Questions 701- 1050 Flashcards
affective dysregulation in dependent personality disorder, if not responsive to psychotherapy, can be treated with
lamotrigine
HIV pt with hx of HA, fever, neck pain
he has been working in parks/around soil
cryptococcal meningitis
tx for cryptococcal meningitis
Amp B and flucytosine for 2 weeks, then suppression with fluconazole for 8 weeks
when is O2 supplementation initiated in COPD pt?
when saturation drops to 88%
What categories go into Bishop scoring?
station
cervix consistency
dilation
position
effacement
short, plump, gram negative bacilli with capsule
Klebsiella
four factors that influence AFI
- ureteroplacental blood flow
- fetal urination
- fetal lung fluid
- fetal swallowing
dx gastrinoma with
secretin stimulation test
ulcer located in the stomach where a large tortuous arteriole erodes and causes gastric hemorrhage
Dieulafoy’s ulcer
wounds that do not heal, and especially burns, can turn into SCC, and then be considered…
marjolin ulcer
biochem abnormality in bruton’s
abnormality in tyrosine kinase
sexual arousal from touching or rubbing against unwilling people
frotteuristic disorder
MC elevated enzymes in dermatomyositis
CK and aldolase
first line tx for mild comedonal (open blackheads, closed whiteheads)
topical retinoid
tx for black widow spider bite
antivenom
calcium gluconate no longer recommended
rifampin MOA
inhibiting bacterial DNA-dependent RNA polymerase
COBRA stands for
consolidated omnibus budget reconciliation act
prevents sudden loss of health coverage
SAAG greater than 1.1 and ascitic fluid protein <2.5
cirrhosis
SAAG > 1.1 and ascitic fluid protein >2.5
HF
constrictive pericarditis
budd chiari syndrome
MOA of Salmonella
elicits host immune response that upregulate intracellular cAMP
profuse, thick yellow green exudate from eyes within 5 days s/p birth
N gonorrhea
dark specs of material and small translucent cement surrounding the hair shaft
louse/pediculosis
tachypnea a/w URI, with wheezing on exam and evidence of hyperinflation on an otherwise nl CXR
asthma
psych presentation but HTN and tachycardia, tactile halluciantions, aggressive behavior, poor dentention, skin excoriations
Methamphetamine intoxication
low hypocretin 1
narcolepsy
interviewing a psych pt, you need to ask
open ended questions
nystagmus in intoxicated person
PCP
tx for lithium toxicity
hemodialysis
what is the time frame with alcohol withdrawal symptoms?
mild 6-24 hrs
seizures 12-48h
hallucinosis 12-48h
DT 48-96 h
Buproprion MOA and indication
NE and DA reuptake inhibitor
for 2nd line for depression
no weight gain, no sexual side effects
schizophrenia MRI shows
enlarged ventricles with diffuse cortical atrophy
buproprion is contraindicated in
eating disorders and seizure disorders
what drug can cause a disulfuram like reaction?
metronidazole
first thing to give someone undergoing alcohol withdrawal
thiamine
tx for LV HF exacerbation
IV diuretics
pt has chorioamnionitis, next step?
immediate induction of labor
differentiate 5 alpha reductase deficiency and androgen insensitivity syndrome
5 alpha reductase will not have breast development at puberty
AIS will have breast development at puberty
immune mediated disorder characterized by the infiltration of inflammatory cells into a segment of the spinal cord
transverse myelitis
where does sensation get lost in cuada equina?
sensory loss involves thighs and buttocks
why is hypotension a side effect of epidural anesthesia?
redistribution to the lower extremities and venous pooling from sympathetic blockade
more specific findings of congenital syphilis
snuffles (copious rhinorrhea) and a maculopapular rash that may desquamate or become bullous
infant with cough with apnea and posttussive emesis
pertussis
individual puts negative feelings associated with a person or situation onto a “safer”, more acceptable object or situation
displacement
attributing one’s own feelings to someone else
projection
severe penicillin allergy, but pt got syphilis
doxycycline
dilated cardiomyopathy that develops during the last month of pregnancy or within 5 months following delivery
peripartum cardiomyopathy
dx cutaneous leprosy by
skin biopsy
acute onset of hypertension and AKI in pt with systemic sclerosis
dx?
tx?
