General Flashcards
0
Q
Common cause of bitemporal hemianopsia in adult and children?
A
Prolactinoma in adults and craniopharyngeoma in children
1
Q
What are the four most common causes of pancreatitis?
A
- gallbladder stones
- alcoholism
- hypercalcemia
- hyper triglyceridemia
2
Q
Causes of eosinophilia
A
DNAAACP drugs Neoplasm Allergy, asthma (Churg-strass) Addisons adrenal insufficiency Acute tubular necrosis Collagen vascular disease Parasites (loffler's pneumonitis due to ascaris lumbricoides)
3
Q
Common causes of secondary hypertension
A
Pheochromocytoma, hyperaldosteronism, Cushing syndrome, renal artery stenosis, oral contraceptives, coarctation of the aorta and chronic kidney disease
4
Q
What anti-hypertensives can be used in a patient with severe pre-clampsia?
A
Hydralazine, labetalol, nifedipine or sodium nitroprusside
5
Q
When is it appropriate to administer hypertonic saline in SIADH?
A
When there are active seizures
6
Q
What cause of back pain is exacerbated with standing and walking but relieved with sitting a son hyperflexion of the hips?
A
Spinal stenosis
7
Q
What causes flat top purple pruritic polygonal papules?
A
Lichen planus
8
Q
Continuos machine like murmur
A
PDA
9
Q
What should you suspect in a woman with pre-eclampsia in the first trimester
A
Consider hyditaform mole
10
Q
What is the first line treatment for a GH secreting pituitary adenoma
A
Transphenoidal resection of the tumor
11
Q
What are the indications for the repair of an AAA (4)
A
Size >5.5cm
Symptomatic
Rupture
Rapidly expanding
12
Q
What is a side effect that many of the atypical antipsychotics have
A
Weight gain leading to the development of diabetes type II
13
Q
What type of lung cancer is associated with SIADH and other paraneoplastic syndromes
A
Small cell lung cancer
14
Q
Decreased urine specific gravity and increased serum osmolality
A
Diabetes insipidus
15
Q
Treatment of afib of unknown duration
A
Anticoagulation heparin to long term warfarin
Rate control with beta blockers, verapamil, digoxin
16
Q
What characteristics would make you suspect a Nevus to be melanoma?
A
ABCD Asymmetry Irregular boarders Color changes or variation Diameter changes
17
Q
Most common site for ectopic pregnancy
A
Ampulla of the Fallopian tube
18
Q
What acid base disturbance is seen in pregnant women
A
Respiratory alkalosis
19
Q
CSF findings of SAH
A
Increased pressure and a lot of RBC…if a few days then xanthochromia
20
Q
Pre-teen with anger, destruction of property, theft and violence towards family and pets
A
Conduct disorder;considered as a precursor to antisocial personality disorder
21
Q
Hypoxia, pulmonary edema with a normal pulmonary capillary wedge pressure
A
Problem is in the lungs since PCWP is indicative of the left atrial pressure and that’s normal; ARDS
22
Q
Vaginal bleeding in a 18 week gravid patient with no products of conceptus in the vaginal vault, membrane rupture, open cervical os
A
Inevitable abortion
23
Q
Treatment for cardiogenic shock
A
Number one is pressors, specifically dobutamine
24
ICU pt that has woken up and is alert but cannot move at all except his eyes
Locked-in syndrome (lesion at the level of the brain stem)
25
Systemic diseases that can result in nephritic syndrome
Diabetes , SLE, Amyloidosis
26
Diagnosis: hypertension, depression and kidney stones
Hyperparathyroidism
27
Diagnosis: elevated BP in arms and low BP in legs
Coarctation of aorta
28
Diagnosis: Hypertension with proteinuria
Renal disease
29
Hypertension with hypokalemia
Hyperaldosteronism
30
Hypertension and hyperkalemia
Renal artery stenosis and renal failure
31
Hypertension, tachycardia , diarrhea and heat intolerance
Hyperthyroidism
32
Anti-hypertensive medication with 1st dose hypotension
Alpha blockers
33
Anti-hypertensive medication with hypertrichosis
Minoxidil
34
Anti-hypertensive medication with dry mouth, sedation and rebound hypertension
Clonidine
35
Anti-hypertensive medication with cough
ACEI
36
Anti-hypertensive medication with bradycardia, impotence and asthma exacerbation
Beta blockers
37
Anti-hypertensive medication with reflexive tachycardia
Vasodilators
38
Anti-hypertensive medication to avoid in sulfa allergies
Loop and thiazides diuretics
39
Anti-hypertensive medication with SE of angioedema
ACEI
40
Anti-hypertensive medication known to cause drug induced lupus (antibodies seen)
Hydralazine (anti-histone)
41
Anti-hypertensive medication that can cause cyanide toxicity
Nitroprusside
42
What anti-hypertensive medication is contraindicated in COPD?
No selective beta blockers
43
What anti-hypertensive medication is contraindicated in pregnancy?
