Questions 351-700 Flashcards
if pt has 2 or more errors in drawing the clock, what disease should be considered?
Alzheimer disease
Alzheimer disease often presents concurrently with
vascular dementia
acute epididymitis tx for <35
ceftriaxone and doxycycline
covers gonorrhea and chlamydia
acute epididymitis tx for >35 yo
levofloxacin OR ofloxacin
E. coli, other coliforms, and pseudomonas
tx for moderate acute otitis externa
topical Cipro HC (hydrocortisone)
topical preparation that is acidic and contains an antibiotic, an antiseptic, and a glucocorticoid
suspect what in elderly adults with anemia, fatigue and hypercalcemia
multiple myeloma
presents in adolesence with progressive ataxia, dysarthria, scoliosis, and cardiomyopathy;
loss of vibratory sense and proprioception also occur due to degeneration of the dorsal spinal columns
Friedreich ataxia
typically occurs following an infection (eg varicella), and presents with acute onset (within hours to days) of ataxia, nystagmus, and dysarthria
vibratory and position senses and reflexes are not affected
symptoms resolve in about 2 weeks
acute cerebellar ataxia
claw and hammer toe deformities in an older person
longstanding diabetes with peripheral neuropathy
characteristic triad of periorbital edema, myositis, and eosinophilia
trichinellosis
ischemia in the affected UE, vertebrobasilar ischemia (dizziness, ataxia, dysequilibrium)
lower brachial systolic BP in affected arm and systolic bruit in supraclavicular fossa on affected side
subclavian steal syndrome
stenosis or occlusion of the proximal subclavian artery, leading to reversal of blood flow in the ipsilateral vertebral artery
subclavian steal syndrome
acute graft rejection time frame
first 6 months following transplant
lymphocytic infiltration of the intima with inflammatory tubular disruption
renal biopsy of acute renal allograft rejection
vasoconstriction of the afferent and efferent arterioles, leading to prerenal AKI and HTN
renal biopsy unremarkable
what drug caused this reaction?
acute toxicity to calcineurin inhibitors (tacrolimus)
dx vestibular schwannoma
MRI of internal auditory canals
corrected calcium equation
= (measured Ca) + 0.8 x (4 - serum albumin)
once hypoparathyroidism has been r/o for hypocalcemia, what is the next step?
serum 25-hydroxyvitamin D level
increased anterior-posterior diameter of the eye will cause
myopia
nearsightedness
image to converge anterior to the retina
cotton wool spots on retina
retinal microinfarctions
two complications of myopia
retinal detachment
macular degeneration
MOA of ecstasy
increase in synaptic NE, DA, and 5HT
what illicit drugs might cause serotonin syndrome?
ecstasy and bath salts
increased bone turnover, XR evidence of widespread osteopenia and subperiosteal bone reabsorption
pt already has CKD
renal osteodystrophy
progressive back pain with focal lumbar tenderness, increased alkaline phosphatase, and L1/L2 sclerotic lesions
metastatic prostate cancer
mucin producing tumors (pancreatic, gastric, ovarian, breast) can secrete tissue factor into the blood, which intermittently triggers …. and can lead to …
coagulation cascade and can lead to chronic DIC
in this consumptive coagulopathy, pts have normal platelet counts and coagulation times but are at increased risk for venous and arterial thrombosis, and to a lesser extent, mucocutaneous bleeding
chronic DIC
Down syndrome 6 yo with weakness, gait changes, urinary/fecal incontinence, and vertebrobasilar symptoms such as dizziness, vertigo, imbalance, and diplopia.
upper motor neuron findings
atlantoaxial instability
(rheumatic)
symptoms due to compression of the spinal cord
individual transforms unacceptable emotions, desires, or impulses into their extreme opposite
reaction formation
low mood but doesnt meet criteria for MDD after an event
dx and tx?
