Study Guide Incorrect Flashcards
1
Q
Exercise stress test findings suggest ischemic heart dz
A
Sudden drop in BP
Reproduceable angina on exertion
Reproduceable DOE + dizzi
STEMI or NSTEMI on EKG
2
Q
beginning stage of pathogenesis of atherosclerosis
A
endothelial dysfxn (from smoking, DM, HTN, HLD)
3
Q
lipid-lowering agent that… SE facial flushing
A
niacin
4
Q
lipid-lowering agent that… SE elevated LFTs, myositis
A
fibrates
ezetimibe
statins
5
Q
lipid-lowering agent that… SE GI discomfort, bad taste
A
bile acid-binding resins
6
Q
lipid-lowering agent that… best effect on HDL
A
niacin
7
Q
lipid-lowering agent that… best effect on TG
A
fibrates
8
Q
lipid-lowering agent that… best effect on LDL/chol
A
statins
9
Q
lipid-lowering agent that… binds c. difficle toxin
A
cholestyramine
10
Q
what patients should be on statin tx?
A
ASCVD (ACS, TIA, CVA, angina, revascularization, PAD)
DM + 40-75 yo
LDL > 190
10 y ASVCD risk > 7.5 + 40-75 yo
11
Q
pharmacologic stress test agents
A
adensoine
dipyridemol
dobutamine
12
Q
elevated homocysteine tx
A
B12 B6 and B9
13
Q
Medications can negatively affect lipid measurements
A
PO estrogen
BB + thiazide diuretics
antipsychotics (clozapine, olanzapine)
protease inhibitors
14
Q
defining characteristics of Prinzmetal angina
A
vasospasm (not atherosclerosis) chest pain at night 5-15 m nL caridac cath angio smoker younger
15
Q
55 M report from health screening showed markedly elevated serum LDL, TG, and total chol –> most approp next step
A
fasting lipid profile
16
Q
utility of homocysteine screening in atherosclerosis
A
increased risk for:
CVA
PAD
CAD
17
Q
benefit of bb in pt with unstable angina?
A
decrease HR and BP
decreased O2 demand
decreased ischemia
decreased mortality
18
Q
MC COD s/p MI
A
v fib
19
Q
RHD valve damage
A
mitral stenosis
20
Q
how long after onset MI does troponin I begin to rise and how long stay elevated
A
4 h to 7-14 days
21
Q
MAP calculation
A
2/3 x DBP + 1/3 x SBP
22
Q
type cardiomyopathy most closely associated with amyloidosis
A
restrictive cardiomyopathy
23
Q
Rxs impt in outpt tx of cCHF
A
ACEi BB spironolactone loop diruetics digoxin
24
Q
two MC Rx to treat Prinzmetal angina
A
#1 CCB (dilitazem) #2 nitrates
25
type of shock matches: reduced venous return to left heart due to pHTN
obstructive shock
26
vasopressor at high doses optimizes the alpha-1 vasoCNX
epinephrine
| dopamine
27
MC ECHO finding with myocarditis
impaired ventricular function
28
Janeway lesions
NON-tender petechiae on palms/soles
29
Osler nodes
tender nodules on finger/toe pads
30
Roth spots
retinal hemorrhages
31
Splinter hemorrhages
petechiae under nail beds
32
ECG findings suggestive of cardiac tamponade
electrical alternans
| low voltage
33
Beck's triad
JVD
hypoTN
muffled heart sounds
(cardiac tamponade)
34
Tx acute pericarditis
NSAIDs
| colchicine
35
Tx chronic constrictive pericarditis
pericardectomy
36
pulsus paradoxus
drop in SBP > 10 mmHg during inspiration
| cardiac tamponade
37
How do calcium channel blockers work to reduce the ischemic effects of acute angina?
promote coronary and peripheral vasodilation --> decreased HTN --> decrease afterload
reduce myocardial contractility and O2 demand
38
tx 3rd degree heart block
ventricular pacemaker
| stop BB, CBB, digoxin
39
tx HOCM
BB
avoid volume depletion
restrict physical activity
40
MI tx inititate immediately
ASA
nitrates
O2 if need
41
which antiarrhythmic avoid in pt with pre-existing lung disease
amiodarone
42
PEx findings expected with pericardial effusion
deminished heart sounds
| decreased apical
43
Rx to treat stable, asx ventricular tachycardia
amiodarone!
procainamide
sotalol
44
do not shock _____ rhythms
asystole
| PEA
45
max number epi doses when treating cardiac arrest?
no max
46
ACLS protocol for ventricular fibrillation
```
#1 shock, start CPR 2 m
-
recheck rhythm
-
#2 shock, CPR 2 m, epi 1 mg Q3-5 m
-
recheck rhythm
-
#3 shock, CPR, may give amio 300
-
repeat
```
47
H & T causes of asystole/PEA pulseless electrical activity
```
hypovolemia
hypoxemia
H+ (acidosis)
hyperkalemia
hypokalemia
hypogycemia
hypothermia
```
```
tamponade
tension PTX
thrombosis (MI)
thrombosis (PE)
trauma
toxins
```
48
Rxs that block transmission through AV node
adenosine
BB
CCB
digoxin
49
MC cause of 2* HTN given... high BP in UE but low in LE
coarctation of aorta
50
MC cause of 2* HTN given... proteinuria
CKD
51
MC cause of 2* HTN given... hypokalemia
hyperaldosteronism
| renal artery stensis
52
MC cause of 2* HTN given... tachy, diarrhea, heat intol
hypertTHY
53
MC cause of 2* HTN given... hyperkalemia
renal failure
54
Tx afib of unknown duration
rate and anticoagulate
| BB and warfarin/hep
55
2 CV dz that are biggest RF for CHF?
HTN
| ischemic heart dz
56
JNC-8 bp guidelines 1st line rules...
