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Bina's Step 2 CK Flascards > Bina's HY > Flashcards

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)

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2
Q

Urethritis, conjunctivitis, arthritis, mucocutaneous lesions, Achilles tendon pain

A

Reactive arthritis

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3
Q

What is the triad of Wernicke’s encephalopathy?

A
  1. Encephalopathy 2. Gait ataxia 3. Oculomotor dysfunction
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4
Q

Dysmenorrhea, dyspareunia, infertility

A

Endometriosis

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5
Q

Relative bradycardia despite fever

A

Legionella

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6
Q

Periorbita edema, myositis, eosinophilia

A

Trichinellosis

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7
Q

Malignant hyperthermia s/s

A

Muscle rigidity. High T and HR. High CK and K. High CO2.

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8
Q

Gallstone ileus triad

A

Small bowel obstruction, gas within the biliary tree and a gallstone (stone gets impacted in ileocecal valve)

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9
Q

Bounding pulses and increased pulse pressure in a child

A

PDA

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10
Q

Heart sound increased with inspiration

A

Right sided

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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

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12
Q

CXR of child shows streaky densities bilaterally w/ mild hyperinflation

A

CF

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13
Q

Glucagonoma

A

Classic necrolytic erythema

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14
Q

What are common psych features of fragile X?

A

ADHD

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15
Q

CSF shows

A

=

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16
Q

Young person w/ lung and liver sx

A

A1 Antitrypsin deficiency

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17
Q

Lesion in what nerve causes wrist drop?

A

Posterior cord (–> Axillary and Radial)

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18
Q

Lesion in what nerve causes deltoid paralysis?

A

Axillary

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19
Q

Lesion in what nerve causes difficulty flexing elbow?

A

Musculocutaneous

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20
Q

Lesion in what nerve affects intrinsic muscles of the hand?

A

Ulnar

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21
Q

Lesion in what nerve causes saturday night palsy?

A

Radial - had a rad time. 2/2 compression of axilla –> wrist drop

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22
Q

Lesion in what nerve causes loss of wrist flexion?

A

Median

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23
Q

Lesion in what nerve causes foot drop?

A

Common peroneal

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24
Q

Lesion in what nerve causes loss of sensation on sole of foot?

A

Tibial (Knee trauma, Baker cyst)

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25
Q

Lesion in what nerve causes difficulty adducting leg?

A

Obturator

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26
Q

Lesion in what nerve causes difficulty flexing thigh?

A

Femoral

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27
Q

Lesion in what nerve causes difficulty extending leg?

A

Femoral

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28
Q

Young guy with HF sx

A

Myocarditis –> dilated cardiomyopathy

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29
Q

Over 3 months, a 30 yo F has had intermittent h/a, palpitations, sweating, irritability, pallor.

A

Pheochromocytoma (Sustained or paroxysmal hypertension, H/a, Sweating)

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30
Q

What are the agents used for malignant htn (3)?

A
  1. Labetolol, 2. Nitroprusside, 3. Nicardipine

BP is >= 180/120. Reduce to 100mmHg

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31
Q

What workup should all pts w/ htn receive (4)?

A
  1. Lipid profile
  2. Chem panel
  3. Baseline EKG
  4. UA (occult hematuria, urine protein/creatinine ratio)
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32
Q

Severe htn after 55 yo, abd bruit, recurrent pulm edema or resistant HF

A

Renovascular dz (2ndary htn)

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33
Q

Htn w/ confusion, depression, psychosis

A

Primary hyperparathryoidism (2ndary htn)

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34
Q

Htn w/ brachia-femoral pulse delay

A

Coarctation of aorta (2ndary htn)

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35
Q

Htn w/ fatigue, dry skin, cold intolerance

A

Hypothyroid (2ndary htn)

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36
Q

CSF shows WBC 1200, glucose 30, protein 300

A

Bacterial

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37
Q

CSF shows WBC 800, glucose 50, protein 90

A

Viral (high WBC, normal ish everything else)

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38
Q

CSF shows WBC 800, glucose 5, protein 300

A

TB (similar to bacterial, but WBC not as high, glucose very low)

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39
Q

CSF shows WBC 1, glucose 50, protein 300

A

GBS

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40
Q

Baby has craniofacial anomalies, growth def, cardiac defects, facial cleft. Mom used what in utero

A

Phenytoin (funny toe)

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41
Q

DM pt w/ ear pain and drainage, +/- granulation tissue

A

Malignant OE

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42
Q

Abx effective against pseudomonas?