adjustment disorder
psychotherapy
when an extraneous variable changes the direction or strength of an association between a risk factor and a disease
effect modification
the bias that results when the exposure-disease relationship is obscured by the effect of an extraneous factor associated with both exposure and disease
confounding bias
what helps determine whether a variable is a confounder or an effect modifier
stratified analysis
this results when an external variable positively or negatively impacts the effect of a risk factor on the disease of interest
effect modification
complex, multiloculated adnexal mass with thick walls and internal debris
tubo-ovarian abscess
complication of PID
fever = infection or malignancy
infection
tx for female head hair loss
topical minoxidil
tx for male pattern balding
minoxidil, finasteride
bipolar woman wants to switch from valproate to another medication because she wants to get pregnant
lamotrigine
tx for OCD
CBT based on Exposure and response prevention and/or pharmacotherapy with an SSRI
MOA of clomipramine
TCA
inhibits reuptake of serotonin and NE
hoarseness of voice and fungating laryngeal mass
laryngeal squamous cell carcinoma
(breastfeeding jaundice/breast milk jaundice)
starts the first week of life
breastfeeding jaundice
(breastfeeding jaundice/breast milk jaundice)
peaks at 2 weeks of age
breast milk jaundice
insufficient intake of breast milk resulting in decreased bilirubin elimination and increased enterohepatic circulation
breastfeeding jaundice
high levels of beta-glucuronidase in breast milk deconjugate intestinal bilirubin and increase enterohepatic circulation
breast milk jaundice
prerenal AKI is characterized by (low/high) urine sodium of…
(low/high) FeNa of …
and BUN:Cr > ….
low urine sodium of <20 mEq/L
low FeNA of <1%
BUN:Cr >20:1
pt OD on what?
CNS depression, hypotension, and other anticholinergic effects (dilated pupils, hyperthermia, and intestinal ileus)
TCAs
OD of TCA besides anticholinergic symptoms can cause…
and is treated with…
QRS prolongation
sodium bicarb to improve BP, narrow QRS, and prevent arrhythmia
prolonged QT has caused torsades
tx
magnesium sulfate
4 anomalies of tetrology of Fallot
- RVOT obstruction ( pulmonary stenosis or atresia)
- RVH
- overriding aorta
- ventricular septal defect
how does squatting during a tet spell help the patient?
knee-to-chest positioning will kink the femoral arteries
increasing systemic vascular resistance
reducing R to L shunting
four things to suspect when a pt presents with hypokalemia, alkalosis, and normotension
- surreptitious vomiting
- diuretic abuse
- bartter syndrome
- gitelmans syndrome
inherited disease of a defect in the thick ascending limb of the LOH leading to hypokalemia, alkalosis, and normotension/hypotension
Bartter syndrome
normotensive, hypokalemia, hypocalciuria, severe hypomagnesiemia, metabolic alkalosis, increased renin and aldosterone
ion exchange defect in distal convoluted tubule
autosomal recessive
gitelman syndrome
Ethacrynic acid is a loop diuretic used in patients with what allergies?
sulfonamide allergies
what action will increase intensity of mitral stenosis murmur
why
squatting
increased venous return to the heart and an increased amount of blood traversing the stenotic valve
the handgrip maneuver acts to
increase afterload, resulting in decreased LV emptying
handgrip will increase the intensity of what murmur
aortic regurg
duty to protect individuals threatened by a patient court case
Tarasoff
court case confirming patients have the right to refuse life-sustaining treatments and confirmed that a feeding tube was a medical tx that did not have unique status
Cruzan v Director, MO DoH
operation without consent is assault case/legal precedent for informed consent
Schloendorff v Society of NY hospital
ulcer on the medial side of the leg
venous stasis ulcer
prophylactic therapy for migraines
beta blockers, CCB, TCAs, valproic acid, SSRIs, and topiramate
dihydroergotamine is …
an abortive medication for migraine headache
erenumab binds to
CGRP receptor and can be used for migraine prevention
high cost
common lab abnormalities in tumor lysis syndrome
hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia
side effect of stimulants for treating ADHD
decreased seizure threshold
insomnia
increased BP
appetite suppression
why do you transplant the left kidney?
L kidney has longer vein, making transplantation technically easier
presence of both a major mood disorder (bipolar I or MDD) and a primary psychotic disorder (schizophrenia)
psych symptoms must be present without the presence of mood symptoms for at least one 2-week period
schizoaffective disorder
subacute cutaneous lupus erythematous genetic HLA associations
HLA-B8 and HLA-DR3
HLA-Cw6
Psoriasis
HLA-DQ2 and HLA-DQ8
celiac disease
4 diseases that go with HLA-B27
Psoriatic arthritis
Ankylosing spondylitis
Reactive arthritis
IBD-related arthritidies
HLA-B51
Bechet disease
TCA overdose does what to EKG?
