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Incorrects 4 Flashcards

1
Q

Granulomatosis with Polyangiitis antibodies?

A

Antineutrophil cytoplasmic antibodies (c-ANCA). p-ANCA (MPO or myeloperoxidase) can be positive, but rarely. Usually in other vasculitis conditions.

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2
Q

Clinical manifestations of granulomatosis with polyangiitis?

A

Sinusitis/otitis (ulcers)
Saddle nose
Lung nodules/cavitations
Rapidly progressive glomerulonephritis (biopsy shows pauci-immune GN - ie minimal IgG present on immunoflorescence)

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3
Q

Triad in invasive aspergillosis?

A 
In immunocomp (CD4<50 usually):
Fever
Pleuritic CP
Hemoptysis
***Imaging shows focal lesions (nodules with or without cavitation).
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4
Q

Electrolyte abnormality possible in succinylcholine?

A

Severe hyperkalemia from depolarization of muscle and K+ release. Individuals with denervation diseases (upregulation of postsynaptic ACh receptors), muscle atrophy, or rhabdo (injured cells release of K+) can be at risk due to potassium shift out of cells. ust use vec or roc as they are nondepolarizing.

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5
Q

SE of halothane?

A

Acute liver failure

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6
Q

SE of etomidate?

A

Adrenal insufficiency (inhibits 11ß-hydroxylase)

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7
Q

Nitrous oxide SE?

A

Inactivates vitamin B12 and inhibits methionine synthase activity

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8
Q

Propofol SE?

A

Myocardial depression (avoid in ventricular systolic dysfxn)

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9
Q

Initial preferred imaging to Dx uterine fibroids?

A

US

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10
Q

Initial preferred imaging to Dx ovarian pathology?

A

US

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11
Q

Endometrial biopsy is usually performed at what age and with what Sx?

A

Women 45 or older with abnormal bleeding or postmenopausal bleeding.

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12
Q

What is the difference between exertional heat stroke (EHS) and heat exhaustion?

A

Both have temperature >40C (104F), but EHS presents iwth CNS dysfxn (confusion, irritable, SZ).

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13
Q

Management of uncomplicated small bowel obstruction?

A

Conservative management involves bowel rest, NG tube sxn, correct metabolic issues (fluids, K+ if low, Abx).

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14
Q

Complicated small bowel (ischemia, strangulation, necrosis) management?

A

Emergency abdominal laparotomy. Delay of surgery can increase mortality risk.

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15
Q

Psychotic-like Sx expected in borderline personality disorder?

A

Stress related paranoia and dissociation (depersonalization) may be mistaken for primary psychosis. A history of childhood trauma is common in this disorder.

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16
Q

Imaging modality preferred in suspected ureteral calculi?

A

US or CT without contrast. US in pregnant is preferred. CT is most sensitive/specific even moreso than US.

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17
Q

Gambling disorder presents very similarly to what disorder?

A

Substance use disorders. Craving, chronic relapsing course with signs of addiction (withdrawal, increased gambling to achieve desired effect (tolerance), distress when cutting back on gambling, concealing extent of gambling, etc.)

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18
Q

Sx of acute fatty liver of pregnancy?

A

Acute hepatic failure in 3rd trimester or early post partum. Prolonged PT and PTT, hypoglycemia, and encephalopathy are classic.

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19
Q

HELLP syndrome Sx?

A 
RUQ pain
Preeclampsia
N/V
Hemolysis (MAHA)
Elevated liver enzymes
Low platelet count
***On the preeclampsia spectrum. Proteinuria is expected also.
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20
Q

Intrahepatic cholestasis of pregnancy Sx?

A

Generalized pruritis
Hyperbilirubinemia
Transaminitis

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21
Q

Preeclampsia is an RF for what bleeding risk in pregnant women?

A

Abruptio placentae (vaginal bleeding, severe abd./pelvic pain, uterine tenderness/rigidity).

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22
Q

HELLP Syndrome Rx?

A

Delivery of child is definitive Rx. Magnesium for seizure prophylaxis and antihypertensives.

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23
Q

Intrahepatic cholestasis of pregnancy Rx?

A

Ursodeoxycholic acid

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24
Q

Schizophrenic being treated in the ER with haldol complains of not being able to look down. He appears to be looking up at you through his eyebrows. Dx?

A

Oculogyric crisis (forced, sustained elevation of the eyes upwardly). This is a SE of hladol and is an acute dystonic reaction.

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25
Q

Acute bronchitis Sx?

A

Cough >5 days to 3 weeks (+/- purulent sputum) without systemic Sx (fever, chills, etc). Usually viral and presents after URI. CXR is normal. Small amounts of blood in the sputum may be due to inflammation/epithelial damage.

