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Third Year Shelf > Family Medicine > Flashcards

Family Medicine Flashcards

1
Q

Normal maximum heart rate

A

220-patients age

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2
Q

Key symptoms of MI/ angina(6)

A 
Chest heaviness
Pressure
Pain
Radiating to left arm, shoulder, jaw
SOB
Diaphoresis is a key symptom
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3
Q

Chest pain radiating to shoulder, neck or back, worse with deep breathing or cough

Relieved by sitting up and leaning forward

A

Pericarditis

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4
Q

Severe chest pain radiating to back, associated with unequal pulses or blood pressure in arms

A

Aortic dissection

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5
Q

Tachypnea

Tachycardia

A

Pulmonary embolism

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6
Q

Sharp localized chest pain with reproducible tenderness

Exacerbated by exercise

A

Costochondritis

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7
Q

Drugs to not take if taking stress test

A

Beta blockers

Digoxin

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8
Q

Pharmacologic stress test

A

Dobutamine

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9
Q

Stress test for CAD positive if patient develops (3)

A

ECG changes (ST elevation or depression)
Decrease blood pressure
Failure to exercise more than 2 minutes due to cardiac symptoms

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10
Q

Echocardiography

A

Ultrasound of heart

Picture of heart

Can evaluate function

Valvular defects
Strength of heart muscle (ejection fraction)
Wall motion abnormality

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11
Q

Left heart catheterization process

vs right heart catheterization

A

Wire is inserted through a vessel (radial or femoral) and threaded to coronary vessels

Right heart catheterization is through a vein

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12
Q

Tx Stable angina

A

Beta blocker (reduces myocardial oxygen demand)
Aspirin
Nitroglycerin

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13
Q 
Chest pain certain hour in the morning
Chronic
- what is it
- imaging
- tx
A

Prinzmetal’s angina
- coronary vasospasm

No stenosis or plaque in coronary vessels

ECG may show transient ST elevations

Tx: Calcium channel blockers
Nitrates to reduce vasospasm

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14
Q

Acute coronary syndromes

A

Unstable angina or actual MI

Imbalance of myocardial oxygen supply and demand

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15
Q

Serum markers for MI

A

1 hr-4 : myoglobin elevated (peak 6)

3 hrs-12 : Troponin T or I
- very sensitive and specific
- elevated for a week
(peak 18-24)

4-8 hr: creatinine phosphokinase
(peak 18-24)
-nonspecific 
- but CK MB is specific
- elevated 3-4 days
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16
Q

Patients with acute coronary syndrome should be given

A

MONA + beta blocker

Morphine
Oxygen
Nitate
Asprin (clopidogrel if allergy)

Morphine should be given last

Placed on cardiac monitor (at risk for arrhythmias)

Unfractioned heparin

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17
Q

Closed fist over chest sign

A

Levine’s sign

Sign of acute coronary syndrome

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18
Q

Thrombolytics

A 
Streptokinase
Urokinase
Anistreplase
Alteplase
Reteplase

Contraindications are risk of bleeding

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19
Q

ACS + ST elevation MI Tx

A

MONA + beta blocker

Thrombolytics and/or catheterization

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20
Q

TIMI score (7)

A

scoring system for aptients with NSTEMI to determine if cath necessary

> 65
>= 3 CAD risk factors
Prior coronary stenosis
ST changes of ECG
>= 2 anginal episodes in 24 hrs
Use of aspirin in prior week
Positive serum markers

TIMI >4 get invasive management

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21
Q

ECG changes in II, III, aVF

A

Inferior wall MI

Affects right ventricle

Major danger of dropping preload

Tx: maintain preload with aggressive fluids and avoid nitrates

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22
Q

ST elevations in V1, v2, V3

A

Anteroseptal MI

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23
Q

ST elevations in V5, V6, I, aVL

A

Lateral wall MI

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24
Q

Tall ST elevation in II, III, AVF, tall R with ST depression in V1, V2, and ST elevation in V4R

A

Posterior wall MI

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25
Q

Medications for discharge with ACS (5)

A 
Aspirin
Beta blocker
ACE inhibitor
Statin
Clopidogrel (if stent placed)
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26
Q

Patient with known history of CHF with a low EF. Most likely cause of death?

A

Arrhythmia

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27
Q

Death 4-5 days after MI

A 
Ruptures
- free wall
-intraventicular septum
- papillary muscles
(causes mitral regurg)
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28
Q

Death 48 hours after MI

A

Arrhythmias

  • ventricular tachycardia when myocardium reprofuses
  • bradycardia
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29
Q

Death 1-2 after MI

Fever, chest pain, generalized malaise

ECG shows diffuse ST-T changes

Tx

A

Dressler syndrome

Fever, pericarditis, pleural effusions

Tx: NSAIDS and steroids

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30
Q

Left heart failure vs Right

A

LHF
- pulmonary venous congestion

RHF
- systemic venous congestion

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31
Q

Right heart failure causes (5)

A 
CAD (MI that damaged the right ventricle)
2nd degree to LHF
Pulmonary HTN
Endocarditis damaging tricuspid valve
Ventricular septal defect
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32
Q

Left Heart failure causes (5)

A 
CAD (MI that has damaged the left ventricle)
Hypertension
Mitral and aortic valve disease
Endocarditis
Dilated cardiomyopathy
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33
Q

Left heart failure signs (7)

PE signs (4)

A 
SOB
Orthopneu
Paroxysmal nocturnal dyspnea (SOB when laying down)
Dyspnea on exertion
Cough
Diaphoresis
Nocturia

Rales
S3 gallop
Tachycardia
Peripheral edema

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34
Q

Right heart failure signs (4)

PE signs (8)

A

RUQ pain (due to hepatic congestion)
SOB
Abdominal swelling (ascites)
Weight gain

Hepatomegaly
Hepatojugular reflex
JVD
Ascites
Cirrhosis
Abnormal LFTs
Peripheral edema
Cyanosis
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35
Q

Young patient with sudden death

  • name
  • MOA
  • heart sound
A

Hypertrophic Cardiomyopathy (HCM)

Hypertrophy of the interventricular septum narrows the LV outflow tract

High velocity systolic flow draws the anterior leaflet of the mitral valve into the tract causing a dynamic LV outflow tract obstruction.

Sudden death due to arrhythmia

Paradoxical splitting of S2

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36
Q

Hypotension
Muffled heart sounds
JVD

Systolic bp drops by 10 mm hg with inspiration

Narrow pulse pressure

A

Pericardial tamponade

Beck’s triad

  • Hypotension
  • muffled heart sounds
  • jvd

Pulsus paradoxus: drop by 10

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37
Q

Pericardial tamponade ECG

A

Low voltage or electrical alternans

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38
Q

ECG low voltage, T wave flattening, inversion in V1 and V2, notched P waves

Tx

A

Constrictive pericarditis
- scarring from acute pericarditis

Pericardiectomy

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39
Q

Any disorder that causes dilation of the atria can cause

A

atrial fibrillation

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40
Q

Loud S2/ tapping apex

Opening snap followed by mid-diastolic rumbling murmur

A

Mitral stenosis

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41
Q

Holosystolic murmur best heard at the apex with radiation to the axilla

A

Mitral regurg

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42
Q

Systolic ejection murmur
Crescendo decrescendo
Radiating to the carotids

Low volume pulse

Decreases with valsalva

A

Aortic stenosis

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43
Q

Early diastolic decrescendo murmur best heard at left 3/4th intercostal space

A

Aortic regurg

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44
Q

Holosystolic murmur left sternal border

Increased by inspiration

A

Tricuspid regurg

Hepatomegaly

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45
Q

mid-Diastolic rumbling murmur left sternal border with an opening snap and wide, splitting S1

A

Tricuspid stenosis

Hepatomegaly
Icterus, edema

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46
Q

Midsystolic click
Apex
Wide split of S2

A

Mitral valve prolapse

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47
Q

Sodium channel blockers

A

Lidocaine

  • Suppresses ventricular dysrhythmias
  • SE: drowsiness, confusion, psychosis, seizure, av block, respiratory depression
Quinidine
- Suppresses ventricular dysrhythmiasa
- Suppresses Atrail presmature beats
- Suppresses A fib
SE: Cinchonishm, tinnitus, eharing loss, visual changes, delirium, torsades de pointes
Procainamide
-Suppresses ventricular dysrhythmiasa
- Suppresses A fib
- A flutter
- WPW
SE: Myocardial depression, prolonged QT, torsades de points, V-fib
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48
Q

Beta blockers

  • 4 examples
  • what they treat
  • SE of all beta blockerse
A

Class II

Propranolol

  • SVT
  • Thyrotoxicosis
  • Acute MI
  • HTN

Metoprolol

  • SVT
  • acute MI
  • HTN

Esmolol

  • SVT
  • thyrotoxicosis

Labetalol
- HTN

SE all beta blockers
- bronchoconstriction

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49
Q

Class III: prolongs action potentials

A

Amiodarone
- VT, VF, Afib, WPW
SE: bradycardia, av block, corneal deposits, skin discoloration, hepatotoxicity, iodine can cause hypo/hyperthyroidism

Bretylium
- ventricular dysrhythmias

Sotalol
- AV reentry, svt, WPW
SE: bradycardia, CHF, perpherial edema

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50
Q

Calcim channel blockers

A

Verapamil
Diltiazem
Amlodipine
Nifedipine

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51
Q

Adenosine

A

SVT

SE flusing hypotension

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52
Q

Digoxin

A

Rate control of Atrial tachydysrhythmia, increased inotrophy for CHf

TOxicity, vomiting, confusion visual changes,

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53
Q

Antihypertensive agents

A

Nitroprusside
- malignant htn

Minoxidil
- severe htn

Hydralazine

  • preeclampsia
  • direct vasodilator

Clonidine
- central acting agent

Phentolamine

  • parenteral alpha blocker
  • htn due to pheochromocytoma

Prazosin
- PO alpha blocker

ACE inhibitors

Angiotensin receptor blockers

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54
Q

Sulfonylureas

A

Glimepiride
GLycuride
Glipizide

Stimulates insulin secretion from the pancreas

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55
Q

Meglitinides

A

repaglinide
Nateglinide

Increase insulin production by the pancrease

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56
Q

Biguanides

A

Metformin

Decrease liver’s glucose production and slightly increase muscle glucose uptake

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57
Q

Thiazolidinediones

A

Troglitazone
Rosiglitazone
Pioglitazone

Decreases insulin resistance at the muscle and liver

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58
Q

Alpha glucosidase inhibitors

A

Acarbose
Miglitol

Slows the digestion of carbohydrates

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59
Q

DDP-4 inhibitor

A

Sitagliptin

Increases insulin production and decreases the liver’s production of glucose

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60
Q

GLP-1 analog

A

Exenatide

Enhances insulin secretion, decreases liver glucose output and may suppress appeitite

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61
Q

Pramlintide

A

Synthetic nalog of hte human homrone amylin that is cosecreted with insulin

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62
Q

Tylenol

A

Acetaminophen

Fever, aches

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63
Q

A firm nodule palpable over the carpometacarpal joint of the thumb

A

Trigger thumb
Stenosing flexor tenosynovitis

Tendon sheath thickens creating palpable nodule

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64
Q

Pain with palpation of the anatomic snuffbox

A

Scaphoid bone fractures

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65
Q

Chronic venous insufficiency presents with

A

pain, pruritus, discoloration and thickening of the skin and edema

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66
Q

Medication induced myopathy

A

Statin drugs

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67
Q

Fetal demise

Closed cervix

A

Missed abortion

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68
Q

Incomplete abortion

A

Incomplete evacuation of the products of conception from the uterus

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69
Q

Inevitable abortion

A

Cervix is dilated but no products of conception have yet evacuated

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70
Q

Pregnancy with vomiting and yeast infection

Dont give what?
Acetaminophen
Bismuth salicylate
Clotrimazole
Diphenhydramine
Loperamide
A

Dont give bismuth salicylate (aspirin)

Yeast infection prefered antifungal during pregnancy= clotrimazole

Antihistamine during pregnancy for pruritis= diphenhydramine

Safe opioid in pregnancy= Loperamide
Opioid receptor agonist works on mu receptor of large intestine. Decrease activity of bowel movements

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71
Q

NSAIDS

A

Ibuprofen

Naproxen

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72
Q

Danazol

A

Synthetic androgen that decreases the secretion of estradiol in hopes to suppress menstrual cycle

SE: hirsutism, acne, male pattern baldness

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73
Q

Leuprolide

A

Gonadotropin-releasing hormone analogue that suppresses the menstrual cycle by down-regulating LH and FSH secretion

SE: menopause symptoms

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74
Q

Repeat labs if consume what

A

alcohol

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75
Q

Tx Pelvic inflammatory disease (PID)

A

Cefriaxone and doxycycline

Ceftriaxone covers neisseria gonorrheae

Doxy covers chlamydia (or azithromycin)

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76
Q

Patient with cirrhossi

Painless rectal bleeding from what vein

A

Superior rectal vein

Superior rectal vein drains into the inferior mesenteric vein which is part of portal system

System is under HTN in chronic liver disease

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77
Q

Esophageal varices is due to what vein

A

Engorgement of left gastric vein

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78
Q

Caputmedusae due to what vein

A

Engorgement of the paraumbilical vein

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79
Q

Smoker who had trauma to breast. Breast now inflamed and tender. Pus coming out nipple

Tx

A

Periductal mastitis
- inflammatory condition of the breast that occurs in smokers

Smoking damages mamary ductal tissue causing inflammation of the subareolar ducts which can then become infected

Unilateral breast tenderness

Amoxicillin-clavulanate
Clindamycin if penicillin allergy

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80
Q

Anti-tissue transglutaminase

A

Celiac

Allergy to gliadin

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81
Q

Infant with sickle cell needs what vaccine

A

Reduction of the spleens ability to filter bacteria from the blood

At risk for bacterial infections with encapsulated organisms

  • Streptococcus pneuoniae
  • Haemophilus influenzae
  • Neisseria meningitidis

Pneumococcal polysaccharride vaccine

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82
Q

Prophylaxis tx of animal bite

A

Amoxicillin-clavulanate

Tx pasteurella

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83
Q

First line tx for suspected staph infections like cellulitis

A

Dicloxacillin (beta-lactamase resistant penicillin)

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84
Q

Recurrent pruritic vesicular rash on fingers palms and/or soles

A

Dyshidrotic eczema

Triggered by allergic response (metals)

Rash persists during times of vacation or when offending agent removed

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85
Q

Yellow thickened nails in asymmetric distribution.

