everything Flashcards
(162 cards)
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
2
Q
posterior urethral valve is diagnosed by ____
A
voiding cystourethrogram
3
Q
______ is the most accurate measurement of Fe stores
A
Ferritin
4
Q
first line treatment for restless leg syndrome
A
pramipexole, ropinirole
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
6
Q
hirschprung disease is diagnosed via
A
rectal suction biopsy
7
Q
symptoms of hirschprung disease
A
delayed meconium passage, abdominal distention, contrast enema with dilated descending colon and narrow resctosigmoid colon
8
Q
Dx: delayed meconium passage, abdominal distention, contrast enema with dilated descending colon and narrow resctosigmoid colon
A
Hirschprung disease
9
Q
a solitary pulmonary module requires surveillance if it is larger than _____cm
A
0.8 cm
10
Q
ACLS for PEA arrest
A
Compressions, no shock
11
Q
torsades can be provoked by ______ in patients with long QT
A
bradyarrhythmia, hypoMg, hypoK, low Temp, SSRIs, HIV
12
Q
treat torsades with _____
A
IV Mg
13
Q
definition of recurrent UTIs
A
2+ in 6 months, 3/year
14
Q
treatment for recurrent UTI
A
suppression therapy
15
Q
medications that decrease Levothyroxine absorption
A
Iron, Ca, AlOH, PPIs, sucralfate
16
Q
management of mild hidradenitis
A
topical clinda, lifestyle modifications (weight loss, smoking cessation, hygiene)
17
Q
treatment for hidradenitis with nodules, tracts, or scarring
A
(moderate disease) PO doxy
18
Q
when using amiodarone and warfarin together, ______
A
reduce warfarin dose by 20-50% (amio increases serum concentration of warfarin)
19
Q
when do you treat people with salmonella infection?
A
patients <12 months, immunocompromised, >50 with atherosclerosis
20
Q
treatment for salmonella
A
cipro, bactrim, ceftriaxone
21
Q
side effects of carbamazepine
A
bone marrow suppression, SIADH in elderly, glaucoma, urinary retention
22
Q
in a patient with suspected brain death with neuro exam positive for brain death what is the next test?
A
apnea test
23
Q
in a patient with suspected brain death with difficult neuro exam, what is the next test?
A
EEG or CT
24
Q
most common cause of sudden death with steering wheel MVC injuries?
A
Aortic injuries
25
_____ is the most sensitive test for diagnosing osteonecrosis of the femoral head
MRI
26
most common cause of secondary dilated cardiomyopathy
CAD (ischemic cardiomyopathy)
27
Dx: mild crampy abd pain (peripheral), fecal urgency, bloody diarrhea in patient w/ CAD. ^WBC, lactic acidosis. Friable edematous mucosa on cscope
colonic ischemia
28
Dx: patient with HIV, altered mental status, rash of papules w/ central umbilication/necrosis
Disseminated cutaneous cryptococcosis
29
Dx: cold symptoms, then development of muscle weakness, paresthesias, dec deep tendon reflexes, dysautonomia
Guillain Barre
30
time course of guillain barre
symptoms worsen over 2 weeks, plateau for 2-4 weeks, recover over months
31
when do you treat Guillain Barre with IVIG?
if non ambulatory or if symptoms developed in past 4 weeks
32
Dx: sudden onset of muscle weakness triggered by emotional episodes
cataplexy
33
treatment for cataplexy
stimulants, SSRIs, SNRIs, TCAs
34
Name TIMI criteria
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
35
a TIMI score of ____ would stratify a person with NSTEMI/unstable angina to cath within 24 hours
3-7
36
A TIMI score of 0-2 would stratify a person with NSTEMI/unstable angina to _____
stress test
37
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
1. age 65+
38
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
2. 3+ CAD risk factors
39
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
3. known CAD >50%
40
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
4. recent ASA use
41
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
5. 2+ anginal episodes 24hr
42
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
6. Pos trop
43
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. _____
7. ST changes >0.5mm
44
clinical factors that determine if a child with ITP needs IVIG?
mucosal bleeding or hemorrhage
45
CLL diagnosis on labs?
smudge cells, +flow cytometry (tissue bx not required)
46
what symptoms of CLL confer worse prognosis?
multiple chain lymphadenopathy, hepatosplenomegaly, anemia, thrombocytopenia
47
EKG findings in AVNRT?
narrow complex tachycardia with regular r-r intervals, can have pseudo p in inferior leads
48
Wolf Parkinson’s White is associated with development of ____
AVRT
49
saw palmetto is used for ___
BPH
50
side effects of Saw Palmetto
G.I. upset, increased bleeding risk
51
risk factors for children < 1 with iron deficiency anemia?
delayed introduction of solids, cow/soy/goat milk
52
risk factors for children > 1 with iron deficiency anemia?
