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Board-Study Flashcards - Stuff that needs to stick > Step 2 Deck 2 > Flashcards

Step 2 Deck 2 Flashcards

1
Q

37 yo patient with weakness, dizziness and recent syncopal epsiodes. Has had vague chest discomfort the last week. He has thready pulses over both radial artieries that diappear with deep insipration. Likely dx?

A

Cardiac tamponade resulting from a viral pericarditis

pulsus paradoxus is what is the physical exam finding described

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2
Q

Typical CSF findings for HSV encephalitis?

A

Elevated RBC and protein count, normal glucose.

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3
Q

What does HSV encephalitis look like in a patient?

A

headache, seizures, confusion, stupor occurring over a few days.

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4
Q

Explain lung spirometry findings in patients with restrictive lung disease vs COPD.

FEV1
FVC
FEV1/FVC

A

Restrictive:
FEV1: decrease
FVC: decrease
FEV1/FVC: normal

COPD:
FEV1: decreased
FVC: normal
FEV1/FVC: decreased

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5
Q

Treatment for candida vaginalis?

A

Oral fluconazole

could also maybe use topical nystatin

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6
Q

What does riboflavin (b2 deficiency look like?

A
  • angular cheilitis
  • glossitis
  • stomatitis
  • normocytic anemia
  • seborrheic dermaitits
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7
Q

What does b3 (niacin) deficiency look like?

A

Dermatitis
Diarrhea
Dementia
aka PELLAGRA

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8
Q

51 yo man with renal failure. Has had nocturia and flank pain for the last several years. NO recent weight loss. BP is 164/100. Has hepatomegaly. Enlarged mass also felt on R flank deep palpation.
Dx?

A

ADPKD

Pts have HTN and palpable kidneys on exam. Liver may be enlarged due to cystic involvment. R kidney is lwoer, which makes it easier to palpate in general.

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9
Q

You suspect aortic dissection in a patient. Explain your rationale for choosing TEE vs CT angio?

A

TEE: This is the preferred choice for a aptient with renal insufficiency or hemodynamic instability

CT angio: Preferred study in hemodynaically stable patients with good kidney fxn

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10
Q

Let’s talk about after MI complications:

Hypotension, clear lung fields, and Kussmaul’s sign.

A

RV failure

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11
Q

Patient has acute pulmonary edema and a new systolic murmur 4 days after MI.

A

Severe mitral regurgitation with flail leaflet from papillary muscle rupture

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12
Q

5 days after MI patient has shock and return of chest pain. Patient also has holosystolic murmur and both R and L heart failure.

A

Interventricular septum rupture

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13
Q

One week after MI patient has severe shock and chest pain. He then becomes unresponsive with PEA.

A

Free wall rupture

You don’t see any HF in this one

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14
Q

How can you tell by exam if a person has hypercortisolism due to ACTH secretion or just cortisol?

A

If they have hyperpigmentation you know it must be ACTH overproduction. (The whole POM-C cleavage thing)

ALso keep in mind that ACTH is a polypeptide hormone, whereas cortisol is a steroid

Small cell lung cancer is a common cause of paraneoplastic ACTH production

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15
Q

Man with sx of TIA in the etting of atrial fibrillation. What meds does he need to get on now?

A

Warfarin or a NOAC

Dabigatran, rivaroxaban, apixiban, edoxaban

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16
Q

How could you tell between an empyema and a tuberculosis pleural effusion?

A

They are both going to be exudative and have a lot of protein, BUT the neutrophil count will be WAY higher in an empyema and they should have a lot more serious systemic sx.

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17
Q

59 yo with small cell lung carcinoma. Complains of headaches that are diffuse and worse when leaning forward. He has facial and upper extremity swelling and has NO peripheral edema.

dx?

What should be done to relieve his symptoms?

A

Radiation therapy (palliative)

This is is superior vena cava sundrome. Cuased by tumor compresssion on the SVC

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18
Q

MEthods to reduce the risk of aspiration pneumonia?

name 2

A

Diet modification

Elevation of head of bed to 30-45 degrees

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19
Q

Most common intracranial tumors in adults?

A

Metastasis from other areas

melanoma, lung, breast, renal are most common

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20
Q

Symmetric proximal muscle weakness. Painless with elevated creatitine kinase. NO skin findings are present.
Dx?

A

Polymyositis

Skin findings would make this dermatomyositis

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21
Q

What is a good rule of thumb for picking out ALS in a patient?

A

The presence of UMN signs like hyperreflexia and babinski reflex
AND
LMN signs like fasciculations and atrophy

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22
Q

What is Todd’s paralysis?

A

Common transient occurrence after a complex partial seizure. Could be leg-dragging or something like that

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23
Q

26 yo African AMerican woman with left sided pleuritic chest pain and dyspnea for 7 days. ALso has 3 months of BLT knee pain and swelling without erythema. HEart sounds are muffled. ABdomen is nontender. No peripheral edema. HGB 9.6, PLT 90, WBC 3.8, Cr 1.9. CXR shows left-sided pleural effusion and enlarged cardiac silhoette.

Dx?

A

Lupus

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24
Q

Stable patient found to have ventricular tachycardia on ECG.

Tx?

A

Load with amiodarone!

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25
Q

2 steps:
What do calcifications of the pancreas seen on CT probably mean?

Cause?

A

Means chronic pancreatitis

Most common cause is alcoholism

(gallstone and alcohol are the 2 biggest reasons for ACUTE pancreatitis)

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26
Q

On the test you see the wordsL shiny, hairless, this skin. What do you think?

