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Step 3 > Step 3 part 1 > Flashcards

Step 3 part 1 Flashcards

1
Q

Tx for latent TB

A

9months isoniazid

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2
Q

MI: Lateral wall defect of LV means which coronary a. is occluded:

A

Left circumflex coronary a.

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3
Q

Recent trip to Africa
Periodic fevers, myalgias
Splenomegaly
thrombocytopenia

A

Malaria (plasmodium falciparum)

Ppx: antimicrobial

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4
Q

Acute otitis bugs in kids: (3)
*if concurrent purulent conjunctivitis
Tx

A

Moraxella, strep.pneumo, non-typeable H. influenza.
(adenovirus less common cause-no purulent discharge)
*If concurrent purulent conjunctivitis: H. Influ
Tx: uncomplicated-10day course of amoxicillin
recurrent-amp/clavulanic acid (augmentin)
Myringotomy, tube placement if persistent >3mth or 3 and + occurrences in 6 mth

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5
Q

Kartagener syndrome

A

autosomal recessive disorder, situs inversus, chronic sinusitis, airway disease bronchiectasis. Primary ciliary dyskinesia

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6
Q

Common causes of recurrent or chronic sinusitis

A

Air pollution, second hand smoke, inadequately treated acute sinusitis, structural abnormalities, allergic rhinitis (seasonal allergies)

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7
Q

vertigo, unilateral hearing loss, tinnitus

A

Meniere’s disease

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8
Q

Presbycusis

A

Loss of hearing with aging,

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9
Q

serous otitis media v.s suppurative otitis media v.s bacterial otitis externa vs. necrotizing otitis externa

A
  • Serous otitis media: fluid in ear but not infected or inflammed, Exam= bulging tympanic membrane
  • Suppurative otitis media: Infected fluid in middle ear, will drain purulent fluid tympanic membrane ruptures. Fever, cranky kids, No pain with manipulation of pinna. Staph Aureus.
  • Bacterial otitis externa: Swimmer’s ear, pain with manipulation of pinna. Pseudomonas
  • Necrotizing otitis externa: aggresive Pseudomonas infection affecting surrounding bone. Fever, pain, purulent drainage but usually elderly and diabetic and immunocompromised
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10
Q

Acute otitis media risk factors in babies

A

Second hand smoke, no breastfeeding, pacifier use, day care,

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11
Q

PPSV 23 vaccine (pneumococcal polysaccharide vaccine) is given to kids with___

A

cochlear implants, asplenia, cardiac disease, sickle cell anemia (kids at high risk of pneumococcal diseases). **if less than 2 years old PPSV 13 is better to mount immune response

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12
Q

Tympanostomy for acute otitis media recommended for kids when

A

3 or + episodes in 6 months or 4+ episodes in 12mth, or high risk of speech and hearing impairment (craniofacial abnrmlaties kids or neurodevlpmtal disorders)

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13
Q

dysphagia vs odynophagia

A

diffculty swallowing vs pain with swallowing

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14
Q

Thyroglossal duct cysts

A

Common appearance of neck swelling that moves with protusion of tongue. 1/3rd appear after 20 yo. Thyroglossal duct connects tongue to thyroid. Ectopic tissue often only functional thyroid tissue so get imaging before considering cutting it out.

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15
Q

chronic rhinitis:

  • allergic
  • non-allergic
A

AR appears at <20yo w/ watery eyes, sneezing, nasal congestion, watery rhinorrhea. Identifiable triggers. Normal or pale blue mucosa with polyps.
NAR appears >20yo w/ nasal blockage, rhinorrhea and post-nasal drip. Cant ID trigger. Nasal mucosa: nrml or boggy and erythematous. Tx: intranasal glucocorticoids or antihistamines

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16
Q

otalgia

A

ear pain

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17
Q

cleft lip +/- palate: repair at age___

A

3 mths of age, RUle of 10: 10lbs, 10 weeks of age, 10g of Hgb
Can be autosomal dominant or recessive or X linked

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18
Q

Negative exercise stress test means…

A

<1% risk of cardiovascular events in the next year

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19
Q

Factors associated with increased risk of CV event on exercise stress test: -Clinical variables v/s EKG variables

