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6.20.17 Flashcards

1
Q

PID –> outpt tx

A

ceftriaxone + doxy + metro

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2
Q

PID –> inpt tx

A
  • 1st: cefoxitin + doxy

- alt: clindamycin + gent

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3
Q

what is courvoisier sign? seen in what condition?

A

palpable gallbladder –> pancreatic cancer

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4
Q

T/F: painless jaundice is NOT common in pancreatic cancer

A

T

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5
Q

jaundice in pancreatic cancer indicates?

A

obstruct intrapancreatic CBD –> sign of adv dz

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6
Q

what PE finding is highly suggestive of spinal cord compression?

A

vertebra pt tenderness w percussion

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7
Q

spinal cord compression –> presentation (3)

A
  • vertebral tender
  • sensory level
  • hyperreflex
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8
Q

spinal cord compression –> should start what med immed?

A

glucocorticoid –> decrease compression –> prevent permanent paralysis

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9
Q

chol embolization synd –> most accurate dx test

A

bx of skin lesion –> chol xls

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10
Q

chol emboli –> tx

A

supportive: no specific tx to reverse atheroembolic dz

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11
Q

chol emboli –> urine finding

A

eosinophiluria

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12
Q

A-fib –> initial tx

A

rate control:

  • BB
  • CCB –> verapamil, diltiazem –> block AV node
  • digoxin
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13
Q

A-fib –> rate controlled to under 100 –> next step?

A

anticoag:
- warfarin
- dabigatran
- rivaroxaban

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14
Q

A fib –> goal of care (2)

A
  • rate ctrl

- anticoag

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15
Q

T/F: rate ctrl drugs do NOT convert pt into sinus rhythm

A

T

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16
Q

CHADS score –> components

A
  • CHF/cardiomyopathy
  • HTN
  • Age >75
  • DM
  • Stroke or TIA = 2pts
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17
Q

CHADS score <1 –> tx

A

ASA

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18
Q

CHADS score >2 –> tx

A
  • warfarin
  • dabigatran
  • rivaroxaban, apixaba`n
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19
Q

diabetic nephropathy –> earliest renal abnormality? 1st change that can be quantitated?

A

earliest abnormal: glomerular hyperfiltrate

earliest qty: glomerular BM thicken

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20
Q

sz –> can lead to post or ant shoulder dislocation?

A

post

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21
Q

10M –> persistent HA w no relief, daily nonbloody nonbilious emesis, eyelid retract, limited upward gaze, prefer downward gaze –> what condition?

A

pineal gland tumor:

  • parinaud synd
  • obstructive hydrocephalus
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22
Q

parinaud synd –> presentation (3)

A
  • limited upward gaze –> prefer down gaze
  • eyelid retract (Collier sign)
  • light-near dissoc (pupil react to accomm but not to light)
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23
Q

T/F: absent/decreased achilles reflex –> normal in elderly pt

A

T

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24
Q

diclofenac –> what kind of drug

A

NSAID

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25
Q

defibrillation is for what conditions (2)

A
  • Vfib

- pulseless V tach

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26
Q

synchronized cardioversion is for what conditions (3)

A

complex tachyarrythmia:

  • Afib
  • A flutter
  • VT w pulse
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27
Q

suspect lupus –> initial test

A

antinuclear Ab (ANA)

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28
Q

suspect SLE –> ANA+ –> next step

A

ANA sens but not specific for SLE –> test for more specific Ab –> confirm dx:

  • anti-dsDNA
  • anti-Smith
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29
Q

suspect SLE –> why not do anti-dsDNA as initial test

A

anti-dsDNA is more specific for SLE but is not sens

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30
Q

73M w dementia –> low abd pain for 36hr –> refused oral intake, last bowel mvmt 2day ago –> h/o BPH, hemorrhoid, HTN, hyperlipid, chronic neck pain-started amitriptyline 8days ago –> abd full & tender at midline below umbilicus –> what condition?

A

amitriptyline –> antichol –> reduce detrusor contract, prevent urethral sphincter relax –> acute urinary retention

antichol + pressure from urine retention –> constipation

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31
Q

27F preg 28wk gestation –> abnormal pap high grade squamous intraepi lesion –> next step?

A

HSIL –> immed colposcopy w bx of abnormal lesions –> even if preg d/t high risk of progress to cancer

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32
Q

menopause –> hot flash –> tx

A

wt loss

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33
Q

menopause –> hot flash ssx not improve w wt loss –> next tx?

A

hormone replace tx

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34
Q

what is the only indication for HRT

A

<60yo –> menopause in past 10yr –> vasomotor ssx

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35
Q

polyarthralgia, tenosynovitis, vesiculopustular skin lesion –> classic triad for what condition?

A

disseminated gonococcal infect

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36
Q

use dependence –> MC seen w what kind of anti-arrhythmic?

A

class IC

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37
Q

class IC antiarrhythmic –> use dependence –> can cause what change in EKG w fast HR?

A

widened QRS

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38
Q

what is oral leukoplakia

A

hyperplasia of squamous epithelium –> reactive precancerous lesion

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39
Q

when should bx oral leukoplakia for malig transformation to SCC?

A

develop areas of induration/ulceration

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40
Q

appearance: oral leukoplakia vs SCC

A

leukoplakia: white patch w granular texture

SCC: areas of induration/ulceration

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41
Q

anti-histone Ab –> seen in what condition?

A

drug induced lupus

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42
Q

SLE –> maintenance tx

A

hydroxychloroquine

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43
Q

SLE –> lupus nephritis –> tx

A

IV cyclophosphamide –> oral mycophenolate

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44
Q

BPH –> which area/zone of prostate enlarges?

A

central zone

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45
Q

what herbal supplement works for BPH?

A

saw palmetto

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46
Q

lactose intol –> may be 2ndary to what conditions (2)

A
  • Crohns

- bact overgrowth

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47
Q

what is hepatorenal synd

A

progressive renal fail d/t adv liver dz: renal vessels vasoconstrict –> renal hypoperfusion

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48
Q

hepatorenal synd –> tx

A

liver transplant is only cure –> usu fatal w/out it

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49
Q

shoulder dystocia –> what are 6 steps to deliver fetus?

