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1
Q

Yellow fever vaccination

A

Live attenuated vaccine
When travelling africa asia south america
🚫 Egg allergy,immunosuppression

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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)

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3
Q

Most common microorganism in brain abscess >

A

Viridans strep and S. Aureus

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4
Q

Normal pressure hydrocephalus

A

Gait disturbance
dementia
urinary incontinence

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5
Q

Homocysteinemia

A

increased risk of thrombosis

give B6 pyridoxine

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6
Q

Acute angle closure glaucoma

A

Severe eye pain
Pupil dilated and poorly responsive to light
Migraine like symptoms

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7
Q

Strongest association with Cerebrovascular accidentº

A

Hypertension

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8
Q

Congenital adrenal hyperplasia

A

90% due to 21 hydroxylase deficiency

⬇️ Cortisol and aldosterone > ⬆️ ACTH&raquo_space; ⬆️Adrenal hyperplasia &raquo_space; ⬆️ FSH LH 17 hydroxyprogesterone

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9
Q

Pregnant woman + metabolic alkalosis

A

Hyperemesis gravidarum

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10
Q

Anterior mediastinal mass

A

Thymoma
Teratoma
Thyroid
Terrible lymphoma

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11
Q

Dacryocystitis

A

Infection of the lacrimal sac

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12
Q

Which is the most effective intervention in diabetic nephropathy + azotemia ?

A

Intensive blood pressure control

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13
Q

MEN 1

A

Primary ⬆️PTH
Pituitary tumors
Pancreatic tumors

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14
Q

MEN 2A

A

Medullary thyroid cancer (calcitonin)
Pheochromocytoma
Parathyroid hyperplasia

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15
Q

MEN 2B

A

Medullary thyroid cancer
Pheo
Mucosal neuromas/marfanoid habitus

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16
Q

Migraine prophylaxis

A

Topiramate
Divalproex
Tricyclic antidepressants
Beta blockers

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17
Q

Guillian barre syndrome treatment?

A

IV immunoglobulin or plasmapheresis

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18
Q

Ehrlichiosis

A

Tick borne Southeastern&south central US

Fever + altered mental status + No rash + penias

Doxycicline

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19
Q

Acute multiple sclerosis treatment

A

Treatment: Glucocortids > if not effective > Plasmapheresis

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20
Q

Pseudotumor cerebri

A

look for an obese woman with headaches

ICP may lead to momentary vision loss

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21
Q

Leprosy

A

Chronic granulomatous > M. leprae
Immigrants

Chronic, anesthetic, macular hypopigmented lesions. Nearby nerves often become nodular.

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22
Q

Epididymis

A

> 35 yo : E. Coli

<35 yo: Chlamydia trachomatis, N. gonorrhoeae

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23
Q

UTI + Alkaline urine ?

A

Proteus mirabilis

Klebsiella pneumoniae

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24
Q

Mitral valve prolapse

A

Due to myxomatous degeneration of the mitral valve

most common cause of Mitral regurgitation in the first world!

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25
Q

Tricyclic antidepressant toxicity

A

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

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26
Q

Differential for esophageal ulcers

A

––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

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27
Q

Iron poisoning

A

Radiopaque pills

abdominal symptoms, hematemesis > hypotensive shock, anion gap metabolic acidosis

Whole bowel irrigation> Deferoxamine

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28
Q

Large abdominal surgery+Bloody diarrhea postsurgery

A

Ischemic colitis

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29
Q

Congenital bicuspid aortic valve

A

aortic regurgitation in adults

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30
Q

Waldernstrom macroglobulinemia

A

IgM spike! > Plasma cell malignancy

Hyperviscosity syndrome, neuropathy, penias

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31
Q

Rheumatic fever

A

Give Penicillin

If persistent heart disease&raquo_space; >10 years or until 40 years

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32
Q

Bruton agammaglobulinemia

A

X linked
Low serum igs and few B cells
symptoms after 6 months
Sinopulmonary and GI infections

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33
Q

Myasthenic crisis

A

⬆️ Weakness, respiratory insufficiency

Plasmapheresis

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34
Q

Herpes retinitis

A

HIV +

Keratitis > acute retinal necrosis

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35
Q

CMV retinitis

A

HIV

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36
Q

Varicella postexposure prophylaxis

A

immune: prior infection or 2 prior doses
Immunocompetent: Give vaccine
Immunocompromised: Immunoglobulin

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37
Q

Type 2 Heparin induced thrombocytopenia

A

Thrombocytopenia + arterial trombosis

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38
Q

Lyme disease treatment

A

1st: Doxycicline
2nd: Amoxi also for children and pregnant women
Serious disease: Ceftriaxone

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39
Q

Sturge weber syndrome

A

Seizures
Mental retardation
Port wine stain or nevus flammeus

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40
Q

Mumps

A

Parotiditis
Orchitis
Aseptic meningitis

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41
Q

Cancer + Cachexia treatment

A

Progesterone analogues

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42
Q

Torsades de pointes + stable

A

Intravenous magnesium

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43
Q

Hemineglect syndrome

A

Lesion of the non dominant parietal lobe (spatial organization

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44
Q

Metastasic breast cancer + hypercalcemia

A

Biphosphonates

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45
Q

Graves’ disease treatment

A

Mild/ pregnant / older: Methymazole

Moderate to severe: radioactive iodine

Large goiter / pregnant / huperparathyroidism: surgery

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46
Q

48 hours old baby, irritability, high pitched cry, poor sleeping, tremors, seizures, sweating, sneezing

