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Primary Care > Medicine Qbank 3 > Flashcards

Medicine Qbank 3 Flashcards

1
Q

unexplained congestive heart failure, low voltage, increased left ventrulcar wall thickness in patients w/o HTN

A

cardiac amyloidosis

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2
Q

h. pylori in gastric adenocarcinoma

A

not curative. (is in MALT lymphoma). treat if tumor is resectable after CT, PET

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3
Q

CD4 less than 200, or candidiasis

A

pneumocystis jirovecii, trimethoprim-sulfamethoxazole

oral candiasis is risk factor

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4
Q

CD4 less than 100

A

toxoplasma gondii, trimathoprim-sulfamethaxazole

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5
Q

CD4 less than 50

A

mycobacterium avium complex, azithromycin

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6
Q

CD4 less than 150

A

Histoplasma, itraconazole

ohio and mississippi river walleys

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7
Q

acyclovir and valacyclovir in HIV

A

used in recurrent herpes simplex regardless of CD4

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8
Q

fluconazole prophylaxis

A

for cryptococcal, but not done in US. treats candidiasis as needed

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9
Q

peripheral edema, hypoalbuminemia, urinary protein excretion greater than 3g/day

A

nephortic syndrome. (can cause dyslipidemia leading to athrosclerosis, stroke and MI.)

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10
Q

antipseudomonal betalactam that coversgram +/-; empiric tx for febrile neutropenia

A

piperacillin-tazobactam, cefepime or meropenem

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11
Q

10 minutes of morning stiffness

A

OA. More would suggest inflammatory arthritis. crepitus is also a sign of OA

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12
Q

treat osteoathritis that is refractory to NSAIDs and steriods

A

colchicine

calcium pyrosphosphate can be present in joints

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13
Q

three definitive tests for syphilis

A

VDRL, FTA-ABS, and spirochetes on dark field microscopy. Test positive syphilis pt for HIV

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14
Q

chronic epigastric pain (on and off), malabsorption (steathorrhea, wt loss), DM

A

chronic pancreatitis: alcoholic, CF, ductal obstruction or autoimmune

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15
Q

ELevated CA19-9 levels

A

pancreatic cancer. most patients die within one year

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16
Q

chornic cough, mainly nocturnal

A

check PFTs for asthma

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17
Q

tx hypersensitivity pneumonitis

A

(ground glass or haziness of lower fields, wt loss, clubbing, honeycombing)
avoid antigen! (parrots, molds). systemic steroids can treat acute symptoms

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18
Q

dull low-back pain, worse at night, improves throughout the day

A

inflammatory arthritis: AS, psoriatic arthritis, reactive arthritis, arthritis of IBD. AS affects apophyseal joints

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19
Q

high intraocular pressyre with cupping of optic disk, tunnel vision

A

open angle glacoma. AAs, runs in familys, diabetes.

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20
Q

poor nightvision, curtain falling with vitreous bleed, or floaters

A

DM retinopathy (leading causeof aquired blindness)

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21
Q

blurred vision, problems withnighttime driving, and glare

A

cataracts

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22
Q

immune rxn that lookslike acute syphilis

A

jarish-herxheimer reaction to dead syphilis in syphilis treated with penicillin

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23
Q

symptomatic relief in new diagnosis of hyperthyroidism

A

beta blockers

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24
Q

indication for propylthiouracil

A

when radioactive iodine is contraindicated,like pregnancy. inhibits thyroid hormon synthesis and conversion of T3 to T3. Relapse post-tx in 2/3 of patients

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25
Q

most common mets to the liver

A

GI, breat, lung

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26
Q

contraindications for liver transplant

A

cardiopulmonary dz causing prohibitive risk, incurable or recent cancer (

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27
Q

trimethoprim-sulfamethazole AE

A

rash, neutropenia, hyperkalemia, elevated transaminases

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28
Q

minimizepulmonry complications beforegiving antibiotics

A

give corticosteroids if PaO235

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29
Q

PAD tx

A

low dose aspirin, statin, smoking cessation, supervisedexerciseprogram

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30
Q

PAD tx persistent symtpomsdespite exercise therapy

A

cilostazol and percutaneous or surgical revasculazation

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31
Q

evaluated back pain: normal x-ray, increased ESR/CRP

A

MRI, then CTbiopsy if needed

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32
Q

asymptomatic or HA, deafness, neuropathy andbone/back pain

A

paget’s

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33
Q

DM screening

A

USPSTF: pts with BP over 135/80
ADA: all patients over 45

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34
Q

ABG inPE

A

High Aa,decreased PaCO2

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35
Q

Low testosterone workup

A

measure serum prolactin!pituitary MRI indicated in pt with elevated prolactin, testosterone

