Bina's HY Flashcards
1
Q
45 yo M w/ epigastric pain, diarrhea. Hx of PUD, 20 yrs smoking. Endoscopy shows prominent gastric folds, 3 duodenal ulcers, upper jejunal ulceration. Suspect?
A
Z-E (Gastrinoma)
2
Q
Urethritis, conjunctivitis, arthritis, mucocutaneous lesions, Achilles tendon pain
A
Reactive arthritis
3
Q
What is the triad of Wernicke’s encephalopathy?
A
- Encephalopathy 2. Gait ataxia 3. Oculomotor dysfunction
4
Q
Dysmenorrhea, dyspareunia, infertility
A
Endometriosis
5
Q
Relative bradycardia despite fever
A
Legionella
6
Q
Periorbita edema, myositis, eosinophilia
A
Trichinellosis
7
Q
Malignant hyperthermia s/s
A
Muscle rigidity. High T and HR. High CK and K. High CO2.
8
Q
Gallstone ileus triad
A
Small bowel obstruction, gas within the biliary tree and a gallstone (stone gets impacted in ileocecal valve)
9
Q
Bounding pulses and increased pulse pressure in a child
A
PDA
10
Q
Heart sound increased with inspiration
A
Right sided
11
Q
Fatigued and dyspnic pt w/ loud S1, sharp sound after S2, low-freq diastolic murmur at apex that increases in intensity before S1
A
Mitral stenosis
Loud S1 = calcified mitral valves snapping shut.
Sharp sound after S2 = opening snap
12
Q
CXR of child shows streaky densities bilaterally w/ mild hyperinflation
A
CF
13
Q
Glucagonoma
A
Classic necrolytic erythema
14
Q
What are common psych features of fragile X?
A
ADHD
15
Q
CSF shows
A
=
16
Q
Young person w/ lung and liver sx
A
A1 Antitrypsin deficiency
17
Q
Lesion in what nerve causes wrist drop?
A
Posterior cord (–> Axillary and Radial)
18
Q
Lesion in what nerve causes deltoid paralysis?
A
Axillary
19
Q
Lesion in what nerve causes difficulty flexing elbow?
A
Musculocutaneous
20
Q
Lesion in what nerve affects intrinsic muscles of the hand?
A
Ulnar
21
Q
Lesion in what nerve causes saturday night palsy?
A
Radial - had a rad time. 2/2 compression of axilla –> wrist drop
22
Q
Lesion in what nerve causes loss of wrist flexion?
A
Median
23
Q
Lesion in what nerve causes foot drop?
A
Common peroneal
24
Q
Lesion in what nerve causes loss of sensation on sole of foot?
A
Tibial (Knee trauma, Baker cyst)
25
Lesion in what nerve causes difficulty adducting leg?
Obturator
26
Lesion in what nerve causes difficulty flexing thigh?
Femoral
27
Lesion in what nerve causes difficulty extending leg?
Femoral
28
Young guy with HF sx
Myocarditis --> dilated cardiomyopathy
29
Over 3 months, a 30 yo F has had intermittent h/a, palpitations, sweating, irritability, pallor.
Pheochromocytoma (Sustained or paroxysmal hypertension, H/a, Sweating)
30
What are the agents used for malignant htn (3)?
1. Labetolol, 2. Nitroprusside, 3. Nicardipine
| BP is >= 180/120. Reduce to 100mmHg
31
What workup should all pts w/ htn receive (4)?
1. Lipid profile
2. Chem panel
3. Baseline EKG
4. UA (occult hematuria, urine protein/creatinine ratio)
32
Severe htn after 55 yo, abd bruit, recurrent pulm edema or resistant HF
Renovascular dz (2ndary htn)
33
Htn w/ confusion, depression, psychosis
Primary hyperparathryoidism (2ndary htn)
34
Htn w/ brachia-femoral pulse delay
Coarctation of aorta (2ndary htn)
35
Htn w/ fatigue, dry skin, cold intolerance
Hypothyroid (2ndary htn)
36
CSF shows WBC 1200, glucose 30, protein 300
Bacterial
37
CSF shows WBC 800, glucose 50, protein 90
Viral (high WBC, normal ish everything else)
38
CSF shows WBC 800, glucose 5, protein 300
TB (similar to bacterial, but WBC not as high, glucose very low)
39
CSF shows WBC 1, glucose 50, protein 300
GBS
40
Baby has craniofacial anomalies, growth def, cardiac defects, facial cleft. Mom used what in utero
Phenytoin (funny toe)
41
DM pt w/ ear pain and drainage, +/- granulation tissue
Malignant OE
42
Abx effective against pseudomonas?
