First 200 Flashcards
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1
Q
Low sodium with a lung mass
- Identify
- Treatment
A
- SIADH
- Treat lung CA, drug Demeclocycline (inibits ADH in distal convoluted tubule), hypertonic saline
(demigod Crook on a cycle)
2
Q
Foul-smelling sputum with right lower lobe infiltrate
Identify
A
Aspiration pneumonia
Causes by alcoholism, reflux, dementia, seizures etc
3
Q
A diabetic infant will have (and why):
- Hypoglycemia / Hyperglycemia
- Hyperviscosity / Hypoviscosity
A
- Hypoglycemia - High maternal BG has baby making high levels of insulin
- Hyperviscosity - 2/2 polycythemia due to hypoxia caused by maternal high basal metabolic rate (diabetes)
4
Q
MCD: Child aged 2-5 with flank mass
A
Wilms tumour
5
Q
Neutrophil count <500/mm3 and fever following chemotherapy
Identify & treatment
A
Febrile neutropenia
Blood cultures, admit pt, start emperic abx (3 or 4th gen ceph)
6
Q
Sudden familial cardiac arrest, possibly african-american
- Most likely diagnosis
- Murmur will increase / decrease with what?
A
- Hypertrophic cardiomyopathy
2. Decrease with handgrip, Increase with valsalva
7
Q
MCD: Joint pain with painless lesions and a new sex partner
A
Disseminated gonococcal infection
8
Q
Recurrent cheek mass
- Diagnosis
- Which nerve is in danger with surgery
A
- Recurrent parotid neoplasm
2. Facial nerve
9
Q
Stepwise treatment for ascites. List the 4
A
- Sodium and water restriction (2L per day)
- Pot-sparing diuretics eg. Spironolactone
- Loop diuretic (not exceeding 1L per day)
- Frequent tapping
- pt presents (W)ith POT-belly LOnging for TAPPING
10
Q
MCD: Delayed separation of the umbilical cord with periodontal abscesses
A
Leukocyte adhesion problems
11
Q
Pt with pheochromocytoma was given a drug after which BP spikes suddenly
- What drug was given
- Why did this happen
A
- Beta blocker
- Giving a beta blocker without an alpha blocker causes unopposed alpha stimulation, causing a spike in BP. Make sure to give an alpha first, or give the alpha and beta blockers at the same time
12
Q
MCD: Kid with pes cavus, absent ankle jerk, gait problems
A
Friedrich’s Ataxia
13
Q
Swollen face & body following trauma or infection
- Diagnosis
- Main peptide involved & why its involved
A
- Angioedema 2/2 C1 receptor dysfunction
2. Bradykinin increases due to the above dysfunction
14
Q
Bilateral muscle weakness a) with elevated CK or b) with normal CK levels
- Diagnosis
- Diagnostic test
A
A) With elevated CK levels - hypothyroidism, test TSH levels
B) With normal CK levels - polymyositis, do muscle biopsy
15
Q
How do statins cause myopathy?
A
Statins inhibit HMG-CoA reductase which prevents HMG-CoA from converting to mevalonate. Mevalonate is needed for synthesis of CoQ10, which - reduced - leads to myopathy
16
Q
Where are craniopharyngiomas, and what do they cause
A
Above sella tursica, compressing the pituitary and optic chiasm
Causes bitemporal blindness (tunnel vision) and headaches
17
Q
MCD: “String of beads” angiogram of renal artery & bruit over costovertbral angle
A
Fybromuscular dysplasia (most common 2dary HTN in kids)
18
Q
Most common cause of corneal blindness in the US?
A
HSV infection
19
Q
HIV patient presenting with
1) painful retinal necrosis, fundoscope reveals central retinal necrosis
2) painLESS loss of vision, fundoscope shows fluffy or granular lesions around retinal vessels
What infection?
A
1) painful - HSV or VZV
2) painless - CMV
- Top HHVs are the painful ones, the lower HHV-5 (CMV) is the poefter causing painless with fluffy findings
20
Q
MCD: Itching, xanthomatous lesions and hepatomegaly
A
PBC
21
Q
Which diseases are linked to anti mitochondrial antibodies? (mnemonic)
A
People leaving AMA gets out to SEE “C” the STReet
C - celiac disease
S - Sjogrens, scleroderma
T - thyroid, hypo and autoimmune thyroid disease
R - Raynauds
22
Q
What is CREST syndrome?
