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STEP 2 > STEP 2 - UWORLD > Flashcards

STEP 2 - UWORLD Flashcards

1
Q

how to prevent stones

A

increase fluids, decrease Na in diet, decrease protein in diet, normal Ca an duse thiazide diuretcs

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2
Q

infections from joint replacements, < and > 3 months

A

< 3 months = s aureus

> 3 months = s epi

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3
Q

post cholecystectomy syndrome - test

A

ERCP

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4
Q

early diastolic murmur with hyperdynamic or water hammer pulse

A

AR

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5
Q

next step for pt who is mildly hypercalcemic

A

check PTH first

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6
Q

hormone produced in adrenal tumor in women

A

DHEAS

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7
Q

why does DHEAS producing tumor also have decreased LH

A

negative feedback

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8
Q

child with hip pain after URI

A

transient synovitis

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9
Q

child with hip pain, negative XR, fixed, slightly abducted externally rotated limb

A

transient synovitis

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10
Q

you suspect transient synovitis - what do you do next and what do you rule out

A

legg-calves-perth disease with XR of hip

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11
Q

hyperoxaluria found in what dz

A

crohns

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12
Q

recurrent candidiasis in older woman

A

check A1c

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13
Q

pt has minor symptoms but also lung consolidation, what now

A

CXR and empiric abx - chance of bacterial conversion is high

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14
Q

gene with MEN2a/b

A

RET proto-onco genes

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15
Q

medullary thyroid CA and pheochromocytoma

A

MEN2a/b

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16
Q

heart problems (3) with Turners

A

bicuspid aortic valve
aortic coarctation
aortic root dilation

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17
Q

tumor in precocious puberty in female

A

granulosa cell

ovarian mass

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18
Q

MCC of congenital hypothyroidism

A

thyroid dysgenesis

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19
Q

type of dysfunction in Zenkers

A

motor - sphincter/esophageal dysmotility

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20
Q

pathophysiology of Zenkers

A

posterior herniation bt fibers of cricothyroid muscle

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21
Q

35 year old woman with infertility and hypothyroidism

A

premature ovarian failure

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22
Q

hormone levels in premature ovarian failure

A

increased FSH, decreased estrogen, increased GnRH

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23
Q

gross hematuria w/i 5 days of URI and normal complement levels

A

IgA nephropathy

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24
Q

gross hematuria 2-3 weeks after URI with low C3 and C3 deposits on kidney bx

A

post infectious glomerulonephritis

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25
Q

MCC of glomerulonephritis

A

IgA nephropathy

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26
Q

sudden contralateral sensory loss with ballistic movements

A

thalamic stoke (proximity to BG)

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27
Q

burning pain on same side as sensory loss 4 weeks after stroke

A

thalamic pain syndromw

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28
Q

Bipolar pt with renal failure or BUN/Cr elevation - medication choice?

A

valproate

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29
Q

test of choice in suspected pancreatic CA

A

ab CT

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30
Q

pituitary necrosis from ischemia

A

Sheehan syndrome

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31
Q

hypotension, lethargy, weight loss 2/2 ACTH impairment

A

Sheehan syndrome

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32
Q

endometrial hyperplasia from medication

A

tamoxifen

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33
Q

effect of long term NPO on gall bladder

A

stasis&raquo_space; gall stones

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34
Q

fever, leukoctosis, LUQ pain and chest pain

A

splenic abscess with left sided endocarditis

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35
Q

diagnostic reqs for acute liver failure

A

ALT/AST >1000
hepatic encephalopathy
INR >1.5

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36
Q

what can retropharyngeal abcess become that is worse and how

A

necrotizing mediastinitis, through alar fascia

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37
Q

Looks like pericarditis, you want to do pericardiocentesis, but make sure you check WHAT first

A

the fucking BUN, if it’s >60 then it’s uremic pericarditis

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38
Q

6 week old baby with some odd facial features has loud S2, systolic ejection murmur

A

AV septal defect

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39
Q

how to calculate TTKG

A

(urine K/serum K)/(urine osm/serum osm)

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40
Q

<2 vs >4 TTKG means?