A
  • Clinical variables: poor exercise capacity, angina at low workload, fall in SBP from baseline, chronotopic incompetence
  • EKG variables: >1mm ST depression, ST depression at low workload, ST elevations without Q waves, Ventricular arrhythmias
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20
Q

Bronchoprovocation testing for asthma. Positive and diagnostic findings are:

A

Fall in expiratory volume in 1 sec>10% =positive
if fall >15%=diagnostic
> 20% reduction in FEV1 with methacholine

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21
Q

TCA overdose

list TCA:

A

amitriptyline, nortriptyline, trimipramine, desipramine. (SNRIs, antihistamine, anticholinergic activity)
Mental status change, seizures, respi depression
Anticholinergic effects: dry mouth, blurred vision, dilated pupils, flushing, hyperthermia, urinary retention
CV effect:sinus tachycardia, arrhythmias, hypotension–> cause most of the death in TCA overdose as it prolongs PR/QRS/QT interval–> V.tach, V.fib
Tx: Sodium bicarbonate, best tx for managing cardiotoxic effects: increases pH and neutralizes TCA (non ionized) making them less available to bind to rapid sodium channels and inhibit them. It also increases extracellular Na.

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22
Q

mydriasis

A

dilated pupil

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23
Q

refeeding syndrome is due to which electrolyte being low:

A

phosphate
As dextrose present in TPN is given it shifts Phosphate into cells causing hypophosphatemia–> seizures, rhambdomyolysis, arrhythmias, CHF

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24
Q

obstructive vs. restrictive PFT

A

Obstructive: decreased FEV1 and decreased FEV1/FVC
Restrictive: decreased FEV1 and FVC but increased FEV1/FV, it will be > 80%

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25
Q

bacterial endocarditis ppx

A

High risk cardiac conditions: previous IE, prosthetic valve, structural valve abnormality in transplanted heart, unrepaired/repaired congenital heart disease
Indicated procedures: Dental, GU and GI if active infection, infected sin and muscle surgery, prosthetic cardiac material placement.

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26
Q

asthma or cystic fibrosis pt w/ recurrent exacerbation of fever, malaise, cough with brownish sputum, wheezing and bronchial obstruction

A

allergic bronchopulmonary aspergillosis: pt become hypersensitive to Aspergillus antigens w/ intense IgE and IgG immune responses.
aspergillus
-CT shows bronchiectasis
-eosinophilia
-positive skin test for Aspergillus
-elevated Apergillus specific and total IgE
tx: steroids and antifungal

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27
Q

DVT treatmt

A

Oral Xa factor inhibitor (rivaroxaban) for > or = to 3 months for pt with DVT or PE and no cancer. If malignancy LMWH has better outcome.

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28
Q

harsh holosystolic murmur in 4th left intercoastal space

A

Ventricular septal defect (enlarged RV, LA, LV, pulm arteries)

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29
Q

mid-systolic ejection murmur over the LSB

wide and fixed splitting of S2

A

Atrial septal defect (enlarged RA, RV)

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30
Q

Hypertrophic cardiomyophathy murmur is

A

Harsh cresc-decresc systolic murmur at apex and L left sternal border

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31
Q

Beck triad

A

hypotension, JVD, decreased heart sounds

Cardiac tamponade most spe finding is: Early diastolic collapse on echo

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32
Q

trastuzumab-related cardiotoxicity is irreversible or reversible

A

reversible

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33
Q

TIMI score:

A

assess mortality for patient with unstable angina or NSTEMI: 1pt each
-Age> or = to 65
-> or = 3 risks factor for CAD (Family history of CAD, hypertension, hypercholesterolemia, diabetes, or current smoker)
-Known CAD (= or >50% stenosis)
-Aspirin use in last 7 days
-Severe angina (2 or + episodes in 24hr)
-EKG ST changes greater or equal than 0.5mm
-positive cardiac enzymes
0-2 Low risk: stress test
3-7: coronary angiogram w/in 24h
Hemo unstable: immediate coronary angiogram

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34
Q

Aortic dissection tx

A

Adequate pain control (morphine), lowering SBP to 100-120; decreasing LV contractility to reduce aortic wall stress (beta blocker first line: esmolol/propranolol/labetalol, +/- Nitroprusside if SBP still >120), emergent surgical repair
**hydralazine (arterial vasodilator), nitroprusside (arterial and venous vasodilator) cause reflex sympathetic stimulation–> tachycardia, increased LV contractility and increased aortic wall shear stress which could increase propagation of aortic dissection

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35
Q

Kerley B lines represent:

A

interstitial edema

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36
Q

Maternal hyperglycemia can cause what on babies heart?

