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5.30.17 Flashcards

1
Q

spinal A synd –> affects what areas of spinal cord? (4)

A
  • corticospinal tract
  • spinothalamic tract
  • ventral horn
  • lat gray matter
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2
Q

spinal A synd –> presentation? where?

A
  • bilat loss of pain/temp –> 1 level below lesion
  • bilat spastic paresis –> below lesion
  • bilat flaccid paralysis –> at level
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3
Q

spinal A synd –> what area of spinal cord spared?

A

dorsal column

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4
Q

amyotrophic lat sclerosis –> affects what areas of spinal cord (2)?

A
  • corticospinal tract

- ventral horn

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5
Q

poliomyelitis –> affect what area of spinal cord? results in what presentation?

A

ventral horn –> flaccid paralysis

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6
Q

vitB12 def –> –> affects what areas of spinal cord (2)?

A
  • corticospinal tract

- dorsal column

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7
Q

Brown-Sequard synd –> affect what area of spinal cord?

A

all tracts on 1 side of spinal cord

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8
Q

what nerves responsible for taste? on what areas of tongue?

A
  • facial N –> ant 2/3

- glossopharyngeal –> post 1/3

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9
Q

what nerve responsible for parotid gland?

A

glossopharyngeal N

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10
Q

violent flailing mvmts on 1 side of body is called?

A

hemiballimus

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11
Q

hemiballimus –> caused by lesion at?

A

subthalamic nucleus

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12
Q

CN III palsy –> results in what position of eye?

A

down & out

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13
Q

upward gaze paralysis –> caused by lesion at what?

A

sup colliculi

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14
Q

upward gaze paralysis –> seen in what condition?

A

parinaud synd

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15
Q

location of stroke: contralat LE & trunk –> weak

A

ACA

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16
Q

location of stroke:

  • contralat face & UE –> weak, decreased sens
  • aphasia
  • neglect
  • bilat visual abnormal
A

MCA

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17
Q

location of stroke: contralat visual abnormal

A

PCA

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18
Q

location of stroke:

  • focal motor/sens deficit
  • loss of coordination
  • difficult speak
A

lacunar A

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19
Q

location of stroke:

  • vertigo
  • loss of coordination
  • difficult speak
  • visual abnormal
  • coma
A

basilar A

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20
Q

lacunar A infarct –> 5 synd

A
  • pure motor hemiparesis
  • pure sensory stroke
  • ataxic hemiparesis
  • sensory/motor
  • dysarthria clumsy hand synd
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21
Q

1ary amenorrhea –> normal 2ndary sex charact –> should look for what conditions (2)?

A
  • anatomical abnormal

- XY genotype

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22
Q

1ary amenorrhea –> no 2ndary sex charact –> high FSH, LH –> should look for what conditions (2)?

A
  • gonadal agenesis/dysgenesis

- ovarian fail

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23
Q

1ary amenorrhea –> no 2ndary sex charact –> low FSH, LH –> should look for what conditions (2)?

A
  • prolactinoma

- hypo-pit dysfx

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24
Q

2ary amenorrhea –> normal thyroid, prolactin –> neg progestin, estrogen-progesterone challenge –> what condition?

A

Asherman synd

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25
Q

2ary amenorrhea –> normal thyroid, prolactin –> neg progestin, pos estrogen-progesterone challenge –> high FSH, LH –> what condition?

A

ovarian fail

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26
Q

2ary amenorrhea –> normal thyroid, prolactin –> neg progestin, pos estrogen-progesterone challenge –> low FSH, LH –> what condition?

A

hypo-pit dysfx

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27
Q

2ary amenorrhea –> normal thyroid, prolactin –> pos progestin –> hirsutism –> should look for what conditions (4)?

A
  • PCOS
  • ovarian tumor
  • adrenal tumor
  • Cushing synd
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28
Q

2ary amenorrhea –> normal thyroid, prolactin –> pos progestin –> no hirsutism –> should look for what conditions (2)?

A
  • anorexia nervosa, exercise, stress

- hypo-pit dysfx

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29
Q

which IBD presents w watery diarrhea? which w bloody diarrhea?

A
  • Crohn’s –> watery

- UC –> bloody

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30
Q

which IBD can present w abd mass?

A

Crohn’s

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31
Q

Crohn’s –> extraintestinal manifestations (5)?

A
  • arthritis
  • ankylosing spondylitis
  • uveitis
  • primary sclerosing cholangitis
  • nephrolithiasis
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32
Q

which IBD can lead to toxic megacolon?

A

both

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33
Q

which IBD can lead to bowel obstruct?

A

UC

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34
Q

UC –> extraintestinal manifestations (6)?

A
  • arthritis
  • ankylosing spondylitis
  • uveitis
  • primary sclerosing cholangitis
  • erythema nodosum
  • pyoderma gangrenosum
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35
Q

which IBD can present w lead pipe on barium enema?

A

UC

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36
Q

which IBD has sig increased risk of colon CA?

A

UC

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37
Q

59M –> 10day intermittent abd cramp, diarrhea 30min after eat –> also N, weak, palpitation, diaphoresis –> 3 wks ago distal gastrectomy for perforated peptic ulcer –> normal abd exam, surg incision healing well –> what condition?

A

dumping synd

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38
Q

dumping synd –> pathophys

A

pyloric sphincter –> injury/surg bypass –> loss of normal axn –> hypertonic gastric content –> quickly empty into duodenum, small intestine –> fluid shift from intravasc space to small intestine:

  • hypotension
  • stim autonomic reflex
  • release intestinal vasoactive peptides
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39
Q

dumping synd –> tx

A

dietary modification

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40
Q

sinus bradycardia –> initial tx

A

atropine

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41
Q

1ary amenorrhea –> no 2ndary sex charact –> uterus is present –> next step? why?

A

serum FSH –> determine hypo-pit (central) dysfx vs gonadal (peripheral) abnormal

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42
Q

1ary amenorrhea –> no 2ndary sex charact –> uterus is present –> high FSH –> indicates what cause?

