Week 3 Flashcards
(471 cards)
1
Q
Antibiotics if kid meets all CENTOR criteria?
A
No, must be confirmed on rapid stress or culture as opposed to adults
2
Q
Pneumatosis intestinalis in a neonate?
A
NEC
3
Q
Treatment for enuresis
A
Behavior modification ->enuresis alarms (take 3-4months to be effective ->oral desmopressin for immediate help (not meant as monotherapy)
4
Q
White granular patch on buccal mucosa of patient with tobacco and alcohol use? Leukoplakia - precancerous lesion
A
How to treat leukoplakia and when to biopsy? Stop tobacco and it will disappear in 2-3 weeks, biopsy if you see ulcers or induration
5
Q
Large, painful liver mass in a young woman with signs of obstruction?
A
Hepatic adenoma, common with OCP vs. focal nodular hyperplasion, less common and will have arterial flow evidence
6
Q
Prophylaxis for GBS in patient’s who have not been screened
A
- <37 weeks gestation
- Intrapartum fever
- ROM >18 hrs
7
Q
Blurring of grey white matter interface after blunt trauma
A
Diffuse axonal injury - rotational force at area of decreased density results in vegetative state out of proportion to CT finding
8
Q
Cause of hypogonadotropic hypogonadism
A
oss of pulsatile GnRH secretion precipitated by weight loss, stress, or chronic illness
9
Q
chronic anesthetic, macular (often hypopigmented) skin lesions with raised well-demarkated borders and nearby nodular and tender nerves (D/BT)
A
Leprosy (mycobacterium leprae) - full thickness biopsy
10
Q
Treatment for minimal lesion leprosy? Treatment with extensive lesions?
A
Limited - dapsone or rifampin, extensive dapsone/rifampin AND clofazimine
11
Q
Treatment of rheumatic fever and follow up after?
A
Benzathine pen G until adulthood
12
Q
Rapidly progressive cellulitis of submandibular space (D/P/serious complication/BT/Tr)
A
Ludwig angina - usually dental infection - polymicrobial, can result in airway compromise, CT scan of the neck, IV antibiotics and removal of inciting tooth - does not need drainage
13
Q
Hemolytic anemia following sulfa drugs (D/P)
A
G6PD deficiency, X-linked genetics
14
Q
Cape distribution sensory loss with preservation of vibration and proprioception neuro cause (D/P/associated disease). Why would there be areflexia?
A
Synringomyelia - fluid filled cavity that may represent dilation of central canal or separate cavity - Arnold Chiari type I - areflexia and weakness from compression of anterior horn gray matter
15
Q
Affect of anesthesia on pheochromocytoma
A
Catecholamine surge - sudden huge hypertension
16
Q
Affect of b-blockers on pheochromocytoma-
A
unnopoosed alpha adrenergic stimulation
17
Q
Mild megaloblastic anemia on phenytoin, primidone, or phenobarbitol (Path)? Other causes of this deficiency?
A
Impaired folic acid absorption, folic acid supplementation. Other drugs - Trimethoprim and Methotrexate - dihydrofolate reductase inhibitors - need folinic acid (leucovorin) to reverse anti-folate effect of methotrexate)
18
Q
Elevation in folate and cobalmin deficiency? Distinguishing elevation?
A
Elevation of homocysteine (decreased conversion to methionine), methylmalonic acid concentration elevated in cobalamin deficiency due to decreased conversion to succinyl coA
19
Q
Biphasic respiratory distress in an infant which improves with neck extension
A
vascular ring
20
Q
Differentiate vascular ring and laryngomalacia?
A
Place patient prone - laryngomalacia should improve
21
Q
Why have ankylosing spondylitis patients do PFT’s?
A
To check for restritive pattern due to rib fixation - residual volume normal or increased due to rib fixation in inspiratory position
22
Q
MRO chest injury from fall or blunt trauma?
A
Blunt aortic injury
23
Q
anticoagulation, symptoms of weakness and dizziness, evidence of anemia and tachy with significant back pain -
A
> internal hemmorhage, consider retroperitoneal which can occur at normal INR’s spontaneously
24
Q
Hypertension in pregnancy after 20 weeks without nephropathy?
A
Gestational hypertension
25
Chronic hypertension pregnancy risks?
Preeclampsia, PPH, GDM, placental abruption, fetal growht resitriction, perinatal mortality, preterm delivery, oligohydramnios
26
Workup for sleep terrors?
None - typically resolve in 1-2 years
27
Thyroid issue affecting 1/15 women after childbirth? Description?
Postpartum thyroiditis - brief hyperthyroid phase followed by hypothyroid phase with bradycardia, diastolic hypertension, lower extremity edema and possible coarse facies
28
Associated antibody with postpartum thyroiditis
anti-thyroid peroxidase - variant of Painless/silent thyroiditis - return to euthyroid state over several months
29
Syncope, hypotension, and new right bundle branch block when recovering from major operation?
Massive PE
30
Fetal nontender head swelling that does not cross suture lines?
Cephalohematoma - subperiostial
31
Fetal nontender head swelling that does cross suture lines?
Caput succedaneum
32
Treatment of tardive dyskinesia
d/c or switch drug - Clozapine has least EPS
33
If suspicion is high enough for arterial occlusion, do what first?
Heparin
34
Cause of putaminal hemmorhage in chronic hypertension <60
Charcot-Bouchard aneurysms
35
Atopic dermatitis presentation difference in infants vs. children/adults?
Intant - itchy scaly crusted lesions on extensor surfaces, trunks, cheeks, scalp
Child/adult- Lichenified plaques in flexural creases
36
Stuttering episodes of nausea, vomitting, with pneumobillia
Gallstone ileus
37
Differentiate pneumobilia from gallstone ileus?
Hypoactive bowel sounds pneumobilia, hyperactive bowel sounds gallstone ileus
38
Can polymyositis cause dysphagia?
Yes
39
Managing substance induced cardiac ischemia?
Benzo's for blood pressure and anxiety, aspirin, nitro and calcium channel blockers fine, Beta-Blockers CONTRAINDICATED, unopposed alpha effect of cocaine, catheterization if needed
40
Risk of pulmonary toxicity with amiodarone correlates to what measure of drug intake?
Total cumulative dose
41
profound back pain, hematuria, hypotension, and coronary ischemia on EKG?
AAA rupture - gross hematuria from bladder venogongestion
42
Impaired taste, impaired wound healing, immune dysfunction, alopecia, skin rash for someone on parenteral nutrition
Zinc deficiency
43
Fragile hair, skin depigmentation, neuro dysfunction like B12, and sideroblastic anemia
Copper deficiency
44
Dermatitis (hyperpigmented), diarrhea, dementia (pellagra)
Niacin (B3) deficiency
45
Deficiency leading to thyroid dysfunction and cardiomyopathy?
