Review Set 1 Flashcards
1
Q
A pt presenting with fatigue, low fever, bilateral ankle arthritis, headaches, and cervical lymphadenopathy with non-caseating granulomas is most likely to also have what additional finding?
A
Bilateral Hilar Adenopathy (Associated with Sarcoidosis)
2
Q
When should post-exposure prophylaxis against HIV be given to a health care worker who has an occupational exposure to urine from an HIV + patient?
A
Iff the urine contained visible blood. (if no blood, just cleanse the area well with soap and water)
3
Q
What are the first line agents for acute gout?
A
NSAIDs
Colchicine
4
Q
What antihypertensive medication/class can be helpful in decreasing uric acid levels (modesty)?
A
Angiotensin Receptor Blockers (ARBs)
-Losartan
5
Q
Which hypertensive/ cardiac medications can worsen hyperuricemia in patients with gout?
A
Thiazide Diuretics (can increase serum uric acid level) Loop Diuretics (can raise blood urc Aspirin (decreases renal urate excretion)
6
Q
What type of heart murmur is associated with
Loud first heart sound and
Low-pitched diastolic
rumble (heard best at apex)
EKG showing broad, notched P-waves
A
Mitral Stenosis
7
Q
What are the signs and symptoms associated with Methylphenidate toxicity?
A
Anorexia Weight Loss Nausea/Vomiting Insomnia Palpitations/Tachycardia Elevated BP Dilated Pupils (Mydriasis) Dry Mouth Nervousness Tics Agitation/Irritability/Aggression Growth Retardation (later)
8
Q
What are the paraneoplastic syndromes associated with Small Cell Carcinoma of the Lung?
A
SIADH
Lambert-Eaton Myesthenia Syndrome
Ectopic ACTH production
9
Q
What paraneoplastic syndrome is associated with Squamous Cell Lung Cancer?
A
Hypercalcemia d/t Parathyroid hormone-like Protein (PTHP) production
10
Q
Which antidiabetic medication class is associated with Lactic Acidosis?
A
Metformin (Biguanides)
11
Q
Which antidiabetic medication class is associated with Weight Gain and Hypoglycemia?
A
Insulin Secretagogues:
Sulfonylureas
Meglitinides
12
Q
Which antidiabetic medication class is associated with Pancreatitis?
A
GLP-1 Agonists (Exenatide)
13
Q
Which antidiabetic medication class is associated with Fluid retention, heart failure, and weight gain?
A
Thiazolidinediones
-glitazones
14
Q
Which antidiabetic medication class is associated with UTI and Hypotension?
A
SGLT2 Inhibitors (act at the kidneys): -gliflozins
15
Q
Which antidiabetic medications class is associated with diarrhea and flatulence?
A
Alpha-glucosidase Inhibitors:
Acarbose
Miglitol
16
Q
Which antidiabetic class of medication is associated with Nasopharyngitis?
A
DPP4- inhibitors:
-gliptins
17
Q
What are three physical exam findings that can confirm a diagnosis of Carpel Tunnel Syndrome?
A
1) Wrist Hyperflexion –>Sx
2) Tapping on Median Nerve at Carpel tunel–>Sx
3) Raised hand overhead–>Sx
18
Q
How is disease progression in Ankylosing Spondylitis monitored?
A
Serial Radiographs of Spine: -AP and Lateral Lumbar -Lateral Cervical -Sacroiliac joints and Hip Measure ESR (or other acute phase reactants)
19
Q
What are the common extraarticular manifestations of Ankylosing Spondylitis?(6)
A
Restrictive Lung Disease
Apical Pulmonary Fibrosis
Anterior Uveitis (can be initial presentation)
Aortic Regurgitation
IgA Nephropathy
Secondary Amyloidosis (Nephrotic Syndrome)
20
Q
What is the empiric treatment for a hospitalized patient with Community Acquired Pneumonia?
A
IV Ceftriaxone + Azithromycin (or Clarithromycin)
21
Q
When should Aminoglycosides be used to in the treatment of Community Acquired Pneumonia?
