Quizlet cards - 12-07-15 - Sheet1 Flashcards
1
Q
What to do if someone JUST amputated their finger?
A
Place finger in sterile saline-moistened gauss -> put in plastic bag with ice -> ER -> can salvage finger within 24 hrs of amputation
2
Q
What do antipsychotics do to thermoregulation?
A
It frakk’s w/ it.
3
Q
When do you start scoping a dude/dudette w/ UC, and how often?
A
8-10 yrs post dx yearly
4
Q
Why do ppl who receive crazy amounts of PRBC’s tend to develop hypoCa?
A
The citrate anticoag taint binds to the Ca boyz.
5
Q
When do you do the Fluorescein eye exam taint / what do you use it for?
A
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
6
Q
When is dat clomiphene citrate taint used? What is it?!
A
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.
7
Q
What would you see on an ab-XR on a kid who OD’d on iron pills?
A
Radio-opacities ‘n stuffs in ze stomachz.
8
Q
How do you figure out the endocrinological abnormalities in Turner grills?
A
Super-dog-taint-phail ovaries -> no negative feedback mechanisms on pituitaries.
9
Q
Can you see abnormalities in ppl w/ stress fx’s?
A
Not always. It’s mainly a clinical dx really.
10
Q
What are the mood sx’s peeps refer to when they talk about schizoaffective d/o?
A
BOTH mania and depression! A-durrrr /FailFish
11
Q
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?
A
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.
12
Q
Pathophys of osteomalacia?
A
Low Vit D (most commonly) -> terribad bone mineralization (normal bone mineralization needs adequate Ca and phos)
13
Q
What are the indications for octreotide, in the context of ppl w/ liver dz?
A
For peeps with ACTIVE variceal bleeding. Using it for esophageal variceal bleeds ppx is taint–can confirm.
14
Q
What’s a more accurate test? Spirometry or peak flow?
A
Spirometry!
15
Q
Findings for trisomy 21 on 2nd trimester quadriple screen?
A
High beta-hCG, high inhibin, LOW AFP, low estrodiol
16
Q
Findings for trisomy 18 on 2nd trimester quadriple screen?
A
Normal inhibin A, low AFP, low beta-hCG, low estrodiol
17
Q
Findings for neural tube defects on 2nd trimester quadriple screen?
A
High AFP, rest WNL
18
Q
What does ze uncal herniation juice look like?
A
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)
19
Q
Why do pts with hyperosmolar hyperglycemic state have low body K lvls?
A
Loss of K in urine f/ glucosuria-induced K loss
20
Q
Why cath epidural’d grills who gave birth and have urinary incontinence?
A
Overdistended bladder delays return of normal bladder fxn.
21
Q
What are 4 questions I should ask myself whenever I run into an arthritis type case?
A
1) poly or monoarticular?
22
Q
What is the relationship btwn birth weight and the incidence of intraventricular hemorrhage?
A
lower birth wt = higher incidence
23
Q
MS vs MG?
A
MS: multiple neurological sx’s interspersed by time.
24
Q
Features of Lewy body dementia?
A
parkinsonian-like sx’s, visual hallucinations, AMS, decline in executive fxn
25
What type of dissociative d/o does Dust probably have, given his beginnings in the game and why?
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.
26
Out of all the hyperthyroid dz's, why is Graves' dz tx'd with iodine associated w/ the highest rates of hypothyroidsm?
The whole damn gland's superactive, so the iodine will blast the whole gland.
27
Why are practically all males with CF infertile?
The taint mucus accumulates in utero and wrecks vas deferens dev
28
WTH are hydatic cysts?!
Liver cysts caused by some taint protozoa thing called Echinococcus something -> associated with close contact w/ dogs and sheep.
29
Which form of contraception is preferred in lactating moms and why?
Progestin-only OCP's, since estrogen frakk's w/ milk production/milk composition.
30
What to do if the pt's Pap comes back showing ASCUS (atypical sq cell of undetermined sig)?
HPV screen THEN do colposcopy/bx IFF HPV screen comes back (+)
31
Pt w/ ASCUS has an HPV screen that came back (-). What now?
Repeat Pap in 6 mo.
32
WTH is dat CHARGE syndrome taint?
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.
33
WTH is dat VACTERL syndrome taint?
A manifestation of a wide variety of genetic mutations (yeah, like that helps.)
34
What is anal atresia esp associated w/?
Down Syndrome!
35
Risk factors for RCC?
Cig smoking, DM, HTN
36
Most likely complication for VUR?
Renal scarring (lol I answered RCC instead on a q. GET REKT)
37
Indications for steroids in L&D pts?
IFF baby is
38
What is DES?
Some synthetic estrogen that was used f/ 1938-1971 to prevent spontaneous abortions, premature delivery, and such. It was TAINT
39
What are 3 complications that are associated with DES use?
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
40
In general, for medically stable premies, how should you schedule vaccinations?
By their chronological age, NOT their gestational age.
41
What is the earliest sign of hypovolemia?
t-t-t-t-tachycardia
42
Bruton's agammaglobulinemia VS Common variable immunodeficency! WHAT R ZE DIFF'S EH?!
Bruton's: X-linked recessive, presents w/in first 6-9 mo of life, has markedly low or absent B cells on PBS
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.
- more common in men
44
What is the preferred mode of tx for acute atks of cluster headaches?
100% o2, as it's the most rapid acting / effective than NSAIDS, nasal sumatriptan
45
What can you use for cluster headache ppx?
Ergots, NSAIDs, Verapamil
46
What are 2 things that set adhesive capsulitis (frozen shoulder) from the other types of shoulder injuries?
1) more stiffness than pain (THINK OF THE NAME!)
47
Which part of the axial skeleton does RA affect, and what are the complications of that said effect?
Involvement of cervical spine -> frakk's w/ cervical spine structure -> cervical spinal cord compression
48
Pathophys of ARDS?
Lung dmg -> lung inflammation -> leakage of dmging fluid into alveoli -> loss of surfactant + alveolar dmg -> stiff lungs, pulmonary HTN, taint gas exchange
49
What are the three most common bugs that are responsible for secondary bacterial PNA's?
S. aureus, H. flu, S. pneumo
50
`Which secondary bacterial PNA-causing bug(s) is/are associated w/ necrotizing bronchopneumonia that leads to mini abscesses?
S. aureus
51
Q: Exam findings
Clamy: moderate swelling, moderate watery discharge, less purulent than gono
52
Q: Which one is moar severe?!
GONO IS!!!!!!!!!!!!!!!!!!!!!!!111one
53
Q: Best way to prevent?
Universal prenatal screening + tx of both as necessary
54
Q: ppx ointment differences?
Gono is ppx'd w/ that erythromycin ointment.
55
How to tx syphillis in nonpreggo pts w/ PCN allergy?
Doxycycline, and arithromycin to a lesser extent.
56
How to tx syphillis in preggo pts w/ PCN allergy?
desensitize then give PCN
57
Pathophys of HELLP syndrome?
Taint placentation -> systemic inflammation + coag cascade + complement cascade triggered -> platelet consumption + MAHA -> get rekt liver
58
What are those Baker cysts Amare Stat. had at one point & what's its pathophys?
Inflamed synovium 2/2 OA, RA, cartilage tears -> excessive fluid production -> fluid accumulates in popliteal fossa -> ZE BULGE -> cyst
59
How do the transaminase lvls tend to behave in ppl with HCV?
ALT/AST wax and wane.
