Serge Step2 Flashcards
1
Q
Bug causing pneumonia in alcoholic with bloody cough?
A
Klebsiella
2
Q
How does left sided colon ca present?
A
Obstruction
3
Q
How does right sided colon ca present?
A
Bleeding (Anemia)
4
Q
Means of biopsy with centrally located lung nodule
A
Bronchoscopy
5
Q
Means of biopsy with peripherally located lung nodule
A
CT-guided lung biopsy
6
Q
What is the Rx for Ankylosing Spondylitis (and what to avoid)?
A
NSAIDs
Escalate to Sulfasalazine, Etanercept
(Avoid Steroids in this particular autoimmune dz)
7
Q
What are the 2 reasons for changing HIV meds?
A
- Side effects
- Viral load
NOT CD4 count
8
Q
What is treated by Metronidazole?
A
“GGET Back Close to the Metro”
Gardnerella Giardia Entamoeba Bacterioides Clostridium Dificile
9
Q
What is a specific marker for CSF?
A
beta-2 transferrin
10
Q
What is a Dandy-Walker malformation?
A
Absence of the posterior cerebellar vermis
11
Q
What is the main spinal cord malformation associated with Chiari II malformations?
A
Meningomyelocele
12
Q
What is the main spinal cord malformation associated with Chiari I malformations?
A
Syringomyelia
13
Q
What are the most common brain tumors in kids?
A
Astrocytoma
Medulloblastoma
14
Q
What are the most common brain tumors in adults?
A
Mets
Glioblastoma
15
Q
How would you treat a TIA?
A
ASA
16
Q
What vessel would cause a stroke with dizziness, loss of balance, etc?
A
Vertebrobasilar
17
Q
What is Wallenberg’s Syndrome?
A
Lateral Medullary Sx
- Loss of pain and temp sensation on the ipsi face and contra body
- Dysphagia, slurred speech, ataxia, facial pain, vertigo, nystagmus, Horner’s syndrome, diplopia
18
Q
What are 3 reasons for giving IV contrast?
A
Infection
Tumor
Vessel problem (like PE)
19
Q
IVDU with back pain, concerning for…
A
Epidural Abscess
Image with MRI
20
Q
Most common brain tumor found in the sella in kids
A
Craniopharyngioma
21
Q
Tumor affecting area of 4th ventricle in kids
A
Pilocytic Astrocytoma
22
Q
Brain tumor affecting cerebellum in kids
A
Medullobastoma
23
Q
What effects do anti-Ro and -La cause in the fetus?
A
Congenital AV block
24
Q
What is the rx for Huntington’s
A
Haloperidol
25
Meds for migraine prophylaxis
Beta Blockers
26
Meds for acute abortion of igraine
Triptans
27
What type of cancer is preceded by actinic keratoses?
Squamous cell skin ca
28
Redness of the hair follicle, often on the buttocks
Folliculitis (mild)
29
Micro abscess of the hair follicle, often on the buttocks
Furuncle (mod)
30
Large lesion after folliculitis, often on the buttocks
Carbuncle (severe)
31
What skin ca is arsenic exposure a risk factor for?
Squamous cell carcinoma
32
Why does silicosis confer risk for TB?
Both affect upper part of lungs
33
Categories of drugs associated with rashes (3)
1. Sulfas
2. Pen/Ceph
3. NSAIDs
34
What rash is characterized by herald patch + Christmas tree distribution?
Pityriasis rosea (think red bulbs on a Christmas tree)
35
Most important prognostic factor for melanoma
Depth of lesion
36
Marker for melanoma
S-100
37
Rx for Malassezia furfur
Selenium sulfide
38
Rx for Shingles
Valacyclovir
39
Rx of CMV
Gancyclovir
40
EKG changes caused by hypo Ca
Short QT
41
EKG changes caused by hyper Ca
Long QT
42
What stabilizes the cardiac membrane in hyper Ca?
Bicarb and fluids
43
How would you differentiate IgA vs. PSGN as a cause of hematuria?
IgA 1 wk
44
What type of damage causes eosinophils in the urine?
Interstitial Nephritis
45
What type of damage causes muddy brown casts in the urine?
