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Step 2 question review > Questions 701- 1050 > Flashcards

Questions 701- 1050 Flashcards

1
Q

affective dysregulation in dependent personality disorder, if not responsive to psychotherapy, can be treated with

A

lamotrigine

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2
Q

HIV pt with hx of HA, fever, neck pain

he has been working in parks/around soil

A

cryptococcal meningitis

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3
Q

tx for cryptococcal meningitis

A

Amp B and flucytosine for 2 weeks, then suppression with fluconazole for 8 weeks

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4
Q

when is O2 supplementation initiated in COPD pt?

A

when saturation drops to 88%

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5
Q

What categories go into Bishop scoring?

A

station

cervix consistency

dilation

position

effacement

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6
Q

short, plump, gram negative bacilli with capsule

A

Klebsiella

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7
Q

four factors that influence AFI

A
  1. ureteroplacental blood flow
  2. fetal urination
  3. fetal lung fluid
  4. fetal swallowing
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8
Q

dx gastrinoma with

A

secretin stimulation test

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9
Q

ulcer located in the stomach where a large tortuous arteriole erodes and causes gastric hemorrhage

A

Dieulafoy’s ulcer

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10
Q

wounds that do not heal, and especially burns, can turn into SCC, and then be considered…

A

marjolin ulcer

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11
Q

biochem abnormality in bruton’s

A

abnormality in tyrosine kinase

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12
Q

sexual arousal from touching or rubbing against unwilling people

A

frotteuristic disorder

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13
Q

MC elevated enzymes in dermatomyositis

A

CK and aldolase

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14
Q

first line tx for mild comedonal (open blackheads, closed whiteheads)

A

topical retinoid

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15
Q

tx for black widow spider bite

A

antivenom

calcium gluconate no longer recommended

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16
Q

rifampin MOA

A

inhibiting bacterial DNA-dependent RNA polymerase

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17
Q

COBRA stands for

A

consolidated omnibus budget reconciliation act

prevents sudden loss of health coverage

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18
Q

SAAG greater than 1.1 and ascitic fluid protein <2.5

A

cirrhosis

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19
Q

SAAG > 1.1 and ascitic fluid protein >2.5

A

HF

constrictive pericarditis

budd chiari syndrome

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20
Q

MOA of Salmonella

A

elicits host immune response that upregulate intracellular cAMP

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21
Q

profuse, thick yellow green exudate from eyes within 5 days s/p birth

A

N gonorrhea

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22
Q

dark specs of material and small translucent cement surrounding the hair shaft

A

louse/pediculosis

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23
Q

tachypnea a/w URI, with wheezing on exam and evidence of hyperinflation on an otherwise nl CXR

A

asthma

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24
Q

psych presentation but HTN and tachycardia, tactile halluciantions, aggressive behavior, poor dentention, skin excoriations

A

Methamphetamine intoxication

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25
Q

low hypocretin 1

A

narcolepsy

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26
Q

interviewing a psych pt, you need to ask

A

open ended questions

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27
Q

nystagmus in intoxicated person

A

PCP

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28
Q

tx for lithium toxicity

A

hemodialysis

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29
Q

what is the time frame with alcohol withdrawal symptoms?

A

mild 6-24 hrs

seizures 12-48h

hallucinosis 12-48h

DT 48-96 h

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30
Q

Buproprion MOA and indication

A

NE and DA reuptake inhibitor

for 2nd line for depression

no weight gain, no sexual side effects

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31
Q

schizophrenia MRI shows

A

enlarged ventricles with diffuse cortical atrophy

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32
Q

buproprion is contraindicated in

A

eating disorders and seizure disorders

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33
Q

what drug can cause a disulfuram like reaction?

A

metronidazole

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34
Q

first thing to give someone undergoing alcohol withdrawal

A

thiamine

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35
Q

tx for LV HF exacerbation

A

IV diuretics

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36
Q

pt has chorioamnionitis, next step?

A

immediate induction of labor

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37
Q

differentiate 5 alpha reductase deficiency and androgen insensitivity syndrome

A

5 alpha reductase will not have breast development at puberty

AIS will have breast development at puberty

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38
Q

immune mediated disorder characterized by the infiltration of inflammatory cells into a segment of the spinal cord

A

transverse myelitis

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39
Q

where does sensation get lost in cuada equina?