A

1) McRoberts maneuver
2) Rubin maneuver
3) Woods maneuver
4) deliver post arm
5) deliberately fracture clavicle
6) Zavanelli maneuver

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50
Q

what is McRoberts maneuver

A

flex knees –> suprapubic pressure

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51
Q

what do Rubin & Woods maneuvers do?

A

rot fetus shoulders

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52
Q

what is Zavanelli maneuver

A

push fetal head back into uterus –> C/S

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53
Q

difference bw spont abortion vs intrauterine fetal demise

A

abortion: <20wk

fetal demise: >20wk

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54
Q

MC type of urinary incontinence in elderly

A

urge incontinence

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55
Q

what is urge incontinence

A

detrusor –> invol & uninh contract –> sudden urge to urinate –> invol loss of urine

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56
Q

urge incontinence –> 1st line tx

A

bladder training exercise

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57
Q

urge incontinence –> 1st line tx fail –> next tx?

A
  • anticholinergic (oxybutynin)

- TCA (imipramine)

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58
Q

66F –> 3mo agitation, restless, poor sleep, HA, gain 14lb –> h/o smoke –> BP 160/110, facial plethora, scattered bruises, Na 147, K 3.2, glucose 205 –> what condition?

A

smoke –> small cell lung cancer –> ectopic ACTH production –> hypercortisol –> Cushing synd

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59
Q

3F –> dysuria –> h/o 3 bladder infect trted w abx, constipation since start cow’s milk –> suprapubic tender, anal fissures –> UA & culture show UTI w E.coli –> normal renal US, voiding cystoureterogram –> what condition?

A

constipation –> fecal retention –> compress bladder –> incomplete void –> urine stasis –> recurrent cystitis

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60
Q

11mo black M –> ant fontanelle wide open, pliable skull bones w/out stepoffs, bony prominences of costochondral jxs, genu varum –> what condition?

A

vitD def –> rickets

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61
Q

rickets –> presentation (3)

A
  • craniotabes (softening of cranial bones)
  • rachitic rosary (costochrondral jt hypertrophy)
  • genu varum (femoral/tibial bowing)
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62
Q

MC 1ary bone tumor in children/YA

A

osteosarcoma

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63
Q

2nd MC 1ary bone tumor in children/YA

A

Ewing sarcoma

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64
Q

osteosarcoma –> typically involve what part of bone

A

long bone –> metaphyses

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65
Q

osteosarcoma –> XR finding (2)

A
  • “sunburst” periosteal rxn

- Codman triangle

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66
Q

Ewing sarcoma –> XR finding

A

“onion skin”

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67
Q

63F –> leg swelling –> h/o HTN, OSA, smoke for 30yr –> 2+ pitting edema, dilated & tortuous superficial veins, ulcer on L medial ankle –> what condition?

A

chronic venous insuff –> venous HTN –> varicose veins, edema, medial skin ulcer, skin discolor

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68
Q

chronic venous insuff –> initial tx

A

conservative:
- leg elevate
- exercise
- compression therapy

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69
Q

48M –> pain in R foot/leg after small cut while sailing –> now fever w rigors –> h/o hemochromatosis –> T 103, edema, dark bullae, streaking erythema –> what condition? causative org?

A

marine environ –> vibrio vulnificus –> wound contamination –> necrotizing fasciitis, septic shock

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70
Q

who is at particularly great risk for vibrio vulnificus infect?

A

liver dz

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71
Q

78M –> 6mo progressive b/l butt pain that radiate to thigh, calves –> worse w ambulation, improve when lean on cane, sit –> cannot walk more than 2-3blocks –> mod relief w IBU –> what condition?

A

spine OA –> osteophytes –> lumbar spine stenosis –> compress lumbar N roots –> neurogenic claudication

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72
Q

common causes of spinal stenosis (3)

A
  • degen arthritis (spondlyosis)
  • degen disk dz
  • thickening ligamentum flavum
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73
Q

47M black farmer from Missippi –> 3wk malaise, nonproductive cough, fatigue, SOB –> h/o smoke –> erythema nodosum, CXR bilat patchy opacities, enlrg mediastinal & hilar LN –> HIV, TB neg –> LN bx noncaseating granuloma –> trted for sarcoidosis w steroid –> deteriorate rapid –> CXR progression of pulm infiltrate –> what condition?

A

Histoplasmosis

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74
Q

27F –> 2mo hirsutism –> acne, clitoromegaly –> abd CT L adrenal mass –> what condition?

A

androgen-producing neoplasm

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75
Q

intussusception –> constant or episodic pain?

A

episodic

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76
Q

acute resp distress –> ABG findings:

  • acid-base
  • O2
  • CO2
A
  • acid-base: resp alk
  • O2: low
  • CO2: low
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77
Q

acute resp distress –> Swan-Ganz catheterization findings during mech vent:

  • wedge pressure
  • PaO2:FiO2 ratio
A
  • wedge pressure: <18mmHg

- PaO2:FiO2 ratio: <200

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78
Q

Wegener’s granulomatosis –> aka

A

granulomatosis w polyangiitis

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79
Q

granulomatosis w polyangiitis –> bx finding

A

noncaseating granuloma

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80
Q

sudden dyspnea, pleuritic CP, feeling of impending doom, loud S2, decreased breath sounds –> what condition?

A

PE

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81
Q

PE –> need to be on anticoag for how long

A

3-6mo

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82
Q

PE –> EKG findings (3)

A
  • tachycardia
  • lead I: S wave
  • lead III: T wave inversion
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83
Q

suspect PE –> V/Q scan equivocal –> next step

A

angiography

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84
Q

29M –> copious watery diarrhea for 10day –> returned from vacation to E Europe where hiked & swam in local lakes –> what condition? causative org?

A

ingest contaminated water –> Cryptosporidium parvum –> prolonged traveler’s diarrhea

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85
Q

traveler’s diarrhea that is prolonged, profuse and watery is often caused by what type of pathogen?

A

parasitic

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86
Q

development of AV block in pt w infective endocarditis –> raise suspicion for what condition?

A

perivalvular abscess

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87
Q

bilat trigeminal neuralgia –> raise suspicion for what condition?

A

MS

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88
Q

pseudotumor cerebri –> most sig comp?

A

blind

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89
Q

26F –> microcytic anemia nonresponsive to iron supplement –> adopted from Greece –> what condition?

A

B-thal minor

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90
Q

fever, chill, LUQ pain, splenic fluid collection –> what condition?

