Step 2 CK Flashcards
(Glipizide, glyburide, glimepiride) What kind of medications are these and what do they do?
Insulin medications and they increase endogenous secretion of insulin
How does metformin work?
Increases insulin sensitivity
What are the side effects for glyburide, glipizide and glimepriride?
Hypoglycemia and weight gain
How does rosiglitazone work?
Increase insulin sensitivity
What is the side effect of rosiglitazone?
weight gain and edema
How do they alpha glucosidase inhibitors work?
decrease intestinal absorption of carbohydrates
Whats the symptomatic treatment for hyperthyroidism?
Propanolol
Whats the main treatment for hyperthyroidisim?
Methimazole or PTU
Whats the definitive treatment for hyperthyroidism?
radioactive thyroid ablation or surgery
How do you treat thyroid storm?
IV propanolol and steroids
What kind of thyroid nodules has an increase risk of malignancy?
Cold nodules
Does increased uptake or decreased uptake hold an increase risk of malignancy?
decreased
What condition gives you persistent serum hypercalcemia, low calcium in urine, and normal PTH and no symptoms?
Familial hypocalcuric hypercalcemia
How do you treat hypercalcemia?
IV fluids and loop diuretics
Which cushings is suppressed with high dose dexamethasone?
Cushing disease
What is the treatment for a Prolactinoma?
Dopamine agonist (bromocriptine, cabergoline)
What is the treatment for pheochromocytoma?
Alpha blockers and beta blockers
What is the neuroimaging finding for schizophrenia?
Enlargement of cerebral ventricles
What is the neuroimaging finding for panic disorder?
decreased volume of amygdala
What is the neuroimaging finding for autism?
increased total brain volume
What is the neuroimaging finding for obsessive compulsive disorder?
abnormalities in orbitofrontal cortex and striatum
What is the neuroimaging finding for post traumatic stress disorder?
decreased hippocampal volume
What drug is contraindicated in cocaine induced STEMI?
Beta blockers
What is the test of choice for meconium ileus and hirschsprung disease?
contrast enema
If a patient has recurrent nephrolithiasis what would be the best advice for prevention of stones?
decrease Protein in the diet
What kind of hemangioma do you get in infancy?
Strawberry hemangioma (superficial hemangioma)
What is the side effect for methimazole?
Agranulocytosis
What is the side effect for PTU?
Hepatic failure
What is the side effect for the calcium channel blocker amlodipine?
Peripheral edema
How do you treat a scaphoid fracture?
immobilization
What is the best test to diagnose stones?
CT scan without contrast or ultrasound
What is the side effect for amiodarone?
Pulmonary toxicity
What is plummer-vinson-syndrome?
Where you have esophageal webs, iron deficiency anemia and glossitis
What is the musculature made out of in the upper 3rd of the esophagus?
Skeletal muscle
What is the musculature made out of in the lower 3rd of the esophagus?
smooth muscle
If you have painfull swallowing what imaging test would you do? (odonophagia)
Endoscopy
If you had difficulty swallowing what imaging test would you do? (dysphagia)
Barium swallow then endoscopy
What condition gives you chest pain, dysphagia and odynophagia after ingestion of hot or cold liquids?
Esophageal spasm
What is the treatment for esophageal spasm?
Nitrates or CCB
What muscle is affected in a Zenker diverticulum?
cricopharyngeus muscle
What is the most common type of esophageal cancer worldwide?
Squamous cell carcinoma
What is the most common esophageal cancer in the United States?
Adenocarcinoma
What is the risk factors for squamous cell carcinoma of the esophagus?
Alcohol and smoking
What is the risk factors for adenocarcinoma od the esophagus?
Barrets esophagus from Chronic GERD
What is the location in the esophagus where you are most likely to find squamous cell carcinoma?
upper and middle 3rds of the esophagus
What is the location in the esophagus where you are most likely to find adenocarcinoma?
lower 1/3 of the esophagus
How would you diagnose gastritis?
upper endoscopy
What is the triple therapy for H.pylori infection?
amoxicillin, clindamycin, omeprazole
What are stress ulcers and how do you treat them?
Stress ulcers include curling ulcers from burn injuries and cushing ulcers from traumatic brain injury. Treat with prophylactic PPIs
What is a krunkenberg tumor?
It is a gastric adenocarcinoma that metastasizes to the ovary
What is MALT?
MALT is mucosa-associated lymphoid tissue lymphoma which is a rare gastric tumor associated with chronic H. pylori infection that can be cured with triple therapy
What cancer is associated with an enlarged left supraclavicular lymph node?
Gastric cancer
What is the treatment for diarrhea caused by campylobacter?
Erythromycin
What is the most common cause of bacterial diarrhea?
campylobacter
What is the most common cause of pediatric diarrhea?
rotavirus
Whats the most common complication of C. diff?
toxic megacolon
What is the treatment for C.diff
metronidazole or vancomycin
What is the treatment for entamoeba histolytica?
metronidazole
How do you treat salmonella and shigella?
TMP-SMX
What does lactose break down into and what enzyme facilitates this?
glucose and galactose facilitated by lactase
What condition present with abdominal cramps, wheezing, cutaneous flushing, diarrhea, and right sided cardiac valvular lesions?
Carcinoid syndrome
What is the treatment for carcinoid syndrome?
octreotide
How do you diagnose carcinoid syndrome?
Urine levels of 5-HIAA
What condition gives you periodic crampy abdominal pain, bilious vomiting, abdominal distention and tenderness, no passing of flatus or stools and hyperactive bowel sounds?
Small bowel obstruction
What condition gives you continuous diffuse abdominal pain, nausea and vomiting, abdominal distenstion and tenderness, hypoactive bowel sounds and no flatus or bowel movements?
Ileus
What is the most common cause of acute lower GI bleeding in older patients?
Diverticulosis
What is Charcot’s triad and what condition is it associated with?
- RUQ pain
- Jaundice
- Fever/chills
Associated with ascending cholangitis
What condition is associated with an increased alkaline phosphatase level and increased direct bilirubin?
Choledocolithiasis
What is the next step in management for acute ascending cholangitis and choledocolithiasis?
ERCP
What are anti-smooth muscle antibodies associated with?
Autoimmune hepatitis
What is the treatment for acute hepatitis?
supportive care
What is the treatment for chronic hepatitis B?
interferon and lamivudine
What is the treatment for chronic hepatitis C?
interferon and ribavirin
What condition is associated with increased alkaline phosphatase, jaundice, pruritus, and positive antimitochondrial antibodies?
Primary biliary cirrhosis
What is the treatment for primary biliary cirrhosis?
ursodeoxycholic acid
What is the treatment for wilsons disease?
penicillamine
What is the hallmark finding in pancreatic cancer?
nontender, palpable gallbladder
What is the initial workup for a postmenopausal women with an adnexal mass?
transvaginal ultrasound and CA-125 level
What is the treatment for a patient with WPW syndrome who is in atrial fibrillation?
Procainamide
What is the test of choice for malrotation/volvulus?
upper GI series
What medications can you use to drive potassium intracellularly?
- Insulin
- Glucose
- Sodium bicarbonate
- Albuterol
What is the treatment for pseudotumor cerebri?
Acetazolamide
If you have blood at the beginning of urination what should you think of?
urethral injury
If you have blood at the end of urination what should you think of?
Bladder or prostate problems
At what weight should an infant not get immunizations?
Whats the mutation in Marfans syndrome?
Fibrillin 1 gene
What are the treatments for BPH
Alpha blockers (terazosin, tamsulosin) or finesteride
What is the treatment for bullous impetigo?
Oral antibiotics like clindamycin, cephalexin, dicloxcillian
What is the treatment for non-bullous impetigo?
topical muciprocin
What is the problem with giving lidocaine to a person who had a MI?
It can increase risk for asystole
What is the treatment for measles?
vitamin A and supportive care
What are the complications of bronchiolitis in infants?
apnea or respiratory failure
What are the complications of subarachnoid hemorrhage?
- Rebleeding after day 1
- Vasospasm after day 3
- increased ICP
- Seizures
- SiADH
What in the spinal fluid and confirm the diagnosis of subarchnoid hemorrhage?
Xanthrochromia
recurrent stones since childhood, hexagonal crystals on urnalysis and positive cyanide nitroprusside test is associated with what condition?
Cystinuria
What is the abnormality in cystinuria?
Defective amino acid transport
Pagets disease of the breast is associated with what kind of cancer?
Adenocarcinoma
What biopsy finding are suggestive of bullous pemphigoid?
IgG and C3 deposits at the dermal-epidermal junction
What are the autoantibodies targeting in pemphigus vulgaris?
desmoglein
What are the autoantibodies targeting in bullous pemphigoid?
hemidesmosomes
Pronator drift is associated with what type of brain abnormality?
upper motor neuron disease
Which cause of direct hyperbilirubinemia gives you dark granular pigment in the hepatocytes?
Dubin johnson syndrome
Leads 2, 3, AVF correlates with what kind of MI?
Inferior MI
Whats the antidote to heparin?
Protamine sulfate
What is cryoprecipitate?
More concentrated form of fresh frozen plasma. Contains factor 8 and fibrinogen
What is the diagnostic test for vWD?
ristocetin cofactor assay
What is the treatment for vWD?
DDVAP(desmopressin)
What is the difference between the labs in vWD and hemophilia?
In vWD there is platelet dysfunction so the bleeding time and PTT is prolonged but in hemophilia PTT is prolonged
What 3 things can give you microangiopathic hemolytic anemia that leads to schistocyted on peripheral blood smear?
- HUS
- DIC
- TTP
What is the treatment for TTP?
steroids and plasmapheresis
What is the treatment for ITP?
Steroids and IVIG
What is contraindicated in patients with HUS?
antibiotics
What are some specific tests for iron deficiency anemia?
Increased RDW and low ferritin levels
elevated MMA and elevated homocysteine is associated with what?
b12 deficiency
Normal MMA and elevated homocysteine levels are associated with that?
folate deficiency
What is indicative of a positive schilling test?
When a patient suspected of B12 deficiency is given radiolabed B12 and it comes out in the urine. Tell you there is a B12 deficiency
When you have increased LDH levels and decreased haptoglobin what does that tell you?
Hemolysis
The presence of auer rods are indicative of what condition?
AML
What is the translocation for the philadelphia chromosome and what condition is it associated with?
t(9;22) associated with CML
What is the preferred treatment for the M3 subtype of AML?
All trans-retnoic acid therapy
What chromosome translocations are associated with M3 subtype of AML?
Chromosome 15 and 17
Smudge cells are associated with what condition?
CLL
What is the treatment for CML
imtinab
Reed Sternberg cells are associated with what condition?
Hodgkins lymphoma
Which type of hodgkins disease has the best prognosis?
Lymphocyte predominant
What symptoms should raise suspicion for multiple myeloma?
anemia, renal failure and bone pain
Dutcher bodies are characteristic of what disease?
Waldenstrom’s macroglobulinemia
What is AL amyloid associated with?
multiple myeloma and Waldenstroms macroglobulinemia
What is AA amyloid associated with?
chronic inflammatory diseases
What is graft vs host disease?
Its a type of allogenic infection where donot T lymphocytes attack host tissues in the skin, liver and GI tract
What is the treatment for graft vs host disease?
high dose steroids
Whats the problem in hyperacute transplant rejection?
Preformed antibodies ABO incompatability
When would you see a reaction in hyperacute transplant rejection and what would that reaction be?
within minutes and vascular thrombi or ischemia
What is the problem in acute transplant rejection?
T cell mediated response
What are the side effects of HCTZ diuretic?
hyperglycemia, hyperlipidemia, hyperuricemia, hypokalemia, hypomaganesium, hyponatremia
What is bronchoalveolar lavage used for?
to evaluate for malignancy or opportunistic infections like PCP
What is the single most important prognostic factor in breast cancer?
TNM staging
Does central cord syndrome affect the lower extremeties or the upper extremeties?
upper extremeties
What is the treatment of choice for syphillis?
Penicillin
What is a patient is allergic to penicillin, what is the treatment for syphillis?
doxycycline
What is a patient is pregnant with syphilis and they are allergic to penicillin, what is the treatment?
desensitized penicillin
What is a patient has tertiary syphillis and they are allergic to penicillin, what is the treatment?
ceftriaxone
Ankylosing spondylitis is associated with what eye condition?
ANterior uveitis
What is the treatment for gastroparesis?
metoclopromamide
What is the management of suspected spleen injury?