wide QRS complexes and QT prolongation
antidote for TCA overdose
sodium bicarb infusion to narrow the QRS
bupropion is contraindicated if a pt has…
hx of seizures
Smoking cessation tx
behavioral intervention and nicotine replacement
anti-NMDA receptor IgG antibodies
NMDA receptor encephalitis
NMDA receptor encephalitis most often occurs in young women with
ovarian teratomas
Antibodies found in the majority of patients with Dermatitis herpetiformis
anti-endomysial antibodies
anti-tissue transglutaminase antibody
mineral oil preparation of skin scraping with microscopy
scabies dx
positive sphinx test indicates the sacrum is
stuck backward
first line prophylactic treatment of chronic GVHD
methotrexate
If the % BSA affected by burn injury exceeds 20%, then ..
place a urinary cath to measure urinary output
The goal for urinary output in severe burn victims is about
0.5 mL/kg/hour
Patients with severe bleeding require platelet transfusion if platelet count is below
50k
pt that is not bleeding, platelet transfusion recommended when platelet ct is less than
10k
discolored lesion on colonoscopy with vessels that are dilated, thin walled and without smooth muscle
angiodysplasia
brain stem encephalitis aka…
can be caused by…
but MC is…
rhomboencephalitis
infectious, autoimmune, and paraneoplastic
MC infectious cause is Listeria
electric sensation down the back with flexion of the neck
Lhermitte’s sign
pharm tx for bulimia nervosa
fluoxetine
first line tx for schizoid personality disorder
psychotherapy
corneal vascularization and cheilosis or glossitis
riboflavin deficiency (vit B2)
sympathetic innervation of the heart, thoracic levels
T1-T5
chapman point for the heart
between the second and third rib
pervasive distrust and suspiciousness of others
paranoid personality disorder
Cluster A - odd or eccentric
paranoid, schizoid, schizotypal
cluster B - dramatic, emotional, or erratic
antisocial, borderline, histrionic, narcissistic
cluster c- anxious or fearful
avoidant, dependent, OCPD
XXY
Klinefelter syndrome
majority of men are infertile
enterobius vermicularis
pinworm
tapeworm acquired through ingestion of undercooked infected pork
taenia solium
intestinal protozoa that causes bloody diarrhea and may lead to the formation of a hepatic abscess
Entamoeba histolytica
affected leg is usually externally rotated and appears longer than the unaffected leg
hip - anterior dislocation
affected limb is shortened and internally rotated
posterior hip dislocation
elderly patient falls laterally onto a hip - dx?
physical exam?
femoral neck fx
externally rotated and shortened limb
bleeding episode in pt with vWD tx
desmopressin
Brugada on EKG
persistent ST elevations in V1-V3 leads with RBBB, with or without terminal S waves in lateral leads
can fluoroquinolones be used in pregnancy?
no, risk bone and cartilage damage
shortest effective course of tx for uncomplicated UTI
fosfomycin
cyanide toxicity typically presents with ….
leading to an increased anion gap metabolic acidosis
profoundly elevated lactic acid
differentiate DKA from alcholic ketoacidosis by
hyperglycemia
What differentiates PCP from cocaine intoxication?
absence of nystagmus in cocaine intoxication
differentiate symptoms of polymyalgia rheumatica with polymyositis
Polymyalgia rheumatica - proximal muscle pain and stiffness
polymyositis - proximal muscle weakness
what fundoscopic exam finding is consistent with abuse?
vitreous hemorrhage
lipid and protein deposits found in Bruch’s membrane in the macula in patients with age related macular degeneration
Drusen
increased optic cup to disc ratio
glaucoma
test for ataxia and proprioceptive loss in which the patient stands with their feet together and eyes closed
Romberg test
trigger finger is aka
stenosing flexor tenosynovitis
loss of full extension of the affected finger or fingers at the MCP joint
painless and nodule on the palmar surface
dupuytren contracture
fetal US shows bilaterally enlarged kidneys with increased echogenicity, oligohydraminos, and pulmonary hypoplasia
ARPKD
autosomal recessive polycystic kidney disease
rheumatic heart disease causes what valve issue?
mitral stenosis
pts on chronic steroids who are going to undergo surgery should…
increase their steroid dose to keep from adrenal insufficiency
serum immunoglobulins and B cell concentration are markedly low to absent
Bruton agammaglobulinemia
serum immunoglobulins are decreased but B cells are normal
Common variable immunodeficiency
caused by impaired T cell development and subsequent B cell dysfunction
T and B cells are markedly decreased
severe combined immunodeficiency
prevertebral calcifications
extensive atherosclerosis consider AAA
complication of atopic dermatitis with painful vesicles and punched out erosions with hemorrhagic crusting along with fever and LAD
eczema herpeticum of HSV
burning or itching of the eyelids, discharge, and often foreign body sensation in the eye
exam shows redness, swelling, and scaling at the lid margin, and conjunctiva may be inflamed
etiology is variable
blepharitis
inflammation at the eyelid margin, most prominent at the opening of the meibomian glands
when dopamine is blocked in the tuberoinfundibular pathway, the production of … increases, resulting in…
prolactin
galactorrhea, menstrual irregularities, and infertility
4 antipsychotic meds most likely to cause increase in prolactin level?
