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Med > Mix > Flashcards

Mix Flashcards

1
Q

Abortion due to APLS

A

before week 10

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2
Q

Normal post-void urine volume

A

Less than 12 ml

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3
Q

BPH versus prostate cancer location

A

BPH involves the Center that is transitional zone

Prostate cancer more often involves the periphery of the gland and presents with firm asymmetric or nodular enlargement

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4
Q

The preferred initial treatment for uncomplicated benign prosthetic hyperplasia

A

Alpha-1 blockers

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5
Q

5-alpha-reductase inhibitors initiation of effect For treatment of BPH

A

6-12 mo

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6
Q

Pathology associate with analgesic nephropathy

A

Papillary necrosis
Chronic tubulointerstitial nephritis
Polyuria/strile pyuria with WBC cast are early findings
Microscopic hematuria and renal colic may occur following sloughing of renal papilla
Proteinuria/impaired urinary concentration

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7
Q

Consequences of chronic analgesic abuse

A

Premature aging
atherosclerotic vascular disease
urinary tract cancer

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8
Q

Muddy brown granular cast seen in

A

Acute tubular necrosis

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9
Q

When to report to the coroner or medical examiner?

A

Patients in the hospital who died due to an unknown cause, a medical complications, suspected illegal activities, or within 24 hours of presentation

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10
Q

Pick’s disease symptoms

A 
Fronto-temporal dementia:
Personality changes (euphoria, disinhibition, apathy ) compulsive behaviors (peculiar eating habits), hyperorality, impaired memory. visual and spatial functions are usually intact
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11
Q

General paresis type of neurosyphilis

A

Decreased concentration and memory loss, dysarthria, tremor of fingers and lips, irritability and mild headache

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12
Q

PPSV23 vs PCV13

A

PPSV23: Contains 23 polysaccharides. Induces a relatively T-cell-independent B-cell-response that is less affective in young children and the elderly.

PCV13: contains 13 polysaccharides that have been covalently attached to inactivated diphtheria toxin protein. Induces a T-cell-dependent B-cell response resulting in improved immunogenicity due to the formation of higher affinity antibodies and memory cells

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13
Q

Pneumococcal vaccine recommendations

A

PCV 13 for all infants and young children.
PPSV 23 administered to adults less than 65 years old with predisposing conditions for example chronic heart/lung disease, diabetes mellitus, cirrhosis.
Both vaccines for immunocompromised patients and all individuals above 65

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14
Q

Vaccines producing a predominantly CD8+ T cell response

A

MMR

Intranasal influenza

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15
Q

Duchenne inheritance pattern

A

X-linked recessive

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16
Q

Duchenne screening test

A

CPK, aldolase

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17
Q

8 AM cortisol level/ ACTH levels in adrenal insufficiency

A

Cortisol <5 + high ACTH, confirms adrenal insufficiency

Both low, suggests central AI

Cortisol >15 rules out AI

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18
Q

Initial evaluation of pts with suspected adrenal insufficiency

A

8AM Cortisol
Plasma ACTH
ACTH stimulation test

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19
Q

Normal chloride levels

A

96 to 106

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20
Q

Aspirin exacerbated respiratory disease

A

Asthma
Chronic rhinosinositis
Nasal polyposis
Nasal congestion/bronchospasm following NSAIDs

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21
Q

Adrenal destruction to produce insufficiency

A

90%

e.g. metastasis from SCLC

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22
Q

Infectious agents causing adrenal destruction

A

TB
Fungal
CMV

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23
Q

The most common cause of vitreous hemorrhage

A

Diabetic retinopathy

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24
Q

Difficulty to visualize eye fundus or its details

A

Vitreous hemorrhage

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25
Q

Treatment of choice for malignant otitis externa

A

IV cipro

Others:
Piperacillin, ceftazidime

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26
Q

Medications causing priapism

A 
Trazodone
Prazocin (the most common)
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27
Q

Treatment of premature ejaculation

A

SSRIs (delay orgasm)

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28
Q

Intussusception in HSP versus other cases

A

More likely to be small-bowel or ileo-ileal in HSP. If do not reduce spontaneously often require surgical management.
Not evident contrast enema. Diagnosis with target sign on ultrasound

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29
Q

Acyclovir nephrotoxicity

A

When the acyclovir concentration in the collecting duct exceeds its solubility crystallization crystalluria and renal tubular damage may result.
Usually transient
Can be prevented and treated with adequate hydration and dosage adjustment and slowing the rate of intravenous infusion.

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30
Q

Treatment of acute prostatitis

A 
TMP-SMX
or
Fluoroquinolone
4-6 wk
Urethral catheterization should be avoided
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31
Q

Salicylate intoxication

A

Tinnitus, fever, tachypnea, nausea, GI irritation

Causing respiratory alkalosis+ anion gap metabolic acidosis
pH usually around normal
Rx: alkalanization and dialysis

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32
Q

Prevention of bladder complications of cyclophosphamide

A

Drinking plenty of fluids
Voiding frequently
Taking MESNA

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33
Q

Cochlear dysfunction is as side effect of

A

Cisplatin
Carboplatin
Aminoglycosides

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34
Q

Optic neuritis is a side effect of

A

Ethambutol

HCQ

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35
Q

Peripheral neuropathy is adverse effect of

A 
Phenytoin
Isoniazid
Vincristine
Heavy metals
Chronic alcohol
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36
Q

Raynaud is side effect of

A

Beta blockers

Ergotamines

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37
Q

Gout is side effect of

A

Cyclosporin

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38
Q

Brain abscess etiology in non-HIV patients

A

Viridans streptococci (the most common)
Staph aureus
Gram negatives

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39
Q

Brain abscess on CT scan

A

Typically reveals cerebritis initially, but within 1 to 2 weeks the infection consolidates to ring- enhancing and Central necrosis

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40
Q

Brain abscess treatment

A

Prolonged antibiotic therapy (metro, ceftriaxone, vancomycin) and aspiration

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41
Q

The most common source of a single brain abscess

A

Direct extension from adjacent infection for example otitis media, sinusitis, dental infection

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42
Q

Penile fracture management

A

A urological emergency and urgent surgical management is necessary

Retrograde urethrogram if: blood at the meatus, hematuria, dysuria, urinary retrntion

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43
Q

Adversely effects of Tamoxifen

A 
Hot flashes(most common)
VTE
Endometrial hyperplasia/carcinoma
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44
Q

The most common adverse effect of inhaled corticosteroid

A

Oropharyngeal candidiasis

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45
Q

Trichotillomania subtype in DSM5

A

Obsessive compulsive related disorder

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46
Q

Treatment for trichotillomania

A

Habit reversal training which is a form of cognitive behavioral therapy

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47
Q

Eye complication of neurofibromatosis

A 
Optic gliom
Causing:
Slowly progressive unilateral visual loss
Dyschromatopsia
Exophthalmus
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48
Q

Whistling noise during respiration following rhinoplasty

A

Septal perforation

Usually due to septal hematoma but also septal abscess

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49
Q

Mild proteinuria(microalbuminuria)

A

30-300 mg/d

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50
Q

Clues for reasons other than DM accountable for proteinuria in DM pts

A

Onset of proteinuria <5y after disease onset
Active urine sediment
>30% reduction in GFR within 2-3 mo of ACEI/ARB initiation

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51
Q

Respecters for developing diabetic microangiopathy

A 
DM>10y
Poor glycemic control
Elevated blood pressure 
Smoking
Increasing age
Ethnicity (African-American, Mexican-American)
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52
Q

Gall stone formation in pts on TPN is due to:

A

No protein/fat in duodenum, no secretion of CCK, gall bladder stasis.