A

PERIPHERAL VASCULAR DISEASE

also non-healing ulcers

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27
Q

46 yo woman with HTN. Has been steadily rising despite diet and exercise modification. 2 weeks after starting chlorthalidone, she presents to the ED with repeated falls adn leg cramps. She has no sensoary loss but has 4/5 muscle strngth BLT in LE. What is going on? How should she be managed after stabilization?

A

Weakness and leg cramps after thiazide diuretic suggest HYPOKALEMIA. In the setting of persistent HTN, this probably means hyperaldosteronism.

These patient need an adrenal gland CT. IF it’s an adenoma, they need an eadreanlectomy. If its adrenal hyperplasia, then give Spironolactone (aldosterone antagonist)

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28
Q

70 yo man lethargic and barely responsive. PMH of COPD, HTN and PUD. He has had right shoudler pain for 3 wks according to wife. Ca foudn to be 14.1.
Dx?

A

Hypercalcemia liekly for underlying lung malignancy

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29
Q

Mechanism for hypercalcemia of malignancy?

A

PTHrP secretion
(parathyroid-hormon-related-protein)

This causes hypophosphatemia and hypercalcemia.

Ca of this magnitude does not occur in hyperparathyroidism

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30
Q

Recommended prophylaxis to avoid gallstone problems in patients with gastric bypass surgery?

A

Either cholcystectomy at surgery
OR
prophylactic ursodeoxycholic acid

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31
Q

50 yo male. Hematuria with proteinuria. had sore throat this last week. Where in the kidney is the problem?

A

Glomerulus

SOunds like either IgA nephropathy or post-strep glomerulonephritis

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32
Q

Treatment for overflow incontinence?

Techniques and pharm!

A
  • Suprapublic pressure, timed voids, double-voiding
  • Cholinergic agonists (bethanechol)
  • May later require self-cath
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33
Q

ALcoholic recently admitted for serious esophageal varice bleeding is recovering well. His ascites is well-controlled with spironolactone and alcohol abstinence. In order to avoid bleeding again in the future what is the next step?

A

Start on beta-blockers (these will reduce reisk of variceal bleed)

TIPS can later be used as a very last resort after trying nitrates, and banding too.

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34
Q

Myocarditis should be suspected in young patients with a recent viral illness who present with heart failure, chest pain, or arrhythmias. What can develop after myocarditis?

A

Dilated cardiomyopathy

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35
Q

Painless jaundice is considered pancreatic cancer until proven otherwise. What’s likely going on with painless jaundice and elevated bilirubin/alk phos?

A

Cholestatic cause of jaundice, like pancreatic mass blocking the common bile duct

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36
Q

What are the typical findings in a severe toxic ingestion of iron pills?

A

N/V, diarrhea. If severe both vomit and diarrhea will be bloody. Can also lead to hypovolemic shock.

Later findings include metabolic acidosis, hepatotox, bowel obstruction, or death

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37
Q

What infectious etiology should be considered in patient with back pain, intermittent fevers, normocytic anemia, and XR evidence of pulmonary and spinal disease?

A

Disseminated tuberculosis

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38
Q

Lab tests to always consider in a patient with new-onset a fib and weight loss?

A

T4 and TSH

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39
Q

Knee twisting injury often causes what pathology?

What is classic of the exam?

A

Meniscal Tear

  • Classic sx: Locking or catching of knee joint, impaired extension, exacerbation while squatting, painful click while felxing or extending
  • Thessaly or McMurray Tests
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40
Q

What is the most important characteristic for prognosis in evaluating an astrocytoma (or glioblastoma)?

A

Tumor grade (determined by degree of anaplasia)

Age and functional status at diagnosis are also important factors

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41
Q

Often pts with CLL are asymptomatic at dx. Median survival is 10 years. Treatment is not necessary until advanced symptoms occur. What is first line treatment when they do occur?

A

Monocloncal antibodies against CD20 anitgen

Called: Rituximab

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42
Q

MOst common cause of bacteremia/sepsis in sickl cell patient?

A

Strep pneumo!

Get that vaccine!

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43
Q

What kind of antibiotic prophylaxis should patients with mitral valve prolapse get before dental procedures?

A

none - not necessary, risk still low

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44
Q

diastolic rumbling murmur with opening snap?

tx?

A
  • mitral stenosis

- balloon valvuloplasty

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45
Q

3 possible etiologies of aortic insufficiency?

A

endocarditis
aortic dissection
infarction

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46
Q

diastolic rumbling murmmur heard at right sternal border?

A

Aortic insufficiency

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47
Q

Systolic crescendo-decrescendo murmur heard at right sternal border?

Pathogenesis?

Tx?

A
  • Aortic Stenosis
  • Atherosclerosis
  • Valve replacement
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48
Q

holosystolic murmur heard best at apex

A

Mitral insufficiency

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49
Q

Let’s say you hear a systolic crescendo-descrescendo murmur at the right sternal border, but the aptient is not an old man with atherosclerosis, he is an 18 year old guy. What exam should you do?

A

Have them to a leg lift orsquat and see if the murmur improves. If it does then this is actually hypertrophic cardiomyopathy!

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50
Q

What if on examination of a 25 year old woman you hear mitral regurgitation. Then you have her squat and you listen again and the murmur improves?

A

Mitral valve prolapse!

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51
Q

Patient with severe agitiation is given t doses of haloperidol to calm him down. The next morning he complains of muscle stiffness and difficulty turning his neck. What is the best treatment for his complaints?

A

So this is acute dystonia from the antipsychotic.

Treat with an anticholinergic like diphenhydramine

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52
Q

How do you calculate the anion gap?

A

Anion gap = Na - HCO3 - Cl

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53
Q

Likely underlying cause in amenorrhea of elite female athlete?

A

Secondary amenorrhea from lack of estrogen

they have decreased gnrh and LH too

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54
Q

Hemolytic uremic syndrome results in which kind of anemia?

