UWorld2 Flashcards
(473 cards)
1
Q
What is presentation of open angle glaucoma?
A
- insidious onset, gradual loss of peripheral vision and tunnel vision
high IOP
ophtho exam w/ cupping of optic disc
2
Q
What is presentation of retinal detachment?
A
unilateral sudden curtain falling in front of eye
3
Q
What are some complications of malaria?
A
jaundic, acute renal failure, pulmonar edema
4
Q
What are potentially reversible causes of urinary incontinence?
A
- delirium
- infection
- atrophic urethritis/vaginitis
- pharmaceuticals
- psychological
- excess urine output
- restricted mobility
- stool impaction
5
Q
What is next step if pt w/ squamous cell CA in cervical LN w/ negative CT chest?
A
panendoscopy = esophagus, bronch, laryngoscopy to look for primary tumor
6
Q
What is ppx for HIV exposure?
A
initiate ARB uregntly in first few hours
3 or more drug regimen w/ 2 NRTIs (tenofovir, emtricitabine)
plus integrase inhibitor (raltegravir), protease inhibitor, or NNRTI
for 4 wks
7
Q
What lifestyle meausres to prevent gout?
A
stop alchol
low purine diet
avoid diuretics, pyrazinamide
8
Q
What is presentation of entamoeba histolytica?
A
primary infection: blood diarrhea
liver abscess: RUQ pain, single cyst in R lobe
9
Q
What is tx for entamoeba histolytics?
A
metronidazole
10
Q
What is tx for carbon monoxide poisoning?
A
100% O2 nonrebreather
11
Q
What is presentaiton of CO poisoning?
A
confusion, agitation, somnolence, can have seizure
bright cherry red lips
12
Q
What is level of BHCG and AFP in seminoma?
A
B-HCG elevated
AFP normal
vs non-seminomatous germ cell tumors have both
13
Q
What is tx for goodpasture?
A
emergent plasmaphoresis
14
Q
What is tx for wegeners (granulomatosis w/ polyangiitis)?
A
cyclophosphamide + steroids
15
Q
What is pathophys of goodpasture?
A
anti glomerular basement membrane antibodies
16
Q
What is MCC sudden cardiac arrest immately post-infarction?
A
reentrant ventricular arrhythmia {V fib]
17
Q
What type of abx is used to treat serious gram negatives?
A
aminoglycosides
18
Q
What are complications of ventilation w/ high PEEP?
A
- alveolar damage
- tension pneumo
- hypotension
19
Q
What is presenation of RCC?
A
- flank pain, hematuria, palpable abdominal renal mass
L sided scrotal varicoceles –> fail to empty when recumbent 2/2 tumor obstrcution of gonadal vein
20
Q
What is best test to dx RCC?
A
CT abdomen
21
Q
What meds do you need to hold for 48 hrs prior to cardiac stress test?
A
BBlockers, CCBs, nitrates
22
Q
What are the findings of simple, pre-proliferative, and proliferative diabetic retinopathy?
A
simple: microaneruysm, ehmorrhage, exudate, retinal edema
pre-proliferative: cotton woll spots
porlfieratvie: neovascularization
23
Q
What is presentation of macular degeneration?
A
distorted visiona nd cetnral scotoma
icnraesed risk w/ cigarettes
24
Q
What is tx for diabetic retinomthy?
A
argon laser photocoagulation
25
What is presentation of acute prostatitis?
- fever, chills, malaise, myaglia
pelvic pain, cloudy urine
pyuria
tender prostate
26
What is tx for acute prostatitis?
TMP-SMX or flouroquinolones
27
What plasma K, HCO3 and urine Cl in vomiting?
- low K
- high bicarb
- low urine Cl [vs bartter/gitelman/diruetic = high urine Cl]
28
What things cause hypokalemic metabolic alkalosis w/ high urine Cl?
diuretic abuse
bartter
giltelman
29
What is likely etiology if urine initially w/ hematuria vs urine initially clear then turns red by end of stream vs red the whole time?
initial hematuria = urethral damage
terminal hematuria = bladder or prostate damage
total hematuria = damage in kidney or ureters
30
What is likely etiology of RUQ or epigastric pain w/ N/V/R shoulder pain after fatty meal?
biliary colic 2/2 gallstones
31
What are distinguishing features of fibromyalgia?
- widespread MKS pain in both side
fatigeu when arising from sleep
no lab abnormalities (normal ESR/muscle enzymes)
point tenderness
32
What are distinguishing features of polymyositis?
- symmetric prox muscle weakness
- difficulty climing stairs
elevated muscle enzymes (AST, LDH, aldoalse, CK)
- emg abnormal
33
What are distinguishing features of polymyalgia rheumatica?
```
- age > 50
aching and morning stiffness ? pain
decreased ROM
no significant muscle tenderness
high ESR
```
34
What lab levels in DI?
- decreased ADH
- high serum Na
- dilute urine
35
What lab levels in SIADH?
- urine osm ? serum osm
concentrated urine
excess H2O reabsorption --> hyponatremia
low serum uric acid
36
What vessel, EKG leads in anterior MI?
LAD
| some or all of V1-V6
37
What vessel, EKG leads in inferior MI?
RCA or LCX
| st elevation in II, III, aVF
38
What vesssel, EKG leads in posterior MI?
LCX or RCA
- st depression V1-V3
ST elevation in I, aVL (CX) OR ST depression in I and aVL (RCA)
39
What vessel, EKG leads in RV MI?
RCA
| ST elevation in V$-V6R
40
How do you dx hisoplasmosis?
- cytopenia
- high LDG and ferritin
- high LFTs
- best DX = urine or serum antigen
41
What is tx for histo?
mild to moderate = itrazonazole
| severe or disseminated = amphotericin B
42
What is likely dx if white patch/plaque on oral mucosa that cannot be scraped off?
leukoplakia
43
What is first dx step for back pain w/ some red flags but no sx of cord compression?
plain xray and ESR
44
What is tx for comedonal acne?
topical retinoids
| salicylic, azelaic, or glycolic acid
45
What is tx for inflammatory acne?
mild: topical retinoid + benzoyl peroxide
mod: add topical abx (erythromcyin, clindamycin)
severe: add oral abx
46
What is tx for nodular (cystic) acne?
mod: topical retinoid + benzoyl peroxide, topical abx
severe: add oral abx
unresponsive severe: oral isotretinoid
47
What is presentation of whipples disease?
arthralgias, wt loss, fever, diarrhea, ab pain
| PAS positive material in lamina proprio of small intestine
48
What can you use to diagnose hep B in the symptomatic phase?
HBsAg
| IgM anti-HBc
49
What is classic triad of splenic abscess?
fever, leukocytosis, LUQ ab pain
50
What are risks for splenic abscess?
```
infective endocarditis w/ hematogenous spread
hemoglobinopathy (sickle)
HIV
IVDU
trauma
```
51
In pulm edema what is the A-a gradient, PaCO2, does it correct w/ supplemental O2?
yes corrects
high A-a gradient
normal or high PaCO2
52
What is the tx for comedonal acne?
topical retinoids
53
How do you distinguish cellulitis from erysipelas?
cellulitis = erythema, edema of skin may have streaking, regional lymphadenopathy
erysipelas = limited to epidermis, raised sharp borders and intense erythema
54
What is tx for frostbite?
rewarming with wrm ater
55
What is tx for tinea corporis?
terbinafinecreamor oral griseofulvin for extensive disease
56
What is presentation of epidermal inclusion cyst?
discrete nodule, freely movable,central punctum
57
What is tx for dermatitis herpetiformis?
gluten free diet + dapsone
58
What diseases assocaited w/ seborrheic dermaittis?
HIV, parkinson
59
What is tx for seborrheic dermatitis?
topical intufungal --> ketoconazole selenium sulfide
60
What are senile purpura?
echymoses in older pts in areas exposed to repeat minor trauama
2/2 age related loss of elastic fibers in perivascular connective tissue
61
What is ichthyosis?
dry rough skin w/ horny plates over extensor surfaces of limbs
62
What should you think if hypopigmented lesions w/ fine scale and pruritis?
masassezia = tinea versicolor
tx = selenium sulfide or topical ketoconazole
63
What type of skin lesion presents as non-healing ulcer w/ polygonal cells w/ atypical nuceli at all levels of epidermis and zones of keratinizaiton?
squamous cell carcinoma
64
What should you suspect if pt develops nonhealing painless bleeding ulcer in a chronic scar?
squamous cell carcinoma!