A
C - Calcinosis (calcium deposits in skin, pink-white nodules on skin)
R - Raynaud’s
E - Esophageal dysmotility
S - Sclerodactyly - Joint pain & fibrosis of skin (shiny appearance)
T - Telangiectasias (“Mat-like” patches on face and arms)
23
Q
Difference between esophageal dysmotility with INCREASED or DECREASED LES tone?
A
Increased LES tone - think achalasia (also birds beak)
Decreased tone - think scleroderma (possibly as part of CREST)
24
Q
Based on organ damaged, differentiate between ethylene glycol and methanol poisoning
A
Ethylene glycol - damages kidneys (damages EGg shaped organs)
Methanol - damages eyes (MMMMMy eyes!!)
25
What are the 4 things to look for with multiple myeloma?
CRABS
C - Calcium high
R - Renal impairment
A - Anemia
B - Bone pain
26
Symptoms of iron intoxication
Phase 1 - GI symptoms (bleeding, 30min - 6 hrs) >>> Sudden onset (Iron brew will stab through you), upper endo first
Phase 2 - Latent (asymptomatic, 6-24hrs)
Phase 3 - Sudden shock & metabolic acidosis (6-72hrs)
Phase 4 - Hepatotoxicity (12-96hrs)
27
MCD: Pain with active and passive lifting of arm above the head, hx of repetative movement ABOVE the head (look for painters)
Rotator cuff tendonitis / impingement
- painters pain-T(endonitis)-I(mpinge)-ng
28
Withdrawel of what drug leads to tonic-clonic seizures?
Alprazolam (short acting benzo)
29
MCD: Neonate with bilateral cataracts, hypoglycemia and jaundice
Caused by?
What if it was cataracts WITHOUT jaundice?
Galactosemia
Caused by galactose-1-phosphate uridyl transferase deficience
Without jaundice - galactokinase deficiency
30
Granulations seen in ear with pain and drainage
Diagnosis?
Cause?
Treatment?
Malignant Otitis Externa
Pseudomonas Aeruginosa
Systemic ciprofloxacin
31
Post-op patient with sudden onset nausea, vomiting, hypotension, hypoglycemia AND hx of steroid use?
Acute adrenal insufficiency
32
How do VIPomas present?
- Mass in the head of pancreas
- Watery diarrhea
- Signs of hypokalemia (leg cramps)
- Decrease of amount of stomach acid
33
Which component of the DTaP vaccine usually causes seizures?
Pertussis
34
Buzz words: Enlarged cardiac silhouette which pushes up the left main bronchus
Diagnosis?
Reason / Preceding event?
Treatment?
Rheumatic heart fever
Mitral valve stenosis
Surgery
35
How to differentiate between ARDS and cardiogenic pulm edema?
With ARDS, PCWP will be LESS than 18mmHg. With cardiogenic pulm edema, it will be MORE.
36
Tremor that increases with directed movement in elderly pt
Diagnosis?
Tests?
Treatment?
Essential tremor
MRI of brain & spine
Primidone or propranolol
37
Which are unique to either Parkinson's or Essential Tremor
Unilateral presentation
Head tremor
Resting tremor
Immediate of tremor with movement
PD
ET
PD
ET
38
Inappropriate behaviour, fidgety male with worsening balance
Diagnosis?
Tests?
Treatment?
Huntingtons
Genetic testing / CT scan of brain shows atrophy of caudate & putamen
Symptomatic
39
Infection followed by ascending paralysis
Diagnosis?
Tests?
Treatment?
GBS
Albumino-cytologic dissociation (elevated protein with normal cell count) in CSF
IVIG / plasmaphoresis
40
Patient with paranoid schizophrenia - firstline treatment?
Side-effects?
Last-line treatment? Why?
Risperidone (atypical antipsychotic)
Typical antipsychotics - EPS (extrapyramidal) like laryngospasm
Clozapine - causes agranulocytosis
41
What is the pathology for PROXIMAL vs. DISTAL weakness?
