Set 1 Flashcards
Postereolateral knee injury is injury to what? What is the diagnostic test?
Injury to ACL
Lachman tests
Vertigo + Tinnitus. Dx? Tx?
Meniere Disease
Tx = Limit intake of salt, caffeine, nicotine and alcohol
Positive Dix-Hallpike Manuever. Dx? Tx?
Dx = Binign Proxysmal Positional Vertigo Tx = Epley and Semont Maneuvers
In DKA what happens to pottasium?
Patient is hypokalemic, due to renal lose of potassium. However the pottassium serum level may look normal because the acidosis causes potassium to leave cells and enter the serum.
Formal vision screening during well-child visit is recommended at what age?
4 yrs
Rotavirus vaccine is recommended when.
2-8 months
2 risk factors for newborn Respiratory Destress Syndrome.
Prematurity
Maternal Diabetes Mellitus
What symptoms make you suspect possible Acute Lymphoblastic Lukemia
Bone Pain
Lymphadenopathy
Hepatosplenomegaly
Petechiae (from thrombocytopenia)
Treatment of premature ventricular contractions
Increase metaprolol
What is the criteria for placing an Automatic Implantable Cardioverter-Defibrulator
Ventricular arrhythmias (e.g. ventricular tachycardia) in patients with ejection fraction < 35%. Or if Pt had previous MI then EF<30%
Under what length is a cervix considered short? And what is the management?
2cm
Management: IF previous preterm labor then cerclage. IF no previous preterm labor then vaginal progesterone.
Diastolic collapse with elevated right ventricular pressure. Dx?
Cardiac tamponade
Dilated left ventricle with apical hypokenesis. Dx?
Cardiogenic shock
Inferior vena cava engorgement. Dx?
Cardiogenic shock
Dilated right ventricle and hypokenesis. Dx?
Pulmonary embolism
What is the antibiotic for aspiration ammonia?
Clindamycin
Diagnosis for a patient that comes in with pulmonary symptoms, gastrointestinal symptoms, and hyponatremia. And what is the treatment?
Legionella
Fluoroquinolone
If you rapidly correct hyponatremia what can happen? If instead you rapidly correct hypernatremia what can happen?
Hyponatremia correction = demyelination
Hypernatremia correction = cerebral edema
What cancer produces parathyroid hormone related protein?
Squamous cell carcinoma
What cancer produces SIADH?
Small cell lung cancer
If you have pulmonary symptoms in a patient, the sputum is stained and reveals weakly acid-fast bacteria. What is your differential and how do you identify the proper organism? What is the difference in the treatment?
Nocardia = Filamentous branching - Tx=TMP-SMX Actinomyces = No branching - Tx = Penicillin Mycobacteria = Strongly acid-fast, unlike the two above that her weakly acid-fast
What are premature atrial complexes? What are precipitating factors of premature atrial complexes?
When an atrial contraction is initiated somewhere other than the Sino atrial node. This causes a premature atrial contraction. It can be identified on an EKG by an usual P-wave. Premature atrial complexes can be caused by factors such as stress, alcohol, smoking, caffeine.
Seratonin Syndrome symptoms. List 4.
Mydriasis
Hyperreflexia
Tachycardia
Hypertension
SSRIs should be discontinued __(time)__ before beginning an MAOI
2 wks
3 symptoms of disseminated gonococcal infection
Fever
Polyarthralgia
Pustular rash
Most common cause of death in End Stage Renal Disease
Cardiovascular disease
Phenelzine. What type of drug is this?
MAOI
What is phencyclidine?
PCP
How is the mitral valve affected in hypertrophic cardiomyopathy? How does it relate to the murmur?
During systole, the mitral valve leaflets move anteriorly toward the interventricular septum. The contact between the mitral valve and thick septum causes the left ventricular outflow obstruction, which causes a systolic murmur.
Nephrotic syndrome increases risk for what 3 complications? Describe the mechanism?
Nephrotic syndrome = proteinuria
Low protein levels cause increased liver protein and lipid synthesis.
