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1
Q

Differential of depressed mood

A

MDD: ≥2 weeks, ≥5 of 9 (depressed mood AND SIGECAPS)

PDD (dysthymia): ≥2 years of chronic depressed mood; ≥2 of the following: appetite disturbance, sleep disturbance, low energy, low self esteem, poor concentration, hopelessness

Adjustment disorder with depressed mood: w/in 3 mo of stressor. Marked distress/functional impairment BUT does not meet criteria for MDD
-treatment: counseling and brief psychotherapy

Normal stress response: Not excessive/out of proportion no functional impairment

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2
Q

Workup of palpable breast mass

A

Age < 30:

  1. Ultrasound +/- mammogram
    • simple cyst –> needle aspiration (if pt desires)
    • complex cyst/mass or solid mass –> image-guided core biopsy

Age ≥ 30:

  1. Mammogram +/- ultrasound
    • suspicious for malignancy –> core biopsy
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3
Q

Congenital adrenal hyperplasia

A

MC GC A

21-hydroxylase: [ ↓ ] [ ↓ ] [ ↑ ]

  • salt wasting from lack of aldosterone (vomiting, hypotension, low sodium, high potassium)
  • hypoglycemia from lack of cortisol
  • ambiguous genitalia in girls, precocious puberty in boys
  • elevated 17-hydroxyprogesterone
  • treatment: glucocorticoids and mineralocorticoids

11β-hydroxylase: [ ↑ ] [ ↑ ] [ ↑ ]

  • hypertension, low K
  • ambiguous genitalia in girls
  • elevated 11-deoxycorticosterone and 11-deoxycortisol

17α-hydroxylase: [ ↑ ] [ ↑ ] [ ↓ ]

  • hypertension, low K
  • ambiguous genitalia in boys
  • absent puberty

***Autosomal recessive deficiency in 21-hydroxylase is most common. The other two have HYPERtension

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4
Q

Which type of congenital adrenal hyperplasia has salt wasting?

A

MC GC A

21-hydroxylase: [ ↓ ] [ ↓ ] [ ↑ ]

  • salt wasting from lack of aldosterone (vomiting, hypotension, low sodium, high potassium)
  • hypoglycemia from lack of cortisol
  • ambiguous genitalia in girls, precocious puberty in boys
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5
Q

Tetanus prophylaxis

A

≥3 tetanus toxoid doses:

  • clean or minor wound: vaccine if last dose ≥10 years ago, no TIG
  • dirty or severe wound: vaccine if last dose ≥5 years ago, no TIG

Unimmunized, uncertain, or <3 tetanus toxoid doses:

  • vaccine only, no TIG
  • vaccine PLUS TIG

TIG = tetanus immune globulin

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6
Q

H. pylori treatment

A

No PCN allergy, no macrolide use: PPI + clarithromycin. + amoxicllin for 10-14d [triple therapy]

PCN allergy, no prior macrolide or metronidazole use: PPI + clarithromycin + metronidazole for 10-14d [modified triple therapy]

High macrolide or metronidazole resistance OR treatment failure after 1 course of therapy: PPI + bismuth + metronidazole + tetracycline for 10-14d [quadruple therapy]

MAKE SURE TO CONFIRM ERADICATION (breath test or stool test)

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7
Q

Screening for HIV

A

Recommended test: p24 (HIV antigen) + HIV1/2 antibodies

1-4 weeks is window period, so should test 4 weeks after high-risk encounter

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8
Q

When should postexposure prophylaxis be started for HIV?

A

Ideally 1-2 hours after (< 72 hours)

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9
Q

What test is needed before starting ART for HIV?

A

Hepatitis B, since some regimens can target both

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10
Q

Carotid artery dissection

A

Contributors: trauma, HTN, smoking, connective tissue disease

Presentation: unilateral head & neck pain, transient vision loss, ipsilateral partial Horner syndrome (ptosis and miosis without anhidrosis), signs of cerebral ischemia (e.g., focal weakness)

Diagnosis: CT or MR angiography

Treatment:

  • thrombolysis (if ≤4.5 hrs after symptom onset)
  • antiplatelet (aspirin) +/- anticoagulation
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11
Q

Complex regional pain syndrome

A

Pain out of proportion to injury, temperature change, edema, abnormal skin color

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12
Q

Cryptorchidism

A
  • if still undescended at 6 months –> orchiopexy

- even with orchiopexy, there is a risk of malignancy

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13
Q

Number needed to treat

A

NNT = 1/ARR

ARR = control group event rate – experimental group event rate

ARR = absolute risk reduction

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14
Q

Absolute risk reduction

A

ARR = control group event rate – experimental group event rate

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15
Q

Most common suppurative complication of acute otitis media

A

Mastoiditis

displacement of the auricle

Fever, ear pain, tenderness to the area

Treatment: IV antibiotics and surgical drainage (tympanostomy or mastoidectomy)

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16
Q

Treatment of acute mania

A

Antipsychotics (e.g., risperidone)

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17
Q

Most common pathogen identified in corneal foreign bodies

A

coagulase negative Staphylococcus

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18
Q

Euthyroid sick syndrome

A

LOW T3, normal TSH and T4

Decreased peripheral conversion to T3

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19
Q

TST (PPD) interpretation

A

LATENT TB

5 mm:

  • HIV
  • recent contact with TB
  • fibrotic changes on CXR (suggestive of prior TB)
  • organ transplant recipients
  • immunocompromised

10 mm:

  • recent immigration from high prevalence country
  • injection drug user
  • residents and employees of high-risk settings (prisons, homeless shelters, healthcare facilities)
  • kids < 4

15 mm:
- no known risk factors

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20
Q

BCG vaccine and TST (PPD)

A

Should rarely cause >15 mm induration. And it decreases significantly 15 years after vaccine is received

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21
Q

Treatment of latent TB

A

3-4 months of rifamycin-based therapy

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22
Q

Management of acute calculous cholecystitis

A

Diagnosis: RUQ US showing gallstones with GB wall thickening or sonographic Murphy sign

If US is negative or inconclusive –> HIDA scan

Patients should get surgery within 72 hours, but diagnosis should be confirmed first

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23
Q

Urethral diverticulum

A

Dysuria, postvoid dribbling, dyspareunia, anterior vaginal mass

Associated with recurrent UTIs, hematuria, and stress urinary incontinence

Tender anterior wall vaginal mass that expresses bloody, purulent fluid on manipulation of the urethra

Diagnosis: MRI pelvis

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24
Q

Who needs chemoprophylaxis for meningococcal meningitis?

A
  • Household members
  • roommates or inmate contacts
  • child care center workers
  • persons directly exposed to respiratory or oral secretions (kissing, mouth-to-mouth resuscitation, intubation)
  • seated next to person ≥8 hours (flying)

Rifampin (alt: cipro or IM CTX)

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25
Q

Interpretation of odds ratio

A

OR < 1: exposure is associated with lower odds of the outcome compared to no exposure

OR = 1: exposure is not associated with the outcome

OR > 1: exposure is associated with higher odds of the outcome compared to no exposure

Confidence interval that excludes 1 is significant

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26
Q

Pediatric OSA

A

Due to adenotonsillar hypertrophy

Treatment: tonsillectomy/adenoidectomy

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27
Q

Neurofibromatosis type I

A

Acoustic neuroma (usually unilateral), cutaneous neurofibromas (hyperpigmented café au lait spots), axillary freckling, Lisch nodules

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28
Q

Neurofibromatosis type II

A

Bilateral acoustic neuromas (deafness), hypopigmented spots

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29
Q

Tuberous sclerosis

A

Congenital hypopigmented macule (ash-leaf spots), glial proliferation, and several organ hamartomas/cysts

PROGRESSIVE NEUROLOGIC IMPAIRMENT

TSC1/2 mutations

Derm: ash-leaf spots, Shagreen patches, angiofibromas of malar region

Neuro: CNS lesions, epilepsy (infantile spasms), intellectual disability, autism

Cardiac: rhabdomyomas

Renal: angiolipomas

Need regular tumor screening (MRI brain/kidney)

CAUSE OF DEATH: neurologic (epilepsy)

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30
Q

Sturge-Weber syndrome

A

Facial port-wine stain and leptomeningeal angiomatosis

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31
Q

Osler-Rendu-Weber syndrome

A

Multiple telangectasias and vascular lesions of the CNS

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32
Q

Postexposure prophylaxis for HIV

A

Combination ART within 1-2 hours of exposure, for 4 weeks

Then test for HIV at 6 weeks and 4 months

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33
Q

Diagnosis of menopause

A

≥1 year of amenorrhea

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34
Q

Who needs endometrial biopsy?

A

Women ≥45 with anovulatory bleeding

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35
Q

Pubertal gynecomastia

A

Resolves within 1 year

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36
Q

Hypoparathyroidism vs pseudohypoparathyroidism

A

HypoPTH: low PTH, low Ca, high phos
PseudohypoPTH: high PTH, low Ca, high phos

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37
Q

Hazard ratio interpretation

A

Likelihood of an event occurring in a treatment group relative to the control group

Null value = 1

HR < 1: event is less likely to occur in a treatment group than the control group

HR > 1: event is more likely to occur in a treatment group than the control group

Statistically significant: CI does NOT include 1

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38
Q

Immune thrombocytopenia

A

Presentation

  • antecedent viral infection
  • asymptomatic petechiae and purpura
  • mucous membrane bleeding

Labs

  • ISOLATED thrombocytopenia
  • negative DAT

Treatment

  • mild or no bleeding: observe
  • moderate/severe bleeding: IVIG
  • chronic ITP with no response to pharmacotherapy: splenectomy
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39
Q

Treatment of toxic megacolon

A

Medical unless there’s perforation

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40
Q

Standard deviations and percentage of data set

A
  • 1 to 1: 68%
  • 2 to 2: 95%
  • 3 to 3: 99.7%
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41
Q

Levels of prevention

A

Primordial: prevention of risk factors themselves
Primary: action taken before a patient develops a disease
(prevent occurrence of the disease)
Secondary: attempts to prevent the progression of a disease at its initial stage before irreversible pathologic changes occur
Tertiary: taking all actions available to limit impairments and disabilities
Quaternary: mitigate and/or limit the consequences of unnecessary or excessive intervention by the health system

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42
Q

Subclinical hyperthyroidism

A

Clinical characteristics

  • suppressed TSH
  • normal thyroid hormone levels
  • hyperthyroid symptoms may or may not be present

Causes

  • exogenous thyroid hormone
  • Graves’ disease
  • nodular thyroid disease

Indications for treatment

  • TSH persistently < 0.1
  • TSH 0.1 - 0.5 PLUS additional risk factors
    • ≥ 65
    • heart disease
    • osteoporosis
    • nodular thyroid disease
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43
Q

Can physicians keep information about sexual activity of minors from parents?

