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Mixed Questions Flashcards

1
Q

painless abdo bleeding in 60 year old

A

ANGIODYSplasia

- dilated submucosal wins and AV malformation

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2
Q

sudden onset abode pain and tenderness followed by bloody diarrhea within 24 hours

A

ischemic colitis

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3
Q

if SSRI fails for depression what do you use

A
  1. make sure you have an adequate trail of SSRI - 6 months
  2. SNRI ( Venlafaxine)
  3. or other 1st line : Bupropion ( c/i in anorexia) , mirtazapine
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4
Q

conversion disorder

A

dx. of exclusion
- neurological symptoms inconsistent when you do the exam
functional impairment
precipitated by psych stress

Treatment:
- education about disorder, CBT , physical modalities for motor symptoms

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5
Q

watery diarrhea in 26 year old female - think of what?

A

laxative abuse

- ,melanosis coli - dark brown discolouration with pale patches of lymph follicles

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6
Q

failure of follicle to mature - other name?

A

PCOS

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7
Q

failure of mullein duct fusion

A

anatomic cause of infertility

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8
Q

what complication occurs within days - months after cardiac surgery

A

PARACARDIAL EFFUSION

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9
Q

x-ray findings in Pulmonary embolism

A

atelectasis

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10
Q

decreased passive and active abduction flexion and rotation at the left shoulder

A

adhesive capsulitis

decrease passive and a active range of motion

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11
Q

pain with abduction external rotation and subacromial tenderness

A

Rotator cuff tendinopathy

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12
Q

rotator cuff tear

A

similar to rotator cuff tendiopathy but weakness with external rotation age > 40

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13
Q

acute GI symptoms , forgetfulness, motor and sensory neuropathies ( stocking and glove distribution) , microcytic anemia

A 
LEAD POSSIONING 
Labs: 
- anemia 
- elevated venous lead level 
- elevated since protoporphyrin level 
- basophilic stippling on peripheral smear
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14
Q

when do you give penicillin to treat GBS

A

before onset of labour - if treated too early before labour starts - you can get bacterial regrowth

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15
Q

DDX for bilious vomit in neonate

A
  1. meconium ileus
  2. hirchsprung
  3. malrotation
  4. Duodenal atresia
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16
Q

mittelschmerz

A

unilateral abdo pain in young women ( days 10-14 of cycle )
- reassurance

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17
Q

suspect nursemaid elbow - what do you do?

A

gently hyperpronate the right forearm

OR supination of forearm and flexion of elbow

x-ray is NORMAL

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18
Q

cause of acanthuses nigicans

A
  1. insulin resistance

2. gastrointestinal malignancy

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19
Q

multiple skin tags

A

insulin resistance
pregnancy
crowns disease ( periano)

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20
Q

Porphyria cutanea tarda

A

Hep C

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21
Q

sudden onset of severe psoriasis , recurrent herpes zoster , disseminated molluscs contaginosum

A

HIV infect

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22
Q

severe seborrheic dermatitis

A

HIV

Parkinson disease

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23
Q

Pyoderma gangrenosum

A

inflammatory bowl disease

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24
Q

pneumonitis, hepatitis , gastroenteritis - in immunocompromised patient

A

think CMV

Dx: PCR

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25
Q

what type of shock is a lady who had a placenta abruption

A 
HYPOVOLEMIC SHOCK 
- decrease RA pressure 
PCWP - decrease 
Cardiac infer - decrease 
after load - increase 
MvO2 - decrease
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26
Q

if patient developed EPS on first gen antipsychotic what treatment should she go on?

A

Zipasidone (low risk metabolic profile)

Olanzapine ( AVOID in diabetics - b/c weight gain and metabolic effects

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27
Q

fever cough low grade fever
bad breath and fluctuant ass in patients neck
elderly

A

zener’s diverticulum

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28
Q

dx and ZD

A

contrast esophagram

Tx: surgery

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29
Q

varicella post exposure prohyplaxis

A

hx of immunity ( prior infection or 2 doses of vaccine)
Yes - observe
No - immunocompetent - varicella vaccine
No - immunocompetent - VZIG

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30
Q

x-ray and CT finding of PE

A

X-ray - hampton hump

CT - wedge shaped pleural based opacification

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31
Q

x-ray shows widened mediastinum and barium studies show a dilated esophagus with a smooth tapering of the distal esophagus
what is it? hx of difficult swelling solid then liquid

A

ACHALASIA

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32
Q

possible achalasia - how to confirm Dx?

