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STEP 2 CK > STEP 2 CK > Flashcards

STEP 2 CK Flashcards

0
Q

Anti-jo-1 ab

A

Dermatomyositis

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1
Q

Anti-mi-2 ab

A

Dermatomyositis

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2
Q

Complement-mediated diseases

A 
PAM IS Crying
Post-infectious glomerulonephritis
Atheroembolic dx
MPGN
Infectious endocarditis
SLE
Cryoglobulinemia
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4
Q

ACh receptor ab

A

Myesthenia gravis

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5
Q

C-ANCA ab

A

Wegener’s granulomatosis (granulomatosis with polyangiitis)

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5
Q

ACE level blood test

A

Sarcoidosis

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6
Q

Anti-smooth muscle ab

A

Autoimmune hepatitis

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7
Q

MELD Score

A

Prediction of 3 mo mortality - bili/INR/Cr
MELD=3.78[ln(serum bilirubin)]+11.2[ln(INR)]+[ln(serum creatinine)]+6.4
40+ = 70%
30-39 = 50%
20-29 = 20%

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8
Q

Lupus criteria

A 
SOAP BRAIN MD (4/11)
Serositis
Oral ulcers
Arthritis
Photosensitivity
Blood (any -penia, anemia)
Renal dx
ANA+
Immuno (+ anti-Smith/dsDNA/phospholipid)
Neuro
Malar rash
Discoid rash
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9
Q

CA 15-3

A

Breast ca

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10
Q

Light’s criteria

A 
Transudate versus exudate
PFprotein:Sprotein > 0.5
PF LDH:S LDH > 0.6
PF LDH > 2/3 upper limit of nl for S LDH
T: inc hydrostatic or dec oncotic pressure
E: inc capillary permeability
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11
Q

CREST syndrome

A 
Calcinosis
Raynaud's phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasias
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12
Q

CEA tumor

A

Colon cancer

General adenocarcinomas

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13
Q

Anti-TPO ab

A

Hashimoto’s thyroiditis

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15
Q

Cyclic citrallinated peptide (CCP) ab

A

Rheumatoid arthritis

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15
Q

Enolase tumor

A

Small cell carcinoma

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16
Q

AFP tumor

A

Hepatocellular carcinoma

Gonadal cancers

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17
Q

Beta HCG tumor

A

Choriocarcinoma

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18
Q

CA 19-9

A

Pancreatic cancer

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19
Q

Anti-jo ab

A

Polymyositis

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20
Q

CHA2DS2-VASc score

A 
0 low, 1 moderate, 2+ high risk
CHF
HTN
Age (75+)                          2 pts
DM
Stroke/CVA/VTE               2 pts
Vascular dx
Age (65-74)
Sex (F)
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21
Q

Cryptosporidium parvum

A

Diarrhea in HIV, watery, emerging cause of traveler’s diarrhea too when considering a trip to somewhere with poor sanitation and exposure to wilderness and bodies of water
Tx nitazoxanide

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22
Q

Well’s criteria for DVT

A

Pretest probability of DVT (0-1 unlikely, 2+ likely [30%])
1 pt: active cancer, 3+ cm uneven calf swelling, swollen unilateral superficial veins, unilateral pitting edema, hx of DVT, swollen entire leg, tenderness along deep vein, immobilization, bedridden/post-op
-2 pts: other dx more likely

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23
Q

HIV ADR: indinavir

A

Crystal-induced nephropathy

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24
Q

Well’s criteria for PE

A

Pretest probability of PE (0-1 15%, 2-5 30%, 6+ 60%)
3 pts: clinical signs of DVT, other dx less likely than PE
1.5 pts: tachycardia 100+

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25
Q

Anti-centromere ab

A

Scleroderma

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26
Q

HIV ADR: didanosine

A

Pancreatitis

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27
Q

HIV ADR: abacavir

A

Hypersensitivity syndrome

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28
Q

HIV ADR: NRTIs

A

Lactic acidosis

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29
Q

HIV ADR: NNRTIs

A

Steven-johnson syndrome

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30
Q

HIV ADR: nevirapine

A

Liver failure

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31
Q

MI Classifications

A
  1. Ischemia due to plaque rupture
  2. Ischemia due to O2 demand mismatch
  3. Sudden cardiac death
  4. a/w angioplasty or stenting
  5. a/w CABG
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32
Q

Blastomycosis

A

Mississippi/Ohio river valley
Broad-based budding yeast
Wart-like skin lesions, ulcers, respiratory dx, osteomyelitis, prostate

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33
Q

Nocardia

A 
Weakly acid fast
Gram + rods, aerobic
Filamentous branching
Pna (cavitations), brain, soft tissue
HIV, immunocompromised
Tx w bactrim
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34
Q

CA-125

A

Ovarian cancer

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35
Q

CRAB

A 
Multiple myeloma
HyperCalcemia
Renal impairment
Anemia/marrow full of malignant cells
Bone issues
Dx immune electrophoresis THEN BM bx
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36
Q

Beta-2 microglobulin

A

Multiple myeloma

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37
Q

Histoplasmosis

A 
Mississippi/Ohio river valley
Asymptomatic or mild pulmonary infx
Papular crusting skin lesions, non-caseating granulomas
Bird/bat droppings
Septated hyphae
Dx w urine or serum antigen (fastest)
Tx w itraconazole
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38
Q

Anti-topoisomerase-1 ab

A

Systemic sclerosis/scleroderma

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39
Q

Coccidioidomycosis

A

Desert SW/central valley CA
Spore inhalation
Dimorphic fungus
CNS dissemination

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40
Q

Cosyntropin test

A

ACTH analogue testing for primary AI

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41
Q

Aspergillosis

A

Mold, lung involvement, immunocompromised patient
No skin lesions
Mobile cavitary lung mass
“Halo sign” or air crescent lesions on CT

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42
Q

Actinomyces

A 
Gram + rods, branching
Anaerobic
Head and neck abscesses
Yellow sulfur granules
Tx w penicillin
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43
Q

Celiac dz tests

A

Anti-TTG
Antiendomysial
IgA antigliadin

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44
Q

TSH immunoglobulin

A

Grave’s dx

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45
Q

Anti-mitochondrial ab

A

Primary biliary cirrhosis (PBC)

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46
Q

Calcitonin tumor marker

A

Medullary thyroid cancer

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47
Q

FAMES warfarin drug interactions

A 
Fluconazole
Amiodarone
Metronidazole
Erythromycin
Sulfa drugs

Tylenol

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48
Q

CA 27-29

A

Breast ca

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50
Q

Serum osmolarity

A

Sosm = 2Na + (BUN/2.8) + (Glc/18)

Normal 275-295

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50
Q

SIADH criteria

A 
Euvolemic hyponatremia
Decreased serum osmolarity
Increased urine osmolarity
Increased urine sodium concentration
Failure to correct with NS IVF
a/w small cell lung cancer
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51
Q

3 major post-MI complications

A

LV free wall rupture to pericardial tamponade
Papillary muscle rupture to MR
Interventricular septum rupture

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52
Q

Tumor lysis syndrome (K, PO4, Ca, uric acid)

A

Inc (intracellular)
Inc (intracellular)
Dec
Inc

PO4 binds Ca, K released, uric from protein degradation

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53
Q

Hyperkalemia tx

A
  1. Calcium gluconate if EKG changes
  2. Drive into cells w insulin/glc, beta2 agonist, NaHCO3
  3. Excrete with NS and loop diuretic, cation resin (kayexelate, sodium polystyrene sulfonate), hemodialysis
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54
Q

Hydatid cyst

A

Echinococcus
a/w dog exposure
Eggshell calcifications
Surgery + albendazole coverage

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55
Q

HLA-B27

A

Ankylosing spondylitis
Young female
Stiff in AM gets better
Anterior uveitis

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56
Q

Nephrotic syndromes

A

FSGS- black/hispanic, obese, HIV, heroin, crescent formation
Membranous nephropathy- adenocarcinoma, NSAIDs, HBV, SLE
MPGN- HBV, HCV, subepithelial spikes and domes
MCD- NSAIDs, lymphoma, podocyte effacement
IgA nephropathy- URI

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57
Q

Rotor syndrome

A

Benign hyperbilirubinemia, conjugated
No hepatic pigmentation
Hepatic storage defect

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58
Q

Gilbert’s syndrome

A

Unconjugated hyperbilirubinemia
Defect in conjugation within hepatocytes
No apparent liver dx

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59
Q

Crigler-najjar syndrome

A

Type 1 severe w neuro dx, death, encephalopathy, bili 25-50

Type 2 not as severe, bili

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60
Q

Bullous pemphigoid

A

Benign, itchy, tense blisters (not flaccid)
No oral
IgG and C3 at dermal epidermal junction (subepi)

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61
Q

Pemphigus vulgaris

A 
Skin and mucous membranes
Flaccid bullae, painful, erosive
Positive Nikolsky's sign (sloughing)
Anti-desmoglein abs form
Intercellular IgG deposits in epidermis (intra epi)
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62
Q

Anti-desmoglein ab

A

Pemphigus vulgaris

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63
Q

Renal calculi diet recs

A

Increase fluids
Increase dietary calcium
Decrease protein and oxalate
Decrease sodium

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64
Q

CML

A

Philadelphia chr t(9:22)
Gleevec
Decreased leukocyte alk phos

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65
Q

hyperGLUC

A 
Glycemia
Lipidemia
Uricemia
Calcemia
(HypoNa/K)
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66
Q

Rubella

A

Fever, tender LAD
Blanching red maculopapular rash on face and spreads to trunk/ext within 24 hrs
Arthralgias
Congenital cataracts/glaucoma

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67
Q

Class 1 antiarrhythmics

A 
DQP LTM FP
Na channel blocker
Disopyramide, quinidine, procainamide
Lidocaine, tocainamide, mexilitine
Flecainide, propafenone
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68
Q

Waldenstrom’s macroglobulinemia

A

IgM spike
Hyperviscosity of the blood, engorged blood vessels in eyes, mucosal bleeding
HSM
Visual disturbances

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69
Q

Class 2 antiarrhythmics

A

Beta blockers

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70
Q

Drug ADR: Cyclosporine

A 
Nephrotoxic
HyperK
HTN
Gum hypertrophy
Hirsutism
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71
Q

Drug ADR: Mycophenolate

A

Bone marrow suppression

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72
Q

Drug ADR: Tacrolimus

A

Nephrotoxic
HyperK
HTN
Very similar to cyclosporine, same MOA

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73
Q

Drug ADR: Azathioprine

A

Diarrhea
Leukopenia
Hepatotoxicity

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74
Q

Class 3 antiarrhythmics

A

K channel blocker
Amiodarone
Sotalol
Dofetilide

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75
Q

Duke’s criteria for IE

A

Def: 2maj or 1maj+3min
Poto: 1maj+1min or 3min

Major: blood cx (s viridians, s aureus, enterococc), echo show vegetation
Minor: ivdu, fever, embolic dx, immune dx, blood cx not major

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76
Q

Class 4 antiarrhythmics

A

Ca channel blockers

Verapamil, diltiazem

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77
Q

Osmolar gap

A

Observed osm - calculated osm

Calculated serum osm = 2Na + glc/18 + BUN/2.8

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78
Q

Otosclerosis

A

Low frequency conductive hearing loss

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79
Q

Babesia

A

Transmitted by ixodes tick
Northeastern US
Hemolysis, jaundice, renal failure
Giemsa-stain blood smear

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80
Q

Presbycusis

A

High frequency sensorineural hearing loss

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81
Q

Bacillary angiomatosis

A 
Bartonella gram neg bacilli
Constitutional symptoms
Exophytic skin lesions resembling pyogenic granuloma/cherry angioma
Risk of biopsy is hemorrhage
HIV association
Tx erythromycin
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82
Q

Giardia

A

Bloating, diarrhea, fatty foul smelling, malabsorptive
Ova and parasites in stool
Areas with poor sanitation
Tx with metronidazole

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83
Q

Ehrlichiosis

A

Spotless RMSF
Flu sx, leukopenia, thrombocytopenia
Dx PCR or morulae in monocytes
Tx doxycycline

