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1
Q

Reduced (10-30% of normal) UGT activity; indirect hyperbilirubinemia, usually asx/transient jaundice

A

Gilbert’s syndrome

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2
Q

Autosomal recessive; none (Type I) or little (Type II) UGT activity; indirect hyperbilirubinemia

A

Crigler Najjar Syndrome

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3
Q

MRP2 gene mutation; mild conjugated hyperbilirubinemia; grossly black liver; asx except with illness/pregnancy

A

Dubin Johnson Syndrome

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4
Q

Similar to Dubin Johnson syndromes but milder + no black liver

A

Rotor’s Syndrome

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5
Q

Gastrin secreting tumor —> HCL hypersecretion

A

Zollinger-Ellison syndrome

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6
Q

Screening for HCC

A

Alpha-FP, US

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7
Q

Rupture of distal esophagus after repeated, forceful vomiting

A

Boerhaave’s Syndrome

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8
Q

Mucosa lower esophageal constrictions at squamocolumnar junction; associated with hiatal hernia

A

Schatzki Ring

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9
Q

Pharyngoesophageal pouch/false diverticulum

A

Zenker’s Diverticulum

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10
Q

AST>ALT

A

Alcoholic hepatitis

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11
Q

ALT>AST

A

Viral hepatitis

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12
Q

Post MI pericarditis

A

Dressler’s syndrome

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13
Q

Meds that decrease mortality in HF

A

ACEi, ARB, BB, nitrates, hydralazine, spironolactone

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14
Q

Electrolyte abnormalities in ACEi, loop diuretics, K-sparing diuretics, and thiazides

A

ACEi - hyperkalemia
Loop - hypOkalemia, hypOcalcemia, hypOnatremia, hyperglycemia, hyperuricemia
K-sparing - hyperkalemia
Thiazide - hypOnatremia, hypOkalemia, hyperglycemia, hyperuricemia

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15
Q

Distant muffled sounds, increased JVP, hypotension

A

Beck’s triad, pericardial tamponade

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16
Q

Heart swinging in fluid; ECG sign (pericardial effusion)

A

Electric alternans

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17
Q

Signs of constrictive pericarditis

A

Pericardial knock
Kussmaul’s sign
Pulses paradoxus

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18
Q

Signs of cardiac tamponade

A

Kussmaul’s sign
Pulses paradoxus
Beck’s triad

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19
Q

Nonatherosclerotic inflammatory dx of small + medium arteries/veins; strongly associated with tobacco

A

Buerger Disease

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20
Q

ECG: RBB pattern, ST elevation V1-V3, T wave inversion V1+V2; may cause syncope, v-fib, sudden cardiac death

A

Brugada syndrome

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21
Q

Usually seen with lung SCC

A

Pancoast Syndrome
Hypercalcemia
Cavitary lesions

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22
Q

Dilated neck veins, facial plethora, prominent chest veins, common in small cell lung cancer

A

SVC syndrome

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23
Q

Shoulder pain, Horner’s syndrome, atrophy of hand/muscles; often seen in NSCLC (esp squamous cell)

A

Pancoast Syndrome

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24
Q

Diarrhea due to increased serotonin; flushing, tachycardia, bronchoconstriction, hemodynamic instability

A

Carcinoid syndrome/tumor

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25
Q

Palpable edema and swelling of costal cartilages with costochondritis

A

Tietze syndrome

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26
Q

Criteria for exudates (Light’s criteria)

A

Pleural fluid protein >0.5

LDH for pleural fluid:serum >0.6 OR Pleural fluid LDH > 2/3 upper limit of normal LDH

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27
Q

Pneumonia, increased LFTs, GI sxs, hyponatremia

A

Legionella

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28
Q

PNA with cavitary lesions

A

S. Pneumonia
S. Aureus
Klebsiella

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29
Q

Gram + cocci in pairs

A

S. Pneumo

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30
Q

Gram + cocci in clusters

A

S. Aureus

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31
Q

Gram - rods

A

H. Flu
Klebsiella
Pseudomonas

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32
Q

Mississippi + Ohio Valley; bird/bat poop; PNA

A

Histoplasmosis capsulatum

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33
Q

PNA; southwest US soil

A

Coccidioides

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34
Q

PNA w abscess

A

S. Aureus
Klebsiella
Anaerobes

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35
Q

PNA w bullous myringitis

A

S. Pneumo

Mycoplasma

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36
Q

PNA w/ rusty blood-tinged sputum

A

S. Pneumo

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37
Q

PNA with currant jelly sputum

A

Klebsiella

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38
Q

PNA with green sputum

A

H. Flu

Pseudomonas

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39
Q

PNA w/ foul smelling sputum

A

Anaerobes

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40
Q

Causes of anion gap metabolic acidosis

A 
Methanol
Uremia
DKA
Propylene Glycol
Izoniazid, infection
Lactic Acidosis
Ethylene Glycol
Rhabdo/
Renal failure
Salicylates
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41
Q

Causes of non-gap metabolic acidosis

A 
Hyperalimentation
Acetazolamide
Renal Tubular Acidosis
Diarrhea
Ureto-pelvic shunt
Post-hypocapnia
Spironolactone
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42
Q

Causes of metabolic alkalosis

A

Vomiting
Diuretics
Post-hypercapnia

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43
Q

Causes of respiratory alkalosis

A 
CNS disease
Hypoxia
Anxiety
Mech ventilators
Progesterone
Salicylates/Sepsis
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44
Q

Determining an acid base disorder

A

Look at pH
Look at PCO2: if going in opposite direction from pH —> respiratory
Look at HCO3: if going in SAME direction as pH —> metabolic

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45
Q

Age for Lung CA screen for smokers

A

55-80

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46
Q

Treatment for primary biliary cirrhosis

A

Ursodeoxycholic acid

Cholestyramine

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47
Q

Copper acculturation in brain, kidney, cornea;

A

Wilson’s Disease

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48
Q

Periumbical ecchymosis; sign of pancreatic hemorrhage

A

Cullen’s sign

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49
Q

Flank ecchymosis; sign of hemorrhagic pancreatitis

A

Turner’s sign

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50
Q

Palpable, non-tender, distended gallbladder it’s associated jaundice (CBD obstruction); associated with pancreatic cancer

A

Courvoisier’s sign

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51
Q

Pancreatic tumor markers

A

CEA, CA-19-9

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52
Q

Painless rectal bleeding; may cause intussesception, volvulus, or obstruction

A

Meckel’s diverticulum

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53
Q

Current jelly stools, vomiting, colicky abdominal pain, sausage-shaped mass

A

Intussesception

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54
Q

Asthma, nasal polyps, allergy to aspirin

A

Samter’s triad

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55
Q

Hyperkeratosis, hemorrhage, hematologic (anemia)

A

Vitamin C deficiency

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56
Q

Peripheral neuropathy, symmetric impairment of sensory, motor, and reflexes, anorexia, muscle cramps, wasting

A

“Dry” beriberi (thiamine deficiency)

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57
Q

High output failure, dilated cardiomyopathy, edema (deficiency)

A

“Wet” beriberi (B1 deficiency)

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58
Q

Ophthalmoplegia, ataxia, global confusion

A

Wernicke’s encephalopathy

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59
Q

Memory loss and confabulation; thiamine deficiency

A

Korsakoff’s dementia

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60
Q

Lesions of mouth, magenta-colored tongue, angular cheilitis, pharyngitis, photophobia/corneal lesions, scrotal dermatitis

A

Oral-ocular-genital syndrome (B2/riboflavin deficiency)

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61
Q

Diarrhea, dementia, dermatitis

A

Pellagra (B3/niacin deficiency)

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62
Q

Autoimmune destruction of parietal cells that secrete intrinsic factor

A

Pernicious anemia (B12 deficiency)

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63
Q

Autosomal recessive; urine with musty/mousy odor; vomiting; mental retardation

A

PKU

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64
Q

Traveler’s diarrhea; drinking unsanitary water; watery diarrhea, abdominal cramping, vomiting

A

Enterotoxogenic E. Coli

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65
Q

RLQ pain with LLQ palpation; appendicitis

A

Rovsing sign

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66
Q

RLQ pain with internal and external hip rotation with bent knee; appendicitis

A

Obturator sign

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67
Q

RLQ pain with right hip flexion/extension; appendicitis

A

Psoas Sign

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68
Q

Tenderness at the point 1/3 the distance from the anterior superior iliac spine and navel; appendicitis

A

McBurney’s point tenderness

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69
Q

Abdominal pain out of proportion to exam

A

Acute Mesenteric Ischemia

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70
Q

Chronic, dull abdominal pain that is worse after meals

A

Chronic Mesenteric Ischemia

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71
Q

Characteristics specific to ulcerative colitis (7)

A 
Tenesmus
Bloody diarrhea
Primary sclerosing cholangitis
Toxic megacolon 
Sandpaper appearance on endoscopy
“Stovepipe sign” - loss of haustra on barium study
\+PANCA
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72
Q

Characteristics specific to Crohn’s disease (8)

A 
Transmural
Weight loss
No visible blood usually
Perianal dx (fistulas, strictures, abscesses, granuloma)
B12 + Fe deficiency
Skip lesions w/ cobblestone appearance on endoscopy
“String sign” on barium
\+ASCA
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73
Q

