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1
Q

anaphylaxis sx

A

rash
hTN
tachycardia
SOB/wheezing/stridor

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2
Q

anaphylaxis tx

A

epic
antihistamines
glucocorticoids
airway protection

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3
Q

angioedema management

A
  1. airway
  2. FFP or ecallantide
  3. long term: danazole and stanazole
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4
Q

angioedema dx

A

decreased C2 and C4

C1 esterase inhibitor

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5
Q

non- chemical causes of uticaria

A

pressure
cold
vibration

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6
Q

how long is the acute phase of HIV

A

first 4 weeks

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7
Q

sudden SOB, hTN, tachycardia, new blowing diastolic murmur

A

aortic regurg

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8
Q

eyelid erythema/edema, eye pain, opthalmoplegia, proptosis

A

orbital cellulitis

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9
Q

polymyositis vs dermatomyositis

A 
skin involvement (duh):
butterfly/scaly knuckles/V/shawl/telangiectasias
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10
Q

if you dx dermatomyositis, what do you check for

A

malignancy

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11
Q

joints affected in polymyositis/dermatomyositis

A

hips, shoulders, neck

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12
Q

direct vs indirect hernias

A

direct: medial to inf epigastric art, not external inguinal ring
indirect: lateral to inf epigastric art, through ring

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13
Q

BUN/Cr ratios and etiologies

A

< 15: think intrinsic causes
>15: think postrenal
>20: think prerenal

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14
Q

prerenal causes

A 
hypovolemia
shock
sepsis
anaphylaxis
hepatorenal syndrome
renal artery stenosis
fibromuscular dysplasia
NSAIDs/ACE-Is
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15
Q

postrenal causes

A

nephrolithiasis
prostate probs
congenital
bladder/pelvic masses

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16
Q

what kind of renal dz –> increased urine osm (>500) + why

A

prerenal (decreased renal blood flow –> decreased GFR –> attempt to conserve vol –> retain Na and water/concentrate urine –> increase BUN and Cr)

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17
Q

young, HTN female w/ abdominal bruit

A

fibromuscular dysplasia is most likely

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18
Q

vessels affected by fibromuscular dysplasia

A

renal and carotid arteries

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19
Q

renal mass found on ultrasound workup

A

Sx: refer to urology

no sx: get a CT w/ contrast if there are some signs of septa, calcifications or other masses

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20
Q

renal mass found on CT: workup criteria

A

Bosniak’s Classification of Cystic Renal Masses

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21
Q

Bosniak’s Classification

A

(for cystic renal masses)
Class I: benign –> no actions till there are sx
Class II: probable benign (have septation, minimal calcification, or are high density) –> serial CTs every 6 - 12 mo
Class III: some malignant signs (thick/irregular borders, irregular calc, loculated, enhance w/ contrast) –> MRI then bx/ablation/excision
Class IV: clearly malignant (enhancing, heterogenous, “shaggy”) –> surgical excision

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22
Q

when would a positive renal bx result in ablation rather than excision

A

high risk pts

unwilling to have surgery

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23
Q

brocas aphasia: which vessel is occluded

A

middle cerebral artery (superior branch) of dominant side (L for right handed)

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24
Q

wernicke’s aphasia: which vessel occluded

A

middle cerebral artery (inferior branch) of dominant side (L for right handed)

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25
Q

brain infection w/ CD4 < 100

A

toxoplasmosis encephalitis

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26
Q

brain infection w/ CD4 count < 50

A

CMV

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27
Q

brain lesions in HIV pts

A

ring enhancing: toxoplasmosis (MC, multiple), primary CNS lymphoma (solitary, well-defined)

non-enhancing: progressive multifocal leukoencephalopathy (+demyelination); HIV dementia (more symmetric, less well demarcated)