A

Dermatophytoses

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86
Q

Herpes simplex on fingers

A

Pruritc fluid filled vesicles on fingers after periods of stress

Lesions will have erythematous bae and progress to pustular and ulcerative lesions

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87
Q

Hyperkeratotic plaques, pruritic papules and scales

Linear burrows

A

Scabies

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88
Q

Newborn rash not on palms or soles

A

Erythema toxicum neonatorum (ETN)

Self limiting

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89
Q

Acne neonatorum

A

Rash forehead, nose and cheeks.

White heads

Resolves in 4 months

Due to androgen stimulation

If persists suspect excessive androgen production

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90
Q

Generalized rash on infant that involves trunk and extemities

Diffuse mottling

Improves when warmed

A

Cutis marmorata

Due to infants vascular response to cold temps

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91
Q

white/yellow papules on forehead, cheeks and nose.

Sampling shows keratin within dermis

A

Milia

resolves within 1 month w/o tx

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92
Q

First line medication for prevention and tx of osteoporosis

A

T score below -2.5

Bisphosphonates

  • alendronate
  • risedronate
  • zoledronate
  • ibandronate

MOA: bind to hydroxyapatite to decrease bone resorption and inhibit osteoclast from breaking down bone

SE: erosive esophagitis

Denosumab
- monoclonal ab

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93
Q

Calcitonin

A

Inhibits osteoclasts and decreases bone resorption

Only indicated for tx osteoporosis not prevention

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94
Q

Estrogen in osteoporosis

A

Prevention only

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95
Q

Raloxifene

A

Prevention and tx osteoporosis

Selective estrogen receptor modulator (SERM) and inhibits bone resorption

Does not increase risk of endometrial or breast cancer

Risk of DVt and PE

Bisphosphonates are first line

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96
Q

Teriparatide

A

Parathyroid hormone analogue and anabolic agent indicated in tx of osteoporosis and reduces both vertebral and nonvertebral fractures in postmenopausal women

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97
Q

Elderly man take sildenafil and passes out what happened

A

Phosphodiesterase type 5 inhibitors

  • sildenafil
  • tadalafil
  • vardenafil

Enhance nitric oxide within the body leading to increased vasodilation and penile erection

Contraindicated in patient who are taking a nitrate medication (nitroglycerin, isosorbide mononitrate, isosorbide dinitrate) due to potentiation of nitric oxide, causing dangerous hypotension and syncope

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98
Q

Alpha receptor antagonists

A

terazosin
Tamsulosin
Doxazosin

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99
Q

Dont give beta blocker to

A

Metoprolol
Labetalol
Carvedilol

Bradycardia
Heart block
Hemodynamic instability

decompensated CHF (decreased ejection fraction leading to bilateral lower extremity edema and pulmonary effusion)

are not hemodynamically stable

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100
Q

CYP450 inhibitors

A

Erythromycin
Cimetidine
Ketoconazole
Itraconazole

Inhibition of P450 results in increase in PDE-5 inhibitor levels within serum –> increased nitric oxide and vasodilation

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101
Q

Women with preeclampsia and in labor give what

A

IV magnesium sulfate

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102
Q

Lung maturity glucocorticoids

A

Dexamethasone

Betamethasone

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103
Q

Magnesium sulfate

Toxicity

A

Seizure prophylaxis and tocolytic in pregnancy

Check for toxicity by assessing for hyporeflexia of deep tendon reflexes, pulmonary edema, decreased urine output, cardiopulmonary arrest

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104
Q

Gemfibrozil prevents

A

[Fibrates]

Pancreatitis

Hypertriglyceridemia is associated with increased risk of developing pancreatitis

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105
Q

Dilated bronchi with adjacent companion arteries the are smaller in size with large cystic spaces and honey combing

  • patient profile
  • sign
  • disease process
  • imaging
A

Bronchiectasis

Months to years of a daily cough and mucopurulent sputum, normal spirometry, unresponsive to antibiotics

Signet ring sign

Transmural inflammation and scarring , processses damage the surrounding lung parenchyma by destroying the muscular and elastic components of the bronchial walls.

HRCT imaging

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106
Q

Right Calf pain when walking, decrease in calf muscle size, lack of hair, thickened toe nails, left ankle/foot have stronger pulses

-Test

A

Peripheral arterial occlusive disease (PAOD)

Lack of palpable pulses, thinning or lack of hair, increase toe nails all signs of decreased arterial blood flow.

1st: Ankle-brachial index (ABI) (less than 0.9)
Diagnosis: Angiography

Smoking makes worse

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107
Q

Firm or tense musculature, no atrophy, normal pulses, normal ABI. Pain with exertion relieved by rest. Trauma

  • test
A

Compartment syndrome

Needle compartment pressure readings

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108
Q

Asain infant with large blue spots since birth

A

Congenital dermal malanosis

“Mongolian blue spots”

Darker skinned ethnic groups

Asymptomatic hyperpigmented macules and patches on back and buttocks

Benign disappear by age 2

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109
Q

Think iron-deficiency anemia check what lab

A

Serum ferritin

Second check iron levels

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110
Q

Patient with low hemoglobin but high MCV check what

A

macrocytic anemia

check peripheral blood smear

if shows megaloblastic features (hypersegmented neutrophils) , then take reticulocyte count. If less than 2% check B12 and folate

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111
Q

Austin Flint murmur

  • is what
  • heard
  • symptoms(5)
A

Aortic regurgitation

Diastolic rumbling murmur (doesnt have opening snap like mitral stenosis)

Palpitations are uncomfortable in AR due to the widened pulse pressure.

Head bobbing
Nail bed pulsations
Uvula pulsations
“water hammer’ pulse- rapid distention and collapse upon palpation of the pulse

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112
Q

Harsh crescendo-decrescendo, mid-systolic ejection murmur with a palpable thrill

A

Pulmonary stenosis

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113
Q

Early diastolic high pitched blowing, decrescendo murmur heard at left second intercostal space

A

Pulmonary regurgitation

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114
Q

Tumor marker elevated in patients with colorectal cancer

A

Carcinoembryonic antigen (CEA)

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115
Q

AFP elevated in what cancers

A

Liver cancer
Germ cell cancers
- teratomas

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116
Q

CA15-3

A

transmembrane glycoprotein known as MUC1 expressed by MUC1 gene

Tumor marker that is overexpressed in malignant breast glandular cells in patients with breast cancer

Used to trended treatment or for recurrence

Not diagnostic

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117
Q

CA19-9

A

Tumor marker for multiple cancers involving GI tract (pancreatic, gall bladder/ biliary duct, and gastric cancers)

Also elevated in endometrial cancer

Trending for tx

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118
Q

CA-125

A

elevated in ovarian cancer

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119
Q

Kidney stone formation in patient with Crohn’s due to what

A

malabsorption of fatty acids and bile salts.

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120
Q

Decreased urinary citrate excretion as cause for kidney stones is see with

A

Chronic diarrhea and metabolic acidosis

Which leads to low urinary pH

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121
Q

Screening at 28 weeks pregnancy

A

gestational diabetes

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122
Q

Screen for group B streptococcal infection at what week

A

36 weeks

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123
Q

Most common bladder cancer

A

Transitional cell carcinoma

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124
Q

Uterine cancer is probably what type

A

Leiomyosarcoma

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125
Q

Squamous cell carcinoma in the bladder due to

A

Schistosoma haematobium

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126
Q

Serum testing shows elevated serum alpha-fetoprotein levels, most likely cause

A

Inaccurate gestational age

If age is accurate consider neural tube defects

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127
Q

Abdominal pain improved with defecation. No blood or pus. Weight loss. Diffuse abdominal tenderness, discrete mass in RLQ

Erythrocyte sedimetantion rate and C reactive protein are elevated

Narrowed thickened ileum, string sign

  • Another sign
A

Crohn’s disease

Normocytic with iron deficiency and elevated ferritin.

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128
Q

IBS imaging

A

Nothign seen on pathology or radiologic findings

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129
Q

Lead pipe
Bloody diarrhea
Mucous discharge from rectum
Distal rectum

A

Ulcerative colitis

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130
Q

Infant excessive diaphoresis, poor feeding, and failure to thrive.

Holosystolic murmur at lower left sternal border

A

Ventricular septal defect

left to right shunt

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131
Q

Wide fixed split S2 and a systolic ejection murmur at the left upper sternal border

A

Atrial septal defect

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132
Q

Wide pulse pressure
Continuous machinery murmur (present both systole and diastole) at he upper left sternal border

Bounding peripheral pulses

A

Patent ductus arteriosus

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133
Q

Menstrual migraines tx

A

NSAID first line

Sumatriptan taken at he onset of symptoms

Frovatriptan is prophylactic but don’t use if trying to get pregnant

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134
Q

75 y.o with painful skin rash on abdomen. Petechiae with scattered hemorrhagic bullae and black eschar

Aspirin
Atorvastatin
glargine
lisinopril
metoprolol
warfarin
A

Warfarin skin necrosis

  • paresthesias
  • sensation of pressure
  • extreme pain

Edematous, erythematous flush with developing petechiae that progress to hemorrhagic bullae with necrotic eschar

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135
Q

Adverse effect aspirin

A

Samter’s triad of asthma
aspirin intolerance
nasal polyps

Aspirin intoxication
- respiratory alkalosis from increased respiratory drive before culminating in an anion gap metabolic acidosis from salicylate toxicity

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136
Q

Atorvastatin

  • MOA
  • AE
A

competitive inhibitor of HMG-CoA reductase

Lower total cholesterol with predominant effect on decreasing low-density lipoprotein

AE: diarrhea and myopathy

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137
Q

Glargine

  • what is it
  • MOA
  • AE
A

Long-acting insulin analogue

Stimulate peripheral glucose uptake by skeletal muscle and fat

Inhibiting hepatic gluconeogenesis, lipolysis and proteolysis and enhancing protein synthesis

AE: hypoglycemia, hypokalemia, local allergic rxn at injection site

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138
Q

Lisinopril

  • what is it
  • MOA
  • AE
A

ACE inhibitor

Coronary artery disease to lower afterload resistance
DM to protect glomerulus from hyperfiltration injury by preventing constriction of the efferent arteriole

AE: Cough

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139
Q

Metoprolol

  • what is it
  • fxn
  • AE
A

selective beta-1 antagonist

control heart rate in sinus tachycardia and atrial fibrillation

AE: dizziness, headache, bradycardia and wheezing

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140
Q

Beta 1 selective antagonists vs beta blockers

A

A-M beta 1 selective

  • atenolol
  • Esmolol

N-Z non selective antagonists

  • nadolol
  • timolol

outliers (carvedilol, labetalol) non selective

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141
Q

Pemphigoid gestationis

A

pregnancy associated autoimmune disease

Vesiclse and bullae

C3 deposit on basement membrane

SImilar to bullour pemphigoid and differentiated by “salt split techinique”

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142
Q

Impetigo herpetiformis

A

type of pustular psoriasis that presents during the second half of pregnancy

Group pustules and erythematous patches and plaques with overlying scale.

Hyperpigmentation common

Inguinal and axillary areas, also well as flexural surface arms and legs.

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143
Q

Pruritic urticarial papules and plaques of pregnancy (PUPPS)

A

similarly to pemphigoid gestationis but lesions will not progress to tense bullae

Third trimester

Abdomen

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144
Q

Absence seizures medication

AE

A

Ethosuximide

Dizziness is more common side effect does not require monitoring

Serious adverse effect is pancytopenia
Check CBC

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145
Q

Group A streptococcus (GAS) pharyngitis tx

A

Penicillin V

(if cant take oral penicillin G which is IM)

[anaphylactic Penicillin allergy then azithromycin]

[nonanaphylactic penicillin allergy then cephalosporin]

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146
Q

Amoxicillin-clavulanate tx for

A

Respiratory tract infections

Animal/human bites

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147
Q

75 y.o nipple discharge past week. “creamy” discharge left breast. sometimes bloody. Mammogram last year normal, no lump.

Inverted nipple, normal areola, no erythema, LN normal sized

Ductoscopy reveals dialted ducts filled with secretions and fibrotic debris

Tx

A

Duct ectasia

Benign breast condition of increasing age

[ductal Carcinoma involves areola]

Tx complete duct excision

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148
Q

Nipple inversion

A

Carcinoma

Duct ectasia

Periductal mastitis

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149
Q

Straw colored or clear discharge from breast

A

Intraductal papilloma

Benign neoplasm in lumen of breast

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150
Q

Trauma or biopsy of breast. pain and small breast masses

Debris-filled dilated duct

A

Mondor’s disease

Superficial thrombophlebitis of the breast develops when blood clots form in the superficial veins of the breast

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151
Q

Inflammation in the subarolar ducts, no dilation. Younger woman or men.

Associated with

Tx

A

Periductal mastitis

SMoking

Tx: broad-spectrum antibiotics or drainage since frequently leads to infection

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152
Q

STD with reactive arthritis

A

Chlamydia trachomatis

Reiters syndrome

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153
Q

keratoderma blennorrhagicum

A

hyperkeratotic lesions of palms of hands or soles of feet

Reactive arthritis

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154
Q

circinate balanitis

A

painless erythematous lesion of glans penis

Chylamydia

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155
Q

Hypotension
JVD
muffled heart sounds

A

Pericardial tamponade

caused by myocardial rupture

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156
Q

Pleural effusion caused by

A

Increased pulmonary capillary pressure, decreased capillary oncotic pressure, or increased membrane permeability

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157
Q

SOB, anxiety and cough with pink frothy sputum

A

Pulmonary edema

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158
Q

HIV positive individual give was vaccine

A

13 and 23 valent pneumococcal vaccine

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159
Q

Give H. influenzae vaccine to who

A

asplenia

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160
Q

Normal weight gain in pregnancy

A

25-35 lbs

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161
Q

Pregnancy BMI over 30 weight gain

A

11-20 lbs

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162
Q

Pregnancy BMI under 18.5 weight gain

A

35-45 lbs

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163
Q

Meningococcal vaccine to

A

11-18 years old

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164
Q

Leg swelling and fatigue. Has diabetes. Normal breathing sounds. Distended abdomen with positive lfuid wave. 3+ pitting edema. UA found urine protein/ creatinine ratio of 3.4

What do they have?
Complication?