Hyperlipidemia causes increased risk for complication of: ATHEROSCLEROSIS
In nephrotic syndrome, antithrombin III is lost in the urine. This leads to hypercoagulability and increased risk of MI / STROKE.
Nephrotic syndrome also causes loss of immunoglobulins in urine, which increases risk of INFECTION.
Typical symptom of central retinal vein occlusion.
Sudden unilateral visual impairment
Typical symptoms of macular degeneration
Central vision impairment
Rocky Mountain spotted fever symptoms? organism? Tx?
Symptoms = Rash on palms and soles Organism = Rickettsia rickettsii Tx = Chloramphenicol
What is Lhermitte sign and what is it associated with?
Lhermitte sign is an electrical sensation that runs down the back and limbs. It is most associated with Multiple Sclerosis.
If someone has hypercalcemia and hypertension what should you suspect?
Hypercalcemia = Hyperparathyroidism Hypertension = Pheochromocytoms Together = MEN2A
What labs do you look at to diagnose Histoplasma infection?
Pancytopenia (due to bone marrow infiltration)
High AST, ALT
What kind of decelerations are seen with umbilical cord compression?
Variable decelerations
vWF deficiency. What is the platelet count?
Platelet count is NORMAL
Ptosis, which improves with application of ice pack. Dx>
Myasthenia Gravis
Lamber-Eaton is a associated with what condition?
Small Cell Lung Cancer
Special tests for Hereditary Spherocytosis
Eosin-5-maleimide binding
Acidified Glycerol Lysis Test
What is the level of WBCs in CLL?
> 100,000
What do you see on peripheral smear of ALL?
Small lymphocytes without much cytoplasm, lots of chromatin.
Hairy cell leukemia. Does it have lymphadenopathy or splenomegaly?
Splenomegaly
ALL: Does it have lymphadenopathy or splenomegaly?
Lymphadenopathy
CLL: Does it have lymphadenopathy or splenomegaly?
Lymphadenopathy
Define the following:
Depersonalization/derealization disorder
Dissociative amnesia
Dissociative identity disorder
Depersonalizatio/derealization disorder = feeling of detachment or experiencing surroundings as unreal. However identity testing is intact.
Dissociative amnesia = inability to recall important personal information
Dissociative identity disorder = Multiple personality disorder
Upper GI bleeding leads to what effect on BUN/CR and why?
BUN/CR is increased, because upper GI bleeding causes increased urea production (due to intestinal breakdown of hemoglobin) and increase urea reabsorption (due to hypovolemia from bleeding)
How to differentiate between lactational mastitis and breast abscess?
Both present with fever and unilateral breast pain
However breast abscess presents with fluctuance on physical exam, while lactational mastitis is not fluctuant.
Peau d’orange. Dx?
Inflammatory Breast Cancer
In infectious mononucleosis what hematologic lab values do some patients develop and why?
Anemia and Thrombocytopenia
Due to cross reactivity of anti-EBV antibodies and antibodies to RBCs and platelets.
How to differentiate between fibrocystic changes and fibroadenoma?
Fibrocystic changes = multiple masses
Fibroadenoma = solitary mass
Watershed areas of the colon
Splenic flexure
Rectosigmoid junction
Name 2 ototoxic medications
Loop diuretics
Aminoglycosides
What are FSH and LH levels in Sheehan syndrome?
Sheehan = hypopituitarism
Low FSH and LH
Difference between symptoms of Open Angle Glaucoma and Closed Angle Glaucoma
Open angle = gradual loss of peripheral vision
Closed angle = acute severe pain, blurry vision, nausea, vomiting
Dactylitis (sausage fingers) and nail changes. Dx?
Psoriatic arthritis
What is crystalline arthritis?
This refers to gout and pseudogout
Grotton’s papules. What are they? What is the diagnosis?
Grotton’s papules = violacious scaly plaques on the MCP joints.
Dx = Dermatomyositis
Charcot joint. What is it? What diseases is it associated with?
