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1
Q

pt come in for insomnia, anxiety –> increased liver enzyme, macrocytosis –> condition?

A

chronic alcohol use

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2
Q

prolonged hypotension –> leads to what kidney condition?

A

acute tubular necrosis

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3
Q

indicates what conditon?

  • muddy brown granular cast
  • RBC cast
  • WBC cast
  • fatty cast
  • broad and waxy cast
A
  • muddy brown granular cast: acute tubular necrosis
  • RBC cast: glomerulonephritis
  • WBC cast: intersistial nephritis, pyelonephritis
  • fatty cast: nephrotic synd
  • broad and waxy cast: chronic renal fail
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4
Q

BUN:Cr ratio –> values and what they indicate

A

> 20:1 –> pre-renal

<20:1 –> intra-renal

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5
Q

post-menopause –> vag bleed –> next step?

A

think of endometrial hyperplasia or cancer:

pelvic US –> eval endometrial thickness, assess for other pelvic pathology

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6
Q

post-menopause –> vag bleed –> when do endometrial bx?

A

pelvic US –> endometrial thickness >4mm –> bx to eval for malig

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7
Q

whipple dz –> MC presenting ssx (5)

A
  • chronic malabsorptive diarrhea
  • wt loss
  • migratory non-deforming arthritis
  • LAD
  • low grade fever
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8
Q

what meds increase risk of diverticulosis?

A

ASA, NSAID

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9
Q

cervical intraepithelial neoplasia 3 –> next step?

A

cervical conization (type of excisional bx)

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10
Q

what are howell-jolly bodies?

A

RBC –> nuclear remnant

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11
Q

howell-jolly bodies –> seen in what condition?

A

asplenia (ie sickle cell)

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12
Q

morton neuroma –> charact

A
  • distal forefoot –> metatarsal heads to 3rd & 4th toes –> numb, ache, burn
  • Mulder sign: crepitus bw 3rd & 4th toes
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13
Q

morton neuroma –> who? pathophys?

A

usu runner –> mech-induced neuropathic degen of interdigital N –> ssx worse when walk on hard surface, wear tight/high heel shoes

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14
Q

morton neuroma –> tx?

A

metatarsal support or padded shoe insert

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15
Q

transudate vs exudate

A

transudate:
- increased hydrostatic pressure
- decreased oncotic pressure
- -> low protein

exudate: inflamm –> increase vasc permeability
- -> high protein, lactate dehydrogenase

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16
Q

regular schedule for meningococcal vaccine

A
  • primary vaccine –> 11-12yo

- booster at 16yo

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17
Q

first stage of labor –> consists of what phases?

A
  • latent phase: gradual cervical dilation

- active phase: rapid dilation

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18
Q

what constitutes arrest of active labor?

A

cervical dilatrion >6cm:

  • no cervical change for >4hr w adeq contractions
  • no cervical change for >6hr w inadeq contractions
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19
Q

arrest of active labor –> next step?

A

C-section

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20
Q

osteoarthritis –> PE findings (3)

A
  • bony enlrgment, tenderness
  • crepitus w mvmt
  • painful, decreased ROM
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21
Q

glasgow coma scale –> who? for what? assesses?

A

all trauma pt:

  • estimate severity of neuro injury
  • predict prognosis of coma & other conditions (bact meningitis, traumatic brain injury, subarachnoid hemorrhage)

Assess:

  • eye opening
  • verbal resp
  • motor resp
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22
Q

ARDS –> pathophys? results in?

A

infect, trauma, other –> lung injury –> alveolar space –> release proteins, inflamm cytokines, neutrophils –> blood, proteinaceous fluid –> into alveoli –>

  • lose surfactant –> alveoli collapse
  • diffuse alveolar damage

Results in:

  • impair gas exchange
  • decreased lung compliance
  • pHTN
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23
Q

abruptio placentae –> RF (3)

A
  • # 1 HTN
  • cocaine
  • maternal trauma
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24
Q

abruptio placentae –> presentation

A
  • abd/back pain
  • fetal heart rate abnormal
  • variable vag bleed
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25
Q

what is modified wells criteria?

A

pretest probability of PE:
<4 –> PE unlikely
>4 –> PE likely

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26
Q

sickle cell dz –> aplastic crisis –> pathophys? charact?

