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Medicine > Step 2 > Flashcards

Step 2 Flashcards

1
Q

Once pt has PID, what to screen for?

A

HIV, syphilis, hep b, cervical cancer (pap). Hep C if Hx of IVDU

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2
Q

MOA of ondansetron

A

Serotonin 5HT3 antagonist

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3
Q

Pathogenesis of carpal tunnel syndrome

A 
hypothyroidism - deposition of mucopolysaccharide protein complexes (matrix substances)
pregnancy - increased fluid in tunnel
amyloidosis - amyloid fibril deposition
RA - tenosynovial inflammation
acromegaly - synovial tendon hyperplasia
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4
Q

Disease to screen for w/ Dx of carpal tunnel

A

hypothyroidism, espec if bilateral

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5
Q

First indicator of hypovolemia

A

tachycardia

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6
Q

head injury with lucid interval

A

acute epidural

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7
Q

head injury w/ biconvex discs? semilunar?

A

Biconvex - epidural

Semilunar - subdural

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8
Q

Labs expected in menopause or primary ovarian failure?

A

elevated FSH and LH (FSH more elevated than FSH)

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9
Q

Down syndrome pt with UMN findings?

A

atlantoaxial instability

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10
Q

Tx of absence seizures

A

valproate or ethosuximide

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11
Q

Risk of bipolar manic episode

A

Gen pop - 1%

+Hx in first degree relative - 5-10%

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12
Q

Tx of idiopathic hypercalciuria -> kidney stones

A 
In order of importance:
incr fluid intake
nl/increased calcium in diet
dietary sodium restriction
decreased dietary protein/oxalate
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13
Q

Medication used to induce spasms on diagnostic testing for either esophageal spasm or prinzmetal’s angina

A

Ergonovine

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14
Q

Name 4 lacunar stroke syndromes & locations of lesions

A

Pure motor hemiparesis-Posterior limb of internal capsule
Pure sensory-VPL of the thalamus
Ataxic-hemiparesis-Anterior limb of internal capsule
Dysarthria-clumsy hand-Basal pons

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15
Q

Enzyme deficient in galactosemia. Mild version (cataracts only)?

A

Galactosemia - galactose-1-phosphate uridyl transferase deficiency
Cataracts only - galactokinase deficiency

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16
Q

Pathophysiology of hepatorenal syndrome?

A

portal hypertension -> NO release in splanchnic circulation -> generalized systemic vasodilation -> renal hypoperfusion and pre-renal renal failure

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17
Q

Enzyme deficient in galactosemia. Mild version (cataracts only)?

A

Galactosemia - galactose-1-phosphate uridyl transferase deficiency
Cataracts only - galactokinase deficiency

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18
Q

Pathophysiology of hepatorenal syndrome?

A

portal hypertension -> NO release in splanchnic circulation -> generalized systemic vasodilation -> renal hypoperfusion and pre-renal renal failure

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19
Q

Gestational age at which you attempt external cephalic version for breach presentation

A

37 weeks

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20
Q

Most common site of coronary artery occlusion

A

Left anterior descending artery

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21
Q

Posterior descending coronary artery derives from?

A

70%-R coronary artery
10%-L circumflex artery
20%-anastamosis of RCA and circumflex

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22
Q

During exercise, cardiac output increases by…

A

increasing stroke volume initially, then by increasing heart rate

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23
Q

Normal PR interval

A

<0.2 sec

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24
Q

Normal QRS complex

A

<0.12 sec

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25
Q

AE of statins

A

myositis, increased LFTs

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26
Q

AE of niacin

A

flushing, increased LFT, insulin resistance, gout

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27
Q

Medicines given in acute MI

A 
IV morphine
supplemental O2
Nitroglycerin
Aspirin
Heparin if PCI, LMWH if not
B-Blocker
Statin
Anti-platelet (clopidogrel or ticagrelor)
Keep K >4 and Mg > 2
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28
Q

DDx for chest pain

A 
C - cocaine/costochondritis
H - hyperventilation/herpes zoster
E - esophageal spasm/esophagitis
S - stenosis of aorta
T - trauma
P - PE, pneumonia, pericarditis, pancreatitis
A - angina, aortic dissection, AAA
I - infarction
N - neuropsychatric disease
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29
Q

Dressler syndrome

A

fever, pericarditis, and increased ESR 2-4 wks post MI

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30
Q

What should you consider before cardioversion for a-fib?

A

If in A-fib > 2 days, TEE should be performed first to r/o mural thrombus formation. If present, anticoagulate for 3-4 wks prior to cardioversion

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31
Q

When are PVC’s concerning?

A

> 3 per min or Hx of CAD (Tx w/ b-blocker)

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32
Q

Drugs that decr mortality in CHF

A

ACE-I, B-blockers, and spironolactone

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33
Q

Hypertensive urgency vs emergency

A

Both w/ BP > 180/120. Urgency is asymptomatic. Emergency is w/ renal failure, pulmonary edema, aortic dissection, encephalopathy, papilledema

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34
Q

Tx options for hypertensive urgency/emergency

A

nitroprusside, nitroglycerin, labetalol, diazoxide

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35
Q

Causes of secondary hypertension

A

young men - alcohol intake
young women - OCPs, fibrous dysplasia of renal artery
elderly - atherosclerosis -> renal artery stenosis

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36
Q

Test for pheochromocytoma

A

24 hr urine for catecolamine products (metanephrines, vanillylmandelic acid, homovanillic acid)

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37
Q

Conn’s syndrome

A

Aldosterone secreting adrenal neoplasm. -> HTN, high aldosterone/low renin, hypokalemia, metabolic alkalosis

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38
Q

Which tests should be ordered on everyone with new Dx of HTN?

A

ECG - assess if heart has been affected (LV hypertrophy)

CMP & UA - clues to possible secondary causes of HTN

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39
Q

Lab to differentiate insulinoma vs exogenous insulin?

A

C-peptide level high in insulinoma, low in exogenous

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40
Q

Describe the Somogyi effect

A

If too much NPH is given at night, glucose level at 3am will be low -> stress hormone release -> hyperglycemia at 7am.

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41
Q

Describe the Dawn phenomenon

A

hyperglycemia caused by normal secretion of growth hormone early in the morning -> nl glucose level at 3am but high at 7am.

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42
Q

How to manage DM pt’s who are NPO for surgery?

A

1/3 to 1/2 of normal dose of insulin is given and glucose levels are monitored

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43
Q

How is LDL calculated?

A

LDL = total cholesterol - HDL - triglycerides/5

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44
Q

Differentiating AS and HOCM murmurs

A

AS - valsalva decreases murmur
HOCM - valsalva increases murmur
Both decrease with fist clenching

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45
Q

Causes of restrictive cardiomyopathy

A

Sarcoidosis
Amyloidosis
hemochromatosis

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46
Q

Causes of dilated cardiomypathy

A 
Idiopathic
Alcohol
Beriberi
Coxsackie B, cocaine
Doxorubicin
HIV
Pregnancy
Hemocrhomatosis
Ischemic heart disease
Chagas
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47
Q

EKG in acute pericarditis

A

global ST elevation

PR depression

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48
Q

Causes of acute pericarditis

A

viral, tuberculosis, SLE, uremia, neoplasm, post MI inflammation (dressler), medicaitons (isoniazid, hydralazine), radiation, recent heart surgery

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49
Q

Causes of cardiac tamponade

A

acute pericarditis, chest trauma, LV rupture post MI, dissecting aortic aneurysm

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50
Q

Beck triad

A

hypotension, distant heart sounds, and distended neck veins seen in cardiac tamponade

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51
Q

Causes of myocarditis

A

Viruses - coxsackie, parvo b19, HHV6, adeno, echo, EBV, CMV, influenza
Bacteria - Rickettsia
Fungi
Parasites - Trpanosoma cruzi (Chagas)
Drugs - doxorubicin, chloroquine, penicillin, sulfas, cocaine, radiation

