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All COMLEX STEP 2 Q's Flashcards

1
Q

What are Head CT findings in a 45 year old caucasian male w frequent sudden jerky movements of upper extremities. Irritability, does not visit family/friends, decline in professional performance. Father died in nursing home w similar symptoms.

What is tx for motor sx?

A

Huntington’s chorea - Atrophy of caudate nucleus

Tx for motor sx: Tetrabenazine
–“orphan drug” - only indication is huntington’s

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2
Q

What is dx?
Skin rash, joint pain, malaise, fatigue, hx of IV drugs, palpable purpura, hepatosplenomegaly
Urinalysis: hematuria, rbc casts, proteinuria
Serum: low complement, positive Anti-HCV

A

Mixed essential cryoglobinemia - palpable purpura, proteinuria, hematuria

  • cryoglobinemia - protein ppt in refrigerated serum+plasma
  • –palpable purpura, arthralgia, myalgia (small-medium vasculitis)

a/w hep C

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3
Q

what is the LDL goal in a patient with CAD? What is the normal

A

LDL < 100 mg/dL in CAD

100 - 129 in healthy pts

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4
Q

what are pathological q waves (what does it mean? how can you tell it’s pathological?)

A

Prior MI
Width > 1mm (1 small box)
depth >25% of QRS complex

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5
Q

What ECG findings are in a positive exercise stress test?

what other findings indicate a positive stress test?

A

ST segment depression = subendocardial ischemia

Decreased Thallium 201 (Dipyridamole) uptake, CP, Hypotension, Arrhythmias

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6
Q

What is the standard of care for Stable Angina?

A

Aspirin + B-blocker, nitrates for CP

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7
Q

How are Unstable angina and NSTEMI differentiated? How are they similar?

A

no elevated troponin or CK-MD in Unstable angina

both do not have elevated ST segments or pathological Q waves

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8
Q

What is the medical management of Unstable Angina?

A

Aspirin, Clopidogrel, B-blockers, LMWH (Enoxaparin), Nitrates, O2

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9
Q

What electrolyte abnormalities are often seen in unstable angina?

A

Hypokalemia

Hypomagnesemia

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10
Q

In what case can Troponin I be falsely elevated?

A

Renal failure

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11
Q

When do Troponin levels peak and return to normal levels?

A

increase within 3 to 5 hours
peak in 24 to 48 hours
returns to normal in 5 to 14 days

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12
Q

When do CK-MB levels peak and return to normal. How often should they be measured?

A

peaks in 24 hours
returns to normal in 48 to 72 hours

measured upon admission and taken every 8 hours for the next 24 hours

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13
Q

Which are the only agents shown to reduce mortality in MI?

A

Aspirin
B-blockers
ACE-i

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14
Q

What is Dx?
Pt w pmh of MI few months ago presents w fever, malaise, pericarditis, leukocytosis, pleuritis

what is Tx?

A

Dressler’s syndrome (immuno dz)

Tx: Aspirin, second line: Ibuprofen

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15
Q

What is most likely Dx:

Ovarian US - mass with thick septations, solid components, peritoneal free fluid

A

Ovarian malignancy

elevated CA-125

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16
Q

How is Hemothorax differentiated from Pulmonary contusion in a trauma patient?

A

Hemothorax - CXR shows PLEURAL EFFUSION

Pulmonary contusion - CXR shows ALVEOLAR OPACITIES

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17
Q

What is the probable cause of easy bruising/epistaxis in a cystic fibrosis patient? What will be found at decreased levels

A

Vitamin K:
Factors II, VII, IX, X, C, S

Increased PT, INR
Normal PTT (unless severe deficiency)
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18
Q

What is the initial Tx of most symptomatic Systolic CHF patients?

A

ACEi + Diuretic (Furosemide or HCTZ)

ACEi - reduce mortality

Hyponatremia in CHF patients parallels severity of HF

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19
Q

What is the most common cause of death in CHF?

A

sudden death from Ventricular arrhythmias

–Ischemia provokes ventricular arrhythmias

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20
Q

Which medications are contraindicated in patients with CHF? (4)

A
  1. Metformin - can cause lethal lactic acidosis
  2. TZD’s (pioglitazone)- fluid retention
  3. NSAIDs - risk of CHF exacerbation
  4. Negative inotropic antiarrhythmics (Diltiazem, Verapamil, etc)
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21
Q

How is diastolic CHF managed? what should not be used?

A

B-blockers
Diuretics (lasix)
ACEi

should NOT: Digoxin, Spironolactone,

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22
Q

What is the most common cardiac manifestation of Marfan’s syndrome?
second?

A
  1. Mitral Valve prolapse

2. Aortic Root dilatation

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23
Q

What is the CHA2DS2-VASc Score?

A 
Congestive Heart Failure
Hypertension
Her (female)
Age >75 - 2 points
Diabetes Mellitus
Stroke Hx
Vascular dz hx
Age 65-74 - 1 point
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24
Q

What should the height and weight be of a 12 month old child relative to their birth weight and height?