first gen: haloperidol and fluphenazine
second gen: risperidone and paliperidone
N. meningitidis ppx agents
rifampin or ciprofloxacin
In ILD, pts have impaired gas exchange resulting in reduced diffusion capacity of CO and increased
alveolar-arterial gradient
anemia of CKD is due to
erythropoietin deficiency
tx for anemia of CKD is
erythropoiesis-stimulating agents such as erythropoietin or darbepoetin
Inadequate response to erythropoietin-stimulating agents (ESAs) is most commonly due to
iron deficiency
hyperventilation in panic attacks results in
respiratory alkalosis
elevated pH, low pCO2
elevated blood pH results in dissociation of the hydrogen ions bound to albumin, leading to increased calcium binding and a decrease in
serum ionized calcium
abx tx for postpartum endometritis
ampicillin, clindamycin, gentamicin
abx tx for chorioamnionitis
ampicillin, genatmicin
clonidine is an alpha 2 agonist; missing doses of this can cause
rebound hypertension due to vasoconstriction
anticholinergic overdose toxidrome
- blind as a bat - blurred vision
- mad as a hatter - psych issues
- red as a beat - flushing
- hot as hell - decreased sweating
- dry as a bone
- tacky as a leisure suit - tachycardia
differentiate serotonin syndrome with overdose of anticholinergic
SSRI overdose will have sweating and diaphoresis while anticholinergic excess will have decreased sweating
p-ANCA and eosinophilia
Churg struass
p-ANCA, hep B surface antigen or antibody, mononeuropathies such as foot drop
polyarteritis nodosa
tx for porphyria cutanea tarda
phelbotomy and chloroquine
initial tx of bullous pemphigoid
topical corticosteroid and systemic anti-inflammatory
persistent difficulty in the social use of verbal and nonverbal communication
social (pragmatic) communication disorder
child onset fluency disorder
stuttering
gestational thrombocytopenia
benign and self-limited
reassure and observe
a pincer grasp would be expected at what age?
9 months
volar aspect of the first 3.5 digits is innervated by what nerve?
median nerve
highly sensitive test that can be used to rule out muscular dystrophy if the test is negative
serum CK
anteromedial aspect of tibia
pes anserine bursitis
pes anserine is made up of what muscle insertions?
gracilis, sartorius, and semitendinosis
personality disorder with shyness and low self confidence
avoidant personality disorder
intense fear of being disliked and avoid relationships for fear of rejection
avoidant personality disorder
basal body temp elevates once..
ovulation has occurred
Ewing sarcoma on biopsy
small round blue cells
Tardive dyskinesia develops in the setting of prolonged exposure to dopamine blocking agents, causing
upregulation and supersensitivity of dopamine receptors
male pt with infertility, associated with tall stature, gynecomastia, small testes, and signs of decreased virilization
Klinefelter syndrome XXY
in klinefelter syndrome, infertility is due to testicular fibrosis with
seminiferous tubule dysgenesis, azoospermia, hypogonadism, and elevated FSH and LH levels
pts with this complete syndrome are genetically male but phenotypically female and most often present with primary amenorrhea
Congenital androgen insensitivity syndrome
cerebral and retinal hemangioblastomas, pheos, and renal cell carcinoma are associated with
von hippel lindau syndrome
ischemic stroke is (hypoattenuated/hyperattenuated) on CT
hypoattenuated
cerebellar hemorrhage tx with signs of neuro degeneration or bleed >3cm is
urgent surgical decompression
what is the most sensitive test for screening for nephropathy
urine albumin to creatine ratio test
diabetics screen annually with this
early diastolic murmur
aortic regurg
testing for vertebral osteomyelitis?