-
43
Fracture of humeral midshaft injures
Radial nerve (wrist drop)
44
Fracture of medial epicondyle of humerus injures
Ulnar nerve
45
WBC casts
Tubulointerstitial nephritis
46
66 yo M w/ 4 wk hx increasing back pain, severe constipation, constant urination. Hb 9.5, BUN 28, Cr 1.9, ESR 80. Suggests
Multiple myeloma
47
70 yo M w/ 3h severe constant chest and neck pain radiating to back. Hx htn and DMT2. bp 189/110 on R and 181/112 on L. Decr diastolic murmur at R sternal border. EKG shows T wave inversions in V5 and 6.
Aortic dissection
48
65 yo M w/ severe CP radiating to back, bp 170/110 on R and 130/110 on L.
Aortic dissection
49
75 yo M w/ severe CP radiating to back, weak peripheral pulses.
Aortic dissection
50
Constipation, anorexia, vomiting, weakness, polyuria, confusion/lethargy suggests
HyperCa
51
Which macrocytic anemia associated w/ neuro sx?
B12 - vegans, pernicious anemia
52
Muddy brown casts
Acute tubular necrosis
53
66 yo w/ 3 mo hx back pain, recent hearing loss
Paget's disease
54
Waxy casts
CKD
55
Fatty casts
Nephrotic syndrome
56
Serotonin syndrome s/s
Hyperreflexive (myoclonic jerk), Tachycard, High bp, n/v/d
57
78 yo M in ED after syncope, has CP and neck pain. Hx includes htn, hld, DMT2. T 99.2, bp 144/92 R 142/90 L, P 109. EKG shows sinus tach, LV hypertrophy, no other changes. TTE shows pericardial effusion.
Aortic dissection --> pericardial effusion
58
Rx in the meantime for high bp in aortic dissection?
BB
59
74 yo F w/ 1 w n/d/decr app. Few days incr fatigue and palpitations. PMH afib and cardiomyopathy Rx Lasix, metop, digoxin, warfarin. BP 140/90 P 70 irregularly irregular. Scattered wheezing. INR 2.3. Next steps?
1. Digoxin
2. EKG
3. PT/INR
R/o digoxin tox, life threatening arrhythmias, and coagulopathy 2/2 dehydration
60
Signs of HF, elevated JVP w/o inspiratory decline, tracings show prominent x and y descents, decr heart sounds,
Constrictive pericarditis
61
Young woman has myopathy. Don't forget about
Thyroid myopathy (includes tremor) - both hypo and hyper
62
What is osteitis deformans?
Paget's dz of bone
63
Nephrotic syndrome + palpable kidneys, hepatomegaly, ventricular hypertrophy, recurrent infx
Secondary AA AS A COMPLICATION of chronic inflammatory conditions
Rx: Colchicine
64
Painless bleeding in preggo w/ fetal deterioration
Vasa previa
65
Neovascularization and conjuctivitis
Trachoma 2/2 Chlamydia
Rx: topical tetracycline or PO azithro
66
Ingestion: CNS depression, disconjugate gaze, absent ciliary reflex
Iospropyl alcohol ingestion
No increased anion gap, no metabolic acidosis!
67
Htn retinopathy s/s
Not typically vison loss
AV nicking, coper/silver wiring, exudates, hemorrhage
68
Displaced retinal emobli vs. occlusion of central retinal vein thrombus
Both can cause vision loss, but
| displaced retinal thrombus - white edema around arterioles vs. dilated tortuous veins w/ hemorrhage
69
Allergic conjunctivitis vs. atopic keratoconjunctivitis?
Both 2/2 allergy but atopic keratoconjunctivitis is more severe (thick mucous d/c, blurred vision)
70
High alk phos but nl Ca, PO4, and LFTs suggest
Paget dz of bone
71
Ophthalmoscopy shows microaneurysm, dot and blot hemorrhage, hard exudate, macular edema
DM retinopathy
72
Ophthalmoscopy shows multiple sores in macular region
Atrophic macular degen
73
Ophthalmoscopy shows new blood vessels that leak, bleed, and scar retina
Macular degeneration
74
What are the indications for prompt delivery with induction of labor (2)?
1. Chorioamniotitis 2. Eclampsia
75
What counts for prolonged ROM?
>= 18 to 24 h
76
Rx for Chagas?
Benznidazole (Cruz in a Benz)
77
Uticaria, abd pain, resp problems (dry cough, dyspnea, wheezing). Dx and rx?
