Set 1 Flashcards
1
Q
Postereolateral knee injury is injury to what? What is the diagnostic test?
A
Injury to ACL
Lachman tests
2
Q
Vertigo + Tinnitus. Dx? Tx?
A
Meniere Disease
Tx = Limit intake of salt, caffeine, nicotine and alcohol
3
Q
Positive Dix-Hallpike Manuever. Dx? Tx?
A
Dx = Binign Proxysmal Positional Vertigo Tx = Epley and Semont Maneuvers
4
Q
In DKA what happens to pottasium?
A
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.
5
Q
Formal vision screening during well-child visit is recommended at what age?
A
4 yrs
6
Q
Rotavirus vaccine is recommended when.
A
2-8 months
7
Q
2 risk factors for newborn Respiratory Destress Syndrome.
A
Prematurity
Maternal Diabetes Mellitus
8
Q
What symptoms make you suspect possible Acute Lymphoblastic Lukemia
A
Bone Pain
Lymphadenopathy
Hepatosplenomegaly
Petechiae (from thrombocytopenia)
9
Q
Treatment of premature ventricular contractions
A
Increase metaprolol
10
Q
What is the criteria for placing an Automatic Implantable Cardioverter-Defibrulator
A
Ventricular arrhythmias (e.g. ventricular tachycardia) in patients with ejection fraction < 35%. Or if Pt had previous MI then EF<30%
11
Q
Under what length is a cervix considered short? And what is the management?
A
2cm
Management: IF previous preterm labor then cerclage. IF no previous preterm labor then vaginal progesterone.
12
Q
Diastolic collapse with elevated right ventricular pressure. Dx?
A
Cardiac tamponade
13
Q
Dilated left ventricle with apical hypokenesis. Dx?
A
Cardiogenic shock
14
Q
Inferior vena cava engorgement. Dx?
A
Cardiogenic shock
15
Q
Dilated right ventricle and hypokenesis. Dx?
A
Pulmonary embolism
16
Q
What is the antibiotic for aspiration ammonia?
A
Clindamycin
17
Q
Diagnosis for a patient that comes in with pulmonary symptoms, gastrointestinal symptoms, and hyponatremia. And what is the treatment?
A
Legionella
Fluoroquinolone
18
Q
If you rapidly correct hyponatremia what can happen? If instead you rapidly correct hypernatremia what can happen?
A
Hyponatremia correction = demyelination
Hypernatremia correction = cerebral edema
19
Q
What cancer produces parathyroid hormone related protein?
A
Squamous cell carcinoma
20
Q
What cancer produces SIADH?
A
Small cell lung cancer
21
Q
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?
A
Nocardia = Filamentous branching - Tx=TMP-SMX Actinomyces = No branching - Tx = Penicillin Mycobacteria = Strongly acid-fast, unlike the two above that her weakly acid-fast
22
Q
What are premature atrial complexes? What are precipitating factors of premature atrial complexes?
A
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.
23
Q
Seratonin Syndrome symptoms. List 4.
A
Mydriasis
Hyperreflexia
Tachycardia
Hypertension
24
Q
SSRIs should be discontinued __(time)__ before beginning an MAOI
A
2 wks
25
3 symptoms of disseminated gonococcal infection
Fever
Polyarthralgia
Pustular rash
26
Most common cause of death in End Stage Renal Disease
Cardiovascular disease
27
Phenelzine. What type of drug is this?
MAOI
28
What is phencyclidine?
PCP
29
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.
30
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.
31
Typical symptom of central retinal vein occlusion.
Sudden unilateral visual impairment
32
Typical symptoms of macular degeneration
Central vision impairment
33
Rocky Mountain spotted fever symptoms? organism? Tx?
```
Symptoms = Rash on palms and soles
Organism = Rickettsia rickettsii
Tx = Chloramphenicol
```
34
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.
35
If someone has hypercalcemia and hypertension what should you suspect?
```
Hypercalcemia = Hyperparathyroidism
Hypertension = Pheochromocytoms
Together = MEN2A
```
36
What labs do you look at to diagnose Histoplasma infection?
Pancytopenia (due to bone marrow infiltration)
| High AST, ALT
37
What kind of decelerations are seen with umbilical cord compression?
Variable decelerations
38
vWF deficiency. What is the platelet count?
Platelet count is NORMAL
39
Ptosis, which improves with application of ice pack. Dx>
Myasthenia Gravis
40
Lamber-Eaton is a associated with what condition?
Small Cell Lung Cancer
41
Special tests for Hereditary Spherocytosis
Eosin-5-maleimide binding
| Acidified Glycerol Lysis Test
42
What is the level of WBCs in CLL?
> 100,000
43
What do you see on peripheral smear of ALL?
Small lymphocytes without much cytoplasm, lots of chromatin.
44
Hairy cell leukemia. Does it have lymphadenopathy or splenomegaly?
Splenomegaly
45
ALL: Does it have lymphadenopathy or splenomegaly?
Lymphadenopathy
46
CLL: Does it have lymphadenopathy or splenomegaly?
Lymphadenopathy
47
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
48
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)
49
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.
50
Peau d'orange. Dx?
Inflammatory Breast Cancer
51
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.
52
How to differentiate between fibrocystic changes and fibroadenoma?
