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1
Q

Hypertension in pregnancy

A

Gestational hypertension: new onset of HTN (>140/>90) at >20 wks in the absence of proteinuria or end organ damage
-no drug therapy

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2
Q

Most common sequela of undescended testicle

A

INFERTILITY&raquo_space; testicular cancer

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3
Q

Treat acute flare-up of multiple sclerosis

A

Corticosteroids (methylprednisolone)

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4
Q

Salmonella infection

A

From water, eggs, poultry, or seafood

Nausea, vomiting, diarrhea [+ mild blood], cramping

DO NOT TREAT ages 2-50 who are not severely ill or immunocompromised
-no benefit, and may actually prolong carriage and increase risk of relapse

DO TREAT: severe disease (high fever, severe diarrhea, need for hospitalization) or those who are immunocompromised; infants and older adults

Children: amoxicillin or TMP/SMX
Adults: fluoroquinolones

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5
Q

Parameters in neurogenic shock

A

Characterized by decreased SVR (distributive shock)

RAP: decreased
CO: decreased
SVR: decreased

Causes BRADYCARDIA, while all other causes of chock lead to tachycardia

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6
Q

If >30% increase in serum creatinine after starting an ACE inhibitor

A

Bilateral renal artery stenosis

If <30%, can continue ACE-i

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7
Q

sJIA criteria

A

Arthritis + daily fever for 2 weeks + any one:

  • evanescent red rash
  • generalized lymphadenopathy
  • hepatomegaly or splenomegaly
  • serositis
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8
Q

Medical therapy in hypertrophic cardiomyopathy

A

Beta blocker + non-dihydropyridine CCB (verapamil)

Diuretics, nitrates, and digoxin can worsen clinical status

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9
Q

First step after PPROM

A

(<37 wks)

Assessment of fetal lung maturity via lamellar body count

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10
Q

Treatment of gustatory rhinitis

A

Nasal ipratropium

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11
Q

Treatment of essential thrombocythemia

A

Aspirin for low risk cases

Hydroxyurea for intermediate to high risk disease

Interferon for refractory cases

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12
Q

Eczema herpeticum

A

A complication of severe atopic dermatitis (eczema) where superinfection of eczema with HSV causes a vesicular eruption on preexisting inflamed skin

Fever and pain

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13
Q

Erythroderma (exfoliative dermatitis)

A

Erythema and scaling of >90% of body surface

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14
Q

Dyslexia is classified as a

A

Specific learning disorder

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15
Q

Important for ADHD diagnosis

A

In >1 setting (e.g., home AND school)

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16
Q

Ascertainment (sampling) bias

A

Study population differs from target population d/t nonrandom selection methods

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17
Q

Nonresponse bias

A

High nonresponse rate to surveys/questionnaries can cause errors is nonresponders differ in some way to responders

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18
Q

Berkson bias

A

Disease studied using only hospital-based patients may lead to results not applicable to target population

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19
Q

Prevalence (Neyman) bias

A

Exposures that happen long before disease assessment can cause study to miss deceased patients that die early or recover

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20
Q

Attrition bias

A

Significant loss of stud participants may cause bias if those lost to f/u differ significantly from remaining subjects

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21
Q

Recall bias

A

Common in retrospective studies

Subjects w/ negative outcomes are more likely to report certain exposures than control subjects

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22
Q

Observer bias

A

Observers misclassify data d/t individual differences in interpretation or preconceived expectations regarding study

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23
Q

Reporting bias

A

Subjects over- or under-report exposure history d/t perceived social stigmatization

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24
Q

Surveillance (detection) bias

A

Risk factor itself causes increased monitoring in exposed group relative to unexposed group, which increases probability of identifying disease

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25
Q

In kids <3 y.o., watch out for ______ on CXR

A

the thymus: “sail sign” (triangular shape)

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26
Q

Osteogenesis imperfecta

A
  • autosomal dominant
  • Type I collagen gene (COLA1)

Mild-moderate:

  • frequent fractures
  • blue sclerae
  • conductive hearing loss (and assx speech delay)
  • short to normal stature
  • dentinogenesis imperfecta
  • joint hypermobility

Lethal (type II)

  • in utero +/or neonatal fractures
  • pulmonary failure
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27
Q

Posterior urethral valves

A

Newborn boys w/ bladder distension, decreased urine output, and respiratory distress (d/t oligohydramnios and subsequent lung hypoplasia)

Renal and bladder US and voiding cystourethrogram

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28
Q

Raynaud disease vs phenomenon

A

Raynaud phenomenon: presence of pain, cold intolerance, and color change of distal extremities, secondary to conditions like SLE and scleroderma

Raynaud disease: presence of isolated Raynaud phenomenon

Tx: keep warm and CCBs

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29
Q

Verruca vulgaris is caused by

A

HPV 1-4

NOT covered in the HPV vaccine

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30
Q

HPV strains

A

Verruca vulgaris: 1-4

Genital warts: 6, 11 [covered by vaccine]

Cervical cancer: 16, 18, 31, 33 [covered by vaccine]

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31
Q

Most specific EKG finding in digoxin toxicity

A

Inverted T waves

Bradycardia, hypotension, conduction delay, downward swooping of ST segment, inverted T wave, hyperkalemia

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32
Q

Congenital hypothyroidism vs neonatal hypothyroidism

A

Congenital: low or absent thyroid hormones AT BIRTH

Neonatal: aka “cretinism,” postnatal tests are NORMAL

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33
Q

Pain medication in pregnancy

A

Cyclobenzaprine (category B)

NOT opioids because of NAS

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34
Q

Trigeminal neuralgia may be the forme fruste of

A

multiple sclerosis

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35
Q

Antithyroid medication side effects

A
  • agranulocytosis

- hepatic damage

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36
Q

Agranulocytosis classic hint

A

sore throat and high fever

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37
Q

Metformin and CKD

A

Metformin should not be used if Cr > 1.4, as potentially fatal lactic acidosis can develop

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38
Q

Initial evaluation after cystoscopy demonstrates bladder cancer

A

transurethral resection of the bladder tumor (TURBT)
-assesses histologic grade and depth of invasion (non-muscle invasive, muscle invasive, metastatic)

If muscle-invasive, then CT/MRI

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39
Q

Pioglitazone side effect

A

Fluid retention and peripheral edema, which can worsen CHF

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40
Q

Maternal vs classic hypothyroidism

A

Maternal: tacycardia
Classic: bradycardia

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41
Q

Biopsy of atopic dermatitis shows

A

spongiosis

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42
Q

Down syndrome most common cardiac defect

A

Complete atrioventricular septal defect

Failure of endocardial cushions to merge results in both VSD and ASD

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43
Q

If recurrent UTI symptoms but negative UA, next step is

A

Cystoscopy

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44
Q

First-line for cellulitis

A

po cephalexin

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45
Q

Treatment of dangerous hypercalcemia

A

IV salmon calcitonin with concurrent bisphosphonate

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46
Q

Treatment of acute cystitis in first trimester

A

Cefpodoxime, amoxicillin-clavulanate, or fosfomycin

Nitrofurantoin and TMP-SXM are contraindicated in first trimester and near term

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47
Q

Treatment of HPV genital warts in pregnancy

A

Trichloracetic acid or bichloracetic acid

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48
Q

Treatment of Torsades de pointes

A

IV magnesium sulfate

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49
Q

Constitutional growth delay

A

delayed growth spurt, delayed puberty, delayed bone age

  • normal birth weight and height
  • 6mo-3yo growth velocity slows and percentile drops
  • 3yo regains normal velocity, tracking 5th-10th percentile
  • bone age xrays delayed compared to chronological age
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50
Q

IV fluid resuscitation in children

A

IV ISOTONIC crystalloid (NS or LR)

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51
Q

Complications of PPROM

A
  • preterm labor
  • intraamniotic infection
  • placental abruption
  • umbilical cord prolapse
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52
Q

PPROM

A

PROM <37 wks

<34 wks (reassuring): latency abx, corticosteroids
<34 wkd (nonreassuring): delivery
>34 wks: delivery

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53
Q

If postmenopausal bleeding

A

TVUS or endometrial biopsy

Rule out endometrial cancer

If TVUS >4mm, need biopsy

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54
Q

Cervical displacement may be seen in

A

Endometriosis

d/t adhesions

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55
Q

Peripartum cardiomyopathy

A

Development of DCM within last month of pregnancy or w/in 5 months following delivery

Prorgessive DOE, lower extremity edema, S3
Associated w/ mitral regurgitation

Dx: transthoracic echo

Rx: like any HF

Immediate delivery only if hemodynamically unstable

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56
Q

Lichen planus association

A

HepC

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57
Q

Osetosarcoma vs Ewing sarcoma vs giant cell

A

Osteosarcoma: spiculated “sunburst” pattern, Codman triangle (periosteal elevation)

Ewing: “moth-eaten” appearance, onion skinning, Codman triangle

Giant cell (aka osteoclastoma): “soap bubble” appearance

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58
Q

If abdominal free air on XR from perforated viscus

A

Emergent surgery

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59
Q

Emergency contraception options and timing

A
  • copper IUD (0-5d)
  • Ulipristal pill (0-5d)
  • Levonorgestrel pill (0-72h) [PLAN B]
  • Progestin (0-72h)
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60
Q

Tourette syndrome treatment

A
  • antidopamine agents
    - tetrabenzine (dopamine-depleting agent)
    • antipsychotics (risperidone, haloperidol)
  • alpha-2-adrenergic agonists (not as good)
    • guanfacine, clonidine
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61
Q

Pseudodementia

A

MDD in elderly can mask as cognitive impairment

REVERSIBLE

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62
Q

Bleeding disorder in patients with cystic fibrosis

A

Vitamin K deficiency due to exocrine pancreatic insufficiency

  • prolonged PT
  • easy bleeding, mucosal bleeding, epistaxis
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63
Q

First step in evaluation of severe hypospadias

A

Karyotype analysis, since can represent virilization of XX or undervirilization of XY

Severe hypospadias

  • urethral meatus located at the perineum or scrotum
  • underdeveloped penis/glans
  • severe penile curvature
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64
Q

CSF in CJD

A

elevated 14-3-3 protein titers

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65
Q

Bordetella pertussis prophylaxis

A

Recommended for all close contacts

Azithomycin, erythromycin, or clarithromycin
Azithromycin in <1 mo

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66
Q

Scarlet fever

A

d/t Strep pyogenes

  • fever and pharyngitis
  • tonsillar erythema and exudates
  • strawberry tongue
  • tender anterior cervical nodes
  • sandpaper rash

tx: penicillin (amoxicillin)

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67
Q

Staphylococcal scalded skin syndrome

A

d/t Staph aureus

-superficial flaccid bullae followed by extensive exfoliation of the skin

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68
Q

Potassium in DKA

A

Can be high or normal (since acidemia and decreased insulin cause EC shift), but total body potassium is depleted

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69
Q

Management of chorioamnionitis

A

Antibiotics and immediate delivery, regardless of gestational age

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70
Q

Distinguish PNES from epilepsy

A

-absence of self injury, incontinence, or post-ictal confusion

Suggestive features of PNES

  • forceful eye closure
  • side-to-side head or body movements
  • rapid alerting and reorienting
  • memory recall of the event
  • in front of witnesses
  • may model behavior off friend/family member w/ epilepsy
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71
Q

Antibiotics for epiglottitis

A

d/t Haemophilus influenzae type B, strep, staph

Treat empirically with: Ceftriaxone (Hib + strep) and vancomycin (staph)

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72
Q

Severe pain in areas of lymphadenopathy after small quantities of alcohol

A

Hodgkin lymphoma

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73
Q

Hodgkin lymphoma labs

A

Elevated LDH and eosinophilia

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74
Q

Endometrial polpys

A

Regular menstrual bleeding with additional intramenstrual bleeding

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75
Q

Claw and hammer toe deformities

A

Due commonly to peripheral diabetic neuropathy

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76
Q

Preseptal cellulitis vs orbital cellulitis

A
  • eyelid erythema and swelling
  • chemiosis
  • rx: oral antibiotics

Not as severe as orbital cellulitis

  • sx of preseptal cellulitis PLUS
  • pain w/ EOM, proptosis, +/or ophthalmoplegia w/ diplopia
  • needs IV abx +/- surgery
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77
Q

McCune-Albright syndrome

A
  • café au lait spots
  • precocious puberty
  • fibrous dysplasia of bone
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78
Q

Causes of osteomyelitis in sickle cell disease

A
  • Salmonella
  • staph aureus

Treat w/ vancomycin and ceftriaxone

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79
Q

Post C-section mother with signs of hemorrhagic shock

A

Intraabdominal bleeding from uterine artery injury –> retroperitoneal hematoma

Emergency lapatotomy

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80
Q

Widening of the prevertebral space on xray

A

Retropharyngeal abscess

Fever, dysphagia, muffled voice, pain w/ neck extension

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81
Q

Methemoglobinemia

A

Excessive exposure to oxidizing agents (dapsone, nitrates, local anesthetics) results in CYANOSIS (can also get lethargy, respiratory depression, seizures, and death)

Fe++ –> Fe+++, which is unable to bind O2
Hgb changes and get a left shift (increased affinity for O2, which leads to decreased oxygen delivery to tissues)

Pulse ox of ~85% regardless of true oxygen saturation level

Supplemental O2 has no effect

ABG: falsely elevated oxygen saturation level (normal PaO2) since measures only unbound arterial oxygen (and not Hgb-bound O2)

Rx: methylene blue (or high dose ascorbic acid (vitC) if not available)

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82
Q

Cyanosis with feeding that is relieved with crying

A

Choanal atresia (failure of posterior nasal passage to canalize)

Dx: inability to pass catheter through nares

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83
Q

When to get a CT in bacterial sinusitis

A

focal HA, early morning vomiting, AMS, focal neurologic signs

CT: ring-enhancing brain abscess

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84
Q

Citalopram consideration

A

Dose-dependent QT prolongation

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85
Q

SSRI with the lowest risk of drug-drug interactions

A

Sertraline

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86
Q

Normal progression of active labor

A

Latent: 0-6 cm
Active: >6-10– ≥1 cm every 2 hrs

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87
Q

Rectus abdominis diastasis

A

Weakening of the linea alba between the rectus abdominis muscles

NO FASCIAL DEFECT

Nontender abdominal bulge (often in pregnant or postpartum patients)

Managament is conservative w/ observation and reassurance

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88
Q

Marfan syndrome gene

A

fibrillin-1

Autosomal dominant

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89
Q

Refeeding syndrome

A

Due to insulin –>

Low phosphorus, potassium, and magnesium

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90
Q

Stomal (anastamotic) stenosis post Roux-en-Y bypass

A

w/in the first year:
-progressive nausea, postprandial vomiting, GERD, and dysphagia to the point of not tolerating liquids

EGD w/ balloon dilatation

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91
Q

ALL vs sickle cell disease

A

Sickle cell disease does not have lymphadenopathy

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92
Q

Manifestations of mumps

A
  • parotitis
  • orchitis
  • meningitis
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93
Q

Cephalohematoma

A

Subperiosteal scalp swelling w/

  • firm
  • nontender
  • does not cross suture lines
  • no skin discoloration

RF: forceps or vacuum-assisted delivery

Most resorb spontaneously, but increased risk of hyperbilirubinemia and may need phototherapy

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94
Q

Caput succedeneum

A

Scalp swelling superficial to the periosteum that crosses suture lines

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95
Q

When to do CTA vs D-dimer

A

Modified Wells criteria

PE likely: CTA
PE unlikely: D-dimer

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96
Q

Rubella

A

Low-grade fever, lymphadenopathy (suboccpital, posterior auricular, posterior cervical), maculopapular exanthem that spreads cephalocaudally

Forsccheimer spots (erythematous papules on the soft palate) may be seen

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97
Q

Cause of Duchenne muscular dystrophy

A

Deletion of the dystrophin gene

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98
Q

Treatment of neonatal conjunctivitis

A

Oral azithromycin

monitor for pyloric stenosis

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99
Q

Erythromycin association in neonates

A

pyloric stenosis

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100
Q

If rash 1-3 weeks after varicella vaccine

A

Mild but contagious infection from live-attenuated vaccine.

