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4.29.17 Flashcards

1
Q

preg –> hyperandrogen ssx –> 2 MC causes

A
  • preg luteoma

- theca luteum cyst

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2
Q

preg luteoma –> US finding

A

solid ovarian mass –> 50% bilat

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3
Q

preg luteoma –> effect on fetus

A

F fetus –> virilization

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4
Q

preg luteoma –> tx

A

no maternal tx warranted –> after delivery –> regress spont

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5
Q

oxytocin –> how can cause sz?

A

oxytocin similar to ADH –> water retention –> hypoNa –> sz

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6
Q

pt w fever –> WBC 690 –> normal CXR & UA –> what condition?

A

febrile neutropenia

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7
Q

neutropenia –> definition

A

absolute neutrophil count <1500

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8
Q

febrile neutropenia –> pathophys

A

ANC <1000 –> higher risk for overwhelming bact infect d/t absent/blunted neutrophil-mediated inflamm response

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9
Q

febrile neutropenia –> MC org

A

G neg –> esp Pseudomonas

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10
Q

febrile neutropenia –> tx

A

medical emergency –> early empiric abx –> anti-pseudomonal:

  • cefepime
  • meropenem
  • pip/tazo
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11
Q

COPD pt –> sudden onset severe dsypnea & R chest pain –> what condition?

A

2ndary spont pneumothorax

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12
Q

COPD –> 2ndary spont pneumothorax –> pathophys

A

alveolar sacs –> chronic destruct –> lrg alveolar blebs –> rupture –> leak air into pleural space

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13
Q

vag bleed, closed cervix, viable fetus on US –> what condition?

A

threatened abortion

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14
Q

preg –> amphetamine abuse –> at risk for what conditions (5)

A
  • preterm delivery
  • preeclampsia
  • abruptio placentae
  • fetal growth restrict
  • intrauterine fetal demise
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15
Q

6mo F –> loss of motor milestones, hypotonic, HSM, bright red macula –> condition?

A

Neimann-Pick dz

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16
Q

Neimann-Pick dz –> enzyme def?

A

sphingomyelinase

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17
Q

Neimann-Pick dz –> presentation (4)

A
  • areflexia
  • HSM
  • cherry red macula
  • dev milestone regress
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18
Q

difference: Niemann-Pick vs Tay Sachs

A

Tay Sachs –> similar to Niemann Pick except:

  • hyperreflexia
  • no HSM
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19
Q

Tay Sachs –> enzyme def

A

B-hexosaminidase A

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20
Q

15 F –> 1ary amenorrhea, anosmia, no pubic hair, normal uterus/ovaries –> condition?

A

Kallman synd

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21
Q

Kallman synd –> pathophys

A

XR –> dysfx migration of fetal GnRH & olfactory neurons:

  • hypogonadotropic hypogonad
  • rhinencephalon hypoplasia
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22
Q

Kallman synd –> genotype

A

normal genotype:

  • 46XX
  • 46XY
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23
Q

Kallman synd –> presentation

A
  • delayed/absent puberty

- anosmia

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24
Q

Kallman synd –> LH & FSH levels

A

GnRH def –> low LH & FSH

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25
Q

58 M –> sz –> former smoker –> otherwise normal H&P –> MRI –> several lesions at gray & white matter jx –> what condition?

A

lung CA –> brain mets

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26
Q

lung CA –> mets to brain –> MRI finding

A

gray & white matter jx –> mult well-circumscribed lesions w vasogenic edema

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27
Q

pt w chronic liver dz –> vaccines same as gen population –> need what other vaccines?

A
  • Hep A
  • Hep B
  • 23-valent pneumococcal
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28
Q

> 65yo –> what type of pneumococcal vaccine?

A

13-valent –> followed by 23-valent

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29
Q

<65yo –> high risk comorbid condition –> what type of pneumococcal vaccine?

A

13-valent –> followed by 23-valent

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30
Q

<65yo –> chronic condition that increase risk of invasive pneumococcal dz–> what type of pneumococcal vaccine?

A

23-valent alone

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31
Q

<65yo –> comorbid condition at high risk for pneumococcal dz –> what are some high risk comorbid conditions? (5)

A
  • CSF leak
  • sickle cell dz
  • cochlear implant
  • congenital/acquired asplenia
  • immunocomp
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32
Q

what are some chronic conditions that increase risk of invasive pneumococcal dz (5)

A
  • heart dz
  • lung dz
  • DM
  • smoke
  • chronic liver dz
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33
Q

myasthenia gravis –> pathophys

A

autoAb –> nAChR at NM jx –> receptor degradation –> impaired AP propagation –> muscle weak

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34
Q

myasthenia gravis –> presentation (2)

A
  • ocular –> ptosis, diplopia

- bulbar dysfx –> fatigable chewing, dysphagia w nasopharyngeal regurg, dysarthria

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35
Q

myasthenia gravis –> chest imaging –> finding

A

ant mediastinal mass –> thymoma

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36
Q

went to Arizona –> CAP, arthralgia, erythema nodosum –> what condition?

A

coccidioides –> valley fever

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37
Q

hydroxychloroquine –> MOA

A

TNF & IL-1 inh

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38
Q

hydroxychloroquine –> AE (1)

A

retinopathy

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39
Q

DMARDS (5)

A
  • methotrexate
  • leflunomide
  • hydroxychloroquine
  • sulfasalazine
  • TNF inh
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40
Q

Tourette synd –> 2 MC comorbid conditions

A
  • ADHD

- OCD

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41
Q

52 F –> morning stiffness, MCP jts involved, nontender nodule at elbow, elevated ESR –> what condition?

A

RA

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42
Q

early RA –> which jts? (4)

A
  • fingers –> MCP & PIP
  • toes –> MTP
  • wrist
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43
Q

RA –> commonly affect what part of axial skeleton?

