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Review > Step 2 Qbank review > Flashcards

Step 2 Qbank review Flashcards

1
Q

how does Crohn’s disease lead to nephrolithiasis?

A

Normally Oxalate is bound by calcium in the gut preventing its absorption, with Crohn’s and other fat malabsorption diseases, calcium is preferentially bound to fat. The unbound oxalate is then absorbed and leads to hyperoxaluria and oxalate stone formation.

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2
Q

Conditions associated with formation of calcium phosphate stones

A

Hyperparathyrodism and RTA

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3
Q

Cause and treatment of acute unilateral cervical adenitis

A

Typically caused by Streptococcal and staphylococcal infections. Treatment usually consist of I&D plus CLINDAMYCIN (since s. aureus produced b-lactams -MRSA- Amoxicillin is a poor choice).

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4
Q

Essential tremor

A

Essential tremor is often bilateral, affects upper extremities and worsens at the end of an activity.

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5
Q

Parkinson’s disease tetrad

A

Resting tremor, rigidity, postural instability, and bradykinesia.

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6
Q

Definition of chronic bronchitis.

A

Chronic productive (white sputum, may have some blood tinge) for 3 months in 2 successive years. Cigarette smoking is the leading cause.

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7
Q

Luteoma presentation

A

Classically presents in AA women, 30-40, during pregnancy, up to 1/3 can develop hirsutism. On U/S is appears as a multinodular solid mass on BOTH ovaries.

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8
Q

Painless bloody stools in well appearing neonate

A

Milk or soy protein proctocolitis.

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9
Q

Cyclical vomiting

A

Reccurent self limitign episodes of v/n in children in absence of other causes. Higher incidence in children of parents with + migraine hx. Tx: antiemetics and reassurance for the parents.

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10
Q

Unusually dark urine

A

conjugated hyperbilirubinemia

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11
Q

Light’s criteria transudative vs exudative

A

Any pos in LC = exudative (inflammatory process)

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12
Q

Causes of Dyspepsia

A

NSAIDs, Gastric or esophageal cancer and symptomatic H. Pylori infx

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13
Q

mucomycosis

A

Caused by fungus Rhizopus, most often in suceptible diabetics. Presents with low grade fever, dull facial pain, and bloody nasal discharge. Tx surgical debridement + IV AMPHOTERICIN.

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14
Q

Infective endocarditis presentation and treatment.

A

Present with intermittent fever, fatigue, new holosystolic murmur and pos cultures. Start with Vancomycin, it covers staph, strep and enterococci. After cultures, if PCN sensitive, treat with IV PCN-G or IV CEFTRIAXONE.

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15
Q

Pneumothorax presentation

A

tachypnea, tachycardia, DISTENDED NECK VEINS, tracheal deviation away from injury (diff in pressures)

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16
Q

Pneumothorax mgt

A

needle thoracostomy, possible chest tube and intubation

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17
Q

Comorbidites associated with panic disorder

A

Major depression, bipolar disorder, agoraphobia (fear of public spaces), and substance abuse.

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18
Q

Holosystolic murmurs

A

TR, MR, and VSD

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19
Q

CMV retinitis

A

HIV pt CD4<50, yellowish-white patches of retinal opacifications and retinal hemorrhages. Tx Valganciclovir, Ganciclovir or Forscarnet

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20
Q

HIV Candidal esophagitis

A

Oral thrush and candidal esophagitis treat with 1-2 weeks of fluconazole.

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21
Q

HIV esophagitis HSV

A

small, well circumscribed round/ovid ulcers and intranuclear inclusions. Tx: ACYCLOVIR

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22
Q

HIV esophagitis CMV

A

Large linear ulcers and intranuclear and intracytoplasmic inclusion (Owl eyes). Tx: GANCICLOVIR

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23
Q

5 common side effects of Amiodarone

A

Pulmonary fibrosis, Hypothyrodism, Hepatotoxic, Corneal deposit and Blue-gray skin discoloration

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24
Q

Signs of tracheobronchial injury

A

Hemoptysis, pneumomediastinum, and air leak even after chest tube placement.

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25
Q

Galactosemia presentation and cause

A

infant or newborn with FTT, BILATERAL CATARACTS, jaundice and hypoglycemia. Due to Galactose 1 phosphate uridyl transferase deficiency. Pt are at increased risk of E. coli neonatal sepsis.

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26
Q

Galactokinase deficiency.

A

Pt only presents with cataracts. Otherwise asymptomatic.

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27
Q

what does and S4 indicate? Due to?

A

Indicates a stiff left ventricle, occurs in setting of restrictive cardiomyopathy or LVH from prolonged HTN.

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28
Q

Most common cause of Nephrotic syndrome in adults

A

Membranous glomerulonephritis. Associated with HBV, syphilis, malaria, and gold. With SPIKE AND DOME appearance due to granular deposits of IgG and C3 on BM.

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29
Q

Complication of membranous glomerulonephritis (or any nephrotic syndrome).

A

Renal vein thrombosis, presents sudden onset of abdominal pain, fever, and hematuria. Due to loss of antithrombin III in the urine (remember the proteinuria of nephrotic syndrome), the loss puts pts at risk of venous and arterial thrombosis.

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30
Q

Describe electrical alternans

A

QRS complex with variable amplitude from beat to beat, due to heart changing axis as it swings back and forth within an increased quantity of pericardial fluid.

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31
Q

Signs of pericardial effusion

A

muffled heart sounds, unpalpable apical pulse, dyspnea on exertion, dull chest pain, enlarged heart.

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32
Q

New onset of RBBB

A

consider a PE

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33
Q

chorioamnionitis

A

suspect in setting of PROM, maternal fever, leukocytosis, uterine tenderness, and fetal tachycardia (sign of maternal infx).

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34
Q

PROM delivery or c-section

A

Save the c-section for cases of evident fetal distress, eg late decelerations.

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35
Q

Cause of hypercalcemia in chronic granulomatous diseases (eg Sarcoidosis).

A

Elevated calcitrol (1,25 dihydroxy vit D). Treat with corticosteroids, will reduce the calcitrol levels.

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36
Q

Treatment of hypercalcemia in sarcoidosis vs malignancy.

A

Sarcodisosis hypercalcemia treated with corticosteroids. Malignancy hypercalcemia is treated with Zoledronic acid.

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37
Q

What do Howell-Jolly bodies indicate?

A

Indicates abscence of spleen, either functional, autoinfarction, infiltrative disorder, or splenic congestion. They represent nuclear remnats within RBCs, appear as single, round, blue inclusion on WRIGHT stain.

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38
Q

What are Heinz bodies?

A

Hemoglobin precipitation seen in G6PD deficiency. Hg becomes oxidized and forms insoluble precipitants, Heinz bodies, they appear on the periphery of RBC with blue dye (cyrstal violet)

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39
Q

most common cause of congenital hypothyrodism in the US

A

Thyroid dysgenesis

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40
Q

PCOS cancer risk

A

Endometrial hyperplasia -> carcinoma, remember PCOS is an annovulatory (thus no inc ovarian cancer risk) unbalanced estrogen secretion state.

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41
Q

Signs and symptoms of spinal cord compression.

A

UMN dysfunction distal to site of compression, includes weakness, hyperreflexia, and + Babinski (extensor plantar response).

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42
Q

Legg-Calve-Perthes disease

A

Idiopathic avascular necrosis of the femoral capital epiphysis. Commonly affects boys between 4 and 10. Presents with hip, groin, or knee pain plus antalgic gait.

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43
Q

ARDS vent goal, PaO2, PaCO2

A

goal: mechanical vent with low tidal volume and PEEP (between 5-15 mm Hg). PaO2: measure of oxygenation, mainly affected by FiO2 and PEEP. PaCO2: measure of ventilation, mainly affected by RR and TV.

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44
Q

Renal changes in pregnancy and lab values.

A

In pregnancy both renal plasma flow and glomerular filtration rate INCREASE, causing a DECREASE in serum BUN and Cr.

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45
Q

Acute Tubular Necrosis (ATN) cause and UA findings.

A

Due to ischemic or nephrotoxic insult. Serum Cr is elevated. Urinalysis shows GRANULAR CAST, HEMATURIA, and RENAL EPITHELIAL CELLS.

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46
Q

Renal papillary necrosis presentation and associated disease.

A

Painless hematuria. Look for sickle cell trait.

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47
Q

Treatment acute COPD exacerbation.

A

O2, inhaled bronchodialators (albuterol), inhaled anticholinergics (ipratropium), systemic glucocorticoids, consider abx (levofloxacin - respiratory FQ)

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48
Q

Infective endocarditis in pt with MVP community vs healthcare-associated (HCA).

A

Community most commonly due to viridans group streptococcus (s. mutuans, s. sanguis, s.??). HCA most commonly due to staph aureus.

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49
Q

Acute stress disorder

A

Similar to PTSD, but symptoms lasting from 3 days to 1 month post traumatic event.

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50
Q

Prosthetic joint infection early vs delay onset

A

Early: w/i 3 months. Erythema, swelling, drainage, fever. Staph aureus, GNR, anerobes. Delayed: > 3 months. Persistent pain, loosening implant. Coag neg staph (staph. epidermidis)

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51
Q

Syringomyelia

A

Areflexic weakness in upper extremities and loss of pain and temperature with preserved pos/vibration in “cape” distribution.

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52
Q

Cannabis intoxication behavioral and psychological changes.

A

Euphoria and relaxation. Pts have conjunctival injection, dry mouth, tachycardia, and increased appetite. Psychomotor impairment and PARANOIA may also occur.

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53
Q

Rib notching

A

Caused by dilatation of collateral chest wall vessels in Coarcation.

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54
Q

Stroke in child with soft palate trauma.

A

Either from compression of ICA leading to embolic stroke or ICA dissection leading to ischemic stroke.

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55
Q

Treatment of kawasaki disease

A

Aspirin + IVIG, treatment is just to prevent coronary artery aneurysm and MI/ischemia

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56
Q

Fusion beats

A

capture of both atrial and ventricular beats. Diagnostic of sustained monomorphic ventricular tachycardia.

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57
Q

Babesiosis

A

NE united states, tick bite, in immunocompromised and asplenics. Parasite enters RBCs and causes HEMOLYSIS. Jaundice, hemolytic anemia, thrombocytopenia, high ESR, NO RASH. Dx- Giemsa thin and thick smear. Tx- quinin+clinda or atovaquone+azithromycin

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58
Q

MEN TYPE 1

A

Parathyroid adenoma, Pituitary tumors, and Pancreatic tumors

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59
Q

MEN TYPE 2A

A

Medullary thyroid cancer, Pheochromocytoma, and Parathyroid hyperplasia

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60
Q

MEN TYPE 2B

A

Medullary thyroid cancer, Marfinoid habitus, and Pheochromocytoma

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61
Q

Recommendation for pts with renal calculi

A

Decreased protein and oxalate, Decreased Sodium intake (high sodium promotes Ca excretion leading to more stones), Increased fluids, and Increased Calcium dietary intake

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62
Q

BMT recipient with both lung and intestinal involvement (colitis)??