A

Heroin abstinence syndrome

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47
Q

Baby
Nail and digit hypoplasia
Dysmorphic facies
Mental retardation

A

Fenitoin exposure

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48
Q

Antenatal test: Down syndrome

A

> 35 YO
⬆️ MSAFP, INHIBIN A
⬇️ Estriol

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49
Q

Neural tube or abdominal wall defects

A

⬆️ MSAFP

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50
Q

Antenatal test: trisomy 18

A

⬇️ MSAFP BHCG ESTRIOL

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51
Q

Risk for ovarian cancer

A

Endometriosis
Use of fertility drugs
Nulligravity
family history (BRCAmutation)

CA 125 levels > higher specificity for postmenopausal women

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52
Q

Protective factors for ovarian cancer

A

Delayed menarche

early menopause

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53
Q

Risk factors for cervical cancer

A

Immunosuppression
Many sexual partners
smoking

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54
Q

Endometrial cancer risk factors

A 
Chronic anovulation
Obesity 
Tamoxifen
Early menarche 
No babies
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55
Q

Protective for endometrial cancer

A

Progesterone

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56
Q

On warfarin + emergent surgery

A

Plasma

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57
Q

Adjustment disorder treatment

A

Psychotherapy

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58
Q

Antiphospholipid syndrome

A

Venous thromboembolism / Miscarriages
Lupus anticoagulant, anticardiolipin, b2 glycoprot 1 atb
⬆️PTT

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59
Q

First UTI baby

A

Ultrasound

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60
Q

Anterior cruciate lesion

A

Popping sensation
Hemarthrosis
Joint instability (anterior drawer test, lachman test)

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61
Q

Untreated vesicoureteral reflux

A

Renal scarring

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62
Q

Vit D def

A

Exclusive breastfeeding

Craniotabes
Costochondral joint hypertrophy
Genu varum

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63
Q

Spontaneous pneumothorax treatment

A

Small <2 cm: O2

Large stable: needle aspiration or chest tube

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64
Q

Refractant schizophrenia

A

––Clozapine

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65
Q

Abnormal pap smear results

A

Immediate colposcopy

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66
Q

Carcinoid syndrome

A

Flushing, diarrhea, valvular lesions

NIACIN DEFICIENCY

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67
Q

Trichinellosis

A

Parasitic: Trichinella

Myositis + eosinophilia + periorbital edema

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68
Q

CIN 3 treatment

A

LEEP
Cold knife conization
cryoablation

Do pap + hov 1-2 years postprocedure

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69
Q

Giant cell arteritis

A

Headaches, jaw claudication, visual disturbances

complications: aortic aneurism

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70
Q

Infertility

A

<35 yo women: 12 months trying

>35 yo women: 6 months trying

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71
Q

Absence seizures

A

No postictal period

Provoked by ventilation

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72
Q

Severe combined immunodeficiency

A

Severe infections
Failure to thrive
lymphopenia (CD 19+: B cells, CD 3+: T cells)
Tx: Stem cell transplantation

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73
Q

Smoking cessation

A

Nicotine replacement therapy
Varenicline: mood changes, suicidality
Bupropion: 🚫 seizures or bulimia

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74
Q

Uremic coagulopathy

A

Due to platelet dysfunction

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75
Q

Contraindicated vaccines on pregnancy

A

HPV
MMR
Lived attenuated influenza

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76
Q

Recommended vaccines in pregnancy

A

Tdap
Inactivated influenza
RhoD

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77
Q

Indicated vaccines for high risk patients

A

Hep B, Hep A, Pneumococcus, Haemophilus, meningococcus, Varicella zoster immunoglobulin

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78
Q

Polycythemia vera

A 
Erythrocytosis
Hyperviscosity 
aquagenic pruritus
pletora
splenomegaly

tx: phlebotomy & hydroxyurea

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79
Q

Bhcg AFP

mediastinal mass

A

Non seminomatous germ cell tumors

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80
Q

HIV

renal failure

A

Focal segmental glomerulosclerosis

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81
Q

Tetralogy of Fallot

A

Ventricular septal defect
Overriding aorta
Right ventricular outflow tract obstruction
RV hypertrophy

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82
Q

Testicular mass > suggesting cancer

A

Orchidectomy

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83
Q

Which tests&raquo_space; sexually active women < 25 yo ?

A

Gonorrhea and chlamydia testing
Pap 21 yo or >3 yo
HPV starting 30 -65 yo: is negative 5 years interval

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84
Q

Pharmacotherapy + depression

A

Continuation: 4-9 months
Maintenance: 1 years
If severe: lifetime

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85
Q

Chemotherapy associated neuropathy

A

Vincristine
Cisplatin
Paclitaxel

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86
Q

Cyanotic baby at rest and feeding > resolves when crying

A

Choanal atresia

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87
Q

Tetralogy of Fallot

A

Ventricular septal defect
Overriding aorta
Right ventricular outflow tract obstruction
RV hypertrophy

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88
Q

Muscle rigidity
delirium
autonomic instability
high fever

A

Neuroleptic malignant syndrome

Due to dopamine disregulation

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89
Q

Treatment TTP

A

plasma exchange

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90
Q

Unstable sinus bradycardia: treatment

A

Atropine > 3-5 min

No response: transcutaneous pacing

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91
Q

Osler weber rendu syndrome

A

Telangiectasias + epistaxis + widespread AV malformations

Also AVMs in the lungs > chronic hypoxemia > polycythemia

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92
Q

Malignant otitis externa

A

Granulation tissue within the canal
Due to Pseudomonas
Might be nerve involvement