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84
Q

Whipple’s disease

A

T whippelii
Malabsorptive diarrhea, weight loss, athralgias, pigmentation, PAS positive staining in lamina propria, villous atrophy
Tx ceftriaxone then bactrims

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85
Q

Reversible causes of PEA

A

H: hypovolemia, hypoxia, hydrogen (acidosis), hypo/hyperK, hypothermia

T: tension pneumo, tamponade, toxins, thrombosis, trauma

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86
Q

Maddrey’s hepatitis discriminant function index

A

Index = 4.6(PT-ctrlPT)+bilirubin

>32 Prednisolone tx (or pentoxifylline)

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87
Q

CURB-65

A

Confusion
Uremia
RR > 30
BP

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88
Q

CKD Staging

A 
Stage             eGFR         Cockgroft-Gault (age, wt, Cr)
1                      90+
2                      60-89
3a                    45-59
3b                    30-44
4                      15-29
5
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89
Q

Rome criteria

A

> = 3 days/mo for 3 mos + >= 2 of following:

  1. Change in frequency
  2. Change in form of stool
  3. Sx improve with BMs
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90
Q

Child-pugh score

A

1pt 2pts 3pts
T bili 3
Serum alb >3.5 2.8-3.5 2.30
Ascites None Mild Mod-Severe
Hep Enceph None Ctrl w meds Refractory to meds

A: 5-6, 100% 1yr, 85% 2yr
B: 7-9, 81%, 57%
C: 10-15, 45%, 35%

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91
Q

Indications for hemodialysis

A

Refractory hyperkalemia
Hypervolemic/pulm edema non-responsive to diuretics
Refractory metabolic acidosis

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92
Q

RIPE Therapy

A

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

RIPE 2 mos, RI 4 mos.
Positive PPD - 9 mos isoniazid

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93
Q

Felty syndrome

A

RA
Splenomegaly
Neutropenia

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94
Q

Caplan syndrome

A

RA
Pneumoconiosis
Lung nodules

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95
Q

Drug ADR: Anti-TNFi

A

Reactivation of latent TB

PPD screening required

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96
Q

Drug ADR: Hydroxychloroquine

A

Retinal toxicity

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97
Q

Drug ADR: Methotrexate

A

Lung and liver toxicity

Bone marrow suppression

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98
Q

Anti-phospholipid syndrome

A

Clotting
Normal PT time
Prolonged aPTT time
Mixing studies do not resolve

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99
Q

Behcet syndrome

A

Painful oral/genital ulcers - sterile skin pustules
Erythema nodosum
Uveitis/blindness
MS-like symptoms, neurologic dysfn, nonspecific
Arthritis

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100
Q

Cryoglobulinemia

A

Associated with Hep C
C4 mediated
Purpura, neuropathy, glomerulonephritis, arthralgias
Rheumatoid factor increased

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101
Q

Cold agglutinin associations

A

EBV
Mycoplasma
Lymphoma

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102
Q

Dengue fever

A 
Similar to malaria but 4-7 days from mosquito bite
Retro orbital pain
Fever
HA
Rash
Muscle/joint pains
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103
Q

Human african trypanosomiasis

A 
"Sleeping sickness"
Tsetse fly
Acute fever
Trypanosomal chancre
Myocarditis
Neurological sx
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104
Q

Malaria

A

Mosquito-borne
Cyclical fevers ~2 weeks from insect bite
GI sx, anemia, thrombocytopenia

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105
Q

Meningococcal vaccine

A

First 11-12 yo

Booster before college-age assuming first dose before age 16

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106
Q

Chalazion vs Hordeolum vs BCC

A

C: rubbery nodule, r/o cancer, steroid inj
H: frequent hot compresses, drain
BCC: confirm biopsy, remove

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108
Q

UA Casts

A

Muddy brown ATN
RBC Glomerulonephritis
WBC Insterstitial nephritis or pyelonephritis
Fatty Nephrotic syndrome
Broad/waxy Chronic renal failure
Hyaline nl protein Tamm-Horsfall a/w dehydration

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109
Q

Carbon monoxide poisoning

A

Smoke inhalation- automobile, wood/furnace, charcoal
Seizure, AMS, wheeze, HA, bright red lips, abd pain
Skin pink/red hue
Dx carboxyhemoglobin levels
Tx 100% O2, pulse ox cannot differentiate from normal SpO2

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110
Q

IV adenosine

A

narrow-complex supraventricular tachy
slows sinus rate conduction
inc AV nodal conduction delay

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110
Q

ABI

A
  1. 3-1.0 normal

0. 9-0.4 PAD

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111
Q

IV amiodarone

A

wide-complex ventricular tachy

can also push lidocaine as alternative

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112
Q

Conn syndrome

A 
Elevated aldosterone, low renin
HypoK manifests as muscle cramping and weakness
Metabolic alkalosis
HAs, thirsty
Tx with spironolactone
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113
Q

Renal osteodystrophy

A

Chronic renal failure, retain phosphate, abnl processing of vit D
Low calcium, high phosphate, parathyroid hyperplasia

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114
Q

Overflow incontinence

A

High postvoid volume
Catheterizations
Cholinergic agonist, bethanecol

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115
Q

Stress incontinence

A

Increased intraabdominal pressure, cough, sneeze

Pelvic floor kegel exercises

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116
Q

Urge incontinence

A

Detrusor instability

Anti-cholinergic or TCA

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117
Q

ADR: Trastuzumab

A

Tx HER2 positive breast cancer
Combined with chemo tx leads to cardiotoxicity
Screening echo req’d prior to start

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118
Q

Familial hypocalciuric hypercalcemia

A

Hypercalcemia and UrineCa/Cr clearance ratio

Benign, asymptomatic

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119
Q

Bell’s palsy

A

Central: above facial nucleus, forehead sparing
Peripheral: below facial nucleus, non-sparing

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120
Q

Cat scratch disease

A

Bartonella henselae
Azithromycin
Positive warthin-starry stain

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121
Q

Amebic liver abscess

A 
Entamoeba histolytica
Endemic mexico
Hx bloody diarrhea
Low grade fevers presently w vague abd pain
Single thin wall cyst
Tx w flagyl
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122
Q

Hep B birth weight vaccine req

A

2 kg

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123
Q

Exertional vs nonexertional heat stroke

A

E: strenuous exercise, ice water immersion
N: no stress, cool water evaporating only

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124
Q

Decreasing contrast-induced nephropathy

A

Non-ionic contrast
IV hydration w NS or isotonic bicarb
NAC

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125
Q

Meds during cardiac stress test

A

Hold: BB, CCB, nitrates
Ctn: ACEi, ARB, digoxin, statins, diuretics

Pharm vasodilator stress: hold dipyridamole 48hrs, caffeine 12hrs

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126
Q

Diffuse axonal injury

A

Traumatic brain injury
Deceleration
Vegetatuve patient
CT minute punctuate hemorrhages and blurry grey-white interface

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127
Q

TTP-HUS

A 
Adult patient
Unexplained hemolytic anemia
Renal injury
Uremic sx
ADAMS-13 deficiency
Tx w plasmaphoresis TTP, HUS self-limited
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128
Q

Pneumococcal vaccine

A

PCV13 adults >65 followed by PPSV23 in 6-12 mos

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129
Q

ARDS

A

Respiratory distress and worsening
Bilateral lung opacities looking like pulmonary edema
No signs cardiac failure or fluid overload
PaO2/FiO2

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131
Q

Management of hypercalcemia

A

> 14: NS, calcitonin, then bisphosphonate long term, NO loop diuretics
12-14: NS, observe if asymptomatic

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132
Q

Melanosis coli

A

Biopsy finds dark brown discoloration of colon with lymph follicles shining through as pale patches. Result of laxative abuse with bisacodyl (anthraquinone-containing).

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132
Q

HIV esophagitis

A

Candida: oral thrush, oral fluconazole.
Herpes: small round/ovoid ulcers and intranuclear inclusions, acyclovir.
CMV: large linear ulcers and intranuclear/intracytoplasmic inclusions, ganciclovir.

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133
Q

MEN Syndromes

A

1: primary hyperparathyroid, enteropancreatic tumors, pituitary tumors
2A: MTC, pheo, parathyroid hyperplasia
2B: MTC, pheo, mucosal/intestinal neuromas, marfanoid habitus

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134
Q

McCune-Albright syndrome

A

Triad: cafe au lait spots, polyostotic fibrous dysplasia, endocrine hyperfunction (precocious puberty)

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135
Q

Aromatase deficiency

A

Cannot convert testosterone to estrogen
Masculinization, normal internal genitalia, ambiguous external
Gestational mother resolves after delivery, virilized XX child

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136
Q

Human rabies exposure

A

Rabies vaccine and immune globulin following exposure to high-risk animal

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137
Q

Amyloidosis dx and tx

A

Biopsy abdominal fat pad

Colchicine as ppx and acute tx

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139
Q

Fetal hydantoin syndrome

A

Phenytoin in utero

Hypoplastic fingers/nails/distal phalanges, cleft lip/palate

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140
Q

Congenital CMV

A

Periventricular calcifications, microcephaly, chorioretinitis, retarded, blind, deaf, jaundice, HSM, petechiae
Tx ganciclovir

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140
Q

SIRS criteria

A

T >38.5 or 90
RR>20
WBC >12,000 or 10% bands

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141
Q

Saline-responsive and unresponsive metabolic alkalosis

A

SR: urine chloride 20, tx underlying dz

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142
Q

Congenital rubella

A

PDA, deaf, cataracts, microcephaly, blueberry muffin purpura rash, HSM, thrombocytopenia, retarded

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143
Q

Neurocysticercosis

A

Parasitic infx of brain, multiple cysts
Pigs
tx albendazole

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144
Q

Cauda equina vs conus medullaris syndrome

A

CE: severe LBP unilateral radiculopathy, saddle anesthesia, hyporeflexia (LMN), asymmetric weakness, late B/B dysfn
CM: lesser degree of radiculopathy, symmetric, perianal anesthesia, hyperreflexia (UMN), lesser weakness early B/B dysfn

Both tx emergent steroids, MRI, surgery

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145
Q

Methanol intoxication

A

OCULAR
HA, nausea, emesis, epigastric pain
Coma, optic disc hyperemia, vision blurred/loss
Tx fomepizole

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146
Q

Paroxysmal nocturnal hemoglobinuria

A 
CD55/59 deficiency
Overactive complement system
Dark urine first of the day
Pancytopenia and iron deficiency
Death by thrombosis
Tx prednisone
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147
Q

AML/APML

A

Auer rods

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148
Q

CLL

A

Smudge cells
LAD, fatigue, HSM, infections
Warm autoimmune antibodies
Tx fludarabine

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149
Q

CML

A

Fever, night sweats, splenomegaly, pruritus
BCR-ABL
Tx imatinib/gleevec

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150
Q

Myelodysplastic syndrome

A

Pre-leukemia
Pelger-huet cells, bilobed
Ringed sideroblasts

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151
Q

CHOP therapy

A

Cyclophosphamide
Adriamycin
Vincristine
Prednisone

For NHL

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152
Q

Non hodgkin lymphoma

A

Prolif of lymphocytes in lymph nodes and spleen
Painless LAD, no warmth or erythema
B cell symptoms fever, sweats, weight loss
Cannot aspirate nodes, must excise bx
CHOP therapy

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153
Q

ABVD therapy

A

For HL

Adriamycin
Bleomycin
Vinblastine
Dacarbazine

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154
Q

ADR: doxorubicin

A

Cardiomyopathy

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155
Q

Hodgkin lymphoma

A

Reed sternberg cells, painless LAD, B cell sx. Localized around cervical area. Minimal change disease association
ABVD therapy

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156
Q

ADR: vincristine

A

Neuropathy

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157
Q

ADR: bleomycin

A

Pulmonary fibrosis

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158
Q

ADR: cyclophosphamide

A

Hemorrhagic cystitis

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159
Q

ADR: cisplatin

A

Renal/ototoxicity

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160
Q

Hairy cell leukemia

A

Tartrate resistant acid phosphatase stain
Dry tap for bone marrow aspiration
Tx cladribine