A

CMV pneumonitis.

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63
Q

Hallmarks of cellulitis

A

Warmth, erythema, edema, and tenderness.

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64
Q

Hallmarks of Necrotizing fasciitis

A

Purplish discoloration of skin, gangrenous changes (bullae, crepitous) and systemic toxicity.

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65
Q

Encapsulated bacteria

A

Some Killers Have Pretty Nice Capsules, .

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66
Q

Lactation mastitis

A

S. aureus (MSSA)Dicloxacillin or Cephalexin. S. aureus (MRSA) Clinda or Bactrim or Vanco.

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67
Q

Anorexia vs Bulimia

A

Anorexia (BMI < 18.5) give CBT and Olanzapine (Atypical) s/e is weight gain. Bulimia (normal BMI, but binge/purge) CBT/nutrional rehab, SSRI may be needed.

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68
Q

TCA overdose

A

CNS depression, hypotension, anticholinergic effects (dilated pupils, hyperthermia, decreased bowel sounds). Tx: NaHCO3 if hypotensive, QRS prolongation, or v-arrhythmia.

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69
Q

Diabetic gastroperesis treatment

A

Use a prokinetic agent, eg METOCLOPROMIDE or ERYTHROMYCIN

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70
Q

Chronic granulomatous disease

A

Defect of phagocytic cells due to NADPH oxidase enzyme complex dysfunction. Look for recurrent infections with Catalase positive bact (S. Aureus, Serratia, Klebsiella, and Aspergillus). Nitroblue Tetrazolium (NBT) NEGATIVE (does not turn blue, the color change means normal cell capable of making reactive oxygen species). Tx: daily TMP/SMX and gamma interferon.

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71
Q

Wiskott-Aldrich syndrome

A

X-linked. Presents with young boy with ECZEMA, THROMBOCYTOPENIA, AND RECURRENT ENCAPSULATED INFECTIONS. Will have LOW IgM levels with HIGH IgA/IgE

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72
Q

Chediak-Higashi syndrome

A

Decreased phagocytic activity because of failure of phagolysosome formation. Bacteria are not destroyed and PMN dysfunction leads to recurrent pyogenic infections (pus producing), partial albinism (light skin and hair with eye photosensitivity), and neuropathy.

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73
Q

Causes of Hypercalcemia of malignancy (solid vs lymphomas).

A

Due to PTHrP leading to excessive bone resorption. Lymphomas cause 1,25VitD production leading to increased gut absorption.

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74
Q

Down syndrome on quad screen

A

ELEVATED B-HCG and Inhibin A with a LOW MSAFP and Estriol

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75
Q

Beckwith-Wiedemann syndrome

A

Overgrowth disorder with predisposition for neoplasm (Wilm’s tumor and hepatoblastoma) screen with U/S and alpha fetoprotein. Pts presents with big babies, with big tongues and hemihyperplasia. Can also have abdominal wall defects.

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76
Q

Use of bronchoalveolar lavage (BAL)

A

Suspected malignancy and opportunistic infections (eg PCP).

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77
Q

How is heart function affected in Cardiac Tamponade.

A

An exaggerated shift of the interventricular septum toward the left ventricular cavity reducing LV chamber volume (reducing preload/stroke volume/ CO). Beck’s triad: hypotension, distended neck veins, muffled heart sounds. Also look for pulsus paradoxus.

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78
Q

Best way to reduce progression of diabetic nephropathy?

A

Blood pressure control.

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79
Q

G6PD Von gierkes disease

A

hypoglycemia, lactic acidos, hyperuricemia, and hyperlipedemia. Doll like face (fat cheeks), thin extremities, short stature, big old belly (enlarged liver and kidneys).

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80
Q

Most important prognostic indicator in ALF

A

PT.

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81
Q

Long term sequelae of bacterial meningitis

A

Hearing loss, Loss of cognitive fx,Seizures,Mental retardation, and Spasticity or paresis

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82
Q

Cerebral salt wasting syndrome

A

A complication of SAH. Presents with Hyponatremia. Due to an inappropriate secretion of vasopressin leading to water retention. Then an increase in atrial BNP. May also develop SiADH.

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83
Q

Definition and S/S of elevated intracranial pressure.

A

Elevated ICP >20 mm Hg. S/S diffuse HEADACHES (WORSE IN THE MORNING), nausea and vomiting early in the day, vision changes, papilledema, CN deficits, somnolence, confusion, unsteadiness, Cushing’s reflex (HTN with bradycardia).

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84
Q

Toxoplasmosis ppx vs treatment

A

PPX: TMP-SMX. Treatment - Sulfadiazine and pyrimethamine + leucovorin (prevent heme tox). If pregnant treat with Spiramycin

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85
Q

How are ACEi renal protective in DM?

A

ACE reduce intraglomerular hypertension. In DM, renal damage comes from glomerular hyperfiltration leading to intraglomerular hypertension.

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86
Q

Delusional disorder

A

One or more delusions and NO psychotic symptoms in otherwise high-functioning individual.

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87
Q

Treatment of EtOH withdrawl

A

Benzodiazepine, Librium (chlordiazepoxide).

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88
Q

Sympathetic opthalmia

A

Also known as spared eye injury. Due to immune-mediated inflammation of normal eye after penetrating injury to the other. Present with anterior uveitis. Thought to be due to uncovering of hidden antigens, usually stuck in the eye and protected from immunological recognition. After penetrating injury an immune response ensues.

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89
Q

Treatment of chlamydia

A

Single dose Azithromycin or 7 day course of Doxycycline

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90
Q

Lennox-Gastaut Syndrome

A

Childhood seizures (multiple types), impaired cognitive function, and SLOW SPIKE AND WAVE ACTIVITY ON EEG.

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91
Q

Complex partial seizure

A

Last a few minutes, impaired consciousness, starting spells, automatisms (lip smacking, swallowing, picking movements of the hand), post-ictal confusion. Hyperventilation EEG DOES NOT show change in activity.

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92
Q

Malignant otitis externa

A

Seen in diabetics, usually due to Pseudommonas. Look for ear pain, drainage,, and GRANULATION TISSUE WITHIN EAR CANAL. GIve IV ciprofloxacin.

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93
Q

Hairy Cell Leukemia (B-cell lymphoma) cytochemical features and treatment

A

Cytochemical feature: Tartrate-resistant acid phosphatase (TRAP) stain. Treatment - Cladribine (Purine analog)

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94
Q

Treatment for CLL, NHL

A

CLL: Chlorambucil and prednisone, NHL: CHOP (Cyclophosphamide, Hydroxydaunorubicin, Oncovin [vincrisitine], Prednisone)

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95
Q

Lumbar spinal stenosis

A

Common cause of back pain, pt > 60, presents with back pain radiating to buttocks and thighs, interferes with walking and gets better with LUMBAR FLEXION. In comparison lumbar disk herniation gets worst with lumbar flexion.

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96
Q

Treatment of acute glaucoma (EM)

A

Mannitol, acetazolamide, pilocarpine or timolol.

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97
Q

Effects of DES exposure on offspring

A

Clear cell adenocarcinoma of the vagina and cervix, Cervical anomalities, and Uterine malformations.

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98
Q

Preferred study for diagnosis of melanoma.

A

Excisional biopsy, once confirmed 1 cm margin excision for treatment.

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99
Q

Gout acute attack vs ppx

A

Acute attack - NSAIDS, steroids, colchicine.

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100
Q

Herpangina

A

Due to Coxsackie A virus. Leads to formation of vesicles on tonsils and soft palate. Usually seen in children, presenting with sore throat, fever, and pain with swallowing.

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101
Q

Retropharyngeal abscess presentation

A

Neck pain, fever, limited neck mobility, inability to open mouth (Trismus) and limited cervical extension. Usually due to penetrating trauma to retropharyngeal space (chicken bones). I&D, broad spectrum abx, mediastinal spread is the worst complication.

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102
Q

Five Ps of compartment syndrome

A

Pain (early finding), Paresthesias (burning or tingling), Pallor, Pulselessness (late finding), and Paresis/paralysis

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103
Q

Treatment of GB

A

IVIG and plamapheresis.

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104
Q

Polymorphous maculopapular rash after Amoxicillin in pt with

A

Mono: Epstein Barr virus.

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105
Q

Compare and contrast Preseptal cellulitis and Orbital cellulitis

A

In common: eyelid edema, erythema, tenderness, fever, and leukocytosis. Orbital cellulitis is more severe, also presents with vision impairment, proptosis, pain with EOM, ophthalmoplegia (eye paralysis)

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106
Q

How does squatting help kid with tet spell.

A

The position increases systemic vascular resistance and decreased the shunting of blood from RV to LV across the VSD.

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107
Q

Immunofluorescence patterns of kidney disease

A

Linear Ig deposits: anti-glomerular BM dz (Goodpasture syndrome). Granular Ig deposits: Immune complex glomerulonephritis (Lupus or post strep GN)

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108
Q

Treatment of cellulitis with systemic signs (fever, tachy, etc)

A

IV Nafcillin or Cefazolin.

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109
Q

Pickwickian syndrome

A

Severely obese pt with wakeful alveolar hypoventialtion 2/2 to impaired chest wall compliance.

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110
Q

Treatment for dermatitis herpetiform

A

Dapsone and gluten free diet. Presents are erythematous papules, vesicles, and bullae arranged symmetrically. Group in a herpetiform pattern over extensor surfaces, upper back, and buttocks.

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111
Q

Common medications causing renal insufficiency or failure.

A

Chronic NSAID use (ATN or Papillary Necrosis), Cyclosporine, Aminoglycosides, and Methicillin.

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112
Q

SLE with isolated skin and joint involvement, drug of choice and s/e.

A

Hydroxycholoquine, main side effect is damage to eyes, most serious is retinopathy, but can also have corneal damage.

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113
Q

Tx chemotherapy induced n/v

A

Ondansetron, a 5HT3 serotonin antagonist.

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114
Q

Open angle glaucoma presentation and treatment

A

Asymptomatic in initial stages, followed by painless gradual loss of peripheral vision over year, eventually leading to tunnel vision and halos around lights. Tx: timolol.

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115
Q

Drug induced esophagitis presentation and offending agents

A

Direct mucosal injury to esophagus. Presents with sudden onset odynophagia and retrosternal pain with difficulty swallowing. Antibiotics (Tetracycline), Anti-inflammatories (ASA, NSAIDS), Bisphosphontes (Alendronate) and Others (Potassium Chloride, Quinidine, and Iron).