Proximal - think muscle (myopathies, MG)
Distal -think nerve (GBS, ALS etc)
42
Best way to diagnose acoustic neuromas?
MRI with gadolinium
43
Most common cause of comorbidities and mortality following SAH?
Vasospasm with symptomatic infarction & ischemi
44
Difference between partial complex seizures and partial seizure with secondary generalization?
Partial with sec. generalization has TONIC-CLONIC acitivity. Partial complex does not.
45
Pt presenting with ascites and new onset abdominal disconfort and/or AMS
1. Most likely diagnosis
2. Diagnosis
3. Treatment
4. Complications
1. SBP
2. Paracentesis - PMN of >250 and ascites (SAAG score of more than 1.1 means portal hypertension)
3. Abx
4.
46
Pt presents with chronic diarrhea, abdominal pain and weight loss
1. Most likely diagnosis
2. How to diagnose
1. Crohn's
| 2. Labs: Anemia, reactive thrombocytosis. Colonoscopy
47
Does nitroglycerin dilate veins or arteries?
Veins
48
Pt presents with hx of alcohol & smoke with long-standing palpable cervical lymph node
1. Most likely diagnosis
2. How to diagnose
1. Squamous cell carcinoma of the mucosa of the head
| 2. Biopsy & panendoscopy to find primary
49
Preterm baby presents with fever & vomiting in the first 2 weeks
1. Most likely diagnosis
2. How to diagnose
1. Necrotizing enterocolitis
| 2. XRay shows pneumatosis intestinalis
50
Pt presents with hx of HIV and dry cough with exertional dyspnea. Chest xray is fuzzy in the lower lobes
1. Most likely diagnosis
2. How to diagnose
3. Treatment
1. PCP
2. Xray
3. TMP-SMX with steroids
51
Pt presents with bleeding metatstatic lesion in the brain with distant hx of melanoma
1. Most likely origin
1. Malignant melanoma (if he has ANY history of melanoma)
52
Pt presents with acute onset hemolysis following sulfa drugs
1. Most likely diagnosis
2. How to diagnose
1. G6PD deficiency
| 2. Blood smear shows bite cells,
53
Pt presents withblunted calicies on IVP, recurrent UTI's and focal parenchymal scarring
1. Most likely diagnosis
1. Chronic pyolonephritis
54
Pediatric pt presents with hip pain following a URI
1. Most likely diagnosis
2. How to diagnose
3. Treatment
1. Transient synovitis
2. Hip will be flexed, abducted and externally rotated
3. Ibuprofen and weightbearing restriction
55
4 factors to differentiate septic arthritis from transient synovitis
1. Fever > 102
2. WBC count > 12K
3. ESR > 40
4. Refusing weight bearing
Remember : take FeWER risks with SA
56
Pt presents with hx of alcoholism and AMS with fruity breath
1. Most likely diagnosis
2. How to diagnose
3. Treatment
1. Acute hepatic encephalopathy
2. High ammonia
3. Lactulose
57
Young pt presents with acute onset CHF
1. Most likely diagnosis
2. How to diagnose
1. Coxsackie B
| 2. Hepatomegaly, S3, pleural effusion
58
Reed Sternberg cells means..?
Hodgkin lymphoma
59
Pt presents with bone mets and hypercalcemia
1. Most likely diagnosis
2. How to treat 1) acute vs. hypercalcemia due to 2) malignancy or 3) extra production of vit. D
1. Tumour secretion of PTHrP
2. 1. IV saline & furosemide
2. 2. Bisphosphonates
2. 3. Corticosteroids
60
Why are CCBs contraindicated in STEMIs?
It causes PERIPHERAL VASODILATION and cause REFLEX TACHYCARDIA
61
African American Pt presents with bone pain
1. Most likely diagnosis (2)
2. How to diagnose & differentiate the top 2
1. Septic arthritis or osteonecrosis
2. SA - will have fever and joint tenderness with NO weightbearing - caused by staph or salmonella
Osteonecrosis won't have these things
62
How would the following birth-traumas present?