Strongyloidiasis. Ivermectin
78
Rx for pinworm?
Albendazole, pyrantel pamoate
79
Palms and sole rashes
CaRS:
Coxsackie
Rocky Mountain Spotted Fever
Syphilis
80
Histology of fungus: macrophage filled w/ fungus
Histo
81
Histology of fungus: broad-base budding
Blastomycosis
82
Histology of fungus: spherule filled w/ endospores
(larger than RBC like larger than Cali)
83
Irregular, broad, nonseptae at wide angles
Mucor
84
Germ tubes at 37 degrees C
Candida
85
Pseduohyphae and budding yeasts at 20 degrees C
Candida
86
Septae hyphae at 45 degree angles
Aspergillus
87
Disc-shaped yeast on silver stain
Pneumocystis jirovechi
88
Fever, headache, retro-orbital pain, rash, myalgia and arthralgia.
+/- hemorrhage in skin or nose
Dengue fever
89
Progressive disease: fever in 1st week, abd pain and salmon rash (trunk to extremities) in 2nd week, hepatosplenomegaly w/ abd complications in 3rd week
Typhoid (TRIphoid) fever
90
Pt w/ fevers/chills, LUQ pain, splenic fluid collection, and L side pleural effusion concerning for
Splenic abscess (classic triad: fever, leukocytosis, LUQ abd pain)
91
Pt w/ 3 yr hx of upper abd pain. Dull epigastric and LUQ pain for hours. Not relieved by antacids. Precipitated by food. Occasional diarrhea. Lost 15 lbs over last 12 mo. Smokes and drinks daily. Likely
Chronic pancreatitis (chronic epigastric pain w/ intermittent pain-free interval, malabs, DM +/- changes in amylase/lipase)
Ddx:
- Stomach cancer = early satiety
- Esophageal cancer = dysphagia, emesis
92
Brick red crystals in urine
Sign of dehydration --> suspect breastfeeding jaundice
93
Hyperactive BS
SBO
94
Pancreatitis due to this HIV therapy
Didanosine
95
Hypersensitivity due to this HIV therapy
Abacavir (hypersensitive in the heart of the monster)
96
Lactic acidosis due to this HIV therapy
Any of the NRTIs
97
SJS due to this HIV therapy
Any of the NNRTIs
98
Needle shaped crystals in urine sediment (crystal-induced nephropathy) due to this HIV therpy
Indinavir
99
Liver failure due to this HIV therapy
Navirapine
100
What is trihexyphenydyl?
Anticholinergic used in PD (Tri Hussies having Fun at the beach)
101
Cellulitis in the face of a child likely 2/2
H. influenze
102
Erysipelas likely 2/2
GAS
103
Fomepizole is used to reverse
Ethylene glycol poisonsing
104
Sodium thiosulfate is used to reverse
CN tox
105
high-grade reflux in females that persists into adulthood with no clear secondary cause
surgical repair
106
multiple 2nd trimester spontaneous abortions
cervical cerclage
107
erythematous knee with effusion and fever
arthrocentesis [ need to tell apart gout from septic arthritis]
108
spontaneous pneumothorax in a tall young man
supplemental oxygen
109
clue cells seen in vaginal swab in a fertile woman
oral metronidazole
110
acute open-angle glaucoma
1)beta-2-antagonist eye drops i.e. timolol, betaxolol
111
chronic sinusitis
CT scan of the face (coronal section)
112
someone with tinnitus, progressive hearing loss, and multiple episodes of vertigo
dietary restrictions- particularly of caffeine, salt, and tobacco (Meniere's disease)
113
someone that comes in with headaches and shows papilledema in the opthalmic exam
CT scan of the head non-contrast - r/o mass
114
treament for scabies
permethrin
115
Scaphoid fracture that is negative on X-ray
spica cast and re-evaluate in 2~3 weeks
116
3-hour old infant with poor feeding who vomits green material and has a double-bubble on KUB
decompression of the GI tract...requires nasogastric tube
117
mini-mental status exam of
neuropsychologic testing to rule-out alzheimer's (other causes of dementia)
118
cord compression confirmed with CT-spine
dexamethasone ( before MRI of the spine to gold-standard confirm cord compression)
119
borderline personality disorder
dialectical behavioral therapy
120
Pulmonary edema in acute CHF exacerbation
100% O2 therapy
121
Pulmonary edema in acute CHF exacerbation after 100% O2 therapy
IV furosemide
122
supraventricular tachycardia with HR=160 bpm with p-wave preceding all QRS sinus rhythm
Vagal manuevers first -carotid massage, then valsalva , then pharmacological-CCBs or adenosine
123
Asymptomatic aortic stenosis
Hydrocholorothiazide to reduce preload
124
Hypertension with underlying diabetes type 2
ACE-inhibitor or ARB
125
Syncope with normal vitals and no previous episodes
Check the electrolytes and medications - thiazide diuretics can cause hypokalemia and arrythmia
126
PR interval=o.3 sinus rhythm normal
Nothing, no management needed; PR>0.2 is first degree heartblock
127
A-fib secondary to hypertension for >48 hours
Diltiazem; rate control + anticoagulant
128
A patient presents with hypertension and chest pain on exertion
IV nitroglycerin for lowering the blood pressure
129
Palpitations with underlying lung disease i.e. COPD
72 hr Holter monitor
130
Angina symptoms
Beta-blockers - they increase the threshold of amgina
131
Post anterolateral MI and Percutaneous coronary intervention
Clopidogrel
132
teenage patient grunting and blinking many times a day for at least 1 year
haloperidol
133
suspected pulmonary embolism
spiral CT scan
134
prinzmetal angina
calcium channel blockers or nitrates (also for esophageal spasm)
135
Lambert Eaton Syndrome
radiation and chemotherapy as it is the manifestation of a pre-existing small cell carcinoma of the lung.