  • <10 lesions
  • maculopapular +/or vesicular
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101
Q

First step in workup of pediatric asymptomatic or isolated proteinuria

A

First morning urine protein:Cr ratio

Transient proteinuria

  • fever
  • exercise
  • seizure
  • stress
  • volume depletion

Orthostatic proteinuria
-present throughout day but not first thing in the morning

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102
Q

Management of neonatal clavicle fracture

A

Reassurance and gentle handling

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103
Q

Alport syndrome

A

X-linked mutation of type IV collagen

Nephropathy
-hematuria (micro or gross)
-progressive renal insufficiency
-+/- proteinuria
-+/- HTN
Bilateral sensorineural hearing loss
Anterior lenticonus (lens protrusion)

Renal biopsy: longitudinal splitting of GBM

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104
Q

Lennox-Gastaut syndrome

A

presents by age 5

  • intellectual disability
  • severe seizures of varying types
  • slow spike-and-wave pattern
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105
Q

Juvenile myoclonic epilepsy

A

Generalized seizures during adolescence, most commonly myoclonic jerks

Can also see absence and GTC

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106
Q

Children <2 y.o. w/ first febrile UTI

A
  • antibiotics

- renal and bladder US

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107
Q

Acute fatty liver of pregnancy

A
  • nausea, vomiting
  • RUQ, epigastric pai
  • fulminant liver failure
  • profound hypoglycemia
  • elevated animotransferases (2-3x normal)
  • increased bilirubin
  • thrombocytopenia
  • DIC

Treatment: immediate delivery

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108
Q

Fecal elastase

A

High SN and SP for exocrine pancreatic insufficiency

LOW in severe pancreatic insufficiency

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109
Q

Diagnosis of Budd-Chiari syndrome

A

abdominal Doppler US

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110
Q

Congenital rubella

A
  • sensorineural hearing loss
  • cataracts
  • patent ductus arteriosus
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111
Q

Treatment of giardiasis

A

metronidazole

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112
Q

Chronic granulomatous disease

A
  • Most re X-linked recessive
  • abnormalities of NADPH oxidase
  • recurrent pulmonary and cutaneous infections
  • catalase positive pathogens (Staph aureus, Serratia, Burkholderia, Aspergillus)

Dx:

  • dihidrorhodamine 123 test
  • nitroblue tetrazoline test
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113
Q

Rett syndrome

A
  • girls
  • normal development until 6-18mo
  • regression of speech
  • loss of purposeful hand movements
  • stereotypical movements
  • gait abnormalities
  • period breathing abnormalities

MECP2 gene mutation

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114
Q

How much cow’s milk is too much for kids?

A

> 24 oz/d

IDA

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115
Q

Mixed connective tissue disease

A

Features of SLE, systemic sclerosis, and polymyositis

  • Raynaud phenomenon
  • hand/finger swelling
  • arthritis/synovitis
  • inflammatory myopathy
  • PHTN
  • malar or discoid rash
  • mild CNS and/or renal disease
Anti-U1 ribonucleoprotein
ANA
RF, anti-CCP
CK
Anemia/cytopenias
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116
Q

Most common cause of pneumonia in CF by age

A

<20: staph aureus

>20: pseudomonas

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117
Q

Otosclerosis

A
  • young (30s) Caucasian
  • F>M
  • AD w/ incomplete penetrance

-imbalance of bone resorption and deposition –> stiffening of stapes

  • progressive and conductive hearing loss
  • paradoxical speech discrimination in noisy environments
  • +/- reddish hue behind TM

Treatment

  • hearing aids
  • surgery (stapes reconstruction)
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118
Q

Arm/forearm swelling with pain and mild erythema in the setting of PICC line

A

Upper extremity DVT

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119
Q

PICC infection vs UE DVT

A

DVT has normal appearing catheter site (no purulence)

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120
Q

Treatment of UE DVT

A

3 months of anticoagulation

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121
Q

Risks of short interpregnancy interval

A
  • maternal anemia
  • PPROM
  • preterm delivery
  • low birth weight
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122
Q

Contraindications for breastfeeding

A
  • active untreated TB
  • HIV infection
  • herpetic breast lesions
  • active varicella infection
  • chemotherapy or radiation therapy
  • active substance use
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123
Q

Infant contraindication for breastfeeding

A

galactosemia

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124
Q

Treatment of tinea corporis

A

1st line: topical antifungals (clotrimazole, terbinafine)

2nd line, diffuse, or tinea capitis: ORAL antifungals (griseofulvin, terbinafine)

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125
Q

Treatment of MDD w/ psychotic features

A

Antipsychotic + antidepressant

OR

ECT

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126
Q

Fibroids (leiomyomata uteri) during pregnancy

A

Can grow but then outgrow blood supply leading to fibroid infarction and necrosis

  • severe abdominal pain
  • uterine tenderness
  • contractions (from PG release from fibroid)
  • palpable, firm, tender mass
  • leukocytosis (release of inflammatory cytokines)

Rx: conservative- pain control w/ indomethacin (PG inhibitor)

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127
Q

Triad of HUS

A
  • microangiopathic hemolytic anemia
  • thrombocytopenia
  • AKI

d/t Shiga-toxin producing E. coli (O157:H7)

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128
Q

Why is APL a medical emergency?

A

DIC

Consumptive coagulopathy –> pulmonary/cerebrovascular hemorrhage

Probably d/t release of tissue factor and release of plasmin

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129
Q

If see acute onset of joint effusion after minor joint trauma, think

A

hemarthrosis –> hemophilia

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130
Q

Membranous nephropathy association

A
  • SLE
  • HepB
  • HepC
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131
Q

Focal segmental glomerulosclerosis association

A

-HIV

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132
Q

Signs/sx of opioid intoxication but negative drugs screen

A

SEMISYNTHETIC and SYNTHETIC opioids

Semisynthetic

  • oxycodone
  • hydrocodone
  • hydromorphone

Synthetic

  • fentanyl
  • meperidine
  • methadone
  • tramadol

Drug screen measures MORPHINE, which is a breakdown product of all natural opioids (heroin, codeine)

Use mass spec to catch false negative

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133
Q

Impetigo caused by

A

Staph aureus or GAS (strep pyogenes)

Bullous is caused by staph aureus

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134
Q

Treatment of impetigo

A

Topical antibiotics: mupirocin

Oral antibiotics for widespread non-bullous or extensive bullous: cephalexin, dicloxacillin, clindamycin

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135
Q

Most common complication of sickle cell anemia

A

Painless hematuria (micro or gross)

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136
Q

Active phase arrest

A

No cervical change in ≥4 hrs w/ adequate contractions (≥200 Montevideo units averaged over 10 min)

OR

No change in ≥6 hrs w/ inadequate contractions

Most commonly d/t cephalopelvic disproportion

C-SECTION

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137
Q

Management of active phase arrest

A

C-section

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138
Q

Anemia of prematurity

A

Etiology

  • impaired EPO production
  • short RBC life span
  • iatrogenic blood sampling

Clinical manifestation:

  • usually asymptomatic
  • tachycardia, apnea, poor weight gain

Labs:

  • low hgb and hct
  • low reticulocyte count
  • normocytic, normochromic RBCs

Treatment

  • minimize blood draws
  • iron supplementation
  • transfusions
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139
Q

Cyanotic heart diseases of the newborn

A

The 5 Ts, with fingers!

  1. Truncus arteriosus
  2. Transposition of the great vessels
  3. Tricuspid atresia
  4. Tetralogy of Fallot
  5. Total anomalous pulmonary venous return
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140
Q

Hereditary angioedema

A

Pathophys

  • C1 inhibitor deficiency/dysfunction
  • excesive bradykinin

Features

  • swelling (face, genitals, extremities) w/o urticaria
  • laryngeal edema
  • colicky abdominal pain, vomiting, diarrhea

Dx

  • low C4 level
  • Low C1 inhibitor protein or fxn

Management
-C1 inhibitor concentrate

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141
Q

If positional headache (worse when upright, better when supine), think

A

postdural puncture headache

Also nausea, vomiting, neck stiffness

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142
Q

Detection of 21-hydroxylase deficiency

A

Dehydration, salt wasting, virilization

Elevated 17-hydroxyprogesterone levels

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143
Q

Severe aortic stenosis

A

valve area <1cm^2

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144
Q

Next step if think Guillain-Barré syndrome

A

spirometry

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145
Q

Triphalangeal thumbs

A

Diamond-Blackfan anemia

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146
Q

Diamond-Blackfan anemia

A

Congenital erythroid aplasia

  • craniofacial abnormalities
  • triphalangeal thumbs
  • increased risk of malignancy
  • MACROCYTIC anemia
  • reticulocytopenia
  • normal plt, WBC
  • steroids
  • RBC transfusions
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147
Q

Best contraception for antiphospholipid syndrome

A

COPPER IUD

Hormonal contraception is contraindicated in hypercoagulable states

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148
Q

Management of status epilepticus

A

≥5 min or ≥2 seizures in which patient does not completely regain consciousness

IV benzo + IV antiepileptic (fosphenytoin, phenytoin, leviteracetam, valproic acid)

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149
Q

Wiskott-Aldrich syndrome

A

X-linked recessive defect in WAS protein gene
Impaired cytoskeleton changes in leukocytes, platelets

  • eczema
  • microthrombocytopenia (small platelets, low platelet count)
  • recurrent infections

Treatment: stem cell transplant

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150
Q

Treatment of measles

A

Supportive. If hospitalized, vitamin A

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151
Q

Antihypertensive class to avoid in diabetes

A

Beta blockers:

  • weight gain
  • decreased insulin sensitivity
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152
Q

Testing after HCV exposure

A

Anti-hepatitis C antibody

  • if positive, indicates PREEXISTING infection
  • if negative:
    • repeat testing with either qualitative hepatitis C RNA (>3 wks post-exposure) or anti-hepatitis C antibodies (>6 months post-exposure)
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153
Q

What testing is recommended for all patients with ITP?

A
  • HepC

- HIV

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154
Q

Common cause of active phase protraction

A

(<1 cm/2hrs)

Cephalopelvic disproportion

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155
Q

Androgen insensitivity syndrome and management

A

XY

X-linked mutation in androgen receptor

  • genotypically male but phenotypically female
  • breast development [free testosterone aromatized to estrogen]
  • absent or minimal pubic/axillary hair
  • F external genitalia
  • absent uterus, cervix, upper 1/3 of vagina
  • cryptorchid testes

Management:
-elective gonadectomy d/t risk of testicular cancer from cryptorchidism

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156
Q

Praeder-Willi vs Angelman syndrome genetics

A

PW: deletion of PATERNAL 15q11-q13
AS: deletion of MATERNAL 15q11-q13

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157
Q

What to do if dog w/o rabies vaccine bites someone?

A

Quarantine for 10d. NO PEP if animal is healthy

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158
Q

Sequela of status epilepticus

A

cortical laminar necrosis

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159
Q

Most sensitive for diagnosis of heart failure

A

elevated BNP

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160
Q

HIV and delivery

A

viral load ≤ 1000: ART + vaginal delivery

viral load ≥ 1000: ART + zidovudine + C-section

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161
Q

Infant treatment of mother w/ HIV

A

Maternal viral load ≤ 1000: zidovudine

Maternal viral load > 1000: multidrug ART

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162
Q

HIV treatment during pregnancy

A

ART

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163
Q

Treatment of lung abscess

A

Clindamycin

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164
Q

Risk of pernicious anemia

A

Increases risk of intestinal-type gastric cancer and gastric carcinoid tumors

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165
Q

Thrombotic thrombocytpenic purpura

A

Decreased ADAMTS13 –> uncleaved vWF multimers –>plt trapping and activation
Acquired (autoantibody) or hereditary

Hemolytic anemia w/ schistocytes
Thrombocytopenia (increased bleeding time, normal PT/PTT)
Sometimes w/
-renal failure
-neurologic manifestations
-fever

Management

  • plasma exchange
  • glucocorticoids rituximab
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166
Q

HUS vs TTP

A

HUS more associated w/ E. coli O157:H7 and is primarily a renal disorder; neurologic manifestations uncommon

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167
Q

Td vs Tdap

A

Tdap ONCE as a substitue for Td, then 10 every 10 yrs

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168
Q

Adult pneumococcal vaccination

A

19-64

  • Chronic heart, lung, liver disease; DM, smokers, alcoholics: PPSV23 alone
  • Very high risk (CSF leaks, cochlear implants; sickle cell, asplenia; immunocompromised; CKD): PCV13 + PPSV23

≥65
-PCV13 + PPSV23

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169
Q

Methanol poisoning

A

Nausea, vomiting, epigastric pain

Vision loss, coma

Hyperemic optic disc

AG metabolic acidosis

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170
Q

Ethylene glycol vs methanol poisoning

A

AG metabolic acidosis in both

Methanol: damages eyes
EG: damages kidneys

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171
Q

Manage hyperkalemia

A

Stabilize myocardium: calcium gluconate

Lower serum K:

  • insulin with glucose
  • beta-2 agonists
  • sodium bicarbonate
  • diuretics
  • resins
  • dialysis
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172
Q

Diagnosis of aortic dissection

A

HD stable: CTA

HD unstable OR renal insufficiency: TEE

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173
Q

Chikungunya fever

A
  • high fevers and severe polyarthralgias
  • headache, myalgias, conjunctivitis, maculopapular rash
  • lymphopenia, thrombocytopenia, transaminitis

Chronic arthritis/arthralgias in >50%, may require methotrexate

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174
Q

Pubertal gynecomastia

A

BENIGN condition characterized by gradually enlarging glandular breast tissue in adolescent boys

Unilateral or bilateral

Reassurance and observation, self-resolving

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175
Q

Oxytocin toxicity

A
  • hyponatremia
  • hypotension
  • tachysystole
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176
Q

VSD murmur

A

Holosystolic with apical diastolic rumble

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177
Q

Reye syndrome

A

Pediatric aspirin use during viral infection (e.g., influenza or varicella infection)

Acute liver failure
Encephalopathy

  • increased ALT, AST
  • increased PT, PTT, INR
  • increased NH3

Treatment: supportive

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178
Q

TRetament of staphylococcal toxic shock syndrome

A

vancomycin + clindamycin

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179
Q

SCID

A

A disorder of T-cell development leading to severe B-cell dysfunction

Treatment: stem cell transplant

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180
Q

Cardiac myxoma

A

Benign neoplasm, 80% located in LA

Position-dependent mitral valve obstruction (mid diastolic murmur; dyspnea, lightheadedness, syncope)
Embolization of tumor fragments (stroke, acute limb ischemia)
Constitutional symptoms (fever, weight loss)
Increased ESR (from cytokine release)

Sometimes hear “tumor plop” at the end of diastole

Echo and prompt surgical resection

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181
Q

Fibromuscular dysplasia

A

Women <50

  • resistant HTN from renal artery involvement
  • cerebrovascular FMD w/ symptoms of brain ischemia (amaurosis fugax, Horner syndrome, TIA, stroke)
  • nonspecific symptoms (HA, pulsatile tinnitus, dizziness) from carotid artery or vertebral artery involvement
  • can also involve iliac, subclavian, and visceral arteries
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182
Q

If lateral gaze palsy (abducens nerve) and diplopia in HIV, think

A

Cryptococcus neoformans infection

Increases ICP

Also fever, malaise, umbilicated skin papules

LP w/ india Ink stain or capsular polysaccharide antigen testing

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183
Q

Contraindication to triptans and ergots

A

Coronary artery disease

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184
Q

Disseminated gonococcal infection

A

Triad:

  • polyarthralgia
  • tenosynovitis
  • painless vesicopapular skin lesions

OR just purulent monoarthritis

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185
Q

Effect of angiotensin II on the kidney

A

Preferential vasoconstriction of the efferent arteriole (increases intraglomerular pressure)

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186
Q

Galactosemia

A

Galactose-1-phosphate uridyl transferase deficiency

  • failure to thrive
  • bilateral cataracts
  • jaundice
  • hypoglycemia
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187
Q

Tubo-ovarian abscess

A

Complication of PID

  • fever
  • abdominal pain
  • complex, multiloculated adnexal mass with thick walls and internal debris on US
  • elevated markers: leukocytosis, CRP, CA-125
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188
Q

Treatment of chlamydia vs gonorrhea

A

Empiric: azithromycin + ceftriaxone
Confirmed chlamydia: azithromycin
Confirmed gonorrhea: azithromycin + ceftriaxone

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189
Q

Ovarian cancer marker

A

CA-125

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190
Q

If new lesion on CXR, next step is

A

Chest CT

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191
Q

Treat PCP intoxication

A

Benzos

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192
Q

Analgesic nephropathy

A
  • chronic tubulointerstitial nephritis

- papillary necrosis

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193
Q

Diabetes drug that causes weight loss

A

GLP-1 agonists

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194
Q

When to involve urology for kidney stones

A
  • ≥10 mm
  • refreactory pain
  • anuria
  • AKI
  • urosepsis
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195
Q

Duodenal vs jejeunal atresia

A

Duodenal: double bubble and gassless colon
Jejeunal: triple bubble and gassless colon

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196
Q

At what CD4 count should HIV patients not get live-attenuated vaccines?

