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2nd qbank pass Flashcards

1
Q

Contraindication to low molecular weight heparins (rivaroxiban and enoxaparinn)

A

ESRD

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2
Q

Pt with hypotensionn, vomiting, abdominal pain, and fever post-op in s/o of using steroids for chronic condition

A

acute adrenal insufficiency

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3
Q

CT scan findings in ischemic colitis

A

thickened bowel wall, if anything

Especially at splenic flexure or rectosigmoid junction

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4
Q

Abdominal wounds requiring exploratory lapartomy

A

any penetrating wound below the 4th intercostal space (nipples)

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5
Q

Patellar tendinitis vs patellofemoral pain syndrome

A

tendinitis: episodic pain and tenderness, usually seen in athletes in jumping sports

pain syndrome: chronic knee pain worsened by activity or prolonged sitting, common in women

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6
Q

Gross hematuria and urinary retention in setting of MVA

A

pelvic fracture and extraperitoneal bladder injusry

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7
Q

Required imaging to confirm presence of a psoas abscess

A

CT

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8
Q

Required management of someone with clavicular fx

A

angiogram to r/o injury to brachial plexus/subclavian artery

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9
Q

Post-op complication that can be prevented with fluid hydration and oral hygeine

A

acute bacterial parotitis (around POD8 with other wound-type complications)

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10
Q

Patient with painless acute vision loss unilaterally with dilated veins and widespread retinal hemorrhages intermixed with patches white exudate

A

central retinal vein occlusion

Associated with HTN

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11
Q

cardiogenic shock after coronary artery bypass grafting may be concerning for ___

A

aortic dissection

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12
Q

When to transfuse platelets

A

when under 5k for anyone for preventing spontaneous bleeds

50k prior to surgery

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13
Q

Lymphoma:presentation

A

child with pan-adenopathy
hepatomegaly
pancytopenia

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14
Q

Major cause of male infertility

A

varicocele

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15
Q

mupirocin

A

antibiotic topical cream used for impetigo

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16
Q

older female presenting with peeling, scaling, and cracking of right nipple with otherwise normal breast exam

A

paget disease of the breast

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17
Q

spinal dysraphism =

A

neural tube defect

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18
Q

Hypocalcemia and hyperphosphatemia in s/o normal kidney function =

A

hypoparathyroidism (PTH deficiency)

Causes include post-surgical (parathyroidectomy or thyroidectomy, autoimmune destruction, non-autoimmune destruction from hemochromatosis/wilson disease/neck irradiation)

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19
Q

Early anterior spinal cord infarction

A

spinal shock post-op

abrupt onset BL flaccid paralysis and loss pain/temp sensation below level of infarct

NOTE: UMN signs (spasticity and hyperreflexia) develop over days to weeks

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20
Q

TX of acalculous cholecystitis

A

antibiotics and percutenous cholecystostomy followed by cholecystectomy when condition stabilizes

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21
Q

Early satiety, nausea, nonbilious vomiting, and wt loss in patient with a previous acid ingestion =

A

gastric outlet obstruction 2/2 pyloric stricture

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22
Q

Features and TX of a peritonsillar abscess

A 
fever
sore throat/difficulty swallowing
trismus
hot potatoe voice
uvula deviation away from enlarged tonsil
pooling of saliva

TX with needle aspiration (or I&D) plus antibx

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23
Q

Former smoker with early satiety, weight loss, fatigue, and back/abdominal pain worse at night

A

pancreatotic adenocarcinoma

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24
Q

Kid with vague left-sided chest discomfort weeks after MVA

A

diaphragmatic rupture

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25
Q

Post-prandial abdominal pain and bilious vomiting in kid with trauma to abdomen 2 days ago

A

duodenal hematoma

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26
Q

ipsilateral oculomotor nerve palsy

A

uncal herniation

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27
Q

Complications of supracondylar fx of humerus

A

NOTE: most common fxs in peds, mostly from falling on outstretched hand

Most common–entrapment of the brachial artery or median nerve

compartment syndrome rare but can lead to volkmann contracture (of the hand)

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28
Q

Sphincter of Oddi dysfunction

A

functional biliary d/o d/t dyskinesia or stenosis of the SOD

recurrent episodic pain in RUQ and/or epigastric region with worsening of pain with opioid analgesics.