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52
Q

Criteria for rheumatic heart disease

A

Hx of recent strep infxn w/ 2 major or 1 major and 2 minor criteria

Major (JONES):
Joints - polyarthritis
<3 heart - carditis, valvular damage
Nodules - Subcutaneous nodules
Erythema marginatum
Syndenham Chorea
Minor (PEACE):
Previous rheumatic fever
ECG with PR prolongation
Arthralgias
CRP and ESR elevated
Elevated temperature
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53
Q

Choice of HTN med in person w/ osteoporosis

A

thiazide diuretics - maintains high/normal serum calcium

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54
Q

Tx options for HTN in pregnancy

A

hydralazine, methyldopa, labetalol, nifedipine

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55
Q

HTN med to avoid in depression

A

B-blocker, may worsen sx

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56
Q

HTN med to avoid w/ gout

A

diuretic - increase serum uric acid

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57
Q

HTN med to avoid w/ asthma/COPD

A

nonselective b-blocker (propranolol, timolol) -> bronchoconstriction

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58
Q

HTN med to avoid in CHF

A

Ca channel blocker - reduced HR/contractility may exacerbate heart failure

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59
Q

HTN med to avoid in DM

A

thiazide diuretic - impaired glucose tolerance

B-blocker - mask signs of hypoglycemia

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60
Q

Differentiating septic vs neurogenic shock

A

In neurogenic shock, there is vasodilation + bradycardia

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61
Q

Risk factors for polyarteritis nodosa? vessels affected?

A

Hep B&C, young>elderly, men>women

small-medium (kidneys, heart, GI, muscles, nerves, joints)

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62
Q

Risk factors for temporal arteritis

A

> 50, women>men. 1/2 also have polymyalgia rheumatica

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63
Q

Risk factors for takayasu arteritis? vessels affected?

A

asian. women age 10-40

Aorta + branches (-> cerebrovascular/myocardial ischemia)

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64
Q

Small-medium vessel vasculitis with asthmatic Sx

A

Churg-strauss (allergic granulomatosis with angiitis or eosinophilic vasculitis)
Increased serum eosinophils, p-anca, lung biopsy may show eosinophilic granulomas

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65
Q

Risk factors for Henoch-Schonlein purpura? vessels affected?

A

More common in children

IgA immune compelx-mediated vasculitis affecting arterioles, capillaries, and venules

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66
Q

S/Sx of Kawasaki disease?

A

fever for >5 days, lymphadenopathy, conjunctival lesions, mucositis, maculopapular rash, edema of hands/feet

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67
Q

Tx of Kawasaki disease?

A

ASA, IVIG

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68
Q

If temporal arteritis is suspected…

A

Do not wait for biopsy to start prednisone

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69
Q

Dx/Tx of legionnaire’s disease

A

cough, fever >39 w relative bradycardia (80-90), GI Sx, confusion
Urine antigen or culture on charcoal agar
Tx: axithromycin/levofloxacin

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70
Q

Elevated L mainstem bronchus on radiograph

A

L atrial enlargement (i.e. from mitral stenosis 2/2 rheumatic heart disease)

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71
Q

Tx for human/dog bites

A

amox/clav

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72
Q

Most common organ injured in blunt abdominal trauma

A
  1. spleen 2. liver 3. kidney

Duodenum/pancreas are less commonly injured

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73
Q

Decreased DTR in pt with pre-eclampsia

A

Mg sulfate toxicity. Discontinue and give calcium gluconate

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74
Q

Infant with hypoglycemia, macrosomia, macroglossia, hemihyperplasia, umbilical hernia/omphalocele

A

Beckwith-Wiedemann syndrome (chromosome 11p15 anomaly)

Screen with abd US for wilm’s tumor and hepatoblastoma

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75
Q

Most common congenital cause of aplastic anemia? Other findings?

A

Fanconi anemia (chromosomal breaks)
Short, microcephaly, abnormal thumbs, hypogonadism, abnormal ears, hypopigmented spots
(note: it is a macrocytic anemia)

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76
Q

Breath holding spells seen in kids 6-18 months are a/w?

A

iron deficiency anemia

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77
Q

Complications of orbital cellulitis

A

Orbital abscess, intracranial infection, cavernous sinus venous thrombosis

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78
Q

Chromosome 5p deletion

A

Cri-du-chat. Microcephaly, hypotonia, short, cat-like cry

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79
Q

Colon cancer screening in UC pt’s

A

Start 8 yrs after Dx, then repeated every 1-2 years. Done w/ random blind biopsies to detect dysplasia

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80
Q

“worst headache of life” with negative CT. What next?

A

lumbar puncture to r/o subarachnoid hemorrhage

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81
Q

Iron studies in iron deficiency

A

low iron, low ferritin, high TIBC, and low transferrin saturation

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82
Q

Most common causes of microcytic anemia

A

iron deficiency, anemia of chronic disease(micro or normocytic), thalassemia

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83
Q

Electrolyte abnormality seen in subarachnoid hemorrhage

A

hyponatremia 2/2 cerebral salt wasting and/or SIADH

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84
Q

DDx/Tx of pulmonary-renal syndromes

A

Wegeners - steroids and cyclophosphamide
Goodpasture’s - plasmapheresis
Others: severe polyarteritis nodosa, idiopathic rapidly progressing glomerulonephritis

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85
Q

Labs in tumor lysis syndrome

A

hyperphosphatemia, hyperkalemia, hyperuricemia

hypocalcemia

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86
Q

RSV infxn increases risk of…

A

asthma later in life

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87
Q

Management of pt w/ sign of infxn (ie fever/sore throat) in pt on antithryoid drug (propylthiouracil/methimazole)?

A

Stop drug and draw CBC to determine if infection from agranulocytosis (i.e. WBC <1000)

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88
Q

Lab finding with antiphospholipid antibody (lupus anticoagulant)

A

spuriously prolonged PTT (actually causes prothrombotic state)

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89
Q

Corneal vesicles and dendritic ulcers

A

herpes simplex keratitis

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90
Q

Tx of Giardia

A

metronidazole

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91
Q

MEN syndromes

A

I: pituitary, parathyroid, pancreas
II: medullary thyroid, pheo, parathyroid
III: medullary thyroid, pheo, mucosal neuromas, marfanoid habitus

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92
Q

Complication of giving glucose to an alcoholic

A

precipitating Wernicke’s encephalopathy. Give thiamine first

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93
Q

Wernicke vs Korsakoff syndromes

A

Both 2/2 thiamine deficiency
Wernicke - reversible. ophthalmoplegia, nystagmus, ataxia, and/or confusion
Korsakoff - irreversible. psychosis with anterograde amnesia + confabulation

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94
Q

Tx of aspirin overdose

A

Alkalinization of the urine with sodium bicarbonate

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95
Q

Tx of SIADH

A

water restriction

demeclocycline (induces nephrogenic DI)

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96
Q

What causes spurious (false) hyponatremia?