65
What is most likely etiology of asymptomatic non-healing ulcer in lower lip?
squamous cell carcinoma
66
What is tx for non pregnant person w/ syphilis and penicillin allergy?
oral doxycyline
67
What is tx for PVCs?
if asx: nothing
| if sx: BBlockers
68
What is presentaiton of cryoglobulinemia?
```
palpable purpura
glomerulonephritis
arthralgias
HSM
peripheral neuropathy
hypocompletmentemia
```
69
When do you give live vaccines (MMR, varicella, zoster, live flu) in HIV?
as soon as posisble w/ CD4 >200
70
What are recommendations for Tdap in HIV?
Tdap once
repeat for women during each pregnancy
Td every 10 yrs
71
What are recomendations for pneumococal vaccination in HIV?
PCV13 once
| PPSV23 8 wks later then eery 5 yrs
72
What are findings in central retinal vein occlusion?
painless loss of vision
- venous dilation and tortuosity 2/2 venous occlusion
- scattered and diffuse hemorrhages 2/2/ backpup blood and increased resistace
blood and thunder appearance
cotton wool spots
disk swelling
73
What is bakers cyst?
2/2 excess fluid production by inflamed synovium
| occurs in RA, OA
74
What are sx of ADPKD?
- hematuria
- flank pain
- htn
- palpable BL ab masses
- proteinuria
- CKD
75
How do you dx ADPKD?
US (or CT, MRI) of abdomen showing multiple renal cysts
76
What are the main side effects of amiodarone?
- heart block, QT prolongation
- chronic interstitial pneumonitis
- thyroid changes
- high LFTs, hepatitis
- blue gray skin
- peripheral neuropathy
- optic neuropathy
77
What is postop endopthalmitis?
occurs w/in 6 wks of surgery
presnet w/ pain, decreased visual acuity, swollen eyelids and conjunctiva, corneal edema, infection
tx = intravitreal abx injection or vitrectomy
78
What is usualy mech of osteomyelitits in DM?
2/2 contiguous spread from foot ulcer
79
What are best markers for DKA resolution?
serum anion gap
| beta hydroxybutyrate
80
What lab findings in hereditary spherocytosis?
- increased mean corpuscular hemoglobin conc
- negative coombs
- osmotic fragility on acidified glycerol lysis test
- abnormal eosin-5-maleimide binding test
81
What is the pathophysiology of hereditary spherocytosis?
AD mutation in ankyrin gene = abnormal plasma membrane scaffold protieins
82
What disease is 2/2 absent CD55 on RBCs?
paroxysmal nocturnal hemoglobinuria = complement attacks RBCs
83
What is likely dx if pt w/ gnawing epigastric pain at night relieved w/ water and bread?
likely duodenal ucler
| --> over 90% are 2/2/ h pylori
84
What is tx of diabetic gastroparesis?
metoclopramide
erythromycin
cisapirde
85
WHat does high leukocyte alk phos tell you?
leukemoid reaction 2/2 severe infection or inflammation
86
How do you distinguish leukemoid reaction from CML?
leukemoid reaction has high leukocyte alk phos
87
What is ramsay hunt?
- herpes zoster infection of ear 2/ facial nerve palsy and vesicles in audity canal
88
What should you think if pt w/ DM2 presenting with facial droop, ear drainage, and granulation tissue in ear canal?
malignant otitis externa 2/2 pseudomonas
| complicated by osteomyelitis of skull base
89
What is tx for malignant otitis externa?
cipro or other systemic abx that are effective against pseudomonas
90
When do you use IV colloids vs crystalloids?
- crystalloids for dehydration
| - colloids (albumin) for burns or conditions w/ hypoproteinemia
91
What are findings on physical exam w/ lung consolidation?
- bronchial breath sounds = have full expiratory phase
- dullness to percussion
- increased fremitus
- bronchophony
- egophony
- whispered pectoriloquy
92
What is next step in dx BPH after do a rectal exam?
UA = assess for urinary infection and hematuria
| if life expectancy > 10 yrs --> also do PSA
93
What should you think if elderly pt w/ bone pain, renal failure, and hypercalcemia?
MM until proven otherwise
94
What is tx for DKA (including what type of insulin)?
- normal saline
- regular insulin
- K correction
- abx if infected
95
What are side effects of androgen abuse?
men: decreased sperm, gynecomastia
women: acne, hirsutism, voice deepening, menstrual irregularities
CV: LVH, decrease HDL, increased LDL
psych: aggressive
heme: polycythemia
96
How do you distinguish emphysema from chronic bronchitis on PFTs?
emphysema = low DLCO
| chronic bronchitis = normal DLCO
97
What are lab findings in PBC?
elevated IgM
98
What is tx for PBC?
ursodeoxycholic acid
99
What is tx for acute aoritc dissection?
beta blocker = IV labetolol
type A = ascending --> do medical and srugical
type B = descending only --> do medical therapy alone
100
What is tx for endocarditis w/ strep viridans?
IV penicillin G or IV ceftriaxone for 4 weeks
101
What is tx for aspiration pna?
clindamycin or amp-sulbactam for anaerobes
102
What is likely dx if pt syncopizes when emotionally stressed, preceded by lightheadedness, weakness, blurred vision?
vasovagal syncope
| establish dz w/ upright tilt table test
103
What is the abdominal succussion splash?
```
dx gastric outlet obstruction = place stethoscope over upper abdomen and rock patient back and forth at the hips
retained gastric material > 3 hrs after meal will generate slash sound
```
104
What are characteristics of low risk vs high risk pulm nodule?
low = 15 yrs smoking cessation, smooth
high risk = > 2cm, > 60yo, current smoker, quit
105
What happens to CO, PCWP, SVR, BP in hypovolemic shock?
- decreased CO
- decreased PCWP/RAP (preload)
- increased SVR
- decreased BP
106
What happens to CO, PCWP, SVR, BP in cardiogenic shock?
- decreased CO
- increased PCWP
- increased SVR
- decreased BP
107
What happens to CO, PCWP, SVR, BP in septic shock
- increased CO
- normal/decreased PCWP
- decreased SVR
- decreased BP
108
What should you think if pt w/ liver cyst filled with daughter cysts?
hydatid cyst = sign of echinococcus granulosus infection
2/2 infection from sheep / dog
usually liver and lung involved
109
What is presentation, timing, sx of echo, and artery usually involved in RV failure 2/2 MI?
present: hypotension w/ clear lungs, kussmaul sign
echo: hypokinetic RV
timing: acute
RCA
110
What is presentation, timing, sx on echo, and artery usually involved in papillary rupture 2/2 MI?
present: acute, severe pulm edema, new holosystolic murmur
echo: severe MR w/ flail leaflet
timing: acute + w/in 3-5 days
RCA
111
What is presentation, timing, sx on echo, and artery usually involved in IV septum rupture 2/2 MI?
present: shock and CP, new holosystolic murmur, biventricular failure
echo: L to R shunt at ventricle, step up O2 level between RA and RV
acute and w/in 3-5 d
LAD = apical, RCA = basal
112
What is presentation, timing, sx on echo, and artery usually involved in free wall rupture 2/2 MI?
present: shock and CP, JVD, distant heart sounds
echo: pericardial effusion w/ tamponade --> progresses rapidly to PEA
w/in first 5dys - 2 wks
113
What is pathophysiology of paget?
increased bone turnover = increased osteoclast --> bone breakdown and compensatory increased bone formation = mosaic pattern of lamellar bone
114
What is presentation clostridium perfringens diarrhea?
- brief illnes w/ watery diarrhea, cramps, fever
| - associated w/ undercooked or unrefrigerated food
115
What is presentation of salmonella diarrhea?
watery diarrhea w/ fever, ab pain, vomiting
| undercooked eggs + poultry
116
What is presentation of vibrio vulnificus diarrhea?
vomiting, diarrhea, ab pain
w/ hx raw or undercooked shellfish
may have invasive life threatening if liver dz
117
What is presentation of e coli diarrhea?
watery diarrhea, may be bloody if EHEC
| undercooked beef
118
What is atributable risk percent equation?
(RR-1)/RR
119
What are complications of high PEEP in ARDS?
barotrauma, tension pneumo
120
What side effects of thiazide use?
- hyperglycemia, increased LDL/TG, hyperuricemia (gout), hyperCa
- hypoNa, hypoK,
121
What electrolyte changes in ASA tox?
mixed respiratory alkalosis and anion gap met acidosis w/ normal pH
122
What etiology should you think if pt post-BMT w/ resp distress and GI sx and multifocal diffuse patchy infiltrates?
