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USMLE3 > Deck2 > Flashcards

Deck2 Flashcards

1
Q

Diarrhea. High: bili, LDH, retic, Cr, schistocytes+. Low: PLT.
Dx?

A

HUS

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2
Q

BK virus assn?

A

renal transplant rejection

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3
Q

Most sensitive test neurosyphilis?

A

CSF FTA (99% sensitive)

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4
Q

OM suspected. XR neg for assd changes. NSIM?

A

MRI (if contraindications, bone scan).

If suggestive > bone bx

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5
Q

Bilateral Bells Palsy. Assd Dx?

A

Lyme

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6
Q

Tick attached in non-endemic area. ASx. NSIM?

A

Remove tick, reassure.

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7
Q

Tx Lymes

A

Doxy or Amox

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8
Q

Arthralgia, eye pain, pathergy. Dx?

A

Behcet

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9
Q

Preg F, HBV needle stick. Had vaccine but Abs undetectable. NSIM?

A

Ig & vax

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10
Q

M w/ urinary urgency, frequency, burning. Dx/Tx?

A

urinary NAAT. Tx: azithro/ceftriaxone

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11
Q

Trichomonas- Best Dx test?

A

NAAT

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12
Q

Why is RPR not the best test for syphilis?

A

Neg in 25%, takes several months to be positive

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13
Q

3 best drugs for MRSA cover

A

Doxy
TMP-SMX
Clinda

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14
Q

Mupirocin is only for:

A

impetigo (it has less AE than bacitrcin/neomycin)

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15
Q

Histoplasmosis- Dx test & Tx?

A

Urinary Ag, Amphotericin

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16
Q

The only situation in which you would delay HAART

A

Cryptococcal inf.

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17
Q

Tx travellers diarrhea

A

Azithromycin

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18
Q

Tx Anaplasma/Erlichia

A

Doxy

Dx: serologu IgG/IgM

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19
Q

Hunter: LAD, myalgia, conjunctivitis, PNA, ulcer on hand. Dx?

A

Tularemia (assn w/ rabbits)

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20
Q

Tx Dengue

A

Supportive. Note vax exists.

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21
Q

Tx Listeria meningitis

A

Ampicillin-gentamycin

if PNC allergy TMP-SMX

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22
Q

Tx mucor mycosis

A

Amphotericin

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23
Q

Tx cryptococcal meningitis

A

Amphotericin & flucytosine

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24
Q

Most ACCURATE test Crypto meningitis?

A

CSF Ag & fungal Cx, NOT india ink

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25
Q

Neck stiffness. CSF: high protein, high opening pressure, low cell count. Dx?

A

Cryptococcal meningitis. V poor prognosis.

also high cryptococcal Ag

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26
Q

Peroneal palsy causes:

A

foot drop

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27
Q

Most spec test for meningitis (from CSF)

A

Cx

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28
Q

Bacterial meningitis suspected. Tx?

A

Vanc//ceftriaxone

ADD GCS if: S.pneumo (MCC) or TB

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29
Q

When to order head CT in setting of suspected meningitis

A

focal findings, severe papilledema, severe confusion

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30
Q

Cluster HA: abortive Tx?

A

Abortive: TRIPTAN (if contraindicated > 100% O2)

Triptans are contraindicated in preg & CAD

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31
Q

MCC migraine trigger

A

emotions

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32
Q

Cluster HA: PPX?

A

PPX: verapamil, prednisone, lithium

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33
Q

Triptans contraindications?

A

CAD & preg

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34
Q

Aprepitant use & drug class?

A

antiemetic for chemo.

MOA: neurokinin 1 receptor antagonist

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35
Q

Migraine drugs worsen ______

A

Parkinsons (prochlopromazine, metoclopramide)

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36
Q

Papilledema may cause ___ palsy

A

CN VI palsy & compression of the optic nerve

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37
Q

First line OCD Tx

A

SSRI

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38
Q

Avoid anticholinergics in following Dx:

A

Glaucoma, constipation, BPH

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39
Q

Medication for IBD flare?

A

GCS

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40
Q

Which correlates w/ IBD disease activity?

  1. erythema nodosum
  2. pyoderma gangrenosum
  3. PSC
A
  1. erythema nodosum
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41
Q

MCC UC flare

A

NSAIDs

note: quitting smoking may cause flare as smoking is protective in UC

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42
Q

GCS sparing agent in IBD?

A

6MU- Azathioprine

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43
Q

Why would you give GCS to an UC patient to plans to quit smoking?

A

quitting smoking may cause flare as smoking is protective in UC

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44
Q

Preg w/ fistulizing Crohns. Tx?

A

infliximab

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45
Q

Fecal WBC+, RLQ pain, rash. Dx?

A

r/o Yersinia (pseudoappendicitis)

Tx TMP-SMX

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46
Q

Tx Yersinia

A

TMP-SMX

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47
Q

Steatorrhea, small bowel diverticulae, FOBT-, Hgb 8. Dx?

A

Pernicious anemia in setting of SIBO (note diverticulae/steatorrhea are signs of SIBO)
Tx: rifaximin

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48
Q

Tx SIBO

A

rifaximin (also metro, cipro, tetracycline, amox)

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49
Q

1cm tubular adenoma, next colonoscopy?

A

3-5y

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50
Q

34yo FHx father CRC age 55. Age of first colonoscopy with subsequent screen intervals?

A

40yo then Q5yrs

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51
Q

Lynch syndrome colonoscopy interval?

A

Q1-2y

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52
Q

Tx ectopic pregnancy: Stable VS unstable

A

Stable: MTX
Unstable: Surg

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53
Q

MC location of ectopic pregnancy

A

ampulla of fallopian tubes

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54
Q

Ectopic pregnancy: RFs

A 
Hx ectopic preg
In vitro 
PID
Hx pelvic surg
tobacco
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55
Q

hCG+ & complex adnexal mass. Dx?

A

Ectopic preg

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56
Q

Edema w/ CCB:

  • prevalence
  • MOA
  • Tx
A

25%
MOA: preferential dilation of precapillary vessels > increased capillary hydrostatic pressure > extravasation
*** decreased if combined w/ ACEi (which cause post-capillary dilation)

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57
Q

AE of DHP CCBs

A

edema (25%)
HA
flushing
dizziness

(amlo, nifedipine)

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58
Q

AE of HCTZ

A
  • hypoK, hypoNa
  • hyperuricemia
  • hyperglycemia
  • renal failure
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59
Q

goal BP in ischemic CVA

A

<180/105

if above, give IV labetaolol or nicardipine: rapid onset, easy titration
No role of PO antiHTN meds in this period

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60
Q

When to resume anticoag sp tPA for CVA

A

at 24h before antiPLT, anticoag or invasive procedures

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61
Q

Low ADAMTS13 activity > DIC. Dx?

A

TTP
Sx: RF, neuro sx, fever, abd pain/N, rash
Tx: plasma exchange

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62
Q

Tx TTP

A

plasma exchange

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63
Q

Petechial rash, RF, thrombocytopenia, MAHA, AMS. Dx?

A

TTP

Tx: plasma exchange

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64
Q

3rd trim, hemolytic anemia, thrombocytopenia, high LFTs. Dx?

A

HELLP syndrome

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65
Q

Suppurative otitis media AKA:

A

AOM

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66
Q

Pathogen most commonly assd w/ TM rupture in AOM.

A

group A strep

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67
Q

Cranky infant w/ AOM. Suddenly crankiness improves. What do you suspect?

A

TM rupture

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68
Q

Elderly pt reports tripping over rug. No LOC/dizziness. Which test do you perform?

A

Get-up-and-go test. If pt is unsteady/has difficulty, further eval necessary.

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69
Q

Average risk pt on anticoag for afib. Risk of bleed requires pt for fall __x

A

300x (low risk, hence AC benefits>risk)

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70
Q

CURB65 score

A 
Confusion 
Urea >20
RR >30
BP <90/60
>65yo

2- hospital admit
3+- ICU

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71
Q

Elderly televisit, possible PNA. NSIM?

A

CURB-65, send to ER for further eval.

High RF:

  • > 65
  • pulm, cardiac, renal d
  • immunosupp
  • morbid obesity
  • natives
  • NH
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72
Q

High risk cardiac conditions (prosthetic valve, hx IE, CHD subtypes): When is bacterial endocarditis ppx required?

A
  • dental surg
  • resp tract incision
  • GU/GI procedure in setting of infection
  • surg infected skin/m
  • surg prosthetic valve material
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73
Q

Which of the following is NOT indication for bacterial endocard ppx?

  • dental surg
  • resp tract incision
  • GU/GI procedure
  • surg infected skin/m
  • surg prosthetic valve material
A
  • GI/GU procedure (UNLESS active infection)
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74
Q

Tx for anovulatory bleed in menopausal transition.

A
  • cyclic progestin tx
  • low dose OCP
  • hormonal IUD
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75
Q

Indication for uterine bx in setting of anovulatory uterine bleed during menopausal transition.

A
  • > 45 w/ suspected anov bleed

- <45 w/ persistent abnormal bleed or RFs (obesity. PCOS)

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76
Q

Pathophys anovulatory bleed in menopausal transition.

A
  • oocyte depletion & abnormal follicular development

- failure of ovary to secrete progesterone

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77
Q

Meds w/ MCC AE in elderly

A
  • anticholinergics
  • antipsych
  • antiHTN
  • sedatives
  • diuretics
  • NSAIDs
  • GCS
  • digoxin
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78
Q

Most important factor in periop adverse drug RXN in elderly?

A

Multiple meds

(note: already higher risk per
- high gastric pH > higher absorp
- low GFR
- reduced body water)

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79
Q

Standard enteral feeding = ___ kCal/kg/day w/ __g/kg/day protein

A

30 kCal/kg/day
1 g/kg/day protein

(less if malnourished)

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80
Q

PE suspected in preg. NSIM?

A

V/Q +/- LE doppler

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81
Q

Asthma exacerbation in pregnancy, goal sats?

A

> 95% to prevent fetal hypoxia

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82
Q

GBS suspected. Which test is crucial?

A

frequent measurement of vital capacity & neg inspiratory force to monitor resp status (30% require intubation)

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83
Q

CSF in EBV

A

high protein

normal WBC

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84
Q

EBV Tx?

A

plasma exchange or IVIg (if non-ambulatory, w/in 4wks sx)

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85
Q

Tx botulism

A

serum antitoxin & abx

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86
Q

Tx transverse myelitis

A

high dose GCS

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87
Q

Evolution of GBS infection?

A
  • 2wks progressive motor weakness
  • 2-4wks plateau sx
  • slow, spontaneous recovery over months

IVIg or plasma exchange shortens course by 50%

by 1yr -85% can walk, 60% full remission

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88
Q

Prognosis GBS

A

IVIg or plasma exchange shortens course by 50%

by 1yr -85% can walk, 60% full remission

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89
Q

Motor weakness, paresthesias, autonomic dysfunction (bowel/bladder), sensory deficit, RF for MS in future. Dx?

A

Transverse myelitis (tx: high dose GCS)

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90
Q

Maroon hematochezia, orthostatics+, hypoTN, tachy. NSIM?

A

EGD (15% hematochezia: UGIB). Higher suspicion for UGIB if hemodynamic instbility+

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91
Q

Best way to approach acutely psychotic pt w/o insight?

A

avoid challenging their beliefs and maintain interpersonal distance

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92
Q

AE of following:

  1. Ginko biloba
  2. Ginseng
  3. Kava
A
  1. increased bleed
  2. increased bleed
  3. severe liver inj
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93
Q

AE licorice

A

HTN

hypO-K

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94
Q

Black cohosh known AE

A

hepatic injury

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95
Q 
Which may cause HTN crisis?
A. Ginko
B. Ginseng
C. Echinacea
D. St.Johns Wort
E. Kava
F. Black Cohosh
A

D - St Johns Wort

also: drug interactions w/ SSRI, OCPs, anticoag, digoxins

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96
Q

Which may cause allergic reactions & dyspepsia?

A. Ginko
B. Ginseng
C. Echinacea
D. St.Johns Wort
E. Kava
F. Black Cohosh
A

C. Echinacea

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97
Q

AE: bleed risk

A. Ginko
B. Ginseng
C. Echinacea
D. St.Johns Wort
E. Kava
F. Black Cohosh
A

A&B

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98
Q

MCC nonbullous impetigo

A

MCC: S.aureus
~S.pyogenes

Tx: topical mupirocin or PO keflex if severe

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99
Q

Tx nonbullous impetigo

A

Tx: topical mupirocin or PO keflex if severe

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100
Q

Diarrhea: watery, non-bloody x 2 days, abd cramps. Afebrile. Recent travel. Likely dx?

A) Rotavirus
B) Norovirus
C) E.coli 
D) Salmonella
E) Shigella
F) Giardia
G) Cryptosporidium
H) Campylobacter
A

C) E.coli (ETEC)

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101
Q

Bloody D, severe RLQ pain. Dx?

A) Rotavirus
B) Norovirus
C) E.coli 
D) Salmonella
E) Shigella
F) Giardia
G) Cryptosporidium
H) Campylobacter
I) Vibrio parahemolyticus
A

H) Campylobacter

pseudoappendicitis like Yersinia!

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102
Q

Brief illness, predominantly vomiting. Dx?

A) Rotavirus
B) Norovirus
C) E.coli 
D) Salmonella
E) Shigella
F) Giardia
G) Cryptosporidium
H) Campylobacter
I) Vibrio parahemolyticus
A

A & B

+/- nonbloody D & fever

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103
Q

Chronic illness in immunocompromised. Dx?

A) Rotavirus
B) Norovirus
C) E.coli 
D) Salmonella
E) Shigella
F) Giardia
G) Cryptosporidium
H) Campylobacter
I) Vibrio parahemolyticus
A

G) Cryptosporidium (esp Isospora)

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104
Q

Pt has is giardia, now ASx. How long are they contagious?

A

months

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105
Q

Seafood > Diarrhea- watery/bloody, abd cramps, N/V, fever. Dx?

A) Rotavirus
B) Norovirus
C) E.coli 
D) Salmonella
E) Shigella
F) Giardia
G) Cryptosporidium
H) Campylobacter
I) Vibrio parahemolyticus
A

I) Vibrio parahemolyticus

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106
Q

Gold standard for detecting CF?

A

sweat chloride test

if Cl elevated in 2 tests= diagnostic

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107
Q

X-linked immune disorder w/ severe bacterial/fungal PNA & skin infection. Dx test and diagnosis?

A

dihydrorhodamine 123 oxidation

Dx: Chronic granulomatous disease

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108
Q

MC complication of RSV in infants?

A

Recurrent wheezing in >30%.

**Advise pts to avoid triggers of airway reactivity esp cigarette smoke

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109
Q

Bronchiolitis
1- MCC
2- Dx work up
3- Tx

A

1- RSV
2- clinical
3- supportive

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110
Q

Indications: bronchiolitis PPX

A

Palivizumab for:

  • <29w gest
  • chronic lung disease of prematurity
  • hemodynamically significant CHD
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111
Q

1yo w/ nasal congestion/discharge, cough. Wheezing/crackles, resp distress (tachypnea, retractions, nasal flaring). Tx?

A

Supportive (bronchiolitis/RSV).

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112
Q

When is risk of apnea highest w/ bronchiolitis/RSV infection?

A

<2mo

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113
Q

BV can be treated with metro OR ____

A

Clindamycin

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114
Q

Frothy green/yellow discharge, vaginal pruritis/erythema +/- punctate hemorrhages. Dx?

A

Trichomoniasis, Tx metro

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115
Q

Widespread T cell activation via exotoxins acting as superAg. What do you expect in the history?

A

Tampons or nasal packing

|&raquo_space;massive cytokine release&raquo_space; TSS

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116
Q

TSS Tx?

A

IVF (up to 20L/day), Clinda (prevents toxin synth) +/- vanc or ox/nafcillin

Remove tampon/nasal packing.

DONT GIVE GCS- not useful

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117
Q

Influenza vax is recommended ____ to ____ (months)

A

Sept-April

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118
Q

Indications for IVC placement in setting of PE?

A
  • AC complications
  • AC contraindications
  • AC failure in setting of PE/DVT
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119
Q

55yo w/ PE, given SC enox & warfarin&raquo_space; severe UGIB, EGD showing many ulcers. NSIM?

A

STOP warfrin & enox. Place IVC filter.

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120
Q

PE. Which antcoag do you give?

A

PO Warfarin & SC heparin/LMWH

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121
Q

Mutation in filaggrin gene. Dx?

A 
Atopic derm
(skin barrier dysfunction & Th2 skewed immune response > IgE production)
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122
Q

Atopic derm: skin barrier dysfunction & Th2 skewed immune response > ___ production

A

IgE

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123
Q

What prevents atopic derm?

A

Early exposure to non-pathogenic microorganisms: daycare, dogs, farm etc

(Atopic derm: skin barrier dysfunction & Th2 skewed immune response > IgE production)

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124
Q

Subchorionic hematoma on US in F w/ some spotting in first trim. Tx?

A

Expectant, serial US to monitor. RF for:

  • spontaneous abortion
  • abruptio placentae
  • PPROM
  • preterm delivery
  • preeclampsia
  • fetal growth restriction
  • intrauterine fetal demise
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125
Q

Which is NOT a complication of subchorionic hematoma?

A) spontaneous 
B) abruptio placentae
C) placenta accreta 
D) PPROM
E) preterm delivery 
F) preeclampsia
G) fetal growth restriction
H) intrauterine fetal demise
A

C) placenta accreta

(RF for subchorionic hematoma:

  • infertility Tx
  • anticoag
  • uterine abn
  • recurrent preg loss
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126
Q

Dose of folate supplementation to prevent NTD?

A

average risk: 0.4mg
high risk: 4mg
(ie. hx NTD, seizure meds/MTX, DM, low folate intake)

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127
Q

Neural tube formation occurs by __ weeks gestation

A

6

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128
Q

MCC CAH: ___ deficiency

A

21-hydroxylase

elevated 17 hydroxyprogesterone

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129
Q

F infant w/ ambiguous genitalia, hypotension, hypoNa, hyperK, hypoglyc. Tx?

A

Likely CAH (MCC 21 hydroxylase deficiency)

Tx: hydrocortisone & fludrocortisone

  • high salt diet
  • +/- genital reconstructive surgery (females)
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130
Q

Mnemonic for CAH- which have HTN? virulization?

A

CAT mnemonic w/ 1s as arrows up.

HTN: 17a hydroxylase & 11b hydroxylase def

virulization: 21 & 11 hydroxylase

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131
Q

Bronchoprovocation test: FEV1 decreased by >__ is positive, by >__ is diagnostic

A

> 10 positive

>15 diagnostic

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132
Q

Pathomech of exercise-induced bronchoconstriction?

A

smooth muscle constriction triggered by exertion VS large amounts of cold/dry air&raquo_space; mast degran

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133
Q

Tx exercise induced asthma?

A

SABA 10-20 min before exercise w/ inhaled GCS if regular exercise

(mast cell stabilizers may be used for patients who dont tolerate SABA. Ex: cromolyn or nedocromil)

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134
Q

Exercise induced asthma but pt cannot tolerate SABA. Tx?

A

mast cell stabilizers may be used for patients who dont tolerate SABA. Ex: cromolyn or nedocromil

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135
Q

Tx cyanide toxicity?

A

sodium thiosulfate

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136
Q

Initial HTN goal in setting of HTN emergency?

A

Lower BP no more than 25% in 2-6h (to avoid MI, isch CVA, AMS, seizures)

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137
Q 
Signs/Sx of extending dissection: 
A) motor abnorm
B) sensory abnorm
C) seizures
D) AMS
E) aphasia
A

A, B, E

NOT seizures/AMS

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138
Q

Pt s/p Tx of HTN emergency then develops AMS & unexplained metabolic acidosis. Dx?

A

Suspect cyanide toxicity w/ nitroprusside.

Tx sodium thiosulfate

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139
Q

Single factor indications for stress ulcer PPx EXCEPT:

  • PLT <50k
  • INR >1.5
  • PTT >2x norm
  • intubation >48h
  • > 1wk ICU stay
  • GIB/PUD w/in 12m
  • head truma
  • spinal cord injury
  • major burn
A

> 1wk ICU stay (this requires another factor to qualify for stress ulcer PPX) ie:

  • GCS
  • occult GIB >6 days
  • sepsis
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140
Q

MOA stress ulcers in:

  • head trauma
  • sepsis
A

head trauma: increases gastrin secretion > parietal cell stimulation> acid secretion

sepsis: mucosal ischemia `

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141
Q

M infant w/ palpable bladder & US w/ bilateral hydronephrosis, dilated/thickened bladder & oligohydramnios. Dx?

A

Posterior urethral valves (likely abnormal insertion of Wolffian ducts)

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142
Q

Which is most associated w/ unilateral hydronephrosis?

A) post urethral valve
B) uteropelvic junction obstruction
C) vesiculourethral reflux

A

B

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143
Q

Which is most associated w/ bladder thickening and dilation of the proximal urinary tract?

A) post urethral valve
B) uteropelvic junction obstruction
C) vesiculourethral reflux

A

A

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144
Q

Which is most associated w/ recurrent UTIs?

A) post urethral valve
B) uteropelvic junction obstruction
C) vesiculourethral reflux

A

C

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145
Q

Dx test for posterior urethral valves?

A

voiding cystourethrogram- visualization of the proximal urethra when the catheter is removed

Tx: cystoscopy (direct visualization & ablation)

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146
Q

Abx > bite cells, schistocytes, Heinz bodies. Dx?

A

G6PD deficiency- extravascular hemloysis triggered by oxidative stress

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147
Q

MCC Cold agglutinin mediated autoimmune hemolytic anemia?

A

viral infection (direct antiglutinin+)

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148
Q

Diagnostic test for G6PD def?

A 
G6PD assay (detects NADPH formation)
**may be false negative during acute hemolytic episode therefore recheck afterwards if strong suspicion
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149
Q

Widower in critical state. Two sons say “terminal extubation as dad would have wanted” and two daughters say “do everything you can”. NSIM?

A

Involve hospital ethics committee

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150
Q

Tx infertility in PCOS?

A

Clomiphene or Letrozole

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151
Q

Which drug depletes hypothalamic estrogen receptors?

A

Clomiphene (then hypothal percerives low estrogen&raquo_space; increased release of GnRH&raquo_space; LH & FSH&raquo_space;increased ovulation)

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152
Q

Describe the mechanism of the HPO axis.

A
  1. Ovarian theca cells produce angrogens
  2. Aromatase converts the angrogens to estrogen
  3. Hypothal percerives high estrogen
  4. decreased release of GnRH&raquo_space; LH & FSH 5. ovulation inhibited

*high estrogen inhibits ovulation, low estrogen encourages it

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153
Q

Leuprolide MOA

A

GnRH agonist - decreases pulsatile GnRH release, hence decreasing LH FSH release > inhibits ovulation

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154
Q

Smoking cessation at least __ weeks pre-op decreases post-op pulm complications

A

4+ weeks

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155
Q

When are PFTs indicaed pre-op?

A
  1. prior to lung RESECTION to estimate post-op lung vol
  2. optimize pre-op COPD control if baseline cannot be determined
  3. DDx dyspnea: ie. cardiac disease vs deconditioning
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156
Q

MOA MG

A

Abs against the AChR

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157
Q 
Which 2 meds DO NOT increase digoxin toxicity?
A) verapamil
B) enalapril
C) quinine
D) amiodarone
E) atenolol 
F) spironolactone
A

B & E

enalapril & atenolol

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158
Q

Which two vaccines should pregnant women get?

A

Tdap (btwn 27-36w)

influenza

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159
Q

MC AE breast implants

A

capsular contracture >pain, shape distortion, implant deflation/rupture

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160
Q

Are breast implants linked with breast CA?

A

NO

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161
Q

Risk of breastfeeding w/ silicone implants?

A

NONE.
Silicone levels are not elevated in those with implants and even if they were, silicone in milk is NOT harmful to infants).

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162
Q

How does breast CA screening differ for women w/ breast implants?

A

It doesnt.
Mammograms recommended at regular intervals.

(breast MRI Q2-3y to check for aSx rupture which could lead to scarring)

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163
Q

Neonate w/ T4 of 6 & TSH of 46. No clinical signs of hypothyroidism, NSIM?

A

Immediate Tx &
- endo referral
- thyroid US
- confirm labs
(note T4 crosses the placenta but levels drop after delivery)
**Early Tx to prevent neuro injury & permanent intellectual disability starting at 2wks

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164
Q

MCC hemoptysis

A

acute bronchitis

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165
Q

Threshold of carotid stenosis for endarterectomy?

