everything Flashcards

1
Q

a child with recurrent UTIs, b/l hydronephrosis on ultrasound, a thickened and dilated bladder, and proximal urethral dilation has _____

A

Posterior urethral valve

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2
Q

posterior urethral valve is diagnosed by ____

A

voiding cystourethrogram

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3
Q

______ is the most accurate measurement of Fe stores

A

Ferritin

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4
Q

first line treatment for restless leg syndrome

A

pramipexole, ropinirole

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5
Q

Routine preoperative PFTs are/are not done

A

Are not done. Only do before lung resection, to optimize COPD control, evaluate undiagnosed dyspnea

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6
Q

hirschprung disease is diagnosed via

A

rectal suction biopsy

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7
Q

symptoms of hirschprung disease

A

delayed meconium passage, abdominal distention, contrast enema with dilated descending colon and narrow resctosigmoid colon

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8
Q

Dx: delayed meconium passage, abdominal distention, contrast enema with dilated descending colon and narrow resctosigmoid colon

A

Hirschprung disease

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9
Q

a solitary pulmonary module requires surveillance if it is larger than _____cm

A

0.8 cm

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10
Q

ACLS for PEA arrest

A

Compressions, no shock

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11
Q

torsades can be provoked by ______ in patients with long QT

A

bradyarrhythmia, hypoMg, hypoK, low Temp, SSRIs, HIV

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12
Q

treat torsades with _____

A

IV Mg

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13
Q

definition of recurrent UTIs

A

2+ in 6 months, 3/year

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14
Q

treatment for recurrent UTI

A

suppression therapy

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15
Q

medications that decrease Levothyroxine absorption

A

Iron, Ca, AlOH, PPIs, sucralfate

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16
Q

management of mild hidradenitis

A

topical clinda, lifestyle modifications (weight loss, smoking cessation, hygiene)

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17
Q

treatment for hidradenitis with nodules, tracts, or scarring

A

(moderate disease) PO doxy

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18
Q

when using amiodarone and warfarin together, ______

A

reduce warfarin dose by 20-50% (amio increases serum concentration of warfarin)

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19
Q

when do you treat people with salmonella infection?

A

patients <12 months, immunocompromised, >50 with atherosclerosis

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20
Q

treatment for salmonella

A

cipro, bactrim, ceftriaxone

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21
Q

side effects of carbamazepine

A

bone marrow suppression, SIADH in elderly, glaucoma, urinary retention

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22
Q

in a patient with suspected brain death with neuro exam positive for brain death what is the next test?

A

apnea test

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23
Q

in a patient with suspected brain death with difficult neuro exam, what is the next test?

A

EEG or CT

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24
Q

most common cause of sudden death with steering wheel MVC injuries?

A

Aortic injuries

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25
Q

_____ is the most sensitive test for diagnosing osteonecrosis of the femoral head

A

MRI

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26
Q

most common cause of secondary dilated cardiomyopathy

A

CAD (ischemic cardiomyopathy)

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27
Q

Dx: mild crampy abd pain (peripheral), fecal urgency, bloody diarrhea in patient w/ CAD. ^WBC, lactic acidosis. Friable edematous mucosa on cscope

A

colonic ischemia

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28
Q

Dx: patient with HIV, altered mental status, rash of papules w/ central umbilication/necrosis

A

Disseminated cutaneous cryptococcosis

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29
Q

Dx: cold symptoms, then development of muscle weakness, paresthesias, dec deep tendon reflexes, dysautonomia

A

Guillain Barre

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30
Q

time course of guillain barre

A

symptoms worsen over 2 weeks, plateau for 2-4 weeks, recover over months

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31
Q

when do you treat Guillain Barre with IVIG?

A

if non ambulatory or if symptoms developed in past 4 weeks

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32
Q

Dx: sudden onset of muscle weakness triggered by emotional episodes

A

cataplexy

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33
Q

treatment for cataplexy

A

stimulants, SSRIs, SNRIs, TCAs

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34
Q

Name TIMI criteria

A
  1. age 65+
  2. 3+ CAD risk factors
  3. known CAD >50%
  4. recent ASA use
  5. 2+ anginal episodes 24hr
  6. pos trop
  7. ST changes >0.5mm
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35
Q

a TIMI score of ____ would stratify a person with NSTEMI/unstable angina to cath within 24 hours