60
Can you gives me some extrahepatic HCV jooce?
Heme: cryo!
61
What is porphyria cutanea tarda characterized by?
Fragile skin, photosensitivitiy, vesicles and such on dorsum of hands, has a STRONK assoc. w/ Hep C!
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?
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.
63
Situation: parent refuses to give kid tx for an EMERGENCY situation. What do you do?
Give the tx to kid anyway. BALLAH
64
What is the endometrial ca risk factor jooce made of?
Unopposed estrogen (f/ tamoxifen, obesity, PCOS).
65
Should you treat someone w/ abnormal uterine bleeding who potentially has endometrial ca w/ hormonal therapy?
Yep, ONLY AFTER r/o endometrial ca first.
66
What is the pathophys of PSVT?
Extra conductions loopin' around in the AV node.
67
How does cold water immersion affect the ANS?
It increases vagal tone.
68
A G2P1 woman w/ a baby at 32 weeks gestation presents with preeclampsia-eclampsia. What to do / why?
Give steroids + induce labor at same time. Baby is
69
Tx mode of choice for ppl with fulminant liver failure?
GOTTA TRANSPLANT DEM DOE OR ELSE...they'll RIP 80% chance of the time /BibleThump
70
Can roid takers present with behavioral changes and things?
YAS YAS YAS. They in fact become more aggressive.
71
When do you use immunosuppressive therapy on ppl w/ MG?
After tx w/ anti-Ach's phail.
72
Can you give me teh factitious d/o vs malingering d/o JOOCE?
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)
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?
Gross appearance: sessile adenoma (as opposed to pedunculated adenoma)
74
What's the go-to psych drug for smoking cessation?
Buproprion (Wellbutrin), with of course, nicotine patches, counseling, and teh sort.
75
Gots a preggo bipolar pt on Lithium. What congenital abnormalities should we be concerned about?
1st trimester: cardiac abnormalities, a la Ebstein's abnormality
76
Pt's got torsades. What to do next?
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.
77
When is calcium gluconate used, in the context of some kind of cardiotox?
When the cardiotox is there 2/2 hyperkalemia.
78
Which form of steroids do you use to treat acute exacerbations of COPD?
Systemic (methylprednisolone), NOT inhaled (fluticasone). Inhaled form would inc that said person's risk of developing PNA
79
Can you give me teh Trypanosoma cruzi jooce?
It's a bug that causes Chagas dz. It's endemic in S. America and can manifest itself as megacolon, megaesophagus, heart failure
80
Etiologies of constrictive pericarditis?
Idiopathic/viral, cardiac surgery, radiation therapy, TB (in endemic areas)
81
1st gen PCN's (pen G, K, etc) - What do they miss?
GI anaerobes, STAPH, H. Flu, GNR, Enterococus
82
2nd gen PCN's (anti-staph's, i.e., nafcillin, dicloxacillin) - What do they miss?
GI anaerobes, MRSA, H. Flu, GNR, Enterococcus
83
3rd gen PCN's (amox, ampicillin) - What do they miss? What can they cover that the 1st, 2nd gen PCN's can't?
Misses: GI anaerobes, staph, beta-lactamase (+) H. Flu, most GNR's
84
Amox-clav / amp-sulbactam - What do they miss? What other coverage do they provide, that amox / amp alone can't?
Misses: GI anaerobes not named bacterioides, MRSA, the other gram (-)'s,
85
Is aspiration PNA always associated with UL infiltrates?
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.
86
What are two big CI's for doxycycline use? What would serve as okay alternates?
Preggo pts and pts who are
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?
Phototoxic drug eruptions are common with tetracyclines.
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?
Nah. In fact, it's used for maintenance therapy for primary immunodeficiency dz's.
89
How can you differentiate histoplasmosis vs blastomycosis, considering they affect very similar geographical areas?
In histo, disseminated dz is very rare in immunocompetent ppl, whereas in blasto, disseminated dz is quite common, even in immunocompetent ppl.
90
What is prolactin production affected by from the endocrinological standpoint?
Stim'd by serotonin and TRH and inhibited by dopamine.
91
What is the most common cause of death in pts with acromegaly?
Mostly from
92
On CXR, you find 'free air under diaphragm'. What next?
XXXXXXXXXXXXXXXXX LAAAAAAAAAAAAAAAAP
93
Olanzapine - most common SE?
WT GAIN. btw, it's not a side effect that ONLY affects teens!
94
What's the antipsychotic that's associated w/ agranulocytosis?
Clozapine mainly.
95
What are the P/E findings for pts with intracranial HTN?
papilledema, CNVI deficits, peripheral visual field defects
96
What is a contraindication for LP's in pts with clear s/s of intracranial HTN?
a mass effect or obstruction in the brain of some kind
97
What's the preferred form of initial anticoag in pts with severe renal insufficiency?
Old school heparin. Your Lovenox and the other 'newer' anticoags are kinda C/I'd in these said pts
98
What is dantrolene / when is it used?
It's a muscle relaxant that's sometimes used in ppl w/ NMS
99
Can you give me ze taint optic neuritis jooce?
central scotoma (swollen optic disc), AFFERENT PUPILLARY DEFECT, changes in visual acuity and color perception
100
What's the diff btwn Heinz bodies and Howell-Jolly bodies?
Heinz bodies = little aggregates of denatured Hb
101
Why do you see a ~10 week gestation-sized in a nonpreg pt w/ adenomycosis?
Think about it -> uterine glands inside muscle tissue -> blood accumulates in said glands inside muscle tissue -> uterus gets bigger
102
What's 'otitis media with effusion'?
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)
103
What does thyroglobulin measure?
It measures native synthesis of thyroid hormone.
104
Which one is a true statement? TRH increases prolactin lvls OR prolactin increases TRH lvls?
TRH increases prolactin lvls. Prolactin itself has no effect on TRH
105
Does dextrose in a given saline solution have any role in initial fluid resuscitation?
Nope. I have no idea why.
106
Which one's associated w/ dat onion appearance on XR?
osteosarcoma BY FAR is the more common bone cancer. Ewing's is associated w/ the onion appearance on XR.
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?
Carcinoid syndrome = sx's of serotonin overload. Carcinoid cells produce an @$$load of 5-HT, which can therefore deplete niacin in the body.
108
Hepatic adenomas are associated with chronic use of which med? And do you see regular hepatic tissue on bx?
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)
109
What is the preferred go-to tx modality in young pts with renal artery stenosis (bilat or unilat), and why?
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.
110
When are ACEI's indicated for a renal artery stenosis situation?
In older pts with unilat renal artery stenosis.
111
What's the bug that's responsible for post-dental procedure IE's? Give its members as well
Strep viridans -> S. mutans (most common), S. mitis, S. sanguis, S. salivaris.
112
How would you describe general XR findings in someone w/ OA? What additional findings can you find?
OA = 'degenerative signs'. Also can find bony spurs.
113
How is hazard ratio used?
If >1, event is more likely in tx grp. If
114
What do subgroup analysis tables show in randomized clinical trials?
Whether certain pt characteristics (age, comorbidities, etc) had an effect on outcome
115
What's another name for osteitis deformans?
Paget's dz of bone!
116
Why are pts with RA at an inc risk for developing osteoporosis?
Dec activity, chronic steroid use, chronic inflammation
117
Neuroimaging defects in psych d/o - SCZ?
Enlargement of cerebral ventricles
118
Neuroimaging defects in psych d/o - OCD?
