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First 200 Flashcards

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1
Q

Low sodium with a lung mass

  1. Identify
  2. Treatment
A
  1. SIADH
  2. Treat lung CA, drug Demeclocycline (inibits ADH in distal convoluted tubule), hypertonic saline

(demigod Crook on a cycle)

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2
Q

Foul-smelling sputum with right lower lobe infiltrate

Identify

A

Aspiration pneumonia

Causes by alcoholism, reflux, dementia, seizures etc

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3
Q

A diabetic infant will have (and why):

  1. Hypoglycemia / Hyperglycemia
  2. Hyperviscosity / Hypoviscosity
A
  1. Hypoglycemia - High maternal BG has baby making high levels of insulin
  2. Hyperviscosity - 2/2 polycythemia due to hypoxia caused by maternal high basal metabolic rate (diabetes)
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4
Q

MCD: Child aged 2-5 with flank mass

A

Wilms tumour

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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)

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6
Q

Sudden familial cardiac arrest, possibly african-american

  1. Most likely diagnosis
  2. Murmur will increase / decrease with what?
A
  1. Hypertrophic cardiomyopathy

2. Decrease with handgrip, Increase with valsalva

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7
Q

MCD: Joint pain with painless lesions and a new sex partner

A

Disseminated gonococcal infection

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8
Q

Recurrent cheek mass

  1. Diagnosis
  2. Which nerve is in danger with surgery
A
  1. Recurrent parotid neoplasm

2. Facial nerve

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9
Q

Stepwise treatment for ascites. List the 4

A
  1. Sodium and water restriction (2L per day)
  2. Pot-sparing diuretics eg. Spironolactone
  3. Loop diuretic (not exceeding 1L per day)
  4. Frequent tapping
  • pt presents (W)ith POT-belly LOnging for TAPPING
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10
Q

MCD: Delayed separation of the umbilical cord with periodontal abscesses

A

Leukocyte adhesion problems

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11
Q

Pt with pheochromocytoma was given a drug after which BP spikes suddenly

  1. What drug was given
  2. Why did this happen
A
  1. Beta blocker
  2. 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
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12
Q

MCD: Kid with pes cavus, absent ankle jerk, gait problems

A

Friedrich’s Ataxia

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13
Q

Swollen face & body following trauma or infection

  1. Diagnosis
  2. Main peptide involved & why its involved
A
  1. Angioedema 2/2 C1 receptor dysfunction

2. Bradykinin increases due to the above dysfunction

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14
Q

Bilateral muscle weakness a) with elevated CK or b) with normal CK levels

  1. Diagnosis
  2. Diagnostic test
A

A) With elevated CK levels - hypothyroidism, test TSH levels

B) With normal CK levels - polymyositis, do muscle biopsy

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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

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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

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17
Q

MCD: “String of beads” angiogram of renal artery & bruit over costovertbral angle

A

Fybromuscular dysplasia (most common 2dary HTN in kids)

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18
Q

Most common cause of corneal blindness in the US?

A

HSV infection

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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

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20
Q

MCD: Itching, xanthomatous lesions and hepatomegaly

A

PBC

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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

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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)

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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)

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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!!)

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25
Q

What are the 4 things to look for with multiple myeloma?

A

CRABS

C - Calcium high
R - Renal impairment
A - Anemia
B - Bone pain

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26
Q

Symptoms of iron intoxication

A

Phase 1 - GI symptoms (bleeding, 30min - 6 hrs)&raquo_space;> 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)

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27
Q

MCD: Pain with active and passive lifting of arm above the head, hx of repetative movement ABOVE the head (look for painters)

A

Rotator cuff tendonitis / impingement

  • painters pain-T(endonitis)-I(mpinge)-ng
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28
Q

Withdrawel of what drug leads to tonic-clonic seizures?

A

Alprazolam (short acting benzo)

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29
Q

MCD: Neonate with bilateral cataracts, hypoglycemia and jaundice

Caused by?

What if it was cataracts WITHOUT jaundice?

A

Galactosemia

Caused by galactose-1-phosphate uridyl transferase deficience

Without jaundice - galactokinase deficiency

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30
Q

Granulations seen in ear with pain and drainage

Diagnosis?
Cause?
Treatment?