A

endoscopic evaluation

can differentiate b/e achalasia and pseudoachalasia

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33
Q

MOA of clopidogrel

A

P2y12 receptor blocker

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34
Q

screening for lung cancer

A

Annual low dose chest CT in patients 55-80 with >30 pack year history - who are currently smoking or quit within the last 15 years ) - reduce cancer mortality

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35
Q

when is DEXA scan used for screening?

A

Women grater than or equal to 65 or at high risk using FRAX tool

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36
Q

calf is swollen tense and exquisitely tender, worse with passive extension of the knee

A

Compartment syndrome

  • if pain is out of proportion
  • clue: WORSE pain on passive stretch
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37
Q

dx of PJP

A

done on microscopy with specialized stains

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38
Q

best way to prevent measles spread

A

airborne precautions

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39
Q

macupapular rash that starts at head and spreads to body but spares palms and soles

A

measles

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40
Q

patient fetus has anencephaly - ROM at 35 weeks what do you do?

A

just let her do expectant vaginal delivery

- the baby is non viable anyways so no point of corticosteroids

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41
Q

patient has stroke then becomes depress

A

its important to tell them there are treatments for depression that can help you feel better

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42
Q

causes of RDS

A

prematurity
maternal diabetes
male sex
prenatal asphyxia

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43
Q

treatment of bipolar disease that is not being controlled with one agent

A

Lithium OR valproate acid

PLUS

2nd gen antipsychotic

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44
Q

turner syndrome

A

increase risk for decrease bone mineral density

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45
Q

clinical of congenital hypothyroidism

A 
apathy 
weakness 
hypotonia 
large tongue 
sluggish movements

Tx: levothyroixine

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46
Q

specific infection of dementia v.s normal aging

A

if patient is getting lost in familiar places

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47
Q

fibroadenoma in adolescent - what do you do?

A

examine after next menstrual cycle

  • if decrease –> reassurance
  • if increase –> ultrasound
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48
Q

renal angioblastomas ass . w/ what condition

A

tuberous sclerosis ( facial angiofibromas, hyper pigmentation macules, ash leaf spot)

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49
Q

incase of unilateral bloody discharge with normal mammogram

A

intraductal papilloma

if abnormal mammogram - pages disease

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50
Q

cause of otitis external

A

pseudomonas

s. aures

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51
Q

HIV positive , water diarrhea, low grade fever, WL CD4 < 180

A

Cryptosporidium

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52
Q

CD4 <100 watery diarrhea, crampy diarrhea, WL, fever is rare

A

microsporidium isosporidium

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53
Q

water diarrhea, high fever>39 , WL Cd4<50

A

MAC - mycobacterium avium complex

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54
Q

frequent small volume diarrhea, hematochezia, abode pain, low grade fever , WL , Cd4< 50

A

Cytomegalovirus

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55
Q

whats beck triad

A

distended neck veins
muffled heart sounds
hypotension

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56
Q

what does cardiac tamponade cause

A

decrease left ventricular preload

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57
Q

when do you do surgery in patient with FAP

A

early 20s - does not need to be an urger surgery

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58
Q

what happens to glucose with thiazide

A

s/e hyperglycaemia

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59
Q

s/e of thiazides

A
  • increase LDL and cholesterol
  • hyperglycaemia
  • high plasma triglycerides
  • hyperurecemia
  • hypokalemia
  • hypomagnesemia
  • hypercalcemia
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60
Q

pancytopenia in 30 year old women

A

SLE - due to destruction of RBC

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61
Q

HTN and undetectable plasma to renin ratio

A 
primary hyperaldosteronism 
(cause adrenal adenoma, bilateral adrenal hyperplasia)
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62
Q

what does pernicious anemia increase your risk for

A

gastric cancer ( increase by 2X)

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63
Q

what organism is responsible for deep wound infections following puncture wounds

A

Pseudomonas aeruginosa

osteomylitis

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64
Q

ludwig angina

A

rapidly progressive submandibular and sublingual spaces

source of infection - most commonly an infected mandibular molar

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65
Q

test for C.diff

A

stool toxin testing

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66
Q

what kindly problem do patients with HSP get?

