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Incorrects 6 Flashcards

1
Q

Proper Dx and Rx for Premenstrual syndrome and premenstrual dysphoria disorder?

A

Dx: menstrual diary to link Sx to cycle
Rx: SSRI. Combined OCs can also help by preventing ovulation.

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2
Q

What medication can lead to hypercalcemia with high/high-normal PTH?

A

Lithium.

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3
Q

What medications lead to hypercalcemia with low PTH?

A

Thiazides usually. Vitamin A and D toxicity can cause this also.

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4
Q

Tacrolimus and cyclosporine MOA?

A

Calcineurin-inhibition.

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5
Q

Cyclosporine SE?

A

Nephrotoxicity, hyperkalemia, HTN, gum hypertrophy, hirsutism, and tremor.

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6
Q

Tacrolimus SE?

A

Nephrotoxicity, hyperkalemia, HTN, and tremor. No hirsutism or gum hypertrophy.

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7
Q

Azathioprine MOA?

A

Purine analog that convets to 6-mercaptopurine to inhibit purine synth.

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8
Q

Azathioprine SE?

A

Dose related diarrhea, leukopenia, hepatotoxicity.

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9
Q

Mycophenolate MOA?

A

Reversible inhibitor of inosine monophosphate dehydrogenase (IMPDH), which is a rate-limiting enzyme in de novo purine synth.

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10
Q

Mycophenolate SE?

A

Bone Marrow suppression.

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11
Q

MCC of otitis externa?

A

Pseudomonas

S. Aureus

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12
Q

Expected urine sodium levels in SIADH?

A

> 40mEq/L usually. This would be in the presence of concentrated urine.

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13
Q

What odd renal effect can SSRIs cause in the elderly especially?

A

SIADH.

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14
Q

In hyponatremia due to polydipsia or low solute intake, what is the urine osmolality?

A

Appropriately low (<100mOsm/kg H2O). The kidneys are not damaged and retain capacity to dilute urine unlike SIADH.

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15
Q

Colorectal cancer, endometrial cancer, and ovarian cancer are classic for what syndrome?

A

Lynch syndrome. aka Hereditary nonpolyposis colorectal cancer

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16
Q

Hemangioblastoma, renal cell carcinoma, pheochromocytoma and pancreatic neuroendocrine tumors are class for what syndrome?

A

Von Hippel-Lindaue disease.

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17
Q

An IV drug user with new onset AV nodal conduction abberancies likely has?

A

Perivalvular abscess. This is often responsible for AV node dysfxn and conduction delays.

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18
Q

An IV drug user with new onset left lower sternal border systolic murmur accentuated by inspiration is likely?

A

Tricuspid endocarditis.

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19
Q

Hypercalcemia in the setting of normal PO4- and alkaline phosphatase is likely?

A

Milk-alkali syndrome (usually calcium carbonate).

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20
Q

When to give the PCV13?

A

Anyone over 65 (followed by PPSV23 later);

High risk patients under 65 (CSF leaks/cochelar implants, sickle cell, aslpenia, immunocomp, CKD).

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21
Q

Who gets PPSV23 alone?

A

Anyone age 19-64yo.

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22
Q

When is Tdap given as an adult rather than Td?

A

As a one time booster to replace any 10 year booster later on OR pregnant women OR anyone coming into contact with children

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23
Q

What exposure leads to clear cell adenocarcinoma of the vagina?

A

Diethylstilbestrol (DES) in utero.

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24
Q

First testing required when Raynaud’s occurs?

A

ANA, RF, ESR, complement. Raynaud’s is associated with many connective tissue diseases (SLE, scleroderma, thromboangiitis obliterans). Primary Raynaud’s is NOT associated with connective tissue disease (negative ANA, RF, ESR).

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25
Q

MCC of neonatal sepsis?

A

Group B Strep. This presents within 7 days of vaginal birth. If mom is GBS+ and a C sxn occurs, sepsis within 7 days may be due to mother passing it via her hands. This is still more likely than Listeria.

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26
Q

Sx of Listeria?

