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Mistakes > Cumulative Review > Flashcards

Cumulative Review Flashcards

1
Q

Calcineurin Inhibitors

A

Cyclosporine

Tacrolimus

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2
Q

Major side effects of Cyclosporine

A 
Nephrotoxicity
Hyperkalemia
Hypertension
Gum Hypertrophy
Hirsutism
Tremor
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3
Q

Major side effects of Tacrolimus

A

Nephrotoxicity
Hyperkalemia
Hypertension
Tremor

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4
Q

Fleshy immobile mass on the midline hard palate

A

Torus Palatinus
Congenital
May increase in size over time
No intervention necessary unless it becomes symptomatic

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5
Q

Niemann-Pick Vs. Tay-Sachs

A

Niemann-Pick - Sphingomyelinase Deficiency

Tay-Sachs - Beta Hexosaminidase A deficiency

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6
Q

Baby meets milestones
Within first 6 months, regresses from milestones
Cherry red macula
Feeding difficulty/hypotonia

A

Areflexia = Niemann-Pick (Sphingomyelinase deficiency)
Also has hepatosplenomegaly

Hyperreflexia = Tay-Sachs (Beta Hexosamindase deficiency)

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7
Q

Someone is resuscitated with 1/2 NS

A

Think iatrogenic hyponatremia

Treat with hypertonic saline & close monitoring of lytes

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8
Q

Flu Vaccine guidelines

A

Annually in all adults

IM inactivated is more effective than live attenuated

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9
Q

Td booster guidelines

A

Every 10 years

Tdap as one-time dose in place of Td

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10
Q

Pneumococcal vaccine guidelines

A

All adults >=65 get PCV13 (conjugate), then PPSV23 (polysaccharide) later

Also true for adults < 65 with high-risk comorbid conditions:
CSF Leaks
Sickle Cell Disease
Cochlear Implants
Asplenia
Immunocompromised
Adults <65 with conditions increasing the risk of invasive pneumococcal disease:
Heart or lung disease
Diabetes
Smoking
Chronic liver disease

Start with PPSV23 alone, then do the PCV13 PPSV23 sequence after 65

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11
Q

Cat bite care

A

Irrigation & ceaning
Augmentin (PPX for pasturella)
Tetanus booster (if not up to date)
Avoid closure

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12
Q

School-age child comes in with viral symptoms and proteinuria but no hematuria

A

Repeat urine dipstick on 2 separate occasions

Probably transient proteinuria or orthostatic proteinuria, but if still positive 2 more times, investigate for significant renal disease

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13
Q

Meningococcal vaccine guidelines

A

Primary vaccination at age 11 - 12
Booster at age 16 - 21

High Risk:
Complement deficiency
Asplenia
College students in residential housing (age <= 21)
Military recruits
Travel to endemic environments (Africa, Mecca, Saudi Arabia)

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14
Q

Patients receiving TNF antagonists should not get

A

Live-Attenuated Vaccines:
Varicella
Influenza (intranasal)
MMR

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15
Q

Yellow fever vaccination

A

Required for some countries in central africa

If allergic to eggs, or immunocompromised, must get a documented medical waiver instead, and be counseled on mosquito protection

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16
Q

Properties of a confounder

A

It is linked to the exposure

It is linked to the outcome

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17
Q

Pericardial thickening & calcification

Sharp X & Y descents

A

Constrictive pericarditis

TB causes this in Africa, India & China

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18
Q

First line therapy for narcolepsy

A

Modafinil (nonamphetamine, promotes wakefulness)

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19
Q

Most common cause of aplastic crisis in sickle cell anemia patients?