A

splenic abscess

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91
Q

splenic abscess –> most commonly assoc w what condition

A

infective endocarditis

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92
Q

splenic abscess –> classic triad presentation

A
  • fever
  • leukocytosis
  • LUQ abd pain
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93
Q

splenic abscess –> can also present w what other ssx (3)

A
  • L pleuritic CP
  • L pleural effusion
  • splenomeg
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94
Q

70F –> fever, cough, CXR R lower lobe infiltrate –> what condition? causative org?

A

Strep pneumo (#1 cause of CAP) –> CAP

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95
Q

rickets –> lab findings:

  • alk phos
  • phos
  • Ca
  • PTH
A
  • alk phos: high
  • phos: low
  • Ca: low
  • PTH: high
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96
Q

what is Marjolin ulcer

A

SCC arising w/in burn wound

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97
Q

suspect acute aortic dissection –> initial dx study in hemodynamic stable pt

A

CT angio

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98
Q

new murmur & fever –> raise suspicion for what condition?

A

infective endocarditis

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99
Q

infective endocarditis –> Duke criteria –> need to meet how many criteria to dx?

A
  • 2 major
  • 1 major + 3 minor
  • 5 minor
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100
Q

infective endocarditis –> Duke criteria –> what are major criteria

A
  • bacteremia

- new regurg murmur, echo –> vegetation

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101
Q

infective endocarditis –> Duke criteria –> what are minor criteria

A
  • fever
  • RF: IVDA, h/o endocarditis, prosthetic valve
  • vasc comp: embolism, Janeway lesion, intracranial hemorrhage
  • rheum comp: Roth spots, Osler nodes, glomerulonephritis
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102
Q

suspect aortic dissection –> best initial test? most accurate test?

A

initial: CXR
accurate: CT angiogram

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103
Q

aortic dissection –> most important goal in management

A

ctrl BP –> BB

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104
Q

at what age start screen for AAA?

A

65

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105
Q

what is Grey Turner sign

A

ecchymosis on back/flanks

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106
Q

what is Cullen sign

A

ecchymosis around umbilicus

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107
Q

Grey Turner sign, Cullen sign –> indicate what condition?

A

AAA –> expansion & impending rupture

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108
Q

find AAA –> at what size need surg?

A

5cm

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109
Q

amphetamine, cocaine, bath salt –> intox –> tx

A
  • antipsych
  • benzo
  • antiHTN
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110
Q

amphetamine, cocaine, bath salt –> withdrawal –> tx

A
  • bupropion

- bromocriptine

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111
Q

microcytic anemias (4)

A
  • IDA
  • anemia of chronic dz
  • thal
  • sideroblastic
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112
Q

normocytic anemias (5)

A
  • sickle cell
  • G6PD def
  • spherocytosis
  • autoimmune hemolysis
  • paroxysmal nocturnal Hburia
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113
Q

asx hyperCa, elevated PTH –> what condition?

A

1ary hyperPTH

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114
Q

infective endocarditis –> strep mutans –> tx?

A

IV:

  • ceftriaxone
  • PCN G
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115
Q

HOCM –> symptomatic –> tx

A

neg inotropic agent –> BB –> prolong diastole, decrease contractile –> decrease LVOT obstruct –> improve angina

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116
Q

neonate –> 1st week of life –> should have how many wet diapers a day?

A

equal to infant’s age in days: 4day –> 4diapers

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117
Q

“brick-red” areas on diaper –> what is it? indicates what?

A

urate xls –> mild dehydration

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118
Q

when does breastfeed fail jaundice occur? breast milk jaundice?

A

breast fail: 1st week of life

breast milk: start 3-5day –> peak at 2wk

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119
Q

breastfeed fail jaundice –> cause

A

lactation fail:

  • maternal: infreq feed, …
  • infant: poor latch, …
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120
Q

how can distinguish bw breastfeed fail jaundice vs breast milk jaundice

A

dehydration vs no dehydration & no feeding problems

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121
Q

breastfeed fail jaundice –> pathophys

A

lactation fail –> inadeq stooling –> decrease bili elimination –> increase bili in circulation

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122
Q

breast milk jaundice –> pathophys

A

breast milk –> high B-glucurondinase –> deconj bili –> increase bili in circulation

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123
Q

chickenpox –> type of rash

A

successive crops of intensely pruritic vesicles

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124
Q

acute pancreatitis –> MCC? 2nd MC? 3rd MC?

A 
#1) alcohol
#2) gallstone
#3) hyperTG
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125
Q

serum TG level must be what to be considered potential cause of pancreatitis?

A

> 1,000mg/dl

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126
Q

what PaO2 shows hypoxemia?

A

<60mmHg

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127
Q

resp fail –> mech vent –> still hypoxemia –> increasing what values can increase oxygenation? (2)

A
  • FiO2

- PEEP

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128
Q

cyclosporine –> what kind of drug

A

calcineurin inh (immunosupp)

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129
Q

cyclosporine –> MOA

A

decrease production of inflamm cytokines by T-cell lymphocytes

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130
Q

calcineurin inh (2)

A
  • cyclosporine

- tacrolimus

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131
Q

cyclosporine –> AE (6)

A
  • nephrotoxic
  • hyperK
  • HTN
  • gum hypertrophy
  • hirsutism
  • tremor
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132
Q

tacrolimus –> AE (4)

A
  • nephrotoxic
  • hyperK
  • HTN
  • tremor

same as cyclosporine but not hirsutism, gum hypertrophy

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133
Q

azathioprine –> AE (3)

A
  • diarrhea
  • leukopenia
  • heptatoxic
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134
Q

mycophenolate –> AE (1)

A

BM suppress

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135
Q

EKG –> broad flat T wave –> what condition?

A

hypoK

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136
Q

what is fusion beat

A

electrical impulse from 2 diff sources act on same region of heart at same time

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137
Q

ventricular fusion beat –> appearance on EKG

A

hybrid of both normal & wide QRS

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138
Q

wide complex tachycardia w fusion beats –> what condition?

A

sustained monomorphic ventricular tachycardia

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139
Q

sustained monomorphic ventricular tachycardia –> pt is stable –> tx

A

amiodarone

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140
Q

kidney stone –> obstruct ureter –> imaging of choice to dx?