A

Mother has flu-like Sx and baby gets septic Sx and meningitis (bluging fontanelle, etc.)

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27
Q

In a patient presenting with severe abd pain radiating to the back, what is the next step to confirm acute pancreatitis?

A

Amylase and lipase. An abd. CT can be done if Dx is still unclear or if they fail to improve with conservative Rx.

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28
Q

For what are bone scans used?

A

Metastatic bone disease or osteomyelitis.

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29
Q

When are long acting injectable antipsychotics indicated?

A

Chronic nonadherence.

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30
Q

MCC of isolated, asymptomatic elevation of alkaline phosphatase in an elderly patient?

A

Paget disease of bone (aka osteitis deformans).

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31
Q

Elevated procollagen type 1 N propeptide (PINP) and urine hydroxyproline are markers of?

A

Pagets disease of bone.

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32
Q

An elevated calcium and PSA over what level is suspicious for?

A

Metastatic prostate cancer.

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33
Q

What occurs after suction D&C of hydatidiform mole?

A

ß-hCG levels are followed weekly until undetectable. This is important because a plateau or increase in ß-hCG is diagnostic of geestational trophoblastic neoplasia (GTN) (eg choriocarcinoma). ß-hCG is followed for 6 months after undetectable. If it rises, that is likely GTN. Contraception should be prescribed during this time.

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34
Q

CA-125 is a tumor marker for what cancer?

A

Epithelial ovarian cancer.

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35
Q

Why is aldosterone unaffected in central adrenal insufficiency?

A

The adrenal glands are intact and respond to the RAS for aldosterone secretion.

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36
Q

Why is aldosterone reduced in primary adrenal insufficiency?

A

The adrenal glands are damaged and aldosterone secretion is affected. Hyperkalemia and hyponatremia with low BP is a feature due to hypoaldosteronism. Elevated ACTH secretion also causes hyperpigmentation.

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37
Q

How can age related dry eyes (age related sicca syndrome) and Sjögren syndrome be differentiated?

A

Though Sx are almost identical, Sjögrens shows up in middle age, not after 65, and most have a positive ANA. If there are systemic Sx, then it is probably secondary to systemic sclerosis.

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38
Q

What is focal nodular hyperplasia?

A

A benign solid liver mass made up of arteries commonly found in women.

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39
Q

Hepatic adenoma is associated with?

A

Long term OCs in women. It may hemorrhage or transform, but rarely.

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40
Q

Hepatocellular carcinoma lab marker?

A

Elevated AFP.

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41
Q

Hepatic angiosarcoma is a rare liver neoplasm associated with what toxin exposure?

A

Vinyl chloride gas
Arsenic compounds
Thorium dioxide

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42
Q

Cholangiocarcinoma Sx?

A

Biliary obstrxn (jaundice, pruritis, light-colored stools, dark urine).

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43
Q

Main RF for cholangiocarcinoma?

A

PSC.

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44
Q

What form of CBT is used in Tourette’s?

A

Habit reversal training

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45
Q

Enlargement of what leads to atrial fibrillation?

A

Either of the atria. This can be due to valvular problems (eg RH leading to MS).

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46
Q

Required testing in amaurosis fugax?

A

Carotid US. Carotid atherosclerosis is the most common site of emboli formation due to plaque. Emboli from the heart causing amaurosis fugax is rare and echo is rarely needed.

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47
Q

A 40yo female presents to the office with blurry vision. She has an afferent pupillary defect on neurologic exam and optic disk swelling on fundoscopy. Dx?

A

Multiple sclerosis. Do LP and CSF analysis (oligoclonal bands).

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48
Q

What are the first 3 factors considered in a Pt with low corrected calcium before checking PTH?

A

Low magnesium? Recent blood transfusion (high citrate)? Is it due to a drug?

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49
Q

Pathophys behind low calcium in hypomagnesemia?

A

Low magnesium can cause PTH resistance to low Ca++.

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50
Q

How much is serum Ca++ reduced for each 1gm/L albumin decrease in the blood?