A

Malignant Otitis Externa

Pseudomonas Aeruginosa

Systemic ciprofloxacin

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31
Q

Post-op patient with sudden onset nausea, vomiting, hypotension, hypoglycemia AND hx of steroid use?

A

Acute adrenal insufficiency

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32
Q

How do VIPomas present?

A
  • Mass in the head of pancreas
  • Watery diarrhea
  • Signs of hypokalemia (leg cramps)
  • Decrease of amount of stomach acid
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33
Q

Which component of the DTaP vaccine usually causes seizures?

A

Pertussis

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34
Q

Buzz words: Enlarged cardiac silhouette which pushes up the left main bronchus

Diagnosis?
Reason / Preceding event?
Treatment?

A

Rheumatic heart fever

Mitral valve stenosis

Surgery

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35
Q

How to differentiate between ARDS and cardiogenic pulm edema?

A

With ARDS, PCWP will be LESS than 18mmHg. With cardiogenic pulm edema, it will be MORE.

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36
Q

Tremor that increases with directed movement in elderly pt

Diagnosis?

Tests?

Treatment?

A

Essential tremor

MRI of brain & spine

Primidone or propranolol

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37
Q

Which are unique to either Parkinson’s or Essential Tremor

Unilateral presentation
Head tremor
Resting tremor
Immediate of tremor with movement

A

PD
ET
PD
ET

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38
Q

Inappropriate behaviour, fidgety male with worsening balance

Diagnosis?

Tests?

Treatment?

A

Huntingtons

Genetic testing / CT scan of brain shows atrophy of caudate & putamen

Symptomatic

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39
Q

Infection followed by ascending paralysis

Diagnosis?
Tests?
Treatment?

A

GBS

Albumino-cytologic dissociation (elevated protein with normal cell count) in CSF

IVIG / plasmaphoresis

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40
Q

Patient with paranoid schizophrenia - firstline treatment?

Side-effects?

Last-line treatment? Why?

A

Risperidone (atypical antipsychotic)

Typical antipsychotics - EPS (extrapyramidal) like laryngospasm

Clozapine - causes agranulocytosis

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41
Q

What is the pathology for PROXIMAL vs. DISTAL weakness?

A

Proximal - think muscle (myopathies, MG)

Distal -think nerve (GBS, ALS etc)

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42
Q

Best way to diagnose acoustic neuromas?

A

MRI with gadolinium

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43
Q

Most common cause of comorbidities and mortality following SAH?

A

Vasospasm with symptomatic infarction & ischemi

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44
Q

Difference between partial complex seizures and partial seizure with secondary generalization?

A

Partial with sec. generalization has TONIC-CLONIC acitivity. Partial complex does not.

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45
Q

Pt presenting with ascites and new onset abdominal disconfort and/or AMS

  1. Most likely diagnosis
  2. Diagnosis
  3. Treatment
  4. Complications
A
  1. SBP
  2. Paracentesis - PMN of >250 and ascites (SAAG score of more than 1.1 means portal hypertension)
  3. Abx

4.

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46
Q

Pt presents with chronic diarrhea, abdominal pain and weight loss

  1. Most likely diagnosis
  2. How to diagnose
A
  1. Crohn’s

2. Labs: Anemia, reactive thrombocytosis. Colonoscopy

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47
Q

Does nitroglycerin dilate veins or arteries?

A

Veins

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48
Q

Pt presents with hx of alcohol & smoke with long-standing palpable cervical lymph node

  1. Most likely diagnosis
  2. How to diagnose
A
  1. Squamous cell carcinoma of the mucosa of the head

2. Biopsy & panendoscopy to find primary

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49
Q

Preterm baby presents with fever & vomiting in the first 2 weeks

  1. Most likely diagnosis
  2. How to diagnose
A
  1. Necrotizing enterocolitis

2. XRay shows pneumatosis intestinalis

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50
Q

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
A
  1. PCP
  2. Xray
  3. TMP-SMX with steroids
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51
Q

Pt presents with bleeding metatstatic lesion in the brain with distant hx of melanoma

  1. Most likely origin
A
  1. Malignant melanoma (if he has ANY history of melanoma)
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52
Q

