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Important Topics Flashcards

1
Q

Pruritic rash affecting the web spaces of the hands. Also seen with patients close contacts. Diagnosis and txmnt

A

Scabies

Permethrin cream

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2
Q

3 day old with bilious vomiting, abd distension, failure to pass meconium, and gas a stool expulsion with DRE. Diagnosis and what is the gold standard test would you use?

A

Hirschsprung’s disease

rectal suction biopsy

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3
Q

When would you use anal rectal manometry vs. rectal suction biopsy to diagnose Hirschsprung’s disease?

A

Rectal suction biopsy is the gold standard with higher sensitivity.

Rectal manometry is also less accurate in babies < 1 month

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4
Q

2 possible tests that can help diagnose upper GI obstruction?

A

Abd US

Upper GI series

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5
Q

When would you use a contrast enema for diagnosis and txmnt?

A

Contrast enema can help you diagnose and treat intussusception

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6
Q

Abd cramps, vomiting, high pitched bowel sounds, leukocytosis, and a tender groin mass. Diagnosis and txmnt

A

Incarcerated inguinal hernia. Requires surgical management

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7
Q

Management of asymptomatic primary hyperPTH?

A

Regular followup of calcium, Cr, and Dexa

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8
Q

When would you want to screen for MEN in a patient with hyperPTH?

A

If they are very symptomatic or if they have a FMH of MEN

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9
Q

Multiple erythematous plaques with central clearing beginning on the extremities. Rash name and leading cause?

A

Erythema multiforme caused by HSV

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10
Q

Difference between erythematous plaques with central clearing in erythema multiforme and erythema migrans

A

Migrans (Lyme disease) is slow spreading an centered around the tick bite.
Multiforme occurs faster and has multiple lesions

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11
Q

<30 yo with palpable breast mass. What studies do you get?

A

US first then mammogram if it is equivocal

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12
Q

< 30 yo with breast mass gets imaging that shows simple cyst. Management? What if it is a complex cyst?

A

Needle aspiration for simple cyst to decompress. Image guided core biopsy for complex cyst

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13
Q

> 30 yo with breast mass. What studies do you order? What if the initial tests make you more concerned about malignancy?

A

Mammogram first. Follow up with US if equivocal.

Image guided core biopsy if imaging is concerning

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14
Q

When do you initiate HTN meds?

A

Observe for 1 year with behavior modifications. Can also start if there is organ damage or a high risk comorbidity like ACS

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15
Q

When can physicians talk to families about organ procurement?

A

When they are specially trained to do so

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16
Q

When would you treat with racemic epinephrine? Describe symptoms

A

Croup

Barky cough with inspiratory stridor

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17
Q

Cough, post-tussive emesis, and lympocytosis. Dx and txmnt

A

Pertussis

treat with macrolides like azithromycin

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18
Q

Kid with lung issue. When would you treat with

  1. azithromycin
  2. ceftriaxone
  3. oseltamivir
  4. prednisone
  5. racemic epi
A
  1. pertussis
  2. Staph pneumonia
  3. Influenza
  4. Asthma exacerbation
  5. Croup
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19
Q

Multiple, bilateral, small, round nodules in the upper lobes on chest imaging are likely

A

Silicosis

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20
Q

Bilateral linear and reticular opacities, irregular bronchovascular thickening of the upper lobes, and enlarged mediastinal and hilar lymph nodes

A

Sarcoidosis

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21
Q

Management of asymptomatic hernias in kids.

A

Hernia repair electively in 1-2 weeks. Operate urgently if incarcerated

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22
Q

Hydrocele management
Varicocele management
Cryptorchidism management

A

Hydrocele- Reassurance and observation. REsolve in 1 yr

Varicocele - may require surgery in early puberty if symptomatic

Cryptorchidism - Wait until 6 months as they may descend

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23
Q

When would you consider giving menopausal hormone therapy? Who would you not give it to?

A

MHT for healthy women less than 60

Greater risk if >60, have CHD, liver disease, previous stroke or breast cancer

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24
Q

On dyslipidemia meds and get strep throat which is treated with antibiotics. Get muscle soreness and increased CK. What happened?

A

Statin induced myositis. The macrolide antibiotic cann affect statin metabolism

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25
Q

Increased PTT with normal PT. Possible causes with h/o bleeding. Possible causes if no hx of bleeding

A

Hemophilia A, B and vWF disease would all have h/o bleeding

Acquired hemophilia due to a factor VIII inhibitor if no h/o bleeding

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26
Q

Liver cyst with fever. No organisms on bacterial culture. Aspirate is thick, dark brown fluid like anchovy paste. Cause?

