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Smartbook Flashcards

1
Q

Dural based, extra-axial, well circumscribed mass in the brain that is partially calcified

A

Meningioma (resect it)

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2
Q

Stress–> syncope. Cause? Tx?

A

Vasovagal syncope

Try counterpressure techniques (leg cross with tensing, hand/arm grip with tensing)

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3
Q

Sudden onset of pain, redness and possible purulent discharge of medial epicanthus. Cause and Tx?

A

Dacrocystitis (infection of lacrimal sac)

Cause MC staph, strep–> Abx

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4
Q

What marker(s) are needed to dx HepB?

A

HBsAg and IgM anti-HBc. Don’t use viral DNA

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5
Q

SGA infants are at risk for what major problem and what is associated with it?

A

HYPOXIA–> polycythemia

also hypoglycemia, hypothermia, hypocalcemia

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6
Q

1st step of tx for severe hypovolemic hypernatremia?

A

Normal saline (avoid cerebral edema)

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7
Q

Anterior mediastinum masses? Where are bronchogenic cysts? What about gut, neural stuff?

A

Ant: T’s: Thymoma, Thyroid tumor, Teratoma, Terrible lymphoma. Bronchogenic/tracheal in middle mediastinum. Gut/neural is posterior

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8
Q

HIV pt with painful keratitis and retinal necrosis?

A

HSV, VZV

CMV–> painless, no keratitis, hemorrhages and “fluffy” lesions on fundoscopy

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9
Q

1st step in hepatic encephalopathy tx?

A

Correct electrolytes, replace fluid, underlying cause

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10
Q

Cephalohematoma vs. Caput Succedaneum

A

Cephalohematoma: subperiosteal hemorrhage, 1 bone only, swelling w/out bruising
Caput S: Diffuse, ecchymotic scalp swelling

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11
Q

Difference in stress fracture vs shin splint tenderness?

A

Point-tenderness vs. diffuse
(stress fracture= female athlete triad)
(shin splint= more likely overweight/underused)

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12
Q

Asymmetric chest expansion, down left sided breath sounds, normal BP, no JVD in an intubated pt.

A

Right mainstem bronchus intubation (hypotension would be present with others)

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13
Q

Garlic breath? Other Sxs? Tx?

A

Arsenic poisoning
Acute: vomiting, diarrhea, QTc prolongation
Chronic: Pigmentation change, hyperkeratosis, stocking-glove neuropathy
Tx: Dimercaprol, DMSA

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14
Q

Proteinuria cause with long standing DM?

A

Diabetes… Don’t skip over this or overthink

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15
Q

Hydroxyurea main SE(s)?

A

Myelosuppression (also feels like have the flu)

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16
Q

3 RF associated with aortic aneurysm rupture (and expansion)?

A

1) Cigarette smoking
2) Size > 5.5 cm
3) >1 cm growth per year

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17
Q

MCD association that is not kid?

A

Lymphoma

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18
Q

What antiarrhythmics can be used with WPW syndrome?

A

Rhythm control only! Procainamide, ibutilide

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19
Q

Best tx for diabetic neuropathic pain?

A

Gabapentin. TCA works, but lots of SE and not ok to use in old people

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20
Q

Scattered macules, papules, pustules on baby body that is asx

A

Erythema toxicum neonatorum

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21
Q

Most common and serious SE of TPN?

A 
Bloodstream infxn (acute)
Note: if keep using for >2 wks, cholestasis comes into play.
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22
Q

Skin lesions associated with some infxn (?) that develop into non-tender nodules with central necrosis?

A

Ecthyma gangrenosum, pseudomonas

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23
Q

Viral infxn–> loss of pulse with inspiration?

A

Cardiac tampanode from acute pericarditis

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24
Q

Pleural effusion with very high protein (>4g), >70% lymphocytes, dec. glucose? What else could help?

A

TB, ADA

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25
Q

Relation of NG tube feeds to aspiration? Best way to prevent aspiration?

A

Increases it as does any gastric feed. Raise head of bed to prevent.

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26
Q

Ascites, fever, AMS. Mechanism?

A

SBP. Bacterial translocation across intestinal wall.

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27
Q

Ca > 12.

A

Malignancy

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28
Q

What does secondary hyperPTH look like?

A

High phosphate, low calcium, with CKD. Causes increased PTH which can cause bone resorption and pain

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29
Q

Name 3 main causes of hepatic encephalopathy in an already cirrhotic pt. Expand on 3rd.

A

1) Infection
2) Electrolyte abnormalities
3) Increased nitrogen: GI BLEED, increased dietary protein

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30
Q

Metabolic acidosis + GI hemorrage (diarrhea and hematemesis)

A

Iron poisoning.

Also hepatotoxic and can cause bowel obstruction

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31
Q

Twisting injury of knee.

A

Meniscus

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32
Q

Tx of CLL?

A

Rituximab possible (anti-CD20)

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33
Q

On PE, how might you differentiate between hyponatremia caused by extrarenal fluid losses and SIADH?

A

Extrarenal: hypovolemic
SIADH: euvolemic

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34
Q

MC cause of sepsis in sickle cell? Osteomyelitis?

A

S. pneumo for sepsis.

Osteo: S. aureus> salmonella

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35
Q

How does valvular stenosis appear on doppler?

A

Increased flow velocity across valve

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36
Q

Describe fragile X syndrome behavioral characteristics?

A

Austim-like

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37
Q

Eosinophils–> think what?

Post catheterization?

A

Parasites, cholesterol emboli

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38
Q

When do we need to suspect listeria for meningitis?

A

Babys and old/immunocompromised

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39
Q

Wt. loss and iron deficiency anemia with chronic diarrhea?

A

Malabsorption likely

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40
Q

Fever + FND

A

Abscess (look for IVDA)

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41
Q

Three stages of HyperK EKG?

A

1) Peaked T waves
2) loss of P waves
3) Widened QRS (looks like sine-wave next to peaked T waves)

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42
Q

Neutropenia and fever, check for what?

A

Infxn.. Obvious, but could be deadly.

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43
Q

When is it ok to stop with V/Q scan in pregnant possible PE pts?

A

Only if it completely rules it out. ANything slightly, even a tad bit abnormal–> get CT

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44
Q

HIV drug with insomnia, weird dreams, depression, anxiety?

A

Efavirenz (NNRTI)

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45
Q

Leukocytoclastic vasculitis?

A

HSP

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46
Q

Widened mediastinum on CXR. What next? Stable vs. unstable.

A

Stable: CT scan or angio
Unstable: Thoracotomy now

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47
Q

What is MOA of ergot derivatives? Headache med to not give it with?

A

Serotonin somehow, don’t give with triptans due to serotonin syndrome!

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48
Q

Loss of red reflex on eye exam?

A

Cataracts

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49
Q

Sterile pyuria and dysuria?