A

3-7

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36
Q

A TIMI score of 0-2 would stratify a person with NSTEMI/unstable angina to _____

A

stress test

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37
Q
  1. ______
  2. 3+ CAD risk factors
  3. known CAD >50%
  4. recent ASA use
  5. 2+ anginal episodes 24hr
  6. pos trop
  7. ST changes >0.5mm
A
  1. age 65+
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38
Q
  1. age 65+
  2. ______
  3. known CAD >50%
  4. recent ASA use
  5. 2+ anginal episodes 24hr
  6. pos trop
  7. ST changes >0.5mm
A
  1. 3+ CAD risk factors
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39
Q
  1. age 65+
  2. 3+ CAD risk factors
  3. _______
  4. recent ASA use
  5. 2+ anginal episodes 24hr
  6. pos trop
  7. ST changes >0.5mm
A
  1. known CAD >50%
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40
Q
  1. age 65+
  2. 3+ CAD risk factors
  3. known CAD >50%
  4. ________
  5. 2+ anginal episodes 24hr
  6. pos trop
  7. ST changes >0.5mm
A
  1. recent ASA use
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41
Q
  1. age 65+
  2. 3+ CAD risk factors
  3. known CAD >50%
  4. recent ASA use
  5. _____
  6. pos trop
  7. ST changes >0.5mm
A
  1. 2+ anginal episodes 24hr
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42
Q
  1. age 65+
  2. 3+ CAD risk factors
  3. known CAD >50%
  4. recent ASA use
  5. 2+ anginal episodes 24hr
  6. _____
  7. ST changes >0.5mm
A
  1. Pos trop
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43
Q
  1. age 65+
  2. 3+ CAD risk factors
  3. known CAD >50%
  4. recent ASA use
  5. 2+ anginal episodes 24hr
  6. pos trop
  7. _____
A
  1. ST changes >0.5mm
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44
Q

clinical factors that determine if a child with ITP needs IVIG?

A

mucosal bleeding or hemorrhage

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45
Q

CLL diagnosis on labs?

A

smudge cells, +flow cytometry (tissue bx not required)

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46
Q

what symptoms of CLL confer worse prognosis?

A

multiple chain lymphadenopathy, hepatosplenomegaly, anemia, thrombocytopenia

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47
Q

EKG findings in AVNRT?

A

narrow complex tachycardia with regular r-r intervals, can have pseudo p in inferior leads

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48
Q

Wolf Parkinson’s White is associated with development of ____

A

AVRT

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49
Q

saw palmetto is used for ___

A

BPH

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50
Q

side effects of Saw Palmetto

A

G.I. upset, increased bleeding risk

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51
Q

risk factors for children < 1 with iron deficiency anemia?

A

delayed introduction of solids, cow/soy/goat milk

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52
Q

risk factors for children > 1 with iron deficiency anemia?

A

> 24 oz milk /day, < 3 servings Fe rich food

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53
Q

how to differentiate microcytic anemia of Fe def and thalassemias?

A

mentzner index. if > 13 —> Fe def

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54
Q

how do you calculate mentzner index?

A

MCV/RDW

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55
Q

Dx: shoulder pain, ipsilateral miosis and anhidrosis, weakness of ipsilat hand muscles, pain 4&5th digits

A

Pancoast tumor

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56
Q

describe horner syndrome

A

ipsilateral miosis, enopthalmos, anhidrosis

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57
Q

describe nerve symptoms of pancoast tumors

A

weakness/atrophy intrinsic hand muscles, pain/paresthesia of 4&5th digits, medial arm, forearm

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58
Q

What are the signs of spinal cord compression in pancoast tumor?

A

decrease in lower extremity deep tendon reflexes +/- back pain

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59
Q

abdominal pruritis in a pregnant patient with no rash is _____

A

pregnancy induced skin changes

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60
Q

Dx: pruritic, erythrematous papules on the abdomen of a pregnant patient that spreads to the extremities but spares the face/pals/soles

A

polymorphic eruption of pregnancy

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61
Q

Dx: truncal rash in pregnant patient that starts at belly button as urticaric plaques and moves to vesicles and bullae. No mucosal involvement

A

pemphigoid gestationis

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62
Q

pemphigoid gestationis is treated with ____

A

high potency steroids, antihistamines

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63
Q

when do you start diabetic patients on a statin?

A

at age 40

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64
Q

Dx: delirium, megaloblastic anemia, inc indirect bill in an elderly patient

A

B12 deficiency

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65
Q

when would you use warfarin in a pregnant patient?