A

Protozoal infection with entamoeba histolytica

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27
Q

Txmnt of acute prostatitis?

A

TMP-SMX of ciprofloxacin for 6 weeks

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28
Q

When to surgically repair AAA? Non surgical management

A
  • > 5.5 cm
  • Increased in size more than 0.5 cm in 1 yr
  • Symptomatic with back or abd pain

Re-eval w/ US or CT every 6 months

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29
Q

When can a pt w/ uncomplicated MI return to work?

When can a pt w/ MI and heart failure return to work?

A

Uncomplicated - 2 weeks

Complicated 3-4 months

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30
Q

Txmnt of Kawasaki Dz?

A

ASA and IVIG

Echo to r/o complications

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31
Q

Complications of Kawasaki dz

A

Coronary artery aneurysms

MI

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32
Q

Common causes of recurrent cellulitis

A

tinea pedis infection
lymphedema
severe venous insufficiency

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33
Q

3 steps for evaluating hematochezia in hemodynamically stable pts

A
  1. Colonoscopy, if no source then
  2. EGD, if no source then
  3. Capsule endoscopy or repeat EGD
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34
Q

4-5 steps for evaluation hematochezia if hemodynamically unstable

A
  1. Resuscitate
  2. +/- Surgery or IR consult
  3. EGD

No source and still unstable
4a. Angiography

No source, but stable
4b. Colonoscopy

No source
5b. Capsule endoscopy

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35
Q

Menstrual bleeding common for uterine fibroids

A

Heavy, regular bleeding

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36
Q

When would you give protamine sulfate?

A

To reverse heparin due to bleeding

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37
Q

Warfarin patient develops a serious bleed, how would you tx?

A

Stop warfarin

Reverse with Vitamin K and add FFP.

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38
Q

Long QT and short QT, what is the relationship with calcium

A

Long QT - hypocalcemia

Short QT - hypercalcemia

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39
Q

Old lady lives in a home, gets admitted to the hospital for PNA and gets antbiotics and a foley. She gets worse one day after the foley and has a few loose stools. Dx?

A

C. diff

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40
Q

Connect electrical alternans to hypotension

A

There is a pericardial effusion causing alternans. The cardiac tamponade is reducing flow into the right heart leading to decreased cardiac preload.

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41
Q

When should a patient be counseled about renal replacement therapy? What does renal replacement therapy mean?

A

When their GFR < 30
Renal replacement therapy means
kidney replacement, hemodialysis, or peritoneal dialysis

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42
Q

When do you add EPO in CKD?

A

when Hgb< 10

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43
Q

Normocytic anemia, hypercalcemia, mild renal insufficiency, and bone pain. Dx? What test should you order?

A

Multiple myeloma

24 hour urine protein electrophoresis

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44
Q

Soft, scrotal mass that increases in size with Valsalva. What are they at risk for? How would you tx?

A

Varicocele
At risk for testicular atrophy and infertility due to increased temp

Gonadal vein ligation in young boys w/ atrophy

NSAIDs and scrotal support in older men

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45
Q

Newborn has cyanosis when feeding that improves with crying. Dx? What would you do to confirm?

A

Choanal atresia.

Try passing a nasogastric catheter

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46
Q

1st step for evaluating tracheoesophageal fistula

A

Insert gastric catheter followed by XR

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47
Q

Txmnt of symptomatic, recurring, malignant pleural effusion

A

Large volume thoracentesis followed by chemical pleurodesis. Palliative txmnt

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48
Q

Parameters for lead intoxication

A

< 44 = mild
45-69 = moderate
>70 = severe

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49
Q

Lead intoxication txmnt based on severity

A

Contact local public health - mild

DMSA - moderate intoxication

Dimercaprol and EDTA -severe

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50
Q

What test should be done on a pt with PCP PNA after starting antibiotic txmnt that would affect management? Why?
What would you do?

A

ABG analysis
Lysis of organisms can lead to an inflammatory response that causes hypoxia

If partial pressure of O2 is <70 or alveolar-arterial gradient is >35 then give steroids

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51
Q

4 cases in which you would prescribe antibiotic prophylaxis prior to a invasive procedure for infective endocarditis?