A
  • medangial deposition of igA mediated small vessel vasculitis
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67
Q

postcholecystecomy syndrome

A

abdominal pain or dyspepsia ( nausea) that occurs wither postoperatively or months after cholecystectomy

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68
Q

treatment of postcholecystectomy syndrome

A

ERCP

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69
Q

mucopurulent urethral discharge in sexually active person who has absence of identifiable bacteria on culture or gram stain - what is Dx?

A

Chlamydia urethritis

NEED Nucleic acid amplification testing

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70
Q

first treatment of BPH

A

alpha blockers

THEN 5 alpha reductase

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71
Q

does OCP increase or decrease risk of endometrial and ovarian cancer

A

DECREASE risk of both cancer

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72
Q

battery diarrhea, decrease acid secretion, flushing, lethargy, N V muscle weakness cramps

Dx and lab values

A

VIPOMA
- labs :
hypo Kalemia
Hypercalcemia ( increase bone resorption)
Hyperglycaemia due to increased glycogenolysis
Stool studies show secretory diarrhea with sodium and osmolal gap < 50 mmOsm/kg

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73
Q

VIPOMA location

A

tail of pancreas on abode ct

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74
Q

bladder cancer screening

A

no screening require

- even if heavy smoker or family history

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75
Q

difference b/w acute stress disorder and adjustment disorder

A

Stress disorder - as// w life threatening traumatic event - get flashbacks, nightmares

Adjustment disorder - stressor or multiple terrors ex: living alone for first time, living away from home , academic stress etc. develops within 3 months

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76
Q

risk of developing what if baby has bronchiolitis

A

apnea ( esp if infant < 2 months)

resp failure

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77
Q

marfanoid habits

A

mutation in fibrillar 1 gene

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78
Q

difference b/w marphans and homocystinuria

A 
homocystinuria will also have 
- Marphinoid features 
PLUS 
- fair skin 
- intellectual disability 
- thromboembolism 
- LENS DISSOCIATION downward ( not upward)
79
Q

PATIENT tries to give gift to doctor - what should they say

A

i appreciate your thank you… but i am unable to accept gifts

Exceptions to saying yes to gifts: cost, type , timing , intention of gift

If patient has a mental illness - accepting gift not appropriate b/c it may affect their judgement

80
Q

causes of thyrotoxicosis with decrease RAIU

A
  • painless ( silent thyroiditis)
  • subacute ( deQuervain) thyroiditis
  • amiodarone induced thyroiditis
  • excess dose of levothyroxine
81
Q

treatment of painless thyroiditis

A

propanolol - may be prescribed to control symptoms of adrenergic overstimulation - such as palpitations or tremulousness

82
Q

what booster vaccine do you get from age 11-18

A

meningococcal poster vaccine ( if primary vaccine age < 16)

83
Q

follicular thyroid cancer vs. benign follicular adenoma

A
  • invasion of timor capsule or blood vessel - more likely follicular thyroid cancer
84
Q

suspect Cushing disease - what do you test?

A

24 hour urinary cortisol excretion
Late night salivary cortisol assay
Low dose dexamethasone suppression txt

( low acuity for morning cortisol level b/c - overlap in cortisol level in normal subjects and those with cushing disease

85
Q

chest x-ray reveals spotty calcifications along left heart border - what is dx?

A

constrictive pericarditis

  • right heart failure with pericardial knock ( mid diastolic sound), , elevated JVP and calcifications on CXR)
86
Q

asthma v.s COPD

A

look for > 12% increase in FEV1 before and after bronchodilator use

87
Q

MOST common cause of kidney stones

A

calcium oxalate stones

88
Q

calcium phosphate stones

A

common in :

  • hyperparathyroidism
  • renal tubular acidosis
89
Q

His patient with PPD test > 5mm - what do you do?