A

parvovirus B19 –> sudden halt in RBC production

  • severe anemia
  • low retic (<1%)
  • no HSM
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27
Q

cause of ascending aortic aneurysm? descending?

A

ascending: cystic medial necrosis, connective tissue disorder
descending: atherosclerosis

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28
Q

duration of:

  • brief psychotic disorder
  • schizophreniform disorder
  • schizophrenia
A
  • brief psychotic disorder: 1day-1mo
  • schizophreniform disorder: 1-6mo
  • schizophrenia: >6mo
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29
Q

what is: placenta accreta

A

placenta attach directly to myometrium

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30
Q

uterine inversion –> management

A

1) aggressive fluid replace
2) manual replace uterus
3) remv placenta, uterotonic drug

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31
Q

newborn –> conjugated hyperbili + hepatomegaly –> condition?

A

biliary atresioa

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32
Q

biliary atresia –> 1st step in eval? result?

A

abd US –> absent/abnormal gallbladder

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33
Q

biliary atresia –> tx?

A

Kasai procedure (hepatoportoenterostomy) –> eventually liver tx

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34
Q

ALL –> how dx?

A

BM bx –> >25% lymphoblasts

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35
Q

gallstone + typical biliary colic ssx –> tx?

A

elective lap chole

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36
Q

acute cholecystitis –> tx?

A

chole in 72hr

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37
Q

suspect achalasia –> next step?

A

endoscopy to r/o malig (pseudoachalasia)

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38
Q

bursitis –> how affect active ROM? passive?

A

active: decreased or painful
passive: normal

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39
Q

prepatellar bursitis –> presentation (3)?

A
  • ant knee pain, tender
  • erythema
  • localized swelling
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40
Q

acute prepatellar bursitis –> pathophys

A
  • penetrating trauma
  • repetitive friction
  • local cellulitis

–> S. aureus infect bursa

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41
Q

acute prepatellar bursitis –> how confirm dx?

A

aspirate bursal fluid –> cell count & Gram stain

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42
Q

absence sz –> comorbidity (2)?

A
  • ADHD

- anxiety

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43
Q

postmenopause –> large adnexal mass + vag bleed + endometrial hyperplasia –> condition?

A

granulosa cell tumor of ovary

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44
Q

granulosa cell tumor of ovary –> vag spot –> why?

A

secrete estrogen –> endometrial hyperplasia –> postmenopausal bleed

45
Q

granulosa cell tumor of ovary –> endometrial hyperplasia –> next step? why?

A

endometrial hyperplasia –> risk of endometrial cancer –> endometrial bx

46
Q

8yo M –> staring episodes –> tilt head, chew, not respond to name/touch –> confused for 20min after –> condition?

A

focal sz w LOC

47
Q

focal sz –> presentation?

A
  • motor (headturning), sensory (paresthesia), or autonomic ssx (sweat)
  • may have LOC & automatism (chewing)
48
Q

how can provoke absence sz?

A

hypervent

49
Q

UA –> positive leukocyte esterase –> indicates?

A

significant pyuria

50
Q

UA –> positive nitrite –> indicates?

A

presence of Enterobacteriaceae (E.coli –> convert nitrate in urine to nitrite)

51
Q

polysaccharide vaccine –> how induce immunity?

A

Tcell-indep Bcell response:

polysacc –> bind Ab on Bcell –> mod level of interm-affinity Ab

52
Q

conjugate vaccine –> how induce immunity?

A

Tcell-dep Bcell response:
polysacc-protein conjugate –> bind Ab on Bcell –> protein component activate Tcell receptor –> high levels of high-affinity Ab + memory cell formation

53
Q

pneumococcal vaccine –> what kind for:

  • infant
  • young child
  • <65yo + predisposing comorbid
  • immunocomp
  • > 65yo
A
  • infant: PCV13
  • young child: PCV13
  • <65yo + predisposing comorbid (chronic heart/lung dz, DM, cirrhosis): PPSV23
  • immunocomp: PPSV23 + PCV13
  • > 65yo: PPSV23 + PCV13
54
Q

tachycardia-mediated cardiomyopathy –> how to improve LV fx?

