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3.28.17 Flashcards

1
Q

who/what conditions are at high risk for colon cancer (4)?

A
  • FMHx of adenomatous polyps or colorectal cancer (CRC)
  • IBD
  • familial adenomatous polyposis
  • hereditary nonpolyposis CRC (Lynch synd)
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2
Q

IBD –> when start colon cancer screening? How often?

A

8yr after dx –> colonoscopy w bx –> every 1-2yr

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3
Q

Marfanoid body habitus –> what condition?

A
  • Marfan synd

- homocystinuria

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4
Q

homocystinuria –> genetic disorder –> what type of heredity? enzyme def?

A

AR –> cystathionine synthase def

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5
Q

distinguishing features: Marfan synd vs homocystinuria

A
  • Marfan: aortic root dilation

- homocystinuria: intell disability, thrombosis

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6
Q

child –> fair hair & eyes, dev delay, cerebrovasc accident –> condition?

A

homocystinuria

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7
Q

homocystinuria –> tx

A
  • vitB6, folate, vitB12 –> lower homocysteine levels

- antiplatelet or anticoag –> prevent stroke, CAD, VTE

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8
Q

3yo F –> recurrent bact infect, severe periodontitis, marked leukocytosis –> condition?

A

leukocyte adhesion def

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9
Q

leukocyte adhesion def –> CBC findings?

A

marked leukocytosis w neutrophilia

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10
Q

leukocyte adhesion def –> 1st presenting sign

A

delayed umbilical cord sep

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11
Q

leukocyte adhesion def –> pt presentation

A

recurrent skin & mucosal bact infect:

  • no pus
  • poor wound heal
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12
Q

erlichiosis –> found in what part of USA?

A
  • SE

- S central

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13
Q

erlichiosis –> pt presentation

A
  • flu-like illness

- neuro ssx (confusion)

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14
Q

erlichiosis –> lab findings (4)

A
  • leukopenia
  • thromobcytopenia
  • elevated LFT
  • elevated lactate deH
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15
Q

erlichiosis –> tx

A

doxycycline

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16
Q

shoulder dystocia –> warning signs (2)

A
  • prolonged 1st/2nd stage of labor

- turtle sign: fetal head deliver –> retract into perineum

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17
Q

42yo M –> iron def anemia –> most likely cause?

A

chronic GI blood loss

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18
Q

when is prosthetic joint infect early onset? delayed onset?

A

early onset: <3mo

delayed: 3-12mo

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19
Q

early onset prosthetic joint infect –> org?

A

virulent org –> Staph aureus, Pseudomonas

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20
Q

delayed onset prosthetic joint infect –> org?

A

less virulent org –> coag-neg staph

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21
Q

delayed onset prosthetic joint infect –> presentation

A
  • chronic pain
  • implant loosen
  • gait impair
  • sinus tract form
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22
Q

DM type I –> onset

A

bimodal:
- 4-6yo
- early puberty

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23
Q

what is: fetal growth restriction

A

US-estimated fetal wt <10th percentile for gestational age

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24
Q

symmetric fetal growth restriction –> onset?

A

1st trimester

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25
Q

symmetric fetal growth restriction –> etiology (2)

A
  • chrom abnormal

- congenital infect

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26
Q

asymm fetal growth restriction –> onset?

A

2nd-3rd trimester

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27
Q

asymmetric fetal growth restriction –> etiology

A

utero-placental insuff –> ie HTN

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28
Q

charcot joint –> 3 major assoc conditions

A
  • DM
  • tabes dorsalis (3ary syphilis)
  • vitB12 def
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29
Q

charcot joint –> pathophys

A

nerve damage –> decreased proprioception, pain, temp –> pt unknowingly traumatize wt-bearing joints –>

  • 2ndary degen jt dz
  • jt deformation
  • fxal limitation
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30
Q

charcot joint –> imaging findings

A
  • loss of cartilage
  • osteophyte
  • loose bodies
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31
Q

drug-induced acne –> common side effect of what drug?

A

glucocorticoids

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32
Q

definition: bacteruria

A

> 100,000 CFU/ml bact

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33
Q

preg –> why at increased risk of ascending infect (pyelonephritis)?

A

increased progesterone –> relax smooth muscle –> ureteral dilation

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34
Q

preg –> asymptomatic bacteriuria –> at increased risk for (2)?

A
  • preterm labor

- low birth wt

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35
Q

chorioamnionitis –> dx

A

clinical dx:

  • maternal fever
  • > 1 of following: uterine tender, maternal/fetal tachycardia, malodorous amniotic fluid, purulent vag discharge
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36
Q

chorioamnionitis –> tx

A
  • IV broad spectrum abx
  • delivery –> oxytocin to accelerate labor
  • antipyretic –> reduce maternal fever –> improve fetal tachycardia
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37
Q

bronchiectasis –> pathophys

A

infect + impaired bact clearance –> recurrent bact infect, inflamm, tissue damage –> bronchi thicken & dilate

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38
Q

recurrent dyspnea, fever, tenacious sputum, hemoptysis, crackles, digital clubbing –> condition?

A

bronchiectasis

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39
Q

succinylcholine –> type of drug?

A

depolarizing neuromusc blocker

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40
Q

why beware use of succinylcholine in burn pt?

A

burn injury, stroke, skeletal muscle trauma –> upreg postsynaptic ACh receptors –> succinylcholine –> bind ACh receptors –> K efflux –> severe hyperK –> cardiac arrythmia

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41
Q

DM –> small fiber injury –> type of ssx?

A

positive symptoms:

  • pain
  • paresthesia
  • allodynia
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42
Q

DM –> large fiber injury –> type of ssx?

A

negative symptoms:

  • numb
  • loss of proprioception & vibration sense
  • diminished ankle reflex
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43
Q

what is hydrogen breath test

A

test of lactose intolerance: ingest lactose –> measure increased breath hydrogen –> indicate bacterial carb metab

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44
Q

lactose intolerance –> test results of following:

  • hydrogen breath test
  • stool test for reducing subst
  • stool pH
  • stool osmotic gap
A
  • hydrogen breath test: positive
  • stool test for reducing subst: positive
  • stool pH: low
  • stool osmotic gap: increased
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45
Q

inflamm acne –> tx

A

topical retinoid + benzoyl peroxide

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46
Q

mod-severe inflamm acne –> tx

A

topical retinoid + benzoyl peroxide

+ topical abx

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47
Q

acne –> when use oral abx or isotretinoin?

A

severe/recalcitrant inflamm acne

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48
Q

neonate –> micrognathia, microcephaly, rocker bottom feet, overlapping fingers, absent palmar creases –> condition?

A

trisomy 18 (Edwards synd)

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49
Q

trisomy 18 (Edwards synd) –> cardio comp?

A

congenital heart dz –> #1 VSD

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50
Q

endometriosis –> definitive dx

A

laparoscopy –> visualize & biopsy endometrial implants

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51
Q

suspect endometriosis –> empiric tx

A

NSAID + oral contraceptive

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52
Q

suspect endometriosis –> empiric tx fail –> next step?