A
Suspicion of Pseudomonas involvement
22
Q
What is the formula for NNT
A
If an intervention shows a benefit for the specified outcome, then calculate NNT:
NNT= 1/ARR
ARR= incidence rate (unexposed) - incidence rate (exposed)
23
Q
What is the formula for NNH
A
If the intervention does not show any benefit for the specified outcome, then calculate NNH:
NNH= 1/ARI ARI= incidence rate(exposed) - incidence rate (unexposed)
24
Q
What is the formula for calculating the Odds Ratio?
A
Odds Ratio (OR)= ad/bc
25
What is the management for a pt presenting with substernal chest pain relieved with nitrates, mild SOB, a h/o HTN and active smoking, with an EKG showing sinus tachycardia and ST-depression in several leads?
```
Acute Coronary Syndrome:
*Aspirin (Immediately)
*Antiplatelet (ADP Rec Blocker)
*Anticoagulation
B-Blocker
Statin (before discharge)
```
*These have been shown to decrease risk of nonfatal MI and CV-related death in pts with ACS
26
What is the first step in management for a pt who presents with acute ischemic stroke?
CT w/o contrast to R/O hemorrhage (to inform TPA use)
If no bleed: review any contraindications to TPA
If no contraindications: Administer TPA w/in 4.5 hrs of symptom onset
27
What is the ideal range for BP management following TPA?
Greater than 140/90mmHg
| Less than 185/105
28
What is the max allowed BP for pts with ischemic stroke who did NOT receive TPA?
up to 220/120mmHg
29
What are the contraindications to MMR vaccine?
1)Anaphylaxis to: Neomycin, gelatin
2) Pregnancy
3) Immunecompromised state (including tumors)
30
What is the most likely dx in a child with Sickle Cell disease who presents with pain in hands and feet?
Dactylitis
31
What medication should be used to manage a pt with chest pain following cocaine use?
Benxodiazepines
32
What medicationis used to control BP in pt with cocaine use who has received benzos?
Alpha-Antagonists : Phentolamine
Can also use:
Nitrate: Nitroglycerine or Nitroprusside
33
Why should b-blockers be avoided in cocaine -related hypertensive patients?
To prevent coronary vasospasm (secondary to unopposed alpha stimulation)
34
What pesentation is most likely associated with a mechanical obstruction of the oropharyngeal/upper esophageal area.
Dysphagia of solids first, then liquids
| Associated aspiration, coughing, drooling, or difficulty initiating swallowing
35
When an upper esophageal/oropharyngeal obstruction is suspected, what imaging modality is preferred?
Nasopharyngeal Laryngoscopy or Barium Swallow (esophagram)
36
What presentation is associated with neuromuscular swallowing disorder?
Difficulty swallowing solids and liquids simultaneously
37
When there is suspicion of a lower esophageal pathology, what initial test(s) is/are indicated?
Barium Swallow followed by Esophagogastroduodenoscopy (EGD)
38
What is the treatment for mild Otitis Externa (Swimmer's Ear)
Clean ear canal
| Apply Topical Acidifiers (Acetic Acid)
39
What is the treatment for Mild/Severe Otitis Externa?
Clean canal
Apply topical Antibiotics 7-10 days:
-Polymixin B/Neomycin
-Ciprofloxacin
40
What should be added to the treatment regimen for patients with mild-severe Otitis Externa who have associated pruritis and severe pain?
Topical corticosteroids (Hydrocortisone)
41
What evaluation should take place in elderly patients with cataracts before cataract surgery becomes the definitive treatment plan?
Eye exam to r/o Macular Degeneration
42
What is the most likely dx for a patient presenting with hypopigmented cafe-au-lait spots and fhx of bilateral deafness (acoutsic neuromas)?
.
Neurofibromatosis 2
43
What symptoms are typically associated with NF-1?
Axillary Freckles
| Hyperpigmented cafe-au-lait spots Unilateral Acousitc Neuroma
44
What is the most important side effect of Nitroprusside thereapy and its treatment?
Cyanide Toxicity
Tx: Stop the drug and give Sodium Thiosulfate
45
What are the signs/symptoms of cyanide toxicity?
