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1
Q

Alpha synuclein

A

Parkinson’s

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2
Q

Thymus absence on X-ray

A

Di George syndrome or thymic hypoplasia

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3
Q

Evaluation of Primary Amenorrhea

A 
Pelvic exam or U/S 
uterus present (serum FSH)- increased karotype decreased cranial MRI

Uterus absent (karyotype, serum testosterone) 46xx normal female testosterone abnormal Mullerian development 46 xy normal male testosterone level androgen insensitivity syndrome

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4
Q

Preseptal cellulitis

A

Eyelid erythema and swelling, chemosis txt: oral Abx

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5
Q

Orbital cellulitis

A

symptoms of preseptal cellulitis plus PAIN w/ EOM, proptosis and/or opthalmoplegia w/diplopia txt: IV Abx and Surgery

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6
Q

Cat scratch Dx

A

Etiology: Bartonella henselae, fastidious gram - bacteria

Clinical manifestation- papule at scratch/bite site, regional adenopathy, +/- fever of unknown origin (>14days)

Dx: clinical +-serology

Txt: azithromycin

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7
Q

ALS

A

Loss of upper and lower motor neuron loss

High CPK levels

Riluzole, Baclofen, CPAP and Bipap, Tracheostomy

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8
Q

Charcot Marie Tooth Dx

A

Lose both motor and sensory innervation (distal weakness and sensory loss, wasting in legs, decreased DTRs, tremor)

Foot deformity with high arch common (pea cavus) legs look like inverted champagne bottles

Most acc test EMG

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9
Q

Peripheral Neuropathy

A

Best initial therapy- pregabilin gabapentin

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10
Q

Facial Nerve (Bell Palsy)

A

Best initial therapy: Prednisone

Most common complication: corneal abrasion

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11
Q

Guillain Barre

A

Bilateral Ascending weakness with loss of reflex, respiratory muscles weakness
Autonomic dysfunction
Most specific diagnostic test EMG/ nerve conduction studies
Decrease in FVC and peak
Inspirational

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12
Q

Myasthenia Gravis

A

Muscular weakness from antibodies against ach receptors at the NMJ

Double vision, difficulty chewing, ptosis, weakness of limb muscles worse at end of day

best initial test: Ach receptor antibodies

Most acc test: EMG

Imaging- Chest X-ray, CT, MRI for thymoma

Best initial therapy: Neostigmine

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13
Q

Acute myasthenic crisis

A

Severe, overwhelming dx, profound weakness, respiratory involvement

Txt: IVIG or plasmapheresis

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14
Q

Kawasaki Dx

A

Epidemiology 90% age <5, Asian

Dx criteria (4 of the following plus >5 days of fever)

  • conjunctivitis
  • mucositis (injected, fissured lips or pharynx, strawberry tongue)
  • cervical lymphadenopathy
  • rash: erythematous, polymorphous, generalized, perineal erythema & desquamation, morbilliform-erythema
  • edema of hands and feet
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15
Q

Cat bites

A

Pasturella multiocida, anaerobic bacteria

MGMT: copious irrigation and cleaning, prophylactic amoxicillin/clavulanate, tetanus booster as indicated, avoid closure

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16
Q

Key features of a craniopharyngioma

A

Low grade malignancy derived from remnants of rathke pouch, optic chiasm compression-bitemporal hemianopsia, pituitary stalk compression- endocrinopathies( GH, DI), suprasellar calcified mass on imaging

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17
Q

Alzheimer’s Dx

A

MRI, VDRL or RPR B12, Thyroid

Txt: Donepezil, rivastigmine, galantamine, memantine

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18
Q

Lewy Body Dementia

A

Ass w/Parkinson’s Txt w levodopa/carbidopa

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19
Q

Creutzfeldt Jakob Dx

A

Rapidly progressive dementia w/myoclonic jerks, normal CT & MRI, CSF w/ 14-3-3 protein, biopsy is most accurate

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20
Q

Chronic pancreatitis

A

Secretin stimulation is the most accurate test for chronic pancreatitis

Best initial test: X-ray and abdomnial CT

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21
Q

Group B Strep pregnancy prophylaxis

A

Penicillin G 35 to 37 weeks

If severe allergy to PCN: vancomycin

Minor allergy: cefazolin

When sensitivity is available and PCN Allergy : clindamycin erythromycin

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22
Q

Primary ciliary dyskinesia

A

Resp tract findings: chronic sinopulmonary infxn, nasal polyps, bronchiectasis, digital clubbing

Extrapulm findings: situs inversus, infertility due to immobile spermatozoa, NORMAL GROWTH

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23
Q

Cystic Fibrosis

A

Resp tract findings: chronic sinopulmonary infxn, nasal polyps, bronchiectasis, digital clubbing