A

cervical spine

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44
Q

RA –> cervical spine involved –> comp (2)?

A
  • spinal subluxation

- spinal cord compression

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45
Q

what are rheumatoid nodules

A

firm nontender subcut nodules –> usu close to pressure pts –> ie elbow

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46
Q

33 F –> loss of pain/temp in cape-like dist –> normal vibrate/proprioception –> what condition?

A

syringomyelia

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47
Q

what is syringomyelia

A

spinal cord –> fluid filled cavity –> from:

1) dilation of central canal
2) spinal parenchyma –> separate cavity

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48
Q

syringomyelia –> MC assoc condition

A

Arnold Chiari malformation type 1

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49
Q

syringomyelia –> 2 MC location

A
  • cervical

- thoracic

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50
Q

syringomyelia –> presentation (3)

A
  • UE –> weak, areflexia

- sensory loss –> cape dist

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51
Q

what makes S3 heart sound

A

LA –> blood into LV –> hit blood already in LV –> blood reverberate

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52
Q

S3 –> indicates what pathologic medical condition?

A

LV fail

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53
Q

LV fail ssx –> best initial tx

A

IV diuretic

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54
Q

Crohn’s –> small bowel resect –> now has gen bone pain –> XR –> decreased bone density, femoral neck pseudofx –> what condition?

A

osteomalacia

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55
Q

Crohn’s –> small bowel resect –> osteomalacia –> pathophys

A

Crohn’s & small bowel resect –> malabsorption –> vitD def

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56
Q

osteomalacia –> MC cause

A

vitD def

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57
Q

osteomalacia –> lab findings

  • Ca
  • phosphate
  • PTH
  • alk phos
A
  • Ca: low
  • phosphate: low
  • PTH: increased
  • alk phos: increased
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58
Q

osteomalacia –> characteristic XR finding

A

bilat & symm pseudofractures (Looser zones)

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59
Q

osteomalacia –> presentation (2)

A
  • muscle weak

- bone pain

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60
Q

47 F G4P4 –> low abd pain –> relieved w urination, painful intercourse, normal external genitalia, normal UA –> what condition?

A

interstitial cystitis (painful bladder synd)

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61
Q

interstitial cystitis –> presentation (3)

A
  • bladder pain w filling –> relief w void
  • freq, urgency
  • chronic pelvic pain –> dyspareunia
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62
Q

what is interstitial cystitis

A

chronic painful bladder condition of uncertain etiology

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63
Q

pronator drift –> indicates what?

A

UMN lesion –> pyramidal/corticospinal tract dz

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64
Q

62 M –> sudden onset pain & red in L eye –> photophobia, N, severe HA –> not relieved w ibuprofen –> had used oral decongestant for cold –> nonreactive & dilated pupil –> what condition?

A

acute angle closure glaucoma

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65
Q

acute angle closure glaucoma –> presentation (6)

A
  • sudden onset eye pain
  • HA
  • N
  • conjunctival erythema
  • corneal opacification
  • mid-dilated pupil
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66
Q

acute angle closure glaucoma –> gold standard for dx

A

gonioscopy: specialized prismatic lens w slit lamp –> visualize iridocorneal angle

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67
Q

pt w suspected acute angle closure glaucoma –> next step?

A
  • urgent ophthalmologic consultation

- tonometry –> measure intraocular pressure

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68
Q

abnormal uterine bleed –> definition

A

menstrual bleed:

  • prolonged –> >5day
  • heavy
  • irreg
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69
Q

53 M –> strange itchy rash on L nipple for 1mo –> no relief w steroid –> no periods for 2 yr –> what condition?

A

Mammary Paget dz

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70
Q

Mammary Paget dz –> presentation

A

painful, itchy, eczematous and/or ulcerating rash on nipple –> spread to areola

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71
Q

Mammary Paget dz –> assoc condition?

A

breast adenoCA

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72
Q

acetaminophen –> effect on warfarin

A

inh CYP450 –> increase warfarin effect –> increase bleed

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73
Q

what meds can increase warfarin effect (4)?

A
  • acetaminophen
  • NSAID
  • amiodarone
  • abx
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74
Q

preterm infant –> MC cause of anemia

A

anemia of prematurity

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75
Q

anemia of prematurity –> pathophys

A
  • diminished EPO
  • short RBC life span
  • blood loss from phlebotomy
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76
Q

anemia of prematurity –> lab findings:

  • Hb
  • Hct
  • retic
A
  • Hb: decreased
  • Hct: decreased
  • retic: low
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77
Q

prepubertal F –> MC vaginal foreign body

A

toilet paper

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78
Q

prepubertal F –> vaginal foreign body –> tx

A

topical anesthetic:
- calcium alginate swab
OR
- irrigation w warm fluid

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79
Q

Graves ophthalmology –> pathophys

A
  • thyrotropin receptor Ab –> retroorbital fibroblast, adipocytes
  • activated T cells
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80
Q

what tx for Graves can worsen ophthalmology? why? what can be done about it?

A

radioactive iodine –> increase thyrotropin receptor Ab titer

glucocorticoids

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81
Q

Graves dz w mod-severe ophthalmopathy –> prefered tx

A

thyroidectomy

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82
Q

Graves dz –> 3 primary tx options

A
  • radioactive iodine
  • antithyroid drugs (propylthiouracil, methimazole)
  • thyroidectomy
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83
Q

suspect chronic pancreatitis –> next step to dx?