```
Flushing (early)
Cyanosis (late)
Altered Metal Status
N/V
Arrhythmias
Tachypnea then respiratory depression
Pulmonary Edema
Metabolic Acidosis (Lactic Acisosis)
Renal Failure
```
46
Which medications/drugs decrease free T4 and increase TBG?
Estrogen
Tamoxien
Raloxifene
Methadone, heroin
47
When should GBS screening take place in pregnancy?
Between 35-37 weeks: vaginorectal swab
48
When should GBS prophylaxis be given to a pregnant pt. withunknown GBS status?
Iff they also have:
- h/o infant with early GBS infection
- h/o GBS+ bacturia in current pregnancy
- preterm labor before 37 weeks GA
- membranes ruptured >/= 18 hrs
- has intrapartum fever >/=100.4
49
When should antibiotics be included with incision and drainage for the treatmetn of skin abscess?
```
Add Antibiotics if :
Multiple abscesses
Diameter >5cm
Extensive surrounding Cellulitis
Systemic Signs
Immunecompromised State
Age less than 6 months
```
50
What thyroid patholigies are associated with decreased RAIU?
- Subacute Thyroiditis (Dequervaine's)
- Painless Thyroiditis
- Iatrogenic/Factitious Thyroiditis
51
What is the treatment for Painless Thyroiditis?
B-Blockers (hor hyperthroid phase symtpoms)
52
What is the most likely diagnosis in a pt with a h/o schizophrenia or any psychotic disorder who is on medication but comes to the office and on physical exam exhibits abnormal limb/muscle activity (catalepsy), extreme fatigue/stupor, mutism, negativism, posturing, echolalia, echopraxia, or waxy flexibility (resistance to positioning)?
Catatonia
53
What is the preferred treatment for catatonia?
Benzodiazepines or ECT
54
What is the preferred treatment for singular, non-metastatic, early stage glottic tumors without Lymph node involvement?
Radiation
| May also consider Laser Excision
55
What is the initial management for a pt with symptoms suggesting Sicca (Sjogren's) Syndrome?
Schirmer Test (secretory deficiency)
and AutoAntibody screen (Anti-Ro,La, ANA, RF)
56
What is the most likely dx ina pt with a h/o benzodiazeepine use that was recently stopped, autonomic instability, tremors, and restlessness/agitation?
Benzodiazepine withdrawal
57
What is the treatment of choice for benzodiezepine withdrawal?
Benzodiazepines (IV) and slowly taper once sx's resolve.
58
What diagnosis should be considered in a pt with symptoms of Sjogren's syndrome who also presents with submandibular mass?
B-cell non-Hodgkin's Lymphoma (d/t ncreases B-cell activation and infiltration of salivary glans asociated with Sjogen's Syndrome)
59
How are Central Retinal Artery Occlusion and Central Retinal Vein Occlusion differentiated?
Central Retinal Artery Occlusion is associated with Cherry Red Spot on fundus and w/w/o h/o Amaurosis Fugax
Central Retinal Vein Occlusion is associated with more gradual onset, retinal hemorrhages and optic disc edema (BLOOD and THUNDER)
60
What is the etiology of Progressive multifocal Leukoenceohalopathy (PML)?
JC Virus (polyomavirus)
61
What is the most likely dx in an immune compromised pt who presents with hemiparesis, speech, vision, and gait disturbances found to have multiple demyelinating, non-caseating lesions w/NO mass effect?
Progressive Multifocal Leukoencephalopathy (PML)
62
How are PML and HIV Encephalopathy distinguished?
PML: focal neuro deficits, asymmetric demyelinating lesions.
HIV Encephalopathy: Dementia prominent symptom, No focal deficits (or very few), Symmetric demyelinating lesions
63
What is the most likely dx in a pt. presenting with flushing, miosis, wheezing, bradycardia, altered mental status or sensorium, and garlic odor on clothes?
Organoposphate Toxicity
64
When a pt is suspected of having organophosphate toxicity, what test can confirm the diagnosis?
RBC Acetylcholinesterase Activity
| RBC Cholinesterase
65
What is the preferred first line treatment for Primary Dysmenorrhea?
