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Uworld Buzz step2 > random8 > Flashcards

random8 Flashcards

1
Q

CDC vax guidlines for north africa (ie Egypt)?

A

HAV
HBV
typhoid
polio booster

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2
Q

when is yellow fever vax recommended?

A

sub-saharan africa and central/south america travel

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3
Q

clubbing and sudden onset joint arthropathy in a chronic smoker is suggestive of?

A

hypoertrophic osteoarthropathy (pulmonary disease caused subset)

  • associated w/ lung CA –> need to get CXR to rule out malignancy
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4
Q

post menopausal women w/ new onset breast tenderness and thickened endometrial stripe w/ large ovarian mass - what tumor are we thinking?

A

Granulosa cell tumor (secrets estrogen)

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5
Q

dopaminergic agonists used in med management of prolactinoma?

A
  • carbergoline

- bromocriptine

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6
Q

carbergoline and bromocriptine are what and both can be used in what situation?

A
  • dopamine agonist

- used in med management of prolactinomas

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7
Q

newborns of moms w/ active HBV should receive what at birth?

A
  • HBIG
  • HBV vax

BOTH!

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8
Q

small for gestational age infants may have what complications (5)?

A
  • hypoxia
  • polycythemia (bc inc EPO response to hypoxia)
  • hypoglycemia
  • hypothermia
  • hypoCalcemia
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9
Q

beckwith wiedemann syndrome is due to?

A

deregulation of gene expression in chromosome 11p15 (which codes for insulin like growth factor 2)

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10
Q

phys findings at birth w/ beckwith wiedemann syndrome?

A
  • macrosomia (rapid growth until late childhood)
  • macroglossia
  • hemihyperplasia (one side bigger than other)
  • medial abdominal wall defects (ie umbilical hernia, omphalocele)

+/- visceromegaly

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11
Q

what is beckwith wiedemann syndrome?

A

overgrowth disorder –> predisposition to neoplasms

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12
Q

beckwith wiedemann syndrome inc risk for?

A
  • Wilms tumor

- Hepatoblastoma

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13
Q

what is surveillance for beckwith wiedemann newborns?

A

at birth: monitor for hypoglycemia

birth - 4 yo: screening abd u/s and alpha-getoprotein levels from birth (looking for malignancy)

4-8yo: abd u/s every 3 mo

8- adolescence: renal u/s

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14
Q

bradycardia, AV block, hypotension, and diffuse wheezing - suggest what type of overdose?

A

Beta blocker overdose

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15
Q

wheezing w/ overdose – think?

A

beta blocker overdose

bc beta 2 blockade!

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16
Q

treatment of beta blocker overdose?

A

1) secure airway, IV fluids
2) Atropine to treat hypotension and bradycardia
3) if hypotension profound or refractory give IV glucagon

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17
Q

Main P2y12 receptor blocker to know?

A
  • clopidogrel
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18
Q

what is action of clopidogrel?

A

P2y12 receptor blocker

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19
Q

main medical therapy to improve morbidity and mortality in pts w/ CHD?

A
  • Dual antiplatelet therapy (aspirin and clopidogrel)
  • Beta blockers
  • ACE-i/ARBs
  • HMG-CoA reductase inhibitors (statins)
  • Aldosterone antagonists (sprionolactone, eplerenone) - in pts w/ V EF
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20
Q

phosphodiesterase 5 inhibitors are used for what and do what?

A
  • erectile dysfunc

- vasodilators

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21
Q

phosphodiesterase 5 inhib are contraindicated in pts also on what med?

A

nitrates (risk of hypotension)

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22
Q

milrinone is what type of med and who is it contraindicated for?

A
  • selective phophodiesterase inhib

- contraindicated in pts w/ HF (inc mortality)

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23
Q

statins are what type of med?

A

HMG-CoA reducatse inhibitors

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24
Q

differences b/t the various prostatitis? (ie chronic bacterial, inflammatory, non inflammatory, acute bacterial)

A

Afebrile w/ irritative voiding symp (ie urgency, freq, discomfort)

  • Chronic Bacterial: secretions inc WBC w/ growth on cx
  • Inflammatory: secretions w/ inc WBC, cx neg
  • Non-Inflammatory: nL secretions and cx

Acute bacterial: FEBRILE, exquistely tender prostate, U/A w/ bacteriuria and pyuria (+/- irritative voiding symp)

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25
Q

essential tremor + HTN - what med best?

A 
beta blocker (ie propranolol)
 - can treat both
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26
Q

aminoglycosides can cause what organ issue?

A

Acute renal failure

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27
Q

amikacin is what type of med?

A

aminoglycoside

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28
Q

multi-drug resistent pyelonephritis likely caused by what group of bugs?

A

gram neg rods

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29
Q

spasticity, UMN or LMN?

A

UMN

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30
Q

bulbar symp, UMN or LMN?

A

UMN

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31
Q

fasciculation, UMN or LMN?

