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Everything Flashcards

1
Q

Cases

Testing for PCOS

A 
24 urine cortisol
24 urine 17-ketosteroid
serum testosterone, total and free
serum prolactin
bhcg
LH
FSH
TSH
CBC
BMP
Glucose tolerance
US Abdomen/transvag
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2
Q

Presentation of Kawasaki in <6months

A

Can be incomplete

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3
Q

Screening for celiac disease

A

anti-transglutaminase ab

anti-endomysial ab

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4
Q

Antibodies with primary biliary cirrhosis

A

Anti-mitochondrial

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5
Q

Tx scabies

A

Permethrin

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6
Q

Femur fx in nonambulating child, most likely dx?

A

Child abuse

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7
Q

First line drug therapies for obesity

A 
Orlistat
Phentermine/topomax
Lorcaserin
Wellbutrin/naltrexone
Liraglutide
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8
Q

Fx of entacapone

A

Prolongs effect of levodopa

COMT inhibitor

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9
Q

In COPD exacerbations, before intubation, always try

A

Noninvasive PP ventilation

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10
Q

Tx for nitroprusside cyanide toxicity?

A

sodium thiosulfate

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11
Q

Cases

Renal causes of renal failure

A

Toxins

Infectious

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12
Q

Cases

Lead exposure kids, order:

A

Lead pain assay at home;

follow finger stick with blood lead, quantitative

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13
Q

Cases

Postrenal causes of renal failure

A

BPH

Nephrolithiasis

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14
Q

Meningitis with gram pos cocci in clusters, use what drug?

A

IV nafcillin

10-14 days

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15
Q

Contraindications to MHT in women

A 
CAD
liver disease
hx breast cancer
venous thromboembolism
stroke
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16
Q

Sensitivity

A

a/(a+c)

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17
Q

NNT

A

1/ARR
ARR = CER - EER
Control event rate - Experimental event rate

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18
Q

TCA used in OCD

A

clomipramine

SSRIs first line w/ exposure and response therapy

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19
Q

PPV

A

a/(a+b)

TP/TP + FP

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20
Q

Restless leg syndrome association

A

Iron deficiency

Check ferritin levels

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21
Q

4x4 table

A 
DISEASE+ | -
TEST + | a | b |
             \_\_\_\_\_
TEST -  | c | d |
a = TP, b = FP, c = FN, d = TN
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22
Q

Mgmt hydrocele in infant

A

Observe, most resolve by age 1

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23
Q

Patients with severe nephrotic syndrome are predisposed to:

A

Thrombotic events, infections

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24
Q

Cases

Tx Graves disease

A

Methimazole
Propranolol
If any FH of cardiac stuff, high risk to develop VT, need Holter or inpatient monitoring

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25
Q

Sxs of medial medullary syndrome

A

vertebral or anterior spinal artery occlusion
contralateral paralysis of arm and leg
tongue deviation TOWARD lesion

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26
Q

Drugs for Rhythm control on a-fib

A

Dofetilide
Ibutilide
Amiodarone

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27
Q

Fastest way to reverse warfarin

A

Prothrombin complex concentrate

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28
Q

High indirect bilirubin means

A

Hemolysis

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29
Q

Cases

Mgmt postrenal failure

A 
Stat US
Urology consult
Catheterize
if fever, BC, UC, start Cipro
All stat
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30
Q

HFE genetic testing for

A

hereditary hemochromatosis

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31
Q

When to add antifungal therapy in neutropenic fever?

A

Persistent fever for 5-7 days with no response to abx

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32
Q

Tx of choice for prolonged QRS due to TCA OD

A

Sodium bicarb

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33
Q

Most common extraintestinal manifestation of Entaemoeba Histolytica

A

Liver abscess
Aspirate looks like anchovy paste
Aseptic/negative gram stain

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34
Q

Urine leakage with sneeze, cough etc.