A

in a patient with a mechanical heart valve, 2nd & 3rd tri only

66
Q

what medication would you use for pregnant patient in the 1st trimester with bipolar I and mania?

A

Haldol, possibly 2nd gen antipsychotics

67
Q

after restarting iron supplementation in the child with Fe deficiency anemia ______ recovers first

A

the retic count (then Hb/Hct, then ferritin)

68
Q

how do you monitor a patient on doxorubicin?

A

MUGA/Radionucleotide ventriculography

69
Q

how do you tell if erectile dysfunction is psychogenic?

A

sudden onset, situational, normal nocturnal erections

70
Q

when would you anticoagulate in nonvalvular Afib?

A

CHADS-VASc 2+

71
Q

CHADS-VASc score parameters

A
C (CHF) 
H (HTN) 
A2 (75+) 
D (DM) 
S2 (stroke/TIA) 
V (vasc dz) 
A (age 65-74) 
Sc (sex-F)
72
Q

how do you diagnose chronic prostatitis?

A

UA + UCx before and after prostate massage. UA >20 leuks

73
Q

treatment for chronic prostatitis?

A

alpha blockers, abx, anti-inflammatories, psychotherapy

74
Q

How many cigarettes is an absolute contraindication to oral contraceptive pills?

A

15+ cigarettes/day in someone 35+ years

75
Q

____ Is the most important modifiable risk factor to reduce AAA expansion

A

cigarette smoking

76
Q

clinical manifestations of radiation induced cardiotoxicity

A

MI, restrictive cardiomyopathy, constrictive pericarditis, valvular abnormalities, conduction deficits

77
Q

ST elevation thresholds

A

> 1mm in all leads but V2-3. In V2-3, >1.5mm for F, >2mm in M 40+, >2.5mm for M <40. Also new LBBB

78
Q

Exam findings consistent with severe AS

A

soft, single second heart sound, delayed and diminished carotid pulse, loud and late peaking systolic murmur

79
Q

When do you reccommend a mammogram at 40?

A
  • 2 1st degree relatives with breast CA
  • 3 1st/2nd degree relatives with breast CA
  • Any relatives with breast+ovarian
  • 1st degree relatives with bilateral breast CA
  • Male relative with breast CA
80
Q

Persistent chest pain and arm weakness in a patient with recent cocaine use should raise suspicion for ____

A

aortic dissection

81
Q

Bilirubin levels for severe hyperbilirubinemia

A

> 20-25

82
Q

treatment for BV

A

topical/PO metronidazole, clindamycin

83
Q

Dx: sudden onset syncope in a patient with a history of an MI?

A

cardiogenic syncope 2/2 Vtach

84
Q

Dx: Exertional syncope in a patient with a systolic murmur?

A

Aortic stenosis or HCM

85
Q

NYHA class II heart failure definition

A

slight limitation with physical activity, ordinary activity causes symptoms (fatigue, dyspnea, palpitations)

86
Q

NYHA class III heart failure definition

A

marked limitation with physical activity, less than ordinary activity causes symptoms

87
Q

Add ____ in black patients with NYHA class III/IV heart failure if not responding to current therapy

A

hydralazine + imdur/nitrates

88
Q

Add ____ in patiets with NYHA class II heart failure if EF < 40%

A

beta blockers

89
Q

Add ____ in patients with NYHA class II heart failure if EF < 30%

A

spironolactone, defibrilator

90
Q

Add ____ in patients with NYHA class III heart failure if symptomatic on spironolactone

A

digoxin

91
Q

medications that can cause decreased oral contraceptive efficacy

A

antiepileptics: phenytoin, carbamazepine, topiramate

92
Q

Risk factors for spontaneous abortion

A

prior spontaneous abortion, AMA, substance abuse, extremes in BMI

93
Q

Diagnostic management of patient after cardiac cath with tender pulsatile mass at puncture site?

A

ultrasound (likely pseudoaneurysm)

94
Q

____ is the ideal time for pelvic surgery in a pregnant patient with a pelvic mass

A

2nd trimester

95
Q

Labs to check in patient with confirmed elevated Hb?

A

check epo level, carboxyhemoglobin level if elevated

96
Q

Causes of polycythemia

A

polycythemia vera, renal cell carcinoma, chronic hypoxia (smoking, CO poisoning, cardiopulmonary disease)

97
Q

best contraception for women with PCOS who don’t want to use OCPs

A

progesterone IUD

98
Q

How to manage levothyroxine in pregnant patient with hypothyroidism?