A

LMN

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32
Q

hyperreflexia DTR, UMN or LMN?

A

UMN

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33
Q

cortical and subcortical atrophy disproportionately greater in temporal and parietal lobes – think?

A

Alzheimers

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34
Q

personality changes & loss of social restraint w/ dementia –> becomes mute, immobile, and incontinent - think?

A

Frontotemporal lobe dementia

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35
Q

pt w/ asthma attack become hypokalemic – why?

A

inhaled beta-2 agonist use (ie albuterol)

–> stim K shift into cells + release of insuline which further inc intracellular K shift

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36
Q

how long does a pt w/ mono have to refrain from sports?

A

> = 3 wks (regardless of symp as this is period w/ greatest splenic rupture risk)

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37
Q

common side effect of dihydropyridine CCB?

A

peripheral edema (due to dilated peripheral BV – NOT allergy)

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38
Q

Triggers for SJS/TEN?

A

Drugs:

  • allopurinol
  • Abx (sulfonamides
  • Antconvulsants (ie carbamazepine, lamotrigine, phenytoin)
  • NSAIDs
  • Sulfasalazine
  • Mycoplasma pneumonia
  • Vax
  • Graft-vs host disease
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39
Q

clinical features of SJS/TEN?

A
  • acute influenza like prodrome
  • necrosis & sloughing of epidermis
  • mucosal involvement
  • rapid onset erythematous macules, vesicles, and bullae
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40
Q

adjustment disorder?

A

emotional or behavior symp dev w/in 3 mo of an identifiable stressor that last no longer than 6mo once stressor ends

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41
Q

prussian blue stain indicates?

A

prescence of hemosiderin – found in urine during hemolytic episodes

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42
Q

common meds than can precipitate a hemolytic epi in G6PD deficiency (3)?

A
  • sulfa drugs
  • antimalarials
  • nitrofurantoin
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43
Q

most common location for medulloblastoma?

A

cerebella vermis

- imp location for balance or gait coordination

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44
Q

common symp of medulloblastoma?

A
  • truncal or gait instability (ie ataxia, bc most common location is in cerebellar vermis which is imp for balance and gait coordination)
  • can also cause obstructive hydrocephalus
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45
Q

most common cerebral hemisphere tumors in kids?

A

low grade astrocytomas

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46
Q

craniopharyngiomas are found where?

A

suprasellar masses

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47
Q

two most common posterior fossa tumor (ie cerebellar)?

A
  • cerebellar astrocytoma

- medulloblastoma

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48
Q

what is parinaud syndrome?

A
  • limited upward gaze w/ downward preference
  • b/l eye lid retraction
  • light-near dissociation
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49
Q

what tumors cause parinaud syndrome?

A

pineal tumors (bc pressure on pretectal region of midbrain)

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50
Q

PNA w/ CNS and GI features – think

A

legionnaires

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51
Q

PNA w/ hypOnatremia, hepatic dysfunction, diarrhea, fever and gram stain of sputum w/ a lot of PMNs but no organisms – think?

A

legionella

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52
Q

most common way to confirm dx of legionella?

A

urine antigen testing

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53
Q

treatment for legionnaires disease?

A

Macrolide or fluoroquinolone

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54
Q

leuprolide is and can treat what?

A
  • GRH agonist

- can treat symptomatic endometriosis –> but can lead to menopausal symp

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55
Q

adolescent w/ nasal obstruction, visible nasal mass w/ bony erosion, and frequent noseleeds - think?

A

Juvenile angiofibroma

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56
Q

chronic epigastric pain radiating to the back that improves with sitting up or leaning forward - think?

A

chronic pancreatitis

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57
Q

blood smear w/ RBC w/ single, round, blue inclusions on Wright stain - think?

A

Howell Jolly bodies (likely to due to hyposplenism)

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58
Q

hemoglobin precipitation inclusions are what and found when?

A
  • Heinz Bodies

- G6PD deficiency under crystal violet stain

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59
Q

recurrent skin and mucosal bacterial infx w/o pus and with poor wound healing and CBC w/ neutrophilia - think?

A

leukocyte adhesion deficiency

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60
Q

leukocyte adhesion deficiency caused by?

A

defective integrins on leukocyte surface –> can’t adhere to vasc endothelium –> can’t migrate to site of infx/inflam

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61
Q

delayed umbilical cord separation (age>3 wks) - think?

A

leukocyte adhesion deficiency

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62
Q

adenosine deaminase is an AR form of what?

A

SCID - lack of mature B and T lymphocytes

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63
Q

pts w/ complement deficiency are at an inc risk for what?

A

disseminated bacterial infx esp w/ encapuslated bacteria (strep pneumo, HiB, Neisseria, etc)

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64
Q

peridontal infx w/ hx of many cellulitis and sinus infx and CBC shows very high WBC w/ neutrophilia - think?