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36
Q

fixed splitting of s2

A

atrial spetal defects. also may have midsystolicpulmonary flowmurmur

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37
Q

fall in systemic arterial pressure more than 10mmHg during inspiration

A

pulsus paradoxus, cardiac tamponade

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38
Q

pulsus parvus and tardus

A

decreased amplitudeand delyaed upstroke, associated with aortic stenosis

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39
Q

Metabolic syndrome definition

A 
Waist over 40 in men, 35 in women
fasting glucose 100-110
blood pressure over 130/80
triglycerides over 150
HDL
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40
Q

indications for chest tube in pleural effusion

A

pH

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41
Q

weakness, back pain and dizziness in pt on warfarin

A

think bleeding. retroperitoneal hematoma!

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42
Q

nonspecific symptoms(fatigue, irritability, insomina), myalgias, hypertension, nephropathy, cognitive deficits, and neuropathy

A

lead toxicity. think occupational exposure

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43
Q

chronic renal failure in pt w/history of anagelsic use

A

papillary necrosis or chronic tubulointersistial nephritis

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44
Q

muddy borwn casts

A

acute tubular necrosis. ischemic or nephortoxic acute renal failure

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45
Q

hematuria (RBC casts), edema, hypertension, proteinuria

A

glomerulonephritis (nephritic syndrome)

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46
Q

chronic pylonephritis may cause

A

chronic tubulointerstitial nephritis (like analgesics cause. WBC casts)

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47
Q

HIV esophagitis: white plaques

A

candida, tx fluconazole

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48
Q

HIV esophagitis: large linear ulcers

A

CMV, tx ganciclovir

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49
Q

HIV esophagitis: vesicles and round/ovoid ulcers (“volcano-like”)

A

herpes simplex, tx acyclovir

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50
Q

HIV esophagitis: endoscopy with biopsy indications

A

sore throat w/nonresponse to two weeks of fluconazole for thrush

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51
Q

CT shows pulmnary nodules with halosign, or lesions with an air crescent

A

aspergillus

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52
Q

ucleratedpapule at sight ofinfection, then papules alonglymph flow

A

sprortrichosis

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53
Q

fever, dry cough, wt loss, pleuritic chest pain; erythema multiformeand nodosum, arthalgias

A

coccidiodomycosis (SWUS, central and south america)

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54
Q

joint deformation in SLE

A

SLE arthritis is nondeforming

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55
Q

distal phalangeal resorption, “pencil in cup”

A

psoriatic arthritis, mutilans varient

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56
Q

tx for fibromyalgia

A

regular aerobic exercise, sleep hygiene, duloxetine & TCAs if all else fails
(fibromyalgia pts have pt tenderness on midtrapezius, lateral epicondyle, costochondrial junction, and greater trochanter)

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57
Q

increased dental caries, enlargedsalivary lymph nodes, dry mouth and eyes

A

sjogren’s syndrome, serum antibodies aginst SSA (RO)/SSB (La)

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58
Q

acute pulmnary edema, new S3,peripheral edema and JVD

A

perioperativeMI

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59
Q

arthritic/gout symptoms after eneteric or genitourinary infection

A

reactive arthrits, tx NSAIDs

other signs: mouth ulcers, urethritis, enthesitis

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60
Q

waxy skin, macroglossia, asymptomatic nephrotic syndrome, restrictive cardiomypoathy, peripheral or autonomic neuropathy, bleeding diathesis

A

amyloidosis (can be primary AL or secondary AA to chronic inflammation as in RA, IBD, chronic infection. Can cuase nephoritc syndrome

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61
Q

chronic sterile granulomatous inflammation of meibomian gland (inner eyelid)

A

chalazion

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62
Q

purulent eyelid gland infection

A

hordeolum, usually staph

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63
Q

small external hordeolum, zeis or molls glands

A

stye

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64
Q

purulent arthritis without skin lesions

or triad: tenosynovitis of wrists, ankles, fingers, knees; dermatitis, migratory purulent arthritis

A

disseminated gonnacoccal infection. cultures may be neg, screening for hiv and syphilis recommended.