A

Nephrotic syndrome
- proteinuria leading to hypoalbuminemia and diffuse edema

DM common cause

Complication is venous thrombosis

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165
Q

Most common diagnosis in obese child with hip pain

A

Slipped capital femoral epiphysis (SCFE)

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166
Q

Urine bright red and has clots indicated

A

Extraglomerular source of bleeding within the urinary tract

non-glomerular cause

  • nephrolithiasis
  • tumor
  • cystic kidney disease

UA first step
Then ultrasound

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167
Q

ASO

A

obtained when suspicion of post-streptococcus glomerulonephritis.

History sore throat or skin infection preceding hematuria

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168
Q

Hematuria cola colored or HTN then get

A

Complement C3 level

Red blood cell casts or greater than 2+ protein on UA

C3 levels low in post-infectious glomerulonephritis, lupus nephritis or membranoproliferativev glomerulonephritis

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169
Q

Order in child with 2 or more febrile UTI infections

A

voiding cystourethrogram (VUR)

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170
Q

11 y.o vaccine

A

TDaP
Meningococcal
HPV

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171
Q

Fluoride supplemented water at what age for infant

A

6 months

primary source needs 0.6 parts ppm

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172
Q

Imaging to get with chest congestion and cough

A

plain chest radiograph

rule out pneumonia, cardiomegaly, pleural effusions, aortic dissection

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173
Q

Clumsiness (wide based ataxia), incomprehensible speech (explosive dysarthria), bilateral babinski sign, and bilateral loss of deep tendon reflexes

  • cardiac abnormality
A

Friedreich ataxia

Hypertrophic obstructive cardiomyopathy

Neurodengenerative disorder of axons within cerebellum and dorsal colums

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174
Q

Japanese male, ataxia, loss of vibratory sense, hyperreflexia. Hyperpigmentation, behavior changes, decreased school performance, spasticity and paralysis

A

Adrenoleukodystrophy

X linked recessive peroxisomal disorder

ABCD1 gene
Very long chain fatty acids into peroxisome

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175
Q

Metachromatic leukodystrophy

A

autosomal recessive

Deficiency of arylsulfatase A leads to accumulation of cerebroside sulfate.

2 years of age

Loss of previous achieved milestones, tremors, truncal ataxia, hyperreflexia, hypotonia, nystagmus, and optic atrophy

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176
Q

Coarse face, large tongue, electrical cardiac abnormalities, cherry red macular spot. 3-5 months olds. muscle weakness.

A

Tay-Sachs disease

- no hepatosplenomegaly

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177
Q

Osteoarthritis medication

A

Patients with CHF should not get NSAIDs

Give Duloxetine

[Acetiaminophen used to be first line but studies show no efficacious]

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178
Q

Diagnostic choice for hypertrophic obstructive cardiomyopathy

A

Echocardiogram

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179
Q

tx hypertrophic obstructive cardiomyopathy

A

beta blocker

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180
Q

Anemia of chronic disease lab values

  • MCV
  • iron
  • ferritin
  • total iron binding capacity
A

Low MCV
Low iron
High Ferritin
Low total iron binding capacity

Anemia of chronic disease (rheumatoid arthrits) iron is packed in the cells in excess so ferritin is high, serum iron low and TIBC low

Different from iron deficiency anemia

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181
Q

Low MCV
Normal iron
Normal ferritin
normal TIBC

A

Thalassemia

inadequate production of chains of hemoglobin

Microcytic anemia

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182
Q

Non-productive cough, wheezing, dyspnea. Flattening of the inspiratory loop and normal FVC and FEV1/FVC

A

Vocal cord dysfunction

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183
Q

COPD values

A

Decrease FEV1/FVC ratio

Normal inspiratory flow loop

Irreversible with bronchodilator

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184
Q

Asthma values

A

Decrease FEV1/FVC ratio

Normal inspiratory flow loop

reversible with bronchodilator

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185
Q

Restrictive lung disease values

A

Reduced FVC

Normal FEV/FVC

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186
Q

Productive cough and SOB for 4 months. Started with fever and congestion.

Decrease pulmonary fxn testing

A

Chronic bronchitis
- obstructive airway disease

Typically cyanotic

PFT <70%

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187
Q

Emphysema

A

Breathe rapidly

Xray: bullae, flattened diaphragm, hyperinflated lung fields

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188
Q

Bronchiectasis

A

Chronic cough with sputum production

Purulent, foul smelling sputum for several years to months

Dilated and thickened airways, mucus plugs

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189
Q

Bronchiolitis obliterans

A

Rare cause of cough in adults

Small airway obstruction caused by fibrosis or inflammation

Present with non-productive cough and dyspnea with wheezing

CT: expiratory air trapping within bronchioles, bronchial wall thickening, ground glass opacities

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190
Q

Pregnant mother with upper respiratory tract infection then baby has hear loss what virus

A

CMV

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191
Q

Tx CMV

A

ganciclovir

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192
Q

CMV microscopy

A

Owl’s eye

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193
Q

Signs of rubella in infant

A

Cataracts
Hearing loss
Cardiac malformations

Maculopapular rash

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194
Q

Enlarged thick and pale placenta

Hepatomegaly
Persistent maculopapular rash
Failure to move limb (pseudoparalysis due to pain)

A

Congenital syphilis

- sensiorneural hearing loss, interstitial keratitis, hutchinson teeth

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195
Q

2 y.o child should be able to

A

Run
Kick a ball
Undress
Two word sentences

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196
Q

Stacking ability for years

A

1 year = 3 cubes

2 year= 6 cubes

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197
Q

3 y.o should be able to

A

draw circl (pi=3.14)
ride tricycle
three word sentences

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198
Q

4 y.o should be able to

A

Draw cross or rectangle
Hop on one foot
Recognize colors/ numbers
Cooperative play

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199
Q

5 y.o should be able to

A 
Draw a square
Skip
Catch a ball
Print own name
Tie shoelaces
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200
Q

Tumor of jaw

A

Burkitt lymphoma

  • starry sky
  • EBV related
  • non-hodgkin lymphoma
  • t(8;14)
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201
Q

t(11;14)

A

mantle cell lymphoma

Elderly

Palpable lymphadenopathy

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202
Q

t(14;18)

A

Follicular lymphoma

Germinal centers

BCL-2 over epxression

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203
Q

Large cells with vesicular chromatin and prominent nucleoli

A

Diffuse Large B cell lymphoma (DLBCL)

NHL

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204
Q

Reed-Sternberg cells

A

Binucleated “owl eyed” giant cells in hodgkin lymphoma

Prominent mediastinum

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205
Q

Patient with asthma and recurrent exacerbations of fever, cough, and dyspnea

Brown mucus plugs

Has what?
Test

A

Allergic bronchopulmonary aspergillous

Also experience central bronchiectasis

Diagnostic: total serum IgE test (elevated) and allergy skin prick test for IgE antibody to Aspergillus

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206
Q

Who to screen for AAA

A

65-75 who ever smoked

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207
Q

Dont give aspirin to those with history of

A

ulcers

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208
Q

3 y.o with swelling all over body. Denies abodminal pain, hematuria or dysuria. Periorbital edema, abdominal distension with a fluid wave, 3+ pittign edema. 3+ proteinuria.

A

Minimal change disease

  • proteinuria
  • hypoalbumenia
  • edema
  • hyperlipidemia

Younger than 10

Proteinuria > 3.5 grams

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209
Q

Nephropathy associated iwth Hep B/ C infection

A

Membranous nephropathy

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210
Q

POst-infectious glomerulonephritis characterized by

A

hematuria
edema
HTN

decreased C3 complement elvels

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211
Q

non-bloody, non-purulent chronic diarrhea
Diffuse abdominal pain relieved by defecation
Painful finger joints

  • what is it
  • labs
  • diagnostic
A

Crohns disease

Elevated ESR and CRP
Anemia of chronic infxn (normocytic w/ iron def and elevated ferritin)

Diagnostic: colonoscopy with ileoscopy and biopsy

SKip lesions
Cobblestoning
Noncaseating granulomas

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212
Q

Anti-cyclic citrullinated peptide (antiCCP)

A

Rheumatoid arthritis

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213
Q

Pain between the toes in the interdigital space, numbness and paresthesias radiating to the toes proximal to the pain

Exacerbated by tight shoe wear

A

Morton’s neuroma

Mulder’s sign: palpable painful click along with reproducible symptoms

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214
Q

Sesamoid fracture

A

First toe pain

Due to overuse (runners)

Swelling and tenderness along the medial aspect on the plantar surface of the first metatarsophalangeal joint

Pain worse with dorsiflexion

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215
Q

Granuloma annulare

A

benign skin lesion that is asymptomatic and presents iwth 1-2 mm flesh colored and/or erythematous papules that coalesce to form 5 cm annular appearing plaque.

Ankles, feet, hands, fingers and extensors of arms and legs

Center of lesion can be hyperpigmented and scaling absent

“Looks like like ring worm”

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216
Q

Violacous, shiny, polygonal papules of varying sizes on flexural surfaces of limbs.

Fine white reticular scales on papules

A

Lichen planus

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217
Q

Mammogram screening

A

50-74 every 2 years

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218
Q

Colorectal cancer screening

A

50-75

One of the options:

Fecal occult blood testing annually

Sigmoidoscopy every 5 years

Colonoscopy every 10 years

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219
Q

Screening for 75 y.o female

A

Alcohol misuse and counseling

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220
Q

Hold up infant hand

A

4 months

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221
Q

Sit or crawl at age

A

6 months

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222
Q

Pertussis diagnosis

tx

A

PCR

Macrolides (azithromycin)

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223
Q

Rheumatoid arthritis joints

A

PIP, MCP

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224
Q

Recurrent Hematuria after upper respiratory infection. Negative for strep

A

IgA nephropathy

Occurs are upper respiratory infection o ATHLETIC EXERTION

Mild flank pain
Low grade fever

Associated with cirrhosis, celiac disease, and HIV

Renal biopsy with immunofluorescence reveal the presence of IgA deposit

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225
Q

Acute onset renal failure with UA revealing nephritic sediment (red blood cell casts, dysmorphic red blood cells, white blood cells), mild to moderate proteinuria

Also have SOB, cough and hemoptysis

A

Good pasture syndrome

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226
Q

Palpable purpura on skin, abdominal pain, arthralgias, and renal insufficiency with hematuria. No proteinuria

Biopsy: granulocytes within the walls of the small arterioles and venules

A

Henoch-Schonlein purpura

IgA vasculitis

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227
Q

63 y.o alcoholic with nausea, vomiting and diffuse abdominal pain. Has had symptoms before. Metabolic acidosis, elevated serum beta-hydroxybutyrate and urine ketones. Glucose normal adminster what

A

Thiamine and dextrose

Alcoholic ketoacidosis
Possible Wernicke encephalopathy

Acidosis will resolved self after thiamine, dextrose and saline

Thiamine needed to bring pyruvate to TCA cycle (thiamine deficient leads to shift in pyruvate towards production of lactic acid instead of into TCA cycle)

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228
Q

Pregnant female with pre-existing hypothyroidism

A

increase by 30%

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229
Q

Urease breath test

A

H. pylori

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230
Q

Antiparietal ab

A

autoimmune gastritis

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231
Q

IgA nephropathy

A

painless gross hematuria that occurs simultaneously with infection

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232
Q 
Sore throat 2 weeks ago
Hematuria
Red blood cell casts
Proteinuria
Low complement C3 level
A

Post-infectious glomerulonephritis

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233
Q

young patient with low back pain gradual progression. Space narrowing and sclerosis around sacroiliac joint

Also develop
Labs

A

Ankylosing spondylitis

Calcaneal tendon enthesitis

Plantar fasciitis

ESR and CRP elevated
HLA-B21 genotype

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234
Q

Complication of Crohns disease

A

B12 deficiency

Macrocytic anemia with a decrease in serum cobalamin (vit B12)

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235
Q

Vaccination during pregnancy

A

Tdap 27-36 weeks

[Dont give]

  • MMR
  • Zoster
  • Varicella
  • live flu
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236
Q

Lytic lesions and cortical thickening of fibula and tibia

A

Pagets disease

Elevated alkaline phosphatase

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237
Q

Tx acute exacerbation of asthma

A

Oxygen
Inhaled beta 2 agonist
Oral corticosteriods

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238
Q

Intermittent asthma

A

Symptoms less than or equal 2 days per week

Nighttime awakenings less than 2 x per month

Beta agonist 2 x per week

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239
Q

Mild persistent asthma

A

symptoms greater than 2 days per week

Nighttime awakening 3-4x per month

inhaler > 2 x per week

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240
Q

Moderate persistent asthma

A

Daily symptoms

Nighttime awakenings > 1 per week

Daily use of inhaler

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241
Q

Severe persistent asthma

A

Symptoms throughout day

Nightly awakenings

Inhaler several times per day

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242
Q

Diarrhea
Dementia
Dermatitis

A

Niacin deficiency

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243
Q

CHARGE syndrome

A

CHD7 mutations

Coloboma (defects in iris)
Heart anomalies
Choanal atresia (NG tube cant pass through nasal passage)
Restricted growth
Genital hypoplasia
Ear anomalis (small low set) and deafness

Polyhydramnios

Difficulties feeding

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244
Q

Pregnant uncontrolled DM complication in infant

A

horseshoe kidney

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245
Q

Patient with hyperthyroid, improve symptoms most rapidly?