ACEI/ARBS
44
What anti-hypertensive medication is contraindicated in advance renal disease with hyperkalemia ?
ACEI/ARBS and k sparing
45
What anti-hypertensive medication is contraindicated in gout?
Diuretics
46
What heart sounds are considered benign in asymptomatic pts with no history of disease?
Low grade early systolic murmurs, sometimes s3, splitting of s1, splitting of s2 on inspiration
47
What heart defect is associated with chromosome 22q11 deletion?
Tetralogy of fallout and turncus arteriosus is associate with DiGeorge syndrome
48
What heart defect is associated with Down syndrome?
Endocardial cushion defects (VSD, ASD)
49
What heart defect is associated with congenital rubella?
PDA and pulmonary artery stenosis
50
What heart defect is associated with Turners?
Coarctation of the aorta
51
What heart defect is associated with Marfans?
Aortic insufficiency (AR)
52
What is the next best step in management after a brain tumor has been diagnosed by head CT/MRI?
Full body scan and Bone scan to find source of tumor or presence of mets
53
What are the Ws of post operative fever?
```
Wind-atelectasis
Water- UTI
Wound- infection after 5 days
Wonder drugs- medications including antibiotics
Walk-dvt
Wain- thrombophlebitis
```
54
What medications are used to treat TB meningitis?
Same medication protocol used for pulmonary TB: rifampin, isoniazid,pyrazinamide and ethambutol
55
Characteristic features of pericarditis?
```
Pleuritic chest pain better when leaning forward worse when supine
Dyspnea
Cough
Friction rub
Pulsus paradoxus
JVD
Fever
ST segment elevation in all leads
```
56
Antidote to toxicity with acetaminophen
n acetyl cysteine
57
Antidote to toxicity with Lead
EDTA, dimercaperol and succimer
58
Antidote to toxicity with cyanide
Na thiosulfate, hydroxycobalamin,Na nitrate
59
Antidote to toxicity with methyl hemoglobin
Methylene blue and vitamin c
60
Antidote to toxicity with opioids
Naloxone and naltrexone
61
Indication for surgical excision of parathyroid adenoma? And how is this different from the indication in parathyroid hyperplasia?
Parathyroid adenoma: symptomatic, high elevated serum calcium, 24 hour urine calcium greater than 400mg, bone scan score T -2.5, creatinine clearance reduced by 30% and age
62
Classic EKG finding in atrial flutter
Saw tooth pattern appearance of p waves
63
60 year old obese patient with dirty-looking velvety patch at the back of the neck: diagnosis and work up required
Acanthosis nigricans
Work up for diabetes and in pts over 45 years with new development of this dermatological finding should concern for visceral malignancy
64
MCC hypothyroidism
Hashimoto's
65
Bias when a screening test can detect a disease earlier in the course increasing survival time
Lead time bias
66
Exceptions to informed consent
Emergency situations, pt lacking decision making capacity and pt that has waived his right to informed consent
67
90 year old with palpable flank mass and he atria found to have bilaterally enlarged kidneys with cysts: diagnosis and brain finding associated with this condition
Adult PCKD and look for berry aneurysm
68
4 main cause of microcytic anemia
MC is iron deficiency, thalessemia, anemia of chronic disease and lead poisoning
69
Treatment in iron OD
Deferoximine
70
What is the minimum acceptable urine output in a stable patient
30 cc/hr
71
What are the classic symptoms (and lacking symptoms) for strep pharyngitis
Fever, sore throat, erythematous pharynx, tonislar exudate
| Lack of cough and rhinorrhea
72
What defense mechanism is a person displaying when they can calmly describe a gory murder scene they witnessed
Isolation
73
EKG finding of peaked T waves and flattened QRS
Hyperkalemia
74
What area is Lyme disease endemic to
North east US
75
What joints are affected in rheumatoid arthritis
MCP and PIP joints (not DIP)
76
Dx: xerostomia, enlarged parotid gland, xerophthalmia and anti-LA antibodies
Srögren's syndrome
77
MCC seizures in young adults
Head trauma, ETOH withdrawl and brain tumors
78
MCC of non-obstetric post-partum cause of death
Thromboembolic event (DVT->PE)
79
Uterine bleeding in a 18 week gestation with no products of concepts expelled and closed cervical os
Threatened abortion
80
Dx: immunodeficiency with eczema, thrombocytopenia and high IgA
Wisckott-Aldrich syndrome
81
Dx: pt with diarrhea, tachycardia and heat intolerance
Hyperthyroid
82
Complications of pressors like norepinephrine in shock?
Ischemia/ necrosis Of fingers and toes
Mesenteric ischemia
Renal failure
83
What intervention is most effective in reducing blood pressure
Weight loss
84
What is the preferred initial anti-hypertensive in other with no comorbidities
Thiazides: hydrochlorothiazide and chlorthalidone
85
What is the anti-hypertensive indicated in diabetes pt?
