Random Flashcards
1
Q
Yellow fever vaccination
A
Live attenuated vaccine
When travelling africa asia south america
🚫 Egg allergy,immunosuppression
2
Q
Meningococcal vaccination
A
Primary> 11-12
BOOSTER 16-21
Risk do it even if >18 —> asplenia, college, travel to endemic areas (sub saharan africa, Muslim hajj pilgrimage)
3
Q
Most common microorganism in brain abscess >
A
Viridans strep and S. Aureus
4
Q
Normal pressure hydrocephalus
A
Gait disturbance
dementia
urinary incontinence
5
Q
Homocysteinemia
A
increased risk of thrombosis
give B6 pyridoxine
6
Q
Acute angle closure glaucoma
A
Severe eye pain
Pupil dilated and poorly responsive to light
Migraine like symptoms
7
Q
Strongest association with Cerebrovascular accidentº
A
Hypertension
8
Q
Congenital adrenal hyperplasia
A
90% due to 21 hydroxylase deficiency
⬇️ Cortisol and aldosterone > ⬆️ ACTH»_space; ⬆️Adrenal hyperplasia »_space; ⬆️ FSH LH 17 hydroxyprogesterone
9
Q
Pregnant woman + metabolic alkalosis
A
Hyperemesis gravidarum
10
Q
Anterior mediastinal mass
A
Thymoma
Teratoma
Thyroid
Terrible lymphoma
11
Q
Dacryocystitis
A
Infection of the lacrimal sac
12
Q
Which is the most effective intervention in diabetic nephropathy + azotemia ?
A
Intensive blood pressure control
13
Q
MEN 1
A
Primary ⬆️PTH
Pituitary tumors
Pancreatic tumors
14
Q
MEN 2A
A
Medullary thyroid cancer (calcitonin)
Pheochromocytoma
Parathyroid hyperplasia
15
Q
MEN 2B
A
Medullary thyroid cancer
Pheo
Mucosal neuromas/marfanoid habitus
16
Q
Migraine prophylaxis
A
Topiramate
Divalproex
Tricyclic antidepressants
Beta blockers
17
Q
Guillian barre syndrome treatment?
A
IV immunoglobulin or plasmapheresis
18
Q
Ehrlichiosis
A
Tick borne Southeastern&south central US
Fever + altered mental status + No rash + penias
Doxycicline
19
Q
Acute multiple sclerosis treatment
A
Treatment: Glucocortids > if not effective > Plasmapheresis
20
Q
Pseudotumor cerebri
A
look for an obese woman with headaches
ICP may lead to momentary vision loss
21
Q
Leprosy
A
Chronic granulomatous > M. leprae
Immigrants
Chronic, anesthetic, macular hypopigmented lesions. Nearby nerves often become nodular.
22
Q
Epididymis
A
> 35 yo : E. Coli
<35 yo: Chlamydia trachomatis, N. gonorrhoeae
23
Q
UTI + Alkaline urine ?
A
Proteus mirabilis
Klebsiella pneumoniae
24
Q
Mitral valve prolapse
A
Due to myxomatous degeneration of the mitral valve
most common cause of Mitral regurgitation in the first world!
25
Tricyclic antidepressant toxicity
Seizures,anticholinergic toxicity
cardiac toxicity>> 🚫 Na+ channels >arrhythmias > if QRS >100 ms > Sodium Bicarbonate > reduces affinity of the channel for the TCAs
Give activated charcoal if <2 h of ingestion
26
Differential for esophageal ulcers
––Pill esophagitis > mid 1/3, sudden onset, discrete ulcer with normal appearing surronding mucosa (Tetracyclines, potassium chlorid, biphosphonates)
––Candida> white plaques
––Cancer> progressive dysphagia and unintentional weight loss
27
Iron poisoning
Radiopaque pills
abdominal symptoms, hematemesis > hypotensive shock, anion gap metabolic acidosis
Whole bowel irrigation> Deferoxamine
28
Large abdominal surgery+Bloody diarrhea postsurgery
Ischemic colitis
29
Congenital bicuspid aortic valve
aortic regurgitation in adults
30
Waldernstrom macroglobulinemia
IgM spike! > Plasma cell malignancy
| Hyperviscosity syndrome, neuropathy, penias
31
Rheumatic fever
Give Penicillin
| If persistent heart disease >> >10 years or until 40 years
32
Bruton agammaglobulinemia
X linked
Low serum igs and few B cells
symptoms after 6 months
Sinopulmonary and GI infections
33
Myasthenic crisis
⬆️ Weakness, respiratory insufficiency
| Plasmapheresis
34
Herpes retinitis
HIV +
| Keratitis > acute retinal necrosis
35
CMV retinitis
HIV
36
Varicella postexposure prophylaxis
immune: prior infection or 2 prior doses
Immunocompetent: Give vaccine
Immunocompromised: Immunoglobulin
37
Type 2 Heparin induced thrombocytopenia
Thrombocytopenia + arterial trombosis
38
Lyme disease treatment
1st: Doxycicline
2nd: Amoxi also for children and pregnant women
Serious disease: Ceftriaxone
39
Sturge weber syndrome
Seizures
Mental retardation
Port wine stain or nevus flammeus
40
Mumps
Parotiditis
Orchitis
Aseptic meningitis
41
Cancer + Cachexia treatment
Progesterone analogues
42
Torsades de pointes + stable
Intravenous magnesium
43
Hemineglect syndrome
Lesion of the non dominant parietal lobe (spatial organization
44
Metastasic breast cancer + hypercalcemia
Biphosphonates
45
Graves' disease treatment
Mild/ pregnant / older: Methymazole
Moderate to severe: radioactive iodine
Large goiter / pregnant / huperparathyroidism: surgery
46
48 hours old baby, irritability, high pitched cry, poor sleeping, tremors, seizures, sweating, sneezing
