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Incorrects 2 Flashcards

1
Q

Rx for candida vaginitis?

A

Fluconazole

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2
Q

Rx for trichomoniasis?

A

Metronidazole; Rx sexual partner

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3
Q

Rx for BV?

A

Metronidazole or clindamycin

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4
Q

Pt presenting with thyrotoxicosis and low radioactive iodine uptake may have what conditions?

A

Thyroiditis (painless, subacute, or amiodarone induced)
Exogenous thyroid
Iodide exposure
Struma ovarii

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5
Q

Thyrotoxicosis with normal or elevated radioactive iodine uptake may have what conditions?

A

Graves
Toxic multinodular goiter
Toxic nodule

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6
Q

How does subacute (de Quervains) thyroiditis present vs painless (silent) thyroiditis on PE?

A

Subacute presents with tenderness to palpation, painless does not, though both may have goiter and low RAIU on thyroid scan.

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7
Q

BPPV Sx?

A

Nystagmus, nausea without significant ear pain, tinnitus, or hearing loss.

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8
Q

Meniere disease Sx?

A 
Triad:
Episodic dizziness
Low-frequency hearing loss
Tinnitus
***Vertigo lasts for days with NV and horizontal-torsional nystagmus during episodes.
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9
Q

Vertebrobasilar insufficiency Sx?

A

Vertigo with neurological Sx like dysarthria, diplopia, numbness.

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10
Q

What antibiotcs can lead to ototoxicity causing vertigo?

A

Aminoglycosides (eg gentamicin)

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11
Q

What criterion are met to indicate the need for excision of cervical neoplasia?

A

Must be >25yo with CIN3 or more. Clear margins and no evidence of invasion means Pap testing is required with HPV co-testing q 1-2 yrs afterwards.

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12
Q

13/40

A

4516

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13
Q

Antibody assoc. with celiac’s disease?

A

IgA anti-tissue transglutaminse (TTG) antibody. IgA endomysial antibody and IgA/IgG against gliadin peptide.

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14
Q

Next step after positive serology for anti transglutaminase antibody?

A

Upper endoscopy and small bowel biopsy regardless of positive serology to confirm Celiac’s Dx.

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15
Q

Pneumococcal vax recommended for who?

A

> 65 year olds and anyone 19-64 within a nursing home, with immunocompromise, or cochlear implants.

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16
Q

Antibody associated with Wegener’s granulomatosis (granulomatosis with polyangiitis)?

A

c-ANCA (cytoplasmic antineutrophilic cytoplasmic antibodies). p-ANCA negative.

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17
Q

What part of the penis is responsible for erection?

A

Corpus cavernosum is filled with vascular epithelial cells. Sildenafil inhibits PDE5 resulting in cGMP elevation and vasodilation. Corpus spongiosum forms the glans and surrounds the urethra distally.

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18
Q

What diuretic will enhance the prevalence of gout?

A

HCTZ. It causes uric acid resorption.

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19
Q

What is guarda resp altor?

A

A judicially appointed guardian.

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20
Q

What is the primary difference between a DNR and a living will?

A

DNR: medical document outlining wishes during the current stay in the hospital
Living will: legal document outlining wishes if the patient were to get sick/incapacitated

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21
Q

What is bronchiolitis?

A

Inflammatory illness of small airways affecting children <2. Low fever, rhinorrhea, cough, and periods of apnea may occur. MCC is RSV. Xray may be negative or show interstitial infiltrates/atelectasis.

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22
Q

Most sensitive testing modality for H. Pylori?

A

Serology. 90-99% sensitive. Biopsy is only done if there are signs of danger (bleeding, anemia, early satiety, etc.). Conversion of positive serology to negative after Rx suggests bacterial cure, but this may take months/years after eradication.

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23
Q

Can H. Pylori be cultured?

A

No. Never culture it. It is fastidious.

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24
Q

Most specific testing for H. pylori?

A

Biopsy with urease testing is highest (95-100%).

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25
Q

What is the best Dx test for H. pylori and the best test after Rx for eradication?

A

Serology and urea breath test respectively.

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26
Q

What is triple therapy for H. Pylori?

A

Amoxicillin
Clarithromycin
PPI

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27
Q

Drugs for Parkinson’s Rx?

A

Bromocriptine (dopaminergic)
Amantadine (antiviral/dopaminergic)
Levodopa/carbidopa
Selegiline (MAOI)

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28
Q

Drugs for Alzheimer’s Rx?