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116
Q

2 year old developmental milestones

A

Speak 2 word phrases, Follow 2 step commands, Walk upstairs, build tower of six cubes, help remove clothes.

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117
Q

Demeclocycline MOA and s/e

A

MOA: ADH antagonist used to treat SIADH (only use if fluid restriction and high salt intake fail to correct hyponatremia). Side effects: nephrogenic DI, photosensitivity, abnormalities of bone and teeth.

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118
Q

Damage to lateral spinothalamic tracts presentation.

A

Contralateral loss of pain and temperature sensation beginning two levels below level of lesion.

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119
Q

Brown Sequard

A

Hemisection of spinal cord, usually due to penetrating spinal trauma. Findings: IPSILATERAL UMN signs, ipsilateral loss of tactile, vibration, proprioception. CONTRALATERAL loss of pain and temp 2 levels BELOW lesion. LMN signs (flaccid paralysis at level of lesion). If lesion occurs above T1 => Horners syndrome.

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120
Q

Bare metal stens vs Drug eluding stents

A

Besides the regular regimen of ASA, BB, ACEi, Statins. Bare metal stents should get 1 month of Clopidogrel (ADP antagonist). Drug eluding stents should get 12 months of Clopidogrel.

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121
Q

Hartnup’s disease

A

Deficiency of neutral amino acid (tryptophan) transporter. Leads to Pellagra (Niacin deficiency - 4Ds)

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122
Q

Presentation of HUS in peds

A

Child recently recovered from diarrheal illness (E. coli O157:H7, Shigella, Salmonella, Yersinia, and Campylobacter), now presents with purpura/multiple petichiae on exam, ACUTE RENAL FAILURE, MICROANGIOPATHIC HEMOLYTIC ANEMIA, FEVER, THROMBOCYTOPENIA. Peripheral smear with schistocytes and giant platelets 2/2 to microangiopathic hemolytic anemia and thrombocytopenia. Intravascular hemolysis -> elevated LDH/ indirect bilirubin / reticulocyte count.

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123
Q

Findings suggestive of rhabdomyolysis and treatment.

A

Elevated CPK and Potassium, from cell rupture and release. May lead to Acute Tubular Necrosis (ATN). On urinalysis, a + dipstick test for blood with no RBC on microscopy, suggestive of myoglobin in urine. Tx: aggressive hydration, mannitol and urine alkanization may also help.

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124
Q

Mycobacterium avium complex (MAC) HIV pos ppx vs treatment.

A

ppx: Azithromycin (CD4 < 50), treatment: Clarithromycin

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125
Q

Hyper-IgM syndrome

A

High IgM with deficiency of IgG, IgA. Presents with recurrent sinopulmonary infections and Pneumocystis carinii pneumonia. The unique susceptibility to opportunistic infection (PCP) and neutropenia with high IgM distinguish HI from XLA (Bruton’s)

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126
Q

Bacillary angiomatois

A

Seen in immunocompromised pts. Due to Bartonella hensalae(cat scratch - Gram neg bacillus) or Bartonella quintana (tick bite). Presents with fever, weight loss, malaise, abd pain and characteristic cutaneous and visceral angioma like blood vessel growths. Dx: biopsy, but they love bleed out. Tx: ERYTHROMYCIN OR TETRACYCLINE.

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127
Q

Ethylene glycol poisoning

A

UA will show calcium oxalte crystal (rectangular, enveloped shaped crystals). Ethylene glycol will cause both an anion gap and osmolar gap metabolic acidosis.

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128
Q

Main 3 treatment options of Graves and s/e

A

Antithyroid:PTU vaculitis and MMIteratogenic. Both can cause agranulocytosis. RAI: worsening ophthalmopathy. Surgery: Laryngeal nerve damage, hypocalcemia 2/2 parathyroid damage.

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129
Q

Nerve commonly injured with anterior dislocations of shoulder

A

Axillary nerve, it can cause paralysis of deltoid and teres minor muscle as well as loss of sensation over lateral upper arm.

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130
Q

Phenytoin toxicity

A

Presents with HORIZONTAL nystagmus, cerebellar ataxia, and confusion.

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131
Q

Lithium toxicity

A

Presents with tremor, hyperreflexia, ataxia and seizures.

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132
Q

Alport’s syndrome presentation and cause.

A

A familial disorder, presents in boys 5-20 y/o with recurrent gross sensorineural deafness, cataracts, hematuria, and proteinuria (hereditary nephritis).

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133
Q

MI with pulmonary edema, what to give? what to avoid?

A

Give Furosemide, help decrease cardiac preload and thereby decreasing pulmonary capillary pressure. Avoid beta-blockers, can worsen the pulm edema.

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134
Q

Translumination test for testicles.

A

Translumination POSITIVE in hydroceles, fluid in the tunica vaginalis. Translumination NEGATIVE in varicoceles, due to incompetence of testicular valve veins (often affects left testicle). Leads to dilatation of pampiniform plexus.

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135
Q

Treatment of pasteurella multocida (dog/cat bites).

A

Deep punctures from cat bites. Treat with Augmentin (amoxicillin/clavulanate) or Ampicillin.

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136
Q

Central retinal artery occlusion (CRAO)

A

Painless loss of monocular vision (2/2 embolism). Commonly associated with amaurosis fugax. Fundoscopy shows retinal whitening (diffuse ischemia). Look for hx of carotid bruit, site of clot genesis. Tx: Ocular massage and high flow oxygen.

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137
Q

Pt with hemolytic anemia and thrombocytopenia.

A

TTP, check peripheral smear for schistocytes.

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138
Q

Necrosis after warfarin, what happened?

A

Protein C deficiency in the first days creates hypercoagulable state, increased risk of thrombus.

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139
Q

Osteonecrosis (aseptic necrosis/avascular necrosis) 2/2 chronic corticosteroid use. Mechanism?

A

Disruption of bone vasculature.

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140
Q

Presentation of Zollinger-Ellison syndrome

A

Multiple duodenal ulcer and jejunal ulcers are pathognomic. Steatorrhea develops as increased stomach acid inactivates pancreatic enzymes.

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141
Q

Primary biliary cirrhosis

A

AUTOIMMUNE reaction (Anti-mitochondrial antibodies). MIDDLE AGED WOMEN (new pruritis), increased billirubin, jaundice.

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142
Q

Infective endocarditis following dental procedure, bugs?

A

Viridans group streptococci: S. mutants, S. sanguis, S. salivariu.

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143
Q

Prebyscusis

A

High frequency bilateral sensorineural hearing loss. Presents in old age, pt have difficulty hearing in noisy/crowded environments.

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144
Q

Hepatic encephalopathy management

A

Potassium repletion, Intravascular volume repletion (albumin), Lactulose (ammonia trapping), Rifaximin (nonabsorbable antibiotic if lactulose unresponsive w/i 48 hrs)

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145
Q

Presentation of lesion Middle Cerebral Artery Occlusion

A

CONTRALATERAL somatosensory and MOTOR WEAKNESS (face, arm, and leg), Conjugate eye deviation to infarct, Aphasia. Hemineglect (right parietal lobe)

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146
Q

Presentation of Anterior Cerebral Artery Occlusion

A

CONTRALATERAL somatosensory and motor weakness, mostly lower extremity. Dyspraxia (no coordinated mvts), urinary incontinency

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147
Q

Scarlet fever presentation, cause, and treatment.

A

Presents with prodome of fever, headache, vomiting, and sore throat. 12-48 hours later, fine pink BLANCHING papules appear on neck and trunk (feel like sandpaper). Typically due to GAS tonsilitis or pharyngitis. Tx: Penicillin G. (?)

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148
Q

Otosclerosis.

A

Bony overgrowth of stapes footplate, results in conductive hearing loss.

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149
Q

Cholesteatoma.

A

New onset of hearing loss or chronic ear drainage despite abx. On otoscopy granulation tissue and skin debris may be present.

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150
Q

Leukocoria (white reflex in eye)

A

Retinoblastoma.

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151
Q

Ethylene gylcol poisoning treatment

A

FOMEPIZOLE or Ethanol to inhibit alcohol dehydrogenase. NaHCO3 to correct acidosis or hemodialysis.

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152
Q

Myasthenia gravis acute management

A

Pyridostigmine (oral anticholinesterase)

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153
Q

Ebstein’s anomaly

A

ASD, atrialized RV (from lower insertion of TV), malformed TV

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154
Q

Schizophrenia criteria

A

2 of the following Positive symptoms: Delusion, Hallucinations, Disorganized speech, Disorganized behavior. Negative symptoms (flat affect, decreased emotional reactivity, poverty of speech, lack of purpose, and anhedonia)

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155
Q

Torus palantinus

A

Congenital, benign bony growth. Presents as fleshy immobile mass on the midline hard palate, present for years. No tx unless interferes with speech or eating.

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156
Q

Furunculosis

A

Just good old boils. Due to S. Aureus (coagulase +). Present as inflammed boils (carbuncles).

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157
Q

Inheritance pattern muscular dystrophies + key features

A

Duchenne: x-linked recessive deletion of dystrophin gene on Xp21. Onset 3-5, Gower maneuver, calf pseudohypertrophy. Becker: x-linked recessive deletion of dystrophin gene on Xp21. Onset age 5-15. Milder weakness compared to Duchenne. Myotonic: AD, trinucleotide expansion on 19q. Onset age 12-30. Facial weakness, weak/delayed hand grip, dysphagia, cataracts, and testicular atrophy.

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158
Q

Charcot joint

A

Bone and joint destruction secondary to a neuropathy and loss of sensation.

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159
Q

Criteria for Malignant hypertension

A

Presence of sever HTN (> 180/120 mm Hg) associated with RETINAL HEMORRHAGES, EXUDATES, AND/OR PAPILLEDEMA.

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160
Q

Relapse-remitting MS treatment

A

Acute episodes with not significant disease progression between episode. Tx: Interferon-beta.

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161
Q

Patellofemoral compression test

A

Pain elicited by extending knee while compressing the patella (also reproducing pain with squatting). Highly suggestive of patellofemoral syndrome .

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162
Q

SSSS toxin target, presentation, illness script.

A

Toxin targets desmoglein 1 (keratinocyte adhesion thus + Nikolsky). Presents with prodrome of fever, irritability, and skin tenderness. Erythema start on face, spread with 48 hours.

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163
Q

Acute Rheumatic Fever

A

Child with pericarditis, chorea (continuous irregular, and rapid irregular jerks), subcutaneous nodules, elevated ESR and hx of untreated sore throat and fever. Due to GAS - streptococcus pyogenes pharyngitis.

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164
Q

Trousseau’s syndrome presentation and disease association.

A

A hypercoagulability disorder presenting with recurrent and migratory superficial thrombophlebitis at unusual sites. Associated with occult visceral malignancy, most commonly pancreatic cancer.