CMV pneumonitis
123
What are side effects of EPO therapy?
worsening of HTN
HA
flu like sx
red cell aplasia
124
What is mech of decreased O2 sat when pt lies on side of lung w/ PNA?
PNA = acts a physiolgoic shunt
V and P are greatest at lung bases
if turn on side with PNA down then V is greatest in area of lung where shunt is = increased shunt
125
What are complications of mono?
autoimmune hemolytic anemia and thrombocytopenia
| splenic rupture
126
What kind of drug causes tendinopathy and tendon rupture?
fluoroquinolones
127
What should you think if pt w/ pain on overhead motion of arm esp internal rotation and forward flexion and no pain at rest?
subacromial bursitis
128
What are rules for colonoscopy in pts w/ UC?
begin colonoscopy 8 yrs after dx, repeat every 1-2 yrs
129
What is presentation of lead poisoning in adult?
GI (ab pain, constipation ,anorexia)
neuro (cog, peripheral neuropathy)
hematologic (anemia)
130
What lab findings suggest lead poison?
- anemia (microcytic)
- elevated serum zinc protoporphyrin
- high cr
131
What is likely etiology of substernal chest pain that radiates to arm/shoulder/jaw, precipitated by exertion?
coronary artery disease = angina
132
What is likely etiology of sharp stabbing chest pain worse w/ inspiration worse when lying flat?
pericarditis
133
What is likely etiology of pleuritic CP w/ resp distress and hypoxia?
PE or pneumothorax
134
What is likely etiology of nocturnal non-exertional substernal CP?
GI/esophagela
135
What is likely etiology of CP that follows repetitive activity?
chest wall or MSK pain
136
What are criteria for HNPCC?
- 3 relateives w/ colon cancer, 1 must be first degree
- 2 or more generationss
- at least 1
137
What statistical test to compare 2x2 table of observed and expected values?
chi square test
138
What statistical test to compare two means?
z test or t test
139
What is contraindication to succinylcholine use?
pts at risk for hyperkalemia (b/c can cause it)
- burn or crush injury > 8 hrs (risk rhabdo)
- demyelinating (guillan barre)
- tumor lysis
140
How can you differentiate from a and B thalassemia?
both with low MCV and target cells
alpha = normal Hgb eletrophoresis
Beta = increased hgb A2
141
What is likely cause of UTI in pt w/ urine pH 8.5?
proteus = secretes urease to alkalinize urine --> form struvite stones
other urease: klebisella, pseudomonas, staph, ureaplasma
142
What is next step for pt w/ subacute cough and postnasal drip after acute illness?
try 1st gen antihistamine for UACS (chlorpheniramine)
143
What is tx for cocaine induced stemi causing STEMI? what should you avoid?
give ASA, nitrates, PTCA or thrombolysis
avoid B blockers (can cause unopposed alpha)
can use CCB and alpha blockers
144
What is pathophys and presentation of pellagra?
```
niacin defiiciency (B3)
- diarrhea, dermatitis, dementia
```
145
What should you think if pt prsents w/ malar rash that increases w/ sunlight, ab tenderness, and watery diarrhea, depression, and difficulty remembering?
pellagra = 3 Ds
146
What is presentation of acute intermittent porphyria?
episodic ab pain, N, V, diarrhea, sweating, agitation/anxiety, confusion
no photosensitivity
147
What is next step if pt w/ suspected avascular necrosis of hip w/ normal radiograph?
do MRI to dx
148
at what levels of sx should you add daily ICS for asthma control?
- sx > 2x wk
- 3-4 nighttime awakenings/mo
- use beta agonist > 2 x wk
149
What should you think if pt w/ flattened top and bottom of flow volume loop?
fixed upper airway obstruction like larygneal edema 2/2/ food allergy
150
What are findings in anabolic steroid abuse?
- low LH/FSH
- normal T
- acne, gynecomastia, decreased testicle size, aggressive, psychotic
- erythrocytosis, cholestasis, hepatic failure, dyslipidemia, slightly elevated creatinine
151
What are clinical sx of arteriovenous fistula?
- decreased SVR
- increased preload
- increased CO
- widened pulse P, strong peripheral arterial pulse (brisk carotid upstroke), systolic flow murmur, flushed extremities
152
What is post void residual volume in BPH?
> 50mL
153
What is likely cause of older man w/ significant lower GI hemorrhage?
diverticulosis = painless
154
What is equation for calcium correction?
corrected Ca = measured + 0.8 (4 - albumin)
155
What should you think if pt presents w/ fever, HA, myaglias, neuro sx, leukopenia, and thrombocytopenia after tick bite?
human monocytic ehrlichiosis
tx = doxy while waiting confirmation test
156
What is presenation of ehrlichiosis
```
tick borne (lone star) in SE and central US
flu like illness w/ confusion, luekopenia, thrombocytopenia, elevated LFTs, LDH
```
dx: intracytoplasmic morulae in monocytes, PCR for ehrlichiosis
tx = doxy
157
What is tx for uremic pericarditis?
hemodyalisis
158
How do you distinguish gonococcal from reactive arthritis?
reactive: urethritis, conjunctivitis, mucocutaneous lesions, asymmetric
gonococcal: fever, gram stain/culture
159
What should you think if pt w/ chondorcalcinosis?
hemachromatosis
160
What are earliest changes in diabetic nephropathy?
glomerular hyperfiltration = first change
ACEi decreased intraglomerular hypertension
thickening of BM is first change that can be quantified
161
What should you think if pt w/ dully tympanic membrance that is hypomobile?
serous otitis media = middle ear effusion, have conductive hearing losss
162
What is mech of presbyopia w/ age?
decreased lens elasticity leads to difficulty w/ near vision
163
What are major causes of morbidity and mortality in pts w/ PAD?
MI /CVA
164
What should you think if immune compromised pt presents w/ pulmonary nodules w/ halo sign?
invasive aspergillosis
165
What shoudl you think if pt w/ contact lens + painful R eye and opacification and ulceration of cornea?
contact lens asscoaited infectious keratisis = medical emergency
usually 2/2 gram negative
166
What type of heart med has use dependence w/ increased QRS with higher HR?
class 1C antiarrhythmics = flecainide and propafenone
167
What two types of cardiac drugs have use dependence?
```
CCBs (increased PR w/ high HR)
Class 1C (flecainide) (increased QRS w/ increased HR)
```
168
What happens to RAAS in CHF?
activation of RAAS and increased ADH
- vasoconstriction of afferent and efferent glomerular arterioles --> inceased vascular resistance and net decrease in RBF
- peripheral vasoconstriction of efferent renal arterioles --> increased intraglomerular pressure
- decreased Na delivery to distal tubule
169
What is 1st line therapy for stable chronic angina?
beta blocker --> improves exercise tolerance, improves survival in those w/ MI
add CCB if angina persists
170
How do you dx SBP?
- temp > 100
- Asictes w/ PMN > 250 + positive culture
- SAAG (serum albumin - ascites albumin) > =1.1 = portal htn as the cause
- ascites protein 50
171
What is tx for SBP?
3rd gen ceph
172
What should you do if pt presents w/ sudden eye pain, HA, nausea, conjunctival erythema, mid dilated pupil?
do gonioscopy or ocular tonometry = concern for acute angle glaucoma
173
What is acalculous cholecysitis?
acute inflammation of gallbladder in absence of gallstones
| - occurs in hospitalized pts w/ etxtensive burns, trauma, TPN, prolonged fasting, mechanical ventilation
174
What are indications for long term O2 in COPD?
PaO2 55% if PaO2
175
What types of polyps are most likely to be malignant?
villous adenoma, sessile adenoma, and size > 2.5cm
176
What is likely location of hemorrhage if pt w/ contralaterla hemiparesis and hemisensory loss, homonymous hemianopsia, and gaze palsy?
basal ganglia
177
What is likely location of hemorrhage if pts w/ no hemiparesis but w/ facial weakness, ataxia, nystagmus, occiptal HA, neck stiff?
cerebellum
178
What is likely location of hemorrhage if pt w/ contralateral hemiparesis and hemisensory loss, nonreactive miotic pupils, upgaze palsy, eyes deviate toward hemiparesis?
thalamus
179
What is likely location of hemorrhage if pt w/ contralateral hemiparesis, contralateral hemisensory loss, homonymous hemianopsia, eyes away from hemiparesis?
cerebral lobe
hemiparesis = frontal
hemisensory = parietal
homonymous hemianopsia = occipital
180
What is likely location of hemorrhage if pt w/ deep coma, total paralysis w/in minutes, pinpoint reactive pupils?
pons
181
What is common location of intracranial hemorrhage in hypertension?
basal ganglia, cerebellum, tahlamus, pons
182
What are complications of SAH? which occur within 24 hrs vs a few days later?