CKD > race
| DM > age
57
next step in management of pt with DVT if pt has a high likelihood of falling
IVC filter
58
when might subclinical mitral stenosis from RHD become clinically apparent
fluid overloaded (inc SV)
pregnancy
tachycardia
59
tx giant cell arteritis
high dose steroids
60
tx HSP
self-limited
61
tx thromboangiitis obliterans
stop smoking
62
Plummer-Vinson syndrome
TRIAD:
esophageal webs
dysphagia
IDA
63
most approp dx test x esophageal dysphagia to solids
EGD
| *but if high risk perf, barium swallow
64
chest pain; uncoordinated esophageal contractions; corkscrew pattern on barium swallow dx
diffuse esophageal spasm
65
4 potassium-sparing diuretics
spironolactone (antiandrogenic)
epiplerenone
amilioride
traimterene
66
Tx Wegeners/granulomatosis with polyangiitis
steroids
| cyclophosphamide
67
sx strongly suggest upper GI himorrhage
+ NG lavage
hematemesis
hemodyamic instability
68
feared complication of Kawasaki disease
coronary artery aneurysms
69
tx Whipple dz
ceftriaxone x 2 wk
THEN
TMP-SMX x 12 mo
70
chronic diarrhea + positive stool Sudan stain + normal D-xylose test --> most likely cause of malabsorption
pancreatic insufficiency
stool Sudan stain + = fat in stool***
71
caucasion + foul-smelling chrinc diarrhea + IDA
Celiac
72
immigrant DR + foul-smelling chronic diarrhea + macrocytic anemia
Tropical sprue
73
chronic diarrhea + arthralgias + ataxia dx
Whipple dz
74
SVR and HR in anaphylactic shock
decreased SVR
| increased HR
75
SVR and HR in neurogenic shock
decreased SVR
| decreased HR
76
food poisoning as results of mayonnaise sitting out too long
s. aureaus
| salmonella
77
rice water stools
vibrio cholerae
| ETEC
78
mild intestinal infection that can become neurocysticercosis
taenia solium
79
diarrhea from seafood
vibrio cholerae
| vibrio parahemolyticus
80
bloody diarrhea from poutry
campylobacter
s. aureaus
salmonella
81
bloody diarrhea + liver abscess
entomoeba histolytica
82
diarrhea in AIDS pt
cryptosporidium
83
tx for entamoeba histolytica
metronidazole
84
tx giardia lamblia
metronidazole
85
tx salmonella spp.
fluoroquinolone (if immunocompromised)
86
tx shigella spp.
fluoroquinolone or TMP-SMX
87
tx campylobacter jejuni
fluoroquinolone or azithromycin
88
type esophageal cancer most prevalent in US
adenocarcinoma
89
vasculitis with necrotizing granulomas of lung and glomerulonephritis
GPA
90
next step management pt < 50 with minimal BRBPR
anoscope
91
vasculitis characterized by necrotizing imm complex inflammation of visceral/renal vessels
polyarteritis nodosa
92
next step: colonoscopy reveals colon cancer in the sigmoid colon
CT ab/chest/pelvis for staging
93
benign heart sounds
```
early quiet systolic murmur
no evidence of dz
split S1
split S2 on inspiration
S3 < 40 yo
```
94
35 F + PUD + hypercalcemia + amenorrhea --> dx
MEN1
gastrinoma
PTH tumor
adenoma
95
Rx to stop insulin production in pt with insulinoma
octreotide
| diazoxide
96
high risk acalculous cholecystitis
critically ill
| TPN
97
Tx (medical) x UC
small bowel = mesalamine
large bowel = sulfasalazine (5-ASA + sulfapyridine)
stroids x acute exacerbation
98
gi infection associated with diarrhea and pseudoappendicits
yersinia enterocolitis
- pork
- puppies
- pseudoappex
- pharyngitis
99
hepatitis virus increase risk HCC
hep B > C
100
abx combinations used in outpatient tx of diverticulitis
metronidazole
| ciproflaxacin/TMP-SMX/Augmentin
101
positive HBcAb only
window period of active infection
102
vaccines for cirrhotics
hep A
hep B
pneumo
standard
103
Rxs for ileus
stigmines
erythromycin
metocloperamide
104
two diuretics used in conjunction x ascites/portal HTN
spironolactone
| furosemide
105
Budd-Chiari syndrome sx
jaundice
hepatomegaly
ascities
+/- RUQ pain
106
aortic stenosis - indications for valve replacement
syncope
CHF
dyspnea
angina
107
Paraneoplastic syndromes with polycythemia
```
Potenially Really High Hematocrit
Pho
RCC
HCC
hemangioblastoma
```
108
most widely use screening test for hemochromatosis
ferritin
109
vasopressor theoretically causes renal vasodilation
dopamine
110
65 Af Am F + weakness + LE + rash on chest --> lab to establish diagnosis
CK, AST/ALT, aldolase
LDH
ANA
Anti-Jo 1
dermatomyositis
111
most sensitive and speciifc lab test for dx of chronic pancreatitis
low fecal elastase
112
"pencil-in-cup" deformities of DIP joints
psoriatic arthritis
113
acute gout tx
1. NSAIDs
2. glucocorticoids
3. colchicine
114
tx 16 M bullseye ring in axilla two weeks after camping trip, dx and first-line tx
early localized Lyme dz
| doxycycline 100 mg BID x14d
115
45 F + swollen, warm, erythematous L knoee + tender + ROM extremely limited --> best dx test and tx
dx: synovial fluid analysis
tx:
1. IV abx empiric
2. surgical I&D
116
24 F + markedly elevated BP + nL body weight, exercise, not smoker, no OCPs --> 2* cause of HTN should be considered? radiological imaging?
