7.13.17 Flashcards

(180 cards)

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
hematuria --> dysmorphic vs normal RBC --> glomerular or nonglom etiology?
glom: dysmorphic non: normal
26
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?
chronic kidney dz --> decrease GFR --> decreased Ca, elevated phosphorus --> increase PTH (PTH hyperplasia & 2ary hyperPTH) --> renal osteodystrophy --> bone pain
27
chronic kidney dz --> what lab values indicate 2ary hyperPTH
elevated phosphate + low Ca
28
spont bact peritonitis --> ascitic fluid --> PMN count
>250
29
spont bact peritonitis --> tx
empiric broad spectrum abx --> 3rd gen ceph
30
62M --> 2day confuse, lethargy --> h/o cirrhosis, black stool for past few days --> moderate ascites, stool occult +, pitting edema, asterixis --> what condition?
GI bleed --> blood absorbed in small intestine --> high N loaded state --> hepatic encephalopathy
31
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?
aspiration pneumonia --> septic shock
32
bronchial breath sounds --> normal over trachea --> if heard elsewhere, indicates what?
no ventilation (ie consolidation) --> sound originates from bronchi and transmits to chest wall
33
septic shock --> how lead to acidosis?
septic shock --> hypotension & hypermetab state --> insuff O2 delivery to meet metab demands --> increased anaerobic metab --> lactic acid --> metab acidosis
34
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?
coxsackie B --> myocarditis --> dilated cardiomyopathy --> heart fail
35
when (what presentation) should suspect myocarditis?
young --> recent viral ill: - HF - CP - arrhythmia
36
T/F: pt w murmur needs dental prophylaxis
F
37
normal T4 5-12 --> if increase upper limit to 13 --> what happens to: - sens - spec
sens --> decrease spec --> increase
38
humeral midshaft fracture --> freq comp?
radial N injury
39
radial N injury --> presentation (2)
- weak wrist/finger extend | - loss of sens dorsal hand
40
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?
Thailand --> hookworm infect --> enter lung --> then intestines --> ingest blood: - diarrhea - malabsorption - IDA
41
3rd trim screens (3)
- gestational DM - alloimmunization - maternal anemia
42
at what gestational age are 3rd trim screens done
20-28wk
43
gestational DM --> screening test? positive test?
1hr gtt >140
44
positive screen for gestation DM --> definitive test? positive test?
3hr gtt (any two): - fasting >90 - 1hr >130 - 2hr >155 - 3hr >140
45
maternal anemia screen --> positive test?
Hb <10
46
positive screen for maternal anemia --> cause of anemia?
iron def
47
normal duration of stage 2 labor in nulliparous mother
3hr
48
what kind of mult gestation is at risk for twin twin transfusion?
monoZygotic monoChorionic diAmniotic
49
twin twin transfusion --> who does worse little twin or big twin?
big twin bc got too much blood
50
postpartum hemorrhage --> uterus absent --> what condition
uterine inversion
51
postpartum hemorrhage --> uterus boggy --> what condition
uterine atony
52
postpartum hemorrhage --> uterus firm --> what condition
retained placenta
53
postpartum hemorrhage --> uterus normal --> what condition
vag laceration
54
HIV preg --> tx --> preferred NRTI
tenofavir + emtircitabine
55
HIV preg --> when can vag delivery?
viral load <1000 + HAART
56
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
MM
57
what presentation points to mult myeloma?
anemia + renal insuff + hyperCa
58
how does MM lead to renal insuff
monoclonal light chain --> clog renal tubule
59
fragile X --> presentation (5)
- delayed milestone - autistic beh - intell disability - elongated face - large testes
60
VSD --> how many days after MI?
3-5day
61
CP, SOB, hypotension, tachycardia, hypoxia --> what condition?
PE
62
FEV1/FVC: obstructive pattern? restrictive?
obstructive: <70% restrictive: >70% (FVC <80%)
63
obstructive pattern --> what condition? - low DLCO - normal DLCO - high DLCO
low: emphysema normal: chronic bronchitis, asthma low: asthma
64
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?