A

-

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43
Q

Fracture of humeral midshaft injures

A

Radial nerve (wrist drop)

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44
Q

Fracture of medial epicondyle of humerus injures

A

Ulnar nerve

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45
Q

WBC casts

A

Tubulointerstitial nephritis

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46
Q

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

A

Multiple myeloma

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47
Q

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.

A

Aortic dissection

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48
Q

65 yo M w/ severe CP radiating to back, bp 170/110 on R and 130/110 on L.

A

Aortic dissection

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49
Q

75 yo M w/ severe CP radiating to back, weak peripheral pulses.

A

Aortic dissection

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50
Q

Constipation, anorexia, vomiting, weakness, polyuria, confusion/lethargy suggests

A

HyperCa

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51
Q

Which macrocytic anemia associated w/ neuro sx?

A

B12 - vegans, pernicious anemia

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52
Q

Muddy brown casts

A

Acute tubular necrosis

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53
Q

66 yo w/ 3 mo hx back pain, recent hearing loss

A

Paget’s disease

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54
Q

Waxy casts

A

CKD

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55
Q

Fatty casts

A

Nephrotic syndrome

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56
Q

Serotonin syndrome s/s

A

Hyperreflexive (myoclonic jerk), Tachycard, High bp, n/v/d

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57
Q

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.

A

Aortic dissection –> pericardial effusion

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58
Q

Rx in the meantime for high bp in aortic dissection?

A

BB

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59
Q

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?

A
  1. Digoxin
  2. EKG
  3. PT/INR

R/o digoxin tox, life threatening arrhythmias, and coagulopathy 2/2 dehydration

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60
Q

Signs of HF, elevated JVP w/o inspiratory decline, tracings show prominent x and y descents, decr heart sounds,

A

Constrictive pericarditis

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61
Q

Young woman has myopathy. Don’t forget about

A

Thyroid myopathy (includes tremor) - both hypo and hyper

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62
Q

What is osteitis deformans?

A

Paget’s dz of bone

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63
Q

Nephrotic syndrome + palpable kidneys, hepatomegaly, ventricular hypertrophy, recurrent infx

A

Secondary AA AS A COMPLICATION of chronic inflammatory conditions

Rx: Colchicine

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64
Q

Painless bleeding in preggo w/ fetal deterioration

A

Vasa previa

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65
Q

Neovascularization and conjuctivitis

A

Trachoma 2/2 Chlamydia

Rx: topical tetracycline or PO azithro

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66
Q

Ingestion: CNS depression, disconjugate gaze, absent ciliary reflex

A

Iospropyl alcohol ingestion

No increased anion gap, no metabolic acidosis!

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67
Q

Htn retinopathy s/s

A

Not typically vison loss

AV nicking, coper/silver wiring, exudates, hemorrhage

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68
Q

Displaced retinal emobli vs. occlusion of central retinal vein thrombus

A

Both can cause vision loss, but

displaced retinal thrombus - white edema around arterioles vs. dilated tortuous veins w/ hemorrhage

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69
Q

Allergic conjunctivitis vs. atopic keratoconjunctivitis?

A

Both 2/2 allergy but atopic keratoconjunctivitis is more severe (thick mucous d/c, blurred vision)

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70
Q

High alk phos but nl Ca, PO4, and LFTs suggest

A

Paget dz of bone

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71
Q

Ophthalmoscopy shows microaneurysm, dot and blot hemorrhage, hard exudate, macular edema

A

DM retinopathy

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72
Q

Ophthalmoscopy shows multiple sores in macular region

A

Atrophic macular degen

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73
Q

Ophthalmoscopy shows new blood vessels that leak, bleed, and scar retina

A

Macular degeneration

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74
Q

What are the indications for prompt delivery with induction of labor (2)?

A
  1. Chorioamniotitis 2. Eclampsia
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75
Q

What counts for prolonged ROM?

A

> = 18 to 24 h

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76
Q

Rx for Chagas?

A

Benznidazole (Cruz in a Benz)

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77
Q

Uticaria, abd pain, resp problems (dry cough, dyspnea, wheezing). Dx and rx?

A

Strongyloidiasis. Ivermectin

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78
Q

Rx for pinworm?

A

Albendazole, pyrantel pamoate

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79
Q

Palms and sole rashes

A

CaRS:
Coxsackie
Rocky Mountain Spotted Fever
Syphilis

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80
Q

Histology of fungus: macrophage filled w/ fungus

A

Histo

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81
Q

Histology of fungus: broad-base budding

A

Blastomycosis

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82
Q

Histology of fungus: spherule filled w/ endospores

A

(larger than RBC like larger than Cali)

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83
Q

Irregular, broad, nonseptae at wide angles

A

Mucor

84
Q

Germ tubes at 37 degrees C

A

Candida

85
Q

Pseduohyphae and budding yeasts at 20 degrees C

A

Candida

86
Q

Septae hyphae at 45 degree angles

A

Aspergillus

87
Q

Disc-shaped yeast on silver stain

A

Pneumocystis jirovechi

88
Q

Fever, headache, retro-orbital pain, rash, myalgia and arthralgia.