A

microangiopathic hemolytic anemia!

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55
Q

Classic presentation of HUS?

A

Child who recently recovered from diarrheal illness. Presents with acute renal failure, microangiopathic hemolytic anemia, thrombocytopenia, and schistocytes on peripheral smear.

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56
Q

What are the CHA2DS2 VASc criteria?

A
  • CHF (1)
  • HTN (1)
  • Age >75 (2)
  • DM (1)
  • Stroke (2)
  • Vascular dis (1)
  • Age 65-74 (1)
  • Sex female (1)

2+? Warfarin!

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57
Q

Patient has been in afib with RVR for the last couple weeks most likely. He is hemodynamically stable. Initial management?

A

Rate control first with beta-blcokers or Ca channel blockers

Diltiazem, Digoxin

Hemo unstable -> cardioversion

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58
Q

TCA overdose can present with CNS cardiac and anticholinergic findings. If a patient overdoses on notriptyline and his ECG shows wide QRS complexes, what is the best step to manage this?

A

Sodium bicarb

This is used to treat cardiac toxicity characterized by prolonged QRS as well as ventricular arrhythmias

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59
Q

30 yo woman with dizziness and unsteadiness for 2 weeks. Sob but no chest pain. Has chronic cough and had an episode of uveitis 6 months ago that was treated. ECG shows sinus rhythm with 2:1 atrioventricular block and left bundle branch block. CXR shows BLT midfield lung opacities.
Dx?

A

Sarcoidosis

Pt with recent uveitis, dyspnea, and presyncope liekly due to conduction abnormalities. Sarcoid w/ cardiac involvement. Can cause conduction defects, restricted and dilated cardiomyopathy.

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60
Q

Initial treatment for myasthenia gravis?

A

Pyridostigmine!!!!!!!

Acetylcholinesterase inhibitor

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61
Q

AWesome medication you should always remember will slow the progression of diabetic nephropathy!?!?!?!?!

A

ACE inhibitors

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62
Q

You can remember Duschenne and Becker muscular dystrophy as X-linked recessive disorders involving deletion of dystrophin on chromosome Xp21. What is the genetic component of myotonic muscular dystrophy?

A

Autosomal dominant expansion of CTG repeats on chromosome 19.

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63
Q

How does myotonic muscular dystrophy present?

A

Progressive muscle weakness, facial weakness, hand grip myotonia, and dysphagia.

ALSO: Arrhythmias, cataracts, balding, and testicular atrophy

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64
Q

There is a difference in risk factors that cause assymetric vs symmetric fetal growth restriction. What are the most common for both?

A

Symmetric FGR:

  • maternal intrauterine infection
  • Infant genetic disorder
  • fetal anomaly

Asymmetric FGR:

  • Diabetes
  • HTN
  • Smoking
  • Antiphospholipid antibody syndrome
  • Autoimmune (SLE)
  • Cyanotic cardiac disease
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65
Q

Etiology of variable decelerations. Name 3.

A
  • cord compression
  • oligohydramnions
  • cord prolapse
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66
Q

Patient in labor, fetal tracing shows variable decelerations which become persistent. What is the first line management?
2nd line?

A
  • Start with left lateral positioning

- if this fails, may need amniotransfusion

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67
Q

hcg responsible for what function in pregnancy?

A

preservation of corpus luteum

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68
Q

78 year old diabetic with wornseing ear pain and drainage. Pain is unrelenting, hear loss present. External audiotry canal is edematous with purulent discharge and granulation tissue. TM is clear.
Best tx?

A

Malignant External Otitis

Treatment is with Ciprofloxacin!

(Because you NEED something good for pseudomonas)

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69
Q 
Hard question:
Tell me about what b cells and Ig's look like in each syndrome:
- CD40 ligand defic (Hyper IgM)
- Common variable immunodef
- Job syndrome
- Selective IgA def
- X linked agammaglob
A
  • CD40 ligand def: Tons of IgM
  • Common Variable: Normal B cells and ALL Ig’s low
  • Job syndrome: lots of IgE
  • Selective IgA: Low IgA
  • X linked Agamma: b cells and all Ig’s low
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70
Q

Big cause of mortality in infant meningococcemia?

A

Adrenal Failure

Waterhouse Friderichsen Syndrome

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71
Q

How to confirm dx of laryngomalacia?

A

Direct laryngoscopy

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72
Q

25 yr old with 2 past spontaneous miscarriages tests positive for VDRL. She also has WBC 7, PLT 88. NExt step in management?

A

This patient possibly has antiphosholipid antibody syndrome (often has false + VDRL).

Start her on LMWH to avoid arterial/venous thromboses than can cause spontaneous abortions

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73
Q

How can the Hep B vaccine decrease the incidence of cancer?

A

Decreases chance of hepatocellular carcinoma

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74
Q

What type of antibodies are present in hashimoto’s thyroiditis?

A

Anti-TPO antibodies

Anti-thyroid peroxidase antibodies

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75
Q

Which systolic murmur presents with a delayed and diminished carotid pulse?

A

aortic stenosis

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76
Q

Methotrexate is an antimetbolite drug. What are some its common side ffects?

A
  • GI sx
  • Oral ulcers or stomatitis
  • rash
  • alopecia
  • hepatotix
  • pulm tox
    bone marrow suppression

Remember to give folate!

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77
Q

Murmur associated with “water hammer” pulses?

A

Aortic regurgitation

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78
Q

Patient with carcinoid syndrome is likely tp experience whcih vitamine deficiency?
WHY?

A

Niacin deficiency

It’s because tons of serotonin is being converted from tryptophan in carcinoid cells.

Tryptophan is ALSO use to produce Niacin

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79
Q

The D-xylose test is used for what?