A

Poorly controlled glucose–> glycogen deposit on myocardium–> hypertrophy of heart w/ septum most often affected–> outflow tract obstruction
Condition resolves after birth!

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37
Q

Antecedent nasal congestion/discharge, cough

Age <2yo now presenting with wheezing/crackles, respiratory distress

A

Bronchiolitis, caused by Respiratory Syncytial virus
Tx: respi isolation and supportive care or Palivizumab if Preterm, chronic lung disease or heart disease
-> associated with reccurent wheezing and reactive airway disease in up to 30% of kids

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38
Q

Number needed to treat NNT

number of pts needed to be treated in order to prevent or cure one disease or medical condition

A

NNT: 1/ARR (absolute risk reduction)

-ARR: risk of “something” in exposed/treated group - the risk in UNexposed/placebo/control group

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39
Q

Initial treatment for HCOM

A

Beta blockers best initial tx
Negative inotropes: also verapamil and dysopyramide
(slow HR for more filling of LV)

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40
Q

Wolf Parkinson White syndrome sx, tx

A

Wide QRS, delta waves
Kid becomes dizzy, dypsneic, passes out and recovers with not other sx
tx: procainamide, quinidine, ablation of pathway
Sudden cardiac death risk is low but increases in pt with episodes of tachyarrhytmias.

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41
Q

CHADS2VASc

A 
CHF (1pt)
HTN (1pt)
Age>75yo (1pt)
Stroke or TSA (2pt)
Vascular disease (1pt)
Age 65 to 74yo (1pt)
Sex female (1pt)
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42
Q

First degree AV block

A

Prolonged PR interval

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43
Q

Second degree AV block

  • Mobitz 1
  • Mobitz 2
A

Mobitz 1: Wenckebach: PR progressively longer until QRS droppes
Mobitz 2: no PR prolongation, QRS dropped intermittently

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44
Q

third degree AV block

A

none of the P waves conduct to ventricle

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45
Q

Noncyanotic congenital heart defects

A

ASD, VSD, PDA

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46
Q

Cyanotic congenital heart defect

A

Truncus arteriosus, Transposition of great vessels, tricuspid atresia, Tetralogy of fallot: VSD, RVH, pulm stenosis, overriding aorta, total anomalous pulm venous return

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47
Q

Calcium channel blocker names and SE

A

amlopidine, nifedipine (dihydropyridine)> non-DHP CCB (verapamil, diltiazem)
SE: peripheral edema in 25% after 6mth of use

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48
Q

HTN prevention

A
  • weight loss best non pharmalogical measure
  • Dash diet next
  • Exercise
  • Low sodium diet
  • Reduce alcohol intake
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49
Q

Severe aortic stenosis criteria:

  • Aortic jet velocity
  • Mean transvalvular pressure gradient
  • Valve area
A

-Aortic jet velocity > or = 4.0m/sec
-Mean transvalvular pressure gradient> or = 40mmHg
-Valve area < or = to 1cm cubed
Valve replacement if onset of sx, EF<50% or getting cardiac surgery for other stuff (CABG)

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50
Q

Causes of acquired long QT syndrome

A
  • Meds: Diuretics, antiemetics, antipsychotics, TCA, SSRI, antarrhythmics, antiangical , Antimicrobial
  • Met disorder: HYPO K, Mg, Ca, starvation, hypothyroidism
  • Bradyarrhythmias: Sinus node dysfxn, AV block
  • Others: Hypothermia, MI, Intracranial disease, HIV
  • -> Mg Sulphate tx
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51
Q

Brugada syndrome EKG findigns

A

pseudo-RBBB and persistent ST elevation of V1 to V2

  • pt die from V.fib not exertional related
  • ICD
  • Quinidine, 1a
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52
Q

Marfan mutation in ___ gene

A

fibrillin gene

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53
Q

Hazard ration that are significant

A

HR>1 is significant

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54
Q

Sensitivity analysis

A

Repeating primary analysis calculations after modifying certain criterias or variable ranges. The goal is to determine whether such modifications affect the results initially obtained.