Heroin abstinence syndrome
47
Baby
Nail and digit hypoplasia
Dysmorphic facies
Mental retardation
Fenitoin exposure
48
Antenatal test: Down syndrome
>35 YO
⬆️ MSAFP, INHIBIN A
⬇️ Estriol
49
Neural tube or abdominal wall defects
⬆️ MSAFP
50
Antenatal test: trisomy 18
⬇️ MSAFP BHCG ESTRIOL
51
Risk for ovarian cancer
Endometriosis
Use of fertility drugs
Nulligravity
family history (BRCAmutation)
CA 125 levels > higher specificity for postmenopausal women
52
Protective factors for ovarian cancer
Delayed menarche
| early menopause
53
Risk factors for cervical cancer
Immunosuppression
Many sexual partners
smoking
54
Endometrial cancer risk factors
```
Chronic anovulation
Obesity
Tamoxifen
Early menarche
No babies
```
55
Protective for endometrial cancer
Progesterone
56
On warfarin + emergent surgery
Plasma
57
Adjustment disorder treatment
Psychotherapy
58
Antiphospholipid syndrome
Venous thromboembolism / Miscarriages
Lupus anticoagulant, anticardiolipin, b2 glycoprot 1 atb
⬆️PTT
59
First UTI baby
Ultrasound
60
Anterior cruciate lesion
Popping sensation
Hemarthrosis
Joint instability (anterior drawer test, lachman test)
61
Untreated vesicoureteral reflux
Renal scarring
62
Vit D def
Exclusive breastfeeding
Craniotabes
Costochondral joint hypertrophy
Genu varum
63
Spontaneous pneumothorax treatment
Small <2 cm: O2
| Large stable: needle aspiration or chest tube
64
Refractant schizophrenia
––Clozapine
65
Abnormal pap smear results
Immediate colposcopy
66
Carcinoid syndrome
Flushing, diarrhea, valvular lesions
| NIACIN DEFICIENCY
67
Trichinellosis
Parasitic: Trichinella
| Myositis + eosinophilia + periorbital edema
68
CIN 3 treatment
LEEP
Cold knife conization
cryoablation
Do pap + hov 1-2 years postprocedure
69
Giant cell arteritis
Headaches, jaw claudication, visual disturbances
| complications: aortic aneurism
70
Infertility
<35 yo women: 12 months trying
| >35 yo women: 6 months trying
71
Absence seizures
No postictal period
| Provoked by ventilation
72
Severe combined immunodeficiency
Severe infections
Failure to thrive
lymphopenia (CD 19+: B cells, CD 3+: T cells)
Tx: Stem cell transplantation
73
Smoking cessation
Nicotine replacement therapy
Varenicline: mood changes, suicidality
Bupropion: 🚫 seizures or bulimia
74
Uremic coagulopathy
Due to platelet dysfunction
75
Contraindicated vaccines on pregnancy
HPV
MMR
Lived attenuated influenza
76
Recommended vaccines in pregnancy
Tdap
Inactivated influenza
RhoD
77
Indicated vaccines for high risk patients
Hep B, Hep A, Pneumococcus, Haemophilus, meningococcus, Varicella zoster immunoglobulin
78
Polycythemia vera
```
Erythrocytosis
Hyperviscosity
aquagenic pruritus
pletora
splenomegaly
```
tx: phlebotomy & hydroxyurea
79
Bhcg AFP
| mediastinal mass
Non seminomatous germ cell tumors
80
HIV
| renal failure
Focal segmental glomerulosclerosis
81
Tetralogy of Fallot
Ventricular septal defect
Overriding aorta
Right ventricular outflow tract obstruction
RV hypertrophy
82
Testicular mass > suggesting cancer
Orchidectomy
83
Which tests >> sexually active women < 25 yo ?
Gonorrhea and chlamydia testing
Pap 21 yo or >3 yo
HPV starting 30 -65 yo: is negative 5 years interval
84
Pharmacotherapy + depression
Continuation: 4-9 months
Maintenance: 1 years
If severe: lifetime
85
Chemotherapy associated neuropathy
Vincristine
Cisplatin
Paclitaxel
86
Cyanotic baby at rest and feeding > resolves when crying
Choanal atresia
87
Tetralogy of Fallot
Ventricular septal defect
Overriding aorta
Right ventricular outflow tract obstruction
RV hypertrophy
88
Muscle rigidity
delirium
autonomic instability
high fever
Neuroleptic malignant syndrome
Due to dopamine disregulation
89
Treatment TTP
plasma exchange
90
Unstable sinus bradycardia: treatment
Atropine > 3-5 min
| No response: transcutaneous pacing
91
Osler weber rendu syndrome
Telangiectasias + epistaxis + widespread AV malformations
| Also AVMs in the lungs > chronic hypoxemia > polycythemia
92
Malignant otitis externa
Granulation tissue within the canal
Due to Pseudomonas
Might be nerve involvement
93
Empyema
Low glucose <60
low pH < 7,2
High protein
94
Pap smear in HIV
TWICE the diagnosis year
| annually thereafter
95
Tdap vaccine in adults
At 11-18 once
| >19 yo if not before
96
Laxative abuse
Watery diarrhea
Hypokalemia
Hypermagnesmia
Colonoscopy: Melanosis coli > dark brown discoloration of the colon
97
Trousseau's syndrome
Unexplained superficial venous thrombosis
CA > pancreas!!! lung, prostate, stomach, colon acute leukemias
98
Foodborne poisoning
S aureus / bacillus cereus > hours> quick onset (preformed toxin)
C. perfingens, ETEC > 1 day> Enterotoxin made in intestine
Bacterial epithelial invasion: campylobacter jejuni, listeria monoH
99
high yield!!!!!!!!!!!!