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28
Q

acute hemolytic blood transfusion reaction possible sx

A

fever, flushing, rigors, dyspnea, chest pain, abd pain, n/v, hTN, hematuria

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29
Q

type II DM dx criteria

A

random gluc > 200
fasting > 126
A1C > 7

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30
Q

what to worry about with a fam history of medullary thyroid cancer

A

MEN 2A/B

check for pheo

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31
Q

all the weird details about multiple myeloma

A 
elevated IgG (--> renmal problems)
lytic lesions (esp in skull)
hypercalcemia
fried egg plasma cells with "clock face" chromatin (tons of them on marrow bx = plasmacytosis)
rouleaux formations of RBCs
Bence Jones (Ab light chains) in urine
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32
Q

all the weird details about Waldenstrom’s macroglobulinemia

A 
elevated IgM
rouleaux formations of RBCs
hyperviscocity 
cryoglobulinemia 
cold agglutinins
NO bone lesions/hyperCa
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33
Q

all the weird details about Langerhan’s Histiocytosis

A

Birbeck granules (tennis racket)
lytic bone lesions
eosinophilic granulomas
brown-purple skin lesions

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34
Q

transfusion rxns by time frame

A

minutes: allergic (uticaria, pruritis, anaphylaxis)
1st few hours: febrile nonhemolytic rxns
1st 24 hrs: acute hemolytic rxns
days after: delayed hemolytic rxns

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35
Q

what to bx in suspected Wegners (granulomatosis w/ polyangiitis)

A

lung

can do kidney, but lots of false negatives

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36
Q

polyarteritis nodosa vs granulomatosis w/ polyangiitis

A

PN spares the lungs

PN has transmural vascular necrosis where GWP has granulomas

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37
Q

definitive tx for achalasia

A

myotomy of LES

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38
Q

TRAP+ cell leukemia

A

hairy cell leukemia

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39
Q

t(9; 22)

A

CML (usually) (middle age)

can be ALL (teen)

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40
Q

smudge cells

A

CLL

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41
Q

auer rods

A

AML/APL

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42
Q

treated with all-trans-retinoic acid

A

APL (of AML)

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43
Q

dx of BPHG

A

pelvic U/S w/ post void residual

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44
Q

dx of vesiculoureteral reflux

A

voiding cystourethrogram

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45
Q

neurogenic bladder dx

A

urodynamic testing

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46
Q

poison ivy hypersensitivity type

A

type IV (delayed, T)

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47
Q

ABO transfusion rxns hypersensitivity type

A

type II (IgG)

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48
Q

TSH/thyroxine levels in primary vs secondary hypothyroidism

A

primary: increased TSH, decreased thyroxine
secondary: decreased both

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49
Q

causes of secondary hypothyroidism

A

pit tumors, brain surgery, cranial radiation

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50
Q

what causes hyperpigmentation in adrenal insufficiency

A

increased levels of ACTH

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51
Q

painless, unilateral scrotal swelling that transilluminates

A

hydrocele

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52
Q

when to fix a hydrocele

A

if pt has pain or pressure

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53
Q

DM, hyperpigmentation and cirrhosis

A

hereditary hemochromatosis

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54
Q

iron study results for hemochromatosis

A

increased ferritin and transferrin saturation

transferrin is more sensitive

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55
Q

hypertrophic CM heart description

A

asymmetric hypertrophied non-dilated L ventricl

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56
Q

amyloid CM heart description

A

concentrically thickened ventricles w/ diffuse fibrin deposits

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57
Q

systolic murmur worse w/ valsalva, better w/ squatting

A

hypertrophic CM

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58
Q

valsalva does what to preload

A

decreases

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59
Q

squatting does what to preload

A

increases

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60
Q

young smoker with hand/feet ischemia

A

thromboangiitis obliterans (Buerger dz)

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61
Q

conditions that can have erythema nodosum

A

post-strep infection
sarcoidosis
IBD
TB

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62
Q

tx for erythema nodosum

A

treat underlying if can

NSAIDs, oral steroids, potassium iodide

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63
Q

people at increased risk of renal cell carcinoma

A

von Hippel-Lindau, tuberous sclerosis

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64
Q

cancers people w/ tuberous sclerosis are at risk for

A

cardiac rhabdomyomas
astrocytomas
renal cell cancer

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65
Q

intellectual disability, seizures, hamartomas, renal failure

A

tuberous sclerosis

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66
Q

pernicious anemia at risk for what

A

gastric adenocarcinoma

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67
Q

myesthenia gravis pts at risk for what cancer

A

malignant thymomas

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68
Q

paget dz risk of what cancer

A

fibrosarcoma of bone

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69
Q

sx of HCa

A

weakened bones, lethargy, depression, nausea/vom/constipation, kidney stones
(bones, stones, abdominal groans and psychiatric moans)