A

Follow TSH and total T4, increase levothyroxine by 25-50%

99
Q

Patients with toxic thyroid nodule require ____ before definitive treatment

A

methimazole/PTU to become euthyroid

100
Q

Definitive treatment for toxic thyroid nodule

A

hemithyroidectomy or radioactive iodine ablation

101
Q

Imaging choice in patient with uncontrolled HTN, abdominal bruit, elevated Cr? Looking for?

A

Renal duplex ultrasound. Looking for renovascular HTN

102
Q

Risk factors for cavities in children

A

sugary diet, nighttime bottles/feeding, inadequate fluoride, family history of cavities, low SES

103
Q

Dx: recurrent asthma exacerbations, central bronchiectasis on CT, fleeting/changing infiltrates on CXR

A

allergic bronchopulmonary aspergillosis

104
Q

Treat hypotension during surgical removal of pheochromocytoma with ______

A

fluid bolus, pressors if necessary

105
Q

Hyponatremia, SIADH in patient with lung cancer most likely has ______ lung ca

A

small cell carcinoma

106
Q

What do you do in a patient with post extubation stridor in respiratory distress not responding to conservative measures?

A

re-intubate

107
Q

Normal language development at age 2

A

50+ words, 2 word phrases

108
Q

Vomiting, lethargy, dehydration, hypoNa, ambiguous genetalia in young baby?

A

congenital adrenal hyperplasia

109
Q

congenital adrenal hyperplasia is most commonly caused by a deficiency in _____

A

21-Hydroxylase

110
Q

21-hydroxylase deficiency in congenital adrenal hyperplasia is confirmed with _______

A

elevated 17-hydroxyprogesterone

111
Q

Dx: multiple cafe au lait spots, axillary/inguinal freckling?

A

Neurofibromatosis I

112
Q

Patients with neurofibromatosis I need what screening exam?

A

optho for optic pathway gliomas

113
Q

First test in suspected bowel perforation?

A

CXR to look for pneumoperitoneum

114
Q

In a patient with chronic hypoparathyroidism with low Ca and elevated urinary Ca, add ______

A

thiazide diuretic

115
Q

____ is preferred for EtOH withdrawal in patients with liver disease

A

lorazepam

116
Q

Indications for MTX use in ectopic pregnancy

A

stable patients with beta-hCG < 5000, adnexal mass < 3.5 cm, no cardiac activity

117
Q

Indications for laparoscopy in patients with ectopic pregnancy

A

unstable patient, beta-hCG > 5000, adnexal mass > 3.5cm, fetal cardiac activity

118
Q

Treatment for mild ulcerative colitis

A

topical 5-ASA like mesalamine suppository

119
Q

Treatment for moderate ulcerative colitis

A

oral 5-ASA like sulfasalazine, steroids. Azathioprine/6-MP if not responsive to initial therapy

120
Q

Treatment of UTI in nonpregnant patient?

A

3 days of bactrim or cipro

121
Q

Treatment of UTI in pregnant patient?

A

7 days of macrobid or augmentin

122
Q

How is SIADH different from psychogenic polydipsia on labs?

A

both hypoNa, SIADH has high UOsm > 100, PPd has low UOsm < 100

123
Q

lab values in SIADH

A

low Na, SOsm < 275, high UOsm > 100, high UNa > 40

124
Q

Symptoms of acute HIV infection

A

sore throat, fever, lymphadenopathy, maculopapular rash, painful mucocutaneous ulcers (low WBC, low plt)

125
Q

In a patient with trastuzumab-related cardiotoxicity, you ____

A

stop the trastuzumab and the EF will recover

126
Q

Sodium bicarbonate is used in a TCA overdose to ____

A

prevent ventricular arrhythmias (widened QRS)

127
Q

A patient with CAD and new hypothyroidism [should/should not] start levothyroxine before heart cath and stenting?

A

Should not. Starting will increase risk of MI in patient, must start slowly.

128
Q

Dx: fever and vesicles/ulcers on posterior oropharynx of child with sore throat?

A

Herpangina (hand foot and mouth) 2/2 coxsackie

129
Q

Dx: fever and vesicles/ulcers on anterior oral mucosa and around mouth of child?

A

Herpes gingivomastitis

130
Q

Modifiable risk factors for colorectal cancer?

A

Smoking (current, long term), Alcohol (>4 drinks/day), obesity

131
Q

Protective factors against colorectal cancer?

