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random6 Flashcards

1
Q

fetal anemia presents w/?

A

sinusoidal fetal heart tracing w/ no variability

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2
Q

fetal head compression –>?

A

early decelerations

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3
Q

early decels due to?

A

fetal head compression

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4
Q

placental insufficiency –>?

A

late decelerations

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5
Q

late decels due to?

A

placental insufficiency

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6
Q

variable decels due to?

A

compression of umbilical cord

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7
Q

compression of umbilical cord –?

A

variable decels

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8
Q

rotavirus vax contraindicated if?

A
  • Hx of intussusception
  • Hx of uncorrected congenital malformations in GI tract (ie Meckel’s)
  • SCID
  • anaphylaxis to vax ingredients
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9
Q

loss of pain and temp in cape distribution (along dermatomes) - think? issue where?

A

syringomyelia

- distrubance of crossing spinothalamic tracts at the ant commisure

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10
Q

ursodeoxycholic acid can be used for?

A

prophylactically prevent gallstones (esp after gastric bypass)

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11
Q

risk of esophageal variceal bleed –> med treatment?

A

Non-selective B-Blocker (ie propranolo or nadolol)

- reduces portal venous pressure —> dec risk of hemorrhage

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12
Q

dec appetite, abd discomfort, abdominal fullness, now w/ painless jaundice – think?

A

Pancreatic CA

  • even w/ elevated bili and alk phos bc can be due to mass in panc blocking bile
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13
Q

iron toxicity –> ?

A

Early:
- n/v/d - hemorrhagic (BRB v and dark green stools) –> hypovolemic shock

Late:

  • severe lactic acidosis
  • hepatotoxicity
  • organ failure
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14
Q

new onset seizures can make you worry for what?

A

Brain tumors

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15
Q

most common adult brain CA?

A

Astrocytomas (specifically glioblastoma multiforme which is type grade IV)

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16
Q

what effects prognosis of astrocytomas most?

A

degree of anaplasia (atypia, mitoses, neovascularity or necrosis)

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17
Q

common first line therapy for CLL?

A

Rituximab (monoclonal Ab against CD20 on B lymphocytes)

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18
Q

monoclonal Ab against CD20 is what med to treat what?

A
  • Rituximab

- CLL

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19
Q

Imatinib inhibits what and is for what disease?

A
  • Inhibits product of BCR-ABL tyrosine kinase fusion

- CML

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20
Q

BCR-ABL - think?

A

CML

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21
Q

arm twitching - think?

A

simple partial seizure

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22
Q

dx of brain abscess uses what imaging?

A

gadolinium enhanced brain MRI

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23
Q

nL serum osmolality?

A

285 - 295

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24
Q

most common bacteremia in sickle cell pts?

A

Strep pneumo

can cause sepsis

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25
Q

what do you use for empiric abx in febrile sickle cell pt?

A

1) 3rd gen cephalosporin (ie ceftriaxone)

2) add vanco if concern for meningitis or osteoarticular infx

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26
Q

who received abx prophylaxis b4 dental appts? (3)

A

High risk pts for bad outcomes w/ IE:

  • prosthetic valves
  • prior hx of IE
  • unrepaired congenital heart disease
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27
Q

acute dystonic reaction treat w/?

A

anticholinergics

  • diphenhydramine
  • benztropine
  • trihexyphenidyl
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28
Q

halperidol can cause what via dopamine receptor antagonism?

A

acute dystonia (EPS, ie torticollis)

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29
Q

treatment of epi ovarian CA?

A

exploratory laparotomy and tumor debulking followed by platinum based chemo

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30
Q

PCOS wants to get preggers treat?

A

1) weight los
2) clomiphene

and/or metformin

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31
Q

vertigo is?

A

sensation of spinning

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32
Q

presyncope is?

A

feeling like one is about to faint

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33
Q

disquilibrium is ?

A

sense of imbalance

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34
Q

sensation of spinning?

A

vertigo

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35
Q

feeling like one is about to faint?

A

presyncope

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36
Q

sense of imbalance?

A

disequilibrium

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37
Q

injury to the radial nerve may cause?

A

wrist drop due to weakness of the extensor muscles

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38
Q

test for intact sensation of radial nerve by?

A

testing dorsal surface of hand

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39
Q

oblique fracture of middle humerus most at risk of what being damaged?

A

radial nerve (travels in spiral groove along dorsal aspect)

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40
Q

supracondylar fracture of humerus worry what is being injured?

A

median n.

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41
Q

abduction and adduction of fingers controlled by?

A

ulnar nerve

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42
Q

weakness of elbow flexion and forearm supination - think?