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70
Q

HCa EKG

A

shortened QT

arrhythmias

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71
Q

hypercalcemia/hyperPTH ddx

A

lithium (Ca + PTH)
thiazide diuretics (Ca)
parathyroid adenoma (Ca + PTH)
familial hypocalciuric hypercalcemia (Ca + PTH)
malignancy (Ca)
vit D def (PTH) usually from kidney failure

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72
Q

hypercalcemia, metabolic alkalosis and renal insufficiency

A

milk-alkali syndrome

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73
Q

CXR in bleomycin toxicity

A

interstitial pneumonitis w/ honeycombing

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74
Q

positive obstructive atelectasis cause

A

mucus plug

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75
Q

signs/sx of ventilator-associated pneumonia

A

new fevers, purulent tracheobronchial secretions, leukocytosis
CXR: focal lung consolidation

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76
Q

pemphigus vulgaris

A

flaccid blisters that start in MM, tear easily, IgG/C3 in epidermis

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77
Q

bullous pemphigoid

A

tight blisters that spare MM, often post uticaria/pruritic rash, don’t tear easily, IgG/C3 in subepidural BM

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78
Q

IgA deposits in papillary dermis

A

dermatitis herpetiformis

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79
Q

IgA deposits in BM of skin

A

linear IgA dermatosis

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80
Q

spontaneous pneumothorax risk factors

A

male 10 - 30, tall and thin

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81
Q

ABCDE of melanoma

A 
asymmetry 
border
color
diameter (>6mm)
evolving
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82
Q

ruptured esophageal varices: Tx

A

immediate EGD w/ banding

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83
Q

other dz a/w celiacs

A

dermatitis herpetiformis
type 1 DM
selective IgA deficiency

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84
Q

oculomasticatory myorhythmia

A

rhythmic movements of eye convergence w/ masticatory muscle contractions
seen in whipples

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85
Q

whipples tx

A

ceftriaxone then TMP-SMX

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86
Q

hemophilia coag

A

aPTT

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87
Q

von willebrand coag

A

bleeding time, aPTT

ristocetin cofactor assay

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88
Q

which vessel?: vertigo, horners, nystagmus, face sensation down, opposite body sensation down

A

(same side as face)
posterior inferior cerebellar artery
Wallenberg’s syndrome

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89
Q

which vessel?: return of primative reflexes (rooting, grasping, suckling)

A

anterior cerebral artery

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90
Q

which vessel?: vertigo, vertical nystagmus, dysarthria, ataxia, face sensory changes, “drop attacks” or labile BP

A

vertebrobasilar artery

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91
Q

fever, new/severe unilateral HA, acute onset focal deficit

A

brain abscess (usually hx of chronic sinusitis, otitis media, mastoiditis, dental cavity, etc)

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92
Q

sinusitis – when to give Abx

A

Abx: > 10 days, complications like facial swelling or tooth pain (give amoxicillin)
No Abx: everything else (give nasal saline and decongestants)

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93
Q

sinusitis – when to get a CT

A

chronic (ongoing for > 12 weeks)

do nasal culture too

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94
Q

cancers at high risk for brain mets

A

lung, breast, melanoma

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95
Q

MC brain tumor in adults

A

mets

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96
Q

MC primary brain tumor in adults

A

glioblastoma multiforme

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97
Q

HA worse in the AM w/ nausea/vomiting is a sign of?

A

increased ICP

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98
Q

constant HA worse in the am w/ n/v and ring enhancing mass on CT

A

glioblastoma multiforme

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99
Q

HIV pt w/ HA, personality changes, neuro deficits, seizures

A

primary CNS lymphoma

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100
Q

primary CNS lymphoma tx

A

high dose methotrexate then radiation

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101
Q

organism in neurocysticercosis

A

taenia solium

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102
Q

risk of crazy high sugar in DM

A

hyperglycemic hyperosmolar state

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103
Q

tx for hyperglycemic hyperosmolar state

A

fluid replacement and insulin drip

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104
Q

spontaneous DVT or PE with hx of miscarriages

A

factor V leiden mutation

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105
Q

double layer basement membrane

A

membranoproliferative GN

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106
Q

RF for membranoproliferative GN

A

hep C

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107
Q

what does amiodarone pulm-tox look like?

A

dyspnea, cough, fever
CXR: ground glass
BAL: PMNs, T-cells, “foamy” macs

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108
Q

severe diarrhea –> what kind of electrolyte imbalance?