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161
Q

5 Ts cyanotic congenital heart defects

A 
Transposition of great vessels
Tetralogy of fallot
Tricuspid atresia
Truncus arteriosus
Total anomalous pulm venous return
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162
Q

Complete mole vs partial mole

A

C: 2 sperm, lacks genetic material, no fetal tissue, theca lutein cysts, snowstorm/grapes on US
P: triploid, +fetal tissue on US
Tx evacuation and suction curettage, serial B-hCG levels

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163
Q

Retinal detachment

A

“Curtain down over eyes”

Tears, gray-appearing retina, floaters, light flashes

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164
Q

Proteus mirabilis

A

UTI with alkaline urine
Secretes urease
Struvite stones (staghorn calculi)- coffin shaped
Associated with indwelling catheters

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165
Q

Perivalvular abscess

A

IV drug abuse
Diastolic murmur, aortic (Tricuspid would be systolic)
AV conduction abnormality

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166
Q

Central retinal artery occlusion

A 
Sudden painless loss of vision
Pallor of optic disc
Cherry red fovea
Segmentation of blood in vessels
Tx ocular massage and high flow O2
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167
Q

Cavernous sinus thrombosis

A

Valveless system so uncontrolled skin/sinus/orbit infection can cause
Severe HA, bilateral periorbital edema, CN3/4/5/6 deficits
Increased intracranial pressure

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168
Q

Schizoaffective disorder

A

Mood episode (depression or mania) w psychotic sx and pd of psychosis without mood sx for at least 2 weeks

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169
Q

Diagnosing hepatitis B

A

Acute: HbsAg and IgM anti-HBc
Chronic: HBV DNA

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170
Q

Cluster headache

A 
Awakening w severe retroorbital pain
Unilateral
Ipsilateral horner's
Red eye, tearing, rhinorrhea
Tx 100% O2
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171
Q

Progressive multifocal leukoencephalopathy

A

JC virus, immunocompromised patient
Focal neuro sx, hemiparesis, dysarthria, visual abnl, gait abnl
Multiple demyelinating non-enhancing lesions
No mass effect

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172
Q

Decrease mortality COPD

A

Home O2

Smoking cessation

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173
Q

Hypertensive complications

A

Severe htn: >180/120
Malignant htn: severe w end-organ or life threatening complications
HTN encephalopathy: severe w cerebral edema/focal neuro deficits

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174
Q

Herpes simplex keratitis vs herpes zoster ophthalmicus

A

HSK: pain, photophobia, dec vision, dendritic ulcer, clear vesicles on cornea
HZO: vesicular rash in trigeminal distribution, dendriform corneal ulcer, conunctivitis

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175
Q

OBGYN HIV

A

Mom: triple antiretroviral tx
Baby: zidovudine 6 wks w serial HIV PCR

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176
Q

Zinc deficiency

A

Result of chronic TPN

Alopecia, skin lesions surrounding orifices, abnl taste, impaired wound healing

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177
Q

Selenium deficiency

A

Result of chronic TPN
Most impt complication is cardiomyopathy
Malabsorption, malnutrition

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178
Q

Pulsus paradoxus

A

Drop >10 in blood pressure on inspiration

Pericardial effusion or severe asthma/COPD bc inc lung volume

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179
Q

Cyanide poisoning

A

Smoke inhalation- plastic, rubber, paint, house fire
blocks ATP production, leads to anaerobic and lactic acidosis
Neurologic and cardiorespiratory stimulation acutely followed by depression and arrest
Anoxic brain injury
Bitter almond breath
Tx hydroxocobalamin or sodium thiosulfate

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180
Q

Friedreich ataxia

A

Most common spinocerebellar ataxia
Neuro: ataxia, dysarthria, posterior column degeneratiom
Skeletal: scoliosis, foot deformity, hammer toes
Cardiac: CMO
Respiratory compromise

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181
Q

Uric acid kidney stone

A

Low urine pH, hyperuricosuria, needle-shaped crystals on UA
Dx w ultrasound or CT (preferred)
Tx hydration, alkalinize urine, low-purine diet, potassium citrate

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182
Q

Waldenstrom macroglobulinemia

A

IgM overproduction
Hyperviscosity- lethargy, blurry vision, retinal vessels engorged, mucosal bleeding
Tx plasmapheresis

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183
Q

Ristocetin cofactor assay

A

Von willebrand dx, tx DDAVP

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184
Q

Russel viper venom test

A

Lupus anticoagulant

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185
Q

Pain worse w food

A

Gastric ulcer

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186
Q

Pain better w food

A

Duodenal ulcer

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187
Q

H. pylori

A

Assoc’d w duodenal ulcer 90%
Assoc’d w gastric ulcer 60%
Tx PPI + clarithromycin + amoxicillin
Can add bismuth/flagyl/doxycycline

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188
Q

Somatostatin receptor scintigraphy

A

Most accurate for gastrinoma bc somatostatin receptors so upregulated against gastrin

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189
Q

Dopamine pathways

A

Mesolimbic: anti-psychotic efficacy
Nigrostriatal: extra-pyramidals, dystonia/parkinsonism/akathisia
Tuberoinfundibular: prolactin

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190
Q

Diamond-blackfan anemia

A

Macrocytic anemia, low retics, congenital anomalies

Pure red cell aplasia

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191
Q

Most common complications anorexia nervosa

A

Osteoporosis

Pregnancy: SGA baby, infertility not as common

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192
Q

Wiskott-aldrich syndrome

A

Eczema, thrombocytopenia (small platelets, production dysfn), hypogammaglobulinemia (infections)

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193
Q

Sturge-weber syndrome

A

Unilateral cavernous hemangioma along trigeminal distribution
Radiographic intracranial calcifications, “tramline”
Tx skin w argon laser
Tx seizures and decrease intraocular pressure

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194
Q

Unilateral cervical lymphadenitis

A

Most commonly staph or strep

Tx clindamycin - lymph node penetration and adequate coverage

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195
Q

Winter’s formula

A

(Bicarb x 1.5) + 8 +/-2

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196
Q

Alcoholic cerebellar degeneration

A

Gait dysfn, truncal ataxia, dysmetria, intention tremor, dysdiadochokinesia. Negative babinski.

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197
Q

CMV pneumonitis

A

Post-bone marrow transplant

Pneumonitis and colitis

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198
Q

5-a reductase deficiency

A

46 xy
M internal genitalia, F or undermasculinized ext genitalia
Masculinize at puberty due to testosterone
No breast tissue, diffs from andr insens

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199
Q

Androgen insensitivity

A

46 xy
Resists androgens, M int genitalia
+breast tissue separates from 5-a reductase deficiency

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200
Q

Premature ovarian failure

A

Estrogen deficient
LH and FSH inc
FSH moreso due to slower clearance
FSH:LH>1.0

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201
Q

Location of broca’s, wernicke’s, and arcuate fasciculus

A

B: left frontal
W: left temporal
A: left temporal

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202
Q

Leukocyte adhesion defect type 1

A

Delayed separation of umbilical cord
Recurrent bacterial skin/mucosal infx
Leukocytosis w absence of leukocytes in inflamed/infected tissue

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203
Q

Acute angle-closure glaucoma

A

Sudden onset eye pain, HA, nausea, conjunctival erythema, photophobia, non-reactive pupil
Associated with decongestant use
Dx tonometry, GS=gonioscopy
Tx acetazolamide, mannitol, timolol, pilocarpine
NEVER use atropine, dilating agents

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204
Q

Chagas disease

A

Trypanosoma cruzi
Latin america
Megacolon, megaesophagus, myocarditis

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205
Q

Trousseau syndrome

A

Migratory thrombophlebitis assoc’d w cancer (pancreas MC)

CT looking for neoplastic dz

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206
Q

Thyroid in pregnancy

A

Total T4: inc x1.5
Free T4: inc
TSH: dec
TH production inc, TBG inc and binds T4, so- much inc’d TT4, some inc’d FT4, suppresses TSH

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207
Q

Distinction btwn anorexia and bulimia

A

A: maintain weight below minimal acceptable level

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208
Q

MC Down syndrome cardiac defects

A
  1. Endocardial cushion, complete AV septal defect: loud S2 2/2 pulm HTN, systolic ejection murmur, holosystolic VSD murmur
  2. VSD: harsh holosystolic murmur LLSB
  3. ASD: fixed split S2, systolic ejection murmur
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209
Q

Mucormycosis

A

Rhizopus species
DM immunocompromised
Nose, maxillary sinus
Low fever, bloody nasal dc, congestion, eye involvement, necrotic turbinates

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210
Q

Cataract

A

Thickening of the lens
Due to oxidative damage
Opacification of lens, blurry vision, difficult night vision

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211
Q

Open angle glaucoma

A

Insidious loss peripheral vision
Increased intraocular pressure
Cupping of optic disc

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212
Q

Cancer-related anorexia/cachexia

A

Tx progesterone analogue, then steroids

Cannibus has insufficient evidence

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213
Q

ASC-US management

A

HPV DNA test
Pos: colpo
Neg: pap and HPV in 3 yrs

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214
Q

CMV retinitis

A

MC ocular complication of HIV
Painless, fluffy/granular retinal lesions, hemorrhages
Tx ganciclovir, foscarnet

vs HSV/VZV which cause painful conjunctivitis/keratitis and vision loss

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215
Q

Cocaine-induced chest pain

A

IV benzos
Also aspirin, nitro, CCBs
BBs contraindicated, unopposed alpha

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216
Q

Psych neuroimaging

A 
Autism: inc brain vol
OCD: orbitofrontal cortex and striatum
Panic do: amygdala
PTSD: hippocampus
Schizo: enlarged ventricles
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217
Q

Brain mets

A

Lung>breast>unk primary>melanoma>colon

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218
Q

Purulent vs non-purulent cellulitis

A

Staph vs strep

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219
Q

Differentiate folic acid from B12 deficiency

A

Both inc homocysteine

B12 inc methylmalonic acid

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220
Q

FAP and HNPCC colorectal cancer screening

A

FAP: sigmoidoscopy every yr begin 12yo
HNPCC: colonoscopy every yr begin 25yo

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221
Q

Buerger’s disease (thromboangiitis obliterans)

A

Small vessel vasculitis
Smoking
Black gangrenous fingers
Digit autoamputation

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222
Q

Takayasu arteritis

A

Large vessel vasculitis

Pseudo coarctation symptoms from aortic arch vasculitis

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223
Q

Gardner syndrome

A

Colon ca

Bone ca

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224
Q

Turcot syndrome

A

Colon ca

CNS ca

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225
Q

JONES criteria

A

rheumatic fever

joints, heart/carditis, nodules, erythema marginatum, syndenham chorea

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226
Q

Universal pregnancy screening

A

HIV, syphilis, Hep B

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227
Q

Congenital toxoplasmosis

A

Chorioretinitis, hydrocephalus, intracranial calcifications, multiple ring-enhancing lesions
Tx pyrimethamine and sulfadiazine

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228
Q

Cirrhosis surveillance

A

ultrasound liver for HCC q6mo
AFP q6mo
EGD for varices q6mo

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229
Q

Sulfonylureas

A

hypoglycemia, weight gain
add to metformin
ex: glipizide

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230
Q

GLP-1 receptor agonist

A

used w desired weight loss
add to metformin
ex: exenatide

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231
Q

ADR: TZDs (pioglitazone)

A

worsening cardiac fn in CHF pt with DM

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232
Q

DPP-4 inhibitors

A

inc endogenous incretins, stimulate natural release of body’s insulin

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233
Q

hyperactive DTRs, cramping, convulsions following multi-transfusion surgery

A

hypocalcemia

citrate in transfused blood binds free calcium and magnesium

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234
Q

ADR: isoniazid

A

peripheral neuropathy, tx vit B6

hepatitis

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235
Q

Sodium thiosulfate

A

cyanide poisoning antidote

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236
Q

SAAG

A

> 1.1 indicates portal HTN, inc hydrostatic pressure

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237
Q

Flumazenil

A

benzo OD antidote

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238
Q

Fomepizole

A

alcohol dehydrogenase inhibitor

ethylene glycol poisoning antidote, also methanol antidote

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239
Q

Wernicke’s encephalopathy

A

encephalopathy, ataxia, oculomotor dysfn (nystagmus, gaze palsy)

add irreversible amnesia, confabulation = korsakoff

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240
Q

ADR: risperidone

A

hyperprolactinemia, gonadal dysfn

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241
Q

Rheumatic fever PCN ppx

A

no carditis: 5 yrs pcn
carditis but resolved: 10 yrs or 21yo
carditis and persistent: 10 yrs or 40yo

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242
Q

VACTERL

A

vertebral, anal, cardiac, tracheoesophageal, esophageal, renal, limb

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243
Q

Oral succimer

A

mild lead poisoining antidote

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244
Q 
NF 1 (von Recklinghausen dz)
NF 2
A

1: cafe au lait, axillary freckling, lisch nodules (eyes), optic glioma
2: bl acoustic neuromas (vestibular schwannomas)

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245
Q

IV calcium EDTA

A

severe lead poisoning antidote

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247
Q

Anti-phospholipid syndrome

A

high aPTT, thrombocytopenia, arterial/venous thromboses

false positive VDRL

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248
Q

Paraneoplastic small cell lung cancer

A

SIADH
ACTH
LEMS

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249
Q

Paraneoplastic squamous cell lung cancer

A

PTHrP

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250
Q

Coxiella burnetii

A

Q fever, inhaled, a/w livestock or unpasteurized milk.