A

<200

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197
Q

Neuroleptic malignant syndrome

A 
T > 40C (104F)
Confusion
Muscle rigidity 
Autonomic instability
Elevated CK
Leukocytosis

Dantrolene or bromocriptine if refractory

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198
Q

Congenital CMV

A
  • microcephaly

- periventricular calcifications

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199
Q

Bipolar drug of choice in pregnancy

A

Lamotrigine

Lithium can cause Ebstein anomaly

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200
Q

Type II osteogenesis imperfecta

A
  • intrauterine demise
  • multiple fractures
  • limb deformities
  • fetal growth restriction
  • hypoplastic thoracic cavity
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201
Q

Treatment of Bell palsy

A

Glucocorticoids +/- acyalovir or valacyclovir

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202
Q

Benzodiazepines without active liver metabolites

A

LOT

Lorazepam
Oxazepam
Temazepam

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203
Q

Abnormal biophysical profile score is consistent with

A

fetal hypoxia

prompt delivery indicated

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204
Q

If palpable breast mass

A

< 30: US

> 30: mammogram

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205
Q

Congenital toxoplasmosis

A

US:

  • bilateral ventriculomegaly
  • diffuse intracranial calcifications

Clinical features:

  • chorioretinitis
  • hydrocephalus
  • seizures
  • intellectual disability
  • SN hearing loss

Rx:

  • spiramycin
  • pyrimethamine, sulfadiazine, folinic acid
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206
Q

First step in LUTS

A

UA (evaluate hematuria and infection)

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207
Q

Treatment of acute viral pericarditis

A

NSAIDs + colchicine

Corticosteroids are second line

Corticosteroids are used in patients w/ contraindications to NSAIDs (renal failure)

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208
Q

CVP in types of shock

A

Elevated: obstructive, cardiogenic
Decreased: hypovolemic, distributive

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209
Q

CVP provides an estimate of

A

cardiac preload (since CVP approximated RAP)

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210
Q

Spontaneous pneumomediastinum

A

RFs

  • asthma exacerbation
  • respiratory infection
  • tall, thin, adolescent boy

Clinical:

  • acute chest pain, SOB, cough
  • subcutaneous emphysema
  • Hamman sign (crunching sound over heart)

Dx:
-mediastinal gas on CXR

Tx:

  • rest, analgesics
  • avoid Valsalva
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211
Q

G6PD level

A

may be normal during an attack in G6PD deficiency

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212
Q

Most common malignancy from asbestos

A

Bronchogenic carcinoma, esp in smokers

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213
Q

MAO-I adverse effect

A

Hypertensive crisis if eat foods rich in tyramine (wine, cheese)

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214
Q

Painful vs painless bleeding

A

Painful: placental abruption
Painless: placenta previa

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215
Q

Light criteria

A

Exudative effusion:

  • pleural protein / serum protein > 0.5
  • pleural LDH / serum LDH > 0.6
  • pleural LDH > 2/3 upper limit of normal for serum LDH
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216
Q

MEN1

A
  • Pituitary adenoma
  • Primary hyperparathyroidism
  • Pancreatic/GI neuroendocrine tumors
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217
Q

MEN2A

A
  • Parathyroid hyperplasia
  • Medullary thyroid carcinoma
  • Pheochromocytoma
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218
Q

MEN2B

A
  • Medullary thyroid carcinoma
  • Pheochromocytoma
  • Marfanoid body habitus
  • Mucosal neuromas
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219
Q

Warfarin overdose reversal

A

IV vitamin K and prothrombin complex concentrate

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220
Q

If depression and peripheral neuropathy

A

SNRI

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221
Q

Who requires penicillin for GBS prophylaxis

A

Women w/ unknown GBS status and

  • ROM ≥18h
  • intrapartum fever
  • prematurity (<37 wks)
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222
Q

Primary biliary cholangitis antibody

A

antimitochondrial

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223
Q

Acute cholangitis

A

Charcot triad: fever, RUQ pain, jaundice

Reynolds pentad: Charcot + hypotension, AMS

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224
Q

Edwards syndrome

A

Trisomy 18

  • microcephaly
  • prominent occiput
  • IUGR
  • micrognathia
  • closed fists w/ overlapping digits
  • rocker bottom feet
  • cardiac defects (VSD)
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225
Q

Infected ascites

A

PMNs ≥ 250

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226
Q

SAAG

A

SAAG = serum albumin – ascites albumin

≥1.1: PORTAL HYPERTENSION
-cardiac ascites, cirrhosis, Budd-Chiari syndrome

<1.1
-TB, peritoneal carcinomatosis, pancreatic ascites, nephrotic syndrome

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227
Q

Intermittent explosive disorder vs disruptive mood dysregulation disorder

A

IED:
-recurrent episodes of impulsive verbal or physical aggression

DMDR:

  • disproportionate physical or verbal outbursts
  • persistent irritability or anger between episodes
  • onset before age 10
  • diagnosis NOT made after 18
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228
Q

Management of simple renal cyst

A

reassurance

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229
Q

Kleihauer-Betke smear

A

Performed prior to calculation of RhoGAM dose

Indicated in

  • abortion
  • ectopic pregnancy
  • amniocentesis
  • vaginal bleeding
  • placenta previa
  • placental abruption
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230
Q

Cluster headache prophylaxis

A

Verapamil

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231
Q

Topical treatment for condyloma accuminata (anogenital warts)

A

Imiquimod cream

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232
Q

Spironolactone side effects

A

Anti-androgen effects

  • gynecomastia
  • erectile dysfunction
  • dizziness
  • dry mouth
  • thirst
  • abdominal distress
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233
Q

First line therapy for vulvovaginal candidiasis

A

INTRAVAGINAL azoles (clotrimazole, miconazole, tioconazole)

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234
Q

Most common infectious cause of erythema multiforme

A

HSV

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235
Q

Inferior MI leads

A

II, III, avF

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236
Q

Lateral MI leads

A

I, avL, V5, V6

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237
Q

Anterior MI

A

Some or all V1-V6

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238
Q

Langerhans cell histiocytosis

A
  • lytic bone lesions
  • skin lesions (purplish papules, eczematous ras)
  • lymphadenopathy, hepatosplenomegaly
  • pulmonary cysts, nodules
  • central diabetes insipidus

Dx: Langerhans cells on bone/skin biopsy

Tx

  • chemotherapy (prednisone +/- vinblastine)
  • desmopression for DI
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239
Q

When is trial of labor contraindicated?

A
  • classical C-section (vertical incision)
  • abdominal myomectomy w/ uterine cavity entry

Require laparotomy and delivery

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240
Q

Missed abortion

A
  • no vaginal bleeding
  • closed cervical os
  • no fetal cardiac activity or empty sac
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241
Q

Threatened abortion

A
  • vaginal bleeding
  • closed cervical os
  • fetal cardiac activity
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242
Q

Inevitable abortion

A
  • vaginal bleeding
  • dilated cervical os
  • products of conception may be seen or felt at or above cervical os
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243
Q

Incomplete abortion

A
  • vaginal bleeding
  • dilated cervical os
  • some products of conception expelled and some remain
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244
Q

Complete abortion

A
  • vaginal bleeding
  • closed cervical os
  • products of conception completely expelled
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245
Q

Most effective nonpharmacologic approaches to lower BP

A
  1. weight loss

2. DASH diet

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246
Q

WAGR syndrome

A
  • Wilms tumor
  • Aniridia
  • Genitourinary abnormalities
  • Intellectual disability (“r”…)
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247
Q

Treatment of minimal change disease

A

Corticosteroids

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248
Q

Adjustment disorder timing

A
  • symptoms develop w/in 3 months of stressor

- symptoms last no more than 6 months after stressor ceases

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249
Q

Generalized anxiety disorder timeline

A

≥ 6 mo

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250
Q

Treatment of PMR-GCA spectrum

A

PMR: low-dose po glucocorticoids

GCA: intermediate- to high-dose po glucocorticoids

GCA w/ vision loss: pulse high-dose IV glucocorticoids for 3d followed by intermediate- to high-dose po glucocorticoids

START STEROIDS BEFORE BIOPSY

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251
Q

Order of therapy in PMR/GCA

A

STEROIDS and then temporal artery biopsy

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252
Q

Confirm lead poisoning

A

VENOUS lead level

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253
Q

What is not affected by panhypopituitarism?

A

Aldosterone (since primarily regulated by RAAS

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254
Q

Hypopituitarism

A

Glucocorticoid deficiency, hypogonadism, and hypothyroidism

  • central adrenal insufficiency (low cortisol and ACTH): fatigue, anorexia, hypoglycemia, eosinphilia, pale skin
  • hypogonadotropic hypogonadism (low FSH, LH, testosterone): low libido, erectile dysfunction, testicular atrophy
  • central hypothyroidism (low or inappropriately normal TSH, low free T4): cold intolerance, constipation, bradycardia
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255
Q

Primary adrenal insufficiency vs hypopituitarism

A

PAI: aldosterone is lost –> hyperkalemia, severe hypotension ; ACTH increased –> hyperpigmentation

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256
Q

Management of Vtach

A

Stable: IV amiodarone
Unstable: synchronized cardioversion

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257
Q

What EKG finding is diagnostic for sustained monomorphic ventricular tachycardia?

A

Fusion beats

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258
Q

Viral myocarditis

A

Viral prodrome followed by s/sx of heart failure (resp distress, murmur, hepatomegaly)

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259
Q

Appendicitis during pregnancy

A

Uterus displaces the appendix

R mid- to upper quadrant OR R flank pain

IMMEDIATE SURGERY (appy)

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260
Q

5-alpha-reductase deficiency

A

Impaired testosterone to DHT conversion

46, XY
Phenotypically female at birth- M internal genitalia and F external genitalia
NO breast development
Puberty- virilization (clitoromegaly, increased muscle mass, nodulocystic acne)

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261
Q

Secondary spontaneous pneumothorax

A

Patients w/ underlying respiratory disease (COPD, CF) w/ acute onset worsening of resp symptoms. Esp in smokers

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262
Q

Which kids should get pavalizumab for RSV bronchiolitis?

A
  • preterm birth <29 wks
  • chronic lung disease of prematurity
  • hemodynamically significant congenital heart disease
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263
Q

First step in evaluating primary amenorrhea

A

Pelvic US

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264
Q

Labs in Turner syndrome

A

XO

Increased FSH and LH (d/t low estrogen so no feedback)

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265
Q

Histoplasmosis

A
  • Mississippi and Ohio River basins
  • pulmonary symptoms w/ mediastinal or hilar lymphadenopathy
  • arthralgias
  • erythema nodosum

-caseating or noncaseating granulomas

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266
Q

DHEAS is produced mainly in the

A

adrenals

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267
Q

Causes of asterixis

A
  • hepatic encephalopathy

- uremic encephalopathy

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268
Q

Trimethoprim electrolyte abnormality

A

Hyperkalemia

also may increased Cr

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269
Q

Breast fat necrosis

A
  • fixed mass
  • calcifications on mammography
  • biopsy: fat globules and foamy macrophages
  • no further workup
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270
Q

Medications that decrease suicide risk

A
  • lithium

- clozapine

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271
Q

Most common cause of sepsis in sickle cell disease

A

Streptococcus pneumoniae

usually from non-vaccine serotypes

Prophylax w/ penicillin

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272
Q

Primary ovarian insufficiency associations

A
  • Turner syndrome (XO)
  • Fragile X syndrome AND pre-mutation carriers
  • Autoimmune oophoritis
  • Anticancer drugs
  • Pelvic irradiation
  • Galactosemia
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273
Q

What type of anemia (MCV) does lead poisoning cause?

A

Microcytic

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274
Q

Treatment of BV during pregnancy

A

po metronidazole

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275
Q

Why might a patient undergoing laparoscopy develop bradycardia, AV block, or even asystole?

A

peritoneal stretch receptors –> increased vagal tone

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276
Q

HIV infection in infancy

A
  • failure to thrive
  • chronic diarrhea
  • lymphadenopathy
  • oppurtunistic infections: PCP pneumonia, candida
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277
Q

Antihypertensives in pregnancy

A
  • labetalol
  • methyldopa

Hydralazine and CCBs also acceptable

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278
Q

Pacemaker complication

A

Tricuspid regurgitation –> RHF

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279
Q

Seizures in the setting of pediatric bacterial gastroenteritis

A

Shigella

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280
Q

Antiphospholipid syndrome

A

Thrombotic event OR pregnancy morbidity in the setting of a positive antibody (either anticardiolipin, anti-beta2-glycoprotein-I, or lupus anticoagulant)

Prolonged PTT

Most important RF: SLE

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281
Q

Highest vs lowest risk second generation antipsychotics for metabolic syndrome

A

High risk: olanzapine, clozapine

Low risk: aripiprazole, ziprasidone

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282
Q

Antipsychotics for bipolar depression

A
  • quetiapine
  • lurasidone

Avoid antidepressant monotherapy

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283
Q

Tetralogy of Fallot

A
  • pulmonic stenosis (RVOT obstruction)
  • RVH
  • overriding aorta
  • VSD

Tet spells: acute hypoxemia and cyanosis

Harsh, crescendo-decrescendo systolic ejection murmur (d/t pulmonic stenosis)
Single S2 (normal aortic, inaudible pulmonic)
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284
Q

Most common cause of megalobastic anemia in chronic alcohol use

A

Folic acid deficiency

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285
Q

Pulmonary artery cath results indicative of pulmonary hypertension

A

Elevated pulmonary artery pressure

Elevated right atrial pressure

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286
Q

PCWP represents

A

LAP and L heart function

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287
Q

Elevated PCWP w/ elevated PA and RA pressures

A

L-sided HF leading to R-sided HF

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288
Q

Normal PCWP indicates

A

normal LV function

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289
Q

Normal PCWP in the setting of elevated RH pressures (PA, RA)

A

intrinsic pulmonary process (e.g., PE)

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290
Q

Treatment of hypernatremia

A

Assess volume status:

 Euvolemic: FREE WATER supplementation

 Hypovolemic: 
      Asymptomatic: 5% dextrose
      Symptomatic: 0.9% saline until asymptomatic, then 5% dextrose
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291
Q

What type of fluid is 5% dextrose?

A

HYPOTONIC

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292
Q

Mixed cryoglobulinemia

A

Small vessel vasculitis

  • palpable purpura
  • arthralgias
  • fatigue
  • peripheral neuropathy
  • liver involvement
  • renal disease

Strongly associated w/ HepC infection

Labs

  • hypocomplementemia
  • polyclonal IgG
  • anti-HCV antibodies
  • RF
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293
Q

Lithium electrolyte abnormality

A

Hypercalcemia d/t hyperparathyroidism

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294
Q

Diagnosis of intra-amniotic infection

A

Maternal fever + ≥1

  • fetal tachycardia (>160)
  • maternal leukocytosis
  • purulent amniotic fluid
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295
Q

Reye syndrome histology

A

Microvesicular steatosis (fatty infiltration)

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296
Q

Treatment of UTIs in kids

A

Third-generation cephalosporin (e.g., cefixime)

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297
Q

True positive, sensitivity, specificity

A

True positive = sensitivity

False positive = (1 - specificity)

If you increase sensitivity, you decrease specificity

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298
Q

Treatment of Paget disease of bone

A

Bisphosphonates

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299
Q

Decrease risk of septic embolic events in infective endocarditis

A

IV antibiotics

NOT heparin

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300
Q

S3 vs S4

A

S3: results from the sudden cessation of blood flow into a dilated LV during the passive filling phase of diastole; eccentric hypertrophy; LV volume overload (e.g. HF)

S4: caused by blood striking a stiff LV during atrial systole just before mitral valve closure (S1); concentric LV hypertrophy d/t systemic HTN or severe aortic stenosis

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301
Q

Hyperandrogenism in PCOS lab

A

elevated serum testosterone

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302
Q

Which hormone is increased in PCOS

A

LH

also testosterone

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303
Q

Types of decelerations in FHT

A 
Early: fetal head compression 
Late: ureteroplacental insufficiency 
Variable (abrupt): 
-cord compression
-oligohydramnios
-cord prolapse
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304
Q

Early deceleration

A

fetal head compression

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305
Q

Late deceleration

A

uteroplacental insufficiency

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306
Q

Variable deceleration

A
  • cord compression
  • oligohydramnios
  • cord prolapse
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307
Q

Management of recurrent variable decelerations

A

-maternal repositioning (reduces cord compression)

If they still do not improve: amnioinfusion

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308
Q

Hormone levels in Turner syndrome

A

low estrogen and progesterone –> lack of negative feedback –> high FSH and LH

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309
Q

Tricuspid regurgitation murmur

A

holosystolic murmur that increases w/ inspiration

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310
Q

First step in penile fracture

A

retrograde urethrogram

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311
Q

Uterine tachysystole

A

> 5 contractions in 10 min

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312
Q

HACEK organisms

A

~3% of infective endocarditis

Haemophilus aphrophilus
Aggregatibacter actinomycetemcomitans
Cardiobacterium hominis
Eikenella corrodens
Kingella kingae
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313
Q

Which type of glaucoma is acute?

