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IM & Step 2 > Qbank Step 2 > Flashcards

Qbank Step 2 Flashcards

1
Q

What 4 cancers cause ectopic Cushing’s syndrome?

A
  1. Small Cell Lung Ca
  2. Pancreatic Cancer
  3. Neuroendocrine tumors
  4. Bronchial carcinoids
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2
Q

erythematous papules with a central scale with a sandpaper like texture on palpation

A

actinic keratoses

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3
Q

what is trismus?

A

inability to open the mouth normally, seen in retropharyngeal abscess

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4
Q

how long is a pt at risk for strep pneumo sepsis after splenectomy?

A

> 30 years!!! pts should receive anti-pneumococcal, h flu, and meningococcal vaccines several weeks before operation and daily oral penicillin ppx for 3-5 years following splenectomy

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5
Q

palpable purpura + proteinura + hematuria?

A

suspect mixed cryoglobulinemia: also includes nonspecific systemic symptoms, arthralgias, hepatosplenomegaly, and hypocomplementemia

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6
Q

what infection is associated with mixed cryoglobulinemia?

A

hepatitis C

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7
Q

how does henoch-schonlein purpura present? (5)

A
  • presents in childhood as:
    1. palpable purpura on the buttocks
    2. Abdominal pain
    3. Arthralgias
    4. Proteinuria
    5. Hematuria
  • serum complement levels are normal
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8
Q

how do you differentiate between restrictive and obstructive lung disease on PFTs?

A

The FEV1/FVC ratio:
restrictive >80%
obstructive <80%

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9
Q

What are the criteria for making a diagnosis of polymyalgia rheumatica? (4)

A
  1. Age over 50
  2. Aching pain in the neck, pelvis, and shoulder lasting >1mos
  3. Morning stiffness lasting ?1hr
  4. ESR >40
    tx: low dose prednisone
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10
Q

what disease does polymyalgia rheumatica commonly present with?

A

giant cell arteritis

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11
Q

what are some maneuvers used to treat paroxysmal supraventricular tachycardia? (3) how do they work?

A
  1. Valsalva
  2. carotid sinus massage
  3. immersion in cold water
    - these increase vagal tone and decrease conduction through the AV node
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12
Q

what is paroxysmal supraventricular tachycardia and what is one med used to tx it?

A
  • most common paroxysmal tachycardia in pts without structural heart defects
  • heart rates between 160-220bpm
  • caused by re-entry into the AV node
  • Adenosine: AV nodal blocker short acting
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13
Q

what 4 diseases are associated with erythema nodosum?

A

erythema nodosum: painful subcutaneous nodules on the anterior surface of the lower legs

  1. Sarcoid
  2. TB
  3. Histoplasmosis
  4. IBD
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14
Q

all forms of gestational trophoblastic disease present w what 3 symptoms?

A
  1. Irregular vaginal bleeding
  2. Enlarged uterus
  3. Pelvic pain
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15
Q

what are some causes of pericardial effusion?

A
  1. Idiopathic (most common) following viral
  2. Malignancy
  3. Post-MI
  4. Uremia
  5. Autoimmune diseases
  6. Hypothyroidism
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16
Q

risk factors for splenic abscess?

A
  1. Infection: infective endocarditis with hematogenous spread
  2. Immunosuppression
  3. IV drug use
  4. Trauma
  5. Hemoglobinopathies
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17
Q

treatment of splenic abscess?

A

splenectomy!! or IR drainage for poor surgical candidates

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18
Q

why does niacin cause pruritis and flushing??

A

niacin-induced prostaglandin and histamine release causing peripheral vasodilatation, NOT a hypersensitivity reaction

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19
Q

Side effect of rifampin?

A

causes red to orange discoloration of body fluids including urine, saliva, sweat and tears (even soft contact lenses)

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20
Q

Pts with rheumatoid arthritis are at risk of developing what long term complication?

A

osteoporosis/osteopenia/fractures

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21
Q

why does sickle cell trait cause painless hematuria?

A

papillary ischemia: which is due to the relatively low local oxygen partial pressure

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22
Q

focal segmental glomerulosclerosis is associated with what?

A
  • African Americans (more than 1/2 of nephrotic cases in AA)
  • Obesity
  • Heroin
  • HIV
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23
Q

pt has celiacs but a negative IgA anti-tissue transflutaminase!?!?!? what!?!

A
  • ppl w/ celiacs often have selective IgA deficiency as well meaning…. no IgA! so serological studies will be negative
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24
Q

what plasma aldosterone concentration: plasma renin activity ratio suggests primary hyperaldosteronism?

A

Ratio >20

with plasma aldosterone >15ng/dL

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25
Q

Pleural fluid glucose <60mg is usually due to what 6 causes?

A
  1. Rheumatoid pleurisy
  2. Complicated parapneumonic effusion or empyema
  3. Malignant effusion
  4. TB pleurisy
  5. Lupus pleuritis
  6. Esophageal rupture
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26
Q

Pleural glucose <30 usually due to what 2 causes?

A
  1. Empyema

2. Rheumatic Effusion

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27
Q

what serum compliment levels are low in poststrep glomerulonephritis?

A

C3 complement

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28
Q

what is winters formula?

A

PaCO2 = 1.5 (HCO3) + 8

- can be used to calculate the expected PCO2 during respiratory compensation for a primary metabolic acidosis

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29
Q

when should you take a pt with SBO to the OR?

A

when they dont improve with conservative measures or there’s signs of strangulation (fever, tachycardia, leukocytosis, metabolic acidosis)

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30
Q

what is Trousseau’s syndrome? 6 associated cancers?

A
  • aka migratory superficial thrombophlebitis
  • is a hypercoagulable disorder that usually presents with unexplained superficial venous thrombosis at unusual sites (arm, chest area)
  • most commonly associated with visceral malignancy:
    1. Pancreas
    2. Lung
    3. Prostate
    4. Stomach
    5. Colon
    6. Acute leukemias
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31
Q

Pt complains of seeing halos around lights

A

think of angle closure glaucoma

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32
Q

what two factors increase the overall risk of vertical transmission of HCV from mom to baby?

A
  1. HIV coinfection

2. High HCV viral load

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33
Q

whats the risk of sexual transmission of HCV?

A

in a monogamous heterosexual parternship: 0.1% annually aka VERY LOW

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34
Q

what medications are known to cause idiopathic intracranial hypertension? (IIH)

A
  1. Growth hormone
  2. Tetracyclines (minocycline, doxycycline)
  3. Excessive vitamin A and its derivatives
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35
Q

treatment for idiopathic intracranial hypertension not caused by medications?

A
  1. Weightloss

2. Acetazolamide

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36
Q

pt has a PAINLESS corneal ulcer- what nerve is affected?

A

First branch of trigeminal: ophthalmic branch

  • carries sensory fiberst to the scalp, forehead, upper eyelid, conjunctiva, cornea , nose and frontal sinuses
  • damage to V1 results in corneal anesthesia!
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37
Q

DMARD: MOA & Adverse affect- Methotrexate

A 
MOA: Purine antimetabolite
SE: Hepatotoxicity
Stomatitis (oral ulcers)
Cytopenias
Rash, alopecia
bone marrow suppression
pulmonary toxicity
- thus give folic acid supplemetation
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38
Q

DMARD: MOA & SE

Leflunomide

A

MOA: Pyrimidine synthesis inhibitor
SE: Hepatotoxicity
Cytopenias

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39
Q

DMARD: MOA & SE

Hydroxychloroquine

A

MOA: TNF and IL-1 Suppressor
SE: Retinopathy

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40
Q

DMARD: MOA & SE

Sulfasalazine

A

MOA: TNF and IL-1 suppressor
SE: Hepatotoxicity
Stomatitis
Hemolytic anemia

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41
Q 
DMARDs: SE (4)
TNF inhibitors (adalimumab, certolizumab, etanercept, golimumab, infliximab)
A
  1. Infection
  2. Demyelination
  3. CHF
  4. Malignancy
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42
Q

treatment of pt with torsades de pointes?

A

magnesium sulfate + stop offending agents

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43
Q

what drugs cause torsades?

A
  1. TCAs
  2. Anti-arrhythmics: amiodarone, sotalol
  3. Anti-infective agents: moxifloxacin, fluconazole
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44
Q

a large pedunculated exophytic papule with a collarette of scale, resembles a large pyogenic granuloma or cherry angioma

A
  • Bacillary angiomatosis: caused by bartonella henslae or quintana
  • characteristic skin lesion + fever, weight loss, malaise and abdominal pain
  • diagnosis made via tissue bx
  • extreme caution must be taken in bx lesions bc they are prone to hemorrhage
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45
Q

pathophys of analgesic nephropathy

A
  • seen in pts w several years of analgesic abuse
  • chronic tubulointerstitial damace: due to renal papillary necrosis from papillary ischemia induced by analgesic-mediated vasoconstriction of medullary blood vessels
  • RBCs are unchanged on UA (whereas deformed in glomerulopathy)
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46
Q

smudge cells and atypical lymphocytes

A

CLL: use flow cytometry to prove clonality

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47
Q

JAK2 mutations are associated with what?

A

myeloproliferative diseases: particularly polycythemia vera

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48
Q

erythematous papules with a central scale and a sandpaper like texture

A

actinic keratoses

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49
Q

treatment of frostbite to fingers?

A

rapid re-warming with warm water

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50
Q

what two liver diseases are associated with mallory hyaline bodies on liver bx?

A
  1. Alcohol liver injury

2. Wilsons disease

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51
Q

liver biopsy shows hepatocytes containing granules that are PAS positive and diastase resistant

A

Alpha-1 antitrypsin deficiency

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52
Q

treatment of uric acid stones?

A
  • theyre highly soluble in alkaline urine so alkalinization of urine pH >6.5 with oral potassium bicarbonate or potassium citrate is indicted
    (uric acid stones account for approx 10-15% of cases of total nephrolithiasis, seen in pts iwth unusually low urine pH levels and hyperuricosuria, they are radiolucent but can be seen on USG and CT)
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53
Q

what is the most common thyroid hormone pattern in sick euthyroid syndrome?