A

peripheral cause –> hypergonadotropic amenorrhea

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43
Q

1ary amenorrhea –> no 2ndary sex charact –> uterus is present –> low FSH –> indicates what cause?

A

central cause –> hypogonadotropic amenorrhea

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44
Q

1ary amenorrhea –> no breast dev –> next step?

A

serum FSH

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45
Q

1ary amenorrhea –> low FSH –> next step?

A

pit MRI

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46
Q

1ary amenorrhea –> high FSH –> next step?

A

karyotype

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47
Q

36M –> painless nodules & lrg wartlike lesions on R forearm, back of neck –> 2mo dry cough w mild malaise –> lives in southern Wisconsin –> 4-5cm warty heaped up skin lesions w violaceous hue, lesion on neck has small peripheral ulcer –> wet prep shows yeast –> what condition?

A

blastomycosis

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48
Q

15M –> progressive muscle weak –> 2mo increasing difficult facial expression, swallow –> no pain –> previously healthy, adopted –> ptosis, temporal waste, emaciated extremities, testicular atrophy –> normal neuro exam –> what condition?

A

myotonic muscular dystrophy type 1 (Steinert dz)

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49
Q

3 types of muscular dystrophy

A
  • Duchenne
  • Becker
  • myotonic
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50
Q

MC adol/adult-onset muscular dystrophy

A

myotonic

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51
Q

myotonic muscular dystrophy –> mode of inheritance

A

AD

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52
Q

Duchenne muscular dystrophy –> mode of inheritance

A

XR

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53
Q

what is myotonia

A

delayed muscle relax

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54
Q

myotonic muscular dystrophy –> presentation (4)

A
  • grip myotonia (delayed muscle relax)
  • facial weak
  • foot drop
  • dysphagia
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55
Q

myotonic muscular dystrophy –> comorbidities (4)

A
  • cardiac conduction anomaly –> arrythmia
  • cataract
  • testicle atrophy/infertile
  • bald
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56
Q

young sex active F –> pharyngitis, fever, low abd pain –> what condition?

A

gonococcal pharyngitis + PID

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57
Q

what is Charcot triad

A
  • RUQ pain
  • jaundice
  • pain
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58
Q

Charcot triad –> indicates?

A

cholangitis

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59
Q

nonstress test –> what is normal (reactive) test?

A

in 20min: >2 15bpm accelerations –> last >15sec

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60
Q

fetal heart rate trace –> cause of deceleration:

  • early
  • late
  • variable
A
  • early: head compression
  • late: uteroplacental insuff
  • variable: umbilical cord compress
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61
Q

fetal heart rate trace –> recurrent late deceleration –> indicates?

A

fetal hypoxia

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62
Q

fetal heart rate trace –> recurrent late deceleration –> next step?

A

prompt delivery

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63
Q

APGAR –> what is score of 1 for each compt?

A
  • appearance: pink torso, blue extremities
  • pulse: <100
  • grimace: grimace
  • activity: some mvmt
  • resp: poor, weak cry
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64
Q

APGAR –> what is score of 2 for each compt?

A
  • appearance: pink
  • pulse: >100
  • grimace: strong cry
  • activity: active mvmt
  • resp: good strong cry
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65
Q

52F –> intense itch & fatigue –> hepatomegaly, no jaundice, bilat xanthelasma –> high chol, high alk phos, high bili –> US normal common bile duct –> what condition?

A

primary biliary cholangitis

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66
Q

primary biliary cholangitis –> pathophys

A

autoimmune –> destroy small bile ducts –> intrahep cholestasis

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67
Q

primary biliary cholangitis –> whom?

A

middle age F

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68
Q

primary biliary cholangitis –> presentation (4)

A
  • fatigue
  • pruritis
  • hepatomeg
  • elevated alk phos
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69
Q

primary biliary cholangitis –> how confirm dx

A

anti-mito Ab titer

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70
Q

hyperCa –> PTH is elevated or inapprop normal –> MC indicates?

A

1ary hyperPTH

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71
Q

28M –> want help for anxiety –> every time board plane, heart pound, can’t catch breath –> new job requires lots of travel, worried can’t fly –> has been fearful of planes since uncle died in plane crash 15yr ago –> what condition?

A

specific phobia

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72
Q

specific phobia –> tx

A

CBT w exposure

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73
Q

42M –> sz –> h/o gen tonic-clonic sz –> stopped taking valproate 6mo ago –> pt w confused, lethargic –> Na 140, K 4, Cl 103, Bicarb 17 –> what condition?

A

postictal lactic acid

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74
Q

postictal lactic acid –> pathophys

A

sz (esp tonic clonic) –> skeletal muscle hypoxia –> sig raise serum lactic acid level

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75
Q

postictal lactic acid –> tx? why?

A

self-limited –> typically resolve in 90min

==> observe –> repeat chem panel in 2hr

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76
Q

acute MI –> MC cause of sudden cardiac arrest in immed post-infarct period?

A

reentrant V arrhythmia –> ie V-fib

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77
Q

pneumonia –> hypoxemia –> pathophys

A

pneumonia –> alveolar consolidation –> marked impair vent –> RtoL intrapulm shunting, extreme vent/perfusion (V/Q) mismatch –> hypoxemia

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78
Q

vent (V) & perfusion (Q) are highest in what area of lung? why?

A

lung bases: gravity create hydrostatic pressure acting on both air & blood

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79
Q

acute pneumonia on L –> 94% O2 when lie on R, 89% when lie on L –> pathophys

A

lie on L –> gravity –> increase blood flow to L lung –> worsen vent/perf mismatch –> worse RtoL intrapulm shunt –> worse hypoxemia

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80
Q

66M –> 3mo R arm pain –> progressive worse, no relief w NSAID –> also back pain, HA –> CBC normocytic anemia –> XR osteolytic lesions –> what condition?

A

mult myeloma

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81
Q

suspect mult myeloma –> next step?