If hemodynamically unstable do exploratory laparatomy. If hemodynamically stable do a CT scan and decide if surgery is needed
If you suspect endometriosis what is the best way to test for it?
Laparascopy
What is the treatment for Printzmetal angina?
Nitrates or CCB
What are the contraindications to rotavirus vaccination?
- History of intussusception
- History of GI abnormalities
- Anaphylaxis
- SCID
After diagnosing a patient with Guillain-Barre syndrome what is the most important next step in management?
Assess pulmonary function with spirometry
What receptors are affected in Lambert Eaton syndrome?
Presynpatic voltage gated calcium channels
What receptors are affected in Myasthenia gravis?
Postsynaptic acteylcholine receptors
Whats unique about blastomycosis?
Endemic in Wisconsin, Mississippi, Ohio. Has pulmonary, skin, and lytic bone lesion findings
What conditio can give you these findings; pericardial calcifications, prominent x and y descents, fatigue and dyspnea and fluid overload?
Constrictive pericarditis
Where are the endemic areas for tuberculosis constrictive pericarditis?
Africa, India and China
What is the treatment for tinea capitis?
Oral Griseofulvin
How do you treat uric acid stones?
Alkinaztion of the urine with potassium citrate
What is the management for spontaneous bacterial peritonitis?
Diagnostic paracentesis
What are the most likely cultured bacteria in spontaneous bacterial peritonitis?
E.coli and Klebsiella
Malabsorption, increased alk phos and PTH, decreased calcium and phosphorus are associatef with what condition?
Osteomalacia
What is the problem in osteomalacia?
Vitamin D deficiency and impaired osteoid matrix mineralization
What is the treatment for hairy cell leukemia?
Cladribine
What kind of gait do you get with parkinson disease?
hypokinetic gait
Malabsorption, increased alk phos and PTH, decreased calcium and phosphorus are associatef with what condition?
Osteomalacia
What is the problem in osteomalacia?
Vitamin D deficiency and impaired osteoid matrix mineralization
What is the treatment for hairy cell leukemia?
Cladribine
If i have a patient with increased serum iron, decreased TIBC and normochromic and hypochromic RBCs what condition should i be thinking of?
Sideroblastic anemia
What is the treatment for sideroblastic anemia?
Pyridoxine
What is the next step in treatment of a patient who is having an acute excerbation of COPD who has been given short acting beta agonists, steroids and antibiotics and still isnt responding to treatment?
Noninvasive positive pressure ventilation
What is the treatment for stable angina?
- Beta blockers
- CCB
- Nitrates
Menniers Disease affects which part of the ear?
Inner ear
What is the treatment for SVT?
Adenosine
What is the treatment for Ventricular tachycardia?
Amiodarone or lidocaine
What are the metabolic abnormalities in tumor lysis syndrome?
- Hyperuricemia
- Hyperkalemia
- Hyperphosphatemia
- Hypocalcemia
What is the most common cause of pneumonia from 6wks-18yrs?
RSV
What is the most common cause of pneumonia in the elderly?
Strep pneumo
What is the most common cause of pneumonia in young adults (18-40)?
Mycoplasma pneumonia
What is the most common cause of pneumonia in adults?
Strep pneumo
What is the most common cause of pneumonia in hospital setting?
Gram negatives
What is the most common cause of pneumonia in neonates?
Group B strep
What is the most common cause of pneumonia in COPD?
H. Flu
What is the most common cause of pneumonia in patients with cystic fibrosis?
kids-Staph aureus
Adults- psuedomonas
What is the most common cause of aspiration pneumonia?
Anaerobes
What is the most common cause of pneumonia in alcoholics/IV drug abusers?
Strep pneumo then klebsiella
What is the treatment for a patient with active TB?
2 months of isoniazide, rifampin, ethambutol and pyrazinamide then 4 months of isoniazide and rifampin.
What should you always give with isoniazide to prevent peripheral neuritis?
Vitamin B6
What is the treatment for latent TB with a positive PPD test?
9 months of isoniazide
What is the side effect of ethambutol?
optic neuritis
What is the side effect of rifampin?
turns body fluids orange
What is the side effect of isoniazide?
Peripheral neuropathy and hepatitis
What is the treatment for strep throat?
Penicillin
What can give you odynophagia, trismus, muffled voice, and deviated uvula away from lesion?
Peritonsillar abscess
What is the test of choice for sinus imaging?
CT scan
What is the treatment for acute bacterial sinusitis?
Amoxicillin/clavulanate
What is the treatment for coccidioidomycosis?
Fluconazole
What is the most common cause of postviral pneumonia?
Staph aureus
What is the prophylactic treatment for meningitis?
Rifampin
What is the most common cause of meningitis for elderly patients?
Strep pneumo
What is the most common cause of meningitis for patients 6-60yrs?
N. meningitidis
What is the most common cause of meningitis for neonates?
Group B strep
What is the most common cause of meningitis for kids from 6months-6yrs?
Strep pneumo
If you find RBCs in CSF without a history of trauma what should you start to think of?
HSV encephalitis
What is the treatment for HIV encephalitis?
IV acyclovir
What is the treatment for CMV encephalitis?
IV ganciclovir
What type of infection gives you CSF with elevated proteins, low glucose, and elevated WBCs?
Bacterial meningitis
What type of condition gives you CSF with high elevated opening pressure?
Pseudotumor cerebri
If you have a patient with a triad of headache, fever, and focal neurological deficit what should you be suspicious of?
Brain abscess
What is the treatment for a pregnant HIV+ patient who is not currently being treated?
zidovudine for mom and baby
What is the only live vaccine you can give HIV+ patients?
MMR
What is the treatment for cryptococcal meningitis?
IV amphotericin B
An HIV+ patient from Ohio presents with low grade fever, dry cough, malaise, weight loss, hepatosplenomegaly, pancytopenia, hilar lymphadenopathy and palatal ulcers. What condition is this?
Disseminated TB
What is the treatment for PCP?
TMP-SMX
What organs does CMV hit?
eyes, brain, GI, lungs
Foamy macrophages with acid fast bacilli?
mycobacterium avium
How do you treat mycobacterium avium?
Clarithromycin
If i have an HIV+ patient with a CD4 cell count
Azithromycin
What is the treatment for toxoplasmosis?
pyrimethamine+sulfadiazine
What is the prophylactic treatment for toxoplasmosis?
TMP-SMX or pyrimethamine+dapsone
If i have HIV and a CD4 cell count
PCP
If i have HIV and a CD4 cell count
Toxoplasmosis
If i have HIV and a CD4 cell count
Mycobacterium avium
What condition gives you these 3 stages….1. painless transient papule or ulcer, 2. painfull swelling of inguinal nodes, 3. anal pruritus with discharge, rectal strictures, elepantiasis?
Lymphogranuloma venereum
What is the treatment for chlamydia?
doxycycline
What is Reiters syndrome?
conjunctivitis, urethritis, arthritis
What is the treatment for gonorrhea?
ceftriaxone
If i have a patient with a suspected UTI and increased urine pH what should i think of?
infection with proteus mirabilis
What is the treatment for an uncomplicated UTI?
Nitrofurantoin or TMP-SMX 3-5days
What is the treatment for a UTI in a pregnant woman?
Nitrofurantoin 3-7days
What is the treatment for complicated UTI?
TMP=SMX or nitrofurantoin for 7-14days
What is first line therapy for pyelonephritis?
Fluoroquinolones
What is the first line chemoprophylaxis for chloroquine resistant malaria?
Mefloquine
What happens if you give a patient with mono ampicillin?
They develop a maculopapular rash
What rash starts on the wrists and ankles and spread centrally?
Rocky mountain spotted fever
What is the imaging test of choice for osteomyelitis?
MRI
Which immunosuppressant can cause gum hypertrophy?
cyclosporine
What is the treatment for dermatitis herpatiformis?
Dapsone
What condition could give you proximal muscle weakness in the lower extremities, difficulty ascending or descending stairs or rising from a seated position?
Polymyositis
What condition gives you recurrent pyogenic infections at 6 months of age with decreased concentrations of IgG, IgA, IgM, and IgE along with decreased B cells?
Brutons agammaglobinemia
What is the treatment for malignant otitis externa?
Ciprofloxacin
What can give you envelope shaped crystals?
ethylene glycol poisoning
What back condition is excerbated by exstension of the spine (standing and walking downhill) and relieved by flexion (sitting and walking uphill)?
Lumbar spinal stenosis
What are the serious side effects associated with cyclophospamide?
hemorrhagic cystitis, bladder carcinoma, sterility and myelosuppression
How can you prevent the toxic affects of cyclophosphamide?
hydration and MESNA
What is the most common cause of pneumonia in nursing home residents?
Strep pneumo
What is the treatment for bacterial meningitis in immunocompromised patients?
Vancomycin, ampicillin, cefepime
What is the treatment for bleeding esophageal varices?
octreotide
If you have a patient in pre-term labor and it is determined that her baby has bilateral renal agenesis what is the next step in management of the patient?
Allow spontaneous vaginal delivery because the condition is incompatible with life
What condition can present after travel or being on a cruise ship and give you a pneumonia like illness with high fever, watery diarrhea, headache, confusion, and hyponatremia?
Legionella
How do you treat legionella?
Fluoroquinolone
What is advanced sleep phase disorder?
Inability to stay awake in the evening after 7pm. Leads to early morning insomnia
What is delayed sleep phase syndrome?
Inability to fall asleep at normal bedtimes (10pm-midnight)
What condition can give you acne with monomorphous erythematous papules distributed over the face, arms, and trunk with no open or closed comedones?
Sterid acne
what is the main pathopysiologic mechanism underlying acne vulgaris?
Androgen excess
When do you do hip ultrasound in a baby with hip dysplasia?
2wks-6months
When do you do hip x-ray in a baby with hip dysplasia?
4-6months
Which medication is contraindicated in cocaine induced chest pain?
Beta blockers
What is the drug of choice for cocaine induced chest pain?
Nitrates or calcium channel blockers
What condition can give you an IgM spike and hyperviscosity?
Waldenstroms macrogliobinemia
Patient has difficulty reading fine print and has to hold reading material at an arms length in order to read them. What condition does he have?
Presbyopia
What is the abnormality in presbyopia?
Loss of elasticity in the lens
What eye problem gives you central visual field loss in a patient over age 50?
Age related macular degeneration
What eye condition has increased lens opacity and difficulty with night vision and driving at night?
Cataracts
What eye condition has elevated intraocular pressure, peripheral visual field defects followed by central visual loss?
Open angle glaucoma
If a patient is determined to be legally brain dead do you need permission to take him off life support?
NO!
What radiologic finding is associated with pseudogout?
Chondrocalcinosis
What is the most common ear pathology in patient with HIV?
Serous otitis media
What kind of shoulder injury give you an abducted arm that externally rotated?
Anterior shoulder injury
What kind of shoulder injury gives you an adducted arm thats internally rotated?
Posterior disclocation
What kind of injury do you get when you fall on an outstretched hand?
Colles fracture (distal radius)
If you have a positive valgus stress test what does that tell you?
Medial collateral ligament tear
If you have a positve varus stress test what does that tell you?
Lateral collateral ligament
In a motor vehicle accident when you have a dashboard injury what conditions does that predispose you to?
Posterior disclocation of the hip and PCL injury
What nerve can cause wrist drop?
Radial nerve
What nerve can cause foot drop?
Peroneal nerve
What nerve can cause claw hand?
ulnar nerve
What nerve can be injured in a anterior shoulder disclocation?
Axillary nerve
What condition causes pain with reptitive stress and resisted strength testing?
Tendinitis
What condition can cause bowel or bladder dysfunction, impotence, and saddle area anesthesia?
cauda equina syndrome
What is the treatment for a herniated disk?
NSAIDS
What condition gives you lower back pain that radiates to the arms, buttocks, and legs and improves upon flexion at the hips?
Spinal stenosis
What condition can give you a soap buble appearance x-ray?
Giant cell tumor of bone
What is the treatment for an acute attack of gout?
NSAIDS
Whats a side effect of hydroxychloroquine?
retinal toxicity
What condition gives you splenomegaly, rheumatoid arthritis and neutropenia?
Felty syndrome
Which joint is spared in RA but is present in OA?
DIP joint
What endocarditis is associated with lupus?
libman Sacks endocarditis
What is the treatment for Raynauds phenomenon?
Calcium channel blockers
What is the treatment for fibromyalgia?
Antidepressant
What condition causes pain and stiffness in the shoulder and pelvic girdles?
polymalgia rheumatica
What is the treatment for polymalgia rheumatica?