A
  • a fall in total and free T3 levels, normal T4 and TSH, this is due to the decreased peripheral conversion of T4 to T3
  • on recovery from the nonthyroid illness, pts may experience a modest, transient increase in the serum TSH levels
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54
Q

6month old boy has recurrent pyogenic (s pneumo and h flu) infections

A

think brutons agammaglobulinemia: x linked recessive

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55
Q

what is the defect in brutons agammaglobulinemia?

A

defect in tyrosine kinase in B cells

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56
Q

what are 3 neurologic complications of measles?

A
  1. Encephalitis (within days)
  2. Acute disseminated encephalomyelitis (within weeks)
  3. subacute sclerosing panencephalitis (within years)
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57
Q

3yo boy has recurrent staph infections & aspergillus

A

think chronic granulomatous disease: mutation causes loss or inactivation of the NADPH oxidase responsible for oxidation, patients experience recurrent infections by catalase expressing organisms
gram stain = neutrophils filled wth bacteria

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58
Q

C3 deficiency predisposes kids to what?

A

recurrent infections with encapsulated bacteria beginning shortly after birth

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59
Q

kid w recurrent fungal and viral infections

A

think DiGeorge syndrome

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60
Q

steps for management of newborn who doesnt pass meconium within first 24 hours?

A
  1. KUB: to look for pneumoperitoneum from perforated bowel
  2. Contrast enema: to assess for microcolon (meconium ileus- gastrografin can break up meconium and is thus therapeutic) or a transition zone w dilated megacolon (hirschsprung disease)
  3. If meconium ileus: get sweat chloride test, if hirschsprung: get rectal biopsy
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61
Q

how does maternal diabetes lead to Resp distress syndrome in infants?

A
  • maternal diabetes delays the maturation of surfactant production in the lungs
  • fetal hyperinsulinism antagonizes the actions of cortisol and may delay the lung maturation process
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62
Q

infants with laryngomalacia are at risk of waht?

A

GERD- which can aggravate airway collapse

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63
Q

Eerb duchenne palsy involves what branches?

A

C5-C7

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64
Q

2 known GI complications of HSP in kids?

A

GI Hemorrhage

Intussusception

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65
Q

risk factors for cholecystitis in children? (3)

A
  1. Sickle cell anemia
  2. Hereditary spherocytosis
  3. Obesity
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66
Q

what EKG finding is a minor Jones criteria for rheumatic fever?

A

proloned PR interval

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67
Q

most common complication of HUS?

A

renal damage

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68
Q

classic triad of congenital rubella syndrome?

A
  1. Deafness
  2. Cataracts
  3. Cardiac defects
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69
Q

how do you confirm the diagnosis of Lyme arthritis?

A

ELISA and western blot testing

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70
Q

what is reactive arthritis?

A
  • acute and asymmetric oligoarthritis that occurs 1-4 weeks after urethritis or diarrheal infection
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71
Q

most common cause of bacteremia in sickle cell patients?

A

strep pneumo

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72
Q

when is a voiding cystoureterogram indicated in peds patients?

A
  1. Patient is under 10 years of age
  2. Male
  3. Prepubertal non-sexually active female
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73
Q

medulloblastoma arises from where?

A

cerebellar vermis

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74
Q

what is associated with breathholding spells??

A

Iron Deficiency Anemia

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75
Q

what 3 factors increase the risk of iron deficiency anemia in infants?

A
  1. Maternal IDA
  2. Prematurity
  3. Early introduction of cow’s milk before age 12 months
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76
Q

when should you supplement vitamin B12 in infants?

A

those exclusively breastfed by strict vegetarian mothers

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77
Q

difference in timing of transient synovitis and legg-calve-perthes disease?

A

transient synovitis: 1 month

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78
Q

symptoms of riboflavin deficiency? (vit b2)

A
  • cheilosis
  • glossitis
  • seborrheic dermatitis (often affecting the genital areas)
  • Pharyngitis
  • edema and/or erythema of the mouth
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79
Q

Differential for T wave inversions: (5)

A
  1. MI
  2. Myocarditis
  3. Old pericarditis
  4. Myocardial contusion
  5. Digoxin toxicity
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80
Q

the most common primary bone tumor affecting children and young adults?

A

osteosarcoma

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81
Q

most common cause of congenital hypothyroidism in the US?

A

thyroid dysgenesis

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82
Q

4 contraindications to the rotavirus?

A
  1. Anaphylaxis to ingredients
  2. Hx of intussusception
  3. Hx of uncorrected congenital malformation of GI like Meckels
  4. SCID
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83
Q

doxycycline is contraindicated in what 2 patient populations?

A
  1. Children <8 years
  2. Pregnant women
    - use oral amoxicillin or cefuroxime instead
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84
Q

when do you use IV ceftriaxone in Lyme disease?

A

reserved for Lyme meningitis and heart block (manifestations of early disseminated lyme disease)

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85
Q

what is the most common childhood cancer?

A

Acute Lymphoblastic Leukemia

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86
Q

what are the 3 most common cardiovascular abnormalities seen in Turner’s syndrome?

A
  1. Bicuspid aortic valve
  2. Coarctation of the aorta
  3. Aortic root dilation
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87
Q

treatment of kawasaki’s?

A

ASA plus IVIg

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88
Q

what are the HLA-B27 associations?

A 
PAIR:
Psoriasis
Ankylosing spondylitis
IBD
Reiter's syndrome
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89
Q

screening recommendations for AAA?

A

any many 65-75 who have ever smoked

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90
Q

4 drug classes that are known to cause esophagitis?

A
  1. Tetracyclines
  2. ASA (and many NSAIDs)
  3. Bisphosphonates
  4. Others: Potassium chloride, quinidine, Iron
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91
Q

treatment of choice for uremic pericarditis?

A

hemodialysis!

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92
Q

Indications for Hemodialysis (6)

A
  1. Refractory hyperkalemia
  2. Volume overload unresponsive to diuretics
  3. Refractory metabolic acidosis (pH <7.2)
  4. Uremic pericarditis
  5. Uremic encephalopathy or neuropathy
  6. Coagulopathy due to renal failure
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93
Q

electron microscopy findings include alternating areas of thinned and thickened capillary loops with splitting of the GBM

A

alport’s syndrome

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94
Q

what is the most common primary intracardiac tumor and where are they usually found?

A

atrial myxomas: found in the L atrium

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95
Q

what antiretroviral drug is known to cause crystal-induced nephropathy?

A

Idinavir (protease inhibitor)

thus monitor with UA and serum Cr levels q3-4months

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96
Q

Name the life threatening ART side effect:

Didanosine

A

pancreatitis

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97
Q

Life trheatening side ART effect:

Abacavir

A

Hypersensitivity syndrome (rash -> anaphylaxis upon next exposure)

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98
Q

Life threatening ART side effect:

NRTIs

A

lactic acidosis

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99
Q

Life threatening ART side effect: NNRTIs

A

SJS

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100
Q

Life threatening ART side effect: Nevirapine

A

liver failure

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101
Q

when do u give itraconazole for histo ppx in HIV pts?

A

when CD4 count is less than 100 and they live in areas endemic for histoplasmosis

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102
Q

hereditary spherocytosis is disorder of what?

A

autosomal dominant disorder of spectrin- the protein that provides scaffolding for RBCs

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103
Q

treatment of hereditary spherocytosis?

A

folate supplementation and splenectomy

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104
Q

Diagnostic criteria for ATN? (4)

A
  1. Urine osmolality 300-350 (but never 20
  2. FeNa >2%
  3. BUN:Cr <20:1
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105
Q

Name the association:

  1. Muddy brown granular casts
  2. RBC casts
  3. WBC casts
  4. Fatty casts
  5. Broad and waxy casts
A
  1. Muddy brown: ATN
  2. RBC: glomerulonephritis
  3. WBC: Interstitial nephritis and pyelonephritis
  4. Fatty casts: nephrotic syndrome
  5. Broad and waxy: chronic renal failure
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106
Q

what is MEsna used for?

A

to prevent hemorrhagic cystitis caused by certain chemotherapeutic agents (cyclophosphamide)

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107
Q

3 phases of Trichinellosis? (from eating undercooked pork)

A
  1. Initial: larvae invade the intestinal wall causing abdominal pain, N/V, diarrhea
  2. Second: hypersensitivity as larvae migrate causing splinter hemorrhages, conjunctival and retinal hemorrhages, chemosis
  3. Third: larvae enter skeletal muscle, muscle pain tenderness, swelling & weakness
    - blood count usually shows eosinophilia
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108
Q

triad of trichinella?

A
  1. Periorbital edema
  2. Myositis
  3. Eosinophilia
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109
Q

2 types of autoimmune hemolytic anemia?

A
  1. Warm agglutinin: more common, due to autoimmune disease that is tx with steroids, rituximab (CD20 ab), splenectomy, or immunosuppression
  2. COld agglutinin: may be due to infections or autoimmune disease causing intravascular hemolysis, tx is supportive care (warming body) and RBC transfusions
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110
Q

Cyclosporine and tacrolimus: MOA?

A

calcineurin inhibitors

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111
Q

Major side effects of cyclosporine? Tacrolimus?

A

Cyclosporine:

  1. Nephrotoxicity
  2. Hyperkalemia
  3. HTN
  4. Gum hypertrophy
  5. Hirsutism
  6. tremor
    * Tacrolimus has the same EXCEPT for hirsutism and gum hypertrophy
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112
Q

Major toxicities of azathioprine? 3

A
  1. Dose related diarrhea
  2. Leukopenia
  3. Hepatotoxicity
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113
Q

Major toxicity of mycophenolate?

A

bone marrow suppression

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114
Q

treatment of myasthenia crisis?

A

endotracheal intubation and withdrawal of anticholinesterases for several days

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115
Q

what are the 5 major criteria of rheumatic fever?

A
  1. Polyarthritis
  2. Chorea
  3. Carditis
  4. Subcutaneous nodules
  5. Erythema marginatum
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116
Q

treatment of rheumatic fever?

A

penicillin G

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117
Q

infantile hypertrophic pyloric stenosis is most common in what pts?

A

first born males age 3-5 weeks

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118
Q

what are the risk factors for jejunal/ileal atresia in infants?

