NTK Flashcards
1
Q
Murmurs needing further work up
A
Systolic III or greater Any diastolic
2
Q
Rumbling diastolic with opening snap = Tx?
A
Mitral stenosis Balloon valvuloplasty Surgery later
3
Q
Pathology of aortic insufficiency
A
Infection Infarction Aortic Dissection
4
Q
Acute aortic insufficiency =
A
Cardio gen I shock Flash pulmonary edema
5
Q
Chronic aortic insufficiency
A
CHF Chest pain
6
Q
Rumbling diastolic murmur right sternal border second intercostal space =
A
Aortic insufficiency
7
Q
Pathogenesis of aortic stenosis
A
Atherosclerosis Older men
8
Q
Crescendo, descrescendo systolic murmur at right sternal border 2nd ic space
A
Aortic stenosis
9
Q
Systolic, high pitched, HOLOSYSTOLIC murmur at the apex of the heart
A
Mitral insufficiency (regurgitation)
10
Q
Two murmurs More blood - less murmur
A
HCM and MVP
11
Q
Common meds leading to exposing G6PD
A
Dapsone TMP-SMX Nitrofurantoin
12
Q
When to check G6PD level?
A
6-8 weeks after an attack
13
Q
Coombs positive for IgG = warm autoimmune hemolytic anemia Conditions?
A
Autoimmune diseases Cancer
14
Q
Diagnosis of PNH? Tx?
A
Flow cytometry Eculizumab
15
Q
Female pt Elevated T4 Cold Thyroid uptake scan Next step?
A
Sestamibi of Ovaries Struma ovarii
16
Q
Thyroid Storm Tx steps
A
Cool down - IVF, Cold blankets Propranolol PTU/Methimazole Steroids
17
Q
Radioactive iodine better for (3)
A
Multinodular goiter Toxic adenoma Struma ovarii
18
Q
Anterior Pituitary secretes
A
ACTH TSH GH FSH/LH
19
Q
Prolactinomas Macroadenoma more likely in? Micro?
A
Men get macro Women get micro
20
Q
Prolactinoma treatment
A
Dopamine agonists CABERGOLINE, bromocriptine
21
Q
What releasing hormone can cause elevations of prolactin?
A
TRH
22
Q
Acromegaly work up steps
A
ILGF-1 Glucose suppression test + equals failed to suppress MRI SURGERY
23
Q
Pyramid of importance of pituitary hormones (In descending order)
A
ACTH TSH GH LH/FSH
24
Q
Three MCC of Chronic Hypopituitary
A
Autoimmune Deposition disease - sarcoidosis, amyloidosis Tumor
25
Lung cancer with SIADH
Small cell
26
Treatment for nephrogenic DI when all else fails
Gentle dieresis w/ HCTZ +\- Ameloride
27
Remnants of nuclear material in RBC's
Howell Jolly Bodies Indicates splenectomy or functional hyposplenism
28
Hemoglobin precipitates in RBC's
Heinz bodies
29
Dofetilide Type of med? Side effects?
Class III antiarrhythmic for management of atrial arrhythmias dose dependent QT prolongation
30
Horizontal nystagmus, cerebellar ataxia, confusion Toxicity?
Phenytoin
31
Tremor, hyperreflexia, ataxia, seizures Toxicity?
Lithium
32
Nonpregnant patients with syphilis and anaphylactic penicillin allergy Tx?
Doxycycline
33
Steps for lead screening (If positive risk factors)
Capillary lead \>5 Confirm with Venous lead Level 45-69 = DMSA Level \>70 = Dimercaprol + EDTA
34
Abnormal eosin-5-maleimide binding test =
Hereditary spherocytosis
35
Congenital Rubella triad
Cataracts/glaucoma Sensorineural hearing loss Congenital heart disease
36
Key difference between bulimia and anorexia
Weight Bulimia = normal weight Anorexia = low weight
37
MCC of spontaneous lobar hemorrhage in adults over 60 Most common lobes involved?