In case of resection of distal ileum, no resorption of conjugated bile acids And Ca, increased concentration of cholesterol in hepatic bile.

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53
Q

Gallbladder stone formation in pregnancy is due to

A

Estrogen, increased cholesterol secretion

Progesterone, decreases reduces bile acid secretion and gallbladder motility

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54
Q

Lambert-Eaton involved receptor

A

Autoantibodies against Presynaptic membrane voltage-gated Ca channels in motor nerves

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55
Q

Lambert-Eaton features

A 
Proximal muscle weakness
Autonomic dysfunction
Cranial nerve involvement
Diminished or absent DTR
Vigorous muscle activity can improve reflexes and muscle strength temporarily
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56
Q

Lambert-Eaton Rx

A

Guanidine
3,4-diaminopyridine
IVIg
Immunosuppressants

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57
Q

Mixed upper and lower motor neuron symptoms

A

ALS

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58
Q

Adenomatous polyps with higher chance of malignancy

A

Sessile
Villous
Increased size (esp >2.5cm)

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59
Q

The mist common type of polyp found in colon

A

Adenomatous

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60
Q

Prevalence of adenomatous polyps

A

30-50%

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61
Q

Risk of malignancy in adenomatous polyps

A

<1%

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62
Q

People with colon polyps having positive FOB

A

5%

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63
Q

The null value of RR

A

1

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64
Q

Hyperkalemia definition

A

> 5

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65
Q

K sparing diuretics

A

Triamterene
Amiloride
Spironolactone
Eplerenone

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66
Q

K decreasing diuretics

A

Hydrochlorithiazide

Furosemide

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67
Q

K increasing drugs

A 
Non selective BB
ACEI
ARB
NSAIDs
Cardiac glycosides
K sparing diuretics
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68
Q

Gender dysphoria duration for diagnosis

A

At least six months

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69
Q

Vaginismus duration for diagnosis

A

At least six months

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70
Q

Normal calcium range

A

8.5 to 10.3

Ionized calcium 4.4 to 5.4

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71
Q

Hypercalcemia features

A

Stones, bones, abdominal moans, psychic groans

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72
Q

Deficiencies in chronic alcoholism

A 
Hypomagnesemia 
Hypokalemia
Hypophosphatemia
Hypoalbuminemia
Vit B1
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73
Q

Reason for refractive hypokalemia in people with chronic alcohol consumption disorder

A

Hypomagnesemia

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74
Q

IgA nephropathy (vs PSGN)

A

Within 5 days after infection (vs 10-21d in PSGN)
Young male adults, 20-30y (vs children 6-10y)
Normal complement (vs low C3)

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75
Q

The most common cause of GN in adults

A

IgA nephropathy

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76
Q

GNs with low complement level

A

PSGN (C3)

Lupus (C3, C4)

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77
Q

Hemorrhagic transformation definition

A

Deterioration of neurological status in less than 48 hours after the initial ischemic stroke,

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78
Q

Patients more susceptible to hemorrhagic transformation

A

If stroke affects a large area
If stroke is due to an embolic cause
If a stroke has been treated with thrombolytics

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79
Q

Management of hemorrhagic transformation

A

Emergent noncontrast CT scan of the head

Urgent surgical decompression

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80
Q

Saline responsive metabolic alkalosis (volume loss)

A

Vomiting (low urine chloride)
NGT (low urine chloride)
Prior diuretic use (low urine chloride)
Current diuretic (urine chloride high)

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81
Q

Saline unresponsive metabolic alkalosis

A 
Bartter
Gitelman
Primary hyperaldostronism
Cushing
Ectopic ACTH

All with high urine chloride

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82
Q

The difference between previous and current diuretic consumption

A

Low urine chloride level in prior diuretic use

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83
Q

Extrathyroidal manifestations of secondary hyperthyroidism

A

None

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84
Q

Normal TSH range

A

0.45 to 4.12

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85
Q

Normal T4 level

A

4.6 to 12

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86
Q

Normal T3 levels

A

80 to 180

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87
Q

MPGN Pathology/pathogenesis

A

Dense intramembranous deposits that stain for C3. (Type2, dense deposit disease)

Due to IgG Ab against C3 convertase of the alternative complement pathway (C3 nephritic factor). These Abs lead to persistent complement activation and kidney damage

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88
Q

Nephrotic syndrome complications

A 
Increased TG, Cholesterol
Hypercoagulability state
Increased risk of atherosclerosis, stroke, MI
Decreased Vit D, increased PTH
Decreased iron, alb, protein
Loss of transferrin, microcytoc anemia
Loss of TBG, decreased T4 levels
Decreased immunity
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89
Q

The most common manifestation of coagulopathy in nephrotic syndrome

A

Renal vein thrombosis

Usually due to membranous glomerulopathy

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90
Q

Associations of ADPKD

A 
Hepatic cysts
Berry aneurisms
Mitral valve prolapse
Aortic regurgitation
Colonic diverticuli
Abdominal wall/ inguinal hernia
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91
Q

Oligohydramnios in late-term with normal fetal screening tests

A

Delivery

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92
Q

Mg excretion

A

Solely by kidneys, therefore needs dose adjustment based on kidney function

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93
Q

Mg toxicity management

A

Stop Mg therapy

Give IV Ca Gluconate

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94
Q

Flushing
Headache
Nausea
Hyporeflexia

A

mild Mg toxicity

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95
Q

Hypocalcemia
Areflexia
Somnolence

A

Moderate Mg toxicity

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96
Q

Anosognosia

A

Lack of insight

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97
Q

Brain lobe damage resulting receptive aphasia

A

Left temporal lobe

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98
Q

Brain lobe damage responsible for motor aphasia

A

A frontal cortex lesion if the dominant lobe is involved

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99
Q

Urine osmolality in primary polydipsia

A

<100 mOsm/kg

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100
Q

Nephrolithiasis <5mm Rx

A

NSAIDs

Fluid intake> 2 litter/d

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101
Q

Indication of complete and detailed metabolic evaluation and patients with urinary stones

A

Recurrent stone

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102
Q

A complete urinary evaluation for recurrent stone includes

A

Calcium, citrate, creatinine, uric acid, oxalate, pH, sodium levels

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103
Q

MgSO4 for PTL up to

A

To all < 32 wk

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104
Q

Tocolytic+betamethasone for PTL

A

To all <34 wk

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105
Q

For 35th, 36th, 37th wk PTL

A

+/- Betamethasone

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106
Q

GBS prophylaxis in cesarian versus vagina delivery

A

Not needed for cesarian unless indications present AND PROM

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107
Q

Body habitus in MEN2B

A

Marphanoid
Kyphosvoliosis
Lordosis

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108
Q

Test necessary for pts with MTC

A

RET mutation (to look for pheo before operation of MTC)

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109
Q

Cystinuria

A 
Hexagonal crystals in urine
Defective transport of dibasic aa
Radio-opac, hard
Recurrent stones since childhood
Positive family history
Positive urinary cyanide nitroprusside test (screening, comfirmation)
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110
Q