A

screening test –> serum protein electrophoresis (SPEP) –> elevated serum monoclonal protein (M-spike)

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82
Q

mult myeloma –> screening tests (3)

A
  • serum protein electrophoresis
  • urine protein electrophoresis
  • free light chain analysis
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83
Q

mult myeloma –> how confirm dx?

A

BM bx

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84
Q

what is electrical alternans

A

varying amp of QRS

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85
Q

electrical alternans w sinus tachy –> what condition?

A

large pericardial effusion

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86
Q

26M –> wks of low abd pain, bloody diarrhea, fecal urgency –> ssx more severe in last 2 days –> fever, abd distention, leukocytosis, hypotension, tachycardia –> what condition?

A

IBD –> toxic megacolon

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87
Q

35F –> few days mult painful oral sores –> previously occured 3mo ago –> recently ant uveitis, recurrent genital lesions –> hyperpigment skin lesion, tender indurated areas on legs –> what condition?

A

behcet synd

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88
Q

behcet synd –> whom? (2)

A
  • YA

- Turkish, middle east, Asian

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89
Q

behcet synd –> presentation (4)

A
  • reucrrent oral aphthous ulcers
  • genital uclers
  • uveitis
  • erythema nodosum
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90
Q

what is pathergy

A

exagg ulcerating skin response following minor injury (needlestick)

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91
Q

behcet synd –> major cause of morbidity

A

thrombosis

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92
Q

18mo M –> blood in stool –> no previous bleed, h/o recurrent otitis media/herpes labialis/pneumonia –> eczema, scattered petechiae –> low platelet count, small platelets –> what condition?

A

Wiskott-Aldrich synd

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93
Q

Wiskott-Aldrich synd –> mode of inheritance?

A

XR

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94
Q

Wiskott-Aldrich synd –> triad

A
  • thrombocytopenia
  • eczema
  • recurrent infect
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95
Q

Wiskott-Aldrich synd –> pathophys

A

WAS protein defect –> impaired cytoskeleton in leukocytes, platelets

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96
Q

Wiskott-Aldrich synd –> tx

A

hemat stem cell transplant

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97
Q

mod-severe croup –> tx

A

corticosteroid + nebulized epinephrine

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98
Q

27F –> unable to conceive for 1yr –> normal periods, normal semen –> h/o hosp for pelvic infect in late teens –> next step? why?

A

hysterosalpingogram –> look for anatomic cause of infertility –> tubal scar/obstruct from PID

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99
Q

MC fracture in ped pop

A

supracondylar fracture of humerus

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100
Q

supracondylar fracture of humerus –> MC comp (2)

A

entrapment of:

  • brachial A
  • median N
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101
Q

craniopharyngioma –> what is? location?

A

pit stalk –> rathke pouch –> epithelial remnant –> low grade malig –> in suprasellar region adj to optic chiasm

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102
Q

craniopharyngioma –> presentation (3)

A

compress:
- optic chiasm –> bitemporal hemianopsia –> run into corners of walls/furniture
- pit stalk –> mult endocrinopathies –> GH def, DI

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103
Q

craniopharyngioma –> imaging finding

A

suprasellar calicified mass

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104
Q

24-28wk gestation –> prenatal screen

A

50g 1hour glucose challenge

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105
Q

what is Kussmaul sign

A

increase in jugulovenous pressure on inhalation

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106
Q

Kussmaul sign –> assoc w what condition (2)

A
  • constrictive pericarditis

- restrictive cardiomyopathy

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107
Q

acute coronary synd –> assoc w what heart sound

A

S4

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108
Q

what is pulsus paradoxus

A

decrease >10mmHg BP on inspiration

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109
Q

pulsus paradoxus –> assoc w what condition

A

cardiac tamponade

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110
Q

leads V2-4 –> assoc w what area of heart?

A

LV –> ant wall

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111
Q

inf wall of heart –> assoc w what leads?

A

II, III, aVF

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112
Q

mortality at 1 yr after event: inf wall MI vs ant wall MI

A

inf: <5%
ant: 30-40%

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113
Q

PR interval >200ms –> what condition?

A

1st deg AV block

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114
Q

MI –> PVC –> tx? why?

A

don’t trt PVC –> tx worsens outcome

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115
Q

post wall MI –> assoc w what leads?

A

V1-2

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116
Q

which is worse: RBBB vs LBBB

A

LBBB

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117
Q

acute MI –> 1st step in management? why?

A

ASA –> lower mortality

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118
Q

acute STEMI –> 2nd step in management?

A

angioplasty

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119
Q

pt w CP –> measure serum troponin –> what can cause false pos result?

A

renal insuff

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120
Q

MI –> alt if ASA allergy

A

clopidogrel

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121
Q

acute NSTEM –> 2nd step in management after ASA? why?

A

LMWH –> prevent clot from growing further

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122
Q

tPA (thrombolytic) –> beneficial for STEMI, NSTEMI, or both?

A

STEMI only

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123
Q

heparin –> best for STEMI or NSTEMI?

A

NSTEMI

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124
Q

acute coronary synd: GPIIb/IIIa inh –> whom? (2)

A
  • NSTEMI

- PCI, stenting

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125
Q

which is better for mortality benefit: unfractionated hep or LMWH?

A

LMWH

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126
Q

NSTEMI –> all meds given –> but not pt not better –> next step?

A

urgent angiography

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127
Q

MI –> symptomatic bradycardia –> tx

A

atropine

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128
Q

MI –> symptomatic bradycardia –> atropine not effective –> tx

A

pacemaker

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129
Q

R coronary A supplies what (3)

A
  • RV
  • AV node
  • inf wall of heart
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130
Q

RV infarct –> tx

A

high vol fluid replace

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131
Q

what comp of acute MI shows:

  • bradycardia
  • cannon A waves
A

3rd deg AV block

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132
Q

acute MI –>
- bradycardia
- no cannon A waves
==> what condition?

A

sinus bradycardia

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133
Q

acute MI –>
- sudden loss of pulse
- jugulovenous distention
==> what condition?