Meniere dz
65
Meniere dz --> pathophys
inner ear disorder --> defective resorb endolymph --> increased vol & pressure of endolymph --> damage vestibular & cochlea
66
Meniere dz --> classic triad
- tinnitis - episodic vertigo - sensorineural hearing loss
67
molar preg --> tx
suction curettage
68
molar preg --> f/u?
- monitor B-hCG | - contraceptive (1yr)
69
choriocarcinoma --> initial eval
TVUS
70
choriocarcinoma --> best for dx?
bx curettage
71
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?
septic arthritis
72
septic arthritis --> presentation (2)
- acute monoarthritis: hot swollen, decreased ROM | - fever
73
septic arthritis --> MC org
G+ org --> ie staph aureus
74
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?
UTI --> sepsis --> ICU --> limited mobility --> pressure ulcer (early stage)
75
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?
chest tube --> injure intercostal A: - hemothorax --> impair breathing --> hypoxia - intravasc vol deplete --> decrease LV preload
76
bacterial meningitis --> empiric tx? to cover what?
3rd gen ceph: MCC org (strep pneumo, N meningitdis, GBS, H flu) + vanco: S pneumo that may be resistant to B-lactams + dexamethasone
77
64M --> on chronic glucocorticoids --> bact meningitis --> empiric tx w 3rd gen ceph + vanco --> need what additional abx? why?
ampicillin >50yo or immunocomp --> Listeria
78
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?
AR
79
AR --> type of murmur?
descrendo diastolic
80
36M --> LBP, malaise, loss of sensation & motor in b/l LE --> h/o daily IVDA --> what condition?
epidural abscess
81
epidural abscess --> MC org
staph aureus
82
epidural abscess --> classic triad
- fever - focal back pain - neuro deficit
83
suspect epidural abscess --> next best step
broad spectrum IV abx
84
4M --> sore throat, pain when swallow food, runny nose --> erythema of pharynx w few vesicles, mild enlrg tonsils --> what condition?
viral pharyngitis Coxsackie A --> herpangina
85
tumor lysis synd --> lab findings: - Ca - phosphate - K - uric acid
- hypoCa - hyperPhosphate - hyperK - elevated uric acid
86
tumor lysis synd --> presentation (7)
- N/V - bowel disturb - low urine output - acute renal insuff - sz - tetany - arrhtymia
87
RF for transposition of great vessels
diabetic mother (NOT gestational DM)
88
RF for tetralogy of fallot
Down's
89
find subarachnoid hemorrhage on CT --> next step
angiography --> still bleeding?
90
suspect subarachnoid hemorrhage but CT is negative --> next step?
LP --> xanthochromia
91
early subarachnoid hemorrhage (48hr) --> should worry about and manage what 3 conditions?
- bleed - hydrocephalus - sz
92
SAH --> how manage bleed?
- BP <140/90 | - coil/clip
93
FND, HA, N/V, coma --> h/o HTN --> what condition?
intraparenchymal hemorrhage
94
intraparenchymal hemorrhage --> tx
craniotomy/evacuate --> decrease ICP
95
intraparenchymal hemorrhage --> monitor?
daily CT --> expanding hematoma
96
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?
topical anesthetic --> metHb --> cyanosis
97
metHb --> trigger
oxidizing subst: - dapsone - nitrite - local/topical anesthetic
98
metHb --> pathophys
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
metHb --> lab findings: - pulse ox - PaO2
pulse ox: low --> ~85% PaO2: normal
100
metHb --> tx
methylene blue
101
foodborne illness --> vomit predominant --> 3 MC org
- staph aureus - bacillus cereus - norovirus
102
1wk F --> dehydration, enlarged clitorus, BP 74/42, Na 128, K 5.8 --> what condition?