A

since it is > 5mm - consider positive

do C-ray
if positive - treat active TB

if negative and No symptoms –> treat as latent TB – 9 month of ionized and pyridoxine

90
Q

danger of CPK levels

A

this is most likely due to rhabdomyolysis

high CPK levels –> acute renal tubular necrosis due to myoglubinuria

91
Q

difference b/w axonopathy of small nerve fibers and large nerve fibers

A

small - with be ass/ with POSITIVE symptoms - pain, parenthesis, allodynia

Large fibers - NEGATIVE symptoms - numbness, loss of proprioception and vibration sense, diminished ankle reflexes

92
Q

most common cause of glomerulonephritis in adults

A

IgA nephropathy - recurrent episodes of gross hematuria usually within 5 days of URTI

  • differentiated from Post infectious GN based on earlier onset of upper res tract infection related GN and normal serum complement level
93
Q

treatment of SVT in hemodynamic instability patient

A

go straight for synchronized cardioversion

if stable - could d o vagal maneuvers and adenosine

94
Q

when do you get free wall rupture post acute MI

A

within 5 days to 2 weeks

  • chest pain
  • shock
  • distant hear sounds

Echo
- pericardial effusions with tamponade

95
Q

when do you get papillary muscle rupture

A

acute or within 3-5 days

  • SEVERE pulmonary edema
  • new holosystolic murmur r
96
Q

inter ventricular septum rupture - when you see it

A

acute or within 3-5 days post MI

  • chest pain
  • NEW holosystolic murmur
  • biventricular faliure
  • shock
97
Q

left ventricular aneurysm

A

up to several months post MI

  • subacute heart failure
  • stable angina
98
Q

where is Eikenella bacteria found

A

mouth flora

  • think HACEK organisms
99
Q

CT shows CT scan with several nodular lesions with surrounding ground glass opacities in the right upper lobe

A

invasive aspergillosis

Train

  • fever
  • chest pain
  • hemoptysis

Postive biomarkers 0 galactomannan , beta D glucan

100
Q

what happens in garish Herzhiemer reaction

A

rapid lysis of spirochetes

  • ## within 6-48 after initiating treatment for syphilisacute fever , chills and myalgia and reach progression in secondary syphilis
101
Q

TREATMENT of vasovagal syncope

A
  1. reassurance
  2. avoidance of triggers
  3. counter pressure techniques for recurrent episodes
102
Q

large amount of blood in urine with relative absence RBC on urine microscopy - what do you think?

A

myoglobinuria - caused by rhabdomyolitis - leads to acute renal failure

  • you will also see HIGH potassium in labs
103
Q

Causes of recurrent episodes of pneumonia

A

involving same region
1. local airway obstruction ( neoplasm, FB)

  1. recurrent aspiration ( seizures, alcohol, drug use, non infections- vasculitis, BOOP)

Involving different regions of the lung

  1. Immunodeficiency ( hiv, leukemia, CvID)
  2. sinopulmonary disease
  3. non infections
104
Q

when do you dx. impaction of gallstone in the ileum

A

normally Dx preoperatively

105
Q

acute cholecystitis is impaction of gallstone where

A

in the cystic duct

106
Q

difference b/w gallstone in cystic duct vs. gallstone

A

Cystic duct - Upper right quadrant pain

CBD - normally by gallstone or cancer - usually has JAUNDICE

107
Q

18 weeks pregnant and noticed to have a 7cm solid mass in ovary with hyperangrogenism symptoms - what do you do?