A

Donepezil (AChase Inhibitor)

Tacrine, rivastaigmine, galantamine are also AChAse Inhibitors.

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29
Q

Memantine use?

A

Dementia.

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30
Q

Memantine MOA?

A

NMDA receptor antagonist can be neuroprotective in dementia. Often combined with galantamine.

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31
Q

Management of croup?

A

Humidified O2 in mild disease. Steroids and racemic epi in severe.

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32
Q

What is the confirmatory test in a patient with a positive PPD?

A

QuantiFERON-TB Gold test.

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33
Q

Immigrants, prisoners, and IV drug users with a PPD test must have how much induration for a positive test?

A

≥10mm

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34
Q

What is a positive PPD in ALL persons?

A

≥15mm

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35
Q

HIV+ or immunosuppressed or those who came into contact with a TB+ person require how much induration for positive PPD test?

A

≥5mm

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36
Q

At what ages do immediate family have to have MI Hx to increase the chance of MI in the patient?

A

Father or brother w/ MI BEFORE 55 or mother or sister with MI BEFORE 65 would increase the chance of MI in a patient.

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37
Q

Expected joint changes in psoriatic arthritis?

A

Spine and DIPs.

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38
Q

Expected joint changes in RA?

A

MCP, PIP, ankles, knees, hips, spine.

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39
Q

Required creatinine for IV contrast administration?

A

1.5 or less.

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40
Q

Medication that must be DCed before contrast administration?

A

Metformin. IV contrast can cause decreased metabolism and accumulation leading to lactic acidosis.

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41
Q

HbA1c levels for normal, pre, and postDM?

A

6, 6-6.4, and ≥6.5% respectively.

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42
Q

Fasting plasma glucose for normal, pre, and postDM?

A

<100
100-125
≥126 respectively.

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43
Q

2 Hour postprandial blood sugar in normal, pre, and post DM?

A

<140
140-199
≥200

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44
Q

Random blood sugar that confirms Dx of DMII?

A

≥200

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45
Q

Name the 7 activities of daily living (ADL) in elderly?

A 
Bathing
Continence
Toileting Transferring
Grooming
Dressing
Eating
***These ADLs are self-care activities needed for daily living.
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46
Q

What activities are needed for independent living in the elderly?

A

Instrumental activities of daily living (IADL)

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47
Q

Name the 8 IADL?

A 
Transportation
Shopping
Cooking
Housecleaning
Laundry
Using telephone
Managing money
Taking meds
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48
Q

ABx for mastitis?

A

Anti-S. Aureus meds: amox/clav, dicloxacillin, cephalexin. Azithro or clindamycin if PCN allergy.

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49
Q

Fundoscopic exam in non-proliferative retinopathy in DM2?

A

Cotton wool spots (nerve fiber layer infarcts)
Intraretinal hemorrhage
Macular edema

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50
Q

Fundoscopic exam in proliferative retinopathy in DM2?

A

Neovascularization of retinal vessels due to VEGF from ischemia. Can lead to hemorrhage and retinal detachment.

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51
Q

Define complete abortion

A

Products of conception have evacuated uterus and cervical os is now closed

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52
Q

Define incomplete abortion

A

Vaginal bleeding and cramping are occurring alongside an open cervical os where products of conception can be seen/palpated within the CERVICAL CANAL (vs inevitable within internal cervical os)

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53
Q

Define inevitable abortion

A

Bleeding/cramping pain accompanied by dilated os and visible/palpable products in the INTERNAL CERVICAL OS (vs incomplete within cervical canal)

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54
Q

Define threatened abortion

A

Vaginal bleeding that occurs within the first 20 weeks of pregnancy

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55
Q

What is the biggest RF for future miscarriage?

A

Previous miscarriage. Maternal age and smoking are also RFs, but not as strong.

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56
Q

First-line OUTPATIENT Rx in normally healthy person with typical pneumonia?

A

Macrolides (azithro or clarithromycin)
OR
Doxycycline
***These cover typicals and atypicals for PNA.

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57
Q

First-line OUTPATIENT Rx in Pt with cormorbidities with typical pneumonia?

A

Flourquinolones (levo or moxifloxacin)
OR
a ß-lactam plus a macrolide

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58
Q

Retinal examination revealing irregular, white ovoid lesions on the retina are likely?