A

laparoscopy –> visualize & biopsy endometrial implants

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53
Q

endometriosis –> common sole presenting symptom

A

infertility

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54
Q

adnexal fullness on PE –> US –> ovarian cyst –> hyperechoic nodules & calcifications –> condition?

A

dermoid ovarian cyst (mature cystic teratoma)

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55
Q

dermoid ovarian cyst (mature cystic teratoma) –> dx

A

US –> ovarian cyst –> hyperechoic nodules & calcifications

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56
Q

dermoid ovarian cyst (mature cystic teratoma) –> comp

A

ovarian torsion

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57
Q

ovarian torsion –> typical presentation

A

acute onset unilat lower abd pain

possibly:
- N/V
- fever

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58
Q

when give anti-D immune globulin?

A
  • 28-32wk gestation

- after delivery if baby Rh+

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59
Q

STD test –> +chlamydia, -gonorrhea –> pt asymptomatic –> tx

A

azithromycin only

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60
Q

pt w infectious mono –> difficult swallow, labored breathing, severe tonsillar enlrg –> comp most at risk for developing?

A

acute airway obstruct

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61
Q

pt w infectious mono –> difficult swallow, labored breathing, severe tonsillar enlrg –> at risk for acute airway obstruct –> tx

A

corticosteroid

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62
Q

pts at highest risk for osteomyelitis (3)

A
  • IVDA
  • sickle cell
  • immunosupp
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63
Q

vertebral osteomyelitis –> onset

A

chronic (>6wk) & insidious w minimal ssx

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64
Q

most reliable sign for vertebral osteomyelitis

A

tender to gentle percussion over spinous process

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65
Q

vertebral osteomyelitis –> characteristic back pain

A

not relieved by rest

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66
Q

vertebral osteomyelitis –> most sensitive dx

A

MRI

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67
Q

terminal deoxynucleotidyltransferase (TdT) –> positive in what cell types (2)?

A

pre-B & pre-T lymphoblasts

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68
Q

lymphoblast –> +Tdt –> positive for what other immunostain?

A

periodic acid Sciff (PAS)

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69
Q

myeloblast vs lymphoblast –> difference in immunostain?

A

myeloblast: +peroxidase
lymphoblast: -peroxidase –> +PAS

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70
Q

5yo M –> hip pain –> most common cause

A

transient synovitis

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71
Q

transient synovitis –> tx

A
  • rest

- NSAID

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72
Q

transient synovitis –> lab findings

A

usu no lab abnormalities

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73
Q

Marfan synd –> mutation?

A

fibrillin-1

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74
Q

sarcoidosis –> CXR findings

A

bilat hilar adenopathy

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75
Q

sarcoidosis –> tissue bx findings

A

noncaseating granuloma

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76
Q

when give HPV vaccine

A
  • start age 11-12

- until age 26

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77
Q

sig smoking history & hyperCa –> CXR –> hilar mass –> condition?

A

squamous cell Ca

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78
Q

paraneoplastic synd seen in:

  • squamous cell Ca of lungs
  • small cell lung CA
A
  • squamous cell Ca of lungs: PTHrP

- small cell lung CA: ACTH, SIADH

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79
Q

UA –> lrg amt of blood –> urine microscropy shows 0-1 RBC –> condition?

A

rhabdomyolysis –> myoglobinuria

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80
Q

penile fracture –> goes to ER –> pain, can’t urinate, swollen penis –> next step? why?

A

blood at meatus, dysuria, urinary retention –> suspected urethral injury –> retrograde urethrogram

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81
Q

vitiligo –> pathophys

A

autoimmune –> regional destroy melanocytes

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82
Q

vitiligo –> tx

A

topical or systemic corticosteroid

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83
Q

HSV encephalitis –> CSF findings (3)

A
  • lymphocytic pleocytosis
  • increased erythrocytes
  • elevated protein
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84
Q

7yo M –> FOOSH –> supracondylar humerus fx –> complains of increasing pain despite mult doses of pain meds –> should be concerned about what?

A

cmpt synd

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85
Q

40yo F –> wt loss, lid lag, hand tremor, A-fib w RVR –> condition?

A

hyperthyroid

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86
Q

hyperthyroid –> A-fib –> tx

A

BB

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87
Q

healthcare worker never got HepB vaccine –> needlestick from pt w active HepB infect –> next step?

A

HB vaccine & HB immune globulin ASAP

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88
Q

HIV pt –> CD4 <50 –> bloody diarrhea –> condition?

A

CMV colitis

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89
Q

HIV pt –> CD4 <50 –> bloody diarrhea –> next step?

A

colonoscopy w bx –> look for CMV colitis

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90
Q

HIV pt –> CD4 <50 –> bloody diarrhea –> CMV colitis –> r/o what other condition?

A

ocular exam –> r/o concurrent retinitis

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91
Q

oxytocin –> AE (3)

A
  • hypoNa
  • hypotension
  • tachysystole
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92
Q

what is uterine tachysystole

A

abnormally freq contractions –> >5 contractions in 10min

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93
Q

premature neonate –> comp (3)

A
  • resp distress synd
  • patent ductus arteriosus
  • bronchopulm dysplasia
  • intraventricular hemorrhage
  • necrotizing enterocolitis
  • retinopathy of prematurity
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94
Q

premature neonate –> how screen for intraventricular hemorrhage? why do a screen?

A

screen w serial head US

25-50% asymptomatic

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95
Q

premature neonate –> intraventricular hemorrhage –> comp? pathophys?

A

blood accum –> irritate arachnoid villi –> impair ability to absorb CSF –> hydrocephalus

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96
Q

premature neonate –> intraventricular hemorrhage –> how prevent IVH?

A
  • prevent preterm labor

- antenatal corticosteroid

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97
Q

uterine fibroids –> dx

A

US

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98
Q

what is metatarsus adductus

A

congenital foot deformity –> medial deviation of forefoot

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99
Q

metatarsus adductus –> tx

A

resolve spontaneously

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100
Q

menstrual irreg, infertile, enlrg ovaries, acanthosis nigricans –> condition?

A

PCOS

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101
Q

PCOS –> tx

A

1st line: wt loss –> decreased peripheral estrogen conversion

wt loss unsuccessful: clomiphene citrate (SERM) –> induce ovulation

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102
Q

clomiphene citrate –> MOA

A

SERM

block estrogen receptor at level of hypothalamus –> inh neg feedback mech –> hypothalamus restore pulsatile GnRH secretion –> normalize LH, FSH level –> LH surge –> ovulation

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103
Q

traumatic head injury –> CT –> hyperdense football-shaped lesion –> condition?

A

epidural hematoma

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104
Q

traumatic head injury –> progressive lethargy –> CT –> epidural hematoma –> tx

A

symptomatic –> emergent neurosurg hematoma evacuation

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105
Q

52yo F –> gradual onset weakness of leg muscles –> several months can’t climb stairs –> no other problems –> condition?

A

polymyositis

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106
Q

polymyositis –> clinical presentation

A
  • slowly progressive proximal weakness of LE

- no/mild muscle pain/tender

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107
Q

polymyositis –> dx? results?