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93
Q

Empyema

A

Low glucose <60
low pH < 7,2
High protein

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94
Q

Pap smear in HIV

A

TWICE the diagnosis year

annually thereafter

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95
Q

Tdap vaccine in adults

A

At 11-18 once

>19 yo if not before

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96
Q

Laxative abuse

A

Watery diarrhea
Hypokalemia
Hypermagnesmia

Colonoscopy: Melanosis coli > dark brown discoloration of the colon

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97
Q

Trousseau’s syndrome

A

Unexplained superficial venous thrombosis

CA > pancreas!!! lung, prostate, stomach, colon acute leukemias

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98
Q

Foodborne poisoning

A

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

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99
Q

high yield!!!!!!!!!!!!
Ataxia, dysarthria
scoliosis, feet deformities
Cardiomaopathy in 90%

A

Friedreich ataxia

Autosomal recessive

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100
Q

Delusional disorder

A

> 1 delusions > 1 month

Functional

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101
Q

SIADH

A

Hypotonic hyponatremia in an euvolemic patient

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102
Q

Polycystic ovary syndrome + infertility treatment

A

Weight loss

Clomiphene citrate

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103
Q

Alzheimer’s disease treatment

A

First line: Cholinesterase inhibitors (donezepil, galantamine, rivastigmine)

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104
Q

Pertussis prophylaxis

A

Despite vaccination status

Macrolides

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105
Q

Aortic stenosis etiology

A

<70: bicuspid valve

>70: calcification

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106
Q

Contraindication for breastfeeding

A

TBC
HIV infection
Herpetic breast lesions
Varicella infection <5 days before and 2 days after delivery

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107
Q

Osteoporosis screening

A

1 DEXA > 65 yo

<65 yo increased risk (smoking, excessive alcohol intake, estrogen deficiency, sedentary lifestyle)

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108
Q

Alport’s syndrome

A

Gross hematuria
Proteinuria
Sensorineural deafness

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109
Q

Carpal tunnel syndrome

A

Clinical diagnosis

Nerve conduction studies

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110
Q

Child not taking in social settings, talks at home

A

Selective mutism (anxiety disorder)

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111
Q

Pronator drift

A

Sign suggesting > Pyramidal tract or cortical disease

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112
Q

First seizure episode in a healthy adult

A

Exclude: Metabolic and toxic causes

After that > Imaging , LP

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113
Q

Most common cause of community acquired bacterial meningitis

A

Strep pneumo

>50 yo or immunocompromised > Also Listeria monocytogenes

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114
Q

Risk factors for C difficile

A

Antibiotics (clynda, fluroquinolones)
Hospitalization
>65 yo
Gastric acid suppresion

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115
Q

C difficile diagnosis and treatment

A

Stoop PCR or toxin detection

Oral metronidazole or vancomycin

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116
Q

Athlete / insidious onset of localized pain / point tenderness

A

Stress fracture

Tibia, tarsal bones

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117
Q

STEMI initial treatment

A 
Supplemental oxygen  
Aspirin 325 mg
P2Y12 inhibitor 
Nitrates 
B blocker if not contraindicated 
High do se statin 
Anticoagulation
Pulmonary edema > Furo !
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118
Q

Goals gestational DM

A

Fasting: <95
1h : <140
2h: <120

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119
Q

Child with sickle cell disease / acute drop in hb / low reticulocyte, most likely diagnosis?

A

Aplastic crisis

Associated with Parvovirus B19

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120
Q

Vancomycin side effects

A

Ototoxicity
Red man syndrome
Nephrotoxicity

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121
Q

White matter demyelination
Nonenhancing hypodense white matter lesions no edema
<200CD4

A

Progressive multifocal leukoencephalopathy

Due to reactivation of JC virus

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122
Q

Clinical presentation Pancoast tumors

A

Shoulder pain
Horner syndrome
C8 T1 involvement
weight lost

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123
Q

Best markers indicating resolution of DKA

A

Serum anion gap

Beta-hydroxybutyrate

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124
Q

Patient with bipolar history and severe episode (psych, high risk of suicide, aggression)

A

Lithium or valproate + second generation antipsychotic

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125
Q

Dysphagia to solids and liquids
weight loss
Manometry: ⬆️ LES resting pressure / Incomplete LES relaxation

A

Achalasia

Barium esophagogram: bird-beak narrowing near LES

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126
Q

Child 6-36 months
previous diarrhea now in periodic pain
Currant jelly stools
Target sign on US

A

Intussusception

Tx: Air enema

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127
Q

EBV DNA in CSF + HIV

A

Suggest lymphoma

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128
Q

Absence seizures treatment

A

Ethosuximide

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129
Q

Bilateral internuclear ophthalmoplegia

A

Classical in Multiple sclerosis

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130
Q

Tardive dyskinesia

A

Orofacial / choreathetoid movements

Due to D2 receptor upregulation and supersensitivity

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131
Q

Avoid transmission of measles

A

Airborne protection (negative pressure room, N95 facemask)

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132
Q

Unilateral Renal artery stenosis

A

ACEs / ARBs

Contraindicated only in bilateral

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133
Q

Hypertrophic cardiomyopathy

auscultatory maneuvers?

A

–Increasing LV cavity size > ⬆️ Preload or afterload (squatting - leg raise - handgrip) > ⬇️ MURMUR

–decreasing cavity size > ⬇️ preload (valsalva, standing, amyl nitrate ) > ⬆️ MURMUR

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134
Q

Blunt trauma + stable > what’s next?

A

FAST > CT

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135
Q

Sjogren syndrome diagnosis ?