A

Chlamydia

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50
Q

Prolonged QT leads to what arrhythmia?

A

Torsades (Mg)

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51
Q

1) Injury to fear with supracondylar humerus fracture?
2) Surgical neck of humerus?
3) Midshaft?

A

1) Brachial artery (median nerve)
2) Axillary nerve (post. circumflex artery)
3) Radial nerve (deep brachial artery)

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52
Q

Pre-eclampsia before 20 wks.

A

Molar pregnancy

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53
Q

Epitrochlear nodes, gray mucous patches

A

Syphilis

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54
Q

What do you do with a positive capillary lead level?

A

Confirm with venous level. Capillary is only good for screening.
Tx: severe (>70) Dimercaprol + EDTA
Moderate (45-69): DMSA

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55
Q

Stent placement, recurrent MI days later. What happened?

A

Non-adherence to antiplatelet agents

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56
Q

Systemic disease + rapidly progressive ulcer?

A

Pyoderma gangrenosum

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57
Q

Toxo vs. CMV congenital infection brain calcification patterns?

A

Toxo: Diffuse
CMV: periventricular

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58
Q

Transplant patient on immunosuppressants with multi organ system problems including PNA?

A

Suspect CMV

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59
Q

Histo or Blasto can cause disseminated infection in immunocompetent?

A

Blasto (e.g. cutaneous nodules/plaques)

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60
Q

SE or cyclosporine vs. tacrolimus

A

Tacro: nephrotoxic, hyperK, HTN, tremor
Cyclosporine: same + HIRSUTISM + GUM HYPERTROPHY

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61
Q

Skin involvement location in CREST.

A

Only distal extremities. Trunk involvement is now scleroderma (interstitial lung disease before PAH unlike CREST)

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62
Q

Precocious puberty with advanced bone age and increased LH? Workup and Tx?

A

Central/Gonadotropin Dependent–> get MRI–> Tx with GnRH agonist continuous to preserve growth

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63
Q

Part of cerebellum that medulloblastoma effects?

A

Vermis (central)

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64
Q

Treatment of acute CHF

A

LMNOP (lasix, morphine, nitrates, oxygen, position)

No B-blockers acutely

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65
Q

RA increases risk for what other bone problem? What is osteitis deformans?

A

Osteoporosis

OD= Pagets

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66
Q

Anti-HBc and Anti-HBs signifies what?

A

Resolved infection (HBsAg stays positive in chronic infection state)

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67
Q

IBD + ank. spond?

A 
Actually sacroileitis (just looks like ank spond)
Also: uveitis/episcleritis, pyoderma gangrenosum, other arthritis
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68
Q

What meds can cause SIADH? What common phenomena?

A

Meds: Carbamazepine, SSRIs, NSAIDs

Pain/Nausea can cause it too

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69
Q

Bradycardia, hypotension, wheezing, hypoglycemia, delirium, seizures, cardiogenic shock. Tx?

A

Beta blocker OD.
1st: Atropine and IVF
Glucagon if profound/refractory hypotension

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70
Q

Hypokalemia EKG. Major med cause?

A

U waves, flattened T waves, PVCs

Diuretics

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71
Q

Wiskott Aldrich Gene? What does it do?

A

WASP, cytoskeleton remodeling

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72
Q

1st step with confirmed hypercalcemia?

A

PTH level

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73
Q

What is sympathetic ophthalmoplegia?

A

One eye gets penetrating injury, “hidden” antigens are uncovered causing the second eye to be attacked by immune system

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74
Q

Dense deposit disease. What is it and what causes it?

A

MPGN type 2. C3 convertase with IgG against it casues persistent complement activation

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75
Q

What do you do for suspected acute spinal cord compression?

A

Emergency surgical consult and neuroimaging (spinal)

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76
Q

Rapidly enlarging thyroid mass with surrounding structure compression in a pt. with Hashimoto?

A 
Thyroid lymphoma (primary)
Could also resemble anaplastic thyroid carcinoma
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77
Q

Abdominal trauma with negative fast scan and positive rebound tenderness. What next?

A

Ex-lap. Rebound tenderness is ominous sign

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78
Q

What happens if you give folate to B-12 deficient patient?

A

Megaloblastosis and anemia correct. Neuro sx worsen

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79
Q

What is required for milk-alkali syndrome?

A

Alkalosis… Hypercalcemia, renal insufficiency

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80
Q

Small fiber vs. large fiber DM.

A 
Small= positive sx (pain, paresthesia, allodynia)
Large= negative sx (numbness, dec. reflexes, proprioception, vibration)
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81
Q

How do you diagnose PCP pneumonia?

A

Sputum, BAL stains. Do not culture.

Note: LDH elevated with PCP pna

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82
Q

Unilateral varicocele that doesn’t disappear when lay back? What else might you see?

A

Mass lesion.

Renal cell carcinoma- blood in urine, polycythemia

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83
Q

1st line treatment for enuresis?

A

Desmopressin

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84
Q

Stridor that is better when prone, worse when supine.

A

Laryngomalacia

Also exacerbated by URI, Feeding

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85
Q

Pt. has HepC with liver damage. What do you need to do? What is tx?

A

Prevent further damage: Vaccinate vs HepB, HepA, no alcohol

Tx: sofosbuvir, velpatasvir

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86
Q

Tx for pancreatic pseudocyst?

A

Sx: drainage endoscopically
Asx: nothing

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87
Q

Female child with vulvar/perianal pruritis and rash at elbow and back of knee?

A 
Still pinworm (even though she also has eczema)
Itches at night/bedtime
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88
Q

Felty syndrome

A

Inflammatory arthritis, splenomegaly, neutropenia

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89
Q

Dec. B/T cells, normal WBC, recurrent infxns in infant

A

SCID. Don’t be fooled by normal WBC

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90
Q

Pain worsened with passive flexion of wrist or resisted extension

A

Lateral epicondylitis (extensors of wrist)

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91
Q

What must you exclude to diagnose ITP?

A

HIV, HepC

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92
Q

DBS vs. Fanconi Anemia

A

DBS: babies, anemia with low retic., congenital anomalies
Fanconi: 8 year olds, pancytopenia, cafe-au-lait, Missing thumbs, short stature, small head

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93
Q

Male hypogonadism with low LH/FSH.

A

Secondary: check for causes including prolactin level

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94
Q

Does NPH have asymmetric neuro lesions?

A

nope

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95
Q

Pronator drift is what type of sign?

A

UMN lesion (UMN innervates supinators more than pronators)

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96
Q

After cardiac surgery, fever, CP, leukocytosis, mediastinal widening on CXR. What do you do?

A

Acute mediastinitis: drain, surgically debride, prolonged abx

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97
Q

Do lacunar infarcts present with 2 months of HA/nausea?

A

No, consider mass lesion

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98
Q

Dyspnea, glomerulonephritis, increased Cr, painful fingertips, fever, fatigue.