A

muscle bx –> mononuclear infiltrate surrounding necrotic and regenerating muscle fibers

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108
Q

67yo F –> severe vulvar itch & burn –> thin, dry white plaque-like vulvar skin w loss of labia minora –> condition?

A

lichen sclerosus

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109
Q

lichen sclerosus –> pt presentation

A

vulva:
- intense pruritis
- white atrophic plaque –> “cigarette paper”

  • dyspareunia
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110
Q

lichen sclerosus –> dx?

A
  • clinical dx

- definitive dx: punch bx –> confirm dx & r/o vulvar SCC

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111
Q

lichen sclerosus –> comp?

A

premalig lesion for vulvar SCC

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112
Q

Paget dz of bone –> lab findings:

  • Ca
  • Ph
  • alk phos
  • urine hydroxyproline
A
  • Ca: normal
  • Ph: normal
  • alk phos: high
  • urine hydroxyproline (bone turnover marker): high
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113
Q

64yo F –> worsening focal back pain, bilat LE weak, sensory loss, gait ataxia –> condition?

A

spinal cord compression

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114
Q

spinal cord compression –> pt presentation (4)

A
  • worsening focal back pain
  • bilat LE weak
  • sensory lsos
  • gait ataxia
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115
Q

spinal cord compression –> can develop what in acute phase? What is a late finding?

A

acute phase –> spinal shock:

  • absent reflex
  • flaccid paraplegia

late –> bowel/bladder disturb

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116
Q

watery diarrhea –> 3 categories

A
  • osmotic
  • secretory
  • fxal
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117
Q

secretory diarrhea –> hallmark

A
  • lrger daily stool vol (>1L/day)

- occur even during fasting/sleep

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118
Q

how distinguish osmotic vs secretory diarrhea?

A

stool osmotic gap

osmotic: elevated
secretory: reduced

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119
Q

secretory diarrhea –> pathophys

A

luminal ion channels disrupted –> state of active secretion

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120
Q

pre-eclampsia –> definition

A

new onset HTN at >20wk gestation + proteinuria +/or end organ damage

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121
Q

pre-eclampsia w severe features –> what are severe features (4)

A

evidence of end organ damage:

  • severe HA
  • visual changes
  • severe transaminitis
  • elevated creatinine
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122
Q

HTN crisis –> 1st line drugs for BP ctrl (3)

A
  • hydralazine
  • labetalol
  • nifedipine
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123
Q

what are the types of primary humor deficiencies? (5)

A
  • X-linked agammaglobulinemia
  • common variable immunodef
  • IgA def
  • hyper-IgM synd
  • IgG subclass def
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124
Q

primary humor deficiencies –> clinical features

A

virus, encap bact –> sinopulm infect –> recurrent and/or severe

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125
Q

hyper-IgM synd –> lab findings:

  • B cells
  • IgG
  • IgA
  • IgM
A
  • B cells: normal
  • IgG: low
  • IgA: low
  • IgM: high
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126
Q

X-linked agammaglobulinemia –> lab findings:

  • B cells
  • IgG
  • IgA
  • IgM
A
  • B cells: low or absent

- Ig: low

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127
Q

common variable immunodef –> lab findings:

  • B cells
  • IgG
  • IgA
  • IgM
A
  • B cells: normal

- Ig: low

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128
Q

IgA def –> lab findings:

  • B cells
  • IgG
  • IgA
  • IgM
A
  • B cells: normal

- IgA: low

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129
Q

IgG subclass def –> lab findings:

  • B cells
  • IgG
  • IgA
  • IgM
A
  • B cells: normal

- IgG: low

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130
Q

fever & pulm ssx worsen after initial improve –> condition?

A

2ndary bact pneumonia after influenza

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131
Q

19yo M –> influenza –> 2ndary bact pneumonia –> org?

A

comm-acquired MRSA

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132
Q

19yo M –> influenza –> 2ndary bact pneumonia w comm-acquired MRSA –> clinical features (5)

A

rapidly progressive, necrotizing pneumonia:

  • high fever
  • productive cough (often hemoptysis)
  • leukopenia
  • multilobar cavitary infiltrates
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133
Q

greatest RF for cerebral palsy

A

premature birth

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134
Q

cerebral palsy –> usual cause

A

prenatal insult to brain development

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135
Q

cerebral palsy –> grp of synd characterized by?

A

nonprogressive motor dysfx

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136
Q

cerebral palsy –> #1 form seen in preterm infants

A

spastic diplegia

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137
Q

cerebral palsy –> 3 subtypes

A
  • spastic
  • dyskinetic
  • ataxic
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138
Q

spastic diplegia –> presentation (3)

A

LE:

  • hypertonia
  • hyperreflexia
  • equinovarus deformity
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139
Q

50% of cerebral palsy pts also have ___?

A

intell disability

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140
Q

cerebral palsy –> how are their mvmts?

A

voluntary mvmts:

  • uncoordinated
  • limited
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141
Q

suspected acromegaly –> preferred initial test

A

insulin-like growth factor 1

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142
Q

what is Wallenberg synd

A

lat medullary infarct

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143
Q

Wallenberg synd –> cause

A

occlusion of post inf cerebellar or vertebral A

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144
Q

Wallenberg synd –> clinical features (5)

A
  • loss of pain/temp over ipsilat face & contralat body
  • ipsilat bulbar muscle weak –> hoarse
  • vestibulocerebellar impair –> vertigo, nystagmus
  • Horner’s synd
  • motor fx of face & body spared
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145
Q

what PFT result suggests asthma?

A

> 12% increase in FEV1

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146
Q

pt gets implantable pacemaker –> R heart fail –> should suspect what comp?

A

tricuspid regurg d/t direct leaflet damage or inadeq leaflet coaptation

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147
Q

tricuspid regrug –> type of murmur?

A

holosystolic

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148
Q

severe aortic stenosis –> PE findings (3)

A
  • carotid pulse –> delayed & diminished
  • soft S2
  • mid-late systolic murmur –> max at 2nd R intercostal space
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149
Q

what is pulsus parvus and tardus? seen in what condition? what causes it?

A

severe aortic stenosis –> blood flow obstruct –> diminished & delayed carotid pulse

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150
Q

what causes S2 heart sound?

A
  • mainly aortic (A2) valve closure

- pulmonic valve (P2) closure

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151
Q

why is S2 heart sound soft in severe aortic stenosis?

A

aortic leaflets –> thicken & calcify –> reduce mobility

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152
Q

term neonate –> polycythemia –> definition

A

> 65% hemotocrit

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153
Q

neonate –> polycythemia –> etiologies (3)

A
  • excess transfer placental blood: delayed cord clamp
  • in-utero hypoxia: maternal HTN, smoke
  • poor placental gas exchange: maternal DM
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154
Q

neonate –> polycythemia –> ssx (4)

A
  • usu asx
  • resp distress
  • hypoglycemia
  • neuro ssx
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155
Q

vegans at risk for what vit def?

A

B12

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156
Q

vitB12 def –> ssx (2)

A
  • anemia

- neuro comp

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157
Q

vegan –> fatigue & pallor –> started on folic acid –> fall & forgetfulness –> why?