A
  • cardiac tamponade

- free wall rupture

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134
Q 
acute MI -->
- inf wall MI
- clear lungs
- tachycardia
- hypotension w nitroglycerin
==> what condition?
A

RV infarct

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135
Q

acute MI –>
- new murmur
- rales/congestion
==> what condition?

A

valve rupture

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136
Q

acute MI –>
- new murmur
- increase in O2sat on entering RV
==> what condition?

A

septal rupture

137
Q

acute MI –>
- loss of pulse
==> what condition?

A
  • V tachy

- V fib

138
Q

acute MI –> treated in hosp –> what test does everyone get prior to discharge? why?

A

stress test –> detect residual ischemia

139
Q

positive stress test –> next step?

A

angiography

140
Q

which IBD is assoc w masses and obstruction?

A

Crohns

141
Q

+ANCA –> which IBD?

A

UC

142
Q

+antisaccharomyces cerebesiae Ab (ASCA) –> which Ab?

A

Crohns

143
Q

IBD –> tx for chronic maintenance of remission

A

5-ASA derivatives –> mesalamine

144
Q

perianal Crohn’s –> tx

A

cipro + metronidazole

145
Q

IBD –> severe exacerbation –> trt w steroid –> stop steroid –> severe recurrence –> should have used what to what to wean off steroid?

A

azathioprine/6-mercaptopurine + Ca + vitD

146
Q

IBD –> fistula –> tx

A
  • anti-TNF (infliximab)

- surg if not respond to anti-TNF

147
Q

which steroid is specific for IBD?

A

budesonide

148
Q

bact meningitis –> CSF findings:

  • cell count
  • protein
  • glucose
A
  • cell count: 1000’s PMNs
  • protein: elevated
  • glucose: decrease
149
Q

cryptococcus/lyme/rickettsia meningitis –> CSF findings:

  • cell count
  • protein
  • glucose
A
  • cell count: 10-100’s lymphocytes
  • protein: possibly elevated
  • glucose: possibly decreased
150
Q

TB meningitis –> CSF findings:

  • cell count
  • protein
  • glucose
A
  • cell count: 10-100’s lymphocytes
  • protein: markedly elevated
  • glucose: may be low
151
Q

viral meningitis –> CSF findings:

  • cell count
  • protein
  • glucose
A
  • cell count: 10-100’s lymphocytes
  • protein: usu normal
  • glucose: usu normal
152
Q

bact meningitis –> best initial tx

A

ceftriaxone + vanco + steroid

153
Q

MC neuro deficit or untreated bact meningitis?

A

CN 8 deficit –> deaf

154
Q

pt diagnosed w cirrhosis –> EGD nonbleeding varices –> prophylactic tx for varices?

A

nonselective BB –> propranolol, nadolol –> reduce risk:

  • progress to large varices
  • variceal hemorrhage
155
Q

> 60yo –> MC cause of spont lobar hemorrhage

A

amyloid angiopathy

156
Q

thrombocytopenia without anemia or leukopenia –> what condition?

A

ITP

157
Q

all pt w presumed ITP –> should be tested for what?

A

HIV & HVC

158
Q

presumed ITP –> why test for HIV?

A

may be presenting finding in 5-10% chronic HIV infect

159
Q

HTN & hypoK –> suspect what condition?

A

1ary hyperaldos

160
Q

suspect 1ary hyperaldos –> preferred initial screening test

A

plasma aldos conc to plasma renin activity ratio (PAC/PRA ratio) –> >20

161
Q

suspect 1ary hyperaldos –> +screening test PAC/PRA ratio >20 –> confirm dx?

A

adrenal suppression testing

162
Q

1ary hyperaldos confirmed by adrenal suppression test –> next step?

A

adrenal imaging

163
Q

1ary hyperaldos –> no discrete unilat mass –> next step? why?

A

adrenal venous sampling –> most sensitive test for differentiate adrenal adenoma vs bilat adrenal hyperplasia

164
Q

65F –> 2day difficult eating –> food drop out of mouth, discharge in L ear –> h/o DMII, HTN, hyperlipid –> poorly compliant –> granulations in ear, facial asymm, L angle of mouth deviate down –> what condition?

A

malig otitis externa

165
Q

malig otitis externa –> classic clinical feature

A

granulation tissue in ear canal

166
Q

what is intrauterine fetal demise

A

fetal death at >20wk

167
Q

24F –> 28k gestation –> intrauterine fetal demise –> next step?

A

vag delivery –> can be delayed til pt is ready

168
Q

myasthenia gravis –> best initial test

A

AchR Ab

169
Q

systemic sclerosis –> most specific test

A

SCL-70 (topoisomerase Ab)

170
Q

anti-Jo –> assoc w what condition?

A

polymyositis, dermatomyositis

171
Q

anti-Ro –> assoc w what condition?

A

Sjogren

172
Q

systemic sclerosis –> tx

A

methotrexate

173
Q

systemic sclerosis –> pulm fibrosis –> tx

A

cyclophosphamide

174
Q

CF –> PFT shows what pattern?

A

mixed obstructive + restrictive patterns

175
Q

CF –> PFT findings:

  • FVC
  • TLC
A
  • FVC: decreased

- TLC: decreased

176
Q

CF –> sputum culture is likely to grow what org (4)?

A
  • H flu
  • pseudomonas
  • S aureus
  • Burkholderia cepacia
177
Q

pleural effusion –> exudate –> assoc w what conditions? (2)

A
  • infect

- cancer

178
Q

pleural effusion –> what findings suggest exudate:

  • LDH
  • protein
A
  • LDH: >60% of serum

- protein: >50% of protein

179
Q

pleural effusion –> pH<7.2 –> suggest what?

A

empyema

180
Q

lung cancer screen –> what ages?

A

55-80

181
Q

adrenal insuff –> what is a common CBC abnormality?

