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Step 2 CK > Step 2 Ck flashcards > Flashcards

Step 2 Ck flashcards

1
Q

steroids

A

inhibit IL-1 production

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2
Q

methotrexate

A

folic acid antagonist, inhibits DHF reductase, S-phase specific, inhibits DNA synthesis

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3
Q

cyclosporine

A

calcineurin inhibitor; inhibits IL-2 production; nephrotoxic, gum hypertrophy, hursutism

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4
Q

tacrolimus (FK506)

A

calcineurin inhibitor; inhibits signaling thru T cell receptor

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5
Q

mycophenylate mofeil

A

prevents T cell activation

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6
Q

azathioprine

A

antineoplastic; cleaved to mercaptopurine; inhibits DNA/RNA synthesis; BM suppression

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7
Q

antithymocyte globulin (OKT3)

A

antibody against CD3 on T cells; causes pulmonary edema

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8
Q

basiliximab, daclizumab

A

monoclonal antibody to IL-2 receptor

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9
Q

fetal heart tones begin at

A

10-12 weeks

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10
Q

fetal quickening (movement) occurs at

A

17-18 weeks

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11
Q

4 measurements that can be taken from fetal US

A

crown-rump length, biparietal diameter, femur length, abdominal circumference

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12
Q

abdominal circumference

A

most reliable parameter for set. fetal weight in cases of fetal growth restriction

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13
Q

Gestational sac is visible by what gestational age?

A

five weeks

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14
Q

b-hCG peaks when?

A

10 weeks GA

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15
Q

average increase in weight during pregnancy

A

25 lb (11 kg)

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16
Q

additional kcal needed during pregnancy

A

100-300 kcal/day

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17
Q

when should supplemental iron be started in a pregnant woman?

A

first prenatal visit

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18
Q

What 2 supplement to pregnant vegans need?

A

Vit D, Vit B12

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19
Q

What cardiovascular parameters DECREASE during pregnancy?

A

blood pressure and peripheral vascular resistance

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20
Q

What happens to electrolytes during pregnancy?

A

NOTHING! Remain unchanged.

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21
Q

What causes herpangina?

A

coxsackievirus (an enterovirus)

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22
Q

How do you screen for Hep C on the first prenatal visit? What about Hep B?

A

Hep C - history. Hep B - HBsAg

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23
Q

When is gestational diabetes screened for in pregnancy?

A

weeks 24-28

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24
Q

How are AFP results reported?

A

multiples of the median (MoM)

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25
Q

Quad screen shows “pan-low”.

A

trisomy 18 (low AFP, low estriol, low b-hCG, low inhibin A)

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26
Q

Quad screen shows low AFP, low estriol, high b-hCG, high inhibin A.

A

Down syndrome

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27
Q

Risk of fetal loss during chorionic villus sampling

A

1%

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28
Q

Third trimester test used to detect presence of phosphatidylglycerol

A

amniocentesis

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29
Q

tetratogen that can cause lack of cranial ossification

A

ACEI

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30
Q

tetratogenic defects of streptomycin or kanamycin

A

hearing loss; CN VIII damage

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31
Q

2 tetratogens causing anotia or microtia

A

thalidomide, Vit A

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32
Q

can cause neonatal nasal hypoplasia an stippled bone epiphyses

A

warfarin

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33
Q

tetratogen assoc. w/ neonatal bowel atresia

A

cocaine

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34
Q

Woman with hyperhomocysteinemia loses a 19 week pregnancy. What enzyme is deficient?

A

methylene tetrahydrofolate reductase

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35
Q

Amount of caffeine required to cause spontaneous abortion

A

> 500 mg/day

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36
Q

Deficiency of what hormone increases risk for spontaneous abortion? (estrogen, progesterone, growth hormone, testosterone, or FSH)

A

progesterone

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37
Q

Prophylactic med for toxo during pregnancy

A

spiramycin

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38
Q

Cardiac defect assoc. w/ congenital rubella

A

PDA

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39
Q

treatment for congenital CMV

A

postpartum ganciclovir

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40
Q

Pregnant HIV+ women should receive what prenatal meds?

A

AZT or nevirapine

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41
Q

When does an HIV+ women get a C-sec?

A

viral load >1000

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42
Q

eye disease in late congenital syphilis

A

interstitial keratitis

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43
Q

Tx for threatened AB

A

pelvic rest for 24-48 hrs, then follow up US

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44
Q

How can misoprostol be administered?

A

oral, vaginal, sublingual, buccal

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45
Q

2 meds used for first-trimester therapeutic abortions

A

misoprostol, mifepristone

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46
Q

How does oxytocin work to induce or augment labor?

A

binds receptors on myometrium, increases Ca influx to stimulate contractions

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47
Q

Components of a Bishop score

A

dilation, effacement, station, cervical position, cervical consistency

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48
Q

Prolonged active stage of labor due to

A

cephalopelvic disproportion

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49
Q

things that can decreases fetal heart rate variability

A

hypoxia, opioids, magnesium, sleep cycle

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50
Q

drug assoc. w/ a “pseudosinusoidal” variability pattern on fetal heart rate tracings

A

meperidine

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51
Q

complication of a supine nonstress test

A

maternal hypotension

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52
Q

What is “15-15-2-20”?

A

Normal “reactive” nonstress test: 2 FHR accelerations _ 15 bpm above baseline lasting _ 15 sec over a 20 min period

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53
Q

Next step if nonstress test is nonreactive?

A

biophysical profile

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54
Q

How can you induce contractions in a contraction stress test?

A

nipple stimulation or oxytocin

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55
Q

Next step if contraction stress test is positive

A

delivery

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56
Q

components of a biophysical profile

A

fetal tone, fetal breathing, fetal movement, amniotic fluid volume, nonstress test

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57
Q

what is a modified biophysical profile?

A

NST + amniotic fluid index

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58
Q

reversal of umbilical artery diastolic flow indicates what?

A

IUGR

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59
Q

nerve responsible for perineal pain during delivery

A

pudendal (S2-S4)

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60
Q

lab values seen in hyperemesis gravidarum

A

high b-hCG, high estradiol, large ketonuria (get a UA)

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61
Q

First step in dx of hyperemesis gravidarum?

A

rule out molar pregnancy w/ ultrasound +/- b-hCG

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62
Q

Tx for hyperemesis gravidarum

A

Vit B6, antihistamines (doxylamine, promethazine, dimenhydinate). If severe, metoclopramide, ondansetron, prochlorperazine. If dehydrated, IVFs, NPO, parental nutrition, IV dimenhydrinate.

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63
Q

First step in management of gestational diabetes

A

ADA diet, exercise, glucose monitoring. Insulin only if all this fails

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64
Q

Management of pregestational diabetic during labor

A

IV insulin drip and hourly glucose measurements

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65
Q

antihypertensive meds in pregnancy

A

methyldopa (#1), metoprolol, nifedipine, hyralazine

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66
Q

Most likely cause of hemolytic anemia, elevated liver enzymes, and thrombocytopenia in pregnancy

A

(HELLP syndrome) Vasospasm leading to hemorrhage and organ necrosis

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67
Q

Tx for preeclampsia if far from term?

A

modified bed rest and expectant management

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68
Q

How to administer magnesium for seizure prophylaxis in preeclampsia

A

continuous MgSO4- IV drip

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69
Q

Dx: Pregnant woman present w/ vaginal bleeding & abdominal pain. US shows a retroperitoneal clot.

A

placental abruption

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70
Q

Next step in management for mild placental abruption with premature fetus

A

bed rest

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71
Q

Management of placenta previa

A

No vaginal exam. Tocolytics. Betamethasone for lung maturity. C-sec delivery.

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72
Q

Next step in assessing a reproductive age woman w/ acute onset abdominal pain, + pregnancy test and empty uterus on US

A

serial hCG to confirm ectopic pregnancy

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73
Q

medical management for small, unruptured ectopic pregnancy

A

methotrexate

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74
Q

What should be given to an IUGR fetus near due date?

A

steroids (betamethasone) _ 48 hrs prior to delivery to accelerate fetal lung maturity

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75
Q

fetal anomalies assoc. w/ polyhydramnios

A

duodenal atresia, TE fistula, anencephaly

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76
Q

What can be done for Rh isoimmunization hemolysis prior to delivery?

A

intrauterine blood transfusion

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77
Q

Woman has gestational trophoblastic disease. What dietary modifications could have prevented this?