A

vegan –> B12 def –> folic acid supplementation –> correct anemia –> but rapid progress of neuro comp

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158
Q

44yo M –> H&P, labs, abd US –> found to have cirrhosis –> should look for what else?

A

screen EGD –> esophageal varices

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159
Q

primary prophylaxis for esophageal variceal hemorrhage

A
  • nonselective BB –> propranolol or nadolol

- endoscopic variceal ligation

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160
Q

who is at low (<10%) pretest probability of CAD (2)?

A
  • any age –> asx

- <50 F –> atypical CP

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161
Q

pt w chest pain –> at low pretest probability for CAD –> next step?

A

no further dx testing for CAD

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162
Q

pt w chest pain –> at high pretest probability for CAD –> next step?

A
  • start meds for CAD

- expert eval to consider coronary angiography

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163
Q

pt w chest pain –> at interm pretest probability for CAD –> next step?

A

EKG stress test

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164
Q

pericarditis –> EKG findings

A

diffuse ST segment elevations

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165
Q

chronic kidney dz –> chest pain –> condition?

A

uremic pericarditis

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166
Q

pericarditis –> what’s heard on cardiac auscultation?

A

friction rub

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167
Q

chronic kidney dz –> uremic pericarditis –> tx

A

hemodialysis:
- rapid resolve chest pain
- reduce size of any assoc pericardial effusion

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168
Q

clues to correct diagnosis of AD polycystic kidney dz (3)

A
  • HTN
  • palpable bilat abd masses
  • microhematuria
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169
Q

AD polycystic kidney dz –> #1 extrarenal manifestation

A

hepatic cysts

170
Q

gestational DM –> 1st line tx? 2nd line?

A

1st line: dietary mod

2nd line: insulin, metformin, glyburide

171
Q

maternal gestational DM –> delivery –> shoulder dystocia –> initial management

A
  • McRoberts maneuver –> flex hips toward abd
  • apply suprapubic pressure

–> relieve almost half of shoulder dystocias w no further intervention

172
Q

2ndary amenorrhea –> initial eval

A
  • B-hCG –> exclude preg
  • prolactin
  • TSH
  • FSH
173
Q

erythema nodosum –> assoc w what conditions (6)

A
  • strep infect
  • sarcoidosis
  • TB
  • coccidioidomycosis
  • IBD
  • Behcet dz
174
Q

erythema nodosum –> what imaging should be done? why?

A

CXR –> assess for sarcoidosis

175
Q

Rotor’s synd –> pathophys

A

defect in hepatic secretion of conj bili into biliary system

176
Q

positive urine bili assay –> indicates?

A

buildup of conj bili

177
Q

smoker –> mild ssx –> small cell lung CA –> SIADH –> hypoNa –> tx

A

asx or mild symptoms –> fluid restrict

178
Q

most accurate way to determine estimated gestational age

A

1st trimester US w crown-rump length

179
Q

hereditary angioedema –> charact by (4)?

A

rapid onset:

  • noninflamm edema –> face, limbs, genitalia
  • laryngeal edema
  • intestine edema –> colickly abd pain

no evidence of urticaria

180
Q

hereditary angioedema –> pathophys

A

C1 inh def –> elevated edema-producing factors C2b & bradykinin

181
Q

nasal polyps –> ssx (3)

A
  • bilat nasal obstruct
  • nasal discharge
  • anosmia
182
Q

nasal polyps –> assoc w what conditions (3)

A
  • chronic rhinosinusitis
  • asthma
  • ASA-exacerbated resp dz: ASA/NSAID –> bronchospasm
183
Q

45min ago –> ingest drain cleaner –> next step?

A

1st 12-24hr –> endoscopy –> assess severity of damage & guide further tx

184
Q

uterine rupture –> presentation

A
  • vaginal/intraabd bleed
  • pain
  • fetal distress/demise
185
Q

uterine rupture –> PE findings

A
  • abdominally palpable fetal parts at rupture site

- no presenting fetal parts vaginally

186
Q

iron poisoning –> presentation (3)

A
  • abd pain
  • hematemesis
  • metab acid
187
Q

somatic symptom disorder –> management

A

regularly scheduled visits:

  • est strong physician-pt relationship
  • limit dx testing, referrals
188
Q

42 F –> intermittent blood staining left bra –> normal PE & mammogram –> condition?

A

intraductal papilloma

189
Q

intraductal papilloma –> clinical features (2)

A
  • unilat bloody nipple discharge

- no assoc mass, LAD

190
Q

42 F –> intermittent blood staining left bra –> normal breast exam –> next step?

A

mammogram –> r/o carcinoma (even w/out palpable breast mass)

191
Q

intraductal papilloma –> mammogram finding

192
Q

1 brain tumor in children

A

low-grade astrocytoma –> particularly pilocytic astrocytoma

193
Q

supratentorial tumor –> classic presentation (3)

A
  • sz
  • weak
  • sensory change
194
Q

post fossa tumor –> typical presentation

A

cerebellar dysfx –> ie ataxia, dysmetria

195
Q

bedwetting is normal before what age?

196
Q

chronic LBP –> 6 major causes

A
  • mechanical
  • radiculopathy
  • spinal stenosis
  • inflamm
  • metastatic cancer
  • infectious
197
Q

chronic LBP –> d/t mechanical –> 2 types of mechanical LBP?

A
  • muscle strain

- disc degen

198
Q

chronic LBP –> d/t radiculopathy –> clinical features (3)

A
  • radiate below knee
  • positive SLR
  • neuro deficits
199
Q

chronic LBP –> d/t mechanical –> clinical features (2)

A
  • normal neuro exam

- paraspinal tender

200
Q

chronic LBP –> d/t spinal stenosis –> clinical features (2)

A
  • pseudoclaudication

- relieved by leaning forward

201
Q

chronic LBP –> d/t inflamm (ie spondyloarthropathy) –> clinical features (2)

A
  • worse w rest, better w activity

- sacroiliits

202
Q

chronic LBP –> d/t metastatic cancer –> clinical features (3)

A
  • > 50yo
  • worse at night
  • not relieved with rest
203
Q

chronic LBP –> d/t infectious –> clinical features (3)

A
  • recent infect/IVDA
  • fever
  • focal spine tender
204
Q

S4 heart sound –> assoc w what conditions (2)?

A
  • V hypertrophy

- acute MI

205
Q

S3 heart sound –> assoc w what conditions (3)?

A
  • heart fail
  • restrictive cardiomyopathy
  • high output states
206
Q

S3 heart sound –> normal in whom?

A
  • child
  • YA
  • preg
207
Q

S4 heart sound –> normal in whom?

A

healthy older adult

208
Q

what creates S3 heart sound?

A

turbulent blood flow to ventricles d/t increased vol

209
Q

what creates S4 heart sound?

A

blood forced into stiff ventricle

210
Q

what should raise suspicion for HIT (2)

A
  • > 50% decrease in platelets

- new thrombus in 5-10 days

211
Q

HIT –> pathophys

A

autoAb to platelet factor 4 –> coat platelets:

  • spleen –> remv these platelets –> thrombocytopenia
  • platelets activate –> platelet aggregation –> arterial & venous thrombus
212
Q

26yo F –> blurry vision in L eye –> light –> dilate –> condition?

