Questions 1-350 Flashcards
1
Q
Posterior costal tenderpoints are typically associated with (inhalation/exhalation) somatic dysfunction (elevated/depressed) ribs.
A
inhalation
elevated
2
Q
What is the treatment for burkitt lymphoma?
A
rituximab
CD20 antibody
3
Q
How do you treat small cell lung cancer?
A
radiation and chemo
4
Q
iron is absorbed in the ….
folate is absorbed in the ….
A
duodenum
jejunum
5
Q
window period of hep B serology will show
A
core ab IgM then IGg positive
6
Q
II, III, aVF infarct location
A
RV infarction
7
Q
treatment for RV infarction
A
isotonic flusids, aspirin and cardiac cath
NO nitrates
8
Q
How do you prevent infection from foley cath after surgery?
A
keeping urine collecting bag below the level of the bladder, ensuring good downward flow
9
Q
abundance of small normal appearing lymphocytes and ruptured smudge cells
A
CLL
10
Q
plasma cells with fried egg appearance
A
multiple myeloma
11
Q
Dutcher bodies /PAS positive staining IgM deposits around nucleus
A
waldenstrom macroglobulinemia (non-hodgkin like lymphoma)
12
Q
lymphoid cells with cytoplasmic projections
A
hairy cell leukemia
13
Q
TRAP stain (tartrate resistant acid phosphatase)
A
hairy cell leukemia
14
Q
giant cells with bilobar nuclei and eosinophilic nucleoli
A
Reed sternberg cells
hodgkin lymphoma
15
Q
PT, PTT, and platelet count in Vit C deficiency
A
normal PT, normal PTT, normal platelet count
16
Q
gingivitis, ecchymoses, perifollicular hemorrhage, petechiae, curly hairs
A
vit C deficiency/scurvy
17
Q
PT, PTT, platelet count in hemophilia A
A
normal PT, increased PTT, normal platelet count
(factor 8 deficiency, intrinsic pathway affected)
18
Q
PT, PTT, platelet count in von willebrand disease
A
normal PT, increased PTT, normal platelet count
(vwf carries factor 8)
19
Q
PT, PTT, platelet count in ITP
A
normal PT, normal PTT, decreased platelet count
20
Q
what type of RTA is common in sickle cell disease pts and diabetics?
A
type IV RTA
21
Q
What medications can cause a type IV RTA
A
ACE-I and NSAIDs
22
Q
What is the physiologic defect in type IV RTA?
A
hypoaldosteronism or aldosterone resistance
hyperK, urine pH <5.5, positive urine anion gap
23
Q
type I RTA is (distal/proximal)
A
distal
24
Q
type II RTA is (distal/proximal)
A
proximal
25
impaired distal acid secretion, hypoK, urine pH \> 5.5, positive urine anion gap
type I RTA
26
impaired proximal bicarb reabsorption, hypoK, urine pH \<5.5, negative urine anion gap
type II RTA
27
thromboangiitis obliterans aka
buerger disease
28
thromboangiitis obliterans is closely linked to...
tobacco use
29
young smoker with symptoms of claudication, extremity or digit ischemia, or superficial thrombophlebitis
thomboangiitis obliterans
30
granulomatous skin disorder occurring primarily in diabetics, present with well-demarcated papule or plaque that gradually enlarges; generally non painful and on shins
necrobiosis lipodica
31
down and out right eye with pupillary dilation
oculomotor nerve palsy due to compression by a posterior communicating artery aneurysm
32
overall most common site of anuerysm rupture
anterior communicating artery branching point with ACA
33
aneurysm spot causing bitemporal heteronymous hemianopsia
compressing optic chiasm, ACOM artery aneurysm
34
decreased pain and or temp of the ipsilateral face and contralateral body
wallenberg syndrome
posterior inferior cerebellar artery
35
First, second, and third line treatments of status epilepticus
1. benzos (lorazepam)
2. Antiseizure drugs (fosphenytoin)
3. rapid sequence intubation with propofol
36
testicular tumor with AFP + and no b-hCG
prepubertal males
yolk sac tumor/endodermal sinus tumor
37
testicular tumor that is well-defined hypoechoic lesions in testicular parenchyma without cystic areas on US
mild elevation b-hCG, no increase of AFP
seminoma
38
testicular tumor characterized by areas of necrosis and hemorrhage
choriocarcinoma
39
testicular tumor with symptoms of gynecomastia, loss of libido, or ED in adult males/precocious puberty in children
leydig cell tumors
40
treatment of CAP in non-ICU inpatient setting
beta-lactam abx plus a macrolide or respiratory fluoroquinolone to cover both typical and atypical bugs
ceftriaxone and azithromycin
41
MC typical bug in CAP
MC atypical bug in CAP
S. pneumo
mycoplasma pneumoniae
42
What are two respiratory fluoroquinolones?
levofloxacin and moxifloxacin
43
What is CURB-65 and what is it used for?
