Smartdeck, 6.8 start Flashcards
1
Q
most affective antipsychotic for treatment-resistant schizophrenia and schizoaffective disorder?
A
clozapine
2
Q
most severe AEs of clozapine
A
agranulocytosis, seizures, myocarditis
3
Q
compared to other antipsychotics, which one has the greatest risk of seizures?
A
clozapine
4
Q
what actions are associated with risk reduction for long term rx opioid misuse?
A
state rx drug monitoring, random UDS, regular follow up
5
Q
gold standard for evaluating risk in pt with hx of cervical surgery
A
transvaginal US
6
Q
dysarthria, loss of DTRs, progressive gait and limb ataxia in adolescence
loss of position and vibratory senses
hypertrophic cardiomyopathy
A
friedreich ataxia
7
Q
acute onset of ataxia, nystagmus, and dysarthria following an infection
A
acute cerebellar ataxia
8
Q
musty odor urine
A
phenylketonuria
9
Q
if PKU goes untreated…
A
intellectual disability and seizures
10
Q
how to detect PKU
A
newborn screening
tandem mass spectrometry of dried blood spots
later in life - quantitative amino acid analysis
11
Q
tx of PKU
A
dietary restriction of phenylalanine
12
Q
how to differentiate hirschsprungs v meconium ileus
A
level of obstruction
Hirsh- rectosigmoid, normal consistency, positive squirt sign
mec ileus - ileum, inspissated consistency, negative squirt sign
13
Q
bone pain and pancytopenia in a child
also fever, pallor, bruising, and hepatosplenomegaly
A
acute lymphoblastic leukemia
14
Q
acute, unilateral cervical lymphadenitis in child is MCC by
A
S. aureus or S. pyogenes
15
Q
pt has pna and developed signs of septic shock
airway is secure, what next?
A
IV normal saline
16
Q
what is the MCC of community acquired bacterial meningitis
A
S. pneumo
can occur with or without concurrent pneumococcal pna
17
Q
Vagal maneuvers will affect with node in the heart, AV or SA?
A
AV
18
Q
High dose IV acyclovir can cause
A
crystalluria with renal tubular obstruction
19
Q
diaphragmatic flattening in COPD caused by hyperinflation result in
A
increased work of breathing
20
Q
intrinsic renal failure is commonly due to
A
acute tubular necrosis
high urine sodium
21
Q
glomerulonephritis is characterized by
A
hematuria with RBCs
22
Q
precocious puberty, normal bone age, really just increasing body hair
A
premature adrenarche
caused by early activation of adrenal androgens, more common in obsese children
23
Q
profound hypoglycemia in pregnancy
A
acute fatty liver of pregnancy
24
Q
management of acute fatty liver of pregnancy
A
immediate delivery
25
mucopurulent drainage with a friable cervix
acute cervicitis
26
management of hydatiform mole
DnC
serial bhCG post evacuation
contraception for 6 months
27
in adolescents, abnormal uterine bleeding is caused by
immature hypothalamic-pituitary-ovarian axis
causing irregular, heavy bleeding
28
in hemodynamically stable pt, acute uterine bleeding can be managed with
IV estrogen or high dose oral estrogen/progestin contraceptive pills
29
how long do you need pharmacotherapy for bipolar pt with multiple episodes?
likely life long
30
palpable lymph node, small/\<2cm, soft, mobile nodes, localized to one area in a child or young adult
next step?
observation
31
tx for body dysmorphic disorder
SSRI and CBT
32
prerenal AKI is characterized by
low urinary sodium (\<20)
low fractional excretion of sodium (\<1%)
elevated BUN:Cr \>20:1
urine sediment is bland
33
stable pt with wide complex tachycardia can be initially managed with
antiarrhythmics like amiodarone
34
daily copious mucopurulent sputum in pt with chronic cough
bronchiectasis
35
test to determine if Crohns or UC
colonoscopy
36
older adult with progressive neck pain, gait disturbances, lower motor neuron signs in UE, and UMN signs in LE
cervical spondylotic myelopathy
37
persistent, eczematous, and/or ulcerating rash is localized to the nipple and spreads to the areola
paget disease of the breast
38
what kind of cancer is associated with Paget disease of the breast?