A

Propranolol

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246
Q

Female
Easy bruising
Heavy bleeding
Elevated thromboplastin time

A

Von Willebrand disease (vWD)

AD

Deficiency of factor VIII- related antigen

Defect in clot formation and coagulation cascade

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247
Q

Isolated defect in clot formation

A

Thrombocytopenia

Increased bleeding time
low platelet levels

PT PTT normal

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248
Q

Isolated defect in coagulation cascade

A

Hemophilia A / B

A: deficiency of factor VIII

B: def factor IX

Prolonged PTT
Bleeding time and PT normal

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249
Q

Hypercalcemia medication

A

Thiazide diruetics
(Hydrochlorothiazide)

Lithium

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250
Q

Loop diuretics and calcium

A

Dump calcium

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251
Q

Elevated calcium
Elevated PTH

Tx

A

Primary hyperparathyroidism

Surgicial removal of one or more parathyroid glands

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252
Q

Fenofibrate AE

A

Hepatotoxicity

Can enhance myalgias when combined with statin

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253
Q

Hyperpigmented, thickened, scaly, edematous skin lesion

A

Lichen simplex chronicus

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254
Q

Christmas tree rash

salmon colored on trunk w/ central clearing

A

Pityriasis rosea

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255
Q

Sore throat with enlarged tonsils bacteria

A

Streptococcus pyogenes

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256
Q

Biopsy technique for raised, superficial non-pigmented lesion

A

Shave biopsy

For nonmelanoma skin cancer

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257
Q

Curettage and electrodessication used when

A

Treatment not diagnostic method in low risk patients younger than 60 with known diagnosis of a primary babsal cell carcinoma located in an area that is without hair and doesnt require depth of removal

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258
Q

Excisional biopsy use when

A

Including Mohs surgery

First line tx for SCC and basal cell carcinoma

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259
Q

Ingestion of clostridial spores

A

causes botulism syndrome in infants under the age of 8 months

Honey to babies

Adults and older children not effected

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260
Q

Riluzole

A

medication for ALS

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261
Q

Dantrolene

A

muscle relaxer

Used in ALS to relieve spasticity

Can cause weakness, dizziness and sedation

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262
Q

Tx Temporal arteritis

A

First line prednisone

IV methylprednisolone (if visual disturbances)

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263
Q

Dihydroergotamine

A

ergot alkaloid medication used for abortive tx inpatients presenting to ER with a severe migraine not resonding to other migraine medication

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264
Q

Patients with diabetes should get what screen

A

urinary spot microalbumin/creatinine ratio

if >30 ug/mg then should be started on ACE (-pril) or angiotensin receptor blocker (-sartan) to prevent hyperfiltration injury

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265
Q

Rapidly gowing, solitary, friable, bright red, papule that bleeds from little trauma

Trauma precedes lesion

A

Pyogenic granuloma

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266
Q

Painful, small blue-red, blanchable, vascular papules or nodules in deep dermis on distal extremities (palm, wrist, forearm, foot, under nails)

A

Glomus tumors

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267
Q

Verruca vulgaris

A

non-genital warts caused by HPV

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268
Q

Thyroid nodule
Low TSH

Test to get

A

technetium-99m or radioactive iodine

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269
Q

3 y.o with bruising. Sick a month ago. Low platelet count. Normal hemoglobin. Normal blood times

A

Immune thrombocytopenia

Ab to platelet membrane antigens results in increased platelet clearance by spleen and thrombocytopenia

2-5 y.o following viral infection or young women 20-40s

Resolves 3-6 months

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270
Q 
Mucocutaneous bleeding
Fever
Fatigue
Weight loss
Bone pian
Lymphadenopathy
Hepatosplenomegaly

Anemia
reduced or elevated white count, anemia

A

Acute lymphocytic leukemia

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271
Q

Thrombocytopenia
Hemolytic anemia
Acute kidney injury

Child < 5 with prodromal episode of abdominal pain and bloody diarrhea followed by pallor, fatigue, easy bruising and hematuria

A

Hemolytic uremic syndrome

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272
Q 
Thrombocytopenia
Hemolytic anemia
Renal disease
Fever
Neurologic changes
A

Thrombotic thrombocytopenic purpura

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273
Q

Xray rules for angkel

A

Unable to bear weight for 4 steps

Tenderness along distal 6 cm of the tibia or fibula

Tenderness over the posterior medial or lateral malleolus

Tenderness at he base of the 5th metatarsal

Tenderness of navicular bone

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274
Q

Streptococcal infection diagnosis

A

positive rapid antigen detection test for group A streptococcus

Positive throat culture

Elevated anti-streptolysin O (ASO) Ab titer

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275
Q

Clostridium difficile tx

A

vancomycin

not metronidazole any more

276
Q

Tx traveler diarrhea

A

Ciprofloxacin

277
Q

Tx shigella

fever bloody diarrhea

A

Azithromycin (marcolide)

278
Q

Tx recurrent C. difficile

A

Rifaximin

279
Q

reactive non stress test

A

presence of 2 accelerations within 20 minutes with or without fetal movement

acceleration= increase by 15 bpm for a duration of 15-120 seconds

280
Q

Diagnose DM

A

1) Fasting blood glucose of greater than or equal to 126 on two separate occasions
2) A1C >= 6.5 on two separate occasions
3) 2 hr post oral glucose tolerance test >= 200
4) Random glucose >= 200 with DM symptoms

281
Q

Recurrent nose bleeds
Telangiectasias
Visceral lesions
First degree releatiev

A

Hereditary hemorrhagic telangiectasia

282
Q

Thormbocytopenia

A

Associated iwth nose bleeds

Platelet count will be low

Peripheral smear will show giant platelets

283
Q

Low pitched systolic ejection murmur that is described as “vibratory” or “musical” and improves with valsalva and loud when supine

A

Still’s murmur

Innocent murmur of childhood

284
Q 
Maternal fever
Tachycardia
Uterine tenderness
Fetal tachycardia
Abdominal pain
Foul-smelling fluid in underwear
No costovertebral angle tenderness
2 cm dilated, 10% effacement, microscopic analysis of fluid reveals delicate ferning pattern

A. Bacterial vaginosis
B. Chorioamnionitis
C. Placental abruption
D. Pyelonephritis

A

Chorioamnionitis

-Premature rupture of membranes is crucial risk factor

285
Q

Presence of amniotic fluid is confirmed on examination with

A

nitrazine testing

pH of the amniotic fluid is alkaline between 7.0 to 7.3. when compared to vaginal fluid acidity of 3.8 to 4.2

and/or

fern testing- presence of delicate ferning pattern on microscopic analysis

286
Q

Vaginal discharge “fishy”

clue cells

A

Bacterial vaginosis

287
Q

Brief, arrhythmic, involuntary, bilateral upper extremity myoclonic jerks without loss of consciousness

  • Triad
  • Age
  • EEG
A

Juvenile myolconic epilepsy

Presents in adolescence

Myoclonic jerks
Generalized tonic-clonic seizures
Absence seizures

EEG: rapid, generalized, irregular spike and polyspike waves

No fever, trauma, infection

288
Q

Febrile seizures

A

6 months - 5 years

Generalized tonic-clonic activity
Fever
Postictal confusion
Fatigue

Preceding upper respiratory infection or recent immunization with DTP/ MMR

15 min
non-recurrent

TX: acetaminophen for fever

289
Q

Lennox-Gastaut syndrome

A

presents around age 2

Multiple types of seizures along with mental retardation, developmental regression and abnormal EEG

EEG: paroxysms of fast activity and slow spike and wave discharges

TX valproic acid/ clonazepam

290
Q

Panayiotopouos syndrome

A

benign occipital epilepsy

Focal seizure disorder

3-6 y.o

Occipital (visual) and autonomic disturbances (vomiting), unilateral head/eye deviation, loss of awareness, heiclonic seizures and migranous headahces

30 min

Eyes closed EEG occipital andposterior temporal spikes

Tx: carbamazepine

291
Q

Supplement for breastfed infants and for formula fed infants who do not consume at least 1 liter formula per day

A

Vit D

292
Q

Iron supplement in infant

A

exclusive breastfeeding pst 4-6 months

293
Q

Tx vulvovaginal candidiasis in nonpregnant female

A

oral fluconazole

294
Q

Thick, whitish discharge. No odor. pH 4.

microscopic with KOH= pseudohyphae or budding yeast

A

Vulvovaginal candidiasis

295
Q

pH > 4.5, clue cells
Odor

Tx

A

bacterial vaginosis

Metronidzole

296
Q

pH ? 4.5, postcoital bleeding, dysuria, grene or yellow discharge, frothy, odor. Motile flagellated protozoa

tx

A

Trichomoniasis

Metronidazole

297
Q

Benign skin lesion that is flat pink or salmon colored, blanching skin patch between eyebrows or on nape of neck

A

Nevus simplex

298
Q

Port wine stain, asymmetric, unilateral, flat, dark red to purple patch on face.

A

Nevus flammeus

Over concentration of capillaries located around the V1 branch of the trigeminal nerve.

Can be associated iwth sturge weber syndrome (causes angiomas in brain)

  • port wine stain
  • glaucoma
  • seizures
299
Q

Symmetric mottling of the skin that involves the trunk and extremities

A

Cutis marmorata

Reassurance no tx

300
Q

Small, erythematous papules and vesicles that occur on cover skin.

A

Miliaria rubra

due to sweat gland obstruction

301
Q

Type 2 second degree av block due to

A

disturbance in conduction distal to AV node, most often in purkinje system

302
Q

Delayed conduction between SA and AV node

A

First degree AV block

303
Q

Accessory route of conduction around the AV node

A

Atrioventricular reentrant tachycardia

Palpitations
Regular narrow complex tachycardia on ECG with inverted P waves

304
Q

Complete block of conduction between SA and AV nodes

A

Third degree AV block

Ventricles generating an escape rhythm via its own accessory pace maker

305
Q

Painful swelling joints. pulmonary embolism. DVT what abnormalitity

A

Factor V Leiden

Defective form of Factor V taht is resistant to degradation by protein C

Patients prone to clotting

306
Q

PT measures

A

extrinisc pathway

Factor VII

307
Q

PTT measures

A

Intrinsic pathway

TENET
XII, XI, IX, VIII, X

308
Q

Bleeding into joints, epistaxis, prolonged post-op bleeding

A

Def Factor VIII or Factor IX

Hemophilia A/B
X linked

309
Q

Hemoglobin A1C measures

Falsely lower by (6)

Elevated by (

A

measurement of glycoslyated hemoglobin

Average blood glucose for past 3-4 months

Lower

  • sickle cell
  • acute blood loss
  • hemolytic anemia
  • erythropoietin therapy
  • chronic renal failure
  • b12, iron, folate tx

Elevate

  • anemia due to B12 def
  • chronic renal failure w/ elevated concentration urea
  • AA, hispanic, asain descent
310
Q

Third degree block EEG

A

Wide QRS
Regular P-P interval
no conducted P waves

311
Q

Narrow QRS irregularly irregular P-P interval

some conducted P waves

A

Atrial fibrillation

312
Q

Wide QRS
Regular P-P interval
no conducted P waves

A

Third degree AV block

313
Q

narrow QRS
regular P-P interval
SLowed conduction of P waves

A

First degree AV block

314
Q

Narrow QRS
regular irregular P-P interval
some conducted P waves

A

atrial flutter

315
Q

Wide qrs
regular p-p interval
some conducted P waves

A

Mobitz II second degree heart block

316
Q

Prediabetes diagnosis

A

fasting glucose 100-125

A1c 5.7-6.4%

317
Q

Tx acute bacterial rhinosinusitis

A

Amoxicillin-clavulanate

Allergy: (children) cephalosporin

Allergy (adult): doxy

318
Q

4 y.o AA fatigue and yellowing eye. Dysuria. UTI and antibiotic prior to.

A

G6PD deficiency

Jaundice, pallor, dark urine and back pain 2-4 days after oxidative stress from certain medications (sulfas and anti-malarias) or infections

Heinz bodies (oxidized hemoglobin) or bite cells on smear

319
Q

Hereditary spheocytosis

A

Splenomegaly

rigid RBC that are cleared by spleen

320
Q

Sore throat, fever, fatigue, bilateral posterior cervical lymphadenopathy, tonsillar enlargement, splenomegaly, palatal petechiae

Tx w/ antibiotics got worse

  • What is it
  • Diagnosis
A

Infectious mononucleosis

Heterophile antibody test

[ if negative then CBC then EBV]

[if positive, perform rapid strep test]

321
Q

Projectile vomiting
Mobile mass
3 week old infant

Imaging?

A

Pyloric stenosis

ultrasound

322
Q

Double bubble on ultrasound

A

Annular pancreas

Associated with down syndrome, tacheoesophageal fistula, imperforate anus and hirschsprung disease

323
Q

Bilious vomiting within hours of birth. Double bubble on ultrasound

-also seen

A

Duodenal atesia

Scaphoid abdomen (sunken anterior abodminal wall)

324
Q

Nonbilious vomiting that turns bilious
Currant jelly stool
Palpable sausage-shaped mass
“Target sign””

A

Intussusception

325
Q

Infant distended abdomen, tenderness, and rigidity on palpation, currant jelly stool, lethargy, fever, tachycardia, hypotension.