Selenium deficiency
46
Pure hemisensory loss stroke location
- Thalamus, VPL and VPN
47
Ipsilateral face and contralateral body pain/temp loss, ipsilateral bulbar muscle weakness, vertigo, and horner's (D/P)
Lateral medullary infarction, PICA occlusion
48
Ipsilateral oculomotor palsy, ataxia, and contralateral hemiparesis
Midbrain stroke- ataxia from superior cerebellar peduncle, hemeparesis from cerebral peduncle
49
Signs that a stroke may be cortical?
Aphasia, agnosia
50
Contralateral hemiparesis, sensory loss, and conjugate gaze palsy
putaminal damage with corresponding internal capsule
51
Area responsible for spatial organization?
Non-dominant (usually right) parietal lobe
52
Fatigue, weight loss, hypotension, inability to breast feed after complicated pregnancy?
Sheehan's syndrome - ischemic infarction and necrosis of pituitary
53
What to check for after loss of consciousness
POSTICTAL STATE
54
Pulsus paradoxus after severe chest pain radiating to back and widened mediastinum?
Aortic dissecion with cardiac tamponade
55
Lab finding of antiphospholipid syndrome?
Paradoxical Prolonged PTT that does not correct when diluted with normal plasma as it binds the phospholipids used in assays
56
preferred long term oral anticoagulant in end-stage renal disease?
Warfarin
57
Intrauterine demise with multiple limb fractures and hypoplastic thoracic cavity (D/P)
Type II Osteogenesis Imperfecta - AD disorder related to type 1 collagn synthesis
58
New onset spinal signs in a 6 yo girl with down syndrome?
Atlantoaxial instability
59
First line bipolar medications?
Lithium, valproate, quetiapine, lamotrigine
60
Nausea, vomitting, weight loss, and signs of dehydration in gestational mom of twins? Differentiator from typical N/V of pregnancy?
Hyperemesis gravidarum - differentiate by presence of ketones in the urine
61
Rapid onset <1 year hirsuitism with virilization (D/BT)?
Androgen-secreting neoplasm, get serum testosterone and DHEAS levels - elevated test normal DHEAS - ovarian source, DHEAS elevatedd - adrenal tumor
62
Fatigue, anorexia, hypoglycemia with testicular atrophy and cold intolerance, constipation, mild hyponatremia and hypotension.
Panhypopituitarism - fatigue, anorexia, hypoglycemia (low cortisol) testicular atrophy (hypogonadotropic hypogonadism) cold intolerance, constipation (hypothyroidism), hyponatremia/hypotension (ADH/decreased peripheral artery
63
What adrenal hormone is unaffected by panhypopituitarism?
Aldosterone
64
Diagnosis of HIT type 2:
Heparin exposure >5 days AND
1. Platelet count reduction >50%
2. New thrombosis/expanding thrombosis
3. Necrotic skin lesions
4. Anaphylaxis
65
Diagnosis of Type 2 HIT
Serotonin release assay
66
Alternatives to heparin in HIT:
Argatroban, fondiparinux, eventually warfarin
67
Antibodies for lupus (sensitive then specific)
ANA sensitive, anti-dsDNA and anti-Sm (specific)
68
Felty syndrome
RA PLUS splenomegaly and neutropenia
69
First test in alkali ingestion in absence of perf or respiratory distress?
Endoscopy to assess for esophageal damage
70
Do studies show steroids help after esophageal damage?
No
71
PCOS with normal testosterone?
Can appear normal due to decreased levels of sex hromone binding globulin,elevated free testosterone not measured
72
Second line for bipolar treatment
Lithium or valproate with a second gen antipsychotic
73
Standard vitamin supplementation with measles?
Vitamin A - promotes antibody producing cells and regenteration of epithelium
74
Vit E deficiency symptoms?
Hemolytic anemia, neuro complications like ataxia
75
Phases of pertussis
Catarrhal (1-2 weeks) - mild cough, rhinitis
Paroxysmal (2-6 weeks) - whoop, postussive emesis
Covalescense (weeks - months) gradual resolutions
76
Treatment for pertussis
Macrolides
77
Blood findings with pertussis
marked lymphocytosis
78
Do you need pallor or pulselessness to diagnose compartment syndrome?
NO, unusual finding
79
Metabolic abnormalities of hypothyroidism?
Hyperlipidemia, hyponatremia, assymptomatic elevations of CK and serum transaminases
80
Painless, rapid, and transient vision loss with "curtain descending" (D/ most common cause)
Amaurosis fugax - most commonly caused by atherosclerotic emboli from ipilateral carotid artery
81
Age of onset of neonatal conjunctivits and treatment?
<24 hours -silver nitrate chemical - eye lubricant
2-5 days - gonococcal - IM ceftriax
5-14 days - chlamydial - PO macrolide
82
Cause of Lesch-Nyhan syndrome?
X-linked recessive cause by deficiency of hypoxanthine guanine phosphoribosyltrasnsferase - accumulation of hypoxanthine and uric acid
83
6 mo girl regressing in speech and motor function with hand wringing?
Rett syndrome
84
Important cause of hypocalcemia in alcoholics (D/P)
Hypomagnesemia - decreased release of PTH but not associated with elevated phos levels
85
Correction for albumin level via calcium
0.8 for every 1 gm/L decrease in albumin
86
Be careful giving sildenafil with what?
Alpha blocker (doxazosin) due to possibility of severe hypotension
Nitrates - severe hypotension
87
Leading cause of euvolemic hyponatremia in someone taking lithium?
Diabetes insipidus
88
Difference between complete and partial DI?
Complete - urine mOsm/kg <300 (often less than 100)
| Partial - urine osmols from 300-600
89
Causes of nephrogenic DI?
Severe hypokalemia, hypercalcemia, meds (lithium, demeclocycline, foscarnet, cidofovir, amphotericin
90
Treatment of nephrogenic DI due to lithium?
Salt restriction and d/c lithium
91
Criteria for IBS
Recurrent abdominal pain/discomfort >3 days/month for 3 months with 2/3 of the following:
1. Symptom improvement with bowel movement
2. Change in stool frequency
3. Change in form of stool
92
HIT rate higher with fractionated or unfractionated heparin? How to tell the difference?
unfractionated, markedly elevated aPPT with unfractionated heparin
93
Why irregular cycles in adolescents?
Immature and insufficient - confirmed with menarche after exogenous progesterone administration
94
target blood glucose levels in gestational DM
Fasting <=95, 1 hr postprandial <=140, 2 hr postprandial <=120
95
Managing shoulder dystocia
BE CALM - breathe (don't push), elevate legs and flex hips, call for help, suprapubic pressure, enlarge vaginal opening with episiotomy, maneuvers
96
McRoberts maneuver value in shoulder dystocia
relieves almost half
97
Cyanide toxicity mechanism of action?
potent inhibitor of cytochrome oxidase a3 and inhibits reduction to ferrous iron
98
Main toxins of smoke?
Hydrogen cyanide and carbon monoxide
99
Treating cyanide toxicity
hydroxocobalamin or sodium thiosulfate
100
Delusions, tactile hallucinations, aggression, poor dentition, excoriations
methamphetamine use disorder
101
Severe GI symptoms, confusion, ataxia, and tremors with CNS irritability like seizures for bipolar patient? What medication change might have happened?