A

injury to musculocutaneous nerve

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43
Q

palliative treatment of pancreatic adenocarcinoma causing extrahepatic cholestatis?

A

First line: endoscopic stent placement

2nd: surgical bypass

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44
Q

ursodeoxycholic acid is the only FDA approved treatment for what?

A

primary biliary cirrhosis

(doesn’t change mortality, just symp help)

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45
Q

malignant pleural effusions appear how?

A
  • exudative

- low pH (

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46
Q

absent p waves w/ irregularly, irregular QRS complexes?

A

atrial fibrillation

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47
Q

rate control meds for a fib?

A

1) beta blockers (adrenergic antagonists) - ie metoprolol or exmolol
2) non-dyhyidrophyridine Ca channel blockers - ie diltiazem or verapamil

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48
Q

dementia w/ early onset ataxia, urinary incontinence and dilation of ventricles on neuroimaging?

A

NPH

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49
Q

finding on neuroimaging for NPH?

A

dilated ventricles

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50
Q

round, eosinophilic, intracytoplasmic inclusions w/in neurons of substantia nigra - is?

A

Lewy body dementia

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51
Q

pt w/ multiple myeloma w/ renal issues but no proteinuria - where is kidney issue?

A

Renal tubular damage (from monoclonal light chains clogging tubules -> casts & toxicity)

(proteinuria would be seen if it was in the glomerulus)

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52
Q

slow rise in creatinine in pt w/ severe HTN and recurrent flash pulm edema - think?

A

Renal artery stenosis

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53
Q

4 big trinucleotide repeat disorders?

A

Fragile X
Friedrich ataxia
Huntington
Myotonic dystrophy

“X-Girlfriend’s First Aid Helped Ace My Test!”

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54
Q

friedreich ataxia symp?

A
  • kyphoscoliosis
  • muscle weakness
  • loss of DTR, vib and proprio
  • staggering gait
  • hammer toes or high instep (pes cavus)
  • DM
  • nystagmus
  • dysarthria
  • -> hypertrophic cardiomyopathy
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55
Q

fragile X features?

A
  • intellectual disability
  • autistic features
  • elongated face w/ large ears
  • enlarged testes
  • delayed milestones
  • macrocephaly
  • hypotonia
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56
Q

first line treatment of acute sundowning w/ agitation ?

A

Antipsychotic (ie haloperidol)

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57
Q

nL cardiac output?

A

5 L/min

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58
Q

nL RA pressure ?

A

0-8

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59
Q

nL RV pressure?

A

15-25/3-12

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60
Q

nL pulm artery pressure?

A

15-25/8-15

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61
Q

Right heart pressures elevated w/ nL to low PCWP in a pt w/ hypoxia, tachypnea, and tachycardia - think?

A

PE

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62
Q

palpable purpura, proteinuria, and hematuria – think?

A

Mixed cryoglobulinemia

can also have arthralgias, hapatosplenomegaly, and hypocomplementemia

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63
Q

confirmatory finding for mixed cryoglobulinemia?

A

circulating serum cryoglobulins

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64
Q

what is a common underlying infx found w/ pts w/ mixed cryoglobulinemia?

65
Q

what should pts w/ mixed cryoglobulinemia be tested for?

66
Q

trendelenburg sign caused by?

A

weakness in gluteus medius and minimus m.

potentially bc of superior gluteal n. dysfunction

67
Q

superior gluteal nerve dysfunction can lead to what sign?

A 
Trendelenburg sign
(bc of weakness of gluteus minimus and medius m.)
68
Q

complicated diverticulitis w/

A

IV abx and observation

worsening symp –> surg

69
Q

complicated diverticulitis w/ >3cm abscess treatment?

A

CT guided percutaneous drainage

if after 5 dys symp not controlled –> surgical drainage and debridement

70
Q

complicated diverticulitis w/ fistuala, perforation w/ peritonitis, obstruction or recurrent attacks - treatment?

A

Sigmoid resection

71
Q

med to close PDA?

A

Indomethacin

72
Q

med to keep open PDA?

A

Prostaglandin E1

73
Q

avoid lithium use in pts w/ what organ issues?

A

renal disease pts

74
Q

avoid valproate in pts w/ what organ issues?

A

liver disease pts

75
Q

most effective med to treat bipolar depressive episode?

A

lamotrigine

76
Q

most significant side effect of lamotrigine?

A

Steven Johnson syndrome

77
Q

Acute behavioral agitation in manic episode – treat?

A

Antipsychotic (1st or 2nd gen)

  • lithium, valproate, carbamazepine would take too long
78
Q

Treatment for anorexia? (3)

A
  • CBT
  • Nutritional Rehab
  • Olanzapine if no response to above
79
Q

Treatment for Bulimia (3)?