A

sensory loss involves thighs and buttocks

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40
Q

why is hypotension a side effect of epidural anesthesia?

A

redistribution to the lower extremities and venous pooling from sympathetic blockade

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41
Q

more specific findings of congenital syphilis

A

snuffles (copious rhinorrhea) and a maculopapular rash that may desquamate or become bullous

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42
Q

infant with cough with apnea and posttussive emesis

A

pertussis

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43
Q

individual puts negative feelings associated with a person or situation onto a “safer”, more acceptable object or situation

A

displacement

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44
Q

attributing one’s own feelings to someone else

A

projection

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45
Q

severe penicillin allergy, but pt got syphilis

A

doxycycline

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46
Q

dilated cardiomyopathy that develops during the last month of pregnancy or within 5 months following delivery

A

peripartum cardiomyopathy

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47
Q

dx cutaneous leprosy by

A

skin biopsy

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48
Q

acute onset of hypertension and AKI in pt with systemic sclerosis

dx?

tx?

A

scleroderma renal crisis

ACE inhibitors (captopril)

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49
Q

initial step in HHS tx

A

normal saline

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50
Q

once the normally functioning thyroid tissue is removed after cancer tx, what is used as a tumor marker?

A

thyroglobulin

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51
Q

pts with CIN 3 on bx require

A

cervical conization, excisional bx

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52
Q

extrapulmonary manifestations of sarcoidosis include

A

nervous system involvement, (facial nerve palsy), lymphadenopathy, hypercalcemia, and parotid gland swelling

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53
Q

in a sickle cell pt, an acute drop in Hgb with low retic ct and no splenomegaly

A

aplastic crisis

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54
Q

MCC of aplastic crisis

A

parvovirus B19 (with or without symptoms)

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55
Q

aplastic anemia affects

A

pancytopenia due to bone marrow failure

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56
Q

PEA… next step

A

chest compressions

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57
Q

classical cesarean delivery

A

contraindicates future vaginal

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58
Q

fetal risks associated with preeclampsia

A

chronic uteroplacental insufficiency

fetal growth restriction/low birth wt

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59
Q

maternal complications from preeclampsia

A

placental abruption

DIC

eclampsia

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60
Q

comorbidities associated with Tourette’s

A

ADHD and OCD

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61
Q

within 2 weeks post op of CABG, fever, tachy, chest pain, leukocytosis, and wound drainage

A

mediastinitis

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62
Q

tx acute mediastinitis

A

surgical debridement and abx

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63
Q

rudy/pleothoric appearance in newborn with Hct >65%

A

neonatal polycythemia

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64
Q

MRI shows ventricular enlargement and diffuse white matter changes

A

HIV associated neurocognitive disorder

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65
Q

symptoms with PML

A

subacute, AMS common, show cortical involvement (motor deficits, ataxia, vision changes)

MRI show well-delineated, asymmetric white matter lesions

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66
Q

complication of epidural anesthesia in pt who was previously taking an anticoagulant

A

spinal epidural hematoma

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67
Q

gross bleeding on colonoscopy, but also poor prep

A

angiodysplasia

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68
Q

fetal ultrasound shows double bubble sign

A

duodenal atresia

VACTERL

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69
Q

elevated PaCO2 causing respiratory acidosis

underlying cause?

A

hypoxemia

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70
Q

pulmonary embolism, atelectasis, pleural effusion, and pulmonary edema all cause

A

V/Q mismatch

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71
Q

pt with AIDs has progressive blurred vision, floaters, and yellow white exudates adjacent to the fovea/retinal vessels

A

CMV retinitis

tx with valganciclovir

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72
Q

esophagitis with oral thrush

A

tx with fluconazole empirically

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73
Q

resistant HTN in kidney transplant pt

added ACE-I and renal fxn declined

A

transplant renal artery stenosis

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74
Q

irregular, soft mass in scrotum

increases in size during valsalva and does not transluminate

A

varicocele

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75
Q

suspected SAH but CT non con is clean, what next?