A

D-xylose is absorbed in the small intestine without enzyme degradation.

Patients who absorb it normally have intenstinal mucosal disease like Celiac. Patient who absorb it fine must have an enzyme deficiency malabsorption (like chronic pancreatitis)

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80
Q

Patient has combination of ataxia, scoliosis, and cardiomyopathy. What should you think of?

A

Friedrich ataxia!

The most common of the spinocerebellar ataxias

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81
Q

Midshaft humerus fracture fear of damaging what structure?

A

Radial nerve

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82
Q

best tx for C-diff?

A

metronidazole

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83
Q

Most common cause of septic arthritis?

When do you see the two lesser common causes?

A

Staph Aureus

IV drug use/immunosuppressed: Pseudomonas or E.Coli

Sexually active young adult: Neisseria Gonorrhea

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84
Q

What kind of anemia is seen in patients with DIC?

A

Microangiopathic hemolytic anemia

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85
Q

How often are screening mammographies recommended?

A

In women over 50 - every two years

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86
Q

How often should lipid profiles be screened in adults?

A

Every 5 yrs

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87
Q

Cisplatin toxicity?

A 
Nephrotox
Tinnitus
Hearing loss
N/V
Neurotox
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5
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88
Q

64 yo patient on immunosuppressive medications for recent kidney transplant presents with headache, nausea, fever and neck rigidity. He is started on high dose ceftriaxone along ampicillin. What are each of these abx treating?

A

Strep Pneumo, Neisseria Meningitis, and Hemophilus Influenzae are the 3 most common and are covered by Ceftriaxone.

Over 60 and immunocompromised give patient special risk for Listeria Monocytogenes, which is covered by Ampicilln

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89
Q

3 yo boy presents with 2 days of fever cough and worsening SOB. He recently recovered from diarrheal infection due to Giardia. Hx significant for recnt lobar pneumonia and recurrent ear infections since 6 months old. Physical exam shows small tonsils and crackles in the RLL. Most likely cause of symptoms?

A

X-linked gammaglobinemia (or Bruton Agammaglobulinemia)

Caused by abnomral B-lymphocyte maturation

Treatment is monthly IVIG and prophylactic abx

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90
Q

How do you treat symptomatic sarcoidosis?

A

Glucocorticoids

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91
Q

After bladder training and pelvic floor exercises, what is a first line medication for urge incontinence?

A

Oxybutinin

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92
Q

Diet recommendation for renal calculi prevention?

A
  • increased fluids
  • decreased sodium
  • normal calcium intake
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93
Q

How does the knee-chest position help patient with tetralogy of fallot during a tet spell?

A

Increases systemic vascular resistance

This increases pulmonary blood flow and improves cyanosis

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94
Q

Explain in detail why lactulose is used in hepatic encephalopathy

A

HE is a complication of cirrhosis due to liver’s inability to convert ammonia to urea. Ammonia and other toxins stimulate GABA and inhibit glutamate pathways in the brain. Often precipitated by medications, hypovolemia, infection, or excessive nitrogen load. Nonabsorbable disaccharides like lactulose get metabolized to short chain fatty acids that acidify the colon. This acidification causes the ammonia to convert to ammonium and create catharsis as well.

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95
Q

Immediate drug of choice after diagnosing Primary Biliary Cholangitis

A

ursodeoxycholic acid

96
Q

Characteristic finding lon peripheral blood smear in patient with CLL?

A

Smudge cells

Smudge cells are mature, but fragile lymphocytes

97
Q

Initial testing for venous thromboembolism in a pregnant patient?

A

Ventilation/Perfusion scan

98
Q

Which HIV drug is knowto cause insomina with vivid/bizarre dreams, deprresion, anxiety, confused thinking, and aggression?

A

Efavirenz

VIRENZ VIVID

99
Q

You need to know treatment for each type of incontinence.
Stress:
Urge:
Overflow:

A

Stress: Pelvic floor exercises, pessary, pelvic floor surgery

Urge: Bladder training, Oxybutinin

Overflow: Double-voiding/suprapubic pressure, Bethanechol, catheterization

100
Q

What kind of pathology is the vasculitis of HSP?

A

Leukocytoclastic vasculitis

101
Q

Patient presents with 3cm swelling in medial aspect of right labium majorus. Has pain in the area when sitting down and attempting sexual intercourse. Dx and Tx?

A

Bartholin gland cyst

Needs incision and drainage

102
Q

Patient with unknown PMH has howell Jolly bodies on smear as well as thrombocytosis. Likely issue?

A

Patient likely has lack of spleen or spleen that does not function.

103
Q

first line for tocolysis?

A

Nifedipine - a caclium channel blocker

104
Q

Patient with genetic hypertriglyceridemia. Palmar xanthomas, etc.

Most appropriate initial tx?

A

Fibric acid deriv like FENOFIBRATE

105
Q

Most effective way of limiting progression of diabetic nephropathy?

A

Tight blood pressure control

106
Q

Treatment for Raynaud’s phenomenon?

A

Nifedipine (calcium channel blockers)

107
Q

Give me the run-down for oral combo contraceptives and cancer risk:

A

Increased risk of:
- Cervical and breast cancer

Decreased risk of:
- ovarian and endometrial cancer

108
Q

60 yo patient with two epsidoes of syncope over a 12 hr period. 1 eating breakfast and 1 watching TV. THey were sudden blackouts lasting 1-2 minutes without confusion afterward. He has had some diarrhea recently. PMH of CAD, paroxysmal A-fib. Takes statin, aspirin, clopidogrel, lisinopril, and solatol. Vitals and chest exam normal.

Most likely explanation?

A

Sudden onset syncope without prodrome is consistent with arrhythmia. This kind of syncope is actually very rare in A-fib so we would actually assume this is a ventricular arrythmia like torsades de pointes.