A

Lab value is low, but total body sodium is normal
hyperglycemia
hyperproteinemia
hyperlipidemia

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97
Q

Classic cause of hyponatremia in pregnant patients

A

Oxytocin, which has an anti-diuretic hormone like effect

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98
Q

When hypokalemia persists after replacement

A

check Mg levels. hypomagnesemia blocks retention of potassium

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99
Q

Correction for hypocalcemia in the setting of hypoalbuminemia

A

For every 1 unit decrease in albumin below 4, add 0.8 to calcium level

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100
Q

AE of MAOI’s

A

serotonin syndrome

hypertensive crisis with consumption of foods high in tyramine (aged meats/cheeses)

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101
Q

Diamond Blackfan Syndrome

A

macrocytic pure red cell aplasia a/w congenital anomalies including short stature, webbed neck, cleft lip, shielded chest, and triphalangeal thumbs
Defect -> incr apoptosis of erythroid progenitor cells

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102
Q

Concern for high flow O2 in COPD exacerbation

A

bringing O2 sat above 95% decreases resp drive ->hypercarbia -> lethergy/seizure/arrhythmia.
For same reason, use benzos/narcs sparingly

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103
Q

MOA of cyclosporine and tacrolimus

A

calcineurin inhibitors -> decreased IL2 production

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104
Q

Major AE of cyclosporine/tacrolimus

A

nephrotoxicity, hyperkalemia, HTN, tremor
Cyclosporine: add gum hypertrophy and hirsutism
Tacrolimus: add neurotoxicity

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105
Q

Major AE of azathioprine

A

diarrhea, leukopenia, hepatotoxicity

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106
Q

Major AE of mycophenolate

A

bone marrow suppression

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107
Q

Tests to order prior to starting lithium

A

Creatinine, thyroid function tests, pregnancy test

AE of nephrotoxicity, hypothyroid, ebstein anomaly in fetus

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108
Q

Left sided varicocele that fails to empty when recumbent

A

Renal cell carcinoma

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109
Q

sinusitis is most common in which sinuses?

A

maxillary

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110
Q

Lab for mycoplasma pneumonia

A

positive cold agglutinin test

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111
Q

Differentiating emphysema with chronic bronchitis

A

Dlco is normal with chronic bronchitis but decreased in emphysema

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112
Q

COPD pt w/ resting O2 sat <88%

A

home O2 program

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113
Q

AE of clozapine (antipsychotic)

A

agranulocytosis

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114
Q

Tx of nondisplaced scaphoid fx? displaced?

A

wrist immobilization for 6-10 weeks. ORIF.

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115
Q

b-HCG level where you should see intrauterine pregnancy

A

1500-2000

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116
Q

Murmur of endocarditis in IVDU

A

tricuspid regurg -> systolic murmur that increases with inspiration

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117
Q

Which part of DTaP is a/w anaphylaxis, encephalopathy, or seizure?

A

Pertussis. give DT instead for next shot

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118
Q

headache, vision changes, and pulsatile tinnitus with normal head imaging

A

think of pseudotumor cerebri and order LP for high opening pressure

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119
Q

Use of d-xylose test

A

tests passive diffusion ability of small intestine. If it shows up in stool instead of being absorbed, think celiac disease, whipple disease, bacterial overgrowth
If normal, think pancreatic insufficiency

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120
Q

CT finding in huntington’s

A

atrophy of caudate nucleus and putamen

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121
Q

Which medications may cause folate deficiency?

A

methotrexate, phenytoin, trimethoprim

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122
Q

Med to give if pt with MI gets vtach or vfib

A

lidocaine

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123
Q

Lung cancer metastasizes to

A

BLAB: bone liver adrenals brain

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124
Q

Paraneoplastic syndrome a/w squamous cell lung cancer

A

PTHrP -> hypercalcemia (others are all small cell)

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125
Q

Lab test in wegener’s (granulomatosis with polyangiitis)

A

c-anca

noncaseating granuloma on biopsy

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126
Q

Time cutoff for tracheostomy

A

if intubation required for >3 weeks

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127
Q

Steeple sign

A

subglottic narrowing on neck radiographs seen in croup

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128
Q

microbe that usually causes croup?

A

parainfluenza

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129
Q

Tx of croup?

A

supportive

aerosolized epinephrine and inhaled corticosteroids in severe cases

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130
Q

Bleeding tendency with normal coagulation studies

A

uremia (causes platelet defect), vit c deficiency, chronic steroid use

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131
Q

Tx of hypertrophic cardiomyopathy

A

beta blockers and verapamil allow ventricle to fill

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132
Q

young person or one with minimal smoke exposure with emphysema

A

alpha-1 antitrypsin deficiency

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133
Q

pneumoconiosis that predisposes to TB

A

silicosis

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134
Q

Cause of normal pressure hydrocephalus

A

decreased CSF absorption

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135
Q

Dx of gitelman/Bartter syndromes

A

hypok, alkalosis, and increased urinary K/Cl concentration (defect is in Cl and K resorption)
renin and aldosterone are high due to hypovolemia

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136
Q

bilirubin in the urine indicates

A

conjugated hyperbilirubinemia

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137
Q

EKG findings in RV infarct

A

usually seen along with inferior infarct (II III aVF), but ST depression in I and aVL point to RV infarct

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138
Q

Medications to avoid in RV infarct

A

diuretics and nitroglycerin. W/ SA node involvement in RV infarct, they are dependent on preload for CO and are therefore given fluids

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139
Q

Tx of pagets

A

if symptomatic, bisphosphonates

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140
Q

dysphagia with decrease in lower esophageal sphincter tone and absence of peristaltic waves in the lower two-thirds of the esophagus

A

scleroderma

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141
Q

erythema nodosum in AA female

A

think sarcoid

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142
Q

diabetes, diarrhea, necrotic migratory erythema, weight loss

A

glucagonoma

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143
Q

time to do external cephalic version

A

after 37 wks gestation

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144
Q

Tx of cholangitis

A

supportive care and broad spectrum abx. if they worsen, biliary drainage with ERCP

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145
Q

Steroid dose where there is concern for acute adrenal crisis

A

prednisone >20mg (or its equivalent) for >3 weeks

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146
Q

when is the odds ratio close to the same value as relative risk

A

rare disease

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147
Q

Risk of TPN on gall bladder

A

no CCK release -> no gall bladder contraction -> stasis, stones. decreased enterohepatic circulation in small bowel resection also contributes (-> altered composition of bile)

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148
Q

Surveillance in compensated cirrhosis

A

US for hepatocellular ca +/- AFP q6 months

EDG for varices

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149
Q

Tests for fetal lung maturity

A

lecithin:sphingomyelin ratio > 2

phosphatidyl glycerol present

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150
Q

Complication of meningococcal meningitis

A

waterhouse-friedrichsen syndrome (adrenal hemorrhage -> vasomotor collapse)

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151
Q

Thyroid study results in normal pregnancy

A

Pregnancy -> incr TBG -> increased total T3 and T3, normal free T3 and T4, and normal TSH

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152
Q

How to calculate anion gap? Normal?

A

Na-(bicarb+Cl). Normal = 6-12

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153
Q

Hx c/w celiac (Event blunting of villi), but + travel history

A

tropical sprue

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154
Q

DDx for spherocytes on smear? How to differentiate?

A

HS, autoimmune hemolytic anemia

Coombs test

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155
Q

Vesicles on palm of hand

A

herpetic whitlow

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156
Q

Nocardia Tx

A

trimethoprim-sulfamethoxazole (SNAP)

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157
Q

Actinomyces Tx

A

penicillin (SNAP)

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158
Q

Drug for emergency contraception? When can it be given?