A

Myocarditis- May have increased ESR, RF

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99
Q

Can you still get GBS meningitis after prophylaxis?

A

Yes. Ppx does not decrease horizontally spread, late-onset GBS

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100
Q

Immunosuppressed adult with herpes like rash

A

Zoster… Acyclovir

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101
Q

Hyperinflation of effected lung is associated with what?

A

Foreign body inhalation

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102
Q

Equilibrated diastolic intracardiac pressures

A

Tampanode

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103
Q

Air in the gallbladder wall suggests what? Next step?

A

Emphysematous cholecystitis

Emergency surgery and abx w/ CLOSTRIDIUM coverage (e.g. amp-sulbactam)

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104
Q

Facial swelling and difficulty breathing in a HTN pt.

A

Look for ACE-i, angioedema can happen ANYTIME

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105
Q

Limited shoulder movements after fall on outstretched arm.

A

Consider rotator cuff- Get MRI

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106
Q

Next step if you suspect duodenal atresia?

A

Upper GI series

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107
Q

If pulm HTN is occurring secondary to LV dysfunction, what do you do?

A

Treat LV dysfunction (CHF)

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108
Q

Risk factor for C. diff besides recent abx/hospitalization?

A

PPI use (any gastric acid suppression)

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109
Q

What needs to be prophylaxed for in pts. getting immunosuppressants following solid organ transplant?

A

PCP- TMP-SMX

Possibly CMV with gancylovir

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110
Q

TB with non-gap metabolic acidosis. What happened?

A

Primary adrenal insufficiency (most common worldwide cause). Decreased H+ excretion due to decreased aldosterone

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111
Q

Which type of aortic dissection is emergency surgery required?

A

Type A- ascending aorta involvement

  • If stable, get a CT first
  • Unstable get TEE
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112
Q

What is wrong with the head of a baby with Edwards syndrome?

A

Micrognathia

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113
Q

MOA of hepatorenal syndrome?

A

Splanchnic arterial dilation, dec. vasc. resistance, renal vasoconstriction (ultimately decreased perfusion)

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114
Q

What do you see on thyroid labs with euthymic sick syndrome most commonly?

A

Normal T4, TSH

Decreased T3

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115
Q

Medications that can cause pancreatitis?

A

Diuretics, IBD drugs, HIV drugs, metronidazole, SEIZURE DRUGS (VPA esp.)

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116
Q

Location of stroke with HTN, contralateral hemiparesis and hemisensory loss, gaze palsy? What does pontine stroke look like?

A

Putamen/BG or Thalamus

Pons-Pinpoint pupils + COMA

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117
Q

Do you need a bx to diagnose Sjogrens? If you get a bx, where do you get it from?

A

Not if clx + Ab. Get bx from minor glands of lip if needed (not major salivary glands)

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118
Q

Osteomyelitis organism if stepped on a nail?

A

Pseudomonas if went through shoe

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119
Q

What has to be covered/what is empiric treatment for febrile neutropenia?

A

Pseudomonas + broad

Cefipime, meropenem, zosyn

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120
Q

Important next step with clavicle fractures?

A

Neurovascular check

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121
Q

Probable lupus: check ANA or ds-DNA first?

A

ANA (sensitive). Don’t want to risk the false negatives with ds-DNA

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122
Q

Fanconi anemia genetics? Phenotype?

A

DNA repair genes (AR or XLR)

Abn. thumbs, pancytopenia, hypogonadism, hyper/hypopigmentation, eye/ear abnormalities

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123
Q

What is the mentzer index?

A

MCV/RBC(millions)
>13 IDA
<13 thalassemia

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124
Q

What is the normal concentration of HbF in SS pts who are not treated?

A

5-15% (hydroxyurea >15%)

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125
Q

What happens to the murmur of AS with increasing severity?

A

1) Later in systole
2) Soft and single S2
Note: sxs indicate severe

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126
Q

Back pain that seems innocent but is associate with wt. loss. Next step?

A

x-ray (r/o malignant involvement)

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127
Q

1st step for preconception thalassemia r/o?

A

CBC (sensitive before specific)

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128
Q

Best thing lifestyle-wise to lower BP?

A

Wt. loss> DASH> exercise

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129
Q

What do you look for anytime you see nitroprusside treatment? Next step?

A

Cyanide toxicity (HA, confusion, arrhythmia, flushing, resp. depression). Thiosulfate to cure

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130
Q

Pain at shoulder prominence, hip, elbow, greater trochanter of femur. What do you suspect?

A

Enthesitis (inflammation at tendon insertion sites) as a manifestation of ankylosing spondylitis

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131
Q

Heat stroke vs. Heat exhaustion?

A

Stroke: + AMS, T>105 (thermoregulation fail)
Exhaustion: no AMS, T<104 (fail for adequate fluid/salt)

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132
Q

No liver failure but asterixis? Tx?

A

Consider uremic encephalopathy

Dialysis (lactulose won’t work)

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133
Q

Painful red nodules on leg? 22 y/o AA female? Next step?

A

Erythema nodosum, 28% associated with sarcoid, get a CXR

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134
Q

How do you treat prolonged QT syndromes? What are the two types, inheritance, and distinguishing factor?

A

1) Tx with B-blockers and pacing
2) Jervell-Lange-Nielsen (AR and hearing loss)
3) Romano-Ward (AD)

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135
Q

First step to dx suspected Cushings? (3 options)

A

1) low dose dexamethasone
2) 24 hr urine cortisol
3) late night salivary cortisol

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136
Q

What can worsen eye disease of Graves that is used for Tx? Prevention?

A

Radioactive iodine–> inc. TRAB antibodies. Prophylax with steroids

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137
Q

Generally, what do S3 and S4 represent?

A

S4: diastolic failure
S3: systolic (CHF from stiff ventricle)

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138
Q

What is the aldosterone level in adrenal insufficiency secondary to chronic steroid use?

A

Normal. RAAS still works normally with steroids and is not suppressed.

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139
Q

Drugs to use in HOCM?

A

B-blocker or CCB (anything to prolong diastole)

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140
Q

How do you treat pediatric constipation?

A

Fiber/laxatives (don’t suggest juice–> fixes constipation but can cause a host of other problems)

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141
Q

HTN and bilateral upper abdominal masses in an adult?

A

Consider ADPKD

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142
Q

Tx for 1st degree AV block?

A

Observe unless sx or prolonged QRS (then get EP studies)

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143
Q

1st time seizure. Tox screen or EEG 1st?

A

Tox. screen. Rule out causes that are not primary seizures

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144
Q

What is a risk factor for NEC besides prematurity? AKA when might you see it in term infants?

A

Congenital heart disease +/- hypotension

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145
Q

Seborrheic dermatitis and normochromic, normocytic anemia are associated with what vitamin deficiency? What else will be there?