Steroids
What condition presents in a kid with arthritis and evanescent salmon colored rash?
Juvenile idiopathic arthritis
What is the time frame to use tPA in a stroke?
within 3hrs from onset of symptoms
How do you treat increased ICP?
Mannitol and hyperventilation raising the head of the bed
In the setting of severe hypertension or hemorrhagic stroke what is the treatment?
IV labetalol or nicardipine
If you have 100% occlusion of a carotid artery should you do a carotid endarterectomy?
NO!!!!
What is the single greatest risk factor for stroke?
HTN
What kind of condition can cause pseudodementia in the elderly?
subdural hematoma
If you have an intracerebral hemorrhage and start to develop a fixed dilated pupil that goes down and out what should you think of?
Uncal herniation
What neurotransmitter is associated with migraine headaches?
Serotonin
red wine in a young female is a trigger for what condition?
migraine
How do you prophylactically treat a migraine headache?
Anticonvulsants, beta blockers, CCB, TCA’s
If you have already developed a migraine headache what is the treatment?
NSAIDS or triptans
What bacteria is the most common cause of carvernous sinus thrombosis?
Staph aureus
What is the imaging test of choice for cavernous sinus thrombosis?
MRI
What kind of seizure has progressive jerking of body regions, hallucinations, but no loss of consciousness?
Simple partial seizure
What kind of seizure has episodes of lip smacking associated with impaired level of consciousness followed by confusion?
Complex partial seizure
What is the treatment of choice for partial seizures?
phenobarbital
What is the treatment for acute seizures lasting longer than 2 minutes?
benzodiazepine
What is the treatment for generalized tonic clonic seizures?
Phenytoin
What condition gives you a 3 second spike and wave discharge pattern?
Absent seizure
What is the first line treatment for an absent seizure?
Ethosuximide
What is the second line treatment for an absent seizure?
Valproic acid
How do you induce an absent seizure?
hyperventilation
What conditions gives the following EEG finding…. hypsarrhythmia?
infantile spasm
What is the treatment for infantile spasm?
ACTH
What condition gives you an EEG finding of slow spike and wave complexes?
Lenox-Gastaut syndrome
What is benign paroxysmal positional vertigo?
Condition where you get episodic short lived vertigo and nystagmus induced by postitional head changes. Not associated with nausea or vomiting
What is the abnormality in benign paroxysmal positional vertigo?
dislodged otolith
What is the treatment for benign paroxysmal positional vertigo?
Modified Epley maneuver
What condition can give you recurrent vertigo with auditory symptoms?
Menieres disease
What condition can give you acute onset of severe vertigo, gait instability, nausea, vomiting and nytstagmus?
Acute vestibular neuritis or labyrinthitis
What condition causes recurrent vertigo without auditory symptoms?
Vestibular migraine
What condition gives you proximal muscle weakness that gets worse as the day progresses. Also has dysarthria, dysphagia, ptosis and double vision?
Myasthenia Gravis
What are some associated finding with mysthenia gravis?
thyrotoxicosis and thymoma
What is the diagnostic test for myasthenia gravis?
Edrophonium (tensilon) test
What is the treatment for myasthenia gravis?
pyridostigmine
What type of multiple sclerosis gives you the best prognosis?
relapsing and remitting
What is the treatment for multiple sclerosis?
interferon
What is the treatment for acute excerbations for multiple sclerosis?
Corticosteroids
How do you diagnose guillian-barre syndrome?
nerve conduction studies and CSF with elevated proteins
What is the treatment for guillian-barre syndrome?
Plasmapheresis and IVIG
What is the most common cause of death in alzheimers patients?
aspiration pneumonia or other infections
How do you definitively diagnose alzheimers disease?
autopsy
What condition causes significant changes in behavior and personality?
Picks disease
Whats abnormal in Picks disease?
Atrophy of the frontal and temporal lobes
What condition gives you myoclonic jerks, ataxia and dementia?
Creutzfeldt-Jakob disease
What is the inheritance for hungtington disease?
Autosomal dominant
bilateral hand tremor is associated with what condition?
Essential tremor
What is the inheritance for neurofibromatosis?
Autosomal dominant
What chromosomes can you find defect on for neurofibromatosis 1 and 2?
Chromosome 17 and 22
What are some symptoms of neurofibromatosis type 1?
cafe au lait spots, optic glioma, lisch nodules, neurofibromas
Bilateral acoustic neuromas are associated with what condition?
Neurofibromatosis type 2
What condition is associated with ash-leaf spots, mental retardation and convulsive seizures?
Tuberous sclerosis
What heart condition is associated with tuberous sclerosis?
Rhabdomyoma
What is the dominant hemisphere?
left hemisphere
Where is broca’s area located?
posterior inferior frontal gyrus
In Brocas aphasia what happens to repetition?
Repetition is impaired
Where is the defect in Wernickes’s aphasia?
posterior superior temporal gyrus
A hard dilated painful red eye is associated with what condition?
closed angle glaucoma
What medication should you avoid in closed angle glaucoma?
Atropine
Headaches triggered by darkness is associated with what condition?
closed angle glaucoma
A fundoscopic exam that shows cupping of the disc and loss of peripheral vision is associated with what condition?
open angle glaucoma
What is the diagnostic test for open angle glaucoma?
Tonometry
What condition is associated with a cherry red spot and sudden painless unilateral blindness?
Central retinal artery occlusion
When should you hear fetal heart tones?
10-12wks
When should you appreciate fetal movement?
17-18wks
When is ultrasound most reliable to determine gestational age?
first trimester
When can you start to see a intrauterine pregnancy on ultrasound?
B-hCG of 1000-1500
When should you get a B-hCG level?
- Diagnose pregnancy
- Diagnose and follow ectopic pregnancy
- monitor trophoblastic disease
- Screen for fetal aneuploidy
How is the renal flow and GFR affected in pregnancy?
Both increases
How much folic acid is needed to prevent neural tube defects in a lady with history of neural tube defects in previous pregnancy?
4mg
How much folic acid is needed in pregnant women?
0.4mg
On your initial OB visit what test are you ordering?
CBC, Rh factor, type and screen, UA and culture, rubella antibody titer, HBsAg, RPR/VDRL, gonorrhea and chlamydia, PPD, HIV, Pap smear, tay-sachs and cystic fibrosis
When should the Quad screen be offered?
15-22wks
When do you do the glucose tolerance test in pregnancy?
24-28wks
When do you do the RhoGAM for Rh- women?
28wks
When do you do the GBS culture?
35-40wks
What does the QUAD screen consist of?
- MSAFP
- Inhibin A
- B-hCG
- Estriol
What is the QUAD screen useful for?
Detecting chromosomal abnormalities
What things can cause an elevated AFP level?
neural tube defects, incorrect dating, abdominal wall defects, fetal death, multiple gestation, placental abruption
What things can cause a reduced AFP?
Trisomy 21 and 18, incorrect dating, fetal demise
What is PAPP-A?
This is an associated pregancy protein that is screened for at 9-14wks that can detect trisomy 18 and 21
What would the quad screen show for a patient with down syndrome?
- AFP decreased
- Estriol decreased
- B-hCG increased
- Inhibin A increased
What would the quad screen show for a patient with edwards syndrome?
- AFP decreased
- Estriol decreased
- B-hCG decreased
- Inhibin A decreased
What is chorionic villus sampling?
Test done around 10-12wks gestation where you aspirate placental tissue for genetic diagnosis.
What is amniocentesis?
Test done around 15-20wks gestation where you aspirate amniotic fluid for genetic diagnosis.
When is an amniocentesis indicated?
- Advanced maternal age(>35)
- RH sensitized pregnancy
- Abnormal quad screen
- determine fetal lung maturity
What is a spontaneous abortion?
Loss of pregnancy prior to 20th wk of pregnancy
What is the most common cause of first trimester spontaneous abortion?
chromosomal abnormalities
What torch infection gives you periventricular calcifications?
CMV
What torch infection gives you blueberry muffin purpuric rash, hearing loss and cataracts?
Rubella
What torch infection gives you hydrocephalus, chorioretinitis, and intracranial calcifications?
Toxoplasmosis
What torch infection gives failure to thrive, bacterial infections and increase incidence of upper and lower respiratory tract infections?
HIV
What torch infection gives you snuffles, saddle nise, maculopapular rash, and hepatomegaly?
Syphilis
What is the treatment for an incomplete spontaneous abortion?
manual aspiration or a D&C
What is the treatment for intrauterine fetal demise?
Induce labor
What is the management of HSV in a pregnant women in the third trimester?
If the patient has active lesions upon delivery then perform a C-section
How many cm is the active stage of labor?
4cm-10cm
What are the stages of labor?
- Onset of cervical dilation
- Complete cervical dilation until the delivery of the baby
- Delivery of baby until the delivery of placenta
What are some reasons for fetal bradycardia on heart rate monitor?
Cord prolapse, uterine hyperstimulations, and rapid fetal descent
What are some reasons for fetal tachycardia on heart rate monitor?
maternal fever, hypoxia, fetal anemia
What is a normal reactive non stress test?
Greater than 2 accelerations of 15bpm above baseline lasting for 15 seconds over a period of 20minutes
If you have a nonreactive stress test what is the next step in management?
Biophysical profile
What is a biophysical profile?
A test that uses a real time ultrasound to assign a score measuring fetal tone, fetal breathing, amniotic fluid, movement, and NST
What is the amniotic fluid value for oligohydramnois?
AFI
If morning sickness persists beyond the first trimester what condition should you think of?
hyperemesis gravidarum
What are some causes of hyperemesis gravidarum?
Multiple gestations, first pregnancy, or molar pregnancy
What is the next step in management if you suspect a patient to have hyperemesis gravidarum?
rule out molar pregnancy with ultrasound and BhCG
What is considered abnormal for a 50gram glucose tolerance test performed at 24-28wks gestation?
> 140mg/dL
If you have an abnormal 50gram glucose tolerance test what is the next step in management?
Confirm with a 3hr 100gram oral glucose tolerance test
What are the abnormal valies for a 3hr 100 gram oral glucose tolerance test?
- Fasting >95
- 1hr >180
- 2hr >155
- 3hr> 140
What are the goal glucose numbers for a patient with gestational diabetes?
Fasting
What is the most common complication for a pregnant women with uncontrolled pregestational diabetes?
congenital malformations
What if a patient is a prediabetic and is pregnant what are her glucose goals?
Fasting is
What is the cutoff to be diagnosed as gestational HTN?
HTN that develops >20wks gestation
What are the appropriate HTN medications to use in pregnancy?
Methyladopa, labetalol, nifedipine
What is preeclampsia?
Condition in pregnancy occurring after 20wks gestation where the patient develops HTN, proteinuria and edema
What is the cutoff to be determined to have proteinuria associated with preeclampsia?
> 300mg
What are the characteristics of severe preeclampsia?
- BP >160/110
- proteinuria >5g
- headache
- blurred vision
- HELLP syndrome
- RUQ pain
- Clonus
What are some signs of magnesium toxicity?
Loss of DTRs, respiratory paralysis and coma
How do you treat magnesium toxicity?
IV calcium gluconate
What is the karotype for a complete molar pregnancy?
46XX
Which molar pregnancy contains fetal tissue?
Incomplete molar pregnancy
What is the karotype for incomplete molar pregnancy?
69XXY
Which molar pregnancy does not contain fetal tissue?
complete molar pregnancy
A snowstorm appearance on pelvic ultrasound is characteristic of what condition?
Molar pregnancy
What is considered postpartum hemorrhage?
> 500ml for vaginal deliveries
>1000ml for C-section
What is the management for severe postpartum hemorrhage?
uterine artery embolization
What condition causes hypogonadotropin deficiency and anosmia?
Kallman syndrome
What is the age for premature menopause
before age 40
What is the diagnostic test sequence for a patient with suspected secondary amenorrhea?
- pregnancy test
- TSH/prolactin
- progestin challenge
What is the meaning of a progestin challenge test coming back positive?
Means there is anovulation.
What is the meaning of a progestin challenge test coming back negative?
Means there is estrogen deficiency
The classic triad of pain, menorrhagia, and enlarged uterus is associated with what condition?
Adenomyosis
What is the test of choice for endometriosis?
Laparoscopy or laparotomy
What is the treatment for endometriosis?
OCPs
What is the most common complication of endometriosis?
Infertility
What is treatment for menorrhagia?
OCPs or mirena IUD
A young female presents with a fever and abdominal pain with a positive chandelier sign what condition are these symptoms associated with?