A

levonorgestrel. up to 120 hours after intercourse

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159
Q

Tx of cerebral septic emboli (from endocarditis)

A

abx

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160
Q

Meds a/w pancreatitis

A 
diuretics - furosemide, thiazides
IBD - sulfasalazine, 5-asa(mesalazine)
immunosuppresives - azathioprine, l-asparaginase
seizures - valproic acid
AIDS - didanosine, pentamidine
Abx - metronidazole, tetracycline
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161
Q

Dx of acute angle glaucoma

A

tonometry

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162
Q

test that determines presence of feto-maternal hemorrhage ?

test for amount of hemorrhage? (to determine rho-gam dose)

A

presence - rosette test

amount - Kleihauer-Betke stain

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163
Q

Tx of heavy, active vaginal bleeding in DUB

A

high dose estrogen

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164
Q

Management of congenital diaphragmatic hernia

A

intubate, then decompress stomach/bowel w/ ng tube

Bag valve/blow by O2 contraindicated as it can inflate stomach/bowel and worsen resp status

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165
Q

AE of all 2nd generation antipsychotics

A

metabolic syndrome

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166
Q

AE of ziprasidone

A

metabolic syndrome

QT prolongation

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167
Q

Tx of h. pylori

A

amoxicillin, clarithromycin, PPI

amoxicillin, metronidazole, bismuth, PPI

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168
Q

serologic test for autoimmune hepatitis

A

anti-smooth muscle antibody

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169
Q

serologic test for primary biliary cirrhosis

A

antimitochondrial antibodies

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170
Q

management of penile fracture

A

urethrogram (assess for urethral injury) then surgery

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171
Q

Dx/Tx of hairy cell leukemia

A

Dx: TRAP stain
Tx: Cladribine

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172
Q

illicit drug causing hallucinations and vertical nystagmus

A

PCP

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173
Q

Choice of anticoagulation in AFib

A 
CHADS2 score
CHF, HTN, age>75, DM, Stroke(2pts)
0: no anticoag(preferred) or aspirin
1: anticoagulation(preferred) or aspirin
2+: anticoagulate
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174
Q

Location of gastrin producing tumor in zollinger ellison syndrome?

A

duodenum (70%) or pancreas

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175
Q

Serology for celiac disease

What if negative?

A

IgA antiendomysial and antigliadin antibodies

if negative, think of concurrent IgA deficiency

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176
Q

Tx of tropical sprue

A

folic acid replacement, tetracycline

removal of gluten has no effect

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177
Q

Biopsy results in whipple’s disease

A

jejunal biopsy shows foamy macrophages on periodic acid-schiff stain and villous atrophy

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178
Q

Negative sudan test (no steatorrhea) and low stool pH

A

lactase deficiency

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179
Q

serology in inflammatory bowel disease

A

crohns - ASCA (anti yeast saccharomyces cerevisiae antibodies) frequently positive
UC - pANCA frequently positive

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180
Q

sites of carcinoid tumor

A

bronchopulmonary tree, ileum, rectum, appendix

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181
Q

Lab test for serotonin syndrome

A

urine 5-hydroxyindolacetic acid (5-HIAA)

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182
Q

mutation in FAP, gardner, and turcot syndromes

A

adenomatous polyposis coli (APC) gene

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183
Q

cancers seen in Gardner syndrome

A

FAP(colon) + bone/soft tissue tumors

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184
Q

cancers seen in Turcot syndrome

A

FAP(colon) + CNS tumors

185
Q

What are the colonic polyps seen in peutz-jegher’s syndrome

A

hamartomas w low risk of malignancy

186
Q

What is removed in whipple procedure

A

pancreatic head, duodenum, prox jejeunum, common bile duct, gall bladder, distal stomach

187
Q

Tx of stroke in sickle cell disease

A

exchange transfusion (-> decreased sickling to prevent further infarct). tPA unlikely to help as etiology is sludging, not true thrombus

188
Q

use of leukocyte alkaline phosphatase

A

high in leukemoid reactions, low in CML

189
Q

most common cause of infantile febrile seizures

A

roseola (sixth disease, HSV 6)

190
Q

use of winter’s formula

A

calculate expected PCO2 in metabolic acidosis

PCO2 = 1.5 HCO3 + 8

191
Q

When to use water soluble contrast instead of barium

A

when you expect perforation. Exception: in esophageal perforation, use barium (water soluble causes pneumonitis)

192
Q

Gilbert/Crigler najjar - conj/unconj hyperbilirubinemia?

A

unconjugated

due to deficiency in glucuronosyl transferase, the enzyme which conjugated bilirubin

193
Q

Rotor/Dubin-Johnson - conj/unconj hyperbilirubinemia?

A

conjugated

Due to defect in transporting conjugated bilirubin out of liver

194
Q

what is struma ovarii

A

teratoma that secretes thyroid hormone

195
Q

serology in hashiomoto’s

A

antimicrosomal antibodies

196
Q

features of mccune albright syndrome

A

ovarian cysts, pseudoprecocious puberty, polyostotic fibrous dysplasia of bone, cafe au lait spots

197
Q

management of pheochromocytomas

A

stabilize with alpha, then beta blockers. then remove surgically

198
Q

When to stop pt’s metformin

A

acute renal failure, hepatic failure, or sepsis (all increase chance of developing lactic acidosis)

199
Q

lab test in wilson’s disease

A

low serum ceruloplasmin

200
Q

medications that cause priapism

A

trazadone, prazosin

201
Q

Risk of untreated thyroid toxic adenoma

A

tachyarrhythmias(a-fib), incr osteoclastic activity -> bone loss

202
Q

AE of amiodarone

A

hypo&hyperthyroid, hepatotoxicity, pulmonary fibrosis, corneal deposits, skin discoloration

203
Q

polyarthralgias, tenosynovitis, and vesiculpustular skin lesions

A

disseminated gonococcal infection

204
Q

Kid w/ self limiting episodes of vomiting with no apparent reason w/ fhx of migraine headaches

A

cyclical vomiting

205
Q

What other disorder to think about in an HIV pt with purple skin lesions besides kaposi sarcoma

A

Bartonella -> bacillary angiomatosis (cutaneous and visceral angioma-like blood vessel growths). abx->involution of lesions

206
Q

use of SAAG (serum ascites albumin gradient)

A

if > 1.1 (transudative), ascites is due to portal hypertension

207
Q

Tx of x linked agammaglobulinemia

A

regular infusions of IVIG

208
Q

Risk to offspring of DES exposure

A

adenocarcinoma of vagina/cervix, cercial anomalies, uterine malformations
Males: cryptochordism, microphallus, hypospadias, testicular hypoplasia

209
Q

immunostaining for ALL

A 
terminal deoxynucelotidyltransferase (TdT) - present only in pre b and pre t lymphoBLASTS
The blasts are also PAS-positive
210
Q

Drug that slows progression of ALS

A

Riluzole

211
Q

How to distinguish primary biliary cirrhosis and primary sclerosing cholangitis

A

Gender - PBC female, PSC male
ERCP in PSC shows string of pearls
antimitochondial abs in PBC
UC a/w PSC

212
Q

Tx of type II crigler-najjar

A

this is mild deficiency similar to gilbert

phenobarbital -> incr hepatic synthesis of glucuronyltransferase

213
Q

which type of kidney stone is radiolucent?

A

uric acid stones. Tx: alkalinization of urine w/ oral potassium bicarb/potassium citrate

214
Q

diffuse telangiectasias, recurrent epistaxis, widespread AV malformations

A 
hereditary telenagiectasia (osler-weber-rendu). 
autosomal dominant
215
Q

EKG in pericardial effusion

A

shows electrical alternans, where amplitudes of the QRS complexes vary from beat to beat

216
Q

Abx prophylaxis in HIV pts

A

CD4 < 200: TMPSMX for PCP

<50: azithromycin for MAC

217
Q

Drugs most commonly responsible for SJS/TEN

A

sulfonamides, barbituates, phenytoin, NSAIDs

218
Q

Tx of impetigo

A

topical mupirocin or oral erythromycin

219
Q

test that distinguishes maternal vs fetal blood

A

apt test

220
Q

Tx of cocaine induced chest pain

A

benzos, aspirin, nitro, Ca channel blockers

B blockers are contraindicated

221
Q

First line Tx of OCD

A

SSRI or clompiramine

222
Q

when to perform gonadectomy in androgen insensitivity syndrome

A

after completion of breast development and attainment of adult height (after puberty)

223
Q

Damage to good eye after penetrating image to other eye

A

Sympathetic ophthalmia - due to immunologic mechanism involving recognition of ‘hidden’ antigens

224
Q

Hep B a/w…

A

polyarteritis nodosa, membranous glomerulonephritis

225
Q

Tx of DI

A

central: ADH
nephrogenic: stopping offending medicine, give thiazide diuretics (paradoxically lowers urine output)

226
Q

can’t pee (urethritis due to chlamydial infection), can’t see (uveitis), can’t climb a tree (arthritis)

A

Reiter’s syndrome

227
Q

Serology in scleroderma

A

CREST: anticentromere antibody
diffuse: antitopoisomerase

228
Q

CREST syndrome includes?

