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USMLE3 > Misc > Flashcards

Misc Flashcards

1
Q

1st choice antiHTN meds for pt on lithium:

A

CCB

2nd choice loops

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2
Q

1st line antiHTN meds

A

ACE/ARB, CCB

2nd HCTZ, 3rd hydralazine, clonidine

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3
Q

1st line Tx for nasal polyps?

A

Nasal GCS, if no improvement >surg

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4
Q

27yo M, ASx, proteinuria on multiple UAs. NSIM?

A

16hr urine sample, day/night to r/o orthostatic proteinuria

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5
Q

30yo M w/:

  • pyrexia
  • pharyngitis
  • LAD
  • arthralgia
  • blanching red maculopapular rash
  • mucocutaneous ulcer

Dx?

A

Acute HIV syndrome

1-3wks after infection in 50-70%

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6
Q

3cm Breast CA w/o LN involvement. Tx?

A

lumpectomy w/ adjuvant chemo/rad

if 3+ LNs involved or tumor >1cm, give adjuvant tx

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7
Q

45yo M w/ blisters, acantholysis on Tzank. Dx?

A

pemphigus vulgaris

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8
Q

80yo CRC w/ mets. Na 114, K 4.5, gluc 80.

uric acid low, BUN 12. W/u & suspected Dx?

A

UNa (high) & UOsm (high)

SIADH

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9
Q

____ is a precursor of thyroid hormones produced by mature thyroid cells & stored in follicles.

A

Thyroglobulin

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10
Q

AChR Ab negative, but MG suspicion is high. NSIM?

A

EMG (repetative nerve stim & tensilon), + if demonstrated fatiguability.

Note: AChR Ab have sen 85%, spec 100%

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11
Q

Acute gout at one site. Tx?

A

IL GCS

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12
Q

Acute hirsutism 30-40yo F. NSIM?

A

US ovaries r/o tumor

if neg, CT adrenals

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13
Q

Acute vs chronic demyelinating polyneuropathy/GBS.

A

Acute: S/p Campy, CMV. Auto-Abs.
Chronic: no pathogen link. Anti-GM1 gangliosde Abs

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14
Q

ADAMTS13 mutation. Dx & Tx?

A

TTP, plasmapheresis

ADAMTS13= metalloproteinase that breaks down vWF

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15
Q

Admin instructions for Ca+ acetate in HD patients w/ hyperPh

A

take with meals

not in AM or empty stomach

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16
Q

ADPKD extrarenal complications (5)

A
  1. MVP (26%)
  2. diverticulosis
  3. HTN
  4. cerebral aneurysms
  5. hepatic cysts
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17
Q

ADPKD: assd abnormalities

  1. cardiac
  2. hepatic
  3. GI
A
  1. MVP
  2. hepatic cysts
  3. diverticulosis
    (also HTN, cerebral aneurysms)
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18
Q

Adrenal adenoma > high aldoserone. Dx?

A

Conns

diastolic HTN, HA, m weakness, polyuria

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19
Q

Adult Stills disease Sx? Tx?

A

Arthritis, rash, fevers, transaminitis, ~LAD, ~pericarditis, v high ferritin. May look like mono.

Tx: mild, LFTs <3x norm- NSAIDS
LFT >3x norm- GCS

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20
Q

AE of exogenous GH (ie athletes)

A

HTN & fluid ret (edema/CTS)

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21
Q

AE: priapism, orthostatic hypoTN, sedation. Which medication?

A

Trazodone

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22
Q

AIDS pt from Mississippi w/ oral ulcers- which systemic fungal d?

A

Histoplasmosis (associated w/ bat droppings/caves, spelunking)

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23
Q

AKI w/ RBC casts. NSIM?

A

Bx

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24
Q

Alcohol w/o AG & + osmolar gap

A

isopropyl (both high w/ others)

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25
Q

Anaplasia definition?

A

cells loose function and structural definition

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26
Q

Anemia assd w/ radiation

A

aplastic

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27
Q

Anemia, thrombocytopenia, AKI, GI sx, arthralgias, purpura. Tx?

A

HSP, supportive

If Dx is unclear, renal bx

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28
Q

Anthrax: Tx?

A

Cipro or Doxy

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29
Q

Anti-GM1 gangliosde Abs assn?

A

Chronic demyelinating polyneuropathy/GBS

not acute

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30
Q

Anti-histone Abs+, dsDNA & complement wnl. Dx?

A

Drug induced lupus

Meds: INH, hydralazine, procainamide, BB, phenothiazines

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31
Q

Anti-malarial that can precipitate hemolytic anemia in G6PD.

A

Primaquine (others less so)

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32
Q

Anti-mitochondrial Abs. Dx?

A

PBC (dx up to 15% in scleroderma)

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33
Q

Anti-smooth m Abs. Dx?

A

AI hepatitis

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34
Q

Anti-topoisomerase. Dx?

A

Scleroderma

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35
Q

antiD Ig 2nd dose in preg: titration should be ____

A

increased based on bleed severity

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36
Q

AntiJo+. Dx?

A

Polymyositis, dermatomyositis

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37
Q

Antiphospholipid syndrome suspected. Best initial test after coags?

A

no correction of prolonged aPTT w/ mixing study

factor deficiencies correct on mixing

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38
Q

Aortic dissection. Which meds to be given STAT before surgical repair?

A

BB, nitroprusside

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39
Q

Arthralgia, eye pain & pathergy+. Dx?

A

Pathergy needed for Becet Dx

exaggerated skin injury sp minor trauma

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40
Q

Assn ribosomal P ab in SLE?

A

SLE cerebritis

  • brain edema
  • psychosis/mania
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41
Q

Associated condition:

  • Armadillo
  • Bats
  • Rats
A

Leprosy
Rabies
Plague

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42
Q

Asthma exacerb: first line

A

albuterol & GCS

later: ipratropium

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43
Q

Asthma: uncontrolled w/ standard Tx. IgE elevated. NSIM?

A

Omalizumab (anti IgE Ab)

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44
Q

Asthmatic in disress w/ normal pCO2 after tx. NSIM?

A

Intubate

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45
Q

Asx 74yo w/ hx carotid endardectomy, CABG 3y ago. Recommended pre-op screen?

A

Nothing

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46
Q

Asx pt is NOT fom Lyme endemic area. Tick attached. Management?

A

Reassurance

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47
Q

Asx pt w/ pre-exciting LBBB. Which pre-op eval do they require?

A

None. (unless new LBBB w/ CP)

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48
Q

Bacillary angiomatosis: Etiology, significance

A

Bartonella henselae, AIDS-defining

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49
Q

Bacterial prostatitis w/ urinary retention, Tx?

A

suprapubic cath/bladder decompression

Cipro or TMP-SMX

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50
Q

Bartters synd looks like ____ overdose

Gitelmans synd looks like ____ overdose

A

Thiazine (works on DT)
Loop (works on ascending limb)
(both hypoK)

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51
Q

BBs and which antiarrhythmic may induce bronchospasm?

A

Adenosine, hence caution in asthmatics

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52
Q

BCx w/ capnocytophaga. How did the pt get infected?

A

Bitten by a doggo

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53
Q 
Beach
Liver D
EtOH
Bullous skin lesion
Food poisoning

Dx?

A

Vibrio vulnificus

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54
Q

Behcet pulm complication

A

pulm artery aneurysm

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55
Q

Behcets: orogenital ulcers, arthralgia, uveitis.

Biggest concern:
Dx test:
Tx:

A

Concern: blindness
Dx test: pathergy test
Tx: colchicine for prevention,
may give GCS for acute ulceration

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56
Q

Best BP med for gout?

A

ARBs (increase uric acid excr)

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57
Q

Best test Addisons dx?

A

Cosyntropin (ACTH) Stim test
0, 30, 60min
if <18-20= adrenal insuff.

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58
Q

Biggest lifestyle modification to lower BP?

A

weight loss/exercise

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59
Q

Bites: cat/dog/human. NSIM?

A 
Tdap (if dirty wound <5yrs, clean <10yrs) 
PLUS augmentin (amovi/clav)
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60
Q

BK virus assn

A

renal transplant rejection

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61
Q

Black widow bite. Tx?

A 
Ca gluconate (venom plummets Ca)
antivenin
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62
Q

Bloody D, 2-4d sp undercooked chicken.
Complic: GBS or post-inflamm arthritis.
Tx?

A

Dx: Campylobacter

Tx: Only use abx if high risk.
Best: Azithromycin (previously cipro but resistence is rising)

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63
Q

Blue pt sp nitrates or anesthetic. Dx & Tx?

A

Methemoglobinemia
Methylene blue

(Disease MOA oxidation: ferrous > Fe3)

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64
Q

Bowel sounds in SBO

A

Initially high pitched tinkling&raquo_space; absent

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65
Q

BP arms > BP legs. Dx?

A

Coarctation

in adults: HTN & rib notching also

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66
Q

Bronchiectasis w/u.

A

First CXR, then CT.

PFT: obstructive

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67
Q

Bupropion inhibits reuptake of __ & __

A

NE & D

AE: HA, tachycardia, low sz threshold, insomnia

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68
Q

Bx: periodic acid schiff & macrophages. Dx?

A

Whipples

Farmer w/ malabs/steatorrhea, D, arthritis, encephalopathy, LAD

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69
Q

c-ANCA:
p-ANCA:
anti-GBM:

A
  1. Wegeners (granulomatosis w/ polyangitis)
  2. ChurgStrauss & microscopic polyangitis
  3. Goodpastures
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70
Q

Calcinosis cutis, reynauds, sclerodactyly. Dx?

A

CREST

Calcinosis Cutis 
Reynauds
Esophageal dysmotility
Sclerodactyly 
Telangiectasias
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71
Q

Calcitonin is a tumomr marker for ___ CA

A

medullary thyroid

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72
Q

Cardiac procedure > fever, livedo reticularis, petechiae, digital ischemia, AKI. Dx?

A

Cholesterol emboli

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73
Q

Catamenial PTX. Path?

A

Pulm endometriosis > cyclic bleed > PTX

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74
Q

Cell-free DNA testing performed at ___wk.

What do you do if it is +?

A

> 10th wk.

Invasive testing: CVS or amniocentesis for direct genotype analysis

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75
Q

CF w/ brown mucous plugs. Work up:

A

r/o ABPA (another assd condition is asthma)

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76
Q

Chagas Tx

A

Benznidazole, nifurtimox

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77
Q

Chagas vector

A

kissing bug bite

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78
Q

Chronic interstitial nephritis & papillary necrosis is often caused by:

A

analgesics (analgesic nephropathy)

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79
Q

Chronic regional pain syndrome: Dx (most accurate)?

A

bone scintigraphy- low metabolic activity > osteopenia

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80
Q

Cluster HA.

Sx, freq, Tx?

A
  • unilat tearing/rhinorrhea & stabbing pain behind eye.
  • 1+ HA daily for 1-2h x few weeks.
  • O2
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81
Q

Colicky abd pain, high pitched tinking sounds, AXR w/o air in rectum. What are the MCC of this condition?

A

Bowel adhesions & incarcerated hernia

SBO

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82
Q

Complication of gadolinium in renal failure?

A

nephrogenic systemic fibrosis

no Tx

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83
Q

Complication of spontaneous abortion

A 
hemorrhage
retained products
septic abortion
uterine perf
uterine adhesions
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84
Q

Complications of cerebral venous sinus thrombosis:

A

seizures
focal neuro deficits
confusion

RF: preg, OCP, inf, CA, trauma
Dx: MRI w/ MRV
Tx: LMWH

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85
Q

Complications of Rh incompatability

A
  • kernicterus 2/2 RBC lysis
  • fetal anemia > CHF
  • extramedullary hematopoesis (HSM, portal HTN, ascites, hydrops fetalis)
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86
Q

Conns suspected. CT/MRI neg for adenoma. NSIM?

A

adrenal vein aldosterone sampling

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87
Q

Constipation > D, pink rash, HSM, fatigue, fever, relative brady. Tx?

A

Cephalosporin or Cipro/FQ (S.typhi)

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88
Q

Copper IUD is the best choice for:

A

young women with light menses

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89
Q

Cough, hemoptysis, SOB, dark urine,
CXR infiltrates
UA 50-100 RBC, RBC cast, ANA-
Bx Linear IgG on BM

Dx?

A

Goodpastures (Anti-GBM d)

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90
Q

CREST suspected. Best initial test? Best confirmatory test?

A

ANA, then anti-centromere

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91
Q

Criteria for chest tube in empyema?

A

pH <7.19

purulent material, WBC+++

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92
Q

Croup Tx?

A

No stridor at rest: GCS + humidified air

Stridor at rest: GCS + racemic EPI

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93
Q

Cryoglobulinemia assn?

A

HCV

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94
Q

Cx: Cigar shaped yeast, rosette clusters, septate hyphae. What was the mode of infection?

A

Gardening (Sporothrix schenckii)

Tx: Itraconazole PO if cutaneous/lymph
if systemic > ampho B

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95
Q

DDx central vs nephrogenic DI

A

ADH/DDAVP will improve central but not nephrogenic type

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96
Q

DDx Polycythemia vera vs 2o polycythemia

A

PV: low EPO
2o: high EPO

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97
Q

DDx thalassemia vs IDA

A

RDW (thalassemia:wnl, IDA: elevated)

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98
Q

Deficiency in NADPH oxidase. ↑ risk of catalase-positive infections (S. aureus, E. coli, Aspergillus, Candida, etc.) Dx?

A

Chronic granulomatous D
(Dx w/ nitroblue tetrazolium)
Granuloma formation as deficiency in NADPH oxiade > lack of ability to make ROS to for NADPH oxidative burst /lyse pathogen)

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99
Q

Denosumab (Prolia, Xgeva). Use?

A

Injectable for osteoporosis SC Q6m

if cannot tolerate bisphosphonates or have poor renal function

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100
Q

Devastating findings on head CT, labs wnl, not on sedatives, vitals wnl. Absent brain stem reflexes, apnea test+. What additional test to confirm brain death?

A

Nothing

*IF not all above were present, ancillary test should be used: EEG, CTA/MRA

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101
Q

DEXA T score -1 to -2.5 deviations from norm=

A

osteopenia

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102
Q

Diarrhea that improves at night/fasting. Type?

A 
Osmotic 
(high osmotic fecal gap >100)
- celiac sprue
- chronic pancreatitis
- lactase deficiency
 -lactulose/laxative abuse
- Whipple's disease
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103
Q

Dicyclomine & hyoscyamine use?

A

Anti-spasmotics for crampy pain

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104
Q

dimethyl fumarate use?

A

MS: decreases sx and progression but NOT disease modifying

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105
Q

Disseminated histoplasmosis/systemic disease. Tx?

A

Amphotericin IV then itraconzaole PO

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106
Q

DKA- in addition to hyperglyc work up, also order the following:

A

EKG, trop, (r/o ACS)
UA (r/o UTI)
CXR (r/o PNA)

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107
Q

DKA: MCC/trigger

A

infection

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108
Q

DM neuropathy: Tx?

A

Best: SNRI (duloxetine), Lyrica, TCA
Also: gabapentin, lamotrigine, carbamaz

Topical lido or capsaicin

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109
Q

DOAC values:

  • PT
  • aPTT
  • INR
A

all increased (Xa inhibitor)

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110
Q

DVT risk in CVA: __%

A

10% (esp w/ hemiparesis)

PPX w/ SC heparin
IPC if already on thrombolytic, DAPT, AC 2/2 bleed risk

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111
Q

Dx of choice:

  1. achalasia
  2. GERD
  3. Barretts
A
  1. manometry
  2. 24pH monitor
  3. EGD
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112
Q

Dx test for gastroparesis? Tx?

A

Nuclear med scinigraphy

Freq small meals, metoclopramide

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113
Q

Dx test for hiatal hernia

A

CT

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114
Q

Dx test of choice for PTX in urgent setting?

A

US: inability to detect lung sliding against pleura

CXR/CT- too much time
CXR must be AP otherwise sen <50%

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115
Q

Dysphagia 10yrs sp heartburn onset. Dx?

A

Schatzki’s ring- unknown mech

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116
Q

Ehlers. MCCOD?

A

Spontaneous arterial rupture.

note also 50% colonic perf risk

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117
Q

Elderly w/ afib, CHF, confusion, decreased appetite, constipation, prox m wasting. Lab w/u?

A

TSH- Apathetic thyrotoxicosis

  • tachcardia masked by BB
  • often no proptosis/lid lag, thyromegaly or tremor
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118
Q

Empiric Tx osteomyelitis?

A

Vanc/ceftiaxone (need MRSA cover)

  • avoid vanc/zocyn per nephrotox
  • taper abx to C/S of bone bx
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119
Q

Erythema nodosum: MCC (4)

A

Post-strep
Sarcoidosis
Coccidiodomycosis
Crohns

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120
Q

Esoph Bx w/ Dx:

  • Owl eyes:
  • Inclusion body:
A

CMV (large ulcers)

HSV (small crops)

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121
Q

Esoph webs & anemia. Which CA is pt at risk for?

A

SCC

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122
Q

Farmer w/ malabs/steatorrhea, D, arthritis, encephalopathy, LAD. Dx?

A

Whipples D (PAS+, macrophages)

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123
Q

Febrile neutropenia in pt on chemo. NSIM?

A

START abx w/ pseudomonas cover
(cefepime, meropenem, imipenem, zocyn)

If still febrile x 3d, add vanc
If still febrile after vanc, add caspofungin

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124
Q

Fertile female w/ reticulonodular infiltrates/honeycombing. Spontaneous PTX w/ chylous pleural effusion. Dx?

A

Lymphangioleiomyomatosis

2/2 abn prolif immature smooth m cells involving alveolar septae/walls

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125
Q

FHx premature CAD:

A

55 M, 65 F

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126
Q

Foot paresthesias > loss of vibration sense/proprioception. Rhomberg+, LE spasticity/weakness. Decreased achilles reflex. NSIM?

A

B12 level, then MMP & homocysteine (both elevated- B12 def)

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127
Q

Foot/wrist drop, asthma/allergic rhinitis, skin nodules, high IgE. Dx?

A

Churg Strauss (also eosinophilia, sinusitis)

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128
Q

For BIPASS, how long do saphinous veins vs intramammary veins last?

A

saphinous: 5yrs
intramammary: 10yrs

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129
Q

Friable grey pseudomembrane in a teen. Dx work-up?

A

SCx
Toxin assay

(diptheria) Tx: erythro or penG

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130
Q

Friable grey pseudomembrane in a teen. MC complications

A

myocarditis, neuritis, renal d

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131
Q

GERD improvement in sp 3 months of PPI. NSIM?

A

GRADUAL TAPER (gastrin levels are very high, quitting cold turkey will spike gastrin levels wth rebound sx)

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132
Q

GERD w/o response to PPI. NSIM?

A

24h pH

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133
Q

Gold standard Dx of Trichomonas vaginalis

A

NAAT

However wet mount (pear shaped, motile) may suffice to make Dx.

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134
Q

Graves has __% remission w/ meds in 1yr

A

50%, if persistent > c/w meds or ablate

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135
Q

Greatest prognostic factor Br CA?

A

LN spread

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136
Q

harsh holosystolic murmur over 3/4th ICS w/ thrill:

A

VSD (small- loud, big-quiet)

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137
Q

HD indications

A

diuretic resistant pulmonary edema

hyperkalemia (refractory to medical therapy)

metabolic acidosis (refractory to medical therapy)

uremic complications (pericarditis, encephalopathy, bleeding)

dialyzable intoxications (eg, lithium, toxic alcohols, and salicylates).

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138
Q

HD, pyrexia. NSIM?

A

BCx and give vanc/gentamycin

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139
Q

Heavy smoker w/ high EPO. Which lab do you order to r/o CO toxicity?

A

carboxyhemoglobin

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140
Q

Heinz Bodies or Bite cells- Dx?

A

G6PD def

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141
Q

Hemotympanum noted after MVA/trauma. Dx?

A

basilar skull fracture

also CSF otorrhea/rhinorrhea, battle sign, racoon eyes

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142
Q

high osmotic fecal gap >100. Etiologies?

A
  • Celiac sprue
  • chronic pancreatitis
  • lactase deficiency
  • lactulose/laxative abuse
  • Whipple’s disease
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143
Q

High renin, high aldo, abd bruit, AKI. Dx?

A

RAS

note renal hypoperfusion increases RAAS

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144
Q

HIT+. Tx?

A

STOP all heparins. Give Fonadaparinux.

note: high clotting AND bleed risk

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145
Q

HIV w/ transaminitis.
CT: mult cystic lesions
Warthin–Starry silver w/ organisms
DDx?

A

Bacillary angiomatosis

2/2 Bartonella henselae

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146
Q

House fire, pH < 7.2, Lactate ≥ 10 mmol/L. In addition to treating CO poisoning w/ 100% O2, you give ___ for possible concomittant ___ toxicity.