MC: OCPs
2nd: RAS 2* fibromusclar dysplasia
imaging: "beads on a string" of renal A on angiogrpahy
117
AI condition most likey seen in pt with endcarditis caused by steril vegetations of immune compex depositions
SLE
| Libman-Sacks endocarditis
118
MC cancer of bones
METS
119
suspected osteomyelitis --> non-dx xray, MRI not availabe, next best test to make definitieve dx of osteomyelitis
bone bx and cx
120
6- M + new pt + legs bowed out + kyphosis + hearing loss + fav ht not fit anymore + most sensitive imaging tes to dx this process?
radionucleotide bone scan
Paget
121
medical management of PAD
```
smoking cessation
exercise
good diet
glucose control
anti-HTN
cilostazol
```
122
caution for which complication of FOOSH
avascular necrosis
123
caution for which complication of anterior shoulder dislocation
axillary N
124
caution for which complication of fx of 5th metacarpal neck
bite inf
| tendon lac
125
caution for which complication of humerus fx
radial N inj, wrist drop
126
caution for which complication of tibial fx
compartment syndrome
127
caution for which complication of pelvic fx
hemorrhage
128
45 obese F + pruritus + clay-colored stools + dark urine + elev ALP and bili --> most likely cause
biliary tract obstruction
129
pain increases with passive straight leg raise
herniated disc
130
29 M + alcoholism + vom + seere uper abd pain + elev lipase --> dx and tx
acute pancreatitis
1. admit to ICU
2. IV fluids
3. correct electrolyties
4. pain managment
5. NPO
6. NG for enteral feeds poss
131
microcytic anemias
```
IDA
lead poisoning
sideroblastic anemia
thalessemia
AOCD
```
132
normocytic anemias
AOCD
hemolytic anemia
hemorrhage
133
macrocytic anemias
folate def
B12 def
liver dz
alcohol abuse
134
IDA iron studies vs. AOCD
IDA: decreased ferritin, increased TIBC
AOCD: increaed ferritin
135
pt with acute diarrheal illness, which labs should be otbtained in order to id causative organism?
no workup necessary (MC viral)
*if no fever or bloody diarrhea = no workup
136
imaging preferred for soft tissue?
| imaging preferred for bone?
soft tissue - MRI
| bone - CT
137
in hemolytic anemia ,why haptoglobin decreased? why LDH increased?
free haptoglobin decrease bc free hemoglboin released from cell lysis/hemolysis and needs to be bound up
LDH is found inside RBCs, so hemolysis = inc LDH outside the cell duh
138
most likely PUD relieved with eating and wore 2-5 hours after eating
duodenal
139
lose weight with which PUD?
gastric
140
tx for diarheal illness due to cryptosporidium parvum
HIV
| nitazoxanide
141
tx for diarrheal illness due to trichinella spiralis
mabenazole
142
anemia + basophilic stippling of RBCs
leadpoisoning microcytic
thalessemia
EtOH use
143
degmacytes and Heinzs bodies
G6{D deficiency
Heinz bodies = denatured hgb in RBC
144
anemia + mintal status change + neuropathy + constipation
lead poisoning
| microcytic
145
most likely abx tx for diarrheal illness due to salmonella
fluoroquinolone or TMP-SMX
146
most likely abx tx for diarrheal illness due to shigella
fluoroquinolone or TMP-SMX
147
most likely abx tx for diarrheal illness du eto camplylobacter jejuni
ciprofloxacin or azithromycin
148
thrombocytopenia while being treated with heparine for PE --> tx
1. stop heparin
2. labs to confirm HIT: hep induced agg assay, ELISA immunoassay
3. start argatroban until PLT > 100
4. transition to warfarin, 3 mo tx
149
classic pentad for TTP
```
MAHA
thrombocytopenia
fever
AMS
renal failure/uremia
```
150
two steps to hemostasis
1. temporary plug = "PLT plug"
| 2. permanent clot = "FIBRIN clot"
151
tx vW dz
DDAVP
vWF concentrate
OCPs
avoid ASA
152
MC causes of DIC acronym
STOP Making Thrombi
```
sepsis
trauma
OB complications
pancreatitis
malignancy
transfusions
```
153
coag changes in TTP-HUS
PLT dec
BT inc
PT nL
PTT nL
154
coag changes in hemophilia A or B
PLT nL
BT nL
PT nL
PTT inc
155
coag changes in vW dz
PLT nL
BT inc
PT nL
PTT inc
156
coag changes in DIC
PLT dec
BT inc
PT inc
PTT inc
157
coag changes in vit K def
PLT nL
BT nL
PT inc
PTT nL/inc
158
coag changes in ESLD
PLT nL/dec
BT nL/inc
PT inc
PTT inc
159
thrown from horse --> LBP + urinary retention _ dec rectal tone --> tx
emergent surgical decompression of cauda equinea
| steroids to dec spinal cordinflammation
160
approp eval of pt susp celiac
lab: tissue transglucaminase IgG + anti-gliadin ab + anti-endomysial ab
img: EGD biopsy of intestine
161
MOA abciximab
gp IIb/IIIa i
162
MOA apixaban
direct Xai
163
MOA clopidogrel
ADP-R i
164
MOA dabigatran
direct thrombin i
165
MOA dalteparin
LMWH
166
MOA ticlopidine
ADP-R i
167
MOA tirofiban
gp IIb/IIIa i
168
safe anticaogs in pregnancy x DVT
heparin
| LMWH
169
lab test to monitor warfarin?