Extrapulm findings: pancreatic insufficiency, infertility due to absent vas deferens (azospermia), FAILURE TO THRIVE

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24
Q

Ectopic pregnancy

A

Risk factors: previous ectopic, previous pelvic/tubal surgery, PID

Clinical FX: abdominal pain, amenorrhea, vaginal bleeding, hypovolemic shock in ruptured ectopic, cervical motion, adnexal + abdominal mass

Dx: +hCG, transvaginal U/S revealing adnexal mass, empty uterus

Stable: MTX, unstable SURG

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25
Q

Necrotizing Enterocolitis

A

Risk factors: prematurity, very low birth weight(<1.5 or 3.3ibs), enteral feeding (formula >breast milk)

Clinical Fx: vital sign instability, lethargy, bilious emesis, bloody stools, abdominal distension

X-ray: pneumatosis intestinalis, portal venous gas, pnemoperitoneum

Txt: bowel rest: parenteral nutrition, broad spectrum Abx, +/- surgery

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26
Q

Congenital hypothyroidism

A

Initially normal at birth, symptoms develop after maternal T4 wanes: lethargy, constipation, enlarged Fontanalle, protruding tongue, umbilical hernia, jaundice, dry skin
Dx: Elevated TSH low T4
Txt: Levothyroxine

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27
Q

Impetigo

A

Non bullous- staph aureus, group A Strep, bullous- S. Aureus

Limited skin involvement: mupirocin

extensive Skin involvement: oral Abx (cephalexin, dicloxacillin)

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28
Q

12 months

A

Infants weight triples, height doubles standing and learning to walk, uses a 2finger pincer grasp, says 1 word other than mama and dada and follows 1step command w/gesture

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29
Q

Prader Willi syndrome

A

Paternal 15q11-q13 deletion death by choking

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30
Q

Most common cause of pneumonia in CF children is

A

Staph Aureus

Txt: IV vancomycin

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31
Q

SCID (severe combined immunodeficiency

A

Failure of T cell development (adenosine deaminase) B cell dysfunction due to absent T cells

XLR, autosomal recessive

  • recurrent severe viral, fungal or opportunistic infxn (pneumocystis)
  • failure to thrive
  • chronic diarrhea

Txt:?stem cell transplant

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32
Q

Bacterial Meningitis

A

Clinical features: fever, increased intracranial pressure (vomiting, AMS, headache), meningal irritation (nuchal rigidity)

complications: hearing loss (most common), intellectual disability, cerebral palsy, epilepsy

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33
Q

Achalisia

A

Best initial test: Barium swallow
Most accurate: Manometry

Txt: Heller myotomy

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34
Q

Most acc test for esophageal cancer

A

Endoscopy

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35
Q

Esophageal spasm

A

Esophageal best initial test
Manometry most acc test

Txt: nitrates, calcium channel blockers

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36
Q

Plummer Vinson syn

A

Dysphasia, Iron def anemia , glossitis

Txt: iron replacement

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37
Q

Best test for Zenker’s Diverticulum

A

Esophagram

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38
Q

Boerhaave’s Syndrome

A

Full thickness tear

Hamman’s sign- crepitus
Subcutaneous air
EMERGEnCY

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39
Q

Pancreatic cancer

A

Painless jaundice

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40
Q

Most accurate test Gastritis

A

EGD

+ h pylori

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41
Q

Stress Ulcer Prophylaxis

A

Mechanical ventilation
Burns-curling ulcer
Head trauma-cushing
Coagulopathy

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42
Q

Zillinger Ellison Syndrome

A

Diarrhea, abdominal pain, anemia and Heme positive stools

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43
Q

Carcinoid syndrome

A

Flushing, wheezing, CV murmur(tricuspid regurgitation), diarrhea.
Best initial test: 5HIAA (urinary 5-hydroxyindoleacetic acid)
Txt: Octreotide

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44
Q

Paracentesis is performed when

A

New onset ascites
Abdominal pain and tenderness
Fever

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45
Q

Symptomatic from anemia means

A

SOB, Lightheaded, confused and sometimes syncope, hypotension and tachycardia, and chest pain

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46
Q

TTP

A 
Hemolysis
Low platelet
Renal insufficiency 
Neurological disorder (confusion, seizure
Fever
Normal PT, PTT

Txt Plasmapharesis or FFP no platelets

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47
Q

Paroxysmal nocturnal hemoglobinuria

A

CD 55, CD 59 decay accelerating factor deficiency

Hemolysis n thrombosis

Episodic dark urine
Pancytopenia
Txt Prednisone, bone marrow transplant, eculizumab, folic acid