A

Riboflavin + angular chelitis, stomatitis, glossitis

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146
Q

Dx if you have mild prolactin elevation (e.g. 85) and decreased HPA axis otherwise?

A

Non-functioning adenoma

Note: in medication induced prolactinemia, the HPA axis is otherwise unaffected

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147
Q

Most common vaccine travelers need?

A

HepA. Yellow fever if south america/sub-saharan Africa

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148
Q

Guidelines for AAA screening?

A

1 time abd. US for males 65-75 who have EVER SMOKED

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149
Q

What is the E in JONES criteria? What does it look like?

A

Erythema marginatum- evanescent pink rash with sharp edges

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150
Q

Name 5 finding sin Behcet syndrome.

A

1) Oral Ulcers
2) Genital Ulcers
3) Erythema Nodosum (interesting)
4) Thrombosis
5) Eye lesions

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151
Q

Tx for adjustment disorder? When is it MDD?

A

Psychotherapy, if 5/9 SIGECAPS are met

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152
Q

Rules for pneumococcus vaccines?

A

> 65: sequential PCV-13, PPSV-23
<65 with chronic condition: PPSV-23, sequential at 65
<65 with immunosup, SS, cochlear implants, asplenia: Sequential before 65
Note PCV-13 is conjugated, PPSV-23 is polysaccharide

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153
Q

What will you see on x-ray of acute tampanade? Name the triad…

A

Normal. Only big heart in chronic.

Triad: hypotension, JVD, dec. heart sounds

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154
Q

Hepatitis mentioned + skin blisters on back of hand, skin fragility and scarring

A

PCT (check porphyrins)

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155
Q

How do you treat infective endocarditis if cultures state that it is penicillin sensitive?

A

Still IV tx for 3-4 weeks. Ceftriaxone popular as it is only 1x/day

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156
Q

1st step in treating probable disc herniation?

A

Still NSAID trial- most resolve spontaneously

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157
Q

Suprapubic pain, gross hematuria, pelvic fracture, no peritonitis

A

Extraperitoneal bladder injury (trauma)

158
Q

Name the inheritance and 5 thinks you see in NF-1.

A

AD

Cafe-au-lait, axillary freckling, lisch nodules (eye), neurofibromas, optic gliomas.

159
Q

Renal tumor with TS?

A

Angiomyolipoma

160
Q

Acute thyrotoxicosis, non-tender/slightly enlarged thyroid with decreased radioiodine uptake

A

Painless thyroiditis

161
Q

Top thing with pediatric stroke? What if lactic acidosis and increased CK present?

A

Sickle cell, MELAS (mitochondrial)

162
Q

Flushing, diarrhea, wt. loss, cramps and pancreatic mass.

A

VIPoma (carcinoid not in pancreas and also causes wheezing)

163
Q

What is winter’s formula?

A

1.5xHCO3+8+/-2

164
Q

What type of stroke is a lacunar stroke?

A

Ischemic (small vessel)

165
Q

How do you treat SIADH normally? What sx make it severe and how do you treat it then?

A

Normal: fluid restrict
Severe: Any CNS sx, hypertonic saline (if the replacement fluid is not of greater osmolarity than the urine, you are making the hyponatremia worse)

166
Q

Wallenberg is what location and what sx?

A

Lateral medullary: Hoarseness, dysphagia, loss of gag reflex, vestibulocerebellar impairment, Horner’s, ips face and contra body sx.

167
Q

What tips you off to medial medullary stroke? Lateral pontine?

A

MM: tongue deviation
LP: muscles of mastication and trigeminal nerve

168
Q

Do you have to respect a patient who declines treatment and is serious threat to public health?

A

Nope, hold involuntarily

169
Q

CXR–> linear atelectasis

A

Bronchiectasis (recurring infxns with high sputum volume)

170
Q

Cocaine and alcohol night before, took aspirin for hangover and now vomits with blood in it.

A

Acute erosive gastropathy (blood in first instance of vomit since the vomiting is not what caused it unlike Mallory-Weiss)

171
Q

supraclavicular fat pad

A

Most specific for Cushing’s syndrome

172
Q

Triad of hemolytic anemia, pancytopenia, thrombosis

A

PNH

173
Q

What does the D-xylose test tell you? What might you need to rule out?

A

Decreased absorption in proximal small bowel (requires no breakdown). Good test for celiac, but may need a trial of rifaxamin to rule out Small intestine bacterial overgrowth

174
Q

Varicella exposure in a healthy pt. with only 1/2 vaccinations, what do you do? When is the second one normally? What do you do for immunocompromised with exposure?

A

1) Give second vaccine (usually at 4 y/o)
2) Varicella Ig
Note: Kids <1 need nothing

175
Q

Increased gastric residual volume, vomiting, abd distension, acidosis in 3 wk old preterm infant? What is on XR?

A

NEC

XR: Pneumatosis intestinalis and PORTAL VENOUS AIR

176
Q

Biggest lifestyle RF for pancreatic cancer?

A

Smoking

177
Q

When do you brace low back pain? What are the first two steps?

A

Never… NSAIDS then Exercise therapy

No pain meds, muscle relaxants

178
Q

Home distilled whiskey + microcytic anemia + neuro sx. What else does this cause?

A

Lead poisoning, gout (inc. uric acid)

179
Q

Bilateral hearing loss with tinnitus? What if vertigo present?

A

Without vertigo: Presbycusis

With vertigo: Meniere’s

180
Q

Recommendations for recurrent renal stone patients?

A

Increased fluid, DECREASED Na intake, no change in Ca intake. Increased Na leads to increased Ca excretion. (Hyperoxaluria only comes into play with malabsorption)

181
Q

Wt. loss, epigastric pain (gnawing) that is worse at night after head trauma a month ago.

A

Pancreatic cancer (don’t be penalized by knowledge… Cushing ulcer is acute with GI bleed and neuro impairment)

182
Q

PMR tx?

A

Low dose prednisone

183
Q

LAD, peaked T waves on neonatal EKG with decreased pulmonary markings (murmur is present)

A

Tricuspid atresia. Must have ASD and VSD.

Note: Normal newborn have RAD due to RV pumping blood to body in via PDA in utero

184
Q

Aplastic anemia vs aplastic crisis

A

Aplastic anemia: pancytopenia (congenital, acquired, but not SS)
Aplastic Crisis: SS pts. with sudden anemia and dec. retic.

185
Q

Acute abdominal pain, fever, hematuria in nephrotic syndrome patient?

A

Renal vein thrombosis (most commonly in MN)

186
Q

Preferred imaging for vertebral osteomyelitis?

A

MRI

187
Q

Different presentation of lipoma vs. epidermal inclusion cyst?

A

Lipoma: rubbery, irregular, persists
EIC: firm, mobile, may regress/recur, CENTRAL PUNCTUM often

188
Q

Hepatic cyst with daughter cysts?

A

Echinococcus (internal septation actually)

189
Q

Drop arm test? Muscles to abduct?