A

eosinophilia

182
Q

adrenal insuff –> lab findings:

  • glucose
  • K
  • acid-base status
  • Na
  • BUN
A
  • glucose: hypo
  • K: hyper
  • acid-base status: metab acid
  • Na: hypo
  • BUN: high
183
Q

most specific test for adrenal fx

A

cosyntropin stim test

184
Q

what is cosyntropin

A

synthetic ACTH

185
Q

why is kidney stone assoc w Crohn’s dz?

A

increased oxalate absorption

186
Q

what kind of kidney stones are not visible on XR?

A

uric acid

187
Q

how was cystine kidney stones managed?

A

alkalinize urine

188
Q

kidney stone –> 5-7mm –> tx?

A

nifedipine + tamsulosin to help them pass

189
Q

what diuretic increases Ca resorption?

A

thiazide

190
Q

cardiac tamponade –> Beck triad

A
  • hypotension
  • elevated JVD
  • distant heart sounds
191
Q

cardiac tamponade –> cardiac catherization finding

A

elevated and equilization of intracardiac diastolic pressures

192
Q

suspect cardiac tamponade –> how confirm dx

A

urgent echo

193
Q

missed abortion:

  • vag bleed
  • cervix
  • fetal cardiac activity
  • POC
A
  • vag bleed: none
  • cervix: closed
  • fetal cardiac activity: absent
  • POC: not passed
194
Q

threatened abortion:

  • vag bleed
  • cervix
  • fetal cardiac activity
  • POC
A
  • vag bleed: yes
  • cervix: closed
  • fetal cardiac activity: present
  • POC: not passed
195
Q

inevitable abortion:

  • vag bleed
  • cervix
  • fetal cardiac activity
  • POC
A
  • vag bleed: yes
  • cervix: dilated
  • fetal cardiac activity: present or absent
  • POC: not passed
196
Q

incomplete abortion:

  • vag bleed
  • cervix
  • fetal cardiac activity
  • POC
A
  • vag bleed: yes
  • cervix: dilated
  • fetal cardiac activity: absent
  • POC: some passed
197
Q

complete abortion:

  • vag bleed
  • cervix
  • fetal cardiac activity
  • POC
A
  • vag bleed: yes or none
  • cervix: closed
  • fetal cardiac activity: absent
  • POC: completely expelled
198
Q

neuroleptic malig synd –> tx

A

dantrolene or bromocriptine

199
Q

candida vulvovaginitis –> tx

A

azole –> oral fluconazole

200
Q

sickle cell dz –> MC cause of sepsis

A

Strep pneumo

201
Q

sickle cell dz –> sepsis prophylaxis? til what age?

A

PCN –> 5yo

202
Q

adenomyosis –> presentation

A

dysmenorrhea + heavy bleed –> progress to chronic pelvic pain

203
Q

stroke –> hemineglect –> what lobe was affected?

A

R (non-dominant) parietal lobe

204
Q

65M –> sudden painless loss of vision in R eye –> 5hr ago similar but transient loss of vision in the same eye –> h/o HTN, DM, hyperchol, PVD, ant wall MI 6yr ago –> R eye visual acuity 20/60, retinal whitening –> what condition?

A

central retinal A occlusion (CRAO)

205
Q

central retinal A occlusion (CRAO) –> tx

A

ocular massage + high flow O2

206
Q

what arrhythmia is most specific for digitalis toxicity?

A

atrial tachycardia w AV block

207
Q

digitalis toxicity –> what 2 digitalis effects cause atrial tachycardia w AV block?

A
  • increased ectopy

- increased vagal tone

208
Q

thyrotoxicosis –> HTN –> pathophys

A

increased myocardial contract & HR –> hyperdynamic circulation

209
Q

6M –> difficult moving R arm & leg –> had been playing alone in room –> mom heard “thud” and found him unconscious –> awake & alert, normal speech & beh, unable to mv R arm & leg –> gradually regain motor fx –> what condition?

A

1st time sz w Todd paralysis

210
Q

what is Todd paralysis

A

self-limited focal weak that occur after focal/gen sz –> postictal period –> partial/complete hemiplegia of ipsilat upper & lower ext –> resolve w/in 36hr

211
Q

28M –> MVA –> SBP 60, HR 130, RR 30 –> neck veins flat, abd distended, altered mental status –> after intubated & mech vent –> cardiac arrest –> pathophys?

A

internal hemorrhage –> hypovol shock –> decreased central venous pressure –> mech vent –> acute increase intrathoracic pressure –> cut off venous return –> sudden loss of RV preload –> loss of cardiac output –> cardiac arrest

212
Q

Conn’s synd –> lab findings:

  • BP
  • Na
  • K
  • acid/base
A
  • BP: HTN
  • Na: mild hyper
  • K: hypo
  • acid/base: metab alk
213
Q

what is iodinated contrast material (iopanoic acid, ipodate) given in thyroid strom?

A
  • block peripheral conversion of T4 to T3

- block release of existing hormone

214
Q

palpate nodule on thyroid –> next step

A

T4, TSH

215
Q

palpate nodule on thyroid –> normal T4, TSH –> next step

A

FNA

216
Q

nodule on thyroid –> normal T4, TSH –> FNA indeterminate –> next step

A

excisional bx

217
Q

nonstress test –> nonreactive –> next step?

A

BPP or CST

218
Q

nonreactive nonstress test –> how choose bw BPP vs CST?

A

BPP if CST is CI –> ie CI to labor –> placenta previa, prior myomectomy

219
Q

what is a normal biophysical profile

A

1) NST: reactive
2) amniotic fluid vol: >2x1cm fluid pocket, AFI >5
3) fetal mvmt: >3
4) fetal tone: >1 flex/extend
5) fetal breathing mvmt: >1 for >30sec

220
Q

BPP –> score 0-4/10 –> indicates?

A

fetal hypoxia d/t placental dysfx/insuff

221
Q

BPP –> score 0-4/10 –> next step? why?

A

prompt delivery d/t high probability of fetal demise

222
Q

62F –> difficult remember important dates & appts –> poor conc, daytime sleepy, easy fatigue –> decreased appetite but gained 4 lb in 3mo –> visited ENT for hoarseness, laxative for constipation, ASA for knee pain –> what condition?

