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1
Q 
TTP
Path:
Sxs:
Labs:
Tx:
A

Path: Deficiency in ADAM TS13 (normally cleaves vWF into smaller pieces for degradation) due to an acquired autoantibody–> microthrombi

SXs: FAT RN
Fever
Anemia
Thrombocytopenia
Renal Failure
Neuro symptoms

Labs:

  • Increased bleeding time, but normal PT/PTT
  • Anemia with Schistocytes

Tx:
-Exchange transfusion (NEVER TRANSFUSE PLTS)

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2
Q 
DIC
Path:
Sxs:
Labs:
Tx:
A

Path: There are so sick the start to form clots where they shouldn’t, the use up the clotting materials and start to bleed

Sxs:
Septic

Labs:

  • Anemia with Schistocytes
  • Increased PT and PTT
  • Fibrinogen is decreased
  • D-dimer is increased

Tx:
Supportive
Fix Sepsis

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3
Q 
HIT
Path:
Sxs:
Dx:
Tx:
A

Path: antibodies to plts
Sxs: Plts drop after 7 to 14 days on heparin, normal PT/PTT
Dx: HIT antibodies
Tx: Stop heparin, put agatroban and bridge to warfarin

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4
Q 
ITP
path:
Sxs:
Dx:
Tx:
A

path: antibodies to plts
Pt: women with autoimmune disorder with low plt

Dx:*diagnosis of exclusion

Tx:
low plts–>steroids
critically low plts–> IgG to hide the Plts

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5
Q

Hemolytic anemia lab findings

A

Increased LDH
Decreased haptoglobin
Schistocytes on smear

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6
Q

Positive likelihood ratio
what?
Calculation?

A

what is it: the chance of finding an event in someone with the disease vs that someone without a disease

calculation:
+LR= (sens)/(1-spec)

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7
Q

negative likelihood ratio
what?
Calculation?

A

what is it: the chance of testing negative in someone with the disease vs that someone without a disease

calculation:
-LR= (1-sens)/(spec)

***The smaller the likelihood ratio the less likely the pt is to have to disease if they have a negative test

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8
Q

Esophageal cancer types and risk factors

A

Adenocarcinoma-chronic reflux and barrett’s esophagus
—distal to mid esophagus

Squamous cell carcinoma-smoking and alcohol
—upper esophagus

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9
Q

bacterial conjunctivitis Tx

A

Doesn’t wear contacts—>Erythromycin ointment or azithromycin drops

Wears contacts–> Fluoroquinolone drops (to cover for possibility of pseudomonas)

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10
Q

tx opioid withdrawal

A

-Methadone
OR
-In hospital may need to use clonidine (alpha 2 adrengeric agonist) due to availability

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11
Q

Scromboid poisoning

Sxs:

A

Sxs: Oral burning, flushing, headache, palpitations and diarrhea
-Start 10 to 30 minutes after eating fish, Sxs are self-limited

Path: IF fish is stored to hot, some of its products are broken down to histamine.

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12
Q

Thiazide effect on calcium

A

retains more calcium in the serum

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13
Q

Cerebral venous sinus thrombosis tx

A

Heparin or Low molecular weight heparin (if pregnant)

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14
Q

% of people within 1 SD

A

68%

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15
Q

% of people within 2 SDs

A

95%

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16
Q

% of people within 3 SDs

A

99.7%

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17
Q

At what bHCG does a pregnancy become visible on ultrasound

A

> 1,500

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18
Q

ARR

A

Control rate-treatment rate

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19
Q

NNT

A

1/ARR

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20
Q

Tick paralysis
vs
Guillane Barre

A

Tick paralysis- progresses over hours (start of sxs in 4 to 7 days after bite)
vs
Guillane Barre- hx of GI or URI sxs, the paralysis progressed over several days to weeks

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21
Q

Thyroid lymphoma

Pt:

A

Pt: suspect in a patient with a history of hashimoto’s thyroiditis with a rapidly enlarging thyroid gland and subsequent obstructive symptoms

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22
Q

Medullary thyroid cancer lab

A

Elevated calcitonin

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23
Q

Sxs of mixed cyroglobulinemia

A

Palpable purpura
Weakness
Arthralgia
-20% get glomerulonephritis

Labs:
hypocomplementemia
Rheumatoid factor

Path: secondary to an underlying inflammatory condition (MC is Hep C)

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24
Q

which is an intrinsic characteristic of the test?