Lithium toxicity - Thiazide diuretics decrease secretion of lithium
102
Meds that increase lithium levels
ACEi, NSAIDS, tetracyclines, metronydazole
103
Classic lab finding in poststreptococcal glomerulonephritis and related path
Immune complex deposition gets attacked by complement, leading to C3 in glomeruli and low complement C3 in serum
104
Treatment of PGSN?
Supportive and blood pressure control
105
Most common cause of renal vein thrombosis and path?
Membranous glomerulonephropathy - loss of ATIII
106
Anemia, low haptoglobin, elevated bilirubin, elevated LDH - intravascular hemolysis
Hepatic vein thrombosis with hemolysis - paroxysmal nocturnal hemoglobinuria
107
BT for paroxysmal nocturnal hemoglobinuria and path?
Flow cytometry, shows abscence of CD 55 and CD 59 due to genetic defect in GPTD anchor - lack of complement inhibition allows membrane attack complex to form
108
Mono-like illness with persisten fever, malaise, fatigue, absodlute lymphocytosis and >10% atypical lymphocytes
CMV
109
Differentiate CMV from EBV
Usually mild or absent pharyngitis, lymphadenopathy, and splenomegaly - supported by negative monospot and positive CMV IgM serology
110
what causes pain in primary amenorrhea?
Release of prostaglandins from endometrium causes uterine contractions - treat with NSAIDS
111
NMS non dantrolene management?
Bromocriptine or amantadine that can reverse dopamine block
112
Treatment of severe serotonin syndrome?
Cryoheptadine
113
Treatment of antipsychotic dystonias and EPS?
Benztropine
114
Major causes of sudden death?
CAD, cardiomyopathy, arrhthmia, congenital heart defect
115
Difference between Stevens-Johnson syndrome and Toxic epidermal necrosis?
<10%, SJS, >30% body involvement, TEN
116
Causes of TEN?
Antibiotics, anticonvulsants, allopurinol
117
Loop diuretic sensory side effect? what primes this effect?
Ototoxicity, concurrent aminoglycosides or renal insufficiency
118
Monocular vision loss, afferent pupillary defect, and central sotoma in a young woman -
Optic neuritis often due to MS
119
When to perform antepartum fetal surveillance?
high risk pregnancies like maternal hypertension, DM, or fetal post-term pregnancy or growth restriction
120
Common way to conduct antepartum fetal surveillance for gestational hypertension
Weekly BPP's starting at 32 weeks
121
BPP score of 6/10
Equivocal, repeat in 24 hours
122
Definition of latent Tb -
no signs on chest x-ray, nfiltrate, lymphadenopathy, or symptoms
123
Treatement for latent TB
oniazid and Pyridoxine (to prevent isoniazid neuropathy)
124
Mono plus mucocutaneous ulcers plus skin rahs plus diarrhea?
HIV
125
Genital warts medical name?
Condylomata acuminata
126
HPV strains causing genital warts?
6 and 11
127
Nonsurgical treatment for genital warts?
Podophyllin resin, trichloroccetic acid
128
Condylomata lata vs. acumunata?
Lata - syphillis, acuminata - warts
129
Most common complication for sickle cell trait?
Microscopic gross hematuria and hyposthenuria (impairment concentrating urine)
130
Differential for liver abscess?
Entamoeba histolyica - young person with dyssentery
Echinoccocus - usually assymptomatic, frequent contact with animals, may have eosinophilia
Bacterial - older diabetic or liver disease patient
131
Test for entomoeba histolytica? Treatment?
Serologic testing (stool microscopy insensitive at liver stage) treatment with metronidazole AND a luminal agent like paromomycin
132
Entamoeba vs echinococcus which to drain -
drain echinococcus and give albendazole, don't drain entamoeba
133
Murmur in aplastic crisis? Usually cause in sickle cell?
Functional systolic murmur due to hyperdynamic blood flow. Parvo B19, can happen even without preceding viral symptoms
134
Pulmonary vasoocclusion and infection, fever, chest pain, and new radiographic infiltrate in sickle cell?
Acute chest syndrome
135
After O2, best treatment for cluster headaches?
Subcutaneous sumatriptan
136
Hypertension, bradycardia, and respiratory depression in the face of head trauma?
Cushing's reflex, elevated ICP
137
Signs of uncal herniation and cause?
1. . Contralateral crus cerebri against tentorial edge - ipsilateral hemiparesis
2. Compression of ipsilateral oculomotor nerve - Early mydriasis - late - down and out puil (unopposed trochlear and abducens)
3. Contralateral homonymous heminopsia - compression of ipsi posterior cerebral artery
4. Altered level of consciousness - reticular formation
138
Distinguished polymalgia rheumatica and fibromyalgA
PR has elevated ESR, CRP, PR usually only tender due to bursitis or synovitis, more commonly stiff shoulders and pelvic girdle
139
Major adverse effect of hydroxyurea?
Myelosuppression
140
Normal percentage of HbF in sickle cell patient?
5-15%, increases with hydroxyurea
141
Side effects of second gen antipsychotic olanzapine and clozapine?
Weight gain, dyslipidemia, hyperglycemia, increased risk for diabetes
142
Henoch Schonlein purura path and manifestations
IgA mediated leukocytoclastic vasculitis, gravity dependent palpable purpura, arthritis, and renal disease similar to IgA nephropathy
Normal platelet count and coag studies, commonly find hematuria +-RBC casts +- Proteinuriea
143
Treatment for HSP
Supportive unless severe, then glucocorticoids and hospitalization
144
thyroid changes in pregnancy?
Increased thyroxine binding globulin and increased thyroxine production resulting in total thyroid hormone level with minial increase to T4 = if already hypothyroid can worsen hypothyroid state
145
Bartholin cyst location and presentation
Vulvar vestibule at 4 and 8 oclock - large cysts can cause vaginal pressure and discomfort with motion but clinically cyst is small, mobile, nontender, cystic mass behind the posterior labium majora with extension to vagina
146
Differentiate bartholin cyst vs bartholyn abscess?
Abscess indurated and tender
147
What causes staph toxic shock syndrome?
Toxin 1- superantigen
148
High PTH, high calcium, low urine calcium excretion?
Familial hypercalcemic hypocalciuria, defect in calcium-sensing receptor, UCCR <0.01 comparedto >0.02 in HPTH
149
Workup for primary autoimmune insufficiency?
8 am serum cortisol and plasma ACTH
150
What is the ACTH stim test?
Cosyntropin given, should have a rapid rise of cortisol but will have low (central insufficiency) or insignificant rise
151
Basal cortisol low, ACTH high, minimal response to cosyntropin - primary adrenal insufficiency
Basal cortisol low, ACTH low, minimal response to cosyntropin - secondary or tertiary adrenal insufficienct
152
Difference between PPSV23 and PPCV13
PCV13 is conjugated and induces T-cell dependent B-cell response
153
Hypertonic and hyperrreflexia lower extremities in infant with lower extremity feet pointing inwards? Risk factors?