Hepatitis, pneumonia.

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251
Q

Von-gierke’s dz

A

glucose 6-phosphatase deficiency
“doll-face”, thin extremities, short, distended abd w enlarged liver/kidneys
hypoglycemia, seizures, lactic acidosis

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252
Q

Pompes’ dz

A

acid maltase deficiency

“floppy baby”, cardiomyopathy/failure, hepatomegaly

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253
Q

Diabetic retinopathy

A

microaneurysms, hemorrhages, edema, exudates
+/- cotton wool spots
+/- neovascularization

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254
Q

Management acetaminophen overdose

A

charcoal, serum acetaminophen levels

can be asymptomatic 24 hours, use levels to guide NAC

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255
Q

Carcinoid syndrome

A

episodic flushing, chronic diarrhea (secretory), valvular heart disease (tricuspid), weight loss, “pounding sensation”
a/w niacin deficiency
dx 5-HIAA levels 24hr urine
tx octreotide, resection

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256
Q

Toxoplasmosis

A

HIV-associated mass brain lesion
ring-enhancing
ppx w bactrim, tx w sulfadiazine/pyrimethamine

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257
Q

Hyperthyroid-induced afib w RVR management

A

BBs, propranolol

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258
Q

Schizoid personality disorder

A

social detachment, rather be alone than with others
restricted affect
no magical thinking

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259
Q

Schizotypal personality disorder

A

eccentric behavior, difficulty w normal relationships

magical thinking, bizzare

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260
Q

Schizophreniform disorder

A

“diet schizophrenia”

same sx, just not long enough i.e.

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261
Q

bHCG level seen on US

A

2000

if lower, wait 48-72hrs and re-US

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262
Q

Brutons agammaglobulinemia vs CVID

A

BA: dec Ig’s, B cells and lymph tissue absent, tx IVIG
CVID: dec Ig’s, B cells and lymph tissue present but don’t work, inc risk lymphoma, tx IVIG

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263
Q

Cushing reflex

A

HTN, bradycardia, resp depression

suggests brainstem compression

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264
Q

Sickle cell stroke management

A

exchange transfusion, keep hydroxyurea on board

fibrinolytics have no role

265
Q

Acute HIV vs EBV mono

A

HIV: rash, diarrhea
EBV: tonsillar exudates
otherwise very similar

266
Q

MESNA

A

used to prevent hemorrhagic cystitis etc with cyclophosphamide use

267
Q

Optic neuritis

A

MS association

painful eye movements, central scotoma, decreased visual acuity, change in color perceptions, afferent pupillary defect

268
Q

ADR: theophylline

A

CNS: HA, insomnia, seizures
GI: nausea, vomit
Cardiac: arrhythmia, multifocal atrial tachy, PVCs, palps

269
Q

ADR: aminoglycosides (aGNATS)

A

nephrotoxicity, follow UA

typically used for serious gram negative infx, commonly UTI/pyelo

270
Q

Toco strip: early, late, variables

A

E: head compression
L: uteroplacental insufficiency
V: cord compression

271
Q

NMS

A

Tx dantrolene
fever, muscle rigidity, AMS
differ from SS bc no diarrhea

272
Q

Granulomatosis with polyangiitis (Wegener’s)

A

C-ANCA positive
upper and lower respiratory: epistaxis, hemoptysis, rhinorrhea/purulence, saddle nose bridging, destruction of nasal cartilage
skin lesions: palpable purpura, painful subq nodules, pyoderma gangrenosum-like lesions
glomerulonephritis
Tx cyclophosphamide and prednisone

273
Q

Chronic HTN vs Gestational HTN vs PES

A

C: onset before 20 wks
G: onset after 20 wks
PES: HTN + proteinuria after 20 wks, if HTN before and new onset protein, then PES superimposed

274
Q

PES severe features criteria

A

HTN 160/110
Cr 1.1 or double baseline
pulm edema, elevated LFTs, CNS sx

275
Q

Leukoplakia

A

larger white patches or plaques in oral mucosa
unable to scratch off
must biopsy to r/o SCC
a/w smoking and alcohol

276
Q

Aphthous stomatitis

A

looks like normal ulcer in mouth

277
Q

Gingivostomatitis

A

grime cold sore on the lip like MM

278
Q

Thiamine (B1) and dextrose for alcoholism

A

B1 and then glucose always

279
Q

Methemoglobinemia

A

similar to CO poisoning
skin and mucous membrane blue/purple hue sets it apart
Tx methylene blue

280
Q

Tuberous sclerosis

A

retarded, seizures, red facial nodules, ash leaf spots, retinal hamartomas

281
Q

Restless leg syndrome

A

Tx pramipexole or ropinorole first line DA agonists, not what Dr. Lowden did with neurontin

282
Q

Ethylene glycol poisoning

A

RENAL
AKI from oxalate precipitating with calcium, renal failure
Ca levels are then low
Tx fomepizole

283
Q

ADR: loop diuretics

A

ototoxicity

284
Q

Goodpasture syndrome

A 
Lung and kidney involvement, hemoptysis
No upper resp tract involvement
No skin, joint, GI, eye, neuro involvement
Dx linear deposits, anti-GBM ab
Tx plasmapheresis, steroids
285
Q

IgA nephropathy (Berger dz)

A

1-2 days following URI
Gross hematuria
Tx ACEi and steroids

286
Q

PSGN

A

Cola-colored urine, periorbital edema, HTN, oliguria

Best test anti-streptolysin titers and anti-DNAse ab

287
Q

Alport’s syndrome

A 
Collagen type IV defect
Sensorineural hearing loss
Visual disturbance
No tx
Electron microscopy shows thickening and thinning of capillary loops with splitting of the basement membrane
288
Q

Acute dystonia

A

a/w anti-psychotic tx

Tx anticholinergics or antihistamines (benztropine or diphenhydramine)

289
Q

Galactokinase deficiency

A

Bilateral cataracts congenital

otherwise asymptomatic

290
Q

Galactose-1-phosphate uridyl transferase deficiency

A 
Galactosemia
FTT, bl cataracts, mental retardation, jaundice, hypoglycemia, hepatomegaly
Inc levels galactose
\+/- aminoaciduria
Inc risk neonatal sepsis from e. coli
291
Q

Spinal cord compression management

A

Initial: need MRI, but add steroids first

Dec vasogenic edema and relieves pressure

292
Q

Aspirin-exacerbated resp dz (AERD)

A

Prostaglandin/leukotriene imbalance from NSAID use, results in bronchospasm and nasal congestion
a/w nasal polyps
Tx by avoiding aspirin, using montelukast if asthmatic

293
Q

Best HTN benefits

A

weight loss > DASH > exercise

294
Q

Testing prior to lithium

A

a/w DI, hypothyroid, ebstein anomaly
check UA (Cr) and TSH/T4 (thyroid) prior to starting
check pregnancy test in fertile women

295
Q

Carotid endarterectomy

A

Never below 50%
Symptomatic anything above 50%
Asymptomatic anything above 70%

296
Q

Antiarrhythmic use dependence

A

Class 1 and 4
Na- flecainide/propafenone
Ca- verapamil/diltiazem

297
Q

Monosodium urate crystal

A

gout

298
Q

Hydroxyapatite

A

complexed calcium in bones and teeth

299
Q

Calcium pyrophosphate crystal

A

pseudogout (which is a/w hemochromatosis)

300
Q

Torsades management

A

HD stable: mag

HD unstable: defibrillate

301
Q

Single and multiple brain mets management

A

Single, good performance: resect
Single, poor performance: whole brain radiotherapy
Multiple: whole brain radiotherapy
Screwed: palliative and seizure ppx

302
Q

Renal tubular acidoses

A

1 (distal): high urine pH >5.5, no H+ secretion, CaOx stones, dx administer acid, tx HCO3
2 (proximal): fanconi syndrome, no HCO3 reabsorption, dx administed bicarb, tx thiazides
4: low urine pH, high K, distal tubule dysfn, hypoaldosterone, dx urine salt loss, tx fludrocortisone

303
Q

Amaurosis fugax

A

transient monocular vision loss
retinal vessel emboli
ipsilateral carotid MC source, duplex carotids

304
Q

HBV exposure

A

vaccinated: no tx

unsure or nonvaccinated: HBV vaccine and HBIg

305
Q

Tx hypertrophic cardiomyopathy

A

BB or cardio selective CCB

prolong filling time, decrease obstruction

306
Q

Umbilical artery flow velocimetry

A

used in IUGR below 10th %ile
Nl: high velocity flow in diastole
Abnl: decreased, absent, reverse end diastolic flow

307
Q

Non-reactive NST

A

Either CST or biophysical profile

Nl CST: no variable or late decels = reassuring

308
Q

A-thalassemia minor vs B-thalassemia minor

A

B has HbA2 levels inc

309
Q

Dermatofibroma vs lipoma vs epidermal inclusion cyst

A

D: pigmented nodule, central dimple
L: nonpigmented, nonregressing
EIC: regresses and returns

310
Q

Fanconi anemia

A

MC congenital aplastic anemia
multiple DNA repair gene mutations implicated
macrocytic anemia, congenital malformations, poor growth

311
Q

Syringomyelia

A

cape-like areflexic weakness and sensory loss bl UEs
spares posterior columns bc hits anterior first spinothalamics first
fluid-filled central area of cord

312
Q

Number needed to treat

A

1/ARR

absolute risk reduction

313
Q

ADR: ceftriaxone in infant

A

inc risk kernicterus in infant with hyperbili

314
Q

Neonatal conjunctivitis

A

24 hrs: chemical, tx lubricant
2-5 d: gonococcal, eyelid swelling, cornea ulcers/edema, purulent dc, tx IV/IM ceftriaxone
5-14 d: chlamydial, eyelid swelling, bloody/purulent dc, tx oral erythromycin

315
Q

ADR: erythromycin in infant

A

inc risk pyloric stenosis

316
Q

Flail chest management

A

PPV, helps with symmetrical chest rise

317
Q

Exclusion criteria tPA

A

BP 185/110
INR 1.7, long PT or aPTT
Recent stroke/bleed

318
Q

Lennox-Gastaut syndrome

A

children, mental retardation, multiple types of seizures

319
Q

ADR: propylthiouracil

A

agranulocytosis

any sx of infx or illness, stop drug, obtain CBC

320
Q

Panic disorder management

A

Acute: benzo (lorazepam)
Chronic: SSRI and CBT

321
Q

Type I, II, III metatarsus adductus

A

I: overcorrect passively/actively into ABduction, observe
II: correct p/a to neutral, tx orthosis
III: rigid feet don’t correct, serial casting or surgery if refractory

