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Step 2 ck mine > CK > Flashcards

CK Flashcards

1
Q

Subarachnoid hemorrhage –> and other realted consequences by timeline !

A

rebleeding 24hrs

vasospasm - first week

circle of willis by-products from degraded blood causes vasospasm and meningeal irritation(stiff neck)

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2
Q

Hydrocephalus from any reason

A

see multiple neurodeficits

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3
Q

tods palsy

A

happens after a focal motor seizure

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4
Q

Back pain that’s exacerbated by standing And Relieved with “sitting” and “hyperflexion” Of the hips?

A

Spinal stenosis

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5
Q

Rheumatod Athritis and what joints of hand effected

A

Meta carpals and Proximals distal joints are spared

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6
Q

Joint pain and stiffnes = gets worst by the course of the day

A

Osteoarthritis

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7
Q

Multiple fractures and blue sclera

A

Osteogenesis imperfecta

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8
Q

Hip Pain Back pain plus stiffness= that improves by the course of the day and gets worst at rest ? diagnosis test?

A

Ankylosing Spondylitis Test for HLA-B27

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9
Q

Young men comes and has problems with urination (urethritis) red eyes (conjunctivitis) Bone pain (Arthritis)

A

Reactive Reiters M/c Chlamydia also Camplylobacter Shigella and Salmonella ,Ureaplasma

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10
Q

55 y/o Sudden and excuciating pain MTP After drinking Red wine

A

Gout (N&N) Negatively bifringent and needle shaped

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11
Q

Positively bifringent

A

pseudogout = rhomboid shaped

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12
Q

Anemia and Increased ESR Elderly woman Hip and shoulder joint pain and stiffness

A

Polymyalgia Rheumatica

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13
Q

Fall on outstretched hand= what bone fractured

A

Distal radius=colles also check scaphoid

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14
Q

Humoral fracture= what signs present if radial nerve damaged

A

Wrist drops Thumb cant abduct

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15
Q

Most common “ primary” and “malignant” tumor of bone?

A

Multiple Myeloma

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16
Q

Unilateral “PeriOrbit pain” Tearing and “Erythema” on conjuctiva

A

Clustered by Cluster Headache

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17
Q

Unilateral “PeriOrbit pain” Tearing and “Erythema” on conjuctiva

A

Clustered by Cluster Headache

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18
Q

SubArachnoid Hemorrhage Most Common Cause is

A

TRAUMA second m/c cause is Aneurysm

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19
Q

Middle age man with Acute broken speech What type of aphasia? What Lobe? What Is the Artery?

A

Broca Frontal Lobe Left Middle Carotid Artery Distribution

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20
Q

Hyperdensity is Crescent shaped Does not cross Midline Which hemorrhage

A

Subdural Bridging Vein Torn

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21
Q

Initially, Altered mental status Then a Lucid Interval

A

Epidural Hematoma Middle Meningeal Artery Treatment = Neurosurgical Evacuation

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22
Q

CSF in SubArachnoid Hemorrhage

A

Increased ICP RBC Xanthochromia

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23
Q

TCA Overdosed Effect on heart?

A

Anticholinergic effect Tachycardia Hypotension Wide P and R Wide QRS Wide Q and T Arrhythmia

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24
Q

Anticholinergic Overdose Therapy

A

Supplemental Oxygen and Intubation IV Sodium Bicarbonate for QRS widening or Ventricular Arrhythmia

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25
Q

Hypotension with Respiratory Depression Tachycardia and/or with Arrhythmia Dry mouth Dilated Pupil Blurry Urinary retention flushing and hyperthermia

A

TCA overdose Anticholinergic effects

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26
Q

problem initiating swallowing

A

Oropharyngeal Dysphagia– drools, nasal regurgitation, lungs regurgitation, recurrent aspirational Pneumonia ( mostly right lobe) usually liquids parkinson stroke Myasthenia prolonged intubation zenkers test -Do VideoFluorodic Barium Swallow

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27
Q

Swalloing is ok but after few seconds feels sensation of food getting stuck

A

Esophageal Dysmotility or obstruction Achalasia Scleroderma spasm obstruction from goiter, strictures, Atrial enlargement

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28
Q

Swalloing is ok but after few seconds feels sensation of food getting stuck

A

Esophageal Dysmotility or obstruction Achalasia Scleroderma obstruction from goiter, strictures, Atrial enlargement

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29
Q

Hydralazine and Nitrates dilate what?

A

Hydralazine dilate ARTERIOLES Nitrates dilate VEINS

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30
Q

Radiation Anthracycline chemo

A

Can cause pericarditis and it can take upto 20 years

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31
Q

shiga toxin–> how does it causes hemolysis

A

activates platelets (due to renal endothelial damage) —> platelets form microthrombi—>microangiolytic hemolysis

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32
Q

AVPR2

A

Hereditary Nephrogenic DI

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33
Q

AVPR2

A

Hereditary DI

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34
Q

renal artery stenosis and hypertension–> how to diagnose?

A

doppler ultrasound duplex, only if abnormal urianalysis or high creatinine

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35
Q

factors that precipitate HEPATIC ENCEPHALOPATHY

A

Hypokalemia sedatives, narcotics infecttion porto systemic shunt

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36
Q

Alkalosis and nitrogen (LIVER problem)

A

excess bicarbonates converts nh4 to nh3 NH3 enters brain

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37
Q

Beta 2

A

Releases insulin

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38
Q

uvea

A

middle layer–>between sclera and retina

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39
Q

Bipolar 1 Drugs = How many?

A

four drugs for bipolar 1 Lithium and valproate Quietapine and Lamotrigine

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40
Q

Lithium ContraIndication?

A

If Creatinine is more than 1.2

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41
Q

Headache and momentarily vision loss and increasing blind spot

A

Increasing blond spot means OPTIC NERVE HEAD is INCREASING. Normally optic nerve head is a blindspot. ICP and Vision loss= pappilaedema

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42
Q

Elderly and aldosterone relation

A

Increased Aldosterone elderlies–>decreased baroreceptor reflex(autonomic crash) –> hypotension–>orthostatic Syncope—>Renal Hypoperfusion–>RAAS activated in response

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43
Q

Severe coughing paroxysm?

A

can cause subcutaneous emphysema increased idntraalveolar pressure causes the air to leak out –>pneumothorax–>chest x ray

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44
Q

Hemoptysis systemic causes

A

Wegener goodpasture SLE Vasculitis

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45
Q

Hemoptysis Cardiac cuases

A

Mitral stenosis Acute Pulmonary Edema

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46
Q

Low PLATELETS Elevated liver enzymes Hypertension Anemia

A

HELLP Don’t worry about elevated Alkaline Phosphatase (pregnancy related elevation)

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47
Q

HELLP

A

See Anemia Low platelets elevated liver enzymes–> causes swelling of liver capsule

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48
Q

Tilted uterus tender

A

Adhesions caused by ectopic endometrial implanted tissue ENDOMETRIoasis

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49
Q

M Tuberoculosis Lymphadenopathy

A

Non Tender Mostly cervical

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50
Q

papule and tender lymphadenopathy and pet exposure

A

Bartonella hansellae

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51
Q

Bloor Urea Nitrogen

A

7-18

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52
Q

TSH

A

0.5 to 5.0

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53
Q

white, grey or tan discharge

A

Bacteria

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54
Q

alpha 3 chain of collagen 4

A

goodpasture

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55
Q

IgM Cold Aggluttins

A

EBV Mycoplasma WaldenStrom

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56
Q

Hematocrit Male

A

41% to 53%

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57
Q

Hematocrit female

A

36% to 46%

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58
Q

fork in middle of head

A

weber test vibration heard better and compensatory amplified my middle hear in absence of air conducted ambient sound. person lateralizes to the affected ear in web

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59
Q

WIdened Medistinum + Pericardial effusion + Syncope

A

Aortic Dissection

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60
Q

Silent murmur

A

Ovale

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61
Q

Most common infant cyanotic

A

Transposition of great vessels Give indomethacin to keep Arteriosis open to mix oxygenated blood into pulmonary artery

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62
Q

Av Nodal Acting drugs for fibrillation

A

Digoxin Adenosine Beta blockers Calcium blockers They act on problem that arises from Av node in wolf –>there is accessory pathway and AV is bypassed–> give Procainamide or Ibulitide

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63
Q

tet spell

A

Pulmonary stenosis in TOF–>spasmed during tension–> cyanosis due to increased PVR–>blood flows through VSD from Right ventricle to LEft VEntricle

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64
Q

acuminata ( condiluminata)

A

6 and 8 = low risk hpv they bleed

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65
Q

lichen planus

A

T cell-mediated reaction against epithelial cells.

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66
Q

HIGH FEVER leukopenia thrombocytopenia Elevated liver enzymes and also Lactate Dehydrogenase + TICK BITE

A

Ambylomomma Ehrlichiosis monocytes got mulberry like inclusions Empiric = Doxicycline

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67
Q

Athlete/ runner/ dancer Underweight woman Point tenderness on bone/leg

A

Stress fracture of tibia overweight = diffuse pain ( not point )–> shin splints

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68
Q

CRYSTALS in tubules after drug intake

A

Acyclovir Sulfonamides methotrexate ethylene gycol protease inhibitors in hiv

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69
Q

Frothy and yellowish or greenish discharchage with malodorous tinge to it

A

Motile truckomonas Give metro

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70
Q

Offwhite fishy odor

A

gardarenella clue

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71
Q

normal chloride

A

95-105

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72
Q

perisistent vomiting and nystagmus

A

give thiamine

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73
Q

sudden glaucoma>

A

closed angle

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74
Q

african with diabetes and cupping of optic disk

A

gradual open angle glaucoma

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75
Q

social anxiety DSM5 = Perfomance related

A

Beta blockers on as needed basis benzo can be given but sedation will impact the presentation or performances try to control the symptoms like tremors, tachycardia and diaphoresis by a beta blocker

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76
Q

Anteverted Uterus

A

curves down to push the bladder–> incontinence

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77
Q

DKA

A

monitor serum Anion gap give iv insulin iv potassium

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78
Q

barky cough rhinorrhea congested

A

Croup steepling –>laryngotracheitis parainfluenza virus give steroid for milder case add nebulized epinephrine for stridor at rest (serious)

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79
Q

drooling, dysphagia, resp dristressed

A

Epiglotittis = H.I tripod sign

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80
Q

age less than 5 lips or tongue mucositis conjuctivits fever not responding to anti pyretics strawberry tongue blanching maculopapular rash

A

kawasaki disease

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81
Q

3 hurtz wave on eeg no postictal period lost in staring Easily provoked by hyperventilation lasts about 20 seconds

A

Absence seizure both hemispheres

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82
Q

Lost in stare plus a postictal state 2-3 minute episode normal eeg

A

Focal seizure

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83
Q

HyperEsthesia

A

Excessive sensitivity to the touch to skin

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84
Q

Rash head to trunk spares palms and soles darkens/coalescense high fevers longer duration

A

ola measle

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85
Q

fever leaves but rash comes

A

roseola

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86
Q

pinkish rash head to trunk well appearing child milder fever

A

ella-rub

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87
Q

most common cause of spontaneous lobar hemorrhage in elderlies

A

Amyloid angiopathy amyloid protein gets deposited in the vessel walls and causes the weakening of the vessels –> leads to formation of the hematoma ( increased ICP ) or Rupture most common lobes are parietal lobe and occipital lobe parietal lobe rupture=somatosensory zone affected–>contralateral Hemisensory loss

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88
Q

high cholesterol low sodium

A

hypothyroidism it is hypotheized that low thryoid slows metablosim of cholesterol and increases adh or decreases gfr

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89
Q

Normal albumin

A

4

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90
Q

below 200 cells in HIV whats the prophylaxis

A

TMP-SMX for =PCP and tox Azithromycin = Avium

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91
Q

ELDERLY+ diabetic+ gradual decline in sensorium

A

hyperosmlolar = Hyperosmolar hyperglycemic state due to hopovolemic state led decrease in gfr

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92
Q

pulsus paradox

A

systemic blood pressure that drops during inspiration is more than 10 1) heart constricted due to cardiac temponade, the pericardial sac 2) lyngs hyperinflated and pushe heart from both sides and not let it accomodate blood so, during inspiration the venous return comes to the right heart –> pushes the interventricular septum in to the left ventricle–>decreases stroke volume

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93
Q

Acute Unilateral swollen lump on neck non toxic appearcing age less than 5 years

A

Lymphadenitis due to aureus no systemic symptoms Bilteral is EBV with systemic

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94
Q

Crystal violet dye on PERIPHERAL SMEAR

A

detects insoluble hemoglobin precipitated in rbc , in wake of g6pd deficiency

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95
Q

pain on hip ‘flexion’ pain on hip extension

A

septic joint psoas sign

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96
Q

Tocolytics

A

Indomethacin B2 agonist nifedipine Magnesium= weak tocolytic but used for fetal Neuroprotection in <32 weeks

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97
Q

unilateral swelling of a lymph node plus tender

A

aureus adenitis

Markedly tender and Erythematous

Unilateral = Bacterial

Bilateral = Viral = Adenovirus, EBV, CMV

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98
Q

African American

urinating frequently despite decreasing intake

A

Hyposthenuria

Sickle cell trait or disease

if trait, cells sickle in hypoxic and hyperosmolar conditions of vasa recta in renal medulla——>impairs free water reabsorption and also impairs counter-current exchange ( low gravity urine/unconcentrated)

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99
Q

CoPD AND Edema Relation

A

Copd = hypoxic lung problem—>Vasoconstricted pulmonary vasculature—–>pressure backs up >>Pulmonary Artery>>>Right Ventricle>>>>Veins>>>>>>Edematous conditions

Isolated Right heart failure due to Pulmonary Disorder–> Cor Pulmonale

see =

Jugular Wave AKA a wave

Congested Liver

tricuspid regurgitates

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100
Q
A

Pulmonary capillary wedge pressure

measures left ventricular end diastolic pressure

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101
Q

Poisoning case

pills on the floor

Opacities seen on abdomen Xray

Hypotensive and Hematemesis

Labs show low CO2

A

Iron ( Not Aspirin)

Biggest clue= Opaque

30 mins= Abdominal pain, Vomits, diarrhea and Hypotensive shock

2 days= liver necrotic

2-8 weeks = Pyloric Stenosis

Iron = vasodilatory–> hypotensive–> unperfused body–>lactic acid buildup–> anion gap acidosis—> respiratory compensation

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102
Q

Painless monoocular vision loss

and

Painful monocular vision loss

A

Painless = emboli with matching history

Painful = Angle-closure Glaucoma ( will see red eye too)

Embolized Central retinal Artery= Retina Whitening—> ocular massage with high flow oxygen is most rapid

for close angle glaucome==Topical pilocarpine or beta blocker topically

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103
Q

Monospot Heterophile test

A

Comes negative in first week (25%)

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104
Q

catching or locking feeling

no pain on rotation/extension/flexion of the knee

no ligamentous laxity

patient played soccer and came with joint pain–>later had a swelling

A

meniscal tear

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105
Q

Vertical cesarean

or

history of myomectomy

A

precaution on uterus rupturing

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106
Q

lack of empathy

entitlement

A

Narcisstic

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107
Q

Dramatic

Seeks Attention

A

Histrionic

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108
Q

Chaotic relationships

Labile mood

Impulsive

Inner emptiness and self harm

A

Border

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109
Q

Odd Thoughts

odd perceptions

odd Beliefs

A

Schizotypal

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110
Q

apgar scores

A
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111
Q

VDRL

RPR

A

Treponema Pallidum syphilis

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112
Q

Rhinorrhea

Abnormal long bone radiographs

Diffuse MaculoPapular rash that desquamates

A

congenital Syphilis

see blueberry muffin =due to extramedullary hematopoiesis

jaundice and hepatosplenomegaly–>due to activated reticuloendothelial system

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113
Q

Toddler with UTI

Treated for and now is well

what next?

A

do Ultrasound of bladder and kidneys to rule out any anatomic problems

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114
Q

Pertusis case in family

A

give macrolides to every family member

azithromycin

clarithromycin

Erythromycin

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115
Q
A

Lobar pneumonia = increased fremitus

Strep

Klebsiella in alcoholics

Legionella = severe pneumonia

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116
Q

Herniated disk pain

A

Radiates to the thighs

Positive straight leg test

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117
Q

Lumbosacral strain

A

back pain with

negatives

negative = straight leg test

Negative = Babinski

Deep tendon reflexes = normal

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118
Q

Compression fracture of Vertebrae

A

Intense back pain

+

Local spinal Tenderness

Postmenopausal or senile cases

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119
Q

Urine Sodium is more than (—-) in hyopvolemic patient in (—-)

& FENa is (—-),

along with urine osmolarity of (—–)

see what casts

A

20

In Acute Tubular Necrosis

FENa = more than 2%

Urine Osmolarity is always more than 300

Dark ( muddy brown cast)

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120
Q

Muddy Brown cast

what urine osmolarity is mostly seen ?

A

Always more than 300

case of Acute Tubular Necrosis

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121
Q

Chronic Renal Failure and what casts

A

Broad casts ( waxy)

CRF—> Reduces renal Mass—>Tubules dilate and nephrons enlarge to compensate–>This is where broad casts originate

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122
Q

Fatty casts

A

Nephrotic syndrome

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123
Q

subtract the risk (exposed) from risk (unexposed)

divide it by risk (exposed)

A

Attributable risk percent

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124
Q

Attributable Risk

A

a/a+b - c/c+d

The difference in risk between exposed and unexposed

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125
Q

Relative Risk?

A

Risk of developing the disease in the exposed group

Divided by

risk of developing the disease in the unexposed group

a/a+b divided by c/c+d

Cohort

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126
Q

Cohort Studies

A

Compares two groups

one group has a risk factor or a exposure

second group is totally without it

Exposed vs non exposed

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127
Q

Unable to respond to protein C

A

Factor 5 Leiden

Autosomal Dominant

White Population

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128
Q

Erythema Nodosum

A

Inflammation of fat cells under the skin

results in

tender red nodules or lumps

IBD, behcet, Sarcoidosis (african)

infection= strep, mycoplasma,ebv,histo,cocco,yersinia,catscratch

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129
Q

ST depression in Lead I & aVL

A

Posterior MI

RCA

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130
Q

Left Anterior Descending artery

A

Leads V1-V6 —->Anterior Heart ischemia

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131
Q

Bacterial Meningitis above 50 y/o

A

Listeria (Ampicillin)

Strep (Cefepime-pseduomonas,HI,neisseria)

neisseria

Cefepime, Vancomycin, Ampicilin

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132
Q

Incomplete fusion of MULLERIAN duct

A

Bicornuate or a heart shaped uterus –> more chances of Cornuate/ interstitial ectopic pregnancy

Cornuate area has abundant blood supply–> Uterine and ovarian vessels —> hemorrhage here can be life-threatening

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133
Q

Infant sneezing

tachypneic

diaphoretic

irritated

poor sleep

tremors

A

mom abused Heroin

Opioids have the most dramatic effects of withdrawal seen on infant

Mother addicted to heroin should be put on Methadone—> later infant can be controlled

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134
Q

Infant showing jitteriness

Hyperactive Moro Refelx

excessive sucking

A

Cocaine

Placental Abruption

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135
Q
A

Painless Bright blood bleeding that ceases in 1-2 hours with or without uterine contractions

Transabdominal/Transvaginal ultrasonography

first give tocolytics if premature

then give betamethason

and deliver with C-section

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136
Q

TNF and Interleukin 1 inhibitor

A

Sulfasalazine ( liver toxic and hemolytic anemia, stomatitis)

hydroxychloroquine ( Retinopathy )

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137
Q

Tissue Necrosis Factor Inhibitors

A

Certoli

Etanercept

Infliximab

Golimumab

Adalimumab

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138
Q

Collision—> Direct blow —> lower abdomen and pelvis

diffuse pain in the abdomen

dull pain in the shoulder

CT scan of the abdomen and pelvis will most likely has impact on

A

Dome of the bladder ( bordered by the peritoneal cavity–>phrenic nerve–>shoulder)

Increased intravesical pressure–>crushes

cure is always obtained upon suturing without sequelae

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139
Q

High riding prostate on digital rectal exam

A

Posterior Urethral injury (—> bulbourethral junction or membranous urethra)

Extraperitoneal

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140
Q

Normal Potassium values

A

3.5 –>5.0

Beta agonists and Insulin causes Hypokalemia —> by shifting potassium into the cells

K+ channel blocking antiarrhythmics=

Ibutilide, sotalol, dofetilide, Amiodarone

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141
Q

Normal Bicarbonate

A

22-28

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142
Q

Back pain or Abdominal Pain

hypotension

Syncope

A

Possible Abdominal Aortic Aneurysm

can spill into RetroPeritoneum–>can cause aortocaval fistula–>with Inferior Vena Cava—> Venous Congestion in retroperitoneum—>like bladder—>fragile and distended veins in bladder rupture—> Gross Hematuria

