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7.13.17 Flashcards

1
Q

FEV1 65% of predicted
FVC 58% of predicted
FEV1/FVC 85%
what condition?

A

interstitial lung dz

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2
Q

normal FEV1/FVC

A

80%

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3
Q

what is arrest of active phase of labor?

A

no cervical change –> contractions:

  • adeq –> >4hr
  • inadeq –> >6hr
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4
Q

at what cervical dilation does active phase of labor start?

A

6cm

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5
Q

protracted active phase of labor –> MCC

A

inadeq contractions

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6
Q

protracted active phase of labor –> tx

A

oxytocin

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7
Q

what are adeq uterine contractions?

A

forceful and occur q2-3min

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8
Q

pleural effusion –> Lights criteria –> exudate

A

protein (pleural:serum): >0.5

LDH: >0.6

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9
Q

pleural effusion –> exudate –> common cause (3)

A
  • infect
  • malig
  • PE
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10
Q

pleural effusion –> exudate –> what 3 charact of exudate point to TB vs other etiology?

A
  • high protein (always >4)
  • lymphocytic leukocytosis
  • low glucose (<60)
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11
Q

43F –> 2 day confuse, lethargy –> h/o hepC, alcohol, IVDA –> T100.8, BP 120/70, HR 110, RR 20 –> scleral icterus, scattered spider angioma, abd distended w shifting dullness, diffuse tender –> what condition?

A

cirrhosis –> spont bact peritonitis

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12
Q

tense bullae –> what condition?

A

bullous pemphigoid

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13
Q

bullous pemphigoid –> bx finding

A

subepidermal cleavage –> IgG deposit at BM

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14
Q

preg –> high risk pts should take how much folic acid? avg risk pts?

A

4mg vs 0.4

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15
Q

preg –> who is at high risk for neural tube defects (4)

A
  • methotrexate
  • antiepileptic
  • DM
  • prior preg w NTD
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16
Q

34F –> MVA –> CP, SOB –> BP 90/50, HR 118, O2 88% –> neck veins distended, trachea deviated R, L breath sounds absent –> what condition?

A

tension pneumo –> superior vena cava compression –> impede venous return

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17
Q

tension pneumo –> tx? MOA?

A

needle decompress –> allow lung re-expand –> increase venous return

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18
Q

DM during preg –> increased risk for what conditions in neonate (3)

A
  • fetal lung immaturity
  • preterm
  • macrosomia
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19
Q

DM during preg –> why increased risk of RDS?

A

maternal hypergly –> fetal hyperinsulin –> delay cell maturation –> immature pneumocytes –> can’t produce surfactant

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20
Q

how can differentiate 1ary hyperPTH vs hyperCa of malig?

A

hyperCa of malig: rapid rise in Ca –> severe neuro ssx

1ary hyperPTH: modest hyperCa –> usu asx or mild, nonspecific ssx

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21
Q

1ary hyperPTH –> Ca usu at what level?

A

<12 (modest)

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22
Q

45F –> severe RUQ abd pain radiate to R shoulder, N/V –> h/o roux en Y gastric bypass –> what condition?

A

gastric bypass –> rapid wt loss –> promote gallstone formation –> symptomatic gallstones

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23
Q

UA –> blood & protein vs blood & no protein –> glomerular hematuria or nonglomerular etiology?

A

glomerular: blood & protein
nonglomerular: blood, no protein

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24
Q

hematuria –> gross vs microscopic blood –> glomerular or nonglom etiology?

A

glomerular: microscopic
nonglomerular: gross

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25
Q

hematuria –> dysmorphic vs normal RBC –> glomerular or nonglom etiology?

A

glom: dysmorphic
non: normal

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26
Q

35F –> several week severe ache in low back, hip, knees –> h/o end stage renal dz, DM1, sarcoid –> Cr 3.1, Ca 7.9, phosphorus 6.1 –> what condition?