A

> 70%

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166
Q

Carotid endarterectomy RISK>BENEFIT in the following situations:

A
  • poor surg candidates (comorb++)
  • ipsilateral CVA w/ persistent disabling sx
  • 100% occlusion
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167
Q

Delayed puberty, short stature but normal growth velocity, delayed bone age. Dx?

A) constitutional pubertal delay
B) familial short stature
C) hypothyroid
D) Kallmann

A

A) constitutional pubertal delay

(Tx: watchful waiting, +/- hormonal delay)

*pubertal onset correlates w/ FHx, normal expected adult height (FHx late bloomers)

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168
Q

Puberty is delayed if >__yrs M, > __yrs F

A

> 12 F, >14 M

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169
Q

Anosmia & hypogonadotropic hypogonadism. Males w/ cryptorchidism & micropenis. Dx?

A

Kallmanns

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170
Q

Constitutional pubertal delay. Tx?

A

Counselling. If significant psychosocial concerns: T & E for M >14, F >12 respectively.

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171
Q

Tender breast cyst shown to be simple on US. NSIM?

A

FNA

  • if nonbloody & cyst resolves: no Tx
  • if bloody > Bx & additional imaging

note: if simple breast cyst is asx, observe only

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172
Q

Serum prolactin and ___ are indicated for the eval of galactorrhea.

A

TSH

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173
Q

MCC of failure to thrive in infants?

A

Psychosocial stressors:

  1. poverty (lack of access to food)
  2. lack of knowledge of appropriate feeding techniques
  3. poor parental/child relationship (neglect/abuse)
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174
Q

Presentation v suspicious of gout. NSIM?

A

Arthrocentesis!! Even if highly suspected, should be confirmed (note uric acid levels may often be normal during exacerbation)

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175
Q

RF for gout?

A

Meds: diuretics, ASA< immune suppressants

Hx: surgery, trauma, recent hosp, CKD, organ transplant, vold depletion

Lifestyle: obesity, meat/seafood, high fat diet, excessive EtOH

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176
Q

Negatively birefringent needle shaped crystals under polarizing light. Dx?

A

Gout

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177
Q

Positively birefringent rhomboid shaped crystals. Dx?

A

Pseudogout

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178
Q

Tx acute gout

A
  1. NSAIDS!!!
  2. if CKD, CHF, PUD, on AC&raquo_space; colchicine
  3. if severe liver/renal failure or on drug inhibiting c p450&raquo_space;intraarticular GCS (unless >2 joints involved, then PO)
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179
Q

Colchicine

  • dose
  • most effective when:
  • contraindications
A
  • 1.2mg > 0.6 an hour later x 2-3 days after sx resolve
  • given w/in 24h sx onset
  • severe liver/renal d or other meds blocking c p450
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180
Q

When do you give intraarticular GCS for acute gout?

A
  • contraindications to NSAIDs AND colchicine (and only 1 or 2 joints affected)
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181
Q

Spinal rotation > __ degrees represents significant scoliosis.

A

7 deg

5deg in obese

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182
Q

Forward bend test in a 12yo shows 8deg spinal rotation. NSIM?

A

XR spine to confirm deg

if <7, reassurance

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183
Q

Purpose of putting thoracic block under the foot while evaluating scoliosis?

A

Block should correct thoracic prominence if 2/2 leg-length discrepancy

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184
Q

Cobb angle:
< __deg= normal
> __deg= scoliosis
> __deg= severe scoliosis

A

<10 normal
>10 scoliosis
>40 severe scoliosis

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185
Q

Suspected amaurosis fugax. What do you expect on physical exam?

A

Carotid bruit (v common finding)

NSIM: carotid US

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186
Q

Name the etiology of enuresis:

1) hypoTN, proteinuria/hematuria
2) low spec urine gravity
3) adenotonsillar hypertrophy

A
  1. CKD
  2. DI
  3. OSA

Also:

  • DM
  • UTI
  • overflow incontinence
  • constip
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187
Q

IVDU w/ HA, generalized maculopapulr rash, photophobia, neck stiffness, N/V, decreased hearing & occasional visual floaters. Dx?

A

Suspect secondary syphilis
(ie. Sx meningitis, ocular syphilis, otosyphilis, & likely early syphilis: rash, LAD)

CSF VDRL test is universally reactive

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188
Q

Most common helminths?

A
  • Ascaris (roundworm)
  • Trichuris (whipworm)
  • Ancyclostoma duodenale (hookworm)
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189
Q

Peripheral eosinophilia after pt returns from developing country. Most likely tx?

A

albendAZOLE for helminth infection

mebendazole is slightly better for hookworm

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190
Q

Tx for Entamoeba hystolitica vs Giardia?

A

Metronidazole (both protozoal)

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191
Q

Tx pregnant women and children w/ travellers diarrhea?

A

Azithromycin (in reg adults- azithro or cipro)

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192
Q

MC Tx travellers diarrhea?

A

Azithro or Cipro

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193
Q

20yo w/ depression, hepatic & neuro dysfunction (dysarthria, tremor). NSIM?

A

Slit lamo exam, r/o Wilsons

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194
Q

Beck triad: hypoTN, JVD+, decreased heart sounds. Dx?

A

Cardiac tamponade

Tx: cath pericardiocentesis or surgical pericardial window for rapid removal of pericardial fluid

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195
Q

TTE showing IVC collapse, R atrial & ventricular collapse. Dx?

A

Cardiac tamponade, most spec finding is “early diastolic collapse of R ventricle & atrium”

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196
Q

Tx cardiac tamponade?

A

cath pericardiocentesis or surgical pericardial window for rapid removal of pericardial fluid

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197
Q

Abnormal increase of JVP during inspiration- Dx?

A

constrictive pericarditis or restrictive cardiomyopathy

aka Kussmauls sign

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198
Q

SBP normally ____ (increases/decreases) w/ inspiration

A

decreases

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199
Q

Exaggerated drop in BP during inspiration d/t bowing of R ventricle into L ventricle. Which conditions?

A
  • cardiac tamponade
  • severe asthma
  • COPD
  • constrictive pericarditis
  • marked obesity
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200
Q

Blunt thoracic trauma. Best initial imaging?

A

FAST (focused assessment with sonography in trauma)

- ID of injuries that can be rapidly fatal (PTX, aortic dissection, hemoperitoneum, pericardial effusion > tamponade)

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201
Q

Mechanism of ACUTE HEMOLYTIC blood transfusion rxn?

A) Recipient anti-IgA Abs vs donor IgA

B) ABO incompatibility

C) Cytokine accum during blood storage

D) Recipient IgE against blood product component

E) Donor anti-leukocyte Abs

F) Anamnestic Ab response

G) Donor T lymphocytes

A

B) ABO incompatibility

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202
Q

Mechanism of FEBRILE NON-HEMOLYTIC blood transfusion rxn?

A) Recipient anti-IgA Abs vs donor IgA

B) ABO incompatibility

C) Cytokine accum during blood storage

D) Recipient IgE against blood product component

E) Donor anti-leukocyte Abs

F) Anamnestic Ab response

G) Donor T lymphocytes

A

C) Cytokine accumulation during blood storage

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203
Q

Mechanism of URTICARIAL blood transfusion rxn?

A) Recipient anti-IgA Abs vs donor IgA

B) ABO incompatibility

C) Cytokine accum during blood storage

D) Recipient IgE against blood product component

E) Donor anti-leukocyte Abs

F) Anamnestic Ab response

G) Donor T lymphocytes

A

D) Recipient IgE against blood product component

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204
Q

Mechanism of TRALI?

A) Recipient anti-IgA Abs vs donor IgA

B) ABO incompatibility

C) Cytokine accum during blood storage

D) Recipient IgE against blood product component

E) Donor anti-leukocyte Abs

F) Anamnestic Ab response

G) Donor T lymphocytes

A

E) Donor anti-leukocyte Abs

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205
Q

Mechanism of DELAYED HEMOLYTIC RXN 2/2 blood transfusion?

A) Recipient anti-IgA Abs vs donor IgA

B) ABO incompatibility

C) Cytokine accum during blood storage

D) Recipient IgE against blood product component

E) Donor anti-leukocyte Abs

F) Anamnestic Ab response

G) Donor T lymphocytes

A

F) Anamnestic Ab response

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206
Q

Mechanism of GRAFT VS HOST 2/2 blood transfusion?

A) Recipient anti-IgA Abs vs donor IgA

B) ABO incompatibility

C) Cytokine accum during blood storage

D) Recipient IgE against blood product component

E) Donor anti-leukocyte Abs

F) Anamnestic Ab response

G) Donor T lymphocytes

A

G) Donor T lymphocytes

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207
Q

Which two blood transfusion reactions occur >6h?

A) Recipient anti-IgA Abs vs donor IgA

B) ABO incompatibility

C) Cytokine accum during blood storage

D) Recipient IgE against blood product component

E) Donor anti-leukocyte Abs

F) Anamnestic Ab response

G) Donor T lymphocytes

A

F) Anamnestic Ab response
(delayed hemolytic rxn)

G) Donor T lymphocytes
(GVHD)

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208
Q

Most common adverse reaction to transfusion?

A

febrile non hemolytic

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209
Q

Fever/chills w/in 1-6hrs of initiating transfusion. Likely Dx?

A

febrile non hemolytic rxn

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210
Q

Which is better for premedication in preventing blood transfusion reactions?
A) GCS
B) antihistamines
C) acetaminophen

A

NONE, they do not prevent them

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211
Q

Post-transfusion: rapid flank pain, fever, hemolysis, oliguria and DIC. NSIM?

A

Stop transfusion & hydrate w/ IV NS

ABO mismatch > acute hemolytic rxn

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212
Q

MCCOD sp steering wheel injury in MVA?

A

aortic injury

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213
Q

Why is CT chest useful during initial dx pulm CA?

A
  • mediastinal LN mets
  • chest wall invasion
  • tumour size, staging
  • detect pleural effusions
  • mets (liver/adrenal)
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214
Q

Renal transplant recipient develops significant AKI w/ starting ACEi. Dx?

A

underlying transplant renal artery stenosis (renal hypoperf stimultes RAAS > HTN & maintained GFR. ACEi lowers angiotensin II acutely&raquo_space; significant decrease in GFR & AKI)

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215
Q

Renal transplant recipient develops resistant HTN, flash pulmonary edema or progressive loss of renal function. What do you suspect?

A

renal artery stenosis

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216
Q

MOA AKI & >30% GFR drop in the setting of ACEi use w/ renal transplant?

A
  1. renal hypoperf stimultes RAAS > HTN & maintained GFR.

2. ACEi lowers angiotensin II acutely&raquo_space; significant decrease in GFR & AKI

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217
Q

_____ causes HTN in ~10% patients, 2yrs sp renal transplant

A

Transplant renal artery stenosis.

Important causes:

  • improper surgical anastomosis
  • CMV
  • acute rejection
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218
Q

Explosive onset multiple pruritic SKs, NSIM?

A

Consider screening for CA (esp pulm/GI)

Leser-Trelat

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219
Q

Sarcoma botryoides is a tumor of the: ____

A

vagina (cluster of grapes presentation)

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220
Q

Indications for bisphosphonates?

A
  1. T-score 20% major osteoporotic fracture or >3% hip fracture
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221
Q

Malignancy assd w/ PCOS?

A

Endometrial hyperplasia/CA
(chronic anovultion&raquo_space; unopposed estrogen&raquo_space; endometrial hyperplasia)

**May use OCP or progestin IUD (provides endometrial protection by thinning the endometrium)

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222
Q

How does a progestin IUD prevent endometrial CA in PCOS?

A
  1. unopposed estrogen & chronic anovulation
  2. uncontrolled endometrial proliferation
  3. progestin IUD (provides endometrial protection by thinning the endometrium)
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223
Q

“Begins as shoulder pain worst at night”

A) Rotator cuff impingement
B) Rotator cuff tear 
C) Adhesive capsulitis
D) Biceps tendinopathy/rupture
E) GH OA
A

C) Adhesive capsulitis

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224
Q

Abnormal vaginal bleeding, enlarged uterus, vaginal lesion, preg test+. Dx?

A

r/o choriocrcinoma (most aggressive form of gestational trophoblastic neoplasia, mets common)
- often sp hydatiform mole but may be after reg pregnancy

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225
Q

Choriocarcinoma

  1. Work up
  2. Tx
  3. Marker for disease progression
A
  1. Work-up:
    - CXR
    - pelvic US
    - LFT
    - TFT
    - BUN/Cr
  2. Tx:
    MTX & hysterectomy
  3. BhCG
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226
Q

Pt reporting persistent severe pain despite 2 months ROM exercises for adhesive capsulitis. NSIM?

A

GCS injection +/- saline distension in the joint space. Consider more aggressive PT

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227
Q

When to Tx febrile seizure?

A

> 5mins (to avoid cardioresp compromise)

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228
Q

Diagnostic criteria for febrile seizure? (4)

A
  • no hx afebrile seizure
  • 6 months to 5 years
  • no signs CNS inf
  • no acute metabolic cause (hypoglyc)
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229
Q

Use of inferior petrosal sampling?

A

DDx source of ACTH (pituitary vs ectopic)

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230
Q

Which alcohol leads to severe HAGMA & Kussmaul breathing?

A

Ethylene glycol (antifreeze)

Tx: fomepizole

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231
Q

Tx for:

  • methanol tox
  • ethylene glycol tox
A

Fomepizole (both)

MOA: inhibitor of ADH
more potent inhibitor than EtOH

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232
Q

Anthracyclines: type of cardiac injury?

A

dose-dependent DILATED cardiomyopathy

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233
Q

MCCOD in survivors of Hodgekin Lymphoma?

A

secondary malignancy (breast, lung, GI, acute leukemia, NHL)

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234
Q

Radiation cardiotoxicity characteristics?

A

fibrosis!

  1. restrictive cardiomyopathy
  2. constrictive pericarditis
  3. valvular d (MS/MR, AS/AR)
  4. > > MI
  5. SSS or heart block
  6. may affect coronary vessels
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235
Q

First line seizure abortive Tx ?

A

benzo

if persists, give fosphenytoin

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236
Q

Seizure lasting >5mins. No improvement with benzo. NSIM?

A

give fosphenytoin

avoid barbiturates if possible per AE: sedation/resp depression

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237
Q

Management complete airway obstruction in <1yo VS >1yo?

A

<1yo should be placed face down on examiners arm receiving alternating back blows and chest thrusts

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238
Q

Multiple umbilicated pink lesions. Assn and Tx?

A

Often peds & immunocompromised/HIV.

Tx: self limited
May remove w/ cryo/curettage or podophyllotoxin

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239
Q

Confluence of prurituc, reddish brown, finely wrinkled papules. Wood lamo w/ coral red fluorescence.
Pathogen?
Dx?

A

Erythrasma

Corynebacterium minutissumus

Tx: erythromycin
~clindamycin

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240
Q

Erythrasma

A

Tx: erythromycin

~clindamycin

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241
Q

Tx for photoaging?

A

tretinoin (retinA)

*NOT isotretinoin

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242
Q

Aerobics instructor becomes pregnant & inquires about exercise recs during pregnancy. Advice?

A

Pt who are alredy conditioned for long duration, high intensity exercise can safely resume/continue their regimen during pregnancy

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243
Q

Which is NOT a maternal complication of adolescent pregnancy?

A) hydatiform mole
B) gestational DM
C) preeclampsia
D) anemia
E) operative vaginal delivery
F) postpartum depression
A

B) gestational DM

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244
Q

Which is NOT a maternal complication of adolescent pregnancy?

A) Gastroschisis 
B) Omphalocele
C) NTDs
D) preterm birth
E) low birth weight
F) perinatal death
A

C) NTDs

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245
Q

Which is NOT a RF for gestational DM?

A) FHx DM
B) obesity
C) primigravida
D) multiple gestation
E) maternal age >25
A

C) primigravida

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246
Q

MEN 1

A

***Primary hyperPTH
**Panc/GI NE tumors
Pituitary adenoma

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247
Q

Most commonly occurring manifestation of MEN1

A

Primary hyperPTH

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248
Q

30yo F w/ hx PUD, FHx pituitary adenoma presents for hyperCa. Dx?

A 
r/o MEN1
(3 Ps) 
- pituitary adenoma
- panc/GI NE tumor
- hyperPTH
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249
Q

The following are associated w/ which MEN syndrome?

  • gastrinoma
  • VIPoma
  • glucagonoma
  • insulinoma
A 
MEN 1
(3 Ps) 
- pituitary adenoma
- panc/GI NE tumor
- hyperPTH
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250
Q

Tx of parathyroid adenomas in MEN1?

A

subtotal >3.5 glands or total parathyroidectomy w/ autotransplant into muscle pocket
(esp if pt is <50yo or >50 w/ complications)

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251
Q

Indications for parathyroidectomy?

A
  1. hyperCa w/ Sx
  2. end organ complications
    - osteoporosis
    - CKD
    - nephrolithiasis
  3. calciuria >400mg/d
  4. hyperCa >1mg above norm
  5. <50yo (as d/t future risk of complications)
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252
Q

Test to screen for medullary CA?

A

calcitonin (MEN2)

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253
Q

Weight loss, necrolytic migratory erythema, hyprglycemia. Dx?

A

glucagonoma (also assd w/ MEN1)

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254
Q

Which is NOT a malignant feature?

A) eccentric calcification
B) hoarseness 
C) hard axillary LN
D) popcorn calcification
E) spiculated margins
A

D) popcorn calcification

pulm hamaratoma

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255
Q

Which is calcification is malignant?

A) eccentric 
B) popcorn 
C) concentric 
D) laminated
E) central 
F) diffuse/homogenous
A

A) eccentric

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256
Q

Ataxia, urinary incont, forgetfulness. Dx?

A

NPH

dilated ventricles on imaging

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257
Q

NPH- which sx occurs early in the disease?

A

ataxia

then urinary incont, dementia

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258
Q

Rapid eye movement sleep behaviour disorder: associated dementia?

A

dementia w/ Lewy Bodies

you act out vivid/violent dreams

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259
Q

Prognosis frontotemporal dementia?

A

fatal w/in 8yrs

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260
Q

USPSTF recs for breast CA screening?

A

age 50-74

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261
Q

High risk FHx breast CA is NOT?

A) 1st/2nd deg w/ breast AND ovarian CA

B) Two 1st deg w/ breast CA including one <50yo

C) 2+ 1st or 2nd deg relatives w/ breast CA

D) 1st deg w/ bilateral breast CA

E) Ashkenazi w/ any 1st or 2nd deg relatives w/ breast or ovarian CA

G) breast CA in a male relative

A

C) 2+ 1st or 2nd deg relatives w/ breast CA

** its actually 3 or more

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262
Q

MC reason for requesting euthanasia?

A

Loss of autonomy
Loss of dignity
Loss of ability to engage in pleasurable activities

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263
Q

Pt requests euthanasia. What needs to be addressed?

A

Gather info re: concerns/fears. Eval for:

  1. coercion from others
  2. underlying mental illness
  3. physical sx (ie pain)
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264
Q

MC presentation acute HCV?

A

ASx

if sx: malaise, N, jaundice, RUQ pain x 2-12wks

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265
Q

Acute HCV. How long does it take RNA to detected? Ab formed?

A
  1. RNA detection w/in days-8wks.

2. HCV abs w/in 2-6 months

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266
Q

Step up in O2 sat from RV to pulm a. Dx?

A

PDA

or aorto-pulm window

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267
Q

Step up in O2 sat from RA to RV. Dx?

A
  • VSD
  • PDA w/ pulm regurg
  • coronary fistula to RV
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268
Q

Step up in O2 sat from SVC to RA. Dx?

A
  • ASD
  • ruptured sinus of valsalva
  • VSD w/ TR
  • coronary fistula to RA
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269
Q 
Step up in O2 sat from SVC to RA. Dx?
A) VSD
B) PDA w/ PR
C) VSD w/ TR 
D) coronary fistula to RV
A

C) VSD w/ TR

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270
Q

Murmur: continuous, best heard in L infraclavicular area. Dx?

A

PDA

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271
Q 
Which is NOT  feature of Tetralogy of Fallot?
A) RV outflow obstruction
B) LV hypertrophy
C) overriding aorta
D) VSD
A

B) LV hypertrophy

**RV hypertrophy

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272
Q

__% childrean w/ ADHD will have sx into adulthood.

A

33-66%

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273
Q

T/F: Stimulant therapy for ADHD increases risk of abuse or substance use

A

FALSE

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274
Q

When are non-stimulant meds given for ADHD?

A

If pt has a personal hx of substance use disorder

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275
Q

MCC uncontrolled HTN?

A

non-adherence (>40%)

Also

  • suboptimal med regimen
  • poor adherence to lifestyle changes
  • white coat HTN
  • inaccurate BP measurement in clinic
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276
Q

Definition resistent HTN?

A

HTN despite 3 antiHTN meds (including diuretic)

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277
Q

Persistent preoccupation about having serious illness while having mild/NO somatic sx.

A

illness anxiety disorder

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278
Q

Multiple sx over time, high healthcare use and preoccupation w/ sx. Dx?

A

somatic sx disorder

DDx illness anxiety disorder has mild/NO sx

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279
Q

Tx for ACD?

A

Tx underlying condition.

May give EPO if low. R/o IDA, thalassemia, myelodysplasia.

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280
Q

Chest discomfort, tachycardia,hypoTN sp PCI. Dx?

A

Cardiogenic shock 2/2 abrupt occlusion&raquo_space; impaired myocardial contractility

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281
Q

Low cardiac index, elevated PCWP & increased SVR. Dx?

A

cardiogenic shock

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282
Q

High cardiac output, Low PCWP & SVR. Type of shock?

A

Septic/neurogenic (distributive)

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283
Q

Equalization of RA & RV pressures during end diastole. Dx?

A

Cardiac tamponade 2/2 rapid accum of fluid in pericardial space

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284
Q

DDx SAH vs traumatic LP

A

SAH: xanthochromia

(CSF discoloration 2/2 Hgb breakdown)

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285
Q

CSF: RBC 75000 w/o xanthochromia. Dx?

A

traumatic LP (high RBC, WBC, protein, glucose)

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286
Q

Cachexia & severe COPD. CA ruled out. Dx?

A

Likely pulmonary cachexia syndrome 2/2

  • increased WOB > caloric use (in setting of low appetite & low dietary intake)
  • systemic inflam > catabolism
  • skeletal m hypoxia, GCS use
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287
Q

____ occurs in 20-40% of COPD patients&raquo_space; impaired balance, increased infections & mortality

A

Pulmonary cachexia syndrome

T optimize lung function, exercise, nutrition

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288
Q

Weight loss, fatigue, hypoTN, bradycardia. Dx?

A

Addisons

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289
Q

In COPD, early satiety occurs 2/2:

A

diaphragmatic flattening

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290
Q

STRUCTURAL causes abnormal uterine bleeding (non-preg)

A

Polyp (endometrial)
Adenomyosis
Leiomyoma
Malig & hyperplasia

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291
Q

NON-STRUCTURAL causes abnormal uterine bleeding (non-preg)

A 
Coagulopathy 
Ovulatory dysfunction
Endometrial (infect/inflam)
Iatrogenic 
Not yet classified
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292
Q

Tx of acute uterine bleeding

A

combination OCP containing high-dose Estrogen (use IV if cannot tolerate or ineffective PO)

If unstable, no improvement of E contraindications > D&C

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293
Q

Premenopausal F w/ ovulatory menorrhagia who does not desire future fertility. Tx?

A

endometrial ablation

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294
Q

MOA of Tx acute menorrhagia in stable pt?

A

OCP w/ high E&raquo_space; promotes hemostasis & further prolif of disorganized endometrium

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295
Q

F neonate w/ labial swelling, leukorrhea & uterine withdrawal bleed. Mech?

A

high levels of maternal E crossing the placenta. After delivery E decreases hence pituitary is stimulated to produce more prolactin.
(also&raquo_space; uni/bilateral gynecomastia w/ galactorrhea)

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296
Q

M neonate w/ unilate gynecomastia & galactorrhea. Firm like disc-like tissue under areola. Parents inquire about prognosis.

A

high levels of maternal E crossing the placenta. Resolves in 6 months.

*parents should be discouraged about expressing milk as it may stimulate further prolactin/oxytocin release from pituitary)

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297
Q

Acute inferolateral wall STEMI develops sinus bradycardia. NSIM?

A

Atropine IV, If no effect > transvenous cardiac pacing, then PCI.

Note: NE increases O2 demand & should be avoided.

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298
Q

Mech of bradycardia in inferior VS anterior MI?