A

Cotton-wool patches. These soft exudates are from infarcted nerve fibers 2nd to chronic HTN. AV nicking often accompanies.

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59
Q

What are Drusen spots?

A

Small yellow, round spots on the retina that may indicate macular degeneration or normal aging.

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60
Q

Microaneurysms in the macular area are commonly associated with what Dx?

A

DM retinopathy.

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61
Q

Roth spots are commonly associated with?

A

Bacterial endocarditis. They appear as hemorrhagic lesions with pale white centers.

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62
Q

Aneurysm diameter with increased risk of rupture?

A

> 5.5cm or rapid expansion (>0.5cm) over 6 month period

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63
Q

AAA recommended screening?

A

Men b/t 65-75 yo who have ever smoked

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64
Q

Best method to reduce risk of rupture in AAA?

A

Smoking cessation is biggest. HTN and reduction of lipids doe not play a big role oddly enough, only in CV disease.

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65
Q

What is the primary hip extensor?

A

Glut maximus (L4-S1) mainly, but also hamstring (L4-S2 sciatic)

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66
Q

What is the primary hip abductor?

A

Glut medius (L4-S1)

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67
Q

Claudication in a young adult should consider what Dx?

A

Impingement of the artery. Atherosclerosis in a young adult is unlikely.

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68
Q

Initial study in child >2 years with at least one prior UTI?

A

Voiding cysturethrogram. Detection of vesicoureteral reflux is critical. It is the MC cause of febrile UTIs.

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69
Q

Initial study in child <2years (2-24 months) with first febrile UTI?

A

Renal/bladder US. If abnormalities are found (hydronephrosis), a voiding cysturethrogram is next.

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70
Q

What is first-line Rx for onychomycosis?

A

Oral terbinafine OR oral itraconazole

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71
Q

When suspecting primary ovarian failure in a young female with early menopausal signs, what should be measured first?

A

FSH. Elevation on 2 occasions separated b y amonth is Dx of POF. Elevation of LH may accompany FSH, but is not diagnostic of POF.

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72
Q

What is primary ovarian failure?

A

Women under 40 with signs of menopause (oligo/amenorrhea and hot flashes, irritability, weight gain, dryness/itching/atrophy of vagina).

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73
Q

Indwelling catheters that lead to infxn by a gram-negative rod that is motile and has a green appearance on culture and a fruity odor is likely?

A

Pseudomonas. Often a flouroquinolone is appropriate Rx (Levo or cipro)

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74
Q

Dx and Rx in BPPV?

A

Dx: Dix-Hallpike maneuver (tilt head back and rotate head to side - causes dizziness and nystagmus)
Rx: Epley maneuver (series of maneuvers that reposition otoliths in canals)

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75
Q

A female with Rx for bacterial vaginosis goes out with friends and experiences an unusual reaction, GI upset, HA, and flushing. Dx?

A

Disulfram-like reaction. Metronidazole is a typical Rx for BV and can cause this SE when mixed with alcohol.

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76
Q

First line Rx for HTN in African American patients?

A

HCTZ or another diuretic OR a calcium channel blocker (amlodipine)

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77
Q

At 12-16 weeks gestation, what rule out test should be done?

A

Urine culture for asymptomatic bacteriuria as to prevent pre-term labor risk.

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78
Q

Goal INR for A. fib?

A

INR between 2 and 3 is normal.

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79
Q

What differentiates classic from non-classic migraine headaches?

A

Classic present with an aura, but nonclassic do not, though both share the same symptoms otherwise.

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80
Q

FEV1 increase that is considered “reversible”?

A

12-15%

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81
Q

Common HTN meds that can precipitate gout?

A

Thiazides and loop diuretics. Both enhance urate reuptake by blocking its excretion.

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82
Q

Meds used for painful diabetic neuropathy?

A

Tricyclics (amitriptyline, desipramine)

Anticonvulsants (gabapentin, pregabalin)

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83
Q

List the next of kin in order.

A 
Spouse
Adult child
Parent
Next of kin (adult sibling)
Default surrogate (legally appointed)
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84
Q

If a patient does not improve after empiric Rx for GERD what is the next Dx step?

A

Upper endoscopy

85
Q

Brown tumors of the bone are associated with what?

A

Hyperparathyroidism due to osteitis fibrosa cystica. These lesions are cysts filled with blood, fibrous tissue, and osteclasts.

86
Q

First-line agent in human bite?