A

chronic kidney dz –> decrease GFR –> decreased Ca, elevated phosphorus –> increase PTH (PTH hyperplasia & 2ary hyperPTH) –> renal osteodystrophy –> bone pain

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27
Q

chronic kidney dz –> what lab values indicate 2ary hyperPTH

A

elevated phosphate + low Ca

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28
Q

spont bact peritonitis –> ascitic fluid –> PMN count

A

> 250

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29
Q

spont bact peritonitis –> tx

A

empiric broad spectrum abx –> 3rd gen ceph

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30
Q

62M –> 2day confuse, lethargy –> h/o cirrhosis, black stool for past few days –> moderate ascites, stool occult +, pitting edema, asterixis –> what condition?

A

GI bleed –> blood absorbed in small intestine –> high N loaded state –> hepatic encephalopathy

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31
Q

70F –> lethargy, decreased oral intake, SOB –> last night vomit –> h/o Parkinson w cog impair –> T 102, BP 70/60, HR 120, bronchial breath sounds in R lung base –> what condition?

A

aspiration pneumonia –> septic shock

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32
Q

bronchial breath sounds –> normal over trachea –> if heard elsewhere, indicates what?

A

no ventilation (ie consolidation) –> sound originates from bronchi and transmits to chest wall

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33
Q

septic shock –> how lead to acidosis?

A

septic shock –> hypotension & hypermetab state –> insuff O2 delivery to meet metab demands –> increased anaerobic metab –> lactic acid –> metab acidosis

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34
Q

38M –> 1wk fatigue, DOE, choking sensation when fall asleep supine –> h/o URI 2wk ago –> bibasilar crackles, pitting edema, PMI 6th intercostal space ant axillary line –> what condition?

A

coxsackie B –> myocarditis –> dilated cardiomyopathy –> heart fail

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35
Q

when (what presentation) should suspect myocarditis?

A

young –> recent viral ill:

  • HF
  • CP
  • arrhythmia
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36
Q

T/F: pt w murmur needs dental prophylaxis

A

F

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37
Q

normal T4 5-12 –> if increase upper limit to 13 –> what happens to:

  • sens
  • spec
A

sens –> decrease

spec –> increase

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38
Q

humeral midshaft fracture –> freq comp?

A

radial N injury

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39
Q

radial N injury –> presentation (2)

A
  • weak wrist/finger extend

- loss of sens dorsal hand

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40
Q

16M –> several month nausea, watery diarrhea, bloat, wt loss –> h/o dry cough, SOB, wheeze that resolved; emigrate from Thailand –> Hb 10.4, MCV 72 –> what condition?

A

Thailand –> hookworm infect –> enter lung –> then intestines –> ingest blood:

  • diarrhea
  • malabsorption
  • IDA
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41
Q

3rd trim screens (3)

A
  • gestational DM
  • alloimmunization
  • maternal anemia
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42
Q

at what gestational age are 3rd trim screens done

A

20-28wk

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43
Q

gestational DM –> screening test? positive test?

A

1hr gtt >140

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44
Q

positive screen for gestation DM –> definitive test? positive test?

A

3hr gtt (any two):

  • fasting >90
  • 1hr >130
  • 2hr >155
  • 3hr >140
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45
Q

maternal anemia screen –> positive test?

A

Hb <10

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46
Q

positive screen for maternal anemia –> cause of anemia?

A

iron def

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47
Q

normal duration of stage 2 labor in nulliparous mother

A

3hr

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48
Q

what kind of mult gestation is at risk for twin twin transfusion?

A

monoZygotic
monoChorionic
diAmniotic

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49
Q

twin twin transfusion –> who does worse little twin or big twin?

A

big twin bc got too much blood

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50
Q

postpartum hemorrhage –> uterus absent –> what condition

A

uterine inversion

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51
Q

postpartum hemorrhage –> uterus boggy –> what condition

A

uterine atony

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52
Q

postpartum hemorrhage –> uterus firm –> what condition

A

retained placenta

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53
Q

postpartum hemorrhage –> uterus normal –> what condition

A

vag laceration

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54
Q

HIV preg –> tx –> preferred NRTI

A

tenofavir + emtircitabine

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55
Q

HIV preg –> when can vag delivery?