A

hydroxocobalamin (B12 precurs), cyanide

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147
Q

How is ebola transmitted?

A 
Bodily fluids (semen, sweat, urine)
NOT airborne
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148
Q

How long after initiating HAART does IRIS occur?

A

weeks

symptomatic Tx +/- short course GCS

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149
Q

How long is a stress test valid for pre-op eval?

A

2 years

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150
Q

HSP Tx

A

supportive

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151
Q

HTN emergency: avoid dropping BP >__% in 24h.

A

20%

Tx: labetalol, nitrates, esmolol, nifedipine

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152
Q

HTN, periorbital edema, 1wk sp skin infection. Dx?

A

PSGN

cross reactivity of anti-strep ab w/ GBM

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153
Q

Hx anorexia/insomnia. Pt presents for MDD, does not want sexual adverse effects. Best choice of antidepressant?

A

Mirtazepine (effects of weight gain and sedation)

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154
Q

Hx working w/ electronics, alloys or dental ceramics. Chronic interstitial pneumonitis in upper lobes. Granulomatosis. Dx?

A

Berylliosis

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155
Q

HyperK & chronic illness= RTA #__

A

4

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156
Q

Hypertrophic Osteoarthropathy.

Etiologies: 1o vs 2o

A 
1o = rare, M>F, PLT fragmenting 
2o = 2/2 bronchiectasis, CF, IBD, infective endocarditis, cyanotic heart d
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157
Q

HypoCa, hyperPh, hyperPTH. Dx & path?

A

PseudohypoPTH

2/2 PTH organ resistence

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158
Q

HypoK, hyperNa, met alk, low renin. M.weakness, HA, polyuria. Dx?

A

Conns. Also elevated diastolic HTN.

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159
Q

HypoNa w/u steps

A
  1. SeOsm (most: hypoOsm, unless pseudoHyopoNa)
  2. Hyper, Eu or Hypovolemic?
  3. UrOsm & UrNa
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160
Q

ICU Na 114, gluc 1750. Tx?

A

Insulin & NS

disregard Na as it is pseudohypoNa

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161
Q

If breast CA sentinel node+, perform:

A

axillary LN dissection

if negative, dont perform

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162
Q

IgA vs PSGN:

  1. complement levels
  2. timing after URTI
A

IgA: complement wnl, soon after/during URTI
PSGN: low complement, 2w post URTI

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163
Q

Indication for carotid endardectomy

A

78-99% stenosis

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164
Q

Indications for cell-free DNA testing & what does it test?

A
  • maternal age >35
  • abn maternal serum test
  • US w/ fetal aneuploidy signs
  • hx preg w/ fetal aneuploidy
  • parental balanced Robertsonian transl.

Tests for T21, T18, T13 & sex chromosome aneuploidies

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165
Q

Indications for modified radical mastectomy

A
  • > 7cm or smaller in small breasts where clear margins cannot be obtained
  • 2+ primary breast tumors

(otherwise lumpectomy w/ RAD)

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166
Q

Indications for oseltamivir after 48h Sx

A

Increased risk:

  • 65+
  • preg > 2wks postpartum
  • chronic d (pulm, renal, cardiac)
  • immunosupp
  • BMI >40
  • natives
  • NH or chronic care facility
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167
Q

Inreaperitoneal organs

A

stomach, ileum/jej, transverse c, sigmoid, liver, gallb, panc, spleen

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168
Q

Ischemic CVA Sx x 4h, NSIM?

A

tPA if no contraindications (<4.5h window)

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169
Q

Isolated 2cm pulm nodule, no prior imaging. NSIM?

A

CT

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170
Q

ITP. Fastest improvement w/ following Tx:

A

IVIg

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171
Q

Kartageners Dx?

A

Sperm mobility test

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172
Q

Known AE of flumazenil

A

seizures

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173
Q

Labs in ABPA

A
  • skin: A. fumigatus +
  • eosinophilia >500
  • IgE >417
  • IgG/IgE exaggerated response to A.fumig

CXR fleeting infiltrates
CT central bronchiectasis

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174
Q

Largest source of potassium in diet?

A

meat

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175
Q

Least AE:
A) mupirocin
B) bactrim
C) neomycin

A

A (use: impetigo!!)

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176
Q

Leptospirosis is transmitted via:

A

contam water/food w/ animal urine

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177
Q

Leucovorin use?

A

(folinic acid) First line for folate supplementation

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178
Q

Levels in Conns:

  • K
  • Na
  • met alk or acidosis?
  • renin
A

hypoK
hyperNa
met alk
low renin (high aldo > feedback inhibition)

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179
Q

Levels in Cushing:

  • renin
  • aldo
A
  • low

- low

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180
Q

Linear deposits IgG & C3 in epidermal BM. Dx?

A

Bullous pemphigoid
(note: no correlation w/ Ab amount and disease severity!)

(note: pemphigus vulgaris is intradermal)

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181
Q

long aPTT and normal PT. Dx?

A

antiphospholipid syndrome

  • Beta2 GLP1 ab
  • anticardiolpin
  • lupus anticoagulant

(best initial test no correction w/ mixing study)

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182
Q

Low cortisol, low aldosterone, hyperK, hypoNa. Fatigue, hyperpigmentation. Tx?

A

lifelong GCS (ie pred 5mg QD)

Dx: Addisons

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183
Q

Low UOsm & UNa. How can you DDx psychogenic polydipsia vs nephrogenic DI?

A

nocturia occurs w/ DI but not psychogenic as pt is not drinking at night

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184
Q

Low/normal vaginal pH w/ vaginitis. Dx?

A

Trichomonas (Candida & BV: high pH)

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185
Q

Lubiprostone use

A

IBS-C or opioid-induced constipation

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186
Q

Lung CA w/ ectopic PTH-rp.

A

SCC

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187
Q

Lung mass w/ gynecomastia/galactorrhea. Which Lung CA?

A

Large cell lung CA (ectopic bhCG)

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188
Q

Lyme Tx age <8 vs >8

A

<8 amox

>8 doxy

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189
Q

Lymphogranuloma venerum. Pathogen?

A

Chlamydia (**painless ulcer)

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190
Q

Malaria PPX

A

Mefloquine or atovaquone
(NOT doxy d/t phototoxicity)

**Mefloquine is contraindicated for psych hx or arrhythmi

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191
Q

Male w/ dysuria, urinary urgency/frequency. Dx test?

A

Urinary NAAT

Tx: Doxy & Azithro

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192
Q

MALT lymphoma. Cause & Tx?

A

Hpylo, Tx PPI/amox/clarithro

If no improvement chemo/rad

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193
Q

Maltese cross, ixodes tick bite. Tx?

A

Babesia. Azithromycin & atovaquone.

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194
Q

Massive trauma inury- IV unsuccessful x 10 mins. NSIM?

A

IO access

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195
Q

MC polyneuropathy in Churg Strauss?

A

foot/wrist drop

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196
Q

MC RF GERD

A

obesity

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197
Q

MC sexual dysfunction in men?

A

premature ejaculation

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198
Q

MC statin AE

A

liver dysfunction

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199
Q

MC thyroid CA?

A

Papillary

2nd MCC: Follicular

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200
Q

MCC Cx negative endocarditis?

A

Bartonella & coxiella

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201
Q

MCC erythema multiforme

A

HSV

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202
Q

MCC lung CA in female & non-smokers?

A

Adenocarcinoma

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203
Q

MCC organ damage in severe congenital anemias?

A

hypertransfusion regimen > iron overload

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204
Q

MCC painful swallowing in HIV

A

Esophageal candidiasis (often w/ oral inf)

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205
Q

MCC sexual dysfunction in men w/ SSRI?

A

retrograde ejaculation

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206
Q

MCCOD Scleroderma?

A

Pulm HTN

then renal

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207
Q

Medication for PAD?

A

Cilostazol

  • improves claudication
  • increases walking distance
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208
Q

Medication to improve cardiac contractility via inhibiting cAMP defred, used in advanced CHF pt w/ shock to be bridged to heart transplant?

A

Milrinone (AE: hypotension, tachycardia, vent arrhythmias, GI upset)

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209
Q

Medication which can mask hypoglycemia in DM?

A

BB

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210
Q

Meds causing Tubulointerstitial nephritis.

A
  • NSAIDs
  • PCN
  • sulpha drugs
  • rifampin
  • HCTZ
  • furosemide
  • phenytoin
  • cimetidine
  • allopurinol
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211
Q

Meds for PAD? (4)

A

Cilostazol, DAPT, statin, metoprolol if CAD
Good glycemic/BP control
Quit smoking dummie

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212
Q

Meds that increase risk of Cdiff: (4)

A

Clindamycin
Cipro FQs
Cephalosporins
PPI

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213
Q

Meds that interfere w/ folate metabolism? (3)

A

MTX, phenytoin, trimethoprim

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214
Q

Mefloquine: contraindications

A

psych hx or arrhythmias

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215
Q

Megaloblastic anemia, D, cheilosis, glossitis. Dx?

A

folate def

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216
Q

MELD parameters

A

Bili
INR
Cr
+/- Na

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217
Q

Meningitis PEP indicated for following:

A
  • household members, immediate contacts
  • involved in CPR/intubation, kissing
  • seated next to >8h (ie flight)

(best agent: rifampin BID x 2 days,
~also cipro or ceft x 1 dose)

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218
Q

Metanephric blastema differentiate into _____

A

kidneys

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219
Q

Mid systolic ejection murmur (due to increased PV flow) & mid diastolic rumble:

A

ASD (also wide fixed splitting of 2nd heart sound)

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220
Q

Mid to late systolic murmur of MR. Softer after admin of amyl nitrate inhalation/Valsalva. Delayed w/ squatting. Dx?

A

MVP

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221
Q

Milrinone use?

A

Medication to improve cardiac contractility via inhibiting cAMP defred, used in shock pt to be bridged to heart transplant

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222
Q

MOA cholelithiasis in setting of spherocytosis

A

Spherocytosis > HA > RBC breakdown > cholelithiasis (& splenomegaly)

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223
Q

MOA diarrhea in scleroderma?

A

progressive colonic fibrosis >inability to absorb free water

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224
Q

MOA EPI

A

Stimulates cAMP

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225
Q

MOA IDA in nephrotic syndrome?

A

loss of carrier proteins

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226
Q

MOA PTX in advanced COPD?

A

bleb rupture

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227
Q

MOA renal failure > hypoCa+

A

decreased vitD production
decreased phos excretion
» Ca deposits in tissues

hence risk of:

  • osteomalacia/osteoporosis
  • osteitis fibrosa cystica (2/2 high PTH)
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228
Q

monoclonal ab against HER2

A

traztuzumab

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229
Q

Mosquito bite, fever, flu-like, severe arthralgias. Dx?

A

Chikungunya

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230
Q 
Most effective Tx GERD: 
A) H2 blocker
B) Diet modification 
C) Weight loss
D) PPI
A

D

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231
Q

Most sensitive response for nephrogenic DI?

A

no response to ADH

Tx:
supplement Mg, Ph, Ca
HCTZ
low protein/Na diet

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232
Q

MS suspicion occurs when:

A

2 attacks of neuro deficits w/ some resolution

OR

2 brain lesions separated by time

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233
Q

MS:

  • initial dx test?
  • most accurate dx test?
A

MRI brain/neck (LP for oligoclonal bands only if MRI is equivocal)

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234
Q

MUDPILES

A 
Methanol
Uremia (RF)
DKA (EtOH acidosis, ketoacidosis)
Paraldehyde
Isoniazid, iron
Lactic acodosis
EtOH 
Salicylates/ASA
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235
Q

Murmur assd w/ pulm HTN

A

TR

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236
Q

Na 112
UOsm 50
UO high
POsm 230

Dx?

A

Psychogenic (serum & urine are wet)

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237
Q

Nephrotic syndrome MOA HLD

A

Increased cholesterol production to make up for loss of oncotic protein

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238
Q

Neuro complication of mycoplasma PNA?

A

GBS (also Campylobacter gastroenteritis)

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239
Q

Neurosyphilis: CSF FTA vs CSF VDRL

A

FTA: v sen, lower spec. (good test to r/o)
VDRL: v spec, ~ sen (good dx test)

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240
Q

New onset HTN & proteinuria or end organ damage. Dx?

A

Preeclampsia

Dx after 20w gest

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241
Q

Normochromic anemia w/ basophillic stippling. Dx & assd neuro deficit?

A

Lead tox.
Sx: abd pain, HA, irrit, fatigue,
wrist/foot drop

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242
Q

NSAIDs cause constriction of afferent or efferent?

A

efferent

they also cause direct toxicity

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243
Q

Nuclear catastrophe occurs. What do you give to protect the thyroid?

A

K+ iodine (competes w/ radioactive isotopes)

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244
Q

Numerous K supplements w/o improvement. Which lab do you order?

A

Mg (hypoMg affects K absorp)

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245
Q

OGTT performed at ___ wks gest

A

26

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246
Q

Oligomenorrhea, acne, hirsutism, clitomegaly. Dx?

A

Non-classical CAH

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247
Q

Opthalmoplegia & ataxia in pregnant woman with hyperemesis. Tx?

A

High dose thiamine (Wernickies from thiamine deficiency)

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248
Q

p wave increased in lead II suggests:

A

RV hypertrophy & ?chronic hypoxia

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249
Q

Palpable purpura, arthralgia, GN, low C4 in pt w/ HCV. Dx?

A

Cryoglobulinemia

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250
Q

PAN suspected. Which Dx test do you order first?

A

Abd CT: reveals microaneurysms of blood vessels in the renal, hepatic, or mesenteric circulations.

If non-Dx, Bx affected region

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251
Q

Pancytopenia w/ blasts++. Dx?

A

Acute leukemia

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252
Q

Pancytopenia, low retic. BMB: hypocellular w/ fat cells. Dx & Tx?

A

Dx: Aplastic anemia, Tx: BMT.

Etiologies: MCC: unknown,
benzene, arsenic, chloramphenicol, carbonic anhydrase inhib, CMV, EBV, parvovirus

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253
Q

Pancytopenia.

BMB: hypercellularity w/ dysplasia of marrow & precursor cells. Dx?

A

Myelodysplastic syndrome

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254
Q

PAP indication in HIV

A

Q6months- Q1year. If 3x wnl, then Q3years?

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255
Q

Papillary necrosis suspected. Dx test?

A

CT: translucent spots on renal parenchyma

Path: vasoconstriction
2/2 SCD, DM, NSAIDs, ASA

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256
Q

Parameters used in Child-Pugh?

A 
Bili 
PT 
Alb 
Ascites
Encephalopathy
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257
Q

PCOS:

  • LH: FSH = __:__
  • TSH (low, wnl, high)
  • DHEA (low, wnl, high)
A
  • LH: FSH = 2-3:1
  • TSH slight elevation
  • DHEA wnl
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258
Q

Peak age for primary pulm HTN

A

20-30

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259
Q

Peaked Ts on EKG. NSIM?

A

Ca gluconate

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260
Q

PEP for meningitis. Agents?

A

Best: rifampin BID x 2 days

~or

  • cipro x 1 dose
  • ceft x 1 dose
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261
Q

PEP HBV vs HBC

A

HBV: Ig & vax (transm risk 10-30%)
HBC: no ppx (transm risk 3-6%)

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262
Q

Periph lungs, digital clubbing, SIADH. Which lung CA?

A

AdenoCA

MCC lung CA in female & non-smokers

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263
Q 
Peripheral neuropathy w/u: 
A1C >DM
B12 > deficiency
ESR > \_\_\_\_
electrophoresis > \_\_\_\_
A

ESR> nerve related vasculitis

Serum immunoelectrophoresis & quant Ig > paraproteinemia

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264
Q

Pioglitazone effect on bones?

A

decreased bone density

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265
Q

Polycythemia. EPO high. Dx?

A

chronic hypoxia or RCC

if EPO was low= true PV

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266
Q

Polycythemia. EPO low. Dx?

A

PV

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267
Q

Post prandial emesis. Cerulide toxin present. Pathogen?

A

B.cereus

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268
Q

PPI AEs:

A
  • increased risk Cdiff, PNA, osteoporosis

- Mg, iron, B12 deficiencies

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269
Q

Pralidoxime is an antidote for:

A

Cholinergic toxicity

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270
Q

Pre-eclampsia PPx for high risk pts?

A

ASA 12wks gest

High risk:

  • hx pre-eclampsia
  • CKD
  • chronic HTN
  • DM
  • mult gest
  • AI

Also: ~nulliparity, maternal age, obesity

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271
Q

Preg w/ HBV needle stick. Had vacccine but HBs Ab not detected. NSIM?

A

Ig & HBV vaccine

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272
Q

Preg w/ hx SCD has hyperemesis gravidum. What is she at risk of developing?

A

Sickle crisis
(hepatic vaso-occlusive crisis 2/2 hypovol)

RUQ pain, anemia, jaundice

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273
Q

Preg woman w/ HA worse w/ coughing/sneesing. ICP is high. Undergoes sz in ER. Dx?

A

r/o cerebral venous thrombosis w/ MRI & MRV.

RF: preg, OCP, CA, inf, trauma
Tx: LMWH

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274
Q

Primary Tx Br CA

A

Breast-conserving lumpectomy w/ subsequent RAD (same results as radical mastectomy).

Modified radical mastectomy if:

  • > 7cm or smaller in small breasts where clear margins cannot be obtained
  • 2+ primary breast tumors
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275
Q

Prolactinemia <150. Etiologies

A
  • Chlorpromazine, Promethazine (low D)
  • Metoclopramide (low D)
  • SSRI / MAO /TCA

If >150, r/o prolactinoma

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276
Q

Pseudoappendicitis sp spoiled meat. Dx?

A

Yersinia entercolitis

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277
Q

Pseudoparkinsonism develops days>wks after starting which meds?

A 
(2/2 D block)
1st gen antypsych
lithium 
valproate
metoclopramide
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278
Q

Psych pt w/ involuntary movements of tongue/mouth worsened by anticholinergics. Tx?

A

benzos, botox (tardative dyskinesia)

MOA: D block (1st gen 25%, 2nd gen 5%)

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279
Q

Psych, urinary incont, leg weakness. Which artery is affected?

A

anterior cerebral a

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280
Q

Pt diagnosed w/ seizure disorder, Tx started. 1-3wks later: pyrexia, leukocytosis, diffuse purpuric eruprion, LAD, hepatitis. Dx?

A

Dx: Phenytoin hypersensitivity syndrome
Tx: switch phenytoin to valproate, give GCS.

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281
Q

Pt from central america w/ ventricular apical aneurysm. Dx?

A

Chagas

Also:

  • biventricular HF R>L w/ cardiomegaly
  • mural thrombus w/ embolic complications
  • fibrosis > conduction abn
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282
Q

Pt has anti-histone abs. Which drugs do you ask if she is taking?

A

Hydralazine, procainamide, isoniazid

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283
Q

Pt in burning building. CarboxyHb 32%. You give 100% O2 via NRB. NSIM?

A

ABG, EKG, trop (r/o isch from lack of perfusion)

Carbon monoxide poisoning. Dont give bicarb as it is metabolized to more CO2.

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284
Q

Pt on antidepressant c/o insomnia. Which medication do you prescribe?

A

Trazodone (great adjunct to MDD tx if insomnia 2/2 MDD)

AE: priapism, orthostatic hypoTN, sedation

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285
Q

Pt on HD w/ pruritus & increased bleeds. Possible mech?

A

Uremia prevents PLT degran > increased bleed

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286
Q

Pt on PCP w/ agression. Tx?

A

Benzo

2nd line: antipsychotic

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287
Q

Pt sp splenectomy gets bitten by a dog and develops hypotension. Pathogen?

A

Capnocytophaga

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288
Q

Pt w/ DM or PCOS is taking metformin. Becomes pregnant. What do you advise in terms of medication?

A

Continue metformin- improves outcomes

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289
Q

Pulm arterial HTN= Pulm a pressure > ___

A

25mmHg

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290
Q

Pulm HTN path

A
  1. injury to vasc endothelium
  2. medial hypertrophy & intraluminal prolif
    » narrowed lumen
  3. local procoag state w/in endothelium
    » thrombosis
  4. decreased pulm arterial flow
  5. R heart hypertrophy & TR
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291
Q

Pulm lesion:

  • popcorn appearance. Dx?
  • onion skinning. Dx?
A

popcorn- hamartoma

onion- granuloma

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292
Q

Pyrexia, abd cramps, bloody/mucous D w/ tenesmus. Assd w/ ~reactive arthritis. Dx?

A

Shigella sonnei

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293
Q

Radionuclear iodine uptake DDx: Low/high?

  • Thyroiditis
  • Graves
  • Toxic/multinodular goiter
  • Factitious hyperthyroidism
A

low
high
high
low

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294
Q

RAS: Dx of choice?