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29
Q

farmer presenting with chronic diarrhea, wt loss, migratory arthralgia, LDN, and low-grade fever

A

whipple disease

risk factors for contraction unclear

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30
Q

Positive prussian blue stain in urine sample =

A

hemosiderin in urine 2/2 hemolysis (think G6PD in s/o antibiotic use)

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31
Q

Malignancies and auto-antibodies associated with dermatomyositis

A

malignancies: ovarian, lung, pancreatic, stomach, colorectal, non-hodgkin lymphoma

auto-antibodies: anti-Jo1 (against synthetase) and anti-Mi-2 (against helicase)

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32
Q

Tdap vaccine guidelines: adults

A

q10yr x 3 doses

if get a wound and greater than 3 doses received– clean wound if less than 10yrs away from last Tdap or give Td if >10yr since

if get a wound and less than 3 lifetime doses–Td if <5yr since tdap and td + IVIGif >5yrs

td is booster

NOTE: DTap ONLY for peds population (larger dose than Tdap)(

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33
Q

Pneumococcal vaccine guidelies: adults

A

once <60yo (13)
once >65yo (23)

NOTE: never give 13 and 23 at the same time

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34
Q

confounding vs effect modification

A

confounding: a third factor negates the relationship btw the exposure and outome (eg season negates relationship btw ice cream consumption and drowning)

effect modification: a third factor ENHANCES the relationship btw the exposure and outcome (eg smoking enhances relationship btw OCPs and thrombosis)

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35
Q

relative risk =

A

people who develop disease out of those exposed/ people who develop disease in those not exposed

NOTE: this is for cohort studies

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36
Q

Odds ratio =

A

odds of exposure in people who have the disease / the odds of exposure in people who do not have the disease

NOTE: this is for case-control studies

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37
Q

when to do aortic valve surgery in pt with infective endocarditis

A

if infection is persistent/difficult to treat medically

if there is significant valvular dysfxn resulting in heart failure

if septic embolization is recurrent

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38
Q

Inflammatory acne: TX

A

topical retinoids + nezoyl peroxide + topical antibiotivs

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39
Q

Nodular (cystic) acne: TX

A

oral isotretinoin

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40
Q

well-defined, erythematous plaques with satellite vesicles or pustules in intertriginous and occluded skin areas

A

intertrigo

d/t infection with Candida species

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41
Q

Widely distributed papules that are pruritic, skin-colored, and have areas of central umbilication in a person with HIV

A

molluscum contagiosum (poxvirus)

NOTE: can occur in children and adults w/out HIV through skin-to-skin contact or by fomites, but is less disseminated and shorter in duration

HIV testing should be considered if lesions widespread or involve face

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42
Q

2 conditions seborrheic dermatitis is associated with

A

HIV

Parkinsons

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43
Q

Acanthosis nigricans associated with ____ in younger pts and ____in older pts

A

DM, malignancy (usually GI or GU)

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44
Q

US to screen for AAA in ____

A

any male btw 65-75yo who has a smoking h/o

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45
Q

Pt with recent URI treated with amoxicillin presenting with picture of hemolysis and splenomegaly

A

think warm (IgG mediated) agglutinin auto-iummune hemolytic anemia

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46
Q

Specific aminoglycoside that causes both ototoxicity and vestibulopathy

A

gentamicin

Note: this is a bilateral vestibulopathy, which negates any vertigo, albeit oscillopsia can still occur

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47
Q

Hepatitis, gastroenteritis, and pneumonitis in patient on immunosuppression for organ transplant

A

tissue-invasive CMV

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48
Q

Symptoms of PCP

A

occur in organ transplant pts without prophylaxis

Pulmonary sxs (respiratory failure, cough, dyspnea) only (no GI symptoms)

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49
Q

Sudden loss of vision + pale retina and dark “cherry red” macula

A

retinal artery occlusion

TX with 100% O2, ocular massage, acetazolamide, or anterior chamber paracentesis

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50
Q

Sudden vision loss with venous dilation and cotton wool spots

A

Retinal vein occlusion

TX with ranibizumab

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51
Q

VEGF-is

A

ranibizumab, bevacizumab, aflibercept

used to treat neovascular changes in diabetic retinopathy and or macular degeneration

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52
Q

blurred vision, floaters, photopsia (sensation of flashing lights) =

A

CMV retinitis

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53
Q

Acute angle glaucoma: TX

A

mannitol, acetazolamide, pilocarpine, or timolol

AVOID anti-cholinergic agents like atropine

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54
Q

Simple vs pre-proliferative vs proliferative/malignant diabetic retinopathy: the fundoscopic exam