adenocarcinoma
39
does primary syphilis have associated adenopathy
yes
mild to moderate LAD is often present
40
what causes granuloma inguinale?
klebsiella granulomatis
41
extensive, progressive, painless genital ulcers, usually without LAD
granuloma inguinale
42
infection causing vaginal pH \<4
candida
normal pH is 3.8 -4.5
43
initial evaluation of mixed urinary incontinence
voiding diary
44
first line tx for primary dysmenorrhea
NSAIDs
45
physiologic change of pregnancy associated with insulin
increased insulin resistance due to increased levels of placental somatomammotropin
46
what is placental somatomammotropin?
human placental lactogen
47
what is the cause of labial adhesion?
if symptomatic, what is the tx?
low estrogen production
topical estrogen cream
48
side effect of oxytocin
similar to ADH, hyponatremia, seizure
49
Pts in preterm labor at \<32 weeks require:
betamethasone (decrease risk neonatal RDS)
tocolytics/indomethacin
mag sulfate for fetal neuroprotection
50
what age can get vulvar lichen sclerosus
prepubertal girls and perimenopausal or postmenopausal women
51
tx vulvar lichen slcerosus
superpotent corticosteroid tx
52
in what age pt would you see labial adhesions?
\<2 yo
53
high risk pts in pregnancy require what in third tri?
repeat testing for STIs
54
pregnant lady with pruritis worse on hands and feet; markedly elevated total bile acids
intrahepatic cholestasis of pregnancy
55
absent coagulation factor carboxylation
vit K deficiency
56
rupture of emissiary veins upon scalp traction during delivery
subgalel hemorrhage
57
diffuse fluctuant swelling extending beyond suture line in neonates
subgaleal hemorrhage
58
subperiosteal vessel rupture
cephalohematoma
59
firm, non fluctuant swelling, does not cross suture line in neonate
no significant blood loss
cephalohematoma
60
pressure of presenting part of the scalp against a dilating cervix
caput succadaneum
61
moderately dehydrated normal kid
IV normal saline
62
neonate with bruising after a home birth
vit K deficiency
reduced coagulation factor carboxylation
63
multiple infxns, S. aureus, Serratia, Burkholderia cepacia (catalase positive)
chronic granulomatous disease
64
umbilical cord fails to separate, decrease immune system
leukocyte adhesion deficiency
65
preterm, leukocytosis, metabolic acidosis, bilious vomiting
necrotizing enterocolitis
66
cyanosis in infant, bounding peripheral pulses, harsh systolic murmur at lower left sternal border, loud S2
truncus arteriosus
67
cyanosis, tachypnea, single loud S2
transposition of great vessels
68
defect in NADPH oxidase
chronic granulomatous disease
69
infecting organisms are catalase positive (S. aureus, E. coli, candida, klebs, pseudo, aspergillus, nocardia, serratia)
chronic granulomatous disease
70
diagnostic test for chronic granulomatous disease
dihydroorhodamine test
71
defect in neutrophil chemotaxis/microtubule polymerization
chediak higashi
72
oculocutaneous albinism, peripheral neuropathy, neutropenia
chediak higashi
73
coarse facies, abscesses, retained primary teeth, hyper IgE, dermatologic
Jobs syndrome
Hyper IgE
74
tx of hyper IgE syndrome
penicillinase-resistant abx and IVIG
75
recurrent neisseria infxns, rarely lupus or glomerulonephritis
MAC deficiency
76
tx for spascity of cerebral palsy
diazepam, dantrolene, baclofen
77
sepsis work up
CBC, UA, blood/urine/CSF culture
78
tongue fasiculations and symmetric proximal muscle weakness, greater in LE than UE
spinal muscular atrophy
79
young child with cervical paravertebral sympathetic chain LAD, droopy eyelid, constricted pupil, abdominal mass
neuroblastoma
80
elevated vanillylmandelic acid and homovanillic acid
neuroblastoma
81
3 yo presents with gross hematuria and painless right sided abdominal mass
wilms tumor
82
claw sign on abdominal mass imaging in kid
wilms tumor
83
kidney mass crossing midline on imaging
neuroblastoma
84
osteosarcoma (aka osteogenic sarcoma) is also associated with
Rb and Paget disease
85
predominantly cortical small tumor, severe nocturnal pain
dx and tx
osteoid osteoma
NSAIDs
86
where is osteoblastoma located?