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143
Q

Chronic blockade of Dopamine receptors

A

leads to D2 receptor upregulation and supersensitivity—–> Tardive Dyskinesia

(TD, or could be from Excitotoxic destruction of GABA neurons in Striatum)

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144
Q

Preoccupied with details

sense of control

preoccupation with orderliness and perfectionism

A

Obsessive-compulsive personality disorder

versus

OCD = ritualistic behaviour

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145
Q

how to evaulate fetus hypoxia or not

( in case if there is lesser fetal movements reported by mother )

A

Biophysical profiling

Non-stress test= fetus showing an increase of at least 15 beats to its normal graph upon stimulation (mother should be monitored on lateral tilt)

Contraction test= FHR is monitored via spontaneous or induced ( nipple/oxytocin)–>good if negative –>no late decelerations

Contraction test contraindicated in volatile membrane cases

BPP = scoring –>Fetal tone, fetal breath, fetal movement, amniotic fluid Volume, Fetal NST

score of 2 for all== 8 or above is ok

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146
Q

Utero-placental insufficiency

A

causes fetal decelerations

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147
Q

Barky Cough

Inspiratory stridor

rhinorrhea

congested

A

Croup –> URI–>Subglottic space narrowed—> Steeple sign–>inflammation of Larynx–>Laryngotracheobronchitis—> Hoarse Voice & Inspiratory stridor that worsens with agitation

IM Corticosteroid & Nebulized Epinephrine

Single stranded

negative sense

helical

ParaInfluenza

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148
Q

Time of the year= Fall/Winter

Crackles and coarse sounds (washing machine)

Increased Respiratory Rate

CXR may show hyperinflated Lungs, Interstitial infiltrates & Atelectasis

A

RSV–> Bronchiolotis

2-4 days of prodromal fever with rhinorrhea

MILD fever vs bacterial pneumonia(toxic looking)

Lower Respiratory Track

Corticosteroid no help

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149
Q

Inspiratory and Expiratory Stridor (Biphasic)

Improves with Neck Extension (decreases tracheal compression)

Worsens when prone

A

Vascular Sling

Stridor plus dysphagia, Vomiting and difficulty feeding

seen very early at age = <1 y/o

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150
Q

Chronic Inspiratory only stridor that improves with prone position

A

Laryngomalacia

collapse of supraglottic structures

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151
Q

drooling and stridor

difficulty in handling oral secretions

A

swelling of epiglottis

H.influenzae nontypable and strep

serious & progressive(lifethreatening)

dysphagia,muffled voice

cyanosis

inspiratory retractions

To maximize air entry –> patients sit like sniffing dog position —> tripod –> neck extended and chin protruding

DO not examine the throat (may cause laryngospasm) in absense of anesthesiologisy/otolaryngologist

Xray–>Thumb print sign

true emergency –ABC–> secure airway–>intubate/tracheostomy–>IV antibiotic( ceftriaxone/cefuroxamine

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152
Q

Glomerular hematuria facts

A

Microscoping and not Gross

PSGN

IGA nephropathy

Alport

Dysmorphic RBC cast

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153
Q

BRCA

A

BRCA 1 = 60%

Breast and ovarian cancer

after birth, do bilateral prophylactic Salpingo-Oophorectomy (BSO)

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154
Q

secondary Raynaud

A

caused by

SLE (ANA)

Scleroderma( Anti TP-1)

Thromboangiitis obliterans

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155
Q

tugging on ear

ear pain

Bulging or Retraction Of TM

A

Acute Otitis Media

High Dose Amoxicillin

Chronic Otitis Media—>Tympanostomy Tube

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156
Q

Otitis Media Complications

A

Meningitis

TM perforation

Mastoiditis

Cholesteatomas

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157
Q

-1 Station

A
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158
Q

Breech fetus

A
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159
Q

Anovulation

A

Progesterone defect

Progestin challenge–> WIthdrawal bleed—>if bleeds than due to nonCyclic GnRH problem or PCOS

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160
Q

Progestin Challenge

A

give for 10 days–>

if bleeds—>

Then noncyclic gnrh or PCOS

If doesnt bleed–> ovaries not secreting estrogen

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161
Q

Exenatide

Liraglutide

A

Glucagon-Like peptidase—>decreases the release of Glucagon

Weight loss also is seen

no HYPOGLYCEMIC risk

given mostly after Metformin failure

Pancreatitis (Ar)

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162
Q

Action on Glucagon

(Antidiabetic)

A

Exenetide

Liraglutide

Adverse reactions–> Weight loss, Pancreatitis

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163
Q

Adverse Reactions

Edema

Fractures

Heart Failure

A

Glitazone

Pioglitazone

Rosiglitazone

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164
Q

AntiDiabetic Contraindicated in Renal Failure

A

Acarbose

Miglitol

(Intestinal Brush Border)

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165
Q

CXR = Enlarged Pulmonary Arteries

Echo=RVH–> comes with RHF–>Edema, JVD, Abdominal Distention

A

Cor pulmonale

Due to

Idiopathic Pulmonary Htn

M/c is due to COPD

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166
Q

Envelop Shaped

or

Dumbbell-shaped

Stone

A

Calcium Oxalate

Ethylene Glycol, crohns

Happens when citrate is sent less to the kidneys

(Hypocitarturia)

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167
Q

Anion Gap

A

S-BC = 10 to 14 is normal

Sodium minus

Total of (HCO3 and Chloride)

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168
Q

hemolysis

leukopenia

fever

jaundice

hepatosplenomegaly

tonsils with exudates

A

EBV

Viral suppresses WBC

splenic congestion–>platelet sequestration–>thrombocytopenia

hemolysis–>jaundice

EBV induced cross-reactivity–>antibodies also act on RBC & platelets ( increased reticulocytes and thrombocytopenia)

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169
Q

Macroglossia

hemyHYPERPLASIA

hyperinsulinism

Omphalocele

A

Beckwith-Wiedemann syndrome

plus

Wilms Tumor

WT 2 mutation

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170
Q

Early sclerosis–>diffuse–>of mesangium–>early age Nephrotic

plus

dysgenesis of gonads(pseudohermaphroditism)

plus

Wilms tumor

A

Denys-drash

Syndrome

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171
Q

Unilateral

Palpable mass (flank)

A

Wilms

loss of function of WT1 or 2 on chromosome 11

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172
Q

cherry red spot

A

Macula

receives blood supply from ciliary arteries that arise from the ophthalmic artery

rest of the eyeball receives from the central retinal artery that also branches off from the Ophthalmic artery

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173
Q

Peripheral nerve disorders?

A

Guillain Barre

diabetic neuropathy

Myeloma–>Amyloid neuropathy

Lead poisoning

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174
Q

Upper Motor Neuron Disorders

A

Vasculitis

Leukodustrophy

B12 deficiency

Brain Mass

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175
Q
A

tonsillar exudate

cervical adenitis

strep

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176
Q

post Anesthesia–>major hypertension

tachycardia

pale

History of hypertension and headaches

A

Pheochromocytoma

Paraganglionomas

produce catecholamines from chromaffin cells

Episodes can be brought on by pressure on the stomach like from palpation or position changes//Anesthetic drugs//Surgical procedures

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177
Q

syphilis plus antibiotic treatment

A

problem Post Spirochetal treatment —>

Jarisch-herxheimer reaction

Rapid destruction of spirochetes–>febrile illness—>typically within 12 hrs–> headache, sweating,hypotension

plus syphilitic rash–> diffuse and macular on palms and soles

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178
Q

Premenopausal Woman

premenstrual pain of breast

bilateral

multifocal

A

Fibrocystic change’ case

fluid filled–> duct dilation–>simple cysts that are nonproliferative lesions

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179
Q

Most common cause of nipple discharge—> serous or bloody

A

Intraductal papilloma

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180
Q

Estrogen containg drugs for migraine patient!

A

contraindicated

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181
Q

Four most common drugs that cause WBC to increase in urine with maculpapular rash

A

Interstitial nephritis

TMP-SMX

Cephalosporin

NSAID

Penicillin

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182
Q

Tender Warm Erythematous Rash

Raised boundaries

Fever

A

Erysipelas

Group A pyogenes

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183
Q

Otitis Media vs Externa

A

Media= Haemophilus influenzae, Strep, Moraxella

Externa = Pseudomonas Aeruginosa

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184
Q

Bilateral Patchy inflitrates post trauma

A

ARDS

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185
Q

Nikolsky positive

A

SJS

Toxic epidermal Necrolysis- more than 20% of the body plus mucus gland involvement

Pemphigus Vulgaris

Staphylococcal scalded skin syndrome

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186
Q

Meningitis case

management

A

LP–>IV antibiotics

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187
Q

Waking up with headche

blurry

nausea

vomiting

A

DO MRI

(not just the migraine case)

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188
Q

Cluster

A

Oxygen and verapamil

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189
Q

COPD family

A

Bronchitis (Mucus glands hypertrophied and at least 3 months of a productive cough)

Emphysema

Asthma

FEV1/FVC –> less than .7

Maximum inspiration–>expire maximally=VC

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190
Q

Renal failure plus creatinine very high and parathyroid mechanism

A

Excess Phosphorus & low calcium–>secondary HyperParathyroid—->raises calcium from bones and excretes phosphorus

Secondary hyperparathyroidism ( chrnonically, in ESRD–> does lead to tertiary primary hyperparathryodism)

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191
Q

TB mimicking infections living in granulomas

A

Histoplasmosis

Blastomycosis

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192
Q

Hilar Lymphadenopathy

Mediastinal lymphadenopathy

erythema nodosum

caseating granuloma

A

Histoplasmosis = Mississippi and Ohio river basin

Organism targets histiocytes and reticuloendothelial system—>Lymphadenopathy, pancytopenia, and hepatosplenomegaly

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193
Q

Patient with splenectomy and tick

fever

chils and sweats

tender and palpable liver edge

A

Babesiosis case

Hemolytic Anemia–>

Intravascular hemolysis –>dark urine,jaundice, reticulocytosis, increased lactate dehydrogenase, Indirect Hyperbilirubinemia

Thrombocytopenia

Organisms live in rbc–>MALTESE cross

Atovaquone plus azithromycin

severe–>clindamycin plus quinine

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194
Q

fever

rash that spreaded centripetally

on

palms and soles

A

RMSF

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195
Q

Juvenile Idiopathic Arthritis

young patients come with multiple joint pain

A

Chronic Inflammation of more than one joints–>symmetric–>atleast 6 weeks

Inflammation–>hepcidin hides iron–>anemia

hyperferritinemia

Hypergammaglobulinemia

chronic inflammation–>vitamins and iron used up by WBC–>anemia

thrombocytosis

increased ESR

Increased CRP

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196
Q

Which one is gall bladder in this ct scan

A

Round green is gall bladder

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197
Q

Pan tri regurg (systolic murmur)

Parasternal heave

Ascites

Hepatomegaly

JVD

Abdominal Distention/pain

A

Right heart failure

could be due to Pulmonary Hypertension

PH could be due to COPD, Raynaud’s

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198
Q

Structural abnormalities

in

Orbitofrontal cortex

and

basal ganglia ?

A

seen in

Obsessive Compulsive Disorder

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199
Q

Infant

with

accelerated head growth

Increased head volume

A

Autism

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200
Q

Atrophied ( red in picture)

A

Huntington CAG

decreased Ach and GABA

Increased Dopamine

Aggression depression and then dementia

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201
Q

Schizophrenia

Plus

Mood

A

SchizoAffective

hallucinations/delusions (schizophrenia)

happened at least once

in

The absence of MOOD symptoms

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202
Q

narrowed airways or inflammation

A

whistling sound

–> wheezing

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203
Q

Chronic Cough

A

post nasal drip (Airway cough Syndrome)

GERD

Asthma

ace i

NonAsthmatic eosinophilic bronchitis

Chronic Bronchitis

Bronchiectasis

Malignancy

Parenchyma of Pulmonary problems

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204
Q

Bleeding ectopic pregnancy–>where to see the blood

A

the pouch of Douglas ( cul-de-sac)

Recto-Uterine Pouch

do culdocentesis

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205
Q

Ageing man

central vision problem

versus

peripheral vision problem

A

Central aka Scotoma–> Macular degeneration (oxidatve,chroidal neovascularization VEGF)–>distortion/metamorphsia

peripheral pressure—> Glaucoma ( open angle–> years)

opacification of lens–>(diabetes) Cataract

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206
Q

progesterone analogs

magstrate

medroxyprogesterone

A

for cachexic patients to increase appetite

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207
Q

Metoclopramide

A

Prokinetic for gastroparesis

and

Antiemetic too

Erythromycin —> IV –>acute exacerbation of diabetic gastroparesis

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208
Q
A
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209
Q

Promethazine

A

Antihistamine

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210
Q

M3

A

Gq

Increases secretions

Increases Gut Peristalsis

Increases Bladder Contractions

releases insulin

miosis

constricts bronchioles(methcholine–>challenge test for asthma)

Used by –>Ach,Neostigmine,Bethanecol

Carbachol(open angle glaucoma)–>constrics pupil–>humor lets flow

Pilocarpine->for closed angle–>contracts sphincter of pupil

and cililary muscle–>for open angle

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211
Q

Too much of lucency of lungs on CXR

A

Air filled lungs–>too much lucency means extra air in lungs–> emphysema

Lower bases–> Panacinar –>AAT deficiency

Upper base–>Centrilobular–>Smoking

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212
Q

Marfanoid

fair skin and hair and blue eyes

slurry speech w/ left sided weakness

seen ophthalmologist

A

Homocystinuria

( fair skin and hair)

marfanoid habitus

ectopic lentis

chances of thromboembolic events –> stroke

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213
Q

seizuric patient

urine labs show–>large blood but low or non rbc

A

Rhabdomyolysis

standard urinalysis cannot differentiate between myoglobin and hemoglobin

Large amount of myoglobin –>leads to renal failure

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214
Q

4 Month Old

Severe Hypoglycemia

Increased Lactic Acid

Round face like a doll

history–>episodes of infection/otitis media

physical–>lethargic & flat anterior fontanelle

A

Glucose-6-phosphatase deficiency

Glucose — X—> Glucose 6 Phosphate

Glycogen stored up

Hepatomegaly

Renomegaly

Severe Hypoglycemia–>Seizures

The liver does not pump out Glucose–> increased lactic acid and triglycerides

Increased Uric Acid–> Gout

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215
Q

Infant–>infection–>

–>hypoglycemic–>

–>sudden death

A

MCAD

can’t use fatty acids to make ketones

during fasting

or

during infection ( increased demand)

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216
Q

MCAD deficiency

See what on lab

A

Hyperammonemia

fatty acyl carnitines in blood

seizures

coma

Liver dysfunction

Avoid fasting

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217
Q

What two deficiencies cause

Hypoketotic

Hypoglycemia

A

Systemic primary Carnitine deficiency

Medium Chain Acyl-CoA Dehydrogenase Deficiency

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218
Q

Cell Type

Infection or Drug—-> hemolytic anemia

Cells without cental pallor=

A

Spherocytosis

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219
Q

Howell-Jolly Bodies

A

Asplenia or functional #hyposplenia

Spleen Problem

Nuclear Remnants

Normally removed by the spleen

seen in

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220
Q

Excess Iron in Mitochondria

A

Sideroblastic Anemia

Basophilic Stipple–> peripheral smear

Directly in Bone Marrow–>special stain–>Prussian Blue

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221
Q

Bone Pain

Cytopenia

Hepatosplenomegaly

A

GlucoCEREBROsidase def–> Gaucher

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222
Q

Normal Blood Urea and Nitrogen

A

7-18

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223
Q

Prothrombin Time

A

1

2

5

7 EXTRINSIC

10

INR–> Measures PT–> if increased PR–> Extrinsic 7 defect

1 is normal

aPTT–> all factors except 7 and 13 –> Intrinsic defect if increased

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224
Q

Partial Thro

A
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225
Q

Cirrhotic patient

comes with variceal bleed

A

Volume repletion with IV

–> Give antibiotics to gastrointestinal bleed for infection complications

—> Give octeoride to inhibit vasodilatory hormones

–> Endoscopy–>in 12hrs–> to diagnose and treat active bleed

–>Uncontrollable bleed case–>put temporary balloon tamponade

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226
Q

Myeloblasts

A

peroxidase positive

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227
Q

Mouth ulcers

Nonbloody diarrhea

Abdominal Pain

arthritis

Rash–>erythema nodosum

A

Crohns

cobble stone and skip

strictures and bowel wall thickens

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228
Q

SBO

proximal

A

Early Vomiting

Abnormal Contrast filling on CXR

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229
Q

Mid or Distal SBO

A

Colicky Abdominal Pain

Prominent Abdominal Distension

Dilated Loops on CXR

Hyperactive bowel sounds

Constipation-Obstipation

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230
Q

SBO

Most common cause

A

Adhesions

–>Post surgery or inflmmation processing

COngenital–> Ladd in Infants

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231
Q

Fundal Placenta

A

Attached at top of the uterus

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232
Q

pain on heel

most intense in morning –>first steps–>gets better later

patient is a runner or stood for long time on hard surface

A

Plantar fasciitis

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233
Q

ELderly Patient

acute ankle pain

swelling and warm

progressive pain

involved joint has effusion

articular cartilage has chronic calcification

A

Pseudogout

acute cases

Calcium pyrophosphate–>Positive bifringent

Rhomboid shaped

Chondrocalcinosis usually present

effusion has inflammatory cells–>inflammation causes warmth and tenderness

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234
Q

Synovial fluid Analysis

effusion

15000-30,000 cells/mm3

A

Pseudogout

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235
Q

Synovial fluid

effusion

WBC –> upto 50,000 cells/mm3

A

Urate Gout

More than 50,000 cells/mm3 –> Septic Arthritis

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236
Q

Cauda equina roots

A

Not part of spinal cord

counts in the Peripheral Nervous system

Below L1-L2

–>L4 to S5

Send out Parasympathetic flow–> bladder and lower bowel

Urethral and Anal Sphincter

sensorium to saddle area

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237
Q

Cauda equina vs Conus Medullaris

A

Cauda equina –>L4 to S3

Gradual–> Lower tail like fibers–> Assymetric involvment of ROOTS–> LMN roots–>peripheral–>hyporefelxia

–> Saddle anesthesia,leg involvement and radiculopathy –> most likely Cauda equina

Conus–>ENds at L3–>Bladder dysautonomia–>Injury to the spinal region and also the roots–>UMN and peripheral –>

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238
Q

Bacterial endocarditis management

A

Obtain serial blood cultures

from

three different Venipuncture sites

prior to starting an antibiotic therapy

to ensure

the microorganism is identified

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239
Q

Patient with history of

PVD +atherosclerosis (High Cholesterol) or Alcohol

comes with

epigastric pain

increased amylase or lipase

mottled skin

A

Pancreatitis

Atheros–>give antiplatelet only–>IV only–>nothing given by mouth

supportive care

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240
Q

Antiarrhythmic drugs

slow binding

and

slow rate of dissociation

A

1C

Flecainide & Propafenone

Binds to tissue in action and potentiate QRS widening

Contraindicated in Post-MI

&

Structural heart abnormalities

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241
Q

Patient in emergency

Post trauma

respiratory distress in 10 hrs

no rash

A

Pulmonary contusion

Non-lobular pneumonia–> not dependent on anatomic landmarks

more than 10 hrs–> plus rash = fat emboli from broken bone–> Rash accompanies too

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242
Q

Fever

leukocytosis

bloody stool with mucus

Abdominal Distension

A

Xray

check for toxic megacolon post difficile or IBD

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243
Q

Normal Oxygen Saturation

A

95—>100%

PAo2= Alveolar

Pao2=Arterial

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244
Q

Passive VAccine!!

A

Preformed Antibodies

IgG –> crosses placenta

IgA–> in breast milk

Humanized Monoclonal Antibodies

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245
Q

Passive Vaccinations for–?

A

Tetnus

Diptheria

Hepatitis B

Rabies

Varicella

Botuli

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246
Q

Oscillopsia—>?