Pulmonary manifestation?

A 
calcinosis
Raynaud's
esophageal dysmotility
sclerodactyly (tight skin of fingers and toes)
telangectasias
pulm- interstitial fibrosis
229
Q

medical Tx of prolactinoma

A

bromocriptine, cabergoline, or pergolide (dopamine agonists)

230
Q

renal disease + deafness

A

Alport’s syndrome

231
Q

Preferred Tx of grave’s

A

radioactive iodine (contraindicated in pregnancy and severe ophthalmopathy)

232
Q

AE of OCPs

A

breakthrough bleeding, HTN, thromboembolism

Not weight gain

233
Q

Quad screen results in down syndrome

A

increased b-hcg and inhibin a

decreased MSAFP and estriol

234
Q

Pseudogout a/w ..?

A

hyperparathyroidism

235
Q

Dark (strikingly black) liver

A

dubin-johnson syndrome

236
Q

pt with bilat trigeminal neuralgia, you should think of…

A

MS

237
Q

serology in dermatomyositis

A

anti-Mi-2 (anti helicase)

238
Q

maligancies that -> incr erythropoietin

A

renal cell carcinoma
hepatocellular carcinoma
pheochromocytoma
hemangioblastoma

239
Q

causes of normal anion gap acidosis

A

diarrhea, RTA, TPN, hypoaldosteronism

240
Q

Causes of anion gap acidosis

A 
MUDPILES
methanol
uremia
DKA
Paraldehyde
Isoniazid/Iron
Lactic acidosis
ethanol/ethylene glycol
salicylates
241
Q

causes of metabolic alkalosis

A

vomiting, diuretics, cushing, hyperaldosteronism, adrenal hyperplasia

242
Q

causes of hypernatremia

A 
6 D's
diuretics
dehydration
DI
docs (iatrogenic)
diarrhea (and vomiting)
disease of kidney - hyperaldosteronism
243
Q

Calculate expected rise in Na with correction of hyperglycemia

A

add 1.6 to Na level for every 100 mg/dL glucose >100. (i.e. if 300, add 3.2)

244
Q

Sx of serum sickness

A

fever, urticarial rash, polyarthalgia, lymphadenopathy. occurs 10 days after administration of drugs i.e. penicillin, amox, TMPSMX, cafaclor in the setting of viral illness

245
Q

Tx of lyme? What if pregnant or <8 yo?

A

doxycycline

preg / <8yo - amoxicillin

246
Q

dysphagia, iron deficiency anemia, glossitis

A

plummer vinson syndrome (dysphagia due to esophageal web)

247
Q

Amsel criteria for dx of BV

A 
3/4 of:
thin, gray-white vaginal discharge
vaginal pH > 4.5
whiff test with KOH
clue cells
248
Q

Pt with pneumonia picture s/p bone marrow transplant (+/- colitis)

A

CMV pneumonitis

249
Q

What to do with contacts of pt w/ pertussis

A

all close contacts get erythromycin for 14 days, regardless of age, immunization, or symptoms

250
Q

Tx of dermatitis herpetiformis

A

gluten fre diet and dapsone

251
Q

dry and rough skin with horny plates over extensor surfaces of the limbs (lizard skin)

A

ichthyosis vulgaris

252
Q

Workup of primary amenorrhea after ultrasound

A

uterus present - FSH. if increased, karyotype. if decreased, cranial MRI
uterus absent - karyotype

253
Q

Dx/Tx of enterobius vermicularis

A

this is pinworm, so positive scotch tape test

albendazole

254
Q

IgM spike on electropharesis + hyperviscosity of blood

A

waldenstrom’s macroglobulinemia (remember MM is high IgA/IgG)

255
Q

testicular pain relieved by supporting scrotum

A

points towards epididymitis over torsion

256
Q

when to perform orchiopexy in cryptochordism

A

prior to age 5

257
Q

What is the cause of leukocyte adhesion defect?

A

deficient expression of CD18 by leukocytes

258
Q

Pt with sickle cell disease or trait with nocturia

A

hyposthenuria - sickling in vasa recta -> impaired free water reabsorption

259
Q

Tx of myasthenia gravis

A

pyridostigmine (edrophonium is for Dx only)

260
Q

Site of ectopic foci that cause a-fib?

A

pulmonary veins

261
Q

CSF finding in MS

A

oligoclonal bands

262
Q

metabolic abnromalities seen in hypothyroidism

A

hyperlipidemia, hyponatremia, asymptomatic elevations in CK, ALT, AST

263
Q

bilateral solid ovarian masses during pregnancy

A

pregnancy luteoma. benign, may cause hirsutism

264
Q

Complications seen in acromegaly

A

heart failure, DM, spinal cord compression, vission loss 2/2 pressure of tumor on optic nerve

265
Q

GH should increase with ? and decrease with ?

A

should increase with insulin, and decrease with glucose administration

266
Q

adrenal insufficiency + incr skin pigmentation

A

addison’s disease (autoimmune destruction)

267
Q

CAH that leads to aldosterone production only (amenorrhea in females, ambig genitalia in males)

A

17-a hydroxylase deficience

268
Q

CAH that leads to sex hormone production only (+/- hypotension due to lack of mineralcorticoids)

A

21-a hydroxylase deficiency

269
Q

CAH that leads to sex hormone overproduction and HTN due to some mineracorticoid excess

A

11-a hydroxylase deficiency

270
Q

infant with poor feeding, jaundice, umbilical hernia, hypotonicity

A

think of cretinism (congenital hypothyroid)

271
Q

things that shift hemoglobin curve to the right

A

-> increased O2 delivery to tissues

acidosis, incr temp, high altitude, exercise

272
Q

types of cells that are lymphoid in origin

A

T: prothymocyte, t lymphoblast, t cells
B: pre-b, b lymphoblast, b-cell, plasma cell

273
Q

drugs that cause hemolytic anemia

A

penicillin, methyldopa, quinidine

274
Q

drugs that decr folate

A

methotrexate, trimethoprim, phenytoin

275
Q

antipseudomonals

A

cefepime, pip/tazo, aztreonam, ciprofloxacin, imipenem/cliastatin, gentamycin

276
Q

premalignant lesion leading to squamous cell carcinoma of the skin

A

actinic keratosis

277
Q

incr risk of cholangiocarcinoma

A

ulcerative colitis, liver flukes (clonorchis)

278
Q

clues to histiocytosis

A

CD1 positive cells with birbeck granules(tennis racket inclusions)

279
Q

Niemann-Pick vs Tay Sacks

A

Both: Cherry red macula, loss of milestones/retardation
Tay Sachs: Hexosaminidase A. hyperacusis, seizures.
Niemann Pick: Sphingomyelinase. protruding abd, hepatosplenomegaly, lymphadenopathy

280
Q

Triad of kartegener’s

A

recurrent sinusitis, bronchiectasis, dextrocardia

281
Q

Tx of CML

A

imatinib (tyrosine kinase inhibitor)

remember 9:22 translocation (philadelphia chromosome) -> abnormal tyrosine kinase activity

282
Q

Pts with hashiomotos at incr risk for?