- rebleed in first 24 hrs
- vasospasm after 3 days
- seziure, hydrocephalus, hyponatremia
183
What is tx to prevent vasospasm in CAH?
nimodipine
184
What is tx for myasthenia gravis crisis?
plasmapharesis or IVIG
PLUS steroids
185
What is presentation of central cord syndrome?
occurs in hyperesxtension in juries
| weakness more pronounced in UE than LE may be accompanied by localized deficit in pain and temp sensation
186
What is presenation of neurofibromatosis type 2?
subcuteanous fibromas
hyperpigmented cafe au lait spots
deafness 2/2/ acoustic B/L neuromas
187
What are characteristics of thrombotic stroke?
hx of atherosclerotic risk factors
local in situ artery obstruction
sx fluctuate = stuttering progression w/ periods of impovements
188
What are characteristics of embolic stroke?
hx of cardiac dz
| onset of sx is abrupt and maximal at the start
189
What are characteristics of intracerebral hemorrhage?
uncontrolled htn, coagulopathy, illicit drug use
| sx progress over min to hr
190
What cadn primidone precipitate?
can precipiate aucte intermitten porphyria = ab pain, neur and psych sx
191
what should oyu think if pt w/ unilateral HA w/ N/V, eye pain w/ conjunctival injection and dilated pupil w/ poor response to light?
acute angle clousre glaucoma
192
What is location and presentation of broca aphasia?
- sparse nonfluent speech
- preserved comprehension
- impaired repetition
- R heiparesis
- dominant frontal lobe
193
What is location and presentation of wernick aphasia?
- fluent and volumincous lacks meaning
- diminished comprehension
- impaired repetition
- R superior visual field defect
- dominant temporal lobe
194
What is location and presentation of conduction aphasia?
- fluent w/ phonemic errors
- relatively preserved comprehension
- very poor repetition
195
What is the etiology of a pt w/ staggering, wide based gait, w/ dysdiachokinesia, + romberg?
cerebellar
- degen
- stroke
- drug/alc
- B12 eficiency
196
What is etiology of gait w/ start and turn hesitation?
gait apraxia = frontal gait
| can be 2/2/ frontal lobe degen or NPH
197
What is etiology of gait w/ foot drop, excess hip and knee flexion, slapping quality?
2/2 distal sensory loss and wekaness from common peroneal motor neuropathy
L5 radiculopathy = common
198
What are criteria for TPA in stroke?
```
- sx onset w/in 3-4.5 hrs
contraindications:
- hemorrhage r multilobar infarct of > 33% of cerebral hemisphere
- trauam in past 3 mo
- hx of hemorrhage or neoplasm
- recent incracranial or psinal surgery
- acitve bleed in past 7 days
BP > 185/110
- plt 1.7, PT > 15 or high aPTT
```
199
What are complications of pseudotumor cerebri?
blindness
| should do shunting or optic nerve sheath fenestration to rprevent blindness
200
What blood vessel and location involved in wallenberg syndrome?
lateral medulla
| incracranial vertebral artery
201
What are sx of wallenberg (lateral medullary)?
vestibulocerebellar: vertigo, falls to side of lesion, diplopia and nysgagmus
- loss of pain and temp ipsi face and contra body
- dysphagi, dysarthria, hoarseness
- ipsilateral horners
202
What is presentation of medial medullary syndrome? what blood vessel
contralateral hemiparesis
contralateral loss of vibration/position
ipsilateral tongue paralysis w/ deviation to side of lesion
due to occlusion of vertebral or anterior spinal artery
203
What is presentation of medial mid pons infarct?
contralateral ataxia and hemiparesis of face, trunk, limbs (ataxic hemiparesis)
loss of contralateral tactile and position sense
204
What is presentation of lateral pons lesions?
weak muscles of mastication, diminished jaw jerk, imparied tactile and psotion sese over face
205
What is first line tx for idiopathic intracranial hypertension?
acetazoloamide (inhibits carbonic anhydrase --> decrease csh production)
add furosemide if continued sx
206
What is tx for pt w/ stroke on no tx?
give asa
207
What is tx for pt on stroke already on ASA?
ASA + dipyridamole or clopidogrl
208
What is tx for pt on stroke on asa if pt also w/ intracranial large artery atherosclerosis?
ASA + clopidogrel
209
How do you dx parkinson?
2 of 3 cardinal signs: rest tremor, rigidity, bradykinesia
210
What is presentation of corneal abrasion?
severe eye pain 2/2 trigeminal nerve sensory innervatio (unless trigeminal nerve dysfunction then have anesthesia)
photohobia w/ reluctance to open eye
flouorescein eam shows corneal staining deficit
211
What is tx for acute dystonic reaction?
benztropine or diphenhydramine
212
What is tx for akathisia 2/2 antipsychotic?
benzo (lorazepam)
213
What location of stroke causes severe dysethesia and sensory loss?
thalamic stroke
214
What is tx for solitary brain met? vs multiple mets?
surgical resection of mass if good performance status and stable extracranial disease
for multiple = do whole brain radiation
215
What location of brain responsible for hemi-neglect syndrome?
non-dominant parietal lobe
216
What is likely dx if pt is awoken from sleep w/ acute severe retroorbital pain and ptosis and miosis w/o blurry vision?
cluster HA
ppx = verapamil, lithiu, ergotamine
tx for acute = 100% O2 and subq sumatriptan
217
What is presentation of posterior lim of internal capsule lesion (lacunar infarct)?
U/L motor impairment
| no visual field deformities or sensory/cortical deficits
218
What is presentation of anterior cerebral artery occlusion?
contralateral somatosensory and motor deficit, predominantly lower extremity
abulia (lack of will)
dyspraxia, emotional disturbance, urinary incontinence
219
What is presentation of MCA occlusion?
contra somatosensory and motor deficit (face, arm, leg)
conjugate eye deviation toward side of infarct
homonymous hemianopia
aphasia (dominant)
hemineglect (nondominant)
220
What is presentation, tx for carbon monoxide poisoning?
present: smoke inhalation, HA, N, pink red skin
dx by high carboxyhemoglobin level
tx: hyperbaric O2
221
When is carotid sinus massage useful?
in paroxysmal SVT = regular narrow complex tachycardia
222
What is dacrocystitis?
infection of lacrimal sac
occurs in infants and adults > 40
sudden pain and redness in medial canthal region, purulent discharge
use systemic abx for staph aureus or B hemolytic strep
223
What is episcleritis?
infection of tissue between conjunctiva and sclera
acute onset midld to mod discomfort, photophobia, watery discharge
diffuse or localized bulbar cojunctival injetion
224
What is chalazion?
chronic granulomatous inflammation of gland above eyelid = hard painless lid nodule
225
What is presentation of orbital cellulitis?
infeciton posterior to orbital septum = abrupt fever, proptosis, restriction EOM, swollen red eyelids
226
What is next step if pt presents w/ concern for foreign body in eye?
pen light exam, if no abrasian --> do fluorescein exam
227
How can you tell difference between neurogenic and vascular claudication?
neurogenic = posture dependent, worse w/ lumbar extension (walking down), better w/ flexion (walking while bent fwd), low back pain, normal pulses
vascular: externioally dependent, decreased pulses, cool extremities, dx by ABI
228
What is likely dx if pt w/ cystic hepatic lesion w/ eggshell calcification?
echinococcus = hydatid cyst
229
What is tx for pt w/ SIADH and confusion/lethargy?
hypertonic saline in first 3-4 hrs to increase Na > 120
| then gluid restriction
230
What should you think if diabetic pt presents w/ necrotic nasal turbinate w/ fever, face pain, and hyphae? tx?
mucormycosis 2/2/ rhizopus
| aggressive surical debridement + IV emphotericin B
231
What is best test to dx and evaluate pt w/ acute diverticulitis?