Charcot joint = neuropathic arthropathy
Associated with diabetic peripheral neuropathy, syphillis and alcoholism.
Most specific lab test for rheumatoid arthritis
Cyclic citrulinated peptide antibody
What is the difference between X-RAY imaging of osteoarthritis vs. rheumatoid arthritis?
Osteoarthritis = Osteophytes & Joint space narrowing
Rheumatoid arthritis = Periarticular erosions
What are the special hemoglobins that you see in alpha and beta thalassemia?
Alpha-Thal = Beta(4) (i.e. HbH) or Gamma(4) (i.e. Hemoglobin Barts)
Beta-Thal = HgBA2 (>3.5%)
Antimitochondrial antibody. Diagnosis?
Primary biliary cholangitis
Which biliary tract disease is assoiciated with ulcerative cholitis?
Primary sclerosing cholangitis
What are complications of Primary Biliary Cholangitis?
Malabsorption (leads to Osteoporosis and Osteomalacia)
Hepatocellular Carcinoma
What are complication of Primary Sclerosing Cholangitis?
Cholangiocarcinoma
Gallbladder Cancer
What kind of drugs cause neuroleptic malignant syndrome?
Dopamine antagonist medications (e.g. Haloperidol)
What is the difference between the time course of bacterial vs viral rhinosinusitis?
Viral rhinosinusitis improves within 5-10 days.
Bacterial rhinosinusitis can have fever >3days or persistent symptoms >10 days, requiring antibiotics
What does Moraxella catarrhalis cause?
Otitis media (in children) COPD exacerbation
What are 2 ultrasound findings of congenital toxoplasmosis?
Diffuse intracranial calcifications
Bilateral ventriculomegaly
How to differentiate between extraperitoneal bladder injury and intraperitoneal bladder injury?
Extraperitoneal bladder injury is more common with pelvic fracture. Commonly presents with gross hematuria.
Intraperitoneal bladder rupture results in intraperitoneal leakage of urine. It results in chemical peritonitis, which presents with symptoms of diffuse abdominal pain, guarding, rebound.
Difference between medial tibial stress syndrome (shin splits) and tibial stress fracture. Typical patient and physical exam.
Shin splits occur in overweight patients and present as diffuse tenderness on physical exam.
Stress fractures occur more often in underweight patients and present as point tenderness on physical exam.
Name of infection after cataract surgery
Postoperative endophthalmitis
How does positioning affect varicocele?
Increases on standing, decreases when supine
What drugs to use to treat the tremor of Parkinson’s.
Use the anticholinergics: Benztropine or Trihexyphenidyl
These improve tremor and rigidity, but do not help bradykinesia.
Symptoms of presbycusis
Bilateral hearing loss associated with advanced age.
Tinnitus
Symptoms of ostosclerosis
Conductive hearing loss
Special named conjugate hyperblirubinemia. Which one is more severe?
Dubin-Johnson syndrome
Rotor syndrome
(Dubin is more severe with a black liver, but both are benign)
Special named unconjugated hyperbilirubinmia. Which one is more sever?
Crigler-Najjar
Gilbert
(Crigler-Najjar is more severe with absent UDP-glucuronosyltransferase, while in Gilbert it is just decreased)
Acute stress disorder vs Adjustment Disorder
Acute stress disorder is the precursor to PTSD. Acute stress disorder lasts 3 days to 1 month, while PTSD is more than 1 month.
Adjustment disorder is defined as emotional symptoms that do not meet criteria for major depression. They occur within 3 months of an identifiable stressor and last less than 6 months.
When to give TMP-SMX prophylaxis to HIV patients. What does it prevent?
CD4<200
prevents Pneumocystis pneumonia & Toxoplasmosis
When to give Azithromycin or Clarithromycin to HIV patients. What does it prevent?
CD4<50
prevents Mycobacterium avium complex
HIV patient with EBV DNA in CSF & a solitary ring-enhancing lesion on MRI. Dx? CD4 count?