A

CT or plain film –> pancreatic calcifications

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84
Q

suspect chronic pancreatitis –> why not amylase/lipase to dx?

A

can be normal & nondiagnostic

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85
Q

45 M –> HA & confusion for 2 days –> no focal weak/sensory ssx –> low Hb & platelets, elevated Cr –> fragmented RBC on blood smear –>normal prothrombin –> what condition?

A

thrombotic thrombocytopenic purpura

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86
Q

thrombotic thrombocytopenic purpura –> pathophys

A

acquired/hereditary autoAb –> low ADAMTS13 –> vWF multimers –> platelet trap & activate

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87
Q

thrombotic thrombocytopenic purpura –> presentation –> pentad

A
  • thrombocytopenia
  • microangiopathic hemolytic anemia
  • renal insuff
  • neuro changes
  • fever
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88
Q

thrombotic thrombocytopenic purpura –> tx

A

emergent plasma exchange:

  • replenish ADAMTS13
  • remv autoAb
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89
Q

18 F –> clitoromegaly, normal uterus, amenorrhea –> undetectable estradiol, estrone –> what condition?

A

aromatase def

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90
Q

aromatase def –> presentation

A
  • normal internal genitalia
  • external virilization
  • undetectable estrogen levels
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91
Q

aromatase def –> pathophys

A

prevent conversion of androgen to estrogen

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92
Q

asbestos exposure –> resulting MC malig

A

bronchogenic carcinoma

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93
Q

asbestosis –> pathognomic CXR finding

A

pleural plaques

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94
Q

53F –> G2P2 –> R pelvic pain for 3 mo –> h/o tubal ligation, C-section, smoke & EtOH –> neg B-hCG –> US –> ovarian mass –> solid components, thick septations, mod amt of peritoneal fluid –> what condition?

A

epithelial ovarian carcinoma

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95
Q

epithelial ovarian carcinoma –> US findings (3)

A
  • solid mass
  • thick septation
  • ascites
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96
Q

epithelial ovarian carcinoma –> presentation (3)

A
  • pelvic/abd pain
  • bloat
  • early satiety
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97
Q

1st trim screen –> purpose

A

estimate risk of trisomy 18 & 21

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98
Q

prenatal screen –> abnormal –> followup with what diag testing?

A
  • amniocentesis
  • chorionic villus sampling
    depending on GA
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99
Q

1st trim screen –> components

A
  • preg-assoc plasma protein (PAPP)
  • B-hCG level
  • fetal nuchal translucency
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100
Q

1st trim screen –> abnormal results that suggest aneuploidy

A
  • B-hCG: elevated

- nuchal translucency: increased

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101
Q

when use amniocentesis vs chorionic villus sampling

A
  • amniocentesis: 15wk GA

- chorionic villus sampling: 10-13 GA

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102
Q

suspect hep induced thrombocytopenia –> next step?

A
  • stop hep

- start direct thrombin inh (argatroban) or fondaparinux

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103
Q

newborn –> necrotizing enterocolitis –> RF (3)

A
  • prematurity
  • hypotension
  • congenital heart dz
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104
Q

38F –> G1P0 –> 1st prenatal visit –> BP 141/96, no other ssx –> next visit BP 152/106 –> what condition?

A

primary HTN

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105
Q

preg –> chronic HTN –> definition

A

<20wk GA –> >140/90

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106
Q

gestational HTN –> definition

A

> 20wk GA –> new onset elevated BP –> no proteinuria, end organ damage

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107
Q

preeclampsia –> definition

A

> 20wk GA –> new onset elevated BP –> proteinuria or end organ damage

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108
Q

eclampsia –> definition

A

preeclampsia + new onset grand mal sz

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109
Q

mitral stenosis –> presentation (4)

A
  • dsypnea
  • orthopnea
  • paroxsymal nocturnal dyspnea
  • hemoptysis
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110
Q

mitral stenosis –> assoc comp?

A

LA enlrg –> A-fib –> systemic thromboembolic comp (stroke)

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111
Q

what can increase thyroglobulin (2)?

A
  • preg

- OCP

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112
Q

what can decrease thyroglobulin (2)?

A
  • nephrotic synd

- androgen use

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113
Q

preg –> lab findings:

  • TBG
  • total T4
  • free T4
A
  • TBG: increased
  • total T4: increased
  • free T4: normal
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114
Q

nephrotic synd –> lab findings:

  • TBG
  • total T4
  • free T4
A
  • TBG: decreased
  • total T4: decreased
  • free T4: normal
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115
Q

pneumothorax –> common causes (8)

A

A CHEST IN:

  • asthma
  • CF
  • HIV
  • emphysema
  • spont trauma
  • iatrogenic
  • neoplasm
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116
Q

suspect tension pneumothorax –> next step

A

immed needle decompress

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117
Q

small pneumothorax –> tx

A

may resolve w suppl O2 only

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118
Q

SLE –> freq have false pos test for what?

A

syphilis

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119
Q

TTP –> lab results:

  • PT/PTT
  • fibrinogen
  • D-dimer
A
  • PT/PTT: normal
  • fibrinogen: normal
  • D-dimer: normal
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120
Q

myasthenia gravis –> assoc w what conditions (2)?

A
  • thymoma

- thyrotoxicosis

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121
Q

CHF exacerbation –> tx

A

LMNOP:

  • lasix
  • morphine
  • nitrate or nesiritide
  • O2
  • positioning/pressor (dobutamine)
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122
Q

40 M –> car accident –> broke leg –> IV ketorolac –> pain persistent –> h/o of opioid addiction –> best analgesic choice?