A

optic neuritis

213
Q

what is optic neuritis

A

inflamm (immune mediated) demyelination of optic N

214
Q

optic neuritis –> who?

215
Q

optic neuritis –> assoc w what condition?

A

frequently heralding ssx of mult sclerosis

216
Q

optic neuritis –> clinical features (5)

A
  • acute onset monocular vision loss
  • central scotoma
  • afferent pupil defect
  • “washed out” color vision
  • pain w eye mvmt
217
Q

COPD exacerbation –> cardinal ssx (3)

A
  • increased dyspnea
  • increased cough –> more freq/severe
  • sputum –> change color/vol
218
Q

COPD exacerbation –> tx

A
  • short acting bronchodilator –> B2 agonist & antichol
  • systemic glucocorticoids
  • O2 –> sat 88-92%
  • abx if >2 cardinal ssx
219
Q

what is cor pulmonale

A

RV fail d/t pulm HTN caused by underlying condition

220
Q

1 cause of cor pulmonale

221
Q

solitary pulm nodule (SPN) –> definition

A
  • rounded opacity
  • <3cm
  • completely surrounded by pulm parenchyma
  • no assoc LN enlrg
222
Q

solitary pulm nodule (SPN) –> next step for:

  • lesion w high risk of malig
  • low risk
A
  • lesion w high risk of malig: surg excision

- low risk: monitor w serial CT

223
Q

what is ASA-exacerbated resp dz (AERD)

A

pseudoallergic rxn to NSAID

224
Q

ASA-exacerbated resp dz (AERD) –> typically occur in who (2)?

A

pt w comorbid:

  • asthma
  • chronic rhinosinusitis w nasal polyposis
225
Q

ASA-exacerbated resp dz (AERD) –> presentation (3)

A
  • asthma ssx –> cough, wheeze, chest tight
  • nasal ssx: congest, rhinorrhea
  • ocular ssx: periorbital edema
226
Q

ASA-exacerbated resp dz (AERD) –> pathophys

A

ASA –> inh COX1 & 2 –> inh brkdown of arachadonic acid to prostaglandins (anti-inflamm) –> LOX –> arachdonic acid to leukotrienes (pro-inflamm)

227
Q

dermatomyosistis –> assoc w what condition?

A

internal malig –> must do age-approp cancer screen

228
Q

34 F –> amenorrhea –> chemotherapy 5 yr ago for non-Hodgkin lymphoma –> all else normal –> what condition? why?

A

ovarian fail d/t ctx –> ctx & rad also affect proliferating granulosa & theca cells of ovary

229
Q

mammogram –> how often?

230
Q

pap –> how often?

231
Q

lipid panel –> how often?

232
Q

mammogram –> who?

233
Q

young adult –> liver dz & neuropsych ssx –> condition?

A

Wilson’s dz

234
Q

preg at 35wk gestation –> urine leak w laugh/cough –> leakage has increased –> find nitrazine-positive fluid, low aminiotic fluid index –> condition?

A

preterm premature rupture of membrane

235
Q

preterm premature rupture of membrane (PPROM) –> definition

A

<37 wk gestation –> rupture membranes before labor

236
Q

preterm premature rupture of membrane (PPROM) –> management

A
  • > 34 wk –> deliver

- <34 wk –> expectant management

237
Q

abd succussion splash –> test for what condition?

A

gastric outlet obstruction

238
Q

abd succussion splash –> how do you do this test? what is a positive test?

A

1) stethoscope over upper abd
2) rock pt back & forth at hips

–> splash sound –> indicate hollow viscus filled w fluid & gas

239
Q

catatonia –> tx

A
  • benzo

- ECT

240
Q

thyroid storm –> triggers (5)

A
  • thyroid/nonthyroid surg
  • trauma
  • infect
  • iodine contrast
  • childbirth
241
Q

thyroid storm –> ssx (7)

A
  • tachycardia
  • HTN
  • cardiac arrhythmia
  • high fever
  • tremor
  • altered MS
  • lid lag
242
Q

what org (3) can cause retinitis in HIV pt?

A
  • VZV
  • HSV
  • CMV
243
Q

how differentiate VZV/HSV retinitis vs CMV retinitis?

A

VZV/HSV:

  • severe, acute retinal necrosis –> pain
  • keratitis
  • uveitis
  • fundoscopy: peripheral pale lesions, central retinal necrosis

CMV:

  • painless
  • no keratitis/conjunctivitis
  • fundoscope: hemorrhage, fluffy/granular lesions around retinal vessels
244
Q

COPD –> criteria for initiate longterm home O2 tx

A
  • resting PaO2 <55 mmHg
  • resting O2 sat <88%

R heart fail or hematocrit >55%:

  • PaO2 <59
  • O2 sat <89%
245
Q

what is cutaneous larva migrans

A

creeping cutaneous eruption d/t dog/cat hookworm larva

246
Q

how does cutaneous larva migrans occur?

A

contaminated sand/soil –> walk barefoot

247
Q

cutaneous larva migrans –> ssx

A
  • portal of entry –> pruritic papular lesion

- intensely pruritic, migrating serpiginous reddish-brown tracks

248
Q

cutaneous larva migrans –> tx

A

ivermectin

249
Q

something flew into eye while drilling –> normal penlight exam –> next step

A

fluorescein exam

250
Q

toxic shock synd –> ssx (5)

A
  • fever
  • myalgia
  • marked hypotension
  • diffuse erythematous macular rash (erythroderma)
  • can progress to multiorgan involvement
251
Q

toxic shock synd –> assoc w (3)?

A
  • tampon
  • nasal packing
  • post-surg infect
252
Q

75 M –> routine checkup –> normal but high alk phos –> what condition?

A

Paget dz of bone –> #1 cause of asymptomatic elevation of alk phos in elder

253
Q

dyspnea, S3 heart sound, bibasilar crackles, low EF –> what condition?

A

decompensated CHF d/t LV systolic dysfx

254
Q

CHF ssx –> macrocytic anemia, thrombocytopenia, 2:1 AST:ALT, no CAD on angiography –> cause of CHF?

A

heavy alcohol –> dilated cardiomyopathy (alcoholic cardiomyopathy)

255
Q

alcoholic cardiomyopathy –> what is most likely to reverse heart fx?

A

stop alcohol

256
Q

what is malig HTN

A

severe HTN (>180/120) w:

  • retinal hemorrhage
  • exudate
  • papilledema
257
Q

76M –> substernal chest pain –> cardiac catheter shows significant coronary stenosis –> 5 hrs later –> 75/60 BP, 120 HR, diaphoresis, flat neck veins –> what condition?

A

retroperitoneal hematoma

258
Q

retroperitoneal hematoma –> presentation

A
  • sudden hemodynamic instability

- ipsilat flank/back pain

259
Q

retroperitoneal hematoma –> how confirm dx

A

noncontrast CT abd/pelvis
OR
abd US

260
Q

retroperitoneal hematoma –> tx

A

supportive:
- bed rest
- intensive monitor
- IV
- blood transfusion (if needed)

261
Q

when need to deliver bad news –> should 1st assess what?