A

viral load <1000 + HAART

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56
Q

63M –> 6mo progressive fatigue, wt loss –> h/o 7mo ago pneumonia –> Hb 9.2, MCV 86, plt 150,000, WBC 9200, Ca 11.8, BUN 30, Cr 2.2 –> UA no proteinuria or hematuria –> what condition

A

MM

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57
Q

what presentation points to mult myeloma?

A

anemia + renal insuff + hyperCa

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58
Q

how does MM lead to renal insuff

A

monoclonal light chain –> clog renal tubule

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59
Q

fragile X –> presentation (5)

A
  • delayed milestone
  • autistic beh
  • intell disability
  • elongated face
  • large testes
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60
Q

VSD –> how many days after MI?

A

3-5day

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61
Q

CP, SOB, hypotension, tachycardia, hypoxia –> what condition?

A

PE

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62
Q

FEV1/FVC: obstructive pattern? restrictive?

A

obstructive: <70%
restrictive: >70% (FVC <80%)

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63
Q

obstructive pattern –> what condition?

  • low DLCO
  • normal DLCO
  • high DLCO
A

low: emphysema
normal: chronic bronchitis, asthma
low: asthma

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64
Q

33F –> sensation of severe spinning & intense nausea for 1-2hr, has lie to down w eyes closed for relief, hear mechanical humming –> tuning fork on forehead, sound more prominent in L ear –> what condition?

A

Meniere dz

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65
Q

Meniere dz –> pathophys

A

inner ear disorder –> defective resorb endolymph –> increased vol & pressure of endolymph –> damage vestibular & cochlea

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66
Q

Meniere dz –> classic triad

A
  • tinnitis
  • episodic vertigo
  • sensorineural hearing loss
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67
Q

molar preg –> tx

A

suction curettage

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68
Q

molar preg –> f/u?

A
  • monitor B-hCG

- contraceptive (1yr)

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69
Q

choriocarcinoma –> initial eval

A

TVUS

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70
Q

choriocarcinoma –> best for dx?

A

bx curettage

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71
Q

63F –> 1day swelling of R 2nd MCP w guarding, tender –> h/o RA, joint deformities of b/l wrists, MCP, PIP –> R 100.8, BP 140/90, HR 90 –> what condition?

A

septic arthritis

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72
Q

septic arthritis –> presentation (2)

A
  • acute monoarthritis: hot swollen, decreased ROM

- fever

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73
Q

septic arthritis –> MC org

A

G+ org –> ie staph aureus

74
Q

86F nursing home resident –> progressive lethargy, fever –> BP 75/40, HR 120, O2 85%, WBC 22000, urine >100WBC –> pt was treated appropriately –> 3day later nonblanching erythema on both heels –> what condition?

A

UTI –> sepsis –> ICU –> limited mobility –> pressure ulcer (early stage)

75
Q

61M –> L pleural effusion –> 2L of yellowish fluid drained by thoracentesis –> 2hr later SBP 70, HR 130, O2 91%, dull to percussion, absent breath sounds –> what condition?

A

chest tube –> injure intercostal A:

  • hemothorax –> impair breathing –> hypoxia
  • intravasc vol deplete –> decrease LV preload
76
Q

bacterial meningitis –> empiric tx? to cover what?

A

3rd gen ceph: MCC org (strep pneumo, N meningitdis, GBS, H flu)
+
vanco: S pneumo that may be resistant to B-lactams
+
dexamethasone

77
Q

64M –> on chronic glucocorticoids –> bact meningitis –> empiric tx w 3rd gen ceph + vanco –> need what additional abx? why?

A

ampicillin

> 50yo or immunocomp –> Listeria

78
Q

murmur after S2 and declines in intensity until disappear suddenly before S1 –> heard along L & R sternal borders –> accentuated when sit up, lean forward, put hands behind head –> what condition?

79
Q

AR –> type of murmur?

A

descrendo diastolic

80
Q

36M –> LBP, malaise, loss of sensation & motor in b/l LE –> h/o daily IVDA –> what condition?

A

epidural abscess

81
Q

epidural abscess –> MC org

A

staph aureus

82
Q

epidural abscess –> classic triad

A
  • fever
  • focal back pain
  • neuro deficit
83
Q

suspect epidural abscess –> next best step

A

broad spectrum IV abx

84
Q

4M –> sore throat, pain when swallow food, runny nose –> erythema of pharynx w few vesicles, mild enlrg tonsils –> what condition?