A

Closed angle

Open angle is a chronic process that is often asymptomatic until gradual progression of peripheral vision loss- cupping of the optic disc

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314
Q

Treat antipsychotic-induced parkinsonism

A

Benztropine or amantadine

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315
Q

Kawasaki disease

A

Fever ≥5d +

  • conjunctivitis
  • rash
  • adenopathy
  • strawberry tongue (mucositis)
  • hand/foot edema (extremity edema)
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316
Q

Antidepressants w/ short vs long half life

A

Short: paroxetine (paxil)
Long: fluoxetine (4-6d)

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317
Q

FSH and LH in functional hypothalamic amenorrhea

A

decreased

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318
Q

Treatment of prolactinoma

A

Asymptomatic microprolactinoma (<10 mm): no treatment

Macroprolactinoma (>1 cm) or symptomatic microprolactinoma):

 - dopamine agonists (cabergoline, bromocriptine)
 - surgery (transphenoidal) IF fail to respond OR large (≥3 cm)
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319
Q

Takayasu arteritis

A

Asian F 10-40

symptoms

  • constitutional (fevers, weight loss)
  • arterio-occlusive (claudication, ulcers) in UE
  • arthralgias/myalgias

findings

  • BP discrepancy
  • pulse deficits
  • arterial bruits

diagnosis

  • elevated ESR, CRP
  • CXR: aortic dilatation, widened mediastinum
  • CT/MRI: wall thickening, narrowing of lumen

treatment
-systemic glucocorticoids

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320
Q

Acute kidney rejection most commonly occurs

A

w/in 6 mo of transplantation

  • T-cell mediated
  • asymptomatic rise in Cr
  • diagnosis confirmed by renal biopsy: lymphocytic infiltration of the intima

High dose IV glucocorticoids

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321
Q

Howell-Jolly bodies

A

post-splenectomy or functional asplenia/hyposplenism

Retained RBC nuclear remnants (that are typically removed by the spleen)

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322
Q

Heinz bodies

A

G6PD deficiency

Oxidized and precipitated hemoglobin

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323
Q

Sertoli-Leydig cell tumors

A

Sex cord-tromal tumor of OVARY
-INCREASED TESTOSTERONE [think: “Sir”-toli]

Rapid-onset virilization
-voice deepening
-M pattern balding
-increased muscle mass
-clitoromegaly
Oligomenorrhea
Estrogen deficiency [T inhibits HPG axis]
Unilateral, solid adnexal mass
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324
Q

Most common cause of AA amyloidosis and AL amyloidosis

A

AA: rheumatoid arthritis
AL: multiple myeloma

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325
Q

B12 vs folate deficiency

A

ELEVATED MMA in B12

NORMAL MMA in folate

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326
Q

Afib rate control options

A
  • beta blockers (metoprolol)
  • CCBs (diltiazem)

digoxin

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327
Q

Loeffler endocarditis

A

Restrictive cardiomyopathy presenting w/ s/sx of HF

Diastolic dysfunction

d/t EOSINOPHILIC infiltration and endocardial fibrosis

causes

  • hypereosinophilic syndrome
  • parasitic infection
  • autoimmune
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328
Q

Threatened abortion vs inevitable abortion

A

Threatened: CLOSED
Inevitable: OPEN

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329
Q

Dietary advice for kidney stones

A
  1. fluids
  2. low sodium
  3. normal Ca
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330
Q

Alpha thalassemia spectrum

A

Alpha thalassemia minima (1 gene loss): asymptomatic, silent carrier
Alpha thalassemia minor (2 gene loss): mild microcytic anemia
Hemoglobin H disease (3 gene loss): chronic hemolytic anemia
Hemoglobin Barts (4 gene loss): hydrops fetalis, high-output cardiac failure, anasarca, death in utero

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331
Q

Causes of MICROCYTIC anemia

A

TAILS

Thalassemia
Anemia of chronic disease
Iron deficiency anemia
Lead poisoning
Sideroblastic anemia
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332
Q

Ludwig angina

A

Rapidly progressive cellulitis of the submandibular and sublingual spaces

Woody or brawny neck

Most arise from DENTAL INFECTIONS (mandibular molars)

Complication: acute airway obstruction

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333
Q

Most common cause of nonreactive fetal nonstress test

A

fetal sleep cycle (≤ 40 min)

If so, can extend 40-120 min to ensure that fetal activity outside of sleep is captured

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334
Q

Most common cause of otitis externa

A

Pseudomonas aeruginosa

Tx: topical abx (fluoroquinolone) +/- topical glucocorticoid

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335
Q

If cannot distinguish between transient synovitis and septic arthritis

A

bilateral hip ultrasound

Unilateral effusion –> arthrocentesis

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336
Q

Best measurement to follow DKA

A

Anion gap OR BHOB

NOT acetoacetate

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337
Q

Most common transfusion reaction

A

Febrile nonhemolytic transfusion reaction

1-6h after transfusion

Fevers, chills, malaise NO hemolysis

Prevent w/ leukoreduction

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338
Q

Treatment of lithium toxicity

A

Dialysis

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339
Q

Nonemergency situation where patients refuse life-saving treatment for child

A

obtain a court order to treat

If emergency, go ahead and treat immediately

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340
Q

Most common source of rabies transmission in the US

A

Bats

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341
Q

Why do exudative pleural effusions have low glucose?

A

High metabolic activity of leukocytes and bacteria

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342
Q

Multisystem atrophy (Shy-Drager syndrome)

A
  1. parkinsonism
  2. autonomic dysfunction
  3. widespread neurological signs
343
Q

ASD vs PTSD

A

1 month

344
Q

von Hippel Lindau

A

AUTOSOMAL DOMINANT
VHL tumor suppressor gene mutation (chromosome 3)

  • cerebellar and retinal hemangioblastomas
  • pheochromocytoma
  • renal cell carcinoma (clear cell type)
345
Q

Precocious puberty marker

A

advanced bone age

346
Q

Hemophilia inheritance

A

A, B: X-linked recessive

C: autosomal recessive

347
Q

XLA

A
  • recurrent sinopulmonary and gastrointestinal infections after age 6mo
  • absence of lymphoid tissue on examination (e.g., tonsils, lymph nodes)
  • low immunoglobulins and B cells
  • normal T-cell concentration
  • no response to vaccinations

Treatment

  • Ig replacement therapy
  • ppx abx if severe
348
Q

Hazard ratio

A

< 1: more likely to occur in control group
> 1: more likely to occur in treatment group

Close to 1: little difference between groups

349
Q

Calculate SN and SP

A 
SN = TP / (TP + FN)
SP = TN / (TN + FP)
350
Q

Pseudothrombocytopenia

A

Lab error d/t platelet aggregation in vitro

Peripheral smear: large clumps of platelets

351
Q

CAH d/t 21-hydroxylase deficiency

A
  • dehydration and salt wasting (hypotension, hyponatremia, hyperkalemia)
  • elevated 17-hydroxyprogesterone
  • virilization and ambiguous genitalia in F
352
Q

Bedwetting is normal before age

A

5

353
Q

PUD caused by

A

H. pylori

354
Q

Primary hypoparathyroidism

A

hypocalcemia and hyperphosphatemia in the presence of normal renal function

  • post-surgical (most common)
  • autoimmune
  • congenital absence or maldevelopment of parathyroids (e.g., DiGeorge syndrome)
  • defective CaSR on parathyroids
  • infiltrative: hemochromatosis, Wilson’s, neck irradiation
355
Q

Placenta previa major risk factor

A

Prior C-section

Also:

  • prior placenta previa
  • multiple gestation
  • advanced maternal age
356
Q

Painless (silent) thyroiditis

A

Variant of Hashimoto thyroiditis (chronic autoimmune thyroiditis)
Mild, brief HYPERTHYROID phase
Small, NONTENDER goiter
Spontaneous recovery

Positive anti-TPO antibodies
Low radioiodine uptake

Can occur postpartum, called postpartum thyroiditis

357
Q

Subacute (de Quervain) thyroiditis

A

Likely postviral inflammatory process
Prominent fever and HYPERTHYROID symptoms
PAINFUL/tender goiter

Elevated ESR, CRP
Low radioiodine uptake

Treatment: beta-blockers and NSAIDs

358
Q

Decreased radioiodine uptake in the thyroid in the setting of thyrotoxicosis

A

release of pre-formed thyroid hormone

359
Q

Stimulate appetite in cancer patients

A

progesterone analogue (megestrol acetate, medroxyprogesterone acetate)

steroids

360
Q

Contraindication for external cephalic version

A

active labor

361
Q

Polyuria with hypernatremia

A

Diabetes insipidus

362
Q

Distinguish central DI from nephrogenic DI

A

Central: significant hypernatremia (>150) d/t impaired thirst mechanism
Nephrogenic: normal Na (d/t intact thirst mechanism and adequate water intake)

363
Q

Epidural prolongs which phase of labor

A

Second (10 cm to delivery)

364
Q

Central vs peripheral precocious puberty

A

Both have advanced bone age

Low LH: peripheral
High LH: central

365
Q

If diagnose central precocious puberty

A

Get MRI to evaluate for tumor

366
Q

Pathophys of tardive dyskinesia

A

upregulation and supersensitivity of dopamine receptors

367
Q

Lacunar infarct

A

Posterior limb of internal capsule

-unilateral MOTOR impairment

  • no sensory or cortical deficits
  • no visual field abnormalities
368
Q

Anterior cerebral artery occlusion

A
  • contralateral SOMATOSENSORY + MOTOR deficit, predominantly in the LOWER EXTREMITY
  • abulia (lack of will or initiative)
  • dyspraxia, emotional disturbances, urinary incontinence
369
Q

Digitalis toxicity arrhythmia

A

atrial tachycardia w/ AV block

370
Q

CLL histology

A

smudge cells

371
Q

Management of congenital long-QT syndromes

A

Propranolol and pacemaker

372
Q

Exception to C-section for breech

A

Non-viable fetus. In this case, allow vaginal delivery to decrease maternal risk

373
Q

Anion gap calculation

A

AG = Na - (bicarb + Cl)

374
Q

If no fetal HR on Doppler

A

Transabdominal US (diagnostic for intrauterine fetal demise)

375
Q

Pregnancy management in patients w/ a h/o HSV

A

Antiviral suppression w/ acyclovir or valacyclovir beginning at 36 wks

If lesions or prodromal symptoms during labor, C-section

376
Q

If bilateral vestibular schwannomas, think

A

Neurofibromatosis type II

377
Q

Causes of lactic acidosis

A

MUDPILES

Methanol
Uremia
DKA
Propylene gycol/paraldehyde
INH/iron
Lactic acidosis
Ethylene glycol
Salicylates (aspirin)
378
Q

DES exposure in utero is a risk factor for

A

vaginal CLEAR CELL adenocarcinoma

379
Q

Fanconi anemia

A

Inherited DNA repair defect [ausotomal recessive]
Bone marrow failure

  • short stature
  • hypo-/hyperpigmented macules
  • abnormal thumbs
  • GU malformations
  • pancytopenia
  • positive chromosomal breakage testing

Treatment: hematopoetic stem cell transplant

380
Q

Clues to Legionella

A
  • pneumonia
  • diarrhea
  • hyponatremia

tx: macrolides or fluoroquinolones

381
Q

Antipsychotic most likely to cause hyperprolactinemia

A

Risperidone

382
Q

Sporothrichosis

A 
Sporothrix shenkii (dimorphic fungus)
Gardeners and landscapers

Skin papule –> ulceration w/ nonpurulent, odorless drainage
Proximal lesions along lymphatic chain
LAD rare

Rx: 3-6 mo po itraconazole

383
Q

Progression of F puberty

A

Thelarche –> pubarche –> growth spurt –> menarche

Premanarchal patients <15 w/ normal breast and pubic hair development require no further evaluation

384
Q

EPO side effect

A

HTN

385
Q

Kidney stones in patient w/ recurrent UTIs

A

Struvite stones

Urease-producing organisms: Klebsiella, Proteus

Increased urine ammonia production

Large staghorn calculi

386
Q

Clue to milk-alkali syndrome

A

Hypercalcemia with METABOLIC ALKALOSIS (increased bicarb)

387
Q

Chemotherapy-induced peripheral neuropathy

A
  • vincristine
  • cisplatin
  • paclitaxel
388
Q

Differentiate asthma from COPD

A

Spirometry before and after inhaled bronchodilator

Asthma is completely reversible.
COPD may be partly reversible, but not completely

389
Q

Bullous impetigo vs SSSS

A

Bullous impetigo: LOCALIZED SSSS. Patients appear well. Honey-colored crusting

SSSS: systemic including fever and irritability

390
Q

BUN:Cr ratio in pre-renal AKI

A

> 20:1

391
Q

Coag abnormality in antiphospholipid syndrome

A

Prolonged PTT

NOT fixed w/ mixing study

392
Q

Arsenic poisoning

A

Acute: garlic breath, vomiting, watery diarrhea, QTc prolongation

Chronic: hypo-/hyperpigmentation, hyperkeratosis, stocking-glove neuropathy

Rx: dimercaprol, DMSA

393
Q

Type 4 renal tubular acidosis

A
  • non-AG metabolic acidosis
  • persistent hyperkalemia
  • mild/mod renal insufficiency

Commonly occurs in patients w/ poorly controlled DM

394
Q

REM sleep behavior disorder is a risk factor for

A

Parkinson disease

395
Q

Management of congenital umbilical hernia

A

Observation (most resolve by 5)

396
Q

When in pregnancy to screen for GDM

A

24-28 wks

397
Q

Brown-Séquard syndrome

A
  • ipsilateral hemiparesis
  • ipsilateral diminished proprioception, vibratory sensation, and light touch
  • contralateral diminished pain and temperature- 1-2 levels BELOW cord injury
398
Q

Clozapine side effect

A

Neutropenia and agranulocytosis

399
Q

Endometrial cells on Pap smear

A

<45: common and benign; no further workup

≥45: may be d/t endometrial hyperplasia/cancer; require endometrial biopsy

400
Q

Necrotizing (malignant) otitis externa

A

> 60, diabetes

Pseudomonas aeruginosa

Severe, unremitting ear pain (worse at night + w/ chewing)
Deficits of lower cranial nerves
Granulation tissue in external auditory canal
Elevated ESR

IV antipseudomonal abx (e.g., ciprofloxacin)
+/- surgical debridement

401
Q

Main complication of drowning

A

ARDS (water washes out sufractant)

402
Q

If multiple febrile UTIs in infants

A

Voiding cystourethrogram (assess for VUR)

403
Q

Homocystinuria

A
  • autosomal recessive
  • Marfanoid
  • intellectual disability
  • thrombosis
  • downward lens dislocation
  • megaloblastic anemia
  • fair complexion

rx: vitamin B6, B12, folate, and anticoagulation

404
Q

Angioedema from ACE inhibitors

A

can happen ANYTIME, not just right after start of medication

405
Q

Carboprost contraindication

A

asthma (can cause bronchoconstriction)

406
Q

Methylergonovine contraindication

A

HTN

407
Q

Management of uterine atony

A

First line: uterine massage and oxytocin
Second line: TXA

  • bimanual uterine massage
  • high-dose oxytocin
  • misoprostol
  • tranexamic acid
  • carboprost
  • methylergonovine
408
Q

Tinea cruris

A

jock itch

topical antifungals [but NOT nystatin]

409
Q

Kartagener syndrome

A
  • sinus iversus
  • recurrent sinusitis
  • bronchiectasis
410
Q

Most common organisms to cause brain abscess

A
  • staph aureus
  • viridans strepococci
  • anaerobes

Usually from otitis media, sinusitis, or dental infection

411
Q

Organism associated with infective endocarditis in patients w/ urinary pathology

A

Enterococcus

412
Q

Which cardiac medications are contraindicated in WPW syndrome?

A
  • digoxin
  • CCBs
  • beta blockers
  • adenosine
413
Q

Treatment of hyperthyroidism in pregnancy

A

1st trimester: PTU

2nd and 3rd trimesters: methimazole

414
Q

Red, dusky plaque that always recurs in the same location

A

Fixed drug eruption

NSAIDs, sulfonamides, tetracycline, carbamazepine

415
Q

Bowen disease

A

skin squamous cell carcinoma in situ

416
Q

If suspect ruptured peptic ulcer

A

x-ray

417
Q

Treatment of adrenal insufficiency

A

Prednisone (has glucocorticoid and mineralocorticoid activity)

418
Q

Which drug is contraindicated in myasthenia gravis?