The greatest risk factor for variant angina

A

Smoking

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111
Q

Associations of variant angina

A

Raynaud

Migraine

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112
Q

Factors worsening variant angina

A 
Exercise
Hyperventilation
Emotional stress
Cold wxposure
Cocaine use
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113
Q

Prinzmetal ECG

A

ST elevation during attack (during the night)

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114
Q

Rx of variant angina

A

CCB
Nitrate
+smoking cessation

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115
Q

Drugs that should be avoided in prinzmetal

A

BB

ASA

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116
Q

Migraine preventative Rx

A 
BB
Topiramate
Valproate
TCA (amitriptyline)
Venlafaxine
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117
Q

Migraine abortive Rx

A 
NSAIDs
Acetaminophen
Antiemetics
Ergots
Triptans
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118
Q

Anti epileptic drugs causing low folate levels

A

Phenytoin
Primidone
Phenobarbital
(Inhibit intestinal absorption)

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119
Q

Drugs antagonizing dihydrofolate reductase

A

Trimethoprim

MTX

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120
Q

At which GFR will there be metabolic acidosis due to renal failure?

A

<20

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121
Q

Normal AG metabolic acidosis with hyperkalemia (+ mild/moderate RF)

A 
Hyperkalemic RTA (type4)
Aldosterone deficiency/resistance
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122
Q

RTA in DM pts

A 
RTA 4 (damage to juxtaglomerular apparatus)
They have:
K: 5.2-6
HCO3: 15-20
GFR: 20-50
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123
Q

How to discontinue lithium

A

Slow tapering

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124
Q

Neurocysticercosis Rx

A

Albendazole

CS seizure/ICH Rx

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125
Q

Tinea solium infection route

A

Fecal-oral, ingested eggs

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126
Q

Myasthenia crisis onset symptoms

A

Generalized and bulbar muscle weakness

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127
Q

Factors precipitating myasthenic crisis

A

Infection
Surgery
Drugs (azithromycin, aminoglycosides, BB)

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128
Q

Myasthenic crisis Rx

A

If deteriorating respiratory status, intubate
Pyridostigmine temporarily held (to reduce secretions)
CS
IVIG or plasmaphresis (preferred) once stabilized
+/- MFM, AZA

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129
Q

Chlorthalidone drug category

A

Thiazide diuretic

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130
Q

Thiazides metabolic effect

A

Increased insulin resistance, increased BS

Increased TG, Cholesterol

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131
Q

The thiazide diuretic with most hyperglycemic effect and most cardiovascular beneficial effect

A

Chlorthalidone

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132
Q

Late-onset CAH symptoms

A 
Premature adrenarche/pubarche 
Severe cystic acne (resistant to Rx)
Accelerated linear growth
Advanced bone age
Normal electrolytes
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133
Q

Idiopathic precocious puberty

A

Almost exclusively in girls

Accounts for 80% of gonadotropin-related puberty

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134
Q

Center (gonadotropin-dependent) vs peripheral (gonadotropin-independent) puberty

A

Baseline level of LH is increased or will Increased with GnRH stimulation

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135
Q

Neurological symptoms in Plagra

A

Affective symptoms, memory loss, psychosis

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136
Q

niacin deficiency observed in:

A 
Corn products as main food (deficient in B3)
Alcoholism
Chronic illness
Carcinoid syndrome
Hartnup disease
Prolonged INH
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137
Q

Post void residual volume diagnostic of retention

A

> 50 ml

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138
Q

Uncomplicated cystitis w/u

A

Just urinalysis

Culture not needed unless failure of initial treatment

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139
Q

Complicated cystitis

A

Associated DM, pregnancy, RF, obstruction, catheter, procedure, ImSupp, hospital acquired

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140
Q

Rx for uncomplicated cystitis

A

Nitrofurantoin 5 d
TMP/SMX 3 d
Fosfomycin single dose
Q if above not possible

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141
Q

Rx of complicated cystitis

A

Urine culture
Q (cipro, levo) 5-14 d
Ampi/genta , ceftriaxone if severe

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142
Q

Pyelonephritis Rx

A

U/C
Outpatient: Q (cipro, levo)
Inpatient: Q, AG +/- ampi

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143
Q

If symptoms of UTI with negative U/A (dipstick)

A

U/C

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144
Q

Positive nitrite in U/A indicates

A

Enterobacteriaceae

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145
Q

Tx of a single bone eosinophilic granuloma (LCH)

A

Conservative

Spontaneously resolves

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146
Q

Most common etiology of nephrotic syndrome associated with renal vein thrombosis

A

Membranous glomerulopathy

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147
Q

Asymptomatic bacteriuria in pregnancy

A

Culture > 100,000 colonies/ml

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148
Q

Rx of UTI/ asymptomatic bacteriuria in pregnancy

A 
Nitrofurantoin 5-7 d
Amoxi, amoxi-clav 3-7 d
Fosfomycin single dose
Cephalexin
Avoid: Q
Avoid: TMP-SMX in 1st and 3rd T
Test of cure
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149
Q

Pyelonephritis treatment during pregnancy

A

Hospitalization
Intravenous antibiotics (b-lactams, meropenem)
Avoid aminoglycosides unless other agents cannot be used
Change to 10 to 14 day course of oral antibiotics after afebrile for 24 hours

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150
Q

Other name for osgood-schlatter

A

Traction apophysitis of tibial tubercle

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151
Q

PAS-positive material in intestinal lamina propria

A

Whipple

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152
Q

Whipple symptoms

A 
White men
4th-6th decades of life
Wt loss
Abd pain, diarrhea, malabsorption,distention, flatulence, steatorrhea
Migratory polyarthropathy
Chronic cough
Myocardial, valvular involvement
Dementia, Supranuclear ophthalmoplegia, myoclonus
Intermittent low grade fever
Skin pigmentation
LAP
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153
Q

Indication of renal Bx in children with nephrotic syndrome

A

> 10 y/o
Unresponsive to Tx
Progressive

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154
Q

Intervention based on APGAR

A

< 7, further evaluation and resuscitations,
If apnea/gasping, HR< 100, positive pressure ventilation, +/- ETT
HR< 60, intubate, chest compression, 100% O2

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155
Q

Children stroke etiologies

A

SCD (Hx of pain crisis, dactylitis, ethnicity)
congenital diseases
Infections
Systemic illness

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156
Q

Diagnosis of fat emboli

A

Presence of fat droplets in urine

Intra-arterial Fat globules on fundoscopy

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157
Q

CXR in fat emboli

A

Diffuse bilateral pulmonary infiltrates

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158
Q

Time of fat emboli

A

12-72 hr after injury

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159
Q

Rx of fat emboli

A

Respiratory support

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160
Q

Mediastinal germinal cell tumor markers

A

Seminoma (beta in 1/3)

Non- seminomatous (AFP, beta

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161
Q

Esophageal coin Rx

A

If asymptomatic: observe for 24 hours

If symptomatic, time unknown: flexible endoscopy

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162
Q

Batteries, sharp objects, multiple magnets in esophagus Rx

A

Immediate endoscopy

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163
Q

Dx of wilson

A

Low serum ceruloplasmin (<20)
Increased urinary copper excretion
Kayser-Fleischer