A

Parvovirus B19

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20
Q

PAS-positive material in the lamina propria of small intestine

A 
Whille's Disease
Tropheryma Whillelii (Bacillus)
Arthralgias
Weight Loss
Feber
Diarrhea
Abdominal Pain
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21
Q

Patient presents with iron deficiency anemia

A

Do endoscopy to look for source of bleeding

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22
Q

Tricuspid valve infective endocarditis in IVDU

A

Throws septic emboli with staph aureus

Pulmonary infiltrates, abscesses, infarct, gangrene, cavities

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23
Q

Transaminitis
Macrocytosis
Early morning waking

A

Alcohol use disorder

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24
Q

Recurrent sinopulmonary infections (sinusitis, pneumonia)
Recurrent GI infections (giardia)
Associated with autoimmune diseases & atopy

A

Selective IgA deficiency

Transfusions lead to anaphdylaxis from Ab against IgA

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25
Q

Temperature in neonatal sepsis

A

High OR Low

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26
Q

Causes of amaurosis fugax

A

Temporal Arteritis

Carotid Atherosclerosis

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27
Q

Kid has a virus

Kid gets Aspirin or other NSAIDs

A

Kid gets Reye syndrome

Microvesicular fatty infiltration of the liver. Causes acute liver failure:
Transaminitis
Coagulopathy
Nausea/Vomiting
Hypermmonemia
Encephalopathy
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28
Q

Sensory loss
Rest pain
Muscle weakness

A

Immediately threatened limb

Start anticoagulation

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29
Q

Alkalosis has what effect on calcium?

A

More is bound to albumin

Functional hypocalcemia even though total body calcium is normal.

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30
Q

Stroke in an IVDU

A

Think endocarditis, especially if there is a fever

Antiplatelet therapy is only good for patients with atherosclerotic disease, so no need to put them on that therapy.

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31
Q

Tick bite in the south
Fever, malaise, AMS
Transaminitis & high LDH
Leukopenia and/or Thrombocytopenia

A

Ehrlichiosis

Give empiric doxy while awaiting confirmatory testing
Diagnosis is clinical, but can be confirmed by seeing:
Intracytoplasmic morulae in WBC
Also can confirm with PCR

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32
Q

Treatment for Ehrlichiosis

A

First Line - Doxycycline

Second LIne - Chloramphenicol

33
Q

Appearance of a TOA on ultrasound

A

Complex multiloculated adnexal mass

CRP & CA-125 will be elevated
Leukocytosis

34
Q

Lymphadenopathy that is small, mobile, nontender, soft

A

Will regress on its own within several weeks. Observe.

Only evaluate with CBC, viral titers, inflammatory markers if the LAD persists

35
Q

Risk factors for neonatal respiratory distress syndrome

A

PREMATURITY

Male Sex
Perinatal Asphyxia
MATERNAL DIABETES (Delays maturation of surfactant production)
C-section without labor

36
Q

Mechanism of maternal diabetes leading to fetal underdevelopment of surfactant

A

Maternal hyperglycemia triggers fetal hyperglycemia
Hyperinsulinism antagonizes cortisol
Sphingomyelin can’t mature, and surfactant needs that.

37
Q 
High Sed Rate
Positive Rheumatoid Factor
Nonspecific infectious symptoms
Cardiopulmonary symptoms
Immune-complex glomerulonephritis
Painful hand nodes
A