Structural abnormalities in striatum and orbitofrontral cortex
119
Neuroimaging defects in psych d/o - Autism?
Inc total brain vol
120
Neuroimaging defects in psych d/o - Panic d/o?
Dec amygdala vol
121
Neuroimaging defects in psych d/o - PTSD?
Dec hippocampus vol
122
What are the c/i's for iodine therapy in a Graves setting?
Pregnancy and severe ophthalmopathy. I guess this is where your PTU's and such come in
123
What is considered a 'normal' contraction stress test?
No late decels (no placental insufficiency), no variable decels (no cord compression) within appropriate time period.
124
-- Scorpion studying neuro. "ARISE!!"
They ARISE from the cerebellar vermis. Its associated sx's come from its mass effect (including the N/V from obstructing CSF flow)
125
-- Scorpion studying neuro.
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
126
Fanconi's anemia - give me some jooce?
auto recessive dz, dx'd around secondary school time, associated w/ progressive pancytopenia + macrocytosis, various deformities.
127
Diamond-Blackfan anemia - give me some jooce?
macrocytic anemia assoc w/ major congenital deformities
128
Wiskott-Aldrich Syndrome - give me some jooce?
X-linked dz assoc w/ eczema, thrombocytopenia, low Ig lvls
129
What is considered a normal NST?
2 sets of fetal heart accelerations w/in a 20-40 min period.
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?
Endoscopy in next 24 hrs.
131
Name the cardiac manifestations that are assoc w/ Marfan's eh?
Aortic dissection/regurg/dilatation, MVP
132
What is pulsus parvus et tardus?
Parvus = weak. Tardus = late. It's one of the physical findings that's associated w/ aortic stenosis.
133
How does high aldo influence bicarb lvls?
High aldo = high bicarb. And this is how it happens, at least from my understanding
134
How do you tell the diff btwn orbital cellulitis and preseptal cellulitis?
Anatomy. How?
135
If you see a unilateral solid nontender neck mass in a pt w/ a significant smoking hx, what are you thinking?
SCC!!!!!
136
Zenker's diverticulum - where do you see it? How can you see it? What complications is it assoc w/?
Where? Upper esophagus.
137
What are the risk factors for C. diff?
Old age, recent abx use, ESRD on HD, being hospitalized, prolonged gastric acid suppression.
138
How do you clinically distinguish Tay-Sachs f/ Niemann-Pick dz?
Tay-Sachs - hyperreflexia
139
How do you differentiate MGUS from MM? What basic studies can you do to help differentiate this?
MGUS has NO anemia, hypercalcemia, lytic lesions, and renal insufficiency. CBC, CMP, and a metastatic skeleton bone XR study will help.
140
What murmur is ze bicuspid aortic valve assoc w/?
AR!
141
What is selection bias?
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.
142
What are some unique features of Legionnaire's dz (Legionella PNA)?
extrapulmunary sx's (hyponatremia, mild hepatitis, GI sx's, hematuria and proteinuria).
143
What are the appropriate next steps in mgmt for ppl w/ suspected acute limb ischemia?
Anticoag + immediate vasc surgical interventions.
144
Solid tumor cancers are associated with which nephrotic syndrome?
Membranous nephropathy
145
Lymphomas are assoc w/ which nephrotic syndrome?
Minimal change dz.
146
Hep B and C are associated w/ which nephrotic syndrome
Membranous nephropathy and less commonly, membranoproliferative glomerulonephritis
147
HIV, heroin use, and being of African American and Hispanic descent is associated w/ which nephrotic syndrome?
Focal segmental glomerulosclerosis.
148
Okay. I know that sensitivity and specificity is independent of prevalence. Does that apply for PPV and NPV? Why/why not?
PPV and NPV is DEPENDENT on prevalence. If you do the math, you'll see.
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?
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.
150
What's the role of CA-125 as a tumor marker?
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)
151
What is mucormycosis? What's the most common org responsible? How is it best treated?
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.
152
How does transient synovitis come about? When does it resolve typically?
It comes about after a viral infection, typically, and it resolves in 1-4 weeks.
153
What is the duration of lithium therapy dependent on in bipolar ppl? Assume no C/I's for lithium in this case.
If person had 1 manic ep, give 1-2 yrs worth post remission. If person had 2+ manic ep., consider long term therapy.
154
Kawasaki JOOCE - Dx criteria?
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
155
Kawasaki JOOCE - Tx?
Aspirin + IVIG
156
Kawasaki JOOCE - Feared complications?
Coronary vessel aneurysms, MI / cardiac ischemia.
157
When is adrenal gland imaging indicated in newborns?
if you clinically suspect CAH
158
What are some of the effects of maternal estrogen on newborns? Do you need to do anything about it?
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.
159
Does IBD ONLY affect ppl who are around the 20's?
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.
160
Malignant otitis externa! Can you tell me what its causative bug typically and what its risk factors are?
Causative bug: Pseudomonas
161
How is number needed to treat defined? How is it mathematically defined?
NNT = # of ppl that need to receive tx to prevent ONE adverse event.
162
How do you differentiate Hep A from the other hepatitis viruses clinically?
Its mode of onset, associated risk factors, etc. Since Hep A is fecal-oral, its onset is more acute than Hep B or C.
163
What happens when you see a confidence interval include "1" in its range (ex: CI = 0.8-3.0), what should you think?
That the null hypothesis is true. Since the CI includes the null value, (RR = 1.0), the outcome is considered statistically insignificant.
164
What is the relationship btwn the range of the confidence interval and sample size?
Lower range of CI = higher sample size.
165
How do you characterize dermatomyositis? What is it associated w/?
It's characterized by muscle weakness and various skin findings. ~15% of these pts have an underlying malignancy.
166
What is the DoC for hairy cell leukemia?
Cladribine
167
What is the go-to regimen for CLL?
Chlorambucil and prednisone
168
Why are ppl with h/o opiate abuse given morphine, when they are in the hospital in a lot of pain?
Undertx of pain leads to higher chance of relapse, longer hospitalizations, and 'patient dissatisfaction'
169
What are some medical situations you MUST avoid in pts who have a right sided ventricular infarct?
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.
170
When would you do Holter monitoring?
IFF the arrythmia itself is causing sx's!
171
What are the MC presentations for neonatal sepsis?
High or low temp, poor feeding, irritable/lethargic baby
172
What risk factors is associated w/ jejunal atresia? What would you find on ab XR?
it's associated w/ vasoconstrictive drug use during preg (i.e., cocaine). You'll see a 'triple bubble sign' on ab XR.
173
Which of the diabetes drugs is associated w/ wt loss?
Your GLP-1 agonists (glucagon-like peptide agonists), i.e., exenatide. POOP
174
What are the indications for using clozapine?
Tx-resistant SCZ, SCZ assoc w/ suicidality.
175
3 things are necessary for the dx of DKA. What are they?
1) RBG > 250 mg/dL
176
Which cardiac murmur is associated w/ an opening snap?
MS! (I said AS lol. REKT)
177
What is spondylolisthesis?
A forward slippage of vertebrae 2/2 some kind of congenital reason. Typically affects children.
178
How do you differentiate LoC from seizures vs vasovagal?
Seizures -> delayed return of mental status
179
When is D&C indicated in pts who are having an inevitable abortion?
When they are hemodynamically unstable
180
When is expectant mgmt appropriate in pts who are having an inevitable abortion?