Cerebral amyloid angiopathy Parietal and Occipital
38
MCC intracranial hemorrhage in children
AVM
39
Ischemic stroke appears _______ on CT
Hypodense on CT
40
Signs of posterior urethral injury Diagnostic imaging study of choice
Blood at meatus High riding prostate Perineal or scrotal hematoma Retrograde urethrogram
41
Trimethoprim mechanism of hyperkalemia
Blocks Na channels in collecting tubule (Similar to amiloride)
42
Galactosemia quartet Deficient enzyme
FTT Bilateral cataracts Jaundice Hypoglycemia galactose-1-phosphate Uridyl transferase
43
Treatment of warm Autoimmune Hemolytic anemia
High dose glucocorticoids first
44
Alcoholic dilated cardiomyopathy Tx?
Abstinence Return to function or normalization is possible
45
Trial of labor contraindicated for what two prior surgeries?
Vertical c section Abdominal myomectomy with UTERINE CAVITY ENTRY
46
Most common transfusion reaction is?
Febrile nonhemolytic
47
Fever and chills within 1-6 hours of transfusion = D/t?
Febrile nonhemolytic reaction Cytokines accumulated during blood storage
48
Fever, flank pain, hemoglobinuria, renal failure and DIC within an hour of transfusion = Causes by?
Acute Hemolytic ABO incompatibility Positive direct Coombs , Pink plasma
49
Mild fever and hemolytic anemia 2-10 days after transfusion= Due to?
Anamnestic antibody response Positive direct Coombs, positive new antibody screen
50
Anaphylactic transfusion reaction is due to?
IgA deficiency Anti-IgA antibodies
51
Respiratory distress, noncardiogenic pulmonary edema within 6 hours of transfusion =
TRALI Donor anti-leukocyte antibodies
52
Risk factor most common for TAA and AAA
Atherosclerosis
53
Risk factor most common for aortic dissection
Hypertension
54
Stable SVT tx Unstable?
Adenosine Shock
55
Stable Afib tx Unstable
Rate control - BB Shock
56
Stable Torsades tx Unstable
Magnesium Shock
57
Stable Vtach tx Unstable?
Amiodarone Shock
58
MCC of prolonged or arrested second stage
Fetal malposition
59
Major side effect of Hydroxychloroquine
Retinopathy Regular eye exams
60
Vast majority medulloblastomas occur where?
Cerebellar vermis
61
Most common hemispheric tumors in children
Low grade Astrocytomas
62
What type of tumor is associated with Parinaud syndrome?
Pineal gland tumor
63
Observation and analgesics is appropriate for acute otitis media under what conditions?
Age over 2 years Normal immune system Symptoms mild and unilateral
64
Secretory diarrhea vs Osmotic diarrhea Stool osmotic gap
Low in secretory Elevated in osmotic
65
Amantadine side effects
Livedo reticularis Ankle edema
66
Two tests for Chronic Granulomatous Disease
Nitroblue tetrazolium Dihydrorhodamine
67
Which alcohol ingestion is not associated with high anion gap or acidosis
Isopropyl alcohol Methanol, ethylene glycol, and alcohol ketoacidosis are all associated with High gap acidosis
68
Mechanism of decreased vital capacity in COPD
Air trapping during expiration
69
Intranuclear and intracytoplasmic inclusions = Intranuclear only =
CMV HSV
70
Most common complication of asymptomatic bacteriuria in pregnant women Why?
Acute pyelonephritis Progesterone of pregnancy relaxes smooth muscle and causes ureteral dilatation Also associated with pre term labor and low birth weight
71
Increased risk of vibrio infection with what underlying disease?
Liver disease (Like hemochromatosis, cirrhosis, hepatitis)
72
Tachypnea beginning shortly after birth but resolving by day 2 Imaging findings
Transient tachypnea of newborn Bilateral perihilar linear streaking
73
Tachypnea and severe cyanosis in term or post term infant
Persistent pulmonary hypertension
74
Patients with CPPD should be evaluated for what underlying causes?