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55
Q

Common CNS infection in AIDS

A

Cryptococcus neoformans

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56
Q

rhomboid shape and positive birefringence under polarized light

A

Pseudogout. Calcium pyrophosphate dihydrate crystals, 50% of pt with hemochromatosis have these crystals. So does hyperparathyroidism, hypoparathyroidism. Tx: colchicine and NSAIDS

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57
Q

disease modifying anti-rheumatic drugs DMARDs

A

RA tx
-methotrexate, steroids than use infliximab or etanercept (anti-cytokine such these last 2 can reactive TB so screen with PPD skin test prior to giving)

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58
Q

Microcytic anemia

A

Lead poisoning, Thalassemia, sideroblastic anemia, iron deficiency

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59
Q

Sensitivity

A

TP/(TP+FN) Ability to detect disease
High sensitivity test: Screening test (catch them all, how many signals have to go off before pt deemed to have disease, good to catch as many even if negative to r/o disease)

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60
Q

Specificity

A

Ability to detect health TN/(TN+FP)
High specifity: disease confirmation
(ok well you might loose people that have the disease but you wont have a test + if someone doesn’t have the disease)

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61
Q

Positive predictive value

A

When a test is +, the PPV measures how likely it is that pt has the disease. Depends on prevalance of disease and spe/sensi of test. The higher the prevalence the higher the PPV
TP/(TP+FP)

62
Q

Negative predictive valure

A

When test -, NPV measures how likely it is that the pt is healthy (not with disease) TN/(TN+FN)

63
Q

Attributable risk

A

number of cases attributable to one risk factor. put another way, the amount you would expect the incidence to decrease if a risk factor were removed .
AR: (Risk in exposed-in UNexposed)/risk in exposed

64
Q

Relative risk

A

compares the disease risk in exposed population to disease risk in the unexposed population. Any RR value other than 1 is clinically significant. ONLY AFTER PROSPECTIVE or experimental study.
RR: risk in exposed group/risk in UNexposed group

65
Q

Odds ratio

A

ONLY for retrospective studies. Compares odds of pt w/ disease having been exposed v.s odds of pt w/out disease got exposed

66
Q

p<0.05

A

stat significant (less than 5% chance)

67
Q

metoclopramide

A

Reglan: anti-emetic, dopamine antagonist (peripheral and central D2 blocker) SE: extrapyramidal symptoms: akathisia, dystonia, parkinson-like symptoms

68
Q

neonatal hyperbilirubinemia

A

Mild: maximize brestfeeding every 2-3h
Moderate: Phototherapy, consider formular and IV fluids
Severe (bilirubin >20-25mg/dL): exchange transfusion in baby

69
Q

likelihood ratio

A

the probability of a given test result occurring in a patient with a disorder compared to the probability of the same result occuring in a pt without the disorder. Calculated from spe/sensi not dependent on prevalence
Positive LR: Sensi / (1-spe)
Negative LR: (1-sensi)/spe

70
Q

Confounding bias vs. Effect modification bias

A

Effect modification bias: an extraneous variable (effect modifier) changes the direction or strength of the effect an independent variable has on the dependent variable (outcome). ex: aspirin causes Reye syndrome in children and not in adults. Effect modifier: age
Stratifying by the effect modifier will show different effect in each stratum
Confounding bias: extraneous variable (confounder) obscures the association between exposure and outcome. Stratification doesnt change anything

71
Q

Child, platelet count<100,000 w/ sudden onset of bleeding: petechiae/purpura, mucosal bleeding, internal hemorraghe . Recent viral infection, NO current systemic disease or other abnrml labs.

A

Immune thrombocytopenia due to autoimmune platelet-specific autoantibodies.
If mild tx: observation
If moderate/severe: IV immune globulin
(50% have remission after few years).