A 
<2 = nonrenal reason for hypokalemia
>4 = renal reason for hypokalemia
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41
Q

renal bicarb secretion depends on

A

counter transport of Cl

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42
Q

calculate the osmolar gap

A

osmolarity - (2[Na] + glucose/18 + BUN/2.5)

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43
Q

what does a osmolar gap of >10 mean

A

toxic ethanol ingetsion

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44
Q

metabolic derangement in acetazolamide use

A

increased Cl and decreased K

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45
Q

lepirudin, dabigatran, argabatran are what

A

direct thrombin inhibitors

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46
Q

when can you use direct thrombin inhibitors

A

NV Afib, VTE prophylaxis, HIT

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47
Q

corrected anion gap

A

anion gap + (4 - [albumin] x 2.5)

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48
Q

metabolic changes with thiazide diuretics

A

decreased K, Na, H

increased glucose, lipids, uric acid, Ca

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49
Q

treatment for CAP

A

IP: ceftriaxone + azithromycin OR moxifloxacin
OP: Azithroymcin

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50
Q

treatment for HAP

A

Vanc/Zosyn

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51
Q

treatment for PCP

A

Bactrim +/- steroids (decreased PaO2 or hypoxic)

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52
Q

treatment for bronchitis

A

macrolide/doxy/FQ or nothing

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53
Q

young man with knee catching after a game

A

meniscal tear - MRI&raquo_space; surgery

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54
Q

ischemic colitis after what kind of surgery

A

vascular/AAA repar

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55
Q

CT shows thickening of bowel wall

A

ischemic colitis

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56
Q

stroke without hemiparesis or sensory loss

A

likely hemorrhagic

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57
Q

cerebellar hemorrhage

A

ipsilateral hemiataxia

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58
Q

atypical depression in a smoker not treated before

A

buproprion, not MAOI

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59
Q

if no fetal heart tones on doppler

A

U/S for fetal demise

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60
Q

next step for mom and baby after fetal demise

A

baby - autopsy for karyotype/genetics

mom - antiphospholipid syndrome/fetomaternal hemorrhage

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61
Q

toxicity of trasztusamab

A

cardiotoxicity - do ECHO frequently

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62
Q

angular chelitis, glossitis, stomatitis, normocytic/chromic anemia, seborhic dermatitis

A

B2 riboflavin def

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63
Q

HZ on both eyes?

A

still fucking HZ even though it shouldn’t be

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64
Q

water bottle shaped heart with no maximal impulse point

A

cardiac tamponade

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65
Q

pt with mono and really sore throat at risk for

A

acute airway obs, could be at risk for peritonsilar abscess but NEVER retropharyngeal abscess