A

abd US

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141
Q

which study design is best for determining incidence of a dz

A

cohort

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142
Q

pernicious anemia –> need to monitor for what longterm comp?

A

gastric CA

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143
Q

pernicious anemia –> why have increased risk of gastric cancer?

A

pernicious anemia –> chronic atrophic gastritis –> decrease produce IF

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144
Q

chronic alcohol –> cerebellar dysfx –> presentation ( 5)

A
  • gait instability
  • truncal ataxia
  • difficult w rapid alt mvmt
  • hypotonia
  • intention tremor
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145
Q

Creutzfeldt-Jakob dz –> EEG finding

A

sharp, triphasic, synchronous discharges

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146
Q

18mo M –> recurrent sinopulm infect, PMI displaced to R chest –> what condition?

A

Kartagener synd

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147
Q

Kartagener synd –> classic triad presentation

A
  • situs inversus
  • recurrent sinusitis
  • bronchiectasis
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148
Q

25F –> hair loss w receding hairline, light periods q35-50day, extensive acne, BMI 33 –> what condition?

149
Q

ALS –> tx? what type of drug?

A

riluzole (glutamate inh)

150
Q

75M black –> h/o DM, HTN –> fundoscopy cupping of optic disc, constricted peripheral vision –> what condition?

A

1ary open angle glaucoma

151
Q

open angle glaucoma –> more common in whom?

152
Q

open glaucoma –> natural progression of dz

A

initially asx –> gradual loss of peripheral vision –> eventual tunnel vision

153
Q

what differentiate bw heat exhaustion vs heat stroke

A

exhaust: >104F
stroke: >104F + CNS dysfx (confuse, irritable, sz)

154
Q

exertional heat stroke –> tx

A

rapid cool –> #1 ice water immersion

155
Q

65M –> COPD exacerbation –> started on inhaled bronchodilator, systemic steroid, high flow Ow, IV lorazepam –> 30min later lethargic, confused, gen tonic clonic –> what condition?

A

advanced COPD –> supplemental O2 –> CO2 retention –> acidosis:

  • change level of consciousness
  • cerebral vasodilate –> sz
156
Q

advanced COPD –> how does supplemental O2 cause CO2 retention

A
  • increase dead space perfusion –> V/Q mismatch
  • decrease affinity of oxyHb for CO2
  • reduce alveolar vent
157
Q

pap smear –> atypical squamous cells of undetermined significance (ASCUS) –> management

A

1) HPV screen

2) repeat pap 6mo

158
Q

pap smear –> abnormal (LSIL, HSIL) –> management

A

colposcopy –> LEEP, conization, laser ablation

159
Q

toxic shock synd –> abx

A

oxacillin or nafcillin

160
Q

24F –> 37wk gestation –> fetus is breech –> next step

A

external cephalic version –> if fail, schedule C/S

161
Q

suspect Cushing’s synd –> next step to confirm dx?

A

low dose dexamethasone test

AND

late night salivary cortisol assay

OR

24hr urine free cortisol

162
Q

placental abruption –> maternal comp (2)

A
  • DIC

- hypovol shock

163
Q

40F –> EKG to assess for CAD –> 85% sens, 80% spec, PPV 25%, NPV 96% –> test is neg –> what is probability has CAD?

A

1-NPV = 4%

164
Q

Beckwith-Wiedemann synd –> comp

A
  • Wilms tumor

- hepatoblastoma

165
Q

27M –> periorbital swell, dark urine –> h/o 3wk ago skin infect trted w dicloxacillin –> BP 150/90, urine RBC casts, low serum C3, BUN 40, Cr 2 –> what condition?

A

post strep glomerulonephritis

166
Q

38F –> 5mo fatigue since birth of twins –> had uterine atony & bleed trted w mult transfusions –> h/o depression not taking antidep –> difficult keep track of all new responsibilities, often forget to eat, LMP before last preg, BP 85/55, BMI 18, Hb 10.1 –> what condition?

A

Sheehan synd

167
Q

MC nephrotic synd assoc w Hodgkin lymphoma

A

minimal change dz

168
Q

MC nephrotic synd assoc w malig

A

membranous nephropathy

169
Q

Hodgkin lymphoma –> trt w ctx & rad –> comp

A

ctx & rad –> 2ary malig

170
Q

glioblastoma multiforme –> CT/MRI finding

A
  • “butterfly” appearance w central necrosis

- heterogenous, serpiginous contrast enhancemt

171
Q

8F –> 2 bone fx, moonlike face, 2 light brown spots w irreg contour on back, bruise on arm, breast budding and enlarged areola, course dark pubic hair –> what condition?

A

McCune-Albright synd

172
Q

McCune-Albright synd –> 3 P’s

A
  • precocious puberty
  • pigmentation (cafe au lait spots)
  • polyostotic fibrous dysplasia
173
Q

TCA overdose –> how does sodium bicarb help?

A

sodium bicarb –> increase pH, increase Na –> decrease TCA’s cardio-depressant effects on Na channels

174
Q

66M –> new dx of HTN –> CT angio reveals 80% atherosclerotic narrow of R renal A –> next step

175
Q

HTN & renal A stenosis –> why not trt w renal A stent or surg revasc?

A

not proven superior to med therapy to ctrl BP, reduce CV outcomes

==> reserve for pts w:

  • resistant HTN
  • recurrent flash pulm edema
  • refractory HF d/t severe HTN
176
Q

solid organ transplant –> immunosupp –> opportunistic infect –> pneumonia –> caustative org (2)?

177
Q

what meds can trigger myasthenic crisis (3)

A
  • BB
  • aminoglycoside
  • FQ
178
Q

when do quad screen ?

A

2nd trim (15-20wk)

179
Q

trisomy 18 –> quad screen results:

  • MSAFP
  • B-hCG
  • estriol
  • inhA
A
  • MSAFP: decreased
  • B-hCF: decreased
  • estriol: decreased
  • inh A: normal
180
Q

trisomy 21 –> quad screen results:

  • MSAFP
  • B-hCG
  • estriol
  • inh A
A
  • MSAFP: decreased
  • B-hCG: increased
  • estriol: decreased
  • inh A: increased
181
Q

neural tube or abd wall defect –> quad screen results:

  • MSAFP
  • B-hCG
  • estriol
  • inh A
A
  • MSAFP: increased
  • B-hCG: normal
  • estriol: normal
  • inh A: normal
182
Q

OA vs RA: how long does morning stiffness last

A

OA: 30min
RA: 60min

183
Q

RA nodules –> bx finding

184
Q

RA –> XR finding

A

periarticular osteopenia

185
Q

RA –> tx for everyone

A

NSAID + DMARD

186
Q

RA –> tx –> preferred DMARD?