congenital adrenal hyperplasia --> 21 hydroxylase def
103
21 hydroxylase def --> lab findings: - cortisol - aldos - test - 17-hydroxyprogesterone
- cortisol: low - aldos: low - test: high - 17-hydroxyprog: high
104
refeeding synd --> pathophys
carb intake --> insulin surge --> promote cell uptake of phosphorus, K, Mg
105
refeeding synd --> presentation (4)
- arrhythmia - CHF - sz - Wernicke encephalopathy
106
3M --> sickle cell dz --> pallor, unable to awaken --> BP 55/30, HR 190, RR 45 --> significant splenomeg & tender LUQ --> what condition?
splenic sequestration --> hypovol shock
107
tachycardia & hypotension --> what type of shock (2)
- septic | - hypovol
108
splenic sequestration --> pathophys
RBC pool in spleen: - severe acute anemia - splenic engorge - hypovol shock
109
SCD --> splenic sequestration --> lab findings: - retic count - plt
- retic: elevated | - plt: decrease
110
SCD --> splenic sequestration --> why thrombocytopenia?
plts trapped in spleen too
111
minimal change dz --> kidney bx findings: - light microscopy - IF - electron microscopy
- light: normal - IF: normal - electron: effacement of foot processes
112
herpangina vs herpetic gingivostomatitis: - seasonality - location of vesicles
summer/early fall vs none post oropharynx vs ant oropharynx
113
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?
atopic dermatitis --> risk for superimposed infect --> HSV --> eczema herpeticum
114
suspect acute pancreatitis --> next step
serum amylase & lipase --> >3x normal
115
acute pancreatitis --> dx criteria (3)
- epigastric pain radiate to back - >3x amylase, lipase - imaging: pancreas enlrg
116
preterm labor --> expectant managemt at what gestational age?
>34wk
117
preterm labor --> <32wk gestation --> why Mg sulfate administered?
lower risk of neuro comorbidities NOT used as tocolytic (bc it is a weak tocolytic)
118
dog/cat bite --> abx
amoxi/clav
119
human bite --> abx
amoxi/clav
120
black widow spider bite --> presentation
abd pain like pancreatitis
121
black widow spider bite --> tx
IV Ca
122
ethylene glycol ingest --> lab findings: - anion gap - osmolar gap
- anion gap: yes | - osmolar gap: yes
123
methylene ingest --> lab findings: - anion gap - osmolar gap
- anion gap: yes | - osmolar gap: yes
124
ethylene glycol/methylene --> tx
fomepizole or EtOH
125
ethylene glycol ingest --> comp
renal fail
126
ethylene glycol ingest --> clever way to dx?
wood's lamp --> urine fluoresce
127
salicylate toxicity --> tx
- alkalinize urine | - diurese
128
cyanide toxicity --> tx
thiosulfate
129
reye synd --> liver bx findings
microvesicular fatty infiltration
130
prolactinoma --> tx
dopamine agonist (cabergoline, bromocriptine)
131
1day F w DiGeorge synd & truncus arteriosus in NICU --> poor feed, bloody stool, cyanotic, abd distention --> what condition?
cong heart dz --> reduced mesenteric perfusion --> necrotizing enterocolitis
132
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?
unexplained gross/microscopic hematuria + bladder CA RF (smoke) --> cystoscopy
133
cardiac catherization --> sudden hemodynamic instability & ipsilat back pain --> what condition?
retroperitoneal hematoma
134
HSV vs CMV retinitis: - pain - keratitis/conjunctivitis - fundoscopy
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
30M --> something into eye while drilling --> normal penlight exam --> next step
fluroescein exam
136
prospective study --> many subjects were lost to followup by end of study --> what type of bias?
selection bias --> attrition bias
137
MC type of transfusion rxn? when does it occur?