322
Q

Primary CNS lymphoma

A

EBV DNA in CSF

solitary weakly enhancing periventricular lesion

323
Q

Contact-lens keratitis

A

pseudomonas, serratia

Tx remove contacts, possible topical abx

324
Q

Granulosa vs Leydig cell tumors

A

G: estrogen
L: testosterone

325
Q

WPW in atrial fibrillation

A

HD stable: procainamide

HD unstable: electrical cardioversion

326
Q

ADR: metoclopramide

A

dopamine antagonist, used for nausea, vomiting, gastroparesis
prokinetic
a/w extra-pyramidal side effects

327
Q

A1AT deficiency

A

panacinar emphysema
liver cirrhosis
PAS positive stain, diastase resistant

328
Q

Subclinical hypothyroid

A

mild elevated TSH

normal T3 and T4

329
Q

Symptomatic sinus bradycardia

A

IV atropine (anticholinergic/antimuscarinic). 2nd line is transcutaneous pacing OR IV dopamine OR IV epi

330
Q

BCC vs SCC

A

BCC: below mouth, most common
SCC: above, sun exposed, crustier

331
Q

Botulism (infantile vs foodborne)

A

I: ingest spores, tx human botulism immune globulin
F: ingest preformed toxin, tx equine botulism antitoxin

332
Q

Pheochromocytoma blood pressure management

A

alpha blocker prior to beta blocker

avoid unopposed alpha

333
Q

Dermatitis herpetiformis

A

a/w celiac dz

Tx dapsone, NOT ACYCLOVIR

334
Q

SAH vasospasm

A

tx nimodipine (CCB)

335
Q

Trichinellosis (trichinosis)

A

triad periorbital edema, myositis, eosinophilia
ingested uncooked meat
gi sx, subungual hemorrhages, ocular hemorrhages

336
Q

Fibromuscular dysplasia

A

Tx angioplasty and stent placement, surgery if stent fails

337
Q

Giant cell arteritis

A

steroids, then temporal artery biopsy

serial CXR surveying for aortic aneurysm (common complication)

338
Q

ADR: digoxin (cardiac)

A

atrial tachy with AV block

rare combo, fairly specific for dig tox

339
Q

Mycobacterium leprae

A

insensate hypopigmented skin plaques
periph nerve dmg causes muscle atrophy, crippling deformities
suspect in Asian patient
Dx skin biopsy, demonstrate acid fast bacilli

340
Q

Homocystinuria

A

cystathionine synthase deficiency
cerebrovascular accident, dev delay, fair complexion
many overlapping features with marfan
Dx inc methionine and homocysteine levels
Tx B6, folate, B12 to dec homocystiene levels
Also tx w antiplatelet/AC

341
Q

Fabry dz

A

a-galactosidase deficiency
angiokeratomas, periph neuropathy, corneal dystrophy
renal/heart failure
thromboembolic events

342
Q

Krabbe dz

A

galactocerebrosidase deficiency

retarded, blind, deaf, paralyzed, neuropathy, seizures

343
Q

Tay-Sachs dz

A

B-hexosaminidase deficiency

retarded, weakness, seizures, cherry-red macula

344
Q

Chronic liver dz vaccines

A

HAV, HBV, PPSV23 before 65 then PCV13 followed by PPSV23 again, influenza yearly, Td every 10 yrs

345
Q

ADR: epidural anesthesia

A

vasodilation and venous pooling from sympathetic blockade

346
Q

Aspirin/BBs in asthma

A

may induce cough from bronchoconstriction

347
Q

Effects of O2 and CO2 on blood flow

A

CO2 affects vascular tone more than O2
high CO2: vasodilate to inc blood flow
low CO2: vasoconstrict

348
Q

Refeeding syndrome

A

insulin surge drives K, PO4, Mg into cells, causing arrhythmias and cardiopulmonary failure

349
Q

Afib vs Aflutter anatomic etiology

A

afib: ectopic pulm vein foci
aflutter: tricuspid annulus re-entrant circuit

350
Q

Arrest of labor

A

> 4hrs with good ctx or >6hrs with poor ctx

351
Q

Cataplexy

A

sudden loss muscle tone w strong emotion

352
Q

Narcolepsy

A

daytime sleepiness, cataplexy, sleep attacks, hyponogogic/hypnopompic hallucinations, sleep paralysis.
feel refreshed from naps
Tx sleep hygiene, modafinil/stimulants if needed

353
Q

DVT iso inc homocysteine levels

A

inc homocysteine inc risk of thromboembolic events
Tx B6, folate and add B12 only if documented deficiency
DVT tx heparin, warfarin, and normalize homocysteine

354
Q

Neonatal tetanus

A

umbilical stump infx
poor suckling, fatigue, rigidity, spasms
look for lack of maternal vaccines or home birth with dirty tools or untrained deliverer

355
Q

Hepatic adenoma

A

a/w OCP use

complications of hemorrhage or malignant transformation

356
Q

Cholesteatoma

A

chronic ear dysfn, continued drainage, granulation tissue with skin debris, retraction pocket in TM

357
Q

CMV colitis

A

low CD4, chronic bloody diarrhea

internuclear and intracytoplasmic inclusions (owl’s eye)

358
Q

Luteoma vs theca luteum cyst

A

bl solid vs cystic mass, luteoma a/w virilization, both regress spont after pregnancy

359
Q

Acute AC in pt with renal insufficiency

A

unfractionated heparin better than LMWH and factor Xa inhibitors, all of which are renally metabolized, but unfrac heparin easy to monitor with aPTT and then can switch to warfarin after 5 days

360
Q

Gallstones management

A

asymptomatic: observe
symptomatic, poor surg candidate: ursodeoxycholic
symp, good surg cand: cholecystectomy

361
Q

Anterior mediastinal masses

A

thymoma
teratoma
thyroid
terrible lymphoma

362
Q

ADR: succinylcholine

A

disaster a/w hyperkalemia

use vecuronium when inc K

363
Q

Presbyopia

A

dec lens elasticity, classic presentation needing to hold things further from eyes to see

364
Q

Plummer vinson syndrome

A

esophageal web, a/w iron deficiency

dysphagia, stomatits

365
Q

Klumpke palsy

A

C8 T1, claw hand, extended wrist, ext MCPs, flexed IPs

+/- horner’s

366
Q

Erb-duchenne palsy

A

C5 C6, waiter’s tip, extended elbow, pronate forearm, flex wrist and fingers

367
Q

Hand-foot-mouth dz

A

posterior oropharynx vesicles, hand and feet

NOT perioral

368
Q

Tdap vs Td

A

first ADULT vaccination is Tdap then Td every 10years

women get repeat Tdap for each pregnancy

369
Q

Howell-jolly bodies

A

sickle cell anemia. nuclear remnants.

370
Q

Bite cells and heinz bodies

A

G6PD deficiency or thalassemia. hemoglobin ppts.

371
Q

Synchronized cardioversion vs defibrillation

A

SC: symptomatic or sustained VT or unstable afib w RVR
D: vfib or pulseless VT
Neither has a role in PEA - start compressions

372
Q

PMR vs FM

A

PMR has elevated ESR, CPK and aldolase normal, give steroids. FM has entirely normal labs, can treat with TCAs or gabapentin, do not give steroids.

373
Q

Congenital syphilis

A

palms and soles rash (ulcerative), HSM, jaundice, anemia, rhinorrhea
late hutchinson teeth

374
Q

Strabismus

A

misalignment of eyes, abnormal after 4 months, patch the normal eye or “penalize/blur” it

375
Q

HTN hemorrhagic strokes

A

putamen, thalamus, pons, cerebellum, cortex

in that order

376
Q

HIV post-exposure ppx

A

3-drug tx immediately for 4 weeks
draw serologies in the mean time
if negative, end tx after 4 weeks

377
Q

Post-partum contraception

A

high prolactin levels suppress GnRH anyways, but use progestin-only OCPs. mixed OCPs haven’t been studied yet

378
Q

MC cause of death acromegaly

A

cardiac

379
Q

Intussusception associations

A

rotavirus vaccine, HSP

380
Q

CHARGE

A 
C: coloboma of eye
H: heart defects
A: atresia of choanae
R: retarded growth/development
G: genitourinary
E: ear/deaf
381
Q

Currant jelly blood

A

Klebsiella pna

intussusception

382
Q

CAH

A

21-hydroxylase deficiency, inc 17-hydroxyprogesterone
Hypotensive child, electrolytes abnl
hypoNa, hypoCl, hypoglycemia, hyperK
Girls ambiguous genitals, inappropriate facial hair, virilization
Boys nl initially, then delayed sexual devel

383
Q

Scarlet fever

A

strep pyogenes
fever, pharyngitis, sandpaper rash, strawberry tongue, cervical LAD
Dx inc anti-streptolysin O titer
Tx penicillin, azithromycin, cephalosporin

384
Q

Contacts of pt with epiglottitis

A

Rifampin for close contacts, ceftriaxone for pt

385
Q

Contacts of pt w whooping cough

A

macrolide for pt and all close contacts, isolate pt

386
Q

Diptheria

A

Corynebacterium diptheriae
gray pseudomembranous plaques on pharyngeal wall
do not scrape plaques
Tx w antitoxin, abx won’t help

387
Q

Glc load vs glc tolerance test

A

24-28 wks gestation
load is 50g and test at 1 hr
tolerance is 100g and test at 1, 2, 3hrs

388
Q

Medical management ectopic pregnancy

A

Methotrexate, but first obtain LFTs for risk of hepatotoxicity. Follow bHCG until hits zero, should dec 15% every few weeks. If fails, then surgery.
Cannot medically manage if 3.5+cm

389
Q

Placenta accreta/increta/percreta

A

A: attached to superficial uterine wall
I: attached to myometrium
P: invades through to serosa/bladder/rectum

390
Q

Diabetes screening pregnancy

A

24-28wks, 2 step method
50g glc load test: if >140 pos, follow 100g glc tolerance
100g glc tol test: >95 fast, 180, 155, 140

391
Q

Abortion vs Stillbirth

A

20 weeks threshold

392
Q

Tetanus ppx

A

Immunized: clean- Td toxoid if last was >10yrs, dirty- Td toxoid if last was >5yrs. NO immune globulin
Unk/Nonimm: clean- Td toxoid, dirty- Td toxoid and immune globulin

393
Q

Varicella post-exposure ppx

A

Immunized: nothing

Unk/Nonimm: immunocompetent- varicella vaccine, immunocompromised- varicella zoster IG

394
Q

Central vs peripheral precocious puberty

A

high FSH, LH vs low FSH, LH

395
Q

Management of pseudotumor cerebri

A

Acetazolamide and furosemide initially, then serial lumbar punctures if not working. LPs are not long term answer. Long term tx refractory indicates surgery for peritoneal shunt.

396
Q

Management chronic HBV

A

Chronic HBV, acute liver failure, cirrhosis issues, or high HBV DNA levels
Tx entecavir or tenofovir

397
Q

Ludwig’s angina

A

infx of submandibular and sublingual glands. MC source infx tooth. MC cause of death is asphyxiation. drooling, fever, soft tissue crepitus.
Tx abx and tooth extraction

398
Q

Aromatase in adipose tissue

A

Peripheral conversion of adrenal androgens into estrogen by aromatase, which is present in adipose tissue. There is not a frank increase in production. Leads to milder menopause

399
Q

Pna sepsis in CF

A

Young children MC cause is staph aureus. Assume MRSA, cover IV vancomycin. As get into adolescence etc, switches to pseudomonas most common. Co-existing influenza infx inc chances of staph aureus.

400
Q

PCOS

A

Weight loss, OCPs, clomid for ovulation induction, metformin. LH:FSH ratio 3:1.