heparin?
LMWH?
INR/PT
PTT
anti-factor Xa activity
170
why octreotide in tx GI bleed 2/2 esophageal varices?
somatostatin analog --> dec splanchnic blood flow + portal BP ==> dec variceal bleeding
171
management septic shock 2/2 perionitis
1. ICU
2. IV fluids BOLUS NOW
3. norepi
4. empiric abx
5. Bcx/sputum/Ucx
6. CXR
7. insulin drip
8. telemetry
9. CVP/MAP
172
u wave
hyper Ca
hypoK
hyperTHY
173
MC leukemia in adults
CLL
174
philadelphia chromosome
CML
175
leukemia with peripheral blasts are PAS + and TdT +
ALL
176
leukemia wiht peripheral blasts PAS -, myeloperoxidase +, Auer rods
AML
177
associated with t(9;22)
CML*** also ALL
178
peripheral smear of asx pt reveals macrocytosis and hypogranular granulocytes with bilobed nuclei --> dx
myelodysplastic syndrome
179
MM findings mnemonic
CRAB
hyperCalcemia
Renal failure
Anemia
Back pain
180
pruitis after hot bath or shower
polycythemia vera
181
blurred vision after hot bath or shower
optic neuritis
182
spinal cord lesion: fasciculations + spastic paralysis
ALS
183
spinal cord lesion:bilateral loss of pain/temp sensation below the lesion + bilateral spastic paralysis below lesion + bilteral flaccid paralysis at level of lesion
anterior spinal artery syndrome
184
spinal cord lesion: impaired proprioception _ pupils do not react to light
DCML --> tabes dorsalis
185
lesion to ____ presents as agraphia and acalculia
dominant parietal lobe
186
ppx for close contacts of N. meningiditis meningitis
rifampin
cipro
ceftiaxone
(either)
187
when should CT scan be perfomred as next step instead of LP in pt suspected of having meningitis
```
focal neuro
new onset seizures
hx CNS dz
papilledema
IC
AMS
```
188
skin manifestations characteristic of dermatomyositis
```
malar rash
shawl
heliotrope eruption (violaceous eyelids)
Gottron's papules
Mechanics hands
```
189
HA + fever + progressive muscle weakness + CSF: inc lymphocytes, nL glucose, slightly elevated protein --> dx/pathogen
poliovirus
| West Nile VIrus
190
27 M + progressively owrsening HA + persistent + nest step
MRI head
191
72 F + TIA + other imaging appropriate
ECHO
US of carotid arteries
MRA/CTA
192
mest diagnositc test for hereditary spherocytosis
osmotic fragility test
193
DVT develops stroke --> study to identify the MC undelrying etiology of stroke?
TEE
194
two MC locations of aneurysms in Circle of Willis
anterior communicating artery
| posterior communicating A
195
MC causes of seizures in young adults (18-35 yo)
trauma
EtOH w/d
brain tumor
196
42 M + tonic-clonic + known epilepsy + seizing for past 10 minutes dx and tx
status epilepticus
ABCs
benzos IV diazepam
if intubated, IV barbituates (phenobarb)
197
best tx TTP
large volume plasmaphoresis
| steroids
198
Coags with warfarin use
PLT nL
BT nL
PT inc
PTT inc
199
ASA coags
PLT nL
BT inc
PT nL
PTT nL
200
brain lesion seen in pt with PD?
| in HD?