Tubo-ovarian abscess
What is the most common complication of tamoxifen therpay?
Endometrial cancer
If your pap smear shows ASCUS what is the next step in management?
HPV test
If your pap smear shows ASCUS and you do a HPV test and it comes back negative what is the next step in management?
repeat pap smear in 1yr
If your pap smear shows ASCUS and you do a HPV test and it comes back positive what is the next step in management?
Colposcopy
What is urinary incontinence caused by coughing, sneezing or lifting?
Stress incontinence
What is the treatment for urinary stress incontinence?
Pessary, kegal exercises and vaginal vault suspension surgery
What kind of urinary incontinence is caused presented by a strong urge to void?
Urge incontinence
What is the treatment for urge incontinence?
Anticholinergics or TCAs
What type of urinary incontinence is presented by chronic urinary retension?
Overflow incontinence
What is the treatment for overflow incontinence?
Urethral catheter
What breast condition causes bloody nipple discharge?
Intraductal papilloma
What is the screening test for a female under 30 who presents with a breast mass?
Ultrasound
If you have a HER2/neu positive cancer what is the treatment?
Trastuzumab
If you have a estrogen and progesterone positive breast cancer what is the treatment?
Tamoxifen
What is the prophylactic treatment for a transplant patient against opportunistic infections?
TMP-SMX
What are the PFT finding is COPD?
- decreased FEV1/FVC ratio
- normal-decreased FVC
- normal -increased TLC
- decreased DLco
What drugs can cause interstitial lung disease?
Amiodarone, bleomycin, and nitrofurantoin
What is the treatment for sarcoidosis?
steroids
eggshell calcifications are associated with what condition?
silicosis
What is a complication of silicosis?
TB
What is the treatment for ARDS?
PEEP
popcorn calcification are associated with what?
benign lung nodule
What condition can cause hypovolemia and a high normal pulmonary capillary wedge pressure in a MVA and after fluid resusciation the PCWP increases but does not correct the blood pressure?
Myocardial contusion
What are the lab results for polymalgia rheumatica?
Elevated ESR and CRP
What is the treatment for vaginal canidiasis?
Fluconazole
If you have a patient with abnormal quad screen results suggesting down syndrome, what is the next step in management of the patient?
Ultrasound to assess amniotic fluid and fetal growth or malformations
What is cell free dna testing?
Used for patient with abnormal quad screen results
What test are good for fetal karotyping in pregnancy?
CVS and amniocentesis
Where are medulloblastomas located?
cerebellar vermis
What are some complications of PEEP therapy?
- alveolar damage
- tension pneumothorax
- hypotension
What affect does PEEP therapy have on FRC?
increases FRC
If you have mildly elevated TSH levels and normal circulating thyroid hormones what condition should you be worried about?
subclinical hypothyroidism
If you have elevated thyroid hormones with normal TSH levels what condition should you be worried about?
Generalized resistance to thyroid hormones
If you have high levels of TSH and low levels of circulating thyroid hormones what condition should you be worried about?
Primary hypothyroidism
If you have low or inappropriately normal levels of TSH and low levels of thyroid hormones what condition should you be worried about?
secondary/tetriary hypothyroidism
If a patient has a chronic scar with a nonhealing painless bleeding ulcer what condition should you think of?
Squamous cell carcinoma
What is the next diagnostic step for sqamous cell carcinoma of the skin?
Punch, shave, or excisional biopsy
What eye condition presents with loss of fundus details a sudden loss of vision and onset of floaters?
Vitreous hemorrhage
What is the most common cause of vitreous hemorrhage?
Diabetic retinopathy
What cardiac enzyme is useful to detect reinfarctions?
CK-MB
Target sign of x-ray/ultrasound is associated with what condition?
intussusception
If you have a newborn with feeding intolerance, lethargy abdominal distension and bloody stools what condition should you suspect?
necrotizing enterocolitis
If a patient has symptoms suggestive of BPH what is the diagnostic test that should be ordered?
urinalysis
What is a normal rhinne test?
AC>BC
What does it suggest if you have an abnormal rhinne test?
BC>AC and you have conductive hearing loss
With a webber test how do you determine if the test is normal?
If the sound is equal in both ears
With a webber test how do you determine if you have conductive hearing loss?
The sound lateralizes to the affected ear
With a webber test how do you determine if you have a sensineural hearing loss?
The sound is heard louder in the opposite ear
What is the most common pathogen implicated in a subacute (>3months) prosthetic joint infection?
Staph epidermis
What is the most common pathogen implicated in a acute (
Staph aureus
What condition presents with a patient who has a history of normal skin at birth that gradually progresses to dry scaly skin?
ichthyosis vulgaris
What causes vitiligo?
Autoimmune destruction of melanocytes
What exam finding can still be observed in a patient who is brai dead?
Deep tendon reflexes
What are the inhalation injuries you should suspect in house fires?
carbon monoxide and cyanide posioning
What is the antidote for cyanide poisoning?
hydroxocobalamin or sodium thiosulfate
Vesicles and erosions on the dorsum of the hands are characteristic of what condition?
Porphyria cutanea tarda
If you have a patient with porphyria cutanea tarda what disease should you be screening for?
Hepatitis C
Essential mixed cryoglobulinemia is associated with what underlying disease?
Hepatitis C
What is the most likely cause of edema when a patient has edema while the leg is dependent but improves when the leg is elevated?
Venous valve incompetence
What affect does antipsychotics have on prolactin?
Antipsychotics are dopamine blockers and dopamine blockers cause increase prolactin
What is the treatment for stress incontinence?
Kegal exercises and urethropexy
What is the treatment for urge incontinence?
Oxybutynin therapy
What is the abnormality in urge incontinence?
detrusor hyperactivity
What is the abnormality in stress incontinence?
dysfunction or urethral sphincter
What is the treatment for overflow incontinence?
Bethanechol or alpha blockers
If you have a patient in a MVA who has chest pain and once you give IV fluids there hpoxemia worsens what condition should you suspect?
Pulmonary contusion
What is the treatment for sarcodosis?
steroids
Loss of pain and temperature sensation in a cape-like distribution and upper extremity weakness is associated with what condition?
Syringomyelia (fluid filled cavity in spinal cord)
Between folate and B12 which one depletes faster if it is lacking in the diet?
Folate
What is the treatment for lactation suppression?
Tight fitting bra and ice packs and pain medication
Delayed closure of anterior fontanelle, bony prominences of costochondral junctions, genu varum, and pliable skull bones without step offs are associated with what condition?
Rickets
What are some risk factors for rickets?
exclusive breastfeeding, increased skin pigmentation and decreased sun exposure
The term cor pulmonale refers to what?
Right heart failure
HIT predisposes you to what complication?
arterial thrombosis
Clear cell adenocarcinoma of the vagina and cervix are associated with what?
In utero exposure to DES
bite cells and heinz bodies are associated with what condition?
glucose-6-phosphate dehydrogenase deficiency
Doughy skin is a symptom of what condition?
Hypernatremia
Which electrolyte abnormality can cause hypokalemia?
Hypomagnesemia
Which electrolyte abnormality has a characteristic prolonged QT interval?
hypocalcemia
What are some characteristic symptoms of hypomagnesemia?
hyperactive reflexes, seizures, arrhythmias
What is the treatment for RTA type 1?
replace bicarbonate
What is the treatment for RTA type 2?
thiazide diuretic
What is different about RTA type 4?
Its caused by aldosterone defciency or resistance, you get acidic urine and you get hyperkalemia
If you have white cells and eosinophils in your urine what condition should you think of?
acute interstitall nephritis
If you have red blood cell casts or dysmophic red blood cells in your urine what condition should you think of?
glomerulonephritis
If you have granular casts, renal tubular cells or muddy brown casts in your urine what condition should you think of?
Acute tubular necrosis
If you have white cells and white cell casts in your urine what condition should you think of?
pyelonephritis
If you have hyaline cast in your urine what should you think of?
normal urine sediment or volume depletion
What are these values for someone with prerenal azotemia? BUN/CR, Fractional Na, urine sodium, urine osmality
- BUN/Cr- >20:1
2. fractional Na- 500
What are these values for someone with acute tubular necrosis? BUN/CR, Fractional Na, urine sodium, urine osmality
- BUN/Cr- 1%
- Urine Na- >20
- Urine osmolality-
Which glomerular disease gives you a low C3 level?
post strep glomerulonephritis
What is the treatment for Wegeners granulomatosis?
steroids
Histology shows linear anti-GBM deposits?
Goodpastures syndrome
Prescence of c-ANCA?
wegners granulomatosis
Histology shows fusion of epithelial foot processes?
minimal change disease
What is the treatment for minimal change disease?
steroids
What nephrotic syndrome is associated with IV drug abuse and HIV?
focal segmental glomerulosclerosis
Histology shows spike and dome pattern and associated with hep B virus?
Membranous nephropathy
Histology shows tram track appearance?
membranoproliferative nephropathy
Staghorn calculi are associated with what kind of stones and whats the etiology?
Struvite stones from proteus
Which kind of stones do you want to alkalinize the urine for?
uric acid and cystine stones
Which stones are radiolucent?
uric acid stones
Which stones have hexagonal crystals and positive urinary cyanide nitroprusside test?
cystine stones
What is the imaging test of choice for adult polycystic kidney disease?
Ultrasound
What is the diagnostic test for hydronephrosis?
ultrasound
If you have a male infant with a distended palpable bladder and low urine output what condition should you suspect?
Posterior urethral valves
When should you order a VCUG?
- Any boy presenting with first UTI
2. Any girl
What is cryptorchidism?
Failure of 1 or both testes to descend into the scrotum
Does cryptorchidism have an increased risk for testicular malignancy?
YES!!!
What is the treatment for cryptorchidism?
Orchiopexy by 6-12months
Does bringing the testes into the scrotum decrease the risk of testicular cancer in cryptorchidism?
NO!!!
Patient comes in with painless scrotal swelling and the scrotum transilluminates. Whats the diagnosis?
Hydrocele
Patient comes in with painless scrotal swelling and the scrotum has a bag of worms appearance. It does not transilluminate. What is the diagnosis?
Varicocele
Patient comes in with painful scrotal swelling and the pain is relieved by elevating the scrotum. What condition is this?
Epididymitis
Patient comes in with painful scrotal swelling and the pain is not relieved by elevating the scrotum. What condition is this?
Testicular torsion
Which scrotal swelling condition give you loss of the cremasteric reflex?
testicular torsion
What medications can cause erectile dysfunction?
Beta blockers, SSRIs, TCA, diuretics
What is the recommended screening method for prostate cancer?
Annual DRE after age 50
What kind of cancer is bladder carcinoma?
Transitional cell carcinoma
What is the imaging test of choice for bladder cancer?
cystoscopy
Older man presents with hematuria, flank pain and a flank mass. What is the diagnosis?
renal cell carcinoma
B-hCG in a male is characteristic of what?
testicular choriocarcinoma
What is the treatment for a seminoma?
Chemotherapy
What fracture are pathognemomic for child abuse in kids?
Spiral fracture of humerus and femur, bucket fracture (jerking arms), posterior rib fracture (squeezing chest)
What can you find on opthalmologic exam that can point you towards child abuse?
retinal hemorrhages
Which congenital heart defect presents with severe cyanosis within the first few hours of life?
Transposition of the great vessels
What is the most common cause of congenital heart disease?
VSD
What is the most common cyanotic congenital heart lesion in the newborn?
Transposition of the great vessels
What has to happen for transposition of the great vessels to be compatible with life?
Have to have a PDA and VSD or ASD
What are the risk factors for transposition of the great vessels?
diabetic mother and digeorge syndrome
What is digeorge syndrome?
- Cardiac anomlies
- abnormal facies
- Thymic aplasia
- cleft palate
- hypocalcemia
- 22q11 deletion
What is the most common cyanotic congenital heart disease in children?
Tetralogy of fallot
What would you see on CXR for a newborn with transposition of the great vessels?
egg on the side
What is the treatment for transposition of the great vessels?
prostaglandin to keep the PDA open
What are the 4 anomalies of tetralogy of fallot?
- Pulmonic stenosis
- Overriding aorta
- right ventricular hypertrophy
- VSD
What is the normal growth pattern for infants?
- Double weight by 4-5months
- Triple weight by 1yr
- Quadruple weight by 2yrs
What is the age of onset of puberty in girls?
10-12yrs
What is the age of onset of puberty in boys?
12-14yrs
What is the age of precocious puberty for boys?