A
  • CBT
  • Nutritional Rehab
  • SSRI (fluoxetine), of in combo w/ above
80
Q

Binge eating disorder treatment (4)?

A
  • CBT
  • Behavior weight loss therapy
  • SSRI
  • Lisdexamfetamine, topiramate
81
Q

difference b/t bulimia and binge eating disorder?

A

Bulimia compensates for the binging w/ purging of some type –> maintenance of nL weight

Binge eating disorder just binges –> becomes overweight

82
Q

difference b/t anorexia and bulimia?

83
Q

treatment of serious iron poisoning?

A

Deferoxamine

84
Q

radioopaque tablets on xray in child w/ low HCO3, hypotension, hematemesis, abd pain, and cool extremities –think?

A

Iron poisoning –> shock

give IV resuscitation and deferoxamine

85
Q

What is used in TCA or aspirin overdose?

A

Sodium bicarb

86
Q

Torsades de points due to prolonged QT interval give?

87
Q

Severe lithium toxicity - treat?

A

Hemodialysis

88
Q

moderate to severe lead poisoning give?

A

Calcium EDTA

89
Q

child w/ irritability, poor appetite, headaches, abdominal pain, and anemia - toxin is?

A

Lead poisoning

90
Q

mild to moderate lead poisoning treat w/?

A

Oral succimer

91
Q

Acetaminophen toxicity treat w/?

A

N-acetylcysteine

92
Q

abd pain, hematemesis, shock, and metabolic acidosis after a child ingests something radioopaque - think?

A

Iron overdose!

93
Q

pt on TPN w/ epigastric and RUQ pain - likely?

A

gallstones due to gallbladder stasis

94
Q

why does an ileal resection contribute to formation of gallstones?

A

Decreased enterohepatic circulation bile acids –> altered hepatic bile composition –> supersaturation w/ cholesterol –> gallstones

95
Q

incred RBC destruction inc risk of what type of gallstone?

96
Q

what is cause of inc dev of cholestrol gallstones in pregnancy?

A
  • Estrogen-induced inc in chol secretios

- Progesterone causes a) reduction in bile acid and b) slows gallbladder emptying

97
Q

when is Anti - D immune globulin (RhoGAM) administered?

A

In Rh- women at:

  • 28 wks
  • or 2/in 72 hrs of any procedure where feto-maternal blood may mix (ie abortion, amniosentesis, delivery, trauma etc)
98
Q

difference b/t shin splints and stress fracture?

A

no tibial tenderness on palpation w/ shin splints

99
Q

shin splints aka?

A

medial tibial stress syndrome

100
Q

pain at specific area that inc w/ jumping or running w/ local swelling and point tenderness to palpation - think?

A

stress fracture

101
Q

best imaging for stress fracture?

A

MRI or bone scan

102
Q

marfans is due to mutation of what?

A

fibrillin 1 gene

103
Q

homocystinuria caused by?

A

cystathionine synthase deficiency

104
Q

fibrillin 1 gene mutation –>?

105
Q

cystathionine synthase deficiency –>?

A

homocystinuria

106
Q

defective collagen production –>?

A

Ehlers-Danlos

107
Q

Ehlers-Danlos due to?

A

collagen production defect

108
Q

Klinefelter due to?

A

nondisjunction resulting in an extra X chromosome

109
Q

upward lens dislocation - think?

110
Q

downward lens dislocation think?

A

homocystinuria

111
Q

first marker to appear in serum in acute hep B infx?

A

HBsAg (4-8 wks after infx)

112
Q

2nd marker in HBV that appears around when clinical symp appear and elevation of aminotransferase levels?

A

IgM anti-HBc

113
Q

what is best test to diagnose new infx of Hep B (pick 2 markers)

A

HBsAg
IgM anti-HBc

b/c HBsAg is first marker to dev and IgM anti-HBc may be only marker apparent during window period

114
Q

transaminase levels >25 times nL limit w/ ALT>AST - think?

A

Viral Hepatitis

115
Q

best test for HAV?

A

Anti-HAV (IgM)

IgM Ab to HAV

116
Q

Anti-HAV (IgG) positive indicates (2)?

A
  • Prior HAV infx
    OR
  • Prior HAV vaccination
117
Q

HBsAg is and indicates?

A
  • antigen found on surface of HBV

- Indicates HBV infx (can’t tell if acute or chronic)

118
Q

Anti-HBs is and indicates?

A
  • Ab to HBsAg

- Indicates immunity to HBV (recovered or immunized)

119
Q

What will you never see if you’ve only been vaccinated against HBV?

120
Q

What may be only positive marker during infx window period of HBV?

