Week 1 Flashcards
(432 cards)
1
Q
Can abduct one eye but not adduct the other simultaneously, bilateral defect abducting eye has nystagmus? D/P
A
Internuclear opthalmoplegia due to damage to heavily myelinated fibers in MLF from MS
2
Q
Internuclear opthalmoplegia unilaterally
A
Lacunar stroke or MS
3
Q
Symptom: Fluctuating and fatigable proximal muscle weakness worsening later in the day: ptosis, diplopia, dysphagia, dysarthria, and even respiratory crisis. D/BT/Tr
A
Best next test: Acetylcholine receptor antibodies with CT scan for thymoma
Treatment: AChEi like pyridostigmine, immunotherapy, and thymectomy
4
Q
Unexplained fever in someone undergoing severe surgery with grimace to RUQ palpation? (D/BT)
A
Acalculous cholecystitis - first ultrasound then CT or HIDA if needed for diagnosis - due to stasis of gallbladder
5
Q
Level that prolactin typically reaches in prolactinoma? Effect on LH? Effect on TSH?
A
>
- LH low by feedback. TSH may or may not be low by mass effect
6
Q
Dyspnea in DS patient while feeding after 6 weeks with murmurs at LUSB and LLSB (D/P)
A
complete av-septal defect - loud S 2, systolic ejection murmur from ASD, holosytolic murmur of VSD
7
Q
Bilateral foot deviation of newborn firstborn which can be pasively and actively moved laterally (D/Tr)
A
metatarsus adductus - no intervention necessary
8
Q
Rigid position of foot medial/upward deviating forefoot and hindfoot with hyper-plantar flexion (D/Tr)
A
Club foot - manipulation and casting, surgery if it doesn’t work
9
Q
Who to screen for diabetes?
A
> =45 or risk factors
10
Q
When to begin low-dose CT screening for lung cancer? How many pack years to qualify?
A
55-80, >30 pack years who have quit <15 years ago
11
Q
Pap test years division?
A
3 years 21-29, can switch to PAP and HPV every 5 for 30-65
12
Q
Respiratory failure after infection or fluoroquinolone (or other antibiotic use) - (D/Tr)
A
myasthenic crisis - ICU for airway protection
13
Q
Management of acute exacerbation of COPD? Sputum cultures?
A
O2 with low target, bronchodilators, systemic glucocorticoids, antibiotics if >=2 cardinal symptoms - 3-7 days, oseltamivir if flue, NPPV if vent failure
DON’T collect sputum cultures unless patient at risk for Pseudomonas
14
Q
Cardinal symptoms of COPD
A
Increased dyspnea, increased cough, sputum color or volume change
15
Q
Most common valve issue leading to IE
A
mitral valve prolapse
16
Q
Was it right for me to start on omeprazole for reflux?
A
Yes, because I had laryngopharyngeal involvment. Otherwise, I would have done lifestyle changes and H2 blocker
17
Q
Tdap schedule
A
single dose at 11-18 or later if not receiving it then, then vaccine every 10 years and during eachc pregnancy
18
Q
Blood tinged sputum in young patient who just had a virus with no smoking history and no TB risk factors
A
Bronchitis - reassurance and no further workup
19
Q
Side effect of haloperidol related to movement in Parkison’s patients?
A
Worsening
20
Q
Benzos for elderly?
A
No, high risk for withdraw, dependence, motor effects, and paradoxical agitation
21
Q
Triad of wernicke encephalopathy?
A
Encephalopathy, ocular dysfunction, gait ataxia
22
Q
Treatment for Wernicke encephalopathy?
A
Thiamine before glucose
23
Q
Is colposcopy and cervical biopsy performed during pregnancy for high grade cervical carcinoma?
A
Yes
24
Q
When to use HPV cotesting when evaluating squamous change?
A
Triage atypical squamous cells and low grade
25
Effects of dopamine antagonism of 2nd gen antipsychotics like risperidone?
Tubuloinfundibular - hyperprolactinemia
Nigrostriatal - parkinsonism
Mesolimbic - antipsychotic effect
26
What happens to FSH and LH levels in menopause?
Elevated
27
How long amennorhea to be considered menopause?
1 year
28
What is premature ovarian failure
menopause before 40
29
Amenorrhea in normal SH and LH setting
Check for obesity
30
Placenta previa precautions and follow-up
No intercourse, no digital cervical examination, inpatient admission for any bleeding
Do not need weekly ultrasounds, if not resolved in third trimester ultrasound then C section 36-37 weeks as labor can cause bleeding
31
Causes of methemoglobinemia
Dapsone, n itrites, LOCAL AND TOPICAL ANESTHETICS
32
Why low O2 sats in methemoglobinemia
Absorption spectrum of mehemo - PaO2 is normal
33
Why methylene blue for methgbemia
Reducer for NADPH
34
Question type: An opacity with minimal fluid layering on lateral decubitus film"
fluid question - asking what to do with large and small effusions - small effusions without respiratory distress get oral antibiotics and close follow-up, large get intervention
35
Cause of HIV-Associated Neurocognitive disorder?
Replication of HIV in central nervous system
36
Precipitous drop in blood pressure in young person with medical Jc of asthma, eczema, pneumonia recurrence after transfusion (D/P)
Selective IgA deficiency, lack of IgA allows for formation of antibodies against IgA so if there's any in a blood transfusion, it can cause anaphylaxis
37
Palpable purpura, proteinuria, hematuria +non-specific symptoms (D/Associated virus/Lab finding
mixed cryoglobulinemia, Hep C, hypocomplementemia
Restudy kidney
38
What is the most common cause for isolated proteinuria in children and what is the follow up?
Transient proteinuria - repeat disptick on two later occassions
39
Microcephaly, microagnathia, overlapping fingers, rocker bottom feet, and absent palmar crease in newborn?
Trisomy 18 (Edwards syndrome)
40
Heart defect with Edwards?
VSD
41
Is acrocyanosis always pathologic?
no, central cyanosis is more predictive
42
Short term treatment of hypercalcemia for severe, moderate, and assymptomatic?
Severe - >14 or symptomatic - NS plus calcitonin short term, bisphosphonate long term.
Moderate (12-14)/Assymptomatic - usually no treatment required unless symptomatic
43
Antibiotic for trachoma
azithromycin
44
Back pain, normocytic anemia, and arm pain with osteolytic lesion in elderly patient (D/BT)
Multiple Myeloma, SPEP/UPEP
45
When is splenic rupture most likely in mono?
3-4 weeks
46
Pt. with gout presents with a hot red joint, what are two important differentiators? -
is this typical for a gout flare, how long did it take to come on (12-24 hours to maximal onset with gout attack)
47
Do crystals appear in joints when not having active gout attacks?