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164
Q

PAS positive, diastase resistant granules on hepatic Bx

A

Alpha1 antitrypsin deficiency

165
Q

Mallory bodies on liver biopsy

A

Wilson

166
Q

Dx of Ogilvie syndrome

A

Abdominal CT

167
Q

Spinal cord complication years following a cord injury

A

Syringomyelia (whiplash injury)

168
Q

Post operative mediastinotis presentation

A

Within 14 days

169
Q

Acute mediastinitis Rx

A

drainage
debridement
Immediate closure
Antibiotics, prolonged

170
Q

Anabolic steroid abuse signs

A 
Infertility
Acne
Gynecomastia
Hepatic failure
Cholestasis
dyslipidemia
Elevated Hb
Elevated Crdecreased testicular size
Aggressiveness
Psychosis
Decreased FSH, LH, GnRH
171
Q

Pts with CAD who should refrain from sex

A 
Ongoing stable/unstable angina
Incomplete revascularization
LV dysfunction
Symptomatic heart failure
High risk arrhythmia 
Within 2 wk of MI

Until appropriately evaluated and stabilized

172
Q

1st line Tx for erectile dysfunction in CAD

A

Sildenafil

Contraindicated with nitrates and a-blockers

173
Q

Blue discoloration of vision

A

Sildenafil

174
Q

First line treatment for erectile dysfunction in diabetic patients

A

Sildenafil

175
Q

Chronic prostatitis or chronic pelvic pain syndrome symptoms

A 
Pelvic pain for more than three months without an identifiable cause
Irritative voiding symptoms
Pain with ejaculation
Blood in the semen
Afebrile
Little or no prostate tenderness
Normal urinalysis and urine culture
Treatment includes:alpha blockers, 5alpha reductase inhibitors, antibiotics (Q)
176
Q

Testicular tumor with increased testosterone and estrogen

A

Leydig

177
Q

Isolated Diminished or lost Achilles reflexes in old ages

A

Normal finding

178
Q

Cryptochidism Tx

A

Surgery before one year of age

179
Q

Neonatal hydrocele management

A

Both communicating and non-communicating hydroceles will resolve spontaneously by the age of 12 months and can be safely observed during that period.

180
Q

Varicocele treatment

A

If fertility desired: ligation of gonadal vein

If fertility not desired: Scrotal support and NSAIDs.

181
Q

The most common form of shoulder dislocation

A

Anterior

182
Q

Anterior versus posterior shoulder dislocation

A

Anterior: arm slightly abducted externally rotated
Posterior: arm adducted and internally rotate had

183
Q

Duchenne vs Becker muscular dystrophy

A

Absent vs reduced Dystrophin

Under 5 vs older than 5 y/o

184
Q

Friedriech ataxia

A 
The most common type of spinocerebellar ataxia
AR
Presentsbefore 22 y
Gait ataxia
Dysarthria
Concentric hypertrophic cardiomyopathy
DM
Hammer toe
Scoliosis
Dysmetria
Nystagmus
Ansent DTR
185
Q

Bacterias causing HUS

A

EHEC
Shigella
Pneumococ

186
Q

Iridodonesis

A

A rapid contraction and dilation of the iris in Marfan

187
Q

Marfan mutation

A

Fibrillin-1

AD

188
Q

Homocystinuria

A 
AR
Deficiency of cystathion synthase
(Metabolism of methionine)
Fair complexion
Thromboembolic events
Intellectual disability 
Downward lens dislocation
189
Q

EDS

A

Collagen disorder

190
Q

Fibrillin2 mutation

A

Congenital contractional arachnodactyly
No ocular/ cardiovascular disorder
Joint contractures

191
Q

Narrow forehead
Almond-shaped eyes
Downturned mouth
compulsive binge eating

A

Prader-Willi syndrome

Maternal uniparental disomy

192
Q

Prominent forehead

Macrorchidism

A

Fragile X

193
Q 
Hyperuricemia
Self mutilation
Mental retardation
Dystonia
Choreoathetosis
A

Lesch-Nyhan

194
Q

Precocious puberty
Cafe-au-lait
Polyostotic fibrous dysplasia
+/- (hyperthyroidism, prolactin- , GH-secreting pituitary adenoma, adrenal hypercortisolism)

A

McCune-Albright

Sporadic

195
Q

Chlamydia/gonorrhea screening

A

NAAT method (on urine, endocervical, urethral, vaginal specimens)
Target:
High risks
Sexually active <25

196
Q

If positive NAAT

A

AB
Abstinence from sex
Testing of partner within past 2 mo

197
Q

ECG, Echo, exercise test in athletes indicated when:

A 
Marfan
Chest pain
DOE
FHx of CMP, long QT Syndrome
Premature cardiac death/disability in close relative <50
198
Q 
Clenched hands with overlapping fingers
Micrognathia
Low set ears
Heart defect
Renal defect
Limited hip abduction
Rocker-bottom feet
A

Trisomy 18

199
Q 
Aplasia cutis
Microphthalmia
Microcephaly
Holoprosencephaly
Polydactyly
Cleft palate
Cardiac defect
Umbilical hernia/omphalocele
Renal defect
Rocker-bottom feet
A

Trisomy 13

200
Q

Lymphedema
Cystic hygrome
Fetal hydrops
Horse-shoe kidney

A

Turner

201
Q

C1q and C4 levels in angioedema

A

C1 q normal in hereditary angioedema, depressed in acquired form.
C4 levels depressed in all forms of angioedema.

202
Q

Angioedema due to ACEI occurs at:

A

Anytime

Tx: epinephrin if life threatening

203
Q

Drug causing HUS

A

Cyclosporine

204
Q

Cyclosporine neurotoxicity

A 
Often reversible
Headache
Visual disturbance
Seizure
Mild tremor
Akinetic mutism
205
Q

Tx Of hypertension due to cyclosporine

A

Calcium channel blocker

206
Q

The most common side effect of cyclosporine

A

Nephrotoxicity

Reversible or irreversible

207
Q

Drug with gout as side effect

A

Cyclosporine

208
Q

Cyclosporine side effects

A

Nephrotoxicity, hypertension, neurotoxicity, glucose intolerance, infection, malignancy, gingival hypertrophy, gout, hirsutism, GI manifestations, hyperkalemia, hypophosphatemia, hypomagnesemia

209
Q

Tacrolimus versus cyclosporine regarding side effects

A

Tacrolimus does not cause hirsutism or gum hypertrophy

And has a higher incidence of neurotoxicity diarrhea and glucose intolerance

210
Q

Chronic granulomatous disease

A

XLR
Inability to produce hydrogen peroxide, impaired intracellular killing in phagosomes.
Recurrent pulmonary and cutaneous infections, suppurative adenitis, osteomyelitis.
Catalase positive organisms (staph A, serratia, Burkholderia, aspergillus, nokardia)
Test: Neutrophil function testing:
Dihydrorhodamine 123 test
Nitroblue tetrazolium test
Normal CBC
Tx: prophylaxis with: TMP-SMX, itra. IFN gamma injection if severe

211
Q

Chediak-Higashi

A

Staph A, strep pyogenes

212
Q

Leukocyte adhesion efficiency

A 
Impaired neutrophil migration
Delayed umbilical cord separation (>21d)
Recurrent nonpurulent skin infection
Severe Periodontitis, omphalitis
Marked neutrophilia
Poor wound healing
Staph A, G negative bacilli
213
Q