A

leukocyte adhesion deficiency

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65
Q

pulm nodule w/ halo sign on CT in pt on steroids/chemo - think?

A

aspergillosis

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66
Q

pulm lesion w/ air crescent on CT in immuncompromised pt- think?

A

aspergiollosis

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67
Q

where can aspergillus be in lung?

A

ANYWHERE

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68
Q

histoplasmosis findings on CXR?

A
  • hilar adenopathy

- areas of pneumonitis

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69
Q

fever, cough, SOB, hemoptysis in immunocompromised pt. CXR finds cavitary lesion and CT show pulm nodules w/ halo - think?

A

aspergillosis

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70
Q

tamoxifen and raloxifene are?

A

selective estrogen receptro modulators

estrogen agonist

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71
Q

side fx of SERMs?

A
  • Hot flashes (bc estrogen agonist)
  • Venous thromboembolism
  • Tamoxifen ONLY: endometrial hyperplasia and CA
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72
Q

chronic steroid use has risk of what to bones (2)?

A
  • Osteopenia/Osteoperosis

- AVN of femoral head (osteonecrosis)

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73
Q

signs of osteonecrosis of femoral head?

A
  • pain in groin, thigh, or butt worse w/ activity and relieved by rest (eventually will progress to rest pain too)
  • reduced range of motion (abduction and internal rotation)
  • joint instability
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74
Q

best imaging of AVN of femoral head?

A

MRI most sensitive, xray can look nL

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75
Q

vision impairing opacification of the lens?

A

cataract

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76
Q

painless blurred vision w/ glare and often halos around lights (make night driving hard) - think?

A

cataract

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77
Q

acute/subacute loss of vision w/ swollen disc, venous dilation w/ tortuosity, diffuse retinal hemorrhages, +/- cotton wool spots - think?

A

Central retinal vein occlusion

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78
Q

Macular degeneration affects where in the vision?

A

central

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79
Q

2 primary forms of macular degeneration?

A
  • atrophic (dry): slow progressive b/l vision loss

- exudative/neovascular (wet): agressive, unilateral vision loss

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80
Q

open angle glaucoma presents?

A

insidious onset w/ gradual loss of peripheral vision and consequent tunnel vision

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81
Q

gradual loss of peripheral vision, high intraocular pressures, and cupping of optic disc - think?

A

open angle glaucoma

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82
Q

open angle glaucoma finding on opthalmoscopic exam?

A

cupping of optic disc

ie cup to disc ratio >0.6 - bc cup enlarged

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83
Q

sudden unilateral loss of part or all of visual field as if “a curtain fell over the eye” - think?

A

retinal detachment

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84
Q

treatment of absence seizures?

A
  • Ethosuximide

- valproate

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85
Q

initial drug for partial seizures?

A

Phenytoin

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86
Q

most common predisposing factor for orbital cellulitis?

A

bacterial sinusitis

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87
Q

pain w/ eye movements, proptosis, ophthalmoplegia, and diplopia - think?

A

orbital cellulitis

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88
Q

persistent depressive disorder (dysthemia) needs?

A
  • chronic depressed mood >= 2 yrs (1 yr in kids/adolescent)
  • no symptom free period for >2 mo
  • at least 2 of the following:
    • poor appetite/overeating
      • insomnia/hypersomnia
      • low energy or fatigue
      • low self-esteem
      • poor conc/diff making decisions
      • feelings of hopelessness
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89
Q

delusional disorder is?

A
  • > =1 delusion for >= 1 mo
  • no other psychotic symp
  • can function apart from delusion (behavior not obviously bizarre/odd)
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90
Q

delusions are?

A

fixed beliefs that are firmly held despite conflicting evidence

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91
Q

when hypothyroid pt get preg how do you adjust levothyroxine dose?

A

increase by approx 30%

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92
Q

ovarian mass with absent doppler flow think?

A

ovarian torsion

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93
Q

contraindications to radioactive iodine treatment?

A
  • pregnancy

- very severe ophthalmopathy

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94
Q

what is henoch schnlein purpura?

A

IgA mediated leukocytoclastic vasculitis

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95
Q

clinical manifestations of HSP? (4)

A
  • palpable pupura (usually lower limbs)
  • arthritis/arthralgia
  • abd pain, intussuceptions
  • renal disease similar to IgA nephropathy
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96
Q

Treatment for HSP?

A

most: supportive (hydration and NSAIDs)

severe –> hospitaliztion and systemic steroids

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97
Q

HSP effecting kidneys would show what on biopsy?

A

deposition of IgA in mesangium (similar to IgA nephropathy)

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98
Q

palpable purpura on lower extremities, arthralgias, abdominal pain, and renal disease - think?

A

HSP

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99
Q

risk factors for necrotizing enterocolitis (4)?

A
  • prematurity

- very low birth weight (breast milk)

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100
Q

clinical signs of necrotizing enterocolitis

A
  • VS instability
  • Lethargy
  • Vomiting
  • Bloody stools
  • Abd distension/tenderness
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101
Q

most common effected site by NEC?