His use of solatol, CAD, or hypo-mg or hypo-k from diarrhea could all predispose him to torsades.

109
Q

Patient with recent epsiodes of syncope has prolonged PR and QT intervals without St evlevations. His K is low. Best initial tx?

A

Magnesium sufate!

Patient in danger of developing torsades. Initial tx of torsades in a stable patient is Mg sulfate, even if Mag level is normal

110
Q

After 60 yo has an MI he is treated with cardiac catheterization and drug-eluting stent. In addition to aspirin, a beta blcoker, statin and ACEi, what should be included in his tx regimen?
What is the mechanism of action?

A

Clopidogrel (ticagrelor, prasugrel)

P2y12 receptor blocker

These are antiplatelet drugs, improve morbidity/mortality in this context

111
Q

ACute post-partum urinary retention reulting from prolonged labor, perineal trauma, and regional analgesia. What is this condition actually stemming from?

A

Bladder atony

temporary and reversible

112
Q

Maternal complications that may extend from a placental abruption?

A
  • DIC

- Hypovolemic shock

113
Q

Drug tx for Tourette’s syndrome?

A
  • Antipsychotics
114
Q

2 yo w/ firm nodular mass in right flank. ALso has abdominal pain, fever, and irritabilty. Abd XR shows mutliple calcifications in the renal area.
Dx?
Serum elevation in what?
Embryonic origin?

A
  • Neuroblastoma
  • HVA and MVA will be elevated
  • Neural crest cell embryonic origin of tumor
115
Q

How soon should methotrexate be started in progression of rheumatoid arthritis?

A

Immediately

Joint damage occurs early in the course, so get that MTX going right away!

116
Q

64 yo male presents with 13 hrs of chest pain and found to have anterior STEMI. Medical therapy initiated without other intervention. The next day he reports left leg pain. On exam his leg is mottled and coldwith absence of distal pulses. Vascular surgery is consulted and anticoagulation is initiated. What else should be done right away?

A

Should do an echo to check for left ventricular thrombus

this is relatively common in anterior STEMIs

117
Q

34 yo patient for infertility appt. She has had irregular cycles for 12 months and no periods for 3 months. She has hot flashes, dyspareunia,, and mood disturbance. She has 1 3yo daughter. Pelvic exam shows atrophic vaginal mucosa. FSH very elevated, Prolactin is normal, pregnancy test negative, TSH normal.
Best treatment for her infertility?

A

Premature Ovarian Failure
(decreased estrogen with increased FSH/LH)

The only option available is in vitro fertilization with donor oocytes

118
Q

Most common mucopurulent cervicitis?

A

Chlamydia trachomatis

tx w/ azithromycin

119
Q

Difference between Stevens Johnson and Toxic Epidermal Necriolysis?

A

SJS : 30%

10-30% = overlap

120
Q

65 yo patient with decreased appetite, nausea, abdominal bloating adn early satiety. Hx of GERD, DM with retinopathy. Home glucose are 40-400. MOst helpful treatement for this patient?

A

Patient has diabetic gastroparesis!

Metoclopramide or another prokinetic would be very helpful (erythromycin, cisapride, etc)

121
Q

How to treat actinomyces?

Nocardia?

A
  • Long course of penicillin

- Trimethoprim-sulfamexazole

122
Q

13 yo patient with hx of rheumatic fever 1 year ago immigrates to the U.S. She has a diastolic murmur on auscultation but is asymptomatic. Does she need any treatment now?

A

She needs penicillin prophylaxis for many years!

123
Q

How do you test for C-diff?

A

C-diff TOXIN testing by PCR or immunoassay

124
Q

Patient found to have renal stones - they are 100% uric acid stones. Good therapy for future prevention?

A

Alkalinize the urine with oral potassium citrate

125
Q

Patient has seizures and he has a creatinine of 2.1. YOu also notice he is on Nitroprusside for hypertensive crisis. What are you thinking?

A

Cyanide toxicity

presents with altered mental status, lactic acidosis, seizures, and coma

OFten in setting of prolonged nitroprusside infusions with renal insufficiency

126
Q

Criteria for arrest of labor?

A

2 options:
1 - dilated over 6cm without cervical change over 4 hrs despit contractions
2 - No cervical change for over 6 hrs without good contractions

127
Q

Patient presents in 13th week of gestation with vaginal bleeding and is found to have threatened abortion. Management from here?

A

Reassurances and outpatient follow-up (US 1 week later)

128
Q

Diabetic patient suffering from severe sinus problems and you dx it as mucormycosis. The question is, what is the causative organism?

A

Rhizopus

Mucormycosis will lead to death in days to weeks without tx

129
Q

Typical level of obstruction in cystic fibrosis vs hirschsprung disease?

A

HD: Rectosigmoid

CF: Ileum

Also rememebr that HD has the “squirt sign” yuck!

130
Q

Telangiectasias, recurrent nose bleeds and oral lesions. Also has very high hemoatocrit…
Dx?

A

Osler-Weber-Rendu syndrome

131
Q

15 yo pt with 1 week non-productive cough, fever, sore throat and headaches. Has target-shaped lesions on all 4 extremities. LLL shows interstitial infiltrates on CXR. Sputum gram stain shows polymorphonuclear cells but no organisms.
dx?

A

Atypical pneumonia

Most commn is mycoplasma pneumonia

132
Q

Where are hormones being produced in a child with precocious sexual development. They have pubic and axillary hair, acne, and body odor even though they are under 9!

A

Early activation of adrenal androgen release

So adrenals!

133
Q

2nd trimester quadruple screen.

How do you diagnose Trisomy 21, trisomy 18, and neural tube/abd defects?

