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General Wrong Answers Flashcards

1
Q

Prophylaxis after exposure to n meningitis

A

Close exposure: household members, childcare, directly exposed to oral droplets (mouth to mouth or intubation), sitting next to someone for 8 hr

Prophy regimens—> to eradicate pharyngeal carriage of organism:

  • cipro 500mg single dose
  • rifampin 600mg BID x2 days
  • ceftriaxone 250mg single dose
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2
Q

Lab tests to rule out other things when making clinical dx fibromyalgia

A
  • anemia- CBC
  • inflammatory Arthropothy - esr or crp
  • hypothyroid - TSH
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3
Q

What is imaging of choice to dx pneumothorax

A

Bedside ultrasound

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4
Q

sickle cell disease in pregnancy

A
  • dehydration (nausea/vomiting) is common trigger for vasoocclusive episode
  • acute pain episodes more common during pregnancy
  • repetitive episodes a/w increased fetal problems (growth restriction, preterm labor)
  • a/w maternal complications: preE, abruption
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5
Q

4 aspects of capacity

A
  • comminicate a choice
  • understand info provided
  • appreciate consequences
  • rationale about a decision (weigh risks & benefits, offer reasons for decision)
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6
Q

presence of HbA:HbS in 60:40 ratio on hgb electrophoresis

A

sickle cell trait

-asymptomatic & does not cause anemia

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7
Q

dx of pediatric iron deficiency anemia

A
  • screening hgb at age 1yo

- hemoglobin <11 g/dL; low MCV, high RDW

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8
Q

alpha thalassemias

A

presence Hg barts (4 gamma chains) seen on electrophoresis

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9
Q

beta thalassemias

A

mutations in the beta globin genes

sickle beta thal: predmoinantly HbS and <30%HbA
- often HbF and HbA2 elevated

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10
Q

secondary hyperpara

A
  • high PTH, low/normal Ca
  • can be caused by vitamin D deficiency; can see osteomalacia & hypophosphate (with normal calcium levels)

increased parathyroid hormone causes increased renal excretion of P while maintaining calcium at normal levels

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11
Q

primary hyperparathyroid

A

-elevated PTH, elevated Ca

Occasionally, a person may have an elevated calcium level and a normal or minimally elevated PTH level

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12
Q

treatment for catatonia

A

benzo &/or ECT

-antipsychotics can worsen catatonia

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13
Q

caloric intake goal for enteral feeding

A

30kcal/kg/day ; lower for patients with severe preexisting malnutrition

1g/kg protein is approrpiate

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14
Q

time period to give antiviral in flu

A

efficacy declines precipitoiusly if initiated >48hr after sx onset

aniviral=oseltevir

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15
Q

management of gout in renal failure/renal transpant

A

intraarticular glucocorticoids

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16
Q

tx of paryoxysmal supraventricular tachycardia

A

hemodynamically stable: vagal maneuvers (valsalva) or adenosine

hemodynamically unstable: urgen synchronized cardioversion

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17
Q

EKG findings in wolf parkinson white

A

short PR interval, slurred upstroke of QRS (“delta wave,” wide QRS

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18
Q

renal failure & HepC

A

think cryoglobulinemia

serum cryoglobulin levels

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19
Q

antineutorphil cytoplasmic antibodies (ANCA)

A

help test for granulomatosis with polyangiitis

a/w normal or elevated complement levels & resp symptoms

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20
Q

anti-dsDNA antibodies

A

usually seen with SLE

see low complement levels

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21
Q

antiglomerular basement membrane antibodies

A

seen in Goodpasture disease ( glomerulonephritis & pulm sx)

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22
Q

streptozyme test

A

test for strep infection

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23
Q

factorial study

A

aka fully crossed study design – utilizes greater than or equal to 2 interventions and ALL COMBOS of those interventions

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24
Q

crossover study

A

subjects are exposed to different treatments or exposures sequentially

(subjects crossover and serve as their own controls)

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25
Q

cross sectional study

A

observational study where 1 specific population is studies at one point in time

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26
Q

nested study

A

aka nested case-control study; retrospective observational study where subsets of controls are matched to cases & analyzed for variables of interst