ATN
46
What type of damage causes RBC casts in the urine?
Glomerulonephritis
47
What is the main side effect of EPO?
HTN
48
Aldosterone causes: alkalosis/acidosis?
ALdosterone causes ALkalosis
49
Spironolactone causes: alkalosis/acidosis?
Opposite of aldo, so: acidosis
50
Furosemide and HCTZ cause: alkalosis/acidosis?
Same as aldo, so: alkalosis
51
Acetazolamide causes: alkalosis/acidosis?
ACidosis
52
Diffuse mesangial proliferation signifies what kind of renal disease?
IgA Nephropathy
53
What electrolyte would you give a pt with renal failure?
Ca, to compensate for renal osteodystrophy
54
What is the Rx for mild hypoNa?
Water restriction
55
What is the Rx for moderate hypoNa?
Loop diuretic and IV NS
56
What is the Rx for severe hypoNa?
IV hypertonic saline
57
What is the main cause of acute endocarditis?
Staph aureus
58
What is the main cause of subacute endocarditis?
Strep viridans (GBS)
59
HIV ulcer: vesicles, smaller ulcerations
Herpes (Rx Acyclovir)
60
HIV ulcer: large linear ulceration
CMV (Rx Ganciclovir)
61
HIV ulcer: white plaques
Candida (Rx Fluconazole)
62
Rx for community acq pneumo with no comorbidities (and with?):
Azithromycin or Doxy
| Cipro OR Cephalosporin + Azithromycin
63
Rx for hospitalized pneumonia
(and if in ICU):
Azithro + Cephalosporin OR
Cipro
(Azithro + Ceph IV OR Ceph + Cipro)
64
Rx for abscess or aspiration pneumo:
Clindamycin
65
First line Rx for latent TB:
Isoniazid (+ B6) for 9mo
66
Second line Rx for latent TB:
Rifampin for 9mo
67
Repeated Neisseria infection indicates what immunodeficiency?
Complement (C5-9), MAC complex deficiency
68
What are the 3 most common causes of bacterial meningitis (and Rx) in an adult?
1. Strep pnemo (Vanc)
2. Neisseria (Cephalosporin)
3. Listeria (Amp)
69
What are the 3 most common causes of bacterial meningitis (and Rx) in a neonate?
1. GBS (Cephalosporin)
2. E Coli (Gent)
3. Listeria (Amp)
70
What are the risk percentages of contracting Hep B, Hep C, and HIV from needle stick?
Hep B 30%
Hep C 3%
HIV 0.3%
71
Right sided flank pain + hematuria post nephrotic syndrome is concerning for:
Renal Vein Thrombosis
| - Nephrotic syndrome causes hypercoag state due to deficiency of antithrombin III
72
What antibiotic would you give for ppx to an HIV pt with CD4
TMP SMX (Toxo, PCP)
73
What antibiotic would you give for ppx to an HIV pt with CD4
Azithromycin (MAC)
74
What are the 4 classes of people you vaccinate for Neisseria meningitidis?
1. Military recruits
2. College kids
3. Complement deficiency
4. Asplenia
NOT children, NOT PLWH
75
What are the symptoms of AZT-related toxicity?
Muscular tox (proximal > distal)
76
What HIV illness produces neuro sx with normal MRI and LP?
Vacuolar (HIV) myelopathy
77
Most common cause of seizures across the world (and Rx)?
Neurocystisercosis (Albendazole)
78
Rx for Legionella?
Macrolide (Erythromycin)
79
Rx for Nocardia?
Remember SNAP
| Sulfa Nocardia
Actinomyces Penicillin
80
When would you prophylax for endocarditis?
1. Procedure that poses risk (cutting, not scoping) AND
| 2. Risk factor for endocarditis (structural lesion)
81
What are risk factors for endocarditis from procedure?
```
Prior endocarditis
Valve abnormalities (prosthetic, or regurge, etc)
```
82
What is the Rx for endocarditis prophylaxis?
Amoxicillin
83
What are 2 nephrotic syndromes that cause big kidneys?