Pt presents with acute onset hemolysis following sulfa drugs

  1. Most likely diagnosis
  2. How to diagnose
A
  1. G6PD deficiency

2. Blood smear shows bite cells,

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53
Q

Pt presents withblunted calicies on IVP, recurrent UTI’s and focal parenchymal scarring

  1. Most likely diagnosis
A
  1. Chronic pyolonephritis
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54
Q

Pediatric pt presents with hip pain following a URI

  1. Most likely diagnosis
  2. How to diagnose
  3. Treatment
A
  1. Transient synovitis
  2. Hip will be flexed, abducted and externally rotated
  3. Ibuprofen and weightbearing restriction
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55
Q

4 factors to differentiate septic arthritis from transient synovitis

A
  1. Fever > 102
  2. WBC count > 12K
  3. ESR > 40
  4. Refusing weight bearing

Remember : take FeWER risks with SA

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56
Q

Pt presents with hx of alcoholism and AMS with fruity breath

  1. Most likely diagnosis
  2. How to diagnose
  3. Treatment
A
  1. Acute hepatic encephalopathy
  2. High ammonia
  3. Lactulose
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57
Q

Young pt presents with acute onset CHF

  1. Most likely diagnosis
  2. How to diagnose
A
  1. Coxsackie B

2. Hepatomegaly, S3, pleural effusion

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58
Q

Reed Sternberg cells means..?

A

Hodgkin lymphoma

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59
Q

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
A
  1. Tumour secretion of PTHrP
    1. IV saline & furosemide
    1. Bisphosphonates
    1. Corticosteroids
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60
Q

Why are CCBs contraindicated in STEMIs?

A

It causes PERIPHERAL VASODILATION and cause REFLEX TACHYCARDIA

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61
Q

African American Pt presents with bone pain

  1. Most likely diagnosis (2)
  2. How to diagnose & differentiate the top 2
A
  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
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62
Q

How would the following birth-traumas present?

  1. Erb-Duchenne
  2. Klumpke’s
  3. Fractured clavicle
A
  1. Absent Moro, waiter’s tip
  2. Horner’s with ipsilateral hand paralysis
  3. You can feel the fracture, decreased arm movement
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63
Q

What is the OD symptoms of

  1. Vitamin A
  2. Vitamin D
  3. Vitamen K
  4. Iron
  5. Aspirin
  6. Lead
A
  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
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64
Q

Pt presents with drug-induced interstitial nephritis

  1. Most likely presentation
  2. Most likely drug involved
  3. Treatment
A
  1. Fever, rash, joint pain. Possibly sterile pyuria.
  2. PCNs, cephs and sulfa
  3. Stop offending drug
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65
Q

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
A
  1. Aortic dissection
  2. TEE
  3. Control HTN, stage dissection
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66
Q

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
A
  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
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67
Q

Pt presents with kidney stones and hx of Crohn’s

  1. Most likely type of stone
A

Oxalate

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68
Q

Paget’s disease - what are the calcium, phosphate and AP levels?

A

Calcium & phosphate - normal

AP - high

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69
Q

First line treatment for longterm bipolar / mania?

A

‘shhh, quiet! LOL! Lame…’

Quetiapine, lithium, olanzapine, lamotrigine

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70
Q

Pediatric Pt presents with rash & hematuri 2 weeks after infection

  1. Most likely diagnosis
  2. Complications
  3. Treatment
A
  1. Henoch-schonlein purpura
  2. Intussusception
  3. Steroids & monitoring of renal function
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71
Q

Common meds that cause hyperkalemia (4)

A

ACEI, NSAIDs, K-sparing diuretics like spironolactone and amiloride

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72
Q

What is the most common cause for purpura in krimpies

A

Senile purpura - caused by perivascular connective tissue atrophy

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73
Q

Causes for hyponatremia

  1. With hypovolemia (2)
  2. With euvolemia (3)
  3. With hypervolemia (3)
A
  1. GI losses, renal losses
  2. SIADH, psychogenic polydipsia, hypothyroidism
  3. CHF, cirrhosis, CKD
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74
Q

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?
A

Aspirin sensitivity syndrome - pts taking aspirin for the heart condition shows asthma like symptoms…

Start leukotriene-receptor antagonist

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75
Q

Baby with olive shaped mass in RUQ

A

Pyloric stenosis

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76
Q

How does pleural fluid pH determine chest tube placement?