A

thyroid lymphoma

283
Q

Tx for hep C

A

peginterferon + ribavirin +/- protease inhibitor (-avir)

284
Q

large number of mulluscum contagiosum lesions should make you think of…

A

HIV (also seen in corticosteroid use/chemotherapy)

285
Q

causes of sideroblastic anemia (ringed sideroblasts on smear)

A

genetic disorder in heme synthesis or alcohol, isoniazid, lead poisoning

286
Q

mnemonic for types of hypersensitivity reactions

A

ACID: anaphylaxis, complement mediated (aka antibodies), immune complex mediated, delayed (t-cell/macrophages)

287
Q

clotting factors not synthesized by the liver

A

vWF and factor VIII

288
Q

MOA of clopidogrel/ ticlopidine

A

block ADP receptors to suppress fibrinogen binding to site of injury

289
Q

MOA of abciximab

A

inhibits platelet GP IIB/IIIa receptors to block platelet aggregation

290
Q

decreased ristocetin cofactor activity

A

von willibrand disease

291
Q

recommendation for contact sports w/ mono

A

refrain until spleen no longer palpable (usually 1-3 months)

292
Q

Tx of needle stick

A

prophylactic zidovudine and lamivudine +/- protease inhibitor
HIV Ab testing immediately, 6 wks, 3 months, and 6 months after exposure

293
Q

management of infant born to HIV mother

A

zidovudine given to mother during labor, and infant for 6 weeks after birth. Test for presence of virus (not anti-HIV which will be present from mother) in first 6 months of life

294
Q

HIV with odynophagia

A

candida esophagitis (white plaques), CMV (deep, linear ulcers), herpes, aphthous ulcers

295
Q

MOA of raltegravir

A

integrase inhibitor (inhibits HIV integration into host DNA)

296
Q

MOA of enfuvirtide

A

fusion inhibitor (inhibits viral ability to fuse with CD4 and enter cell)

297
Q

MOA of miraviroc

A

CCR5 inhibitor (blocks entry into cell)

298
Q

drugs that improve fertility in PCOS

A

clomiphene, metformin

299
Q

Tx for fibromyalgia

A

exercise

TCAs (amitriptyline). pregabalin, duloxetine, milnacipran are alternatives.

300
Q

back pain + restrictive PFT pattern

A

Ankylosing spondylitis

301
Q

if hypokalemia is difficulty to correct, think of…

A

hypomagnesemia

302
Q

pt reports that straight grid lines appear curved

A

macular degeneration (also see drusen deposits)

303
Q

Tx options for neutropenic fever

A

ceftazidime, cefepime, imipenem, meropenem, pip/tazo, or combo therapy (antipseudomonal beta lactam + aminoglycoside)

304
Q

w/ Dx of mononucleosis, also consider

A

acute HIV infection

305
Q

most common sequela of meningitis

A

hearing loss. need hearing eval after resolution

306
Q

steeple sign on lateral neck xray

A

croup (laryngotracheitis caused by parainfluenza virus)

307
Q

pseudomembranes in oral cavity + myocarditis

A

diphtheria

308
Q

auer rods

A

AML

309
Q

Tx of chlamydial conjunctivitis or pneumonia in newborn

A

oral erythromycin, despite risk of pyloric stenosis

310
Q

timing of gonococcal vs chlamydial conjunctivitis

A

gonococcal - day 3-5 of life

chlamydial - day 5-14

311
Q

management of bed wetting

A
  1. behavior modifications (no caffeine, no drinking before bed, reward system)
  2. enuresis alarm
  3. desmopressin
  4. TCAs (imipramine)
312
Q

Tx of cancer related anorexia/cachexia

A

progesterone analogs (megestrol acetate and medroxyprogesterone acetate) +/- steroids

313
Q

Triad of wiskott-aldrich? inheritance pattern?

A

thrombocytopenia, eczema, recurrent bacterial infections

x linked recessive

314
Q

how is anti-rH antibody titer measured? cutoff for rhogam?

A

not useful if titer is > 1:6, which means sample diluted 6 times shows no antibodies. 1:6 solution has more antibodies than 1:2, which shows no antibodies after being diluted twice

315
Q

meds to hold for 48 hrs prior to first cardiac stress test

A

b blockers, ca channel blockers, nitrates

316
Q

differentiating methanol vs ethylene glycol ingestion

A

both-anion gap metabolic acidosis
methanol - dmgs the eyes
ethylene glycol - dmgs the kidneys

317
Q

describe fetal hydantoin syndrome (seen w/ phenytoin use in pregnancy)

A

small body size, microcephaly, digital&nail hypoplasia, midfacial hypoplasia, clefting, hirsutism, rib anomalies

318
Q

Reed sternberg cells (owl eyes) on lymph node biopsy

A

hodgkin lymphoma

319
Q

starry sky appearance on lymph node biopsy

A

burkitt lymphoma (EBV related, t[8;14])

320
Q

fragile skin, photosensitivity, vessicles/erosions on the dorsum of the hands

A

porphyria cutanea tarda - screen for HCV due to strong association

321
Q

extrahepatic sequelae of HCV

A

porphyria cutanea tarda, cryoglobulinemia -> membranoproliferative glomerulonephritis, lichen planus, leukocytoclastic vasculitis

322
Q

inability to release hand after handshake

A

myotonic muscular dystrophy. autosomal dominant

323
Q

Rocky mountain spotted fever minus rash

A

ehrlichiosis. Tx: doxycycline

324
Q

Tx of scabies

A

permethrin cream to whole body. tx all contacts as well. Preferred over lindane due to it’s neurotoxicity.

325
Q

Tx of tinea versicolor

A

selendium sulfide shampoo or topical imidazoles

326
Q

Tx of lice

A

permethrin cream

327
Q

Tx options for acne (in order)

A

topical benzoyl peroxide
topical clindamycin, oral tetracycline/erythromycin
topical tretinoin
oral isotretinoin

328
Q

Tx of rosacea

A

topical metronidazole or oral tetracycline

329
Q

psych disorder where people pull out their hair

A

trichotillomania

330
Q

pruritic, purple, polygonal papules on the legs +/- oral mucosal lesions

A

lichen planus

331
Q

location of CN nuclei

A

3,4: midbrain
5-8: pons
9-12: medulla

332
Q

kid with cough >2 weeks without clear cause + one of: paroxysmal cough, inspiratory whoop, or post-tussive emesis?
confirmatory test?

A

pertussis
during first 4 weeks of illnes, nasopharyngeal culture and/or PCR
after 4 weeks of Sx, serology

333
Q

Tx of pertussis?

A

macrolide abx - do not wait for lab confirmation before starting

334
Q

Tx of frequent PVCs

A

asymptomatic: none
symptomatic: b blockers

335
Q

cause of outflow obstruction in hypertrophic cardiomyopathy

A

hypertrophied interventricular septum and abnormal motion of mitral valve leaflets referred to as systolic anterior motion (SAM)

336
Q

Causes of pulseless electrical activity (PEA)

A 
Hypovolemia
Hypoxia
Hyper/hypokalemia
Hyperthermia
Hydrogen ions (acidosis)
Tamponade
Tension pneumothorax
Thrombosis (MI/PE)
Tablets/toxins
337
Q

Veins accessed for pulmonary artery catheter (swan ganz)

A

L subclavian or R internal jugular vein

338
Q

cause of nonhemoltyic febrile transfusion reactions? Tx?

A

antibodies to human leukocyte antigens (HLAs)

acetaminophen

339
Q

cause of delayed hemolytic transfusion reactions? (delayed 2-10 days after transfusion)

A

antibodies to Kidd or D (Rh) antibodies

340
Q

cause of acute hemolytic transfusion reaction?