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48
Q

Smudge cell

A

CLL

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49
Q

Cord compression

A

History of Cancer

Vertebral tenderness, sensory level, hyperreflexia

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50
Q

Epidural Abscess

A

Fever, high ESR

Vertebral tenderness, sensory level, hyperreflexia

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51
Q

Cauda Equina

A

Bowel and bladder incontinence, erectile dysfunction

Bilateral leg weakness
Saddle area anesthesia

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52
Q

Disk herniation

A

Pain, numbness of medial calf or foot

Loss of knee and ankle reflexes, positive straight leg raise

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53
Q

Felty Syndrome

A

RA
Splenomegaly
Neutropenia

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54
Q

Caplan Syndrome

A

RA
Pneumoconiosis
Lung nodules

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55
Q

Hydroxychloroquine

A

Toxic to retina

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56
Q

Juvenile Rheumatoid Arthritis/ Still’s Dx

A

Often only with fever spikes, salmon colored rash, on chest and abdomen

Splenomegaly
Pericardial effusion
Mild joint symptoms

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57
Q

Lupus flare

A

Decrease in complement and raise in anti-DS DNA

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58
Q

What is the treatment to prevent recurrence of spontaneous abortion in Antiphospholipid Syndrome

A

Heparin and Aspirin

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59
Q

Anticardiolipin

A

Ass with spontaneous abortion in APL Syndrome

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60
Q

Anticentromere antibodies

A

CREST syndrome

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61
Q

CREST syndrome

A 
Calcinosis
Raynaulds phenomenon 
Esophageal dysmotility
Sclerodactyl
Telangiectasia
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62
Q

Polymyositis / Dermatomyositis

Best initial test and most accurate test

A

Best initial CPK and Aldolase

Most accurate test: muscle biopsy

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63
Q

Keratoconjuctivitis sicca
Dental caries
Dyspareunia

A

Sjögren’s syndrome

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64
Q

Most dangerous complication of Sjogren’s

A

Lymphoma

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65
Q

Sjogren best initial test and most accurate test

A

Best initial Schirmer test
Most accurate test lip or parotid gland biopsy

Best initial test on blood RO AND LA (SS-A- SS-B)

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66
Q

Water mouth

artificial tears

A

Best initial therapy for Sjogrens

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67
Q

Polyarteritis nodosa

A

Foot drop
Stroke in a young person
Hep B, C
Always spares lungs

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68
Q

Leukocytoclastic vasculitis

A

Henoch Schonlein purpura

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69
Q

Juvenile rheumatoid arthritis has an excellent prognosis with

A

Positive ANA

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70
Q

Best initial test in an acute asthma exacerbation

A

ABG or Peak Expiratory flow
Mild- resp alkalosis
Severe- resp acidosis

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71
Q

Most accurate diagnostic test in asthma

A

PFTs

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72
Q

Adverse effects of inhaled steroids

A

Dysphonia and oral candidiasis

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73
Q

Management of acute asthma exacerbation

A

Oxygen
Albuterol +- inhaled anticholinergic (ipratropium)
Corticosteroids

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74
Q

If pt with acute asthma exacerbation has no response to oxygen, albuterol, and steroids or develops a respiratory acidosis what should you consider

A

Endotracheal intubation and mechanical ventilation

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75
Q

Chronic bronchitis

A

Productive cough for more than 3 months/year for 2 consecutive years

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76
Q

COPD exacerbation

A

Increase cough
Sputum
SOB

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77
Q

Best initial test COPD

A

Chest X Ray
Increased AP diameter
Air trapping flattened diaphragm

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78
Q

Most acc diagnostic test for COPD

A

PFT
Decreased FEV1/FVC
Increase TLC and RV
Decreased DLCO in emphysema

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79
Q

Acute exacerbation COPD

A

ABG - increase PCO2 and hypoxia

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80
Q

EKG COPD

A

A fib or multifocal atrial tachycardia (MAT)
RAH or RVH
Echo: RA or RV hypertrophy, Pulmonary HTN

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81
Q

Improved mortality COPD

A 
Smoking cessation
Oxygen therapy (pao2 <55 or Sa02 < 90 or if pt has cor pulmonale pulmonary HTN or polycythemia PaO2 <60 or Sa02 <90
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82
Q

When do you prescribe antibiotics for COPD flare

A

Requiring hospitalization or having 2/3 cardinal symptoms

  1. Dyspnea
  2. Increased sputum production
  3. Increased sputum purulence

Abx: s. Pnemo, h flu or moraxella

Macrolides (azithromycin, clarithromycin), cephalosporin (cefuroxime, cefixime), amoxicillin/clavulanic acid, quinolone: levofloxacin, moxifloxacin), doxycycline or Bactrim