A

Increase dietary folate and/or beta-carotene

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78
Q

chemo tx for malignant gestational trophoblastic tumors

A

MTX or dactinomycin

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79
Q

Uterus is evacuated of a “mass of grapes.” Next step?

A

weekly b-hCG

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80
Q

recoil of the perineum during second stage of labor indicates impending…

A

shoulder dystocia (this is called “turtle sign”)

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81
Q

When is cervical ripening indicated?

A

failure to progress in latent stage; failure to have progressive cervical change

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82
Q

What medicine is used for cervical ripening?

A

misoprostol (a prostaglandin)

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83
Q

Next step if pregnant woman presents w/ “gush of blood”?

A

nitrazine paper test, fern test, or indigo carmine dye test

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84
Q

what is contraindicated on pts w/ PROM?

A

digital vaginal exam (increases risk for infection)

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85
Q

What effect does ABx have during tx of PROM, other than preventing infection?

A

they prolong the latency period

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86
Q

ABx given in cases of rupture of membrane

A

ampicillin and gentamicin

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87
Q

What is tachysystole?

A

> 5 uterine contractions in 10 min

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88
Q

ABx given for GBS ppx if preterm delivery is likely

A

penicillin or ampicillin

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89
Q

murmur likely heard in a premie

A

continuous machine-like murmur of PDA

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90
Q

fetal head position at risk for failure to progress

A

occiput posterior

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91
Q

1 risk factor for fetal malpresentation

A

prematurity

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92
Q

Most common form of breech presentation?

A

frank breech: thighs flexed, knees extended

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93
Q

What should be given to decrease gastric acidity during c-sec?

A

sodium citrate

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94
Q

fistula assoc. w/ episiotomy

A

rectovaginal

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95
Q

First step in managing uterine atony

A

bimanual uterine massage

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96
Q

Difference btw placenta accreta/increta/percreta

A

accreta: partial invasion of myometrium, increta: further/full invasion, percreta: penetrates uterine serosa

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97
Q

Next step once Sheehan syndrome is diagnosed by MRI

A

cortisol replacement

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98
Q

When will lactose intolerance be evident?

A

Within 1 week postpartum. (Mature milk does not have lactose until 1 week)

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99
Q

ABx for mastitis

A

dicloxacillin, cephalexin

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100
Q

thelarche begins when?

A

8-11 years old

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101
Q

menarche begins when?

A

10-16 years old

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102
Q

What is the lipid profile during menopause?

A

high cholesterol, low HDL

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103
Q

What malignancy/malignancies are postmenopausal pts on HRT at risk for?

A

breast cancer

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104
Q

What malignancy/malignancies are postmenopausal pts on HRT protected from?

A

endometrial cancer, ovarian cancer

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105
Q

Name IUDs effective for 3, 5, and 10 years, respectively.

A

Implanon (progestin-only IUD) - 3 years, Mirena (IUD w/ progestin) - 5 years, Mirena (IUD w/ progestin) - 5 years

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106
Q

When must the “morning after pill” be taken to be effective?

A

within 120 hours (5 days) of unprotected sex

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107
Q

16 yo w/ amenorrhea has normal smell, negative pregnancy test, normal 46 XX karyotype and normal breasts. Next step?

A

bone age x-ray (PA left hand)

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108
Q

How do you treat premature ovarian failure?

A

combined estrogen/progestin HRT

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109
Q

Excess levels of what mediator are present in primary dysmenorrhea?

A

PGF-2a

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110
Q

MCC of infertility in menstruating women >30 years old

A

endometriosis

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111
Q

First line treatment for endometriosis. First line for adenomyosis.

A

Combined OCPs (endometriosis). NSAIDs (adenomyosis).

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112
Q

Major complication of adenomyosis

A

can progress into endometrial carcinoma (rare)

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113
Q

Postmenopausal woman w/ abnormal uterine bleeding has a 5 mm endometrium on US. Next step?

A

endometrial biopsy

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114
Q

Tx for CAH?

A

Glucocorticoids

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115
Q

What are the 17-ketosteroids?

A

DHEA and androstenedione

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116
Q

First enzyme in glucocorticoid synthetic pathway

A

cholesterol desmolase

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117
Q

CAH when 11-DOC is elevated

A

11b-hydroxylase deficiency

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118
Q

Woman with skin rash and US that shows subcapsular follicles in a “pearl necklace” pattern

A

PCOS (rash is acanthosis nigricans)

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119
Q

first line tx for ovulatory stimulation in PCOS

A

clomiphene +/- metformin

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120
Q

PCOS incr risk of what cancer(s)?

A

breast, endometrial (not ovarian)

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121
Q

Tx for asymptomatic Bartholin gland cyst

A

no treatment +/- warm soaks

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122
Q

Tx for trichomoniasis

A

single-dose PO metronidazole or TINIDAZOLE for pt and partner(s)

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123
Q

grayish-white vaginal discharge vs. yellow-green, frothy vaginal discharge

A

grayish-white = bacterial vaginosis, yellow-green, frothy = trichomoniasis

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124
Q

If not managed appropriately, TSS can lead to death by what mechanism?

A

ARDS (most common), or severe hypotension or hemorrhage 2_ to DIC.

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125
Q

Dx: 23 yo F present w/ vomiting, watery diarrhea, T 103F, and and desquamating rash. Blood cx negative.

A

toxic shock syndrome

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126
Q

What should women w/ fibroids be told re: pregnancy and menopause?

A

Fibroids may grow during pregnancy and shrink during menopause, as they are estrogen and progesterone sensitive.

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127
Q

Dx: 40 yo F present w/ urinary frequency, pelvic pressure and a “cobblestone uterus” on exam.

A

uterine leiomyoma (fibroids)

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128
Q

Medical management of BLEEDING assoc. w/ uterine fibroids

A

medroxyprogesterone acetate or danazol

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129
Q

poor prognostic factors for endometrial cancer

A

p53 gene mutation, serous or clear cell histology

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130
Q

When can cervical cancer screening stop

A

women _70 yo w/ 3 normal Paps, or total hysterectomy

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131
Q

T or F: Women who have had Gardasil no longer need to be screened for cervical cancer.

A

FALSE

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132
Q

A 30 yo F has had 3 consecutively normal Paps. Next step?

A

Pap once every 3 years

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133
Q

Next step if cervical cytology (Pap) shows ASCUS.

A

HPV DNA testing

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134
Q

Next step if cervical cytology (Pap) shows ASCUS and HPV DNA test is negative? Is positive?

A

If negative: repeat Pap in 1 year, If positive: colposcopy

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135
Q

Only time a pregnant woman should get colposcopy

A

Pap shows HSIL (high-grade squamous intraepithelial lesion)

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136
Q

HPV subtypes assoc. w/ vulvar cancer

A

16, 18, 31

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137
Q

Which is a risk factor for vulvar cancer: lichen planus or lichen sclerosus?

A

lichen sclerosus

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138
Q

Diagnosis of vulvar cancer

A

vulvar punch biopsy

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139
Q

female organ prolapse increases risk for what cancer?

A

vaginal cancer

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140
Q

Other than colon cancer, Lynch II syndrome (or HNPCC) is assoc w/ what other cancer(s)?

A

ovarian, endometrial, breast

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141
Q

benign or malignant: 5 cm calcified cystic Right adnexal mass with unilocular septations

A

benign

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142
Q

increased CA-125 is assoc. w/ what benign condition?

A

endometriosis

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143
Q

Tx for ovarian mass w/ LDH+ genetics

A

surgery + postop chemo + RADIATION (dysgerminoma)

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144
Q

what is “procidentia”?

A

marked uterine prolapse

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145
Q

MCC of infectious vulvovaginitis in kids

A

Group A strep

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146
Q

Dx: little girl has a “bunch of grapes” within the vagina

A

sarcoma botryoides (rhabdomyosarcoma)

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147
Q

Dx: 6 yo F w/ precocious puberty and dark skin spots that stop at the midline

A

McCune-Albright syndrome (precocious puberty, polyostotic fibrous dysplasia [bone disorder], unilateral cafe-au-lait spots)

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148
Q

mechanism of fibrocystic breast change

A

exaggerated stromal tissue response to hormones & growth factors

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149
Q

What dietary modification can be suggested to help w/ fibrocystic change?