1. Erb-Duchenne
2. Klumpke's
3. Fractured clavicle
1. Absent Moro, waiter's tip
2. Horner's with ipsilateral hand paralysis
3. You can feel the fracture, decreased arm movement
63
What is the OD symptoms of
1. Vitamin A
2. Vitamin D
3. Vitamen K
4. Iron
5. Aspirin
6. Lead
1. A - pseudotumour cerebri, irritability and vomiting (A-list for VIP)
2. D - anorexia, nausea, vomiting, HA, polyuria/dipsia (D is draining)
3. K - hyperbilirubinemia (in kids)
4. Iron - corroding the GI (with related symptoms), hypotension
5. Aspirin - fever, tinnitus, metabolic acidosis with vomiting
6. Lead - ataxia, seizures, abd pain and encephalopathy
64
Pt presents with drug-induced interstitial nephritis
1. Most likely presentation
2. Most likely drug involved
3. Treatment
1. Fever, rash, joint pain. Possibly sterile pyuria.
2. PCNs, cephs and sulfa
3. Stop offending drug
65
Pt presents with CP radiating to the back and a lower BP in the left arm
1. Most likely diagnosis
2. How to diagnose
3. Treatment
1. Aortic dissection
2. TEE
3. Control HTN, stage dissection
66
Pt presents with hx of running or hiking now a multi-week hx of forefoot pain
1. Most likely diagnosis
2. How to diagnose
3. Treatment
1. Morton's neuroma
2. Squeezing 3 & 4th metatarsels together produces a 'click' with plantar pain
3. Support and padded shoes; if this fails, surgery
67
Pt presents with kidney stones and hx of Crohn's
1. Most likely type of stone
Oxalate
68
Paget's disease - what are the calcium, phosphate and AP levels?
Calcium & phosphate - normal
AP - high
69
First line treatment for longterm bipolar / mania?
'shhh, quiet! LOL! Lame...'
Quetiapine, lithium, olanzapine, lamotrigine
70
Pediatric Pt presents with rash & hematuri 2 weeks after infection
1. Most likely diagnosis
2. Complications
3. Treatment
1. Henoch-schonlein purpura
2. Intussusception
3. Steroids & monitoring of renal function
71
Common meds that cause hyperkalemia (4)
ACEI, NSAIDs, K-sparing diuretics like spironolactone and amiloride
72
What is the most common cause for purpura in krimpies
Senile purpura - caused by perivascular connective tissue atrophy
73
Causes for hyponatremia
1. With hypovolemia (2)
2. With euvolemia (3)
3. With hypervolemia (3)
1. GI losses, renal losses
2. SIADH, psychogenic polydipsia, hypothyroidism
3. CHF, cirrhosis, CKD
74
Asthma-like symptoms in someone who has a hx of heart disease who has never had asthma
1. What should be at the top of the ddx?
2. What should the next step be?
Aspirin sensitivity syndrome - pts taking aspirin for the heart condition shows asthma like symptoms...
Start leukotriene-receptor antagonist
75
Baby with olive shaped mass in RUQ
Pyloric stenosis
76
How does pleural fluid pH determine chest tube placement?
If pH is below 7.2, CT needs to be placed
77
Pt presents with a LOT of vomiting in the first trimester
1. Most likely diagnosis
2. What to rule out
3. Treatment
1. Hyperemesis gravidarum
2. Rule out hydatidiform mole or choriocarcinoma with b-HCG levels
3. Supportive
78
Pediatric Pt presents with sustained rotation of his neck to one side, resisting movement. Possible neck swelling.
1. Most likely diagnosis
2. Next step (to rule out what..?)
1. Acquired torticollis
| 2. Xray to rule out cervical spine fracture or dislocation (due to atlantoaxial sublaxation)
79
The difference between scarlet fever and kawasaki?
Scarlet fever has a 3-5 day fever span, and the rash goes away by 6 days.