A

Magnesium sulfate

-causes myasthenic crisis w/ severe respiratory depression

419
Q

Pruritic urticarial plaques and papules of pregnancy (PUPP)

A

treat w/ topical steroids +/- oral antihistamines

420
Q

Cardiac complications of sarcoidosis

A
  • cardiac noncaseating granuloma
  • conduction defects (complete AV block most common)
  • restrictive cardiomyopathy (early)
  • dilated cardiomyopathy (late)
  • valvular dysfunction
  • HF
  • can get sudden cardiac death
421
Q

How soon after OCP discontinuation do regular menses return?

A

1-3mo

Evaluate for secondary amenorrhea >3 mo in women w/ regular menses and >6 mo in women w/ irregular menses

422
Q

Most common cause of splenic abscess

A

Infective endocarditis

423
Q

Treatment of splenic abscess

A

Splenectomy

Antibiotics alone associated w/ >50% mortality

424
Q

Splenic abscess

A
  • fever
  • leukocytosis
  • LUQ pain

Can also get L-sided pleuritic chest pain, L pleural effusion, splenomegaly

Most commonly d/t infective endocarditis

Splenectomy

425
Q

Contraindication to rotavirus vaccine

A
  • personal history of intusussception

- uncorrected congenital malformation of GI tract (e.g. Meckel diverticulum)

426
Q

Latent TB

A

Positive PPD (>5, 10, 15) with negative imaging

9 months of isoniazid with pyridoxine

427
Q

OCPs and migraine w/ aura

A

Contraindicated d/t increased risk of stroke

428
Q

Order of steps in suspected infant meningitis

A

First LP then antibiotics

unless hypotension or status epilepticus

429
Q

Upper vs lower motor neuron facial palsy

A

Central: FOREHEAD SPARING
Peripheral: think Bell palsy, entire face

Bell palsy may also cause decreased lacrimation, hyperacusis, reduced taste sensation over anterior tongue

430
Q

Most common cause of infertility after 35

A

decreased ovarian reserve

Regular menstrual cycles but decreased oocyte number and quality

431
Q

Treatment of acute dystonia

A
  • benztropine

- diphenhydramine

432
Q

Acute rheumatic fever criteria

A

d/t untreated strep pharyngitis

2 major OR 1 major + 2 minor

Major: JONES

  • Joints (migratory arthritis)
  • ❤️ (carditis)
  • nodules (subQ)
  • Erythema marginatum
  • Sydenham chorea

Minor

  • fever
  • arthralgias
  • elevated ESR/CRP
  • prolonged PR interval
433
Q

Antibiotics for febrile neutropenia

A
  • cefipime
  • meropenem
  • piperacillin-tazobactam
434
Q

Cause of tinea versicolor

A

Malasszeia (globosa, furfur)

435
Q

Mechanisms of action of second generation antipsychotics and consequence

A

Dopamine (D2) AND serotonin (2A) antagonists

The addition of serotonin antagonism decreases risk of extrapyramidal side effects

436
Q

Aromatase deficiency

A

Inability to convert androgens to estrogens
-begins in utero leading to transient masculinization of the mother

  • Female
  • at birth, ambiguous genitalia
  • adolescence: delayed puberty, osteoporosis,undetectable estrogen (no breast development), high concentrations of gonadotropins (polycystic ovaries)
  • normal internal genitalia
  • external virilization (clitoromegaly)
  • undetectable serum estrogen
437
Q

TXA caution

A

be careful in patients w/ hypercoagulabilty

438
Q

Trisomy 21 quadruple screen

A

MSAFP: low
beta-hCG: high
estriol: low
inhibin A: high

439
Q

Trisomy 18 quadruple screen

A

MSAFP: low
beta-hCG: low
estriol: low
inhibin A: normal

440
Q

Neural tube or abdominal wall defect quadruple screen

A

MSAFP: high
beta-hCG: normal
estriol: normal
inhibin A: normal

441
Q

Causes of Ogilvie syndrome

A
  • electrolyte abnormalities (hypokalemia, hypomagnesemia, hypocalcemia)
  • major surgery, trauma, severe infection
  • medications (opioids, anticholinergics)
  • neurologic disorders (dementia, stroke)
442
Q

Treatment of Ogilvie syndrome

A

NPO, NG/rectal tube decompression

If no improvement in 48h: neostigmine

443
Q

What determines severity of Tetralogy of Fallot?

A

the degree of RVOT obstruction

The increased PVR shunts deoxygenated blood across the VSD and into the aorta – cyanosis, Tet spell

444
Q

Why does knees-to-chest help Tet spell?

A

INCREASES SVR

Reduces right-to-left shunting (increases pulmonary blood flow and relives hypoxia)

445
Q

Managament of COPD exacerbation

A
  • inhaled bronchodilators (beta-2 agonist + anticholinergics)
  • SYSTEMIC CORTICOSTEROIDS
  • abx
  • O2
446
Q

Most common causes of acute bacterial rhinosinusitis

A
  • nontypeable haemophilus influenzae
  • streptococcus pneumoniae
  • moraxella catarrhalis

Rx: amoxicillin +/- clavulanate

447
Q

ADHD treatment in patients w/ h/o addiction

A

atomoxetine (non-stimulant)

448
Q

First step in evaluating primary amenorrhea in patients w/ uterus

A

FSH

Distinguishes between central (lo/normal FSH) and peripheral (hi FSH) causes of amenorrhea

449
Q

Stool osmotic gap

A

Elevated: osmotic diarrhea
Reduced: secretory diarrhea

450
Q

If dilated cardiomyopathy in young adults, consider

A

viral myocarditis

451
Q

Causes of unconjugated hyperbilirubinemia

A
  • overproduction (hemolysis)
  • reduced uptake (drugs, portosystemic shunt)
  • conjugation defect (Gilbert)
452
Q

Conjugated hyperbilirubinemia with normal AST, ALT, alk phos

A
  • Dubin-Johnson syndrome
  • Rotor syndrome

Defect in hepatic excretion of conjugated bilirubin

453
Q

Causes of pseudogout

A
  • hyperparathyroidism
  • hypothyroidism
  • hemochromatosis
454
Q

Euthyroid sick syndrome mechanism

A

decreased peripheral conversion of T4 to T3

Low T3, NORMAL TSH and T4

455
Q

If history of preterm delivery d/t spontaneous preterm labor or PPROM

A

IM progsterone during 2nd and 3rd trimesters

also serial cervical length measurements w/ cerclage placement if short cervix

456
Q

Laxative vs diuretic abuse

A

Hypotension and hypovolemia, but elevated urinary sodium indicates loss from the urinary tract (diuretics)

Diuretic abuse has

  • high urinary sodium
  • high urinary potassium
457
Q

Which vaccine has significant waning immunity?

A

pertussis

458
Q

FHH vs primary hyperparathyroidism

A

FHH: LOW urine Ca
PHPT: HIGH urine Ca

459
Q

Low basal LH in precocious puberty

A

do GNRH stimulation test

  • low LH: peripheral precocious puberty
  • high LH: central precocious puberty
460
Q

Non-classic CAH

A

d/t 21-hydroxylase deficiency

Precocious puberty (gonadotropin-independent) BUT sufficient glucocorticoid and mineralocorticoid levels, so NO electrolyte abnormalities

461
Q

Treatment of central retinal artery occlusion

A

ocular massage and high-flow oxygen

462
Q

Why is there HTN in AD PCKD?

A

cysts –> localized renal ischemia –> increased RENIN release –> RAAS –> secondary hyperaldosteronism

Rx: ACE inhibitors

463
Q

Buproprion is contraindicated in

A
  • seizures

- bullimia

464
Q

Diagnosis of ectopic pregnancy requires

A

TVUS

465
Q

S4

A

Stiff ventricle

466
Q

Most effective single agents for allergic rhinitis

A

intranasal glucocorticoids

467
Q

Lyme prophylaxis not needed if

A

tick removed before 36h

468
Q

Two major inhalants in smoke

A
  • carbon monoxide
  • hydrogen cyanide [rx: hydroxocobalamin or sodium thiosulfate]

Treat emprically fro cyanide toxicity

469
Q

If preeclampsia <20 weeks

A

hydatidiform mole

470
Q

VIPoma

A
  • watery diarrhea
  • muscle weakness/cramps (d/t hypokalemia)
  • hypo/achlorhydria
  • flushing

-hypokalemia, hypercalcemia, hyperglycemia

  • secretory diarrhea
  • elevated VIP

May be part of MEN syndrome

471
Q

Central retinal vein occlusion

A

“Blood and thunder appearance”

  • optic disc swelling
  • retinal hemorrhages
  • dilated veins
  • cotton wool spots
472
Q

Nightmare disorder vs sleep terror disorder

A

Nightmare disorder (REM): recurrent episodes of awakening from sleep with recall of highly disturbing and frightening dream content. On awakening, patient is fully alert, remembers the dream, and can usually be consoled

Sleep terror disorder (non-REM): incomplete awakenings, unresponsiveness to comfort, no recall of dream content

473
Q

Optimal fetal position at labor

A

occiput anterior

474
Q

Beta blocker overdose and treatment

A

Bradycardia, hypotension, wheezing, hypoglycemia, delirium, seizures, cardiogenic shock

Rx:

  • IV fluids, atropine
  • IV glucagon (for profound or refractory hypotension)
475
Q

Ewing sarcoma buzzwords

A
  • onion skinning

- moth-eaten appearance

476
Q

Atypical melanoma

A

May NOT have ABCDEs of melanoma. Look instead for:

  • ugly ducking sign (90% sensitive)
  • palpable nodularity
  • itching, bleeding, tingling
477
Q

Uric acid stones

A

Form in ACIDIC URINE (low pH)

Radiolucent (NOT seen on xray)

Treat with alkalinization of the urine with potassium citrate

478
Q

Streptococcal perianal dermatitis

A

Superficial infection with GAS

Bright, sharply demarcated, confluent erythema over perianal/perineal area
Perianal pruritis and pain, esp w/ stooling
Can have perirectal fissures and blood-streaked stools
May get constipation from withholding d/t pain

Clue: close contact w/ recent strep infection (cellulitis, pharyngitis)

Rx: po abx (penicillin, amoxicillin)

479
Q

Primary vs secondary/tertiary adrenal insufficiency labs

A

Primary: low cortisol, high ACTH

Secondary/tertiary: low cortisol, low ACTH

480
Q

Cat scratch disease

A

d/t Bartonella henselae

  • papule at scratch/bite site
  • regional adenopathy (enlarged, tender, erythematous)
  • +/- FUO (≥14d)

Rx: azithromycin

481
Q

Antipsychotics should not be used in patients with

A

Dementia with Lewy bodies

482
Q

Management of physiologic ovarian cysts

A

observation w/ repeat examination

483
Q

Osteoid osteoma

A

Benign bone-forming tumor

Pain
-worse at night
-relieved by NSAIDs
-unrelated to activity
NO systemic symptoms

Xray: small, round lucency

Rx

  • NSAIDs
  • monitor for spontaneous resolution
484
Q

Bright red, firm, exophytic nodules in an HIV patient

A

bacillary angiomatosis (d/t bartonella)

rx: po erythromycin

485
Q

Glucose in glucagonoma

A

elevated

486
Q

Any patient w/ sternal wound drainage

A

chest imaging to evaluate for mediastinitis (fluid collection, pneumomediastinum)

487
Q

Timing of hematuria

A

Initial: URETHRA

  • urethritis
  • trauma (e.g., cath)

Continuous: ANYWHERE IN UT

  • renal mass
  • glomerulonephritis
  • urolithiasis
  • PCKD
  • pyelonephritis
  • urothelial cancer
  • trauma

Terminal: BLADDER, PROSTATE

  • urothelial cancer
  • cystitis
  • urolithiasis
  • BPH
  • prostate cancer
488
Q

Neurocystercircosis caused by

A

tinea solium

pork tapeworm

489
Q

Hypothyroidism and amenorrhea

A

Low T4 –> increased TRH –> increased TSH and PRL –> decreased GnRH –> decreased LH and FSH –> anovulation/amenorrhea

490
Q

Anatomic origin of atrial fibrillation

A

pulmonary veins

491
Q

Anatomic origin of atrial flutter

A

tricuspid annulus

492
Q

Adequate trial of SSRI

A

≥6 WEEKS

493
Q

When to give Rho-GAM

A

ONLY for Rh(D)-negative patients (where father is Rh(D)-positive), even in first pregnancy (prevent alloimmnuizatoin)

28-32 wks gestation
<72h after delivery of Rh(D)-positive infant

Others

  • <72h after spontaneous abortion
  • ectopic pregnancy
  • threatened abortion
  • hydatidiform mole
  • CVS, amniocentesis
  • abdominal trauma
  • 2nd and 3rd trimester bleeding
  • external cephalic version
494
Q

What vaccines should NOT be given during pregnancy?

A
  • MMR
  • varicella
  • HPV
  • live-attenuated influenza
495
Q

Medial vs lateral knee pain

A

Medial: pes anserine syndrome. Highly localized
Lateral: IT band syndrome. Poorly localized

496
Q

Classic CAH

A

21-hydroxylase deficiency
AR

Salt wasting
-hypotension
-dehydration
-vomiting
Virilization in girls 
Decreased sodium
Increased potassium 
Decreased glucose
Increased 17-hydroxyprogesterone
Increased testosterone
497
Q

Water bottle-shaped heart

A

Large pericardial effusion

498
Q

Intermittent asthma definition

A

Symptoms ≤2 d/wk
Nighttime awakening ≤2d/mo

Normal spirometry
No limitation on daily activity

Manage w/ prn albuterol

499
Q

Hemorrhagic transformation

A

Complication of ischemic stroke

<48h: acute deterioration of neurologic status

RFs:

  • large area
  • embolic stroke
  • treatment w/ thrombolytics

Emergent non-con CT –> urgent surgical decompression

500
Q

Erlichiosis

A

“RMSF without the spots”

  • actue febrile illness w/ malaise and AMS
  • leukopenia, thrombocytopenia
  • elevated LFTs, LDH

Rx: doxycycline

Treat empirically

501
Q

Treatment of postpartum endometritis

A

Clindamycin and gentamycin

Fever, uterine tenderness, purulent lochia

502
Q

Bacillary angiomatosis

A

Bartonella (henselae, quintana) infection in HIV (CD4 <100)

Vascular cutaneous lesions (red/purple papules –> friable pedunculated or nodular lesions)
Constitutional symptoms
Organ involvement (liver, CNS, bone)

Rx:
-abx (doxycycline, erythromycin) + ART

503
Q

Internuclear ophthalmoplegia results from damage to the

A

medial longitudinal fasciculus (MLF)

(mediates communication between CN III and CN VI nuclei)

Unilateral: lacunar stroke (pontine artery)
Bilateral: MS

504
Q

Management of inevitable abortion

A

Based on patient preference and hemodynamic stability (anemia, tachycardia, hypotension)

HD unstable: suction curettage, Rho-GAM
HD stable: expectant management or misoprostol

505
Q

Cortisol in depression

A

increased

506
Q

Preferred fluid resuscitation in burn victims

A

LR

507
Q

Treat complicated infantile (strawberry) hemangioma

A

propranolol

508
Q

Acid-base effects on calcium homeostasis

A

Ionized calcium is physiologically active

Alkalosis: more Ca bound to ALBUMIN, making it unavailable

Acidosis: increased ionized calcium
Alkalosis: decreased ionized calcium

509
Q

Medullary thyroid cancer comes from

A

calcitonin-secreting parafollicular C cells

monitor recurrence w/ calcitonin levels

510
Q

Organ failure complication of scleroderma

A

Scleroderma renal crisis

  • sudden onset renal failure
  • malignant HTN
  • microangiopathic hemolytic anemia or DIC, thrombocytopenia
511
Q

Caution w/ heterophile (Monospot) test

A

25% false negative rate during first week of illness

512
Q

If high-grade squamous intraepithelial lesion on Pap during pregnancy

A

colposcopy and biopsy if see concerning features

513
Q

Most common cause of neonatal sepsis

A

GBS (can also be late onset, >7d)

514
Q

Infant botulism vs foodborne botulism

A

Infant botulism: ingestion of C. botulinum SPORES from environmental dust or honey
-rx: human-derived botulism IG

Foodborne: ingestion of preformed C. botulinum TOXIN from canned food
-equine-derived botulism IG