A

reduce caffeine intake (methylxanthine abstention)

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150
Q

phylloides tumor is a subtype of what?

A

fibroadenoma (benign)

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151
Q

Tx for fibroadenoma & phylloides tumors

A

excision

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152
Q

dietary risk factors for breast cancer

A

high fat, low fiber

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153
Q

supraclavicular LAD indicates breast cancer stage ___

A

IV

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154
Q

comedocarcinoma is a subtype of what?

A

DCIS (ductal carcinoma in situ)

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155
Q

tumor markers for recurrent breast cancer

A

CEA, CA 15-3, CA 27-29

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156
Q

Breast cancer receptor status w/ poor prognosis

A

Triple negative: ER-, PR-, EGFR- (HER2/neu is an EGF receptor)

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157
Q

lumpectomy + axillary dissection + postop radiation has equal efficacy as what?

A

modified radical mastectomy (total mastectomy + axillary dissection)

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158
Q

MCC of infertility in menstruating women < 30 years old

A

PID

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159
Q

nodularities on the broad ligament and a retroverted uterus suggest

A

endometriosis

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160
Q

strawberry cervix or cervical petechiae

A

trichomonas

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161
Q

Tx for chlamydia

A

doxycycline x 7 days OR azithromycin once. If pregnant, erythromycin or azithromycin

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162
Q

T or F: Automatically give gonorrhea treatment to pts w/ chlamydial infection.

A

False. Give pts w/ gonorrhea infection treatment for suspected chlamydia.

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163
Q

Dx: normal looking 16 yo girl w/ breasts but no axillary or pubic hair and amenorrhea

A

androgen insensitivity

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164
Q

Tx for mastitis due to MRSA

A

Bactrim (TMP-SMX) or clindamycin

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165
Q

30 yo F who uses an IUD for contraception develops PID. Most likely organism?

A

Actinomyces israelii

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166
Q

A 20 yo F on OCPs requires elective surgery. What should you tell her about her OCP use?

A

Stop 1 month before surgery, and do not restart until 1 month after surgery.

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167
Q

Guy w/ skin fifth metacarpal fracture gets hand infection.

A

Boxer’s fracture w/ human oral pathogens (Eikenella). Give ABx.

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168
Q

NAME?

A

squeezing gastrocnemius elicits no foot plantar flexion; indicates Achilles rupture. (+ test may be a normal finding in elderly pts.)

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169
Q

Tx for carpal tunnel syndrome

A

splint wrist + NSAIDs. Surgery for intolerable symptoms.

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170
Q

subacromial bursa lies between acromion and

A

supraspinatus muscle

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171
Q

trochanteric bursitis located at insersion of what muscle?

A

gluteus medius

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172
Q

21 yo college student w/ painful, swollen elbow. No history of gout or trauma.

A

olecronon bursitis

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173
Q

most common site for lumbar disc herniation

A

L5-S1 (L4-L5 is second most common)

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174
Q

50 yo man w/ low back pain. X ray shows facet hypertrophy and degenerative changes. Next step?

A

(Spinal stenosis) NSAIDs and abdominal muscle strengthening

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175
Q

Dx: 65 yo M w/ knee pain and crepitus, X-ray shows subchondral bone cysts, aspiration of joint fluid is straw-colored.

A

osteoarthritis

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176
Q

Dx: During a Super Bowl party, a 40 yo M goes on a drinking binge and develops severe acute foot pain.

A

gout

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177
Q

anti-cyclic citrullinated peptide antibodies

A

rheumatoid arthritis (anti-CCP antibodies)

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178
Q

First line therapy for ACUTE gout attacks

A

NSAIDs (e.g., indomethacin)…NOT acetaminophen, which has no anti-inflammatory properties

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179
Q

Tx for gout: overproducers vs. undersecretors

A

overproducers: allopurinol

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180
Q

60 yo F w/ HTN on lasix gets acute foot pain

A

gout (remember, POSTmenopausal women!)

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181
Q

Tx of choice for acute gout in pts w/ renal disease

A

steroids (oral prednisone)

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182
Q

NAME?

A

decr spinal flexion seen in ankylosing spondylitis

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183
Q

What are two extra-articular manifestations of ankylosing spondylitis?

A

anterior uveitis (or iridocyclitis), heart block

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184
Q

20 yo M w/ skin rash, dactylitis and abnormal hand x-ray

A

psoriatic arthritis (“pencil in cup” deformity)

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185
Q

Pts w/ dermatomyositis are at risk for what malignancies?

A

lung & breast cancer

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186
Q

Which of the following is assoc. w/ polymyositis and dermatomyositis? A. endocarditis B. myocarditis C. pericarditis

A

B. myocarditis

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187
Q

antibody assoc. w/ polymyositis & dermatomyositis

A

anti-Jo-1 antibodies

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188
Q

anti-smooth muscle antibody

A

autoimmune hepatitis

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189
Q

anti-RNP antibody

A

mixed connective tissue disease

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190
Q

anti-topoisomerase 1 antibody

A

scleroderma

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191
Q

anticentromere antibody

A

CREST syndrome

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192
Q

anti-Ro antibody

A

neonatal lupus

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193
Q

c-ANCA

A

Wegener’s (granulomatosis w/ polyangiitis)

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194
Q

p-ANCA

A

microscopic polyangiitis

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195
Q

type of anemia assoc. w/ rheumatoid arthritis

A

anemia of chronic disease

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196
Q

Dx: 40 yo F w/ ulnar deviated hands, LUQ mass, and low WBC count

A

Felty’s syndrome (RA, splenomegaly and neutropenia)

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197
Q

best initial disease-modifying antirheumatic drug (DMARD) for RA

A

methotrexate

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198
Q

Dx: inflammatory myopathy affecting M>F, distal muscles, loss of deep tendon reflexes and no autoantibodies

A

inclusion body myositis

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199
Q

anti-Mi-2 antibodies

A

polymyositis/dermatomyositis

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200
Q

anti-synthetase antibodies

A

another name for anti-Jo-1 antibodies assoc. w/ polymyositis/dermatomyositis

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201
Q

anti-signal recognition antibodies

A

cardiac conduction manifestations assoc. w/ polymyositis/dermatomyositis

202
Q

features of CREST syndrome

A

calcinosis, Raynaud’s, esophageal dysmotility, sclerodactyly, telangiectasias

203
Q

drug used for cutaneous scleroderma

A

penicillamine

204
Q

Tx for Raynaud’s

A

CCBs (vasospasm)

205
Q

Pt w/ calcinosis, Raynaud’s, esophageal dysmotility, sclerodactyly and telangiectasias develops acute renal failure. What could have prevented this?

A

ACEIs (scleroderma renal crisis)

206
Q

anti-leucine aminopeptidase antibody

A

Sjogren’s syndrome

207
Q

lupus often affects which heart valve?

A

mitral valve (Libman-Sacks endocarditis)

208
Q

what tests should be ordered for neonates w/ lupus?

A

EKG and echo (for congenital heart block and transposition of great vessels, respectively)

209
Q

involvement of which organ system(s) excludes drug-induced lupus?

A

CNS and/or renal (these are spared in drug-induced lupus)

210
Q

temporal artery biopsy in giant cell arteritis will show what?

A

thrombosis, necrosis of media, presence of lymphocytes and/or plasma cells

211
Q

<11 tender points in a 50 yo F w/ depression and anxiety

A

myofascial pain syndrome

212
Q

cause of death in Duchenne muscular dystrophy

A

cardiac fibrosis -> high-output heart failure -> pulmonary congestion

213
Q

What immunostain is used to diagnose Duchenne muscular dystrophy?

A

Western blot

214
Q

endocrinopathy assoc. w/ slipped capital femoral epiphysis

A

hypothyroidism. Rule out w/ TSH

215
Q

Tx for scoliosis based on degree of involvement

A

50 degrees: surgery

216
Q

Dx: boy w/ arthritis, daily high/spiking fevers and an evanescent, salmon-colored rash

A

Still’s disease (acute febrile/systemic juvenile idiopathic arthritis)

217
Q

Tx for juvenile idiopathic arthritis

A

NSAIDs

218
Q

Which organisms causing pneumonia can be diagnosed with a urine antigen test?

A

Legionella and Strep pneumo

219
Q

Pneumonia diagnosed w/ serum cold agglutinin test

A

Mycoplasma

220
Q

Dx: Pt w/ fever, productive cough, and sputum Gm stain shows lancet-shaped Gm+ diplococci

A

S. pneumoniae

221
Q

Pt being treated for TB complains of new vision problems. Cause?