Kawasaki's fever lasts at least 5 days
80
Pt presents with sudden onset hypotension and massive rise in LFTs
1. Most likely diagnosis
Ischemic hepatic injury
81
Immunocompromised Pt presents with intense superficial pain in localized area
1. Most likely diagnosis
2. How to diagnose
3. Treatment
1. Activated shingles
2. Hx of chickenpox with immunocomprimised state
3. Acyclovir
82
Pt presents with joint pain (prob hip) after long-term corticosterd treatment
1. Most likely diagnosis
2. How to diagnose
1. Avascular necrosis
| 2. MRI of the joint
83
How long after acetaminophen OD do you 1) get a plasma level and 2) administer antidote (what is it?)
1. 4hrs for plasma level
| 2. N-acetylcysteine within 8 hours following ingestion
84
Pt presents with "ruby red lesions" on the lips, possibly other vessels on the skin. Family hx.
1. Most likely diagnosis
2. Most dangerous complication
1. Osler-Weber-Rendau
| 2. AV shubt in the heart or lungs
85
Positive Trendelenburg sign -
1. What is it?
2. What muscle is involved?
3. What nerve innervates?
1. Contralateral hip drooping during monopedal stance
2. Gluteus mini and medius
3. Sup. gluteal nerve
86
"Soap bubble appearance" on epiphysis of a long bone - what is it?
Giant cell tumour
87
Swollen joint - how do you identify
1. Pseudogout (type of crystal, how the crystal is described, pt's relevant history)
2. Gout (same)
1. Pseudo - calcium pyrophosphate; rhomboid, positively birefringent; hx of trauma or surgery
2. Gout - monosodium urate; negatively birefringent needles; hx of similar events (negative needle nikki)
88
Pt with hx of arrythmias / palpitations has increased QRS with stress test
Drug involved?
Which drug prolongs the PR interval?
Flecainide - prolongs QRS
verapamil - prolongs PR
89
Major cause of <4mnth old baby crying for a few hours a day without being soothed?
Colic. Baby will outgrow it by 4mnths
90
With lactose intolerance - what would the stool osmotic gap be (high or low)? What test is used to diagnose L. Intolerance?
HIGH osmotic stool gap
Bath hydrogen test
91
Which symtoms/conditions are associated with the following stones
1. Calium oxalate
2. Calcium phosphate
3. Uric acid
4. Cysteine
5. Struvite
1. 75-90% of stones. Calcium does not have to be high. Look for MALABSORPTION
2. Primary hyperthyroidism, RTA
3. Gout, dehydration
4. Family hx of cysteine stones.
5. Urease producing bacteria (proteus common) this means hx of UTI
92
Pregnancy UTI - drug?
Nitrofurantoin
93
Pt with CP is given nitroglycerin, and the pain
1. .. resolves. What is it likely ot be?
2. .. does NOT resolve. What is it?
1. Resolves with nitro - likely stable angina.
| 2. NO resolve - unstable angina or MI. Possibly GERD etc. also
94
Drug used for V-tach
amiodarone
95
In addition to pain control, how does morphine help in an MI?
improves pulmonary edema
96
Which drugs to give in an acute MI
AABC H MNO
| ASA, ACEI, beta-blocker, clopidogrel, heparin, morphine, nitroglycerin, oxygen
97
Pt with swallowing problems - bird's beak on image. Diagnosis & Treatment?
Achalasia
| Treat with pneumatic dilatation or botulism injection
98
Treatment for esophageal spasm or nutcracker esophagus
Calcium Channel Blockers
99
Pt presents with CP and diffuse ST-elevation
Diagnosis?
It is relieved by which body position?
Most common cause?
Pericarditis
Relieved by leaning forward
MCC - Coxsackie virus
100
Ripping CP radiating to back
1. Diagnosis?
2. Associated with? (genetic)
1. Aortic dissection
| 2. Marfan's
100
Foreign pt with sudden onset heart problems, incl. AFib
1. Likely diagnosis?
2. Most likely etiology (anatomy, microbiology, pathology)
3. What will phys exam reveal?
1. Rheumatic heart fever
2. Strep. pyo, mitral valve stenosis,
3. Diastolic rumble w opening snap
101
WTF is cilostazol?
Antiplatelet
102
Furosemide causes what electrolyte abnormalities?