A

methotrexate

187
Q

RA –> tx –> biologic for severe dz –> which biologic used?

A

TNFa inh (infliximab, rituximab, etanercept)

188
Q

RA + neutropenia + splenomeg –> what condition?

A

Felty synd

189
Q

episodic pounding sensation, chronic diarrhea, wt loss, tricuspid regurg –> what condition?

A

carcinoid synd

190
Q

carcinoid synd –> presentation (5)

A
  • episodic flushing (hallmark)
  • secretory diarrhea
  • cutaneous telangiectasia
  • bronchospasm
  • tricuspid regurg
191
Q

carcinoid synd –> dx

A

24hr urine 5-hydroxyindoleacetic acid

192
Q

cirrhosis + psychosis –> what condition?

193
Q

Wilson dz –> presentation (5)

A
  • neuro: psychosis, delusion, personality change
  • ataxia, chorea
  • cirrhosis
  • Kayser-Fleisher ring
  • Coombs neg hemolytic anemia
194
Q

Wilson dz –> best initial test

A

slit lamp –> Kayser-Fleisher ring

195
Q

Wilson dz –> lab findings:

  • serum ceruloplasmin
  • urinary copper
A
  • serum ceruloplasmin: decreased

- urinary copper: increased

196
Q

Wilson dz –> tx

A

penicillamine or trientine –> chelate copper –> remv from body

197
Q

Wilson dz –> tx –> need what supplement? why?

A

zinc –> interfere w intestinal Cu absorption

198
Q

stable angina –> first line tx? why?

A

BB –> decrease exertional HR & myocardial contractility –> reduce myocardial O2 demand –> alleviate ssx, improve exercise tolerance

199
Q

find solid testicular mass –> next step?

A

radical orchiectomy

200
Q

stable angina –> tx –> how does nitroglycerin relieve pain?

A

systemic vasodilate –> decrease LVEDV –> decrease wall stress –> decrease myocardial O2 demand

201
Q

consolidation of lung:

  • breath sounds
  • tactile fremitus
  • percussion
A
  • breath sounds: increased (crackles, egophony)
  • tactile fremitus: increased
  • percussion: dull
202
Q

Sjogren –> increased risk for what malig?

A

non-Hodgkin lymphoma

203
Q

what is isolated systolic HTN? pathophys?

A

SBP >140, normal DBP

old age –> stiff, less elastic arterial wall

204
Q

17F –> loss of consciousness, fall –> recent brkup w bf, stress at school, sleep poorly –> after 20min wake up, disoriented to time/place –> what condition?

A

LOC, loss postural tone, delayed return to baseline –> sz –> postictal state

205
Q

how to calculate sensitivity

A

TP / (TP + FN)

206
Q

how to calc specificity

A

TN / (TN + FP)

207
Q

how to differentiate confounding vs effect modification

A

confounding: stratify pop into grps –> since confounder remved –> no sig diff bw 2 grps

effect modification: stratify grps –> sig diff bw 2 grps

208
Q

11M –> 7mo recurrent thoughts of stabbing mother to death, must recite prayer 20times to make thoughts stop, does this 3-5times a day, feels extremely guilty, increasingly anxious and withdrawn –> what condition?

209
Q

55F –> tender erythematous, palpable cord-like veins on L arm –> similar epsiode on chest 2wk ago that improved on own –> also several months of heartburn, mild epigastric pain –> what condition?

A

Trousseua’s synd –> migratory superficial thrombophlebitis

210
Q

Trousseau’s synd –> usu assoc w what conditon?

A

occult visceral malig –> #1 pancreatic

211
Q

cilostazol –> what kind of drug?

A

phosphodiesterase inh (cAMP)

212
Q

cilostazol –> used to trt what condition?

213
Q

pentoxyfylline –> what kind of drug?

214
Q

pentoxyfylline –> used to trt what condition?

215
Q

T/F: wt gain is NOT an AE of OCP

216
Q

ascending weak + loss of reflex –> next step?

A

LP –> high protein, few cells –> Guillain Barre

217
Q

pt has Guillain-Barre –> next step? why?

A

PFT to detect impending resp fail:

  • decreased FVC
  • decreased peak inspiratory pressure
218
Q

Guillain-Barre –> tx

A

IVIG or plasmapheresis

NEVER steroid

219
Q

closed angle glaucoma –> tx

A

constrict pupil:

1) a-agonist
2) BB

220
Q

pt w h/o closed angle glaucoma –> should never give what med?

221
Q

chronic progressive loss of central vision –> what condition?

A

macular degen

222
Q

wet macular degen –> fundoscopy findings

A

blood/fluid

223
Q

dry macular degen –> fundoscopy findings

A
  • drusen

- pigmt change

224
Q

macular degen –> tx:

  • wet
  • dry
A
  • wet: laser

- dry: nothing

225
Q

acute mania –> escalating agitation –> tx

A

antipsych –> manage psychosis & agitation acutely –> more rapid onset than lithium, mood stabilizer

226
Q

pharm company –> physicians may accept what kind of gifts?

A

nonmonetary gifts of minimal value that directly benefit pts –> unbiased ed material, drug samples

227
Q

MC congenital heart defect in Down synd

A

complete AV septal defect (CAVSD)

228
Q

neonate –> cyanosis despite supp O2 –> probable congenital heart dz –> next step?

A

prostaglandin E1 –> maintain PDA –> potentially life saving

229
Q

neonate –> probable congenital heart dz –> next step after give PGE1?

A

echo to ID specific cardiac lesion

230
Q

24M –> 2 day fever, sore throat, hoarse, can’t swallow d/t severe pain –> T 103, drool, muffled voice, stridor, pooled secretions in oropharynx, ant neck tender –> what condition?

A

infectious epiglottitis

231
Q

why is gymnastics not recommended in preg?

A

high fall risk

232
Q

phlebotomist –> needlestick injury from HIV+ pt –> next step

A
  • draw blood for HIV seroogy

- start 3drug antiretroviral tx immed

233
Q

folic acid/cobalamin def –> what abnormal lab finding? why?