A

side effect of ethambutol is optic neuritis

222
Q

Pt being treated for TB now has elevated liver enzymes. Cause?

A

side effect of INH is hepatitis

223
Q

Who should be notified of new TB diagnosis

A

ALL cases of TB (both latent & active) must be reported to local and state health departments.

224
Q

MCC of bacterial diarrhea? Tx?

A

Campylobacter. Erythromycin

225
Q

Choroidal tubercles on eye exam in a pt w/ a cough suggests what?

A

miliary TB

226
Q

Next step in TB pt treated w/ 2 months of RIPE.

A

4 months of INH + rifampin

227
Q

What is an alternative to ethambutol in RIPE tx of TB?

A

streptomycin

228
Q

Tx for strep throat

A

penicillin x 10 days

229
Q

Dx: Pt w/ strep throat develops thrombophlebitis of the jugular vein

A

Lemierre’s syndrome, due to oral anaerobe Fusobacterium

230
Q

First-line tx for acute bacterial sinusitis

A

amoxicillin/clavulanicate 500 mg PO TID x 10 days

231
Q

What are hemagglutinin and neuraminidase?

A

glycoproteins assoc. w/ influenza A

232
Q

Antigenic drift is specific for which influenza virus(es)?

A

only influenza A

233
Q

What phenomenon allows individuals to be affected w/ influenza more than once?

A

antigenic drift

234
Q

How old do you have to be to get a flu shot?

A

_ 6 months old

235
Q

When is LP contraindicated in meningitis?

A

papilledema or focal neurologic deficits

236
Q

Close contacts of pts w/ meningococcal meningitis should receive what for ppx?

A

rifampin

237
Q

Tx for seizures due to meningitis

A

benzos and phenytoin

238
Q

What is the only live vaccine you can give an HIV+ patient?

A

MMR

239
Q

Dx: HIV pt w/ cough and sputum stain shows folded cysts containing comma-shaped spores

A

Pneumocystis jiroveci pneumonia

240
Q

T of F: Mycobacterium avium complex (MAC) is only a disease of immunocompromised individuals.

A

False. 1_ pulmonary MAC occurs in apparently healthy non-smokers (Lady Windermere syndrome)

241
Q

What is the most common serious medical complication of pregnancy?

A

pyelonephritis

242
Q

First-line med for uncomplicated pyelonephritis

A

PO fluoroquinolones

243
Q

MCC of sepsis in IVDUs?

A

Staph aureus

244
Q

mechanism of Gm+ shock? Gm- shock?

A

Gm+ is exotoxin. Gm- is endotoxin (lipopolysaccharide)

245
Q

MCC of catheter-related sepsis?

A

Staph aureus or Staph epidermidis

246
Q

Top 2 DDx for fever of unknown origin. If you’re forced to choose 1, which is it?

A

infection (#1) and cancer (#2)

247
Q

Tx for Lyme disease in children <8 yo and in pregnant pts?

A

oral amoxicillin

248
Q

disease transmitted by American dog tick

A

Rocky Mountain Spotted Fever

249
Q

RMSF is a disease of A. large arteries B. medium arteries C. medium veins D. large veins E. capillaries

A

capillaries

250
Q

Tx for RMSF in pregnant women

A

chloramphenicol

251
Q

Other than Pseudomonas, what causes otitis externa?

A

Enterobacteriaceae

252
Q

mechanism of pulmonary anthrax

A

hemorrhagic mediastinitis

253
Q

Vascular or immunologic: Janeway lesions? Roth spots? Osler’s nodes?

A

Janeway lesions - vascular, Roth spots - immunologic, Osler’s nodes - immunologic

254
Q

Drug of choice for anthrax? Second-line?

A

Cipro first, then doxycycline

255
Q

pneumonia-causing organism in COPD pts?

A

Haemophilus influenzae

256
Q

Most likely cause of pneumonia in a college student or soldier?

A

Mycoplasma (atypical)

257
Q

What is the primary Tx for Pneumocystic pneumonia? What are 3 alternatives?

A

TMP-SMX. Alternatives: pentamidine, atovaquone, dapsone

258
Q

late, rare complication of measles

A

subacute sclerosing panencephalitis

259
Q

osteochondritis of tibial tubercle

A

Osgood-Schlatter

260
Q

Pt is started on hydroxychloroquine for treatment of rheumatoid arthritis. Next step?

A

eye exam every 6 months (retinal toxicity)

261
Q

When should Rh typing be done in pregnancy?

A

first prenatal visit

262
Q

Prenatal measurement that most accurately measures fetal age?

A

biparietal diameter

263
Q

Name 3 conditions associate w/ postterm pregnancy (prolonged gestation)

A

anencephaly, oligohydramnios, placental sulfatase deficiency (x-linked ichthyosis)

264
Q

Dx: proteinuria, edema, RUQ pain and hypertension at 12 weeks gestations

A

think hydatidiform mole (gestational trophoblastic tumor) OR choriocarcinoma

265
Q

most important risk factor for developing preeclampsia

A

chronic kidney disease (from SLE or type 1 DM)

266
Q

What test can be used to calculate the dose of RhoGAM to be given?

A

Kleinhauer-Betke test (quantifies the amount of fetal blood in maternal circulation)

267
Q

dyslexia or alexia can result from stroke in what arterial distribution?

A

PCA

268
Q

T or F: Pt must be 18 yo or older to get tPA for acute stroke.

A

TRUE

269
Q

In the immediate postictal period, what hormone is likely to be elevated?

A

prolactin

270
Q

low leukocyte alkaline phosphatase is assoc w/ what malignancy?

A

CML

271
Q

large, globular (water bottle shaped) heart on CXR

A

pericardial effusion

272
Q

treatment for nocardia

A

TMP-SMX

273
Q

Pt reports severe dizziness after turning in bed and reaching overhead. What anatomical structure is involved?

A

posterior semicircular canals

274
Q

What is meclizine (and other antivertigo meds) contraindicated in BPPV?

A

they inhibit central compensation

275
Q

labyrinthitis is mimicked by a stroke in what artery?

A

AICA (lateral pontine syndrome)

276
Q

vestibular neuritis is mimicked by a stroke in what artery?

A

PICA (lateral medullary syndrome, Wallenberg syndrome)

277
Q

How are labyrinthitis and vestibular neuritis different?

A

Labyrinthitis includes auditory symptoms (unilateral tinnitus, ear fullness, hearing loss). Vestibular neuritis does not.

278
Q

Dx: 25 yo pt has N/V, vertigo and unsteady gait. Bedside head impulse test shows left-beating nystagmus.

A

acute peripheral vestibulopathy (vestibular neuritis or labyrinthitis), on the RIGHT b/c nystagmus beats opposite of lesion

279
Q

Dx: 22 yo F presents w/ 24 hrs of vertigo, N/V, and photophobia. She denies tinnitus, aural fullness or hearing loss. Her gait is normal. What other condition does she most likely have?

A

migraine headaches (this is a vestibular migraine)

280
Q

Difference in muscle stimulation test in myesthenia gravis and Lambert-Eaton

A

MG: decremental response (worsens w/ repetitive stimulation. LE: incremental response (improves)

281
Q

Lambert-Eaton antibodies attack what?

A

pre-synaptic Ca++ channels

282
Q

Myesthenia gravis antibodies attack which type of receptors? A) muscarinic B) nicotinic C) calcium D) TSH E) presynaptic

A

nicotinic acetylcholine receptors

283
Q

Drugs that can exacerbate myesthenia symptoms

A

antibiotics (aminoglycosides, tetracyclines), beta-blockers, anti-arrhythmics (lidocaine, procainamide, quinidine)

284
Q

most common subtype of multiple sclerosis

A

relapsing-remitting

285
Q

What would you tell a pregnant pt w/ MS about what to expect regarding her symptoms?

A

improvement of symptoms during pregnancy

286
Q

Pt treated for MS develops severe CNS deterioration. Medication responsible?

A

Natalizumab (Tysabri) - risk for JC virus-mediated progressive multifocal leukoencephalopathy (PML)

287
Q

What is the geographic assoc. w/ MS?