>24 oz milk /day, < 3 servings Fe rich food
53
how to differentiate microcytic anemia of Fe def and thalassemias?
mentzner index. if > 13 —> Fe def
54
how do you calculate mentzner index?
MCV/RDW
55
Dx: shoulder pain, ipsilateral miosis and anhidrosis, weakness of ipsilat hand muscles, pain 4&5th digits
Pancoast tumor
56
describe horner syndrome
ipsilateral miosis, enopthalmos, anhidrosis
57
describe nerve symptoms of pancoast tumors
weakness/atrophy intrinsic hand muscles, pain/paresthesia of 4&5th digits, medial arm, forearm
58
What are the signs of spinal cord compression in pancoast tumor?
decrease in lower extremity deep tendon reflexes +/- back pain
59
abdominal pruritis in a pregnant patient with no rash is _____
pregnancy induced skin changes
60
Dx: pruritic, erythrematous papules on the abdomen of a pregnant patient that spreads to the extremities but spares the face/pals/soles
polymorphic eruption of pregnancy
61
Dx: truncal rash in pregnant patient that starts at belly button as urticaric plaques and moves to vesicles and bullae. No mucosal involvement
pemphigoid gestationis
62
pemphigoid gestationis is treated with ____
high potency steroids, antihistamines
63
when do you start diabetic patients on a statin?
at age 40
64
Dx: delirium, megaloblastic anemia, inc indirect bill in an elderly patient
B12 deficiency
65
when would you use warfarin in a pregnant patient?
in a patient with a mechanical heart valve, 2nd & 3rd tri only
66
what medication would you use for pregnant patient in the 1st trimester with bipolar I and mania?
Haldol, possibly 2nd gen antipsychotics
67
after restarting iron supplementation in the child with Fe deficiency anemia ______ recovers first
the retic count (then Hb/Hct, then ferritin)
68
how do you monitor a patient on doxorubicin?
MUGA/Radionucleotide ventriculography
69
how do you tell if erectile dysfunction is psychogenic?
sudden onset, situational, normal nocturnal erections
70
when would you anticoagulate in nonvalvular Afib?
CHADS-VASc 2+
71
CHADS-VASc score parameters
```
C (CHF)
H (HTN)
A2 (75+)
D (DM)
S2 (stroke/TIA)
V (vasc dz)
A (age 65-74)
Sc (sex-F)
```
72
how do you diagnose chronic prostatitis?
UA + UCx before and after prostate massage. UA >20 leuks
73
treatment for chronic prostatitis?
alpha blockers, abx, anti-inflammatories, psychotherapy
74
How many cigarettes is an absolute contraindication to oral contraceptive pills?
15+ cigarettes/day in someone 35+ years
75
____ Is the most important modifiable risk factor to reduce AAA expansion
cigarette smoking
76
clinical manifestations of radiation induced cardiotoxicity
MI, restrictive cardiomyopathy, constrictive pericarditis, valvular abnormalities, conduction deficits
77
ST elevation thresholds
>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
Exam findings consistent with severe AS
soft, single second heart sound, delayed and diminished carotid pulse, loud and late peaking systolic murmur
79
When do you reccommend a mammogram at 40?
- 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
Persistent chest pain and arm weakness in a patient with recent cocaine use should raise suspicion for ____
aortic dissection
81
Bilirubin levels for severe hyperbilirubinemia
> 20-25
82
treatment for BV
topical/PO metronidazole, clindamycin
83
Dx: sudden onset syncope in a patient with a history of an MI?
cardiogenic syncope 2/2 Vtach
84
Dx: Exertional syncope in a patient with a systolic murmur?