72
Q

Multiple myeloma

A

Malignant clonal proliferation of plasma cells that produces monoclonal protein
CRAB
Calcium elevation
Renal insufficiency
Anemia (normolytic)
Bone Pain (lytic lesions, commonly low back)
Dx: serum or urine protein electrophoresis
> or = to 10% clonal plasma cells in bone marrow or soft tissue/bone plasmacytoma
(If untreated complication can be hyperviscosity syndrome, renal insufficiency, hyperCa, infection, thrombosis)

73
Q

external validitiy in biostats means

A

generalizability

74
Q

vitamin B6 is called

A

pyroxidine

75
Q

SAAG

A

serum-ascites albumin gradient:
If > or = to 1.1 then portal HTN, think CHF, cirrhosis, alcoholic hepatitis
If < then 1.1 NOT portal HTN think peritoneal carcinoma, peritoneal TB, nephrotic syndrome, pancreatitis, serositis

76
Q

Pernicious anemia: autoimmune destruction of

A

parietal cells or intrinsic factor (antibodies against those two)
on gastric endoscopy: antropy of body and fundus, glandular atrophy, intestinal metaplasia, inflammation (autoimmune metaplastic atrophic gastritis)

77
Q

Diagnosis test for sickle cell disease

A

Hemoglobin electrophoresis

78
Q

Most common inherited thrombophilia (repeat DVT/PE)

A

Factor V leiden

79
Q

bug of osteomyelitis in sickle cell kid and abx tx

A

Salmonella, MRSA, Ceftriaxone and clinda

80
Q

Acute chest syndrome in sickle cell ABX tx

A

Azithromycin (for mycoplasma pneumo) and ceftriaxone (for strep pneumo)

81
Q

Polycythemia Vera has an elevated or decreased EPO, due to mutation of — gene

A

Jak2 mutation, tyrosine kinase gene
Polycythemia vera has low EPO, bone marrow goes crazy and makes too much rbc
(Secondary polycythemia has high EPO usually 2/2 to chronic hypoxia/sleep apnea)

82
Q

Drugs that induce pancreatitis

A

Thiazide diuretics and loop diuretics, ACE inhib, ARB
Autoimmune (mesalamine, corticosteroids)
Chronic pain (NSAIDS, acetaminophen, opiates)
Seizure (valproate, carbamazepine)
HIV (Lamivudine)

83
Q

MELD (Model for End Stage Liver Disease)

A

Calculated based on sodium, creatinine, bilirubin, inr
Used for 90 day survival prognosis and prioritizing of liver transplantation.
Score of 10 or greater is bad.

84
Q

Light criteria, exudate and transudate common causes

A

Exudate if:
-Pleural protein/serum protein> 0.5
-Pleural LDH/Serum LDH>0.6
-Pleural LDH> 2/3 upper limit of normal serum LDH
Pathophysiology of exudate: inflammation
Common causes: Infection, malignancy, CT disease, PE, pancreatitis, post-CABG

Transudate
Patho: Hydrostatic or oncotic pressure
Causes: Cirrhosis, nephrotic syndrome, heart failure, constrictive pericarditis

85
Q

hematochezia w/ orthostatic hypotension (or hemodynamic instability) suggests bleeding at Upper or Lower GI?

A

Upper: large volume bleed

86
Q

Primary biliary cholangitis

A

Symptoms: fatigue, pruritus, inflam. arthritis, RUQ pain, xanthelasmata, xanthomata
Dx: elevated ALkaline Phosphatase, +AMA, liver biopsy, antimitochondrial antibodies
Tx: Ursodeoxycholic acid, liver transplantation
Pathophysio: autoimmune disease, T cell attack on intrahepatic bil ducts–> fibrosis, obliteration of ducts–> cirrhosis
Screen them for osteoporosis and osteopenia

87
Q

Elevated TSH and normal T4 get…. test

A

Antithyroid peroxidase measurement for hashimoto (hypothyroidism)

88
Q

DEXA T score for osteoporosis and osteopenia

A

T -2.5 or lower is osteoporosis

T-1 to -2.5 for osteopenia

89
Q

hypertension + hypokalemia and test to order to confirm diagnosis

A

Conn’s syndrome= primary hyperaldosteronism

Test: plasma aldosterone to renin ratio (ratio> 30 is suggestive, need aldosterone level >15 too)