A

Yes (unless there is suspicion of abuse, etc)

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44
Q

Acute appendicitis in pregnancy

A

Can present atypically since uterus displaces appendix upward (i.e. can lack McBurney point tenderness)

Image with ULTRASOUND (if inconclusive, MRI)

Appendiceal perforation increases the risks of spontaneous abortion, preterm labor, and preterm delivery. Also pylephlebitis (infective suppurative portal vein thrombosis)

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45
Q

Imaging for acute appendicitis in pregnancy

A

ULRTASOUND

If inconclusive, MRI

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46
Q

Complication of untreated appendicitis or other intraabdominal or pelvic infections

A

Pylephlebitis (infective suppurative portal vein thrombosis)

Fever, RUQ pain, jaundice, hepatomegaly

Elevated ALP and GGT

Imaging shows thrombus

Polymicrobial bacteremia is common

Broad spectrum antibiotics

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47
Q

Risk factors for UTI in kids

A
  • female
  • uncircumcised males
  • urologic abnormalities (e.g., vesicoureteral reflux)
  • bowel/bladder dysfunction (e.g., constipation)
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48
Q

Workup of pediatric UTI

A

If < 24 months and febrile:

- renal and bladder ultrasound (and voiding cystourethrogram if abnormal)

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49
Q

Measles (rubeola)

A
  1. Prodrome: cough, coryza, conjunctivitis, fever, Koplik spots
  2. Maculopapular exanthem
    • cephalocaudal and centrifugal spread
    • spares palms/soles

Fever + rash (as opposed to roseola fever then rash)

Can give vitamin A in hospitalized patients

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50
Q

Kawasaki disease

A

≥5 days of FEVER + ≥ 4

  • conjunctivitis
  • mucosal changes
  • lymphadenopathy (> 1.5 cm)
  • rash
  • extremity changes

Mnenomic: CRASH & Burn (5+ days of fever)

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51
Q

Erythema infectiosum

A

Parvovirus B19

Fever, cough –> slapped cheek rash and reticular truncal rash

School aged children

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52
Q

Roseola

A

Fever –> defervesce –> rash

HHV6

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53
Q

Scarlet fever

A

Streptococcus pyogenes

Fever, pharyngitis, sandpaper rash

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54
Q

Natural history of eczema (atopic dermatitis)

A

Resolved by adulthood

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55
Q

Healthy worker effect

A

Selection bias where the working population is healthier than the nonworking

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56
Q

Papular urticaria

A

Delayed hypersensitivity reaction to insect bites

(not true urticatia)

H1 blockers, topical corticosteroids

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57
Q

Lichen planus

A

Purutic, pink/purple, polygonal papules and plaques

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58
Q

Nummular eczema

A

Coin-shaped

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59
Q

Antithyroid medications in pregnancy

A

1st trimester: PTU

2nd/2rd trimester: methimazole

“Pregnant? PTU!”

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60
Q

Anterior uveitis (iritis)

A

Pain, redness, variable vision loss, constricted and irregular pupil

Slit lamp: leukocytes in anterior segment

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61
Q

Infectious keratitis

A

Severe photophobia and difficulty keeping eye open

Penlight: corneal opacity or infiltrate

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62
Q

Postoperative atrial fibrillation (following cardiac surgery)

A

Spontaneously converts so sinus rhythm within days

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63
Q

Foot drop

A

Peroneal nerve

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64
Q

Femoral nerve injury

A

Inability to extend the knee, loss of knee jerk reflex, sensory loss over the anterior and medial aspects of the thigh, medial aspect of shin, and arch of the foot

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65
Q

If patient comes in with signs/symptoms of Lyme disease

A

Early localized Lyme: Oral doxycycline (serologic testing is often negative in early disease, so early Lyme is a CLINICAL diagnosis)

Early and late disseminated: serologic testing prior to treatment

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66
Q

Order of Lyme testing

A

ELISA –> Western blot

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67
Q

Type of psychotherapy for OCD

A

Exposure and response prevention therapy

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68
Q

Treatment of fibroids

A

Depends on fertility goals

  1. hormonal contraception
  2. hormonal IUD
  3. GnRH agonist (for preop)
  4. surgery
  5. uterine artery embolization
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69
Q

Sharp object ingestion

A

Urgent endoscopy (prevent esophageal perforation`)

e.g. fish bone

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70
Q

Prevention of fat emboli

A

Early immobilization and operative fixation of fractures

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71
Q

Fat embolism

A
  • Respiratory insufficiency
  • neurologic impairment
  • petechial rash

Prevention: Early immobilization and operative fixation of fractures

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72
Q

Subclinical hypothyroidism

A

Elevated TSH with normal T4

Most common cause: Hashimoto thyroiditis

Anti-TPO antibodies can help establish diagnosis and determine whether to treat

Complications: recurrent miscarriages, severe pre-eclampsia, preterm birth, low birth weight, placental abruption

Whom to treat: significant elevations in TSH, goiter, convincing hypothyroid symptoms

TSH levels

  • ≥10: treat
  • 7-9.9
    • < 70: treat
    • > 70: treat if convincing hypothyroid symptoms
  • upper limit of normal to 6.9
    • < 70: treat if convincing hypothyroid symptoms, enlarging goiter, or elevated anti-TPO titer
    • ≥ 70: do not treat (possible harm)
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73
Q

Most common cause of subclinical hypothyroidism

A

Hashimoto thyroiditis

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74
Q

When to use thyroid radionucleotide uptake scan

A

Workup of HYPERthyroidism

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75
Q

Complications of subclinical hypothyroidism

A

Recurrent miscarriages, severe pre-eclampsia, preterm birth, low birth weight, placental abruption

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76
Q

Elevated serum calcitonin

A

Medullary thyroid cancer

In isolation or part of MEN 2 (A or B)

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77
Q

Pretibial myxedema

A

NON-pitting edema of the legs

HYPERthyroidism

(DO NOT CONFUSE with myxedema coma which is hypothyroidism)

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78
Q

Enuresis

A

Urinary incontinence (primarily nocturnal) age ≥ 5

Primary nocturnal enuresis: the inability to have ever achieved nighttime dryness

Workup: urinalysis

  • ultrasound is only needed if there are urinary symptoms (daytime incontinence, weak stream)
  • creatinine is only needed if there are signs of renal disease (hypertension)

Treatment:

  • treat comorbid conditions (constipation)
  • behavioral modification (restrict evening fluids)
  • enuresis alarm
  • desmopressin
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79
Q

Workup of enuresis

A

Urinalysis

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80
Q

Anticoagulation during pregnancy

A

LWMH throughout pregnancy, UFH before delivery (since can be reversed with protamine)

Unless has mechanical valve, in which case warfarin 2nd and 3rd trimester (and then UFH before delivery)

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81
Q

Mechanical valve anticoagulation in pregnancy

A

LWMH in first trimester, warfarin in 2nd and 3td trimesters, UFH in the last few weeks before delivery

UFH is easily reversed with protamine

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82
Q

Mechanical vs bioprosthetic valve

A

Mechanical: more durable, lower risk of failure, but LIFELONG ANTICOAGULATION

Bioprosthetic valve: 3 months of anticoagulation

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83
Q

Warfarin and breastfeeding

A

OK: warfarin does NOT enter breastmilk

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84
Q

Management of adhesive capsulitis

A

Mild: range of motion exercises
Severe: steroid injections, surgery if refractory

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85
Q

Infectious mononucleosis diagnosis

A

Heterophile antibody test (Monospot)

25% false negative rate during first week of illness

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86
Q

Workup of normocytic anemia

A

Reticulocyte count

production vs destruction

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87
Q

Treatment of Tourette syndrome

A
  • antidopaminergic agents
    • tetrabenazine (dopamine depleter)
    • antipsychotics (dopamine receptor blockers)
  • alpha-2 adrenergic receptor agonists
  • behavioral therapy
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88
Q

Diagnosis of Tourette syndrome

A

BOTH vocal and motor tic (> 1 year, not necessarily concurrent)

Commonly comorbid with ADHD and OCD

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89
Q

Abruptio placentae

A

Placental detachment from the uterus before fetal delivery

RFs

  • HTN, preeclampsia
  • abdominal trauma
  • prior AP
  • cocaine and tobacco use

Presentation

  • sudden onset vaginal bleeding
  • abdominal or back pain
  • high-frequency, low-intensity contractions
  • rigid, tender uterus

Diagnosis

  • clinical
  • US: +/- retroplacental hematoma

Complications

  • fetal hypoxia, preterm birth, mortality
  • maternal hemorrhage, DIC

Acute AP with active bleeding is an indication for delivery

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90
Q

Placenta previa

A

When the placenta implants over the cervix

PAINLESS vaginal bleeding

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91
Q

Management of pressure ulcers

A

I/II: semipermeable dressings to maintain moist environment

III/IV: debridement of devitalized tissue

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92
Q

Which patients need endoscopy for dyspepsia?