A

Gentamicin

Aminiglycoses

next level of vertigo

ototoxicity/cochlea cells damaged +

motion sensitive vestibular cells

in the inner ear damaged

aka vestibulopathy–>both end organs damaged–>No left right imbalance–>patients don’t feel vertigo

Oscillopsia–> see the objects moving

Abnormal head thrust test–>eyes miss the target–>get to the target after a bit

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247
Q

whats the fracture–>

of what bone–>

what important structures –>

A

Supracondylar fracture

of the Humerus

Median nerve and Brachial artery at risk

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248
Q

FInger Clubbing Mechanism

A

Megakaryocytes skip the Pulmonary route

–>That fragments them

Instead goes to the microcirculation –>nail beds

–>gets stuck in there due to size–>

release –> PDGF & VEGF

Cases

Right –> Left Shunt

Cystic FIbrosis

Lung MAlignancies

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249
Q

Humid vacation

comes back with hypopigmented spots

A

Tinea Versicolor

Malassezia Globosa

if multiple

Malassezia Multicularis

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250
Q

A patient comes in winter

no erythema

no exudates

A

Icthyosis Vulgaris

attributed to dryness at young age

gets worse as you age

a defect in a filaggrin gene

give keratolytics or topical retinoids

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251
Q

Progressive muscle weakness

difficulty making facial expressions

atrophy of thenar and hypothenar

Testicular Atrophy

Delayed relaxation on the contraction of thenar and hypothenar

A

CTG Myotonic Chromosome 19

Arrhythmia

Balding

Cataract

Infertility

death from respiratory failure or cardiac

–> Weakness of Skeletal(face forearm foot drops), Cardiac(conduction) and Smooth muscles(Dysphagia)

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252
Q

Becker vs dystrophin

A

Both XLR

Dystrophin starts earlier–>age2

Becker at 6

Both have Cardiomyopathy–>Dystrophin has scoliosis too

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253
Q

X linked Dominant

Big testes

A

Fragile X

Long face and Large Jaw with MVP

Hypermethylated FMR1 Gene–>stops expressing

Most Common cause of –>Inherited –Intellectual Disability

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254
Q

Chronic Major depression with psychosis

Patient won’t eat or drink

A

ECT

or antidepressive with antipsychotic

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255
Q

M3

A

BronchoConstriction

AntiMuscarinics–>Ipratropium, Toptropium (Long Acting) ————->COPD

Antimuscarinic AR (Mioisis blocked–>dilated pupil, accomodation blocked–>glaucoma danger)

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256
Q

Anti-Saccharo myces cerevisiae antibody

A

Th1–>Non Caseating–>Crohns

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257
Q

Crypt Abscesses

P-ANCA

Blood in stool or tissue

A

Ulcerative colitis

( Check for colorectal carcinoma–both crohn and UC)

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258
Q

woman gravida 5

Coughing/laughing—>Pee

A

Stress with normal post voidal urine vol

little voiding post sneezing/cough

–>weak pelvic floor

levator ani damaged –>u shaped sling that holds–> urthera and bladder in place

damaged sling–> hypermobile or prolapsing urethra or bladder

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259
Q

Performance anxiety

tremors and tachycardia

to use as need basis

A

Beta-blocker propranolol

sole perfomance anxiety

avoid drowsiness of benzos

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260
Q

Chronic Sinopulmonary infections

with

infertility

A

Cystic fibrosis–> absent vas deferens–>Azoospermia

Primary ciliary dyskinesia—>immotile sperm

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261
Q

Prophylactic therapy for ARF

A

Benzathine IM Penicillin G

Every 4 weeks

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262
Q

Loud S1

A

atrial doors delay in natural closing during end of ventricular diastole—> ventricular systole then closes it

delay–>either by

increased atrial pressure or

short diastole in tachycardia

stenotic valve

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263
Q

Breast swelling

w/pain

diffusely warm & erythematosus

with

dimpling

A

Inflammatory Breast Carcinoma

Rapid onset Edematous cutaneous thickening

Rare but aggressive

Next step is to screen–>Mammography & Ultrasound

but biopsy confirms

peau de orange

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264
Q

Prostate Cancer bone lesions ?

A

Osteoblastic

Osteolytic–>Multiple Myeloma

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265
Q

Toddler–> 12th month old

A

Pincer Grasp

Stands well

Walks first step in independence

Says more than mama and dada

18th month—-> runs and kicks a ball (10-25 words)

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266
Q

Radioactive Iodine Therapy

A

taken up by thyroid or extra tthyroid tissue( toxic nodula or adenoma)

Beta emission –>induces slow necrosis of follicular cells–> 90% get permanent hypothyroid ( in case thyroid uptake –>extra tissue case stays normal)

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267
Q

Brain stem models

A

T–>M–>P—>M

Thalamus–>Midbrain–>Pons–>Medulla

Basilar Artery–>P–>M–>Lower medulla

Basilar–>AICA–>Pons–>Facial Droop

Subclavian–>Vertebral–>PICA–>Lateral Medulla–=

9/10/11->Hoarseness)

( spinothalamic-> pain & temp from contralateral)

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268
Q

Hoarseness

and

Contralateral Pain and Temperature loss

A

PICA–>Lateral Medulla smoked

Subclavian———->Vertebral—>PICA

9-10-11 Smoked———>Dysphagia+Hoarseness

ST smoked———>Contralateral Pain and temp

Sympathetic fibers smoked—>Ipsilateral Horners

Inferior cerebellar peduncle smoked—> Dysmetria, Ipsilatera Ataxia

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269
Q

Patient C/W

Decreased sweating

droopy eyelid

Arm undershooting or overshooting–>missing target

Vomiting and vertigo

A

Lateral Medulla smoked

PICA ( basilar)

Intraprenchymal bleed

Also –>labyrinthe artery impacted–>ipsilateral sensorineural deafness–>Vertigo

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270
Q

Patient c/w

tongue falling onto one side

and paralysis of other side of body

A

Medial Medulla smoked

Anterior spinal artery

Lateral Cortico Spinal tract( c/paralysis)

Medial Leminiscus ( c/proprioception)

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271
Q
A
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272
Q

Lateral Medulla

A

cranial Nerves 9 –10—-11

PICA

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273
Q

Smoked –>

Sympathetic fibers

9 10 11 CN

Labyrinth artery

A

Lateral Medulla

PICA

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274
Q

Patient C/w

Contralateral paralysis

But w/

The absence of cortical signs–>aphasia or visual loss

A

Lentriculostriate artery

Chronic HTN—–>hyalinized—–>Charcot-Bouchard Aneurysm—>Lacunar Infarct

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275
Q

Patient c/w

atrophied hand muscles

and ischemic pain

A

Thoracic outlet syndrome

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276
Q

Nonreactive fetal stress test

A

with normal fetal movements–>possibly fetal sleep

h/ of no fetal movements–>placental insufficiency

umbilical cord compression

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277
Q

Holosystolic Murmurs

A

Tr

Mr

VSD

Handgrip —->Increased Afterload—->Increases sound of Holosystolic Murmurs

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278
Q

Inspiration–>Murmur

A

Increases Right heart sounds

Increased Venous Return

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279
Q
A
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280
Q

HIT

A

Take it off heparin

give direct thrombin inhibitors–>Argatroban,Dabigatran

or factor Xa inhibitors–>Fondaparinux

if platelets are down 150,000–>

dont give warfarin

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281
Q

Polycythemia Vera

A

normally

hypoxia–>EPO–>jak–>proliferation

PV–>jak mutated–>turned on

low EPO

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282
Q

Patient c/w

spasticity and fasciculations

also with

hyperreflexia

and atrophy of same muscles

but no

bladder or bowel dysfunction

A

ALS

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283
Q

treatment-resistant schizophrenia

A

Clozapine

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284
Q

2 Week old infant

mild eyelid swelling

bilaterally draining eyes

A

Chalmydia Conjuctivitis

PO Macrolide

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285
Q

FIrst week of life for infant

Profusely draining eyes

markedly eyelid swelling

corneal ulceration or edema

A

Gonococcal conjuctivits

IM 3rd gen cephalosporin–>single dose (cefotaxime)

severer than chlam(macrolide)

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286
Q

draining ulcers but odorless

patient is gardener

none lymphadenopathy

lesions were seen along the line of lymphatic drainage

A

Sporotrichosis

dimorphic fungus that sits on decaying plants

Several months of Itraconazole cures it

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287
Q

Fever and sore throat

after fish bone scratched the throat

posterior pharyngeal wall–>red–>& Bulging

The neck is stiff w/ reduced motion

Neck’s lateral radiographing–>shows increased thickening of Paravertebral soft tissue

A

Trauma to the posterior pharynx——->Retropharyngeal Abscess

buccopharyngeal fascia–>Pharynx–> retropharyngeal space–>Alar Fascia–>Danger space–>paravertebral fascia

if it passes through alar fascia–>it can rapidly transmit to posterior mediastinum–> to the level of diaphragm–>Acute necrotizing mediastinitis

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288
Q

Drooling

Dysphagia

Odynophagia

fever

the case of infected tooth

A

Ludwig Angina

see the red and warm mouth

w/ bilateral cellulitis

of submental, sublingual and submaxillary spaces

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289
Q

Shoulder Dystocia Management

A

BE CALM

Breath ( dont push)

Elevate legs–> thighs against abdomen

Call for help

Apply suprapubic pressure

Larger vaginal opening–>epsiotomy

Maneuvers

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290
Q

Be Calm Maneuvers ?

A

Posterior arm–> deliver

Rotate posterior shoulder–> apply pressure to anterior aspect of the posterior shoulder–>woods screw

apply pressure to the posterior aspect of the posterior shoulder-->Adduct posterior fetal shoulder

Mother on All Four

Re place fetal head into the mothers pelvis

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291
Q

Prenatal visit tests

A

RhoD and hemoglobin and hct, MCV

Viral –>Vdrl,RPR,Hiv

Immunity to rubella vericella

vaccine to influenza

PAP AND PCR FOR CHLAM

Urine culture and protein

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292
Q

Toddler Patient c/w

failure to thrive–> not been able to gain weight

weight is <5percentile

Urine labs show alkaline urine

Family Hx of nephrolithiasis

A

All type of RTA–>failure in growth

RTA —–> body is acidic—-> Cells cant grow and divide properly in an acidic environment

either due to increased excretion of hco3 (RTA2)

or

decreased excretion of acid (RTA1)

Type 2 is linked with Fanconi –> along with hco3 expulsion–> aciduria and phosphaturia

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293
Q
A
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294
Q

hydroxyurea side effects

A

Myelosuppression

neutropenia

anemia

thrombocytopenia

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295
Q

Increased Conversion

Fe2+ ——>fe3+

A

Methemoglobinemia

oxidizing fe2+===>Fe3+

fe3+ does not dissociate from o2 –>Cyanotic

Dapsone

Anesthetics–>Benzocaine

Methemo–>is created to hold and trap cyanide

Tx–> methylene blue, Vit C

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296
Q

Anion Gap caused by what?

A

>12

Mud Piles

Methanol

uremia

diabetic ketoacidosis

propylene glycol

iron tabs

isoniazid tx

lactic acidosis

salicylates

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297
Q

Pralidoxime is given with

A

Atropine

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298
Q

Multiple lesions

on

Liver

A

Metastatic

seeded from some other primary cancer

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299
Q

Unobliterated processus Vaginalis–>

A

Infant–>

patent processus vaginalis–>

hydrocele or Inguinal hernia

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300
Q

Patient w/ HIV

floaters and blurry vision

A

CMV

Retinitis

Full-thickness retinal inflmmation–>Moves centripetally–> along the vessels–>edema and scarring–>Blurring, floaters & photopsia

scarring/edema–> retinal detachment

Intravitreal Injection if the lesion is close to the fovea or optic nerve

Photopsia= sensation of flashing lights

centripetally= moving towards the center

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301
Q

Toxoplasmosis eye

A

chorioretinitis

Nonvascular pattern

comes with EYE PAIN

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302
Q

Chorioretinitis

A

Toxoplasmosis –>with eye pain, congenitally comes with a triad

CMV–>congenital–>sexual or organ transplant–>c/w hearing loss, periventricular calcifications

Syphilitic–> c/w uveitis and almost always w/ Meningitis

Herpes–>Simplex–>keratitis–>Corneal, tearing and discharge

Herpez–>zoster–>Cornea or Iris–> Vesicular Eruption

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303
Q
A
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304
Q

Cholecystectomy

A

postoperative diarrhea

due to

Insufficient bile absorption

by

terminal ileum

CholeDOcholithiasis–>stone in CBD–>ERCP to remove stone–>then do cholecystectomy

stone from CBD–>travels to vater–>can block both pancreatic and gall flow to intestine

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305
Q

Bronchiectasis

A

dilated airways///& or Bronchial wall damage

due to

chronic inflammation from

Infections

or

structural airway defect

Inflammation//structural defect//masses –> cause obstruction

Do high res CT scan

==>> Obstructive disease

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306
Q
A

Achrocordon

skin tag

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307
Q
A

seborrheic keratosis

stuck on

can be flat, raised or velvety and greasy

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308
Q
A

actinic keratosis

premalignant lesion

dry and scaly

base is erythematous

sun exposed areas

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309
Q
A

Basal cell carcinoma

pearly or waxy//shiny

BCC flat or rolled border

((SCC ==>>firm red pimple))

papule –> or a nodule

Overlying Telangiectasia

Ulcerates

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310
Q

Seborrheic keratosis

vs

Melanoma

A

Seborrheic keratosis

quite similar to melanoma

but

melanoma is on sun-exposed areas

and its not greasy

and melanoma does not have rubbery texture

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311
Q

Normal WBC in CSF

A

0-5 wbc per mm3

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312
Q

post cardiac surgery –>CABG

patient has

increased diastolic pressures in right heart

and

increased PCWP

plus sign of Cardiogenic Shock

A

the patient is in cardiac tamponade

rare, but Important situation post CABG

Fluid accumulated in pericardial sac

Management

Echocardiograph to size up–>Immediate percutaneous or surgical drainage

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313
Q

Tumor lysis

A

cells are destroyed

–> Intracellular ions–> potassium and phosphate–> are liberated

hyperkalemia–> arrhytmia

Hyperphosphatemia –> Binds and traps calcium–> hypocalcemia

uric acid increased too due to increased destructions of cells and nucleic acids

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314
Q

Patient was treated for lung malignancy

before the age of

30

A

Lung cancer treatment in patient <30 y/0

18.2 % chances to secondary malignancy from chemo or radiation therapy

later in life

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315
Q
A

Post radiation–>fibrosis

lungs lose volume

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316
Q
A

Lung cancer X-Ray

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317
Q
A

aspergilloma

occur in normal immunity patients with structurally defect lungs ( pre-existing cavities// Cysts )

Air crescent is seen along the periphery of the cyst

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318
Q
A

Apical Cavities

comes with consolidation

and

Lymphadenopathy–>Lobar pneumonia

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319
Q

facial plethora

and

Hypertension

A

Cushing Syndrome

with central obesity

and

proximal muscle weakness

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320
Q

Parathyroid

increased

A

calcium and kidney stones

w/

Neuropsychiatry–> confusion, depression,psychosis

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321
Q

Pericarditis

A

MI & dressler

Aortic Dissection

Rheumatic fever

viral

Uremic

Neoplasms

Collagen Vascular disease –>RA, SLE

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322
Q
A
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323
Q

Petechial rash–>vesicles, bullae

progressed to gangrenous

Pt has fever and vomiting

A

Meningococcemia

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324
Q
A

Macule

m/c

Rubella

measles

Tuberous sclerosis

actinic keratosis

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325
Q
A

papule

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326
Q
A

bulla

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327
Q

Pulmonary EMbolism

A

ABG

will show

Hypocapnia (response –>tacgypnea)

hypoxemia –> less O2 in arterial blood

increased alveolar to arterial gradient

Massive embolism –>hypercapnia

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328
Q

Postoperative pulmonary complications

A

Atelactasis

Bronchospasm

Prolonged ventilation

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329
Q

acanthosis nigrican

A

skin folds –> thick and velvety

DM

PCOS

Obesity

Cushing Disease

Paraneoplastic Adenocarcinoma

Metabolic syndrome–>NAFLD

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330
Q

MAcrovascular fat deposition

–>peripheral displacement of nuclei

A

NAFLD

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331
Q

A pervasive distrust and suspiciousness

personality–>that subtly has that kind of impact

A

Paranoid “personality”

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332
Q

Gallstones with no symptoms

tx

A

No treatment

elective laparoscopic cholecystectomy–>if some symptoms present

urgent cholecystectomy–>if choledocholithiasis, cholecystitis, gall stone pancreatitis

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333
Q

cervic bleeds on swab

A

cervicits due chlam or gonorrhea

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334
Q

Breastfeeding contradictions

A

Active Varicella

herpetic breast

active untx tb

active substance abuse

maternal hiv

chemo/radiation

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335
Q

Alcoholic Cirrhotic patient

w/ flapping tremor

comes with fever and

Gas

in Small and Large Bowel

A

SPontaenous bacterial peritonitis

do paracentesis to verify

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336
Q

normal b cells

low immunoglobins

A

Common Variable

Delayed presentation–> after 2nd year or later

sinopulmonary infections

bronchiectasis

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337
Q

migratory arthralgia

variable joint pain

months ago–>went to NE usa

A

Lyme

Lyme’s several months-years later–>

Arthritis =years

Encephalitis==years

Peripheral Neuropath===years

some months=

carditis

Meningitis

CN 7 palsy

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338
Q
A

crusted sores

beneath

which ulcers form

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339
Q

elderly patient on medication

factor X inhibitors

hx of htn

altered consciousness

focal occipital headache

A

stroke

non-contrast ct scan ( contrast is difficult to differentiate from blood–> do non contrast)

white hyperdense

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340
Q
A
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341
Q

Irregular bump

Normal overlying epidermis (skin)

doesn’t regress

A
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342
Q

firm nodule

on lower extremities

the fibrous component that causes dimpling when pinched

A
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343
Q

Firm and freely movable

nodule with central punctum

A

semisolid core

keratin and lipid

epidermis lodged in dermis due to trauma or comedones

can increase in size or cheezy white discharge

usually, resolve spontaneously

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344
Q

patient with Micrognathia

&

Lymphopenia

A

Normal Thymic Sail Sign

absence –> 22q11 microdeleted

===>> DiGeorge

Conotruncal defect

Abnormal face

Hypocalcemic

===>>> tetany, Seizures, Arrhythmia

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345
Q

valsalva

leaning forward

cough

A

increases intracranial pressure

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346
Q

Coarctation of aorta

ovarian failure

A

Turner

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347
Q
A

Crown to Rump length

w/

first trimester Ultrasound

is most accurate method to determine gestational age

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348
Q

Antipsychotic patient

highly febrile and stiff

A

NMS

post dopamine blockage by antipsychotics

Tx of NMS===>Dopaminergic—>Bromocriptine, Amantadine

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349
Q

Very Short

acting

Depolarizing

muscle relaxant

to induce—>Paralysis during anesthesia

A

Succinylcholine

Anesthetics A/r –>Malignant Hyperthermia

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350
Q

Cholinesterase Inhibitor

A

Saves Ach from acetylcholinesterase

=====>>>Ach increases

Physostigmine===>>>>>>Ach

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351
Q

young patient

hypertensive

bruits

Increased Renin and Aldosterone

A

Fibromuscular Dysplasia

or Renal Artery Stenosis

===> both decreases renal perfusion

FMD–>Bruits can be closer to mandible angle–>Vertebral

or at renal

FMD==>>>>>> Renal–Vertebral–Carotid

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352
Q

EBV Lymphadenopathy

A

Tender and mobile

Patient==>>>Hemolytic anemia & Thrombocytopenia

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353
Q

>25% of Lymphoblasts

A

ALL

see in

Down syndrome

t 12:21

===>>>>CNS testes

T cell ALL—->>>>Medistinal mass

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354
Q

adhd

A

do not deceit ppl

do not act violently

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355
Q

>40 y/o patient

c/w

Dysmenorrhea

Menorrhagia

w/ no Adnexal Mass

A

Adenomyosis

Endometrial glands==IN==>> uterus muscle

Symmetrically enlarged Uterus + >40y/o

=Adeno

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356
Q

Cystic mass on ovary

young woman

Noncyclic pain exacerbated by movement//exercise

Dysmenorrhea

A

Chronic pelvic pain—>>reproductive woman

–>>cystic

Endometriosis

Infertility>>Dyschezia

Locations

Recto-Vaginal Septum

posterior cul-de-sac

Uterosacral Ligament

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357
Q

Pelvic mass

Calcified and hyperechoic

A

Mature Teratoma

no infertility concern

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358
Q

Sickle cell bugs

A

Encapsulated bugs

Neisseria

streptococcus

haemophilus

vaccine===>>> fixed Neisseria and haemophilia cases

But

Strep is difficult to trap for an SCD patient

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359
Q

Sickle bone pain

A

Aureus or salmonella–>osteomyelitis

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360
Q

Patient comes w/Renal Dysfunctioning & fragmented cells

Fever ,Neurologic signs

w/

Low wbc ,Low Platelets

and

Low hemoglobin

A

Thrombotic Thrombocytopenic Purpura

Microangiopathic hemolysis==>> Decreased haptoglobin

fever+renal+neuro+hemolysis

Emergent plasma exchange

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361
Q

Young patient

–>>High serum Calcium

–>>High-Normal Parathyroid Hormone

But

Low urine Calcium

A

Familial hypocalciuric Hypercalcemia

Calcium-sensing receptor problem

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362
Q
A
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363
Q