20y; autosomal dominant; polyposis; mucocutaneous hyperpigmentation; increased risk of CRC/ovarian CA

A

Peutz-Jehgers Syndrome

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74
Q

CRC biomarkers

A

CEA

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75
Q

Age for colonoscopy screening

A

Start at age 50, q10
Start at age 40 if relative >60y with CRC, q10
Start at age 40 if relative <60y with CRC, q5

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76
Q

Contaminated fried rice; incubation period 1-6h; vomiting, cramps, diarrhea

A

bacillus cereus

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77
Q

fecal/oral contamination; cramps lower abdominal pain, high fever, tenesmus, explosive mucoid/blood/watery diarrhea, leukocytosis (>50k);

A

shigella

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78
Q

contaminated milk, tofu, or pork; mimics appendicitis; invasive infectious diarrhea

A

yersinia enterocolitica

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79
Q

invasive; fecal-oral transmission from poultry products and exotic pets; abdominal pain, fever, cramping, “pea soup stools”; self-limited

A

salmonella gastroenteritis

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80
Q

invasive; fecal-oral transmission from poultry products and exotic pets; abdominal pain, fever, cramping, “pea soup stools”, intractable fever, bradycardia, “rose spots”

A

typhoid fever (salmonella)

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81
Q

invasive infectious diarrhea; undercooked beef, unpasteurized milk, day care centers, contaminated water; bloody diarrhea, crampy abd pain, vomiting; cytotoxins

A

enterohemorrhagic E Coli

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82
Q

invasive infectious diarrhea; contaminated poultry, raw milk, water, dairy cattle; watery–>bloody diarrhea, fever, HA, abd pain; Guillan-barre syndrome

A

campylobacter jejuni enteritis

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83
Q

contaminated water from streams/wells; frothy, greasy, foul non-bloody diarrhea

A

giardia lamblia

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84
Q

GI colitis; liver abscess

A

amebiasis

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85
Q

farmers/contaminated soil; malabsorption, weight loss, steatorrhea, nutritional deficiency, arthritis, neurologic sxs

A

Whipple’s disease

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86
Q

lesion seen in anterior shoulder dislocation; groove on humeral head

A

Hill-Sachs lesion

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87
Q

lesion seen in anterior shoulder dislocation; glenoid inferior rim fracture

A

Bankart lesion

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88
Q

common nerve injury in anterior shoulder dislocations

A

axillary nerve

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89
Q

rotator cuff tears are more common above what age? Whats more common in younger patients?

A

40

tendonitis/subacromial bursitis/impingement

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90
Q

tests for impingement

A

supraspinatus strenght test (“empty can”)
Hawkins (elbow/shoulder flexed @ 90)
Drop arm test (unable to lift past shoulder)
Neer test (thumbs down, forward flex)

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91
Q

What sensation should you check with FOOSH injuries?

A

deltoid to r/o brachial plexus injury

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92
Q

Management for humeral shaft fracture

A

sugar tong splint

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93
Q

What nerve should you check with humeral shaft fracture?

A

radial nerve; wrist drop

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94
Q

common signs of thoracic outlet syndrome

A

brachial plexus: pain/paresthesia, esp ulnar side

subclavian vein/artery: swelling/discoloration/cyanosis

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95
Q

“Tram tracks” on CXR

Or “signet-ring” sing on CT

A

Bronchiectasis

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96
Q

Side effects of HIV drugs

A

Rifampin - orange body fluids
Isoniazid - hepatitis and peripheral neuropathy
Pyrazinamide - hepatotoxicity and polyarthralgias
Ethambutol - optic neuritis

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97
Q

Most common electrolyte disturbance of sarcoidosis

A

Hypercalcemia

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98
Q

Treatment for pulm HTN

A

Sildenafil

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99
Q

Carcinoid tumor rx

A

Octreotide

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100
Q

anterior fat pad on xr

A 
radial head fracture (adults)
suprachondylar fracture (peds)
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101
Q

complications of suprachondylar fractures

A

median/radial nerve + brachial artery injury

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102
Q

what nerve injury should you look out for in an olecranon fracture?

A

ulnar nerve

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103
Q

“goose egg” swelling near elbow with limited flexion

A

olecranon bursitis

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104
Q

proximal ulnar shaft fracture with anterior radial head dislocation

A

Monteggia fracture

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105
Q

mid-distal radial shaft fracture with dislocation of the distal radio-ulnar joint

A

Galeazzi fracture

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106
Q

“ivory white” calcified pleural plaques on CXR

A

asbestosis

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107
Q

lateral epicondylitis (inflammation of the extensor carpi radialis brevis muscle tendon)

A

tennis elbow

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108
Q

medial epicondylitis (inflammation of the pronator teres/flexor carpi radialis tendon)

A

golfer’s elbow

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109
Q

what nerve/vessel injuries must be ruled out with a elbow dislocation?

A

brachial artery

median/ulnar/radial nerve

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110
Q

lightly tapping (percussing) over the nerve to elicit a sensation of tingling or “pins and needles” in the distribution of the nerve; carpal/cubital/tarsal tunnel

A

Tinel’s sign

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111
Q

make a strong pinch between the thumb and index finger and grip a flat object such as a piece of paper between the thumb and index finger; attempts to pull the object out of the subject’s hands to test for CUBITAL tunnel

A

Froment’s sign

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112
Q

cast for scaphoid fracture

A

thumb spica

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113
Q

distal radial fracture with dorsal/posterior (“dinner fork”) angulation

A

Colles fracture

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114
Q

complication of Colles fracture

A

extensor pollicus longus tendon rupture

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115
Q

cast for Colles/smith fracture

A

sugar tong splint

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116
Q

distal radial fracture with ventral/anterior (“garden spade”) angulation

A

smith’s fracture

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117
Q

carpal bone injury with a “piece of pie” sign on AP XR or “spilled teacup” on lateral

A

lunate dislocation

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118
Q

avascular necrosis of lunate bone d/t lunate fracture

A

Kienbock’s disease

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119
Q

cast for lunate fracture

A

thumb spica

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120
Q

autonomic dysfunction following bone/soft tissue injury; pain out of proportion, swelling, extremity color changes, increases nail and hair growth

A

complex regional pain syndrome

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121
Q

what prophylaxis is recommend for complex regional pain syndrome?

A

vitamin C for fractures

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122
Q

avulsion of extensor tendon; unable to straighten distal finger

A

mallet (baseball) finger

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123
Q

disruption of extensor tendon at base of middle phalanx –> hyper flexion of middle joint

A

Boutonniere deformity

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124
Q

ulnar collateral ligamental injury of the thumb; unstable MCP joint; thumb far away from digits

A

Skier’s(acute)/Gamekeeper’s(chronic) thumb

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125
Q

cast for gamekeeper’s/skier’s thumb

A

thumb spica

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126
Q

cast for boxer’s fracture

A

ulnar gutter splint

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127
Q

intraairticular fracture through the base of the first metacarpal (MCP) bone

A

Bennet/Rolando Fracture

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128
Q

SALTER classification

A 
S (I) - same
A (II) - above
L (III) - lower
T (IV) - through
R (V) - rammed/compression
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129
Q

tenosynovitis of abductor pollicus longus and extensor pollicus brevis; pain along radial aspect of wrist–> forearm

A

DeQuervain’s tensynovitis

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130
Q

flex both wrists for 30-60 sec to reproduce carpal tunnel symptoms

A

Phalen’s test

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131
Q

signs of carpal tunnel

A

Tinel’s sign
Phalen’s test
thenar muscle wasting

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132
Q

contracture of palmar fascia due to nodules/cords; fixed flexion at MCP joints

A

Dupuytren Contracture

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133
Q

treatment for Dupuytren contracture

A

steroid/collagenase injections, PT, surgery

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134
Q

main complications of hip dislocation

A

avascular necrosis

sciatic nerve injury

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135
Q

difference in presentation between hip dislocation and hip fracture

A

dislocation: leg shortened and internally rotated
fracture: leg shortened and externally rotated

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136
Q

idiopathic avascular necrosis of femoral head in children 4-10 yrs old; painless limp, pain in hip/knee/groin, internal rotation of leg

A

Legg-Calve-Perthes Disease

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137
Q

hip disorder common in 7-16y old obese, male children; hip/thigh/knee pain with external rotation of leg

A

Slipped Capital Femoral Epiphysis

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138
Q

inward bowing of knees

A

vaLgus

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139
Q

outward bowing of knees

A

vaRus

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140
Q

sign of PCL injury

A

pivot shift test, posterior drawer test

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141
Q

sign of ACL injury

A

lachman’s test, anterior drawer test

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142
Q

knee popping, locking, giving away, +McMurray’s sign

A

meniscal tear

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143
Q

best xray view for patellar fracture

A

sunrise view

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144
Q

palpable defect above knee d/t quadriceps tendon rupture

A

patella baja

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145
Q

palpable defect below the knee d/t patellar tendon rupture

A

patella alta

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146
Q

important complication to look out for in tib-fib dislocation (which often reduces itself

A

popliteal artery rupture

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147
Q

sign of peroneal nerve injury

A

foot drop

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148
Q

pseudothrombophlebitis syndrome that mimics DVT

A

Baker’s cyst rupture

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149
Q

common in runners; knee pain behind or around patella; worse with climbing or sitting; apprehension sign with patella pressure

A

patellofemoral syndrome

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150
Q

most common knee pain in runners; lateral knee pain

A

IT band syndrome

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151
Q

pain or resistant to adduction of leg parallel to table; IT band syndrome

A

Ober test

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152
Q

most common ligament damaged in ankle sprain

A

anterior talofibular collateral ligament

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153
Q

what are the Ottawa ankle rules?