Ataxia, dysarthria
scoliosis, feet deformities
Cardiomaopathy in 90%
Friedreich ataxia
| Autosomal recessive
100
Delusional disorder
> 1 delusions > 1 month
| Functional
101
SIADH
Hypotonic hyponatremia in an euvolemic patient
102
Polycystic ovary syndrome + infertility treatment
Weight loss
| Clomiphene citrate
103
Alzheimer's disease treatment
First line: Cholinesterase inhibitors (donezepil, galantamine, rivastigmine)
104
Pertussis prophylaxis
Despite vaccination status
| Macrolides
105
Aortic stenosis etiology
<70: bicuspid valve
| >70: calcification
106
Contraindication for breastfeeding
TBC
HIV infection
Herpetic breast lesions
Varicella infection <5 days before and 2 days after delivery
107
Osteoporosis screening
1 DEXA > 65 yo
| <65 yo increased risk (smoking, excessive alcohol intake, estrogen deficiency, sedentary lifestyle)
108
Alport's syndrome
Gross hematuria
Proteinuria
Sensorineural deafness
109
Carpal tunnel syndrome
Clinical diagnosis
| Nerve conduction studies
110
Child not taking in social settings, talks at home
Selective mutism (anxiety disorder)
111
Pronator drift
Sign suggesting > Pyramidal tract or cortical disease
112
First seizure episode in a healthy adult
Exclude: Metabolic and toxic causes
| After that > Imaging , LP
113
Most common cause of community acquired bacterial meningitis
Strep pneumo
| >50 yo or immunocompromised > Also Listeria monocytogenes
114
Risk factors for C difficile
Antibiotics (clynda, fluroquinolones)
Hospitalization
>65 yo
Gastric acid suppresion
115
C difficile diagnosis and treatment
Stoop PCR or toxin detection
Oral metronidazole or vancomycin
116
Athlete / insidious onset of localized pain / point tenderness
Stress fracture
| Tibia, tarsal bones
117
STEMI initial treatment
```
Supplemental oxygen
Aspirin 325 mg
P2Y12 inhibitor
Nitrates
B blocker if not contraindicated
High do se statin
Anticoagulation
Pulmonary edema > Furo !
```
118
Goals gestational DM
Fasting: <95
1h : <140
2h: <120
119
Child with sickle cell disease / acute drop in hb / low reticulocyte, most likely diagnosis?
Aplastic crisis
| Associated with Parvovirus B19
120
Vancomycin side effects
Ototoxicity
Red man syndrome
Nephrotoxicity
121
White matter demyelination
Nonenhancing hypodense white matter lesions no edema
<200CD4
Progressive multifocal leukoencephalopathy
Due to reactivation of JC virus
122
Clinical presentation Pancoast tumors
Shoulder pain
Horner syndrome
C8 T1 involvement
weight lost
123
Best markers indicating resolution of DKA
Serum anion gap
| Beta-hydroxybutyrate
124
Patient with bipolar history and severe episode (psych, high risk of suicide, aggression)
Lithium or valproate + second generation antipsychotic
125
Dysphagia to solids and liquids
weight loss
Manometry: ⬆️ LES resting pressure / Incomplete LES relaxation
Achalasia
Barium esophagogram: bird-beak narrowing near LES
126
Child 6-36 months
previous diarrhea now in periodic pain
Currant jelly stools
Target sign on US
Intussusception
Tx: Air enema
127
EBV DNA in CSF + HIV
Suggest lymphoma
128
Absence seizures treatment
Ethosuximide
129
Bilateral internuclear ophthalmoplegia
Classical in Multiple sclerosis
130
Tardive dyskinesia
Orofacial / choreathetoid movements
Due to D2 receptor upregulation and supersensitivity
131
Avoid transmission of measles
Airborne protection (negative pressure room, N95 facemask)
132
Unilateral Renal artery stenosis
ACEs / ARBs
| Contraindicated only in bilateral
133
Hypertrophic cardiomyopathy
| auscultatory maneuvers?
--Increasing LV cavity size > ⬆️ Preload or afterload (squatting - leg raise - handgrip) > ⬇️ MURMUR
--decreasing cavity size > ⬇️ preload (valsalva, standing, amyl nitrate ) > ⬆️ MURMUR
134
Blunt trauma + stable > what's next?
FAST > CT
135
Sjogren syndrome diagnosis ?
