Quizlet cards - 12-07-15 - Sheet1

Question 1

What to do if someone JUST amputated their finger?

Answer 1

Place finger in sterile saline-moistened gauss -> put in plastic bag with ice -> ER -> can salvage finger within 24 hrs of amputation

Question 2

What do antipsychotics do to thermoregulation?

Answer 2

It frakk’s w/ it.

Question 3

When do you start scoping a dude/dudette w/ UC, and how often?

Answer 3

8-10 yrs post dx yearly

Question 4

Why do ppl who receive crazy amounts of PRBC’s tend to develop hypoCa?

Answer 4

The citrate anticoag taint binds to the Ca boyz.

Question 5

When do you do the Fluorescein eye exam taint / what do you use it for?

Answer 5

To detect foreign objects in the eye using some orange dye thing -> use if gross exam w/ a pencil light shows nothing + H&P highly suggests foreign obj in eye

Question 6

When is dat clomiphene citrate taint used? What is it?!

Answer 6

To induce ovulation in those grills who have egg reserves, but aren’t ovulating, like when they have PCOS or sth. It is an estrogen analog.

Question 7

What would you see on an ab-XR on a kid who OD’d on iron pills?

Answer 7

Radio-opacities ‘n stuffs in ze stomachz.

Question 8

How do you figure out the endocrinological abnormalities in Turner grills?

Answer 8

Super-dog-taint-phail ovaries -> no negative feedback mechanisms on pituitaries.

Question 9

Can you see abnormalities in ppl w/ stress fx’s?

Answer 9

Not always. It’s mainly a clinical dx really.

Question 10

What are the mood sx’s peeps refer to when they talk about schizoaffective d/o?

Answer 10

BOTH mania and depression! A-durrrr /FailFish

Question 11

Given: IM and strep throat present pretty similarly. Some ppl might preemptively give someone w/ IM amoxicillin or sth, thinking that it’s strep throat. And then BAM! Rash. What’s that rash about / is it truly an allergic reaction?

Answer 11

Why that rash happens is unknown. But whatever the case may be, it ain’t no allergic rxn + the rash tends to pop up after someone w/ IM takes amoxcillin. Strange.

Question 12

Pathophys of osteomalacia?

Answer 12

Low Vit D (most commonly) -> terribad bone mineralization (normal bone mineralization needs adequate Ca and phos)

Question 13

What are the indications for octreotide, in the context of ppl w/ liver dz?

Answer 13

For peeps with ACTIVE variceal bleeding. Using it for esophageal variceal bleeds ppx is taint–can confirm.

Question 14

What’s a more accurate test? Spirometry or peak flow?

Answer 14

Spirometry!

Question 15

Findings for trisomy 21 on 2nd trimester quadriple screen?

Answer 15

High beta-hCG, high inhibin, LOW AFP, low estrodiol

Question 16

Findings for trisomy 18 on 2nd trimester quadriple screen?

Answer 16

Normal inhibin A, low AFP, low beta-hCG, low estrodiol

Question 17

Findings for neural tube defects on 2nd trimester quadriple screen?

Answer 17

High AFP, rest WNL

Question 18

What does ze uncal herniation juice look like?

Answer 18

AMS/coma, contra homonymous hemianopsia (f/ compression of posterior cerebral artery, leading to ischemia of visual cortex), ipsi hemiparesis (f/ compression of crus cerebri), loss of CN III, IV, and VI (late game)

Question 19

Why do pts with hyperosmolar hyperglycemic state have low body K lvls?

Answer 19

Loss of K in urine f/ glucosuria-induced K loss

Question 20

Why cath epidural’d grills who gave birth and have urinary incontinence?

Answer 20

Overdistended bladder delays return of normal bladder fxn.

Question 21

What are 4 questions I should ask myself whenever I run into an arthritis type case?

Answer 21

1) poly or monoarticular?

Question 22

What is the relationship btwn birth weight and the incidence of intraventricular hemorrhage?

Answer 22

lower birth wt = higher incidence

Question 23

MS vs MG?

Answer 23

MS: multiple neurological sx’s interspersed by time.

Question 24

Features of Lewy body dementia?

Answer 24

parkinsonian-like sx’s, visual hallucinations, AMS, decline in executive fxn

Question 25

What type of dissociative d/o does Dust probably have, given his beginnings in the game and why?

Answer 25

Disociative fugue b/c of his ‘travel hx’ – he was one of General Gaius’s men, but probably escaped / traveled far away / forgot who he was b/c of all the crap he prob did under General Gaius.

Question 26

Out of all the hyperthyroid dz’s, why is Graves’ dz tx’d with iodine associated w/ the highest rates of hypothyroidsm?

Answer 26

The whole damn gland’s superactive, so the iodine will blast the whole gland.

Question 27

Why are practically all males with CF infertile?

Answer 27

The taint mucus accumulates in utero and wrecks vas deferens dev

Question 28

WTH are hydatic cysts?!

Answer 28

Liver cysts caused by some taint protozoa thing called Echinococcus something -> associated with close contact w/ dogs and sheep.

Question 29

Which form of contraception is preferred in lactating moms and why?

Answer 29

Progestin-only OCP’s, since estrogen frakk’s w/ milk production/milk composition.

Question 30

What to do if the pt’s Pap comes back showing ASCUS (atypical sq cell of undetermined sig)?

Answer 30

HPV screen THEN do colposcopy/bx IFF HPV screen comes back (+)

Question 31

Pt w/ ASCUS has an HPV screen that came back (-). What now?

Answer 31

Repeat Pap in 6 mo.

Question 32

WTH is dat CHARGE syndrome taint?

Answer 32

A ‘series’ of congenital defects seen in conjxn. It’s an AD dz that’s associated w/ a mutation of some gene that has a role in DNA binding or some taint.

Question 33

WTH is dat VACTERL syndrome taint?

Answer 33

A manifestation of a wide variety of genetic mutations (yeah, like that helps.)

Question 34

What is anal atresia esp associated w/?

Answer 34

Down Syndrome!

Question 35

Risk factors for RCC?

Answer 35

Cig smoking, DM, HTN

Question 36

Most likely complication for VUR?

Answer 36

Renal scarring (lol I answered RCC instead on a q. GET REKT)

Question 37

Indications for steroids in L&D pts?

Answer 37

IFF baby is

Question 38

What is DES?

Answer 38

Some synthetic estrogen that was used f/ 1938-1971 to prevent spontaneous abortions, premature delivery, and such. It was TAINT

Question 39

What are 3 complications that are associated with DES use?

Answer 39

ppl who were delivered under the ‘care’ of DES have 1)a 40-fold inc risk of clear cell adenoCa of the vagina and cervix; 2) preggo issues; 3) GU tract abnormalities

Question 40

In general, for medically stable premies, how should you schedule vaccinations?

Answer 40

By their chronological age, NOT their gestational age.

Question 41

What is the earliest sign of hypovolemia?

Answer 41

t-t-t-t-tachycardia

Question 42

Bruton’s agammaglobulinemia VS Common variable immunodeficency! WHAT R ZE DIFF’S EH?!

Answer 42

Bruton’s: X-linked recessive, presents w/in first 6-9 mo of life, has markedly low or absent B cells on PBS

Question 43

What are the various characteristics of cluster headaches? But srsly doe, I can’t be bothered to learn about the various types of headaches / migraines, which is why they’re on this Quizlet taint. YEAP.

Answer 43

• more common in men

Question 44

What is the preferred mode of tx for acute atks of cluster headaches?

Answer 44

100% o2, as it’s the most rapid acting / effective than NSAIDS, nasal sumatriptan

Question 45

What can you use for cluster headache ppx?

Answer 45

Ergots, NSAIDs, Verapamil

Question 46

What are 2 things that set adhesive capsulitis (frozen shoulder) from the other types of shoulder injuries?

Answer 46

1) more stiffness than pain (THINK OF THE NAME!)

Question 47

Which part of the axial skeleton does RA affect, and what are the complications of that said effect?

Answer 47

Involvement of cervical spine -> frakk’s w/ cervical spine structure -> cervical spinal cord compression

Question 48

Pathophys of ARDS?

Answer 48

Lung dmg -> lung inflammation -> leakage of dmging fluid into alveoli -> loss of surfactant + alveolar dmg -> stiff lungs, pulmonary HTN, taint gas exchange

Question 49

What are the three most common bugs that are responsible for secondary bacterial PNA’s?

Answer 49

S. aureus, H. flu, S. pneumo

Question 50

`Which secondary bacterial PNA-causing bug(s) is/are associated w/ necrotizing bronchopneumonia that leads to mini abscesses?

Answer 50

S. aureus

Question 51

Q: Exam findings

Answer 51

Clamy: moderate swelling, moderate watery discharge, less purulent than gono

Question 52

Q: Which one is moar severe?!

Answer 52

GONO IS!!!!!!!!!!!!!!!!!!!!!!!111one

Question 53

Q: Best way to prevent?

Answer 53

Universal prenatal screening + tx of both as necessary

Question 54

Q: ppx ointment differences?

Answer 54

Gono is ppx’d w/ that erythromycin ointment.

Question 55

How to tx syphillis in nonpreggo pts w/ PCN allergy?

Answer 55

Doxycycline, and arithromycin to a lesser extent.

Question 56

How to tx syphillis in preggo pts w/ PCN allergy?

Answer 56

desensitize then give PCN

Question 57

Pathophys of HELLP syndrome?

Answer 57

Taint placentation -> systemic inflammation + coag cascade + complement cascade triggered -> platelet consumption + MAHA -> get rekt liver

Question 58

What are those Baker cysts Amare Stat. had at one point & what’s its pathophys?

Answer 58

Inflamed synovium 2/2 OA, RA, cartilage tears -> excessive fluid production -> fluid accumulates in popliteal fossa -> ZE BULGE -> cyst

Question 59

How do the transaminase lvls tend to behave in ppl with HCV?

Answer 59

ALT/AST wax and wane.

Question 60

Can you gives me some extrahepatic HCV jooce?

Answer 60

Heme: cryo!

Question 61

What is porphyria cutanea tarda characterized by?

Answer 61

Fragile skin, photosensitivitiy, vesicles and such on dorsum of hands, has a STRONK assoc. w/ Hep C!

Question 62

Situation: parent refuses to give kid tx for a non emergency, yet fatal condition (ex: chemo to an ALL kid). What do you do?

Answer 62

Get other ppl involved, continue to try to educate pt about risks vs benefits, and if sh*t hits the fan, GET A COURT ORDER for said tx.

Question 63

Situation: parent refuses to give kid tx for an EMERGENCY situation. What do you do?

Answer 63

Give the tx to kid anyway. BALLAH

Question 64

What is the endometrial ca risk factor jooce made of?

Answer 64

Unopposed estrogen (f/ tamoxifen, obesity, PCOS).

Question 65

Should you treat someone w/ abnormal uterine bleeding who potentially has endometrial ca w/ hormonal therapy?

Answer 65

Yep, ONLY AFTER r/o endometrial ca first.

Question 66

What is the pathophys of PSVT?

Answer 66

Extra conductions loopin’ around in the AV node.

Question 67

How does cold water immersion affect the ANS?

Answer 67

It increases vagal tone.

Question 68

A G2P1 woman w/ a baby at 32 weeks gestation presents with preeclampsia-eclampsia. What to do / why?

Answer 68

Give steroids + induce labor at same time. Baby is

Question 69

Tx mode of choice for ppl with fulminant liver failure?