Cerebral palsy - prematurity
154
2-8 week old with regurgitation, painless bloody stools, and eczema
Milk/soy protein induced enterocolitis - eliminatie milk and soy from maternal diet or initiate hydrolyzed formula - spontaneously resolves in a year
155
Sudden onset of vaginal bleeding in pregnant woman with high frequency, low-intesnity contractions and hypertonic, tender uterus?
Abruptio placentae - retroplacental bleeding
156
Risk to mother of placental detachment? Risk to baby?
DIC and shock to mother, hypoxia and preterm delivery to baby
157
Treatment for bullous pemphigoid?
High potency topical glucocorticoid
158
Saline responsive vs saline unresponsive metabolic alkalosis
Saline unresponsibe - typically hypervolumia (hyperaldosteronism, Cushing syndrome, excess black licorice) OR kidney issue (Barter's, Gitelman's) - not corrected by saline and elevated levels of urinary chloride
Saline unresponsive - loss of gastric secretions - volume depletion and low serum Cl/low urinary chloride
159
Risk in infant <2 mo of bronchiolitis?
Apnea or recurrent wheezing
160
What to give exceptionally high risk kids with bronchiolitis?
Palivizumab
161
Most common bacteria colonized in CF'r before age 20? After age 20?
Staph aureus, pseudomonas
162
Hypernatremia and dilute urine?
Think diabetes insipidus
163
Do central or nephrogenic DI patients compensate better?
Nephrogenic - no decreased thirst
164
Cause of pericarditis in kidney failure? Treatment? Level at which it occurs?
Uremia, dialysis, usually BUN > 60mg/dL
165
Major gluconeogenic amino acid and what is it converted to?
Alanine to pyruvate
166
Main substrates of gluconeogenesis?
Alanine, glutamine, lactate, and glycerol 3-phosphate
167
Opsonization?
Antibody mediated phagocytosis conducted by the spleen - patients with asplenia at high risk of pneumococcal, meningococcal and Hib
168
Umbillicus sensory level?
T10
169
Low MCV, RDW, Mentzer index <13, target or teardrop cells:
thalassemia
170
Differentiate iron deficiency anemia and thal minor
thal has higher reticulocyte count and normal RDW
171
Parkinson's symptoms on risperidone but can't back down the dose?
Add benztropine (appropriate to switch to clozapine for tardive)
172
First or second generation antihistamines for postnasal drip causing cough?
First gen - who knows why, no response in 2-3 weeks warrants further workup
173
Intraductal papilloma bening or malignant?
Benign
174
Differentiate intraductal papilloma and infiltrating ductal carcinoma?
Mass, microcalcification, and lymphadenopathy
175
Inflammatory arthritis, splenomegaly, and neutropenia
Felty syndrome
176
what has a dose-dependent causal effect on breast cancer?
Alcohol
177
Is vaginal bleeding/fissures normal in menopause?
Yes
178
Rett syndrome gene and major comorbidity
X-linked MECP2, seizures
179
Hyperandrogenism of pregnancy with bilateral cysts?
Either luteomas or theca lutein cysts, luteomas confer risk of virilization to female fetus but theca lutein cysts do not, both managed expectantly
180
Painless extensive bleeding during pregnancy?
Placenta previa
181
Differentiate placenta previa from vasa previa?
Vasa previa has rapid deterioration of fetal well being due to fetal bleeding
182
Common bug in febrile neutropenia?
Pseudomonas and other gram positives due to disruption of mucosal barriers
183
Therapy for febrial neutropenia?
Antipseudomonal agent - cefepime, meropenam, pip-tazo
184
Mitral valve dysfunction in HOCM?
Systolic anterior motion of mitral valve contacts thickened septum and causes LVOT
185
Bacterial of fungal infection within the eye?
Endopthalmitis - usually postoperative
186
CML gene and translocation?
BCR-ABL between 9;22 - leukemogenesis due to constantly activated tyrosine kinase, inhibited by imatinib
187
AML M3 variant treatment
Vitamin A
188
AML exposures:
Benzene, radiation, or past CML with blast crisis
189
Markers for ALL?
cALLA and Tdt
190
Treatment for ALL? Test?
Chemo plus ARA-c for CNS prophylaxis +/- radiation. LP to see if CNS, then need radiation
191
Leukemia you die with? Treatment?
CLL - chemo only for young (stem cell transplant) or old and symptomatic
192
Cause of spider angiomas and palmar erythema in cirrhosis?
Hyperestronism - impaired metabolism of circulating estrogen - effects vascular wall dilation
193
Cause of dupuytren contracture?
fibroblast proliferation and collagen deposition
194
COPD and cirrhosis run in the family?
Alpha-1 antitrypsin disease
195
AAT liver risk?
Hepatocellular carcinoma
196
Bilateral lung infiltrates, confusion/ataxia, and diarrhea following travel? (D/Tr)
Legionella, treat with macrolides or fluoroquinolones
197
Aortic stenosis signs in a young person and unequal blood pressures?
Supravalvular aortic stenosis due to congenital left ventricular outflow obstruction - palpable thrill in sternal notch
198
Cause of Hyper-IgM syndrome
X-linked defect in CD40 - Tcells have trouble binding to B cells to induce class switching
199
Differentiate hyper-IgM from Brutons X-linked agammaglobulinemia and Common variable immunodeficiency
Low B cells in bruton's and low IgM, normal B-cells in common variable and low IgM
200
Low IgG levels in 3-6 month old?
nadir of maternally derived antibody - transient
201
Management of preterm labor by week period
<32 weeks - betamethasone, tocolytics, magnesium sulfate, penicillin if unknown GBS
32-<34 weeks - betamethasone, tocolytics, penicillin if unkown GBS
34-<37 weeks - maye betamethasone, penicillin if GBS unknown
202
Why don't we use tocolytics after 34 weeks?
Indomethacin - closure of DA and oligohydramnios, nifedipie - maternal hypotension, tachy
203
Cause of nasopharyngeal carcinoma? Risk population?
EBV, southern china
204
Aflatoxin cancer association?
Hepatocellular carcinoma
205
Muscular dystrophy onsets:
Duchenne 2-3, gower sign and cal hypertrophy, X-linked recessive deletion of dystrophin, death by 20-30 from respiratory or heart failure
Becker 5-15- missing dystrophin, less severe Duchenne's (decreased dystrophin, not absent)
Myotonic - 12-30 - facial weakness, hand grip, myotonia, dysphagia, autosomal dominant expansion of CTG in DMPK gene
206
Wilms tumor associated syndrome
WAGR - wilm's, aniridia, genitourinary, retardation
Beckwith-Wiedemann
Denys-Drash
207
Treatment of Wilm's
tumor excision and chemo, maybe radiation
208
Mammography schedule?
women 50-75 every 2 years
209
Pap schedule
21 to 65 every 3 years
210
HLD screening?