A

acute pain management –> similar for all pts regardless of subst abuse hx

==> IV morphine is approp option

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123
Q

acute liver fail –> dx criteria triad

A
  • elevated aminotransferases
  • ssx of hep encephalopathy
  • syn liver dysfx –> INR >1.5
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124
Q

acute liver fail –> MC cause

A

acetaminophen toxicity

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125
Q

29M –> splenectomy after MVA –> receives RBC transfusion –> min after –> wheeze –> resp distress, low BP, lose consciousness –> most likely cause of transfusion rxn?

A

anaphylactic rxn

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126
Q

who gets anaphylactic rxn to blood transfusion?

A

IgA def

has anti-IgA Ab –> attack IgA in blood transfusion

127
Q

MEN2B –> components (3)

A
  • medullary thyroid cancer
  • pheochromocytoma
  • mucosal neuroma/marfanoid habitus
128
Q

4mo M –> harsh sound w inspiration –> esp when lie on back, improve when upright or during “tummy time” –> growing well, full term, no comp w delivery –> what condition?

A

laryngomalacia

129
Q

laryngomalacia –> pathophys

A

“floppy” supraglottic struct –> collapse during inspiration

130
Q

laryngomalacia –> presentation

A

inspiratory stridor –> worse when supine

131
Q

laryngomalacia –> dx

A
  • usu clinical

- mod/severe –> confirm w flexible laryngoscopy

132
Q

laryngomalacia –> tx

A

most –> reassurance d/t spont resolve

133
Q

MC cause of vitB12 def in N Europe whites?

A

pernicious anemia

134
Q

pernicious anemia –> presentation (5)

A
  • megaloblastic anemia
  • atrophic glossitis (shiny tongue)
  • vitiligo
  • thyroid dz
  • neuro abnormal
135
Q

34M –> recurrent episodes of acute, severe R periorbital pain –> last 30-45min –> miosis, lacrimation, nasal drainage –> no vision change –> what condition?

A

cluster HA

136
Q

cluster HA –> #1 abortive tx

A

100% O2 by facemask

137
Q

ASCVD –> when start statin?

A

40-75yo –> 10yr risk of atherosclerotic CV dz –> >7.5%

138
Q

40M –> sudden onset odynophagia, retrosternal CP, difficult swallow –> endoscopy –> mid-3rd esophagus –> circumferential deep ulcer w relatively normal surrounding mucosa –> what condition?

A

pill induced esophagitis

139
Q

pill induced esophagitis –> presentation (3)

A

sudden onset:

  • odynophagia
  • retrosternal pain
  • difficult swallow
140
Q

pill induced esophagitis –> endoscopy findings

A

discrete ulcer –> normal surrounding mucosa

141
Q

pill induced esophagitis –> typically caused by what meds (4)

A
  • tetracycline
  • potassium chloride
  • bisphosphonate
  • NSAID
142
Q

40F –> MVA –> hurt R leg –> reduced knee extension, decreased sensory to medial lower thigh & leg –> what nerve injured?

A

femoral N

143
Q

femoral N –> motor fx

A

thigh –> ant cmpt:

  • knee extend
  • hip flex
144
Q

femoral N –> sensory fx

A
  • ant thigh

- med leg

145
Q

what branch of femoral N provide sensory to ant thigh & med leg?

A

saphenous

146
Q

angiodysplasia –> assoc w what conditions (3)?

A
  • advanced renal dz
  • vWF dz
  • aortic stenosis
147
Q

39F –> diag w placenta previa –> what is contraindicated in this pt (3)

A
  • intercourse
  • digital cervical exam
  • vag delivery
148
Q

what are the 4 manifestations of alcohol withdrawal synd (4)

A
  • mild withdrawal
  • sz
  • alcoholic hallucinosis
  • delirium tremens
149
Q

alcoholic hallucinosis –> presentation (3)

A
  • intact orientation
  • hallucination
  • stable vital signs
150
Q

alcoholic hallucinosis –> onset? when resolve?

A

12-24hr –> resolve in 24-48hr

151
Q

hallmark of delirium tremens

A

disorientation and global confusion

152
Q

38F –> obese, oligomenorrhea –> abnormal uterine bleed –> workup should include what (3)

A
  • CBC
  • pelvic US
  • endometrial bx
153
Q

38F –> obese, oligomenorrhea –> abnormal uterine bleed –> why do endometrial bx?

A

has RF for endometrial hyperplasia –> obesity, oligomenorrhea

154
Q

15M –> recurrent hematuria & proteinuria, sensorineural hearing loss –> FMHx of renal dz –> what condition?

A

Alport’s synd

155
Q

Alport’s synd –> electron microscopy findings

A
  • capillary loops –> alternating areas of thin & thick

- glomerular BM splitting

156
Q

56M –> severe crushing midsternal CP, diaphoresis, dyspnea –> had drug-eluting stent placed in LAD 10 days ago –> EKG shows ST elevation in I, aVL, V1-4 –> what condition? what caused it?

A

MI of LAD d/t medication noncompliance

157
Q

coronary A stent –> #1 cause of stent thrombosis

A

premature discontinuation of antiplatelet therapy

158
Q

coronary A stent –> pt should be on what antiplatelet therapy?

A

ASA + platelet P2Y12 receptor blocker (clopidogrel, prasugrel, ticagrelor)

159
Q

MC cause of mitral regurg in developed countries

A

mitral valve prolapse

160
Q

Goodpasture’s dz –> affects what organ systems

A
  • lung

- kidney

161
Q

Goodpastures’ dz –> how dx?