Acquired Genetic defect leading to hemolysis and hypercoagulability

–>>>abdominal pain and dark urine

A

Paroxysmal nocturnal hemoglobinuria

Procoagulant microparticles generated through complement dependent damage of platelets and venous endothelium

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364
Q

Prosthetic joint

==>>>Joint pain

===>> 3 to 12 months

A

Coagulase Negative Staph Epidermidis

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365
Q

granulomas

A

Non caseating – occupational

Sarcoidosis

Crohns

Caseating===>> Central necrosis===>>>Infectious cases

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366
Q

The whole fetus is small==>>

A

Symmetric FGR

Congenital insults

Asymmetric –>>Placental insufficiency

Asymmetric –>>Various sizing paramenters tell different gestation age

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367
Q

toddler

arches the back

during or after feeding

A

GERD

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368
Q

Opioid Antagonist

A

No to opioids

Naloxone

Naltrexone

Methyl-Naltrexone

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369
Q

Opioid Partial Agonist

A

BuproNorphine

Heroin Maintainance===>>>Give w/ opioid antagonist OR Methadone

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370
Q

Actinomyces

A

Not like Nocardia

Not Aerobic

Not Acid-fast

Tx with Penicillin G

Act==>> Filamentous and gram-positive

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371
Q

Irregular uterus

Globular and Firm mass

pelvic pressure

several protuberances on the mass

A

Leiomyomata uteri

===>> fibroids

Palpated Nodular & immobile uterus==> endometriosis

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372
Q

Intermenstrual Spotting

Uterus Enlarged

A

No prolonging of Menses

Polyps in the uterus ( Endometrium)

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373
Q
A

costal MArgin

T8

T10 Umbilicus

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374
Q

Decreased

Maternal Serum Alpha-Fetoprotein

A

Aneuploidy

18 & 21

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375
Q
A

Adenopathy===>> Large and Swollen Lymph Nodes

Bilateral==>>> Sarcoidosis

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376
Q

CXR shows Thickening at hilum bilaterally

Erythema nodosum

Migratory Polyarthralgia

Fever

A

Sarcoidosis—>>LofGren Syndrome

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377
Q

Reproductive woman

comes w/

Sudden lower abdomen pain

=====>>>>>> Unilateral

without

====>>>>Leukocytosis

A

Ovarian Torsion

differential

appendicitis or ectopic ==>> have leukocytosis

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378
Q

Glasgow

A

==>>Eye Opening –> out of 4

==>> Verbal Response—> out of 5

==>>Motor Response–> out of 6

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379
Q

Myasthenia Gravis

A

The 3rd decade in a woman

6th or 8th in Man

Ach receptor destroyed

Bulbar–>>Chewing difficulty, nasal speeching

Ocular

Proximal Limbs–>Arms

Respiratory muscles

MG===>> Gets precipitated By drugs–> Quinolones, Macrolides, Beta Blockers and Infections

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380
Q

Live attenuated vaccine

contradiction

for CD4 cells

below===??

A

CD4 <200

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381
Q

OCD

A

Intrussive

ritualistic thoughts

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382
Q

depressed looking patient

mask like facial expressation

withdrawn

less energetic

stiff walk

stooped posture

resists passive flexion

A

Parkinson

rigidity with bradykinesia

stooped posture and hypokinetic stiff walk–> short steps walk

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383
Q

Hypomania vs MAnia

A

patient is able to perform with more energy at the office in hypomania

Mania—>>>patient ends up in hospital or gets noticed for highly jubilant

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384
Q

smaller plateles

cytoskeletan defect

====>>> Antigen not presented

A

Wiskott

IgA IgE increased but

Low===>>> IgG IgM

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385
Q

Staph infection alongside Strep

the patient comes w/ peripheral neuropathy

A

Chediak

Lysosomal trafficking problem

Lysosomal unable to fuse with ==>Phagolysome

progressive neurodegeneration

&

Albinism (partial)

–>LymphoHistioCytosis

—> Milder COagulation problems too

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386
Q

hyperpigmented macules vs hypopigmented

A

Hyperpigmented ===>>>Neurofibramotosis

HyPopigmented====>>>Ash leaf==>>Tuberous

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387
Q

NF1 Vs NF2

A

Nf2 ==> 2 ears ringing

2 Intracranial tumor====>>Meningioma Ependymoma

2 eyes==>> Juvenile Cataract

the heavier load is on NF1==>>

Eyes nodules,

peripheral sheath tumors

freckles

Intracranial mass

Pheochromocytoma

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388
Q

Microcephaly

A

13atau

Cri-Du-Chat 5p-

Maternal PKU

Zika

Xrays

Fetal Alcohol w/ smooth philtrum

Fetal Anticonvulsant Hydantoin w/ hirsutism Microephaly & cleft –>Phenytoin

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389
Q

Patient comes w/

dark urine & abdominal pain

plus

Scleral ICTERUS

RUQ ===>>>> Palpable Mass

No fever or any other concerns

A

Cyst

BiLiarY ==>> Intra or Extrahepatic

Most Common===>>Extrahepatic type 1

===>>>Congenital Dilation of BiLiary Tree

Presents w/ Cholangitis

And maybe accompanied w/ Pancreatitis in older children

Biliary Cysts ====>>> Cholangiocarcinoma

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390
Q

Recent UTI

elevated ESR

Normal Leukocytes

Normal Temperature

A

Vertebral Osteomyelitis

MRI

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391
Q

A pulsating Headache

Papilledema

Increased CSF opening pressure

Worse at night

awaken her from sleep

A

pseudotumor cerebri

IIH

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392
Q

ELevated Direct Hyperbilirubinemia

Elevated Alkaline Phosphatase

A

Cholestasis===>>>>

Bile Duct Obstruction

Bile duct = Alkaline Phosphatase

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393
Q

Eye Pain

Sensitivity to light

blurry

Repeated attacks

A

Anterior

Uveitis

Turbidity of aqueous

Ciliary muscle spasm===>> pain

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394
Q

Stepwise decline in

===>>>Executive functioning ( decisions )

===>>>>forgetfulness

A

Vascular dementia

White matter==>>cortex //subcortical Infarctions

versus

Early & Insidious onset of dementia==>>Alzheimer

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395
Q

Medial Temporal Lobe Atrophy

Early onset memory loss

slowly progresses

Language

Visuospatial defects

A

Alzheimer

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396
Q

ILLness anxiety disorder

A

No symptoms

but patient keeps worrying

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397
Q

A patient was resting comes w/

a new chest pain

===>> Occurs at rest

that is progressively worsening

==>>>Troponin is normal

A

Unstable Angina

ST may be seen if not enzymes

Tx==>> ASA, IV nitro,IV morphine

Refractory to therapy===>> IV heparin, Schedule Angiography, Possible revascularization–> PCI, CABG

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398
Q

Hypotensive

DIstant Heart Sounds

JVD

A

Excess fluid in Pericardial sac======>>>>>>

Cardiac Tamponade

Rate of effusion/ fluid formation is important than the size

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399
Q

Hx of

SLE / Pericarditis / Malignancy / TB / Trauma

A

Fluid forms around the heart

in a pericardial sac

===>>> Tamponade

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400
Q

Murmur that increases with less preload

A

Hypertrophic

Cardiomyopathy

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401
Q

Lithium===>> Congenital impact on fetus

A

Malformation of Tricuspid valve===>> atrialized RV

+

Atrial Septal Defect

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402
Q

Mood Stabilizers

Congenital Defects==>>

A

Cranio-Facial defect

Neural Tube

Genital Anomaly

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403
Q

third-trimester patient==>Clear purulent vaginal discharge

w/ fever

uterine fundal tenderness

fetal tachycardia

&

Maternal Leukocytosis

A

IAI==>Intraamniotic Infection

IAI==>aka==>Chorioamnionitis

Common==>> Patients with premature or prolonged rupture of membranes

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404
Q

Macroglossia

A

Hypothyroid

Beckwith-WiEDEman==>>hemihyperplasia

amyloidosis

mucopolysaccharidosis

neurofibramotosis

Vascular malformations==>>hemangioma

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405
Q
A

stasis dermatitis

venous valve incompetence==>> pooling of blood

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406
Q

2-word phrases

>5o word vocabulary

A

2 year old

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407
Q

Chronic MS care

A

Ibterferon Beta

Glatiramer

Acute exacerbation/flare==>> Steroids

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408
Q

serratia

auerus

burkholderia

plus abscess

===>>>>>>>>>

A

Chronic Granulomatous disease

Defect in NADPH

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409
Q

Non purulent infections

A

Leukocyte Adhesion Def

Impaired neutrophil migration

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410
Q

Gnawing===>>> Insidious epigastric pain

worst at night

weight loss

A

Pancreatic Adenocarinoma

Duodenal ulcer==>> relived by food

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411
Q
A
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412
Q

Walks upstairs==>>both feet on each step

A

2nd year

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413
Q

Endemic area

Upper lobe cavity

hypoglycemic

hypotensive

eosinophilia

hyperkalemia

A

Infection-induced Adrenal damage

TB or fungus ==> adrenal insufficiency==>

Retention of

potassium (alkaline)

&

Hydrogen ( Acidic)

===>>> Normal anion gap hyperkalemic** & hyponatremic **Acidosis

414
Q

eye pain and blurry

Dilated pupil not reactive to light

A

Glaucoma

415
Q
A
416
Q

Hyperkalemia on ECG

A

Potassium more than 6.5

==>>>> Delayed phase 0==>>Longer Action Potential===>>><strong> <u>Widened </u></strong>QRS

& increased P——>R interval

==>> Seen as Delayed InterVentricular & Atrioventricular communication

=>Apprears==>>>LBBB/RBBB

With

The narrow base of T wave but a Peaked tower

==>>As hyperkalemia worsens==>>

417
Q

arm has higher Blood pressure than legs

A

Turner

Streaked ovaries==>> Not going to produce Estrogen

418
Q

turner 5 things

A

1 Horseshoe kidney

2 Straked ovaries

3 Coarctation of aorta==>> upper limbs higher bp

4 palate= narrow with high arch

5 bicuspid

419
Q

Upgoing plantar reflex

A

Abnormal

===>> UMN injury

Nociception==>>S1===> Tibial nerve–>Sciatic nerve—> Roots–>L5 S1==>> Synapses at Anterior Horn

Anterior Horn==>> Motor response==>back to the ==>>L5 S1==>>>>>Sciatic nerve–>>bifurcations—> Tibial Flexors and Deep peroneal nerve Extensors===>>>> Loss of ability to suppress Extensor==>> UPGOING FLEXION

420
Q

Leukocyte Alkaline Phosphate

A

Higher in Leukomoid rxn

versus

Lower in CML

421
Q

Metamyelocytes

A

Metamyelocytes higher than Myelocytes==>LEUKOMOID

Matures than Myelocytes

higher in Leukomoid

versus

Myelocytes are higher than Metamyelocytes in CML

422
Q

urinary Incontinence

with

contralateral paralysis more pronounced in

Lower Limbs

A

Anterior Cerebral artery stroke of frontal lobe mesial

423
Q

No organized P waves seen

A

Atrial Fibrillation

Narrow complex QRS==Rapid ventricular Response

Atrial Fibrillation==>>Supra Ventricle

424
Q

Stroke Suspicion

do what next>

A

figure out

if stroke is

Hemorrhagic or Ischemic

Hemorrhagic ==> SubArc or Intracranial bleed

Ischemic ==> emboli or clot

425
Q

Statin for LDL?

A

needs to be more than

190

426
Q

Hirsutism

A

In Woman

Male pattern hair loss

and

Male pattern hair growth

427
Q

Period sharp waves on EEG

Hypokinetic= Pyramidal Dysfunction

Nor move nor speak ==> Akinetic Mutism

Rapid dementia

A

creutzfeldt-jakob

twitching muscles and cerebellar dysfunctions

also visual disturbances

428
Q

Amblyopia

A

Vision loss from disuse of deviated eye

429
Q

Suprapubic

A

Bladder==>>Pain==> Cystitis==>

Nitrofuontain 5 days

TMP-SMX 3 days

Floxacin==for s_ulfa allergics_ or resistant

Complicated cases like

–> diabetics, catheters, Uobstructions, CKD, pregnancy, Hospital Acquired==>> Do culture in these cases

iLiohypogastric nerve

430
Q

High Amylase

high lipase

high BMI

High Alkaline Phosphatase

High Alanine ALT

A

Acute pancreatitis fue to gall stone

==>>>PAind radiates to the back

431
Q

T3 effect on vessels and heart

A

T3===>> Decreases SVR

and

Increases Ionotropy

and Increases Chronotropy

By increasing Sensitivity

To

Circulating Catecholamines

And increases B1 receptor Transcription

432
Q

CURB 65

A

5

BUN= More than 20

confusion

respirations more than 30

BP if = systole less than 90 or diastole less than 60

Age more than 65

score out 5

more than 1===>>>> Admit in to the hospital

433
Q

NonSpecific signs of congenital Infection

A

Blueberry muffin

Hepatoplenomegaly

jaundice

Growth restriction

434
Q

undercooked meat and congenital infection

A

Toxoplasmosis

The mother might have swollen glands only

( Lymphadenopathy )

Infant==>> Intracranial calcifications ==> Diffuse

Hydrocephalus

Chorioretinitis

435
Q

Mother had

Rash and Arthritis

and swollen glands and lymph nodes

A

Respiratory drops–> Mom–>Rubella-> rash and arthritis

Infant–> Pulmonary Artery HYPOPLASIA

Cataracts

Deafness

436
Q

SAAG

A

Peritoneal fluid Albumin - Serum Albumin

==>>> More than 1.1 = Portal Hypertension

437
Q
A

Tripod ==>> Epliglottis==> Hemu

Do Endotracheal Intubation

438
Q

Choriocarcinoma

A

Most commonly after Hyaditiform Mole

Can happen after normal delivery or a spontaneous abortion

439
Q

Non Stimulatory ADHD medication

Non stimulatory medication for Wakefulness and narcolepsy, cataplexy

A

Atomoxetine (NE)

Modafinil (D)

440
Q

Second Generation Anti Psychotic

has

Partial D2 agonism

A

Ari-piprazole

441
Q

Very painful menses

normal durations and periods

but painful and lot of bleeding

A

Adenomyosis

==endometrial dinosaur trapped in Myometrium park

===>>>Uniformed uterus

442
Q

Tenderness over Anterior Vaginal Wall

A

Bladder pain syndrome

aka interstitial Cystitis

Bladder hurts when filling up or voiding up

==>> dysuria and increased frequency

443
Q

Irregularly enlarged uterus

with heavy bleeding

but not painful

A

Fibroids

444
Q

Painful menses

but no heavy bleeding ( Dysmenorrhea)

A

Endometriosis

progresses to chronic pelvic pain due to accumulations of islands and ==>>adhesions

445
Q

Nuclear

A

jolly body

446
Q

Heinz

A

Denatured squished hemoglobin

post hemo-lysis

autoimmune hemolyziz makes heinz ketchup of hemoglobin

447
Q

COPD and acidosis

A

COPD cases have “the gradual” increase in PaCO2

Gradualness lets kidneys compensate

Renal tubules increase HCO3 retention

448
Q
  1. TNF & IL1 inhibitor

Adverse reaction

A

Hydroxycholoroquine

====>>> Retinopathy

449
Q
  1. IL 1 and TNF inhibitor

Adverse Reaction

A

Sulfasalazine

Hemolysis

Hepatotoxic

Stomatitis

450
Q

Only TNF Inhibitors

Adverse RXN

A

5 TNF inhibitors exist

Goli=Mumab

Adali-Mumab

Certoli-Zumab

Inflixi-Mab

Eta-nercept

Adverse==> Demyelination, CHF

==>> Malignancy

451
Q

Rebound Tenderness

A

Pain upon removal of pressure

=>Represents aggravation of parietal layer

of Peritoneum

by Stretching or Moving

==>>Indicates Peritonitis–>>Appendicitis//Ulcerative colitis

AKA

Blumberg Sign

452
Q

Chronic & episodic

abdominal pain

With

Rebound Tenderness,

suddenly worsens

Xray shows ==

A

Xray will show free air under the diaphragm==>

just below the edge of the base of the lung

=Perforated peptic ulcer

Gastric secretions==>> released into the peritoneum

==peritonitis==> rebound tenderness

453
Q

Persistent

Severe Epigastric Pain

Xray shows ileus of small intestines

A

Gallstone Pancreatitis

comes with nausea and vomiting

454
Q

Episodic

RUQ pain

fatty meal

A

BiLiary COLIC(pain)

Gallstones pressing against the opening of the cystic duct

455
Q

Minimal Change disease

what tool to employ

A

Electron Microscopy

biopsy and Immunofluorescence will yield nothing

456
Q
A

Cerebellar hemorrhage

an occipital headache

vermis=> unstable trunk

hemisphere==> Limbs unstable

repeated vomiting by patient and unstability to stand with no loss of consciuousness should raise suspicion

Horizontal gaze palsy

457
Q

Hemineglect

A

hemineglect ==> parietal lobe stroke

458
Q

Acute Coronary Syndromes

A

A spectrum of Clinical signs or syndromes

Caused by

Plaque disruption or Vasospasm

that Leads to

The Acute Myocardial Infarction

ST segments/ Ecg/ S4 heard

Unstable Angina or ST-elevated MI

459
Q

Pleuritic chest pain With FEVER

Right Atrial Strain–> minor JVD

O2 saturation less than 96%

Irregular heartbeat

tachycardic

tachypneic

narrow QR

A

Pulmonary EMbolism

strains and obstructs flow out of the Right heart

==> Fibrillation

460
Q
A

Discoid Plaque

461
Q
A

Erythematous Papules

462
Q

Ciprofloxacin

TMP-SMX

Tetracyclines

Penicillin

A

Not good for Oral anaerobic

463
Q

Pain began in Lower Abdomen

but progressed to upper

vomit

fever

chills

sexually active

Irregular menses

intermenstrual spotting

negative pregnancy test

A

PID

starts in lower quadrant

may involve liver capsule–> upper abdomen pain and vomit

464
Q

Patient comes with

Hypercalcemia

and pancytopenia

A

The typical presentation of Multiple Myeloma

Volume depleted due to polyuria

465
Q

Patient in a trauma unit

stuporous & reacts only to noxious

BP is 6o systolic

Asystole & Pulseless –>post mechanical ventilation

A

Hypovolemic patient

pre-ventilation==> he is, either way, getting a lesser venous return to the right atrium

1) Positive pressure Mechanical Ventillation==>>Intrathoracic Pressure increases==>>>>> collapses Venous capacitance vessels ( IVC) ==>>cuts off venous return
2) Pre-Intubation==>> Sedatives used==>>Relaxes Venous Capacitance Vessels==>> Also decreases Venous return

466
Q

spares palms and soles

A

Rubeola Measles

pityriasis Rosea

Ricketsia Typhus

467
Q

Rash on Palms And Soles

A

Secondary Syphilis

Coxsackie Virus

Rocky Mountain Spotted fever

Acral Lentiguous

Toxic shock desquamation

Kawasaki desquamation

468
Q

Patient younger than 1 year old

Took a International trip

What infection can the baby spread

A

Rubeola Measles

the vaccine is given at age 1 and 4

469
Q

Vesicles on outer ear and facial droop

A

Ramsay Hunt Syndrome

Herpes===>> Bell’s palsy

470
Q
A

Tophaceous Gout

471
Q
A

Osteoarthritis

472
Q
A
473
Q

Rotavirus

A

risk of Intussusception

474
Q

paradoxical agitation

A

Agitated after an hour of taking benzodiazepine

475
Q

altered state of consciousness

A

Postical

post seizure

476
Q

severe trauma

burns

parentral nutrition long time

A

Severly ILL patients in ICU

chole stasis ==> Acalculous cholecystitis

Seconday gall bladder infection–>Pericholecystic fluid

477
Q

Examination finding==>> but pain is out of propoprtion and doesnt make sense

segmental bowel thickening

A

Mesenteric Ischemia

478
Q

herniated disk

A

pain will radiate

479
Q
A

MACROLIDES

FLUOROQUINOLONES

ANTIFUNGAL

===>>> QT PROLONGATION==>>TORSADES

IV MAGNESIUM

{{ one antiArrhythmic drug causes QT prolongation too==>> Sotalol}}

480
Q
A

Hidden P waves

Adenosine==>>PSVT

481
Q

Chlamydia vs gonococcal conjuctivits

A

Chlam–>> watery and after 5 days of birth

Gonococcal–>> copious and Purulent and same day

482
Q

Neonatal conjunctivitis with Copious and Purulent discharge

A

Gonococcal Conjuctivits

483
Q

No palpable fetal presenting part at the station

but presentable abdominal fetal parts

A

Uterine rupture

484
Q
A

Multilayered onion texture

Ewing sarcoma

485
Q
A

Osteoid Osteoma

486
Q

pulmonary embolism on ECG

A
487
Q

GBS screening

A

32-35 weeks

488
Q

Deleted vs reduced Dystrophin gene

A

Deleted in Duchenne

reduced in Becker

489
Q

Myotonic discharges

A

Delayed muscle relaxation

cataracts and heart conduction problem

mostly facial and intrinsic hand muscles dysfunction

Myotonic dystrophy

490
Q

essential tremor

A

worsons at end of activity

(wehn approaching to pick up a remote)

versus

basal ganglia tremor

==> that worsens when body is at rest and improves when trying to pick up a remote