A

Incidence is greater at higher latitudes (more common with further distance from equator)

288
Q

first line treatment for OCD

A

SSRIs

289
Q

first line treatment for anxiety

A

SSRIs

290
Q

first line treatment for post-traumatic stress disorder

A

SSRIs

291
Q

mechanism of flumazenil

A

COMPETITIVE antagonist at GABA receptor (antidote to benzo intoxication)

292
Q

Lactate (as in lactated Ringer’s) can cause what psychiatric disorder?

A

panic attacks

293
Q

Pt is has been treated for panic disorder with a bezno. Today, she is started on an SSRI. Next step?

A

Slowly taper benzo (Do Not stop “cold turkey”)

294
Q

1st and 2nd MCC of PTSD in men

A

1st - rape. 2nd - combat

295
Q

What 2 neurotransmitters are deficient in Alzheimer’s?

A

NE and ACh

296
Q

An ICU pt is disoriented to person, place, and time. Once the underlying etiology is resolved, which will he regain orientation to first?

A

Person, then place, then time.

297
Q

depression involves what cortex of the brain?

A

left prefrontal cortex

298
Q

Dx: A pt is has been treated for a mood disorder for the last 2 years. Today she presents w/ poor appetite, sad mood, excessive guilt, weight gain and suicidal ideations.

A

Double depression (major depressive episode on top of dysthymia)

299
Q

Is electroconvulsive therapy for depression safe in pregnancy?

A

YES

300
Q

A 30 yo F undergoes ECT for major depression. What is the most likely adverse effect that she will experience?

A

anterograde amnesia

301
Q

A 60 yo M has depression 6 months after a stroke. Which artery is most likely involved?

A

Anterior cerebral artery

302
Q

T or F: hallucinations and illusions are a normal part of normal bereavement

A

True, as long as pt recognizes them as hallucinations/illusions

303
Q

40 yo F is treated w/ fluoxetine for MDD. If she starts an MAOI, when should she stop taking fluoxetine?

A

5 weeks before starting MAOI (for other SSRIs, stop 2 weeks before)

304
Q

A pregnant woman give birth to a baby who develops pulmonary hypertension. She was being treated for major depression. Most likely drug?

A

paroxetine

305
Q

25 yo M treated for depression has BP of 130/110. Most likely cause?

A

Venlafaxine - causes diastolic hypertension

306
Q

how does isocarboxazid treat depression?

A

inhibits monoamine oxidase (MAOI)

307
Q

ICU pt w/ h/o depression is given an MAOI. BP is now 210/100. Best therapeutic step?

A

Phentolamine (alpha blocker)

308
Q

What is the prevalence of bipolar type I?

A

1%

309
Q

What percentage of bipolar pts commit suicide?

A

10-15%

310
Q

If you have to choose between a mood stabilizer and an antidepressant to treat bipolar depression, which do you choose first? Why?

A

Mood stabilizer to avoid antidepressant-induced mania

311
Q

Activity of what enzyme is decreased by lithium?

A

adenylyl cyclase

312
Q

How is lithium eliminated from the body? What chronic condition precludes its use?

A

renally excreted; avoid in pts w/ poor renal function

313
Q

Pt present w/ excessive thirst and “urinating a lot.” UA shows low urine osmolality. Pt has h/o of bipolar disorder (treated). Dx?

A

diabetes insipidus caused by lithium, which acts as an ADH antagonist

314
Q

Bipolar pt is started on a new medicine. 2 weeks later, her ammonium levels are way high. Cause?

A

Valproic acid

315
Q

Dx: corpus callosum atrophy, decreased dendritic branching, chromosome 22, frontal hypoactivity, limbic hyperactivity

A

schizophrenia

316
Q

Suicide rate among schizophrenics is

A

10%

317
Q

hallucinations + “waxy flexibility”

A

catatonic schizophrenia

318
Q

EEG pattern in schizophrenia

A

normal

319
Q

antipsychotic causing retinal pigmentation

A

thioridazine (th-EYE-oridazine)

320
Q

What test should be done before starting quetiapine?

A

slit lamp eye exam (risk of cataracts)

321
Q

Most common side effect of atypical antipsychotics (risperidone, quetiapine, aripiprazole, etc)

A

weight gain (T2DM is #2)

322
Q

Difference between pemozide and pemoline

A

pemozide - dopamine receptor antagonist used for Tourette’s. pemoline - psychostimulant used for ADHD

323
Q

What pediatric infection may lead to autism?

A

congenital rubella

324
Q

MCC of inherited mental retardation

A

Fragile X syndrome

325
Q

MCC of congenital mental retardation

A

Down syndrome

326
Q

T or F: weight gain is not a side effect of combined oral contraceptive pills

A

TRUE

327
Q

T or F: bilateral renal agenesis is incompatible with life

A

TRUE

328
Q

First line treatment for cancer-causing anorexia

A

progestins

329
Q

What secondary malignancy does Tamoxifen predispose to?

A

endometrial cancer

330
Q

T or F: Reason UTIs are more common in females is closer proximity of urethra to anus.

A

False - It’s b/c the urethra is shorter.

331
Q

Withdrawal from what two substances can lead to nightmares and increased appetite?

A

amphetamines and cocaine

332
Q

A pt in the ED is belligerent, threatening and has nystagmus. His urine toxicology screen is negative. He’s given haldol and placed in isolation. He appears to calm down. 3 hours later, he becomes acutely violent. By what mechanisms did this occur?

A

PCP - recurrence due to reabsorption in GI tract

333
Q

What street drugs have no withdrawal syndrome?

A

LSD and marijuana (So remember that the “munchies” occur during marijuana use, not withdrawal.)

334
Q

T or F: caffeine withdrawal can lead to weight gain

A

TRUE

335
Q

Pt in the ED says he just stopped “using” because he is engaged and no longer wants to be a druggy. His pupils are dilated, he has piloerection, rhinorrhea and excessive yawning. He is at risk for what? A. withdrawal seizure B. sudden cardiac death C. vivid flashbacks D. weight gain E. no life threatening event

A

Opioid withdrawal is not life-threatening and does not lead to seizures, weight gain, cardiac problems or flashbacks.

336
Q

A 17 yo F gymnist w/ BMI 16 is admitted for electrolyte abnormalities. What cardiac condition is she most likely to develop? A. aortic stenosis B. mitral stenosis C. mitral valve prolapse D. hypertrophic cardiomyopathy E. aortic insufficiency

A

mitral valve prolapse is a common complication of anorexia nervosa

337
Q

Dx: A man is arrested for rubbing his genitals on an old lady on the subway. He tells police he enjoys doing this all the time.

A

Frotteurism

338
Q

Dx: A 40 yo F presents w/ strap-like red marks on her wrists, ankles and neck. She says she enjoys being bound before sex with her lover.

A

masochism

339
Q

Sleep disorder w/ decreased REM sleep latency

A

narcolepsy (reach REM sleep faster)

340
Q

Tx for cataplexy assoc. w/ narcolepsy

A

SSRI

341
Q

Tx for obstructive vs. central sleep apnea

A

OSA: CPAP, weight loss. CSA: BiPAP (mechanical ventilation)

342
Q

Pt has a new job working the night shift (8PM-6AM) at a convenient store. He says he cannot fall asleep when he gets home and wants to try melatonin. What should you tell him about melatonin? A. Take it when you get to work. B. Take it when you get home from work. C. Take it 5 1/2 hours before going to sleep. D. An SSRI would be a better choice. E. Take diphenhydramine 5 hours before going to sleep.

A

Take melatonin 4-6 hours before sleep in circadian rhythm sleep disorders

343
Q

Number of specific complaints to diagnose somatization disorder

A

4 pain, 2 GI, 1 sexual, 1 neurologic

344
Q

30 yo F present w/ 10lb weight gain. She started a new medicine for depression. She denies sexual dysfunction, N/V, tremor or insomnia. Most likely med?

A

mirtazapine

345
Q

increased P wave amplitude

A

P pulmonale (right atrial enlargement)

346
Q

increased P wave width, or notched P waves

A

P mitrale (left atrial enlargement)

347
Q

2 pulmonary conditions where pulsus paradoxus is seen

A

asthma and COPD

348
Q

Tx for A-fib

A

ABCD: Anticoagulant (warfarin), Beta blocker, Cardioversion/CCB, Digoxin

349
Q

MCC of 2nd degree AV block Mobitz II

A

fibrosis of conduction system

350
Q

If left untreated, what are pts w/ Mobitz II at risk for developing?