CNS lymphoma
CD4<100
HIV patient with nonenhancing areas of demyelination on MRI. Dx? CD4 count?
Progressive multifocal leukoencephalopathy due to JC virus.
CD4<200
How to tell apart Primary Hyperparathyroidism from Familial Hypocalciuric Hypercalcemia.
Both may present with high Calcium and high/normal PTH. However in Primary Hyperparathyroidism the Urine(Calcium)/Creatinine ratio > 0.02. In Familial Hypocalciuric Hypercalcemia Urine(Ca)/CR < 0.01
What is Euthyroid Sick Syndrome? Mechanism? Tx?
Euthyroid Sick Syndrome is low T3, but normal T4 and TSH. It occurs in acutely ill patients. Occurs due decreased peripheral conversion of T4 to T3.
Treatment is not recommended, treat the underlying condition.
What test is used to determine the dose of anti-D immune globulin after delivery.
Kleihauer-Betke test (measure amount of fetal cells in maternal circulation)
What drugs can increase the risk of lithium toxicity?
Thiazides ACEI NSAIDs Tetracyclines Metronidazole
Symptoms of Lithium toxicity
GI symptoms: Neausea, vomiting, diarrhea
Neuro symptoms: confusion, ataxia, tremor, seizures
Drugs that cause Acute Interstitial Nephritis
5 Ps Pee (diuretics) Pain-free (NSAIDs) Penecillins and other Abx: Cephalosporins, TMP-SMX PPIs rifamPin
Symptoms of Acute Interstitial Nephritis
Hematuria Pyuria Costovertebral tenderness Fever \+/- Arthralgias
Durgs that cause Acute Tubular Necrosis. And other causes.
Drugs: Aminoglycosides Radiocontrast agents Lead Cisplatin Ethylene glycol
Other causes: Crush injury (myoglobinuria) Hypotension Shock Sepsis
Causes of renal papillary necrosis.
Mn* SAAD Sickle cell Acute pyelonephritis Analgesics (NSAIDs) Diabetes mellitus
What are the different casts of intrinsic renal disease subtypes.
Glomerulonephritis = RBC casts
Acute Interstitial Nephritis = WBC casts
Acute Tubular Necrosis = muddy brown casts
Drug used to decrease cravings in Alcohol Use Disorder.
Naltrexone
First-line pharmacologic therapies for smoking cessation
Bupropion
Varenicline
What diuretic will decrease calcium in urine and thus decrease likelihood of nephrolithiasis?
Thiazide diuretics
At what point in pregnancy is the 1 hr glucose challenge test performed?
24-28 wks
Compare the risk to the fetus from maternal hypertension vs gestational diabetes.
Maternal hypertension = microsomia and oligohydramnios (AFI<5)
Gestational diabetes = macrosomia and polyhydramnios (AFI>24)
What cervical length results in increased risk of preterm labor.
< 2.5 cm
Management of placenta previa
C-section by 37 wks
Periodic acid-Schiff stain is used to diagnose what disease? What are the symptoms?
Whipple disease caused by Tropherema Whipplei
Symptoms = Malabsorptive diarrhea, migratory arthritis, lymphadenopathy, fever
Symptoms of theophylline toxicity
CNS (headache, insomnia, seizure)
GI (Nausea, vomiting)
Cardiac (Arrhythmias)
Patients with Turner syndrome that become pregnant (rare) have increased risk of what?
Aortic dissection
PCOS: the drug and the mechanism to treat infirtility
Clomiphene citrate stimulates ovulation. In PCOS, the high estrone levels cause short GnRH pulses, which cause LH/FSH misbalance, which causes lack of LH surge, which poor folicle maturation and oocyte release (anovulation).
Back pain, weight loss and smoking history. Next step in management?
CT Abdomen
b/c suspecting pancreatic cancer
When to do sacroiliac joint imaging.
When you suspect Ankylosing Spondylitis
It present in males < 40 with back pain that is worse at night