A

ankle films: pain along lateral or medial malleolus
foot films: mid foot or 5th metatarsal/navicular pain
both: unable to walk >4 steps

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154
Q

spiral proximal fibular fracture d/t rupture of distal talofibular syndesmosis

A

Maisonneuve fracture

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155
Q

fracture of distal tibia from impact with talus

A

Pilon (tibial plafond) fracture

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156
Q

post tibial nerve compression from overuse or restrictive footwear; pain numbness @ medial malleolus, heel, and sole

A

tarsal tunnel syndrome

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157
Q

diabetic foot

A

Charcot’s joint

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158
Q

painful mass near tarsal heads; reproducible pain on palpation + mass

A

Morton’s neuroma

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159
Q

transverse fracture through diaphysis of 5th metatarsal

A

Jones fracture

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160
Q

triggers for G6PD

A

infections, stress, fava beans, aspirin, and other drugs.

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161
Q

A condition causing red blood cells to break down in response to certain triggers leading to fever, dark urine, abdominal and back pain, fatigue, and pale skin

A

G6PD

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162
Q

disruption of the articulation between the medial cuneiform and the base of the 2nd metatarsal +/- metatarsal fractures

A

Lisfranc injury

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163
Q

most common site for herniated disc

A

L5-S1

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164
Q

tests for herniated disk

A

straight leg raise

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165
Q

signs of a herniated disk at L4

A

anterior thigh pain
weakness with ankle dorsiflexion/knee extension
loss of knee jerk

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166
Q

signs of a herniated disk at L5

A

lateral thigh/leg, hip, and groin pain/parasthesia

weakness with big toe extension

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167
Q

signs of a herniated disk at S1

A

posterior leg/calf and plantar foot pain/parasthesia
weakness with plantarflexion
loss of ankle jerk

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168
Q

new onset bowel retention/incontinence, saddle anesthesia, bilateral leg pain, decreased anal sphincter tone

A

cauda equina syndrome

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169
Q

what alleviates/worsens spinal stenosis?

A

worsens: extension, prolonged standing
alleviates: flexion, sitting/walking uphill

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170
Q

scoliosis, cafe au lait spots, skin tags, axillary freckles

A

neurofibromatosis

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171
Q

measurement of the severity of scoliosis

A

Cobb’s angle (>10=scoliosis)

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172
Q

defect in pars interarticularis of spine from repetitive hyperextension

A

spondylolysis

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173
Q

forward slipping of vertebrae on another

A

spondylolithesis

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174
Q

most common organism seen in acute osteomyelitis in newborns (<4mos)

A

GBS

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175
Q

most common organism seen in acute osteomyelitis in children (>4mos) as well as general acute/chronic osteomyelitis

A

S. Aureus

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176
Q

most common organism seen in acute osteomyelitis in those with sickle cell disease

A

salmonella

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177
Q

most common organism seen in acute osteomyelitis in those with puncture wound or IVDU

A

pseudomonas

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178
Q

most common organism(s) in septic arthritis

A

S. Aureus
N. Gonorrhea (sexually active young adults)
Strep

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179
Q

what amount of WBCs from an arthrocentesis would be considered a septic joint?

A

> 50K

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180
Q

what pressure is diagnostic of compartment syndrome?

A

> 30-45mmHg

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181
Q

bimodal distribution; bone pain/swelling; “sun ray burst” on XR; mixed sclerotic/lytic lesions

A

osteosarcoma

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182
Q

which is the malignant tumor: osteosarcoma or osteochondroma?

A

osteosarcoma

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183
Q

most common in children/males; bone pain/joint swelling; “onion peel” appearance on XR

A

Ewing’s sarcoma

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184
Q

pedunculate benign bone tumor that often grows away from bone

A

osteochondroma

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185
Q

autosomal dominent; abnormal bone remodeling; high ALP (normal Ca + phos), bone pain, stress fracture or warmth, DEAFNESS, headache; COTTON WOOL appearance of skull on xray

A

Paget’s disease

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186
Q

treatment for Paget’s

A

bisphosphanates and calcitonin

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187
Q

diagnostic tests fo SLE

A

ANA (non-specific)

Anti-dsDNA + anti-smith (specific but not sensitive)

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188
Q

associated with SLE; may cause frequent miscarriages, livedo reticularis (discoloration of skin); increased risk of arterial and venous thrombosis

A

antiphospholipid ab syndrome (APLS)

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189
Q

calcinosis cutis, Raynaud’s, esophageal motility d/o, sclerodactyly, telangectasia

A

CREST syndrome (limited cutaneous systemic sclerosis)

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190
Q

treatment for Raynaud’s

A

CCB (amlodipine)

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191
Q

diagnostic tests for scleroderma

A

anti-centromere ab (CREST/limited cutaneous)
anti-scl-70 ab (diffuse cutaneous/multi-organ involvement)
ANA (non-specific)

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192
Q

treatment for scleroderma

A

DMARD (methotrexate)

CCB (for Raynaud’s)

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193
Q

diagnostic tests for Sjogren’s

A 
ANA
antiSS-A (Ro)
antiSS-B (La)
RF
Schirmer test (decreased tear production)
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194
Q

treatment for Sjogren’s

A

artificial tears, pilocarpine (cholinergic)

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195
Q

treatment for fibromyalgia

A

TCA
SSRI
Cymbalta
Exercise

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196
Q

progressive symmetrical proximal muscle weakness, dysphagia, skin rash, polyarthralgias, muscle wasting

A

polymyositis

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197
Q

diagnostic tests for polymyositis and dermatomyositis

A

aldolase, CK (muscle enzymes)
anti-Jo 1 Ab (specific)
anti-SRP Ab (polymyositis)
Anti-Mi-2 Ab (dermatomyositis)

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198
Q

HELIOTROPE (blue/purple) eyelid discoloration, GOTTRON’s papule (knuckles), malar rash (INCLUDING nasolabial folds), “SHAWL or V sign”

A

dermatomyositis

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199
Q

fever, joint pain, malaria rash SPARING nasolabial folds

A

SLE

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200
Q

triggers for gout attack

A

purine-rich foods (alcohol, oily fish, yeasts), diuretics, ACEi/ARBs, HIV meds, aspirin

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201
Q

arthrocentesis finding indicative of gout

A

negatively birefringent NEEDLE-shaped urate crystals

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202
Q

acute management of gout

A

NSAIDS (indomethacin), colchicine, steroids (if severe)

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203
Q

chronic management of gout

A

allopurinol (inhibits xanthine oxidase), colchicine

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204
Q

calcium phosphate deposition in joints; most commonly in knee

A

pseudogout

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205
Q

arthrocentesis finding indicative of pseudogout

A

positively birefringent RHOMBOID-shaped crystals

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206
Q

treatment for pseudogout

A

steroids, NSAIDS, colchicine (prophylaxis)

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207
Q

symmetric MCP/PIP/wrist/knee/MTP/shoulder/ankle joint pain, worse with REST, morning joint stiffness, boutonniere/swan neck deformities

A

RA

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208
Q

diagnostic tests for RA

A

RF (initial)
anti-cetrullinated peptide ab (specific)
ESR,CRP

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209
Q

triad of RA + splenomegaly + low WBC

A

Felty’s syndrome

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210
Q

pneumoconiosis + RA

A

Caplan syndrome

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211
Q

treatment for RA

A

DMARDs, NSAIDs, steroids

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212
Q

DIP/thumb/knee/hip/spine pain, worse with ACTIVITY, evening joint stiffness

A

osteoarthritis

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213
Q

XR RA vs osteoarthritis

A

osteo: osteophytes, ASYMMETRIC joint space loss
RA: osteopenia, SYMMETRIC joint space loss

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214
Q

daily arthritis, high fevers, SALMON-colored migratory rash, hepatosplenomegaly, lymphadenopathy, pericardial/pleural effusions, hepatitis

A

systemic juvenile idiopathic arthritis

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215
Q

important part of managing juvenile idiopathic arthritis

A

frequent eye exams to check for iridocyclitis

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216
Q

labs notable for rhabdomyolysis

A

increased CPK >20k
increased LDH, ALT
hyperkalemia
hypocalcemia

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217
Q

main complication of rhabdo

A

acute tubular necrosis

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218
Q

list the large, medium, and small vessel vasculitis syndromes

A

large: GCA, takayasu
medium: kawasaki, polyarteritis nodosa
small: eosinophilic GPA, wegeners GPA, microscopic polyangitis, HSP

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219
Q

large vessel vasculitis that affects aorta, aortic arch, and palm arteries; usually follows illness; can cause MI, TIA, CVA, HTN crisis, lower extremity claudication, aneurysms; diminished pulses, bruits, asymmetric BPs, cool extremities

A

Takayasu arteritis “pulseless disease”

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220
Q

treatment for Takayasu arteritis and GCA

A

high dose corticosteroids

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221
Q

most common in children; conjunctivitis, polymorphous rash, arthritis, cervical lymphadenopathy, strawberry tongue

A

Kawasaki disease

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222
Q

complications of Kawasaki

A

coronary artery aneurysms, MI

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223
Q

treatment for Kawasaki

A

IV IgG + high dose aspirin

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224
Q

systemic vasculitis of medium/small arteries; microaneurysms ; associated with HBC/HCV; HTN, renal failure, fevers, myalgias, neuropathy, livedo reticularis

A

polyarteritis nodosa

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225
Q

small vessel vasculitis with asthma, hypereosinophilia, chronic rhinosinusitis

A

eosinophilic granulomatosis with polyangiitis (EGPA or Churg Strauss)

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226
Q

which syndromes are P-ANCA positive?