A

pt’s comprehension, fears, desire for info

262
Q

premature atrial contractions found on EKG –> pt is asymptomatic –> tx

A

avoid precipitating factors:

  • tobacco
  • alcohol
  • caffeine
  • stress
263
Q

premature atrial contractions found on EKG –> pt is symptomatic –> tx

264
Q

membranoprolif glomerulonephritis type 2 –> pathophys

A

C3 convertase Ab –> persistent activation of alt complement pathway –> kidney damage

265
Q

membranoprolif glomerulonephritis type 2 –> microscopic finding

A

dense intramembranous deposits that stain for C3

266
Q

what is mixed cryoglobulinemia synd? assoc w what condition?

A

immune complex deposition disorder

assoc w chronic hep C

267
Q

mixed cryoglobulinemia synd –> presentation (5)

A
  • fatigue
  • palpable purpura
  • arthralgia
  • renal dz
  • peripheral neuropathy
268
Q

mixed cryoglobulinemia synd –> lab findings (5)

A
  • serum cryoglobulin
  • hypocomplement
  • +RF
  • elevated transaminase
  • kidney injury
269
Q

suspect mixed cryoglobulinemia –> what would be most helpful in establishing dx?

A

viral hep serology

270
Q

neonate –> bilious emesis –> abd XR shows dilated bowel –> next step?

A

contrast enema –> determine level of obstruction

271
Q

neonate –> bilious emesis –> d/t meconium ileus –> contrast enema will show what?

A

microcolon

272
Q

status epilepticus –> what lead to what hallmark condition?

A

cortical laminar necrosis –> persistent neuro deficit, recurrent sz

273
Q

6 hr postpartum –> lower abd pain –> hasn’t been able to void, persistent urine dribbling –> what condition?

A

postpartum urinary retention & overflow incontinence

274
Q

postpartum urinary retention –> RF (3)

A
  • prolonged labor
  • perineal trauma
  • regional analgesia
275
Q

adol –> initial menstrual cycles –> irreg & anovulatory –> pathophys

A

immature hypothalamic-pituitary-gonodal axis –> insuff secrete GnRH

276
Q

hiking this morning –> tick bite, tick still attached –> next step?

A

remv tick w small forceps

277
Q

hiking this morning –> tick bite, tick still attached –> does pt require prophylaxis?

A

no –> only if tick attached >36hr

278
Q

what is amiloride

A

K+ sparing diuretic

279
Q

CMV –> what reduces risk of transmission?

A

good hygiene

280
Q

preg –> CMV infect –> tx

A

no tx if infect develop during preg

281
Q

when should suspect stroke?

A

sudden appearance of focal neuro deficit –> >24hr

282
Q

1 cause of thrombotic ischemic stroke

A

atherosclerosis –> carotid, basilar, vertebral A

283
Q

1 artery involved in embolic ischemic stroke?

284
Q

stroke –> ACA –> ssx

A

weak –> contralal:

  • face
  • LE
  • trunk
285
Q

stroke –> MCA –> ssx (7)

A
  • contralat hemiparesis
  • contralat hemisensory loss
  • hyperreflexia
  • bilat visual abnormal
  • contralat neglect
  • aphasia (if dominant hemis)
  • inability to perform learned axns (if nondominant hemis)
286
Q

stroke –> PCA –> ssx

A
  • contralat visual abnormal –> homonymous hemianopsia

- if bilat PCA –> blind

287
Q

stroke –> basilar A –> ssx (7)

A
  • CN abnormal
  • contralat –> full body –> weak, decreased sensation
  • vertigo
  • loss of coordination
  • difficult speak
  • visual abnormal
  • coma
288
Q

stroke –> lacunar A –> 4 synd

A
  • pure motor hemiparesis
  • pure sensory stroke
  • ataxic hemiparesis
  • dysarthria clumsy hand synd
289
Q

stroke –> lacunar A –> #1 synd

A

pure motor hemiparesis

290
Q

pt has stroke –> when trt HTN? why?

A

do NOT trt HTN immed following stroke unless:

  • > 220/120
  • CAD

==> maintain cerebral perfusion

291
Q

ischemic stroke –> when can do thrombolytic tx?

292
Q

ischemic stroke –> acute setting –> meds?

A
  • antiplatelet (ASA) –> prevent additional stroke

- statin

293
Q

pt has TIA –> what is 5yr risk of stroke?

294
Q

ischemic stroke –> 2 most important RF

295
Q

what is amaurosis fugax

A

(example of TIA) transient, curtain-like loss of sight in ipsilat eye d/t microemboli to retina

296
Q

TIA of carotid –> presentation (4)

A
  • loss of speech
  • contralat extremity –> paralysis/paresthesia
  • 1 limb –> clumsy
  • amaurosis fugax
297
Q

TIA of vertebrobasilar system –> presentation (7)

A
  • vertigo/double vision
  • ipsilat face –> numb
  • contral limbs –> numb
  • dysarthria
  • hoarse/dysphagia/projectile vomit
  • HA
  • drop attack
298
Q

lacunar stroke –> pathophys –> what causes narrowing of arterial wall?

A

thickening of vessel wall (not by thrombosis)

299
Q

predisposing factor for lacunar stroke

A

HTN (DM also important)

300
Q

stroke: what causes global ischemia & infarct?

A

nonvasc cause –> low CO, anoxia

301
Q

subclavian steal synd –> pathophys

A

proximal stenosis of L subclavian A –> exercise L arm –> retrograde flow from vertebral A to supply blood to arm –> “steal” blood from vertebrobasilar system

302
Q

subclavian steal synd –> PE findings (3)

A
  • BP: L arm < R
  • decreased pulse in L arm
  • UE claudication
303
Q

stroke –> pure motor hemiparesis –> what area was affected?

A

lacunar A –> internal capsule

304
Q

stroke –> dysarthria, clumsy hand –> what area was affected?

A

lacunar A –> pons

305
Q

stroke –> pure sensory deficit –> what area was affected?

A

lacunar A –> thalamus

306
Q

thrombotic stroke –> onset

A

rapid or stepwise –> classically –> wake from sleep w neuro deficits

307
Q

stroke –> 1st imaging test

A

CT w/out contrast

308
Q

stroke –> CT non-contrast findings

A
  • ischemia: dark area

- hemorrhagic: white

309
Q

stroke –> young pt (<50) –> RF (5)

A
  • oral contraceptive
  • hypercoag state –> protein C/S def, anti-PLP synd
  • vasconstrictive drug use –> cocaine, amphetamine
  • polycythemia vera
  • sickle cell
310
Q

carotid duplex US screen –> who?

A

all pts w:

  • carotid bruit
  • PVD
  • CAD
311
Q

what is mag resonance arteriogram for?

A

definitive test: head & neck vessels –> ID stenosis, aneurysms

312
Q

stroke –> what comp can occur in 1-2 day?