NSAIDs for 2-4 months, started 2-3 days before menses onset.
66
What is the pathophysiological cause of Primary dysmenorrhea?
Excessive prostaglandin (F2) release
67
For what Glascow Coma Scale (GCS) score is intubation recommended?
8 or less
68
What test is the recommended initial test to detect pernicious Anemia?
Serum anti-Intrinsic Factor Autoantibodies
69
What are the three main histological components of Pernicious Anemia?
Glandular Atrophy ( Body and Fundus)
Intestinal Metaplasia
Inflammation
This type of gatritis is called Autoimmune Metaplastic Atrophic Gastritis (AMAG)
70
What is the treatment for Photoaging?
Tretinoin (all-trans-retinoic acid)
71
What antibiotic is used to treat rosacea?
Metronidazole
72
What finding is associated with a worse prognosis in a pt with acute PE?
Elevated Cardiac Troponin
| associated with higher risk of death
73
What skin condition is associated with HepC virus?
Lichen Planus
74
What is the most likely dx for a pt who presents with mental status changes, autonomic dysfunction (htn, tachycardia, diaphoresis, hyperthermia, mydriasis, diarrhea), and neuromuscular hyperactivity (myoclonus/ocular clonus, rigidity, hyperreflexia, tremor)
and a h/o of medication treated depression?
Serotonin Syndrome
(diaphoreses, tachycardia, mydriasis, hyperthermia/fever, tremor, agitation, rigidity, clonus, diarrhea)
Clinical Dx
75
What is the treatment for Serotnin Syndrome?
Stop serotonergic medications
Benzos for sedation
Supportive Care
Severe Cases:
Serotonin antagonist: Cyproheptadine
76
How are Serotonin Syndrome and NMS distinguished?
Serotonin Syndrome: Hyperreflexia, hyperkinesia/Clonus
NMS: Lead Pipe rigidity ( far more apparent than Serotonin syndrome), bradykinesia,
77
What are the 3 D's associated with urethral diverticulum?
Dribbling
Dysuria
Dyspareunia
78
What is the imaging modality of choice in evaluating a pt for urethral diverticulum?
Transvaginal Ultrasound or
| MRI
79
What is the mot likely dx for an adolescent pt who presents with a inter-ictal EEG that shows bilateral polyspike and slow discharge pattern?
Juvenille Myoclonic Epilepsy
80
What is the treatment of choice for Juvenille Myoclonic Epilepsy?
Valproic Acid
81
What is the gold standard for diagnosing active Tb?
```
Sputum culture (microscopy)
Should perform simultaneously with sputum microscopy
```
82
What is the criteria for determining a pt with active Tb non-infectious?
3 negative sputum smears
(Note, they can be noninfectious but still have active disease that needs t
83
What factor(s ) about CVS increase risk of transverse limb reduction anomaly?
Age of gestation
84
What should be used to treat acute gout in a pt with renal failure or those who have recently undergone renal transplant?
Intraarticular or Systemic Gucocorticoids.
85
What is the prophylaxis of choice for a human bite?
Amoxicillin-Clavulanate or (Ampicilin/sulbactam)
86
What is the most likely dx in a pt presenting with shiny, pruritic, polygonal-shaped violaceous plaques and papules on the flexural surfaces of skin, nails, mucours membranes of mouth (white streaks), or genetalia and lesions can appear with whitish, lacy pattern (Wickham striae)?
Lichen Planus
87
What is the treatment for Seborrheic Dermatitis?
Antifungal Shampoo
-Ketokonazole-daily
OR
Antiproliferative (medicated) Sahmpoo
-Selenium, Tar, orZinc-based
88
What is the normal Reticulocyte Count Range?
0.5% - 1.5% of the RBCs
89
What are two typical features of a Posterior Communicating Artery Stroke?
Cranial Nerve III Palsy: ptosis and anisocoria
90
What are the treatments for severe GBS?
Plasmapharesis and IVIG
91
What two initial medications should be given to patients with Acute Decompensated Heart failure with pulmonary edema and persistent HTN?
IV Diuretics (furosemide)
IV Vasodilators (Nitrates): decrease preload and afterload
92
What are the typical findings on an ECG Tracing associated with Wolf-Parkinson-White (WPW) Syndrome?