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26
Q

Seronegative spondyloarthritis (eg ankylosing spondylitis) is improved and worsened by what?

A

Worse with rest and improved by activity. Usually seen in younger men. Osteoarthritis is the opposite. Better with rest and worse with activity.

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27
Q

If indomethacin does not effectively control RA, what is next?

A

Methotrexate

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28
Q

If Methotrexate is taken for 6 months and does not control RA, what is next?

A

Nonbiologic agents: Sulfasalazine, hydroxychloroquine, leflunomide, azathioprine
OR
Biologic agents: etanercept, infliximab, etc.

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29
Q

An incidental urine dipstick with 2+ proteinuria in a child with fever without hematuria, pyuria, or active urine sediment requires?

A

Repeat dipstick on 2 subsequent occasions. Kids can have transient proteinuria due to fever, exercise, seizure, stress, or volume depletion. Orthostatic proteinuria is very common and is increased protein in urine when standing upright, but returns to normal when recumbent.

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30
Q

What is the most common congenital cyanotic heart disease IN THE neonatal period?

A

Transposition of the great vessels. 2 separate circulations in the heart to the body.

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31
Q

Required first step in suspected transposition of great vessels?

A

Prostaglandins, echocardiography to confirm Dx. Then surgical septostomy to allow for shunting between L and R heart.

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32
Q

Most commn congenital cyanitc heart defect AFTER THE neonatal period?

A

Tetrology of Fallot. This presents from birth to years depending on right ventricular outflow obstrxn and plmonary blood flow.

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33
Q

Onset of papillary muscle rupture post MI?

A

Acute or w/in3-5 days

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34
Q

Interventricular septum rupture onset post MI?

A

Acute or w/in 3-5 days

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35
Q

Free wall rupture onset post MI?

A

Within 5days to 14 days

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36
Q

Left vent aneurysm onset post MI?

A

Up to several months

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37
Q

When is Xray indicated in back pain?

A

Suspected malignancy (elevated risk), compression facture, or ankylosing spondylitis. Inflammatory markers (ESR) can increase sensitivity.

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38
Q

When is MRI indicated in back pain?

A

Sensory/motor deficits, cauda equina syndrome, epidural abscess/infxn suspected.

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39
Q

What test is done in the case that MRI is contra’d?

A

Radionucleotide bone scan or CT.

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40
Q

Rx for TTP (MAHA in the presence of low platelets)?

A

Plasma exchange. Replenish ADAMTS13 and remove autoantibodies to ADAMTS13. ADAMTS13 cleaves vWF multimers normally, when uncleaved platelets activate.

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41
Q

Normal ankle-brachial index?

A

Ratio of systolic BP in either the posterior tibial or dorsal pedis artery to the systolic BP of the brachial artery. Normal: 0.91 - 1.30. Over 1.3 suggests calcified/incompressible vessels. Under 0.91 is abnormal and indicates PAD. Under 0.4 is severe disease.

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42
Q

How is Dx of CMV retinitis made?

A

Fundoscopy. It shows yellow-white, fluffy, hemorrhagic lesions along the vasculature of the retina. Often presents with floaters and blurry vision. PCR may not be sufficient as viremia can develop independently of end-organ disease.

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43
Q

HIV retinopathy Sx?

A

Cotton-wool retinal lesions that resolve over weeks/months.

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44
Q

Toxoplasmic chorioretinitis presents with?

A

Eye pain and decreased vision. Retinal lesions do not follow vascular distribution.

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45
Q

Syphilitic chorioretinits appears as?

A

Uveitis and diminished visual acuity along with syphilitic meningitis.

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46
Q

Next step in evaluating gallstone pancreatitis?

A

RUQ abd US. Elevated Alk phos and absence of alcohol Hx point to gallstones>EtOH or other causes. ALA >150 also suggests gallstones.

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47
Q

In a patient with epigastric pain that radiates to the back and amylase/lipase levels >3x the normal limit, what next test is needed to Dx pancretitis?

A

None. CT is not indicated if 2/3 characteristic pancreatitis signs are present.

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48
Q

Women with postmenopausal vaginal bleeding require what testing?

A

Endometrial biopsy.

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49
Q

Women with abnormal uterine bleeding (>7 days bleeding or periods outside 24-38 day window) who are under 45 will get a uterine biopsy if?

A

Unopposed estrogen (obesity, anovulation) are present OR they failed medical management of uterine bleeding.

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50
Q

In a pregnant female, the presence of what on ultrasound would indicate possible threatened abortion?

A

Subchorionic hematoma. Pain, bleeding, and a closed cervix under 20 weeks gestation with this sign on ultrasound is typical of threatened abortion. The fetus has normal heartbeat.