A
  • poor fetal gut perfusion from maternal use of vasoconstricive medications or drugs ie cocaine & tobacco
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119
Q

what is often the first symptom of autistic disorder?

A

lack of social smile

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120
Q

tx of choice for impetigo?

A

topical mupirocin

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121
Q

what are the indications for imaging prior to LP in infants and children?

A
  1. Hx of hydrocephalus
  2. Hx of head trauma
  3. Hx of VP shunt or neurosurg
  4. Comatose
  5. Focal neurological findings
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122
Q

birth weight should be regained by

A

10-14 days

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123
Q

How do you diagnose tinea corporis?

A

with a skin scraping and potassium hydroxide examination, or clinically

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124
Q

babies born with a sacral dimple or tuft of hair should be screened for what and how?

A

for occult spinal bifida with a lumbosacral ultrasound (if this is abnormal then perform a MRI of spine

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125
Q

treatment of choice for developmental dysplasia of hip in infant <6 months?

A

Pavlik hip harness

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126
Q

features of vascular ring in children

A
  1. Presents before 1 year
  2. Persistent stridor that improves with neck extension
  3. Associated with cardiac abnormalities
    - result of abnormal development of the aortic arch causing tracheal, bronchial or esophageal compression
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127
Q

inheritance of myotonic muscular dystrophy?

A

autosomal dominant

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128
Q

Intraventricular hemorrhage is common in which neonates?

A

born <1500g

- thus screening w serial head USs is necessary

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129
Q

what is the most common predisposing factor for orbital cellulitis?

A

bacterial sinusitis

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130
Q

MOA of ethosuximide?

A

affects the thalamic neurons by woking against calcium currents

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131
Q

how does vitamin A help reduce mortality in pt w measles??

A

it helps the GI and respiratory epithelium regenerate and enhances the immune system

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132
Q

how do you diagnose choanal atresia?

A

first: try passing a catheter through nose 3-4cm into oropharynx
then: CT scan with intranasal contrast, which shows a narrowing at the level of the pterygoid plate

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133
Q

what two immunizations are known to cause febrile seizures?

A
  1. DTaP

2. MMR

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134
Q

what is the Guthrie urine test?

A 
a qualitative (coloration) test that detects the presence of metabolic products of phenylalanine in the urine
- used to diagnose PKU, can also use blood phenylalanine levels
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135
Q

heart defects associated with digeorge?

A
  1. Trucus arteriousus
  2. TOF
  3. Interrupted aortic arch
  4. Septal defects
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136
Q

pathology of retinoblastoma?

A

inactivation of the Rb suppressor gene: can be familial or sporadic
- failure to treat early may lead to death from liver and brain mets

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137
Q

what is werdnig-Hoffman syndrome?

A

autosomal recessive disorder that involves degeneration of the anterior horn cells and cranial nerve motor nuclei
aka floppy baby syndrome

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138
Q

what is the most common extracranial solid tumor of childhood?

A

neuroblastoma

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139
Q

neuroblastoma arises from what embryonic origin?

A

neural crest cells: amplification of n-myc proto-oncogene and hyperdiploidy

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140
Q

wilms tumor arises from what embryonic origin?

A

metanephros: embryologic precursor of the renal parenchyma

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141
Q

mesonephros gives rise to the what?

A
  1. Seminal vesicles
  2. Epididymis
  3. Ejaculatory ducts
  4. Ductus deferens
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142
Q

paramesonephron gives rise to what?

A
  1. Fallopian tubes
  2. Uterus
  3. Part of the vagina
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143
Q

disregulation of imprinted gene expression in chromosome 11p15
- macroglossia, rapid growth, hemihyperplasia, umbilical hernia or omphalocele

A

Beckwith-Wiedemann syndrome

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144
Q

deletion of paternal copy of 15q11-q13

A

Prader Willi syndrome: sporadic disorder due to maternal uniparental disomy (inheriting both copies on chrom 15 from mother)

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145
Q

paternal uniparental disomy- deletion of maternal copy of chromosome 15q11-q13

A

angelman syndrome

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146
Q

pts w galactosemia are at an increased risk of what kind of sepsis?

A

e coli neonatal sepsis

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147
Q

bullous type impetigo is caused by what organism?

A

staph!

the other type is vesiculo-pustulo which i think is from strep

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148
Q

small erythematous patch on a kids cheek that is raised, sharply demarcated with advancing pargins

A

erysipelas: red, indurated, tense and shiny plaque
- can have lymphatic involvement
- usually due to Streptococci, penicillin is DOC

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149
Q

most common heart defects in downs from most common

A
  1. Complete Atrioventricular septal defect (endocardial cushion) = heart failure at 6 weeks
  2. VSD
  3. ASD
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150
Q

what is the most common cause of secondary hypertension in children?

A

fibromuscular dysplasia: most commonly affects the R renal aa, angiography shows a string of beads pattern to the renal aa

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151
Q

radiographic evidence of intra-cranial calcifications that resemble a tramline + seizures

A

sturge-weber syndrome

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152
Q

most common presenting symptom of craniopharyngioma in children vs adults

A

Children: retarded growth due to growth hormone and thyroid function
Adults: sexual dysfunction/amenorrhea

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153
Q

treatment for acute migraine HA?

A

IV Antiemetics (chlorpromazine, prochlorperazine, metoclopramide)

  • can add NSAIDs or triptans too
  • propanolol and amitriptyline are used for migraine prophylaxis
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154
Q

How does ABPA (allergic bronchopulmonary aspergillosis) usually present?

A

its a hypersensitivity reaction to Aspergillus colonization of the bronchi

  • occurs most commonly in patients with athma or CF
  • presents with:
    1. Fever
    2. Malaise
    3. Productive cough
    4. Eosinophilia
    5. Hemoptysis
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155
Q

what are the causes of atypical pneumonia? (5)

A
  1. Mycoplasma pneumoniae (most common in ambulatory setting)
  2. Chlamydia pneumoniae
  3. Legionella
  4. Coxiella
  5. Influenza
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156
Q

what cause of atypical pneumonia is assocaited with a skin rash?

A

mycoplasma pneumo:

erythema multiforme: dusky red target shaped skin lesions over all four extremities

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157
Q

what is cerebral salt-wasting syndrome?

A

may occur in patients with subarachnoid hemorrhage
1. Inappropriate secretion of vasopressin -> water retention
2. Increased secretion of atrial/brain natriuretic peptide which causes cerebral salt wasting
- can also see SIADH
= hyponatremia

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158
Q

treatment of pagets disease?

A

tx symptomatic pts with bisphosphonates

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159
Q

what drug can cause a maculopapular rash with EBV?

A

amoxicillin (and other antibiotics)

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160
Q

what marker is relatively specific for hairy cell leukemia?

A

CD11c

- will also be tartrate-resistant acid phosphatase (TRAP) stain

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161
Q

neurocystericercosis is caused by what?

A

eating the larval stage of the pork tapeworm Taenia solium (eat eggs excreted by another person)

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162
Q

hyatid cysts are caused by what and seen in what pts?

A
  • caused by echinococcus species and usually seen in the liver and lungs
  • more common in sheep breeders
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163
Q

what type of hemolytic anemia do you see in a malignant lymphoproliferative disorder?

A

warm autoimmune type- caused by anti-red blood cell IgG antibodies,
tx: prednisone, if that doesnt work then splenectomy

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164
Q

why do people with chronic renal failure have abnormal hemostasis? tx?

A

due to uremic coagulopathy: several uremic toxins cause platelet dysfunction- ie guanidinosuccinic acid

  • PT, PTT and TT are normal, BT is prolonged
    tx: Desmopressin, cryoprecipitate and conjugated estrogens
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165
Q

what is the underlying pathology of parkinsons?

A

degeneration of neurons in the substantia nigra- leading to decreased dopaminergic activity and increased cholinergic activity

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166
Q

the risk of hemophilic arthropathy can be significantly reduced by what?

A

prophylactic treatment with factor concetrates

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167
Q

treatment of choice in kids with constipation?

A

Oral laxatives: polyethylene glycol and mineral oral

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168
Q

direct head injury followed by a lucid interval then rapid neurologic deterioration w HA vomiting seizures, confusion and lethargy

A

epidural hematoma: injury to meningeal blood vessels, do not cross suture lines
- dx = CT scan

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169
Q

clinical features that necessitate an emergent craniotomy in epidural hematomas? 5

A
  1. GCS <8
  2. Signs of increased ICP
  3. Pupillary abnormalities
  4. Hemiparesis
  5. Cerebellar signs
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170
Q

whats Friedreich taxia?

A

most common type of spinocerebellar ataxias

  1. Neurologic sx: ataxia, dysarthria
  2. Skeletal: scoliosis, feet deformities
  3. Cardiac: concentric hypertrophic cardiomyopathy
    - most common cause of death are cardiomyopathy and resp complications
    - lifespan >20 years
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171
Q

what is the most common pathogenic organism in young CF children in the setting of concurrent influenza infection?

A

Staph aureus

- after the age of 20, pseudomonas becomes the most common in CF pts

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172
Q

kid w downs syndrome presents with upper motor neuron findings?

A
  • Think atlantoaxial instability
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173
Q

what drugs can cause a serum sickness like reaction and in what setting?

A
  1. Amoxicillin
  2. Penicillin
  3. Cefaclor
    - in the setting of a viral illness
    sx: fever, uticarial rash, polyarthralgia and lymphadenopathy
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174
Q

what is the most common complications of supracondylar fractures?

A

entrapment of the brachial artery

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175
Q

classic triad of congenital rubella?

A
  1. Leukocoria (white papillary reflex) from cataracts
  2. Murmur of PDA
  3. Hearing loss
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176
Q

how does congenital CMV and rubella differ?

A 
Congenital rubella (triad of leukocoria, PDA< hearing loss)
Congenital CMV: deafness, purpura, hepatospneomegaly, sensorineural hearing loss
  • In CMV, the deafness is typically unilateral, blindness is usually due to chorioretinitis, and the heart is unaffected
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177
Q

injury in nurse maids elbow??