A

If pH is below 7.2, CT needs to be placed

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77
Q

Pt presents with a LOT of vomiting in the first trimester

  1. Most likely diagnosis
  2. What to rule out
  3. Treatment
A
  1. Hyperemesis gravidarum
  2. Rule out hydatidiform mole or choriocarcinoma with b-HCG levels
  3. Supportive
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78
Q

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..?)
A
  1. Acquired torticollis

2. Xray to rule out cervical spine fracture or dislocation (due to atlantoaxial sublaxation)

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79
Q

The difference between scarlet fever and kawasaki?

A

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

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80
Q

Pt presents with sudden onset hypotension and massive rise in LFTs

  1. Most likely diagnosis
A

Ischemic hepatic injury

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81
Q

Immunocompromised Pt presents with intense superficial pain in localized area

  1. Most likely diagnosis
  2. How to diagnose
  3. Treatment
A
  1. Activated shingles
  2. Hx of chickenpox with immunocomprimised state
  3. Acyclovir
82
Q

Pt presents with joint pain (prob hip) after long-term corticosterd treatment

  1. Most likely diagnosis
  2. How to diagnose
A
  1. Avascular necrosis

2. MRI of the joint

83
Q

How long after acetaminophen OD do you 1) get a plasma level and 2) administer antidote (what is it?)

A
  1. 4hrs for plasma level

2. N-acetylcysteine within 8 hours following ingestion

84
Q

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
A
  1. Osler-Weber-Rendau

2. AV shubt in the heart or lungs

85
Q

Positive Trendelenburg sign -

  1. What is it?
  2. What muscle is involved?
  3. What nerve innervates?
A
  1. Contralateral hip drooping during monopedal stance
  2. Gluteus mini and medius
  3. Sup. gluteal nerve
86
Q

“Soap bubble appearance” on epiphysis of a long bone - what is it?

A

Giant cell tumour

87
Q

Swollen joint - how do you identify

  1. Pseudogout (type of crystal, how the crystal is described, pt’s relevant history)
  2. Gout (same)
A
  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
Q

Pt with hx of arrythmias / palpitations has increased QRS with stress test

Drug involved?

Which drug prolongs the PR interval?

A

Flecainide - prolongs QRS

verapamil - prolongs PR

89
Q

Major cause of <4mnth old baby crying for a few hours a day without being soothed?

A

Colic. Baby will outgrow it by 4mnths

90
Q

With lactose intolerance - what would the stool osmotic gap be (high or low)? What test is used to diagnose L. Intolerance?

A

HIGH osmotic stool gap

Bath hydrogen test

91
Q

Which symtoms/conditions are associated with the following stones

  1. Calium oxalate
  2. Calcium phosphate
  3. Uric acid
  4. Cysteine
  5. Struvite
A
  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
Q

Pregnancy UTI - drug?

A

Nitrofurantoin

93
Q

Pt with CP is given nitroglycerin, and the pain

  1. .. resolves. What is it likely ot be?
  2. .. does NOT resolve. What is it?
A
  1. Resolves with nitro - likely stable angina.

2. NO resolve - unstable angina or MI. Possibly GERD etc. also

94
Q

Drug used for V-tach

A

amiodarone

95
Q

In addition to pain control, how does morphine help in an MI?

A

improves pulmonary edema

96
Q

Which drugs to give in an acute MI

A

AABC H MNO

ASA, ACEI, beta-blocker, clopidogrel, heparin, morphine, nitroglycerin, oxygen

97
Q

Pt with swallowing problems - bird’s beak on image. Diagnosis & Treatment?

A

Achalasia

Treat with pneumatic dilatation or botulism injection

98
Q

Treatment for esophageal spasm or nutcracker esophagus

A

Calcium Channel Blockers

99
Q

Pt presents with CP and diffuse ST-elevation
Diagnosis?
It is relieved by which body position?
Most common cause?