A

Supraspinatus.
1st 15 degrees is supraspinatus
Need serratus anterior to get >90 degrees

190
Q

Postmenopausal pt. with suspicious ovarian mass: laparoscopy or CA-125?

A

CA-125 in unison with U/S before lap.

191
Q

Where might fibromuscular dysplasia manifest other than kidney, what does it look like, and how do we diagnose it in general?

A

Brain: ischemia sx or non-specific (HA, tinnitus)
Dx: U/S or CTA

192
Q

Pearly papule with rolled borders and central ulceration on skin?

A

BCC, BCC, BCC, BCC. Do not miss this

193
Q

Claw hand vs. Waiters Tip. Name, roots involved?

A

Claw hand: Klumpke (plus horners, C8-T1)

Waiter’s Tip: Erb Ducheene (upper, C5,C6)

194
Q

What supplements are required in breastfed babies? What about preterm?

A

Breastfed only (all): supplement Vitamin D
Preterm: supplement iron for 1 yr if breastfed only
If term: supplement iron beginning at 4 mo. if breastfed

195
Q

What labs should you perform if diagnosing HTN?

A

U/A, BMP, Lipids, EKG (aka dont jump to wild stuff)

196
Q

What is the effect of CHF on kidneys?

A

CHF–> RAAS activation–> constricted efferent renal arterioles

197
Q

What do we use to decrease alcoholic cravings if actively drinking? What if in maintenance?

A

Active: naltrexone
Maintained: Acamprosate (glutamate)

198
Q

What facts do you know about follicular and papillary thyroid cancer?

A

Follicular: hematogenous spread
Papillary: most common, psammoma bodies, histology

199
Q

What if somebody cannot take warfarin/stay on schedule after DVT?

A

Go to direct Xa inhibitors

200
Q

COPD heart sounds? CXR in regard to pulmonary arteries?

A

Distant due to hyperinflated lungs. Enlarged central pulmonary arteries.

201
Q

Nephritic syndrome most associated with HepB?

A

Membranous Nephropathy (also most common in white people)

202
Q

Solitary pulmonary nodule with high malignancy risk?

A

Surgical excision (if no LN palpable)

203
Q

Why do infections with encapsulated bacteria increase in asplenic patients?

A

Deficits in antibody responds and antibody mediated phagocytosis/complement activation (opsonization decreased, not actual complement function)

204
Q

Anemia with B6 deficiency?

A

Sideroblastic

205
Q

What do you do if someone develops tardive dyskinesia?

A

Switch to clozapine

206
Q

HSV infection after atopic dermatitis?

A

Eczema herpeticum

207
Q

Pelvic bladder pain, dyspariunia, urinary frequency, urgency with normal UA (female)

A

Interstitial cystitis

208
Q

Sx for milk-alkali syndrome?

A

N/V, constipation, polyuria, polydipsia, neuropsych. sx (essentially hypercalcemia…)

209
Q

What is the next step if someone gets a needle stick with high HIV exposure risk?

A

PEP immediately. 3 rugs for 4 weeks (tenofovir, emtracitabine, raltegravir)

210
Q

Mumps can cause parotitis, orchitis, and what?

A

Meningitis (aseptic)

211
Q

How do you treat hypernatremia if euvolemic? Hypovolemic?

A

Euvolemic (free water supplementation
Hypovolemic + sx: NS until euvolemic, then D5W
Hypovolemic + asx: D5W

212
Q

Difference in CXR with Histo and Coccidio?

A

Histoplasmosis is bilateral, coccidio is unilateral

213
Q

How does pancreatitis cause hypotension?

A

Local/systemic vascular endothelial injury, vasodilation and vascular permeability

214
Q

Dry eyes, dry mouth, dry vagina in premenopausal women.

A

Sjogrens (decreased lubrication).

No estrogen deficiency if premenopausal

215
Q

Severe pain after fracture of supracondylar humerus and pulses intact?

A

Watch for compartment syndrome

216
Q

Tx for tourette?

A

alpha-2 agonists (clonidine, gaunfacine)

Antipsychotics (risperidone)

217
Q

STDEV first three?

A

68, 95, 99.7

218
Q

Where is there not chloroquine resistance? What do we use? What malaria does hypnozoites and what do we use?

A

Not in mexico, argentina. Use doxy, mefloquine, atovaquone-proguanil elsewhere.
Vivax (primaquine)

219
Q

Is fever normal with vertebral osteomyelitis?

A

No. Usually indolent

220
Q

Tx for agitation with acute mania?

A

Antipsychotics

221
Q

Acute pulmonary edema tx?

A

Lasix first (no beta blocker in acute CHF)

222
Q

When can oseltamivir be used?

A

1st 48 hours of sx only

223
Q

First step in cause of metabolic acidosis question?

A

Winters formula

224
Q

How do we get rid of uric acid stones?

A

Alkalinize urine with K-Citrate

225
Q

Catatonia Tx?

A

Benzo or ECT

226
Q

Lateral neck XR finding for retropharyngeal abscess?

A

Paravertebral widening

227
Q

Flank pain, low volume voids, alternated with high?

A

Obstructive uropathy

228
Q

Stable patient with REGUALR narrow complex tachycardia?

A

Adenosine (or vagal)

229
Q

Attrition bias is a form of what?

A

Selection bias

230
Q

Suspect developmental dysplasia of hip. Next Step?

A

U/S of hips

231
Q

Alternative cause for stress incontinence besides urethral hypermobility?

A

Mass lesion, e.g. fibroids pressing on bladder

232
Q

What is the most common SE of girls with CF?

A

Recurrent/chronic rhinosinusitis (only 20% infertile)

233
Q

Which has sharp borders: cellulitis or erysipelas?

A

Erysipelas (cellulitis is deeper, cannot see it all)

Note: carbuncle is multiple furuncles

234
Q

How do you differentiate CF from primary ciliary dyskinesia without CXR or studies?

A

Pancreatic insufficiency (exocrine) leads to vitamin deficiency in CF

235
Q

Inability to close eye suggests what about facial nerve lesion?

A

Below pons

236
Q

How does hepatic hydrothorax happen?

A

Theoretically there are small defects in diaphragm that let fluid through

237
Q

Most common type of kidney stone?

A

Calcium oxalate

238
Q

Timeline and treatment for 3 types of neonatal conjunctivitis?

A

<24 hr: chemical–> lubricant only
2-5 days: Gonorrhea (severe)–> IM ceftriaxone
5-14 days: Chlamydia (mild)–> Oral macrolide

239
Q

How do you treat cyanide toxicity (3 options)?

A

Hydroxycobalamin, Thiosulfate, Nitrates (methemoglobinemia)

240
Q

What type of eye infection is most common cause of worldwide blindness?