A

LP

increased opening pressure, xanthochromia, and high RBC ct that does not decline with collection tubes

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76
Q

amenorrhea, signs of estrogen deficiency, and elevated FSH, <40 yo

A

primary ovarian insufficiency

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77
Q

ppx options for close contacts of N. meningiditis pts

A

rifampin, ceftriaxone, or cipro

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78
Q

complication of cardiac cath, presenting with sudden hemodynamic instability and ipsilateral flank or back pain

A

retroperitoneal hematoma

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79
Q

hepatitis B is a significant risk factor for what nephrotic syndrome

A

membranous nephropathy

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80
Q

tx for somatic symptom disorder

A

regularly scheduled visits with same provider

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81
Q

pt gets flu, takes abx, gets better for a few days, then develops PNA

bug?

what does XR look like?

A

S. aureus (CA- MRSA)

multilobar cavitary infiltrates

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82
Q

tension type HA can present in …. when other contributing factors are also present

A

depression

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83
Q

indolent symptoms of HA, malaise, low grade fever, incessant cough, and nonexudative pharyngitis

A

Mycoplasma pneumoniae

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84
Q

decompensated heart failure in young adult

viral prodrom a few weeks ago

A

viral myocarditis

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85
Q

MCC nephrotic syndrome in children

dx?

tx?

A

minimal change disease

prednisone

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86
Q

asymmetric corneal light reflexes and asymmetric red reflexes

A

strabismus

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87
Q

MTX toxicities

A

hepatotoxicity

stomatitis

cytopenias

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88
Q

sulfasalazine toxicities

A

hepatotoxicity

stomatitis

hemolytic anemia

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89
Q

asthma can be diagnosed if there is at least a ….

A

12% increase in FEV1

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90
Q

Pulmonary arterial hypertension is a common manifestation of systemic sclerosis that results from

A

intimal hyperplasia of the pulmonary arteries

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91
Q

what improves mortality in pts with ARDS?

A

low tidal volume ventilation

results in lower pulomary pressures, decreasing the likelihood of overdistending alveoli

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92
Q

normal pleural fluid pH

transudative pH

A

7.6 is normal

transudative is 7.4-7.55

exudative is 7.3-7.45

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93
Q

Liver cirrhosis ends up causing hepatorenal syndrome by what method?

A

increase NO in splanchnic circ

systemic vasodilation, decrease BP

renal hypoperfusion

increase RAAS

increase Na retention and volume retention

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94
Q

FeNa >2% means

A

intrarenal issue

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95
Q

amikacin toxicity

A

renal

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96
Q

contraindication for ACE-I

A

bilateral renal artery stenosis

97
Q

what value do you want to shift K at?

A

greater than 7

98
Q

post void residual volume of bladder <150 in female and <50 in male

dx? tx?

A

neurogenic bladder

oxybutinin/antimuscarinic

99
Q

simple cyst tx?

A

asx, no follow up required

100
Q

solid, circular, no septae in kidney mass, pain but no other symptoms

A

simple cyst

101
Q

pt has varicocele that won’t really go away, what do I need to think about?

A

left sided renal cancer

102
Q

tacrolimus and cyclosporine casue kidney injury by

A

arteriolar vasoconstriction, prerenal failure

103
Q

envelope shaped oxalate crystals - cause?

A

ethylene glycol poisoning

104
Q

6-48 hours after initiating tx for syphilis

A

Jarisch-Herxheimer reaction

105
Q

hx of TB, this pt now has fever, weight loss, fatigue, cough, hemoptysis and a cavitary lesion on CT

A

chronic pulmonary aspergillosis

106
Q

MC GI anomaly associated with Down Syndrome

A

duodenal atresia

107
Q

prenatal US of duodenal atresia

A

polyhydraminos, double bubble on XR, no distal intestinal gas

108
Q

tx duodenal atresia

A

enteral feeds, NG tube decompression, surgical repair

109
Q

thin, wrinkled vulvar skin resulting in hypopigmentation and increased skin sensitivity causing an intense pruritis,

can have perianal skin involvement

A

lichen sclerosis

110
Q

pruritic, purple plaques that are sometimes associated with thin, white striae around the labia and vulva

A

vulvar lichen planus

111
Q

develops secondary to repetitive scratching, pt develops a hyperplastic response that causes thickened, leathery skin

A

lichen simplex chronicus

112
Q

pt dx’d with lichen sclerosis, next step?