A
  1. Prosthetic cardiac valves
  2. Previous endocarditis
  3. Valvulopathy in pt who received cardiac transplant
  4. Congenital heart dz
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52
Q

Txmnt for acetaminophen toxicity depending on time since ingestion

A

< 4hrs - activated charcoal

>4 hrs - N-acetylcysteine (NAC)

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53
Q

What environmental factor has the greatest increase of risk for pancreatic cancer?

A

Cigarette smoking

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54
Q

What kind of pt gets a implantable cardioverter-defibrillator (ICD) vs cardiac resynchronization therapy w/ biventricular pacemakre?

A

ICD- 1. Prior MI and LVEF <30%
2. NYHA Class II or III heart failure and LVEF < 35%

Biventricular pacemaker - LVEF <35% w/ long QRS

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55
Q

Man w/ impotence, ED, galactorrhea, and bitemporal hemianopsia. Txmnt 1st and 2nd line?

A

First line - dopamine agonist like bromocriptine or cabergoline

2nd line - Surgery

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56
Q

What is the mechanism of Factor V Leiden causing thrombophilia?

A

Resistance to the anti-thrombotic effect of protein C

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57
Q

How to treat QRS prolongation (>100 sec) in TCA OD

A

Give bicarbonate increases TCA binding so that it doesn’t bind Na channels

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58
Q

4 tests to order in an obese patient

A
  1. HgbA1c
  2. Lipids
  3. LFTs
  4. TSH
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59
Q

How does orlistat work for weight loss?

A

Inhibits pancreatic lipases, which decrease fat absorption and lead to diarrhea

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60
Q

How do you dx EHEC?

How do you tx it?

A
  • Stool culture (sorbitol-MacConky agar)
  • Shiga toxin

Tx:
Supportive therapy
Avoid abx due to risk of HUS

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61
Q

Triad of hemolytic uremic syndrome?

A
  1. Acute renal failure
  2. Microangiopathic hemolytic anemia
  3. Thrombocytopenia
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62
Q

Iron and ferritin levels in iron deficiency anemia vs. thalassemia

A

Fe deficiency - decreased iron and ferritin

Thalassemia - Normal to increased iron and ferritin

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63
Q

Pregnant pt with RA. Which meds should be stopped and when

A

Continue hydroxychloroquine d/c methotrexate 3 months prior to pregnancy due to NTD

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64
Q

Screening tests for neural tube defects?

A

2nd trimester US and AFP

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65
Q

Kidney transplant pt on immunosuppressives gets AKI and biopsy shows renal tubular damage w/ prominet basophilic intranuclear inclusions. DX? Txmnt?

A

BK-virus induced nephropathy (Polyoma virus)

Decrease immunosuppression and possible antiviral therapy

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66
Q

How much of Medicaid is children?

A

About 50%

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67
Q

When should you deliver a diabetic mom with a baby weighing > 9.9 lbs, and how should the baby be delivered?

A

Deliver by c-section at 39 weeks

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68
Q

One difference between hypothyroid myopathy and inflammatory myopathy?

A

Hypothyroid myopathy does not have muscle soreness at baseline and may have other hypothyroid features

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69
Q

3 medications that would reduce the frequency of migraines

A

Propanolol
Valproate
Amitryptiline
(ergotamines are better to abort headaches not prevent them).

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70
Q

How could you reduce ventilator associated ARDS complications?

A

Decrease tidal volume. Prevents overdistending alveoli and causing barotrauma.

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71
Q

4 Ps of lichen planus

A

Pruritic
polygonal
planar
purple

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72
Q

Pt is volume down and develops hypotension after being started on a ventilator. What is the txmnt and why?

A

Ventilator increases intrathoracic pressure and decreases preload. Tx w/ NS bolus

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73
Q

What are pts with nephrotic syndrome at increased risk for?

A

Thrombotic event, possibly due to loss of anticoagulants in the urine.

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74
Q

3 risks associated w/ Parvovirus B19 in a pregnant pt

A
  1. Fetal anemia
  2. Hydrops fetalis
  3. Fetal demise
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75
Q

What would you do to monitor for severe complications from Parvovirus B19 in a pregnant pt

A

Periodic US

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76
Q

Elevated Iron, ferritin, and transferrin and some mild psych sxs. Dx? What test would you get?

A

Hereditary hemochromatosis

genetic studies looking for HFE mutation

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77
Q

Name an abx that can cause esophagitis?