A

Tri 18: Low MSAFP, low b-hCG, low estriol, normal inhibin A

Tri 21: Low MSAFP, high b-hCG, low estriol, high inhibin A

Neural/Abd: high MSAFP, normal b-hCG/estriol/inhibin A

134
Q

triple bubble sign with gasless colon?

A

jejunal atresia

135
Q

Treatment for SIADH causing hyponatremia?

Asymptomatic vs symptomatic

A

Asymptomatic: fluid restriction and possible satl tabs

Symptomatic: Boluses of hypertonic saline

136
Q

Cocaine-associated chest pain in 32 yo male.
Initial treatment?
Contraindicated medication?

A

Initial: Benzos!

Contraindicated: beta-blockers

137
Q

Talk to me about SAAG?

A

SAAG is serum albumin minus peritoneal albumin

if over 1.1 = portal HTN

if under 1.1 = NOT portal HTN

138
Q

What kind of murmur is present in an IV drug user with bacterial endocarditis?

A

Tricuspid regurgitation

  • holosystolic murmur that increases with inspiration
139
Q

What is kleihauer-Betke test used for?

A

determine dose of Rhogam (anti-D immuen globin) that needs to be given within 72 hrs of delivery

At 28 weeks everyone gets standard 300micro-g

140
Q

What are the recommended vaccines for adults 19-64?

A
  • Tdap once, then Td booster every ten years
  • Flu annually
  • PPSV23 alone: CHF, lung or liver disease, DM, smokers, alcoholics
  • PCV13 nd PPSV23: CSF leaks, cochlear implants, sickle cell, asplenia, immunocompromised, CKD
141
Q

Recommended vaccines over 65 yo?

A
  • Tdap once, Td booster every 10 yrs
  • flu annually
  • 1 dose PCV13 followed by PPSV23 in 6-12 mos
142
Q

What primary immune deficiency can actually cause anaphylaxis during blood transfusions?

A

Selective IgA deficiency

143
Q

What is the underlying cause of congenital hypothyroid?

A

Thyroid dysgenesis

tend to see decreased activity, hoarse cry, and jaundice

144
Q

3 ways to treat grave’s disease:
- radioactice iodide, antithyroid drugs (propylthiouracil, methimazole), and thyroidectomy

Which of these 3 causes worsening of Grave’s opthalmopathy?

A

Radioactive iodide

its because the destroyed thyroid cells release excess thyroid hormone

145
Q

After giving birth, mother found to be positive for Hep B. Next step?

A

ADminister hep B IG followed by Hep B vaccine

146
Q

Patient with less than 3 asthma attacks per week or less than 2 astham awakenings a month can just stay on albuterol rescue. If this number increases, what is the next step in therapy?

A

Inhaled corticosteroid for control

147
Q

Well-appearing 1 mo old infant with painless bloody stools. ALso has had some vomiting and diffuse eczema on the body.
Cause?

A

Milk protein-induced enterocolitis

148
Q

Patient with recent suspected flu infection presents with pneumonia. Causitive organism?

A

Staph Aureus

149
Q

Guy with hx of ulcerative colitis presents with fatigue, elevated aminotrasnferases and alk phos. Positive pANCA. ESR 102.
Dx?

A

Primary Sclerosing Cholangitis

150
Q

Important side effect to consider in Ca channel blockers like amlodipine?

A

peripheral edema

151
Q

What electrolyte abnormality is a good predictor of congestive heart failure severity and adverse outcomes?

A

Hyponatremia!

152
Q

Treatment of Raynaud phenomenon:

A

Ca channel blockers like amlodipine and nifedipine

153
Q

Progression of acne treatment?

A

topical retinoids, acids -> topical abx -> oral abx

-> oral isotretinoin

154
Q

Nerve responsible for sensation of the anterior thigh and medial leg as well as for knee extension and hip flexion

A

Femoral nerve

155
Q

Nerve responsible for muscles of anterior and lateral leg and sensation to anterolateral leg and dorsum of foot

A

peroneal nerve (superficial and deep)

aka Fibular nerve

156
Q

Describe the different situations when you use:

  • Ca gluconate
  • Mag sulfate
  • Na Bicarb
A

Ca gluc: Cardioprotective in cases of hyperkalemia

Mag sulfate: Patient suffering from prolonged QT induced Torsades

Na bicarb: TCA overdose leading to hypotension, QRS prolongation, and ventricular arrhythmia

157
Q

3 firs-line abx during pregnancy?

A
  • amoxicillin
  • nitrofurantoin
  • cephalexin
158
Q

7 week old slightly-pale but well appearing infant born premature and being fed formula. Hgb 7.8, WBC 7, PLT 230, retic 0.8%.

Dx?

A

Anemia of prematurity

159
Q

3 keys to treating HHS?

hyperosmolar hyperglycemic state

A
  • Aggressive hydration with NS
  • IV insulin
  • Careful monitoring and supplementation of potassium
160
Q

HIV patient with 4 day history of low grade fever, profuse watery diarrhea, and abdominal cramps. Most importnat next step in management?

A

Stool exam studies

161
Q

35 yo with 5 day history of low back pain. Positive straight leg sign. Best next step in management?

A

trial of NSAIDs

162
Q

What kind of infectin causes endometritis?

How do you treat it?

A

Polymicrobial

Clindamycin and Gentamicin

163
Q

Recipient of pRBC transfusion experiences febrile NON-hemolytic reaction 2 hours after transfusion. What could have bene done to prevent this?

A

Leukoreduction of donor blood

164
Q

65 yo pt with rapidly progressive dementia, myoclonus, sharp waves complexes on EEG. Likely dx?

A

Creutzfeldt-Jakob

165
Q

Common manifestations of bulbar dysfunction?

