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PANRE > Exam Missed Qs > Flashcards

Exam Missed Qs Flashcards

1
Q

In HIV+ patients, what bacteria/virus is Kaposi Sarcoma assoc with

A

Human Herpesvirus 8

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2
Q

In labor what does the L:S ratio represent

A

Fetal lung maturity

L:S ratio of <2:1 means lungs are immature

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3
Q

Pt is lip smacking, teeth grinding, and rolling tongue

a. tardive dyskinesia
b. NMS
c. serotonin syndrome
d. acute dystonic rxn
e. akathisia

A

tardive dyskinesia

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4
Q

patient started an antipsychotic med and now days later has intermittent spasms, truisms, protrusions of the tongue, facial grimacing, torticollis and diff speaking.

A

acute dystonic rxn

should include “reversible”

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5
Q

the need for restlessness and constant motion

A

akathisia

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6
Q

what causes NMS

A

decreased dopamine

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7
Q

what are symptoms of NMS

A

hyporeflexia
urinary incontinence
hyperthermia

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8
Q

what do prostaglandins and oxytocin do

A

cause increased contractions

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9
Q

signs of right anterior cerebral artery occlusion

A

contralateral (left sided):
hemiparesis LEG > ARM

urinary incontinence
personality change
abulia (lack of will)

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10
Q

signs of right posterior cerebral artery occlusion

A

visual hallucinations

“crossed symptoms” - ipsilateral nerve deficits, contralateral weakness, comas, drop attacks

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11
Q

what is Naegeles rule with estimated delivery date

A

Day 1 of LMP - 3 months + 7 days

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12
Q

what is koebner’s phenomenon

A

new skin lesions appearing along lines of trauma

nonspecific, e.g. psoriasis, vitiligo, lichen planus, infx

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13
Q

what electrolyte issue is usually caused by brain bleeds

A

SIADH –> hyponatremia

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14
Q

when are koplik spots seen

A

measles/rubeola

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15
Q

describe the measles/rubeola rash pattern

A

brick-red
starts on face and spreads to trunk
lasts 7 days

(after a prodrome)

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16
Q

describe the rubella rash pattern

A

light red to pink
spotted
lasts 3 days

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17
Q

describe the 5ths disease rash

A

slapped cheek

lacy red rash on extremities

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18
Q

describe the CSF findings for SAH

A

increased CSF opening pressure

xanthochromia that does not diminish

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19
Q

describe CSF findings for idiopathic intracranial HTN

A

increased CSF opening pressure

otherwise normal

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20
Q

describe the CSF findings for Guillain Barre syndrome

A

high protein

normal WBC

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21
Q

describe the CSF findings for ms

A

increased oligoclonal IgG bands

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22
Q

describe the CSF findings for viral meningitis, aseptic meningitis, or encephalitis

A

increased protein
normal glucose
increased WBC (*lymphocytes)

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23
Q

describe the CSF findings for fungal meningitis and TB meningitis

A

increased protein
decreased glucose
increased WBC (lymphocytes)

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24
Q

describe the CSF findings in bacterial meningitis

A

increased protein
decreased glucose
increased polymorphonuclear neutrophils

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25
Q

what is the 1st line therapy for unstable tachycardia

A

synchronized cardioversion

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26
Q

what is the 1st line therapy for stable narrow-complex tachycardia

A

adenosine

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27
Q

what is the 1st line therapy for stable wide-complex tachycardia

A

amiodarone (class iii anti arrhythmic)

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28
Q

unsynchronized cardioversion is aka

A

defibrillation

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29
Q

kidney stones: urea-splitting enzymes causing struvite stones (3)

A

proteus
klebsiella
pseudomonas

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30
Q

trisomy 21 vs trisomy 18 on the triple screen test

A

trisomy 21:
AFP: low
BHCG: high
estradiol: low

trisomy 18:
AFP: low
BHCG: low
estradiol: low

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31
Q

which cardiac med contains iodine

A

amiodarone

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32
Q

brief, sporadic, single repetitive jerks or twitching of 1+ muscle groups

A

myoclonus

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33
Q

repetitive, rhythmic, jerking that usually lasts less than 2-3 minutes

A

clonus

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34
Q

sustained contraction with twisting of the body and abnormal posturing

A

dystonia

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35
Q

repetitive, non-rhythmic movements or vocals

A

tics

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36
Q

rapid, involuntary, jerky, uncontrolled purposeless movements

A

chorea

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37
Q

what do you use as a tumor marker in medullary thyroid carcinoma / MEN2

A

calcitonin

mtc arrises from the parafollicular cells which secrete calcitonin, so in this dz calcitonin is elevated