A

Ca++ decreases by 0.8 per every gram of albumin reduced in the blood.

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51
Q

What other electrolyte is expected to coexist with hypomagnesemia in alcoholics?

A

Hypophosphatemia.

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52
Q

When should antivirals be administered for influenza infxn?

A

Those with RFs (≥65yo, pregnancy, chronic medical conditions) for influenza complications should get antivirals (oseltamivir) anyway. Or those w/o RFS who are <48hrs from start of Sx.

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53
Q

If a patient with new HIV refuses to tell their partner, what is the next step?

A

The doctor must report to the local health department within 48hrs any new STD Dx (eg HIV). They will tell the husband.

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54
Q

Abnormal dilations within the nail fold capillaries on nail fold microscopy in a man over 40 with Raynaud’s may signify what disease?

A

Connective tissue disease (SLE, RA, etc.). Secondary Raynaud’s is more typical in men over 40 and the capillary bed microscopy can be predictive of connective tissue disease. This is normal in primary Raynaud’s.

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55
Q

Infection of the lacrimal duct?

A

Dacrocystitis

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56
Q

Infection of the sclera?

A

Episcleritis

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57
Q

Abscess on the upper or lower eyelid?

A

Hordeolum

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58
Q

Chronic granulomatous inflammation of the meibomian gland of the eye?

A

Chalzion

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59
Q

MCC of AA amyloidosis in the US?

A

Rheumatoid arthritis.

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60
Q

S/S of amyloid induced nephrotic syndrome?

A

Nephrotic Sx (proteinuria, etc.) and organ enlargement (kidneys enlarged, hepatomegaly).

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61
Q

Typical microscopy findings on renal biopsy due to amyloid deposition?

A

Congo red staining of amyloid deposits, apple-green birefringence under polarized light, and fibrils present on electron microscopy in BM.

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62
Q

What kind of amyloidosis occurs in multiple myeloma and Waldenström macroglobulinemia?

A

Light chains (lambda). AL means amyloid light-chain.

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63
Q

What kind of amyloidosis occurs in chronic inflammatory conditions (RA or inflammatory bowel disease) or chronic infxn (osteomyelitis, TB)?

A

AA amyloidosis. Abnormally folded ß-2 microglobulin, apolipoprotein, or transthyretin

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64
Q

Nerve injury in the median pattern of the hand is possible due to dislocation of the?

A

Lunate.

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65
Q

If scaphoid fracture is suspected, what can confirm the Dx?

A

CT or MRI.

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66
Q

Displaced scaphoid Fx rerquires?

A

Surgery.

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67
Q

Wrist immobilization of a nondisplaced scaphoid Fx requires what imaging?

A

Serial Xray to RO osteonecrosis or nonunion.

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68
Q

Whether a patient has the capacity to make medical decisions is determined by the?

A

Physician.

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69
Q

Whether a patient has the competency to make medical decisions is determined by the?

A

Courts.

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70
Q

Methotrexate SE?

A

Hepatotoxicity
Stomatitis
Cytopenia (Marrow)

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71
Q

Leflunomide SE?

A

Hepatotoxicity

Cytopenia

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72
Q

Hydroxychloroquine SE?

A

Retinopathy

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73
Q

Sulfasalazine SE?

A

Hepatotoxicity
Stomatitis
Hemolytic anemia

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74
Q

TNF inhibitor (adalimumab, etanercept, infliximab) SE?

A

Infxn
Demyelination
CHF (Echo)
Malignancy

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75
Q

A pregnant woman gets an epidural prior to labor. An hour later she has low BP, bradycardia, and respiratory problems. She is intubated soon after due to resporatory arrest. Dx?

A

“High spinal” or “total spinal” epidural anesthesia. This is a dangerous complication due to either intrathecal (within the sac covering the cord) injxn or anesthetic overdose.

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76
Q

S/S of idiopathic intracranial HTN?

A

HA, transient vision loss, pulsatile tinnitus, diplopia

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77
Q

CN affected in idiopathic intracranial HTN?