CT scan
232
How can you differentiate between waldenstrom macroglobulinemia and MM?
waldenstrom: IgM, hyperviscosity (ex. retinal vein engorgement), pain and numbness in extremities, bruise/bleed easily, splenomegaly
MM: IGG or IgA, hyperCa, high creatinine, anemia, bone pain
233
What is tennis elbow?
lateral epicondylitis = pain w/ supination or extension of wrist and point tenderness distal to lat epicondyle
234
What is presentation of inferior MI? what extra tx?
hypotension, JVD, clear lung fields
give IVF to increase preload, avoid nitrates and diuretics
235
What is tx for stable torsades? unstable?
```
stable = iv mag
unstable = immediate defibrillation
```
236
What are the two types of HIT?
type 1 = nonimmune mediated
- more common, 1-4 days after heparin, plt > 100K
- tx = continue heparin
type 2 = immune mediated
- less common, 5-10 days after hep, plt > 20K, increased risk of thrombosis
- tx = stop heparin, use alternate anticoagulan
237
What is nonallergic rhinitis?
- nasal congestion w/ rhinorrea, sneezing, postnasal drainage, no obvious allergi trigger, erythematous nasal mucosa
- tx for mild = intranasal antihistamine or glucocorticoids
- for mod to severe = combo therapy
238
What type of nephrotic syndrome assocaited w/ heroin and HIV?
FSGS
239
What findings in cholesterol crystal embolism 2/2 angiography/catheterization?
- livedo reticularis, blue toe syndrome
- kidney injury
- hollenhorst palques
- eosinophilia, high cr, low complement
- eos in urine
240
What kind of hearing loss 2/2 aminoglycosides?
sensorineural = air conduction > bone in both ears, weber lateralizes to unaffected ear
241
What are weber and rinne findings in pt w/ otosclerosis?
conductive hearing loss
- bone > air in affected, air > bone in unaffected
- lateralized to affected ear
242
What should you do to prevent complications of diverticulosis?
increase intake fruit and fiber, decrease ASA, smoking NSAID use
chronic constipation is responsible for diverticulosis
243
What type of stone is cystine stone?
hard
radioopaque
hexagonal
244
What test for cystinuria?
urinary cyanide nitroprusside
245
What is presentation of vit D excess?
ab pain, constipation , polydipsia 2/2 hypercalcemia
246
How can you differentiate between herpest opthalmicus vs herpes keratitis?
herpes opthalmicus = 2/2 zoster, in elderly, w/ fever malaise and burning/itching in periorbital region, vesicular rash in V1 division
herpes keratitis = corneal vesicles and dendritic ulcers
247
What are clinical sx of polycythemia vera?
```
hypertension 2/2/ increased volume
peptic ulcers 2/2 histamine release from basophils
gout 2/2 increased cell turnover
plethoric face
splenomegaly
```
248
What is most common preventable risk factor for kidney stones?
hydration
249
What types of kidney stones are radio-opaque (visible on ab radiograph)?
calcium stones
| struvite stones
250
What are examples of some meds that cause hyperkalemia?
- B blockers
- ACEi
- ARBs
- K sparing diuretics (spironolactone, amiloride)
- digozin
- NSAIDs
251
What is pathophysiology of mallory weiss tera?
increased intragastric pressure during vomiting causes tears in mucosa of distal esophagus and proximal stomach
252
What is most likely dx in pt w/ adrenal insufficiency and calcifications in the adrenal glands B/L?
adrenal TB = prominent cause of adrenal insufficiency in developing countries
253
What is presentation of scleroderma renal crisis?
```
acute renal failure
malignant htn (HA, vision, nausea)
urinalysis w/ proteinuria
MAHA w/ schistocytes
thrombocytopenia
```
254
When do you see burr cells (echinocytes) on smear?
spiculated RBCs
| in liver dz and ESRD
255
When do you see howell jolly bodies on smear?
basophilic dark bellets in RBCs
| in pts w/ splenectomy or functional asplenia
256
When do you see spur cells (acanthocytes) on smear?
liver disease
257
When do you see target RBCs?
thalassemia or chronic liver (espectially obstructive) dz
258
What characteristics suggest ascites is 2/2 portal hypertension?
SAAG >1.1 = serum albumin - ascites albumin
total protein
259
What is presentation of patellofemoral syndrome?
young female athlete
subacute to chronic pain worse w/ squatting, running, prolonged sitting
test = patellofemoral compression test = extend knee while compressing patella
260
What is presentation of patellar tendonitis?
athletes
| episodic pain and tenderness at inferior patella
261
What is presentation of osgood schlatter?
pre-adolescent athlete w/ recent growth spurt
increased pain w/ sports, relieved by rest
tender and swelling at tibial tubercle
262
What do testosterone and DHEAS tell you about excess androgen production?
high T w/ normal DHEAS = ovarian source
| high DHEAS w/ normalish T = adrenal source
263
What is immediate tx for hyperthryoidism until underlying cause is identified?
propanolol
264
What should you think if pt w/ resistant htn?
secondary cause:
- renovascular dz
- renal parenchymal dz
- aldosteronism
- pheo
- cushing
265
What should you look for in renovascular hypertension?
- cr elevated > 30% from baseline after ACE/ARB
- recurrent flash pulm edema
- diffuse atherosclerosis
- htn onset after 55yo
- asymmteric kidney size
- abdominal bruit
266
What is mech and side effects of selegiline?
MAO B inhibitor
| - insomnia, confusion
267
What is mech and side effects of entacapone/ tolcapone?
COMT inhibitor
| - dyskinesia, hallucinations, confusion, nausea, orthostasis
268
What is mech and side effects of bromocription, pramipexole, ropinirole?
dopamine agonist
- somnolence, hypotension, confusion
- hallucinations
269
What are side effects of amantadine?
ankle edema
| livedo reticcularis
270
What does pronator drift suggest?
sensitive/specific for UMN lesion
271
How can you differentiate cauda equina syndrome from conus medullaris syndrome?
cauda equina = b/l, severe radicular pain, saddle hypo/anesthesia, asymmetric motor weakness, hyporeflexia/arreflexia, late onset bowel and bladder
conus medullaris: sudden onset severe back pain, perianal hypo/anesthesia, symmetric motor weakness, hyperreflexia, early onset bowl and bladder
272
What is most common site of ulnar nerve compraession?
at elbow medial epicondyle groove
273
What is best test to dx acoustin neuromas?
gadolinium enhanced MRI
274
What is the location and presentation of pure motor hemiparesis?
posterior internal capsule
u/l motor face, arm, lesser extent leg, mild dysarthria, no sensory visual or higher cortical function
275
What is location and presentation of pure sensory stroke
thalamus
unilateral numb, parastehsia, hemisensory deficit of face, arm, trunk, leg
276
What is location and presentation of ataxic hemiparesis
anterior internal capsule
weakness in lower extremity and ipsilateral arm and leg incoordination
277
What is location and presentation of dysarthria-clumsy hand syndrome?
lacunar - basis pontis
head weak, mild motor aphasia, no sensory changes
278
What is presentation of diabetic CN III neuropathy
ischemic nerve damage
only somatic nerve affected
parasympathetic reatins fnction
ptosis + down and out gaze w/ normal light and accomodation
279
What is the path of pain/temp tracts?
lateral spinothalamic
| have loss of pain and temp beginning contralateral two levels below level of lesion
280
What is major side effect of metoclopramide?