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27
Q

pragmatic study

A

aims to determine whether intervention works in real-life

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28
Q

antipsychotic use in dementia with lewy bodies

A

these patients are very sensitive to antipsychotics – may cause more confusion, worse parkinsonism, & autonimic dysfunction

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29
Q

pleural effusion that is exudative with elevated adenosine deaminase level

A

pathonmeumonic for TB

since TB effusion usually caused by hypersensitivity reaction to M TB, pleaural fluid smear is usually aspetic

–>pleural biopsy often required for dx of TB

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30
Q

lab findings in rocky mountain spotted fever

A

low platelets
low Na
elevated AST & ALT

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31
Q

treatment for pulmonary hypertension

A

if not type 1 (idiopathic). treat the underlying cause leading to PH (ex OSA, ILD, L heart failure)

treatment: endothelin antagonist (bosentan, ambrisentan) to dilate pulm arteries

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32
Q

physical findings in femoral nerve injury

A

inability to extend knee
loss of knee jerk reflex
sensory loss: anterior/medial thigh. medial shin, arch of foot

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33
Q

radiographic findings suggestive of BENIGN lung calcification

A 
popcorn
concentric
laminated
central
diffuse homogenous
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34
Q

radiographic findings suggestive of MALIGNANT calcification

A

reticular
punctate
eccentric

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35
Q

character of tension type headache pain

A

nonthrobbing, dull, tight

while migraines are often throbbing/pulsatile

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36
Q

timeline for postpartum blues

A

typically peaks at 5 days postpartum, resolves within 2 weeks

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37
Q

gonococcal vs nongonococcal urethritis in men

A

gonococcal: PURULENT discharge; intracellular gram neg diplococci on stain

non conoccocal: WATERY duscharge; aseptic stain (leukocytes)

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38
Q

antibiotics and botulism

A

abx (esp aminoglycosides_ are avoided because they can cause c. botulinum to lyse in the colon – leading to INCREASED toxin absorption

instead: give botulism immune globulin (BIG-IV)

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39
Q

technical name for GBS

A

strep agalactiae

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40
Q

evidence of scaphoid fx

A

decreased grip strength, decreased wrist ROM, tenderness of scaphoid (anatomic snuffbox)- radial/dorsal side of wrist

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41
Q

complications of poorly healed scaphoid fx

A

avascular necrosis & nonunion

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42
Q

tx for active TB in pregnancy

A

3drug therapy (INH, rifampin, ethambutol) for 2 mo, then INH + RIF for additional 7mo; plus pyridoxine throughout

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43
Q

what med may cause a utox false positive for methamphetamine?

A

metformin

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44
Q

treatment for severe PCP intoxication

A

benzo

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45
Q

Chronic Myeloid Leukemia

A
  • results from translocation of chromosomes 9 & 22 (Philadelphia chr)
  • causea production of bcr/abl fusion protein– uninhibits tyrosine kinase
  • tx: tyrosine kinase inhibors
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46
Q

ecythma gangenosum

A

usually associated with psuedomonas bacteremia in immunocompromised pt
- tx with double IV abx against psuedomonas (ex pip tazo.& gentamicin)

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47
Q

low serum 21 hydroxylase level

A

seen in congenital adrenal hyperplasia (presents with hyeperkalemic metabolic acidosis)

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48
Q

Ages for peds GI stuff

A
  • infantile pyloric stenosis: 3-6weeks

- intussusception: 6-26months

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49
Q

which meds cause increased risk of pyloric stenosis

A

azithro & erythromycin – esp in first 2 weeks of life – a/w with icnreased risk of infantile hypertophic pyloric stenosis

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50
Q

conditions a/w osteonecrosis

A

SLE, sickle cell, antiphospholipid ab syndrome, chronic rendal dz on dialysis, trauma, Gauchers dz, HIV, after renal transplant, Caissons dz

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51
Q

finding in >90% pts with sarcoidosis

A

> 90% have hilar or mediastinal adneopathy (get a chest xray!)