Pneumonia severity
Confusion
Uremia (BUN \>20)
Respirations (\>30)
Blood pressure (\<90 systolic)
65 - age 65 or greater
44
All HIV pts, regardless of CD4 count should receive what vaccinations?
influenza and pneumonia vax
45
CD4 ct \<200, ppx for..... with....
PCP with TMP-SMX or dapsone
46
CD4 ct \<100, should ppx for .... with ....
Toxoplasma with TMP-SMX
47
CD4 ct \< 50-100 ppx for.... with ...
MAC with weekly azithromycin or daily clarithromycin
48
formation of a biliary-enteric fistula from long-standing cholelithiasis eroding through the wall of the gallbladder will possibly cause...
gallstone ileus
49
where does gallstone ileus occur?
MC at ileocecal valve due to narrowing, but can be anywhere along GI tract, especially where prior surgical anastomosis is
50
What is the Rigler triad in gallstone ileus
radiographic findings of bowel obstruction, pneumobilia, and RLQ gallstone
51
what is definitive treatment of gallstone ileus?
enterolithotomy
52
what staging systems are used for CLL?
Rai and binet
53
this staging system for CLL is based on the gradual and progressive increase in the body burden of leukemic lymphocytes
1. lymphocytosis
2. lymphadenopathy
3. organomegaly
4. anemia, thrombocytopenia
Rai system
54
this staging system of CLL considers 5 potential sites of involvement:
cervical, axillary, inguinal lymph nodes, and spleen and liver
determined by physical exam
Binet staging
55
What is the Ann Arbor staging system used for?
stage lymphomas, classically associated with Hodgkin Lymphoma
56
What is the revised international prognostic index used for?
prognosis tool of choice for diffuse large B cell lymphoma (MC NHL) in pts receiving R-CHOP chemo
57
three drugs commonly causing hyperkalemia
TMP-SMX, ACE-Is/ARBs, NSAIDs
58
empiric therapy for adults \>50 yo with bacterial meningitis
ceftriaxone, vanc, ampicillin
59
empiric abx for bacterial meningitis in neonates ( \<1 mo)
ampicillin and cefotaxime
60
empiric abx for bacterial meningitis in children to adults \< 50 yo
ceftriaxone and vanc
61
in multiple myeloma, plasma cells produce
IgG, IgA, and light chains
62
HIV pregnancy at 38 weeks and \>1000 viral load
C section with IV zidovudine 3 hours pre op
63
muscle pain, depressed mood, polyuria, constipation
hypercalcemia
64
hydatid cyst in the liver is due to
echinococcus granulosus
65
eggshell calcification of a hepatic cyst on CT
hydatid cyst
66
treatment of hydatid cyst
surgical resection under the cover of albendazole
67
What is the second MCC of intracerebral hemorrhage after hypertension?
cerebral amyloid angiopathy
68
where will cerebral amyloid angiopathy typically be located within the brain?
lobar
69
What is the MCC of intracerebral hemorrhage in children?
cerebral AV malformation
70
on fetal heart rate tracing, this appears as persistent fetal bradycardia (ie \<110)
fetal AV block
71
What is the most serious complication of neonatal lupus?
fetal AV block
72
What is a stool marker for inflammatory diarrhea? (typically elevated in pts with IBD)
fecal calprotectin
73
family history of sudden death, congenital sensorineural deafness, and QT interval prolongation are concerning for...
Jervell and Lange-Nielsen syndrome (AR congenital long QT syndrome)
74
tx of congenital long QT syndrome
beta blockers with pacemaker
75
MC complication of influenza
secondary bacterial pneumonia
76
secondary bacterial pna s/p influenza in a young person is likely...
CA-MRSA
| (severe, necrotizing pneumonia)
77
MCC of pediatric stroke
sickle cell disease
78
cyanosis occurs with feeding, relieved by crying
choanal atresia
79
spontaneous cerebellar hemorrhage might present with (ipsilateral/contralateral) hemiataxia
ipsilateral
80
photosensitive rash, multisystemic symptoms (arthralgias, pancytopenia, splenomegaly)
what antibody assay do I get?