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65
Q

tx disseminated gonnacoccal infection

A

IV ceftriazone for 7-14 days, switch to po cefixime when clinically improved, empire azithromycin once or seven days of doxy for chlamydia

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66
Q

toxic shock presentation

A

diffuse rash, fever and HYPOtension

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67
Q

tx severe symptomatic hypercalcemia

A

vigorous IV normal saline (Ca over 12)
hemodialysis with calcium free dialysate if unresponsive.
long term tx is bisphosphonates
avoid loops except in heartfailure

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68
Q

hypercalcemia symptoms

A

salt wasting, volume depletion, dry membranes, high BUN/Cr ratio

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69
Q

arrhythmia in digoxin toxicity

A

atrial tach with AV block

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70
Q

tx chalazion

A

incision and cutterage ( v. hot compress for stye, plus antibiotic ointment if needed)

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71
Q

associated with hyperpigmentation

A

primary adrenal insufficiency, usually autoimmune. hyperkalemia, hyponatremia, hypotension

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72
Q

low cortisol, high ACTH, low aldo

A

primary adrenal insufficiency, autoimmune

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73
Q

low corticol, low ACTH, normal aldo

A

secondary adrenal insufficiency. possible hyponatremia, but no severe symptoms. usually from taking glucocorticoids, but can be lymphocitc invasion of pitiatuary or sheehans syndrome (pituiatry infarct) in paptpartum F

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74
Q

p waves unrelated to QRS, dx and tx

A

complete heart block, cardiac pacing

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75
Q

abscence of measurable erythropoetin in urine

A

polycythemia vera

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76
Q

increased bone marrow iron

A

hemachromatosis, anemia of chronic diseae, sideroblastic anemia

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77
Q

auer rods

A

acute promyelocytic leukemia

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78
Q

difference between AML and CML

A

fever is uncommon in AML and suggests infection, splenomegaly is rare, and peripheral smear shows myleoblasts

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79
Q

tartrate restitant acid phophatase

A

hairy cell

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80
Q

low leukocyte alkaline phosphate activity

A

chronic myelogenous leukemia (phil. chrom. BCR-ABL1 inhibits tk phos)

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81
Q

myeloblasts

A

AML

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82
Q

most common US leukemia

A

CLL

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83
Q

blast cells

A

lymphoblastic leukemia

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84
Q

reed sternberg cells

A

on biopsy in Hodgkins

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85
Q

leukocytosis, basophilia, splenomegaly

A

CML

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86
Q

pruritic rash on wrists and hands

A

scabies

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87
Q

scabies tx

A

permethrin 12%, oral ivermectin

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88
Q

lyme tx

A

orl doxycycline, IV ceftriazone if disseminate, severe, amoxicillin in pregnant or kids under eight

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89
Q

doxycycline in kids

A

discolors teeth, skeletal malformation

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90
Q

dx ankylosing spondylitis

A

xray showing fused sacroiliac joints or bamboo spine

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91
Q

prussian blue

A

when positive indicates hemolysis (presence of hemosiderin) in urine

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92
Q

dark urine after meds (antibiotics, antimalarials, nitrofuratoin) or infection

A

think G6P deficiency, oxidative stress. heinz bodies

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93
Q

hemolysis caused by alphahethyldopa or pencillin

A

autoimmune 2/2 igG binding to RBCs, Coombs +

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94
Q

epidural hematoma cause

A

middle meningeal artery (lentiform)

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95
Q

subarachnoid hemorrhage cause

A

ruptured aneurysm, sometimes trauma

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96
Q

subdural hematoma cause

A

torn bridging veins

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97
Q

Post-transplant patient w/pneumonia and colitis

A

CMV

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98
Q

IgG autoantibodies against platelet membrane glycoproteins

A

ITP: antecedent viral infection, petechiae and ecchymosis, mucocutaneous bleeding. tx systemic glucocorticoids

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99
Q

mild thrombocytopenia, giant platelets, disproportionate bleeding

A

Bernard-Soulier, AR absence of platelet glyocprotein Ib-IX-V

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100
Q

common acquired causes of aplastic anemia

A

parvovirus, EBV, drugs, chemo, radiation

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101
Q

platelets remain over 30,000; no clinical bleeding

A

hypersplenism

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102
Q

thrombocytopenia, microangiopathic hemolytic anemia, low clotting factors, long PT

A

DIC

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103
Q

recurrent chalazion tx

A

histology for sagacious carcinoma, basal cell carcinoma. Then steroid injection and/or incision and cuttrage

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104
Q

parenchymal atrophy due to calyceal dilation

A

obstructive uropathy

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105
Q

pathologic hallmark of diabetic nephropathy

A

nodular glomerulosclerosis, though diffuse is more common (Kimmelstiel-Wilson nodules, basement membrane changes

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106
Q

shoulder: decrease in passive or active motion, more stiffness than pain

A

adhesive capsulitis

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107
Q

shoulder: pain with abduction, external rotation, subacromial tenderness, normal range of motion

A

rotator cuff tendinopathy (tear in pts over 40)

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108
Q

anterior shoulder pain, with lifting, carrying, reaching overhead; weakness uncommon

A

biceps tendinopathy/rupture

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109
Q

uncommon trauma-induced gradually onset of deep/anterior shoulder pain. decreased active and passive abduction, external rotation