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52
Q

most common bugs in orbital cellulitis

A

(same as sinusitis in kids, often precedes orbital cellulitis)
-stre viridans, strep pneumo, staph, h flu

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53
Q

cancers that metastasize to spinal column

A

prostate, breast, lung, non-hodgkins lymphoma, renal cell

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54
Q

cherry red, flat lesion on colonoscopy

A

angiodysplasia

frequent cause of occult GI bleed

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55
Q

conditions a/w angiodysplasia

A

ESRD, von willebrand, aortic stenosis – all cause increased bleeding rates with angiodysplasia

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56
Q

what biliary condition a/w ulcerative colitis

A

primary sclerosing cholangitis

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57
Q

which lipid meds worsen glycemic control

A

niacin

atorvastatin

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58
Q

calories in carbs vs alcohol vs fat

A

4cal per gram carb
7cal per gram alcohol
9cal per gram fat

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59
Q

which DM meds help with cardiac risk

A

SGLT2i and GLP1

flozins & -tides

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60
Q

which DM helps with oligomenorrhea in PCOS

A

metformin – increases ovulation in PCOS

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61
Q

“Break Bone fever”

A

Dengue Fever - flulike isllness with market myalgias, rash, thrombocytopenia, spontaneous bleeding –> shock

tourniquet test – petechiae after BP cuff

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62
Q

untreated celiac disease puts you at risk for …

A

enteropathy associated T cell lymphoma (EATL)

primarily affects proximal jejunum

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63
Q

gout flare with renal dz

A

avoid NSAIDS, so do intra-articular steroid injection, especially beneficial if the flare is only at one joint

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64
Q

initial testing for HIV+ patient

A

CD4 count, viral load, HIV genotype, hep B labs, HepC, TB, STIs

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65
Q

clinical picture of amniotic fluid embolism ayndrome

A

cardiogenic shock, hypoxemic respiratory fialure, DIC, coma, sezure

pathophys: amniotic fluid triggers massive anaphylactoid rxn resulting in vasospasm

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66
Q

aksthesia/parkisonian sx in cancer pt

A

think about anti-emetics; metoclopramide ia a central & peripheral D2-blocker & can result in anti-pyramidal sx

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67
Q

biggest risk of ginkgo biloba

A

increased bleeding/potentiating anticoagulation

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68
Q

diabetic retinopathy screening

A
  • inT1DM: 5 years after dx

- inT2DM: at time of dx and annual

69
Q

actinic keratosis is premalignant for what

A

increased risk of squamous cell carcinoma

70
Q

exam findings for PE

A

loud P2 and pleural friction rub, tachycardia

71
Q

seborrheic keratosis

A

benign, “stuck on”

72
Q

abx choice in bacterial conjunctivitis

A
  • non contact wearers: azithromycin drops

- contact lens wearers: fluoroquinolone drops (due to higher risk pseudomonas)

73
Q

first line abx for lactational mastitis

A

dicloxacillin or cephalexin (both safe during breastfeeding)

74
Q

PCOS tx

A

first line: weight loss; then OCP; if want to conceive -oetrozole for ovulation inductin

(avoid spiro if wanting to get pregnant)

75
Q

pathophys of lupus nephritis

A

immune complex mediated glomerular injury (primarily of anti-DS DNA antibodies), – this causes completment to be fixated, leading to low complement in blood

(so monitor anti DS DNA & complement)

76
Q

anti-smith anitbodies

A

highly specific for SLE; may be helpful to ID pts at risk for developing renal dysfuntion (but not helpful if already have renal dysfuctnion, bc stay elevated even after dz isnt active)

77
Q

causes of elevated gastrin

A
  • zollinger ellison syndrome
  • hypercalcemia
  • use of PPI
78
Q

adverse hospital events

A
  • most common: related to surgery
  • next most common: adverse drug events
  • general care (fall, pressure ulcers)
  • hospital acquired infxn
79
Q

LV apical aneurysm in absence of coronary artery disease

A

pathognomonic for Chagas cardiomyopathy (2/2 T. Cruzi protozoa)

80
Q

arthropathy a/w hemochromatosis

A

commonly the 2nd and 3rd MCPs (and also knees, ankles, shoulders)
-xray findings: subchondral cysts, sclerosis, osteopenia

81
Q

oxidative stress than can trigger G6PD intra & extra vascular hemolysis

A
  • infection
  • sulfa drugs
  • fava beans
82
Q

positive RF and ant CCP antibodies

A

correlate with RA

83
Q

what supplement do you have to take with methotrexate?