A
  • Inf: increased vagal tone
  • Ant: damage to conduction system below AV node

**therefore anterior unlikely to respond to atropine

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299
Q

Acute inferolateral wall STEMI develops sinus bradycardia. Why should you AVOID the following:

  • NE
  • dobutamine
A

NE increases O2 demand (contraindicated in STEMI)

Dobutamine is inotropic hwr the issue here is chronotropy

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300
Q

BV can be treated w/ metronidazole OR

A

clindamycin

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301
Q

BV RFs?

A
  • increased E (preg)
  • menses
  • sex
  • recent abx
  • douching
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302
Q

Complications BV during preg? Prevention?

A
  • spontaneous abortion
  • PPROM
  • preterm labor
  • chorioamnionitis
  • postpartum endometritis

**Abx tx does not decrease risk of above complications

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303
Q

Why do you Tx BV in pregnancy?

A

for SYMPTOMATIC relief

  • *Abx tx does not decrease risk of complications:
  • spontaneous abortion
  • PPROM
  • preterm labor
  • chorioamnionitis
  • postpartum endometritis
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304
Q

MOA of increased BV risk w/ sexual activity?

A

lowers vaginal pH & lowers concentration of vaginal lactobacillus

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305
Q

Bee sting > rash, wheezing. VSS, BP wnl. NSIM?

A

IM EPI (2 system sx present: skin/resp. Hypotension does NOT need to be present to dx anaphylaxis)

  • H blockers, GCS, SABA are *adjuvant tx
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306
Q

Anaphylaxis sp wasp sting. How effective is venom immunotherapy?

A

Quite- may reduce risk of anaphylaxis 2/2 sting from 35-60% to <5%

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307
Q

Infant w/ groin rash that spares creases. Tx?

A

topical barrier ointment (petrolatum, zinc oxide)

Dx: contact derm

(DDX beefy w/ skinfold involvement & satellite lesions: candida)

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308
Q

MCC diaper dermatitis

A
  1. contact dermatitis

2. candida dermatitis

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309
Q

Why should cornstarch or talcum powders be avoided for use of diaper rash ppx?

A

risk of aspiration

Tx:

  • contact derm w/ petrolatum/ zinc
  • candida derm w/ nystatin or clotrimazole

AVOID GCS 2/2 risk of systemic absorp & adrenal suppression

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310
Q

Why should high-potency GCS be avoided for diaper rash?

A

Due to risk of systemic absorp & adrenal suppression.

Tx:

  • contact derm w/ petrolatum/ zinc
  • candida derm w/ nystatin or clotrimazole
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311
Q

F w/ prolonged intubation is extubated&raquo_space; stridor. No improvement w/ GCS. NSIM & Dx?

A

Reintubate.
Dx: laryngeal edema (present in 30%, 5% require re-intubation)

Multidose regimen GCS prior to extubation may decrease risk. (GCS after extubation dont help)

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312
Q

Prevention of neonatal gonoccocal conjunctivitis?

A

topical erythromycin ointment

Tx: ceftriaxone/cefotaxime IM x 1

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313
Q

Prevention vs Tx of neonatal gonoccocal conjunctivitis?

A

PPx: topical erythro
Tx: ceftriaxone/cefotaxime IM x 1

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314
Q

Neonate (2-5do) w/ copious mucopurulent discharge, chemosis & eyelid erythema. How could this have been prevented?

A

topical erythromycin ointment

(Tx: ceftriaxone/cefotaxime IM x 1)

Dx: gonococcal conjunctivitis

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315
Q

Bile salt-induced diarrhea may be seen in which 3 conditions?

A
  • post-cholecystectomy
  • ileal resection
  • short bowel syndrome
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316
Q

MOA diarrhea sp cholecystectomy?

A
  1. Liver produces bile acid
  2. bacteria convert to secondary bile acids in GI which causes diarrhea
  3. sp cholectectomy- bile is not stored, instead dumped into colon
Tx cholestyramine (bile salt binding resin)
- occurs in 5-10%
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317
Q

Tx diarrhea sp cholecystectomy?

A

cholestyramine (bile salt binding resin)

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318
Q

Malabsorption syndrome 2/2 anatomic (hx surg) or motility (DM, sclerosis) disorders. Sx: abd pain, bloating/flatus/D. Tx?

A

rifaximin

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319
Q

Octreotide: used for which types of diarrhea?

A

VIPoma

AIDS-related

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320
Q

Tx AOM

1st & 2nd line, PNC allergy

A
  1. amox x 10 days
  2. amox-clav

PNC allergic: clinda or azithro

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321
Q

Concurrent AOM & purulent conjunctivitis. Pathogen?

A

non-typable H influenzae

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322
Q

Which pathogen is associated w/ tympanostomy tubes?

A

S.aureus (otherwise not commonly associated w/ AOM)

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323
Q

AOM: Same or different pathogen?

A) Improvement, then AOM after a week

A

same

If >2wks later, different pathogen

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324
Q

AOM treated w/ high dose amox x 10 days. a few days after Tx, AOM recurs. Tx?

A

Amoxi-clav

resistance per beta lactamase producing strain of non-typable H.influenzae

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325
Q

Indications for a tympanostomy tube?

A
  • > 3 months effusion
  • > 3 AOM / 6 months
  • > 4 AOM / yr
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326
Q

Which types of acne are salicylic, azelaic or glycolic acids for?

A

comedonal or non-inflamm

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327
Q

Moderate inflammatory acne. No improvement w/ BP wash and topical retinoids. NSIM?

A

add topical abx (clarithro/erythro). If ineffective, PO doxycyline.

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328
Q

40yo F w/ fatigue, pruritus, arthralgia, hypopigmented skin, xanthelasma, elevated alkP. Dx?

A

PBC
- obtain anti-mitochondrial ab (v sen & spec), if negative > liver bx to confirm

Tx: ursodeoxycholic acid
Liver transplant if advanced

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329
Q

40yo F w/ fatigue, pruritus, arthralgia, hypopigmented skin, elevated alkP & anti-mitochondral ab. MCCOD? Tx?

A

Liver cirrhosis (Dx: PBC, path: fibrosis & obliteration of intrahepatic bile ducts, F 30-65yo)

Tx: ursodeoxycholic acid
Liver transplant if advanced
(**GCS & immunosupp NOT useful)

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330
Q

Which screening test is regularly recommended in setting of PBC?

A

bone densometry as osteopenia/osteoporosis is a frequent complication despite normal vitD level (unknown mech). Recommend vitD/Ca & alendronate PRN)

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331
Q

Angular cheilosis & stomatitis. Vit def?

A

riboflavin (B2)

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332
Q

Dilated cardiomyopathy & polyneuropathy. Vit def?

A

Wet Beriberi (B1)

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333
Q

Photosensitivity, dermatitis, diarrhea, dementia. Vit def?

A

niacin (B3)

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334
Q

Exposure & response prevention rx is the best CBT for which condition?

A

OCD

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335
Q 
Best Rx for borderline?
A) response-prevention
B) dialectical
C) interpersonal
D) psychodynamic 
E) supportive
A

B

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336
Q 
Best Rx for OCD?
A) exposure & response-prevention
B) dialectical
C) interpersonal
D) psychodynamic 
E) supportive
A

A) exposure & response-prevention

+/- SSRI, 2nd line TCA: clomipramine

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337
Q

Meds for OCD?

A

1st line SSRI

2nd line TCA: clomipramine

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338
Q

Buspirone use?

A

GAD

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339
Q

Polymyalgia rheumatica is a disorder of:

A

proximal joints, tendons, bursae (NOT muscles, hence CK is wnl)

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340
Q

Why is CK normal in polymyalgia rheumatica?

A

It is inflammation of proximal joints, tendons, bursae (NOT muscles, hence CK is wnl)

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341
Q

Fatigue, weight loss, fever. Rapid onset pelvic girdle/shouler pain/stiffness. CK wnl, high ESR. Tx?

A

Low dose GCS w/ rapid response.

Dx polymyalgia rheumatica

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342
Q 
High CK, low ESR. Dx?
A) polymyalgia rheum
B) statin myopathy
C) dermtomyositis 
D) polymyositis
A

B) statin myopathy

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343
Q

DDx post-partum blues VS MDD?

A

Post-partum blues: <2wks

MDD: >2wks
if MDD criteria not fully met: adjustment disorder

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344
Q

Best antidepressants while breastfeeding?

A

sertraline & paroxetine

if already on other antidepressants during preg, dont change

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345
Q

First time febrile UTI in child <24 months. Abx given. Additional w/u?

A

US renal & bladder to r/o anatomic abnormalities.

- if recurrent infections or abnormal US findings > voiding cystourethrogram

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346
Q

First time febrile UTI in child <24 months. Abx given. Recurrent infections or abnormal US renal/bladder findings. NSIM?

A

voiding cystourethrogram (identifies vesicoureteral reflux which requires abx ppx)

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347
Q

Incidentalloma in sellar region. ASx, no hormonal abn. NSIM?

A

Reassure, periodically assess w/ MRI

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348
Q

Slurred speech, LUE weakness x 3h. BP 220/115. NSIM?

A

Lower BP <185/110, then thrombectomy (alteplase)

** note: giving alteplase in setting of severely elevated BP is a risk for hemorrhagic conversion

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349
Q

AE CHF. Initial goal of Tx?

A

Reduce cardiac preload

  • diuretics
  • vasodilators (NTG, nitroprusside) *unless hypoTN

If hypoTN:
- O2, NE, diuresis when tolerated

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350
Q

51yo F w/ bilat nipple discharge. Breast exam benign, no LAD, labs/mammo wnl. NSIM?

A

Reassure & observe

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351
Q

Meningitis: CSF w/ high opening pressure, neutrophilic leukocytosis, high protein, low glucose. Neg gram stain/Cx. Etiology?

A

Bacterial
(note gram stain sen 60-90%)

NSIM: abx

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352
Q

Seizure. CSF w/ lymphocytic pleiocytosis, RBC+, elevated protein. MRI w/ temporal lobe abn. Dx?

A

HSV encephalitis

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353
Q

GCS > mood sx, psychosis. NSIM?

A

Lower the dose

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354
Q

RF for mood sx w/ use of GCS?

A
  • female
  • high dose
  • longer duration (hwr may occur at any time)
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355
Q

Which is NOT a possible AE of GCS?

A) depression 
B) anxiety 
C) sleep disturbance
D) psychosis 
E) restlessness
F) memory loss
A

NONE (they all are). If present, reduce the dose.

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356
Q

IDA Which value improves FIRST after initiating tx?

A) ferritin
B) HCT
C) Hgb
D) MCV: RBC ratio
E) retic count
A

E) retic count

**retic is low in IDA as BM cannot produce RBCs w/o iron substrate

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357
Q

MC deficiency in peds?

A

iron, Hgb <11 (often asx, universally detected on 1yr screen)

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358
Q

Anemia Hgb cutoff in peds?

A

Hgb <11

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359
Q

Peds w/ Hgb <11. Ferrous sulfate prescribed. Pts mother asks if pt has to take medication “forever”. You reply:

A

Take for additional 2-3 months afte Hgb normalizes.

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360
Q

TIA. What is the risk of CVA w/in 48h? w/in 30 days?

A

48h: 5%
30d: 12%

Therefore urgent comprehensive eval <48h:

  • MRI >CT
  • CTA/MRA, US carotids
  • tele & TTE
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361
Q

Suspected TIA resolved by time pt arrived to ED, NSIM?

A

urgent comprehensive eval <48h:

  • MRI >CT
  • CTA/MRA, US carotids
  • tele & TTE
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362
Q

Anemias w/ normal MCV & low retic?

A

Leukemia
Aplastic
Infection
Med AE

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363
Q

Anemias w/ low MCV & high retic?

A 
hemorrhage
hemolysis
- AI
- proxysmal nocturnal hemoglobinuria 
- spherocytosis
- G6PD def...
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364
Q

IDA in 60yo M, FIT+. Colonoscopy wnl. NSIM?

A

Consider EGD to r/o slow bleeding ulcer.

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365
Q

Athlete w/ episodic pain at inferior patella. Dx?

A

Patellar tendonitis

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366
Q

35yo F w/ anterior knee pain worst w/ squatting or stairs. Dx?

A

Likely PFS (pain w/ extending the knee while compressing the patella)

Tx quad stretching/ strengthening,
NSAIDs often NOT helpful.

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367
Q

Acute/episodic medial/inferior knee pain. Dx?

A

anserine bursitis

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368
Q

Anterior knee pain w/ swelling over patella. Frequently complicated by secondary infection 2/2 S.aureus. Dx?

A

Prepatellar bursitis (housemaids knee)

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369
Q

Common complication of prepatellar bursitis?

A

Secondary infection/septic brusitis 2/2 S.aureus.

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370
Q

Tx C.O. poisoning?

A

high flow O2 via NRB

if severe: hyperbaric oxygen

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371
Q

Housefire. HA, malaise, nausea, dizziness. Pulse ox 97%. Dx?

A

r/o CO poisoning. Pulse ox cannot ddx btwn CO & O2. CarboxyHgb required.

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372
Q

Which is highly sensitive & poorly specific if CHF?

A) DOE
B) orthopnea
C) PND
D) JVD
E) LE edema
F) S3
A

A) DOE

note, the rest are highly specific but poorly sensitive

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373
Q

Kerely B lines indicate ___ when evaluating CHF.

A

interstitial edema which may progress to alveolar edema

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374
Q

Why is pulmonary edema less common in chronic CHF than acute CHF?

A

pulm lymphatics can gradually increase fluid outflow rate up to 10x from baseline when needed- HWR in acute edema lymphatics do not have time to adapt&raquo_space; pulm edema

Chronic CHF often presents as interstitial edema (Kerley B) lines on CHF w/o alveolar edema

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375
Q

Which CMP value is often present w/ obesity hypoventilation syndrome?

A

high bicarb

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376
Q

Features of Juvenile Arthritis?

  • age
  • F/M prevalence
  • complication
A

50% oligoartic age 2-4
40% polyartic age 2-5, 10-14

F>M
**may be complicated by Asx uveitis in 20%, hence must screen with slit lamp

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377
Q

5yo w/ limp worse in the morning. Afebrile, joint swelling/warmth of shoulder & knee. Which screening test must be performed?

A

Juvenile arthritis may be complicated by Asx uveitis in 20%, hence must screen with slit lamp

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378
Q

5yo w/ limp worse in the morning. Afebrile, joint swelling/warmth of knee. Tx?

A

Juvenile arthritis
Tx:
- Mild= NSAIDs, IA GCS
- Severe (2+ joints, elevated ESR/CRP, impaired activity): = MTX, ~biologics

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379
Q

Pernicious anemia Dx test?

A

anti-IF Ab testing
50-84% sen, 100% spec

(Schilling may be used as second line test if Ab is neg)

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380
Q

Autoimmune, glandular atrophy of gastric body/fundus, intestinal metaplasia, inflammation. Dx?

A

AMAG (Autoimmune, metaplastic atrophic gastritis) assd w/ pernicious anemia.

Immune response against oxitinic cells and intrinsic factor.

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381
Q

AMAG (Autoimmune, metaplastic atrophic gastritis) presents as atrophy in which part of the stomach?

A

gastric body and fundus

NOT antrum

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382
Q

40yo w/ Raynaud & GERD presents w/ severe HTN & AKI. Dx?

A

r/o scleroderma renal crisis
Mech: thickening of vessel wall and narrowing of vascular lumen in renal arterioles > isch > RAAS > HTN (often malig HTN w/ CNS Sx and papilledema)

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383
Q

40yo w/ Raynaud & GERD presents w/ severe HTN & AKI. Drug of choice?

A

(Scleroderma Renal Crisis) Captopril/ACEi reverse angiotensin induced vasoconstriction
- Mild increase in creatinine is expected and does not warrant stopping tx.

  • Nitroprusside may laso be added if CBS/papilledema+ acutely hwr beware of rapid BP drops&raquo_space;ATN
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384
Q

When are ACEi first line in the setting of AKI?

A

Scleroderma Renal Crisis!
Captopril/ACEi reverse angiotensin induced vasoconstriction

Mild increase in creatinine is expected and does not warrant stopping tx.

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385
Q

30yo w/ CP sp cocaine. Benzo, NTG & ASA given. EKG w/ ST elevations in multiple leads despite Tx. NSIM?

A

Coronary angio & PCI for STEMI

Note: CCBs given for persistent CP hwr if EKG showing STEMI despite Tx, go straight to PCI

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386
Q

30yo w/ CP sp cocaine. Benzo, NTG & ASA given. EKG w/ ST elevations in multiple leads despite Tx. PCI cannot be performed per rural area. NSIM?

A

fibrinolytics

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387
Q

30yo w/ CP sp cocaine. Benzo, NTG & ASA given. EKG w/ ST elevations improve w/ Tx, hwr CP persists. NSIM?

A

Nifedipine/CCB

if persistent BP, phentolamine can be given

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388
Q

Emergent CVS complications of cocaine?

A
  • MI
  • aortic dissection
  • neuro ischemia/CVA
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389
Q

Highly effective Tx for uni/bipolar depression if:
- psychotic features+
- persistent suicidality
or
- rapid tx response needed (nutrient depletion etc)

A

ECT (safe in preg)

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390
Q

Which conditions can be treated w/ ECT?

A
  • MDD
  • bipolar
  • catatonia
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391
Q

Bipolar preg F w/ psychotic sx, refusing to eat and drink. Tx?

A

ECT (safe in preg)

  • lithium takes too long to titrate (RF Ebstein anomaly)
  • valproate contraindicated in preg (NTD, cleft lip/palate, limb defects, microcephaly, IUGR, craniofacial or genital abn)
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392
Q

**From Egypt, hematuria.
Dx test?
Tx?

A

D: Urine sediment microscopy (ID: eggs)
Tx: praziquantel

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393
Q

Cdiff Tx:

  1. First episode
  2. First recurrence
  3. Mult recurrence
  4. Fulminant
A
  1. PO vanc ot fidaxomycin
  2. PO vanc w/ extended taper (or fidaxo if van used initially)
  3. ”” OR
    PO vanc then rifaximin
    Consider fecal microbiota transplant
  4. PO vanc (high dose) AND IV metro
    +/- surg
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394
Q

Tx fulminant Cdiff (hypoTN, ileus, toxic megacolon?

A 
PO vanc (high dose) AND IV metro 
\+/- surg

** if ileus, consider intracolonic vanc

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395
Q

Cdiff tx sp vanc tx, recurrs one month later. Tx?

A

PO vanc w/ extended taper (or fidaxo if van used initially)

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396
Q

Clindamycin, cephalosporin, FQs pose risk for Cdiff. Which Abx are better?

A

Aminoglycosides

TMP-SMX

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397
Q

CF pulm exacerbation:
Pathogens?
Tx?

A

S.aureus, P.aeruginosa

Tx: vanc PLUS 2 agents for Psaudomonas:

  • Cephalosporins (Cefepime or Ceftazidime)
  • Aminoglycoside (Amikacin or Tobramycin)
  • carbapenems
  • aztreonam
  • colistin
  • zocyn
  • ticarcillin-clavulonic acid
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398
Q

60yo F sp MVA w/ ischemic CP, decomp HF, moderate troponemia, EKG ischemic changes in precordial leads. Cath w/o obstructive changes. TTE: LV mid/apical hypokinesis. Tx?

A

Supportive care

Stress-induced/Takotsubo cardiomyopathy
- likely 2/2 cathecolamine surge

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399
Q

Stress-induced/Takotsubo cardiomyopathy suspected. Expected TTE findings?

A

TTE: LV mid/apical hypokinesis > balloon shaped heart “octopus trap”

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400
Q

EKG w/ ST elevations & T wave inversions. TTE: LV mid/apical hypokinesis. Coronary angiography w/o obstructive coronary disease. Dx?

A

Stress-induced/Takotsubo cardiomyopathy, likely 2/2 cathecolamine surge

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401
Q

Sharp CP. EKG: diffuse ST elevations. Assd Dx?

A

Acute pericarditis

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402
Q

** Antithrombotic Rx for mechanical heart valves?

A

ASA and warfarin

MV has 2x higher risk than AV

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403
Q

**Mechanical heart valve replacement. When is the INR goal 2-3 VS 2.5-3.5?

A 
INR 2-3: AV w/o RF
INR 2.5-3.5: 
- MV 
- AV  w/ RF 
- ~first 3m sp AV replacement

RF: afib, HFrEF <30, hx VTE, hypercoag state

(NOTE: all pts on warfarin AND ASA)

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404
Q

When is INR 2.5-3.5 recommended?

A
  • MV replacement
  • AV replacement w/ RF
  • ~first 3m sp AV replacement

RF: afib, HFrEF <30, hx VTE, hypercoag state

(NOTE: all pts on warfarin AND ASA)

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405
Q 
Which acute pancreatiits scoring systems sucks for predicting severity?
A) Ransons
B) APACHE II
C) SIRS
D) BISAP
A

A) Ransons

Cannot be calculated until 48h of admission and has been found to be poor predictor

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406
Q

Which 3 lab values have shown to be good predictors of pancreatitis severity?

A
  • BUN >20 (worse outcomes)
  • HCT >44% (indicates hemoconcentration 2/2 3rd spacing)

~ CRP >150 (rises slowest)

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407
Q 
Which is not a good single-item predictor of acute pancreatitis severity?
A) BUN
B) TG
C) CRP
D) age
E) obesity
F) HCT
A

B) TG

also note: lipase >1000 has been associated w/ worse outcomes but is not a good single item predictor

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408
Q

33yo F w/ 3 UTI in 6 months. Tx?

A

Qualifies for postcoital abx or daily.

TMP-SMX
nitrofurantoin
cephalexin
ciprofloxacin

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409
Q

33yo F w/ urinary frequency/burning. UA:

blood++
protein-
LE++
nitrite+

NSIM?

A

Tx UTI

  • TMP-SMX
  • nitrofurantoin

Note: acute cystitis is a common cause of hematuria

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410
Q

80yo M w/ dementia. More frequently agitated, aggressive, requires olanzapine/haldol PRN. Develops Parkinsonism. NSIM?

A

D/C antipsychotics! (increased mortality in dementia patients & AE++)
Only use: if patient or caretakers safety is threatened

Opt for behavioural interventions, antidepressants, antidementia drugs.

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411
Q

Why is haldol contraindicated for Lewy Body Dementia?

A

neuroleptic sensitivity (worsens Parkinsonism)

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412
Q

80yo urinary incontinence, orthostatic hypotension, hallucinations, dementia, excessive somnolence. Pt develops Parkinsonism & confusion w/ low dose haldol. Dx?

A

Lewy Body Dementia

avoid neuroleptics d/t extreme sensitivity

413
Q

Tx for AK & Bowens but NOT SCC/BCC?

A

5-FU or phototherapy

414
Q

75yo w/ SCC. Refuses surgery, cryotherapy or electrotherapy. NSIM?

A

Can Tx w/ radiation (hwr requires multiple visits and increases risk of future CA, hence only for elderly refusing all other tx)

415
Q

Pruritus in pregnancy. DDX pregnancy induced skin changes VS hepatic cholestasis of pregnancy ?

A

Hepatic cholestasis of preg:

  • generalized pruritus, esp palms/soles,no rash
  • increased bile acids, LFTs
  • RF IUFD
  • deliver at 37wks
  • Tx: ursodeoxycholic acid antiH

Pregnancy induced skin changes

  • focal pruritus, no rash
  • labs grossly wnl
  • no obstetric risk
  • Tx: antiH, UV light, oatmeal baths
416
Q

Pregnant woman w/ hx atopy has disseminated papular rash. Dx?

A

Atopic eruption of pregnancy

417
Q 
3rd trim pregnancy: Pruritic, erythematous papules that begin on abdominal striae and spread to extremities. Face/palms/soles spared.
Dx: 
A) Atopic eruption of preg
B) Intrahepatic cholestasis 
C) polymorphic eruption of pregnancy
D) pregnancy induced skin changes 
F) pemphigoid gestationis
A

C) polymorphic eruption of pregnancy

418
Q

Pregnancy induced skin changes. Tx?

A

antiH, UV light, oatmeal baths

419
Q

AI disease in 2nd/3rd trim, abdominal pruritus > periumbilical urticarial papules/plaques which spreads to body > tense bullae (spares mucous membranes) Dx?