A

Doxycycline

78
Q

1st step if pt is haveing COPD exacerbation an impending respiratory failure?

A

1st - non-invasive positive pressure ventilation

2nd- Intubation

79
Q

Txmnt for candida vulvovaginitis? Pregnant vs. non-pregnant

A

Pregnant - vaginal clotrimazole, miconaole, or nystatin

Non-pregnant - oral Fluconazole

80
Q

3 causes of metabolic alkalosis w/ hypokalemia

A

Vomiting, diuretic use, and inherited Na wasting conditions

81
Q

What bx do you worry about w/ furuncles and carbuncles? 3 meds you could use.

A

Clindamycin
Doxycycline
TMP-SMX

82
Q

Kid w/ focal seizure. What is the gold standard evaluation?

A

MRI brain to evaluate for a mass

83
Q

Difference in timing between a cohort study and a case-control study?

A

Cohort study - prospective. Follows cohort of pts split up by risk factor

Case-control - looks back retrospectively to see if those whoa developed the dz had the exposure

84
Q

UC pt has cholestatic pattern liver injury, What test should you order?

A

Consider primary sclerosing cholangitis. Order endoscopic cholangiography

85
Q

Side effects of olanzapine and clozapine

A

Weight gain

Metabolic effects like DM

86
Q

Side effects of TCA

A

Anticholinergic - Dry mouth, blurred vision, constipation, confusion, and urinary retention.

87
Q

One sign that is different in truncus arteriosus vs. hypoplastic left heart syndrome

A

Truncus arteriosus would have a systolic ejection murmur

88
Q

How could you keep a PDA open? How could you close it?

A

Prostaglandin E1

NSAIDs

89
Q

Rh- Mom with 2nd Rh+ baby. If the Ab test is negative how would you treat. What if it were positive?

A

Anti-D IG @ 28 weeks and < 72hrs after delivery

If positive anti-D Ig will make no difference since she is already alloimmunized

90
Q

1st test to order when evaluating PCOS? Next test to assess for a commonly associated syndrome?

A

Pelvic US

Oral glucose tolerance test to eval for DM

91
Q

Txmnt for primary mitral regurg with LVEF 30-60%?

A

Mitral valve repair or replacement

92
Q

Why is early txmnt so important in shingles?

A

Decreases long term complications like post-herpetic neuralgia

93
Q

How long before it’s called infertility in a 30 yo F, 35 yo F?

A

30 - 1 year of unprotected sex

35 - 6 months of unprotected sex

94
Q

Triad of disseminated gonococcal infxn

A

Tenosynovitis of distal extremities

Dermatitis - pustules on hands and feet

Polyarthralgia - asymmetric and migratory

95
Q

Txmnt for disseminated gonoccocal infxn

A

IV CTX and a single dose of azithromycin

96
Q

Does PEG placement improve outcomes in demeneted pts?

A

No proven benefit

97
Q

Reflexes in Guillain-Barre? CSF findings. Txmnt?

A

Hyporeflexia

Increased protein and NL leukos

IVIG or plasmapharesis. Watch resp status

98
Q

Txmnt for sick sinus syndrome with tachy-brady?

A

Pacemaker for bradycardia. Then rate control meds for tachy

99
Q

Motor signs of PD and laterality

A

Bradykinesia
Cogwheel rigidity
Resting tremor

u/l onset and persistent asymmetry

100
Q

2 causes of acute tubular necrosis

A

Renal ischemia

Contrast-induced nephropathy

101
Q

How can you differentiate contrast-induced nephropathy from aortic atheroembolism in a pt after cardiac cath?

A

Contrast - muddy brown casts in urine

Atheroembolism - eosinophilia and eosinophiluria

102
Q

What is BUN/Cr in prerenal azotemia?

103
Q

Hematuria
Flank pain
Firm, nontender abd mass, which moves with respiration

A

Renal cell carcinoma

104
Q

When should oral nutrition begin in a pt w/ acute pancreatitis?

A

As soon as they have an appetite

105
Q

Frontline txmnt for chronic gout

A 
Start allopurinol (xanthine oxidase inhibitor)
Support w/ colchicine (or NSAIDs if, intolerant) for flares
106
Q

Abnl thrombotic event, splenomegaly, and erythrocytosis. What test would you order to dx?