PD: depigmentation of substantia nigra (decreased DA)
HD: atrophy of caudate nucleus (incrased DA)
201
Treat ALS Rx
riluzol
202
MC rx used to tx HD
MC: tetrabenazine (DA antagonist)
| or antipsychotics
203
cold agllutinins are classically associated with which infections
mycoplasma pneumoiae
| mononucleosis EBV
204
recent Cuban immigrant + malabsorptive diarrhea _ megaloblastic anemia --> dx and tx
Tropical sprue
tx: folate, tetracycline OR sulfa x 2-6 mo
205
Most sensitive test for MS
MRI brain, orbits, spinal cord
206
meds decreased freq of relapses in MS
```
interferon beta
glatiramer
natalizumab
dimethyl fumarate
teriflunomide
```
207
diarrhea + pink eye
adenovirus
208
tx Alzheimer dz
```
anticholinesterase i (donepazil, rivastigmine, galantamine)
menantine (NMDA Rec i)
```
209
dementia + visual hallucinations + frequent falls
Lewy Body Dementia
210
type syncope consistent with type 1 DM interrupted while eating
hypoglycemia
211
elbows in decorticate posturing
flexing
212
tx first line x RLS
pramipexole
ropinirole
(DA agonists)
213
spinal cord lesion:bilateral loss of pain/temp sensation below the lesion + bilateral spastic paralysis below lesion + bilteral flaccid paralysis at level of lesion
medullary pyramids
214
obese woman + papilledema + HA
idiopathic intracranial HTN
215
jaw muscle pain when chewing
temporal arteritis
216
headache + extraocular muscle palsies
cavernous sinus thrombosis
217
headache occurring either befoer or after orgasm
postcoital cephalagia
218
frontal headache made worse by bending over
sinus HA
219
infarct of MCA leads to which types of aphasia
expressive (Broca's)
comprehension (Wernicke's)
conductive
220
How do sx of encephalitis differ from meningitis
encephalitis: focal neurologic deficits
meningitis: leptomeningeal inflammation, special tests, nuchal rigidity
221
Tx options for essential tremor
```
propranolol
benzos
primidone
deep brain stimulation
thalamotomy
```
222
Characteristic features of Brown-Sequard syndrome
(hemisection of SC)
- ipsilateral SPASTIC paralysis BELOW lesion
- ipsilateral FLACCID paralysis AT LEVEL lesion
- contralateral loss vibration and proprioception BELOW lesion
- contralateral loss pain and temperature 1-3 levels BELOW lesion
223
upper quadrantic anopsia - where lesion?
temporal lobe
224
lower quadrantic anopsia - where lesion?
parietal lobe
225
Tx for dry age-related macular degeneration (ARMD)
smoking cessation
| antioxidants
226
Tx for retinal detachment
cryotherapy
laser photocoagulation
surgery
227
4 MC sequelae of meningitis in children
1. HL
2. ID
3. seizure disorder
4. spastic paralysis
228
inflammation of internal Meibomian sebaceous glands
chalazion
229
Major exam finding in open-angle glaucoma
cup-to-disc ration > 50%
230
clinical features of acute angle-closure glaucoma
```
red eye
sudden
painful
rockhard eye
pupil fixed and mid-dilated
```
231
tx for acute angle-closure glaucoma
```
immediate referral to ophtho
If no ophtho in >1 hr:
- 1 drop pilocarpine
- 1 drop apraclonidine
- 1 drop timolol
ONE MINUTE APART
acetazolamide
maybe mannitol
```
--> surgery for laser iridotomy
232
Weber test: conductive hearing loss goes to ___ear
damaged ear = conductive HL
WEBER HELPS LATERALIZE
233
Rinne test: nL
AC > BC
234
Triad of Meniere disease
HL
tinnitus
vertigo
235
empiric tx fo brain abscess
if post-surgical (MRSA and pseudomonas):
- vancomycin AND ceftazidime
- drain by needle decompression
- if mass effect, glucocorticoids
236
typical presentation IIH
```
obese female in 20-30s
HA in AM
pulsatile
papilledema
blurred vision, loss peripheral
LP = increased opening pressure
```
237
what is ethacrynic acid
loop diuretic
| non-sulfa
238
best diuretic for mild to moderate CHF with expanded ECV
```
loop (furosemide)
aldosterone antagonist (spironolactone)
```
239
best diuretic for increased intracranial pressure
mannitol
240
renal pathology: anti-GBM antibodies, hematuria, hemoptysis
Goodpastures
241
renal pathology: IF: linear pattern of IgG deposition
GBM = goodpastures
242
renal pathology: crescent formation in glomeruli; p-ANCA positive
pauci-immune rapid progressive GN
243
renal pathology: positive ANCA
GPA
| RPGN
244
renal pathology: hypercellular glomeruli and subepithelial"humps"
PSGN
245
two meds ppx against meningococcal meningitis
rifampin
| cipro
246
Which EEG pattern is seen in cases of absence seizures
generealized 3/sec spike and wave pattern
247
urinary casts are made of
Tamm-Horsfall mucoprotein (made by kidneys)
248
renal pathology: multiple mesangial nodules
Kimmelsteil-Wilson nodules
| diabetic nephropathy
249
nephrotic syndrome associated with hep B
membranous GN
250
renal pathology: EM: subendothelial "humps" and "tram track" appearance
MPGN
251
renal pathology: EM: "Spike and dome" pattern of basement membrane
MGN
252
apple-green birefringence with Congo red stain under polarized light
amyloidosis
253
vasodilating effect of nitroglycerin
dilates veins
254
vasodilating effect of dihydropyridine CCBs
veins and arteries
255
vasodilating effect of hydralazine
arteries
256
vasodilating effect of nitroprusside
veins and arteries
257
2 yo develops lethargy, hypoglycemia, abnL LFTs one week after being seen for febrile URI, dx
Reye syndrome (hepatoencephalopathy, assuming parents gave ASA for fever)
258
Greatest RF RCC
smoking
259
cardiac abnormalities assoc with ADPKD