EPS = tardive dyskinesia, dystonic reactions, parkinsonism
281
What is pathophys of NPH?
decreased CSF absorption
282
Which type of abx causes ototoxicity?
aminoglycosides (esp gentamicin)
283
What is tx for restless leg syndrome?
mild/intermittent: supplement Fe if
284
What is the biggest risk factor for stroke?
hypertension
285
What is major complication of status epilepticus?
permanent injury 2/2/ excitatory cy
286
What is presentation of glucocorticoid induced myopathy
proximal muscle weakness and atrophy w/o pain
LE >UE
normal ESR, normal CK
287
What is presentation of polymyalgia rheumatica? ESR and CK?
muscle pain and stiffness in shoulder and pelvic girdle
decreased ROM shoulder/neck/hip
respond to steroid
high ESR, normal CK
288
What is presentation of inflammatory myopathy? ESR and CK?
muscle pain, tener, prox muscle weakness
+/- skin rash and inflammatory arthrtis
high ESR, high CK
289
What is presentation of statin induced myopathy? ESR and CK?
prominent muscle pain/tenderness +/- weakness
rare rhabdo
normal ESR, high CK
290
What is presentation of hypothyroid myopathy? ESR and CK?
muscle pain, cramps, weakness of prox muscles
delayed tendon reflex
normal ESR, high CK
291
What vaccines should a patient receive who just had splenectomy? and when?
either 14 days before or after splenectomy should get:
- PCV13 [then will get PPSV23 wks later]
- meningococcus
- HIB
292
What are clinical criteria to dx toxic megacolon?
radiographic evidence of colonic distension PLUS at least 3 of:
- fever > 38, HR > 120, PMNs > 10,5000, anemia
plus one of:
- volume depletion
- electrolyte changes
- hypotension
- altered sensorium
293
What are side effects of hydroxychloroquine?
retinopathy --> do eye exam every 6 mo
294
What type of liver nodule will have hx w/ sinusoids and kupffer cells?
fibral nodular hyperplasia
295
What type of liver nodule will have atypical hepatocytes w/ glycogen and lipids?
hepatic adenoma
296
What is presentation / risk factors for hepatic adenoma?
usually R hepatic lobe
in younger women w/ hx OCPs
complications = intra-tumor hemorrhage and malignant transformation
297
What is the effect of estrogen on levothyroxine?
increases TBG concentration --> has no effect in pt w/ normal thyroid but for pt w/ hypothyroid will increase drug dose requirement
298
What is a varicocele? presentation?
dilation of pampiniform plexus
- bag of worms, smaller in supine, bigger w/ standing/valsalva
US: retrograde venous flow
299
What is tx for varicocele?
gonadal vein ligation in boy/young men w/ testicular atrophy
scrotal support and NSAIDs in older men who do not desire more children
300
What is the pathophys/presentation of small intenstine bacterial overgrowth?
2/2/ anatomical abnormalities, motility d/o (DM, scleroderma), other causes
sx: ab pain, diarrhea, bloating, excess flatulence, malabsorption, wt loss, anemia
dx: endoscopy, hydrogen breath test
301
What is tx for small intestine bacterial overgrowth?
7-10 d abx (rifaximin, amox-clavulanate)
avid anti-motility drugs
diet changes
trial pro-motility agents
302
What is tx for asperiglloma? invasive aspergillosis?
```
aspergilloma = surgical resect
invasive = voriconazole or capsofungin
```
303
What is tx for pagets?
bisphosphonates
304
What are clinical features of VIPoma?
```
watery diahreah
- low Cl
flushing, lethargy, N/V, muscle weak
hypokalemia
hypercalcemia
hyperglycemia
```
305
What is tx for cardiogenic shock 2/2 RV MI?
daul antiplatelet, statins, anticoagulation , uregent revascularization
+ high flow IVF b/c very preload dependent
avoid nitrates, diuretics, opioids
306
What should you think if pt w/ MI, hypotension, distended jugular veins and clear lung fields?
RVMI
307
What should you think if pt w/ central scotoma, afferent pupil defect, change in color perception, decreased visual acuity?
optic neuritis
308
What underlying conditions associated w/ erythema nodosum (painful subQ pretibial nodules)?
sarcoid, TB, histo, recent strep, IBD
309
What is likely dx if electrical alternanas and sinus tach?
pericardial effusion
if hemodynamically unstable --> do emergency pericardiocentesis
if stable --> do echo to confirm
310
What is tx for acute angle closure glaucoma? what should you avoid?
tx = mannitol, acetazolamide, pilocarpine, or timilol to decrease IOP
avoid atropine = dilated pupil and worsens
311
What is tx for cholelithiasis 2/2 4Fs?
surgery = cholecystectomy
if poor surgical candidate or refuse --> ursodeoxycholic acid + avoid fatty foods
312
What are recommendations for meningococcal vaccine and booster?
- primary age 11-12 (or 13-18 if not previosuly vaccinated)
- if havent received can get it at 19-21 if high risk, in college
if received before 16 yo, get booster between 16-21
313
WHat other findings associated w/ dermatomyositis?
associated w/ internal malignancy --> ovarian, lung, pancreatic, stomac, CLC, lymphoma
314
What imaging test to dx rotator cuff tear?
MRI
315
What is tx if pt w/ MI has pulm edema?
IV furosemide (as long as not hypotensive or hypovolemic)
316
What is tx if pt w/ MI has persistent pain, hypertension, or HF?
IV nitroglycerin (unless hypotensive, RV infarct, or severe AS)
317
What is tx if pt w/ MI has persistent severe pain?
IV morphine
318
What is tx if pt w/ MI has unstable sinus bradycardia?
IV atropine
319
WHat is tx for pt w/ high homocysteine?
give B6 (pyridoxine) --> acts as cofactor for cystathionine B synthase to metabolize homocysteine into cystathionine
320
What is pathophysiology of neurocysticercosis?
consumption of T solium eggs from human feces (not from eating pork)
321
What are features of constrictive pericarditis?
fatigue/DOE, peripheral edema and ascites, high JVP, pericardial knowck, pulsus paradoxus, kussmaul sign
ekg low voltage or w/ AFib
pericardial thickening or calcification
prominent x and y descents on JVP
322
What are common etiologies of constrictive pericarditis?
in africa/india/china MCC = TB
| in US mcc = idiopathic or viral > radiation > heart surgery
323
How can you distinguish viral URI from influenza?
viral URI: slow stepwise migratory or evolving sx, rhinorrhea, coryza, sneeze, pharyngitis, mild systemic sx, nasal edema w/ normal or erythematous pharynx
flu: abrupt and dramatic, mild UR sx, prominent systemic sx, variable exam
324
What are recommendations for palying sports in pt w/ mono?
refrain from sports for at least 3 wks until sx resolve
325
What eye finding likely in pt w/ axillary freckling and cafe au lait spots?
NF type 1
| can have optic glioma = progressive U/L vision loss and exopthalmos
326
What is likely dx if diarrhea w/ p-ANCA?
ulcerative colitis
327
What is next step if pt w/ DVT and bleeding on enoxaparin?
stop enoxaparin, do IVC failure
328
What are indications for IVC failure in DVT?
failure of anticoagulation or recurrence of DVT/PE
329
What should you think if pt w/ syncope and crescendo-decrescendo systolic murmur along LSB w/o carotid radiation?
HOCM
330
What is tx for legionella?
macrolide or FQ
331
What are likely aldo, cortisol, ACTH levels in pt w/ adrenal insufficiency 2/2 chronic glucocorticoid therapy?
decrease ACTH, cortisol
| normal aldo
332
What is presentation of MAC?
nonspecific (fever, cough, diarrhea, wt loss)
splenomegaly
high alk phos
333
Who is at risk for mac? what is ppx?
CD4
334
What is mech of nitroglycerin decreasing pain in cardiovascular dz?
dilated veins = capacitance vessels --> get venous pooling and decreased preload and those decreased work of heart
335
What are possible clinical presentations of amyloidosis?
```
- proteinuria or nephrotic syndrome
restrictive cardiomyopathy
hepatomegaly
peripheral neuropathy
visible organ enlargement
bleeding diasthesis
```
336
How do you dx amyloidosis?
abdominal fat bad biopsy
337
What are other findings in aortic regurg besides early diastolic murmur?
hyperdynamic pulse = bounding
338
What valve defect is associated w/ pulsus parvus and tardus?
aortic stenosis
339
What are findings of analgesic nephropathy?
2/2 long term use of ASA or ibuprofen
high cr w/ hematuria or sterile pyruia
mild proteinuria
340
What disease is characterized by bile duct loss?
primary biliary cirrhosis
341
What can you do to prevent uric acid stones?
hydrate
alkalinize urine --> give K citrate
low purine diet
342
What is pathophys of CML?
fusion 9;22 --> BCR-ABL = philadelphia chrmosomes so have high tyrosine kinase activity
343
How can you tell difference between leukemia and leukemoid reaction?
low leukocyte alk phos in leukemia vs normal or high in leukemoid reaction
344
How can you tell difference between polycythemia vera and CML?
polycythemia vera has high leuk alkaline phosphatase
345
What is presentation of osler weber rendu syndrome?
hereditary telangiectasias = AVMs in mucous membranes, skin, GI tract,
---> diffuse telangiectasia, recurrent epistaxis, widespread AV malformations
346
What should you think if patient w/ decreased peripheral vision and cupping of optic disc?
primary open angle glaucoma
347
What is tx for small nonbleeding varices?
prophylaxtic BB (propanolol, nadolol) to reduce progression to large varices
348
When is staph aureus likely cause of endocarditis?
prosthetic valve
IV catheter
implanted device
IVDU
349
When is strep viridans likely cause of endocarditis?