A

weight should triple

height should increase by 50%

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25
What are pediatric symptoms of DiGeorge Syndrome?
22q11.2 deletion 1. Conotruncal heart defect (ToF, Truncus arteriosus, VSD, interrupted aortic arch) 2. Hypocalcemia (muscle twitches) 3. Cleft palate 4. immunodeficiency 5. renal abnormalities 6. hypoplasia of thymus
26
Dx of 3 week old? 1. large fontanelles 2. poor feeding, decreased activity 3. decreased stooling 4. macroglossia
Congenital hypothyroidism poor growth, dev delay, dry skin, hypotonia
27
What is dx in 3 month old male? | thrombocytopenia (hematochezia, melena, epistaxis), eczema, immunodeficiency
Wiskott- Aldrich (X-linked defect of WAsp gene) --involved w cytoskeleton remodeling tx: supportive, IVIG, steroids, platelet transfusions * *Hematopoietic stem cell transplantation
28
What are complications of a twin-to-twin transfusion syndrome in monochorionic twins?
donor twin - hypovolemia, anemia, oligohydramnios (fetus appears stuck to uterine wall), small of gestational age recipient twin - hypervolemia, plethora, polyhydramnios, CHF, JAUNDICE (excess rbc's)
29
``` What is dx: sensorimotor neuropathy w stocking-glove distribution painful hypersensitivity, hyporeflexia hypo and hyper pigmentation of skin hyperkeratosis of palms and sole ``` Labs: anemia, elevated AST, ALT what is the management?
Arsenic Poisoning Tx: Dimercaprol, DMSA
30
What are the following reflexes: 1. C5 2. C6 3. C7 4. L4 5. S1
1. Biceps 2. Brachioradialis 3. Triceps 4. Patellar 5. Achilles
31
What are some ways you can differentiate Squamous Cell Ca with Basal Cell Ca
SCC: ulcerated, occurs more commonly in IMMUNOSUPPRESSED pts, NEURO invasion (Sx)
32
What is the next best step in management for: 1. large burn that is black, dry, numb 2. superficial, partial thickness burn
1. immediate excision, skin grafting | 2. silver sulfadizine, triple abx
33
Cirrhosis pt w ascites, 102 fever, Paracentesis shows pmn leukocyte count 350/mm^3 What is most appropriate management?
3rd gen cephalosporin (Cefotaxime) Spontaneous bacterial peritonitis (SBP) - PMN count >250/mm^3
34
Pt w 2 week cough followed by vomiting or sweating. 99.3, normal cxr, leukocytosis 1. what is dx, management? 2. what is second line?
1. Bordetella pertussis (whoop) - Azithromycin/macrolides | 2. TMP-SMX - if pt allergic to macolides
35
What is the management of scabies?
Permethrin 5% cream applied to the neck down or Oral Ivermectin
36
What is organism/tx? profuse watery diarrhea, fevers, abd tenderness stool culture: H2S negative, nonmobile, non-lactose-fermenting bacteria
Shigella - negative: motility, H2S, lactose fermentation Tx: Ciprofloxacin, Azithromycin, Ceftriaxone
37
What empiric abx should be given to a CF child with a concurrent influenza infection and recurrent skin infections?
Vancomycin | --S. aureus is most common pathogenic organism in young children w CF
38
What time period should pt respond to antidepressants before switching meds? what additional med can be added as augmentation?
8 weeks - lithium can be added | also - aripiprazole, olanzepine, quetiapine, etc
39
What tests should be run before prescribing lithium to a 29 year old female?
BUN Cr Thyroid fxn studies pregnancy test
40
What is the first line treatment for OCD?
Cognitive Behavioral Therapy = Most effective | Paroxetine (SSRI) = first line medication
41
A schizophrenic on high doses of lithium and risperidone develops tardive dyskinesia. what is the next best step?
Switch to clozapine if pt is symptomatic with dosage reduction.
42
Which muscles should muscle energy be directed for the following ribs? 1. first rib 2. second rib 3. 3-5 4. 6-9 5. 10-11
1. Anterior Scalene 2. Posterior Scalene 3. Pec Minor 4. Serratus Anterior 5. Lat Dorsi
43
How is a Serum Ascites Albumin gradient interpreted?
Paracentesis SAAG > 1.1 = portal hypertension is extremely likely to be cause of ascites (ie CHF)
44
What is most likely dx/affected structure: | Weightloss, cheilitis, hyperglycemia, elevated serum glucagon, decreased amino acids
Glucagonoma - pancreatic alpha cells amino acids are reduced from gluconeogenesis from amino acids US/CT scan Sx relief - octreotide
45
What is the genetic disorder involved with Familial adenomatous polyposis? when should screening begin in pts w a fam hx of FAP?
Autosomal dominant mutation in the tumor suppressor gene, APC, located on chromosome 5 Flexible sigmoidoscopy or Colonoscopy starting at PUBERTY
46
What is likely dx? 60 yr old w hoarseness, firm solitary nodule in thyroid gland, cervical lymphadenopathy labs show elevated calcitonin
Medullary thyroid carcinoma - originates from parafollicular cells (C cells)
47
What endocrine disorder shows low calcium elevated phosphate elevated PTH? what is associated dx? how to differentiate?
Pseudohypoparathyroidism - target organ resistance to PTH a/w 1. Renal failure 2. Albrights hereditary osteodystrophy (bone deformation)
48
what is the next best step in treatment for an afib pt who overdosed on their meds. INR level is 10.1
Vitamin K replacement (II, VII, IX, X, C, S) use Fresh Frozen Plasma if there is active bleeding
49
When is MATERNAL AFP measured? what is it used to determine? | What is the workup for elevated AFP?
15-20 weeks - detect open neural tube defects, multiple gestations, abdominal wall defects --US then amniocentesis for AFP, Acetylcholinesterase activity
50
What is the treatment choice for endometriosis?
NSAIDs + OCP
51
what is most likely dx: 17 year old w US findings of 8cm ovarian cyst w calcifications and hyperechoic nodules what are pt's at higher risk for?
Cystic Teratoma = Dermoid Ovarian Cyst Ovarian Torsion
52
What is dx? Fever, flank/abdominal pain, weight loss, generalized muscle ache, foot drop. lacy, red rash on extremities. arthralgia elevated ESR, leukocytosis, Hep B Ag, proteinuria, elevated serum Cr.
Polyarteritis nodosa - systemic, abd pain, neuro, cardiac dz (chf, htn, arrhythmias), skin rashes ---vasculitis that affects small-medium vessels -Strong association with Hep B*
53
which structure is at risk in a fracture of the humeral shaft?
``` Radial N (lies in radial groove) --wrist drop, extensor weakness, paresthesia on back of the hand. ```
54
What are electrolyte/hormonal serum findings in: (4) 55 year old smoker w 3 day hx of hematuria, fever, left flank pain. palpable flank mass. US reveals localized renal mass.
Renal cell Ca paraneoplastic syndromes: 1. Polycythemia (increased EPO) 2. Cushing's 3. HTN (increased renin) 4. Hypercalcemia (PTH-like hormone)
55
What are withdrawal Sx of: 1. cocaine 2. opioids
1. dysphoria, excessive sleep, hunger | 2. Rhinorrhea, lacrimation, yawning, abdominal/leg cramping. piloerection, nausea, vomiting, diarrhea, dilated pupils
56
28 year old R breast mass. no fam hx. mass is 2cm, nontender, mobile, firm in RUQ. 1. which test should be ordered? 2. most appropriate diagnostic modality? 3. next best step?
Fibroadenoma 1. Ultrasound 2. Fine needle biopsy/aspiration 3. observe for 1 menstrual cycle
57
What are sx of spondylolisthesis
Anterior displacement of a vertebrae: low back pain waddling gait tight hamstrings
58
What of Sx of cauda equina syndrome?
``` Sciatica Low back pain decreased DTR Saddle anesthesia bladder/bowel dysfunction motor/sensory deficits ```
59
Whens should colonoscopies begin i pts with Lynch syndrome (Hereditary non-polyposis colorectal cancer)
every 1 to 2 years beginning at 20-25 or 10 years prior to the earliest colorectal cancer dx in the family HNPCC: colorectal, ovarian, gastric, biliary tract, brain, prostate, skin, ENDOMETRIAL
60
What are 4 manifestations of MEN Type IIB
1. Marfanoid body habitus 2. pheochromocytoma 3. Medullary thyroid carcinoma 4. Mucosal neuromas (ie tumor of the tongue)
61
How do you calculate Number needed to treat from Absolute risk reduction?
NNT = 1/ARR
62
What is the most common sequela after bacterial meningitis?
sensorineural hearing loss - children should be followed up with audiometry other less common sequela: seizures, cranial N palsies, cognitive deficits, ataxia
63
Which STI is associated with Nephropathy w renal bx showing IgG and C3 deposits at basement membrane w a spike-dome appearance?
``` Syphilis - Membranous Glomerulonephritis HBV HCV malaria malignancy SLE gold salts penicillamine ``` Tx: prednisone
64
What is the management of Torsades de pointes in: 1. unstable pts 2. stable and conscious pts
1. defibrillation | 2. IV magnesium
65
what is the treatment for post partum endometritis
Clindamycin + Gentamicin | -ampicillin
66
how is an exhalation dysfunction of rib 5 treated with muscle energy?
``` pt lays supine ipsilateral hand on forehead grab key rib angle posteriorly pt holds breath in full inhalation + push ipsilateral elbow towards contralat ASIS Raise key rib (push inf on rib angle) ```
67
Where would a chapman's point be found in a pt with colon cancer?
ANTERIOR iliotibial band
68
What is dx? Seizure, fatigue, jaundice. hx of bloody diarrhea. Febrile, lower extremity petechiae. Hgb 9.2, mcv 90 fL, platelet count 70,000, total bilirubin 3.0 (direct 0.3) Cr 4.5. peripheral blood smear shows schistocytes
Thrombotic thrombocytopenic purpura (TTP)/Hemolytic uremic syndrome (HUS) FAT RN: fever, anemia, thrombocytopenia, renal dz, Neuro dysfunction
69
Pt has hx of spinal cord injury. He experiences diaphoresis, flushing, headache. Needs frequent catheterization. Where is location of lesion?
T6 or above - autonomic dysreflexia/hyperreflexia
70
What is the USPSTF recommendation for mammography in pt w no fam hx? ACOG recommendation?
mammogram every other year starting at 50-75 | ACOG suggests annually at 40
71
What are risk factors for PPROM? what is the management?
``` genital tract infection smoking grand multiparity polyhydramnios previous PROM/PPROM ``` 1. <34 weeks - no signs of fetal compromise = Abx, steroids, surveillance - fetal compromise = Abx, steroids, Mg if <32 wks, delivery 2. 34 to <37 weeks: Abx, +/- steroids, Delivery
72
what are the differences in findings in Rotor syndrome and Dubin Johnson? Urinalysis?
Rotor - normal liver color, elevated urine coproporphyrin --Coproporphyrin III makes up 80% of urine coproporphyrin Dubin-Johnson - darkly pigmented liver --Coproporphyrin I make up 80% of urine coproporphyrin
73
what is the most appropriate dx test in suspected multiple myeloma?
urine protein electrophoresis
74
what is the first line therapy for OCD?
CBT + clomipramine (TCA) or an SSRI
75
What is the treatment of GBS? what is it associated with?
a/w influenza vaccine | Tx: Plasmapheresis or IVIG
76
What medications are used to treat adrenal insufficiency (gluco/mineralo)
Hydrocortisone - replacement of mineralocorticoid and glucocorticoid Fludrocortisone - replaces just Mineralocorticoid Prednisone - replaces just glucocorticoid
77
What is the best management in a pt w a fam hx of colon cancer. recent colonoscopy shows over 400 polyps, bx shows adenomatous
Familial adenomatous polyposis - Autosomal dominant | --Total colectomy
78
What are the 5 components of the primary respiratory mechanism?
1. Inherent motion of the brain and spinal cord 2. Fluctuation of CSF 3. Mobility of intracranial and intraspinal membrane 4. Articular mobility of cranial bones 5. involuntary mobility of sacrum between ilia
79
Which vertebral segments are treated with muscle energy using patient's head?
T1-4
80
What is the work up for a low risk patient who has 2 cm centrally located nodule with calcifications in bullseye pattern seen on CT/
low risk pt (no smoking, under 50) | -2 years of serial chest CTs
81
What are components of MEN type 1 (Wermer's syndrome)
Autosomal dominant tumors of: 1. parathyroid (hyperparathyroidism) 2. pancreatic islet cells (insulinomas, gastrinomas) 3. pituitary gland (hyperprolactinemia, GH secretion, gynecomastia)
82
what is dx: | pt started on haloperidol three days ago presents w oculogyric crisis
Acute dystonia - hours to days after starting antipsychotic (neuroleptic) drugs -extrapyramidal movement disorder
83
what is dx: pt on fluphenazine for 15 months w involuntary tapping of lower extremities, abnormal twisting movement of the right leg
Tardive dyskinesia | --TIMING is important (months or years after start of meds)
84
What are 3 adverse affects of oxytocin overdose?
1. Uterine Tachysystole 2. Hyponatremia - oxytocin has similar structure to ADH = water retention 3. Hypotension
85
What are the indications/contraindications for: 1. Tamoxifen 2. Raloxifene
1. decreases post menopausal osteoporosis, increases risk for endometrial carcinoma, Hot flashes 2. same as tamoxifen, does NOT increase risk for endometrial carcinoma, also DECREASES breast cancer risk. both are contraindicated if hx of thrombosis
86
Minimal change dz: 1. Sx 2. Light microscopy findings 3. electron microscopy findings 4. Tx
1. edema, fatigue, abdominal pain, PROTEINURIA in children (usually <10) 2. normal 3. diffuse effacement of foot processes of podocytes (Tcell mediated) 4. Corticosteroids (bx is reserved for steroid resistance)
87
What is the underlying mechanism of Tardive dyskinesia
A/w dopamine blocking agents (antipsychotics) | - dopamine receptor supersensitivity
88
what is the cause of an anion gap acidosis in a pt who just experienced a general tonic clonic seizure. What is the next step
Postictal lactic acidosis - from skeletal muscle hypoxia | --Observe and repeat labs in 2 hours, usually self limited
89
What does the following measure: 1. PT, INR 2. PTT
1. Extrinsic system (Tissue factor, VII) | 2. Intrinsic system (XII, XI, VIII, IX)
90
How is multifocal atrial tachycardia identified on EKG?
- 3 or more different P-wave morphologies in the same lead - HR greater than 100 beats per minute - irregularly irregular rhythm
91
What are CBC findings of Polycythemia Vera?
Increased phenotypically normal RBC's, granulocytes, platelets
92
What are the viscerosomatic levels for lower ureters and bladder?
T11-L2
93
What is the gold standard for diagnosing RSV, parainfluenza?
Nasopharyngeal swab
94
what is the pathophysiology of Myasthenia gravis?
Autoantibodies against NICOTINIC post-synaptic acetylcholine receptors
95
What type of psychiatric medication can cause hyperprolactinemia?
Antipsychotics - especially typical | --ie fluphenazine
96
What is the mechanism involved in symptoms relief with parkinson's medication?
supplement dopamin decrease cholinergic activity (Benztropine + trihexyphenidyl = anticholinergic)
97
What is the difference between ethylene glycol and methanol poisoning
methanol - optic disc hyperemia, eye damage | ethylene glycol - kidney damage
98
What is the mechanism of thyrotoxicosis in a new born to a mother with graves disease?
Transplacental TSH-receptor ANTIBODY | --Methimazole + B blocker is given to symptomatic pt's until condition self resolves in few weeks/months
99
Which vitamin deficiency can result in neutropenia | hypochromic anemia
Copper deficiency - occurs in premature infants, absorption disorders, genetic disorders Sx: anemia, osteoporosis, leukopenia
100
What is a dx of a 45 year old pt w depressed mood for a year after her son moved out. Weight gain, sleep for 15 hours. briefly cheers up when son visits her.
Atypical Depression - mood reactivity + 2 of the following: --weight gain, increased appetite, hypersomnia, leaden paralysis, sensitivity to rejection
101
What is dx: | 45 year old female w abd pain, diarrhea, steatorrhea, cholelithiasis and diabetes mellitus
Somatostatinoma - somatostatin secreting tumors of the duodenum of delta cells of pancreas
102
What is dx: | 35 year old pt w 7 year hx of ocp use has 2 cm hepatic tumor. No abd pain. US shows central scar on tumor
Focal nodular hyperplasia - "CENTRAL SCAR" benign - continue oral contraception
103
What occurs at each axis of the sacrum: 1. superior transverse axis 2. Middle transverse axis 3. Inferior transverse axis
1. respiratory and inherent sacral motion 2. postural motion (bending over) 3. innominate rotation
104
What is the empirical treatment of bacterial meningitis in a nonimmunocompromised host? Close contacts? Where are organisms usually carried in close contacts
Neisseria = Petechial rash Vancomycin Ceftriaxone Steroids Ciprofloxacin, Ceftriaxone, or Rifampin for close contacts - organisms in NASOPHARYNX
105
What is the causative organism of Tinea Versicolor? KOH findings? Tx?
Malassezia globosa -Spaghetti & meatball pattern of hyphae and yeast Tx: topical ketoconazole, topical terbinafine, selenium sulfide lotion/shampoo or oral -azole
106
5 year old pt w enlargement of clitoris. puberty tanner stage 4. Lab studies show hyponatremia, hyperkalemia. What is the most appropriate test to order?
21-hydroxylase deficiency | --order Serum 17-hydroxyprogesterone level
107
What is dx classification and treatment? 17 year old w cough that occurs throughout the day and awaken at night every night. Pt is dx w asthma
Severe Persistent Asthma Tx: inhaled high dose glucocorticoids, inhaled LABA, SAB2A
108
What is the appropriate next step in a 52 year old male that has 2 cm central nodule in L lung, 3 cm central nodule in R lung. Bx shows Small cell carcinoma
Chemotherapy - SCLC located centrally, considered a systemic disease (surgical tx is uncommon cause SCLC is usually spread
109
What is most likely organism: 5 year old male w maculopapular rash that started on face, spreading to neck and extremities. Says he is experiencing "bone pain" Suboccipital lymphadenopathy
Rubella (Togavirus/German measles) - -suboccipital/postauricular lymphadenopathy - -maculopapular rash that starts on the face and spreads caudally. - -Arthralgias
110
What is the likely organism: 3 year old w high fever given supportive therapy. Fever resolves 3 days later, and child returns w maculopapular rash that started on the trunk w spreading to neck
HHV6 (Roseola infantum, exanthem subitum, sixth dz) -2-5 day self limiting fever, followed by maculopapular rash that starts on trunk and spreads to neck/extremities
111
How are Niemann-Pick and Tay-Sachs dz differentiated?
Hepatosplenomegaly is NOT present in Tay-Sachs N-P: sphingomyelinase deficiency TS: hexosaminidase A deficiency
112
How is a exhalation dysfunction of the first, second, third ribs on the left treated w muscle energy?