A

3rd degree AV block

351
Q

cannon A waves

A

3rd degree AV block

352
Q

Most common indication for pacemaker placement

A

sick sinus syndrome (tachycardia-bradycardia syndrome)

353
Q

What are the CHADS2 criteria? What is it used for?

A

Risk for stroke in pts w/ A-fib. C - CHF (1) H - HTN (1) A - Age _ 75 (1) D - Diabetes mellitus (1) S2 - prior Stroke, TIA, or Thromboembolism (2)

354
Q

When do you anticoagulate a pt w/ A-fib? When do you cardiovert?

A

Anticoagulate if CHADS2 score of 2 or more, or for A-fib >48hrs. Cardiovert for new A-fib (<48hrs), no left atrial clot, or after 3-6 weeks of warfarin w/ INR 2-3.

355
Q

T or F: atrial rate is nearly twice the ventricular rate in atrial flutter

A

true (atrial rate 240-320, ventricular rate ~ 150)

356
Q

What lifestyle modifications can reduce risk of A-fib?

A

decreased alcohol consumption

357
Q

What is an example of atrioventricular reciprocating tachycardia?

A

WPW (ectopic connection btw atrium and ventricle)

358
Q

Dx: 60 yo M c/o SOB and lightheadedness. EKG shows retrograde P waves and tachycardia.

A

atrioventricular reciprocating tachycardia

359
Q

Tx of choice for symptomatic PVCs

A

beta-blockers

360
Q

3 broad causes of PVCs

A

hypoxia, electrolyte abnormalities, hyperthyroidism

361
Q

Drug of choice for wide-complex V-tach

A

amiodarone

362
Q

A pediatric pt has congenital deafness and an abnormal EKG. Most likely arrhythmia to develop?

A

Torsades de pointes (assoc. w/ congenital deafness)

363
Q

Treatment for acute pulmonary congestion in CHF

A

LMNOP: Lasix, Morphine, Nitrates, O2, Position (upright)

364
Q

Pt has CHF and is “maxed out” on all available meds. His EF is now <35%. What is a reasonable next step?

A

implantable biventricular cardiac defibrillator (ICD)

365
Q

What is torsemide?

A

Loop diuretic (same suffix as furosemide)

366
Q

T or F: spironolactone, amiloride, and triamterene are all aldosterone receptor antagonists

A

F - only spironolactone. Amiloride and triamterene are K+ sparing ENaCs (sodium channel blockers)

367
Q

Pt is on diuretics and has hemolysis with bite cells. He has an abnormally low G6PD level. Most causative agent?

A

acetazolamide (carbonic anhydrase inhibitor) - sulfa allergy

368
Q

What complication of mannitol makes it contraindicated in CHF?

A

pulmonary edema

369
Q

HIV pt present w/ SOB and nocturnal cough. He is compliant w/ all meds. CD4 count is 150. S3 gallop on exam. Echo shows dilated ventricles. Most causative agent?

A

AZT can cause dilated cardiomyopathy

370
Q

Pt w/ acromegaly is at risk for developing what heart condition?

A

dilated cardiomyopathy (systolic HF)

371
Q

What “heart meds” should be avoided during CHF?

A

CCBs

372
Q

Hypertrophic cardiomyopathy is assoc w/ which of the following conditions? A. fragile X syndrome B. trisomy 21 C. trisomy 18 D. Friedreich’s ataxia E. Marfan syndrome

A

Friedreich’s ataxia

373
Q

Pts w/ hypertrophic cardiomyopathy may have a defect in which protein? A. frataxin B. collagen C. elastin D. ankyrin E. hyaluronidase

A

frataxin

374
Q

What chromosome is Friedreich’s ataxia assoc with?

A

9

375
Q

A 19 yo football player collapses during practice. ECG shows LVH. Echo shows a dynamic outflow obstruction. What med would you choose to start first?

A

beta blocker

376
Q

Young pt comes in for a sports physical. Workup reveals hypertrophic cardiomyopathy. FHX is positive for early death of an uncle. Advice to pt: A. You are well enough to compete in sports. B. Follow up in 6 months. C. You may compete in non-contact events. D. You should avoid intense athletic competition and training.

A

Avoid intense athletic competition and training.

377
Q

Restrictive cardiomyopathy is best described as A. autoimmune B. neoplastic C. infiltrative D. inflammatory E. obliterative

A

infiltrative (amyloidosis, sarcoidosis, hemochromatosis)

378
Q

Pt w/ hereditary iron overload is diagnosed w/ restrictive heart disease. Most likely finding would be A. bibasilar crackles B. dullness to chest percussion C. neck vein distension D. history of nocturnal cough E. left atrial enlargement

A

neck vein distension. Right sided HF signs/symptoms are more predominant in restrictive cardiomyopathy

379
Q

Pts w/ what conditions are considered to have “coronary artery disease risk equivalents”?

A

DM, symptomatic carotid artery disease, PAD, AAA

380
Q

Describe the following features of Printzmetal’s (variant) angina: ST changes, cardiac enzyme levels, mechanism of symptoms

A

ST-segment elevations, normal cardiac enzyme levels, coronary vasospasm

381
Q

Which of following carry a mortality benefit in treating angina? A. beta blockers and aspirin B. ACEIs and ARBs C. CCBs D. supplemental oxygen E. heparin

A

beta blockers and aspirin

382
Q

Cardiac enzyme levels in unstable angina

A

normal

383
Q

How do abciximab, eptifibatide, and tirofiban work to treat angina?

A

inhibit glycoprotein IIb/IIIa

384
Q

A 55 yo M has a new MI. What is the best predictor of survival?

A

left ventricular ejection fraction

385
Q

Most sensitive & specific cardiac enzyme: A. CK-MB B. troponin I C. troponin T D. myosin light chain E. LDH

A

troponin I

386
Q

Man presents w/ chest pain radiating to his neck and L arm. EKG shows ST depression in leads V1-V2. Next step?

A

posterior EKG (leads V7-V9) to asses for posterior wall/transmural MI (will see ST elevations in V7-V9)

387
Q

Most common complication leading to death following acute MI is A. fatal arrhythmia B. ventricular free wall rupture C. interventricular septal rupture D. atheroembolic stroke E. ventricular septal defect F. papillary muscle rupture G. reinfarction

A

fatal arrhythmia

388
Q

Dx: Pt presents for follow up 2 months from MI. T 101, chest discomfort. CXR shows pleural effusions. EKG shows diffuse ST elevations. WBC 12,000, ESR is 30. What is the Tx?

A

Dressler’s syndrome (autoimmune). Tx is aspirin.

389
Q

Lipid profile diagnostic of dyslipidemia

A

Total cholesterol >200, LDL > 130, HDL < 40, Triglycerides > 150

390
Q

When should fasting lipid profiles occur?

A

Starting at age 35 if no CAD risk factors. Start at age 20 if CAD risk factors. Then repeat every 5 years.

391
Q

Pt is started on a new cholesterol medicine. She presents to the ED the next day with facial swelling, wheezing, and decreased O2 sats. Most likely causative agent?

A

ezetimibe (cholesterol absorption inhibitor) can cause angioedema

392
Q

Single most effective lifestyle modification for hypertension

A

weight loss

393
Q

Single most effective lifestyle modification for hypertension in a non-obese patient

A

DASH diet

394
Q

Pt has an aldosterone-secreting adrenal adenoma. Describe pH, K+ and renin levels.

A

metabolic alkalosis (incr pH), hypokalemia, low renin

395
Q

What feature of labetalol makes it a good choice for hypertensive emergencies?

A

it’s an alpha- and beta-blocker

396
Q

ECG finding of pericarditis other than diffuse ST segment elevation

A

PR depression

397
Q

A 50 yo M recently had an MI. He develops acute pericarditis on hospital day 3 and is started on daily corticosteroids. He is at risk for what?

A

ventricular free wall rupture due to corticosteroids

398
Q

Which of the the following would you expect to be low in a pt on a beta blocker? A. aldosterone B. renin C. androstenedione D. angiotensin converting enzyme E. cortisol

A

beta blockers can decrease renin release

399
Q

A man w/ HTN and DM is taking lisinopril and losartan. His WBC count today is 4500. Could this be an effect of the medicine?

A

Yes - ACEIs and ARBs can cause leukopenia

400
Q

What determines the severity of cardiac tamponade?