90
Q

Statin should be initiated in pt of ages 40-75 with diabetes 1 or 2 who have LDL> or = to

A

LDL> or = to 70mg/dL

91
Q

systemic sclerosis Limited (CREST) vs. diffuse

A 
Limited:
C: Calcinosis of skin
R: Raynaud phenomenon
E: Esophageal dysmobility
S: Sclerodactyly
T: telectangia
Diffuse: Skin + lungs (pulm HTN and interstitial lung disease) + GI involvement
92
Q

Jaundice due to breastfeeding failure vs. breast milk

A

Breastfeeding failure: first week of life due to subopitmal breastfeeding leading to decreased bilirubin elimination
Breast milk jaundice: age 3-5 days peaks at 2 weeks w/ adequate breastfeeding due to High levels of beta-glucuronidase in breast milk deconjugate intestinal bilirubin and increase enterohepatic circulation (kernicterus from breast milk jaundice is very rare)

93
Q

Predictors of acute pancreatitis severity are

A

BUN>20, BMI>30, Hematocrit>44% ( indicates hemoconcentration from third spacing losses, CRP>150

94
Q

Patient at increased risk of colon cancer

A

First degree relative <60 yo with colon cancer OR greater/equal to 2 first degree relative with colon cancer or adenomatous polyps at any age

95
Q

Treatment of DKA:

A
  • Normal saline bolus over an hour
  • Insulin drip
  • IV with K if K low or normal
  • > dont give bicarbonate (no benefit and might cause hypokalemia, metabolic alkalosis, cerebral edema)
  • If glucose<200 but pt still has elevated anion gap then halve insulin drip and add dextrose infusion
  • When transitioning to subQ insulin, continue insulin gtt fror 1-2h to allow subQ to take effect and prevent rebound ketoacidosis.
96
Q

Amiodarone 3 different effects on the thyroid:

A
  • 1) Amiodarone decreases peripheral conversion of T4 to T3 therefore pt has High T4, low T3 and normal or mildly elevated TSH. Most prominent in first 3 months and then improves, clinically euthyroid
  • 2) High iodine content in amiodarone inhibits TH synthesis-> primary hypothyroidism
  • 3)Amiodarone induced thyrotoxicosis, TSH is low.
97
Q

non insulin hyperglycemic agent that cause hypoglycemia as side effect

A

Sulfonylurea (glyburide, glipizide, glimepiride), meglitinide (repaglinide, nateglinide) bc they increasei insulin secretion by pancreatic cells

98
Q

anosmia, hypogonadotropic hypogonadism

A

Kallman syndrome

99
Q

radioactive iodine uptake in subacute thyroiditis ( deQuervain’s) is…

A

diminished bc thyroiditis causes release of stored TH not increase in TH production!
Also low uptake of iodine in painless/silent thyroiditis, postpartum thyroiditis, TH abuse

100
Q

Treatment of subacute Thyroiditis

A

supportive (NSAIDS, betablocker)

101
Q

Presentation of subacute thyroiditis

A

Likely postviral inflammatory process (after URI), fever, hyperthyroid symptoms, painful/tender goiter with diminished radioactive iodine uptake.

102
Q

non insulin hyperglycemic agent that cause weight gain

A

Thiazolidinediones: Pioglitazone, rosiglitazone (increases insulin sensitivity in peripheral tissue by PPAR transcription regulator).

103
Q

Symptoms of adrenal insufficiency ( Addison’s disease), PE, labs

A

weight loss, abdominal pain, asthenia, amenorrhea, fatigue, poor appetite. PE: muscle tenderness, decreased axillary and pubic hair, **Increased pigmentation due to co-secretion of ACTH and melanocyte stimulating hormone
Labs: hyponatremia, hyperkalemia, mild hyperchloremic metabolic acidosis, hypoglycemia
Test: morning cortisol with ACTH if low cortisol but elevated ACTH= primary adrenal insufficiency

104
Q

Tx for pustulopapular rosecea

A

topical metronidazole, if no pustules can treat with topical brimonidine *pt usually also have ocular symptoms

105
Q

Erythema nodosum

A

painful and erythematous subcutneous nodules, located bilaterally in lower extremities
Associated with Sarcoidosis