A

Amox/clav. Gram stain with aerobic and anaerobic cultures are needed. Copious irrigation, debridement needed.

87
Q

Intermittent asthma FEV1?

A

> 80%

88
Q

Mild persistent asthma FEV1?

A

> 80%

89
Q

Moderate persistent asthma FEV1?

A

60-80%

90
Q

Severe persistent asthma FEV1?

A

<60%

91
Q

Asthma daytime frequency by class?

A

Intermittent: <2x/wk
Mild: >2x/wk (not daily)
Moderate: daily
Severe: many times a day

92
Q

Asthma night time frequency by class?

A

I: <2x/mo
Mi: 3-4x/mo
Mo:>1x/wk, not nightly
Severe: 7nights a week

93
Q

Escalating management of asthma by class?

A

I: SABA
Mi: SABA + low dose inhaled glucocorticoid
Mo: SABA + low dose inhaled glucocorticoid + LABA
Severe: SABA + high dose inhaled steroid + LABA

94
Q

First-line Rx in ACUTE gout attack?

A

Indomethacin (an NSAID). Colchicine largely not used anymore.

95
Q

What cause of ED must be ruled out first?

A

Meds (~25% of cases are meds)

96
Q

What feature of allergic conjunctivitis differentiates it from other causes?

A

Pruritis (sometimes a grainy or foreign body sensation). Adenovirus does not have itchiness.

97
Q

Rx for allergic conjunctivitis?

A

Topical NSAID (Ketorolac) and antihistamines

98
Q

Prophylaxis required for needle stick by healthcare professional in HIV+ patient?

A

Inhibition of viral replication. This is usually done by blocking reverse transcriptase via NRTIs and NNRTIs.

99
Q

Proper management of smoking cessation?

A

Behavioral and pharmacologic (Varenicline preferred over bupropion). Initial should include counseling and the patch, then meds and counseling if that fails. No bupropion if SZ Hx. Verenicline contra’d in depression for suicide risk.

100
Q

Can schedule II drugs (eg morphine, etc) have refills?

A

No. A new script must be written. Schedule 3-5 however have different rules.

101
Q

Impairment of pain, temperature, and sensation in neuropathy is due to loss of?

A

Small nerve fibers.

102
Q

Impairment of vibratory and proprioceptive sensations in neuropathy is due to loss of?

A

Large nerve fibers.

103
Q

Most sensitive antibody for Celiac’s disease?

A

Anti-transglutaminase Ab.

104
Q

Most specific antibody for Celiac’s disease?

A

Anti-gliadin Ab.

105
Q

Most important step in celiac’s disease management?

A

Gluten free diet. Can retest 3 months post diet change and see if serology is still present.

106
Q

Initial pharmacological management after MI?

A

MONA-GBS. Morphine, O2, nitro, ASA, GP2a3b inhibitors, ß-blocker, high dose statin. Only ASA and ß-blockers reduce mortality.

107
Q

Appropriate total diet Ca++ intake and Vit D intake in osteoporotic females?

A

Daily intake should be at 1200mg Ca++ and 800IU Vitamin D. Do not supplement if adequate levels are part of diet.

108
Q

Optimal intake of Ca++ and Vit D in PREmenopausal women and men with osteoporosis?

A

1000mg C++ and 600IU Vitamin D.

109
Q

Chapman’s for upper and lower lung?

A

Ant: 3rd IS upper lung, 4th IS lower lung
Post: B/t spinous/transverse processes of vertebrae

110
Q

FEV1/FVC expected in COPD?

A

<0.7 or (<70%)

111
Q

FEV1 expected in COPD?

A

<80% with little change post-dilator.

112
Q

What reduces pain in duodenal ulcer?

A

Eating. Pain usually resumes ~2-3 hours after a meal.

113
Q

What physical manifestation accompanies duodenal ulcer?

A

Weight gain due to eating, whereas in gastric ulcers weight loss is common due to decreased eating.

114
Q

NSAID use is more common in what type of ulcer?

A

Gastric ulcers.

115
Q

H. Pylori infxn is more commonly responsible for what type of ulcer?

A

Duodenal ulcers.

116
Q

What is in triple therapy?

A

PPI and two antibiotics. Typically amoxicillin and clarithromycin. If PCN allergy, use metronidazole.

117
Q

What is in quadruple therapy?

A

PPI
Bismuth
Metronidazole
Tetracycline

118
Q

Treatment of pheochromocytomas?