If they're stable clinically, and if they desire to avoid medical / surgical mgmt.
181
What kind of murmur would you hear in pts w/ aortic stenosis?
Systolic murmur best heard at R 2nd intercostal space with radiation to apex and carotids.
182
What are the benefits from controlling HbA1C to
Decreased microvascular complications.
183
2) Inc deposition of poorly mineralized osteoid
#1 = osteitis deformans / Pagets dz
184
How do you differentiate btwn esophagitis 2/2 herpex simplex vs cytomegalovirus?
Herpex simplex esophagitis - assoc w/ vesicles and round or oval shaped ulcers.
185
Sepsis in adults vs neonatal sepsis -- differences?
Sx's in neonates in context of sepsis = more nonspecific
186
Pt presents w/ breast milk jaundice. What to do?
Nothing really. The elevated bili that's associated w/ this doesn't really require intervention.
187
If you see a CXR of a person with acute cardiac tamponade 2/2 an MVA, what would you find?
Nothing really remarkable.
188
What is the MCC of lower GI bleeds in the elderly?
Diverticulosis!
189
What are the main differences btwn these pneumococcal vaccines: PPSV23 and PCV13?
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.
190
When are PPSV23 and / or PCV13 administered?
- Administer PPSV23 in adults
191
What is lichens sclerosis, and what is it associated w/?
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.
192
Babesiosis vs Ehrlichiosis -- can I has ze jooce?
Babesiosis - xmitted by Ixodes tick, presents with fever, jaundice, hemolysis, thrombocytopenia. Rash is typically not seen, except in severe illness
193
When are paps started?
At age 21, regardless of sexual activity. However, for the immunocompromised, start Paps at the onset of sex
194
What is bronchiolitis / how does it present? What's its feared complication?
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
195
How does beta blockers work on the heart (in general)?
Dec's HR and elongates diastole.
196
What is the cosyntropin test exactly?
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.
197
How do you tell the difference btwn HSV retinitis and CMV retinitis?
HSV retinitis presents with eye pain, keratitis, conjuctivitis, and its characteristic fundoscopic findings that I can't give two owl pellets about.
198
How do you differentiate btwn a consolidation process vs a pleural effusion?
There's a difference?! PogChamp -- YEP
199
So..someone comes in w/ acute coke intoxication. What are the initial steps in mgmt? Why do those initial steps?
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.
200
Which drug do you NOT give someone who has acute coke intoxication? Why?
Do NOT give that person beta blockers. Unopposed alpha activity will worsen the coronary vasoconstriction.
201
How do you differentiate btwn asymmetrical and symmetrical IUGR from the baby'? How do you differentiate btwn the two from an etiological perspective?
Asymmetrical = head is normal in size. Everything else is small. Caused by maternal vascular compromise (i.e., HTN, autoimmune dz, cocaine/tobacco abuse, etc)
202
What are the contraindications for the rotavirus vaccine?
anaphylaxis, h/o intusseption, h/o untreated congenital GI abnormalities, SCID.
203
Why do we give the rotavirus vaccine anyway?
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.
204
How are CI and precision related?
Smaller CI range = more precision. Remember that a larger sample size helps with this as well.
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?
Propranolol = B-Blocker -> unopposed alpha activity -> vasoconstriction -> BP GOES HIGHER
206
So..it seems like cellulitis and erypsipelas are pretty similar. How do you differentiate them?
Cellulitis involves skin AND subQ tissue.
207
What are the s/sx of mag sulfate tox?
1) depressed DTR (f/ NMJ blockade)
208
Which medication contains cyanide?
Sodium nitroprusside. NOT hydralazine. OOPTH
209
Which skin lesion is thought to be a precursor for SCC of the skin?
Actinic keratosis.
210
What is SCID caused by?
adenosine deaminase deficiency
211
What is the idea behind relieving sx's in hemo-stable WPW pts?
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.
212
What's the breakdown for the bugs responsible for causing acute bacterial sinusitis?
Strep pneumo (~30%), H. flu (~30%), others (40%)
213
How does crytococcal meningitis present?
Headache, fever, malaise. All sx's are subacute in nature. You won't really see that typical nuchal rigidity in these pts!
214
Immunosuppressant therapy SE profile jooce - Tacrolimus!
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.
215
Immunosuppressant therapy SE profile jooce - cyclosporine!
nephrotox, HTN, neurotox, glc intolerance, infection, malignancy, GI sx's, GUM HYPERTROPHY, HIRSUITISM
216
Immunosuppressant therapy SE profile jooce - azathioprine!
dose-related leukopenia, diarrhea, hepatotox
217
Immunosuppressant therapy SE profile jooce - mycophenidate!
BM supression
218
What are the different types of EPS? For the EPS's that can be treated, what can you treat them with?
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.
219
Is glioblastoma multiforme common in children?
Nope! They are more common in the elderly.
220
What is Meniere's dz?
It's a dz that involves dilatation of the endolymphic compartment of the inner ear.
221
What are the nonpharm appropaches to treating Meniere's dz?
Minimize endolymph retention by restricting caffeine, alcohol, high salt diet, and nicotine.
222
What are the clinical manifestations of PNH?
1) hemolysis -> hematuria
223
What's the proposed pathophys behind the pruritis and flushing that we see with niacin use?
Prostaglandin induced vasodilatation. That's why we give ppl aspirin w/ niacin to decrease the chances of this happening!
224
What are the complications for babies who are 'small for gestational age'?
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)
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?
Stop PTU on the first signs of fever and sore throat, and then check CBC.
226
Which micronutrient is breastmilk deficient in?
Vit D
227
When are preggo ladies tested for glc intolerance?
24-28 weeks. Go earlier if pt has risk factors.
228
When you suspect someone with tension pneumothorax (and also in resp distress), what do you first--intubation or needle thoracostomy? And why?
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.
229
When would you choose valproic acid over lithium when tx'ing bipolar d/o?
if pt has renal dysfxn
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?
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.
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?
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%.
232
When are gastric lavages CI'd? And why?
1) caustic ingestions (of an acidic/basic substance) -> risk dmg to oropharynx and esophagus
233
When do you give N-acetylcysteine as an antidote to acetaminophen tox?
If >8-10 g have been ingested in the past 24 hrs or less
234
If the person ingested a toxic amount of Tylenol 25 hrs ago, what therapy do you give him/her?
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.
235
How does aspirin OD present?
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.
236
How do you tx aspirin OD? How does dat said tx modality work?
ALKAIZER ZE URINE (aka alkalize with NaHCO3). This effectively increases ze rate of aspirin excretion.
237
How does TCA tox present?
Anti-Ach sx's, seizures, arrythmia (f/ QRS widening)
238
How do you tx TCA tox? How does dat said tx modality work?
NaHCO3. This doesn't increase the rate of TCA excretion, but it protects the heart from arrythmias.
239
How does nerve gas work?
It inhibits Ach metabolism
240
What precipitates digoxin tox? Why is that so?
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.
241
How does digoxin tox present?
HyperK, AMS, visual disturbances, arrythmia
242
Methanol vs ethylene glycol ingestion--how do you differentiate?
Metabolism of methanol yields formaldehyde. Ethylene glycol yields oxalate. Formaldehyde is toxic to eyes. Oxalate is toxic to kidneys.
243
How do you tx methanol and ethylene glycol tox?
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.
244
What is CO2's effect on cerebral vasculature?