Aortic stenosis or HCM
85
NYHA class II heart failure definition
slight limitation with physical activity, ordinary activity causes symptoms (fatigue, dyspnea, palpitations)
86
NYHA class III heart failure definition
marked limitation with physical activity, less than ordinary activity causes symptoms
87
Add ____ in black patients with NYHA class III/IV heart failure if not responding to current therapy
hydralazine + imdur/nitrates
88
Add ____ in patiets with NYHA class II heart failure if EF < 40%
beta blockers
89
Add ____ in patients with NYHA class II heart failure if EF < 30%
spironolactone, defibrilator
90
Add ____ in patients with NYHA class III heart failure if symptomatic on spironolactone
digoxin
91
medications that can cause decreased oral contraceptive efficacy
antiepileptics: phenytoin, carbamazepine, topiramate
92
Risk factors for spontaneous abortion
prior spontaneous abortion, AMA, substance abuse, extremes in BMI
93
Diagnostic management of patient after cardiac cath with tender pulsatile mass at puncture site?
ultrasound (likely pseudoaneurysm)
94
____ is the ideal time for pelvic surgery in a pregnant patient with a pelvic mass
2nd trimester
95
Labs to check in patient with confirmed elevated Hb?
check epo level, carboxyhemoglobin level if elevated
96
Causes of polycythemia
polycythemia vera, renal cell carcinoma, chronic hypoxia (smoking, CO poisoning, cardiopulmonary disease)
97
best contraception for women with PCOS who don't want to use OCPs
progesterone IUD
98
How to manage levothyroxine in pregnant patient with hypothyroidism?
Follow TSH and total T4, increase levothyroxine by 25-50%
99
Patients with toxic thyroid nodule require ____ before definitive treatment
methimazole/PTU to become euthyroid
100
Definitive treatment for toxic thyroid nodule
hemithyroidectomy or radioactive iodine ablation
101
Imaging choice in patient with uncontrolled HTN, abdominal bruit, elevated Cr? Looking for?
Renal duplex ultrasound. Looking for renovascular HTN
102
Risk factors for cavities in children
sugary diet, nighttime bottles/feeding, inadequate fluoride, family history of cavities, low SES
103
Dx: recurrent asthma exacerbations, central bronchiectasis on CT, fleeting/changing infiltrates on CXR
allergic bronchopulmonary aspergillosis
104
Treat hypotension during surgical removal of pheochromocytoma with ______
fluid bolus, pressors if necessary
105
Hyponatremia, SIADH in patient with lung cancer most likely has ______ lung ca
small cell carcinoma
106
What do you do in a patient with post extubation stridor in respiratory distress not responding to conservative measures?
re-intubate
107
Normal language development at age 2
50+ words, 2 word phrases
108
Vomiting, lethargy, dehydration, hypoNa, ambiguous genetalia in young baby?
congenital adrenal hyperplasia
109
congenital adrenal hyperplasia is most commonly caused by a deficiency in _____
21-Hydroxylase
110
21-hydroxylase deficiency in congenital adrenal hyperplasia is confirmed with _______
elevated 17-hydroxyprogesterone
111
Dx: multiple cafe au lait spots, axillary/inguinal freckling?
Neurofibromatosis I
112
Patients with neurofibromatosis I need what screening exam?
optho for optic pathway gliomas
113
First test in suspected bowel perforation?
CXR to look for pneumoperitoneum
114
In a patient with chronic hypoparathyroidism with low Ca and elevated urinary Ca, add ______
thiazide diuretic
115
____ is preferred for EtOH withdrawal in patients with liver disease
lorazepam
116
Indications for MTX use in ectopic pregnancy
stable patients with beta-hCG < 5000, adnexal mass < 3.5 cm, no cardiac activity
117
Indications for laparoscopy in patients with ectopic pregnancy
unstable patient, beta-hCG > 5000, adnexal mass > 3.5cm, fetal cardiac activity
118
Treatment for mild ulcerative colitis
topical 5-ASA like mesalamine suppository
119
Treatment for moderate ulcerative colitis
oral 5-ASA like sulfasalazine, steroids. Azathioprine/6-MP if not responsive to initial therapy
120
Treatment of UTI in nonpregnant patient?
3 days of bactrim or cipro
121
Treatment of UTI in pregnant patient?
7 days of macrobid or augmentin
122
How is SIADH different from psychogenic polydipsia on labs?
both hypoNa, SIADH has high UOsm > 100, PPd has low UOsm < 100
123
lab values in SIADH
low Na, SOsm < 275, high UOsm > 100, high UNa > 40
124
Symptoms of acute HIV infection
sore throat, fever, lymphadenopathy, maculopapular rash, painful mucocutaneous ulcers (low WBC, low plt)
125
In a patient with trastuzumab-related cardiotoxicity, you ____
stop the trastuzumab and the EF will recover
126
Sodium bicarbonate is used in a TCA overdose to ____
prevent ventricular arrhythmias (widened QRS)
127
A patient with CAD and new hypothyroidism [should/should not] start levothyroxine before heart cath and stenting?