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83
Q

Best initial test Bronchiectasis

A

Chest X Ray

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84
Q

Most accurate test Bronchiectasis

A

High Resolution CT

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85
Q

Community acquired pneumonia

A

Within 48 hours of hospitalization

Pneumonia occurring before hospitalization

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86
Q

Recent viral infection pneumonia

A

Staph aureus

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87
Q

Anaerobic pneumonia

A

Poor dentition

Aspiration

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88
Q

Hoarseness

A

Chlamydophilia pneumonia

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89
Q

Abdominal pain or diarrhea pneumonia

A

Lower lobe pneumonia irritating intestines through diaphragm

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90
Q

Outpatient treatment for CAP

A
  1. Previously healthy or no antibiotics in past 3 months
    Macrolide (Azithromycin/clarithromycin) or Doxycycline
  2. comorbidities or Abx past 3 mo
    Respiratory floroquinolone (Levofloxacin or Moxifloxacin)
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91
Q

Inpatient treatment for CAP

A
  1. Resp fluoroquinolone: levofloxacin or moxifloxacin

2. Ceftriaxone and azithromycin

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92
Q

CURB 65

A 
Confusion
Uremia (BUN>30)
Resp distress RR>30, pulse >125
BP low (systolic <90)
Age >65

Also:pO2 <60, pH <7.35, sodium <130, glucose >250, Temp >104 or comorbidities such as cancer, COPD, CHF, renal failure or liver dx

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93
Q

Healthcare associated Pneumonia

A

Pneumonia > 48 hrs after admission

Much higher incidence of Gram - bacteria such as E. Coli or Pseudomonas

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94
Q

HAP Treatment

A

Cefepime or Ceftazidime
Or Pip/Tazo
Or imipenem, meropenem or doripenem

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95
Q

Look for the following changes in VAP (ventilator associated pneumonia)

A
  1. Fever and/or rising WBC count
  2. New infiltrate on chest X-ray
  3. Purulent secretions coming from endotracheal tube
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96
Q

Most acc diagnostic test of VAP

A

Open lung biopsy

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97
Q

VAP treatment

A
  1. Anti-pseudomonal beta-lactam (cephalosporin- ceftazidime or cefepime or penicillin pip/tazo or carbapenem imipenem )
  2. 2nd anti-pseudomonal agent (aminoglycoside gentamicin or amikacin)
  3. MRSA agent (Vancomycin or Linezolid)
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98
Q

Lung Abscess best initial test

A

Chest Xray, CT more accurate best biopsy (sputum culture always wrong answer)

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99
Q

Best treatment for Lung abscess

A

Clindamycin

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100
Q

PCP best initial test

A

Chest X-ray showing bilateral interstitial infiltrates or ABG showing hypoxia or increased Aa gradient
LDH is always elevated

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101
Q

PCP most accurate test

A

Bronchoalveolar lavage

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102
Q

Sputum stain PCP

A

If positive no need for further testing

If negative-bronchoscopy as the best diagnostic test

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103
Q

PCP treatment

A

Bactrim
Add steroids when PaO2 <70 or Aa gradient >35
If toxicity to Bactrim: Clindamycin and primaquine (contraindicated in G6PD) or Pentamidine

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104
Q

PCP prophylaxis

A

Bactrim

If rash or neutropenia atovoquone or Dapsone (contraindicated in G6PD)

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105
Q

TB best initial test

A

Best initial test: Chest X Ray
Sputum stain and culture specifically for acid fast bacilli (mycobacterium) must be done 3x to fully exclude TB
If 3 negative acid fast but clinical suspicion is high: Bronchoscopy with BAL or pleural biopsy

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106
Q

TB treatment standard of care

A 
RIPE 
PE- May be stopped after 2 mo
RI for 4 months
Total of 6 mo
Txt is extended to 9 mo (osteomyelitis, miliary TB, meningitis, pregnancy)
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107
Q

Toxicity of TB Meds

A

All cause hepatotoxicity (don’t stop unless transaminases rise 3-5x upper limit of normal)
Rifampin- red color
Isoniazid- peripheral neuropathy (txt pyridoxine)
Pyrazinamide- hyperuricemia (txt allopurinol if symptomatic only)
Ethambutol- optic neuritis/color vision (txt decrease dose in renal failure)

108
Q

In TB txt pregnant pts should not receive

A

Pyrazinamide

109
Q

Glucocorticoids are used in TB

A

Decrease risk of constrictive pericarditis in those with pericardial involvement and decrease neurological complications in TB meningitis

110
Q

Positive PPD > 5

A 
HIV positive
Glucocorticoid users
Close contact with active TB pt
Abnormal calcification on Chest X-ray
Organ transplant recipients
111
Q

Positive PPD >10

A 
Recent immigrants
Prisoner
Healthcare workers
Close contact with TB
Hematologic malignancy, alcoholics, DM
112
Q

Latent TB txt positive PPD

A

9mo Isoniazid

113
Q

ILD best initial test

A

Best initial- Chest X-ray
More accurate: High resolution CT
Most accurate: Lung biopsy