SLE
antinuclear antibody
81
fixed, widely split S2
atrial septal defect
82
large ASD or VSD is not corrected and PVR exceeds SVR due to chronic L to R shunting
Eisenmenger syndrome
83
wide pulse pressure and continuous machine-like murmur or loud S2 and bounding peripheral pulses
PDA
84
week 1: fever/chills
week 2: abdominal pain with bloddy diarrhea
week 3: faint, salmon-colored macules (rose-spots)
typhoid fever/salmonella typhi
85
severe enterocolitis with bloody diarrhea s/p undercooked beef
E. coli 0157:H7
86
2nd MC organism related to HUS
Shigella dysenteriae
87
bloody diarrhea possibly with proctitis, rectal prolapse, toxic megacolon, intestinal obstruction, leukemoid reaction, or neurologic symptoms
Shigella dysenteriae
88
vitamin B12 and folate deficiencies will show what on peripheral smears?
hypersegmented neutrophils, elevated MCV, and macroovalocytes
89
bilobed nuclei of neutrophils seen on peripheral smear are indicative of
Pelger-Huet anomaly
lamina B receptor gene mutation
90
In pts with HIV associated nephropathy, what is the prominent feature on kidney biopsy?
focal segmental glomerulosclerosis
91
four features of nephrotic syndrome:
proteinuria \>3.5, generalized edema, hypoalbuminemia, and hyperlipidemia
92
what drug is contraindicated in vasospastic/Prinzmetal angina?
nonselective beta blocker
because could result in unopposed alpha-1 activity, worsening vasoconstriction, causing cardiac ischemia
93
Cushing triad (3 things)
widening pulse pressure, irregular respirations, and bradycardia
94
Cushing triad implies
impending or imminent brain herniation
95
grip weakness and numbness of the hand that is exacerbated by abduction and extension of the upper extremity
thoracic outlet syndrome
96
pain on thumb and wrist movement with focal tenderness over the radial styloid
De Quervain tenosynovitis
97
provocative test for dx of de quervain tenosynovitis
finkelstein test
98
PD pts with psychosis, if they cannot tolerate a reduction of carbidopa-levodopa can be treated with
second gen antipsychotic
quetiapine, pimavanserin
99
MCC of oculomotor nerve palsy
ischemic neuropathy due to poorly controlled DM
100
pts with ischemic CN III palsy typically have ptosis, down and out gaze, and
preserved pupillary response
101
What is systemic therapy for angle-closure glaucoma?
acetazolamide to reduce production of aqueous humor
102
child with hx of arthralgia and psychosis, together with thrombocytopenia, hematuria, and proteinuria is concerning for
SLE
103
anti-U1 RNP
Mixed Connective Tissue Disease (MCTD)
104
mixed connective tissue disease has features of ...
SLE, systemic sclerosis, and polymyositis
105
acquired autoantibody to ADAMTS13
TTP
thrombotic thrombocytopenic purpura
106
plasma protease that cleaves vWF off the endothelial surface
ADAMTS13
107
treatment for cryptococcal meningioencephalitis
amp B with flucytosine
then maintenance with fluconazole
108
tx for deramtophytosis and onychomycosis
griseofulvin
109
tx for cerebral toxoplasmosis
sulfadiazine-pyrimethamine
110
new onset JVD and RBBB are indicative of...
R heart strain
| (commonly associated with PE)
111
total T4, free T4, and TSH in pregnancy
increased, unchanged, decreased
112
tx for invasive pulmonary aspergillosis
1-2 weeks IV voriconazole plus an echinocandin (caspofungin)
transitioned to prolonged therapy with voriconazole PO
113
three common causes of exudative pleural effusion
infection (pna)
malignancy
rheumatologic disease
114
3 MCC of transudative pleural effusion
heart failure
cirrhosis (hepatic hydrothorax)
nephrotic syndrome
115
rheumatoid effusions are marked by very low .... and very high...
low glucose
high LDH
116
why would buproprion be a good choice after 2 failed SSRIs for depression?
NE/DA reuptake inhibitor (no serotonergic effects)
does not cause weight gain
no sexual side effects
117
chronic, near daily HA in setting of regular use of acute HA medications in pts with preexisiting HA disorder
medication overuse headache
118
the presence of a single vertebral fracture, esp cervical, in a pt with blunt trauma is an indication to
image the entire spine due to risk of a second, noncontiguous vertebral fx
119
wide complex tachycardia with fusion beats
sustained monomorphic ventricular tachycardia
120
tx for stable pt with sustained monomorphic VT
IV amiodarone
121
regular, narrow complex tachycardia, no fusion beats
paroxysmal supraventricular tachycardia
122
tx for PSVT
carotid sinus massage/vagal maneuver
123
MC primary cardiac neoplasm
atrial myxoma
124
* position dependent mitral valve obstruction
* mid diastolic murmur
* dyspnea, lightheadedness, syncope
* embolization -\> stroke
* constitutional symptoms
atrial myxoma
125
pathologic cause of mitral valve prolapse
myxomatous valve degeneration
126
* high fever, malaise, throat pain
* throat PE: hyperemic yellow or grayish-white papulovesicles
herpangina
127
four causes of gout from increased urate production
1. primary/idopathic
2. myeloproliferative/lymphoproliferative disorders
3. tumor lysis syndrome
4. hypoxanthine guanine phosphoribosyl transferase deficiency
128
2 causes of gout from decreased urate clearance
1. CKD
2. thiazide/loop diuretics
129
pruritis triggered by hot baths, headaches, hepatosplenomegaly
polycythemia vera
130
what prolactin level correlates with symptomatic prolactinoma
\>200
131
How is LH affected in prolactinoma in a male?