A

Atbs to Ro SSA and La SSB

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136
Q

Toddler with hemolytic anemia, thrombocytopenia, acute renal failure and bloody diarrhea

A

HUS

Tx: supportive

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137
Q

Renal tubular acidosis

A

Non Anion gap metabolic acidosis (⬆️ K+)

+ preserved kidney function

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138
Q

Porphyria cutanea tarda

A

Blisters, bullae, scarring, hypo/hyperpigmentation

Common in > Hep C, HIV, excessive alcohol consumption, estrogen use, smoking.

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139
Q

Ankylosing spondylitis associated diseases

A

Heart block
Uveitis
Enthesitis >

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140
Q

Male in his 20s with >3 months fatigue, hip pain that worsens with inactivity/ relieved with exercise, XR > erosions and arthritis involving sacroiliac joints

A

Ankylosing spondylitis

Also: dactylitis, enthesitis, HLA B27

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141
Q

Treatment for parkinsonism

A

Benztropine or amantadine

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142
Q

Common initial symptoms in MS

A 
Optic neuritis 
Transverse myelitis (Motor + sensory loss below level of lesion + bowel or bladder dysfunction)
Internuclear ophthalmoplegia > medial longitudinal fasciculus 
Cerebellar dysfunction
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143
Q

Supracondylar humerus fracture complication

A

Neurovascular injury&raquo_space; compartment syndrome

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144
Q

Dementia with lewy bodies, clues:

A

Visual hallucinations, parkinsonism, fluctuating cognition

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145
Q

Vascular dementia, clues:

A

Stepwise decline, early executive dysfunction

146
Q

Ewing sarcoma presentation

A

Long bones chronic pain
Swelling
deformity

147
Q

Osteoid osteoma

A

Adolescence - males
Xray: round radiolucency
Relief with NSAIDS

148
Q

Endometrial biopsy indications

A

> 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
Q

HELLP syndrome

A

Hemolysis
Elevated liver enzymes
Thrombocytopenia

Thought to result from abnormal placentation leading to systemic inflammation and coagulation activation

150
Q

Missed abortion

A

No bleeding / cervical os closed

no fetal cardiac activity

151
Q

Amyotrophic lateral sclerosis

A

Upper and lower motor neuron lesions

Spasticity
bulbar symptoms
⬆️ deep tendon reflex / fasciculations

152
Q

Most common pediatric CNS tumors

A 
Pilocytic astrocytoma 
Supratentorial tumor (seizures, increased ICP)
153
Q

IF child with pertussis > prophylaxis to close contacts?

A

Macrolides despite vaccination status

154
Q

Myotonic muscular dystrophy

A

Auto dominant

12-30 yo / facial weakness / hand grip myotonia / dysphagia / small testicles / arrhythmias

155
Q

Most common cause of sepsis in SCD

A

S pneumoniae

Despite vaccination

156
Q

Herpangina

A

Due to Coxsackie A virus
3 - 10 yo
summer - fall
Fever / pharyngitis / gray vesicles- ulcers posterior!

157
Q

Hereditary angioedema

A

spontaneous angioedema / no urticaria

etiology: C1 inhibitor deficiency

158
Q

Juvenile idiopathic arthritis

A

> 6 weeks
Joint inflammation

Findings: >CPR, hyperferritinemia, hypergammaglobulinemia, thrombocytosis, anemia

159
Q

Phenylketonuria post neonatal diagnosis

A

Quantitative amino acid analysis

Increased phenylalanine levels

160
Q

Wrist and hand joints pain + clubbing + Pulmonary disease

A

Hypertrophic osteoarthropathy

161
Q

Hypernatremia treatment?

A

Euvolemic > Free water

Hypovolemic > symptoms > first SSN > when euvolemic 5% DE

162
Q

Fetal risk for maternal HTN

A

Growth restriction
perinatal mortality
preterm delivery
oligohydramnios

163
Q

Immediately should raise suspicion of deliberate immersion injury?

A

spare flexor surfaces

164
Q

ewing’s sarcoma

A

⬆️ Male 20s
Metaphysis and diaphysis of femur > most common
X ray > lytic lesion > onion skin appearance > moth eaten pattern

165
Q

Stress urinary incontinence treatment

A

Exercises > pelvic floor surgery (most effective)

166
Q

Urge incontinence treatment

A

Bladder training > antimuscarinic drugs (oxybutinin)

167
Q

Overflow incontinence

A

Constant involuntary dribbling

Tx: Cholinergic agonist > bethanecol

168
Q

Falling to improve after SRI trial

A

switch to another first line antidepressant > duals

169
Q

Diethyllstilbestrol in utero exposure risks

A

VAGINAL CLEAR CELL ADENOCARCINOMA
cervical or uterine malformations
males: cryptorchidism, microphallus

170
Q

Rhino orbital cerebral mucormycosis treatment

A

Surgical debridement > ampho B

171
Q

Sickle cell trait risks

A

Hematuria > due to papillary necrosis

Inability to concentrate urine

172
Q

Neurofibromatosis 1

A

cafe au lait spots
macrocephaly
mental retardation
short stature

173
Q

Neurofibromatosis 2

A

bilateral acoustic neuromas and cataracts

174
Q

Ethylene glycol intoxication

A

flank pain, hematuria, tetany
calcium oxalate crystals
high anion gap metabolic acidosis

175
Q

Treatment ethylene glycol and methanol poisoning

A

Fomepizole (competitive inhibitor of alcohol dehydrogenase)

176
Q

Methanol poisoning

A

Visual blurring, afferent pupillary defect
high osmolar gap
metabolic acidosis high anion gap

177
Q

Thiazides side effects (HTZ, chlorthalidone)

A

hyperglycemia, increased LDL

Hypokalemia, hypercalcemia

178
Q

Enlargement of submandibular glands, association?