Short PR Interval ( less than 120msec)
Delta wave
Wide(ning) QRS
93
What cardiac conditions are pts with bicuspid aortic valves at risk of developing?
Aortic Dilation
Aortic Aneurysm
Aortic Dissection
94
What is the best modality to eveluate a pancreatic cyst?
Endoscopic Ultrasound with Aspiration
95
Which anatomic region of cells becomes responsive during acute Otitis Media and can result in persistent symptoms?
Mastoid Air cells
96
What is the involuntary normal response to Caloric Stimulation in the oculovestibular test?
Transient, conjugate, slow deviation of gaze to the side of stimulation (brainstem) followed by saccadic correction to the midline (cortical correction)
97
Which antidiabic medication is associated with inducing fluid retention and how?
Thiazolidinedione (PPAR-y agonist)
| [These receptors are also in collecting ducts and activation increases Na reabsorption]
98
What are the ECG findings typically associated with Paroxysmal Supraventricular Tachycardias?
Narrow, Regular QRS
Unidentifiable P-waves
Sudden Onset
99
What is the modality of choice to confirm a dx of Spinal Stenosis?
MRI of spine
100
Which patients presenting with anginal-chest pain should be sent for coronary angiography without Stress Test first?
Those with High Pretest probability:
-typical angina with CAD risk factors
(HTN, DM, FHx)
OR
Those with chronic uncontrolled angina despite optimal therapy
101
What is the most likely dx in a pregnant pt who presents with pruritis, papules, vesicles around the umbilicus?
Herpes Gestationis (Pemphigoid Gestationis)
102
What is the main difference between Herpes Gestationis and Papular Urticarial Papules and Plaques of pregnancy (PUPPP)?
HG: periumbilicar area is involved but abdominal striae are NOT involved.
PUPPP: striae are involved but periumbilical area is spared.
103
What is the treatment for HG?
Topical Trimacinoline
Note: Herpes Gestationis is an autoimmune condition)
104
What are the contraindications to using Ulipristal for emergency conrtaception?
Renal/liver disease
| Uncontrolled Asthma
105
What is the treatment of choice for severe PID?
IV ceftriaxone and IV Doxycycline
or
IV cefoxitin and IV doxycycline
Need all drugs IV for severe PID
106
What is the hallmark EKG finding of Multifocal Atrial Tachycardia (MAT)?
3 or more distict P wave shapes
Narrow QRS
PR, RR segment variability
HR up to 200 bpm
107
What are the main causes of Multifocal Atrial Tachycardia?
Hypoxia (always r/o fisrt with trial of O2 supp)
COPD
Hypokalemia
Hypomagnesemia
Coronary/Hypertensive/valvular disease
Meds (Theo/amino-phylline, Isopreterenol)
108
How Is Multifocal Atrial Tachycardia managed?
R/o underlying causes first with hypoxia, hypokalemia and hypomagnesemia being investigated first.
If O2 supp fails and labs do not show electrolyte problem, can treat with medication:
-B-blockers (if no contraindications like
COPD, asthma)
-Verapamil (in those with COPD or
asthma)
109
What is the empiric treatment of choice for Cat SCRATCH Disease?
Observation for Immune competent and localized cases
Azithromycin for disseminated or immunocompromised cases
110
What is the empiric treatmetn of choice for a mammalian bite?
Amoxicilin-Clavulanate (does not cover bartonella henselae
111
When should oral vancomycin be the first line treatment for C. difficile colitis?
```
In severer cases:
Serum WBC >15000/mm3
Fever (>38 or 100.9)
Creatinine >1.5 x baseline
Serum Albumin
```
112
What is the most likely complication associated with Bacterial Conjunctivitis?
Keratitis (inflammation of the Cornea)
113
What is the treatment of choice for Bacterial Conjunctivitis?
Erythromicin Ointment
NOTE: can also use sulfa drops or polymixin/TMP drops
114
What are the most common organisms associated with bacterial conjunctivitis?
S.aureas
Strep pneumo
Moraxella catarrhalis
Haemophilus influenzae
115
What is the treatment for latent Tb?