A

Alpha blockade (Phenoxybenzamine) followed by ß-blockers

119
Q

Histopathology in Alzheimer’s disease?

A

Plaques containing amyloid beta deposition and neurofibrillary tangles made of hyperphosphorylated tau filaments.

120
Q

Rx in hepC?

A

IFN-alpha and ribavirin

121
Q

Form of hepatitis virus that leads to fetal mortality?

A

HepE. Spread through fecal-oral route this virus leads to infxn of pregnant women.

122
Q

When is the methacholine challenge used?

A

If PFTs are normal OR bronchodilator challenge is nondiagnostic, but asthma is still suspected.

123
Q

When is an ABG used?

A

In an acute setting with a dyspneic, obtunded, or non-responsive Pt in order to determine the etiology of their respiratory condition.

124
Q

What criteria indicate bisphosphonates in an elderly female?

A

Anyone with osteopenia (T-score: -1 to -2.5) and a 10 year probability of hip Fx >3%.

125
Q

Additional drug used in the treatment of a patient with asthma taking ASA, but experiencing side effects?

A

Leukotriene receptor antagonist (-lukast). Elevated leukotrienes result from the blockade of COX1 and 2 which exacerbate asthma.

126
Q

What does Spurling’s maneuver test for?

A

Turning and extending the cervical spine while compressing it leads to raducular Sx in affected.

127
Q

Chapman’s point for adrenal gland?

A

A: 1” lateral and 2” superior from umbilicus
P: TP of T11

128
Q

How many views in suspected spondylolisthesis Xray?

A
  1. AP, lateral, 2 oblique, and a zoomed-in of L5-S1.
129
Q

Lateral epicondylitis results from damage to what muscle?

A

Extensor carpi radialis brevis.

130
Q

Initial HTN management in African-Americans and elderly?

A

HCTZ. Unless they have DMII of kidney disease, then its an ACEI/ARB.

131
Q

What is the goal of the initial evaluation after HTN Dx?

A

Target organ damage. Do an ECG, CBC, BMP, UA, and check lipids.

132
Q

Fxn of the ACL?

A

Prevent forward motion of tibia on femur (especially in 15-30° flexion) and prevent lateral and medial movement .

133
Q

When is the ACL most commonly injured?

A

Tibia is externally rotated and planted and receives a valgus strain on knee.

134
Q

Most sensitive PE test for ACL tear?

A

Lachman’s test. Stabilize femur with one hand and bend knee to 30° flexion and pull tibia forward.

135
Q

CAG repeats are assoc with?

A

Huntington’s

136
Q

GAA repeats assoc with?

A

Friedreich’s ataxia

137
Q

CTG repeats assoc with?

A

Myotonic dystrophy

138
Q

CGG repeats assoc with?

A

Fragile X

139
Q

What are Lewy bodies made of?

A

Abnormal alpha-synuclein conformational protein folding.

140
Q

Initial scan required in malignant otitis externa?

A

Brain CT or MRI. Malignant otitis externa means that it will spread to the local bone tissue. This is usually pseudomonas.

141
Q

What is the current theory on the cause of migraine HA?

A

Trigeminovascular system input. Cerebral vasodilation is no longer the assumed cause.

142
Q

Abortive for migraine HA?

A

Sumatriptan and other triptans. The SSRI effects result in relief. NSAIDs, ergotamin, and dihydroergotamine are used also.

143
Q

Rx for cluster HA?

A

100% O2.

144
Q

Prophylaxis for migraine HAs?

A 
ß-blockers
Ca++ blockers (verapamil)
TCAs
Valproic acid
SNRIs (venlafaxine, topiramate)
145
Q

Most commonly fractured carpal bone?

A

Scaphoid, followed by the triquetrum.

146
Q

Missed Fx of the scaphoid can lead to what?

A

Nonunion (delayed/arrested fracture repair within 6 months of injury) or AVN (can lead to nonunion also).

147
Q

What is a nondisplaced fracture?

A

One in which the fracture is stable. Thumb spica is appropriate in scaphoid Fx, for example.

148
Q

What is the treatment of a nondisplaced scaphoid Fx?

A

Thumb spica and serial radiographs with CT after completion to check for union.

149
Q

To ensure bone union after Fx, what study is required?

A

CT is the most sensitive and specific.

150
Q

Special tests for subacromial impingement of the supraspinatous tendon?