A

Pericarditis

Relieved by leaning forward

MCC - Coxsackie virus

100
Q

Ripping CP radiating to back

  1. Diagnosis?
  2. Associated with? (genetic)
A
  1. Aortic dissection

2. Marfan’s

100
Q

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?
A
  1. Rheumatic heart fever
  2. Strep. pyo, mitral valve stenosis,
  3. Diastolic rumble w opening snap
101
Q

WTF is cilostazol?

A

Antiplatelet

102
Q

Furosemide causes what electrolyte abnormalities?

A

“Loop loo-ses all except SoChlo”
Hypernatremia, -chloride
Hypokalemia, -magnesemia

103
Q

Pt gets up, BP drops by 18mmHg -

  1. What is this called?
  2. Which 2 conditions show this?
A
  1. Pulsus paradoxus

2. Severe asthma, pericarditis/tamponade

104
Q

Diagnosis-
1. Different BPs in left and right arm?

  1. Getting up drops BP.
A
  1. Aortic dissection

2. Pericarditis/tamponade, severe asthma

105
Q

Pt with CP relieved with sitting forward 2 weeks after MI.

  1. Diagnosis?
  2. Treatment?
A
  1. Dressler’s - pericarditis 2 weeks after MI. AUTOIMMUNE

2. Anti-inflammatory drugs

106
Q

What are the most important lifestyle changes to control BLOOD PRESSURE

A
  1. Weight loss, 2. Physical activity, 3. Salt, 4. Alcohol
107
Q

WTF is alprazolam and used for?

A

Short-acting benzo

Used in anxiety & panic attacks

108
Q

Most common reason for sudden tachcardia (160-220) in otherwise healthy people

A

PSVT - AV re-entry

109
Q

WTF is adenosine and used for?

A

Short-acting AV node blocker

Used for AV re-entry tachies

110
Q

Treatment for PVCs

A

If symptomatic, amiodarone. If asymptomatic, observe

111
Q

Most common ectopic foci for AF

A

Pulmonary veins

112
Q

What arrhythmia is seen with digitalis toxicity?

A

Atrial tach with AV block

113
Q

What type of murmur in young people can be ingnored as benign?

A

Soft mid-systolic murmurs

114
Q
  1. What is the most common cause of death in pt with acute MI?
  2. How does this happen?
A
  1. Complex ventricular arrhythmia due to reentry

2. Conduction is blocked in areas 2/2 ischemia, creating a v.fib reentrant vent. arrhythmias

115
Q

Most common heart problem with IV drug use

A

Subacute bacterial endocarditis (look for emboli from either mitral or tricuspid showing up as AKI or diffuse pulmonary infarcts)

116
Q

Which heart drug can cause peripheral edema

A

Ca-channel blockers (eg. amlodipine)

117
Q

Pt presents with acute CP and pulseless tachy 5 days after MI

118
Q

Definitive diagnosis of AS

119
Q

How does niacin cause flushing?

A

Prostaglandin-induced peripheral vasodilation

120
Q

List the 3 major mechanical complications following an MI

A
  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
Q

Pink-white lesions on skin
1. Small ones ..?

  1. Large ones ..?
A
  1. Calcinosis (think scleroderma)

2. Psoriasis

122
Q

Pericarditis with chronic renal failure and BUN > 60

  1. Diagnosis
  2. Treatment
A
  1. Uremic pericarditis

2. Hemodialysis

123
Q

Pt from South America with megacolon/megaesophagus and cardiac issues - diagnosis?

A

Chagas (protozoan)

124
Q

How is reflux diagnosed?

A

24hr - pH monitoring

125
Q

What should you worry about with breath-holding spells?

A

Iron-deficiency anemi

126
Q

What is the HR in

1) atrial tach
2) atrial flutter

A

1) 150-250

2) 250-350

127
Q

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)

A

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
Q

Pt with intense CP, unilateral pleural effusion which shows high amylase content
Name two possibilities, with the differentiating finding

A

Esophageal rupture or acute pancreatitis

Pancreatitis would not have a widened mediastinum

129
Q

SBE with confirmed Strep Viridans (PCN susceptible) - 2 treatment options?

A

1) PCN G IV

2) Ceftriaxone IV

130
Q

SBE - bug involved? Oral or IV abx?