1. AIDS nephropathy
| 2. Amyloid nephropathy
84
What kind of nephrotic syndrome does heroin abuse predispose to?
FSGS
85
Treatment of choice for Aspergillus
Voriconazole (vortex in sketchy)
86
Rx for bacterial meningitis > 50 yo
Amp, Cef, Vanc
87
Rx for bacterial meningitis
Cef and Vanc
88
Rx for bacterial meningitis caused by Neiserria
Cef alone
89
Rx for bacterial meningitis caused by Strep pneumo
Cef and Vanc (resistance)
90
Rx for bacterial meningitis caused by Listeria
Ampicillin
91
Rx for oral thrush
Clotrimazole
92
Heart complication assoc w Lyme
AV block
93
What bugs do you worry about with CD4
94
When do you give steroids for increased ICP?
Meningitis or encephalitis
| Trauma
95
Neuro signs + fever after sinusitis is suspicious for:
cavernous sinus thrombosis
96
What bug causes Kaposi Sarcoma?
HSV 8
97
CT with hemorrhage in temporal lobes is suspicious for what infectious cause?
Herpes (treat with IV Acyclovir)
98
Murmur: opening snap and mid-diastolic
mitral stenosis
99
What are three drugs that can be used as anticoag in the case of HIT?
1. Argatroban
2. Fondaparinux
3. Lepirudin
(Direct thrombin inhibitor)
100
What is the most common cause of B12 deficiency anemia in the US?
Pernicious anemia, abx against parietal cells (or IF)
101
Causes of aplastic anemia (ABCs):
Arsenic
B19 (Parvo)
Chloarmphenicol
...and Fanconi’s
102
What is Bernard-Soulier disease?
platelet adhesion disease
| Big Suckers
103
Glanzmann's Thrombasthenia
platelet aGGregation disease
104
What is Chediak Higashi?
problems with microtubules and neutrophils, recurrent infection
105
What is the rx for afebrile anemia with neutropenia?
observation
106
What is the rx for febrile anemia with neutropenia?
Cefepime
Pip-Tazo
Meropenem
...and Pegfilgastrim
107
What clotting disorders present with schistocytes and decreased platelets?
DIC
HUS
TTP
HELLP
108
Schistocytes and decreased platelets with abnormal PT and PTT:
DIC
109
Schistocytes and decreased platelets, preceded by GI/viral illness:
HUS
110
Schistocytes and decreased platelets with confusion, renal issues:
TTP
111
Schistocytes and decreased platelets in a pregnant woman:
HELLP
112
Rx for TTP
Plasmaphoresis
113
Conditions with high MCHC
Hereditary spherocytosis
| Autoimmune hemolytic anemia (Coomb's positive)
114
Rx for severe spherocytosis?
Splenectomy
115
Rx for mild spherocytosis?
Folate
116
Following sx indicate:
Nocturnal hemoglobinuria
Aplastic anemia
Thrombosis
Paroxysmal Nocturnal Hemaglobinuria
117
What test differentiates CML and leukemoid reaction?
CML: low LAP
Leukemoid: high LAP
118
What chronic disease is often associated with TTP?
HIV
119
What drug prevents Tumor Lysis Syndrome?
Allopurinol
120
First rx for hyperCa + sx (serious situation)
IV saline
| - Can follow with bisphos
121
Diabetic with elevated morning glucose. What are the two reasons?
1. Dawn phenom: not getting enough insulin before bed
| 2. Somegyi phenom: too much insulin at night, low bG in the middle of the night, rebound high in the morning
122
How do you differentiate the causes of elevated morning blood glucose?
3AM blood glucose check
123
What is the rx for prolactinoma
Dopamine agonist first: bromocriptine, cabergoline, pergolide
If that doesn't work, sx
124
Testicular tumors with high hcG (hCG is SET high)
```
Hydatiform mole
Choriocarcinoma
Gestational trophoblastic disease
Seminoma
Endodermal sinus tumor
Teratoma
```
125
Testicular tumors with high AFP (Fetus YET Lives)
```
Fetus = AFP
Yolk sac tumor
Endodermal sinus tumor
Teratoma
Liver ca
```
126
What is the Rx for Addisonian crisis?