A

CT angio

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295
Q

Recommend ____ in patients w/ FHx to prevent Alzhemers.

A

Vit E 400 units/day

exercise DOES NOT prevent Alz

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296
Q

Recurrent asthma exac.
Fever/lethargy
Productive cough w/ brown mucous plugs
Fleeting infiltrates on CXR

Dx?

A

ABPA

Also

  • skin: A. fumigatus +
  • eosinophilia >500
  • IgE >417
  • IgG/IgE exaggerated response to A.fumig
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297
Q

Renal Bx: IgG along GBM
Pulm: hemosiderin laden macrophages

Dx?

A

Goodpastures (antiGBM d)

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298
Q

Renal failure mechanism of hyperPTH

A

decreased vitD production
>decreased GI Ca/Ph absorp
» increased PTH to improve Ca level

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299
Q

Renal injury 2/2 aminoglycosides/amox?

A

AIN
Intrinsic renal damage
UA: high UNa, RBC, prot, Eos

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300
Q

Retroperitoneal Organs

A 
Supraadrenals
Aorta/IVC
Duodenum (2nd/3rd part)
Pancreas (except tail) 
Ureters
Colon (asc/desc) 
Kidneys
Esoph
Rectum
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301
Q

Reversal meds:

  • prothrombin complex concentration
  • protamine sulfate
  • idarusizimab
  • andexanet
A
  • warfarin
  • heprain
  • dabigatran
  • DOAC
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302
Q

RF for hyperemesis gravidum

A

multigestation
hx motion sickness
hx migraines

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303
Q

RF for spontaneous abortion

A
  • advanced maternal age
  • hx spontaneous abortion
  • PSA
  • BMI extremes
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304
Q

Rh incompatability > HSM, portal HTN, ascites, hydrops fetalis. MOA?

A

extramedullary hematopoesis (2/2 RBC lysis)

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305
Q

Rh incompatability: Mother __, infant ___

A
  • , +

mothers abs > fetal RBC lysis >kernicterus

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306
Q

Rheum Fever: Major criteria?

A 
Joint pain (polyarth)
O Carditis 
Nodules (SC)
Erythema marginatum 
Syndactam chorea

Minor: Hx RF, arthralgia, fever, ^ESR, ^WBC, prolonged PR

**Dx requires 2 major OR 2 minor w/ 1 major

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307
Q

Risk of supplementing SSRI w/ StJohns Wort?

A

5HT Synd

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308
Q

Risks of St.Johns Wort

A
  • inconsistent studies ?mild efficacy in MDD
  • 5HT Synd w/ concurrent SSRI
  • DRUG INTERACTIONS
    • OCP
    • HAART
    • immunosupp
    • nacotics
    • antifungals
    • anticoag
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309
Q

Rose gardener lesion > lymph spread. Tx?

A 
Itraconazole PO (?or K-iodide)
Ampho B IV if disseminated

Cx: Cigar shaped yeast, rosette clusters, septate hyphae

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310
Q

RPR & FTA positive. HA & blurry vision. NSIM?

A

LP, r/o neurosyphilis

dont just admin Tx for syphilis as it differes from that of neurosyphilis

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311
Q

RTA assd w/ amphotericin?

A

Distal RTA 1 (hypokalemic)

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312
Q

Rusty nail puncture. NSIM if:

  1. Tetanus booster >5yrs ago
  2. Tetanus booster <5yrs ago
A
  1. tetanus booster

2. no management

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313
Q

Salicylate tox. Medical management?

A

IV bicarb (urinary alkalosis), +/- HD

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314
Q

Salmonella typhi gastroenteritis. Tx?

A

Supportive

Assd w/ reptiles, birds, eggs.
N/V/D (non-bloody, profuse)

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315
Q

SBO or paralytic ileus?
A) diffuse continuous abd pain
B) BS always absent
C) AXR no air in rectum

A

A) paralytic ileus
B) paralytic ileus
C) SBO

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316
Q

SCD passing necrotic material in urine. Renal path?

A

papillary necrosis

CT: translucent spots on renal parenchyma

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317
Q

Schizophrenic w/ limb rigidity, shuffling gait, bradykinesia, postular instability, unhabituated glabellar reflex. Dx?

A

Pseudoparkinsonism (2/2 D block)

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318
Q

Screening recs AAA?

A

65-75yo w/ any smoking hx

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319
Q

Several hours after uncooked meat > D/V/cramps, resolves in 24h. Dx?

A

Clostridium perfringens intoxication

C. perfringens infection: gas gangrene

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320
Q

SIADH: high or low?

  • SOsm
  • SNa
  • UOsm
  • UNa
A

low
low
high
high

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321
Q

SIADH: MOA

A

increased ADH
> increased H2O absorp in collecting ducts
» diluted serum & concentrated urine

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322
Q

Signs of basilar skull fracture

A

Racoon eyes
Battle sign
CSF rhinorrhea/otorrhea
hemotympanum

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323
Q

Silicosis requires periodic screen of ___

A

TB 2/2 increased risk

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324
Q

Sjogrens: assd CA?

A

lymphoma

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325
Q

Sjogrens: high suspicion but labs (ANA, ro, la) not convincing. How do you confirm the dx?

A

salivary gland bx

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326
Q

SLE: Which is more specific antiSmith or dsDNA?

A

antiSmith

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327
Q

SNRI for MDD & GAD?

A

Venlafaxine

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328
Q

SOB 30 years after sandblasting, glasswork, quartz mining. Dx?

A

Silicosis

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329
Q

Sodium thiosulfate is used for which complication of ERSD?

A

Calciphylaxis

disease mech: increased Ph drives Ca to be deposited in tissues

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330
Q

Spina bifida complications

A
  • motor/sensory dysfunction
  • neurogenic bladder/bowel
  • hydrocephalus
  • scoliosis
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331
Q

Spinal cord compression suspected. NSIM?

A

Emergent high dose GCS

do not wait for MRI!

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332
Q

Spontaneous abortion: preg loss

A

<20wks

chromosomal abn

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333
Q

SSRI given > manic sx. NSIM?

A

STOP SSRI.
Can start lithium or valproate
(if still no improvement > add antipsychotic)

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334
Q

Steps on rusty rake, never vax. Tx?

A

Ig & vax

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335
Q

Stool wnl, gluc breath test +. Dx? (3)

A

Dysmotility (IBS, DM, SBOv)

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336
Q

Strict glycemic control: effect on neuropathy?

A

slows progress (does not reverse it)

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337
Q

Strongest BB for BP?

Strongest antiHTN med for BP?

A

labetalol

minixodil (4th line, v strong)

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338
Q

TBW low
UOsm low
SOsm high
SNa high

Dx?

A

DI

DDx: if ADH/DDAVP given it will improve all parameters above in central but not in nephrogenic

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339
Q

Testicular pain, testes in transverse position. Dx?

A

torsion

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340
Q 
Th1 cells 
> IFNy relese 
>> activate microphages
>>> TNFa
>>>> maintain macrophages 
>>>>> \_\_\_\_\_ formation
A

granuloma

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341
Q 
Thiazide effect on: 
A) calcium
B) magnesium
C) potassium
D) uric acid
E) glycemia
F) lipids
A

BC decreased, rest increased

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342
Q

Three things to give in stupurous pt:

A

naloxone, dextrose, thiamine

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343
Q

Thrombolytic indication for PE?

A

Impending RV failure or CV instability

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344
Q

Thrombolytics used for acute CVA. When to start ASA?

A

24h after tPA admin

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345
Q

Thyroid nodule. NSIM?

A

TSH

  • if low, Tx
  • if high, FNA (r/o CA d/t cold nodule)
  • also if nodule >1.5cm, Bx
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346
Q

TIA. Which anti-PLT regimen & for how long?

A

DAPT x 3 weeks

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347
Q

Toe discoloration sp angiography. Dx & Tx?

A

Dx atheroemboli
Tx IVF

(Bx lipids in capillaries)

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348
Q

Topical for impetigo?

A

Mupirocin

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349
Q

Traztuzumab:

  • cardiotox in __%
  • reverisble or irreversible?
  • cumulative tox w/ dose or not?
A

5% (doxrubicin 25%)
reversible (doxrub is not reversible)
non-cumilative (doxrub is cumulative)

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350
Q

Triad. Dx?

  • Ipsilateral facial paralysis
  • Ear pain
  • Vesicles in auditory canal/auricle, hard palate, ant 2/3 of tongue.
A

Ramsay Hunt Synd

?VZV complication, more severe than Bells.
Tx: antivirals/GCS

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351
Q

Trigeminal neuralgia: dx imaging & recs for imgaing

A

MRI to to r/o neurovascular compression for trigeminal nerve root or brain lesions MS

(note: Hx ask whether VZV infection or rad/other possible trigem injury w/in 6m)

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352
Q

Trigeminal neuralgia: Tx?

A

Carbamazepine

2nd line: lamotrigine, lyrica

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353
Q

Trousseus sign+, Chvostek sign+, perioral paresthesias. Dx?

A

hypoCa (also irrit, cramps, MDD, sz)

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354
Q

Tumor in zona fasciculata:

Tumor in zona glomerulosa:

A

Conns
Cushings

Adrenal Cortex: (salt sugar sex GFR)
Medulla: Stress hormones

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355
Q 
Tumor lysis: Following are high or low?
K 
Ph 
Ca 
urate
A

high
high
low
high

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356
Q

Tx & duration antiphospholipid sx

A

Warfarin INR 2-3, lifelong

May add ASA 81 if additional CVS RF

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357
Q

Tx ABPA

A

itraconazole & GCS

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358
Q

Tx

ABPA

Pulmonary aspergilloma

Invasive aspergillosis

A

ABPA: Oral prednisone if severe
Itraconazole if recurrent

Pulmonary aspergilloma: lobectomy

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359
Q

Tx absence sz

A

ethosuximibe

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360
Q

Tx Bacillary angiomatosis

A

Doxycycline

2/2 bartonella henselae

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361
Q

Tx central DI

A

vasopressin/ADH (DDAVP)

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362
Q

Tx cerebral venous thrombosis

A

LMWH (does not increase risk of IC hemorrhage, however prevents clot propagation)

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363
Q

Tx CMV

A

Ganciclovir

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364
Q

Tx Conns based on path

A

if 2/2 adenoma: surgical

if 2/2 hyperplasia: spironolactone

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365
Q

Tx diptheria

A

erythromycin or pen G

diptheria antitoxin if severe

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366
Q

Tx Dressler Syndrome

A

NSAIDs (ie increase ASA)

Complications

  • constrictive pericarditis
  • pericardial effusion > tamponade
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367
Q

Tx dystonic rxn

A

Benadryl or benztropine

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368
Q

Tx for mild vs severe malaria:

A

mild: atovaquone, mefloquine
severe: ART drugs (artemether, artesunate)

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369
Q

Tx functional hypothalamic amenorrhea

A

(athlete triad)

Ca/vitD, caloric supplement, estrogen

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370
Q

Tx glaucoma

A
  1. Topical BB (decrease humor production)

2. Topical prostaglandin

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371
Q

Tx HIV nephropathy

A

HAART

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372
Q

Tx immune reconstitution syndrome

A

Usually supportive- NSAIDs, +/- short course GCS

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373
Q

Tx insomnia in elderly

A

1st line- aways CBT

Then lowest dose of z drugs etc

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374
Q

Tx Jarisch Herxheimer rxn

A

Nothing, resolves in 48h

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375
Q

Tx juvenile myoclonic epilepsy

A

Valproate

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376
Q

Tx Kaposi sarcoma

A

interferon-a

also used to HBV, HCV

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377
Q

Tx lupus nephritis

A

cyclophosphamide, GCS

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378
Q

Tx MS crisis

A

GCS (if ineffective > plasmaphoresis)

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379
Q

Tx myxedema coma?

A

GCS & T4

80% mortality

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380
Q

Tx NMS

A

dantrolene

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381
Q

Tx of papillary/follicular thyroid CA? tumor marker?

A

surg >rad

thyroglobin

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382
Q

Tx postpartum thyroiditis

A

propanolol

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383
Q

Tx Scleroderma renal disease?

A

ACEi

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384
Q

Tx SIADH

A

Mainstay: fluid restriction <800mL/day

For severe Sx/hypoNa:

  • tolvaptan
  • 3% NaCl
  • Loops
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385
Q

Tx SLE pulm fibrosis?

A

cyclophosphamide, mycophenoate, MTX

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386
Q

Tx spina bifida

A

surgical closure +/-:

  • intermittent cath
  • lax/enemas
  • bracing/correct deformities
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387
Q

Tx spontaneous abortion

A
  • expectant
  • misoprostol induction
  • D&C if hemodyn instab
  • Rho D Ig PRN
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388
Q

Tx Syphilis:

  • 1o, 2o
  • latent
  • neuro
  • congenital
A
  • 1o, 2o: ben penG x 1
  • latent: ben penG IM weekly x 3 weeks
  • neuro: acq penG IV Q4h x 10-14d
  • congen: acq penG IV Q8-12h x 10d
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389
Q

Tx TCA OD

A

bicarb

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390
Q

Tx Wegeners/Goodpastures

A

GCS, cyclophosphamide or mycophenoate

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391
Q

UA: microscopic hematuria, ~proteiuria, eosinophilia. Dx?

A

Tubulointerstitial nephritis

  • NSAIDs
  • PCN
  • sulpha drugs
  • rifampin
  • HCTZ
  • furosemide
  • phenytoin
  • cimetidine
  • allopurinol
392
Q

Unilat tearing/rhinorrhea & stabbing pain behind eye. Tx?

A

O2

393
Q

Unknown immunity to tetanus. Rusty nail puncture. NSIM?

A

IVIg & tetanus booster w/ series

2nd dose after 4-8w, 3rd 6-12 months later

394
Q

Uremia, CP, pyrexia, pericardial friction rub. NSIM?

A

HD

395
Q

Use of Gleason score

A

Prognostic for prostate CA

  • if low and elderly: no surg
  • if high & young: surg
396
Q

V high PSA. US neg. NSIM?

A

Bx 12 sites of prostate

397
Q

Valproic acid causes toxicity to which 2 organs?

A

liver/panc

also NTD in preg

398
Q

VZV most accurate test?

A

PCR

399
Q

Walking milestone should be achieved by:

A

16 months

400
Q

Watery D, abd cramping, flatus, ADEK malabsorp. Dx & Tx?

A

Dx: Giardia
Tx: Metro

401
Q

What are the RFs which modify LDL goals? (5)

A
  1. Smoking
  2. HTN (or on Tx)
  3. low HDL
  4. FHx premature CAD (<55 M, <65 F)
  5. Age (>45 M, >55 F)
402
Q

What is the only indication for warfarin tx for afib?

A

Mitral stenosis

403
Q

What kind of acidosis do RTAs cause?

A

NAGMA

404
Q

When do you stop DOAC before surgery?

A

1-2 days

405
Q

When do you use heparin for acute CVA?

A

never

406
Q

When to use ticlopidine or prasugrel in acute CVA?

A

AVOID ticlopidine: TTP & thrombocytopenia

AVOID prasugrel: higher risk of brain hemorr

407
Q

Which 2 Dx can present w/

LOW UOsm & UNa?

A

psychogenic polydipsia
nephrogenic DI

(DDx nocturia occurs w/ DI but not psychogenic as pt is not drinking at night)

408
Q

Which Ab do you test in pregnant SLE pt to screen for neonatal lupus?

A

Anti-Ro

409
Q

Which agent is used for chemical decortication? (breaking up fibrous tissue around lung)

A

alteplase

410
Q

Which does NOT work via V-gated Na channels?
A) carbamaz
B) phenytoin
C) valproate

A

C (valproate)

411
Q 
Which drug DECREASES lithium?
A) ACE/ARB
B) osm diuretic 
C) thiazides
D) NSAID
E) metronidazole
F) tetracyclines
A

B (ie mannitol)

all others INCREASE lithium

412
Q

Which goes first w/ presbyaccusis- high or low pitch?

A

high

413
Q

Which hormone is elevated in female w/ adrenal tumor and virilizing sx?

A

DHEA

414
Q 
Which is NOT a cause of paralytic ileus?
A: bowel adhesions
B: recent surg
C: atherosclerosis
D: abd inf
E: opioids
F: anti-cholinergics
G: anti-parkinsons meds
A

A: bowel adhesions (cause SBO!)

415
Q 
Which is not first line for DM neuropathty?
A) duloxetine
B) Lyrica
C) TCA
D) valproate 
E) gabapentin
F) lamotrigine
G carbamaz
A

D (note: duloxetine & lyrica are best)

416
Q

Which Lung CA is assd w/ both ectopic ADH & ACTH?

A

Small cell (> Cushings & SIADH)

417
Q

Which murmur is:

  • improved w/ increased venous return
  • non-ejection click, systolic
A

MVP

418
Q

Which parameters do you use to monitor SLE flare?

A

high dsDNA & low complement

419
Q

Which tumors are associated w/ increased proagulant release?

A

mucin-producing tumors (CRC/panc)

420
Q

Why does RPR suck for syphilis Dx?

A

takes many months to be +.

1/4 of syphiis pts are RPR neg

421
Q

Why is bicarb relatively contraindicated CO poisoning despite ongoing acidosis?

A

it is metabolized to more CO2 (CO and CO2 compete for clearance, therefore elimination of both is slowed).

422
Q

Why is G6PD def more prevelent in men?

A

XL rec

423
Q

Why PPI is taken in AM, pre-prandial?

A

GH increases proton pumps, highest levels in AM

424
Q

Why should you avoid D5W in hypokalemia?

A

D5W increases insulin which further decreases K

425
Q

Wide fixed splitting of 2nd heart sound:

A

ASD

426
Q

WPW on EKG. NSIM?

A

Electrophysiology study for possible ablation

427
Q

You need to r/o OM. First test?

A

XR
if +: bone bx
if -: MRI, if + perform bone Bx
(if you cant perform MRI > bone scan)

428
Q

You suspect low testosterone. Which labs do you order?

A

Free T in AM

the PRL, LH/TSH

429
Q

Young man wakes up w/ back pain. No trauma. Dx?

A

r/o ankylosing spondylitis

430
Q

Young woman w/ heavy menses and easy bruising. PLT wnl. Dx?

A

r/o vWF def w/ risocetin assay (checks VWF function)

431
Q

Partial SBO suspected. (SBO w/ air in distal colon). Tx?

A

Observation 12-24h. If no improvement, surg consult.

432
Q

MCC septic arthritis peds:
<3 months:
>3 months:

A

<3 months- S.aureus, GBS, GN bacteria

>3 months- S.aureus, GAS

433
Q

Child w/ hip pain, refusal to bear weight, pyrexia, leukocytosis. MRI/US shows effusion. NSIM?

A

drainage/debridement

IV Abx

434
Q

Neonate- irritable, febrile, poor feeding, refusal to be held. Hip flexed, abducted, externally rotated. NSIM?

A

US hip to r/o septic arthritis, if effusion: debride/IV abx

435
Q

RF hip dysplasia

A

Breech

Female

436
Q

Precipitating factors hepatic encephalopathy

A 
Drugs (sedatives, narcotics)
Hypovol (D > excess urea, nitrogen. Excessive diuresis)
HypoK
High nitrogen (GIB)
Inf (PNA, UTI, SBP)
TIPS
437
Q

Tx Hepatic encephalopathy

A

Vol/electrolyte repletion.

Lactulose/rifampin to decrease ammonia

438
Q

Septic arthritis suspected. Labs?

A

WBC, ESR, CRP
BCx
Arthrocentesis (WBC >50,000)

MRI/US effusion

439
Q

Breastfeeding benefits: maternal

A
  • decrease post-partum bleed
  • faster return to pre-partum weight
  • natural contraceptive (child spacing)
  • DECREASE br & ov CA risk
440
Q

Breastfeeding benefits: infant

A
  • improved GI function (low risk necr enterocolitis)
  • decrease infections: (OM, gastroenteritis, resp)
  • decreased risk of pediatric CA
441
Q

Which maternal CA does breastfeeding lower?

A

breast and ovarian CA

442
Q

__% weight loss in 1st week of life.

A

10%, then breast milk production meets demand & birth weight is surpassed in 2nd week

443
Q

How often do new mothers breast feed?

A

Q1-3h

444
Q

Breast milk contains all essential nutrients *except:

A

vitD

445
Q

Infection complications of atopic derm

A

Molluscum contagiosum
Impetigo
Tinea corpis
Eczema herpeticum HSV1

446
Q

Complications of eczema herpeticum

A

hepatitis
encephalitis
keratitis

Tx acyclovir

447
Q

Why is CAGE no longer recommended for EtOH screen?

A

Would not catch moderate/heavy use

448
Q

Best single question to screen for EtOH overuse

A

How many times in the last year have you had 6+ drinks men (4+ women) drinks at one time?