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51
Q

Dx criteria for acute bacterial rhinosinusitis?

A

Symptoms persist≥10 days without improvement. Onset is severe≥3days (fever≥102.2F or 39C). Symptoms follow biphasic pattern (get better then worsen).

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52
Q

Bacterial sinusitis Rx?

A

Amox/clav

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53
Q

When would a culture of sinus fluid in sinusitis be necessary?

A

After Rx failed.

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54
Q

Breastfeeding jaundice is caused by?

A

Insufficient intake of breast milk (poor breastfeeding) resulting in decreased bilirubin elimination and increased enterohepatic circulation. Sx include poor breastfeeding and signs of dehydration.

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55
Q

Breast milk jaundice is caused by?

A

Adequate feeding with normal exam other than jaundice. Breast milk (containing excess ß-glucuronidase) deconjugates intestinal bilirubin leading to increased enterohepatic circulation.

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56
Q

When does breastfeeding jaundice occur?

A

1st week of life

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57
Q

When does breast milk jaundice occur?

A

Begins 3-5 days and peaks at 2 weeks.

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58
Q

Rx for breastfeeding jaundice?

A

Breastfeed more often. ~q2-3 hours.

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59
Q

When should phototherapy be initiated in a full-term, healthy infant?

A

When total bilirubin ≥20mg/dL.

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60
Q

When should exchange transfusion be initiated in neonates with jaundice?

A

≥25mg/dL of total bilirubin

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61
Q

Gold std for acute angle closure glaucoma?

A

Gonioscopy. This is usually done by an ophthalmologist on consult.

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62
Q

A man with psoriatic patches on his arms has experienced DIP joint pain in the mornings and stiffness that seems to improve over the course of the day. Likely Dx?

A

Psoriatic arthritis. Occurs in 5-30% of patients with psoriasis and typically presents with DIP involvement. Morning stiffness is classic for all inflammatory arthritidies.

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63
Q

A decreased reticulocyte count int he presence of anemia is characteristic of?

A

Aplastic anemia.

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64
Q

Diabetic Pts with long-standing foot ulcers, fever, and X-ray evidence of osteomyelitis likely have infxn from what type of mycrobial?

A

Polymicrobial bone infxn due to contiguous spread from the overlying ulcer. Wound debridement, evaluation of arterial insufficiency, empiric IV ABx (piperacillin-tazo plus vanco)

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65
Q

What is the sequelae of chronic exposure to antigens that lead to hypersensitivity penumonitis (bird droppings, molds)?

A

Pulmonary fibrosis and restrictive lung pattern on spirometry.

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66
Q

Classic appearance of gout on Xray?

A

Punched-out erosions with a rim of cortical bone.

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67
Q

Classic appearance of RA on Xray?

A

Periarticular osteopenia with erosions of the joint margin.

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68
Q

Joint fluid WBC numbers expected in noninflammatory (OA) arthritis?

A

200-2,000. PMNs 25% or less.

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69
Q

Joint fluid WBC numbers expected in inflammatory (RA, gout) arthritis?

A

2,000-100,000. PMNs >50%

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70
Q

Septic joint fluid WBCs?

A

50K - 150K. PMNs >80 - 90%

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71
Q

Which form of osteogenesis imperfecta leads to fetal demise?

A

Type II. It is autosomal dominant, thus, mother may have had multiple aborta in her Hx.

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72
Q

Longstanding hypercalcemia, as in hyperparathyroidism, can lead to what type of BP changes?

A

HTN. Possibly due to contractility and arterial compliance changes.

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73
Q

Hyperthyroidism leads to what changes in SVR and BP?

A

SVR is decreased in hyperthyroidism, but BP, usually systolic, increases due to positive inotropic and chronotropic effects.

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74
Q

A woman presents with painful, subcutaneous nodules on the anterior lower legs. She has arthralgias and malaise also. What lab tests and imaging are necessary?

A

Aside from CBC, liver fxn, renal fxn test we also need antistreptolysin-O antibodies, PPD skin test. CXR for sarcoidosis/TB also. Sarcoid, TB, histoplasmosis, IBD, and Behcet disease as well as streptococcal infxn are associated with erythema nodosum, which is what this woman has.

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75
Q

Digital clubbing is associated with what conditions most commonly?

A

Lung malignancies
Cystic fibrosis
Right to left cardiac shunts

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76
Q

Does COPD cause digital clubbing?

A

No. If clubbing is found on examination of COPD Pt, then occult malignancy should be searched for (eg CXR). Hypoxia does NOT cause clubbing, rather, megakaryocyte release of VEGF and PDGF into vascular beds causes clubbing in capillaries.