hypogonadism with low T and low or inappropriately normal LH
132
all preterm neonates born at \<32 weeks gestation should undergo what screening?
screening head US at 1-2 weeks
133
what is the greatest risk factor for intraventricular hemorrhage
prematurity
134
first 3-4 days of life in premature neonate who has bulging fontanel, anemia, apnea, and seizures
interventricular hemorrhage
ruptured germinal matrix vessels
135
tx for unstable, regular, narrow complex tachycardia (SVT)
synchronized cardioversion
136
all pts with persistent tachyarrhythmia (narrow or wide) causing hemodynamic instability should be managed with
immediate synchronized direct current cardioversion
137
subacute thyroiditis is aka
de Quervain's thyroiditis
138
benign, self-limited condition that classically begins after an upper respiratory infection and progresses
inflammatory process in the neck
subacute thyroiditis
139
subacute thyroiditis tx
NSAIDs for pain
resolves on its own
140
preferred method to evaluate cervical cytology in pregnant women is
colposcopy
141
renal failure, vision changes, neuro deficits in setting of over-consumption of fish
mercury poisoning
142
tx of mercury poisoning
chelating agents such as succimer, dimercaprol, penicillamine
143
muscle biopsy shows vacuoles and filamentous inclusions
inclusion body myositis
144
muscle biopsy shows lymphocytic infiltration of endomysium
polymyositis
145
hepatitis virus associated with injection drug abuse and with blistering in sun-exposed areas
hepatitis C
porphyria cutanea tarda
146
WAGR syndrome
Wilms tumor, aniridia, GU abnormalities, and intellectual disability
147
characteristic triangular lifting of periosteum
osteosarcoma
148
Turner syndrome heart defects
bicuspid aortic valve, aortic coarctation
149
poor feedings, constipation, low tone, large anterior fontanelle, macroglossia, and an umbilical hernia
congenital hypothyroidism
150
rapidly expanding multilobular breast mass
phyllodes tumor
151
Cobb angle between 10 and 20 in skeletally immature pt can be managed with
home exercises and observation
152
curves with cobb angle between 20 and 45 in skeletally immature pt can be tx'd
bracing and serial monitoring
153
cobb angle greater than 45
surgical fusion
154
155
is ECT safe during pregnancy?
yes
156
lamotrigine severe AE
SJS
157
irreversible, potentially fatal complication of elevated indirect bilirubin levels
kernicterus
158
prophylaxis of variceal bleeding
nonselective beta blockers
| (propranolol or nadolol)
159
odansetron MOA
selective 5-HT3 antagonist
160
Pt with bronchiectasis, concern for infections by what organism?
Pseudomonas, TB, H. influ, mor cat, S. aureus, S. pnemo, MAC
161
clinical manifestations of mild bleeding (epistaxis/gingival) with petechiae or ecchymoses and isolated thrombocytopenia
ITP
162
What type of hypersensitivity reaction is ITP?
type II HS rxn
163
IgG-platelet factor 4 protein complexes
HIT
heparin induced thrombocytopenia
164
anticentromere antibody
CREST syndrome
165
antihistone antibodies
drug induced lupus
166
anti-Jo 1 ab
polymyositis
167
scl-70 antibody
anti-DNA topoisomerase I antibody
systemic sclerosis
168
proximal, two component, intra-articular first metacarpal fx
Bennett fx
169
avulsion fx off the base of the proximal phalanx of the thumb with associated injury to the ulnar collateral ligament
gamekeeper thumb fx or skier thumb
170
stress fx involving the base or proximal third of the fifth metatarsal
Jones fx
171
avulsion injury at the base of the fifth metatarsal at insertion of peroneous brevis tendon
dancer fx aka pseudo-Jones fx
172
why is a pregnant lady hypercoaguable?
resistance to activated protein C increases after the first tri
173
leukocytosis with predominance of granulocytes
peripheral smear shows basophilia and granulocytosis with neutrophils
CML
174
BCR- ABL1
f(22:9)
philadelphia chromosome
CML
175
resistant major depressive disorder - can add what drug to tx?
atypical antipsychotic in conjunction with SSRI
176
tx of viral labrinthitis
control symptoms of vertigo with meclizine (antihistamine)
177
hx of infection and CHF with evidence of acute intrinsic renal failure
acute tubular necrosis (ATN)
178
pts with ATN will typically have a FeUrea...