Yes
48
Claudication like symptoms with postural relief and normal ABI? Most common cause?
neurogenic (rather than vascular) claudication - osteoarthritis of the spine
49
Stages of Lyme disease with treatment:
Early - erythema migrans, fatigue, headache, myalgias, arthralgias - early oral doxy
Early disseminated - multiple erythema migrans, unilatera/bilateral CN palsy, Meningitis, carditis, migratory arthralgias - IV ceftriaxone
Late - arthritis, encephalitis, peripheral neuropathy - IV ceftriaxone
50
High fever, polyarthralgia, and pustular rash (D/Test finding)
Disseminated gonococcal infection, normally negative blood cultures due to fastidious growth requirements of N gonorrhoeae
51
Thyroid levels in any patient with acute, severe illness
euthyroid sick syndrome - fall in T3 and T4 from multiple levels
52
Treatment for papillary thyroid cancer
Surgical resection - radioiodine abltation if increased risk of tumor recurrence and thyroid replacement to suppress TSH
53
Most common fracture in pediatrics from fall on an outstretched hand
supracondylar fractures
54
What is at risk in supracondylar fractures (D/Cl)
brachial artery injury or median nerve entrapment - test for neuro and brachial/radial pulses before and after
55
Differentiate myoclonus due to seizure vs myoclonus due to syncope
presence of trigger, presence of aura, head deviation or body posturing, tongue laceration, prolonged postictal phase
56
What electrolyte level mirrors CHF severity (D/P)
hyponatremia, renal hypoperfusion results in release of renin and secretion of ADH
57
CHF poor prognostic factors? Clinical, Lab, electrocardiography, echocardiography, associated conditions.
Clinical - Higher NYHA class, resting tachy, S3 gallop, elevated JVP, Low blood pressure (<100/60), mitral regurg, low peak VO2
Laboratory - Hyponatremia, elevated pro-BNP, renal insufficiency
Electrocardiography - >120 msec QRS, left bundle branch block
Echo - severe LV dysfunction, Concomitant diastolic dynsfunction, reduced RV function, PHTN
Associated conditions - anemia, afib, DM
58
Why would a mother alloimmunize to Rh factor if she was given the standard dose of anti-D immune globulin?
50% of mothers need more than the standard dose of anti-D immune globulin, if placental abruption or other exposures, should perform Kleihauer-Betke test
59
Very athletic thin female with ammenorhia (D/P/BT)
Functional hypothalamic amenorrhea - Hypothalmaic suppression of GnRH, LH, FSH, and ultimately estrogen, does not respond to medroxyprogesterone acetate challenge
60
Urethritis, asymmetric oligoarthritis, and conjunctivitis, especially with mucocutaneous lesions or Achilles tendon pain (D/Tr)
Reactive arthritis - NSAIDS
61
Flank pain with intermittent episodes of high volume urination
renal calculi
62
Decrease in renal function in cirrhotic patient which does not respond to fluids (D/P)
Hepatorenal syndrome - dilation of the splanchnic artery causing activation of the RAS system
Write this down as learning issue
63
Three risks of cryptorchidism and what can be done about them.
Testicular torsion, infertility, and testicular cancer - all three improve with orchipexy before age 1, although cancer risk remains elevated but improved detection with surgical fixation
64
Extended aggression, agitation, combativeness, psychosis, delerium, myoclonus, and sometimes seizures with unremarkable urine drug screen?
Bath salts
65
Awakening in first 1/3 of night without responsiveness to comfort or recall of dream content
sleep terror
66
What happens to the ovaries when you have a hydatidiform mole?
Proliferative trophoblastic tissue secretes B-hCG, causing hyperstimulation of ovaries and formation of theca lutein cysts - bilateral, multilocular ovearian cysts
67
How to treat a hyatidiform mole
dilatation, suction, and curetage or hysterectomy after decrease of B-hCg
68
What is the maternal analogue of B-HCG
LH
69
yperemesis gravidarum, a large uterus compared to last menstruation, and bilaterally enlarged ovaries? (D)
Hyatidiform mole
70
Multilocular, bilateral 10-15 cm ovaries in face of elevated b-hcg
theca lutein cysts
71
three causes of theca lutein cysts
gestational trophoblastic disease, multifetal gestation, interftility treatment
72
Lower abdominal pain migrating into pleuritic RUQ pain
perihepatitis (Fitz-Hugh_curtis) from pelvic inflammatory disease
73
Treatment for PID
Third generation cephalosporin plus azithromycin OR doxy
74
Complications of PID
tubo-ovarian abscess, infertility, ectopic pregnancy, perihepatitis
75
Why urinary urgency in diverticuluitis?
Bladder irritation from inflamed sigmoid colon
76
Workup for suspected esophageal perf?
CXR or CT scan, or water-soluble contrast esophagogram to find leak site - PPI, broad spectrum antibiotics, nutrition, and surgery
77
HOCM genetic inheritance, clinical manifestation, increase the murmurs
Genetic: autosomal dominant
Clinical: Systeloic ejection and dual upstroke pulse due to midsystolic obstruction
Murmur increase: Anything reducing preload - valsalva strain, abrupt standing. Decrease with increased preload OR afterload - squatting, leg raise, hand grip
78
Role of head thrust test?
Detecting vestibulopathy
79
Cause of oscillopsia
bilateral vestibular injury
80
Inability to recall important personal information after traumatic or stressful event (with travel qualifier)
Dissociative amnesia with dissociative fugue
81
Multiple personality
dissociative identity disorder
82
Anterograde amnesia resolving after 24 hours -
transient global amnesia
83
Spot Hashimoto's in a question stem
Chronic hypothyroidism, +antithyroid peroxidase antibodies
84
Rapidly enlarging goiter with compressive symptoms with hx of Hashimoto's
thyroid lymphoma , especially common in Hashimoto's population - retrosternal extension
85
treatment for slowly progressive, nonpainful swelling of mandible with sulfur granule sinus tracks after dental procedure?
Penicillin for 2-6 months with surgery reserved for severe disease
86
Female athlete triad for stress fracture?
Low caloric intake, hypomenorrhea/amenorrhea, low bone density
87
Clinical presentation of stress fracture? Contrast to shin splints
Insidious onset of localized pain, point tenderness, possible negative x-ray - as opposed to shin splints which is diffuse areas of tenderness usually in overweight individuals
88
Most common cause of meningitis in young infants?
Group B strep
89
Meningitis in infant at 8 days?
Horizontally transmitted GBS
90
Most common cause of recurrent UTI's in infants and children? (D/BT)
Vesicoureteral reflux - voiding cystourethrogram
91
Most common cause of chronic renal insufficiency/failure?
Posterior urethral valves
92
Large flank masses, respiratory distress, and Potter faces?
Autosomal dominant polycystic kidney disease
93
When is intermittent strabismus a problem?
After 4 months of age
94
Swollen hands and feet with only soft tissue swelling in AA descent w/t low grade fever?
Initial presentation of vaso-occlusive crisis in sickle cell anemia
95
Acute or subacute pain with focal pain at 1 site and positive blood culture in SS?
Osteomyelitis
96
Chronic worsening pain with absence of fever, warmth, or erythema is SS?
Avascular necrosis
97
ARP calculation
(risk in exp-risk in unexp)/risk in exp OR (RR-1)/RR
98
Bilateral hilar adenopathy in middle aged woman (especially AA)?
Sarcoidosis
99
Type of inflammation in sarcoidosis
Type of inflammation in sarcoidosis
100
Evaluation of patient with abdominal pain radiating to the groin with vomiting and unremarkable exam? Why not others?