+/- hemorrhage in skin or nose

A

Dengue fever

89
Q

Progressive disease: fever in 1st week, abd pain and salmon rash (trunk to extremities) in 2nd week, hepatosplenomegaly w/ abd complications in 3rd week

A

Typhoid (TRIphoid) fever

90
Q

Pt w/ fevers/chills, LUQ pain, splenic fluid collection, and L side pleural effusion concerning for

A

Splenic abscess (classic triad: fever, leukocytosis, LUQ abd pain)

91
Q

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

A

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
Q

Brick red crystals in urine

A

Sign of dehydration –> suspect breastfeeding jaundice

93
Q

Hyperactive BS

A

SBO

94
Q

Pancreatitis due to this HIV therapy

A

Didanosine

95
Q

Hypersensitivity due to this HIV therapy

A

Abacavir (hypersensitive in the heart of the monster)

96
Q

Lactic acidosis due to this HIV therapy

A

Any of the NRTIs

97
Q

SJS due to this HIV therapy

A

Any of the NNRTIs

98
Q

Needle shaped crystals in urine sediment (crystal-induced nephropathy) due to this HIV therpy

A

Indinavir

99
Q

Liver failure due to this HIV therapy

A

Navirapine

100
Q

What is trihexyphenydyl?

A

Anticholinergic used in PD (Tri Hussies having Fun at the beach)

101
Q

Cellulitis in the face of a child likely 2/2

A

H. influenze

102
Q

Erysipelas likely 2/2

A

GAS

103
Q

Fomepizole is used to reverse

A

Ethylene glycol poisonsing

104
Q

Sodium thiosulfate is used to reverse

A

CN tox

105
Q

high-grade reflux in females that persists into adulthood with no clear secondary cause

A

surgical repair

106
Q

multiple 2nd trimester spontaneous abortions

A

cervical cerclage

107
Q

erythematous knee with effusion and fever

A

arthrocentesis [ need to tell apart gout from septic arthritis]

108
Q

spontaneous pneumothorax in a tall young man

A

supplemental oxygen

109
Q

clue cells seen in vaginal swab in a fertile woman

A

oral metronidazole

110
Q

acute open-angle glaucoma

A

1)beta-2-antagonist eye drops i.e. timolol, betaxolol

111
Q

chronic sinusitis

A

CT scan of the face (coronal section)

112
Q

someone with tinnitus, progressive hearing loss, and multiple episodes of vertigo

A

dietary restrictions- particularly of caffeine, salt, and tobacco (Meniere’s disease)

113
Q

someone that comes in with headaches and shows papilledema in the opthalmic exam

A

CT scan of the head non-contrast - r/o mass

114
Q

treament for scabies

A

permethrin

115
Q

Scaphoid fracture that is negative on X-ray

A

spica cast and re-evaluate in 2~3 weeks

116
Q

3-hour old infant with poor feeding who vomits green material and has a double-bubble on KUB

A

decompression of the GI tract…requires nasogastric tube

117
Q

mini-mental status exam of

A

neuropsychologic testing to rule-out alzheimer’s (other causes of dementia)

118
Q

cord compression confirmed with CT-spine

A

dexamethasone ( before MRI of the spine to gold-standard confirm cord compression)

119
Q

borderline personality disorder

A

dialectical behavioral therapy

120
Q

Pulmonary edema in acute CHF exacerbation

A

100% O2 therapy

121
Q

Pulmonary edema in acute CHF exacerbation after 100% O2 therapy

A

IV furosemide

122
Q

supraventricular tachycardia with HR=160 bpm with p-wave preceding all QRS sinus rhythm

A

Vagal manuevers first -carotid massage, then valsalva , then pharmacological-CCBs or adenosine

123
Q

Asymptomatic aortic stenosis

A

Hydrocholorothiazide to reduce preload

124
Q

Hypertension with underlying diabetes type 2

A

ACE-inhibitor or ARB

125
Q

Syncope with normal vitals and no previous episodes

A

Check the electrolytes and medications - thiazide diuretics can cause hypokalemia and arrythmia