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38
Q

patient with MG: how do you tell myesthenia crisis versus cholinergic crisis

A

*give Edrophonium
If sx worsen –> cholinergic
If sx improve –> myastheia

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39
Q

GI: “string sign”

A

crohns dz

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40
Q

PE test for ACL?

A

Lachman

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41
Q

PE test for menisci?

A

McMurray

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42
Q

epigastric pain better w/ food: duodenal or gastric ulcer

A

duodenal

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43
Q

epigastric pain worse w food: duodenal or gastric ulcer

A

gastric

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44
Q

what electrolyte abnormality may be seen with B12 injections

A

hypokalemia

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45
Q

Bartonella; Pasteurella

which one assoc with cat scratch, which one assoc with cat bite

A

bite: pasteurella
scratch: bartonella

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46
Q

FOOSH with fat pad in a kid vs. in an adult

A

kid: supracondylar fx
adult: radial head fx

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47
Q

what are these signs: tapping of facial nerve causes spasms, carpal spasms with inflation of BP cuff

and what electrolyte abnormality is it assoc with

A

hypocalcemia WHICH GOES HAND-IN-HAND WITH hypomagnesemia

signs: Chvostek’s sign and Trousseau’s sign

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48
Q

pathognomonic: tetrad inclusions seen within RBCs on peripheral smear

A

babesiosis

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49
Q

morale clusters within WBCs on peripheral smear

A

ehrlichiosis

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50
Q

intracellular RBC parasites seen on peripheral smear

A

malaria

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51
Q

larvae in striated muscle on muscle biopsy

A

trichinosis

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52
Q

brain tumor occurring in the hemispheres and parasagittal regions, attached to the dura

A

meningioma

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53
Q

brain tumor costing the corpus collosum with butterfly appearance

A

glioblastoma multiforme

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54
Q

brain tumor seen in kids in 3rd or 4th ventricle

A

ependymoma

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55
Q

brain tumor in the cerebellopontine, assoc with unilateral senrosineural hearing loss

A

schwannoma (tumor of CN VIII)

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56
Q

a sterile wisp of cotton to test corneal riflex: which nerve is being tested

A

CN V (trigeminal)

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57
Q

name all of the cranial nerves I-XII

A

1: olfactory
2. optic
3. oculomotor
4. trochlear
5: trigeminal
6: abducens
7: facial
8: vestibulocochlear (auditory)
9: glossopharyngeal
10: vagus
11: spinal accessory
12: hypoglossal

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58
Q

which CN controls taste on the posterior 1/3 of tongue and swallowing

A

glossopharyngeal (CN 9)

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59
Q

which CN controls chewing and facial sensation

A

trigeminal (CN 5)

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60
Q

which CNs control eye movement (3)

A

oculomotor (CN 3)
trochlear (CN 4)
abducens (CN 7)

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61
Q

which CN controls pupil constriction

A

oculomotor (CN 3)

62
Q

which CN controls the muscles of the tongue

A

hypoglossal (CN 12)

63
Q

which CN controls taste on the anterior 2/3 of the tongue

A

facial (CN 7)

64
Q

what is Boerhaave syndrome

A

an esophageal rupture which causes air to be absorbed into tissues –> pneumomediastinum

65
Q

pH: 7.36
PaCO2: 68
HCO3: 36

A

pH = normal but on acidic side, so think ACIDOSIS.

COMPENSATED because ph is close to normal and all other values are abnormal

PRIMARY RESPIRATORY ACIDOSIS because the co2 is elevated

elevated bicarb w/ normal ph confirms this is compensated; if bicarb was normal, it would be uncompensated

66
Q

DOC to increase HDL?