Causes

A

Sphincter tone down

Urethral hypermobility

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35
Q

Cases

If K elevated…

A

D5/Insulin, EKG

and recheck

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36
Q

New atrial flutter of unknown duration, first next step

A

Anticoagulate

ie Xa inhibitor

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37
Q

Cutoff for cesarean delivery at 39 weeks with fetal macrosomia

A

> 9.9lb (4.5kg)

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38
Q

Primary sclerosing cholangitis is a complication of

A

Ulcerative colitis

Dx w/ endoscopic cholangiography or MRCP

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39
Q

Afebrile bloody diarrhea suggests what pathogen

A

Enterohemorrhagic E Coli w/ shiga toxin 0157:H7

RF undercooked beef and animal exposure

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40
Q

Drop in PTH, medical causes

A

Immobilization

Malignancy

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41
Q

Tx vaginosis

A

Metronidazole oral

Clindamycin vaginal

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42
Q

Tx pertussis

A

Azithromycin

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43
Q

Best tx for urine cx growing fungus

A

Change Foley

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44
Q

ARR

Absolute Risk Reduction

A

CER-EER

Control event rate - Experimental event rate

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45
Q

Mgmt pregnant patients with Parvo

A

Serial US
Middle cerebral artery measurements
correct anemia in mom

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46
Q

Case-control, what study direction

A

Retrospective

Compute OR

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47
Q

Cases

Remember for the ICU

A 
PPI or H2 
Bed rest
I/Os
SCDs/pneumatic CDs
Stool softener
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48
Q

Patients with CAD should be on what dose statin?

A

High intensity

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49
Q

Fractures that are pathognomonic for non accidental trauma in children:

A

Spiral fractures
metaphyseal “bucket handle” fx
Posterior rib fx
Fxs at various stages of healing

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50
Q

Menopausal help in pts with DVT/PE risk

A

Escitalopram

SNRIs

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51
Q

Confusion and shortened QT, electrolyte abnormality?

A

Hypercalcemia

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52
Q

Longest acting insulin

A

Glargine

same efficacy over 24 hrs

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53
Q

Tx prosthetic valve endocarditis

A

Ceftriaxone
Vancomycin
Gentamicin

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54
Q

Surveillance recommendations for aneurysms 3-4cm

A

q2-3 years

for >4cm, every 6-12 months

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55
Q

Tx for catatonia

A

Benzos

ECT

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56
Q

DM pt w/ no hx of HF presents with CHF sxs, drug cause?

A

Pioglitazone
Rosiglitazone
thiazolidinedione (TZD) class

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57
Q

Most dangerous complication of GPA Wegener’s

A

Alveolar hemorrhage

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58
Q

What is a cross-sectional study?

A

Observational

A specific population is observed at one point in time

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59
Q

Orders with lead tox

A

Blood lead, quant
Erythrocyte protoporphyrin
LFTs

Succimer for mid range, EDTA dimercaperol for high range

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60
Q

Bitemporal hemianopsia, mass?

A

Mass on optic chiasm

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61
Q

Recommended initial tx for head and neck cancer

A

combined chemo and radiation

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62
Q

Transient red cell aplasia, aplastic crisis

virus?

A

Parvo, B19

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63
Q

IVF bolus amt in kids

A

500cc

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64
Q

Pressures indicating compartment syndrome

A

> 30
or delta pressure <20-30
delta pressure = diastolic - compartment

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65
Q

Worsening renal fx after initiation of ACEi/ARBs suggests

A

renal artery stenosis…if transplanted, issue w/ anastomosis is common cause
also see unexplained atrophic kidney
recurrent flash PE w/ HTN

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66
Q

Cohort study

A

2 groups chosen with and without RF and then followed
——-> Prospective
Compute RR

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67
Q

Tx RLS

A

Pramipexole, ropinirole- dopamine agonist

Gabapentin enacarbil

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68
Q

ARDS pearl

A

Low TV, 6-8 mg/kg

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69
Q

Shoulder pop and subsequent bruising, dx

A

Bicep tendon rupture

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70
Q

When to talk about renal replacement therapy

A

When GFR < 30

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71
Q

Mgmt neonatal hypothyroidism

A

Confirm TSH, T4
Immediate levothyroxine
US thyroid
Refer to endocrinology

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72
Q

Cases

Symptomatic tx constipation in small children

A

Milk of magnesia

Docusate

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73
Q

Methotrexate is what antagonist

A

Folate

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74
Q

Child with pallor, poor school performance, fatigue, CBC shows basophilic stippling;
dx?