A

Genetic mutation analysis for JAK2 mutation. Suspicious for polycythemia vera

107
Q

Txmnt for postpartum thyroiditis

A

Propanolol

108
Q

Possible ongoing issues w/ postpartum thyroiditis?

A

Increased risk of persistent goiter and chronic thyroid sxs

109
Q

In what kind of study would you use an odds ratio? Show odds ratio calculation.

A

Odds ratios can be used in case-control studies (retrospective)

(a/c)/(b/d) or ad/bc. The sums are not used in the denominator because they cross out

110
Q

What meds would you give a sexual assault victim. Name organism you are treating.

A
  • HIV: Tenofovir -emtricitabine w/ raltegravir
  • Chlamydia - azithromycin
  • Gonorrhea - CTX
  • Trichomonas (if seen on the slide) - Metronidazole
  • HBV immunoglobulin and vaccine (if non-immune)
111
Q

Txmnt for gallstone pancreatitis c/b acute cholangitis? 1st step and back up

A

ERCP can confirm dx and remove stone

Pecutaneous cholecystostomy is reasonable if the pt has CI for ERCP

112
Q

Schizophrenic w/ persistent negative sxs, but well controlled on 1st gen anti-psychotic

A

Social skills training not change to 2nd gen anti-psychotic

113
Q

PT on SSRI has sexual dysfxn. How would you tx?

A

Switch to bupropion or mirtazapine; or keep SSRI and augment w/ sildenafil

114
Q

Which has a greater effect on decreasing blood pressure, smoking or weight loss?

A

Weight loss is more significant.

115
Q

Are diffuse ST elevations always present in peri-infarction pericarditis?

A

No. They may be affect by post-MI changes.

116
Q

What is the timing for Dressler syndrome?

A

Several weeks after MI

117
Q

What is the txmnt for viral or idiopathic pericarditis?

A

Colchicine or NSAIDs

118
Q

Txmnt for peri-infarction pericarditis?

A

High dose ASA

119
Q

Most common complication of bacterial conjunctivitis? Most common type of pt?

A

Keratitis - infection of the cornea

Most common in contact wearers

120
Q

Lung cancer. When would you biopsy a hilar node vs. supraclavicular node?

A

Get the hilar node if the cancer is isolated to the lung

Get the supraclavicular node if there are mets

121
Q

How can you distinguish a confounder from effect modification?

A

When stratifying results:

No effect on direction or strength = confounder

Different effects in the different stratum = effect modification

122
Q

Back pain that increases w/ extension? DX?

A

Spinal stenosis

123
Q

1st and 2nd meds in asthma exacerbation? Next steps?

A 
SABA
Then ipratropium (anticholinergic) for  1 hr

Oral or IV corticosteroids and then magnesium

124
Q

Emergency contraceptivs

  1. Most effective
  2. Most effective if pt has cervicitis
  3. A backup oral option
A
  1. Copper IUD
  2. Ulipristal (antiprogestin)
  3. OCP
125
Q

Esophageal varices causing hematemesis can be treated with what med? What can be used to prevent future hemorrhage?

A

Octreotide

Nonselective beta blockers like propnaolol

126
Q

1st line txmnt for bacterial conjunctivitis? Contact wearers? Why?

A

Polymixin-trimethoprim drops or azithromycin drops

Contacts get a fluorquinolone to cover for psuedomonas

127
Q

What are the 2 most important factors when considering prognosis in COPD?

A

Age

FEV<40

128
Q

What is the difference between a physician attending a conference and a physician lecturing at a conference when it comes to accepting gifts?

A

Just attending - can’t get anything

Lecturing - can accept reimbursement for flight or honoraria

129
Q

What V/Q scan result can help you decide that the pt doesn’t have a PE?

A

It has to be normal V/Q. Low or moderate probability does not r/o and must be tested further.

130
Q

Paraneoplastic syndrome with Squamous cell carcinoma (SCC)?

A

Hypercalcemia due to PTHrP

131
Q

Paraneoplastic syndromes associated w/ small cell lung cancer?

132
Q

What txmnt should be given to a brain dead organ donor to protect the organs? (3)

A

Keep euvolemic, normotensive, and normothermic.

Give IVF, demospressin, and pressors if needed

133
Q

What kind of smoker should be screened for lung cancer and by what modality?