A

radial head subluxation: child typically keeps hand in pronated position and refuses attempted forearm supination

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178
Q

low birth weight, closed fists with the index overlapping the 3rd and the 5th overlapping the 4th, microcephaly, prominant occiput, micgrognathia, abduction, short sternum, cardiac and renal malformations, and mental retardation

A

Edwards syndrome: trisomy 18

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179
Q

whats the actual name of the pinworm?

tx?

A

enterobius vermicularis

tx: albendazole or mebendazole, but do NOT use in pregnant patients

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180
Q

how is HSP different from other causes of purpura?

A

it has a normal platelet count

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181
Q

first line treatment for pertussis?

A

macrolide antibiotic: erythromycin, azithromycin, or clarithromycin
- must treat all family and close contacts regardless of immunization status

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182
Q

3 syndromes associated wtih Wilms tumor? (nephroblastoma)

A
  1. WAGR: wilms, aniridia, GU anomalies, intellectual disability
  2. Beckwith-Wiedemann syndrome
  3. Denys-Drash syndrome
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183
Q

epidemiology of neuroblastoma? how does it differ from Wilms?

A
  • third most common pediatric cancer (after leukemia and brain), but most common cancer in FIRST year of life
  • presents as an abdominal mass that CROSSES the midline whereas Wilms does NOT cross the midline
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184
Q

whats the primary pathophysiologic cause of throbocytopenia in patients with WAS?

A

decreased platelet production

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185
Q

what are the EKG findings of WPW? (3)

A
  1. Shortened PR interval
  2. Slurred initial portion of the QRS complex (delta wave)
  3. Widened QRS
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186
Q

treatment of reyes syndrome?

A

administration of glucose with FFP and mannitol to decrease cerebral edema

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187
Q

what is Jervell-Lange-Nielson syndrome?

A

one of the congenital QT prolongation syndromes
- autosomal recessive disease characterized by:
1. congenital deafness
2. QT prolongation
tx= propanolol

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188
Q

what should be used as IV fluid resuscitation in children?

A

isotonic saline or LR

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189
Q

precocious puberty + cafe au lait spots + multiple bone defects (polyostotic fibrous dysplasia)

A

McCune-Alright syndrome

- sporadic defect in the G protein cAMP kinase function

190
Q

what commonly causes encephalitis in immunocompetent adults?

A

Herpes viruses: herpes simplex, varicella, EBV

191
Q

Difference between chlamydial and gonococcal urethritis?

A

Chlamydial: mucupurulent discharge, cx shows <100 colonies
gonococcal: less common, discharge is purulent and gram stain usually reveals the causative organisms

192
Q

preferred management of a solitary brain metastasis? what about multiple brain metastases?

A

surgical resection followed by whole brain radiotherapy

multiple brain mets: palliative whole brain radiation

193
Q

How do ventricular aneurysms usually present on EKG?

A

persistent ST segment elevation after a recent MI and deep Q waves in the same leads

194
Q

greatest risk factor for variant (prinzmetal’s) angina? tx? what should be avoided and why?

A

smoking
tx: ccb’s or nitrates
avoid nonselective beta blockers and ASA bc they can promote vasoconstriction

195
Q

what is dermatitis herpetiformis and what is it associated with? tx?

A
  • grouped herpetiform arrangement of papules and vesicles on the extensor surfaces, elbows, knees, upper back and buttocks
  • intensely pruritic
  • assoc w gluten-sensitive enteropathy (celiacs dx)
    tx: dapsone
196
Q

what are the two watershed zones in the colon?

A
  1. The splenic flexure, which is supplied by narrow terminal branches of the SMA
  2. The recto-sigmoid junction, supplied by narrow terminal branches of the IMA
197
Q

treatment of heat stroke?

A

evaporative cooling: spraying pt w lukewarm water and running fans to circulate air

198
Q

treatment of nocardia infection in immunocompromised patients?

A

TMP-SMX

199
Q

low PaO2 and high PCO2 (50-80 mmHg) suggests what?

A

alveolar hypoventilation:

  1. COPD, OSA, obesity hypoventilation, scoliosis
  2. Myasthenia gravis, lambert eaton syndrome, guillain barre syndrome
  3. Drugs: anesthetics, narcotics, sedatives
  4. Brain lesion, infection or stroke
200
Q

treatment of mucormycosis in sinuses?

A

Aggressive surgical debridement plus early systemic treatment with amphotericin B (the only effective drug against this guy)

201
Q

treatment of acute exacerbation of COPD includes what 4 therapies?

A
  1. Supplemental O2 (88-92% target sat)
  2. Inhaled bronchodilators (b2 and anticholinergics)
  3. Antibiotics: levo
  4. Systemic glucocorticoids
202
Q

whats the virus that causes molluscum contagiosum?

A

poxvirus

203
Q

treatment f choice for TTP-HUS??

A

plasmapheresis: removes the offending autoantibodies and repletes the deficient enzymes

204
Q

why do you have HYPOcalcemia in tumor lysis syndrome?

A
  • phosphate and potassium are both intracellular ions, when theyre released the phosphate binds to calcium and causes hypocalcemia
205
Q

what are two indications (lab values) for tube thorocostomy in a pt with empyema?

A
  1. Low pH (<60
206
Q

what test confirms the diagnosis of amyloidosis?

A

tissue biopsy of abdominal fat pad, bone marrow, rectum, kidney, endomyocardial

207
Q

2 main differences between IgA nephropathy and PSGN?

A
  1. Complement levels are normal in IgA and decreased in PSGN

2. PSGN occurs 10-21 days after infxn, IgA occurs 5 days

208
Q

whats Hamman’s sign and when do you see it?

A

audible crepitus on cardiac auscultation

- seen in a tracheobronchial tear & esophageal ruptures

209
Q

3 components of the GCS?

A
  1. Eye opening (4 pts)
  2. Verbal response (5)
  3. Motor activity (6 pts)
210
Q

what is Leriche syndrome? triad

A
  • arterial occlusion at the bifurcation of the aorta into the common iliac arteries
    1. Claudicationof hip/thigh/buttocks
    2. Impotence
    3. Symmetric atrophy of the bilateral lower extremities
211
Q

high riding prostate should make u suspicious of what?

A

pelvic fracture- prostate is displaced from pelvic hematoma

212
Q

treatment of MCL tears?

A

bracing and early ambulation

213
Q

what virus is associated with nasopharyngeal carcinoma? 2 other associations?

A

EBV
- assoc is so strong that EBV titer levels may be used to track the progress of therapy
(cancer is also assoc w smoking and chronic nitrosamine consumption)

214
Q

characteristic of central cord syndrome?

A

weakness that is more pronounced in the upper extremities than the lower
- occurs w hyperextension injuries in elderly patients with degenerative changes in the cervical spine, causing selective damage to the central portion of the anterior spinal cord

215
Q

pts w a GSW to abdomen need ex lap in what 3 circumstances?

A
  1. Hemodynamically unstable
  2. Evidence of peritonitis
  3. Evisceration of any organ
216
Q

signs of a fat embolism following long bone fracture? 3

A
  1. Respiratory distress
  2. Mental status changes
  3. Petechiae
    - following a latent period of 12-72 hours following the initial injury
217
Q

what type of cancer should be suspected in all non healing wounds?

A

squamous cell carcinoma

218
Q

what part of the spinal cord is most vulnerable to infarction?

A

thoracic spinal cord- bc its dependent on radicular arteries in the vertebral aa

219
Q

diagnosis and treatment of anterior spinal artery syndrome?

A

dx: emergent MRI
tx: supportive care and lumbar drains

220
Q

what is Volkmann’s ischemic contracture?

A

the final sequel of compartment syndrome in which the dead muscle has been replaced w fibrous tissue

221
Q

treatment of duodenal hematoma?

A

conservatively- with nasogastric suction and parenteral nutrition

222
Q

whats mcmurrays sign?

A
  • a palpable or audible snap occurring while slowly extending the leg at the knee from full flexion while simultaneously applying tibial torsion
  • indicative of a medial meniscus tear
223
Q

pathophysiology of presbyopsia?

A

loss of elasticity in the lens

224
Q

what diseases are assoc with primary biliary cirrhosis?

A
  1. Sjogrens syndrome
  2. Raynaud’s syndrome
  3. Scleroderma
  4. autoimmune thyroid disease
  5. hypothyroidism
  6. celiac disease
225
Q

what drug is used as both treatment and prophylaxis of secondary amyloidosis?

A

colchicine

226
Q

CXR descriptions refer to what:
Popcorn calcification
Bulls eye

A

Popcorn calcification: hamartoma

Bulls eye: granuloma

227
Q

an eccentric lytic area w a soap bubble appearance is seen at the epiphyseal region of the distal femur

A

Giant cell tumor of bone: benign and locally aggressive skeletal neoplasm seen in young adults

  • presents w pain, swelling, and decreased ROM
  • most commonly the distal femur an proximal tibia around the knee
  • surgery is tx of choice
228
Q

why do CCBs cause significant edema?

A

due to the property to dilate peripheral blood vessels

229
Q

what pathogens should be considered in patients with travelers diarrhea lasting >2 weeks? (3)

A
  1. Cryptosporidium
  2. Cyclospora
  3. Giardia
230
Q

what imaging modality is used to detect myocardial iron overload in hereditary hemochromatosis?

A

Cardiac MRI

231
Q

5 criteria of diagnosing metabolic syndrome?

A
  1. Abdominal obesity
  2. Fasting glucose >100-110
  3. Blood pressure >130/80
  4. TGs >150
  5. low HDL cholesterol
232
Q

what type of injury causes an anterior shoulder dislocation and how does it present??

A
  • most common form of shoulder dislocation, usually caused by a direct blow or fall on an outstretched arm
  • arm is held slightly abducted and externally rotated
233
Q

what type of injury causes a posterior shoulder dislocation and how does it present?

A
  • caused by violent muscle contractions during a tonic-clonic seizure
  • exam shows flattening of the anterior shoulder, prominent coracoid process, and pt holds arm internally rotated and adducted
234
Q

radiographs show circular appearance of the humeral head and a widened joint space after a seizure

A

posterior shoulder dislocation, described are the light bulb sign and rim sign

235
Q

what is the imaging modality of choice for massive hemoptysis?? (>600mL/24hr)

A

Bronchoscopy! also pt should be placed with the bleeding lung in the dependent position (lateral position) to avoid collection in the airways of the opposite lung

236
Q

why are pts w Crohns dx at increased risk for oxalate nephrolithiasis?