Birds beak

A

Malrotation

326
Q

Growth on knee, painless, increased insize over 3 months. Rough coalescing, flesh colored hyperkeratotic papules. No bleeding

Scraping revelas several thrombosed capillaries

A

Warts (verruca vulgaris)

HPV

327
Q

Flesh colored dome shpaed papules with central umbilication

A

Molluscumc ontagiosum

328
Q

Slapped cheek

A

Parvovirus B19

329
Q

Screening at initial visit for pregnancy (6)

A

Cervical cancer screening

Pap smear

Blood group

Rh status

Rubella status

STI screening including HIV, syphilis, gonorrhea, and chlamydia, hep B

330
Q

DM testing in pregnancy when

A

24-28 weeks

331
Q

Group B strep screening in pregnancy when

A

36 weeks

332
Q

Elevated Creatinine and BUN=

NSAID use

A

kidney injury via decreased synthesis of prostaglandins

333
Q

Tx herpes w/ pregnancy wanting to give vaginal birth

A

Treat any recurrent herpes episode with oral acyclovir and begin daily oral acyclovir therapy after 36 weeks gestation even if no episodes develop

334
Q

Blood transufion of anemia

A

Only if severe hemoglobin less than 8

335
Q

Tx acute onset of excruciating pain with external hemorrhoids within 72 hours

A

Surgical excision

336
Q

Rubber band ligation tx

A

appropriate non-surgical tx for internal hemorrhoids

337
Q

Hemorrhoids conservative tx

A

Fiber supplementation
Stool softeners
laxatives
topical analgesics

338
Q

Bone pain
Low hemoglobin
Low hematocrit

A

Multiple myeloma

CRAB
hyperCalcemia
Renal failure (IgG light chains in urine)
Anemia
Bone lesions
339
Q

Metastatic cancer spread to bone

A

Late stages of prostate cancer

Characterized by elevated alkaline phosphatase

340
Q

Solitary painless well circumscribed, rubbery, mobile breast mass

A

Fibroadenomas

341
Q

Painless breast lump found below the areola with bloody nipple discharge

Breast pain
Retraction
Enlargement
Itchy nipple

A

Infiltrating ductal carcinoma

342
Q

Drug that causes increase in baseline fetal heart rate and incidence of fetal tachycardia

A

Terbutaline (beta-adrenergic agonist)

343
Q

Betamethasone on fetal heart rate

A

Decrease in fetal heart variability and abolishment of diurnal fetal rhythms

344
Q

Opioids/ morphine on fetus

A

Decrease variability

Decrease frequency of accelerations

345
Q

When should a baby start solid baby food

A

after 4-6 months of age

346
Q

Child should begin whole cows milk when

A

after 1 year of age

347
Q

Pregnant patients with preeclampsia without severe features should deliver when

A

37 weeks

348
Q

Preeclampsia with severe features

A

Blood pressure greater than 160/110

Proteinuria higher than 5 g

End organ damage

Persistent frontal headache, visual disturbances, acute mental status changes, RUQ pain, peripheral edema, and oliguria

349
Q

Elevated unconjugated hyperbilirubinemia without underlying cause

A

Gilbert

Show at times of stress

350
Q

Crigler-Najjar syndrome

A

unconjugated hyperbilirubinemia

Complete absence of bilirubin UGT enzymatic activity

First days of life

351
Q 
elevated conjugated bilirubin
Fatigue
pururitus
RUQ pain
middle aged female
hepatosplenomegaly
hyperpigmentation
xanthelasma (yellow deposition of fat near eyelid)

antimitochondrial ab

A

Primary biliary cirrhosis

autoimmune destruction of the hepatic biliary system

352
Q

Wilson disease

A

cirrhosis common initial presenation

Ascites, jaundice, spider nevi, palmar erytehma, digital clubbing, prominent abdominal veins, caput medusae, hematemesis

mental status changes, seizures

Decreased serum ceruloplasmin, increased urinary copper

353
Q

Positive whiff-amine test

A

bacterial vaginosis

fishy odor when KOH added

354
Q

Rare epithelial cells covered in bacteria seen on microscopy

A

Clue cells

bacterial vaginosis

355
Q

Medication that interact w/ phosphodiesterase type 5 inhibitors (sildenafil, tadalafil, vardenafil)

A

antiretroviral medications increase the levels of PDE-5 inhibitors

356
Q

Thyroid mass that grows rapid in a year.

Hard painless

No cervical adenopathy

Diagnosis?

A

Reiter thyroiditis

Surgical biopsy

[Other thyroid nodules can do FNA]

357
Q 
Neutropenia
Dyspnea
Fever
Cough
Halo sign on xray
Macronodule surrounded by ground-glass opacity
A

Aspergillosis

358
Q

Sarcoidosis what is seen

A

cough, dyspnea, hemoptysis, night sweats, WL

Hypercalcemia

African americans

Bilateral hilar adenopathy

Non-caseating granulomatous infiltration

359
Q

Most common genetic abnormality that is aborted

A

autosomal trisomy

360
Q

Child with repeat proteinuria positive

A

Orthostatic proteinuria

Characterized by proteinuria while in the upright position which resolves when supine

Diagnose with morning urine protein-to-creatinine ratio

361
Q

Serum antinuclear antibody

A

Lupus

362
Q

GBS positive in first baby

A

Should not be test again with next babies just get GBS prophylaxis

363
Q

Pneumonia can be prevented by

A

Getting flu vaccine

Succumb to bacterial infection when weakened by flu virus

364
Q

Most common cause of secondary htn (htn that is no reduced by 3 different medications)

-diagnosis

A

renal artery stenosis

renal arteriogram

365
Q

Secondary htn with hypokalemia and hypernatremia

A

Primary aldosteronism

366
Q

Noncaseating granulomas
Clacified nodular opacities with hilar and mediastinal lymphadenitis

Upper lobes

A

Beryllium

367
Q

Honey combing

A

Asbestosis

368
Q

Infant with jaundice and hyperbilirubinemia

diagnosis?

A

Hemolytic disease of newborn

Due to IgG ab from mother

Direct Coombs test

369
Q

Constellation of benign and malignant tumors

A

Von Hippel Lindau disease

AD

Mutations inthe VHL gene

370
Q

Hematuria
Flank pain
palpable abdominal or flank mass

A

Renal cell carcinoma

VHL

371
Q

p53 mutation

A

AD Li-fraumeni syndrome

Several malignancies throughout life time

Sarcomas
Breast cancer
Brain tumors
Adrenocortical carcinomas

372
Q

Neurofibromatosis type 1

A

cafe au lait sots
neurofibromas

RAS protein

373
Q

Osteomyelitis starts with

A

infection of surround soft tissues

Staphylococcus aureus

374
Q

PCOS causes what

A

dysregulated intrinsic ovarian androgen production

375
Q

steps in asthma

A
  1. SABA as needed
  2. low-dose inhaled glucocorticoids
  3. medium-dose inhaled glucocorticoids
    low dose inhaled glucocorticoids plus LABA
  4. medium dose inhaled glucocorticoids plus LABA
  5. High dose Consider omalizumab
376
Q 
Alcoholic
Low hemoglobin
Low heamtocrit
Siderocytes
Basophilic stipping positive for iron

-cause?

A

Abnormality in heme synthesis

Excessive alcohol is most common cause of sideroblastic anemia

Heme synthesis is disrupted causing iron to accumulate in mitochondria causes the bone marrow to produce ringed sideroblasts

377
Q

Defect in hemoglobin structure

  • on blood smear
A

Thalassemia

poikilocytosis (irregular shaped)
target cells (bull’s eye)
Schistocytes

378
Q

watery/ Bloody diarrhea
Ate chicken

Motile, spiral, gram-negative rods

A

Campylobacter jejuni

Poulty and unpasteurized milk

379
Q

Anaerobic gram negative bacillus

A

EHEC E. coli

bloody diarrhea

beef

380
Q

Gram negative motile bacilli

watery stool

septic arthritis

A

salmonella

381
Q

non-motile, glucose fermenting

gram negative rod

A

Shigella

bloody diarrhea

382
Q 
gram negative bacillus
bloody diarrhea
pork, milk, water, tofu
erythema nodosum
appendicitis
A

yersinia enterocolitica

383
Q

Infant not passing meconium

cystic fibrosis

A

Meconium ileus

384
Q

Hirschsprung disease

A

functional obstruction due to developmental abnormality of enteric nervous system

Absence of ganglion cells in distal colon

Not passing meconium

Negative for stool in rectal vault

385
Q 
Preterm
2-3 weeks old
formula fed
abdominal distention
bloody stool
penumatosis intestinalis (gas/air in bowel wall)
A

Necrotizing enterocolitis

386
Q

Bilateral proximal muscle aches (shoulders and hips)

Morning stiffness over an hour

Giant cell arteritis in past

A

Polymyalgia rheumatica (PMR)

elevated IL-5, CRP, ESR

387
Q

Anti-Mi-2 or anti-jo-1 ab

A

dermatomyosistis

388
Q

Progressive symmetrical proximal muscle weakness (not pain)

A

Polymyositis

Anti-Mi-2 or anti-jo-1 ab

389
Q

Sand paper spot on skin, redder,

A

AK

cryotherapy

390
Q

Lower triglycerides

A

Fibrates
(fenofibrate
gemfibrozil)

391
Q

Cause of anemia in renal failure patients

A

Suppression of erythropoietin

392
Q

Blood loss anemia

A

Microcytic

MCV <80

393
Q

Hemolysis causes increase in

A

serum bilirubin due to degradation of heme as RBC are destroyed

Haptoglobin levels would also be expected to be low

Haptoglobin binds to hemoglobin and levels decrease as hemoglobin is released form destroyed RBC

394
Q

Iron deficiency anemia

A

Microcytic

MCV <80

395
Q

Inhaled chlorine causes what

  • predominant cell type
A

Reactive airway dysfunction syndrome (RADS) or irritant-induced asthma

Last more than 3 months

Caused by chlorine, aerosol and smoke

Positive methacholine challenge

Improved with bronchodilatory therapy

Airway inflammation from RADS (not atopy)

Presence of neutrophils

396
Q

Predominant cell type in asthma

A

eosinophil

397
Q

Predominant cell type in allergic rxn

A

basophil

398
Q

Complication of bronchodilator therapy

A

Transient arterial oxygen desaturation

Increase in ventilation-perfusion (V/Q) mismatch

Characterized by dyspnea, wheezing, hypoxia, tachycardia, and tachypnea

399
Q 
Dark urine
Tired
Jaundice with scleral icterus
Low hemoglobin
Low hematocrit
Normal MCV
High reticulocyte
High Lactate dehydrogenase
High total bilirubin

Bite cells
Heinz bodies

A

G6PD deficiency

Symptoms to hemolytic anemia (jaundice, scleral icterus, anemia)

Common precipitating factor is ingestion of fava beans, acute infection, oxidant drugs

(dapsone, sulfonamides, primaquine, nitrofurantoin)

400
Q

Avoid high altitudes

A

recommended to prevent sickle cell crisis

401
Q

Ascites, fever, chills, jaundice and abdominal pain, tenderness and fluid wave on examination

Fluid analysis reveals a neutrophil count > 250, lactate > 25 and pH less than 7.35, total protein less than 1 gram/dL

Tx

A

Spontaneous bacterial peritonitis (SBP)

Bacterial infection of peritoneal cavity

Empiric antibiotics with third generation cephalosporin (cefotaxime) or aminoglycoside (gentamicin) with ampicillin

Cefotaxime preferred due to risk of nephrotoxicity with aminoglycoside

402
Q

Total protein less than 2.5

A

Transudate

403
Q

Total protein > 2.5

A

Exudate

404
Q

What should be given with large volume paraecentesis

A

Albumin

405
Q

Biliary atresia

A

More common cause of cholestasis in newborn

1 wk to 8 wks

Jaundice
Pale colored stool
Dark urine
Hyperbilirubinemia
Elevated direct bilirubin
406
Q

1 wk to 8 wks

Jaundice
Pale colored stool
Dark urine
Hyperbilirubinemia
Elevated direct bilirubin

No mass

A

Biliary atresia

407
Q

Pale colored stool
Direct hyperbilirubinemia
Hepatomegaly
Palpable mass in RUQ

A

Choledochal cyst

Bilirubin conjugated and excreted but unable to get into bowel

408
Q

Positive coombs test

A

Hemolytic disease of the newborn

409
Q

Breast milk jaundice

A

Beta glucouronidase in breast milk removed glucuronic group that was added during conjugation

Leading to further accumulation and indirect hyperbilirubinemia

410
Q

Cold, constipated, lethargic, yellow baby with a large tongue and poor feeding.

A

Congenital hypothyroidism

Elevated TSH

411
Q

26 with history of chronic htn goes in to labor. Boggy uterus and bleeding. What intervention is contraindicated

Carboprost
Methylergonovine
Misoprostol
Oxytocin
Uterine fundal massage
A

Methylergonovine

Contraindicated in patient with htn

Acts directly on the smooth muscle of the uterus and increases the tone, rate and amplitude of rhythmic contractions

412
Q

Carboprost should be avoided in

A

prostaglandin analogue

Uterotonic agent

Dont use in patient with asthma

413
Q

Misoprostol

A

synthetic prostaglandin

binds myometrial cells causing contraction

Uterotonic agent

Use in post partum hemorrhage

414
Q

Oxytocin

A

Use in post partum hemorrhage

Naturally made by pituitary gland

415
Q

Ulcer with H. pylori tx

A

Omeprazole (or lansoproazole) or an antidiarrheal (bismuth subsalicylate)

Plus 2 antibiotics
Amoxicillin
Clarithromycin

416
Q

Helix shaped, gram negative bacterium

test

A

H. pylori

Fecal antigen test
Carbon 13 urea breath test

417
Q

Infant test positive on Barlow and Ortolani tests

A

Developmental dysplasia of the hip or congenital dislocation of the hip

Orthopedic referral

418
Q

Infant hip flexed at 90 degrees and adduction of the leg with posterior pressure directed at the knee

A

Barlow test

Positive if there is a clunking sensation or a sensation of movement is felt as the femoral head exits the acetabulum posteriorly

419
Q

Gripping the infant’s femur, flexing the leg at the hip at 90 degrees and applying anterior pressure on the thigh towards the acetabulum

A

Ortolani test

Positive if a clunking sensation is felt

420
Q

Positive barlow maneuver and negative ortolani what next

A

Observation and repeat exam

421
Q

What confirms the diagnosis of celiac disease

A

Gastroduodenoscopy with biopsy

Upper endoscopy and duodenal biopsy demonstrating enterocyte villous atrophy is diagnostic

422
Q 
Chest pain
Tachycardia
Dyspnea
Hemoptysis
and recent travel
A

Pulmonary embolism

423
Q

Pulmonary embolism on EKG

A

Sinus tachycardia

Sinus rhythm with ventricular rate of 132 beats per minute

424
Q

ECG with diffuse ST segment elevations and PR interval depresion without T wave inversions

A

Pericarditis

425
Q

Greater tahn 1 mm ST elevations in leads II, III, aVF

A

Inferior wall MI

426
Q

S-waves in lead I, Q waves in lead III, and inverted T waves in lead III

A

S1Q3T3

Pulmonary embolism

[Sinus tachycardia: Sinus rhythm with ventricular rate of 132 beats per minute more common for PE]

427
Q

Testicular torsion caused by

A

congenital malformation of the processus vaginalis leading to inadequate fixation of the testicle to the tunica vaginalis

428
Q

Ascending bacterial infection from the prostatic urethra

A

Epididymitis

429
Q

Dilation of the pampiniform venous plexus

A

Varicoceles

Mass and heaviness within the left side of the scrotum that is associated with a dull, achy pain. “ bag of warms”

430
Q

Male with low grade fever, headaches and malaise followed by parotitis then gens pain and swelling and edema of scrotum

A

Mumps –> systemic viral infection –> epididymoorchitis

Inflammation of the testicle and epididymis

431
Q

Chemotherapy to treat HER2/neu positive breast cancer

A

Trastuzumab

432
Q

Clomiphene

A

selective estrogen receptor modulator that acts to inhibit hypothalamic estrogen receptor which blocks estrogen negative feedback on GnRH

GnRH persist and instigate the release of FSH and LH

Use with infertile female with PCOS

433
Q

Raloxifene

A

selective estrogen receptor modulator taht acts to regulate osteoclast and osteoblast activity

Tx osteoporosis

Only use if failed first line therapy bisphosphonates (-dronate)

Can also be used to tx estrogen receptor and progesterone receptor positive breast cancer

Less likely to potentiate endometrial cancer

434
Q

Rituximab

A

monoclonalab against CD20 found on B cells.