Atbs to Ro SSA and La SSB
136
Toddler with hemolytic anemia, thrombocytopenia, acute renal failure and bloody diarrhea
HUS
Tx: supportive
137
Renal tubular acidosis
Non Anion gap metabolic acidosis (⬆️ K+)
| + preserved kidney function
138
Porphyria cutanea tarda
Blisters, bullae, scarring, hypo/hyperpigmentation
Common in > Hep C, HIV, excessive alcohol consumption, estrogen use, smoking.
139
Ankylosing spondylitis associated diseases
Heart block
Uveitis
Enthesitis >
140
Male in his 20s with >3 months fatigue, hip pain that worsens with inactivity/ relieved with exercise, XR > erosions and arthritis involving sacroiliac joints
Ankylosing spondylitis
Also: dactylitis, enthesitis, HLA B27
141
Treatment for parkinsonism
Benztropine or amantadine
142
Common initial symptoms in MS
```
Optic neuritis
Transverse myelitis (Motor + sensory loss below level of lesion + bowel or bladder dysfunction)
Internuclear ophthalmoplegia > medial longitudinal fasciculus
Cerebellar dysfunction
```
143
Supracondylar humerus fracture complication
Neurovascular injury >> compartment syndrome
144
Dementia with lewy bodies, clues:
Visual hallucinations, parkinsonism, fluctuating cognition
145
Vascular dementia, clues:
Stepwise decline, early executive dysfunction
146
Ewing sarcoma presentation
Long bones chronic pain
Swelling
deformity
147
Osteoid osteoma
Adolescence - males
Xray: round radiolucency
Relief with NSAIDS
148
Endometrial biopsy indications
> 45 yo: postmenopausal bleeding
< 45 YO: Abnormal uterine bleeding plus > risks (obesity, anovularion), failed medical management, lynch syndrome
>35 YO: atypical glandular cells on pap test
149
HELLP syndrome
Hemolysis
Elevated liver enzymes
Thrombocytopenia
Thought to result from abnormal placentation leading to systemic inflammation and coagulation activation
150
Missed abortion
No bleeding / cervical os closed
| no fetal cardiac activity
151
Amyotrophic lateral sclerosis
Upper and lower motor neuron lesions
Spasticity
bulbar symptoms
⬆️ deep tendon reflex / fasciculations
152
Most common pediatric CNS tumors
```
Pilocytic astrocytoma
Supratentorial tumor (seizures, increased ICP)
```
153
IF child with pertussis > prophylaxis to close contacts?
Macrolides despite vaccination status
154
Myotonic muscular dystrophy
Auto dominant
12-30 yo / facial weakness / hand grip myotonia / dysphagia / small testicles / arrhythmias
155
Most common cause of sepsis in SCD
S pneumoniae
| Despite vaccination
156
Herpangina
Due to Coxsackie A virus
3 - 10 yo
summer - fall
Fever / pharyngitis / gray vesicles- ulcers posterior!
157
Hereditary angioedema
spontaneous angioedema / no urticaria
etiology: C1 inhibitor deficiency
158
Juvenile idiopathic arthritis
>6 weeks
Joint inflammation
Findings: >CPR, hyperferritinemia, hypergammaglobulinemia, thrombocytosis, anemia
159
Phenylketonuria post neonatal diagnosis
Quantitative amino acid analysis
| Increased phenylalanine levels
160
Wrist and hand joints pain + clubbing + Pulmonary disease
Hypertrophic osteoarthropathy
161
Hypernatremia treatment?
Euvolemic > Free water
| Hypovolemic > symptoms > first SSN > when euvolemic 5% DE
162
Fetal risk for maternal HTN
Growth restriction
perinatal mortality
preterm delivery
oligohydramnios
163
Immediately should raise suspicion of deliberate immersion injury?
spare flexor surfaces
164
ewing's sarcoma
⬆️ Male 20s
Metaphysis and diaphysis of femur > most common
X ray > lytic lesion > onion skin appearance > moth eaten pattern
165
Stress urinary incontinence treatment
Exercises > pelvic floor surgery (most effective)
166
Urge incontinence treatment
Bladder training > antimuscarinic drugs (oxybutinin)
167
Overflow incontinence
Constant involuntary dribbling
Tx: Cholinergic agonist > bethanecol
168
Falling to improve after SRI trial
switch to another first line antidepressant > duals
169
Diethyllstilbestrol in utero exposure risks
VAGINAL CLEAR CELL ADENOCARCINOMA
cervical or uterine malformations
males: cryptorchidism, microphallus
170
Rhino orbital cerebral mucormycosis treatment
Surgical debridement > ampho B
171
Sickle cell trait risks
Hematuria > due to papillary necrosis
| Inability to concentrate urine
172
Neurofibromatosis 1
cafe au lait spots
macrocephaly
mental retardation
short stature
173
Neurofibromatosis 2
bilateral acoustic neuromas and cataracts
174
Ethylene glycol intoxication
flank pain, hematuria, tetany
calcium oxalate crystals
high anion gap metabolic acidosis
175
Treatment ethylene glycol and methanol poisoning
Fomepizole (competitive inhibitor of alcohol dehydrogenase)
176
Methanol poisoning
Visual blurring, afferent pupillary defect
high osmolar gap
metabolic acidosis high anion gap
177
Thiazides side effects (HTZ, chlorthalidone)
hyperglycemia, increased LDL
| Hypokalemia, hypercalcemia
178
Enlargement of submandibular glands, association?