A

hypothyroid

223
Q

1ary postpartum hemorrhage –> MCC

A

uterine atony (uterus fail to contract)

224
Q

uterine atony –> RF (4)

A
  • prolonged labor
  • induction of labor
  • operative vag delivery
  • fetal wt >8.8lb
225
Q

33F –> dull ache in RUQ abd –> OCP for 12yr –> US solitary hyperechoic 7cm lesion in liver –> what condition?

A

hepatic adenoma

226
Q

adol –> MCC of short stature & pubertal delay

A

constitutional growth delay

227
Q

constitutional growth delay –> natural progression

A

normal birth wt/ht –> 6mo-3yo –> growth velocity slow –> drop percentile on growth curve –> at 3yo –> regain normal growth velocity –> follow growth curve at 5-10th percentile –> delay puberty & adol growth spurt –> eventually puberty –> normal adult ht

228
Q

constitutional growth delay –> bone age radiograph findings

A

delayed bone age

229
Q

extra-axial well circumscribed dural-based mass –> partially calcified –> what condition?

A

meningioma

230
Q

subarachnoid hemorrhage –> noncontrast CT finding

A

acute bleed around brainstem & basal cisterns

231
Q

burkitt lymphoma –> chemotx –> develop hyperK –> why?

A

tumor lysis synd

232
Q

hyperK –> 3 goals of therapy

A

1) stabilize cardiac membrane w Ca
2) shift K intracell
3) decrease total body K

233
Q

hyperK –> rapid acting tx options (3)

A
  • insulin w glucose
  • B2-agonist
  • sodium bicarb
234
Q

lambert-eaton myasthenic synd –> assoc w what condition?

A

underlying malig –> small cell lung CA

235
Q

Afib –> what tx is used to reduce risk of systemic thromboembolism?

A

anticoag:
- warfarin
- non-vitK ant oral anticoag –> apixaban, dabigatran, rivaroxaban

236
Q

paroxsymal nocturnal Hb –> presentation (3)

A
  • hemolysis –> fatigue
  • cytopenia
  • hypercoag state –> venous thrombosis –> intraabd, cerebral V
237
Q

paroxsymal nocturnal Hb –> how confirm dx

A

flow cytometry –> absence of CD55 & CD59 proteins on RBCs

238
Q

which lifestyle mod has greatest effect on high BP?

A

wt loss

239
Q

which lifestyle mod has 2nd greatest effect on high BP?

A

DASH diet

240
Q

what lifestyle mod most reduces risk of pancreatic cancer?

A

smoke cessation

241
Q

what are environ RF of pancreatic cancer (3)

A
  • smoke
  • chronic pancreatitis
  • obese
242
Q

70M –> pain & stiff in neck, shoulder, pelvic girdle –> elevated ESR –> what condtition?

A

polymyalgia rheumatica

243
Q

polymyalgia rheumatica –> tx

A

low dose prednisone

244
Q

antral ulcer –> bx shows adenoCA –> next step? why?

A

most gastric cancer diagnosed at advanced stages ==>

CT –> stage (eval extent of cancer) –> determine prognosis & tx options

245
Q

5M –> red tender fluctuant ant cervical mass 2cm –> what is causative org?

A

acute lymphadenitis –> MCC –> S aureus, Strep pyogenes

246
Q

mumps –> presentation (2)

A
  • fever

- parotitis

247
Q

mumps –> comp (2)

A
  • aseptic meningitis

- orchitis

248
Q

65M –> MVA–> marked weak UE, can mv LE –> h/o OA, cervical spondylitis –> cervical spine XR mild degen arthritis –> what condition?

A

Central cord sync

249
Q

Central cord synd –> how typically occur? In whom?

A

Elder –> cervical spine –> preexisting degen changes –> hyperext injury

250
Q

Central cord synd –> presentation

A
  • weakness more in UE than LE

- UE –> loss of pain/temp

251
Q

Ant (ventral) cord synd –> presentation

A

Bilateral spastic motor paresis distal to lesion

252
Q

Ant spinal cord synd –> MCC

A

Occlusion of ant spinal A

253
Q

Brown sequard synd –>presentation

A
  • ipsi: weak, spastic, loss vibrate/propioception

- contralat: loss pain/temp

254
Q

Brown sequard synd –> MCC

A

Penetrating injury –> hemisection of cord

255
Q

do OCP increase/decrease TBG? what happens to total T4?

A

increase TBG –> increase total T4

256
Q

what is sodium ipodate/iopanoic acid used for?

A

severe hyperthyroid –> not respond to conventional therapy –> lower T3/T4 –> rapid improve hyperthyroid

257
Q

thionamide –> 1 major AE

A

agranulocytosis

258
Q

which thionamide is preferred for preg pt?

A

PTU

259
Q

1ary hyperPTH –> what urine lab finding is markedly elevated?

A

cAMP

260
Q

hyperCa –> tx –> how increase urinary excretion?

A
  • IVF

- furosemide –> inh Ca resorb

261
Q

glucocorticoids are only effective for what 2 causes of hyperCa?

A
  • vitD related mech (intoxication, granulomatous disorder)

- mult myeloma

262
Q

abd & diaphragm –> paradoxic mvmt on inspiration –> indicates what?

A

impending resp fail

263
Q

asthma exacerbation –> ABG –> hypo or hyper carbia?

A

hypocarbia

264
Q

asthma exacerbation –> PaCO2 is decreased, normal, or increased?

A

decreased

265
Q

asthma exacerbation –> normal or increased PaCO2 –> indicates?

A

resp muscle fatigue or severe airway obstruct –> resp fail may ensue

266
Q

what is forced vital capacity

A

total amt of air force-exhale after taking deep breath

267
Q

asthma severity –> categories (4)

A
  • mild intermittent
  • mild persistent
  • mod persistent
  • severe persistent
268
Q

asthma severity –> what is?