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165
Q

Courvoisier’s sign

A

Nontender palpable gallbladder. hallmark of pancreatic cancer.

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166
Q

Ophthalmologic problems HIV pts

A

VZV and HSV: PAINFUL severe, acute retinal necrosis associated with pain, keratitis, uveitis, and peripheral pale lesions and central retinal necrosis on funduscopic exam. CMV retinitis: PAINLESS, associated with keratitis or conjunctivitis. On funduscopic exam - hemorrhages and fluffy or granular lesions around the retinal vessels.

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167
Q

Presentation of cerebellar hemorrhage.

A

Evolves over a few hours, typically have acute onset of occipital headache, repeated vomiting, and gait ataxia. Large hemorrhage may have CN VI palsy with conjugate deviation and blepharospasm (eye lid twitch)

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168
Q

Renal failure unresponsive to fluid resuscitation in alcoholic.

A

Hepatorenal syndrome, only tx is liver transplant.

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169
Q

Neuroleptic Malignant Syndrome presentation and treatment.

A

Present 2 weeks after initiation of dopaminergic antagonist (eg typical antipsychotics - Haloperidol, Fluphenazine, Chlorpromazine). Presents with FEVER, MUSCLE RIGIDITY, AUTONOMIC INSTABILITY, AND AMS. Elevated CK is common. Treat with Dantrolene or Bromocriptine.

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170
Q

HACEK

A

hemophilus, actinobacillus, cardiobacterium, eikenella, kingella

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171
Q

Lemierre’s syndrome

A

A complication of pharyngitis with jugular thrombophlebitis and septic embolus. Due to Fusobacterium (oral anaerobe).

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172
Q

Treatment of Coccidioidomycosis, Histo, and balstomycosis

A

Itraconazole. Severe cases, give IV Amphotericin B.

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173
Q

Malaria treatment

A

Chloroquine, unless in P. falciparum resitant areas where you use mefolquine. (??)

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174
Q

Centor Criteria

A

fever greater than 38
tender anterior cervical adenopathy
lack of cough
pharyngotonsillar exudates

3 out of 4 highly suggestive of streptococcal pharyngitis. Give PCN x 10 days. (alternatives Cephalosporins, Amoxicillin, Azythromycin). 1 out of 4 highly unlikely, 2

175
Q

Still’s disease

A

Spiking/recurrent high fevers, salmon-colored maculopapular rash of trunk and extremities, poly-arthritis and arthralgias. JRA subtype.

176
Q

Presentation of occulomotor nerve injury

A

Ptosis and the eye looks down and out, due to unopposed actions of lateral rectus and superior oblique (CN IV).

177
Q

Occular findings characterisitic of MS

A

INO, due to demyelination of medial longitudinal fasciculus.

178
Q

Causes and imaging of choice for non-traumatic avascular (aseptic) necrosis of hip.

A

Chronic corticosteroid therapy, alcoholism, and hemoglobinopathies (eg SCA). Imaging study MRI.

179
Q

Hepatitis E transmission and risk for fulminant hepatitis.

A

Transmission of HEV due to fecally contaminated water, RARE person to person transmission. Commonly found in India, Asia, Africa, and Central America. Abrupt s/s abd pain, hepatomegaly, n/v/anorexia, and jaundice. Beware of pregos, high risk of HEV infection -> fulminant hepatitis (specially in 3rd trimester)

180
Q

Developmental dysplasia of hip presentation and screening studies.

A

Palapable clunk with Ortolani or Barlow maneuvers with palpable clunk (send to Ortho). A soft click, leg-length discrepancy, or asymmetrical inguinal folds suggestive of hip laxity. Usually resolves by 2 weeks. If infant between 2w - 6m, do U/S of hip. >6m get an xray (femoral head and acetabulum are not ossified until 6 months)

181
Q

Ortolani maneuver and Barlow maneuver

A

Ortolani maneuver: abduction (away from center) with anterior lifting of hip (pulling out). Barlow maneuver: adduction (towards center) with posterior pressure of the hip (pushing in).

182
Q

Treatment of developmental dysplasia of hip

A

< 6 months - try a Pavlik harness. > 6 months - reduction under anesthesia.

183
Q

Treatment for tourette disorder.

A

Antipsychotics: Preferable to use 2nd generation antipsychotics: Risperidone

184
Q

First generation antipsychotics

A

Pimozide, Haloperidol, Fluphenazine

185
Q

Atypical antipsychotics

A

Risperidone, Olanzapine, Aripiprazole, Paliperidone, Quetiapine, Ziprasidone

186
Q

Most common cause of isolated proteinuria in peds, work up?

A

Transient proteinuria, get follow up urine dipstick test x 2, to r/o persistent proteinuria indicative of underlying renal disease.

187
Q

Pulmonary Nocardiosis: presentation, gram stain, and treatment.

A

Pts with deficient cell-mediated immunity (AIDS, lymphoma, or transplant) are at increased risk of pulmonary or disseminated disease. Subacute pneumonia, often leads to empyema. Gram stain: CROOKED, BRANCHING, BEADED, GRAM POSITIVE AND PARTIALLY ACID FAST FILAMENTS. Tx: TMP-SMX or Minocycline oral.

188
Q

Cervical mucus in Follicular, Ovulatory, and Luteal Phase.

A

Follicular phase - Thick, scant and acidic (no sperm can survive). Ovulatory phase - clear, profuse and thin. Stretches up to 6 cm and exhibits ferning on microscope. Luteal phase - Progressively thicker (no sperm can swim through it)

189
Q

Pediatric brain tumors

A

Benign astrocytomas (most common infra/supratentorial). Medulloblastoma (most common in posterior fossa, involve vermis). Pinealoma (dosal aspect of midbrain, paralysis of vertical gaze and retraction of the eye lid.

190
Q

Pancoast tumors presentation

A

Commonly present with shoulder pain and horner’s syndrome. Can also have weakness, atrophy of hand muscles, pain/paresthesias of arms, and enlarged supraclavicular LN. Get a CXR.

191
Q

Horner’s syndrome

A

Ptosis, miosis, and anhidrosis

192
Q

Most common complication of sickle cell trait and electrophoresis pattern

A

Sickle cell trait - painless hematuria, due to sickling in renal medulla. HgbA - 60% HgbS - 40% HgbF - 2%

193
Q

Test to assess infertility due to age

A

Early follicular phase FSH levels, a clomiphene challenge, or Inhibin B levels.

194
Q

Hepatic hydrothorax

A

Results in right sided pleural effusion. Treatment is therapeutic thoracentesis, salt restriction, and diuretics. Consider TIPS placement with refractory hepatic hydrothorax.

195
Q

Femoral nerve: Motor function and sensory areas

A

Motor: leg flexion at hip and leg extension at knee.
Sensory: Anterior thigh and medial leg via saphenous branch.

196
Q

Tibial nerve: Motor function and sensory areas

A

Motor: Flexion of knee, plantar flexion of foot
Sensation: Leg (except medial side - femoral/saphenous) and plantar foot.

197
Q

Obturator nerve: Motor function and sensory areas

A

Motor: Adduction (toward center) of thigh.
Sensation: medial thigh (small area)

198
Q

Deep peroneal (tibial) nerve: Motor function and sensory areas

A

Motor: Foot dorsiflexion and toe extension
Sensory: Between first and second toe
Injury causes foot drop.

199
Q

MOA of NaHCO3 use for TCA overdose.

A

Given with TCA overdose leading to QRS > 0.10 seconds. NaHCO3 reverses the prolongation of the QRS by increasing extracellular sodium concentration, this competes for the Na channels and decreases the cardio depressant action of TCA.

200
Q

Basal cell carcinoma

A

Slow growing papule with pearly, rolled borders, and overlying telangiectasia.

201
Q

Cause of death in pts with Acromegaly

A

Cardiovascular complications eg congestive heart failure.

202
Q

Features of neonatal clavicular fracture

A

Crepitus over clavicle, asymmetric moro reflex.

203
Q

When is a DPL indicated

A

Hemodynamically unstable pt with BLUNT abdominal trauma and inconclusive FAST.

204
Q

Explain coronary steal phenomenon

A

Dipyridamole and adenosine cause vasodilation. In CAD, the vessels distal to obstruction are maximally dilated. The use of either will cause normal vessels to dilate and “steal” blood flow from CAD compromised blood vessels.

205
Q

Bronchiectasis presentation

A

Presents with cough, mucopurulent sputum (yellow), and hemoptysis that responds to antibiotics. Need a CT for definitive diagnosis, look for bronchial dilation, lack of airway tapering, and bronchial wall thickening.

206
Q

Trihexyphenidyl - indication, MOA

A

Used in early Parkinson, generally in younger patients where tremor is the primary symptom.. MOA: Anticholinergic.

207
Q

De Quervain tensynovitis

A

Classically affects young mothers as they hold infants with thumb outstretched (abducted/extended). Condition is due to inflammation of abductor polis longus and extensor pollicis brevis tendons as they pass through a fibrous sheath at the radial styloid process. Pain can be elicited by direct palpation on the radial side at base of wrist base.

208
Q

Cause of Hemolytic Uremic Syndrome

A

Due to toxin released by E. Coli. Toxin enters circulation and injures endothelial cells of the kidney.

209
Q

Primidone indication and s/e

A

Primidone is an anticonvulsant used to treat essential tremors (BB are first line). It can precipitate acute intermittent porphyria, which manifests as abdominal pain, neurologic and psychiatric abnormalities. Diagnose by checking urine porphobilinogen.

210
Q

Two manifestations of Chagas disease.

A

Megacolon 2/2 destruction of nerves controlling the GI smooth muscles. Can also cause dilated cardiomyopathy, mechanism is not known.

211
Q

Pseudotumor cerebri presentation and complication.

A

A bening intracranial hypertension in YOUNG, OBESE, WOMEN with headaches suggestive of brain tumors but normal imaging. Neurological signs are usually absent but will have papilledema on fundoscopic exam. Most common complication is blindness, treat with weight reduction, or acetazolamide.

212
Q

Carpal tunnel syndrome, various etiologies: pregnancy, amyloidosis, acromegaly, RA, and hypothyroidism.

A

Pregnancy: accumulation of fluid, specially in third trimester. Amyloidosis: (primary systemic amyloidosis), in setting of ESRD or hemodyalysis with beta 2 microglobulin deposition. Acromegaly: bilateral due to soft tissue enlargement, synovial edema, and tendon hyperplasia. RA: inflammation of tendons. Hypothyroidism: Deposition of mucopolysaccharide protein complexes.

213
Q

Aphasia types as associated neurological features

A

Broca’s sparse nonflent speech, normal comprehession. Will also show RIGHT HEMIPARESIS. Wernicke’s fluent speech without meaning, poor comprehension. Will also have RIGHT SUPERIOR VISUAL FIELD DEFECT.