515
Q

HHS treatment

A

-NORMAL SALINE

  • IV insulin
  • careful monitoring of K
516
Q

If recent diagnosis of diabetes, think

A

pancreatic cancer

abdominal CT

517
Q

Symmetric vs asymmetric fetal growth restriction

A

Symmetric:

  • chromosomal abnormalities
  • congenital infection

Asymmetric:

  • uteroplacental insufficiency (HTN, etc)
  • maternal malnutrition
518
Q

Interpretation of D-xylose test

A

D-xylose is absorbed in the PROXIMAL SMALL INTESTINE, without degradation by pancreatic or brush border enzymes

Abnormal: small intestinal mucosal disease (e.g., celiac)
Normal: enzyme deficiencies, pancreatic insufficiency

519
Q

Illicit drug that causes nystagmus

A

PCP

520
Q

Liver cyst with daughter cysts

A

Echinococcus granulosus (dog tapeworm)

Hepatic cyst w/ eggshell calcification

Rupture- fever, eosinophilia

Albendazole
Surgery if ruptured

521
Q

Treatment of multifocal atrial tachycardia

A

Treat underlying cause (commonly COPD)

522
Q

Multifocal atrial tachycardia and association

A

P waves of ≥3 different morphologies
Irregular RR intervals
Atrial rate >100/min

Most commonly caused by COPD

Treat underlying cause

523
Q

Management of presumed candida esophagitis

A

po fluconazole

EGD if fail therapy

524
Q

Clue for adolescent depression

A

May be more IRRITABLE than sad

525
Q

Depression w/ poor sleep and appetite

A

Mirtazapine

526
Q

If EBV identified in CSF, think

A

primary CNS lymphoma

527
Q

Treatment of normal pressure hydrocephnalus

A

ventriculoperitoneal shunting

528
Q

Continuous flow murmur

A

PDA

529
Q

Most common renal manifestation of HSP

A

hematuria

530
Q

Ototoxic drugs

A
  • aminoglycoside abx (gentamycin)
  • salicylates
  • chemo (cisplatin)
  • loop diuretics (esp hi dose)
531
Q

Coombs test in PNH

A

NEGATIVE since complement-mediated

532
Q

Spherocytes w/ negative Coombs test

A

Autoimmune hemolytic anemia

533
Q

Causes of Cushing syndrome

A
  • excess glucocorticoids
  • ACTH-producing pituitary adenoma
  • ectopic ACTH production
534
Q

PPROM <34wks

A

If uncomplicated

  • expectant management
  • latency antibiotics
  • corticosteroids
  • magnesium if <32 wks
535
Q

When to deliver patients w/ PPROM

A

34 wks

536
Q

When to give magnesium in PPROM

A

<32 wks

537
Q

Management of HIV needlestick

A

Draw blood and start 3-drug ART immediately

538
Q

If SVT on EKG

A

Adenosine

SVT is a category that includes many different arrhytmias, so in order to identify, use adenosine to slow down

(can also use vagal maneuvers)

539
Q

Neurofibromatosis type I

A

AD NF1 mutation

  • café au lait spots
  • multiple neurofibromas
  • Lisch nodules

All features:

  • café au lait spots
  • clustered freckles
  • Lisch nodules (tan colored lesions of the iris)
  • neurofibromas
  • optic glioma
540
Q

Attributable risk

A

AR = (RR–1)/RR

541
Q

Most specific sign of acute otitis media

A

bulging TM

542
Q

Interventions to reduce risk of ventilator-associated pneumonia

A
  • elevate head of bed 30-45 degrees
  • suction subglottic secretions
  • minimize patient transport
  • limit use of gastric acid suppression
543
Q

Therapy for bacterial prostatitis

A

6 wks of TMP/SMX or fluoroquinolone

544
Q

Clues to uremic pericarditis

A
  • BUN >60
  • most do NOT have classic diffuse ST-elevation

Treat w/ hemodialysis

545
Q

False positive VDRL

A

Antiphospholipid syndrome

546
Q

Management of antiphospholipid syndrome in pregnancy to avoid pregnancy loss

A
  • low dose aspirin

- low molecular weight heparin

547
Q

Anticoagulant contraindicated in pregnancy

A

Warfarin

548
Q

Ages to stop screenings

A

Mammogram: 75
Pap: 65
Colonoscopy: 75

549
Q

Infectious cause of primary adrenal insufficiency

A

TB

550
Q

Acid-base status in primary adrenal insufficiency

A

Normal AG metabolic acidosis

low aldosterone –> sodium wasting –> retention of K and H+ –> normal AG, hyperkalemic and hyponatremic metabolic acidosis

551
Q

Lynch syndrome

A

AD

  • colorectal cancer
  • endometrial cancer
  • ovarian cancer
552
Q

FAP

A
  • colorectal cancer
  • desmoids and osteomas
  • brain tumors
553
Q

Treatment of psychosis in Parkinson disease

A
  • reduction of antiparkinsonion medications if possible
  • low-potency antipsychotic: quetiapine, clozapine, pimavanserin

AVOID high-potency antipsychotics like haloperidol and risperidone which have higher risks of extrapyramidal symptoms

554
Q

If suspect critical limb ischemia

A

IV heparin before evaluating with imaging

555
Q

Management of lone AF

A

Nothing

556
Q

Where do medullablastomas most commonly occur

A

cerebellar vermis

557
Q

Second stage arrest criteria and management

A

≥3h pushing in a prima w/o epidural (≥4 w/ epidural)
OR
≥2h pushing in a multi w/o epidural (≥3 w/ epidural)

Operative vaginal delivery (e.g., vaccuum, forceps)

558
Q

Tetanus prophylaxis

A

≥3 tetanus toxoid doses:

  • clean: vaccine only if last ≥10 years ago
  • dirty: vaccine only if last dose ≥5 years ago

Unimmunized or <3 doses:

  • clean: vaccine only
  • dirty: vaccine AND tetanus immune globulin
559
Q

Most effective antipsychotic

A

clozapine

560
Q

Lyme treatment for kids and pregnancy

A

Amoxicillin

561
Q

Diagnosis of lactose intolerance

A

hydrogen breath test

562
Q

Leukemoid reaction vs CML

A

LAP score HIGH in leukemoid reaction

563
Q

Prevent oxygen toxicity in ventilation

A

FiO2 <60% when possible

564
Q

Pathophys of graft-vs-host disease

A

Donor T-cells attack host antigens

Rash
Diarrhea
Liver dysfunction

565
Q

Workup of bilious emesis in newborn

A

abdominal xray –> contrast enema

566
Q

Pathophys of high-output HF

A

AVF –> shunting of blood from arterial to venous side –> increased preload –> compensatory increase in HR and SV

Also get decreased afterload (d/t decreased SVR)

567
Q

What statistical values varies based on the pre-test probability

A

PPV and NPV

A patient w/ a high prbability of having a disease will have a low NPV, and a patient w/ a low probability of having a disease will have a high NPV

568
Q

Most common cause of sudden cardiac arrest in acute MI

A

Ventricular fibrillation

Ventricular arrhythmias are very common in the immediate post-MI period. Re-entry is the mechanism.

569
Q

If splenic infarction, suspect

A
  • hypercoagulable states
  • embolic disease
  • hemoglobinopathy
570
Q

Which non-germ cell cancer can express AFP?

A

HCC

571
Q

Effect of hydroxyurea in sickle cell disease

A

Increases HbF

Dilutes the amount of sickled Hb

572
Q

Where in the lung is the destruction of alpha-1-antitrypsin deficiency?

A

Lower lobes

573
Q

If COPD symptoms in the young (or w/ no h/o smoking)

A

Think A1AT. May not have liver involvement…

574
Q

When to use adjunctive steroids in PCP infection

A
  • low PaO2 (≤70)

- A-a gradient ≥35 on RA

575
Q

Cavitary lesions and pulmonary symptoms in an IV drug user

A

septic emboli from infective endocarditis

Staph aureus

Nodular infiltrate w/ cavitation

576
Q

Physiologic bowlegs (genu varum) resolves before

A

2 y.o.

577
Q

Childhood onset fluency disorder

A

= stuttering

578
Q

Language disorder

A

difficulties in the acquisition and use of language d/t deficits in comprehension and/or production

579
Q

Varicella vaccine given at

A

1 and 4

580
Q

Colles fracture

A

Distal radius

Impacts the MEDIAN nerve

  • carpal tunnel- paresthesias, impaired thumb abduction (APB)
  • decreased sensation over anterolateral hand
581
Q

Triad of fat embolism syndrome

A

24-72h after fracture of marrow-containing bone or pancreatitis

  • respiratory distress
  • neurologic dysfunction (e.g., confusion)
  • petechial rash (<50%)
582
Q

Caution re dx of fat embolism syndrome

A

Rash is present in <50% of cases

583
Q

Nutritional rickets

A

d/t vitamin D deficiency

  • delayed closure of fontanelles
  • wrist enlargement
  • craniotabes (soft skull bones)
  • progressive symmetric or asymmetric bowing of legs
  • rachitic rosary (widening of the costochondral joints)- bony prominences on exam
584
Q

Treatment of postpartum blues

A

reassurance and observation

assess after 2 wks

585
Q

Urine cholride in diuretic abuse and Bartter and Gittleman

A

HIGH

586
Q

Acid-base status in chronic diarrhea

A

metabolic acidosis (loss of bicarb) and hypokalemia

587
Q

Acute calcineurin inhibitor renal toxicity

A

Tacrolimus and cyclosporine [inhibit IL-2 production]

VASOCONTRICTIVE properties

  • HTN
  • pre-renal AKI

Acute toxicity can be precipitated by cyt P450 inhibitors since they are hepatically cleared

588
Q

Protective mechanism of sodium bicarbonate in TCA overdose

A

TCAs inhibit fast SODIUM channels in myocardium

NaHCO increases pH and extracellular sodium, thereby alleviating the cardio-depressant action on sodium channels

589
Q

Hepatic cyst w/ eggshell calcification

A

hydatid cyst- Echinococcus granulosus

590
Q

If anti-D antibody titer elevated during subsequent pregnancy

A

inadequate dose following delivery (common in operative, placental abruption, etc.)

Need to use K-B test to determine proper dose

591
Q

Stevens-Johnson vs toxic epidermal necrolysis

A

<10%: SJS
10-30%: SJS-TEN overlap
>30%: TEN

592
Q

Most effective treatment for depression

A

Combimation of SSRI/SNRI and psychotherapy (CBT or interpersonal)

593
Q

Schizoid vs avoidant personality disorder

A

Schizoid: prefers to be alone
Avoidant: avoids people out of fear of rejection/embarrassment

594
Q

Lymphadenitis

A

Lymphadenopathy that is tender, enlarged, and erythematous

Most commonly d/t staph aureus or GAS

595
Q

Bloody diarrhea culprits

A
  • E. coli (EHEC- shiga)
  • Shigella
  • Campylobacter
596
Q

Do OCPs cause weight gain?

A

NO

597
Q

If diagnose someone with rheumatic heart disease

A

penicillin prophylaxis (IM penicillin G)

598
Q

Calcium gluconate indications

A

Hyperkalemia with:

  • EKG changes
  • K ≥7 w/o EKG changes
  • rapidly rising K d/t tissue breakdown
599
Q

First step in hypercalcemia

A

Normal saline

Then calcitonin, then bisphosphonates

600
Q

Primary vs secondary/tertiary hyperparathyroidism

A

Primary: low phosphorus

Secondary/tertiary: high phosphorus

601
Q

Meningococcal vaccination schedule

A

11-12 and booster at 16

602
Q

Abnormal uterine bleeding on OCPs in patients <45

A

endometrial biopsy

603
Q

Cyanide toxicity

A

d/t nitroprusside infusion

  • AMS
  • lactic acidosis
  • seizures
  • coma

High risk in prolonged infusions, higher doses, or renal disease

604
Q

Polymyositis

A
  • chronic PROXIMAL muscle weakness
  • elevated muscle enzymes (CK, aldolase, AST)
  • autoantibodies: ANA, anti-Jo1
  • muscle biopsy: endomysial infiltrate, patchy necrosis
605
Q

Salicylate toxicity

A

Respiratory alkalosis + AG metabolic acidosis

  • near normal pH
  • low PaCO2
  • low bicarb
606
Q

PTSD in children

A
  • distressing dreams w/ vague content (monsters, etc.)
  • reenactment of traumatic themes in play
  • emotional dysregulation
  • behavioral difficulties
607
Q

What is not effectie for tinea pedis?

A

Nystatin

608
Q

Most common side effect of tamoxifen

A

hot flashes

also endometrial cancer and venous thromboembolism

609
Q

Alopecia areata

A

Autoimmune attack on hair bulb cells

Genetic presidposition

  • painless, patchy, nonscarring hair loss
  • narrowing of hair shafts close to skin surface (exclamation point hairs)
  • positive hair pull test (>5-6 hairs pulled)

Rx

  • mild/mod: topical or intralesional corticosteroids
  • extensive: topical immunotherapy, oral corticosteroids
610
Q

Beta thalassemia Hb electrophoresis

A

Increased Hb A2 and Hb F

611
Q

What therapy improves survival in beta thalassemia?

A

Chelation therapy, since they are transfusion dependent and at risk for iron overload

612
Q

Hepatojugular reflex d/t

A

impaired RH function.

Helps distinguish between CARDIAC and hepatic edema

Liver disease: NO HJR

613
Q

Which pathology is most common in native infective endocarditis?

A

MITRAL VALVE –> mitral regurgitation

614
Q

If chondrocalcinosis (calcification of articular cartilage)

A

Calcium pyrophosphate disease- pseudogout

Rhomboid-shaped, weakly positively birefringent CPPD crystals

615
Q

Treat SIADH

A

begin w/ fluid restriction +/- salt tablets

Severe hyponatremia: hypertonic (3%) saline

616
Q

Cystinuria

A

Impaired transport of cystine and dibasic amino acids (COLA) in renal tubular and intestinal epithelial cells

Increased renal excretion –> cystine stone = HEXAGONAL CRYSTALS

inherited

Urinary cyanide-nitroprusside test

617
Q

Hashimoto thyroiditis increases risk of which cancer

A

thyroid lymphoma

Rapidly enlarging mildly tender goiter w/ compressive symptoms, B symptoms (like all lymphoma), anti-TPO antibodies

618
Q

If GBS asymptomatic bacteriuria or UTI during pregnancy

A

do not need GBS screen; do need prophylactic penicillin

619
Q

When are tocolytics indicated

A

<32 wks

Indomethacin is first line

620
Q

Babesiosis

A

From Ixodes tick (NE US)

  • flu like: fevers, fatigue, HA, myalgias
  • anemia, thrombocyropenia, elevated bilirubin, LFTs, LDH [intravascular hemolysis]
  • severe: ARDS, CHF, DIC, splenic rupture

Dx: blood smear: maltese cross (intraerythrocytic rings)

rx

  • atovaquone + azithromycin
  • severe: quinine + clindamycin
621
Q

Dobutamine

A

beta-1 agonist

Use in decompensated HF to improve ejection fraction

  • positive inotrope (increased myocardial contractility)
  • positive chronotrope (increased HR)
  • improves forward ejection of a higher blood volume–decreased LVESV
622
Q

Contraception in breastfeeding and postpartum

A

Copper IUD or progestin-only (pills or implant)

623
Q

Location of Huntington disease pathology

A

caudate and putamen

624
Q

Management of active phase arrest

A

C-section, because no further change is expected

Most commonly d/t cephalopelvic disproportion

625
Q

Indication for oxytocin in labor

A

Augmentation of labor IF CONTRACTIONS ARE INADEQUATE (<200 Montevideo)

Used in PROTRACTED labor (dilation <1 cm/2h), but NOT arrest

626
Q

Tumor lysis syndrome labs

A
  • increased phosphorus, potassium, uric acid
  • decreased calcium

AKI
Arrhythmias

rx

  • IVF
  • allopurinol or rasburicase
627
Q

Multiple myeloma and infections

A

Increased risk d/t hypogammaglobulinemia from marrow infiltration

628
Q

Management of DVT in patients w/ contraindications to anticoagulation (active bleeding, recent surgery, hemorrhagic stroke)

A

IVC filter

629
Q

Pericardial knock is described as a

A

middiastolic sound

630
Q

Recurrent bacterial infections in an adult should raise suspicion for

A

Common variable immunodeficiency

631
Q

If cytopenias and DIC, suspect

A

AML/APML

632
Q

Felty syndrome

A
  • rheumatoid arthritis
  • splenomegaly
  • neutropenia
633
Q

Erb palsy vs Klupmke palsy

A

Erb: waiter’s tip
-C5-C6 injury

Klumpke: claw hand, Horner syndrome
-C8-T1 injury

634
Q

Narcolepsy drug

A

Modafinil

635
Q

Non-stimulant for ADHD

A

Atomoxetine

636
Q

Caution w/ NPH

A

Not all 3 features are required- only gait dysfunction is mandatory. Go w/ MRI findings!