  • mild intermittent
  • mild persistent
  • mod persistent
  • severe persistent
A
  • mild intermittent: ssx 2 or less/wk
  • mild persistent: 2 or more but not daily
  • mod persistent: daily; freq exacerbations
  • severe persistent: continual; freq exacerbations, limited physical activity
269
Q

asthma –> long term ctrl

  • mild intermittent
  • mild persistent
  • mod persistent
  • severe persistent
A
  • mild intermittent: none
  • mild persistent: low dose inhaled steroid
  • mod persistent: low steroid + LABA
  • severe persistent: med/high steroid + LABA
270
Q

erythema migrans –> hallmark of what condition?

A

lyme dz

271
Q

which heart blocks require pacemaker implantation?

A
  • 2nd deg heart block Mobitz type II

- 3rd deg (complete) heart block

272
Q

21M –> assaultive beh, reckless disregard for safety of self & others, lack of remorse –> what condition?

A

antisocial personality disorder

273
Q

15M –> assaultive beh, reckless disregard for safety of self & others, lack of remorse –> what condition?

A

conduct disorder

274
Q

antisocial personality disorder –> must be at least what age for diagnosis?

A

18

275
Q

antisocial personality disorder –> must have a h/o what condition for diagnosis?

A

conduct disorder before 15yo

276
Q

marijuana –> presentation (7)

A
  • tachycardia
  • tachypnea
  • HTN
  • dry mouth
  • conjunctival injection
  • increase appetite
  • slow rxn time
277
Q

increased ICP –> tx –> hypervent –> how does hypervent decrease ICP?

A

hypervent –> decrease cerebral PaCO2 –> rapid vasoconstrict –> decrease ICP

278
Q

35F –> breast mass –> fixed, spiculated, calcifications –> h/o bilat reduction mammoplasty for mammary hyperplasia –> bx foamy macrophages & fat globules –> what condition?

A

fat necrosis of breast –> present very similar to breast cancer

279
Q

68F –> painless jaundice, conj hyperbili, markedly elevated alk phos –> what condition?

A

biliary obstruct d/t pancreatic, biliary CA

280
Q

bite cells & Heinz bodies –> what condition?

A

G5PD def

281
Q

pt found to have chronic HCV infect –> goals of tx (2)

A
  • trt underlying cause –> antiviral

- prevent further liver damage –> avoid alcohol, hep A & B vaccine

282
Q

22F –> RUQ pain, fever, chill, vomit –> started as low abd pain –> sex active w 1 partner, no contraception –> what condition?

A

PID w perihepatitis (Fitz-Hugh-Curtis)

283
Q

55M –> mult falls, dry mouth, dry skin, ED –> recently diagnosed w resting tremor –> PE orthostatic hypotension, rigidity, bradykinesia –> what condition?

A

mult system atrophy (Shy-Drager synd)

284
Q

Shy-Drager synd –> presentation (3)

A
  • Parkinsonism
  • autonomic dysfx
  • widespread neuro signs
285
Q

25F –> sore chest pain –> discomfort wearing sports bra –> LMP 3wk ago –> PE b/l nonfocal chest tender, diffuse cordlike thickening of breasts –> what condition?

A

fibrocystic change

286
Q

62F –> worsening skin lesions –> 6days ago CABG for CAD –> receiving low dose subQ hep for DVT prophylaxis –> PE several lrg purple/black patches on periumbilical area surrounded by erythema –> what condition?

A

HIT type 2

287
Q

subQ hep (enoxaparin) –> HIT –> classic presentation

A

skin necrosis at abd injection site

288
Q

hep –> HIT –> alt tx for DVT prophylaxis?

A

alt anticoag:

  • argatroban
  • fondaparinux
289
Q

80F –> fatigue –> h/o b/l knee OA that significantly limit mobility –> meds lisinopril, chlorthalidone, naproxen, ASA –> PE conjunctival pallor –> what condition?

A

iron def anemia: NSAID, ASA –> gastritis, gastric ulcer –> chronic GI blood loss

290
Q

clobetasol –> type of drug?

A

steroid

291
Q

bullous pemphigoid –> presentation

A
  • pruritis

- tense bullae

292
Q

bullous pemphigoid –> tx

A

high potency topical glucocorticoid

293
Q

middle age F –> found wandering streets w abnormal gait –> incoherent, not oriented to time or place –> T 97.3, BP 160/100, HR 100, RR 18, BMI 17 –> bitemporal wasting, dry mucus membranes, pupils 3mm & react slowly –> what condition?

A

Wernicke encephalopathy

294
Q

Wernicke encephalopathy –> pathophys? who?

A

alcoholism & chronic malnutrition –> thiamine (vitB1) def

295
Q

Wernicke encephalopathy –> classic triad

A
  • encephalopathy
  • ocular dysfx
  • gait ataxia
296
Q

47M –> fatigue, elevated liver enzyme, occasional jt pain, small vesicles & erosions on back of hands & arms –> what condition?

A

chronic HCV

297
Q

what derm condition is high assoc w HCV?

A

porphyria cutanea tarda

298
Q

43M –> freq epigastric burn not relieved by antacid –> brought on my heavy lifting at work, go away in 10-15min –> h/o SLE trt w prednisone, hydroxychloroquine –> normal PE, EKG –> what condition?

A

atypical angina: SLE –> accelerated atherosclerosis –> premature CAD

299
Q

34M –> SOB, difficult swallow –> h/o difficult breath, food intolerance, skin allergies –> PE excessive resp muscle use, retract subclavicular fossa during inspiration, urticaria over upper body –> what condition?