A
  • folate

MTX is a folate antimetabolite

84
Q

GERD, raynauds, HTN with renal failure

A

scleroderma real crisis

tx: ace-inhibitor

85
Q

hormonal changes in menopause

A

rise in FSH and LH

ovaries can no longer respond to hormonal signals

86
Q

definition primary amenorrhea

A

abscence of menses by age 15 OR absence of menses within 5 years breast development

87
Q

definition secondary amenorrhea

A

absence of menses for 3 cycles (if previously regular) or six months (if previously irreg)

88
Q

LH / FSH ratio in PCOS

A

elevated LH/FSH ratio is characteristic

89
Q

Rotterdam Criteria for PCOS

A

requires 2 out of the 3:

  • oligo or anovulation
  • hyperandrogen (clinically or by elevatedf or total T)
  • polycystic ovaries on u/s
90
Q

inpatient abx for PID

A 
-cefoxitin + doxy
OR
-clinda +gent
OR
amp-sulbactam + doxy
91
Q

dx pregnancy of unknown location

A

hCG <3000 and no intrauterine preg or adnexal masses

if HDS, repeat hcg in 48hr (if doesnt double, suspect ectopic)

92
Q

med to help with vasomotor instablity of menopause

A

venlafaxine and some other SSRIs

93
Q

contraction stress test

A

used to ID uteroplacental dysfunction & predict how baby will tolerate labor

positive (abnml): late decels in conjunction with at least 50% ctx

94
Q

scoring BPP

A

“test the baby man”

  • tone
  • breathing
  • fetal movements
  • amniotic fluid pocket
  • nonstress test

score 8-10 is reassuring
less than or equal to 6 is worrisome, prompt delivery vs repeat

95
Q

abx contraindicated in pregnancy

A 
tetracycline
quinolones
sulfonamides third trimester
streptomycin
tmp (bactrim) (folic acid antagonist)
96
Q

GERD meds contraindicated in pregnancy

A

alka seltzer & bismuth (contains NSAID)

97
Q

why are NSAIDs contraindicated in pregnancy

A

may cause oligo and closure of PDA, esp in third trimester

98
Q

timing of postpartum blues

A

usually resolves within 2weeks

99
Q

definition of oligo &poly

A

oligohydramnios: AFI less than or equal to 5cm on u/s
poly: AFI greater than or equal to 25cm on u/s

100
Q

additional lab to get in subclinical hypothyroid

A

(High TSH, normal T4)

anti TPO (antithyroid peroxidase) – when antithyroid levels are present, high likelihood to become overtly hypohtyroid

101
Q

complications of scleroderma

A

Lung- ILD, pulm HTN
Kidney: HTN, scleroderma renal crisis
Heart: fibrosis, pericarditis,

102
Q

why no antihistamines for poison ivy?

A

it’s a type IV (cell mediated) HSR; not histamine mediated

103
Q

treatment for latent TB

A

isoniazid x 6- 9mo

  • other options: isoniazid & rifampin weekly x3mo (not for HIV pts)
  • rifampin x4mo
104
Q

types of esophageal carcinoma

A
  • adenocarcinoma – distal to mid esophagus, usually 2/2 Gerd & Barretts
  • SCC – upper esophageal lesions, 2/2 alcohol & tobacco
105
Q

treatment for intussusception

A

air or saline enema

106
Q

henoch schonlein purpura (IgA vasculitis)

A
  • palpable purpura/petechia on LEs, arthralgia, abd pain/intussusception, renal dz (like IgA neph)
  • normal platelets & coags
  • hematuria
  • tx: supportive care (steroids for severe sx)
  • preceding resp illness 50% of time
107
Q

hemolytic uremic syndrome

A
  • microangiopathic hemolytic anemia, thrombocytopenia, acute renal failure
  • pts <5yo
  • after a blodoy diarrheal illness
108
Q

idiopathic thrombocytopenic purpura (ITP)

A
  • petechia or purpura, usually after a low impact injury

- often follows URI

109
Q

thrombotic thrombocytopenic purpura (TTP)