A

non-anion gap metabolic acidosis

decreased potassium, increased Cl

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109
Q

how to calculate anion gap

A

sodium - chloride - bicarb
< 12 = non anion gap
> 12 = anion gap

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110
Q

anion gap dx

A 
Methanol, metformin
Uremia
DKA
Propylene glycol
Iron, INH
Lactic acidosis
Ethylene glycol
Salicylates, starvation
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111
Q

1st line tx CAP

A

azithromycin

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112
Q

stevens johnsons vs toxic epidermal necrolysis

A

> 30% of total body surface –> toxic epidermal necrolysis

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113
Q

causes of toxic epidermal necrolysis

A

meds: sulfonamides, allopurinol, carbamazepine, lamotrigine, phenobarbital and piroxicam
infections: viral, mycoplasma pneumonia

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114
Q

angiofibroma, ash-leaf spots, shagreen patch, intellectual disability, epilepsy

A

tuberous sclerosis

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115
Q

treatment for ventricular fibrillation

A 
...defibrillation
then epi (or vasopressin) if didn't work (while doing cpr)
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116
Q

tx for ventricular tachycardia w/ pulse

A

lidocaine

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117
Q

cherry red macular spot

A

central retinal artery occlusion (caused by carotid atherosclerosis or cardiogenic emboli)

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118
Q

yellow deposits (drusen) around macula

A

dry age related macular degeneration

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119
Q

night blindness –> dry eyes

A

vit A def

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120
Q

blood/vessels in subretinal space

A

wet age related macular degeneration

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121
Q

old, acute abd pain, bloody diarrhea, leukocytosis (hx of atherosclerosis)

A

acute mesenteric ischemia

122
Q

1st line tx acute cluster headache

A

high flow 100% O2

123
Q

suspect acute bacterial meningitis: management

A
  1. non-contrast head CT to r/o mass lesions, strokes, hematoma
  2. LP
    (if can’t LP/delay –> start Abx)
124
Q

abx for acute bacterial meningitis

A

1 mo - 65: vanco, ceftriaxone

baby or old: vanco, ceftriaxone +ampicillin

125
Q

+ PPD size in HIV +

A

> 5 mm

126
Q

vaccinations for HIV +

A 
hep A
hep B
pneumococcal
HPV
annual flu
127
Q

prophylactic abx for HIV (<200)

A

TMP-SMX against pneumocystis jiroveci

128
Q

prophylactic abx for HIV (<50)

A

azithromycin (or clarithromycin) against mycobacterium avian

129
Q

prophylactic abx for HIV w/ thrush

A

TMP-SMX against pneumocystis jiroveci

130
Q

pathophys of hepatic encephalopathy

A

bacteria in gut make ammonia, can’t be taken out by damaged liver

131
Q

serum-ascites albumin gradient(whats the over under)

A

> 1.1 = transudative

< 1.1 = exudative

132
Q

transudative causes of ascites

A

cirrhosis, CHF

133
Q

exudative causes of ascites

A

malignancy, infection, pancreatitis, nephrotic syndrome

134
Q

light’s criteria

A 
for pleural effusions
transudative if:
effusion to serum protein > 0.5
effusion to serum LDH > 0.6
effusion LDH > 2/3 normal
135
Q

transudative causes of pleural effusions

A

cirrhosis, CHF, nephrotic syndrome

136
Q

MC kidney stone

A

Ca oxalate

137
Q

when to work up back pain presenting normally

A 
> 6 wk duration
(+) straight leg raise
red flags (suspect tumor, infection, or cauda equina)
138
Q

when to get an MRI for back pain

A

hx cancer or weight loss
fever, chills
incontinence, bilateral leg weakness, saddle anesthesia

139
Q

when to get an xray for back pain

A

suspect fractures: trauma or osteoporosis

> 6 wk pain with conservative management

140
Q

heart thing a/w diff BP in arms than legs

A

coartaction of aorta

141
Q

heart thing a/w forceful arterial pulse with rapid collapse

A

aortic regurg

142
Q

initial tx for pylonephritis

A

cipro

143
Q

sickle cell w/ acute chest pain, dyspnea

A

acute chest syndrome

144
Q

wolf parkinson white ecg changes

A

short pr
wide qrs
delta wave

145
Q

hyperkalemia ecg

A

peaked T waves

widened qrs

146
Q

when do you see u waves

A

hypokalemia

147
Q

kidney problems a/w Crohns

A

CaOxylate stones (fat malabsorption –> ca not absorbed –> hyperoxaluria)