A) Atopic eruption of preg
B) Intrahepatic cholestasis 
C) polymorphic eruption of pregnancy
D) pregnancy induced skin changes 
F) Pustular psoriasis of pregnancy 
E) pemphigoid gestationis
A

E. Pemphigoid gestationis (FKA herpes gestationis)

Dx Clinical but can be confirmed w/ bx

Tx: high potency topical GCS & antiH

Obstetric complications:

  • prematurity
  • fetal growth restriction
  • neonatal pemphigoid gestationis
420
Q

Pregnant F: Erythematous plaques, surrounded by sterile pustules that spread outward to flexural regions (axilla, inframammary). Non-pruritic. Dx?

A) Atopic eruption of preg
B) Intrahepatic cholestasis 
C) polymorphic eruption of pregnancy
D) pregnancy induced skin changes 
F) Pustular psoriasis of pregnancy 
E) pemphigoid gestationis
A

F) Pustular psoriasis of pregnancy

421
Q

Tx pemphigoid gestationis

A

high potency topical GCS & antiH (resolves sp delivery)

  • if resistant to above:
  • PO GCS
  • rare: cyclosporine, azathioprine
422
Q

Pemphigoid gestationis adequately Tx w/ topical triamcinolone & antiH. Pt asks about prognosis?

A

Good, resolves sp preg but risk of recurrence w/ subsequent pregnancies

Note: 
Obstetric complications: 
- prematurity
- fetal growth restriction
- neonatal pemphigoid gestationis
423
Q

Intrahepatic cholestasis of pregnancy: Tx?

A 
Definitive Tx: delivery 
Ursodeoxycholic acid MOA: 
- decreases GI cholest absorp
- decreases hepatic cholest excretion 
HENCE less cholesterol in bile & increase in bile flow
424
Q

Elderly w/ magnetic/wide-based gait, frequent falls, urinary incont & AMS. Tx?

A

Triad for NPH
Tx: ventriculoperitoneal shunting

Dx:

  • MRI: enlarged ventricles, out of proportion to brain atrophy
  • improvement w/ CSF removal (30-50mL)
425
Q

NPH suspected: Dx work up?

A

Dx:

  • MRI: enlarged ventricles, out of proportion to brain atrophy
  • improvement w/ CSF removal (30-50mL)

Tx: Tx: ventriculoperitoneal shunting

426
Q 
HRT puts patients at risk for
A) breast CA 
B) CRC
C) ovarian CA 
D) endometrial CA
A

A) breast CA

It reduces risk of CRC! Neutral for endometrial/ovarian

427
Q

RF of HRT?

A
  • VTE
  • Breast CA
  • CAD >60
  • CVA
  • gallbladder disease

(mostly in women 60+)
Has benefits for women <60, non-smokers, no hx VTE or breast CA

428
Q

T/F: HRT reduces risk of all cause mortality <60.

A

TRUE

429
Q

Benefits of HRT outside of menopausal sx?

A

Reduces risk of following:

  • DM (decreased insulin resistance)
  • all cause mortality <60
  • osteoporosis
  • CRC
430
Q

Fever, pharyngitis & sandpaper-like rash. Pathogen?

A

Spyogenes

431
Q

6yo w/ fever/cough > erythematous cheeks, reticular truncal rash. Dx?

A

Erythema infectiosum.

Parvovirus

432
Q

Fever/fatigue, cough, coryza, conjunctivitis&raquo_space; maculopapular rash starts on face & spreads caudally. Foreign travel. Which pediatric exanthem?

A

MEASLES (RUBEOLA)

Tx VitA if hospitalized, otherwise supportive

433
Q

Tx rubeola?

A

MEASLES (RUBEOLA)

Tx VitA if hospitalized, otherwise supportive

434
Q

Stent thrombosis sp coronary artery stenting w/in 30 days. MCC?

A

Med nonadherence (DAPT)

435
Q

Papular urticaria:

  • cause
  • Tx?
  • prognosis
A

Cause: delayed HS reaction to insect bites
Tx: antiH, topical GCS, avoid insect bites

Prog: occasionally recurrent course over wks/months
More common in peds

436
Q 
Pale halos are associated w/: 
A) papular urticaria
B) lichen planus
C) pityriasis rosea
D) nummular eczema
E) guttate psoriasis
A

A) papular urticaria

437
Q

Why is trazodone not used for MDD monoTx?

A

V high doses required to tx MDD which often cause intolerable daytime sedation
- used to Tx insomnia in MDD

438
Q

Needlestick, contact w/ mucous membrane or non-intact skin comes into contact w/ HIV fluids. Which fluid is NOT infectious?

A

urine
feces
tears
vomitus

Otherwise if blood, semen, vaginal secretions, ~CSF, ~pleural, ~pericardial: PEP

439
Q

Advised PEP for HIV needlestick.

A

3-drug HAART x 4wks

440
Q

What is seen on the contrast enema in setting of meconium ileus?

A

microcolon

441
Q

48h neonate has not passed meconium. Contrast enema shows normal caliber rectosigmoid & a dilated descending colon. AXR shows multiple loops of large bowel and no air in the rectum. Dx?

A

Hirschprung

Dx: suction bx

442
Q

Biggest absolute & relative contraindications to organ transplant?

A

absolute: active EtOH/PSA
relative: poor social suppory

443
Q

New onset unexplained CHF. Which tests are indicated?

A

Evaluate CAD w/ coronary angiography or stress test

(note: acute MI causes irreversible myocardial death HWR in chronic myocardial ischemia, some tissue is still viable & may have reversibly depressed contractility!)
In these pt revasc can lead to improvement in: Sx, systolic funct & long term mortality

444
Q

MCC dilated cardiomyopathy

A

idiopathic (primary)

2nd MCC: CAD > isch cardiomyopathy

445
Q

CRC screening indications w/ UC?

A

start 8-10yrs sp Dx

Q1-3y

446
Q

**CRC screening for patients w/ 1st deg FHx or high risk adenomatous polyp

A

age 40 (or 10y prior to 1st deg family dx)

Q5y (or 10y if FHx >60)

447
Q

Clozapine has superior efficacy in tx schizophrenia hwr reserved for tx-resistant cases per risk of: _________

A

agranulocytosis

448
Q

Flaccid paralysis, hyporeflexia & sensory level/ bladder or bowel dysfunction sp URTI. Dx?

A

Transverse myelitis

DDx GBS does not have sensory level/ bladder or bowel dysfunction

449
Q

Flaccid paralysis, hyporeflexia & sensory level/ bladder or bowel dysfunction sp URTI. Transverse myelitis suspected. NSIM?

A

MRI to r/o less likely etiologies:

  • post traumatic
  • CA/tumor
  • herniated disk
  • epidural abscess

Tx: 3-5 days high dose GCS

450
Q

Tx Transverse myelitis?

A

high dose GCS x 3-5 days

451
Q

Tx neonatal hyperbilirubinemia

A

Mild: maximize feeds 2-3h
Mod: photoRx, hydration,
Severe: exchange transfusion (ie. bili >20)

** note: severe hyperbilirubinemia&raquo_space;kernicterus (permanent brain damage)

452
Q

When do you Tx neonatal hyperbilirubinemia w/ exchange transfusion and why?

A
  • bili >20
  • failed photoRx
  • neuro sx: lethargy/
    hypotonia

**severe hyperbilirubinemia&raquo_space;kernicterus (permanent brain damage)

453
Q

breastfeeding failure jaundice pathomech?

A

Lactation failure > decreased bili elimination > increased enterohepatic circ

454
Q

High levels of b-glucuronidase in breast milk > deconjugates interstinal bili > increased enterohepatic circ. Dx?

A

Breast milk jaundice

455
Q

How does parvovirus manifest in adults?

A

Flu-like > acute onset symmetrical joint pain/ swelling/ stiffness (F>M). +/- reticular rash (less common), transient aplastic anemia

Tx: NSAIDs, supportive

456
Q

Pharyngitis > migratory polyarthritis, erythema marginatum, subcutaneous nodules. Dx?

A

Acute rheumatic fever

457
Q

Dx test parvovirus

A

Often clinical

May confirm w/ serology (parvovirus B19 IgM abs)

458
Q

Acromegaly: Common causes of death?

A

CVS (HTN, septal hypertrophy, conduction defects, CAD, myocardial fibrosis)

Other:

  • resp
  • DM
  • CA (esp CRC)
459
Q

MC CA in acromegaly?

A

CRC (more polyps also)

460
Q

HR >150, hemodynamically stable, widened QRS, regular rhythm. Dx & Tx?

A

Monomorphic Vtach

  • amiodarone
  • procainamide
  • sotalol
  • lidocaine
461
Q

HR >150, hemodynamically stable, widened QRS, irregular rhythm.

A

?afib w/ aberrant conduction.

  • procainamide
  • ibutilide
462
Q

HR >150, narrow QRS, reg rhythm. Dx & Tx?

A

non-afib SVT
(ie AVNRT)

Tx: vagal maneuver, adenosine

463
Q

Ultra short BB used for rapid control of afib?

A

Esmolol

464
Q

IV iron given > flushing, SOB/wheezing & hypoTN. NSIM?

A

EPI IM (suspect anaphylaxis)

465
Q

Infantile hemangioma- prognosis?

A

prolif 0-6 months, then red>violet w/ regression

IF:

  • > 5 lesions: liver US
  • facial/segmental: TTE & MRI head (PHACE)
  • cervicofacial: laryngoscopy
  • lumbosacral: spinal US
466
Q 
Infantile hemangioma. What further w/u is needed for the following?
1. >5 lesions
2. facial/segmental: 
3. cervicofacial:
4 lumbosacral:
A
  1. liver US
  2. TTE & MRI head (PHACE)
  3. laryngoscopy
  4. spinal US
467
Q

Indication for BB w/ infantile hemangioma?

A
  • large, facial, segmental &/or rapidly growing (ulceration/scarring)
  • periorbital
    (RF visual impair)
  • hepatic
    (RF high output HF)
  • subglottic
    ( RF airway obstruct)
468
Q

Which does NOT fade with time?
A) nevus flammeus
B) infantile hemangioma
C) nevus simplex

A

A) nevus flammeus (port wine stain)

  • blanchable
  • red capillary malformation
  • do not cross midline
469
Q

MCC acute epididymitis:
<35yo?
>35yo?

A

<35yo STD
>35yo coliform bact (bladder obstruction)

Dx: NAAT, UA/UCx

470
Q

Progressive unilateral scrotal pain w/ edema & tenderness. Improved w/ testicular elevation. Dx work up?

A

Dx: NAAT, UA/UCx

<35yo STD
>35yo coliform bact (bladder obstruction)

471
Q

Progressive unilateral scrotal pain w/ edema & tenderness. Improved w/ testicular elevation. Tx?

A

<35yo STD:
= ceftriaxone/doxy

> 35yo coliform bact (bladder obst)
= cipro

472
Q

5yo M w/ meningitis, parotitis & orchitis. Dx?

A

Mumps

473
Q

MCC viral orchitis?

A

Mumps
Parvovirus
Rubella

474
Q

TTP Tx:

A) enhancing release vWF from endothelium

B) increasing amt/activity of plasma metalloprotease

C) removing trigger for uncontrolled activation of the coag cascade

D) supressing Ab production against PLT Ag

A

B) increasing amt/activity of plasma metalloprotease

Note: TTP path is 
1. Low ADAMTS13 (a plasma metalloprotease) 
2. uncleaved vWF multimers
3. PLT trapping/ activation 
4.  diffuse microthrombi
5. PLT consumption 
6. intravasc RBC shearing > MAHA
(^schist, bili, LDH, LFT)
7. Organ ish: AKI, neuro sx
475
Q

What is ADAMTS13 and what does it do?

A

a plasma metalloprotease which cleaves v large strings of vWF off the vascular endothelial wall

TTP: autoAbs against ADAMTS13

476
Q

AutoAbs against ADAMTS13 >MAHA. Tx?

A

plasma exch
GCS
rituximab

**PLT transfusions may worsen MAHA (only in very severe bleed)

477
Q

Abs against PLT Ag. Dx?

A

ITP

478
Q

TTP pathogenesis

A
  1. AutoAbs against ADAMTS13 (plasma metalloprotease) > low levels
  2. vWF multimers go uncleaved
  3. PLT trapping/ activation
  4. diffuse microthrombi
  5. PLT consumption
  6. intravasc RBC shearing > MAHA
    (^schist, bili, LDH, LFT)
  7. Organ ish: AKI, neuro sx
479
Q

Hospitalized pt w/ >50% PLT drop & new art/venous thrombosis. NSIM?

A

obtain 5HT assay & STOP all heparins.

START direct thrombin inhibitor (argatroban, bivalirudin) OR fondaparinux (synthetic pentasaccharide)

480
Q

PE > anticoag > HIT. Heparins stopped & started on argatroban/ bivalirudin/ fondaparinux. When do you start warfarin?

A

When PLT recover >150
(note, you continue the non-heparin AC until INR becomes therapeutic)

Direct oral anticoagulants may be considered (apixaban)

481
Q

Hypopigmented spots, FHx bilateral deafness. Dx?

A

NF2 (cafe au lait spots, bilateral acoustic neuromas)

DDx NF1: HYPERpigmented spots & UNIlateral deafness)

482
Q

Hypopigmented maculae, organ hamartomas/cysts., epilepsy, cardiac rhabdomyosarcoma.
Dx?

A

Tuberous Sclerosis

Ashleaf spots
Shagreen patch
Heart rhabdomyosarcoma
Lung hamartomas
Epilepsy 
Angiomyolipoma of kidney
Facial angiofibroma
483
Q

Following features are features of ____

  • Leptomeningeal- capillary-venous malformation.
  • Port wine stain
  • glaucoma
  • MR
  • seizures
A

Sturge Weber

484
Q

ASHLEAF mnemonic Tuberous Sclerosis

A 
Ashleaf spots
Shagreen patch
Heart rhabdomyosarcoma
Lung hamartomas
Epilepsy 
Angiomyolipoma of kidney
Facial angiofibroma
485
Q

Heart rhabdomyosarcoma

& lung hamartomas. Dx?

A

Tuberous Sclerosis

Ashleaf spots
Shagreen patch
Heart rhabdomyosarcoma
Lung hamartomas
Epilepsy 
Angiomyolipoma of kidney
Facial angiofibroma
486
Q

Angiomyolipoma of kidney, Assd Dx?

A

Tuberous Sclerosis

Ashleaf spots
Shagreen patch
Heart rhabdomyosarcoma
Lung hamartomas
Epilepsy 
Angiomyolipoma of kidney
Facial angiofibroma
487
Q

Red spots on lips. Which other features do you expect?

A

Telangiectasia
Epistaxis
AVM

Dx: Osler Weber Rendu AKA hereditary hemorrhagic telangiectasia

488
Q

Untreated AK has a __% risk of progression to SCC.

A

20%

489
Q

Multiple Aks. Tx?

A

Field Tx:

  • 5FU
  • Immiquimod
  • voltaren gel
  • photodynamic rx
490
Q

39yo smoker w/ GERD presents to ED c/o dull annoying CP sp meal x 2h. NSIM?

A

EKG & trops x 2+.
Give ASA & NTG.

Must r/o MI

491
Q

Preg 22w gest w/ new onset HTN, AKI & proteinuria. Dx?

A

Preeclampsia
*new onset HTN >20w gest
AND
* proteinuria &/or end organ damage

Severe features:

  • > 160/110 x 2 (>4h apart)
  • thrombocytopenia
  • ^ Cr
  • ^ LFTs
  • pulm edema
  • visual/cerebral sx
492
Q

Preeclampsia w/ severe features:

  • > 160/110 x 2 (>4h apart)
  • low PLT
  • ^ Cr
  • ^ LFTs
  • pulm edema
  • visual/cerebral sx

Management?

A 
If severe features, deliver 34w+
Mg sulfate
antiHTN
- labetalol
- hydralazine

(if no severe features, deliver 37w+)

493
Q

RF preeclampsia?

A
  • nulliparity

- advanced maternal age

494
Q

Why is Mg given in preeclampsia?

A

seizure ppx

495
Q

Severe features of preeclampsia?

A
  • > 160/110 x 2 (>4h apart)
  • low PLT
  • ^ Cr
  • ^ LFTs
  • pulm edema
  • visual/cerebral sx

Think KIDNEY, LUNG, LIVER, HEAD, BLOOD

496
Q

35yo sp gastric bipass c/o back pain. Takes vitD & Ca supplement. Labs show Ca 9, Ph 2.2, AlkP 155, PTH 955. DEXA w/ osteopenia. NSIM?

A

measure serum 25 hydroxy vitD.

Likely inadequate vitD supplement. Osteomalacia & secondary hyper PTH.

497
Q

Level of vit D

- deficiency

A 
def <20
insuff 20-30
498
Q

Initial Tx of vitD def VS maintenance?

A

cholecalciferol D3 50,000U /wk x 8wks

THEN
1,500-2,000U /d
(*Unless malabsorp:
3,000-6,000U /d)

499
Q

Why should zolendronic acid NOT be used in setting of vitD def?

A

Risk of hypoC

500
Q

Which supplements should be prescribed s/p gastric bipass?

A

VitD (high dose)
B1, B12, folate
Ca, Fe
trace minerals

501
Q

Which is NOT a feature of atopic derm?

A) mutation in filaggrin
B) ^ H2O content
C) ^ inflamm
D) ^ permeability 
E) Th2 skewed response 
F) lichenification 
G) assd w/ food allergy 
H) ^ IgE
I ) eosinophilia 
J) improved w/ cotton clothing
A

B) ^ H2O content

*Pt should maintain skin hydration EMOLIENTS!
EMOLIENTS!
EMOLIENTS!

502
Q

Lab findings in atopic derm?

A

High IgE & eosinophils

503
Q 
Tx atopic derm
A) face, flexural
B) mild
C) severe
D) v severe
A 
A) calcineuric inhibitors (tacrolimus) 
B) mild GCS- hydrocortisone
C) mod/high potency GCS-
triamcinolone
betamethasone 
D) UV tx or systemic immunosuppressants
504
Q 
Which are most common for tattoo removal?
A) dermabrasion
B) cryo
C) thermal cautery 
D) surg resection 
E) laser
A

A) dermabrasion
E) laser

  • biggest AE:
  • scarring
  • skin discoloration
505
Q

Knee pain s/p jumping from height > popping, pain/swelling & difficulty bearing weight. Pt cannot actively extend the knee or raise the leg against gravity. Dx?

A

Patellar tendon tear

RF: FQs, strong quad contraction with foot firmly planted

506
Q

Lachman test + Dx?

A

ACL tear

Lachmans (20deg) is more sensitive than anterior drawer (90deg)

507
Q

MCC neonatal sepsis

A

GBS

508
Q

Indications for GBS PPx w/ ampicillin, PNC or cefazolin >4h from delivery (4)

A
  1. maternal GBS bacteruria
  2. maternal rectovag Cx obtained 36-38w gest
  3. sibling w/ invasive GBS disease
  4. unknown GBS status w/ RF (PPROM >18h)
509
Q

Peripartum PPX Group B Strep- Abx?

A

ampicillin, PNC or cefazolin >4h from delivery

510
Q

Mother is afebrile. Tested GBS+ during preg. Abx administered 2h before birth. NSIM?

A

**Should have been 4h before labor, hence inadequate ppx HWR as infant is well appearing, OBSERVATION 36-48h recommended (as almost all neonates will have sx in this time)

511
Q

Which 3 scenarios warrant BCx/Abx to neonate despite ppx?

A
  • maternal fever during labor
  • sx neonatal infection: fever/lethargy
  • gest age <35 prompted by signs of infection
512
Q

BEST Tx for head/neck CA
A) rad
B) chemo
C) chemo/rad

A

C) chemo/rad

513
Q

Best antiHTN med used in gout?

A

ARBs per uricosuric effect

Avoid thiazides/loops

514
Q

Blow to the knee or significant twisting force >popping sensation, rapid hemarthrosis & joint instability.

A

ACL tear

Dx

  • Lachmans+
  • anterior drawer+
  • MRI
515
Q

Preg sp MVA, wearing seatbelt. Abd pain, high-freq/low-instensity contractions. Rigid tender uterus, no vaginal bleed. Reassuring fetal non-stress test. NSIM?

A

r/o concealed abruptio placentae w/ US

& Order Kleihauer-Betke to detect and quantify the amount of fetal maternal hemorrhage by calculating percent of fetal RBCs in maternal circ (determines the amount of RhoD globulin needed to decrease risk of alloimmunization

516
Q

Kleihauer-Betke test use?

A

detects and quantify the amount of fetal maternal hemorrhage by calculating percent of fetal RBCs in maternal circ (determines the amount of RhoD globulin needed to decrease risk of alloimmunization

517
Q

70yo w/ CAD, PAD, ESRD on HD p/w ild/moderate crampy abd pain abd pain w/ fecal urgency > hematochezia. Afebrile. Labs: WBC+, lactic acidosis. CT: colonic wall thickening, fat stranding. Endoscopy: edematous/friable mucosa. Dx & Tx?

A

Colonic ischemia
(watershed, hypovol, atherosclerosis)

Tx: IVF, bowel rest. Abx

Colonic resection if necrosis develops

518
Q

Tx colonic ischemia

A

Tx: IVF, bowel rest. Abx

Colonic resection if necrosis develops

519
Q

Colonic ischemia: Imaging and labs?

A

Labs: WBC+, lactic acidosis.

CT: colonic wall thickening, fat stranding. +/- pneumatosis. Endoscopy: edematous/friable mucosa.

520
Q

RF colonic angiodysplasia

A

CKD
AS
VWD

521
Q

Beneficence VS non-maleficence

A

duty to be of benefit to patients VS do no harm

522
Q

Protective factors from suicide?

A
  • social support/ family connection
  • pregnancy
  • parenthood
  • religion
523
Q

Which valve is best listened to after exhaling in L lateral decubitus position?

A

Mitral

524
Q

Should you accept the following from a patient:
A) a watch
B) box of chocolates

A

A) no, but reassure pt you will give them the best care

B) yes, to refuse a small token of appreciation may be damaging to the pt-physician relationship

525
Q 
Which of the following are most likely to be injured w/ medial laceration of the eyelid?
A) punctum
B) canaliculi 
C) levator muscle
D) nasolacrimal duct
E) lacrimal sac
A

B) canaliculi

526
Q

**Which EKG findings are diagnostic of a STEMI?

A
  • > 1mm all leads EXCEPT V2 & V3
  • V2/V3 >1.5mm F
  • V2/V3 >2mm M >40
  • V2/V3 >2.5mm M <40
  • new LBBB
527
Q

Which is NOT diagnostic of a STEMI?

A) >2mm in all leads except V2/V3

B) V2/V3 >1.5mm F

C) V2/V3 >2mm M >40

D) V2/V3 >2.5mm M <40

E) new LBBB

A

A) >2mm in all leads except V2/V3

** >1mm in all leads except V2/V3

528
Q

STEMI in rural setting. NSIM?

A

fibrinolytics (alteplase etc) w/in 30mins as PCI cannot be performed in <120mins

529
Q

25yo M w/ sudden onset foot pain, pulselessness/coolness. Etiology?

A

Acute arterial occulusion likely 2/2 cardiac emboli

  • afib
  • severe ventricular dysfunction
  • endocarditis
  • valvular disease
  • atrial myxoma
  • prosthetic valve
530
Q 
25yo M w/ sudden onset foot pain, pulselessness/ coolness. Which is NOT the cause?
A) afib
B) severe ventricular dysfunction 
C) endocarditis
D) factor V Leiden heterozygosity 
E) valvular disease
F) atrial myxoma 
G) prosthetic valve
A

D) factor V Leiden heterozygosity

**assd w/ venous thrombosis

531
Q

Cardiac tumor: Extremely friable, may lead to tumor emboli. May obstruct mitral valve if large. Dx?

A

Atrial myxoma (MC cardiac tumor)

  • Assd w/ rapid HF onset or new onset afib
532
Q

Dysuria, postvoid dribbling, dyspareunia, anterior vaginal mass. Assd w/ hematuria, recurrent UTIs, stress urinary incont. Dx?

A

urethral diverticulum

RF: repeated infection, inflammation and pelvic trauma (vag delivery, surgery)

533
Q

Fever, dyspareunia, abd/pelvic pain, mucopurulent cervical discharge, cervical motion tenderness. Dx?

A

PID

polymicrobial inf of the upper reporductive tract 2/2 unTx chlam/ gono

534
Q

Urethral diverticulum Dx work up & Tx?

A

UA
UCx
MRI pelvis
US pelvis

Tx: manual decompression, needle aspiration, surgical repair

535
Q

High risk featur of head trauma in peds <2yo is NOT:

A) fall >3ft
B) AMS/fussy
C) palpable skull fracture
D) frontal scalp hematoma

A

D) frontal scalp hematoma

**NON_frontal scalp hematoma (esp >3cm)

536
Q

Gold standard for Dx sclerosing cholangitis?