A

increased homocysteine

involved in conversion of homocysteine –> methionine

234
Q

how differentiate bw folic acid def vs cobalamin def?

A

cobalamin –> also involved in conversion of methylmalonyl-CoA –> succinyl CoA

==> increased methylmalonic acid

235
Q

NSTEMI –> long term medical tx

A
  • ASA + P2y12 receptor blocker (clopidogrel)
  • BB
  • ACEI
  • statin
236
Q

43M –> erectile dysfx, fatigue –> h/o alcohol, smoke –> brown skin, fasting glucose 130, AST 78, ALT 80 –> what condition?

A

hereditary hemochromatosis:

  • elevated liver enzyme
  • skin pigment
  • “bronze diabetes”
  • hypogonad
237
Q

acute epididymitis –> cause:

  • <35
  • > 35
A
  • <35: sexually transmited –> chlamydia, gonorrhea

- >35: bladder outlet obstruct –> coliform bact –> E.coli

238
Q

case ctrl study –> can use odds ratio as close approximation of relative risk if what is true?

A

rare dz assumption: incidence of dz is low

239
Q

immunocomp + bilat interstitial infiltrates –> what condition?

A

PCP pneumonia

240
Q

PCP pneumonia –> lab finding –> LDH

241
Q

AIDS –> PCP prophylaxis –> should use what if pt can’t take TMP/SMX? and if can’t take that either?

A

1) TMP/SMX
2) dapsone
3) atovaquone

242
Q

PCP pneumonia –> pt experiences TMP/SMX toxicity –> alt to TMP/SMX?

A
  • pentamidine

- clinda + primaquine

243
Q

septic arthritis –> arthrocentesis finding –> WBC?

244
Q

caustic esophageal injury –> dx?

A

EGD w bx –> determine severity

245
Q

caustic esophageal injury –> when can gastric lavage?

246
Q

diabetes, hepatomeg, arthritis w chondrocalcinosis –> what condition?

A

hereditary hemochromatosis

247
Q

what are some 2ndary causes of pseudogout? (3)

A
  • hyperPTH
  • hypothyroid
  • hemochromatosis
248
Q

hyperK –> EKG findings –> sequence

A

1) peaked T wave
2) prolong PR, wide QRS
3) P wave disappear
4) AV block, sine wave

249
Q

when need to emergent trt for hyperK (3)

A
  • serum K increase rapidly
  • > 6.5mEq/L
  • EKG changes
250
Q

hyperK –> need to emergent trt –> what is most immed measure?

A

IV Ca –> stabilize cardiac myocyte membrane –> make resistant to hyperK effects

251
Q

mastitis –> abx tx

A
  • dicloxacillin

- cephalexin

252
Q

45F –> progressive fatigue, myalgia, proximal muscle weak in LE that cramp after short distance, hyporeflex, elevated CK –> What condition?

A

hypothyroid myopathy

253
Q

midgut volvulus w malrotation –> dx

A

upper GI series (barium swallow)

254
Q

frostbite –> tx

A

rapid rewarm w warm water

255
Q

GLP-1 agonist examples

A
  • exenatide

- liraglutide

256
Q

GLP-1 agonist –> benefits to using

A
  • induce wt loss

- lower risk of hypoglycemia

257
Q

sulfonylurea –> AE

A
  • hypoglycemia
  • wt gain
  • sulfa allergy
258
Q

thiazolidinedione –> examples

A
  • rosiglitazone

- pioglitazone

259
Q

sulfonylurea –> examples

A
  • glyburide
  • glimerpiride
  • glipizide
260
Q

thiazolidinedione –> AE (3)

A
  • wt gain
  • fluid retention –> exacerbate CHF
  • decrease bone mineral density
261
Q

GLP-1 agonist –> AE

A

pancreatitis

262
Q

celiac dz –> assoc w what Ab (2)?

A
  • IgA anti-tissue transglutaminase

- IgA anti-endomysial Ab

263
Q

why some pts w celiac disease test neg for anti-ttg and anti-endomysial?

A

selective IgA def –> common in celiac dz

264
Q

SIADH:

  • hypo/hypertonic
  • hypo/hyperNa
  • hypo/eu/hypervol
A

hypotonic hypoNa

euvol

265
Q

which agents for PE should not be used in pts w renal insuff?

A
  • LWMH (enoxaparin)
  • IV factor Xa inh (fondaparinux)
  • oral factor Xa inh (rivaroxaban)
266
Q

suspect hemochromatosis –> next step?

A

ferritin –> >1000

transferrin –> >50%

267
Q

suspect hemochromatosis –> ferritin & transferrin elevated –> next step?

A

confirm dx –> liver bx

268
Q

hemochromatosis –> comp (7)

A
  • cirrhosis
  • cardiomyopathy
  • DM
  • arthritis
  • hypogonad
  • hypothyroid
  • hyperpigment
269
Q

55M –> lower urinary tract ssx –> prostate is uniformly enlarged, smooth and rubbery –> next step

A

BPH –> UA & U culture to r/o infect

270
Q

mechanism of dz: polymyositis vs dermatomyositis

A
  • polymyositis: T cell mediated

- dermatomyositis: humoral –> Ab complex deposition

271
Q

polymyositis vs dermatomyositis –> muscle bx –> location of inflamm & muscle fiber fibrosis

A
  • polymyositis: endomysial

- dermatomyositis: perivascular & perimysial

272
Q

polymyalgia rheumatica –> assoc w what condition?

A

temporal arteritis

273
Q

polymyalgia rheumatica –> presentation (3)

A
  • hip & shoulder muscle pain (bilat)
  • constitutional ssx: malaise, fever, depress, wt loss, fatigue
  • jt swell
274
Q

polymyalgia rheumatica –> hip & shoulder muscle pain:

  • when stiff
  • when pain
  • muscle strength
A
  • stiff: morning, after inactivity
  • pain w mvmt
  • normal strength
275
Q

polymyalgia rheumatica –> tx

276
Q

Klumpke palsy –> presentation (3)

A
  • “claw hand”: ext wrist, hyperext MCP, flex IP, absent grasp reflex
  • Horner synd (ptosis, miosis)
  • intact Moro & biceps reflex
277
Q

Klumpke palsy –> damage what N roots?