136
stroke outside the 3 hour period but within 6 hours
intra-arterial tPA administration
137
osteopenia in an elderly patient
calcium, vitamin D, and weight-baring exercise
138
tracheobronchial rupture
bronchoscopy (flexible or rigid)
139
abdominal pain out of proportion to clinical findings
laparatomy
140
Guillane Barre Syndrome
plasmapheresis or IVIG with admission to ICU
141
shoulder dystocia on observing the Turtle sign(retraction of head back into perineum)
McRoberts maneuver - flexion of mother's thighs against her abdomen
142
central retinal artery occlusion
ocular massage with high flow oxygen
143
malaria protection for a trip to India spent outdoors
Mefloquine
144
avoiding calcium oxalate stones
decrease protein,oxalate, and sodium intake
145
nephrogenic diabetes insipidus
free water and hydrochlorothiazide
146
carbon monoxide poisoned pregnant lady with carboxyhemoglobin >15%
hyperbaric oxygen (oxygen >100%)
147
flu-like illness with cherry red lips; multiple family membersl; carboxyhemoglobin
100% oxygen
148
a digoxin user with a potassium of 5.5 mg/dL
Digibind (Fab fragment
149
Wernicke's Encephalopathy
thiamine, then glucose ( in that order)
150
Alcohol withdrawal
fluid resuscitation, thiamine, dextrose, folate, benzodiazepines(diazepam, chlordiazepoxide)
151
septic arthritis
ceftriaxone + vancomycin
152
prophylaxis against acute limb ischemia in a person with a-fib
dabigatran
153
acute febrile non-hemolytic transfusion reaction
discontinue transfusion, give IV acetaminophen
154
acute cholecystitis
IV fluids, pain medication, and cholecystectomy within 72 hours
155
abscess size >3cm
CT-guided percutaneous drainage
156
single 2cm nodule on Chest X-ray in a 25 yo male
check old Chest-X-ray to compare size or presence of the nodule.
157
ulcer that is not infected and does not involve the bone
debridement
158
how to diagnose hepatorenal syndrome
IV colloid challenge , if no improvement then positive for hepatorenal syndrome
159
Primary light chain amyloidosis
mephalan and prednisone
160
local baldness
minoxidil
161
severe acute pancreatitis >30% necrosis on MRI
imipenem followed by percutaneous needle biopsy
162
pseudocyst on CT-abdomen
if expanding or pain symptoms, then drain it. otherwise leave it alone.