MRI spine
MC GI complication of HSP
intussusception
intestinal edema and bleeding associated with HSP act as lead point
in this syndrome jaundice may be triggered by fasting or consumption of a fat-free diet, physical exertion, febrile illness, stress, or menstruation.
caused by reduced bilirubin glucuronidation and results in intermittent jaundice due to a mild, unconjugated hyperbilirubinemia
Gilbert syndrome
mangement of Gilbert syndrome
reassurance and supportive care
what do vagal maneuvers do to the heart?
increase parasympathetic tone in heart
temporary slowing of conduction in the AV node
increase AV node refractory period
leading to termination of AV node reentrant tachycardia
MC form of paroxysmal supraventricular tachycardia
AVNRT
neonatal conjunctivitis at 5-14 days
dx and tx
chlamydial
oral azithromycin (PO macrolide)
neonatal conjunctivitis 2-5 days
dx and tx
gonococcal
single dose IM 3rd gen cephalosporin
<24 hours neonatal conjunctivitis
dx and tx
chemical
eye lubricant
neonatal presentation of maternal infection with Listeria
sepsis or meningoencephalitis
neonate with short palprebral fissures, thin vermilion border, and smooth philtrum
fetal alcohol syndrome
neonatal presentation of maternal toxoplasmosis infection
chorioretinitis and jaundice
isolated hyperpigmented patches with an increased density of hair follicles
congenital melanocytic nevus
first line medication for pertussis tx and postexposure ppx?
who gets postexposure ppx?
macrolides (eg azithromycin)
all close and high risk contacts should get ppx, regardless of immunization status
commonly used anti-seizure medication that can cause pancreatitis?
valproic acid
holosystolic murmur heard over the apex with radiation to the axilla
mitral regurg
fever, HA, and periorbital swelling; usually palsy of CN III, IV, VI resulting in ophthalmoplegia
cavernous sinus thrombosis
unilateral HA and ipsilateral Horner’s syndrome (with pupillary constriction)
carotid artery dissection
acute onset, severe HA, patients with …. often have vomiting, photophobia, neck stiffness, and lethargy
SAH due to saccular aneurysm
characteristic polysomnographic finding in MDD
decreased REM sleep latency
decreased slow wave sleep
increased REM sleep duration and density
confirmation of clinical dx of perforated viscus
upright XR chest and abdomen
what is contraindicated if acute GI perf is suspected?
endoscopy
because air insulfflation and instrumentation may worsen the perforation
child <2 yo with cough, congestion, diffuse wheezes/crackles, and respiratory distress
bronchiolitis
hx of diabetes, opiate use; symptoms of bloating, abdominal pain, loose stools, and positive glucose breath test
small intestinal bacterial overgrowth (SIBO)
why would SIBO develop in someone
altered small bowel motility (uncontrolled DM, chronic opiate use, scleroderma) or those who have surgery involving the ileocecal valve
gold standard for diagnosis of small intestinal bacterial overgrowth
jejunal aspiration demonstrating a high bacterial concentration
carbohydrate breath test using glucose or lactulose can diagnose
small intestinal bacterial overgrowth
tx of small intestinal bacterial overgrowth
abx like rifaximin or neomycin
tx for mild ulcerative colitis
mesalamine
posterior mediastinum mass
neurogenic tumors
meningocele, enteric cysts, lymphomas, diaphragmatic hernias, esophogeal tumors, and aortic aneurysms
middle mediastinum mass
bronchogenic cysts
anterior mediastinum mass
thymoma, retrosternal thyroid, teratoma, and lymphomas
osteoporosis, normocytic anemia, renal insufficiency, and hypercalcemia
multiple myeloma
multiple myeloma can be diagnosed with
serum protein electrophoresis
to get symptomatic relief from heart failure, what drug do you give?
IV diuretics
S3 is associated with
left ventricular heart failure
recurrent edema without associated pruritis or urticaria
autosomal dominant, hereditary angioedema
pathophys of hereditary angioedema
deficiency in or dysfunction of C1 inhibitor (C1 esterase inhibitor)
leads to elevated bradykinin, causing edema
tx for acute swelling in hereditary angioedema
C1 inhibitor concentrate; or a bradykinin antagonist (icatibant), or kallikrein inhibitor (ecallantide)
examples of cell mediated (type IV) hypersensitivity
PPD test and allergic contact dermatitis
what are typical findings in immune complex mediated (type III) hypersensitivity reactions?