A

Age 55-80

30 pk yr history, either current smoker or quit w/in last 15 yrs.
Annual CT chest

134
Q

Apnea of prematurity vs. periodic breathing

A

Periodic breathing is brief, 5-10 secs

Apnea of prematuriy is >20 secs and resolves when they hit 37 weeks

135
Q

Cause of exudative effusion w/ lymphocyte predominance and increased adenosine deaminase (ADA)?

136
Q

Chronic non-productive cough that worsens w/ exercise, forced expiration, and allergen exposure? Dx?

A

Cough variant asthma

137
Q

3 HTN meds that can cause pancreatitis

A

Furosemide
chlorthalidone
Hydrochlorothiazide

138
Q

What is a more subtle sign of hemodynamic instability when evaluating hematochezia? First test after resuscitating?

A

Orthostatic hypotension

EGD, then colonoscopy if equivocal

139
Q

Definition of sensitivity?

Definition of specificity?

A

Sensitivity - probability of a diseased person testing +

Specificity - probability of a non-diseased person testing -

140
Q

Differences on contrast enema between Hirschsprungs and meconium ileus (CF)?

A

Hirschsprungs - Normal or narrow colon w/ dilated large bowel

Meconium ileus - has consistent microcolon

141
Q

Case fatality rate vs mortality rate?

A

Case fatality - proportion of people with a condition who die from that condition

Mortality rate - Probability of dying from a condition in the general population

142
Q

Attack rate definition?

A

Proportion of people who develop a disease amongst the total population at risk

143
Q

Test for identifying infantile hypertrophic pyloric stenosis

144
Q

What kind of acidosis would you expect in a pt w/ 21-hydroxylase deficiency (CAH)

A

Hyperkalemic metabolic acidosis

145
Q

What is a risk factor for hypertrophic pyloric stenosis in infants under 2 weeks?

A

Previous txmnt w/ azithromycin or erythromycin

146
Q

In preparation for early surgery in peptic ulcer perforation what 3 things can you do in the preoperative setting?

A
  1. IVF
  2. Broad spectrum abx covering Gram - organisms
  3. PPI
147
Q

Does a higher or lower negative likelihood ratio point to a lower likelihood that the disease is present?

A

A lower magnitude NLR means it is less likely the disease is present.

148
Q

PT w/ an anal abscess is a greatest risk for developing what?

149
Q

Txmnt for dyspepsia w/ typical GERD sxs

150
Q

Txmnt of dyspepsia w/o GERD sxs. If >60 vs. <60. If <60 what test next? Txmnt?

A

> 60 - endoscopy
<60 - H. pylori testing
If H. pylori + - triple therapy
If H. pylori negative Get PPI trial

151
Q

What is triple therapy for H. pylori?

A

Omeprazole
Clarithromycin
Amoxicillin

152
Q

How and when do you confirm H. pylori eradication?

A

Fecal antigen test or urea breath test 4 weeks later

153
Q

Decreased sample size leads to an increase in Type I or Type II errors?

A

Increases Type II errors (Failing to reject a false null hypothesis) - false negative

154
Q

What is it called when you repeat a primary study calculation after modifying certain criteria?

A

Sensitivity analysis

155
Q

What type of study is best for infectious outbreaks or rare diseases?

A

Case control studies

156
Q

Normal distribution. What % is w/in 1, 2, and 3 SD?

A

1 SD - 68%
2 SD - 95%
3 SD - 99.7%

157
Q

Negatively skewed data. Order mean, median, and mode. What about for positively skewed data?

A

Modemedian>mean

158
Q

What tests should be considered for analyzing data if you are comparing proportions? When would you use one over another?

A

Big sample size - Chi-square test

Small sample size - Fisher’s exact test

159
Q

What test would you consider if you are analyzing your data based on the means? What helps you choose?

A

Paired T-test - same individual over time (dependent variable)

Student’s T-test - Independent samples w/ 2 groups

ANOVA - More than 2 groups

160
Q

Type I error is?

A

Incorrectly concluding there is an association

161
Q

Type II error is?

A

Incorrectly concluding there is not an association

162
Q

What does 1-Beta mean?

A

Power of the study. Probability of accurately detecting an association

163
Q

In Fe deficiency anemia what increases first, Hgb, Hct, or retic ct?

164
Q

How can you prevent preeclampsia in those w/ increased risk

A

Daily ASA @ 12 wks gestation

165
Q

Loss of pupillary rxn, vertical gaze paralysis, loss of optokinetic nystagmus, and ataxia. Dx?