449
Q

AUDIT-C

A

How often
How many in one sitting
How often >4F, >6M

450
Q

Indications to Tx ASx bacteruria

A
  • preg
  • urologic process
  • w/in 3 months renal transplant
451
Q

SAH suspected. CT head inconclusive. NSIM?

A

LP

452
Q

CVA Sx at 12h. CT w/ ischemic CVA. NSIM?

A

CTA head/neck

  • large vessel occlusion +: mech thrombectomy
  • large vessel occlusion -: ASA, statin
453
Q

CVA on CT, 12h sp Sx onset. CTA head/neck showing large vessel occlusion. NSIM?

A

mech thrombectomy
(if it were negative, ASA/statin)

**no mech thrombectomy >24h

454
Q

After __ CVA Sx, pts are never eligible for thrombectomy.

A

24h

455
Q

Amiodarone toxicity

A 
Chronic interstitial pneumonitis, PNA, ARDS
Photosensitivity
Skin discoloration
Bone marrow toxicity 
Thyroid dysfunction 
Abn LFTs

*cumulative dose

Tx: d/c amio, GCS if life-threatening

456
Q

Non-caseating granulomas in the colon. Dx?

A

Crohns. Also:

  • transmural inflammation
  • fissures
  • apthous ulcers
457
Q

GN rod, lactose-fermenting, bacillus w/ thick polysaccharide capsule. Tx?

A

Tx: FQ or 3rd gen ceph

Klebsiella or Ecoli.

458
Q

Eosin methylene blue agar changes color. What does this mean?

A

Lactose fermenter

459
Q

Why should GCS never be used in burns?

A

Delay healing

460
Q

Third degree burn. Tx?

A

Excision of necrotic tissue & splint thickness splint graft

461
Q

MC location of venous ulcers?

A

above medial ankle

462
Q

Warfarin induced skin necrosis

When:
Why:

A

3-5d after starting warfarin

Pro-coag state decreased protein C+S
drug induced microvascular occulusion

463
Q

Pyoderma gangrenosum assd w/:

A

UC.

Neutrophillic dermatosis sp small papule after minor trauma (pathergy)&raquo_space; large necrotic wound

464
Q

Neutrophillic dermatosis sp small papule after minor trauma (pathergy)&raquo_space; large necrotic wound. Assd w/ UC?

A

Pyoderma gangrenosum

465
Q

MC location of arterial ulcers

A

Lateral ankle and digit tips.

also pallor, decreased pulse, atrophy, claudication

466
Q

Atropine may precipitate which acute eye condition?

A

Acute angle closure glaucoma

467
Q

Pathologic inclusions in UMN & LMN. Dx?

A

ALS

468
Q

Demyelination of brain/spinal cord axons. Dx?

A

MS

469
Q

Preg, PLT 70-150 in 2nd/3rd trimester, no bleeds/bruising. No fetal thrombocytopenia.

Dx:
Path:
Tx:

A

Dx: Gestational thrombocytopenia
Path: hemodil & accelerated PLT destruction
Tx: Resolves sp pregnancy . Fetal/materanal bleed risk is NOT elevated.

Monitor w/ CBC, obtain post-partum CBC to ensure resolution

470
Q

Neuraxial analgesia (epidural) contraindications (2)

A

PLT <70
rapidly worsening thrombocytopenia

(risk of epidural hematoma)

471
Q

High risk Sx sp minor head trauma

A 
retrograde amnesia >30 min 
vom 2+ 
seizures
severe HA
Basilar fracture signs
GCS <14
AMS or LOC
neuro deficit
472
Q

High risk patients sp minor head trauma.

A

> 65
coagulopathy
drug/EtOH intox
high risk inj mech (ie ejected from vehicle)

473
Q

Tx anal abscess

A

I&D
abx (if DM, immunosupp, extensive cellulitis, valvular cardiac d)

*larger abscess may need surgery
MC complication: fistula

474
Q

MC complication anal abscess

A

fistula

475
Q

Labs at 24-28w gestation

A

Hgb/HCT
Ab screen if RhD neg
50g 1h GTT

476
Q

Lab at 36-38w gestation

A

GBS

477
Q

Initial visit pre-natal labs

A 
RhD, Ab screen 
Hgb/HCT, MCV
HIV, VDRL/RPR, HBs Ag
Rubella/Varicella ab
PAP
Chlamydia PCR
UrCx
UrPr
478
Q 
Initial previsit prenatal labs, all EXCEPT
RhD, Ab screen 
Hgb/HCT, MCV
50g 1hr GTT
HIV, VDRL/RPR, HBs Ag
Rubella/Varicella ab
PAP
Chlamydia PCR
UrCx
UrPr
A

50g 1hr GTT

479
Q

50g 1hr GTT is positive. NSIM?

A

Confirm w/ 1hr GTT

480
Q

human placental lactogen: role in pregnancy?

A

Induces maternal insulin resistance to increase fetal glucose supply

481
Q

hypocretin 1 deficiency- Dx?

A

narcolepsy

482
Q

REM sleep latency <15 min may suggest:

A

narcolepsy if also recurrent lapses into sleep or multiple naps daily

483
Q

Narcolepsy criteria for Dx

A
  • fragmented sleep
  • REM <15 min of falling asleep
  • hypocretin 1 def
  • hypnagogic hallucinations
  • cataplexy 70%
  • sleeping at inappropriate times
484
Q

1st line Tx narcolepsy

A

modafenil

+ schedule naps during the day w/ good sleep hygiene

485
Q

Tx cataplexy

A

SNRI or SSRI or TCA

Sodium oxybate (Na-GHB) effective but rarely used abuse potential and restrictive regulations

486
Q

Tx absence sz

A

Valproic acid

487
Q

Difficult to control asthma, nasal polyps, chronic sinusitis, rhinitis, palpable purpura. Dx?

A

Churg Strauss (AI vasculitis)

488
Q

Shoulder pain/weakness, ipsilateral ptosis, miosis, anhidrosis, supraclav LAD. Dx?

A

Sup pulm sulcus tumor (Pancoast) w/ Horners Syndrome
Often NON-SmCLC

Horners signifies poor prognosis

489
Q

Sup pulm sulcus tumor (Pancoast) w/ Horners Syndrome. Which type of CA?

A

Non-SmCLC

Horners signifies poor prognosis

490
Q

Shoulder pain/weakness, ipsilateral ptosis, miosis, anhidrosis, supraclav LAD, weight loss. Treatment?

A

GCS, surg, rad

Pancoast tumor likely NON- SmCLC

491
Q

Acute cervicitis etiologies

A

Inf: Chlamydia/Gonorrh

Non-inf: IUD, latex, douching

492
Q

Mucopurulent discharge, post-coital/intermenstrual bleed, friable cervix. Which Dx tests do you order?

A

NAAT
Wet Mount

**Tx empirically: Doxy/Ceftriaxone
(if preg: doxy/azi). Tx sexual partners.
Dont wait for results to Tx

493
Q

Mucopurulent discharge, post-coital/intermenstrual bleed, friable cervix. NSIM?

A

Obtain NAAT, wet mount & Tx empirically: Doxy/Ceftriaxone
(if preg: doxy/azi)
Also Tx sexual partners

494
Q

Tx Chlamydia/Gonorrhea in preg vs non-preg

A

non-preg: Doxy/Ceft

preg: Doxy/Azi

495
Q

Chlam/gonorr suspected. After initiating Tx, how long should they abstain from sex?

A

1 week

496
Q

Tx amiodarone toxicity?

A

GCS if life threatening

Discontinue amio

497
Q

DKA Tx: When to add D5W to NS?

A

When gluc <200.

498
Q

Formula to calculate AG?

A

Na- (Cl + HCO3)

499
Q

Tuberculin skin test +.

No Sx, CXR wnl. Tx?

A 
Latent TB is
- non infectious
- activates in 5-10%
- 6-9m INZ should be offered 
(**highly recommended for immunosuppressed, inmates, HCP)
500
Q

Who should Tx latent TB?

A

immunosuppressed
inmates
HCP

Tx: INZ x 6-9 months

501
Q

Tx Bacterial prostatitis

A

Abx: cipro, TMP, SMX

bladder decompression PRN (ie supbladder cath)

502
Q

Dx test of PTX in emergent setting?

A

US (inability to detect lungs sliding against one another)
Other studies take too much time.
Also CXR sen only 50% if supine

503
Q

CKD pt w/ prolonged bleeding time, otherwise coags wnl (APTT, PT, PLT). Which tx should pt receive prior to surgical procedure?

A

desmopressin (for PLT dysfunction)

MOA: increases release of vWF release from endothelium

504
Q 
Renal dysfunction assd increased bleeding risk. What do you expect in labs: low/wnl/high
A) aPTT
B) PT 
C) bleeding time
D) PLT
A

normal
normal
prolonged
normal

MCC: PLT dysfunction
Tx: desmopressin
(MOA: increases release of vWF release from endothelium)

505
Q

Infant w/ refractory candidal diaper dermatitis and failure to thrive. Which labs do you order?

A

HIV DNA or RNA PCR (nucleic acid test)

(other signs, LAD, HSM, chronic D, poor w gain)

DDX zinc deficiency: also has perioral derm and D

506
Q

Diagnostic test for HIV in infants <18 months

A

HIV DNA or RNA PCR (nucleic acid test)

**serology is unreliable as it may reflect maternally transmitted abs

507
Q

Infant w/ persistent diaper rash, perioral derm and diarrhea. Tx?

A

zinc! (severe deficiency)

508
Q

Strep throat can be diagnosed w/ rapid strep Ag test OR:

A

throat Cx

**rapid strep test is highly spec but not very sensitive hence if negative, always obtain Cx

509
Q
  • *Strep throat Tx
    1) standard
    2) PNC allergic
A

1) PNC or amoxicillin
2) mild: cephalosporin
anaphylaxis: azi or clinda

510
Q

Strep pharyngitis complications? (4)

A
  • peritonsilar abscess
  • anterior cervical LAD
  • post strep GN
  • RF
511
Q

7yo M w/ sore throat, fever, abd pain, HA, no cough/rhinorrhea. Tonsillar erythema/exudates, cervical LAD. Rapid strep test is neg. NSIM?

A

Obtain throat Cx!

**rapid strep test is highly spec but not very sensitive hence if negative, always obtain Cx

512
Q 
Rapid strep test is: 
A) v sen, not spec
B) not sen, v spec
C) not sen or spec
D) v sen, v spec
A

B) not sen, v spec

has high positive predictive value. If neg, obtain Cx

513
Q

Tx acute diverticulitis

A

bowel rest

Abx: ie cipro, metro

514
Q

Elderly w/ LLQ pain, fever, N/V, ileus. tachy, WBC+. Which dx test do you order?

A

CT abd (PO & IV contract)

515
Q

No improvement w/ 2-3 days abx for diverticulitis. NSIM?

A

repeat abd CT w/ PO/IV contrast

r/o abscess, fistula, perf

516
Q

MC complication of diverticulitis?

A

colonic abscess (15-55%) “acute diverticulitis that does not improve w/ 2-3 days of abx”

Tx: percutaneous drainage & IV abx
+/- partial colectomy

517
Q

Tx colonic abscess sp diverticulitis

A

percutaneous drainage & IV abx

+/- partial colectomy

518
Q

____ should be performed in most pt 6-8wks sp complete resolution of diverticulitis

A

colonoscopy to r/o CA

**NOT earlier as it is contraindicated in acute diverticulitis

519
Q 
Hyperthyroid sx 2 months after delivery, non-tender goiter & labs:  
- low TSH
- high T4
- TPO Ab++
- high thyroglobulin 
I123 uptake is LOW.
Dx?
A

postpartum thyroiditis

variant of chronic lymphocytic/Hashimoto thyroiditis

520
Q

Postpartum thyroiditis: high/low?

1) TSH
2) T4
3) TPO
4) thyroglobulin
5) I123 uptake

A 
low
high
high
high 
low

DDx Graves (has HIGH I123 uptake)

521
Q

Why is thyroglobulin elevated in Graves and postpartum thyroiditis?

A

Graves: increased follicle activity

PT: destruction of follicles

522
Q

Preg & thyroid

  • what causes ^TBG
  • what causes ^thyroxine
A
  • increased E > ^TBG
  • bCG > ^ thyroxine release (hCG looks like TSH)

Elevated total T4 but euthyroid during preg

523
Q

HbA & HbS in 60:40 ratio. Dx?

A

SCD carrier

ASx, no anemia

524
Q

Why are button batteries dangerous when ingested?

A

They conduct electricity > ulceration, liquefication necrosis, perforation.

ALWAYS remove if in esoph. Close monitoring if beyond esoph > endoascopic/surg removal if not progressing.

525
Q

DM 2/2 chronic pancreatitis, Tx?

A

metformin if mild
insulin if severe

** avoid DPP4 inhibitors (sitagliptin) or GLP1 receptor agonists (liraglutide etc) per risk of pancreatitis

526
Q

Pancreatogenic DM (ie chronic panc): Why are patients more prone to HYPOGLYCEMIA & why is DKA RARE?

A

Loss of glucagon-producing alpha cells and insulin producing beta cells.

527
Q

HIV, RLL infiltrate. Thoracentesis: lymphocyte predom, no organisms. Elevated adenosine deaminase. How do you confirm the Dx?

A

Pleural Bx (TB effusion)

**note: those w/ HIV cannot mount sufficient mediated defence to create upper lobe cavitations hence > lobar, pleural, disseminated infection

528
Q

What is seen on thoracentesis in an HIV pt w/ TB?

A
  • no organisms, lymphocyte-predominant, exudative effusion (similar to CA, hence check adenosine deaminase for DDx)

NSIM pleural bx

529
Q

HIV pt dx w/ TB. When do you start HAART?

A

1-2wks after starting tx for TB (to avoid IRIS)

530
Q

6yo M w/ RUE HTN, LE claudication & murmur. Dx?

A

Coarctation
(Most commonly sporadic in males, less common: Turners)

Note: milder narrowing in childhood, in neonates: HF ? shock after PDA closure

531
Q

Aortic coarctation murmur?

A

Continuous systolic murmur at LUSB

Also on Exam:

  • brachiofemoral pulse delay
  • UE HTN

CXR: rib notching & figure 3 sign (aortic narrowing)

532
Q

CXR: rib notching & figure 3 sign. Dx?

A

Aortic coarctation

TTE confirms Dx

533
Q

Parasternal heave assd w/:

A

RVH

534
Q

Decline in BP >10mmHg during inspiration. Dx?

A

pulsus paradoxus, cardiac tamponade

535
Q

Resected medullary thyroid CA. At time of surgery calcitonin was 240, now 120. NSIM?

A

CT neck/chest to r/o mes.
If still neg: CT abd, bone scan.

~~I111 octreotide or PET.

536
Q

Why is iodine not useful in detecting mets sp medullary thyroid CA resection?

A

medullary CA involves parafollicular C cells that do not secrete iodine

537
Q

SLE suspected, which is more likely to be positive?

  • dsDNA
  • antiSmith
A

dsDNA (sen 66-95%)

antiSmith sen only 25%

538
Q

Which lab value correlates w/ disease activity or development of lupus nephritis?

A

dsDNA

539
Q

Tx SLE

A

low dose prednisone
hydroxychloroquine

(cyclophosphamide or MTX w/ GCS for more serious sx- lupus nephritis, CNS sx, vasculitis)

540
Q

Immigrant 30yo F dyspnea+++ x 2wks, diastolic murmur on exam. TTE w/ MV 1.5cm. NSIM?

A

pregnancy test
(Dx: severe MS)

Note normally gradual worsening of Sx (SOB > cough, hemoptysis, RHF ie HSM, periph edema) BUT pregnancy may cause RAPID worsening of sx

541
Q

K 7 w/ arrhythmia. Tx?

A

Calcium gluconate

542
Q

Prolonged PR interval, prolonged QRS, disappearance of P waves, Dx?

A

hyperK

543
Q

HyperK w/ EKG showing Prolonged PR interval, prolonged QRS, disappearance of P waves. Tx?

A

First CaGluconate

Then

  • beta agonists
  • glucose & insulin
544
Q

Abnormal sigmoidoscopy. NSIM?

A

Colonoscopy w/ any abnormal finding on sigmoidoscopy

545
Q

Lab work up for suspected lead poisoning?

A

venous lead
CBC
iron/ferritin
retic

546
Q

DDx premature thelarche/adrenarche VS precocious puberty?

A

bone age!

normal bone age: premature thelarche/ adrenarche

advanced bone age:
precocious puberty

547
Q

Precocious puberty in girls

A

F <8

M <9

548
Q

Which nerve injury?

  1. inability to extent knee
  2. problem w/ leg adduction
  3. quad weakness
  4. foot drop
A
  1. femoral
  2. obturator
  3. femoral
  4. peroneal
549
Q

Clinical criteria+ & abn neuro findings. What is needed to fulfil brain death criteria?

A

apnea test (no breathing 8-10min after taking off vent & pH <7.28)

Avoid apnea test in hypercapnea

550
Q

Which toxicity?

Tachypnea, tachycardia, hyperthermia, dizziness, GI Sx (N/V)

A

ASA

  • stimulates resp center in the medulla > resp alk
  • chemoreceptor trigger zone > N/V
  • Cochlear neurotoxicity > tinnitus (early)
  • AMS (cerebral tissue injury/ neuroglycopenia > cerebral edema)
  • lacticemia & hyperthermia *via inhibition of cellular metabolism
  • severe: pulm edema, arrhythmia, death
551
Q

Effects of ASA toxicity (+++)

A
  • stimulates resp center in the medulla > resp alk
  • chemoreceptor trigger zone > N/V
  • Cochlear neurotoxicity > tinnitus (early)
  • AMS (cerebral tissue injury/ neuroglycopenia > cerebral edema)
  • lacticemia & hyperthermia *via inhibition of cellular metabolism
  • severe: pulm edema, arrhythmia, death
552
Q

Which toxicity?

fever, dry mucous membranes, tachycardia, nonreactive mydriasis, erythema, anhydrosis, AMS. Dx?

A

Anticholinergic

(also urinary ret)

Tx: physostigmine

553
Q

Tx ASA intox

A
  • IV bicarb (alkalization)
  • D5W (to avoid neurohypoglycemia)
  • activated charcoal if <2h ingestion
  • HD if pulm edema or fluid overload (limiting bicarb infusion), AMS, RF, cerebral edema, severe acidosis,, v high ASA
554
Q

Indication for HD in Tx of ASA toxicity

A
  • pulm edema or fluid overload (limiting bicarb infusion)
  • AMS
  • RF
  • cerebral edema
  • severe acidosis
  • v high ASA
555
Q

Cholinergic toxicity Tx?

A

atropine

556
Q

Pathogen cat scratch disease?

A

Bartonella hensele

Tx

  • self limiting
  • azithromycin
557
Q

Complications of which disease?

  1. coronary a aneurysm
  2. LN suppuration
A
  1. Kawasaki

2. Cat scratch d

558
Q

10yo F w/ fever x 2wks, unilateral LAD, unilateral conjunctivitis. Papule on arm. Dx & Tx?

A

Cat scratch disease

Tx

  • self limiting
  • azithromycin

Note: LAD regional to bite/scratch. MC: unilat axillary or inguinal hwr if scratch is in the face > cervical LAD w/ possible conjunctivitis (Parinaud syndrome0

559
Q

Acute mania Tx?

A

antipsychotic IM

(lithium & valproate are NOT appropriate for acute mania:

  • PO admin
  • require titration
  • days-wks for effect
560
Q

Avoid lithium in ___ disease and valproate in __ disease

A

Lithium- renal

Valproate- hepatic

561
Q

Range for impaired fasting blood glucose?

A

100-126

562
Q

What is impaired glucose a risk factor for?

A

CAD & DM

gluc 100-126

563
Q

Pt has hx latent TB. How do you screen them?

A

CXR (they have a positive tubberculin skin test and quantiferon for life)

564
Q

Initial Tx cough predom GERD

A

PPI x wks & lifestyle modification

565
Q

Cough, inflamm of nasal mucosa, oropharyngeal cobblestoning. Tx?

A

Tx: Intranasal GCS
Dx: Upper Airway Cough Syndrome

566
Q

Constipation, pelvic pressure, LBP, fecal incont & pelvic mass increasing w/ Valsalva. Tx?

A

Kegals & surgery or pessary

567
Q

Steps in primary amenorrhea w/u

A
  1. pelvic exam/US
  2. Uterus + > FSH
    - high FSH > karyotype
    - low FSH > brain MRI
  3. Uterus - > karyotype & serum T
    - 46 XX & normal female T > abnormal Mullerian development
    - 46 XY & normal male T > AIS
568
Q

Absent uterus, 46 XX & normal female testosterone. Dx?

A

abnormal Mullerian development

569
Q

Breasts+, primary amernorrhea, no pubic/axillary hair. Dx?