A

viral pharyngitis

Coxsackie A –> herpangina

85
Q

tumor lysis synd –> lab findings:

  • Ca
  • phosphate
  • K
  • uric acid
A
  • hypoCa
  • hyperPhosphate
  • hyperK
  • elevated uric acid
86
Q

tumor lysis synd –> presentation (7)

A
  • N/V
  • bowel disturb
  • low urine output
  • acute renal insuff
  • sz
  • tetany
  • arrhtymia
87
Q

RF for transposition of great vessels

A

diabetic mother (NOT gestational DM)

88
Q

RF for tetralogy of fallot

89
Q

find subarachnoid hemorrhage on CT –> next step

A

angiography –> still bleeding?

90
Q

suspect subarachnoid hemorrhage but CT is negative –> next step?

A

LP –> xanthochromia

91
Q

early subarachnoid hemorrhage (48hr) –> should worry about and manage what 3 conditions?

A
  • bleed
  • hydrocephalus
  • sz
92
Q

SAH –> how manage bleed?

A
  • BP <140/90

- coil/clip

93
Q

FND, HA, N/V, coma –> h/o HTN –> what condition?

A

intraparenchymal hemorrhage

94
Q

intraparenchymal hemorrhage –> tx

A

craniotomy/evacuate –> decrease ICP

95
Q

intraparenchymal hemorrhage –> monitor?

A

daily CT –> expanding hematoma

96
Q

15mo M –> “turned blue” –> h/o teething trted with “numbing cream” –> BP 90/60, HR 158, RR 30, O2 86% –> supplemental O2 fail to increase pulse ox –> what condition?

A

topical anesthetic –> metHb –> cyanosis

97
Q

metHb –> trigger

A

oxidizing subst:

  • dapsone
  • nitrite
  • local/topical anesthetic
98
Q

metHb –> pathophys

A

Hb –> 1 of 4 iron molecule –> oxidized to ferric (Fe3+) instead of ferrous (Fe2+):

  • ferric site: less O2 affinity
  • ferrous sites: increased O2 affinity

==> decreased O2 delivery to peripheral tissues

99
Q

metHb –> lab findings:

  • pulse ox
  • PaO2
A

pulse ox: low –> ~85%

PaO2: normal

100
Q

metHb –> tx

A

methylene blue

101
Q

foodborne illness –> vomit predominant –> 3 MC org

A
  • staph aureus
  • bacillus cereus
  • norovirus
102
Q

1wk F –> dehydration, enlarged clitorus, BP 74/42, Na 128, K 5.8 –> what condition?

A

congenital adrenal hyperplasia –> 21 hydroxylase def

103
Q

21 hydroxylase def –> lab findings:

  • cortisol
  • aldos
  • test
  • 17-hydroxyprogesterone
A
  • cortisol: low
  • aldos: low
  • test: high
  • 17-hydroxyprog: high
104
Q

refeeding synd –> pathophys

A

carb intake –> insulin surge –> promote cell uptake of phosphorus, K, Mg

105
Q

refeeding synd –> presentation (4)

A
  • arrhythmia
  • CHF
  • sz
  • Wernicke encephalopathy
106
Q

3M –> sickle cell dz –> pallor, unable to awaken –> BP 55/30, HR 190, RR 45 –> significant splenomeg & tender LUQ –> what condition?

A

splenic sequestration –> hypovol shock

107
Q

tachycardia & hypotension –> what type of shock (2)

A
  • septic

- hypovol

108
Q

splenic sequestration –> pathophys

A

RBC pool in spleen:

  • severe acute anemia
  • splenic engorge
  • hypovol shock
109
Q

SCD –> splenic sequestration –> lab findings:

  • retic count
  • plt
A
  • retic: elevated

- plt: decrease

110
Q

SCD –> splenic sequestration –> why thrombocytopenia?