A

punch biopsy to rule out malignancy

113
Q

normal lab values amylase

A

up to 125

114
Q

normal lab value alk phos

A

up to 100

115
Q

tx of campylobacter infxn

A

supportive care only

116
Q

nonbilious hungry, but projectile vomiting infant

A

pyloric stenosis

117
Q

what happens to cortisol during major depressive disorder?

A

increased serum cortisol

due to hyperactivity of the HT-pit-adrenal axis

118
Q

How does sleep change in MDD?

A

decreased REM sleep latency and decreased slow-wave sleep

119
Q

what can cause a false positive for PCP on a UDS?

A

dextromethorphan, ketamine, tramadol, venlafaxine

120
Q

first line drug for fibromyalgia?

A

TCAs

121
Q

endocarditis with recent hx of pyelo

A

enterococci

122
Q

two MC organisms for brain abscess

A

viridans streptococci

S. aureus

123
Q

fetal US shows edematous scalp and nuchal fold

A

hydrops fetalis

124
Q

hydrops fetalis and no assoicated dysmorphic features

A

alpha thalassemia major

125
Q

first week of life with vomiting, jaundice, hypotonia, and hepatomegaly

develops cataracts

A

galactosemia

deficiency of GALT

126
Q

tx of galactosemia

A

galactose free diet/soy based formula

127
Q

soap bubble appearance in bone

A

giant cell tumor

128
Q

age related loss of elastic fibers in perivascular connective tissue

A

senile purpura

129
Q

MC infxn in CF kids

A

S. aureus

130
Q

MC infxn of CF 20yo and older

A

pseudomonas

131
Q

acquired hyperpigmentation disorder that occurs primarily on sun exposed areas of the face during pregnancy

irregularly shaped, hyperpigmented macules

dx? tx?

A

melasma

avoid sun

132
Q

hearing loss that paradoxically improves in noisy environments

A

conductive hearing loss

possible otosclerosis

133
Q

hemolytic anemia, thrombocytopenia

renal failure

neuro manifestations

fever

A

TTP

thrombotic thrombocytopenic purpura

134
Q

tx of TTP

A

plasma exchange

glucocorticoids

rituximab

135
Q

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

A

ACA stroke

136
Q

MCC of sudden cardiac arrest in immediate post infarction period

A

v fib

137
Q

long term analgesic use with 1 or more analgesics (NSAIDs) can cause CKD due to …. and hematuria due to…

A

tubulointerstitial nephritis

papillary necrosis

138
Q

loss of paternal copy of 15q11-q13

A

prader willi syndrome

139
Q

loss of maternal copy of chromosome 15q11-q13

A

angelman syndrome

140
Q

reticulocytes and platelets in sequestration crisis of SCD

A

increased retics

decreased platelets

141
Q

mom taking DES can cause what in daughter?

A

clear cell adenocarcinoma of the vagina

142
Q

histo of pseudogout

A

rhomboid shaped crystals with positive birefringence

143
Q

gout histo

A

needle shaped crystals with negative birefringence

144
Q

atypical squamous cells of undetermined significance (ASCUS) and LSIL should do what?

A

conservative mgmt, repeat cytology in 12 months

145
Q

adverse reactions of bisphosphonate after taking them for 7 years at least

A

atypical femur fracture

146
Q

adverse effects of teriparatide?

A

orthostatic hypotension, osteosarcoma, myalgias, nausea, arthralgias, and leg cramps

147
Q

CAH internal sex organs

A

are typically normal for females, male internal sex organs may not be present

148
Q

what is the kidney issue in alport syndrome?

what is a specific finding that goes with this?

A

glomerulonephritis

Red blood cell casts

149
Q

waxy and broad casts

A

advanced CKD

150
Q

granular muddy brown casts

A

acute tubular necrosis

151
Q

repeated infxns, abnl cell counts, peripheral smear with immature cells and Auer rods

A

AML

152
Q

Sjogren pt is at an increased risk of developing

A

type I, distal, RTA

hypercalciuria

increased renal stones

153
Q

tumor markers for recurrent breast cancer

A

CEA, CA 15-3, CA 27-29

154
Q

s-100 is associated with

A

neural crest tissue

elevated in melanoma and neural tumors such as astrocytomas

155
Q

Drug to tx actinomyces

A

penicillin G

156
Q

menieres disease is aka

A

idiopathic endolymphatic hydrops

157
Q

five days high fever and rash in kid

dx?

complication?