A

Trachoma: follicular conjunctivitis/inflammation that, if repeated, leads to inversion of eyelashes, corneal scarring, and blindness.
Cause: chlamydia trachomatis A, B, C

241
Q

What can be said about choledocholithiasis if alk. phos. is normal?

A

Ruled out

242
Q

Irregular scrotal mass separate from testicle, no transillumination, larger with standing/valsalva.

A

Varicocele (no transillumination)

243
Q

How does vitamin D deficiency cause bone loss?

A

Impaired matrix mineralization

244
Q

What is a factorial study design?

A

Multiple variables. Participants get multiple interventions

245
Q

Reactive arthritis triad? What other two things? Tx?

A

Urethritis, arthritis, conjunctivitis
Enthesitis (relation to ank spond), oral ulcers
NSAIDs

246
Q

When are fibrates indicated for hyper TG? What do you do otherwise?

A

Resistant or >1000 (pancreatitis risk). Otherwise use statin and lifestyle modification first (e.g. stop alcohol)

247
Q

If you see hypertension and hypoK what do you suspect if only low dose HCTZ?

A

Inc. aldosterone, check renin/aldosterone concentrations

248
Q

Midface hypoplasia, microcephaly, cleft lip/palate, digital hypoplasia, hirsutism, dev. delay birth defects?

A

Fetal hydantoin syndrome (phenytoin or other AEDs)

249
Q

Relation of hashimoto to pregnancy?

A

High titers of anti-TPO antibodies can cause miscarraige regardless of thyroid status

250
Q

Cause of PNA in CF pt? What age is the crossover?

A

<20: staph aureus

>20: pseudomonas

251
Q

If you see proteinuria and hematuria, what is the cause?

A

Glomerular path with any proteinuria

252
Q

2 most common bugs in brain abscesses?

A

Staph a. and Strep viridans

253
Q

1st step with suspected diaphragmatic hernia in newborn?

A

Intubate (bag mask can cause respiratory decline quickly)

254
Q

Mastoiditis + nocturnal headaches, morning nausea. What is next step?

A

Possible brain abscess, get CT

255
Q

What type of vaccine is yellow fever?

A

Live-attenuated

256
Q

If a traveler goes to high risk area for meningococcus and has only had one shot, what do you do?

A

Give booster (usually recommended at 16-21)

257
Q

If NSAIDs are not relieving cancer pain, what is next?

A

Short-acting opiods

258
Q

What does ARDS do to lung compliance?

A

Decreases

259
Q

What is the run-down on tetanus ppx after wound?

A

If at least 3 doses lifetime, toxoid vaccine if last dose >5 yrs ago for dirty wound or >10 yrs for minor
If not 3 doses lifetime: minor wound gets vaccine, severe gets vaccine+ IG

260
Q

W/u for caustic ingestion?

A

EGD

261
Q

What DM drug causes wt. loss? Which are wt. neutral? Wt. gain?

A

Loss: GLP-1 agonists (exenatide)
Neutral: DPP4 (gliptans), metformin
Gain: TZDs, sulfonylureas

262
Q

If you think someone is having an MI, what do they get NOW?

A

ASA

263
Q

Non-exudative pharyngitis plus lower abdominal pain.

A

Consider gonococcal pharyngitis and PID (note: this causes non-tender LAD unlike EBV)

264
Q

If DVT with no PE, what is first: anticoagulation or compression U/S?

A

U/S (unlike in PE)

265
Q

Tx for peritonsillar abscess?

A

Needle aspiration and IV abx

266
Q

Upper GI pain, nausea, without regurgitation or dysphagia or change in bowel habits?

A

Most likely PUD (check for H. Pylori)

267
Q

Fever, increased WBC, LUQ pain suggests what? What is associated?

A

Splenic abscess. Infective Endocarditis. Abscess can also cause pleuritic pain and effusion

268
Q

Dullness to percussion plus increased breath sounds?

A

PNA

269
Q

Malabsorption post bypass surgery with increased fecal fat and vitamin deficiencies?

A

small intestine bacterial overgrowth (Dumping syndrome= osmotic diarrhea post high carb meals)

270
Q

When does C. diff get IV vancomycin?

A

Never ever (only oral)

271
Q

Chronic, congenital growth that is hard on the hard palate?

A

Torus palatinus

272
Q

What rhythm is associated with digoxin toxicity?

A

Atrial tachycardia with AV block

273
Q

How do you treat acne?

A

Comedonal: topical retinoids
Next: benzoyl peroxide if inflammatory
Next: Topical abx–> oral abx
If nodular (>5mm, cystic) and unresponsive to above tx, then add oral isotretinoin

274
Q

Inheritance of alports?

A

XLD

275
Q

Crohn pt. does not improve on 5-ASA in three weeks. What now?

A

Add abx (metro +/-cipro)

276
Q

What is the first step for suspected meningitis? What next?

A

1st: blood culture
2nd: steroids + abx
3rd: CT if papilledema (note: peds pt with fontanelles don’t need this)
4th: LP

277
Q

What type of deficiencies are associated with parenteral nutrition?

A

Trace mineral deficiencies (zinc, selenium, copper, chromium)

278
Q

Name the deficiency:

1) alopecia, pustular skin rash, impaired taste, dec. wound healing
2) thyroid dysfxn, cardiomyopathy
3) brittle hair, depigmentation, neuro sx, sideroblastic anemia
4) impaired glucose control in DM

A

1) Zinc
2) Selenium
3) Copper
4) chromium

279
Q

What should you check for in a patient with worsening somatic symptom disorder?

A

Other life stresses

280
Q

Inflammatory, oligoarticular, asymmetric arthritis without positive gram stain?

A

Lyme. Note: JIA is symmetric

281
Q

What is the most common cause of newborn hypothyroidism?

A

Thyroid dysgenesis is much more common than synthesis defects of TH (AR for synthesis)

282
Q

What are the number one and two best lifestyle changes for hypertension?

A

1) Wt. loss

2) DASH diet (>exercise)

283
Q

Down syndrome kid with loud S2, systolic ejection murmur at RUSB, holosystolic murmur at LLSB + bibasilar crackles?

A

Complete AV canal defect (TOF has outflow murmur only)

284
Q

Which bleeds and swells more? ACL or meniscus?

A

ACL

285
Q

What CBC findings go with scleroderma renal crisis? Tx?

A

MAHA and thrombocytopenia (similar to TTP). Treat with ACE-i even if Cr is increased

286
Q

If aphasia is present, where is the stroke?

A

Big vessels (likely MCA)

287
Q

Ear pain/drainage, granulation tissue on exam, facial nerve palsy + fever?

A

Malignant otitis externa (pseudomonas)

288
Q

What do RBC casts indicate?

A

Glomerular damage

289
Q

How do TCAs cause cardiac problems? What do we give to fix it and why does it work?

A

They bind fast sodium channels. Sodium bicarb does two things: the bicarb. increases pH and decreases the TCA, Na competes and forms large Na gradient to overcome TCA binding

290
Q

Thick cord-like vessels that get red keep popping up all over body. What now?