A

glenohumeral osteoarthrits

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110
Q

most important prognostic indicator in breast cancer

A

TNM stage (tumor burden)

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111
Q

prog in breast cancer, most to least

A

TNM, ER+ and PR+ (good), Her-2neu (bad), poor differentiation (bad)

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112
Q

most common neuro symptom in Lyme (borrelia burgdorferi)

A

facial nerve palsy

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113
Q

triad of ipsilateral facial pain, ear pain, and vesicles in auditory canal

A

Ramsay Hunt syndrome (herpse zoster oticus)

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114
Q

most common cause of idiopathic facial nerve palsy

A

herpes simplex and varicella zoster reactivation

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115
Q

graft v host pathogenesis

A

activation of donor T lymphocytes (affects skin, intestine, liver)

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116
Q

expansive soap-bubble lytic area on x-ray

A

giant cell tumor: benign and locally aggressive bone tumor of young adults, often on distal femur or proximal tibia near knee

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117
Q

pain at night, unrelated to activity but responsive to NSAIDs, cortical lesions with central lucency on xray

A

osteiod osteoma

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118
Q

osteoclast resorbtion of bone leads to fibrous replacement, brown tumors, salt and pepper on imaging

A

osteolitis fibrosa cystica (Von Recklinghausen dz of bone)

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119
Q

pain with flexing long finger while patient extends fingers and wrist

A

radial tunnel syndrome, may accompany lateral epicondylitis

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120
Q

anterior MI vessel and leads

A

LAD, V1-6

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121
Q

inferior MI vessel and leads

A

RCA or LCX. ST elevation in II, III, aVF

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122
Q

posterior MI vessel and leads

A

LCX or RCA, ST depression in V1-3, elevation in 1 and aVL (LCX), depression in 1 and aVL (RCA)

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123
Q

lateral MI vessel and leads

A

LCX, diagonal; ST elevation in Leads I, aVL, V5, V6; ST depression in II, III, and aVF

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124
Q

right ventricular MI vessel and leads (occurs in 1/2 of inferior MI)

A

RCA, ST elevation in leads V4-V6

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125
Q

leading cause of B12 deficiency

A

pernicious anemia! anti-intrinsic factor antibodies. associated with 2x risk of gastric cancer

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126
Q

microcytic anemia, elevated RBCs, hypochromia on smear with target cells

A

beta thalassemia

127
Q

macro-ovalocytes, megoblasts and hypersegmented neutrophils on smear

A

cobalamin (B12) deficiency

128
Q

treat iron overload in transfusion-dependent thalassemia or sickle cell

A

deferoxamine

129
Q

tx anemia of chronic disease, CKD, transient bone marrow failure

A

erythropoetin

130
Q

folic acid deficiency anemia

A

megaloblastic

131
Q

increases hemoglobin f levels

A

hydroxyurea (sickle cell)

132
Q

tx autoimmune hemolytic anemia

A

prednisone

133
Q

tx symptomatic hereditary spherocytosis

A

splenectomy (also used in autoimmune hemolytic anemia, beta-thalassemia and hemoglobin H dz)

134
Q

tx beta-thalessemia

A

no tx required

135
Q

BUN/Cr in dehydration

A

greater than 20. give crystalloid solutions (normal saline. colloid solutions are used in burns, hypoproteinemia)

136
Q

severe polyarthralgias, HA, myalgia, fever, rash, recent travel to tropical area

A

chikungunya fever (from aides mosquito). tx supportive

137
Q

Direct Coombs +

A

Autoantibodies are on the surface of RBCs (autoimmune hemolysis)

138
Q

Indirect Coombs

A

Screens for autoantibodies to RBCs in the serum. Used in cross matching, prevention newborn hemolytic disease

139
Q

pyroxidine

A

tx sideroblastic anemia (isoniazid!). normo/hypochromic (is B6: also in EtOH, drug malnutrition)

140
Q

acid-fast oocytes in stool of HIV pt

A

cryptosporidium (CD under 180)

141
Q

spores in HIV pt stool

A

microsporidia

142
Q

abx cause this type of hearing loss

A

neurosensory

143
Q

hyperthyroid with low I uptake

A

thyroiditis, stroma ovari (rare, nonpalpable thyroid)