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66
Q

pt is strep, 3 yrs old and has swallowing problems

A

retropharyngeal abscess

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67
Q

don’t choose retropharyngeal abscess unless

A

pt is <4 or had recent trauma

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68
Q

DOE, orthopnea, choking on laying down, lower ext edema

A

diastolic dys with preserved EF

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69
Q

methimazole s/e

A

agranulocytosis

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70
Q

PTU s/e

A

liver failure

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71
Q

which Graves disease drug in 1st trimester

A

PTU

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72
Q

sore throat and fever while taking methimazole

A

agranulocytosis

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73
Q

pt with STEMI, give MONA BASH unless flash pulmonary edema then give

A

loop

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74
Q

difference bt seminomitous vs nonseminomatous tumors

A

semi - Bhcg

non-semi - Bhcg and AFP

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75
Q

spider angiomas, palmar erythema, gynecomastia, testicular atrophy

A

hyperestinism in cirrhosis

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76
Q

vascular wall dilation in cirrhosis

A

estrinism

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77
Q

frequent watery nocturnal diarrhea

A

possible laxative abuse

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78
Q

malanosis coli/dark brown spots on proximal colon

A

laxative abuse

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79
Q

menarche should start during what tanner stage

A

4

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80
Q

postpartum with signs of PE

A

go straight to anticoag

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81
Q

painless episodes of GI bleeding

A

angiodysplasia

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82
Q

MC place for angiodysplasia

A

R colon

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83
Q

angiodysplasia often co-occurs with what other disorder

A

AS

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84
Q

treatments for PAD

A

exercise&raquo_space; cilostozol&raquo_space; revascularization

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85
Q

blood problems in scleroderma

A

schistocytes

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86
Q

schistocytes, AKI, thrombocytopenia, malignant HTN

A

scleroderma

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87
Q

mcc of second stage arrest of labor

A

fetal malposition

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88
Q

vaccines 2 year old sickle cell patients need

A

PPSV23 and MCV4

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89
Q

reason for hypoCa in pancreatitis

A

precipitation of calcium soaps

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90
Q

FAST scan cannot see what areas

A

retroperitoneal or other peritoneal bleeds - it’s good for splenic but not kidney or aorta or pancreas

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91
Q

treatment for bacterial rhinosinusitis

A

augmentin (levo is as effective but has poorer s/e panel)

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92
Q

3 relatives, 2 generations, 1 before 50

A

Lynch, HNPCC

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93
Q

types of cancer in HNPCC

A

endometrial and colon

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94
Q

genetic failing in HNPCC

A

DNA mismatch repair with microsatelitte

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95
Q

tx for cholestasis of pregnancy

A

ursodeoxyacid, deliver at 36 weeks

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96
Q

CENTOR score

A 
C - no cough (1 pt)
E - exudates (1 pt)
N - node involvement (1 pt)
T - temp over 39
OR - <14 (1 pt) or >44 (-1pt)

<1 = nothing
2-3 rapid strep
>4 = rapid strep and treat regardless

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97
Q

location of b/l nose bleed

A

posterior - use packing

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98
Q

major/minor Duke criteria for IE

A

Maj: bacteremia, new onset regurg, vegetations
Minor: RF, fever, vascular, rheumatological

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99
Q

Tx for IE/SBE

A 
native valve: vanc ONLY
prosthetic valve <60d: vanc + gent + cefipime
61-364 days: vanc + gent
>365 days: vanc + gent + ceftriaxone
SBE: gent + ceftriaxone
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100
Q

Imaging modality for IE

A

TEE

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101
Q

when is surgery indicated for IE

A

florid CHF, veg >15mm, veg >10mm + embolism, stroke or MI, fungus, abscess

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102
Q

can’t give vanc in IE?

A

daptomycin

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103
Q

how long to treat IE/SBE for

A

4-6 weeks

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104
Q

increased Uosm and Una

A

SIADH

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105
Q

treatment for SIADH

A

demeclocycline to induce DI

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106
Q

Uosm is decreased and urine is dilute

A

DI

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107
Q

dx for DI

A

Deprive the Internal water

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108
Q

decreased serum Na and decreased serum Osm

A

SIADH from too much ADH

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109
Q

Not enough ADH

A

DI

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110
Q

euvolemic hypotonic hyponatremia causes

A

RATS

RTA, Addisons, thyroid, SIADH

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111
Q

how to deal with symp vs non symp SIADH

A

symp - water deprivation

non-symp - CT scan

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112
Q

what to check in euthryroid sick syndrome

A

rT3

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113
Q

thyroglobulin differences bt biologic and medically induced hyperthyroid state

A 
biologic = increased
induced = nonexistant
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114
Q

thyroid finding in recurrent miscarriage

A

antiTPO ab

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115
Q

most common factor in CP

A

prematurity

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116
Q

MCC of sepsis in fully vaccinated SS child

A

s pneumo

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117
Q

lesion of facial nerve: below vs above pons

A

below - Bell’s palsy

above - forehead sparing, may have hemiplegia, hemisensory loss

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118
Q

small for gestational age child with hearing loss and cataracts

A

congenital rubella

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119
Q

pt with HF and hx of MI

A

left ventricular aneurysm

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120
Q

deep Q waves and persistant ST elevation on EKG

A

left vent aneurysm

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121
Q

iron deficiency anemia and malabsorption

A

celiac

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122
Q

suspected celiac pt without IgA antiendomysial ab

A

could still be, maybe they’re selective IgA deficiency

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123
Q

movement of blood from high pressure aorta to low pressure pulmonary artery results in this murmur