Men 35+ lipid panel every 5 years
211
Most common hypercoagulable disorder?
Factor V Leiden - does not respond to protein C - continued thrombin formation
212
Ways to improve oxygenation
FiO2 or PEEP only
213
Best strategy in improving ARDS survival?
High PEEP
214
Resembles a DVT but has a medial malleoulus crescent sign?
Probably a popliteal cyst rupture but get an ultrasound just in case
215
How to transfuse an IgA deficient individual?
Washed red cell products
216
First line treatment for PMS?
Selective serotonin reuptake inhibitors
217
Brief transient euphoria, loss of consciousness, dermatitis around the mouth
Inhalent abuse
218
When to give hypertonic saline for hyponatremia?
CNS symptoms (signalling risk of cerebral edema)
219
Rate of increase of sodium?
<8meq/L over 24 hours
220
Night blindness, photophobia, dry scaly kin, dry eye, wrinkled, cloudly cornea -
vitamin A deficiency
221
Symptoms of early pregnancy, belief to be pregnant, no evidency on ultrasound or urine
pseudocyesis - somatization of stress- often will interpret negative pregnancy tests to be positive
222
Typical place for brain cancer metastasis?
white gray matter junction
223
Percentage of lung cancer patients presenting first with brain mets?
30%
224
Ugly duckling sign (appearance different than the other) of a mole?
90% sensitive for melanoma
225
Painless purpura, fatigue, weakness, fleeting joint pains, low C4 factor
Cryoglobulinemia
226
Differentiate mixed cryoglobulinemia from TTP
TTP has much more severe anemia and thrombocytopenia, non-palpable purpura
227
Anti-cyclic citrullinated peptide and RF
Rheumatoid arthritis
228
3-4 month old with doll-like face, thin extremities, short stature, protuberant abdomen?
Glucose-6-phosphatase deficiency (Von Gierke's) - cannot convert glycogen to glucose - get glycogen buildup, seizures, lactic acidosis, hyperuricemia
229
MS worsening factor of environment?
High temperature weather
230
LP finding in MS?
Oligoclonal IgG bands
231
Cause of Prader-Wili - deletion of parental copy of chromosome 15q11
Cause of Angelman syndrome - paternal uniparental disomy (mamma's boy, daddy's girl)
232
Thiazide effect on those with diabetes and metabolic syndrome
Hyperglucose, hypertriglyceride
233
Hemolytic anemia, increased mean corpuscular hemoglobin, jaundice, splenomegaly?
Hereditary spherocytosis
234
Fatigue, weakness, GI symptoms but no vomitting or diarrhea, and low BP?
Primary adrenal insufficiency
235
Signs of AS:
Weak slow rising pulse (parvus and tardus), single soft S2, mid-tolate peaking systolic murmur
236
abdominaal pain worse at night, weight loss and fatigue, migratory thrombophlebitis
Pancreatic cancer
237
Cushing ulcer typical presentation?
prominent gastric bleeding, acute onset
238
RA hot swollen single joint with fever?
Septic arthritis, RA is more at risk
239
Sail sign in child <3
Thymus
240
Treating bradycardia in hypothermia?
Active rewarming
241
What is tachysystole?
>5 contractions in 10 minutes, usually induced by labor inducers which can also cause tetanic contractions
242
Side effect of tachysystole
fetal heart rate trace abnormalities due to less blood flow 2/2 less relaxation, generally well tolerated
243
Side effects of oxytocin?
Tachysystole, hyponatremia, hypotension
244
Achalasia with slowly worsening symptoms and B signs?
Psuedoachalasia due to esophageal cancer
245
Back pain/perineal pain for >-3 months with irritative voiding symptoms and unidentifiable cause and normal urine culture?
Chronic prostatitis/chronic pelvic pain syndrome, inflammatory if leukocytes in urinalysis - diagnosis of exclusion, treat with antibiotics and usual antiprostate drugs
246
Eczematous ulcerating rash of the nipple -
Paget's disease of the breast - usually due to adenocarcinoma
247
5 days post-MI for anterior infarction be watching for?
Ventricular free wall rupture
248
Common manifestation of Lyme carditis?
AV node conduction block
249
How to diagnose Lyme?
B burgdorferi serology (ELISA and western blot
250
Subacute to chronic lateral elbow pain with history of repetitive or forceful wrist extension, pain with passive wrist flexion
Lateral epicondylitis "tennis elbow" - normal treatment + counterforce bracing
251
Goodpasture antibody target?
Type IV collagen
252
Arteries affected by fibromuscular dysplasia?
Renal and internal carotid arteries
253
Subauricular systolic bruit?
nternal carotid artery - usually not affected by atherosclerosis like the carotid bulb
254
Livideo reticularis, blue toes, kidney injury, ocular spots, eosinophilia in urine post cardiac catheterization
Cholesterol crystal syndrome
255
Preferred diagnostic study for aortic dissection in patient with renal failure
transesophageal echocardiography
256
Test of choice for aortic dissection in hemodynamically stable patients?
Transesophageal echo
257
What to check in potential hypertensive emergency?
Check for retinal hemmorhages, papilledema
258
Worst case scenario in a posterior oropharyngeal injury?
Internal carotid artery dissection
259
Most common cause of congenital aplastic anemia? Short stature, hypopigmentation, hypoplastic thumbs (D/P)
Fanconi anemia - DNA repair defect
260
Vaccines for premes with chronilogical or gestational age? Exception?
Chronilogical. Exception is hep B, should be >=2 kg before
261
Goal age of delivery for PPROM?
34 weeks EGA
262
Goal date for delivery with preeclampsia with severe features?
>=34 weeks
263
Severe hypertensive crisis in pregnant mother treatment?
Hydralazine or labetalol - don't use labetalol if bradycardic or nifedipine (oral)
264
Viral prodrome followed by chest pain, respiratory distress, S3 gallop, and holosystolic murmur?
Myocarditis resulting in dilated cardiomyopathy
265
Acute fevers chills and myalgias 6-48 hrs after treatment for early syphillis, lyme, or leptospirosis?
Jarish-Herxheimer - support with IV fluids, acetaminophen, NSAIDS
266
Carcinoid secretions?
Histamine, serotonin, VIP
267
Deficiency in carcinoid and mechanism?
All cellular tryptohan used for production of serotonin, tryptophan is also used for niacin - can result in pellagra (diarrhea, dermatitis, glossitis, angular stomatitis, dementia)
268
Nephrotic syndrome in AA or Hispanic obese IV drug user?
FSGS
269
Nephrotic syndrome in pt. with hx of hep b or c and lipodystrophy?
Membranoproliferative glomerulonephritis
270
Most common cause of acute epidydimitis in patients >35?
E. Coli/coliform ascending bacteria related to bladder outlet obstruction
271
Treatment for coliform epidydimits?
Levofloxacin
272
Afib and pleuritic chest pain?