CVID

A 
Recurrent respiratory and G.I. infections:
Pneumonia, sinusitis, otitis
Salmonella, campylobacter, giardia
AI disease: 
RA, thyroid
Chronic lung disease: 
Bronchiectasis
G.I. disorders:
Chronic diarrhea(spru-like) , chronic giardiasis
IBD-like conditions
Granuloma development
Increased risk for NHL
214
Q

CVID diagnosis

A

Low IgG, IgA/IgM
No response to vaccination
Tx: Ig Replacement therapy

215
Q

The most common primary immunodeficiency in adults

A

CVID

216
Q

Hyper IgM shndrome

A

Absence of CD40 ligand on T-cells
Increased IgM
Decreased other classes of Ig
Nl B-cell count
Recurrent sinopulmonary infections with encapsulated bacteria
Increased risk of opportunistic infections (PCP)
FTT
Tx: prophylactic ABs, interval IVIg admenistration

217
Q

Bruton

A 
X-linked 
Agammaglobulinemia
Low Igs
Absent/low B-cells
Absence of lymphoid tissue
218
Q

The most common primary immunodeficiency

A

Selective IgA deficiency

219
Q

Selective IgA def

A

Usually asymptomatic
Recurrent Sinopulmonary and gastrointestinal infections
Associated with Autoimmune diseases and atopy
Anaphylaxis during transfusion
Low or absent IgA

220
Q

Traveling to north Africa

A 
Vaccins:
Hepatitis A (the most common vaccine preventable disease)
Hepatitis B
Typhoid
Polio booster
221
Q

Yellow fever vaccine

A

For those traveling to sub-Saharan Africa and equatorial South American countries

222
Q

Meningococcal vaccination

A

Hajj

223
Q

Contraindication to pertussis vaccine

A

Progressive neurologic disorder (until treatment is established and condition stabilized)
Encephalopathy within a year of previous vaccine dose

224
Q

Precautions for dT vaccine:

A

Moderate-severe acute illness
Guillain Barré within 6 wk of vaccine
Arthus type hypersensitivity following dT containing vaccine

225
Q

Precautions for pertussis vaccine

A

Moderate or severe acute illness
Reaction to previous doses
Seizure within three days
Temperature 40.5 or higher within two days
Hypotonic hyporesponsive episode within two days
Inconsolable persistent crying within two days

226
Q

Vaccinations in stable preterm infants

A

According to chronological age

227
Q

The exception to hepatitis B vaccine at birth in a premature infant

A

Weight under 2 kg

228
Q

Rota vaccine contraindication

A

Anaphylaxis
Hx of intussusception
History of uncorrected congenital malformation of the gastrointestinal tract for example Meckel’s diverticulum
SCID

229
Q

SCID

A

Failure of T cell development
X linked recessive
Autosomal recessive
Recurrent severe viral fungal or opportunistic infections
FTT
Chronic diarrhea
Low Ig levels
Low T cell count (viral, fungal, opportunistic)
B cell dysfunction (sinopulmonary, GI infections)
Chronic diarrhea
Absence of lymphoid tissue on examination
Treatment: stem cell transplant

230
Q

Vaccines contraindicated in CLA (Bruton)

A

Live vaccines

231
Q

Randomization is a method to control

A

Confounding

Selection bias

232
Q

Statistical modeling for example multi variant analysis is to control

A

Confounding

233
Q

The null value for correlation coefficient

A

0

234
Q

Confounding versus effect modification

A

Can be elucidated via stratification:
If stratification leads to no significant difference in the stratified groups then it is confounding.
Conversely if there is a significant difference between the two groups then the variable is an effect modifier.

235
Q

When is the odd ratio a good approximation of relative risk in a study

A

When the disease is rare

236
Q

The medication reconciliation intervention most likely to result in a decrease in adverse drug events and healthcare utilization

A

Pharmacist directed interventions

High-risk patients targeted interventions

237
Q

Respondent bias

A

Is present when the outcome is obtained by the patient’s response and not by objective diagnostic methods
For example migraine headache

238
Q

The effect of sample size on confidence interval

A

Smaller sample size=increased CI=decreased power

Larger sample size=decreased CI=increased power

239
Q

Hazard ratio

A

The ratio of an event rate occurring in the treatment group compared to an event rate occurring in the non-treatment group. A ratio less than 1 indicates that the treatment group had a significantly lower events rate while values greater than 1 indicate that the treatment group had a much higher event rate.

240
Q

Factorial design

A

Involves two or more experimental interventions, each with two or more variables that are studied independently

241
Q

Susceptibility bias

A

When is the treatment regimen selected for a patient depends on the severity of the patient’s condition, a form of selection bias known as susceptibility bias can result (confounding by indication)

242
Q

Intention to treat analysis

A

To avoid selection bias in studies patients are randomly assigned to treatments to minimize potential confounding variables. many studies also perform any intention to treat analysis to deal with the selection bias. An I TT analysis compares 2 initial randomized treatment groups (the original intention) regardless of the eventual treatment, to avoid counting crossover patients.

243
Q

As-treated analysis

A

Conversely to ITT, as-treated analysis compares the groups based on the actual treatment received. An as-treated analysis is performed to gauge the effectiveness of the treatment itself, with less regard for potential confounders.

244
Q

Drugs associated with photosensitivity reaction

A 
Tetracyclines
Chlorpromazine
Prochlorperazine
Furosemide
Hydrochlorothiazide
Amiodarone
Promethazine
Piroxicam
245
Q

Infection organisms in burn patients

A

Staphylococcus aureus and other gram-positive organisms immediately after a severe burn
After more than 5 days most infections are due to gram-negative organisms (for example pseudomonas aeruginosa) or fungi (for example Candida)

246
Q

Burn patients more susceptible to infection

A

If more than 20% surface area is involved

247
Q

The earliest signs of infection in a burn patient

A

A change in appearance ( partial thickness injury turns into a full thickness injury) of the wound or the loss of a viable skin graft

248
Q

Burn wound sepsis findings

A

T<36.5 or >39
Progressive tachycardia>90
Progressive tachypnea>30
Refractory hypotension (systolic blood pressure <90)

249
Q

Diagnosis of burn wound infection:

A

Quantitative wound culture (>100,000/g)

Biopsy to determine tissue invasion depth

250
Q

Treatment of burn wound infection

A

Piperacillin/tazobactam
Carbapenem
+/- vancomycin (MRSA)
+/- AG (MDR pseudomonas)

251
Q

Burn wound infection symptoms

A 
A change in appearance of the wound
Reduce or increase temperature
Tachycardia
Tachypnea
Hypotension
Oliguria
Unexplained hyperglycemia
Thrombocytopenia
Mental status changes
252
Q

Erysipelas vs cellulitis

A

Raised edges vs flat edges
Rapid spread vs indolent spread
Early fever vs later fever