look straight ahead and pt lifts head anteriorly. physician grasps rib angle posteriorly and resists anterior head movement
113
What is the difference between bulimia and anorexia? what is first line treatment for Anorexia?
anorexia = body weight < 85% expected, fear of gaining weight, distorted body image, amenorrhea ---Tx: Nutritional rehab + Psychotherapy bulimia = patient of normal weight/overweight
114
What are pts w klinefelters at higher risk for? most common type? Sx?
extragonadal germ cell tumor - -Mediastinal nonseminomatous germ cell tumor = most common! - -----mediastinal mass = chest pain, chronic cough, SVC syndrome, Horner syndrome
115
What is most appropriate management of Variant Angina (Prinzmetal)
Calcium channel blockers (diltizem, etc) | Long acting nitrates
116
What is first workup step in pt w syncope?
Electrocardiogram
117
What is the next step in a pt already on metformin with an A1C of 7.9%?
Add sulfonylurea (Glyburide, etc) if A1C is b/w 7 and 8.5
118
Why is HVLA contraindicated in Down Syndrome patients?
weakness of the alar and transverse ligaments = can result in dens moving posteriorly = quadriplegia
119
What is: 1. Colles Fracture 2. Boxer's Fracture 3. Monteggia's fracture 4. Galeazzi's fracture 5. Nightstick fracture
1. distal end of radius is bent dorsally (dmg to median nerve) 2. fx of fifth metacarpal (tx: closed reduction and splint) 3. fx of ULNAR shaft w dislocation of RADIAL head 4. Diaphyseal fracture of DISTAL RADIUS w DISRUPTION of radioulnar joint 5. fx of ulnar shaft
120
What are symptoms of roseola infantum
rash that starts on trunk and spreads peripherally AFTER fever typically
121
What are Sx of Erythema Infectiosum
Parvovirus B19 (5th dz) - -fever, nasal, congestion that last for a few days - -followed by "slapped cheeks" then ery thematous rash begins on arms and spreads to trunk and fades in lace like pattern. Acute Arthralgia/arthritis (resemble RA)
122
What is the management of a scaphoid fracture w a normal radiograph?
casting for 10 days and REIMAGING (signs of healing should appear) -surgical exploration if displacement >1mm
123
What are serum changes in Wilson dz?
``` Decreased total serum copper Increased free copper decreased ceruloplasmin Hypoalbuminemia elevated aminotransferases ```
124
What is the most appropriated test to confirm dx of Cardiac tamponade?
Transthoracic echocardiogram
125
``` What is dx in newborn: polydactyly meningomyelocele rocker-bottom feet cleft palate eye malformations GI/cardiac/renal dz ```
Trisomy 13 - Patau syndrome
126
``` What is dx in newborn: intellectural disability microcephaly micrognathia clenched fist prominent occiput rocker-bottom feet hypertelorism ```
Trisomy 18 - Edward's syndrome
127
What are liver manifestations of oral contraceptive use? what other risk factors? management?
Hepatic adenoma - OCPs, Anabolic steroids, glycogen storage dz - Tx: 1. Discontinue OCPs 2. Surgical resection IF SYMPTOMATIC
128
How is Cdiff dx'd?
C diff toxin PCR (EIA assay has lower sensitivity but higer specificity) - slower test, often used in conjunction
129
When should umbilical hernias be treated in children?
if it has not spontaneously reduced by 4 years old
130
dx? Tx? | 16 year old w maculopapular rash, allergic rhinitis, asthma, positive for p-ANCA
Churg-Strauss (allergic granulomatosis) Tx: glucocorticoids + immunosupressive drugs
131
What is a medication that may be used to reduce incidence of PUD a/w NSAIDs? sidefx?
Misoprostol side fx = abd pain, diarrhea (NSAIDs inhibit prostaglandin synthesis)
132
What are the two DIAGNOSTIC tests for syphilis?
1. Dark field microscopy | 2. direct fluorescence antibody testing of lesion tissue
133
Upon itiating abx for Group A strep, the patient is considered contagious for how long?
1-2 days on abx
134
What are 3 first line drugs for maternal hypertensive crisis?
1. IV Hydralazine - vasodilator 2. IV Labetalol - DONT use w bradycardia (<60bpm) 3. PO Nifedipine - difficult to use w emesis *Methyldopa is used for chronic maternal htn
135
How do you treat an acute psychotic episode in a pt that has previously responded to haloperidol but experienced extrapyramidal symptoms?
Second generation antipsychotics: 1. ziprasidone (low metabolic risk) 2. Olanzapine (high metabolic risk) 3. Lurasidone 4. Aripiprazole
136
Dx? Immediate management? Newborn w resp distress. Prenatal US shows polyhydramnios. O2 sats 82%. Exam shows nasal flaring, grunting, barrel shaped chest. Absent breath sounds on L. Normal aeration of R side. Heart sounds are loudest in R chest. Abdomen is Scaphoid
Congenital Diaphragmatic Hernia - polyhydramnios can occur from esophgeal compression. - concave abdomen - barrel shaped chest Management - Emergency intubation (mask ventilation risks aerating stomach, further compromising lungs)
137
What is the cause of decreased total calcium in a patient w nephrotic syndrome?
``` Decreased Albumin = decreased total calcium (bound to albumin) Q Ionized Ca (physio active form) are still at normal levels ```
138
What is the management of uncomplicated chronic low back pain?
Chronic > 12 weeks | Tx: Exercise therapy
139
What is dx: 50 yr old postmenopausal female w 2 day hx of vaginal spotting. Phys exam shows thin female w large adnexal mass. US shows endometrial thickening. No evidence of hirsutism/virilization
Granulosa-theca cell tumor --hormonally active = hyperextrogenism (Sertoli-Leydig = androgen = virilization)
140
What is most common cause of pancreatitis in children/adolescents?
Blunt trauma to abdomen | -Sx: epigastric pain radiating to back + N/V
141
What is difference b/w postpartum blues and postpartum depression?
Blues - appear within first weeks and remit by end of 2 weeks postpartum Depression - delayed from 2 weeks to 12 months
142
What is causative organism: 24 yr old breast feeding pt presents w pain in left nipple. No fevers, chills, fatigue. Nipple is erythematous, shiny, w flaky skin at areola. No erythema of breast.
Candida albicans - pain, burning, redness of NIPPLE, shiny appearance - -Azole cream for nipple - -Check infants mouth for thrush, give oral azole to infant (S. aureus causes nipple cracks/fissures)
143
What is most common cause of primary hyperparathyroidism? Second most common? Tx? Localization technique?
1. Parathyroid adenoma 2. Parathyroid hyperplasia Surgical excision - localize w Sestamibi scan
144
What are 3 relative contraindicatiosn to lymphatic omm treatments?
Metastatic Cancer Disseminated/Febrile infections Chronic infections
145
How is the diagnosis of boerhaave syndrome made? (2 ways)
Chest CT | Iodinated contrast esophagram
146
What are 3 indications for long term oxygen therapy in COPD patients?
1. SaO2 < 88% 2. PaO2 <55 mmHg 3. PaO2 55-59 mmHg if right sided HF or erythrocytosis are present
147
When is excisional bx of a breast mass indicated?
1. All palpable dominant breast masses in women over 50 2. Masses that persist after FNA (except fibroadenomas) 3. Bloody aspirate
148
What level are somatic visceral changes present in a pt w UC in the sigmoid colon? what other organs share this visceral level
T12-L2 - distal 1/3 of transverse colon, descending, sigmoid colon, rectum - prostate - lower ureter - bladder
149
What is likely dx: 30 year old smoker w nonproductive cough, SOB. CXR shows bilateral nodules/cysts, Lytic lesions of the ribs. what protein will be expressed on these cells?
Langerhans cell histiocytosis - -proliferation of specialized bone marrow-derived Langerhans cells. - -Dyspnea, Non-productive cough, fatigue, weight loss. - -CXR = bilateral nodules, cysts, honey combing (interstitial), boney lesions of ribs *CD1a is used to identify
150
what is the dx test for infantile botulism?
Stool C. botulinum toxin assay
151
What is dx? most specific lab test? 35 yr old female w fatigue, white finger tips in cold weather. dysphagia, small blood vessels on her body. Skin has hard nodular type lesions on upper extremities, tightness of skin
``` CREST syndrome: Calcinosis Raynaud's Esophageal dysmotility Sclerodactyly Telangiectasias ``` Anti-centromere Abs
152
What is the first line tx of tourettes? What are 4 comorbidities?
Typical Antipsychotics (haloperidol, fluphenazine) Comorbidities - ADHD - OCD - learning disorders - conduct disorder
153
What is the workup for elevated prolactin levels?
MRI of the brain
154
what is the most common cause of PUD? what is the most common blood type associated?
H. pylori infection G"A"stric ulcers - Type A Du"O"denal ulcers - Type O
155
What 2 lab findings are used to monitor response of osteomyelitis to therapy?
ESR and CRP
156
What is the time period required for a diagnosis of schizophrenia?
6 months
157
What are the 3 most common risk factors for spontaneous pneumothorax?
1. Smoking 2. fam hx 3. Marfans
158
What is most likely dx: | 2 year old w bloody nose. Has unilateral nasal discharge w foul smell.
Foreign body
159
What is first line treatment of Fibromyalgia? What is first line med? What are other three drugs that are approved for management.
Initial: pt edu, regular aerobic exercise, good sleep hygiene First line med: TCA's (Amitryiptline) Others if nor responding to TCA: 1. duloxetine (SNRI) 2. milnacipran (SNRI) 3. pregabalin
160
What are treatments for acute mania/psychosis?
Antipsychotics (Olanzapine is IM and has rapid onset) Lithium Anticonvulsant mood stabilizers (valproate)
161
What is most likely congental heart defect? 1 week old w central cyanosis. ECG shows left axis deviation. holosystolic murmur at left lower sternal border. fam hx has maternal uncle who dies from hypoplastic left heart syndrome
Tricuspid valve atresia
162
What is cause? what should be done? COPD pt has exacerbation. He is given inhaled bronchodilators, systemic steroids, high-flow facial mask oxygen, IV lorazepam. He becomes lethargic and confused and experiences a general tonic-clonic seizure
Carbon dioxide retention - -high flow oxygen causes loss of compensatory vasoconstriction = worsens V/Q mismatch - -Increase in oxyhemoglobin reduces uptake of CO2 from Haldane effeect - -decrease respiratory drive/minute ventilation *O2 sats should be titarted to 90%-94% or paO2 between 60-65
163
What is the most common congenital heart defect in children w Edwards?
Trisomy 18 - VSD - microcephaly, micrognathia - absent palmar creases - rocker bottom feet
164
What is management of Community-acquired pneumonia? Criteria and treatment
``` CURB-65: Confusion Uremia (BUN > 20) Resp rate > 30 BP < 90 systolic or < 60 diastolic Age > 65 ``` Scoring: <2 outpt w Macrolides (azithromycin, clarithromycin, erythromycin) or Doxycycline =2 inpt w respiratory fluoroquinolone or Macrolide w Beta-lactam >3 ICU w B-lactam/resp fluoroquinolone or B-lactam/Macrolide
165
What is the treatment choice for Acute Otitis Media in a child?
Amoxicillin (S.pneumo, M. cata, H. flu) Augmentin - if pt had amoxicillin within past 30 days. or Sx dont improve after 48 to 72 hrs on high-dose amoxicillin
166
What are the classifications of Scoliosis?
1. Mild: 5-15, treated w OMT, PT 2. Moderate: 20-45, tx orthotics, PT, OMT 3. Severe: >50 - surg intervention >50: Resp compromise >75: Cardiac compromise
167
What is dx: 30 yr old male w scrotal mass: 2 cm cystic, transilluminates located superior and posterior to testis
Spermatocele Hydrocele are Ant + Lat
168
What should happen before administering Rh(D) immune globulin in a pt w placental abruption
Rh(D) typing
169
What is dx: 40 yr old recently visited Wisconsin. Cough, fever, chest pain, severe arthralgia. Non-pruritic verrucous/ulcerating skin lesions Tx? Appearance?
Blastomycosis - Midwest/Southcentral States - Fever, cough, CP, weightloss, painless VERRUCOUS/Ulcerated skin lesions - Bone lesions - CNS disease KOH: broad based budding Tx: Itraconazole, Amph B if dissemiated/HIV
170
What is the management of a 1. pleural effusion 2. empyema
1. therapeutic thoracentesis for large or symptomatic transudative/malignant exudative 2. Chest tube + empiric IV Abx
171
What is dx: | 1 month old w jaundice, hepatosplenomegaly, cataracts, cardiac murmur, hearing loss
Rubella Virus - cataracts - hearing loss - "blueberry muffin" rash - hepatosplenomegaly - intellectual/dev disability
172
What is management of bat bite in pt: 1. vaccinated 2. unvaccinated
Vaccinated: irrigation + 2 doses of rabies vaccine prophylaxis Unvaccinated: irrigation + passively immunized + 4 doses of rabies vaccine prophylaxis
173
What is dx? most specific test? 70 year old pt w nasal congestion, shortness of breath, hemoptysis ESR 60 mm/hr and WBC 11,000. Urine has red cells, red cell casts
Granulomatosis w polyangiitis (Wegeners) --C-ANCA (abs against proteinase-3) -Upper + Lower Resp Sx + Glomerulonephritis
174
What is most effect Tx for pt w rhinitis during the fall. pt's father was dx'd w atopic conjunctivitis
Dx: Allergic rhinitis (most significant risk factor = fam hx of atopy or asthma) Tx: Intranasal corticosteroid
175
What is first line treatemtn of hemodynamicaly unstable pt w confirmed or highly suspected pulmonary embolsm?
tPA
176
How is Meckels diverticulum diagnosed? Tx?
Technetium-99m pertechnetate scan Tx: Surgical exicision -can lead to intestinal obstruction, volvulus, intussusception
177
What is dx and next workup step in 54 yr multiparous woman w 5 month hx of urinary incontinence. admits to urinary frequency, dribbling, hesitancy. second step shows large postvoid residual volume. What is appropriate tx?
Overflow incontinence - Urinalysis Tx - Self-catheterization and treating underlying cause
178
What is dx: 32 year old at 38 weeks gestation. hx of cesarean delivery. intially at 6cm dilated 60% effaced, fetal head at 0 station. She experiences intense lower abdominal pain. moderate vaginal bleeding, cervix is 6cm dilated, 60% effaced, fetal head at -3 station. Fetal heart rate is tachy w variable decelerations
Uterine Rupture - loss of fetal station is pathognomonic - occurs at scar of prior cesasean delivery
179
70 year old pt has BP of 165/75. ECG shows LVH. What is cause of HTN?
Rigidity of arterial wall | - isolated SYSTOLIC HTN (sys>140, dia<90)
180
What is the dx criteria fro Adjustment disorder w depressed mood? Tx?
Onsent within 3 months of identifiable stressor Marked distress &/or functional impairment Tx: psychotherapy
181
What is the cause of swelling in hands and feet of a newborn w Turner's syndrome?
Lymphatic network dysgenesis | --severe obstruction can result in cystic hygroma
182
What are the first 4 steps in early neonatal care in an uncomplicated pregnancy?
1. Initial physical assessment (APGAR) 2. removal of airway secretions 3. drying infant, keep warm 4. early preventatie measures (silver nitrated eye drops, vitamin K)
183
How long should a patient continue antidepressant tx after achieving remission of depressive symptoms
continue for an additional 6 months in a pt w single-episode unipolar major depression.
184
What is difference between Marfan's syndrome and Homocystinuria
Marfan's: Autosomal dominant, Fibrillin abnormality, Long fingers, Scoliosis, ECTOPIC LENTIS, LOOSE JOINTS Homocystinuria: marfanoid habitus, Mental retardation, Osteoporosis, LENS SUBLUXATION, TIGHT JOINTS
185
What is the appropriate management for: 1. cleft lip 2. cleft palate
1. Surgical repair by 3 months | 2. Special nipple for feeding + surgical repair at 9 months
186
What is the most common cause of meningitis in a 7 month old? What are characteristics of the organsim?
S. pneumoniae -most common cause: 3 months - 9 years after 30 yrs old -Lancet-shapted gram positive alpha-hemolytic encapsulated
187
What is dx: 50 year old w new fever and weightloss Labs: WBC 54,000, HgB 14, hematocrit 42%, increased leukocyte alkaline phosphatase. Bone marrow bx: hypercellularity
Leukemoid reaction - secondary to infection - Increased leukocyte alkaline phosphatase - --CML has DECREASED leukocyte alkaline phosphatase
188
What is the dx: neck pain, hyperthyroid sx, hx of sinusitis, elevated ESR, T4, decreased TSH level Iodine uptake? Tx?
Subacute GRANULOMATOUS thyroiditis (de Quervain's) - Decreased iodine uptake - NSAIDs **subacute lymphocytic thyroiditis is PAINLESS
189
What is the definitive diagnostic test for Fanconi anemia? what is the patient at greater risk for?
chromosome breakage test | -greater risk for AML, liver tumors, other malignancies
190
What is dx: 2 day old child w chorioretinitis. Mother admits to ingesting raw meat during pregnancy. Jaundice What will head CT show?
Toxoplasmosis - hydrocephaly - chorioretinitis - jaundice - hepatosplenomegaly - mental retardation - microcephaly CT - intracranial calcifications (especially Basal Ganglia)
191
What causes variable deceleration in fetal heart rate monitoring?
Umbilical cord compression
192
What causes early deceleration in fetal heart rate monitoring?
Fetal head compression
193
What causes late deceleration in fetal heart rate monitoring?
uteroplacental insufficiency
194
What is the next step after establishing an airway in a child w epiglotitis? What is the most common cause?
Administer antibiotics -empiric = 3rd gen cephalosporin + vancomycin/clindamycin mostly caused by H flu (most common), then S.pneumo, Group A strep, S aureus
195
What is Dx, Cause, Tx? | 40 yr old w bipolar dz has polyuria, dehydration. Urine osmolality is extremely low, slight response w vasopressin.
Nephrogenic DI - caused by Lithium Tx: Sodium restriction and Thiazide +/- Amiloride
196
What is dx? 11 year old girl w 15 lb weight loss over past month. Frequent melanotic diarrhea, abd pain. Aphthous oral ulcers, perirectal skin tag
Crohn's disease
197
What is dx: | child w/ episodes of depersonalization followed by lip smaking. EEG shows three per second spike and wave discarges
Absence seizure idsorder
198
What are the following: 1. Curling's ulcer 2. Cushing ulcer 3. Marjolin's ulcer 4. Marginal ulcer 5. Buruli ulcer
1. Curling: Duodenal ulcer that occurs acutely after a burn 2. Cushing: gastric/duodenal ulcer caused by elevated intracranial pressure 3. Marjolin - malignant transformation of CHRONIC wound (most commonly a burn) 4. Marginal ulcer - jejunal ulcer after gastrojejunostomy 5. Buruli - manifestation of mycobacterium ulcerans
199
What is dx? etiology? 15 year old boy w progressive weakness. Increasing difficulty making facial expressions, swallowing, ptosis, temporal wasting, thin chees, inverted V-shaped upper lip, testicular atrophy