"Loop loo-ses all except SoChlo"
Hypernatremia, -chloride
Hypokalemia, -magnesemia
103
Pt gets up, BP drops by 18mmHg -
1. What is this called?
2. Which 2 conditions show this?
1. Pulsus paradoxus
| 2. Severe asthma, pericarditis/tamponade
104
Diagnosis-
1. Different BPs in left and right arm?
2. Getting up drops BP.
1. Aortic dissection
| 2. Pericarditis/tamponade, severe asthma
105
Pt with CP relieved with sitting forward 2 weeks after MI.
1. Diagnosis?
2. Treatment?
1. Dressler's - pericarditis 2 weeks after MI. AUTOIMMUNE
| 2. Anti-inflammatory drugs
106
What are the most important lifestyle changes to control BLOOD PRESSURE
1. Weight loss, 2. Physical activity, 3. Salt, 4. Alcohol
107
WTF is alprazolam and used for?
Short-acting benzo
Used in anxiety & panic attacks
108
Most common reason for sudden tachcardia (160-220) in otherwise healthy people
PSVT - AV re-entry
109
WTF is adenosine and used for?
Short-acting AV node blocker
Used for AV re-entry tachies
110
Treatment for PVCs
If symptomatic, amiodarone. If asymptomatic, observe
111
Most common ectopic foci for AF
Pulmonary veins
112
What arrhythmia is seen with digitalis toxicity?
Atrial tach with AV block
113
What type of murmur in young people can be ingnored as benign?
Soft mid-systolic murmurs
114
1. What is the most common cause of death in pt with acute MI?
2. How does this happen?
1. Complex ventricular arrhythmia due to reentry
| 2. Conduction is blocked in areas 2/2 ischemia, creating a v.fib reentrant vent. arrhythmias
115
Most common heart problem with IV drug use
Subacute bacterial endocarditis (look for emboli from either mitral or tricuspid showing up as AKI or diffuse pulmonary infarcts)
116
Which heart drug can cause peripheral edema
Ca-channel blockers (eg. amlodipine)
117
Pt presents with acute CP and pulseless tachy 5 days after MI
Tamponade
118
Definitive diagnosis of AS
Echo
119
How does niacin cause flushing?
Prostaglandin-induced peripheral vasodilation
120
List the 3 major mechanical complications following an MI
1. Papillary muscle rupture resulting in MR (pansystolic murmur WITH radiation to axilla)
2. Left ventricle free wall rupture (tamponade)
3. Interventricular septum rupture (pansystolic murmur w/o radiation)
121
Pink-white lesions on skin
1. Small ones ..?
2. Large ones ..?
1. Calcinosis (think scleroderma)
| 2. Psoriasis
122
Pericarditis with chronic renal failure and BUN > 60
1. Diagnosis
2. Treatment
1. Uremic pericarditis
| 2. Hemodialysis
123
Pt from South America with megacolon/megaesophagus and cardiac issues - diagnosis?
Chagas (protozoan)
124
How is reflux diagnosed?
24hr - pH monitoring
125
What should you worry about with breath-holding spells?
Iron-deficiency anemi
126
What is the HR in
1) atrial tach
2) atrial flutter
1) 150-250
| 2) 250-350
127
Complications following an MI (causing what 2 things):
1) First 3-7 days
2) 5 days after
2) Weeks to months (with chest pain)
3) Days to months (no chest pain)
1) papillary muscle rupture - causes severe MR and pulm. edema
2) ventricle wall rupture - acute tamponade & PEA
3) Dressler's - autoimm. pericarditis, diffuse ST-elevations
4) ventric. aneurysm - diffuse ST-elevations with MR
128
Pt with intense CP, unilateral pleural effusion which shows high amylase content
Name two possibilities, with the differentiating finding
Esophageal rupture or acute pancreatitis
Pancreatitis would not have a widened mediastinum
129
SBE with confirmed Strep Viridans (PCN susceptible) - 2 treatment options?
1) PCN G IV
| 2) Ceftriaxone IV
130
SBE - bug involved? Oral or IV abx?
Strep viridans
IV ONLY!! No oral abx
131
Treatment for HCOM
B-blocker. Consider CCB if pt cannot tolerate BB
132
What is the difference between amlodipine and diltiazem?