\>50%
179
UA in ATN
muddy brown, granular casts
180
fatty casts, with a maltese cross
nephrotic syndrome
181
increased number of hyaline casts
volume depletion
182
tx for nasal polyps
intranasal steroid spray
183
if complete polypectomy is not feasible for colon lesion, you should get
multiple biopsies to get pathologic diagnosis
184
negligence of a physician to an established pt, which results in direct harm to the pt
breach of duty
185
parvovirus in pt with SCD can lead to
aplastic crisis
186
\>10% clonal plasma cells
multiple myeloma
187
"dry tap"
primary myelofibrosis
188
EKG showing ST depression with concave-up morphology (hockey stick morphology)
digoxin toxicity
189
In patients with Myasthenia Gravis, what drug is contraindicated in a preeclamptic pregnant pt?
magnesium sulfate
may trigger myasthenic crisis due to inhibition of acetylcholine release at the neuromuscular junction
190
Seizure ppx for pregnant, preeclamptic pt with MG
valproic acid
191
What abx will worsen symptoms of MG?
fluoroquinolones or aminoglycosides
192
What most often occurs in young, athletic men who lift weights or engage in activities that have repetitive overhead arm motions?
spontaneous upper extremitiy DVT
193
normal creative and healthy behaviors for young children include...
imaginary friends, pretend play, and storytelling with fanciful detail
194
type of psychotherapy that is used to reinforce a patient's ability to cope with stressors and is commonly used for low-functioning patients or those in crisis who are at risk of decompensating
supportive psychotherapy
195
This type of psychotherapy focuses on the role of unconscious conflict and gaining insight into how past experience shapes present situations
psychodynamic psychotherapy
196
what technique is commonly used to treat substance abuse
motivational interviewing
197
monoarticular arthritis of the knee that occurs in a weight-bearing, afebrile pt
Lyme arthritis part of Lyme disease
198
infective endocarditis due to prosthetic valves, intravascular catheters, implanted devices (PM/defib), and IV drug users
S. aureus
199
infective endocarditis due to nosocomial UTI
enterococci
200
Next step for penile fracture?
retrograde urethrography prior to surgery
201
dermatitis, diarrhea, dementia
pellagra
niacin deficiency
202
niacin deficiency is seen in populations like...
corn products diet
alcholics/chronic illness
carcinoid syndrome
Hartnup disease
prolonged isoniazid interfering with tryptophan metabolism
203
painless loss of monocular vision
RF: CAD, endocarditis, valvular disease, long bone fx, hypercoaguable conditions, vasculitis, atrial myxoma
central retinal artery occlusion (CRAO)
204
tx of central retinal artery occlusion
ocular massage and high flow oxygen
205
buspirone is primarily used to treat
anxiety disorders
206
mirtazapine antidepressant has AE of
sedation, fatigue, and weight gain
207
emphysema plus liver issues
alpha-1 antitrypsin deficiency
208
deep ST depressions in leads V1-V3, with ST elevations when leads V7-V9 are placed
isolated posterior STEMI
L circumflex artery
209
used in children to test vesicoureteral reflux
voiding urethrogram
210
What kind of poisoning is common after house fires?
AMS, elevated lactate, breath that smells like bitter almonds
cyanide poisoning
211
Rib inhalation somatic dysfunction is noted to have restriction in rib motion on ...
the key rib being the most...
exhalation
caudal
212
supination of the ankle causes the fibular head to move
posteriorly
213
pronation of the ankle cause the fibular head to move...
anteriorly
214
one of the most common complaints of male patients receiving beta blockers
ED
215
What is the most aggressive type of lung cancer, often centrally located, and has a very strong correlation with smoking?
small cell lung vancer
216
peripheral lung cancer and more commonly causes superior vena cava syndrome and hoarseness
large cell carcinoma
217
mature appearing lymphocytes with scant cytoplasm, condensed chromatin, and clefted nuclei are commonly seen following what infxn?
bordetella pertussis
218
two times you might see rouleaux formation
Waldenstrom macroglobulinemia or multiple myeloma
219
MC leukemia that occurs after the age of 50
CLL
220
response to infection, drugs, or from an underlying medical condition like DKA
WBC \>50k
leukemoid reaction
221
raloxifene acts as an estrogen receptor antagonist in ...