Hyperparathyroid Hypothyroid HEMOCHROMATOSIS (especially with family history of diabetes)
75
Chrondrocalcinosis is seen in?
CPPD NOT RA OR GOUT
76
Hookworms 2 Disease Tx?
Ancylostoma caninum and braziliense Cutaneous Larval migrans Ivermectin
77
Work up of chronic cough that worsens at night and doesn't improve with anti histamines
PFT's Or Trial of corticosteroids
78
Young person Unsteady gait and weakness of lower limbs Decreased vibratory and position sense High plantar arches MRI shows atrophy of spinal cord, minimal cerebellar atrophy T wave inversions on ekg
Friedrichs Ataxia Trinucleotide repeat disorder GAA
79
aortic regurgitation best heard in right sternal border = Combined with 2:1 AV block and IVDA
Aortic root disease Perivalvular abscess
80
Trichomoniasis Treat patient and partner or just patient?
Patient and partner
81
Nocturia on an AA patient
Hyposthenuria Related to Sickle Cell trait - family history
82
Elderly Bone pain Hypercalcemia Renal insufficiency Granular casts on urinalysis
Multiple myeloma Monoclonal protein production
83
Scotch tape tests positive Organism? TreatMent?
Enterobius vermicularis Albendazole or pyrantel pamoate For patient and all household contacts
84
Agents causing idiosyncratic liver reactions
Isoniazid Chlorpromazine Halothane Antiretrovirals
85
Raised lesions, \<1cm Dimples in the center when edges are pinched Dx
Dermatofibroma Buttonhole sign
86
Predominant leukemia in children 2-10 Diagnostic?
ALL Presence of \>25% lymphoblasts in the marrow PAS positive aggregates TdT positive
87
IUGR Closed fists with overlapping fingers Dx? Other findings
Trisomy 18 Micrognathia Prominent occiput Rocker-bottom feet
88
Electrical alternans with sinus tach Highly specific for?
Pericardial effusion
89
3-4 months Doll like face Seizures Lactic acidosis Hypoglycemia
Von Gierke disease Glucose-6-phosphatase
90
Isolated enuresis in children Stepwise treatment
1- enuresis alarms 2- desmopressin 3- tricyclics (imipramine, desimpramine)
91
Diffuse telangiectasias Recurrent nosebleeds Arteriovenous malformations widespread Dx?
Osler-Weber-Rendu
92
Immediate intervention for CRAO
Ocular massage and high flow O2
93
25% false negative rate during first week of symptoms for what disease
Infectious Mono EBV
94
2nd degree block - Mobitz I
Constant p-p INCREASING P-R interval Decreasing R-R Prolonging to dropped beat
95
MEN 1
PRIMARY HYPERPARATHYROID Pituitary tumors Pancreatic
96
MEN 2A
MEDULLARY THYROID CANCER Pheochromocytoma Parathyroid hyperplasia
97
MEN 2B
MEDULLARY THYROID CANCER Pheochromocytoma Mucosal neuromas, MARFANOID habitus
98
MCC of erysipelas Involvement of what is particularly suggestive?
Group A Strep Strep pyogenes External ear involvement
99
Management shoulder dystocia
Breathe, do not push Elevate legs - Mcroberts Call for help Apply suprapubic pressure L- enlarge vaginal opening Maneuvers - Rubin, gaskin, zavanelli
100
Early decelerations =
Fetal head compression
101
Late decelerations=
Uteroplacental insufficiency
102
Variable decelerations=
Cord compression, cord collapse, oligohydramnios
103
MCC of osteomyelitis in normal pt Sickle cell?