491
Q

patient severe abdominal pain and vomiting

history of previous abdominal surgery

hasnt passed any flatulus

peristaltic pain

distanded and tympanic abdomen

A

SBO or mesenteric ischemia

But SBO has an air-fluid level in distended loops of small bowel

SBO–>if severe==>do emergent abdominal explorations urgery( due to risk of impending ischemia, strangulation)

for mesenteric ischemia==>> do CT

492
Q

Anxiety

panic

treatment

A

Acute==> benzodiazepine

chronic maintenance = ssri

keep in mind CBT and SSRI will ta ake month to kick in

493
Q
A

jejunal atresia

cocaine

494
Q
A

nerves are missing

enterocolitis, megacolon, bowel obstruction and intestinal perforation

495
Q

the holosystolic murmur that increases with squatting

at

3rd to 4th left intercostal space

A

VSD

496
Q

Short systolic murmur

disappears with squatting

non ejection type click

A

MVP

squatting–> increased preload–> delays prolapsed valve–> late click and shorter murmur

497
Q

Infective endocarditis murmur

A

Systolic–> MR

498
Q

PEEP

Positive

end

expiratory

pressure

A

Given in ARDS to keep alveoli from collapsing

more positive than atmospheric pressure

Ards( inflamed and damaged lung)

peep damages already fragile lung tissue

PEEP–> Tension pneumothorax

499
Q
A

Tension Pneumothorax

Air leaks out of lungs

gets trapped in pleura

==>> pushes back the the collapsed lung

==> compresses the mediastinum

==>> hypotensive patient

500
Q

Refractory hypokalemia in alcoholic

A

Hypomagnesemia

Magnesium stops potassium secretion by Renal

outer medullary potassium channels

501
Q

uterus larger than gestation age

patient is hypertensive

hyperthyroid

and vomiting that increases RUQ pain

Abnormally elevated hCG

A

Hyaditiform mole

compare with fitz hurg curtis ==>> fever hypotension and sepsis

502
Q

What kind of fibroids don’t cause miscarriage

A

Subserosal Fibroid and pedunculated

503
Q

Exudative pharyngitis vs non exudative

A

Exudative==>> EBV

non Exudative ==>>>>>Gonococcal

504
Q

High fevers

vomiting and diarrhea

headache and confusion

Pulmonary manifestations==>>comes after systemic

A

Legionella Pneumophilia

505
Q

Medroxyprogesterone depot

A

Every 3 months

inhibits the release of GnRH

Suppresses ovulation

weight gain breast tenderness

spotting and menstrual irregularities

506
Q

Premenopausal // Young one

adnexal fullness

h_yperechoic nodules_

cyst has calcifications

A

Mature teratoma – Cystic

507
Q

Multiseptated bilateral cystic masses

Do not have calcifications or hyperechoic nodules

A

Theca lutein cysts

happens in pregnancy due to ovarian stimulation by hCG

508
Q

neutropenia

recurrent sinusitis

splenomegaly

stomatitis /gingivatitis

A

Felty syndrome(severe rheumatoid arthritis with vaculitis and skin ulcers)

gaucher

sarcoidosis

509
Q

Corticospinal tract in brain

A
510
Q

First gen antipsychotic given to a patient

After a while he develops a sustained contraction/ spasm

what medication to treat this

A

Acute dystonia–> spasmed–> torticollis or eyes looking up constantly or facial grimacing or tongue twisting or protuding

==> develops in hours to days

==>> Treat with Anticholinergics

or

Antihistamines

Antipsychotic originated Spasm is treated with Anticholinergics

511
Q

Post chemo

patient is febrile

and

Neutropenic

what drug==?

A

Tazobactam - piperacillin

covers both gram-negative and positive

Antipseudomonal beta-lactams

cefepime

meropenem

piperacillin-tazobactam

512
Q

Vericella vaccines

Chickenpox

at what age

A

At

Age 1 and 4

513
Q

Bacterial Pharyngitis criteria

A

Centor

Fever by history

Tender Anterior Cervical lymphadenopathy

exudate on tonsil

An absent cough

==> if all 4 present==>> give antibioitcs

==> if 2or 3 present==>> do Rapid strep test

Bacterial Pharyngitis==>> Mostly Group A strep===>>>>>>Oral Penicillin or Amoxicllin

514
Q

Viral Symptoms

A

Cough Rhinorrhea Conjunctivitis Oral Ulcers

Viral Pharyngitis==>> symptomatic treatment only

515
Q

Atrial fibrillation

or ST-elevated MI

and what?

A

Chances of atrial originated thrombus==>>Left Ventricular thrombus

Do transthoracic Echocardiogram

and

Echocardiogram

516
Q

Aortic Regurgitation

A

Diastolic murmur

Blood comes back to LV==>>

Large volume in LV==>>LV stretches out to hold==>> bigger water hammer stroke volume to be pumped out==>>LV hypertrophies

Hypertrophic heart==>>insufficiency takes birth==>> blood starts backing up into lungs==>> pulmonary cracksles heard==>> mostly bilateral

517
Q

Placenta previa vs Placenta Abruptio

A

Abruptio has constant pain

although both bleed in mostly third trimester as the baby grows and put more stress on attachment of placenta to the endometrium

518
Q

cocaine vs paranoid personality disorder

A

see paranoia with sympathetic activation signs ( diaphoresis, tremor, vigilant)

519
Q

When you see various healed scars on the abdomen

or history gunshot wounds

or history of trauma

or the history of an car accident

A

Think==>> Splenectomy==>Impaired antibody faciliated Phagocytosis==>> Gram positive** cocci==>> that are **Encapsulated

520
Q

splenic opsonization

A
521
Q

hyperkalemia and hypocalcemia

A

Hyperkalemia==> PR prolongation

Wide QRS

loss of P-wave

Hypocalcemia==>>QT prolongation

522
Q

B12 forms what two biochemistry products

A

B12 produces

Succinyl co A

&

Methionine

Methylmalonyl Acid—-b12 and folic—->>>>$uccinyl coA

Homocysteine —–B12—–>>>>Meth

523
Q

Hepatosplenomegaly

diffuse cervical or posterior lymphadenopathy

develops a Rash after amoxicillin

A

EBV

test is positively hetero

524
Q

PPSV 23

A

Under 65

with

Heart conditions

Diabetic

Smoking

Lung Disease

525
Q

Td vs Tdap

A

Tdap should be given atleast once in place of Every 10 yr booster of Td

or Adults that are going to closer contact with kids

526
Q

Broad based gait

Difficuty with heel to shin testing

A

Cerebellar lesion

posterior circulation

527
Q

Psychodynamic therapy

A

Traces problems to their roots in childhood

and

An Unconscious conflict

528
Q

CBT plus Dialectical

A

For borderline personalities==>>mindfulness and proper emotion regulation

529
Q

Fishy and yellow

A

FY=T

Fishy yellow=Trichomonas

530
Q

Prematurity

Maternal Alcohol, tobacco

A

Risk of fetal Cerebral palsy

==>>epilepsy, Intellectual disability, strabismus, Scoliosis

Cp==>>non progressive motor dysfunction

three kinds

Spasitc Diplegia->m/c in preterm infant==>>hypertonic and hyper reflexia of mostly lower limbs–> both feet pointing down and inward–>>equinovorous deformity

Dyskinetic Diplegia

Ataxic Diplegia

531
Q

Shy-Drager Syndrome

A

Patient with parkinsonian symptoms

(cerebellar and pyramidal dysfxn)

comes with

Impotence

orthostatic hypertension

abnormal sweating

disturbance of bowel or bladder control

impotence gastroparesis

532
Q

Ashkenazi jew

gross dysfunction of ANS

with severe hypotension

A

Riley Day syndrome==>> Familial Dysautonomia

533
Q

Crohns and Stone

A

Oxalate Stone

increased fat in intestines steals calcium away from oxalate

Alone oxalate gets reabsorbed more==>>stone

Calcium prevents oxalate stone formation

Fat malabsorption disorders promote oxalate stones

534
Q

seminoma germ cell tumor

A

produces only hCG

535
Q

AFP and B hCG

A

produced by

only Nonseminoma germ cell tumor

536
Q

Copper

A

Depression

hepatic dysfunction

copper from liver spills==>> goes to basal ganglia==>parkinsonian tremor

537
Q

atopic

A

scaly or papular rash

538
Q

contact dermatitis

A

vesicles and papules

539
Q

Duodenal ulcer

A

pain gets better with food

food-D

540
Q

Young woman

alternating diarrhea and constipation

pain gets better after stooling

mucus, loose stool

A

IBS

541
Q

bullous impetigo

A

Honey color crusted lesions

staph aureus

common in children

542
Q

rash thats limited to exposed skin

makes linear streaks where skin has brushed against the plant leaves

A

vesicle and small bullae at site of exposure

plants nickle dye leather rubber

poison ivy

atopic contact dermatitis

eroded erythematous plaques with vesicles

type 4

543
Q

upper abdominal systolic-diastolic bruit

Also see, unexplained rise in serum

creatinine after staring ACE inhibitors

A

Renal Artery Stenosis

544
Q

Eye

redness of Medial Canthal

Purulent discharge

A

Infection of lacrimal sac==>Dacrocystitis

545
Q
A

Abscess over the eyelid

==>> could be upper or lower eye lid

546
Q
A

Orbital cellulitis

happens behind the orbital septum

==> comes with fever and restriction of Extraocular muscles movement

red eye lids

547
Q

Gums growing ==>gingival hyperplasia

A

Phenytoin

I cell disease

Cyclosporine

Calcium channel blockers

548
Q

Eosiniphilia

wbc cast

hematuria

sterile pyuria

A

interstitial nephritis

penicillin, sulfonamides, cephalosporin

549
Q

15 -20 weeks

definitive karyotypic

A

Amniocentesis

invasive–> risk of membranes rupture, fetal injury and pregnancy

550
Q

woman > 35

first trimester–10th week

A

cell free fetal DNA

551
Q

reticular, peri hilar opacities–> linear

A

surfactant deficiency

552
Q

hyperphagia

almond eyes

microphallus —>hypogonadism

A

dysmorphic facies of prader willi

paternal deletion

of 15q11

553
Q

11p15

A

Beckwith-Wiedemann

rapid growth

macroglossia

HEMIHYPERPLASIA

Umbilical hernia

554
Q

15q11-q13

A

Angelman Syndrome

short stature

ever smiling

hand flapping

ataxia and seizure

555
Q

Ketoralac

Meloxicam

Peroxicam

A

NSAID

556
Q

Paget disease of the breast

A

Adenocarcinoma

557
Q

Exudative pleural effusion

A

==>

Pleural protein / serum protein = .5

==>> Pleural LDH / Serum LDH = .6

==> Pleural LDH==> more than 2/3rd the upper limit of serum LDh

558
Q

if bacteria gets into effusion (pleural)

A

makes it acidic with low glucose seen and more WBC are seen

Empyema==>> have additional, frank pus

559
Q

Hypoalbunemia

HF

A

Transudative effusion

Bilateral

560
Q

Dopamine precursors

leva/carba for elderlies

A

Adverse effects==> somnolence, hallucination, confusion

561
Q

prevents breaking down of dopamine

A

COMT

Entacapone and tolcapone

adverse effects –>choreiform dyskinesia

562
Q

Absent thelarche–> absent breast

short height

what hormones are increased

A

FSH

and Lh

increased in turner due

to absent estrogen and progesterone

563
Q

Edema

=Angioedema==> facial/periorbital/circumfurol

A

ACE inhibitors

564
Q

Sun-exposed body area

non-healing ulcer

rough and thickened

patient is on chronic immunosuppressive agent

A

Squamous Cell Carcinoma

565
Q

Carotid pulse

with

dual upstroke

A

Hypertrophic Cardiomyopathy

dual CAROTID stroke due to obstruction by ASSYMETRICAL HYPERTROPHIED HEARD

566
Q

Aminoglycosides

gentamycin tobramycin

neomycin

A

Severe Gram Negative Infections

567
Q

Clindamycin

A

Anaerobic bacteria above diaphragm

Metronidiazole => below diaphragm

568
Q

trauma patients

A

Cervical immobilization

spine stability

Cardio-Respiratory stability

Peripheral IV access

Pelvic injury ( if not visible==> insert a urinary catheter to assess urinary retention

and prevent possible bladder injury from distension

569
Q

IV cefazolin

A

60 minutes before surgery ( prophylaxis)

570
Q

CHF creates what kind of murmur

A

MR==>>Holosystolic

LV dilated or remodeled==> dilation causes mitral annulus enlargement and remodeling causes papillary muscle displacement==>> MR

571
Q

Rotator cuff tear visualizing?

Xray or MRI

A

MRI

MRI scan==> visualizes soft tissue around the bone==> shows the tear in muscle

Xray can show only calcification

572
Q

CD4 22

Diarrhea

3mm induration

A

AVIUM

Azithromycin

573
Q

HIV diarrhea

A

180—>>50

180–> crypto–> Watery

100——>Isosporodium—->watery

50——>Avium—->watery

50=====>>>>CMV==>> Bloody

574
Q

Pregnant patient

hyperandrogenic symptoms

Ultrasound—>> bilateral cysts on ovaries

A

Observe and expectant management

hyperandrogenic states mostly seen in african americans

cysts form==>> luteoma 30% are asymptomatic

575
Q

Hypotension

==>> Decreased RBF–>>

A

Decreased RBF==>> Renal saves Na+ and Urea

FeNa+ decreased

Uxe decreased

Hypotension==>>>Prerenal

576
Q

Ischemia ( nephritis)

or toxins

to the tubules==>>

A

Intrinsic Renal Failure

patchy necrosis–>>debris

debris obstruct–> builds a backflow–> GFR decreases–>> impaired rabsorption too–> excretion increases of Na and urea

577
Q

Urine gets darker after starting a drug regimen

A

Drug-induced Interstitial nephritis

penicillin

cephalo

sulfonamides

578
Q

Peripheral eosinophilia

eosinophiluria

pyuria

hematuria

A

Interstitial Nephritis

Drug-induced

579
Q

ADh on sodium

A

Just deals with water

580
Q
A

Pain will be Bilateral that will radiate and get better on rest

and get worst with ambulation

OsteoArthritis of Spine

581
Q
A

Ground glass

and bronchograms ( fluid)

RDS in infant

=> prematurity

Maternal diabetes= High glucose==> Insulin==> antagonizes cortisol==> delays production of sufractant

MAle gender and cesareon without labor is a risk too

582
Q

undercooked fish

A

clonorchis , diphyllobothrium latum

Biliary problemo

B12 problemo

583
Q
A

Bulging==>> hydrocephalus

sunken==> dehydration

584
Q

Vomiting

hco3 = high or low

A

Vomiting==> loses stomach acid

==>alkalosis

but

volume also lost==> contraction

contraction==> RAAS=> K+ and H+ secreted into urine==> contraction alkalosis

585
Q
A

Lichen planus

pruritic flat topped plaques

586
Q

AFP and hCG elevated

A

Non seminoma germ cell tumors

Seminoma= only hCG, not even some AFP elecated

587
Q

Augmenting Antidepressant medication to make the patient hit baseline function

A

Add antidepressant of different mechanism

or

add second generation antipsychotic

or

psychotherapy

588
Q

SiADH

A

If you give normal saline

water stay but kidneys will throw out the sodium

Hyponatremic Hypovolemia

589
Q

Asymmetric oligoarthritis

with conjunctivitis and mouth ulcers

urethral discharge

A

Reactive arthritis

initial therapy==> NSAIDs

590
Q

reactive Arthritis

Vs

gonococcal septic arthritis

A

reactive will have

conjunctivitis

asymmetrical arthritis

mouth ulcers

enthesitis (Tendon pain, mostly Achilles)

591
Q

Osler nodes

A

painful fingertip nodules

592
Q

drugs that increase Potassium

in the body

A

Beta blockers–> block K+ uptake

ace inhibitos

cyclosporine

heparin

nsaids

succinylcholine

trimethoprim ( like amiloride, K+sparing)

593
Q

headaches

A

Mig –>Pulsates and throbs-> unilateral

Cluster–> sharp and behind one eye

Tension–> Band like, dull tight and persistent

594
Q

Duodenal ulcer

A

Worst at empty stomach

acid drives into duodenum unopposed and drives it crazy

595
Q

Warty skin lesion

Violaceous nodule

peripheral ulcer

midwest states

A

Blastomycosis

bone pain and also genitourinary

596
Q
A
597
Q

ALF

most common cause of death

A

Cerebral edema

598
Q

gerd adenocarcinoma

A

Gerd for 20 years

Gerd==>> most probably barrets==>> strectures

strictures==>>symmetric==>circumferential narrowing==> distal esophagus

strictures==>> progressive dysphagia to solids==>may even block acid reflux due to narrowing

599
Q

achalasia

A

peristalsis issue

==> shows dilated proximal esophagus

both liquids and solids

600
Q

Fanconi Anemia

vs

Fanconi Syndrome

A

Fanconi Anemia==> Bone marrow failed and cafe au lait spots, short stature, hypogonadism, skeletal anomalies

Fanconi Syndrome==> Proximal Convoluted Tubule doesn’t reabsorbs shitt

601
Q

Macrocytic

but

Non-MegaloBlastic

A

Liver failure

Diamond beclo

Alcoholism

602
Q

Ectopic Pregnancy

A

hCG==>>Transvaginal Ultrasound

603
Q
A

Congenital Melanocytic Nevus

604
Q
A

Nevus Flameus

605
Q

HIIT

confirmatory test

A

Serotonin release essay

606
Q

Disseminated Histoplasmosis

A

IV

Liposomal Amphotericin B

607
Q

Cytokines from stored blood

A

Leukocytes–>> cytokines

Non-Hemolytic

Febrile

Reaction

==>> Fever, Chills, And Malaise

608
Q

Diabetic–>see bicarbonate–>if low

&

hyperkalemia

(with mild renal dysfunction)

A

H+ and K+ don’t get secreted out

by the collecting duct ==> Type 4 RTA

Diabetic +Elderly==>> JG apparatus damaged==> Hypreninemic ==> Hypoaldosteronism==> H+ and K+ stay in body==> metabolic acidosis

H+ does not get secreted==> Hco3 does not get generated

609
Q

Lithium

A

toxicity increases

in

dehydration

thiazides

ace

whatever gets the reabsorption increased

610
Q

profound lymphopenia

A

SCiD

611
Q

Brutons and lymph

A

Absent Lymphoid Tissue

612
Q

A cough with laughing, night, exercise, steam

Resembles common cold

paroxysms of cough

A

Whoops

pertusis

Forceful coughing==> vomit==>weight loss

Lymphocytosis may be seen

Macrolides=> decreases severity and contagion

613
Q

ectopic tachicardia and av block

A

digitalis toxicity

614
Q

Pendular reflex

A

Less brisk==> cerebellar dysfunction

615
Q

Medial Cerebellar lesion

A

Truncal Ataxia

Nystagmus

dysmetria ( tremor when reaching for a target )

Impaired and rapid alternating movements

( Dysdiadochokinesia )

Muscle hypotonia–> pendular knee

616
Q

Acute Pelvic pain

A

A ROPE

Appendicitis–> RLQ pain–>>fever and vomiting

Ruptured Ovarian cyst===>> recent strenuous activity

Ovarian Torsion

Pid==Gradual

Ectopic pregnancy

617
Q

myopathy

A

if with palpitations–> thyroid

with tenderness–> Polymyositis

facial or ocular weakness—> MG

CNS disorders plus lactic acids= MELAS mitochondrial–>red ragged

Daptomycin

statins, fibrates,

618
Q

Newborn

Scaphoid /concave abdomen in newborn

Breathing emergency= (breath sounds not heard on left side)