A

Migratory thrombophlebitis, get CT to rule out abdominal tumor

291
Q

IBD patient presents with systemic symptoms, bloody diarrhea, distension and peritonitis. What do we do?

A

Get x-ray to check for toxic megacolon

292
Q

What increases stool osmotic gap? How is it calculated?

A

Any osmotically active substance that is no Na or K. (290- (Na+K)). Essentially measured osmoles minus the calculated osmoles based on Na and K

293
Q

Boy with precocious puberty that is gonadotropin-independent and normal testicles?

A

CAH (21-hydroxylase def.)

294
Q

What is the goal of scoliosis treatment?

A

Cobb angle < 40 degrees at skeletal maturity (if this goal is reached, leave it alone)

295
Q

Tx for rheumatic fever with heart disease?

A

Continuous penicillin for 10 years or until 40 years old (whichever is longer). Pretty much zero cases of rheumatic heart disease get to stop tx anytime soon.

296
Q

Cause of AV block on EKG in endocarditis patients?

A

Perivalvular abscess likely on the AORTIC VALVE

297
Q

What type of drug is amikacin?

A

Aminoglycoside (nephro and oto toxic)

298
Q

First step with signs and symptoms of adrenal insufficiency?

A

Cosyntropin (ACTH) stim test

299
Q

When do you transfuse acutely bleeding GI patients?

A

Hb<7 if stable, if unstable Hb<9

300
Q

Most common cause of aortic regurgitation in developed countries vs. non-developed?

A

Developed: Congenital bicuspid aortic valve
Non: Rheumatic heart disease

301
Q

What do you do with non-concerning palpable LN in kids or young adults

A

Observe

302
Q

Do infants typically need CT before LP?

A

No, fontanelles are protective vs. increased ICP

303
Q

Bilateral lower extremity pains in a child 2-12 years old with no other symptoms?

A

Growing pains, no treatment besides reassurance

304
Q

Mechanism of dobutamine, adenosine, and dipyridamole stress tests?

A

Dobutamine: increases HR and contractility

Adeno/Dipyr: vasodilators (stenosed arteries cannot)

305
Q

How many lesions go with Kaposi sarcoma?

A

Can be multiple (violaceous lesions are a good hint)

306
Q

Tx of cutaneous larva migrans?

A

Ivermectin (ancylostoma caninum or A. braziliense)

307
Q

Asx thin-walled, septated 12 cm cyst in ovary of 46 y/o?

A

Likely cystadenoma (benign)

308
Q

Size of normal SI, LI, cecum?

A

3, 6, 9 rule: 3 cm SI, 6 cm LI, 9 cm cecum

309
Q

Neonatal meningitis tx?

A

Amp + Gent + Acyclovir (if any risk for HSV)

310
Q

Size of liver cyst that requires action if asx?

A

> 4 cm (smaller ones leave alone, no rescreen even needed)

311
Q

How do you differentiate cauda equina and conus medullaris syndromes?

A

Cauda equina: LMN–> hyporeflexia

Conus Medullaris: UMN–> hyperreflexia

312
Q

What congenital heard defects cause single S2? Egg- on a string CXR?

A

S2: ToGV (egg on a string), tricuspid atresia, truncus
Note: ToGV is MC congenital cyanotic heart defect

313
Q

What might be the cause of a new onset RBBB?

A

PE

314
Q

What causes cradle cap? Distribution?

A

Seborrheic dermatitis- rash where there are hair follicles

315
Q

Does cirrhosis cause LE edema?

A

Duh. Albumin down

316
Q

Describe peak airway pressure and plateau pressure mathematically? What is implied if plateau pressure changes? What if peak airway pressure changes with no change in plateau pressure?

A

PAP: resistive pressure + plateau pressure
Plateau= elastic pressure + PEEP
Plateau pressure changes with a change in compliance of some sort (e.g. ARDS). If it doesn’t change and PAP does, then it is a change in resistance (since plateau pressure calculated during inspiratory hold- no resistance plays a role)

317
Q

Cause of situational syncope? Another name for vasovagal?

A

Cause: autonomic response

Vasovagal= neurocardiogenic

318
Q

What is the arrangement of CN III?

A

Parasympathetic fibers are peripheral (easier access to blood supply) than middle motor fibers

319
Q

Tx for the 4 types of EPS?

A

Dystonia: benztropine or diphenhydramine
Akathisia: Beta blocker or benzo
Parkinson: Benztropine or amantadine
TD: switch to clozapine

320
Q

MC cause of urinary tract obstruction in young boys? Problem that is discovered with first binger?

A

Posterior urethral valve (includes a membrane)

Ureteropelvic junction obstruction

321
Q

Most likely cause among lower GI bleeds to cause hemodynamic instability?

A

Diverticulosis

322
Q

Inheritance of myotonic dystrophy?

A

AD (trinucleotide repeat)

323
Q

Temperature with opiod OD? What do you do?

A

Can be hypothermic, give naloxone and see if it gets better

324
Q

Measurement of massive hemoptysis? What do you do?

A

> 600 ml in 24 hrs or >100 ml/hr
ABCs–> bronchoscopic intervention
Only need surgery if bronchoscopic measures fail

325
Q

Classic cause of hidden anaphylaxis with trauma?

A

Latex allergy (catheter)

326
Q

Persistent pneumothorax despite chest tube after blunt trauma? Also have pneumomediastinum and subcutaneous emphysema.

A

Tracheobronchial rupture (right mainstem bronchus)

327
Q

What is the toxic APAP dose? When is charcoal allowed?

A

> 7.5 g, only in first four hours

328
Q

Pneumonia in COPD patient cause?

A

H. influenzae

329
Q

What do you do if IDA doesn’t respond to iron?

A

Check GI for blood loss, eventually could move to IV iron

330
Q

Best method to cool someone with heat stroke?

A

Immerse in cold water, evaporative methods (cooling blankets don’t help)

331
Q

What should you do after making a dx of osteosarcoma?

A

Get lung CT for mets

332
Q

3 meds to give with variceal bleed?

A

PPI, octreotide, ceftriaxone (abx)

333
Q

Post catheterization (cardiac): hypotension, tachycardia, flat neck veins, back pain

A

Retroperitoneal hematoma (get CT of abd/pelvis)

334
Q

Does negative VDRL help much in early primary syphilis?

A

No, get darkfield or FTA-ABS (still very sensitive)

335
Q

Anemia plus splenomegaly in an 18 year old AA male with no med hx one week after URI was treated by amoxicillin?

A 
Warm AIHA (Abx, cancer, autoimmune)
No complications and big spleen significantly decrease chances of SS
336
Q

How to tx frostbite? Is warm IV fluid ok?

A

Rapid rewarming in water. The IV fluid thing is for hypothermia, not frostbite

337
Q

What do you do with severe bradycardia that accompanies hypothermia?