A

Red flags and AGE (≥ 60)

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93
Q

Normal language development at age 2

A

≥50 words, use of 2-word sentences

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94
Q

If language delay in a child

A

Needs audiology evaluation

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95
Q

If thyroid nodule

A

TSH and US

If suspicious findings on US –> FNA

If normal or high TSH –> FNA

If low TSH –> radio-uptake scan

  • if hot nodule –> treat hyperthyroidism
  • if low or indeterminate –> FNA
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96
Q

Management of differentiated thyroid cancer (papillary, follicular)

A

Depends on extent of disease

Need ultrasound of neck and cervical lymph nodes for staging

Small <1cm cancers can be managed with lobectomy. Larger ones require total thyroidectomy. And extension into neck requires radical neck dissection.

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97
Q

Management of corticosteroid-induced psychiatric symptoms

A

Dose reduce, if possible (or stop altogether)

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98
Q

Polymyalgia rheumatica

A

Rapid-onset pain and stiffness in the shoulders and hips (+/- neck involvement)

  • fatigue, weight loss, low-grader fever
  • 10% associated with giant cell arteritis (headache, jaw claudication, visual symptoms)
  • elevated ESR, CRP

Disorder of joints, bursae, and tendons, NOT muscle!

NORMAL STRENGTH AND CK

Treatment: glucocorticoids

Temporal artery biopsy IF symptoms of GCA

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99
Q

What to do if suspect giant cell (temporal) arteritis

A

Temporal artery biopsy, BUT biopsy should not delay the start of steroids

Start steroids first if high clinical suspicion

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100
Q

What to do if you see a patient subject to a potentially harmful treatment

A

Contact state medical board to report the physician

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101
Q

Characteristic of uterine rupture

A

Loss of fetal station

Also acute pain, vaginal bleeding, late decelerations, palpable fetal parts

Need emergency laparotomy for delivery and uterine repair

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102
Q

When to use amnioinfusion

A

Treat variable decelerations from umbilical cord compression

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103
Q

Trastuzumab-associated cardiotoxicity

A

REVERSIBLE

Due to “myocardial hibernation,” not atherosclerosis

Not dose related

STOP if EF drops significantly

Treat with GDMT

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104
Q

Management of gallstone pancreatitis

A

Depends on severity

Mild [no organ failure or local or systemic consequences]: cholecystectomy within 7 days of clinical improvement (during hospitalization)

Severe: delayed cholecystectomy, may also need ERCP if persistently abnormal liver chemistries

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105
Q

Options for type II HIT

A

Direct thrombin inhibitors (argatroban, bivalirudin) or fondaparinux

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106
Q

Can patients with type II HIT ever get heparin again?

A

NO

Even though antibodies don’t last long, it is life threatening

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107
Q

Can a grandparent consent for a child?

A

In non-emergent situations, no

Must be the PARENT or LEGAL GUARDIAN

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108
Q

Definition of hypoglycemia

A

≤ 60

(Remember Whipple’s triad: low blood glucose, symptoms of hypoglycemia, symptomatic relief with administration of glucose)

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109
Q

Viral meningoencephalitis

A

Signs of meningitis and neuro abnormalities after viral infection

Most common: enteroviruses (coxsackie), HSV, adenoviruses

Treatment: empiric acyclovir + vanc + 3rd gen cephalosporin

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110
Q

Manifestations of sarcoidosis

A

Pulmonary

  • bilateral hilar adenopathy
  • interstitial infiltrates

Cutaneous

  • papular, nodular, or plaue-like lesions
  • erythema nodosum

Opthalmologic

  • anterior uveitis (iridocyclitis or iritis)
  • posterior uveitis
  • keratoconjunctivitis sicca

Reticuloendothelial

  • peripheral lymphadenopathy
  • hepatomegaly
  • splenomegaly

Musculoskeletal

  • acute polyarthritis (usually ankles)
  • chronic arthritis

Cardiovascular

  • atrioventricular block
  • dilated or restrictive cardiomyopathy

CNS/endocrine

  • facial nerve palsy
  • central diabetes insipidus
  • hypercalcemia

Löfgren syndrome

  • erythema nodosum
  • hilar adenopathy
  • migratory polyarthralgia
  • fever
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111
Q

Confirmatory diagnosis of sarcoidosis

A

Biopsy from easiest accessible site (usually a lymph node or skin lesion)

If there is no accessible lesion, do bronch with biopsy

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112
Q

Preferred agent for awake intubations

A

Ketamine

Dissociation, amnesia, analgesia, sympathetic surge

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113
Q

Failed airway

A

Cricothyrotomy

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114
Q

Management of pelvic organ prolapse

A

Pessary vs surgery is equally effective. Depends on whether they are surgical candidate

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115
Q

Surgery for stress incontinence

A

Mid-urethral sling procedure

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116
Q

CRC screening in patients with a first-degree relative with CRC

A

10 years before they were diagnosed OR 40, whichever comes first

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117
Q

If positive stress test

A

Medical management (aspirin, statin, beta blocker, optimization of risk factors) and, if high risk features on stress test percutaneous coronary angiography

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118
Q

Postpartum hemorrhage

A

Causes

  • uterine atony (most common)
  • retained placenta
  • genital tract laceration
  • uterine rupture
  • coagulopathy

Uterine atony:

  • Heavy vaginal bleeding with soft, enlarged uterus above the umbilicus
  • uterine massage and oxytocin
  • second line: methylergonovine, carboprost, misoprostol
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119
Q

Uterine atony

A

Most common cause of postpartum hemorrhage

Heavy vaginal bleeding with soft, enlarged uterus above the umbilicus

Treatment: uterine massage and oxytocin
-second line: methylergonovine, carboprost, misoprostol

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120
Q

Odds ratio calculation

A

OR = (a * d) / (b * c)

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121
Q

Tumor lysis syndrome

A

High phosphorus, potassium, uric acid
Low calcium

AKI, cardiac arrhythmias, seizures

Pretreatment with allopurinol/febuxostat and fluids

Treat with IV fluids and rasburicase

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122
Q

Pheochromocytoma screening

A

Plasma or urine free metanephrine

If positive, get CT or MRI abdomen

  • if positive: surgery, genetic testing, alpha then beta blocker,
  • if negative: MIBG scan, octreotide scan, PET scan, whole body MRI

(Pheos are usually in the adrenals)

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123
Q

Management of hyper/hypotension during pheochromycytoma surgery

A

Hypotension: fluids (pressors if needed)

Hypertension: nitroprusside, phentolamine, or nicardipine

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124
Q

Indication for EPO in CKD

A

Hgb < 10

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125
Q

CKD and CAD

A

CKD increases the risk. Any may present atypically. Low threshold for stress testing.

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126
Q

Ferritin in thalassemia

A

High due to increased RBC turnover

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127
Q

Eczema herpeticum

A

HSV superinfection of atopic dermatitis

Also get fever and lymphadenopathy

Need systemic antivirals (acyclovir)

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128
Q

Acute myelopathy

A

transverse myelitis vs compressive (NOT GBS which would not have sensory level or bowel/bladder dysfunction)

If sensory level or bowel/bladder dysfunction, need MRI spine

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129
Q

Urinary schistosomiasis

A

Urinary symptoms, terminal hematuria, peripheral eosinophilia

Diagnosis: urinary sediment microscopy

Treatment: praziquantel

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130
Q

Acute vs chronic dysentery

A

Acute bloody diarrhea is most commonly due to BACTERIAL INFECTION

< 2 weeks

Begin with stool pathogens

Endoscopy if chronic

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131
Q

Pre-eclampsia

A

New onset HTN (≥140/≥90) at ≥20 weeks gestation
PLUS
proteinuria and/or end-organ damage

Severe features

  • ≥160/≥110 (x2, 4hrs apart)
  • thrombocytopenia
  • elevated creatinine
  • elevated transaminases
  • pulmonary edema
  • visual or cerebral symptoms

Management

  • magnesium sulfate (seizure prophylaxis)
  • antihypertensives
  • without severe features: delivery at ≥37 weeks
  • with severe features: delivery at ≥34 weeks
  • MATERNAL STABILIZATION FIRST, THEN DELIVERY
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132
Q

Most commonly injured nerve in shoulder dislocation

A

Axillary –> numbness/tingling over lateral aspect of shoulder

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133
Q

Treatment of strep pharyngitis

A

Amoxicillin (or penicillin)

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134
Q

If cervicitis

A

Treat empirically with CTX/doxy

Sexual partner(s) should also be treated

No need to remove IUD

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135
Q

Hirschprung disease on contrast enema

A

TRANSITION ZONE between normal caliber rectosigmoid and markedly dilated descending colon

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136
Q

Imaging for pyloric stenosis

A

Abdominal ultrasound

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137
Q

Problems with sputum AFB

A

Gold standard, but

  1. low sensitivity (false negatives)
  2. can’t distinguish between TB and nmbTB

Need mycobacterial culture or NAAT

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138
Q

Management of actinic keratosis

A

Cannot be left untreated since can progress to squamous cell carcinoma

Individual lesions: cryosurgery, surgical excision, curretage
Numerous: 5-fluorouracil cream

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139
Q

Labs in anabolic steroid use

A

Low testosterone, FSH, LH

High LDL, low HDL

Erythrocytosis

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140
Q

Treatment of PAD

A

Step 1A

  • smoking cessation
  • BP and diabetes control
  • aspirin
  • high intensity statin (regardless of cholesterol level)

Step 1B
-supervised exercise therapy

Step 2
-Cilostozol (just for symptoms)

Step 3
-revascularization

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141
Q

Hawthorne effect

A

Awareness of being in study –> change in behavior

Threat to internal validity

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142
Q

Essential tremor treatment

A

Propranolol

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143
Q

Acute mania in pregnancy

A

Antipsychotics

ECT for treatment resistant or very severe cases

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144
Q

Lateral medullary (Wallenberg) syndrome

A
  • Vertigo/nystagmus
  • loss of pain and temperature sensation in the ipsilateral face and contrlateral body
  • bulbar weakness
  • ipsilateral Horner syndrome