A

observation and expectant management

hyperandrogenism symptoms - with ovarian mass - think LUTEOMAS - resolves spontaneous after delivery

108
Q

increase gastric residual volume and abdominal distention in preterm

A

THINK NEC

  • look for pneumatosis intestinal ( intramural air and portal venous air on x-ray
109
Q

symptoms of intracranial hypertension

A

nausea , vomitting
mental status exam
focal neurological

110
Q

mass on hard palate of a young individual

A

think torus palatinus

  • no surgery
  • benign growth
111
Q

example of selection bias

A

sampling bias

nonresponse bias

berkkson bias - decrease studied using only hospital based patients

prevalence bias ( Neyman bias) - exposure that happen long before disease assessment can cause study to miss disease patients that die early or recover

attrition bias - loss of study participants may cause loss of follow up bias

112
Q

what bias is considered loss to follow up

A

selection bi

ases

113
Q

difference b/w leukemoid reaction and CML

A 
Leukemoid 
- WCC > 50 000 
- cause- severe infection 
- LAP score - high 
MORE neutrophils > bands
CML 
- elevated WCC > 100 000 
BCR-ABL fusion 
Low LAP score 
Less mature neutrophils (Blast > neutrophils) 
Absolute basophilia may be present

LAP = leukocyte alkaline phosphatase

114
Q

3 month history of low grade fever, night sweats , productive cough and WL, skin involvement and lytic bone lesions from Wisconsin - think?

A

BLASTOMYCOSIS
- fungal infection near Great lakes, mississippi river and ohio river

x-ray resembles Tb and histoplasmosis

Characteristic feutre = ulcerative skin lesions and lytic bone lesions

115
Q

best treatment for chronic venous insufficiency

A

LEG ELEVATION
- helps with the incompetence venous valves

then compression stockings
exercise

116
Q

why do you get eyelid protosis in graves disease

A

orbital tissue expansion

117
Q

increase intraocular pressure causes

A

glaucoma

118
Q

how can hypo magnesium cause refractory hypokalemia

A

due to the removal of inhibition of renal potassium excretion and should be suspected in patients that is difficult to correct potassium

119
Q

what electrolyte abnormalities can be caused by hypoalbunemia

A

hypocalcemia

120
Q

treatment for a patient with a single brain metastasis

A

surgically accessible location and good performance status

followed by stereotactic radio surgery or whole brain radiation therapy to the tumour bed

121
Q

patient is on insulin basal and metformin - has okay surgards in the morning but high HbA1c - what is the cause

A

hyperglecmic events postprandial

122
Q

funds shows cupping of optic disc what is dx?

A

primary open angle glaucoma

123
Q

what is the cause of hypoclaemia after person receives blood transfusion

A

calcium chelation by a substance in the transfused blood

124
Q

meds that cause hyperkalemia

A 
B-blocks 
ACE inhibitors 
K sparing diuretics 
Digoxin 
Cyclosporin 
Heparin 
NSAIDS 
Succinylcholine 
TMP/SMX
125
Q

what antibiotic causes hyperkalemia

A

TMP/SMX

126
Q

what drugs can be used to help prevent recurrent nephrolithiasis

A

thiazide diuretics
urine alkalization - with potassium citrate/ bicarbonate sale )
allopurinol ( for hyperuricosuria related stones)

127
Q

mid ear effusion without signs of active infection

A

serous otitis media

- exam will show: Dull tympanic membrane that is hypomobilic on pneumatic otoscope

128
Q

dull tympanic membrane that is hypo mobile on otoscope

A

non infectious effusion

129
Q

boss of a patient calls you to ask if he is in hospital what is your response

A

i can confirm that the patient is currently hospilitized and i anticipate he will be able to return to work

130
Q

constrictive pericarditis causes

A

US:
- viruses, cardiac surgery, chest radiation and idiopathic causes

Developing countries - TB ( Africa, india , china )

131
Q

what effects dose systemic sclerosis has on the esophagus

A
  • atrophy and fibroses of the smooth muscle in the lower esophagus ( leads to decrease peristalsis and decrease tone in the lower esophagus)
132
Q

what bacteria is in the mouth

A

viridian’s group streptococci

133
Q

how to tell if it is vomitting or diarrhea

A

diahrea - will have bicarb loss

vomitting - will have urinary chloride LOW

134
Q

nephrotic syndrome then presents with hematuria -

A

think renal infarction
renal vein thrombosis is an important complication of nephrotic syndrome

MOST likely ass/ w/ membranous glomerulopathy

135
Q

what should patients with idiopathic thrombocytopenia purport be investigated for