A

the RATE of fluid formation

401
Q

Dx: Pt presents w/ dyspnea and tachycardia. ECG shows electrical alternans

A

pericardial tamponade

402
Q

MCC of valvular heart disease in the US

A

mechanical degeneration

403
Q

Indications for valve replacement in aortic stenosis

A

ACS - angina, CHF, syncope

404
Q

Dx: physical exam reveals a paradoxically split S2 sound

A

aortic stenosis (P2 then A2, delayed emptying of left ventricle)

405
Q

What is a Duroziez’s bruit (or Duroziez’s sign)?

A

femoral bruit heard in aortic regurgitation

406
Q

A 65 yo M w/ a 20 pack-year smoking history but quick 20 years ago. He has HTN and is here for a routine appointment. What screening, if any, should he receive?

A

A one-time abdominal ultrasound for AAA is recommended for all men ages 65-75 who have ever smoked.

407
Q

murmur likely to be heard in a proximal aortic dissection

A

aortic regurgitation (early diastolic murmur)

408
Q

Pt presents w/ “blue toes” after undergoing a carotid endarterectomy. Mechanism?

A

cholesterol atheroembolism (“blue toe syndrome”)

409
Q

Most likely reason that a pt’s ABI could read 1.4 for example (normal is 0.9)

A

calcification of arteries

410
Q

Most likely diagnosis if child present w/ lower extremity lymphedema

A

Milroy’s disease (hereditary lymphedema of childhood)

411
Q

Best initial management for lymphedema? A. prophylactic antibiotics B. diuretics C. exercise and massage therapy D. surgical decompression

A

exercise and massage therapy and pressure garments

412
Q

Pt presents to ED w/ syncopal episode. Further workup reveal a cardiac origin. What is this pt’s risk of sudden cardiac death in the next year? A. less than 5% B. greater than 5% but less than 20% C. 40% D. 75% E. >90%

A

up to 40%

413
Q

T or F: Unstable angina is caused by increased O2 demand of myocardium.

A

False. O2 demand is unchanged in unstable angina, as opposed to stable angina where O2 demand is increased. Unstable angina is caused by reduced resting coronary BF.

414
Q

Drug of choice for anticoagulation following and NSTEMI.

A

enoxaparin

415
Q

What can be given during coronary angiography to induce Prinzmetal’s angina?

A

IV ergonovine

416
Q

Pt has chest pain and Q waves on EKG. This finding is specific for A. subendocardial injury B. transmural injury C. right heart injury D. necrosis E. panic-induced chest pain

A

necrosis (ST depression = subendocardial, ST elevation = transmural)

417
Q

First EKG feature seen in MI

A

peaked T waves

418
Q

Drug of choice for post-MI pericarditis

A

aspirin

419
Q

As an alternative to ARBs in pts w/ CHF who are intolerable to ACEIs, what else can be given?

A

hydralazine/isosorbide dinitrate combination

420
Q

Which post-MI dysrhythmia carries the worst prognosis? A. atrial fibrillation B. atrial flutter C. ventricular D. supraventricular tachycardia tachycardia E. sinus bradycardia

A

V-tach

421
Q

Next step for V-fib? A. synchronized direct current cardioversion B. synchronized indirect current cardioversion C. unsynchronized direct current cardioversion D. unsynchronized indirect current cardioversion E. adenosine

A

defibrillation = unsynchronized direct current cardioversion

422
Q

Good antiarrhythmic drug for WPW

A

procainamide (does not affect AV node)

423
Q

how does atropine work to treat bradycardia?

A

blocks vagal stimulation to SA node

424
Q

Most likely location of delay in first degree AV block is A. within the atrial myocardium B. in the SA node C. in the AV node D. in the bundle of His E. along either bundle branch

A

in the AV node

425
Q

Vitamin and mineral deficiency assoc. w/ dilated cardiomyopathy

A

thiamine (wet beriberi), selenium

426
Q

Dx: on physical exam, a bisferious pulse is seen in the carotid arteries

A

pulsus bisferiens can be seen in HOCM

427
Q

What causes elevated and equal diastolic pressures in all 4 heart chambers?

A

pericarditis and/or tamponade

428
Q

A pt w/ mitral stenosis present w/ hemoptysis. How can mitral stenosis cause hemoptysis?

A

elevated LA pressure can rupture anastomoses of small bronchial veins

429
Q

Dx: 50 yo M w/ SOB and angina has a bobbing uvula on physical exam.

A

aortic regurgitation/insufficiency (this is MŸller’s sign)

430
Q

Dx: Pt has a Cullen sign, severe back pain, and BP 190/100.

A

AAA about to rupture (can cause Cullen or Grey Turner sign)

431
Q

Lysosomal storage disease w/ hypotonia, cherry red spot and hepatomegaly? Deficiency?

A

Neimann-Pick. Sphingomyelinase deficiency

432
Q

Lysosomal storage disease w/ hypotonia, cherry red spot, but not hepatomegaly. May have exaggerated startle response. Deficiency?

A

Tay-Sachs. Hexosaminidase deficiency

433
Q

Erythema nodosum affects which of the following? A. dermal-epidermal junction B. subcutaneous fat C. dermal lymphatics D. epidermal granular layer E. periosteal matrix

A

subcutaneous fat (it is a panniculitis)

434
Q

2 neoplasms that secrete ectopic ACTH

A

small cell lung cancer, (bronchial) carcinoid tumor, medullary thyroid carcinoma

435
Q

A 50 yo F on long-term prednisone complains of weight gain and purple striations on her abdomen. Which of the following is most likely absent from her history or physical exam? A. unwanted facial hair B. depression C. retrocervical fat pad D. hypertension E. easy bruisability

A

Unwanted facial hair. Iatrogenic cushing’s (syndrome) does not have the androgen excess seen in cushing’s disease (ACTH-dependent Cushing’s).

436
Q

A pt has episodic HTN, palpitations, tremor and diaphoresis. A CT and MRI are negative for adrenal lesions. What other test could be done to make the diagnosis?

A

MIBG nuclear scan - able to locate extra-adrenal or metastatic pheochromocytoma/paragangliomas. Octreotide scan is also good for neuroendocrine tumors

437
Q

Most common location for extra-adrenal pheo

A

aortic bifercation (organ of Zuckerkandl)

438
Q

Pt w/ psych history present w/ dilute urine. After a water deprivation test, his urine osm increases. Dx?

A

psychogenic polydipsia. (note: in diabetes insipidus, urine osm would remain dilute after water deprivation test.)

439
Q

A 30 yo F presents for routine checkup. She is drinking her third cup of coffee this morning, as is her usual. Today she appears jittery and diaphoretic. She recalls having palpitations at work that usually resolve throughout the day, but she often gets a headache at the end of the day. She does not smoke, drink alcohol or use drugs. She denies family history of cancer. BP 135/85, P 100, R 16, T 98.6. Plasma free metanephrines are normal. Urine vanillylmandelic acid is elevated. MRI of abdomen and MIBG scan are negative. Most likely diagnosis?

A

Coffee and tea can falsely elevate VMA. She is most likely experiencing symptoms related to her coffee.

440
Q

A pt has hypercalcemia, elevated calcitonin levels, long arms and fingers, and mucosal neuromas. What chromosome is most likely implicated?

A

MEN 2B (here) and 2A are caused by RET proto-oncogene mutation. Located on chromosome 10. (Think “MEN on TEN”)

441
Q

Confirmatory test for adrenal insufficiency

A

8AM plasma cortisol level (will be low). Confirm w/ synthetic ACTH stimulation test (cortisol will fail to rise much).

442
Q

Dx: A pt has weight loss, hypoglycemia and abdominal pain. Morning plasma cortisol is low and does not correct w/ ACTH stimulation. She is an asthmatic and takes a daily inhaled corticosteroid. She ran out of meds last week and has not had them refilled. Her BP is 120/80. She should receive

A

Adrenal insufficiency due to cessation of long-term glucocorticoids should be treated with replacement of glucocorticoids ONLY. Chronic use reduces ACTH, but mineralocorticoids are not ACTH-dependent, so they will be unchanged.

443
Q

CBC finding in adrenal insufficiency?

A

eosinophilia

444
Q

The presence of antibodies to which of the following confirms the diagnosis of diabetes mellitus?