A

restore sinus rhythm or aggressive ctrl ventricular rate

55
Q

what is: missed abortion

A

preg loss at <20wk gestation prior to expulsion of gestational tissue

56
Q

missed abortion –> presentation

A
  • usu asymptomatic

but can present w:

  • loss of preg ssx
  • light vag bleed
57
Q

missed abortion –> findings (3)

A
  • closed cervix
  • decreasing B-hCG
  • US: no fetal heartbeat
58
Q

spherocytosis –> lab findings:

  • MCHC
  • MCV
  • peripheral smear
  • Coombs test
  • acidified glycerol lysis test
  • eosin-5-maleimide binding test
A
  • MCHC: increase (d/t membrane loss & RBC dehydration)
  • MCV: low
  • peripheral smear: spherocytes
  • Coombs test: neg
  • acidified glycerol lysis test: increase osmotic fragility
  • eosin-5-maleimide binding test: abnormal
59
Q

spherocytosis –> increase risk for what conditions (2)?

A
  • bilirubin gallstones

- parvovirus B19 –> aplastic crisis

60
Q

spherocytosis –> presentation –> classic triad

A
  • hemolytic anemia
  • jaundice
  • splenomegaly
61
Q

spherocytosis –> tx

A

supportive: folic acid, transfusion for severe anemia

62
Q

spherocytosis –> what does splenectomy do for pt? what does it not do?

A
  • improve anemia
  • reduce gallstone risk

not change increased MCHC

63
Q

anti-D immune globulin –> when administered during preg?

A

28wk gestation + w/in 72hr of delivery

64
Q

what is: Kleihauer-Betke test

A

determine if need higher than standard dose of anti-D immune globulin after delivery

65
Q

sickle cell trait –> #1 comp

A

painless hematuria (d/t sickling in renal medulla)

66
Q

chronic renal fail –> phlebotomy –> not stop bleed –> why?

A

platelet dysfx –> abnormal hemostasis

67
Q

chronic renal fail –> platelet dysfx –> lab findings:

  • PT
  • PTT
  • platelet count
  • BT
A
  • PT: normal
  • PTT: normal
  • platelet count: normal
  • BT: prolong
68
Q

chronic renal fail –> platelet dysfx –> tx? MOA?

A

DDAVP –> increase release of factor VIII-vWF multimers from endothelial storage sites

69
Q

lung cancer –> paraneoplastic synd –> muscle weak –> what paraneoplastic synd could it be (3)?

A
  • myasthenia gravis
  • Lambert-Eaton synd
  • dermatomyositis
70
Q

what is: dermatomyositis

A

idiopathic inflamm myopathy –> immune-med muscle injury

71
Q

dermatomyositis –> presentation

A
  • symm proximal muscle weak

- erythematous rash –> Gottron’s sign, heliotrope rash

72
Q

SLE –> lab findings on CBC (3)

A
  • hemolytic anemia
  • thrombocytopenia
  • leukopenia
73
Q

1 RF for spont preterm delivery

A

h/o spont preterm delivery

74
Q

h/o spont preterm delivery –> how to decrease risk of spont preterm delivery w next preg

A
  • progesterone supplementation

- serial cervical length measurements

75
Q

supravalvular aortic stenosis –> exertional angina –> why?

A

aortic stenosis –> LV hypertrophy –> exercise –> increase myocardial O2 demand –> subendo ischemia –> angina

76
Q

simple breast cyst –> aspirate clear yellow fluid –> next step?

A

f/u in 2-4 mo for clinical breast exam –> monitor for recurrence

77
Q

ankylosing spondylitis –> exam findings (5)

A
  • arthritis (sacroillitis)
  • reduced chest expansion, spinal mobility
  • enthesitis (tenderness at tendon insertion sites)
  • dactylitis (swelling of fingers/toes)
  • uveitis
78
Q

preg –> elevated maternal serum AFP –> indicate what fetal conditions (3)?

A
  • open neural tube defect
  • ventral wall defect –> gastroschisis, omphalocele
  • mult-gestation preg
79
Q

preg –> elevated maternal serum AFP –> next step?

A

US –> eval fetal anatomy

80
Q

preg –> decreased maternal serum AFP –> indicate what fetal condition?

A

aneuploidy

81
Q

methamphetamine –> risk for what heart condition?