Problem is low aldo and cortisol
1. Fluids
2.
Fludrocortisone (aldo depleted)
Prednisone (cortisol depleted)
127
Steps in evaluating thyroid nodule
1. TSH
2. Radionucline thyroid scan (if toxic adenoma--stop)
3. FNA of mass (to evaluate for ca)
4. Treat
128
Steps for treating thyroid storm:
pre-1: cooling and blankets
1. Beta blocker (propanolol)
2. PTU/methimazole
3. Steroids (decrease conversion of T3 to T4)
129
Steps for treating pheo crisis:
1. alpha blockers
| 2. beta blockers
130
Most common cause of asymptomatic hyper Ca?
Hyperparathyroidism
131
Most common cause of symptomatic hyper Ca?
Cancer
132
Eval of Cushing's:
Low THen High
1. low dose dexamethasome
2. acTH
3. high dose dexa
133
3 Causes of Toxic Megacolon
1. C dif
2. UC
3. Chagas
Rx: surgery
134
Treatment for Primary Biliary Sclerosis
Ursodeoxycholic acid
Cholestyramine to decrease itching (by reducing bile salts)
135
Conditions in which you would do upper GI endoscopy first?
1. Achalasia
2. Nutcracker syndrome
3. Esophagitis
136
Rx for Cholangitis
1. Fluids
2. Abx (Metronidazole, Cef)
3. Sphincterotomy (ERCP)
137
Common causes of ascites in USA
1. Alcoholic cirrhosis
| 2. In women, ovarian cancer causing peritoneal carcinomatosis
138
Steps in diagnosing gastrinoma
1. Serum gastrin level
2. Secretin stim
3. Imaging to look for gastrinoma
139
What causes pigmented macrophages in the submucosa and lamina propria (no other findings)?
Chronic laxative use
Melanosis coli
Often assoc with heroin abuse bc of chronic constipation associated
140
What is the rx for hepatic encephalopathy?
Lactulose + low prot diet +/- Rifaximin (2nd line)
141
Derm lesions assoc w UC
1. pyoderma gangrenosum
| 2. erythema nodosum
142
Name that derm condition:
| tender erythematous nodules on lower extremity
erythema nodosum
143
Name that derm condition:
| palpable pruritic papules on lower extremity
palpable = vasculitis
HSP
144
Name that derm condition:
| pruritic vesicles on the elbows and knees
dermatitis herpetiformis
Celiac
145
Name that derm condition:
| edema and brown dyspigmentation of lower extremity
vascular insufficiency
146
Common cause of watery diarrhea in AIDS
Cryptospora
147
Common cause of bloody diarrhea in AIDS
CMV --may see giant cells, deep lesions
148
Common presentation of ovarian cancer
Peritoneal carcinomatosis
| - Ascites in the abdomen
149
Where does H pyloric cause peptic ulcers?
Antrum and prox duodenum
150
Where does ZE/gastrinoma cause ulcers?
Distal duod and jejunum
151
What is the first rx for malignant HTN?
IV nitroglycerin/prusside
OR
IV b-blocker (labetolol)
152
How does carotid massage slow down the heart?
Increases parasympathetic tone by increasing AV conduction delay
153
Drugs given in acute MI
```
ASA
B blocker
Morphine
Nitro
Oxygen
```
154
What drug in the subacute phase of an MI has been shown to most improve mortality?
B-blocker
Spironolactone and ACE-i also improve mortality benefit, but work better at low EF
155
Rx for mild aortic stenosis
ACE-i
156
Rx for severe aortic stenosis
valve replacement
157
What organs does amiodarone affect?
Thyroid
Lungs: fibrosis
Liver: increased LFTs
Skin: smurf sign
158
Acute management of Pulm Edema (NOMAD)
```
Nitrates
1. O2
Morphone
ASA
2. Diuretic: IV furosemide
```
159
What is the rx for AFib in an emergency?
Rhythm control: defibrillate
160
What is the rx for AFib that is non-emergent
Rate control: b-blocker
161
What drugs create change in color vision?
- Digoxin
- Ethambutol
- Sildenafil
162
What is the most common cause of aortic coarctation in a young patient?