Ultrasound for cheap non-dangerous, spiral CT for detailed information
X-ray - some stones not visible
Contrast CT - contrast not necessary for visualization
IVP - once was test of choice, noncontrast CT better without contrast risks
101
Most common cause of oculomotor nerve palsy? Differentiator - no parasympathetic change (pupil dilation) but somatic change
Ischemic neuropathy - somatic fibers more internal and prone to ischemia
102
How can loop diuretics cause AGMA?
-AKI -> uremia
103
Compensation from chronic respiratory acidosis of COPD?
-Metabolic alkalosis from high bicarb
104
Treatment of assymptomatic bacturia in pregnancy? (P/BT) What treatments to avoid?
Treatment: cephalexin, amoxicillin-clavulonate, or nitrofurantoin with repeat urine culture to confirm clearance after regimen
Why: Progesterone causes smooth muscle relaxation increasing pylonephritis risk and preterm delivery
What to avoid:
Fluoroquinolones - fetal bone deformities
Doxy - grey teeth and bone development
Bactrim: ONLY SECOND TRIMESTER, first trimester messes with folic acid and third due to neonatal kernicterus
105
recent catheterization, anticoagulation with heparin, sudden onset of hypotension, tachcardia, flat neck veins, and back pain
Retroperitoneal hematoma from arterial acess site bleeding
106
Most common complication of cardiac catheterization?
Complication at catheter insertion site
107
Signs of smoke inhalation injury
1. Burns on the face
2. Singed eyebrows
3. Oropharyngeal inflammation
4. Carbonaceous sputum or blistering carbon deposity
5. Stridor
6. Carboxyhemoglobin level >10%
108
Role of intubation, glucocorticoids, and antibiotics in inhalation injury:
Intubation - low threshold, protects against airway edema due to supraglottic injury
Glucocorticoids - contraindicated - diabetogenic and immunosuppressive effects
Prophylactic Antibiotics - not indicated despite increased psuedomonal infection risk
109
Initial workup for symptomatic children with rapidly increasing head circumference?
CT or MRI - not LP
110
Are SSRI's safe in pediatric OCD?
Yes
111
Irritant contact dermatitis vs. allergic contact dermatitis
Nonimmunologically related vs immunologically related
Similar clinical presentation
Mostly chronic symptoms
112
Dysmenorrhea with heavy menstrual bleeding that starts in later reproductive years progressing to chronic pelvic pain (D/BT/Tr)
Adenomyosis, MRI or pelvic ultrasound, hormonal methods followed by hysterectomy
113
Heavy menstrual bleeding in endometriosis?
No
114
Unilateral abdominal pain with sudden onset and adnexal mass and lack of doppler flow on ultrasound?
Ovarian torsion
115
With polyneuropathy, pancytopenia, and mild transaminase elevation, can also include hyper/hypopigmentation and hyperkeratosis of palms and soles what exposure should you be watching for (D/Tr)
Arsenic, chelation with dimercaprol
116
Places you might find arsenic?
Mining, pesticide, metalwork, antique pressure treated wood
117
Describe the pubertal development of women by age and phys
1. Activate hypothalmic-pituitary-ovarian axis with pulsatile secretion of GnRH
2. Breast development 8-12 from estrogen, then pubic hair
3. Menarche around Tanner stage 4 - 2-2.5 after initial breast bud development, <15 considered normal if everything else changing appropriately
4. Often growth spurt 6 month before
118
How to treat ADHD when substance abuse/misuse is a concern? Mechanism of action?
Atomoxetine - NE reuptake inhibitor
Buproprion
TCA
119
Severe PID requiring hospitalization treatment:? What qualifies for inpatient?
IV cefoxitin plus oral doxy. High fever, inability to take oral antibiotics, pregnancy, risk of nonadherence, complication
120
Markedly elevated aminotransferases, signs of hepatic encephalopathy, and synthetic liver dysfunction in setting of acetaminophen and alcohol (D/P/Tr)-
ALF, NAPQI, N-acetylcysteine
121
Wisconsin man has upper lobe consolidation, lytic lesions in anterior ribs, and well-circumscribed verrucous crusted lesions (D/BT/Tr)
Blastomycosis, budding yeast from sputum culture, itraconazole or amph B
122
ever >5 days, conjunctivitis, oral mucosal changes (erythema, fissured lips, strawberry tongue), rash, extremity changes, and cervical lymphadenopathy of >1.5 (D/Tr/BT
Kawasaki Disease (Fever +4/5 above), treat with IVIG with 10 days to prevent coronary artery aneurysms, and aspirin. Follow up with echo
123
Scarlett fever rash vs. kawasaki rash
Scarlett fever - sanddpaper, kawasaki, maculopapullar
124
CONSTIPATIOn, abdominal pain, and polydispia -
hyercalcemia in patient using vitamins for osteoporosis (D/P)
125
Milk-alkali induced hypercalcemia
causes renal vasoconstriction and impaired ADH potency -> hypovolemia
126
Medications raising risk of MAS
thiazides, ACEi's, NSAIDS
127
Electrolyte imbalance of MAS
metabolic alkalosis, hypophosphatemia, hypomagnesemia, AKI, low PTH
128
what happens in TCA overdose?
Cardiac toxicity due to fast sodium channel inhibition in the His-Purkinje system - prolongs repolarization and refractory period - results in hypotension, vtach
129
Indication for sodium bicarb in TCA overdose? Mechanism of action?
QRS > 100 msec. Increased pH causes decreased drug avidity, increased sodium effects TCA's binding to fast channels
130
Sodium bicarb for aspirin overdose?
increases salicyclate excretion through urine alkalinazation
131
Elevated opening pressure, low white blood cell count, low glucose, elevated protein (D/Tr) in face of HIV (CD4 count)
Cryptococcus meningitis, AmB and flucytosine for 2 weeks then fluconazole for 8 weeks first dose, maintenance for a year. < 100
132
Respiratory distress, neurologic dysfunction, and petechial rash after fracture of large bones
Fat Embolism syndrome
133
Symptoms of internal capsule ischemia plus vomitting, lethargy, headache?
Putaminal hemmorhage
134
Hypoglycemia in insulin dependent diabetics after meals with dysphagia and uncomfortable fullness (D/Tr)
Diabetic gastroparesis - dietary modification and metoclopramide or erythromycin
135
Most common extracranial solid tumor of childhood? (D/Cl)
Neuroblastoma, urine and serum catecholamine elvation
136
Horner's syndrome in child with harlequin sign and paravertebral mass -
neuroblastoma
137
Why use ACEi in unilateral RAS?
ACEi reduces angiotensin II levels dilating glomerular efferent arterioles - this makes the stenotic kidney RBF fall but the unaffected kidney compensates by not being subject to vasoconstriction
138
Most sensitive lab value for orthostatic hypotension
decreased urine sodium
139
Colon cancer screening options:
Starting at 50 (or 10 years before first degree relative diagnosis)
1. FOBT annually OR
2. Sigmoidoscopy q5 years and FOBT q 3 years OR
3. Colonoscopy every 10 years
140
Arching of back, frequent spit-ups, poor weight gain in infant
GERD
141
Blood-streaked, mucousy, loose stools or severe constipation
Milk protein allergy
142
Pill induced esophagitis causes
tetracyclines, NSAIDs, bisphosphonates, potassium chloride, iron
143
Agoraphobia and recurrent, spontaneous anxiety attacks? Difference between this and social anxiety disorder?