A

high fiber diet, NSAID use, hormone replacement, exercise

132
Q

medications for reglan-induced dystonia

A

benadryl or benztropine

133
Q

Dx: hyperpigmentation, pituitary enlargement, visual field defects with history of bilateral adrenalectomy

A

Nelson’s syndrome

134
Q

A patient on anti epileptic medication finds out she is pregnant. What do you do?

A

Continue AED, add folate, screen for congenital abnormalities with AFP and ultrasound. Do not switch or discontinue

135
Q

Post exposure prophylaxis regimen (HIV)

A

Triple drug therapy with tenofovir-emtricitabine + raltegravir. Start within 72 hours, continue for 28 days

136
Q

Lab findings in paget disease of the bone

A

normal Ca, elevated alk phos

137
Q

treatment for paget disease of the bone

A

bisphosphonates

138
Q

when do you treat RSV bronchiolitis with ribavirin?

A

immunocompromised patients with severe disease only

139
Q

Bronchiolitis is diagnosed via _____

A

clinical picture only

140
Q

Workup in patient with diagnosed medullary thyroid cancer

A

serum calcitonin, CEA, neck ultrasound, test for RET mutations, screen for coexisting tumors (pheo, hyperpara)

141
Q

Treatment for breastfeeding mastitis

A

dicloxacillin, cephalexin

142
Q

treatment for active TB in a pregnant patient

A

Multidrug therapy (IZD, rifampin, ethambutol) and pyridoxine B6

143
Q

The left circumflex coronary artery supplies blood to the ________

A

lateral wall of the left ventricle

144
Q

The left anterior descending coronary artery supplies blood to the _____

A

anterior and anterolateral walls of the left ventricle

145
Q

Causes of sudden mitral regurgitation

A

papillary muscle rupture (MI)

ruptured chordae tendinae (connective tissue disease, endocarditis, rheumatic heart disease)

146
Q

How does schizoaffective disorder differ from schizophrenia in diagnosis?

A

Schizoaffective disorder has mood symptoms lasting a significant portion of illness and throughout illness

147
Q

Guidelines for pacemaker use in heart failure

A

EF < 35%
NHYA class II +
LBBB w/ QRS > 150ms

148
Q

Treatment for cerebral venous sinus thrombosis

A

LMWH

149
Q

Dx: severe headache, focal neurologic deficits in pregnant patient?

A

Cerebral venous sinus thrombosis

150
Q

Imaging findings of acute cholangitis?

A

biliary duct dilation

151
Q

Antibiotics that increase the risk of developing pyloric stenosis?

A

Macrolides

152
Q

Prophylaxis in patient with HIV and CD4 count < 200

A

Bactrim (PCP ppx)

153
Q

Prophylaxis in patient with HIV and CD4 < 100

A

Bactrim (PCP, toxo ppx)

154
Q

Prophylaxis in patient with HIV and CD4 < 50

A

Azithromycin (MAC)

155
Q

HIV Patient with PCP infection should be treated with antibiotics and _________ if __________

A

corticosteroids; if PaO2 < 70 on room air

156
Q

In an HIV patient with suspected PCP infection but negative sputum/BCx, you _______

A

do a BAL. need definitive diagnosis (could be something else, like TB)

157
Q

Medications that predispose to the development of gout?

A

Diuretics, ASA, immunosuppressants (cyclosporine, azathioprine, etc)

158
Q

Treatment of acute gout in patient with renal failure and kidney transplant?

A

glucocorticoid injection. Colchicine can’t be used with azathioprine

159
Q

What are the 4 Ts of HIT?

A

Thrombocytopenia ( dec 30-50%)
Timing (5-10d after heparin initiation)
Thrombosis (new, or progressive, or skin necrosis)
alTernative causes unlikely

160
Q

Name the common extrapulmonary manifestations of sarcoidosis

A

skin: papular, nodular, plaque-like
eye: uveitis, sicca
joints: polyarthritis
CNS: facial nerve palsy
hepatomegaly, peripheral lymphadenopathy
almost always fatigue

161
Q

name symptoms of neurosyphilis

A

subacute meningitis, cranial neuropathies, visual disturbances. Often preceded by rash, lymphadenopathy

162
Q

Features on stress test that would make you go to cath in patient with stable angina

A

symptoms: poor exercise capacity, +cp at low work, low BP
EKG: 1mm STd, STd at low work, STE w/o Qs, arrhythmias