A

antibodies to ABO groups (clerical error)

341
Q

Tx of idiopathic intracranial hypertension (pseudotumor cerebri)

A

acetazolamide (blocks choroid plexus carbonic anhydrase -> decr CSF production) +/- furosemide is 1st line
If failed, optic nerve sheath decompression or lumboperitoneal shunting
steroids and serial LPs only used as bridging Tx due to AEs

342
Q

Tx of bipolar disorder

A

atipycal antipsychotics
lithium
valproic acid
can use any as monotherapy or atypical antipsychotic + one of the others for more severe disease

343
Q

flushing of face with hot drinks, heat, emotion

A

rosacea

344
Q

labs distinguishing folate and B12 deficiencies

A

both cause elevated homocysteine (involved in conversion of homocysteine to methionine)
B12 also causes elevated methylmalonic acid (involved in conversion of methylmalonyl-coa to succinyl-coa)

345
Q

Tx of variant (prinzmetals) angina

A

Ca channel blockers/nitrates

avoid nonselective b blockers and aspirin as they can promote vasoconstriction

346
Q

type of conversion disorder where woman thinks she’s pregnant, but isnt

A

pseudocyesis

347
Q

Jervell lange nielson syndrome?

A

autosomal recessive prolonged QT syndrome + deafness

Tx: b-blocker +/- pacemaker

348
Q

Tx of diabetic neuropathy

A

TCAs. alternative is gabapentin

349
Q

worrisome sequela of pseudotumor cerebri

A

vision loss

350
Q

wrist/foot drop, think of…

A

lead toxicity

351
Q

cause of hereditary angioedema? Tx?

A

autosomal dominant deficiency of C1 esterase inhibitor
acute Tx: subq epineprhine
long term Tx: androgens -> incr liver production of C1 esterase inhibitor

352
Q

description of internuclear ophthalmoplegia

A

seen in MS due to demyelination of the medial longitudinal fasciculus
On lateral gaze in both directions, whichever eye is abducted has horizontal nystagmus

353
Q

Tx of psotpartum endometritis

A 
polymicrobial infection
IV clindamycin (anaerobes + gram +'s) and gentamycin (gram -'s)
354
Q

Tx of toxic megacolon in UC

A

prompt IV steroids, NG decompression, fluid management, bowel rest

355
Q

Tx of graft vs host disease

A

acute: steroids, tacrolimus, mycophenolate
chronic: thalidomide, hydroxychloroquine

356
Q

prophylaxis for contacts of pt with neisseria meningitis

A

rifampin or ciprofloxacin

357
Q

round eosinophilic inclusions in neurons

A

negri bodies, seen in rabies

lewy bodies, seen in parkinson’s & lewy body dementia

358
Q

Chediak higashi syndrome?

A

AR defect in microtubule polymerization -> giant granules in neutrophils, infections, oculocutaneous albinism

359
Q

herpes zoster in young adult, think…

A

HIV

360
Q

chronic mucocutaneous candidiasis a/w ?

A

hypothyroidism

361
Q

cause of isolated systolic hypertension seen in the elderly

A

decreased elasticity of the arterial wall

362
Q

Live vaccine that can be given to HIV pts

A

MMR

363
Q

A-a gradient calculation

A

(PAO2) - (PaO2) = (150-PaCO2/0.8) - PaO2

Nl is <15

364
Q

Tx of MS

A

Acute: steroids
chronic: beta-interferon or glatiramer acetate

365
Q

Why do atypical antipsychotic meds have less extrapyramidal side effects?

A

Along with D2 blockade, they also bind to serotonin receptors

366
Q

joint pain in hand, dactylitis (sausage digit), nail involvement

A

psoriatic arthritis

367
Q

contraindications to buproprion

A

seizure hx or hx of anorexia/bulimia which predispose to seizures

368
Q

low T3 with normal TSH & T4 after a severe illness

A

sick euthyroid syndrome

369
Q

Tx of hepatic encephalopathy

A

lactulose, rifaximin, laxatives

370
Q

contraindications to succinylcholine

A

hyperkalemia, or pts at risk for it (burn, crush injury, guillan barre, tumor lysis)

371
Q

metabolic side effects of HCTZ

A

hyperglycemia, incr LDL and triglycerides

hyponatremia, hypokalemia, hypercalcemia, hyperuricemia

372
Q

umbilicated vesicles after being treated for atopic dermatitis

A

eczema herpeticum (form of primary HSV). can be life threatening, Tx with acyclovir promptly

373
Q

Chondrocalcinosis can be cause by ?

A

idiopathic (pseudogout), hypomagnesemia, hyperparathyroidism, hemochromatosis

374
Q

screening test for PKU

A

Guthrie test of the urine, tests metabolic products of phenylalanine

375
Q

lab test for recurrent MI

A

CK-MB (typically returns to normal after 1-2 days). Troponin T takes 10

376
Q

AE of hydroxychloroquine

A

retinopathy - requires eye exams every 6 months

377
Q

Tx of beta blocker toxicity

A

First, IV fluids and atropine. Then, glucagon

378
Q

seborrheic dermatitis a/w?

A

parkinsonism or HIV

379
Q

EKG finding with digitalis toxicity

A

atrial tachycardia with AV block

380
Q

DDx for anterior mediastinal mass

A

thymoma, teratoma, thyroid cancer, terrible lymphoma

381
Q

How to differentiate between AS and MR murmurs

A

hand grip increases MR and decreases AS

382
Q

Cancers seen in Lynch syndrome

A

colon, endometrial

383
Q

physical exam test to differentiate liver vs cardiac cause of peripheral edema

A

hepatojugular reflux

384
Q

Defect in huntington’s disease

A

autosomal dominant. multiple CAG repeats on chromosome 4

385
Q

Tx of alzheimer’s

A

cholinesterase inhibitors (donepezil, rivastigmine, galantamine)
memantine
occupational therapy

386
Q

NF 1 mnemonic

A 
Cafe au lait spots
Optic glioma
Freckling
Fam Hx (AD)
Iris hamartomas
Skeletal lesions
387
Q

Tumor seen in NF 2

A

bilateral acoustic schwannoma (also get cataracts)

388
Q

Tx of narcolepsy

A

Modafinil (preferred), methylphenidate, meoline
TCAs to prevent cataplexy
regular sleep cycle w/ naps

389
Q

amniotic labs in neural tube defect

A

increased amniotic AFP and acetylcholinesterase

390
Q

differentiating etiologies of hematuria based on timing in the stream

A

initial - urethral damage
terminal - bladder/prostatic damage
total - renal/ureter damage

391
Q

persistent ST elevation months after an MI

A

think of ventricular aneurysm

392
Q

how to differentiate surreptitious vomiting from other causes of hypokalemia like diuretic abuse/bertter’s/gittlemans’

A

urinary chloride will be low in vomiting, high in others

393
Q

newly dx’ed myasthenia gravis, what to do next

A

chest ct for thymoma

394
Q

Lab test to confirm heparin induced thromboycytopenia

A

serotonin release assay

395
Q

Lifestyle modifications for tx of HTN in order of effectiveness

A 
weight loss
dash diet
exercise
limit sodium
limit alcohol
396
Q

Tx of cluster headaches

A

prophylaxis: verapamil. lithium, ergotamine
acute: 100% O2, subq sumatriptan

397
Q 
give Dx:
Muddy brown casts
RBC casts
WBC casts
Fatty casts
Broad/waxy casts
A 
muddy brown - ATN
RBC - glomerulonephritis
WBC - interestitial nephritis or pyelonephritis
fatty - nephrotic syndrome
broad/waxy - CRF
398
Q

CT showing multiple minute punctate hemorrhages with blurring of grey/white junction