106
Q

Erythema nodosum + facial palsy + lymphadenopathy

Dx, Tx

A

Sarcoidosis, Tx: steroids, Dx: biopsy of LN or parotid gland or lacrimal glands, salivary glands

107
Q

Chronic urticaria

A

Recurrent episodic sx of wheals + pruritus >6 weeks. Ususally episodes last 24h. Self-resolves in 2-5 years. Triggers: many cold/hot due to mast cell activation.
40% have associated angioedema
Tx: second generation antihistamine (loratadine, cetirizine)

108
Q

Cetirizine

A

second generation antihistamine

109
Q

Severe seborrheic dermatitis is associated with

A

HIV and Parkinson’s

110
Q

Pyoderma gangrenosum is associated with

A

Necrotic deep ulcers. associated with Inflammatory bowel disease

111
Q

Paget disease labs:

A

Elevated Alakaline phosphatase, nrml Ca

Tx: bisphosphonates

112
Q

Niacin deficiency

A

Pellegra: dementia, diarrhea, dermatitis (in sun exposed area +/- blisters), stomatitis, cheilosis

113
Q

polymyositis and dermatomyositis dx test (antibodies)

A

ANA, anti-Jo 1, anti SRP

114
Q

Polymyositis vs. Polymyalgia rheumatica

A

Polymyositis: weakness
Polymyalgia: pain and stiff, no weakness.
Both treated with steroids

115
Q

Primary adrenal insufficiency vs. central adrenal insufficiency

A

Primary: High ACTH, subnormal increase in cortisol with ACTH stimulation
Central: Low ACTH, subnormal response to ACTH stimulation bc of adrenal atrophy from chronic ACTH deficiency

116
Q

ulcerative colitis treatment

A

Mesalazine (mesalamine, 5 Aminosalicylic acid)

117
Q

Treatment for trigeminal neuralgia

A

carbamazepine

118
Q

Treatment of status epilepticus

A
  • benzodiazepine: lorazepam, diazepam.
  • if seizure persist: phenytoin (1b antiarrhythmic medication which causes hypotension and AVblock.) Fosphenytoin does not have these SE.
  • if seizure persist: phenobarbital
119
Q

Absence seizure treatment

A

ethosuximide

120
Q

Anterior spinal artery infarction symptoms

A

Loss of motor functional below
Loss of pain and temperature
Intact sensation and proprioception

121
Q

Brown Sequard syndrome symptoms

A

Loss of pain and temperature on contralateral side

Lost of proprioception, vibration and motor on the ipsilateral side

122
Q

Syringomyelia

A

Loss of pain and temperature bilaterally in arms, loss of reflexes and atrophy.

123
Q

Benztropine, trihexylphenidyl

A

anticholinergic medication. Relieve tremor and rigidity in mild parkinsonism.

124
Q

Amantadine

A

increase release of dopamine from substantia nigra

125
Q

pramipexole, ropinirole

A

dopamine agonist. In severe parkinsonism.

126
Q

LMN or UMN:

weakness, wasting, fasciculations

A

LMN

127
Q

LMN or UMN:

weakness, spasticity, hyperreflexia, extensor plantar responses

A

UMN

128
Q

Spina bifida clinical features and comorbidities

A

Tx at birth is surgery but pt can still have:
Neurogenic bladder/bowel
Motor/sensory dysfunction
Hydrocephalus
Scoliosis
*Elevated alpha-fetoprotein on maternal screening is suspicious for Neural tube defect

129
Q

Cerebral palsy features

A

delayed motor milestones
hyperreflexia, hypertonia, sustained clonus
comorbid seizures, intellectual disability
*risk factor is prematurity, low birth weight
W/u: MRI (majority have abnormal findings such as periventricular leukomalacia, brain malformation, ischemia)

130
Q

Mini mental status examination: score of ____ indicates dementia

A

<20
20-24 mild dementia
(its out of 30)

131
Q

Tuberous sclerosis:
Cause
Clinical features: skin, neuro, CV, renal
MCC of death

A

Autosomal dominant
“Ash-leaf spots” hypopigmentation
Angiofibromas
Shagreen patches
Epilepsy, CNS lesions, cognitive disabilities, Autism, behavioral problems
Rhabdomyomas (regress in adult life), angiomyolipomas
*Most common cause of death is epilepsy and neuro impairment