A

Just warm them, this will be resistant to pacing anyhow

338
Q

Can you increase dose of SSRI after 2 weeks if not enough effect?

A

NO, give it 4-6 weeks to kick in

339
Q

What could cause celiac disease confirmed with Bx that had negative antibody tests?

A

IgA deficiency (common association)

340
Q

Name some things that increase Warfarin effectiveness?

A

NSAIDS, APAP, cranberry juice

341
Q

Can you switch pyelonephritis to narrow spectrum therapy when the cultures come back?

A

You can if they are symptomatically improving after 48 hours (even ok to go to orals)

342
Q

Causes of clubbing?

A

Lung malignancy, cystic fibrosis, R–> L cardiac shunts. COPD, hypoxia alone DO NOT CAUSE IT

343
Q

What is the top stroke risk factor?

A

Hypertension for both types

344
Q

First line treatment for vasospastic angina? Be specific.

A

Diltiazem (or other CCB): diltiazem is a powerful dilator of coronaries, less peripheral arteries

345
Q

What is the relation of kidney stones to ileus?

A

Kidney stone colic–> vagal rxn–> ileus

Either way, get CT (non-con)

346
Q

Can tubulointerstilial nephritis have proteinuria?

A

Yes, and it is the correct answer if they are going for analgesic induced kidney failure (or papillary)

347
Q

What do you do with a positive PPD followed by a negative CXR?

A

Treat latent TB with INH + B6 for 9 months

348
Q

How do we deal with foreign vaginal body in kids?

A

Irrigation or alginate swab, otherwise need anesthesia. Never bimanual exam on kid (even with analgesia)

349
Q

Most common location of ectopic focus of a. fib?

A

Pulmonary veins

350
Q

What is a little known cause of secretory diarrhea?

A

Post-surgical change

351
Q

How is NAFLD related to DM in regards to lipolysis?

A

Insulin resistance leads to increased peripheral lipolysis which causes it to come back to liver. Hepatic FFA cause increased oxidative stress and production of proinflammatory cytokines

352
Q

How should you think of urinary Cl in alkalosis?

A

If kidney works (not hyperaldo, bartters, gitelmans), then HCO3 will be excreted in exchange for Cl in distal tubule and urinary Cl will be low

353
Q

Can you do a vaginal delivery if no active herpes and no prodromal sx?

A

Yes, don’t need ppx

354
Q

Flexion hip contracture 20 degrees, 1 year of hip pain, narrowed joint space on x-ray. Subchondral sclerosis too. Pain not at rest

A

OA

355
Q

What does the EMG show with ALS?

A

Fibrillation potential and widespread denervation

356
Q

Severe hemolytic disease of newborn is caused by what?

A

Rh incompatibility

357
Q

What predisposes to toxicity with the drug that can cause PVCs?

A

Hypokalemia (diuretics) predisopse to digoxin toxicity which can cause PVCs

358
Q

Widespread molluscum warrants search for what?

A

HIV

359
Q

Can bereaving people have auditory hallucinations?

A

Nope

360
Q

If GBS was treated in pregnancy, what do you do at birth?

A

PPX

361
Q

Is brisk, rotary nystagmus ok?

A

No, work it up

362
Q

What do you do if BPH has orthostatic hypotension?

A

Skip the alpha blocker

363
Q

Next step with raynauds?

A

ANA

364
Q

What dietary recommendation should you make for diverticulosis patients?

A

High fiber (the nut/seed thing is not real anymore)

365
Q

Corneal vesicles and dendritic ulcers?

A

Herpes simplex keratitis

366
Q

Where might you see bacillary angiomatosis? Tx?

A

Skin usual, rarely organs such as liver, CNS, and bone. Tx with doxycycline, erythomycin

367
Q

What is left ventricular filling pressure? What happens to it an acute MI with papillary muscle rupture?

A

It is the same as LV EDP, this increases in acute MR

368
Q

What does breast feeding do for ovarian, endometrial and breast cancer risks?

A

Decreases ovarian and breast risk, not ovarian

369
Q

What does breast feeding prevent in kids?

A

Disease, NEC, childhood cancer

370
Q

How is blood pressure influenced in hypo and hyperthyroidism? Mechanism?

A

Hypertension in both
HYPERthyroid: increased CO, decreased SVR
HYPOthyroid: increased SVR

371
Q

What does good glycemic control in diabetics protect against?

A

Only microvascular complications: nephropathy and retinopathy. No definitive evidence on how it effects macrovascular (stroke, MI) or overall mortality

372
Q

Three requirements to diagnose acute liver failure?

A

1) Liver injury signs (increased enzymes)
2) Hepatic encephalopathy
3) Liver synthetic dysfunction (INR >1.5)

373
Q

What is the CI interval required to avoid for RR/OR, what is the other circumstance?

A

RR/OR: cannot cross 1

Mean difference: cannot cross 0

374
Q

How long before you see EBV amoxicillin rash?

A

> 24 hours (still watch for allergic rash earlier)

375
Q

Name two comorbid conditions with absence seizures.

A

ADHD, anxiety

376
Q

Attributable risk percent given RR

A

(rr-1)/rr

377
Q

Use dependent QRS widening? Use dependent PR prolongation?

A 
QRS: class 1C (flecanide, propafenone)
PR: CCBs
378
Q

What are the approved appetite stimulants for cancer related cachexia syndrome?

A

Progesterones> steroids

379
Q

Melanosis coli?

A

Laxative abuse

380
Q

Complications/results of PBC?

A

Malabsorption (ADEK def), metabolic bone disease (osteoporosis), HCC

381
Q

What type of CT used for kidney stone imaging?

A

NON_CONTRAST

382
Q

Most common skin cancer in immunosuppressed? What if skin cancer is not on head/neck?

A

SCC for both

383
Q

How do you differentiate herpangina from herpetic gingivostomatitis?

A

Both have fever and pharyngitis.
Herpangina: gray vesicles/ulcers on posterior oropharynx
Herpetic: red gingiva, clusters of small vesicles on anterior oropharynx

384
Q

What do labs look like with chikungunya? What is the most common sx?

A

Look like tick borne (increased ALT/AST, thrombocytopenia, leukopenia). High fevers and polyarthralgias

385
Q

First step with suspected infection with peritoneal dialysis?

A

Gram stain fluid

386
Q

To and fro murmur with bounding pulses and widened pulse pressure?

A

PDA

387
Q

Type of DM with DKA?

A

Type I

388
Q

First treatment with PAD? ABI of severe?

A

Conservative: stop smoking and exercise. <0.4

389
Q

When do you wean COPD patients from ventilator?

A

When normal abg (can retain CO2) and awake/alert

390
Q

Just tried alcohol for the first time, now abdominal/ colicky pain?

A

Ureteropelvic junction obstruction (get US)

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