Fibrocystic changes = multiple masses
| Fibroadenoma = solitary mass
53
Watershed areas of the colon
Splenic flexure
| Rectosigmoid junction
54
Name 2 ototoxic medications
Loop diuretics
| Aminoglycosides
55
What are FSH and LH levels in Sheehan syndrome?
Sheehan = hypopituitarism
| Low FSH and LH
56
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
57
Dactylitis (sausage fingers) and nail changes. Dx?
Psoriatic arthritis
58
What is crystalline arthritis?
This refers to gout and pseudogout
59
Grotton's papules. What are they? What is the diagnosis?
Grotton's papules = violacious scaly plaques on the MCP joints.
Dx = Dermatomyositis
60
Charcot joint. What is it? What diseases is it associated with?
Charcot joint = neuropathic arthropathy
| Associated with diabetic peripheral neuropathy, syphillis and alcoholism.
61
Most specific lab test for rheumatoid arthritis
Cyclic citrulinated peptide antibody
62
What is the difference between X-RAY imaging of osteoarthritis vs. rheumatoid arthritis?
Osteoarthritis = Osteophytes & Joint space narrowing
| Rheumatoid arthritis = Periarticular erosions
63
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%)
64
Antimitochondrial antibody. Diagnosis?
Primary biliary cholangitis
65
Which biliary tract disease is assoiciated with ulcerative cholitis?
Primary sclerosing cholangitis
66
What are complications of Primary Biliary Cholangitis?
Malabsorption (leads to Osteoporosis and Osteomalacia)
| Hepatocellular Carcinoma
67
What are complication of Primary Sclerosing Cholangitis?
Cholangiocarcinoma
| Gallbladder Cancer
68
What kind of drugs cause neuroleptic malignant syndrome?
Dopamine antagonist medications (e.g. Haloperidol)
69
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
70
What does Moraxella catarrhalis cause?
```
Otitis media (in children)
COPD exacerbation
```
71
What are 2 ultrasound findings of congenital toxoplasmosis?
Diffuse intracranial calcifications
| Bilateral ventriculomegaly
72
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.
73
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.
74
Name of infection after cataract surgery
Postoperative endophthalmitis
75
How does positioning affect varicocele?
Increases on standing, decreases when supine
76
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.
77
Symptoms of presbycusis
Bilateral hearing loss associated with advanced age.
| Tinnitus
78
Symptoms of ostosclerosis
Conductive hearing loss
79
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)
80
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)
81
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.
82
When to give TMP-SMX prophylaxis to HIV patients. What does it prevent?
CD4<200
| prevents Pneumocystis pneumonia & Toxoplasmosis
83
When to give Azithromycin or Clarithromycin to HIV patients. What does it prevent?
CD4<50
| prevents Mycobacterium avium complex
84
HIV patient with EBV DNA in CSF & a solitary ring-enhancing lesion on MRI. Dx? CD4 count?
CNS lymphoma
| CD4<100
85
HIV patient with nonenhancing areas of demyelination on MRI. Dx? CD4 count?
Progressive multifocal leukoencephalopathy due to JC virus.
| CD4<200
86
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
87
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.
88
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)
89
What drugs can increase the risk of lithium toxicity?
```
Thiazides
ACEI
NSAIDs
Tetracyclines
Metronidazole
```
90
Symptoms of Lithium toxicity
GI symptoms: Neausea, vomiting, diarrhea
| Neuro symptoms: confusion, ataxia, tremor, seizures
91
Drugs that cause Acute Interstitial Nephritis
```
5 Ps
Pee (diuretics)
Pain-free (NSAIDs)
Penecillins and other Abx: Cephalosporins, TMP-SMX
PPIs
rifamPin
```
92
Symptoms of Acute Interstitial Nephritis
```
Hematuria
Pyuria
Costovertebral tenderness
Fever
+/- Arthralgias
```
93
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
```
94
Causes of renal papillary necrosis.
```
Mn* SAAD
Sickle cell
Acute pyelonephritis
Analgesics (NSAIDs)
Diabetes mellitus
```
95
What are the different casts of intrinsic renal disease subtypes.
Glomerulonephritis = RBC casts
Acute Interstitial Nephritis = WBC casts
Acute Tubular Necrosis = muddy brown casts
96
Drug used to decrease cravings in Alcohol Use Disorder.
Naltrexone
97
First-line pharmacologic therapies for smoking cessation
Bupropion
| Varenicline
98
What diuretic will decrease calcium in urine and thus decrease likelihood of nephrolithiasis?
Thiazide diuretics
99
At what point in pregnancy is the 1 hr glucose challenge test performed?
24-28 wks
100
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)
101
What cervical length results in increased risk of preterm labor.
< 2.5 cm
102
Management of placenta previa
C-section by 37 wks
103
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
104
Symptoms of theophylline toxicity
CNS (headache, insomnia, seizure)
GI (Nausea, vomiting)
Cardiac (Arrhythmias)
105
Patients with Turner syndrome that become pregnant (rare) have increased risk of what?
Aortic dissection
106
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).
107
Back pain, weight loss and smoking history. Next step in management?
CT Abdomen
| b/c suspecting pancreatic cancer
108
When to do sacroiliac joint imaging.
When you suspect Ankylosing Spondylitis
| It present in males < 40 with back pain that is worse at night