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77
Q

Unilateral vs bilateral adrenal adenoma/hyperplasia leading to hyperaldosteronism Rx?

A

Unilateral: surgical resxn
Bilateral: medical (eplerenone> spirinolactone - less sexual SE)

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78
Q

Management of specific phobias (eg fear of heights)?

A

CBT w/ exposure is first line often with systemic desensitization. Benzos are used rarely.

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79
Q

Eye movement desensitization and reprocessing is a form of psychotherapy used for Rx of what?

A

PTSD

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80
Q

Appropriate Rx in performance subtype of social anxiety disorder?

A

Beta blockers

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81
Q

Why are phobias and panic disorder treated differently if they are a spectrum of anxiety disorder?

A

Panic disorder does NOT have a clear trigger, whereas panic attacks due to a phobia have a specific stimulus. Thus, panic disorder is treated with SSRI and phobias require CBT.

82
Q

Sx of congenital rubella syndrome?

A 
Deafness
Cardiac defects (eg PDA)
Hepatosplenomegaly
Microcephaly
Cataracts
83
Q

MC congenital cause of aplastic anemia (bone marrow failure resulting in pancytopenia)?

A

Fanconi anemia. X-linked disorder associated with DNA repair gene dysfxn due to chromosomal breaks. Aplastic anemia and bone marrow failure, short stature/abnormal thumbs/hypogonadism, skin hypo/hyperpigmentation, and low-set ears are some typical features.

84
Q

When is expectant or medical (misoprostol) management of abortion appropriate in hemodynamically stable Pts?

A

In stable patients with minimal bleeding. Both avoid risks of surgery, but require longer Rx times. Oxytocin is ineffective as the oxytocin receptors are not abundant in early pregnancy.

85
Q

Bleeding/spotting between periods without uterine enlargement, rather than prolonged menses is the hallmark of?

A

Endometrial polyps.

86
Q

Almost all cases of mitral stenosis are caused by?

A

Rheumatic fever from GAS.

87
Q

What Rx is appropriate in Pts with Hx of rheumatic fever?

A

Continuous antibiotic prophylaxis. IM benzathine PCN G every 4 weeks is preferred for 5-10 years.

88
Q

What is the drug of choice in schizophrenic or schizoaffective Pts with recurrent suicidality?

A

Clozapine.

89
Q

Sx of congenital toxoplasmosis?

A

Macrocephaly, chorioretinitis, diffuse intracranial calcificiations

90
Q

Sx of Primary ciliary dyskinesia?

A

Recurrent sinopulmonary infxns, bronchiectasis, +/- situs inversus (Kartagener syndrome). Dysmotile cilia due to dynein mutations leads to poor mucus removal and chronic infxn.

91
Q

In early Lyme disease, what is the first symptom and what occurs months later?

A

Early symptoms start with erythema migrans which is followed by monoarticular arthritis (usually knee pain) months later.

92
Q

All patients with disseminated gonococcal infxn (polyarthralgias, tenosynovitis, vesiculopustular skin lesions) should undergo screening for?

A

HIV.

93
Q

Best testing to cofirm suspected chronic pancreatitis?

A

Abd. CT. Pancreatic calcifications are present on CT. Patchy inflammation and fibrosis of the “burned-out pancreas” are classic. Lipase and amylase are often normal or only slightly elevated.

94
Q

A female taking lithium presents with hypernatremia and signs of severe dehydration. Her urine osmolality is low and serum osmolality is high. What is the initial step to be taken?

A

Give 0.9% NS IV, until she becomes euvolemic. Then give 5% dextrose in water to dilute via addition of free water. Serum sodium should not be reduced by more than 0.5mEq/dL/hr or 12 in 24hrs.

95
Q

A patient with severe HTN and end stage renal disease who presents with Sx of retinal hemorrhage and other end organ damage may be taking what drug that precipitated the incident?

A

Erythropoietin.

96
Q

How do ß2 agonists cause K+ shift into cells?

A

Stimulation of Na/K ATPase pump and Na-K-2Cl cotransporter and insulin release stimulation.

97
Q

Vomiting causes metabolic alkalosis, which leads to what electrolyte shift?

A

K+ wasting in the kidney occurs due to H+/K+ exchange in an attempt to retain H+.

98
Q

If a patient is bitten by a tick in the southern or south-eastern US, what disease must be considered?

A

Ehrlichiosis.

99
Q

Ehrlichiosis is commonly described as what other disease?

A

“Rocky mountain spotted fever without the spots”. Confusion, AMS, clonus, and neck stiffness are typical to both. Both are rickettsial diseases.

100
Q

What labs are expected in ehrlichiosis?