A

ERCP

assd w/ UC

537
Q

Most specific abs or Dx AI hepatitis are anti-smooth muscle abs AND _____

A

ANA (homogenous staining pattern)

538
Q

AI hepatitis disease course?

A

may progress to cirrhosis & liver failure w/in 6 months. Young/middle-aged women

539
Q

Which mechanical obstetric emergency is PPROM associated w/?

A

umbilical cord prolapse&raquo_space; fetal hypoxia

540
Q

PPROM > cord compression. Tx?

A

Downward dog pose to relieve pressure or manual elevation of presenting fetal part to relieve cord compression prior to EMERGENT C/S.

541
Q

PPROM > fetal recurrent variable deccelerations & brady. Dx?

A

r/o cord compression

Tx: emergent C/S

542
Q

Worst HA of life but head CT w/o signs of SAH. NSIM?

A

LP to check xanthochromia which appears >6h sp bleed. Then CTA for bleed source.

CTH is 100% sensitive w/in 6h of sx onset, then rapid decline.

543
Q

CSF: elevated RBC in first tube, then declining number of RBCs in successive tubes. Dx?

A

Traumatic LP

544
Q

Newborn w/ conjugated hyperbilirubinemia (DBili >20% TBili) Dx?

A

Biliary atresia 2/2 progressive obstruction of extrahepatic biliary tree

545
Q

Which presents in the first week of life?
A) Breast milk jaundice
B) Breastfeeding failure jaundice

A

B) Breastfeeding failure jaundice

546
Q

Breast milk jaundice Tx?

A

Monitoring & f/u of bili levels. **EXCLUSIVE BREASTFEEDING ENCOURAGED, resolves w/in 3 months

547
Q

MCC viral meningoencephalitis in peds?

A
  1. Coxakievirus (enterovirus)
  2. HSV
  3. West Nile (arbovirus)

Tx: acyclovir for HSV & vanc/ceftriaxone until ruled out, otherwise supportive

548
Q

RMSF Tx?

A

doxy

549
Q

Top 3 Tx options

& duration uncomplicated cystitis.

A
  • nitrofurantoin x 5d
  • TMP-SMX x 3d
  • fosfomycin x 1

**preg test beforehand

550
Q

Tx complicated cystitis

A

FQ (cipro, levo)

Ampi-genta

551
Q

Pregnant F w/ complicated cystitis. Which is NOT a Tx option?

A) cipro
B) cefopodoxime
C) cephalexin
D) amoxi-clav
E) fosofomycin
A

A) cipro
(AVOID FQ in preg: toxic to developing cartilage)

**nitrofurantoin may only be used in 2nd & early 3rd trimester.

Also avoid

  • TMP-SMX
  • tetracyclines
552
Q

Match the Abx w/ teratogenicity:

A) toxic to developing cartilage

B) congenital deafness

C) NTD, cardiac defects

D) cleft palate

A

A) FQs
B) gentamycin
C) TMP-SMX
D) TMP-SMX

553
Q

MCC diaper dermatitis?

A
  1. contact

2nd MCC candida

554
Q

Positive stress test. NSIM?

A

Start ASA, statin, BB. Optimize BP/glycemic control, quit smoking.

If high risk features ie TWI w/ minimal exertion > coronary angiography (if no high risk features hwr angina+, also undergo angio)

555
Q

Which of the following DOES NOT have an early incubation period <10d?

A) typhoid
B) dengue
C) chukungunya 
D) legionella
E) leishmania
A

E) leishmania

>3w

556
Q 
Which of the following has an early incubation period <10d?
A) legionellosis
B) leptospirosis
C) leishmaniasis 
D) rickettsial d
E) malaria
A

A) legionellosis

557
Q

Sub-saharan Africa > febrile illness 2wks after return. HA, thrombocytopenia. Which Dx to establish Dx?

A

Blood smear, Plasmodium falciparum

558
Q

How to alter AM insulin regimen if planning a 45min run?

A

Lower AM aspart

  • if over 45min, consider lowering PM levemir also
  • if gluc <100 before/during/after run, additional carbs should be consumed
559
Q

NSIM in unilateral nipple discharge if

  • > 30
  • <30
A

> 30: mammogran AND US

<30: US
+/- mammogram

MCC papillary tumor (benign but may have assd areas of atypia, DCIS or unvasive intraductal carcinoma

560
Q

MCC unilateral breast discharge?

A

MCC papillary tumor (benign but may have assd areas of atypia, DCIS or unvasive intraductal carcinoma

NSIM:
- >30: mammogran AND US
- <30: US
+/- mammogram

561
Q

Lobular carcinoma in situ on core bx. NSIM?

A

excisional bx w/ surveillance

Then +/- chemoprevention w/ SERMS ir tamoxifen/raloxifene

(this is a nonmalig region w/ no mammogram/clinical correlate. RF for lobular/ductal CA

562
Q 
Lobular carcinoma in situ on core bx. Which is NOT part of subsequent management?
A) excisional bx
B) modified mastectomy 
C) sentinel node bx
D) tamoxifen
E) chemo/rad
A

B,C,E

NSIM: excisional bx w/ surveillance

Then +/- chemoprevention w/ SERMS ir tamoxifen/raloxifene

563
Q

55yo w/ mild TSH suppression but normal T3/T4, no sx, RRR, normal bone density. NSIM?

A

recheck TSH in 6-8wks

high chance of TSH normalization

564
Q

Tx large prolactinoma compressing optic chiasm?

A

D receptor agonists (bromocriptine, cabergoline) ALWAYS first line.

Often decrease in tumor size w/in few days (visual sx improve before shrinkage)

565
Q

Most potent medication for raising HDL?

A

niacin (lowers LDL/TGs) hwr not as effective as statins.

566
Q

Which diabetics are advised to start a MODERATE intensity statin?

A

> 40yo w/ ASCVD <20

if >20, high-intensity

567
Q

When do you give a basal bolus in management of DKA?

A

Gluc <200
Pt can eat
HCO3 >15
AG <12

568
Q

Amenorrhea <40yo. High FSH, low E. NSIM?

A

adrenal Abs
TSH
karyotype

Common causes:

  • chemorad
  • AI (Addisons, hypothyroidism)
  • FragileX, Turner
569
Q

Child swallowed coin an hour ago, seen in stomach on CXR. NSIM?

A

Repeat XR in 1wk UNLESS high risk object (battery, magnet, sharp item) then endoscopic removal

(most objects will pass spontaneously, coin is not a high risk object)

570
Q

RF for splenic vein thrombosis?

A

acute/chronic pancreatitis or pancreatic CA (damaged or compressed by pancreatic inflammation)

571
Q

Isolated gastric varices are a hallmark of:

A

splenic vein thrombosis

572
Q

Splenic vein thrombosis w/ GIB. Tx?

A

splenectomy

573
Q

RUQ pain, hepatomegaly, jaundice, rapidly developing ascites. R/o thrombosis of:

A

hepatic veins or intra/suprahepatic IVC. (Budd-Chiari)

Chronic> ascites, cirrhosis, portal HTN

574
Q

Hgb 7.2, MCHC 27%, MCV 72, ferritin wnl. Dx?

A

IDA (note ferritin cutoff is <15, but not sensitive. Commonly ferritin 15-30 can also be deficient.

575
Q

Non-caseating granulomas. Negative fungi/AFB. Dx?

A

Sarcoidosis

576
Q

Erythema nodosum, bilateral hilar LAD, polyarthralgia. Dx?

A

Lofgrens Syndrome (Sarcoidosis)

577
Q

Sarcoidosis pt w/ erythema at the junction of the cornea/sclera, constricted pupil, blurred vision, moderate eye pain. Dx?

A

Anteroir uveitis

578
Q

Elderly pt w/ severe eye pain, mid dilated pupil, HA, N/V. Dx?

A

Acute closure glaucoma

579
Q

Bacterial/fungal infection of the intraocular cavities&raquo_space; decreased visual acuity, aching of the affected eye and conjunctival injection. Assd w/ severe underlying illness or recent eye surgery. Dx?

A

Endopthalmitis

580
Q

Complication of GERD that can cause obstructive dysphagia in young patients. Often prolonged, careful chewing.

A

Peptic stricture formation (difficulty swallowing solid food >liquids

DDx achalasia: dysphagia solids AND liquids from the beginning

581
Q

In which conditions is hyperCa 2/2 immobilization most often seen?

A

Pagets, adolescents

v high bone turnover

582
Q

Tx hyperCa 2/2 immobilization for prolonged periods?

A

bisphosphonates: decrease bone resorption > preserve bone mass

583
Q

HyperCa 2/2 extrarenal production of 1,25 OH-vitD?

A

Granulomatous disorders (sarcoidosis, TB)

584
Q

MOA hyperCa in paraproteinemias?

A

Increase in total bount Ca but ionized free Ca is wnl

585
Q

Pt sp laparoscopic surgery> persistent abd pain, fever, some guarding, no rigidity, ileus+, WBC+. NSIM?

A

abd CT w/ PO contrast to eval for unrecognized bowel injury (ie bowel puncture, thermal inj)

**if frank peritonitis suspected (guarding, rigidity, rebound tenderness) straight to laparotomy w/o imaging

586
Q

Signs of frank peritonitis?

A 
Abd pain 
Guarding
Tense abd
Rebound
WBC, fever, ileus
587
Q

Sp laparoscopic cholecystectomy > low fever, N, abd pain. Serum bili++. NSIM?

A

r/o bili injury w/ abd CT vs ERCP. Surgical repair likely required.

588
Q

High TSH, high T4/T3, elevated alpha subunit 85%, high GH. Dx?

A

TSH secreting pituitary adenoma

Tx: somatostatin analogs, +/- transsphenoidal surgery

589
Q

Tx TSH secreting pituitary adenoma?

A

somatostatin analogs, +/- transsphenoidal surgery

590
Q

TSH secreting pituitary adenoma. High/low?

A) TSH
B) T4/T3
C) alpha subunit
D) TBH

A

all high

591
Q

Thyroid hormone resistance syndrome. High/low?

A) TSH
B) T4/T3
C) alpha subunit
D) TBH

A

A) high
B) high
C) wnl
D) wnl

592
Q

Recurrent sinopulm infections due to encapsulated bacteria per lack of opsonizing IgG. Dx?

A

X-linked agammaglobulinemia

complement dysfunction ie C3 def also causes increased infections w/ encapsulated bacteria

593
Q

Impaired PMH chemotaxis. Dx?

A) SCID
B) CGD
C) leukocyte adhesion def
D Agammaglobulinemia

A

C) Leukocyte adhesion def.

recurrent skin/mucosal infections

594
Q

Dementia, spastic paresis, hyperreflexia, impaired vibration, Romberg+. Dx?

A

B12 def > subacute combined degeneration

595
Q

MC neuro Sx of Wilsons d?

A

dysarthria

596
Q

B12 def > subacute combined degeneration. Reversible or not?

A

Reversible!

597
Q

B12 def - MOA of mild indirect hyperbilirubinemia, low haptoglobin, ^LDH, normal retic?

A
  1. defective DNA synth w/ megaloblastic transformation of bone marrow and intramedullary hemolysis
  2. intense erythroid hyperplasia but erythroid cells do not mature & die in BM
598
Q

Which is an example of EXTRAhepatic cholestasis?
A) biliary stricture
B) PBC
C) PBS

A

A) biliary stricture

599
Q

Direct or indirect hyperbilirubinemia
A) extrahepatic cholestasis
B) intrahepatic cholestasis (PBC, PSC)

A

both direct

600
Q

Isolated indirect hyperbilirubinemia 2/2 impaired hepatic conjugation. Dx?

A

Gilbert syndrome

Tx supportive

601
Q 
Which is NOT a Tx for rosacea?
A) topical metro
B) topical clinda
C) azelaic acid
D) BP wash
E) dapsone 
F) ) laser
G) topical brimonidine
A

E) dapsone
(NOT USED)

all others used.
topical metro is best

602
Q

CRC screening in pts w/ FDR w/ CRC.

A

START colonoscopy age 40 or 10y before dx FDR CRC (whichever comes first)

Then Q5y if FDR dx <60, or Q10y if >60

603
Q

Hiker in CT > confluenct erythematous macule, malaise, fatigue, arthralgia. NSIM?

A) Lyme Western Blot
B) ELISA for B.burgdorferi
C) PO doxycycline
D) IV ceftriaxone

A

C) PO doxycycline

**serologic studies are falsely negative in EARLY infection, hence abx given promptly if sufficient clinical evidence

HWR early disseminated Lyme should be confirmed w/ ELISA>Wblot.
(ie. carditis, neuritis, multiple erythema migrans)

604
Q

Disseminated Lyme suspected
(ie. carditis, neuritis, multiple erythema migrans). NSIM?

A) Lyme Western Blot
B) ELISA for B.burgdorferi
C) PO doxycycline
D) IV ceftriaxone

A

B) ELISA for B.burgdorferi

(then W.blot)

Disseminated/late should be confirmed w/ ELISA>Wblot prior to tx

605
Q

Bacterial enteritis in peds/bloody dysentry. Tx?

A

Supportive!
Hydration!

*UNLESS sepsis, <3mo, immunocompromised

Note: Abx may prolong carriage in Salmonella or predispose Ecoli inf >HUS

606
Q

Profound D. Which PO hydration is best?
A) water
B) juice
C) hydration solution

A

C) hydration solution w/ low osm, gluc++ & electrolytes

Water may lead to hyponatremia/glycemia

607
Q

Bitemporal hemianopsia & hyperpigmentation s/p bilateral adrenalectomy for Cushings. Dx?

A

Nelsons Syndrome
(aggressive)

  • pituitary microadenoma w/ suprasellar extension on MRI
  • extremely high plasma ACTH d/t loss of negative feedback by adrenal GCS
608
Q

Bitemporal hemianopsia & hyperpigmentation s/p bilateral adrenalectomy for Cushings. What do you expect on:

A) MRI brain
B) ACTH levels

A

Nelsons Syndrome
(aggressive)

A) pituitary microadenoma w/ suprasellar extension on MRI

B) extremely high plasma ACTH d/t loss of negative feedback by adrenal GCS

Tx: surg/rad

609
Q

Why is Cushings disease no longer treated w/ bilateral adrenalectomy?

A

Risk of aggressive tumor (Nelsons, pituitary microadenoma w/ suprasellar extension on MRI) which has v high ACTH levels due to loss of negative feedback from adrenal GCS

610
Q

Tx ureteral stones (w/o urosepsis, AKI, complete obstruction)

A

<1cm: hydration, pain control, alpha blockers, strain urine. (uncontrolled pain/no stone passage in 4-6w > urology consult)

> 1cm: urology consult

Note: stones <5mm pass spontaneously

611
Q

Which medications facilitate ureteral stone passage?

A 
alpha blockers 
(ie. tamsulosin) x 4wks. If no passage:
  • lithotripsy
  • percutaneous nephrolithotomy
  • (rarely) laparoscopic stone removal
612
Q

STOP BANG risk stratification OSA

A 
Snoring
Tired (daytime)
Observed apnea
Pressure (HTN)
BMI >35
Age >50
Neck size >17 M
Gender M

> 4 intermediate risk >PSG

613
Q

Narcolepsy suspected. NSIM?
A) polysomnography
B) multiple sleep latency test
C) modafenil

A

ABC in that order

Polysomnography is recommended to r/o other sleep disorders first

614
Q

Tropical area > abd pain, transient cough, anemia, eosinophilia. Dx?

A

Hookworm
- Ancyclostoma
duodenale
- Necator americanus

Dx stool O/P

Tx albendazole, nitazoxanide

615
Q

LE DVT+ VS PE. Tx?

A

Both the same

No CA:

  • DOAC (onset 2-4h, no monitoring) x 3-6 months
  • warfarin is less convenient )onset 5-7d, requires 5d heparin bridge & monitoring INR)

CA+:
- LMWH

616
Q

65yo F w/ breast CA has PE on CTA. Tx?

A

LMWH per cancer

(If no cancer: 
- DOAC 
(onset 2-4h, no monitoring) 
- warfarin 
(less convenient, onset 5-7d, requires 5d heparin bridge & monitoring INR)
617
Q

MC congenital deficiencies > hypercoagulability?

A

protein C
protein S
antithrombmbin III

618
Q

Duration of AC Tx for PE or DVT?

A

3-6 months

619
Q 
52yo F om MHT for vasomotor sx develops DVT. Do you:
A) STOP MHT, start raloxifene
B) STOP MHT, start SSRI
C) C/W MHT, add AC
D) Switch to E-only MHT
A

B) STOP MHT, start SSRI

*50-70% of patients have reduction in vasomotor sx

620
Q

60yo w/ RA & severe arthralgias not improved w/ MTX. NSIM?

A

Consider TNFa inhibitor (infliximab, etanercept). Screen for latent TB beforehand.

621
Q

Suspected septic arthritis. NSIM?

A

Arthrocentesis & prompt IV abx to prevent joint destruction

622
Q

35yo F w/ primary ovarian insufficiency > DEXA -2. Tx?

A) raloxifene
B) bisphosphonate
C) E w/ medroxyprogesterone acetate
D) conjugated E

A

C) Estrogen w/ medroxyprogesterone acetate
**until 50!

Relieves vasomotor/ vaginal sx & minimizes bone loss. Progesterone must be added to prevent endometrial CA.

Raloxifene and bisphosphonates are only for postmenopausal osteoporosis

623
Q

8yo F w/ bloody, mucoid vaginal discharge & grape-like structures protruding from the vagina. Dx?

A

Sarcoma botryoides
(aggressive)
Tx better outcomes w/ new chemo/rad

624
Q

2yo w/ painless abd mass. Flushing/ diaphoresis, HTN. Dx?

A

NEUROblastoma
(MCC extracranial solid tumor peds)
<2yo, vs Wilms <5yo

  • HTN via mass compressing renal artery
  • catecholamine secretion per medullary mass
625
Q

Wilms vs Neuroblastoma.

A) prevalent age
B) painful/painless

A

Wilms

  • painful, <5yo
  • hematuria

Neuroblastoma

  • painless, <2yo
  • flushing/diaphor

(both: HTN, abd mass)

626
Q

Postmaturity syndrome: >42w gest, small, wrinkled/peeling skin, long fingernails, meconium stained placental membranes. Mechanism?

A

after 40w gest, placental function deteriorates

> fetal malnutrition & wasting

627
Q

SERMs AE?

A
  • VTE
  • vasomotor sx
  • uterine hyperplasia/CA/sarcoma (tamoxifen only)
628
Q

SERMs Use?

A
  • Prevention of BR CA in high risk (LCIS, atypical hyperplasia)
  • postmeno osteoporosis (raloxifene)
  • adjuvant CA tx (tamoxifen)
629
Q

SERM MOA?

A

competitive inhibitor of estrogen binding. Mixed agonist/antagonist

630
Q

Lead level for mild toxicity & Tx?

A

5-44

repeat in 1 month

631
Q

Moderate lead level & Tx?

A

45-69
DMSA succimer

(if >70 dimercaprol & EDTA)

632
Q

Lead level >70. Tx?

A

dimercaprol & EDTA

(If lead 45-69
DMSA succimer)

633
Q

Turners S confirmed. Which conditions should you screen for?

A
  • aortic coarctation (BP x 4 extremities)
  • horseshoe kidney (renal US)
  • hypothyroidism
  • celiac
  • neuropsych testing at school (normal IQ expected hwr risk of learning disabilities)
634
Q

Which of the following DOES NOT increase w/ advanced maternal age?
A) T21
B) XXY
C) X0

A

C) X0 Turners
D/t random error in cell division: nondysjunction. Sporadic event. Subsequent pregnancies w/ risk near general population

635
Q 
Which pressure ulcers require debridement?
A) stage 1
B) stage 2
C) stage 3
D) stage 4
A

C) stage 3: full thickness skin loass with visible SC fat

D) stage 4: full thickness skin loss with exposed bone, tendon, muscle

  • otherwise
  • maintain moist enviro
  • AVOID dry gauze
  • AVOID abx unless signs of infection
636
Q

Neonatal polycythemia:
HCT > ___
Tx?

A

HCT >65%

Tx:
1. If ASx: IVF, glucose, observe

  1. If Sx: partial exchange transfusion (withdrawing blood & exchanging w/ NS)

(Sx: lethargy, poor feeding, hypotonia, apnea, SOB, cyanosis, hyperbili, hyperviscocity)

637
Q

SIGECAPS - how many need to be fulfilled for MDD dx?

A

5

Sleep distrub
Interest
Guilt
Energy
Concentration
Appetite
Psychmotor agit.
SI
638
Q

Palivizumab indications?

A

RSV if

  • <29w gest
  • chronic lung d of prematurity
  • hemodynamically significant heart disease
639
Q

Severe cough w/ leukocytosis (50% lymphocytes). Dx?

A

Likely pertussis

Tx: macrolides

640
Q

What must you consider w/ cataract surgery in the setting of concomitant AMD?

A

cateracts provides protection from AMD. Consider risk/benefit

641
Q

Elderly, difficulty reading, scotomas, needing for brighter light for visualization. Which defect?

A

AMD

642
Q

Most prevalent optho dx in elderly?

A

cataracts 45%
AMD 20%

glaucoma 10%

643
Q

Sexually active diabetic w/ IUD has recurrent vaginal discharge which improved last year sp fluconazole. NSIM?

A) obtain detailed sexual hx
B) remove IUD
C) review blood sugar
D) schedule vaginal exam

A

D) schedule vaginal exam

*Hx is unreliable and should be confirmed w/ pelvic exam, wet mount microscopy * NAAT

644
Q

Angiodysplasias- mechanism?

A

chronic occlusion of submucosal veins > vasc congestion and formation of dysplastic AV collaterals

645
Q

Why are the following assd w/ GI angiodysplasias?

1) ESRD
2) AS
3) VWD

A

1) uremia > PLT dysfunction
2) acquired vWD 2/2 mechanical disruption
3) vWF deficiency (needed for PLT aggreg)

646
Q

Carcinoid syndrome is assd w/ which valvular path?

A

TV

647
Q

Preterm labor <32wks. What do you administer?

A
  • betamethasone
  • PNC if GBS or unknown
  • tocolysis (indomethacin)
  • MgSO4
648
Q

Preterm labor 32.0/7-33.6/7 wks. What do you administer?

A
  • betamethasone
  • PNC if GBS or unknown
  • tocolysis (nifedipine)
649
Q

Preterm labor 34.0/7-36.6/7 wks. What do you administer?

A
  • betamethasone

- PNC if GBS or unknown

650
Q

When do you administer MgSO4 in preterm preg?

A

If <32wks gest

651
Q

Which tocolytic do you use for preterm preg <32wks VS 32.0/7-33.6/7 ?

A

<32wk: indomethacin (NOT after 32wks per risk of oligohdramnios

32.0/7-33.6/7 wks:
nifedipine

652
Q

What is the Family Medical Leave Act?

A

Upt to 12wks unpaid leave w/ job protection

Qualifying

  • > half time
  • employed >1yr
  • > 50 employees at job

Serious health condition, childbirth/newborn care, Care of spouse/child/parent

653
Q

Who qualifies for the Family Medical Leave Act?

A

Qualifying

  • > half time
  • employed >1yr
  • > 50 employees at job

FOR
Serious health condition, childbirth/newborn care, Care of spouse/child/parent

654
Q

“PTSD <1month: is called:

A

Acute stress disorder

655
Q

Tx acute stress disorder

A

Trauma focused CBT

if >1 month dx PTSD

656
Q

MCC hemoptysis?

A

pulm infections 70%

  • bact PNA
  • aspergillosis
  • lung abscess
  • TB
657
Q

SAAG DDx

A

> 1.1 = portal HTN
(CHF, cirrhosis, alc hepatitis)

<1.1= NO portal HTN
(peritoneal CA or TB, nephrotic s, pancreatitis, serositis)

658
Q

Prior to elective surgery, which conditions have to be optimized?

A
  • CHF
  • COPD
  • smoking cessation 4wks+
  • OSA
659
Q 
Which DOES NOT have AE of bleeding?
A) garlic
B) ginko biloba
C) ginseng
D) saw palmetto
E) liquorice
A

E) liquorice

660
Q

What are the following used for?
A) kava
B) liquorice
C) saw palmetto

A

A) anxiety/insomnia
B) PUD, bronchitis
C) BPH

661
Q

Which is known for hepatic injury?
A) ephedra
B) saw palmetto
C) black cohosh

A

C) black cohosh (used for menopausal sx)

Also causes hypoTN

662
Q

New HTN, hypoK, low aldo, low plasma renin, met alk. Which supplement is the pt taking?