Infective endocarditis

38
Q

Peripheral Neuropathy
Heart Failure
Wernicke-Korsakoff Syndrome

A

Thiamine Deficiency

Whole grains, meat, fortified cereal, nuts, legumes

39
Q 
Angular cheilosis
Stomatitis
Glossitis
Normocytic anemia
Seborrheic dermatitis
A

Riboflavin Deficiency

Dairy, eggs, meat, green vegetables

40
Q

Dermatitis
Diarrhea
Delusions/Dementia
Glossitis

A

Niacin Deficiency

Meat, whole grains, legumes

41
Q 
Cheilosis
Stomatitis
Glossitis
Irratibility
Confusion
Depression
A

Pyridoxine Deficiency

Meat, whole grains, legumes, nuts

42
Q

Megaloblastic anemia

Neural tube defects

A

Folate Deficiency

Green leafy vegetables, fruit, meat, fortified cereal/grains

43
Q

Megaloblastic anemia
Confusion
Paresthesias
Ataxia

A

Cobalamin Deficiency

Meat, dairy

44
Q

Punctate hemorrhage
Gingivitis
Corkscrew hair

A

Scurvy

Citrus fruits, strawberries, tomatoes, potatoes, broccoli

45
Q

Causes of normal anion gap metabolic acidosis

A 
Diarrhea
Fistulas
Carbonic anhydrase inhibitors
RTA
Ureteral diversion
Iatrogenic
46
Q

Non-anion gap metabolic acidosis

Preserved kidney function

A

RTA

47
Q

Type 4 RTA

A

Hyperkalemic RTA
Metabolic acidosis
Preserved renal function
Poorly controlled diabetes

48
Q

Elevated T4

Normal TSH

A

T4-binding globulin is increased

Could be from estrogen (OCPs, pregnancy, HRT, hepatic dysfunction, tamoxifen)

49
Q

Preterm labor < 32 weeks

A

Betamethasone
Tocolytics
Magnesium sulfate
Penicillin if GBS positive or unknown

50
Q

Reversible causes of asystole/PEA

A 
Hypovolemia
Hypoxia
Hydrogen ions
Hypokalemia (or hyperkalemia)
Hypothermia
Tension pneumothorax
Tamponade
Toxins (narcotics, benzos)
Thrombosis
Trauma
51
Q

12 month milestones

A

Gross motor:
Stands well
Walks first steps
Throws a ball

Fine:
2 finger pincer grasp

Language:
First words (other than mama and dada)

Social:
Separation anxiety
Follows 1-step commands with gestures

52
Q

18 month milestones

A

Gross Motor:
Runs
Kicks a ball

Fine:
Builds a tower of 2 - 4 cubes
Removes clothing

Language:
10 - 25 words
Identifies at least 1 body part

Social:
Understands “mine”
Begins pretend play

53
Q

2 year milestones

A

Gross Motor:
Stairs w/ both feet on each step
Jumps

Fine:
Builds a tower of 6 cubes
Copies a line

Language:
50+ words
2-word phrases

Social:
Follows 2-step commands
Parallel play
Begins toilet training

54
Q

3 year milestones

A

Gross Motor:
Stairs with alternating feet
Tricycle

Fine:
Copies circle
Uses utensils

Language:
3-word sentences
Speech 75% intelligible

Social:
Knows age/gender
Imaginative play

55
Q

4 year milestones

A

Gross Motor:
Balances & hops on 1 foot

Fine:
Copies a cross

Language:
Identifies colors
Speech 100% intelligible

Social:
Cooperative play

56
Q

Side effects of Beta-2 Agonists

A

Hypokalemia (Drive potassium into cells)
Tremor
Headache
Palpitations

57
Q

Why does polycythemia in the neonate lead to respiratory distress?

A

As hematocrit rises, so does viscosity of blood. It can’t reach vital organs, and it also leads to hypoglycemia and hypocalcemia from increased cellular uptake

58
Q

Mediastinal mass

A 
Bronchogenic cyst (benign)
Tracheal tumors
Pericardial cysts
Lymphoma
Lymph node enlargement
Aortic aneurysms of the arch
59
Q

Where are neurogenic tumors in the mediastinum found?