A

terminal ileum and colon

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102
Q

feeding intolerance, abd distension, bloody stools, vomiting in a full term newborn w/ congenital heart disease causign cyanosis - think?

A

necrotizing enterocolitis

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103
Q

xray findings w/ NEC? (3)

A
  • pneumatosis intestinalis (gas in bowel wall)
  • portal venous gas
  • pneumoperitoneum (free air in abd)
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104
Q

Treatment of NEC?

A
  • supportive care (bowel rest, parenteral hydration/nutrition)
  • broad-spectrum IV abx

+/- surgery

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105
Q

elderly man w/ agitation onset around time of taking this type of med – what is the type of med?

A

Benzo’s

–> paradoxical agitation

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106
Q

indications that the SBO is complicated and warrants emergency abd exploration?

A
  • change in character of the pain
  • fever
  • hemodynamic instability
  • guarding
  • leukocytosis
  • significant metabolic acidosis
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107
Q

yellow-white fluffy hemorrhagic lesions along the vasculature in pt w/ HIV and CD4 count

A

CMV retinitis

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108
Q

CMV retinitis findings?

A
  • full thickness retinal inflammation that moves along vasculature (–> edema & scarring)
  • blurred vision
  • floaters
  • photopsia (sensation of flashing lights)
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109
Q

CMV retinitis can inc risk of?

A
  • blindness (esp lesions near fovea and optic n.)

- retinal detachment (esp w/ lots of scarring)

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110
Q

newborn w/ dec lung markings on CXR and left axis deviation, tall peaked p waves, and minimal R waves in precoridal leads on ECG - think?

A

tricuspid atresia

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111
Q

subdural hematoma occurs when?

A

shearing forces tear bridging veins

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112
Q

subdural hematoma finding on CT?

A

crescent shaped hyperdensity (acute) or hypOdensity (chronic) crossing suture lines

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113
Q

how to tell b/t methanol and ethylene glycol poisoning?

A

what they hurt!

Methanol -> eye damage (think moonshine)

Ethylene glycol (antifreeze) - kidney damage

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114
Q

easiest reverisble risk factor for pancreatic CA?

A

stop smoking!

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115
Q

typical signs of cerebellar degeneration? (6)

A
  • gait dysfunction
  • truncal ataxia
  • nystagmus
  • intention tremor/dysmetria (limb-kinetic tremor when attempting to touch a target)
  • impaired rapid alternating movements (dysdiadochokinesia)
  • pendular knee reflex (m hypotonia –> persistent swinging)
116
Q

clasp knife phenomenon seen in what pts?

A

pts w/ hypERtonia due to pyramidal tract disease

117
Q

hypothyroidism despite high levels fo T4 and T3 and nL levels fo TSH - think?

A

receptor defects in peripheral tissues –> generalized resistance to TH

118
Q

primary hypothyroidism has what T4/3 and TSH levels?

A

low T4/3
High TSH

issue at thyroid gland

119
Q

secondary or tertiary hypothyroidism - where and what T4/3 and TSH levels?

A

low T4/3
low/inappropriately nL TSH

2ndary: pituitary gland
tertiary: issue at hypothalamus

120
Q

amaurosis fugax is?

A

painless loss of vision from emboli

121
Q

amaurosis fugax can be a sign of?

A

impending stroke

122
Q

nontraumatic sub arachnoid hemorrhage usually results from?

A

saccular or berry aneurysm rupture

123
Q

elevated opening pressure on MP and unexplained xanthochromia (yellowish color of CSF indicating bilirubin indicating hemolysis) - think

A

subarachnoid hemorrhage

124
Q

amyloid angiopathy –> bleeding where?

A

intracerebral hemorrhage

125
Q

HTN associated w/ what type of hemorrhages?

A

intraparenchymal or intracerebral hemorrhage

126
Q

kaposi sarcoma associated w/ what virus?

A

HHV-8

127
Q

dendritic ulcers in eye - think?

A

herpes simplex keratitis
or
Herpes zoster ophthalmicus

tell diff by presentation

  • HSK - pain, photophobia, blurred vision, tearing, redness
  • HZO: elderly, fever, malaise, burning, itching w/ periorbital rash
128
Q

on cephalosporin, pt has fever, rash, arthralgias hematuria, sterile pyuria, eosinophilia/uria w/ WBC casts - think?

A

drug induced intersittial nephritis

*happens w/ penicillina, cephalosporins, NSAIDs, sulfonamides, rifampin, phenytoin, and allopurinol

129
Q

maj difference b/t OCPD and OCD?

A

OCPD - ego- syntonic (thinks beliefs are good)

OCD: ego-dystonic (compulsions cause anxiety)

130
Q

dev of new conduction abnormality in pt w/ IE – think?

A

perivalvular abscess

131
Q

early diastolic murmur - think?