joint swelling, fever, and rash
age >50 yo
subacute to chronic pain in shoulder and hips
morning stiffness lasting >1 hr
consitutional symptoms
elevated ESR >40
no other apparent explanation
polymyalgia rheumatica
tx for polymyalgia rheumatica
low dose glucocorticoids (prednisome 10-20 mg daily)
excessive daytime sleepiness, cataplexy, and REM sleep-related phenomenon
narcolepsy
shy-drager syndrome
multiple system atrophy
- parkinsonism
- autonomic dysfunction
- widespread neurological sings
multiple system atrophy/shy-drager syndrome
tx for multiple system atrophy
aimed at intravascular volume expansion with fludrocortisone, salt supplementation, alpha agonists, and application of constrictive garments to the lower body
horner syndrome triad
regional dysautonomia
anhydrosis, miosis, and ptosis
in children of Ashkenazi Jewish descent, presenting at birth, with feeding problems and low muscle tone
gross dysfunction of the ANS (no tears) with severe orthostatic hypotension
Riley-Day syndrome aka familial dysautonomia
pt has isolated urticaria that improves with transfusion cessation and diphenhydramine administration
urticarial transfusion reaction
preformed IgE antibodies
what can differentiate cocaine intoxication from bipolar disorder and other primary psych disorders?
signs of sympathetic stimulation (eg diaphoresis, mydriasis, tachycardia, and hypertension)
anion gap calculation
anion gap = sodium - (chloride + bicarb)
normal is 10-14
MUDPILES mneumonic
Methanol
Uremia
DKA
Propylene glycol/paraldehyde
Isoniazid/iron
Lactic acidosis
Ethylene glycol (anitfreeze)
salicylates (aspirin)
Bell palsy tx
prednisone
can copy a circle or a line, but no squares or stick figures
age?
3 yo
African American, HIV hx, and IV heroin use are all risk factors for
focal segmental glomerulosclerosis
increased excretion of protein in the urine leads to decrease in oncotic pressure.
response to oncotic pressure by the liver includes increasing synthesis of…
lipoproteins, resulting in hyperlipidemia
macroglossia, restrictive cardiomyopathy, congo red stain
amyloidosis
At what age do you switch to forward facing car seats?
2 years old
when can children use the seat belt without other boosters?
4’ 9 and between 8 and 12 years old
finding seen on both CXR that may resemble the thymus gland in children or a lateral XR of the humerus indicating a distal humerus fx in a child or a radial head fx in adult
sail sign
for stable patients with a primary spontaneous pneumothorax >50%
tx
moderate size chest tube
what happens to CO, PVR, and PCWP in anaphylactic shock?
CO increases (through an increase in HR in order to maintain BP)
PVR decreases (arteries dilate due to histamine release)
PCWP decreases (slightly, due to relative hypovolemia because of vasodilation)
chronic hemolysis, such as in sickle cell, can lead to what gallbladder issue?
pigmented gallstones and complications thereof
up to 80% of osteosarcomas will metastasize to
the lungs
salicylate toxicity will initially cause….
and then turn into…
respiratory alkalosis
high anion gap metabolic acidosis
initial tx of salicylate toxicity
gastric lavage
loss of stapedial reflex is in
otosclerosis
pathophys of migraine?
trigeminovascular system dysfunction
what causes atypical community acquired pna in otherwise healthy people?
what can be developed in this?
mycoplasma pna
autoantibodies against RBCs called cold agglutinins (IgM antibodies that agglutinate RBCs at 4C)
for pts for one month with recent implantation of BMCS, or for 12 months in setting of a DES or ACS
dual antiplatelet therapy
(asa + P2Y12 blocker)
Score greater than or equal to 2 on CHA2DS2VASC recommends
anticoagulation recommended
asymptomatic bacturia, if left untreated in pregnancy can lead to
acute pyelonephritis, ARDS, and preterm labor and delivery
What will LH level be in patient with central precocious puberty?
high basal LH or an LH level that increases with GnRH stimulation
What will LH level be in peripheral precocious puberty?
low/normal LH levels
in pts whom RA is suspected but who have a negative RF test result get
anti-CCP
does seronegative RA have a better or worse prognosis than RF+ and CCP+ RA
better prognosis
new solitary pulmonary nodule on CXR, next step
chest CT to eval for malignancy
the antecedent illness of intussusception is thought to cause
hypertrophy of peyer patches in the terminal ileum
thereby serving as a nidus for telescoping
HSP can cause intussusception due to the
formation of a small bowel hematoma from the autoimmune vasculitis
bone marrow infiltration -> anemia and thrombocytopenia
splenomegaly -> severe and worse than hepatomegaly
bony pain/skeletal involvement
failure to thrive or delayed puberty
Gaucher disease
glucocerebrosidase deficiency
Gaucher disease
short stature, anemia, hypoplastic thumbs, pancytopenia
fanconi anemia
mechanism of pulmonary hypertension in systemic sclerosis
hyperplasia of the intimal smooth muscle layer of the pulmonary arteries leading to increased PVR
chronic inflammation with noncaseating granulomas is consistent with
sarcoidosis
Has received 3 tetanus toxoid doses but have not received revaccination for tetanus in the last five years
dirty puncture wound
single dose of Tdap
unimmunized, uncertain, or <3 tetanus toxoid doses
clean wound
tetanus vaccine, no TIG
unimmunized, uncertain, or <3 tetanus toxoid doses
dirty wound
tetanus vaccine plus TIG
infant with periventricular calcifications
congenital CMV
MC sequelae of CMV
sensorineural hearing loss, presenting as failed hearing screen in a newborn or develop later in childhood
what will decrease the murmur heard in hypertrophic cardiomyopathy?