148
Q

thrombocytopenia management

A

Asx, > 30000 –> nothing
Sx, > 30000 –> glucocorticoids (or IgG if cant); then splenectomy if need or rituximab
Asx, < 30000 –> tx as above

149
Q

when to give oseltamivir

A

flu for 2 or fewer days

150
Q

Hep B markers: vaccine vs. natural immunity

A

vaccine: (+) Anti-HBs (surface)

from infection: (+) Anti-HBs and (+) Anti-HBc

151
Q

Hep B markers: acute vs chronic infection

A

both (+) HbsAg and (+) Anti-HBc

Acute also has (+) IgM Anti-HBc

152
Q

best initial screening for cushings

A

low dose dexamethasone suppression test

153
Q

epigastric pain – awakens pt from sleep

A

duodenal ulcers apparently

154
Q

cause of anion gap acidosis in septic shock

A

decreased organ perfusion –> lactic acidosis

155
Q

well differentiated papillary thyroid cancer tx

A
  1. surgery
  2. radioactive iodine ablation
  3. T4 (levo)
156
Q

Graves tx

A

radioactive iodine ablation + levo

157
Q

what else to consider w/ achalasia

A 
SCCAN
Sarcoidosis
Chagas
CA (esp gastric)
Amyloidosis
Neurofibromatosis
158
Q

kidney stones dx

A

helical CT w/o contrast

159
Q

hypercalcemia workup

A
  1. serum parathyroid
  2. check for cancers
  3. bone density (not for dx)
160
Q

hyperkalemia tx

A

calcium gluconate (stabilize <3)
insulin/glucose
albuterol
keyexolate (Na polystyrene sulfonate)

161
Q

time frame: chronic sinusitis

A

> 12 wks (3 mo)

162
Q

non hemolytic febrile transfusion rxn tx

A

tylenol (+ stop transfusion)

163
Q

uticarial allergic transfusion rxn tx

A

diphenhydramine (+ stop transfusion)

164
Q

inflammatory bowel dz dx

A

fecal lactoferrin

165
Q

pheochromocytoma tx

A
  1. alpha blockers
  2. beta blockers
  3. surgery
166
Q

large bowel vs small bowel ischemia

A

large: low grade pain + hematochezia
small: severe pain OOP, vomiting

167
Q

cause of pigmented (black) gallstones

A

chronic hemolysis
cirrhosis
Asian…?

168
Q

cholesterol gallstone RFs

A

fat, female, forty, fertile (birth control)

+ estrogen replacement therapy

169
Q

paraneoplastic Abs

A

Anti-Hu (small cell lung)

Anti-Yo (breast/gyn)

170
Q

brain complication of autosomal dom polycystic kidney dz

A

cerebral aneurysms –> subarachnoid hemorrhages

171
Q

subarachnoid hemorrhage dx

A

non contrast CT

172
Q

why does that smoker have cough + low sodium

A

SIADH from small cell carcinoma

173
Q

polycythemia ddx

A

high altitude life
obstructive sleep apnea
carbon monoxide
sports cheating (exogenous EPO, steroids)
paraneoplastic (renal cell, hepatic, pheo, fibroids)
polycythemia vera (LOW EPO)

174
Q

polycythemia vera dx

A

JAK-2 mutation

175
Q

polycythemia vera tx

A

ASA, phlebotomy

176
Q

abdominal pain, psych stuff, red/pink urine

A

acute intermittent porphyria

177
Q

triggers for acute intermittent porphyria flares

A

alcohol
barbiturates
OCPs
hep C

178
Q

chemo drug that –> hemolytic uremic syndrome

A

mitomycin

179
Q

aortic dissection tx

A
  1. beta-blocker or nitroprusside

2. surg: graft/ or endovascular stent/graft

180
Q

why do you get increased Ca in lung cancer

A

paraneoplastic – release parathyroid hormone-RELATED protein

181
Q

tx primary pulmonary HTN

A

sildenafil

182
Q

PE Dx

A

D-dimer to r/o PE in low risk
high risk get a CTA
V/Q scan for those who can’t CTA