A

AR

132
Q

when AR is due to valvular disease best heard where?

A

Left sternal border (3rd and 4th intercostal space)

133
Q

mitral valve perforation presents how?

A
  • acute CHF

- systolic murmur of MR

134
Q

tricuspid IE usually has what murmur?

A

holosystolic murmur of TR accentuated w/ inspiration

135
Q

muddy brown cast found w/?

A

Acute Tubular Necrosis

136
Q

RBC casts found w/?

A

Glomerulonephritis

137
Q

WBC casts found w/?

A

Interstitial nephritis or pyelonephritis

138
Q

Fatty casts found w/?

A

Nephrotic syndrome

139
Q

Broad and waxy casts found w/?

A

Chronic renal failure

140
Q
  • BUN/CR -> 20:1
  • UOsm 300-350
  • UNa >20
  • FeNa >2%

what is this?

A

ATN

141
Q

hepatic encephalopathy likely due to?

A

inability to break down ammonia into urea

142
Q

bronchoalveolar lavage very useful to work up what lung infx?

A

Pneumocysitis PNA

143
Q

brochoalveolar lavage useful in evaluation of what? (2)

A
  • malignancy

- opportunistic infx (ie PCP)

144
Q

ethelyne glycol toxicity –> clinical findings?

A
  • high anion gap metabolic acidosis
  • hypoCalcemia
  • Calcium oxlate crystal deposition in kidneys –> AKI, hematuria, flank pain
145
Q

Fomepizole treats?

A

ethylene glycol overdose

146
Q

very high anion gap w/ very low bicarb level (

A
  • ethlyene glycol overdose

- methanol overdose

147
Q

sodium thiosulfate treats?

A

cyanide poisoning

148
Q

ethlyene glycol overdose, treat w/?

A

Fomepizole

149
Q

pt w/ painful blurred vision and fixed, mid dilated eye w/ headache and nausea – think?

A

Acute angle closure glaucoma

150
Q

patchy redness on white of eye w/ mild pain and discharge in pt w/ autoimmune disorder - think?

A

Episcleritis

151
Q

atopic dermatitis aka ?

A

eczema

152
Q

eczema aka?

A

atopic dermatitis

153
Q

PAS positive - think? (2)

A
  • Whipple’s disease

- Lymphoblasts (ie ALL)

154
Q

rash that spreads from face to trunk to extremities w/ viral appearing prodrome and leukopenia and thrombocytopenia - think?

A

measles

155
Q

what has been shown to reduce the morbidity and mortality in pts w/ measles?

A

Vit A

156
Q

mag sulf toxicity findings?

A
  • neuromuscular depression (m paralysis, dec/absent DTRs)
  • dec resp effort/apnea
  • somnolence
  • visual distrubances
157
Q

nL skin at birth that gradually progresses to dry scaly skin - think?

A

Icthyosis vulgaris

158
Q

icthyosis vulgaris’ nickname?

A

“lizard skin”

159
Q

MAOI + tyramine –> what?

A

HTN crisis

160
Q

PAS positive macrophages in lamina propria containing non-acid fast gram positive bacilli - think?

A

Whipple’s disease (Tropheryma whippelii)

161
Q

diarrhea, migratory non-deforming arthritis, lymphadenopathy, weight loss, and low grade fever w/ small intestine bx showing PAS positive macrophages - think?

A

Whipple’s disease

162
Q

Add abx to COPD exacerbation if?

A

2 or more of following:

  • inc SOB
  • inc cough (more freq or severe)
  • Change in sputum prod (inc vol or change in color)

OR
Mechanical ventilation requirement

163
Q

what is time frame to treat most pts w/ oseltamivir or zanamivir by?

A

w.in 48 hrs of influenza symptom onset

164
Q

which pts if they presented w/ influenza you would still provide oseltamivir even if outside 48hrs? (7)

A
  • > 65yo

- pregnant or

165
Q

1st stage of labor (active) is ?

A

6-10cm cervical dilation

166
Q

1st stage of labor (latent) is?

A

0-6cm cerivcal dilation

167
Q

2nd stage of labor?

A

complete dilation to delivery

168
Q

3rd stage of labor is?

A

delivery of baby to expulsion of placenta

169
Q

arrested labor in the first stage is diagnosed when?

A

> 6cm dilation w/ ROM and 1 of the following:
- no cervical change >=4hrs despite adequate contractions (>=200montevideo untis for >= 2 hrs)
OR
- No cervical change for >=6hrs w/ inadequate contractions

170
Q

adequate contractions are?

A

adequate contractions = >=200 Montevideo units for >=2hrs

171
Q

contraction strength =?

A

peak mmHg - baseline mmHg

172
Q

montevideo unit = ?

A

of uterine contractions in 10 min x contraction strength

173
Q

fetal renal agenesis indicates?

A

not compatible w/ life bc there will be severe pulm hypoplasia

174
Q

lower back pain that is worse at night but improves w/ physical activity think?