126
Q

PR interval=o.3 sinus rhythm normal

A

Nothing, no management needed; PR>0.2 is first degree heartblock

127
Q

A-fib secondary to hypertension for >48 hours

A

Diltiazem; rate control + anticoagulant

128
Q

A patient presents with hypertension and chest pain on exertion

A

IV nitroglycerin for lowering the blood pressure

129
Q

Palpitations with underlying lung disease i.e. COPD

A

72 hr Holter monitor

130
Q

Angina symptoms

A

Beta-blockers - they increase the threshold of amgina

131
Q

Post anterolateral MI and Percutaneous coronary intervention

A

Clopidogrel

132
Q

teenage patient grunting and blinking many times a day for at least 1 year

A

haloperidol

133
Q

suspected pulmonary embolism

A

spiral CT scan

134
Q

prinzmetal angina

A

calcium channel blockers or nitrates (also for esophageal spasm)

135
Q

Lambert Eaton Syndrome

A

radiation and chemotherapy as it is the manifestation of a pre-existing small cell carcinoma of the lung.

136
Q

stroke outside the 3 hour period but within 6 hours

A

intra-arterial tPA administration

137
Q

osteopenia in an elderly patient

A

calcium, vitamin D, and weight-baring exercise

138
Q

tracheobronchial rupture

A

bronchoscopy (flexible or rigid)

139
Q

abdominal pain out of proportion to clinical findings

A

laparatomy

140
Q

Guillane Barre Syndrome

A

plasmapheresis or IVIG with admission to ICU

141
Q

shoulder dystocia on observing the Turtle sign(retraction of head back into perineum)

A

McRoberts maneuver - flexion of mother’s thighs against her abdomen

142
Q

central retinal artery occlusion

A

ocular massage with high flow oxygen

143
Q

malaria protection for a trip to India spent outdoors

A

Mefloquine

144
Q

avoiding calcium oxalate stones

A

decrease protein,oxalate, and sodium intake

145
Q

nephrogenic diabetes insipidus

A

free water and hydrochlorothiazide

146
Q

carbon monoxide poisoned pregnant lady with carboxyhemoglobin >15%

A

hyperbaric oxygen (oxygen >100%)

147
Q

flu-like illness with cherry red lips; multiple family membersl; carboxyhemoglobin

A

100% oxygen

148
Q

a digoxin user with a potassium of 5.5 mg/dL

A

Digibind (Fab fragment

149
Q

Wernicke’s Encephalopathy

A

thiamine, then glucose ( in that order)

150
Q

Alcohol withdrawal

A

fluid resuscitation, thiamine, dextrose, folate, benzodiazepines(diazepam, chlordiazepoxide)

151
Q

septic arthritis

A

ceftriaxone + vancomycin

152
Q

prophylaxis against acute limb ischemia in a person with a-fib

A

dabigatran

153
Q

acute febrile non-hemolytic transfusion reaction

A

discontinue transfusion, give IV acetaminophen

154
Q

acute cholecystitis

A

IV fluids, pain medication, and cholecystectomy within 72 hours

155
Q

abscess size >3cm

A

CT-guided percutaneous drainage

156
Q

single 2cm nodule on Chest X-ray in a 25 yo male

A

check old Chest-X-ray to compare size or presence of the nodule.

157
Q

ulcer that is not infected and does not involve the bone

A

debridement

158
Q

how to diagnose hepatorenal syndrome

A

IV colloid challenge , if no improvement then positive for hepatorenal syndrome

159
Q

Primary light chain amyloidosis

A

mephalan and prednisone

160
Q

local baldness

A

minoxidil

161
Q

severe acute pancreatitis >30% necrosis on MRI

A

imipenem followed by percutaneous needle biopsy

162
Q

pseudocyst on CT-abdomen

A

if expanding or pain symptoms, then drain it. otherwise leave it alone.

163
Q

elderly patient with intermediate to high risk factors for coronary artery disease

A

stress test

164
Q

needle-stick and unvaccinated for HepB

A

give HepB IV-IgG and HepB vaccine

165
Q

MRI contraindicated in suspicious looking equivocal X-ray

A

Technetium bone scan

166
Q

man comes in with a painless chancre on the penis

A

swab the exudate and perform dark-field microscopy

167
Q

Tzanck positive

A

acyclovir

168
Q

methods of genital warts

A

cryotherapy , lasers, trichloroacetic acid or podophyllin

169
Q

acute viral pericarditis recurrence prevention

A

colchicine

170
Q

pericardial effusion

A

pericardial window placement or pericardiocentesis

171
Q

pneumonia, dyspnea, dry cough fever chest pain in HIV patient

A

Bronchoscopy with alveolar lavage

172
Q

dysuria, suprapubic pain, and hematuria continue despite empiric antibiotics for UTI