scleroderma renal crisis
ACE inhibitors (captopril)
initial step in HHS tx
normal saline
once the normally functioning thyroid tissue is removed after cancer tx, what is used as a tumor marker?
thyroglobulin
pts with CIN 3 on bx require
cervical conization, excisional bx
extrapulmonary manifestations of sarcoidosis include
nervous system involvement, (facial nerve palsy), lymphadenopathy, hypercalcemia, and parotid gland swelling
in a sickle cell pt, an acute drop in Hgb with low retic ct and no splenomegaly
aplastic crisis
MCC of aplastic crisis
parvovirus B19 (with or without symptoms)
aplastic anemia affects
pancytopenia due to bone marrow failure
PEA… next step
chest compressions
classical cesarean delivery
contraindicates future vaginal
fetal risks associated with preeclampsia
chronic uteroplacental insufficiency
fetal growth restriction/low birth wt
maternal complications from preeclampsia
placental abruption
DIC
eclampsia
comorbidities associated with Tourette’s
ADHD and OCD
within 2 weeks post op of CABG, fever, tachy, chest pain, leukocytosis, and wound drainage
mediastinitis
tx acute mediastinitis
surgical debridement and abx
rudy/pleothoric appearance in newborn with Hct >65%
neonatal polycythemia
MRI shows ventricular enlargement and diffuse white matter changes
HIV associated neurocognitive disorder
symptoms with PML
subacute, AMS common, show cortical involvement (motor deficits, ataxia, vision changes)
MRI show well-delineated, asymmetric white matter lesions
complication of epidural anesthesia in pt who was previously taking an anticoagulant
spinal epidural hematoma
gross bleeding on colonoscopy, but also poor prep
angiodysplasia
fetal ultrasound shows double bubble sign
duodenal atresia
VACTERL
elevated PaCO2 causing respiratory acidosis
underlying cause?
hypoxemia
pulmonary embolism, atelectasis, pleural effusion, and pulmonary edema all cause
V/Q mismatch
pt with AIDs has progressive blurred vision, floaters, and yellow white exudates adjacent to the fovea/retinal vessels
CMV retinitis
tx with valganciclovir
esophagitis with oral thrush
tx with fluconazole empirically
resistant HTN in kidney transplant pt
added ACE-I and renal fxn declined
transplant renal artery stenosis
irregular, soft mass in scrotum
increases in size during valsalva and does not transluminate
varicocele
suspected SAH but CT non con is clean, what next?
LP
increased opening pressure, xanthochromia, and high RBC ct that does not decline with collection tubes
amenorrhea, signs of estrogen deficiency, and elevated FSH, <40 yo
primary ovarian insufficiency
ppx options for close contacts of N. meningiditis pts
rifampin, ceftriaxone, or cipro
complication of cardiac cath, presenting with sudden hemodynamic instability and ipsilateral flank or back pain
retroperitoneal hematoma
hepatitis B is a significant risk factor for what nephrotic syndrome
membranous nephropathy
tx for somatic symptom disorder
regularly scheduled visits with same provider
pt gets flu, takes abx, gets better for a few days, then develops PNA
bug?
what does XR look like?
S. aureus (CA- MRSA)
multilobar cavitary infiltrates
tension type HA can present in …. when other contributing factors are also present
depression
indolent symptoms of HA, malaise, low grade fever, incessant cough, and nonexudative pharyngitis
Mycoplasma pneumoniae
decompensated heart failure in young adult
viral prodrom a few weeks ago
viral myocarditis
MCC nephrotic syndrome in children
dx?
tx?
minimal change disease
prednisone
asymmetric corneal light reflexes and asymmetric red reflexes
strabismus
MTX toxicities
hepatotoxicity
stomatitis
cytopenias
sulfasalazine toxicities
hepatotoxicity
stomatitis
hemolytic anemia
asthma can be diagnosed if there is at least a ….