May also see upper motor neuron signs

637
Q

Ventilation pressures

A

Peak airway pressure = airway resistance + plateau pressure

Plateau pressure = elastic pressure + PEEP

638
Q

Relative risk interpretation

A

Null value is 1, so if RR = 1 NO association between exposure and outcome

RR > 1: outcome occurs more frequently in exposed group

RR < 1: outcome occurs less frequently in exposed group

639
Q

Cardiac cath in tamponade

A

Elevated and equilibrated intracardiac diastolic pressures

640
Q

Painful vs painless vision loss in HIV

A

Painful: HSV, VZV
Painless: CMV

641
Q

Evaluation of an anastamotic leak

A

Contrast CT –> surgery

642
Q

Microcytic anemia w/ low reticulocyte count

A

IDA

643
Q

Iron in thalassemias

A

Elevated d/t increased RBC turnover

644
Q

Reticulocyte count in thalassemias

A

Elevated

645
Q

Bilirubin in thalassemias

A

Elevated d/t hemolysis

646
Q

Tests to identify primary adrenal insufficiency

A
  • 8am serum cortisol and plasma ACTH: low cortisol, high ACTH
  • ACTH stimulation test (cosyntropin test): minimal response
647
Q

Conduct disorder vs ASPD

A

≥18 y.o. = ASPD

648
Q

Preecmalpsia with severe features

A

New-onset HTN ≥20 wks PLUS proteinuria &/or end-organ damage PLUS:

  • BP ≥160/≥110
  • thrombocytopenia
  • increased creatinine
  • increased transaminases
  • pulmonary edema
  • vision or cerebral symptoms
649
Q

Labetalol contraindication in preecmalpsia

A

bradycardia

650
Q

Herpangina

A

d/t Coxsackie A virus

ages 1-7, late summer-early fall

  • fever
  • pharyngitis
  • gray vesicles/ulcers on oropharynx

tx: supportive

651
Q

Postnatal workup of fetal growth restriction

A

send placenta for histopathologic examination

652
Q

Workup of jaundice w/ choelstatic pattern

A

abdominal imaging (US or CT)

653
Q

Two categories of autoimmune hemolytic anemia

A

WARM agglutinin AIHA

  • IgG
  • steroids to treat

COLD agglutinin AIHA
-IgM

Splenomegaly
NO schistocytes

654
Q

Miliary TB

A

History suspicious for TB and diffuse reticulonodular appearance on X-ray

655
Q

If a presumed Jehova’s Witness without a blood transfusion card or advance directive who does not have capacity

A

give blood

656
Q

Are fiancés legal next-of-kin?

A

NO

657
Q

Number needed to treat

A

NNT = 1/ARR

ARR = absolute risk reduction

658
Q

Ideal NNT

A

1

659
Q

Presbyopia mechanism

A

decrease in lens elasticity –> difficulty w/ near vision

660
Q

Treatment of drug-resistant CMV

A

foscarnet

661
Q

If lack of bleeding after progesterone challenge

A

low estrogen (e.g., POI)

662
Q

Crucial lab in primary ovarian insufficiency

A

Elevated FSH

663
Q

POI vs Asherman syndrome

A

Both have no progesterone withdrawal bleeding

POI: increased FSH

664
Q

If deep, longstanding, elevated ESR, or large diabetic ulcer

A

Foot imaging (xray, MRI) to assess possible osteomyelitis

665
Q

Acute abdominal pain in young woman on anticoagulation, suspect

A

Ruptured ovarian cyst complicated by hemoperitoneum

666
Q

Case control vs cohort study

A

Case control: OUTCOME first, look for RFs

Cohort: RISK FACTOR first, look for outcome

667
Q

If septic arthritis not responding to vancomycin

A

Likely a GN bug, so broaden coverage to ceftriaxone

e.g. Kingella kingae

668
Q

5-alpha reductase deficiency vs androgen insensitivity syndrome

A

AIS: XY, phenotypically female, absent/minimal axillary/pubic hair (peripheral androgen resistance), BREAST DEVELOPMENT

5AR: XY, phenotypically female, VIRILIZATION @PUBERTY (e.g., clitoromegaly), no breast development

669
Q

Imaging for kidney stones

A

US or NON-CONTRAST CT

670
Q

Watch out for atypical presentations of MI

A
  • women
  • elderly
  • DM

Epigastric pain, nausea, vomiting, diaphoresis

671
Q

Croup

A

Laryngotracheitis

PARAINFLUENZA infection

  • inspiratory stridor
  • barking cough
  • hoarseness

Mild (no stridor @rest): humidified air +/- steroids
Mod/severe (stridor @rest): steroids + racemic epinephrine

672
Q

Pemphigus vulgaris vs bullous pemphigoid

A

Pemphigus vulgaris:

  • painful, FLACCID bullae
  • Nikolsky sign (separation of epidermis w/ light friction)
  • Antibodies against desmoglein 1 and 3

Bullous pemphigoid:
-pruritis, TENSE bullae

673
Q

Diagnosing of Cushing syndrome

A
  1. confirm hypercortisolism
    - late-night salivary cortisol assay
    - 24h urine free cortisol
    - overnight low-dose dexamethasone suppression test
  2. If hypercortisolism confirmed:
    - ACTH level (to establish Cushing disease /ectopic ACTH vs adrenal adenoma)
674
Q

Twin classification is based on

A

Chorionicity: # of placentas
Amnionicity: # of amniotic sacs

675
Q

Labor with taut bulging bag with no palpable presenting fetal part

A

Cannot determine presentation, so use transabdominal US

Presentation will help determine route of delivery

  • cephalic –> vaginal
  • breech, transverse –> CS
676
Q

Magnesium toxicity and treatment

A

[Loss of DTRs, respiratory depression, cardiac arrest]

Mild: nausea, flushing, headache, hyporeflexia

Mod: areflexia, hypocalcemia, somnolence

Severe: respiratory paralysis, cardiac arrest

Rx:

  • STOP mag
  • give IV calcium gluconate
677
Q

Management of ectopic pregnancy

A

Stable: methotrexate
Unstable: surgery

678
Q

Paget disease of bone is a RF for

A

osteosarcoma

679
Q

Chronic bacterial prostatitis caution

A

MAY NOT HAVE PROSTATIC TENDERNESS

  • recurrent UTI symptoms
  • painful ejaculation
  • transient improvement w/ abx
  • +/- prostatic tenderness

rx: 6 wks fluoroquinolone

680
Q

Therapeutic window for TPA in stroke

A

symptom onset <4.5hrs ago

MANY exclusion criteria

681
Q

Stroke anticoagulation

A

Aspirin

If already on aspirin: aspirin + clopidogrel (or dipyridamole)

682
Q

Heparin in stroke?

A

NO (high risk of bleeding)

683
Q

Most common cause of pediatric stroke

A

Sickle cell disease

684
Q

Tuberous sclerosis

A

AD mutation in TSC1/2 genes

Derm
-hypopigmented macules (ash leaf spots)
-angiofibromas of the malar region
-Shagreen patches
Neuro
-CNS lesions (hamartoma)
-epilepsy
-intellectual disability
-autism and behavioral disorders (hyperactivity)
CV
-rhabdomyomas ***evaluate all pts w/ echo***
Renal
-angiolipomas
685
Q

If cardiac rhabdomyoma, think

A

Tuberous sclerosis

686
Q

Monoclonal IgM

A

Waldenström macroglobulinemia

687
Q

Persistent ST-elevation post-MI and deep Q waves in same leads

A

ventricular aneurysm

Progressive LV enlargement –>

  • HF
  • refractory angina
  • ventricular arrhythmias
  • functional MR
  • mural thrombus
688
Q

Greater trochanteric pain syndrome

A

(aka trochanteric bursitis)

Mostly obese F >50

Chronic lateral hip pain
Pain worse w/ hip flexion or lying on affected side

Focal tenderness over trochanter

US: degeneration of tendons, tendinosis

Tx:

  • exercise, PT, activity modification
  • NSAIDs
  • steroid injection
689
Q

Hypocalcemia w/ elevated PTH

A
  • vitamin D deficiency (check 25-hydroxy vitamin D)

- CKD (check Cr)

690
Q

Factor V Leiden

A

AD activated protein C resistance

PrC resistance –> decreased degradation of factor V –≥thrombin formation –> thrombosis

PT and aPTT can be normal

691
Q

Which types of twins are at risk for twin-twin transfusion syndrome?

A

MONOCHORIONIC [1 placenta]

692
Q

Indications and contraindications for external cephalic version

A

Breech/transverse @ ≥37 wks

Contraindications:

  • prior classical CS
  • prior extensive uterine myomectomy
  • placenta previa
693
Q

Absence seizures may be accompanied by

A

automatisms

NO post-ictal state

694
Q

Cause of infertility in Kleinfelter syndrome

A

47, XXY

Seminiferous tubule dysgenesis –> testicular fibrosis –> azospermia, hypogonadism, elevated FSH & LH (and elevated testosterone)

695
Q

Management of uterine inversion

A

MANUAL REPLACEMENT OF UTERUS

Then can remove retained placenta

696
Q

Most accurate method of determining gestational age

A

First trimester US w/ crown-rump length measurement

697
Q

Vitamin deficiency in carcinoid syndrome

A

Niacin (diarrhea, dementia, dermatitis)

698
Q

Rhythm control of Afib in patients w/ WPW

A

stable: ibutilide or procainamide
unstable: cardioversion

699
Q

If Zollinger-Ellison syndrome, look for

A

MEN 1 [pituitary, parathyroid, pancreas/GI neuroendocrine]

700
Q

What drug to avoid in acute closed angle glaucoma

A

Atropine [mydriatic]

[Treat w/ mannitol, acetazolamide, pilocarpine, or timolol]

701
Q

Most PEs come from

A

PROXIMAL (thigh)&raquo_space;> distal (calf)

Femoral and popliteal veins

702
Q

Immediate treatment of frostbite

A

warm WATER (not air)

703
Q

Toxoplasmosis can come from

A
  • cat feces
  • raw or undercooked meat
  • unwashed fruits/veggies
704
Q

Paget disease of bone is d/t

A

osteoCLAST dysfunction –> increased bone turnover

705
Q

First line for chemotherapy-induced nausea

A

Ondansetron (serotonin receptor antagonist)

706
Q

CREST syndrome

A

associated w/ limited cutaneous systemic sclerosis

Calcinosis cutis
Raynaud phenomenon
Esophageal dysmotility with reflux
Sclerodactyly
Telangectasia

Often associated with pulmonary arterial hypertension

707
Q

Tight glucose control decreases risk of

A

MICROVASCULAR complications (retinopathy, nephropathy), not macrovascular or all-cause mortality

708
Q

Cellulitis vs erisypelas

A

Cellulitis: deep- flat, indistinct borders

Erisypelas: superficial- raised, sharp borders and intense erythema

709
Q

Acute interstitial nephritis

A

d/t drugs (penicillins, TMP/SMX, cephalosporins, NSAIDs)

  • maculopapular rash
  • fever
  • new drug exposure
  • +/- arthralgias

AKI
Hematuria, pyuria, WBC casts
Eosinophilia, urine eosinophils

710
Q

Placental fluid volume in post-dates pregnancy

A

Oligohydramnios (d/t placental insufficiency)

711
Q

Most reliable finding to distinguish epilepsy from syncope

A

Tongue biting (usually lateral)

712
Q

Women with recurrentvulvuvaginal candidiasis should be tested for

A

Diabetes (HbA1c)

713
Q

False positive PCP drug screen

A

Dextromethorphan

714
Q

Solitary, hyperpigmented macules w/ increased density of overlying dark, coarse hair in infant

A

Congenital melanocytic nevus

Can transform to melanoma

715
Q

Features suggestive of blunt cardiac injury

A

persistent tachycardia and new arrhythmia after blunt chest trauma

continuous cardiac monitoring and echo

716
Q

What type of bone lesion does prostate cancer typically cause?

A

osteoBLASTIC

  • normal or low Ca
  • elevated alk phos
  • focal, sclerotic bone lesions
717
Q

Restrictive vs obstructive lung disease

A

Obstructive: low FEV1/FVC ratio

Restrictive: normal/high FEV1/FVC ratio; low VC

718
Q

Empiric treatment of community-acquired pneumonia

A

Outpatient

  • healthy: macrolide OR doxycycline
  • comorbidities: fluoroquinolone OR beta-lactam + macrolide

Inpatient

  • IV fluoroquinolone
  • beta-lactam + IV macrolide

ICU

  • beta-lactam + IV macrolide
  • beta-lactam + IV fluoroquinolone

Of note, fluoroquinolone must be resipratory:

  • levofloxacin
  • moxifloxacin
719
Q

Calciphylaxis

A

(aka calcific uremic arteriolopathy)

pathyphys

  • arteriolar and soft tissue calcification
  • local tissue ischemia and necrosis

RFs

  • ESRD (HD, transplants)
  • hypercalcemia, hyperphosphatemia
  • hyperparathyroidism
  • obesity, DM
  • oral anticoagulants (e.g., warfarin)

clinical

  • painful nodules and ulcers
  • soft tissue calcification on imaging
  • skin biopsy: arterial calcification/occlusion, subintimal fibrosis

Can become infected and lead to sepsis. Mortality is high.

NORMAL CALCIUM DOES NOT EXCLUDE DIAGNOSIS

720
Q

Bipolar I vs bipolar II

A

Bipolar I: Manic episode(s)

Bipolar II: hyponamic episode(s) AND ≥ MDE

721
Q

If elderly with severe lymphocytosis, hepatosplenomegaly, LAD, and bicytopenia (anemia and thrombocytopenia), think of

A

CLL

Diagnose w/ flow cytometry

722
Q

Diagnose CLL

A

flow cytometry

723
Q

Empiric treatment of meningitis in immunocompromosed patients

A

cefipime or ceftazidime + vancomycin + ampicillin

Also give empiric steroids (to prevent neurologic sequelae of strep pneumo meningitis, but d/c once ruled out)

724
Q

Trichinellosis

A

[Triad: periorbital edema, myositis, eosinophilia]

Ingestion of undercooked meat (usually pork)

Intestinal stage (w/in 1wk of ingestion):
-asymptomatic OR abd pain, N/V/D

Muscle stage (up to 4wks after ingestion):

  • myositis
  • fever
  • subungual splinter hemorrhages
  • periorbital edema
  • eosinophilia (>20%)
  • elevated CK, leukocytosis
725
Q

Hypokalemia in alcoholism d/t

A

hypomagnesemia [since Mg inhibits K secretion through ROMK]

726
Q

Hawthorne effect

A

change behavior if know you’re being studied

727
Q

Aplastic anemia

A

Pancytopenia (and its sequelae) w/ normal cell morphology on peripheral spear and no splenomegaly

728
Q

If suspect DVT (positive Wells)

A

Compression US BEFORE treatment (opposite of PE where you treat and then image)

729
Q

Treat adjustemtn disorders

A

psychotherapy

730
Q

Glucagonoma

A
  • weight loss
  • necrolytic migratpry erythema [erythematous papules that coalesce to form large indurated papules w/ central clearing]
  • DM/hyperglycemia
  • GI sx (diarrhea, anorexia, abd pain)

dx: markedly elevated glucagon level

731
Q

Widened pulse pressure

A

Increased systolic, decreased diastolic

e.g., aortic regurgitation

732
Q

Bleeding disorder in renal failure

A

Platelet dysfunction

Normal PT, aPTT, platelet count
Prolonged BT

Desmopressin (DDAVP) is treatment

733
Q

Small vs large fiber neuropathy

A

Small fiber: positive sympotms (pain, paresthesia, allodynia)
Large fiber: negative symptoms (numbness, loss of proprioception and vibration sense, diminished ankle reflexes)

734
Q

Isoniazid side effect and management

A

INH hepatitis

Increased risk in drinkers, liver disease, >50

If suspicious for INH hepatitis, STOP INH

But, if only MINOR elevations in LFTs (very common), continue INH

735
Q

Management of first-degree AV block

A

Depends on QRS

Normal QRS: observation
Prolonged QRS: EP testing

736
Q

Pericardial calcifications

A

Constrictive pericarditis

737
Q

Features of constrictive pericarditis

A

Etiology

  • idiopathic or viral
  • cardiac surgery or radiation therapy
  • TB

Clinical presentation

  • fatigue and dyspnea on exertion
  • peripheral edema and ascites
  • increased JVP
  • pericardial knock (early sound after S2)
  • pulsus paradoxus
  • Kussmaul sign (lack of inspiratory decline in CVP)

Diagnosis

  • EKG: nonspecific, Afib, or low-voltage QRS
  • Imaging: pericardial thickening and calcification
  • JVP tracing: prominent x and y descents
738
Q

If sudden-onset hypotension, cyanosis, and hypoxia that fails to respond to 100% O2 in a neonate, think

A

PDA-dependent congenital heart disease [sudden closure of the ductus has affected blood flow]

  • coarctation of the aorta
  • D-transposition of the great arteries
  • hypoplastic LH syndrome
  • TAPVR
  • Tricuspid atresia

R –> L shunt of deoxygenated blood

Ductal-dependent defect requires PDA to be maintained:
-prostaglandin E1

739
Q

Drugs that affect the ductus arteriosus

A

Prostaglandin E1: keeps it open

Indomethacin: closes it

740
Q

If suspect diaphragmatic rupture on xray

A

CT

741
Q

Suppurative thyroiditis

A

(aka infectious thyroiditis)

Suppurative INFECTION of the thyroid gland

High-grade fever and pain at thyroid gland.