Answer 69

GOTTA TRANSPLANT DEM DOE OR ELSE…they’ll RIP 80% chance of the time /BibleThump

Question 70

Can roid takers present with behavioral changes and things?

Answer 70

YAS YAS YAS. They in fact become more aggressive.

Question 71

When do you use immunosuppressive therapy on ppl w/ MG?

Answer 71

After tx w/ anti-Ach’s phail.

Question 72

Can you give me teh factitious d/o vs malingering d/o JOOCE?

Answer 72

Both will produce sx’s of some sort intentionally. Factitious ppl will do so to assume the sick role (I wanna be taken care of~ … in a sort of frakk’d up way), whereas malingering ppl will do so with some kinda secondary gain (get pain meds to feed addiction, etc)

Question 73

HOKAY, HO, we know that certain types of polyps can lead to colon ca. Polyps of a certain gross appearance, size, and histologcal characteristics are more associated w/ colon ca than others. What are these characteristics?

Answer 73

Gross appearance: sessile adenoma (as opposed to pedunculated adenoma)

Question 74

What’s the go-to psych drug for smoking cessation?

Answer 74

Buproprion (Wellbutrin), with of course, nicotine patches, counseling, and teh sort.

Question 75

Gots a preggo bipolar pt on Lithium. What congenital abnormalities should we be concerned about?

Answer 75

1st trimester: cardiac abnormalities, a la Ebstein’s abnormality

Question 76

Pt’s got torsades. What to do next?

Answer 76

Depends on whether they are hemodynamically stable or not. Obv, you’d want to correct the underlying cause, but first, if they’re hemo stable, give mag sulfate. If they’re hemo unstable, shock ‘em.

Question 77

When is calcium gluconate used, in the context of some kind of cardiotox?

Answer 77

When the cardiotox is there 2/2 hyperkalemia.

Question 78

Which form of steroids do you use to treat acute exacerbations of COPD?

Answer 78

Systemic (methylprednisolone), NOT inhaled (fluticasone). Inhaled form would inc that said person’s risk of developing PNA

Question 79

Can you give me teh Trypanosoma cruzi jooce?

Answer 79

It’s a bug that causes Chagas dz. It’s endemic in S. America and can manifest itself as megacolon, megaesophagus, heart failure

Question 80

Etiologies of constrictive pericarditis?

Answer 80

Idiopathic/viral, cardiac surgery, radiation therapy, TB (in endemic areas)

Question 81

1st gen PCN’s (pen G, K, etc) - What do they miss?

Answer 81

GI anaerobes, STAPH, H. Flu, GNR, Enterococus

Question 82

2nd gen PCN’s (anti-staph’s, i.e., nafcillin, dicloxacillin) - What do they miss?

Answer 82

GI anaerobes, MRSA, H. Flu, GNR, Enterococcus

Question 83

3rd gen PCN’s (amox, ampicillin) - What do they miss? What can they cover that the 1st, 2nd gen PCN’s can’t?

Answer 83

Misses: GI anaerobes, staph, beta-lactamase (+) H. Flu, most GNR’s

Question 84

Amox-clav / amp-sulbactam - What do they miss? What other coverage do they provide, that amox / amp alone can’t?

Answer 84

Misses: GI anaerobes not named bacterioides, MRSA, the other gram (-)’s,

Question 85

Is aspiration PNA always associated with UL infiltrates?

Answer 85

Not always. When ppl get asp PNA while standing up, the infiltrates tend to be on the lower lobe. However, when ppl get it while lying down, infiltrates tend to be on the upper lobes.

Question 86

What are two big CI’s for doxycycline use? What would serve as okay alternates?

Answer 86

Preggo pts and pts who are

Question 87

When we give kids doxycycline for acne or Lyme dz or w/e, why do we tell them to stay away from the sun?

Answer 87

Phototoxic drug eruptions are common with tetracyclines.

Question 88

We all know IVIG has many uses, a couple of them being lupus flares and GBS. Is it only used in the acute setting?

Answer 88

Nah. In fact, it’s used for maintenance therapy for primary immunodeficiency dz’s.

Question 89

How can you differentiate histoplasmosis vs blastomycosis, considering they affect very similar geographical areas?

Answer 89

In histo, disseminated dz is very rare in immunocompetent ppl, whereas in blasto, disseminated dz is quite common, even in immunocompetent ppl.

Question 90

What is prolactin production affected by from the endocrinological standpoint?

Answer 90

Stim’d by serotonin and TRH and inhibited by dopamine.

Question 91

What is the most common cause of death in pts with acromegaly?

Answer 91

Mostly from

Question 92

On CXR, you find ‘free air under diaphragm’. What next?

Answer 92

XXXXXXXXXXXXXXXXX LAAAAAAAAAAAAAAAAP

Question 93

Olanzapine - most common SE?

Answer 93

WT GAIN. btw, it’s not a side effect that ONLY affects teens!

Question 94

What’s the antipsychotic that’s associated w/ agranulocytosis?

Answer 94

Clozapine mainly.

Question 95

What are the P/E findings for pts with intracranial HTN?

Answer 95

papilledema, CNVI deficits, peripheral visual field defects

Question 96

What is a contraindication for LP’s in pts with clear s/s of intracranial HTN?

Answer 96

a mass effect or obstruction in the brain of some kind

Question 97

What’s the preferred form of initial anticoag in pts with severe renal insufficiency?

Answer 97

Old school heparin. Your Lovenox and the other ‘newer’ anticoags are kinda C/I’d in these said pts

Question 98

What is dantrolene / when is it used?

Answer 98

It’s a muscle relaxant that’s sometimes used in ppl w/ NMS

Question 99

Can you give me ze taint optic neuritis jooce?

Answer 99

central scotoma (swollen optic disc), AFFERENT PUPILLARY DEFECT, changes in visual acuity and color perception

Question 100

What’s the diff btwn Heinz bodies and Howell-Jolly bodies?

Answer 100

Heinz bodies = little aggregates of denatured Hb

Question 101

Why do you see a ~10 week gestation-sized in a nonpreg pt w/ adenomycosis?

Answer 101

Think about it -> uterine glands inside muscle tissue -> blood accumulates in said glands inside muscle tissue -> uterus gets bigger

Question 102

What’s ‘otitis media with effusion’?

Answer 102

It’s a sort of ‘post acute otitis media’ state where the person’s ear continues to have effusions in their ear after the resolved infection, without any signs of inflammation (fever, tugging on ear, etc)

Question 103

What does thyroglobulin measure?

Answer 103

It measures native synthesis of thyroid hormone.

Question 104

Which one is a true statement? TRH increases prolactin lvls OR prolactin increases TRH lvls?

Answer 104

TRH increases prolactin lvls. Prolactin itself has no effect on TRH

Question 105

Does dextrose in a given saline solution have any role in initial fluid resuscitation?

Answer 105

Nope. I have no idea why.

Question 106

Which one’s associated w/ dat onion appearance on XR?

Answer 106

osteosarcoma BY FAR is the more common bone cancer. Ewing’s is associated w/ the onion appearance on XR.

Question 107

What are the sx’s of carcinoid syndrome, and what is a well known associated nutritional deficiency associated w/ this syndrome, if not properly addressed?

Answer 107

Carcinoid syndrome = sx’s of serotonin overload. Carcinoid cells produce an @$$load of 5-HT, which can therefore deplete niacin in the body.

Question 108

Hepatic adenomas are associated with chronic use of which med? And do you see regular hepatic tissue on bx?

Answer 108

These dudes are associated w/ long term OCP use, and on bx, you will NOT see normal hepatic tissue (no bile ducts and the like)

Question 109

What is the preferred go-to tx modality in young pts with renal artery stenosis (bilat or unilat), and why?

Answer 109

angioplasty w/ stent placement is the go-to modality for these grp of ppl, as interventional therapy was shown to be more effective than medical therapy.

Question 110

When are ACEI’s indicated for a renal artery stenosis situation?

Answer 110

In older pts with unilat renal artery stenosis.

Question 111

What’s the bug that’s responsible for post-dental procedure IE’s? Give its members as well

Answer 111

Strep viridans -> S. mutans (most common), S. mitis, S. sanguis, S. salivaris.

Question 112

How would you describe general XR findings in someone w/ OA? What additional findings can you find?

Answer 112

OA = ‘degenerative signs’. Also can find bony spurs.

Question 113

How is hazard ratio used?

Answer 113

If >1, event is more likely in tx grp. If

Question 114

What do subgroup analysis tables show in randomized clinical trials?

Answer 114

Whether certain pt characteristics (age, comorbidities, etc) had an effect on outcome

Question 115

What’s another name for osteitis deformans?

Answer 115

Paget’s dz of bone!

Question 116

Why are pts with RA at an inc risk for developing osteoporosis?

Answer 116

Dec activity, chronic steroid use, chronic inflammation

Question 117

Neuroimaging defects in psych d/o - SCZ?

Answer 117

Enlargement of cerebral ventricles

Question 118

Neuroimaging defects in psych d/o - OCD?

Answer 118

Structural abnormalities in striatum and orbitofrontral cortex

Question 119

Neuroimaging defects in psych d/o - Autism?

Answer 119

Inc total brain vol

Question 120

Neuroimaging defects in psych d/o - Panic d/o?

Answer 120

Dec amygdala vol

Question 121

Neuroimaging defects in psych d/o - PTSD?

Answer 121

Dec hippocampus vol

Question 122

What are the c/i’s for iodine therapy in a Graves setting?

Answer 122

Pregnancy and severe ophthalmopathy. I guess this is where your PTU’s and such come in

Question 123

What is considered a ‘normal’ contraction stress test?

Answer 123

No late decels (no placental insufficiency), no variable decels (no cord compression) within appropriate time period.

Question 124

– Scorpion studying neuro. “ARISE!!”

Answer 124

They ARISE from the cerebellar vermis. Its associated sx’s come from its mass effect (including the N/V from obstructing CSF flow)

Question 125

– Scorpion studying neuro.

Answer 125

ARISE! They ARISE from the posterior part of the midbrain. Its associated sx’s come from its mass effects (i.e., N/V f/ CSF obstruction, screwing with CNIII, superior colliculus). Note that the pineal gland sits just posterior to the midbrain. OH YE

Question 126

Fanconi’s anemia - give me some jooce?

Answer 126

auto recessive dz, dx’d around secondary school time, associated w/ progressive pancytopenia + macrocytosis, various deformities.

Question 127

Diamond-Blackfan anemia - give me some jooce?

Answer 127

macrocytic anemia assoc w/ major congenital deformities

Question 128

Wiskott-Aldrich Syndrome - give me some jooce?

Answer 128

X-linked dz assoc w/ eczema, thrombocytopenia, low Ig lvls

Question 129

What is considered a normal NST?

Answer 129

2 sets of fetal heart accelerations w/in a 20-40 min period.

Question 130

So..say someone comes in after a caustic ingestion of some sort. You stabilize said person’s ABC’s, decontaminate said person, start fluids, and do necessary imaging. What to do next?

Answer 130

Endoscopy in next 24 hrs.

Question 131

Name the cardiac manifestations that are assoc w/ Marfan’s eh?

Answer 131

Aortic dissection/regurg/dilatation, MVP

Question 132

What is pulsus parvus et tardus?

Answer 132

Parvus = weak. Tardus = late. It’s one of the physical findings that’s associated w/ aortic stenosis.

Question 133

How does high aldo influence bicarb lvls?

Answer 133

High aldo = high bicarb. And this is how it happens, at least from my understanding

Question 134

How do you tell the diff btwn orbital cellulitis and preseptal cellulitis?

Answer 134

Anatomy. How?