12% increase in FEV1
Pulmonary arterial hypertension is a common manifestation of systemic sclerosis that results from
intimal hyperplasia of the pulmonary arteries
what improves mortality in pts with ARDS?
low tidal volume ventilation
results in lower pulomary pressures, decreasing the likelihood of overdistending alveoli
normal pleural fluid pH
transudative pH
7.6 is normal
transudative is 7.4-7.55
exudative is 7.3-7.45
Liver cirrhosis ends up causing hepatorenal syndrome by what method?
increase NO in splanchnic circ
systemic vasodilation, decrease BP
renal hypoperfusion
increase RAAS
increase Na retention and volume retention
FeNa >2% means
intrarenal issue
amikacin toxicity
renal
contraindication for ACE-I
bilateral renal artery stenosis
what value do you want to shift K at?
greater than 7
post void residual volume of bladder <150 in female and <50 in male
dx? tx?
neurogenic bladder
oxybutinin/antimuscarinic
simple cyst tx?
asx, no follow up required
solid, circular, no septae in kidney mass, pain but no other symptoms
simple cyst
pt has varicocele that won’t really go away, what do I need to think about?
left sided renal cancer
tacrolimus and cyclosporine casue kidney injury by
arteriolar vasoconstriction, prerenal failure
envelope shaped oxalate crystals - cause?
ethylene glycol poisoning
6-48 hours after initiating tx for syphilis
Jarisch-Herxheimer reaction
hx of TB, this pt now has fever, weight loss, fatigue, cough, hemoptysis and a cavitary lesion on CT
chronic pulmonary aspergillosis
MC GI anomaly associated with Down Syndrome
duodenal atresia
prenatal US of duodenal atresia
polyhydraminos, double bubble on XR, no distal intestinal gas
tx duodenal atresia
enteral feeds, NG tube decompression, surgical repair
thin, wrinkled vulvar skin resulting in hypopigmentation and increased skin sensitivity causing an intense pruritis,
can have perianal skin involvement
lichen sclerosis
pruritic, purple plaques that are sometimes associated with thin, white striae around the labia and vulva
vulvar lichen planus
develops secondary to repetitive scratching, pt develops a hyperplastic response that causes thickened, leathery skin
lichen simplex chronicus
pt dx’d with lichen sclerosis, next step?
punch biopsy to rule out malignancy
normal lab values amylase
up to 125
normal lab value alk phos
up to 100
tx of campylobacter infxn
supportive care only
nonbilious hungry, but projectile vomiting infant
pyloric stenosis
what happens to cortisol during major depressive disorder?
increased serum cortisol
due to hyperactivity of the HT-pit-adrenal axis
How does sleep change in MDD?
decreased REM sleep latency and decreased slow-wave sleep
what can cause a false positive for PCP on a UDS?
dextromethorphan, ketamine, tramadol, venlafaxine
first line drug for fibromyalgia?
TCAs
endocarditis with recent hx of pyelo
enterococci
two MC organisms for brain abscess
viridans streptococci
S. aureus
fetal US shows edematous scalp and nuchal fold
hydrops fetalis
hydrops fetalis and no assoicated dysmorphic features
alpha thalassemia major
first week of life with vomiting, jaundice, hypotonia, and hepatomegaly
develops cataracts
galactosemia
deficiency of GALT
tx of galactosemia
galactose free diet/soy based formula
soap bubble appearance in bone
giant cell tumor
age related loss of elastic fibers in perivascular connective tissue
senile purpura
MC infxn in CF kids
S. aureus
MC infxn of CF 20yo and older
pseudomonas
acquired hyperpigmentation disorder that occurs primarily on sun exposed areas of the face during pregnancy
irregularly shaped, hyperpigmented macules
dx? tx?
melasma
avoid sun
hearing loss that paradoxically improves in noisy environments
conductive hearing loss
possible otosclerosis
hemolytic anemia, thrombocytopenia
renal failure
neuro manifestations
fever
TTP
thrombotic thrombocytopenic purpura
tx of TTP
plasma exchange
glucocorticoids
rituximab
CL motor and/or sensory deficits, more pronounced in the lower limb than upper limb
urinary incontinence, gait dyspraxia, primitive reflexes, abulia, and emotional disturbances
ACA stroke
MCC of sudden cardiac arrest in immediate post infarction period
v fib
long term analgesic use with 1 or more analgesics (NSAIDs) can cause CKD due to …. and hematuria due to…
tubulointerstitial nephritis
papillary necrosis
loss of paternal copy of 15q11-q13
prader willi syndrome
loss of maternal copy of chromosome 15q11-q13
angelman syndrome
reticulocytes and platelets in sequestration crisis of SCD
increased retics
decreased platelets
mom taking DES can cause what in daughter?