183
Q

metastatic prostate Ca tx

A

less androgens:
GnRH agonists (leuprolide, goserelin)
adrenal inhibitor (ketoconazole)
or @ receptors (flutamide)

184
Q

diff btwn asthma and COPD

A
  1. asthma is reversible

2. diffusion capacity for CO (normal for asthma, down in COPD)

185
Q

recurrent oral/genital ulcers in young person (not herpes)

A

Behcet’s

186
Q

lewy body dementia tx

A 
levodopa (parkinson sx)
acetylcholinesterase inhibitors (behavioral/hallucinations)
clonazepam (sleeping crap)
187
Q

acute urinary retention management

A

try to pass a foley
suprapubic if can’t
then surg consult

188
Q

supplement to give w/ isoniazid (and why)

A

B6, avoid neuropathy

189
Q

electrolyte weirdness in kidney failure

A

down phosphorus
up potassium
down calcium

190
Q

MCC osteomyelitis

A

staph aureus (even in DM pts)

191
Q

when can you give anti-motility in diarrhea

A

non-invasive, non-bloody

192
Q

erythematous, scaly plaques on the face w/ remission and relapse

A

seborrheic dermatitis

193
Q

benign esophageal strictures tx

A

endoscopic dilation

194
Q

drugs causing aplastic anemia

A

chloramphenicol

valproate, carbamazapine, phenytoin

195
Q

phenytoin toxicity sx

A 
vertical nystagmus
sedation,
hTN
arrhythmias
GI distress
196
Q

hemolytic anemia ddx

A 
autoimmune 
paroxysmal noctural hemoglobinuria
sickle cell
malaria/babesia
hereditary spherocytosis
G6PD deficiency
microangiopathic (DIC, TTP, HUS)
mechanical (heart valve)
197
Q

dx paroxysmal nocturnal hemoglobinuria

A

flow cytometry

198
Q

dx sickle cell

A

hb electrophoresis

199
Q

dx autoimmune hemolytic anemia

A

Coombs

200
Q

dx hereditary spherocytosis

A

osmotic fragility test

201
Q

hemolysis, thrombosis, pancytopenia

A

paroxysmal nocturnal hemoglobinuria

202
Q

psychomotor slowing w/o aphasia

A

NPH (part of whacky)

203
Q

pts > 50 w/ bilateral shoulder and hip pain/stiffness

A

polymyalgia rheumatica

204
Q

labs for polymyalgia rheumatica

A

ESR > 50

205
Q

what else to check for with polymyalgia rheumatica

A

temporal arteritis

206
Q

tx for secondary lymphedema (ex: post lymph node bx)

A

compression + skin care

207
Q

thyroid enlargement weeks after infection

A

subacute thyroiditis

208
Q

when to bx prostate

A

abnormal DRE

PSA > 4

209
Q

gradual bilateral loss of central vision

A

age related macular degeneration (dry?)

210
Q

cupping of optic disc

A

open-angle glaucoma

211
Q

kid with edema and heavy proteinuria – most likely cause

A

minimal change disease

212
Q

dx minimal change disease

A

renal bx and electron microscopy

213
Q

cause of shock liver

A

not adequate liver perfusion –> ischemic hepatitis

214
Q

chemo pt w/ fever and decreased WBCs

A

neutropenic fever

215
Q

tx for neutropenic fever

A

start broad spectrum abx, and get blood/urine cultures

216
Q

dx Conn’s syndrome (also, wut is it)

A

aldosterone secreting tumor

measure aldosterone-renin ratio (+ is > 20)

217
Q

palpably enlarged but non-tender gallbladder

A

sign of extrahepatic biliary obstruction (courvoisier’s sign)

218
Q

tx: ball cancer

A
  1. inguinal orchiectomy (not simple – leads to seeding)
  2. retroperitoneal lymph node dissection
  3. radiation/chemo
219
Q

management: guillain barre

A
  1. hospitalize + get serial PFTs

2. IgG (non-ambulatory only) or plasma exchange for tx (combo not better)

220
Q

dx: guillain barre

A

Clinical but may see

LP: up protein, normal WBC

221
Q

PPD (+) for close contacts

A

> 5 mm

222
Q

shiny, umbilicated, dome-shaped papules

A

molluscum contagiosum

223
Q

how does Mg affect K?