Think PE
273
Progressive ataxia in adolescence with kyphoscholiosis and pes cavus?
Fredereich ataxia - GAA tinucleotide repeat in frataxin gene
274
Cuase of ataxia-telangectasia and risks?
DNA repair deficits, malignancy
275
Does GBS affect vibratory or position senses?
No
276
Most common cause of inherited intellectual disability and genetics?
Fragile X, CGG trinucleotide repeats in X chromosome
277
SUPER high white count and hepatosplenomegaly in a pneumonia patient?
Check for CLL with flow cytometry
278
Hepatic encephalopathy acidosis or alkalosis?
Alkalosis - promotes conversion from ammonium to ammonia which can enter CNS and drives down potassium - treate with potassium repletion and IV volume repletion
279
New mother with a thumb issue?
De Quervain tenosynovitis, inflammation of abductor pollicis longus and extensor pollicis brevis
280
Patent ductus arteriousus, sensineural hearing loss, and cataracts in an infant?
Rubella
281
Chorioretinitis, hydrocephalus, and diffuse intracranial calcifications in an infant?
Congenital toxo
282
Chorioretinitis with periventricular calcifications in a newborn?
CMV
283
Hepatomegaly, nasal discharge,osteoarticular destruction, and maculopapular rash in newborn?
Congenital syphillis
284
Postgastrectomy nausea, diarrhea, cramping, sweating, palpitations after eating?
Dumping sndrome - rapid emptying of gastric contents into duodenum
285
Treatment for aspiration pneumonia?
Clindamycin, amoxicillin-clavulanate
286
Cause of Zenker diveticulum?
Eosophageal dysmotility leads to posterior herniation above the upper esophageal sphincter
287
Where to start for infertility workup?
Semen analysis
288
AFP in gastroischesis?
Elevataed, passes through the exposed bowel wall into amniotic fluid
289
Isolated or comorbid gastroischesis usually?
Isolated
290
Positive RPR workup?
Need fluorescent treponemal antibody test - postive tests require confirmation from other method
291
Hydrophobia, aerophobea, pharygneal spasm, spastic paralysis, agitation, and ascending flaccid paralysis?
Rabies - most common in bats in US, dogs in developing world, need rabies immune globulin and vaccine immediately
292
Why are CF men infertile?
Inspissated mucus obstructs development of vas deferens, resulting in congenital absence
293
What causes the peripheral insulin resistance of increased pancreatic B cell hyperplasia of pregnancy?
Human placental lactogen (hPL), a somatomammotropin
294
Fever, rash, or arthralgia with peripheral eosinophilia, hematuria, sterile pyura, eosinophiluria?
Drug induced interstitial nephritis
295
Delayed bleeding after minimal trauma in 3 yo, especially hemarthrosis (D/P/BT)
Hemophilia, A is VIII deficiency and B is IX deficiency, X-linked recessive disorder, BT is coagulation study which will show elevated PTT, normal PT, absent or lowered factors
296
How to treat hemophilia for extensive bleeding
Factor replacement, desmopressin for mild hemophilia
297
Patient got a tan and has hypopigmented mildly itchy lesions (D/Path finding)
Tinea versicolor due to malazessia, KOH shows budding yeast (spaghetti and meatballs), treat topically with selenium sulfide or ketoconazole
298
PBC relationship to Lipids?
HLD
299
Asbestosis carcinoma cancer risk multiplier?
Smoking
300
Location of emphysematous changes in COPD and AAT
COPD - centriacinar selective to upper lobes, AAT panacinar of lower lobes
301
Common side effect of medroxyprogesterone (the contraceptive shot?)
weight gain
302
How to test for lactose intolerance?
Rise of hydrogen in breath test indicating carb metabolism
303
Which dystophy is autosomal dominant trinucleotide expansion?
Myotonic dystrophy, DMD and Becker's are X-linked
304
Symptoms of myotonic dystrophy?
Dysphagia (most dangerous), myotonia, cardiac conduction problems, cataracts, testicular atrophy, frontal baldness, insulin resistance
305
Screening with BWS?
Abdominal ultrasound and AFP for Wilms and hepatoblastoma
306
How does thyrotoxicosis cause hypertension?
Leads to positive inotropic and chroniotropic changes leadign to tachycardia, systolic hypertension, widened pulse pressure, afib adn aflutter
307
Thyrotoxic effects on heart?
Rhythm issues, systolic hypertension, heart failure, angina symptoms
308
Middle mediastinal mass w/o warning signs?
Bronchogenic cyst, tracheal tuor, pericardial cyst
309
Where are neurogenic mediastinal masses located?
Posterior mediastinum
310
Indications for home O2 in COPD'r
PaO2<55 mmHg, SaO2 <88%, slightly higher in those with cor pulmonale
311
Diarrhea occuring even during fasting or sleep?
Secretory diarrhea
312
Distinguish osmotic from secretory diarrhea?
Stool osmotic gap
313
Typical finding of SCC biopsy
keratin pearls
314
Bladder part injury that leads to peritonitis?
Bladder dome
315
Is HFpEF the same as high output heart failure?
No, high output heart failure occurs ins severe anemia, hyperthyroidism, beri beri, and Paget's
316
Part of bowel resection that can contribute to gallstone?
Ileum
317
Most common predisposing factor for acute bacterial sinusitis in a child?
Viral infection
318
Fluid of choice for hypernatremia?
NS
319
How long to d/c SSRI before starting MAOI?
2 weeks
320
Mental status changes, autonomic dysregulation, and neuro hyperactivity in psych patient?
Check serotonin syndrome
321
New onset GI symptoms, confusion, ataxia, tremor in hospitalized schizoaffective patient?
Think lithium toxicity from some other given drug reducing renal clearanc
322
Insomnia, fatigue, weight gain in a woman of childbearing years
Expect pregnancy
323
Where is Dxylose absorbed? Does it need enzymes?
Functional proximal intestines, no enzymes needed
324
Treatment for toxo?
Sufadiazine and pyrimethamine plus leucovorin to prevent hemmorhage - initiate ART 2 weeks after beginning treatment
325
Treatment of MAC GI/pulm
clarithromycin and ethambutol
326
Vaginal bleeding, pelvic pain, nausea, vomitting?
Think ectopic pregnancy
327
Peritoneal irritation from ovulation follicular fluid?
Mittelscmirtz
328
Active panic attack acute treatment?
Benzodiazepine
329
Diverticular abscess in stable patient?
CT percutaneous drainage
330
First line treatment for cognitive AD symptoms?
Cholinesterase inhibitors - donepezil, rivastigmine
331
Methimazole side effects:
Agranulocytosis, teratogen in 1st trimester
332
Propylthiouracil side effects:
Hepatic fialure, ANCA-vasculitis
333
Radiodine side effects
worsening of opthalmopathy
334
Preferred treatment for nephrogenic DI?
HCTZ
335
Right sided motor and sensory issues predominant in lower extremity WITH urinary incontinence and WITHOUT visual defects?