A

inflammatory spondyloarthopathy

ankylosing spondylitis, psoriatic, reactive, or IBD arthritis

175
Q

inflammation of ligamentous insertion?

A

enthesitis

176
Q

envelope shaped kidney stones?

A

Calcium oxalate

177
Q

radioopaque kidney stones?

A
  • Calcium (oslate and phosphate)
  • Struvite (ammonium, Mg, phos)
  • Cystine
178
Q

radiolucent kidney stone?

A

uric acid

179
Q

precipitates at low pH kidney stones?

A
  • Ca oxalate
  • Uric acid
  • Cystine
180
Q

precipitates at high pH kidney stones?

A
  • Ca phosphate

- Struvite

181
Q

coffin lid shaped kidney stones?

A

struvite

182
Q

rhomboid or rosette shaped kidney stones?

A

uric acid

183
Q

hexagonal shaped kidney stones?

A

cystine

184
Q

kidney stones cause by infx w/ urease bugs (ie proteus, klensiella, staph sapro etc)?

A

struvite

185
Q

commonly form staghorn calculi?

A

struvite or cystine kidney stones

186
Q

which kidney stone have a postive sodium cyanide nitroprusside test?

A

cystine

187
Q

which kidney stones are related to a family inborn error?

A

cystine

188
Q

treatment of infant botulism from environmental spores?

A

human derived botulism immune globuline

189
Q

foodborne botulism treatment?

A

equine derived botulism antitoxin

190
Q

treatment of guillain barre syndrome?

A

pooled human immune globulin

191
Q

botulinum toxin does what?

A

blocks acetylcholine release at presynaptic NMJ

192
Q

face and arm swelling w/ weight lost new onset SOB w/ smoking hstory and anterior wall veins engorgement - think?

A

SVC syndrome likely due to malignancy causing obstrution

193
Q

bright red firm friable vascular exophytic nodule in an HIV pt - think?

A

bacillary angiomatosis

194
Q

bacillary angiomatosis caused by?

A

bartonella - gram neg bacillus

195
Q

treatment of bacillary angiomatosis?

A

oral erythromycin

196
Q

common etiologies of crystal induced AKI? (5)

A
  • acyclovir
  • sulfonamides
  • methrotrexate
  • ethylene glycol
  • protease inhibitors
197
Q

preferred initial DMARD in pts w/ mod to severe RA?

A

methotrexate

198
Q

indications of methotrexate toxcity?

A
  • oral ulcers
  • acute rise in serum transaminases
  • bone marrow suppression (macrocytic anemia, leukopenia, thrombocytopenia)
199
Q

felty syndrome?

A

clinical disorder seen in pts w/ severe long standing (>10yrs) RA that is characterized by neutropenia and splenomegaly

200
Q

treatment of polymyalgi rheumatica?

A

low dose prednisone

201
Q

treatment for giant cell artertitis?

A

high dose prednisone

202
Q

treatment for fibromyalgia

A

initial: exercise and good sleep hygiene
next: TCAs

203
Q

fatigue, stiffness, poor sleep w/ point tenderness at mid trapezius, lateral epicondyle, costochondral junction of chest and greater trochanter w/ otherwise nL phys exam and nL labs (incl ESR) - think?

A

fibromyalgia

204
Q

bipolar pts w/ inadequate response to monotherapy and/or severe episode maintenance treatment is?

A

combo therapy w/:
- Lithium or valproate
AND
- a second gen antipsychotic (ie quetiapine)

205
Q

PCV13 followed by PPSV23 6-12mo later recommended for pts

A

very high risk comoborbidities (ie sickle cell, HIV, CKD, etc)

206
Q

PPSV23 alone for pts

A
  • current smokers

- chronic med conditions (ie heart, lung, liver, DM)

207
Q

pneumococcal conjugat vaccine is?

A

PCV13

208
Q

pneumococcal polysaccharide vaccine is?

A

PPSV23

209
Q

pneumococcal 23 valent vax is what type

A

polysaccharide

210
Q

pneumococcal 13 valent vax is what type?

A

conjugate

211
Q

pt w/ chronic headaches now w/ elevated Cr w/ painless hematuria and sterile pyuria w/ WBC casts and small kidneys b/l w/ renal papillary calcifications on CT - think?

A

analgesic nephropathy

212
Q

Analgesic nephropathy causes what type of kidney injury?

A

tubulointerstitial nephritis

213
Q

management of somatic symptom disorder?

A
  • regularly scheduled visits w/ same provider
  • limit unnecessary workup
  • focus on stress reduction and improving coping strategies
  • legitimize symp but make funtional improvement the goal
214
Q

burning of rubber or plastic can cause?

A

cyanide inhalation/toxicity

215
Q

bitter almond breath indicates?

A

inhaled cyanide

216
Q

what presents similar to CO exposure but is due to burning of rubber or plastic?