A

Kawaski disease

coronary artery aneurysm

158
Q

screening results concerning for down syndrome

A

decreased AFP

decreased estriol

increased bhCG

increased inhibin A

159
Q

edwards syndrome genetic screening will show

A

decreaed AFP

decreased estriol

decreased bhCG

decreased Inhibin A

160
Q

H. influ shape

A

gram negative coccobacillus

161
Q

tumor marker for granulosa cell tumors

A

inhibin

162
Q

septic/distributive shock

cardiac output, peripheral vascular resistance, pulm cap wedge pressure?

A

high cardiac output, low PVR, low PCWP

163
Q

rupture of bicep tendon, what nerve?

A

musculocutaneous

164
Q

coffin lid appearance

dx and tx

A

struvite stone

surgical removal 2/2 size and tx bacterial infxn

165
Q

ppx to prevent tumor lysis syndrome

A

allopurinol

166
Q

down syndrome pt complaining of fever, pallor, fatigue

A

myelofibrosis, early sign of acute leukemia

167
Q

tx for E. coli prostatitis

A

cipro or levo

168
Q

first step in mgmt of pt with delirium and psychomotor agitation

A

typical antipsychotic

169
Q

symmetric painful swelling of the hands, feet, or both in a young child with sickle cell disease

A

dactylitis

170
Q

test used to assess the degree of motion at the lumbar spine in pt with suspected ankylosing spondylitis

A

Schober test

171
Q

what can COPD do to the blood

A

cause polycythemia

172
Q

pts with pancreatitis are at high risk for ARDS due to the release of

A

phospholipase A from the pancreas, which digests surfactant in the lungs

173
Q

HBcAb IgG positive

HBsAg positive

A

chronic carrier hep B

174
Q

stage of decubitus ulcer if destruction of dermis and visulization of fat but not muscle, tendon or bone

A

stage III

175
Q

stage of decubitus ulcer if area of ulceration through the dermis, or a fluid filled blister

A

stage II

176
Q

contraindication to cranial OMM

A

increased ICP

177
Q

what receptor positive is associated with a favorable disease outcourse in breast cancer?

A

progesterone receptor positive

178
Q

high grade squamous intraepithelial lesion found on pap. next step?

A

colposcopy if <25 yo

excisional procedure if >25yo

179
Q

periarticular bony erosions without evidence of new bone formation on XR

A

RA

180
Q

psoriatic arthritis symmetry

A

asymmetric

181
Q

ED but sometimes wakes up with a boner

A

psychological

182
Q

is the smallpox vaccine live or killed?

A

live

183
Q

asymmetric FGR is the result of

A

placental dysfunction during the second or third trimester

HTN, pregestational DM

184
Q

histoplasmosis presentation can mimic the presentation of

A

sarcoidosis

185
Q

pt with suspected sarcoidosis does worse after immunosuppressive therapy

A

histoplasmosis

186
Q

addition of NSAIDs to lithium can cause increased lithium level and these symptoms

A

GI upset, confusion, ataxia, and tremor

187
Q

nonviable fetus in breech position

A

allow spontaneous vaginal delivery

188
Q

what reduces morbidity and mortality rates in kids with severe measles?

A

vitamin A

189
Q

small testes, low LH, infertility

A

exogenous steroid use

190
Q

imaging used for psoas abscess

A

CT

191
Q

Multiple myeloma affect on kidneys

A

decreased renal function

bland UA, may show granular casts

192
Q

cardioinhibitory is aka

A

vasovagal

193
Q

ERCP yesterday and severe abdominal pain today, what test?

A

lipase

194
Q

initial drug of choice for myasthenia gravis?

A

pyridostigmine

195
Q

spinal epidural abscess, bacterial infxn of epidural space, typically arises in the setting of

A

bacteremia from IVDA or distant infxn

196
Q

fever, malaise, focal back pain, and progressive neuro findings

A

spinal epidural abscess

197
Q

solitary liver mass with stellate central scar and radiating fibrous bands

A

focal nodular hyperplasia

198
Q

SEVERE hemorrhoid pain in initial external hemorrhoid, tx?

A

hemorrhoidectomy instead of conservative

199
Q

complications of drowning injuries

A

ARDS, cerebral edema, arrhythmia

200
Q

pleural fluid glucose <60 is usually due to

A

exudative pleural effusion

201
Q

how do you decrease risk of ventilator associated pna?