1st: MVP (mild)
2nd: aortic regurgitation
260
AE of antiHTN: first dose orthostatic hypotension
alpha bockers - prazosin
261
AE of antiHTN: hypertrichosis
minoxidil
262
AE of antiHTN: bradycardia and asthma exacerbation
nonselective BB
263
first-line rx for idiopathic intracranial hypertension
acetazolamide
264
Todd's paralysis
post-ictal hemiparesis
<15 minutes
not more than 24 h
265
volume status expected with hyponatremia due to thiazide diuretics
hypovolemic or euvolemic
266
volume status expected with hyponatremia due to Addison disease
hypovolemic
267
volume status expected with hyponatremia due to hypothyroidism
euvolemic
268
volume status expected with hyponatremia due to renal failure
hypervolemic
269
volume status expected with hyponatremia due to psychogenic polydipsia
euvolemic
270
MC causis of SIADH
```
TBI and other CNS
Pulm: PNA and small cell lung cancer
Rxs
HIV
surgery
```
271
meds can be used to rapidly correct hyperkalemia by shifting potassium into cells
beta-agonists - albuterol
bicarbonate
insulin and glucose
272
tx for nephrogenic diabetes insipidus
1st: thiazide
2nd: indomethacin
amiloride for lithium induced DI
273
tx lithium induced DI
amiloride
274
meds known for causing hyperkalemia
```
ACEi
ARB
BB
digoxin
spironolactone
epiplernone
amiloride
triamterine
```
275
meds known for causing hypokalemia
```
loop diuretics
thiazides
albuterol
insulin
CAi/acetazolamide
```
276
which electrolytie abnL causes QT prolongaction
hypocalcemia
277
MC primary sources of metastates to the brain
```
Lots of Bad Stuff Kills Glia
lung
bone
skin/melanoma
kidney/RC
Gi/CRC
```
278
common causes of respiratory alkalosis
```
hyperventilation
anxiety
ASA tox
asthma
PE
high altitude
```
279
common causes of respiratory acidosis
COPD
respiratory distress
NMJ
opioids
280
common causes of metabolic alkalosis
```
vomiting
NG lavage
diuretics
volume contraction
hyperaldosteronism
Cushing syndrome
```
281
NAGMA
diarrhea
PTA
TPN
Addison dz/low aldosterone
282
distinguishing caracteriscis of RTA type 1 - distal
increased urine pH >5.3
low serum K
low serum bicarb
283
distinguishing characteristics of RTA IV
hypoaldosteronism
nL urine pH
high serum K
nL serum bicarb
284
distinguishing characteristics of RTA II - proximal
nL urine pH
low serum K
low serum bicarb
285
typical complaints of retinal detachment
shade covering eye
flashes of light (photopsias)
sudden onset floaters
286
tx for uric acid renal stones
potassium citrate
| bicarbonate
287
type UTI most likely make pt susceptible to struvite renal stones
urease-positive
klebsiella
proteus
s. saprophyticus
288
meds useful in pt with nephrolithiasis for passing a stone by relaixng teh smooth muscle in the distal ureters
tamsulosin (alpha blocker)
| nifedipine
289
1st line antihypertensive in LVH and HTN
ACEi/ARB
| CCB
290
1st line antihypertensive in hyperthyroidism
BB
291
bacterial meningitis PEx signs
Brudinski sign - neck flexion --> knee flexion
| Kernig sign - pain with straightening flexed leg
292
antiHTN rx SE rxn in patient with sulf allergy
HCTZ
293
tx epididymitis
<35 yo: G/C = IM ceftriazone and doxycycline PO x10d
>35 yo or anal: enterbacteracea = fluoroquinolone or TMPSMX
294
found unconscious, what administer before empiric glucose infusion?
thiamine before glucose
295
classic sx BPH
```
frequency
urgency
hesitancy
nocturia
weak stream
```
296
two classes of meds tx BPH
5alpha reductase: finasteride, dutasteride
alpha1 antagonism: tansulosin, alfuzosin, sitodosin, terazosin, doxasosin
297
hormonal meds to patients with metastatic prostate cancer
GnRH analogue (leuprolide, goserelin) CONTINUOUSLY
298
tx for acute bacterial prostatitis
e. coli
- TMP-SMX
- fluoroquinolone
299
AE antihypertensive: cyanide toxicity
sodium nitroprusside
300
Most sensitive test for MS
MRI head and orbits
301
normal puberty progression
```
adrenarche
conadarche
thelarche
pubarch
growth spurt
menarche
```
302
Tx Guillain-Barre
IVIG OR plasmaphoresis ASAP
motility agents for ileus
mech vent if respiratory involvemenet
303
classic features distinguish orbital cellulitis from periorbital cellulitis
orbital cellulitis:
diplopia
pain with EOM
proptosis
304
tx open-angle glaucoma
```
acetazolamide
mannitol
prostaglandins
pilocarpine (cholinergic)
timolol (BB)
apraclonidine (alpha adrenergic)
```
305
frontotemporal dementia presentation
change personality
inappropriate behavior
dementia
progressive aphasia
306
lewy body dementia
AH + VH
Parkinsonian features
dementia
falls and syncope
307
tx for NPH
VP shunt
308
tx IIH
acetazolamide, wt loss, serial lumbar punctures, +/- VP shunt
309
dermatoligic finding of NF1
cafe au lait spots
neurofibromas shag sweater
axillary/inguinal freckles
hemangioblastomas
310
cherry-red spot on macular ddx
Neiman Pick
Tay Sacks
Retinal artery occlusion
311
-triptan drugs contraindicated in
```
pregnant
just took triptan/ergotamine
CAD
prinzmetal angina
sulfa allergy
```
312
child presents with acute-onset ear pain, otoscopy reveals large, reddish vesicles on TM, dx, org, and tx
bullous myringitis
mycoplasma pneumoniae
macrolide: ACE
313
MC cause of sensorineural HL
presbycusis (high freq)
314
MC cause of conductive HL
otosclerosis
315
pt undergoes crnaiotomy and drain placemtn for evac of SDH, initally drainage is serous, HOD#3 drainage becomes thick and yellow and neuro exam deteriorates, cause?