114
Q

Agents to decrease rate of progression to IPF

A

Pirfenidone and nintedanib

115
Q

Best initial test in Sarcoidosis

A

Chest X-ray

116
Q

Most accurate test for Sarcoidosis

A 
Lymph node Biopsy- granulomas 
Elevated ACE
Hypercalcemia
Granulomas in sarcoid make Vit D
PFTs-restrictive lung disease
117
Q

Best initial test for PE/DVT

A

Chest X-ray
EKG
ABG

118
Q

When are thrombolytics the right answer for DVT/PE

A
  1. Hemodynamically unstable (hypotension, tachycardia)
  2. acute RV dysfunction
    Contraindicated in recent surgery or bleed
119
Q

Direct acting thrombin inhibitors are the answer for DVT/PE when

A

HIT (fondaparinux), argatroban, lepirudin

120
Q

ARDS

A

Pa02/FI02 <200
Normal findings on R heart Cath
Normal PCWP <18

121
Q

LH/FSH deficiency presentation

A

Both genders decreased libido and decreased axillary, pubic abs body hair

Men- unable to produce testosterone or sperm, erectile dysfunction and decreased muscle mass

Women- unable to ovulate or menstruate normally and become amenorrheic

122
Q

GH deficiency presentation

A

Adults -few symptoms

Child- dwarfism

123
Q

Kallman Syndrome presentation

A

Decreased FSH and LH
Decreased GnRH

Anosmia

124
Q

Panhypopituitarian diagnostic test

A

Hyponatremia from
Hypothyroidism
Glucocorticoid underproduction
Potassium level normal (Aldosterone is not affected)

MRI- detects compression
GH- IGF level 
ACTH And Cortisol levels
LH, FSH, Testosterone 
TSH
125
Q

Treatment for panhypopituitarism

A

Thyroxine
Cortisol
Testosterone and Estrogen

126
Q

Acromegaly best initial test

A

Insulin like growth factor (IGF)

127
Q

Most accurate test for Acromegaly

A

Glucose suppression test

128
Q

MRI for Acromegaly

A

Only after lab identification of acromegaly

129
Q

Best initial therapy for Acromegaly

A

Surgery (Transphenoidal resection of pituitary)

130
Q

Meds for Acromegaly used if surgery does not work

A

Cabergoline: Dopamine agonist inhibit GH release
Octreotide or lanreotide: Somatostatin inhibits GH release
Pegvisomant: GH receptor antagonist

131
Q

Hyperprolactinemia Diagnostic Tests

A

Thyroid function test
Pregnancy test
BUN/Cr ( kidney Dx elevates prolactin)
Liver function test (cirrhosis elevates prolactin)

MRI is done after
High prolactin level is confirmed
Secondary causes like Meds are excluded
Patient is not pregnant

132
Q

Treatment for Hyperprolactinemia

A

Dopamine agonist
Cabergoline
Transphenoidal surgery when NOT responding to meds

133
Q

Pearls for hypothyroid treatment

A

High TSH (double normal) plus normal T4 =treatment

Anti thyroid peroxidase antibodies tell who needs thyroid replacement when T4 is normal and TSH is high

134
Q

Best initial test for hypothyroidism

135
Q

Best initial test for hyperthyroidism

136
Q

Pituitary Adenoma

137
Q

Best initial therapy for Graves ophthalmopathy

A

Steroids

For those unresponsive to steroids
Radiation

138
Q

Treatment for subacute thyroiditis

139
Q

Treatment for pituitary adenoma

140
Q

Thyroid storm treatment

A

Propanolol (blocks conversion of T4 to T3)
Thiourea drugs(methimazole and propylthiouracil) block hormone production
Iodinated contrast material
Steroids
Radioactive iodine

141
Q

Next step after normal TSH/T4 in found in a pt with a Thyroid nodule

142
Q

Most common cause of asymptomatic hypercalcemia

A

Primary hyperparathyroidism

143
Q

Short QT syndrome is seen in what electrolyte disorder

A

Hypercalcemia

144
Q

Treat acute hypercalcemia with

A

Saline
Bisphosphonates
Calcitonin

145
Q

Management of Hyperparathyroidism

A

DEXA

Preop imaging of neck with sonography or nuclear scan prior to surgery

146
Q

Treatment of Hyperparathyroidism

A 
Surgery 
When surgery is not possible cinacalcet
Indications for removal of parathyroids:
Bone disease (osteoporosis)
Renal involvement including stones
Age under 50
Calcium consistently 1 point above normal
147
Q

What electrolyte abnormality causes a prolonged QT

A

Hypocalcemia

148
Q

Best initial test for hypercortisolism

A

Low dose dexamethasone suppression test

149
Q

Most accurate test for hypercortisolism

A

Cortisol testing
24 hr urine
Late night salivary

150
Q

Best next test after Cortisol testing

A

Serum ACTH level

151
Q

If serum ACTH is low what is the next best step

A

CT Adrenals in search of an adrenal mass

152
Q

If serum ACTH is high what is the next best step

A

High dose dexamethasone test to distinguish Ectopic vs Pituitary

High ACTH and cortisol- ectopic (does not suppress)
Suppression of cortisol- pituitary adenoma Cushing disease

153
Q

If a pt fails high dose dexamethasone test what is the best next step?