ACA stroke, urinary incontinence unlikely in lacunar stroke, visual defects likely in MCA stroke
336
Ammenorhea with negative BhCG workup?
Prolactin, TSH, FSH
337
Severe auditory canal infection and base of skull infection with granulation tissue and an edematous external auditory canal
Pseudomonas aeruginosa
338
IV drug of choice for pseudomonal MOE?
Ciprofloxacin
339
Adult-onset disral muscular weakness and atrophy with dysphagia?
Inclusion body myositis
340
Typical symptoms of GBS?
Ascending flaccid paralysis with distal parethesias
341
typical finding of CSF in GBS?
Albuminocytologic dissociation - normal WBC, high protein
342
Immunocompromised, febrile, productive cough, low PO2, 2/6 Left upper border HM?
Pneumonia, fever causes hyperdynamic heart state
343
Preferred enema style for intussuception?
Air enema - safer cleaner than contrast enema
344
Action tremor with no additional signs?
Essential tremor
345
Marked hypertension and acute kidney injury in setting of systemic schlerosis? (D/Path)
Scleroderma renal crisis - upt to 20% of patients with diffuse cutaneous sclerosis. Increased vascular permeability, activation of coagulation cascade, increased renin along with microangiopathic hemolytic anemia - schizocytes and thrombocytopenia
346
Burr cell meaning?
End stage renal disease, liver disease
347
Howell-Jolly body meaning?
Asplenia or splenectomy
348
Target cell meaning?
Thalasemmia or chronic liver disease
349
Pyrexia, tachy, delirium, and vomitting on hyperthyroidism after CT?
Thyroid storm due to iodine load from contrast
350
How to treat boodborne botulism?
Horse-derived antitoxin
351
What does botulin toxin inhibit?
Presynaptic acetylcholine release at NMJ
352
Tetanus infection or toxin?
Toxin - blocks release of GABA and glycine
353
Cut down on alcohol craving?
Naltrexone or acamprosate
354
Basic lab analysis for suspected essential hypertension?
Urinalysis, chemistry panel, lipid profile, baseline EKG
355
MEN1 three P's
Parathyroid adenoma/hyperplasia, gastrointenstinal/pancreatic tumors (ZE), pituitary adenomas
356
Smudge cells?
Pathognomoic for CLL
357
Cause of gilberts?
UDPglucuronosyltransferase
358
If pet is available for quarantine, does dog bite require prophylaxis for rabies?
No, dogs develop full symptoms in 5-10 days vs humans for 1-3 months
359
When to give tetanus immunoglobulin? Unimmunized, dirty wound
Dirty wound last tetanus update? Within 5 years
360
Infant chronic diarrhea, lymphadenopathy, and failure to trhive PLUS opportunitstic infections?
Consider T lymphocyte deficiency
361
Differentiate HIV infection with ADA deficiency in infant?
ADA deficiency has profound lymphopenia
362
Recurrent severe infections from staph A., serratia, and aspergillus?
chronic granulomatous disease, impaired phagocytosis means catalase + infections proliferat
363
Path of toxic megacolon in UC?
Subset get inflammation to smooth muscle layer leading to colonic dilation
364
Treatment for IBD toxic megacolon?
IVF, broad spectrum antibiotics, bowel rest, and IBD specific corticosteroids
365
Hemolysis, bite cells, Heinz bodies
G6PD deficiency
366
Right sided pleural effusion with moderate lymphocytosis and elevated protein?
Suggestive for TB
367
Key enzyme to produce estrone/estogren from androstenedione?
Aromatase
368
Hormones in Kallmann syndrome
hypogonadotropic hypogonadism
369
Why avoid prolonged high FiO2?
Oxygen toxicity
370
Brain complication of ADPKD?
Cerebral aneurysms
371
Preferred med for ADPKD hypertension?
ACEi
372
vWD have bleeding into tissue?
No, normally mucosa, think hemophilia for tissue bleeding or hemarthrosis
373
Herpangina vs. HSV
Herpangina, Coxackie A, summer/early fall, gray vesicles on tonsillar pillars and posterior oropharynx
374
HSV
mostly oropharynx and lips
375
Age cut off for likey sjogren's
middle age, unusual for initial presentation after 65
376
>65 sjogren's presentation but no antibodies?
Age-related sicca syndrome due to decreased exocrine output from glands
377
How quickly does RAI therapy ablate thyroid follicles?
weeks to months
378
Why does lymphedema transition from pittingto nonpitting?
Deposition of subcutaneous collagen and adipose tissue
379
Inability to lift skin off of dorsum of foot?
Stemmer sign, highly specific for lymphedema
380
Differentiate RDS of newborn vs transient tachypnea?
Lung volumes - low lung volumes in RDS
381
Path cause of TTN? Delayed resoprtion of alveolar fluid
Chest x-ray finding of transient tachypnea of newborn?
| Fluid in interlobar fissures
382
Highly sensitive syphillis test?
FTA-ABS (treponemal)
383
Drugs that cause a phototoxic drug reaction -
Tetracyclines - exagerated sunburn reactions with erythema,edema, and vesicles
384
Hard to visual fundus, dark red hue, sudden loss of vision
Vitreous hemorrhage - treat with upright position during sleep
385
Pancytopenia, spenomegaly due to clonal B-cell neoplasm?
Hairy cell leukemia - look for "hairy cell projections"", dx with bone marrow biopsy
386
Differentiating test between CML and leukmoid reaction?
Decreased leukocyte alkaline phosphatase score in CLL
387
Auer rods in all myelocytic leukemias?
No, only AML
388
Rapidly progressing dementia and myoclonus?
Creutzfelt-Jacob
389
CSF fluid finding for Creutzfelt-Jakob disease?
14-3-3 regulatory proteins
390
Dermatomyositis classic violaceous poikiloderma locations
Heliotrope, shawl, and gottron's (on knuckles)
391
Gottron's papules?
Scaly papules over joints pathognomonic for dermatomyositis
392
Classic autoantibodies for dermatomyositis?
Anti-Jo, anti-Mi-2
393
Common comorbidity with dermatomyositis?
Internal malignancies
394
Risk factor for hypergonadotropic hypogonadism -
hypothyroidism
395
Limited upward gaze, upper eyelid retraction, prostitutes pupil?
Parinaud syndrome - pineal gland mass (can also add obstructive hydrocephalus signs)
396
Length of QT interval?
2 big boxes
397
Elongated QT interval treatment?
Maintain levels of calcium, potassium, and magnesium pharmacotherapy, Beta blockers, may need pacemaker
398
CD19 and CD3 association?
19-Bcells, 3-T cells
399
Differentiate breastfeeding jaundice and breast milk jandice
Breastfeeding - insufficient intake with suboptimal breastfeeding and dehydration around 1 week - causes less bilirubin output
Breastmilk - 3-5 days to 2 weeks, high levels of B-glucoronidase in breast milk - everything else normal
400
Cause of Kaposi sarcoma?