What is the age of precocious puberty for girls?
What is klinefelters syndrome?
Condition of hypogonadism in males with a 47XXY that presents with testicular atrophy, gynecomastia, tall stature, and female hair distribution
What is the most common cause of primary amenorrhea?
Turners syndrome
What is the abnormality in PKU?
decreased phenyalanine hydroxylase
What is the abnormality and symptoms in Nieman-Pick disease?
deficiency in sphingomyelinase with symptoms of cherry red spot and hepatosplenomegaly
What is the abnormality in Tay-Sachs disease and what are the symptoms?
Lysosomal storage disease caused by a deficiency in hexosaminidase presents with slowed development and regression and cherry red spot
little kid presents with colicky abdominal pain, vomiting and bloody stool. What condition are you thinking of?
Intussusception
What is the test of choice for intussusception?
Ultrasound
What would the ultrasound show for intussusception?
target sign
What is the pathognemonic physical exam finding for intussusception?
sausage shaped abdominal mass in the RUQ
What is the treatment for intussusception?
Air constrast enema
What medication can cause pyloric stenosis?
erythromycin
What is the imaging test of choice for pyloric stenosis?
ultrasound
A little kid presents with sudden intermittent painless rectal bleeding…what condition are you suspecting?
Meckels diverticulum
What is the imaging test of choice for meckels diverticulum?
Technitium 99 scan
What is the imaging test of choice for hirschsprung disease?
Barium enema
How do you definitively diagnose hirschsprung disease?
rectal biopsy
Baby presents in the first month of life with bilious vomiting and crampy abdominal pain, distention and passage of bloody stool. What is the diagnosis?
Malrotation
What is the imaging test of choice for malroation?
upper GI series
Pneumatosis intestinalis on abdominal x-ray is pathognomonic for what condition?
necrotizing enterocolitis
What is the enzyme deficiency in SCID?
adenosine deaminase
What is the treatment for chronic granulomatous disease?
TMP-SMX
What condition can cause delayed separation of the umbilical cord?
Leukocyte adhesion deficiency
What immunodeficiency causes albinism, peripheral neuropathy, and neutropenia?
Chediak-Higashi syndrome
What immunologic condition causes hyper IgE, eczema, and abscesses of the skin?
Job syndrome
What is the treatment for kawasaki disease?
aspirin and IVIG
What is the treatment for acute otitis media?
High dose amoxicillin
What is laryngotracheobronchitis?
croup
Patient comes in leaning forward in tripod position and has their neck hyperextended and the chin protruding…What condition are you suspecting?
epiglottis
What is the management of epiglottis?
endotracheal intubation in the OR and IV antibiotics like ceftriaxone
What is the gold standard for diagnosing pertussis?
culture
What is the treatment for pertussis?
erythromycin
Cough, coryza, conjunctivitis and koplik spots goes with what condition?
Measles
Kid presents with high fever. After the fever subsides a maculopapular rash appears. What is the dianosis?
Roseola
What causes roseola?
HHV-6 and 7
What causes hand foot and mouth disease?
coxsackie A virus
What APGAR score requires rescucitation?
0-3
What causes RDS in infants?
surfactant deficiency
Retained amniotic fluid and prominent perihilar streaking in interlobular fissures is associated with what condition?
transient tachypnea of the newborn
Air bronchograms and ground glass appearance on CXR is characteristic of what condition?
RDS
Double bubble sign on abdominal x-ray is associated with what condition?
duodenal atresia
Child comes in with an abdominal mass that is painless and does not cross the midline, aniridia and hemihypertrophy. What is the diagnosis?
Wilms tumor
Child comes in with a abdominal mass that crosses the midline, opsoclonus/myoclonus. What is the diagnosis?
neuroblastoma
What is the best diagnostic step after suspecting neuroblastoma?
24hr urine VMA and HVA
If a patient has leukocoria what does that suggest?
- Retinoblastoma
- Retinopathy of prematurity
- Cataracts
Strabismus becomes a problem after what age?
3months
If you have a egg allergy what vaccine cant you receive?
MMR and influenza
What are the live vaccines you should avoid in pregnant and immunocompromised patients?
- Polio
- Varicella
- MMR
What lives vaccines are okay to give HIV patients?
- Varicella
2. MMR
Abdominal pain, vomiting and wrist or foot drop are associated with what?
lead poisoning
What does the peripheral blood smear show for lead poisoning?
microcytic hypochromic anemia and basophilic stippling
What glascow coma scale number warrants intubation?
Patient presents with absent breath sounds on one side, hypotension, distended neck veins, hypoxemia, and tracheal deviation. What is the diagnosis?
tension pneumothorax
What is the next step in management after tension pneumothorax is suspected?
Needle decompression
If you suspect urethral injury what is the test of choice?
retrograde urethrogram
If a previously stable chest trauma patient suddenly dies what should you suspect?
air embolism
If a new diastolic murmur presents after chest trauma what should you suspect?
aortic dissection
What should you suspect if a patient comes in from a MVA and CT shows blurring and punctate hemorrhaging along the gray-white matter junction?
Diffuse axonal injury
Patient presents with paradoxical movement of his chest upon inspiration. What condition should we suspect?
flial chest
What is the treatment for flial chest?
oxygen and narcotics
What is a positive kehrs sign?
This is when you have shoulder pain due to diaphragmatic irritation from a splenic rupture
A burn that is painless, white and charred is what kind of burn?
third degree burn
What layers are involved in a 3rd degree burn?
epidermis and full thickness dermis
What layers of the skin are involved in a first degree burn?
epidermis
A burn that is painful and has blisters present is what kind of burn?
second degree burn
What layer of the skin is involved in a second degree burn?
epidermis and partial thickness of the dermis
What is the parkland formula for burns?
fluids for the first 24hrs= 4xWeight in kg x %BSA
What is the treatment for malignant hyperthermia?
dantrolene
What are the cause of postop fevers?
- WInd
- Water
- Walking
- Wounds
- Wonder drugs
- Womb
What is the treatment for neuroleptic malignant syndrome?
dantrolene
What animals contain rabies?
skunks, racoons, foxes, bats
What can induce malignant hyperthermia?
halothane
What happens with cardiac output, PCWP, and PVR in hypovolemic shock?
- CO= decreased
- PCWP=decreased
- PVR=increased
What happens with cardiac output, PCWP, and PVR in cardiogenic shock?
- CO= decreased
- PCWP= increased
- PVR= increased
What happens with cardiac output, PCWP, and PVR in obstructive shock?
- CO= decreased
- PCWP= increased
- PVR= increased
What happens with cardiac output, PCWP, and PVR in septic shock?
- CO=increased
- PCWP= decreased
- PVR= decreased
What happens with cardiac output, PCWP, and PVR in anaphylactic shock?
- CO= increased
- PCWP decreased
- PVR= decreased
Which way does carbon monoxide move the hemoglobin-dissociation curve?
to the left
What is the lab test you should look for if you are suspecting carbon monoxide poisoning?
carboxyhemoglobin
Patient presents with ataxia, frquent falls, dysarthria, scoliosis and “hammer toe deformity”. What condition are you suspecting?
Friedreich ataxia
What is the most common cause of death in Friedreich ataxia?
Cardiomyopathy
What test can compare two means?
two-sample t test
What test can compare three means?
ANOVA
What is the recommendation for exercise in a pregnant patient?
moderate intensity exercise for atleast 30min 5-7days a week
What exercise activities are unsafe in pregnancy?
- contact sports
- high risk falls
- scuba diving
- hot yoga
Which antipsychotic has been implemented in cause high prolactin levels?
risperdone
What is the karotype for a patient with complete androgen insensitivity?
46XY
What is absent in a patient with complere androgen insensitivity?
uterus, vagina, axillary and pubic hair
What is the karotype for mullerian agenesis?
46XX
What is absent in mullerian agensis?
uterus and vagina
In a patient with cryptorchid gonads, when should they undergp gonadectomy?
After puberty
What kind of drug is odansetron and what is it useful for?
serotonin antagonist and its useful for chemotherapy induced nausea and vomiting
What is the first step in management for a patient who presents with a stroke within 4hrs?
tPA
What is the first step in management for a patient who presents with a stroke after 4hrs?
Aspirin
What is the next step in management for a patient who presents with a recurrent stroke who is already taking aspirin?
give aspirin + dypyridamol or clopidogrel
How do you calculate the anion gap?
Na- (bicarb+Cl)
Pulsus paradoxus is associated with what heart condition?
cardiac tamponade
Bounding pulses are associated with what heart condition?
aortic regurgitation
Pulsus parvus et tardus is associated with what heart condition?
aortic stenosis
What is the prophylactic treatment for rheumatic heart disease and how long should they be treated?
Penicillin. treatment should be for 10yrs or until the patient is 21
If you have an elavated WBC count and elevated leukocyte alkaline phosphatase(LAP) what should you suspect?
Leukemoid reaction
Whar causes molluscum contagiosum?
Poxvirus
What are some ways you can prevent recurrent kidney stones?
- reduce sodium intake
- reduce protein intake
- normal calcium intake
- thiazide diuretic
- alkalinization of urine
- reduce oxalate
- increase fluids
- allopurinol
What is the managment for pheochromocytoma?
First give alpha blocker then beta blocker
What is the mutation for the most severe form of neurofibromatosis type 2?
nonsense mutation
What is the mutation for the milder form of neurofibromatosis type 2?
missense
What is the treatment for trigeminal neuralgia?
Carbamazepine
What is the imaging test for suspected shaken baby syndrome?
nonconstrast CT scan
What condition can cause a abdominal succussion splash?
pyloric stricture
What is a risk factor for pyloric stricture?
acid ingestion which leads to fibrosis and formation of pyloric stricture
Patient presents with early satiety, nausea, vomiting and weight loss with a history of acid ingestion. What is the diagnosis?
Pyloric stricture
What is the treatment for acute decompensated heart failure?
- Oxygen
- loop diuretic
- Nitrates
What causews edema of the hands and feet in Turners syndrome?
dysgenesis of the lymphatic network
What organism is partially acid fast with filamentous branching rods?
Nocardia
What is the test of choice after myasthenia gravis has been confirmed and why do you perform that test?
CT scan of chest looking for thymoma
How does tamoxifen affect osteoporosis?
decreases the risk of osteoporosis
What condition of ulcerative colitis requires regular surveillance?
colorectal carcinoma
She asymptomatic gallstones be treated?
NO!!!
What is the ankle brachial index test useful for?
Peripheral artery disease
What is an abnormal ankle-brachial index?
What is the most common side effect of levodopa/carbidopa?
hallucinations
What is the treatment for Guillian-barre syndrome?
IVIG or plasmapheresis
What is the preferred method of contraception in a postpartum women who is breastfeeding?
progestin only oral contraceptives
A pulmonary nodule with a “halo sign” is characteristic of what?
Aspergillosis
What is the staging modality in gastric adenocarcinoma?
CT scan
Do you find crypt abscess in crohns or UC?
UC
Do you find abdominal pain and bloody stools in crohns or UC
UC
Do you find pseudopolyps in crohns or UC?
UC
Do you find granulomas in crohns or UC?
crohns
What is Kussmauls sign?
increase in JVD with inspiration
Patient presents with inferior MI, hypotension, JVD, kussmauls breathing and clear lung sounds. What is the diagnosis?
right ventricular infarct
What is the treatment for a right ventricular infarct?
IV fluids
What is the most common cause of endocarditis in IV drug abusers?
Staph aureus
What is the treatment for infective endocarditis in IV drug abusers?
Vancomycin
A gardener presents with a painless ulcer on their finger that spreads along their forearm. What are you thinking of?
Sporotrichosis
Patient presents with a tick bite from the south like arkansas with confusion and no rash. What are you suspecting?
ehrlichiosis
Patient presents with recurrent oral ulcers and genital ulcers, eye lesions, and skin lesions. What is the diagnosis?
Behcet’s syndrome
bone age
constitutional growth delay
If you have a patient under 65 with chronic liver disease what pneumococcal vaccine should they receive?
PCV23 only
If a patient is over 65 yrs old what pneumococcal vaccine should they receive?
PVC13 followed by PCV23
When a patient has sickle cell anemia when do you do blood transfusion instead of hydroxyurea therapy?
- Acute stroke
- Acute chest syndrome
- aplastic crisis
- anemia
What is the next best step after electrical burn?