A

CN VI palsy.

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78
Q

Dx of idiopathic intracranial HTN?

A

MRI and/or Lumpar puncture with high opening pressure (>250).

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79
Q

Rx of idiopathic intracranial HTN?

A

Weight loss and acetazolamide.

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80
Q

What comorbid finding occurs in 70% of cases of idiopathic intracranial HTN?

A

Empty sella.

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81
Q

Management of symptomatic hypercalcemia in primary hyperparathyroidism?

A

If unde 50, parathyroidectomy. For those who refuse surgery, bisphosphonates.

82
Q

Best step in management for polymyalgia rheumatica?

A

Low dose prednisone.

83
Q

Best next step in management of temporal arteritis?

A

First expedite a temporal artery biopsy, then give high dose prednisone.

84
Q

How is polymyalgia rheumatica diagnosed?

A

ESR>40 with elevated CRP in presence of Sx. DO NOT DO ANA or RF, these are not specific to PMR.

85
Q

How long must a tick be attached before treatment of Lyme initiated?

A

> 36 hours. Transmission requires 48-72 hours to occur in saliva.

86
Q

Late term/post term pregnancy complications for fetus?

A 
Oligohydramnios (≤2cm deep)
Meconium aspiration
Stillbirth
Macrosomia
Convulsions
87
Q

Lymphogranuloma venereum Sx?

A

Caused by chlamydia trachomatis (L1-L3) it presents with small shallow ulcers that are painless, but can progress to painful, fluctuant adenitis (buboes).

88
Q

A female presents with painful, pruritic, ulcerative genital lesions and inguinal lymphadenopathy. How to confirm the Dx?

A

NAAT. This could be herpes OR lymphogranuloma venereum. Both are confirmed with PCR (NAAT utilizes PCR).

89
Q

MC complication in meningitis of a child?

A

Hearing loss. Epilepsy and others can occur, but far less commonly.

90
Q

When is carotid endarterectomy recommended?

A

Symptomatic Pts (TIA or stroke Hx within past 6 months) with high grade (70-99%) stenosis.

91
Q

Basic idea of Reye syndrome?

A

Pediatric aspirin use during a viral infxn leading to acute liver failure and encephalopathy (AST, ALT, PT, INR, PTT, NH3 are all elevated). Rx: supportive

92
Q

N-acetylcysteine (mucomyst) causes what effects that are beneficial in combating tylenol OD?

A

Increase glutathione levels and binding NAPQI (tylenol toxin metabolite).

93
Q

Abnormal 1 hour 50g glucose testing?

A

> 140mg/dL

94
Q

Threshold levels for 3 hour 100g glucose testing?

A

1hr<180
2hr<155
3hr<140

95
Q

Sx of ectopic pregnancy?

A

Amenorrhea, abd./pelvic pain, vaginal bleeding, ßhCG+

96
Q

What is Lofgren syndrome?

A

Erythema nodosum, hilar adenopathy, migratory polyarthralgia, fever assocaited with sarcoidosis.

97
Q

Best Rx in the case of beta blocker OD?

A

Glucagon. Pacing seems like it would help, but do glucagon. Especially if the patient is bradycardic WITH wheezes.

98
Q

Elderly man with lower extremity motor weakness, hyperreflexia, and bladder dysfxn raise concern for what?

A

Spinal cord compression.

99
Q

What is the Rx for spinal cord compression from malignancy?

A

Glucocorticoids.

100
Q

What is leukocytoclastic vasculitis?

A

Small vessel vasculitis due to a hypersensitivity resulting in palpable purpura, vessicles, bulllae of the skin.

101
Q

What test is required to confirm patellofemoral syndrome?

A

Patellofemoral compression test: extend the knee and compress the patella. Pain also worse with squatting. This is a syndrome of overuse in athletes. Pain comes from BEHIND the patella.

102
Q

Patellar tendonitis presents on what part of the knee?

A

Episodic pain in the INFERIOR patella.

103
Q

Patellofemoral syndrome and patellar tendonitis present BOTH in what population?