A

cardiomyopathy

82
Q

milk-alkali synd –> symptoms

A
  • N/V, constipation
  • polyuria/polydipsia
  • neuropsych ssx
83
Q

milk-alkali synd –> pathophys

A

excess intake Ca & absorbable alkali –> hyperCa –>

  • renal vasoconstrict –> decrease GFR
  • renal lose Na & H2O –> hypovol –> increase resorb bicarb
84
Q

milk-alkali synd –> lab findings (4)

A
  • hyperCa
  • metabolic alk
  • acute kidney injury
  • suppressed PTH
85
Q

Turner synd –> CV abnormalities (3)

A
  • bicuspid aortic valve
  • coarcation of the aorta
  • aortic root dilation
86
Q

Turner synd –> karyotype

A

45, X

87
Q

karyotype –> find 45, X –> next step?

A

eval for CV abnormalities –> 4-extremity blood pressure & echo

88
Q

postpartum psychosis –> management

A

medical emergency –> increased risk of suicide & infanticide –> hosp –> antipsych med & trt underlying disorder

89
Q

cold knife conization –> how eval risk of preterm delivery

A

gold standard: transvag US –> measure cervical length

90
Q

nonhosp pt –> polyuria –> most likely dx (3)

A
  • DM
  • primary polydipsia
  • DI
91
Q

Na levels:

  • primary polydipsia
  • central DI
  • nephrogenic DI
A
  • primary polydipsia: low
  • central DI: high
  • nephrogenic DI: normal
92
Q

central DI –> pathophys

A

pituitary –> decreased ADH –> kidney –> decrease water resorb –> water loss –> polyuria –> dilute urine & hyperNa

93
Q

what is complicated cystitis

A

infect assoc w factors that increase risk for abx resistance or tx failure –> DM, CKD, preg, immunocomp, urinary tract obstruct, hosp-acq infect, infect assoc w procedure/indwelling foreign body

94
Q

uncomplicated cystitis –> abx options (3)

A
  • nitrofurantoin
  • TMP/SMX
  • fosfomycin
95
Q

complicated cystitis –> next step?

A

urine culture –> then initiate tx

96
Q

complicated cystitis –> tx

A

fluoroquinolone

97
Q

pyelonephritis –> next step?

A

urine culture –> then initiate tx

98
Q

cirrhotic patient on diuretic –> hepatic encephalopathy –> pathophys?

A

diuretic –> low intravasc vol despite total vol overload –> metab alk + hypoK –> increase NH3

99
Q

cirrhotic patient on diuretic –> metab alk + hypoK –> hepatic encephalopathy –> tx?

A
  • replete K
  • replete intravasc vol
  • ammonia-lowering meds: lactulose
100
Q

1st trimester –> lab findings:

  • total T4
  • free T4
  • TSH
A
  • total T4: increased
  • free T4: no change or mild increase
  • TSH: decreased
101
Q

preg –> increase thyroid hormone –> pathophys?

A
  • estrogen –> stim thyroxine-binding globulin syn –> increase total TH
  • hCG –> stim TSH receptor –> increase TH production

–> to cope w metabolic demands of preg

102
Q

18mo M –> intussusception –> how dx?

A

US guided air contrast enema

103
Q

primary influenza pneumonia –> CXR findings?

A

b/l diffuse interstitial infiltrates

104
Q

dobutamine –> used to manage what condition?

A

severe heart fail assoc w severe LV systolic dysfx & cardiogenic shock

105
Q

dobutamine –> MOA

A

stim B1 receptor –> increased myocardial contractility –> improve EF, reduce LV end systolic vol –> symptomatic improve decompensated heart fail

106
Q

how does pneumonia cause hypoxemia?

A

inflamm exudate –> fill alveoli –> R to L intrapulm shunt (vent/perfusion mismatch: perfusion w/out vent)

107
Q

hypoxemic –> increase FiO2 –> hypoxemia does not correct –> indicates?

A

absence of alveolar vent –> ie pneumonia d/t to intrapulm shunt

108
Q

neonate –> <10% percentile for gestational age at birth –> comp (5)

A
  • hypoxia
  • polycythemia
  • hypoglycemia
  • hypothermia
  • hypoCa

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