clear cell adenocarcinoma of the vagina
histo of pseudogout
rhomboid shaped crystals with positive birefringence
gout histo
needle shaped crystals with negative birefringence
atypical squamous cells of undetermined significance (ASCUS) and LSIL should do what?
conservative mgmt, repeat cytology in 12 months
adverse reactions of bisphosphonate after taking them for 7 years at least
atypical femur fracture
adverse effects of teriparatide?
orthostatic hypotension, osteosarcoma, myalgias, nausea, arthralgias, and leg cramps
CAH internal sex organs
are typically normal for females, male internal sex organs may not be present
what is the kidney issue in alport syndrome?
what is a specific finding that goes with this?
glomerulonephritis
Red blood cell casts
waxy and broad casts
advanced CKD
granular muddy brown casts
acute tubular necrosis
repeated infxns, abnl cell counts, peripheral smear with immature cells and Auer rods
AML
Sjogren pt is at an increased risk of developing
type I, distal, RTA
hypercalciuria
increased renal stones
tumor markers for recurrent breast cancer
CEA, CA 15-3, CA 27-29
s-100 is associated with
neural crest tissue
elevated in melanoma and neural tumors such as astrocytomas
Drug to tx actinomyces
penicillin G
menieres disease is aka
idiopathic endolymphatic hydrops
five days high fever and rash in kid
dx?
complication?
Kawaski disease
coronary artery aneurysm
screening results concerning for down syndrome
decreased AFP
decreased estriol
increased bhCG
increased inhibin A
edwards syndrome genetic screening will show
decreaed AFP
decreased estriol
decreased bhCG
decreased Inhibin A
H. influ shape
gram negative coccobacillus
tumor marker for granulosa cell tumors
inhibin
septic/distributive shock
cardiac output, peripheral vascular resistance, pulm cap wedge pressure?
high cardiac output, low PVR, low PCWP
rupture of bicep tendon, what nerve?
musculocutaneous
coffin lid appearance
dx and tx
struvite stone
surgical removal 2/2 size and tx bacterial infxn
ppx to prevent tumor lysis syndrome
allopurinol
down syndrome pt complaining of fever, pallor, fatigue
myelofibrosis, early sign of acute leukemia
tx for E. coli prostatitis
cipro or levo
first step in mgmt of pt with delirium and psychomotor agitation
typical antipsychotic
symmetric painful swelling of the hands, feet, or both in a young child with sickle cell disease
dactylitis
test used to assess the degree of motion at the lumbar spine in pt with suspected ankylosing spondylitis
Schober test
what can COPD do to the blood
cause polycythemia
pts with pancreatitis are at high risk for ARDS due to the release of
phospholipase A from the pancreas, which digests surfactant in the lungs
HBcAb IgG positive
HBsAg positive
chronic carrier hep B
stage of decubitus ulcer if destruction of dermis and visulization of fat but not muscle, tendon or bone
stage III
stage of decubitus ulcer if area of ulceration through the dermis, or a fluid filled blister
stage II
contraindication to cranial OMM
increased ICP
what receptor positive is associated with a favorable disease outcourse in breast cancer?
progesterone receptor positive
high grade squamous intraepithelial lesion found on pap. next step?
colposcopy if <25 yo
excisional procedure if >25yo
periarticular bony erosions without evidence of new bone formation on XR
RA
psoriatic arthritis symmetry
asymmetric
ED but sometimes wakes up with a boner
psychological
is the smallpox vaccine live or killed?
live
asymmetric FGR is the result of
placental dysfunction during the second or third trimester
HTN, pregestational DM
histoplasmosis presentation can mimic the presentation of
sarcoidosis
pt with suspected sarcoidosis does worse after immunosuppressive therapy
histoplasmosis
addition of NSAIDs to lithium can cause increased lithium level and these symptoms
GI upset, confusion, ataxia, and tremor
nonviable fetus in breech position
allow spontaneous vaginal delivery
what reduces morbidity and mortality rates in kids with severe measles?
vitamin A
small testes, low LH, infertility
exogenous steroid use
imaging used for psoas abscess
CT
Multiple myeloma affect on kidneys
decreased renal function
bland UA, may show granular casts
cardioinhibitory is aka
vasovagal
ERCP yesterday and severe abdominal pain today, what test?