A

Young athletes.

104
Q

Do patients with Social phobia performance type require an SSRI?

A

No. Only give this subtype a beta blocker or a benzo.

105
Q

Expected findings below hemisected (Brown sequard) cord on right?

A

Ipsilateral: loss of fine touch/proprioception and spastic hemiparalysis
Contra:Loss of pain/temp (starting a few levels below the lesion due to decussation)

106
Q

If occurring high enough, what Sx can occur in Brown sequard?

A

Horners Syndrome if Sx occur in cervical spine.

107
Q

What is the most important RF associated with the development of aortic dissxn?

A

Systemic HTN. Usually these people are >60.

108
Q

If a young person <40 has an aortic dissxn, what is the likely associated cause?

A

Marfan’s. Up to 50% are due to Marfans in Pts<40.

109
Q

Man with possible tick bite presents with fever, fatigue, myalgias, and headache. He has anemia and thrombocytopenia. Next step?

A

Blood smear to look for Maltese Cross. He has babesiosis. Bilirubin, LDH, and LFTs can be elevated.

110
Q

Rx for babesiosis?

A

Atovaquone and azithromycin OR quinine and clindamycin (severe cases).

111
Q

Rocky Mountain spotted fever Sx?

A

Feer, HA, myalgias and prominent rash spreading centripetally (to the center) and includes palms/soles. No anemia/hemolysis.

112
Q

Lyme disease Sx?

A

Early: erythema migrans, fever, myalgias, HA, and/or lymphadenopathy. Anemia with hemolysis uncommon.

113
Q

Ehrlichiosis Sx?

A

Fever, myalgia, HA with leukopenia/thrombocytopenia. If hemolysis occurring with leukopenia, think babesiosis. Unlikely in ehrlichiosis.

114
Q

Tourniquet testing is for?

A

Dengue fever. Pump cuff up and if 20 or so petechiae arise/square inch, the positive. LeukoPENIA and thrombocytoPENIA are common. Hemolysis unusual.

115
Q

Imaging testing for Parkinson Disease?

A

There are no imaging tests or lab tests that can confirm Dx moreso than a physical exam.

116
Q

MCC of bone tumor in children and young adults?

A

Osteosarcoma. Rx: excision and chemo.

117
Q

Osteosarcoma location?

A

Metaphysis of long bones. Usually no constitutional Sx.

118
Q

Imaging/labs for osteosarcoma?

A

Sunburst. Codman triangle. Alk phos elevated.

119
Q

Ewing sarcoma imaging?

A

Osteolytic lesion with periosteal reaction producing reactive bone laters that causes “ONION SKIN”

120
Q

Osteoid osteoma imaging?

A

Sclerotic, cortical lesion with cental lucent nidus. These respond to NSAIDs and pain is usually worse at night.

121
Q

Women with pseudocyesis require what?

A

Psych evaluation and treatment.

122
Q

Classic Sx in Renal cell carcinoma?

A

Flank pain, hematuria, palpable abd. renal mass with scrotal varicoceles (left often). Anemia or erythrocytosis, thrombocytosis, fever, hypercalcemia, cachexia.

123
Q

What is the temperature and sx in moderate hypothermia?

A

28-32°C or 82-90°F. Bradycardia, lethargy, hypoventilation, reduced shiver reflex. Everything is slowed down. In severe everything is collapse/coma. In mild, ataxia/shivering predominate.

124
Q

New onset ascites is evaluated first with what test?

A

Paracentesis.

125
Q

What drug class would help in aspirin-exacerbated respiratory disease (AERD)?

A

Leukotriene inhibitors (Zileuton) and leukotriene receptor antagonists (Montelukast).

126
Q

Cell-mediated (or delayed) hypersensitivity occurs when?

A

48-72 hours after exposure.

127
Q

Cell-mediated hypersensitivity is due to?

A

T-cell activation. No antibodies involved. (eg contact dermatitis, SJS syndrome, TEN)

128
Q

Antibody-mediated cell destruction is what type of reaction?