EKG
What topical burn medication cannot penetrate an eschar but causes hypokalemia and hyponatremia?
silver nitrate
What topical burn medication can penetrate an eschar and hurts bad?
mefadine
What topical burn medication cannot penetrate an eschar but causes leukopenia?
silver sulfadiazine
What is the work-up for a penetrating injury to the neck in zone 1?
Aortagraphy
What is the work-up for a penetrating injury to the neck in zone 3?
Aortagraphy and triple endoscopy
What is the work-up for a penetrating injury to the neck in zone 2?
exploratory surgery
If you have a chest x-ray showing free air under the diaphram what is the next step in management?
Surgery
If you have a patient with a stab wound but they are stable what is the next step in management?
FAST scan
If you perform a FAST scan and it comes back equivocal what is the next step in management?
Diagnostic perotineal lavage
If you have a positive FAST scan or diagnostic peritoneal lavage what is the next step in management?
exploratory laparotomy
Patient has blunt abdominal trauma with a handle bar sign. What is the most likely injured organ?
pancreas
Patient presents with blunt abdominal trauma and is in stable condition. What is the next best step?
Abdominal CT
Patient presents with shoulder pain following a seizure or electrical shock, what is the diagnosis?
Posterior shoulder dislocation
Patient presents with a outwardly rotated arm and numbness over the deltoid, what is the diagnosis?
Anterior shoulder dilocation
What is the genetic defect in malignant hyperthermia?
Ryanodine receptor gene defect
What bugs can cause necrotizing fascitis?
strep and clostridium perfingens
What are common cause of fever on Post-Op day 1?
- atelectasis
- Necrotizing fascitis
- Malignant hyperthermia
What is lights criteria?
Tells you if a pleural effusion is transudative or exudative. If protein ratio
WHat is the characteristic effusion seen with adenocarcinoma of the lung?
exudative effusion with high hyaluronidase
What are the 3 diagnostic criteria for ARDS?
- bilateral fluffy infiltrates on x-ray
2. PaO2/FiO2
What is the treatment for symptomatic hypercalcemia?
Short term-IV hydration and calcitonin
Long term- bisphosphanates
What is the enzyme deficiency in Lesch_Nyhan syndrome?
Hypoxanthine-guanine phosporibosyl tranferase
How does antipsychotics induce hypothermia?
inhibiting the body shivering mechanism and inhibiting autonomic thermoregulation
What kind of cancer does OCPs increase your risk of getting?
cervical cancer
What kind of cancer does OCPs decrease your risk of getting?
endometrial and ovarian cancer
How does antipsychotics induce hypothermia?
inhibiting the body shivering mechanism and inhibiting autonomic thermoregulation
What kind of cancer does OCPs increase your risk of getting?
cervical cancer
What kind of cancer does OCPs decrease your risk of getting?
endometrial and ovarian cancer
PAD increases your risk for what complication in the future?
myocardial infarction
What is the therapeutic INR range for an idiopathic DVT?
2-3
What is the therapeutic INR range for patients with prothetic valves?
2.5-3.5
What type of heparin causes HIT?
unfractionated heparin
What is the treatment for HIT?
leuprilide or argotraban
If you are suspecting diverticulitis in a patient but the patient is not improving with antibiotic therapy what is your next step in management?
CT scan
If you are suspecting a patient to have glaucoma what medication do you want to avoid?
atropine
What is the antidote for iron intoxication?
deferoxamine
kid presents with andominal pain hematemesis and metabolic acidosis after pills were found scattered on the floor. and abdominal films show small opacities in the stomach and duodenum. What did they ingest?
iron
What is the pathology of pseudotumor cerebri?
impaired CSF absorption by arachnoid villi
What is the treatment for pseudotumor cerebri?
weight reduction and acetazolamide
What is the most significant complication in psedotumor cerebri?
blindness
Patient has a tender mass palpated in the popliteal fossa, what do you suspect?
Baker cyst
What causes a baker cyst?
excessive fluid production from inflamed synovium
What is the reason for hypotension after giving a pregnant lady and epidural?
the sympathetic nerve fibers can become blocked and cause vasodilation and venous pooling
Patient presents with unilateral transient loss of vision and says it felt like a curtain was falling down in my eye, what is the diagnosis?
Amaurosis fugax
What causes Amaurosis fugax?
retinal emboli that are displaced
Patient falls on an outstretched arm then the patient is unable to abduct their arms and they are also unable to adduct their arms smoothly without the arm falling quickly to the side. What kind of injury is this?
rotator cuff injury
What is the defect in osteogenesis imperfecta?
Mutation in type 1 collagen
What mechanism is employed in myocardial perfusion scanning when dipyridamole is given?
coronary steal phenomenon
An x-ray finding of the knee with an expansile and eccentric lytic area describes what and is related to what condition?
soap bubble appearnace related to giant cell tumor of bone
What things can trigger meniere’s disease?
- Alcohol
- Caffeine
- nicotine
- Salt
If you have a patient with a solid testicular mass and ultrasound suggest that it is a testicular tumor what is the next step in management?
orchiectomy
If you change the cutoff point to a higher cutoff point what happens to sensitivity and specificity?
sensitivity decreases and specificity increases
What part of the brain is affected in hemi-neglect syndrome?
parietal lobe
Whats elevated in seminomas
BhCG
What is the most common vitamin deficiency in the US?
folic acid
Patient presents with night blindness and dry skin what vitamin are they deficient in?
vitamin A
What vitamin deficiency causes neonatal hemorrhage and increased PT and PTT?
vitamin K
Patient presents with diarrhea, dermatitis and dementia, what is the diagnosis?
Pellegra
What vitamin deficiency cause stomatitis and cheilosis? (crusting of the lips and mouth)
Vitamin B2(riboflavin)
Patient presents with swollen gums, bruising, anemia and poor wound healing. What vitamin is deficient?
Vitamin C
Selenium deficiency causes?
cardiomyopathy
Magnesium deficiency causes?
muscle weakness and cramps, worsened hypocalcemia, tremor
What are the symptoms of beri-beri?
polyneuritis, dilated cardiomyopathy, high cardiac output failure, edema
What are the side effects of loop diuretics?
hypokalemia and ototoxcitiy
What is the side effect of phenytoin?
gingival hyperplasia
What is the defect in syringomelia?
central canal defect that causes impaired drainage of CSF (fluid filled cavity)
What kind of accident commonly is associated with syringomyelia?
cervical whiplash accident
What kind of bacteria is gram positive, anaerobic filamentous branching and colonizes the oral cavity?
actinomyces
What is the preferred therapy for a patient with an actinomyces infection?
Penicillin
What is chemoprophylaxis for HIV patients with a positive PPD test?
isoniazide and pyridoxine for 9months
What is the biggest risk factor for raloxifene therapy?
DVT
What is the difference between raloxifene therapy and tamoxifen therapy?
Tamoxifen therapy gives an increase risk for endometrial cancer and Raloxifene gives an increase risk for DVT
Chondrocalcinosis is associated with what condition?
hemachromatosis
What is the mechanism for SVT?
reentry into the AV node
How does vagal maneuvers or medical therapy decrease SVT?
decrease AV node conductivity
What is the picture for club foot?
calcaneum is in the varus position, midfoot is in the varus position and forefoot is in adduction
What is the treatment for a child suspected of clubfoot?
immediate stretching, manipulation, followed by casting
What chromosome abnormality is most consistent with cri-du-chat syndrome?
Chromosome 5
What is the problem in pagets disease of bone?
disorganized bone remodeling
How are osteoclast and osteoblast affected in paget disease of bone?
Osteoclast activity is increased
Osteoblast activity is increased
What is the treatment for Giant Cell Arteritis?
High dose steroids
What are the symptoms of bells palsy?
- Inability to raise eyebrow or close the eye
- drooping of the corner of the mouth
- Disappearance of the nasolabial fold
What is the genetic inheritance for hemophilia?
X-linked recessive
What condition do you use the D-xylose test to confirm?
celiac disease
Which TORCH infection can cause anemia and hyperbilirubinemia?
syphilis
What are the screening test for syphillis?
- RPR
2. VDRL
What is the confirmatory test for syphilis?
FTA-ABS
Periventricular calcifications in a newborn is characteristic of what?
CMV infection
What is metoclopramide?
Its a dopamine antagonist drug used to treat nause, vomiting and gastroperesis
What is the treatment for dystonic reactions,dyskinesia and parkinsonism?
benztropine
If a patient obtains a needle stick from a known Hepatitis B person and the patient doesnt know their vaccination status, what is the next step in management?
Hepatitis B immunoglobin and Hepatitis B vaccination
If a patient obtains a needle stick from a known Hepatitis B person and the patient is Hepatitis B immune, what is the next step in management?
Reassurance
Patient presents with severe headache and vomiting. Patient is also seeing halos around lights. On physical exam she has a nonreactive dilated pupil what is the diagnosis?
acute angle closure glaucoma
Which pulmonary renal syndrome requires plasmapheresis?
Goodpastures syndrome
What is the treatment for Wegeners syndrome?
Cyclophospamide and steroids
What is the treatment for uremic pericarditis?
Hemodialysis
What is the bacteria that cuases infection from cat and dog bites?
Pasteurella multocida
What is the treatment for a cat or dog bite?
Amoxicllin/clavulanate
What is the treatment for narcolepsy?
Modafinil
In a HIV positive person what opportunistic infection are you worried about with a CD4 cell count less than 50
Mycobacterium avium
In a HIV positive person what opportunistic infection ae you worried about with a CD4 cell count less than 200
Pneumocystis jirovecii and oral candidiasis
In a HIV positive patient what opportunistic infection are you worried about with a CD4 cell count less than 100
Toxoplasma gondii
In a HIV positive patient with a CD4 count less than 150
Histoplasma
What is the prophylactic treatment in a HIV positive patient with a CD4 count less than 150
itraconazole
What is the prophylactic treatment in a HIV positive patient with a CD4 count less than 50
azithromycin
What is the prophylactic treatment in a HIV positive patient with a CD4 count less than 200
TMP-SMX
What is the prophylactic treatment for a HIV positive patient with a CD4 cell count less than 100
TMP-SMX
What are some causes of non-anion gap metabolic acidosis?
- Diarrhea
2. RTA
NSAIDS and lymphoma are associated with what kind of nephrotic syndrome?
minimal change
African americans and HIV is associated with what kind of nephrotic syndrome?
Focal segmental glomerulosclerosis
Hepatitis B and C are associated with what kind of nephrotic syndrome?
Membranoproliferative glomerulonephritis
Lupus and Hepatitis B is associated with what kind of nephrotic syndrome?
Membranous nephropathy
2month old baby presents with eczema, regurgitating of his milk, and painless bloody stools are associated with what condition?
Milk-protein induced entercolitis
Patient presents with progressive vision loss in one eye and when looking at a set of parallel lines they appear wavy and bent to them, what is the diagnosis?
macular degeneration
What is the primary risk factor for macular degeneration?
age
Lens opacification is associated with what condition?
cataracts
What is the inheritance pattern for myotonic muscular dystrophy?
autosomal dominant
What is the inheritance pattern for duchenne and becker muscular dystrophy?
X-linked recessive
Patient presents with facial weakness, dysphagia, myotonic handgrip and testicular atrophy, what condition should you be thinking of?
Myotonic muscular dystrophy
Patient has irregular heavy vaginal bleeding, what is the next step in management to stop the bleeding?
- High dose estrogen
- High dose OCPs
- High dose progestin pills
Patient presents with severe local lower back pain thats worse at night, lower extremity weakness, decreased spincter tone, and hyperactive deep tendon reflexes, what is the diagnosis?
Spinal cord compression
What is the treatment for spinal cord compression?
steroids
What condition causes severe itching after bathing?
Polycythemia vera
What is the treatment for pertussis in a child less than 1month?
Azithromycin
What is the treatment for pertussis in people greater than 1month?
Erythromycin
Pelvic ultrasound shows enlarged ovary with decreased blood flow, what is the diagnosis?
Ovarian torsion
Pelvic ultrasound shows free fluid near an ovarian cyst, what is the diagnosis?
Ruptured ovarian cyst
What should you be thinking of when separating arterial thrombosis from arterial embolus?
Arterial thrombosis is a gradual process and Arterial embolus is a sudden process
What are the side effects of ACE inhibitors?
cough, angioedema and hyperkalemia
What are the side effects of loop diuretics?
Ototoxicity and hypokalemia
What is the treatment for ITP?
IVIG or steroids
When do you treat vs. observe an adult patient with ITP?