A

Lead poisoning;

Also look for constipation, asymptomatic

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75
Q

Lambert Eaton syndrome is a paraneoplastic manifestation of what cancer

A

Small cell lung cancer

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76
Q

If CT scan negative and high suspicion for SAH, next step

A

LP for xanthochromia

77
Q

How to diagnose PCP/PJP PNA

A

Induced sputum, if inconclusive, bronchoalveolar lavage

Pay careful attention to ABG, if pO2 <70, need steroids with tx

78
Q

Tx acute a-fib w/ rvr

A

Cardizem IV bolus, then drip

Start wafarin on ward

79
Q

Causes of incomplete emptying and urine dribbling

A

Impaired detrusor contractility

Bladder outlet obstruction

80
Q

Cases

If infant requires phototherpy, add:

A

Erythromycin drops

81
Q

Most common reason for iron deficiency anemia in males

A

GI blood loss

82
Q

Initial tx of prolactinoma

A

Bromocriptine or cabergoline (dopamine agonists)

83
Q

Reversal for warfarin

A

IV Vitamin K and FFP

84
Q

Most common 2 migraine prophylaxes

A

Beta blockers
TCAs
(Ergotamine for acute mgmt)

85
Q

Granulomas in sarcoidosis

A

Noncaseating

86
Q

When to insert defibrillator?

A

EF <30% and prior MI; or

LV <35% w/ moderate/severe HF

87
Q

BUN:Cr associated with UGIB

A

> 20:1

88
Q

Thyroid medication recommendations in pregnancy

A

PTU in first trimester

then switch back to methimazole

89
Q

What is a factorial study?

A

Utilizes greater than or equal to 2 interventions, and all combinations of interventions

90
Q

Mild lead level in children

A

<44

91
Q

When do patients get statin induced myositis (>10x normal CK)

A

First few months of taking statin

Abx/meds interactions, ie macrolides, cyclosporine

92
Q

Most accurate measurement of iron stores

A

Ferritin level

93
Q

Palpable breast mass >30 –>

A

Mammogram +/- US –>…

94
Q

Restless leg syndrome first line tx

A

Pramipexole
Ropinirole
Dopamine agonists

95
Q

Pernicious anemia involves absent rugae in the

A

fundus

96
Q

Specificity

A

d/(c+d)

97
Q

Tx inflammatory acne

A

Add topical abx ie erythromycin

98
Q

How to make dx of Hirschsprung disease

A

Rectal suction biopsy

Anorectal manometry less accurate in <1 month old

99
Q

Cases

Do what before radioiodine test

A

Pregnancy test

100
Q

Cause of sudden urge to urinate

A

Detrusor hyperactivity

101
Q

Infant with cyanosis and noisy breathing w/ normal heart sounds, dx

A

Choanal atresia
Insert NG tube
Requires prompt surgical repair

102
Q

Cases

How to differentiate between prerenal and renal causes of renal failure:

A 
Calculate FeNa (Fractional Excretion of Sodium)
FeNa < 1 --> prerenal
103
Q

Complication of nephrotic syndrome

A

Peritonitis

104
Q

Antibodies with systemic sclerosis/scleroderma

A

Anti-centromere
Velcro sound on lung auscultation
Cutaneous only version - telangectasias

105
Q

Tx of rosacea

A

topical metronidazole

brimonidine

106
Q

Parotid gland enlargement in a young woman suggests

A

Bulimia

107
Q

Common causes of long QT (>450 men, >470 in women)

A 
Fluoroquinolones
Antipsychotics
Congenital
Hypomagnesemia
Hypokalemia
108
Q

How to diagnose multiple myeloma

A

Monoclonal protein in urine/serum

Serum or urine 240hr protein electrophoresis

109
Q

Ddx tachypnea in newborn

A

PNA/sepsis
TTN
hyaline membrane disease

110
Q 
Ipsilateral Horner's syndrome
nystagmus
Hoarseness
Loss of P&amp;T in contralateral limbs
dx?
A

Wallenberg syndrome
*facial pain can look like trigeminal neuralgia
Lateral medulla from intracranial vertebral artery infarction

111
Q

Cases

FeNa < 1

A

FeNa < 1 –> prerenal
Bun:Cr&raquo_space; 20:1
Spot urine Na < 20 meq/L

112
Q

Common cause of transient tachypnea of the newborn

A

C-section

113
Q

leukocytes x % neutrophils =

A 
# neutrophils
>250 = SBP
114
Q

Effect of lithium on PTH

A

Raises

115
Q

How to dx cryptococcus

A

India ink
tx ampho B and flucytosine
markedly elevated opening pressure
*serial LPs to reduce cryptococcal burden

116
Q

Cases

Mgmt GBS PNA neonate

A 
Ampicillin
Cefotaxime
\+/- Gentamicin when meningitis ruled out
diet not oral is RR > 60
wean O2 for sat > 94%
117
Q

Use DMSA succimer in children with

A

Moderate lead level

45-69

118
Q

Target cells and nucleated RBCs,

dx

A

Thalassemia

119
Q

Hyperthyroid in pregnancy, failed PTU tx, next step

A

Surgery

120
Q

Predictors of mortality in end stage liver disease

A 
Bilirubin
INR
Cr
Na
*for 90 day survival
121
Q

Tx carbuncle or skin abscess

A

Clindamycin, for MRSA

122
Q

Why does cocaine cause heart attacks?