A

hep C and HIV

  • treating the underlying infection can affect the platelet count
136
Q

patients with plantar puncture wound through footwear who develop osteomyltitis - due to what organism

A

pseudomonas aeruginosa

137
Q

sever burns - wat infection are you at risk of

A

gram negative sepsis

138
Q

treatment of CF with S.aurea infection

A

vancomycin

139
Q

most common cause of bacterial pneumonia in young children with CF

A

s. aures

140
Q

tremor without any gait changes what should you think

A

think essential tremor eat with propranolol

141
Q

what type of hearing loss is prescycusis

A

sensorineural hearing loss

142
Q

for TB skin testing - what is considered a negative test

A

anything < 15mm in a otherwise healthy person - no need to get CXR

143
Q

HIV cD4 = 80, CXR has bilateral reticulonodular opacities with hilar lymphadenopathy and elevated aminotransferase levels - what do you think

A

Urine histoplasma antigen

144
Q

alcoholic hallucinations vs. delirium tremens

A

alcoholic hallucinosis :
- visual auditory or tactile
- intact orientation
stable vitals

Delirium tremens
- confusion, agitation , fever, tachycardia , hypertension, diaphoresis, hallucinations

145
Q

patient has asthma attack, intubated then exulted and develops muscle weakness and hand tremor - what do you do?

A

do serum electrolytes - patient most likey has low K+ from a lot of beta 2 agonist

146
Q

factor V Leiden

A

activated protein C resistance

147
Q

clinical manifestation of methemoglobin

A

Clinical

  • cyanosis
  • pulse oximetry - 85%
  • dark chocolate coloured blood

labs

  • saturation gap
  • normal PaO2
  • normal A-a gradient
148
Q

Child < 2 years UTI - what is next

A

usually do renal and bladder US

if hydronephrosis or scarring seen in new borns < 1 month and children age <2 years with recurrent UTI - then thats when you do a voiding cystouretrogrma

149
Q

TB CSF findings

A

WBC - 5-1000
Glucose < 10
Protein > 250

150
Q

viral CSF findings

A

WBC 100-1000
Glucose normal
Protein < 100

151
Q

Management of hypernatremia

A

Normal saline hydration plus calcitonin
AVOID LOOP DIURETICS UNLESS VOLUME OVERLOAD

Long term - bisphosphnates

152
Q

AKI hypternsion and systemic sclerosis - what is happening?

A

patient has scleroderma renal crisis which can develop 5 years after Dx
- schistocytes

Urinalysis - will show mild proteinuria

153
Q

target cells

A

hemoglobinopathies (thalseemia)

chronic liver disease

154
Q

Spur cells

A

liver disease

155
Q

Burr cells ( also known as echinocytes) - speculated appearing red blood cells with serrated edges

A
  • liver disae

- end stage renal disease

156
Q

besides antipsychotics what other meds can cause acute dystonia

A

metoclopramide ( dopamine agonist)

157
Q

acute limb schema - what is the cause

A

major cardiac sources of arterial emboli

158
Q

most common bacteria for brain abscess

A

viridian’s streptococci
S. aureus
- gram negative organism

159
Q

young patient with FEVER and ring enhancing lesions n CT what do you think of ?

A

HIB positive? - too

If HIV negative - think brain abscess - viridians , s. acres, gram negative organisms

160
Q

cardiac auscultation reveals ejection click followed by crescendo decrescendo systolic murmur over the left second intercostal space and widened splitting of the S2

A

pulmonary stenosis

- congenital defect that remain asymptomatic until adulthood

161
Q

patient has infective endocarditis and hx of UTI - what bacteria do you think is common for causing IE