214
Q

Cyclosporine MOA and s/e

A

Calcineurin inhibitors. Major side effects include: nephrotoxic, hyperkalemia, hypertension, gum hypertrophy, hirsutism, and tremor.

215
Q

Gilbert’s syndrome

A

A familial disorder of bilirubin glucorinidation, due to reduced production of UDP glucuronyl transferase. Leads to a predominantly unconjugated hyperbilirubinemia. Usually asymptomatic, but fasting, hemolysis, or fevers can trigger hyperbilirubinemia.

216
Q

Crigler-Najjar Type 1

A

AR, due to UDP glucuronosyltransferase deficiency. Leads to indirect bilirubin levels are typically 20-25 mg/dL, but can go as high as 50 mg/dL. Presents as severe jaundice and kernicterus. Unresponsive to phenobarbital, but can use phototherapy and plasmapherisis short term, liver tx only definitive cure.

217
Q

Crigler-Najjar Type 2

A

AR, indirect bilirubin levels are < 20 mg/dL. Survive into adulthood with no kernicterus or neurological impairment. Responsive to phenobarbital.

218
Q

Riley-Day syndrome (Familial dysautonomia)

A

AR, predominantly seen in children of Ashkenazi Jews. Presents as gross dysfunction of autonomic NS with severe orthostatic hypotension.

219
Q

Shy-Drager syndome

A

Parkinson pt with onset of orthostatic hypotension or any autonomic dysregulation symptom. Degenerative disease with multiple system atrophy. Presents with parkinsonism, autonomic dysfunction, and wide spread neurological signs (cerebellar, pyramidal, LMN).

220
Q

Benefits of breast feeding mother and child.

A

Mother: Reduced risk of breast and ovarian cancer. No risk change for endometrial cancer. Infant: Improved GI function, prevents otitis media, gastroenteritis, respiratory illness, UTI, decreased risk of necrotizing enterocolitis.

221
Q

Imaging findings in appendicitis with U/S, indications?

A

Prefer imaging technique for appendicitis during pregnancy. U/S with graded compression technique: findings of noncompression and dilation of the appendix are diagnostic.

222
Q

Clinical manifestations of Vitamin D deficiency rickets?

A

Ping pong ball skull, delayed fontanel closure, genu varum, enlarged skull with frontal bossing, enlarged costochondral joints (rachitic rosary), and enlarged long bone joints (wrist widening)

223
Q

Constitutional growth delay

A

Presents with delayed growth spurt, delayed puberty, and delayed bone age. Kid drops of the growth curve between 6m to 3 years, follows along the 5th-10th percentile, but will eventually have growth spurt and reach mid parental height.

224
Q

Mixed cryoglobulinemia

A

Presents with IC deposition in small blood vessels, leads to endothelial injury, inflammation and end organ damage. These present as palpable purpura, proteinuria, hematuria, arthragias, and hepatosplenomegaly. IC are composed of IgM ab (similar to RF) that form complexes with IgG anti HCV antibodies, HCV RNA, and complement (this is why they will have a hypocomplementemia).

225
Q

Cause of TTP

A

Decreased ADAMTS13 activity. Pt develops fever, microangiopathic hemolytic anemia, thrombocytopenia, and purpura. Renal failure and neuro findings are also possible.

226
Q

Waldenstrom’s macroglobulinemia cause.

A

A rare, chronic plasma cell neoplasm with terminally differentiated B cells that produce high numbers of IgM. They invade BM, LN, and spleen. Produce excessive amounts of IgM, causing a hyperviscosity thus predisposing to strokes.

227
Q

Waldenstrom’s macroglobulinemia sign and symptoms

A

Increased size of spleen, liver, and LN. Tired from anemia (BM invasion), easy bruising, night sweats, headaches, visual problems, and pain and numbness of extremities 2/2 demyelinating sensorimotor neuropathy.

228
Q

C. diff colitis mild-moderate vs severe

A

Mild-moderate: WBC < 15K, Cr < 1.5x baseline. Treat with ORAL Metronidazole. Severe: WBC >15K, Cr > 1.5x baseline. Treat with ORAL Vancomycin.

229
Q

Granulomatosis with polyangiitis (Wegener’s) clinical triad

A

Systemic vasculitis, upper and lower airway granulomatous inflammation, and glomerulonephritis (RBC cast, proteinuria, and sterile pyuria). Labs will also show positive C-ANCA and elevated CRP.

230
Q

Manifestation of cutaneous blastomycosis

A

Well-circumscribed verrucous nodules and plaques that progress to microabscesses.

231
Q

Mobile cavitary mass in lung

A

Consider Aspergilloma, presents as a crescent radiolucency next to a rounded mass. Cavitary lesion is due to destruction of underlying lung parenchyma, debris and hyphae form fungus ball that is mobile. Pt may present with intermittent hemoptysis.

232
Q

Management of nonbleeding esophageal varices vs bleeding esophageal varices.

A

Start with BB, reduces chances of progression to large varices and variceal bleeding. If BB are contraindicated to endoscopic variceal ligation. Active bleeding use Octreotide, causes splanchnic vasoconstriction and reduced portal blood flow. Can also do endoscopic sclerotherapy.

233
Q

Causes of Idiopathic Intracranial Hypertension.

A

High opening pressure vision changes, papilladema, and/or CN palsies. Common in young obese women. Due to growth hormones, tetracyclines, excessive vita A (Isoretinoin).

234
Q

MRI findings of PML

A

Multiple demyelinating, non-enhancing lesions, with no mass effect. Affects primarily cortical white matter.

235
Q

Causes of increased peak pressures on I/O vent pt.

A

Normal plateau (increase comes from resistive pressure increase); bronchospasm, mucus plugs, biting ET tube. Increased plateau (increase comes from elastic pressure increase or decreased lung compliance): Pneumothorax, pulmonary edema, pneumonia, atelectasis, right mainstem intubation.

236
Q

Why is aldosterone unaffected in central (tertiary) adrenal insufficiency but pt is still hyponatremic?

A

The principal regulators of aldosterone is angiotensin II and potassium. In central adrenal insuffiency the hyponatremia is due excessive antidiuretic hormone production form the posterior pituitary. Cortisol normally suppresses the secretion of antidiuretic hormone.

237
Q

Choroidal rupture

A

BLUNT EYE TRAUMA leading to blurred vision with central scotoma, retinal edema, crescent-shaped streak concentric to the optic nerve, subretinal hemorrhage

238
Q

Retinal detachment presentation

A

Sudden onset of photopsia (flashes of light) and floater, classic description of “curtain coming down over my eyes.”

239
Q

Helmet cells

A

Fragments of RBC, suggest traumatic hemolytic conditions, eg DIC, HUS, and TTP

240
Q

Basophillic stippling

A

Ribosomal precipitates, look like blue granules dispersed throughout cytoplam. Seen in Sideroblastic anemia, Thalassemias, and lead or heavy metal poisoning.

241
Q

Carcinoid syndrome

A

Bronchospasm, Flushing, Diarrhea, and right ventricular disease. High levels of 5-HIAA in urine. Tx: Octreotide

242
Q

Glucagonoma presentation and dx study.

A

Suspect in pts with mild DM or hyperglycemia with NECROTIC MIGRATORY ERYTHEMA, diarrhea, anemia, and weight loss. Glucagon levels > 500 pg/mL are diagnostic.

243
Q

Mechanism leading to right side heart failure in COPD.

A

Chronic hypoxemia causes constriction of pulmonary arterial system and in time leads to pulmonary hypertension. This leads to RVH and eventual right ventricular failure.

244
Q

Gastroschisis vs Omphalocele

A

Gastroschisis: bowel protudes through defect on right side of umbilical ring, bowel is NOT covered by a protective membrane, bowel is angry (naked), not associated with other abnormalities outside of GI tract. Omphalocele: intraabdominal contents protude through umbilical ring, bowel is covered by peritoneal membrane, can be associated with other congenital abnormalities

245
Q

VACTERL syndrome

A

Vertebrae, Anal atresia, CV tree, Tracheo-Esophageal fistula, Renal and Radial abnormalities, Limb defects

246
Q

Anterior cord syndrome

A

Associated with burst fracture of vertebra, presents with total loss of motor function below level of lesion, loss of pain/temp on both sides of lesion, and intact propiception.

247
Q

Central cord syndrome

A

Commonly seen in elderly 2/2 forced hyperextension type injury of the neck. Presents with burning pain and upper extremity paralysis, spares the lower extremities.

248
Q

Malaria ppx

A

If traveling to chloroquine resistant areas such as Sub-saharan africa, Amazon, Souther Asia use Mefloquien, Atovaquone-Proguanil, and Doxycycline.

249
Q

Pulsus paradoxus

A

> 10 mm Hg fall in systolic BP during inspiration. Associated with cardiac tamponade, but can also present in severe asthma and COPD.

250
Q

Adjustment disorder

A

Development of emotional or behavioral symptoms in response to identifiable stressor w/i 3 months.

251
Q

Generalized anxiety diosder

A

Excessive worry over MANY aspects of life. PT has hard time keeping worries out mind, leads to significant impairment in daily function. Unlike OCD, pts with GAD do not engage in repetitive compulsions to decrease anxiety.

252
Q

DDX of otalgia

A

Acute otitis media: middle ear effusion + acute eardrum inflammation. Otitis media w/ effusion: effusion w/o inflammation. Bullous myringitis: serous liquid filled blisters on tympanic membrane, due to virus. Cerumen impaction: wax in ear canal.

253
Q

Invasive aspergillosis

A

Immunocompromised patients, may present with fever, cough, dyspnea, or hemptysis. On CXR, a cavitary lesion, CT scan shows pulmonary nodules with a halo sign or lesions with air crescent.

254
Q

Cephalohematoma vs caput succedaneum

A

Cephalohematoma is a subperiosteal hemorrhage, limited to surface of one cranial bone, DOES NOT CROSS MIDLINE OR SUTURES. A slow process, so may take hours to become visible. Caput succedaneum is a diffuse ecchymotic swelling of the scalp. Involves portion of the head presenting during vertex delivery, EXTENDS ACROSS MIDLINE AND SUTURES.

255
Q

What does leukocyte esterase and nitrites signify on UA?

A

Leukocyte esterase indicates pyuria. Nitrates indicate presence of E. Coli which converts urinary nitrates into nitrites.

256
Q

Serum sickness

A

Type III HS. Complexes deposited in membranes, fix complement, lead to tissue damage. Typically caused by drugs now. Takes 5-10 days. Fever, Urticaria, Arthralgias, proteinuria, lymphadenopathy.

257
Q

TB ppx HIV pos

A

Pos PPD with neg CXR, give them INH/Pyridoxine (VitB6) 9 months. Vit B6 will not prevent INH induced hepatitis, LFT monitoring is needed.

258
Q

Pheylketonuria presentation and screening test.