lipase
initial drug of choice for myasthenia gravis?
pyridostigmine
spinal epidural abscess, bacterial infxn of epidural space, typically arises in the setting of
bacteremia from IVDA or distant infxn
fever, malaise, focal back pain, and progressive neuro findings
spinal epidural abscess
solitary liver mass with stellate central scar and radiating fibrous bands
focal nodular hyperplasia
SEVERE hemorrhoid pain in initial external hemorrhoid, tx?
hemorrhoidectomy instead of conservative
complications of drowning injuries
ARDS, cerebral edema, arrhythmia
pleural fluid glucose <60 is usually due to
exudative pleural effusion
how do you decrease risk of ventilator associated pna?
elevate head of bed to 45 degree angle
chronic granulomatous disease is caused by
impaired intracellular killing by phagocytes
how do you dx chronic granulomatous disease?
neutrophil function testing
dihydrorhodamine 123 or nitroblue tetrazolium testing
negative family hx of anemia and positive coombs test
autoimmune hemolytic anemia
what should be suspected in the pt with hx of malignancy who develops back pain with motor and sensory abnormalities?
epidural spinal cord compression
what kind of anemia do NSAIDs cause?
iron deficiency anemia
diagnostic test for peripheral arterial disease
ankle brachial index
pt recently admitted to a supervised setting
develop tremor, agitation, and elevated pulse and blood pressure
alcohol withdrawal
electrolytes in tumor lysis syndrome
hyperuricemia, hyperK, hyperphosphatemia, hypocalcemia
In pagets, what is the calcium, phosphorus, alk phos, and urine hydroxyproline levels?
normal calcium
normal phosphorus
high alk phos
high urine hydroxyproline
What CD4 count is the line for if it is okay for an HIV pt to receive a live attenuated vaccine?
>200, okay for live vaccine
tx of MDD with psychotic features
antidepressant plus antipsychotic
four things/diseases that would increase the risk for preeclampsia and require screening for preeclampsia then at the first prenatal visit
T1DM, HTN, SLE, multiple gestation
tx for mild, asx polyhyrdaminos at term gestation
expectant mgmt
betamethasone is given to patients at risk for
preterm delivery to reduce the risk of neonatal respiratory distress syndrome
response to hypovolemia with increased cardiac index and stroke volume, leading to pulse pressure increase, can manifest as
bounding peripheral pulses
translucent/gray teeth in kid who always seems to be getting fx
osteogenesis imperfecta
what is the glomerular abnormality in HSP
mesangial deposition of IgA
monoarticular knee joint effusion in a kid, what else do you need to ask about for hx
accompanying rash
what condition is gastroschisis associated with?
isolated defect
changing cervix on digital exam and no fetal presenting part, next step
transabdominal US to find head
PTH, Ca, P in Vit D deficiency
high PTH, low Ca, low P
MC malignancy of the liver
mets
fecal occult positive and solitary liver lesion
met from colon
blunt abdominal trauma but symptoms start being bad 24-48 hours later
duodenal hematoma
pt with functional asplenia will have what on blood smear?
Howell jolly body - remnant of RBCs
middle mediastinum pathologic findings
bronchogenic cysts, tracheal tumors, pericardial cysts, lymphoma, lymph node enlargement, and aortic aneurysms of the arch
fatigue, palpable purpura, arthralgias, renal disease, peripheral neuropathies
cryoglobulinemia
get hep panel
tx of adjustment disorder
psychotherapy
contraindication to raloxifene
hx of venous thromboembolism
increased swelling and pain in fx that is unresponsive to escalating analgesics, what are you considered about?
compartment syndrome
hemarthrosis after minor trauma, next step
coagulation studies
weak or spraying urine flow and incomplete emptying
increased postvoid residual volume
urethral stricture
high energy mechanism of injury and obvious big extremity issue, next step?
CT cervical spine
tuberous sclerosis is characterized by distinct skin features and …
benign tumor formation, like subependymal giant cell tumors in the brain and cardiac rhabdomyomas
toddler with S3
myocarditis
from viral infxn
super elevated AFP in fetus, next step?
get US, AFP can regress back to the mean after being elevated
multiloculated adnexal mass with thick walls and internal debris on US
tubo-ovarian abscess