A

liquorice

663
Q

Lithium is associated w/ significant rates of which organ dysfunction?

A

Thyroid

  • interferes w/ synth & release of thyroid hormones.
  • goiter 40-50%
  • hypothyr 20-30%
  • rarely hypERthyroidism

*obtain thyroid studies before lithium tx and then Q6-12 months

664
Q 
Well-controlled bipolar on lithium develops high TSH low T4. NSIM?
A) check lithium level
B) observe & recheck 4w
C) start synthroid
D) check rT3
E) stop lithium
A

C) start synthroid

665
Q

Pt w/ hip fracture develops PE. Later spikes fever, WBC 10.5. No overt signs of infection. NSIM?

A

Collect BCx but DO NOT start abx unless signs of infection

PE causes fever in ~15% cases ?2/2 necrosis

666
Q

Which group of DM drugs is known for euglycemic DKA?

A

SGLT2 inhibitors

Often triggered by

  • starvation
  • intense exercise
  • rapid lowering of insulin regimen
  • EtOH consump
  • severe illness
667
Q

LLE venous and arterial doppler inaudible. Suspected limb ischemia. STAT heparin bolus/drip given. NSIM?

A) catheter based/surg revasc
B) emergent surg revasc
C) amputation

A

C) amputation

If venous/arterial audible
> catheter based/surg revasc

If venous audible but arterial inaudible > emergent surg revasc

668
Q

LLE venous audible and arterial doppler inaudible. Suspected limb ischemia. STAT heparin bolus/drip given. NSIM?

A) catheter based/surg revasc
B) emergent surg revasc
C) amputation

A

B) emergent surg revasc

If venous/arterial audible
> catheter based/surg revasc

If venous/arterial INaudible
>amputation

669
Q

First thing you do when acute limb ischemia is suspected?

A

STAT heparin bolus/drip

Then depending on severity…
A) catheter based/surg revasc
B) emergent surg revasc
C) amputation

670
Q 
Assd w/ urticaria & aggravation of psoriatic rash?
A) Furosemide
B) HCTZ
C) Lisinopril
D) Amlodipine
E) Metoprolol
A

C) Lisinopril (ACEi)

671
Q 
Assd w/ photosensitivity?
A) Furosemide
B) HCTZ
C) Lisinopril
D) Amlodipine
E) Metoprolol
A

B) HCTZ
(sulfonamides carry risk of photosensitivity)

D/C med, use sunscreen, avoid sun

672
Q

Rash with eggs. Can you give the influenza IM vaccine?

A

yes.

if eggs > hypoTN, resp distress, emesis = GIVE vax under medical supervision

673
Q

Consumption of eggs > hypoTN, resp distress, emesis. Can you give the influenza IM vaccine?

A

GIVE vax under medical supervision (provider who can recognize/Tx severe allergic rxn)

674
Q

Smoker w/ mets everywhere (brain, liver, lungs, supraclav/mediastinal LAD). Where do you bx?

A 
Supraclav LNs
(bx distant site of spread in advanced disease, supraclav= accessible/easy)
675
Q

MCC PNA in HIV

A

S.pneumo (hwr more invasive, lobar)

676
Q

Cardiac arrest 2/2 hypERkalemia. Tx?

A

Ca gluconate

Na HCO3

677
Q

TCA OD: Tx?

A

Na HCO3

678
Q

When do you give TPA in management of cardiac arrest?

A

When the cause of cardiac arrest is suspected to be PE

679
Q 
Which is NOT a consequence of an irreducible inguinal hernia?
A) bowel isch
B) epididymitis 
C) impaired fertility
D) testicular atrophy
A

B) epididymitis

note entrapped intestines can compromise blood supply to the testes and bowel.

680
Q

Pts who take acetaminophen for HA >10 days/month can develop:

A

secondary HA 2/2 medication overuse

681
Q

Cluster HA preventative med?

A

Verapamil starting at 240mg

(may add topiramate)

Note 100% O2 is for ACUTE Tx

682
Q

Cluster HA:
A) Acute tx
B) preventative tx

A

A) 100% O2
(if ineffective may try unilateral intranasal sumatriptan or lidocaine)

B) Verapamil 240mg+

683
Q 
Which IS NOT a contraindication to VZV vax?
A) anaphylax to neomycin
B) anaphylax to gelatin
C) pregnancy
D) solid tumor 
E) Controlled HIV
F) immunosuppressive rx
G) blood CA
A

E) Controlled HIV

only contraindicated in severe HIV

684
Q

4yo w/ brother receiving immunosuppression sp renal transplant. What do you advise in terms of the VZV vaccine?

A

Get it and monitor for rash (10% peds get a rash after the vaccine which may be contagious)

685
Q

4yo planned to undergo immunosuppression per renal transplant. What do you advise in terms of the VZV vaccine?

A

Get 2x doses of the vaccine at least 4w before immunosuppressive tx

686
Q

Sex w/ some dude who wasfound out to be HIV+. NSIM?

A

PEP: tenofovir-emtricitabine w/ raltegravir w/in 72h x 4wks

2NRTI PLUS other

687
Q 
Which Abx is NOT a low risk for Cdiff?
A) monobactams
B) TMP-SMX
C) macrolide
D) tetracyclines
E) aminoglycosides
A

A) monobactams

Other HIGH risk:

  • Clindamycin
  • Cephalosporins 3rd/4th gen
  • Floroquinolones
688
Q

When do you obtain imaging when suspecting Cdiff?

A

severe d (WBC >15, Cr >1.5) or fulminant d (septic shock, apparent ileus, megacolon)

689
Q

When do you use metronidazole PO in setting of Cdiff?

A

NEVER

may be added as IV in fulminant disease

690
Q

First line Tx for pseudofolliculitis barbae?

A

Stop shaving

- alternatives: single blade, warm compress before shaving, hair clipper, depilation, laser hair removal)

691
Q

Tx CML

A

tyrosine kinase inhibitor
then +/- BMT

path: translocation of chr 9/22 > Philadelphia chr > bcr/alb production > unregulated tyrosine kinase system.

692
Q

Translocation of chr 9/22 > Philadelphia chr > bcr/alb production > unregulated tyrosine kinase system. Tx & Dx?

A

Dx: CML

Tx: tyrosine kinase inhibitor
then +/- BMT

693
Q

bcr/alb production > unregulated tyrosine kinase system. Tx & Dx?

A

Dx: CML

Tx: tyrosine kinase inhibitor
then +/- BMT

(also Translocation of chr 9/22 > Philadelphia chr)

694
Q

33yo w/ LLE DVT, tx initiated. 2d later has ischemic CVA. Which Dx test will reveal etiology?

A

TTE/TEE w/ bubble study

paradoxical emboli

695
Q

Nurse w/ needles stick injury involving pt w/ undetectable HIV. NSIM?

A

Even though the risk is low, still Tx w/in 1-2h

3drugs x 4wks

696
Q

Urolithiasis > inf, AKI or severe pain. Tx?

A

Percutaneous nephrostomy OR

~retrograde ureteral stent

697
Q 
CKD pt w/ Hgb 9, MCV 84, PLT 240, WBC 7. NSIM?
A) check iron
B) start EPO
C) manage CKD
D) supplement iron
E) monitor
A

A) check iron

*prior to starting EPO r/o all other causes of anemia (check iron, ferritin, transferrin, retic, B12/folate, FOBT)

698
Q

Why must all anemia etiologies be ruled out prior to starting EPO in ACD/CKD?

A
  1. reversible causes should be treated first
  2. IDA is common in ACD & RBC morphology may be normal in early disease. May treat baed on ferritin/transferrin.
  3. EPO may rapidly deplete iron stores, hence iron should be checked before and throughout tx
699
Q

Hyperthermia, acidosis, rhabdo, muscle rigidity, diaphoresis in psych pt. Tx?

A

Dantrolene for malignant hyperthermia.

700
Q

Homeless psych M found wandering outside in the summer, confused. Non-disphoretic but 41C, tachycardic, hypotensive, AKI, transaminitis, acidotic, rhabdo+. Tx?

A

Rapid cooling, misting, ice water immersion, ice packs, fluid restriction, electrolyte correction

(NOT neuroleptic malignant syndrome per lack of overt muscle rigidity & diaphoresis. Above demonstrates multiorgan failure)

701
Q

What do you expect on labs in heat stroke?

A

MULTIORGAN DYSFUNCT

  • *CNS: confusion, weakness, dizzy, lethargic, ataxic, seizures
  • AKI
  • transaminitis
  • ARDS, pulm edema
  • DIC
  • rhabdo
702
Q

Tight glycemic control is beneficial in preventing which conditions?

A

neuropathy
nephropathy
retinopathy

NOT macrovascular conditions (MI, CVA)

703
Q

Fish oil can be effective in treating refractory _____

A

hyperTG

704
Q

Risk of starting seizure meds on OCPs?

A

seizure meds (EXCEPT gabapentin & valprote) induce cp450 > increased OCP clearance/decreased efficacy.

**IUD/implants DO NOT AFFECT cp450!

705
Q

Sheehan syndrome: in addition to amenorrhea, which sx would you see?

A

panhypopituiritm
hypothyroidism
adrenal insufficiency (electrolyte abnormalities, hyperpigmentation)

706
Q

AE: GI distress, dizziness, fatigue, photosensitivity, dry mouth:

A) garlic
B) ginko biloba
C) ginseng
D) saw palmetto
E) liquorice 
F) St Johns Wort
A

F) St Johns Wort

Also: anorgasmia, urinary frequency, swelling

707
Q

Seizure meds induce or inhibit cytochrome p450?

A

INDUCE

hence increase clearance of other meds metabolized by this pathway

708
Q

Which seizure meds DO NOT induce c-p450?

A) valproate
B) phenytoin
C) gabapentin 
D) carbamazepine
E) ethosuximibe 
F) phenobarbital
G) topiramate
A

A) valproate

C) gabapentin

709
Q

Scrotal trauma > moderate scrotal pain, swelling/bruising. NSIM?

A

US +/- surgical exploration if pain is moderate/severe.
R/o testicular rupture, fracture, avulsion or compression by scrotal hematoma.

(if sx mild/resolving > ice packs, analgesia, f/u)

710
Q

Blood at tip of meatus, urethral injury suspected. NSIM?

A

Retrograde urethrography

711
Q

PFT in active asthma attack: high/low?

A) TLC
B) FEV1
C) FEV1/FVC
D) DLCO

A

normal
low
low
normal

administration of albuterol should result in significant improvement in FEV1 (>15% baseline)

712
Q

Positive Methacholine challenge if >__ % reduction in FEV1

A

20%

713
Q

Methacholine challenge test is:
specific?
sensitive?

A

sensitive but not specific (can be positive in COPD)

Hence good negative predictive value

714
Q

Which supplements/ vitamins have been shown to prevent dementia?

A

NONE
Recommend lifestyle modifications.

Vit E may delay progression in mild/moderate dementia

715
Q

Vit E role in dementia?

A

may delay progression in mild/moderate dementia

does NOT prevent development of dementia

716
Q

Affordable Care Act: Cost of preventative services ie mammogram?

A

NO COST

hwr copays/coinsurance may apply to other services

717
Q

CAD suspected. Severe OA/DJD. NSIM?

A) adenosine myocardial perfusion imaging
B) dobutamine echo
C) coronary angio
D) exercise EKG

A

A) adenosine myocardial perfusion imaging

B) dobutamine echo

718
Q

Which is NOT a feature of B12 def?

A) ataxia
B) dementia
C) delirium
D) macrocytic anemia
E) increased bilirubin
A

*none of them

(all are features, note that it can present as delirium)

DDX: thiamine def (ataxia, ophthalmoplegia, AMS)

719
Q

Wish of pts not to know results of genetic testing should be respected EXCEPT in testing of:

A

newborn babies or children for treatable conditions

720
Q 
Complete resolution of MDD sx after 2 months of SSRI. NSIM?
A) gradual taper
B) lower dose
C) continue x 4 months
D) switch to CBT
A

C) continue x 4 months

Tx for total of 6 months to reduce risk of relapse

721
Q

Other than DM, what are RFs for mucor?

A
  1. solid organ/stem-cell transplant

2. hematologic malig

722
Q

How is mucor diagnosed?

A

sinus endoscopy w/ bx & cx

723
Q

DM w/ fever. nasal congestion, purulent nasal discharge, HA & sinus pain. Assn?

A

Mucor

Dx: sinus endoscopy, Bx/Cx
Tx: debride, ampho B then stepdown PO tx

724
Q

Complications of mucor?

A

necrotic extension to palate, orbit, brain

725
Q

Slow growing, locally aggressive, benign neoplasm with a high rate of local recurrence sp surgical excision. In trunk/extremity, intraabd/bowel/mesentry or abd wall. Assd w/ Garners. Dx?

A

Desmoid tumor
NSIM: CT/MRI to eval size w/ bx histology

DDX lipomas do not recur sp excision

726
Q

Desmoid tumors: increased incidence w/ which condition?

A

FAP (Gardner)

727
Q

Which of the following is NOT a RFs for infection after a mammalian bite:

A) cat bite
B) human bite
C) dog bite
D) bites on extremities
E) bites >12h old
A

C) dog bite

Note: cat and human bites to the face are NOT high risk

***Any bites that are NOT high risk for infection CAN be sutured

728
Q 
Which of the following bite wounds can you suture?
A) cat bite
B) human bite
C) dog bite
D) bites on extremities
E) bites >12h old
A

C) dog bite

***Any bites that are NOT high risk for infection CAN be sutured

Note: cat and human bites to the face are NOT high risk

729
Q

MC fungal pathogen to cause balanitis?

A

Candida

*screen for DM (may be first presenting sign

730
Q

Thick white discharge around glans of uncircumsized 2-5yo boy. Dx?

A

Candida

*screen for DM (may be first presenting sign

731
Q

ETT depth:
F?
M?

A

21cm

23cm

732
Q

Field intubation. Diminished lung sounds on L, resp distress, hypoxia. NSIM?

A

CXR to r/o R mainstam bronchus intubation.

Tx: retract PRN

733
Q

Large PTX: tachycardia, tachypnea, hypoxemia and decreased lung sounds on affected side BUT no JVD, tracheal deviation or hypoTN. NSIM?

A

CHEST TUBE

If tension physiology (hypoTN, JVD+, tracheal deviation) has NOT YET developed > chest tube

**Needle decompression is for tension PTX in whom cardiac arrest is imminent

734
Q

When should screening for DM retinopathy/retinopathy should start for the following?
DM1
DM2

A

DM1- after 5y Dx

DM2- immediately

735
Q

ASA for DM w/ ASCVD risk age 50-70. Which type of prevention?

A) primary
B) secondary
C) tertiary

A

B) secondary

736
Q

55yo M w/ CHF develops fatigue, bilateral knee/ankle pain, myalgia, HSM. Which labs do you order?

A

ANA & anti-histone abs

r/o drug-induced lupus

737
Q 
Which of the following DOES NOT cause drug-induced lupus?
A) hydralazine
B) procainamide
C) etanercept
D) infliximab
E) minocycline
A

They all cause it

738
Q

Tx/prognosis of drug-induced lupus?

A

Discontinue offending agent > improvement w/in weeks to months

739
Q

2 MCC RF for vulvar CA?

A
  • Persistent HPV
  • Chronic inflamm
    (ie lichen sclerosis)

Also:

  • immunodef
  • hx cervical CA
  • smoking
740
Q

Intertrigo w/u?

A

clinical
confirm w/ KOH

Tx: miconazole, nystatin, terbinafine. Keep areas dry, Tx underlying condition)

741
Q

Pathogen in normal flora which causes superficial well-defined erythematous patches or thin plaques w/ fine wrinkling in groin/axillae, inframammary or periumbilical region. Pathogen & Dx?

A

Corynebacterium minutissimum (GP bacillus)

Dx: Erythrasma

Tx: topical clinda/erythro
OR fusidic acid
OR azole

742
Q

Management/surveillance for the following EGD findings:
A) No dysplasia
B) low grad dysplasia
C) high grade dysplasia

A

A) EGD in 3-5y
B) EGD in 6-12m OR endoscopic eradication
C) endoscopic eradication

PPI for all

743
Q 
Which is NOT a finding in sarcoidosis?
A) high ACE
B) hyperCa
C) high ESR
D) hypocalciuria
A

D) hypocalciuria

Its hyPERcalciuria

744
Q

PFTs in Sarcoid: high/low?

A) DLCO
B) FEV1
C) FEV1/FVC

A

low
low
low

(mixed restrictive AND obstructive)

745
Q

Sarcoidosis prognosis?

A

75% resolve over time and do not recur

746
Q

Tx of sarcoidosis: ASx vs Sx/pulm impairment?

A

ASx: no Tx
Sx: 12-24m GCS

For progressive disease: MTX, AZA, TNFa inhib

747
Q

CXR: Recurrent PNA in same lobe. NSIM?

A

CT to r/o endobronchial lesion. If unrevealing but suspicion+, bronchoscopy.

Other causes:

  • abscess
  • empyema
  • bacterial resistance
  • TB/fungal pathogens
  • immune dysfunction
  • non-infectious/inflam conditions mimicking PNA
748
Q

Nephrolithiasis: first line Dx modality?

A

non-contrast helical CT

749
Q

Which is NOT a RF for nephrolithiasis in pregnancy?

A) ^biliary sludge
B) increased calciuria
C) urinary stasis
D) deceased bladder capacity

A

A) ^biliary sludge

750
Q

Preg w/ paroxysmal, severe flank pain radiating to labia. NSIM? (imaging)

A 
renal/pelvic US
(if neg, transvaginal US) 
(if STILL neg, 
- Tx empirically
- MR urogram
- low dose CT urogram
751
Q

CT shows 3.8 loculated cystic lesion in the head of the pancreas. NSIM?

A

endoscopic US and aspiration to r/o malig

**less adverse effects and more sensitive than ERCP

752
Q

Benign pancreatic cyst. Recommended surveillance?

A

CT q3-6 months

753
Q

Neonatal scalp swelling that crosses suture lines after prolonged delivery. Dx & Tx?

A

Dx: Caput succedaneum
Tx: observe, should resolve in few days

754
Q 
Neonate w/ bleed btwn scalp & periosteum which crosses suture lines and may be fatal from rapid expansion > hymodynamic instability. Dx?
A) subgaleal bleed
B) cephalohematoma
C) caput succedaneum
D) subdural hematoma
E) epidural hematoma
A

A) subgaleal bleed

ICU admission, volume replacement. Serial CBC/coags

755
Q

Periodic breathing in infants (breathing pauses 5-10s w/ subsequent rapid shallow breaths). Mechanism?

A

recurrent central apnea due to immaturity of the nervous system in infants <6m

Benign/physiologic
DDX apnea of prematurity which lasts >20s

756
Q

65yo w/ acute limb ischemia of RLE successfully managed w/ thrombus aspiration. 2h later > intense pain RLE w/ burning/paresthesias. Dx?

A

Post-ischeic compartment syndrome

interstitial edema & possibly intracellular swelling s/p tissue ischemia and subsequent reperfusion

757
Q

Compartment pressure >__mmHg or delta pressure (diastolic - compartment p)

A

CP: >30
delta <20-30

> > emergent fasciotomy

758
Q

Tourettes
A) age of onset
B) worsened by
C) sex: M or F

A

A) <18yo (mostly 5-15yo)
B) stress/fatigue
C) M>F

*tics may be suppressed for a brief period, pt feels relief after urge release

759
Q

Tourettes Tx?

A 
A) behavioral (habit reversal training) 
B) antiD
- tetrabenazine (D depleter)
- antipsych (receptor blocker) 
C) alpha2 adrenergic antagonists (clonidine)
760
Q

Tic prevalence in normal children? prognosis?

A

25%
remit spontaneously in weeks/months

chronic tic disorder involves vocal OR motor tic but not both, >1yr

761
Q

Erb Duchenne palsy. Prognosis?

A

(neonatal brachial plexus injury)
Spontaneous recovery w/ weeks/months
Supportive care

762
Q

Neonatal pulm hypoplasia, flattened facies, limb deformity (clubfoot) are complications from:

A

Oligohydramnios (2/2 growth restriction, preeclampsia etc)

763
Q

Torticolis and developmental dysplasia of the hip are complications of:

A) breech
B) macrosomnia
C) oligohydramnios
D) PPROM 
E) IUGR
A

A) breech

764
Q 
Akathisia is NOT treated w/: 
A) propanolol
C) benztropine
C) benzo 
D) antipsych dose decrease
E) baclofen
A

E) baclofen

First try to decrease dose if feasible, if not try propanolol

765
Q

30yo F w/ severe throbbing, unilateral HA, papilledema & visual changes (diplopia/ blurriness) Dx?

A

r/o idiopathic intracranial HTN

Tx:

  • weight loss
  • acetazolamide
  • topiramate
  • loops
  • shunting
766
Q

All infants w/ speech/language delay should undergo:

A

formal audiology testing

eval for recurrent otitis media, ototoxic meds

767
Q

Variceal bleed: MC complications which lead to increased mortality?

A

infections (50%), HE, RF

infections:
- UTI
- SBP
- Asp PNA
- primary bacteremia

hence PPX Abx indicated

  • IV ceftriaxone x 7d
  • transition to PO bactrim/cipro for total abx 7 days
768
Q

Variceal bleed: How can you prevent the MC associated complication?

A

PPX Abx indicated
(infections in 50%)
- IV ceftriaxone x 7d
- transition to PO bactrim/cipro for total abx 7 d

MC infections:

  • UTI
  • SBP
  • Asp PNA
  • primary bacteremia

Other complications

  • RF
  • HE
769
Q

Paradoxical abdominal wall retraction during inspiration when laying supine: Dx & Dx test?

A

diaphragmatic paralysis

Dx: sniff test w/ fluoroscopy

770
Q

MCC bilateral diaphragmatic paralysis?

A

ALS or other neuro d

771
Q

Pt w/ lower extremity muscle atrophy, tongue fasciculations & diaphragmatic paralysis. Dx?

A

r/o ALS

772
Q

Sniff test is used to dx:

A

diaphragmatic dysfunction

773
Q

Gross hematuria. NSIM?

A

UA/UCx

  • RBC casts & new proteinuria >r/o glom d
  • infection > bx
  • other: CT, cytology, cystoscopy
774
Q

Tx diffuse esophageal spasm?

A

CCBs

Also:
~nitrates
~tricyclics

775
Q

Dx tests for diffuse esophageal spasm?

A

Manometry: (GOLD standard) intermittent peristalsis, multiple simultaneous contractions

Esophagram: corkscrew pattern

776
Q

40yo w/ GERD has intermittent CP, dysphagia for solids/liquids. Which test is the gold standard for Dx?

A

Manometry: intermittent peristalsis, multiple simultaneous contractions

Tx: CCBs
Also:
~nitrates
~tricyclics

777
Q

Dysphagia, heartburn: manometry w/ hypomotility & low amplitude contractions/ lower sphincter pressure. Dx?

A

Scleroderma

778
Q

Degeneration of the Auerbach plexus causes:

A

Achalasia, failure of LES relaxation.

Esophagram shows dilated esophagus & birds beak

(may be secondary achalasia 2/2 chagas)

779
Q

IDA, dysphagia, esophageal webs. Tx?

A

Plummer Vinson improves w/ tx of anemia

780
Q

Legionella Tx?

A 
Resp FQ (levofloxacin) 
Macrolides (azithromycin)
781
Q

Recent travel, fever, brady, PNA, confusion, ataxia, diarrhea. Tx?

A

Legionnaires
Resp FQ (levofloxacin)
Macrolides (azithromycin)

Note: sputum gram stain only shows PMNs
Dx w/ urine Legionella Ag

782
Q

Legionella suspectedbut gram stain only shows PMNs- why?

A

intracellular organism

Dx w/ urine Ag

783
Q

Cruiseship, febrile, brady, diarrhea. NSIM?

A

Labs: hypoNa,
Legionella Ur Ag

CXR: lobar infiltrate

784
Q

40yo w/ diarrhea, mucus discharge, tenesmus. Colonoscopy: pallor, friability, mucosal hemorrhage. Dx?

A

Likely radiation proctitis (if hx radiation).
If chronic, assd w/ fistula formation, strictures, rectal bleeding.

Tx: +/- sucralfate or GCS enemas

*Exclude other causes of diarrhea.

785
Q

Sudden onset severe psoriasis & recurrent VZV is associated w/ ?

A

HIV (also disseminated molluscum contagiosum)

786
Q

Acanthosis nigricans is associated w/ insulin resistance AND:

A

GI malignancy

787
Q

Acanthosis nigricans in patient w/ normal BMI, appearing on the palms/soles, mucous membranes. Dx?