253
Q

Self resolution of molluscum

A

Within 6 to 12 months

254
Q

Molluscum virus

A

Pox

255
Q

Treatment of low risk BCC on trunk and extremities

A

Electrodesiccation and Curettage

256
Q

Treatment of high-risk BCC on trunk and extremities

A

Total excision with 3 to 5 mm margins

257
Q

Treatment of BCC on face

A

Mohs

258
Q

Conditions associated with PTC

A 
Hepatitis C
HIV
Excessive alcohol consumption
Estrogen use
Smoking
259
Q

Treatment of PCT

A

Hydroxychloroquine
Phlebotomy
Treatment of the underlying condition

260
Q

Treatment of seborrheic dermatitis

A

First line: emollience and non-medicated shampoos

Second line: topical antifungals or low potency glucocorticoids

261
Q

medications causing drug-induced acne

A 
Steroids
Androgens
Azathioprine
EGFR inhibitors
Phenytoin
Antipsychotics
Isoniazide 
Cyclosporine
262
Q

Chloracne locations

A

Head, neck, axilla

Exposure to pollutant dioxin

263
Q

The most common reason for black dot Tinea capitalist

A

T. Tonsurans

264
Q

Pityriasis versicolor micro-organism

A

M. Gobosa

265
Q

The infection causing TEN

A

Mycoplasma pneumoniae

266
Q

Potassium levels in primary adrenal insufficiency versus Central adrenal insufficiency

A

Those with PAI usually have hyponatremia and hyperkalemia due to concurrent mineralocorticoid insufficiency. by contrast potassium is normal in patience with Central adrenal insufficiency, although hyponatremia can be present due to increased release of antidiuretic hormone

267
Q

Treatment for adrenal crisis

A

Should be started empirically with intravenous hydrocortisone or Dexamethasone and with aggressive fluid support

268
Q

Doses of corticosteroid Needing stress does during acute illness

A 
Three weeks in patients taking prednisones 20 mg/day or higher.
Patients taking less than 5 mg have minimal risk and usually do not require a stress dosing.
Intermediate does (5 to 20) can cause HPA suppression and require pre-operative evaluation with an early morning cortisol levels to determine risk.
269
Q

Primary vs secondary adrenal insufficiency

A

Primary: hyponatremia, hyperkalemia, hyperchloremic metabolic acidosis, hypotension, hyperpigmentation. Other AI disorders.
Secondary: normal K, normal acid-base, normal/low Na.

270
Q

Acute adrenal crisis symptoms

A

Abdominal pain
shock
fever
Altered mental status

271
Q

Adrenal insufficiency due to HIV

A

can be due to opportunistic infections

Or due to treatment with Azoles

272
Q

Initial evaluation of adrenal insufficiency

A

8 AM cortisol
Baseline ACTH
Cosyntropin stimulation

273
Q

The most common electrolyte abnormality in PAI

A

Hyponatremia

274
Q

Ovary dysfunction syndrome’s discovered by karyotyping

A

Turner

Fragile x

275
Q

Diagnosis of carcinoid syndrome

A

24 hour urinary excretion of 5-HIAA
CT/MRI of abd, pelvis
OctreoScan to detect metastases
Echo if symptoms of carcinoid heart disease

276
Q

Carcinoid syndrome treatment

A

Octreotide ( if symptomatic/prior to surgery or anesthesia)

Surgery for liver metastasis

277
Q

Heart problem with carcinoid syndrome

A

Tricuspid regurgitation

278
Q

Effect of hypomagnesemia on Ca, P, PTH

A

PTH level is variable (decreased mg induces PTH resistance, decreases PTH secretion)

Ca level is low
P level is normal

279
Q

Effect of renal failure on Ca, P, PTH, Calcitriol

A

Decreased GFR -> increased P -> increased PTH, decreased D3, decreased Ca (binding) -> more decrease in Ca, more increase in PTH

280
Q

The effect of decreased vitamin D on serum P calcium and PTH

A

P: low to low-normal
Ca: normal
PTH: high

281
Q

The age of percentile drop in children with constitutional growth delay

A

Between 6 months to 3 years of age

282
Q

Cushing disease

A

ACTH producing pituitary adenoma

283
Q

Normal serum osmolality

A

275 to 295

284
Q

Normal serum sodium

A

135 to 145

285
Q

Normal urine osmolality

A

300 to 900 usually 500 to 800

286
Q

Labs in Primary polydipsia

A

Hyponatremia (<137)
Urine osmolality <100 (<1/2 of plasma)
Urine osmolality < serum osmolality

287
Q

Which urine osmolality rules out DI?

A

> 600

288
Q

Serum Na in central vs nephrogenic Na

A

Central DI: high serum Na (>150 due to thirst impairment)

Nephrogenic DI: nl (intact thirst)

289
Q

HbA1c levels

A

6.5 and more, DM
<5.7, Nl
5.7-6.4, increased risk

290
Q

FBG interpretation

A

> 125, DM
100-125, increased risk
<100, Nl

291
Q

Oral hypoglycemic agent helping weight reduction

A

GLP-1 receptor agonist:

Exenatide, liraglutide

292
Q

OHA after metformin failure

A

Usually sulfonylurea

But also TZD, GLP-1 inh,…

293
Q

Second agent for metformin failure

A

Depends on pt’s condition

294
Q

OHA with adverse effect of bone fracture

A

TZD, pioglitazone

295
Q

OHA with adverse effect of bladder cancer

A

TZD: pioglitazone

296
Q

Can pioglitazone be used in Renal failure?

A

Yes

297
Q

Wt neutral OHAs

A

Metformin

DPP-4 inhibitors (sitagliptin)

298
Q

Sitagliptin

A

Wt neutral
DPP-4 inh
Low risk of hypoglycemia
Ok in renal insufficiency

299
Q

OHA with adverse effect of pancreatitis

A

GLP-1 agonist

300
Q

OHA acting via increase of incretin

A

DPP-4 inh

301
Q

The primary intervention to slow decline in GFR after development of azotemia diabetes mellitus

A

Intensive blood pressure control

302
Q

Initial risk of initiating ACE inhibitors or ARB in patients with diabetic nephropathy

A

Acute decline in GFR

Hyperkalemia

303
Q

The amount of daily protein recommended for patience with diabetic nephropathy and azotemia

A

0.8 mg/kg/d

304
Q

First line antihypertensive treatment in Black pts with or without CKD

A

With CKD: ACEI, ARB

Without CKD: diuretics, CCB

305
Q

Rx for painful diabetic neuropathy

A

TCA
duloxetine
Pregabalin
Gabapentin

306
Q

Pregabalin Mechanism of action

A

It is a structural analog of GABA and decreases pain by inhibiting the release of excitatory neurotransmitters by binding to voltage gated calcium modulators on nerve terminals.

307
Q

Amitriptyline not good for:

A

> 65 y

Cardiac disease

308
Q

Tests for sensory deficits in diabetic foot

A 
Sense of pressure: 10 g monofilament
Vibration: tuning fork
Pain: pinprick
Temprature
Proprioception
Ankle jerk
309
Q

Small fiber versus large fiber neuropathy in DM

A

Small fiber: positive symptoms: pain, paresthesia, allodynia.

Large fibers: negative symptoms: numbness, loss of vibration/proprioception, diminished ankle reflexes

310
Q

When to start K in DKA pt?

A

If levels reach<4.5

311
Q

When to add bicarbonate in DKA pt?

A

If pH< 6.9

312
Q

When to add P in DKA pt?