Amlodipine - peripherally acting CCB
| Diltiazem - centrally acting CCB
133
What heart drug causes hypothyroidism?
Amiodarone
134
Whatmeds should be held prior to a stress test?
B-Blockers and digoxin
135
Adults with painless hematuria - first item on ddx?
Kidney, bladder or ureter malignancy
136
Pt from middle east or africa presenting with painless hematuria - top on the ddx?
Host?
Schistosoma infection
Snail
137
Treatment of fractured clavicle during birth?
Reassurance. It will heal in 3-6 weeks.
138
Most common bug for acute unilateral lymph node swelling?
S. aureus
139
Characteristics of endometritis (4)
Treatment?
FULL & FOUL
Fever, Uterine tenderness, Leukocytosis, Foul Lochia
Clinda & gent
140
How does acyclovir affect kidneys?
Causes renal tubule obstruction via crystalluria
141
Pt returning from Puerto Rico with diarrhea, showing blunting of villi..
Tropical sprue
142
Classic injury in kids with penetrating trauma to the soft palate
Internal carotid dissection / compression - both leading to brain injury
143
Sharp, triphasic discharges on EEG
Creutzfeld-Jakob
144
Treatment for cellulitis with systemic signs (2)
1) oral dicloxacillin
| 2) IV Nafcillin or cefazolin
145
Diagnostic test for divurticulitis
CT scan
146
NFM Type 2 - type of DNA mutation?
Nonsense
147
Where is the classic murmur in HOCM?
Lower left sternal border
148
Typical timeframe for C. Diff following abx start?
4-5 days
149
Most common brain tumour in pediatrics?
Second-most common?
Most common - astrocytoma
Second - medullablastoma
150
Treatment for lichen sclerosis?
Topical corticosteroids
151
Newborn baby who becomes cyanotic when feeding, but pink otherwise - diagnosis?
What is this?
Diagnosis & management?
Choanal atresia - nasal malformation
Diagnose with failure to pass catheter 3-4cm through nose, and then by CT
Treat with endoscopy & surgery
152
Initial treatment for frostbite?
1. Warm water (NOT warm air!)
| 2. Only assess and debride after clear seperation of dead / viable tissue
153
Adolescent onset hirsutism & virilism with HIGH 17-hydroxyprogesterone
CAH
154
Does BPH start in the central or peripheral prostate?
Central
155
Krimpies with unexplained syncopy - first think of what?
Sick sinus syndrome
156
Treatment for Prinzmetal's angina
CCBs or nitrates
157
Most common cause of viral meningitis?
Enteroviruses - coxsackie or echovirus
158
Primary medical treatment for AR and why?
CCBs or ACEI - they decrease afterload, improving AR
159
Why do ACEIs get preescribed post-MI?
To prevent ventricular remodeling
160
WTF - filamentous branching, weakly acid-fast rod
Nocardia
161
How does withdrawal present?
1) Cocaine
2) Heroin
3) Alcohol
4) Amphetamine
5) Nicotine
1) Drowsy, fatigued, hungry (opposite of stimulant)
2) Muscle aches, N/V, lacrimation, sweating (opp. of opiod)
3) Onset 12-48hrs after last drink; sweating, tremors, halluc.
4) Same as cocaine
5) Anxiety, irritability, depression, insomnia, bradycardia
162
WTF is etidronate disodium therapy?
Bisphosphonate therapy.
163
Newborn with bilious vomiting and ground-glass appearance in lower abdomen on xray
Meconium ileus (CF)
164
Wat is the nucleotide repeats in Fragile X?
CGG
165
Kid with prominent jaw, large ears and balls
Fragile X
166
What level is considered iron toxicity?
>350mcg/dl
167
Gout attack with splenomegaly and increased pain with hot water - what is the cause of the gout?
Myoproliverative disorder (prob Polycythemia vera)
168
What is a absolute contraindication for buproprion use?
A history of seizures
169
What part of schizophrenia dictates typical vs. atypical drugs?
Typical is better for positive symptoms, atypical for pos and negative
170
Which STD gets screened for during pregnancy, regardless of risk factors?
Syphilios (with RPR test)
171
What are the treatment options for vaginal cancer?