valsalva, moving to standing, nitrates, vasodilators, diuretics
to slow the accumulation of ascites, what should you suggest?
diuretics and dietary sodium control
tx for toxic alcohol consumption
hemodialysis if
- metabolic acidosis
- elevated levels of methanol or ethylene glycol
- evidence of end-organ damage
indications for acute hemodialysis
Acidosis- severe metabolic acidosis
Electrolytes - severe hyperkalemia
Ingestion - toxic alcohols, lithium
Overload - refractory fluid overload
Uremia - uremic pericarditis or encephalopathy
deadly toxin exposure at a work site must be reported to
Occupational Health and Safety Administration (OSHA)
meningismus is caused by
breakdown of blood products within the CSF that triggers inflammation of the meninges
amaurosis fugax is dx’d… what next?
tx like TIA, start on aspirin and get neuro consult
amaurosis fugax is MC due to
plaque rupture from internal carotid artery
kids with ADHD are at increased risk of developing what as an adult?
antisocial personality disorder
GFR value that would contraindicate metformin use in a diabetic?
< 30 GFR
MC type of vulvar cancer
squamous cell carcinoma
athletes that perform repetitive backbending could get
spondylolithesis
purely observational study that looks at a single point in time
cross-sectional study
how is data analyzed in case-controlled study
odds ratio
retrospective and observational study
case-controlled study
observational and prospective study
cohort study
pt divided into groups based on exposure, then followed for development of disease
cohort study
magnetic gait
normal pressure hydrocephalus
to assess severity of Guillian Barre, get
vital capacity
side effect of tretinoin cream for acne
dryness and excessive skin peeling
H. influ is a gram negative …
coccobacilus
Fusobacterium is a group of obligate anaerobic gram negative bacilli responsible for causing
Lemierre syndrome
antecedent oropharyngeal infection, disseminated foci of infection or septic emboli, and bacteremia
Lemierre syndrome
PAS-staining IgM deposits around the nucleus of plasma cells
Waldenstrom macroglobulinemia
urine vanillylmandelic acid is elevated in
pheos
pt at high risk for complications of ETEC should take this as ppx
rifaximin
healthy pt wants ppx for ETEC
bismuth subsalicylate
psoriatic arthritis affects what joint
DIP
elevated anti-streptolysin O titer
Group A strep infection
(rheumatic fever, erythema marginatum, guttate psoriasis)
spoon nails or koilonychia
iron deficiency
what anatomic landmarks do you use to assess leg length
ASIS and medial malleolus
methylene blue is an antidote for what three possible ODs?
nitrates, nitroprusside, or antimalarials
ferritin, serum Fe, TIBC, and RDW
in Fe deficiency anemia
ferritin low
serum Fe low
TIBC high
RDW high
ferritin, serum Fe, TIBC, and RDW
in chronic disease anemia
ferritin high
serum Fe low
TIBC low
RDW normal
ferritin, serum Fe, TIBC, and RDW
in thalassemia
ferritin low
serum Fe low
TIBC normal
RDW normal
tx for severe hyponatremia
100 mL bolus of 3% saline
corkscrew esophagus
esophageal spasm
patients with …. syndrome have low urinary excretion of calcium and high urinary excretion of magnesium
Gitelman syndrome
form of familial hypokalmic alkalosis due to a proximal tubule defect, resulting in hypouricemia
Gullner syndrome
hypokalemia and metabolic alkalosis with hypertension at a young age
Liddle syndrome
polyhydraminos, premature delivery, severe hypokalemia, hypochloremia, metabolic alkalosis, and normal BP
Bartter syndrome
should thoracics or ribs be treated first?
thoracic dysfunction treated first
reciprocal inhibition involves setting up the pt …
to their barrier
and then gently push further toward their barrier
the common peroneal branch of the sciatic nerve innervates what hamstring muscle?