A

Due to phenylalanine hydroxylase deficiency, normally the enzyme break phenylalanine into tyrosine. Untreated leads to mental retardation. UA phenylalanine levels of qualitative Guthrie test are two screening test.

259
Q

Central retinal artery vs vein occlusion

A

Both present with painless vision loss. CRAO: fundoscopic exam shows pallor of optic disc, cherry red fovea, and boxcar segmentation of blood in retinal arteries and veins. CRVO: fundoscopic exam shows disk swelling, venous dilation, tortuosity, retinal hemorrhages, and cotton wool spots.

260
Q

Vitreous hemorrhage

A

sudden loss of vision and floaters in visual fields. Diabetic retinopathy is the most common cause. Important clue: hard to visualize fundus with obscure detials

261
Q

Typical location of MS plaques on MRI

A

Periventricular regions, corpus callosum, deep white matter, and basal ganglia.

262
Q

Cluster headache

A

Intense one sided retroorbital pain that starts suddenly, peaks, and last about 2 hours. Accompanied by ipsilateral Horner’s syndrome, eye redness, tearing, and stuffed or runny nose. Ppx: Verapamil, lithium, ergotamine. Tx: O2 and subcutaneous sumatriptan.

263
Q

Herceptin side effects

A

infusion-related hypotension, flushing, brochoconstriction, skin rashes, CARDIOTOXIC. Pts need echo before they start herceptin, < 55% EF have higher risk of cardiotoxicity.

264
Q

Duodenal hematomas

A

More common in ped after BAT. Most resolve within 2 weeks, treat with NG tube and TPN. Will present with n/v and epigastric pain.

265
Q

MOA statin induced myopathy

A

Decrease coenzyme Q10 synthesis, which is involved in muscle cell energy production,

266
Q

Infective endocarditis in IV drug user

A

Staph, treat with Vancomycin IV to cover MSSA/MRSA.

267
Q

Distortion of straight lines

A

Macular degeneration, look for yellow-white accumulation of extracellular material (Drusen deposits) in the macula.

268
Q

Presentation and treatment of Right Ventricular Infarct.

A

Presents with clear lung fields, hypotension, JVD in settning of inferior wall MI (leads II, aVF, III). Avoid nitrates and diuretics, both decrease preload and exacerbate symptoms. Treat with fluid resuscitation if needed.

269
Q

Marfan presentation + mental retardation + thromboembolic event + downward dislocation of lens.

A

think HOMOCYSTINURIA. Autosomal recessive disease due to cysthathionine synthase deficiency. Tx high dose Vit B6

270
Q

Lens dislocation in Marfan’s vs Homocystinuria

A

Marfan’s the lens dislocates upwards. Homocystinuria the lends dislocates downwards.

271
Q

Temporomandibular joint dysfunction

A

Typicall present with referred pain to ear that is worse when chewing. Pts usually has hx of nocturnal teeth grinding.

272
Q

Management of PEA

A

CPR and vasopressor therapy (eg epinephrine) to achieve adequate cerebral and coronary perfusion. DO NOT SHOCK.

273
Q

Psittacosis

A

Disease transmitted to humans by birds. Pt presents with fever, dry cough, and headache.

274
Q

Infectious cause of constrictive pericarditis vs dilated pericarditis

A

TB - constrictive and Chagas - dilated

275
Q

Treatment of nosocomial pneumonia intubated pt

A

Most likely due to Pseudomonas, treat with Cefepime or Piperacillin-Tazobactam. Ceftriaxone IS NOT effective against Pseudomonas.

276
Q

Osteomyelitis in adult with hx of nail puncture.

A

Although Staph is the most common cause of osteomyelitis in peds and adults, pts with hx of nail puncture most likely have Pseudomonas infection.

277
Q

Treatment Bipolar disorder manic or mixed phase.

A

First line is Lithium, however in pts with abnormal renal function use Valproic Acid.

278
Q

Echinococcosis

A

Parasitic disease caused by tapeworm echinococcus. Associated with sheep farming or close proximity to dogs. Forms a Hydatid cyst (fluid filled) with inner germinal layer and outer acellular laminated membrane, germinal layer gives rise to numerous secondary cyst. Can also show lung involvement. Treat with Albendazole.

279
Q

Neurocysticercosis

A

Caused by Tinea, look for pig exposure on question stem.

280
Q

Bone marrow findings in acquired aplastic anemia.

A

BM biopsy shows profound hypocellularity with a decreased in all cell lines and fatty infiltration of the marrow. Labs will show a normocytic or macrocytic anemia with low reticulocytes.

281
Q

Two concerns with supracondylar fractures of the humerus.

A

First, check distal pulse, immediate concern is for brachial artery injury. Pts can also develop compartment syndrome, presenting as severe pain, pallor, paresthesias, poikilothermia. Late findings include paralysis and pulselessness.

282
Q

Red flags for intracranial pathology

A

Nocturnal headaches and morning vomiting.

283
Q

Effect of massive PE on heart

A

Causes acute RV dilation and failure due to right ventricular outflow obstruction and increased pulmonary vascular resistance. The dilated RV pushes the septum towards the LV causing decrease in LV preload and CO, thus hypotension.

284
Q

McConnell’s sign

A

TTE: dilated RV cavity and hypokinesis of RV free wall with sparing of apex. Seen with massive PE.

285
Q

Cancers associated with Lynch Syndrome (HNPCC).

A

Endometrial cancers.

286
Q

Ehrlichiosis

A

Suspect in pt from endemic regions (??) with hx of tick bite, febrile illness with systemic symptoms, leukopenia, thrombocytopenia, and elevated liver trans. NO RASH. Tx: Doxycycline.

287
Q

Preferred contraception method in lactating mothers?

A

Progestin only oral contraceptives, they do not affect the volume or composition of milk, there are no known side effects for baby, and no risk of DVT.

288
Q

Key findings for Heridatary spherocytosis

A

Autosommal dominant inheritance, presents as hemolytic anemia, jaundice, and splenomegaly in Northern European descent pt. On labs, look for elevated MCHC, negative combs, increased osmotic fragility test (Acidified Glycerol Lysis Test). Look for low MCV if not getting supplemental folate.

289
Q

Complications of hereditary spherocytosis

A

Pigmented gallstones and aplastic crisis from parvovirus B19 infection.

290
Q

Pt with pneumonia after GI endoscopy or upper airway instrumentation, what bugs and treatment

A

Will present with foul smelling sputum. Most likely anaerobes, treat with Clindamycin.

291
Q

Fribromyalgia pain locations and treatment

A

Point muscle tenderness in areas such as mid trapezius, lateral epicondyle, costochondral junction in chest and greater trochanter. Treatment begins with exercise, Duloxetine, TCA (amytriptaline).

292
Q

Treatment for acute abnormal uterine bleeding moderate to severe.

A

High dose estrogen IV, high dose combined OCP, High dose progestin pill, Tranexamic acid (c/i to both estrogen and progesterone)

293
Q

Weight changes in the first 2 weeks of life.

A

Babies can loos up to 7% of birth weight in the first 5 days of life. BW should be normal by age 10-14 days.

294
Q

Kid with acne, goes to beach, gets a sudden onset of redness and swelling over skin over exposed areas within an hour. What medication is he/she on?

A

Tetracyclines (Doxycycline), due to reactive oxygen species causing direct DNA damage.

295
Q

Tropical sprue

A

Pt coming back from endemic area with chronic diarrhea. Look for s/s of malabsorption (B12/folate def), glossitis, cheilosis, protuberant abdomen, and pallor.

296
Q

Tropical sprue biopsy

A

Blunting of villi with infiltration of chronic inflammatory cells, such as lymphocytes, plasma cells and eosinophils.

297
Q

List of Nephrotic syndrome

A 
Minimal Change Disease
Focal Segmental Glomerulosclerosis
Membranous nephropathy
Diabetic nephropathy
Lupus Nephritis
Renal Amyloidosis
Membranoproliferative Nephropathy.
298
Q

Minimal Change Disease

A

Seen in peds, also in adults with hematological malignancies (hogkins), or NSAID use. Tend to have infections and thrombotic events. EM shows fusion of epithelial foot process (podocytes).

299
Q

Focal Segmental Glomerulosclerosis

A

Seen in African americans with uncontrolled HTN, HIV, IV drug users, and obese pts. Look for microscopic hematuria with biopsy showing sclerosis in capillary tufts. Tx: Prednisone, cytotoxic agents and ACE/ARB to decrease proteinuria.

300
Q

Membranous nephropathy

A

Most common in whites, 2/2 solid tumors and IC disease. Associated with HBV, syphilis, malaria, and gold. Look for spike and dome deposits of IgG and C3 on BM.

301
Q

Diabetic nephropathy

A

Can have two descriptions, diffuse hyalinization and nodular glomerulosclerosis (Kimmelstiel-Wilson lesions). Pt have long standing, poorly controlled DM, with evidence of neuropathy or retinopathy. On histology look for thickened GBM, increased mesangial matrix.

302
Q

Lupus Nephritis

A

Can be both nephrotic and nephritic. Reason why every new SLE diagnosis gets a renal biopsy. On histology look for mesangial proliferation, subendothelial and /or subepithelial IC deposits.

303
Q

Renal amyloidosis

A

Look for either plasma cell dyscaria or infection/inflammation. Pts usually have MM or chronic inflammatory diseases such as RA or TB. Classic apple green birefringence on congo stain, shows amyloid. Will also show nodular glomerularsclerosis.

304
Q

Membranoproliferative nephropathy

A

Can be nephrotic or nephritic. Can be associated with HCV, cryoglobulinemia, SLE, and subacute bacterial endocarditis. On IF, shows tram track appearance from double layer basement membrane. All types have low C3.

305
Q

List of Nephritic syndrome

A 
Postinfectious glomerulonephritis (IC)
IgA nephropathy, aka Berger's disease (IC)
Wegner's granulomatosis (Pauci-immune)
Goodpastures syndrome (Anti GBM)
Alport's syndrome (Anti GBM)
306
Q

Postinfectious glomerulosclerosis

A

Associated with recent (2-6 weeks) group A beta hemolytic streptococcal infection. Presents with oliguria, edema, hypertension, and TEA or COKE COLORED urine. Labs show low C3, increased ASO titers, lumpy bumpy IC.

307
Q

IgA Nephropathy (Berger’s disease)

A

Most common nephritic syndrome. Present after GI or URI, may also present with HSP, IC mediated small vessel vasculitis. Will have episodic or microscopic hematuria. Normal C3.

308
Q

Wegner’s granulomatosis

A

Granulomatous inflammation of respiratory track and kidney with necrotizing vasculitis. Presents with hematuria, respiratory symptoms, and hemoptysis from cavitary lung lesions. Presence of c-ANCA, renal biopsy shows segmental necrotizing glomerulonephritis with very few Ig deposits.