- dental procedure
350
When is coag neg staph likely cause of endocarditis?
IV cath
prosthetic valve
pacemaker
351
When is enterococcus likely cause of endocarditis?
nosocomial UTI
352
What is next step if pt presents w/ minimal BRBPR
| - if 50 or red flags?
anoscopy
40-49 --> sigmoid or colonoscopy
> 50 or red flags --> colonoscopy
353
What is tx for raynauds?
CCBs
354
How can you differentiate primary from secondary ryanaud?
```
primary = younger, F, symmetric
secondary = > 40, can be M, asymmetric, feat of tissue ischemia (ulcers) , sys dz
```
355
What is workup for pt w/ suspected secondary raynaud?
CBC and CMP
urinalysis
ANA and RF
ESR and complement levels
356
What is tx for HBV?
tenofovir = drug of choice
interferon = for younger w/ compensated liver disease
lamivudine = in HIV +
entecavir = in decompensated cirrhosis
357
Who should you treat in EBV?
pts w/:
- acute liver failure
- clinical complications of cirrhosis
- advanced cirrhosis w/ high HBV DNA
- w/o cirrhosis but pos HBeAg, HBV DNA > 20K
358
What is tx for cellulitis w/ sys signs? w/o sys?
IV nafcillin or cefazolin
w/o sys: oral dicloxacillin
359
What shoul you think if pt w/ recurrent PNA in same location of lung?
local anatomic obstruction from bronchiectasis, neoplasm, etc
or recurrent aspiration
360
What is a potential long term complications of B12 deficiency?
gastric cancer risk increased in pernicious anemia
361
What is presentations of chronic pancreatitis?
chronic epigastric pain w/ intermittent pain free intervals
malabsorption (steatorrhea, wt loss)
DM
dx by calcifications of CT
362
What is tx for lyme in pregnancy?
amoxicillin
363
What is tx for acute kidney transplant rejection?
IV steroids
364
What is presentation of chikungunya?
aedes mosquito
3-7 day incubation
high fever, polyarthralgias, HA, myalgias, conjunctivitis, maculopapular rash, lymphopenia, thrombocytopenia, elevated LFTs
365
When do you use cyclophosphamide in SLE? what are side effects?
only if pt w/ significant renal or CNS problems
side effects: acute hemorrhagic cystitis, bladder CA, sterility, myelosepression
prevent by giving MESNA
366
What is most common cause of epididymitis?
in younger pt = G/C
| in older = gram neg rods
367
What should you think if pt w/ low D-xylose absorption? what should cahnge after rifamixin?
if no change w/ rifamixin = celiac = absorption problem
if improves w/ rifamixin = SIBO
368
What is reason for refractory hypo-K in pt w/ chronic alcoholism?
hypomagnesemia
| need to correct Mg to correct K
369
What is tx for HOCM?
B Blocker or cardiac acting CCB (diltiazem)
370
What does pressure at held inspiration measure?
plateau pressure = when pulm airflow and resistance = 0
so plateau P = elastic P + PEEP = compliance
371
What happens to cardiac index, SVR, and LVEDV in CHF 2/2 LV systolic dysfucntion?
- decreased CI/CO
- increased SVR
- increased LVEDV
372
What are common manifestations of paroxysmal noctural hemoglobinuria?
in 40s present w/
- hemolysis
- cytopenias
- hypercoaglable
373
What should you think if pt w/ macular rash, vomiting, mucous membrane hyperemia, low platelets
toxic shock syndrome
374
What is first line tx for PCOS?
wt loss and combing E/P contraceptives
375
What is febrile nonhemolytic tranfusion reaction?
MC adverse rxn w/in 1-6 hrs of transfusion
pt w/ fever, chills, malaise, w/o hemolysis
prevent w/ leukoreduction of donor RBCs
376
What lab values can you see in cryoglobulinemia?
low complement
high RF
increasesed LFTs
serum cryoglobulins
377
What drugs are knwon to have ototoxicity?
aminoglycosides
chemo drugs
Asa
loop diuretics
378
What is felty syndrome?
severe long standing RA . 10 yrs + neutropenia + splenomegaly
379
What should you think if pt w/ RA develops painful mouth ulcers?
likely 2/2 methotrexate side effect
380
What is mech, adverse effects of mtx?
mech: purine antimetabolite
SE: hepatotoxicity, stomatitis, cytopenias
381
What is mech, adverse effects of leflunomide?
mech: pyrimidine synthesis inhibitor
SE: hepatotoxitiy, cytopenias
382
What is mech, adverse effects of hydroxychloroquine?
mech: TNF + IL1 suppressor
SE: retinopathy
383
What is mech, adverse effects of sulfasalazine?
mech: TNF + IL1 suppressor
SE: hepatotoxicity, stomatitis, hemolytic anemia
384
What are names of TNF inhibitors? side effects?
ex: adalimumab, etanercept, infliximab
SE: infection, demyelination, CHF, malignancy
385
What is tx for acute limb ischemia?
start IV heparin
| tx = surgical embolectomy or intra-arterial fibrinolysis
386
What are common side effects of dihydropyridine CCBs (ex. amlodipine)?
peripheral edema
387
How do you dz toxic megacolon?
ab xry and
| 3 of: fever > 100.4, HR > 120, WBC > 10.5, aenmia
388
What is tx for toxic megacolon?
IV steroid, nasogastric decompression, abx, fluid managment
if doesnt resolve --> emergency surgery
389
What are sx of dig toxicity?
anorexia, nausea, vomiting, ab pain
| color vision alterations, fatigue/confusion/weakness
390
What precipitates dig toxicity?
amiodarone/verpamil/quinidine/propafenone increase levels of dig --> should decrease dose by 25-50% when start one of them
391
What is presentation of mesenteric ischemia?
severe perimbilical ab pain out of proportion of findings on ab exam
392
How can you differentiate between BPH and prostate CA?
BPH: central portion (transitional zone) hypertrophied, symmetrically enlarged, smooth
prostate ca: lateral lobes, asymmetric enlargement, nodules, firm
393
What is tx for BPH?
alpha 1 blockers (tamsulosin, doxazosin )
or
5 alpha reductase inhibitors (finasteride)
or both
394
What do you see on bx w/ PSC?
fibrous obliteration of small bile ducts intra and extrahepatic
concentric replacement by connective tissue in onion skin pattern
395
How do you dz PSC?
cholangiogram (ERCP/MRCP)
396
What is next step if pt presents w/ sx of adrenal insufficiency?
do cosyntropin stim test
397
What should you think if pt w/ vomiting during intubation that requires suctioning and a few hours later w/ hypoxemiaa nd B/L infiltrates on CXR?
aspiration pneumonitis 2/2 gastric acid damage
398
What is tx for immune compromised person w/ bacterial meningitis?
vanc + amp + cefepime
399
What are side effects of antithryoid drugs?
agranulocytosis
methimazole = 1st tri teratogen, cholestasis
propylthiouracil: hepatic failure, anca associated vasculitis
400
What is presentation of MEN1?
- pituitary adenoma
- primary hyperparathyroidism
- pancreas/GI tumor
401
What is presentation of VIPoma?
secretory diarrhea
hypokalemia
hypochlorhydria
402
What is presentation of glucagonoma?
wt loss
necrolytic migratory erythema
hyperglycemia
403
What is tx for hairy cell leukemia?
cladribine
404
What are characteristics of hairy cell leukemia?
```
TRAP stain (tartrate resistant acid phosphotase)
dry bone marrow tap
```
405
What is presentation of hepatorenal syndrome?
pt w/ cirrhosis, portal htn/edema and reduced renal perfusion 2/2/ GI bleed, vomit, sepsis, excess diruetic, SBP, anemia, or NSAID use
have FeNa
406
What HIV med associated w/ pancreatitis?
didanosine (NRTI)
407
What HIV med associated w/ hypersensitivity syndrome?
abacavir (NRTI)
408
What HIV med(s) associated w/ lactic acidosis?
NRTIs
409
What HIV med(s) associated w/ steven johnson?
NNRTIs
410
What HIV med associated w/ liver failure
nevirapine (NNRTI)
411
What HIV med associated w/ crystal induced nephropathy?
indinavir = protease inhibitor
412
What is anserine bursitis?
sharp localized pain over anteromedial part of tibia
413
What is mech of immunity in polysacchardie vaccine vs conjugate vaccine?
polysaccharide: T cell independent B cell response
- decrease incidence of replacement strains
conjugate:
- increased efficacy in elderly and kids
414
What are extraarticular associated w/ ankylosing spondylitis?
acute uveitis = MC
415
Anti cyclic citrullinated peptide antibodies are assocaited w/ what condition?