A

anti-GAD (glutamic acid decarboxylase) antibodies are specific for DM. (anti-CCP = RA, anti-parietal cell = pernicious anemia, anti-transglutaminase = celiac disease. HLA-DR3 and -DR4 are assoc. w/ DM, but not assoc. w/ antibody production.)

445
Q

Screening recommendations for diabetes in pts w/ NO RISK FACTORS:

A

HbA1c at age 45, then every 3 years

446
Q

Before giving insulin to a pt in DKA, what should be given first?

A

potassium

447
Q

What is the criteria for metabolic syndrome?

A

Abd. circumference: > 40in Men, >35in Women; HDL < 40 (M) OR < 50 (W); Trig _ 150; BP _ 130/85 or need for HTN meds; FASTING glucose _100

448
Q

Mechanism of glipizide, glyburide, glimepiride

A

increased endogenous insulin secretion (Think “SELFonylureas”)

449
Q

Acarbose and miglitol act on what enzyme to treat hyperclycemia?

A

alpha-glucosidase inhibitors (a GI brush-border enzyme), reduce intestinal absorption of carbohydrates

450
Q

Dx: A nurse has anti-insulin antibodies

A

surreptitious insulin use

451
Q

Whipple’s triad of hypoglycemia

A
  1. fasting hypoglycemia with symptoms 2. blood glu < 50 during symptoms 3. giving glucose improves symptoms
452
Q

What leukemia presents w/ a chloroma?

A

AML

453
Q

Other causes of infectious esophagitis besides Candida

A

HSV, CMV

454
Q

Risk factors for SCC of esophagus

A

smoking, alcohol (top 2); dietary deficiencies of thiamine (B1), beta-carotene, zinc, selenium; hot foods/beverages; nitrosamines; toxin-producing fungi

455
Q

Why does esophageal cancer metastasize early?

A

it lacks serosa

456
Q

Tx for esophageal cancer

A

chemoradiation and surgery

457
Q

3 stimulator of HCl

A

ACh, histamine, gastrin

458
Q

What are GERD “alarm symptoms”?

A

blood in stool, dysphagia/odynophagia, weight loss

459
Q

What will bronchoscopic aspirate show in GERD pts?

A

lipid-laden macrophages from phagocytosis of fat in gastric contents

460
Q

Type A chronic gastritis is assoc. what what malignancies?

A

gastric adenocarcinoma and carcinoid tumors

461
Q

Pt has a elevated urine 5-HIAA and pernicious anemia. He most likely has pathology of which of the following?

A

gastric fundus - site of chronic gastritis type A, assoc. w/ pernicious anemia and carcinoid tumors

462
Q

Most common location for chronic gastritis

A

antrum (type B) - where H. pylori lives

463
Q

Which indicates CURRENT H. pylori gastritis: serum IgG antibodies or H pylori stool antigen?

A

H pylori stool antigen (current infection), IgG antibodies = history of exposure

464
Q

Triple therapy for gastritis. What about pt allergies?

A

amoxicillin + clarithromycin + omeprazole (2 ABx + PPI). Metronidazole instead of amoxicillin if penicillin-allergic.

465
Q

Krukenberg tumor is gastric SCC or adeno?

A

adeno

466
Q

How do you treat MALT lymphoma?

A

antibiotics (only cancer curable with antibiotics) - give triple therapy (same as gastritis)

467
Q

Blood types assoc. w/ PUD?

A

type O assoc. w/ duOdenal ulcers; type A assoc. w/ gAastric ulcers

468
Q

45 yo F presents w/ a 5 yr h/o recurrent PUD, unresponsive to meds. Today she has dull, burning epigastric pain. What test show you order now?

A

serum gastrin level (look for MEN type 1 w/ gastrinoma/ZES)

469
Q

Jejunal ulcers =

A

ZE syndrome (pathognomonic)

470
Q

Stain used to detect diarrhea bugs in HIV pts?

A

acid-fast (Cryptosporidium and Isospora)

471
Q

drug assoc. w/ pyloric stenosis in babies

A

erythromycin

472
Q

Tx for traveler’s diarrhea

A

Cipro

473
Q

Pt w/ entamoeba histolytica causing diarrhea is treated w/ steroids. What is he at risk for?

A

fatal perforation

474
Q

Why are ABx and anti-diarrheal therapy contraindicated in E. coli O157-H7 infections?

A

they increase risk of HUS

475
Q

Infectious diarrhea preceded by a “prodrome”? Tx?

A

Salmonella. Tx: oral quinolone (cipro) or TMP-SMX

476
Q

Dx: Young pt develops bloody diarrhea and febrile seizures.

A

Shigella

477
Q

Dx: Pt has just recovered from a 3 day h/o vomiting and diarrhea that resolved without medication. He now has flatulence, diarrhea, low stool pH and an increased stool osmotic gap.

A

transient lactose intolerance following acute gastroenteritis

478
Q

Amino acid deficiency in carcinoid syndrome

A

Tryptophan

479
Q

Mechanism that prevents most carcinoid tumors from creating carcinoid syndrome

A

first pass metabolism by liver

480
Q

Length of symptoms req’d for dx of IBS?

A

at least 3 months

481
Q

Mechanism of leukocytosis in SBO

A

bowel ischemia/necrosis

482
Q

Most likely location of thrombosis causing mesenteric ischemia? Most common risk factor?

A

proximal SMA; atherosclerosis

483
Q

thumbprinting on abdominal Xray represents what, and is found in what disease?

A

bowel wall edema; mesenteric ischemia

484
Q

What labs are elevated in mesenteric ischemia?

A

LDH, lactate, WBC, amylase, CK

485
Q

Difference in Tx btw arterial vs. venous thrombosis causing mesenteric ischemia

A

arterial: anticoagulation + surgery (angioplasty or laparotomy). venous: anticoagulation alone

486
Q

Imaging study of choice for CHILDREN and PREGNANT pts suspected to have appendicitis?

A

ultrasound (not CT)

487
Q

Tx for appendiceal abscess

A
  1. broad spec ABx, 2. PERCUTANEOUS drainage, 3. elective appy 6-8 weeks later
488
Q

Tx for perforated diverticulitis

A

Hartmann’s bowel resection w/ temporary colostomy

489
Q

Which screening is indicated in a pt who is 2 years post-op from colon resection due to colon cancer?

A

Metastatic screening after colon cancer resection includes CEA, colonoscopy, LFTs, CXR and abdominal CT.

490
Q

The majority of colorectal cancers begin as what premalignant lesion?

A

adenomatous polyps

491
Q

A 48 yo M presents for routine follow up. He is asymptomatic. His dad was dx’d w/ colon cancer at age 38. What is your advice today?

A

colonoscopy today

492
Q

Recommended screening for pediatric pts w/ FHX of familial adenomatous polyposis? HNPCC?

A

FAP: genetic testing @ age 10, colonoscopy every 1-2 yrs starting @ puberty. HNPCC: genetic testing @ age 21. If +, colonoscopy every 2 yrs until age 40, then every year.

493
Q

Skin rash assoc. w/ IBD

A

pyoderma gangrenosum

494
Q

Dx: 19 yo presents w/ bloody diarrhea, episcleritis and pseudopolyps on colonscopy.

A

ulcerative colitis. IBD can occur in teens! Episcleritis/uveitis and pseudopolyps are characteristic of UC vs. Crohn’s.

495
Q

character of diarrhea in UC vs. Crohn’s

A

UC: bloody. Crohn’s: watery

496
Q

Pt presents w/ RUQ pain radiation to R scapula. He is 6 months post-op from emergent small bowel resection after a GSW. Abdominal US shows gallstones. Most likely mechanism?

A

loss of enterohepatically circulated bile after resection

497
Q

40 yo F was diagnosed w/ AML 8 weeks ago. Her weight at dx was 135. Today her weight is 115. She is most at risk for GI disorder?

A

Rapid weight loss is a risk factor for gallstones

498
Q

Cure for acalculous cholecystitis

A

percutaneous drainage

499
Q

Mechanism of gallstone ileus is

A

erosive (cholecystoduodenal fistula)

500
Q

Which is true about ERCP with regards to primary sclerosing cholangitis?

A

Both diagnostic and therapeutic. Shows multiple bile duct strictures and dilatations (“beading”). ERCP w/ dilation and stenting of strictures is helpful, but only liver transplantation is definitive treatment.

Step 2 CK (1 decks)

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