A

EGPA, microscopic polyangitis, UC/PSC

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227
Q

which syndromes are C-ANCA positive?

A

Wegener’s

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228
Q

small vessel vasculitis; necrosis of nose, lungs, kidney; URI and LRI sxs, SADDLE-NOSE deformity, glomerulonephritis (hematuria, proteinuria)

A

Wegener’s (GPA; granulomatosis with polyangiitis)

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229
Q

treatment for Wegener’s and microscopic polaynagiitis

A

steroids + cyclophosphamide

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230
Q

small vessel vasculitis that affects arterioles, venules, and capillaries; purpura, cough, dyspnea, hemoptysis, acute glomeronephritis

A

microscopic polyangiitis

231
Q

IgA vasculitis; IgA deposition into skin + kidney most common in children; palpable purpura, abdominal pain, arthritis, hematuria; SELF-LIMITING

A

Henoch-Schonlen purpura

232
Q

IgG Ab against type IV collagen in glomerular basement membrane + alveoli; often post URI; HEMOPTYSIS + glomerulonephropathy

A

Goodpasture’s syndrome

233
Q

treatment for Goodpasture’s syndrome

A

steroids + cyclophosphamide

234
Q

asymmetric inflammatory arthritis, conjunctivitis/uveitis, urethritis; seen with chlamydia

A

Reiter’s syndrome (reactive arthritis)

235
Q

back stiffness (esp morning), better with activity, peripheral arthritis, sacroiliitis; “BAMBOO spine” on XR

A

ankylosing spondylitis

236
Q

marker for ankylosing spondylitis, reactive arthritis, and psoriatic arthritis

A

HLA-B27

237
Q

asymmetric “sausage digits”; sacroiliitis, pitting of nails, chronic uveitis; “pencil in cup” deformity on XR

A

psoriatic arthritis

238
Q

bitemporal hemianopsia

A

optic chiasm lesion

239
Q

total blindness of ipsilateral eye

A

optic nerve or retina lesion

240
Q

homonymous hemianopsia

A

contralateral optic tract lesion

241
Q

nasal hemianopsia

A

ipsilateral LATERAL optic chiasm lesion

242
Q

2 common conditions associated with blepharitis

A

Down’s syndrome

eczema

243
Q

non-tender eyelid swelling; larger, firmer and less painful than stye/hordeolum

A

chalazoin

244
Q

redness to nasal side of lower lid; lacrimal gland infection

A

dacrocystitis

245
Q

signs of an orbital floor (maxillary, zygomatic, palatine) fracture

A

decreased visual acuity
diplopia (esp w/ upward gaze)
orbital emphysema

246
Q

treatment for orbital floor fractures

A

nasal decongestants
prednisone
clinda/unasyn
ophtho referral

247
Q

gradual bilateral/blurred loss of central vision + color vision; DRUSEN (diffuse, small, round, yellow-white spots on outer retina)

A

macular degeneration

248
Q

central vision loss/blindness, COTTON WOOL spots, neovascularization

A

diabetic neuropathy

249
Q

floaters, flashing lights, progressive unilateral vision loss, shadow “CURTAIN” vision loss in peripheral–>central pattern

A

retinal detachement

250
Q

decreased vision, pain with ocular movements, proptosis; most common in children; associated with URI

A

orbital cellulitis

251
Q

most common organisms in orbital cellulitis

A

S. pneumo, GABHS, H. Flu, S. Aureus

252
Q

acute UNILATERAL peripheral vision loss; unilateral ocular pain; halos around lights; “steamy cornea”; “cupping” of optic nerve; increased IOP (>21)

A

acute narrow-angle glaucoma

253
Q

treatment for acute narrow-angle glaucoma

A

acetazolamide (decreases aqueous humor production)
BB (timolol)
cholinergic (pilocarpine)
iridotomy

254
Q

gradual BILATERAL peripheral vision loss; tunnel vision

A

chronic open angle glaucoma

255
Q

treatment for chronic open angle glaucoma

A 
prostaglandin analog (latanoprost)
BB (timolol)
256
Q

treatment for allergic conjunctivitis

A

olopatadine (topical antihistamine)

257
Q

common organisms in NEONATAL infectious conjunctivitis

A

day 2-5: gonorrhea
day 5-7: chlamydia
day 7-11: HSV

258
Q

pain, photophobia, reduced vision, hazy cornea; rapidly progressing; sight-threatening

A

keratitis

259
Q

what is optic neuritis most commonly associated with?

A

multiple sclerosis; autoimmune

ethambutol (HIV med)

260
Q

unilateral color vision loss; visual field defects; ocular PAIN worse with eye movement; papillitis

A

optic neurtitis

261
Q

treatment for optic neuritis

A

IV methyprednisone

262
Q

unilateral ocular pain/redness/photophobia; blurred/decreased vision; associated with systemic inflammatory diseases

A

uveitis

263
Q

acute, sudden, monocular vision loss; pale retina with cherry-red macula

A

central retinal artery occlusion

264
Q

treatment for central retinal artery occlusion

A 
no good treatment options
acetazolamide (decrease IOP)
ocular massage
thrombolysis
anterior chamber paracentesis (drop pressure to dislodge clot)
265
Q

acute, sudden, monocular vision loss; extensive retinal hemorrhages (“blood & thunder” appearance)

A

central retinal vein occlusion

266
Q

most common pathogen in otitis EXTERNA

A

pseudomonas

267
Q

most common pathogens in otitis INTERNA (as well as acute sinusitis)

A

S. pneumo
H. flu
Moraxella
S. pyogenes (GAS)

268
Q

which two conditions are associated with malignant otitis externa?

A

DM

immunocompromised

269
Q

unilateral hearing loss, tinnitus, HA, facial numbness, disequilibrium

A

acoustic/vestibular neuroma (CN VIII)

270
Q

episodic vertigo, NO hearing loss; worse with head position changes; horizontal nystagmus

A

Benign Paroxysmal Positional Vertigo

271
Q

continuous vertigo, N/V, ear pain, +/- fever; vestibular (CN VIII) neuritis + hearing loss/tinnitus

A

Labyrinthitis

272
Q

treatment for labyrinthitis

A

steroids

meclizine (antihistamine, antiemetics)

273
Q

hearing loss, tinnitus, ear fullness, episodic vertigo (lasting min/hrs), horizontal nystagmus

A

Meniere’s Disease

274
Q

treatment for Meniere’s disease

A

meclizine (antihistamine, antiemetic)
HCTZ
avoid salt, caffeine, chocolate, EToH

275
Q

graduation tissue that over time erodes ossicles, painless otorrhea, vertigo, brown/yellow discharge with strong odor from ear

A

cholesteatoma

276
Q

salivary stones

A

sialolithiasis

277
Q

salivary gland infection

A

sialadenitis

278
Q

treatment for sialadentitis/sialithisasis

A

sialogogues

279
Q

ducts involved in sialolithiasis

A

Wharton’s duct

Stenson’s duct

280
Q

LACY white lesions of oral mucosa; associated with HCV

A

oral lichen planus

281
Q

white patchy oral lesions that canNOT be rubber off; painless; precancerous

A

oral leukoplakia

282
Q

non-painful, “feathery” white plaque in oral/buccal mucosa that canNOT be scraped off; associated with EBV and immunocompromised

A

oral hairy leukoplakia

283
Q

white, curd-like plaques that bleed when scraped off; associated with immunocompromised

A

oral candidiasis (thrush)

284
Q

diagnostic method for Candida albicans infection

A

KOH smear

285
Q

treatment for thrush

A

nystatin

286
Q

most common pathogens in peritonsillar abscesses

A

GAS
S. Aureus
polymicrobial

287
Q

cellulitis of the sublingual and submaxillary spaces in the neck; most commonly from dental infections; swelling/erythema of upper neck/chin + pus on floor of mouth

A

Ludwig’s Angina

288
Q

can be used for abortion up to 9 weeks of GA

A

mifeprostone + misoprostol

289
Q

can be used for abortion up to 7 weeks of GA

A

methotrexate + misoprostol

290
Q

can be used for abortion at 4-12 weeks of GA

A

D&C

291
Q

can be used for abortion at 13-24 weeks of GA

A

D&E (dilation and evacuation)

292
Q

amenorrhea d/t increased prostaglandins

A

primary dysmenorrhea

293
Q

amenorrhea d/t pelvic pathology

A

secondary dysmenorrhea

294
Q

management for premenstural dysphoric disorder

A

fluoxetine/sertraline/SSRI

OCP

295
Q

absence of spontaneous mentruation before age 15

A

primary amenorrhea

296
Q

absence of menses for 3 (previously regular) or 6 (previously irregular) menses

A

secondary amenorrhea

297
Q

What is the cause of premature ovarian failure and what disorder is it related to?