A

Advanced liver disease

179
Q

Bipolar depression

A

Quetiapine, lurasidone (second generation antipsychotics)

or lamotrigine

180
Q

Pseudotumor cerebri treatment

A

First line: acetazolamide (🚫 choroid plexus carbonic anhydrase) &raquo_space; add furo&raquo_space; surgical

181
Q

Marfan syndrome inheritance

A

Autosomal dominant (extracellular matrix protein fibrillin-1) mutation

182
Q

liver cyst, hydatid cyst + history of dog feces exposure

A

Echinococcus granulosus > dog tapeworm

tx: < 5 cm albendazole >10 cm percutaneous or surgery

183
Q

History of undercooked fish

A

liver flukes > biliary disease

fish tapeworm, diph latum > megaloblastic anemia

184
Q

pulmonary Histoplasmosis

A 
Mississippi and ohio river basins 
 Symptoms 
mediastinal or hilar lymph nodes 
arthralgias 
erythema nodosum

dx: urinary antigen test

185
Q

Papillary thyroid cancer

A

most common

Spread into local tissues and regional

186
Q

Follicular thyroid cancer hysto clue:

A

Invasion of tumor capsule and blood vessels

187
Q

CSF finding in multiple sclerosis

A

oligoclonal igG band

Normal opening pressure, protein and cell count

188
Q

Hemophilia A

A

X linked recessive

Factor VIII def

189
Q

Hemophilia B

A

X linked recessive

Factor IX

190
Q

Increased risk of malignancy on colonoscopy

A

Adenomatous polyps

⬆️ higher risk: >1 cm , dysplasia, villous

191
Q

HIV screening

A

15-65 yo all patients

192
Q

Wallenberg syndrome

A

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
Q

Microorganism associated with endocarditis after gingival manipulation or respiratory tract manipulation

A

Viridans group streptococci (mutans, viridans, sanguinis)

194
Q

Exudates: light criteria

A

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
Q

Raloxifene

A

Selective estrogen receptor modulators in osteoporosis

Adverse effects: hot flashes, venous thromboembolism

196
Q

Tamoxifen adverse effects

A

Hot flushes
VTE
endometrial cancer

197
Q

Lesch Nyhan syndrome

A

X linked recessive disorder
Due to Hypoxanthine-guanine phosphoribosyl transferase
uric Acid accumulation, automutilation, gouty arthritis, nephropathy.

198
Q

Vitamin K dependant factors

A

X VII II IX 1729 / PROT C & S

199
Q

Acute bacterial rhinosinusitis: micros?

A

s pneumoniae > Hib > Moraxella catarrhalis

200
Q

Pellagra

A

Niacin deficiency >
dermatitis (sun exposed areas, hyperpigmentation)
diarrhea
dementia

Immigrants and alcoholics

201
Q

Painless hematochezia in a toddler

A

Meckel’s diverticulum

Dx: technetiym 99m petechnetate scan

202
Q

Molluscum contagiosum

A

caused by a poxvirus

small skin colored umbilicated papules, spares soles and palms

203
Q

Absence seizures comorbidities

A

ADHD

Anxiety

204
Q

Invasive aspergillosis

A

Fever, chest pain, hemoptysis
CT> Halo sign (nodules with surrounding ground glass opacities)
tx: voriconazole and caspofungin

205
Q

Iron supplementation in children

A

start before 6 months if: prematurity, maternal iron deficiency, cow’s milk before age 12 months

206
Q

SuppLementation of vit b12 in a toddler if:

A

Strict vegetarian mothers

207
Q

Polymyalgia rheumatica

A

> 50 yo
bilateral pain & morning stiffness > 1 month
involvement of neck, shoulders, proximal thigh
elevated ESR >40 OT CRP

208
Q

Tumor lysis syndrome

A

↑ PO4, K, uric acid
↓ Calcium
AKI
cardiac arrhythmias

209
Q

<25 yo, sexually active, mucopurulent discharge with a friable cervix

A

Acute cervicitis

tx: Ceftriaxone + azithromycin

210
Q

Hepatomegaly + diabetes

A

think in hemochromatosis

211
Q

Chondrocalcinosis

A

Diagnostic of pseudogout

need to rule out hyperparathyroidism, hypothyro, hemochromatosis

212
Q

Acidemia after tonic clonic seizure

A

Transient (<90 mins) lactic acidosis

213
Q

Obsessive compulsive disorder treatment

A

SSRI

cognitive behavioral therapy (exposure nd response)

214
Q

Factor V Leiden deficiency

A

activated protein C resistance

Thrombosis!!!

215
Q

Pediatric constipation treatment

A

↑ dietary water and fiber
Limit cow’s milk intake <24 oz
Laxatives

216
Q

Breastfeeding failure jaundice

A

decreased bilirubin elimination
Increased enterohepatic circulation

suboptimal breastfeeding / signs of dehydration

217
Q

Breast milk jaundice

A

adequate breastfeeding

normal examination

218
Q

Smoker / head and neck tumor

A

Squamous cell carcinoma

219
Q

Oxytocin adverse effects

A

Hyponatremia
Hypotension
tachysystole

220
Q

Intensive glycemic control benefit

A

in microvascular complication

<6% HgA1c ↑ mortality

221
Q

Guillain Barré syndrome - respiratory failure

A

evaluate FVC (<20 ML/KG > INTUBATION!)