High CO2 leads to cerebral vasodilatation
245
How do you differentiate btwn Mobitz I (Weckenbach) and II (Mobitz)?
Mobitz I - progress lengthening of PR interval -> QRS drop. Lesion is at the AV node
246
What two cardiac defects are associated w/ Turner's?
Coarctation of aorta, bicuspid aortic valve.
247
What is PANDAS?
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.
248
What are the various consequences of fetal hyperglycemia?
1) higher metabolic demand -> placenta can't keep up -> fetal hypoxia -> polycythemia
249
What is vasa previa?
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.
250
How does vasa previa present?
Painless vaginal bleeding for mom at the onset of ROM. Baby will present initially with tachy, then brady, then a sinusoidal patern.
251
How is vasa previa dx'd and tx'd?
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.
252
How does placentia previa present?
Painless antepartum hemorrhage. Baby will be stable, provided he/she doesn't have anything else going on.
253
How do you differentiate btwn simple vs strangulated SBO?
Simple won't present w/ peritoneal signs (rebound, rigidity). Strangulated will doe.
254
What's the w/u for acquired torticollis?
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)
255
When you suspect someone w/ septic arthritis, do you give abx prior to or after doing the arthrocentesis? Why?
Tapping the joint is both diagnostic and therapeutic.
256
What is fibrodysplasia?
It's a nonatherosclerotic noninflammatory condition that involves abnormal growth in vessel walls. It's a rare dz, and it typically occurs in children.
257
How does fibrodysplasia present?
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.
258
What are the similarities and differences btwn the two sample t-test and the two sample z-test
Similarities: Both of these tests are used to compare two means.
259
When is ANOVA (analysis of variance) used?
It's used to compare 3+ sets of means.
260
What is the chi-square test / when is it used?
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
261
For acute aortic dissections, what's the most appropriate medical intervention? Why?
Beta blockers with both alpha and beta blockade (i.e., labetalol). Lowering both BP and HR help decrease the stress on the aortic wall.
262
How do you differentiate btwn PSVT and SMVT (sustained monomorphic VT)?
PSVT - won't have AV dissociations and/or fusion beats
263
What are fusion beats?
a hybrid of a wide and narrow QRS complex
264
What are the tx approaches to SMVT?
If hemo stable, give IV amio
265
Can you gives me ze typhoid fever jooce?
It's caused by salmonella typhi. It presents w/ a fever, 'salmon rose spots', GI sx's, and bradycardia
266
What are the similarities and differences btwn malaria and dengue fever?
Similarities: Both will present with myalgias and fever.
267
What are things that you'll see in CD that you won't ever see in UC?
Skip lesions, transmural involvement of colon, fistulas, fissures, and noncaseating granulomas (only in ~1/2 of CD cases tho)
268
What can clindamycin cover and not cover?
Covers: gm +'s, anaerobes.
269
What can Bactrim cover and not cover?
Covers: staph, most strep, gm-, H. flu, PCP
270
Unilat cervical lymphadenitis is most commonly caused by which bugs?
S. aureus (more commonly) and strep pyo
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?
Panendoscopy, AKA 3-part endoscopy, which consists of a bronch, endoscopy, and laryngoscopy.
272
What're the differences btwn Rinne's test and Weber's test, at least from their practical standpoint?
Rinne's tests conductive hearing (external ear, middle ear)
273
In the Rinne's and Weber's tests, why do we do a comparison btwn air conduction and bone conduction?
Air conduction tests for conductive hearing.
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?
Rinne's: BC > AC (suggesting conductive hearing loss)
275
Ototoxic abx like aminoglycosides cause which kind of hearing loss?
Conductive hearing loss via otosclerosis.
276
What are the 'modifiable risk factors' for osteoporosis?
Low estrogen, low vit D, dec calcium, malnutrition, meds, immobility, cig smoking, excessive EtOH consumption
277
What's another name for periorbital cellulitis?
Preseptal cellulitis
278
Does a ruptured berry aneurysm present with focal neurological signs?
Not really.
279
What's another name for Pick's dz?
Frontotemporal dementia
280
Is PEA a shockable rhythm?
Nope.
281
What is 'melanosis coli'?
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.
282
Can you see vit D deficiency in ppl w/ nephrotic syndrome? If so, why/why not?
Yes. The loss of protein in urine = loss of cholecalciferol binding protein = low vit D in body
283
Are fluoroquinolones C/I'd in pregnancy? If so, what are the effects?
C/I'd in pregnancy. Usage during preg is associated with bone deformities and joint issues in the fetus.
284
Is amoxicillin C/I'd in pregnancy? If so, what are the effects?
Amoxicillin is relatively safe for preg pts.
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?
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'
286
What are the risk factors for Hep C infxn?
IV drug use, workplace exposure, getting transfusions or transplants before 1992. (donated blood + organs weren't routinely screened in the US before '92)
287
How do you differentiate btwn chronic HTN, gestational HTN, and preeclampsia?
chronic HTN - onset
288
What are some major features of homocysteinuria?
Thrombosis, marfanoid features, developmental delays, fair skin + eyes.
289
Are low-grade fever, leukocytosis, and chills normal during the first 24 hr postpartum period?
If there is no smelly vag discharge, then yep. It's normal.
290
What are anti-CCP ab's associated w/?
RA.
291
How do you distinguish btwn central Bell's Palsy and peripheral Bell's Palsy?
central Bell's - forehead muscles are preserved
292
What are the go-to modalities of tx for Raynaud's?
CCB's and avoidance of aggravating factors.
293
Which antihypertensive meds are used in Raynaud's?
CCB's only. The other types are absolutely useless for Raynaud's.
294
What are the indications for giving corticosteroids w/ abx in the context of a pulmonary infxn?
If pt's PaO2 35.
295
How do you differentiate btwn Waldenstrom's macroglobulinemia, MM, and MGUS?
Waldenstrom's = IgM spike -> thickening of blood
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?
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.
297
What is pulsus paradoxicus? And what does this finding suggest?
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.
298
What is the Kussmaul sign? And what does this finding suggest?
An inc in JVP on inhalation. Normally, JVP stays / drops on inhalation. This finding suggests some kind of RHF type situation.
299
What's the most serious S/E for -quine drugs?
Retinopathy.
300
What is the definition of an 'idiosyncratic drug reaction'?
A rare and unpredictable drug rxn.
301
What's the difference btwn colloid sol'ns and crystalloid sol'ns?
colloid = crystalloid + some substance that prevents it from passing through a semipermeable membrane (i.e., albumin)
302
How does macular degen usually present?
Progressive and bilat central vision loss. Peripheral vision is usually spared.
303
How does open angle glaucoma usually present?
Progressive and gradual loss of peripheral vision -> tunnel vision. Central vision is spared.
304
How does inadequately controlled post op pain contribute to development of atelectasis?
Inadequate pain control -> weakened cough + shallow breathing
305
When do you hospitalize an anorexic?
When they present with unstable vitals and metabolic derangements.
306
Is there a difference in how you tx anorexia and bulimia? If so, what're the differences?
Anorexia: Olanzapine, if nonpharm approaches fail
307
What's an important S/E of buproprion? Who shouldn't use this drug?
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.
308
What is an acrochordon?
A skin tag.
309
Which vaccines are C/I'd in pregnancy?
MMR, varicella
310
What factors decrease or increase the risk of fetal respiratory distress syndrome?
Things that decrease risk = intrauterine stressors, i.e., IUGR, maternal HTN, PPROM
311
What's Osgood-Schlatter's disease? Why does it happen?