Staph aureus Salmonella
104
Most consistent reversible risk factor for pancreatic cancer
Smoking
105
Lab findings in Pagets disease of bone
Normal Ca Normal Phos Elevated Alk Phos Elevated Urine Hyodroxyproline
106
Croup = what virus? Bronchiolitis =?
Parainfluenza RSV
107
RSV vs Croup
Croup has inspiratory stridor and barky cough 3-36 months RSV has no stridor or cough \<2 years
108
Medical treatment for HCM
1) Beta blockers 2) CCB's
109
Medications associated with idiopathic intracranial hypertension
Vit A Tetracyclines Growth Hormone
110
Why do patients with acute ischemia of CN III have preserved pupillary response
Parasympathetic fibers associated with the pupil response are on the outside of the nerve (I.e closer to the blood supply) Nerves to Muscles supplied by CN3 are further away from blood supply
111
Hypocalcemia after massive transfusion more likely in patients with underlying?
Liver disease or damage
112
Most effective nonpharmacologic method to decrease BP in overweight individuals
Weight loss 10% reduction
113
HCG purpose
Maintains corpus luteum Syncytiotrophoblasts
114
Endometriosis vs vaginismus vs vulvodynia
Painful deep penetration + dysmenorrhea Involuntary muscle contraction on speculum insertion Pain to superficial touch of the vaginal vestibule
115
Sudden loss of conscious + loss of postural tone + delayed return to consciousness =
Seizure Possible aura prior Tongue lacerations on exam
116
J❤️NES criteria of acute rheumatic fever
Joints - migratory arthritis Carditis Nodules Erythema marginatum Sydenham chorea
117
An evanescent pink rash with sharp edges
Erythema marginatum
118
Breast feeding decreases risk of what two cancers in women
Breast and ovarian
119
Breast feeding benefits to infant
Improved immunity Prevention of otitis media and respiratory illnesses
120
Precocious puberty in a child Bleeding, endometrial hyperplasia in postmenopausal woman Adnexal mass
Granulosa cell tumor Increased estrogen
121
Woman under 30 Increased LDH or b-HCG Ovarian mass
Dysgerminoma
122
Most common benign ovarian neoplasm
Serous cystadenoma
123
Concentric hypertrophy seen in
Valvular aortic stenosis Untreated hypertension
124
Eccentric hypertrophy seen in
Valvular regurgitation
125
Eczema, regurgitation, painless bloody stools in an infant
Milk protein induced enterocolitis Eliminate all dairy and soy Switch to hydrolyzed formula
126
Drugs that can cause folic acid deficiency
Phenytoin Primidone Phenobarbital Trimethoprim Methotrexate
127
Most common primary bone tumor of children and young adults Characteristic findings on imaging, physical exam
Osteosarcoma Sunburst pattern Codman triangle Tender soft tissue mass in metaphyses of long bone
128
Ewing sarcoma characteristic appearance on x ray
Onion skinning
129
Ovulation induction agent in PCOS
Clomiphene citrate SERM
130
Extended wrist, hyperextended MCP joints, flexed IP joints, absent grasp reflex Infant with shoulder dystocia What's the name of the paralysis? Nerve levels?
Klumpke paralysis C8-T1 Also includes Horner syndrome commonly
131
Most common congenital cause of aplastic anemia Other findings?
Fanconi Short stature. ABNORMAL THUMBS Hypo or hyperpigmented areas, cafe au lait spots Strabismus, low set ears
132
Diagnosis of Fanconi anemia made by?