A

bc oxalate absorption is increased in Crohn disease and all other intestinal diseases causing fat malabsorption

237
Q

what nerve provides sensation to the anterior thigh and medial leg?

A

Femoral nerve

238
Q

what nerve provides sensation to the lateral leg and plantar foot?

A

tibial nerve

239
Q

what nerve provides sensation over the medial thigh?

A

obturator nerve

240
Q

what nerve provides sensation to the anterolateral leg and dorsum of the foot?

A

common peroneal nerve

241
Q

in a trauma victim, how can mechanical ventilation cause acute death??

A

bc positive pressure acutely increases intrathoracic pressure, increasing RA pressure and decreasing systemic venous return,
- this sudden loss may cause acute circulatory failure -> death

242
Q

what is the threshold for performing an escharotomy?

A

25-40mmHg

243
Q

what syndrome is associated with burst fracture of the vertebra?

A

anterior cord syndrome: characterized by total loss of motor function below the level of the lesion with loss of pain and temperature on both sides with intact proprioception

244
Q

pt develops a whistling noise during respiration following rhinoplasty, one should suspect what?

A

nasal septal perforation likely resulting from a septal hematoma

245
Q

most common site of extraperitoneal bladder rupture?

A

bladder neck

246
Q

management of kidney stones?

A
  • if 2L fluid daily
247
Q

Seborrheic dermatitis occurs in all ages but is found with increased frequency in what 2 patient populations?

A
  1. HIV

2. Parkinsons disease

248
Q

whats tinea versicolor?

A

superficial fungal infection of the skin caused by malassezia globosa
- can appear as hyperpigmented macules or pale./pink macules that dont tan

249
Q

how do you calculate the serum osmolality and when do you see a omsolar gap metabolic acidosis?

A

Serum Osm= (2Na + Glu/18 + BUN/2.8)
Osm gap = observed osm - calculated osmolarity
normal <10
- seen in acute methanol, ethanol or ethylene glycol poisoning

250
Q

what metabolic disturbance do you see in aspirin toxicity?

A

mixed anion gap metabolic acidosis and respiratory alkalosis (with no osmolar gap)

251
Q

what are the 2 clinical features of methyl alcohol poisoning?

A
  1. Visual changes (snowfield vision)

2. Acute pancreatitis

252
Q

gradual loss of peripheral vision and consequent tunnel vision
- ophthalmoscopic exam reveals cupping of the optic disk

A

open angle glaucoma

253
Q

what do you see on EEG in Creutzfeldt-Jakob disease?

A

periodic high voltage complexes

254
Q

what drug is approved for amyotrophic lateral sclerosis?

A

Riluzole: a glutamate inhibitor, may prolong survival and time to tracheostomy

255
Q

cavernous hemangiomas of the brain and viscera are assoc with what?

A

von Hippel-Lindau disease

256
Q

cystic hygromas are often found in what patient population?

A

neonates with turner syndrome

257
Q

Dense intramembranous deposits that stain for C3

A

Membranoproliferative Glomerulonephritis, type 2 (dense deposit disease)

258
Q

what is the most important risk factor for bladder cancer?

A

cigarette smoking (even thoug smoking cessation decreases the risk, pts still have a higher risk than nonsmokers even up to 20 years after smoking cessation)

259
Q

hereditary hemochromatosis increases risk for what type of cancer?

A

hepatocellular cancer (responsible for 30% of deaths in these pts)

260
Q

pathophys of BPPV?

A

due to crystalline deposits (canaliths) in the semicircular canals that disrupt the normal flow of fluid in the vestibular system

261
Q

how do you diagnose uremic pericarditis?

A

symptoms of pericarditis in a kidney disease patient

  • BUN >60mg/dL
  • EKG does NOT show normal diffuse ST elevations, bc the inflammatory cells dont penetrate the myocardium
262
Q

drug of choice of IBD induced toxic megacolon?

A

IV corticosteroids

263
Q

what in an example of psychological factors affecting medical condition?

A

asthma exacerbated by anxiety

264
Q

what are the common first line atypical antipsychotic agents for tx of schizophrenia?

A
  1. Ariprirazole
  2. Asenapine
  3. Olanzapine: best tolerated
  4. Risperidone: available in generic
  5. Quetiapine
  6. Ziprasidone
  7. Paliperidone
  8. Iloperidone
265
Q

what 4 antipsychotics come in depot IM form?

A
  1. Fluphenazine
  2. Risperidone
  3. Paliperidone
  4. Haloperidol
266
Q

what 3 drugs are used as mood stabilizers in bipolar disorder?

A
  1. Lithium
  2. Lamotrigine
  3. Valproate
267
Q

Six common findings seen in anorexic patients

A
  1. Osteoporosis*
  2. Elevated cholesterol and carotene
  3. Cardiac arrhythmias(prolonged QT interval)
  4. Euthyroid sick syndrome
  5. HPA dysfxn: anovulation
  6. Hyponatremia 2/2 excess water drinking
268
Q

Pregnant women w a current or previous diagnosis of anorexia nervosa are at risk for what 6 complications

A
  1. Miscarriage
  2. IUGR
  3. Hyperemesis gravidarum
  4. Premature birth
  5. Cesarean section
  6. Postpartum depression
269
Q

which ATYPICAL antipsychotic is most likely to cause EPS?

A

risperidone

* if this happens add benztropine

270
Q

what are the 5 indications for Electroconvulsive therapy?

A
  1. Severe depression (including suicidality, refractive, and psychosis)
  2. Depression in pregnancy
  3. Refractory mania
  4. Neuroleptic malignant syndrome
  5. Catatonic schizophrenia
271
Q

what is the time frame for an adjustment disorder?

A

symptoms occur within three months of an identifiable stressor and lasts no longer than 6 months after the stressor ends
- symptoms must impair level of functioning

272
Q

when should you hospitalize a patient w anorexia nervosa?

A
  1. Dehydration
  2. Electrolyte disturbances
  3. Bradycardia
  4. Severe weight loss
273
Q

in what patient population is buproprion contraindicated?

A

pts w eating disorders- could provoke seizures

274
Q

why does tx an anorexic need close monitoring? aka what complication could occur

A

refeeding syndrome: electrolyte depletion, arrhythmias and heart failure can result from fluid and electrolyte shifts

275
Q

medications used for tx of narcolepsy?

A
  1. Modafinil & Armodafinil: novel stimulants, preferred tx

2. Amphetamines

276
Q

among the second generation antipsychotics, what two cause the greatest weight gain?

A
  1. Olanzapine

2. Clozapine

277
Q

Clozapine’s really serious side effect?

A

agranulocytosis

278
Q

first line treatment for OCD?

A

SSRI! if one SSRI fails, try another

279
Q

treatment of neuroleptic malignant syndrome?

A

dantrolene: skeletal mm relaxant

280
Q

what is lanugo?

A

the fine downy body hair on back and abdomen of anorexic chicks

281
Q

two medical uses of bupropion?

A
  1. Antidepressant

2. Smoking cessation aid

282
Q

what are the 3 most important prognostic factors for astrocytomas?

A
  1. Patients age
  2. Functional status
  3. Tumor grade: degree of anaplasia
283
Q

2 reasons why sickle cell patients are at increased risk for infection w strep pneumo

A
  1. Dont have a spleen to protect from encapsulated organisms

2. THey have an upregulation of PAF, which serves as the attachment site for intact pneumococci

284
Q

what are the two most common causes of malignant pleural effusions?

A
  1. Breast cancer

2. Lung cancer

285
Q

must not miss diagnosis when a pt presents with renal failure, hypercalcemia, bone pain, and anemia?

A

multiple myeloma until proven otherwise

286
Q

how do you distinguish vulvovaginal candidiasis and trichomonas infection?

A

by vaginal pH:
Vulvovaginal candidiasis: pH 4.0-4.5 (thick curd like discharge)
Trichomonas: pH is elevated (green frothy discharge)

287
Q

the facial nerve’s nucleus is located where?

A

lateral aspect of the pons

288
Q

what reflex is absent in testicular torsion?

A

cremasteric

289
Q

what is Prehn’s sign?

A

pain relief with elevation of the testicle, associated with epididymitis

290
Q

what is juvenile myoclonic epilepsy?

A

progression of absence seizures ~10 years, to myoclonic seizures at 15 and generalized tonic-clonic seizures around 16
- myoclonus is worsened by sleep

291
Q

celiacs disease increases the risk of what cancer?

A

intestinal lymphoma

292
Q

whats the most common precipitant of GBS?

A

Campylobacter jejuni

293
Q

3 ekg findings that are seen in worsening hyperkalemia that are NOT peaked t waves

A
  1. Flattening of the P wave
  2. PR prolongation
  3. QRS prolongation
294
Q

pheochromocytoma- arises from where?

A

from the chromafffin cells of the adrenal medulla that secretes excess catecholamines such as epinephrine and norepinephrine

295
Q

initial tx of pheochromocytoma?

A
  • first alpha blockade w phenoxybenzamine followed by the use of B-blockers
  • then surgery
296
Q

what benefit has glucocorticoids been shown to have in COPD exacerbations?

A

improve pulmonary function & decrease the length of hospitalization

297
Q

what antiretroviral drug causes insomnia with vivid/bizarre dreams?

A

Efavirenz: NNRTI, these side effects usually occur with the first few doses

298
Q

extra-adrenal pheochromocytomas are typically seen where?

A

adjacent to the aorta, particularly in the organ of Zuckerkandl

299
Q

when treating a migraine, pts should not take triptans with what other drug?

A

ergots: because this combination could cause prolonged vasospastic reactions
(triptan = 5-HT agonist, ergot = nonspecific 5-HT agonist)

300
Q

first line treatment for pure hypertriglyceridemia?

A

fibric acid derivatives: fenofibrate

301
Q

when do you use clozapine in psychosis?