subdural abscess
316
tx for acute dystonia
EPS = benztropine or benadryl
317
tract: voluntary motor commands from motor cortex to head and neck
corticobulbar spinal tract
318
pt brough to ER with HA, vom, neck pain and fever, progressive muscle weakness, but sensation intact. CSF nL glucose and protein, but lymphocyte count is high dx
poliomyelitis
319
67 M + ischemic stroke, BP 185/100, goal for acute management of HTN following ischemic stroke and meds MC used
permissive HTN: <220/120
labetalol
nicardipine
320
MC organisms in neonatal bacterial meningitis and empiric abx
e. coli
GBS
Listeria
abx: ampicillin and gentamicin
321
CSF findings in healthy
pressure 50-180
WBCs <5
glucose 40-70
protein 20-45
322
CSF findings bacterial
pressure increased
WBCs increased (PMNs)
glucose decreased
protein increased
323
CSF findings viral
pressure MAYBE increased
WBCs increased (lymphocytes)
glucose nL
protein MAYBE increased
324
CSF findings TB
pressure VERY increased
WBCs increased (lymphocytes)
glucose decreased
protein increased
325
SLE, found to have anemia, AIHA or recent menstruation...what test to distinguish?
Coombs test
326
lesion to _____ causes coma
reticular activating system in pons
327
test differentiates central diabetes insipidus from nephrogenic DI
desmopressin challenge --> urine osmolality
328
elevated erythropoietin
elevated hematocrit
normal oxygen saturation
EPO producing tumor (RCC)
329
testicular torsion next step tx
manual detorsion --> surgery for b/l orchiopexy
330
causes of hypovolemia hyponatremia
diuretics/thiazides
Addison dz
loss of fluids
331
segmental sclerosis and hyalinosis on light microscopy
FSGS
332
p-ANCA associated conditions
```
Pauci-immune glomerulonepthritis
microscopic polyangiitis
eosinophilic GPA
PSC
UC
```
333
classic presentation of PSGN
```
periorbital edema
cola urine
HTN
strep 1-3 w ago
increased ASO
```
334
other name for Fitz-Hugh-Curtis
perihepatitis
335
effect of digoxin on stroke volume
decrease extracellular sodium
increase intracellular calcium
= increased heart contraction
336
most approp tx for PCOS
lose weight
OCPs
metformin
spironolactone for hirstuism
337
next step in eval of pt with ASCUS
if 21-24 yo: repeat PAP in 1 year
if >25: HPV test, if positive colposcopy
338
characteristic findings in tertiary syphilis
```
gumma formation
tabes dorsalis
Argyll-Robertson pupils
+ Romberg
loss proprioception
aortitis "tree-barking"
aneurysm of aortic root
aortic regurg
```
339
cardinal movements of labor
```
engagement
descent
flexion
internal rotation
extension
external rotation
expulsion
```
340
EGD changes seen with Barrett esophagus
changed to columnar epithelium
341
how expect weight to increased over first 2 years of life
BW at 2 weeks
double at 4 mo
triple at 12 mo
quadruple at 2 y
342
spider-webbing/marbling of skin newborn rash
cutis marmorata
343
newborn white papules caused by retention of keratin and sebaceous material in pilosebaceous follicles
milia
344
newborn intense reddening of gravity-dependent side and blanching of nondependent side with a line of demarcation between teh two, lasts a few sec-min
Harlequin color change
345
newborn skin vascular malformations occurring on the anpe of neck, upper eyelids, middle forehead, resolve by 18 mo, "salmon patches"
macular stains
| "stork bites"
346
newborn superficial pustules overlying hyperpigmented macules
transient neonatal pustular melanosis
347
kilocalcories in an ounce of breast milk/in formula
both 20 kcal/oz
348
most appropriate tx for macular degeneration
antioxidants: vitamines A, C, E, beta carotene, copper, zinc
349
34 M rash on thigh, campking, 3 day flu like hx, oval-shaped, erythematous lesion with central clearing
erythema chronica migrans
| Lyme disease
350
cleft lip/palate, life expectancy < 1 yr, polydactyly
trisomy 13
351
tall, thin man with gynecosmastia and testicular atrophy
Klinefelter
352
micrognathia, life expectancy < 1 yr, rocker-bottom feet
trisomy 18
353
happy mood, inappropriate laughter, ataxic gait
angelman
354
MC congenital heart defect
VSD
355
keep PDA open
PGE2
356
trisomy 21 heart defects
TF
PDA
endocardial cushion defects: ASD, VSD, onechamber heart
357
bony spur arising from metaphysis of long bone
osteochondroma
358
classic presenting scenario for necrotizing enterocolitis
premature/low birth weight infant
started on tube feeds
develops abd distension and enterocolitis
pneumatosis intestinalis
359
typical presentation intussusception
```
colicly
current jelly stool
pallor
sweating
vom
```
360
causes of hpysiologic jaundice
more blood
fragile infant RBCs
defective UDP glucuronosyltransferase
enterohepatic reabsorption of bilirubin from gut
(physiologic, breast feeding, breast milk jaundice)
361
medical management of ectopic pregnancy with rx:
methotrexate (folate antagonist)
362
tx respiratory distress of the newborn