1-6hr: febrile nonhemolytic transfusion rxn
138
febrile nonhemolytic transfusion rxn --> pathophys
during blood storage --> remaining leukocytes release cytokines: - transient fever - chills - malaise
139
febrile nonhemolytic transfusion rxn --> need to use what type of blood products for future transfusions?
leukoreduced
140
postop fever --> causes & their onset
wind (1) --> water (3) --> walk (5) --> wound (7) --> wonder (10)
141
MC congenital cause of aplastic anemia
fanconi anemia
142
fanconi anemia --> pathophys
AR --> numerous genes involving DNA repair
143
fanconi anemia --> dx
genetic analysis --> chrom breaks
144
fanconi anemia --> presentation (4)
- congenital marrow fail - poor growth - morphologic abnormalities - macrocytic anemia
145
when should suspect septic pelvic thrombophlebitis
postpartum: - persistent fever unresponsive to abx - negative infect eval (blood/urine culture) diagnosis of exclusion
146
septic pelvic thrombophlebitis --> tx
anticoag + abx
147
zinc def --> presentation (5)
- hypogonad - impaired taste - impaired wound heal - alopecia - skin rash w perioral involvement
148
selenium def --> presentation (3)
- thyroid dysfx - cardiomyopathy - immune dysfx
149
copper def --> presentation (5)
- brittle hair - skin depigment - neuro dysfx - sideroblastic anemia - osteoporosis
150
indications for urgent dialysis --> mnemonic
AEIOU: - acidosis - electrolyte abnormal - ingest - overload - uremia
151
colon cancer screen --> stop at what age
75
152
breast cancer screen --> what ages?
50-75
153
cervical cancer screen --> when stop (2)
- 65 + 3 consecutive normals | - TAH
154
lung cancer screen --> who
55-80yo + 30ppd or quit <15yr
155
lung cancer --> how screen? how often?
low dose CT q1yr
156
AAA screen --> what age
>65
157
osteoporosis screen --> what age?
>65
158
HPV vaccine --> what ages?
9-26
159
when suspect progressive supranuclear palsy
parkinson features + limited vertical gaze
160
microcytic anemia + target cells --> what condition?
thalessemia
161
LE innervation: - ant thigh - post thigh/leg - medial thigh - ant/lat leg
- ant thigh: femoral N - post thigh/leg: tibial N - medial thigh: obturator N - ant/lat leg: common peroneal/fibular N
162
sickle cell dz --> aplastic crisis --> pathophys
infect (ie parvovirus B19) --> transient arrest of erthyropoiesis
163
sickle cell dz --> when suspect aplastic crisis
acute drop in Hb + low retic + no splenomeg
164
lactose intol --> dx
lactose hydrogen breath test
165
acute bact rhinosinusitis --> MC org (2)
- strep pneumo | - nontypable H flu
166
acute bact rhinosinusitis --> tx
amoxi/clav
167
2ary amenorrhea --> preg test neg --> next step
check prolactin, TSH, FSH
168
TTP --> tx? MOA?
plasma exchange --> remv pt plasma --> replace w donor plasma --> replenish ADAMTS13, remv autoAb
169
cryoprecipitate --> used to replace what? often used in what condition?
clotting factors, fibrinogen, vWF DIC
170
small cell lung CA --> paraneoplastic (2)
- ACTH --> cushing | - ADH --> SIADH
171
squamous cell CA of lung --> paraneoplastic
PTHrp --> high Ca
172
carcinoid tumor of lung --> dx
urine 5-HIAA
173
carcinoid tumor of lung --> paraneoplastic
serotonin synd
174
tumor lysis synd --> tx? MOA?
rasburicase --> break down uric acid to water-sol allantoin
175
thyroid nodule --> 1st step in eval
thyroid fx test
176
thyroid nodule --> normal thyroid fx --> next step
r/o malig --> FNA
177
stroke --> #1 RF
HTN
178
HIV pt --> molluscum contagiosum on face --> tx
curettage
179
impulsive & aggressive --> which neurotransmitter is low in CSF?
serotonin
180
mild mental retardation --> IQ range
50-70