Chromosomal breaks on genetic analysis + clinical findings
133
Correction for albumin and calcium
Decreases by .8 for every 1g decrease in albumin
134
Empiric antibiotic treatment for human bite
Augmentin (amox-clav)
135
2 MCC of unilateral lymphadenitis
Staph aureus, Strep pyogenes
136
Indications for addition of corticosteroids to TMP-SMX in PCP pneumonia
PaO2 \<70 A-a gradient \> 25
137
Antipseudomonal antibioti s
Ticarcillin, Piperacillin Ceftazidime, Cefepime Amikacin, gentamicin, tobramycin Cipro, levoquin Aztreonam Imipenem, meropenem
138
Abx of choice for malignant otitis externa
IV ciprofloxacin
139
Obstructive lung disease FEV1 FEV1/FVC FVC
\<80% \<70% Normal to decreased
140
Restrictive lung disease including obesity FEV1 FEV1/FVC FVC
\<80% \>70% \<80%
141
Useful differentiating for asthma vs COPD
DLCO is normal in asthma or increased Asthma is REVERSIBLE
142
Rapid onset hirsutism Labs?
Testosterone and DHEAS NOT LH FSH
143
Atelectasis most severe post surgery what day?
Post op day 2
144
Compensation for hypoxemia Labs?
Hyperventilate Respiratory alkalosis Decreased PaCO2
145
Common etiologies of small intestine bacterial overgrowth
Anatomical abnormalities - strictures, surgical Motility disorders - sclerosis, DM Other - ESRD, AIDS, CIRRHOSIS, advanced age
146
Gold standard dx for small intestine bacterial overgrowth
Endoscopy with jejunal aspirate \>10^4 organisms
147
What effect does estrogen have on thyroid hormones
Increased TBG Thyroxine dose would need to be increased in hypothyroid patients
148
Rifampin, phenytoin, carbamazepine effect on thyroid
Increased thyroid hormone metabolism
149
Bile acid binding agents Iron, calcium, aluminum hydroxide PPI, sucralfate Effect on levothyroxine
Decreased absorption
150
When to give prophylactic antiviral for pregnant women with herpes
Starting at 36 weeks
151
Which cause of pericarditis typically doesn't cause the diffuse ST changes?
Uremic
152
Neonatal sepsis needs to be high on the differential with what two symptoms
Decreased activity Poor feeding
153
Pulmonary nodules with surrounding ground glass opacities
Invasive aspergillosis "Halo sign"
154
Physical exam findings of alcoholic cerebellar degeneration
Progressive gait dysfunction Truncal ataxia Nystagmus Intention tremor or dysmetria Dysdiadichokinesia
155
Amenorrhea for \>6 months or 3 cycles Negative bHCG Next?
Prolactin, TSH, FSH
156
Intrauterine fetal demise = Follow up test? Tx?
fetal death \>20 weeks Transvaginal US Followed by D&E or vaginal delivery (\>24 weeks)
157
Syringomyelia is associated with
Arnold Chiari type I malformation
158
Pre eclampsia symptoms at less than 20 weeks can be a complication of?
Hydatidiform mole
159
Most common cause of nonsurgical hypoparathyroid
Autoimmune
160
Emboli ischemic strokes typically have what type of onset?
Abrupt Worst at the start
161
Olanzapine and Clozapine highly associated with?
Metabolic syndrome Get fasting lipids and glucose after 3 months of therapy
162
Acute febrile illness and altered mental status No rash Tick exposure +
Erlichiosis Doxycycline Can see elevated LFT's and leukopenia or thrombocytopenia
163
Is chorioamnionitis an indication for C section?
NO Augment delivery instead Unless another indication for CS is present
164
Phenazyridine
Analgesic for the urinary tract Cystitis treatment
165
Delayed (slow rising) and diminished (weak) pulses
Pulsus parvus et tardus
166
Preferred treatment for bipolar in patient with kidney disease
Valproate Lithium contraindicated Quetta pine and Lamotrigine have efficacy as well
167
Uniformly enlarged uterus found in? Other symptoms?
Adenomyosis Pelvic pain and extremely painful menses with heavy bleeding
168
Gait associated with Parkinson's
Hypotonic gait
169
Urine culture reserved for?
Those who fail initial therapy
170
Elevated PaCO2 and low O2 suggest what type of post surgical lung process?
Alveolar hypoventilation
171
Deficient enzyme in Niemann Pick Differentiation from Tay Sachs?