401
Q

Lead screening

A

Venous sample. Arterial has too high false positive rates.
5-44: repeat test
45-69: DMSA succimer
70+: calcium EDTA

402
Q

Internuclear ophthalmoplegia

A

Lesion of medial longitudinal fasciculus. A/w MS

403
Q

VIPoma

A

Rare pancreatic cell tumor, watery diarrhea, hypoK, hyperCa, hyperglycemia, flushing, cramps, weak. Very similar presentation to carcinoid.
Dx VIP > 75, mass MC in pancreatic tail w liver mets
Tx fluids, resection, octreotide

404
Q

Management of FAP

A

Elective proctocolectomy for all

405
Q

Indication for bronchoalveolar lavage

A

Suspicion for malignancy or opportunistic infx

406
Q

MC premalignant colonic lesion

A

sessile, villous, adenoma, 2.5cm+

407
Q

Physiologic neonatal jaundice

A

High Hb turnover and inc bilirubin production, dec bilirubin conjugation/clearance (immature until 2 wks), inc enterohepatic recycling.
Tx phototherapy unless 20-25 then exchange transfusion.
Goal to prevent kernicterus.

408
Q

ADR: MAOi and tyramine food

A

HTN crisis

409
Q

Milk/Soy protein induced protocolitis

A

Switch to hydrolyzed feeds. Eliminate soy and dairy. Baby will tolerate by age 1 yr.

410
Q

Digoxin toxicity

A

Nausea, emesis, dec appetite, confusion, vision changes, weakness, arrhythmias. Visual scotomata, blurry vision, color perception changes, blindness.
HypoK inc risk of toxicity.

411
Q

Osler-weber-rendu syndrome

A

Hereditary AVMs syndrome. Involve respiratory, GI, mucous membranes. Results in bleeding and chronic hypoxia from weird pulmonary blood flow. Telangiectasias seen on skin and MMs. Recurrent nose bleeds.

412
Q

When minors don’t require parental consent

A

emergency care, STDs, substance abuse, pregnancy

413
Q

Stable and unstable afib with RVR

A

Stable: CCBs or BBs. Rate control
Unstable: synchronized cardioversion

414
Q

HIT 1 vs 2

A

1: Non-immune mediated. Ctn heparin. Plts stay >100k. 1-4 days following administration.
2: Immune mediated. Stop heparin. Plts get very low. 5-7 days out. Anti-platelet factor 4 abs. Risk of thrombosis.

415
Q

Coronary steal

A

Give dipyridamole or adenosine. Coronary vasodilators, inc blood flow 5x. Diseased vessels distal to obstruction cannot increase their myocardial perfusion capacity. Thus, redistribution of extra flow goes to non-diseased areas and the diseased flow diminishes.

416
Q

Chikungunya fever

A

Carribean. Mosquito-borne. Flulike illness, polyarthlragies, maculopapular rash, edema, cervical LAD. Low WBC and mild thrombocytopenia.

417
Q

Platelet dysfn management

A

DDAVP, stimulates vWF multimers from endothelium.

418
Q

Quantitative pilocarpine iontophoresis

A

Sweat chloride test

419
Q

Rosacea

A

Adult patients, telangiectasias on cheeks/nose/chin. Flushing periodically.
Tx topical metronidazole

420
Q

Biophysical profile

A

8+ normal, 6 equivocal, less is abnl

421
Q

Stages of labor

A

1 latent: onset to 4cm dilated
1 active: 4cm to 10cm dilated
2: full dilation to delivery (engage, descent, flexion, int rot, extension, ext rot, anterior shoulder, post shoulder)
3: delivery to placental delivery

422
Q

McRobert’s maneuver

A

macrosomic vaginal delivery, mom flex hips and knees into abdomen and apply suprapubic pressure to straighten the canal

423
Q

HRT contraindications for menopause

A

Hx DVT or breast/endometrial ca

424
Q

Dysfunctional uterine bleeding

A

a/w anovulation. Unopposed estrogen never experiences w/d bleeding from corpus luteum formation and progesterone. Bleeding occurs when endometrium outgrows the blood supply. Anyone over 35 yo gets endometrial biopsy to r/o cancer

425
Q

Erysipelas

A

Strep skin infx. Bacteremia, enlarged lymph nodes, fevers, red streaking of skin, well demarcated tender area of erythema and edema. Leukocytosis.

426
Q

Homunculus

A

Face and arms more lateral in MCA area. Legs medial in ACA area.

427
Q

Central and peripheral lung cancers

A

Central: squamous cell, small cell
Peripheral: adenocarcinoma, large cell

428
Q

Epididymitis MC organisms

A

Adult: chlamydia if sexually active

Prepubescent boy: e coli

429
Q

ADHD management

A

Methylphenidate or dextroamphetamine first line. Side effects include insomnia, appetite suppression, GI disturbance.
Atomoxetine, norepi reuptake inhibitor, second line, but often used first bc low side effect profile.

430
Q

Tourrette management

A

antipsychotics

431
Q

Depression and sleep disorder tx

A

Mirtazapine

432
Q

Bipolar mania and aggressive

A

lithium and atypical antipsychotic

if lithium doesn’t work, use valproic acid

433
Q

Bipolar depression

A

lithium or quetiapine

434
Q

MAOIs

A

Used to tx atypical depression.

phenelzine, isocarboxazid, tranylcypromine

435
Q

Valproic acid toxicity

A

hypoNa, coma, death

436
Q

Depression and need to gain weight with cancer

A

Mirtazapine

437
Q

Serotonin syndrome

A

hyperthermia, myoclonus, diarrhea, flushing, tachy

Tx cyproheptadine

438
Q

ADR: olanzapine

A

inc risk metabolic sydrome compared to other atypical antipsychotics. avoid in DM and obese patients

439
Q

ADR: ziprasidone

A

inc risk prolonged QT. avoid in pts w heart disease

440
Q

ADR: clozapine

A

agranulocytosis

441
Q

Lurasidone

A

only preg class B antipsychotic

442
Q

Antipsychotics least a/w metabolic syndrome

A

aripirazole and ziprasidone

443
Q

Manage panic attack vs disorder

A

Attack: acute, right now, benzos
Disorder: overarching, chronic, SSRIs

444
Q

Only TCA indicated for OCD

A

clomipramine

445
Q

Benzos to be given in pts with liver injury

A

oxazepam, lorazepam. neither is metabolized by liver

446
Q

Sexual identity

A

literally their sex, penis or vagina

447
Q

Gender identity

A

internal feeling of being a man or woman

448
Q

Gender role

A

external patterns of behavior, reflective of identity

449
Q

Sexual orientation

A

gay, lesbian, bisexual, asexual

450
Q

Contraindications to bupropion

A

Epilepsy/seizure disorder, anorexia, bulemia. These cause electrolyte abnl and predispose to seizures.

451
Q

Toxic megacolon

A

Inflammatory bowel disease, acutely worsened, concerning physical exam with acute belly distended/tender/hypoactive. Elevated fever, WBC >10k, tachy, anemia, elevated ESR.
Dx with AXR because management is medical before resorting to surgery. Bowel rest, NGT, steroids, +/- abx. If surgery, then colectomy w ileostomy.

452
Q

Endometrial biopsy for AUB

A

45yo+, younger than 45 w persistent sx, unopposed estrogen (PCOS, obese), prolonged amenorrhea

453
Q

ADR: primidone

A

precipitates acute intermittent porphyria. manifests as abd pain and neuropsychiatric sx.
Dx check urine porphobilinogen

454
Q

Edrophonium test

A

Anticholinesterase test. Rapidly improves sx of MG. Not tx. Tx w pyridostigmine, longer acting.

455
Q

Cystinuria

A

Impaired amino acid transport by renal tubular cells. Forms radioopaque hexagonal renal stones on UA.
Urinary cyanide nitroprusside test shows elevated cystine levels. Familial, recurrent stones.

456
Q

Painless hematuria, sickle cell trait

A

Renal papillary necrosis. SST benign, normal peripheral smear. Look for black kid with no issues and transient episode hematuria. Labs all normal. Hb electrophoresis shows elevated HbAS.

457
Q

Methacholine challenege test

A

Causes bronchoconstriction. Used to dx asthma

458
Q

Ca-Alb correction factor

A

For every dec in alb by 1, Ca dec by 0.8. This is total calcium. Ionized calcium stays regulated but is often not measured in labs directly.

459
Q

Endometritis tx

A

gentamicin and clindamycin

460
Q

Complication of correcting B12 deficiency with B9

A

Corrects megaloblastic anemia, but ppts the neurological dysfn much more rapidly a/w B12 deficiency.

461
Q

Adult parvovirus B19 infx

A

Polyarticular, symmetric, self-limiting, a/w frequent contact with children. Arthritis involving MCP, PIP, wrist. Morning stiffness 15 minutes, less than RA.
Dx by parvovirus IgM

462
Q

Methods of controlling confounding

A

matching, restriction, randomization

463
Q

Post-MI ventricular aneurysm

A

Late complication. Prolonged ST-elevation along same leads with deep Q waves. Enlargement of LV can lead to mitral regurge and CHF.

464
Q

Thyroid cancers

A

Papillary: MC
Follicular: bx to tell from follicular adenoma
Medullary: calcitonin, parafollicular C-cells, RET oncogene
Anaplastic: rare but worst prognosis

465
Q

HIV ppx

A

200 bactrim
150 itraconazole
50 azithromycin

466
Q

MC cause ascending aortic aneurysm

A

cystic medial necrosis or connective tissue disorder

467
Q

MC cause descending aortic aneurysm

A

atherosclerosis

468
Q

Anemia in scleroderma

A

Hemolytic anemia from scleroderma renal crisis. Schistocytes present from microangiopathic hemolysis or DIC.

469
Q

SBP

A

Paracentesis- 250+ PMNs, SAAG >1.1, gram neg e. coli most common, glc >50, protein

470
Q

Morton neuroma

A

numbness/pain btwn 3rd and 4th toe. clicking sensation when squeezing metatarsal joints

471
Q

Respiratory Quotient

A

Rate of CO2 produced to rate of O2 uptake.
Using protein only 0.8
Using glucose only 1.0
Using fatty acid only 0.7
Normal is around 0.8 because combination of all 3

472
Q

MC complication sickle cell trait

A

hematuria

473
Q

Hypersensitivity Types

A

1: IgE- anaphylaxis, immediate, urticaria, mast cell
2: Ab-mediated- IgM/IgG to cell-bound antigens, ex. Rh hemolytic newborn disease
3: Immune-complex- already formed, circulating, ex. serum sickness
4: Cell-mediated- delayed, ex. contact dermatitis

474
Q

Management of EPS with antipsychotics

A

Aside from stopping drug, can give anticholinergics.

Tx benztropine

475
Q

Sick euthyroid vs sublicinical hypothyroid

A

SE: dec total T3, dec free T3, normal T4 and TSH, caused by general thyroid abnl a/w any sickness.
ST: nl T3 and T4, inc TSH

476
Q

Ventilator tidal volume

A

6mL/kg, going higher inc risk of barotrauma

477
Q

PEEP

A

Main modality of management for supplemental O2 in ARDS. 5-15 is the range to work with. Higher inc risk of barotrauma.

478
Q

Anti-SSA(Ro) or Anti-SSB(La)

A

Sjogren syndrome - infiltration of salivary glands

479
Q

MC cause viral meningitis

A

echovirus, coxsackievirus

480
Q

Renal vein thrombosis

A

Nephrotic syndrome patient, sudden onset severe flank pain, fever, gross hematuria. Common a/w membranous glomerulopathy

481
Q

Pediatric constipation and UTI association

A

Hard impacted stool distends colon/rectum compressing outlet of bladder. Leads to urinary stasis and recurrent UTIs. Look for child with constipation and anal fissures who has dysuria but can only pee little amounts.

482
Q

Pediatric incidental proteinuria management

A

follow-up with dipstick at subsequent visit. must evaluate for persistence of proteinuria, at which point more work up would be necessary

483
Q

CMV-mononucleosis

A

Presents as EBV mono without pharyngitis or posterior cervical LAD. Smear shows atypial lymphocytes w basophilic vacuolated appearance. Monospot negative. Splenomegaly present.

484
Q

PKU

A

Phenylalanine hydroxylase deficiency. Retarded, fair skin and eyes, eczema, mousy/musty body odor.
Tx special diet

485
Q

Hereditary fructose intolerance

A

Aldolase B deficiency. Accumulation of F1P w intro of fruits to diet. Vomiting, FTT, lethargy. Seizures and encephalopathy if diet not changed.