“Don’t pick a (PICA) horse (hoarseness) that can’t eat (dysphagia)”

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145
Q

Medial medullary syndrome

A
  • ipsilateral tongue weakness

- contralateral arm/leg weakness

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146
Q

Myotonic dystrophy

A

Autosomal dominant CTG trinucleotide repeat expansion (with anticipation)

Adult: myotonia and weakness (face, hands, ankles)
Childhood: cognitive and behavioral problems (and then the development of classic symptoms)
Infants: hypotonia, respiratory failure, inverted V-shaped upper lip, contractures, club foot, cataracts

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147
Q

Treatment of polycystic kidney disease

A

ACE inhibitors

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148
Q

Treatment of localized squamous cell carcinoma of the glottis

A

Radiation and laser therapy

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149
Q

Acute stress disorder vs PTSD

A

1 month

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150
Q

When is exercise contraindicated in pregnancy

A
  1. patients at risk for preterm delivery
    - cervical insufficiency
    - h/o preterm labor
    - PPROM
  2. patients at risk for antepartum bleeding
    - placenta previa
    - persistent second or third trimester bleeding
  3. patients with underlying conditions that could be exacerbated with exercise
    - severe anemia
    - HTN disorders of pregnancy
    - restrictive lung disease
    - severe heart disease
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151
Q

What can provoke Torsades in patients with long QT

A

Bradyarrhythmia

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152
Q

Management of cryptococcal meningitis

A

Amphoterocin B and flucytosine, followed by fluconazole for a year

Serial LPs if high ICP

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153
Q

Reconstruction of cleft palate

A

Rule of 10s

  • 10 weeks of age
  • 10 lbs of weight
  • 10g of hemoglobin
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154
Q

Treatment of urgency incontinence

A

Bladder training with timed voids

caused by detrusor muscle overactivity

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155
Q

Lead level indication for chelation therapy

A

> 45

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156
Q

ABO hemolytic disease

A

Mom: O+
Baby: A+ or B+

Mom has antibodies against A and B

Mild-moderate: phototherapy
Severe: bilirubin > 20: exchange transfusion

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157
Q

Treatment of allergic bronchopulmonary aspergillosis

A

Systemic glucocorticoids + itraconazole or voriconazole

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158
Q

Serotonin syndrome

A
  • mental status changes
  • autonomic dysregulation (diaphoresis, hypertension, tachycardia, hyperthermia, vomiting, diarrhea)
  • neuromuscular hyperactivity (tremor myoclonus, hyperreflexia)
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159
Q

FMLA

A

can take time off for medical illness or taking care of sick family member

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160
Q

Who gets lichen sclerosus?

A

Hypoestrogenic states: pre-puberty and post-menopause

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161
Q

Bugs from human bites

A
  • Eikenella corrodens
  • viridans streptococci
  • Staph aureus
  • other anaerobes (Fusibacterium, Prevotella)

Amoxicillin-clavulanate

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162
Q

Treat human bite

A

Amoxicillin-clavulanate

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163
Q

SGLT-2 inhibitor side effects

A
  • poluyria
  • UTIs
  • vulvovaginal candidiasis
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164
Q

Radioiodine uptake in subacute (De Quervain) thyroiditis

A

LOW (because of suppressed TSH)

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165
Q

Electrolyte abnormality associated with transfusions

A

Hypocalcemia, since citrate (anticogulant) is a chelator (hyperactive DTRs, muscle cramps, seizures)

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166
Q

Treatment of infant botulism

A

Botulism immune globulin

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167
Q

How long does it take for warts to go away with salicylic acid?

A

2-3 weeks

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168
Q

When are steroids indicated in Pneumocystis pneumonia

A

A-a gradient ≥ 35 on room air

SpO2 < 70

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169
Q

If lobular carcinoma in situ (LCIS)

A

Excisional biopsy

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170
Q

Fentanyl clearance

A

Liver

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171
Q

Treatment of tertiary hyperparathyroidism

A

Parathyroidectomy if:

  • persistently elevated Ca, Phos, PTH
  • soft tissue calcification or calciphylaxis (vascular calcification with skin necrosis)
  • intractable bone pain or pruritis
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172
Q

If acute diverticulitis that doesn’t improve in 2-3 days with antibiotics

A

CT scan

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173
Q

First step in the management of HHS

A

Aggressive fluid resuscitation

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174
Q

Initial workup of polycythemia

A

EPO level

  • high: compensation for chronic hypoxia in pulmonary disease
  • low: polycythemia vera
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175
Q

If suspect Paget disease of bone

A

Obtain calcium and alkaline phosphatase

  • ALP: elevated
  • Ca: normal

Also get radionucleotide bone scan

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176
Q

Treatment of Paget disease of bone

A

Bisphosphonates

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177
Q

Hypothyroid patients who become pregnant or go on OCPs

A

May need higher doses of levothyroxine since TBG is upregulated by estrogen

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178
Q

Diabetic gastroparesis

A

Longstanding diabetes, poor glucose control, autonomic symptoms, constipation

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179
Q

Treatment of PCP intoxication

A

Benzos

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180
Q

Tamoxifen side effects

A
  • hot flashes
  • VTE
  • endometrial hyperplasia/carcinoma
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181
Q

Treatment of Lyme in pregnancy

A

Amoxicilin

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182
Q

Treatment of uncomplicated Zoster

A

7d of valacyclovir

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183
Q

Intubate at what GCS level

A

8 (or before if e/o resp failure)

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184
Q

Treatment of severe mania

A

Lithium/valproate PLUS antipsychotic

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185
Q

Causes of stress urinary incontinence`

A
  • hypermobile urethra

- decreased urethral sphincter tone

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186
Q

Infant cardiac complication of gestational diabetes

A

Transient hypertrophic cardiomyopathy

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187
Q

Prevention of cluster headaches

A

Verapamil

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188
Q

Ruling in vs out

A

Sensitivity: out
Specificity: in

SNOUT SPIN

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189
Q

Treatment of ischemic priapism

A
  1. onset: urination, cold compresses
  2. aspiration of the corpora cavernosa
  3. intracavernosal injection of alpha agonist (phenylephrine)
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190
Q

Most common request for euthanasia/PAS

A

Loss of autonomy and control

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191
Q

Prophylaxis in chronic granulomatous disease

A

TMX/SMX + itraconazole

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192
Q

Empiric treatment of osteomyelitis in sickle cell disease

A

Anti staph agent (nafcillin/oxacillin or cefazolin for MSSA; clindamycin or vancomycin for MRSA) PLUS anti-salmonella (3rd gen cephalosporin CTX or cefotaxime)

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193
Q

When does Pap start?

A

21

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194
Q

If a consultant wants to change plan of care

A

Call PCP first

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195
Q

Preterm prelabor rupture of membranes

A

Leakage of fluid in < 37 weeks without contractions

Nitrazine positive fluid that ferns on microscopy

Likely due to subclinical intrauterine infection (BV is a RF)

Management

  • ≥34 weeks: induction of labor
  • <34 weeks: expectant management
    • prophylactic latency abx (ampicillin + azithromycin)
    • corticosteroids
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196
Q

Herpangina

A

Vesicles on posterior oropharynx

Coxsackie A

Supportive treatment

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197
Q

Buffalo hump in HIV

A

HIV-associated lipodystrophy

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198
Q

Treatment of acute multiple sclerosis

A

IV steroids

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199
Q

Amiodarone effect on warfarin

A

Increases effect, so need to decrease warfarin by 25%-50%

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200
Q

Pyloric stenosis risk factor

A

Macrolide antibiotics

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201
Q

Treatment of postpartum endometritis

A

Clindamycin + gentamicin

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202
Q

Treatment of intrapartum amniotic infection

A

Ampicillin + gentamicin

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203
Q

Risk factors for postpartum endometritis

A
  • C section
  • GBS
  • intraamniotic infection
  • prolonged ROM
  • operative vaginal delivery
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204
Q

What is the kappa statistic?

A

Inter-rater reliability

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205
Q

Otitis-conjunctivitis syndrome

A

nontypeable H. influenzae

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206
Q

Diphtheria complication

A

Myocarditis

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207
Q

Neurologic findings in frontotemporal dementia

A

20% can have motor neuron disease with upper (fasiculations) and lower (hyperreflexia) signs

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208
Q

Culprit bugs in necrotizing fasciitis

A
  • Streptococcus pyogenes (GAS)
  • Staph aureus
  • Clostridium perfringens
  • polymicrobial
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209
Q

Management of complicated ureterolithiasis (obstruction, infection)

A

Perc neph tubes

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210
Q

Dashboard injury

A

PCL

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211
Q

Rheumatic fever criteria

A

Major: JONES

  • joints (migratory arthritis)
  • carditis
  • nodules (subQ)
  • erythema marginatum
  • Sydenham chorea

Minor

  • fever
  • arthralgia
  • ESR/CRP
  • prolonged PR interval

Need penicillin until adulthood to clear GAS

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212
Q

Best test to diagnose pneumothorax

A

Bedside ultrasound

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213
Q

Treatment of malignant otitis externa

A

IV ciprofloxacin

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214
Q

Treatment of cataplexy

A

SNRIs, SSRIs, TCAs, sodium oxybate

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215
Q

Lichen planus is associated with

A

HCV

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216
Q

Best test after starting antithyroid meds

A

T3 and T4 (TSH can remain suppressed for some time)

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217
Q

Management of vertebral compression fracture

A

Pain control (NSAIDs, acetaminophen, opioids, calcitonin) and exercise (not bed-rest). Surgery only for persistent refractory pain

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218
Q

If high-grade squamous epithelial lesion on Pap

A

Colopscopy (or LEEP if ≥25, not pregnant, and done childbearing)

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219
Q

Treatment of TB in pregnancy

A

Isoniazid, rifampin, and ethambutol for 2 months, then INH and RIF for 7 months

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220
Q

Inadequate response to IV diuretics in ADHF

A

Vasodilator (IV nitroglycerin)

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221
Q

Cutaneous cryptococcosis

A

Papules with central umbilication, hemorrhagic crust

Diagnose with biopsy

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222
Q

Treatment of asymptomatic bacteriuria

A
  • cephalexin
  • nitrofurantoin
  • amoxicililn or amoxicillin-clavulanate
  • fosfomycin

NO fluoroquinolones
NO bactrim in 1st or 3rd trimesters

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223
Q

Workup of abusive head trauma

A

Head CT

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224
Q

Follow renal involvement in SLE

A

Complement levels and anti-dsDNA

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225
Q

Management of Charcot arthropathy

A

Casting

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226
Q

How long anticoagulation for provoked DVT?