A

follicular failure to produce E/P or resistant to LH/FSH

Turner’s syndrome

298
Q

What is the progesterone challenge?

A

tests estradiol levels
10mg medroxyprogesterone x10days
+bleeding = enough estrogen

299
Q

scarring of uterine cavity secondary to postpartum or D&C or infection

A

Asherman’s syndrome

300
Q

treatment for Asherman’s syndrome

A

estrogen

301
Q

endometrial tissue within myometrium; SYMMETRIC, SOFT, TENDER, “boggy” uterus; menorrhagia, dysmenorrhea

A

adenomyosis

302
Q

45X0, short webbed neck, no breast development, premature ovarian failure (high FSH/low estrogen)

A

Turner Syndrome

303
Q

46XX, no breast development, amenorrhea, low FSH/low LH

A

HPA insufficiency

304
Q

46XY, normal breast development, high T, amenorrhea

A

androgen insensitivity

305
Q

most common pathogens in endometritis/chorioamnioitis

A

GAS

S. Aureus

306
Q

“chocolate cyst” on laparoscopy

A

endometriosis

307
Q

GnRH analog

A

Leuprolide

308
Q

What TVUS finding is indicative of endometrial cancer/hyperplasia?

A

endometrial stripe >4mm

309
Q

risk factors for endometrial cancer

A

nulliparity, chronic anovulation/PCOS, obesity, estrogen replacement therapy, tamoxifen

310
Q

thin, yellow vaginal discharge, pH >5.5, pruritis

A

atrophic vaginitis

311
Q

estrogen modulator; used for infertility

A

clomiphene

312
Q

urine leakage due to increased intrabdominal pressure

A

stress incontinence

313
Q

treatment for stress incontinence

A

kegal exercises, biofeedback

midodrine (increases urethral sphincter tone)

314
Q

urine leakage accompanied by preceding urge; urgency/frequency, nocturia; OVERACTIVE detrusor muscle

A

urge incontinence

315
Q

treatment for urge incontinence

A

bladder training
tolterodine (bladder relaxant)
oxybutynin (antispasmodic/anticholinergic)

316
Q

urinary retention/incomplete emptying; UNDERACTIVE detrusor muscle or bladder outlet obstruction

A

overflow incontinence

317
Q

treatment for overflow incontinence

A

catherterization

bethanacol (cholinergic, increases detrusor activity)

318
Q

alpha blocker used for BPH; decreases urethral resistant

A

tamsulosin

319
Q

risk factors for ovarian cancer

A 
family hx
infertiliy
nulliparity
>50y
BRCA1/BRCA2
PROTECTIVE: OCPs, high party
320
Q

ovarian cancer mets to umbilical lymph nodes

A

Sister Mary Joseph’s node

321
Q

serum marker for ovarian cancer

A

CA-125

322
Q

Diagnostic labs for PCOS

A

increased testosterone
increased DHEA-S
increased LH:FSH 3:1

323
Q

treatment for PCOS

A 
OCP
spironolactone
leuprolide
clomiphene (for fertility)
metformin
324
Q

which cancer/condition is linked to DES exposure?

A

clear cell cervical cancer and vulvular cancer

cervical insufficiency

325
Q

thin, grey vaginal discharge, fishy odor, pH >5

A

bacterial vaginosis

326
Q

diagnostic lab for bacterial vaginosis

A

clue cells on KOH prep

327
Q

frothy, yellow/green vaginal discharge, strawberry cervix, pH >5

A

trichomoniasis

328
Q

thick, curd-like/cottage cheese vaginal discharge

A

candida vulvovaginitis

329
Q

diagnostic lab for candida vulvovaginitis

A

hyphae, yeast on KOH prep

330
Q

PAINFUL genital ulcer caused by H. Ducreyi

A

chancroid

331
Q

“CAULIFLOWER LIKE” lesions (condyloma acuminata), genital warts

A

HPV

332
Q

PID + hepatic fibrosis/scarring (perihepatitis; RUQ pain)

A

Fitz-Hugh Curtis Syndrome

333
Q

what is the most common pathogen in toxic shock syndrome

A

S. Aureus (enterotoxins)

334
Q

most common pathogens in cystitis/pyelo

A

E. coli

Staph Saprophyticus

335
Q

What levels of WBC in UCx is needed to diagnose a UTI?

A

> 100k

336
Q

hypoestrogenic/hyperandrogenic medication for endometriosis

A

danazol

337
Q

estrogen antagonist in breast, agonist in bone/endometrium

A

tamoxifen

338
Q

what is a beta-HCG >100k indicative of?

A

molar pregnancy

339
Q

At what week are pregnancy women screened for gestational diabetes? With which test?

A

24-28
50g oral glucose challenge; >130 –> 3hr test
100g GTT (3hrs); 2/3 hours must be high

340
Q

when is Rhogam given?

A

at 28 weeks + within 72 hours of delivery

341
Q

meds to delay preterm delivery

A

terbutaline (b2 agonist)

magnesium sulfate

342
Q

med for morning sickness/hyperemesis gravidarum

A

pyroxidine (B6)+doxylamine

343
Q

BP meds safe in pregnancy

A

hydralazine*
methyldopa (weak BP med)
labetalol
nifedipine

344
Q

hemolytic anemia, elevated liver enzymes, low platelets ; often associated with severe preeclampsia

A

HELLP syndrome

345
Q

what are the delivery windows for gestational diabetes? preeclampsia? chronic HTN?

A

GD: 38 weeks
Preeclampsia: 34-36 weeks
Chronic HTN: 39-40 weeks

346
Q

When is a pregnancy woman screened for GBS?

A

32-37 weeks

347
Q

What does APGAR stand for?

A 
Appearance/color
Pulse
Grimace
Activity
Respiration
*scores 0-2
348
Q

medications to give during postpartum hemorrhage

A

oxytocin

misoprotsol

349
Q

what common conditions/tumors are seen in MEN I/II?

A

I: hyperparathyroidism, pituitary tumors, pancreatic tumors
II: hyperparathyroidism, pheochromocytoma, medullary thyroid cancer

350
Q

What is the main cause of secondary hyperparathyroidism?

A

chronic kidney failure (can’t convert vitamin D –> stimulates PTH)

351
Q

clinical signs of hyperparathyroidism (hypercalcemia)

A

strones, bones, abdominal groans, psychic moans
DECREASED deep tendon reflexes
shortened QT interval

352
Q

clinical signs of hypocalcemia

A

Trousseau + Chvostek sign
increased deep tendon reflexes
prolonged QT interval

353
Q

treatment for hypercalcemia

A

furosemide

calcitonin

354
Q

treatment for osteoporosis

A

vitamin D
high impact exercise
bisphosphonates
Raloxifene (selective estrogen receptor modulator)

355
Q

sever osteoporosis, blue sclerae, presenile deafness

A

osteogenesis imperfecta

356
Q

bone pain, muscle weakness, bowing of legs, “looser lines” on XR

A

osteomalacia + ricketts

357
Q

bone pain, muscle weakness, bowing of legs, but high phos and “salt and pepper” skull on XR

A

renal osteodystrophy

358
Q

treatment for Addison’s disease (1ry) and 2ry adrenal insufficiency

A

1ry: glucocorticoids (hydrocortisone) + mineralocorticoids (fludrocortisone
2ry: glucocorticoids

359
Q

common lab abnormalities in adrenal crisis

A

hyponatremia, hyperkalemia, hypoglycemia

360
Q

adrenal aldosteronoma

A

Conn syndrome

361
Q

most common cause of secondary hyperalosteronism (d/t increased renin)

A

renal artery stenosis

362
Q

signs of hyperaldoseronism-induced hypertension

A

hypokalemia

diastolic more elevated than systolic

363
Q

proteinuria, hypoalbuminemia, hyperlipidemia, edema, +/- periorbital edema (children), anemia, DVT, FROTHY URINE

A

nephrotic syndrome

*hyplipidemia/anemia/DVT is a result of low protein –> liver compensates by creating lipoproteins

364
Q

associated with viral infections; mostly children; nephrotic syndrome with NO cellular changes but + podocyte damage on electron microscope

A

minimal change disease

365
Q

treatment for minimal change disease

A

prednisone

366
Q

nephrotic syndrome associated with sclerosis/fibrosis of the glomerulus; associated with HTN (esp AA)