A

Posterior mediastinum

Meningocele
Enteric cysts
Lymphomas
Diaphragmatic hernias
Esophageal tumors
Aortic aneurysms
60
Q

Fanconi Anemia

A

AR or XLR
Chromosomal breaks on genetic analysis

Aplastic anemia
Progressive bone marrow failure
Short stature
Microcephaly
Abnormal thumbs
Hypogonadism
Hypopigmented/hyperpigmented areas
Cafe au lait spots
Large freckles
Strabismus
Low-set ears
Middle ear abnormalities
61
Q

Acquired causes of aplastic anemia

A 
Drugs
Toxins (benzene, glue, etc)
Idiopathic
Viral infections
Immune disorders
Thymoma
62
Q

Most common congenital cause of aplastic anemia

A

Fanconi Anemia
AR or XLR
Chromosomal breaks
Genes involving DNA repair are implicated

63
Q

Things that make Crohns different from UC

A 
Crohns:
Multiple portions of the GI tract
Noncaseating granulomas
Rectal sparing
Fistula formation
64
Q

Toddler hematochezia

A 
Hemorrhoids
Infectious colitis
Intussusception
Meckel's diverticulum
Inflammatory bowel disease
65
Q

Technetium-99m Pertechnetate Scan

A

Scan to detect Meckel’s!

66
Q

Waldenstrom macroglobulinemia

A 
Lymphoplasmocytic malignancy
Excessive monoclonal IgM
End organ damage
>10% clonal B cells by bone marrow biopsy
Hyperviscosity syndrome comes with it
67
Q 
Diplopia
Tinnitus
Headache
Dilated/segmented funduscopic findings
Neuropathy
Infiltrative disease (hepatosplenomegaly, anemia, thrombocytopenia)
A

Hyperviscosity Syndrome

68
Q

UTI with alkaline urine

A

Proteus (most common)
Klebsiella (also possible)

Elevated risk for struvite stones (magnesium ammonium phosphate)

69
Q

Wallenberg Syndrome

A

Hoarse voice and falling to the right
Lateral medulla
Ipsilateral horner’s syndrome
Contralateral hemianesthesia in the body (ipsilateral in the face)

70
Q

Eczema
Microthrombocytopenia (small platelets, low count)
Recurrent infections

A

Wiskott-Aldrich Syndrome
XLR in WAS protein gene
Impaired cytoskeleton changes in leukocytes & platelets
Treatment is stem cell transplant

71
Q

RLQ pain & tenderness that isn’t appendicitis but is infectious

A

Psoas abscess

Abdominal CT scan to diagnose

72
Q

Cardioversion vs. Defibrillation

A

Cardioversion is synchronized to the QRS complex, appropriate for persistent tachyarrhythmia causing hemodynamic instability

Defibrillation gives electricity at at a random point in the cycle. Appropriate for VFib or pulseless VTach

73
Q

Electrolytes of Tumor Lysis Syndrome

A

Increased:
Potassium
Phosphorous
Uric Acid

Decreased:
Calcium (bound by phosphate that is released)

Leads to AKI (uric acid and calcium phosphate deposition) & cardiac arrhythmias

Prophylaxis = Allopurinol or rasburicase, IV Fluids

Treatment = Continuous telemetry, aggressive electrolyte management

74
Q

Jaundice
Nontender, but palpable gall bladder (Courvoisier’s sign)
L supraclavicular adenopathy

A

Pancreatic adenocarcinoma

Abdominal untrasound first
Then abdominal CT
ERCP has very high sensitivity & specificity, but is so invasive that it only should be done if CT is nondiagnostic.

75
Q 
Infant with:
Growth failure
Recurrent respiratory infections
Greasy stool
Bruises
A

Cystic Fibrosis!

Pancreatic insufficiency leads to malabsorption and Vitamin K deficiency

76
Q

Patient has Hodgkin’s Lymphoma and is cured. Now has a pulmonary mass on CXR. What is it?

A

Second malignancy

Having hodgkin’s gives you an 18.5 fold chance of developing another malignancy in your life

77
Q

Prinzmetal angina

A

Vasospastic angina

Recurrent angina during rest or sleep

78
Q

ESRD patient needs bridge to warfarin. What do you use?

A

Unfractionated heparin. LMWH is too associated with bleeding.

Mistakes (8 decks)

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