A
  • chewing fatigue
  • dysphagia
  • nasopharyngeal regurgitation
  • dysphonia
166
Q

What causes myasthenia gravis?

A

Autoantibodies originating in the thymus are directed against nicotinic acetylcholine receptors at the NMJ.

167
Q

2 common locations for rash of dermatomyositis?

A
  • dorsum of fingers (gottron’s sign)

- upper eyelids (heliotrope)

168
Q

Patient with undetectable plasma renin activity and HTN:

A

Hyperaldosteronism

probably from pituitary adenoma or BLT adrenal hyperplasia

169
Q

Treatment for narcolepsy?

A

Stimulants:

  • Modafinil
  • Amphetamines
  • Sodium Oxybate
170
Q

Most common site of ulnar nerve compression?

A

elbow

171
Q

Riluzole used to treat what?

A

ALS

172
Q

Mainstay of symtpom management in COPD?

A

Ipratropium

- inhaled anti-muscarinic

173
Q

Most common causes of digital clubbing?

hint, COPD is NOT one fo them

A

Lung malignancy, cystic fibrosis, R-L cardiac shunts

174
Q

Best way to treat post-ictal lactic acidosis?

A

Transient anion gap metabolic acidosis resolves without treatment within 60-90 minutes

175
Q

Most common early vs late side effects of levodopa/carbadopa tx for parkinsons?

A

Early: hallucinations, dizziness, headache, agitation

Late:
involuntary movements

176
Q

drug of choice for hairy cell leukemia?

A

Cladribine

177
Q

HIV and CD4 count under 50. Patient also has bloody diarhea…
What should you look for?

A

CMV colitis - do colonoscpy with biopsies

178
Q

Likely lung amss and hypercalcemia:

A

squamous cell carcinoma

179
Q

Lung cancer causing SIADH?

A

Small cell carcinoma

180
Q

Transient vision loss in one eye described as a curtain falling down?

A

Amourosis Fugax

181
Q

Most common heart sound in an acute MI?

A

4th heart sound from ventricular stiffening and dysfunction due to ischemia.

182
Q

59 yo male post gastrecetomy 3 weeks ago after a perforated ulcer. For 10 days has had intermitten abdominal cramps and diarrhea always aoccurring 30 minutes after eating. ALso has nausea, weakness, palpitations, light-headedness, and diaphoresis.
Dx?
Tx?

A

Dx: Dumping syndrome

Tx: Small frequent meals, replace simple sugars with complex carbs, more high-fiber and protein-rich foods

183
Q

RDW over 20% in?

A

Iron deficiency anemia. One of the first lab signs that is seen

184
Q

Cauda equina syndrome vs conus medullaris syndrome. One really good way to differentiate their clinical presentation?

A

Cauda equina: assymmetric motor weakness

Conus medullaris: symmetric motor weakness

185
Q

Most common sepsis in sickle cell disease?

A

strep pneumo

186
Q

What is the immune mechanism in graft vs host?

A

Donor T-ce;;s recognize host’s major/minor HLA antigens and creates a cell-mediated immune response

187
Q

Bone marrow transplatn pt with pneumonia-like picture. CT shows halo sign in upper right lung:

A

Apergillosis

188
Q

antidepressant contraindicated in eating disorders due to risk of seizures?

A

bupropion

189
Q

How do patients present with ADPKD?

A

HTN, hematuria, proteinuria, palpable renal masses, progressive renal insufficiency

190
Q

How to manage patient with persistent narrow-complex tachyarrythmia causing hemodynamic instability?

A

Immediate synchronized cardioversion

191
Q

Most common area in the spine affected by rheum arthritis?

A

cervical spine

192
Q

Common complications from acute pancreatitis?

A
  • pleural effusion
  • ARDS
  • ileus
  • renal failure
193
Q

Patient has sx of pericarditis, but also has renal failure.
Your thoughts?
Tx plan?

A

Probably uremic pericarditis

Tx with dialysis

194
Q

Tx for acute viral or idiopathic pericarditis?

A

NSAIDs and colchicine

195
Q

Mechanism of 2nd gen. antipscyhotics?

A

Serotonin 2A and dopamine D2 receptor antagonists

196
Q

Pregnant woman @ 37 weeks gestation found to have chorioamnionitis. Next step after administration of broad spectrum antibiotics?

A

Oxytocin to induce or accelerate labor.

197
Q

2 similar disorder are Tay Sachs and Niemann Pick disease. What is the deficiency in each?

A

Tay Sachs: B-hexosaminidase A deficiency

Niemann-Pick: Sphingomyelinase Deficiency

198
Q

Patient from Mississippi who is initially thought to have sarcoidosis due to cough hilar adenopathy, erythema nodosum, and non-caseating granulomas. HOWEVER, he rapidly decompensates after being started on steroids. Dx?

A

Likely untreated infection -> sounds like Histoplasmosis!

always think of this in endemic area with pulmonary sx and mediastinal/hilar lymph nodes.

199
Q

Ig spike is found in Multiple Myeloma, MGUS, and Waldenstrom Macroglobulinemia. How can you differentiate them?

A

Multiple Myeloma is easy because it’s never an IgM spike, always IgG or IgA.

MGUS: Smaller IgM spike and no end-organ effects are seen clinically

Waldenstrom:Big IgM spike, and end-organ damage. (can get hyperviscosity, neuropathy, and cryoglobulinemia as a result)

200
Q

Episodic flushing, diarrhea, cutaneous telangiectasias, bronchospasm, and tricuspid regurgitation. Dx?

A

Carcinoid syndrome

201
Q

What kind of kidney failure is caused by rhabdomyolysis?