Panic disorder. Social anxiety has specific fear of social humiliation
144
Not sexually active guy wants STD test
HIV screening, 4th gen assay for HIV p24 antigen and HIV antibodies
145
Partial response to antidepressent for patient who is unable to lose weight and feels fatigued?
Buproprion
146
Dysuria, suprapubic tenderness, and dyschezia
Endometriosis on bladder and rectovaginal septum
147
Uterine sign of potential endometrial implants? Common complication of endometriosis?
Fixed in retroversion due to scarring. Infertility
148
Endometriosis dx and treatment
- Definitive - direct visualization with laparoscopy and surgery
- Conservative - oral contraseptives and NSAIDS
149
Assymptomatic adnexal fullness resulting in ultrasound with hyperechoic nodules and calcifications?
Dermoid ovarian cyst
150
Pulmonary nodules after pregnancy?
Choriocarcinoma
151
Simple, thin wall cysts observable in first half of menstrual cycle?
Follicular cysts
152
Homogenous cystic mass with dysmenorrhea?
Ovarian endometrioma
153
Irregular or absent menses with ovaries ringed with multiple simple cysts?
PCOS
154
Multiloculated cystic mass with distortion of normal adnexal structures and systemic symptoms
tubo-ovarian abscess
155
Pelvic pain in a patient with a known ovarian mass?
Ovarian torsion until proven otherwise
156
Pain, fatigue, paresthesias of extremity with concurrent dizziness, ataxia, dysequilibrium worsened with exercise (D/P)
Subclavian steal syndrome (severe stenosis) with reverse flow in vertebral artery on same side
157
Extra gastric symptoms of Crohn's -
uveitis, scleritis, erythema nodosum
158
Hematuria with scrotal varices and polycythemia (D/BT0
Renal cell carcinoma (classic flank pain, hematuria, and palpable abdominal renal mass rare). CT scan of the abdomen best test
159
Symptom cuttoff for ADHD?
Before age 12
160
Maternal serum quadruple test at 15-20 weeks shows low AFP, low estriol, elevated B-hcg, elevated inhibit? Follow-up test?
Down's. cell-free fetal DNA and ultrasound
161
Maternal quad screen when tested?
15-20 weeks EGA
162
Maternal quad screen up AFP and normal estriol, B-HcG, inhibin?
Open neural tube defects or abdominal wall defects
163
Maternal quad screen low AFP, estriol, and Bhcg, normal inhjibin?
Tri 18
164
Hyper or hypothermia in cirrhotic patients?
Hypothermia, fever should be investigated
165
SAAG score for SBP?
>=1.1 consistent, <1.1 makes SBP unlikely
166
Fever, RUQ, and gas in gallbladder in patient with vascular compromise, or immunosuppression (D/P/Tr)
Emphysematous cholecystitis - Clostridium, surgical resection and parenteral antibiotics
167
2 year cough with copious sputum production, no smoking history, crackles and wheezing on PE and bilateral atelectasis on CXR (D/P/BT/Tr)
Recurrent bronchiectasis, infectious insult with impaired clearance resulting in cyclical bacterial proliferation, airway dilation, airway plugging. HRCT scan for initial diagnosis followed by f/u testing. Need antibiotics unlike viral bronchitis
168
New intermittent headache in young white overweight female on OCP's with papilledema? (D/P/Tr)
Benign intracranial hypertension, decreased CSF absorbtions, weight reduction followed by acetazolamide if ineffective
169
Hereditary spherocytosis risk, inheritance, pathogenesis, Lab findings, treatment
Northern european descent, autosomal dominant, defect in ankryin gene, up mean hemoglobin, increased MCH concentration and negative Coombs test, folic acid supplementation, blood transfusions, and splenectomy for treatment
170
Complications of hereditary spherocytosis
Pigment gallstones and aplastic crisis from parvo
171
Tests for hereditery spherocytosis
Osmotic fragility on acidified glycerol lysis, abnormal eosin-5-maleimide binding
172
Paroxysmal nocturnal hemoglobinuria path?
Absent CD55
173
Megacolon and cardiac disease in a brazillian migrant (D/P)
Chagas disease, protozoan trpanosoma cruzi resulting in destruction of nerves controlling GI smooth muscle and prolonged myocarditis,
174
Ecephalopathy, hepatic dysfunction, cerebral edema, and increased intracranial pressure in infant with viral infection? Most common cause of death?
Reye syndrome, kids treated with salicyclates FOR a viral infection. Cerebral edema
175
PCOS infertility treatment?
Clomiphene citrate -SERM that induces ovulation
176
Painless ulcer on sole of foot at head of first metatarsal bone? (D/P/BT)
Likely a neuropathic ulcer, develops due to insensible pain due to large fiber damage and autonomic dysregulation leading to dry feet. Best test is HbA1c
177
Ulcer at tips of digits with diminished pulses, skin pallor, or loss of hair (D/BT) -
arterial ulcer, ABI
178
Ulcer on medial malleoulus with edema (D/BT)
venous ulcer, duplex sonography
179
Anogenital warts virus cause?
HPV
180
First step of evaluation of precocious puberty and why - complication
Bone age- androgens stimaluate increased bone formation and cartilage growth - premature fusion and short for age
181
Differentiate central PP from peripheral PP
-Elevated LH either at baseline or after GnRH stim - means centrally located LH reponse and not periopheral secretion
182
Central PP risk and resulting test?
-Usually idiopathic but can be caused by hypothalmic hamartoma, pituitary adenoma, or mass effect - need MRI of head
183
Precocious puberty with advanced bone age and increased basal LH treatment (D/BT/Tr) -
Central precocious puberty, MRI for masses, GnRH agonist therapy, helps stop epiphyseal plate fusion
184
Precocious puberty with advanced bone age with no LH response to GnRH stim test (D/BT)
Peripheral precocious puberty - Adrenal and pelvic CT evaluates for adrenal or gonadal tumors
185
Premature breast development with normal bone age D/Tr
Premature thelarche, reassurance
186
Most common cause of vitamin B12 deficiency? Presenting signs vs. folate?
Decreased intrinsic factor, megaloblastic anemia with neuro issues
187
Biochemistry of B12/folate deficiency and why anemia can respond to folate if B12 deficient
Folate and cobalmin both cofactors from homocysteine to methionine - folate can improve anemia but does not help neuro
188
Marfanoid habitus with acute chest pain (D/Cl/P)
Acute aortic dissection, early diastolic murmur due to aortic regurg, fibrillin-1 AD mutation
189
Fever, urticaria, lymphadenopathy and polyarthralgia one week after beta-lactams or bactrim(D/P/Tr/labs)
erum sickness-like reaction - immune complex formation - remove offending agent - hypocomplementemia and elevated inflammatory markers like all Type III reactions
190
Does Acute rheumatic fever typically occur with appropriate antibiotic therapy
No
191
What is the EGA after which preeclampsia can be diagnosed?
20 weeks
192
Hypocalcemia symptom and most likely cause?
Muscle twitching, tetany, and hypotension, hypoparathyroidism or renal disease
193
Hypoglycemic seizures vs ecclamptic seizures?
-Anxiety, diaphoresis, tremor
194
Additional risks of ecclampsia? Tr?