A

Simple: microaneurysms, hemorrhages, exudates, and retinal edema

pre-proliferative: cotton wool spots

proliferative: newly-formed vessels

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55
Q

_____ is a complication of 5% of sternotomies

A

acute mediastinitis

NOTE”: tx with drainage, surgical debridement, and prolonged antibiotic therapy

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56
Q

AC that reduces risk of systemic thromboembolism in pts with afib

A

warfarin or apixaban/dabigatran/rivaroxaban

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57
Q

peripartum cardiomyopathy: features

A

rapid-onset systolic heart failure (fatigue, dyspnea, cough, pedal edema) at >36weeks gestation or early puerperium.

NOTE: afib is uncommon in this condition

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58
Q

Nitrates: MOA

A

Primarily smooth muscle relaxer, resulting in systemic vasodilation/venodilation and decrease in cardiac preload (decreased LV wall stress)

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59
Q

Management of rheumatic heart disease

A

treat prophylactically against recurrent group A strep pharyngitis with IM penicillin

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60
Q

Complete AV septal defect: auscultation findings

A

Most common congential heart defect in pts with Down syndrome

Findings: Loud S2 d/t pHTN
SEM at left heart base from increased flow
holosystolic murmur of VSD may be soft or absent if the defect is large

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61
Q

2 hour old infant becomes cyanotic and has a single lod 2nd heart sound on exam

A

transposition

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62
Q

Most common cause of constrictive pericarditis

A

TB

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63
Q

Physical exam findings in constrictive pericarditis

A

Right heart failure –> elevated JVP with abdominal compression (hepatojugular reflex)

Right heart failure –> Kussmauls sign (lack of decrease or even an increase in JVP on inspiration)

Pericardial knock (after S2)

Pericardial calcifications on CXR

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64
Q

TX of afib in stable pts with WPW

A

procainimide or ibutilide

NOTE: AV nodal blocking agents such as adenosine, beta blockers, and CCBs (verapamil) should never be used as they may promote conduction across the accessory pathway and lead to degeneration into VF

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65
Q

Monomorphic ventricular tacycardia

A

wide uniform QRS complex tacycardia with fusion beats showing p waves

treat stable sustained MVT with amiodarone

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66
Q

TX of stable afib/aflutter

A

beta-blocker or CCB (verapamil or dilt) if not in CHFexacerbation

if in CHFexacerbation, give digoxin or amiodarone

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67
Q

2 imaging modalities used to confirm renovascular fibromuscular dysplasia

A

CTa

US doppler

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68
Q

4 meds that can potentiate AC effects of warfarin

A

acetaminophen
NSAIDs
amiodarone
antibx

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69
Q

Viruses implicated in dilated cardiomyopathy

A 
coxsackievirus B
parvovirus B19
HHSV 6
adenovirus
enterovirus
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70
Q

Heart sound heard in MI

A

S4 d/t noncompliance of left ventricle

S4 specifically is the sound of atrial systole as blood is ejected from the atrium into a stiff ventricle

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71
Q

Which has a higher mortality rtate, inferior wall MI or anterior wall MI

A

Anterior wall MIs confer a 30-40% mortality rate vs < 5% for inferior wall MIs

NOTE: Posterior wall MIs (evidenced by ST elevation in leads V1 and V2) have a very low 1 year mortality rate

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72
Q

Meds that confer a mortality benefit following an MI

A

aspirin (if given immediately)
beta-blocker, statin (if LDL >100), ACE-i (espeically if LVEF <40% and anterior wall infarction; should be given during hospital stay)

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73
Q

Absolute contraindications to thrombolytics in someone with STEMI who cant get timely PCI

A

Major bleeding into bowel (melena) or brain

Recent surgery (w/in 2 weeks)

Severe HTN (>180/110)

Recent nonhemorrhagic stroke (w/in last 6 months)

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74
Q

Drug to give immediately (other than aspirin) in NSTEMI

A

heparin

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75
Q

Canon a waves =

A

3rd degree AV block

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76
Q

Causes of systolic CHF (9)

A 
alcohol
thiamine
postviral (idiopathic)
Chagas disease
radiation
adriamycin (doxorubicin) use
hemochromatosis
thyroid disease
peripartum cardiomyopthy
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77
Q