A

r/o GI malignancy

788
Q

Photosensitivity, erythematous tongue, N/V/D, dementia, confusion. Dx?

A

Niacin def (Pellagra)

789
Q

Hyperpigmentation, vitiligo, dehydration, hypotension. Dx?

A

Addisons (primary adrenal insuff)

790
Q

Periodic vertigo, unilateral HL, tinnitus. Dx?

A

Menieres

Tx: prochlorperazine, antihistamines
no cute

791
Q

MC pathogen isolated from corneal foreign body?

A

Staph

~ Strep, Haemophilus, Pseudomonas)

792
Q

Abd pain, vomiting, currant jelly stools, AMS. Tx?

A

Contrast enema is Dx & Tx

793
Q

Best way to prevent DM foot ulcers?

A

Tight glycemic control prevents MICROvascular sequelae, NOT MACROvascular (beneficial for slowing neuropathy)

794
Q

MCC erythema multiforme?

A

HSV

~
Mycoplasma
allopurinol, abx, AI, CA

795
Q

Dx test: Pertussis

A

Cx or PCR
lymphocyte predominant leukocytosis

Tx: macrolides (azithro)

796
Q

Which CA are you at risk for:
A) tamoxifen
B) MHT

A

A) Uterine CA

B) Breast CA

797
Q

30yo < w/ celiac has sx remission. NSIM?

A

perform a detailed dietary review

798
Q

Celiac: after initiating gluten-free diet abs should decline by 50% in ____ (time frame) & normalize w/in ____ (time frame)

A

2 months
12 months

Note: MCC sx recurrence is diet non-adherence or inadvertent ingestion

799
Q

Fever, abd pain, mucopurulent cervical discharge, cervical motion tenderness. Tx?

A

Broad spectrum
(cefoxitin & doxy)
coverage for chlam/gonorr

800
Q

Tx primary nocturnal enuresis (stepwise Tx)

A
  1. Behavioural: restrict evening fluids, reward system x 3-6 months.
    Also Tx comorb conditions ie constipation.
  2. If not effect w/ above: enuresis alarm

If short term solution needed ie sleepover, desmopressin may be used.

801
Q

Mentzer index (___/___) >13 is suggestive of IDA.

A

MCV/RBC

good DDX for alpha/beta thalassemia which are <13

802
Q

Premature 8mo infant w/ lethargy, irritability, pallor & systolic flow murmur. Dx?

A

r/o IDA
- prematurity is a RF per likely inadequate iron stores

MCC <1yo: too much breastfeeding after 6m

803
Q

CMV in HIV occurs w/ CD4

A

<100

retinitis, colitis, esophagitis

804
Q

When is TMP-SMX PPX required in HIV?

A

CD4 <200: PCP

CD4 <100: toxo

805
Q

Dx: Adjustment disorder. Tx?

A

psychotherapy
short-term adjunctive Rx
- sleep aid
- anxiolytic

806
Q

Prenatal care in SCD?

A
  1. baseline 24h Uprotein
  2. baseline chem
  3. serial UCx
  4. Pneumovax
  5. folic supplement
  6. ASA
  7. serial fetal growth US
807
Q

SCD pt is pregnant: which baseline labs do you obtain?

A
  1. baseline 24h Uprotein
  2. baseline chem
  3. serial UCx
808
Q

SCD pt is pregnant: what do you prescribe?

A

ASA
folate
pneumococcal vax
serial fetal growth US

(also obtain baseline chem, 24h urine protein, serial UCx)

809
Q

Which conditions are RFs for preeclampsia?

A

SCD (HTN, nephropathy)
DM (nephropathy)
SLE (nephropathy)

810
Q

SCD obstetric complications?

A

spontaneous abortion
preeclampsia, eclampsia
abruptio placenta
antepartum bleed

811
Q

SCD fetal complications?

A

ftal growth restriction
oligohydramnios
preterm birth

812
Q

Diameter for a skin lesion to be concerning?

A

> 6mm

813
Q

8mm dark lesion w/ irreg borders. NSIM?

A

Excisional bx w/ 1-3mm margins

814
Q

Melanoma, no clinical evidence w/ LN involvement. When is a sentinel LN bx w/ lymphatic mapping indicated?

A

high risk:

  • tumor thickness >0.75mm
  • tumor ulceration
  • lymphatic invasion on Bx
815
Q

Pt on chemo w/ central venous cath for TPN w/ neutropenia, fever, eye pain, decreased visual acuity. Fundoscopy: focal glistening, white, mound like lesions that extend into the vitreous. Pathogen?

A

Candida (endopthalmitis)

RFs

  • disseminated disease
  • central venous cath
  • neutropenia
  • TPN
816
Q

Candida endopthalmitis Tx?

A

Aggressive Tx: amphotericin B x 4-6wks, intravitreal antifungal injection & vitrectomy

817
Q

20yo African F is to go back to her country to undergo genital mutilation by a non-medical practitioner, w/o anesthesia prior to an arranged marriage. NSIM?

A

Educate re: risk/complications

  • hemorrhage
  • infection
  • genital pain/scarring
  • infertility
  • difficulty w/ coitus
  • issues w/ vaginal delivery
818
Q

Allergic rhinitis, allergen avoidance is not possible. Tx?

A

intranasal corticosteroids

819
Q

44yo M w/ new afib RVR, improved w/ metoprolol. TTE/labs wnl. Which other medical management do you initiate?

A

None
CHA2DS2VASc 0
(has to be 2+ to initiate anticoagulation for non-valvular afib)

820
Q

Acute paronychia Tx?

A 
warm antiseptic soaks and topical abx
- burlow solution (aluminum acetate) 
- 1% acetic acid 
~ chlorhexidine 
~topical mupirocin
821
Q

Chronic paronychia

  1. duration
  2. association
  3. clinical signs
  4. Tx
A
  1. > 6wks
  2. variant of contact derm
  3. retraction/loss of cuticle and dystrophic nail changes
  4. high potency topical GCS
822
Q

Herpetic whitlow Tx?

A

supportive

~~acyclovir PO

823
Q

Best Tx onychomycosis?

A

PO terbinafine

824
Q

Plugging of the posterior ear canal is used as a last resort for the tx of:

A 
intractable BPPV
(often does not affect hearing)
825
Q

Neonate is born w/ scalp defects, tracheoesophageal fistula & choanal atresia. Which teratogenic med was the mother using?

A

methimazole (thionamide) for hyperthyroidism

should be avoided only in the 1st trimester per teratogenicity

826
Q

Who should receive the HBV vaccine?

A
  • HCP
  • pregnant women
  • inmates
  • mult sexual partners
  • hx STD
  • IVDU
  • CKD, HCV, HIV
  • household contacts w/ HBV
827
Q

Healthy 37yo w/ postprandial epigastric discomfort/nausea. No relief w/ famotidine x 2wks. NSIM?

A

Offer Hpylori testing

Unless >60yo or alarm features*

828
Q

Which is NOT an alarm feature for dyspepsia?

A) >60yo
B) IDA
C) progressive dysphagia
D) palpable mass/LAD
E) persistent V
F) FHx GI CA
G odynophagia
A

A) >60yo

hwr note that dyspepsia >60 warrants EGD

829
Q

Dyspepsia MCC?

A 
75%: functional
organic causes: 
- NSAIDs
- gastric/esoph CA
- Hpylori
830
Q

Dyspepsia (epigastic pain, N/V, epigastric fullness). Management in <60yo VS >60yo?

A

<60: Hpylo or EGD if high risk features

>60yo: EGD

831
Q

Active TB suspected. Which tests do you order?

A

Sputum AFB & Cx
NAAT

**Cx- GOLD standard (takes 3-8wks

**Smear & NAAT cannot DDx non-TB mycobact from TB

**INFy and TB skin test cannot ddx active/latent

832
Q

Indicated if active TB is suspected by has garbage sensitivity:

A) TB skin test
B) INFy assay
C) AFB smear
D) SpCx
E) NAAT
A

C) AFB smear
(also many false neg)

also cannot ddx non-TB mycobact from TB

833
Q

Which of these is GOLD standard for active TB testing?

A) TB skin test
B) INFy assay
C) AFB smear
D) SpCx
E) NAAT
A

D) SpCx

BUT it takes 3-8wks hence obtain AFB smear & NAAT in meantime

834
Q

Asx immigrant. RUL calcifications. NSIM?

A

Obtain INFy assay to evl for latent TB

**can also do TB skin testing however if false results if hx BCG vax, takes 2 visits (BUT has high spec if no hx BCG vax)

835
Q

Cannot ddx active/latent TB

A) TB skin test
B) INFy assay
C) AFB smear
D) SpCx
E) NAAT
A

A) TB skin test

B) INFy assay

836
Q

ASx. INFy+. CXR wnl. Neg AFB smear/Cx. Dx?

A

Latent TB, non-transmittable

837
Q

Tx Latent TB? (3)

A

Weekly INH + rifapentine
x 3 months

Daily rifampin
x 4 months

Daily INH + rifampin
x 3 months

838
Q

> 95% sen/spec BUT cannot ddx Non-TB & TB mycobacterium?

A) TB skin test
B) INFy assay
C) AFB smear
D) SpCx
E) NAAT
A

E) NAAT

839
Q

How myst AFB sputum be obtained?

A

3 samples, 8-24hrs apart with at least 1 morning sample

840
Q

Surgery > Hyperactive DTR, muscle cramps, rarely convulsions. Which electrolyte disorder?

A

hypoCa

DDX: HypoMg: assd w/ heavy EtOH, prolonged NGT/suction, diarrhea, diuretics and LOSS of DTRs

841
Q

Hyperactive DTR, muscle cramps, rarely convulsions. Why is this NOT hypoMg?

A

hypoMg: LOSS of DTRs

assd w/ heavy EtOH, prolonged NGT/suction, diarrhea, diuretics

842
Q

When do you Bx an AK?

A 
>1 cm
rapid growth 
ulceration
tenderness
cutaneous horns
843
Q

Tx AK

A

few: cryo
many: field Tx w/ 5FU, tirbanibulin, imiquimod

844
Q

Ichthyosis Tx

A

topical lactic acid (amlactin)

845
Q

TSH should be monitored w/ amiodarone Rx every ___

A

3-4 months

MOA: large iodine load suppressses synth of thyroid hormones & amiodarone DIRECTLY INHIBITS conversion of T4 >T3

846
Q

Why do patients on amiodarone require higher than normal doses to tx hypothyroidism?

A

amiodarone DIRECTLY INHIBITS conversion of T4 >T3 (active hormone)

847
Q

39yo w/ hx SLE p/w substernal CP and palpitations> vfib, cardiac arrest, death. Dx?

A 
MI 2/2 premature CAD 
(SLE women have 50x increased risk of CAD) 
- HTN
- DLP
- chronic inflamm
- GCS use
848
Q

22yo F w/ faciall acne, mild hirsutism, mild ^Hgb/HCT. Keeps active, c/o being irritable/emotional Dx?

A

r/o anabolic steroid use

849
Q

Gonorrhea/chlamydia screening w/ NAAT is recommended for:

A

sexually active women <25 annually

OR

high risk (mult sex partners, sex workers)

850
Q

HCV screening is for ages __- __

A

18-79 at least once

or high risk IVDU, transfusion before 1992

851
Q

PAP screening starts age __

A

21

852
Q

Indications for routine RPR screening?

A

high risk:

  • MSM
  • coinfection HIV
  • hx incarceration
  • sex workers
853
Q

RF for peripartum cardiomyopathy

A

> 30yo
mult gest
preeclampsia, eclampsia

854
Q

Peripartum cardiomyopathy onset occurs btwn ___wks gest to ___

A

36wks gest to 5 months postpartum

Tx: standard CHF tx & VTE ppx

855
Q

Prognosis of peripartum cardiomyopathy

A
  • some: spontaneous recovery
  • recurrence highest w/ w/ EF <20
  • persistent PPCM

Pts w/ persistent PPCM are at risk of further LV decline in subsequent pregnancies

856
Q

Repeted vomiting > retrosternal CP, SOB, odynophagia, epigastric pain, shoulder pain. Dx?

A

Boerhaaves

confirm w/ esophagography or CT w/ water soluble contrast

857
Q

Boerhaaves suspected- which test will confirm the dx?

A

esophagography or CT chest w/ water soluble contrast (if neg but suspicion is high, repeat w/ barium contrast)

(note: on CXR you may see pneumomediastinum, L pleural effusion, PTX)

858
Q

Boerhaaves Tx?

A

PPI
Abx
NPO
STAT surg consult

859
Q

Why should EGD be avoided in Boerhaaves?

A

worsens pneumomediastinum d/t insufflation of the esophagus prior to passing the scope

860
Q

Pagets:
Dx Labs?
Dx imaging?
Tx?

A

Labs: high alkP, norml Ca (can measure bone specific fraction of alkP to ddx hepatobiliary d)

Imaging: Radionucleotide bone scan
Note- plain radiographs show mixed lytic sclerotic lesions.

Tx: bisphosphonates (

861
Q

Pagets: Most common presentation?

A

ASx, discovered incidentally on imaging

862
Q

61yo M Labs: high alkP, norml Ca. Plain radiographs show mixed lytic sclerotic lesions. NSIM?

A

Bone scan & tx w/ bisphosphonates once Pagets is confirmed.

863
Q

Asx. Enlarged skill, HL, dizziness, bone pain, spinal stenosis/ radiculopathy. RF for osteosarcoma or giant cell tumors. Dx & Tx?

A

Pagets
Labs: high alkP, Ca wnl
Bone scan & tx w/ bisphosphonates

864
Q

Pagets is a RF for which tumors?

A

osteosarcoma, giant cell tumors ( usually benign)

865
Q

Tx of hearing loss 2/2 Pagets?

A

Calcitonin/bisphosphonates SLOW progression but dont revers HL. No best Tx.

Path:

  • compression of the auditory nerve by bony overgrowth
  • involvement of the cochlea/cochlear capsule
866
Q 
Tx for vaginal condyloma acuminata 
A) surg excision
B) laser excision 
C) podophyllin 
D) trichloroacetic acid 
E) observe & inform pt of likely spontaneous regression
A

D) trichloroacetic acid

  • podophyllin is NOt for internal use. Surg/laser may be considered if medical therapy fails
  • spontaneous regression is NOT common
867
Q

Bat scratch. Rabies vaccine and Ig given a year ago. NSIM?

A

Vaccine booster x 2 (day 0 & 3)

note: Rabies Ig is NOT recommended as it can impair the strenth/rapidity of the immune response

868
Q

No hx vaccine >bat scratch. Rabies PEP?

A

rabies vaccine (day 0,3,7, 14) AND rabies Ig x1

869
Q

Pre-exposure ppx for rabies?

A

rabies vaccine (q1wk x a month) ie 4 doses

870
Q

When is rabies vaccine given WITH Ig?

A) pre-exposure ppx
B) PEP, no hx vax
C) PEP, hx vax

A

B) PEP, no hx vax

871
Q

When is rabies vaccine given day 0 & 3 (w/o Ig)?

A) pre-exposure ppx
B) PEP, no hx vax
C) PEP, hx vax

A

C) PEP, hx vax

872
Q

Screening process for gestational DM?

A

@24-28w

1) 1hr 50g GCT, if +
2) 3h 100g GTT

(100g ingested and then measured at 1, 2, 3h after ingestion. Diagnostic if 2+ values are abnormal)

873
Q

Significants of human placental lactogen?

A

secreted by the placenta, induces insulin resistance > gestational DM

874
Q 
Which is NOT an acceptable agent for gestational DM?
A) glipizide
B) glyburide
C) metformin
D) insulin
A

A) glipizide

875
Q

Target glucose in gestational DM

  1. fasting
  2. 1h postprandial
  3. 2h postprandial
A
  1. <95
  2. <140
  3. <120
876
Q

Medications for gestational DM?

A
  • insulin
  • glyburide
  • metformin
877
Q

Environmental RF for AOM in children?

A
  • formula fed
  • daycare
  • pacifier use
  • secondhand smoke (impairs ciliary clearance of fluids/microbes in eustachian tubes)
878
Q

Does a mother who goes outside to smoke affect her childs health?

A

YES

Esp for AOM. - secondhand smoke (impairs ciliary clearance of fluids/microbes in eustachian tubes). Even if it occurs outside, particulate matter brough indoors w/ hair/clothing

879
Q

Indications for Abx PPx for AOM?

A

> 3 episodes/ 6 months
4 episodes/ 1 year

Last resort tympanostomy

880
Q

Narrow complex tachycardia in hemodynamically STABLE pt. Tx?

A

adenosine

881
Q 
Afib RVR pt becomes pulseless. NSIM?
A) adenosine
B) thrombolytics
C) chest compressions
D) rapid defibrillation
E) rapid synchronized cardioversion
A

C) chest compressions

882
Q

Anaphylaxis w/ hypoTN, resp distress, resolves completely w/ EPI in ED. NSIM?

A

Admit for observation per severe sx

Admission qualifications for anaphylaxis

  • sx lasting hrs+
  • severe sx
  • multiple doses EPI
883
Q

Hip clunk & asymmetric leg creases in infancy. Prognosis?

A

Dx: Developmental dysplasia of the hip

  • excellent if Tx in infancy w/ reduction of dislocated hip
  • poor if not > leg-length discrepancy, gait abnorm & early OA/DJD per abnormal traction in the dysplastic hip
884
Q

Teen girl c/o activity related pain in the hip/groun. Trendelenburg+, some DJD on XR. Dx?

A

Dx: Developmental dysplasia of the hip (abnormal acetabular development >shallow hip socket and inadequate support of the femoral head)

  • excellent if Tx in infancy w/ reduction of dislocated hip
  • poor if not > leg-length discrepancy, gait abnorm & early OA/DJD per abnormal traction in the dysplastic hip
885
Q

Teen w/ abnormal acetabular development >shallow hip socket and inadequate support of the femoral head. What could have prevented this condition?

A

Tx in infancy w/ reduction of dislocated hip

Dx: Developmental dysplasia of the hip

886
Q

Teen w/ significant pain at night around the proximal femur. Dx?

A

r/o osteoid sarcoma (benign)

887
Q

Legg-Calve- Perthes disease.

1) pathology?
2) age of dx

A

1) avascular necrosis of the femoral head

2) age 5-7

888
Q

How to calculate AG?

A

Na - (Cl + HCO3)
should be 10-14

Methanol 
Uremia 
DKA
Propulene glycol 
Isonizaid/iron 
Lactic acidosis 
Ethanol
Salicylates
889
Q

What is the “I” in mudpiles?

A 
Methanol, Metformin 
Uremia 
DKA
Propulene glycol 
Isonizaid/iron 
Lactic acidosis 
Ethanol
Salicylates
890
Q

RF for metformin-induced lactic acidosis?

A

RF
CHF
hypovol
severe liver d

891
Q

Overweight 30yo on OCPs w/ chronic HA, nausea, visual disturbances. Minimal relief w/ NSAIDs. NSIM?

A

Opthalmoscopic exam: papilledema
(eval for idiopathic intracranial HTN)

Other studies to support Dx:

  • LP w/ high OP >20
  • neuroimaging wnl (other than empty sella)
892
Q

What do you expect for the following in idiopathic intracranial HTN?

  1. optho exam
  2. LP
  3. neuroimaging
A
  1. papilledema
  2. high OP >20
  3. wnl (except empty sella)
893
Q

Hip clunk & asymmetric leg creases in infancy. Prognosis?

A

Dx: Developmental dysplasia of the hip

  • excellent if Tx in infancy w/ reduction of dislocated hip
  • poor if not > leg-length discrepancy, gait abnorm & early OA/DJD per abnormal traction in the dysplastic hip
894
Q

Teen girl c/o activity related pain in the hip/groun. Trendelenburg+, some DJD on XR. Dx?

A

Dx: Developmental dysplasia of the hip (abnormal acetabular development >shallow hip socket and inadequate support of the femoral head)

  • excellent if Tx in infancy w/ reduction of dislocated hip
  • poor if not > leg-length discrepancy, gait abnorm & early OA/DJD per abnormal traction in the dysplastic hip
895
Q

Teen w/ abnormal acetabular development >shallow hip socket and inadequate support of the femoral head. What could have prevented this condition?

A

Tx in infancy w/ reduction of dislocated hip

Dx: Developmental dysplasia of the hip

896
Q

Teen w/ significant pain at night around the proximal femur. Dx?

A

r/o osteoid sarcoma (benign)

897
Q

Legg-Calve- Perthes disease.

1) pathology?
2) age of dx

A

1) avascular necrosis of the femoral head

2) age 5-7

898
Q

How to calculate AG?

A

Na - (Cl + HCO3)
should be 10-14

Methanol 
Uremia 
DKA
Propulene glycol 
Isonizaid/iron 
Lactic acidosis 
Ethanol
Salicylates
899
Q

What is the “I” in mudpiles?

A 
Methanol, Metformin 
Uremia 
DKA
Propulene glycol 
Isonizaid/iron 
Lactic acidosis 
Ethanol
Salicylates
900
Q

Pain control in early chronic pancreatitis?

A

Often lifestyle changes are enough.

  • smoking/EtOH cessation
  • frequent, low fat, small meals
  • panc enz supplement

reassess in 1-2 months, if persistent, start analgesic/surg

901
Q

Overweight 30yo on OCPs w/ chronic HA, nausea, visual disturbances. Minimal relief w/ NSAIDs. NSIM?

A

Opthalmoscopic exam: papilledema
(eval for idiopathic intracranial HTN)

Other studies to support Dx:

  • LP w/ high OP >20
  • neuroimaging wnl (other than empty sella)
902
Q

What do you expect for the following in idiopathic intracranial HTN?

  1. optho exam
  2. LP
  3. neuroimaging
A
  1. papilledema
  2. high OP >20
  3. wnl (except empty sella)
903
Q

Why do you obtain neuroimaging prior to LP in patients w/ chronic HA?

A

First exclude mass lesion which would be a contraindication to LP per risk of herniation

904
Q

Poor prognostic factors in LBP?

A
  • ^age
  • poor baseline funct
  • severe self-rate mood and pain sx
  • psych comorb: MDD/anx
  • maladaptive pain behaviours (catastrophosizing, avoidant behaviours)
  • poor recovery expectations
  • no interest in mobility (prolonged bed rest)
  • requiring opioids for pain control
905
Q

Why is propylthiouracil generally avoided except the first trimester of pregnancy?

A

hepatoxicity

note MMZ and PTU may cause agranulocytosis

906
Q

Chronic pancreatitis: Dx test of choice?

A

MRCP

if unavail- abd CT

907
Q 
Chronic pancreatitis in 70yo w/ hip replacement: best diagnostic test?
A) MRCP
B) ERCP
C) Abd CT
D) Abd US
E) AXR
F) EGD
A

C) Abd CT
(normally MRCP but hip replacement is a contraindication)

ERCP used if dx is still unclear after above imaging

Findings: calcifications
+/- pancreatic enlargement, ductal dilation, pseudocysts

908
Q 
Which of the following is NOT good for Dx chronic pancreatitis?
A) lipase
B) amylase
C) abd CT
D) MRCP
A

A) lipase
B) amylase

(they are used for acute panc, often normal in chronic per decreased enzymes in scarred/fibrosed pancreas)

909
Q

Alcoholic w/ low fecal elastase 1. Significance and Tx?

A

significant pancreatic exocrine insufficiency likely 2/2 chronic panc.

Tx: pancreatic enzymes

910
Q

Pain control in early chronic pancreatitis?

A

Often lifestyle changes are enough.

  • smoking/EtOH cessation
  • frequent, low fat, small meals
  • panc enz supplement

reassess in 1-2 months, if persistent, start analgesic

911
Q

Chronic pancreatitis is diagnosed. Tx?

A
  • smoking/EtOH cessation
  • frequent, low fat, small meals
  • ADEK supplemetation
  • panc enz supplement
912
Q

Persistent abd pain in chronic pancreatitis despite lifestyle changes. Tx?

A
  1. First line analgesics: TCA, NSAIDs, pregabalin
  2. Above ineffective > consider opioids.
  3. Other:
    - celiac nerve block
    - ductal decompression (via anastomosing jejunum)
    - extracorporeal shock wave lithotrypsy
    - denervation of afferent nerve fibers leaving the pancreas
    - surgical resection
913
Q

RF chronic pancreatitis?

