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random / exam master questions Flashcards

1
Q

sarcoidosis pres

A

30-40 year old african american female
constituional (fever, malaise), dyspnea, erythema nedosum, parotid gland enlargement, hepatosplenomegaly, arthritis, neuropathy, lymphadenopathy

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2
Q

sarcoid labs

A

elevated ESR, hypercalcemia, hypercalciuria, elevated ACE and leukopenia

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3
Q

sarcoid diagnosis

A

bilateral hilar adenoapthy and diagnostic biopsy of NONCASEATING GRANULOMAS!

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4
Q

sarcoid tx

A
  • lots resolve spontaneously

- more severe: prednisone

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5
Q

tuberculosis - pres

A
  • CASEATING GRANULOMAS w/ fever, night sweats, malaise, fatigue, weight loss
  • w/ progression, productive cough, dsypnea, hemoptysis,, pleuritic chest pain
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6
Q

TB - high risk pop

A

-homeless, immigrants, alcoholics, drug abusers, elderly, HIV pos

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7
Q

CXR w/ TB

A

UPPER LOBE cavitation or superior segment of lower lobe

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8
Q

alcoholic given D5W becomes confused, ataxic w/ nystagmus and internuclear opthalmoplegia…

A

WERNICKES ENCEPHALOPATHY!

-d/t acute thiamine def!

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9
Q

dz d/t chronic thiamine deficiency…

A

KORSAKOFFS ENCEPHALOPATHY! - have presevered long-term memory, language and socially appropriate but have profound short-term memory loss, confabulation

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10
Q

what test is associated w/ recurrent thyroid malignancy post ablation or incomplete thyroidectomy…

A

rising serum thyroglobulin levels - w/ baseline and stimulated thyroglobulin levels >2 ng/ml need repeat u/s and scan to r/o malignancy

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11
Q

requirement before using I131 for hyperthyroidism…

A

pregnancy test! contraindicated in prego!

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12
Q

3 y/o boy who uses hands to push himself upright w/ waddling gait, bilateral calf hypertrophy, lumbar lordosis and hyporeflexia and increased CK levels suggests…

A

duchenne MD - most common type, onset b/n 3-5 in boys
gower’s sign = pushing self upright w/ hands
-see increased CK

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13
Q

trichostatis spinulosa

A

little black dots around nose - can pull out = keratin plug w/ vellous hair

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14
Q

oral hairy leukoplakia suggests…

A

HIV or immunosuppression! rarely seen in immunocompetent!!

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15
Q

farmer presents w/ rigid paralysis after getting puncture wound on foot - drained to find motile rods w/ terminal endospores that look like tennis rackets…

A

c. tetani! (endospores are terminal, look like tennis racket / drumstick)

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16
Q

crepitant cellulitis w/ gas…

A

c. perfringens - central endospores, nonmotile

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17
Q

73 y/o AA w/ lower back and shoulder pain who is anemic w/ hypercalcemia and multiple spots of bony tenderness…expect what on xray and dx?

A

Multiple myeloma!!! lytic bone lesions!

-tx w/ chemo first bortezomib then bone marrow transplant

18
Q

35 y/o w/ nonproductive cough and dyspnea on exertion x 1 week. some weight loss and night sweats, white plaques in mouth w/ dysphagia. hx iv heroin. clear lungs on exam. wbc 2800, pmn 79%……dx and tx

A

AIDS W/ PCP! IV bactrim!!!

  • think AIDS w/ hx drug use, low white count and high ldh w/ esophageal candidiasis
  • CXR may be negative, dx w/ bronchoscopy showing trophozoites or yeast
19
Q

unilateral sharply demarcated scaling lesion on breast….

A

PAGET’S! r/o mammary duct carcinoma (tx would be mastectomy if carcinoma present)

20
Q

types of melanoma…

A

superficial spreading - black/blue plaques
nodular - black/blue rapidly growing papule
acral - most in AA, on fingers/subungal, soles, palms, mucous membranes
lentigo - brown/tan spots on sun exposed skin

21
Q

BCC…

A

-shiny pearly nodule or scaling plaque or solitary flat yellow plaque

22
Q

SCC…

A

red papule / crusted plaque on lips, ears, hands, neck / face

23
Q

kaposis

A

purple plaques on lower limbs or widely disseminated in AIDS

24
Q

high prolactin levels - cause? non-adenoma…

A

chronic renal failure d/t decreased clearance - get kidney function testing then pituitary mri for prolactinoma

25
Q

std initial test for kidney stone…

A

non contrast CT!!

26
Q

cholinergic crisis symptoms…

A

SLUDGE: salivation, lacrimation, urination, defacation, gi pain, E?, rhinorrhea
*muscle fasisculations! not seen w/ MG

27
Q

triad of colicky abd pain + vomiting + rectal bleeding in baby suggests…..

A

intussuseption. ..CURRANT JELLY STOOL AND TELESCOPING!

- most d/t viral infection w/ hypertrophy of peyer’s patches! in young

28
Q

eruptive and tendinous xanthomas…d/t?

A

high chylomicrons and VLDL w/ hyperlipidemia! yellow-red papules on butt and tendons

29
Q

case: pt w/ nausea, anorexia, weakness, constipated, thirst, muscle pain and h/o kidney stones…think about?

A

hypercalcemia!

expect shortened QRS on ekg! can also see J waves and arrest w/ severe!!

30
Q

common complications of aortic coarctation after correction….

A

htn!

31
Q

treatment of cardiogenic shock d/t MI

A
  • *avoid phenylephrine (alpha agonist - pure vasoconstrictor - will increase afterload), BB, no CCB, no crystalloids w/ pulmonary edema
  • w/o pulmonary edema - oxygen, asa, heparin, fluid challenge (250 cc NS) over 5 min
  • w/ severe (MAP <80
32
Q

dose-dependent dopamine effects:

A

<5 mcg/kg = vasodilation
5-10 = beta 1 activity - increase contractility and HR
10 = alpha adrenergic - arterial vasoconstriction

33
Q

drug of choice to prevent cluster headaches…

A

VERAPAMIL!

34
Q

boy who ate pork 3-4 weeks ago, now with watery diarrhea, periorbital edema and muscle pain. has blood eosinophilia and muscle biopsy shows edematous fibers w/ worm…tx?

A

mebendazole! 200-400 TID x 3 d then 400-500 TID x 10 days!

broad spectrum antihelminthic!

35
Q

best diagnostic test for CF?

A

sweat chloride! >60 mmol/L

36
Q

40 y/o man w/ RUQ pain, weight loss, weakness. on exam has ascites, hepatomegaly and h/o hep b. think about? best marker?

A

hepatocellular carcinoma!! order alphafetoprotein (elevated in over 70%)

37
Q

gram negative intracellular diplococci? tx?

A

GONORRHEA!

always cover for chlamydia too - ceftriaxone 125 mg IM + azithromycin 1 g

38
Q

tx for cholinergic crisis

A

stop agent, give atropine. can distinguish from myasthenic crisis w/ edrophonium testing

39
Q

bronchoalveolar lavage of enlarged cells w/ intranuclear inclusions in immunosupp pt w/ acute resp failure…

A

CMV! tx immunosupp only w/ ganciclovir

40
Q

intermittent jaundice and elevated unconjugated bilirubin…dx?

A

gilbert’s syndrome! benign condition! no treatment

41
Q

codman triangle…

A

area of new bone growth d/t lesion at metaphysis - often d/t tumor

42
Q

time for transmission of lyme dz w/ tick bite

A

must feed 24-36 hours

pulmonary (16 decks)

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