spine
87
bony overgrowth of the hard palate
torus palatinus
88
lytic lesions in the skull, in child
langerhans cell histiocytosis
immune cells, langerhan histiocytes, tennis-raquet, bierbeck granules
89
most likely site of injury of clavicular fx
middle third of clavicle
90
overuse apophysitis
osgood schlatter
91
SCFE pt that is less than 10th percentile for height, get
TSH
92
kid with diet of mostly cheese and yogurt and drinks ridiculous amounts of milk
Fe deficiency anemia
93
ambiguous genitalia, super high testosterone, 46, XX
CAH
94
5 alpha reductase deficiency will be in what karyotype?
46 XY
95
aromatase deficiency will present with
virilization in both the fetus and the mom
96
failure to thrive, jaundice, hepatomegaly, infantile cataracts, neuro symptoms
galactosemia
97
excess urination in sickle cell trait
hyposthenuria
kidney cant concentrate urine
98
pt with friederich ataxia is most likely to die from
cardiac issue
99
calcified lesion in sella turcica in kid
craniopharyngioma
100
jaundice, pale stools, and dark urine during 2-8 weeks old
biliary atresia
101
amylase rich, exudative pleural effusion
pancreaticopleural fistula
102
decreased air flow during both inspiration and expiration, flattening the top and bottom of a flow loop is likely caused by
fixed upper airway lesion
103
sudden onset respiratory distress following removal of a central venous catheter
venous air embolism
104
tx of venous air embolism
L lateral decubitus, in order to trap VAE on the lateral wall of the R ventricle
prevents RVOT obstruction and further embolization
105
more than 2 years of numerous periods with hypomanic and depressive symptoms, but not meeting full criteria for hypomania or depressive symptoms
cyclothymic disorder
106
depressed mood lasting most days for more than 2 years
persistent depressive disorder
107
low urine osmolality and low urine specific gravity suggest dilute urine, as seen in
diabetes inspidus
108
high urine osmolality and specific gravity suggest osmotic diuresis from conditions like
diabetes mellitus
109
DVT following a surgery, pt has ESRD tx?
unfractionated heparin followed by warfarin
110
heparin would be contraindicated in what pts?
ESRD pts
111
respiratory distress, neuro dysfunction, and petechial rash after a femur fx
fat embolism syndrome
112
dx of gastric cancer is established with
EGD
113
patchy, nonscarring hairloss, autoimmune
alopecia areata
114
tx of alopecia areata
topical or intralesional corticosteroids
topical triamcinolone
115
laryngomalacia has an
inspiratory stridor
116
drug fever from antibiotics (typically beta lactams) is dx of exclusion and generally accompanied by
rash and peripheral eosinophilia
117
eczema, microthrombocytopenia, and recurrent infections
wiskott aldrich syndrome
118
why do turner syndrome babies have swollen hands and feet
lymphatic network dysgenesis
119
bupivacaine systemic toxicity
CNS overactivity - perioral numbness, metallic taste, tinnitus
generalized tonic clonic seizure
120
within 2 standard deviations of the mean is what percentage?
95% of data
121
greatest risk related to parenteral nutrition
central line associated bloodstream infection
122
thready pulses over both radial arteries that disappear with deep inspiration
pulsus paradoxus
cardiac tamponade
123
characteristic CSF findings in herpes simplex virus encephalitis
lymphocytic pleocytosis, increased erythrocytes, and elevated protein, normal glucose
124
mass causing Cushings is secreting what?