A

Leukopenia, thrombocytopenia, and elevated ATs and lactate dehydrogenase.

101
Q

Rx for ehrlichiosis?

A

Empiric Doxycycline while confirmatory testing is pending (for RMSF also). Chloramphenicol if pregnant.

102
Q

When is imaging indicated in uncomplicated pyelonephritis (flank pain, pelvic pain, NV, fever, CVA tenderness)?

A

After no clinical improvement on antibiotics within the first 72 hours of Rx.

103
Q

What does complicated pyelonephritis look like?

A

Progression to abscess, emphysematous pyelonephritis, or papillary necrosis. Sepsis and organ failure may occur.

104
Q

Risks associated with parenteral nutrition through central venous cath at 7-10 days vs 14+ days?

A

7-10days: At risk of infxn

14+ days: Cholestasis and resultant cholelithiasis

105
Q

Ethylene glycol results in what kind of kidney stones?

A

Calcium oxalate. Alcohol dehydrogenase causes breakdown into oxalic acid that precipitates with calcium in the urine. Hypocalcemia may occur also.

106
Q

What is a reactive non stress test in a fetus?

A

It is reactive if in 20 minutes there are:

≥2 or more accelerations which peak ≥ 15 BPM above baseline and last ≥ 15 seconds or more.

107
Q

What is a biophysical profile?

A

An NST and an US to evaluate amniotic fluid level, tone, breathing, and general body movements of fetus.

108
Q

A patient with poorly controlled diabetes has a foot ulcer that is painless and has s black center. Likely Dx?

A

Ecthyma gangernosum. Commonly associated with Pseudomonas aeruginosa. Antipseudomonal PCNs are preferred (piperacillin).

109
Q

A patient presents with chest pain and loss of palpable radial pulse on inspiration. Dx?

A

Cardiac tamponade. Pulsus paradoxus is a typical feature of tamponade and is defined as a loss of systolic BP with inspiration. Inspiration results in lowered intrathoracic pressure, which expands venous fluid return to the right heart, but reduces preload to the left side of the heart. This causes poor CO in an already compressed system and loss of systolic BP/poor palpable pulses during inspiration.

110
Q

Findings on CSF in HSV encephalitis?

A

Nonspecific actually, but usually include:
Lymphocytic pleocytosis
Elevated protein
Elevated RBCs (from hemorrhagic destrxn of frontotemporal lobes)
Normal glucose

111
Q

Typical CSF findings in bacterial meningitis?

A

Low glucose
Elevated protein
Neutrophilic pleocytosis

112
Q

Typical CSF findings in tuberculous meningitis?

A

Markedly low glucose
Elevated protein
Lymphocytic pleocytosis
***TB causes an exudative pleural effusion with very elevated protein (>4), lymphocytic leukocytosis, and low glucose also.

113
Q

Classic neurogenic claudication PE signs?

A

Lower extremity pain due to extension of the spine (eg walking, prolonged standing). Spinal flexion (leaning forward, walking uphill) eases the Sx.

114
Q

What metabolic or electrolyte changes are appreciated in Cushing syndrome?

A

Hyperglycemia, hypokalemia, HTN (due to the partial mineralocorticoid activity of cortisol).

115
Q

What PE feature of Cushing disease and Cushing syndrome could help distinguish their origin?

A

Cushing disease, due to pituitary ACTH secretion (lung cancer may do this too), results in hyperpigmentation due to ACTH cleavage from POMC (propiomelanocortin), which yields melanocyte-stimulating hormone. An adrenal adenoma/carcinoma is ACTH independent and does not cause skin hyperpigmentation.

116
Q

Protracted active labor definition and Rx?

A

Cervical change slow with or without adequate contractions. Give oxytocin.

117
Q

Arrested active labor (rapid cervical change b/t 6cm-10cm dilation) definition and Rx?

A

No cervical change for:
- 4 or more hours w/ adequate contractions (forceful q 2-3minutes)
OR
- 6 or more hours with inadequate contractions. Do Csxn.

118
Q

When is the CHA2DS2-VASc score risk assessment used?

A

In patients with nonvalvular AF. They need anticoagulation if they have 2 or more points.

119
Q

Are antibiotics given prophylactically in HIV Pts with CD4 counts <200?

A

No. The if >200, ensure all vaccines are up to date. Azithromycin is given if CD4<50 and TMP/SMX if CD4<200.

120
Q

Primary Rx in pancoast tumor that is causing SVC syndrome?

A

Radiation therapy for palliative measure when due to lung malignancy. High dose steroids are used to relieve Sx in SVC syndrome due to lymphoma, but not radiation.

121
Q

Pathology in spontaneous bacterial peritonitis?