Should not. Starting will increase risk of MI in patient, must start slowly.
128
Dx: fever and vesicles/ulcers on posterior oropharynx of child with sore throat?
Herpangina (hand foot and mouth) 2/2 coxsackie
129
Dx: fever and vesicles/ulcers on anterior oral mucosa and around mouth of child?
Herpes gingivomastitis
130
Modifiable risk factors for colorectal cancer?
Smoking (current, long term), Alcohol (>4 drinks/day), obesity
131
Protective factors against colorectal cancer?
high fiber diet, NSAID use, hormone replacement, exercise
132
medications for reglan-induced dystonia
benadryl or benztropine
133
Dx: hyperpigmentation, pituitary enlargement, visual field defects with history of bilateral adrenalectomy
Nelson's syndrome
134
A patient on anti epileptic medication finds out she is pregnant. What do you do?
Continue AED, add folate, screen for congenital abnormalities with AFP and ultrasound. Do not switch or discontinue
135
Post exposure prophylaxis regimen (HIV)
Triple drug therapy with tenofovir-emtricitabine + raltegravir. Start within 72 hours, continue for 28 days
136
Lab findings in paget disease of the bone
normal Ca, elevated alk phos
137
treatment for paget disease of the bone
bisphosphonates
138
when do you treat RSV bronchiolitis with ribavirin?
immunocompromised patients with severe disease only
139
Bronchiolitis is diagnosed via _____
clinical picture only
140
Workup in patient with diagnosed medullary thyroid cancer
serum calcitonin, CEA, neck ultrasound, test for RET mutations, screen for coexisting tumors (pheo, hyperpara)
141
Treatment for breastfeeding mastitis
dicloxacillin, cephalexin
142
treatment for active TB in a pregnant patient
Multidrug therapy (IZD, rifampin, ethambutol) and pyridoxine B6
143
The left circumflex coronary artery supplies blood to the ________
lateral wall of the left ventricle
144
The left anterior descending coronary artery supplies blood to the _____
anterior and anterolateral walls of the left ventricle
145
Causes of sudden mitral regurgitation
papillary muscle rupture (MI)
| ruptured chordae tendinae (connective tissue disease, endocarditis, rheumatic heart disease)
146
How does schizoaffective disorder differ from schizophrenia in diagnosis?
Schizoaffective disorder has mood symptoms lasting a significant portion of illness and throughout illness
147
Guidelines for pacemaker use in heart failure
EF < 35%
NHYA class II +
LBBB w/ QRS > 150ms
148
Treatment for cerebral venous sinus thrombosis
LMWH
149
Dx: severe headache, focal neurologic deficits in pregnant patient?
Cerebral venous sinus thrombosis
150
Imaging findings of acute cholangitis?
biliary duct dilation
151
Antibiotics that increase the risk of developing pyloric stenosis?
Macrolides
152
Prophylaxis in patient with HIV and CD4 count < 200
Bactrim (PCP ppx)
153
Prophylaxis in patient with HIV and CD4 < 100
Bactrim (PCP, toxo ppx)
154
Prophylaxis in patient with HIV and CD4 < 50
Azithromycin (MAC)
155
HIV Patient with PCP infection should be treated with antibiotics and _________ if __________
corticosteroids; if PaO2 < 70 on room air
156
In an HIV patient with suspected PCP infection but negative sputum/BCx, you _______
do a BAL. need definitive diagnosis (could be something else, like TB)
157
Medications that predispose to the development of gout?
Diuretics, ASA, immunosuppressants (cyclosporine, azathioprine, etc)
158
Treatment of acute gout in patient with renal failure and kidney transplant?
glucocorticoid injection. Colchicine can't be used with azathioprine
159
What are the 4 Ts of HIT?
Thrombocytopenia ( dec 30-50%)
Timing (5-10d after heparin initiation)
Thrombosis (new, or progressive, or skin necrosis)
alTernative causes unlikely
160
Name the common extrapulmonary manifestations of sarcoidosis
skin: papular, nodular, plaque-like
eye: uveitis, sicca
joints: polyarthritis
CNS: facial nerve palsy
hepatomegaly, peripheral lymphadenopathy
almost always fatigue
161
name symptoms of neurosyphilis
subacute meningitis, cranial neuropathies, visual disturbances. Often preceded by rash, lymphadenopathy
162
Features on stress test that would make you go to cath in patient with stable angina
symptoms: poor exercise capacity, +cp at low work, low BP
EKG: 1mm STd, STd at low work, STE w/o Qs, arrhythmias