A

in treatment resistance: must have failed 2 trials of meds or in schizophrenia associated with suicidality

302
Q

what two antipsychotics are high risk for metabolic effects?

A

Olanzapine & Clozapine: monitor fasting glucose, lipid panel, BP and waist circumference

303
Q

what atypical antipsychotic has been associated with QT prolongation at higher doses?

A

Ziprasidone

304
Q

first line treatment for alzheimer’s dementia?

A 
cholinesterase inhibitors (Donepezil, rivastigmine, and galantamine)
- donepezil is approved for all stages of alzheimers, memantine is for moderate to severe dementia
305
Q

which benzo is most likely to result in seizures following abrupt discontinuation?

A

alprazolam

306
Q

acute versus long term tx of panic attacks?

A

acute: BZDs

long term: SSRI & CBT

307
Q 
Neuroimaging findings in psychiatric disorders:
Autism:
OCD:
Panic disorder:
PTSD:
Schizophrenia:
A

Autism: increased total brain volume
OCD: abnormalities in orbitofrontal cortex/striatum
Panic: decreased volume of amygdala
PTSD: decreased hippocampal volume
Schizophrenia: enlargement of cerebral ventricles

308
Q

Lithium exposure in pregnancy, what are effects in:
First trimester
Second/third trimester

A

First: cardiac defects of septum & possibly ebsteins anoma;y

2nd/3rd: goiter, transient neonatal neuromuscular dysfxn

309
Q

what hep B marker is still detected in the “window period” when HBsAg has disappeared but anti-HBs is not yet detectable

A

IgM Anti-HBc

310
Q

what is the single most common cause of asymptomatic isolated elevation of alkaline phosphatase in an elderly patient?

A

pagets disease (osteitis deformans)

311
Q

what are the 3 features of multiple system atrophy (Shy-Drager syndrome)

A
  1. Parkinsonism
  2. Autonomic dysfunction
  3. Widespread neurological signs
312
Q

what types of cancers are associated with hypercoagulability?

A

visceral adenocarcinomas: gastric, pancreatic, and ovarian

313
Q

contraindications to radioactive iodine treatment?

A

pregnancy and very severe ophthalmopathy

314
Q

what female androgens are produced where??

A

Ovaries: androstenedione, DHEA, and testosterone
Adrenals: DHEAS

315
Q

gold standard for diagnosing small-intestine bacterial overgrowth syndrome?

A

endoscopy with jejunal aspirate showing >10^5 organisms

316
Q

whats CHOP therapy?

A 
Cyclophosphamide
Adriamycin
Vincristine
Prednisone
*can use it in MALT lymphoma if eradication of H pylori fails
317
Q

pt presents with ear fullness and vertigo

A

menieres disease: abnormal accumulaiton of endolypmh within the inner ear

318
Q

what is primidone? use? side effects?

A
  • an anticonvulsant that converts into phenylethyl… and phenobarbital
  • used for essential tremors
  • SE: may precipitate acute intermittent porphyria which manifests as abdominal pain, neurologic and psychiatric abnormalities
  • dx: urine prophobilinogen
319
Q

nitrates are contraindicated in what setting?? 3

A
  1. Aortic stenosis
  2. Recent phosphodiesterase use
  3. Right ventricular infarction
    (bc nitrates decrease preload)
320
Q

what is the most common cause of cor pulmonale in the US?

A 
COPD: 
symptoms of cor pulmonale-
- exertional symptoms
- loud P2
- tricuspid regurg murmur
- elevated JVP
- peripheral edema
- hepatomegaly/ascites
- if due to COPD: distant heart sounds from hyperinflated lungs
321
Q

what do liver function tests show in hepatic adenomas?

A
  • normal AST/ALT
  • Alk phos and GGT may be elevated in pts who have intratumoral bleeding or multiple adenomas
  • AFP is normal UNLESS malignant transformation has occurred which occurs in 8-13% of pts w hepatic adenomas
322
Q

What are the different treatment options for influenza pneumonia?

A
  1. Neuraminidase inhibitors: oseltamivir and zanamivir

2. For Influenza A: Rimantadine and amantadine

323
Q

what is the most common extra-articular manifestation in pts with ankylosing spondylitis?

A

anterior uveitis

324
Q

what drug is preferred in pts w SLE w isolated skin and joint involvement?

A

hydoxychloroquine

325
Q

what 4 drugs increase hepatic clearance of thyroid hormone?

A
  1. Phenobarbital
  2. Rifampicin
  3. Phenytoin
  4. Carbamazepine
326
Q

Hashimoto’s thyroiditis increases risk of what type of cancer?

A

thyroid lymphoma is 60x higher: will present as a rapid enlargelemt of thyroid gland in pts w preexisting hashimoto’s thyroiditis, compressive symptoms, and “doughnut” sign on CT of neck
- perform CORE biopsy to make diagnosis

327
Q

how long should you wait after acetaminophen overdose to obtain an acetaminophen level and administer N acetylcysteine?

A
  • 4 hours! bc it will not be significant before this
  • give n acetylcysteine anywhere from 4-8 hours of ingestion
  • studies have shown no correlation between the amount of acetaminophen reportedly taken and then measured serum drug level
328
Q

what does the hepatojugular reflex signify?

A
  • when pushing on the abdomen, theres a sustained elevation of JVP >3cm, reflects failing of the R ventricle that cannot accommodate an increase in venous return with abdominal compression
329
Q

what does the serum inhibin B level represent?

A

ovulatory reserve: decreased in older women who have a decreased capacity to ovulate

330
Q

when a female presents with a normal phenotype but lacks a normal vagina and uterus, what 3 diagnoses could it be? how do you differentiate?

A
  1. Mullerian agenesis
  2. Androgren Insensitivity
  3. 5-alpha-reductase deficiency
    - Karyotype differentiates between the two, genotype is XY in androgen insensitivity and 5alpha reductase deficiency
331
Q

management of uterine atony?

A

oxytocin immediately! will cause contraction of myometrial fibers and retraction of myometrial blood vessels and will control bleeding in most cases

332
Q

treatment of lichen sclerosus?

A
  • surveillance w regular clinical exams and biopsies (high incidence of squamous cell carcinoma)
  • use of high-potency topical steroids of the genitals is encouraged
333
Q

pathogens responsible for endometritis?

A

polymicrobial infection

thus tx: clindamycin + gentamicin (IV)

334
Q

what is the gold standard for evaluating the cervix for possible cervical imcompetence?

A

transvaginal ultrasound

335
Q

hypotension after epidural?? how?

A

sympathetic fiber block results in vasodilatation of the lower extremity vessels -> blood venous pooling

336
Q

what are the critical antibody titers that put a fetus at risk for hemolytic disease via Rh isoimmunization?

A

1:8-1:32 (frequently 1:16 is accepted)

337
Q

most common bug that causes yellow mucopurulent cervicitis?

A

chlamydia trachomatis

338
Q

whats the classic triad of hydatidiform mole?

A
  1. Enlarged uterus
  2. Hyperemesis
  3. Markedly elevated BHCG (>100,000)
339
Q

how do you distinguish between hyperemesis gravidarum and morning sickness?

A

in hyperemesis:

  1. Persistence of vomiting
  2. > 5% or prepregnancy weight loss
  3. Presence of ketonuria
340
Q

role of hCG?

A

secreted by the syncytiotrophoblast and is responsible for preserving the corpus luterum during early pregnancy in order to maintain progesterone secretion until the placenta is able to produce progesterone on its own

341
Q

an increase in BP that appears before 20 weeks gestation is due to either what 2 things

A
  1. Chronic hypertension

2. Hydatidiform mole

342
Q

Most significant risk factor for placental abruption?

A

Hypertension of any kind!

343
Q

what is pseudocyesis?

A

usually seen in women who have a strong desire to become pregnant, get body changes that mimick pregnancy
- a form of conversion disorder, management requires psychiatric evaluation and treatment

344
Q

what labs do you see in premature ovarian failure?

A

increased FSH & LH, FSH:LH >1.0 bc FSH has a slower clearance than LH

345
Q

how do you confirm the diagnosis of premature ovarian failure?

A

a markedly elevated FSH level in a woman under age 40 who has experienced >3 months of amenorrhea

346
Q

what is the associatio between hypothyroidism and hyperprolactinemia?

A

TRH stimulates prolactin production

347
Q

what is Kallmann’s syndrome?

A

congenital absence of GnRH secretion associated with anosmia
- present w amenorrhea and absent secondary sexual characteristics such as breast development and pubic hair (FSH and LH are low)

348
Q

what is the earliest sign of magnesium sulfate toxicity?

A

depressed deep tendon reflexes

349
Q

what is the management of urinary retention caused by bladder denervation in epidural anesthesia?

A

intermittent bladder catheterizations

350
Q

what does cystoscopy show in interstitial cystitis?

A

classically demonstrates submucosal petechiae or ulcerations

351
Q

Treatment of Squamous Cell Carcinoma of the Vagina by stage?

A

Stage I & II 2cm: radiation therapy
- stage I & II = no extension to the pelvic wall and no metastases
Stage III & IV or >4cm: combination chemotherapy

352
Q

what 3 things should ALL pregnant women be screened for regardless of risk factors?

A
  1. Syphilis
  2. HIV
  3. Hep B
353
Q

when do you screen a pregnant person for gonorrhea and chlamydia?

A

all women age 25 OR those at increased risk w hx of multiple partners, hx of STIs, etc

354
Q

most common pelvic tumor in reproductive age women?

A

leiomyoma

355
Q

what are the indications for GBS ppx when GBS status is unknown? (4)

A
  1. Delivery at 18hrs
  2. GBS bacteruria during pregnancy
  3. Prior hx of delivery of an infant w GBS sepsis
356
Q

what is the gold standard for making the diagnosis of endometriosis?

A

laparoscopy

357
Q

whats the most accurate and reliable index for estimating fetal size?

A

abdominal circumference bc it is affected in both symmetric and asymmetric fetal growth restriction

358
Q

what are the risks associated with OCP use?

A
  1. Venous thromboembolism
  2. Stroke
  3. MI
  4. Breast cancer
  5. Cervical cancer
  6. Increase TGs
  7. HTN
  8. Worsening of DM
    (it DECREASES the risk of endometrial and ovarian ca, PID, and ectopic pregnancy)
359
Q

what are the 5 components of the Biophysical profile?