A

serious disorder

-pentad: fever, microangiopathic hemolytic anemia, thrombocytopenia, renal failure, neuro impairment

110
Q

thiazolidenediones

A

DM Med
PPAR-y agonist (ex pioglitazone)

PPAR-y receptors are in collecting tubule of nephron –> stimulation results in increased sodium reabsorption ( this is the same channel where aldo mediates sodium retention) –> can cause fluid retention in pts esp with CHF –> pulm edema / other fluid retetion /CHF e

111
Q

benefit of fibrates

A

(ex gemfibrozil)

most effective for reducing TGs, recommended with severe hyperTG to reduce risk of pancreatitis

112
Q

dx of Duchenne muscular dystrophy

A

elevated CK, genetics (dystrophin deletion), muscle bx with fibrosis/fat/muscle degen

113
Q

reversal of warfarin

A
  • prothrombin complex concentrate (normalizes INR within 10min)
  • IV vitamin K (takes 12-24hr)

(FFP only if PCC not available, requires large volume infusioN)

114
Q

“ground glass” abdominal mass in neonate

A

meconium ileus – think CF

115
Q

medical management of hypertrophic CM

A

negative inotropes (beta blocker, verapamil, disopyramide) [weaken the force of contraction]

beta blocker prefered as initial therapy

116
Q

low V/Q in COPD lugns

A

low V/Q regions = poorly ventilated regions undergo hypoxic vasoconstriction ==> supplemental O2 increased the Q, improving gas exchange

117
Q

single most important risk fx for osteoporosis

A

age

118
Q

anemia & indirect hyperbili in neonate

A

think G6PD deficiency (xlinked RBC enzymatic deficiency)

119
Q

hypoCa sx

A

hyperactive DTRs
muscle cramps
convulsions

+Chvostek sign (tap facial nerve and mouth twitches)

120
Q

endoscopic findings with pernicious anemia

A

(cause of vit B12 deficiency, autoantibodies against IF)

glandular atrophy (fundus & antrum), intestinal metaplasia, inflammation

121
Q

pregnancy TSH ranges

A

First tri: 0.1-2.5
Second tri: 0.2-3.0
Third tri: 0.3-3.0

TSH low/suppressed due to TSH actions of B-HCG

122
Q

common associated finding with alopecia

A

nail pitting

123
Q

diaper dermatitis that involves skinfold

A

candida

normal contact dermatitis (treat w barrier cream) usually spares creases/ skinfold

124
Q

what initial screening toget when you suspect dementia

A

TSH, vitamin B12, depression screen

125
Q

common preceding infections for reactive arthritis

A

GI: salmonella, shigella, yersinia, campy, c diff
GU: chlamydia

126
Q

how to differentiate iron deficiency anemia and thalassemia

A

both microcystic

mentzer indec (MCV/RBC)> 13 more likely iron deficiency

<13- more likely thalassemia

127
Q

cephalohematoma vs caput

A

cephalohematoma= DOES NOT CROSS SUTURE LINES; WELL DEMARCATED; reoslves in weeks

caput= hematoma above periosteum that crosses suture lines; resolves in days

128
Q

lowgrade fever, facial pain, nasal congestion

A

acute rhinosinusitis

> 95% due to virus, no need for abx (even thouse with bacterial etiology will often resolve w.o abx)

129
Q

tx of pneumomediastinum

A

condition usually resolves pontaneously (tx is supportive, avoid increasing pulm pressure, can give O2 to speed resorption and initiate nitrogen washout)

130
Q

major risk fx for progression of CKD

A

HTN
proteinuria
Hyperglycemia

131
Q

what amount of Cr rise is ok when starting ACEi

A

up to a 30% rise in serum Cr

132
Q

lab values that predispose to calcium phosphate kidney stones

A

hypercalciuria & alkaline urine; hypocitraturia too

133
Q

viral myositis findings

A

young boys in convalescent phase of flu

symptoms: bilateral calf pain, toe walking, elevated CK

self resolve 5-14days

134
Q

lab findings in acute intersitial nephritis (AIN)

A

(commonly due to drugs)

AKI, pyruria, hematurai , WBC casts, eosinophilia & urinary eosinophils, renal bx showing inflamm & edema

135
Q

prophy for PCP pneumonia

A

bactrim (Tmp sulfa)

136
Q

enlarged cup to disc ratio of optic disc

A

open angle glaucoma

137
Q

dietry changes to prevent kidney stones

A

increase fluids, limit dietary oxalate, increase dietary calcium (Ca binds oxalate)

138
Q

why do transcranial doppler for kids with sickle cell?