breast, endometrial, and vaginal tissues
222
Raloxifene may worsen
menopausal symptoms
223
Organisms commonly causing bloody diarrhea
salmonella
shigella
campylobacter
EHEC
yersinia
entamoeba
224
acetazolamide MOA
carbonic anhydrase inhibitor
225
rash, GI symptoms, and liver dysfunction is the classic triad of ...
acute graft v host disease
226
first line tx for acute GVHD
corticosteroids
MC methylprednisolone
227
group of AD disorders that progressively affect the cerebellum and its connections
gait unsteadiness and extremity incoordination
spinocerebellar ataxia
228
autosomal recessive disorder with onset in childhood with gait unsteadiness and associated cardiac and skeletal disorders
Freidrich ataxia
229
next step for woman beyond 20 weeks gestation presenting with vaginal bleeding
US to check for previa
230
What is contraindicated in any patient suspected to have a placenta previa?
digital cervical exam
231
upper extremity weakness in cape distribution
central cord syndrome
232
Which RTA has hyperkalemia?
RTA type IV
233
pts with nephrotic syndrome are at increased risk of infxn, particularly by ...
encapsulated organisms such as S. pneumo
234
US after 14 weeks dating uses what measures?
biparietal diameter
head circumference
femur length
abdominal circumference
235
what is the single most predictive parameter of gestational age between 14 and 22 weeks?
head circumference
236
acute, raised, sharply demarcated area of erythema with slowly advancing margins - associated with infectious signs and symptoms
in adults in setting of stasis dermatitis and venous insufficiency
in infants, on face, dorsal hands, and scalp
erysipelas
237
loop diuretics (4)
bumetanide, furosemide, torsemide, and ethacrynic acid
238
anaphylaxis within ... days of receiving any vaccine is considered an adverse effect from the vaccine and should be reported to VAERS
7
239
amyloid light chain amyloidosis leads to
restrictive cardiomyopathy
symmetrically thickened ventricular walls
240
impaired consciousness, pupillary abnormalities, neuro-ophthalmic abnormalities, especially of vertical gaze, and acute confusional state
'top of the basilar' syndrome
embolus lodging in rostral basilar artery
241
pt with saddle nose deformity and bilateral auricular inflammation who may have been treated on multiple occasions with antibiotics
relapsing polychondritis
242
what is removed in a Whipple procedure?
head of the pancreas, duodenum, gallbladder, and common bile duct
243
unilateral pure motor hemiparesis
lacunar infarct
244
lacunar infarct involves what arteries
lenticulostriate branches
245
XR shows new periosteal bone formation and osteolysis in ankle of child
osteomyelitis
246
Chadwick sign - during early pregnancy
bluish discoloration of the vulva, cervix, and vagina
247
Psoas syndrome occurs with a hypertonic psoas, which reflexively affects the contralateral...
piriformis
248
upper lumbar somatic dysfunctions that are flexed, side bent, and rotated .... the side of the hypertonic psoas are usually found
toward
249
in psoas syndrome, what should be treated first
upper lumbar segments
250
Posterior chapman point on the upper edge of the TP of L2
bladder
251
posterior chapman point on the intertransverse space of T12-L1 midway between the spinous process and tips of the transverse processes
kidney
252
posterior chapman point on the upper edge of the transverse process of L2 (L3)
urethra
253
3 MC etiologies for fever of unknown origin
collagen vascular disease
chronic infections
malignancies
254
milestones:
1. sit momentarily propped on hands
2. raking grasp
3. babbling
4. transfer hand to hand
6 mo
255
milestones
1. pull to stand
2. crawl
3. pincer grasp
4. say mama and dada
9 mo
256
is duchenne muscular dystrophy associated with developmental delay?
yes
257
DMD causes a primary .... cardiomyopathy and conduction abnormalities
dilated
258
person with SCD and new infiltrate on chest XR plus one of the other symptoms
Acute chest syndrome
259
prior to starting direct acting antivirals, a pt should be tested for
NS5A resistance-associated substitutions
260
4-7 days after initiation of heparin ppx and pt gets DVT
heparin induced thrombocytopenia
261
manifests as thrombosis and drops platelets by 50% from baseline
HIT
262
tx of HIT
stop all heparin products
direct thrombin inhibitor: bivalirudin or argatroban
263
multiple myeloma CRAB mneumonic
Calcium elevation
Renal insufficiency
Anemia
Bone lesions
264
stable pt, provoked DVT, tx
outpatient with apixaban
265
what can increase the serum levels of warfarin, leading to a higher bleeding risk?
statins
266
what tumor would be composed of delta cells from the head of the pancreas?