A

elevate head of bed to 45 degree angle

202
Q

chronic granulomatous disease is caused by

A

impaired intracellular killing by phagocytes

203
Q

how do you dx chronic granulomatous disease?

A

neutrophil function testing

dihydrorhodamine 123 or nitroblue tetrazolium testing

204
Q

negative family hx of anemia and positive coombs test

A

autoimmune hemolytic anemia

205
Q

what should be suspected in the pt with hx of malignancy who develops back pain with motor and sensory abnormalities?

A

epidural spinal cord compression

206
Q

what kind of anemia do NSAIDs cause?

A

iron deficiency anemia

207
Q

diagnostic test for peripheral arterial disease

A

ankle brachial index

208
Q

pt recently admitted to a supervised setting

develop tremor, agitation, and elevated pulse and blood pressure

A

alcohol withdrawal

209
Q

electrolytes in tumor lysis syndrome

A

hyperuricemia, hyperK, hyperphosphatemia, hypocalcemia

210
Q

In pagets, what is the calcium, phosphorus, alk phos, and urine hydroxyproline levels?

A

normal calcium

normal phosphorus

high alk phos

high urine hydroxyproline

211
Q

What CD4 count is the line for if it is okay for an HIV pt to receive a live attenuated vaccine?

A

>200, okay for live vaccine

212
Q

tx of MDD with psychotic features

A

antidepressant plus antipsychotic

213
Q

four things/diseases that would increase the risk for preeclampsia and require screening for preeclampsia then at the first prenatal visit

A

T1DM, HTN, SLE, multiple gestation

214
Q

tx for mild, asx polyhyrdaminos at term gestation

A

expectant mgmt

215
Q

betamethasone is given to patients at risk for

A

preterm delivery to reduce the risk of neonatal respiratory distress syndrome

216
Q

response to hypovolemia with increased cardiac index and stroke volume, leading to pulse pressure increase, can manifest as

A

bounding peripheral pulses

217
Q

translucent/gray teeth in kid who always seems to be getting fx

A

osteogenesis imperfecta

218
Q

what is the glomerular abnormality in HSP

A

mesangial deposition of IgA

219
Q

monoarticular knee joint effusion in a kid, what else do you need to ask about for hx

A

accompanying rash

220
Q

what condition is gastroschisis associated with?

A

isolated defect

221
Q

changing cervix on digital exam and no fetal presenting part, next step

A

transabdominal US to find head

222
Q

PTH, Ca, P in Vit D deficiency

A

high PTH, low Ca, low P

223
Q

MC malignancy of the liver

A

mets

224
Q

fecal occult positive and solitary liver lesion

A

met from colon

225
Q

blunt abdominal trauma but symptoms start being bad 24-48 hours later

A

duodenal hematoma

226
Q

pt with functional asplenia will have what on blood smear?

A

Howell jolly body - remnant of RBCs

227
Q

middle mediastinum pathologic findings

A

bronchogenic cysts, tracheal tumors, pericardial cysts, lymphoma, lymph node enlargement, and aortic aneurysms of the arch

228
Q

fatigue, palpable purpura, arthralgias, renal disease, peripheral neuropathies

A

cryoglobulinemia

get hep panel

229
Q

tx of adjustment disorder

A

psychotherapy

230
Q

contraindication to raloxifene

A

hx of venous thromboembolism

231
Q

increased swelling and pain in fx that is unresponsive to escalating analgesics, what are you considered about?

A

compartment syndrome

232
Q

hemarthrosis after minor trauma, next step

A

coagulation studies

233
Q

weak or spraying urine flow and incomplete emptying

increased postvoid residual volume

A

urethral stricture

234
Q

high energy mechanism of injury and obvious big extremity issue, next step?

A

CT cervical spine

235
Q

tuberous sclerosis is characterized by distinct skin features and …

A

benign tumor formation, like subependymal giant cell tumors in the brain and cardiac rhabdomyomas

236
Q

toddler with S3

A

myocarditis

from viral infxn

237
Q

super elevated AFP in fetus, next step?

A

get US, AFP can regress back to the mean after being elevated

238
Q

multiloculated adnexal mass with thick walls and internal debris on US

A

tubo-ovarian abscess

Step 2 question review (9 decks)

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