Sens and spec
Or
Positive and Negative predictive values

A

Sens and spec

Likelihood ratios are also not affected by prevelance

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25
Tourette syndrome criteria: Tx:
Criteria: More than one motor tic plus one or more vocal tics for over a year Tx:2nd gen antipsychotics (aripiprazole, risperidone) Or Alpha-2 adrenergic receptor antagonists (clonidine, guanfacine)
26
criteria for spontaneous bacterial peritonitis
PMNs>250/mm3 SAAG(serum ascites albumin gradient) >1.1 g/dl Protein <1 g/dl Positive culture
27
Neurofibromatosis type 1 symptoms:
``` Symptoms: Cafe-au-lait macules Optic glioma Axillary and Inguinal freckling Nuerofibromas Pseudoarthrosis ```
28
Drugs for STEMI
``` Aspirin and clopidogrel Nitrates beta blockers statin anticoagulation ```
29
ratio for traumatic tap
RBC:WBC-->(750-1000):(1)
30
Tuberous sclerosis | Sxs:
Sxs: Ash-leaf spots Shagreen patches Angiofibromas of the malar region Cognitive delays Autism Epilepsy Rhambdomyomas Angiomyolipomas (renal)
31
Cancer associated with Sjogren's
B- cell non hodgkins lymphoma
32
Location of lesion causing Construction apraxia (can't copy a drawing)
Non dominant (right sided) parietal lobe lesion
33
Location of lesion causing | acalculia and agraphia
Dominant (left sided) parietal lobe
34
Location of lesion causing | Homonymous upper quadranopia and impaired perception of complex sounds (auditory agnosia)
Nondominant (right sided) temporal lobe
35
Location of lesion causing | Homonymous upper quadranopia and wernicke's aphasia (trouble understanding)
Dominant(left sided) temporal lobe
36
Dementia with Lewy Bodies Sxs: Tx:
Sxs: Fluctuating cognition Visual hallucinations Parkinsonism features ***Dementia appears first and then Parkinsonism Tx: cholinesterase inhibitors(donepezil, Rivastigmine) for cognitive impairment, carbidopa-levodopa for parkinsonism melatonin for REM sleep behavior disorder
37
Vascular dementia | Sxs:
Early executive dysfn, focal neurologic findings
38
Tinea versicolor tx
topical ketoconazole
39
small cell carcinoma
Associated with SIADH (normovolemic hyponatremia)
40
Mesothelioma | Chest XRay
Nodular thickening of the pleura and/or obscuring of the diaphragm
41
Squamous cell carinoma
Cavitary lesion in the bronchus Parathyroid hormone like production can lead to hypercalcemia
42
PCP presentation
Subacute presentation Chest Xray shows: INTERSITIAL infiltrate (S. pneumoniae shows lobar infiltrate) TMP-SMX is prophylaxis for PCP when CDC<200
43
Light criteria
Exudate if: Pleural protein/serum protein>0.5 Pleural LDH/serum LDH>0.6 Pleural LDH >2/3 upper limit of normal of serum LDH
44
Scarlet fever Sxs: Tx:
Sxs: sandpaper rash, strawberry tongue, circumoral palor Tx: Amoxicillin
45
Kawasaki Disease Sxs: Tx:
``` Sxs: Conjunctivitis Mucositis Cervical lymphadenopathy Rash Erythema and edema of hands/feet ``` Tx: Aspirin IVIG
46
lab workup for initial dementia eval
TSH(hyponatremia can be a clue for hypothyroidism), B12 also screen for depression
47
Gout aspirate
shows negatively birefringent crystals
48
Cushing's syndrome | Sxs:
Hypertension, hyperglycemia, osteoporosis, mood swings, Diabetes, hypokalemia, and metabolic alkalosis Dx: Dexamethasone suppression test of measurement of 24 hour urinary free cortisol level
49
Prerenal vs ATN labs
Prerenal: BUN:Cr->20 FEN: <1% Urine Osmolality: >500mOsm/kg ATN: BUN:Cr-10-15 FEN: >2% Urine Osmolality: ~300mOsm/kg
50
Familial hypocalciuric hypercalcemia | Labs:
High PTH High calcium Urine Ca is low (if it is high with the other two labs, they have primary hyperparathyroidism)
51
MEN 1
Pituitary adenomas Primary hyperparathyroidism Pancreatic/gastrointestinal neuroendocrine tumors
52
origin of DHEAS vs testosterone for females
DHEAS-Adrenal gland | Testosterone-Ovaries
53
PCOS
Usually for the 1st half of cycle estrogen predominates, after that progesterone takes over (but these patients don't ovulate) ``` Labs: increased testosterone Normal DHEAS LH/FSH ratio of >3:1 U/S shows excessive follicles ``` Tx: Exercise and weight-loss Metformin OCPs
54
Sertoli-Leydig Tumor
Sxs: virilization Labs: Testosterone-drastically increased DHEAS-normal Tx: Resection
55
Adrenal tumor
Sxs: virilization Labs: Testosterone-normal DHEAS-very elevated Tx: Resection (first need to do an adrenal vein sampling, because it is not always the side with the mass)
56
CAH
pt: Hirsuitism Labs: Testosterone-normal DHEAS-elevated 17-OH-progesterone in the urine Tx: Cortisol Fludrocortisone
57
Prolactinoma | labs to check:
TSH(hypothyroidism can cause increased prolactin) Prolactin-high Tx: carbergoline or bromocriptine
58
Acromegaly | labs to check:
insulin-like growth factor-1 (positive) | Glucose suppression test (does not suppress Growth hormone))
59
SIADH | tx
``` Labs: UrineOsm-increased UrineNA-increased Tx: water restriction or Demeclocycline if that fails ```