Surgical resection for stage 1&2 with <2cm tumour
Radiation for stage 1&2 with MORE than 2cm
Combined chemo for stage 3&4 more than 4cm
172
What is the sail sign on infant xray?
Large thymus - NORMAL
173
Principle cell type as source of testosterone
What can these cells also make, and why?
Leydig cells
Estrogen, due to increased levels of aromatase
174
Most common sex cord stromal tumour
How do these present?
Leydig cell tumours
Increased estrogen and testosterone - gynecomastia, precocious puberty
175
Pt with high levels of b-hCG (non-pregnant) - top tumour?
Choriocarcinoma
176
What would you see with a yolk sac tumour, and what other name does it go by?
Rise in serum AFP
AKA endodermal sinus tumour
177
Top 2 reasons for ESRD in the US
1. Diabetes
2. HTN
Look for pts who has never been to a dr, and now shows up with high BUN/Cr
178
What changes in the kidney do you see with diabetics (leading to ESRD)
1. Year 0-1: glomerular hypoperfusion, renal hypertrophy, decreased GFR
2. Year 1-5: glomerular BASEMENT MEMBRANE THICKENING, normalizing GFR
3. Year 5-10: microalbuminuria, leading to nephropathy
179
Bence Jones proteins - what is it?
Disease process?
Monoclonal globulin protein
Multiple myeloma
180
Rouleaux - what is it?
Disease ?
Stacks of RBCs
Multiple myeloma
181
Acute otitis media - 3 most common bugs
Treatment?
Strep pneumo, h. influ and moraxella
("SHAMe" strep, hflu, amox, moraxella)
Treat: amoxacillin
182
Multiple myeloma - age group?
2. Most common complaint?
3. Bone marrow description?
1. Older pts
2. Back pain
3. Overprolifiration of PLASMA CELLS mainly IgG
183
Bone marrow -
"increased marrow cellularity with megakaryocytic hyperplasia"
Essential thrombocytosis
184
Bone marrow -
"Hypoplastic fat-filled marrow with no abnormal cells"
Aplastic anemia
185
Pts with fever, sore throat and muffled (hot potato) voice
What might be seen on oral exam?
Diagnosis?
Treatment?
Deviated uvula
Dx: peritonsillar abscess (often 2/2 tonsilitis)
Treat: aspiration with abx, if unsuccessful - surgery
186
CP 2 weeks after MI, relieved with sitting forward
Diagnosis & treatment
Dressler's - autoimmune pericarditis
NSAIDs, if not relief - steroids
187
Varying amplitude of QRS on EKG
Diagnosis & Treatment
Cardiac tamponadee
Massive fluid ressus & pericardiocentesis
188
Pt with cold leg in the days following an MI
Diagnosis & treatment
Embolus from left ventricle due to stasis
Echo and heparin
189
Systolic murmur that increases with standing up
HCOM
190
Paradoxical splitting of S2
LBBB
191
Low CO, high PCWP, high SVR
Cardiogenic (often left ventricular failure)
192
Pt from latin america with heart problems
Chagas (protozoan)
193
Firstline treatment of high BP (AFTER AFTER lifestyle mods)
HCTZ
193
Kid going into knee-chest for trouble breathing
ToF (tet spell)
194
What is the relationship between calcium and albumin
What is the formula for corrected calcium
Albumin binds calcium, but the measured calcium is the ionized (unbound) calcium
For every 1gm change in albumin above/below 4g/dL, calcium changes by 0.8 (CalAl 148)
195
Middle-aged pts with telengiectasia over cheeks, nose & chin, aggrevated by sun, emotion or hot liquids
Diagnosis?
Treatment?
Rosecea
Topical metronidazole
196
How does low vit. D cause bone issues?
Causes defective mineralization of bone (also cartilage ONLY in kids)
197
Pt with eye pain & redness, exam shows vesicles and dendritic ulcers in the cornea
Diagnosis?
Herpes simplex keratitis
--- HSV IS THE MOST COMMON CAUSE OF CORNEAL BLINDNESS IN THE US ---
198
Pt with eye pain, red eyes, wears contact lenses. Possible hypopyon
Bacterial keratitis