A

renal bx

162
Q

Goodpasture’s dz –> renal bx findings

A

linear IgG Ab along glomerular BM

163
Q

6hr M –> tachycardia, irritable, warm, flushed skin –> mother had Graves’ dz trted w surg resect 6mo before preg –> became hypothyroid –> trt w levothyroxine during preg –> what condition? what caused it?

A

neonatal thyrotoxicosis

164
Q

6hr M –> neonatal thyrotoxicosis –> mother had Graves trted w surg resect –> became hypothyroid –> trted w levothyroxine during preg –> why is neonatal thyrotoxicosis not caused by transplacental levothyroxine?

A

levothyroxine (like endogenous TH) not cross placenta

165
Q

neonatal thyrotoxicosis –> tx

A

methimazole + BB til self-resolve

166
Q

neonatal thyrotoxicosis –> pathophys

A

TSH receptor Ab –> cross placenta

167
Q

CURB-65 criteria used for what?

A

pneumonia –> risk stratification –> determine hospitalization

168
Q

CURB-65 –> how to score?

A

1pt for each:

  • Confusion
  • Urea >20
  • RR >30
  • BP <90/60
  • > 65yo
169
Q

CURB-65 –> how to interprete score?

A
  • 0 –> low mortality –> outpt tx
  • 1-2 –> interm mortality –> likely inpt tx
  • 3-4 –> high mortality –> urgent inpt admission, possible ICU if score >4
170
Q

CURB-65 –> how

to interprete score?

A
  • 0 –> low mortality –> outpt tx
  • 1-2 –> interm mortality –> likely inpt tx
  • 3-4 –> high mortality –> urgent inpt admission, possible ICU if score >4
171
Q

pneumonia –> must be admitted –> empiric tx?

A
  • FQ –> moxifloxacin

- B-lactam (ceftriaxone) + macrolide (azithromycin)

172
Q

mult sclerosis –> lumbar puncture findings

A

oligoclonal IgG bands

173
Q

mult sclerosis –> when do lumbar puncture?

A

when suspect mult sclerosis but clinical exam/MRI not classic

174
Q

newborn –> IUGR, HSM, juandice, profuse rhinorrhea, desquamating skin rash –> what condition?

A

congenital syphilis

175
Q

clinical findings specific to congenital syphilis (3)

A
  • copious rhinorrhea (snuffles)
  • maculopapular rash –> desquamate or become bullous
  • abnormal long bone XR
176
Q

clinical findings common to all congenital infections (4)

A
  • IUGR
  • HSM
  • jaundice
  • blueberry muffin spots
177
Q

32M –> eye pain & discharge –> has not remv contact lens for 1wk –> cornea is edematous, hazy, ulcerated –> extensive scleral injection –> what condition?

A

contact lens assoc keratitis

178
Q

contact lens assoc keratitis –> most common org

A

Gram neg –> pseudomonas

179
Q

prolonged infusion of sodium nitroprusside can lead to what comp?

A

cyanide toxicity

180
Q

cyanide toxicity –> presentation (5)

A
  • HA
  • confuse
  • arrhythmia
  • flushing
  • resp depression
181
Q

calc: number needed to trt

A

1/ARR (absolute risk reduction)

182
Q

cancer-related anorexia/cachexia synd (CACS) –> tx

A
  • progesterone analogue –> megestrol acetate, medroxyprogesterone acetate
  • corticosteroid
183
Q

23M –> MVA w blunt chest trauma –> JVD, tachycardia, hypotension despite aggressive fluid resuscitation –> what condition?

A

acute cardiac tamponade

184
Q

bath salts –> duration

A

prolonged –> days to weeks

185
Q

bath salts –> what type of drugs

A

amphetamine analog

186
Q

what is endophthalmitis

A

infection w/in eye, particularly vitreous

187
Q

what is potter seq

A

urinary tract anomaly –> anuria/oliguria in utero –> oligohydramnios –> physical anomalies –> pulm hypoplasia, flat facies, limb deformities

188
Q

post urethral valve –> prenatal US –> classic findings (3)

A
  • bladder distention
  • bilat hydroureters
  • bilat hydronephrosis
189
Q

acute Afib –> unstable –> 1st step in management?

A

immed electrical cardioversion to sinus rhythm

190
Q

acute Afib –> stable –> 1st step in management?

A

rate ctrl:

  • BB preferred
  • CCB alternative
191
Q

acute Afib –> what can use for pharmacologic cardioversion (5)

A
  • ibutulide
  • procainamide
  • flecainide
  • sotalol
  • amiodarone
192
Q

acute Afib –> stable –> next step in management after rate ctrl?

A

cardiovert to sinus rhythm

193
Q

does renal fail lead to hypo or hyperCa?

A
  • usu hypo

- can cause hyper d/t 2ndary hyperPTH

194
Q

how does chronic renal fail lead to hypoCa?

A

failing kidney –> not produce enough active vitD –> not absorb Ca

195
Q

how does chronic renal fail lead to 2ndary hyperPTH?

A

hypoCa –> increase secrete PTH

196
Q

hyperCa –> EKG finding

A

shortened QT interval

197
Q

hyperCa –> 1st step in management? why?

A

IVF –> increase urinary excretion

198
Q

vitD intoxication –> hyperCa –> tx

A

glucocorticoids

199
Q

how does pH affect serum K?

A
  • alkalosis –> hypoK

- acidosis –> hyperK

200
Q

hyperCa –> classic presentation

A
  • stones
  • bones
  • groans
  • psych overtones
201
Q

hyperCa –> what ssx are included in “groans” (5)

A
  • muscle pain/weak
  • pancreatitis
  • PUD
  • gout
  • constipation
202
Q

how does hyperPO4 lead to hypoCa?