A

Translocation of bacterial across the intestinal wall seeds ascitic fluid in peritoneum.

122
Q

Dx of peritonitis?

A

Paracentesis. Fluid contains ≥250PMNs/mL and cultures may be negative.

123
Q

Rx of peritonitis?

A

3rd gen ceph (cefotaxime)

Fluoroquinolone

124
Q

What PE findings usually indicates pemphigus vulgaris over bullous pemphigus?

A

PV has oral lesions and BP usually does not.

125
Q

MCC of brain metastasis?

A

Lung, breast, renal cell carcinomas, and melanoma. Notice lung, breast and renal all have two organs…

126
Q

Which patients require additional folic acid during pregnancy?

A

Prior neural tube defect or those on antiepileptics

127
Q

What drug reduces risk of preterm birth in Pts with Hx of prior spontaneous preterm delivery?

A

Progesterone supplementation.

128
Q

Does sertraline need to be DCed during pregnancy?

A

No. It does not increase risk for congenital malformations, but stopping it does increase depression risk and postpartum depression risk.

129
Q

A patient with episodes of “staring off into space” for a minute at a time and becoming unresponsive during those episodes appears to have difficulty moving his right side afterwards. Dx?

A

Complex partial seizures with Todd’s paralysis. Temporal lobe epilepsy is the most likely Dx and a likely cause of complex partial Sz.

130
Q

Infants of diabetic mothers, regardless whether pregestational or gesational, are at risk for?

A

Preterm delivery
Fetal macrosomia
Respiratory distress syndrome (fetal hyperinsulinemia delays cell maturation and results in immature pneumocytes w/ poor surfactant output)

131
Q

In SLE, what antibody is sensitive and what are specific?

A

ANA = sensitive

Anti-dsDNA and Anti-Sm = specific

132
Q

Lab findings expected in SLE?

A 
Anemia (hemolytic)
Thrombocytopenia
Leukopenia
Hypocomplementemia (C3 and C4)
Proteinuria
Elevated Cr
133
Q

What is the BEST SCREEN for primary hyperaldosteronism?

A

Early-morning plasma aldosterone:plasma renin ratio. If the ratio is >20, then suggests primary hyperaldosteronism.

134
Q

Best imaging for suspected primary hyperaldosteronism?

A

CT. Check for bilateral adrenal hyperplasia (50-60%) or adrenal adenoma (40-50%).

135
Q

Best Rx for primary hyperaldosteronism?

A

Aldosterone antagonist (spirinolactone, eplerenone)

136
Q

Sx of primary hyperaldosteronism?

A 
HTN
Hypokalemic alkalosis (muscle weakness and paresthesias)
137
Q

Rx for Cushing syndrome before definitive surgery?

A

Metyrapone.

138
Q

Pts with Roux-en-Y gastric bypass who rapidly lose weight are at risk for?

A

Gallstones. Usually develops several months after surgery.

139
Q

What Rx is often given for 6 months after Roux-en-Y to reduce gallstone development risk?

A

Ursodeoxycholic acid. Some surgeons suggest cholecystectomy at the time of bypass.

140
Q

What severe SE can occur after Roux-en-Y surgery?

A

Anastomotic leaks and bowel ischemia can be fatal.

141
Q

What is dumping syndrome?

A

Rapid gastric emptying that occurs resulting in abd pain, vomiting, diarrhea, and vasomotor sx (flushing, palpitations).

142
Q

What RBC morphology appears on UA in glomerular hematuria vs nonglomerular hematuria?

A 
Glomerular pathology (strep, IgA, Alport): Blood and protein with RBC casts and dysmorphic RBCs.
Nonglomerular (stone, Ca, PKD, infxn): Blood, but no protein with normal RBCs.
143
Q

How long after GAS infxn does glomerular pathology begin?

A

10 or more days. This usually resolves spontaneously.

144
Q

How long after a viral infxn does IgA nephropathy present?

A

Usually about 5 days after viral URI.

145
Q

In CKD patients with low calcium levels, what pathology is occurring in the parathyroid gland?

A

Hyperplasia of the parathyroid gland. Low Ca++ stimulates the gland to grow and produce PTH. This stimulates bone resorption that results in osteitis fibrosa cystica and PTH resistance that causes adynamic bone disease. Cumulatively, this is called renal osteodystrophy (bone pain and increased Fx risk).

146
Q

Rx in urge incontinence?

A

Muscarinic antagonists and beta agonists (mirabegron). They calm the detrusor overactivity.

147
Q

Rx in neurogenic urinary retention?

A

Muscarinic agonists.

148
Q

A patient with transjugular intrahepatic portosystemic shunting (TIPS) is at increased risk for?