Malignant HTN

A

severe HTN w/ retinal hemorrhages, exudates, or papilledema

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78
Q

Time frame for fat embolism

A

12-24hrs following injury

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79
Q

MOA of flushing with niacin use

A

prostaglandin-induced peripheral vasodilation

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80
Q

Defibrilation indicated in ____

A

symptomatic Vfib, Vtach

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81
Q

Hypotonic serum

A

serum osmolality < 275mOsm/kg

82
Q

SIADH: etiologies and lab findings

A

CNS disturbance (stroke, hemorrhage, trauma)

Meds (carbamazepine, SSRIs, NSAIDs)

Lung disease (pna)

Ectopic ADH secretion (small cell lunng caner)

Pain and/or nausea

Labs: hyponatremia, serum osm < 275, urine osm >100, urine Na >40

83
Q

Acute episodes of cough, breathlessness, fever, and malaise that occur within 4-6 hours of antigenic exposure =

A

hypersensitivity pneumonitis

84
Q

CMV mononucleosis: sxs

A

persistent fever, malaise, and fatigue with absolute lymphocytosis on complete blood count and atypical lymphocytes on PBS

85
Q

Essential tremor: txs

A

clonazepam (2nd line)
primidone
propranolol (1st line)

86
Q

Indications for long-term O2 in pts with COPD

A

resting pulse ox of <88

pulse ox of <89% in pts with cor pulmonale, right heart failure, or Hct >55%

87
Q

Types of casts on UA and their associations

A

muddy brown granular cast–acute tubular necrosis

Broad and waxy casts–chronic renal disease

WBC casts–AIN or pyelo

RBC casts–glomerulonephritis

Fatty casts–nephrotic syndrome

88
Q

UA in ATN

A

FeNa >2%
urine osmolality 300-305
urine Na > 20
(kidney unable to concentrate urine)

muddy brown granular casts

89
Q

Respiratory distress, neurologic dysfunction, and petechial rash 24hrs followed MVA

A

triad of sxs representing fat embolism syndrome

90
Q

Una =

A

aldosterone

91
Q

Uosm =

A

ADH

92
Q

Work-up of euvolemic hypotonic hyponatremia

A

Rta
Addisons
Thyroid
SIADH

93
Q

Persistent WBC on a UA with negative culture

A

TB

94
Q

hemorrhagic cystitis caused by ____

A

cyclophosphamide

95
Q

Postrenal azotemia and bleomycin, methylsergide, or radiation exposure =

A

retroperitoneal fibrosis

96
Q

Meds that cause ATN

A

contrast, aminoglycosides, cisplatin, amphotericin, cyclosporin, NSAIDS

97
Q

MOA of contrast in contrast nephropathy

A

contrast causes ATN through spasm of the afferent arteriole that leads to percieved ischemia and pre-renal labs: UNa < 20
FeNa <1%
Uosm > 300
urine specific gravity high

98
Q

Sudden onset flank pain, fever, and hematuria in a patient with sickle cell who has been taking NSAIDS =

A

renal papillary necrosis

99
Q

Goodpasture vs wegners

A

both glomerulonephritities
goodpasture: lung and kidny, but NOT upper respiratory or vascular, involvement, TX with PLEX and steroids

wegners: nose, lung, and kidney involvement

100
Q

Alport syndrome: features

A

defect of type IVcollagen causing glomerular disease, sensorineural hearing loss, and visual distrubance

101
Q

Polyarteritis Nodosa: features

A

systemic vasculitis of small and medium sized vessels that causes glomerular disease

associated with hep B

systemic sxs: fever, malaise, arthralgia, weight loss

Specific sxs: GI (pain worse with eating due mesenteric involvement), neurologic (stroke in a young person), skin (ulcers), cardiac disease

102
Q

bethanechol: MOA

A

cholinergic agent used to treat urinary retention or atonic bladder

103
Q

oxybutynin: MOA

A

anti-cholinergic agent that inhibits cholinergic input during bladder filling, helping to increase bladder capacity

104
Q

tamsulosin: MOA

A

alpha-1 receptor that acts on the distal ureter, lowering muscle tone and reducing reflex ureteral spasm 2/2 stone impaction

105
Q

Urinary retention in older male with a cold –> suspect ___

A

diphenhydramine use (potent anti-cholinergic effects)