A

PDA

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124
Q

mildly accentuated peripheral pulse

A

PDA

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125
Q

s/e of ICD

A

TR

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126
Q

hormonal derangement in OSA

A

increased EPO

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127
Q

increased renin, increased aldo in hypoK and HTN

A

secondary hyperaldosteronism - probably renovasular

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128
Q

decreased renin, increased aldo in hypoK and HTN

A

primary hyperaldosteronism - probably adrenal hyperplasia or aldosterone secreting tumor

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129
Q

decreased renin and aldo with hypoK and HTN

A

non aldosterone cause - probably CAH, cushings, exogenous mineralocorticoid

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130
Q

HTN, mild increase in Na, decreased renin

A

primary hyperaldosteronism

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131
Q

tx for allergic rhinitis

A

intranasal glucocorticoids

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132
Q

gram positive filimentous acid fast bacteria with brain abscess and lung involvemnt

A

nocardia - use bactrim and carbapenam if brain involvement

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133
Q

cardiac arrest after intubation of a hypovolemic pt

A

loss of right ventricular preload because right heart is too weak without volume

134
Q

why might you get cardiac arrest with PPV use in a hypovolemic pt

A

increase in intrathoracic pressure causes cardiac arrest b/c of no back pressure from right heart

135
Q

hypocalcemia with increased PTH

A

renal failure, vitamin D deficiency, PTH resisitance

136
Q

why do you see hypoCa in alkalosis

A

decreased number of charged sites on albumin that bind ca

137
Q

hypoCa with decreased phos

A

vitamin D def

138
Q

hypoCa with increased phos

A

renal failure

139
Q

how to correct Ca

A

[Ca] + {0.8 (4.0 - [albumin]}

140
Q

how does hypomag and hypermag cause hypoCa

A

by causing PTH resistance

141
Q

definition of hypoCa

A

<8.4

<4.2 ionized

142
Q

hypoCa with low to normal PTH

A

hypoparathyroidism

143
Q

holding all other variables constant, increased phos should do what to Ca

A

decrease

144
Q

what happens in the first phase of ATN

A

urine output decreases
BUN increases
lasts 36 hours

145
Q

MCC of intrarenal AKI

A

aminoglycosides

146
Q

what are the 3 phases of ATN

A

1) initiation
2) maint - oliguric (WATCH FOR increased K!)
3) recovery - polyuric (WATCH FOR decreased K!)

147
Q

ATN with intratubular oxalate crystal deposits under polarized light

A

ethylene glycol

148
Q

MCC of ischemic ATN

A

prerenal failure

149
Q

compromises renal perfusion

A 
decreased preload
hypovolemia
systemic vasodilation
cirrhosis
decreased CO
CHF
cardiogenic shock
NSAIDs
150
Q

FeNa >3 and muddy brown casts

A

ATN

Watch for FeNa <1 in contrast or rhabdo

151
Q

MCC of NHL

A

diffuse large B cell (25%)

152
Q

atypical lymphocytes that look like immature B cells

A

NHL - DLBC type

153
Q

types of cell markers in NHL - DLBC

A

CD19, 20, 22, 79a

154
Q

levels of excretion in hypophos - <100mg in 24 hours

A

refeeding syndrome or respiratory alk

155
Q

levels of excretion in hypophos - >100mg in 24 hours

A

hyperPTH or vitamin D deficiency

156
Q

MCC of euvolemic hypernatremia

A

free water loss or DI

157
Q

correct Na for high glucose

A

Na + 0.016 (glucose - 100)

158
Q

PTH inhibits renal reabsorption of what

A

phos

159
Q

how does vitamin D increase phos

A

through intestinal absorption

160
Q

Calculate urine anion gap

A

Na(u) + K(u) - Cl(u)

161
Q

positive UAG

A

RT dysfunction

162
Q

negative UAG

A

GI loss

163
Q

cell markers for PreT ALL

A

CD3, CD7

164
Q

cell markers for Burkitts

A

IgM, CD10, HLADR, CD43,

B antigens, CD19, 20, 22

165
Q

most effective antivirals in HIV

A

tenofovir + emtricitabine

166
Q

next best option if you can’t use the best in HIV (because of renal failure)