Advanced liver disease
179
Bipolar depression
Quetiapine, lurasidone (second generation antipsychotics)
| or lamotrigine
180
Pseudotumor cerebri treatment
First line: acetazolamide (🚫 choroid plexus carbonic anhydrase) >> add furo >> surgical
181
Marfan syndrome inheritance
Autosomal dominant (extracellular matrix protein fibrillin-1) mutation
182
liver cyst, hydatid cyst + history of dog feces exposure
Echinococcus granulosus > dog tapeworm
tx: < 5 cm albendazole >10 cm percutaneous or surgery
183
History of undercooked fish
liver flukes > biliary disease
| fish tapeworm, diph latum > megaloblastic anemia
184
pulmonary Histoplasmosis
```
Mississippi and ohio river basins
Symptoms
mediastinal or hilar lymph nodes
arthralgias
erythema nodosum
```
dx: urinary antigen test
185
Papillary thyroid cancer
most common
| Spread into local tissues and regional
186
Follicular thyroid cancer hysto clue:
Invasion of tumor capsule and blood vessels
187
CSF finding in multiple sclerosis
oligoclonal igG band
| Normal opening pressure, protein and cell count
188
Hemophilia A
X linked recessive
| Factor VIII def
189
Hemophilia B
X linked recessive
| Factor IX
190
Increased risk of malignancy on colonoscopy
Adenomatous polyps
| ⬆️ higher risk: >1 cm , dysplasia, villous
191
HIV screening
15-65 yo all patients
192
Wallenberg syndrome
Infarction at lateral medulla > vertebral artery compromise
Multiple signs: vestibullocerebellar
loss of pain and temp ipsilateral face and contralateral trunk
bulbar muscle weakness
Horner's other autonomic > hiccups, lack of automatic respiration
193
Microorganism associated with endocarditis after gingival manipulation or respiratory tract manipulation
Viridans group streptococci (mutans, viridans, sanguinis)
194
Exudates: light criteria
Pleural protein / serum protein >0.5
pleural LDH / serum LDH >0.6
pleural LDH >2/3 of the upper limit of normal LDH
Also low glucose (due to high metabolic activity of leukocytes )
195
Raloxifene
Selective estrogen receptor modulators in osteoporosis
Adverse effects: hot flashes, venous thromboembolism
196
Tamoxifen adverse effects
Hot flushes
VTE
endometrial cancer
197
Lesch Nyhan syndrome
X linked recessive disorder
Due to Hypoxanthine-guanine phosphoribosyl transferase
uric Acid accumulation, automutilation, gouty arthritis, nephropathy.
198
Vitamin K dependant factors
X VII II IX 1729 / PROT C & S
199
Acute bacterial rhinosinusitis: micros?
s pneumoniae > Hib > Moraxella catarrhalis
200
Pellagra
Niacin deficiency >
dermatitis (sun exposed areas, hyperpigmentation)
diarrhea
dementia
Immigrants and alcoholics
201
Painless hematochezia in a toddler
Meckel's diverticulum
Dx: technetiym 99m petechnetate scan
202
Molluscum contagiosum
caused by a poxvirus
small skin colored umbilicated papules, spares soles and palms
203
Absence seizures comorbidities
ADHD
| Anxiety
204
Invasive aspergillosis
Fever, chest pain, hemoptysis
CT> Halo sign (nodules with surrounding ground glass opacities)
tx: voriconazole and caspofungin
205
Iron supplementation in children
start before 6 months if: prematurity, maternal iron deficiency, cow's milk before age 12 months
206
SuppLementation of vit b12 in a toddler if:
Strict vegetarian mothers
207
Polymyalgia rheumatica
>50 yo
bilateral pain & morning stiffness > 1 month
involvement of neck, shoulders, proximal thigh
elevated ESR >40 OT CRP
208
Tumor lysis syndrome
↑ PO4, K, uric acid
↓ Calcium
AKI
cardiac arrhythmias
209
<25 yo, sexually active, mucopurulent discharge with a friable cervix
Acute cervicitis
tx: Ceftriaxone + azithromycin
210
Hepatomegaly + diabetes
think in hemochromatosis
211
Chondrocalcinosis
Diagnostic of pseudogout
need to rule out hyperparathyroidism, hypothyro, hemochromatosis
212
Acidemia after tonic clonic seizure
Transient (<90 mins) lactic acidosis
213
Obsessive compulsive disorder treatment
SSRI
| cognitive behavioral therapy (exposure nd response)
214
Factor V Leiden deficiency
activated protein C resistance
| Thrombosis!!!
215
Pediatric constipation treatment
↑ dietary water and fiber
Limit cow's milk intake <24 oz
Laxatives
216
Breastfeeding failure jaundice
decreased bilirubin elimination
Increased enterohepatic circulation
suboptimal breastfeeding / signs of dehydration
217
Breast milk jaundice
adequate breastfeeding
| normal examination
218
Smoker / head and neck tumor
Squamous cell carcinoma
219
Oxytocin adverse effects
Hyponatremia
Hypotension
tachysystole
220
Intensive glycemic control benefit
in microvascular complication
| <6% HgA1c ↑ mortality
221
Guillain Barré syndrome - respiratory failure
evaluate FVC (<20 ML/KG > INTUBATION!)