A

hypomagnesemia –> renal potassium wasting

so if Mg is low you can’t fix the K no matter what

224
Q

1st line tx for severe acne

A

oral isotretinoin

225
Q

viral diarrhea time limit

A

14 days

226
Q

tx: uncomplicated pylonephritis

A

cipro/levofloxacin

227
Q

unilateral joint pain/stiffness (better in first 30 min) w/ crepitus or effusion

A

osteoarthritis

228
Q

osteoarthritis tx

A

PT
weight loss
NSAIDs

229
Q

fever, leuks, LLQ pain

A

diverticulitis

230
Q

diverticulitis dx

A

CT

231
Q

diverticulitis tx

A

bowel rest
broad-spec Abx
IV fluids

232
Q

HTN and hK

A

think excess aldosterone

233
Q

bilateral sacroiliitis in teen

A

ankylosing spondylitis

234
Q

weird ankylosing spondylitis things

A

HLA-B27 +
elevated ESR
bamboo spine
pain improved w/ moving/hot showers

235
Q

confluent hyperpigmented or hypopigmented macules on upper torso and arms

A

tinea versicolor

236
Q

healthy-ish old person w/ 2+ cytopenias on peripheral smear

A

myelodysplastic syndrome

237
Q

myeloid cell lines

A 
granulocytes (neutrophils, eos, basophils)
erythrocytes
megakaryocytes/platelets
monocytes
mast cells
238
Q

dx: sarcoidosis

A

biopsy (lung usually)

non-caseating granulomatous infiltration (w/o orgs)

239
Q

ddx: hypernatremia

A 
6 Ds:
diuretics
dehydration
diabetes insipidus 
docs (iatrogenic)
diarrhea
dz of kidney
240
Q

hypernatremia workup

A
  1. check urine osms
  2. high = dehydration
    low = diabetes insipidus
  3. water deprivation/desmopressin
241
Q

1 RF for ischemic and hemorrhagic strokes

A

HTN

242
Q

central DI tx

A

desmopressin

243
Q

CML treatment

A

imatinib

stem cell transplant if fail and young

244
Q

skin findings in hypercholesterolemia

A

xanthomas:
lipid deposits (yellow pustules)
tuberous masses on tendons
xanthelasma (eyelids)

245
Q

OCPs up risk of what in RUQ

A

`hepatic adenoma

246
Q

NASH puts you at risk for what

A

hepatocellular carcinoma

247
Q

MS exacerbation Tx

A

steroids

248
Q

thyroid nodule, no problems – next step?

A

fine needle aspiration

249
Q

blood smear for mono

A

large, dark lymphocytes

250
Q

HTN med for pts w/ CKD

A

ace inhibitors

251
Q

hyperthyroid treatment for preggers

A

propylthiouracil 1st trimester

methimazole 2nd, 3rd

252
Q

tx tension pneumo

A

needle thoracostomy

253
Q

contact dermatitis hypersensitivity type

A

type IV

254
Q

pseudotumor cerebri

A

idiopathic intracranial HTN

255
Q

management for pseudotumor cerebri

A
  1. MRI/CT

2. LP

256
Q

MEN 1

A

pit adenomas
parathyroid hyperplasia
panc tumors

257
Q

MEN 2A

A

parathyroid hyperplasia
medullary thyroid carcinoma
pheo

258
Q

MEN 2B

A

mucosal neuromas
marfanoid
medullary thyroid carcinoma
pheo

259
Q

gas gangrene tx

A
  1. surgical debridement

2. hyperbaric/Abx

260
Q

generalized maculopapular rash days to weeks after starting bactrim (and what to do)

A

drug eruption

stop drug, give antihistamines

261
Q

1st MI blood level to rise (and how fast)

A

myoglobin (1st 2 hours)

262
Q

when does troponin increase/peak (hours)

A

up at 3-12

peak @ 24

263
Q

dull flank pain, hematuria, bilateral kidney masses

A

ADPKD

autosomal dominant polycystic kidney dz

264
Q

tx kawasaki

A

IVIG and hi dose ASA

265
Q

right ventricular heave, loud P2 and tricuspid regurg

A

primary pulmonary HTN

266
Q

tests for primary pulmonary HTN

A

CXR, EKG, Echo

R heart cath is most definitive

267
Q

when do you get the shingles vaccine?