A

Type 2 hypersensitivity. Antibodies bind to certain cell types and lead to hemolysis, thrombocytopenia, or neutropenia for example.

129
Q

Immune complex disease path?

A

Antigens and antibodies form complexes that form in vessels or tissues. They deposit and cause complement activation and neutrophil recruitment. Pts have vasculitis or drug fever after prolonged, high dose drug administration.

130
Q

Lamotrigene worst SE?

A

SJS.

131
Q

Best Rx for acute bipolar DEPRESSION?

A

Quetiapine and lurasidone and lamotrigine. Of course, lithium, valproate, and combos of olanzapine and fluoxetine also are effective.

132
Q

Risks of using antidepressants in patients with bipolar depression?

A

Rapid cycling (≥4 mood episodes/year) and mood cycling.

133
Q

What cancer is associated with pernicious anemia?

A

Atrophic gastritis develops leading to intestinal-type gastric cancer.

134
Q

What Sx present in B12 deficiency?

A

Macrocytic anemia
Glossitis
Peripheral neuropathy

135
Q

First trimester maternal hyperglycemia can lead to what neonatal defects?

A

Congenital heart disease
Neural tube defects
Small left colon syndrome
Abortion

136
Q

Second and third semester maternal hyperglycemia can lead to ?

A

Polycythemia
Organomegaly
Hypoglycemia (neonatal period)
Macrosomia

137
Q

Barlow and Ortolani maneuvers evaluate what respectively?

A

B: A to P push of flexed hip dislocates hip backward
O: rotating leg out and pushing at trochanter causes reduction of dislocated hip

138
Q

Galeazzi test is for?

A

Child lays supine and knee heights evaluated with feet flat on table and hips/knees flexed. Checks for dislocation. Asymmetric inguinal skin folds also used.

139
Q

Proper imaging to check for Hip dysplasia?

A

<4 months: US of hips
>4months: Xray due to ossicification of femoral head and acetabulum
If positive, put in Pavlik harness.

140
Q

What sound qualities of a murmur in a child would be concerning for pathologic murmur?

A

Harsh, holosystolic, or diastolic. Grade 3 or higher. Or increasing with standing or valsalva are all concerning.

141
Q

What sound quality in a murmur would indicate physiologic murmur in a child?

A

Low intensity (grade 1 or 2) and decreased with standing or valsalva. Typically they are early or mid-systolic.

142
Q

Clinical features of prerenal azotemia?

A 
Increased Cr (>50% from baseline)
Oliguria
BUN/Cr ratio>20:1
FENa <1% (all 3 prior findings are due to kidney perception that BP insufficient. Urea retained also passively.)
Bland sediment
143
Q

In severe burns, early infxns are due to what?

A

Gram positive organisms.

144
Q

In severe burns, late infxns (>5days) are due to what?

A

Gram negative organisms (Pseudomonas) or fungi (candida)

145
Q

What are the earliest signs of infxn in a burn patient?

A

Change of appearance of the wound (partial thickness to full thickness injury) or the loss of viable skin graft.

146
Q

Dx for burn infxn?

A

Quantitative wound culture and biopsy for histopathology (determine depth of invasion).

147
Q

Rx for burn infxn?

A

Broad ABx (eg pipercillin/tazobactam, carbapenem) and MRSA coverage (Vancomycin) or Pseudomonas coverage (eg aminoglycoside).

148
Q

What cancers commonly metastasize to the liver?

A

Colon (MCC)
Lung
Breast

149
Q

Solitary liver mass with elevated AFP?

A

Hepatocellular carcinoma

150
Q

MCC of short stature and pubertal delay in adolescents?

A

Constitutional growth delay. Normal birth weight and height but between 6months and 3 years height/growth velocity slows. At about 3 years, the child regains normal growth velocity often at 5th to 10th percentile. Puberty delayed, but does occur. Bone appears delayed on scan vs chronological age.

151
Q

Proper management of constitutional growth delay?

A

Nothing. Hormone supplementation is not necessary and may shorten the growth spurt resulting in shorter final height.