A

abacavir-lamuvidine

167
Q

preferred PIs to NRTI backbone

A

atazanavir or darunavir

168
Q

integrase inhibitiors

A

dolutegravir, elvitegravir, relategravir

169
Q

2/3 of sepsis cases are what kind of bacteria

A

gram positive

170
Q

how does follicular thyroid cancer spread

A

hemotogenously

171
Q

what is produced in the adrenal medulla

A

catecholamines - cats are the center of everything

172
Q

how to diagnose the tupe of cushings

A

low then high

173
Q

pt is hypotensive, N/V, coma

A

acute addisons

174
Q

pt is orthostatic and darker than they should be

A

chronic addisons

175
Q

consyntropin stim test shows increased cortisol

A

anterior pituitary problme

give prednisone only - MRI

176
Q

cosyntropin stim test shows no change to cortisol

A

problem is in the adrenal gland

give prednisone and fludricortisone - CT/MRI

177
Q

normal renin:aldo ratio

A

CAH or licorice OD

178
Q

renin:aldo ratio of <10

A

renovascular disease

179
Q

renin:aldo of >10

A

Conns test with salt suppression test and get MRI/CT if no suppression

180
Q

pt with newly diagnosed DM has GAD or IA2 antibodies

A

only insulin will work

181
Q

treatment for prediabetes

A

lifestyle and metformin

182
Q

treatment succession for diagbetes

A

1) lifestyle and metformin
2) 2nd agent
3) insulin

183
Q

A1c of >9%

A

go straight to insulin

184
Q

best test for DM

A

fasting glucose of >125

185
Q

breast feeding contraindications

A

TB, HIV, herpetic lesions, varicella, chemo/rads, substance abuse

186
Q

w/i 3 months of a change or stressor

A

adjustment disorder

187
Q

sausage digits + joint pain in the DIP

A

psoriatic arthritis

188
Q

hypotension after an epidural

A

vasodilation and venous pooling from sympathetic blockage

189
Q

pt has difficulty walking and cramping when sitting

A

PAD - >0.9 ABI is diagnositc

190
Q

D-xylose test - urinary excretion is decreased

A

absorption problem, likely celiac

191
Q

D-xylose test - urinary excretion is normal

A

pancreatic insufficiency

192
Q

newborn with HR <100

A

PPV

193
Q

newborn with HR <60

A

chest compressions

194
Q

drug that can cause peripheral edema

A

CCBs like amlodipine

195
Q

post parotid surgery complicaton

A

facial droop

196
Q

suspected aortic aneurysm, need to image, Cr high vs normal

A

high - TEE

normal - CT contrast

197
Q

pt with signs of right heart failure and remote history of hodgkinds lymphoma

A

constrictive pericarditis from radiation

198
Q

metabolic alkalosis + decreased urine Cl

A

vomiting

199
Q

bilateral hemiparesis s/p trauma

A

anterior spinal cord (motor is at the front)

200
Q

blunt trauma in pregnancy, and vaginal bleeding what do you do now

A

1) IVF

2) put the pt in L lat decubitus

201
Q

pt with high BUN and normal platelet count is bleeding

A

uremic platelet dysfunction

202
Q

most important thing s/p MI

A

restore blood flow

203
Q

contralatral hemisensory deficit with greater LE weakness and urinary incontinence

A

ACA

204
Q

medication other than abx that increases risk of c difficile

A

PPI

205
Q

acute cholecystitis is wehre

A

cystic duct

common bile duct would have jaundice

206
Q

NNRTIs

A

efavirenz - 1st gen

rilpivirine and etravirine - 2nd gen

207
Q

what lab should you always look for in sepsis

A

lactic acid!