Mytonic dystrophy | -autosomal dominant expansion of CTG in DMPK gene on chromosome 19
200
What is the tx for candida vulvovaginitis
``` Oral Azole (fluconazole) Intravaginal Nystatin ```
201
What electrolyte abnormality can be caused by TMP-SMX?
hyperkalemia - TMP blocks epithelial sodium channel in collecting tubule
202
What are renal changes observed in normal pregnancy? what are the lab findings?
Increased: Renal blood flow, GFR, Renal basement membrane permeability Labs: Decreased Serum BUN, CR, increased renal protein excretion
203
What is the location of dysfunction: | 36 year old woman w pronator drifty?
Pyramidal/Corticospinal tract | Upper motor neuron
204
What is dx? What 3 things will be positive in serology test? 49 yr old woman w swelling/stiffness in hands, raynauds, fatigue, gerd, lungs have bibasilar fine inspiratory crackls
Systemic Sclerosis - Anti-topoisomerase I Abs (anti-Scl-70) - Antinuclear Ab - Anticentromere Ab Sx: Fatigue, weakness, Telangiectasia, sclerodactyly, digital ulcers, calcinosis, arthralgias, dysphagia, raynaud, interstitial lung dz
205
How do you differentiate Amaurosis Fugax with Central retinal vein occlusion?
CRVO - Retinal hemorrhages more common, cotton wool spots, optic disk swelling = "blood and thunder"
206
What is the initial management? 71 yr old w acute substernal cp, dyspnea, bp is 78/57, pulse 102, jvd is present, pulm auscultation shows prominent rales in all lung fields w faint wheezes
Dopamine - flash pulmonary edema, cardiogenic SHOCK --give catecholamine vasopressor - increasee cardiac contractility + vasoconstriction --then MONA BASH
207
What type of HTN medication can be useful in pts with osteopenia, osteoporosis?
Thiazide diuretics - decreases calcium excretion - causes hypercalcemia
208
What is the treatment choice for symptomatic sarcoidosis?
oral corticosteroids
209
What does a sinusoidal heart rate pattern indicate in fetal heart rate monitoring?
Severe fetal anemia = RH isoimmunization or severe hypoxia
210
what is dx: 3 year old w 7 day hx of 101.2 fever. fissuring of lips, erythema and desquamation of palms and soles. Bilateral conjunctivits. Inflamed "strawberry" tongue complications? Tx?
Kawasaki (mucocutaneous lymph node syndrome) - -fever >5days - -bilateral conjunctivis - -uveitis - -strawberry tongue - -cracked lips - -erythematous desquamation of trunk, hands, feet a/w coronary artery aneurysms Tx: IVIG, High dose aspirin
211
What is dx: 35 yr old male w swelling and solid mass on R testicle. Labs shows elevated B-HCG, normal AFP. Histology shows well defined cell membranes w clear cytoplasm "fried egg" appearance what are risk factors for this condition?
Seminoma - -normal AFP - clear cytoplasm, round nuclei = "fried egg" Risk: Cryptorchid testis, infertility, Klinefelter, fam hx
212
What is most likely dx: 25 yr old w hypercortisolism. Low dose dexamethasone test does not cause cortisol reduction (above 1.8). High dose dexamethasone causes cortisol to be supressed What is Tx?
Pituitary tumor - ACTH excretion (Cushing's disease) Tx: tumor removal + replacement glucocoriticoid
213
4 month old born at 28 weeks gestation is seen for wellness check up. what is the appropriate action to prevent infection of RSV?
Palivizumab in high risk pts: high risk = 1. infants <24months w hemodynamically congenital heart defects, chronic lung dz 2. born prior 29 weeks 3. <24month and immunocompromised
214
What is the typical presentation of Wernicke encephalopathy?
"ACE" triad Ataxia Confusion Eye disorders Korsakoff refers to long term dementia that can develop - imaging will show mammillary body lesions
215
What is dx? Tx? chronic alcohol abuse has fatigue, abd pain, conjunctival pallor. Iron, ferritin levels are elevated, normal TIBC. Bone marrow bx shows erythroblasts w stainable deposits of iron in cytoplasm.
Sideroblastic anemia - bx shows ringed sideroblasts --causes: alcohol, isoniazid, chloramphenicol, lead poisoning Labs: increased iron, ferritin normal TIBC Tx: removal of offending agent + Pyridoxin (B6)
216
What is dx: 35 yr old male experiences cramping pains and numbness in left arm and becomes dizzy w double vision when he exercises by punching bag.
Subclavian steal syndrome - obstruction of left subclavian artery prox to origin of vertebral artery. - backflow of blood from vertebral artery to distal subclavian dx: duplex US, MRI, MRA
217
How is relative risk calculated?
(A/(A+B)) / (C/(C+D))
218
What is the management of a hepatic cavernous hemangioma that is incidentally found on US?
Stop hormonal therapy - -watch expectantly - followed by imaging, hemangiomas over 5cm or symptomatic is managed surgically
219
What are 3 ways DM T2 is diagnosed?
1. Fasting glucose > 126 mg/dL 2. Random glucose > 200 + symptoms 3. HbA1c > 6.5%
220
What is dx and tx? 40 year old female w pruritis, scleral icterus, jaundice, hepatomegaly. Labs have elevated alk phos, serum antimitochondrial abs
Primary Biliary Cirrhosis - -Cholestyramine, Cholestipol for pruritis - --Ursodeoxycholic acid to slow dz progression
221
What is the skin manifestation a/w celiacs? Tx?
Dermatitis herpetiformis | Tx = Dapsone + gluten free
222
What is the tx for neuroleptic malignant syndrome? (3)
Stop meds + IV fluids first - -if sever or sx continue: 1. Dantrolene 2. Bromocriptine 3. Amantadine
223
Pt w hx of afib on warfarin has INR of 2.1. He presents w an acute abdomen, abdominal xray shows free air under diaphragm, what is next step?
Fresh frozen plasma to reverse INR for surgery. --in acute setting (ie hemorrhagic stroke) use Prothrombin complex concentrate (PCC) + Vitamin K
224
What is the most common site for the origin of atrial fibrillation
pulmonary veins
225
What kind of medication should children w sickle cell disease be taking?
Children <5 yrs old w SCD should be on prophylactic penicillin S. pneumo - most common cause of sepsis in fxnal asplenia
226
What are the two definitions of active phase labor arrest? what is next step?
active phase begins >6cm dilation 1. no cervical change >4 hrs w adequate contractions 2. no cervical change >6 hrs w/o adequate contractions Cesarean delivery
227
What is Alport syndrome? what are microscopy findings?
"Cant See, Pee, Hear High C" -Renal dz, sensorineural hearing loss, ocular abnormalities abnormalities of Type IV collagen Microscopy = Thinning/Splitting of glomerular basement membrane
228
When should a colonoscopy be offered in a pt with Ulcerative colitis or Crohn's w colonic involvement?
8-10 years after diagnosis (12-15 if dz only in L colon) | -repeat every 1-3 years
229
What are hormonal findings in Turner Syndrome patients?
Ovarian dysgenesis (streak ovaries) - Low estrogen + progesterone elevated LH + FSH
230
Psyche pt w depression and psychosis has symptoms controlled on medication. She has infertility and erratic menstrual periods. What medications is she probably on?
Antipsychotics First gen: Haloperidol, Fluphenazine Sec gen: Risperidone, paliperidone --Dopamine 2 blockers = increase prolactin =galactorrhea, menstrual irregularities, infertility
231
What is dx? Additional findings? how is it dx'd? 2 day old fails bilateral hearing screen. born at 37 weeks via csection due to fetal growth restriction. Mother had brief febrile illness while traveling during first trimester. She reported joint paint 5-7 days after fever. Infants weight, length, head circ is <5th percentile. child has loud murmur over left second intercostal space.
Congenital Rubella - Sensorineural hearing loss - Cataracts = Leukocoria (white pupillary reflex) - PDA Dx: Serology (Infant IgM)
232
What is dx? what will confirm dx? 1 month old male has poor feeding and "floppiness" since birth. Sx have been progressive. Hypotonia, generalized weakness, lack of head control. Eyes have active movment.
Werdnig-Hoffman disease (Spinal muscular atrophy type 1) - -Genetic testing -Autosomal recessive (SMN1 gene) - --Survival motor neuron gene 1 (SMN1) - encodes protein that arrests apoptosis of motor neurons --Extraocular + sphincter muscles are spared
233
What is the power of a test?
``` Power = 1-Beta Beta = risk of type II error ``` type II error = null hypothesis is incorrectly rejected **Decrease type I errors increase type II error = reduces power of test and vice versa
234
``` What is age of infant: front-to-back, back-to-front sitting without support transferring objects from hand to hand responds to name babbles chains of consonants laughts ```
7 months
235
``` What is age of infant: social smile, imitates movements/facial expressions attentive to sounds/voices coos follows moving objects Brings hand to mouth, open/closes hands lifts head and shoulders from prone position cannot sit without support ```
3 months
236
``` What is age of infant: sits w support rolls back to front palmar grasp, holds hands together responds to name recognize, attach to caregivers express anger/happiness vocally ```
5 months
237
``` What is age of infant: crawls well pulls to stand 3 finger grasp, holds bottle, can throw says "mama" and "dada" waves "bye-bye" enjoys gesture games like peek-a-boo ```
9 months
238
``` What is age of infant: shy around strangers, stranger anxiety finger feeds itself follows 1 step command points at objects standing without support move from sitting to crawling two finger grast ```
12 months
239
80 yr old w dyspnea, retired sand blaster. no hx of smoking. CXR shows nodular opacities in upper lobe. What is dx and what is pt at higher risk for developing?
Silicosis - higher risk of TB --silica is cytotoxis to alveolar macrophages Silicosis CXR - nodule opacities in upper lobe
240
What is management of postherpetic neuralgia
Amitriptyline + topical capsaicin | --others: topical lidocain, opioids, gabapentin, pregabalin
241
What are the adult structures of: 1. Anterior fontanelle 2. Posterior fontanelle
1. Bregma | 2. Lambda
242
What is Dx? Tx? 13 year old w 1 hr hx of constant testicular pain. Sudden onset, located in superior pole of right testicle. Testes are tender swollen, w blue dot on superior pole or right testicle.
Torsion of Appendix Testis (remnant of paramesonephric duct) --leading cause of acute scrotum in children 7-14 Tx: Pain control, bed rest, scrotal support
243
What is dx and tx? 6 yr old female w Tanner stage III breasts, Tanner stage II pubic hair, height/weight above 95th percentile. Labs show high LH, FSH levels and increase after GnRH administration MRI of brain is noraml Skeletal age is advanced
True precocious puberty - LH, FSH are high, elevated w GnRH administration. - -MRI may have shown hypothalamic lesion ``` Tx: GnRH analogs: Leuprolide Buserelin Nafarelin Histrelin ```
244
What is the treatment of somnambulism? (2)
Sleepwalking: Benzodiazepines Occasionally Trazodone
245
Where is the chapman's point associated with the prostate?
Lateral and Posterior Margin of Iliotibial Band.
246
What time period is needed to diagnose generalized anxiety disorder?
>6 months
247
What is dx? next best step in management? what is it associated with? 55 yr old w pain, itching, red streaks on left arm. had similar episode on her chest 2 weeks ago that improved on its own. HX of heartburn, upper abdominal pain for last several months. 15-30 yr smoking hx. Tender erythematous, palpable cord-like veins on left arm and upper chest
Migratory superficial thrombophlebitis (Trousseau's syndrome) - --CT ABDOMEN - evaluate for occult tumor - hypercoagulable disorder - unexplained superficial venous thrombosis at unusual sites - -a/w Cancer involving pancreas (most common), lung, prostate, stomach, colon, leukemias
248
What is the pathology of GBS?
demyelination of peripheral motor nerves
249
What is dx criteria of exertional heat stroke? tx?
temp > 104F CNS dysfunction Additional organ damage Ice water immersion
250
what is dx? tx? 4 yr old boy w eye redness w scant, watery discharge. hx of 10 day mild rhinorrhea, cough. Eye exam shows pale follicles, inflammatory changes in tarsal conjunctivae bilaterally. Conjunctivae appear mildly thickened.
Trachoma (Chlamydia trachomatis A,B,C) - leading cause of blindness worldwide from chronic infection-scarring, trichiasis (eyelid inversion) - -conjunctival injection - -tarsal inflammation - -pale follicles Tx: Azithromycin Giemsa stain exam conjunctival scrapings
251
What is dx: 5 yr old girl w pubic, axillary hair. No H/A, visual changes. pt is obese w facial acne, no breast buds. external genitalia is normal, bone age is normal
Premature adrenarche - normal bone age - isolated pubic hair development
252
What is the first line tx of Asymptomatic bacteriuria in a pt at 10 weeks gestation? (3)
1. Cephalexin 2. Amoxicillin-clavulanate 3. Nitrofurantoin
253
What is the physiological affect on preload that valsalva has?
Decreases preload
254
What is dx: 31 yr old female w 6 week hx of perioribital edema, abdominal distention. She has nephrotic range proteinuria. Pt suddnely develops severe right sided abd pain, fever, gross hematuria.
Membranous glomerulopathy - a/w Renal vein Thrombosis + other thromboembolism ---from loss of antithrombin IIII in urine
255
What are fetal complications related to maternal preeclampsia
Chronic uteroplacental insufficiency = 1. Oligohydramnios 2. Fetal growth restriction/small for gestation age
256
What are first line meds for alcohol use disorders? (2) | -circumstances for use?
Naltrexone - mu-opioid antagonist --a/w hepatotoxicity Acamprosate - glutamate modulator --SAFE in liver dz
257
How is a post surgical DVT managed? what if the pt has renal dz?
Warfarin with Heparin bridge | --Unfractionated heparin w renal dz (LMWH is not recommented in ESRD)
258
What is dx: 40 yr old sexually active woman w abominal pain. negative hCG, febrile, enlarged tender right adnexal mass. CRP, CA-125 are elevated. Pelvic US shows large, thick-walled multiloculated mass filled w debris obliterating the right adnexa.
Tubo-ovarian abscess
259
What are 2 structures at risk for entrapment in a supracondylar fracture of the humerus
Brachial A | Median N
260
What are two contraindications for a trial of labor?
Risk of Uterine rupture greatest: 1. Classical Cesarean (vertical incision) 2. Abominal myomectomy w uterine cavity entry
261
15 yr old girl has not begun menstruating. otherwise healthy. Absence of breast developement, no pubic hair. US confirms presence of a uterus What is the next step?
Serum FSH level --distinguish central vs peripheral abnormality If FSH 1. decreased = Pituitary MRI 2. increased = Karyotyping
262
What is the most common electrolyte abnormality in chronic alcoholism? what additional abnormality does it usually cause?
Hypomagnesemia - -causes refractory hypokalemia - -and hypocalcemia
263
What is the diagnostic test for lactose intolerance?
Hydrogen breath test | --enteric bacteria metabolize undigested lactose and produce hydrogen
264
What will kidney fxn labs show in septic shock? prostate hypertrophy?
Septic shock: 1. elevated BUN/Cr in 20:1 ratio 2. FeNa <1% 3. Low urine sodium <20 Prostate Hypertrophy 1. BUN/Cr <20 2. FeNa >2% 3. Urine Na >20
265
What is the indication for Clozapine? What are 6 adverse effects? Which adverse effect is dose-dependent?
``` Treatment resistant psychosis Adverse fx: 1. Agranulocytosis 2. Seizures - DOSE DEPENDENT 3. Myocarditis 4. Bowel Obstruction - anticholinergic/serotonergic 5. Urinary retention - muscarinic antagonism - can cause UTI 6. Sialorrhea - M4 agonist ```
266
What is the screen teset for lead poisoning?
Blood lead level
267
What is the best diagnostic test for Grave's Disease?
Radioiodine uptake scan
268
What is dx: newborn deliverd by vacuum assisted delivery. Has soft nonpitting edema of the occiput that crosses the lambdoidal suture lines. Tx?
Caput succedaneum - -edema under scalp, above galeal aponeurosis - -Crosses suture line Tx: no tx, will spontaneously resolve
269
What is dx: | newborn deliverd by vacuum assisted delivery. Has edema of the occiput that does NOT cross the lambdoidal suture lines.
Cephalohematoma - -collection of blood beneath the Periosteum of one of the calvarial bones - -usually unilateral
270
What is dx: | newborn deliverd by vacuum assisted delivery. Has "boggy" swelling of the occiput
Subgaleal hemorrhage --collection of blood underneath epicraneal aponeurosis --Boggy (caput succedaneum is soft and nonpitting)
271
What is Lasegue's test
Straight leg raise test -coupled w braggard's test to confirm neurologic vs tight hamstring etiology (lower straight leg below pain level and dorsiflex foot)
272
What can be caused by the use of vasopressors in pts w low cardiac output?
Non-occlusive mesenteric ischemia | --Vasopressors (epi, norepi, digoxin) can cause splanchnic vasoconstriction
273
What is dx: | new born w cryptorchidism, hypoplastic lungs, cardiac mumur, bulging abdomen. Radiography reveals dilated ureters
``` Prune belly syndrome 1. abnormal abd musculature 2 Renal dysplasia 3. tortuous/dilated ureters 4. enlarged bladder 5. cardiac/GI anomalies 6. cryptorchidism 7. underdeveloped prostate 8. pulm hypoplasia 9. club foot ```
274
What is next step in 35 yr old female w prolactinoma started on bromocriptine. follow up labs show no change in prolactin level
Cabergoline trial --then surgical intervention is not effective Dopamine agnoists (cabergoline, bromocriptine)
275
What are components of WAGR syndrome?
Wilms tumor (nephroblastoma) Aniridia Genitourinary malformations Retardation
276
What is the chapmans point in a pt w cataracts?
Lateral humerus at level of surgical neck
277
What is the tx for akithisia?
lower dosage or switching antipsychotic and propranolol or benzo
278
What is the malaria prophylaxis for a pt traveling to Kenya in two days? contraindications?
Atovaquone-proguanil ---region of P. falciparium predominance -contraindicated in pregnancy or renal failure Mefloquine - not given in pt w psyche or depression
279
What is the Ann Arbor staging of Hodgkin's lymphoma? 1. Stage I 2. Stage II 3. Stage III 4. Stage IV
1. 1 lymph node involved 2. 2 or more lymph node + same side of diaphragm 3. spread to both sides of diaphragm 4. involves extralymphatic tissue (liver, bone marrow, lungs)
280
What are the stages of Chronic Renal Failure based on GFR?
Stage 1: Normal GFR > 90 2: 60-89 mL/min 3: 30-59 4: 14-29 5: <15
281
What are absolute indications for hemodialysis?