222
Acute pancreatitis complications
pancreatic pseudocyst
| fistula formation
223
Pancreatic pseudocyst treatment
asymptomatic > nothing by mouth
| symptoms > drainage
224
Bloody diarrhea after infrarenal aneurysm repair
bowel ischemia
225
Chronic methamphetamine use
Psychotic symptoms
Weight loss
severe tooth decay
skin excoriations
226
Cryptococcal meningoencephalitis treatment
Amphotericin B + Flucytosine >>> followed by fluconazole x 1 year
227
AIDS + Conductive hearing loss
Most commonly > serous otitis media
228
Innocent murmurs clue
↓ venous return (valsalva, standing) ↓ intensity
229
Howell jolly bodies
Functional asplenia > SCD
230
Helmet cells (schistocytes)
Microangiopathic hemolytic conditions
231
Heinz bodies (bite cells)
Glucose 6 phosphate DH
| Thalassemia
232
TCA overdose
seizures
cardiac conduction delay
anticholinergic effects
QRS >100 ms >>> ↑ ventricular arrhythmia
233
Lithium follow up labs
Thyroid function
BUN /SCR
Uroanalysis
ECG > if coronary risk
234
Lead poisoning
Screen if increased risk > confirm in venous sample
mild 5-44 > repeat in 1 month
45-69 mcg dl> DMSA
SEVERE >70 MCG DL> Dimercaprol + EDTA
235
Hep C
Antibody + molecular testing
if positive > consider ledipasvir + sofosbuvir
Vaccinate for Hepatitis A and B
236
Mittelschmerz
pain due to Ovulation
237
Anti mitochondrial antibodies +
Primary biliary cholangitis
238
Anti smooth muscle antibodies +
Autoimmune hepatitis
239
Histoplasmosis treatment
itraconazole
240
Sporotrichosis
S schenckii> dimorphic fungus
Skin papule> ulceration > lymphadenopathy
tx> itraconazole
241
Dietary recommendations for patients with renal calculi
increased fluid intake, decreased sodium intake, normal dietary calcium
242
Initial prenatal labs?
```
RhD type
HB/Hto MCV
HIV VDRL RPR HBsAg
Rubella Varicella immunity
Pap test
Chlamydia PCR
Urine culture / proteins
```
243
Warfarin interaction: ↓ Effect
```
CYP450 Inducers:
Carbamazepine
phenytoin
ginseng
Oral contraceptive
Rifampin
Phenobarbital
```
244
Warfarin interaction: ↑ effect > bleeding
```
Acetaminophen, NSAIDs
Amiodarone
Cimetidine
Cranberry juice, ginkgo biloba, vit E
omeprazol
Thyroid
SSRI
```
245
Uremic pericarditis
BUN >60
| Diffuse ST segment elevation > rare
246
History of GERD
Slowly progressive dysphagia
Symmetric circunferential narrowing of distal esophagus
Esophageal stricture
247
Potter sequence
Urinary tract anomaly> anuria/oliguria > oligohydramnios > pulmonary hypoplasia, flat facies, limb deformities
248
Present in brain death
Deep tendon reflexes
249
Bacillary angiomatosis
Bright red, firm, friable, exophytic nodules
HIV +
Due to Bartonella > tx: erythromycin
250
Premature newborn vaccination
All, except Hep B if <2000 gr
251
Solid organ transplant chemoprophylaxis
TMP SMX
| if donor + CMV > ganciclovir, valgaciclovir
252
Hepatic hydrothorax
Transudative pleural effusions > due to leakage of ascitic fluid through small defects in the diaphragm
253
Pseudotumor cerebri most significant complication
blindness
254
Carpal tunnel syndrome treatment
Nocturnal wrist splinting > surgery
255
Huntington disease
Chorea, dementia, psychiatric symptoms
Auto dominant
Atrophy of the caudate
256
Neuroimaging studies abnormalities in schizophrenia
Lateral ventricular enlargement
257
Severe cancer pain
Strong short acting opioids > long acting opioids +short acting if pain
258
Peripheral smear findings in thalasemias
Target cells
259
Spherocytosis
Hemolytic anemia / jaundice / splenomegaly
| Auto dominant > Ankyrin protein defect
260
Leriche syndrome
Bilateral hip, thigh and buttock claudication
Impotence
Symmetric atrophy of the bilateral lower extremities
261
Disseminated gonococcal infection
Polyarthralgia
Tenosynovitis
Painless vesiculopustular skin lesions
262
GLP1 analogues effects
↓ HBA1C 0.5%- 1 %
Weight loss
Low hypoglycemia risk
263
Sulfonylureas
Weight gain & hypoglycemia
264
Treatment for CIN 2-3
Cervical conization
Complications: cervical stenosis, preterm birth, PPRM, second trimester pregnancy loss
265
Treatment for social anxiety
Non pharm: Cognitive behavioral therapy
Pharm: SSRI, SNRI
Performance only subtype: B blockers
266
Macular degeneration
Leading cause of blindness in industrialized countries
Earliest: distortion of straight lines
Drusen deposits in the macula
267
Metatarsus adductus
Corrects spontaneously
| Flexible feet
268
RR is similar to OR when....
The incidence of the disease is low
269
Coarctation of the aorta results from...