A

cyanide inhalation

217
Q

what is presenting physical skin findings in methemoglobinemia?

A

cyanosis and bluish discoloration of skin and MM

218
Q

magnesium is solely excreted by?

A

Kidney

219
Q

absolute contraindications to combined hormonal contraceptives? (8)

A
  • migraine w/ aura
  • > =15 cigs/dy & age >=35
  • HTN >=160/100
  • hx of venous thromboembolic disease, stroke, or ischemic heart disease
  • BREAST CA
  • Cirrhosis & LIVER CA
  • ## Maj surgery w/ prolonged immobilization
220
Q

common causes for priaprism (4)?

A
  • sickle cell disease and leukemia - usual in kids/adolescents
  • Perineal or genital trauma (laceration of cavernous a.)
  • neurogenic lesion (cauda equina, spinal cord injury, etc)
  • Meds: trazodone or prazosin
221
Q

most common drug that causes priapism?

A

prazosin

222
Q

initial hematura is?

A

bld at beginning of voiding cycle

223
Q

total hermaturia is?

A

bld during entire voiding cycle

224
Q

terminal hematuria is?

A

bld at end of voiding cycle

225
Q

terminal hematuria suggests?

A

bleeding from prostate, bladder neck/trigone, or post. urethra.

(which can be concerning for CA)

226
Q

terminal hematuria w/ clots indicates?

A

bleeding w/in bladder or ureters concerning for urothelial CA

227
Q

initial hematuria causes? (2)

A
  • urethritis

- trauma (ie catheterization)

228
Q

Terminal hematuria causes (5)?

A
  • Urothelial CA
  • cystitis (infx/post rad)
  • Urolithiasis
  • BPH
  • Prostate CA
229
Q

Total hematuria causes?

A
  • Renal mass (bening/malignant)
  • Glomerulonephritis
  • Urolithiasis
  • PCKD
  • Pyelonephritis
  • Urothelial CA
  • Trauma
230
Q

bedwetting before age what is normal?

A

5

231
Q

you’ve identified small nonbleeding varices in an alcoholic cirrhotic pt, next treatment step?

A

Give non-selective beta-blockers (n and below)

*dec progression and risk of hemorrhage

232
Q

treatment for cryptococcal meningoencephalitis?

A

Induction therapy w/ 2 wks of amphotericin B and flucytosine

Followed by consolidation therapy of 8wks of fluconazole and maintenance w/ it for at least 1 yr

233
Q

Antiphospholipid syndrome - clinical features?

A

1) Thrombotic event (venous or arterial) OR Pregnancy morbitidy (loss, severe preeclampsia, placental insufficiency)
PLUS
2) positive for at least 1 of the following Ab:
a) Anticardiolipin
b) Anti-beta2-glycoprotein-I
c) Lupus anticoagulant

234
Q

biggest risk factor fo antiphospholipid syndrome is?

A

Lupus

235
Q

antiphospholipid syndrome can cause what to be a false positive?

A

VDRL and RPR test –> so you mistakenly think its syphilis!

236
Q

Single S2 - think? (3)

A
  • Transposition of great vessels (+/- VSD)
  • Tricuspid atresia (has VSD)
  • Truncus Arteriosis (w/ systolic ejection murmur)
237
Q

cyanotic baby w/ Narrow mediastinum w/ “egg on a string” heart - think?

A

Transposition of great vessels

238
Q

cyanotic baby w/ Harsh pulmonic stenosis murmur and VSD murmur - think?

A

Tetralogy of Fallot

239
Q

Boot shaped heart in cyanotic baby - think?

A

Tetralogy of Fallot

240
Q

cyanotic baby w/ single s2 and a systolic ejcetion murmu w/ edema - think?

A

Truncus arteriosis

241
Q

Severe cyanotic baby in respiratory distress w/ pulm edema on CXR and enlarged supracardiac vens and SVC - think?

A

Total anomalous pulm venous retun w/ obstruction

242
Q

ice bag test is for?

A

Myasthenia gravis

243
Q

place ice bags on ptosis eyes and they improve indicates?

A

Myasthenia gravis

cold inhib breakdown of acetylcholine at NMJ

244
Q

bacterial meningitis in pt >1mo treatment?

A

IV vanco and ceftriaxone

(cefotaxime in pt

245
Q

bacterial meningitis in pt

A

IV vanco and CEFOTAXIME

>1mo can use ceftri

246
Q

when do you add dexamethasone in bacterial meningitis treatment?

A

when causative agent likely is HiB – protecting against sensoriuneural hearing loss

247
Q

HIV pt CD4 count

A

Progressive disseminated histoplasmosis

248
Q

disseminated histoplasmosis hits what parts of body?

A
  • Systemic (f/c/weight loss)
  • Pulm (cough, SOB)
  • Mucocutaneous lesions (mouth ulcers, nodules, papules)
  • Reticuloendothelial inflammation (ie hepatosplenomegaly, lymphadenopathy)
249
Q

CXR findings for disseminated histoplasmosis?