ACTH, ectopic corticotropin, polypeptide hormone
125
tx for nonvalvular AF
options include: rivaroxaban, dabigatran, apixaban, and endoxaban
126
exudative effusion with very elevated protein
Tuberculosus
127
flu vaccines in HIV
MMR and varicella zoster vaccines in HIV
never give LAIV
live MMR and VZ vaccines CI if \<200 CD4 ct
128
HA worse when leaning forward, JVD but no peripheral edema
superior vena cava syndrome
129
fever, ascites, diffuse abdominal pain, tachycardia, AMS
spontaneous bacterial peritonitis
130
subepidermal blisters
bullous pemphigoid
131
intraepidermal cleavage
pemphigus vulgaris
132
what enzymes are elevated in polymyositis
CK, aldolase, AST
133
with a tension pneumo, the high intrathoracic pressure will
impede venous return to the R atrium by compressing the vena cava
134
what do you see on CT of chronic pancreatitis?
calcifications
135
what happens to lipase in chronic pancreatitis?
doesn't have to be elevated
also, alcohol doesn't always cause liver elevation
136
Pt just had roux en y gastric bypass, and they are likely developing symptomatic gallstones. Why does this happen?
due to rapid weight loss, promoting gallstone formation, likely from increased bile concentrations of mucin and calcium
137
elevated phosphate level and low calcium in setting of CKD is characteristic of ...
the resulting elevation in PTH can cause...
secondary hyperparathyroidism
renal osteodystrophy
138
hypocalcemia and hyperphosphatemia stimulate release of PTH to maintain normal electrolyte levels. overtime, this will result in
parathyroid gland hyperplasia
139
high nitrogen states that could cause hepatic encephalopathy
GI bleeding or dietary changes
140
suicidal pt, hematemesis, green/black diarrhea, severe abdominal pain.
what did she take?
acute iron poisoning
141
new onset AF, unintentional wt loss
what test do you get?
TSH
142
the prognosis of astrocytomas is most affected by
tumor grade, with increased atypia, mitoses, neovascularity, or necrosis conveying a worse prognosis
143
multi-chain LAD, splenomegaly, mild cytopenias, and marked lymphocytic predominant leukocytosis
CLL
144
first line tx of CLL
rituximab, mab v CD20 antigen expressed on B lymphocytes
145
what is the relationship, generally speaking, between sensitivity and specificity?
as sensitivity increases, specificity decreases
and vice versa
146
tx for advanced pancreatic cancer causing jaundice an pruritis by obstructing the CBD
palliative - endoscopic CBD stent placement
147
amlodipine or metoprolol for controlling AF
metoprolol
amlo is DHP, causing vasodilation, not affecting conduction rate
148
wenckebach is a
Mobitz type I
149
why does renal insufficiency happen in multiple myeloma?
light chain cast nephropathy with resultant renal tubular injury
150
trinucleotide CGG repeat on FMR1 gene on the X chromosome
Fragile X syndrome
exhibit features of autism
151
3-5 days s/p MI; acute hemodynamic compromise and a holosystolic murmur at the left sternal border
ventricular septum rupture
152
meckel diverticulum pathophys
ectopic gastric mucosa
153
anemia seen in patients with DIC is often due to
microangiopathic hemolysis
154
mitral stenosis murmur
mid diastolic murmur at the cardiac apex
155
when do you monitor Lipids?
If 10 year ASCVD is \>7.5%
156
hemothorax will do what to preload
decrease preload, blood is pooling elsewhere
157
nonlobular infiltrate on chest CT
pulmonary contusion
158
central obesity, proximal muscle weakness, HTN, and easy bruising
Cushing syndrome
159
upper GI series shows a cork-screw shaped duodenum that is abnormally located in the R abdomen
midgut volvulus
160
common bug causing immunocomprised (like on chronic glucocorticoids) pt to have bacterial meningitis in pt \>50 yo
listeria
161
what can you tell a pt who gets a ton of gout attacks
drink less alcohol
162
oral vesicles in a kid
herpangina, coxsackie A
163
peripheral blood smear shoing signs of dysplasia, oval macrocytes, and hyposegmented/hypogranulated neutrophils
next step?
dx?
bone marrow biopsy
myelodysplastic syndrome
164
MC complication of neutropenia
bacterial infxn
165
what causes symptoms of DKA physiologically
fatty acid breakdown in the liver, generating ketones
166
V/Q scan can be used to rule out PE in pregnancy if...
it is normal
if low probability, get CTA
167
tx for urinary urgency
lifestyle mods, bladder training, antimuscarinic
168
vaginal bleeding in pt \>20 weeks, next step?
US to find placenta location
169
blunt trauma, XR shows widened mediastinum, next step?