A

Parinaud syndrome classic for a pineal tumor

166
Q

Associated conditions w/ craniopharyngioma?

A

Diabetes insipidus and deficiency of 1 or more of the anterior pituitary hormones.

167
Q

Blood type A or B baby born to type O 2nd time mom has hyperbilirubinemia (unconjugated) and positive direct Coombs w/in first 24hrs of life. Dx?

A

ABO incompatibility

168
Q

Type of hyperbiliruinemia seen in biliary atresia

A

Increased direct bilirubin as the bili still gets conjugated. It just can’t be released.

169
Q

What type of hyperbilirubinemia occurs in breast milk jaundice?

A

Increased indirect bilirubin

170
Q

What kind of hyperbili in G6PD deficiency?

A

Increased indirect bili. It doesn’t get conjugated.

171
Q

3 Ds of niacin deficiency

A

dementia
dermatitis
diarrhea
(stomatitis and cheilosis)

172
Q

Erythematous, pruritic, painful rash that doesn’t respond to steroids and starts clearing from the center. Also has mild DM. Dx?

A

Glucagonoma

173
Q

What is a herbal medication that is used to tx BPH?

A

saw palmetto

174
Q

4 alternative meds that can increase bleeding risk?

A

Garlic
Ginko biloba
Ginseng
Saw palmetto

175
Q 
Common side effects:
Statins
Sulfonylureas
Metformin
Thiazolidione (pioglitazone)
A

Statins - myositis and hepatotoxicity

Sulfonylureas - hypoglycemia

Metformin - Lactic acidosis

Thiazolidione - Fluid retention due to Na reabsorption

176
Q

1st test to order when assessing hypercalcemia?

A

PTH to determine if the increase in Ca is independent of PTH

177
Q

Central hypothyroidism and hyponatremia. What tests should you perform?

A

Morning cortisol and since it is low you would follow up w/ ACTH level and ACTH stim test

178
Q

CAH:

  1. Nl genitalia and HTN
  2. Ambigous genitalia and hypotension, Increased K
  3. Ambigous genitalia and HTN
A
  1. 17 alpha-hydroxylase deficiency
  2. 21-hydroxylase deficiency
  3. 11 beta-hydroxylase deficiency
179
Q

What hormone would you expect to be elevated in 21-hydroxylase deficiency?

A

17-hydroxyprogesterone

180
Q

Chronic hypoparathyroidism w/ low/normal calcium and high urine calcium. Txmnt?

A

Give thiazide diuretic to decrease urine calcium and increase serum calcium

181
Q

What kind of complications does tight glycemic controll affect?

A

Reduces microvascular complications like nephropathy and retinopathy

182
Q

Best treatment for hyperthyroid during pregnancy? 2 answers

A

Propylthiouracil for the 1st trimester (may cause liver failure)

Methimazole for the 2nd and 3rd trimester (teratogen)

183
Q

What lcass of medication is octreotide?

A

Somatostatin analog

184
Q

Txmnt of sulfonylurea poisoning? 1st and 2nd line

A

1st - Dextrose

2nd - Octreotide - Decreases insulin secretion

185
Q

3 long term complications of untreated hyperthyroidism

A
  1. Arrhythmia
  2. Cardiomyopathy
  3. Osteoporosis
186
Q

Low testosterone, low FSH/LH, Elevated LFts, tan skin, and hepatomegaly. Dx? Txmnt?

A

Hereditary hemochromatosis

Tx w/ phlebotomy

187
Q

What is penicillamine used to tx?

A

Wilsons dz

188
Q

What disease can develop when treating w/ lithium, and how would you tx it?

A

Lithium induced hypothyroidism

Tx w/ continuing lithium and starting levothyroxine

189
Q

3 common complications of NF1?

A

Optic gliomas
Scoliosis
Pseudoarthroses

190
Q

MEN, syndromes:
1. 3 Ps

  1. 2 Ps
  2. 1 P
A
  1. HyperPTH
    Pituitary tumor
    Pancreatic tumor
  2. Hyper PTH
    Pheochromocytoma
    Medullary thyroid CA, Increased calcitonin
  3. Pheochromocytoma
    Medullary thyroid CA (increased calcitonin)
    Mucosal neuromas
191
Q

3 things that would push you to perform Parathyroidectomy?

A
  1. Symptomatic hyperCa
  2. end organ complications
  3. Urinary Ca > 400

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