A

nicotinic acid

67
Q

what is the hallmark of neurogenic shock

A

hypotension with bradycardia

68
Q

hip issue: affected leg is shortened and internally rotated

A

hip dislocation

69
Q

hip issue: affected leg is shortened and externally rotated

A

intertrochanteric fracture

70
Q

which GI disease has decreased exacerbations with smoking

71
Q

what is the treatment for tardive dyskinesia

72
Q

which diabetic drug is not associated with hypoglycemia

A

metformin (bc it decreases the body’s production of glucose)

73
Q

irregular respirations of quick, shallow breaths of equal depth with irregular periods of apnea

A

Biot’s breathing - common w opioids

74
Q

periods of deep breathing alternating with periods of apnea; smooth transition between the two

A

Cheyne Stokes (seen with HF, resp depression and brain damage)

75
Q

deep, rapid, continuous respirations

A

Kussmauls (metabolic acidosis)

76
Q

tall male with autism, MVP, hyper extensible joints, long and narrow face, frominent forehead and chin, large ears, macroorchidism

77
Q

tall, thin male with gynecomastia, testicular atrophy, difficulty understanding language, might be obese later in life

A

Klinefelter’s syndrome

this is XXY so usually male with poor male sex characteristics

78
Q

short female with webbed neck, prominent ears, a broad chest with hypoplastic, widely spaced nipples. maybe isn’t developing or ovulating.

A

turner’s syndrome

79
Q

tall male with long extremities, joint hyper mobility, arachnodactyly, precuts carinatum, pes planus, striae, MVP, ectopia lentis

A

marfan syndrome

80
Q

male with skin hyper extensibility, joint hyper extensibility, easy bruising, berry aneurisms, smooth doughy skin, + Metenier’s sign

A

Ehlers danlos syndrome

81
Q

Auer rods

82
Q

tx for sickle cell pain crisis

A

hydroxyurea

83
Q

a petechial rash is hallmark for this kind of meningitis

what does it look like on gram stain

A

Neisseria meningitidis

gram negative diplococci

84
Q

what bacteria do you suspect if gram stain shows gram negative bacilli (pink staining, rod-shaped bacteria)

A

Staph aureus

85
Q

coombs positive

coombs negative

A

+ = autoimmune hemolytic anemia

  • = spherocytosis
86
Q

which vitamin deficiency is associated with ocular - oral - genital involvement

A

B2 (riboflavin)

87
Q

hyperkeratosis and hermorrhages is seen with which vitamin def

88
Q

diarrhea, dementia and dermatitis is seen with which vitamin def

A

B3/Niacin

“pellagra”

89
Q

ataxia, oculomotor palsies and confusion are which vitamin def

A

B1/Thiamine

“wernicke’s encephalopathy”

90
Q

looser zones are associated with what vitamin def

A

vitamin d (osteomalacia)

91
Q

describe the HCM murmur

does squatting, standing, valsalva, hand grip make it increase or decrease

A 
SYStolic crescendo-decrescendo
DECREASES with squatting
INCREASES while standing
*increases with valsalva
decreases with handgrip
92
Q

does Valsalva DECREASE or INCREASE the sound of all right/left sided murmurs

93
Q

for which two things does Valsalva actually increase the quality of the murmur

A

HCM

MVP (earlier click)

94
Q

the hallmark of this dz is a RBBB in V1 and V2, ST elevations in V1-V3 with sharp down sloping

A

Brugada syndrome

95
Q

what is the treatment for Brugada syndrome

A

implantation of a defibrillator to prevent sudden death

96
Q

this disease classically presents as ST elevations on EKG and/or t wave inversion with mild elevation of troponins; but coronary arteries show no evidence of MI.
Echo classically shows L Ventricle Apical Ballooning

A

Takotsubo cardiomyopathy

97
Q

MVP is the most common cause of mitral (regurg) or (stenosis)?