A

At least 3 months

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227
Q

Can practices waive copays?

A

No, this is fraud

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228
Q

Most common cause of death at burn centers

A

Supraglottic edema

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229
Q

Mode of delivery for women with condylomata accuminata (genital warts)

A

Vaginal

230
Q

Treatment of Candida endopthalmitis

A

Vitrectomy and amphotericin B

231
Q

How to assess bone involvement in multiple myeloma

A

Whole body low-dose CT

232
Q

Agents for UTI in pregnancy

A
  • nitrofurantoin
  • amoxicillin
  • amoxicillin-clavulanate
  • cephalexin
  • fosfomycin
233
Q

Can HIV positive women breastfeed?

A

No (regardless of ART/viral load)

234
Q

Confirm scoliosis

A

x-ray

235
Q

Normal Cobb angle

A

<10 degrees

for scoliosis

236
Q

To compare the mean of ≥3 groups

A

ANOVA

237
Q

If isolated gastric varices

A

Think splenic vein thrombosis

Commonly associated with pancreatitis or pancreatic cancer

238
Q

Per-protocol vs intention to treat

A

Per-protocol: only include those who adhered

Intention to treat: include everyone randomized

ITT is more conservative, but probably provides a more realistic real-world estimate

239
Q

Standard deviations

A

68-95-99.7

240
Q

Gout crystals

A

Negatively birefringent needle shaped

241
Q

Which patients with atrial fibrillation need anticoagulation?

A

CHADsVASC ≥1

242
Q

Diagnosis of chronic prostatitis

A

UA and Ucx

243
Q

Are febrile seizures associated with epilepsy?

A

Yes

244
Q

Thyroglobulin in exogenous thyroid hormone ingestion

A

Low

245
Q

Features of testicular torsion

A
  • elevation does not help pain

- absent cremaster reflex

246
Q

When to get RhoGAM

A

28 weeks and immediately postpartum

247
Q

Positive glucose challenge test

A

≥140

Then do glucose tolerance test

248
Q

Glucose targets in gestational diabetes

A

Fasting ≤95
1hr postprandial: ≤140
2hr: ≤120

249
Q

Management of supratherapeutic INR

A

Depends on level

<4.5: hold warfarin

4.5-10: hold, and give oral vitK if risk of bleeding

> 10: oral vitamin K

If bleeding, give vitK and PCC

250
Q

Central pontine myelinosis causes

A

Locked in syndrome

preserved wakefulness and awareness

251
Q

Management of pituitary incidentaloma

A

Regular MRIs to follow (as long as no symptoms or hormonal changes)

252
Q

Do we treat hepatitis B?

A

Not usually, unless immunocompromised, acute liver failure, or concommitant viral hepatitis C/D, or preexisting liver disease

253
Q

If still high TSH on levothyroxine

A

Check celiac (malabsorption)

254
Q

Positive predictive value

A

TP/(TP+FP)

255
Q

Negative predictive value

A

TN/(TN+FN)

256
Q

Sensitivity

A

TP/(TP+FN)

257
Q

Specificity

A

TN/(TN+FP)

258
Q

NPH vs long-acting

A

NPH has higher risk of hypoglycemia

259
Q

Attributable risk percentage

A

ARP = (risk in exposed –risk in unexposed)/(risk exposed)

260
Q

Relative risk

A

Risk exposed / risk unexposed

261
Q

If child with balantitis

A

Test for diabetes

262
Q

Treatment of blepharospasm

A

BoTox

263
Q

If placental insufficiency

A

Immediate delivery

264
Q

Doppler findings in placental insufficiency

A

Absent or reversed umbilical artery end-diastolic flow

265
Q

How to prevent febrile nonhemolytic transfusion reactions

A

Leukoreduction

266
Q

Most effective contraception

A

Progestin implant (good for 3 years, and more effective than IUD and tubal ligation)

267
Q

When does viral conjunctivitis stop being contagious?

A

When eye discharge resolves

268
Q

When does bacterial conjunctivitis stop being contagious?

A

After 24h of topical therapy

269
Q

When to get surgery for scoliosis

A

Cobb angle ≥40

270
Q

Screening and confirmation of lead toxicity

A

Screening: capillary lead level
Confirmatory: venous lead level

271
Q

Biggest concern with lead toxicity

A

Cognitive impairment and behavioral problems

272
Q

UA finding suggestive of AIN

A

Pyuria

273
Q

Treatment of hypertrophic cardiomyopathy

A

Beta blocker

274
Q

Autoimmune metaplastic atrophic gastritis

A

From pernicious anemia

  • glandular atrophy (mostly body and fundus, NOT antrum)
  • intestinal metaplasia
  • inflammation
275
Q

Positive tuberculin skin test in a healthcare worker

A

≥10 mm induration

This means latent TB

Treatment should be offered

276
Q

Standardized incidence ratio

A

To determine if the occurrence of cancer in a small population is high or low relative to an expected value

SIR = observed cases / expected cases

277
Q

Croup

A

Parainfluenza viral infection of the larynx and trachea

Symptoms

  • inspiratory stridor
  • barking cough
  • hoarseness

Treatment

  • mild: humidified air and corticosteroids
  • moderate/severe: corticosteroids and nebulized (racemic) epinephrine
278
Q

Hand-foot-and-mouth disease

A

Coxsackievirus infection

  • Painful vesicles/ulcers on anterior oral mucosa
  • macules/papules/vesicles on palms, soles, buttocks
  • +/- systemic symptoms
279
Q

How to select antibiotics for osteomyelitis

A

Bone biopsy with culture

280
Q

If adrenal mass

A

Need to get labs to see if it’s non-functional (which can be managed with serial monitoring) or functional (which needs surgical excision)

281
Q

Patients with Lewy body dementia should not be given

A

Antipsychotics

282
Q

Primary biliary cholangitis antibody

A

Antimitochondrial antibodies

283
Q

Autoimmune hepatitis antibody

A

Anti-smooth muscle

284
Q

Treatment of nonallergic rhinitis

A

Intranasal glucocorticoids

285
Q

Postpartum blues vs depression

A

Blues: ≤2 weeks, and does not meet criteria for MDD

286
Q

Levothyroxine in pregnancy

A

Empirically increase dose, then measure TSH every month

287
Q

Risks of antipsychotics

A

Extrapyramidal symptoms

  • parkinsonism
  • dystonia
  • akathesia
288
Q

Aplastic crisis in sickle cell disease

A

Arrest of erythropeisis

Low reticulocytes

Other cell lines normal

289
Q

Food protein-induced allergic proctocolitis syndrome

A

Blood-streaked stool in a well appearing infant ≤6 months old

  • painless, blood-streaked stools that may contain mucus
  • may have spitup

Non-IgE mediated allergy to cow’s milk proteins (found in formula OR in breastmilk due to maternal dairy consumption)

Commonly presents age 1-4 weeks

Treatment

  • if breastfeeding: remove dairy from maternal diet (can subsequently remove other allergens like soy or egg if symptoms persist) ; can also switch to hydrolyzed formula
  • if formula feeding: switch to hydrolyzed formula

NOTE: don’t switch to soy formula due to potential cross-reactivity between soy proteins and milk proteins

Can reintroduce offending protein around age 1

No long-term sequelae

290
Q

First line treatment of restless leg syndrome

A

Gabapentin, pregabalin

291
Q

Physiologic gynecomastia

A

Old men get breasts due to decreased testicular production of testosterone and an imbalance of estrogen relative to testosterone

292
Q

Which TB screening test to use in BGC recipients

A

IGRA (no risk of false positives)

293
Q

Tongue deviation is due to damage to which nerve

A

Hypoglossal (lick the lesion)

294
Q

Treatment of WPW

A

Catheter ablation

295
Q

Treatment of sulfonylurea overdose

A

Dextrose + octreotide (decreases insulin secretion)

296
Q

Treatment of cocaine vasoconstriction

A
  • benzos
  • nitroglycerin
  • aspirin
  • NO BETA BLOCKERS!!!!
  • calcium channel blockers for ongoing pain
  • phentolamine for persistent HTN
  • PCI for MI (when EKG is unchanged)
297
Q

Falling onto an outstretched hand

A

Colles’ fracture (distal radius) if dinner fork deformity; scaphoid fracture if pain at anatomic snuffbox

298
Q

Central retinal artery occlusion

A

Pale fundus with cherry red spot

299
Q

Central retinal vein occlusion

A

Blood and thunder

300
Q

First line DMARD for rheumatoid arthritis

A

Methotrexate

301
Q

Frenulum tear in a nonambulatory child

A

Suspect abuse

Need to report to CPS

302
Q

If there is disagreement between team and family that ongoing care is futile

A

Ethics committee

303
Q

Tuberculous meningitis eye findings

A

Choroidal tubercles: yellow-white nodules near the optic disc

304
Q

Treatment of tuberculous meningitis

A

2 months of 4-drug therapy + 9-12 months of continuation therapy

Also 8 weeks of steroids

305
Q

Tibial stress fractures on xray

A

Usually normal for first few weeks

306
Q

Which vaccines are contraindicated in pregnancy

A
  • MMR
  • HPV
  • varicella
  • live attenuated influenza (intranasal)
307
Q

Recommended vaccines in preganncy

A
  • flu (inactivated)

- Tdap

308
Q

Treatment of scabies

A

Permethrin (or oral ivermectin)

309
Q

Does actinic keratosis need biopsy?