Observe: platelets>30,000
Treat: Platelets
When do you observe vs treat children with ITP?
observe: only skin manifestations
Treat: Bleeding
Patient presents with a recent upper respiratory infection and an enlarged mediatinum on chest x-ray. CT scan shows a mass in the “middle mediastinum” what is the likely diagnosis?
Bronchogenic cyst
A popping sound in the knee followed by pain and swelling is associated with what kind of injury?
Meniscus tear
What are the parameters assessed in a glascow coma scale?
- Eye opening
- Verbal response
- Motor response
What is another name for Lynch syndrome?
Hereditary non-polyposis colorectal cancer
What other condition is associated with Lynch syndrome?
endometrial carcinoma
Patient presents with a systolic-diastolic abdominal bruit, what is the diagnosis?
renal artry stenosis
How do you get a radial head subluxation? (nursemaid elbow)
pulling child arm or swinging child by the arms
What is the treatment for nursemaid elbow?
hyperpronate the forearm
MEN type 1?
- Primary hyperparathyroidism
- Pancreatic tumor
- Pituitary tumor
MEN type 2A?
- Medullary thyroid carcinoma
- Pheochromocytoma
- Parathyroid hyperplasia
MEN type 2B?
- Medullary thyroic cancer
- Pheochromocytoma
- Mucosal & intestinal neuroma
- Marfanoid habitus
What are characteristics of lung consolidation?
- Dullness to percussion
- Bronchial breath sounds(louder)
- Prominent expiratory phase
- Egophony
- Crackles
If you have mono how long should you refrain from playing sports?
> 3wks
What is the most modifiable risk factor in osteoarthritis?
weight reduction
Where is the most likely source for a DVT?
Proximal deep veins (iliac, femoral, popliteal)
The symptoms of diffuse telangiectasias, recurrent epistaxis and AV malformations are associated with what condition?
Osler-Weber-Rendu syndrome
What is the inheritance pattern for Osler-Weber-Rendu syndrome?
Autosomal dominant
anti-topoisomerase 1 antibodies are associatd with what condition?
scleroderma
Hydatid cyst come from which parasite?
Echinococcosis
What animals carry Echinococcosis?
Sheep
What organs can be affected by Echinococcosis?
Liver and lung
What does infection with Echinococcosis cause?
Hydatid cysts
What occupation is at hish risk for neurocysticercosis?
Pig farmers
Kid presents with headache vomiting and visual distubances. They have limited ability of upward gaze with a tendency for downward gaze. What is the diagnosis?
Pinealoma
What are the vaccinations for adults post-splenectomy?
Either 2weeks before or 2weeks after you need to get Meningococcal, PCV13, and H.flu
Kid complains of progressive bone pain that occurs at night without relation to physical activity. What is the diagnosis?
Osteoid osteoma
What is the treatment for osteiod osteoma?
NSAIDS
What is the side effect of olanzapine?
weight and sedation
Patient presents with a history of a whistling noise during respiration after undergoing a rhinoplasty, what is the diagnosis?
nasal septal perforation
What kind of patient do you see with nasal polyps?
asthma or allergy patients
What is the side effect of clozapine?
agranulocytosis and weight gain
Patient presents with a history of smoking, shoulder pain, weakness in the hands and miosis and ptosis, what is the diagnosis?
pancoast tumor
What is the treatment for pericarditis?
NSAIDS
If a patient is 21-24yrs of age with a ASCUS pap smear what is the next step in management?
Repeat pap smear in 1 yr
If a patient is 25 and older and has a pap test showing ASCUS what is the next step in management?
HPV test
If a patient is 21-24 and has a pap test showing ASC-H what is the next step in management?
colposcopy
If a patient is 21-24 yrs and has had 2 consecutive ASCUS pap smears what is the next step in management?
pap smear in 1 yr
If you are a vegetarian what vitamin deficiency are you prone to?
B12
What is the most common side effect of hydroxychloriquine?
retinopathy
If you suspect breath holding spells what test should you run?
CBC and ferritin
If the patient CSF contains EBV DNA what is the likely diagnosis?
Primary CNS lymphoma
What are 3 primary risk factors for acute otitis media?
- Upper respiratory infection
- exposure to smoke
- formula feedings
Boot shaped heart on x-ray is diagnostic of what condition?
Tetralogy of fallot
What is the most common cause of viral arthrtitis?
Parvovirus B19
What is the typical picture of a patient with viral arthritis?
Person who works in a daycar with arthrtitis that worse in the MCP, PIP and wrist joints
Prolonged therapy with a PPI can increase your risk for what?
C.diff and osteoporosis
What is the management for fibromyalgia?
- Exercise
- Good sleep hygiene
- Antidepressants
What is the preferred treatment for hepatitis B infection?
tenofovir
What are the indications for treatment in a patient with hepatitis B?
- Liver failure
- Infectious (HBe)
- High viral load (> 20,000)
- Cirrhosis
- Immunosuppressed
Pale patches on the back that scale on scraping, what is the diagnosis?
Tinea versicolor
What is the treatment for tinea versicolor?
ketoconazole
What type of an environment is prone to grow tinea versicolor?
Hot and humid environments
What is dark field microscopy?
confirmatory test for syphilis
What is the most common bacteria in febrile neutropenia?
Psuedomonas
What is the treatment for febrile neutropenia?
pipercillin-tazobactam
Patient presents with a history of lupus for which she takes steroids and hip pain for the last 2 weeks. The pain has been increasing and there is no tenderness or warmth around the hip. Range of motion is normal and x-rays are normal. What is the diagnosis?
Avascular necrosis
How do you confirm the diagnosis of avascular necrosis?
MRI
What are the symptoms of anticholinergic toxicity?
dry mouth, dry skin, constipation, urinary retention, flushing, vision changes and confusion
What is the first indicator of hypovolemia?
pulse rate
What are the comorbidities of panic disorder?
- Depression
- Agoraphobia
- Substance abuse
What is the management for kleptomania?
psychotherapy
What is the imaging test of choice for fibroids?
ultrasound
If a patient has an MI and a few hours late develops hypotension and kussmaul sign what is the likely diagnosis?
Right ventricular failure
If a patient had an MI 3-5 days ago and develops severe pulmonary edema and a new systolic murmur what is the likely diagnosis?
Papillary muscle rupture
If a patient had an MI 1 wk ago and develops hypotension and chest pain, jvd and distant heart sounds what is the likely diagnosis?
Ventricular free wall rupture
If a patient had an MI 3-5 days ago and develops hypotension, chest pain, and new systolic murmur and failure of both ventricles, what is the likely diagnosis?
Interventricular septal defect
What medications should be prescribed after an MI with PCI?
aspirin, clopidogrel, ACE, beta blocker, simvistatin
What is the treatment for cervical adenitis?
Clindamycin
What is the etiology of Duchenne muscular dystrophy?
Cuased by deletion of the dystrophin gene
What is the etiology of beckers muscular dystrophy?
Reduced dystrophin gene with milder disease in older kids
What are the complications of muscular dystrophy?
Cardiomyopathy
What are the risk factors for osteoporosis?
- Post-menopausal
- low vitamin D/calcium intake
- steroid use
- lack of weight bearing exercises
- smoking
- alcohol
What is the most common cause of non-melanoma skin cancer?
Basal cell carcinoma
What is the single most important risk factor for squamous cell carcinoma?
sunlight exposure
Which metal in jewelry most commonly causes contact dermatitis?
nickel
Symptoms of hypokalemia?
muscle cramps, muscle weakness, hyporeflexia, fatigue, arrhythmias, flat T waves
Patient presents with a sharpley demarcated, erythematous, edematous, tender skin lesion on their face with raised borders, what is the likely diagnosis?
Erysipelas
What the causative organism for erysipelas?
Group A strep
What is the defect in osteogenesis imperfecta?
Defect in type 1 collagen
Blue sclerae and pathological bone fractures are associated with what condition?
Osteogenesis imperfecta
What is the treatment for norcardia?
TMP-SMX
A rash that consists of firm dome-shaped flesh colored papules with central umbilication is associated with what condition?
molluscum contagiosum
What bug causes bacillary angiomatosis?
Bartonella
What is the treatment for bacillary angiomatosis?
erythromycin
What is the most common side effect of ECT therapy?
amnesia
Patient with Turners syndrome are most at risk of developing what condition?
osteoporosis
Pain between the third and fourth toes on the plantar surface with a clicking sensation, is likely what?
Mortons neuroma
Point tenderness on the plantar aspect of the foot with burning pain in the morning that decreases with activity is likely what?
Plantar fascitis
What is the treatment for a specific phobia?
behavioral therapy
What pathogens are responsible for endometritis?
polymicrobial infection
What is the treatment for endometritis?
clindamycin and gentamicin
What are the pathogens that cause acute bacterial sinusitis?
- Strep pneumo
- non typaeable H. flu
- Moraxella catarrhalis
What is the earliest renal abnormality present in patient with diabetes?
Glomerular hyperfiltration
Patient presents with optic disc hyperemia, what did they ingest?
Methanol
Which statistical test assess associations?
Chi square test
What tremor likely occurs during rest and improves with activity?
Resting tremor of parkinsons
What is Trihexyphenidyl?
An anticholinergic parkinson drug
What is a common association with dermatomyositis?
malignancy
When do you resort to imaging in a patient with uncomplicated pyelonephritis?
if no improvement after 2-3days
High LAP levels are associated with what?
leukemoid reaction
Low LAP levels are associated with what?
CML
Nocturnal chest pain should alert you to what?
GERD
In regards to methylmalonic acid and homocysteine what are the values in B12 and folate deficiency?
B12- elevated homocysteine and methylmalonic acid
Folate- elevated homocysteine and normal methylmalonic acid
What is a risk factor for nasopharyngeal carcinoma?
EBV virus
Which anemia gives you absent thumbs?
Fanconi anemia
What is the difference between fanconi anemia and diamond-blackfan anemia?
DIamond-blackfan anemia is a red cell aplasia that gives you weird thumbs while fanconi anemia is a pancytopenia that gives you absent thumbs
How does the knee to chest position help patient with tetraology of fallot?
Increases systemic vascular resistance
Patient presents with a CD4 count less than 50 and eye exam shows yellow-white patches of retinal opacification and retinal hemorrhages, what is the diagnosis?
CMV retinitis
What is the treatment for CMV retinitis?
ganciclovir or foscarnet
What is the most common complication of vesicoureteral reflux disease?
renal scarring
What is the imaging test of choice for diagnosing vesicouretal reflux disease?
VCUG
If a kid has their first UTI what is the imaging test?
Renal bladder ultrasound
If a kid has recurrent UTI’s what is the imaging test? w
VCUG
What is the accepted treatment for ALS?
Riluzole
What is a side effect of hydroxychloroquine?
retinopathy
What are two complication of nephrotic syndrome?
Hyperlipidemia and hypercoagulablity
What causes ebstein anomaly?
Lithium
What are the side effects of isoretretinoin?
cranifascial defects, heart defects, and deafness
What are the symptoms of HUS?
- microangiopathic hemolytic anemia
- Uremia
- Thrombocytopenia
What are the three things that predispose diabetic patients for foot ulcers?
- neuropathy
- microvascular insufficency
- immunosuppression
What are the risk factors for abdominal aortic aneurysm expansion and rupture?
- Active smoking
- growing in size
- Large diameter
What are the risk factors for an abdominal aortic aneurysm?
- Age (>60)
- Family history
- athersclerosis
- caucasian
- smoking
What are the indications to repair an abdominal aortic aneurysm?
- Symptomatic
- greater than 5.5cm
- rapidly expanding
What is salvage radiation therapy?
therapy used when the original therapy failed and there is recurrence of disease
hat does valsalva do to preload?
decreases preload because it decreases venous return to the heart
What does standing do to preload?
Standing decreases preload and decreases venous return to the heart
What does squatting do?
increases venous return and increases afterload and regurgitation
What does handgripping do?
increases afterload and increases blood pressure and regurgitation
Which murmurs get loader with valsalva
HOCM and MVP
Which murmurs get loader with squatting?
aortic regurgitation, mitral regurgitation and VSD
What is the difference between illness anxiety disorder and somatic symptom disorder?
In somatic symptom disorder a patient has anxiety about atleast 1 symptom that is unexplained while illness anxiety disorder has anxiety about having an illness when few or no symptoms are present and constant negative evals
Patient presents with a long history of OCP use and a solid mass in the liver, what is the likely diagnosis?
Hepatic adenoma
Multiple hepatic nodules of varying sizes is characteristic of what?
Liver metastasis
Patient presents with liver problems who have been exposed to vinyl chloride and arsenic compounds, what is the likely diagnosis?