A

Neer’s
Hawkin’s
Jobe’s/Empty can

151
Q

Special test for thoracic outlet syndrome?

A

Adson’s

152
Q

Test for glenohumoral instability?

A

Apprehension test (flex elbow and take shoulder into 90° abduction and slowly externally rotate)

153
Q

AC joint special test?

A

Cross arm test

154
Q

Cervical nerve root impingement test?

A

Spurling maneuver

155
Q

What sign on MRI imaging of shoulder indicates a SItS muscle tear?

A

Edema within the tendons (eg supraspinatous tendon edema). MRI is used to differentiate tears from impingement.

156
Q

Nerve root associated with all DTRs?

A 
C5 - biceps
C6 - brachradialis
C7 - triceps
L4 - knee
S1 - ankle
157
Q

Comedonal acne Rx?

A

Topical retinoid

158
Q

Inflammatory acne Rx?

A

Oral antibiotics (tetracycline, doxycycline, minocycline, erythromycin)

159
Q

Nodular acne Rx?

A

Oral isotretinoin

160
Q

Definitive testing for lactose intolerance?

A

Hydrogen breath test (>20ppm). Lactose delivered to colonic bacteria produce short chain FAs and hydrogen gas.

161
Q

Management of COPD exacerbation ventilation?

A

Noninvasive preferred over invasive. CPAP or BiPAP can help and are preferred over intubation as nosocomial infxns are so prevalent in intubated patients. Only if the Pt is not breathing on their own or are unable to protect their airway are they being intubated.

162
Q

Best initial test in suspected sprain or separation of AC joint?

A

Xray of the shoulder. MRI would come later.

163
Q

Biceps tendinitis special tests?

A

Yergasons (resist supination and flexion of elbow at same time)
Speeds (palpate bicep tendon in anterior shldr while supinating flexing the arm).

164
Q

Pain with external rotation of the arm at 90° flexion of the elbow indicates possible injury to what muscles?

A

Teres minor
Infraspinatous
These muscles are external rotators.

165
Q

Appropriate medications for aspiration pneumonia?

A

Must cover anaerobes and pseudomonas. Piperacillin/tazobactam or cefepime would be appropriate.

166
Q

Which sleep medications are best for sleep-onset insomnia?

A

Zolpidem, zaleplon, triazolam

167
Q

Which sleep meds are best for sleep-maintenance insomnia?

A

Estazolam, flurazepam

168
Q

How can cubital tunnel syndrome and Guyon’s canal be differentiated on exam?

A

Aside from the numbness pattern in the digits and possibly hypothenar atrophy, Guyon’s only presents with abduction/adduction problems with the 4th/5th digits. Cubital tunnel syndrome will present with this as well as impaired flexion of these digits.

169
Q

Chemoprophylaxis for malaria in chloroquine resistant countries?

A

Mefloquine
Atovaquone-proguanil
Doxycycline

170
Q

Areas where chloroqine chemoprophylaxis is used for malaria?

A

Central America or Caribbean

171
Q

Primaquine use?

A

Destroys P. vivax malaria hepatic hypnozoites

172
Q

S/S of Henoch-Schönlein purpura?

A 
Palpable, nonpruritic purpura
Abdominal pain
Arthralgias
Arthritis
Hematuria
Intussusception (intestinal edema/bleeding)
173
Q

Viral myocarditis commonly leads to what kind of HF?

A

Dilated (eccentric). Usually in younger adults <45.

174
Q

Best next step with newly discovered solitary lung nodule on Xray?

A
  1. Compare to old CXR

2. Do CT (usually)

175
Q

How far from the cervical os can a placenta be to perform vaginal delivery?

A

> 2cm.

176
Q

SS of eosinophilic esophagitis?

A 
Dysphagia
CP/epigastric pain
Reflux/vomiting
Food impaction
Atopic Sx (rash, asthma, etc). 
***Endoscopy w/ eosinophils on esophageal biopsy is diagnostic.
177
Q

CN within cavernous sinus?

A

CN 3, 4, 5, and 6.

178
Q

Physical features of fetal hydantoin syndrome?

A

Hypoplastic fingers/nails

Cleft lip/palate

179
Q

Cavernous sinus thrombosis Sx?

A

Restricted ophthalmic movements

180
Q

What is Dawn phenomenon?

A

Hyperglycemic surge in the early morning due to GH and cortisol release. This results in high sugar when fasting before eating breakfast. Inadequate basal insulin would cause this problem.