HHV8
401
Bone pain worse at night relieved by NSAIDS with a small round lucency on Xray
Osteoid osteoma
402
Ewing sarcoma finding on Xray?
Extensive bony involvmenet and onion skinning
403
HIV dementia has what sort of dysfunction along with apathy and impaired attention?
Subcortical dysfunction such as slow movement and difficulty with movement
404
Common lung manifestation of systemic sclerosis
Pulmonary artery hypertension
405
Mechanism of PAH in systemic sclerosis
hyperplasia of intimal smooth muscle ratio and unaffected lungs
406
Method of action of dobutamine in meth cardiomyopathy?
Increase myocardial contractility/decrease in left ventricular end-systolic volume - primarily B1 action
407
Psych symptoms with neuro symptoms in a child with abnormal liver function test?
Wilson's disease
408
Other places fibromuscular dysplasia occurs outside of renal arteries?
Carotid, vertebral (amaurosis fugax, Horner's, TIA)
409
Dx for fibromuscular dysplasia?
CT angiogram or duplex ultraosound
410
Which diabetes medication can aid in weight loss?
GLP-1 agonists (exenatide, liraglutide
411
GLP-1 risk?
Acute pancreatitis
412
Irregular vaginal bleeding, englarged uterus, and chest pain 6 mo after pregnancy (D/BT)
Choriocarcinoma, quantitative B-hCG
413
Management of postictal lactic acidosis if seizures are controlled?
Recheck after 2 hours, lactic acid AGMA due to skeletal muscle hypoxia
414
Findings from central retinal artery occlusion?
Whitened retina (edam) and red fovea (cherry red spot) as well as defect in afferent pupil reflex
415
Hypokalemia alkalosis and normotension differential?
1. Surreptitious vomiting
2. Diuretic abuse
3. Bartter syndrome
4. Gitelman's syndrome
416
Nontender 2x2 chronic hard palate mass in a young healthy patient?
Congenital torus palatinus - bony growth that only has intervention if symptomatic
417
What agents to avoid in glaucoma?
Atropine - further dilates the pupil and can worsen glaucoma
418
How does Guillain Barre syndrome cause damage?
Demyelination of peripheral nerve fibers
419
What neuromuscular illnesses involve the anterior horn cells?
Spinal muscular atrophy (infants), poliomyelitis, and ALS
420
where is Broca's area located?
Frontal lobe
421
How soon to become vitamin K deficient in acutely ill person with reduced liver stores?
7-10 days
422
subacute fever, chills, malaise, headache with bilateral hilar lymphadenopathy and granulomas with narrow based budding yeast?
Histoplasmosis
423
Emperic treatment of choice for menningococcal meningitis?
Ceftriaxone and vanc, dexamethasone does NOT help
424
RMSF manifestation of CSF?
Seems like viral meningitis
425
Parkinsons med that can cause acute closure glaucoma?
Trihexyphenadyl - anticholinergic
426
Symptoms of refeeding syndrome? Primary deficiency electrolyte?
Pancreatic insulin surge after starvation, shift of magnesium, potassium into cells causing cardiac arythmias, congestive heart failure, and seizures, potassium is primary deficiency due to need for ATP
427
Risk of inverted uterus?
Hemorrhagic shock and lower abdominal pain
428
Path of aortic coarctation?
Thickening of tunica media of aortic arch
429
Physiological findings in depression?
Increased cortisol from hyperactivity of hypothalamic-pituitary-adrenal axis, decreased hippocampal and frontal lobe volumes
430
Nonspecific symptoms with splenomegaly and elevated alk phos and very low CD4 count?
Think dissemeinated MAC
431
Prophylaxis for MAC
Azithromycin
432
Concave abdomen, barrel shaped chest, pulmonary distress in infant?
Think CD4
433
Treatment for bony tumors outside of chemo to prevent pathologic fractures and malignant hypercalcemia?
Bisphosphonates
434
Unexplained superficial venous thrombosis and upper GI issues?
Think trousseau's syndrome (migratory superficial thrombophlebitis) related to pancreatic carcinoma
435
PTHrP cancer producer:
sCa++amous - squamous cell carcinoma
436
SIADH from cancer type?
Small cell carcinoma
437
ectopic ACTH production?
Suspect small cell carcinoma
438
Most important predisposing factor to aortic dissection?
Systemic hypertension
439
weakness and tremors after asthma attack?
Albuterol potassium shifts
440
First line treatment for blood pressure control in aortic dissection?
IV beta blockers - reduce cardiac and aortic wall stress
441
Treatment for TCA toxicity with QRS>100 msec?
Sodium bicarb
442
How does late gestation cause oligohydramnios?
Preferential redistrubtion during placental insufficient shunts blood to brain
443
Signficant air leak after chest tube placement post chest trauma?
Tracheobronchial rupture
444
Hx of RA with enlarged kidneys and hepatomegaly nephropathy cause?
Amyloid deposition - stain apple-green birefringent with Congo red
445
Most common cause of AA amyloidosis in US?
RA
446
Leukopenia, thrombocytopenia, and elevated aminotransferases ofter tic bite?
Ehrlichosis
447
Periorbital edama, myositis, and eosinophilia?
Trichonillosis
448
Diagnosis of celiac?
Anti IgA transglutaminase and IgA anti-endomysial antibodies
449
Blackfan association?
Only red cell line underdevelopment
450
Fanconi anemia
pancellular failure
451
Cyclosporine mechanism of action and side effects?
Inhibiting transcription of IL-2 - nephrotoxicity, hypertension, nuerotoxicity, glucose intolerance, gingival hypertrophy and hisuitism
452
Distinguish cyclosporine vs tacrolimus side effects?
Tacrolimus does not cause hisutism or gingival hyperplasia
453
Azathiaprine mech of action and side effects?
Purine analog converted to 6-mercaptopurine inhibiting purine synthesis - dose related diarrhea, leukopenia, and hepatotoxicity
454
Mycophenolate mech of action and side effect?
Reversible inhibitor of inosine monophosphate - inhibits purines - depresses MARROW
455
Drug stimulant with seizures and hyponatremia?
Ecstasy
456
Treatment of PBC?
Ursodeoxycholic acid - decreases biliary injury by bile acids
457
Aortic stenosis patient has GI bleeding?
Angiodisplasia related to acquied vW factor deficieny
458
Treatment for norcadia?
TMP-SMX and carbapenems if brain involvement
459
Anticentromere antibody?
Limited cutaneous systemic sclerosis
460
Anti-RNA polymerase II antiboday
Diffuse cutaneous sclerosis
461
Elevated homocysteine?
Give B6 and folate
462
Anti CCP
RA
463
Anticentromere
CREST
464
anti dsDNA
SLE
465
Antihistone
Drug induced lupus
466
AntiJo1
Polymyositis/dermatomyositis
467
Antimitocondrial
PBC
468
Anti-Scl-70
Systemic sclerosis
469
Anti Sm
SLE
470
Anti smooth muscle
Autoimmune hepatitis
471
Antitopoisomerase I
Systemic sclerosis