A

yes if >1cm, are tender/indurated, exhibit rapid growth, or fail to respond to treatment (need to rule out SCC)

310
Q

Thiazolinedinedione side effect

A

Fluid retention

311
Q

Verification bias (workup bias)

A

When a study uses gold standard testing selectively in order to confirm a positive or negative result of a preliminary test. Can overestimate sensitivity and underestimate specificity.

To get around- perform test on random sample

312
Q

Scromboid poisoning

A

If fish is stored in temperatures >15 C, histidine –> histamine:

  • flushing
  • throbbing headache
  • palpitations
  • abdominal cramps
  • diarrhea
  • oral burning

Patients may describe the fish as having a bitter taste

Skin erythema, wheezing, tachycardia, and hypotension may be present

313
Q

First step in the workup of gross hematuria

A

UA and UCx

314
Q

Diagnosis of orthostatic proteinuria

A

Split day-night 24h urine protein

315
Q

Precautions for herpes zoster

A

Localized: standard until lesions are crusted
Disseminated: contact + airborne until lesions are crusted

316
Q

Calculation of odds ratio

A

OR = ad/bc

317
Q

Complication of anal abscess

A

Fistula

318
Q

Treatment of akathesia

A

Dose reduce antipsychotic OR start propranolol

319
Q

Congenital rubella

A
  • sensorineural hearing loss
  • cataracts
  • patent ductus arteriosus
  • blueberry muffin rash (purpuric lesions)
320
Q

Treatment of bacterial conjunctivitis

A

Topical macrolide (azithromycin) or topical fluoroquinolone (if wears contacts)

321
Q

Sickle cell trait

A

HgbS:HgbA 40:60

Asymptomatic
Does NOT cause anemia

322
Q

Analgesic nephropathy

A

From NSAIDs

  • chronic, but can present acutely
    • hematuria
    • pyuria
    • proteinuria
    • renal colic
323
Q

Prognosis of sarcoidosis

A

> 75% of cases resolve

324
Q

If patient with hypertrophic cardiomyopathy can’t take beta blockers (e.g., asthma)

A

Nondihidropyridine CCBs (verapamil)

325
Q

When to give oseltamavir for influenza

A

<48h in low risk patients, or anybody hospitalized or are at high risk, regardless of symptom duration

326
Q

Most common cause of pathologic nipple discharge

A

Papilloma

327
Q

When to do LP in syphilis

A

If positive tests and neurologic symptoms

328
Q

What to do in DKA if glucose falls below 200

A

Half the rate of the insulin drip and add dextrose

329
Q

Can doctors date former patients?

A

They shouldn’t. ALWAYS NO for psychiatrists

330
Q

If persistent unilateral middle ear effusion

A

Nasal endoscopy to look for cancer

331
Q

Which sexually transmitted infection can cause stroke?

A

Syphilis

332
Q

Monitoring respiratory function in Guillain-Barré syndrome

A

Serial assessment of vital capacity via NIF- negative inspiratory force

333
Q

What to watch for after VZV vaccination

A

Development of a rash which can be contagious to immunocompromised members of household

334
Q

Thrombotic thrombocytopenic purpura

A
  • renal failure
  • neurologic manifestations
  • fever
  • abdominal pain/nausea
  • petechial rash

Low ADAMTS13

Hemolytic anemia and thrombocytopenia

Treat with plasma exchange

335
Q

Impaired LV function in mitral regurgitation

A

EF ≤60% (since the echo overestimates EF)

336
Q

Long term complication of kidney donation

A

Gestational complications

337
Q

Criteria for thrombolytics in acute ischemic stroke

A

≤4.5 hrs

Disabling symptoms

(radiologic studies may be negative)

338
Q

Digoxin toxicity

A
  • nausea/vomiting
  • anorexia
  • fatiuge
  • confusion
  • visual disturbances
  • cardiac abnormalities

Causes: verapamil, quinidine, amiodarone

339
Q

Treatment of HELLP syndrome

A

Magnesium sulfate

340
Q

IRIS

A

HIV patient started on ART can have transient worsening of infectious symptoms several weeks after starting ART

341
Q

Prenatal testing at 24-28 weeks

A

CBC (anemia) and glucose tolerance test

342
Q

What does topical erythromycin at birth prevent?

A

Gonococcal, NOT chlamydial conjunctivitis

343
Q

Treatment of neonatal clavicular fractures

A

Supportive (no long term sequelae)

344
Q

Elevated insulin, C-peptide, and proinsulin

A

Endogenous insulin secretion

  • tumor
  • surreptitious oral hypoglycemic use

Sulfonylurea or meglinitide use most common (insulinoma is very rare)

345
Q

Most sensitive test for SLE

A

anti-dsDNA

346
Q

Which antibody correlates with disease activity in SLE?

A

anti-dsDNA

Also associated with the development of lupus nephritis

347
Q

Treatment of tinea versicolor

A

Topical ketoconazole

348
Q

Treatment of primary ovarian insufficiency

A

Oral or transdermal estrogen plus progestin

349
Q

Treat salmonella?

A

No (unless immunocompromised)

350
Q

Diagnosis of osteonecrosis of the femoral head

A

MRI

351
Q

Late life depression is a risk factor for

A

Alzheimer’s and vascular dementia

352
Q

Treatment of lactational mastitis

A

dicloxacillin or cephalexin

353
Q

Treatment of breast abscess

A

Ultrasound –> needle aspiration

NOT I&D

354
Q

What to check before starting bisphosphonates

A

Calcium and vitamin D

355
Q

What cancer is associated with Sjogren syndrome?

A

B-cell lymphoma

356
Q

Diagnosis of sporotrichosis

A

Biopsy of lesion with culture

Treat: itraconazole

357
Q

Net clinical benefit

A

Benefit - harm

358
Q

Treatment of peri-infarction pericarditis

A

High dose aspirin

Avoid NSAIDs and steroids which impair myocardial healing

359
Q

Urgent warfarin reversal

A

prothrombin complex concentrate (plus IV vitamin K)

360
Q

Treatment of acute hemolytic transfusion reaction

A

Stop transfusion and give normal saline

361
Q

Adequate contractions

A

Every 2-3 min

362
Q

Active labor

A

≥6 cm

Should progress ≥1 cm/2hrs

363
Q

If inadequate contractions/prolonged labor

A

Oxytocin + amniotomy

364
Q

Arrest of labor

A

> 4hrs of adequate contractions or >6hrs with inadequate contractions

365
Q

Who should be offered cell-free fetal DNA testing?

A

Women ≥35

366
Q

What to do with women who have gestational diabetes once they deliver

A

STOP all antihyperglycemic therapy (since the disease is placenta mediated)

May have T2D though, so get GTT 6-12 weeks postpartum

367
Q

What happens to thyroid hormone levels in pregnancy?

A

Increase

So may look on labs to have subclinical hyperthyroidism, but no need to do anything if clinically euthyroid

368
Q

Treatment of Kawasaki disease

A

IVIG and aspirin

369
Q

Vaccines and IVIG

A

Live vaccines should not be given until 11 months after IVIG

370
Q

First line for insomnia

A

CBT

371
Q

Features suggestive of tuberculous pleural effusion

A
  • exudative
  • lymphocyte predominant
  • elevated adenosine deaminase

Need pleural biopsy

372
Q

MAHA and thrombocytopenia =

A

TTP

373
Q

Organophosphate poisoning

A

DUMBBELLS

  • defecation
  • urination
  • miosis (pinpoint pupils)
  • bronchospasm
  • bradycardia
  • emesis
  • lacrimation
  • salivation
374
Q

Colonic angiodysplasia causing bleeding is associated with

A
  • aortic stenosis

- ESRD

375
Q

Management of preterm labor

A

Defined as regular, painful contractions resulting in cervical dilation at <37 weeks

<32 weeks:

  • antenatal corticosteroids
  • penicillin if GBS+ or unknown
  • tocolysis: indomethacin
  • magnesium sulfate

32-24 weeks:

  • antenatal corticosteroids
  • penicillin if GBS+ or unkonwn
  • tocolysis: nifedipine

34-37 weeks:

  • +/- antenatal corticosteroids
  • penicillin if GBS+ or unknown
376
Q

Elevated AFP in pregnant women is associated with

A

Neural tube defects and ventral wall defects (low AFP is seen in aneuploidies)

Get ultrasound

377
Q

Pediatric dyslipidemia screening

A

Starts at 9 yo in those with CV risk factors

378
Q

Likelihood ratio

A

LR+ = sensitivity/(1-specificity)

LR-=(1-sensitivity)/specificity

379
Q

Who needs statins in diabetes?

A

Everyone ≥40

380
Q

Diagnosis of dermatomyositis

A

Antibody testing:

  • screening: ANA
  • confirmatory: anti-Jo, anti-Mi2

Muscle biopsy only if uncertain diagnosis

381
Q

If hyperkalemia with EKG changes

A

Calcium gluconate

382
Q

Opioids in trauma for patients with opioid use disorder

A

Discuss risks and benefits of opioids with them

383
Q

If bicuspid aortic valve

A

Screen for thoracic aortic aneurysm

384
Q

Metformin and cardiac cath

A

STOP (d/t conrast renal risk, lactic acidosis)

385
Q

Treat infertility in PCOS

A

Letrozole

386
Q

Preeclampsia prevention

A

Aspirin starting at 12 weeks

387
Q

Rapid spreading superficial bacterial infection

A

Erisypelas

Well demarcated and raised

Strep pyogenes

388
Q

Physiologic anemia of infancy

A

Nadir 11 around 2-3 months

389
Q

Central precocious puberty

A

Girls <8, boys <9

ADVANCED BONE AGE

Elevated FSH, LH

390
Q

Can we use slides a pharma company gives us for a conference?