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.
312
Which micronutrient does phenytoin deplete? How does it do this?
It depletes folic acid by messing with its absorption.
313
How do you differentiate btwn otosclerosis and presbycusis?
Otosclerosis: conductive hearing loss, onset typically around middle age.
314
What ab's would you find in someone w/ antiphospholipid syndrome?
Anti-cardiolipin Ab's.
315
Why do you see hypoCa in ppl w/ tumor lysis syndrome?
The high amts of phos flying around binds to Ca.
316
What kind of murmur would you hear in a pt w/ HOCM?
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
317
What's the most common complication of PUD?
Hemorrhage.
318
How do cholesteatomas present?
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.
319
Which coronary artery supplies the vast majority of the blood supply for the SA node, AV node, and the His bundle?
RCA
320
What's a systematic approach of reading EKG's that you can use?
1) Rate
321
If a baby dies in utero, when do you induce labor?
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.
322
What is the Potter sequence?
Baby has taint UT -> baby can't pee well -> oligohydramnios -> pulmonary hypoplasia + flat faces + limb deformities
323
Can you gives me some basics on Wilms' tumor?
It's the MC kidney malignancy in childhood. It presents around 2-5 y/o age w/ a palpable mass.
324
HIV+ person has a PPD of 6mm and has an unremarkable CXR. Next step in mgmt?
Isoniazid + pyridoxine for 9 mo
325
HIV+ person has a PPD of 6mm and has CXR findings suggesting an active TB infx. Next step in mgmt?
Combo of 3-4 anti-TB drugs
326
For pts with flu, how do you guide therapy?
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
327
Can infants present with thryotoxicosis, despite adequate tx of Graves' in mom?
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.
328
When is Mohs surgery used?
For BCC on face
329
Psalms 75:25-26?
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
330
What is capsule endoscopy used to examine?
ze small bowel!
331
Where is the anseline bursa located?
anteromedially over the tibial plateau, just below the knee joint.
332
What are the hemodynamic effects of thyrotoxicosis?
1) elevated systolic BP & widened pulse pressure
333
How does T3 influence beta adernergic activity? Does it have any effect on the actual amount of catecholamines in the body?
It helps increase the sensitivity + # of beta adrenergic receptors expressed, but has absolutely NO effect on the amount of catechol's in the body.
334
What is the pathophys behind warfarin-induced necrosis?
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.
335
What's the most common underlying arrythmia that's responsible for sudden cardiac arrest?
Reentrant ventricular arrythmias
336
What's the difference btwn treatment of DVT and PE, given high clinical suspicion for both?
If you highly suspect DVT, do U/S
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?
Observation for 4-6 hrs.
338
Does everyone who has celiac dz come back (+) for IgA anti-tissue transglutaminase Ab's?
Nope, especially when they have an underlying IgA deficiency!
339
Do benign teratomas have any elevated tumor markers?
NOPE. Actually, if the tests come back w/ elevated tumor markers, suspect a malignant teratoma.
340
There's a 'standard' approach to 'breaking bad news' to pts. What is this approach called? Givez me its basic jooce?
SPIKES
341
What is an anoscope? When is it used?
An anal speculum. You use it when people under
342
For pts who have AFib, they most likely have ectopic foci and stuff where?
In ze pulmonary veinz
343
For pts who have AFlutter, they most likely have taint circuitry where?
In the tricuscpid area.
344
So, a kid swallows a battery. What do you do?
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.
345
What hormone does prolactin suppress?
GnRH
346
What does Steve Nash have a risk of developing over time?
Vertebral fx's 2/2 rigidity + dec bone density
347
Why would someone w/ ankylosing spondylitis be at an inc risk of developing osteopenia / osteoporosis?
Ank spondylitis is a chronic inflammatory condition that's mediated by TNF-alpha & IL-6. I believe these inflammatory markers increase osteoclast activity
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?
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.
349
Can you use plain back XR's to look for lytic lesions and compression fx's.
Oh yeah most defs. Think about it!
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?
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.
351
Diarrhea in HIV (+) people is caused by which organisms?
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
352
When I see someone with h/o HIV and comes in w/ diarrhea, what do I do initially? Why that initial step?
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.
353
How is LVH dx'd on EKG?
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
354
How is RVH dx'd on EKG?
RAD w/ slightly widened QRS, persistence of S wave in V5, V6, R wave > S wave in V1 (R wave gets progressively smaller)
355
How do you define a 'significant Q wave' (one that suggests past infarction) on EKG?
Q wave is either 1 small box in wide OR is 1/3 of the QRS's amplitude
356
How do you dx RBBB vs LBBB on the chest leads?
If R-R' complex is on V1, V2, dx RBBB.
357
How does the presence of an LBBB affect the dx of a possible infarction?
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.
358
What is the role of hyperventilation in EEG's?
It helps illicit interictal epileptiform discharges, which then in turn helps distinguish the various seizure d/o's
359
Complex partial VS typical absence VS atypical absence
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:
360
What's another name for head lice?
Pediculus humanis capitis
361
When you see someone develop an anaphylactic rxn f/ a blood xfusion, what does that person probably have?
IgA deficiency. To avoid this in the future, this person should get IgA deficient plasma and pre-washed RBC's.
362
What's the difference btwn inheritance patterns in kids with Angelman's vs Prader-Willi.
Angelman - deletion of MATERNAL copy of chromosome 15q11-q13
363
How do you determine whether to do an excisional bx or an excision w/ 1 cm margins on a melanoma-looking lesion?
If dx is not confirmed, do excisional bx. If bx shows 1 mm, then you have'ta do a sentinel LN bx.
364
What is Waterhouse-Friderichen syndrome?
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.
365
What's the difference btwn conversion d/o and somatic sx d/o?
Conversion d/o - an otherwise unexplained neurologic sx (i.e., hemiparesis), often 2/2 an acute stressor (rape)
366
Why do pubertal grills tend to have irregular periods?
Immaturity of the hypothalamic - pituitary - gonadal axis -> not enough jooce to sustain regular periods
367
What's THE most important thing you can do for someone w/ a septic joint to help prevent long-term morbidity?
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.
368
What're the differences in the different tx modalities for the 3 different 'forms' of vaginitis we all so love?
- Bacterial vaginitis -> Flagyl
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?
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.
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?
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.
371
What is enthesitis? Where do we see this most commonly?
Enthesitis = inflammation + pain at sites where tendon + ligaments and bone meet.
372
How do you clinically distinguish btwn acute chole and ascending cholangitis?
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.
373
How do you tx ascending cholangitis?
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)
374
How do you distinguish btwn steroid-induced acne and primary acne?
Steroid acne won't have those whiteheads / blackheads (aka comedomes), whereas primary acne has 'em.
375
How do you distinguish btwn generalized seizures and partial seizures?
Generalized involves both hemispheres of the brain.
376
Simple partial VS Partial w/ generalization VS Complex partial
*Simple partial* - No LoC
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?
*Small cell* - ACTH & SIADH
378
What are the tx modalities for managing someone with idiopathic intracranial HTN?
1st line: acetazolamide +/- Lasix
379
What role does mannitol play in someone w/ intracranial HTN?
It's used when someone has IcH 2/2 cerebral edema, and when someone's IcP's are up the wazoo.
380
What's the generic name for Lovenox?
enoxaparin
381
What are some drugs that we can use to improve sx's associated w/ gastroparesis?