144
Q

double duct sign

A

biliary obstruction in pancreatic cancer

145
Q

vitiligo associated dz

A

autoimmune, including perncious anemia

146
Q

risk factors for constrictive pericarditis

A

idiopathic, prior surgery(CABG or valve), TB, malignancy, anemia

147
Q

constrictive pericarditis v cardiac amyloid

A

amyloid has LVH, periorbital purpura, heavy proteinuria and hepatomegaly

148
Q

LH and FSH in PCOS

A

LH:FSH ratio increased

149
Q

nonclassical congential adrenal hyperplasia

A

young adults w/hyperandrogenism, increased 17-hydroxyprogesterone

150
Q

target BP in DM nephropathy

A

130/80

151
Q

acute adrenal insuffiency symptoms

A

hypotension, ab pain, vomiting, diarrhea, wt loss, weakness, orthostasis

152
Q

tx acute adrenal insufficiency

A

dexamethasone, fluids

153
Q

thyroid storm symptoms

A

tachycardia, arrhythmia, HTN, mental status change and lid lag

154
Q

anti-topoisomerase I

A

systemic sclerosis

155
Q

extrapulmonary small cell lung cancer

A

endocrine (SIADH, hyperCa, cushings), heme (trouseaus’. DVTs), neuro (lambert-eaton, neuropathy), MSK (clubbing, dermo/polymyositis)

156
Q

mobitz I cause and tx

A

AV block (avoid digoxin, beta-blockers, or calcium channel blockers.)

157
Q

aminosalicylates

A

methalazine, sulfasalzine. anti-inflammatory, tx UC (IBD), Crohns, RA

158
Q

raised, well-circumscribed itchy plaques, quick to form and resolve

A

urticaria: infxn, drugs, allergy. idio

159
Q

Dubin Johnson v Rotor

A

Dubin has black pigmented liver

160
Q

spared eye injury

A

hidden antigen response

161
Q

SLE eye

A

circulated immune complexes

162
Q

IgE reagin in eye

A

allergic conjunctivitis

163
Q

beta blockers in CHF

A

bad in decompensation (systolic dysfunction)

164
Q

cord-like veins in smoker

A

trouseau’s sign (hypercoag)! CT abdomen for occult visceral malignancy

165
Q

Burr cells

A

ESRD

166
Q

Howell-Jolly bodies

A

black pellets in RBCs, asplenia, post-splenectomy

167
Q

spur cells (acanthocytes)

A

liver disease

168
Q

target cells

A

beta-thal, liver dz

169
Q

low in sick euthyroid

A

T3! T4 and TSH normal

170
Q

false positive VDR-L

A

antiphospholipid. tx (in preg) w/low molecular weight heparin

171
Q

rubella v measles

A

both start on face, spare palms. measles spreads more slowly, has fever over 104

172
Q

anti-basement membrane, linear Ig (dx, symptoms)

A

Goodpasture’s (young coughing men w/bad kidneys)

173
Q

sinitis, kidney problems, older adults, fever and malaise

A

Wegner’s

174
Q

erythropoetin AE

A

increased CV risks, embolism, stroke

175
Q

tx cardiogenic shock

A

nitrates can cause. give saline for hypotension, then dobutamine if needed (beta-adrenergic agonist like epi)

176
Q

tx anaphylactic shock

A

epinephrine (hyotension, bronchospasm)

177
Q

cardiac index

A

proportional to CO, refelcts left ventricular function

178
Q

PCWP

A

reflects left atrial pressure

179
Q

vit. D OD: symptoms, causes

A

hypercalcemia! ab pain, constipation, polydipsia. supplements, granulomatous dz (sarcoid), lymphoma

180
Q

prolactinoma labs

A

prolactin over 200, low LH, norml TSH

181
Q

prolactinoma symptoms (M, W)

A

men: infertility, impotence, gynocomastia. women: menopausal symptoms

182
Q

asthma, rhinosinitis, nasal polyps

A

aspirin-exascerbated respiratory dz (AERD: pseudo-allergy, also caused by NSAIDs)

183
Q

meniere’s triad

A

vertigo, tinnitus, fullness.

184
Q

treat stones this size w/fluids and pain management

A

under 5mm

185
Q

spider angiomas and gynocomastia

A

estrogen not converted to testosterone in liver dz

186
Q

lung infilterates, diarrhea, confusion and fever (non-IC)

A

think of legionella! tx macrolides (-omycin), quinolones (-floxacin)

187
Q

amoxicillin-clavulanate (augmentin)

A

fight bite, cat scratch, sinusitis, CAP (good for beta-lactamase producing haemophilus, moraxella)

188
Q

cephtriaxone

A

beta-lactam, 3rd gen cephalosporine, active against gram positives, some gram neg (NOT for atypical pneumonias)

189
Q

macrolides (-omycin) cover

A

gram positives, limited negatives (pertussis, h. flu). common substitute for penicillin if allergies