-Maternal mortality (10% of pregnancy related mortality), abruptio placentae, DIC, cardiopulmonary arrest
Magnesium sulfate followed by expedient delivery
195
Excessive cow's milk at 1?
Iron deficiency anemia - screen all 1 year olds
196
HTN longstanding in young person wit hepitaxis, headaches, or lower extremity claudication (D/Bt)
Aortic coarctation, simultaneous pulse palpation and UE and LE blood pressures
197
Bacterila infection of the cornea with extended wear contacts (D/Path)
Contact-lense associated keratitis, usually psudomonas or serratia
198
Differentiate anterior uveitis from keratitis?
Cornea is spared in anterior uveitis
199
Tinea capitus path and management:
Dermatophyte infection due to Trichophyton or Microsporum - Oral griseofulvin or terbinafine
200
dysphoria, fatigue, insomnia, and myalgias after d/c paroxetine (D/P)
Antidepressant discontinuation syndrome, happens with short half life SSRI's suh as paroxetine or venlafaxine
201
SSRI with long half life
Fluoexetine
202
Symptoms of iron deficiency anemia
Syncope, palpitations, tachycardia
203
Bipolar I vs. Bipolar II vs cyclothymia
Bipolar I - mania with or without major deptression
Bipolar II - major depressive episodes and hypomania
Cyclothymia - hypomania and dysthymia but no major episodes
204
Decompensation 2 days after ischemic stroke? BT?
Hemorrhagic transmformation - occurs within 48 hours. Emergent CT for urgent surgical decompression
205
Postpartum blues vs. postpartum depression. Which SSRI for postpartum depression?
Blues lasts 2 weeks, depression 4-6 weeks. Use sertraline as it is not in breast milk
206
Normal scalp and hair shaft but losing hair rapidly? (D/BT)
Telogen effluvium, hair pull test >10-15% pull out
207
Postoperative fever, tachy, ches pain, leukocytosis, and sternal wound discharge?
Bacterial mediastinitis - up to 5% of sternal surgeries
208
Afib after CABG
Common and self resolving in <24 hours, treat with rate control
209
Fever, leukocytosis, tachy, and chest pain several weeks after pericardium incision?
Postepericardiotomy syndrome - autoimmune - NSAIDS, steroids, and pericardial puncture if necessary
210
Management of acute mania with psychotic features?
Antipsychotic - lithium would take a few days of titration
211
Role of lamotrigine in bipolar disorder?
helpful with depressive episodes
212
Nystagmus, hypertension, violence, and life threatening hyperthermia
PCP
213
Elevated blood pressure and heart rate, increased alertness
Cocaine
214
Anticholinergic poisoning with history of abuse
Jimson weed
215
When does icthyosis vulgaris get worse? How to treat?
n winter and later in life. Emollients followed by keratolytics like coal tar and topical rertinoids
216
Bite wound most common organisms and therapy?
Strep, staph, eikenella, Haemophilus. Amoxicillin-clavulonate for gram-positive, gram-negative coverage and surgical debridement
217
Anemia, shiny tongue, broad based ataxia, and vitiligo -
ikely pernicious anemia (concommitant vitiligo as autoimmune disease) - can have thrombocytopenia or leukopenia as well
218
Path of pernicious anemia
autoantibodies against gastric IF, confirmed by anti-IF antibodies
219
Isoniazid side effects and distinction between B12 deficiency -
peripheral neuropathy, hepatotoxicity, and sideroblastic anemia (no atrophic tongue)
220
Patient with early syphillis and penicillin allergy?
Doxy, single intramuscular penicillin G is usual test
221
Confirming effective treatment in syphillis?
6-12 month RPR f/u showing 4 fold drop in titers
222
Digeorge pentad
congenital heart disease, facial dysmorphia, thymic, cleft palate, hypocalcemia
223
When DGS is suspected, what should be ordered?
Serum calcium levels (due to PT gland hypoplasia) and echo
224
Strongly associated heart anomaly DGS?
Truncus arteriosis
225
After splenic infarction, what is the most common cause of bacteremia in SS patients?
S. pneumoniae, by far, then other encapsulated organisms like Hib and Nieserria
226
ow is salmonella related to SS?
OSTEOMYELITIS - not sepsis
227
ALS approved treatment and mechanism of action?
Riluzole - glutamate inhibitor
228
Vaccinations that decrease cancer risk?
HPV, Hep B
229
Prolonged hypotension, BUN:Cr <20:1, high urine osmolality, high urine Na, high FENA (D/lab)
ATN, muddy brown casts on urinalysis
230
Broad casts
chronic renal disease
231
RBC casts
glomerular disease or vasculitis
232
WBC casts
interstitial nephritis, pyelonephritis, or other kidney infection
233
Fatty casts -
nephrotic syndrome
234
Top three causes of AOM in kids?
Strep pneumo, nontypeable Hib, moraxella catarrhalis
235
First and 2nd line treatment for AOM in kids
Amoxicillin, then amoxicillin-clavulanic acid
236
When give antibiotics for kids >6 months?
High fever, severe pain, bilateral disease
237
Treatment for vitiligo? Common comorbidity?
Topical corticosteroid for limited disease, oral corticosteroid or calcineurin inhibitors for extensive. Associated with autimmune diseases, especially thyroid disease, especially common
238
MEN1 syndrome conglomerate
hyperparathyroidism, gastrin producing tumors, and pituitary tumors
239
Mild thrombocytopenia with circulating Giant platelets and more bleeding than appropriate for platelet level?
Bernard-Soulier, AR due to glyco Ib
240
Thrombocytopenia after transfusion of blood cells?
Dilutional thrombocytopenia
241
Thrombocytopenia, microangiopathic hemolytic anemia, low clotting factor, prolonged PT and pTT
DIC
242
Formation and deposition of platelet rich thrombi -
thrombotic microangiopathy - Related to DIC
243
Prolonged Bleeding time and aPPT with normal platelets?
Von Willenbrand
244
Substance accumulating in Parkinson's
alpha snyuclein
245
Secondary causes of hypertension and corresponding labs:
Renal parenchymal - urinalysis and Cr
Renovascular - Cr, abdominal bruit
Aldosteronism - Hypokalemia, adrenal incidentaloma
Pheo: BP up with tachy, adrenergism
Cushings: Cushingoid
Hypothyroidism: Dry skin, constipation, etc.
Hyperparathyroidism: confusion, psychosis, poluria, Kidney stones
Coarc - differential hypertension with brachiofemoral delay
246
Significant hypertension with PHPT?
MEN2 - further eval
247
Severe hypertension with flash pulmonary edema/resistant heart failure?
Renal artery stenosis
248
Most common cause of postpartum hemmorhage?
Uterine atony
249
Forceps delivery with large baby and soft and boggy uterus over the umbilicus with postpartum bleeding?
Uterine atony
250
How to manage PPH
IV fluid support, bimanual uterine massage, oxytocin, then uterotonic agents like methylergonovine (contraindicated by hypertension) or carboprost (contraindicated by asthma - hysterectomy in unstable patients
251
Yellow and blue crystals under polyrized microscopy of synovial fluid?
Negatively birefringent urate crystals from Gout
252
Treating gout?
NSAIDS or colchicine in acute attacks, allopurinol long term
253
Definition of pulmonary hypertension
Pressures >25 mmHg
254
Difference between early/late decelerations and variable decelerations?