106
Q

Drugs used to mitigate secondary hyperparathyoidism in CKD

A

Ca

sevelemer (phosphate-binding agent) – only in ESRD

cinicalcet (Ca-sensing receptor agonist)

107
Q

1st line pharmacotherapy for enuresis

A

desmopressin

108
Q

salicylate intoxication: sxs and acid-base disturbance

A

sx triad of tinnitus, fever, and tachypnea

Disturbances:
1st–respiratory alkalosis (from acute salicylate toxicity)

2nd–anion gap metabolic acidosis

109
Q

Most likely electrolyte and acid-base disturbance in AKI

A

anion gap metabolic acidosis

hyperkalemia

110
Q

Glomerular disease seen in Hogkin lymphoma

A

minimal change disease

NOTE: membranous nephropathy is the most common form of nephrotic syndrome associated with carcinoma

111
Q

severe hypercalcemia with pancytopenia in older person =

A

MM

112
Q

Causes of nephrogenic DI (5)

A

lithium, demeclocycline, CKD, hypokalemia, or hypercalcemia

113
Q

Demeclocycline MOA

A

Blocks action of ADHat the collecting duct of the kidney tubule

Used to treat chronic SIADH from metastatic cancer

114
Q

Drugs other than spironolactone and ACE-is/ARBs that can cause hyperkalemia

A

beta-blockers
digoxin
heparin

115
Q

Vitiligo: TX

A

topical or corticosteroids

116
Q

Minimal change disease: TX

A

Highly responsive to steroids

NOTE: if high-suspicion (child <10 with all the sxs, treat without first doing biopsy)

117
Q

Pt with pruiritis triggered by hot baths, hepatospleomegaly, and HA coming in with first gouty attack =

A

polycythemia vera

118
Q

Dyspareunia, urinary frequency, and bladder pain relieved with voiding =

A

interstitial cystitis (painful bladder syndrome)

119
Q

Tetrology of fallot: auscultation findings

A

harsh systolic crescendo-descrescendo murmur over left upper sternal border (pulmonic stenosis)

single S2 (inaudible pulmonary component)

120
Q

Time frame for rash following amoxicillin use with mono

A

after 24hrs

121
Q

Lab findings in pagets disease

A

elevated ALP
elevated gone turnover markers (PINP, urine hydroxyproline)
NL calcium and phosphorus

122
Q

Indications for dialysis

A

A–metabolic acidosis (ph < 7.1 that is refractory to medical therapy)

E–electrolytes. unstable hyperkalemia or asymptomatic hyperk >6.5 that is refractory to medical therapy

I-ingestion. txoic alcohols, salicylates, lithium, sodium valproate, carbamasepine

O-overload

U-uremia (aka symptomatic azotemia, by it with encephalopathy, pericarditis, or bleeding)

123
Q

Causes of polyarticular joint disease

A 
VIRUSSSSSSS
hepC, CMV, EBV, HIV, Parvo
Sero negative
Sero postive (lupus and RA)
Syphillis
Sarcoid
Stills disease
Sepsis
124
Q

Causes of oligoarticular disease

A 
Infectious (gonorrhea or not)
Crystal (gout, pseudogout)
Sero negative (PAIR--psoariasis, ankylosing spondylitis, IBD-related, reactive)
125
Q

Sxs lupus

A 
Malar rash 
Discoid rash (causing allopecia)

Serositis
Oral ulcers
Arthropathy (large joint predilection)
Photosensitivity

Blood (anemia, thrombocytopenia)
Renal failure (ds-DNAassociated with this)
ANA + (gateway antibody–very sensitive)
Immunologic (APLS, anti-histone, anti-smith, ds-DNA)
Neuro

NOTE: need at least 4 of these

126
Q

Lupus nephritis:TX

A

cyclophosphamide, then mycofenylate mofetil

NOTE: always get biopsy first to characterize severity of disease

127
Q

Meds that cause drug-induced lupus

A

hydralazine
procainimide
methyldopa

128
Q

Limited cutaneous systemic sclerosis

A 
CREST
Calcinosis (of vessels->HTN)
Raynauds (tx with CCB)
Esophageal dysmotility (and GERD)
Sclerodactyly (tx with penicillamina)
telangectasias