Bicuspid aortic valve (congenital)
163
Cardiac condition:
| - Pericardial knock
Constrictive pericarditis
164
Cardiac condition:
| - Wide split S2
ASD
165
Cardiac condition:
| - Opening snap and diastolic rumble
Mitral stenosis
166
What is Prinzmetal angina?
vasospasm causing angina and ST changes on EKG
167
What other types of vasospasm is Prinzmetal associated with?
Migraines
Reynaud's
Cocaine
168
What is they typical Rx for anal/rectal disease? (WASH)
WASH
- Warm water (Sitz bath)
- Analgesics
- Stool softener
- High fiber
169
What are 3 complications of Billroth II surgery?
1. Dumping syndrome (diarrhea, soon after sx)
2. Afferent loop syndrome (diarrhea, pain, soon after sx)
3. Gastrojejunocolic fistula (diarrhea and halitosis, long after) sx
170
2 common etiologies of rectocystic fistula (rectum to bladder)
Diverticulosis
| Crohn's
171
Steps in the workup of peripheral vascular disease
ABI
Ultrasound, which includes pulse volume recordings
Some kind of angio: MRI, CT, etc.
Treatment based on angio
172
Stepwise treatment of intercranial hypertension
1. Elevate head of the bed
2. Hyperventilate
3. Stop swelling: mannitol
4. Sedate: propofol
5. Surgery: burr hole or craniotomy
173
```
What surgical complications would you expect at:
Day 1
Day 2
Day 5
Day 7
```
1. atelectasis
2. UTI
5. DVT/PE
7. wound infection, abscess
174
Indications for emergent dialysis
```
Acidosis
Electrolyte abn (K)
Intoxication (think MUDPILES)
Overload, vol
Uremia (pericarditis, encephalitis, bleeding)
```
175
Diagnosis:
| disorganized esophageal contractions that do not involve the LES
Diffuse esophageal spasm
176
Diagnosis:
| tonic contraction of the esophagus that does involve the LES
Nutcracker esophagus
177
Management of BPH with urinary obstruction
Urinary catheter
| Perform subrapubic tube placement
178
What is the workup of bladder ca?
Cystoscopy
179
What is the Rx for mild placental abruption?
Watch and observe with fetal monitoring
180
What is the Rx for moderate placental abruption?
May need C/S but not emergent
| Could try steroids
181
What is the Rx for severe placental abruption?
C/S right away
182
What are the initial tests for syphilis?
RPR or VDRL
183
What is the confirmatory test for syphilis?
MHA-TP or Dark Field Microscopy or FTAB
184
When during the pregnancy do you give Rhogam to an Rh (-) mother?
28 wks
185
Why use LMWH (Enoxaparin) over Hep?
1. can better monitor
| 2. less likely to cause HIT (but can)
186
What to do if baby is
Expectant management, can still move to position itself properly
187
What to do if baby is > 36 wks and in breech position?
External Cephalic Version
188
Indications for treating GBS in pregnancy
1. Previous child with GBS sepsis
2. Positive urine culture at any time in pregnancy
3. Positive blood culture at any tie in pregnancy
Many other criteria but any one will suffice.
189
Choices for UTI in pregnancy
```
Can give many:
Nitrofurantoin
Amoxicillin
Ampicillin
Cephalosporin
```
190
With 2nd UTI in pregnancy what is the management?
Treat UTI and give Abx prophylaxis for the rest of the pregnancy
191
Uncommon complication of maternal diabetes in pregnancy that is not GDM:
sacral agenesis
192
Most common complication of GDM
fetal macrosomia
193
What placental conditions is a mother predisposed to given a history of prior C/S?
Placenta previa
| Placenta accreta
194
What type of C/S is associated with uterine rupture?
Classic (older C/S)
| Transverse (now common) not associated
195
What is the test to confirm placenta accreta?