A

food allergy –> larygneal edema –> upper airway obstruct

300
Q

what is MEN I

A

3 P’s:

  • PTH
  • pancreatic islet cell tumor –> ZES, insulinoma
  • pit tumor
301
Q

what is MEN IIA

A

PPM:

  • PTH
  • pheo
  • medullary thyroid CA
302
Q

what is MEN IIB

A

PMM:

  • pheo
  • medullary thyroid
  • mucosal neuroma/marfanoid habitus
303
Q

what is conn synd

A

adrenal adenoma –> produce aldos

304
Q

1ary hyperaldos –> definitive dx

A

saline infusion or oral sodium load:

  • normal: increase Na –> decrease aldos
  • 1ary hyperaldos: increase Na –> aldos still high
305
Q

1ary hyperaldos –> why important to differentiate cause b/w adrenal adenoma vs adrenal hyperplasia

A

different tx:

  • adrenal adenoma –> resect –> improve/cure HTN
  • adrenal hyperplasia –> spironolactone –> inh aldos axn –> bc b/l adrenalectomy –> HTN not improve
306
Q

young F –> HTN –> MCC?

A

birth ctrl pill

307
Q

HIT –> which is more common –> venous or arterial clots?

A

venous

308
Q

young F –> HTN –> should do what before start HTN med?

A

UPT: thiazide, ACEI/ARB, CCB –> CI in preg

309
Q

lepirudin –> what kind of drug?

A

anticoag –> direct thrombin inh

310
Q

considered preterm labor at what gestation wks?

A

20-37

311
Q

most commonly used tocolytic? what 2 other drugs can be used as tocolytic?

A

Mg sulfate

  • CCB
  • terbutaline
312
Q

preterm labor –> Mg sulfate given as tocolytic –> should do what PE test? why?

A

check DTR –> b/c Mg toxicity can lead to resp dep & cardiac arrest

313
Q

preterm labor –> Mg sulfate given as tocolytic –> should do what PE test? why?

A

check DTR –> b/c Mg toxicity can lead to resp dep & cardiac arrest

314
Q

common peroneal neuropathy –> presentation ( 4)

A
  • foot drop
  • numb/tingle –> dorsal foot, lat shin
  • weak –> ankle dorsiflex, great toe extend
  • normal –> plantarflex, reflexes
315
Q

black pt w HTN –> recommended tx?

A
  • CCB

- thiazide

316
Q

CLL –> how dx?

A

flow cytometry –> clonal mature B cells

317
Q

7M –> lyme dz –> tx

A

oral amoxi

318
Q

brain abscess –> CT finding

A

single ring enhancing lesion w central necrosis

319
Q

brain abscess –> MC org (2)

A
  • strep viridans

- s aureus

320
Q

38F –> several episode L leg weak & numb –> tingle, then numb, then limp –> resolve spont in few hrs –> diminished pinprick to dorsal foot, weak big toe extend, cannot walk on heel –> what condition?

A

common peroneal/fibular neuropathy

321
Q

common peroneal neuropathy –> pathopys

A
  • leg immobilize (cast, bedrest)
  • prolong leg cross
  • prolong squat

–> compress N as cross fibular head

322
Q

common peroneal neuropathy –> presentation ( 4)

A
  • foot drop
  • numb/tingle –> dorsal foot, lat shin
  • weak –> ankle dorsiflex, great toe extend
  • normal –> plantarflex, reflexes
323
Q

late term and post term preg –> at risk for what comp?

A

uteroplacental insuff

324
Q

what is positive predictive value (PPV)

A

TP / (TP + FP)

higher PPV –> positive result more likely to be true

325
Q

leukemoid rxn –> hallmark

A

WBC >50,000

326
Q

how differentiate bw leukemoid rxn vs CML:

  • WBC count
  • LAP score
  • neutrophil precursors
  • absolute basophilia
A
  • WBC: >50,000 vs >100,000
  • LAP: high vs low
  • neutrophil precursors: late (metamyelocytes, bands) vs early (promyelocytes, myelocytes)
  • basophilia: none vs yes
327
Q

A-fib –> MCC origin/location of arrhythmia

A

pulm V

328
Q

A flutter –> MCC origin/location of arrhythmia

A

reentrant circuit around tricuspid annulus

329
Q

cocaine –> myocardial ischemia –> initial tx

A
  • O2

- BZD –> reduce SNS –> decrease anxiety/agitation, improve BP/HR, alleviate CV ssx

330
Q

cocaine –> myocardial ischemia –> should BB be administered? why?

A

block B –> unopposed alpha –> worsen coronary vasoconstrict

331
Q

32F –> fever, chills, pleuritic CP, SOB –> HIV+, IVDA –> CT lungs mult nodular lesions w small cavities

A

IVDA –> infective endocarditis –> septic emboli to lungs

332
Q

severe aortic stenosis –> artificial valve prosthesis –> c/o fatigue –> blood smear schistocytes –> haptoglobin level is decreased or increased? why?

A

Haptoglobin –> bind free Hb –> promote Hb excretion by reticuloendothelial system

hemolytic anemia –> increase free Hb –> bind all avail haptoglobin –> decreased haptoglobin

333
Q

25 black M –> nocturia for months despite restrict fluid intake –> no other ssx –> brother died of “blood disease at 10yo –> Hct 49% –> what condition?

A

sickle cell trait –> sickle in vasa recta –> impair concentrate urine –> hyposthenuria

334
Q

55M –> 1yr progressive difficult walk/balance, freq falls –> DM2, HTN, heavy alcohol/tobacco, med noncompliance –> wide based gait, cannot tandem walk, abnormal heel knee shin test, normal finger nose test –> what condition?

A

alcoholic cerebellar degen: alcohol neurotoxic –> cerebellar vermis –> degen Purkinje fibers (truncal coordination)

335
Q

alcoholic cerebellar degen –> pathophys

A

alcohol –> neurotoxic –> cerebellar vermis –> degen Purkinje fibers (truncal coordination) –> wide based gait, postural instability

336
Q

alcoholic cerebellar degen –> PE cerebellar test findings? why?

  • tandem gait
  • finger nose test
A
  • tandem gait (truncal coodination) impaired

- finger nose test (limb coordination) normal

337
Q

46M –> h/o DM well ctrl –> should also take what non-DM med? why?

A

40-75yo DM –> statin (regardless of lipid levels) –> reduce risk of cardiac events

338
Q

lyme dz –> who should get amoxi instead of doxycycline?

A
  • preg

- <8yo

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