190
Q

quinolones (-floxacin) cover

A

broad-spectrum gram pos and neg

191
Q

uric acid stone tx

A

potassium citrate (alkalizes urine), hydration, low purine diet

192
Q

furosemide and stones

A

increases urine Ca, increase Ca stones

193
Q

HCTZ and stones

A

decreases urine Ca, may decrease Ca stones

194
Q

most stones

A

Ca oxolate. (cysteine in IEM, struvite in proteus UTI)

195
Q

ADAMST13

A

low in familial TTP

196
Q

anti-cardiolipin antibody

A

high in anti-phospholipid syndrome (AV thrombus, miscarriage, microlytic anemia, neurofindings)

197
Q

most common nursing home pneumonia

A

strep pneumo

198
Q

dx rotator cuff tear

A

inject lidocaine to r/o tendonitis, then MRI

199
Q

postmeal ab pain, obstipation, nausea

A

small bowel obstruction

200
Q

prior surgery (cholesistectomy), acid suppression, motility disorders (DM, s.sclerosis), immunosuprression

A

SIBO! diarrhea, malabsorption and wt loss due to bacterial overgrowth

201
Q

BRBPR and neg colonoscopy

A

RBC scintography (tagged RBC scan), less invasive than angiography

202
Q

elevated C-peptide and proinsulin elevation

A

beta cell tumor (high insulin, hypoglycemia)

203
Q

common phototoxic ance treatment

A

tetracyclines (doxy)

204
Q

neuro deficits appear or worsen with folate

A

cobalamin (B12) deficiency

205
Q

INR for DVT, a fib

A

2-3

206
Q

INR for pros. valves

A

2.5-3.5

207
Q

3 Ds of pellagra

A

diarrhea, dermatitis, dementia (and death! naicin deficiency from corn-based diets. Africa, india, china, alcoholics, carcinoid syndrome, Hartnup’s dz)

208
Q

AR amino acid transport disorder, particularly affecting tryptophan

A

Hartnup’s dz, looks like pellagra (niacin def.)

209
Q

smaller confidence interval

A

more precise. increaing sample size decrease CI

210
Q

validity is measured by

A

sensitivity/specificity

211
Q

lactose intolerance tests

A

positive hydrogen breath test, positive stool reducing agents, low stool pH, high stool osmotic gap

212
Q

tx hypertrophic cardiomyopathy

A

BBs (it’s AD)

213
Q

peripheral Ca blocker, arterial dilation

A

amlodipine

214
Q

cardiac acting Ca blocker

A

verapamil, diltiazem, can treat hypertrophic cardiomyopthy

215
Q

pericarditis and renal dysfunction

A

uremic pericarditis! tx dialysis

216
Q

tx idiopathic or viral percarditis

A

indomethacin (NSAID) + colchicine

217
Q

impaired osteoid matrix mineralization

A

osteomalacia. low Ca or Phos! malabsorption, sprue, CLD, CKD

218
Q

defect in collagen I formation

A

osteogenesis imperfecta

219
Q

prophylax for lyme with doxy if

A

deer tick (ixodes scapularis), and 36hr exposure (or engorged), and within 72hr, and lyme rate in area >20%, and doxy not contraindicated

220
Q

meningococcal vaccine age

A

11-12, booster at 16-21

221
Q

no live vaccines in patients on

A

TNF inhibitors (infliximab)

222
Q

tx CKD anemia

A

erythropoetin and Fe

223
Q

abdominal lymphoma and high IgA

A

heavy chain dz

224
Q

hyperviscosity and high IgM

A

Wallenstrom’s macrogloblemia

225
Q

causes of clubbing

A

malignancy, CF, cardiac shunting

226
Q

Fe, ferritin, and tranferrin sat in iron deficiency

A

low, low, low

227
Q

Fe, ferritin, and tranferrin sat in thalassemia

A

high, high, high

228
Q

Fe, ferritin, and tranferrin sat in anemia of chronic dz

A

low, normal, normal

229
Q

mupirocin

A

tx impetigo, and nares MRSA

230
Q

AD ankyrin deficiency

A

hereditary sphereocytosis. high MCHC, high osmotic fragility on acified glycerol lysis test, abnormal eosin-5-maleimide test

231
Q

hereditary sphereocytosis tx

A

folate, transfusions, splenectomy

232
Q

hereditary sphereocytosis complication

A

bilirubin gallstones, aplastic crisis in parvo B19 infection

233
Q

absent CD55

A

paroxysmal noctural hematuria

234
Q

risks in mono

A

splenic rupture, AI hemolytic anemia and thrombocytopenia 2-3 weeks post infection

235
Q

bethanechol

A

cholinergic agent for urinary retention, atonic bladder

236
Q

tamsulosin

A

relaxes distal ureter (helps pass stones)

237
Q

phenazopyridine

A

ureter analgesic, may promote stones

238
Q

secondary amyloid causes

A

inflammatory arthritis, chronic infection, IBD, vasculitis, cancer.