A

CT-scan of the abdomen and pelvis

173
Q

the first test to determine beta-thalassemia anemia in genetic counseling

A

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
Q

no menarche in a 15 year old with no medical problems and Tanner stage 1 with a uterus

A

measure serum FSH (do not measure estrogen because the lack of breast development already tells you there is a lack of it)

175
Q

dog bite with suspicion of rabies

A

quarantine the dog for 10 days; if asymptomatic the whole time, then no need for management (post-exposure prophylaxis)

176
Q

pinpoint calcifications in a newborn whose mother owns a cat

A

pyramethamine and sulfadiazine (Treats toxoplasmosis)

177
Q

peripartum cardiomyopathy - biventricular cardiac failure

A

supportive care

178
Q

eisenmenger’s syndrome in a pregnant woman

A

avoid hypotension give pressors

179
Q

Rheumatic mitral stenosis in a pregnant woman

A

decrease the heart rate to allow time for blood to fill the left ventricle; reduce the IV fluid volume

180
Q

pregnant woman of 16 weeks gestation with fasting blood glucose of 140 mg/dL

A

do quadruple marker screen assess for neural tube defects - specifically caudal regression syndrome - she has overt diabetes mellitus.

181
Q

Estimated fetal weight is >4.5kg by sonogram

A

C-section

182
Q

perinatal management of gestational diabetes

A

IV D5w with insulin drip maintain glucose within 80-100mg/dL

183
Q

non-reactive stress test

A

vibroacoustic stimulation- wake up the baby because most commonly non-reactive ST due to the baby sleeping

184
Q

non-reactive stress test with positive contraction stress test

A

delivery the baby immediately

185
Q

fibromuscular dysplasia

A

percutaneous angioplasty with stent placement

186
Q

a patient undergoing heparin treatment has right arm pain and cold right upper extremity pain with no peripheral pulse

A

…

187
Q

4 month old boy with leg-length discrepancy and positive Ortolani test

A

U/S of the hip followed by Pavlik Harness (splint that holds hip in flexion and abduction) - prevents extension and adduction

188
Q

45 yr old woman overdosed on pills comes in with tinnitus, fever, and tachypnea

A

aspirin intoxiciation - supportive care, activated charcoal, IV hydration, bowel irrigation

189
Q

suspicion in an immigrant man with hypopigmented skin patch with loss of sensation. Had a flu-like illness 1 month prior.

A

perform a skin biopsy -> top ddx is Lepromatous leprosy.

190
Q

A man with mediastinal widening on chest X-ray and equal blood pressures on both arms and moderate pericardial effusion

A

Trams esophageal echo

191
Q

5 day old newborn has lost 7% of their body weight

A

follow up 10-14 days to see if baby has regained it (normal loss of fluid due to labor and in-utero)

192
Q

skin lesions in a patient with celiac disease

A

dapsone (Tx for dermatitis herpetiformis)

193
Q

clinical suspicion for abnormal uterine bleeding

A

endometrial biopsy

194
Q

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.

A

exercise program with aerobic conditioning (Tx for fibromyalgia). Medications - duloxetine, TCAs are a secondary measure.

195
Q

1 month old boy with a harsh holosystolic murmur over the left lower sternal border

A

echocardiography - he has a VSD

196
Q

infant with symmetric descending paralysis, drooling and constipation, poor suck and gag reflex also seen

A

botulism immuneglobulin + supportive therapy(respiratory support, NGT feeding)

197
Q

Lichen sclerosus

A

corticosteroids

198
Q

admission to inpatient ward with febrile neutropenia

A

piperacillin-tazobactam

199
Q

cafe au lait spots with sensorineural hearing loss

A

MRI with gadolinium (suspect acoustic neuroma)

200
Q

MI status post CABG post-op day 5 small pericardial effusion with fever, tachycardia, a-fib.

A

drainage, surgical debridement and antibiotics ( acute mediastinitis)

201
Q

DVT identified on ultrasound

A

CT scan of abdomen, chest, and pelvis - search for any embolism

202
Q

Rhabdomyolysis

A

IV fluids, mannitol and bicarbonate

203
Q

Baseline EKG changes on patient with SSx of stable angina

A

Stress echocardiography instead of exercise treadmill stress test – (echo you need to have a normal EKG reading at rest)

204
Q

presence of bilateral popliteal artery aneurysms

A

CT Abdomen -> 25% chance of abdominal aortic aneurysm present.

205
Q

Asystole

A

CPR and epinephrine(lowers defibrillation threshold, increases myocardial and cerebral blood flow) ; defibrillation does not work for asystole

206
Q

hepatorenal syndrome

A

midodrine and octreotide

Bina's Step 2 CK Flascards (3 decks)

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