CTA chest
170
chronic loss of visual acuity, excessive glare, and halos around bright lights
cataracts
171
advanced cases of cataracts may show
loss of red reflex
172
what beta blockers have been shown to improve symptoms and overall long term survival in stable patients with heart failure and LV systolic dysfunction?
metoprolol succinate
carvedilol
bisoprolol
173
first line tocolytic at 32-34 weeks gestation
nifedipine
174
tocolytic to use prior to 32 weeks
indomethacin
175
what causes central cyanosis
low arterial oxygen saturation
176
urine findings in rhabdo
dark red urine
positive blood
absence of RBC
AKI
177
use of OCPs is associated with decreased risk of
ovarian and endometrial cancer
178
sotalol side effect
torasdes
179
low grade fever, LAD (suboccipital, posterior auriculuar, and posterior cervical), descending rash in child
rubella
180
carditis, chorea, and elevated ESR; also could have erythema marginatum, subcutaneous nodules, and migratory arthritis
acute rheumatic fever
181
best intervention to minimize AAA progression
smoking cessation
182
inability to recall important personal information, usually of traumatic or stressful nature; not explained by another disorder
dissociative amnesia
183
feelings of detachment from, or being an outside observer of, one's self
depersonalization
184
experiencing surroundings as unreal
derealization
185
in depersonalization/derealization disorder, reality testing will be ...
intact
186
irregular patchy hair loss, uneven hair growth and absence of other findings
trichotillomania
187
bloating, steatorrhea, and macrocytic anemia in setting of RYGB surgery
SIBO
188
test to dx symptomatic diverticulitis
abdominal CT with con
189
initial tx for anterior spinal cord injury
disrupted autonomic function - causing urinary retention - put in a bladder catheter
190
membranous nephropathy is a nephrotic syndrome and that means this person is also...
hypercoaguable
191
3 months constipation in older person and pain unrelated to bowel movements is suspicious for
malignancy
192
irregular abdominal protuberance in an acute pregnant lady
fetal parts - uterine rupture
193
antiemetics that are dopamine antagonists?
what are their side effects?
metoclopramide and prochlorperazine
extrapyramidal symptoms
194
IBD is frequently complicated by ... and this can be exacerbated by NSAIDs
arthritis
195
how do you confirm central venous catheter placement?
chest XR
196
how do kidneys repsond to OSA?
increasing epo, resulting in erythrocytosis
197
tx of chemo related diarrhea
loperamide
198
tx of beta blocker toxicity
glucagon
199
retracted TM
eustachian tube dysfunction
200
tumor markers from nonseminomatous germ cell tumors
AFP and hCG both elevated
201
erythema of the central face, facial flushing, telangiectasias, and burning discomfort
erythematotelangiectatic rosacea
202
pregnant pt positive for GBS, needs intrapartum ppx, has low risk penicillin allergy
give cefazolin
203
tx of anaerobic/aspiration lung infection options
amoxicillin, amox-clauv, and clinda
204
before starting MTX, what do you need to check on the pt?
liver labs
205
unstable pt, unknown AAA, next step?
FAST exam
206
TCA overdose and is having cardiac abnormalities, tx?
sodium bicarb
sodium load will alleviate depressant action on myocardial sodium channels
207
short term hyperventilation helps lower ICP by causing
cerebral washout of CO2, leading to vasoconstriction and decreased cerebral blood flow
208
bacterial meningitis in neonate with increased ICP, next step?
LP to properly dx
209
why does cushing syndrome have myopathy??
due to direct catabolic effects of cortisol on skeletal muscle, leading to muscle atrophy
210
AIDs pt with increased ICP, progressive HA, N/V and confusion
cryptococcal meningitis
211
rapid onset episodes of tachycardia, hypertension, and tachypnea often associated often accompanied by fever and diaphoresis after a TBI
paroxysmal sympathetic hyperactivity
212
injury to hip, adduction and internal rotation at the hip
posterior hip rotation
213
indomethacin tocolysis can cause .... and .... although benefits outway risks
oligohydraminos and premature closure of fetal ductus arteriosus
214
where on the bone does pediatric acute osteomyelitis occur?
metaphysis of long bones
215
multiple gastric folds and thickened gastric folds on endoscopy
gastrinoma
216
SBO in crohns disease
fibrotic stricture
217
initial mgmt of frostbite
rapid rewarming in water bath
218
heat exhaustion v heat stroke
exhaustion - mentation remains normal
stroke - AMS
219
parapneumonic effusions with pH \<7.2, glucose \<60, neutro-predominant lymphocytes \>50k
empyema
220
Type A aortic dissection suspected, next step?
what is contraindicated?