Thickening of the tunica media near the junction of ductus art and the aortic arch
270
Etiology of deep plantar infection after a puncture wound
S aureus
| Pseudomonas aeruginosa
271
Endometrioma
Due to endometriosis
| Chronic pelvic pain + cystic ovarian mass
272
G6PD induced hemolytic anemia
X linked disorder
triggered by exposure to infections or sulfas/dapsone
G6PD levels have decreased sensitivity in acute attacks
273
Primary cholangitis
autoimmune destruction of intrahepatic bile ducts
Fatigue/pruritus/jaundice/hepatomegaly/cutaneous xanthomas
↑Alkaline Phosphatase
+ Anti Mitochondrial antibody
Complications: malabsorption, fat vit deficiencies, osteomalacia, hepatocellular carcinoma
274
Heat stroke
Core temperature >40 C and altered mental status
| Exertional if> exercise in hot humid environment
275
Most common cause of liver mass
Metastasic disease
276
Urinalysis in AKI
Muddy brown granular casts > renal tubular epithelial cells
277
Most common lesion in diabetic nephropathy
Diffuse glomerulosclerosis
278
Dermatomyositis
Proximal, symmetric weakness
Gottron's papules, heliotrope rash
DX: ↑CPK Aldolase LDH / + Anti RNP anti Jo1 Anti Mi2
-biopsy
tx: glucocorticoids + gluco sparing agent /screening for malignancy
279
Reye syndrome
```
Encephalopathy
Hepatic dysfunction
Cerebral edema
Increased intracranial pressure
Associations: aspirin & varicella or influenza
```
280
Enuresis pharm interventions
Desmopressin > rapid improvement
281
Diffuse esophageal spasm
Spontaneous pain, odynophagia for cold or hot food
Might improve with Nitrates and calcium channel blockers
DX: Esophageal manometry
282
SSRI
Fluoxetine / Paroxetine / sertraline / citalopram
283
SNRIs
Venlafaxine / Duloxetine
284
Combination of pure sensitive and pure motor symptoms lesion;
Thalamus internal capsule
285
Intussusception
```
Abdominal pain
vomiting
bloody mucus in stools (currant jelly stool)
>US: target sign
>Sausage shaped RUQ mass
tx: air enema> laparotomy
```
286
Classic derangement in pyloric stenosis
Hypochloremic, hypokalemic metabolic stenosis
287
Riluzole is used for:
🚫 glutamate
Treatment of ALS
288
Nitrates antianginal effect
By decreasing preload and left ventricular end diastolic volume > ↓ myocardial oxygen demand
289
Nephrotic syndrome complications
Hypercoagulability
Accelerated atherosclerosis
Hyperlipidemia
290
Multiple system atrophy (shy drager syndrome)
Parkinsonism
Autonomic dysfunction
widespread neurological signs
291
Specific digitalis induced arrhythmia
Atrial tachycardia with AV block
292
Pneumonia in a patient with cystic fibrosis
Cefepime
| Vancomycin
293
Cervicofacial Actinomyces treatment
Penicillin
| If severe > surgery + penicillin
294
Asbestosis
Occupational exposure >Mining, shipyard
Increased risk of cancer
Pleural plaques on XRC
Interstitial fibrosis > restrictive pattern on spirometry
295
Cyclophosphamide adverse effects
```
Acute hemorrhagic cystitis
Bladder carcinoma
sterility
myelosuppression
Prevented with MESNA.
```
296
Pleural effusion > what to do first?
Thoracentesis
| Except in patients with clear cut evidence of CHF
297
Latent pulmonar TBC treatments
Isoniazid + piridoxime >9 months
298
Euthyroid sick syndrome
↓ Total and free T3
| Normal T4 and TSH
299
Type II osteogenesis imperfecta
Multiple fractures
Hypoplastic thoracic cavity
Fetal growth restriction
300
Common variable immunodeficiency
Recurrent GI and respiratory infections
| ↓ IgG IgA/IgM
301
Disseminated Histoplasmosis treatment
Amphotericin B > Itraconazole
302
acute AF in WPW treatment
Hemodynamically unstable > cardioversion
| Stable > ibulitide or procainamide
303
CELIAC DISEASE
suspect if malabsorption and iron deficiency anemia
304
Glucocorticoid related myopathy
No inflammation or tenderness
normal ESR and CK
Starts after months of glucocorticoids use
305
Pediatric constipation is a risk factor for....
UTI
| For complete voiding
306
Gold standard for diagnosis of Duchenne muscular dystrophy
-Genetic testing (dystrophin gene on Xp21)
307
Aortic regurgitation associated pulse
Water hammer pulse (Hyperdinamic pulse)
308
Paget disease
```
↑Bone turnover
↑Alkaline phosphatase
Normal calcium and phosphorus
Osteolytic or sclerotic lesions / focal increase in uptake
Complications: hearing loss,
```
309
Basal cell carcinoma clinical characteristics :
Slow growing papule with pearly rolled borders
310
Primary side effect of hydroxyurea
Myelosuppression
311
Phencyclidine intoxication
```
Aggression
Severe agitation
Impulsivity
Acute psychotic symptoms
Tachycardia
Nystagmus
```
312
Brief psychotic disorder
>1 day
<1 month
full return to function
313
Male with elevated estrogens and a testicular mass
Leydig cell tumors
314
Hyperkalemia acute treatmen if EKG changes
calcium gluconate
315
Fluoroquinolones muskoloeskeletal risks..