152
Q

Are there any other causes of constitutional growth delay?

A

Hypothyroidism. But this would present with sudden “falling off the growth curve” and associated Sx.

153
Q

Does switching from SSRI to SNRI require a washout period?

A

No. Usually, because they have similar MOA the washout is not necessary.

154
Q

Trousseau’s syndrome?

A

Superficial migratory arthritis associated with abdominal malignancy. Often pancreatic carcinoma.

155
Q

Definitive Rx of endometriosis?

A

Hysterectomy with oophorectomy.

156
Q

Intraplacental villous lakes with abnormalities of placental/myometrial interface are found in?

A

Placenta accreta.

157
Q

Antenatally Dx placenta accreta requires what?

A

Planned cesarean hysterectomy (removal of uterus at times of Csxn)

158
Q

How does vasa previa present?

A

Painless antepartum bleeding with fetal HR abnormalities just after ROM.

159
Q

Polycythemia vera is often due to what mutation?

A

JAK2

160
Q

What complications can occur in polycythemia vera?

A

Thrombosis, myelofibrosis, acute leukemia.

161
Q

What cell lines can be elevated in polycythemia vera?

A

RBCs, leukocytes, and thrombocytes can all be elevated. EPO levels will be low (if due to JAK2 mutation) as will iron levels due to use. EPO high in hypoxia caused PV.

162
Q

BCR-ABL fusion found in?

A

CML.

163
Q

Anemia, increased MCHC, and high indirect bilirubin in a newborn that is jaundiced refractory to phototherapy is likely Dx with?

A

Hereditary spherocytosis. Coombs test is negative. Acidified glycerol lysis shows osmotic fragility and eosin-5-maleimide binding test is positive.

164
Q

A child with severe coughing paroxysms and presenting with subQ air requires what imaging?

A

CXR. Pneuomothorax must be ruled out.

165
Q

Gold standard for diagnosing nephrolithiasis?

A

Noncontrast abd. CT.

166
Q

What hormone must be cotested with bilateral breast milk secretion in nonbreast feeding patient?

A

TSH and prolactin are tested together. Hypothyroidism can lead to hyperprolactinemia.

167
Q

Sudden discontinuation of paroxetine and venlafaxine or some other SSRI/SNRIs can cause what?

A

Antidepressant discontinuation syndrome. The shorter half life of these medications or higher doses are associated with severe discontinuation symptoms. Restart and taper the meds to avoid.

168
Q

Inability to raise the eyebrow or close the eye alongside drooping of the mouth corner and nasolabial fold disappearance is typical for?

A

Bell’s palsy. The lesion is “below the pons” in the facial nerve (peripheral, not central). A central lesion would retain eye closure ability and forehead innervation.

169
Q

A CNS lesion above the facial nucleus will cause ipsilateral or contralateral lower facial weakness?

A

Contralateral to the lesion.

170
Q

A patient with HTN and hypokalemia requires what testing?

A

Plasma renin activity and plasma aldosterone concentration. Low renin with high aldosterone indicates primary hyperaldosteronism.

171
Q

When are ABx recommended in COPD exacerbation?

A

Increased sputum clearance especially, but at least 2 Sx (dyspnea, cough, sputum prodxn) and/or mechanical ventilation requirement (NPPI or Intubation).

172
Q

Positive end expiratory pressure allows for what?

A

Alveoli recruitment. This prevents alveolar collapse.

173
Q

FiO2 proper level to prevent O2 toxicity?

A

Usually <60% is considered safe. Displacement of nitrogen in the alveoli can cause collapse and free radicals, paradoxically lowering oxygenation.

174
Q

What bone tumors are associated with paget disease of the bone?

A

Giant cell tumor

Osteosarcoma

175
Q

Proper management of Paget disease of the bone?

A

Bisphosphonates (alendronate or zoledronic acid). Calcitonin has a weaker effect.

176
Q

What three vitamin levels must be checked if a Pt has DVT and subsequently high homocysteine?