AEIOU: 1. Acidosis (metabolic) 2. Electrolytes (severe hyperkalemia) 3. Intoxications (lithium, aspirin, methanol, ethylene glycol) 4. Overload (CHF) 5. Uremia (Uremic pericarditis)
282
What is the most effective emergency contraceptive?
Copper intrauterine device
283
What are lab findings in Paget disease of bone?
Normal Calcium + Phos Elevated Alkaline Phosphatase Bone Turnover markers (PINP, urine hydroxyproline)
284
What metabolic effects do Chlorthalidone and drugs like it cause?
Glucose Intolerance - --impair insulin release from pancreas + peripheral glucose uptake - ---seen in pt w metabolic syndrome (HTN, Dyslipidemia, abdominal obesity
285
What is the difference between chronic hypertension and gestational hypertension in pregnancy?
Chronic - htn prior to conception or 20 weeks gestation Gestational - new onset htn at >or equal 20 weeks gestation
286
What is dx: 29 year old woman w CP, Dyspnea. pain is bilateral, dull, persistent, not worsened by exertion. PMH: vaginal delivery 3 months ago followed by episodes of dark, bloody vaginal discharge. most recent bleeding was 6 days ago. Pelvic exam shows enlarged uterus, closed cervix, dark blood. CXR: multiple bilateral infiltrates of various shapes
Choriocarcinoma - arises from placental trophoblastic tissue | --Dx: quantitative B-hCG
287
What is the initial evaluation of adrenal insufficiency?
1. 8am serum cortisol 2. plasma ACTH - -ACTH (cosyntropin) stimulation test - is performed concurrently b/c it is fast - --no rise in cortisol = PAI
288
Which psyche med is associated with HEPATOTOXICITY, tremor, thrombocytopenia, alopecia?
Valproate - anticonvulsant mood stabilizer
289
What circumstances would the following be found on peripheral smear: 1. Basophilic stippling 2. Heinz bodies 3. Bite cells 4. Howell-Jolly bodies 5. helmet cells
1. basophilic stippling: thalassemias, lead/metal poisoning 2. Heinz: thalassemia, G6PD deficiency 3. Bite Cells: removal of heinz bodies by phagocytes 4. Howell: nuclear remnants of rbc's removed by fxnal spleen. present in asplenism (ie sickle cell) 5. helmet cells (schistocytes) - DIC, HUS, TTP, traumatic microangiopathic hemolytic conditions
290
Which antibody is most sensitive for ruling out drug-induced lupus?
Anti-histone
291
``` What is dx: LH:FSH ratio = 2:1 Hirsutism Oligomenorrhea, amenorrhea acne ``` what is the treatment to address hirsutism
PCOS | --Spironolactone addresses for hirsutism
292
What is the tx for gestational diabetes for the mother?
Tx begins w diet and exercise - add insulin or sulfonlyurea (glyburide) if not efficient - --DONT PRESCRIBE METFORMIN
293
What are 4 complications related to ADPCKD
1. Hepatic cysts 2. Intracerebral berry aneurysms 3. THORACIC aortic aneurysms 4. Valvular heart disease (MNP, AR most common) -also colonic diverticula
294
What is dx? Cell marker? 60 y/o w 5 weeks hx of painless mass on neck that spontaneously enlarges and decreases in size. PMH of pneumonia 5x in past 6 months. Enlarged anterior cervical lymph node. Splenomegaly, petechiae. CBC: neutropenia, thrombocytopenia, lymphocytosis Peripheral: lymphocytosis w small, mature lymphocytes, "smudge cells"
Chronic lymphocytic leukemia (CLL) *CD5 = HIGHLY sensitive for CLL when ruling out other dz
295
What is initial step in treating spinal cord damage/compression?
Prompt corticosteroid administration
296
What is the appropriate prenatal preventative measure for pt at high-risk for neural tube defects?
4.0 mg folic acid daily
297
What is next step for pt w guaiac positive nipple discharge?
surgery for tx and dx confirmation
298
Which drug can slow the progression of ALS?
Riluzole
299
What is dx, 1st/2nd line tx? 55 yr old w low back pain, radiates to left butt and thigh. Pain is worse when walking down stairs and relieved by sitting. weakness of L leg
Lumbar spinal stenosis 1st line tx: NSAIDs 2nd line tx: Steroid injection
300
What are xray findings of: 1. Alpha-1-antitrypsin deficiency 2. COPD?
1. Panacinar emphysema = Hyperlucency at lung bases | 2. Centrilobular emphysema = Hyperlucency at lung apices
301
What is first line TX for ascites?
salt restriction + Spironolactone or Furosemide HCTZ is not used to preserve potassium
302
Which nerve roots are affected in: 1. Erb-Duchenne 2. Klumpke
1. C5-C6 | 2. C8-T1, sometimes Horner's sx
303
what is dx: 25 yr old female w 6 weeks dyspnea fatigue, pallor, scleral icterus, mild jaundice, splenomegaly. Elevated indirect bilirubin, lactate dehydrogenase. Peripheral smear: spherocytes w/o central pallor. Direct Coombs test is positive
Autoimmune hemolytic anemia - pallor, jaundice, splenomegaly, lab findings - positive Coombs test
304
What is dx? associated condition? 64 year old from china has progressive L neck swelling, nasal congestion, frequent epistaxis, H/A, hx of rhinosinusitis. Nasopharyngoscopy shows mass in posterior nasal cavity. Bx shows poorly differentiated carcinoma
Nasopharyngeal carcinoma - -a/w reactivation of Epstein Barr Virus - -endemic to southern China, Africa, Middle East
305
What is the management of lactation suppression in a pt whose child died?
NSAIDs + supportive bra --dopamine agonist therapy is NOT FDA approved
306
What is dx: 18 year old african american with polyuria. Mother died at 32 of a stroke. Urinalysis is negative except for specific gravity of 1.001
Hypothenuria --polyuria + Low urine specific gravity (normal is 1.01-1.03) + normal serum sodium From Sickle cell trait - sickled RBC's impair free water reabsorption + counter current exchange
307
What is the follow up after a suction curettage of a hyatidiform mole?
1. contraception 2. Weekly B-hCG until undetectable 3. Monthly B-hCG for 6 months 4. can retry conception if B-hCG negative
308
What is dx? Tx? | Girl w episodes of sinusitis, streptococcal bacteremia. Giardia infection. 5th percentile of weight, hx of asthma
CVID - abnormal B-cell differentiation = deficiency of IgG + IgA or IgM Tx: IVIG infusion
309
What is the most appropriate way to limit risk of infection of household contacts in a pt w whooping cough?
Macrolide Abx for all household contacts
310
What is dx: 11 year old with SCD presents w shortness of breath, weakness, fatigue. no fever, cough. He has tachycardia, 3/6 systolic murmur is hear throughout the precordium. No hepatosplenomegaly. Lungs are CTA. Hgb - 4.5. Reticulocytes: 0.1%
Aplastic Crisis - sever anemia + low reticulocytes (<1%) + no splenomegaly - -sudden halt in rbc production - -systolic murmur is from hyperdynamic blood flow --can be caused by Parvovirus B19 WITHOUT PRECEDING VIRAL SYMPTOMS Tx: Blood transfusions
311
What is the management of diabetic nephropathy once macroproteinuria develops?
Intensive Blood pressure control (target: 130/80)
312
What type of hypertensive medications can benefit a pt w calcium oxalate kidney stones?
thiazide diuretics - compensatory rise in sodium + water reabsorption = increase passive reabsorption of calcium
313
How is a 1cm palpable, firm, round breast mass managed in a 36 year old patient?
Mammography, if suspicious - core biopsy Age <30: US +- Mamm Age >30: Mamm
314
What is the posterior chapman's point a/w the appendix? Segmental innervation?
Tip of transverse process of T11 T12 on the right
315
Which lab value is an accurate measure to monitor heparin in a pt being treated for DVT?
PTT - levels will increase within 6 hrs of administration
316
How are inversion ankle sprains classified?
Type I : just ATFL Type II: ATFL + FCL Type III: ATFL + FCL + PTFL
317
Which nerve roots are most likely affected: | Acute back pain, radiates to anterior thigh and medial aspect of calf
L2/3/4 - anterior thigh + medialcalf
318
What is the most common location for compartment syndrome of the leg?
anterior compartment
319
which tx/chemotherapy agent should be used in a 55 yr old w incidentally found GIST positive for c-kit mutation?
wide surgical excision + | imatinib (c-kit is a tyrosine kinase mutation that causes proliferation of GISTs that is inhibited by imatinib)
320
How do you differentiate a Peritonsillar abscess and Retropharyngeal abscess?
Both have muffle "hot potato" voice, fever, trismus peritonsillar - uvula deviation (US to differentiate between cellulitis and abscess) retropharyngeal: Neck stiff, neck pain, tenderness - -use CT w IV contrast if physical exam cant distinguish
321
What is the Treatment of superficial thrombophlebitis?
NSAIDs, elevation ,support stockings REPEAT PHYs EXAM within 7 to 10 days to look for progression. Anticoag + surgery only considered if thrombosis extends to deep veins --DUPLEX US to rule out DVT if signs of progression
322
What is dx? prevention? tx? contagious period? | 5 year old w fever, coryza, cough, conjunctivitis, erythematous + maculopapular rash, blue-white spost on buccal mucosa
Rubeola (measles) Prevention: MMR Vaccine Tx: Vitamin A contagious period: 4 days after onset of maculopapular rash(child can return to school in 5 days)
323
What is dx? management? what is at higher risk? | 32 yr AA at 18 weeks gestation. has noticed facial hair and acne. US shows bilateral 7cm solid masses in the ovaries
Dx: Luteoma of pregnancy - -benign, occurs more often in AA's - -hyperandrogenism Tx: Observation/Expectant management --Luteomas regress spontaneously after delivery * Female fetus at high risk of virilization - -higher risk of ovarian torsion * Theca luteum cysts are not Solid onUS
324
What is criteria for infantile colic?
excessive crying for >3hrs/day, >3days/week over a period of >3 weeks - resolves spontaneously by 4 months - review consoling techniques w parents
325
what is dx? 27 yr old nulliparous pt w intermittent left pelvic pain over last 8 months. Pt is sexually active, stopped taking ocp 2 yrs ago. LMP was 2 weeks ago. Normal sized uterus, enlarged left adnexa. US shows homogeneous cystic-appearing mass on left ovary.
Endometriosis - mass = endometrioma | --infertility can be improved by surgical resection
326
What is dx: 62 yrs old w occasional ear pain + hard, non-tender submandibular mass that is 3 cm in diameter. on HCTZ, Metformin. smokes two packs of cigarettes per day.
Squamous cell carcinoma - -Hard unilateral, non-tender lymph nodes = suspicious for Ca - -Vast majority of Head/Neck cancer is SCC.
327
What is dx? maternal exposure? tx? 1 day old boy w macrocephaly and jaundice. Mother went to Zambia during first trimester. Had fever for 2 weeks, swollen glands, and muscle aches that resolved spontaneously. Head CT shows hydrocephalus + diffuse intracranial calcifications.
Congenital toxoplasmosis Exposures: Undercooked meat, Unwashed fruits/veggies, Cat feces Dx: from serology Tx: Pyrimethamine, Sulfadiazine, Folate for a year
328
What is tx: 1. STI empiric 2. Confirmed just Chlamydia 3. Confirmed just Gonorrhea
1. Azithromycin/Doxycycline + Ceftriaxone 2. Azithromycin/Doxycycline 3. Azithromycin/Doxycycline + Ceftriaxone (From high false negative rates) Azithromycin is preferred b/c it is single dose + safe during pregnancy
329
what are neuroimaging findings most likely found in a schizophrenia patient?
Lateral ventricular enlargement | loss of cortical tissue
330
What is the management of cryptorchid testes in a pt with complete androgen insensitivity syndrome?
Gonadectomy after puberty | --cryptorchid gonads have a risk of developing a dysgerminoma or gonadoblastoma after puberty
331
What is dx? Tx? 50 yr old w persistent cough, started 5 days ago productive w yellow sputum. Bilateral upper extremity arthralgia. 99.2 F, Pulmonary exam reveal scattered rhonchi
Viral Acute Bronchitis - Productive cough that lasts up to 20 days - Commonly a/w Arthralgia - Tx: supportive therapy: - dextromethrophan - acetaminophen
332
What is dx: 68 yr old woman w severe fatigue, weightloss, shortness of breath. BP 118/72. Diastolic sound followed by solft diastolic murmur
Myxoma - most common primary heart tumor --commonly presents in R or L atria -"ball valve" obstruction of mitral valve = Early diastolic sound followed by diastolic murmur
333
What is the tx: 46 female undergoes total thyroidectomy for papillary carcinoma. 3rd day post op she has perioral numbness and tingling of the fingers. Serum Ca is 8.0
1. Ca>7.5: oral calcium carbonate or calcium citrate 2. moderate: increase dose or calcitriol 3. Laryngospasm or Arrhythmia: IV Ca Gluconate
334
Dx: mole that looks like brown plaque w feeling of velvet
Seborrheic keratosis
335
Dx: dysphagis w solids. Serum iron level 150. Upper endoscopy shows circumferential membrane in distal esophagus at the squamocolumnar jxn
Schatzki's ring
336
What is choanal atresia?
Blockage of nasal passage | -Inability to insert NG tube
337
What is prophylactic treatment for cluster headaches? initial treatment?
Verapamil, prednisone, valproic acid, topiramate, ergotamine Initial tx: 100% oxygen
338
what is dx: 45 year olf female w pmh of cholecystectomy w 6 hour hx of RLQ pain. Constipation, episode of vomiting. Experiencing hallucinations. Upper extrmity weakness, tachycardia, Urinalysis has elevated level of aminovulini acid
Acute intermittent porphyria --porpyobilinogen deaminase deficiency =elevated aminolevulini acid + porphobilinogen Sx: Acute Abd pain, vomiting, constipation, tachycardia, HTN, muscle weakness, extremity pain, Psyche Sx' --NOT a/w rash (unlike other types of porphyria)
339
What Chapman's point is associated with Otitis media?
Clavicle lateral to where they cross the first ribs | --some say it located on first rib
340
What is the most common cause of epididymitis in a 31 year old patient?
<35: Chlamydia | >35: E. Coli
341
What is difference between deficiency in Cobalamin and Folate?
Cobalamin (B12) - Neuro Sx, elevated MMA + homocysteine, B12 levels may or many no be decreased Folate (B9) - ONLY Homocysteine is elevated
342
What is the CO, PCWP, SVR in: 1. Cardiogenic shock 2. Neurogenic shock 3. Septic shock 4. Hypovolemic shock
1. Low CO, High PCWP, High SVR 2. Low CO, Low PCWP, Low SVR 3. High CO, Low PCWP, Low SVR 4. Low CO, Low PCWP, High SVR
343
What are contraindications for Bupropion? Why do some pts prefer it?
Norepi + Dopa reuptake inhibitor --Does not cause weight gain or sexual dysfunction Contraindications: 1. Seizures 2. Eating disorders - electrolyte abnormalities can ppt seizures 3. Recent MAO-i use
344
What is the abx used for Actinomyces?
penicillin
345
What should physician do in a nonemergency situation in which a parent refuses potentially life-saving treatment for their child?
Seek a court order mandating treatment
346
How do you calculate Attributable risk percent?
ARP = (risk in exposed - risk in unexposed)/risk in exposed ARP = (RR-1)/RR ARP is excess risk in a population that can be explained by exposure to a particular risk factor
347
What is dx? tx? Pt w pruritic lesions. started w papule on index finger that ulcerated and drained odorless nonpurulent discharge. Developed similar nodules on right forearm. Works as landscaper and lives w cat. Nonfebrile. Several proximal nontender subq nodules on forearm. no lymphadenopathy
Sporotrichosis (Dimorphic fungus from decaying vegetation) culture lesions/sputum = cigar-shaped yeast Sx: Fever, Hemoptysis, Produtive cough (in pulmonary infection) skin papule - ulceration w nonpurulent drainage proximal lesions along lymphatic chain Tx: 3-6 months of Oral Itraconazole
348
What is dx? usual organsims? pain/swelling of inner aspect of eye for past 2 days. Tenderness, edema, redness over medial canthus. Slight pressure over area causes expression of puruelnt material. Visual acuity is normal.
Dacryocystitis - infection of the lacrimal sac - -pain/redness in medial canthal region - purulent discharge -usual: S. aureus, B-hemolytic Strep
349
What is the preferred management of: 1. unilateral adrenal adenoma 2. bilateral adrenal hyperplasia
1. surgery | 2. aldosterone antagonists
350
what is the next step in management of decreased fetal movements?
Non-stress test: fetal compromise should be suspected
351
What is the diagnostic and treatment modality of intussusception in a 22 month old child?
Air or saline enema under sonographic or fluoroscopic guidance -surgery if it does not reduce
352
What is dx? etiology? other causes? dx modality? 32 year old w 6 months of progressive weakness, exertional dyspnea. PMHofr stab wound to right thigh 10 months ago. BP is 160/60, HR 100. R leg feels warm appears flush. Carotid upstroke is brisk. PMI is displace to the left. soft systolic murmur is hear over apex that does not change w Valsalva
High Output HF - Stab wound created AV Fistula - more shunting of blood bypassing capillary bed = chronic higher preload - compensatory rise in HR, SV to meet O2 demands of periperal tissue. Other causes: Thyrotoxicosis, Paget dz, anemia, thiamine deficiency dx extremity AVF w Doppler US
353
What is dx: 52 yr old w rapidly progressing dementia, behavioral abnormalities, myoclonus. EEG shows sharp, triphasic, synchronous discharges
Creutzfeldt-Jakob dz | --spongiform encephalopathy caused by a prion
354
What are lab findings of Acute mesenteric ischemia? what is the treatment of choice?
Leukocytosis Elevated amylase Elevated phosphate Metabolic acidosis (elevated lactate) Tx: Heparin anticoagulation
355
What is the management of 31 yr old pt w HSIL on recent pap test. Not pregnant. Cervical intraepithelial neoplasia 3 is found. what are the next steps?
Colposcopy + cervical bx CIN3 All nonpregnang pts age >25 require excision of transformation zone (Conization) or LEEP, Cryoablation Then Pap test w HPV 1 and 2 years post procedure if margins are clear
356
What is dx? findings at L5? | Positive seated flexin test on left. Shallow L sacral sulcus, Anterior R inf lat angle. positve lumbosacral spring
Left on Right Sacral torsion | L5: FRS Right
357
What are rules of L5 sacral mechanics?
1. L5 is ALWAYS sidebent towards side of axis in both Forwards and Backwards torsions 2. Backward torsions: L5 follows Type II, Rotates towards same side as axis
358
What are Sx/lab findings in a pt w a VIPoma? Tx?
VIPoma = vasoactive intestinal polypeptide secreting tumors of the pancrease Sx: watery diarrhea, Hypochlorhydria Labs: Hyperglycemia, Hypokalemia, elevated serum VIP US/CT can show tumor Tx: Octeotide
359
What is dx: 6 month old w seizures. Microcephaly, jaundice, hepatosplenomegaly, Hearing loss. Ct scan shows periventricular calcifications