A

Portosystemic encephalopathy. Occurs in up to 35% of patients with TIPS. Shunt between portal vein and the IVC bypasses teh liver.

149
Q

What dietary changes may be beneficial to a patient with TIPS?

A

Low protein diet. This helps limit ammonia levels.

150
Q

What BUN:Cr ratio is supportive of hepatic encephalopathy due to a GI bleed?

A

> 20:1 ratio. Hepatic encaphalopathy due to other causes is not necessarily correlated with ammonia levels beyond a two-fold increase.

151
Q

Initial Rx for plaque psoriasis?

A

Topical high-potency glucocorticoids OR vitamin D derivatices (calcipotriene)

152
Q

Medial meniscal injury is commonly from what motion of the knee?

A

Twisting usually. Sometimes on uneven ground. Sx include impaired extension, instability, and exacerbation of pain with squatting.

153
Q

MC brain tumor in adults?

A

Astrocytoma. They are a subcategory under gliomas (any brain tumor of glial cell origin).

154
Q

What is a grade IV astrocytoma?

A

Glioblastoma multiforme. Usually these present with neovascularity and necrosis.

155
Q

Most common factor in astrocytoma prognosis?

A

Tumor grade. Increased atypia, mitosis, neovascularity, or necrosis convey worse prognosis.

156
Q

What is the Rx for CLL?

A

Rituximab. This targets the CD20 antigen on B cell lymphocytes and can increase infxn risk. This is for symptomatic Rx only (massive splenomegaly, B symptoms, bone marrow failure).

157
Q

Urine sodium ≤20mEq/L with hypovolemic hyponatremia indicates what cause?

A

Extrarenal losses. eg Diarrhea, vomiting, burns, pancreatitis.

158
Q

Urine sodium >20mEq/L with hypovolemic hyponatremia indicates what cause?

A

Diuretics OR mineralocorticoid deficiency

159
Q

Empiric ABx in sickle cell Pt with febrile illness without identified infxn source?

A

Suspect Streptococcal infxn (*encapsulated bug): 3rd gen Cephalosporin (Ceftriaxone). Add Vanco if meningitis or osteoarticular infxn suspected.

160
Q

What conditions require ABx prophylactically in Pts with known cardiac conditions that are at risk for IE from an invasive procedure?

A

Prosthetic heart valve
Previous Hx of IE
Abnormal valve
Unrepaired congenital heart disease

161
Q

Dysgerminomas present in adolescents and frequently secrete?

A

LDH. Though some secrete ßhCG.

162
Q

What does doppler ultrasound measure across the valve in echocardiography?

A

Blood flow velocity across the valve. Blood flow toward the transducer records as positive (above the baseline) and blood flow away records as negative (below baseline).

163
Q

Dx for Benign Paroxysmal Positional Vertigo?

A

Dix-Hallpike maneuver

164
Q

Rx for Benign Paroxysmal Positional Vertigo?

A

Epley maneuver. Meds are generally ineffective.

165
Q

First line Rx in advanced pancreatic cancer with common bile duct obstrxn (severe jaundice)?

A

Endoscopic stent placement in the common bile duct. Surgical bypass from the bile duct to the jejunum is second line if stent placement is difficult.

166
Q

Parasitic intestinal infections are diagnosed by?

A

Checking 3 stool specimens for ova and parasites on separate days (a negative study has low sensitivity).

167
Q

In multiple myeloma, what kind of kidney injury is expected to arise?

A

Renal tubular injury. Monoclonal protein production (light chains) lead to clogged renal tubules and cast formation w/ toxicity (myeloma cast nephropathy). This is not detectable on UA as normal UA detects albumin, not monoclonal proteins. Signs of glomerular injury (hematuria and proteinuria) make this more likely in the presence of renal dysfxn.

168
Q

What other kinds of renal injury can be caused by multiple myeloma?

A

Glomerular injury and nephrotic syndrome. Amyloidosis and monoclonal immunoglobulin deposition disease are responsible, but these would present with hematuria and proteinuria as is typical of glomerular pathology.

169
Q

Genetic testing reveals what in Fragile X?

A

> 200 repeats of CGG at the FMR1 gene on the X chromosome is diagnostic.

170
Q

A child exhibiting self-mutilative behaviors at a young age likely has?

A

Lesch-Nyhan syndrome.

171
Q

A holosystolic murmur at the left sternal border of a patient with a known PE is present. She has no prior valvular pathology. What causes this?

A

Tricuspid regurgitation from elevated right sided heart pressures.

172
Q

Normal postvoid residual in males and females?

A

F<150mL

M<50mL

173
Q

Squatting reduces symptoms in tetrology of fallot and has what effect on the murmur?