A
  • Androgen insensitivity syndrome

- (Cryptorchid testes+, vagina ends in blind pouch, breasts develop 2/2 excess T aromatized to E)

570
Q

Amenorrhea >__ of age is considered abnormal.

A

15+

571
Q

House fire. Dx tests to r/o CO poisoning?

A
  • ABG w/ carboxyhemoglobin level, lactate++
  • Also order EKG w/ cardiac enzymes to r/o MI
  • **note: pulse oximetry is often normal
572
Q

Tx CO poisoning.

A
  • high flow 100% O2

- intubation/hyperbaric oxygen if severe

573
Q

Pulse ox levels w/ CO poisoning.

A
  • wnl (pulse ox cannot differentiate oxyHgb vs carboxyHgb)
574
Q

Which populations should be tested for HCV?

A
  • RF (IVDU, RBC before 1992, unreg tattoo w/ transaminitis

- high prevalence groups: HIV, HD, incarcerated, born 1945-1965

575
Q

HIV screening indicated for ages: ___-___

A

13-65

576
Q

Associated conditions?

  • Duodenal atresia
  • Pyloric stenosis
  • Meconium ileus
  • Hirschprungs
A

Duodenal atresia:
- Downs

Pyloric stenosis:
- maternal macrolide use in preg

Meconium ileus:
- CF (pathomnemonic)

Hirschprungs:
- Downs

577
Q

Dx tests for CF?

A
  • CFTR mutation (genetic testing)
  • elevated sweat Cl
  • abn nasal potential difference
578
Q

Congenital cataracts, vomiting, poor feeding, lethargy, jaundice, hepatomegaly. Dx?

A
  • galactosemia
579
Q

Sandpaper rash, circumoral pallor, strawberry tongue. Abx choice?

A

Amoxicillin (Dx Scarket Fever)

580
Q

Dx criteria for Kawasaki Disease?

Fever >5d AND 4 of the following:

A
    1. conjunctivitis
    1. mucous memb changes
    1. rash
    1. cervical LAD
    1. extremity edema/eryth
      (If not all are present, order CRP/ESR & re-examine the following day.)
581
Q

Kawasaki Tx

A

IVIg & ASA
(complic: coronary a aneurysms & vent dysfunction)
TTE at Dx, then 2w and 6w sp Tx

582
Q

Kawasaki Labs:

A
  • high: WBC, PLT, ESR, CRP, LFTs

- low: Hgb

583
Q

Kawasaki etiology

A
  • febrile vasculitis of unknown etiology, ??viral assn
584
Q

Intervals for TTE w/ Kawasaki

A

at Dx, then 2w and 6w sp Tx

585
Q

IVIg recently given. Pt is due for a scheduled vaccine. NSIM?

A
  • postpone vaccine by 11 months sp completion IVIg Tx
586
Q

Tx primary vs secondary (central) adrenal insufficiency

A
  • Primary: GCS & mineralocorticoids
  • Secondary (central) GCS
    (note mineralocorticoids regulated by RAAS)
587
Q

Primary adrenal insufficiency etiolgies?

A
  • MCC: AI

- Also infection (TB) or metastatic infiltration

588
Q

34yo F w/ fatigue, weight loss, N/V/abd pain, orthostatic hypotension, hyperpigmentation. What lab values do you expect?

  • Na
  • K
  • eosinophils
  • AM cortisol
  • ACTH
A 
hypoNa
hyperK
high eos
low AM cortisol
high ACTH
589
Q

40yo w/ newly diagnosed HTN & flank fullness. NSIM?

A

renal US (r/o ADPKD)

590
Q

Tx ADPKD

A
  • aggressive RF control (CVD, CKD)
    • ACEi for HTN, statins
  • HD, transplant if ESRD
591
Q

ADPKD Extrarenal features

A
  • ventral/inguinal hernias
  • MVP, AR
  • hepatic & pancreatic cysts
  • colonic diverticulosis
  • cerebral aneurysms
592
Q

ADPKD: true/false

  • Genetic testing required to confirm Dx
  • MRI brain required to screen for aneurysms
  • Interval renal US to monitor progression/RCC
  • CT abd to check for panc/hepatic cysts
A

All false
Genetic test only if imaging unclear
MRI brain only for high risk pt (FHx, Hx bleed)
Renal US sensitivity is too low to monitor cyst growth. No RCC risk
CT abd not necessary

593
Q

18yo finds out his parent has ADPKD. NSIM?

A
  • US renal screen w/ counselling beforehand

- If single parent is affected, 50% change of disease in child

594
Q

1st line Tx Torsades

A
  • Mg Sulfate

- (if no improvement, temporary transvenous pacing)

595
Q

Pt w/ torsades. No improvement w/ MgSO4, NSIM?

A
  • temporary transvenous pacing
596
Q

Most important predictor of survival in COPD?

A
  • age & FEV1 (<40 is severe obstruction)

- LESS SO: cigarette smoking, low BMO, airway bact load, decreased exercise capacity, HIV

597
Q

Dose/duration of oral GCS for asthma exacerbation?

A
  • 40-60mg daily x 5-7 days
598
Q 
Sarcoidosis effect on following systems: 
Skin
Eyes
Joints
Nervous S. 
Reticuloendothelial system
A

Skin: papular, nodular or plaque-like lesions
Eyes: uveitis & keratoconjunctivitis sicca
Joints: acute polyarthritis
Nervous S: Facial N palsy, central DI, hyperCa
Reticuloendothelial system: hepatomegaly 20%, periph LAD 40%
*extrapulm sarcoidosis is almost always accompanied by significant fatigue

599
Q

Facial N palsy: Red flag sx?

A
  • sparing of the upper face
  • assd hearing loss
  • assd facial twitching
  • worsens sp 3wks
  • does not improve in 4m
600
Q

40yo w/ polyarthritis, facial nerve palsy, LAD, hepatomegaly. NSIM?

A
  • CXR for Dx Sarcoidosis
601
Q

CXR w/ hilar LAD. What is necessary to confirm Dx?

A
  • r/o TB

- ***Bx: excisional LN w/ noncaseating granuloma (may be from accessible periph LAD), if unclear, transbronchial bx

602
Q

Tx urethritis

A
  • Gonococcal: ceftriaxone
  • Non-gonococcal: azithromycin (or doxy)
    (Aseptic: Chlamydia, Ureaplasma, Mycoplasma, Trichomonas)
603
Q

Pt treated for non-gonococcal urethritis continues to have sx. NSIM?

A
  • repeat urine NAAT (likely re-infection, resistance or infection not susceptible to azithro)
604
Q

Target TSH w/ Synthroid for differentiated thyroid CA (papillary & follicular)

  1. Small, low risk
  2. Intermediate risk
  3. Large, aggressive/mets
A

Small, low risk— TSH 0.1-0.5 x 6-12 months, then normal
Intermediate risk— TSH 0.1-0.5
Large, aggressive/mets— TSH <0.1

605
Q

Abx for bacteremia 2/2 HD catheter

A
  • vanc and cefepime (or genta)
606
Q

Indications for long-term HD catheter removal

A
  • severe sepsis
  • hemodynamic instability
  • evidence of metastatic infection (endocarditis)
  • pus at cath site
  • sx sp 72h abx
  • BCx growing S.aureus, Pseudomonas, fungi
607
Q

Indications for adding caspofungin for Tx catheter-related bloodstream infection

A
  • TPN
  • prolonged use broad spectrum abx
  • blood CA
  • solid organ transplant
  • femoral cath
  • Candida colonization at multiple sites
608
Q

Spinal infection (OM, epidural abscess).

A
  • WBC:
  • Fever:
  • BCx:
    All above may be wnl. BCx+ in 50%
    Dx of choice MRI, then CT w/ bx
609
Q

Spinal infection (OM, epidural abscess). Diagnostic tests to confirm?

A
  • spinal MRI, then CT-guided bx
610
Q

40% S.aureus bacteremia develop metastatic infection. Which structures are most commonly affected?

A
  • heart valves
  • lungs
  • osteoarticular structures
611
Q

Preschool age child w/ PNA. MCC (pathogen) & Tx?

A
  • S.pneumo

- Tx: high dose amoxicillin

612
Q

Child w/ PNA, focal lung findings. MCC?

A
  • S.pneumo
  • Tx: high dose amox
    (if findings were diffuse, likely M.pneuom, Tx azithro)
613
Q

Older child w/ PNA, bilateral lung findings. Pathogen and Tx?

A
  • Likely M.pneumo

- Tx: azithro

614
Q

Why is cipro never given for PNA?

A
  • poor lung penetration (unlike FQs moxi and levo)
615
Q

Polymyalgia rheumatica Tx?

A
  • low dose GCS 10-20mg QD (if no response, question Dx)
616
Q

50+, bilateral pain/AM stiffness of shoulders/hips >1h, fever, malaise
Decreased active ROM. ESR/CRP++. Dx and Tx?

A
  • Polymyalgia rheumatica, low dose GCS

* *often assd w/ GCA (temporal arteritis), requires high dose GCS)

617
Q

GCA (temporal arteritis):

  1. Dx test?
  2. Tx?
  3. Which myopathy is it associated with?
A
  • polymyalgia rheumatica
  • temporal artery bx
  • high dose GCS (40-60mg QD)
618
Q

SBO or ileus?

  • presence of gas in the colon/rectum
  • bowel w/ air-fluid levels
A

ileus

SBO

619
Q 
Testicular CA
Age: 
RF: 
Dx w/u: 
Staging: 
Tx: 
Cure rate:
A
  • 15-35
  • FHx, cryptorchidism, ~HIV
  • scrotal US, bhCG, AFP
  • CT, CXR
  • radical oorchiectomy, chemo
  • 95%
620
Q

Tx infectious epididymo-orchitis

A
  • ceftriaxone IM x1 & doxy PO x 10
621
Q

Antipsychotic use in dementia.

A
  • worsens mortality 2/2 ?increased cardiac events, CVA, falls, asp PNA.
  • used when benefits outweight risk > use minimal dose/duration w/ constant re-eval
622
Q

Rectal prolapse: indications for surgery?

A
  • full thickness prolapse, signs of ischemia/strangulation
  • debilitating sx (incont, constip, mass sensation)
    (otherwise medical tx: kegals, hydration/fiber)
623
Q

Splenic rupture:
1st step:
Dx w/u?
Tx?

A
  • IVF
  • CT w/ contrast to eval extent of bleed
  • non-operative preferred (observation, serial CBC, embolization)
  • if persistent hemorrhage despite above, laparotomy/splenectomy
624
Q 
Statin use for which one of these is primary prevention? 
A) >40yo w/ DM
B) ACS
C) Stable angina
D) hx CABG/stents
E) CVA/TIA
F) PAD
A

A (rest are secondary ppx)

625
Q

Indication for mod vs high-intensity statin for secondary prevention of ASCVD?
(ie. ACS, stable angina, hx CABG/stents, CVA, TIA, PAD)

A
  • age <75: high intensity
  • age >75: mod intensity
    (note atorvastatin 40-80mg & rosuvastatin 20-40mg are high intensity)
626
Q

Primary vs secondary ppx?

A
  • primary: pure prevention in at risk pt (ie DM >give statin to prevent ASCVD)
  • secondary: Pt has hx ASCVD and you would like to prevent a second occurrence
627
Q

When its PTU recommended over MMZ for hyperthyroidism?

A
  • first trimester of pregnancy only
628
Q

MOA hyperthyroidism & osteoporosis

A
  • elevated thyroid hormones stimulate Ca & Ph release from bone
629
Q

Anti-TPO Abs+++. Dx?

A
  • hashimotos

thyroid stimulating Ig is high in Graves

630
Q

Induced sputum sensitivity for PCP?

A
  • 60-90%, therefore if suspicion is high, Tx or obtain BAL (sen 90-100%)
631
Q

Indication for GCS in addition to TMP-SMX for PCP?

A
  • ABG: A-a gradient >35 and/or PaO2 <70 RA

- (some research suggests pulse ox <92% alone can be indication)

632
Q

Organophosphate poisoning Tx?

A
  • pralidoxime and atropine
  • emergent resuscitation: O2, IVF, intub
  • activated charcoal if w/in 1hr
633
Q

Schizoaffective disorder vs MDD or BPD w/ psych features

A
  • Schizoaffective: 2+ weeks of psych features w/o mood/manic sx
634
Q

MCC septic abortion

A
  • sp elective abortion
  • Tx: BCx/EndoCx, genta/clinda, suction curettage, +/- hysterectomy
  • Risks: sepsis, ARDS, DIC
635
Q

Tx septic abortion

A
  • Tx: BCx/EndoCx, genta/clinda, suction curettage, +/- hysterectomy
636
Q

Malnourished alcoholic. CMP/Mg/Ph wnl. You give D5W, thiamine, folate. Pt develops profound generalized weakness the next day. Mechanism?

A
  • Refeeding syndrome > hypoPh (ATP shifts Ph into cell) > rhabdo
  • NSIM: check CK, phos. Supplement phos
637
Q

Family/friends ask for prescription. Response?

A
  • “I would like to help you but I am uncomfortable prescribing for someone I am not treating”
    (prescribing for friends/family should be restricted to emergent situations when no other physician is available)
638
Q

Congenital vs pediatric rubella Sx

A
  • Congen: SNHL, cataracts, PDA, (blueberry muffin rash in minority)
  • Ped: fever, cephalocaudal spread of maculopapular rash
    (teens/adults w/ addition of arthralgia/arthritis)
639
Q

Neonate w/ SNHL, cataracts, PDA. Dx?

A
  • rubella (German measles)
640
Q

Dx?
Neonate, HSM, SNHL, periventricular calcifications
Neonate, HSM, SNHL, intracerebral calcifications

A
  • CMV

- Toxoplasmosis

641
Q

Causes of non-resolving PNA/infiltrates?

A
  • Bronchoalveolar cell carcinoma
  • carcinoid endobronchial obstruction (young, non-smoker)
  • lymphoma
  • eosinophilic PNA
  • bronchiolitis obliterans organizing PNA (BOOP)
  • systemic vasculitis
  • pulm alv proteinosis
  • drugs (amiodarone)
642
Q

CXRs w/ recurrent PNA in same lobe. Extensive smoking Hx. NSIM? Test to confirm Dx?

A
  • endobronchial obstruction likely CA
  • NSIM CT scan
  • Ultimate Dx test: flex bronch
643
Q

BAL showing hemosiderin laden macrophages. Dx?

A
  • vasculitis: granulomatosis w/ polyangitis, anti-GBM disease, etc
644
Q

Lateral shoulder pain or pain with arm abduction or external rotation suggests:

A
  • rotator cuff path: tendonitis/tear or impingement
645
Q

Competitive inhibitor of ACh?
Cholinesterase reactivating agent?
Uses?

A
  • Atropine
  • Pralidoxime
  • Organophospate poisoning
646
Q

Garlic like odor from clothes?

Garlic odor from breath?

A
  • clothes: organophosphate tox

- breath: arsenic tox

647
Q

Pancreatitis is 1% drug induced via sensitivity to sulfonamides, ischemia 2/2 hypovol, increased viscosity of panc secretions. Examples of meds?

CVS: 
AI: 
Pain: 
Antiepileptics: 
HIV:
A 
CVS: ACE/ARB, diuretics
AI: azathioprine, mesalamine, GCS
Pain: Tylenol, NSAIDs, opiates
Antiepileptics: valproic acid, carbamazepine
HIV: lamivudine, didanosine, TMP-SM
648
Q

Sudden HA, nausea, nuchal rigidity, ptosis, aniscoria. CVA location?

A
  • posterior communicating artery aneurysm (per CN III dysfunction)
649
Q

Enlarged LNs, mobile/rubbery x 4 wks. NSIM?

A
  • Bx if persist >4wks.
650
Q

DDx viral vs bacterial conjunctivitis?

A
  • both are uni or bilateral, lasting 1-2wks
  • viral: assd w/ prodrome, watery discharge
  • bacterial: more purulent discharge
651
Q

How long is viral conjunctivitis contagious for?

A
  • until eye discharge resolves (morning crusting or conjunctival injection may persist)
652
Q

JONES Criteria?

A 
Joint pain 
O carditis (3w sp infection)
Nodules (subcutaneous)
Erythema marginatum 
Sydenham chorea (1-8 monts sp infection)
(Minor criteria: fever, arthralgia, ESR/CRP, prolonged PR)
653
Q

Onset of carditis vs sydenaham chorea sp GAS pharyngitis?

A
  • carditis ~3 wks (note MR/MS&raquo_space;yrs or decades)

- sydenham chorea 1-8 months

654
Q

Tx for rheumatic fever and indication for GCS?

A
  • PNC,

- GCS only for severe cases

655
Q

Tx syndenham chorea sp RF.

A
  • PNC IM until adulthood as secondary prevention

- if severe sx & pt is at risk of self injury, haloperidol

656
Q

Which medication is avoided in peds 2/2 Reye Syndrome?

A
  • ASA (except Kawasaki)
657
Q

Lyme Sx **

  1. Early (<1 month)
  2. Early disseminated (wks>months)
  3. Late (m>yrs)
A
  • 1) erythema migrans, fatigue, HA, myalgia, arthralgia
  • 2) multiple erythema migrans, uni/bilat CN palsy, meningitis, carditis (AV block), migratory arthralgias
  • 3) arthritis, encephalitis, periph neuropathy
658
Q

MC late complication of Lyme

A
  • arthritis 60%, months/years later
  • Dx w/ ELISA/Western Blot. (Synovial WBC 20-60k)
  • Arthrocentesis is often performed to r/o concomitant septic arth
659
Q

Tx lyme arthritis

A
  • doxy or amox x 28 days (Doxy has better nerve penetration)
  • Prog: most resolve but may recur
660
Q

1st line abx for late lyme in peds <8?

A

A) amoxicillin
B) ceftriaxone
C) doxycycline
- Doxy x 21 days (better nerve penetration)
- (ceftriaxone is used for Lyme carditis/encephalopathy)

661
Q

When is pyridoxine added to the TB regimen and why?

A

to prevent neuropathies in pts on isoniazid who have PMH of:

  • DM
  • uremia
  • EtOH
  • malnutrition
  • HIV
  • preg
  • epilepsy
662
Q

HCP who have latent TB are generally treated w/ which regimen?

A

isoniazid x 9 months

663
Q

quantiferon+, no sx, CXR neg. NSIM?

A

Tx latent TB

note quantiferon is >99% specific

664
Q

When is exercise during pregnancy AVOIDED?

A

Risk of preterm delivery

  • cervical insufficiency
  • PPROM

Risk of antepartum bleed

  • placenta previa
  • persistent 2nd/3rd trim bleed

Underlying condition that could be exacerbated by disease

  • severe anemia
  • preeclampsia
  • restrictive lung d
  • severe heart disease
665
Q 
Which is NOT a contraindication to exercise during pregnancy?
A) cervical insufficiency
B) PPROM
C) in vitro
D) placenta previa
E) persistent 2nd/3rd trim bleed
F) severe anemia
G) preeclampsia 
H) restrictive lung d
I) severe heart disease
A

C) in vitro

666
Q

Glucagonoma

  1. origin
  2. malign or benign
  3. how to confirm dx
  4. Tx
A
  1. pancreas
  2. malignant, often mets to liver
  3. high glucagon levels (assd w/ necrolytic migratory erythema)
  4. surgery
667
Q

Glucagonoma tumors often secrete:

A

Other peptides:

  • VIP
  • calcitonin
  • GLP1
668
Q

Dermatitis, dementia, diarrhea, stomatitis, cheilosis. Tx?

A
  • Pellagra (niacin deficiency)
669
Q

Generalized urticarial rash in child, rubbing the edge produces Darier sign. HSM present in 50%. Dx?

A
  • systemic mastocytosis
670
Q

Tx cough variant asthma?

A
  • GCS & bronchodilators

- if refractory, some efficacy w/ montelukast (leukotriene inhibitor)

671
Q

Rhinorrhea, chronic cough & oropharyngeal cobblestoning. Dx?

A
  • Upper airway cough syndrome
672
Q

Extensive smoking hx & hoarseness. Mechanism?

A
  • laryngeal nodules w/ chronic vocal cord irritation
673
Q

Common causes of papilledema?

A
  • mass lesions
  • increased CSF production
  • decreased CSF outflow (venous sinus thrombosis)
  • idiopathic intracranial HTN (pseudotumor cerebri
674
Q

HA. Papilledema on exam. NSIM?

A

CT head WITH contrast (unless SAH suspected, then without)

**do not perform LP first as a mass lesion must be excluded beforehand per risk of herniation

675
Q

Oligoarthritis, arthrocentesis: >2000 WBC (75% PMN). Sterile. DDx?

A 
RA
viral/Lyme 
SLE
sarcoidosis 
spondyloarthritis
676
Q

Reactive arthritis etiologies.