208
Q

SIRS criteria

A

HR >90
T <36 or >38
WBC <4000 or >12000 or >10% bands
RR >20 or PaCO2 <32

209
Q

Delta gap (what is it)

A

differnce bt anion and bicarb

210
Q

how to calculate the delta gap

A

(AG - 10) - (24 - bicarb)

211
Q

hypoPTH usually does what to phos

A

hypo

212
Q

if saline admin doesn’t work for metabolic alkalosis

A

acetazolamide

213
Q

hyperNa with 800 mOsm/L excretion

A

renal etiology

214
Q

non pharmaceutical intervention for symptomatic hypermag

A

ventilation

215
Q

MC translocation in childhood pre B ALL

A

t(12;21)

216
Q

MC translocation in adult pre B ALL

A

t(9;22) philidelphia chromosome

217
Q

BM failure vs erythrocyte destruction or loss

A

reticulocytes will be down in BM failure

218
Q

extra renal hypovolemia

A

U(Na) <15 or FeNa <1%

219
Q

reticulocytes in hemolytic anemia

A

4-5%

220
Q

increased protein in kaposi sarcoma

A

VEGF

221
Q

angioproliferative disorder associated iwth HIV

A

kaposi sarcoma (HHV8)

222
Q

CD4 count for toxo

A

<100

223
Q

chorioretinitis + hydrocephalus + ring enhancing lesions + cortex and BG involvement

A

toxo

224
Q

imaging for toxo

A

MRI

225
Q

pneumonitis, myocarditis, necrotizing encephalitis

A

toxo

226
Q

what drug must you give with pyrimethamine

A

leucovorin

227
Q

MEN1 vs MEN2a vs MEN2b

A

MEN1 - Pituitary, Parathyrid (HyperCa), Pancreatic tumors (ZE and insulinoma)
MEN2a - Pheo, medullary thyroid CA, hyper PTH
MEN2b - Pheo, medullary thyroid CA, neuronal tumor

228
Q

genes of the MEN syndromes

A

MEN1 - MEN

MEN2a/b - RET

229
Q

dysfunction with basilar or vertebral CVA

A

syncope

230
Q

dysfunction with cerebellum CVA

A

ataxia

231
Q

person on warfarin has brain bleed on CT

A

give FFP

232
Q

causes of seizure

A 
Vascular
Infection
Trauma
Autoimmune
Metabolic
Ingestion
Neoplasm
pSych
233
Q

Pt is seizing and you can’t get it to stop - order of drugs

A

BZDs&raquo_space; fosfophenytoin&raquo_space; Midozalam&raquo_space; Propofol&raquo_space; Phenobarb

234
Q

how do you treat atonic or myoclonic seizures

A

valproate

235
Q

treatment for parkinsons <70 vs >70

A

<70 dopamine agonists like promipexole or ropinarole

>70 levo/carbidopa

236
Q

difference between essential and intention tremor

A

both with movement
intention is worse closer to target
essential you can treat with propranolol

237
Q

only headache you have to image

A

cluster

238
Q

flaccid paralysis, UMN symptoms after, bladder or bowel incontinenece after a repair ofan AA

A

anterior spinal cord syndrome becuase of proximity to artery of Adamkiewicz

239
Q

RA risks increase of what disease

A

osteoporosis

240
Q

SAAG of >1.1 and PMNs of >250

A

SBP

241
Q

child with macrocytic anemia, low reticulocytes, palor, congenital anomalies like webbed neck, cleft life and shield chest, with sporadic or AD/AR inheritance

A

Diamond Blackfan anemia

242
Q

liver abscess, dysentary with travel to an endemic region or animal contact

A

amebic abscess (e histolytica)

243
Q

treatment for liver abscess

A

metronidazole - don’t drain

244
Q

Fat person with restrictive pulmonary problem and respiratory acidosis

A

obesity hypoventilation

245
Q

complex multiloculated adnexal mass with thick walls and debris

A

TOA

246
Q

necrolytic migratory erythema with DM and GI symptoms like weight loss and diarrhea

A

glucagnoma

247
Q

serum glucagon level in a glucagonoma

A

> 500

248
Q

dry eyes, raynauds, cuteous vasculitis, interstitioal lung dz, NHL

A

sjogrens

249
Q

baby that is <28 days old with difficulty feeding and hypotonic and lethargic

A

suspect sepsis

250
Q

type of infection in diabetic ulcer

A

polymicrobial with contiguous spread

251
Q

HIV pt with CD4 <100 and small pustules on the face and groin

A

bartonella - bacilliary angiomatosis

252
Q

AMS, ataxia, diploplia, motor deficits with non ring enhancing brain lesions in HIV pt