Isoniazid (INH) for 9 mos
116
If a pt has a colonoscopy which shows 2 non-villous adenomas each
In 5 years
117
If a pt has a colonoscopy which shows hyperplastic polyps,
10 years
118
If a pt has a colonoscopy which shows > 2 tubular or vilious adenomas, or adenomas that are > 1cm, when should the next colonoscopy be done?
In 3 years
119
What is the most likely diagnosis in a pt who presents with sudden onset SOB, dry cough, high fever, tachycardia, a CXR showing multiple round pulmonary lesions bilaterally, and is an IV drug user? What condition is this dx often associated with?
Septic Pulmonary Embolism (common in IV drug users)
Tend to arise from septic thrombophlebitis (presents as painful subcutaneous mass)
120
What is the main risk associated with long term PPI use and how so?
Osteoporosis --> Increased Hip Fracture Risk
| PPIs: inhibit osteoclast activity, decrease Ca absorption, eventually decreased bone mineral density
121
What are less common risk factors associated with long-term PPI use?
```
GI infections
HypoMg
Interstitial Nephritis
Decreased Vit B12 absorption
Decreased Iron Absorption
```
122
What is the most likely structure injured in a pt who presents with anterior knee pain and swelling associated with normal passive knee extension and flexion but cannot maintain extension of knee against gravity and cannot perform active knee extension.
Patellar Tendon Rupture (complete or incomplete)
123
At what age should adults receive the VZV vaccine to immunize against Herpes Zoster?
60 and over (immunecompetent)
124
Which drugs/drug classes tend to interfere with Lithium Levels?
ACEi/ARBs
Diuretics
NSAIDs
SSRI's
Antiepiletics carbamazepine and phenytoin)
Any medication that can slow GFR or alter K+ and Na+ levels
125
Which medications are preferred to control BP in pts taking lithium?
Dihydropyridine Ca-channel Blockers (Amlodipine)
Beta-blockers (second line)
126
What is the treatment of choice for premenstrual syndrome/premenstrual dysphoric disorder?
SSRI's
127
What should be done next for a pt who has not had any relief using initial SSRI monotherapy to treat PMS/PMDD?
Try another SSRI
NOTE: If pt not interested in child bearing at the time, and SSRI's didtn work, can se combination OCPs.
128
Which anticonvulsant/psychotropic medication carries the greatest risk of severe congenital anomalies if taken during pregnancy?
Valproate
129
What is the preferred empiric treatment for neonatal sepsis?
Ampicillin + Cefotaxime or Gentamicin (=28 days )
NOTE: Cefotaxime preferred when meningitis suspected
Ceftriaxone or Cefotaxime +/- Vancomcin (if suspect meningitis) (>28 days)
130
Why should ceftriaxone be avoided in neonates?
Displaces Bilirubin form Albumin--> Hyperbilirubinemia --> Kernicterus
131
What is the initial step in management for a pt who presents with a h/o asthma that has sudden onset of recurrent fever, malaise cough with brownish mucoid sputum, and wheezing?
Skin prick test for mold Ag (aspergillus)
132
What is the treatment for Acute Bronchopulmonary Aspergillosis?
Prednisone
133
How is treatment tracked in ABPA?
Check Serum IgE levels
Clinical resolution
Xray resolution
134
What are the adverse effects of Ginko biloba?
Bleeding and Platelet Dysfunction
135
What are the antibiotic options for meningococcal prophylaxis?
Rifampin (2 doses for 2 days, PO)
Ciprofloxacin (1 dose, PO)
Ceftriaxone (1 dose)
136
What is the preferred prophylaxis option for meningitis in a female taking OCPs and why?
Ciprofloxacin (1 dose PO)
| No medication interaction as seen with rifampin (increases hepatic metabolism of OCPs)
137
What are the indications for surgery in a pt with Primary Hyperparathyroid?
Symptomatic Hypercalcemia
Asymtomatic and one or more of:
Calcium 1 or more above upper limit of normal
Age
138
Why should SERMs like Reloxifene be avoided before surgery?