A

Strep viridans

IV ONLY!! No oral abx

131
Q

Treatment for HCOM

A

B-blocker. Consider CCB if pt cannot tolerate BB

132
Q

What is the difference between amlodipine and diltiazem?

A

Amlodipine - peripherally acting CCB

Diltiazem - centrally acting CCB

133
Q

What heart drug causes hypothyroidism?

A

Amiodarone

134
Q

Whatmeds should be held prior to a stress test?

A

B-Blockers and digoxin

135
Q

Adults with painless hematuria - first item on ddx?

A

Kidney, bladder or ureter malignancy

136
Q

Pt from middle east or africa presenting with painless hematuria - top on the ddx?

Host?

A

Schistosoma infection

Snail

137
Q

Treatment of fractured clavicle during birth?

A

Reassurance. It will heal in 3-6 weeks.

138
Q

Most common bug for acute unilateral lymph node swelling?

139
Q

Characteristics of endometritis (4)

Treatment?

A

FULL & FOUL
Fever, Uterine tenderness, Leukocytosis, Foul Lochia

Clinda & gent

140
Q

How does acyclovir affect kidneys?

A

Causes renal tubule obstruction via crystalluria

141
Q

Pt returning from Puerto Rico with diarrhea, showing blunting of villi..

A

Tropical sprue

142
Q

Classic injury in kids with penetrating trauma to the soft palate

A

Internal carotid dissection / compression - both leading to brain injury

143
Q

Sharp, triphasic discharges on EEG

A

Creutzfeld-Jakob

144
Q

Treatment for cellulitis with systemic signs (2)

A

1) oral dicloxacillin

2) IV Nafcillin or cefazolin

145
Q

Diagnostic test for divurticulitis

146
Q

NFM Type 2 - type of DNA mutation?

147
Q

Where is the classic murmur in HOCM?

A

Lower left sternal border

148
Q

Typical timeframe for C. Diff following abx start?

149
Q

Most common brain tumour in pediatrics?

Second-most common?

A

Most common - astrocytoma

Second - medullablastoma

150
Q

Treatment for lichen sclerosis?

A

Topical corticosteroids

151
Q

Newborn baby who becomes cyanotic when feeding, but pink otherwise - diagnosis?
What is this?
Diagnosis & management?

A

Choanal atresia - nasal malformation
Diagnose with failure to pass catheter 3-4cm through nose, and then by CT
Treat with endoscopy & surgery

152
Q

Initial treatment for frostbite?

A
  1. Warm water (NOT warm air!)

2. Only assess and debride after clear seperation of dead / viable tissue

153
Q

Adolescent onset hirsutism & virilism with HIGH 17-hydroxyprogesterone

154
Q

Does BPH start in the central or peripheral prostate?

155
Q

Krimpies with unexplained syncopy - first think of what?

A

Sick sinus syndrome

156
Q

Treatment for Prinzmetal’s angina

A

CCBs or nitrates

157
Q

Most common cause of viral meningitis?

A

Enteroviruses - coxsackie or echovirus

158
Q

Primary medical treatment for AR and why?

A

CCBs or ACEI - they decrease afterload, improving AR

159
Q

Why do ACEIs get preescribed post-MI?

A

To prevent ventricular remodeling

160
Q

WTF - filamentous branching, weakly acid-fast rod

161
Q

How does withdrawal present?

1) Cocaine
2) Heroin
3) Alcohol
4) Amphetamine
5) Nicotine

A

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
Q

WTF is etidronate disodium therapy?

A

Bisphosphonate therapy.

163
Q

Newborn with bilious vomiting and ground-glass appearance in lower abdomen on xray

A

Meconium ileus (CF)

164
Q

Wat is the nucleotide repeats in Fragile X?

165
Q

Kid with prominent jaw, large ears and balls

166
Q

What level is considered iron toxicity?

A

> 350mcg/dl

167
Q

Gout attack with splenomegaly and increased pain with hot water - what is the cause of the gout?

A

Myoproliverative disorder (prob Polycythemia vera)

168
Q

What is a absolute contraindication for buproprion use?

A

A history of seizures

169
Q

What part of schizophrenia dictates typical vs. atypical drugs?