Question 135

If you see a unilateral solid nontender neck mass in a pt w/ a significant smoking hx, what are you thinking?

Answer 135

SCC!!!!!

Question 136

Zenker’s diverticulum - where do you see it? How can you see it? What complications is it assoc w/?

Answer 136

Where? Upper esophagus.

Question 137

What are the risk factors for C. diff?

Answer 137

Old age, recent abx use, ESRD on HD, being hospitalized, prolonged gastric acid suppression.

Question 138

How do you clinically distinguish Tay-Sachs f/ Niemann-Pick dz?

Answer 138

Tay-Sachs - hyperreflexia

Question 139

How do you differentiate MGUS from MM? What basic studies can you do to help differentiate this?

Answer 139

MGUS has NO anemia, hypercalcemia, lytic lesions, and renal insufficiency. CBC, CMP, and a metastatic skeleton bone XR study will help.

Question 140

What murmur is ze bicuspid aortic valve assoc w/?

Answer 140

AR!

Question 141

What is selection bias?

Answer 141

A type of bias that forms when a patient’s treatment regiment is dependent on the severity of the pt’s condition. A confounding effect via indication results.

Question 142

What are some unique features of Legionnaire’s dz (Legionella PNA)?

Answer 142

extrapulmunary sx’s (hyponatremia, mild hepatitis, GI sx’s, hematuria and proteinuria).

Question 143

What are the appropriate next steps in mgmt for ppl w/ suspected acute limb ischemia?

Answer 143

Anticoag + immediate vasc surgical interventions.

Question 144

Solid tumor cancers are associated with which nephrotic syndrome?

Answer 144

Membranous nephropathy

Question 145

Lymphomas are assoc w/ which nephrotic syndrome?

Answer 145

Minimal change dz.

Question 146

Hep B and C are associated w/ which nephrotic syndrome

Answer 146

Membranous nephropathy and less commonly, membranoproliferative glomerulonephritis

Question 147

HIV, heroin use, and being of African American and Hispanic descent is associated w/ which nephrotic syndrome?

Answer 147

Focal segmental glomerulosclerosis.

Question 148

Okay. I know that sensitivity and specificity is independent of prevalence. Does that apply for PPV and NPV? Why/why not?

Answer 148

PPV and NPV is DEPENDENT on prevalence. If you do the math, you’ll see.

Question 149

There are 2 out of the 4 possible causes of croup in children that are kind of hard to distinguish. Those said causes are from vascular rings and laryngomalacia. How do you differentiate?

Answer 149

Vascular rings = malformation of a part of the aorta results in a ‘congenital chokehold’ of the larynx. Hence the reason why it gets better when you extend the kid’s neck.

Question 150

What’s the role of CA-125 as a tumor marker?

Answer 150

It’s used in the dx AND in the mgmt of ovarian ca (unlike say, PSA, which is only useful in post-radical prostatectomy f/u’s)

Question 151

What is mucormycosis? What’s the most common org responsible? How is it best treated?

Answer 151

Mucormycosis is one deadly fungal infection of the facial sinuses, most often in ppl with diabetic ketoacidosis / poorly controlled DM, or neutropenia. Rhizopus = MC fungus. Amphotericin C is the only effective antifungal vs Rhizopus.

Question 152

How does transient synovitis come about? When does it resolve typically?

Answer 152

It comes about after a viral infection, typically, and it resolves in 1-4 weeks.

Question 153

What is the duration of lithium therapy dependent on in bipolar ppl? Assume no C/I’s for lithium in this case.

Answer 153

If person had 1 manic ep, give 1-2 yrs worth post remission. If person had 2+ manic ep., consider long term therapy.

Question 154

Kawasaki JOOCE - Dx criteria?

Answer 154

Fever > 5 days & 4+ of the following findings: bilat nonexudative conjuctivitis, mucositis, cervical lymphadenopathy with 1+ LN >1.5 cm, erythematous polymorphous rash, extremity changes

Question 155

Kawasaki JOOCE - Tx?

Answer 155

Aspirin + IVIG

Question 156

Kawasaki JOOCE - Feared complications?

Answer 156

Coronary vessel aneurysms, MI / cardiac ischemia.

Question 157

When is adrenal gland imaging indicated in newborns?

Answer 157

if you clinically suspect CAH

Question 158

What are some of the effects of maternal estrogen on newborns? Do you need to do anything about it?

Answer 158

Effects: breast hypertrophy (in both males and females), swollen labia, mild uterine bleeding, leukorrhea. This is benign and will resolve on its own -> no further w/u or tx is necessary.

Question 159

Does IBD ONLY affect ppl who are around the 20’s?

Answer 159

I mean, although it presents USUALLY around that time, there’s apparently a bimodal distribution, with that second peak peaking around age 60 as well. BEWARE.

Question 160

Malignant otitis externa! Can you tell me what its causative bug typically and what its risk factors are?

Answer 160

Causative bug: Pseudomonas

Question 161

How is number needed to treat defined? How is it mathematically defined?

Answer 161

NNT = # of ppl that need to receive tx to prevent ONE adverse event.

Question 162

How do you differentiate Hep A from the other hepatitis viruses clinically?

Answer 162

Its mode of onset, associated risk factors, etc. Since Hep A is fecal-oral, its onset is more acute than Hep B or C.

Question 163

What happens when you see a confidence interval include “1” in its range (ex: CI = 0.8-3.0), what should you think?

Answer 163

That the null hypothesis is true. Since the CI includes the null value, (RR = 1.0), the outcome is considered statistically insignificant.

Question 164

What is the relationship btwn the range of the confidence interval and sample size?

Answer 164

Lower range of CI = higher sample size.

Question 165

How do you characterize dermatomyositis? What is it associated w/?

Answer 165

It’s characterized by muscle weakness and various skin findings. ~15% of these pts have an underlying malignancy.

Question 166

What is the DoC for hairy cell leukemia?

Answer 166

Cladribine

Question 167

What is the go-to regimen for CLL?

Answer 167

Chlorambucil and prednisone

Question 168

Why are ppl with h/o opiate abuse given morphine, when they are in the hospital in a lot of pain?

Answer 168

Undertx of pain leads to higher chance of relapse, longer hospitalizations, and ‘patient dissatisfaction’

Question 169

What are some medical situations you MUST avoid in pts who have a right sided ventricular infarct?

Answer 169

Since their R ventricle has failed, they now have a lot more trouble maintaining preload. Therefore, avoid drugs that decrease preload, i.e., nitrates, diuretics.

Question 170

When would you do Holter monitoring?

Answer 170

IFF the arrythmia itself is causing sx’s!

Question 171

What are the MC presentations for neonatal sepsis?

Answer 171

High or low temp, poor feeding, irritable/lethargic baby

Question 172

What risk factors is associated w/ jejunal atresia? What would you find on ab XR?

Answer 172

it’s associated w/ vasoconstrictive drug use during preg (i.e., cocaine). You’ll see a ‘triple bubble sign’ on ab XR.

Question 173

Which of the diabetes drugs is associated w/ wt loss?

Answer 173

Your GLP-1 agonists (glucagon-like peptide agonists), i.e., exenatide. POOP

Question 174

What are the indications for using clozapine?

Answer 174

Tx-resistant SCZ, SCZ assoc w/ suicidality.

Question 175

3 things are necessary for the dx of DKA. What are they?

Answer 175

1) RBG > 250 mg/dL

Question 176

Which cardiac murmur is associated w/ an opening snap?

Answer 176

MS! (I said AS lol. REKT)

Question 177

What is spondylolisthesis?

Answer 177

A forward slippage of vertebrae 2/2 some kind of congenital reason. Typically affects children.

Question 178

How do you differentiate LoC from seizures vs vasovagal?

Answer 178

Seizures -> delayed return of mental status

Question 179

When is D&C indicated in pts who are having an inevitable abortion?

Answer 179

When they are hemodynamically unstable

Question 180

When is expectant mgmt appropriate in pts who are having an inevitable abortion?

Answer 180

If they’re stable clinically, and if they desire to avoid medical / surgical mgmt.

Question 181

What kind of murmur would you hear in pts w/ aortic stenosis?

Answer 181

Systolic murmur best heard at R 2nd intercostal space with radiation to apex and carotids.

Question 182

What are the benefits from controlling HbA1C to

Answer 182

Decreased microvascular complications.

Question 183

2) Inc deposition of poorly mineralized osteoid

Answer 183

1 = osteitis deformans / Pagets dz

Question 184

How do you differentiate btwn esophagitis 2/2 herpex simplex vs cytomegalovirus?

Answer 184

Herpex simplex esophagitis - assoc w/ vesicles and round or oval shaped ulcers.

Question 185

Sepsis in adults vs neonatal sepsis – differences?

Answer 185

Sx’s in neonates in context of sepsis = more nonspecific

Question 186

Pt presents w/ breast milk jaundice. What to do?

Answer 186

Nothing really. The elevated bili that’s associated w/ this doesn’t really require intervention.

Question 187

If you see a CXR of a person with acute cardiac tamponade 2/2 an MVA, what would you find?

Answer 187

Nothing really remarkable.

Question 188

What is the MCC of lower GI bleeds in the elderly?

Answer 188

Diverticulosis!

Question 189

What are the main differences btwn these pneumococcal vaccines: PPSV23 and PCV13?

Answer 189

PPSV23 = polysacc only. No conjugate -> no T cell response -> no memory B’s. Not as effective in elderly (>65 y/o) and in young children.

Question 190

When are PPSV23 and / or PCV13 administered?

Answer 190

• Administer PPSV23 in adults

Question 191

What is lichens sclerosis, and what is it associated w/?

Answer 191

It’s thought to be some kind of autoimmune dz that presents with vulvar pruritis and discomfort. B/c of the inflammation, sclerosis to nearby structures can occur. It’s assoc w/ SCC of the vulva.

Question 192

Babesiosis vs Ehrlichiosis – can I has ze jooce?

Answer 192

Babesiosis - xmitted by Ixodes tick, presents with fever, jaundice, hemolysis, thrombocytopenia. Rash is typically not seen, except in severe illness

Question 193

When are paps started?

Answer 193

At age 21, regardless of sexual activity. However, for the immunocompromised, start Paps at the onset of sex

Question 194

What is bronchiolitis / how does it present? What’s its feared complication?

Answer 194

It’s a resp infection typically caused by RSV. In neonates, it presents like a typical viral resp infxn + wheezes, crackles, signs of resp distress. Feared complication = respiratory failure + apnea

Question 195

How does beta blockers work on the heart (in general)?

Answer 195

Dec’s HR and elongates diastole.

Question 196

What is the cosyntropin test exactly?

Answer 196

Cosyntropin’s an ACTH synthetic analog that helps measure cortisol within an hour as opposed to waiting for a couple of days for ACTH to come back.

Question 197

How do you tell the difference btwn HSV retinitis and CMV retinitis?

Answer 197

HSV retinitis presents with eye pain, keratitis, conjuctivitis, and its characteristic fundoscopic findings that I can’t give two owl pellets about.

Question 198

How do you differentiate btwn a consolidation process vs a pleural effusion?

Answer 198

There’s a difference?! PogChamp – YEP

Question 199

So..someone comes in w/ acute coke intoxication. What are the initial steps in mgmt? Why do those initial steps?

Answer 199

Give supplemental O2 and benzos. Why O2? No idea. But the idea behind giving said person benzos = dec anxiety and agitation, dec heart rate, improve CVS sx’s. Also give aspirin (slow platelet aggregation), and vasodilators like CCB’s and nitrates.