239
Q

BBS in pheochromcytoma

A

cause rapid elevation in heartrate. give with alpha blockers (-zosins, losins)

240
Q

tx mysethnia gravis

A

pyridostigmine

241
Q

leukocytosis w/lymphocytosis and smudge cells

A

CLL

242
Q

ipratropium

A

inhaled nti-muscarinic agent for COPD

243
Q

malaria prophylaxis in chloroquin resistant areas (subsaharan Africa, amazon basin, southern and SE Asia)

A

mefloquine, atovaquone-proguanil, and doxycycline

244
Q

cutaneous and visceral angioa-like blood vessel growths

A

bartonella (immunocompromise)

245
Q

most common cause of folate deficiency anemia (megaloblastic!) in the US

A

alcoholism

246
Q

most frequent case of acute epididymitis

A

e.coli

247
Q

postherpetic neuralgia tx

A

TCAs, acute antivirals (valacyclovir, acyclovir)

248
Q

most common viral encephalitis in immunocompetent adults

A

herpes! simplex, varicella, EBV

249
Q

CSF in viral encephalitis

A

high WBC (lymphocytes), normal glucose, high protein

250
Q

empiric antibiotics: age 2-50

A

vanc plus 3g cephalosporin (N. menigitis, s. pneumo)

251
Q

empiric antibiotics: over 50

A

vanc, ampicillin, 3g cephalosporin (n. meningitis, s. pneumo, listeria)

252
Q

empiric anitbiotics: neurosurgery/shunt

A

vanc plus cefepime (GNRs, s. aureus, co-ag negative staph)

253
Q

empiric antibiotics: immunocompromise

A

van, ampicillin, cefepime (s. pneumo, n. meningitis, listeria, GNRs)

254
Q

empiric antibiotics: penetrating injury to skill

A

van, cefepime (GNRs, s. aureus, co-ag negative staph)

255
Q

alternatives to cefepime

A

ceftazidime, meropenem

256
Q

alternative to ampicillin

A

trimethoprim-sulfamethazole for listeria

257
Q

potassium in addisons

A

high! Na is low! anorexia, fatigue, hyper pigmentation, vitiligo,

258
Q

most gallstones

A

cholesterol or mixed, radiolucent

259
Q

alpha-1-antitrypsin

A

emphysema! panlobular (not central as in smoking). also at risk for liver dz

260
Q

PFTS in emphysema

A

low FEV/FCV, high TLC, low DLCO

261
Q

common tumors that met to bone

A

lung, breast, thyroid, prostate

262
Q

bone pain worse at night, constant, with point tenderness

A

metastatic cancer (more common that compression fracture in men under 65)

263
Q

PPV/NPV in increased prevalence

A

PPV goes up, NPV goes down (PPV is proportional to prevalence)

264
Q

new pneumonia w/in weeks of flu

A

s. aureus

265
Q

SAAG over 1.1

A

cardiac ascites or cirrhosis (increased capillary hydrostatic pressure)

266
Q

SAAG under 1.1

A

malignancy, pancreatitis, nephrotic syndrome, TB (increased capillary permeability)

267
Q

periorbital swelling, hematuria and oliguria 10-20 days post throat or skin infxn

A

post-strp glomerulonephritis

268
Q

drug induced interstitial nephritis presentation

A

fever, rash, arthralgia, hematurtia, WBC casts

269
Q

hematurtia after URI w/normal complement levels

A

IgA nephropathy

270
Q

rare cause of hematuria w/nephritis and and low complement

A

membranoproliferative glomerulonephritis

271
Q

tx V. fib

A

(fibrillary waves w/o QRS. defib, and give epi)

272
Q

cath in PE

A

elevated r. atrial and pulmonary arterial pressures, normal PCWP

273
Q

AE: hypothermia

A

fluphenazine (typical antipsychotic, inhibits shivering)

274
Q

AE: TCAs

A

wt change, dizziness, insomnia

275
Q

numbness, weakness and swelling of arm, weakened radial pulse

A

thoracic outlet syndrome (vascular obstruction)

276
Q

positive Neers

A

pain with passive arm raise over 60 degrees

277
Q

murmurs that get louder w/standing and valsalva

A

decreased venous return! HCM, MVP

278
Q

murmurs that get louder with squatting, handgrip

A

(increased BP and regurg fraction!) AR, MR, VSD

279
Q

tx amebic liver abscess

A

metronidazole, plus luminal agent (paromomycin), do not drain!