60
Nephrotic syndrome
Urine protein >3.5 g/day Increased cholesterol edema
61
Folic acid vs B12 deficiency test labs
Methyl malonic acid will be increased in B12 deficiency but not folic acid deficiency
62
prenatal labs
Blood type, antibody screen, Rhesus type, CBC with diff, BMP, Pap smear, Rubella status, syphilis screen, UA and urine culture, hepatitis B surface antigen, HIV testing and counseling, chlamydia testing
63
Nephrotic syndrome criteria
proteinuria hypoalbuminemia (pitting edema) hypogammaglobulinemia Hypercoagulable state (loss of antithrombin III0 Hyperlipidemia (b/c the blood is so thin, so the body throws stuff in to beef it up) ***No hematuria
64
Types of Nephrotic Syndrome
``` minimal change disease Focal segmental glomerulosclerosis membranour nephropathy membranoproliferative glomerulonephritis DM Systemic Amyloidosis ```
65
Nephritic syndrome is characterized by
``` glomerular inflammation and bleeding limited proteinuria (<3.5 g/day) Oliguria and azotemia Salt retention with periorbital edema and HTN RBC cases and dysmorphic RBCs in urine ```
66
screening for celiac
tTG-IgA if under 2 add: Deamidated Gliandin IgA and IgG
67
SAAG >1.1=
portal HTN | think CHF, hepatitis, cirrhosis
68
Type 2 error
failure to reject the null hypothesis when it is false
69
Type 1 error
Rejecting the null hypothesis uncorrectly
70
Somatic symptom disorder
preoccupation with > or = 1 unexplained symptom
71
Illness anxiety disorder
fear of have an illness WITH FEW OR NO SYMPTOMS even after excessive workups have returned negative
72
catatonia tx
benzodiazepines
73
NMS tx
Dantrolene NMS-recent exposure to antipsychotics, autonomic instability, generalized muscular rigidity, fever
74
postitive predictive value
a/(a+b)
75
negative predictive value
d/(c+d)
76
Sensitvity
a/(a+c)
77
specificity
d/(d+b)
78
tx of hyperthyroidism
propranolol and methimazole Propylthiouracil when pregnant
79
Acute dystonia tx:
tx:Benztropine, diphenhydramine
80
tortocollis
valbenzine
81
tx for postpartum endometritis
Clindamycin (aerobic gram positive cocci and penicillin resistant anerobes) AND Gentamicin (gram negatives and some gram positives)
82
PID treatment
Doxycycline and Cefoxitin
83
Probability vs odd
Probability: (events)/(events+non-events) Odds: (events)/(non-events) ***approximate each other when there is a rare disease
84
relative risk
(PROBABILITY in people exposed)/(PROBABILITY in people non-exposed) *** used in cohort study
85
odds ratio
(ODDS of having the exposure in people with the disease)/(ODDS of having the exposure in people without the disease) ***used in case control study
86
ARR vs AR
ARR=(PROBABILITY of disease in people exposed)-(PROBABILITY in people non-exposed) AR=(PROBABILITY in people non-exposed)-(PROBABILITY of disease in people exposed)
87
NNT
1/ARR
88
NNH
1/AR
89
RRR
1-RR
90
Parkinson's tremor pt: tx:
pt: tremor plus bradykinesia plus rigidity tx: levodopa or pramipexole
91
Essential tremor pt: tx:
pt: bilateral, worse with fine motor activity tx: propranolol
92
when to use anova
when you are analyzing the MEAN value of a continuous variable in SEVERAL groups
93
when to use chi squared test
association between CATEGORICAL variables
94
when to use a t squared test
different between two MEANS patient serve as their own control group (ex comparing mean blood pressure before and after tx)
95
Labs in iron deficiency anemia
Iron-low transferrin-high Ferritin-low TIBC-low
96
Multiple myeloma symptoms
CRAB Calcium elevation Renal dysfunction Anemia Bone lesions (can see fractures)
97
MEN 1
diamond pituitary parathyroid pancreas
98
MEN 2A
Square medullary thyroid parathyroid pheochromocytoma
99
MEN2B
Triangle medullary thyroid pheochromocytoma intestinal Marfanoid
100
SLE arthritis vs rheumatoid arthritis
SLE arthritis is usually transient, migratory and associated with only brief morning stiffness Rheumatoid arthritis is chronic, symmetrical synovitis most commonly in small joints of hands and wrists (spares DIP)
101
Classic Urine NA | and Urine osmolality for SIADH
Urine Na>50 | Urine osmolality>100
102
tx for impetigo
topical mupirocin
103
Tinnitus, vertigo not related to postion and hearing loss is most likely caused by:
meniere's disease Salcylates-don't usually have hearing loss BPV- doesn't usually have hearing loss and vertigo is induced by position change
104
Bilateral deafness is associated with?
NF-2
105
Tx for ADH deficient
DDAVP
106
TX for SIADH
demeclocycline
107
Side effect for Ginkgo biloba
Bleeding and plt dysfunction
108
Marker for ovarian cancer
CA 125
109
Anticoagulation in pregnancy
low molecular weight heparin
110
High dexamethasone suppression test for excess cortisol
suppresses-pituitary adenoma | no suppression- atopic ACTH production
111
normal anion gap
10 to 14

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