222
Q

Acute pancreatitis complications

A

pancreatic pseudocyst

fistula formation

223
Q

Pancreatic pseudocyst treatment

A

asymptomatic > nothing by mouth

symptoms > drainage

224
Q

Bloody diarrhea after infrarenal aneurysm repair

A

bowel ischemia

225
Q

Chronic methamphetamine use

A

Psychotic symptoms
Weight loss
severe tooth decay
skin excoriations

226
Q

Cryptococcal meningoencephalitis treatment

A

Amphotericin B + Flucytosine&raquo_space;> followed by fluconazole x 1 year

227
Q

AIDS + Conductive hearing loss

A

Most commonly > serous otitis media

228
Q

Innocent murmurs clue

A

↓ venous return (valsalva, standing) ↓ intensity

229
Q

Howell jolly bodies

A

Functional asplenia > SCD

230
Q

Helmet cells (schistocytes)

A

Microangiopathic hemolytic conditions

231
Q

Heinz bodies (bite cells)

A

Glucose 6 phosphate DH

Thalassemia

232
Q

TCA overdose

A

seizures
cardiac conduction delay
anticholinergic effects
QRS >100 ms&raquo_space;> ↑ ventricular arrhythmia

233
Q

Lithium follow up labs

A

Thyroid function
BUN /SCR
Uroanalysis
ECG > if coronary risk

234
Q

Lead poisoning

A

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
Q

Hep C

A

Antibody + molecular testing
if positive > consider ledipasvir + sofosbuvir
Vaccinate for Hepatitis A and B

236
Q

Mittelschmerz

A

pain due to Ovulation

237
Q

Anti mitochondrial antibodies +

A

Primary biliary cholangitis

238
Q

Anti smooth muscle antibodies +

A

Autoimmune hepatitis

239
Q

Histoplasmosis treatment

A

itraconazole

240
Q

Sporotrichosis

A

S schenckii> dimorphic fungus
Skin papule> ulceration > lymphadenopathy
tx> itraconazole

241
Q

Dietary recommendations for patients with renal calculi

A

increased fluid intake, decreased sodium intake, normal dietary calcium

242
Q

Initial prenatal labs?

A 
RhD type
HB/Hto MCV
HIV VDRL RPR HBsAg 
Rubella Varicella immunity 
Pap test 
Chlamydia PCR 
Urine culture / proteins
243
Q

Warfarin interaction: ↓ Effect

A 
CYP450 Inducers: 
Carbamazepine
phenytoin
ginseng 
Oral contraceptive
Rifampin
Phenobarbital
244
Q

Warfarin interaction: ↑ effect > bleeding

A 
Acetaminophen, NSAIDs
Amiodarone
Cimetidine
Cranberry juice, ginkgo biloba, vit E
omeprazol
Thyroid 
SSRI
245
Q

Uremic pericarditis

A

BUN >60

Diffuse ST segment elevation > rare

246
Q

History of GERD
Slowly progressive dysphagia
Symmetric circunferential narrowing of distal esophagus

A

Esophageal stricture

247
Q

Potter sequence

A

Urinary tract anomaly> anuria/oliguria > oligohydramnios > pulmonary hypoplasia, flat facies, limb deformities

248
Q

Present in brain death

A

Deep tendon reflexes

249
Q

Bacillary angiomatosis

A

Bright red, firm, friable, exophytic nodules
HIV +
Due to Bartonella > tx: erythromycin

250
Q

Premature newborn vaccination

A

All, except Hep B if <2000 gr

251
Q

Solid organ transplant chemoprophylaxis

A

TMP SMX

if donor + CMV > ganciclovir, valgaciclovir

252
Q

Hepatic hydrothorax

A

Transudative pleural effusions > due to leakage of ascitic fluid through small defects in the diaphragm

253
Q

Pseudotumor cerebri most significant complication

A

blindness

254
Q

Carpal tunnel syndrome treatment

A

Nocturnal wrist splinting > surgery

255
Q

Huntington disease

A

Chorea, dementia, psychiatric symptoms
Auto dominant
Atrophy of the caudate

256
Q

Neuroimaging studies abnormalities in schizophrenia

A

Lateral ventricular enlargement

257
Q

Severe cancer pain

A

Strong short acting opioids > long acting opioids +short acting if pain

258
Q

Peripheral smear findings in thalasemias

A

Target cells

259
Q

Spherocytosis

A

Hemolytic anemia / jaundice / splenomegaly

Auto dominant > Ankyrin protein defect

260
Q

Leriche syndrome

A

Bilateral hip, thigh and buttock claudication
Impotence
Symmetric atrophy of the bilateral lower extremities

261
Q

Disseminated gonococcal infection

A

Polyarthralgia
Tenosynovitis
Painless vesiculopustular skin lesions

262
Q

GLP1 analogues effects

A

↓ HBA1C 0.5%- 1 %
Weight loss
Low hypoglycemia risk

263
Q

Sulfonylureas

A

Weight gain & hypoglycemia

264
Q

Treatment for CIN 2-3

A

Cervical conization

Complications: cervical stenosis, preterm birth, PPRM, second trimester pregnancy loss

265
Q

Treatment for social anxiety

A

Non pharm: Cognitive behavioral therapy
Pharm: SSRI, SNRI
Performance only subtype: B blockers

266
Q

Macular degeneration

A

Leading cause of blindness in industrialized countries
Earliest: distortion of straight lines
Drusen deposits in the macula

267
Q

Metatarsus adductus

A

Corrects spontaneously

Flexible feet

268
Q

RR is similar to OR when….