somatostatinoma
267
somatostatin inhibits the release of many hormones, including
TSH
GH
insulin
glucagon
gastin
CCK
268
deficiencies caused by a somatostatinoma lead to
mild DM
steatorrhea
gallstones
269
somatostatin can act in a paracrine fashion to inhibit the secretion of both
insulin and glucagon
270
DM, steatorrhea, gallstones
somatostatinoma
271
in tx of DKA, you start subQ insulin at what time in relation to turning off insulin drip
2 hours before the drip is stopped
272
thiazide diuretic used as a first line for HTN without comorbidities
chlorthalidone
273
spironolactone can be used as a first line medication in the case of
primary aldosteronism
274
missed ART for HIV for a sustained period, prior to restarting ART asap, you should
evaluate pt's viral genotype to see if there are acquired mutations
275
two complications that can occur when restarting ART
immune reconstitution inflammatory syndrome
anti-retroviral therapy resistance
276
an overwhelming immune response upon initiation of ART, as the sudden increase in CD4 cells upon initiating ART tx paradoxically worsens symptoms
(strong immune response causing inflammation)
immune reconstitution inflammatory syndrome
277
viral mutations occuring during an interval without tx for HIV can cause
anti-retroviral therapy resistance
278
what should be suspected in asthmatics with poorly-controlled disease who are unable to wean themselves from corticosteroids
aspergillosis
279
BPP fetal breathing movements must be
one or more episodes of rhythmic fetal breathing movements of 30 seconds or more within 30 minutes
280
BPP fetal movement means
three or more discrete body or limb movements within 30 minutes
281
BPP fetal tone is
one or more episodes of extension of a fetal extremity with return to flexion, or opening and closing of a hand
282
BPP amniotic fluid volume must be
single deepest vertical pocket greater than 2 cm
283
oligohydraminos is defined as... or ...
single deepest vertical pocket of amniotic fluid of 2 cm or less
AFI of 5 cm or less
284
golfer elbow counterstrain set up
elbow flexion, pronation with forearm adduction
285
What two things are strong predictors of diabetic retinopathy?
proteinuria and increased BUN/Cr levels
286
risk for developing post-herpetic neuralgia increases with
age
287
how is friedreich's ataxia inherited?
autosomal recessive condition
288
3 systems of glasgow coma scale
eye response
verbal response
motor response
289
increasing and decreasing respiratory rate and volume followed by period of apnea
Cheyne-stokes
290
rapid deep respirations with short pauses
biot's breathing
aka ataxic breathing or cluster breathing
291
deep increased respirations
Kussmaul's respirations
292
when ROSC occurs, CO2 levels will abruptly rise to
30-40 mmHg
293
proficient quality CPR can be confirmed with waveform capnography with CO2 levels of
10-15 mmHg
294
first step in FPR
flatten the spinal curve
295
Facilitated positional release is an (indirect/direct) and (passive/active) technique
indirect, passive
296
partial or complete absence of the cerebellar vermis
Dandy-Walker Malformation
297
herniation of the cerebellar tonsils, cerebellar vermis, and medulla
chiari type 2 malformation
298
downward displacement of cerebellar tonsils through the foramen magnum
typically asymptomatic
chiari malformation type 1
299
chiari type 2 malformation is also associated with ...
meningomyelocele or syringomyelia
300
chronic nonproductive cough, hypercalcemia, and decreased diffusion capacity
dad died of a 'heart problem'
sarcoidosis
301
bilateral symmetric hilar and mediastinal lymphadenopathy on CXR
sarcoidosis
302
MC lab values in sarcoidosis
elevated ACE and hypercalciuria
303
what lab value can assist in dx of lead toxicity?
serum free erythrocyte protoporphyrin
304
hypertension, hypoK (metabolic alkalosis), hyperNa, hypoMg
Conn syndrome
primary aldosteronism
305
IgG and IgM mediated complement fixation
type II hypersensitivity
306
immune complex mediated complement fixation and subsequent cytotoxicity
type III hypersensitivity
307
3 major causes of delayed emergence from anesthesia
drug effect
metabolic disorder
neurologic disorder
308
what will not trigger a positive result on a standard UDS
semisynthetic (oxycodone, hydrocodone, hydromorphone) and synthetic (fentanyl, meperidine, methadone, and tramadol)
309
despite appropriate tube thoracostomy, repeat CXR shows rapid pneumothorax reaccumulation and increased subcutaneous emphysema, suggesting
tracheobronchial injury/bronchial rupture
310
rapid, large air leak into the chest-tube drainage system and persistent pneumothorax/pneumomediastinum despite tube thoracostomy
tracehobronchial injury
311
older individual witha stenotic cervical spinal canal experiences hyperextension injury to the neck (whip-lash, rear-end collision)
central cord syndrome
312
what modality is used to dx central cord syndrome?