A
  • EtOH
  • CF
  • AI
  • ductal obstruction (CA, stones)
914
Q

Cleft lip
A) inheritance pattern
B) when to operate

A

Multifactorial inheritance: can be AR, AD, XL
assd w/ teratogens, EtOH

Operable at:
10wks, 10g Hgb, 10lbs

915
Q

Why is propylthiouracil generally avoided except the first trimester of pregnancy?

A

hepatoxicity

916
Q

Indications for Tx Graves w/ meds? (4)

A
  • mild disease
  • bridge to surg/ I131
  • elderly w/ limited life expectancy
  • preg
917
Q

Indications for Tx Graves w/ radioactive iodine ablation? (4)

A
  • mod/severe disease
  • desire to avoid surg
  • mild d w/ pt preference
  • unlikely to attain remission w/ meds
918
Q

Indications for Tx Graves w/ thyroidectomy (6)

A
  • v large goiter
  • suspect CA
  • retrosternal compressive goiter
  • concomitant hyperPTH
  • preg pt w/ intolerance to PO meds
  • severe opthalmopatht
919
Q

When is prednisone given in Graves?

A

presence of mod/severe opthalmopathy prior to tx w/ surg or RAI

ie. exopthalmos, periorbital edema, vision changes

920
Q 
What do you check to assess thyroid function after starting meds?
A) TSH
B) TSI 
C) free T3
D) total T4
E) total T3 & free T4
F) TBG
A

E) total T3 & free T4

*check after one month then q2-3 months
TSH remains supressed several months after initiation of meds and does not accurately reflect thyroid function

921
Q

Pt on anti thyroid meds develops agranulocytosis. NSIM?

A

STOP MED IMMEDIATELY

922
Q

What needs to be routinely monitored when taking antithyroid meds?

A

total T3 and free T4

Obtain LFTs and CBC at baseline but DO NOT routinely order unless sx develop (hepatitis, agran)

923
Q

Chronic bacterial prostatitis

  1. duration of sx for dx
  2. def dx test
  3. MCC (pathogen)
  4. RF
  5. Tx
A
  1. > 3 months
  2. UA pre/post prost massage
  3. Ecoli (80%)
  4. DM, smoking, urinary hardware or manipulation
  5. 6wks FQ or TMP-SMX
924
Q

Young/middle aged M w/ dysuria, frequency, pelvic/GU region discomfort, pain w/ ejaculation x 3 months. Dx test and Tx?

A

Chronic bacterial prostatitis

Dx: UA pre/post prost massage.
*Prostate exam often normal but may show hypertrophy, tenderness, edema

Tx: 6wks FQ or TMP-SMX
(MCC Ecoli 80%)

925
Q

30yo M w/ freq/urgency, pain w/ ejaculation, urinary WBC/bacteria x 3 months. RFs & Dx?

A

Dx: chronic bacterial prostatitis

DM, smoking, urinary hardware or manipulation

926
Q

Human bite: What grows in the aerobic dish vs the anaerobic dish?

A

aerobic: GAS, S.aureus
anaerobic: Eikenella corrodens

Also fusobacteria, Prevotella

927
Q

Human bite: Tx?

A
  • debride/irrigate
  • amoxi-clav
  • tetanus vax
  • healing by secondary intention (leave open UNLESS facial location)
928
Q

Gas gangrene: most common pathogens?

A

C perfringens
S pyogenes
S aureus
V vulnificus

929
Q 
HIV M bites some guy at a bar. What do you do for HIV ppx?
A) 3 drugs x 4 weeks
B) 4 drugs x 3 weeks
C) reassure
D) observe, recheck in 1 month
A

C) reassure

**saliva considered v low risk exposure unless mixed w/ blood (oral ulcer, lip cut etc)

930
Q 
Mammalian bite: Tx?
A) clinda
B) Keflex
C) amoxi-clav
D) bactrim
A

C) amoxi-clav
(coverage for oral aerobic and anaerobic pathogens)

*note clinda and keflex cover staph & viridans bur NOT eikinella

931
Q

60yo w/ gallstone pancreatitis per labs. Develops: fever, jaundice, RUQ pain, hypotension, AMS. Dx tests and Tx?

A

r/o acute cholangitis
(ascending infection d/t biliary obstruction, meets Reynolds pentad)

Dx: US biliary dil
!ERCP

Tx: !ERCP (biliary drainage w/in 24-48h)
& abx coverage

932
Q

CXR: cavitary lesion in a bronchus. Dx?

A) SCC
B) Small cell carcinoma
C) Large cell carcinoma
D) Mesothelioma

A

A) SCC

933
Q 
SIADH is assd w/ 
A) SCC
B) Small cell carcinoma 
C) Large cell carcinoma
D) Mesothelioma
A

B) Small cell carcinoma

934
Q 
SIADH
A) normovolemic hyperNa
B) hypovol hyperNa
C) normovolemic hypoNa
D) hypovol hypoNa
A

C) normovolemic hypoNa

935
Q

SIADH: mild/mod. Tx?

A

water restriction
(ideal rate 0.5 mEq/hr)
+/- salt tabs

936
Q

Steps in managing SIADH from mild > severe

A

Mild/mod:

  1. water restriction
  2. salt tabs
  3. ~loops

Severe:
- if above fail > demeclocyline hwr caution per nephrotoxicity)

937
Q

MOA furosemide in SIADH?

A

lowers UOsm & blunts response to AHD hence more water is excreted.
(give w/ sat tabs or hypertonic saline)

938
Q

DVT/PE> How long do you anticoagulate?

A
  • if provoked, 3-6 months

- if idiopathic: 6 months, then eval for continuation based on RFs

939
Q 
Which is NOT a RF for CRC?
A) Caucasian race
B) EtOH
C) Obesity 
D) Smoking
E) IBD
F) FAP
A

A) Caucasian race

*AA have higher rates

940
Q

20yo M sp laparotomy for perforated appendix 2wks ago. Cough, shoulder pain, febrile, tachycardic. Tenderness over 8th/9-11th ribs, abd exam benign. NSIM?

A

Abd US to r/o subphrenic or abdominal abscess

941
Q

60yo w/ gallstone pancreatitis per labs. Develops: fever, jaundice, RUQ pain, hypotension, AMS. Dx tests and Tx?

A

r/o acute cholangitis
(meets Reynolds pentad)

Dx: US/CT- biliary dil
!ERCP

Tx: !ERCP

942
Q

MCC long term complication of IVC filters?

A

recurrent DVTs and IVC thrombosis

Note: they do NOT affect overall mortality & filter migration or perforation through the IVC is rare

943
Q

HIDA helps visualize obstruction of:

A

cystic and common bile ducts to r/o acute cholecystitis

944
Q

Fever, jaundice, RUQ pain is the triad for:

A

acute cholangitis

945
Q

Which nerves at at risk of injury during carotid endarterectomy?

A
  1. hypoglossal nerve(tongue deviates to injured side)
  2. CNV mandibular branch
  3. laryngeal nerve of the vagus
946
Q

Physical exam finding to dx achilles tendon rupture?

A

Thompson test

  • sen/spec >90
  • positive test: absence of plantar flexion on calf squeeze
947
Q

Why is absence of active plantar flexion not a good dx test for achilles rupture?

A

Accessory muscles can also plantar flex (fibularis longus/brevis, plantaris, tibialis posterior)

948
Q

Which nerve is responsible for the following:
A) plantar sensation
B) gastrocnemius funct
C) soleus funct

A

ALL- tibial nerve

949
Q

Test to DDX thalassemia alpha VS beta minor?

A

electrophoresis

w/ beta thalassemia: increased A2

950
Q

Hgb electrophoresis findings:
A) IDA
B) alpha thal minor
C) beta thal minor

A

A) normal
B) normal
C) high Hgb A2

951
Q

Elecrtrophoresis : high Hgb A2. Dx?

A

beta thalassemia minor

952
Q 
Which does NOT cause secondary hypogonadism?
A) chronic illness
B) malnutrition
C) hypothyroidism
D) hyperPRL
E) Klinefelters 
F) Kallmann
G) Cranipharyngioma
A

E) Klinefelters
(it causes PRIMARY hypogonadism)

Note: primary- due to gonadal failure VS secondary d/t hypothal/pit pathology

953
Q

Delayed puberty in boys: absent testicular enlargement (4mL) by age __ & delayed growth spurt.

A

14

Initial w/u: FSH, LH, T, PRL
bone age radiograph

954
Q

List some causes of secondary hypogonadism in males.

A

A) functional: chronic illness, malnutrition
B) hypothyroidism
C) hypogonadism: hyperPRL, cranipharyngioma
D) genetic: Kallmann

955
Q

Constitutional puberty delay features:

A
  • FHx late bloomers
  • short stature
  • delayed bone age
956
Q

Initial work up of delayed puberty?

A

FSH, LH, T, PRL, TSH
bone age radiograph

primary: elevated FSH/LH
secondary: low FSH/LH

(Note: high levels of PRL & TSH interfere w/ GnRH secretion

957
Q

Best Tx for negative sx in schizophrenia?

A

social skills training.

Note: both 1st & 2nd gen antipsychotics suck at improving negative sx

958
Q

Ocular melanoma:

1) best Dx text
2) Tx

A

1) US (most sen)
- note: MRI useful in dx extrascleral extensions for staging & Tx

2) <1cm diam & <3mm thick: close follow up

If larger or sx: brachyRAD
(if v large or extrascleral extension: enucleation)

959
Q

Keratin plugs in the hair follicles.

  1. associated conditions
  2. Tx
A
  1. contact derm, asthma
  2. topical keratolytics (urea, salicylic acid)

Dx: keratosis pilaris

960
Q

Acute pancreatitis > 6wks later: abd pain, biliary/pancreatic duct obstruction, GIB. VSS, exam benign. Dx & Tx?

A

Dx: r/o pancreatic cyst
- complication in 10% sp AP

Tx: supportive, unless significant sx: surgical/endoscopic drainage

961
Q

PSGN: Tx & prognosis?

A
  • Supportive
  • Loops PRN edema
  • antiHTN meds PRN HTN
  • refractory cases: HD

Prognosis: much better in peds. 40% of adults >CKD, persistent HTN, recurrent proteinuria, (10% ESRD)

962
Q

How is SBP diagnosed?

A

Ascitic Cx or >250 PMNs

remember to give albumin to decrease renal injury

963
Q

DVT, ?nonadherence to warfarin post discharge. Presents 4wks later w/ another DVT, INR 1.6. NSIM?

A

start IV heparin (or SC LMWH) until therapeutic INR is achieved w/ warfarin.

(do not consider this anticogulation failure)

964
Q

MOA in familial hypercalciuric hypercalcemia?

A

AD disorder of defective Ca-sensing receptor (senses low levels > increased PTH >increased Ca resorption in renal tubules)

Sx: mild, no Tx required

965
Q

HyperCa w/ elevated PTH. How to DDx FHH VS primary hyperPTH?

A

urinary Ca excretion is high in hyperPTH & low in FHH

966
Q

Urinary Ca excretion: high/low?
A) Primary hyperPTH
B) FHH

A

A) high

B) low

967
Q

Ocular melanoma:

1) best Dx text
2) Tx

A

1) US (most sen)
- note: MRI useful in dx extrascleral extensions for staging & Tx

2) <1cm diam & <3mm thick: close follow up

If larger or sx: brachyRAD
(if v large: enucleation)

968
Q

Boy suspected for primary nocturnal enuresis. Best initial test?

A

UA

  • glucosuria?
  • infection?
  • DI (low spec gravity)?

voiding diary

969
Q

What do these tests diagnose?
A) 24h urine cortisol
B) Plasma ald:renin
C) AM cortisol, AM ACTH, ACTH stim test

A

A) Cushings
B) Conns
C) Addisons

970
Q

plasma aldosterone: renin ratio > __ suggests excessive aldosterone secretion.

A

30

Dx: Conns

971
Q

How is SBP diagnosed?

A

Ascitic Cx or >250 PMNs

972
Q

SAAG >1.1 suggests:

A

portal HTN

973
Q

Tx for hepatorenal syndrome?

A

albumin
octreotide
midodrine

974
Q

Tx VS PPx for SBP?

A

Tx: 3rd gen cephalosporin

PPx: FQs

975
Q 
Overall prognosis of 90 day mortality 2/2 cirrhosis is determined by all EXCEPT:
A) Na
B) bilirubin
C) albumin
D) INR
E) Cr
A

C) albumin

all others in MELD

976
Q

Penile verrucous papilliform growth:

Dx test & Tx?

A

Dx: shave bx (condyloma accuminata)

Tx: immiquimod (first line)

977
Q

Thyroid nodule. US w/o suspicious findings. Low TSH. NSIM?

A

Iodne I123 scintigraphy to determine if it is hot/cold.

If hot: Tx hypothyroidism
If cold: FNA

978
Q

Thyroid nodule. US w/o suspicious findings. Normal/elevated TSH. NSIM?

A

FNA

979
Q

Toxic adenoma. Tx?

A

First: MMZ >euthyroidism
Then: surg or albation

+/- propanolol if sx

(young pts w/o comorbs dont havvve to be preTx prior to I131 ablation)

980
Q

Hyperthyroidsim: for which patients is surgery preferred over ablation?

A
  • v large goiter
  • suspicious for CA
  • pregnancy, breastfeeding (no RAD)
  • obstructive sx: dysphagia
981
Q

BCC: Tx?

A

surg excision 4mm margins (Mohs if face)

2nd line: topical FU, imiquimod, curettage/ electrodessication (only for low risk)

982
Q

Higher risk of metastasis: SCC or BCC

A

SCC

983
Q

Biggest RF BCC

A

local invasion

984
Q

Clozapine

  • use:
  • monitoring labs/freq:
A

use: refractory schizophrenia (highly effective)

monitor for neutropenia/ agranulocytosis

  • weekly x 6 months
  • then biweekly x 6 months
  • then monthly
985
Q

Clozapine AE EXCEPT

A) agranulocytosis
B) seizures
C) hypersalivation
D) thyroid dysfunction
E) ileus/constipation
F) weight gain 
G) PE
H) myocarditis
A

D) thyroid dysfunction

986
Q 
Which meds require avoidance of tyramine containing foods?
A) haldol
B) escitalopram
C) amitriptyline
D) selegiline
E) phenelzine 
F) duloxetine
A

MAOi

D) selegiline
E) phenelzine

Tyramine:

  • strong/aged cheeses - cured meats
  • overripe foods
  • EtOH: beer/wine
  • soy
  • pickled foods
987
Q

Atypical lymphocytes are seen in:

A

mono EBV (& other systemic viral infections)

988
Q

Reed Sternberg cells: Dx?

A

HL

989
Q

Expanding hematoma in neck s/p cath placement > tracheal deviation but VSS. NSIM?

A

intubate

990
Q

Best predictor of opiate toxicity is:

A

RR <12

opioids decrease BOTH hyper capneic & hypoxic respiratory drive via central/peripheral chemoreceptors

991
Q

AE: UTI, hypoTN

A) Sulfonylureas
B) Metformin
C) Meglintides 
(nate, repa)
D) Pioglitazone
E) Exentide
F) Acarbose, miglitol
G) Liraglutide
H) Canagliflozin
I) Sitagliptin
A

H) Canagliflozin
(SGLT2 ingibitor)

MOA: increase renal glucose excretion

992
Q

____ is an antianginal agent used in refractory sx in pts on NTG, BB or CCB.

A

ranolazine

993
Q

CABG is better than PCI for which conditions?

A
  • multivessel d, esp prox LAD & LV dysfunction
994
Q

Cardiac cath reveals L main stenosis. Significance?

A

candidate for coronary revasc

995
Q

SGLT2

A) Sulfonylureas
B) Metformin
C) Meglintides 
(nate, repa)
D) Pioglitazone
E) Exentide
F) Acarbose, miglitol
G) Liraglutide
H) Canagliflozin
I) Sitagliptin
A

H) Canagliflozin

MOA: increase renal glucose excretion

AE: UTI, hypoTN

996
Q

AE: diarrhea, lactic acidosis

A) Sulfonylureas
B) Metformin
C) Meglintides 
(nate, repa)
D) Pioglitazone
E) Exentide
F) Acarbose, miglitol
G) Liraglutide
H) Canagliflozin
I) Sitagliptin
A

B) Metformin
(biguanide)

MOA: inhibit gluconeogensis, decrease hepatic gluc production & increase peripheral glucose uptake

997
Q

AE: pancreatitis, weight loss

A) Sulfonylureas
B) Metformin
C) Meglintides 
(nate, repa)
D) Pioglitazone
E) Exentide
F) Acarbose, miglitol
G) Liraglutide
H) Canagliflozin
I) Sitagliptin
A

E) Exentide
G) Liraglutide

(GLP1 agonists)

MOA: increase gluc-dependent insulin secretion & decrease glucagon secretion, delayed gastric emptying

998
Q

AE: fluid retention, HF, weight gain:

A) Sulfonylureas
B) Metformin
C) Meglintides 
(nate, repa)
D) Pioglitazone
E) Exentide
F) Acarbose, miglitol
G) Liraglutide
H) Canagliflozin
I) Sitagliptin
A

D) Pioglitazone
(thiasolidinediones)

MOA: activate transcription regulator PPARy > decreased insulin resistance

999
Q

AE: nasopharyngitis

A) Sulfonylureas
B) Metformin
C) Meglintides 
(nate, repa)
D) Pioglitazone
E) Exentide
F) Acarbose, miglitol
G) Liraglutide
H) Canagliflozin
I) Sitagliptin
A

I) Sitagliptin
(DPP4 inhibitors)

MOA: increase endogenous GLP1

1000
Q

AE: UTI, hypoTN

A) Sulfonylureas
B) Metformin
C) Meglintides 
(nate, repa)
D) Pioglitazone
E) Exentide
F) Acarbose, miglitol
G) Liraglutide
H) Canagliflozin
I) Sitagliptin
A

H) Canagliflozin
(SGLT2 ingibitor)

MOA: increase renal glucose excretion

1001
Q

Insulin secretagogues:

A) Sulfonylureas
B) Metformin
C) Meglintides 
(nate, repa)
D) Pioglitazone
E) Exentide
F) Acarbose, miglitol
G) Liraglutide
H) Canagliflozin
I) Sitagliptin
A

A) Sulfonylureas
C) Meglintides

AE: hypoglycemia, weight gain

1002
Q

Biguanide:

A) Sulfonylureas
B) Metformin
C) Meglintides 
(nate, repa)
D) Pioglitazone
E) Exentide
F) Acarbose, miglitol
G) Liraglutide
H) Canagliflozin
I) Sitagliptin
A

B) Metformin

AE: lactic acidosis, GI upset/D

1003
Q

GLP1 agonist

A) Sulfonylureas
B) Metformin
C) Meglintides 
(nate, repa)
D) Pioglitazone
E) Exentide
F) Acarbose, miglitol
G) Liraglutide
H) Canagliflozin
I) Sitagliptin
A

E) Exentide
G) Liraglutide

AE: pancreatits, weight loss

1004
Q

Examples of sulfonylureas:

A

Glyburide
Glipizide
Glimepiride

1005
Q

Tetrabenazine: MOA * use?

A

Tourettes, D blocker

1006
Q

Which type of hyperparathyroidism is treated w/ medical management?
A) primary
B) secondary
C) tertiary

A

B) secondary

(the others likely managed w/ surgery)

  • Primary: AI, CA
  • Secondary: vitD def or CKD
  • Tertiary: ESRD (chronic stimulation of PTH release becomes autologous secretion even in the absence of stimulation)
1007
Q

Elderly pt w/ rapid onset of periumbilical pain, out of proportion to exam, N/V. Exam benign. Labs: WBC, amylase, lactate & Ph elevations. NSIM?

A

CTA or MRA to r/o acute mesenteric ischemia

If unclear > mesenteric angiography

1008
Q

Tx giardia

A

metronidazole
avoid pools/water venues
good hand hygiene

*cysts resist chlorination

1009
Q

Indications for suprapubic cath:

A

acute urinary retention in pt w/ recent hx GU surgery or trauma or if urethral cath is unsuccessful

1010
Q

Child. EEG w/ 3Hx generalized spike & wave activity. Tx?

A

Ethosuximibe for absence seizure

1011
Q

CKD: 2 mechanisms in which it causes secondary hyperPTH?

A
  1. CKD causes Ph retention & decreased 1,25 OH viD
  2. LOW 1,25 OH viD means less Ca GI absorp
  3. HIGH Ph >low CA
  4. Low Ca causes increased PTH synth

= secondary parathyroidism

1012
Q

Indications for parathyroidectomy in tertiary hyperPTH?

A) young age
B) persistent hyperPh or hyperCa 
C) v.high PTH levels
D) soft tissue calcification or calciphylaxis 
E) intractable bone pain
A

A) young age

*not an indication as this is TERTIARY hyperPTH

1013
Q

Describe primary VS secondary VS tertiary hyperPTH

A

Primary: AI, CA

Secondary: vitD def or CKD

Tertiary: ESRD (chronic stimulation of PTH release becomes autologous secretion even in the absence of stimulation)

1014
Q

Which type of hyperparathyroidism is treated w/ medical management?
A) primary
B) secondary
C) tertiary

A

B) secondary

  • Primary: AI, CA
  • Secondary: vitD def or CKD
  • Tertiary: ESRD (chronic stimulation of PTH release becomes autologous secretion even in the absence of stimulation)
1015
Q

Elderly pt w/ rapid onset of periumbilical pain, out of proportion to exam. Exam benign. Labs: WBC, amylase, lactate & Ph elevations. NSIM?

A

CTA or MRA to r/o acute mesenteric ischemia

If unclear > mesenteric angiography

1016
Q

Acute mesenteric ischemia. Which lab abnormalities do you expect?

A

High

  • lactate
  • amylase
  • ph
  • WBC

Eval w/ CTA or MRA to r/o acute mesenteric ischemia

1017
Q

Acute mesenteric ischemia. Hx allergy to contrast. Which imaging modality to confirm Dx?

A

MRA (instead of CTA which is generally preferred)

1018
Q

MCC acute mesenteric ischemia? (3)

A
  1. MCC SMA embolus
  2. arterial/venous thrombosis 2/2 atheroclerosis
  3. watershed isch during hypoTN (ie trauma, HD..)

Pts w/ recent MI are at high risk per ease of formation of ventricular thrombi & potential for poor perfusion

1019
Q

Why is recent MI a RF for acute mesenteric ischemia?

A

ease of formation of ventricular thrombi & potential for poor perfusion

1020
Q

Vasculopath w/ cramping abd pain after eating. Dx?

A

Chronic mesenteric ischemia

unlike acute: rapid onset of periumbilical pain, out of proportion to exam, N/V, delayed hematochezia

1021
Q

2wks after delivery, pt develops DOE, orthopnea, pitting edema 3+, worsening HTN, DTR++. Dx?

A

PREECLAMPSIA (can occur up to 12wks postpartum)

1022
Q

Dry cough in child >4wks, otherwise ASx. Afebrile, CTAB,no MRG. NSIM?

A

Spirometry

CXR

1023
Q

HIV: widespread papules w/ central umbilication, some of which are covered w/ a hemorrhagic crust. Dx?

A

Cutaneous cryptococcosis
CD4 <100

(dissem infection also occurs in liver, LN, peritoneum, adrenal glands, eyes)

1024
Q

HIV: widespread papules w/ central umbilication, some of which are covered w/ a hemorrhagic crust. Which test confirms the Dx?

A) lesion bx
B) fungal BCx
C) urine Ag testing
D) lesion scrapings

A

A) lesion bx
(encapsulated yeasts)

  • fungalBCx often positive hwr for a defDx of a SKIN lesion, bx is more sen/spec

Dx: Disseminated cryptococcosis

1025
Q

Cutaneous cryptococcosis Tx?

A
  • IV amphotericin B & PO flucytosine x4-6wks

THEN

  • PO floconazole x 1yr
1026
Q

Which medication is NOT a RF for pseudotumor cerebri?

A) nitrofurantoin
B) cimetidine
C) nifedipine
D) danazol
E) all trans retinoic a 
F) isotretinoin
G) tamoxifen
H) GCS
I) minocycline, tetracycline
A

C) nifedipine

1027
Q

Pt on steroids develops tinnitus, dizziness, diplopia, HA, forgetfulness. Dx?

A

Pseudotumor cerebri

Other causes:

  • endocrine disorders:
  • hypoPTH, hypothyr, addisons, Cushings
*Meds: 
A) nitrofurantoin
B) cimetidine
C) tetracycline
D) danazol
E) all trans retinoic a 
F) isotretinoin
G) tamoxifen
H) GCS
1028
Q

Strep pharyngitis, confirmed woth rapid test. Which abx?

A

amoxicillin OR PNC

NOT amoxiclav

USMLE3 (3 decks)

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