A

Chest CT in search of Ectopic ACTH secreting tumor

154
Q

Best next step after suppression of high dose dexamethasone suppression test?

A

Pituitary MRI

155
Q

What if the pituitary MRI shows no mass?

A

Petrosal sinus sampling for ACTH

156
Q

If surgical removal of hypercortisolism is not successful what is the next best step in treatment?

A

Pasireotide (somatostatin analog)

157
Q

How does an acute adrenal crisis present?

A

Hypotension
Fever
Confusion
Coma

158
Q

Hypoadrenalism findings on lab

A 
Hypoglycemia
Hyponatremia
Hyperkalemia
Met Acidosis
High BUN
Eosinophilia
159
Q

Next best step in management of acute adrenal crisis

A

Replace steroids with hydrocortisone

Fludocortisone

160
Q

Primary hyperaldosteronism lab findings

A

High BP and low K

161
Q

Best initial test for primary hyperaldosteronism

A

Plasma aldosterone to plasma renin ratio

162
Q

A low plasma renin with high aldosterone

A

Primary Hyperaldosteronism

163
Q

Most accurate test for primary hyperaldosteronism

A

Adrenal venous sampling- high aldosterone

164
Q

Treatment for hyperaldosteronism

A

Unilateral-resection

bilateral-eplerenone or spironolactone

165
Q

Best initial test for pheochromocytoma

A

Plasma catecholamines

166
Q

Confirmation of pheochromocytoma

A

24 hr urine metanephrine and catecholamines

167
Q

What is the next best step in management for a pheochromocytoma that originates outside the adrenal gland

A

MIBG scanning

168
Q

Best initial therapy of a pheochromocytoma

A

Phenoxybenzamine (IV alpha blocker)

169
Q

Treatment of Pheochromocytoma

A

Pehnoxybenzamine
Propanolol
Calcium channel blocker
Laparoscopic removal

170
Q

Irregular menstraution
Clinical hirtuism and or high testosterone/DHEA
10 cyst on pelvic ultrasound with enlarged ovary (>10 cm)

A

Criteria to diagnose PCOS

171
Q

Primary Immunodeficiency Disorder Low B cell output Normal T cell

A

Common variable Immunodeficiency (CVID)

172
Q

Primary Immunodeficiency Disorder Low B cells, normal T cells in young male children

A

X-linked (Bruton agammaglobulinemia)

173
Q

Primary Immunodeficiency Disorder Low B cell And T cell analogous to HIV

A

Severe combined immunodeficiency (SCID)

174
Q

Primary Immunodeficiency Disorder Atopic disorders, anaphylaxis

A

IgA deficiency

175
Q

Primary Immunodeficiency Disorder Skin infection (eg Staph)

A

Hyper IgE syndrome

176
Q

Primary Immunodeficiency Disorder normal T cell normal B cell Low platelets, eczema

A

Wiskott- Aldrich Syndrome

177
Q

Primary Immunodeficiency Disorder infections combined with staph, burkholderia, nocardia, aspergillus

A

Lymph nodes with purulent material

178
Q

Most accurate test for Coccidioidomycosis

A

Sputum culture, serology

179
Q

Coccidioidomycosis clues to diagnosis

A

Joint pain

Erythema nodosum

180
Q

Coccidioidomycosis treatment if symptomatic

A

Fluconazole or itraconazole

Severe: amphotericin

181
Q

Histoplasmosis most likely diagnosis when pt presents with

A

Involvement of bone marrow (pancytopenia), spleen and lymph nodes, resembles TB with lung cavities

182
Q

Histoplasmosis most acc test

A

Culture of sputum, blood or affected organs. Urine and serum antigen highly specific

183
Q

Histoplasmosis treatment

A

Severe illness gets amphotericin followed by oral itraconazole

184
Q

Blastomycosis most likely diagnosis when pt presents with

A 
Bone
Skin
Lung
Prostate involvement 
“Broad budding yeast”
185
Q

Mucormycosis most likely diagnosis in

A

Immunocomoromised pts (diabetics in DKA)
Rapidly dissects nasal canals and eyes to brain
Deferoxamine increases risk of mucormycosis by mobilizing iron