A

reticulonodular or interstitial infiltrate

250
Q

Treat disseminated histoplasmosis?

A

mild/maintenance: Itraconazole

mod-sever: Ampho B

251
Q

dx of disseminated histoplasmosis confirm most rapidly w/?

A

serum or urine HIstoplasma antigen immunoassay

252
Q

congenital rubella findings?

A
  • sensorineural hearing loss
  • intellectual disability
  • Cardiac anomalies
  • Cataracts, glaucoma
253
Q

kid w/ los grade fever, conjunctivitis, coryza, cervical lymphadenopathy and w/ head to body spreading erythematous blanching maculopapular rash - thnk?

A

Rubella

254
Q

valgus stress test is testing what ligament in knee?

A

medial collateral ligament

255
Q

knock kneed is what knee deformity?

A

valgus

256
Q

bow legged is what knee deformity?

A

varus

257
Q

varus laxity - what injured ligament?

A

lateral collateral ligament

258
Q

chronic overuse injury characterized by ant knee pain and tenderness?

A

pateller tenodonitis (jumper’s knee)

259
Q

hard, immobile, non-tender boney growth on hard palate of mouth - think? caused by?

A
  • torus palatinus

- congenital

260
Q

gastric MALT lymphoma w/ no metastasis initial treatment?

A

abx to eradicate H. pylori (triple or quadruple therapy)

261
Q

cocaine induce MI, what do you avoid?

A

Beta blockers (bc can make vasospasms worse)

262
Q

cocaine induced MI, what med may you add?

A

CCB or alpha blockers (ie phentolamine) to help reduce vasospasms

263
Q

most common cause of sudden cardiac arrest in the immediate post infarction period (w/in 1 hr) in pts w/ acute MI?

A

Reentrant ventricular arrhythmias (ie v fib)

264
Q

down syndrome pt w/ torticollis, urinary incontinence, dizziness, diplopia, behavioral changes, hyperreflexia, positive babinski,a and ataxia - think?

A

atlantoaxial instability

265
Q

young down syndrome pt w/ upper motor neuron findings - think?

A

atlantoaxial instability

266
Q

infant w/ little prenatal care now w/ rhinorrhea, long bone abnlmalities, and diffuse maculopapular desquamating skin rash that can involve the palms and soles- think?

A

congenital syphilis

267
Q

infant w/ little prenatal care now w/ sensorineural hearing loss, cataracts, and a PDA - think?

A

rubella

268
Q

infant w/ little prenatal care now w/ periventricular calcifications – think?

A

CMV

269
Q

infant w/ little prenatal care now w/ diffuse intracranial calcifications, hydrocephalus, and severe chorioretinitis - think?

A

toxoplasmosis

270
Q

crescendo decrescendo systolic murmur present at L sternal border that does NOT radiate to carotids - think?

A

HOCM (intervemtricular septal hypertrophy)

271
Q

mitral regurg has what type of systolic murmu?

A

holosystolic

272
Q

anterior MI now 5 days later w/ chest pain that progresse to pulseless electrical activity w/ tachy - think?

A

V wall rupture

273
Q

5 days post MI w/ sudden onset hypotension, CHF symp, and a loud holosystolic murmur at LLSB - think?

A

Interventricular wall rupture

274
Q

3 days post MI now w/ sudden onset hypotension and a new holosystoli cmumur at apex that radiates and pulm edema - think?

A

papillary muscle rupture

—> MR

275
Q

TCA overdose w/ widening QRS treat w/?

A

sodium bicarb

276
Q

anaphylaxis, IM or subQ epi injection?

A

IM! it has higher plasma and tissue levels

277
Q

anal fissure treatment?

A
  • high fiber diet w/ adequate fluid intake
  • stool softeners
  • sitz bath
  • topical anesthetic
  • topical vasodilators (ie nifedipine, nitroglycerin)
278
Q

easy PAO2 formula?

A

PAO2 = 150 - (PaCO2/0.8)

*150 = (0.21 x [760-47]) = (FiO2 x[Patm -Ph20])

279
Q

angina pectoris?

A

episodes of substernal pain provocked by emotion

280
Q

episodes of substernal pain provoked by emotion?

A

angina pectoris

281
Q

dipyrdamole and adenosine are coronary what?

A

coronary vasodilators

282
Q

coronary steal is?

A

redistribution of coronary blood flow to “non-disease areas” and perfusion of “diseased areas” are diminshed

  • can be utilized in myocardial perfusion scanning
283
Q

how does dipyridamole help dx in myocardial perfusion scanning ?

A

coronary steal

284
Q

post splenectomy pts are at inc risk for sepsis from encapsulated organisms due to?

A

impaired Ab-mediated opsonization in phagocytosis

285
Q

imaging for psoas abscess?

A

CT scan

*u/s poor sensitivity due to deep nature and number of other organs and bones covering

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