Question 200

Which drug do you NOT give someone who has acute coke intoxication? Why?

Answer 200

Do NOT give that person beta blockers. Unopposed alpha activity will worsen the coronary vasoconstriction.

Question 201

How do you differentiate btwn asymmetrical and symmetrical IUGR from the baby’? How do you differentiate btwn the two from an etiological perspective?

Answer 201

Asymmetrical = head is normal in size. Everything else is small. Caused by maternal vascular compromise (i.e., HTN, autoimmune dz, cocaine/tobacco abuse, etc)

Question 202

What are the contraindications for the rotavirus vaccine?

Answer 202

anaphylaxis, h/o intusseption, h/o untreated congenital GI abnormalities, SCID.

Question 203

Why do we give the rotavirus vaccine anyway?

Answer 203

Rotavirus is notorious for causing gastroenteritis in young children, and presents with fever, vomiting, and osmotic watery diarrhea, which leads to dehydration, and subsequent admission to the hospital. This vaccine dramatically decreased the rates of hospital admissions and deaths.

Question 204

How are CI and precision related?

Answer 204

Smaller CI range = more precision. Remember that a larger sample size helps with this as well.

Question 205

Someone presents w/ s/sx of pheo. You give that person propanolol, thinking that decreasing their sympathetic activity would help. Why is propranolol absolute taint in this case?

Answer 205

Propranolol = B-Blocker -> unopposed alpha activity -> vasoconstriction -> BP GOES HIGHER

Question 206

So..it seems like cellulitis and erypsipelas are pretty similar. How do you differentiate them?

Answer 206

Cellulitis involves skin AND subQ tissue.

Question 207

What are the s/sx of mag sulfate tox?

Answer 207

1) depressed DTR (f/ NMJ blockade)

Question 208

Which medication contains cyanide?

Answer 208

Sodium nitroprusside. NOT hydralazine. OOPTH

Question 209

Which skin lesion is thought to be a precursor for SCC of the skin?

Answer 209

Actinic keratosis.

Question 210

What is SCID caused by?

Answer 210

adenosine deaminase deficiency

Question 211

What is the idea behind relieving sx’s in hemo-stable WPW pts?

Answer 211

Pathophys behind WPW = a bunch of extra taint circuits firing around the AV node. Signals from these accessory circuits bypass the AV node, which makes AV node blocking meds like b-blockers, digoxin, CCB’s, and adenosine absolutely taint for WPW.

Question 212

What’s the breakdown for the bugs responsible for causing acute bacterial sinusitis?

Answer 212

Strep pneumo (~30%), H. flu (~30%), others (40%)

Question 213

How does crytococcal meningitis present?

Answer 213

Headache, fever, malaise. All sx’s are subacute in nature. You won’t really see that typical nuchal rigidity in these pts!

Question 214

Immunosuppressant therapy SE profile jooce - Tacrolimus!

Answer 214

Unlike cyclosporine, it doesn’t cause gum hypertrophy or hirsuitism. It has a higher incidence of neurotox, diarrhea, glc intolerance. But otherwise, the SE profiles for both cyclosporine and tacrolimus are pretty similar eh.

Question 215

Immunosuppressant therapy SE profile jooce - cyclosporine!

Answer 215

nephrotox, HTN, neurotox, glc intolerance, infection, malignancy, GI sx’s, GUM HYPERTROPHY, HIRSUITISM

Question 216

Immunosuppressant therapy SE profile jooce - azathioprine!

Answer 216

dose-related leukopenia, diarrhea, hepatotox

Question 217

Immunosuppressant therapy SE profile jooce - mycophenidate!

Answer 217

BM supression

Question 218

What are the different types of EPS? For the EPS’s that can be treated, what can you treat them with?

Answer 218

acute dystonic rxns, akathisia (subjective restlessness), parkisonism, tardive dyskinesia. For the EPS rxns you can treat (the first 2 listed), use anti-Ach’s like benztropine.

Question 219

Is glioblastoma multiforme common in children?

Answer 219

Nope! They are more common in the elderly.

Question 220

What is Meniere’s dz?

Answer 220

It’s a dz that involves dilatation of the endolymphic compartment of the inner ear.

Question 221

What are the nonpharm appropaches to treating Meniere’s dz?

Answer 221

Minimize endolymph retention by restricting caffeine, alcohol, high salt diet, and nicotine.

Question 222

What are the clinical manifestations of PNH?

Answer 222

1) hemolysis -> hematuria

Question 223

What’s the proposed pathophys behind the pruritis and flushing that we see with niacin use?

Answer 223

Prostaglandin induced vasodilatation. That’s why we give ppl aspirin w/ niacin to decrease the chances of this happening!

Question 224

What are the complications for babies who are ‘small for gestational age’?

Answer 224

Hypoxia (often resulting in polycythemia), hypoglycemia (2/2 dec glycogen stores), hypothermia (2/2 dec amt of subQ fat), hypocalcemia (2/2 dec xfer of Ca across placenta)

Question 225

Hokay, so…we all know that doing routine CBC’s in ppl on PTU = taint. How do we management and look out for potential agranulocytosis?

Answer 225

Stop PTU on the first signs of fever and sore throat, and then check CBC.

Question 226

Which micronutrient is breastmilk deficient in?

Answer 226

Vit D

Question 227

When are preggo ladies tested for glc intolerance?

Answer 227

24-28 weeks. Go earlier if pt has risk factors.

Question 228

When you suspect someone with tension pneumothorax (and also in resp distress), what do you first–intubation or needle thoracostomy? And why?

Answer 228

Needle thoracostomy. If you intubate first, you’ll most likely worsen the pnemothorax cuz of dat PEEP. The sedation with intubation can also worsen the hypotension.

Question 229

When would you choose valproic acid over lithium when tx’ing bipolar d/o?

Answer 229

if pt has renal dysfxn

Question 230

So..you have a hemodynamically unstable pt who had an MVA and has s/sx suggesting blunt ab trauma. The FAST exam comes back inconclusive. What do you do? Ex-lap? Peritoneal lavage?

Answer 230

See if there’s blood in the peritoneum w/ a peritoneal lavage first. If it shows >10 mL of blood. intraperitoneal injury is likely -> therefore lap.

Question 231

Gastric lavages are rarely done. But when they are done, when are they a viable option, in the context of an acute toxic ingestion of some sort?

Answer 231

Gotta do the lavage within 2 hours of ingestion. If you start at 1 hr post-ingestion, you’d only be able to remove about 50%. If you start at 2 hrs post-ingestion, you could only remove about 15%.

Question 232

When are gastric lavages CI’d? And why?

Answer 232

1) caustic ingestions (of an acidic/basic substance) -> risk dmg to oropharynx and esophagus

Question 233

When do you give N-acetylcysteine as an antidote to acetaminophen tox?

Answer 233

If >8-10 g have been ingested in the past 24 hrs or less

Question 234

If the person ingested a toxic amount of Tylenol 25 hrs ago, what therapy do you give him/her?

Answer 234

Nothing. If the person OD’d on Tylenol more than 24 hrs prior to presentation, all known modalities of therapy will be useless/pointless at that point.

Question 235

How does aspirin OD present?

Answer 235

Tinnitis, hyperventilation, renal tox, AMS, inc AG. It will initially present as respiratory alkalosis, and then progress to a metabolic acidosis, as lactate starts to build up f/ aspirin’s inhibition of ox-phos.

Question 236

How do you tx aspirin OD? How does dat said tx modality work?

Answer 236

ALKAIZER ZE URINE (aka alkalize with NaHCO3). This effectively increases ze rate of aspirin excretion.

Question 237

How does TCA tox present?

Answer 237

Anti-Ach sx’s, seizures, arrythmia (f/ QRS widening)

Question 238

How do you tx TCA tox? How does dat said tx modality work?

Answer 238

NaHCO3. This doesn’t increase the rate of TCA excretion, but it protects the heart from arrythmias.

Question 239

How does nerve gas work?

Answer 239

It inhibits Ach metabolism

Question 240

What precipitates digoxin tox? Why is that so?

Answer 240

HypoK precipitates digoxin tox. K and digoxin compete for the same Na/K-ATPase pump thing. Less K means more ‘chances’ for digoxin to bind to dat ATPase.

Question 241

How does digoxin tox present?

Answer 241

HyperK, AMS, visual disturbances, arrythmia

Question 242

Methanol vs ethylene glycol ingestion–how do you differentiate?

Answer 242

Metabolism of methanol yields formaldehyde. Ethylene glycol yields oxalate. Formaldehyde is toxic to eyes. Oxalate is toxic to kidneys.

Question 243

How do you tx methanol and ethylene glycol tox?

Answer 243

Tx is same for both. Give fomeprizole (alcohol-DH blocker) as initial tx to prevent further metabolism of methanol/ethylene glycol, and then dialyze to remove the toxins.

Question 244

What is CO2’s effect on cerebral vasculature?

Answer 244

High CO2 leads to cerebral vasodilatation

Question 245

How do you differentiate btwn Mobitz I (Weckenbach) and II (Mobitz)?

Answer 245

Mobitz I - progress lengthening of PR interval -> QRS drop. Lesion is at the AV node

Question 246

What two cardiac defects are associated w/ Turner’s?

Answer 246

Coarctation of aorta, bicuspid aortic valve.

Question 247

What is PANDAS?

Answer 247

Not the cutie pitootie bear. It stands for “Pediac Autoimmune Neuropsychiatric Disorders Associated w/ Strep infxns”. Kids can get an acute onset OCD or w/e after a strep infxn. Tx is same.

Question 248

What are the various consequences of fetal hyperglycemia?

Answer 248

1) higher metabolic demand -> placenta can’t keep up -> fetal hypoxia -> polycythemia

Question 249

What is vasa previa?

Answer 249

A condition in which the fetus’s blood vessels are lyin’ around the fetus’s head, uncovered by the umbilical cord. You can imagine how vulnerable those vessels would be, esp during labor.

Question 250

How does vasa previa present?

Answer 250

Painless vaginal bleeding for mom at the onset of ROM. Baby will present initially with tachy, then brady, then a sinusoidal patern.

Question 251

How is vasa previa dx’d and tx’d?

Answer 251

Tx w/ ab and xvaginal US’s. Once you see it, offer C-section. If you catch this while the pt is in labor, do an emergency C-section.

Question 252

How does placentia previa present?

Answer 252

Painless antepartum hemorrhage. Baby will be stable, provided he/she doesn’t have anything else going on.

Question 253

How do you differentiate btwn simple vs strangulated SBO?

Answer 253

Simple won’t present w/ peritoneal signs (rebound, rigidity). Strangulated will doe.

Question 254

What’s the w/u for acquired torticollis?

Answer 254

Get a cervical XR to r/o cervical spine fx or dislocations. Get a good hx to evaluate possible underlying etiologies (i.e., URI’s, minor trauma, cervical lymphadenitis)

Question 255

When you suspect someone w/ septic arthritis, do you give abx prior to or after doing the arthrocentesis? Why?

Answer 255

Tapping the joint is both diagnostic and therapeutic.

Question 256

What is fibrodysplasia?

Answer 256

It’s a nonatherosclerotic noninflammatory condition that involves abnormal growth in vessel walls. It’s a rare dz, and it typically occurs in children.

Question 257

How does fibrodysplasia present?

Answer 257

New onset HTN in children. You’ll be able to hear bruits and stuff at the CVA. When you angiogram these kids, you’ll typically see a ‘string o’ beads’ pattern.