A

Increases the intensity of the systolic murmur due to increased SVR and increased flow across the pulmonary valve into the lungs.

174
Q

What is the pathology in a “tet spell”?

A

Right to left shunting during exertion results in cyanosis due to higher resistance in getting blood into the lungs via pulmonary stenosis.

175
Q

When treating psychotic effects in Lewy Body Dementia, what antipsychotics are preferred?

A

2nd generation always and preferably other than risperidone (usually quetiapine), which may have the potential to create/worsen parkinsonian Sx due to heavier D2 antagonism.

176
Q

First line Rx in sexually active Pts with primary dysmenorrhea?

A

Combination estrogen-progestin OCPs. They reduce sx by thinning the endometrial lining, reducing prostaglandin release and decrease uterine contractions. NSAIDs are the first line in NON sexually active Pts.

177
Q

A young female gains several pounds over the course of a few months. She blames this on her oral contraceptives in the office. How is it best to counsel the Pt?

A

OCPs do NOT cause weight gain. This is a common misconception.

178
Q

Time for GBS screen in pregnancy?

A

35-37 weeks

179
Q

Time for screen for asymptomatic bacteriuria in pregnancy?

A

First trimester. Risk of progression to pyelonephritis.

180
Q

Rewarming techniques in mild, moderate, and severe hypothermia?

A

Mild (>90F): passive external rewarming
Moderate (82-90F): active external rewarming
Severe(<82F): Active INTERNAL rewarming

181
Q

At what stage of hypothermia does shivering fail?

A

Moderate (82-90F). Hypoventilation, hypotension, bradycardia, and conduction abnormalities are seen also.

182
Q

Proper Rx for inpatient PID?

A

Cefotetan or cefoxitin (both 2nd gen) IV with oral doxycycline.

183
Q

Proper Rx for outpatient PID?

A

Ceftriaxone plus doxycycline

184
Q

When is Metronidazole added to PID?

A

When it is complicated by tubo-ovarian abscess and additional anaerobic coverage is needed.

185
Q

Pellagra is associated with what syndrome of cancer?

A

Carcinoid syndrome. Niacin deficiency can lead to the 4 D’s dermatitis, diarrhea, dementia, and death.

186
Q

Increasing generalized weakness or bulbar weakness (difficulty swallowing, speaking etc.) is typical before the onset of what type of crisis?

A

Myasthenic crisis. Infection, surgery, medications, or pregnancy may precede Sx. Though botulism may present with symmetric weakness beginning at the face/cranial nerves also, it is usually preceded by GI symptoms.

187
Q

A newborn presents with failure to thrive, bilateral cataracts, jaundice, and hypoglycemia. Likely Dx?

A

Galactosemia (high blood galactose) secondary to galactose-1-phosphate uridyl transferase deficiency. Convulsions and helpatomegaly are also common. Early Dx can reverse Sx, even cataracts.

188
Q

What infxn are babies with galactosemia at risk for?

A

E. Coli neonatal sepsis.

189
Q

Likely Sx in galactokinase deficiency?

A

Cataracts only. They are otherwise asymptomatic.

190
Q

What characteristic can differentiate absence seizures from focal seizures?

A

Postictal period is not present in absence seizures. Absence seizures are provoked by hyperventilation, focal are not. Automatisms may be present in both.

191
Q

An adolescent with myoclonic jerks that occur most prominantly in the morning after awakening likely has what Dx?

A

Juvenile myoclonic epilepsy. Usually generalized Sz in first hour after awakening with myoclonic jerks. Occurs in adolescents.

192
Q

Child with severe intellectual disability and severe seizures of varying types has an EEG with a slow spike-wave pattern. Dx?

A

Lennox-Gastaut syndrome. Usually presents by age 5.

193
Q

Intermittent asthma day, night Dx?

A

2 or less/wk SABA uses

2 or less/month nighttime attacks

194
Q

Mild persistent asthma day, night Dx?

A

> 2-6x/wk (not daily)

3-4x/mo

195
Q

Moderate persistent asthma day, night Dx?

A

Daily

>1x/wk (not nightly)

196
Q

Severe persistent asthma day, night Dx?

A

Multiple times a day

4 - 7x/wk

197
Q

Intermittent asthma Rx?

A

SABA PRN

198
Q

Mild persistent Rx?

A

SABA, Low-dose ICS

199
Q

Moderate persistent Rx?

A

SABA with:
Low-dose ICS + LABA
OR
Medium-dose ICS

200
Q

Severe persistent Rx?

A 
SABA with:
4: Medium-dose ICS + LABA
5: High-dose ICS + LABA 
AND
Omalizumab (if the Pt has allergies)
6: Add oral corticosteroids to 5

UWorld (18 decks)

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