A

PO4 –> bind w Ca –> insoluble precipitate

203
Q

how does hypoMg lead to hypoCa?

A

low Mg –> decrease PTH secrete

204
Q

how does blood transfusion lead to hypoCa?

A

citrated blood –> citrate bind Ca

205
Q

EKG –> prolonged QT interval –> what electrolyte abnormality can cause this?

A

hypoCa

206
Q

hypoCa –> should look for what other electrolyte abnormality?

A

hypoMg

207
Q

Addison dz –> aka?

A

1ary adrenal insuff

208
Q

1ary adrenal insuff –> #1 cause in developed country? in developing country?

A
  • developed: idiopathic

- developing: TB

209
Q

2ndary adrenal insuff –> cause?

A

long term steroid

210
Q

what clinical findings only found in 1ary NOT 2dnary adrenal insuff?

A
  • hyperpigment

- hyperK

211
Q

long term steroid –> 2ndary adrenal insuff –> pathophys?

A

exogenous steroid –> chronic suppress CRH & ACTH –> ill/trauma –> can’t secrete enough cortisol

212
Q

low aldos –> seen in 1ary adrenal insuff or 2ndary or both?

A

only seen in 1ary adrenal insuff

chronic steroid use –> decrease ACTH –> ACTH not affect aldos secretion

213
Q

low aldos –> clinical findings

A
  • sodium loss –> hypoNa, hypovol –> hypotension, shock

- retain K –> hyperK

214
Q

low cortisol –> clinical findings (4)

A
  • GI ssx –> anorexia, N/V, vague abd pain, wt loss
  • mental ssx –> lethargy, confuse, psychosis
  • hypoglycemia
  • hyperpigment
215
Q

1ary adrenal insuff –> lab findings:

  • plasma cortisol
  • ACTH
  • aldos
  • renin
A
  • plasma cortisol: low
  • ACTH: high
  • aldos: low
  • renin: high
216
Q

prerenal kidney injury –> BUN:Cr ratio

A

> 20:1

217
Q

60M –> nausea & abd pain –> had had coronary angiogram & stent 5 days ago –> PMHx HTN, hyperchol, PAD, DM II –> painless purple mottling on both feet, elevated Cr –> what condition?

A

chol crystal embolism

218
Q

chol crystal embolism –> commonly occur after what?

A

vasc procedure

219
Q

chol xl embolism –> clinical features typically seen in what organ systems (5)

A
  • derm
  • renal
  • CNS
  • ocular
  • GI
220
Q

chol xl embolism –> classic derm findings (2)

A
  • livedo reticularis

- blue toe synd

221
Q

chol xl embolism –> classic renal finding

A

acute/subacute kidney injury

222
Q

chol xl embolism –> classic ocular finding

A

Hollenhorst plaque

223
Q

chol xl embolism –> CBC finding

A

eosinophilia

224
Q

65M –> sudden loss of vision in R eye –> PMHx of DM trted w metformin & glyburide –> exam reveals reduced light perception, floating debris, dark red glow –> what condition?

A

vitreous hemorrhage

225
Q

vitreous hemorrhage –> typical presentation (2)

A
  • sudden loss of vision

- onset of floaters

226
Q

vitreous hemorrhage –> MC cause

A

diabetic retinopathy

227
Q

22mo F –> abd pain –> cry & scream inconsolably during episodes –> had 3 URI this winter, gastroenteritis 2wk ago –> palpable cylindrical mass on R abd –> what condition?

A

intussusception

228
Q

intussusception –> MC RF

A

recent viral illness

229
Q

gastroenteritis –> intussusception –> pathophys

A

gastroenteritis –> Peyer patch hypertrophy –> nidus for telescoping

230
Q

intussception –> MC occur in what age grp?

A

<2yo

231
Q

intussusception –> MC occur in <2yo –> if occur in older child –> should suspect what?

A

pathologic lead pt

232
Q

intussusception –> how dx & tx?

A

sonographic/fluoroscopic guidance –> air/saline enema

233
Q

SIADH –> charact findings:

  • serum Na
  • serum osmolality
  • urine osmolality
  • volemia
A
  • hypoNa
  • serum osm: <275
  • urine osm: >100 (inapprop elevated)
  • euvolemic
234
Q

ankylosing spondylitis –> MC extraarticular manifestation

A

ant uveitis (iritis)

235
Q

ant uveitis –> presentation

A

unilat:

  • intense pain
  • photophobia
236
Q

thyroid storm –> precipitating factors

A
  • surg
  • acute illness (trauma, infect)
  • childbirth
  • acute iodine load
237
Q

thyroid storm –> most serious ssx (4)

A
  • high fever
  • hemodynamic instability
  • arrhythmia
  • CHF
238
Q

spinal epidural abscess –> MC org

A

staph aureus

239
Q

spinal epidural abscess –> classic triad

A
  • fever
  • severe focal back pain
  • neuro deficit
240
Q

spinal epidural abscess –> pathophys

A
  • hematologic spread: distant infect, IVDA

- direct inoculation: spinal procedure

241
Q

syphilis –> allergic to PCN –> alt tx?

A

doxycycline

242
Q

what is:

  • false labor
  • latent labor
  • labor
A
  • false labor: mild, irreg contract –> no cervical change
  • latent labor: reg contract –> increase freq & intensity –> gradual cervical change
  • labor: reg painful contract –> cervical change
243
Q

7M –> severe acne –> sig increase in growth, course pubic/axillary hair, normal testicle, bone age 2x higher, –> low LH, not increase after GnRH –> what condition?