SERMs increase risk of thromboembolic event. Stop use 4weeks before surgery
139
What is a characteristic finding in pts with PCP intoxication?
Nystagmus (esp with agitation)
140
What is the treatment for Comedonal Acne?
Topical Retinoids
Salicylic Acid
Azelaic Acid
Glycolic Acid
141
What should be done before prescribing medication for acne in females?
Discuss plans for pregnancy
142
Which acne medications are considered safe during pregnancy?
Topical Erythromycin,
Topical Clindamycin
Azelaic Acid
143
What is the treatment for Mild Inflammatory Acne?
Topical Retinoids + Benzoyl Peroxide
144
What is the treatment for Moderate Inflammatory Acne?
Topical Retinoinds +Bezoyl Peroxide+ Topical Antibiotics
145
What is the treatment for Severe Inflammatory Acne?
Topical Retinoids, benzoyld peroxide, topical Antibiotics+Oral antibiotics
146
What is the treatment for Nodular Cystic Acne that is unresponsive to treatment?
Oral Isotrtinoin
147
What is the initial step in evaluating a patient for Duchenne Muscular dystrophy?
Measure serum CPK
148
What test is used to confirm the dx of Duchenne Muscular Dystrophy?
Genetic Testing (deletion of dystrophin gene on X-chromosome at p21)
149
What diagnosis should be considered in a patient whose physical exam demonstrates pupillary response with accommodation but NOT to direct light ?
Neurosyphilis (Argyll Robertson Pupils)
150
What is the most common indication for hopitaliazation in a pt with Sickle Cell Disease?
Vaso-occlusive Crisis
151
Which anatomic locations tend to be affected by Vaso-occlusive Cirses?
Back, Chest, Abdomen, Extremeties
152
What is the management for a pt with Vaso-occulsive Crisis?
1) Pain Medics (IV or PO Opiates)
2) Gentle rehydration
Note: Outpatient therapy is NSAIDS and Tylenol
153
What type of fluids should be used to rehydrate a pt in the ED for vaso-occlusive crisis?
I/2 or I/4 normal saline if BP and volume status are normal
Normal Saline (1 bolus) if hypotensive or hypovolemic
154
What is the most common cause of death in a pt with sickle cell disease?
Acute Chest Syndrome
155
How is Acute Chest Syndrome diagnosed in a pt with Sickle cell disease?
New Lung Infiltrates (CXR) + one of the following:
```
-wheezing, cough, difficuty breathing
tachypnea
-Temp > 101.3 (38.5)
-Chest Pain
-Hypoxemia (O2sat)
```
156
What tests shold be done in a new dx of Medullary Thyroid cancer?
```
Urine Metanephrines/catecholamines
Calcitonin
CEA (carcinoembryonic antigen)
Neck U/S (ck for mets)
Genetic testing for RET mutation
```
157
Should a pt with hypothyroidism be started on levothroxine prior to cardiac surgery and why/why not?
NO
Levothyroxine can increase myocardial Oxygen demand and this can precipitate an MI, angina, or dysrrhythmia in a pt with compromised coronary perfusion.
Do surgery first then treat hypothyroidism after (as long as no signs of myxedema coma)
158
What treatment combination should be included in Arican-American pts who are dx'd with NYHeart Associateion Class III or IV symptoms associated with LVsystolic dysfunction?
Hydralazine with Nitrates
159
what is the strongest known risk factor for male breast cancer?
Kleinfelter's Syndrome (47, XXY)
160
What electrolyte abnormality can serve as an independent predictor of adverse clinical outcomes in pts with CHF?
Hyponatremia
161
Which antibiotics are treatment options for uncomplicated UTI in pregnancy?
Nitrofurantoin
Amoxicillin
Amoxicillin-clavulanate
Cephalexin
162
Which antibiotics are options for treatment of Pyelonephritis in pregnant patients?
Ceftriaxona (or other 3rd Gen Cephalosporin)
Aztreonam
Ampicillin + Gentamicin
163
What is the most common long term complication of Transurethral Resection Procedure (TURP)?
Retrograde ejaculation --> Dry ejaculate
164
what is the most common shoirt-term complication of TURP?