A

plts trapped in spleen too

111
Q

minimal change dz –> kidney bx findings:

  • light microscopy
  • IF
  • electron microscopy
A
  • light: normal
  • IF: normal
  • electron: effacement of foot processes
112
Q

herpangina vs herpetic gingivostomatitis:

  • seasonality
  • location of vesicles
A

summer/early fall vs none

post oropharynx vs ant oropharynx

113
Q

18mo M –> fever, facial rash –> painful clear vesicles on erythematous skin, dark-red crusting, cervical LAD –> h/o atopic dermatitis to cheeks trted w steroid cream –> what condition?

A

atopic dermatitis –> risk for superimposed infect –> HSV –> eczema herpeticum

114
Q

suspect acute pancreatitis –> next step

A

serum amylase & lipase –> >3x normal

115
Q

acute pancreatitis –> dx criteria (3)

A
  • epigastric pain radiate to back
  • > 3x amylase, lipase
  • imaging: pancreas enlrg
116
Q

preterm labor –> expectant managemt at what gestational age?

117
Q

preterm labor –> <32wk gestation –> why Mg sulfate administered?

A

lower risk of neuro comorbidities

NOT used as tocolytic (bc it is a weak tocolytic)

118
Q

dog/cat bite –> abx

A

amoxi/clav

119
Q

human bite –> abx

A

amoxi/clav

120
Q

black widow spider bite –> presentation

A

abd pain like pancreatitis

121
Q

black widow spider bite –> tx

122
Q

ethylene glycol ingest –> lab findings:

  • anion gap
  • osmolar gap
A
  • anion gap: yes

- osmolar gap: yes

123
Q

methylene ingest –> lab findings:

  • anion gap
  • osmolar gap
A
  • anion gap: yes

- osmolar gap: yes

124
Q

ethylene glycol/methylene –> tx

A

fomepizole or EtOH

125
Q

ethylene glycol ingest –> comp

A

renal fail

126
Q

ethylene glycol ingest –> clever way to dx?

A

wood’s lamp –> urine fluoresce

127
Q

salicylate toxicity –> tx

A
  • alkalinize urine

- diurese

128
Q

cyanide toxicity –> tx

A

thiosulfate

129
Q

reye synd –> liver bx findings

A

microvesicular fatty infiltration

130
Q

prolactinoma –> tx

A

dopamine agonist (cabergoline, bromocriptine)

131
Q

1day F w DiGeorge synd & truncus arteriosus in NICU –> poor feed, bloody stool, cyanotic, abd distention –> what condition?

A

cong heart dz –> reduced mesenteric perfusion –> necrotizing enterocolitis

132
Q

74M –> urinary freq, nocturia, mild strain during urination, 2 episodes of bloody urine –> h/o smoke –> enlrged smooth prostate, UA 0-1WBC, 2-3RBC, trace protein –> next step?

A

unexplained gross/microscopic hematuria + bladder CA RF (smoke) –> cystoscopy

133
Q

cardiac catherization –> sudden hemodynamic instability & ipsilat back pain –> what condition?

A

retroperitoneal hematoma

134
Q

HSV vs CMV retinitis:

  • pain
  • keratitis/conjunctivitis
  • fundoscopy
A

pain vs painless

keratitis vs no keratitis

Fundoscoppy:

  • HSV: widespread pale peripheral lesions, central necrosis of retina
  • CMV: fluffy or granular lesions around retinal vessels
135
Q

30M –> something into eye while drilling –> normal penlight exam –> next step

A

fluroescein exam

136
Q

prospective study –> many subjects were lost to followup by end of study –> what type of bias?

A

selection bias –> attrition bias

137
Q

MC type of transfusion rxn? when does it occur?

A

1-6hr: febrile nonhemolytic transfusion rxn

138
Q

febrile nonhemolytic transfusion rxn –> pathophys

A

during blood storage –> remaining leukocytes release cytokines:

  • transient fever
  • chills
  • malaise
139
Q

febrile nonhemolytic transfusion rxn –> need to use what type of blood products for future transfusions?