A

21 hydroxylase def –> nonclassic (late-onset) congenital adrenal hyperplasia

244
Q

low LH at baseline –> not increase after GnRH –> means what type of precocious puberty?

A

gonadotropin-indep (peripheral) precocious puberty

245
Q

DKA –> leads to what type of respiration?

A

Kussmaul –> rapid & deep

246
Q

DKA –> when give 5% glucose? why?

A

when blood glucose 250 –> prevent hypoglycemia

247
Q

thionamides –> most serious SE

A

agranulocytosis

248
Q

mult sclerosis –> plaques –> classic location

A

at angles of lat ventricles

249
Q

22F preg –> lyme dz –> tx?

A

amoxicillin

250
Q

HELLP synd –> presentation (3)

A
  • preeclampsia
  • N/V
  • RUQ abd pain
251
Q

HELLP synd –> what causes the RUQ abd pain?

A

serious liver problems (centrilobular necrosis, hematoma formation, thrombi in portal capillary system) –> liver swell –> distend hepatic (Glisson’s) capsule –> RUQ/epigastric pain

252
Q

23F –> nasal breathing, stuffy noise, occasional dry cough for >1yr –> ssx fluctuate in intensity w/out inciting factors –> no eye/ear ssx, itch, wheeze, or skin rash –> nasal mucosa boggy & erythematous, lungs clear –> what conditon?

A

nonallergic rhinitis

253
Q

nonallergic rhinitis –> tx:

  • mild
  • mod-severe
A
  • mild: intranasal antihist or glucocorticoid

- mod-severe: combo

254
Q

13F –> L groin mass –> tanner stage 2 breast, normal external F genitalia –> US shows cryptorchid gonads, no uterus –> karyotype 46XY –> what condition?

A

complete androgen insens synd

255
Q

complete androgen insens synd –> pathophys

A

defective androgen receptors –> unresponsive to normal male levels of androgens –> develop phenotypically F

256
Q

complete androgen insens synd –> gonadectomy when? why?

A

after completion of puberty (after attain adult height) –> decrease risk of gonadal malig

257
Q

2nd stage arrest of labor –> MC cause

A

fetal malposition

258
Q

high suspicion for epithelial ovarian CA –> next step?

A

exploratory laparotomy:

  • cancer resect & stage
  • inspect entire abd cavity
259
Q

6M –> R shoulder pain for 2wk –> PE localized swelling –> XR single lytic lesion –> mild hyperCa –> what condition?

A

Langerhans histiocytosis

260
Q

sialadenosis –> seen in what conditions? (2)

A
  • adv liver dz (non/alcoholic cirrhosis)

- dietary/nutritional disorders

261
Q

LE –> progressive proximal muscle weak –> no pain/tender –> what condition?

A

glucocorticoid induced myopathy

262
Q

38F –> progressive proximal muscle weak –> no muscle pain –> facial hirsutism, HTN –> what condition?

A

hypercortisolism (Cushing synd)

263
Q

glucocorticoid induced myopathy –> pathophys

A

cortisol –> catabolic effect on skeletal muscle –> muscle atrophy

264
Q

toxic shock synd –> presentation (3)

A
  • fever
  • hypotension
  • diffuse red macular rash –> involve palms/soles
265
Q

64M –> sharp stabbing back pain that radiate to legs –> difficult urination, pain in saddle region –> severe LE muscle weak, absent LE reflex, sensation diminished asymm –> what condition?

A

cauda equina synd

266
Q

cauda equina synd –> presentation (5)

A
  • severe LBP –> unilat radiculpathy
  • saddle anesthesia
  • hyporeflexia
  • profound asymm motor weak
  • late onset bowel/bladder dysfx
267
Q

conus medullaris synd –> presentation (5)

A
  • severe LBP –> less degree of radiculopathy
  • perianal anesthesia
  • hyperreflexia
  • mild bilat motor weak
  • early onset bowel/bladder dysfx
268
Q

70M –> sudden onset R weak & urinary incontinence –> strength 4/5 R UE, 1/5 R LE, R babinski, decreased sensation in R foot/leg –> visual fields normal –> what condition?

A

stroke in ant cerebral A

269
Q

stroke in ant cerebral A –> presentation

A
  • contralat motor/sensory deficit –> more pronounced in LE than UE
  • occasionally urinary incontinence
270
Q

digital clubbing –> MC causes (3)

A
  • lung malig
  • CF
  • R to L cardiac shunt
271
Q

42M –> recent emigrate from N Africa –> 1mo of abd pain, watery diarrhea, skin rash worse w sun exposure, depressed –> PMHx latent TB trting w isoniazid & pyridoxine –> what condition?

A

pellagra

272
Q

pellagra –> presentation

A

3 Ds:

  • dermatitis
  • diarrhea
  • dementia
273
Q

pellagra –> cause

A

niacin def

274
Q

niacin can be synthesized from what?

A

tryptophan

275
Q

what drug can cause pellagra? how?

A

prolonged isoniazid –> interfere w tryptophan metab

276
Q

common cause of niacin def in developing country?

A

predominant corn diet

277
Q

Duchenne muscular dystrophy –> is dystrophin absent or reduced?