A

progressive multifocal leukoencephalopathy (JC virus)

253
Q

pt with cirrhosis what next

A

EGD to r/o varicies

254
Q

deciding factors on a liver transplant 2/2 acetaminaphen tox

A

Cr >3.4
stage 3/4 encephalopahty
prothromin >100ms/INR 1.5

255
Q

first treatment for BPH

A

alpha blockers like terazosin or terazosin

5alpha reductase inhibitors comes second (finasteride)

256
Q

moderate to severe croup treatement

A

neb epi

257
Q

CAI tox

A

hyperchloremic metabolic acidosis and hypokalemia

258
Q

quickSOFA

A

RR >22
AMS
SBP <100

> 2 for sepsis

259
Q

signs and symptoms of metabolic alk are similar to what

A

hypocalcemia (tetany, confusion, cramps)

260
Q

normal role of antithrombin III

A

inhibits coagulation by lysing Xa and IXa

261
Q

pt in the ICU with BUN of 96 suddenly has increased diuresis and hypernatremia

A

increased in urea causes osmotic diuresis and therefore hypernatremia

262
Q

why does hypovolemic hypernatremia happen

A

more water than Na loss

263
Q

Imaging for portal vein thrombosis

A

contrast MRA, contrast CT but best initial is doppler u/s

264
Q

why is there increased urine sodium in hypovolemic alkalotic pt

A

Na is excreted to keep it, Urine Cl should be <20 in this case

265
Q

Pentad of TTP/HUS

A 
microangiopathic hemolytic anemia
thrombocytopenia
AKI
AMS
Fever
266
Q

Urine Cl of <10 suggests what

A

Cl responsive met alk and volume depletion

267
Q

How to treat moderate lead poisoning

A

45-69 level

succimer

268
Q

How to treat severe lead poisonign

A

> 70 level

EDTA

269
Q

Cancer with CD63, CD11c and CD25 and Anhexin-A1

A

hairy cell leukemia

270
Q

hypocloride makes alkolosis

A

worse

271
Q

hyperCa on EKG

A

short QT and block

272
Q

how to diagnose bladder CA

A

florescence cytoscopy

273
Q

casues of AIN

A

PCN, NSAIDs, allopurinol, sulfa, cephalosporins, PPI and rifampin

274
Q

cancerous progression of polycythemia vera

A

AML

275
Q

Ranson’s criteria

A 
WBC >16000
AST >250
glucose >200
Age >55
LDH >350
276
Q

what is in HgH

A

4 beta chains, missing 3 alphas

277
Q

met alk and hypoK becuase of increased aldo from hypovolemia, also H and K are secreted at alpha intercalated

A

Barters

278
Q

causes of normal gap hypoK met acid

A

RTA 1 - DCT can’t secrete

RTA 2 - decreased bicarb resorption in PCT

279
Q

normal gap hyperK met acid

A

RTA 4 - hypoaldo

280
Q

MCHC in spherocytosis

A

increased because of membrane loass

281
Q

increased proliferation of mesangial cells immune complexes on EM

A

IgA nephropathy

282
Q

mutation in gittlemans

A

AR mutation of NCCT in DCT

283
Q

gonadal dysgenesis, nephrotic syndrome, wilms tumor, mutation of WT1

A

Denys Drash

284
Q

vision loss, myocarditis, respiratory failure, encephalitis, seizures

A

toxocara canis

285
Q

prophylaxis for tension HA

A

TCAs - amitriptylene

286
Q

MOA of valproic acid

A

inhibit Na channels and enhance GABA

287
Q

MOA of topiramate

A

inhibit NMDA glutamate and enhance GABA

288
Q

how does s typhii get into the body

A

through Peyer’s patches in the TI and is taken up by macrophages

289
Q

how does tetanus work

A

cleaves synaptobrevin and inhibits release of glycine and GABA

290
Q

treatment for Meniere’s diesease

A

salt restrcition and meclizine

291
Q

cold water calorics - which direction

A

COWS

cold opposite, warm same

292
Q

in MS how to treat urinary retention, incontinence, spasms, neurogenic pain

A

retention - bethanachol
incontinence - amitriptyelene
spasms -baclofen
neuro - gabapentin