A

No, we need to make our own slides

391
Q

If cryptogenic stroke

A

Ambulatory cardiac monitoring

392
Q

If TIA

A

Medical emergency.

After CT, needs MRI, CT/MRA, EKG, echo, and antiplatelets

393
Q

Deductible vs out of pocket maximum

A

Deductible: amount you need to pay
OOPM: amount you need to pay before insurance pays 100%

394
Q

Management of hydatidiform mole

A

Suction curretage followed by weekly hCG. If decreasing, go to monthly for 6 months until undetectable

If increasing, diagnose gestational trophoblastic neoplasia

NEED CONTRACEPTION DURING THIS PERIOD

395
Q

Which antihypertensives cause photosensitivity?

A

Thiazides

396
Q

Management of subchorionic hematoma

A

Expectant

397
Q

Posterior urethral valve

A

Abnormal insertion of the wolffian ducts into the urethra

Bilateral hydronephrosis, thickened and dilated bladder , dilated proximal urethra

398
Q

If hypoxic on nonrebreather

A

Intubate

399
Q

Valve abnormality in pulmonary embolism

A

Tricuspid regurgitation

400
Q

“swinging fever”

A

subphrenic abscess

Also cough and shoulder tip pain will be seen

401
Q

Diagnosis modality for cerebral palsy

A

MRI

402
Q

If violent patients who do not respond to verbal de-escalation

A

Restrains and IM antipsychotics

403
Q

Relative risk reduction

A

(risk in unexposed - risk in exposed) / risk in unexposed

404
Q

Copay for preventive screenings

A

Zero

405
Q

Treatment of tick paralysis

A

Remove tick

406
Q

First-line treatment of alopecia areata

A

Intralesional corticosteroids

407
Q

Definition of osteoporosis

A

T score ≤-2.5 OR history of low trauma hip/vertebral fractures REGARDLESS OF T SCORE

408
Q

Options for BV

A

Metronidazole or clindamycin

409
Q

Does treating BVin pregnancy prevent pregnancy complications?

A

No

410
Q

When to start Pap

A

21

411
Q

Intususception

A
  • severe, intermittent abdominal pain
  • palpable sausage-shaped mass in R abdomen
  • currant jelly stools

Diagnosis/treatment: air enema

If unclear can do US

412
Q

If clinical decompensation after air enema for intususception

A

AXR to look for perforation

413
Q

Most common complication of TURP

A

Retrograde ejaculation

414
Q

Treatment of gonorrhea vs chlamydia

A

Gonorrhea: ceftriaxone
Chlamydia: azithromycin

Gonorrhea + chlamydia: CTX + doxy

415
Q

Ongoing symptoms after treatment of urethritis

A

Repeat urethral swab

416
Q

If suspect SAH but CT negative

A

LP

417
Q

Severe obstructive lung disease is characterized by

A

FEV1 < 40%

418
Q

Most common cause of nonpurulent cellulitis

A

Strep pyogenes

419
Q

If high suspicion for ACS but normal EKG and trops

A

Repeat EKG and trops

420
Q

Treatment of acute dystonia

A

Benztropine or diphenhydramine

421
Q

Corneal laceration

A

Fluorescein uptake followed by washout (Seidel sign)

Urgent ophtho consult

422
Q

Stopping DOACs before surgery

A

Low bleeding risk: stop day of
Mod/high risk: stop 1-3 days prior

No bridge necessary

423
Q

Treatment of cat scratch disease

A

Azithromycin

424
Q

Chickungunya

A
  • high fever and severe polyarthralgia
  • headache, myalgia, conjunctivitis
  • lymphopenia, thrombocytopenia, elevated LFTs

Supportive care

425
Q

Eye involvement in sarcoidosis

A

Anterior uveitis

426
Q

Toxic thyroid nodule (toxic adenoma)

A

Hyperthyroidism

Treat with beta blocker, antithyroid drugs (to get euthyroid), and then iodine ablation or surgery

Don’t need biopsy because the risk of cancer in these is very low

427
Q

Methimazole or PTU

A

Methimazole is better, unless first trimester of pregnancy

428
Q

What is considered delayed puberty in boys?

A

Lack of testicular enlargement by 14

429
Q

Treatment of pneumothorax

A

Chest tube (unless tension pneumo, in which case needle decompression followed by chest tube)

430
Q

Pediatric pneumonia

A

Focal consolidation: amoxicillin

Bilateral: azithromycin

431
Q

Why do we get EKG in cardiac patients before undergoing noncardiac surgery?

A

Establish a baseline

432
Q

If macrocephaly

A

head ultrasound (if open fontanelle)

433
Q

Traumatic tap

A

High RBC without xanthochromia

434
Q

If sudden sensorineural hearing loss

A

urgent ENT evaluation

Audiogram, steroids, MRI

435
Q

Treatment of keloids

A

Intralesional glucocorticoids

436
Q

GDMT but ongoing symptoms

A

Spironolactone

437
Q

Papule that ulcerates and tracks along lymphatics

A

Sporotrichosis

438
Q

Management of auricular hematoma

A

Prompt evacuation (or risk cauliflower ear and avascular necrosis)

Oral antibiotics for skin flora and Pseudomonas

439
Q

Agents for treating UTI in pregnancy

A
  • amoxicillin-clavulanate
  • cephalexin
  • fosfomycin
  • nitrofurantoin

NO fluoroquinolones or tetracyclines, and NO TMP/SMX in 1st/3rd trimesters

440
Q

When do steroids need taper

A

> 3 weeks

441
Q

Treatment of psoriatic arthritis

A

Methotrexate

Glucocorticoids are contraindicated because they can trigger pustular psoriasis

442
Q

Harsh holosystolic murmur in L 4th ICS with associated thrill

A

VSD

443
Q

Most common congenital heart defect

A

VSD

444
Q

Treatment of lithium toxicity

A

> 4: HD

>2.5 with symptoms or renal failure: HD

445
Q

Isoniazid adverse effect

A

Hepatotoxicity

446
Q

Treatment of icthyosis vulgaris

A

Topical urea

447
Q

Parts of Medicaire

A

A: inpatient
B: outpatient
C: enrollement in private insurance plans
D: meds

448
Q

What do you need to monitor when you start someone with megaloblastic anemia on B12?

A

Potassium (can cause hypokalemia)

449
Q

Treatment of aspiration pneumonia

A

CAP cpverage (ceftriaxone and azithromycin if inpatient)

DO NOT NEED ANAEROBE COVERAGE (unless empyema/abscess)

450
Q

FeNa in ATN

A

> 2 (salt wasting)

451
Q

If metastatic cancer, where should biopsy come from?

A

Most distant site (lymph nodes are nice because they’re easy to access)

452
Q

Relative risk reduction

A

ARR/(control rate)

453
Q

Shoulder dystocia

A

Obstetric emergency

Start with McRoberts maneuver: hyperflex maternal hips

454
Q

If suspect neurofibromatosis type I

A

Get eye exam

455
Q

Consequence of not treating IDA in children

A

Developmental delay

456
Q

If right heart failure after CABG

A

Think constrictive pericarditis

457
Q

Number needed to harm

A

NNH = 1/(absolute risk increase)

458
Q

Treatment of inoperable head and neck cancer

A

Chemo AND radiation

459
Q

When does DEXA start?

A

65 (unless risk factors)

460
Q

Ecthyma gangrenosum

A

From pseudomonas bacteremia in immunocompromised hosts.

Rapid evolution of ≥1 skin lesion from an erythematous macule to a pustule or bullae and then into a nonpainful gangrenous ulcer

Systemic symptoms are common

461
Q

Thyroglossal duct cyst

A

Fluctuant mass that moves superiorly upon swallowing

Need thyroid imaging to identify ectopic thyroid tissue

462
Q

bhCG threshold to be seen on US

A

3,500

463
Q

Arrest of second stage of labor

A

No fetal descent after nulliparous patients push ≥3h (≥4 with epidural)

Most commonly caused by cephalopelvic disproportion

Need C-section

464
Q

Treatment of acute chest syndrome

A
  • ceftriaxone and azithromycin
  • IV fluids
  • pain control
465
Q

Treatment of tinea capitis

A

ORAL griseofulvin or terbinafine

466
Q

PrEP is contraindicated in

A

Abnormal kidney function

467
Q

Hyphema

A

Layering of blood in the anterior chamber

Caused by acute increased intracranial pressure (from trauma) that causes blood vessels to rupture

Admit to hospital for strict bedrest and monitoring of IOP

468
Q

SN, SP, PPV, NPV

A

Sensitivity: TP/(TP+FN)
Specificity: TN/(TN+FP)

PPV: TP/(TP+FP)
NPV: TN/(TN+FN)

469
Q

Treatment of clubfoot (tabes equinovarus)

A

Stretching and serial casting

470
Q

Pathognomonic for Chagas cardiomyopathy

A

LV apical aneurysm

471
Q

Change antiepileptics in pregnancy?

A

NO. Always change before, not during. Even if on valproate.

472
Q

Can women on antiepileptics breastfeed?

A

Yes

473
Q

Postural kyphosis

A

From slouching

Angle normal or slightly abnormal

Just correct with better posture

474
Q

Treatment of diabetes from chronic pancreatitis

A
  • metformin
  • insulin

No DPP-4s of GLP-1s due to increased risk of pancreatitis

475
Q

Nonsurgical options for squamous cell carcinoma of the skin

A
  • cryotherapy
  • electrosurgery
  • radiation
476
Q

Iodine-induced hyperthyroidism

A

Hyperthyroidism after exposure to iodine (e.g., cardiac cath)

Often develops after pre-existing nodular thyroid disease

Usually self-limited and doesn’t need treatment. If persistent symptoms or heart disease, can treat with methimazole

477
Q

Treatment of folic acid deficiency from methotrexate

A

Folinic acid (not folic acid)

478
Q

Treatment of trichomonas

A

SINGLE DOSE ORAL 2g metronidazole

479
Q

Breastfeeding while on metronidazole?