280
Q

mixed cryoglobinemia

A

HCV arthralgias, also associated with chronic vasculitic syndrome (palpable purport, lymphadenopathy, nephropathy, neuropathy)

281
Q

tx acute closed angle glaucoma

A

NOT atropine! IV mannitol (diuretic), acetozolomide (carbonic anhydrase inhibitor, prevents aqueous humour formation), pilocarpine (opens schlemm channel, topical), timolol (BB, reduces humor)

282
Q

wegner’s triad and tx

A

systemic vasculitis, upper and lower airway granulomatous inflammation, and glomerulonephritis. cyclophosphamide

283
Q

loculated, abnormally contoured effusion with adjacent pulmonary infiltration

A

empyema in untreated pneumonia

284
Q

velcro crackles

A

idiopathic pulmonary fibrosis

285
Q

hepatic hydrothorax w/o response to dieuretics

A

TIPs

286
Q

retrospective cohort study v. case control

A

both are retrospective. cohort compares disease incidence in risk factor + and - patients. cohort compares risk factor frequency in dz + and - patients

287
Q

hep C treatment criteria

A

over 18, serum HCV RNA, fibrosis on liver biopsy and chronic hepatitis, compensated liver dz, stable labs

288
Q

contraindications to hep C treatment

A

alcohol and drug use, uncontrolled major depression

289
Q

hep c tx

A

peginterferon plus ribavirin, also protease inhibitor (tela/boceprevir) if genotype 1

290
Q

thin discharge, fish odor, no inflammation. pH over 4.5, amine odor w/KOH

A

bacterial vaginosis (gardnerella), tx metronidazole

291
Q

thin yellow-green frothy discharge, inflammation, pH over 4.5

A

trichomoniasis. motile trichomonads, metronidazole, treat sexual partner

292
Q

thick lumpy discharge, inflammation, normal pH (3.8-4.2), pseudohyphae

A

candida vaginitis, tx fluconazole. (risk factors: pregnancy, DM, recent antibiotics)

293
Q

nocturnal headaches and morning vomitting

A

red flags for intracranial pathology

294
Q

diffuse abdomenal pain, tympani, hyperactive bowel sounds

A

consider SBO. most often adhesions (post-surgical)

295
Q

bacterial meningitis in children

A

empiric abx (ceftriaxone and vanc) and LP; CT if coma, focal findings, or hx of neurosurg

296
Q

eval signs of adrenal insufficiency

A

cortisol and ACTH levels, cosyntropin stimulation test

297
Q

low basal cortisol, high ACTH, minimal response to cosyntropin

A

primary adrenal insufficiency (cosyntropin is ACTH analog)

298
Q

low basal cortisol, low ACTH, suboptimal response to cosyntropin

A

secondary or tertiary adrenal insufficiency

299
Q

bone malformation in DM, osteoporosis

A

osteoblast dysfunction

300
Q

hypercalcemia in sarcoid, TB

A

overproduction of calcitriol (active vitamin d)

301
Q

“mosaic pattern” of lamellar bone, high alk phos, femoral bowing

A

osteoclast dysfunction, as in Paget’s

302
Q

severe or dirty wound, immunocompromised, or incomplete/uncertain vaccine hx

A

give TIG and TT booster (no one else gets TIG; booster for dirty would and more than 5y since booster)

303
Q

Northern Africa vaccine recommendations

A

Hep A, Hep B, typhoid, and polio booster

304
Q

yellow fever vaccine when

A

subsaharan africa, equitorial south america

305
Q

when to get meningococcal vaccine for travel

A

some Asia, sub-Saharan Africa, pilgrims making the hajj to Mecca

306
Q

initial treatment for SIADH

A

fluid restriction. demeclocycline rarely necessary

307
Q

tx exercise-induced bronchospasm

A

inhaled albuterol 10min before (if not daily), otherwise corticosteroids or antileukotrienes (-lukasts)

308
Q

rapid bilateral cellulitis of submandibular and sublingual spaces

A

Ludwig angina, causes by tooth infection. asphyxiation is fatal complication

309
Q

complications of ulcerative colitis

A

sclerosing cholangitis, uveitis, erythema nodosum, spondyloarthropathy, colon cancer, toxic megacolon

310
Q

UC colon cancer screening

A

beginning 8-10 years after diagnosis

311
Q

causes Q fever via inhalation from livestock or unpastuerized milk

A

coxiella burnetii

312
Q

restricitive lung dz in ankylosing spondilytis

A

diminished chest wall and spinal mobility

313
Q

anti-intrinsic factor abs

A

pernicious anemia (leads to b12 def., shiny tongue, gastric cancer)

314
Q

characteristics of Graves opthalmopathy

A

decreased convergence, diplopia, exopthalmos, gritty sensation

Primary Care (3 decks)

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