A

If < 1

313
Q

The best markers indicating resolution of ketonemia

A

Serum anion gap
Betahydroxybutirate

Also: rise in serum bicarbonate and pH

314
Q

Measurement of parameters in DKA

A

Glucose: every hour

Electrolytes and anion gap: every 2-4 h

315
Q

When to add dextrose in DKA?

A

Glucose 200

316
Q

When to change serum in DKA?

A

First: NS

When glucose reaches 200: HS+ D5% + K 20mEq/L

317
Q

Dx of DKA:

A

pH: <7.3
Bicarbonate <15-20
BG> 250

318
Q

The most common pattern of sick euthyroid disease

A

TSH: Nl
FT4: Nl
Total and FT3: decreased

If disease continues:
All decrease

Recovery:
Transient increase in TSH

319
Q

Factors inhibiting peripheral T4 to T3 conversion:

A 
Caloric deprivation
Increased CS
Increased inflammatory mediators
Free fatty acids
Certain medications
320
Q

Positive prussian blue stain in urine indicates

A

Hemosiderin

321
Q

Diabetic gastroparesis treatment

A

Metoclopramide
Erythromycin (IV in acute exacerbations)
Cisaoride (risk of arrhythmia and death)

322
Q

Gaucher manifestations

A

Severe splenomegaly, hepatomegaly
Anemia, thrombocytopenia
Bony pain
FTT, delayed puberty

Glucocerebridase deficiency
Tx: enzyme replacement

323
Q

Glucagonoma

A

NME
Mild DM, easily controllable by OHA & diet
Wt loss m, diarrhea
Ataxia, dementia, proximal muscle weakness
VTE
Anemia
Glucagon >500

324
Q

The major gluconeogenic aa in the body

A

Alanine

325
Q

Onset of gluconeogenesis

A

After 12 hour of fasting

326
Q

Von-Gierkes disease

A 
Glucose 6-phosphotase deficiency
Type 1 glycogen storage disease
3-4 mo of age
Liver, kidneys, intestinal mucosa
Hypoglycemia
Lactic acidosis
Hyperuricemia
Hyperlipidemia
Seizures (hypoglycemic)
Doll-like face
Thin extremities
Short stature
Protuberant abdomen (enlarged liver and kidney)
Normal heart/spleen
327
Q

Type2 glycogen storage disease, pompe

A 
Acid maltase deficiency
First few weeks of life
Floppy baby
Macroglossia
Heart failure
328
Q

Type 3 GSD

A 
Deficiency of glycogen debranching enzyme activity
Hepatomegaly
Hypoglycemia
Hyperlipidemia
FTT
Elevated liver enzymes, fasting ketons
Normal lactate, uric acid
329
Q

Gynecomasia in pubertal boys

A 
In up to 2/3 of boys in mid-late puberty
Uni/bilateral
Resolves within several weeks to 2 years
Due to testicular production of estrogen and peripheral conversion of androgen to estrogen
No W/U or Rx
330
Q

Normal testis volume

A

Prepubertal <3 ml

Post pubertal 8-18 ml

331
Q

Androgens in women

A

Ovary and Adrenal:
Androstenedione
DHEA
Tes

Predominantly Adrenal:
DHEAS

332
Q

Androgenic activity of DHEA & DHEAS

A

negligible and due to conversion to Testosterone and androstenedione

333
Q

Effect of oral and transdermal estrogen on TBG levels

A

Oral, increases TBG (so increased TSH and decreased FT4 in hypothyroid pts who receive Levothyroxin)

Transdermal, no change

334
Q

Effect of androgens in TBG

A

Decrease

335
Q

Confirming the Dx if primary hyperaldostronism

A

Adrenal suppression test after oral saline load

336
Q

Easily induced hypokalemia after diuretics

A

Suspect hyperaldostronism

Check A/R ratio

337
Q

Milk alkali syndrome

A

Excessive intake of Ca & absorbable alkali: CaCO3

Increased risk if: concomitant thiazide diuretic, ACEI/ ARB, NSAIDs

Hypercalcemia -> renal vasoconstriction -> decreased GFR

Hypercalcemia -> inhibition of Na-K-2Cl cotransporter and impaired ADH function -> increased Na and water loss -> hypovolemia -> increased reabsorption of bicarbonate

338
Q

The most common cause of PTH independent hypercalcemia

A

Humoral hypercalcemia of malignancy

Ca>14

339
Q

Effect of increased/decreased pH on Ca

A

Increased pH-> H+ leaves albumin, therefore Ca binds to Alb -> hypocalcemia (total Ca level unchanged)

Decreased pH -> H+ binds Alb -> Ca leaves alb -> increased ionized Ca

340
Q

Type of hypercalcemia with Li

A

PTH dependent

341
Q

Effect of PTH on urine Ca levels

A

Increased urine Ca (despite resorption from distal tubule)

342
Q

Elevated PTH + Hypercalcemia + low urine Ca (<100mg/24h)

A

Familial hypocalciuric hypercalcemia

343
Q

Neonatal thyrotoxicosis

A

Only with graves (passage of Ig through placenta)
Tx: Self-resolves within 3 mo
Methimazole + BB

344
Q

Agranulocytosis with anti-thyroid drugs

A 
With both methimazole and PTU
Mostly during the first 90 days
No need for routine CBC
Check CBC if fever/ sore throat 
D/C promptly
If WBC > 1500, fever and sore throat are unlikely to be due to antithyroids
345
Q

Tx of thyroid adenoma, multinodular goiter

A

Initial: BB + methymazole/PTU
Definitive: surgery, RIA

346
Q

Ophthalmopathy, neonatal thyrotoxicosis in Thyroid adenoma and multinodular goiter

A

Not seen

347
Q

Normal TSH levels

A

0.4-4

348
Q

Normal total T4

A

4.6-12

349
Q

Treatment that worsens thyroid ophthalmopathy

A

RIA
(Administered withCS if mild ophthalmopathy)
Surgery preferred over RAI if mod-sev

350
Q

TFT in suppurative thyroiditis

A

Nl

351
Q

Tx of thyroid storm

A

BB
PTU ( to decrease hormone synthesis)
SSKI (1h after PTU to decrease hormone release)
CS ( to prevent T4 to T3 conversion)

352
Q

Thyrotoxicosis with Normal or increased RAIU

A

Graves
Toxic multinodular goiter
Toxic nodule

353
Q

Painless thyroiditis

A 
Anti TPO+
Variant of Hashimoto
Decreased RAIU
Excludes pts within a year of delivery
A self-limited hyperthyroid phase
Then hypothyroid phase (persists or returns to eu)
No Tx required except BB for hyper phase
354
Q

PVR in hypo vs hyperthyroidism

A

Increase in Hypo
Decrease in Hyper

BP rises in both

355
Q

Normal Mg levels

A

1.5-2.5 mEq/L

356
Q

If hypocalcemia (confirmed with repeat measurement)

A 
R/O:
Hypoalbuminemia
Drugs
Mg
Transfusion

If all Ok, measure PTH

357
Q

Normal P levels

A

2.5-4.5 mg/dL

358
Q

Mg and PTH

A

Hypomagnesemia decreases PTH secretion and induces resistance to PTHo

359
Q

Hypoparathyroidism induced by low Mg levels vs hypoparathyroidism induced by other reasons

A

The first one is not associated with increased phosphate levels
P levels are normal or low in Mg deficiency)