CMV infection (most common TORCH infection) Sx: Petechiae, Periventricular calcifications, hearing loss, visual loss, siezures
360
What is the treatment of choice for trigeminal neuralgia?
Anticonvulsants: Carbamazepine
361
What are Strengths and weaknesses of Case-Control Studies?
Case-control studies identify relationships b/w exposures and dz outcomes Strengths: Require comparatively few subjects (cant study rare dz), can study multiple different risk factors Weakness: hard to make conclusion about correlations (randomized control trials,cohort studies are better at making conclusions about correlations)
362
What is the definition of sepsis? Septic shock? Tx for shock?
``` Documented infection and meets Systemi Inflammatory Response Syndrome criteria: 2 of 4 1. <36C, 96.8F 2. >38C, 100.4 F 3. RR > 20/min 4. WBC <4000 or >12000 ``` Septic Shock = Sepsis + hypotension Tx: Agressive fluid replacement >4L First line: Norepi to maintain MAP of 65
363
How are Missed and Completed Abortions different?
Completed: before 20 weeks gestation, passage of all products of conception, vaginal bleeding, Closed cervical os Tx: follow B-hCG closely Missed: dx'd w US revealing nonviable pregnancy. Vaginal bleeding and cramping are NOT present. closed cervical os
364
What is the tx of restless leg syndrome? What else is always indicated?
``` Dopamine agonists: Pramipexole Ropinirole Levodopa/carbidopa Bromocriptine ``` Iron replacement is always indicated
365
What is med? | Pt overdosed on psyche med. Has ataxia with muscular weakness and heightened reflexes
Lithium
366
What is dx? action to prevent? | Pt w SCD has Hb of 4. transfused w 3 units of packed rbc's. After 30 min complains of chills, nausea, temp of 101.
Non-hemolytic febrile reaction --response to cytokines that build up in the blood products during storage -Use leukocyte-washed blood products
367
What does the thymus look like in children <3yrs old on a CXR?
visible on CXR in children <3 yrs | "Sail Sign" - triangular shape, scalloped border, uniform density
368
What is the medication of choice for pediatric depression?
Fluoxetine or psychotherapy
369
What is the empiric abx for human bite wounds
Amoxicilllin-Clavulanate | --coverage of gram positive/negative, beta-lactamase producing oral anaerobic organisms
370
What are the three recommended? vaccines during pregnancy? | High risk?
Recommended: Tdap Inactivated Influenza Rho(D) immunoglobulin ``` High risk: Hep B, A Pneumococcus H. flu Meningococcus Varicella immunoglobulin ```
371
Which Vaccines are contraindicated during pregnancy?
HPV MMR Live attenuated influenza Varicella
372
What are lab findings of Hyper IgM syndrome? Molecular cause?
Sinopulmonayr infections Normal B cells decreased IgG, IgA increased IgM X-linked defect in CD40 ligand
373
What is the likely cause cardiac arrest of a MVA pt who is severely hypotensive, given IV fluids and placed on mechanical ventilation?
- -hypovolemia causes decreased Central venous pressure - -Positive pressure mechanical ventilation can cause collapse venous vessels and cut off RV preload = loss of CO = cardiac arrest
374
What is the workup for a newborn born a 4.8 with loose skin, large anterior fontanel. no costal retractions or grunting.
Child has Fetal growth restriction | --Send Placenta for histopathologic examination to assess for infection and/or infarction
375
What is the tx choice for ADHD in an adult with substance abuse hx?
Atomoxetine (Norepi reuptake inhibitor)
376
What is the management of uncomplicated cystitis in a nonpregnant woman?
Preferred tx: TMP-SMX (3days), Nitrofurantoin (5days0, fosfomycin (single dose) Fluorquinolones are reserved as 2nd line Urine Culture is initial tx fails
377
What is the dx criteria for major depressive disorder?
atleast 5 Sx: SIG E CAPS ``` Sleed disturbance Interest loss Guilt Energy low Concentration impairment Appetite changes Psychomotor retardation/agitation Suicidal thoughts ```
378
What is the most accurate way to determining gestational age?
First trimester ultrasound | with crown-rump length measurement
379
How are Preseptal cellulitis and Orbita cellulitis different? Sx? Tx?
Preseptal: eyelid erythema/swelling, chemosis Tx: Oral Abx Orbital Cellulitis - bacterial infection Posterior to orbital septum, involves muscles of EOM Sx: Pain w EOM, proptosis &/or ophthalmoplegia w diplopia Tx: IV abx, or surgery
380
Dysregulation of which neurotransmitters is the primary cause of neuroleptic malignant syndrome
Dopamine | --Antipsychotics (D2 receptor antagonism)
381
What do Atypical glandular cells on Pap testing suggest? what is next step in management?
AGC's can be either Cervical or Endometrial Adenocarcinoma ACG in women atleast 35 or <35 w risk factors requries eval for endometrial cancer (Entometrial Bx) with Cervical pathology
382
What is dx: ophth findings? Pt reports progressive visual loss. When closing one eye and looking at small spon on grid made of parallel vertical and horizontal lines he describes the vertical lines as being besnt and wavy.
Macular degernation - leading cause of blindness in industrialized countries. - -distortion of straight lines - Ophth exam - DRUSEN deposits in macula
383
what is 1. internal validity 2. external validity
1. test restuls only correspond to the sample population | 2. test results are generalizable to other populations and situations
384
What is the follow up for a 40 yr old pt dx'd w hypothyroidsm today and started on levothyroxine?
re-evaluate TSH levels 4-6 weeks after initiation of levothyroxine
385
Wife calls and asks her for her husbands medical records. What should you do to prevent lawsuit?
Request written consent from patient and provide Medical records withing 5 working days
386
How is exercise induced asthma diagnosed?
Bronchoprovocation (Methacholine-challenge test) | --Measure lung fxn before and after methacholine administration.
387
What is the fluid of choice for burns in the first 24 hours after injury?
Ringer's Lactate - most closely resembles normal extracellular fluid (capillaries become leaky)
388
How is total body surface area calculated for burns?
Head: 9% (4.5 for posterior, 4.5 anterior) Anterior trunk: 18% (9% chest, 9% abdomen) Posterior trunk: 18% (upper, mid, low back plus butt) Each upper extremity : 9% Each lower extremity 18% Genitalia: 1%
389
What is the next workup in a pt with 7am glucose measurement of 215 mg/dL before breakfast and insulin adminstration? What are you trying to distinguish? What should be done in each case?
Measure glucose at 3am --differentiates between Somogyi effect and Dawn phenomenon Somogyi: overtx: pt becomes hypoglycemic overnight (3am glucose will be low), so pt's body counters and become hyperglycemic in the morning --Tx: Decrease NPH at dinner Dawn phenomenon: Early morning (3am) GH secretion antagonizes insulin so pt's will be hyperglycemic in the middle of the night --Tx: Increase basal insulin at dinner (Glargine and Detemir provide more stable control of overnight insulin than NPH)
390
What is the orientation of the superior facets in the: 1. Cervical region 2. Thoracic region 3. Lumbar region
1. BUM (backward/upward/medial) 2. BUL (backward/upward/lateral) 3. BUM (backward/upward/medial)
391
What is dx? tx? pt w abdominal pain. was discharged from hospital after acute pancreatitis two weeks ago. Pt is afebrile, Serum amylase is elevated. CT scan shows 4cm cyst on pancreatis tail.
``` Pancreatis pseudocysts (collection of pancreatic fluid) --common after onset of acute pancreatitis ``` Tx: if <6cm, no infection = NPO and observation if >6cm: endoscopic cystogastostomy or cysduodenostomy (cyst will drain to stomach or duodenum)
392
What is the treatment of Pelvic inflammatory disease?
Third-gen Cephalosporin + Azithromycin or Doxycycline
393
What is the most common risk factor for orbital cellulitis?
Sinusitis (particularly of the ethmoid or maxillary sinuses)
394
What is dx? next step in management? 4 day old, full-term,exclusively breastfed since birth for 10 mins each breast. Mother's milk began to come in this morning. Infant passed several dark brown, sticky, meconium stools during first 2 days of life, but his last stool was yesterday and dark green. No voided today. Scleral icterus, jaundice, Total bilirubin: 14 mg/dL Direct bilirubin 0.9 mg/dL
Breastfeeding jaundice -Insufficient intake of breast milk = Decreased bilirubin elimination Increased enterhepatic circulation
395
When is Tympanocentesis and culture w Tympanostomy tube placement indicated?
Multiple episodes of AOM (at least 3 episodes in 6 months, or atleast 4 episodes in 12 months) despite appropriate abx treatment
396
What is dx? what is pt at higher risk for? 43 yr old w erectile dysfunction. Drinkgs 1-2 beers every day, 20 pack year smoking hx. BMI is 29. Skin has brownish skin pigmentation. R knee xray has chondrocalcinosis. Fasting glucose 130 AST 78 ALT 80
Hereditary Hemochromatosis --Bronze diabetes --arthralgia (Chondrocalcinosis = pseudogout), elevated hepatic enzymes, Secondary HYPOgonadism, HYPOthyroidism Restrictive or dilated CARDIOMYOPATHY, conduction abnormalities Increase susceptibility to Listeria, Vibrio vulnificus, and Yersinia enterocolitica Increased risk for Hepatocellular Cancer
397
What is medication choice in younger pt with parkinson's wheretremor is primary symptom?
Trihexyphenidyl (Anticholinergic)
398
What is the cause of hypercalcemia in a quadriplegic patient 4 weeks after injury? Tx?
Immobilization - symptomatic hypercalcemia (nausea, polyuria) - suppressed PTH --from increased osteoclastic bone resorption Tx: Bisphospnates
399
What is dx modality? management? 31 yr old woman at 8 weeks gestation w nausea vomiting epigastric pain, dizziness. Unable to tolerate oral intake for past day. BP 90/50, pulse 114/min. current weight is 121.3lb, a decrease of 6.6lb from her prepregnancy weight. Dry mucous membranes, decreased skin turgor. Tachycardia. US shows 3 week twin intrauterine gestation.
Hyperemesis gravidarum - Urinalysis for ketones Severe HG is an indication for hospital admission for IV antiemetics, rehydration, electrolyte repletion --HG is typically unresponsive to oral antiemetics
400
what is the next step when DiGeorge Syndrome is suspected?
Serum calcium levels | Echocardiography
401
What is dx? related nerve injury? | arm in abduction is forced backwards. Pt holds arm in slight abduction and external rotation
Anterior shoulder dislocation | --Axillary nerve damage - abduction weakness
402
Antiphospholipid antibody syndrome is a common cause of a false positive in what test?
VDRL
403
What is dx? 10 year old boy w headache, vomiting, visual disturbances. nonbloody, nonbilious emesis. Neuro exam shows bilateral upper eyelid retraction and limitation of upward gaze with a preference for downward gaze. Pupils react sluggishly to light but respond appropriately to accommodation. DTRs are normal.
Pinealoma: (germ cell tumors) 1. Parinaud syndrome (dorsal midbrain) - limited upward gaze - Collier sign (upper eyelid retraction) - Pupils non-reactive to light, reactive to accommodation 2. Obstructive hydrocephalus - papilledema - headache, vomiting - Ataxia
404
What are clinical associations with Adenocarcinoma of lung
Peripheral location Clubbing Hypertrophic osteoarthropathy
405
What are clinical associations with Squamous Cell Carcinoma of Lung
Central Location - Necrosis and cavitation | Hypercalcemia
406
What are clinical associations with Small Cell Carcinoma of the Lung
Central Location Cushing syndrome SIADH Lambert-Eaton syndrome
407
What are clinical associations with Large cell carcinoma of the lung
Peripheral location Gynecomastia Galactorrhea
408
What is first line treatment for Tinea corporis (ringworm)
Topical Clotrimazole | Topical Terbinafine
409
What is dx? therapy? 55 year old male has scattered erythe atous patches across back that has progressed to more raised and scaly lesions. axillayr lymphadenopathy is present. Bx of lesions show abnormal T-cell infiltrates
Mycosis Fungoides -Most common type of cutaneous T-cell lymphoma, (non-Hodgkin lymphoma) Therapy: mostly topical (radiation, photochemo, laser surgical excision) higher stages is systemic chemo
410
What is the first line for C. diff colitis?
Stop offending abx Oral Vancomycin or fidaxomicin can be used
411
What is the INR goal in: 1. chronic A fib, DVT, PE 2. mechanical heart valves? 3. post MI 4. Antiphospholipid syndrome
1. 2-3 2. 2.5-3.5 3. 2.5-3.5 4. 2.5-3.5
412
How is Toxic shock syndrom usually treated?
IV fluids IV nafcillin Aminoglycoside
413
What is the test of choice to dx diverticulosis?
Colonoscopy
414
What serum marker can be used to monitor re occurrence of colonic adenocarcinoma?
CEA | -measure levels prior to surgical resection
415
What is the most likely finding on blood culture of a pt with a aortic valve replacement 15 months ago w Bacterial endocarditis?
Late Prosthetic valve endocarditis (after 12 months post op) = Streptococcus species -usually subacute symptoms Early (<12 months post op) = S. epidermidis is most common
416
What nerve is affected in entrapment at Guyon's Canal? what are physical findings?
Ulnar N enter Guyon's cana w ulnar A. -Weakness in adduction/abduction of the digits, extending the PIP of little finger
417
What is the treatment choice for insulinoma? second line?
Surgical resection - Tumor is localized w UX or CT --poor surgical candidates consists of diazoxide
418
What is the Johnson classification used for? what are the classifications?
Used to classify PUD's Type I: ulcer along lesser curve of stomach Type II: condition where duodenal ulcer is also present Type III: prepyloric ulcer Type IV: prox gastro esophageal ulcer Type V: ulcer along gastric body
419
What is dx? management? 3 year old female with 6 month limp. Inflammation of left knee, right wrist, left ankle. Ophthalmologic exam reveals uveitis. No urinary symptoms Rheumatoid factor is negative
Pauciarticular onset juvenile rheumatoid arthritis - most common form of juvenil rheumatoid arthris **(4 or fewer joints affected)** - --(Polyarticular is 5 or more joints) - Rheumatoid factor will be negative -a/w: Uveitis, Iridocyclitis, Asymmetrical leg length Tx: NSAIDs + annual eye exams
420
What is likely dx: | 1 year old w facial angiofibromas, five hypomelanotic macules, seizures, intellectual disability
Tuberous Sclerosis - Hypomelanotic macules (ash leaf spots) - Seizures - Intellectual disability - Shagreen patch (cutaneous nevus) - orange peel consistency, lumbosacral region - Facial angiofibromas
421
What is likely dx: | 6 month old w 10 hyperpigmented macules throughout the body and freckled axillary area. Hamartomas of iris. Macrocephaly
Neurofibromatosis type 1 - Cafe-au-lait spots (6 or more) - neurofibromas - freckling of groin or axilla - skeletal abnormalities - Macrocephaly - Lisch nodules (Iris Hamartomas) - Learning disabilities
422
What is the management of a penile fracture with current urinary retention and dysuria?
Retrograde urethrogram then operative repair ``` indications for urethrogram: blood at meatus hematuria dysuria Urinary retention ```
423
what is management of pt w diverticulitis. given oral ciprofloxacin and metronidazole Three days later she returns w abd pain. Repeat CT shows 5 cm rim enhancing perisigmoid fluid collection
Fluid collection >3 cm = CT guided percutaneous drainage --<3cm IV abx, observation Surgical drainage and debridement if Sx are not controlled by 5th day.
424
What is next step if healthcare worker gets stuck whil drawing blood from HIV positive pt. pts most recent CD4 count is 90/uL, rial load is 300,000 copies/mL
Draw blood for HIV serology and start 3 drug antiretroviral therapy immediately --2NRTI + NNRTI or Integrase strand transfer inhibitor (raltegravir) or protease inhibitor
425
What is the next step in management?: 64 year old w 29 pack year smoking hx. has sore throat, 1.5 cm right cervical lymph node. bx shows metastatic squamous cell carcinoma
Panendoscopy (triple endoscopy = esophagoscopy, bronchoscopy, laryngoscopy) to detect primary tumor
426
What is dx? tx? 47 year old woman g4p4 w lower abd pain that is relieved with urination. urinary frequency, dyspareunia. palpation of Anterior Vaginal wall elitis severe pain. Urinalysis is normal
``` Interstitial cystitis (bladder pain syndrome) --more common in women a/w psychiatric & pain disorders (fibromyalgis) ``` - -bladder pain w filling, relief w voiding - -urinary frequency - -Dyspareunia - -Normal Urinalysis
427
Optimization of glycemic control in diabetes mellitus is a/w a reduced risk of what?
MICROvascular complications (nephropathy, retinopathy) Macro vascular benefits have not been firmly established (stroke, MI)
428
What is Mupirocin?
bactroban - topical abx for impetigo, MRSA
429
What is the pneumococcus immunization recommendation for a 60 year old smoker with COPD?
Age 19-64 PPSV23 alone --Chronic heart, lung, liver dz --Diabetics, current smokers, alcoholics PCV13 + PPSV23 - -CSF leaks, cochlear implants - -SCD, Asplenia - -Immunocompromise - Chronic kidney disease
430
``` What is dx? 4 month old boy after generalized tonic-clonic seizure. born at 40 weeks gestation at 50% percentile for height and weight. Since then he has had 3 episodes of URI's and otitis media. Today he is <5th percentile in weight. flat anterior fontanelle. Abdomen is protuberant, liver is palpable 4 cm below right costal margin. Labs: Bicarb 16 Glucose 38 Lactic acid 24 (normal 6-16) Ketonuria elevated Serum triglyceride, uric acid ```
Glucose-6-phosphatase deficiency (Type 1, von Gierke dz) --impaired glycogen to glucose conversion = glycogen accumulation in affected organs ``` Sx: 3-4 months hypoglycemia = seizures lactic acidosis hyperuricemia, hyper lipidemia Doll-like face, rounded cheeks ```
431
What is the dx modality of Premenstrual syndrome (PMS)? first line treatment?
Symptom diary over 2 menstrual cycles - -SSRI's are first line - -Combined OCPs are another tx option: estrogen containing meds are contraindicated in pt w migraines
432
Which meds can be used to augment an SSRI in a pt with major depression disorder with a partial response (25%-50% improvement)
Augmentation = 1. adding antidepressant w a different mechanism of action (ie Bupropion) 2. 2nd gen antipsychoti (aripiprazole) 3. lithium 4. triiodothyronine 5. psychotherapy