RA
416
anti dsDNA is assocaited w/ what condition?
SLE
417
glutamic acid decarboxylase ab is assocaited w/ what condition?
DM1
418
What is charcot joint?
neurogenic arthropathy
2/2 B12 deficiency, DM, peripheral nerve damage
have deformed join w/ decreased sensation and loss of neurologic input, mild pain, fractures, degeneraive joint disease
419
What kind of shock presents w/ high mixed venous O2 sat?
septic shock
420
What should you think if pt presents w/ dark brown discoloration of colon and lymph follicles shining through as pale patches?
= melanosis coli
| sign of laxative abuse
421
What diet recs for pt w/ renal calculi?
- decreased protein and oxalate
- decrease Na
- increased fluid
- increased dietary Ca
422
What is tx for hepatic encephalopathy?
- volume repletion, orrect electrolytes
- nutrition w/o protein resestriction
- oral lactulose
- rifamixin if no improvement in 48 hrs
423
What are alk phos, pth, ca, phos, vit D levels in osteomalacia?
high alk phos, pth
low ca, phos, 25OHD
associated w/ celiac = defective mineralization of bone matrix
424
What is tx for malignant otitis externa?
IV cirprofloxacin
425
What are causes of hypovolemic hyponatremia?
- vol depletion
426
What is a complication of hashimoto thyroiditis?
lymphoma of thyroid
427
What is next step to dx kidney stone?
US or non-contrast spiral CT of abdomen/pelvis
428
Where in mediastinum ar eneurogenic tumors located?
posterior mediastinum
429
What are the middle mediastinal masses?
tracheal tumors, pericardial cysts, lymphoma, lymph node enlargement, aortic aneurysm
430
What differentiates gilbert from crigler najjar 1 and 2?
gilbert = scleral icterus w/ unconjugated hyper bili usually
431
What is tx for hepatic hydrothorax?
initial = salt restriction and diuretics
| TIPS placement if refractory
432
What is tx for entamoeba histolytica liver abscess?
empiric tz w/ metronidazole
433
What parts of presentation make you think pt w/ pancreatitis is 2/2 gallstones?
- no hx of alcoholic, meds, normal lipids
| - ALT > 150
434
What cardiac manifestations of hemochromatosis?
restrictive or dilated cardiomyopathy and conduction abnormalities
435
What electrolyte changes w/ loop diuretics?
- hypoK
- met alkalosis
- pre-renal AKI
436
What happens to thyroid in cirrhosis?
decrease synthesis of binding proteins
| lowers total T3 and T4
437
What is most effective intervention to treat htn?
wt loss --> down by 5-20 SBP for every 10kg wt loss
438
What is malaria ppx for subsaharan africa and SE asia? what about if south america, mexico?
SE asia + subsaharan africa: atovaquone proguanil, doxy, or mefloquine (DOC for pregnancy)
if S america, mexico, korea: primaquine
in areis w/ chloroquine susceptible P falciparium: chloroquine or hydroxychloroquine
439
What is de quevain tenosynoivits?
classically affects new moms holding infant w/ outstretched thumb
affects abductor pollicis longus and extensor pollicis brevis
440
What should you think if pt w/alkalosis and Urine Cl
saline responsive alkalemia
2/2 to prior diuretic use, vomiting, nasogastric aspiration
have met alkalosis, lower urine Cl, low K
441
What is mech of angina in severe aortic stenosis?
CP 2/2 myocardial O2 demand
442
What should you think if pt w/ BL severe hypothyroidism?
hypothyroidism
443
What does expansile eccentric lytic "soap bubble" area of bone suggest?
giant cell tumor of bone
444
What is presentation of giant cell bone tumor?
- distal femur or proximal tibia
- tumor w/ cystic and hemorrhage regions
- eccentric lytic area
- sheets of interspersed large osteoclast giant cells that appear round
445
What is presentation of baker's cyst?
popliteal synovial cyst = swelling on medial side of popliteal fossa 2/2 enlarged gastrocneumius-semimebranous bursa
often 2/2 degenerative joint disease or injury
446
What is presentation of osteitis fibrosa cystica?
```
= von recklinghausen disese of bone = 2/2 hyperPTH from parathyroid CA
brown tumors (fibrous tissue) and bone pain
salt and pepper appearance
```
447
What is presentation of osteoid osteoma?
slcerotic cortical lesion w/ central nidus of lucency
causes pain worse at night and unrelated to activity
relieved by NSAIDs
448
What can you give pt w/ distal stone to help passage?
tamsulosin = alpha 1 antagonist --> relaxes ureteral muscle and decreases intrea-ureteteral pressure
449
What are screening recs for AAA?
male active or former smokers 65-75 one time AAA
450
What type of thyroid CA associated w/ hx of radiation?
papillary carcinoma
451
What type of thyroid CA associated w/ MEN?
medullary thyroid ca = clacitonin producing
452
What is salvage vs adjuvant vs neoadjuvant therapy?
```
salvage = tx when standard therapy fails
adjuvant = in addition o standard
neoadjuvant = tx before stanardar therapy
```
453
What serum level should you check in pt w/ androgen producing adrenal tumor?
DHEA-s (dehydroepiandrosterone sulfate)
454
Where are androstenedione (AS), DHEA (dehydroepiandrosterone), testosterone, and DHEA-S produced in woman?
AS/DHEA/T by ovaries and adrenal
| DHEA-S by adrenals only
455
What should you think if sudden onset sharply demarcated erythematous edematous tender skin lesion w/ rised borders in febrile pt?
erysipelas, MCC = group A B hemolytic strep
456
What is mech of kidney stones in crohns?
increased oxalate absorption
| 2/2 Ca being bound by fat and leainv oxalate unbound
457
What is presentation of cyanide tox?
```
flushing cherry red skin
cyanosis
HA, AMS, seizure, coma
arrhythmias
met acidosis, renal failure
GI sx
tachypnea thne resp depression, pulm edema
```
458
What is trousseau's syndrome? what undelryign dz associated?
hypercoagulability d/o w/ recurent and migratory superficial thrombophlebitis at unusual sites (arm, chest)
associate dw/ occult visceral malignancy (pancreas MC)
459
What is likely cause of excess bleeding in pt w/ chronic renal failure? tx?
platelet dysfunction --> normal PC, PT, PTT, BT is prolonged
tx = DDAVP
460
What is hypertensive emergency? malignant htn? hypertensive encephalopathy?
hypertensive emergecy = htn w/ acute life threatening end organ complications
two subtypes:
- malignant htn = retinal hemorrhages, exudates, papilledema (can also have renal findings)
- hypertensive encephalopathy =
461
How can you differentiate chlamydia vs gonorrhea as cause of urethritis?
urethritis = dysuria, pyuria, urinary freq, discharge
culture negative = chlamydia
- dx w/ nucleic acid amp testing
gonococcal: gram stain w/ gram neg cocci
462
What are strongest predictors of AAA expansion and rupture?
large aneurysm diameter
rapid rate of expansion
current cigarette smoking
463
What are indications for endovascular repair of AAA?
- size > 5.5cm
- rapid rate of expanison > 0.5cm in 6 mo or 1cm in 1 yr
- sx
464
What is tx for Afib in WPW?
cardioversion or procainamide
avoid BB, CCB, dig, adenosine in WPW
465
What is next step if HIV pt w/ oral thrush and sx of esophagitis?
empiric tx w/ fluconazole since most likely candida
if no thrush or fail empiric tx --> do esophagoscopy
466
What is tx for symptomatic bradycardia? what is next step if no response?
IV atropine
if no response pacing
467
What is tx for actinomyces?
penicillin
468
What is tx for nocardia?
sulfonamides
469
What type of thyroid CA w/ psammoma bodies?
papillary
470
How do you dx follicular thyroid CA?
invasion of capsule and blood vessels required to differentiate from follicular adenoma
471
What is tx for legionairs?
macrolide or FQ
472
What does low glucose in pleural effusion suggest?
empyema --> 2/2 high metabolic activity of WBCs or bacteria in fluid
473
What electrolyte abnormality after surgery can cause hyperactive deep tendon reflexes?
hypocalcemia 2/2 getting transfusions w/ citrate