A

60

268
Q

when do old people get the pneumonia vaccine? (and which one?)

A

old folks get the 23 polysaccharide vaccine @ 65

269
Q

peripheral lung lesion in young non-smoking female

A

adenocarcinoma

270
Q

clotting factors affected by warfarin

A 
II
VII
IX
X
(1972)
271
Q

what needs to change if postprandial and fasting glucose levels are high

A

increase basal insulin

272
Q

levels in tumor lysis syndrome

A

sudden increase in K, phos (which can –> hypocalcemia), and uric acid from dying cancer cells

273
Q

prevention of tumor lysis syndrome

A

allopurinol and IV bicarb (+ aggressive hydration)

274
Q

cancers to look out for tumor lysis syndrome

A

ALL
Burkitt’s lymphoma
other high grade lymphomas

275
Q

dx testicular torsion

A

doppler u/s

276
Q

what do you worry about w/ strep bovis infxn?

A

colon cancer

277
Q

causes of eosinophilia

A 
NAACP
neoplasm
asthma/allergy
addisons 
collagen vascular d/os
parasites
278
Q

tx for polyarteritis nodosa complicated by hep B/C

A
  1. corticosteroids

2. plasma exchange

279
Q

spontaneous bacterial peritonitis (SBP) dx

A

paracentesis:

neuts > 250 or + fluid culture

280
Q

asthma drug sequence

A 
SABA (albuterol)
ICS qD (fluticasone or budesonide)
LABA qD (salmeterol or formoterol)
hi dose ICS
oral corticosteroid (prednisone)
281
Q

MC EKG finding in PE

A

sinus tach

282
Q

how do you know if its chronic vs acute pancreatitis

A

amylase/lipase: way high in acute

x-ray: calcifications in chronic

283
Q

dermatomyositis dx

A

muscle biopsy: pathology only in one portion of muscle fascicle

284
Q

lead poisoning tx

A

adults: Ca-EDTA (dimercaprol is old)
kids: succimer

285
Q

T scores mean…

A

-1 to -2.4 = osteopenia

< -2.5 = osteoporosis

286
Q

when do you get a dexa scan?

A

65
hx trauma
hx glucocorticoid use

287
Q

which vessel: oculomotor palsy (ptosis, diplopia, down+out, non-reactive mydriasis)

A

posterior communicating artery (–> subarachnoid hemorrhage)

288
Q

arteries that can –>. subarachnoid hemorrhage (SAH)

A 
circle of willis:
internal carotids
ant cerebral
ant communicating
post cerebral
post communicating
basilar
289
Q

unequal pulses or unilateral claudication

A

takayasu disease

granulomatous thickening/stenosis of aortic arch

290
Q

fund: retinal microaneurysms, blot hemorrhages and cotton wool spots

A

diabetic retinopathy

291
Q

GERD tx

A
  1. lifestyle

2. antacids, H2 blockers, or PPIs

292
Q

when can you get sheehan syndrome

A

right after childbirth or even months/years later

293
Q

tx for acute sheenhan syndrome

A

IV dexamethasone

then MRI the head to r/o other crap

294
Q

MCCs of otitis externa

A

pseudomonas

staph aureus

295
Q

NF1 vs NF2

A

1 has axillary freckling and ocular findings (optic gliomas or iris hamartomas)

296
Q

work up for neurofibromatosis

A 
slit lamp (gliomas/iris hamartomas) (1 only)
plain films (bony lesions)
head imaging (gliomas)
auditory (b/l vestibular schwannomas) (2 only)
297
Q

bone lesions in NF-1

A

x-ray: done dysplasia, vertebral defects, sphenoid wing dysplasia, fibromas

298
Q

cafe-au-lait spots, fibrous skeletal dysplasia, precocious puberty

A

McCune Albright (not NF-1)

299
Q

tx for lyme

A

No CNS/cardiac involvement: doxy
preg/breastfeed/kids < 8: amoxicillin
CNS/cardiac: ceftriaxone

300
Q

IBD + jaundice

A

primary sclerosing cholangitis (a/w UC)

301
Q

dx malaria

A

thick and thin blood smear

302
Q

tx thyroid storm

A

beta blocker (propranolol)
PTU
hydrocortisone
stable iodine (1 hr post PTU)

Step 2 (7 decks)

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