Tx autoimmune disorders (rheumatoid arthritis, polyangiitis with granulomatosis) and B cell lymphomas

435
Q

Tamoxifen

A

selective estrogen receptor modulator used in tx estrogen receptor and progesterone receptor positive breast cancer

CI in patients with endometrial cancer

436
Q

History of abdominal trauma in pregnany is most classically associated with what complication

A

Placental abruption

437
Q

Gestational diabetes in pregnancy is most associated with what complication

A

Shoulder dystocia

438
Q

Placental hypoperfusion is most classically associated with what complication

A

Preeclampsia

439
Q

Vaginal coloinization w/ group B streptococcus is most classically associated with what complication

A

Chorioamnionitis

Maternal fever 100.4
Maternal tachycardia (>100) 
Fetal tachycardia (>160)
Uterine tenderness
Foul smelling amniotic fluid
440
Q 
13 y.o recent cold
yellow eyes
dark urine
fatigue
low hemoglobin
High reticulocyte count

Spherocytes
Coombs test positive

A

Autoimmune hemolytic anemia

Autoantibodies to erythrocytes leading to premature destruction

RBC production increased in bone marrow to compensate= increased reticulocytes

Can occur secondary to infection, malignancy, lupus

441
Q

Anemia
Elevated reticulocyte count
Spherocytes
Negative coombs

A

Hereditary spherocytosis

442
Q

Bell’s palsy type of nerve palsy

A

Peripehral facial nerve palsy

Lower motor neuron of cranial nerve VII

Unilateral complete hemi-facial paralysis (includes forehead)

443
Q

Central facial nerve palsy

A

Dysfunction of the upper motor neuron of cranial nerve VII

Paralysis of the lower face with forehead sparing

444
Q

Annual lung cancer screening

A

patients 55-80 who have 30 pack year

Low dose CT

445
Q

Sickle cell disease at risk for

A

encapsulated organisms

Streptococcus pneumoniae
Haemophilus influenzae
Neisseria meningitidis

Need pneumococcal vaccination

SHiNE SKiS

Strep pneumoniae
Haemophilus influ B
Neisseria meningitidis
Ecoli
Salmonella
Klebsiella
Streptococcus agalactiae
446
Q

Chronic management of sickle cell disease

A

Annual screening for retinopathy and folic acid supplementation

Pneumococcal vaccination

447
Q

Itchy rash
Began as single round itchy red lesion on patients chest.

Within 5 days a large number of smaller red oval lesions appeared.

Follow natural skin lines

Oval well demarcated salmon colored patch with central clearing and scaling at edges

A

Pityriasis rosea

self limiting

linked to upper respiratory infection and in immunosuppresed patients including pregnancy

448
Q

Chordee

A

abnormal ventral curvature of the penis

accompanyed by hypospadias

449
Q

Aspiration pneumonia likely to occur when in the lung

A

Right inferior lobe

450
Q

Finding on complete blood out with chronic myelogenous leukemia (CML)

A

Basophilia

451
Q

child with acute onset fever, sore throat, difficulty swallowing, and muffled speech.

Child leaning forward and hyperextended neck

Drooling from mouth

A

Epiglottitis

Thumb sign

Haemophilus influenzae type B

3rd gen cephalosporin and MRSA coverage

  • ceftriaxone
  • vancomycin
452
Q

Edema
Hypoalbuminemia
Proteinuria > 3 g
Diabetic

A

Diabetic glomerulonephropathy

453
Q

Diabetic glomerulonephropathy can be prevent by what medication

A

Angiotension converting enzyme (-pril)

Decreases glomerular capillary pressure by inhibiting constriction of the efferent renal arteriole

454
Q

Bumetanide

A

loop diuretic

455
Q

Screenings for 65 y.o smoker

A

Abdominal US
Colonoscopy
Fasting lipid panel

[Not PSA]

456
Q

Elevated AFP in pregnancy with non-consistent prenatal care with no ultrasound assume elevated AFP is due to

A

Multiple gestations

Incorrect dating is the most common reason for elevated AFP

457
Q

10 day old iwth bilateral eye swelling, redness, crusting and watery discharge

STI during first trimester

A

Chlamydia trachomatis

Oral erythromycin

458
Q

Vaccine for 15 y.o

A

HPV

459
Q

MMR given when

A

12-15 months
4-6 years
Booster in teens

460
Q

Facial twitching what

A

hypocalcemia

461
Q

Tx for patients on warfarin who develop lift-threatening bleeding or require surgery

A

Vitamin K and Fresh frozen plasma

462
Q

when to do lipid screening

A

men 35 or older

men 20-35 or woemn 20 and older if increased risk of coronary heart disease (smoking, DM, strong family history, HTN, BMI>30)

463
Q

Diabetic patient
Abdominal discomfort after meals that takes hours to dissipate

N/V after meals

Slowed gastric transit w/o evidence of obstruction

A

Autonomic neuropathy

464
Q

Zollinger-Ellison syndrome

diagnosis

A

Gastrinoma

Presents as painful duodenal ulcers, gastroesophageal reflux and diarrhea

Elevated gastrin resulting in increased stomach acid production

Diagnosis made by an elevated fasting serum gastrin concentration

465
Q

ECG on pericarditis

A

Diffuse ST elevations for diagnosis

466
Q

Tx pericarditis

A

Addressing underlying etiology

Exercise restriction

NSAIDS

467
Q

Pain in chest with activity of deep inspiration

Pain with palpation of the chest

A

Costochondritis

468
Q

Fever
New onset cardiac murmur

Purple tender nodules on finger tips, splinter hemorrhages and non-tender nodules on palms and soles

A

Endocarditis

Staphylococcus aureus

Streptococcus viridans if previous damaged valves

469
Q

Aplastic crisis

A

a cell anemia

Characterized by an acute reduction in bone marrow erythropoiesis followed by acute drop in hemoglobin and reticulocyte count

470
Q

Anemia of chronic ifnlammation labs

A

normocytic (early) or microcytic anemia

Low reticulocyte count
Low iron
Elevated ferritin
Low TIBC

471
Q

Wheezing and SOB. SOB not when running around. Itchy eyes and runny nose. Taken aspirin for several weeks due to sprained ankle. Fever. Lacrimation and inject conjunctiva , nasal polyps

  • test
A

Aspirin-exacerbated respiratory disease (AERD)

Samter’s triad

  • aspirin intolerance
  • nasal polyps
  • asthma

Oral aspirin challenge

472
Q

Measurement of DLCO

A

Test of the diffusing capacity of the lungs for carbon monoxide

Can help differentiate obstructive and restrictive lung disease

Only inpatient

Normal or high= asthma
Low= emphysema, interstitial lung disease

473
Q

Acute otitis media tx

A

Oral ibuprofen

< 6months: amoxicillin

6 mn -2 y.o= rapid onset, middle ear effusion or severe illness w/ fever

Allergy to penicillin give azithromycin

474
Q

Chronic purulent otitis media tx

A

Topical antibiotics like aminoglycosides (neomycin), polymyxins, and fluoroquinoles (ciprofloxacin)

dont give ofloxacin to children younger than 12

475
Q

Struma ovarii

A

ovarian tumor comprised of mature and functional thyroid tissue

teratoma of the ovary

Elevated free thyroxine

CA 125 not always elevated

476
Q

Elevated alpha fetoprotein in adult female

A

tumor marker elevated in yolk sac tumors and hepatocellular carcinoma

477
Q

Elevated estradiol in female with pelvic mass

A

Granulosa cell tumors

Precocious puberty

478
Q

Elevated hCG w/o pregnancy

A

Molar pregnancy –> choriocarcinoma

479
Q

History of thyroid disease, rapidly growing neck mass, cough, dysphagia, dyspnea, and neck pain

A

Anaplastic thyroid carcinoma

Surgical biopsy

480
Q 
Bilious vomiting, abdominal distention and abdominal pain
Hemodynamic instability
Hematochezia
Difficulties feeding
Decrease in bowel movements

Bowel sounds hyperactive
No masses

Test to be done

A

Intestinal malrotation

Upper gastrointestinal barium contrast series

Proximal duodenal dilation followed by a “bird-beak” obstruction and then a spiral or corkscrew duodenal configuration

Xray will give double bubble not specific (gastric and duodenal dilation)

481
Q

Tx vulvovaginitis

A

Inflammation of vulva or vagina

Avoid tight cloting and irritants including bubble baths and perfumed soaps

482
Q

Nystatin

A

tx for candidal vulvovaginitis

483
Q

PCOS at risk for

A

Endometrial cancer

Lack of ovulation leads to endometrial hyperplasia

484
Q

Mutation for increased risk of ovarian cancer

A

BRCA 1/2 mutation

485
Q

Tx for acute PE

A

anticoagulation

486
Q 
Sore throat
Fever
Muffled voice
Trismus (inability to completely open the mouth) 
Deviated uvula

Tonsil medially displaced and swollen

A

Peritonsillar abscess

Abscess occurs between the palatine tonsil and its capsule

487
Q

Exudative tonsillitis

A

Precedes peritonsillar abscess

Tonsil will be swollen with exudates

Tonsil will not be deviated though

488
Q

Sore throat
Fever
Tonsillar exudates
Tender anterior cervical lymphadenopathy

No cough

A

Acute pharyngitis

489
Q

Child with stiff neck and not tonsillar involvement

Discrete mass and generalized swelling within th emidline

A

Retropharyngeal abscess

490
Q

12 y.o for persistent nose bleeds. Has URI three weeks ago.

Petechiae

Low platelet count
Elevated bleeding time
Normal PT
Normal PTT

Complete blood count normal

Decreased platelets and occasional megathrombocytes

A

Immune thrombocytopenic purpura

Megathrombocytes (young platelets that are larger in size)

PT and PTT normal since coagualtion factors in affected

491
Q

Prolonged bleeding time

Platelet count normal

A

Glanzmann’s thromboasthenia

Disorder of platelet aggregation due to decrease in glycoproteins GPIIb and IIIa.

492
Q 
Fever
Anemia
Thrombocytopenia
Renal failure
Neurologic symptoms
A

Thrombotic thrombocytopenic purpura

493
Q

Bleeding time increased
Platelet count normal
PTT prolonged (can be normal)
PT normal

Easy bruising
Heavy bleeding
Elevated thromboplastin time

A

Von Willebrand disease

494
Q

Heart problems after death of loved one

Imaging

A

Takotsubo cardiomyopathy

Two step echocardiogram

Transient left ventricular dyskinesia and mimics ACS

Returns to normal 1-4 weeks

495
Q

18 y.o multiple shoulder dislocation. Runs in the family. Visable widened scar superior to umbilicus from piercing.

Mutation

A

Ehlers- Danlos

Type V collagen

COL5A1/ COL5A2

Skin hyperextensibility
Joint laxity
Tissue fragility
Wide atrophic scars

496
Q

COL5A1/COL5A2

A

Ehlers danlos

497
Q

FBN1

A

Fibrillin

Marfan syndrome

Tall
Aortic root dilation
Ectopia lentis

498
Q 
Tall
Atrophic scars
Translucent skin
Prominent cranio-facial deformities (wide spaced eyes)
cleft palate
BIfid uvula

mutation

A

TGFBR1/TGFBR2

Loeys Dietz syndrome

499
Q

TGFBR1/TGFBR2

A

Loeys Dietz syndrome

Tall
Atrophic scars
Translucent skin
Prominent cranio-facial deformities (wide spaced eyes)
cleft palate
BIfid uvula
500
Q

COL1A1/ COL1A2

A

Osteogenesis imperfecta

Type I collagen

501
Q

LAR1

A

Larsen syndrome

similar to EDS with frequent joint dislocations

Also have abnormal craniofacial features (flattened face, depressed nasal bridge, and cleft palate)

502
Q

4 y.o ingested medication

Lethargic, mildly responsive, fever, HR 160. Skin warm and dry no rash, pupils dilated, twitching of arms and legs

Acetaminophen
Amlodipine
Digoxin
Imipramine
propranolol

Involved mechanism of action

Tx

A

Cholinergic inhibition

TCA- imipramine

Mydriasis
Tachycardia
Hyperthermia
Sedation
Coma
Twitching
Seizure
Hypotension
Arrthymia
Dry skin and mucous membranes

Ingestion recent (within 60 min) = activated charcoal

Sodium bicarbonate is indicated if hypotensive, arrhythmia or QRS prolongation

503
Q

Ingestion of beta adrenergic blockade

A

-lol

severe bradycardia and hypotension

504
Q

Ingestion of calcium channel inhibition

A

amlodipine
diltiazem
Verapamil

Hypotension
Severe bradycardia
AV block

505
Q

Acetaminophen overdose

A

Hepatic failure

Nausea/vomiting
jaundice
Abdominal pain
Elevated liver function tests

Tx Charcoal
N-acetylcysteine

506
Q

Digoxin overdose

tx

A

av block
bradycardia
Ventricular tachycardia
atrial tachycardia

severe hyperkalemia

anti-digitalis ab

507
Q

children with multiple episodes of sudden, rapid, symmetric tonic contraction of the neck, trunk and extremities