70/40 BP

Nasal flaring, grunting, barrel shaped chest

A

CdH

Deviation of Abdominal Viscera into the thorax

results in a concave/ scaphoid abdomen & barrel-shaped chest

Emergent Intubation

619
Q

number of times woman has been pregnant regardless of outcome

A

Gravida

620
Q

Preeclampsia Diagnosis

A

Urine Protein/Creatinine ratio

or

24 Hour collection for Total protein –> Gold Standard

621
Q

patchy areas of demyelination

AIDS patient

A

JC virus

622
Q

PTSD less than a month

A

Acute Stress Disorder

If they persist more than a “ Month” ==>> PTSD

623
Q

3 mm pupil size

A

NORMAL

624
Q

sternum angle

A

Below clavicle==>> CVP

Above Clavicle ==>> Jvp

CVP= 5 cm

Jvp= 3 cm

6-8 cm = Normal

625
Q

Mitral classic finding

A

Loud S1

mid DIASTOLIC rumbling at apex

626
Q

a patient comes and tells

that vaginal pain

gets better with urination

Exam-> palpation of anterior vaginal wall elicits tenderness

A

relieved by voiding==> Interstitial Cystitis

Painful bladder syndrome

painful in filling

627
Q

a middle age woman is waiting in room

and tells you she is having painful intercourse

hx-> dental caries only

A

Sicca

increase lubrication

628
Q

cyclophosphamide

Adverse effect

A

Bladder Cancer

629
Q

150-500 Triglycerides

A

Decrease alcohol

exercise

weight loss

fibrates ==>> if above 1000, and abstinence from alcohol

630
Q

patient tells you about recurring

vertigo

unilateral tinnitus and fullness

and sensorineural hearing loss

A

Maniere

631
Q

Elderly patient comes

tells you he cant tolerate loud sound in the room that others can!

bilateral tinnitus

A

Presbycusis-> sensorineural

632
Q

patient tells you

that he gets dizzy

with changing positions or when looking at upper shelf

A

BPPV

dix-hallpike maneuver diagnoses it

Epley maneuver fixes it

633
Q

dialysis related 7 causes of cardiovascular incidents

A

NO= inhibited

accelerated atherogenesis= due to enhanced oxidant stress

increased homocystein== not cleared out by the kidneys

Hyperphosphatemia

hypercacemia- given to fix excess phosphate

Anemia- > tachycardia

ESRd

634
Q

Thiazides

and calcium

A

A milder form of Hypercalcemia

<12 mg

Severe form of hypercalcemia doesnt happen

635
Q

A patient comes to you

with a history of smoking

and now has Hypercalcemia,

severe=> more than 13mg

A

Malignancy related Hypercalcemia

636
Q

Alzheimers

A

Temporal and parietal lobes shrunken

637
Q

Young patient comes

and tells he cant play basketball

he has tenderness on proximal tibia, at the site of patellar tendon insertion

A

Traction Apophysitis ==>> Osgood-Schlatter

RUnning, kneeling, playing –> Quadriceps tendon puts traction on Apophysis of Tibial Tubercle

Firm mass can be felt there due to the heterotropic bone formation

638
Q

Patellar Tendonitis

A

Point tenderness

on

Inferior pole of the patella

(overused)

639
Q

Patient is a long time runner

now feels pain

while walking down hill or down the stairs

A

Patellofemoral Stress syndrome

640
Q

large

thick

multiloculated cystic mass

on one of the adnexal area

A

if fever and high leukocytes==> Tubo-ovarian abscess

if not, or with weight loss => serous cystadenocarcinoma

641
Q

3 wk old Neonatal not pooping after initially pooping fine

also bile vomits

premature born

nasogastric formula

what will be seen on radiography

A

Necrotizing entrocolitis==>>Air in bowel wall and portal veins

Premature–> decreased bowel motility–> bugs can born in stasis

increased permability–>inflammation—> Leukocutosis

intestinal ischemia–> Metabolic acidosis

Gas–> from gas producing bacteria–>>gas in bowel wall and also the gas migrates to mesenteric and portal veins

642
Q

dilated abdoment and duodenum

A

double bubble sign in duodenal atresia==>> bilious vomiting

643
Q

failure to pass meconium within 48 hrs of birth

A

hirschsprung disease

644
Q

contrast and renal

A

Nephro-pathy

Brownish casts ( Mud)

granular texture

CIN - resolves with in 3-5 days

645
Q

patient had coronoary stent placement –> last week

now has mottled skin of legs

and

increased BUN

and Increased Eosinophils

A

cholestrol emboli

646
Q

paroxysmal Norcturnal Hemoglobuneria

and coombs

A

negative Coombs

because

its complement-mediated hemolysis

647
Q

idiosynchratic hepatitis

A

inflammatory cells attack toxins from some drugs

eosinophilia present but absent in==>

==>>isoniazid induced hepatitis

648
Q

Autoimmune hepatitis

A

first rule out

viral

drugs

toxins

after that –> do ANA test or anti smooth muscle antibody test

649
Q

Vaccination to yellow fever

contraindicated in

A

live attenuated vaccine

low immunity cases or where patient is taking methotrexate or biologicals

650
Q

meningococcal booster

A

at age 16-21

primary is at 11

651
Q

Menopause

Genitourinary symptoms

A

urinary incontinence = due to less estrogenic firmness of vagina==>> weak closure pressure of urethra–> recurrent UTI & incontinence

Vulvovaginal dryness–> irritation and pruritus

652
Q

IBS and colonoscopy indications

A

Post diagnosis= 8 years

if rleft side of colon diagnosed= 12-15 years

653
Q

a patient comes into the trauma unit

with

loss of pain and temperature and also loss or weakness of motor function

in lower limbs

bilaterally

A

Anterior Cord Syndrome

Anterior Spinal Artery==> anterior portion of spinal cord is damaged but back one is ok

back of spinal cord==vibration and touch will be ok

654
Q
A

Intussesption

telescoped

air enema==>> goes in from rectum==> uses air or contrast==>> un-telescopes with the use of pressure

655
Q

Action tremor

A

Essential

beta blockers

mild alcohol

Anticonvulsant= Primidone

656
Q

Trochlear groove

A

if you compress the patella into the trochlear groove==>> Patellofemoral pain syndrome

Over use

young adults

dancers or athletes

657
Q

Hyperpigment and Velvety skin

on flexures like axilla and groin

A

If patient lost weight==>> Undelrying malignancy==>> Acanthosis Migricans

If patient gained weight==>>insuline resistant diseases==>> DIabetes mellitus, Polycystic ovary

658
Q

Lymphoma

MaLT

Marginal Zone-B cel Lymphoma

A

Bacterial–> H Pylori

659
Q

nitro on stomach

smoking

High salt

A

Adeno carcinoma of stomach

660
Q

drugs that are not recommended for first line antihypertensives

A

Loop inhibitors

Doxazosin

661
Q

Normal Liver span

A

@Midclavicular level = it spans 8 –> 12 cm

@Midsternum level = it spans 4 —> 8 cm

662
Q

ProPtosis

A
663
Q

Ptosis?

A

Drooping

664
Q

Anti Mitochondrial Antibody

A

Bile duct

if blocked- - - - >>> Cholangitis

Sclerosing –> P Anca

Mitochondrial antibody- –> PBC –> autoimmune and granulomatous

Direct

665
Q

Young patient

More than 5 days of fever

with

Non exudative conjuctivits

non exudative tonsill

lips are fissured

strawberry tongue

lymph node in “ Cervical Area “ more than 1.2 cm in size

A

Kawasaki

also

hands- – > swelled

feet—–> swelled

aneurysms—-> on Coronary artery

666
Q
A
667
Q

rupture after a heart attack in

3 to 5 days

A

Pulmonary Edema ===>>>

Papillary muscle rupture — Right Coronary Artery

Shock And Biventricular Failure===>>

Interventricular septum

Apex— Left anterior descending artery

Basal—> RIght Coronary Artery

Left to Right ventricular flow==>> Blood causes harsh holosystolic murmur and a palpable thrill

668
Q

5 Second Generation Antipsychotics

A

Riseperidone

Ziprasidone

Queitapine

Olanzapine

Aripiprazole

669
Q

lochia rubra

A

blood looking fluid present after delivery= few days

after 3-4 days==>>thin pinkish brown==>lochia serosa

after 2-3 weeks==>> yellow white discharge

670
Q

Muffled voice and drooling

A

Epiglottis

H.Influenzae

671
Q

Casts or eosinophils

A

Interstitial

Acute interstitial nephritis

672
Q

Antibiotic given

FeNa increased

no casts

no eosinophils

A

Aminiglycosides

Amikacin

gentamicin

neomicin

tobramycin

streptomycin

673
Q

Fever, Chills

Bleeding from intravenous sites

bleeding started after blood transfusion

Just after an hour

A

Acute hemolytic Transfusion Reaction

—>> Renal Failure

—>> DIC

674
Q

Celiac tests

Initial and gold standard

A

Initial =>

IgA Anti-tissue Transglutaminase

IgA Anti-Endomysial

DQ = 2 & 8

Gold standard= Biopsy=>

Villous Atrophy or blunted and Hyperplasia of crypts

Check for T-cell Lymphoma

675
Q

Crescendo—>>>>>Decrescendo

A

Aortic Stenosis

Hypertrophic heart —>> Hypertrophied Interventricular Septum

676
Q

young patient

Palpable rash on legs and buttocks

bones hurt

blood in the urine

A

Henoch

vasculitis

colicky abdominal pain—>> Intussusception cases

Renal behaves like IgA nephropathy

Arthritic

arthralgic

677
Q

SiADH ==> What saline?

A

3% saline for hypotonic patient

678
Q

High plantar arch

decreased vibration

position problem

reflexes slow or absent

unsteady gait

cvs problems

A

Freidrich ataxia

679
Q
A
680
Q

general anxiety

vs panic

vs

social

A

general = multiple reasons and chronic

social== while performing or being judged

panic= sudden , without any reason

681
Q

Endocarditis

and

abdominal tenderness

( Had bowel movements )

A

Acute Mesenteric Ischemia

bacterial emboli from heart went to Bowel blood supply

682
Q

Vitiligo vs versicolor

A

Vitiligo is without scaling

683
Q

Extra articular—->> TOPHI

A

Urate

684
Q

Increased MCHC

A

Spherocytosis

Autosomal DOminant

685
Q

Seizure

less than 20sec

doesnt respond vocals or name being called

Presence of automatism

A

Absence seizure

686
Q

Exudative formula

A

A) Protein in Pleural fluid / Protein in serum = more than .5

B) Pleural Fluid Lactate Dehydrogenase/serum Lactate Dehydrogenase = more than.6

687
Q

Wells Criteria

A

To Diagnose Pulmonary Embolism

Clinical Signs of DVT = +3 points

Alternate diagnosis not likely

previous DVT or PE = 1.5

Tachycardic >100

Recent surgery or immobilization

Hemoptysis = +1

Cancer

>4 points —>> PE

688
Q

Alkalotic body

and its influence of Calcium

A

Alkalosis—>> hydrogen gets redistributed from bound albumin-calcium complex and makes it Unionized—> calcium gets deposited more and more on albumin–> hypocalcemic body–> spasmatic

689
Q

papillary thyroid cancer

A

solitary nodule

enlarges slowly

690
Q

Elevated direct bilirubin

+

the patient is febrile and hypotensive

Increased Alkaline Phosphatase

A

Acute Cholangitis

and ascending

(infection)

691
Q

The patient was treated for tremors recently

Now–> comes with a dilated pupil and eye pain.

and

blood shot conjuctiva

A

Patient was probaly treated for parkinsons

and treated

with

anticholinergic drug

Anticholinergic drugs–> block drainage of humor

sudden eye plain–> close angle glaucoma

692
Q
A

scaly

Actinic Keratosis

gets importance due to its progression to Squamous Cell Carninoma

693
Q

capsule vaccine

A

T-cell independent B-Cell response

694
Q

Psychosis

Depression

Personality changes

Liver Enzymes high

gait disturbance

A

Wilsons

copper damages hepatocytes and basal ganglia

695
Q

Intramuscular Penicillin G

A

Syphilis - Treponema Pallidum

Strep

Actinomyces

696
Q

Pain upon removal of pressure on abdomen

A

Rebound Tenderness

Peritonitis

SBO

Peritoneal Irritation

Appendicitis

697
Q
A
698
Q

pertussis

A

lymphocytosis

Hospitalize if less than 6 months old

699
Q

Lymphocytosis

A

Pertussis

EBV

CLL

700
Q

Glasgow

A

below 3 is problems

701
Q

Nephrotic cases

A

Amyloidosis–> Mostly with multiple myeloma or rheumatoid arthritis

Membranous nephro–> SLE, GOLD, NSAIDSSolid tumors, HBV, MAlaria

FSsG- African->HIV HEroine or w/ Uncontrolled HTN

Minimal CHange DIsease

702
Q

Patient has a history of AFib & Nonischemic

cardiomyopathy

now feels constipated, and gained weight

difficulty concentrating and forgetful

A

Amiodarone-induced hypothyroidism

703
Q

Hematuria

and

Scrotal Vericocele

That fails to empty when patient is recumbent

A

Renal cell Carcinoma

Asymptomatic mostly and gets diagmosed really late

tumor obstructs gonadal vein–> Vericocele

704
Q

Normocytic Anemia

A

Membrane defects

enzyme defects

sickle cell

extrinsic microangiopathic/macroangio

infections

Hbc

705
Q
A
706
Q

scleroderma and lungs

A

Interstitial lung disease

Anti Scl 70

anti RnA Pol 3 antibody

707
Q

if you oxidize hemoglobin

A

Heinz body

gets removed by a bite

708
Q

FEV1/FVC in Restrictive

A

Normal

709
Q

Pain on

hip abduction & Internal Rotation

A

Osteonecrosis

( Aseptic necrosis )

sickle cell case–> adults have ( no more foveal artery like kids)

710
Q

Pulsatile groin mass in elderly

pain in anterior thigh

A

Femoral Artery Aneurysm

pain due to femoral nerve entrapment ( runs lateral to artery

711
Q

alcoholic patient in room care

what to expect in his stay?

A

Seizures or Hallucinations = 12 to 48 Hrs

Delerium Tremens = 48 to 96 hrs

712
Q

Cocaine vs Heroin withdrawal

A

Cocaine = Hypersomnia and hyper-eating

Heroin = Diarrhea , cramps dilated pupils and yawning

713
Q

patient tells cant sleep

kids left and make her sad

she drinks wine two sleep

but wakes up at 3

tremor is noted

labs show high liver transimnases

A

Alcohol use disorder

714
Q

tick case

in

southern America

patient has high fevers as well

A

not lyme

lyme is not available south

monocytic ehrilichiosis

Leukopenia

715
Q

septation mass on ovary

thick and solid

A

epithelial carcinoma

of Ovary

and fallopian tube

and

peritoneum

716
Q

breastfeeding delayed or failure

A

neonatal jaundice

delayed breastfeeding–> delayed feeding–>> delayed stooling—->> delayed bile removal

Increased enterohepatic circulation–> Indirect increased

717
Q

marfan and heart

A

Aortic dissection

Aortic root dilation–>> Aortic regurgitation

718
Q

decrescendo

A

aortic regurgitation

719
Q

sudden and severe chest pain

radiates to the back

A

Aortic Dissection

if renal deficit–> do TES

if renal ok –> give contrast–> do CT Angiography

720
Q

Normal Bicarbonate

A

Age of Boy to Becoming man

22—–28

721
Q

Tension Pneumothorax

A

Immediate needle decompression

in second intercostal space

722
Q

Digitalis Overdose

what kind of tachycardia

A

Atrial tachycardia

with

AV block ( due to increased vagal tone)

723
Q

Hypertension case

what is the test list

A

Electrocardiogram

lipid panel ( coronary)

urine analysis (any occult hematuria and protein /creatinine)

724
Q

Impaired tandem walking/heel-shin test

with

preserved finger nose testing

wide based gait

alcoholic for more than 10 years

A

Alcoholic cerebellar degeneration

Vermis

725
Q

Wolff and AV node

A

AF disguised as Wolf bypasses Av block and creates an accessory pathway

rapidly depolarizing ventricle

professionally Cane the wolf by procainamide

or cane its BUTt by Ibutilide

726
Q

check ups for elderly time period

A

every two years = mammography

every three years = pap smear

every ten years = colonoscopy

727
Q

panic disorder treatment

A

short term = benzodiazepine

long term = ssri / cbt

728
Q

primidone

A

barb

essential tremor

729
Q

Acholic stools

Jaundice

Hepatomegaly

A

Biliary atresia

Pipe that connects liver to the intestine is missing (Atresia)

Liver won’t even be able to send “ a tracer “ to the Small bowel aka Scintiography

Do Kasai Procedure

730
Q
A
731
Q

sturge weber vs tuberous sclerosis

A

Seizures with retinal/ocular/ and cutaneous hypopigmented patches

==>>>> Tuberous sclerosis

Seizures with port wine stain only and no hypopigmented patches==> Sturge Weber

732
Q

Ischemic Stroke

what can happen after two days

A

Hemorrhagic Transformaton

repeat CT scan

733
Q

alcohol & tobacco–>> Leukoplacia and SCC

DIfference?

A

Leukoplakia –>> Granular

SCC—>> Ulcerated and Nodular and regional lymphadenopathy present probably

734
Q

Peritonitis

how to check

A

Upright X-Ray of Chest & Abdomen

—>> Free Intraperitoneal Air

735
Q

Prednisone

A

Decreases CRH from hypothalamus

736
Q

Colicky pain

Unable to pass gas

Hyperactive sounds and sometimes no sounds

Pain in “WAVES”

Air/FLuid in bowels

Change in “Character” of pain

Fever

Hemodynamic Instability

A

Short Bowel Syndrome

Mild–> bowel rest, suction and electrolyte fix

Peristaltic rush in the beginning–> hyperactive sounds

as it gets severe–> no sound

Severe–> urgent exploratory exploration

737
Q

Large amounts of purulent sputum

numerous episodes of bronhitis

Gets improved with antibiotics but returns again

now see some blood

A

Atelctactic lung due to

impaired clearing or blockage

=

Bronchiectasis

High-resolution CT scan for Bronchiectasis

738
Q
A

Bronchial wall thickening

first bronchitis episodes

second atelactic lobe

third chronic bronchitis

739
Q

Intraductal Papilloma

Versus

Infiltrating Intraductal carcinoma

A

Both bleed

but

IIC has a mass

740
Q

Depot Medroxyprogesterone

for

Contraception

A

Every 3 months

741
Q

patient comes with Stroke-like

symptoms

hemiplegic pain

headache

A

Figure out if its

Ischemic or hemorrhagic stroke

742
Q

tearing eye pain

pupil size changed

stabbing pain in eye

unilateral

A

Cluster

743
Q

TCA effect on heart

A

QRS widening

Treated with Sodium Bicarbonate

Inhibits Fast Sodium channels

of –>> His-Purnkinje

& myocardium

Decreases Conduction–>

Prolongs Absolute refractory period

744
Q
A
745
Q

Methanol vs Ethanol Poisoning

A

Methanol–>> damages eyes

Ethenal ( glycol) —->> damages kidneys

746
Q

Edwards

A

Rocker bottom feet

overlapping fingers

clenched fist

VSD

MicroGnathia (nose area)

Limited Abduction of hips

Renal defects

747
Q

Vulvar PLAQUE

intense itch

post menopausal woman

loss of labia minora

clitoral hood shrunken

very painful intercourse–> penetration not possible

A

Lichen Sclerosus

paper thin vulvar skin

very high chances of SCC

748
Q

Watery conjunctivitis

A

Allergic and viral

allergic——>> mandatory bilateral

Viral—–>> prodrome

749
Q

Intraparenchymal hemorrhage

A

Sudden neurologic deficits–> worsen–> minutes

Amyloid or Hypertension

Amyloid—> lobar–> elderly

hypertensive–>

750
Q

When

Uncle

herniates after

Epidural

A

Oculomotor compressed–> mydriasis and ptosis

crus cerebri compressed–> hemiperesis–> Ipsilateral

Posterior Cerebral Artery compressed–> Homonymous Hemianopsia–> Contralateral

Reticular formation compressed–> lost consciousness–> coma

751
Q

Pain and temperature impaired

Upper extremity motor function impaired

A

Syringomyelia

752
Q

External Auditory meatus is edematous with purulent discharge

granulation tissue is seen on the floor

Tympanic Membrane is clear

A

Externa case

Anti pseudomonals

AMino= TAG

Cipro levo

ceftiaz-cefepime

Ticar-Piperacillin

753
Q

NMS

malignant hyperthermia

Acute Dystonia

A

Antipsychotic —>>Rigid muscle + HIGH Fever –> NMS–> Dantrolene

Inhaled Anesthetic–> fever+ muscle contracted–>>Dantrolene

Antipsychotic–> rigid muscle without fever–> Diphenhydramine , Benztropine

754
Q

Placenta Previa

vs

Abruptio

A

Abruptio–> uterus is very tender and in pain + fetal Heart rate abnormalities

Previa –> painless bleeding, normal FHR

755
Q

False Labor

A

Irregular contractions without pain

weak in strenght

reassure patient and discharge

756
Q

Panic disorder 7s

A

Recurring

Derealization/Detachment

sweating chilling or trembling

Dizziness

fear of losing control

Worry about additional attacks

Palpitations and shortness of breath

757
Q

Liver CT scan

mass is seen

A

If weight loss–> cancer

Hx of bloody diarrhea–> Amebic cyst—>Entamoeba

Hx of Animal Contact—> Echinoccous

Old man/ hx of peritonitis–> Bacterial abscess

758
Q

Infant Respiratory distress

causes?