Sphingomyelinase Hepatosplenomegaly
172
Abdominal pain following trauma Dilated bowel loops on x ray with no distinct transition point
Paralytic ileus
173
Diarrhea in AIDS patients \<180 cd4 \<100 \<50 \<50
Cryptosporidium - watery diarrhea with fever Microsporidium/Isosporidium - diarrhea WITHOUT fever MAC - high fever CMW - hematochezia, frequent small bowel movements
174
In developing countries and endemic areas TB is a common cause of what heart condition?
Constrictive pericarditis
175
Steps of work up in bilious emesis of a neonate
1. Abd X-ray 2. Contrast enema (pending no pneumoperitoneum on X-ray)
176
First step in meconium ileus of neonate
Hyperosmolar enema Then surgery
177
Three causes of hyperandrogenism in pregnancy
Luteoma Theca lutein cyst Krukenberg tumor
178
Fair hair and eyes Developmental delay Cerebrovascular accident Tall stature
Homocystinuria
179
Mild hypothermia temp Moderate Severe
32-35 C (90-95) 28-32 C (82-90) \<28 C (82)
180
P2Y12 blockers
Clopidogrel Ticagrelor Prasugrel
181
5 therapies shown to improve morbidity and mortality in known CAD
Dual antiplatelet aspirin+ P2Y12 Beta blocker ACE-I/ARB STATINS Aldosterone antagonists
182
First line treatment for uremic pericarditis
Hemodialysis NSAID's if that fails
183
Primary biliary cholagnitis antibody? Tx?
Anti-mitochondrial Ursodeoxycholic acid
184
Primary dose limiting side effect of hydroxyurea
Myelosuppression
185
Glucocorticoids affect thyroid hormones how
Decrease peripheral conversion of T4-T3
186
4. Components of thyroid storm treatment
Beta blocker Thionamide Iodine Glucocorticoids
187
Long standing rheumatoid arthritis + neutropenia + splenomegaly
Felty syndrome
188
Warfarin induced skin necrosis due to?
Protein C deficiency
189
Hypokalemia Alkalosis Normotensive 4 conditions?
Vomiting Diuretic abuse Bartter Gittelman
190
Most important thing to do with acute psychosis in an adolescent or child
Rule out medical or substance related causes
191
Most common risk factor for preterm birth
Prior preterm birth
192
Recommended dietary change for chronic calcium oxalate stones
Low sodium diet
193
Proximal muscle weakness, nontender Tachycardia, weight loss, muscle atrophy
Hyperthyroidism Acute thyrotoxic myopathy Muscle atrophy is a EARLY finding here compared to late with polymyositis
194
Why is the BUN elevated in pre-renal acute kidney injury
RAA axis = reabsorption of Na and water = passive reabsorption of urea
195
Primary prophylaxis for esophageal varices
Nadolol or propranolol Ligation (first)
196
NRTI's with good placental transfer
Zidovudine Tenofovir
197
Neonatal Polycythemia
198
Prenatal, Intrapartum, and Postnatal Management of HIV infection
199
Bronchiolitis
200
Henoch-Schonlein Purpura
201
Flaccid Paralysis Differential
202
TTP
203
Malignancy Related Hypercalcemia COnditions
204
Acute Abd in Women
205
Antiplatelet/Antithrombotic Therapy in Acute Ischemic Stroke
206
Chikungunya
207
Disorders of Sex Development
208
Hereditary Thrombophilias
209
ITP
210
Serum Sickness Syndrome
211
Wallenberg Syndrome
212
Routine Prenatal Studies
213
Rabies PEP
214
Polycythemia vera pathophysioloy
JAK2 mutation
increased ERYTHROCYTE PRODUCTION irrespective of EPO, EPO levels are low
215
Restrictive lung disease PFT values
FEV1 \>75%
FEV1/FVC \>70
Total lung capacity \<80 (decreased residual volume)
216