278
Q

serum to ascites albumin gradient (SAAG) –> how to calc

A

serum albumin - peritoneal albumin

279
Q

SAAG –> how to interprete

A

> 1.1 –> portal HTN

<1.1 –> other cause of ascites

280
Q

what supplement is recommended to be used with methotrexate?

A

folic acid

281
Q

methotrexate –> AE (3)

A
  • hepatotoxic
  • stomatitis
  • cytopenia
282
Q

Paget dz of bone –> lab findings:

  • alk phos
  • urine hydroxyproline
  • Ca
  • phosphorus
A
  • alk phos: increased
  • urine hydroxyproline: increased
  • Ca: normal
  • phosphorus: normal
283
Q

Paget dz of bone –> tx

A
  • bisphonate

- calcitonin

284
Q

G6PD def –> meds that commonly trigger episode (3)

A
  • dapsone
  • TMP/SMX
  • nitrofurantoin
285
Q

G6PD def –> initial test? best test?

A

initial: smear
best: G6PD level 6-8wk after attack

286
Q

G6PD def –> tx

A
  • supportive

- avoid stress

287
Q

what’s the best statistical method to compare proportions?

A

chi square test

288
Q

alcoholic hepatitis –> lab findings:

  • GGT
  • ferritin
A
  • GGT: elevated

- ferritin: elevated

289
Q

bronchogenic cyst –> location

A

middle mediastinum

290
Q

1M –> capillary (fingerstick) blood test –> lead 12ug/dl –> next step?

A

confirm w venous blood draw –> lead level

291
Q

fredreich ataxia –> MC COD

A
  • cardiomyopathy

- resp comp

292
Q

fredreich ataxia –> presentation (3)

A
  • neuro: ataxia, dysrarthria
  • skeletal: scoliosis, feet deform
  • cardiac (concentric hypertrophic cardiomyopathy)
293
Q

suspect infective endocarditis –> next step?

A

blood culture

294
Q

18F –> disseminated maculopapular rash, malaise, Cr 2.0, white blood cell casts, T 100.4 –> h/o dysuria & increase urinary freq 1wk ago trted w TMP/SMX –> what condtiion?

A

allergic interstitial nephritis

295
Q

interstitial nephritis –> presentation (3)

A
  • fever
  • maculopapular rash
  • renal fail
296
Q

new solitary pulm nodule –> next step

A

chest CT –> assess malig risk

297
Q

torsades –> tx:

  • unstable pt
  • stable
A

unstable –> defib

stable –> Mg sulfate

298
Q

newborn F –> IUGR, VSD, hypertonia, closed fists w overlapping digits –> what chrom abnormal?

A

trisomy 18 (Edwards)

299
Q

trisomy 18 (Edwards) –> presentation (5)

A
  • microcephaly –> prominent occiput
  • IUGR
  • micrognathia
  • closed fists w overlapping digits
  • rocker bottom feet
300
Q

study to assess assoc bw L-TRP use & developmet of EMS –> EMS pts asked about L-TRP use –> ppl w/out EMS asked about L-TRP use –> what kind of study?

301
Q

case ctrl study –> main measure of assoc?

A

exposure odds ratio

302
Q

how can differentiate hyperemesis gravidarum from typical N/V of preg? (3)

A
  • > 5% prepreg wt loss
  • electrolyte abnormal
  • ketonuria
303
Q

how deliver fetus w lethal abnormality & breech presentation? why?

A

1 priority –> minimize maternal M&M rather than neonatal benefit

spont vag delivery

304
Q

62F –> 4mo 5mm dark brown lesion on dorsal forearm, smooth border, small eccentric nodule, occasionally itch –> numerous freckles on nose, cheeks, dorsal hands –> next step

A

lesion is substantially different than others –> concerning for melanoma –> excisional bx

305
Q

what is ugly duckling sign

A

mult pigmented lesions –> lesion that is substantially different from others –> 90% sensitive for melanoma

306
Q

56M –> R side weak, speech difficult, difficult writing & repeating –> location of lesion?

A

dominant frontal lobe

307
Q

name narrow QRS tachy (2)

A
  • SVT

- Afib

308
Q

SVT –> EKG findings (3)

A
  • no P wave
  • HR >150
  • reg
309
Q

SVT –> tx for stable pt

310
Q

WPW synd –> pathophys

A

bundle of Kent –> accessory conduction pathway –> premature V excitation

311
Q

WPW synd –> EKG findings (3)

A
  • narrow complex tachy
  • short PR
  • delta wave
312
Q

Ventricular filling –> cardiac tamponade vs constrictive pericarditis

A

cardiac tamponade: V filling impeded thruout diastole

constrictive pericarditis:

  • early diastole: normal rapid fill
  • late diastole: halted abruptly
313
Q

constrictive pericarditis –> presentation (3)

A

diastolic HF:

  • fluid overload: edema, ascites, pleural effusion
  • decreased cardiac output: DOE, fatigue, decreased exercise tolerance, cachexia
  • pericardial knock
  • JVD
314
Q

what is initial vasopressor used in cardiogenic shock?

315
Q

cardiogenic shock:

  • cardiac output
  • SVR
  • PCWP
A
  • cardiac output: decreased
  • SVR: elevated
  • PCWP: elevated
316
Q

cardiogenic shock:

  • SBP
  • urine output
  • LV filling pressure
A
  • SBP: <90
  • urine output: <20ml/hr
  • LV filling pressure: adeq
317
Q

intra-aortic balloon pump –> used for what? what effects does it have?

A

hemodynamic support:

  • decreased afterload
  • increased cardiac output
  • decreased myocardial O2 demand
318
Q

intra-aortic balloon pump –> how does it work?

A
  • deflate in systole: reduce afterload

- inflate in diastole: increase coronary perfusion

319
Q

hypovol shock:

  • cardiac output
  • SVR
  • PCWP
A
  • cardiac output: decreased
  • SVR: increased
  • PCWP: decreased
320
Q

ascites –> SAAG <1.1 –> what could be potential causes of ascites (2)?