A

leukoreduced

140
Q

postop fever –> causes & their onset

A

wind (1) –> water (3) –> walk (5) –> wound (7) –> wonder (10)

141
Q

MC congenital cause of aplastic anemia

A

fanconi anemia

142
Q

fanconi anemia –> pathophys

A

AR –> numerous genes involving DNA repair

143
Q

fanconi anemia –> dx

A

genetic analysis –> chrom breaks

144
Q

fanconi anemia –> presentation (4)

A
  • congenital marrow fail
  • poor growth
  • morphologic abnormalities
  • macrocytic anemia
145
Q

when should suspect septic pelvic thrombophlebitis

A

postpartum:
- persistent fever unresponsive to abx
- negative infect eval (blood/urine culture)

diagnosis of exclusion

146
Q

septic pelvic thrombophlebitis –> tx

A

anticoag + abx

147
Q

zinc def –> presentation (5)

A
  • hypogonad
  • impaired taste
  • impaired wound heal
  • alopecia
  • skin rash w perioral involvement
148
Q

selenium def –> presentation (3)

A
  • thyroid dysfx
  • cardiomyopathy
  • immune dysfx
149
Q

copper def –> presentation (5)

A
  • brittle hair
  • skin depigment
  • neuro dysfx
  • sideroblastic anemia
  • osteoporosis
150
Q

indications for urgent dialysis –> mnemonic

A

AEIOU:

  • acidosis
  • electrolyte abnormal
  • ingest
  • overload
  • uremia
151
Q

colon cancer screen –> stop at what age

152
Q

breast cancer screen –> what ages?

153
Q

cervical cancer screen –> when stop (2)

A
  • 65 + 3 consecutive normals

- TAH

154
Q

lung cancer screen –> who

A

55-80yo + 30ppd or quit <15yr

155
Q

lung cancer –> how screen? how often?

A

low dose CT q1yr

156
Q

AAA screen –> what age

157
Q

osteoporosis screen –> what age?

158
Q

HPV vaccine –> what ages?

159
Q

when suspect progressive supranuclear palsy

A

parkinson features + limited vertical gaze

160
Q

microcytic anemia + target cells –> what condition?

A

thalessemia

161
Q

LE innervation:

  • ant thigh
  • post thigh/leg
  • medial thigh
  • ant/lat leg
A
  • ant thigh: femoral N
  • post thigh/leg: tibial N
  • medial thigh: obturator N
  • ant/lat leg: common peroneal/fibular N
162
Q

sickle cell dz –> aplastic crisis –> pathophys

A

infect (ie parvovirus B19) –> transient arrest of erthyropoiesis

163
Q

sickle cell dz –> when suspect aplastic crisis

A

acute drop in Hb + low retic + no splenomeg

164
Q

lactose intol –> dx

A

lactose hydrogen breath test

165
Q

acute bact rhinosinusitis –> MC org (2)

A
  • strep pneumo

- nontypable H flu

166
Q

acute bact rhinosinusitis –> tx

A

amoxi/clav

167
Q

2ary amenorrhea –> preg test neg –> next step

A

check prolactin, TSH, FSH

168
Q

TTP –> tx? MOA?

A

plasma exchange –> remv pt plasma –> replace w donor plasma –> replenish ADAMTS13, remv autoAb

169
Q

cryoprecipitate –> used to replace what? often used in what condition?

A

clotting factors, fibrinogen, vWF

DIC

170
Q

small cell lung CA –> paraneoplastic (2)

A
  • ACTH –> cushing

- ADH –> SIADH

171
Q

squamous cell CA of lung –> paraneoplastic

A

PTHrp –> high Ca

172
Q

carcinoid tumor of lung –> dx

A

urine 5-HIAA

173
Q

carcinoid tumor of lung –> paraneoplastic

A

serotonin synd

174
Q

tumor lysis synd –> tx? MOA?

A

rasburicase –> break down uric acid to water-sol allantoin

175
Q

thyroid nodule –> 1st step in eval

A

thyroid fx test

176
Q

thyroid nodule –> normal thyroid fx –> next step

A

r/o malig –> FNA

177
Q

stroke –> #1 RF

178
Q

HIV pt –> molluscum contagiosum on face –> tx

179
Q

impulsive & aggressive –> which neurotransmitter is low in CSF?

180
Q

mild mental retardation –> IQ range

Step 2 (12 decks)

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