A

cerebral edema –> mass effect

313
Q

stroke –> cerebral edema –> tx

A

lower ICP:

  • hypervent
  • mannitol
314
Q

ischemic stroke –> acute setting –> give antiplatelet –> what med is not given in acute setting?

A

anticoag –> no efficacy in acute stroke

315
Q

ischemic stroke –> when trt w anticoag?

A

after acute setting if cause was emboli from cardiac source

316
Q

lyme dz –> dx

A
  • clinical diagnosis

- serology to confirm: ELISA –> western to confirm

317
Q

lyme dz –> stage 2 –> may present w what conditions (5)?

A
  • meningitis
  • encephalitis
  • cranial neuritis –> bilat facial N palsy
  • peripheral radiculoneuropathy –> motor or sensory
  • cardiac: AV block, pericarditis, carditis
318
Q

HIV –> CMV –> disseminate –> what organ systems usu involved (2)?

319
Q

what is usu absent in CMV mononucleosis vs EBV mono (2)?

A
  • cervical LAD

- pharyngitis

320
Q

comm-acq pneumonia –> tx

A

3rd gen ceph (ceftriaxone) + macrolide (azithro)
OR
FQ (moxifloxacin)

321
Q

post-viral –> CAP –> what org?

322
Q

COPD –> CAP –> what org?

323
Q

fever + cough –> next step?

A
  • CXR

- O2 sat

324
Q

fever + cough –> cavitary lesion on CXR –> abscess –> tx?

A

3rd gen ceph + clindamycin

325
Q

fever + cough –> negative CXR –> what condition?

A

bronchitis

326
Q

bronchitis –> tx

A
  • macrolide
  • doxycycline
  • FQ (moxi)
327
Q

CAP –> classic presentation

A

sudden chill followed by:

  • fever
  • pleuritic pain
  • productive cough
328
Q

atypical pneumonia –> presentation

A

sore throat & HA –>dry cough, dyspnea

329
Q

pt worried have pneumonia –> normal vitals –> how likely have pneumonia

330
Q

pneumonia ssx, GI ssx, hypoNa –> what condition?

A

legionella pneumonia

331
Q

legionella pneumonia –> who (4)?

A
  • organ transplant
  • renal fail
  • chronic lung dz
  • smoke
332
Q

pneumonia –> comp (3)

A
  • pleural effusion
  • pleural empyema
  • acute resp fail
333
Q

heparin –> HIT –> CBC findings –> platelet count?

A

50% decrease

334
Q

ankylosing spondylitis –> #1 extra-articular manifestation

A

eye:
- ant uveitis
- iridocyclitis

335
Q

ankylosing spondylitis –> cardiac manifestation (2)

A
  • AV heart block

- aortic regurg

336
Q

ankylosing spondylitis –> comp (5)

A
  • restrictive lung dz
  • cauda equina synd
  • spine fx –> spinal cord injury
  • osteoporosis
  • spondylodiscitis
337
Q

sideroblastic anemia –> cause (4)

A
  • drug/alcohol
  • lead
  • B6 def
  • MPD
338
Q

sideroblastic anemia –> type of anemia?

A

microcytic/hypochromic

339
Q

difference –> case ctrl vs retrospective cohort

A
  • case ctrl: outcome –> assoc RF?

- retrospective cohort: RF exposure –> outcome?

340
Q

brain abscess –> classic triad

A
  • fever
  • severe HA –> nocturnal or morning
  • FND
341
Q

brain abscess –> RF (4)

A
  • cyanotic heart dz
  • recurrent sinusitis
  • dental infect
  • otitis media
342
Q

MSK low back pain –> tx for acute pain?

A
  • maintain mod activity
  • NSAID/acetaminophen
  • consider: muscle relaxant, spinal manipulation, brief course of opioids
343
Q

MSK low back pain –> tx for chronic pain?

A
  • intermittent NSAID
  • exercise tx
  • consider: TCA, duloxetine
344
Q

MI –> cardiac catheter & stent –> R toe & all L toes blue –> what condition?

A

“blue toe synd”

345
Q

“blue toe synd” –> pathophys

A

cardiac catheter & other vasc procedures –> disrupt atherosclerotic plaque –> chol crystals into circulation –> atheroembolism (cholesterol embolism) –> tissue/organ ischemia

346
Q

atheroembolism –> clinical manifestations (6)

A
  • blue toe synd
  • livedo reticularis
  • cerebral ischemia
  • intestinal ischemia
  • acute kidney injury
  • Hollenhurst plaque
347
Q

atheroembolism –> tx

A

supportive –> statin

348
Q

what is: cell-free fetal DNA testing

A

maternal plasma –> test for fetal aneuploidy

349
Q

cell-free fetal DNA testing –> who? when?

A

> 35yo preg –> increased risk of aneuploidy –> at >10wk gestation

350
Q

cell-free fetal DNA testing –> abnormal –> next step?

A

confirm results:

  • if at 10-12wk –> chorionic villus sampling
  • if at 15-20wk –> amniocentesis
351
Q

B2 (riboflavin) –> source (4)

A
  • dairy
  • egg, meat
  • green veg
352
Q

B2 (riboflavin) def –> ssx (4)

A
  • angular cheilosis
  • stomatitis/glossitis
  • normocytic anemia
  • seborrheic dermatitis
353
Q

baby dies –> mother comes in for lactation suppression –> how? (5)

A
  • supportive bra
  • avoid nipple stimulation
  • ice
  • NSAID
354
Q

M baby –> diag w cystic fibrosis –> GU comp? pathophys?

A

infertility: fetal genital tract –> inspissated mucus –> obstruct developing vas deferens –> congenital absence of vas deferens –> obstructive azoospermia

355
Q

lip –> #1 malig

356
Q

lip SCC –> most common location?

A

lower lip –> vermilion

357
Q

skin SCC –> biopsy findings

A

invasive cords of squamous cells w keratin pearls

358
Q

uncomplicated preterm premature ROM –> <34wk gestation –> next step?

A

conservative management –> continue in utero fetal growth:

  • corticosteroid –> decrease risk of neonatal resp distress synd
  • abx –> increase interval bw membrane rupture & delivery
359
Q

preterm premature ROM –> when should deliver (3)?

A
  • > 34wk gestation
  • intrauterine infect
  • deteriorating fetal/maternal status
360
Q

methanol poisoning –> more severe conseq (2)

A
  • vision loss

- coma

361
Q

methanol poisoning –> fundoscopic finding

A

optic disc hyperemia

362
Q

sickle cell trait –> renal comp (4)

A
  • painless hematuria
  • UTI
  • renal medullary cancer
  • inability to concentrate urine
363
Q

sickle cell trait –> painless hematuria –> what condition?

A

renal papillary necrosis

364
Q

postop comp –> atelectasis –> postop day?