short head of the biceps femoris
the tibial branch of the sciatic nerve innervates all of teh hamstring muscles except for
the short head of the biceps femoris
what kind of stroke tends to present initially with focal neuro symptoms but can progress to signs of increased ICP like vomiting, HA, bradycardia, reduced alertness?
intracerebral hemorrhage
weeks to months after an MI and the pt now has pericarditis
Dressler syndrome - immune mediated inflammation
aka post-cardiac injury syndrome
midodrine MOA and indication
alpha agonist to tx orthostatic hypotension
when do you give varicella vaccines?
age 1 and 4
major depression and worsening diabetic neuropathy, tx?
duloxetine (SNRI)
ratio of an event rate occurring in the treatment arm versus the non-treatment arm
hazard ratio
hazard ratio less than 1 indicates
the treatment arm had a lower event rate than the non treatment arm
study that involves 2 or more experimental interventions, each with 2 or more variables that are studied independently
factorial design
(renal) dense intramembranous deposits that stain for C3
membranoproliferative glomerulonephritis, type 2
aka dense deposit disease
pathophys of membranoproliferative glomerulonephritis type 2
IgG abs (C3 nephritic factor) directed against C3 convertase of the alternative complement pathway
persistent complement activation and kidney damage
fever, polyarthralgia, pustular rash, sexually active
disseminated gonnococcal infxn
chronic venous insufficiency tx
leg elevation, exercise, and compression therapy
confirm ALS dx with what test?
EMG
shows fibrillation and loss of innervation in multiple muscle groups
seated flexion test assess…
while the standing flexion test assess…
seated: sacroiliac motion
standing: iliosacral motion
top 3 MCC of meningitis in newborn
- GBS
- Neisseria
- Listeria
mangement of recurrent eclamptic seizures that are not responsive to mag sulfate
diazepam
tx of magnesium toxicity
calcium gluconate
MRI brain showing large lesion with irregular borders and central hypointensity, representing areas of focal necrosis
ring enhancing and surrounding edema is common
GBM
MC malignant pediatric brain tumor, infratentorial
medulloblastoma
tx of chancroid/H. ducreyi
single dose PO azithromycin, IM ceftriaxone, a week of erythromycin, or 3 days cipro
tx for lymphogranuloma venereum
doxycycline
liability reason as to why the hospital can be named as a defendant
vicarious liability
failure to continue a work up when it is called for is considered
breach of duty
MCC of osteomyelitis
staph aureus
increased number of lymphocute precursors that are positive for terminal deoxynucelotide transferase, marker of pre B cells or pre T cells
ALL
ALL is often accompanied with what during dx?
tumor lysis syndrome
initial tx of Tumor Lysis Syndrome
start IV fluids and promote diuresis as well as use adjunctive medications such as allopurinol to help lower uric acid levels and prevent renal failure
GI symptoms, excessive weight loss, myalgias, hyperpigmentation
hyponatremia, hyperkalemia, hypercalcemia, and hypoglycemia
Addisonian crisis
herbal supplement known for aphrodisiac properties and is used for tx of sexual dysfunction, DMT2, and fatigue
ginseng
MC adverse effect of ginseng
insomnia
herbal supplement popularly taken to improve overall immune function
echinacea
herbal supplement for tx of dementia, memory impairment, and vascular disorders
ginkgo biloba
Serious adverse effect of Ginkgo biloba use
bleeding
herbal supplement to treat BPH
Saw palmetto
kartagener syndrome triad
situs inversus, chronic sinusitis, and bronchiectasis
excessive fluid accumulation in the interstitium, eg pericardial and pleural effusions in utero
hydrops fetalis
what is the MCC of immune fetal hydrops
Rh (D) alloimmunization
what causes nonimmune fetal hydrops
parvovirus B19
single, subcapsular, low density lesion in the right lobe of the liver
entamoeba histolytica
echinococcous granulosis v entamoeba histolytica
fever is rare in echinococcus unless cyst ruptures, diarrhea is also uncommon
fatigue, weight loss, hypotension, and hyperpigmentation of the skin and mucous membranes in young woman with hypothyroidism
primary adrenal insufficiency
distinct episodes of major depression and hypomania
bipolar disorder type II
heart defect in diGeorge syndrome
truncus arteriosus
intense blood glucose control with insulin decreases the risk of
microvascular complications of diabetes
initial tx for PAD includes smoking cessation, statin, and
exercise program