181
Q

A patient with normal fasting blood sugar (early morning), but an A1C that is high despite these recordings may have what problem?

A

Postprandial hyperglycemia. This is due to inadequate rapid-acting mealtime insulin and the need for a long-acting also.

182
Q

Cavernous hemangiomas of the brain and viscera are associated with what disease?

A

von Hippel-Lindau disease.

183
Q

First-line Rx for esophogeal spasms?

A

Ca++ Channel blockers. Nitrates and TCAs are 2nd line.

184
Q

All sexually active women <25 require what testing?

A

C. trachomatis and N. gonorrhoeae screening annually via nucleic acid amplification test (NAAT) IN ADDITION TO the regular Pap smear.

185
Q

What is pseudodementia?

A

Dementia-like Sx due to depression (memory changes, etc) in elderly.

186
Q

Proper management of flail segment resulting in respiratory distress?

A

Positive pressure mechanical ventilation. This improves oxygenation and causes the flail segment to move normally.

187
Q

Lithium toxicity sx (acute and chronic)?

A

Acute: GI (NVD) and some neuro Sx (fasciculations, Sz)
Chronic: Confusion, ataxia, tremors/fasciculations

188
Q

Common medicines that cause lithium toxicity?

A

Thiazides
NSAIDs (not ASA)
ACEIs
Tetracycline Metronidazole

189
Q

Common SE of vincristine?

A

Peripheral neuropathy. Remember the chemo side effect man in FA.

190
Q

Metabolic syndrome criteria?

A

3/5 of the following:

  1. Abdominal obesity (waist >40” in men of 35” in women)
  2. Fasting glucose 100-110
  3. BP >130/80
  4. TGs >150
  5. HDL <40 (men); <50 (women)
191
Q

Key pathologic feature of metabolic syndrome?

A

Insulin resistance.

192
Q

A female under 50 with severe or resistant HTN may have?

A

Fibromuscular dysplasia.

193
Q

A female under 35 who develops HTN may have?

A

Fibromuscular dysplasia.

194
Q

A female whose creatinine increases by at least 0.5 after starting an ACEI or ARB may have?

A

Fibromuscular dysplasia.

195
Q

Pathology within fibromuscular dysplasia?

A

Noninflammatory and nonatherosclerotic cell development in the arterial wall leading to stenosis, aneurysm, or dissxn of vessels. Renal, carotid, and vertebral most likely effected, but any can be.

196
Q

How can anovulation and premature ovarian failure be differentiated on testing?

A

Anovulation has normal FSH and LH levels. POF has high levels of both. Anovulation is the result of no progesterone withdrawal at the end of menses (often due to orbid obesity) and no ovulation occurs.

197
Q

Lab findings in seminoma?

A

Elevated ß-hCG

198
Q

Lab findings in nonseminomatous germ cell tumors?

A

Elevated AFP and usually ß-hCG

199
Q

Pathology in chronic granulomatous disease?

A

Often Xlinked mutation leads to impaired phagocytic oxidative burst (no H2O2) and resultant impaired intracellular killing by phagocytes.

200
Q

Sx of chronic granulomatous disease?

A

Recurrent infxns early on especially to catalase-positive organisms (S. aureus and aspergillus). Lung and skin infxns most common.

201
Q

Testing for chronic granulomatous disease?

A

Dihydrorhodamine 123 or nitroblue tetrazolium test

202
Q

Common catalase-positive organisms

A 
BASS:
S. aureus
Serratia
Burkholderia
Aspergillus
203
Q

X-linked (Bruton) agammaglobinemia labs?

A

Low B cell concentrations and Ig levels

204
Q

X-linked (Bruton) agammaglobinemia Sx?

A

Recurrent sinopulmonary and GI infxns

205
Q

CH50 assays are for what?

A

Determining total complement concentration. Complement deficiencies present with recurrent infxns from encapsulated bacteria (esp Neisseria)

206
Q

DiGeorge syndrome definitie Dx?

A

Fluorescence in situ hybridization (22q11.2 deletion). Also dysmorphic facies, developmental delays, hypocalcemia, heart issues.

207
Q

Two conditions where T cell levels are markedly decreased?

A

SCID

DiGeorge Synd.

208
Q

BRCA positivity enhances risk of what cancers?

A

Ovarian and breast, not endometrial.

UWorld (18 decks)

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