A

GU
- Chlamydia

GI

  • Salmonella
  • Shigella
  • Yersinia
  • Campylobacter
677
Q

Sacroiliitis, asymmetric oligoarthritis, dactylitis, enthesitis, uveitis. What do you expect from hx?

A

Reactive arthritis 2/2

GU
- Chlamydia

GI

  • Salmonella
  • Shigella
  • Yersinia
  • Campylobacter
678
Q 
Which is NOT part of reactive arthritis?
A) uveitis 
B) sacroiliitis
C) symmetric arth
D) circinate balanitis
E) dactylitis
F) enthesitis
G) urethritis
A

D) symmetric arth

*its asymmetric oligoarthritis

679
Q

RF for developing reactive arthritis excluding GI/GU infection?

A

HLAB27+

(normal pop risk: 8%
HLAB27: 20%)

680
Q

When to give PNC GBS PPx if GBS status is unknown?

A
  • preterm <37w gest
  • PPROM >18h
  • intrapartum fever (ie intraamniotic infection )

(also GBS rectovag Cx/UTI in preg, prior infact w/ early oneset neonatal GBS infection)

681
Q

Dx?

  1. AutoAbs against AChR
  2. inhibited release of Ach into synaptic cleft (ie no action potential)
A
  1. MG

2. Botulism

682
Q 
Which are NOT seen in MG?
A) autonomic dysfunct
B) ptosis
C) diplopia
D) dysarthria
E) dysphagia
F) diminished reflexes
G) fluctuating weakness
A

A) autonomic dysfunct
F) diminished reflexes

Both hwr seen in botulism

683
Q

How does calcium exist in the blood?

A

40% ionized (active)
45% albumin bound
15% bound to organic/inorganic anions

684
Q

Tx adenomyosis?

A

If childbearing not completed: progestin IUD or depot implant

Otherwise hysterectomy

685
Q

Heavy regular menses, chronic pelvic pain, diffuse uterine enlargement. Dx?

A

adenomyosis

DDx endometriosis:

  • fixed uterus
  • rectovaginal nodularity
  • adnexal mass
686
Q

MCC fecal incontinence in elderly?

A

fecal impaction (liquid overflow)

687
Q

Tx of fecal impaction?

A

manual disempaction then enema

aggressive PO bowel regimen to prevent recurrence

688
Q 
Elderly, no BM x 4 days. Exam: hard stool in colon, decreased anal tone. AXR: no air fluid levels. Tx?
A) fiber
B) lactulose
C) stool softner
D) disempaction 
E) rectal tube
A

D) disempaction (manual)

then enema for fecal impaction
- fiber may worsen obstruction

689
Q

Indication for rectal tube?

A

acute pseudoobstruction of colon & dilated colon and acute distension

690
Q

Acitve Lyme in preg woman. Prognosis/fetal outcome?

A

Good if mother receives adequate Tx
- amoxicillin 2-3wks
OR
- cefuroxime

691
Q

Lyme in pregnancy may be treated w/ amoxicillin OR

A
  • cefuroxime

in non-preg pts, doxy is preferred

692
Q

Sandy sensation in eyes and oral thrush. Dx?

A

r/o Sjogrens

“do you wake up at night thirsty or need to drink water to help swallow food”

693
Q

Tx West Nile

A

Supportive

694
Q

Dx West Nile

A

IgM in CSF

695
Q

Peds: MCC viral CNS infections?

A
  1. enterovirus (coxackie)
  2. HSV
  3. West Nile (arbovirus)
696
Q

CNS suspected: which Sx are consistent w/ encephalitis?

A

seizures
confusion
disorientation

(meningitis & encephalitis = likely viral)

697
Q

LEad Tx moderate VS severe?

A

Mod 45-69: DMSA- succimer

Severe 70+: hospitalization
Dimercaprol AND EDTA

698
Q

Oral D penicillamine is used for?

A

Wilsons

699
Q

Viral conjunctivitis cn be Tx w/ warm/cold compress AND

A

+/- antihistamine/

decongestant drops

700
Q

Bacterial conjunctivitis Tx:

  1. first line
  2. preferred in contact lens wearers
A
  1. erythromycin ointment or polymyxin-TMP drops
    ~azithromycin drops
  2. FQ drops (per higher incidence of Pseudomonas)
701
Q 
Which is the BEST tx of bacterial conjunctivitis in contact lens wearers?
A) polymyxin-TMP drops
B) FQ drops
C) azithromycin drops
D) erythromycin ointment
A
  1. FQ drops (per higher incidence of Pseudomonas)
702
Q

Which is NOT a first line Tx for bacterial conjunctivitis?

A) polymyxin-TMP drops
B) GCS drops
C) azithromycin drops
D) erythromycin ointment
E) FQ drops
A

B) GCS drops

703
Q

Contact lens wearers w/ bacterial conjunctivitis are at risk of developing:

A

keratitis (corneal inflammation)

pathogens

  • pseudomonas
  • HSV, VZV
  • acathomoeba
704
Q

Contact wearer, acute bacterial conjunctivitis. After few days of abx > photophobia, impaired vision, foreign body sensation, nSIM?

A

STAT optho

Slit lamp to confirm keratitis

Tx: broaden abx

Risk of scarring/
blindness

705
Q

Cirrhosis w/ ascites, hypoTN, no LE edema. Cr 2.8, BUN 60. SBP ruled out. Confused. NSIM?

A

Volume challenge, if he fails to respond > HEPATORENAL SYNDROME
(otherwise presentation likely intravascular depletion)

Tx:
- octreotide & midodrine
OR
-NE

and albumin x 2-3 days

706
Q

BUN:Cr of 20:1 indicates-

A

prerenal cause

707
Q

Indications for tapering steroids (as opposed to abrupt cessation)

A

> 3wks use (per HPA axis suppression)
OR
Cushingoid appearance

708
Q

Which is NOT a feature of NF1?

A) acoustic neuroma
B) neurofibroma
C) optic glioma 
D) astrocytoma
E) neural crest cell derived tumors
F) chromosome 17 mutation
A

A) acoustic neuroma

*feature of NF2 which also has schwannomas, epenyomas, meningiomas

709
Q 
Which is NOT a feature of NF2?
A) schwannomas
B) acoustic neuroma
C) neural crest derived tumors
D) epenyomas, meningiomas
A

C) neural crest derived tumors

(feature of NF1 which also has: 
A) ch17 mutation
B) neurofibroma**
C) optic glioma 
D) astrocytoma
E) neural crest cell derived tumors
F) presents in childhood 
G) Lisch nodules 
H) axillary freckling
710
Q 
Which is NOT a feature of NF2?
A) schwannomas
B) acoustic neuroma
C) Dx in 3rd decade 
D) epenyomas, meningiomas
E) axillary freckling
A

E) axillary freckling

Thats NF1! which also has 
A) ch17 mutation
B) neurofibroma**
C) optic glioma 
D) astrocytoma
E) neural crest cell derived tumors
F) presents in childhood 
G) Lisch nodules
711
Q

NF1 or NF2

  1. axillary freckling
  2. neurofibromas++
  3. ch17 mutation
  4. auditory issues
  5. cranial neuropathies
  6. optic path gliomas
  7. cafe au lait spots
  8. Dx in 3rd decade
A
  1. NF1
  2. NF1
  3. NF1
  4. NF2
  5. NF2
  6. NF1
  7. NF1
  8. NF2

Note: neurofibroms are rare in NF2

712
Q

72yo started on prozac which is effective but now has jitteriness & insomnia NSIM?

A

switch to SSRI w/ less AE ie Lexapro

713
Q

Feminization of male fetus is caused by which medication?

A

spironolactone

714
Q

AE of PO tetracyclines in Tx of acne?

A
  • teratogenicity
  • increased risk of vaginal trush
  • abx resistance
715
Q

Inflamm acne w/ mild improvement w/ clindamycin gel, BP wash & tretinoin, worse on lower face/neck before menses. NSIM?

A

Try OCP
Likely to respond given hormonal acne sx

May also try:
~Spironoclactone
~PO doxy

716
Q

Risk of syphilis during pregnancy?

A

intrauterine demise & preterm labor

717
Q

RPR or VDRL is positive. NSIM?

A

FTA-abs (treponemal test)

The others are nontreponemal tests, require confirmation

718
Q

Indications or syphilis screening in preg?

A

all: first prenatal visit

high risk: 3rd trimester & delivery

719
Q

Pregnant F w/ confirmed syphilis. Hx PNC allergy: skin rash & SOB. Tx?

A

penicillin desensitization then IM penicillin benz G (PEN G is the ONLY Tx for syphilis in pregnancy)

(4x decrease in serologic titers indicates success)

720
Q 
Which is NOT use to Tx syphilis:
A) pen G IM
B) azithromycin 
C) doxycycline
D) ceftriaxone
E) erythromycin
A

all of them are used

- pen G is first line and the rest are 2nd

721
Q

Fetal effects of syphilis?

A
  • HSM, jaundice
  • hemolytic anemia, thrombocytopenia
  • long bone abnorm
  • failure to thrive
722
Q

Pediatric sepsis: MCC in <28d VS >28d

A

<28d: Ecoli, GBS
(Tx: ampi/gent OR ampi/cefotaxime)

> 28d: S.pneumo, Neisseria
(Tx: ceftriaxone or cefotaxime)

723
Q

Pediatric sepsis: Tx age <28d VS >28d

A

<28d: Ecoli, GBS
(Tx: ampi/gent OR ampi/cefoTAXime)

> 28d: S.pneumo, Neisseria
(Tx: ceftriaxone or cefotaxime)

724
Q

Febrile neonate, NSIM?

A 
CBC
Bx
UA
UCx
CSF cell count
CSF Cx
725
Q

Why should ceftriaxone be avoided in neonates?

A

RF of hyperbilirubinemia (use cefoTAXime instead)

726
Q

Why is bactrim avoided in neonates?

A

RF methemoglobulinemia

727
Q

Hepatic hydrothorax:

  • Path?
  • Tx?
A

Path: passage of peritoneal ascites through the diaphragm

Tx: Na restriction, diuretics (furosemide, spironolactone)
Liver transplant

728
Q

R-sided transudative pleural effusion in patients w/ decompensated HF & ascites. Dx?

A

Hepatic hydrothorax

Tx: Na restriction, diuretics (furosemide, spironolactone)
Liver transplant

~~ thoracic repair of diaphragmatic defects (highly invasive
~~TIPS- relieves portal HTN but risk of encephalopathy & decompensation

729
Q

Which condition is NOT assd w/ bullous pemphigoid?

A) MM
B) dementia
C) Parkinsons
D) MDD
E) BPD
A

A) MM

730
Q

Bullous pemphigoid suspected. NSIM?

A

obtian bx to confirm before Tx (GCS)

731
Q

Skin Bx: IgG/C3 deposition along the BM. AutoAbs to hemidesmosopmes. Tx & Dx?

A

Bullous pemphigoid

Tx: topical high potency GCS (clobetasol)
& PO GCS or doxy

732
Q

Tx bullous pemphigoid

A

topical high potency GCS (clobetasol)

& PO GCS or doxy

733
Q

Urethral hypermobility indicates which urinary incontinence?

A

stress

and decreased urethral sphincter tone

734
Q

Decreased urethral sphincter tone: which urinary incontinence?

A

stress

and urethral hypermobility

735
Q

Urinary incontinence and urethral hypermobility. Tx?

A
  • limit water to 2L/d
  • limit coffee
  • kegals
  • last resort: mid urethral sling procedure
736
Q

Risks of kidney donation?

A

Immediate post-op: DVT, hosp acquired infection

Risk of gestational complications: fetal loss, preeclampsia, gestational DM or HTN

Otherwise:

  • NO increased risk of ESRD (GFR drops immediately post-op but remaining kidney gradually compensates)
  • LOW mortality procedure
737
Q

Blepharospasm:

  • prevalence in which population?
  • triggers
  • Tx?
A
  • older women (maybe 2/2 dry eyes)
  • dry eyes, irritants, bright light
  • Tx: BOTOX
    (v effective in tx of this focal dystonia, INCLUDING cervical dystonia)
738
Q

Tx for generalized dystonia?

A
  • carbi-levodopa
  • trihexyphenidyl
  • diazepam/clonazepam
  • baclofen
  • *deep brain stimulation

(for focal dystonia: botox)

739
Q

Labs & work up for Sjogrens?

A

Schrimer test (slit lamp exam to assess tear break up time)

Labs: ro/la, ANA, RF

Gold standard: labial salivary gland bx (rarely necessary)

US & MRI may be used to assess structure/function of salivary glands

740
Q

How long does an ixodes tick have to be attached to transmit Lyme?

A

36-48h

hence if attached <36h, REASSURE

741
Q

How long does it take for erythema migrans to appear?

A

> 3d

742
Q

IVDU w/ AKI, palpable purpura, arthralgias, high RF, low complement, transaminitis. Dx?

A

r/o mixed cryoglobulinemia in setting of HCV

743
Q

Palpable purpura, arthralgias, weakness, high RF, low complement. Dx & Tx?

A

r/o mixed cryoglobulinemia

Tx:
1. initial (2-3month) immunosuppressive Tx
- stabilize end organ damage ie GN
RITUXIMAB & GCS

  1. Tx underlying d (**HCV, HBV, HIV, malig, rheum d)
744
Q

PSGN: high/norm/low
A) C3
B) C4

A

low C3, normal C4

745
Q

AOM sp Tx. Peristent serous otitis media. NSIM?

A

observe if under 3 months (serous OM is normal for up to 3 months)

746
Q

When is amoxiclav indicated for AOM?

A 
resistant cases
(normally just tx w/ amox)
747
Q

Pediatric epistasix, not resolving sp 10 min nose pinch. NSIM?

A
  1. topical vasoconstrictor ie oxymetazoline (NOT silver nitrate which is a form of chemical cauterization that can be used as second line Tx or electrocautery)

If above fail > nasal packing (bacitracin covered sponge) n

748
Q

Wrestler w/ auricular hematoma. NSIM?

A

STAT I&D & pressure dressing

Otherwise, complications:

  • abscess
  • avasc necrosis
  • fibrocartilage overgrowth
  • cauliflower ear

**daily f/u x 3-5d to assess healing, eval for signs of infection

749
Q

Wrestler w/ auricular hematoma. Complications?

A
  • abscess
  • avasc necrosis
  • fibrocartilage overgrowth
  • cauliflower ear

**daily f/u x 3-5d to assess healing, eval for signs of infection

Tx: STAT I&D & pressure dressing
Avoid NSAIDs to avoid rebleeding

750
Q

Why are OCPs contraindicated in migraine w/ auras?

A

migraines pose slight risk of ischemic stroke

751
Q

ABSOLUTE contraindications to OCPs (12)

A
  • hx DVT
  • hx CVA
  • heart disease
  • cirrhosis/ liver CA
  • breast CA
  • DM w/ end organ d
  • > 35yo smoking >15/d
  • antiphospholipid s
  • migraines
  • BP >160/100
  • major surgery w/ prolonged immobilization
  • <3wks postpartum
752
Q

OCPs increase risk of:
A) breast CA
B) uterine CA
C) ovarian CA

A

A) breast CA
(ABSOLUTE contraindication)

*decreases risk of ovarian/uterine CA

753
Q 
Which is NOT an ABSOLUTE contraindication to OCP use:
A) hx DVT
B)  hx CVA
C) heart disease
D) cirrhosis/ liver CA
E) ovarian CA
F) DM w/ end organ d
G) >35yo smoking >15/d
H) antiphospholipid s
I) migraines
J) BP >160/100
K) major surgery w/ prolonged immobil
L) <3wks postpartum
A

E) ovarian CA

*OCPs are protective in ovarian/uterine CA but contraindicated w/ breast CA

754
Q 
How often do you monitor TSH in pregnancy? Every: 
A) 4 weeks
B) 6 weeks
C) 8 weeks
D) 12 weeks (each trimester)
A

A) every 4 weeks

755
Q 
What happens with the following in pregnancy?
A) TSH receptor stimulation
B) feedback suppression of TSH 
C) circulating TBG
D) Total T3 & T4
E) Free T3 & T4
A 
A) increased via bCG
B) increased
C) increased 
D) increased
E) normal or minimal increase
756
Q 
Which is NOT an early sign of compartment syndrome?
A) taught area
B) muscle weakness
C) paresthesias
D) pain w/ passive stretch
A

C) paresthesias

757
Q

Compartment syndrome w/ pressures > ___ require fasciotomy

A

20-30

758
Q

Which is more accurate in detecting H.pylori eradication: urea breath test or stool Ag?

A

urea breath test

but fecal Ag is more available

759
Q

PUD on endoscopy. When is repeat EGD indicated for surveillance?

A

To confirm healing in those with gastric ulcers & HIGH malignancy risk.

(duodenal ulcers have a v.low malignancy risk)

760
Q

Which conditions warrant confirming Hpylori eradication?

A
  • PUD
  • MALT
  • persistent sx
  • resection of early gastric CA
761
Q

Colonoscopy: hyperplastic polyp >1cm. Next screening?

A

3-5yrs

762
Q

Colonoscopy: Indication for next screening?

A) 1-2 tubular adenomas <1cm
B) 3-4 tubular adenomas <1cm
C) 5-10 tubular adenomas <1cm

A

A) 7-10yrs
B) 3-5yrs
C) 3yrs

763
Q

Colonoscopy: Indication for next screening?
A) hyperplastic adenoma <1cm
B) hyperplastic polyp >1cm

A

A) 10y

B) 3-5y

764
Q

Colonoscopy: Indication for next screening?

A) >10 adenomas
B) large adenoma <2cm removed by piecemeal excision

A

A) 1yr

B) 6 months

765
Q

Which warrants a repeat colonoscopy in 6 months?

A) 1-2 tubular adenomas <1cm
B) 3-4 tubular adenomas <1cm
C) 5-10 tubular adenomas <1cm
D) >10 adenomas
E) adenoma <2cm removed by piecemeal excision
F) hyperplastic adenoma <1cm 
G) hyperplastic polyp >1cm
A

E) adenoma <2cm removed by piecemeal excision

766
Q

Diabetic w/

  • postprandial bloating, N/V
  • weight loss
  • postural dizziness
  • abnormal sweating
  • labile glyc control
  • frequent hypoglyc

NSIM?

A

FIRST r/o mechanical obstruction w/ EGD or barium

THEN: If no obstruction, confirm gastroparesis (DM autonomic dysfunction) w/ nuclear gastric emptying study

767
Q

Tx gastroparesis

A
  • smaller, frequent meals
  • decrease fiber & fat
  • erythromycin or metoclopramide

(refractory cases: liquid diet/PEG/gastric electric stimulation)

768
Q

Elderly pt w/ hip fracture sp mechanical fall. What is necessary upon discharge?

A

Home assessment by a nurse

769
Q

Metformin decreases fasting glucose by ~__%

A

20%

note: also useful in hyperTG & hepatic steatosis

770
Q

Temporal HA, transient vision loss & unilateral: miosis, ptosis, anhidrosis. Dx?

A

Horner syndrome- CAROTID ARTERY DISSECTION

RF: CT d, HTN, smoking, recent infection

Freq complications: TIA/CVA

771
Q

Temporal HA, transient vision loss & unilateral: miosis, ptosis, anhidrosis. Dx test & Tx?

A

Horner syndrome- CAROTID ARTERY DISSECTION

Dx: CTA or MRA
(if neg but high suspicion >cath angio)

Tx: thrombolysis if <4.5h
If not: aspirin +/- AC

772
Q

Temporal HA, transient vision loss & unilateral: miosis, ptosis, anhidrosis. Initial Dx test VS Gold standard for Dx

A

Initial: CTA or MRA

Gold: cath angio

773
Q

Carotid dissection: RF & complications

A

RF: CT d, HTN, smoking, recent infection

Freq complications: TIA/CVA

774
Q

Jaw claudication, fever, anemia, high ESR. Dx?

A

Temporal a bx

775
Q

Longstanding Hashimotos w/ sudden /rapid enlarging thyroid. NSIM?

A

Bx to r/o thyroid lymphoma

Pembertons test: facial plethora after raising hands overhead x20s
thyroid is likely cause of obstructive sx

776
Q

Pembertons test: facial plethora after raising hands overhead x20s. Significance?

A

thyroid is likely cause of obstructive sx

inability to palpate inferior thyroid is also suggestive

777
Q

Longstanding Hashimotos is a RF for which CA?

A

thyroid lymphoma d/t chronic lymphocytic infiltration

signs: rapidly elarging thyroid or obstructive sx

778
Q

antiTPO abs & rapidly enlarging thyroid is a sign of which thyroid CA?