163
elderly patient with intermediate to high risk factors for coronary artery disease
stress test
164
needle-stick and unvaccinated for HepB
give HepB IV-IgG and HepB vaccine
165
MRI contraindicated in suspicious looking equivocal X-ray
Technetium bone scan
166
man comes in with a painless chancre on the penis
swab the exudate and perform dark-field microscopy
167
Tzanck positive
acyclovir
168
methods of genital warts
cryotherapy , lasers, trichloroacetic acid or podophyllin
169
acute viral pericarditis recurrence prevention
colchicine
170
pericardial effusion
pericardial window placement or pericardiocentesis
171
pneumonia, dyspnea, dry cough fever chest pain in HIV patient
Bronchoscopy with alveolar lavage
172
dysuria, suprapubic pain, and hematuria continue despite empiric antibiotics for UTI
CT-scan of the abdomen and pelvis
173
the first test to determine beta-thalassemia anemia in genetic counseling
complete blood count in the female (if no abnormality found, then there is no need for hemoglobin electrophoresis testing; if abnormal then test the partner)
174
no menarche in a 15 year old with no medical problems and Tanner stage 1 with a uterus
measure serum FSH (do not measure estrogen because the lack of breast development already tells you there is a lack of it)
175
dog bite with suspicion of rabies
quarantine the dog for 10 days; if asymptomatic the whole time, then no need for management (post-exposure prophylaxis)
176
pinpoint calcifications in a newborn whose mother owns a cat
pyramethamine and sulfadiazine (Treats toxoplasmosis)
177
peripartum cardiomyopathy - biventricular cardiac failure
supportive care
178
eisenmenger's syndrome in a pregnant woman
avoid hypotension give pressors
179
Rheumatic mitral stenosis in a pregnant woman
decrease the heart rate to allow time for blood to fill the left ventricle; reduce the IV fluid volume
180
pregnant woman of 16 weeks gestation with fasting blood glucose of 140 mg/dL
do quadruple marker screen assess for neural tube defects - specifically caudal regression syndrome - she has overt diabetes mellitus.
181
Estimated fetal weight is >4.5kg by sonogram
C-section
182
perinatal management of gestational diabetes
IV D5w with insulin drip maintain glucose within 80-100mg/dL
183
non-reactive stress test
vibroacoustic stimulation- wake up the baby because most commonly non-reactive ST due to the baby sleeping
184
non-reactive stress test with positive contraction stress test
delivery the baby immediately
185
fibromuscular dysplasia
percutaneous angioplasty with stent placement
186
a patient undergoing heparin treatment has right arm pain and cold right upper extremity pain with no peripheral pulse
...
187
4 month old boy with leg-length discrepancy and positive Ortolani test
U/S of the hip followed by Pavlik Harness (splint that holds hip in flexion and abduction) - prevents extension and adduction
188
45 yr old woman overdosed on pills comes in with tinnitus, fever, and tachypnea
aspirin intoxiciation - supportive care, activated charcoal, IV hydration, bowel irrigation
189
suspicion in an immigrant man with hypopigmented skin patch with loss of sensation. Had a flu-like illness 1 month prior.
perform a skin biopsy -> top ddx is Lepromatous leprosy.
190
A man with mediastinal widening on chest X-ray and equal blood pressures on both arms and moderate pericardial effusion
Trams esophageal echo
191
5 day old newborn has lost 7% of their body weight
follow up 10-14 days to see if baby has regained it (normal loss of fluid due to labor and in-utero)
192
skin lesions in a patient with celiac disease
dapsone (Tx for dermatitis herpetiformis)
193
clinical suspicion for abnormal uterine bleeding
endometrial biopsy
194
reproductive-age woman with widespread pain ,fatigue, poor-sleep, frequent headaches and tenderness to palpation of her neck, shoulders and back. Vitals and labs are normal.
exercise program with aerobic conditioning (Tx for fibromyalgia). Medications - duloxetine, TCAs are a secondary measure.
195
1 month old boy with a harsh holosystolic murmur over the left lower sternal border
echocardiography - he has a VSD
196
infant with symmetric descending paralysis, drooling and constipation, poor suck and gag reflex also seen
botulism immuneglobulin + supportive therapy(respiratory support, NGT feeding)
197
Lichen sclerosus
corticosteroids
198
admission to inpatient ward with febrile neutropenia
piperacillin-tazobactam
199
cafe au lait spots with sensorineural hearing loss
MRI with gadolinium (suspect acoustic neuroma)
200
MI status post CABG post-op day 5 small pericardial effusion with fever, tachycardia, a-fib.
drainage, surgical debridement and antibiotics ( acute mediastinitis)
201
DVT identified on ultrasound
CT scan of abdomen, chest, and pelvis - search for any embolism
202
Rhabdomyolysis
IV fluids, mannitol and bicarbonate
203
Baseline EKG changes on patient with SSx of stable angina
Stress echocardiography instead of exercise treadmill stress test -- (echo you need to have a normal EKG reading at rest)
204
presence of bilateral popliteal artery aneurysms
CT Abdomen -> 25% chance of abdominal aortic aneurysm present.
205
Asystole
CPR and epinephrine(lowers defibrillation threshold, increases myocardial and cerebral blood flow) ; defibrillation does not work for asystole
206
hepatorenal syndrome
midodrine and octreotide