A
  • TB

- cancer

321
Q

LFTs –> mildly elevated (low 100’s) –> think of what conditions (2)

A
  • acute alcoholic hepatitis

- chronic viral hepatitis

322
Q

LFTs –> mod elevated (high hundreds to thousands) –> think of what condition

A

acute viral hepatitis

323
Q

LFTs –> severe elevated (>10,000) –> think of what conditions (3)

A

extensive hepatic necrosis:

  • ischemia, shock liver
  • acetaminophen toxicity
  • severe viral hepatitis
324
Q

dominant frontal lobe lesion –> presentation (3)

A
  • expressive (Broca’s) aphasia
  • contralat hemiparesis (involvement of 1ary motor cortex)
  • contralat apraxia ( involvement of supplementary motor cortex)
325
Q

Broca’s vs Wernicke aphasia

A

Broca: broken speech

Wernicke: difficult comprehend, follow commands –> speak fluently

326
Q

dominant parietal lobe lesion –> presentation (2)

A
  • contralat sensory loss: pain, vibrate, agraphesthesia, asterognosis
  • contralat inf homonymous quadrantanopsia
327
Q

nondominant parietal lobe lesion –> presentation (2)

A
  • anosognosia (denial of one’s disabilities)

- contralat apraxia (inability to carry out learned purposeful mvmts)

328
Q

where is Wernicke’s area located?

A

dominant temporal lobe

329
Q

36M –> occasional morning HA –> BP 175/103, bilat nontender upper abd masses –> what condition?

A

AD polycystic kidney dz

330
Q

organophosphate poisoning –> pathophys

A

inh AChE –> cholinergic excess:

  • bradycardia
  • miosis
  • rhonchi
  • muscle fasciculation
  • salivation
  • lacrimation
  • urination
  • defecation
331
Q

organophosphate poisoning –> tx

A
  • atropine –> reverse effects

- remv clothes & wash skin –> prevent further transcut absorption

332
Q

normal JVP

333
Q

fibromyalgia –> not respond to initial conservative tx –> 1st line drug?

334
Q

45F –> asx –> elevated alk phos, normal AST/ALT, normal RUQ US, positive anti-mito Ab –> what condition?

A

1ary biliary cholangitis

335
Q

1ary biliary cholangitis –> tx

A

ursodeoxycholic acid (UDCA)

336
Q

2 classifications of dysphagia

A
  • oropharyngeal

- esophageal

337
Q

oropharyngeal vs esophageal dysphagia –> presentation

A

oropharyngeal: difficult initiate swallow –> cough, choke, aspirate, nasal regurg
esophageal: sensation of food get stuck in esophagus few sec after swallow

338
Q

suspect oropharyngeal dysphagia –> initial step to eval? how bout for esophageal dysphagia?

A

oropharyngeal: videofluoroscopic modified barium swallow study
esophageal: esophageal motility study, upper GI endoscopy

339
Q

congenitial hypothyroid –> presentation (3)

A

1 –> asx

  • decreased activity
  • hoarse cry
  • jaundice
340
Q

congenital hypothyroid –> MCC

A

thyroid dysgenesis

341
Q

suspect lyme dz –> serology should be performed when? (2)

A
  • early disseminated lyme dz

- late lyme dz

342
Q

30-50F –> pruritis, jaundice –> what condition?

A

1ary biliary cirrhosis

343
Q

30-50M –> pruritis, jaundice –> what condition?

A

1ary sclerosing cholangitis

344
Q

mild-mod cancer related pain –> tx

A

nonopioid analgesic

345
Q

cancer pain –> not relieved w nonopioid analgesic –> tx

A

short acting opioid

346
Q

T/F: active marijuana use is a CI to breastfeeding

347
Q

T/F: active HepB is a CI to breastfeeding

348
Q

systemic onset juvenile idiopathic arthritis –> presentation (3)

A
  • longstanding daily fever
  • arthritis >1jt
  • charact pink macular rash
349
Q

systemic onset juvenile idiopathic arthritis –> lab findings:

  • WBC
  • plt
  • inflamm markers
  • RBC
A
  • WBC: elevated
  • RBC: anemia
  • plt: elevated
  • inflamm markers: elevated
350
Q

HIV pt –> bright red, firm, friable, exophytic nodule –> what condition?

A

bacillary angiomatosis

351
Q

20-30’s yo –> conductive hearing loss –> what condition?

A

otosclerosis

352
Q

glucagonoma –> presentation (5)

A
  • mild DM
  • necrotic migratory erythema
  • diarhea
  • anemia
  • wt loss
353
Q

von Gierke dz –> enzyme

A

type 1 glycogen storage dz –> glucose 6 phosphatase def

354
Q

von Gierke dz –> lab findings:

  • glucose
  • lactic acid
  • uric acid
  • lipid
A
  • hypogly
  • lactic acidosis
  • hyperuric
  • hyperlipid
355
Q

von Gierke dz –> pt appearance (4)

A
  • doll like face
  • short stature
  • thin extremities
  • protuberant abd
356
Q

tinea capitis –> tx

A
  • griseofulvin

- terbinafine

357
Q

66M –> constipation, back pain, anemia, renal insuff, hyperCa –> what condition?

A

mult myeloma

358
Q

how to differentiate Stevens Johnson vs toxic epidermal necrolysis

A

Stevens Johnson: <10% body surface area

toxic epidermal necrolysis: >30%

359
Q

when is EPO started

360
Q

EPO –> MC AE (3)

A
  • worsening of HTN
  • HA
  • flu-like ssx
361
Q

untreated hyperthyroid –> at risk for what comp? pathophys?

A

rapid bone loss

excess TH –> increase osteoclast activity

362
Q

SERM –> AE (3)

A
  • hot flash
  • DVT
  • endometrial hyperplasia (tamoxifen)
363
Q

hyperNa –> assess vol status –> euvolemic –> next step

A

free water supplementation

364
Q

hyperNa –> assess vol status –> hypovol –> symptomatic –> next step

A

1) restore vol w isotonic fluid (0.9% saline)

2) hypotonic fluid for free water supplementation (5% dextrose preferred over 0.45% saline)

365
Q

leprosy –> presentation (3)

A
  • anesthetic hypopigmented lesion w raised borders
  • peripheral N –> nodular, painful deformation
  • peripheral N –> loss of sensory/motor fx
366
Q

leprosy –> dx

A

bx of active edge of lesion

367
Q

AAA screen –> M or F or both? what age?

368
Q

idiopathic intracranial HTN –> first line tx

A

acetazolamide +/- furosemide

Step 2 (12 decks)

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