309
Q

Goodpastures syndrome.

A

Rapid progression glomerulonephritis with pulmonary hemorrhage in mid 20 male. Hemptosys, with no upper tract involvement. Linear anti GBM deposits and hemosiderin filled macrophages in sputum are classic findings.

310
Q

Alport syndrome

A

Hereditary, type IV collagen defect. Present in boys 5-20. Usually asymptomatic hematuria. Can be associated with sensoryneural deafness and eye disorders like cataracts. GBM splitting on EM.

311
Q

Low risk solitary pulmonary nodule

A

Round opacity < 1.5 cm, 7 years prior, nodule margins are characteristically smooth. Follow up with serial CTs.

312
Q

Drugs that cause priaprism

A

Trazadone, antidepressant commonly used for sleep disturbances. Prazosin, an alpha blocker used in HTN.

313
Q

Reason for low glucose in Empyemas

A

These are exudative effusions with a low glucose due to high metabolic activity of leukocytes and bacteria within the pleural fluid.

314
Q

Presentation of metastatic bone pain

A

Typically constant and progressive, the pain worsens with rest.

315
Q

When and why do you discontinue metformin?

A

Any pt with ARF, hepatic failure, or sepsis. There is an increase risk of developing metformin induced lactic acidosis.

316
Q

ROME diagnostic criteria for IBS

A

Recurrent abdominal pain/discomfort > 3 days/month for past 3 months and >2 of the following: symptoms improve with bowel movement, change in frequency of stool, change in form of stool.

317
Q

Vitamin for any kid with Measles

A

Vitamin A. Reduces morbidity and mortality through immune enhancement.

318
Q

Causes of chloride sensitive metabolic alkalosis

A

Presents with urinary chloride < 20 mEq/day and signs of volume depletion. Some causes include Thiazide and loop diuretics and loss of gastric secretions. Can be corrected with saline infusion to restore ECF.

319
Q

Causes of chloride resistant metabolic alkalosis

A

Presents with urinary chloride level > 20 mEq/day and signs of volume expansion. Some causes include Bartter syndrome, Gitelman’s syndrome, and excessive black licorice ingestion. Chloride resistant metabolic alkalosis can not be corrected with saline infusion.

320
Q

Acute dystonic reaction

A

Antipsychotic EPS reaction presenting with sudden onset of sustained contraction of the neck, mouth, tongue, eye muscles. Treat with anticholinergics (Benztropine) or antihistamine (Dipehenhydramine).

321
Q

Akathisia

A

Antispyschotic EPS reaction presenting with inability to sit still. Treat with Beta blockers.

322
Q

Drug induced parkinsonism

A

Antipsychotic EPS reaction of gradual onset, classic PD presentation. Treat with anticholinergics or amantadine (dopamine agonist)

323
Q

EPS risk, high and low risk antipsychotics

A

High risk Haloperidol, Low risk Chlorpromazine.

324
Q

Anti HBc

A

IgM fraction signal acute phase disease, presents during the window period.
IgG fraction signals recovery from disease.

325
Q

Most common symptom of vaginal cancer.

A

Vaginal bleeding and malodorous vaginal discharge. Usually on the upper 1/3 of vagina, posterior wall. Typically SCC.

326
Q

Niemann Pick disease

A

Due to deficiency of sphingomyelinase, leads to accumulation of sphigomyeline (ceramide phosphorylcholine). Presents with cherry red spot, protruding belly, hepatomegally, lymphadenopathy, and regression of milestones.

327
Q

Tay Sachs disease

A

Due to deficiency of hexosaminidase A. Presents with hyperacusis, mental retardation, seizures, cherry red macula. Unlike Niemann Pick, no hepatomegaly or lymphadenopathy.

328
Q

Disorder suggested by gamma gap

A

Mulitple Myeloma, Amylodosis, Waldenstroms macroglobulinemia, and MGUS. Gap represents elevated serum protein with normal albumin.

329
Q

Typical antipsychotic causes hypothermia

A

Fluphenazine, disrupts thermoregulation and shivering mechanism.

330
Q

Warm agglutin vs cold agglutin AIHA

A 
Warm agglutin (IgG) more commonly due to autoimmune disease, treated with steroids, rituximab, splenectomy, or other immunosuppresants.  
Cold agglutin (IgM) is due to infections or autoimmune disease and causes intravascular hemolysis.  Treatment is supportive with warming pt and RBC transfusions.
331
Q

Spherocytosis with postive combs test

A

Autoimmune hemolytic anemia.

332
Q

Only exception to scheduling vaccines by chronological age.

A

Must weight > 2 kg (4 lb 6 oz) before Hep B vaccine.

333
Q

Relative risk confidence interval.

A

The RR must be greater than 1, indicating the risk is more present in exposed vs unexposed. Also the confidence interval can not include 1, for the confidence interval to be statistically significant.

334
Q

Most common cause of anemia in alcoholics

A

Folate deficiency.

335
Q

Low leukocyte alkaline phosphatase with leukocytosis

A

Classic for Chronic Myelogenous Leukemia, will also see elevated Bands. Presents as night sweats and fevers, due to increased metabolism from granulocyte turn over.

336
Q

Diseases associated with low leukocyte alkaline phosphatase.

A

CML, hypophosphatemia, and Paroxysmal Nocturnal Hemoglobinuria.

337
Q

Hypersensitivity types and examples

A

Type 1, IgE mediated, think atopy, uticaria, anaphylaxis.
Type 2, antibody mediated cytotoxic reaction of IgG/IgM to cell bound antigens. Think of AIHA and Rh mismatch.
Type 3, IC mediated, IgG/IgM form complex with antigen, kick of complement/inflammation cascades. Examples are serum sickness and Arthus rx.
Type 4, cell mediated delayed reaction. Allergic contact dermatitis and poison IV, PPD.

338
Q

Drug for treatment resistant schizophrenia

A

Clozapine

339
Q

Behcet’s syndrome

A

Multisystemic inflammatory condition with recurrent oral and genital ulcers, skin lesions such as erythema nodosum, acne nodules, and papulopustar lesions. Postive pathergy test is needed for diagnosis. Treat with corticosteroids, may still progress to dementia and blindness.

340
Q

Virus associated with Kaposi Sarcomea

A

HHV 8

341
Q

Cause of post influenza pneumonia

A

Staph aureus.

342
Q

Goodpasture syndrome treatment

A

Plasmapheresis.

343
Q

Treatment of PSVT

A

Adenosine to slow down AV nodal conduction and interrupt reentry pathway. Carotid sinus massage can transiently slow down SA node and AV node activity.

344
Q

Which thyroid nodules are benign?

A

Hot nodules, treat the hyperthyroidism.

345
Q

Side effect of indinavir (protease inhibitor) therapy

A

Crystal induced nephropathy, due to precipitation of drug in urine and obstruction of urine flow.

346
Q

Short term side effect of Levo/Carbidopa

A

Hallucinations and agitation.

347
Q

Long term side effect of Levo/Carbidopa

A

Involuntary movement.

348
Q

Mucopurulent vs purulent urethral discharge

A

Mucupurolent most likely due to chlamydial urethritis. Purulent most likely due to gonococcal urethritis.

349
Q

Non caseating granulomas

A

Crohns disease.

350
Q

Acquired sideroblastic anemia

A

Due to defective heme synthesis, most commonly due to vit B6 deficiency. Present with two groups of RBC, hypochromic and normochromic. Iron studies show a low TIBC (opposite of Iron def anemia).

351
Q

Indications for Clozapine use

A

Treatment resistant schizophrenia

Schizophrenia associated with suicidality

352
Q

Anitbody titer indicative of alloimmunization

A

1:32. Woman was sensitized by previous Rh positive fetus.

353
Q

Increased risk of alloimmunization

A

Placental abruption

354
Q

Dosing schedule for Anti-D immune globulin

A

At 28 weeks and repeated at 72 hours. Must do Kleihauer Betke test (count number of fetal hemoglobin in mother) to dose adjust.

355
Q

Burning smell before seizure and LOC

A

Partial seizure with secondary generalization. The burning tells you it was partial, the LOC shows that in generalized and crossed the midline.

356
Q

Abortive therapy options for pt with migraine + nausea and vomiting

A

Antiemetics: chlorpromazine, prochlorperazine, or metoclopramide.

357
Q

Cause of drooping of pelvis below horizontal line when standing on one foot (monopedal stance)

A

This is a positive Trendelenburg sign. It is due to weakness or paralysis of the gluteus medius and minimus muscles, these are innervated by the superior gluteal nerve.

358
Q

Treatment for GAD

A

CBT + SSRI

359
Q

Sturge Weber

A

Port wine stain, seizures, one sided neurofindings, and intra cranial calcifications resembling a tramline.

360
Q

Tuberous sclerosis

A

Seizures + adenoma sebaceum.

361
Q

Best screening test for pt with suspected adrenal insufficiency

A

early morning cortisol, ACTH and cosyntropin (ACTH analogue) stimulation.

362
Q

Findings with cosyntropin test that rule out Adrenocoritcal insufficiency (Addison’s disease)

A

An increase of > 20 ug/dL within 30-60 minutes of cosyntropin administration rule out Addison’ disease

363
Q

Test that all recently diagnosed MG pt need

A

CT of the chest, need to rule out coexisting Thymoma.

364
Q

Signs suggestive of retropharyngeal abscess

A

Inability to extend neck and widened pervertebral spaces on lateral neck xray. Also look for fever, painful swallowing, and drooling.

365
Q

Essenstial tremor treatment options

A

Propranolol or anticonvulsants such as Primidone and Topiramate.

366
Q

Indications for cystoscopy

A

Gross hematuria or microhematuria with risk for bladder cancer such as cigarette smoking, occupational exposure (painters, metal workers), chronic cystitis, cyclophosphamide exposure, and pelvic radiation.

367
Q

Varicella exposure of unvaccinated

A

Immunocompetent patients get Varicella vaccine.

Immunocompromised patients get VZIG within 10 days of exposure.

368
Q

Major cause of morbidity with SAH

A

With in 24 hours you worry about rebleeding.
3-10 days after initial presentation the major cause of m/m is vasospasm, most likely due to degradation of spilled blood and its metabolites. Best prevention is using Nimodipine.

369
Q

Complications of shoulder dystocia

A 
Fracture clavicle
Fractured humerus
Erb-Duchenne palsy: "waiter's tip" 
Klumpke palsy: "claw hand"
Perinatal asphyxia
370
Q

Erb Duchenne palsy

A

Presents with decreased moro and bicep reflex. Classic waiter’s tip on PE. Grasp reflex is intact. Due to brachial plexus injury involving the 5th and 6th cervical nerves.