186
Q

Treatment for Mucormycosis

A

Surgical emergency
Amphotericin best initial therapy
Follow up therapy with posaconazole or isavuconazole

187
Q

Best initial therapy for invasive aspergillosis

A

Voriconazole, isavuconazole or caspofungin

188
Q

Best method for detection of Malaria

A

Thick smear

189
Q

Best method for speciation of Malaria

A

Thin smear

190
Q

Treatment for infection with plasmodium falciparum Malaria

A

Mefloquine or atovaquone/proguanil

191
Q

Treatment for infection with non-falciparum infection

A

Chloroquine or primaquine (vivax and ovale only)

192
Q

Tropical disease that presents with:
CNS abnormalities (confusion, seizure, coma)
Hypotension/shock or pulmonary edema
Renal injury, acidosis or hypoglycemia

A

Manifestations of severe malaria

193
Q

Treatment of severe malaria

A

Artemisinins (artemether, artesunate)

194
Q

Prophylaxis for malaria

A

Mefloquine, atovaquone/proguanil
(Avoid mefloquine with history of neuropsychiatric disease )
Doxycycline

195
Q

What tropical Dx presents with Intense joint pain, periarticular edema and rash

A

Chicungunya

196
Q

What tropical disease is characterized by bone pain, the 2nd episode is worse

197
Q

Tropical disease whose 2nd episode presents with thrombocytopenia, petechiae and GI bleeding leading to fatal hemorrhage and shock with low WBC count and high transaminases

198
Q

What tropical disease may cause microcephaly and is ass/ w Guillane Barre

199
Q

Diagnosed with culture showing boxcar shaped encapsulated rods

200
Q

Treatment for Anthrax

A

Quinolone or doxycycline

201
Q

Treatment of Staph sensitive isolates first agents IV & oral

A

IV: oxacillin nafcillin cefazolin
Oral: dicloxacillin cephalexin cefadroxil

202
Q

Treatment of Staph sensitive Isolates additional agents

A

IV cephalosporins, carbapenem, beta-lactam/ beta-lactamase combination
Oral: amoxicillin/clavulanate, any oral cephalosporin

203
Q

Telavancin, dalbavancin, tedizolid, oritavancin, vancomycin, daptomycin, linezolid, ceftaroline

A

MRSA drugs

204
Q

Treatment of Staph resistant isolates first agents

A

IV: vancomycin, linezolid, daptomycin, ceftaroline, oritavancin, telavancin, dalbavancin

205
Q

Treatment of Staph resistant isolates additional agents

A

IV oritavancin, telavancin, dalbavancin

Oral clindamycin tedizolid

206
Q

Best initial test in Meningitis

207
Q

When is a head CT the best initial test for Meningitis?

A

If before LP there is

Papilledema
Seizures
FND
Confusion

208
Q

If there is a contraindication to immediate LP what is the best initial step in manangement

209
Q

Treatment for bacterial meningitis

A

Ceftriaxone, vancomycin and steroids

210
Q

What is the most common neurological deficit of untreated bacterial meningitis?

A

Eighth cranial nerve deficit or deafness

211
Q

Best initial test for Infectious diarrhea

A

Blood and/or fecal leukocytes

212
Q

Greater sensitivity and specificity than stool leukocytes

A

Stool lactoferrin

213
Q

Most accurate test for infectious diarrhea?

A

Stool culture

214
Q

Best initial test for Endocarditis

A

Blood culture

215
Q

If blood cultures are positive for endocarditis what is the next best step in management?

A

Echo TTE first followed by TEE

216
Q

How to diagnose culture negative endocarditis

A 
Oscillating vegetation on echo
Three minor criteria 
-Fever
-Risk IDU or prosthetic valve
-Embolic phenomena
217
Q

Treatment of Endocarditis once cultures are positive

A

Vancomycin + gentamicin

218
Q

When is surgery the next best step in management for Endocarditis?

A
  • CHF or ruptured valve or chordae tendineae
  • Prosthetic valve
  • Fungal Endocarditis
  • Abscess
  • AV block
  • Recurrent emboli while on Abx
219
Q

Most common cause of culture negative Endocarditis

220
Q

When is prophylaxis for Endocarditis the next best step in management

A 
Significant cardiac defect
-prosthetic valve
-previous Endocarditis 
-cardiac transplant with valvulopathy
-unrepaired cyanotic Heart disease 
AND
Risk of bacteremia
-dental work
-resp track surgery that produces bacteremia
221
Q

Prosthetic valve prophylaxis for Endocarditis with Staph

222
Q

Prophylaxis for Endocarditis

A

Amoxicillin

223
Q

Prophylaxis for Endocarditis if PCN allergic

A

Clindamycin, Azithromycin or Clarithromycin

224
Q

Most common presentation of Lyme disease occurs 5-14 days after bite fever often present

225
Q

Next best step in management once Lyme rash appears?