A

focal segmental glomerulosclerosis

367
Q

nephrotic syndrome associated with thickened glomerular basement membrane due to immune complex deposition (SLE, viral hepatitis, etc); most common in white male >40

A

membranous nephropathy

368
Q

diagnostic test for nephrotic syndrome

A

24h urine collection with >3.5g/d of protein

OVAL FAT BODY on miscropscopic examination of urine

369
Q

HTN*, hematuria (RBC CASTS, “coco-cola colored” urine), proteinuria, AZOTEMIA (elevated BUN)

A

acute glomerulonephritis

370
Q

usually 1-days post-URI or GI infection; IgA deposits in kidney –> glomerulonephritis

A

IgA nephropathy (Berger Disease)

371
Q

cola-colored dark urine, puffy eyes, facial edema; post-pharyngeal/impetigo infection

A

post-infectious glomerulonephritis

372
Q

diagnostic labs for post-infectious glomerulonephritis

A

anti-streptolysin titers

low complement

373
Q

treatment for IgA nephropathy/Berger disease/rapidly progressive GN/SLE GN

A

ACEi

corticosteroids

374
Q

diagnostic test for acute glomerulonephritis

A

UA (RBC casts, proteinuria)
BUN/Cr (elevated)
renal biopsy

375
Q

clinical differences between nephrOtic and nephritic/glomerulonephritis

A

nephrotic: glomerular damage; hyperlipidemia, pleural effusion/DVTs, frothy urine, FATTY CASTS/oval fat bodies
nephritic: immune-mediated; azotemia, hematuria, HTN, oliguria, AZOTEMIA, RBC CASTS

376
Q

usually from prerenal AKI or aminoglycosides; epithelial and MUDDY BROWN casts on UA; hyperkalemia, hyperphosphatemia

A

acute tubular necrosis

377
Q

treatment for ATN

A

IV fluids, remove offending agents

378
Q

Intrinsic AKI; inflammatory/allergic; most commonly caused by PCN, NSAIDS, sulfa drugs; fever, eosinophilia, urine esosinophiles, rash, WBC casts

A

acute tubulointerstitial nephritis

379
Q

what do WAXY casts on UA indicate?

A

chronic ATN or ESRD

380
Q

what do WBC casts on UA indicate?

A

AIN (acute interstitial nephritis)

Pyelonephritis

381
Q

what do MUDDY BROWN casts on UA indicate?

A

ATN

382
Q

what do RBC casts on UA indicate?

A

vasculitis or acute glomerulonephritis

383
Q

What other complications are associated with polycystic kidney disease?

A

cerebral “berry” aneurysms

mitral valve prolapse

384
Q

most common cause of HYPOphosphatemia

A

primary hyperparathyroidism

385
Q

most common cause of HYPERphosphatemia

A

renal failure (then primary hypOparathyroidism)

386
Q

diagnostic test for CKD

A

GFR and spot UAblumin/UCreatinine Ratio (ACR)

387
Q

diagnostic test for diabetes insipidus

A

fluid deprivation test

desmopressin stimulation test

388
Q

equation for serum osm; what is a normal serum osm?

A

2Na [+ (Glu/18) + (BUN/2.8)]

normal: 285-295

389
Q

diagnostic labs for testicular cancer

A

alpha-fetoprotein

beta-hcg

390
Q

most common organisms for UTI/pyelo

A

E. Coli
staph saprophyticus
enterococci (if indwelling catheter)

391
Q

most common organisms for prostatitis

A

E. Coli
Pseudomonas
G/C in men <35y

392
Q

treatment for BPH

A

finasteride (5-alpha reductase inhibitor)

tamsulosin (alpha blocker; increases urinary outflow)

393
Q

clinical signs of renal cell carcinoma

A 
hematuria
flank/abdominal pain
palpable mass
L-sided varicocele
HTN
Hypercalcemia
394
Q

most common renal tumor in children; painless, palpable abdominal mass, hematuria, HTN, anemia

A

Wilm’s tumor (nephroblastoma)

395
Q

treatment for nephrolithiasis

A

<5mm: IV fluids, analgesics, tamsulosin
>7mm: shock wave lithotripsy, uretoscopy/stent
>10mm/struvite: percutaneous nephrolithotomy
Uric stones: alkalize urine >6.5

396
Q

treatment for priapism

A

terbutaline (vasoconstriction)
phenylephrine (vasoconstriction)
needle aspiration

397
Q

dopamine agonists used in Parkinson’s (younger patients to delay levodopa use)

A

bromocriptine

pramiprexole

398
Q

treatment for Tourett’s

A

dopamine-blocking agents (haloperidol, risperdone)

399
Q

post-infection immune response (usually campylobacter, CMV, EBV, GI/URI) leading to demyelination; lower –> upper parasthesias/weakness

A

GBS

400
Q

diagnostic test for GBS

A

CSF with high protein and normal WBC

401
Q

treatment for GBS

A

plasmaphoresis

IVIG

402
Q

autoimmune antibody against ACh receptors; progressive weakness with muscle use, ptosis, weakness with chewing; can progress to respiratory failure

A

myasthenia gravis

403
Q

diagnostic tests for myasthenia gravis

A

ice pack test

+ACh-receptor antibodies

404
Q

treatment for myasthenia gravis

A

pyridostigmine/neostigmine (ACh-esterase inhibitor)

plasmapheresis/IVIG for MG crisis

405
Q

what are some clinical signs of MS?

A

weakness, paresthesias, fatigue, TRIGEMINAL NEURALIA, OPTIC NEURITIS
Uhthoff’s phenomenon (worsening of sxs with heat/exercise)
Lhermitte’s sign (neck flexion –> lightening-shock pain down spine)

406
Q

diagnostics tests for MS

A

MRI w/ contrast: white matter plaques

CSF: increased IgG

407
Q

nystagmus, staccato speech, intentional tremor

A

Charcot’s triad (associated with MS)

408
Q

treatment for MS

A

acute: steroids, plasma exchange

relapse/progressive: beta-interferon

409
Q

treatment for cluster HAs

A

acute: 100% O2
prophylaxis: verapamil

410
Q

treatment for migraine HAs

A

triptans, metoclopramide (for nausea), propanolol

411
Q

diagnostic test for pseudotumor cerebri

A

CT scan FIRST to r/o mass

LP

412
Q

treatment for pseudotumor cerebri

A

acetazolamide (diuretic)

413
Q

treatment for trigeminal neuralgia

A

carbamazepine (tegretol), gabapentin

414
Q

what are the main pathogens associated with Bell’s palsy?

A

HSV, VZV, lyme

415
Q

treatment for Bell’s palsy

A

prednisone, artificial tears, acyclovir

416
Q

Bell’s palsy caused by VZV

A

Ramsey-Hunt Syndrome

417
Q

CN responsible for inferior rectus (moving eye down)

A

CN III

418
Q

CN responsible for superior oblique rectus (moving eye to look down+in)

A

CN IV

419
Q

CN responsible for lateral rectus (lateral gaze)

A

CN VI

420
Q

most common pathogens in bacterial meningitis (based on age)

A

<1mos: GBS
1mos-18y: N. Meningitidis (assc with petechial rash); S. Pneumo
18y-50y: S. Pneumo, N Meningitidis
>50y: S. Pneumo, Listeria

421
Q

inability to straighten knee with hip flexion; sign of meningitis

A

Kernig’s sign

422
Q

neck flexion produces knee/hip flexion; sign of meningitis

A

Brudzinski’s sign

423
Q

CSF findings in viral vs. bacterial meningitis

A

bacterial: high protein, high WBC (neutrophils), low glucose
viral: high protein, high WBC (leukocytes), normal glucose

424
Q

most common causes of VIRAL meningitis

A

echovirus, coxsackie

425
Q

most common causes of VIRAL enchephalitis

A

HSV-1

426
Q

mild form of depression that lasts for >2 yrs

A

dysthymic disorder

427
Q

What is buspirone used to treat?

A

GAD (1st line SSRI)

428
Q

What is a major contraindication for bupropion/Wellbutrin?

A

seizure d/o

429
Q

What is are some important complications of MAOIs?

A

MAOI + tyramine: HTN crisis
MAOI + SSRI: serotonin syndrome
MAOI + TCA: delirium + HTN

430
Q

what are the various clusters of personality disorders?