98
Q

again, which one radiates to the axilla - MITRAL (regurg) or (stenosis)

99
Q

for which kidney stones would you use

percutaneous nephrolithotomy

A

large stones >10mm
struvite stones
staghorn calculi

100
Q

for which kidney stones would you use shock wave lithotripsy

A 
large stones (>7mm) that you want to break into smaller ones
Can use with fluids, metoclopromide
101
Q

for which kidney stones would you use uretoscopy with stent

A

for immediate relief if the kidney is obstructed or at risk

102
Q

for which kidney stones would you obvserve

A

small, asx

103
Q

for which kidney stones would you use alkalinization of the urine to dissolve it

A

uric acid stones

104
Q

how do you treat a myasthenia crisis

A

plasmapheresis or IVIG

105
Q

with which CN is herpes zoster ophthalmic associated

106
Q

classic physical exam findings for pleural effusion (fremitus, breath sounds, percussion?)

A

decreased fremitus
decreased breath sounds
dull to percussion

107
Q

anterior or posterior shoulder dislocation: arm in abduction and external rotation, loss of deltoid prominence (“squared-off”)

A

anterior dislocation

MC

108
Q

anterior or posterior shoulder dislocation: arm in adduction with a humeral head provence posteriorly

A

posterior dislocation

severe trauma or seizure

109
Q

ototoxicity and nephrotoxicity are s/e of which TB drug

A

streptomycin

streptomycin is an amiNOglycoside, which treats gram NegOnly, and has s/e of Nephro/Oto-toxicity

110
Q

hepatitis and peripheral neuropathy are s/e of which TB drug

A

isoniazid (INH)

111
Q

optic neuritis is a s/e of which TB drug

A

ethambutol

E for Eye

112
Q

orange colored secretions are a s/e of which TB drug

113
Q

photosensitive dermatitis and hyperuricemia are s/e of which TB drug

A

pyrazinamine

114
Q

Myerson’s sign is seen in parkinson’s disease. what is it

A

a sustained blink when the bridge of the nose is tapped repetitively

115
Q

which optho emergency causes an irregularly shaped pupil, for which you WANT to place a rigid eye shield?

A

globe rupture

116
Q 
which of the following is not seen in a patient with SIADH
a. hyponatremia
b. urine sodium >20
c. decreased serum osmolarity
d isovolemia
e. decreased urine osmolarity

And explain why YEEEEE

A

E!!! You do NOT see a decrease in urine osmolarity.

Increased ADH –> water overload –> increased URINE osmolarity because water is reabsorbed into the body.
You get isovolemic (choice D) , hypotonic (choice C) hyponatremia (choice A)

and INCREASED urine sodium with INCREASED urine osmolarity

117
Q

what is the best drug to treat isolated hypertriglyceridemia

A

fibrates e.g. fenofibrate

118
Q

what is the best drug to lower LDL

A

statins e.g. simvastatin

119
Q

what drug can lower LDL but also increase trigs

A

cholestyramine

120
Q

what is ezetamibe normally used for (lowering LDL, increasing HDL, or lowering trigs)?

A

lowering LDL

121
Q

what is the best drug to increase HDL?

A

nicotinic acid

122
Q

what is the 2nd best LDL-lowering drug, next to statins?

A

nicotinic acid

ergo it DECreases LDL and INCreases HDL

123
Q

MC presentation of sickle cell in kiddos?

A

dactylitis

124
Q

what is the best treatment for kawasaki disease

A

aspirin and IVIG

IVIG decreases cardiac cx

125
Q

Barrett’s esophagus is the precursor to which kind of esophageal carcinoma

A

ADENOCARCINOMA

126
Q

Pt treated with Naf and Gent for endocarditis. Then he gets decreased urine output, increase BUN/Cr. Urinalysis shows epithelial cell casts, low sp gravity, FENA of 3%. What is the dx?

a. obstructive uropathy
b. acute interstitial nephritis
c. acute glomerularnephritis
d. acute tubular necrosis
e. prerenal azotemia

A

D!!! ATN

  • MC intrinsic kidney injury, assoc with ogliuria and increased BUN/Cr
  • also assoc with MUDDY BROWN casts along with epithelial
  • assoc with low sp gravity (dilute) and FENA >2
  • commonly caused by prolonged prerenal azotemia, DYE and AGs
127
Q

how can you tell obstructive uropathy from intrinsic kidney injury??