365
Q

constrictive pericarditis –> #1 cause in developing world

366
Q

constrictive pericarditis –> MC cause in US (4)

A
  • virus
  • cardiac surg
  • chest rad
  • idiopathic
367
Q

constrictive pericarditis –> CXR finding

A

pericardial calcification

368
Q

what is D-xylose test

A

test of proximal small intestine absorption:

  • small intestine mucosal dz –> impaired absorption –> less in blood –> less in urine
  • malabsorption d/t enzyme def –> normal absorption of D-xylose
369
Q

cat scratch dz –> presentation

A
  • mild papular/nodular skin lesion

- ipsilat regional LAD

370
Q

62 F –> 5cm ovarian cyst found on US –> next step?

A

any ovarian mass in postmenopausal pt require investigation –> eval if mass is malig/benign –> CA-125 (marker for epithelial ovarian CA)

371
Q

2 MC posterior fossa tumors in children

A

1) astrocytoma

2) medulloblastoma

372
Q

medulloblastoma –> MC occur in what location? what does this location do?

A

balance & gait coordination

373
Q

cerebellar vermis –> medulloblastoma –> ssx (3)?

A
  • truncal or gait instability

- obstructive hydrocephalus (d/t proximity to 4th ventricle) –> ICP ssx

374
Q

HA, HTN, hyperreflexia, +preg test –> what condition?

A

preeclampsia w severe features

375
Q

preeclampsia at <20wk gestation –> comp of what condition?

A

hydatidiform mole

376
Q

preeclampsia –> likely caused by what?

A

abnormal placental spiral A dev

377
Q

pruritis, fatigue, hepatomegaly, +antimito Ab –> what condition?

A

primary biliary cholangitis

378
Q

primary biliary cholangitis –> skin findings (2)

A
  • pruritis

- xanthoma, xanthelasma

379
Q

primary biliary cholangitis –> pathophys

A

autoimmune –> progressive destroy intrahep bile ducts

380
Q

primary biliary cholangitis –> comp (3)

A
  • malabsorption
  • metabolic bone dz –> osteoporosis, osteomalacia
  • hepatocell CA
381
Q

primary biliary cholangitis –> tx? how does it help?

A

ursodeoxycholic acid –> delay progress

advanced dz –> liver transplant

382
Q

LBP –> 3 MC causes

A

1) musculoligamentous
2) degen disc dz (osteoarthritis)
3) facet arthritis

383
Q

disc herniation –> what worsens pain (2)?

A
  • increase intraspinal pressure: cough, sneeze

- forward flex: sit, drive, lift –> worse leg pain

384
Q

lumbar disc herniation & sciatica –> most pts need what tx?

A

majority improve w conservative tx

385
Q

spinal stenosis –> what worsens pain? what relieves it?

A
  • stand, walk
  • back extend –> worse leg pain

better when bend, sit

386
Q

lumbar disc herniation & sciatica –> tx?

A

conservative:
- anti-inflamm
- PT
- epidural steroid inject

387
Q

lumbar disc herniation & sciatica –> when do surg (2)?

A
  • conservative tx fail

- progressive neuro deficit

388
Q

spinal stenosis –> #1 finding

A

neurogenic claudication

389
Q

what is neurogenic claudication

A

radicular leg/butt pain –> pain, cramp, numb/paresthesia:

  • worse when walk
  • better when sit, forward flex
390
Q

musculoligamentous strain –> typical HPI

A

episode of bend/twist –> lift heavy object –> feel back “give way” –> immed onset back pain

391
Q

musculoligamentous strain –> referred pain?

A

muscle spasm –> butt –> upper post thigh –> knee level

392
Q

vertebral compression fx –> who (2)?

A
  • elder

- long term steroid

393
Q

vertebral compression fx –> location of pain

A
  • level of fx

radiate to:

  • across back
  • around trunk
394
Q

vertebral compression fx –> tx

A

time to heal (6-8wk):

  • brace
  • analgesic
395
Q

spine infect –> who (3)?

A
  • IVDA
  • dialysis
  • indwelling catheter
396
Q

epidural abscess –> tx?

A

surg decompression

397
Q

epidural abscess –> when medical manage instead of surg?

A
  • lumbar spine
  • no neuro deficits
  • no sepsis
398
Q

spine infect –> #1 imaging

399
Q

LBP –> conservative tx for how long before MRI?

400
Q

Motor fx:

  • L2
  • L3
  • L4
  • L5
  • S1
A
  • L2: hip flex
  • L3: knee extend
  • L4: ankle dorsiflex
  • L5: ankle/big toe dorsiflex
  • S1: ankle plantarflex
401
Q

cauda equina synd –> presentation

A
  • severe back/leg pain
  • bladder dysfx
  • saddle anesthesia
402
Q

cauda equina synd –> cause

A

lumbar spine –> severe stenosis (MC d/t acute disc herniation)

403
Q

spontaneous 2ndary (complicated pneumothorax) –> cause

A

comp of underlying lung dz:

  • # 1 COPD
  • asthma
  • interstitial lung dz
  • neoplasm
  • CF
  • TB
404
Q

spontaneous pneumothorax –> presentation

A
  • ipsilat CP –> sudden onset
  • dyspnea
  • cough
405
Q

tension pneumothorax –> cause (3)

A
  • mech ventilation w assoc barotrauma
  • CPR
  • trauma
406
Q

tension pneumothorax –> hypotension –> why?

A

great veins compressed –> impaired cardiac filling

407
Q

suspect tension pneumothorax –> next step –> CXR or decompress? why?

A

med emergency –> can die of hemodynamic compromise –> inadeq CO, hypoxemia

==> needle aspiration —> chest tube

408
Q

difference bw simple vs complex sz

A
  • simple: intact consciousness

- complex: impaired consciousness –> postictal confusion

409
Q

complex partial sz –> features (3)

A
  • impaired consciousness –> postictal confusion
  • automatisms
  • olfactory/gustatory hallucination
410
Q

what kind of sz has LOC?

A

generalized

411
Q

what is salvage tx

A

tx for dz when standard tx fails

412
Q

recurrent sinusitis & otitis, auditory canal ulceration, fatigue, anemia, microscopic hematuria –> what condition?

A

granulomatosis w polyangiitis

413
Q

granulomatosis w polyangiitis –> presentation

A
  • URTI
  • LRTI
  • glomerulonephritis
414
Q

HIV pt –> altered mental status –> PCR of CSF –> EBV DNA –> what condition?

A

primary CNS lymphoma

415
Q

primary CNS lymphoma –> MRI findings

A

solitary weakly ring-enhancing periventricular mass

416
Q

32 F –> dyspnea, orthopnea, peripheral edema –> what condition is causing her ssx?

A

viral myocarditis –> dilated cardiomyopathy –> ssx of decompensated heart fail

417
Q

hemorrhagic stroke –> putamen (basal ganglia) –> presentation? why?

A

injure adjacent internal capsule –> contralat hemiparesis & hemianesthesia

418
Q

1 cause of spontaneous deep intracerebral hemorrhage

A

HTN vasculopathy –> small penetrating branches of major cerebral A

419
Q

URI –> then fever, neck pain, tender goiter –> condition?

A

subacute (de Quervain) thyroiditis

420
Q

subacute (de Quervain) thyroiditis –> pathophys

A

URI –> postviral inflamm process

421
Q

subacute (de Quervain) thyroiditis –> tx

A

BB & NSAID

Step 2 (12 decks)

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