A

thyroid lymphoma d/t chronic lymphocytic infiltration w/ Hashimotos

779
Q

Tx contact dermatitis

A
  • avoid allergen

- <4wks high dose GCS (betamethasone, fluocinonide or if on face: tacrolimus)

780
Q

Tx contact derm on face

A
  • avoid allergen
  • tacrolimus

(if not on face, can use high potency GCS ir betamethasone or fluocinonide)

781
Q

Lichen simplex chronicus- etiology?

A

“neurodermatitis”

- chronic scratching and rubbing (assd w/ anxiety)

782
Q

Which condition is associated w/ Lichen simplex chronicus?

A

anxiety
“neurodermatitis”
- chronic scratching and rubbing

783
Q 
LEAST COMMON trigger of acute cholangitis?
A) gallstone
B) bile duct stenosis
C) incompetence of sphincter of Oddi
D) hematogenous spread 
E) hx sphincterotomy (oddi)
A

D) hematogenous spread

784
Q

Fever, jaundice, RUQ pain, hypoTN, AMS. Dx & Tx?

A

acute cholangitis

RUQ US (r/o ductal dil)

Aggressive IVF
BCx > empiric Tx
- zocyn or cipto/metro

ERCP w/in 24-48h for biliary drainage or gallstone removal

785
Q

Fever, jaundice, RUQ pain, hypoTN, AMS. Abx?

A

acute cholangitis

zocyn or metro/cipro

786
Q

Bloody urine after marathon. UA: RBC+++, blood+++, no casts. NSIM?

A

repeat in a week

  • 25% of marathon runners have hematuria (2/2 bladder bouncing up and down). Hematuria in contact sports is secondary from direct trauma.
  • No casts means GN is unlikely. RBC presence means bloody urine is not soley from rhabdo (CK can be checked)
787
Q

Initial improvement w/ vent x few days and then worsening resp parameters. NSIM?

A
  1. r/o VAT: obtain BAL or tracheobronchial aspiration

2. START empiric abx
MCC asp of Ecoli or Strep BUT if RF for resistance, ensure MRSA & Pseudomonal cover

788
Q

When are GCS indicated in ARDS?

A

controversial

789
Q

Pt sp stem cell/organ transplant, chronic GCS use, chronic neutropenia develops cough, pleuritic CP & hempotysis. CXR: nodules w/ ground glass opacity. Dx?

A

r/o pulm aspergillosis

CT Chest: also halo sign or cavitations w/ air/fluid levels

Labs: Galactomannan & beta-D-glucan elevation

fungal stain/Cx+

Tx: voriconazole, reduce immunosuppressive Tx
+/- surgery

790
Q

IMMUNOSUPPRESSED PT pt w/ cough, pleuritic CP & hempotysis. Labs w/ galactomannan. Dx & Tx?

A

Invasive pulm aspergillosis

CT chest:

  • nodules w/ ground glass opacity
  • air/fluid level, HALO

Tx:

  • Voriconazole
  • reduce immunosuppression
  • +/- surg
791
Q

Tx: Invasive pulm aspergillosis

A
  • Voriconazole
  • reduce immunosuppression
  • +/- surg
792
Q

Tx Aspergillosis
A) Fluconazole
B) Amphotericin B
C) Voroconazole

A

C) Voroconazole

793
Q

Asx F incidentally found to have 1cm gallstone. Tx?

A

Reassurance & no intervention

  • preg > increased risk of gallstones per hormonal changes (they resolve after preg)
794
Q

Childs arm is yanked > arm held extended/ pronated. No swelling, deformity or focal tenderness. NSIM?

A

Radial head subluxation in child (nursemaids elbow)

Tx: hyperpronation or arm or supination of forearm & flexion of elbow

XR IS NOT NECESSARY FOR DX

795
Q

Radial head subluxation in child (nursemaids elbow). Dx work up & Tx?

A

Dx: clinical
Tx: Reduction o hyperpronation or arm or supination of forearm & flexion of elbow

796
Q

ID a LBBB

A

look it up dummi

797
Q

ST elevation in >2 leads. NSIM?

A

CATH LAB

no cardiac enzymes or trops needed

798
Q

Troponemia w/ ST depressions in a few leads. Tx?

A

Dx: NTSEMI

DAPT
NTG
BB
statin
AC
799
Q

Review arrhythmias & how to terminate them

A

:)

800
Q

Tx to achieve rapid warfarin reversal?

A

Prothrombin complex concentrate (normalizes INR w/in 10 mins)

Also add IV vitK (hwr takes 12-24h to take effect)

IF PTCC is unavailable, may use FFP (hwr less desirable d/t large vol & delay for blood compatibility testing)

801
Q

Rapid warfarin reversal desired. In which situation would you give FFP?

A

If prothrombin complex was unavailable

FFP is less desirable d/t large vol & delay for blood compatibility testing

802
Q

Elderly w/ femoral neck fracture. When is non operative management recommended?

A
  • advanced dementia
  • unstable medical
  • non-ambulatory
803
Q

Elderly w/ femoral neck fracture. What is crucial to reduce mortality & risk of pressure ulcers/PNA?

A

performing surgery w/in 48h

804
Q

SCD not in crisis. What do you see on peripheral smear or Hgb electrophoresis?

A

smear: sickled RBC

Hgb electrophoresis: (GOLD Standard)
HIGH HbS, NO HbA

805
Q

SCD: PNC is given until age of __

A

5

806
Q

Maintenance management of SCD: (4)

A

Pneumovax
PNC until 5yo
folic a
hydroxyurea

807
Q

HIGH HbS, NO HbA. Dx?

A

SCD

808
Q

Dactylitis in SCD: mechanism?

A

sequestration in small bones of the hands/feet > bone infarct > vaso-occlusion

809
Q

WHy do SCD patients have chronic anemia?

A

chronic intravascular hemolysis

810
Q

Knock knee appearance age 2-5yo. NSIM?

A

Reassurance: this is physiologic genu varum

  • no pain ambulating
  • normal height
  • no medial thrust
  • no fracture, infection, tumor, swelling/warmth, signs of metabolic disease
811
Q

35yo w/ chronic back pain develops CVS tenderness. Labs showing AKI, hematuria, proteinuria, pyuria, nitrite neg, LE neg, no bact. No stone on imaging. Dx & Tx?

A

Chronic tubular injury > tubulointerstitial nephritis. **ischemic damage to papilla > sloughing >hematuria/pain

d/t chronic use of ASA, acetaminophen, NSAIDs

Tx: discontinue analgesics > stabilize renal funct or w/ some improvement.

812
Q

Necrosis and calcification of the renal papilla. Etiology?

A

Dx: renal papillary necrosis

  • analgesic nephropathy
  • anything causing ischemia (SCD etc)
  • DM
  • pyelo
  • vasculitis
  • pyelo
813
Q

Other than sun/UV light, what are some RFs of skin SCC?

A
  • chronic scars, wounds, burns
  • immunosuppression
  • ionizing radiation exposure
814
Q

Tx invasive SCC

A
  • excise 4-6mm margins
  • Mohs

(IF SCC in situ: may also tx w/ curettage & dessication, cryo, 5FU, imiquimod)

815
Q

What are high risk features of SCC?

A
  • on face, ears, neck, hands, feet, genitals (esp >1cm)

- 2+cm anywhere

816
Q

Which has a higher cure rate: Mohs or excision?

A

Mohs

817
Q

After quitting, mortality risk will fall below current smokers after __yrs

A

5yrs

Also
- reduced cardiac events
- lower osteoporosis risk
-

818
Q

Sudden SNHL. NSIM?

A

STAT ENT

  • audiogram
  • MRI tx
  • GCS tx *high dose w/in 24h

(risk of permanent HL)

819
Q

SNHL

1) AC>BC
2) BC>AC
3) lateralizes to affected ear
4) lateralizes to unaffected ear

A

1) AC>BC

4) lateralizes to unaffected ear

820
Q

Can employers request genetic info?

A

NO. GINA prohibits discrimination by health insurers and employers based on genetic info

821
Q

Mechanisms in which GCS lead to bone loss

A
  • decrease GI absorp
  • renal Ca wasting
  • direct anti-anabolic effect on bones
  • suppress release of GnRH > central hypogonadism
822
Q

Cancer pt develops akathisia, dystonia 0or Parkinson like sx. Mechanism?

A

Possibly 2/2 entiemetic (ie metoclopramide, dopamine antagonist)

Note: MC agents for chemo-assd nausea:
- 5HT3 antagonists ie ondansetron and aprepitant

823
Q

chemo-assd nausea: Tx?

A

5HT3 antagonists:

  • ondansetron
  • aprepitant

Less commonly dopaminergic antagonists (metoclopramide)

824
Q

Indications for injection sclerotherapy?

A

small, symptomatic varicose veins having FAILED 3-6 months of conservative Tx

  • leg elevation
  • compression stockings
  • leg elevation
  • weight loss
825
Q

When is surgical ligation/stripping indicated in the management of varicose veins?

A

Large, symptomatic varicose veins w/

  • ulcers
  • bleeding
  • recurrent thrombophlebitis of veins
826
Q

Bilateral hilar LAD, hyperCa, hyperAlkP, transaminitis. Dx?

A

hepatic sarcoidosis (50-60%)

CT/MRI to view hepatic infiltration w/ non-caseating granulomas

Bx required for defDx

827
Q

MCC legal blindness in the US?

A

DM

  1. prolif DM retinopathy
  2. vitreous bleed
  3. retinal detachment
828
Q

Newly dx DM1 w/ sugars 300s. Pt c/o blurry vision. What is the likely mechanism?

  1. prolif DM retinopathy
  2. vitreous bleed
  3. retinal detachment
  4. optic lens swelling
A
  1. optic lens swelling 2/2 osmotic changes
829
Q

Chronic granulomatous disease: recurrent infections w/ ____ & ____

A
  • catalase positive bacteria
  • fungi

hence ppx: bactrim, itraconazole

830
Q

Chronic granulomatous disease: Dx test?

A

BEST: dihydrorhodamine

~also nitroblue tetrazolium

Tx:

  • ppx: bactrim, itraconazole
  • inf: Cx based abx (prolonged course)
  • hematopoietic cell transplant is curative
831
Q

Chronic granulomatous disease: Tx?

A
  • ppx: bactrim, itraconazole
  • inf: Cx based abx
  • INFy if severe
  • hematopoietic cell transplant is curative
832
Q 
Which is NOT catalase positive?
A) Pseudomonas
B) S.aureus
C) Burkholderia cepacia
D) Serratia
E) Nocardia 
F) Aspergillus
A

A) Pseudomonas

MC infections in CGD:

  • skin: abscess
  • LN: adenitis
  • lungs: PNA
  • liver
  • difficult to tx, requires prolonged course abx
833
Q

2yo w/ hx recurrent infectionsm 4 episodes of cervical LAD p/w PNA w/ Burkholderia cepacia. Is there a CURE for this condition?

A

YES

Dx: CGD
hematopoietic cell transplant is curative

834
Q

Indications for azithromycin/palivizumab PPx?

A

Occasionally used in CF

835
Q

REcurrent sinopulmonary infections by encapsulated bacteria. Dx?

A

XL agammaglobulinemia (def opsonizing IgG & mucosal IgA)

836
Q

Adequate hydration helps prevent skin damage from sun exposure. T/F?

A

True

837
Q

Tx for cardioprotection in the setting of TCA OD?

A

Sodium Bicarb

If refractory
> Mg or lido

838
Q

NaHCO3 is recommended if pH

A

ph <7.1

HCO3 <6

839
Q

TCA OD: Sx?

A

CNS: confusion, drowsiness, seizures, resp depression

CVS: sinus tach, prolonged PR/QRS/QT, arrhythmia (VT, VF)

AntiACh: dry mouth, blurred vision, dilated pupils, urinary ret, flushing, hypothermia

840
Q

Which OD includes the following?

CNS: confusion, drowsiness, seizures, resp depression

CVS: sinus tach, prolonged PR/QRS/QT, arrhythmia (VT, VF)

AntiACh: dry mouth, blurred vision, dilated pupils, urinary ret, flushing, hypothermia

A

TCA

Tx
- IV Sodium Bicarb (for QRS widening or vent arrhythmia)
- If refractory
> Mg or lido

  • O2, intub, IVF
  • charcoal if <2h ingestion
841
Q

Pubertal M w/ small <4cm, firm, unilateral, disc shapedsubareaolar mass. No nipple discharge, axillary LAD, illness. Dx & Tx?

A

Physiologic gynecomastia 2/2 excess E production.
(may be bilateral)

Tx: Reassurance & observation

DDx pseudogynecomastia (fat deposit in overweight boys)

842
Q

What is pseudogynecomastia?

A

fat deposit in breast tissue overweight boys

843
Q

8yo M w/ gynecomastia. NSIM?

A

r/o pathologic hormone imbalance

  • serum PRL if galactorrhea
  • ref: endocrinologist (r/o hyperthyroidism, hCG secreting tumor)
844
Q

Constitutional delay in puberty is considered in girls >__yo w/ short stature and NO breast development.

A

> 12yo

845
Q

F w/ secondary sexual characteristics & no menses at 15yo+. NSIM?

A

Pelvic US & FSH

or if NO secondary sexual characteristics & NO menses at 13yo+.

846
Q

F w/ NO secondary sexual characteristics & NO menses at 13yo+. NSIM?

A

Pelvic US & FSH

or if secondary sexual characteristics & no menses at 15yo+

847
Q

14yo F w/ breasts and pubic hair but no menarche. NSIM?

A

Reassure

if secondary sexual characteristics & no menses at 15yo+ > pelvic US & FSH

848
Q

SIADH:

  1. hypovolemic
  2. euvolemic
  3. hypervolemic
A
  1. euvolemic
849
Q

SIADH:

  1. SOsm ___
  2. UNa >__
A

<275 (hypotonic)
>100
>40

850
Q

Tx SIADH

A
  • fluid restriction
  • +/- Na tabs
  • hypertonic saline for severe hypoNa
851
Q

DDx Psychogenic polydipsia VS SIADH

A

UOsm
PP: <100
SIADH: >100

852
Q

Apart from meds, what is a common trigger for SIADH?

A

PNA

853
Q

First deg relative w/ CRC. Which intervals do you screen with a normal study?

A

CRC Dx
relative <60: Q5yrs
relative >60: Q10yrs

854
Q

Joint injury > local burning pain, edema, vasomotor skin changes and decreased ROM. Dx & Tx?

A

Complex regional pain syndrome

Dx increased resting sweat testing (autonomic dysfunction) OR MRI/XR w/ bone demineralization, muscle wasting

Tx
Nerve block or IV regional anesthesia

855
Q

Stages of Complex regional pain syndrome

A

Joint injury&raquo_space;>

  1. edema, vasomotor skin changes, burning pain
  2. worsening edema, skin thickening, muscle wasting
  3. limited ROM & bone demineralization on XR
856
Q

Mechanism of Complex regional pain syndrome

A
  1. Injury causing decreased sensitivity to sympathetic nerves
  2. Abnormal response to pain
  3. Increased neuropeptide release >allodynia

***90% cases dont have an identifiable nerve injury

857
Q

Hypomanic pt reports upcoming wedding to a guy she just met. NSIM?

A

Explore reasons for the marriage (DONT offer congrats and schedule close f/u for monitoring)

858
Q

30yo dude w/ oral thrush refusing HIV testing. NSIM?

A

Explore reservations

859
Q

40yo M receives Dx of being HIV+. Refusing to tell wife per fear of rejection. SIM?

A

Support pt and strongly encourage them to tell sexual partners.

Note:
Some states have duty-to-warn. Others criminalize withholding dx. Others have anonymous partner notification systems.

860
Q

T/F All new HIV cases are to be reported to Department of Health

A

TRUE

861
Q

Drug user comes in w/ mydriasis, irritability, N/V, abdominal cramping, lacrimation, myalgia/arthralgia. Dx?

A

Opioid withdrawal

862
Q

31yo M w/ epigastric fullness & occasional nausea x few months. NO heartburn, early satiety or weight loss. NSIM?

A

Hpylori testing

also EGD if high risk; GIB, w.lossm >1 alarm sx

863
Q

61yo M w/ epigastric fullness & occasional nausea x few months. NO heartburn, early satiety or weight loss. NSIM?

A

EGD

(if the same scenario was for a pt <60, first step is Hpylori unless alarm sx)

Alarm Sx:

  • progressive dysphagia
  • IDA
  • odynophagia
  • palpable mass/LAD
  • persistent vom
  • FHx GI malig
864
Q

Dyspepsia causes?

A

MCC: idiopathic
Hpylo
NSAIDs
PUD

865
Q

Indications for EGD in eval of dyspepsia?

A

<60 WITH alarm sx

>60

866
Q

MOA ovarian hyperstimulation syndrome

A

high hCG
> increased VEGF in ovaries
> increased vasc permeability
> 3rd spacing (ascites, resp distress, hemoconcentration, hypercoag, e imbalance, AKI, DIC)

867
Q

In Vitro complication w/ ascites, resp distress, hemoconcentration, hypercoag, e imbalance, AKI, DIC. Dx?

A

ovarian hyperstimulation syndrome

Eval:

  • trend CBC, electr
  • serum hCG
  • pelvic US
  • CXR
  • TTE
868
Q

Features of ovarian hyperstimulation syndrome?

A

high hCG
> increased VEGF in ovaries
> increased vasc permeability
> 3rd spacing

  • ascites
  • resp distress
  • hemoconcentration
  • hypercoag
  • e imbalance
  • AKI
  • DIC
869
Q

In Vitro complication w/ ascites, resp distress, hemoconcentration, hypercoag, e imbalance, AKI, DIC. Tx?

A

Correct electrolytes
Para/thoracentesis
- VTE ppx

870
Q

Ovarian Hyperstimulation Syndrome

1- how soon after ovulation induction does it occur?
2- findings on pelvic US?
3- lab findings?

A
  1. 1-2 wks
  2. bilaterally enlarged ovaries w/ multiple follicles
  3. Labs:
    - hemoconcentration
    - hypercoag
    - e imbalance
    - AKI
    - DIC
    - high bhCG
871
Q

In Vitro: 1-2wks later > rapid weight gain, dyspnea, oliguria. Which tests do you order?

A

Suspected Ovarian Hyperstimulation Syndrome.

  • trend CBC, electrolytes
  • monior renal function (high risk AKI)
  • hCG
  • pelvic US (enlarged ovaries, mult follicles)
  • CXR (ARDS, congestion, pleural effusion)
  • TTE (r/o pericardial effusion)
872
Q

Severe AS, now symptomatic. Prognosis if pt does not undergo valve replacement?

A

death w/in 2-3yrs

873
Q

Qualifications for severe AS:

  1. aortic jet velocity >__
  2. mean transvalvular gradient >__
  3. AV area
A
  1. > 4
  2. > 40
  3. <1cm
874
Q

Aortic stenosis w. aortic jet velocity >4 & Sx (angina, syncope, DOE). NSIM?

A

VALVE REPLACEMENT

this pt has severe AS with sx, if untreated- death w/in 2-3yrs

875
Q

Pt has severe AS> In addition to sx onset, what are the other indications for valve replacement?

A
  • LVEF <50%
  • Undergoing other cardiac procedure ie CABG

(Qualifications for severe AS:

  1. aortic jet velocity >4
  2. mean transvalvular gradient >40
  3. AV area <1
876
Q

Mother smoked during pregnancy: Neonatal complications?

A
  • DM
  • Asthma
  • Obesity
  • SIDS

(obstetric complications:

  • spontaneous abortion
  • congen abn
  • PPROM
  • preeclampsia
  • abruptio placentae
  • low birth weight
  • fetal demise)
877
Q

RF for continued smoking during pregnancy?

A
  • heavy use > 1/2 PPD

- other smokers at home

878
Q

Dyspnea, persistent cough, facial fullness/erythema, neck pain, dilated veins of the arms/neck. NSIM?

A

CT neck/chest w/ contrast r/o bronchogenic CA

Dx: superior vena cava syndrome

879
Q

MCC superior vena cava syndrome

A

Bronchogenic CA

880
Q

Initially: Dyspnea, persistent cough, facial fullness/erythema, neck pain&raquo_space;> cyanosis, collateral veins in thorax, ocular proptosis, lingual edema.) NSIM and Dx?

A

CT neck/chest w/ contrast r/o bronchogenic CA (which is causing superior vena cava syndrome)

881
Q

13yo F: short stature, no breasts, amenorrhea. Dx?

A

r/o Turners w/ karyotyping

882
Q

What kind of valvular abnormality is prevalent in Turners?

A

bicuspid aortic valve 30%

883
Q

Bicuspid aortic valve:

  1. Affects __% pop
  2. More freq in M/F?
  3. AD, AR or XL
  4. Screening TTE q__y
A
  1. 1%
  2. M>F
  3. AD
  4. Q1-2y

Also: screening TTE for first degree relatives

Tx: balloon valvuloplasty or surgery (valve & ascending aorta replacement)

884
Q

Bicuspid aortic valve: Tx?