Question 258

What are the similarities and differences btwn the two sample t-test and the two sample z-test

Answer 258

Similarities: Both of these tests are used to compare two means.

Question 259

When is ANOVA (analysis of variance) used?

Answer 259

It’s used to compare 3+ sets of means.

Question 260

What is the chi-square test / when is it used?

Answer 260

When you want to see whether a categorized outcome is due to chance, or due to an actual legit association. Ex: You do a study that examines whether HRT exposure is associated w/ elevated CRP lvls -> make a table of some sort that tells us our observed values in each category (i.e., no HRT exposure & elevated CRP, yes exposure & elevated lvls, etc) -> compare observed values to the null hypothesis (there is no association btwn HRT exposure and CRP lvls) -> chi-square test BOOM

Question 261

For acute aortic dissections, what’s the most appropriate medical intervention? Why?

Answer 261

Beta blockers with both alpha and beta blockade (i.e., labetalol). Lowering both BP and HR help decrease the stress on the aortic wall.

Question 262

How do you differentiate btwn PSVT and SMVT (sustained monomorphic VT)?

Answer 262

PSVT - won’t have AV dissociations and/or fusion beats

Question 263

What are fusion beats?

Answer 263

a hybrid of a wide and narrow QRS complex

Question 264

What are the tx approaches to SMVT?

Answer 264

If hemo stable, give IV amio

Question 265

Can you gives me ze typhoid fever jooce?

Answer 265

It’s caused by salmonella typhi. It presents w/ a fever, ‘salmon rose spots’, GI sx’s, and bradycardia

Question 266

What are the similarities and differences btwn malaria and dengue fever?

Answer 266

Similarities: Both will present with myalgias and fever.

Question 267

What are things that you’ll see in CD that you won’t ever see in UC?

Answer 267

Skip lesions, transmural involvement of colon, fistulas, fissures, and noncaseating granulomas (only in ~1/2 of CD cases tho)

Question 268

What can clindamycin cover and not cover?

Answer 268

Covers: gm +’s, anaerobes.

Question 269

What can Bactrim cover and not cover?

Answer 269

Covers: staph, most strep, gm-, H. flu, PCP

Question 270

Unilat cervical lymphadenitis is most commonly caused by which bugs?

Answer 270

S. aureus (more commonly) and strep pyo

Question 271

When you suspect someone to have SCC of the H + N, especially when they have risk factors (smoking, alcohol use) that predispose them to have this SCC, what’s the best initial step?

Answer 271

Panendoscopy, AKA 3-part endoscopy, which consists of a bronch, endoscopy, and laryngoscopy.

Question 272

What’re the differences btwn Rinne’s test and Weber’s test, at least from their practical standpoint?

Answer 272

Rinne’s tests conductive hearing (external ear, middle ear)

Question 273

In the Rinne’s and Weber’s tests, why do we do a comparison btwn air conduction and bone conduction?

Answer 273

Air conduction tests for conductive hearing.

Question 274

If someone presents to you with unilateral conductive hearing loss of the L ear, what would be your findings on the Weber’s and Rinne’s tests? Why?

Answer 274

Rinne’s: BC > AC (suggesting conductive hearing loss)

Question 275

Ototoxic abx like aminoglycosides cause which kind of hearing loss?

Answer 275

Conductive hearing loss via otosclerosis.

Question 276

What are the ‘modifiable risk factors’ for osteoporosis?

Answer 276

Low estrogen, low vit D, dec calcium, malnutrition, meds, immobility, cig smoking, excessive EtOH consumption

Question 277

What’s another name for periorbital cellulitis?

Answer 277

Preseptal cellulitis

Question 278

Does a ruptured berry aneurysm present with focal neurological signs?

Answer 278

Not really.

Question 279

What’s another name for Pick’s dz?

Answer 279

Frontotemporal dementia

Question 280

Is PEA a shockable rhythm?

Answer 280

Nope.

Question 281

What is ‘melanosis coli’?

Answer 281

It’s a bx finding characterized by a brown discoloration of the colon + lymph follicles shining through as pale patches. It’s a finding associated w/ laxative abuse.

Question 282

Can you see vit D deficiency in ppl w/ nephrotic syndrome? If so, why/why not?

Answer 282

Yes. The loss of protein in urine = loss of cholecalciferol binding protein = low vit D in body

Question 283

Are fluoroquinolones C/I’d in pregnancy? If so, what are the effects?

Answer 283

C/I’d in pregnancy. Usage during preg is associated with bone deformities and joint issues in the fetus.

Question 284

Is amoxicillin C/I’d in pregnancy? If so, what are the effects?

Answer 284

Amoxicillin is relatively safe for preg pts.

Question 285

A kid is born at whatever weeks gestation at 8 lbs with a ht of 20 in. 1 yr later, kid is at 16 lbs with a ht of 24 in. Is this kid on the right growth track?

Answer 285

Nope. Normal growth at 1 yr = TRIPLE kid’s wt & inc ht by 50%. The kid doesn’t meet these two criteria for ‘normal growth rate’

Question 286

What are the risk factors for Hep C infxn?

Answer 286

IV drug use, workplace exposure, getting transfusions or transplants before 1992. (donated blood + organs weren’t routinely screened in the US before ‘92)

Question 287

How do you differentiate btwn chronic HTN, gestational HTN, and preeclampsia?

Answer 287

chronic HTN - onset

Question 288

What are some major features of homocysteinuria?

Answer 288

Thrombosis, marfanoid features, developmental delays, fair skin + eyes.

Question 289

Are low-grade fever, leukocytosis, and chills normal during the first 24 hr postpartum period?

Answer 289

If there is no smelly vag discharge, then yep. It’s normal.

Question 290

What are anti-CCP ab’s associated w/?

Answer 290

RA.

Question 291

How do you distinguish btwn central Bell’s Palsy and peripheral Bell’s Palsy?

Answer 291

central Bell’s - forehead muscles are preserved

Question 292

What are the go-to modalities of tx for Raynaud’s?

Answer 292

CCB’s and avoidance of aggravating factors.

Question 293

Which antihypertensive meds are used in Raynaud’s?

Answer 293

CCB’s only. The other types are absolutely useless for Raynaud’s.

Question 294

What are the indications for giving corticosteroids w/ abx in the context of a pulmonary infxn?

Answer 294

If pt’s PaO2 35.

Question 295

How do you differentiate btwn Waldenstrom’s macroglobulinemia, MM, and MGUS?

Answer 295

Waldenstrom’s = IgM spike -> thickening of blood

Question 296

Which live vaccines can you give to a pt with HIV? Are there any criteria these HIV pts should meet (besides the obv one of ‘they’re not immunized yet’? And if so, what are they?

Answer 296

MMR, varicella, and zoster vacc’s can be given. Give it to pts who have CD4 counts > 200 and if there’s no evidence of an AIDS type illness.

Question 297

What is pulsus paradoxicus? And what does this finding suggest?

Answer 297

A decrease of BP by more than 10 mm Hg on inspiration. Inspiration inc’s venous return and drops BP a little, but not 10+ pts. This finding classically suggests cardiac tamponade. Once the pericardial fluid hits that >250cc mark, the RV and LV will start to ‘compete for space’; that is, one will expand at the cost of the other.

Question 298

What is the Kussmaul sign? And what does this finding suggest?

Answer 298

An inc in JVP on inhalation. Normally, JVP stays / drops on inhalation. This finding suggests some kind of RHF type situation.

Question 299

What’s the most serious S/E for -quine drugs?

Answer 299

Retinopathy.

Question 300

What is the definition of an ‘idiosyncratic drug reaction’?

Answer 300

A rare and unpredictable drug rxn.

Question 301

What’s the difference btwn colloid sol’ns and crystalloid sol’ns?

Answer 301

colloid = crystalloid + some substance that prevents it from passing through a semipermeable membrane (i.e., albumin)

Question 302

How does macular degen usually present?

Answer 302

Progressive and bilat central vision loss. Peripheral vision is usually spared.

Question 303

How does open angle glaucoma usually present?

Answer 303

Progressive and gradual loss of peripheral vision -> tunnel vision. Central vision is spared.

Question 304

How does inadequately controlled post op pain contribute to development of atelectasis?

Answer 304

Inadequate pain control -> weakened cough + shallow breathing

Question 305

When do you hospitalize an anorexic?

Answer 305

When they present with unstable vitals and metabolic derangements.

Question 306

Is there a difference in how you tx anorexia and bulimia? If so, what’re the differences?

Answer 306

Anorexia: Olanzapine, if nonpharm approaches fail

Question 307

What’s an important S/E of buproprion? Who shouldn’t use this drug?

Answer 307

It lowers the seizure threshold. Therefore, ppl w/ seizure d/o’s or any predispositions to getting seizures (i.e., eating d/o’s, concurrent EtOH or benzo use) should avoid this med like the plague.

Question 308

What is an acrochordon?

Answer 308

A skin tag.

Question 309

Which vaccines are C/I’d in pregnancy?

Answer 309

MMR, varicella

Question 310

What factors decrease or increase the risk of fetal respiratory distress syndrome?

Answer 310

Things that decrease risk = intrauterine stressors, i.e., IUGR, maternal HTN, PPROM

Question 311

What’s Osgood-Schlatter’s disease? Why does it happen?

Answer 311

It’s a traction apophysitis of the tibial tubercle. Teens, as they are going through their growth spurts, have a lot of stress where the quads insert in the tibial tubercle. Activities that involve repetitive jumping and stuff’ll make this worse.

Question 312

Which micronutrient does phenytoin deplete? How does it do this?

Answer 312

It depletes folic acid by messing with its absorption.

Question 313

How do you differentiate btwn otosclerosis and presbycusis?

Answer 313

Otosclerosis: conductive hearing loss, onset typically around middle age.

Question 314

What ab’s would you find in someone w/ antiphospholipid syndrome?

Answer 314

Anti-cardiolipin Ab’s.

Question 315

Why do you see hypoCa in ppl w/ tumor lysis syndrome?

Answer 315

The high amts of phos flying around binds to Ca.

Question 316

What kind of murmur would you hear in a pt w/ HOCM?

Answer 316

A crescendo-descrendo systolic murmur that intensifies when preload lowering maneuvers are administered. This murmur is typically from an abnormality in the motion of the mitral valve leaflets (AKA systolic anterior motion) -> contributes to obstruction

Question 317

What’s the most common complication of PUD?

Answer 317

Hemorrhage.

Question 318

How do cholesteatomas present?

Answer 318

Chronic ear drainage, despite adequate abx therapy, new-onset hearing loss. Exam typically shows skin debris and granulation tissue within retraction pockets in tympanic membranes.

Question 319

Which coronary artery supplies the vast majority of the blood supply for the SA node, AV node, and the His bundle?

Answer 319

RCA

Question 320

What’s a systematic approach of reading EKG’s that you can use?

Answer 320

1) Rate

Question 321

If a baby dies in utero, when do you induce labor?

Answer 321

Mainly if you suspect s/sx of coagulopathy in the mother. If the pt doesn’t have coagulopathy, you can either induce or ‘let them do what they want’, as dead babies will get spontaneously delivered either way.

Question 322

What is the Potter sequence?

Answer 322

Baby has taint UT -> baby can’t pee well -> oligohydramnios -> pulmonary hypoplasia + flat faces + limb deformities

Question 323

Can you gives me some basics on Wilms’ tumor?

Answer 323

It’s the MC kidney malignancy in childhood. It presents around 2-5 y/o age w/ a palpable mass.

Question 324

HIV+ person has a PPD of 6mm and has an unremarkable CXR. Next step in mgmt?