Drop from baseline to nadir is <30 s and not always associated with contractions
255
Cause of variable decelerations?
Umbilical cord compression
256
Maternal fever and fetal tachy?
chorioamnionitis
257
Sinusoidal FHR tracing?
Fetal anemia
258
Cause of early decelerations?
Fetal head compression
259
Cause of late decelerations?
Fetal hypoxemia
260
What to do with recurrent variable decelerations?
Maternal repositioning, then amnioinfusion
261
Argyll Robertson (prostitute's) pupil and lancinating pains -
late neurosphyilis (tabes dorsalis)
262
What are the neuro effects of tabes dorsales?
Posterior spinal columns (vibration and proprioception) as well as nerve roots
263
Treatment for neurosyphillis
IV penicillin - 10-14 days
264
Subacute combined degeneration and neurosyphillis -
B12 has spastic paresis and hypereflexia, neurosyphillis has reduced absent reflexes
265
RLQ pain to diffuse unilateral abdominal pain and shoulder pain while on anticoagulatns after strenuous activity -
ruptured ovarian cyst with hemoparitoneum
266
Unexplained neuropathy, abdominal pain, restlessness and tachy? BT?
Acute intermittent porphyria, check urinary porphobilinogen levels (elevated)
267
High serum and low urine osmolality with lithium ingestion?
Lithium induced nephrogenic diabetes insipidus resulting in ADH resistance
268
Path of hepatorenal syndrome
severe liver cirrhosis results in increased NO generation in splancnic circulation causing systemic vasodilation causing renal hypoperfusion resulting in RAAS system upreg worsening overload
269
Does hepatorenal syndrome respond to IV fluids?
No
270
How does nephrotic syndrome increase risk of atherosclerosis?
Low oncotic pressure increases hepatic lipoprotein synthesis, pts are also hypercoagulable due to loss of ATIII
271
Cause of ileus in face of kidney stone?
Vagal reaction caused by uretal colic
272
Is metabolic acidosis appropriately compensated (formula)
Winter's formula - PaCO2 - 1.5*bicarb+8(+/-2)
273
Tinnitus, fever, and tachypnea along with nausea and GI irritation after overdose
aspirin intoxication - respiratory alklosis and AGMA
274
NAGMA causes:
Diarrhea
Fistula
CA inhibitors
Renal tubular acidosis
275
Risk factors for RTA IV:
Diabetic old, damages jg apparatus
276
Fatigue, weakness, borderline hypotension, electrolyte abnormalities, hyperkalemia, hypoglycemia in setting of granulomatous disease (especially TB)
primary adrenal insufficiency due to extrapulmonary TB
277
What ingestion can cause a mixed respiratory alkalosis and metabolic acidosis?
Aspirin - due to stimulation of medullary respiratory center and AGMA due to decreased renal elimination of organic acids
278
Most likely intervention transitioning a patient from acidemic to alkalemic?
Loop diuretic - increased H+ and K+ secretion
279
Common dangerous complication of ADPKD?
Berry aneurysm rupture
280
Most common complication of ADPKD?
Hepatic cysts
281
Characterization of hypertensive nephropathy -
intimal thickening and luminal narrowing of renal arterioles with presence of sclerosis
282
Characterization of diabetic neprhopathy
Increased extracellular matrix, basement membrane thickening, mesangial expansion, and fibrosis
283
Sequence of pathology of DM CKD?
1. Year 1 - glomerular hyperperfusion and renal hypertrophy, up GFR
2. Year 2-5 - glomerular basement membrane thickening, hypertrophy, and mesangial volume expansion, GFR falls
3. Year 5-10 - Microalbuminuria, later overt nephropathy
284
Nephrotic range proteinuria and hematuria with dense intramembranous deposits staining for C3 (d/P)
Membranoproliferative glomerulonephritis Type 2 (Dense deposit disease) - unique that it is caused by IgG antibodies against C3 convertase - results in persistent complement activation and intramembranous deposits
285
AA or hispanic, HIV or heroin -nephropathy
Focal segmental glomerulosclerosis
286
Adenocarcinoma, NSAIDS, hep B, or SLE nephopathy
Membranous nephropathy
287
Hep and C, lipodystrophy nephropathy -
membranoproliferative glomerulonephritis
288
NSAIDS, lymphoma nephropathy -
NSAIDS, lymphoma nephropathy -
289
HIV related nephropathy with azotemia and normal sized kidneys -
collapsing focal and segmental glomerulosclerosis
290
HIV AND Hep B nephropathy
membranous glomerulonephritis
291
Why are ACEi helpful in diabetic nephropathy
reduce intraglomerular hypertension and theraby glomerular disease
292
Renal colic but nothing on CXR?
1. Radioluscent stones (uric acid, xanthine)
2. Calcium stones <1-3 mm in diameter
3. Non stone obstruction - blood clot, tumor
293
Treating uric acid stones (three steps)
1. Hydration
2. Alkalinzation of urine to 6-6.5 with oral potassium citrate
3. Low purine diet
294
Which diuretics hurt and help calcemic kidney stones?
Furosemide makes it worse, increases urine calcium. HCTZ makes it better, decreases urinary calcium (used for recurrent stones)
295
Potassium sparing diuretics?
Amiloride, triamterene
296
Meds that can cause hyperkalemia
b-blockers, K-sparing diuretics,ACE-i, angiotensin II blockers, and NSAIDS
297
What needs to be d/c in AKI in diabetics?
Metformin
298
Does low-dose aspirin need to be d/c'd in AKI's?
No
299
Why do we d/c metformin in hospital setting?
Contributes to acute renal fialure, liver fialure, and sepsis by increasing risk of lactic acidosis
300
Acute renal failure after hospitalization for MDR pyelonephritis, what antibiotic?
Usually aminoglycosides (amikacin)
301
Oliguria in elderly patient on amytriptyline? amitriptyline-induced urinary retention
anticholinergic properties, bladder empties under muscarinic control
302
HTN and palpable kidneys (especially right because of anatomical location?) with recurrent bilateral flank pain?
Autosomal dominant polycystic kidney disease
303
High CO2 and low bicarb in COPD setting?
Acute on chronic CO2 narcosis - normally high CO2 with high serum bicarb
304
Cause of NAGMA in AKI?
impaired H+ secretion, ammonia generation, bicarb resorption
305
Define oliguria in adults
<250 ml in 12 hrs, <0.5 ml/kg/hr
306
Increased risk of postoperative urinary retention
surgical bladder distension, epidural anesthesia use
307
First step in assessing postoperative oliguria
portable bladder scan, then catheterization if + or inconclusive
308
Albuterol and beta-adrenergic shifts in electrolytes?
Potassium intracellular shift - Na-K ATPase pump and NaK2Cl cotransporter, as well as release of insulin
309
Why does ADH remain "on" during hyponatremic dehydration?
Non-osmotic stimulation of ADH in response to ATII
310
When to use sodium bicarb treatment?
Salicyclate toxicity, TCA antidepressant, severe metabolicc acidosis, hyperkalemia
311
Causes of acute pericarditis (4)
Viral, automimmune, uremia, and Post-MI
312
Treatment of uremic pericarditis
confirm no tamponade (>50%), then dialyze
313
Adducted and internally rotated shoulder after seizure?