A
  1. NST
  2. Fetal tone
  3. Fetal movements (3/10min)
  4. Fetal breathing (30/10min)
  5. AFI: 5-20
    *2-5 found on US
    Score 8-10 = normal
360
Q

what is and what causes primary dysmenorrhea?

A
  • lower abdominal pain that radiates to the thighs and back and begin hours before menstruation
  • due to the release of prostaglandins during the breakdown of endometrium
  • women have higher levels of prostaglandins than normal
361
Q

what test do you do to diagnose primary syphilis?

A

dark field microscopy to ID spirochetes: w primary syphilis pt hasnt formed antibodies yet so theres a high rate of false negatives

362
Q

whats a luteoma of pregnancy?

A

a benign condition: appears as bilateral, multinodular, solid masses on both ovaries

  • most commonly seen in AA multiparous women in their 30s or 40s
  • most asymptomatic ut 1/3 of pts develop symptoms of hirsutism and virilization
363
Q

pathophys of PCOS?

A

results from abnormal GnRH secretion that stmiulates the pituitary to secrete excessive LH and insufficient FSH

364
Q

MOA of clomiphene citrate?

A

an estrogen analog that improves GnRH release and FSH release thereby improving the chances of ovulation

365
Q

common causes of premature ovarian failure?

A
  1. Idiopathic #1
  2. Mumps
  3. Oophoritis
  4. Irradiation
  5. Chemotherapy
  6. Assoc w autoimmune disorders: Hashimotos, addisons dx, type I dm, and pernicious anemia
366
Q

what are the two most common causes of hypopituitarism in the postpartum period?

A
  1. Sheehan’s syndrome

2. Lymphocytic hypophysitis

367
Q

whats the Zavanelli maneuver?

A

the last resort in a should dystocia that consists of pushing the baby back into the uterine cavity followed by a cesarean section

368
Q

how does pregnancy increase the incidence of carpal tunnel syndrome?

A
  • estrogen mediated depolymerization of ground substance which causes intertitial edema in the hands and face and increased pressure within the carpal tunnel
    tx: wrist splint
369
Q

Initial therapy of CNS cryptococcal infection in AIDS patients?

A

IV amphotericin B plus oral flucytosine then switch to oral fluconazole

370
Q

treatment of CMV retinitis in AIDS pt with CD4 ct <50?

A

ganciclovir or foscarnet

371
Q

what are 3 major differences between Actinomyces and Nocardia? (both filamentous gram + rods)

A
  1. Actinomyces is anaerobic and not acid fast, nocardia is aerobe and partially acid fast
  2. Actinomyces is more likely to cause cervicofacial disease and sinus tracts
  3. Sulfur granules may be found w actinomyces
372
Q

lower extremity DVTs are divided into what 2 categories?

A
  1. Proximal Deep veins: 90% of acute PEs, iliac, femoral and popliteal
  2. Calf vein thrombosis
373
Q

what are the nonpharmacologic ways to reduce HTN? List in order from most effective to least

A
  1. Weight loss (dec systolic by 5-20 per 10kg)
  2. DASH diet (dec systolic by 8-10)
  3. Exercise: decr systolic by 4-9
  4. Dietary sodium
  5. Alcohol intake: 2/d men, 1/d women
374
Q

ST segment depressions in leads V1 and V2 can suggest what?

A

posterior wall MI

375
Q

what are the antibodies seen in lambert-eaton syndrome?

A

antibodies directed against the voltage-gated Ca channels in the presynaptic motor nerve terminal
- this leads to the defective release of acetylcholine, leading to proximal mm weakness
tx: plasmapheresis and immunosuppressive drug tx
(assoc w small cell lung ca)

376
Q

how can vasospasm following a Subarachnoid hemorrhage be prevented?

A

Nimodipine

usually occurs within 3-10days

377
Q

Where’s the lesion in hemi-neglect syndrome?

A

lesion of the right (non-dominant) parietal lobe

378
Q

whats the mechanism behind aminoglycoside-induced ototoxicity?

A

damage to the motion-sensitive hair cells in the ear

379
Q

drug of choice for trigeminal neuralgia?

A

carbamazepine

bc of risk of aplastic anemia, must monitor with CBC

380
Q

It is normally not necessary to begin antiepileptic drugs for a single seizure UNLESS (3)

A
  1. Presentation in status epilepticus or w focal neuro signs
  2. Abnormal EEG or lesion on CT
  3. FHx of seizures
381
Q

which medication class are the only ones associated with the possibility of retarding the progression of parkinsonism?

A

MAO inhibitors: Selegiline, Rasagiline

382
Q

drugs of choice for prevention and relapse of MS? 2

A

glatiramer and beta interferon

383
Q

pronator drift is relatively sensitive and specific for what kind of lesion?

A

upper motor neuron disease

384
Q

what are the four lacunar stroke scenarios?

A
  1. Pure motor: posterior limb of internal capsule
  2. Pure sensory: VPL nucleus of thalamus
  3. Ataxic hemiparesis: anterior limb of internal capsule
  4. Dysarthria-clumsy hand syndrome: basis pontis
385
Q

what do you see on EEG in CJD?

A

sharp, triphasic synchronous discharges

386
Q

what nerve lesion leads to foot drop?

A

trauma to the common peroneal nerve (L4-S2)

can be congenital as in Charcot-Marie-Tooth disease

387
Q

how do you differentiate between a seminomatous germ cell tumor and nonseminomatous?

A

Seminomatous: 1/3 have increased BhCG but normal AFR

Nonseminomatous (yolk sac, choriocarcinoma, embryonal, mixed germ cell): increased AFP and most have increased BhCG

388
Q

treatment of choice for cancer related anorexia/cachexia syndrome?

A

progesterone analogs: megestrol acetate* or medroxyprogesterone acetate
- TCAs as well

389
Q

women has a eczematous plaque on the left nipple: bx shows large cells that apear to be surrounded by clear halos

A

pagets disease of the breast: aka underlying adenocarcinoma

390
Q

What are the 5 side effects of Amiodarone?

A
  1. Pulmonary toxicity (fibrosis)
  2. Thyroid dysfunction: mostly hypo
  3. Hepatotoxicity: transient elevations in LFTs but only stop if >2x increase
  4. Corneal deposits
  5. Skin changes
391
Q

whats the main measurement used for association in a case control study?

A

exposure odds ratio

392
Q

what is Rotor syndrome?

A

benign condition in which there is a defect of hepatic storage of conjugated bilirubin resulting in its leakage into the plasma

  • LFTs and tx are unnecessary
  • aka conjugated hyperbilirubinemia
393
Q

what type of bilirubin is excreted in the urine? aka can be detected on urine dipstick

A

conjugated bilirubin! its water soluble, loosely bound to albumin and excreted in urine when in excess

394
Q

what are the only contraindications to starting HepC antiretroviral therapy?

A
  1. Ongoing alcohol or drug abuse
  2. Major uncontrolled depression
    * initial tx: peginterferon & ribavirin
395
Q

when you see a person w afibb and are asked whether or not to anticoag, what do you do?

A

CALCULATE THE DAMN CHADS2

396
Q

what is the only type of restrictive cardiomyopathy that is reversible?

A

hemochromatosis

397
Q

atrial tachycardia with AV block

A

digoxin toxicity- arrhtyhmia most specific to it

398
Q

what are the three risk factors associated with abdominal aortic aneurysm expansion and rupture?

A
  1. Large diameter
  2. Rate of expansion
  3. Current cigarette smoking
399
Q

what is erlichiosis?

A
  • tick borne illness from the lone star tick found in SE and south central US
  • presents as a flu-like illness, confusion, but NO RASH
    *so think tick + flu and no rash
    Lab = leukopenia, thrombocytopenia, increased LFTs and LDH
    dx: intracytoplasamic morulae in WBCs
    tx: doxycycline
400
Q

its like a curtain coming down over my eyes

A

think retinal detachment

401
Q

5 most mportant causes of thyrotoxicosis (hyperthyroid) with low radioactive iodine uptake

A
  1. Subacute painless thyroiditis
  2. Subacute granulomatous thyroiditis
  3. Iodine induced thyroid toxicosis
  4. Levothyroxine overdose
  5. Struma ovarii
402
Q

whats the difference between visceral and somatic pain?

A

visceral: diffuse
somatic: localized

403
Q

treatment of Neuroleptic malignant syndrome?

A
  1. Dantrolene: muscle relaxant
  2. Bromocriptine (DA agonist)
  3. Amantadine (an antiviral drug with DA properties)
404
Q

how does acyclovir cause neprhotoxicity?

A

it is poorly soluble in urine and easily precipitates in renal tubules causing obstruction and acute renal failure
- assoc w high dose parenteral therapy used in HSV encephalitis

405
Q

what nephropathy is most commonly seen in pts w Hodgkins lymphoma?

A

Minimal change disease: think its something about lymphocyte dysregulation and cytokine production (IL-13)

406
Q

whats the earliest renal abnormality seen in diabetic nephropathy?

A

glomerular hyperfiltration
- remember that efectiveness of ACE inhibitors in diabetic nephropathy is related to thier ability to reduce intraflomerular hypertension

407
Q

what is a contraindication to the use of succinylcholine for rapid intubation?

A

hyperkalemia!! can cause significant potassium release and life-threatening arrhythmias
- do not use in pts w hyperkalemia, crush or burn injuries, demyelinating illnesses, tumor lysis syndrome

408
Q

what are the different BUN:Cr ratios seen in the 3 AKIs?

A

> 20:1 in pre and postrenal

~10:1 in intrinsic

409
Q

whats the best test for detecting eosinophiluria?

A

Hansel or Wright stain

410
Q

Risk factors for endometrial cancer>

A
  1. Advancing age
  2. Use of unopposed estrogen
  3. Prolonged use of tamoxifen
  4. Obesity
  5. Nulliparity
  6. PCOS
411
Q

what two genetic diseases increase risk for breast cancer?

A
  1. Cowden syndrome

2. Ataxia telangiectasia

412
Q

what does V/Q scan show in pulmonary embolism?