A

think enterococci

162
Q

gingival manipulation and resp tract incision or biopsy

A

viridian’s

163
Q

drugs that cause acute interstitial nephritis

A

TMP SMX
penicillins
Cephalosporin
NSAID

164
Q

what is the most common cause of chronic MR in developed countries

A

MVP - from myxomatous degeneration of the mitral valve leaflet

165
Q

when is Tdap vaccine recommended

A

recommended at the age of 11 and then every 10 years after that

166
Q

when do you get HPV vaccine

A

age 10/11

167
Q

ureic pericarditis

A

occurs in patients with renal failure
BUN > 60
TREATMENT - hemodialysis

168
Q

elevated ALP and CB - what is diagnosis

A

this is indicative of cholesttasis

- the patient should have an US of the right upper quadrant

169
Q

what BP med should you give for patients with primary hyperaldosterone

A

you should give aldosterone antagonist - spirolactone , eperenone

170
Q

anti topoisomerase - Dx

A

Scleroderma

Same as anti SCL 70

171
Q

respiratory acidosis following Surgery - what is diagnosis

A

alveolar hypoventilation

172
Q

what metabolic findings can hypothyroidism cause

A

HYPERLIPIDEMIA
hyponatremia
CK increase
increase serum transaminase

173
Q

high calcium and hilar mass in left lung

A

think squamous cell carcinoma

Real: if bilateral and hypercalclemia think sarcoidosis

174
Q

s/e of nitropurside

A

cyanoide toxicity
- skin: flushing, cyanosis
central nervous system: headache , altéré mental status , seziure
CV: arrhythmia
Resp: tacypnea
GI: abdo pain
Renal : metabolic acidodi from lactic acidosis / renal failure

175
Q

bright sharply demarcated erythema at perianal area with itchiness

A

think perianal streptococcus infection

treat with oral penicillin or amocillin

176
Q

what is affected with pronator drift?

A

pyramidal tract disease of the upper extremities

177
Q

labs in primary hyperaldosteronism

A

Aldosterone pushes out K+ and saves NA

178
Q

decrease tactile fremitus

A

pleural effusions

179
Q

dullness on percussion

A

think consolidation of the lung

180
Q

what type of kidney issue does amyloidosis cause

A

nephrotic syndrome

181
Q

treatment of renal calculi

A

increase fluid intake
limit salt intake
normal dietary calcium

182
Q

fever , back pain and focal spinal tenderness with elevated ESR - what do you do?

A

think patient most likely has vertebral osteomyelitis

  • DO A MRI and the n CT guided needle aspiration and biopsy

if only know the history of back pain fever and focal tenderness - then do ESR and X-ray first then go into MRI

183
Q

fixed upper airway obstruction on flow volume loop

A

looks like a circle without regular shape

Cause laryngeal edema - something obstructing airway

184
Q

what type of pattern with pneumothorax and pulm edema show on flow volume loop

A

restrictive pattern

- shows decrease flow volume with expiratory flow rates that are increased relative to the lung volumes

185
Q

how does primary lymphoma of the thyroid present

A

rapidly progressive thyroid enlargement with compression of surrounding structures

  • increase risk in a patient with Hashimotos thyroiditis
186
Q

what do you think in a post op patient with hypotension , jugular distension and new onset right bundle branch block

A

massive pulmonary embolism

187
Q

what is showed to decrease ventricular remodelling after MIR

A

ACE inhibitor - should start within 24 hour of MI

188
Q

when do you do prophylaxis for MAC in HIV patients

A

CD 4 < 50

give azithryomycin

189
Q

how does mycobacterium avid complex present

A

these patients will have never abode pain, diarrhea, night sweats and WL

Splenmegly

ELEVATED ALK Phosphate

190
Q

why can you get hypotension in acute pancreatitis

A

b/c you can get an intravascular volume loss secondary to local and systemic vascular endothelial injury

Vasodilation increase vascular permeability and plasma leak into the retroperitoneal resulting in hypotension

191
Q

why do you get anemia in vit B 12 deficiency

A

defect in DNA synthesis

192
Q

if someone has blood glycemic control of 7.5% - what is the benefit of decreasing it down to 6.5%

A

ONLY helps with microvascular complications

  • decrease change of retinopathy
  • won’t change the microvascular complication - MI, Stroke
193
Q

unilateral varicose that fails to empty when a patient is recumbent raises suspicion for

A

RCC

- CT scan should be done

194
Q

best treatment of heart block

A

cardiac pacing

uworld (11 decks)

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