360
Q

Injectable drugs that can reduce serum Ca levels

A

Citrate ( via transfusion with hepatic problems)
EDTA
Foscarnet
Lactate

361
Q

The most common non-surgical reason for hypoparathyroidism

A

AI

362
Q

At this glucose level there is near complete suppression of insulin

A

60

363
Q

Secondary hypogonadism in men, evaluation:

A

PRL
+/- MRI (if elevated PRL, mass-effect symptoms, test<150, abn other pituitary hormones)
Transferrin

364
Q

Reasons for secondary hypogonadism in men

A 
Kallman
Hyperprolactinemia
GC (cushing)
Opiates
Tumors damaging gonadotroph cells
Pituitary apoplexy
Infiltration (hemochromatosis)
Systemic disease
Morbid obesity
DM
365
Q

Recovery of HPA function after discontinuation of GC

A

May take up to 6-12 mo

366
Q

Non-functioning hypophysis adenoma vs prolactinoma

A

PRL>200 in prolactinoma

Mild-mod elevation in non-functional adenoma

367
Q

Alcohol effect on LH and testo

A

Suppresses LH

Directly inhibits testo production

368
Q

Hypothyroidism and Serum lipid profile

A

Increased LDL or

increased LDL and triglyceride

369
Q

Myopathy of hypothyroidism

A 
Elevated CK
ESR, CRP: normal or mildly elevated
Associated Delayed DTR and additional features of hypothyroidism
Proximal weakness
EMG: normal or non-specific
370
Q

Treatment of subclinical hypothyroidism?

A

Yes if high anti-TPO

371
Q

Normal TFT

A 
TSH: 0.4-4 
TT4: 4.6-12 microgram/dl
FT4: 0.9-1.7 ng/dl
TT3: 80-180 ng/dl
FT3: 240-480 pg/dl
T3RU:24-37%
372
Q

Thyroid lymphoma radiology

A

Donut sign in CT
Pseudocystic pattern in US
Core biopsy required

373
Q

Evaluation necessary in all patients diagnosed with MTC

A

RET mutation

Plasma fractionated metanephrine assay

374
Q

TFT during pregnancy

A

TSH: Decreased (B-hCG stimulates thyroid)
TT4: increased
FT4: normal or mildly increased
TBG: increased

375
Q

Pregnancy in controlled hypothyroidism

A

Increase dosage of levothyroxin by 30% at the time pregnancy is detected.
Then adjusted every 4 wks

376
Q

Gold standard test for detecting DM in PCOS

A

Oral glucose tolerance test

377
Q

Isolated premature adrenarche is RF for:

A

PCOS
DM2
Metabolic syndrome

378
Q

Symptoms of isolated premature adrenarche

A 
Pubic/axillary hair
Acne
Oily hair and skin
Body odor
Normal bone age
379
Q

W/U for gonadotropin-dependent precocious puberty

A

Brain MRI with contrast

380
Q

Primary Tx for gonadotropin-dependent precocious puberty

A

GnRH agonist

381
Q

No Tx in prolactinoma if:

A

Asymptomatic and <10 mm

382
Q

Tx of prolactinoma

A

If: > 10 mm or symptomatic microprolactinoma
Tx-> cabergoline, bromocriptine

Surgery if: >3cm
Or increase in size while on treatment

383
Q

If high PRL detected,

A 
R/O:
Pregnancy
Renal failure
Drugs
Hypothyroidism
384
Q

Hyperprolactinemia in prolactinoma vs other pituitary tumors

A

Prolactinoma >200

385
Q

Deficient electrolytes in refeeding syndrome

A

Phosphorus is the primary deficient electrolyte
Also Mg, K (causing arrhythmia in atrophic malnourished heart) -> cardiopulmonary failure
Also B1 decrease

386
Q

The reason behind refeeding syndrome

A

Increase in insulin

387
Q

Tx of papillary thyroid carcinoma

A

Surgery (if<1-2cm, partial)
+ adjuvant radioiodine ablation (if large, extrathyroid invasion, lymph node mets, incomplete resection)
+ levothyroxin to suppress TSH

388
Q

Invasion of follicular thyroid carcinoma

A

Capsule
Blood vessels
Hematogenous spread (not lymphatic)

389
Q

Psammoma bodies in thyroid cancer

A

Papillary thyroid carcinoma

390
Q

Hürthle cells

A

Non-specific
Follicular thyroid carcinoma
Benign adenomas
Hashimito

Large, polygonal, eosinophilic cytoplasm, large quantities of mitochondria

391
Q

Thyroid nodule ultrasound suspicious for cancer

A

Hypoechoic
Microcalcification
Internal vascularity

392
Q

stool osmotic gap

A

290-(2x stool Na + 2x stool K)

393
Q

VIPoma

A 
Pancrease tail
Secretory diarrhea (stool osmolar gap<50)
Flushing
N/V
Hypo/achloridia
Hypokalemia
Hypercalcemia
Increased BG
Lethargy
Muscle weakness/cramp
VIP level > 75 pg/ml
394
Q

Osteomalacia radiology

A

Decreased bone density
Thinned cortex
Codfish vertebral bodies
Bilateral and symmetric Pseudo-fractures (Looser zone)

395
Q

Lab findings in osteomalacia

A 
Low VitD (primary reason)
Low/normal Ca
Low P
High PTH
High ALP
Low urine Ca
396
Q

Rickets vs osteomalacia

A

Rickets: Defective mineralization of growth plates

Osteomalacia: Ca or P deficiency at the mineralization front

397
Q

A situation where hypophosphatemia is more marked than hypocalcemia:

A

VitD deficiency

398
Q

Difficulty hearing in crowded or noisy environments

A

Presbycusis

399
Q

Aspirin ototoxicity

A

Tinnitus

In very high doses it can cause hearing loss

400
Q

Furosemide ototoxicity

A

Reversible or permanent hearing loss
Tinnitus
Hearing loss at lower doses if renal failure

401
Q

HELLP

A

Severe form of preeclampsia
Results from: abnormal placentation, systemic inflammation,
Activation of coagulation system and complement cascade

402
Q

Aromatase deficiency

A 
In utero: masculinization of mother (resolves after delivery)
Virilized XX child
Nl internal genitalia
Ambiguous external genitalia
Clitoromegaly
Delayed puberty
Osteoporosis
Undetectable estrogen
High gonadotropins
Polycystic ovaries
403
Q

Test to assess ovarian reserve

A

Day 3 FSH

404
Q

Unilateral bloody breast discharge

A

Intraductal papilloma

405
Q

Irregular and heavy menses in teenagers recently experiencing menarche is due to

A

Anovulatory cycled

406
Q

Evaluation of guaiac negative bilateral breast discharge

A

If lump, skin changes, nipple changes, LAP: mamo, sono

If non: B-HCG, TSH, PRL, guaiac, +/-MRI

407
Q

Management of suspected ovarian tumor on U/S

A

Exploratory laparotomy

408
Q

Tx of ovarian cyst rupture

A

If uncomplicated: conservative with analgesics

If fever, hypotension, tachycardia, hemoperitoneum, infection: surgical, AB…

409
Q

Pelvic pain in a pt with a known ovarian mass

A

Ovarian torsion (esp dermoid tumor)

Med (25 decks)

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