Typically occur before sleep or upon awakening

Regression of psychomotor development

A

Infantile spasms

Triad

  • spasms
  • hyperarrhythmia (chaotic brain waves)
  • mental retardation
508
Q

Petit mal epilepsy

A

Present with absence seizures

509
Q

Family history of kidney cysts

Bloody urine after running into table

A

Autosomal dominant polycystic kidney disease

Renal US

510
Q

11 should be screen for

A

Obesity

511
Q

Corneal abrasions tx

A

Appear green in color

Pseudomonas aeruginosa and other gram negative organisms

discontinuation of contact lens use, disposal of previous lesnses, avoidance of eye patching, use of anti-pseudomonal ophthalmic antibiotic (fluroquinolone or aminoglycoside) ciprofloxacin

if not contact lens wearer then polymyxin B/ trimethoprim solution

512
Q

Single most effective public health measure shown to decrease the prevalence of dental caries

A

Fluoride in public water

513
Q

Child new onset of unilateral conductive hearing loss with white mass behind intact tympanic membrane

A

Cholesteatoma

514
Q

Graudal unilateral hearing loss and tinnitus. Facial nerve weakness

Normal tympanic membrane

Unilateral sensorineural hearing loss

A

Acoustic neuroma

515
Q

Pulsatile tinnitus and gradual painless hearing loss
Middle age female

Pulsating, reddish blue mass behind intact tympanic membrane

A

glomus tumor

Neuroendocrine

516
Q

Sensorineural hearing loss taht is sudden, fluctuating and unilateral hearing loss that begins with low frequencies and progresses to higher frequencies

A

Meniere disease

517
Q

Weber: sound heard best in right ear

Rinne: bone conduction > air conduction in right ear

A

conductive hearing loss R ear

518
Q

Weber: sound heard best in right ear

Rinne: Air conduction > bone conduction

A

Sensorineural hearing loss left ear

519
Q

Labor of first c-section odd

A

Risk of maternal death is decreased with trial of labor compared to repeat c-section

520
Q

If previous c-section risk of uterine rupture is

A

1%

521
Q

What is contraindicated with trial of labor after cesarean delivery

A

Misoprostol

522
Q

Anti-HBc

A

only have if previous infection not immunization

523
Q

Positive McMurry

Knee flexed and externally rotated with valgus stress

A

Medial menicus tear

524
Q

2 week old with foot deformity

Left foot abrupt medial deviation of metatarsals with prominent fifth metatarsal styloid process and a deep skin cleft at the medial midfoot

A

Talipes equinovarus

525
Q

Extreme hyperextension of the foot due to external rotation of the calcaneus, overstretched achilles tendon and tight anterior musculature

A

Calcaneovalgus

” up and out”

526
Q

Rocker bottom feet

Reversed arch, convex plantar surface and deep crease on the lateral dorsal side of the foot

A

Congenital vertical talus

527
Q

Painful non-healing tongue ulcer for 3 months

Smoker

Tender solid 2 cm nodule on left lateral tongue. Lesion is whitish in color with marked ulceration and accompanied by surrounding erythema.

Two anterior cervical lymph nodes are palpable

A

Squamous cell carcinoma

Most common cancer in oral cavity

Especially if smoke

Ovar cavity lesion not healed in 6 weeks w/ LAD

528
Q

Leukoplakia does not

A

ulcerate

529
Q

First step for vulvar lesion

A

Punch biopsy of raised lesion

530
Q

Acetic acid in vaginal exam

A

Only for use w/ colposcopy

531
Q

Imiquimod cream

A

Used for vulvar intraepithelial neoplasia (VIN)

532
Q

2 wk old with rash. Bumps on back of infants scalp. Progress ot whole scalp and neck.

Tx

A

Seborrheic dermatitis (cradle cap)

Self limiting

Greasy scales on scalp

533
Q

Atopic dermatitis

A

presents after 3 MONTHS

pruritis and recurrent

Topical and systemic steroids

534
Q

Diabetic first line medication

A

Metformin
(biguanide)

Decreases hepatic gluconeogensis

535
Q

People who should get Hep A vaccine

A

People traveling to countries iwth high hepatitis A incidence

Working in Hep A lab

Homelessness

If have Hep B/C

Risk of chronic liver disease

536
Q

Neurotoxin secreted from bacteria

A

Botulinum toxin by clostridium botulinum.

Prevents release of acetylcholine

Descending paralysis starting at trunk to extremities

537
Q

Metabolic and vascular effects on peripheral nerves

A

Diabetic neuropathy

Accumulation of sorbitol can cause microvascular damage

538
Q

Tx febrile seizures

A

Acetaminophen and reassurance

539
Q

Antibiotic contraindicated in 7 y.o

A

doxycycline (tetracycline)

risk of tooth enamel staining

540
Q

Acne tx

A

Topical benzoyl peroxide

Tetracycline, macrolides, erythromycin

541
Q

Diabetic retinopathy work up

A

Fluorescein angiography

Stain will elucidate microaneurysm formation and neovascularization

542
Q

Falling curtain

Floaters in eyes

A

Diabetic retinopathy

falling curtain : Signifying vitreous bleeding

Floaters: resolution of bleed

543
Q

Fluorescein staining

A

diagnose corneal abrasions, ulcers and infections

544
Q

Duodenal ulcer perforates and damages

A

gastroduodenal artery

545
Q

Perforated gastric ulcer

A

Left gastric artery

546
Q 
RUQ pain
Hepatomegaly
Jaundice
Ascites
Variceal bleeding
A

Hepatic vein disease

Budd chiari syndrome

Diagnosis by dopple US

547
Q

tumor marker of testicular choriocarcinoma

A

beta-hCG

548
Q

Painless testicular mass
Bilateral increased breast tissue
confusion/ headaches

Solid intratesticular mass with necrotic center

A

Testicular choriocarcinoma

non-seminomatous tumor

Most aggressive of germ cell tumors

Hematogenous spread= brain metastases

549
Q

Frontotemporl dementia vs alzheimers

A

FTD is commonly before 65 years of age

550
Q

w/o spleen need what vaccines

A

H. influenzae type B vaccination

Monovalent meningococcal serogroup B (MenB)

First dose of quadrivalent meningococcal conjugate ACWY ( Men ACWY)

13-valent pneumococcal conjugate vaccine PCV13

551
Q

PPSV23

A

less effective in immunocompromised

Use in those w/ chronic illlnesses non immunocompromised

> 65 y.o

552
Q

Craniosynostosis

A

premature, abnormal fusion of cranial suture lines

553
Q

Obese child that is learning how to walk who appears to have both his feet facing outward at 90 degree angles when standing

Legs have 90 degrees of ER and limited internal rotation

A

Femoral retroversion

554
Q

Genu varum

A

Bowlegs

555
Q

Genu valgum

A

Knock-knees

556
Q

Metatarsus adductus

A

Pigeon toe

Lateral foot border appears C shaped

557
Q

Stiffness in neck, radiates to arm. Numbness is upper extremity and lower extremity hyperreflexia

Imaging

A

MRI of cervical spine

Cervical stenosis

558
Q

Elevated Serum alkaline phosphatase

A

Paget disease of the bone

559
Q 
Pain
Hearing loss
Bowing of the long bones
Lytic lesion
Cortical thickening on imaging
A

Paget disease

560
Q

Initial Tx carpal tunnel

A

Neutral wrist splinting

561
Q

Most effective first step for insomnia

A

CBT

562
Q

scaphoid bone located where

A

anatomical snuff box

563
Q

Hand bones

A

Some Lovers TRI Positions That They Cant Handle

Radial to ulnar

564
Q

Tenderness to palpation on the ulnar aspect of wrist in the proximal hypothenar area

1 cm distal to the flexion crease of the wrist

A

Hook of hamate fracture

565
Q

What to do with tooth if knocked out

A

transport in cold milk or childs saliva

566
Q

Mono is due to what virus

A

EBV

567
Q

Cherry red spot
GM2 ganglioside

Deficiency of

A

Tay-Sachs Disease

Hexosaminidase A

No hepatosplenomegaly

568
Q

Fabry deficiency of

A

Alpha-galactosidase A

Accumulate of glycosphingolipids

Cardiomegaly
Punctate, nonblanching dark red to blue black clusters of ectatic blood vessels directly under skin
Renal failure

569
Q

GM1 gangliosidosis

A

AR

Deficiency of beta-galactosidase A

Hepatosplenomegaly
Cherry red spots
Defective ossification
Facial coarsening
Rapid neurological decline
570
Q

Gaucher disease

A

AR

Deficiency of beta-glucosidase

Glucocerebroside accumulates

Crumbled tissue paper appearance

Ashkenazi jewish

Painless splenomegaly
Anemia
Thrombocytopenia
Fatigue
bruising
neurological impairment
bone pain

Erlenmeyer flask deformity of femur

571
Q

Niemann pick

A

AR

Deficiency sphingomyelinase

Accumualtes sphingomyelin

Ashkenazi jew

Lung disease
Hepatosplenomegaly
Short stature
pancytopenia

Cherry red spot
Neurologic impairment

572
Q

Patietn w/o pulse and no electrical activity what medication

A

Epinephrine for asystole

573
Q

Amiodarone

SE

A

Second medication utilized in VF and pulseless VT if inital vasopressor medication used (epinephrine or vasopressin)

Hepatotoxicity
pulmonary effects (interstitial pneumonitis, pulmonary fibrosi)
Hypotension
Hypothyroidism
CNS disturbances (ataxia, memory disturbances, movement/ coordination issues)
Photosensitivity
Optic neuritis/ neuropathy

574
Q

Atropine

A

Used in patients with symptomatic bradycardia

Avoid w/ AV lbock

575
Q

Digoxin

A

Dont use in WPW

Tx CHF

576
Q

Digoxin effect on ECG

A

Downward scooping of ST segment and inverted T waves

577
Q

B12 deficiency left untreated leads to

A

ataxia

Develop irreversible neurologic deficiency

Demyelination of posterior colums leads to loss of position and vibratory sensation and ataxia

578
Q

Bromocriptine MOA

A

Dopamine receptor agonist

579
Q

Dopamine receptor antagonists tx

A

Psychosis

580
Q

Muscarinic receptor antagonists

A

Tx cholinergic toxicity

Cholinergic toxicity
diarrhea, urination, bradycardia, bronchospasm, lacrimation, lethargy, salivation seizures

581
Q

AA 1 y.o mother with anemia. Height weight and head circumferance in 25% for age

Low hemoglobin
Normal paltelet
Low MCV
Normal red blood cell distribution

Target cells
Tear drop cells

Normal iron
ferritin
TIBC

A

Beta-thalassemia minor

Microcytic anemia

Normal red blood cell distribution

Target or tear drop shpaed cells

Diagnosis confirmed with Elevated hemoglobin A2 level on hemoglobin electrophoresis

582
Q

Pure red cell aplasia

A

normocytic anemia

ineffective erythropoiesis of RBC line caused b infection w parvovirus B19

583
Q

Tall peaked T waves
Shorted QT interval

Muscle weakness
Heart palpitations

A

Hyperkalemia

584
Q 
Painful neck
thyromegaly
Fever
No nodules
Muscle weakness

lab value

A

Subacute thyroiditis

First phase: elevated free T4

Third phase: Elevated TSH

585
Q

Thyroid peroxidase antibody

A

Hashimoto thyroiditis

586
Q

Thyroid stimulating immunoglobulin

A

Grave’s disease

587
Q

Ezetimibe

A

inhibits dietary cholesterol absorption in the intestine by binding to Niemann-pick C1 like 1 protein

588
Q

Cholestyramine

Colesevelam

A

Bile acid sequestrants

bind to bile acids in gut and prevent reabsorption of bile acids.

SE flatulence and loose lbowel movements

Adjuvant medication to statins to help further decrease LDL

589
Q

Pruritus due to hyperbilirubinemia in liver failure patient what medication

A

Bile acid sequestrants

Cholestyramine
Colesevelam

590
Q

Used to help lower triglycerides

A

Fibrates

  • fenofibrate
  • gemfibrozil

Work by inducing lipoprotein lipase

Which decreases hepatic production of apolipoprotein CIII via peroxisome proliferator- activated receptors (PPARs) alpha activity

Triglyceride level > 1000

591
Q

Inhibiting HMB-CoA reductase

A

Statins

Also increase cholesterol metabolism

Decreasess both LDL and triglycerides

Muscle cramping

Assess hepatotoxic and liver function

592
Q

Nicotinic acid moa

A

Niacin

Inhibits peripheral mobilization of fatty acids

Decreases the quantity of substrates needed for hepatic synthesis of triglycerides and VLDLs

Helps to increase HDL levels

SE: flushing

593
Q

4 y.o flu 10 days ago. Swelling in legs and face. Albumin of 4+. serum albumin concentration elevated. Urine protein

  • diagnosis
  • tests
A

Minimal change disease

Renal biopsy and electron microscopy

Showing retracted of the epithelial foot process

Nothing on light microscopy or imaging

594
Q

Increased mesangial matrix and increased mesangial hypercellularity in diffuse mesangial porliferation

A

DMP

595
Q

Discrete segments of glomerular tuft reveal sclerosis

A

Segmental

596
Q

Some glomeruli involved and some spared

A

focal segmental glomerulosclerosis (FSGS)

597
Q

Lobulated glomeruli and mesangial proliferation

A

membranoproliferative glomerulonephritis (MPGN)

598
Q

Low serum complement C3, C4 levels found in

A

Post-infectious nephritis

MPGN

Lupus nephritis

599
Q

Multiple tender erythematous nodules located on the lower extremities (extensor portion) recent illness or pregnancy

A

Erythema nodosum

Also inflammatory bowel, oral contraceptive use, and sarcoidosis can cause

600
Q

Hypopigmented patches (ash leaf spots)
Mental retardation
Epilepsy

Firm papules over the face and growths around the nails

Also grow

A

Tuberous sclerosis

AD

Adenoma sebaceum: Firm papules over the face

periungual fibromas: growths around the nails

Shagreen patches: yellow plaques with a pigskin consistency located on back and buttocks

Cafe au lait spots

Phakomas: yellow retinal plaques

601
Q

Stages of kidney disease

A

GFR

Stage 1: > 90 mL
asymptomatic

Stage 2: 60-89
asymptomatic

Stage 3a: 45-59
anemia, hyperparathyroidism, htn, fluid retention, electorlyte abnromalities

Stage 3b: 30-44
worsening complications

Stage 4: 15-29

Stage 5: < 15
require hemodialysis

602
Q

Joint locking up, popping and catching sensation

Walk with externally rotated leg

Joint crepitus and effusions on palpation

Gradual onset of pain

A

Osteochondritis dissecans

Occurs when cracks form in the cartilage and underlying bone

Leads to avascular necrosis of portions of the bone and fragmentation of tissue into the joint space.