Answer 324

Isoniazid + pyridoxine for 9 mo

Question 325

HIV+ person has a PPD of 6mm and has CXR findings suggesting an active TB infx. Next step in mgmt?

Answer 325

Combo of 3-4 anti-TB drugs

Question 326

For pts with flu, how do you guide therapy?

Answer 326

If pt has had sx’s > 48 hrs, give supportive tx. Treat with appropriate antivirals if pt had sx’s for 48 hrs of sx and doesn’t improve w/ supportive therapy

Question 327

Can infants present with thryotoxicosis, despite adequate tx of Graves’ in mom?

Answer 327

Yep. Said infants are at 5x risk of having this. It goes away after a few months and babies are typically given methimazole + a BB in the interim.

Question 328

When is Mohs surgery used?

Answer 328

For BCC on face

Question 329

Psalms 75:25-26?

Answer 329

Whom have I in heaven but you? And there is nothing on earth that I desire besides you. My flesh and my heart may fail, but God is the strength of my heart and my portion forever

Question 330

What is capsule endoscopy used to examine?

Answer 330

ze small bowel!

Question 331

Where is the anseline bursa located?

Answer 331

anteromedially over the tibial plateau, just below the knee joint.

Question 332

What are the hemodynamic effects of thyrotoxicosis?

Answer 332

1) elevated systolic BP & widened pulse pressure

Question 333

How does T3 influence beta adernergic activity? Does it have any effect on the actual amount of catecholamines in the body?

Answer 333

It helps increase the sensitivity + # of beta adrenergic receptors expressed, but has absolutely NO effect on the amount of catechol’s in the body.

Question 334

What is the pathophys behind warfarin-induced necrosis?

Answer 334

Protein C levels go down faster than the other vit-K dependent clotting factors and such, especially during the first few days of warfarin therapy. This is why people with protein C deficiency are at risk of developing this as well.

Question 335

What’s the most common underlying arrythmia that’s responsible for sudden cardiac arrest?

Answer 335

Reentrant ventricular arrythmias

Question 336

What’s the difference btwn treatment of DVT and PE, given high clinical suspicion for both?

Answer 336

If you highly suspect DVT, do U/S

Question 337

So, you have someone come in for a mild TBI. Said person had like, seconds of LoC, and is stable mentally and physically on exam. You think “oh, gotta watch out for possible concussion”. You know ordering a CT without contrast to r/o any kind of brain bleeds is the way to go, but what’s another viable option for this clinical scenario?

Answer 337

Observation for 4-6 hrs.

Question 338

Does everyone who has celiac dz come back (+) for IgA anti-tissue transglutaminase Ab’s?

Answer 338

Nope, especially when they have an underlying IgA deficiency!

Question 339

Do benign teratomas have any elevated tumor markers?

Answer 339

NOPE. Actually, if the tests come back w/ elevated tumor markers, suspect a malignant teratoma.

Question 340

There’s a ‘standard’ approach to ‘breaking bad news’ to pts. What is this approach called? Givez me its basic jooce?

Answer 340

SPIKES

Question 341

What is an anoscope? When is it used?

Answer 341

An anal speculum. You use it when people under

Question 342

For pts who have AFib, they most likely have ectopic foci and stuff where?

Answer 342

In ze pulmonary veinz

Question 343

For pts who have AFlutter, they most likely have taint circuitry where?

Answer 343

In the tricuscpid area.

Question 344

So, a kid swallows a battery. What do you do?

Answer 344

It depends on where the battery is when you find it on imaging. If it’s past the esophagus, just let it pass. If it’s in the esophagus, get it out with via endoscopy.

Question 345

What hormone does prolactin suppress?

Answer 345

GnRH

Question 346

What does Steve Nash have a risk of developing over time?

Answer 346

Vertebral fx’s 2/2 rigidity + dec bone density

Question 347

Why would someone w/ ankylosing spondylitis be at an inc risk of developing osteopenia / osteoporosis?

Answer 347

Ank spondylitis is a chronic inflammatory condition that’s mediated by TNF-alpha & IL-6. I believe these inflammatory markers increase osteoclast activity

Question 348

What consists of the ‘red flags’ in low back pain? What etiologies should I think of when I see these ‘red flags’ in someone w/ low back pain?

Answer 348

Red flags = Age > 50, nighttime pain, constitutional sx’s (i.e., unintentional weight loss, fever), h/o malignancy, trauma, h/o IV drug use, infection risk, >1 mo w/out any improvements.

Question 349

Can you use plain back XR’s to look for lytic lesions and compression fx’s.

Answer 349

Oh yeah most defs. Think about it!

Question 350

If I see someone w/ a h/o familial colonic polyposis, what’s their risk of developing colon ca? How do I manage this pt?

Answer 350

Risk = 100%. Currently, the only effective method for surveillance / mgmt is a procto-colectomy. Other conservative surveillance measures, i.e., FOBT’s, regular colonoscopies, and CEA have been tried, but showed completely taint results.

Question 351

Diarrhea in HIV (+) people is caused by which organisms?

Answer 351

There’s a whole bloody range of organisms. Here’s a list of some of them: Salmonella, Shigella, Campylobacter, C. diff, Giardia, Crytospordium, MAI, cytomegalovirus

Question 352

When I see someone with h/o HIV and comes in w/ diarrhea, what do I do initially? Why that initial step?

Answer 352

Since there’s a wide range of diff organisms that can cause diarrhea in HIV infected people, you’d first sample the stool for ova and parasites, and check for C. diff. Empirically treating these people with various antimicrobial drugs would be pointless and unwise; it’d be pretty much akin to shooting in the dark, really.

Question 353

How is LVH dx’d on EKG?

Answer 353

The sum of the S wave n V1 and R wave in V5 > 35 mm or 7 big boxes, LAD w/ slightly widened QRS, R wave in aVL > 12mm

Question 354

How is RVH dx’d on EKG?

Answer 354

RAD w/ slightly widened QRS, persistence of S wave in V5, V6, R wave > S wave in V1 (R wave gets progressively smaller)

Question 355

How do you define a ‘significant Q wave’ (one that suggests past infarction) on EKG?

Answer 355

Q wave is either 1 small box in wide OR is 1/3 of the QRS’s amplitude

Question 356

How do you dx RBBB vs LBBB on the chest leads?

Answer 356

If R-R’ complex is on V1, V2, dx RBBB.

Question 357

How does the presence of an LBBB affect the dx of a possible infarction?

Answer 357

The presence of LBBB (with the exception of maybe a septal infarct), makes the dx of an infarct unreliable. Think about it! The EKG can’t tell if the signal can’t go through b/c of dead tissue, or if there’s something intrinsically wrong somewhere in the heart’s conduction system.

Question 358

What is the role of hyperventilation in EEG’s?

Answer 358

It helps illicit interictal epileptiform discharges, which then in turn helps distinguish the various seizure d/o’s

Question 359

Complex partial VS typical absence VS atypical absence

Answer 359

They all present pretty similarly; they all last for a brief time, come with impaired consciousness, automatisms (lip smacking, picking mvmts of hand, etc). But to differentiate them? Here’z ze jooce:

Question 360

What’s another name for head lice?

Answer 360

Pediculus humanis capitis

Question 361

When you see someone develop an anaphylactic rxn f/ a blood xfusion, what does that person probably have?

Answer 361

IgA deficiency. To avoid this in the future, this person should get IgA deficient plasma and pre-washed RBC’s.

Question 362

What’s the difference btwn inheritance patterns in kids with Angelman’s vs Prader-Willi.

Answer 362

Angelman - deletion of MATERNAL copy of chromosome 15q11-q13

Question 363

How do you determine whether to do an excisional bx or an excision w/ 1 cm margins on a melanoma-looking lesion?

Answer 363

If dx is not confirmed, do excisional bx. If bx shows 1 mm, then you have’ta do a sentinel LN bx.

Question 364

What is Waterhouse-Friderichen syndrome?

Answer 364

I remember reading about this a while back on Medscape during MS3. If I see an infant w/ meningococcemia, I should watch out for this condition, since it involves rapid vasomotor collapse and skin rash 2/2 adrenal hemorrhage.

Question 365

What’s the difference btwn conversion d/o and somatic sx d/o?

Answer 365

Conversion d/o - an otherwise unexplained neurologic sx (i.e., hemiparesis), often 2/2 an acute stressor (rape)

Question 366

Why do pubertal grills tend to have irregular periods?

Answer 366

Immaturity of the hypothalamic - pituitary - gonadal axis -> not enough jooce to sustain regular periods

Question 367

What’s THE most important thing you can do for someone w/ a septic joint to help prevent long-term morbidity?

Answer 367

DRAIN DAT JOINT to mitigate permanent dmg. Physical therapy is good and all, but it won’t prevent permanent joint destruction for someone in this situation.

Question 368

What’re the differences in the different tx modalities for the 3 different ‘forms’ of vaginitis we all so love?

Answer 368

• Bacterial vaginitis -> Flagyl

Question 369

So..someone shows up in the ER w/ tearing L sided CP and all of that. You strongly suspect aortic dissection as the primary cause of this CP. What’re the next steps you should take?

Answer 369

It depends on the pt’s renal fxn. If it’s good, you have choices btwn either a TEE and a chest CT w/ contrast. If their renal fxn = taint, TEE is the way to go.

Question 370

It’s a given that we use trop-T and CK-MB as our ‘go to cardiac enzymes’ as part of a w/u for an MI and stuff. What’re the advantages and disadvantages of both?

Answer 370

Trop-T is more sensitive and specific than CK-MB for MI, but it goes back to normal lvls after like 10 days or something.

Question 371

What is enthesitis? Where do we see this most commonly?

Answer 371

Enthesitis = inflammation + pain at sites where tendon + ligaments and bone meet.

Question 372

How do you clinically distinguish btwn acute chole and ascending cholangitis?

Answer 372

They both have fever, URQ, and N/V, and all of that, but ascending cholangitis is characterized by Charcot’s Triad (fever, URQ, CRAZY amts of jaundice), and when things go supprative cholangitis, add confusion and hypotension to Charcot’s Triad to make up Reynold’s pentad.

Question 373

How do you tx ascending cholangitis?

Answer 373

Obviously a chole of some kind won’t do jack crap, as this is an infection of the BILIARY TREE. And since it most commonly arises from an obstruction in the biliary tree 2/2 a stone or stricture. something like an ERCP would do the trick (ERCP can clean up the biliary tree and really help the pt out)

Question 374

How do you distinguish btwn steroid-induced acne and primary acne?

Answer 374

Steroid acne won’t have those whiteheads / blackheads (aka comedomes), whereas primary acne has ‘em.

Question 375

How do you distinguish btwn generalized seizures and partial seizures?

Answer 375

Generalized involves both hemispheres of the brain.

Question 376

Simple partial VS Partial w/ generalization VS Complex partial

Answer 376

Simple partial - No LoC

Question 377

Paraneoplastic syndromes in lung cancers = taint. BUT no amount of BabyRage or BibleThump or SwiftRage is going to change the fact that I have to learn them. So, given that, which paraneoplastic syndromes come from which type of lung cancer?

Answer 377

Small cell - ACTH & SIADH

Question 378

What are the tx modalities for managing someone with idiopathic intracranial HTN?

Answer 378

1st line: acetazolamide +/- Lasix

Question 379

What role does mannitol play in someone w/ intracranial HTN?

Answer 379

It’s used when someone has IcH 2/2 cerebral edema, and when someone’s IcP’s are up the wazoo.

Question 380

What’s the generic name for Lovenox?