A

The incidence of the disease is low

269
Q

Coarctation of the aorta results from…

A

Thickening of the tunica media near the junction of ductus art and the aortic arch

270
Q

Etiology of deep plantar infection after a puncture wound

A

S aureus

Pseudomonas aeruginosa

271
Q

Endometrioma

A

Due to endometriosis

Chronic pelvic pain + cystic ovarian mass

272
Q

G6PD induced hemolytic anemia

A

X linked disorder
triggered by exposure to infections or sulfas/dapsone
G6PD levels have decreased sensitivity in acute attacks

273
Q

Primary cholangitis

A

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
Q

Heat stroke

A

Core temperature >40 C and altered mental status

Exertional if> exercise in hot humid environment

275
Q

Most common cause of liver mass

A

Metastasic disease

276
Q

Urinalysis in AKI

A

Muddy brown granular casts > renal tubular epithelial cells

277
Q

Most common lesion in diabetic nephropathy

A

Diffuse glomerulosclerosis

278
Q

Dermatomyositis

A

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
Q

Reye syndrome

A 
Encephalopathy
Hepatic dysfunction
Cerebral edema
Increased intracranial pressure 
Associations: aspirin &amp; varicella or influenza
280
Q

Enuresis pharm interventions

A

Desmopressin > rapid improvement

281
Q

Diffuse esophageal spasm

A

Spontaneous pain, odynophagia for cold or hot food
Might improve with Nitrates and calcium channel blockers
DX: Esophageal manometry

282
Q

SSRI

A

Fluoxetine / Paroxetine / sertraline / citalopram

283
Q

SNRIs

A

Venlafaxine / Duloxetine

284
Q

Combination of pure sensitive and pure motor symptoms lesion;

A

Thalamus internal capsule

285
Q

Intussusception

A 
Abdominal pain
vomiting
bloody mucus in stools (currant jelly stool)
>US: target sign 
>Sausage shaped  RUQ mass 
tx: air enema> laparotomy
286
Q

Classic derangement in pyloric stenosis

A

Hypochloremic, hypokalemic metabolic stenosis

287
Q

Riluzole is used for:

A

🚫 glutamate

Treatment of ALS

288
Q

Nitrates antianginal effect

A

By decreasing preload and left ventricular end diastolic volume > ↓ myocardial oxygen demand

289
Q

Nephrotic syndrome complications

A

Hypercoagulability
Accelerated atherosclerosis
Hyperlipidemia

290
Q

Multiple system atrophy (shy drager syndrome)

A

Parkinsonism
Autonomic dysfunction
widespread neurological signs

291
Q

Specific digitalis induced arrhythmia

A

Atrial tachycardia with AV block

292
Q

Pneumonia in a patient with cystic fibrosis

A

Cefepime

Vancomycin

293
Q

Cervicofacial Actinomyces treatment

A

Penicillin

If severe > surgery + penicillin

294
Q

Asbestosis

A

Occupational exposure >Mining, shipyard
Increased risk of cancer
Pleural plaques on XRC
Interstitial fibrosis > restrictive pattern on spirometry

295
Q

Cyclophosphamide adverse effects

A 
Acute hemorrhagic cystitis
Bladder carcinoma
sterility 
myelosuppression
Prevented with MESNA.
296
Q

Pleural effusion > what to do first?

A

Thoracentesis

Except in patients with clear cut evidence of CHF

297
Q

Latent pulmonar TBC treatments

A

Isoniazid + piridoxime >9 months

298
Q

Euthyroid sick syndrome

A

↓ Total and free T3

Normal T4 and TSH

299
Q

Type II osteogenesis imperfecta

A

Multiple fractures
Hypoplastic thoracic cavity
Fetal growth restriction

300
Q

Common variable immunodeficiency

A

Recurrent GI and respiratory infections

↓ IgG IgA/IgM

301
Q

Disseminated Histoplasmosis treatment

A

Amphotericin B > Itraconazole

302
Q

acute AF in WPW treatment

A

Hemodynamically unstable > cardioversion

Stable > ibulitide or procainamide

303
Q

CELIAC DISEASE

A

suspect if malabsorption and iron deficiency anemia

304
Q

Glucocorticoid related myopathy

A

No inflammation or tenderness
normal ESR and CK
Starts after months of glucocorticoids use

305
Q

Pediatric constipation is a risk factor for….

A

UTI

For complete voiding

306
Q

Gold standard for diagnosis of Duchenne muscular dystrophy

A

-Genetic testing (dystrophin gene on Xp21)

307
Q

Aortic regurgitation associated pulse

A

Water hammer pulse (Hyperdinamic pulse)

308
Q

Paget disease

A 
↑Bone turnover 
↑Alkaline phosphatase 
Normal calcium and phosphorus 
Osteolytic or sclerotic lesions /  focal increase in uptake
Complications: hearing loss,
309
Q

Basal cell carcinoma clinical characteristics :

A

Slow growing papule with pearly rolled borders

310
Q

Primary side effect of hydroxyurea

A

Myelosuppression

311
Q

Phencyclidine intoxication

A 
Aggression
Severe agitation
Impulsivity 
Acute psychotic symptoms 
Tachycardia
Nystagmus
312
Q

Brief psychotic disorder

A

> 1 day
<1 month
full return to function

313
Q

Male with elevated estrogens and a testicular mass

A

Leydig cell tumors

314
Q

Hyperkalemia acute treatmen if EKG changes

A

calcium gluconate

315
Q

Fluoroquinolones muskoloeskeletal risks..