A

Prematurity

maternal diabetes

cesarean without labor

male sex

See Air Bronchogram on radiograph–> air filled alveoli is standing out, from surround alveoli that are opacified

759
Q

Ground glass ( reticlular) radiograph

and

bronchoghram

A

Respiratory distess (Infant)

760
Q

Viral prodrome

slowly grown and scaled

within a week –> cluster develops in xmas tree pattern

pruritic

wrestler

A

pityriasis rosea

761
Q

wrestler

A

TInea corporis

central clearing

762
Q

Callus

A
763
Q

Primary lung cancer and clubbing

A

Activating mutations of

KRas, EGFR, ALK–>> growth–> Adenocarcinoma on Periphery of Lung

764
Q

Focal Glomerulosclerosis

A

NephrOtic

“He”

hIv

HEroin

hEmoglobinopathy–> Sickle RBc

765
Q

Nephrotic

BCSS

A

membranous–>

Hep B

Hep C

SLE

Syphilis

766
Q

Painless Genital ulcers

A

Granuoma Inguinale–> klebsiella–> extensive ulceration–> granulation in base

single –> clean based ulcer–> corkshaped Syphillis

Shallow–>>small ulcers–> venereum Chlam –>lymphogranulama –> Chlam is Coalesced

767
Q
A
768
Q

Y descent

A

Relaxing descent

Right atrium

ORGASMs into

RIght Ventricle

769
Q

X descent

A

tricuspid pushed back due to increased pressure generated from RV contraction

770
Q

toxoplasmosis –> multiple or single

A

<100 cells

Multiple

Tox–Multiplies–>below 100 cells

771
Q

Solitary Ring

C

A

CNS Lymphoma

772
Q

Spasm of The Coronary

A

Diltiazem

AmloDipine FeloDipine

Sublingual NitroGlycerin –Aborts the ongoing Episode

773
Q

Peridontal Group

A

HACEk

Eikonella CorroDens

kingella

CArdiobacterium HOminiS

Haemophilus Aphrophilus

AggreGatiBacter

774
Q

swollen eye

with

conjuctival injection

but no discharge

A

If pain with ocular movement–> orbital cellulitis

if no pain–> preseptal cellulitis

Orbital–> IV antibiotic +- SUrgery

Preseptal–> Oral Antibiotic

775
Q
A
776
Q

MCA stroke

A

Anosognosia–> Lack of awarens of ones illness

Hemi neglect

Eye deviates–> towards the lesion

Upper limb affected

Face

777
Q

Diabetic kidney timeline

A

H-T-E-N

Hyperfiltration–>BM thickening–>Mesangium expansion–>Nodular

778
Q

for depression

and insomnia and to stimulate hunger ?

A

Mirtazapine

779
Q

6 year old

consistent hip pain but normal xrays

A

Leg–calve-Perthes disease

Idiopathic Avascular necrosis of “A Child”

780
Q

IgE mediated

A

histamine and inflammation

No vesicles

781
Q

Linear allergic reaction

vesicular

some are crusted and some are still wet

A

Delayed

takes time to linear formation

varied presentation due to time elapsed

T cell mediated type 4 attack

782
Q

Optic neuritis causing drugs

A

Ethambutol

Hydroxychloroquine

783
Q

Most effective intervention to prevent post operative pneumonia

A

Incentive Spirometry

Aim to promote lung expansion

( also,deep breathing and CPAP)

784
Q

Anti thrombotic tx criteria

A

CHA2D

S2

VASc

CHF–>Htn–>AGe75–>Diabetes

Stoke

Vascular disease–>Age65-74–>Sex category

785
Q

Prostatitis

vs

BPH

A

similar

but

Prostatitis –> comes with back pain and pain with ejaculation

BPH–> only stream problem

786
Q

tender

and immobile uterus

and adhesive

A

Endometriosis

787
Q

Tardive dyskinesia

after how many months and what drug?

A

6 months

Valbenazine

788
Q

Hemorrhagic bladder

and

bladder cancer

after starting a drug

Which drug?

A

Cyclophosphamide

789
Q

Sudden epigastric pain–> Intense

Free Air under the diaphragm

A
790
Q

Hemodialysis Hypertensive crisis

A

Acute Hypertensive Crisis–> Bilateral Retinal Hemorrhages, Headache and Severe Hypertension

Anemia of CHronic Kidney diseases—> patients are given Erythropoietin

Erythropoietin increases RBc–> HYpertension

791
Q

Compression of heart by Air inspired in Lung

A

systolic pressure drops –> Pulsus paradoxus –> equalized diastolic pressure in all four chambers

Tamponade, Severe croup–> Pulsus paradoxus

792
Q

Cardiogenic shock

A

Heart doesn’t pump out blood

Low urine

cold extremities

Hypotension

793
Q

Schizophrenic patient

cannot sit and keeps wandering here and there

A

Akathisia–> Restless

Beta blocker

Lorazepam

Benztropine

794
Q

Amenorrhea test

A

Hx–>PE–> Pregnancy test–>If negative

–> Prolactin TSH FSH

795
Q

Feltys

A

Advanced Rheumatid Arthritis

W/

Splenomegaly

Neutropenia

796
Q

Behcet

A

Recurring & painful

oral and genital ulcers

w/ Uveitis

797
Q

cruise trip

hotel stay

high fever

crackles

Interstitial Infiltrates

A

Legionella

Low sodium on lab

Macrolides or FLUOROQUINOLONES

798
Q

Atypical pneumonia

A

azithromycin

fluoroquinolone

799
Q

Patient

hx of immobilization

cocaine use

and

lab is shown for creatine Phosphokinase (Kinase)

A

Rhabdomyolysis

Intrinsic Renal Failure

800
Q

Cirrhosis and Portal htn

management?

A

They frequently have Abdominal ascites due to low albumin—> Transdutive effusion–> leaks through small defects in right side ,less muscular side of Diaphragm

–>Hepatic Hydrothorax

801
Q

Tet spell

A

Agitation ,exertion–> increases pulmonary resistance–> RVOT exaggerated–> RV drains into Aorta–> cyanotic spell

Pulmonary stenosis–> blood makes noise at upper left sternal border

Management–> make aorta busy for rv blood–> knee chest positioning

802
Q

Venous valve

vs

lymphatic obstruction

A

Lymphatic obstruction is severe than

venous valve incompetence

803
Q

Enemies of patient with Cystic Fibrosis

A

age one to twenty = Staph Aureus

beyond–strep straps you

Staph comes and let streps come

804
Q

bubbles in urine

A

Check for colo-vesical fistula due

to diverticulitis

805
Q
A
806
Q

Depression after breakup

gets angry–> acts suicidal

A

BPD

DIalect behavior therapy is best

807
Q

Outstreched hand

A

Scaphoid–> snuff box resident–> Avascular necrosis

hook of hamate–> Ulnar

essential tremor–> with movement

Nigra–> give movement–> and tremor is gone–>tremor when (Park)inson

808
Q

Sulfonylurea

A

class 1 and class2

class 1 -> ChlorProp & TOLbut

Class 2 –>

Glim

Glyb

Glip

1= Dislufiram

2= Hypoglycemia

NOT at all a initiation therapy

809
Q

Mumps vs E coli

A

Mumps–> prodrome viral–> high fever–> partitis –> orchitis

Ecoli–> above 35–> bladder obstruction–>unilateral testicular pain–>erythematous–> Epididymitis

Chlamydia & Gonorrhea–> under 35–> urthrtitis–> discharge plus testes pain

810
Q

hyper-resonance to percussion

A

Hyperinflated lung or pneumothorax

if fluid in the lung–> pneumonia–> sound travels better in liquid–> increased breath sounds and increased tactile fremitus

If fluid on the lung–> malignacy or effusion from trauma–> liquid will insulate the sound

811
Q

Disconjugate gaze

absent ciliary reflex

A

Isopropyl alcohol ingestion

812
Q

Within 7 days of neonatal delivery–>

fuller anterior fontanelle

A

Meningitis

Group B

813
Q
A
814
Q

less the 3 months old infant

What causes the meningitis

A

Strep

Listeria

Group B

E coli

Herpes

815
Q

Esophageal aperistalsis differential

A

Eosinophilic--> Gerd–>hx of heart burn and exam->hypercontractility

Increased LES pressure–> Achalasia

Decreased LES pressure–>systemic sclerosis–>Smooth muscle atrophies and fibrosed

816
Q

parvus and tardus are seen in what heart condition

A

seen in

aortic stenosis

parvus–>weak

tardus–> delayed

817
Q

Hot temperature migration

eye disk swollen/blurry/hyperemic

pain and light touch decreased mildly

fatigue

A

MS

818
Q

Acute Abdominal Pain imaging

A

RUQ–>Ultrasonography

LLQ/RLQ–> CT scan

819
Q

Non Exudated Ulcer on vulva

indurated edges

A

Syphilis

820
Q

Blood at urethral meatus

perineal injury

high riding prostate

A

Posterir urethral Inury

Do urethrogram and “aVoid Foley”

821
Q

Infant

Intestinal perforation

microcolon

inissipated mucus in ileum

A

meconium ileus

intestinal perforation –>free air

822
Q

SLE Anemia

A

A) Immune-mediated destruction

B) nephritis – > ineffective erythropoiesis

823
Q
A
824
Q

Capillary refill time

A

Press the thumbnail–> time it will take to re-fill the empty capillaries–> normal is less than 2 seconds

825
Q

Hypertrophic Cardiomyopathy

Treatment

A

BB–> symptomatic relief–> prevent syncope and load on heavy heart

CCb

partial excision or Alcohol Ablation of septum

826
Q

Increases with inspiration

A

TriCuspid Regurgitation

lungs fill in with air–> compresses the vessels–> blood goes back to right ventricle

827
Q

young guy

inspires and murmur is heard

plus

if they show you a arm with needle marks ( in a track)

A

IV

Tricuspid Regurgitation

828
Q

septic emboli

A

MOSTLY middle carotid artery –> stroke

Give IV antibiotics

no need of typical anticoagulants

829
Q

INR >1.3

A

Synthetic Liver Dysfunction

830
Q
A

Palmar Erythema

Due to excess estrogen

Excess estrogen also causes Spider angiomas

831
Q

Turner like craniofacial defects

like webbed neck

but with very low Hemoglobin

A

Diamon becklowith Anemia

also see

triphalangeal thumb

short strature

cleft palate

Defect –> erythroid progenitor cells–> leads to apoptosis of Red blood cells

832
Q

Young patient

age less than 5

comes with tender and swollen single lymph node

Patient is non-toxic appearing

A

Lymphadenitis

Bacterial –> non toxic appearing

833
Q

Accidental case

xray is shown

one lobe looks clouded and loss of diaphragmatic border–> left side

A

look for

1) naso gastric tubes–> if the tubes are in lungs–> abdominal contents have hernited through diaphram tear–> mostly left side
2) if patient is hypotensive

if distended neck veins–> globular arthitecture of heart–> tamponade

if not than just tension pneumothorax

834
Q

lack of muscle atonia in

REM sleep

Beta

A

Dream enactement

Rem is dreaming phase

penile clitoral

Memory process

835
Q

SLeep phases

A

BATS DB

Bats drink blook

836
Q

Central venous catheter

places in

either of

subclavian vein

jugular

azygos

A

Keep checking now

with portable chest radiograph

because, most apporpirate place for the catheter is in lower superior vena cava

all others are smaller veins–> chances of perforation

837
Q

Fever

+

Thick and Multiloculated mass on adenexa

A

abscess

=tubulo-Ovarian

COmplication of PID

polymicrobial infection–> Inflammatory exudate–>purulent fluid–>Wall thickening

838
Q

bugs crawling

withdrawal from what

A

alcohol

839
Q

Hyperechoic nodule

+

calcification

+

and found incidentally

A

cystic teratoma

840
Q

High B-hCG stimulates what?

A

Theca-Luetin cysts

like

in Molar pregnancy

( Present only during pregnancy)

841
Q

Patient has a history of some benign mass in adnexa

Now comes with sudden pain and guarding to deep palpation

A

suspect ovarian torsion, no matter what to anyone with a mass until proven otherwise

842
Q

hyperkalemic patient with stroke and ecg shows bradycardia

what to give

A

IV calcium gluconate

or

IV Insulin

843
Q

Lung

squamous cell carcinoma

small cell cancer

A

Sentrally located

844
Q

Scaphoid Fracture

A

Thumb Spica Splint

repeat radiography in 2 weeks

845
Q

vericella vaccine at what ages?

what if a kid has missed one vaccine and exposed to other kid going through vericella at age of 5

A

varicella at age of 1 and 4

give vaccine if exposed

846
Q

Pleuritic chest pain

with

pregnancy like mass

A

with fever & sepsis–> ectopic due fitz-hugh

without fever or sepsis like –> Hyaditiform mole

847
Q

echinococcus

vs

ameobic cyst

drugs

A

Echinococcus–> Eggshell calcification –>Albendazole

Entamoeba histolytica-->Pasty exudate abscess on liver–>plus bloody diarrhea and flask ulcers–> Metronidazole plus

paromomycin to clear up the intestine

848
Q

MEN 2A

A

Medullary thyroid

PheochromocytomA

Parathyroid HyperplasiA

849
Q

Anti Smooth muscle antibody

OR

Anti Nuclear Antibody

A

Autoimmune Hepatitis

850
Q

gritty sandy irritation in eye

plus

proptosis

A

propotisis = scary protuding eyes

ptosis= eye lid drops

gritty/ sandy kind of irritation= Graves proptosis

MG==> Ptosis== not PROPTOSIS

LEMS==> less frequently ocular

851
Q

Idiopathic Juvenile Arthritis

A

not migratory

852
Q

No mucoid discharge

no purulent discharge

no morning mattering of eye lids

but blood shot eyes

and diarrhe with apthous ulcer in mouth

A

Anterior Uveitis

No mucoid–> not viral

no purulent –> not bacterial

DIarrhea and ulcers–> associated with IBS–> Uveitis

853
Q

more than 25% lymphoblasts

A

ALL

854
Q

BAck pain

Focal exquisite tenderness on palpation

paraspinal muscle spasm

leg raise test is negative

febrile

A

vertebral osteomyelitis

855
Q

bone pain

cytopenia

A

G.Cbro–> GAU-CH-ERrrrr

856
Q

Von Gierke

A

Type VON 1

Glycogen stays in one form only and does not gets broken down to glucose

kids with chubby cheeks–> doll like face

857
Q

Chronic Fluctuating

mood disorders

( when cant dignose depression or bipolar)

A

Cyclothymic

858
Q

Inspiration and venous return

A

Venous return increases and gets into right heart

—->> pushes the interventricular septum into the left heart

—> decreases LEDV

859
Q

Progesterone

vs

hCG

A

progesterone maintains implantation

hCG maintains corpus luteum

860
Q

Lyme

Babesiosis

Ehrilichiosis

RMSF

A

Lyme–>early–>see migrans

Babesios—->splenectomy–>anemia, reticulocytosis, Leukocytosis

Ehrilichiosis–>>lichi and amb –>amblyoma–>leukopenia & thrombocytopenia

RMSF–>wrist and ankles to–> rash on hand and rash on soles

861
Q

mesenteric Ischemia

A

fresh bllod through anus–> Hematochezia

Plus

out of poportion kind of pain

on Periumbilical area

862
Q

Rebound Tenderness

A

anything that irritates

Peritoneum

Appendicitis

Peptic Ulcer Disease

Small bowel Obstruction

863
Q

vaginal bacterial color code

A

Greybound–> Grey bacterieal

GTA–>> trichomonas is green

864
Q

Coliform bacteria

A

Floss after cowliflower

Ecoli–> levofloxacin

865
Q

smooth tapering of distal esophagus with dilated proximal esophagus

A

Achalasia or pseduoachalsis

aperistalsis vs malignancy

Achalasia–>sphincter wont relax

Esophageal cancer–> changes the tissue or compresses it

Endoscopic evaluation

866
Q

pseudotumor cerebri

treatment kya hai bhai

A

acetazolamide

weight loss

stop offending drugs

867
Q

cyst here

A

bakers popliteal cyst

see a crescent shaped ecchymosis

868
Q

Crescent

A

shaped hematoma–> sub-dura bleed

Kidneys–>Light microscopy–>crescent shapes–>antibodies –>RPGN

Crescent shaped Ecchymosis on gastronemius area–> bakers cyst–> can rupture and spill below and cause swelling of calf

869
Q

viral video paramixed Group of dogs

barking and striding

in flames and

larynxing the turkey

A

Croup

inflammation of turkey and larynx

paramyxovirus

dexamethasone–>worse case give Nebulized racemic Epinephrine

870
Q

collison

trauma case

do first what

A

FAST

focussed-assesment-sonograph for Trauma

871
Q

Chronic HCV

A

treatment revolves around prevent further liver damage

–> vaccinate patient

give antioxidants

and give some anti virals

872
Q

Acromegaly

A

COarse face

enlargement of fingers and carpal tunnel–> shooting pain upon tapping

873
Q

BArtholin cyst vs gartner

A

Bartholin–> bahar than gartner

gartner is deeper than bartholin

874
Q

previa = vaginal or cesarean

A

cesarean

vagina if placent is less than 2 cm on os

875
Q

dementia & parkinson

A

if muscular/tremors are present before the hallucinations begin–> parkinson disease dementia

if hallucinations or dementia is present and then later on you get rigid gait–> lewy body dementia

876
Q

Heart Rupturing after M.I

A

(Right Coronary–> Papillary)

Left Anterior Descending–> Interventricular septum

Papillary muscle & Interventricular septum= Within 5 days—-> New Holosystolic Murmur

After 5th day—> LAD–>Wall rupture–> Shock

Aneurysm Formation–> Months

Weeks–>months==remodelling= thin walls of the heart and dilated chamber–> CHF = prevent with ACEi

877
Q

no central pallor rbc

round and small

A

membrane tights it up and constrains the rbc

membrane defect–> tight rbc

round as round abdomen of lifeless married man to a boring wife

chittrocytosis

spherocytosis

878
Q

PVR cystica

A

parathyroid related von recklinghausen increased osteoclastic activity and replacement of bone with brown tumors

879
Q

excess T3

or constant thyroid upregulation

A

osteoclastic

880
Q

Actinic Keratosis

vs

Melanoma

A

white flaky like a deas skin –>AK squamous

brown irregular margin –> Basal

881
Q

Fever

dry cough

CD4 less then 200

A

PCP

Punjab control police–> Rs 200cd4

tmp-smx with glucocorticoids

882
Q

(Stroke kind of presentation)

Neurologic deficits lasted less than 24 hrs

Non contrast CT shows no abnormalities

A

Transient Ischemic Stroke

Aspirin and statin

883
Q

Catatonia

vs

akathisia

vs

NMS and malignant hyperthermia

A

Catatonia–> is a part of syndrome versus others are side effect of drugs

EIther patient would stay immobile and wont move or make purposeless movements

884
Q

rash

face to trunk

and neck to trunk

Head/neck with buccal mucosa

A

face to trunk -3 day german toga rubella

neck to trunk scarlet

head/neck with buccle–> ola -> cough coryza conjuctiva

885
Q

how to diagnose SLE

A

start with

Anti nuclear antibody

if present

then confirm with

Anti double strand dna

anti smith

886
Q

septated mass on ovary

vs

ectodermal calcified mass

A

sepateted mass–>with fluid–>epithelial of ovary/fallopian tube carcinoma

calcified mass–>without fluid–>with nodule–>dermoid ectodermal cystic teratoma

887
Q

Tuning fork web

A

Normally there is a background noise all the time

if you hear the the tuning fork better on one side–> conductive hearing loss on that side–> tuning fork not masked by backgroud noise

if its not heard at all by left ear–> and heard only by the right ear = sensoryneuronal loss of left ear.