132
Q

bilateral cerebellopontine angle masses caused by proliferation of which cells:

A

Acoustic neuroma 2/2 to Schwann cells proliferations (Schwannomas)

133
Q

Vertebrobasilar insufficiency

A

reduced blood flow in the base of the brain, usually 2/2 to thrombi, emboli or arterial dissection. Labyrinth and brainstem often affected: vertigo, dysarthria, diplopia, numbness. Risk factors: HTN, DM, smoking…

134
Q

Pt with asthma or Cystic Fibrosis and recurrent infection and BROWNISH productive cough, fleeting infiltrates on Xray

A

Allergic bronchopulmonary aspergillus: Hypersensitivity disorder, exaggerated IgG and IgE response to aspergillus (noninvasive colonization in lungs)
Tx: glucocorticoid and intraconazole

135
Q

Wallenberg syndrome

A

vertigo, nystagmus (horizontal and vertical), loss of pain and temp in ipsilateral face and CONtralateral body, bulbar muscle weakness (dysphagia, dysarthria, hoareseness, ipsilateral Horner’s syndrome (miosis, ptosis, anhydrosis), hiccups

136
Q

croup: What? Who? Tx?

A

Parainfluenza, <3 yo, barking cough, inspiratory stridor, hoarseness
Tx: humidified air, 1 dose of steroids (IM or oral) if you want to reduce stridor and corticosteroids+ nebulized epinephrine if moderate/severe croup or concern for upper airwary obstruction.

137
Q

Wernicke’s sx and Korsakoff’s sx. + Korsakoff’s MRI findings:

A

Wernicke: encephalopathy, oculomotor dysfunction, gai ataxia. Tx: thiamine.
Korsakoff: retrograde/anterograde amnesia, confabulation MRI: mammillary body atrophy (complication of chronic thiamine deficiency).

138
Q

Tx for prolactinomas

A

dopamine receptor agonist , usually no surgery is required

139
Q

Pineal gland tumor classically presents with ____ syndrome

A

Parinaud’s syndrome: Loss of pupillary reaction, vertical gaze paralysis, loss of optokinetic nystagmus and ataxia

140
Q

SE of carbamazepine

A

Bone marrow suppression: ex neutropenia

141
Q

Which diuretic does not increase lithium levels:

A

CCB or loop diuretics

142
Q

dermatitis herpetiformis presentation:

A

pruritic papules and vesicles on the extensor surface of elbows and knees as well as the buttock and back. Tx: gluten free diet

143
Q

chronic pruritis rash with excoriation and lichenification is:

A

atopic dermatitis, often associated to asthma and allergies. Tx: oral antihistamines, skin hydration, avoidance of hot/dry environment, topical glucocorticoids: hydrocortisone, triamcinolone…

144
Q

Acute cystitis and asymptomatic bacteriuremia treatment in pregnant woman

A

Cephalexin, amoxicillin-clavulanate, fosfomycin, nitrofurantoin (NOT bactrim as it can cause neural tube defects)

145
Q

chlamydia treatment

A

azithromycin, doxycycline

146
Q

Gonorrhea treatment

A

Ceftriaxone

147
Q

Alzheimer medication treatement (3+1)

A 
Anticholinesterase inhibitor (donepezil, rivastigmine, galantamine) 
Memantine
148
Q

Antibiotic treatment in COPD exacerbation: inpatient vs. outpatient

A

Inpatient: Levofloxacin or Ceftriaxone
Outpatient: Bactrim or doxycycline

149
Q

Hypertensive crisis tx drug:

A

Nitroprusside IV

150
Q

Preeclampsia prevention in high risk pt

A

high risk: med hx of HTN, KD, DM, prior preeclampsia

Tx: aspirin starting at 12 weeks gestation

151
Q

Pregnant women w/epilepsys at increased risk for

A

preeclampsia, preterm labor, abruptio placenta,

152
Q

autoimmune hepatitis antibodies (2)

A

anti smooth muscle antibodies and ANA antibodies

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