A

an area of perfusion defect without ventilation defect

*aka a mismatched defect

413
Q

whats the mnemonic for admitting someone to the hospital w pneumonia?

A 
curb65:
confusion
uremia
resp distress
BP low
age >65
414
Q

what is selective IgG3 deficiency?

A

immunodeficiency more common in adult females and is associated with recurrent sinopulmonary and GI infections

415
Q

whats the mutation and cause of factor V leiden?

A
  • point mutation in a gene coding for factor V (coagulation factor)
  • factor V becomes resistant to inactivation by protein C
416
Q

what are the side effects (2) of zafirleukast?

A
  1. Hepatotoxicity

2. Assoc w Churg strauss

417
Q

treatment of choice for ABPA?

A
  1. Oral steroids for severe cases- inhalers cannot deliver a high enough dose of steroids to be effective
  2. Oral itraconazole for recurrent episodes
418
Q

pleural effusion w pH <7.2

A

suggests empyema

419
Q

what 3 drug regimen should be used in Ventilator assoc PNA?

A

2 antipseudomonal & 1 MRSA agent

420
Q

lung auscultation reveals increased tactile fremitus

A

consolidation

421
Q

how does one diagnose tropical sprue?

A

small intestine mucosal biopsy showing blunting of villi and infiltration of chronic inflammatory cells including lymphocytes, plasma cells and eosinophils

422
Q

early symptom is distortion of straight lines such that they appear wavy

A

macular degeneration (can be unilateral)

423
Q

what the heck is emphysematous cholecystitis?

A
  • form of acute cholecystitis that arises 2/2 infection of the gallbladder wall with gas forming bacteria (staph, strep, pseudomonas, klebsiella, e., clostridium)
  • men aged 50-70years
  • can hear crepitus in abdominal wall but without peritoneal signs
  • dx: air fluid levels in the gallbladder or gas shadowing on US
    tx: fluid resuscitation, early cholecystectomy, and parenteral antibiotic therapy that is effective against the gram positive anaerobe Clostridium
424
Q

whats the rate you should correct serum sodium? for hypernatremia

A
  1. 5mEq/dL/hr without eceeding 12mEq/24hr period

- can cause cerebral edema if corrected to quickly

425
Q

pt w hx of depression comes in with empty pill bottle and is obtunded, hyperthermic, dilated pupils, and decreased bowel sounds: ekg found to have QRS prolongation

  • what is the drug?
  • what do you give?
A

TCA overdose

- give sodium bicarb

426
Q

pt came back from tanning in the tropics and still has a white pale velvety patch, scales on scraping
- what is it and whats the tx?

A

tinea versicolor

tx: selenium sulfide lotion and ketoconazole shampoo

427
Q

whats the pathology behind familial hypocalciuric hypercalcemia?

A
  • autosomal dominant
  • caused by abnormal calcium sensing receptors on the parathyroid cells and renal tubules
  • hinders the normal Ca-induced PTH suppression in the setting of hypercalcemia
  • pts have asymptomatic hypercacemia and inappropriately high PTH
  • pts have a very LOW urinary calcium levels
428
Q

tea and toast diet leads to what kind of deficiency?

A

folic acid!

429
Q

triad of disseminated gonococcal infection?

A
  1. Polyarthralgia
  2. Tenosynovitis
  3. Painless vesiculopustular lesions
430
Q

whats the autoantibody associated with dermatomyositis?

A

anti-Mi-2 (against helicase)

431
Q

what is hepatolenticular degeneration?

A

wilsons disease!!!

432
Q

why do you get pruritis after a hot bath in polycythemia vera?

A

due to histamine release from an increased number of circulating basophils

433
Q

vesicles and erosions on the dorsum of the hands

A

porphyrica cutanea tarda (PCT): associated with hepatitis C!!!!

434
Q

pathophys of essential mixed cryoglobulinemia?

A
  • due to circulating immune complexes that deposit in small and medium sized vessels and may be associated with low serum complement levels
  • pts develop palpable purpura, arthralgias and renal complications (membranoproliferative glomerulonephritis)
  • 90% of pts have hepatitis C as well
435
Q

what are 3 scenarios where you see an elevated BUN without an increase in Cr?

A
  1. Bleeding PUD: bacterial breakdown of Hgb in the GI leads to increase in urea absorption
  2. Systemic steroids
  3. Prerenal renal failure
436
Q

liver cyst found + dogs

A

hydatid cyst: Echinococcus granulosus

  • this is the cyst that anaphylaxis can occur secondary to spilling of cyst contents
    tx: surgical resection under the cover of albendazole
437
Q

eggshell calcification of a hepatic cyst on CT scan

A

hydatid cyst: the dog cyst that can cause anaphylaxis if contents get spilled

438
Q

CT shows pulmonary nodules with the halo sign or lesions with an air crescent

A

aspergillosis

439
Q

whats a hordeolum?

A

a stye- a common staph abscess of the eyelid
tx: warm compresses
I&D if it doesnt resolve within 48hours

440
Q

if someone is stuck w a needle from a HIV positive man, what do you use for ppx while awaiting serology?

A

2-3 drug regimen: 2 NRTIs and 1 protease inhibitor mostly

- repeat testing of pts blood should be performed after 6wks, 3 months and 6 months

441
Q

what patients will have an abnormal d-xylose test?

A

proximal small intestine disease: Celiac sprue!!

442
Q

5 types of thyroid cancer in order of frequency

A
  1. Papillary Thyroid cancer (70%)
  2. Follicular
  3. Anaplastic
  4. Medullary: found in MEN syndromes, arises from parafollicular C-cells
  5. Lymphoma: rare, seen in Hashimotos thyroiditis
443
Q

when do u prophylax for lyme disease?

A

must meet all criteria:

  1. Tick is Ixodes scapularis (deer tick))
  2. Tick attached for >36hrs or engorged
  3. In geographic location of tick
  4. No contraindications to doxycycline
444
Q

what bug is most likely to cause a UTI in pts with ALKALINE urine?

A

proteus mirabilis: secretes urease to alkalinize the urine, leading to the formation of struvite stones
- found often in pts with indwelling catheters

445
Q

what are the excisional guidelines for melanoma?

A
  • if the depth is less than 1 m: melanoma can be excised w a 1cm tumor free margin
  • tumors >1mm in depth should have a sentinel lymph node study
446
Q

treatment of central retinal artery occlusion?

A

ocular massage and high-flow oxygen administration

447
Q

progressive and bilateral loss of central vision

A

macular degeneration

448
Q

what is the treatment of choice for lyme disease in pregnant/lactating women or children <8years?

A

amoxicillin

449
Q

what size is considered a microadenoma? tx?

A

<10mm

tx: DA agonists- bromocriptine and cabergoline (new drug, better than bromo)

450
Q

pts w carcinoid syndrome are at risk of developing what vitamin/mineral deficiecny?

A

niacin

  • this is because the increased formation of serotonin from tryptophan
  • niacin is also formed from tryptophan
451
Q

how do you know someone has cleared HBV?

A

serial measurements of ALT and HBeAg every 3-6 months

- need at least 3 normal ALT levels and 2-3 normal HBV DNA tests over 12-month period to confirm inactive carrier state

452
Q

mallory weiss tears are tears of what?

A

submucosal arteries of the distal esophagus and proximal stomach

453
Q

3 infections that cause primary adrenal insufficiency?

A
  1. Tuberculosis: calcificaiton of adrenal
  2. Fungal infection
  3. CMV
454
Q

whats chlordiazepoxide?

A

a benzodiazepine- common choice of treatment for alcohol withdrawal

455
Q

what antidepressant can be used for smoking cessation?

A

buproprion

456
Q

what are the indications of steroid use in PCP pneumonia?

A

PaO2 35 mmHg

457
Q

medical treatment of choice for primary hyperaldosteronism (unilateral adrenal adenoma or bilateral adrenal hyperplasia)?

A

Aldosterone antagonists: Spirinolactone and eplerenone

- in adrenal adenomas, use this if pt is not a surgical candidate or is refusing surgery

458
Q

whats the pathophys behind refeeding syndrome?

A

carbohydrate ingestion stimulates insulin secretion and cellular uptake of phosphorous,potassium, and magnesium
- sx: arrhthmia, CHF, seizures and wernicke encephalopathy

459
Q

whats the mechanism behind QRS prolongation in TCAs?

A

inhibition of cardiac fast sodium channels

- Sodium bicarb reverses this by increasing the extracellular sodium concentration

460
Q

pt presents with AV block, bradycardia, hypotension, and diffuse WHEEZING

A

beta blocker toxicity: intoxication of CCBs, digoxin and cholinergic agents would cause some of the same but wheezing is indicative of beta-blocker toxicity

461
Q

what are the 3 iron loving bugs that ppl w hemochromatosis are at increased risk of developing infection from?

A
  1. Listeria
  2. Vibrio
  3. Yersinia
462
Q

whats the major toxicity of azathioprine?

A

dose related diarrhea, leukopenia, hepatotoxicty

463
Q

whats the major toxicity of mycophenolate?

A

bone marrow suppression

464
Q

what 2 types of mutations are typically more severe than the others?

A

Nonsense and frameshift (as seen in neurofibromatosis type 2)

465
Q

treatment of choice for ethylene glycol/methanol poisoning?

A

fomepizole or ethanol to inhibit alcohol dehydrogenase

466
Q

tx of choice for warm agglutinin autoimmune hemolytic anemia?

A

prednisone (if this is ineffective, the splenectomy is warranted)

467
Q

patient presents with nephrotic syndrome and then POOF has severe right sided abdominal pain, ever, and gross hematuria, what happened?

A

renal vein thrombosis! most commonly occurs with membrnaous glomerulonephritis

468
Q

lambert eaton syndrome is antibodies to what?

A

voltage gated calcium channels in the presynaptic motor nerve terminal

469
Q

pt w hx of bone marrow transplant within (2wks-4months) now has both lung and intestinal disease

A

think of CMV pneumonitis (GI symptoms from upper and lower GI ulcers)
- bronchoalveolar lavage is diagnostic

470
Q

life expectancy of edwards syndrome?

A

95% die within their first year of life

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