Typically euthyroid

742
Q

Anaphylaxis during transfusions is a clue for

A

selective IgA deficiency
-can form IgE antibodies against IgA

Also recurrent sinopulmonary and GI infections, concommitant atopy/autoimmunity

743
Q

Microcytic anemia w/ normal iron studies

A

hemoglobinopathy

744
Q

Rifampin side effect

A

Red body secretions (urine, tears, etc)

745
Q

Important coagulation adverse effect of nephrotic sybdrome

A

Renal vein thrombosis

  • hematuria
  • flank pain
  • scrotal edema

due to hypercoagulability

746
Q

Ecthyma gangrenosum

A

Cutaneous infection w/ Pseudomonas aeruginosa

  • immunocompromised patients w/ pseudomonal bacteremia
  • ischemic necrosis: painless red macule –> indurated pustules/bullae w/ punched-out gangrenous ulcers
  • patients usually febrile/ill
747
Q

Manageent of vaginal foreign body in girl

A
  • topical anesthetic

- vaginal irrigation w/ warm water or removal w/ a swab

748
Q

If refractory symptoms of anaphylaxis after IM epinephrine

A

more epi

749
Q

Greatest risk of parenteral nutrition

A

central-line associated bloodstream infection (CLABSI) since has to be given through central line

bugs

  • coagulase-negative staph
  • staph aureus
  • GNs: Klebsiella pneumoniae, Pseudomonas aeruginosa
  • candida
750
Q

Chest pain, decreased cardiac output, and pulsus paradoxus following viral infection

A

viral pericarditis complicated by cardiac tamponade

751
Q

CSF in herpes simplex encephalitis

A
  • lymphocytic pleocytosis
  • elevated protein
  • normal glucose
  • elevated RBCs
752
Q

Back pain exacerbated by walking downhill but not uphill

A

neurogenic claudication (spinal stenosis)

shopping cart sign

753
Q

If signs of Cushing’s with HYPERPIGMENTATION

A

ectopic ACTH production

  • pituitary ACTH secretion
  • paraneoplastic ACTH secretion
754
Q

Do NG tubes prevent aspiration pneumonia?

A

NO, has to be postjejeunal

Things that do:

  • elevate head of bed
  • limit PPIs
755
Q

Hemodynamic effects of tension pneumothorax

A

high intrathoracic pressure impedes venous return by compressing vena cava

Needle decompression increases venous return

756
Q

How to tell PTX vs tension PTX

A

Tension: HD unstability

757
Q

If both upper and motor neuron signs

A

ALS

e.g., atrophied hand muscles

758
Q

If hypokalemia after starting a thiazide diuretic, think

A

Primary hyperaldosteronism
-bilateral adrenal hypreplasia > unilateral adrenal adenoma

HTN w/ hypokalemia alkalosis, muscle weakness and paresthesias

High aldosterone, low renin

759
Q

Treatment of primary hyperaldosteronism

A

Bilateral adrenal hyperplasia: spironolactone

Unilateral adrenal adenoma: excision

760
Q

Secondary hyperparathyroidism

A

CKD –> low vitD –> low Ca absorption –> hypocalcemia, hyperphosphatemia –> increased PTH –> osteitis fibrosis cystica

Parathyroid hyperplasia

761
Q

Calcium in secondary hyperparathyroidism

A

LOW

762
Q

Tertiary hyperparathyroidism

A

chronic parathyroid stimulation –> autonomously functioning adenomas

  • high PTH
  • high calcium
763
Q

Treat overflow incontinence from neurogenic bladder

A

cholinergic agonsit (bethanechol)

764
Q

Precipitators of hepatic encephalopathy

A
  • infection
  • electrolyte abnormalities
  • high-nitrogen states: GI bleed, diet changes
765
Q

CML vs CLL on CBC

A

CML: leukocytosis of predominately neutrophil lineage
CLL: leukocytosis of premoninately lymphocyte lineage

766
Q

Hypovolemic hyponatremia

A

volume loss (e.g., vomiting, diarrhea) –> ADH release –> RAAS –> hyponatremia

Rx: isotonic saline

767
Q

What type of hyponatremia is SIADH?

A

euvolemic

768
Q

Antibiotic prophylaxis for MVP before dental procedures?

A

NO

769
Q

Treat acute dystonia

A
  • benztropine

- diphenhydramine

770
Q

Midshaft humeral injury causes

A

radial nerve injury

771
Q

What type of shunt is ASD?

A

Left-to-right (shunts more blood to pulmonary circulation, which is why you hear fixed split of S2)

772
Q

Fibrinogen in DIC

A

decreased

773
Q

Albuminocytologic dissociation

A

Guillain-Barré syndrome CSF:

  • elevated protein count
  • normal leukocyte count
774
Q

Factitious disorder vs malingering

A

Factitious disorder: feign symptoms to assume sick role

Malingering: feign symptoms to gain external rewards

775
Q

Management of spinal epidural abscess

A

Broad-spectrum antibiotics

NOT steroids, which would make worse

776
Q

Upper/lower respiratory tract, kidney, and cutaneous involvement

A

Granulomatosis w/ polyangiitis

777
Q

If withdrawing from both alcohol and opioids

A

Treat alcohol withdrawal [benzos], since it is life-threatening

778
Q

If suspect PE in pregnant woman

A

V/Q scan

779
Q

Interpretation of V/Q scan

A

based on PRE-TEST PROBABILITY for PE

Normal V/Q scan w/ any PTP: PE excluded
Low probability V/Q w/ low PTP: PE excluded
High probability V/Q w/ high PTP: PE confirmed
All other combinations of V/Q results and PTPs: additional testing needed (CTA)

780
Q

Complication of hereditary spherocytosis

A
  • pigment gallstones
  • splenomegaly
  • hemolytic anemia
781
Q

Efavirenz side effects

A

Neuropsychiatric: insomnia w/ vivid dreams, depression, anxiety

782
Q

Urge incontinence treatment

A
  • lifestyle modification
  • bladder training
  • antimuscarinics (oxybutinin)
783
Q

What do the positive and negative in blood type refer to?

A

Rh type

784
Q

Next step if painless third trimester bleeding

A

Transabdominal US (suspect placenta previa)

785
Q

If transabdominal US reveals placenta previa

A

TVUA (since TAUS has high false-positive rate for placenta previa)

786
Q

Which beta blocker has not specifically been evaluated in HF survival benefit?

A

Atenolol

instead: metoprolol, carvedilol, bisoprolol

787
Q

Tololytics

A

Indomethacin (COX inhibition)

Nifedipine (CCB)
-SE: tachycardia/palpitations, nausea, flushing, HA

Terbutaline (beta agonist)

  • SE: tachycardia/arrhythmias, hypotension, hypoglycemia, pulmonary edema
  • not frequently used d/t risk of adverse events
788
Q

Treatment of hypertriglyceridemia

A

Fibrates (e.g., fenofibrate)

789
Q

Roseola caused by

A

HHV-6

790
Q

Sudden syncope w/o prodrome most likely to be

A

ventricular fibrillation

sotalol can cause QT prolongation –> TdP

791
Q

If QT prolongation and stable, give

A

magnesium sulfate, even if mag is normal

792
Q

Caution in treating patients w/ RHF

A

Preload dependent, so be very careful with diuresis (can get prerenal AKI)

793
Q

Pharmacotherapy for eating disorders?

A

Bullimia: fluoxetine
Anorexia: not effective

794
Q

Shock after MI

A

Cardiogenic shock

  • high preload
  • low cardiac output
  • high afterload [compensatory increase in SVR]
795
Q

Treatment of acute gout in patients on anticoagulation

A

Colchicine or steroids

NOT indomethacin (increases bleeding)

796
Q

Pathophysiology of urge incontinence

A

detrusor hyperactivity (involuntary detrusor contractions)

797
Q

Hypertensive hemorrhages most commonly occur in the

A

basal ganglia

798
Q

Pre-operative physical therapy prevents

A

post-operative atelectasis/pneumonia, shortens hospital stay

799
Q

When to consider use of hypertonic saline in hyponatremia

A

<120 and symptomatic

800
Q

Prosthetic valve thrombosis

A

Presents like HF

d/t subtherapeutic anticoagulation

MITRAL valve at higher risk d/t less flow

INR goals:

  • aortic: 2-3
  • mitral: 2.5-3.5
801
Q

Fetal fibronectin

A

Used in <34 wks w/ regular contractions and closed cervix to determine if in preterm labor

NOT indicated after 34 wks or if cervical change (because that is definition of labor)

If positive at <34 wks, next step is give steroids

802
Q

If ear displacement, think

A

mastoiditis

IV abx

803
Q

Which gynecologic cancer is an AIDS-defining illness?

A

Cervical cancer

804
Q

Unstable patients who cannot wait for type and cross should receive

A

type O blood

805
Q

If trauma patient in hemorrhagic shock, next step is

A

transfusion (type O if don’t know blood type)

If still hemorrhaging or unstable, massive transfusion protocol: pRBC, plts, FFP in 1:1:1 ratio

806
Q

Local vascular complications of cardiac catheterization

A

Hematoma

  • +/- mass
  • no bruit

Pseudoaneurysm

  • bulging, pulsatile mass
  • SYSTOLIC bruit

AVF

  • no mass
  • CONTINUOUS bruit
807
Q

Giant cell tumor or bone is also known as

A

osteoclastoma

soap-bubble appearance

808
Q

In addition to supportive care, all patients w/ hyperemesis gravidarum should get

A

pelvic US to evaluate multiple gestation or mole

809
Q

Open-angle glaucoma

A

chronic, progressive loss of peripheral vision

cupping of optic disc
increased cup:disc ratio

810
Q

DRESS syndrome

A

Drug (often allopurinol or antiepileptic)
Rash (morbilliform)
Eosinophilia
Systemic Symptoms (fever, malaise, diffuse LAD)

Strop drug and supportive care

811
Q

Recurrent malaria d/t

A

Plasmodium vivax DORMANT hepatic hypnozoites

Treat w/ chloroquine PLUS primaqine to eliminate the hepatic hypnozoites

812
Q

Harsh holosystolic murmur w/ palpable thrill

A

VSD

813
Q

Most effective prevention of herpes

A

consistent condom use

Most transmission occurs during asymptomatic viral shedding

814
Q

Which antiemetics cause extrapyramidal symptoms

A

DOPAMINE ANTAGONISTS

  • prochlorperazine
  • promethazine
  • metaclopramide
815
Q

Interpretation of relative risk and odds ratio

A

> 1: positive association
<1: negative association

1 is null, so CI including 1 is NOT significant

816
Q

Urine sodium in SIADH

A

High, since kidneys do not aggressively retain sodium in euvolemia

817
Q

Drugs that cause SIADH

A
  • SSRIs
  • carbamazepine
  • NSAIDs
818
Q

Reduce blood viscosity in Waldenström macroglobulinemia

A

plasma exchange to reduce IgM levels

819
Q

Management of paraphimosis

A

urgent manual or surgical reduction of the prepuce

820
Q

If mother detects decreased fetal movement

A

Has to be worked up- non-stress test

821
Q

If acute exacerbation of COPD that deos not respond to initial therapy

A

Noninvasive positive pressure ventilation

Trial NPPV before intubation

822
Q

Treatment of E. coli O157:H7

A

Supportive- antibiotics increase risk of HUS

823
Q

Hydroxychloroquine side effect

A

Retinopathy- requires eye monitoring

824
Q

Massive PE definition

A

PE c/b HYPOTENSION +/or acute RH STRAIN

syncope

825
Q

Treatment of syphilis w/ penicillin allergy

A

Doxycycline po

826
Q

Ethylene glycol poisoning urine finding

A

Envelope-shaped calcium oxalate crystals

827
Q

Treat cocaine-associated chest pain

A

Benzos

DO NOT USE BETA-BLOCKERS–> unopposed alpha which worsens coronary vasoconstriction

828
Q

Does progestin increase thromboembolism risk?

A

NO, so can use IUD in these patients

829
Q

Calcineurin inhibitor adverse effects

A
  • nephrotoxicity
  • HTN
  • neurotoxicity (tremor)
  • impaired glucose control
830
Q

Parapneumonic effusion vs empyema

A

Empyema is when parapneumonic effusion becomes colonized w/ bacteria and purulent

831
Q

Anticoagulation in kidney disease

A

unfractionated heparin –> warfarin

832
Q

Management of tardive dyskinesia

A
  • discontinue causative medication
  • switch to SGA (clozapine, quetiapine)
  • valbenazine or deutetetrabenazine
833
Q

Which test best diagnoses bronchiectasis?

A

High-res CT

834
Q

GI watershed areas

A
  • SPLENIC flexure

- rectosigmoid junction

835
Q

Management of enuresis

A
  • behavioral: decreased fluids before bedtime, voiding before bed
  • enuresis alarms
  • DESMOPRESSIN (po) [imipramine only if DDAVP fails]
836
Q

Cause of bacterial conjunctivitis in adults

A

Staph aureus

837
Q

If suspect acromegaly

A

IGF-1

838
Q

All SERMs increase risk of

A

VTE

839
Q

Raloxifene MoA

A

Estrogen antagonist: breast, uterus

Estrogen agonist: bone

840
Q

Treatment of amebic liver abscess

A

Metronidazole, NOT drainage

Entamoeba histolytica, solitary liver lesion

841
Q

Pentad of TTP

A
  • thrombocytopenia
  • MAHA
  • renal insufficiency
  • neurologic changes
  • fever
842
Q

Vitamin A deficiency

A
  • impaired adaptation to darkness
  • photophobia
  • dry scaly skin
  • xerosis conjunctiva
  • xerosis cornea
  • keratomalacia
  • Bitot spots
  • follicular hyperkeratosis of the shoulders, buttocks, adn extensor surfaces
843
Q

Pertussis treatment

A

Azithromycin

844
Q

What type of heparin to use in ESRD

A

UNFRACTIONATED, NOT low molecular weight

845
Q

Physiology of different murmur maneuvers

A

DECREASE PRELOAD

  • Valsalva
  • sit to stand
  • nitroglycerin

INCREASE AFTERLOAD
-sustained hand grip

INCREASE PRELOAD
-passive leg raise

INCREASE AFTERLOAD AND PRELOAD
-squatting

846
Q

Increase intensity of HCM murmur

A

Decrease preload (Valsalva, sit-to-stand)

847
Q

Neonatal thyrotoxicosis d/t

A

Graves disease –> transplacental passage of anti-TSH-R antibody

Rx: methimazole + beta blocker

848
Q

Hyposthenuria

A

The inability of the kidneys to concentrate urine

Common in patients w/ sickle cell and trait

849
Q

Invasive aspergillosis

A

Triad

  • fever
  • pleuritic chest pain
  • hemoptysis

HALO SIGN

850
Q

What medication should all women bearing twins take?

A

Aspirin for preeclampsia prevention

Also:

  • prior preeclampsia
  • CKD
  • chronic HTN
  • DM
  • autoimmune disease
851
Q

Calculate PPV and NPV

A

PPV = TP / (TP + FP)

NPV = TN / (TN + FN)

852
Q

Unfavorable metabolic side effects of thiazide diuretics

A
  • hyperglycemia
  • increased LDL
  • increased TGs
  • hyperuricemia

Also: hyponatremia, hypokalemia, hypomagnesemia, hypercalcemia

853
Q

Caution in perioperative MI

A

may not have pain since analgesia…

854
Q

Which statistical value is sensitive to outliers?

A

Mean

Step 2 CK (1 decks)

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