486
Q

Isolated systolic hypertension

A

Common in elderly. Due to decreased elasticity of arterial wall. Tx w HCTZ, ACEi, CCB

487
Q

Oxybutinin

A

Anticholinergic, urge incontinence

488
Q

Urethral hypermobility

A

Angle >30, a/w stress incontinence

489
Q

Giant cell tumor of bone

A

Local bone tumor, epiphysis long bones, pain, swelling, decreased ROM at joint. Appears as osteolytic lesions or soap bubbles. Contains both cystic and hemorrhagic portions.

490
Q

Osteoid osteoma

A

Sclerotic cortical bone lesion with central lucency. Pain worse at night, not a/w activity. Tx NSAIDs

491
Q

IgA deficiency transfusion anaphylaxis

A

Transfuse pRBCs, must wash cells to remove plasma prior to infusion to avoid anaphylactic reaction.

492
Q

Febrile nonhemolytic transfusion reaction

A

No hemolysis, but malaise, fever 1-6 hrs following transfusion. Tx by leukoreduction of cells prior to transfusion.

493
Q

ADR: RAI therapy for Graves

A

worsening of ophthalmopathy

494
Q

ADR: Methimazole and PTU

A

agranulocytosis. look for signs of infx

495
Q

Chediak Higashi

A

Dysfn of degranulation, chemotaxis, granulopoiesis. Albino, recurrent bacterial infx, pancytopenia.
Tx bactrim ppx and ascorbic acid ppx

496
Q

Somatic symptom vs illness anxiety disorder

A

SS: persistent complaint of >1 sx, concern for it being something terrible despite extensive negative workup and no explanation
IA: persistent worry about something terrible with minimal, if any, sx at all. continually neg workups

497
Q

Waterhouse-Friderichsen

A

Meningococcemia (meningitis with purpura rash), acute decompensation and hypotension, death. Caused by adrenal failure and hemorrhage, complete vasomotor collapse.

498
Q

Blood tests for secondary amenorrhea

A

bHCG, prolactin, TSH, FSH

499
Q

Syphilis management in PCN allergic pt

A

nonpregnant: doxycycline
pregnant: desensitize and give PCN

500
Q

Acute hemolytic transfusion reaction

A

Within 1 hr of transfusion, fever, flank pain, hemoglobinuria, renal failure, DIC (bleeding from IV sites). Positive Coombs. Due to ABO incompatibility.

501
Q

Panacinar vs centriacenar emphysema

A

A1AT deficiency vs smoking COPD

502
Q

Ondansetron/Zofran

A

Serotonin/5HT3 antagonist, anti-emetic, good for chemo-induced nausea

503
Q

Metoclopramide

A

Dopamine antagonist, anti-emetic, not as good as zofran

504
Q

Scopolamine

A

anticholinergic, anti-emetic good for motion sickness, comes in patch form

505
Q

Serum sickness

A

MC caused by abx. 1-2 weeks post-exposure, fever, urticaria, arthralgias. Possible HA, LAD, edema, splenomegaly.
Tx remove offending drug, add steroids if severe

506
Q

Inferior MI

A

2, 3, aVF

RCA occlusion

507
Q

Anterior MI

A

V1-V6 any

LAD occlusion

508
Q

Multiple sclerosis exacerbation and maintenance

A

E: steroids
M: glatiramir acetate and beta-interferon

509
Q

C difficile

A

Risk factors: abx, PPIs, H2 blockers

Tx oral flagyl, oral vanc

510
Q

Beck’s Triad

A

HypoTN, muffled heart sounds, JVD.
Cardiac tamponade. Dec left ventricular filling from shift of ventricular septum towards left, decreasing available filling space. Dec stroke volume and cardiac output

511
Q

Sympathetic ophthalmia

A

Penetrating eye trauma. Anterior uveitis, papilledema, blindness develops, uncovering of “hidden antigens”
Immunologic dmg to eye

512
Q

Lactational mastitis

A

Results from missed feedings and inadequate milk drainage from breast. Continue breast feeding. MC pathogen is staph aureus.
Tx dicloxacillin or cephalexin. If more severe, aim at MRSA

513
Q

SIADH management

A

Goal is to fix Na levels. Fluid restrict first. If need, add hypertonic saline. If very resistant, can give demeclocycline.

514
Q

Demeclocycline

A

ADH receptor antagonist. Used for refractory SIADH.

515
Q

Condyloma accuminata vs lata

A

CA: HPV, raised
CL: syphilis, flat

516
Q

Acne management

A

Cleansers, benzoyl peroxide, topical retinoids, topical abx, oral abx, oral retinoids

517
Q

Dissociative identity disorder

A

Multiple personalities, forget important personal information, and only certain personalities know certain things.

518
Q

Dissociative amnesia

A

Inability to recall important personal information on multiple occasions. Too much to be considered normal.

519
Q

Dissociative fugue

A

Confusion about personal identity, a/w travel and patient not knowing where they are or why.

520
Q

Depersonalization disorder

A

Feeling out of body, significantly impairs daily living, feel detached from themselves.

521
Q

Pleural fluid pH

A

Nl: 6.0
Transudate: 7.4-7.55
Exudate: 7.3-7.45

522
Q

Angiofibroma (juvenile)

A

Epistaxis, localized mass, bony erosion in back of nose. Dangerous due to rich blood supply, requires surgery from specialist, unencapsulated and deeply invasive. Recurrence is common.

523
Q

Pralidoxime

A

antidote for organophosphates, reactivates acetylcholinesterase

524
Q

Mercury poisoning

A

pulmonary toxicity (fibrosis), neurological sx (jittery, twitching, nervous)

525
Q

BSA for burns

A 
Head 9%
Arms 9% each
Legs 18% each
Chest 18%
Back 18%
526
Q

Volume replacement for burn victim

A

%BSA burnt x 4 x weight in kg

527
Q

Hypothermia EKG finding

A

elevated J point

528
Q

Asystole management

A

Epinephrine or vasopressin. Vasoconstricts to shunt blood to heart and brain.

529
Q

VFib management

A

Defibrillate. Then epinephrine/vasopressin. Then amiodarone or lidocaine (amio better). Then magnesium.

530
Q

Vtach management

A

Pulseless: defibrillate
HD stable: amio, then lidocaine, then procainamide.
HD unstable: synchronized cardioversion, then amio, then lido, then procainamide

531
Q

PEA defn and management

A

Nl EKG with no pulses. Start compressions, then worry about getting IVs for fluids and epi running.

532
Q

HD unstable afib management

A

synchronized cardioversion to prevent vfib

533
Q

SVT management

A 
Patient w palpitations. Narrow complex tachy. AV nodal reentry conduction.
Vagal maneuvers (carotid massage, Valsalva, ice immersion). Then adenosine. Then BBs, CCBs
534
Q

WPW

A

Find conduction pathway abnormality with EP studies. Tx acute sx with procainamide or amiodarone. Chronic management with catheter ablation. CCBs and digoxin not to be used, they block the normal conduction pathway

535
Q

Multifocal atrial tachycardia

A

a/w COPD

look for EKG with at least 3 different P wave morphologies

536
Q

Sinus bradycardia

A

Asymp: observe
Symp: atropine and pacemaker

537
Q

Second degree AV block

A

Type 1 Wenckebach: progressive lengthening PR interval until drops beat. observe
Type 2: drops a beat without progressive lengthening, deteriorates to 3rd degree. pacemaker

538
Q

Complications of uncontrolled maternal hyperglycemia

A

macrosomia, neonatal hypoglycemia, polycythemia/hyperviscosity, congenital malformations

539
Q

Post-splenectomy vaccines/ppx

A

pneumococcal, Hib, meningococcal, PCN ppx 3-5 yrs

540
Q

Impotence following pelvic fracture vs penile fracture

A

Pelvic: neurogenic, injury to parasympathetics
Penile: venogenic, AVMs form

541
Q

MC ADR from RAI therapy

A
  1. hypothyroid

2. worsening of ophthalmopathy

542
Q

Struma ovarii

A

ovarian tumor that produces thyroid hormone, results in thyrotoxicosis

543
Q

Brainstem CNs

A

Midbrain: 3, 4
Pons: 5, 6, 7
Medulla: 8, 9, 10, 11, 12

544
Q

CJD

A

Prion dz, rapid dementia, myoclonus, EEG periodic sharp waves, elevated 14-3-3 proteins in CSF

545
Q

Diagnosis of lactose intolerance

A

Clinical suspicion, pos hydrogen breath test, pos stool test for reducing substances, low stool pH, inc stool osmotic gap

546
Q

Digital clubbing associations

A

malignancy, CF, right to left shunts

547
Q

MOE management

A

pseudomonas

Tx ciprofloxacin

548
Q

Quadruple screen abnormalities

A

Trisomy 21: inc bHCG/inhibin A, dec AFP/estriol
Trisomy 18: dec AFP/bHCG/estriol, nl inhibin A
NTD/AWD: inc AFP, nl otherwise

549
Q

Polycythemia vera

A

JAK2 mutation, O2 levels normal, EPO levels low, pruritus from inc histamine from basophils. Tx aspirin, phlebotomy to keep Hct under 45%, hydroxyurea, allopurinol/rasburicase. Antihistamines for itching.

550
Q

ADR: niacin

A

cutaneous flushing and pruritus, managed with aspirin, due to prostaglandin peripheral vasodilation

551
Q

Adult Still Dz or JRA

A

recurrent high fevers, salmon colored rash trunk and extremities, not itchy, flares during febrile episodes, trunk and extremities, arthritis. splenomegaly, pericardial effusion

552
Q

Distinguish sideroblastic anemia from iron deficient anemia from thalassemia

A

SA has inc total iron but decreased TIBC, which is opposite iron deficient anemia. Thal has normal iron studies

553
Q

Labs to follow for immune clearance of HBV

A

HBeAg and ALT remain abnl until cleared

554
Q

ADR: bactrim

A

hyperkalemia due to blockage of ENaC at collecting tubule

555
Q

ADR: macrolides

A

prolonged QT and cholestasis

556
Q

CF infertility

A

congenital absence of vas deferens

557
Q

Hereditary spherocytosis vs autoimmune hemolytic anemia

A

HS: pos family hx, neg coomb’s
AIHA: neg family hx, pos coomb’s
Peripheral smear same for both

558
Q

Biggest risk factor aortic dissection

A

HTN

559
Q

Biggest risk factor aortic aneurysm

A

smoking

560
Q

Order of decision making

A

Patient w capacity, healthcare proxy with agent, living will, family (spouse, adult children, parents, siblings)

561
Q

When do we perform bacterial antigen tests?

A

Abx started before LP

562
Q

Neisseria meningitis management

A

IV ceftriaxone. ppx for close contacts with rifampin, cipro, or ceftriaxone. Pt in droplet isolation.

563
Q

Complication of untreated bacterial meningitis

A

MC 8th cranial nerve deficit, deafness

564
Q

Influenza management

A

Within 48 hours: oseltamivir

Later: supportive

565
Q

HBV first abnl lab in acute infx

A

surface antigen

566
Q

Indication of HBV infx resolved

A

lack of surface antigen

567
Q

HCV management

A

Interferon is secondary now to sofosbuvir and ribavirin combo. Other combo is sofosbuvir and ledipasvir

568
Q

Jarisch-Herxheimer reaction

A

fever and worsening sx after tx syphilis. give aspirin and fever reducers. observe

569
Q

Clostridium septicum

A

order colonoscopy

570
Q

MC culture negative organisms for IE

A

coxiella and bartonella

571
Q

Hereditary angioedema

A

C1 esterase deficiency. Tx ecallantide. Dec levels C2 and C4 on labs.

572
Q

Supracondylar fracture

A

median nerve

brachial artery

573
Q

Midshaft humerus fracture

A

radial nerve

574
Q

Take-tsubo cardiomyopathy

A

Stressful event, catecholamine discharge, acute mycardial damage.

575
Q

Order of test abnormalities for MI

A

EKG, myoglobin, CKMB, trops

576
Q

Rheumatic fever valvular disease

A

mitral stenosis MC

577
Q

Effects on HCM and MVP

A

opposite what you think for others

i.e. less volume, more murmur. more volume, less murmur.