A

A: weird, odd eccentric
B: dramatic, emotional, impulsive
C: anxious, fearful, dependent

431
Q

personality disorder: social withdrawal, hermit-like behavior, prefers to be alone, flat affect, “cold”

A

schizoid personality disorder

432
Q

personality disorder: odd, eccentric, peculiar thought patterns WITHOUT psychosis, “magical thinking”, discomfort with close relationships

A

schizotypal personality disorder

433
Q

personality disorder: distrustful, suspicious, easily insulted, preoccupation with loyalty

A

paranoid personality disorder

434
Q

personality disorder: deviates sharply from norm, harmful, volatile, violates the rights of others, sets fires, harms animals, may begin as conduct disorder in child

A

anti-social personality disorder

435
Q

personality disorder: unstable, unpredictable, **mood swings, moments of intense anger; unable relationships, cannot tolerate “being alone”

A

borderline personality disorder

436
Q

personality disorder: overly emotional, dramatic, seductive, attention-seeking

A

histrionic personality disorder

437
Q

personality disorder: grandiose often excessive sense of self-importance, needs praise and admiration, entitled, lacks empathy, Trump

A

narcissistic personality disorder

438
Q

personality disorder: desires relationships but avoids them; “inferiority complex”, timid, shy, lacks confidence

A

avoidant personality disorder

439
Q

personality disorder: submissive behavior, constantly needs to be reassured, relies on others, will not initiate things

A

dependent personality disorder

440
Q

personality disorder: perfectionist, requires a great deal of order and control, preoccupied with minute details

A

obsessive-compulsive personality disorder

441
Q

meets criteria for schizophrenia but <6mos duration

A

schizophreniform disorder

442
Q

schizophrenia + mood disorder

A

schizoaffective disorder

443
Q

paranoid delisions about things that could happen in real life

A

delusional disorder

444
Q

> 6 mos duration, functional decline + 2 of the following: hallucinations, delusions, disorganized speech, disorganized/catatonic sxs, negative sxs

A

schozophrenia

445
Q

negative vs positive sxs of schizophrenia

A

negative: flat emotional affect, social withdrawal, lack of emotional expression/communication (insufficient dopamine)
positive: hallucinations, delusions, disorganized speech, movement disorders (excess dopamine)

446
Q

treatment for schizophrenia

A

clozapine, risperidone, olanzapine

447
Q

physical symptoms but no physical cause found; preoccupation with medical/surgical therapy

A

somatization disorder

448
Q

neurologic loss of sensory or motor function; caused by psychological factors

A

conversion disorder

449
Q

preoccupation with the fear or belief that one has a serious, undiagnosed disease

A

illness anxiety disorder (hypochondiasis)

450
Q

persistent pattern of negative, hostile, defiant behavior, hyperactivity, blames others

A

oppositional defiant disorder

451
Q

social and academic difficulty, lack of remorse, sets fires, harms animals, sexually uninhibited; <18y

A

conduct disorder

452
Q

purple, polygonal, planar, pruritic papule with fine scales; or lacy lesion of oral mucosa; immune response

A

lichen planus

453
Q

herald patch, salmon-colored macule/papule, Christmas tree pattern

A

pityriasis rosea

454
Q

treatment for pityriasis rosea

A

none

455
Q

treatment for lichen planus

A

topical steroids

456
Q

silver/white scales, raised, dark red plaques, nail pitting, **punctuate bleeding with removal of plaque; SAUSAGE DIGITS, PENCIL-IN-A-CUP DEFORMITY

A

psoriasis

457
Q

treatment for psoriasis

A

high dose steroids, UVB light therapy

458
Q

overgrowth of Malassezia yeast; fine scaling with hypo/hyper pigmentation; “spaghetti and meatball” appearance on KOH

A

pityriasis versicolor

459
Q

usually over sebaceous glands (scalp, face, eyebrows, body folds); erythematous plaques with fine white scales; “cradle cap” in infants; usually due to a fungus

A

seborrheic dermatitis

460
Q

treatment for seborrheic dermatitis

A

selenium sulfide or ketoconazole

461
Q

most common drugs to cause hypersensitivity reactions

A

abx, NSAIDS, allopurinol, thiazide diuretics

462
Q

acute/self limiting rash, often due to infections (HSV) or drugs (sulfa, beta-lactams); dusty-violet target lesions

A

erythema multiforme

463
Q

sloughing of skin, often a reaction to drugs (sulfa) or infection (mycoplasma); <10% of body

A

Steven-johnson syndrome

464
Q

sloughing of skin, often a reaction to drugs (sulfa) or infection (mycoplasma); >30% of body

A

toxic epidermal necrolysis

465
Q

sign of a blistering skin condition; skin will slough off with touch

A

Nikolsky sign

466
Q

treatment for rosacea

A

metronidazole, clonidine (for flushing)

467
Q

most common with prolonged sun exposure; may be pre-cancerous; dry, rough, “sandpaper” skin, hyperkeratotic plaques

A

actinic keratosis

468
Q

small papule/plaque, velvety warty lesion “grease/stuck on appearance”

A

seborrheic keratosis

469
Q

treatment for seborrheic keratosis

A

none

470
Q

common cause of plantar and genital warts (chondyloma acuminata)

A

HPV

471
Q

diagnosis of HPV (wart)

A

whitening of lesion with acetic acid

472
Q

PAINFUL, self-limited, inflammatory nodule on anterior shins; usually due to estrogen exposures (OCPs, pregnancy), sarcoid, infections/inflammatory disease

A

erythema nodosum

473
Q

most common skin cancer type; slow growing, translucent, PEARLY, WXY papule with central ulceration and raised rolled borders

A

basal cell carcinoma

474
Q

skin cancer often preceded by actinic keratosis, HPV infection; most common in lips, hands, neck, and head; red, elevated nodule, white scaly or crusted bloody margins

A

squamous cell carcinoma

475
Q

aggressive skin cancer, ABCDE; most common skin cancer death

A

malignant melanoma

476
Q

self-limiting; single or multiple DOME_SHAPED, flesh-colored/pearly white, waxy papule with central umbilication, POX VIRUS

A

molluscum contagiosum

477
Q

treatment for lice

A

permethrin shampoo

478
Q

treatment for scabies

A

permethrin topical

479
Q

treatment for tinea captitus, tinea barbae, tinea pedis, tinea corporis

A

griseofulvin or topical antifungal

480
Q

urticarial plaques, tense bullae that don’t rupture easily; no Nikolsky sign; treated with steroids

A

bullous pemphigoid

481
Q

classification for minor and major burns

A

minor: <10% TBSA adult, <5% children, does not involve face hands/feet, perineum, joints, circumferential
major: >25% adult, >20%children

482
Q

treatment for keloids

A

corticosteroid injections

483
Q

high fever 3-5 –> rose pink maculopapular blanch able rash trunk/back –> face; caused by HHV6/7

A

Rosealo (sixth’s disease)

484
Q

fecal oral spread esp late summer/early fall; vesicular lesions on reddened base on hand/foot/mouth, mild fever, URI sx

A

coxsackie

485
Q

two complications of coxsackie

A

pericarditis/myocarditis

pleurodynia (severe CP with swelling over diaphragm)

486
Q

strongly associated with celiac disease; IgA complex deposition into dermal papillae; pruritic, papulovesicular rash on extensor surfaces and scalp

A

dematitis herpetiformis

487
Q

low grade fevers, myalgia, HA, painful parotid gland swelling; sometimes associated with orchitis and acute pancreatitis in children; paramyxovirus

A

mumps

488
Q

high fever, cough, coryza, conjunctivitis, Koplik spots, brick-red maculopapular rash on face beginning at hairline–>extremeties/palms/soles; paramyxovirus; main complication is otitis media

A

rubeola (measles)

489
Q

fever, cough, anorexia, lymphadenopathy, pink/light-red spotted maculopapular rash face –> extremities, joint pain, photosensitivity; togavirus

A

rubella (German measles)

490
Q

“blueberry muffin rash”, sensorineural deafness, cataract, mental retardation, heart defects

A

rubella during 1st trimester

491
Q

pathogens of TORCH syndrome

A 
Toxoplasmosis
Other (syphilis, VZV, HIV, fifths disease)
Rubella
CMV
HSV
492
Q

coryza, fever, “slapped cheek”, lacy rash on extremities, spares palms and soles; sometimes associated with arthropathy; parvovirus B19

A

erythema infectiosum (fifth’s disease)

493
Q

most common side effect of vancomycin

A

“red man’s syndrome”/flushing

494
Q

most common side effect of macrolides (azithromycin)

A

prolonged QT

495
Q

most common side effect(s) of fluoroquilolones

A

tendon rupture, QT prolongation

496
Q

most common side effect of clindamycin

A

c.diff colitis

497
Q

most common side effect of tetracyclines (doxy)

A

teeth discoloration (do not give to pt <8), photosensitivity

498
Q

most common side effect of PCN/cephalosporins

A

allergic reaction, nephrotoxicity

499
Q

painless black eschar on exposed skin areas, rapidly progresses to dyspnea/shock, medistinum widening on CXR

A

anthrax

500
Q

transmitted by cat/cat litter; mono-like illness that can lead to encephalitis and chorioretinitis; RING-ENHANCING LESIONS ON HEAD CT

A

toxoplasmosis

501
Q

diagnostic test for HSV

A

PCR, Tzanck smear

502
Q

diagnostic test for CMV

A

antigen tests, “owl’s eye” appearance on bx

503
Q

Which virus is associated with Hodgkin’s lymphoma?

A

EBV

504
Q

What is a complication of fifth’s disease/eryhtema infectiosum in patients with sickle cell?

A

aplastic crisis

505
Q

skin eruptions at the SAME STAGE simultaneously; flu-like sxs

A

small pox/variola

506
Q

prophylaxis for HIV patients with CD4 200-500

A

INH (tuberculosis)

507
Q

prophylaxis for HIV patients with CD4 <200

A

Bactrim (PCP)

Itraconazole (histoplasmosis)

508
Q

prophylaxis for HIV patients with CD4 <100

A

Bactrim (toxoplasmosis)

Cryptococcus (Fluconazole)

509
Q

prophylaxis for HIV patients with CD4 <50

A

azithromycin (MAC)

valganciclovir (CMV retinitis)

510
Q

At what CD4 count is HAART initiated?