A

leading cause of stroke in peds pts

139
Q

if head trauma and >65yo

A

get CT scan (increased risk for occult complications following seeminglyh minor trauma)

140
Q

what 2 ventilator settings determine ventilation (CO2 removal)

A 
tidal volume (want low, 6-8ml/kg predicted weight)
 and RR (want less than 35)
141
Q

what 2 ventilator settings determine arterial oxygenation

A

PEEP ( up 15-20cm H2o) and FiO2 (less than or equal to 60%)

142
Q

what precentage FiO2 is associated with oxygen toxicity

A

prolonged FiO2>60%

143
Q

acute splenic sequestration in sickle cel

A

vasoccolusion within the spleen that causes trapping of RBC & platelets

  • see signs of anemia & palpable spleen
  • treatment- fluid resuscitation, RBC transufions, +/- splenectomy
144
Q

meds that cause pupillary dilation (which can exacerabte angle closure glaucoma)

A
  • nasal decongestatns

- anticholinergics (TCAs, tolterodine)

145
Q

protective fx against ovarian cancer

A
  • OCPs
  • multiparity
  • breastfeeding
  • salpingo-oophorecotmy
146
Q

increased risk of ovarain cancer

A

(longer time ovulating)
early menarche
late menopause
nulliparity

147
Q

complication of IUFD if fetus is retained

A

increased risk of coagulopathy (DIC due to release of TF into maternal circulation from placenta) after several weeks fo fetal retention

148
Q

bug that cause otitis externa

A

pseudomonas

staph

149
Q

bugs that cause otitis media

A

strep pneumo
Hflu
moraxella

150
Q

how to treat methemoglobinemia

A

methylene blue

151
Q

buzz words for nonmalignant pulm nodule

A

diffuse, dense, central
popcron
concentric
target calcification pattern

152
Q

buzz words for malignant pulm nodule

A

size>2cm
sunburst
spiculaiton
upper lobe

153
Q

is biopsying erythema nodosum helpful to dx sarcoid

A

no– the erythema nodosum will not show granulomas, not diagnostically helpful (although clinically it can be)

154
Q

complications of OSA

A 
HTN
LV dysfunction
arrhythmia
pulm HTN
insuling resistance
155
Q

can you see pulm contusion on CXR?

A

yes – irregular, localized lung opacification

156
Q

argyll robertson pupils

A

in late neurosyphilis–pupillary constriction with accomodation but not with light

157
Q

hydrophobia is hallmark symptom of what dz

A

rabies

158
Q

firstline HTN med in african american

A

thiazide

CCB

159
Q

what size aortic aneursym shows increased risk of rupture

A

5cm

160
Q

what is considered a rapidly expanding aortic aneurysm?

A

expand by 0.5cm/year (surgery is indicated)

161
Q

anticoag after valve replacement

A

both aspirin + warfarin

INR goal 2-3 if aortic valve without other risk factors (low EF, AFib, hypercoag, prior clot)

INR goal 2.5-3.5 if mechanical mitral valve

162
Q

cardiac meds that can cause digoxin toxicity when taken with dig

A

verapamil
quinidine
amiodarone

163
Q

bugs causing NSTI

A
  • in diabetes – polymicrobial – c perfringens

- without diabetes - group A strep

164
Q

high risk of developing what after kidney transplant?

A

diabetes

165
Q

what medical problem is associated with restless legs?

A

iron deficiency anemia

166
Q

single item screening for alcohol misuse

A

how many times in the past have you had 5 or more drinks in a day? (4 for women)

167
Q

tx of choice in hepatorenal

A

midodrine
octreotide
albumin

168
Q

pathophys of sickle cell dz

A

autosomal recessive; beta globin mutation

step 3 (1 decks)

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