cervical myelogram
313
complication of mediastinal irradiation and cause of R heart failure
constrictive pericarditis
314
progressive peripheral edema, elevated JVP, hepatomegaly, and ascites
constrictive pericarditis
315
lack of decrease or increase in jugular venous pressure on inspiration
Kussmaul's sign
316
multiple white nodules in the hands and a hx of painful arthritis in the fingers and feet
tophaceous gout
317
deposition of calcium and phosphorus in the skin, presenting with scattered whitish papules, plaques, or nodules
calcinosis cutis
318
CXR shows widened mediastinum, abnormal aortic contour, and/or left-sided effusion due to hemothorax
blunt thoracic aortic injury
319
confirmation of dx of blunt thoracic aortic injury for stable and nonstable pt
stable - CTA
unstable - TEE in OR
320
for blunt thoracic aortic injury, what is the goal systolic blood pressure while doing repiar?
\<100
321
first pneumonia vaccine recommended for all adults \>65
PCV13
322
pna vaccine recommended alone for adults \<65 with other chronic medical conditions
PPSV23
323
In an adult, do you give Td or Tdap?
Td every 10 years with Tdap as a one time dose in place of Td
324
stepwise illness that begins with 1-2 weeks of nonspecific symptoms and then progresses to several weeks of the classic paroxysmal cough
pertussis
325
adult with persistent, vigorous cough, posttussive hemoptysis, and peripheral lymphocytosis
bordetella pertussis
326
respiratory infection that occurs in those with underlying asthma or CF
eosinophil count is elevated
bronchial obstruction, expectoration of brownish mucous plugs, and low grade fever
aspergillosis
327
severe AE of PTU
agranulocytosis
328
how do you watch for agranulocytosis in PTU use?
once pt complains of fever and sore throat, d/c thyroid drug and measure WBC ct.
\<1k warrants permanent discontinuation of the drug
if \>1.5k, drug is unlikely cause
329
anti-mitochondrial antibodies
primary biliary cholangitis
330
antinuclear antibodies and anti-smooth muscle antibodies
autoimmune hepatitis
331
kidney histology in Alport syndrome
longitudinal splitting of the glomerular basement membrane
332
pt \<6 yo with marked proteinuria but no hematuria, renal insufficiency, or hypertension
minimal change disease
333
linear IgG deposition in glomerular basement membrane
Goodpasture syndrome
334
mesangial and glomerular capillary deposition of C3 and IgG
poststreptococcal glomerulobnephritis
335
what is the MC malignancy diagnosed in pts exposed to asbestos?
bronchogenic carcinoma
336
almost 50% of pts with asbestosis have ... which can help differentiate from other causes of pulmonary fibrosis
pleural plaques
337
nail and digit hypoplasia, dysmoprhic facies, and intellectual disability
exposure to phenytoin in utero
fetal hydantoin syndrome
338
retrograde and antegrade amnesia with intact long-term memory, confabulation, apathy, lack of insight, and hx of alcohol use disorder
Korsakoff syndrome
339
dementia, motor dysfunction, dysarthria
a/w severe damage to corpus callosum and surrounding white matter in the context of chronic alcohol use disorder and attendant malnutrition
marchiafava-bignami disease
340
greater than 2 weeks of daily fever, fixed arthritis lasting \>6 weeks, and a pink macular rash that worsens during fever
systemic juvenile idiopathic arthritis
341
malabsorptive bowel disease complication leading to cheilosis, glossitis, and seborrheic dermatitis
riboflavin deficiency
342
blunt chest trauma, persistent tachycardia, new arrhythmia
blunt cardiac injury
343
next step to diagnose blunt cardiac injury
transthoracic echo
344
overloading the knee's extensor mechanism is the fundamental role thought to play in this syndrome
patellofemoral pain syndrome
345
having weaker medial quadricep muscle than lateral quadricep muscles can cause the patella to be pulled...
laterally during quad contraction
346
callus formation on the dorsal surface of the index finger and long fingers of the hand from repetitive contact with the teeth during self-induced vomiting
Russell sign
347
bluish discoloration of the periumbilical area and can be seen in early pregnancy and cases of pancreatic necrosis with retroperitoneal bleeding
Cullen sign
348
Anterior and middle scalenes can elevate what rib?
rib 1
349
posterior scalene elevates rib (#) to tx an (inhalation/exhalation) somatic dysfunction
rib 2
exhalation
350
exhalation somatic dysfunction of ribs 3-5 will use what muscle?
ribs 6-8?
ribs 9-10?
ribs 11-12?
3-5 pec minor
6-8 serratus anterior
9-10 latissimus dorsi
11-12 quadratus lumborum