A

If on high dose (2g), pump and dump

480
Q

Treatment of chronic bacterial prostatitis

A

6 weeks of ciprofloxacin

481
Q

Lung cancer screening

A

50-80 in those with ≥20 pack years

482
Q

Next step in inflammatory acne after benzoyl peroxide and topical retinoid

A

Topical antibiotics

483
Q

Who cannot take rifampin?

A

Women on OCPs

484
Q

Treatment of hyperviscosity from neonatal polycythemia refractory to conservative treatment

A

partial exchange transfusion

485
Q

Dengue

A

Fever after travel to endemic area, associated with

  • flu like febrile illness with marked myalgias/arthralgias
  • diffuse maculopapular rash
  • leukopenia
  • POSITIVE TOURNIQUET TEST

Can progress to circulatory collapse

486
Q

What disease has a positive tourniquet test?

A

Dengue

487
Q

Asymptomatic elderly patient with significant lymphocytosis

A

Think CLL

488
Q

Which test characteristics depend on prevalence?

A

PPV and NPV

489
Q

When to perform external cephalic version for breech presentation

A

37 weeks

490
Q

Kidney stone size to call urology

A

≥10 mm

491
Q

Definitive test for brain death

A

Apnea test (even if everything else is met, need to do apnea test)

492
Q

Bilateral nipple discharge and negative workup

A

Observe

493
Q

Treatment of organophosphate poisoning

A

Atropine and pralidoxime

494
Q

What should all patients diagnosed with scleoderma get

A

PFTs

495
Q

Most common inherited thrombophilia

A

Factor V Leiden

496
Q

If acute cholangitis

A

ERCP

497
Q

Erythema in the diaper region sparing the skin folds

A

Irritant or contact dermatitis

Treat with zinc oxide barrier cream

498
Q

Congenital toxoplasmosis

A
  • chorioretinitis
  • diffuse intracranial calcifications
  • hydrocephalus
499
Q

High-grade carotid stenosis

A

≥70%

Carotid endarterectomy

500
Q

SGLT2 inhibitor side effect

A

Euglycemic DKA

501
Q

Carbemazepine side effects

A

Neutropenia, bone marrow suppression, SIADH

502
Q

Chest pain, EKG changes, normal coronaries

A

Think stress cardiomyopathy

503
Q

Treatment of pediatric ADHD

A

3-5: behavioral therapy

≥6: pharmacotherapy

504
Q

What to do prior to starting stimulants for ADHD

A

Cardiac history and exam

505
Q

Order of Wernicke encephalopathy treatment

A

THIAMINE and then fluids and dextrose

506
Q

Autoimmune hepatitis antibodies

A

ANA and anti-smooth muscle (F-actin)

507
Q

PBC antibody

A

Antimitochondrial

508
Q

Treatment of chlamydia in pregnancy

A

azithromycin

doxy outside of pregnancy

509
Q

When can babies sleep through the night?

A

4-6 months

510
Q

If osteopenia

A
  • Vitamin D and calcium

- calculate FRAX (10-year fracture risk) and start bisphosphonate if positive

511
Q

What age to consider PSA

A

55

512
Q

Most effective contraceptive options for emergency contraception

A

IUD: copper IUD [MOST EFFECTIVE]- can be placed within 5 days

Pill: ulipristal- may be taken up to 5 days after

513
Q

IUD contraindication

A

active pelvic infection

514
Q

Medications after sexual assault

A
  • ceftriaxone
  • doxycycline
  • metronidazole
  • multidrug ART
  • HepB vaccine +/- HepB Ig
515
Q

Complication of compartment syndrome

A

Rhabdomyolysis and acute renal failure

516
Q

Does STEC (Shiga toxin E. coli) diarrhea feature fevers?

A

No, or at least not high ones

517
Q

Treatment of prolactinomas

A

Dopamine receptor agonists

518
Q

Treatment of normal pressure hydrocephalus

A

LPs, and if successful, VP shunt

519
Q

If postextubation stridor

A

Think laryngeal edema and reintubate if respiratory failure

520
Q

Treatment of ocular melanoma

A

Radiotherapy

521
Q

Treatment of onychomycosis

A

Oral terbafine (or itraconazole)

522
Q

Prevention of recurrent hypertriglyceridemia associated pancreatitis

A

Long-term fibrate therapy

523
Q

If pressure does not stop nosebleed

A

Next step is topical vasoconstrictor (oxymetazoline)

524
Q

If isolated anti-HbC

A

get IgM anti-HbC

525
Q

PMR treatment

A

LOW dose prednisone

Don’t need temporal artery biopsy unless you suspect GCA

526
Q

Strep treatment duration

A

10 days

527
Q

TSH goal in follicular and papillary thyroid cancers

A

Low normal

528
Q

Treatment of high risk squamous cell carcinoma of the skin

A

Mohs

529
Q

If unknown time of coin ingestion

A

Endoscopic removal

530
Q

When to repair AAA

A
  • symptomatic
  • size >2x the size of the diameter of the normal aortic segment
  • size ≥5.5 cm
  • expansion >0.5 cm in 6 months
531
Q

Who needs parathyroidectomy for primary hyperparathyroidism?

A
  • < 50
  • symptomatic
  • complications (e.g. osteoporosis)
  • increased risk of complications

Otherwise can just get serial DEXA, creatinine, calcium

532
Q

Most common cause of erythema multiforme

A

Infections, especially HSV

533
Q

Cyanosis that occurs during feeding and improves with crying

A

Choanal atresia

Disgnosis: inability to pass NGT

534
Q

First line test for PCP pneumonia

A

Induced sputum

535
Q

Most common inherited thrombophilia

A

Factor V Leiden (protein C resistance)

536
Q

Next test in metabolic aklalosis

A

Urine chloride

537
Q

Diagnosis of PSC

A

Endoscopic cholangiogram

538
Q

If positive anti-D titers

A

Alloimmunization has already occurred

RhoGAM will not work

539
Q

Umbilical hernia in infancy

A

Usually goes away on its own

540
Q

Primary goal of treating herpes zoster

A

Prevent postherpetic neuralgia

541
Q

Most important risk factor for stroke

A

Prior stroke

542
Q

Why hypotension in tension pneumothorax

A

Compression of IVC –> decreased venous return

543
Q

Treatment of postpartum thyroiditis

A

Beta blockers

544
Q

Conduct disorder

A

The precursor to antisocial personality disorder

545
Q

Vestibular neuritis vs labirynthitis

A

Labirynthitis: associated with hearing loss

546
Q

Best way to communicate abnormal labs/follow up plan to PCP

A

Phone call

547
Q

Painful vs painless genital ulcers

A

Painful

  • HSV
  • chancroid (Haemophilus ducreyi)

Painless

  • syphilis
  • LGV (Chlamydia trachomatis L1-L3)
548
Q

Prevent vertical transmission of HSV

A

If history of HSV, start acyclovir at 36 weeks, and do C-section only if active lesions (or prodromal symptoms)

549
Q

Cupping of the optic disc

A

Open angle glaucoma

550
Q

If suspect parvovirus B19 in pregnancy

A

Get serologies

551
Q

Screen for risk of stroke in sickle cell disease

A

Transcranial Doppler

552
Q

If positive PPD or IGRA

A

Need to screen for symptoms and get CXR to see if latent or active disease

553
Q

Treatment of latent TB

A

Rifamycin-based therapy (preferred)

  • rifampin x4mo
  • rifampin + INH x3 mo

INH monotherapy x6-9mo

554
Q

Nonreactive nonstress test

A

Lack of accelerations = fetal acidemia

Next step is biophysical profile

555
Q

Workup of LUTS

A
  • UA

- PSA

556
Q

Myositis, periorbital edema, eosinophilia

A

Trichinella

From undercooked meat (pork)

557
Q

Treat tinea versicolor

A

Topical selenium sulfide

558
Q

Chloroquine retinopathy

A

Bull’s eye retinopathy

559
Q

Pneumonia vaccines

A

PPSV 23: everyone ≥65, and anyone immunocompromised 19-64 (or with heart/lunglliver disease or AUD)

PCV13: all immunocompromised ≥65 (and then give PPSV 23)

560
Q

Which heart conditions require antimicrobial prophylaxis for high risk procedures?

A
  • prosthetic heart valves
  • prior IE
  • uncorrected cyanotic congenital heart defects
561
Q

Which type of infective endocarditis requuires longer treatment?

A

Prosthetic valve IE (at least 6 weeks)

562
Q

Antibiotic of choice for HACEK IE

A

Ceftriaxone (better G- coverage)

563
Q

Treatment of femoral pseudoaneurysms

A

Utrasound guided thrombin injection

564
Q

Gilbert, Dubin-Johnson, and Rotor: direct vs indirect

A

Gilbert: indirect (impaired conjugation of bilirubin- UDP-g deficiency)
Dubin-Johnson: direct (disorder of bilirubin excretion)
Rotor: direct (disorder of bilirubin excretion)

565
Q

Oligohydramnios

A

Amniotic fluid index ≤5

566
Q

Most common asbestos-related cancer

A

Bronchogenic carcinoma (way more common than mesothelioma)

567
Q

Scleroderma antibodies

A

Anticentromere: CREST syndrome (diffuse)

Anti-Scl-70: diffuse scleroderma (also indicate poor prognosis)

568
Q

APML translocation

A

t(15;17)

569
Q

CML translocation

A

t(9;22)

570
Q

Low leukocyte alkaline phosphatase is seen in

A

CML

571
Q

Treatment of CML

A

Imatinib

572
Q

First line treatment of polycythemia vera

A

Phlebotomy, plus aspirin

Next line is hydroxyurea

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