371
Q

Klumpke palsy

A

Presents with intact moro and biceps reflex. Classic claw hand on PE, may also present with Horner’s syndrome. Due to excessive traction of the 8th cervical and 1st thoracic nerve (reason for Horners).

372
Q

Portion of spine affected by RA

A

Cervical spine, can cause spinal subluxation (dislocation) and spinal cord compression.

373
Q

Smudge cells on smear

A

Abnormal B cells in CLL, resemble lymphocytes but are very fragile and when placed on slide the smear or smudge.

374
Q

Advanced sleep phase syndrome vs Delayed sleep phase syndrome

A

Advanced sleep phase syndrome: fall at sleep really early and have morning insomnia.
Delayed sleep phase syndrome: can’t fall at sleep until really late, but if allowed will have a normal sleep length.

375
Q

Dysphagia to both liquids and solids

A

Motility disorder, get a Barium swallow and possible manometry.

376
Q

Dysphagia with solids progressing to liquids

A

Mechanical obstruction. If any hx of neck rad/surg/cancer tx start with barium swallow, then endoscopy. Otherwise go straight to endoscopy.

377
Q

Squatting - Increased venous return/afterload, Murmurs that get louder and softer.

A

Louder: AR, MR, VSD

Softer: HCM, MVP

378
Q

Handgrip maneuver - Increased afterload/ increased blood pressure. Murmurs that get louder and softer.

A

Louder: AR, MR, VSD

Softer: HCM

379
Q

Mood stabilizers

A

Lithium, ??

380
Q

Description and cause of Molluscum contagiosum

A

Presents with multiple, dome shaped lesions with central umbilicaiton. Due to a poxvirus. In immunocompromised patients it can spread to lid margin causing conjunctivitis.

381
Q

Defects associated with Down Syndrome

A

Cardiac: Complete atrioventricular defect.
GI: Duodenal atresia, Hischsprung disease
Neuro: Early Alzheimer disease
Endo: Hypothyroid, DM type 1
MSK: Atalntoaxial instability

382
Q

Manifestations of complete atrioventricular septal defects

A

A combined ASD and VSD, allow for blood mixing between chambers and abnormal MV and TV allow for significant regurgitation. Excessive pulmonary blood flow results in HF by 6 weeks.

383
Q

Asculation findings of complete atrioventricular septal defect

A

Loud S2 due to pulmonary HTN.
A systolic ejection murmur from left to right ASD
A holosystolic murmur from the VSD, may be soft if the defect is large.

384
Q

Osteoid osteoma

A

Scleroti cortical lesion on imaging (like a hole in the bone). Pain is typically worse at night and unrelated to activity. Pain responds to NSAIDS.

385
Q

Growing pains

A

Pain worst at night, responds to massage and NSAIDS

386
Q

Cast and associated conditions

A

Muddy brown granular cast: ATN
RBC cast: Glomerulonephritis
WBC cast: Interstial nephritis and pyeolnephritis
Fatty cast: Nephrotic syndrome
Broad and waxy cast: Chornic renal failure.

387
Q

Complications of small for gestational age infants

A

Hypoxia, Polycythemia, Hypoglycemia, Hypothermia, and Hypocalcemia.

388
Q

Preterm infant nutrional supplementation needs

A

Preterm infants need Iron and Vit D supplementation until 1 year old.

389
Q

Nutritional supplementation for all exclusively breast fed infants

A

Vitamin D.

390
Q

First line antihypertensive medication in pregnancy

A

Methyldopa, Beta blockers (labetalol), Hydralazine, Calcium Channel Blockers (Nifedipine).

391
Q

Antihypertensive medications contraindicated in pregnancy

A

ACE inhibitos, Aldosterone blockers, Direct Renin inhibitors, Furosemide, ARBs

392
Q

Treatment for stroke in sickle cell pt

A

Exchange transfusion. The stroke is most likely due to sludging and occlusion of cerebral vasculature by sickling cells. Fibronolytics would not help in these cases.

393
Q

Drop foot

A

L5 radiculopathy or traumatic damage to common peroneal nerve.

394
Q

Treatment choices for diabetic neuropathy

A

TCA, but these can worsen urinary symptoms (due to cystopathy) and orthostatic hypotension (due to cardiovascular autonomic neuropathy). In these patients use Gabapentin.

395
Q

Dystonia

A

Occurs between 4 hours to 4 days after receiving antipsychotics. Presents with muscle spasms or stiffness, tongue protrussion or twisting, opisthotonus, and oculogyric crisis. Treat with Benztropine (anticholinergic) or Diphenhydramine (antihistamine, with anticholinergic effect at high doses)

396
Q

Tardive dyskinesias

A

A hyperkinetic movement disorders from medications such as dopamine receptor blockers, antipyschotics, and metoclopramide. Develops within 6 months of starting medication. Symptoms include
Oral and facial: lip smacking, chewing, tongue twisting.
Limb: foot tapping and piano playing fingers
Neck and trunk: torticollis, shoulder shrugging, rocking and swaying.
Resp: grunting noises

397
Q

Treatment for Tardive dyskinesias

A

Stop offending agent, classicaly Risperidone, get a CBC and start Clozapine.

398
Q

Trichotillomania

A

Recurrent hair pulling. Look out for pts who swallow hair (Tricophagia), they can develop trichobezoars presenting with abdominal pain and bowel obstruction.

399
Q

Treatment for impetigo

A

Topical Muporicin or Oral Erythromycin, Dicloxacillin, and Cephalixin. Due to group A beta hemolytic streptococci or Staph aureus.

400
Q

Phenytoin use during pregnancy, fetal abnormalities

A

Craniofacial anomalies, fingernail hypoplasia, growth deficiency, developmental delay, cardiac defects, and facial clefts.

401
Q

Common Iatrogenic complication of cardiac catherization

A

Retroperitoneal hemorrhage from extension of local vascular hematoma in the soft tissue of the thigh.

402
Q

Location of Thymoma

A

Anterior mediastinum, suspect if found in young male or female. Up to 20% of MG pts have a thymoma.

403
Q

Location of neurogenic tumor in chest

A

Posterior mediastinum. MRI is the best modality to evaluate any posterior mediastinal mass.

404
Q

Cancer associated with Pernicious anemia

A

Gastric cancer.

405
Q

Treatment for acute exacerbation of MS

A

Corticosteroids

406
Q

Treatment for to decrease frequency of exacerbations in pt with relapsing remitting or secondary progressive MS

A

Beta-interferon or Glatiramer Acetate.

407
Q

Ulcers and cancer associated with burns

A

Marjolin ulcers leading to Squamous Cell Carcinoma.

408
Q

Predisposing skin lesion leading to SCC of skin

A

Actinic keratosis.

409
Q

Presenatation of Basal Cell Carcinoma

A

Presents in chronically sun exposed areas with pearly telangiectatic papules with central rodent ulceration and pearly rolled up borders.

410
Q

Electrolyte abnormalities in Cushing’s syndrome

A

Hypokalemia and hypernatremia.

411
Q

Hypertension and hypokalemia, what to suspect?

A

Hyperaldosteronism, check plasma renin and aldosterone concentration.

412
Q

Succussion splash on PE

A

Gastric outlet obstruction.

413
Q

Congenital rubella (german measles) infection

A

Sensorineural deafness, PDA, cataracts, and glaucoma.

414
Q

Parapneumonic effusion, indications for tube thoracostomy

A

Low pH (< 7.2) and low glucose (< 60 mg/dL)

415
Q

Skin and eye findings with Sarcoidosis

A

Erythema nodosum and uveitis

416
Q

Classic xray findings for sarcoidosis

A

Bilateral hilar adenopathy and diffuse interstitial infiltrates, can progress to fibrosis, will hear rales on auscultation.

417
Q

PRBC transfusion thresholds, asymptomatic vs symptomatic.

A

Asymptomatic Hg < 7 g/dL

Symptomatic Hg < 9 g/dL

418
Q

CT findings in Bronchiectasis

A

Dilated bronchi with thickened walls.

419
Q

Testicular cancer presentation and diagnosis

A

Hard painless mass in testicle with suggestive ultrasound. Immediate ballectomy.

420
Q

Presentation of early vs late congenital syphilis

A

Hepatosplenomegaly, cutaneous lesions on palms and soles, juandice, anemia and rhinorrhea. Imaging demostrates metaphyseal dystrophy and periostitis.

Late manifestation, about 2 years after birht, include frontal bossing, high arched palate, hutchinson teeth, interstitial keratitis, saddle nose, and perioral fissures.

421
Q

Viral conjunctivitis presentation and treatment

A

Conjunctival inflammation and watery discharge in setting of URI. Common in children and caregivers in the late summer and early fall. Treat with Warm or cold compress and antihistamine decongestants.

422
Q

Abdominal pain gets better by leaning forward

A

Pancreatitis.

423
Q

Describe the Potter sequence

A

Urinary tract anomaly leads to anuria/oliguria in utero. The ensuing oligohydramnios causes pulmonary hypoplasia, flat facies, and limb deformities.

424
Q

Most common urinary tract obstruction of newborns

A

Posterior urethral valves, presents with hydronephrosis and Potter sequence.

425
Q

Diagnositic features of Acute Bacterial Rhinosinusitis

A

Persistent symptoms > 10 days without improvement. Severe symptoms such as fever > 39, purulent nasal discharge, of face pain > 3 days Or, worsening symptoms > 5 days after initially improving viral URI.

426
Q

Treatment for acute bacterial rhinosinusitis

A

Amoxicillin-Clavulanic Acid.

427
Q

Most common predisposing factor for acute bacterial rhinosinusitis

A

Viral URI.

428
Q

Premature ventricular complexes

A

Wide QRS (>120), bizarre morphology, and compensatory pause. If asymptomatic, no treatment. Can occur in healthy individuals, more often seen in pt post MI. For symptomatic patient beta blockers are the first line therapy.

429
Q

Increased DLCO

A

Interstitial lung diseases.

430
Q

Hemolytic anemia in pt with malignant lymphoproliferative disorder.

A

Most likely due to warm agglutin (IgG). Treat with prednisone, if nor response jump to splenectomy.

431
Q

Clinical features of Primary Hyperaldosteronism

A

Hypertension, metabolic alkalosis, hypokalemia, mild hypernatremia. No significant peripheral edema.

432
Q

Diagnosis of Primary Hyperaldosteronism

A

Elevated plasma aldo, low renin. Plasma aldo/renin ration > 20.
Adrenal suppression testing after oral saline, confirmatory.
Abdominal imaging and adrenal venous sampling to distinguis between adrenal adenoma and bilateral adrenal hyperplasia.

433
Q

Methyl alcohol poisoning

A

Visual changes “snowfield vision” and acute pancreatitis

434
Q

Ethyl alcohol poisoning

A

Calcium oxalate crystals (enveloped shaped) with antifreeze poisoning. Look for anion gap metabolic acidosis and osmolar gap.

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