433
What is dx? preferred abx? pt just returned from a cruise to the bahamas comes in w fever, nonproductive cough, shortness of breah for 2 days, headache, abdominal pain, diarrhea for a day. hx of smoking. febrile, lungs have crackles bilaterally, serum glucose is normal, hyponatremia, CXR shows bilateral interstitial infiltrates
Legionella pneumonia --Contaminated water (Hospital, cruise, hotel) Sx: fever >101.8, bradycardia, GI, Pulm sx are delayed Dx: Hyponatremia, Lobar infiltrate, Sputum gram stain = PMN, few/no organisms Urine Legionella Ag Tx: Respirator fluoroquinolone, or newer macrolide
434
What is typical vaginal pH? what is the ph in candida vulvovaginitis? which situations cause elevated pH?
3.8-4.5 Candidal infection: vaginal pH is normal BV + trich = elevated pH
435
How are anterior rib tenderpoints treated?
anterior tenderpoints = depressed ribs treated w flexion, sidebending and rotation towards tenderpoint
436
How is Turner's syndrome treated in a 5 year old who has always been below the 5th percentril for height for her age?
HGH - indicated when height falls below 5th percentile Start on Estrogen/Progestin Therapy and Stop HGH once epiphyseal fusion has occurred Surgical consult for coarctation or aorta
437
What is the most significant risk factor for intraventricular hemorrhage in infants?
risk of IVH is inversely proportional to birth weight
438
What is the time period criteria in the dx of: 1. Acute Stress Disorder 2. PTSD
1. 3 days - 1 month | 2. >1 month
439
What is dx? tx? Immunocompromised pt w hemoptysis. 3 days of fever, pleuritis chest pain, and cough w thick brown sputum. No improvement w oral abx. CXR shows dense right upper lobe infiltrate. CT scan shows several nodular lesions w surrounding ground glass opacities in the right upper lobe. Suputm gram stain shows inflammatory cells but no organisms
Invasive aspergillosis -Triad: fever, pleuritic chest pain, hemoptysis CT: nodules w surrounding ground glass opacities (halo sign) Dx: serum biomarkers for cell wall components (galactomannan assay) and sputum stain/culture Tx: 1-2 IV voriconazole + echinocandin (caspofungin) then transition to prolonged therapy with oral voriconazole alone.
440
What is dx? management? pt in MVA with multiple injuries has multiple blood transfusions, chest tube, pelvis fixation. on 5th day he is minimally responsive and spontaneous respirations. Diminished bowel sounds, facial grimacing w palpation of the RUQ. NG tube aspiration shows retention of gastric contents. CT scans shows gaseous distention of small and large bowels w/o air fluid levels. Gallbladder is distended w no gallstones. small amount of pericholecystic fluid.
Acalculous cholecystitis - commonly seen in severely ill pts in icu w multiorgan failure, trauma, etc. - -Due to Cholestasis and gallbladder ischemia = secondary infection by enteric organisms = edema and necrosis of gallbladder. -Imaging: gallbladder wall thickening + distention and pericholecystic fluid. Management: Abx, percutaneous choleystostomy -once pt condition improves - cholecystectomy w drainage of abscesses
441
What is dx: 80 year old woman w 3+ peripheral edema. fatigue and SOB w activity. BP 140/75 JVD, no heart murmurs. Breath sounds are decreased at the bases bilaterally. Abdomen is distended w flank dullness on percussio. Hb 11.2 Sodium 132 Cr 0.9 Urine protein is 1g/24 hr Echo shows LA enlargement, marked concentric LVH, LV EF is 70% how is EDV, ESV, EF, Coronary Wall Thickness affected?
Restrictive cardiomyopathy - from Amyloidosis --aSx proteinuria or nephrotic syndrome waxy skin, anemia, easy bruising, hepatomegaly, gi bleeding, cardiac amyloidosis, subq nodules, Enlarged tongue, neuropathy EDV - decreased ESV - unchanged EF - unchanged CWT - unchanged
442
When are DEXA scans recommended by USPSTF?
one-teim DEXA screen for all women age >65 | and women <65 w equivalent risk from FRAX assessment tool
443
What is dx? treatment? 32 year old female w epistaxis, menorrhagia, bruising throughout the body. Labs show normal PT time, prolonged PTT time, prolonged bleeding time. Normal platelet count
vWillebrand Disease - binds both platelets and endothelial components = increased bleeding time - carries factor VIII in the blood = increased PTT Tx: Desmopressin (DDAVP) = increases circulating levels of vWF, Factor VIII --Complete deficiency ineven of major bleeding or unresponsiveness to desmopressin is factor VIII (with vWF)
444
what is dx: 4 year old w pruritic rashes on the antecubital folds, bilaterally. occurs every summer for the past 2 years. Multiple raised, erythematous patches
Atopic dermatitis - erythematous, pruritic, patches, may become elevated - a/w asthma, allergic rhinitis, increased IgE levels. - worsened w dry weather
445
wha are the indications for the different dx modalities for PE? what is the management?
Pulmonary angiogram - gold standard Helical CT scan of chest = often dx test of choice, no as accurate as angiogram Vent/perfusion scan = pt where contrast or radiation exposure is contraindicated (renal failure, pregnancy, contrast allergy) Management: Coumadin w heparin bridge - first time PE = anticoagulation for 3-6 months w warfarin
446
When is Rhogam administered?
All Rh negative mothers should receive RhoGAM at 28 weeks.
447
What is the dx? etiology? tx? 65 year old female w two blisters on dorsum of right hand. facial hypertrichosis, hyperpigmentation. denies abdominal pain. Serum and urine porphyrin are elevated.
Porphyria cutanea tarda - deficiency of uroporphyrinogen decarboxylase. - Sx: painless blistering of sun-exposed areas of the skin - that rupture and become crusted. Increased facial hair Tx: chloroquine or phlebotomy (in case of iron overload)
448
what is dx: 55 yr old w hx of rheumatic fever. Cardiac auscultation shows low-pitched diastolic murmur at left lower sternal border that is louder w inspiration
Tricuspid stenosis --R sided = murmur increases w increased R atrial return w inspiration --Mitral stenosis wil have increased murmur w exhalation
449
How d you distinguish syncope from tonic-clonic siezure
syncope - usually maintains bladder control grand-mal seizure - loss of bladder control
450
what is the appearance of Berylliosis on chest xray
Bilateral hilar lymphadenopathy - -indistinguishable from sarcoidosis - -Tx: glucocorticoids
451
what is the appearance of Silicosis on chest xray
Nodular opacitis in the upper lobe
452
what is the appearance of Asbestosis on chest xray
Bilateral opacities with pleural plaques
453
What is dx? 5 year old about to start school has 3 days fever and sore throat that makes him not feel like eating. Oropharyngeal examination shows multiple 1-mm vesicles on anterior tonsillar pillars. Several grayish ulcerated lesions are also seen in the posterior oropharyx. Nonteender cervical lymph nodes are palpable bilaterally
Herpangina - Coxsackie A virus -Summer/early fall seasonality -Sx: Fever, pharyngitis, GRAY vesicles/ulcers on TONSILLAR PILLARS and posterior oropharynx (HSV gingivostomatitis is generally localized to anterior oropharynx and lips)
454
What conditions can pulsus paradoxus be observed?
Cardiax tamponade | Asthma or COPD
455
What is dx: 38 yr old woman w incidental finding of intrahepatic cyst. on CT it is well-defined w eggshell calcification. Never travelled outside the US. has 2 pet dogs at home for 10 years
Hydatid cyst - Echinococcus granulosus | --"Eggshell" calcification
456
What is management of superficial thrombophlebitis?
NSAIDs, elevation, heat, support stockings - pts are encourage to ambulate - sx typically resolve in 7 to 10 days.
457
What is dx? etiology? 44 year old male w increased fatigue. hx of heavy alcohol abuse. Exam show spider angiomata, caput medusa, jaundice, gynecomastia, hemorrhoids, palmar erythema. Cr is 2.7 mg/dL. his pervious Cr 3 months ago was 1.1 mg/dL
Hepatorenal syndrome - from renal artery vasoconstriction - -splanchnic, systemic vasodilation that occurs in cirrhosis and portal HTN = increased CO + decrease SVR - -Sympathetics, Renin angiotensin system are activated to counteract the above = renal vasocontriction = decrease in GFR/renal failure.
458
what is the management: | 40 year old woman w fam hx of breast cancer has lesion on mammography. Stereotactic core needle bx shows LCIS
Excisional biopsy
459
What are pleural fluid findings in tuberculosis?
1. lymphocytes > 80% 2. greatly increased total protein 3. Adenosin deaminase >40 (less than 40 rules out TB)
460
What are pleural fluid findings in rheumatoid arthritis?
Extremely low pleural fluid glucose level | other: empyema, malignancy
461
What is the most common cardiac abnormality associated with Turner's Syndrome? Second most common?
Bicuspid Aortic Valve = most common Coarctation of Aorta = second most common
462
A 21 year old pt with symptoms of infectious mononucleosis presents with a maculopapular rash on her abdomen. She was prescribed a course of abx by her primary care physician. what was the most likely cause of her presentation
Amoxicillin and ampicillin = known to cause a mobilliform rash in EBV cases
463
What is the management of intussusception in a 3 year old
US = metho of choice in detection TX: Air or water soluble contrast enema reduction
464
What is most likely etiology: 3 year old girl w severe oral pain. Has similar sx before. pmh of 2 sinus infections and numerous episodes of cellulitis. Skin cultures from previous infections show S. aureus. and S. pyogenes. Exam shows periodontal inflammation w ulceration and necrosis
Defective leukocyte adhesion - recurrent skin infection (cellulitis, abscess, omphalitis) and mucosal (periodontal) infections - Bx of infected tissue is devoid of neutrophils - Labs showmarked leukocytosis w neutrophil predominance
465
A pt with bipolar disorder is prescribed a new medication. He then develops a rash. What is the most likely medication
Lamotrigine - mood stabilizer, anticonvulsant - Drug rash - -can cause SJS, TEN - drug should be discontinued at first sign of rash
466
How is the risk of preterm labor assessed? how is it managed?
No Hx of Preterm labor = evaluate w TVUS -if <2 cm = treat w vaginal progesterone to maintain uterine quiescence Positive Hx of Preterm labro = Progesterone injections and TVUS - if >2.5cm = serial TVUS - if <2.5cm = cerclage, serial TVUS
467
How are stress fractures of the foot managed?
Fx of 2nd, 3rd, 4th = managed conservatively (rest and simple analgesics) Fx of 5th metatarsal = casting or internal fixation (increased risk for nonunion)
468
What are the risk factors for neonatal respiratoyr distress syndrome?
1. Prematurity = most important 2. male sex 3. perinatal asphyxia 4. Maternal diabetes - increased insulin antagonizes cortisol and block maturation of sphingomyelin. 5. Cesarean section w/o labor
469
What is the management of an acute Multiple Sclerosis exacerbation?
Glucocorticoids (ie IV methylprednisolone) - hastens neurologic recovery --Plasmapheresis should be considered in patients w MS flare who are refractory to corticosteroid therapy
470
What is the dx? additional findings? 8 year old boy w slightly pruritis, erythematous lesion on buttocks and legs that coalesce and darken. Pt also has abdominal pain, nausea, 2 episodes of nonbilious emesis. Hx of seasonal allergies and moderate eczema. Passive range of motion of both hips elicits pain
Henoch-Schonlein --a/w Hematuria Tx: Supportive (hydration & NSAIDs) -hospitalization and systemic glucocorticoids in pts w severe sx
471
What is dx? management? 16 year old undergoes dilatation and curettage at 11 weeks gestation after missed abortion. 2 days later she has vag bleeding and abdominal pain. BP 105/70, 100.5F, pulse 105 Cervic is dilated 2cm and uterus is tender
Septic abortion --ascending infection into the uterus or retained products of conception after abortion Tx: IV abx and dilatation and curettage
472
What is the first step in management of a hypercalcemic crisis
Normal saline - keep urine output greater than 100 cc per hour --increases renal excretion of sodium (followed by calcium)
473
What is the diagnostic test for an insulinoma?
72 hour fast - insulin levels continue to be increased | ---localize w abdominal ultrasound or CT scan
474
What does a trichomonas vaginalis infection increase the risk of?
HIV infection
475
What is dx: etiology 35 year old w family hx of paternal cardiovascular dz at 40. Achilles tendon xanthoma. labs: elevated total cholesterol, significantly elevated LDL, normal TG, HDL
Hyperlipoproteinemia type IIa - most common type of famliial hyperlipproteinemia - -deficiency of LDL receptor - -defective apoprotein B-1000
476
What id dx: etiology eruptive xanthomas, corneal arcus, xanthelasma, dyspnea, pancreatitis, abd pain, hepatosplenomegaly labs: significant elevation in TG
Hyperlipoproteinemia type I - v rare - decreased lipoprotein lipase = increase level of chylomicrons = increased TG
477
What is dx and etiology Labs: increased LDL and VLDL, increased TG sometimes HDL decreased
Hyperlipoproteinemia type IIb - decreased LDL receptor - increase apolipoprotein B
478
What is mortality rate of breast cancer: population: 200,000 700 has breast cancer 75 died
Mortality = (75/200,000) x 100,000 = 37.5/100,000/year have to standardize as per 100,000/year
479
What is the initial workup of uncomplicated mucocutaneous candidiasis (thrush)
test for HIV: | HIV-1/2 antigen/antibody immunoassay
480
What is the firstline therapy of hemodynamically stable pt w a flail chest
Pain management and oxygen therapy
481
How is q angle related to 1. genu varus 2. genu valgus
1. q angle decreased 2. q angle increased normal q angle is 10-12 degrees
482
What findings are more likely in an infant of a mother complicated by gestation diabetes born w macrosomia?
Respiratory distress syndrome hypoglycemia hypocalcemia polycythemia
483
What is the etiology and the lab findings of Renal Tubular Acidosis type IV? TX?
caused by Hypoaldosteronism - hyponatremia - hyperchloremia - hyperkalemia - acidic urine seen in pt w diabetes and interstitial nephritis resulting in hyporeninemic state tx: if hyperkalemia causes EKG changes - IV calcium then loop or thiazide diuretics +/- sodium bicarb
484
What is the etiology and the lab findings of Renal Tubular Acidosis type I? tx?
Distal tubular defect (deficiency in H+ secretion) - urine pH >6.0 - hypokalemia - higher predisposition to develop nephrolithiasis - -from higher calcium and phosphate excretion from alkaline urine -Sjogren's, SLE, autoimmune Tx: Sodium bicarb
485
What is the etiology and the lab findings of Renal Tubular Acidosis type II?
Defect at proximal tubules fxn to reabsorb bicarb - -causes non-anion gap hyperchloremic metabolic acidosis - Low bicarb - high chloride - Low potassium * Distinguish from RTA Type I with Urine pH (RTA T1 cannot acidy urine beyond pH of 5.5) a/w Fanconi's syndrome, Mult Myeloma, Carbonic anhydrase inhibitor use -Tx: Alkali replacement
486
What kidney disorder is most common form of nephrotic syndrome in patients with Hodgkin lymphoma
Minimal change disease
487
What is the criteria for lung cancer screening?
Annual Low-dose chest CT scan 55-80 >30 pack-year smoking hx AND smoke within last 15 years can discontinue: age >80 OR pt quit for >15 years OR other med problems that signficantly limit life
488
What is dx? dx modality? tx? 32 year old w pain, watering, redness in left eye for 2 days. Similar sx few months ago. Exam shows vesicles and dendritic ulcers in cornea
Herpes simplex keratitis epithelial scrapings = multi-nucleated giant cells tx: antiviral therapy (oral or topical)
489
What is the hemoglobin pattern seen in a SCD pateitn on hydroxyurea?
0% HbA 80% HbS 17% HbF 0% HbC SCD: mostly HbS, some (~7%) HbF Hydroxyurea: increases HbF in circulation
490
When is the HPV vaccine recommended?
Male + female: 11-12 Female: through age 26 Male: through age 21
491
23 year old in MVA. has lower extremity fractures, abdominal bruising, scalp lacerations, shortness of breath. BP was 95/60 pulse 120/min. Spine is immobilized, given 1 L IV fluids. becomes progressively drowsy on way to hospital. Develops progressive weakness of the right side of body. BP 160/90, pulse 50. What is dx? which cranial nerve is probably compromised?
Transtentorial (Uncal) Herniation - Compression of contralateral crus cerebri = ipsilateral hemiparesis - compression of CN III = mydriasis (loss of parasym), loss of motor (ptosis, down and out gaze of ipsilateral pupil) - Compression of Retcular formation = decreased consciousness/coma - Compression of ipsi post cerebral artery = ischemia of visual cortex (contralat homonymous hemianopsia)
492
What additional cardiac related drug does digoxin interact with?
Amiodarone - -decrease digoxin dosage when prescribing amiodarone - -Sx: Neuro: anorexia, N/V, abdominal pain, fatigue, confusion, weakness, Color vision alterations also hypokalemia a/w loo diuretic use
493
What are three drugs that can cause folic acid deficiency?
Phenytoin Trimethoprim Methotrexate
494
What are the indications for cesarean section?
1. Complete Placenta Previa 2. Vasa previa 3. Placenta Accreta 4. Active or Symptomatic Herpes Lesions 5. maternal HIV w viral load above 1000 copies/ml 6. Irreversible fetal distress 7. Malpresentation 8. Placental abruption only in presence of deteriorating maternal and fetal status
495
Where do gastinomas or Zollinger-Ellison syndrome usualy arise? has is dx made?
Duodenum -less common in pancreas Dx by: 1. measuring serum gastrin 2. Secretin injection test (normal gastric cells are inhibited by secretin) - -gastrin is remeasured, if elevated = gastrinoma --tumor location is determined by ultrasound or radionuclide octreotide scanning
496
What is the most appropriate management of croup?
Dexamethasone + oxygen subglottic swelling = aerosolized racemic epinephrine imminent resp failure = intubation
497
What is dx? management? what are pt's more susceptible to? 10 year old infant height and weight shows failure to thrive, develops jaundice and has episodes of vomiting. Exam shows hepatomegaly and cataracts
Galactosemia - deficiency in galactose-1-phosphate uridyl transferase Sx: 1. failure to thrive 2. Cataracts 3. Liver disease Tx: avoid dietary galactose (soy-based milk) Infants are more susceptibel to E coli infection
498