A

Stimulates platelet activity and encourages thrombus formation

123
Q

Leading cause of M&M in SAH

A

Cerebral vasospasm, monitor likelihood with transcranial doppler

124
Q

Mgmt cryptorchidism in infants

A

Wait until 6 months

125
Q

Complication of long QT

A

Torsades

126
Q

Lichen planus P’s

A

Pruritic
Planar
Polygonal
Purple

127
Q

Tx of akathesia when can’t reduce antipsychotic

A

Propranolol, Benztropine, benzos

128
Q

Palpable breast mass <30 –>

A

US +/- mammogram –>
simple cyst –> +/- needle aspiration
complex cyst or solid mass –> image-guided core biopsy

129
Q

Most specific finding of tamponade

A

Early diastolic RV collapse

130
Q

Peaked T waves =

A

Hyperkalemia
Also, shortened QT, lengthened PR and QRS
Worst: sine wave

131
Q

What is a crossover study?

A

Subjects are exposed to different treatments or exposures sequentially

132
Q

Mgmt inguinal hernia in children

A

Prompt surgical correction

Patent processus vaginalis

133
Q

High Alpha fetoprotein level suggests

A

Neural tube defect
Next step US
Amniocentesis if US is unclear

134
Q

Complication of compartment syndrome

A

rhabomyolysis –> renal failure

135
Q

Cases

Most common cause of acute renal failure

A

ATN

  • -low intravascular volume, including third spacing
  • -decreased CO
136
Q

Use EDTA and dimercaperol in children with

A

Severe lead level

>70

137
Q

Cases

If dehydrated

A

IVF bolus then continuous drip

138
Q

First step in management of inferior wall MI w/ bradycardia

A

Atropine

139
Q

Primary hyperparathyroidism carries what syndrome risks?

A

MEN types 1 and 2A

140
Q

Basophilic intranuclear inclusions, renal tubular damage after kidney transplant suggest

A

BK virus, polyomavirus –> nephritis

141
Q

Cases

Inpatient routine

A 
Ambulate as tolerated
Diet
Vitals q2, q6
Daily weights
I/Os
Best rest with AMS
Heparin 5000U SQ q12
SCDs
Accuchecks q6
Out of bed to chair
D/C catheter
142
Q

Symptoms of long QT

A 
Palpitations
Presyncope
Syncope
Seizure
Sudden cardiac arrest
143
Q

Severe, sudden onset of hypercalcemia

A

Humoral Hypercalcemia of Malignancy

High PTHrP, low PTH

144
Q

Tx of choice for prolonged QRS due to hypomagnesemia or torsades

A

Magnesium

145
Q

Most common source of rabies in developing countries

A

Dogs

in US, bats

146
Q

Causes of metabolic alkalosis w/ hypokalemia

A
  1. Vomiting
  2. Diuretics
  3. Abnormal Na handling in Gitelman and Bartter syndromes
147
Q

What is terbinafine for?

A

Fungal infections

148
Q

Common sxs of hypothyroid

A 
Pins and needles/carpal tunnel
Mild increase in Cr
Mild normocytic anemia
Mild hyponatremia
Hyperlipidemia
Myopathy
149
Q

Complications of ASD

A

In adulthood - decreased exercise tolerance, afib, right HF, stroke (paradoxical embolization)
*left to right shunt

150
Q

How to test for HIT

A

serotonin release assay

151
Q

Most common congenital heart defects

A

Bicuspid aortic valve

ASD

152
Q

Meds that decrease the effectiveness of OCPs

A 
phenytoin
carbamazepine
ethosuximide
phenobarbital
topiramate
153
Q

Very low risk prostate cancer =

A

Gleason =/< 6 with < 3 cores affected
Normal DRE
PSA <10

154
Q

Another cause of hyperviscosity syndrome besides multiple myeloma

A

Waldenstrom’s macroglobulinemia

155
Q

Three common causes of microcytic anemia:

A
  1. Iron deficiency
  2. Anemia of chronic disease
  3. Thalassemia
    (Lead poisoning if symptomatic, rare)
156
Q

Tx DTs

A

IV lorazepam

when pt can tolerate PO, chlordiazepoxide (Librium)

157
Q

Examples of alpha-1 adrenergic antagonists

A

Tamsulosin

Doxazosin

158
Q

Xray finding in button battery ingestion

A

Double ring sign

159
Q

Cases

In diabetics, order

A

S/S Insulin
Accuchecks q6
HbA1C, routine

160
Q

NPV

A

d/(c+d)

161
Q

Location of hepatocellular carcinoma

A

Liver parenchyma

AFP can be normal or elevated

162
Q

Organ donation protocol

A

Treating physician must be specially trained to have that conversation

163
Q

Underlying issues that throw people into Afib

A 
HF
PE
HTN
ACS
Infection
Subclinical hyperthyroid
164
Q

Causes of prolonged aPTT

A

Intrinsic pathway disorder ie

Hemophilia A, B, von Willebrand

165
Q

If treated Pseudomonas meningitis, use what drug?

A

Ceftazidime
10-14 days
also for suspected neutropenic fever

166
Q

Cases

FeNa > 1

A

Intrinsic Renal Failure
Spot urine Na > 20 meq/L
Proportionate increase in BUN:Cr < 20:1

167
Q

Most common inherites hypercoagulable condition

A

Factor 5 Leiden deficiency –> activated protein C resistance

168
Q

ADHD, can doctor call school?

A

Yes, it’s considered a disability

169
Q

Don’t use spironolactone in men bc of

A

side effect of gynecomastia

170
Q

Direct thrombin inhibitor example

A

Argatroban

171
Q

Tx for vaginal vulvovaginitis in pregnancy

A

Vaginal clotrimazole, miconazole, nystatin

Do not use oral fluconazole during 1st trimester

172
Q

Use cell free fetal DNA test for

A

chromosomal things, is t21

173
Q

Cases

Workup of infant jaundice

A 
Consider hemolysis, polycythemia, TORCH, GBS
CBC
BMP
LFTs - total and indirect bili
I/Os
VS q4
UA
Blood type of infant and mother
Coomb's test, direct
CRP, stat q12
174
Q

Cases

Infant diarrhea differential

A 
Rotavirus
Enterovirus
Adenovirus
Norwalk virus
Shigella
Salmonella
E. Coli - both
Yersinia
Campylobacter
C/ Diff
Appendicitis
Intussusception
Hyperconcentrated infant formula
Otitis Media
UTI
HSP
HUS
Toxins: Iron, Mercury, Fluoride, Lead
175
Q

HIT should be suspected when

A

Plt drop by >50% 5-14 days after starting heparin;

New onset unexplained thrombocytopenia or thrombosis

176
Q

Hypercalcemia in age >50, operate?

A

No, unless symptomatic

Follow DXA, serum Ca and Cr

177
Q

First line tx for Bulimia

A

CBT
then SSRI
Buproprion is contraindicated

178
Q

Acute paralysis w/ presence of a sensory level or bowel/bladder dysfunction suggests

A

acute myelopathy

use MRI

179
Q

Kind of anemia in multiple myeloma

A

Normocytic

MCV 80-100

180
Q

Causes of erythema multiforme (target lesions)

A 
HSV
Mycoplasma pneumonia
Allopurinol
Abx
Autoimmune
Malignancy
181
Q

Secondary causes of RLS

A 
Iron deficiency anemia (check ferritin)
DM
ESRD
MS, Parkinson's
Pregnancy
Drugs ie antidepressants
182
Q

RRR

Relative Risk Reduction

A

(CER-EER)/CER

183
Q

Avoid what hypertensives in patients with gout

A

Thiazide diuretics

Furosemide

184
Q

Give activated charcoal for tylenol ingestion within

A

4 hours of ingestion

At 4 hours, get acetaminophen level and decide whether to give N-acetylcysteine

185
Q

Cases

If renal failure w/ ACEi use…

A

Restrict

186
Q

Dysphagia first test to order (pharynx and upper esophagus)

A

Nasopharyngeal laryngoscopy

187
Q

Cancer found in distal esophagus

A

Adenocarcinoma

188
Q

GI Bleed BMP finding

A

Elevated BUN:Cr

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