Hyponatremia (possibly d/t absorption of fluid during procedure form copious irrigation)
165
Why should anesthetics like lidocaine not be used in pt. with local skin infections?
They will not work d/t the localized acidic environment created secondary to infection. Anesthetics like lidocaine are basic substances and will be neutralized in acid.
166
Describe category A drug risk according to FDA?
Human and animal studies show no fetal risk.
167
Describe category B drug risk according to FDA?
Animal studies show no risk, no human studies done
OR
Fetal risk in animals but no human risk shown
168
Describe category C drug risk according to FDA?
Animal studies show fetal risk, no adequate human studies done
or
No adequate data on animal or human
169
Describe category D drug risk according to FDA?
Fetal risk in human studies or post market surveillance
170
Describe category X drug risk according to FDA?
fetal risk in animals, or human or post market surveillance
171
what is the treatment for mild-moderate plaque psoriasis?
Topical high potency steroids or Vit D derivatives
172
what is the treatment for severe plaque psoriasis or psoriatic arthritis ?
```
phototherapy
systemic therapy (Methotrexate)
```
173
When should propranolol be used in patients with Strawberry (infantile) hemangioma?
If disfiguring or located in area that might interfere with function (eyelid, airway)
174
What is the most likely dx in a pt who presents with lethargy, constipation, weight loss, nausea and vomiting, low-normal TSH and low Free T4?
Central Hypothyroidism
175
What is the next step in management for a pt whose symptoms and thyroid labs suggest central hypothyroidism?
```
Urine cortisol (results show low normal)
Then serum ACTH and ACTH stimulation test
```
176
At what point after birth does physiological jaundice usually appear?
24 hours after birth
177
Whaen does pathologic jaundice usually appear?
Within the first 24 hours of birth (immune or non-immune heloysys
178
What nonpharmacologic intervention has thegreatest reduction capacity on BP?
Weight Loss (at least 10%)
179
What are the 6 P's of Acute Limb Ischemia?
```
Pain
Pallor
Paresthesia
Pulselessness
Pikoilothermia
Paralysis
```
180
What is the immediate step in intervention for a pt with signs of severe acute limb ischemia?
IV Heparin and surgical revascularization
181
What is a major contraindication for Bupropion use?
Seizure disorder
182
What is tone of the best prognostic indicators for acute hepatitis B infection?
Prothrombin time (extrinsic factors)
183
What is the next step in management for a pt whose initial screening test shows +anti-HBc (total core antibody) only?
Check Serum IgM antiHbc (if positive = window period of acute infection)
184
What is the immediate treatment of choice for a pt dx with toxic megacolon?
Steroids if pt has Inflammatory Bowel Dx
| Antibiotics if Infectious Bowel process
185
What is the most likely dx in a pt who presents with pesistent urinary symptoms, anemia, hematuris on dipstick (microhematuria), anemia (microcytic), and recent emigration from another country (in Africa, South America, Asia)?
Shistosomiasis
186
What is the next step in managemnet for a pt suspected of having schistosomiasis whose urinalysis shows microhematuria?
Urine microscopy (see eggs in urine)
| Can also do stool microscopy and visualize ova in stool
187
What treatment should be added to dextrose fluids for a pt with a h/o diabetes who is taking sulfonylurea medications and presents with intractible hypoglycemia?
Octreatide (she likely took excessive dose of sulfonylurea and has over production of insulin)
188
What is the next step in management for a pt who has a copper IUD and whose recent PAP demonstrates Actinomyces but no other findings and pt is asymptomatic?
Follow-up with physician if symptoms occur
| Note: actinomyces is normal flora but can be a complication of IUD, it is rare. Remove IUD if symptomatic
189
what is the preferred imaging modality for a young non-obese boy who presents with hip pain , especially during internal rotation, and swollen, erythematous, warm , tender joint?
Ultrasound (widened Joint space)
| Dx Transient sinovitis (boys 3-10 yrs old, can have hip, knee, or thigh pain)
190
What lab test should be performed initially in the work up of a patient with chronic diarrhea?
Stool Microscopy (check for ova, parasites, blood, WBCs)