RInne–> bone vs air–> air needs to work

888
Q

Factitious

vs

Malingering

A

Factitious= false facts and no gains

Malingering==Money, motivation for multitude gains

Conversion= Emotional Con, no gains

889
Q

Hx =prostate cancer

now has

hyperreflexia

urinary incontinence

A

Spinal nerves are compressed

Epidural Spinal Cord Compression

Intavenous Glucocorticoids–>Decrease vasogenic Edema–>

then MRI to see the theca compression

890
Q

Delerium management

A

establish sleep-wake cycle

frequently reorient the patient

avoid multiple drugs or physocal restraints

891
Q

Pulmonary capillary

A

measures Left Atrial Pressure

892
Q

take two arms blood pressure

A

Takayasu

893
Q

Norepinephrine and Dopamine increaser

A

BuProPion

894
Q

diverticulosis

vs

angiodysplasia

A

Diverticulosis–>arterial bleeding–> bright red blood

angiodysplasia–> anywhere in colon–> m/c in Vwf acquired coz of misbehaving valvcongenitalntial disease–> maroon colored stool

895
Q

bulky & tender uterus

globular shape

A

Adinosaurus

adenomyosis

896
Q

endometrosis

A

Metro pain–peaks–> before menses

oasis out of endometrium–>adhesions–>non mobile uterus

897
Q

Cat Bite

A

mostly

anaerobic & multocida–> amoxicillin/clavulanate

rare–>bartonella hanslae–>azithromycin

898
Q

Holter

A

to monitor intermittent arrhytmia

but Hx needs to have

episodes of syncope,,

or

Palpitations

899
Q

HACEK organisms

dental or colon

A

Dental

900
Q

pyelonephritis in pregnancy

what drug?

A

Cefrtriaxone

901
Q

0.45% given IV

(Hypotonic fluid )

A

check for iatrogenic hyponatremic confusion

reverese by giving 3%

902
Q

Photosensitivity causing drugs

A

tetracyclines

furosemide, thiazide

Amiodarone

Promethazine

Piroxicam

903
Q

tremor at movement

or when anxious

A

essential to keep moving

when at movement–> tremor–> essential tremor

Propranolol

904
Q

Squamous cell carcinoma of head/neck

A

PANendoscopy ( esophagus,laryngeal,broncho)

–>establish histology

–>decide on treatment

905
Q

Akathisia

A

restless

propranolol

benzodiazepine

benztropine

906
Q

Hx of chronic rhinusitis

+

Hemoptysis

+

Tracheal pathology ( some kind on imaging)

+

lung nodules

A

GPA- Pr-Anca

Poly—Ang–iitis

907
Q

Copious watery diarrhea

A

cryptosporidium

cyclospora

Giardia

908
Q

watery diarrhea

A

Giardia

Etec

Cryptospor

Noro, rota & adenovirus

Clostridiums (difficile and perfringens)

909
Q

GAs producing bugs in gall bladder

A

Emphysematous –> cholecystitis

wall of gall bladder is infected

910
Q

accident –> bleeding into stomach

A

hypovolemic shock

911
Q

what pressures are increased in cardiogenic shock

A

Cardiogenic–>> CArdiojammed–> Right atrial & PCWp

blood is seeping into the heart via vena cava–> but wont move forward

912
Q

pseudogout

A

Rhomboid

(remember–>there are no needles on the image & there are no two colors)

913
Q

distal esophagus chocked

A

solid and liquid problem–> achalasia

mass effect/ chagas/ loss of auerBach Myenteric plexus–> Achalasia

Chronic Gastritis–>

914
Q

hepatic troubled patient

Hx of hepatis c

vericeal bleed management?

A

SaO_E

Saline->Vol

Antibiotic–>Ceftriaxone

Octreotide

–> Endoscopy and check the status of bleeding

915
Q

atrophied hand muscle

atrophied testes

A

balding

cataracts

progressive muscle weakness

Myotonic domination

916
Q

XLR-muscle car

A

duchenne and beckers

Lesch Nyhan

VLCFA buildup

defective collagen (menkes)

WISKOTT–> Fucked up cytoskeleton of leukocytes and platelets

G6PD

917
Q

Delusions

vs

Interpersonal Problems

A

Delusions of food being poisoned–> Delusion

Interpersonal pervasive pattern—> Paranoid

918
Q

young patient

Hx of Otitis Media

now

Headaches wake him up

and vomits in the morning

A

do CT or Mri

to rule out Brain abscess

Otitis–Mastoiditis–> Temporal Abscess–> pressure–>supine—> Stimulates Medullary centre vomiting & Area postrema

Contrast–>shows hypointense

CT—> Bone

919
Q

obesessive personality disorder

vs

Obsessive compulsive

A

obsessive personality–> perfection

compulsive–> ritualistic and ego dystonic

920
Q

Copper IUD side effect

A

Heavy bleeding

Not for women with Hx of heavy periods

921
Q

long-term Contraception

A

MedroxyProgsterone injection every 3 months

922
Q

COPD and liver

A

Copd can impact liver

by increasing backflow

copd–>pulmonary htn–> cor pulmonale–> RV backed up–> backs up to liver

923
Q

Diverticulosis

Diagnosis

A

Abdominal CT scan with Contrast

Contradicted–>> Sigmoidoscopy or colonoscopy

Dont put anything in the ass of elderly with constipation issues

924
Q

nail through shoe

what bug and why

A

pseudomonas

because–> humid and warmer in shoe

925
Q

Malignant Hyperthermia

vs Neuroleptic Malignant Syndrome

A

Malignant–> Sucks to be under anesthesia

rapid onset vs NMS

926
Q

Intrauterine fetal demise <20weeks

A

Missed abortion

927
Q

Fluctuant anterior Cervical Mass

+

Neck Swelling

A

Auerus Adenitis

Clindamycin

928
Q

Bilateral Lymph Adenitis

A

EBV and Adenovirus

Well, mostly Viral

929
Q

Pneumothorax

A

spontaneous or gradual

primary or secondary

primary gets tracheal deviation

visceral pleural line is seen

930
Q

Spasm neonatal

stiff neck jaw and stridor

A

tetanus

spasm–> of diaphragm–> respiratory failure

931
Q

conduct disorder

A

Society

property

Aggression

rights

932
Q

Holosystolic

A

lower left sternum–>T.V

tricuspid regurg & VSD

left apex–> Mitral Regurgitation

933
Q

urinary urgency

plus

hematospermia

pain with ejaculation

pernineal pain

A

inflamed prostate

Prostatitis

934
Q

D Dimer nirmal

less than 500

A

rule out PE

if more than 500—> pulmonary angiography

935
Q

Alkaline phosphatase

Conjugate Hyperbilurubinemia

A

Conjugated–> Internal Liver excretion or Extrahepatic block–> Do ultrasound

Alkaline–> Ducts

936
Q

Liver With good AAA Credit Rating

A

Dj

ROTOR

937
Q

easily treated diabetic condition

plaques on skin

A

Glucagonoma

can have ataxia, diarrhea and dementia

venous thrombosis

938
Q

Exudative mechanism

A

infection or inflammation–> cytokines–>increase permability–>fluids moves into pericapillary space–> aids in transportation of immune response

but also causes exudative effusion

see elevated LDH

939
Q

vaginal wall tender

afebrile

voiding frequently

A

interstitial cystitis–> painful bladder syndrome

pain on intercourse

dhakka to bladder

remember what the propalsing bladder is knows as–> Cystocele–> pink seal like face peeking through vagina

940
Q

Amphetamine Analog

A

Bath salts–> Agitation

Ecstasy ( Molly)–>serotonin syndrome

Amphetamine toxicity–> Serotonin Syndrome, SiADH hyponatremia

941
Q

Posterior acousitc Enhancement of mass

A

means it had fluid in it

942
Q

Breast Cancer mass

A

below 30–> needle aspiration or image guided core biopys if it is complex cyst or mass

943
Q

Preecclampsia protein measurements

A

300 mg of protein in a day

Protein / creatinine = More than 0.3

Dipstick = >0.1+

or

signs of End organ Damage

944
Q

Shy drager

A

parkinson symptoms

+

Autonomic Dysfunction

( Abnormal sweating, postural Hypotension, Impotence,

Abnormal Salivation or Lacrimation)

Serious-> Bulbar dysfunction & Laryngeal stridor

Wear Constrictive clothes

945
Q

Stridor

without Infectious Symptoms

stridor begain in neonatal period

A

Laryngomalacia

946
Q

Stridor with ILL appearing & drooling

A

Epiglotittis

947
Q

muffled voice

A

Epiglottitis

Retropharyngeal Abscess

948
Q

Family history of migrains

what other can also be in the family

A

Cyclical Vomiting

949
Q

Hair on a patch

A

congenital melanocytic nevus

950
Q

bluish skin coloration ( greyish)

A

Congenital Dermal Melanocytosis

951
Q

flat patches but hyperpigmented

A

Neurofibromatosis

Mccune-Albright

952
Q

arterial emboli

vs

venous emboli

A

arterial–> mottled leg–ST Elevated MI–> LV sends out emboli

Venous–> warmth, tenderness, swelling (HIT)

Thrombotic patient post MI–> Arterial thrombus–> Do Transthoracic echo–> to rule out bigger LV Thrombus

953
Q

bursitis pains

whats at the medial side of the tibia?

A

Pes Anserine

S

P

I

Pes

954
Q

Aplasitc Anemia like

or

Bone MArrow failure when looking

at

WBC & platelets

is it bone marrow or anything else?

A

Monocytic Ehrilichiosis

Doxycycline

955
Q

ricketsial diseases

A

Doxycycline

cefur

956
Q

Post infection

post toxin

what kind of cardiomyopathy that happens in sudden and quick time

A

Dilated cardiomyopathy–> CHF

957
Q

First Prenatal Visit

A

Syphilis

HIV

Influenza

Rubella

Chlamydia

Protein and RH(D)

958
Q

Inflammatory Ligamentous LBP–>chronic

A

ligamentous insertion site pain–> Inflammatory–> chronic–> Ankylosing Spondyloarthropathy—> worst at rest and gets better with movement

Ligament sprain –> worst with Movement and better with rest, furthermore –> some incident could have led it to that kind of pain–> incident means acute setting

959
Q

A fertile age woman comes to your office

and asks you

what endocrine problems can cause miscarriage

A

Polycystic Ovary

Diabetes

Thyroid diseases

and

prolactin

960
Q

how does preeclampsia causes pulmonary edema

A

preeclampsia–> systemtic ,generalized artery spasm

–>afterload–> backflow to heart and increased pressure

B)

protenuria–> albumin lost–> less oncotic pressure in capillary

961
Q

tennis ball like aorta on image

A

Dissection

Never give thrombolytics or Anticoagulants

962
Q

Asthma amanagement

A

1–2—3—–4

1 = SABA–>

2 = LD ICS—->

3 = LABA +LD ICS or MD ICS–>

Till 2== SABA to LD corticosteroid –>saba has been used about 2 times in week and now Wakes up 3-4 times per month in night

Step 3= if saba has been used everyday–>now woke up too –>now go eithere long actine LABA along with LD or MD on steroid

4 = MD ICS+LABA

Severe= Steps 5 & 6

Step 5 = HD ICS + LABA

& omalizumab for allergy

Step 6

963
Q

Dystonia

A

Disrespecting posture

sustained contraction

(torticollis)

myoclonus vs chorea

myoclnus –>rhymtic jerking

964
Q

Fragile X

A

Mentally fragile but

CGG-jaw

continous growth of gonads and jaw

965
Q

cancer pain managment

A

NSAIDS–> weak opioid–>Short Acting Opioid–>Long Acting opioid

Weak= Tramadol, Codeine

Short= Morphine

966
Q

pregnant and lactating and lyme

A

Lime in front of pregnant ox

Amoxicillin

CefurOXamine

967
Q

Mccune albright

A

cafe spots

polyostotic fibrous displasia

endocrine hyperfunction

968
Q

morton hears a who on feet

A

clicking noise, when two meta tarsals are squeezed together

969
Q

newborn

with Rhinorrhea & Desquamating rash

A

Secondary Syphilis

970
Q

Relationship between Increased insulin in mother and Neonatal lungs

A

Maternal Diabetes–> increased insulin–>

INSULIN ANTAGONIZES CORTISON/CORTISOL

CORTISOL( SPHINGOMYELIN)

971
Q

cesarean contradiction

A

any incision that entered the Uterine cavity

veritical cesarean

myomectomy through the uterine cavity

972
Q

What do you think of when

you see

A Patient

with a Clasp Knife Rigidity of hand

A

UMN lesion

ISsue–> Increased tonicity

973
Q

DHEAS Androgen

is produced

where

A

Adrenal Gland

974
Q

when to give IV HCO3

A

when pH is Below 7.1

975
Q

Post viral

patient comes confused and high fever

imaging shows multiple thin walled cavities

and

he had blood tinged sputum

A

MRSA

post viral causes Necrotizing pneumonia

976
Q

Herniated Disk

A

Unilateral Radiation

977
Q

A child comes

and tells he woke up with a hip pain

has a soccer history and also a URI history

lab is normal

fever is normal

A

Transient Synovitis

978
Q

The newborn is cyanotic when feeding

gets better when he cries

A

ChoAnal Atresia

Failure of the posterior Nasal septum to canalaize

( Charge Syndrome )

979
Q

Charge Syndrome

A

Neonatal

with

Choanal Atresia–> Cyanosis gets better with crying

Coloboma–> hole in the eye–> dripping pupil

Heart defect

Genito-Urinary Defect

Ear abormality–>deafness

980
Q

Ovarian cystic masses

A

Homogeneous –> Endrometrioma

Hyperechoic–>calcified–>dermoid mature teratoma

981
Q

Breast tenderness

bleeding

A

estrogen secreting tumors

Granulosa

thecoma

982
Q

AV node bypassed

A

Wolff

atria to ventricle==> Quick contraction

gets AF= in 30%

Treatement= Procainamide or ibutilide

Don’t give Nodal Blockers-> wolff will bypass more

( Beta blockers, calcium blocker, Adenosine,Digoxin)

983
Q

Congenital Dysmorphic features

A

Smooth philtrum and thin upper lip, limb dislocation–> Alochol

Short distal finger phalanges & hirsutism along with microcephaly–> Phenytoin fetal hydantoin syndrome

corneal scarring/interstitial keratitis ,Saber shins & Hutchison teeth= syphilis

984
Q

Hypodense lesions

A

if on liver–> fluid in it–> contrast not taken up–> Abscess

Hyper dense–>

985
Q

severe stenosis vs mild

A

@right sternum

early peaking–> Mild

late peaking &

leaflets calcified and stenotic–> reduced mobility–> soft S2

986
Q

Penetration through Alar fascia–> posterior neck

A

retropharyngeal Abscess

–>deep space infection of the neck

through Alar Fascia–> infection can spread to Superior Mediastinum–> Anterior Mediastinitis

987
Q

what happens to cardiac Index

in

Septic shock

A

It increases because of Decrease

in SVR

and as Vasodilation happens

–> CI increases

988
Q

RAAS on arterioles

A

Afferent & Efferent –> increased Resistance–> Decreases RBF

constricts two arterioles

989
Q

crescent formation by a hematoma

A

Subdural

990
Q

Central facial nerve palsy

vs

Peripheral Facial Nerve

A
991
Q

holosystolic murmur

A

VSD

992
Q

Absent or diminished R wave

peaked P wave

lack of pulmonary vasculature image on xray

A

Diminished R wave= RV hypoplastic

Peaked P = Right atrium enarged

lack of pulmonary vasculature visualization = due to less blood supply to RV and pulmonic outflow tract–> underdeveloped pulmonic valve

Tricuspid Valve Atresia

993
Q

palpable mass on back bone of a young child

A

Spondylolisthesis

994
Q

HBV vaccine vs natural immunity

A

Anti HBcAb

vaccine doesnt have Core

995
Q

Infective endocarditis predisposition

A

Previous Valve defect= Mitral regurgitation

IV abuse–> Tricuspid regurgitation

996
Q

Epitrochlear Lymphadenopathy

A

With diffuse rash

On palms and soles

997
Q

secondary syphilis

A

Flu like–> sore throat and fever

grey mucus patches

wide spread lymphadenopathy

raised grey genital papules

EPITROCHLEAR is pathognomic

998
Q

Community Acquired Pneumonia

Treatment

A

Beta lactam plus Macrolide

Ceftriaxone plus Azithromycin

Or a

FLuoroquinolone

Moxifloxacin

999
Q

post partum

continous febrile

even with broad spectrum antibiotics

A

Septic Pelvic Thrombophlebitis

1000
Q

Muffled voice

and

uvula deviated

A

do drainage

its

peritonsillar abscess

Complication of tonsillitis

1001
Q

What does 10% of

Renal Cell Cancer

patients get

A

Scrotal Varicocele

( Tumor obstruction of the Gonadal Vein )

1002
Q

Smoking Cessation

A

if bulimic or seizures–> dont give bupropion

if moods problem–> dont give ach partial agonist verencycline

1003
Q

Fibroids vs Endometrioasis

A

Fibroids–>> Irregular and enlarged –>UTERUS

Endometriosis–> Nodularity in extra uteral places–> like posterior cul de sac

1004
Q

Erythromycin can also cause

A

pyloric stenosis

1005
Q

how to confirm HCV chronic status

A

positive serologic test

confirmatory molecular test–> looking for circulating HCV RNA

1006
Q

CF neonate

hasn’t passed the meconeum yet

A

do

xray to rule out pneumoperitneum–>perforation

then

do

water based contrast to get more insight into bowel

1007
Q

smaller vsd

vs

bigger vsd

A

smaller vsd is harsher sounding–> may self resolve

1008
Q

TIA

vs

Demyelinating plaque effect of MS

A

TIA can resolve the same day

but

demyelinated plaque effects lasts atleast a week

MS patient with stroke issue

1009
Q

Trachea

vs

Epiglottis

A

Narrowed trachea–> barking cough-> epinephephrine or corticosteroid

True tripodal emergency of ABC–>Epiglottis swollen–>impeded airflow–> H.I.–> ABC–>Airway needs to be secured

1010
Q

fragmented RBC

A

JIZZTOCYTE

1011
Q

CM vs Horse

A

_C_onus _M_edullaris–> Hyper reacts and numb ass and Early fuck of ass and bladder

Cauda equina—>> slower reflexes and later ass and bladder dysfunction but severe pain though–> bilaterally

1012
Q

if 1 gm of albumin decreases

A

.8 mg of calcium decreases too

1013
Q

a patient comes with a thyroid nodule

what to do now

A

measure TSh

and ultrasound

1014
Q

leas 2 and 3 and avf raised up

and chest pain

A

Avoid Nitroglycerin

—> causes Profound Hypotension

1015
Q

Blastomyces

coccoidiodes

incubation period

A

Blast 3-6 weeks

Cocco–> within 2 weeks

1016
Q

Live Attenuated vaccines

A

Adenovirus, Rotavirus,MMR, Yellow,Influenza nasal,Vericella chickenpox,polio sabin

Live show of vaccine warriors

PYAR-V-MMR–>dangerous to weak immuned

1017
Q

Vaccines

for ages of 4 - 18

A

Pneumococcal

Hib

1018
Q

Approach to Hyponatremia

A

check moistness ( if dry –>hypovolemic)

check edema ( of present–> hypervolemic)

if moist and ( no edema ) –> euvolemic–> SiADH

1019
Q

tympanocentesis & culture

tympanostomy

A

multiple episodes of AOM–>

more than THREE episodes in 6 months

more than FOUR episodes in 12 months

1020
Q

Elderly woman tests

A

BCC

Breast every 2 years

cervical every 3 years

colon every 10 years

1021
Q

tamoxifen’s

anti estrogenic properties are on?

A

Breast

and

CNS (reason for hot flashes)

1022
Q

Lvedp aka ?

lvedp increased in what?

A

LVEDP aka LV filling pressure

LVEDP is increased in

MR or AR

1023
Q

patient comes with tender spots

A

Erythema nodosum

first of all rule out sarcoidosis and tb by doing x ray

pharyngitis step test

cbc

liver test

renal test

1024
Q

Ventricular fibrillation

A

difibrilation

if failed

give amiodarone

1025
Q

patient comes and tells he has

electrical pain sensation

going up and down the body

from back to the lower limbs

A

Lhemette sign of MS

1026
Q

14-3-3 protein on lab work

A

Creutzfelt jakob

–> startling myoclonus

rapid and Profound deterioration

1027
Q

Active labor cervical changes

A

If slower change –> Give Oxytocin

If no change –> Do Cesarean

1028
Q

Glasgow scale

A
1029
Q

Acute Pancreatitis

vs

Chronic

A

Chronic==> Burnt out pancreas–> no lipase increase like in acute

1030
Q
A

Step 2 ck mine (1 decks)

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