Metoclopramide, erythromycin
382
What are the EKG findings in someone with WPW?
A short PR interval, widened QRS, and presence of delta waves (aka 'slurred initial portion of the QRS)
383
So...there are certain CHD's that are more commonly associated w/ specific trisomies. Which CHD's are associated w/ trisomy 21? 18?
Trisomy 21 = ASD + endocardial cushion defect
384
What's the 'rule of 2's' that we talk epidemiology in relation to Meckel's diverticulum?
2% prevalence
385
What's the pathophys behind Mecke's diverticulum?
incomplete obliteration of the fetal vitelline (omphalomesenteric) duct. HAHA I can't be bothered to learn this /FailFish
386
How does Meckel's diverticulum present clinically? How do you dx & tx it?
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.
387
You see and examine a kid, and end up suspecting VSD. What's the next step in mgmt? Why that step doe?
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.
388
Broca's area is located in which lobe?
Dominant frontal lobe.
389
Wernicke's area is located in which lobe?
Dominant parietal lobe.
390
How do you distinguish btwn the three main types of aphasias?
*B*roca's (expressive) aphasia: *B*roken speech
391
What iz ze rosacea?
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.
392
Give me ze rundownz on the etiology of small intestinal bowel overgrowth?
Its etiology stems from various anatomical abnormalities, bowel motility d/o's, amongst others.
393
Psammoma bodies are characteristic of which thyroid cancer?
Papillary ca of thyroid
394
What are the main stages of mental illness? Break them down for me too, plx?
1) *acute*: tx response (defined as 50% reduction of sx's -> remission achieved
395
What're some big differences btwn cherry angiomas and strawberry (capillary hemangiomas)?
Strawberry hemangiomas > cherry angiomas in terms of size. Strawberry hemangiomas appear in infants. Cherry angiomas appear the 3rd-4th decade of life.
396
What are two things you need to really watch out for in clavicular fx's?
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)
397
WTH is pilondal dz?
It's an infection of the sacrococcygeal skin and subQ tissue.
398
What are some complications of constipation in young children?
anal fissures, encoparesis, hemorrhoids, enuresis/UTI's, vomiting
399
How does whooping cough (pertussis) progress in infants and children?
catarrheal (mild cough, rhinitis) -> paroxysmal (cough parosysms w/ 'whoop', post-cough vomiting, apnea) -> convalescent (resolving of sx's)
400
How does acute fatty liver of pregnancy present?
Vague sx's -> ab pain, N/V -> liver failure
401
How is cirrhosis managed?
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.
402
Does albumin have a role in treating / managing minimal change dz?
aaaaaaaaaaaabsolutely not. You're not correcting the underlying cause of minimal change dz, and you might even get the person volume overloaded with this.
403
How do you treat minimal change dz?
corticosteroids.
404
So, you clinically suspect someone to have toxic megacolon. What do you have to do first before you actually make the dx?
You need to get radiological evidence for colonic distention before making the dx.
405
What is salvage therapy?
It's a form of tx when standard therapy fails.
406
What's the difference btwn adjuvant therapy and neoadjuvant therapy?
Adjuvant - what's given as an add-on to standard therapy
407
What are the indications for doing a voiding cystourethrogram?
If you see signs of scarring or hydro on renal U/S
408
So, say someone comes to you with asymptomatic lymphadenopathy. What are the next steps?
Assess size of the LN's. If it's 2cm, bx it to check for malignancy or a granulomatous dz.
409
What is ALS characterized by?
The presence of both UMN and LMN signs.
410
What does Prussian blue stain?
Hemosiderin.
411
Febrile nonhemolytic, acute hemolytic, delayed hemolytic, urticarial/allergic, anaphylactic, xfusion-related lung injury
1) *febrile nonhemolytic* - MCC of immunologic blood xfusion rxn, 2/2 cytokine accumulation during blood storage. Presents w/ fever, chills within hrs of xfusion.
412
What are the common clinical features of carcinoid syndrome?
episodic flushing (can be associated w/ low BP and tachycardia, secretory diarrhea, cutaneous telangiectasias, brochospasm, valvular lesions (more commonly, TR)
413
What is myxomatous valve dz?
A condition that involves weakening of the connective tissue on heart valves. Most commonly affects the mitral valve -> can lead to MVP.
414
What is Ludwig angina? What's the etiology of this condition?
A rapidly progressive bilat cellulitis of the jaw. It classically arises from an infected 2nd or 3rd mandibular molar.
415
What's another name for laryngotracheobronchitis?
Croup
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?
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)
417
How do you differentiate btwn Beckitt-Wiedmann Syndrome and congenital hypothyroidism?
Both will present w/ macroglossia and umbilical hernia. However, unlike congenital hypothyroidism, BWS will also have *hemihyperplasia, macrosomia*, and *hypoglycemia*
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?
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.
419
Are transudative effusions always bilateral?
Not really. For example, transudative effusions from CHF are bilateral only about 2/3 of the time.
420
Administration of which vitamin has been shown to decrease morbidity and mortality in pts with active measles?
Vit A
421
What's the physiologic effect of Valsalva maneuvers?
It decreases preload.
422
How does increasing the afterload affect the murmurs heard in pts with HOCM and MVP?
Increase afterload -> make it 'harder' for heart to pump blood out -> inc ventricular vol -> dec outflow obstruction -> dec intensity of murmur
423
You suspect gastrinoma in someone, do an endoscopy that further suggest gastrinoma. What do you do next?
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.
424
What's the thought process behind doing a secretin stim test?
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'
425
When would you measure HBV lvls in someone?
If the pt has chronic HBV infxn, you would get viral counts to determine their candidacy for antiviral tx.
426
What's the pathophys behind MPGN type II?
Ab's activate C3 -> persistent activation of alternate complement pathway -> kidney dmg
427
1 Peter 3:18
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...
428
Why is EtOH consumption considered a nono / risk factor for gout?
Urate and lactate compete for renal excretion. Too much lactate = too much buildup of urate in the body.
429
How do you differentiate acute stress d/o and PTSD?
Amt of time sx's are present. Acute stress d/o = 3 days - 1 mo. PTSD = 1 mo+
430
What are two questions I should ask myself whenever I'm trying to see whether to recommend a vaccine or not?
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?)
431
Give me some acute bronchitis jooce plx?
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).
432
What do we give to HIV pts to ppx against MAC? When do we give it to them?
ppx w/ arithromycin when their CD4 counts drop to
433
Why are ppl with fat malabsorption at risk of developing kidney stones?
Excess fats in gut binds to Ca++ in gut -> more oxalate absorbed in gut -> Ca-oxalate stones
434
How do you determine which fluids to use initially in pts with hypernatremia?
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.
435
Differentiate btwn essential tremor vs Parkisonian tremor plx?
Essential tremor = bilateral action tremor
436
How do you differentiate btwn osteoid osteoma and giant cell tumors of the bone on XR?
osteoid osteomas kinda look like bullet holes. giant cell tumors of the bone have this eccentric soap bubble type look to it.
437
When I see someone with a renal cyst, what should I do?
Well, is it benign? Malignant? If benign, leave it alone. If it looks malignant, then do further testing.
438
What are the risks/benefits for combo OCP's?
Risks: VTE's, HTN, hepatic adenoma, very small MI & stroke risk.
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?
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)
440
There are 4 joocy S/E's associated w/ erythropoietin. Rank them from most common to least common!