A

IgM anti-HBc

121
Q

IgM Anti-HBc indicates?

A

acute/recent infx

122
Q

IgG Anti-HBc indicates?

A

prior exposure or chronic incx

123
Q

Positive for: HBsAg, HBeAg, IgM Anti-HBc – means?

A

acute HBV infx

124
Q

Positive for Anti-HBe and IgM Anti-HBc - means?

A

Window period

125
Q

Positive for HBsAg, HBeAg, and IgG Anti-HBc - means?

A

Chronic HBV w/ high infectivity (bc HBeAg pos)

126
Q

Positive for HBsAg, Anti-HBe, and IgG-Anti HBc - means?

A

Chronic HBV w/ low infectivity (bc Anti-HBe pos)

127
Q

Positive for Anti-HBs, Anti-HBe, and IgG Anti-HBc - means?

A

Recovered from HBV infx

128
Q

Positive Anti-HBs only means?

A

HBV immunized

129
Q

which illicit drug can cause vertical nystagmus?

130
Q

what do you use for treatment of severe psychomotor agitation due to PCP use?

131
Q

Initial treatment of AOM?

A

10 day course of oral high dose Amoxicillin

132
Q

If pt returns w/in 1 month w/ AOM post initial treatment, now treat w/?

A

Oral Amoxicillin and clavulanic acid (to fight presumably a strain w/ beta lactamase resistence)

133
Q

common bugs –> AOM?

A
  • Strep pneumo
  • nontypeable Haemophilus
  • Morazella catarrhalis
134
Q

IE w/ nosocomial UTI - what bug?

A

enterococcus ( U heart trees)

135
Q

fanconi anemia caused by?

A

defect in DNA repair –> chromosomal breaks

136
Q

benzene exposure can cause what blood issue?

A

aplastic anemia

137
Q

iability to palpate PMI consistent w/?

A

large pericardial effusion

138
Q

pulsus bisferiens (biphasic pulse) seen with?

A
  • AR (+/- AS)
  • HOCM
  • Large PDA
139
Q

post cardiac cath worry for?

A

cholesterol emboli

140
Q

cholesterol emboli post cardiac cath –> what manifestations? (3ish)

A
  • SKIN: Livedo reticularis, blue toe syndrome
  • AKI
  • GI: pancreatitis, mesenteric ischemia
141
Q

pt w/ RA has inc risk of what type of bone issues? (3)

A
  • Osteopenia
  • Osteoporosis
  • Bone fractures
142
Q

paget’s disease of bone – aka?

A

osteitis deformans

143
Q

osteitis deformans - aka?

A

paget’s disease of boen

144
Q

osteitis fibrosa cystica aka?

A

Von Recklinghausen disease of bone

145
Q

osteitis fibrosa is?

A

excessive osteoclastic resorption of bone –> replacement w/ fibrous tissue (brown tumors)

146
Q

osteitis fibrosa cystica is seen in pts w/ what additional disease?

A
  • parathyroid carcinoma

- primary, 2ndary, tertiary hyperparathyroidism (ie renal disease)

147
Q

anti-CCP Ab -thnk?

148
Q

fibrous obliteration of small bile ducts w/ concentric replacement by connective tissue in an onion skin pattern – think?

A

Primary SCLEROSING cholangitis

149
Q

onion skin pattern in liver biopsy - think?

A

primary sclerosing cholangitis

150
Q

Meniere disease due to?

A

excess endolymphatic fluid pressure in inner ear

151
Q

triad in meniere disease?

A
  • vertigo
  • hearing loss
  • tinnitus
152
Q

oscillopsia?

A

sensation of objects moving around in visual field when looking in any direction

  • seen w/ aminoglycoside toxicity esp gentamicin
153
Q

contraindications for breastfeeding? (7)

A
  • active untreated TB (can start post 2wks of treatment)
  • Maternal HIV
  • Herpetic breast lesions
  • Varicella infx
154
Q

preferred confirmatory test for giardia?

A

stool antigen assay (direct immunofluorescence or ELISA)

155
Q

nitrates primary anti-ischemic effect is?

A

Systemic venodilation –> lower preload –> lower LVEDV –> dec myocardial O2 demand by reducing wall stress

*they also vaso dialate coronary a., but above is main effect

156
Q

dark brown discoloration of the colon w/ lymph follicles shining through as pale patches - think?

A

melanosis coli

- seen w/ laxative use

157
Q

pigment in the macrophages of the lamina propria can indicate?

A

melanosis coli

- seen w/ laxative use

158
Q

alcoholism can cause what heart condition?

A

dilated cardiomyopathy –> SOB, S3, bibasilar cracks, low ejection fraction, etc.

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