Ultrasound or MRI
| must image
196
Early decels associated with:
fetal head compression
197
Variable decels associated with:
umbilical cord compression
| - more likely in post term baby with little amniotic fluid
198
Late decels associated with:
uteroplacental insufficiency
- placental factors
- maternal drug use
199
Painless genital infections
```
Syphilis
Chlamydia (just discharge)
```
200
Painful genital infections
Herpes (vesicles)
| H. ducreyi (CRYi out in pain)
201
What is the management of HPV warts?
Cryotherapy
Acid ablation
Burn them off
some kind of topical removal
202
What is the cause of urge incontinence?
Detrusor instability
203
What is the rx for urge incontinence?
Pelvic floor exercises
Anticholinergics
- Oxybutynin
- Impiramine
204
What is the test for stress incontinence?
Provocative stress testing (Q-tip test)
205
What is the test for urinary retention?
Post void residual volume
206
What is the test for urge incontinence?
Clinical diagnosis, but can do cystometry to measure detrusor pressure
207
What cancer risk is decreased by OCPs?
Endometrial ca
CONtraceptives increase cancers that start with CONsonants
208
What cancer risk is increased by OCPs?
Bone
Breast
Cervical
Hepatic
CONtraceptives increase cancers that start with CONsonants
209
What are the confirmatory test and and rx for lichen sclerosus?
Vulvar biopsy
| Clobetosol
210
What is the most common cause of AUB?
Anovulation
211
What is the treatment due to AUB due to anovulation?
```
Mild: nothing
Mod: cyclic progestins or OCPs (high dose progesterone)
Sev: IV fluids and IV hormone
- Estrogen before Progesterone
Only do D&C if this fails
```
212
Most common cause of heavy menstrual bleeding in a young woman, all else normal
Dysfx uterine bleeding
213
What is the cause of DUB?
```
Unopposed estrogen
(DUB = anovulatory cycle)
```
214
3 causes of primary amenorrhea
1. Turner’s
2. Imperforate hymen
3. Androgen insensitivity syndrome (testicular feminization)
215
Condition in which you have ovaries but no uterus
Mullerian agenesis
216
What ist he differences between Tamoxifen and Raloxifen?
Tamoxifen is Terrible for causing endometrial changes (risk of ca)
- Both are protective for breast ca
- Both are protective for osteoporosis
- Both cause hypercoag state
217
Breast disease in which no mass is felt but the entire breast is involved (sometimes associated with orange peel skin)
Inflammatory breast ca
| - Mastectomy
218
Breast disease with ulcerations at the nipple
Paget's disease of the breast
219
Patient presents with painful bowel movements, difficulty with conception, nodularity of the uterosacral ligament. Condition?
Endometriosis
- Also affects ovary
- Most common cause of infertility
220
Causes of enlarged uterus in a repro age woman
Fibroids (irregular enlargement)
| Adenomyosis (diffuse or symmetric or globular)
221
Child (say 4yo) with vaginal discharge/symptoms. What do you suspect?
Foreign body
| - Remove it
222
First step in workup of infertility
Examine the male
223
Pt with "gnawing" abd pain, worse at night, weight loss, fatigue, jaundice, migratory thrombophlebitis. What do you worry about?
Pancreatic adenoca
224
What is postpericardiotomy syndrome?
Pericardial effusion that can occur days or months after cardiac surgery in kids. Can progress to tamponade.
225
What defects are associated with increased Maternal Serum Alpha Fetoprotein (MSAF)?
- Open neural tube defects
- Abd wall defects
- Multiple gestation
226
What defects are associated with decreased Maternal Serum Alpha Fetoprotein (MSAF)?
Aneuploidy (Trisomy 18 and 21)
227
What drugs are associated with photosensitivity rxns?
Tetracyclines (doxy)
Chlorpormazine, perchlorperazine
Furosemide, HCTZ
Amiodarone, promethamine, piroxicam
228
How can you differentiate Herpes Simplex Keratitis from Herpes Zoster Ophthalmicus?
Herpes Simplex
- Vesicles and dendritic depsoits ON the cornea
- Most common cause of corneal blindness
Herpes Zoster
- Periorbital, aka outside the eye, vesicles
- Conjunctivitis of the eye
229
Pt discovered after a seizure, has elevated CPK and K. What complication do you worry about?
Rhabdo
| Resulting renal failure (ATN)