Achilles tendinopathy
316
IF jaundice and pancreatic malignancy suspected:
Ultrasound > likely tumor in the head of the pancreas
317
Major depressive syndrome + psychotic features
Acute: TEC
| Algo antidepressant + antipsychotic meds
318
Non inflammatory joint fluid characteristics:
Clear, WBC 200-2000
| <25% PMNs
319
Inflammatory joint fluid:
WBC 2000-100.000
| PMN>50%
320
Progestin relising IUD:
Amenorrhea
| No wieght loss
321
Active phase labor Protraction
Inadequate contractions <200 MV
cervical changen slower
Give oxytocin
322
Active labor arrest
No cervical change >4h if >200 mvu
No cervical change >6h with <200 mvu
CESAREAN
323
Most common cause of painless lower GI bleeding in adultsº
Diverticulosis
324
Children with Back pain
neurologic dysfunction
palpable step off
Spondylolisthesis
325
Risk factors for aortic dissection
HTN (most common)
Marfan sd
Cocaine use
326
secondary sexual characteristics + ↑ FSH LH
Central precocious puberty
327
Diastolic and continuous murmurs require:
Echocardiogram
328
Solitary accessible brain metastases
Surgical resection
329
Copious purulent eye drainage and eyelid swelling in the first week of life:
Gonococcal conjunctivitis
330
Most common arrhythmias after MI
vENTRICULAR FIBRILLATION
331
Treatment in CO poisoning
100% O2 vya nonrebreather facemask
| Severe> hyperbaric o2
332
Orthostatic hypotension in the elderly due to:
Decreased baroreceptor sensitivity
333
Child with vivid nightmares, remembers dreams, fully awake, consolable
Nightmare disorder
334
Sleep terrors
partial arousals
unresponsiveness
lack of dream content
335
```
After 5 days on UFH >
>50% reduction in platelet count
arterial thrombosis
Necrotic skin lesions at injection sites
anaphylactoid after injections
Diagnosis?
```
Type 2 Heparin induced thrombocytopenia
Dx: Serotonin release assay
STOP all heparins > star a direct thrombin inhibitor (argatroban) or fondaparinux
336
Pregnant woman with edema, malar rash, arthritis, hematuria/ RBC and WBC casts
SLE flare
| confirm with ↓ Complement levels ↑ANAs
337
CSF in herpes encephalitis
Lymphocytic pleocytosis
Erythrocytes
↑ Protein
338
Cystic fibrosis extrapulmonary features
Exocrine pancreatic insufficiency
Biliary cirrhosis
infertility
Osteopenia
339
Absence seizures treatment
Ethosuximide
340
Absence seizures clues
During all activities
<20 sec
automatisms
no response to vocal or tactil stimulation
341
Women >60 yo DMII with epigastralgia first step:
EKG
342
Trichotillomania
Hair pulling disorder
343
Granulomatosis with polyangiitis
Upper and lower respiratory tracts granulomatous inflammation
Glomerulonephritis
344
Megaloblastic anemia due to folic acid deficiency, causes:
```
Most common: nutritional (alcohol or diet)
Phenytoin
Methotrexate
TMP
Phenobarbital
Primidone
```
345
Adenomyosis diagnostic clues
>40 multipaous
dysmenorrhea heavy menstrual bleeding
Enlarged boggy uterus
346
Most common cause of lobar hemorrhage in >60 yo
Amyloid angiopathy
347
Most common cause of deep brain hemorrhage in adults
Hypertensive vasculopathy
348
Berry aneurysm rupture causes ...
Subarachnoid hemorrhage
349
Catatonia treatment
Benzodiazepines
| Electroconvulsive therapy
350
Congenital toxoplasmosis dx clues
Undercooked meat\ cats exposure
Macrocephaly / intracranial clarifications
Tx: pyramethamine, sulfadiazine
351
```
Hemolytic anemia
Jaundice
Splenomegaly
With spherocytes on peripheral smear
Next step?
```
Confirm spherocytosis with
Eosin 5 maleimide binding test / acidified glycerol lysis test
352
Familial adenomatous polyposis
| Next step?
Annual screening
| Proctocolectomy if colorectal cancer or high grade hyperplasia
353
Renal venous thrombosis most common associated to ....
Membranous glomerulopathy
354
Kidney response to hypovolemia
Decreased urine sodium
355
Sideroblastic anemia
Microcytic hypochromic
Normal iron studies
Usually due to piridoxine deficiency
356
SIADH
HyponAtremia
Drum osmolality <275
Urine sodium > 40
Risks >> CNS disturbances, SSRIs, NSAIDs, small cell lung cancer, pneumonia
357
Friederich ataxia diagnostic clues
Autonomic recessive
Cardiomyopathy
Ataxia
Atrophy of the cervical spinal cord and minimal cerebellar atrophy
358
Ulcerative colitis extraintestinal manifestations
```
Arthitis
Aveitis
Episcleritis
Erythema nodosum
Primary sclerosing cholangitis
```
359
Whipple disease
```
Due to T whippeli infection
Abdominal symptoms
Weight loss
CHF / valvular reg
Dementia / cns
Biopsy: PAS positive material in the lamina propia
```
360
Fat malabsorption increases risk of nephrolitiasis due to:
Increase absorption of oxalate