A

Typical is better for positive symptoms, atypical for pos and negative

170
Q

Which STD gets screened for during pregnancy, regardless of risk factors?

A

Syphilios (with RPR test)

171
Q

What are the treatment options for vaginal cancer?

A

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
Q

What is the sail sign on infant xray?

A

Large thymus - NORMAL

173
Q

Principle cell type as source of testosterone

What can these cells also make, and why?

A

Leydig cells

Estrogen, due to increased levels of aromatase

174
Q

Most common sex cord stromal tumour

How do these present?

A

Leydig cell tumours

Increased estrogen and testosterone - gynecomastia, precocious puberty

175
Q

Pt with high levels of b-hCG (non-pregnant) - top tumour?

A

Choriocarcinoma

176
Q

What would you see with a yolk sac tumour, and what other name does it go by?

A

Rise in serum AFP

AKA endodermal sinus tumour

177
Q

Top 2 reasons for ESRD in the US

A
  1. Diabetes
  2. HTN

Look for pts who has never been to a dr, and now shows up with high BUN/Cr

178
Q

What changes in the kidney do you see with diabetics (leading to ESRD)

A
  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
Q

Bence Jones proteins - what is it?

Disease process?

A

Monoclonal globulin protein

Multiple myeloma

180
Q

Rouleaux - what is it?

Disease ?

A

Stacks of RBCs

Multiple myeloma

181
Q

Acute otitis media - 3 most common bugs

Treatment?

A

Strep pneumo, h. influ and moraxella

(“SHAMe” strep, hflu, amox, moraxella)

Treat: amoxacillin

182
Q

Multiple myeloma - age group?

  1. Most common complaint?
  2. Bone marrow description?
A
  1. Older pts
  2. Back pain
  3. Overprolifiration of PLASMA CELLS mainly IgG
183
Q

Bone marrow -

“increased marrow cellularity with megakaryocytic hyperplasia”

A

Essential thrombocytosis

184
Q

Bone marrow -

“Hypoplastic fat-filled marrow with no abnormal cells”

A

Aplastic anemia

185
Q

Pts with fever, sore throat and muffled (hot potato) voice
What might be seen on oral exam?
Diagnosis?
Treatment?

A

Deviated uvula
Dx: peritonsillar abscess (often 2/2 tonsilitis)
Treat: aspiration with abx, if unsuccessful - surgery

186
Q

CP 2 weeks after MI, relieved with sitting forward

Diagnosis & treatment

A

Dressler’s - autoimmune pericarditis

NSAIDs, if not relief - steroids

187
Q

Varying amplitude of QRS on EKG

Diagnosis & Treatment

A

Cardiac tamponadee

Massive fluid ressus & pericardiocentesis

188
Q

Pt with cold leg in the days following an MI

Diagnosis & treatment

A

Embolus from left ventricle due to stasis

Echo and heparin

189
Q

Systolic murmur that increases with standing up

190
Q

Paradoxical splitting of S2

191
Q

Low CO, high PCWP, high SVR

A

Cardiogenic (often left ventricular failure)

192
Q

Pt from latin america with heart problems

A

Chagas (protozoan)

193
Q

Firstline treatment of high BP (AFTER AFTER lifestyle mods)

193
Q

Kid going into knee-chest for trouble breathing

A

ToF (tet spell)

194
Q

What is the relationship between calcium and albumin

What is the formula for corrected calcium

A

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
Q

Middle-aged pts with telengiectasia over cheeks, nose & chin, aggrevated by sun, emotion or hot liquids
Diagnosis?
Treatment?

A

Rosecea

Topical metronidazole

196
Q

How does low vit. D cause bone issues?

A

Causes defective mineralization of bone (also cartilage ONLY in kids)

197
Q

Pt with eye pain & redness, exam shows vesicles and dendritic ulcers in the cornea

Diagnosis?

A

Herpes simplex keratitis

— HSV IS THE MOST COMMON CAUSE OF CORNEAL BLINDNESS IN THE US —

198
Q

Pt with eye pain, red eyes, wears contact lenses. Possible hypopyon

A

Bacterial keratitis

Step 2 CK (6 decks)

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