Associated with anti-centromere antibody

129
Q

Diffuse cutaneous systemic scleroderma

A

limited scleroderma (CREST) plus ILD complicated by pulmonary artery HTN, constrictive pericarditis, scleroderma renal crisis (tx with ACE-is NOTsteroid)

Accociated with anti-scl70 (anti-toporimise)

130
Q

DMARDs in seronegative arthritis

A

only help with skin findings and distal arthritis (as in psoariatic arthritis), not in axial-skeleton (as in ank spond)

use anti-TNFa for axial-skeleton involvement

131
Q

jaw claudication, vision changes, and temporal tenderness =

A

giant cell arteritis

age >50

bypass biopsy and treat with steroids immediately

132
Q

wegners =

A

granulomatosis with polyangitis

133
Q

Causes of avascular necrosis (8)

A 
Steroid use
Alcohol abuse
SLE
APLS
hemoglobinoathies
infections (osteomyelitis, HIV)
renal transplantation
decompression sickness
134
Q

Complications of ciprofloxacin

A

Note: this is a fluroquinolone

tendinopathy and tendon rupture (achilles most common)

tendon pain can occur w/in 24hrs, with median of 8 days after starting drug

135
Q

AA female with recent fatigue and malaise presenting with stroke-sxs, found to have anemia, thrombocytopenia, psotive ANA, and postive RPR =

A

antiphospholipid syndrome

anti-cardiolipin and anti-beta-2-glycoprotein-1 antibodies are the specific antiphopholipid antibodies

136
Q

Juvenile Rheumatoid Arthritis

A

High-spiking fever in a young person with no clear etiology

Splenomegaly
pericardial effusion
mild joint symptoms

Labs: anemia, hypoalbuminemia, and leukocytosis
ANA normal
ferritin elevated

137
Q

Lab findings in an acute lupus flare

A

complement levels drop

anti-DS DNA levels rise

138
Q

Asian/Middle Eastern perso with painful oral and genital ulcers also with erythema nodosum

A

Behcet syndrome

NOTE: Also associated with ocular lesions–> uveitis and blindness
arthritis
CNS lesions mimicking MS

139
Q

Procedures of choice for foreign body aspiration vs ingestion

A

aspiration: rigid bronchoscopy
ingestion: flexible endoscopy

140
Q

Hyperemesis gravidarum and a uterine size-date discrepancy =

A

molar pregnancy

141
Q

Pt coming in with labor like pains and negative pregnancy test, found to have irregularly-shaped, enlarged uterus and firm smooth round mass at cervical os =

A

prolapsing submucosal myoma (fibroid) or leiomyoma uteri

142
Q

Tardive dysinesia: management

A

stop antipsychotic or switch to clozapine

143
Q

Best prognostic factors in breast cancer

A

TMN staging

NOTE: ER and PR postive tumors good prognostic factors, overexpression ofg Her-2/neu oncogene related to worse prognosis

144
Q

Risk factors for carpal tunnel syndrome

A

DM
obesity
hypothyroidism
pregnancy

145
Q

Antibx options in chorioamnionitis

A

ampicillin
gentamicin
clindamycin

146
Q

Crystal-induced acute kidney injury: clinical features

A

common etiologies: IV acyclovir, sulfonamides, methotrexate, ethylene glycol, protease inhibitors

lclinical presentationn: usually asymptomatic elevation of creatinine within 1-7 days of starting drug (NOTE this is in contrast with AIN which takes 7-10days to occur and is symptomatic)

UA: hematuria, pyuria, and crystals

147
Q

Acute dystonia: TX

A

benztropine (anti-cholinergic)

diphenhydramine (antihistamine and anticholinergic)

148
Q

3 pathognommonic facial dysmorphisms of fetal alcohol syndrome

A

(1) small palpebral fissures
(2) smooth philtrum (vertical groove above upper lip)
(3) thin vermillion border

149
Q

Niemmann-Pick disease: path and features

A

path: sphingomyelinase deficiency
features: loss of motor milestones (btw 2-6 monthsw old), hypotonia, feeding dificulties, cherry red mecula, hepatosplenomegaly, areflexia

150
Q

Tay-sachs disease: path and features

A

Path: beta-hexosaminidase A deficiency

Features: Loss of motor milestones (2-6 months old), hypotonia, feeding difficulties, cherry red macula, hyperreflexia

151
Q

Thyrotoxicosis in a woman over the age of 40 with a pelvic mass, ascites, and abdominal pain =