A

Tx: balloon valvuloplasty or surgery (valve & ascending aorta replacement)

885
Q

Bicuspid aortic valve: Complications?

A
  • infective endocarditis
  • severe AR or AS
  • aortic root or ascending aortic dilation
  • dissection
886
Q

ASx 20yo M is diagnosed w/ bicuspid aortic valve on TTE. NSIM?

A

screen all first degree relatives w/ TTE

887
Q

When is ballon valvuloplasty indicated for bicuspid aortic valve?

A

Young adults who plan on becoming pregnant or participating in competative sports IF
- AS w/o calcification or regurg w/ peak gradient >40

888
Q 
Which is NOT required for balloon valvuloplasty for bicuspid aortic valve?
A) must be sx
B) aortic stenosis
C) no AV calcification
D) no AR
E) peak gradient >50
A

A) must be sx

may be symptomatic or asymptomatic

889
Q 
Which is NOT more prevalent in women who have sex w/ women?
A) cervical CA
B) breast CA
C) ovarian CA
D) MDD/anx
E) intimate partner violence
F) syphilis
G) BV
H) CVD
I) obesity
J) DM
A

F) syphilis

890
Q

Why is cervical CA prevalent in women who have sex w/ women?

A
  • less HPV vax
  • less screening
  • higher rates obesity & smoking
891
Q

Why is ovarian/breast CA prevalent in women who have sex w/ women?

A
  • higher rates smoking/obesity
  • less freq screening
  • lower parity
  • less OCP use
892
Q 
Which is NOT a reason for higher incidence of ovarian/breast CA in women who have sex w/ women?
A) higher rates smoking
B) higher rates of obesity
C) less freq screening
D) higher parity
E) loss OCP use
A

D) higher parity

893
Q

TBI > dizziness, disorientation, mild amnesia. When do you need imaging?

A

Only if HIGH RISK features are present:

  • AMS
  • LOC
  • severe HA/V
  • severe mech of injury
  • signs of basillar skull fracture
894
Q

Concussion diagnosed clinically after football head injury. When can pt resume activity?

A

24-48h rest after injury, then gradual return to activity.

  1. light aerobics
  2. moderate non-contact activity
  3. competitive play

*as tolerated
Note: if sx develop upon resuming activity go back to the previous step

895
Q

Concussion diagnosed clinically after football head injury. Pt rests 24h then resumes light activity upon which she gets dizzy. NSIM?

A

24h rest then resume light aerobics

  1. 24h rest then
  2. light aerobics
  3. moderate non-contact activity
  4. competitive play

**if sx develop with any of the steps, go back to the previous step

896
Q

Do you need imaging to r/o IC injury upon head trauma?

A

NO, only if HIGH RISK features are present:

  • AMS
  • LOC
  • severe HA/V
  • severe mech of injury
  • signs of basillar skull fracture
  • worsening sx
897
Q 
Which is NOT an indication for ICD placement in HCM?
A) FHx sudden cardiac death
B) LVH >1.5cm
C) syncope (recurrent or assd w/ exertion) 
D) non-sustained VT on Holter 
E) hypoTN w/ exercise
F) hx cardiac arrest
G) sustained spontaneous VT/VF
A

B) LVH >1.5cm

**Extreme LVH >3cm is an indication for ICD

898
Q

Why are ACEi BAD for HCM?

A

They (along with vasodilators) reduce systemic vascular resistance > worsening LVOT

899
Q

List some indications for ICD placement in HCM?

A 
A) FHx sudden cardiac death
B) extreme LVH, >3cm IV septum
C) syncope (recurrent or assd w/ exertion) 
D) non-sustained VT on Holter 
E) hypoTN w/ exercise
F) hx cardiac arrest
G) sustained spontaneous VT/VF
900
Q

Two good meds for EtOH cessation?

A
  • Naltrexone (mu opioid receptor antagonist)
    ~ Acamprosate (glutamate modulator)
  • *contraindications to naltrexone
  • pts on opioids
  • acute hepatitis
  • liver failure
901
Q

Contraindications to naltrexone?

A
  • pts on opioids
  • acute hepatitis
  • liver failure
902
Q

PCOS: first line Tx for infertility?

A
  1. Weight loss
  2. If unable/no response,
    try LETROZOLE (aromatase inhibitor)
  3. If above are ineffective, try Gonadotropins (LH, FSH) or IVF
903
Q

Why does weight loss improve fertility in PCOS?

A

decreased adipose > decreased peripheral E conversion to T via aromatase.

If unable to lose weight, try LETROZOLE (aromatase inhibitor)

If above are ineffective, try Gonadotropins (LH, FSH) or IVF

904
Q

PCOS & infertility despite unsuccessful weight loss attempts and letrozole. NSIM?

A

Gonadotropins (LH, FSH)

905
Q

Tx to prevent endometrial hyperplasia/CA in PCOS?

A

OCPs

906
Q

PCOS: high or low?
A) T
B) E

A

both high

ovaries producing tons of E&raquo_space; high conversion of E >T via aromatase

907
Q

VZV in elderly. When do you Tx w/ valacyclovir?

A

if lesions <72h

Valacyclovir

  • reduces transmission
  • reduces new lesions
  • reduces post herpetic neuralgia
908
Q 
Which is false about valacyclovir tx for VZV in elderly?
Valacyclovir 
A) does not reduce transmission
B) reduces new lesions
C) reduces post herpetic neuralgia 
D) administered if lesions <72h
A

A) does not reduce transmission

it does!

909
Q

Pt w/ shingles in R flank develops rash in L flank and upper back. NSIM?

A

Admit for disseminated VZV requiring IV acyclovir

  • increase risk of complications ie post-herpetic neuralgia, Ramsay Hunt
  • *contact/airbourne precautions
910
Q

Pt has trigeminal VZV. Later develops facial paralysis & HL on the same side. Dx & Tx?

A

Ramsay Hunt

Tx: antiviral rx

911
Q

Which kind of precautions are necessary in disseminated vs local shingles?

A

local:
rash cover, handwashing

dissem: contact/airbourne (admit to hospital for IV acyclovir)

912
Q

Poor surgical candidate w/ vaginal prolapse. Tx?

A

pessary (placed intravaginally)

If good surgical candidate: hysterectomy w/ prolapse repair

913
Q

70yo undergoes thyroidectomy. 3h later: Slurred speech, R sided weakness. NSIM?

A

CT head w/o contrast to r/o hemorrhagic CVA.

Once excluded- reperfusion )IV thrombolysis or mechanical thrombectomy initiated for PERIOPERATIVE ISCHEMIC STROKE

914
Q

Average age to star walking?

A

12-15m

915
Q

Genu varum in infant- indication for XR?

A
  • progressive bowing
  • unilateral
  • persistent >3yo (normally until 2yo)
  • assd w/ short stature (metabolic d)
916
Q

42yo w/ increasing heartburn & regurg daily. No alarm Sx. NSIM?

A

LIFESTYLE AND
PPI trial x 8wks

If fails: incease PPT to high dose BID

If fails: esophageal pH monitor or EGD

*Note: if Sx are mild, every few days, use famotidine PRN

917
Q

30yo M w/ fatigue, DOE, systolic murmur that increases w/ Valsalva & systolic anterior motion of mitral leaflets. Which meds should you avoid?

A

HCM

Vasodilators: amlodipine, nifedipine, ACE/ARBS, nitrates

(worsening of LVOT)

918
Q

23yo M w/ fatigue, DOE, systolic murmur that increases w/ Valsalva & systolic anterior motion of mitral leaflets. BB initiated w/o much sx improvement. NSIM?

A

ADD verapamil or disopyromide

(more negative inortopes to “weaken force of the contraction”

919
Q

Tx: NON-functioning pituitary adenoma (gonadotrophs) VS PRL-secreting adenomas

A

NON-functioning pituitary adenoma (gonadotrophs): TRANSSPHENOIDAL SURGERY

PRL-secreting adenomas- DOPAMINERGIC MEDS

920
Q

T/F The first line Tx of a non-functioning pituitary adenoma is surgery

A

T

NON-functioning pituitary adenoma (gonadotrophs): TRANSSPHENOIDAL SURGERY

921
Q

Medical contraindications to pregnancy?

A
  • EF <40
  • NYHA III-IV HF
  • Hx peripartum myopathy
  • severe obstructive cardiac lesions
  • severe pulm HTN
    (Eisenmenger)
  • Unstable aortic dil >40
922
Q

Woman had peripartum myopathy during last pregnancy and asks about the risk of her next pregnancy. Answer?

A

Prior peripartum cardiomyopathy is a CONTRAINDICATION to pregnancy

923
Q

30yo F w/ large VSD&raquo_space; EIsenmengers presents asking about how she should prepare for pregnancy. Answer?

A

Eisenmengers is a CONTRAINDICATION to pregnancy.

  • decreased SVR would exacerbate R>L shunting and worsen cyanosis & HF. Maternal mortality 50%. Recommend abortion & hysteroscopic sterilization or subdermal progestin implant
924
Q

Tx Eisenmengers

A

Surg:

  • heart-lung transplant
  • lung transplant plus cardiac defect repair
925
Q

Obese teen M w/ dull hip pain referred to knee, altered gait, limited internal rotation. XR: posterior * inferior displacement of femoral head. Dx & Tx?

A

Dx: Slipped capital femoral epiphysis.

Tx: avoid weight bearing
**STAT surgical pinning

Complications: avascular necrosis, OA

926
Q

Slipped capital femoral epiphysis.

  1. demographic
  2. Tx
  3. complications
  4. ulinateral/bilat?
A
  1. teen M
  2. avoid weight bearing & STAT surgical pinning
  3. Complications: avascular neccrosis, OA
  4. 20-40% have involvement of the other hip by 18m
927
Q

S/p gastrectomy > dizziness, sweating, dyspnea, N/V/D, abd pain after meals. Tx?

A

Dx: dumping syndrome

Tx: HIGH PROTEIN diet

  • small, freq meals
  • low carbs
928
Q

Negative stress test: meaning/significance?

A

<1% CVS events within the next year

test is negative if exertion >85% w/o ST depressions/elevations >1mm

929
Q

**Which meds should be HELD prior to stress test and when?

A) statin
B) BB
C) CCB
D) ASA
E) ACEi
F) nitrates
A

B) BB
C) CCB
F) nitrates

48h prior

930
Q

Upcoming stress test: Which meds should be held?

A

BB
CCB
nitrates

(NOT statin, ASA, ACEi)

931
Q

Exercise stress test:

EKG variables w/ poor prog:

  • STE
  • ST depressions >1mm
  • Vent arrhythmia

What are the clinical variables w/ poor prognosis?

A
  • poor exercise capacity
  • low workload > angina
  • Fall in SBP
  • chronotropic incompetence
932
Q

Angina: which three traits must it have to be considered classic?

A
  • typical location, quality, duration
  • provoked by exercise or emotional stress
  • relieved by NTG

If 2/3: atypical
If 1/3: non-anginal

933
Q

Centor criteria for Dx strep? (4)

Note:
low probability if <3

A
  • tonsillar exudate
  • tender anterior cervical LAD
  • fever
  • NO cough

Tx PO pen V or amox x 10 days

934
Q 
Which is NOT a part of Centor criteria to r/o GAS pharyngitis?
A) tonsillar exudate
B) cough 
C) tender anterior cervical LAD
D)  fever
A

B) cough

*absence of cough

935
Q

Familial hypercalciuric hypercalemia. What do you expect for the following:

  1. Serum Ca
  2. Urine Ca
  3. PTH
  4. bone density
  5. hyperCa Sx
  6. path?
A
  1. mildly high
  2. low
  3. wnl/high
  4. normal
  5. none
  6. mutation in CaSR (sensing receptor) > increased Ca resporp in tubules)
936
Q
  • High serum Ca
  • norm/high PTH
  • ~hyperCa Sx
  • low bone density
  • high urinary Ca excretion

What are the complications of this condition?

A

hyperPTH

Complications: CKD, nephrolithiasis, osteoporosis

937
Q

DDx urinary Ca excretion in FHH VS hyperPTH?

A

FHH: low <100
hyperPTH: high >100
(d/t accelerated bone turnover)

938
Q

Complications of FHH VS hyperPTH?

A

FHH: none

hyperPTH: osteoporosis, nephrolithiasis, CKD

939
Q

High PTHrP
What do you expect for the following:
Ca+
PTH

A

high >14
low

(seen w/ malignancy)

940
Q

urine Ca/CrCl ratio is used to DDX which two conditions?

UCa/SCa)/(UCr/SCr

A

FHH: <0.01

hyperPTH: >0.02

941
Q

Protective factors for epithelial ovarian CA EXCEPT:

A) early menarche
B) OCP
C) multiparity
D) breastfeeding

A

A) early menarche

RFs:

  • early menarche
  • late menopause
  • infertility
  • endometriosis
  • HRT
  • > 50yo
  • BRCA1/2
  • FHx
942
Q 
All are RFs for epithelial ovarial CA EXCEPT (2): 
A) breast feeding 
B) early menarche
C) late menopause
D) infertility
E) endometriosis 
F) multiparity 
G) HRT
H) >50yo
I) BRCA1/2 
J) FHx
A

A) breast feeding
F) multiparity

(both protective, along w/ OCPs)

943
Q

Complex ovarian mass discovered in F 10th wk gestation. NSIM?

  1. US Bx
  2. Chemo
  3. Rad
  4. Surgery now
  5. Surgery in 1 month
A
  1. Surgery in 1 month

**SURGERY in early 2nd trimester

Otherwise risks of torsion, rupture, labor obstruction. If CA is Dx, chemo in 2nd or 3rd trimester.
Note Bx may cause SEEDING

944
Q

Indications for excision of pelvic mass during pregnancy?

A
  • complex features
  • > 10cm
  • persistent

surgery best during early 2nd trimester

945
Q

Tunnel vision, diaphoresis, nausea pallor > syncope. Dx?

A

vasovagal

946
Q

What is COBRA?

A

“Consolidated Omnibus Budget Reconciliation Act”: legal framework in which pt who have left their employer may continue to have health benefits for a limited duration of time (ie job transition, death, divorce)

947
Q 
What do the following cover: 
A) Medicare A:
B) Medicare B:
C) Medicare C:
D) Medicare D:
A

A) inpatient services
B) outpatient services
C) enrolment in private insurance plans ie Advantage
D) meds

948
Q 
What do the following cover: 
A) Medicare A:
B) Medicare B:
C) Medicare C:
D) Medicare D:
A

A) inpatient services
B) outpatient services
C) enrolment in private insurance plans ie Advantage
D) meds

949
Q 
Which covers hospice care?
A) Medicare A
B) Medicare B
C) Medicare C
D) Medicare D
A

A) Medicare A

A) inpatient services
B) outpatient services
C) enrolment in private insurance plans ie Advantage
D) meds

950
Q

Which covers outpatient surgery?

A) Medicare A
B) Medicare B
C) Medicare C
D) Medicare D

A

B) Medicare B

A) inpatient services
B) outpatient services
C) enrolment in private insurance plans ie Advantage
D) meds

951
Q

Rise in Cr >30% after staring ACEi. Dx?

A

r/o renovascular disease

952
Q

Exam findings suggesting renovascular disease? (2)

A

abd bruit
asymmetric renal size >1.5cm

Also: imaging w/ atrophic kidney and rise in Cr >30% after staring ACEi.

953
Q

Prevalence of RAS in the following:

  1. mild HTN
  2. severe HTN
  3. PAD
A
  1. 1%
  2. 45%
  3. 30%

Confirm w/ US doppler
(or CTA/MRA)

954
Q

Recurrent flash pulmonary edema w/ severe HTN. What do you suspect?

A

r/o renovascular disease

Confirm w/ US doppler
or CTA/MRA

955
Q

Which HTN scenarios raise suspicion for renovascular disease?

A
  • resistant HTN
  • malig HTN
  • severe HTN sp 55yo
    >180/120
  • severe HTN w/ CAD/PAD
  • recurrent flash pulmonary edema w/ severe HTN.
956
Q

BEST dx test for renovascular disease?

A

US doppler

Other:
MRA- risk of nephrogenic systemic fibrosis w/ gadolinium

CTA- risk of contrast-induced nephropathy

957
Q

HTN w/ unexplained hypoK. Dx?

A 
primary hyperaldosteronism
(Conns).

Dx: aldo/renin ratio

958
Q

20yo w/ white scrapable oral plaques. In addition to HIV, which test do you order?

A

KOH or gram stain of mucosal scraping to confirm Candida

959
Q

ROUTINE testing for dementia?

A

CBC, CMP< vitB12, TSH
CT/MRI

If at risk:

  • RPR/VDRL (promiscuous)
  • folate (EtOH)
  • vitD (CKD)
960
Q

MMSE

A

<24

<26

961
Q 
Which artery supplies LATERAL WALL of the LV?
A) L circumflex
B) LAD
C) L main
D) RCA
A

A) L circumflex

962
Q 
Which artery supplies INF-POST WALL of the LV?
A) L circumflex
B) LAD
C) L main
D) RCA
A

D) RCA

963
Q 
Which artery supplies ANT & ANT-LAT WALL of the LV?
A) L circumflex
B) LAD
C) L main
D) RCA
A

B) LAD

964
Q

Hx BPH ? urinary obstruction relieved w/ FC. PSA found to be 6.5 NSIM?

A

Recheck in 6-8wks

likely high 2/2 acute manipulation, BPH & urinary retention w/ possible acute infection

965
Q

Causes of high PSA?

A

TRANSIENT

  • urinary retention
  • acute/mild prostate infection/inflam
  • urologic procedure (ie cystoscopy)
  • recent ejaculation
  • DRE

PERSISTENT

  • BPH
  • severe/chronic prostatitis
  • prostate CA
966
Q 
Which is NOT a RF for gout?
A) diuretics
B) ASA 81mg
C) cyclosporine 
D) trauma
E) CKD
F) high carb diet
G) high fat diet
H) hypovol
A

F) high carb diet

*high fat and high protein diets cause gout flares

967
Q

Arthrocentesis to r/o gout.

WBC ~ ___-___

A

2,000-100,000, PMN predom

negatively birefringent, needle-shaped monosodium urate crystals

**do NOT use uric acid levels as an indicator of gout flare

968
Q

Gout: Which is FALSE?
A) uric acid for flare Dx
B) trauma is a trigger
C) surgery is a trigger
D) arthrocentesis 2,000-100,000, PMN predom
E) arthrocentesis: negatively birefringent urate crystals

A

A) uric acid for flare Dx

**do NOT use uric acid levels as an indicator of gout flare, levels can often be wnl

969
Q

Pt w/ CKD has gout flare in big toe confirmed w/ arthrocentesis. Tx?

A

intraarticular injection or ?colchicine!
(cannot use first line indomethacin per CKD)

*if multiple joints > PO GCS

970
Q

Pakinsons > dysphagia, w.loss, frequent PNA. How do you confirm Dx?

A

videofluoroscopic swallowing study

*asp PNA: leading COD in Parkinsons!

Tx: multidisciplinary rehab program (nutrition, SLP, nursing)

971
Q

Recurrent aspiration in Parkinsons confirmed w/ fluoro. Tx?

A

Tx: multidisciplinary rehab program (nutrition, SLP, nursing)

*asp PNA: leading COD in Parkinsons!

972
Q

Recurrent PNA w/ :

  • S.pneumo
  • H.influenzae
  • Pneumocystis
  • Atypicals
A) aspiration
B) COPD
C) Immunodef: HIV, heme CA, hypogamma
D) Post-obstructive 
E) TB
A

C) Immunodef: HIV, heme CA, hypogamma

973
Q

Recurrent PNA w/ :

  • Anaerobes
  • Polymicrobial

Underlying disease?

A) epilepsy 
B) Chronic bronchitis 
C) HIV
D) Post-obstructive 
E) TB
A

A) epilepsy

Also dysphagia & EtOH

Dx: chronic aspiration

974
Q

Recurrent PNA w/ :

  • S.pneumo
  • H.influenzae
  • Moraxella catarrhalis
  • Pseudomonas
  • Viral

Underlying disease?

A) epilepsy 
B) bronchiectasis
C) HIV
D) bronchogenic CA
E) TB
A

B) bronchiectasis

and COPD, CB/emphysema, asthma

975
Q

MC location of asp PNA?

A

RML or RLL

976
Q

**MCC high output HF?

A 
MCC: morbid obesity 
AVF (congenital or acquired) 
hyperthyroidism
severe anemia
advanced cirrhosis
Pagets
thiamine deficiency
977
Q 
Which is NOT a common cause of high output HF?
A) morbid obesity 
B) thiamine deficiency 
C) AVF (congenital or acquired) 
D) hypothyroidism
E) severe anemia
F) advanced cirrhosis
G) Pagets
A

D) hypothyroidism

*hypERthyroidism is a cause

USMLE3 (3 decks)

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