A

Achilles tendinopathy

316
Q

IF jaundice and pancreatic malignancy suspected:

A

Ultrasound > likely tumor in the head of the pancreas

317
Q

Major depressive syndrome + psychotic features

A

Acute: TEC

Algo antidepressant + antipsychotic meds

318
Q

Non inflammatory joint fluid characteristics:

A

Clear, WBC 200-2000

<25% PMNs

319
Q

Inflammatory joint fluid:

A

WBC 2000-100.000

PMN>50%

320
Q

Progestin relising IUD:

A

Amenorrhea

No wieght loss

321
Q

Active phase labor Protraction

A

Inadequate contractions <200 MV
cervical changen slower
Give oxytocin

322
Q

Active labor arrest

A

No cervical change >4h if >200 mvu
No cervical change >6h with <200 mvu
CESAREAN

323
Q

Most common cause of painless lower GI bleeding in adultsº

A

Diverticulosis

324
Q

Children with Back pain
neurologic dysfunction
palpable step off

A

Spondylolisthesis

325
Q

Risk factors for aortic dissection

A

HTN (most common)
Marfan sd
Cocaine use

326
Q

secondary sexual characteristics + ↑ FSH LH

A

Central precocious puberty

327
Q

Diastolic and continuous murmurs require:

A

Echocardiogram

328
Q

Solitary accessible brain metastases

A

Surgical resection

329
Q

Copious purulent eye drainage and eyelid swelling in the first week of life:

A

Gonococcal conjunctivitis

330
Q

Most common arrhythmias after MI

A

vENTRICULAR FIBRILLATION

331
Q

Treatment in CO poisoning

A

100% O2 vya nonrebreather facemask

Severe> hyperbaric o2

332
Q

Orthostatic hypotension in the elderly due to:

A

Decreased baroreceptor sensitivity

333
Q

Child with vivid nightmares, remembers dreams, fully awake, consolable

A

Nightmare disorder

334
Q

Sleep terrors

A

partial arousals
unresponsiveness
lack of dream content

335
Q 
After 5 days on UFH > 
>50% reduction in platelet count
arterial thrombosis
Necrotic skin lesions at injection sites 
anaphylactoid after injections
Diagnosis?
A

Type 2 Heparin induced thrombocytopenia
Dx: Serotonin release assay

STOP all heparins > star a direct thrombin inhibitor (argatroban) or fondaparinux

336
Q

Pregnant woman with edema, malar rash, arthritis, hematuria/ RBC and WBC casts

A

SLE flare

confirm with ↓ Complement levels ↑ANAs

337
Q

CSF in herpes encephalitis

A

Lymphocytic pleocytosis
Erythrocytes
↑ Protein

338
Q

Cystic fibrosis extrapulmonary features

A

Exocrine pancreatic insufficiency
Biliary cirrhosis
infertility
Osteopenia

339
Q

Absence seizures treatment

A

Ethosuximide

340
Q

Absence seizures clues

A

During all activities
<20 sec
automatisms
no response to vocal or tactil stimulation

341
Q

Women >60 yo DMII with epigastralgia first step:

A

EKG

342
Q

Trichotillomania

A

Hair pulling disorder

343
Q

Granulomatosis with polyangiitis

A

Upper and lower respiratory tracts granulomatous inflammation
Glomerulonephritis

344
Q

Megaloblastic anemia due to folic acid deficiency, causes:

A 
Most common: nutritional (alcohol or diet) 
Phenytoin
Methotrexate
TMP
Phenobarbital 
Primidone
345
Q

Adenomyosis diagnostic clues

A

> 40 multipaous
dysmenorrhea heavy menstrual bleeding
Enlarged boggy uterus

346
Q

Most common cause of lobar hemorrhage in >60 yo

A

Amyloid angiopathy

347
Q

Most common cause of deep brain hemorrhage in adults

A

Hypertensive vasculopathy

348
Q

Berry aneurysm rupture causes …

A

Subarachnoid hemorrhage

349
Q

Catatonia treatment

A

Benzodiazepines

Electroconvulsive therapy

350
Q

Congenital toxoplasmosis dx clues

A

Undercooked meat\ cats exposure
Macrocephaly / intracranial clarifications
Tx: pyramethamine, sulfadiazine

351
Q 
Hemolytic anemia 
Jaundice 
Splenomegaly 
With spherocytes on peripheral smear 
Next step?
A

Confirm spherocytosis with

Eosin 5 maleimide binding test / acidified glycerol lysis test

352
Q

Familial adenomatous polyposis

Next step?

A

Annual screening

Proctocolectomy if colorectal cancer or high grade hyperplasia

353
Q

Renal venous thrombosis most common associated to ….

A

Membranous glomerulopathy

354
Q

Kidney response to hypovolemia

A

Decreased urine sodium

355
Q

Sideroblastic anemia

A

Microcytic hypochromic
Normal iron studies
Usually due to piridoxine deficiency

356
Q

SIADH

A

HyponAtremia
Drum osmolality <275
Urine sodium > 40

Risks&raquo_space; CNS disturbances, SSRIs, NSAIDs, small cell lung cancer, pneumonia

357
Q

Friederich ataxia diagnostic clues

A

Autonomic recessive
Cardiomyopathy
Ataxia
Atrophy of the cervical spinal cord and minimal cerebellar atrophy

358
Q

Ulcerative colitis extraintestinal manifestations

A 
Arthitis 
Aveitis 
Episcleritis
Erythema nodosum
Primary sclerosing cholangitis
359
Q

Whipple disease

A 
Due to T whippeli infection
Abdominal symptoms 
Weight loss 
CHF / valvular reg
Dementia / cns
Biopsy: PAS positive material in the lamina propia
360
Q

Fat malabsorption increases risk of nephrolitiasis due to:

A

Increase absorption of oxalate

CK (12 decks)

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