A

Treatment Doxycycline unless preg or a child amoxicillin

226
Q

When is serology in Lyme Dx the best next step in management?

A

Serological testing for Lyme

  • joint
  • neurologic
  • cardiac manifestation
227
Q

Lyme disease treatment for cardiac and neurological manifestations other than the seventh cranial nerve palsy

A

IV ceftriaxone

228
Q

Best initial treatment for HIV

A

2 nucleoside reverse transcriptase inhibitors (NRTIs) and an integrase inhibitor

Integrase inhibitors: dolutegravir, elvitegravir and raltegravir
NRTI: tenofovir, alafenamide and emtricitabine, abacavir and lamivudine

229
Q

This HIV Med is not used during pregnancy

230
Q

PrEP

A

Emtricitabin-Etenofovir

231
Q

Dysuria with flank or CVA tenderness, high fever, occasional abdominal pain, UA with high WBCs

A

Pyelonephritis

232
Q

Best initial test for cystitis

A

Urinalysis >10 WBC

233
Q

Most accurate test for cystitis

A

Urine culture

234
Q

Best initial therapy for UTI

A

Fluoroquinolones like ciprofloxacin

235
Q

Best next step in management for tertiary syphillis

A

IV penicillin

Desensitize to penicillin if allergic

236
Q

Treatment of chronic Hep C

A

Genotype 1- ledipasvir and sofosbuvir orally for 12 weeks
Other genotypes
Sofosbuvir and ribavirin orally

237
Q

Tooth discoloration, type 2 RTA, photosensitivity and esophagitis

A

Adverse effects of Doxycycline

238
Q

Gram negative bacteria covered by amoxicillin

A 
HELPS
H-h. Influenzae
E-coli
L-isteria
P-proteus
S-almonella
239
Q

Best initial step in management for a pt who presents with chest pain

240
Q

After performing an EKG in a pt with chest pain what is the next best step in management if the EKG shows abnormalities

A

Stress Echo or nuclear stress test

241
Q

If a patient presents with chest pain but the EKG shows no abnormalities what is the next best step in management

A

If the pt can exercise: stress test

If pt cannot exercise: chemical stress test (dipyridamole thallium or dobutamine echo)

242
Q

If a pt presents with chest pain and stress test is positive what is the next best step in management?

A

Angiography

243
Q

Angiography is performed 1 or 2 vessel disease is noted what is the next best step in management?

A

Stent placement

244
Q

Angiography is performed 3 vessel disease, left main, or 2 vessel disease in a diabetic is noted what is the next best step in manangement?

245
Q

Medications that Lower mortality in CAD

A

Aspirin
B blocker
Nitroglycerin

246
Q

Treatment in CAD for pts with low EF/systolic dysfunction (best mortality benefit) and regurgitant valvular disease

247
Q

The most common effect of statin medications

A

Liver dysfunction

248
Q

Fibrates plus statins

A

Increase myositis

249
Q

Edema, constipation, heart block

A

Adverse effects of CCB

250
Q

What is the best step in management for CAD when a pt has severe asthma precluding the use of BB, prinzmetal variant angina, cocaine induced chest pain

A

CCBs (verapamil/diltiazem)

251
Q

Internal mammary artery grafts last how many years?

252
Q

Saphenous vein grafts last how many years?

253
Q

ACS best initial step in management?

254
Q

ACS EKG shows ST elevation

255
Q

ACS EKG shows no ST elevation

A

Next get cardiac biomarkers
If + NSTEMI
If - Unstable Angina

256
Q

Increased JVP on inhalation

A

Kussmaul sign- constrictive pericarditis

257
Q

Triphasic scratchy sound

A

Pericardial friction rub

258
Q

May present several days after MI

A

Dressler Syndrome

259
Q

What is the best initial step in ACS management after performing an EKG?

260
Q

After performing an EKG and giving pt aspirin what is the best next step in management ?

A

Angioplasty

261
Q

Acute cholangitis

A

Fever, RUQ pain, jaundice (Charcot triad)

+ hypotension and AMS (Reynolds pentad)

262
Q

Treatment for acute cholangitis

A

Antibiotic coverage ERCP within 24-48 hrs

263
Q

Diagnosis of acute cholangitis

A

Increased direct bili, alk phos, mildly increased ast/alt

Biliary dilation on abdominal U/S or CT scan

264
Q

Autoimmune hepatitis txt and lab findings

A

Elevated ANA and ASMA (anti-smooth muscle antibodies), elevated transaminases Txt: oral glucocorticoids

265
Q

Tumors of the head of the pancreas present with this on imaging

A

Intra and extrahepatic biliary tract dilation

Step 2 CK (6 decks)

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