Hepatic angiosarcoma
Patient presents with cafe au lait spots, precocious puberty and multiple bone defects, what is the likely diagnosis?
McCune-Albright syndrome
What condition can give you altered mental status, gait instability, nystagmus, and conjugate gaze palsy?
Wernicke’s encephalopathy
What is the cause of Wernicke’s encephalopathy?
Thiamine deficiency
What is the drug of choice for osteoarthritis?
Acetaminophen
If you develop HIT what is the managment?
Stop the heparin and give argatroban
What is the manegement for uncomplicated diverticulosis?
increase dietary fiber intake
How does diabetes affect cranial nerve 3?
If causes nerve ischemia of cranial nerve 3 which affects the somati fibers and causes ptosis and a down and out pupil
What pancreatic complication is present 4 wks after an acute onset of pancreatitis?
pancreatic pseudocyst
What is the imaging modality for pseudocyst?
ultrasound
What is the management for a pancreatic pseudocyst?
observation
If you have bilirubin in the urine what does that tell you?
That you have a build up of conjugated bilirubin
What drugs can cause esophagitis?
- tetracyclines
- nsaids and aspirin
- potassium chloride
- aledronate
- iron
What is the etiology of herpangina?
Coxsackie A virus
What is the treatment for herpangina?
ice cream
Patient presents with clusters of small vesicles on anterior oropharynx and lips, what is the likely diagnosis?
Herpetic gingivostomatitis
What is the treatment for herpetic gingivostomatitis?
acyclovir
Patient presents with gray vesicles/ulcers on tonsillar pillars, what is the likely diagnosis?
herpangina
What is the etiology of endocarditis in patient with prosthetic valves, catheters, implanted devices, IV drug use?
Staph aureus
What is the etiology of endocarditis in patients with dental procedures and biopsy of respiratory tract?
strep viridans
What is the etiology of endocarditis in patients with UTIs?
enterococci
What is the etiology of endocarditis in patients with colon cancer or IBD?
Strep bovis
What is rivaroxaban?
It is a factor 10a inhibitor used in the managment of acute DVT or PE
gallbladder wall thickening and pericholecystic fluid is associated with what condition?
Acalculous cholecystitis
What are the antiphospholipid antibodies associated with Lupus that are associated with thromboembolic disease?
lupus anticoagulant and anticardiolipin
What is the treatment for pinworms?
mebendazole
What is the treatment for limb ischemia?
Heparin bolus and vascular surgery consult
A patient with COPD presents with increased dyspnea, increased cough and increased sputum production, what is the likely diagnosis?
Acute COPD exacerbation
What is the management for a patient with COPD exacerbation?
- Oxygen
- Bronchodilator
- Steroids
- Antibiotics
- Positive pressure ventilation
What is indinavir?
Protease inhibitor for AIDS treatment
What is the side effect of indinavir?
crystal induced nephropathy
Classic triad of pain, jaundice, and palpable mass is most likely what?
biliary cyst
Patients with renal faiure who are on hemodialysis, what is the most common cause of death?
Cardiovascular disease
Which part of the bladder is most susceptible to rupture and peritoneal signs?
Bladder dome
What is Lights criteria for an exudative effusion?
- fluid protein/serum protein > 0.5
- fluid ldh/serum ldh >0.6
- fluid ldh > 2/3 upper limit
What conditions will you find a high amylase pleural effusion?
esophageal rupture or pancreatitis
What are the best markers indicating resolution of DKA?
serum anion gap and beta hydroxybutyrate levels
What is malignant hypertension?
- BP > 180/120
2. retinal hemorrhages, exudates, papilledema
What is a hypertensive emergency?
severe hypertension associated with malignant hypertension or hypertensive encephalopathy
What is hypertensive encephalopathy?
cerebral edema
What is the medical management for primary hyperaldosteronism?
aldosterone antagonist
descrescendo early dialstolic murmur?
Aortic regurgitation
What is the treatment for acute pancreatitis?
NPO, nasogastric tube suction, IV fluids, analgesics, antibiotics
What is the management for a patient presenting with placental abruption?
Stable patient- trial of vaginal delivery
unstable patient- C section
What is the most common cause of a nonreactive NST?
fetal sleep cycle
If you suspect a fetal sleep cycle causing a nonreactive NST what is the next step in management?
vibroacoustic stimulation
What are the complications of cryptorchidism?
- inguinal hernia
- subfertility
- testicular cancer
- testicular torsion
What is the management for cryptorchidism?
orchiopexy by 6-12months
For sickle cell anemia what will you see on peripheal blood smear?
sickle cells and howell jolly bodies
If you suspect a stillbirth because of absent fetal movement what is the next step in diagnosis?
ultrasound
Once a stillbirth is diagnosed what is the next step in management?
counsel the patient about delivery options
If you suspect central precocious puberty what is the next step in management?
MRI then GnRH agonist therapy
IV drug user presents with progressive lower back pain. On exam there is severe tenderness to gentle percussion over the vertebrae, what is the likely diagnosis?
vertebral osteomyelitis
What is the initial workup for vertebral osteomyelitis?
CBC, blood cultures, ESR, CRP and x-ray. Then do MRI
What two lab values can give you the best picture of acid base status?
pH and PaCO2
If you are suspecting a patient has Amaurosis fugax what is the next step in management?
Duplex study of neck
What is the most common complication of peptic ulcer disease?
hemorrhage
Atopic dermatitis is another word for what?
eczema
What are some things that can cause acute pancreatitis?
- Gallstones
- Alcohol
- Drugs (antibiotics, seizure meds, diuretics)
What part of the spine is most commonly affected in rheumatoid arthritis?
cervical spine
What are the test to run for a patient who comes in with suspected strep throat?
Rapid antigen test and throat culture
What are the side effects of methotrexate therapy?
oral ulcers, hepatotoxicity, pulmonary toxicity, bone marrow suppression, and alopecia
What can you give a patient to reduce the incidence of adverse effects of methotrexate?
folic acid
What is the management for a patient with suspected ventilator associated pneumonia?
First get a chest x-ray if its abnormal then do a lower respiratory tract sampling then empiric antibiotics
What bugs are associated with ventilator associated pneumonia?
Pseudomona, e.coli, klebsiella, MRSA
What causes viral myocarditis?
coxsackie B virus
What is the management for acute severe pain in a current or former addict?
IV morphine
What are upper motor neuron findings?
hyperreflexia and spascitity
What are lower motor neuron findings?
fasciculations
Contralateral hemiparesis and gaze palsy is a hemorrhage in what part of the brain?
basal ganglia
Occipital headache ataxia and nystagmus is a hemorrhage in what part of the brain?
cerebellum
Contralateral hemiparesis, constricted pupils and upgaze palsy is a hemorrhage in what part of the brain?
thalamus
contact lens keratitis is caused by what?
Pseudomonas
when do you give PCV23 alone?
When a patient is under 65 and has chronic heart, lung or liver condition or diabetes or smoker
In DKA what is your body most likely to be depleted of?
Potassium
What is the most likely cause of pneumonia in a HIV patient?
strep pneumo
What causes acute unilateral lympadenitis?
Staph aureus and group A strep
What causes the pruritis and flushing in niacin?
prostaglandin induced peripheral vasodilation
What is the cause of fanconi anemia?
Chromosomal breaks
What benign lesions of the eye are associated with primary biliary cirrhosis?
Xanthelasma
What can confirm the diagnosis of CLL?
Flow cytometry of the peripheral blood
What are the symptoms of zinc deficiency?
bad taste in mouth, rash, and poor wound healing
delayed fontanelle closure and bowing of the legs are associatd with what condition?
Rickets
Hemorrhagic disease of the newborn is caused by what?
vitamin K deficiency
An elderly patient presents with bleeding gums and bone pain who is on a tea and toast diet, what is the likely diagnosis?
vitamin C deficiency
Is hypospadias or epispadias associated with exstrophy of the bladder?
epispadias
Describe epispadias?
Penile anomaly where the urethra opens on the top side of the penis
Describe hypospadias?
Penile anomaly where the urethra opens on the bottom side of the penis
What is Potters syndrome?
Bilateral renal agenesis, abnormal facies, limb deformities, and lung hypoplasia
Patient describes a shade being pulled over their eye, what should you think of?
Amaurosis fugax
What is a indicator in the question stem that you are dealing with carotid stenosis?
TIA or Amaurosis fugax
What is the next step in mangement if you ae dealing with carotid stenosis?
duplex scan of the carotids
What is the management if you find 50% or less stenosis of the carotid artery?
Aspirin and/or clopidogrel
WHat is the management if you have greater than 70% stenosis of the carotid artery?
Carotid endarterectomy
Patient presents with a pulsatile abdominal mass and hypotension, what is the next best step?
exploratory laparotomy
What is the management of an acute dissection in the ascending aorta?
Surgery
What is the management of an acute dieesction in the descending aorta?
b-blockers
What is the classic presentation for chronic mesenteric ischemia?
Postprandial abdominal pain, a fear of food, and weight loss. Patient usually has a history of athersclerosis
A superficial palpbale cord is a specific sign for what?
Superficial thrombophlebitis
Patient presents with arm problems during exercise and CNS problems what is the diagnosis?
subclavian steal syndrome
What is the most common type of testicular cancer?
seminoma
What is the imaging test of choice for renal cell carcinoma?
abdominal CT scan
What is the size of a stone that is unlikely to pass on its own?
10mm
What is pulseless disease?
Takayasu arteritis
What is the treatment for Takayasu arteritis?
steroids
What is the treatment for Behcet syndrome?
steroids
What is the trreatment for polymyositis?
steroids
What could cause recurrent pneumonia in the same spot in a kid?
foreign body aspiration
Can you use oral hypoglycemics in pregnancy?
NO!!!!
If a patient has an abnormal NST and abnormal Biophysical profile, what is the next step in managment?
COntraction stress test
What is the treatment for a hydatiform mole?
D&C with serial B-hCG levels
When should you give the infant varicella zoster immunoglobin?
If the mother contracts varicella zoster within the last 5 days of the pregnanct or within 2 days post delivery
What is the order of fetal positions during normal labor and delivery?
- descent
- flexion
- internal rotation
- Extend
- external rotation
- expulsion
What antibodies can cross the placenta?
IgG
When do you give rhogam to treat RH imcompatability?
at 28wks and within 72hrs after delivery
What is the treatment for chorioamniotis?
ampicillin and gentamicin
What is the prophylaxis for group B strep?
Penicillin
What is the most common cause of postpartum hemorrage?
uterine atony
What is the treatment for scabies?
Permethrin cream
What is the treatment for lice?
Permethrin cream
WHat causes skin colored smooth waxy papules with a central umbilicated depression that are roughly 0.5cm?
Molluscum contagiosum
What is the treatment for pemphigus vulgaris and bullous pemphigoid?
Steroids
Between pemphigus vulgaris and bullous pemphigoid which one gives you oral lesions?
Pemphigus vulgaris
flesh colored lesion that grows rapidly with a central crater that contains keratinous material, what is the likely diagnosis?
Keratoacanthoma
What is the management for keratoacanthoma?
observation
What is bowen disease?
squamous cell cancer in situ
From what lesion does squamous cell cancer classically develop?
Actinic keratoses
What determines the prognosis of malignant melanom?
Depth of invasion
WHat is actinic keratoses?
premalignant lesion to squamous cell cancer where you get a red scaly plaque in chronic sun exposed areas
A unilateral red oozing or crusting nipple in an adult woman is what?
Paget disease of the nipple
What can cause stomatitis?
riboflavin, niacin, pyridoxine, vitamin C
What is the treatment for gonorrheal conjunctivitis?
ceftriaxone
WHat is the treatment for closed angle glaucoma?
pilocarpine
Catatracts in a neonate should suggest what?
TORCH infection or galactosemia
What changes in the retina are seen in diabetics?
- hemorrgaes
- microaneurysms
- neovascularization
What changes in the retina are seen in hypertension?
- artery narrowing
- wiring
- cotton wool spots
What are the most common bugs causing preseptal and orbital cellulitis?
- Strep pneumo
- H.Flu
- Staph aureus
What is the difference between a stye and a chalazion?
A stye is a painful red lump near the lid margin whereas a chalazion is a painless red lump away from the lid margin
classic dendritic keratitis on fluorescin stain is what?
Herpes simplex keratitis
What should be avoided in herpes simplex keratitis?
steroids
What condition is temporal arteritis associated with?
polymalgia rheumatica