A

IT DOESN’T HAVE CASTS

128
Q

what kind of casts do you see with acute interstitial nephritis and how do you treat that

A

WBC casts

Treat with PCN

129
Q

what kind of casts do you see with acute glomerulonephritis?

A

RBC casts and dysmorphic RBC

130
Q

how can you tell prerenal azotemia from intrinsic kidney injury in that vignette?

A

FENA <1
HIGH specific gravity (concentrated)
(this is because the RAAS is activated)

131
Q

which of the following is a C/I of using MTX for an abortive drug?

  1. Patient’s vital signs are slightly elevated
  2. BHcg > 5000
  3. No fetal heart activity
  4. No free fluid in the retroperitoneum
  5. Gestational sac of 3cm
A

B!!

Here are MTX contraindications:
a. patient is hemodynamically unstable
b. BHcg > 5000
c. there is fetal heart activity
d. ruptured ectopic (= free fluid in the peritoneal cavity)
e. gestational sac > 4cm
also history of TB
132
Q

management of choice for kidney stones <5mm that are symptomatic?

A

IV fluids
toradol
metoclopromide
tamsulosin

133
Q

MOA of tamsulosin?

A

alpha blocker, relaxes bladder neck to promote urinary flow

134
Q

squaring of the vertebral bodies (“bamboo spine”) is assoc with???

A

ankylosing spondy

135
Q

wedge shaped vertebral bodies assoc with???

A

vertebral fracture

136
Q

continuous, machinery like murmur heard loudest at LUSB

137
Q

pinguecula vs pterygium

A

pinguecula: painless nodule on conjunctiva that doesn’t grow
pterygium: fleshy triangular mass that grows on the nasal side of the conjunctiva

138
Q

what is the MOA of zofran

A

serotonin antagonist

139
Q

what is the MOA of metoclopramide, promethazine

A

dopamin agonists

140
Q

what is the definition for acute stress disorder

A

PTSD symptoms occurring less than 1 month from the event

141
Q

1st line ppx treatment for cluster headaches?

142
Q

infectious diarrhea that gives you gray stools

A

vibrio cholera

143
Q

what drug has s/e of hemorrhagic cystitis and increased risk of bladder cancer

A

cyclophosphamide

144
Q

which GERD drug is assoc with cervial ripening and uterine contractions

A

misoprostol

145
Q

which GERD drug is assoc with gynecomastia and impotence

A

cimetidine

146
Q

which of the following is NOT classically associated with diabetes insipidus?

a. isovolemia
b. low urine sp gravity
c. increased thirst
d. decreased urine osmolarity
e. hyponatremia

A

E!!!! You will NOT have hyponatremia

DI patients can get HYPERnatremia unless they keep up with their increased thirst (C). They stay isovolemic (A). Because they drink so much, they have INCREASED urine production with a low specific gravity (dilute) (B) and decreased urine osmolarity (D).

147
Q

Classic presentation if your parathyroid glands are destroyed?

a. high Ca, high PTH, low Phos
b. low Ca, high PTH, high Phos
c. low Ca, low PTH, high Phos
d. low Ca, high PTH, low Phos
e. low Ca, low PTH, low Phos

A

C!

Hypocalcemia so LOW CA
PTH won’t be produced anymore if glands are destroyed on LOW PTH
Ca goes opposite of phosphate so HIGH PHOS

148
Q

what is a negative Prehns test

A

NO relief of testicular pain with elevation of the scrotum - suggestive of testicular torsion

149
Q

what is a negative cremasteric reflex

A

stroking the thigh does NOT cause the testicle to rise upward - suggestive of testicular torsion

150
Q

what diseases are associated with a + prehns test and a + cremasteric reflex

A

epidiymitis and orchitis

151
Q

which drugs exacerbate myathenia gravis (3)

A

beta blockers
FQs
AGs

152
Q

what will classically be seen in post streptococcus glomerulonephritis (s/p strep illness, develops coca cola colored urine)?

a. + C-ANCA antibodies
b. + anti-streptolysin titers
c. + P-ANCA antibodies
d. + anti-glomerular basement membrane antibodies
e. + IgA deposits in the mesangium

A

Anti-streptolysin titers

PANRE (13 decks)

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