578
Q

PAD management

A

Always start diet/exercise/smoking etc. Then add antiplatelet aspirin, and can use cilostazol as most effective medical management. surgery is medical management fails in severely limiting and debilitating disease.
most effective med is cilostazol.

579
Q

Relation of thyroid hormone, GH, and prolactin

A

TRH stimulates prolactin. Prolactin cosecreted with GH. Hypothyroid results in elevated prolactin

580
Q

DLCO in emphysema vs chronic bronchitis

A

E: dec
CB: unchanged

581
Q

MC bacterial pna w COPD

A

Hib

582
Q

ADR: pyrazinamide

A

hyperuricemia

part of ripe therapy

583
Q

EKG findings in PE

A

MC sinus tachy. MC abnl EKG is nonspecific ST-T wave changes. Alternative S1Q3T3

584
Q

Obesity hypoventilation syndrome

A

presents as obstructive sleep apnea, but with elevated bicarb

585
Q

Cinacalcet

A

Tx for hyperparathyroid when surgery cannot be done

586
Q

Diabetic gastroparesis management

A

erythromycin or metoclopramide. mechanism of dysfn is inability of stretch receptors to sense filling from food

587
Q

ADR: colchicine

A

diarrhea and BM suppression (neutropenia)

588
Q

Acute gout attack management

A

NSAIDs (better than colchicine), then steroids, then colchicine if contraindicated for the other two

589
Q

Best BP meds in gout

A

Losartan (ARB), lowers uric acid

590
Q

Sciatica/disk herniation management

A

NSAIDs and continued ADLs. Do not do bed rest. Persistence indicates steroid injection.

591
Q

Dupuytren contracture

A

Hyperplasia of palmar fascia, contraction of 4th and 5th digit. Tx steroids, lidocaine, collagenase injections. Refractory management with surgical release.

592
Q

RA vs OA xray findings

A

RA: erosion of joints, osteopenia
OA: joint space narrowing, osteophytes

593
Q

Pilocarpine

A

increases acetylcholine

594
Q

Worst complication of Sjogren

A

lymphoma

595
Q

Churg-strauss

A

asthma, eosinophilia, renal

596
Q

ADR: bisphosphonates

A

pill esophagitis (remain upright 30 mins), osteonecrosis of jaw

597
Q

Prostethic joint infection

A

MC staph epi. Remove joint, 6-8 wks abx, replace joint.

598
Q

Gonococcal arthritis

A

Polyarticular, not symmetric, tenosynovitis, petechial rash. Culture, but often negative in joint, so culture multiple spots. Tx cephalosporin.

599
Q

Osteomyelitis management

A

MC staph aureus. Sickle cell salmonella. Dx biopsy, not culture.
Children: hematogenous
Adult: contiguous

600
Q

Bilirubin gallstones

A

a/w chronic hemolysis

601
Q

Rasburicase

A

Protects against tumor lysis syndrome related rise in uric acid

602
Q

Lupus anticoagulant and anticardiolipin antibodies

A

Anticardiolipin a/w multiple miscarriages, both thrombophilia w high aPTT. Best study is mixing studies

603
Q

Drugs causing pill esophagitis

A

bisphosphonates, potassium chloride, doxycycline

604
Q

Secretin stimulation test

A

Test of pancreatitis, normal result would show massive inc in bicarb

605
Q

Celiac and tropical sprue management

A

C: avoid gluten
TS: bactrim, doxycycline

606
Q

IBS management

A

fiber, dicyclomine (antispasmodic), TCAs, loperamide for diarrhea, lubiprostone for constipation

607
Q

Abs in crohn and UC

A

CD: ASCA positive
UC: ANCA positive

608
Q

PBC and PSC management

A

ursodeoxycholic acid

609
Q

Wilson dz management

A

penicillamine (copper chelation)

zinc and trientine alternatives

610
Q

EHEC

A

Watery to bloody diarrhea, do not give abx, will ppt HUS

611
Q

C perfringens food poisoning

A

unrefrigerated, nonbloody diarrhea

612
Q

Milk-alkali syndrome

A

hypercalcemia, met alkalosis, renal failure. was common when ppl used antacids for PUD, less common now.

613
Q

New HCV patient initial management

A

Offer liver bx, determine progression before initiating therapy.

614
Q

Vitreous hemorrhage

A

Sudden loss of vision and onset of floaters. Red glow signifies bleeding. Obscured fundus. a/w diabetes

615
Q

Peds volvulus management

A

Hx of bilious emesis, no distal gas in bowel. Dx upper GI series promptly before ischemia. Tx surgically

616
Q

Beckwith-Wiedman

A

Macroglossia, rapid growth, hemihyperplasia, omphalocele/umbilical hernia

617
Q

Angelman Syndrome

A

Smiling, laughing, hand-flapping, ataxia, seizures. Retard, short stature

618
Q

Prader-Willi

A

Hypotonia, poor suck/feeding, hyperphagia, obesity. Risk for DM, OSA, gastric rupture.

619
Q

Rett Disorder

A

Retard, ataxia, stereotyped hand-wringing, developmental delay.

620
Q

Asherman Syndrome

A

Amenorrhea and lack of withdrawal bleeding when tested in woman following D&C. Result of adhesion and scarring of endometrium.

621
Q

PDA murmur

A

“Machine murmur” or “to-and-fro murmur 2nd left intercostal space, loud S2, bounding peripheral pulses, widened pulse pressure in infant. A/w recurrent URIs since birth and poor feeding

622
Q

Adrenoleukodystrophy

A

Very long chain fatty acid metabolism defect, builds up in CNS, adrenals, testes. Long term coma/death.

623
Q

Rabies management

A

First clean wound. Unimmunized: active (rabies vaccine) and passive (rabies Ig). Immunized: rabies vaccine only.
High risk animal- Tested: PEP if positive. Untestable: PEP without testing. If domestic, quarantine and look for warning signs.

624
Q

Wallenberg syndrome

A

Lateral medullary infarct. Horners, loss pain/temp sensory ipsilateral face and contralateral body, ipsilateral bulbar muscle weakness, vertigo/nystagmus/ataxia

625
Q

ADR: nitroprusside

A

cyanide toxicity, result of metabolite, monitor levels of cyanide. Tx sodium thiosulfate or nitrites

626
Q

Hydralazine/labetalol vs nitroprusside vs nitroglycerine

A

H/L: HTN emergency in pregnancy. Fast-acting, arterial vasodilator. DO not use hydralazine in aortic dissection as will increase shearing forces and make worse. Labetalol is first line for dissection.
NP: Small vessel (arteriolar/venule) vasodilator, dec peripheral vascular resistance. Use in HTN emergency/malignant/enceph NON-PREG. Risk of cyanide toxicity as byproduct.
NG: antianginal, no role in HTN management

627
Q

ADR: hydralazine

A

reflex tachycardia

628
Q

BV (gardnerella vaginallis)
Trichomoniasis (trichomonas vaginalis)
Candida (candida albicans)

A

BV: thin, off-white/grey, non-inflam, fish odor, clue cells, pos whiff test, pH > 4.5, tx metronidazole
Trich: thin, yellow/green, frothy, inflam, malodorous, motile trichomonads, pH > 4.5, tx metronidazole pt and partner
Candida: thick, cottage cheese, inflam, pseudohyphae, normal pH

629
Q

Acute aortic dissection management

A

IV BBs, labetalol

630
Q

Peds UTI work-up

A

Renal US: 1st febrile UTI under 2 yo. Recurrent UTIs

VCUG: abnl renal US, UTI under 1 mo, recurrent UTIs under 2 yo, UTI from organism other than e. coli

631
Q

Indicators of response to tx in DKA

A

Follow serum anion gap and/or beta-hydroxybutyrate levels (MC serum ketone in DKA). Urine ketones are not helpful

632
Q

Midazolam

A

Benzo used for conscious sedation for medical procedures. Often an answer choice as a distractor with a second benzo.

633
Q

Hypoventilation

A

Normal A-a gradient but in respiratory acidosis. Also suggested by high PaCO2 and low PaO2. PaCO2 btwn 50-80 is very suggestive.

634
Q

Normal A-a gradient

A

Less than 15, but changes with age, so greater than 30 is universally accepted as large/abnl

635
Q

Langerhans cell histiocytosis

A

Solitary painful lytic long bone lesion, swelling, hypercalcemia. Rule out hyperparathyroid. Treat conservatively, spontaneously resolves.

636
Q

Magnesium sulfate toxicity

A

Depressed DTRs is first sign. Tx calcium gluconate

637
Q

Ewing sarcoma

A

MC in femur, very malignant, easy confused with osteomyelitis, mets to lungs. Characteristic onion-skin periosteal rxns on xray. Described as lytic, central, endosteal scalloping. “Moth-eaten” or mottled w extension to soft tissues.

638
Q

Salicylate toxicity

A

Combined resp alkalosis and met acidosis. RA from salicylate stimulation of resp centers in brainstem. Thus, looking for near normal pH because of the mixed picture.

639
Q

Meniere’s dz

A

Vertigo, nystagmus, tinnitus, ear fullness, hearing loss. Tx dietary modifications i.e. low sodium diet. 2nd line is diuretics and anticholinergics.

640
Q

Home O2 criteria

A

sat 88% or below, or arterial O2 below 55

641
Q

Virus a/w nasopharyngeal cancer

A

EBV

642
Q

Attributable risk percent (what percent of X can be attributed to Y)

A

(RR-1)/RRca

643
Q

Increase warfarin effect

A

Acetaminophen, amiodarone, abx, NSAIDs, omeprazole, SSRIs, cranberry juice

644
Q

Decrease warfarin effect

A

carbamazepine, rifampin, green veggies, OCPs

645
Q

Third degree heart block

A

Regular P-P intervals, regular R-R intervals, they are unassociated

646
Q

Indications for urgent dialysis

A

pH less than 7.1, hyperK cannot be managed by medicine, volume overload unmanaged by diuresis, symptomatic uremia

647
Q

Malaria ppx

A

Africa/SE Asia: mefloquine, atovaquone-proguanil

South America/Mexico: primaquine

648
Q

Post-menopausal asymptomatic pelvic mass

A

transvaginal US and CA-125. do not FNA for fear of seeding. suspicion = surgery, none = observe.

649
Q

Bernard Soulier syndrome

A

absent platelet glycoprotein, mild low plts, circulating giant platelets, severe platelet dysfn, bleeding

650
Q

Lidocaine in ACS situations

A

dec risk vfib, inc risk asystole

651
Q

Addison’s disease acid base status

A

hyponatremic, hyperkalemic NON anion gap met acidosis

652
Q

Sheehan syndrome

A

pituitary infarction, a/w postpartum hemorrhage, mom can’t lactate and menstrual cycles messed up. loss of anterior pituitary hormones (gh, acth, fsh, lh, tsh, prolactin). ADH and oxytocin unchanged

653
Q

Bacterial meningitis infant management

A

Must start empiric abx (ceftriaxone and vanc) prior to LP. cannot delay abx tx. image w CT only with focal neurological findings, coma, or hx of neurosurgery

654
Q

Intrauterine fetal testing

A

Cell-free DNA test: 35+yo chick, 10 wks, looking for abnl, if pos then do chorionic villus sampling
CVS: 10-13 wks, karyotype of baby, looks for down’s
Amniocentesis: 15-20 wks, karyotype

655
Q

Type 1 and 2 error

A

1: false positive, reject null hypoth but its true
2: false neg, accept null hypoth but its false

656
Q

Trachoma

A

Chlamydia trachomatis
Follicular conjunctivitis, neovascularization
Tx topical doxy or oral zpac

657
Q

Infective endocarditis

A 
Bacteremia (staph, strep, HACEK)
New regurge murmur
Vegetations
Risks (IVDU, bad valve)
Fever
Rheum (roth spots eyes, splinter hem, janeway lesions, osler nodes fingers painful)
Vascular (emboli, RF+)
658
Q

Cat scratch vs bite

A

S: macrolide or doxy
B: augmentin

STEP 2 CK (1 decks)

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