What is an appropriate test to dx a 94 year old male w dizziness and visual changes when looking in rearview mirror?
Wallenberg test - hold head in six diff planes of motion for 10 seconds - -detects vertebral artery insufficiency - do NOT perform cervical HVLA on pt w positive test
499
What are some signs and symptoms of a medulloblastoma?
Proximity to 4th ventricle = obstructive hydrocephalus (headache, vomiting, papilledema) major occur in cerebellar vermis = tuncal or gait ataxia
500
What is the next step in management of a hemodynamically stable patient where GBS is suspected?
Spirometry - assess pulmonary function
501
How is Cellulitis different than Erysipelas?
Cellulitis - skin infection of DEEP dermis and subq fat - flat indistinct borders - strep pyo = nonpurulent - staph aur = purulent Erysipelas = limited to epidermis and superficial dermis -Strepto pyogenes =Raised, sharp borders, intense erythema
502
How is Pneumocystis jirovecii diagnosed? How is it managed?
Respiratory sample microscopy w specialized stains - -Induced sputum = least invasive - -Bronchoalveolar lavage = if sputum cant be obtained Tx: TMP/SMX Once CD4 count <200 pts should be started on TMP/SMX of Dapsone prophylactically (Dapsone is just prophylaxis, not tx)
503
What is dx? first line tx? 31 year old w R knee pain, R heel pain, Low back pain. Recently treated for urethral discharge. Tenderness present over Achilles tendon. Mouth ulcers. Synovial fluid analysis shows WBC 10,000 w many PMN leukocytes, negative gram stain
``` Reactive arthritis - NSAIDs Triad: 1. Nongonococcal urethritis 2. Asymmetric oligoarthritis 3. Conjunctivitis Also: Mucocutaneous lesions Enthesitis (Achilles tendon pain) ```
504
What is dx: 34 year old w vague chest discomfort. Recent URI. CXR shows enlarged mediastinum. helical CT shows mass in middle mediastinum
Bronchogenic cyst -other middle mediastinum masses: tracheal tumors, pericardial cysts, lymphoma, lymph node enlargement, aortic aneurysms of the arch Thymoma - ANTERIOR mediastinum
505
What should be monitored while a patient is taking hydroxychloroquine?
eye exam ---risk for retinopathy hydroxychloroquine = TNF & IL-1 suppressor
506
A pt with depression, migraines, rheumatoid arthritis presents after overdosing on one of her meds. She describes nausea, upper abdominal discomfort tinnitus and vertigo. Temp is 100.5, resp 26/min, pulse 115/min Whats is the med? Acid base status?
Aspirin/Salicylate intoxication -Tinnitus, fever, tachypnea, nausea, GI irritation. Respiratory alkalosis from tachypnea Anion gap metabolic Acidosis: uncoupling of oxidative phosphorylation in mitochondria = anaerobic metabolism
507
What are serum side effects of methotrexate? management?
Macrocytic Anemia -methotrexate inhibits dihydrofolate reductase other Sx: nausea, stomatitis, rash, hepatotoxicity, interstitial lung disease, alopecia, fever Tx: supplemental folic acid
508
When is Down's Syndrome screening performed? What are screen findings of Down's?
15-20 weeks w triple test at minimum (hCG, unconjugated estriol, AFP) ---High-risk pregnancies use quad screen >35yrs, presenting late for prenatal care Decreased AFP Decreased Estriol Increased inhibin A Increased hCG
509
What is dx: | 5 year old w painful limp, recent hx of sinusitis, Labs show normal WBC, normal ESR
Transient synovitis
510
What are the actions of the rotator cuff muscles?
``` SITS Supraspinatus - Abduction Infraspinatus - External rotator Teres minor - External rotator Subscapularis - Internal rotator ```
511
What is the anticoagulant of choice in pregnancy?
Subcutaneous heparin | unfractionated or LMWH
512
What is the tx of Otitis externa? | common causes?
S. aureus + Pseudomonas aeruginosa Tx: Topical Ciprofloxacin + Hydrocortisone otic
513
``` What is dx? management? Hospitalized pt for CAP has: Normal TSH Decreased T3 Normal T4 ```
Euthyroid sick syndrome - nonspecific causes - No Tx necessary, self resolving, follow up w thyroid studies
514
What is the management of PUD a/w H. pylori?
Triple therapy: 1. amoxicillin 2. clarithromycin 3. PPI
515
What are symptoms of Uncal herniation
Supratentorial brain herniates downward - compresses CN III | -Ipsilateral fixed dilated pupil, does no constrict to light
516
What are symptoms of Tonsillar herniation
Downward cerebellar herniation - compression of medulla | ---respiratory and cardiac dysfunction
517
What are symptoms of Central hernation
Transtentorial herniation downward - AMS or tear of basilar artery (fatal Duret hemorrhage) - Hyperventilation and Cheyne-Stokes breathing
518
What are ECG findings of hypocalcemia
Prolonged QT interval
519
What are ECG findings of hyperkalemia
peaked T-waves | Widened QRS complexes
520
What are ECG findings of hypercalcemia
Shortened QT interval
521
What is the drug prescribed? additional side fx? pt w hx of depression started on new drug, has painful erection for 6 hours
Trazodone 1. Priapism 2. Orthostatic hypotension 3. Excessive sedation
522
How is endometriosis diagnosied?
Laparoscopy | -powder-burn/gun-powder lesions from hemosiderin
523
What are the step to diagnose primary hyperaldosteronism (Conn's)
1. Measure plasma aldosterone/renin - if >25: 2. Sodium loading - pt given oral sodium of fludrocortisone over 3 days - -if aldosterone level is no suppressed below 10 ng/dL, pt has Conn's
524
What is the management of anorexia in Cancer-related anorexia/cachexia syndrome?
``` Progesterone analogues (ie megestrol acetate) or corticosteroids --increase appetite, weight gain, improve well-being ```
525
What can be used to prevent recurrence of uric acid kidney stones?
Potassium citrate | -alkaline urine + low purine diet
526
which Diabetic medication can assist in weight loss
GLP-1 agonist
527
What is nutrient deficiency? Pt w Crohn disease is restarting oral feeding after surgical procedures. Has diarrhea, alopecia, pustular, crusting skin rash, says food does not taste same as before
Zinc deficiency - absorbed in duodenum and jejunum ``` Sx: Alopecia Pustular skin rash (perioral, extremities) Hypogonadism Impared wound healing Impaired taste Immune dysfunction ```
528
Where is location of hemorrhage: | Stroke pt w right hemiplegia, reight hemisensory loss, leftward deviation of eyes
Left Putamen/Basal Ganglia/Thalamus -almost always involves internal capsule Contralateral hemiparesis + hemianesthesia
529
What is an alternative to penicillin for treating syphillis?
Doxycycline (Primary, Secondary, Latent stages) Ceftriaxone (Tertiary stage)
530
What are preventative prophylaxis options for Migraines?
Topiramate Divalproex sodium TCA B-blockers
531
What is the most likely cause of pneumonia in a 6 year old boy with cystic fibrosis?
Staph aureus in pts <20 | Pseudomonas in pts >20
532
What are the most common causes of vrial meningitis?
90% of cases by non-polio enteroviruses 1. echovirus 2. coxsackievirus
533
What is dx? 35 yr old HIV positive male w eye pain, mild conjunctivitis, rapid progressive visual loss. Exam shows keratitis. Fundoscopy shows widespread, pale, peripheral retinal lesions, central necrosis of the retina
Herpes simplex or Varicella - --CMV retinitis = painless, fundoscopy shows fluffy or granular retinal lesions near retinal vessels + hemorrhages - does not cause initial conjunctivitis or keratitis
534
What is the recommended weight gain for pregnant women 1. with a normal BMI 2. Overweight 3. Obese 4. underweight
1. (18.5-24.9) - 25-35 lbs 2. (25-29.9) = 15-25 lbs 3. (>29.9) = 11-20 4. (<18.5) = 28-40
535
What is the most appropriate next steps when a pt shows symptoms of redman syndrome after given IV Vancomycin
Stop infusion +/- antihistamines and continue vancomycin at slower rate after symptoms subside Redman syndrome = hypotension, dyspnea, erythema, pruritis
536
What is the management of Zenker's diverticulum
Esoophageal myotomy of Cricopharyngeus muscle | -with or without removal of diverticulum
537
How does Neuronal injury in diabetes progress?
Deposition of glycosylation end products --Length-dependent axonopathy = clinical features occuring first in LONGEST nerves (ie feet) Small fiber injury = positive sx (pain, paresthesias, allodynia) Large fiber injury = negative sx (numbness, loss of proprioception/vibration, diminished reflexes)
538
What is pseudocyesis?
Somatiziation of stress = Symptoms of early pregnancy, pt believes she is pregnant, but not
539
What is the underlying etiology of nephrolithiasis in a pt w Crohn's dz?
Increased absorption of oxalate - calcium normally binds oxalate in guy and prevents absorption - -pts w fat malabsorption = calcium preferentially bound by fat = oxalate is unbound = absorbed
540
How are Hirschsprung dz and Meconium ileus differentiated? What are associated comorbidities for each?
Hirschsprung = increased rectal tone, "squirt sign" (forceful expulsion of stool after rectal exam), proximal DILATED colon --a/w for Down Syndrome = Alzheimer, Hypothyroidism Meconium Ileus = Thick, inspissated meconium, obstruction at ileum, NARROW underdeveloped colon - -a/w CF** (virtually diagnostic) - tx w hyperosmolar enema (Gastrografin), then surgery if not effective
541
What are contraindications for the Rotavirus vaccine series given at ages 2-6 months
1. Anaphylaxis to vaccine ingredients 2. Hx of Intussusception 3. Hx of uncorrected congenital malformation of GI tract (ie Meckels diverticulum 4. SCID
542
What is dx? 65 year old w cervical degenerative changes in MVA. marked weakness of both upper extremities, able to move lower extremities.
Central cord syndrome --hyperextension injuries w pre-existing degenerative changes in cervical spine Sx: weakness that is more pronounced in upper extremities than in lower.
543
What is dx? management? 4 month old w macroglossia, 99th percentile for weight, length, head circumference, reducible umbilical hernia, R upper and lower extremities are significantly larger in circumference than L extremities.
Beckwith-Wiedemann syndrome -deregulation of chromosome 11p15 Sx: fetal macrosomia, macroglossia, hemihyperplasia, medial abdominal wall defects Management: 1. Newborns monitored for hypoglycemia (secondary to macroglossia) 2. Abdominal US + AFP levels (significant increased risk of Wilms tumor, Hepatoblastoma) - every 3 months from birth to 4 years, then just US from 4-8
544
What is dx: 17 year old w recurrent nephrolithiasis. uncle has same problem. Urinalysis shows hexagonal crystals. Urinary cyanide nitroprusside test is positive.
Cystinuria -impaired transport of cystine and dibasic amino acids (ornithine, lysine, arginine) -Cystine stones = hard, can be radiolucent
545
What are dietary recommendations for recurrent calcium kidney stones?
1. increased fluid intake 2. decreased sodium intake 3. normal dietary calcium intake
546
What is dx? | Recent travel to mexico. Abdominal pain, N/V, muscle pain in neck and jaw muscles. periorbital edema, eosinophilia
Trichinellosis - undercooked meat -triad: periorbital edema, myositis, eosinophilia Tx: typically slef-limited, severe infections = mebendazole, albendazole w steroids
547
What are common early and long term side fx of SSRI's?
early: headache, nausea, insomnia/sedation, anxiety, dizziness Long-term: sexual dysfunction, weight gain
548
what is dx: 6 year old w refractory GERD symptoms after PPI prescription. Has eczematous patches on bilateral antecubital fossae and behind both knees. Endoscopy shows circular rings and thickened , linear furrowing of esophagus
Eosinophilic esophagitis
549
What are the 3 most common causes of digital clubbing?
1. lung malignancies 2. cystic fibrosis 3. right-to-left cardiac shunts
550
What is CHARGE syndrome?
``` Coloboma - iris malformation Heart Defects Atresia Choanae Retardation of growth/dev GU anomalies Ear abnomalities/deafness ```
551
What is dx? greatest risk of mortality? 15 yr old boy w worsening dysarthria, wide-based, unstable gait. Absent deep tendon reflexes of bilateral lower extremities. MRI shows marked atrophy of medulla and dorsal columns of spinal cord. Scoliosis present
Friedreich ataxia -autosomal recessive, GAA, frataxin gene loss of fxn Hypertrophic Cardiomyopathy Sx: Cerebellar ataxia, dysarthria, loss of vib/position sense, absent DTR, DM, skeletal deformities
552
What is the inheritance pattern of Hypertrophic cardiomyopathy
Autosomal dominant
553
What is dx: HIV positive pt w altered mental status. CD4 count is 40. viral load is 25,000. MRI shows solitary irregular, weakly ring-enhancing mass in periventricular area. Serology is positive for Toxoplasma, PCR of CSF shows EBV DNA
Primary CNS lymphoma
554
What is causation: | Transplant patient has gum hypertrophy and signs of nephrotoxicity
``` Cyclosporine Side fx: 1. Nephrotoxicity 2. HTN 3. Neuro toxicity 4. Glucose intolerance 5. Gingival hypertrophy + Hirsutism ``` (Tacrolimus has similar toxicity profile but does not cause hirsutism of gum hypertrophy)
555
How is Follicular Thyroid Carcinoma diagnosed?
FNA - -Invasion of tumor capsule and/or blood vessels - -hard to tell histologically apart from follicular adenomas (both have follicular cells arranged in microfollicles, clusters, clumps)
556
What is the treatment of catatonia?
Benzos | electroconvulsive therapy
557
Where is lesion? associated dz? 26 year old w double vision, dizziness, unsteady gait. Attempted left gaze = left eye abducts, exhibits horizontal nystagmus, but right eye stays still. Attempted right gaze = right eye abducts and exhibits horizontal nystagmus, left eye remains stationary. Able to converge both eyes.
Bilateral internuclear ophthalmoplegia = Medial longitudinal fasciculus -most likely has multiple sclerosis
558
What is pathogen? Patient back from recent hiking trip where he frequently went swimming in lakes has 10 days fatigue and copious watery diarrhea
Cryptosporidium parvum -traveler's diarrhea, Prolonged, profuse, watery diarrhea -protozoan transmitted ingestion of contaminated water
559
What are quad test findings of Trisomy 18
AFP decrease Estriol decrease Inhibin A decrease hCG normal
560
When are abx indicated for patients w an acute exacerbation of COPD?
1. 2 or more cardinal symptoms - -increased dyspnea, cough, sputum production 2. Mechanical ventilation requirement
561
What is dx? management? 55 yr old caucasian w numerous falls from dizziness. Dry mouth, dry skin, erectile dysfunction over couple weeks. Resting tremors, ridigity, bradykinesia
Multiple System atrophy (Shy-Drager Syndrome) - -Parkinsonism - -Autonomic dysfxn - -Widespread neuro sx Tx: intravascular volume expansion = fludrocortisone, salt supplementation, a-adrenergic agonists, compression stockings
562
What is most likely cause: 3 week old from mother w no prenatal care. Had low-grade fever then had generalized tonic-clonic seizure w mild perioral cyanosis. Brain imaging shows patchy areas of increased attenuation in cerebral cortex. Edema and hemorrhage in L temporal lobe and brainstem.
Herpes simplex virus Sx: characteristic vesicles CNS sx: encephalitis, seizure, full fontanelle Viral transmission to temporal lobe hemorrhage and edema
563
what is the etiology of hereditary angioedema? | how is dx confirmed?
C1 inhibitor deficiency/dysfxn = elevated bradykinin Dx: depressed C4 levles (exaggerated cleavage of C4 by C1)
564
What is the indication of Trastuzumab? what should be tested before prescribing?
Human epidermal growth receptor 2-positive breast carcinoma (HER-2) -echocardiography for baseline cardiac fxn - can cause cardiotoxicity
565
How do you calculate Odds ratio?
(A/C)/(B/D)
566
How do you calculate Relative risk reduction?
1-RR
567
How do you calculate Number needed to harm?
NNH = 1/AR AR = (A/(A+B))-(C/(C+D))
568
What is berkson bias?
study population selected from hospital is less healthy than general population
569
What is a t-test used for?
Checks differences between MEANS of 2 groups
570
What is an ANOVA used for?
checks differences between MEANS of 3 or more groups
571
What is Chi-square used for?
Checks differences between 2 or more percentages or proportions of CATEGORICAL outcomes
572
What are four components of informed consent?
indications risks benefits alternatives
573
How do you manage Central Retinal artery occlusion secondary to embolism?
Ocular massage and high flow oxygen
574
When succinylcholine is used for rapid-qequience intubation, what is the patient at greatest risk for?
Cardiac Arrhythmia -from severe hyperkalemia --succinylcholine triggers influx of sodium ions and efflux of potassium ions = depolarization and temporary paralysis
575
What is a/w a chapman's point between the spinous and transverse processes of T11 and T12
Adrenals
576
Waht is a/w a chapman's point between the spinous and transverse processes of T12 and L1
Kidneys
577
What is a/w a chapman's point on the superior edge of the transverse process of L2
Bladder
578
What are uterotonics used in pregnancy? (3) what are contraindications?
1. Oxytocin 2. Methylergonovine - contraindicated w HTN 3. Carboprost - contraindicated w Asthma
579
What is dx? tx? | 6 year old w congenital bilateral sensorineural hearing loss has syncopal event. ECG shows QT prolongation
Jervell and Lange-Nielsen syndrome --molecular defects in potassium channel -maintain normal levesl of CA, K, Mg Tx: Propanolol, hx of syncope = pacemaker placement
580
What is dx? 4 month old w noisy breathing. inspiratory and expiratory stridor. imrpoves w extension of neck but not when the infant is held prone.
Vascular ring - age <1 w respiratory or esophageal symptoms - stridor is often biphasic,improves w neck extension - -stridor is more prominent w EXPIRATION
581
what is dx?= | 4 month old w noisy breathing. Stridor is most prominent w Inspiration. worsens when supine, improves when prone
Laryngomalacia
582
what is dx? 9 year old w fever, hives, joint pain, pruritic rash tha began 2 days ago covers his trunk and arms. Currently taking oral penicillin for Strep pharyngitis that was dx'd 9 days ago. Temp is 101.8 Palpable lymph nodes in cervical, axillary, and inguinal regions.
Serum sickness-like reaction --Type III hypersensitivity rxn that occurs 1-2 weeks after administration of B-lactams or TMP-SMX SX: Fever, urticaria, polyarthralgia Labs: nonspecific hypocomplementemia, elevated inflammatory markers

COMLEX STEP 2 CE (1 decks)

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