A

struma ovarii

Note: thyroid gland is NOT enlarged with this

152
Q

Association with mammary Paget disease

A

underlying breat adenocarcinoma

153
Q

painful, itchy, eczematous and/or ulcerating rash on nipple that spreads to areola =

A

mammary Paget disease

154
Q

Ototoxic agents (2)

A

loop diuretics

aminoglycosides

155
Q

CXR showing pleural plaques and interstitial abnormalities in the lower lung fields

A

asbestosis

156
Q

CURB-65

A

To determine hospitalization with pna:

Confusion
Urea >20
RR >30
BP low (sys <90 or diastolic <60)
Age >65

0–>outpatient tx
1-2–>inpatient
3-4–> inpatient urgently, possibly ICU

157
Q

Eosinophilic granulomatosis with polyangitis =

A

Churg-Strauss syndrome

chronic rhinosinusitis, including nasal polyps, asthma, and prominent eosinophilia

158
Q

Side effects of high dose beta-agonists

A

hypokalemia (muscle weakness, arrythmias, and EKG abnormalities)
tremor
palpitations
HA

159
Q

Aspirin-exacerbated respiratory disease: MOA

A

non-IgE mediated rxn that results from aspirin-induced prostaglandin/leukotriene misbalance

NOTE: most often seen in patient with a history of asthma or chronic rhinosinusitis with nasal poluposis

160
Q

Headache, insonia, N/V, and palpitations in someone on theophylline who just started taking ciprofloxacin

A

theophylline toxicity

CNSstimulation
GI disturbances
cardiac toxicity

161
Q

Complications of positive pressure ventilation

A

alveolar damage
pneumothorax
hypotension

162
Q

Amniotic fluid embolism: risk factors

A 
advanced maternal age
gravida > 5
Ceasarian or instrumental delivery
placenta previa or abruption
preeclampsia
163
Q

Amniotic fluid embolism: clinical presentation

A

cardiogenic shock
hypoxemic respiratory failure
DIC
coma or seizures

164
Q

Amniotic fluid embolism: TX

A

respirtory and hemodynamic support

consider transfusion

165
Q

Lung abscess: TX

A

clindamycin or penicillin

166
Q

Tests to confirm PCP infection

A

Most accurate: BAL

NOTE: sputum stain is specific and if positive, BAL does not need to be done

167
Q

High LDH and CXR showing bilateral interstitial infiltrates =

A

PCP

168
Q

PCP: TX

A

TMP/SMX (for tx and ppx)
Add steroids if severe

If toxicity to TMP/SMX, use clindamycin + primaquine, or use pentamidine

169
Q

Side effects of TMP/SMX

A

Rash
SJS/TEN
AIN
bone marrow suppresion

170
Q

TB: Positive PPD with induration >5mm in which populations?

A 
HIV-positive patiets
glucocorticoid users
close contacts of those with active TB
abnormal calcifications on CXR
organ transplant recipients

These people have a low threshold for a positive PPD

171
Q

Pyrazinamide: side effects

A

hyperuricemia

172
Q

ethambutol: side effects

A

optic neuritis/color vision change

Decrease dose in renal failure

173
Q

Tx of active vs latent TB

A

ACTIVE (+CXR)
1st 2 months: Rifampin + pyridoxine, isoniazid, pyrazinamide + ethambutol if sensitivty of TB unknown

next 4 months: RI
NOTE: tx extended to >6months if TBcomplicated by meningitis or patient is pregnant

LATENT (-CXR)
9 months of isoniazid

174
Q

ILD: clinical presentation

A

dyspnea, worsening on exertion

fine rales or crackles on auscultation

Loud P2 (2/2 pulm HTN)

clubbing of the fingers

175
Q

TX of ILD if biopsy shows white cell or inflammatory infiltrate

A

prenisone

176
Q

Sarcoid: best initial vs most accurate test

A

best initial: CXR (shows hilar adenopathy +/- interstitial infiltrates)

most accurate: lymph node biopsy (showing noncaseating granulomas)

177
Q

Sarcoid: presentation

A 
restrictive lung disease
parotid gland enlargement
facial palsy
heart block and restrictive cardiomyopathy
CNS involvement
iritis and uveitis
178
Q