A

diffuse axonal injury

399
Q

Meds that cause hyperkalemia

A 
nonselective b-blockers
ACE-Is/ARBs
K sparing diuretics
digoxin
NSAIDs
400
Q

AE of levodopa/carbidopa

A

early: agitation, dizziness, hallucinations

late (5-10 yrs into therapy): involuntary movements

401
Q

pt with frequent changing of lens perscriptions

A

consider glaucoma

402
Q

Tx of exudative macular degeneration

A

ranibizumab (anti veg F Ab)

laser photocoagulation

403
Q

Tx of breast cancer with HER2 amplification (after surgery)

A

trastuzumab

404
Q

Tx options for primary hyperaldosteronism

A

adrenal adenoma: surgery

bilat adrenal hyperplasia or non surgial candidate: spironolactone or eplerenone

405
Q

lab markers in paget’s disease (of bone)

A

alk phos: measurement of bone formation
urinary n telopeptide: measurement of bone breakdown
increased urinary hydroxyproline

406
Q

Dx of acute intermittent porphyria

A

urine porphobilinogen

407
Q

Tx of essential tremor

A

b blocker or primidone

primidone may precipitate acute intermittent porphyria

408
Q

PID in patient with IUD

A

consider actinomyces as cause

409
Q

contraindications to HRT

A

unexplaiend vaginal bleeding
active liver disease
Hx of thromboembolism
Hx of endometrial or breast cancer

410
Q

electrolyte abnormalities seen in refeeding syndrome

A

hypokalemia, hypophosphatemia, hypomagnesemia

411
Q

small erythematous macule that progresses rapidly to larger, nontender nodules with necrosis (espec in immunocompromised)

A

ecthyma gangrenosum - caused by pseudomonas

412
Q

does cardiac tamponade have to be from bleeding?

A

no - remember viral pericarditis as a cause

413
Q

Describe the CSF fluid in an exudate 2/2 TB & differentiate from empyema

A

yellow fluid (not purulent), very high protein (>4), lymphocytic predominant, and glucose level just below serum level.

414
Q

Tx of stable ventricular tachycardia

A

amiodarone

415
Q

Tx of stable supraventricular tachycardia

A

adenosine

416
Q

What prophylactic Tx do ppl need after gastric bypass

A

ursodeoxycholic acid reduces risk of gall stones from 40% to 2%. Can also just take their gall bladder during the surgery.

417
Q

URI followed by nephritis - which 2 are high on ddx?

A

PSGN or IgA nephropathy

418
Q

what labs will you see in chronic kidney disease (regarding parathyroid gland)

A 
high phos (kidney can't secrete)
low Ca (low vit D)
high PTH (parathyroid hypertrophy 2/2 low Ca)
This -> renal osteodystrophy
419
Q

differentiate somatic and visceral pain

A

somatic - well localized (peritoneal irritation)

visceral - vague (stretching of abd viscera in SBO)

420
Q

MOA of rituximab

A

anti CD20 ab. used in Tx of CLL

421
Q

Sx of selenium deficiency

A

cardiomyopathy

422
Q

Sx of vitamin A deficiency

A

blindness, dry skin, impaired immunity

423
Q

Sx of zinc deficiency

A

alopecia, skin lesions, abnormal taste, impaired wound healing, impaired growth in kids

424
Q

things that increase thyroxine requirement in hypothyroid pts

A

pregnancy

estrogen replacement therapy

425
Q

Tx of cat scratch disease

A

organism is bartonella

Tx is azithromycin

426
Q

describe juvenile myoclonic epilepsy

A

absence seizures begin around age 10, which progress to myclonic at 15 and generalized tonic clonic at 16. frequent limb jerking in the morning that is worsened by sleep deprivation

427
Q

progression of EKG changes in hyperkalemia

A

peaked T waves, flattening of p wave, widening of QRS, sine wave, arrest

428
Q

raloxifene effects

A

estrogen agonist on bone - 1st line agent for prevention of osteoporosis
estrogen antagonist on breast and vaginal tissue (decreases breast ca risk)
no change in endometrial ca risk
increases thromboembolism risk

429
Q

pt w/ nephrotic syndrome suddenly gets worse w/ hematuria

A

consider renal vein thrombosis (from loss of ATIII). most commonly caused by membranous glomerulonephritis

430
Q

what type of RBC transfusion should be given to someone w/ previous febrile nonhemolytic transfusion rxn?
IgA deficiency?
BMT recipients?

A

leukoreduced (also decreases CMV transmission and HLA alloimmunization)
washed
irradiated

431
Q

clubbing in a pt w/ COPD

A

lung cancer

432
Q

management of pt with ASCUS on pap smear

A

21-24: repeat in 1 yr

>24: HPV test. pos, colpo. neg, repeat pap+HPV in 3 yrs

433
Q

Tx of pen allergic pt with syphilis

A

doxycycline

if pregnant, desensitization then penicillin

434
Q

UTI with alkaline urine

A

proteus. may cause struvite stones

435
Q 
AE of these HIV meds:
lamivudine
abacavir
didanosine
efavirenz
A

lamuvidine - relatively few, but hepatotoxicity can occur
abacavir - lactic acidosis, hepatitis, hypersensitivity rxn w/ high mortality rate
didanosine - pancreatitis
efavirenz - insomnia with vivid, bizarre dreams

436
Q

imaging study in stable pt after chest trauma w/ mediastinal widneing? unstable?

A

TEE or chest CT

thoracotomy

437
Q

lipid lowering med most effective for triglycerides

A

fibrates

438
Q

Effects of OCPs on ca risk

A

decr risk - ovarian and endometrial

slightly incr risk - breast and cervical

439
Q

pathways involved in schizophrenia

A

mesolimbic (too much dopamine) - positive symptoms
mesocortical (too little dopamine) - neg symptoms
nigrostriatal - EPS
tubuloinfundibular - hyperprolactinemia

440
Q

purple grey metallic rash over sun exposed areas and jaundice in a person on antipsychotics

A

chlorpromazine AE

441
Q

prolonged QT and pigmentary retinopathy in a person on antipsychotics

A

thioridazine AE

442
Q

Tx of akathisia due to antipsychotic

A

propranolol (1st line)

benzos

443
Q

Which antipsychotics don’t affect weight?

A

ziprasidone (prolongs qtc)

aripiprazole (incr akathisia)

444
Q

antipsychotic most a/w weight gain?

A

olanzapine

445
Q

antipsychotic w/ highest risk for EPS and prolactinemia

A

risperidone

446
Q

antipsychotic that causes orthostasis and cataracts

A

quetiapine (alpha blocking properties)

447
Q

meds that might cause depression

A

b blockers, a-methyldopa, IFN, OCPs, drugs of abuse

448
Q

MOA of buproprion

A

Dopamine/norepi reuptake inhibitor

449
Q

Tx of hypertensive crisis with MAOIs

A

phentolamine (a blocker)

450
Q

bipolar pt develops n/v/d, coarse tremor, ataxia, confusion, slurred speech

A

lithium tox. usually precipitated by NSAIDs (use aspirin or sulindac instead)

451
Q

EKG in lithium tox

A

t wave flattening or inversion

u waves

452
Q

Tx of PTSD nightmares (besides SSRI)

A

a blocker (ie prazosin)

453
Q

antipsychotic a/w hypothermia (disrupts shivering mechanism)

A

fluphenazine

454
Q

differentiating laryngomalacia vs vascular ring

A

laryngomalacia - worse in supine. improves in prone

vascular ring - improves with neck extension, a/w cardiac abnormalities (50%)

455
Q

Tx of meniere’s

A

1st line: low salt diet

diuretics, antihistamines, anticholinergics

456
Q

1st test to order w/ new onset torticollis in children

A

cervical spine radiographs to r/o spine fracture/dislocation

457
Q

indicators of poor nutitrion

A

weight loss
albumin
transferrin

458
Q

DOC for wolf parkinson white

A

procainamide

Medicine (6 decks)

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