ACEI/ARBS
86
What is the anti-hypertensive indicated in CHF pts?
ACEI/ARBS
Beta blockers
Spironolactone
Loops (do not decrease mortality but improve congestive symptoms)
87
What is the anti-hypertensive indicated in pt wig BPH?
Alpha blockers
88
What is the anti-hypertensive indicated in LVH?
ACEI/ARBS (remember that angiotensin increases remodeling of heart)
Beta blockers
89
What is the anti-hypertensive indicated in pts with hyperthyroidism?
Beta blocker
90
What is the anti-hypertensive indicated in pts with osteoporosis?
Thiazides
91
What is the anti-hypertensive indicated in patients with benign essential tremor?
Beta blockers
92
What is the anti-hypertensive indicated in post menopausal females?
Thiazides
93
What is the anti-hypertensive indicated in patients with migraines?
Beta blockers
94
What bacteria causes diarrhea and pseudo appendicitis?
Yersenia entercolitica
95
Most common cause of lower GI bleed in pt >40 years old?
Diverticulosis
96
Dx: 45 year old obese female with puritis, clay colored stool and increased bilirubin and alkp?
Biliary obstruction (many causes, gallstone common)
97
Next step in pt with two Pap smears showing atypical squamous cells?
This is ASCUS (atypical squamous cells of undetermined significance), a colposcopy with endocervical curretage should be done for diagnosis
98
What type of breast cancer increase the risk of future invasive cancer of both breasts?
Lobular carcinoma in situ
99
Wheat oral infection will have branching rods under the microscope?
Actinomyces israelii
100
What is the cause of rhomboid shaped crystals that are positively bifringent on knee aspiration?
Pseudogout , calcium pyro phosphate
101
Dx: active 14 year old boy with anterior knee pain?
Osgood schlatter disease
102
Symptoms of placenta previa
Painless vaginal bleeding in the 3rd trimester
103
Dx: target lesions on hands and feet with mild prodrome of fever, malaise and myalgias?
Erythema multiforme (type IV hypersensitivity)
104
Dx: congenital condition with blue berry muffin rash
Rubella
105
Dx: psychiatric condition where person travels to a different place and retains a new identity without memory of their past?
Dissociative fugue
106
Medicine often used to induce ovulation
Clomiphene
107
Hypercholesterolemia treatment that causes flushing and pruritis?
Niacin
108
Acid base disorder seen in salicylate ingestion
Metabolic acidosis with anion gap and respiratory alkalosis
109
Parkland formula used for fluid replacement in burn victims
4ml (body weight kg x BSA %burned)
110
Cause of chest pain in a young patient with angina at rest, ST elevation on EKG but negative cardiac enzymes
Prinzmetal angina
111
Organism that causes pytariasis versicolor
Malysia furfur
112
MCC of pathological fracture in elderly thin females
Osteoporosis
113
What are the HACEK bacteria and what are they associated with?
H. Influenza, actinobacillus, cardiobacter, eikenella and kingella
These organisms are associated with culture negative endocarditis
114
What are the indication for home oxygen in pts with COPD
pO2
115
Why does COPD cause cor pulmonale in the long term?
Hypoxia mediated shunting causes pulmonary hypertension
116
What is the treatment for localized non-small cell carcinoma of the lung
Surgical resection followed by chemo/radiation
117
What is the difference between somogyi effect and the dawn phenomenon and how to differentiate clinically
Both causes hyperglycemia but due to different causes
- somogyi effect- hyperglycemia due to low early morning (3am) hypoglycemia causing release of stress hormones,'usually due to improper insulin dosing
- dawn phenomenon- due to normal physiological rise in stress hormones in the early morning that prepare for waking; diabetics do not produce enough insulin to regulate this surge and thus it results in hyperglycemia
To differentiate do a 2-3am glucose: if low then somogyi effect , if normal glucose then dawn phenomenon
118
What type of immunodeficiency increases the risk of anaphylactic transfusion reaction?
IgA deficiency
119
What is the next best step in 50year old patient with 25 pack year history whose chest X-ray shows a lobar pneumonia in the same location as a recent pneumonia?
Other than give antibiotics a CT scan should be done as this is concerning for lung cancer
120
Imaging that should be done if DVT suspected
Compression ultrasound of the lower extremities
121
Imaging study used to diagnose injury to urethra
Retrograde cystourethrogram
122
Symptoms of basilar skull fracture
Raccoon eyes
Hemotympanum
Mastoid bruising (battle sign)
CSF Fluid leaking from anywhere!
123
Drug of choice for trigeminal neuralgia pain
Carbamazepine
124
Treatment for normal pressure hydrocephalus
Shunting
125
First line treatment for psuedotumor cerebri
Weight loss....then acetezolimide, serial LP, and if all else fails shunting
126
Treatment for Guillan-Barre
IVIG OR plasmapheresis
| And supportive care with a low clinical threshold for need to intubate