Sarcoid: TX

A

prednisone

NOTE: asymptomatic hilar adenopathy does not need to be treated

179
Q

Best initial tests in suspected PE and their findings

A

CXR: usual nl. most common abnormality is atelectasis
EKG: sinus tachycardia, maybe with non-specific ST-T wave changes. Only 5% wll show right axis deviation or RVH and S1q3T3 NOT most common
ABG: high pH and low pCo2

Spiral CT (CT angio): specificity and sensitivity excellent

180
Q

Definition of ARDS

A

Acute respiratory distress syndrome

= pO2/FIO2 ratio < 300

(e.g.if pO2 is 105 on RA or 21% O2, then ratio is 105/0.21 or 500)

181
Q

Pulmonary HTN: TX

A

prostacyclin analogues (PA vasodilators): epoprostenol, treprostinil, iloprost, beraprost

endothelin antagonists: bosentan, ambrisentan

phosphodiesterase inhibitors: sildenafil

NOTE: O2 slows progression, especially with COPD

182
Q

platypnea (dyspnea worse with sitting upright) in s/o cirrohosis =

A

hepatopulmonary syndrome

183
Q

Reversible causes of complete heart block

A

3rd degree heart block

Myocardial ischemia
increased vagal tone (during sleep or due to pain)

metabolic disturbances (hyperk)

AV nodal blocking agents (CCBs)

NOTE: In absence of reversible causes, permanent pace maker indicated. With reversible causes, temporary pace maker can be inserted aand further evaluation undertaken

184
Q

Preferred method of respiraoty support in acute exacerbation of COPD

A

non-invasive positive-pressure ventilation

ventilatory support delivered by facemask rather than ETtube

185
Q

Location of pain: patellofemoral syndromevs patellar tendonitis vs osgood-schlatter disease

A

patellofemoral: chronic petalla (young women athletes, pain with using stairs or prolonged sitting)

patellar tendonitis: episodic inferior patella, (“jumpers knee”)

Osgood-Schlatter disease: tenderness and swelling at tibial tubercle , pain with sports, relief with rest, pre/adolescent athletes

186
Q

Pyelonephritis: Outpatient TX vs inpatient TX

A

Outpaitnet: fluoroquinolones (cipro, levo)

Inpatient: IV antibx (fluoro, aminoglycoside + ampicillin) and obtain urine culture beforehand

187
Q

TX uncomplicated vs complicated cystitis

A

uncomplicated: nitrofurantoin, TMX/SM, fosfomycin
complicated: fluoroquinolones

188
Q

Kidney injury with chronic analgesic use

A

tubulointerstitial nephritis (sterile pyuria and WBCcasts with elevated creatinine) +/- papillary necrosis (trace blood and RBCs)

189
Q

Most common malignancy in smokers with asbestos exposure

A

bronchogenic carcinoma (NOT mesothelioma)

190
Q

Work up of solitary pulmonary nodule

A

low risk: serial CTs
Intermediate: PET scan and biopsy
high: resection

191
Q

Intermediate risk of a solitary pulmonary noudle being lung cancer

A

size: .8-2cm
Surface: scalloped
Smoking: current
Self: btw 40-60yo

192
Q

Pulmonary HTN =

A

mean arterial pressure > 25

193
Q

DLCO in bronchitis- vs emphysema- predominant COPD

A

bronchitis-normal

emphysema-decreased

194
Q

Malignant otitis externa: TX

A

IV cipro

NO surgery

195
Q

Glazed, brightly erythematous lesions on the vulva with erosive (ulcerated )areas

A

lichen planus (from chronic inflammatory skin dystrophy)

196
Q

Normal internal genitalia, external virilization/amiguity (clitoromegaly) and undetectable serum estrogen levels (high FSH and LH)

A

aromatase deficiency

197
Q

McCune-Albright syndrome: clinical features

A

Triad of cafe au laits spots, polyostotic fibrous dysplasia, and autonomous endocrine HYPERfunction (gonadotropin-independent precocious puberty)

198
Q

Ambiguous external genitalia, normal uterus and ovaries, and electrolyte abnormalities

A

congential adrenal hyperplasia d/t 17-alpha hydroxylase deficiency

199
Q

2 causes ofg symmetrical fetal growth restriction

A

chromosomal abnormalities
congenital infection

(first trimester insults)

200
Q

Echinococcus/hytidid vs amebic cysts: clinical features and management

A

hytidid (asym): aspiration and albendazole

amebic cyst (RUQ pain and low grade fevers): metronidazole only

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