Answer 380

enoxaparin

Question 381

What are some drugs that we can use to improve sx’s associated w/ gastroparesis?

Answer 381

Metoclopramide, erythromycin

Question 382

What are the EKG findings in someone with WPW?

Answer 382

A short PR interval, widened QRS, and presence of delta waves (aka ‘slurred initial portion of the QRS)

Question 383

So…there are certain CHD’s that are more commonly associated w/ specific trisomies. Which CHD’s are associated w/ trisomy 21? 18?

Answer 383

Trisomy 21 = ASD + endocardial cushion defect

Question 384

What’s the ‘rule of 2’s’ that we talk epidemiology in relation to Meckel’s diverticulum?

Answer 384

2% prevalence

Question 385

What’s the pathophys behind Mecke’s diverticulum?

Answer 385

incomplete obliteration of the fetal vitelline (omphalomesenteric) duct. HAHA I can’t be bothered to learn this /FailFish

Question 386

How does Meckel’s diverticulum present clinically? How do you dx & tx it?

Answer 386

Anywhere f/ no symptoms, painless hematochezia (most common presentation) to intussusception / intestinal obstruction / volvulus. Dx w/ a T-99m scan thingy (AKA Meckel’s scan). Tx w/ surgery if pt is symptomatic.

Question 387

You see and examine a kid, and end up suspecting VSD. What’s the next step in mgmt? Why that step doe?

Answer 387

Do an echo (symptomatic or not), as it’ll help you determine the size of the VSD and help you look out for other possible CHD’s.

Question 388

Broca’s area is located in which lobe?

Answer 388

Dominant frontal lobe.

Question 389

Wernicke’s area is located in which lobe?

Answer 389

Dominant parietal lobe.

Question 390

How do you distinguish btwn the three main types of aphasias?

Answer 390

Broca’s (expressive) aphasia: Broken speech

Question 391

What iz ze rosacea?

Answer 391

Some skin condition that (potentially) involves the hair follicles. It’s characterized by redness over the cheeks, nose, and chin. It’s similar to the butterfly rash typically seen in SLE pts, BUT it differs in that rosacea has pustules, papules, and telengectasias and stuff. Tx w/ metronidazole as initial therapy.

Question 392

Give me ze rundownz on the etiology of small intestinal bowel overgrowth?

Answer 392

Its etiology stems from various anatomical abnormalities, bowel motility d/o’s, amongst others.

Question 393

Psammoma bodies are characteristic of which thyroid cancer?

Answer 393

Papillary ca of thyroid

Question 394

What are the main stages of mental illness? Break them down for me too, plx?

Answer 394

1) acute: tx response (defined as 50% reduction of sx’s -> remission achieved

Question 395

What’re some big differences btwn cherry angiomas and strawberry (capillary hemangiomas)?

Answer 395

Strawberry hemangiomas > cherry angiomas in terms of size. Strawberry hemangiomas appear in infants. Cherry angiomas appear the 3rd-4th decade of life.

Question 396

What are two things you need to really watch out for in clavicular fx’s?

Answer 396

Think about the anatomy–the subclavian artery and parts of the brachial plexus are reeeeeeally close to the clavicle. So when you see someone w/ a collarbone fx, you should do a thorough neuro exam + ausculate the area of the fx (to eval for obv things)

Question 397

WTH is pilondal dz?

Answer 397

It’s an infection of the sacrococcygeal skin and subQ tissue.

Question 398

What are some complications of constipation in young children?

Answer 398

anal fissures, encoparesis, hemorrhoids, enuresis/UTI’s, vomiting

Question 399

How does whooping cough (pertussis) progress in infants and children?

Answer 399

catarrheal (mild cough, rhinitis) -> paroxysmal (cough parosysms w/ ‘whoop’, post-cough vomiting, apnea) -> convalescent (resolving of sx’s)

Question 400

How does acute fatty liver of pregnancy present?

Answer 400

Vague sx’s -> ab pain, N/V -> liver failure

Question 401

How is cirrhosis managed?

Answer 401

Get LFT’s every so often. If person is asymptomatic / has vague sx’s (aka has compensated cirrhosis), manage w/ liver U/S, biannual AFP’s, and periodic endoscopy for variceal surveillance. If person is symptomatic (aka decompensated), assess those symptoms as necessary.

Question 402

Does albumin have a role in treating / managing minimal change dz?

Answer 402

aaaaaaaaaaaabsolutely not. You’re not correcting the underlying cause of minimal change dz, and you might even get the person volume overloaded with this.

Question 403

How do you treat minimal change dz?

Answer 403

corticosteroids.

Question 404

So, you clinically suspect someone to have toxic megacolon. What do you have to do first before you actually make the dx?

Answer 404

You need to get radiological evidence for colonic distention before making the dx.

Question 405

What is salvage therapy?

Answer 405

It’s a form of tx when standard therapy fails.

Question 406

What’s the difference btwn adjuvant therapy and neoadjuvant therapy?

Answer 406

Adjuvant - what’s given as an add-on to standard therapy

Question 407

What are the indications for doing a voiding cystourethrogram?

Answer 407

If you see signs of scarring or hydro on renal U/S

Question 408

So, say someone comes to you with asymptomatic lymphadenopathy. What are the next steps?

Answer 408

Assess size of the LN’s. If it’s 2cm, bx it to check for malignancy or a granulomatous dz.

Question 409

What is ALS characterized by?

Answer 409

The presence of both UMN and LMN signs.

Question 410

What does Prussian blue stain?

Answer 410

Hemosiderin.

Question 411

Febrile nonhemolytic, acute hemolytic, delayed hemolytic, urticarial/allergic, anaphylactic, xfusion-related lung injury

Answer 411

1) febrile nonhemolytic - MCC of immunologic blood xfusion rxn, 2/2 cytokine accumulation during blood storage. Presents w/ fever, chills within hrs of xfusion.

Question 412

What are the common clinical features of carcinoid syndrome?

Answer 412

episodic flushing (can be associated w/ low BP and tachycardia, secretory diarrhea, cutaneous telangiectasias, brochospasm, valvular lesions (more commonly, TR)

Question 413

What is myxomatous valve dz?

Answer 413

A condition that involves weakening of the connective tissue on heart valves. Most commonly affects the mitral valve -> can lead to MVP.

Question 414

What is Ludwig angina? What’s the etiology of this condition?

Answer 414

A rapidly progressive bilat cellulitis of the jaw. It classically arises from an infected 2nd or 3rd mandibular molar.

Question 415

What’s another name for laryngotracheobronchitis?

Answer 415

Croup

Question 416

You see a kid w/ croup in the ER. When you examine him, you suspect that the kid’s respiration’s gonna fail at some imminent point if you don’t do something. What should you try first?

Answer 416

Try racemic epi before you try intubating the kid. The alpha activity of epi is thought to be helpful in this scenario as well (by decreasing bronchial secretions and mucosal edema)

Question 417

How do you differentiate btwn Beckitt-Wiedmann Syndrome and congenital hypothyroidism?

Answer 417

Both will present w/ macroglossia and umbilical hernia. However, unlike congenital hypothyroidism, BWS will also have hemihyperplasia, macrosomia, and hypoglycemia

Question 418

What do you have to watch out for in kids with Beckitt-Wiedmann Syndrome? What can you do for surveillance for said complications or whatever?

Answer 418

These kids are at a high risk of developing Wilms tumor and hepatoblastoma. Use the ab u/s and serial a-FP’s as surveillance tools.

Question 419

Are transudative effusions always bilateral?

Answer 419

Not really. For example, transudative effusions from CHF are bilateral only about 2/3 of the time.

Question 420

Administration of which vitamin has been shown to decrease morbidity and mortality in pts with active measles?

Answer 420

Vit A

Question 421

What’s the physiologic effect of Valsalva maneuvers?

Answer 421

It decreases preload.

Question 422

How does increasing the afterload affect the murmurs heard in pts with HOCM and MVP?

Answer 422

Increase afterload -> make it ‘harder’ for heart to pump blood out -> inc ventricular vol -> dec outflow obstruction -> dec intensity of murmur

Question 423

You suspect gastrinoma in someone, do an endoscopy that further suggest gastrinoma. What do you do next?

Answer 423

Get serum gastrin lvls after stopping PPI therapy for a week. If it’s 1000 pg/mL, check gastric pH. If gastric pH 4, no gastrinoma–can confirm. If gastrin lvls are 100-1k pg/mL, do a secretin stim test. If it’s positive, localize gastrinoma. If neg, no gastrinoma.

Question 424

What’s the thought process behind doing a secretin stim test?

Answer 424

Secretin normally inhibits gastrin secretion. But in the presence of gastrinoma, the gastrinoma be lyke ‘oh, secretrin. IDGAF ABOUT YOU. I KEEP SECRETIN GASTRIN BWAHAHAHAHAAHA’

Question 425

When would you measure HBV lvls in someone?

Answer 425

If the pt has chronic HBV infxn, you would get viral counts to determine their candidacy for antiviral tx.

Question 426

What’s the pathophys behind MPGN type II?

Answer 426

Ab’s activate C3 -> persistent activation of alternate complement pathway -> kidney dmg

Question 427

1 Peter 3:18

Answer 427

For Christ also suffered once for sins, the righteous for the unrighteous, that he might bring us to God, being put to death in the flesh but made alive in the spirit…

Question 428

Why is EtOH consumption considered a nono / risk factor for gout?

Answer 428

Urate and lactate compete for renal excretion. Too much lactate = too much buildup of urate in the body.

Question 429

How do you differentiate acute stress d/o and PTSD?

Answer 429

Amt of time sx’s are present. Acute stress d/o = 3 days - 1 mo. PTSD = 1 mo+

Question 430

What are two questions I should ask myself whenever I’m trying to see whether to recommend a vaccine or not?

Answer 430

1) Can the person handle the vaccine (is there an indication or contraindication for vacc’ing this person with this specific vaccine, i.e., is this person taking any immunosuppresants / immunocompromised?)

Question 431

Give me some acute bronchitis jooce plx?

Answer 431

It’s a common cause of hemoptysis, and is mostly viral in etiology. Pts will typically have a very recent h/o a URI. Observe said person clinically and see if that person improves, or if you need to investigate further (say, for possible PNA, malignancy, chronic lung dz, etc).

Question 432

What do we give to HIV pts to ppx against MAC? When do we give it to them?

Answer 432

ppx w/ arithromycin when their CD4 counts drop to

Question 433

Why are ppl with fat malabsorption at risk of developing kidney stones?

Answer 433

Excess fats in gut binds to Ca++ in gut -> more oxalate absorbed in gut -> Ca-oxalate stones

Question 434

How do you determine which fluids to use initially in pts with hypernatremia?

Answer 434

Assess vol status first. If euvolemic, free water supplementation should suffice. If hypovolemic, assess whether pt is symptomatic. If symptomatic, give NS initially then give D5 as maintenance fluid once pt is euvolemic. If asymptomatic, give D5.

Question 435

Differentiate btwn essential tremor vs Parkisonian tremor plx?

Answer 435

Essential tremor = bilateral action tremor

Question 436

How do you differentiate btwn osteoid osteoma and giant cell tumors of the bone on XR?

Answer 436

osteoid osteomas kinda look like bullet holes. giant cell tumors of the bone have this eccentric soap bubble type look to it.

Question 437

When I see someone with a renal cyst, what should I do?

Answer 437

Well, is it benign? Malignant? If benign, leave it alone. If it looks malignant, then do further testing.

Question 438

What are the risks/benefits for combo OCP’s?