CT angiography
CI - anticoagulation
221
edema and narrowing of the proximal trachea in 18 mo old with inspiratory stridor
croup
222
unilateral wheezing in a kid, unresponsive to albuterol
FB ingestion
223
giant coffee bean on XR
sigmoid volvulus
224
tx of uncomplicated sigmoid volvulus
flex sig
225
pt with hx of breast cancer and now has mets to at least her spine; abnl labs and hypotension
dx and first test
primary adrenal insufficiency
cosyntropin stimulation test
226
eye complications of Sjogrens
decreased visual acuity, infection, corneal ulceration, corneal perforation
227
migratory, symmetric, polyarticular arthralgias, accompanied by brief morning stiffness; XR shows no evidence of joint destruction
SLE
228
first line tx nummular eczema
topical glucocorticoids
229
bright, sharply demarcated erythema over perianal/perineal area in school aged children
perianal streptococcus
230
beefy red rash involving skin folds with satellite lesions in kids
candida dermatitis
231
tx of papulopustular rosacea
topical metronidazole
232
tx of erythematotelangiectatic rosacea
topical brimonidine
233
sudden onset of psoriasis - test for?
HIV
234
first line tx of OCD
CBT and/or SSRI
235
complication of hyperemesis gravidarum, symptoms of encephalopathy, oculomotor dyfunction, and gait ataxia
wernicke encephalopathy, thiamine deficiency
236
oliguria definition by numbers
\<250 mL urine in 12 hours
237
pt with oliguria and AKI, next step
urgent bladder scan and cath
238
elevated intraocular pressure, optic disc rim thinning, increased cup:disc ratio, otherwise asymptomatic
open angle gluacoma
239
first line tx open angle glaucoma
topical agent to lower IOP, topical prostaglandin (latanoprost, bimatoprost)
240
if prostaglandins are ineffective tx of open angle gluacoma, what is next step?
topical beta blocker like timolol
241
hypercalcemia in setting of metastatic cancer to bone, tx?
bisphosphonates
242
crescendo-decrescedno murmur along L sternal border without carotid radiation
HOCM
243
CXR shows extensive bilateral alveolar opacities
ARDS
244
ARDS pt with insufficient oxygenation, FiO2 is at 70% and PEEP is at 5, what do you change?
increase PEEP because we try to wean to \<60% FiO2 as quickly as possible
245
tx of BCC on trunk or extremities
surgical excision bx with narrow margins
246
postexposure HIV ppx for high risk occupational exposure
3 drug antiretroviral therapy for 4 weeks, start ASAP
247
initial step in evaluation of Cushings syndrome to confirm hypercortisolism
late-night salivary cortisol
24 hour urine free cortisol
overnight low dose dexamethasone test
248
MC testicular malignancy in prepubertal males
yolk sac tumor
249
tx of MVP
reassure and echos on occasion
250
tx of severe mitral stenosis
percutaneous balloon valvuloplasty
251
status epilepticus tx
lorazepam
lorazepam
fosphenytoin
phenytoin
valproic acid
levetiracetam
252
travel to mexico, now has RUQ abd pain, diarrhea and weakness, next step?
RUQ ultrasound
253
only established risk factor for acne
family hx
254
new dx of HTN in pt with fhx of HTN and DM, next step?
EKG
255
MC long term sequelae of untreated bacterial menigitis
eighth cranial nerve/ hearing loss
256
dilated high output cardiomyopathy and heart failure
dx and what vitamin deficiency?
wet beri beri
thiamine
257
3 drugs that could tx community acquired MRSA
TMP-SMX, doxy, clinda
258
tx of cardiogenic shock
NE or DA
259
control exacerbations of Bechet disease with
prednisone