Posterior dyslocation
314
Signs of magnesium toxicity?
Somnolence, loss of deep tenden reflex, respiratory depression
315
Prenatal lab tests first trimester (7)
1. Antibody - RhD and antibody
2. Anemia- Hg, Hct, and MCV
3. Chronic STD - HIV, VDRL, HBsAg
4. Immunity - Rubella, varicella
5. Pap test - if due
6. Quick std - Chlamydia PCR
7. Urine - Culture and protein
316
Prenatal tests at 24-28 weeks (3)
1. Anemia - Hg/Hct
2. Antibody (if RhD neg)
3. 1 hr GCT
317
Final visit tests prenatal (35-37 weeks)
1. GBS
318
Why GTT at end of 2nd trimester?
Placenta secretes hormones to increase maternal insulin resistance to make glucose available for baby. If at risk, should also be tested first trimester for underlying DM2
319
What anticancer drug for hormone sensitive cancers can cause hot flashes? (D/P)
Tamoxifen, thermoregulatory dysfunction in anterior hypothalamus
320
Where does tamoxifen exhibit estrogen agonist activity?
The endometrium, increases risk of cancer or polyps
321
How long to delay antibiotics in favor of collecting blood cultures in acute IE?
1 hour
322
Arthritis with intermittent diarhea and abdominal pain (D/Tr)
Spondylarthritis or sacroiliitis with IBD up to 75% - NSAIDS releive the pain but exacerbaate bowel disease
323
Penile fracture with urinary symptoms?
Get a retrograde urtethrogram
324
Management for penile fractures
Surgery
325
Treatment of carotid stenosis?
Symptomatic with >70% stenosis - carotid endartectomy
Assymptomatic -antiplatelet and statin
326
Most common cardiac anomalies in Turner's?
Bicuspid aortic valve and aortic coarctation
327
Metabolic alkalosis in chronic diarrhea?
Laxative abuse
328
Melanosis coli - dark brown discoleration of the colon with pale patches of skin
due to regular laxative abuse
329
First line treatment for Idiopathic intercranial hypertension?
Acetazolamine - CA inhibitor in coroid plexus
330
Cyanosis aggravated by feedingand relieved by crying (D/BT)?
Choanal atresia. Pass a catheter, then CT
331
When you see coanal atresia, what else should you look for?
CHARGE syndrome - Coloboma, Heart defects, atresia choanae, retardation of growth/development, genitourinary abnormalities, ear abnormalities/deafness
332
Recurrent pregnancy loss with TIA in a young person?
Antiphopholipid syndrome with or without SLE
333
Can a subserosal fibroid affect a pregnancy?
No, subserosal
334
Infant jaundice, light-colored stools, hepatomegaly, and conjugated hyperbilirubinemia (D/BT/Tr)?
Biliary atresia, abdominal ultrasound then scintigraphy, Kasai procedure followed by liver transplant
335
Drugs that can cause crystal induced kidney injuries (6)
1. Acyclovir
2. Sulfonamides
3. Methotrexate
4. Ethylene glycol
5. Protease inhibitors
6. Uric acid (tumor lysis syndrom)
336
MRI for eye foreign body?
NEVER - can displace object
337
Turner syndrome with systolic murmur at left infraclaviclar area?
Aortic coarc
338
Turner syndrome endocrine
streak ovaries - no inhibition, elevated LH and FSH
339
Hypoxemia, tachycardia, tachypnea without evidence of rib fracture in trauma patient and patchy alveolar infiltrate on CXR
Pulmonary contusion, get a CT (CXR takes a while to show
340
What is the risk of not treating hyperthyroidism?
Bone loss and increased risk of fracture and cardiac tachyarrythmias
341
Mechanism of action of heparin?
Binding antithrombin which inactivates Xa and prolongs aPPT
342
Progress of a thrombus 5 days into heparin (D/P)?
Type 2 heparin-induced thrombocytopenia, conformational change to platelet surface PF4 causes immune system to form IgG antibody, resulting in thrombocytopenia AND activated platelets
343
Heart failure in a young person months after a knife stabbing?
AV fistula - shunting of blood from arterial to venous system
344
ABI < 0.9?
Diagnostic of occlusive PAD
345
One time screening for men 65-75 w/t history of smoking?
Abdominal aortic aneurysm
346
How to diagnose Hep C?
Two steps as almost half of patients spontenously clear - first serologic test for HCV antibody then confirmatory molecular test for Hep C
347
ebrile wasting disorder in immunocompromised with pulmonary, mucucuntaneous, and reticuloendothelial manifestations and pancytopenia (D/BT)
Histo - serum or urine antigen immunoassay, not initial fungal cultures due to 4-6 weeks incubation
348
Treatment for histo
IV amphotericin B then oral itraconazole for a year of maintenance
349
Hypertension, hypokalemia, and undetectable renin in someone on multiple anti-hypertensive therapies (D/P)?
Hyperaldosteronism - adrenal adenoma or bilateral adrenal hyperplasia vs. Cushing's vs. , hypokalemia often unmasked with diuretics
350
What is aldosterone escape?
In response to aldosterone, body ups renal blood flow, GFR, and NA excretion through ANP
351
Treatment of primary Raynaud's?
CCB - B-blockers WORSEN condition
352
Risk of congenital melanocytic nevus being cancerous?
Up to 5% depending on size
353
Another name for Mongolian spots?
Congenital dermal melanocytosis
354
Arteries that lead to interventricular septum
LAD or right coronary
355
Differentiate papillary muscle rupture and ventricular wall rupture by clinical signs?
Mitral regurg - soft murmur with no palpable thrill
356
REcommended vaccines during normal pregnancy
Tdap, inactivated influenze, RhoD
357
High risk patient pregnancy vaccinations
Hep A, Hep B, Pneumococcus, Hib, Meningococcus, Varicella-zoster Immunoglobulin
358
what is the q-tip test?
Diagnoses urethral hypermobility - angle of >= 30degrees from horizontal on increase of abdominal pressure
359
What causes impetigo?
GAS and staph aureus
360
treatment of impetigo?
Mupirocen (topical)
361
Out of proportion abdominal pain, elevated amylate, and metabolic acidosis (D/Bt)
acute mesentaric ischemia, CT angio
362
Continued ear drainage in a child with proper antibiotic therapy? Ear finding?
Cholesteotoma. Retraction pocket filled with debri
363
CMV retinal presentation?
Full thickness inflammation that moves centripetally from the vasculature
364
Yellow-white fluffly lesions along vasculature of eye -
CMV - diagnostic
365
Treatment for CMV retinitis -
valganciclovir usually, intravitreal injections if near the nerve or feovea
366
Mumps possible complications
parotiditis, orchitis, and aseptic meningitis
367
Intermittent, fever, malaise, weight loss, chronic rhinosinusitis, lower respiratory tract involvement leading to tracheal narrowing, multiple lung nodules with cavitation, and renal envolvement
Wegeners/ granulomatosis w/t polyangiitis
368
Complication of Wegener's -
necrotizing crescentic pauci-immune glomerulonephritis
369
Diagnosis of granulomatous polyangitis
p-ANCA and tissue biopsy
370
Treatment of wegener's
high dose corticosteroids and cyclophosphamide or rituximab
371
Fever, lower abominal flank pain, and abdominal pain with hip extension
- psoas abscess
372
Best med to slow diabetic nephropathy?