A

Folate, B12, and Vitamin B6. Each are important to biochemical pathways to reduce levels.

177
Q

Clinical signs of ADPKD?

A

HTN (early), palpable abd. masses, proteinuria, CKD (progressive), Cerebral aneurysms, pancreatic and hepatic cysts, cardiac valve disorders, hernias

178
Q

Pts with anemia of chronic disease whose H&H are unresponsive to management of inflammatory disease may require?

A

Erythropoietin or darbopoetin

179
Q

An EEG with sharp, triphasic and synchronous discharges in a man with rapid dementia and behavioral changes is due to?

A

Spongiform encephalopathy due to prion disease (Creutzfeldt-Jakob disease).

180
Q

Vertebral compression fracture pain increases with?

A

Standing, walking, or lying supine. Osteoporosis and malacia are MCC.

181
Q

Lumbar disk degeneration pain typically?

A

Worsens with activity and is relieved by rest. Nighttime pain is not typical.

182
Q

Clinical features of acromegaly (excess GH secretion)?

A

Pituitary enlargement: visual field defects, HA, CN defects
MSK: Gigantism, arthralgias, myopathy
CV: cardiomyopathy, HTN, CHF
GI, endocrine issues present also. Pt may have organomegaly.

183
Q

Rx for Dressler’s syndrome?

A

NSAIDs. Pt will present weeks or months after MI with pericarditis.

184
Q

Proper management of cat bites?

A

Amox/clav. Amoxacillin has activity against Pasteurella and clavulonate will expand it to oral anaerobes also.

185
Q

Proper initial Rx in severe GERD (laryngeal involvement, etc.)?

A

8 weeks of PPI.

186
Q

Aside from PTSD, sexual assault victims are at increased risk of?

A

Suicide and MDD.

187
Q

ECG changes indicating LVH?

A

High voltage QRS complexes
Lateral ST segment depression
Lateral T wave inversion
***Signs of longstanding HTN leading the LVH

188
Q

Confirmational testing for coarctation?

A

Echo.

189
Q

A young man (<40) with severe HTN and epistaxis requires?

A

Searching for 2° causes of HTN (eg coarctation). Brachial-femoral delay, bilateral upper and lower BP measurements may assist.

190
Q

Acute (empiric) Rx for IE?

A

Vancomycin. Until culture is available.

191
Q

Pts with what condition are at higher risk of IE than the normal population?

A

MVP. 5-8x greater risk of IE than normal valve. This affects the mitral valve.

192
Q

When is IE associated with tricuspid regurgitation and vegitations?

A

IV drug use. If no Hx of drug use, then IE far more likely to occur in mitral valve especially w/ MVP Hx.

193
Q

Signs of uterine rupture?

A

Vaginal bleeding, sudden/severe abd pain, intraabdominal bleeding (low BP, tachy), fetal heart decel, loss of fetal station, Palpable fetal parts in abdomen, loss of intrauterine pressure

194
Q

30s man presenting with hyperreflexia and weakness in the lower legs with Hx of IV drug use must consider?

A

Epidural abscess. Even in the absence of fever a big concern in IV drug users. MRI of spine needed!

195
Q

Edrophonium is used to Dx?

A

Myasthenia gravis. Antibodies against the ACh receptor occur.

196
Q

Sexual pain disorder is pain that interferes with sexuality but is not attributable to what?

A

A medical condition (endometriosis, etc).

197
Q

Vaginismus is?

A

A disorder where involuntary contraction of the vaginal musculature leads to inability to have sex. Insertional pain without dysmenorrhea or dyschezia differentiates it from endometriosis.

198
Q

After aspiration of a likely breast cyst in a female <30, when should followup occur?

A

Close interval (2 months or so). Recurrence is common. If mass recurs after aspiration do core biopsy.

199
Q

Age of onset for IBD?

A

Bimodal: 15-40 and 50-80.

200
Q

Rx for Enterobius vermicularis (pinworms)?

A

Albendazole or pyrantel pamoate. All household contacts must be treated.

UWorld (18 decks)

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