Answer 438

Risks: VTE’s, HTN, hepatic adenoma, very small MI & stroke risk.

Question 439

So you know that in general, we honor patient autonomy (given that they are competent of making decisions). What do we balance patient autonomy against?

Answer 439

Whether or not pt poses a threat to public health (ex: if a competent individual with meningococcal meningitis wants to be treated at home instead, hospitalize said person against their wishes, as meningococcal meningitis is a highly contagious dz, and therefore a public health risk)

Question 440

There are 4 joocy S/E’s associated w/ erythropoietin. Rank them from most common to least common!

Answer 440

HTN > Headaches > flu-like syndrome > red cell aplasia

Question 441

Give me ze pathophys jooce behind hereditary angiodema!

Answer 441

C1 inhibitor dysfxn / deficiency / destruction -> elevated lvls of C2 and bradykinin

Question 442

Give me ze etiology jooce behind hereditary angioedema!

Answer 442

Episodes typically come about after physical trauma, dental procedures, or infections

Question 443

What is hereditary angioedema characterized by?

Answer 443

Rapid onset of the following w/out evidence of urticaria:

Question 444

So, based on various studies, what has been the most effective intervention so far for reducing medical errors/adverse drug events/health care utilization when transitioning a patient’s care?

Answer 444

Pharmacist-directed interventions.

Question 445

What is the most common cause of penile fx’s? What’s the next best step when you suspect one?

Answer 445

Sex with woman on top of man = MCC of penile fx’s. When you suspect one, get a retrograde urethrogram to r/o urethral injury first, and then surgically explore the penis to repair the tunica albugenia. Circumcision has no role in tx’ing this.

Question 446

Do we have a means for screening for pancreatic ca in asymptomatic adults?

Answer 446

NOPESIES.

Question 447

What is eczema herpeticum?

Answer 447

It’s a potential complication of eczema, and is 2/2 a superinfection of HSV

Question 448

What drug ppx measures are indicated for pts w/ HIV? When are they indicated?

Answer 448

• If CD4

Question 449

Which immature WBC do you see in the most abundance in pts w/ AML:M3?

Answer 449

Promyelocytes.

Question 450

HINT: AEIOU

Answer 450

Acidosis - Metabolic acidosis w/ pH

Question 451

How can you clinically dx menopause?

Answer 451

Amenorrhea > 1 yr, age > 45 y/o. Reasons for amenorrhea can’t be for another physiological reason (like hyperthyroidism)

Question 452

What consists of the Tetralogy of Fallot?

Answer 452

1) RV obstruction 2/2 pulmonary atresia/stenosis

Question 453

What are the physical findings in Tetralogy of Fallot?

Answer 453

• Single S2

Question 454

Where does a ‘single S2’ sound come from?

Answer 454

Single S2 comes from poor pulmonary blood flow through a stenotic pulmonic valve

Question 455

Why would you find edema in Turner grills?

Answer 455

These grills have taintly dev’d lymphatic networks.

Question 456

When should newborns regain their birth weight?

Answer 456

By latest 2 weeks.

Question 457

Tetanus ppx jooce - person comes in w/ minor wound and has had >3 Tdap’s -> what to do?!

Answer 457

Vaccinate IFF last dose was >10 yrs ago. NO TIG

Question 458

Tetanus ppx jooce - person comes in w/minor wound and has had what to do?!

Answer 458

Vaccinate. NO TIG

Question 459

Tetanus ppx jooce - person comes in w/ dirty/severe wound and has had >3 Tdap’s -> what to do?!

Answer 459

Vaccinate IFF last booster was >5 yrs ago. NO TIG

Question 460

Tetanus ppx jooce - person comes in w/ dirty/severe wound and has had what to do?!

Answer 460

Vaccinate + give TIG

Question 461

What should I watch out for in intubated pts with tension pneumothorax?

Answer 461

Compression of mediastinum -> compromise right heart filling -> hypotension + tachy

Question 462

What’s one thing I should be aware of when I intubate someone w/ ARDS?

Answer 462

The pt’s at a higher risk of developing tension pneumothorax, as their lung parenchyma’s all frakk’d and weakened anyway.

Question 463

What are two things you should screen for when you see someone w/ ITP?

Answer 463

Hep C and HIV.

Question 464

How do you manage delirium in the elderly?

Answer 464

Haldol or other typical/atypical antipsychotics. Benzos are bad, as they tend to metabolize benzos a lot slower.

Question 465

What are the characteristic findings in someone w/ brain death?

Answer 465

Absence of cortical and brain stem fxns. Spinal cord fxns tend to remain intact longer.

Question 466

What makes a test ‘invalid’?

Answer 466

If it has low sensitivity and specificity.

Question 467

Which two drugs are used prior to doing a nuclear heart scan? Why are they used?

Answer 467

Either adenosine or dipyridamole is used. They both dilate coronaries and inc coronary blood flow ~3-5x.

Question 468

What is ‘nursemaid’s elbow’? How do you treat it?

Answer 468

This is a partial dislocation of the radial head that typically comes about when ppl swing children around by their arms or pulling the child’s arm too quickly. Treat this by applying pressure on the radial head and hyperpronating the forearm.

Question 469

What is the conus medullaris?

Answer 469

It’s where the spinal cord ends.

Question 470

Define ‘inspissated stool’.

Answer 470

Thick stool

Question 471

What are the risk factors for intusseption?

Answer 471

Recent viral illnes, recent rotavirus vacc, ‘pathological lead points’ (aka ‘taint areas), i.e., Meckel’s diverticulum, HSP, celiac, intestinal tumors, polyps.

Question 472

What is the most common congenital GI abnormality?

Answer 472

Meckel’s diverticulum!

Question 473

Which two drugs are typically used to tx absence seizures?

Answer 473

Ethosuximide and valproic acid

Question 474

What are tardive dyskinesias characterized by?

Answer 474

involuntary perioral mvmts, i.e., biting, chewing, grimacing, tongue protrusions,

Question 475

What kind of rash do you classically see in someone w/ TSS?

Answer 475

A diffuse erythemateous rash all throughout the body

Question 476

Are blood cx’s reliable in dx’ing disseminated gonoccocemia?

Answer 476

Not really.

Question 477

What do the RBC’s look like on a PBS of someone who’s having a scleroderma renal crisis? How does that happen?

Answer 477

Inflammation -> activation of coag cascade, inc’d vasc permeability, inc renin secretion -> renal failure + malignant HTN -> MAHA or DIC w/ schistocytes

Question 478

What’s a virtual ‘ding ding ding ding’ eye finding in a baby who’s suffered abusive head trauma?

Answer 478

Bilat retinal hemorrhages

Question 479

What’s a potential cardiac complication for ppl w/ h/o stab wounds? How does that complication come about?

Answer 479

stab wound -> healing -> AVF formation (esp if stab wound affected major arteries/veins -> high output cardiac failure 2/2 dec SVR, inc preload, inc CO

Question 480

Which interventions for COPD mgmt have mortality benefits?

Answer 480

smoking cessation + home O2 therapy

Question 481

Is HNPCC only associated with a high risk of developing colon ca?

Answer 481

Not necessarily. One of the subtypes of HNPCC is associated with an inc risk of other GI + GU cancers, with endometrial ca being the most common one.

Question 482

So, a pt comes to you complaining of double vision and muscle weakness, particularly at the end of the day. You suspect MG, and do a w/u w/ an EMG and anti-Ach receptor bodies, and all of them come back (+). What’s the next step after this, and why?

Answer 482

Do a CT chest. An association was found btwn MG and thymomas on a 19 y/o girl wayyyy back in the day, and that girl apparently achieved long-term remission of MG. On top of that, 1/3 of the thymomas are found incidentally on scans/XR’s and such, so..it’s worth it to check for that thymoma, esp when it has a lot of remission potential eh?

Question 483

What do you typically find on CXR’s of ppl who have pulmonary contusions?

Answer 483

Opacities cuz of ze lung bleeding.

Question 484

How do you differentiate fibromylagia from polymyositis and polymyalgia rheumatica from the ‘labs’ perspective?

Answer 484

FM has WNL labs.

Question 485

What are common risk factors for pseudogout?

Answer 485

hemochromatosis, hyperparathyroidism, recent surgery

Question 486

Which heart murmur is associated w/ a widened pulse pressure?

Answer 486

AR!

Question 487

Okay. For some reason, I can’t tell the difference btwn measles and rubella for the life of me. Their prodrome’s practically the same! How do I tell demz apart?!

Answer 487

Measles - high fever (>104 degF), cranial-caudal spread of rash more gradual than rubella’s, NO ARTHRITIS

Question 488

Is steroid-induced myopathy a thing? If so, what would you find on labs?

Answer 488

YEP. CPK and ESR will be normal.

Question 489

I know I have a card on this, but what’s the main pathophys process behind Paget’s dz of bone?

Answer 489

Taint amts of bone turnover -> overactive osteoclasts -> osteoblasts in turn go nuts -> taint bone formation

Question 490

How do you differentiate Leydig cell tumors and seminomas from the lab perspective?

Answer 490

Leydig cell tumors - high testosterone, high estrogen (2/2 inc aromatase expression)

Question 491

So, apparently…some aminoglycosides, gentamycin in particular, can cause vestibular injury. What can you do on your physical exam to detect this?

Answer 491

Do the ‘head thrust’ test. This thing tests the vestibulo-ocular reflex. Normal findings = person looks at object -> turns head rapidly to opposite direction -> eyes remain fixed on target. Abnormal findings = eyes can’t track after abrupt head mvmt.

Question 492

How do you confirm the dx of laryngomalacia?

Answer 492

Flexible laryngoscopy w/ HUUUUUGE epiglottis.

Question 493

Are fluoroquinolones first line tx for UTI’s in non-preggo women?

Answer 493

Nope. Nitrofurantoin and Bactrim are. Use dem -quinolones if the other two fail / if the specific area has high resistance rates

Question 494

Deformed babies 2/2 inappropriate usage of drugs/meds in mom jooce - How does preggo mom’s usage of EtOH affect baby?

Answer 494

midfacial hypoplasia, microsomia, stunted growth, CNS dmg. Unlike phenytoin, cleft palate and excessive hair = very uncommon.

Question 495

Deformed babies 2/2 inappropriate usage of drugs/meds in mom jooce - How does preggo mom’s usage of phenytoin affect baby?

Answer 495

midfacial hypoplasia, microsomia, MR, stunted growth, cleft palate, hirsuitsm, rib anomalies, digital hypoplasia

Question 496

How do you differentiate btwn gingivostomatitis 2/2 Coxackie A virus vs HSV-1?

Answer 496

When Coxackie A is involved -> gray ulcers/vesicles are on the posterior oropharynx. Lesions on the hand and feet might also be seen (hello..hand-foot-mouth dz!). Tends to occur in early summer-fall.

Question 497

You see someone after they had their first miscarriage. What’s the next best thing to do, and why?

Answer 497

Offer an autopsy. 1/2 of the miscarriages are preventable, but the other 1/2 are from unknown factors. So I guess it’s worth it to investigate this further w/ an autopsy.

Question 498

Up to which age is bedwetting normal?

Answer 498

5 y/o

Question 499

You dx someone w/ TTP-HUS. What’s the next best step, and why?

Answer 499

Do a plasma exchange -> eliminate the taint ab’s against ADAMS-13 -> replace it with normally working ADAMS-13 -> vWF can now act normally again.

Question 500

Spherocytes w/ central pellor can be found in which dz’s?

Answer 500

Hereditary spherocytosis AND AIHA!