ACEi
373
CNS stimulation, GI disturbances, and Cardiac toxicity in COPD'r who recently took cipro?
Think theophylline toxicity, subject to cytochrome oxidase system
374
NSCLC mets to brain in a patient <65 with good functional performance status and stable extracranial disease
Aggressive treatment, surgical resection followed by whole brain radiation therapy, no chemo in NSCLC
375
Noncaseating GI tract granulomas
Crohn's disease
376
Treatment order for acne and path of acne
Path - increased sebum, follicular hyperkeratinization, bacterial colonization, and inflammation
Treatment - topical retinoids, benzoyl peroxide, then topical erythromycin
377
Hard, unilateral, non-tender node in the submandibular or cervical region in an old smoker?
SCC - prompt biopsy
378
What causes achalasia?
Impaired peristalsis and inability for LES to relax
379
Best test for diagnosis of achalasia?
Manometry
380
When not to use albuterol for hyperkalemia
active coronary artery disease
381
Late stage complication of radiation therapy?
Constrictive pericarditis
382
Findings of constrictive pericarditis?
Hepatojugular reflux, Kussmaul's sign, and pericardial knock
383
Differential for hematochezia in toddlerhood
hemorrhoids, infectious colitis, intussusception, Meckel's and aIBD
384
Cause of meckel's
incomplete obliteration of vitelline duct
385
Most frequent location of atopic foci causing Afib?
Pulmonary veins
386
When is acanthosis nigricans concerning?
Sudden appearance in middle aged or elderly, especially if they have lost weight and in uncommon spots - suggestive of GI or GU malignancy
387
If failing treatment with initial max dose SSRI, do what?
Switch to another first line like venlafaxine (SNRI)
388
When is buproprion contraindicated?
Bulemia nervosa
389
Nonreactive NST next step? What is it?
Biophysical profile - NST plus ultrasound of amniotic fluid index and fetal status.
390
What is a contraction stress test -
administering oxy until 3 contractions every 10 minutes - contraindicated in placenta previa and prior myectomy
391
Use of umbilical artery flow velocimetery?
Monitor fetal growth
392
Components of BPP and negative test?
```
Reactive HR (2), Amniotic lfuid folume (2, >2cmx1cm), Fetal movements >3 (2), >1 episode of flexion/extension (2), and >=1 breathing episode (2).
0-4/10 - fetal hypoxia due to placental insufficienc
```
393
Meningococcal schedule -
initial at 11-2, booster age 16-21
394
What kind of vaccine is yellow fever
Live attenuated
395
Is acute prepatellar bursitis usually due to infection?
Yes- staph aureus, aspirate the fluid
396
severe headache, abdominal pain, nausea, and vomitting with htn and +hcg in <20 week EGA
likely pre-eclampsia due to hyadatiform mold
397
Signs of alcohol abuse
number of drinks, liver functions AST>ALT 2:1, macrocytosis
398
Suprapubic pain radiating to back or hips made worse by weight-bearing after giving birth to large baby?
pubic symphasis diastesis
399
White matter demylenation with no surrounding edema in HIV with low CD4 count?
Progressive multifocal leukencephalopathy due to JC virus
400
New breast mass with foamy macrophages and fat globules and concordant path findings on excision?
Fat necrosis - reassurance and follow-up
401
Serous otitis media in HIV+ path?
Lymphadenopathy or obstruting lymphomas
402
Digitalis toxicity cardiac finding?
Atrial tachycardia with AV block - increases ectopy in atria while decreasing conduction through AV block
403
Multifocal atrial tachycardia association?
Pulmonary disease
404
Leading cause of blindness in the USA?
Diabetic retinopathy
405
Findings of diabetic retinopathy? 3 types
1. Microaneurysms, hemorrhages, exudates, and retinal edema
2. Pre-proliferative reinopathy with cotton wool spots
3. Proliferative/malignant retinopathy - newly formed vessels
406
Side effect of terazosin -
orthostatic hypotension and dizziness
407
Side effect of 5-alpha reductase inhibitors ("sterides"
decreased libido, ED
408
Amiodarone side effects
Cardiac: Sinus brady, can be proarrhythmic, QT prolongation and torsades
Pulmonary: Chronic interstitial pneumonitis
Endocrine: Thyroid dysfunction
GI: Hepatitis
Ocular: Corneal microdeposits, optic neuropathy
Derm: Blue-gray skin
Neuro: Peripheral Neuropathy
409
What causes anemia of prematurity?
Normally, EPO drops due to O2 concentration after delivery, resulting in blood nadir at 2-3 mo of life. For preterm infants, low EPO + short RBC life span +frequent phlebotomy can lead to frank anemia
410
Medical causes of priapism?
Alpha-1 antagonists, TRAZADONE, some SSRI's, PDE-i, meth and cocaine
411
Non-medication causes of priapism?
Perineal trauma, sickle cell disease
412
One of the most common non-pulm complications of CF?
Sinopulmonary disease - opacifications seen as early as 8 mo
413
The 5 H's and T's of PEA:
1. Hypovolemia Tension Pneumo
2. Hypoxia Tamponade
3. Hydrogen ions Toxins
4. Hyper/Hypokalemia Thrombosis
5. Hypothermia Trauma
414
Treating PEA
1. CPR then epinephrine
415
Difference between treating PEA and pulseless Vtach
shock the Vtach
416
Intense pruitus, dyspareunia, dysuria, and porcelain-white polygonal patches with atrophy?
Lichen sclerosis - still do a punch biopsy to rule out vulvur SCC as it is a premalignant lesion
417
Treatment for lichen sclerosis
high-potency topical corticosteroid (clobestasol)
418
High fever and rigidity on antipsychotic (D/Tr)
Neuroepileptic malignant syndrome - stop antipsycotics and use dantrolene if refractory
419
Differentiated NMS from serotonin syndrome?
Lead pipe rigidity in NMS, not in serotonin syndrome
420
Stuttering stroke progression with periods of improvement?
Thrombotic
421
Abrupt and maximal at start?
Ischemic/embolic
422
Progressive symptoms over minutes to hours with early focal neuro symptoms then intracranial pressure increase?
Intracerebral hemmorhage
423
Severe headache with meningial irritation signs and no focal deficits?
Spontaneous subarachnoid hemmorhage
424
Is afib automatically increased stroke risk?
No, need structural heart defect as well
425
Low APGAR?
pulse ox and PEEP
426
Electrolyte abnormality post thyroidectomy?
Possible hypocalcemia due to accidental removal of paratyhroid gland
427
Elevated LDH and anemia with preeclampsia?
Microangiopathic hemolysis
428
Most common complication of preeclampsia -
fetal grwoth restriction, low birth weight
429
Fever and maculopapular rash one week after MMR vaccine?
Vaccine strain measles
430
Signs of co-ingestion of alcohol with benzo's
Bradycardia, hypotension, respiratory depression, or hyporeflexia
431
Painful red eye with photophobia, tearing, and diminished visual acuity and abdominal symptoms
anterior uveitis
432
Valproate effect on infants? Alternatives for bipolar use?
Neural tube defects, Lamotrigine is safe