A

absent

278
Q

iron def anemia vs thalassemia:

  • MCV
  • RDW
  • # RBC
A
  • MCV: low vs low
  • RDW: high vs normal
  • # RBC: low vs normal
279
Q

thalassemia –> peripheral blood smear findings (3)

A
  • hypochromic microcytic cells
  • target cells
  • teardrop cells
280
Q

46M –> MVA –> hosp day 5 –> RUQ tender, diminished bowel sounds, retention of gastric contents –> CT gaseous distention of small & lrg bowel w/out air-fluid levels, gallbladder distended w no stones –> what condition?

A

acalculous cholecystitis

281
Q

acalculous cholecystitis –> most often seen in whom?

A

severely ill pts (ICU –> multiorgan fail, severe trauma, surg, burn, sepsis, prolonged parenteral nutrition)

282
Q

acalculous cholecystitis –> immed tx?

A

abx + percut cholecystostomy

283
Q

acalculous cholecystitis –> definitive tx?

A

cholecystectomy when medical condition stabilize

284
Q

pap –> atypical glandular cells –> workup requires (3)?

A
  • colposcopy
  • endocerv curettage
  • endom bx
285
Q

pap –> atypical glandular cells –> why need to do endom bx?

A

atypical glandular cells may be d/t either cervical or endom adenoCA

286
Q

45F –> 3mo of prog exertional dypsnea & nonproductive cough –> no CP, edema –> h/o Raynaud, HTN, severe GERD –> skin is thick & firm –> what condition?

A

systemic scleroderma –> interstitial lung dz

287
Q

3mo M –> refuse to feed for 3 day –> head floppy, bilat ptosis, copious drool, weak suck, extremities flaccid –> recently moved to Cali, never ingested any food/honey –> what condition? how did it occur?

A

infant botulism

CA/PA/UT –> environ dust –> inhale soil botulism spores

288
Q

infant botulism –> tx

A

human-derived botulism immune globulin

289
Q

infant botulism –> presentation (3)

A
  • bulbar palsies
  • constipation
  • hypotonia
290
Q

IVDA –> native-valve endocarditis –> empiric abx tx? to cover what org?

A

vanco:
- MRSA
- strep
- enterococci

291
Q

what abx have AE photosens?

A

tetracycline –> doxycycline

292
Q

66M –> routine visit –> h/o poorly ctrl DMII, HTN –> BP 150/90, normal Na, high K, high Cl, low bicarb, high BUN, high Cr –> meds glipizide, furosemide, nifedipine, ASA –> what condition is cause of electrolyte abnormalities?

A

renal tubular acidosis

293
Q

what is renal tubular acidosis

A

grp of disorders charact by non-anion gap metab acid w preserved kidney fx

294
Q

impaired fx of cortical collecting tubule causes what type of RTA?

A

hyperK RTA (type 4)

295
Q

hyperK RTA (type 4) –> pathophys

A

aldos def/resistance –> cortical collecting tubule –> H/K retention

296
Q

hyperK RTA (type 4) –> commonly seen in what condition?

A

poor ctrl DM

297
Q

hyperK RTA (type 4) –> presentation (3)

A
  • non-anion gap metab acid
  • persistent hyperK
  • mild to mod renal insuff
298
Q

16F –> HA & vision change for 1mo –> worse in AM, nausea –> h/o isotretinoin for severe acne –> papilledema, decreased visual acuity, no stiff neck, normal neuro exam, normal head CT –> LP increased opening pressure –> what condition? what caused it?

A

isotretinoin –> idiopathic intracranial HTN (pseudotumor cerebri)

299
Q

idiopathic intracranial HTN –> presentation (4)

A
  • HA
  • vision change (blurry or double)
  • papilledema
  • CN palsy
300
Q

idiopathic intracranial HTN –> CSF findings (2)

A
  • increased opening pressure

- normal studies

301
Q

idiopathic intracranial HTN –> MC in whom?

A

young obese F

302
Q

3 meds that can cause idiopathic intracranial HTN

A
  • growth hormone
  • tetracycline
  • excess vitA & derivatives
303
Q

Crohn’s dz –> nephrolithiasis –> cause?

A

hyperoxaluria

304
Q

Crohn’s dz –> hyperoxaluria –> pathophys

A

Crohn’s –> fat malabsorb –> Ca bind fat instead of oxalate –> increased absorb oxalate in gut

305
Q

genital wart –> topical tx?

A

trichloroacetic acid

306
Q

diabetic nephropathy –> primary intervention to slow progression?

A

intensive BP ctrl

307
Q

diabetic nephropathy –> target BP

A

130/80

308
Q

damage to what N causes corneal anesthesia?

A

trigeminal –> V1 (ophthalmic)

309
Q

poorly ctrl DM –> oculomotor N palsy –> pathophys

A

ischemic neuropathy

310
Q

30M –> 2mo LBP & stiff –> worse in AM, improve w activity –> also 3mo diarrhea & low abd pain –> anemia, thrombocytosis, sacroiliac jt inflamm –> what condition?

A

IBD –> arthritis

311
Q

53F –> severe menopausal ssx –> h/o hypothyroid trt w levothyroxine –> will trt w oral estrogen replacement –> need to change hypothyroid tx in any way? why?

A

oral estrogen –> decrease TBG clearance –> elevated TBG –> increased TBG binding sites –> decreased free thyroxine, increased TSH –> need higher dose of levothyroxine to saturate increased # of TBG binding sites

312
Q

26F –> 6mo lesion on L foot that gradually become firm and slight pigment –> no pain, itch –> no tobacco/alcohol –> central dimple when pinch lesion –> what condtion?

A

dermatofibroma

313
Q

dermatofibroma –> pathophys

A

usu LE –> trauma, insect bite, unknown –> fibroblast prolif –> nontender, firm, hyperpigment <1cm nodule

Step 2 (12 decks)

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