HTN > Headaches > flu-like syndrome > red cell aplasia
441
Give me ze pathophys jooce behind hereditary angiodema!
C1 inhibitor dysfxn / deficiency / destruction -> elevated lvls of C2 and *bradykinin*
442
Give me ze etiology jooce behind hereditary angioedema!
Episodes typically come about after physical trauma, dental procedures, or infections
443
What is hereditary angioedema characterized by?
Rapid onset of the following w/out evidence of urticaria:
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?
Pharmacist-directed interventions.
445
What is the most common cause of penile fx's? What's the next best step when you suspect one?
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.
446
Do we have a means for screening for pancreatic ca in asymptomatic adults?
NOPESIES.
447
What is eczema herpeticum?
It's a potential complication of eczema, and is 2/2 a superinfection of HSV
448
What drug ppx measures are indicated for pts w/ HIV? When are they indicated?
- If CD4
449
Which immature WBC do you see in the most abundance in pts w/ AML:M3?
Promyelocytes.
450
HINT: AEIOU
*A*cidosis - Metabolic acidosis w/ pH
451
How can you clinically dx menopause?
Amenorrhea > 1 yr, age > 45 y/o. Reasons for amenorrhea can't be for another physiological reason (like hyperthyroidism)
452
What consists of the Tetralogy of Fallot?
1) RV obstruction 2/2 pulmonary atresia/stenosis
453
What are the physical findings in Tetralogy of Fallot?
- Single S2
454
Where does a 'single S2' sound come from?
Single S2 comes from poor pulmonary blood flow through a stenotic pulmonic valve
455
Why would you find edema in Turner grills?
These grills have taintly dev'd lymphatic networks.
456
When should newborns regain their birth weight?
By latest 2 weeks.
457
Tetanus ppx jooce - person comes in w/ minor wound and has had >3 Tdap's -> what to do?!
Vaccinate IFF last dose was >10 yrs ago. *NO* TIG
458
Tetanus ppx jooce - person comes in w/minor wound and has had what to do?!
Vaccinate. *NO* TIG
459
Tetanus ppx jooce - person comes in w/ dirty/severe wound and has had >3 Tdap's -> what to do?!
Vaccinate IFF last booster was >5 yrs ago. *NO* TIG
460
Tetanus ppx jooce - person comes in w/ dirty/severe wound and has had what to do?!
Vaccinate + give TIG
461
What should I watch out for in intubated pts with tension pneumothorax?
Compression of mediastinum -> compromise right heart filling -> hypotension + tachy
462
What's one thing I should be aware of when I intubate someone w/ ARDS?
The pt's at a higher risk of developing tension pneumothorax, as their lung parenchyma's all frakk'd and weakened anyway.
463
What are two things you should screen for when you see someone w/ ITP?
Hep C and HIV.
464
How do you manage delirium in the elderly?
Haldol or other typical/atypical antipsychotics. Benzos are bad, as they tend to metabolize benzos a lot slower.
465
What are the characteristic findings in someone w/ brain death?
Absence of cortical and brain stem fxns. Spinal cord fxns tend to remain intact longer.
466
What makes a test 'invalid'?
If it has low sensitivity and specificity.
467
Which two drugs are used prior to doing a nuclear heart scan? Why are they used?
Either adenosine or dipyridamole is used. They both dilate coronaries and inc coronary blood flow ~3-5x.
468
What is 'nursemaid's elbow'? How do you treat it?
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.
469
What is the conus medullaris?
It's where the spinal cord ends.
470
Define 'inspissated stool'.
Thick stool
471
What are the risk factors for intusseption?
Recent viral illnes, recent rotavirus vacc, 'pathological lead points' (aka 'taint areas), i.e., Meckel's diverticulum, HSP, celiac, intestinal tumors, polyps.
472
What is the most common congenital GI abnormality?
Meckel's diverticulum!
473
Which two drugs are typically used to tx absence seizures?
Ethosuximide and valproic acid
474
What are tardive dyskinesias characterized by?
involuntary perioral mvmts, i.e., biting, chewing, grimacing, tongue protrusions,
475
What kind of rash do you classically see in someone w/ TSS?
A diffuse erythemateous rash all throughout the body
476
Are blood cx's reliable in dx'ing disseminated gonoccocemia?
Not really.
477
What do the RBC's look like on a PBS of someone who's having a scleroderma renal crisis? How does that happen?
Inflammation -> activation of coag cascade, inc'd vasc permeability, inc renin secretion -> renal failure + malignant HTN -> MAHA or DIC w/ schistocytes
478
What's a virtual 'ding ding ding ding' eye finding in a baby who's suffered abusive head trauma?
Bilat retinal hemorrhages
479
What's a potential cardiac complication for ppl w/ h/o stab wounds? How does that complication come about?
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
480
Which interventions for COPD mgmt have mortality benefits?
smoking cessation + home O2 therapy
481
Is HNPCC only associated with a high risk of developing colon ca?
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.
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?
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?
483
What do you typically find on CXR's of ppl who have pulmonary contusions?
Opacities cuz of ze lung bleeding.
484
How do you differentiate fibromylagia from polymyositis and polymyalgia rheumatica from the 'labs' perspective?
FM has WNL labs.
485
What are common risk factors for pseudogout?
hemochromatosis, hyperparathyroidism, recent surgery
486
Which heart murmur is associated w/ a widened pulse pressure?
AR!
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?!
*Measles* - high fever (>104 degF), cranial-caudal spread of rash more gradual than rubella's, NO ARTHRITIS
488
Is steroid-induced myopathy a thing? If so, what would you find on labs?
YEP. CPK and ESR will be normal.
489
I know I have a card on this, but what's the main pathophys process behind Paget's dz of bone?
Taint amts of bone turnover -> overactive osteoclasts -> osteoblasts in turn go nuts -> taint bone formation
490
How do you differentiate Leydig cell tumors and seminomas from the lab perspective?
*Leydig cell tumors* - high testosterone, high estrogen (2/2 inc aromatase expression)
491
So, apparently...some aminoglycosides, gentamycin in particular, can cause vestibular injury. What can you do on your physical exam to detect this?
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.
492
How do you confirm the dx of laryngomalacia?
Flexible laryngoscopy w/ HUUUUUGE epiglottis.
493
Are fluoroquinolones first line tx for UTI's in non-preggo women?
Nope. Nitrofurantoin and Bactrim are. Use dem -quinolones if the other two fail / if the specific area has high resistance rates
494
Deformed babies 2/2 inappropriate usage of drugs/meds in mom jooce - How does preggo mom's usage of EtOH affect baby?
midfacial hypoplasia, microsomia, stunted growth, CNS dmg. Unlike phenytoin, cleft palate and excessive hair = very uncommon.
495
Deformed babies 2/2 inappropriate usage of drugs/meds in mom jooce - How does preggo mom's usage of phenytoin affect baby?
midfacial hypoplasia, microsomia, MR, stunted growth, cleft palate, hirsuitsm, rib anomalies, digital hypoplasia
496
How do you differentiate btwn gingivostomatitis 2/2 *Coxackie A* virus vs *HSV-1*?
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.
497
You see someone after they had their first miscarriage. What's the next best thing to do, and why?
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.
498
Up to which age is bedwetting normal?
5 y/o
499
You dx someone w/ TTP-HUS. What's the next best step, and why?
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.
500
Spherocytes w/ central pellor can be found in which dz's?
Hereditary spherocytosis AND AIHA!