603
Q

Pes anserine bursitis

A

Repetitive stress to area

Pain when rising from seated position, ascending stairs, localizes to interior knee (proximal, medial aspect of tibia)

604
Q 
2 y.o 
Fever 104
Rash- flat blotchy erythematous rash on chest, abdomen and back without pustules or desquamation
Red eyes and mouth
Unilateral Enlarged cervical LN
Hands/ feet swollen
Erythema palms and soles
Conjunctivitis
Dry cracked lips

Tx

A

Kawasaki disease

Acute vasculitis in children < 5 y.o

Intravenous immunoglobulin to help prevent coronary artery aneurysms

High fever
Unilateral cervical lymphadenopathy
swelling and erythema palms and soles, bright red oral mucosa

IVIG
Antipruritics
Analgesics (acetaminophen, high dose aspirin)

605
Q

Bright red oral mucosa
Strawberry tongue
Desquamation of hands and feet
Rash

A

Scarlet fever (strep pyogenes)

Antibiotics penicillin

[Doesnt have dry cracked lips, or conjunctivits]

606
Q

Fever, anorexia, weight loss, joint pain, and photophobia

tx

A

malaria

Hydroxychloroquine

607
Q

Plasma exchange

A

performed in cases of polyarteritis nodosa in patients positive with Hep B or C in attempt to clear virus

608
Q

Most significant modifiable risk factor for stroke

A

HTN

609
Q

Childhood disintegrative disorder

A

Devlopmental disorder characterized by normal development until at least 2 years of age followed by regression of language, socail and motor skins

Differentiate from Rett, mets milestones for 2 like climbing stairs, stacking six blocks and two word phrases and following two step commands

610
Q

Child who does not bable by 1 year and not use any words by 15 months no intelligible speech at 2

A

Expressive language disorder

611
Q

Long narrow face, prominent chin, large ears and large testicles
Pale blue irises, high arched palate, joint hyperlaxity

Developmetnal delay

A

Fragile X

X linked dominant

Mutation FMR1

Causes CGG trinucleotide expansion and symptoms will be worse the longer the expansion

612
Q 
Female
Developmental regression
Microcephaly
Mental retardation
Seizures
Hand wringing
A

Rett syndrome

Develop milestones all the way up to 18 months (runs, kicks ball, can stack 4 blocks, begins to toilet train, can name objects)

613
Q

Vaccine to not give immunocompromised

A

Varicella
MMR
Live flu vaccine

614
Q

Vaccine to give HIV patient

A 
Hep B
HPV
Inactived influenza
Pneumococcal
TdaP
615
Q

Avascular necrosis risk factors

A

corticosteroid use

heavy alcohol consumption

616
Q

What medications cause low potassium

A

Albuterol

Beta agonists, inhaled or systemic increase potassiumuptake by cells

Insulin
Loop diuretics
(furosemide, bumetanide)
Sodium polystyrene sulfonate
Alkalinizing agents
(sodium bicarbonate)
617
Q

Losartan causes

A

hyperaklemia

decrease in aldosterone, decrease in activation of Na/K pumps

618
Q

What is elevated in sickle cell disease

A

Reticulocyte percentage

619
Q

Common complication of sickle cell disease

A

avascular necrosis of the femoral head

620
Q

Encapsulated bacteria

A

SHiNE SKiS

Strep pneumoniae
Haemophilus influ B
Neisseria meningitidis
Ecoli
Salmonella
Klebsiella
Streptococcus agalactiae
621
Q

Erythrocyte sedimentation rate

A

rate at which RBC settle in 1 hr

Elevated in inflammatory states due to an increased concentration of fibrinogen that causes RBC to stick together in rouleaux formation

Erythrocytes sedimentation rate is decreased in sickle cell disease, CHF, spherocytosis, polycythemia

622
Q

Diagnosis of multiple myeloma needs what

A

Serum and urine electrophoresis

623
Q

Pneumothorax vs hemothorax

A

Pneumothorax

  • dyspnea
  • chest pain
  • decreased or absent breath sounds
  • HYPERRESONANCE to percussion

Hemothorax
- Dullness to percussion

624
Q

Metoclopramide

A

dopaminergic antagonist used as adjunct to abortive migraine therapy in those who n/v is predominant symptom

SE: acute dystonic rxn (spasmodic or sustained muscle contractions)

625
Q

Metoprolol

A

beta blocker used in migraine prophylaxis in patients with frequent migraines

626
Q

Sumatriptan

A

serotonin receptor agonist

primary abortive therapy in migraine headaches

Contraindicated in those w/ HTN, CAD or peripheral vascular disease

627
Q

Topiramate

A

antiepileptic used in migraine prophylaxis or those whom abortive therapies are ineffective or contraindicated

628
Q

Protein C deficiency

A

inherited thrombophilia that typically presents with venous thromboembolism

hypercoagulable

629
Q

Ototoxicity

A

Aminoglycosides

  • gentamicin
  • tobramycin
  • amikacin
  • neomycin
  • streptomycin

Vancomycin

Aspirin

Cisplatin

630
Q

Lithium SE

A

Nephrogenic diabetes insipidus

Direct nephrotoxicity

Thyroid disturbances

Ebstein anomaly in fetus

631
Q

B12 deficiency bug/ worm

A

Diphyllobothrium latum

pallor
fatigue
weakness
bilateral burning/ numbness/ in feet

632
Q

Ascaris lumbricoides

A

Intestinal obstruction and lungs

round worm

nonproductive cough with fevers, crackles, wheezing and oval infiltrates on xray.

Human feces as fertilzer

633
Q

Giardia lamblia

A

contaminated water

Malaise
Diarrhea
foul smelling flatulence

634
Q

Taenia saginata

A

Undercooked beef

WL
Abdominal pain
nausea
Passing tape worm segments in stool

635
Q

Taenia solium

A

Two routes: eating raw meat or fecal oral transmission

Fecal oral –> brain

Abdominal pain
cramping
N/v
loss appetite

Appendicitis

636
Q

Preeclampsia severe features

A

Visual changes

Headache

Pulmonary edema

N/V, RUQ pain

Anemia

Thrombocytopenia

Proteinuria >= 5 g in 24 hr

3+ on two dip sticks 4 hrs apart

637
Q

Urinary obstruction in male infant

Grunting when peeing

Needed to confirm diagnosis?

A

Posterior urethral valves

Membranous folds within the posterior urethra that cause urinary obstruction in male infants

Grunting and straining when urinating

Failure to thrive

Urosepsis

Voiding cystourethrogram

638
Q

Bladder US shows

A

urinary obstruction or dilated bladder

639
Q

Cystoscopy

A

therapeutic procedure for posterior urethral valves after diagnosis is made

Obliterating the posterior valves

640
Q 
abdominal pain
bloody diarrhea
WL
night sweats
elevated ESR and CRP
pANCA
A

Ulcerative colitis

641
Q

string sign

A

Crohns disease

642
Q

ASCA positive

A

anti-saccharomyces cerevisiae ab

Crohns disease

643
Q

Fistula formation

Skip lesion

A

Crohns disease

644
Q

Screening for DM

A

Over age 45 every 3 years

Fasting blood glucose > 125

645
Q

Tx premature ejaculation

A

SSRI

646
Q

Drug that blocks alpha adrenergic receptors for penis

A

Yohimbine

Psychogenic erectile dysfunction

647
Q

Scotch tape test

A

Enterobius vermicularis

648
Q

Profuse watery mucoid diarrhea with abdominal cramping

Cough, wheezing, pleuritic chest pain
Hemoptysis

Pruritic linear urticarial rash of 1 or more bands

Stepping on soil

A

Strongyloides stercoralis

649
Q

82 y.o chronic cough, sporadic crackles over right lung fields, puts petroleum jelly on chest

Chest xray several poorlyd efined opacities in right lower lobe with bilateral reticulonodular pattern

Foamy macrophages with large cytoplasmic vacuoles and extracellular hdrophobic droplets

A

Lipoid pneumonia

Aspiration pneumonia caused by inhalation or aspiration of exogenous lipoid oils

650
Q

Anti-glomerular basement membrane antibodies

Pulmonary and renal

Hemoptysis
Cough
Fever
hematuria
proteinuria
RBC casts
A

Good pasture syndrome

651
Q 
Sinusitis
otitis medica
cough
renal failure
c-ANCA
A

Granulomatosis w/ polyangiitis

Small vessel vasculitis

652
Q

Ectopia cordia

A

failure of sternum to form

leaving the heart and upper abdominal cavity covered by only a thin layer of skin

Heart expossed

653
Q

Adolescent athlete with knee pain and point tenderness at tibial tuberosity

A

Osgood- Schlatter disease

Osteochondritis of tibial tubercle

Inflammation of patellar ligament where it attaches to the tibial tuberosity

654
Q

Patellar tendinopathy

A

jumpers knee

anterior knee pain that increases over time, worsens with use, may cuase limp

Tenderness more prominent in and localized to the patellar tendon (not tibial tuberosity like osgood schlatter disease)

655
Q

Asymptomatic children with diffusely enlarged, firm non-tender thyroid

test?

A

Autoimmune thyroiditis (hashimoto’s)

TSH, free T4 (thyroxine) and anti- thyroid ab

656
Q 
Headaches
dizziness
erythromelalgia (burning pain)
visual impairment
pruritus

Labs
Mutation

A

Polycythemia vera

Myeloproliferative disorder

hyperviscosity of the blood

Splenomegaly
engorded retinal veins
elevated 
- hemoglobin
- wbc
- platelets
- hematocrit

JAK2 mutation

657
Q

8 day cough
temp 100
tenderness over maxillary region

A

Rhinovirus

Unilateral facial pain/tenderness over cheek

Painin teeth, tymple, vertex or occiput

Erythema nose, cheeks, or eyelids

Postnasal drip or nasal congestion

Cough

658
Q

Bacterial infection (5)

A 
Symptoms > 10 days
Symptoms improve then intensify within 10 days
Fever >102
Purulent nasal discharge
Severe facial pain
659
Q

AAA 4-5.4 cm

A

Repeat US 6-12 months

660
Q

AAA screening

A

65-75 if smoked

661
Q

Surgical repair for AAA

A

elective surgical repair reserved for AAA > 5.5 cm

662
Q

Camper
Diarrhea
Watery malodorous, greasy

A

Giardia lamblia

663
Q

Drinking or swimming water
Mild watery diarrhea in adult
IC: biliary tract involvement

A

Cryptosporidium

664
Q

Immigrant or travelers
Bloody diarrhea
Liver abscess

A

Entamoeba histolytica

665
Q

Abdominal pain
vomiting
Diarrhea
15 hr after ingestion of seafood

A

Vibrio vulnificus

666
Q

Take alpha-1 adrenergic (terazosin) for

when

A

At bedtime

enlarged prostate

Postural hypotension
Lightheadedness

667
Q

Fell on back of right hand

Supination

Tenderness of lateral distal aspect on right forearm

A

Distal radius w/ associated ventral displacement

Smith or reverse colles fracture

falls on flexed wrist

668
Q

Falling on outstretched hand

A

Colles fracture

fracture of the distal radius with associated dorsal displacement

669
Q

Fractures of ulna

A

unlikely to occur in isolation

670
Q

Barking cough
Nasal flaring
Intercostal retractions
Stridor

Steeple sign

A

Croup

parainfluenza virus

671
Q

Most common pharyngitis

A

Fever
No cough
Anterior cervical lymphadenopathy or tonsillar erytehma

Streptococcus pyogenes

672
Q

Virus that can cause pancreatitis

A

Mumps

673
Q

Pancreatitis stool

A

Tan and floats less dense due to malabsorption of fat from exocrine pancreas insufficiency

674
Q

Sore throat and a coalescing gray pseudomembrane in the oropharynx that bleeds when removed

A

Corynebacterium diphtheria

Risk for cardiotoxicity and neurotoxicity

675
Q

Rash on face spreads to trunk and limbs

A

Rubella adult

676
Q

Infant with cataracts
Deafness
Patent ductus arteriosus (machine like murmur)

A

Rubella

677
Q

Rubeola

A

measles

High fever before cough, coryza and conjunctivitis

678
Q

Ulcers that pop up in mouth when stressed

tx

A

Aphthous ulcers

Triamcinolone (oral rinse)

679
Q 
Cough
muscle pains
headaches
Traveled to Ohio for hiking
Fever
Bilateral focal infiltration with hilar lymphadenopathy
A

Histoplasmosis

680
Q 
Southwestern of US
Fever
Dyspnea
Cough
Fatigue
Arthralgias

Unilateral infiltrate with ipsilateral hilar adenopathy

A

Coccidioidomycosis

681
Q

Tuberculosis location in lungs

A

Ghon complex hilar adenopathy

Caseous lesion in lower lung field

682
Q

Tachycardia
narrow QRS complexes w/o P waves

Tx

A

SVT

Adenosine

683
Q

A1C goal of elderly with life expectance less than 10 years

A

8.0%

684
Q

A1C goal for normal DM

A

<7%

685
Q

A1C at risk for DM

A

5.7-6.4

686
Q

Clonidine

A

Not appropriate first step for tobacco cessation or alcohol

Can be used for opiate cessation

alpha 2 noradrenergic agonist

Decreases autonomic arousal and symptoms

Third Year Shelf (7 decks)

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