A

Acute tubular necrosis (ATN)

202
Q

Class of medications beneficial for patients with Alzheimer’s?
Name 2 drugs in this class:

A

Cholinesterase inhibitors

- Donepezil, rivastigmine

203
Q

2 Lab tests for hereditary spherocytosis?

A
  • increased osmotic fragility on acidifed glycerol lysis test
  • Abnormal eosin-5 maleimide binding test
204
Q

Woman being treated for parkinsons is experiencing signs of anticholinergic toxcity. 2 drugs in this class that are used for Parkinson’s?

A

Benztropine

Trihexyphenidyl

205
Q

Man with progressive visual loss in R eye. Whn shown straight grid lines, patient perceives them as curved.
Dx?

A

Macular Degeneration

206
Q

How do statins work?

A
  • Inhibit intracellular HMG-CoA reductase
  • prevent conversion of HMG CoA to mevalonic acid
  • Increase number of cell membrane LDL receptors
207
Q

How long to wait to play contact sports after dx of mono?

A

At least 3 weeks

208
Q

Inheritance pattern f hypertrophic cardiomyopathy?

A

Autosomal dominant

209
Q

Genetic disease that causes tons of cutaneous abcesses?

Test to diagnose?

A

Chronic granulomatous disease

Test with neutrophil fxn testing: (dihydrorhodamine 123 or nitroblue tetrazolium)

210
Q

First renal change seen in diabetic nephropathy?

A

Glomerular hyperfiltration

211
Q

Good diagnostic test for lactose intolerance?

A
  • positive hydrogen breath test
  • postitive stool test for reducing substances
  • low stool pH
  • increased stool osmotic gap
212
Q

What arrhythmia is relatively specific for digitalis toxicity?

A

Atrial tachycardia with AV block

213
Q

Elderly patient with spondylosis has weakness in the upper extremities while strength is normal in the lower extremities.
Dx?

A

Central cord syndrome

214
Q

How many month/years should a bipolar patient stay on lithium?

A

Forever

215
Q

What is the most important cause of bleeding in patients with chronic renal failure?

A

Platelet dysfunction.

This actually involves platelet-platelet as well as platelet vessel interactions

216
Q

Mammary paget’s disease is indicative of whta underlying disorder?

A

Breast adenocarcinoma

217
Q

Treatment for pseudomonal malignant necrotizing otitis externa?

A

IV ciprofloxacin

218
Q

Breath and sounds and tactile fremitus in pleural effusions vs lung consolidation?

A

Pleural effusion: Decreased breath sounds, decreased fremitus

Consolidate: Increased breath sounds and increased tactile fremitus

219
Q

Squamous cell carcinoma is often found in UV exposed areas, but another common presentation is:

A

Chronically wounded, scarred, or inflamed skin

220
Q

Make the connection between obstructive sleep apnea and decreased Cl-

A

OSA causes hypercapnia and respiratory acidosis. In response the kidney increases bicarb retention and decreases CL reabsorption in order to create a compensatory metabolic alkalosis

221
Q

60 yo F patient with acute back pain and point tenderness after lifting?

A

Vertebral compresssion fracture

222
Q

Which diuretic can help prevent urinary calcium stone formation?

A

thiazide diuretics

223
Q

Masses that are found in the MIDDLE mediastinum?

A
  • Bronchogenic cyst
  • tracheal tumors
  • pericardial cysts
  • lymphoma
  • lymph node enlargement
  • aortic aneurysms of arch
224
Q

55 yo patient with BLT morning stiffness for 3 months in the neck, shoulders and hips. NO overt synovitis is seen at the joints and passive range of motion is normal.
Likely dx?

A

Polymyalgia rheumatica

225
Q

Difference between pulmonary contusion and ARDS?

A

ARDS manifests 24-48 hrs after trauma and is always bilateral.

Contusion is more immediate and s only on the affected side

226
Q

Let’s talk about acute eye presentations:

  • Retinal detachment:
  • Diabetic retinopathy:
  • Central veinous occlusion:
  • Macular degeneration:
  • Vitreous Hemorrhage:
A

Retinal detachment: See elevated retina with folds or tearing. Vision loss with showers of floaters

Diabetic Retinopathy: Patients asymptomatic

Central retinal vein occlusion: Sudden, painless loss of vision. There is disk swelling, venous dilation, retinal hemorrhages

Macular degeneration: Painless progressive vision blurring. BLT

Vitreous hemorrhage: Sudden loss of vision and floater onset.

227
Q

Best way to evaluate patient with undiagnosed pleural effusion?

(No evidence for CHF)

A

Thoracentesis

228
Q

Patient in MVA with blunt trauma has an elevated PCWP. AFter IV infusion of NS, the PCWP actually increases.
Dx?

A

Myocradial contusion

229
Q

How do vagal maneuvers improve PSVT?

What are these maneuvers?

A

Maneuvers include carotid massage, valsalva, immersion in cold water.

They increase vagal tone and decrease conduction through the AV node

230
Q

What disorders have pulsus paradoxus?

A
  • asthma
  • COPD
  • pericardial effusion
231
Q

Cause of aortic stenosis by age group?

A

under 70 - bicuspid aortic valve

over 70 - senile calcific

232
Q

Mobitz type 1
vs
mobitz type 2

A

1 - progressive prolongation until drop QRS

2 - constant PR interval with drops of QRS

233
Q

Patient with ACUTE decompensated heart failure. First things first:

A

Furosemide

Get that fluid off!
Worry about b-blockers and all that jazz later

234
Q

Arrythmia caused by digitalis?

A

Atrial tachy with AV block

235
Q

Patients with new-onset A-fib and no signs of ischemia shoudl be checked for what?

A

Underlying thyroid dysfxn

236
Q

Persistent tachycardia causing hemodynamic instability should be managed how?

A

Synchronized cardioversion

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