A

<350 (or viral load >55k)

511
Q

“dew drops on a rose petal”; rash in different stages simultaneously

A

chicken pox

512
Q

strawberry tongue, sandpaper rash, facial flushing, Forchheimer spots

A

Scarlet fever

513
Q

Blood smear: RBCs stick together like a “stack of coins: (Rouleaux formation)

A

multiple myeloma

514
Q

macrocytosis on blood smear

A

B12/folate deficiency
Liver dx
aplastic anemia

515
Q

microcytosis on blood smear

A

iron deficiency anemia
thalassemia
lead poisoning

516
Q

Howell-Jolly bodies on blood smear (small, dense RBC inclusions)

A

patient with splenectomy

517
Q

Blood smear: bite cells (bite like mark on cells from phagocytes)

A

thalassemia

G6PD

518
Q

Blood smear: schistocytes

A 
mechanical RBC damage
hemolytic anemia (TTP, HUS, DIC)
519
Q

Blood smear: target cells (hypo chromic RBC with round area of central pigment)

A

sickle cell, thalassemia, Hgb SC

520
Q

Blood smear: tear-shaped cells/dacrocytes

A

thalassemia, hemolytic anemia

521
Q

Blood smear: ringed sideroblasts, basophilic stippling (blue granules in RBC)

A

lead poisoning

522
Q

electrolyte abnormalities in reseeding syndrome

A

hypokalemia, hypophosphatemia, hypomagnesium

523
Q

Blood smear: burr cells

A

uremia

524
Q

Blood smear: Auer Pod

A

AML

525
Q

Blood smear: smudge cell

A

CLL

526
Q

Blood smear: reed-sternberg cell

A

Hodgkin lymphoma

527
Q

Main causes of vitamin B12 deficiency

A

pernicious anemia, EToH, Crohn’s, veganism, PPI

528
Q

MACROCYTIC ANEMIA; pallor, glossitis, stomatitis, GI sxs, peripheral neuropathy

A

B12 deficiency anemia/pernicious anemia

529
Q

diagnostic test to look for B12 deficiency

A

Schilling test

530
Q

ileocecitis, pseudoappendacitis, common in Scandinavia and Europe

A

Yersinia enterocolitica

531
Q 
microcytic
decreased serum Fe
decreased ferritin
increased TIBC
decreased transferrin saturation
A

iron deficiency anemia

532
Q

what should you consider in a patient that has microcytic anemia with normal Fe and no response to iron supplementation?

A

alpha or beta thalassemia

533
Q

treatment for moderate/severe alpha thalassemia

A

moderate: folate, avoid oxidative stress
severe: blood transfusions, deferoxamine, BMT

534
Q

when do patients become symptomatic with B-thalassemia and why?

A

at 6 months, the fetal hgbF wears off

535
Q

treatment for severe beta-thalassemia

A

weekly transfusions, deferoxamine, BMT

536
Q

microcytic hypo chromic anemia with basophilic stippling, ringed sideroblasts in bone marrow, abdominal pain, constipation, neuro sxs, fatigue, learning disabilities

A

lead poisoning

537
Q

normocytic anemia
decreased serum Fe
increased ferritin
decreased TIBC

A

anemia of chronic disease

538
Q 
normocytic, hemolytic anemia
schistocytes
increased reticulocytes
increased indirect bili
decreased haptoglobin
A

G6PDD

539
Q

defect in RBC membrane –> sphere-shaped cells, anemia, jaundice, splenomegaly, Coombs negative

A

hereditary spherocytosis

540
Q

what can cause a prolonged PTT?

A

heparin, DIC, vWD, hemophilia A+B

541
Q

what can cause a prolonged PT?

A

warfarin overdose, vitamin k deficiency, DIC

542
Q

immune-mediated; thrombocytopenia, microangiopathic hemolytic anemia, kidney failure/uremia, neurologic sxs, fever; NORMAL COAGS

A

Thrombotic Thrombocytopenic Purpura

543
Q

treatment for Thrombotic Thrombocytopenic Purpura

A

plasmapheresis (to remove ab), steroids

544
Q

usually preceded by enterohemorrhagic E. coli, shigella, or salmonella GASTROENTERITIS*; thrombocytopenia, microangioapthic hemolytic anemia, kidney failure

A

hemolytic uremic syndrome

545
Q

treatment for hemolytic uremic syndrome

A

usually self limiting but plasmapheresis if severe

546
Q

triggered by infections, malignancies, or obstetric conditions; elevated PTT/PT/INR, decreased fibrinogen, severe thrombocytopenia, elevated D-dimer

A

DIC

547
Q

when to transfuse platelets

A

<20k

548
Q

isolated thrombocytopenia (normal coags); most common post viral infection in children; immune-mediated; mucocutaneous bleeding, purpura, bruises, petechiae, bullae

A

idiopathic/autoimmune Thrombocytopenic Purpura

549
Q

treatment for idiopathic/autoimmune Thrombocytopenic Purpura

A

children: observation, IVIG
adults: corticosteroids, IVIG

550
Q

most in males, prolonged PTT, normal PT/platelets – corrects with mixing study; excessive hemorrhage in response to trauma, hemarthrosis, epistaxis, bruising

A

Hemophilia A (factor 8) or Hemophilia B (factor 9)

551
Q

treatment for Hemophilia A+B

A

factor 8/9 infusion

desmopressin for HEMOPHILIA A ONLY* (transiently increases factor 8)

552
Q

bleeding with minor cuts, mucocutaneous bleeding, easy bruising, epistaxis, petechiae, prolonged PTT

A

von willebrand disease

553
Q

treatment for moderate/severe von willebrand disease

A

desmopressin, cryoprecipitate
vWF + Factor VIII prior to procedures
avoid aspirin

554
Q

what causes a prolonged PT? PTT? Bleeding time?

A

PT: vit k deficiency, DIC
PTT: hemophilias, vWF def, DIC
Bleeding time: thrombocytopenia, vWF def, DIC

555
Q

lymphocyte neoplasm; bimodal (peaks at 20y + 50y); assoc with EBV; painless lymphadenopathy, hepatosplenomegaly, CYCLIC FEVERS, night sweats, weight loss; Reed-Sternberg cell

A

Hodgkin’s lymphoma

556
Q

lymphocyte neoplasm; mostly peripheral, in old pt and immunocompromised; painless lympadenopathy, splenomegaly, B symptoms rarer

A

Non-Hodgkin’s lymphoma

557
Q

neoplasm associated with monoclonal Ab proliferation; BREAK = bone pain/bone lytic lesions, recurrent infections, elevated calcium, anemia, kidney failure

A

multiple myeloma

558
Q

diagnostic labs for multiple myeloma

A

SPEP (IgG/IgA spike), UPEP (Bence-Jones proteins: kappa or lambda), skull xray with “punched out lesions”

559
Q

treatment for multiple myeloma

A

stem cell transplant, chemotherapy

560
Q

childhood leukemia; pancytopenia, fatigue, petechiae, bruising, lethargy, bone pain, CNS sxs, hepatosplenomegaly, LAD; HYPERCELLULAR BM w/ >20% BLASTS

A

acute lymphocytic leukemia

561
Q

treatment for ALL

A

chemo (highly responsive)

562
Q

B clonal malignancy, >50y adults; often asx and diagnosed on blood tests; peripheral smear with well-differentiated lymphocytes and scattered “SMUDGE CELLS”

A

chronic lymphocytic leukemia

563
Q

treatment for CLL

A

observant if indolent or PO chemo

564
Q

most common in adults >50y; anemia, thrombocytopenia, neutropenia, splenomegaly, gingival hyperplasia; AUER RODS >20% BLASTS IN BONE MARROW

A

acute myeloid leukemia

565
Q

treatment for AML

A

chemotherapy, BMT

566
Q

treatment for tumor lysis syndrome

A

allopurinol

567
Q

signs of tumor lysis syndrome

A

hyperkalemia, hyperuricemia, hyperphosphatemia, hypOcalcemia, acute renal failure

568
Q

most asx until they develop BLAST CRISIS (acute leukemia); strikingly elevated WBC and LDH, splenomegaly; associated with PHILADELPHIA CHROMOSOME

A

chronic myeloid leukemia

569
Q

translocation between chromosome 9 + 22; CML

A

Philadelphia chromosome

570
Q

overproduction of all 3 cell lines; JAK2 mutation; hyperviscosity, pruritis (ESP IN HOT BATH*), splenomegaly, flushed face

A

polycythemia vera

571
Q

treatment for polycythemia vera

A

phlebotomy, hydroxyurea

572
Q

autosomal recessive; increased iron absorption and storage; cirrhosis, cardiomyopathy, bronze skin

A

hereditary hemochromatosis

573
Q

which hemophilic conditions cause hypercoagulability (increased DVTs and PEs)?

A

factor V leiden mutation
protein C deficiency
antithrombin III deficiency

PANCE (2 decks)

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