293
Q

never use what in GBS

A

steroids

294
Q

use what drug in MG

A

cholinesterase inhibitors

295
Q

How to diagnose ALS

A

EMG

296
Q

lateral knee injury - with or without crepitus

A

wo crepitus - MCL

with crepitus - medial meniscus

297
Q

how to treat acalculus cholecystitus

A

percutaneous cholesystotomy

298
Q

dermatophyte of tinea capitus

A

t. tonsurans

299
Q

treatment for tinea capitus

A

oral griseofulvin, terbinafine

300
Q

social vs generalized anxiety

A

social - people, nothing else

generalized - things, events, abstract worries

301
Q

lichen sclerosis vs atrophic vaginits

A

lichen sclerosis is like AV but will involve the anus as well and ther will be white skin or cigarette paper skin

302
Q

hypoNa in someone with decompenssated HF

A

severe sign of HF

caused by increased renin/norepi/ADH
tx: fluid restric, ACE-i, loop

303
Q

other name for strawberry hemangioma

A

superficial hemangioma

304
Q

what can you give in a complicated childhood hemangioma

A

propranolol

305
Q

other risk factors for osteoporosis

A

malabsorption, hypercortisolism, hyperthyroid, hyperPTH, RA, liver/renal, estrogen (early meno/hysterectomy)

306
Q

if you can’t give doxy in lyme disease

A

amoxicillin

307
Q

increased thrombosis risk in PNH where

A

cerebral and abdominal

308
Q

increased bili, LDH and low hapto

A

hemolytic anemia

309
Q

tx for neurocystercosis

A

albendazole

310
Q

imaging for kidney stone

A

u/s or non con CT

311
Q

radiopaque hexagonal crystals with familial hx

A

cysteine stones

312
Q

screening test for cystein stones

A

cyanide nitroprusside

313
Q

disorder of sickle cell disease/trait wehre kidney can’t concentrate urine

A

hyposthenuria

314
Q

renal problem where blood sickles in the vasa recta of the inner medulla

A

hyposthenuria

315
Q

drugs that increase/don’t increase survival in HF

A

increase: ACE, ARB, Beta, spironolactone

don’t increaes: digoxin and loops

316
Q

45 year old pt with cirrhosis - which pneumococal vax?

A

give 23-valnt and then 13 and 23 at 65

317
Q

perihilar linear opacities in newborn

A

respiratory distress syndrome give continuous PPV

318
Q

HTN and ambiguous female genitalia or precocious puberty in male

A

11-OH def

319
Q

HTN and failure of secondary sex charachteristics at puberty

A

17-OH def

320
Q

low urine/serum osm

A

psychogenic polydipsi

321
Q

low urine osm high serum osm

A

DI - diagnose through water deprivation test

322
Q

symptomatic managemet of nephrogenic DI

A

HCTZ, indomethacin, amilioride

323
Q

what will DDAVP do to osm in central DI

A

increase osm

324
Q

drugs that cause nephrogenic DI

A

lithium, demeclocycline, cidofovir, foscarnet, amphotericin B

325
Q

before starting insulin in someone with DKA what do you need to check firsts

A

K

326
Q

most common cause of death in DKA in children

A

cerebral edema

327
Q

overactive aldosterone and RAAS suppression - what kind of adrenal problem

A

primary hyperaldosteronism

328
Q

primary hyperaldosteronism from an aldosterone producing tumor

A

COnns

329
Q

adrenal adenomas - aldosterone producing? cortisol producing? androgen producing? Doesn’t produce?

A

aldo - Conns
cortisol - cushings
androgen - hyperandrogen
no hormone - incidentaloma

330
Q

overproduction of aldo, excess water retention, HTN, H/K wasting with metabolic alk and decreased K

A

Conn’s

331
Q

increased RAAS activity and low volume state

A

secondary hyperaldo - probably from CHF, cirrhosis, renal failure, nephrotic syndrome, (increased renin and aldo)

332
Q

difference between primary and secondary hyperaldo

A

primary - decreased renin and increaed aldo

secondary - increaed renin and aldo

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