```
prevent preterm labor
maternal corticosteroids
CPAP
intubate if need
exogenous surfactant down ET tube
```
363
RF meconium aspiration syndrome
post-term
| fetal distress during labor
364
tx epiglottitis
```
keep kid calm
intubate
vanco OR clina (s. auresu)
AND
cefepime/ceftriaxone (HiB)
```
365
how confirm pertussis
clinical
| nasophargyneal PCR
366
tx early Lyme
doxycycline 100 mg BID x 14 d
if kid or pregnant: amoxicillin or cefuroxime
367
causes desquamation of hands and feet
```
Kawasaki
Scarlet fever
TSS
SJS
mercury toxicity
```
368
abx to be avoided during pregnancy
```
tetracyclines (teeth discoloration)
fluoroquinolones (cartilage toxicity)
aminoglycosides (ototoxicity)
nitrofurantoin (avoid 1st tri)
TMP-SMX (avoid 1st tri)
```
369
spina stenosis differ from PAD
spinal stenosis: worse when standing upright, better bending forward
PAD: doesn't change with position, worse with exertion
370
3 mo difficulty breathing, fatigue, pallor, heart murmur, abnormal thubs, low hemoglobin, nL WBC and PLT. dx, see on bone marrow biopsy
Diamond Blackfan anemia
| decreased erythrocyte precursors
371
presentation common to both CF and Hirschsprung
failure to pass meconium
372
best abx for RMSF
doxycycline
if pregnant, chloramphenichol
*these are the only abx for RMSF!
373
cause of erythroblastosis fetalis
maternal ab against fetal Rh-postiive RBCs
374
typical prsentation osteogenesis imperfecta
```
easy fx
fx in utero
blue sclerae
HL
teeth deformities
pliable skin
hypermobility
```
375
tx spasticity in cerebral palsy with
botulinum toxin
baclofen
dantrolene
benzos
376
heart defect assoc with chromosonme 22q11 deletion
TF
TA
(DiGeorge)
377
heart defect assoc with congenital rubella
PDA or pulmonary stenosis
378
next step aftre confirmed congenital pyloric stenosis
1. correct metabolic abnormalities
| 2. pyloric myotomy
379
next step pt aspirated object that cannot be disloged and is now having difficulty moving air, becoming hpoxic
Heimlich maneuver
| if doesn't work, emergency tracheotomy
380
tx for black widow spider bite
1. antivenin within 30 min of bite
2. clean
3. observe x 24 h
4. abx if secondary infection
5. if systmic sx: lactrodectism - give antispasmotics: benzos
381
tx for skin lac on dorsum of hand that resulted from closed fist hitting victim mouth
irrigate
empiric abx
leave open
382
definition of primary amenorrhea
absence of menses and secondary sexual characteristics by age 13
OR
absence of menses by 15 WITH secondary sex characteristics
383
complications to watch for in pat with electrical burn
```
compartment syndrome
bony injuries
neurologic disturbances
rhabdomyolysis
myoglobinuria
renal failure
acidosis
arrythmias
```
384
ECG findings in hypothermia
j wave (elevated j point)
385
primary sx theophylline toxicity
```
hypokalemia
hyperglycemia
vomiting
seizures
hypotension
arrythmias with major toxicity
```
386
tx for BB and CCB toxicity
atropine
glucagon
insulin and glucose
calcium
387
tx acet toxicity
charcoal within 4 h injgestion
NAC within 8 h
benzos if seizure
388
antidote for ASA toxicity
sodium bicarb
charcoal
dialysis
389
antidote for TCAs
bicarb
| diazepam if seizures
390
antidote for digoxin
digoxin antibody fragments
391
two organisms MC cause of acute cervicitis and tx for each
gonorrhea: ceftriaxone AND azithromycin
chlamydia: doxycycline OR azithromycin
392
middle aged man, needs to buy readign glasses bc having difficulty reading fine print, alost troubl e driving at night and reading road signs, may have presbyopia, should also be examined for what
cataracts
393
tx lead toxicity in children
succimer if mild
| severe: succimer, calcium disodium edetate, dimercaprol
394
antidote for arsenic
dimercaprol
succimer
penicillamine
395
antidote for iron
deferoxamine
396
antidote for mercury
dimercaprol
397
additional studies in case of stable patient with an abd stab wound that penetrated the peritoneum
diagnostic laparoscopy
398
pelvic fx + DPL shows blood in the pelvis next step
emergent laparotomy
399
pelvic fx + DPL shows urine in the pelvis next step
urgent laparotomy (not emergent)
400
pelvic fx + DPL shows nothing + hemodynamic instability next step
angiography with poss embolization
401
blunt abd trauma + unstable + fluid in pelvis on FAST next step
emergent laparotomy
402
blunt abd trauma + unstable + FAST no fluid in pelvis next step
angio with possible embolization
403
blunt abd trauma + unstable + FAST inconclusive next step
DPL
404
blunt abd trauma + stable next step
CT abd/pelvis
405
abd stab + hypotension next step
emergent laparotomy
406
difference between chancre and chancroid (organism, presentation, treatment)
chancre: treponema pallidum, "clean-based painless ulcer indurated margins", penicillin G
chancroid: haemophilus ducreyi, "painful ulcer base covered with purulent exudate), azith or ceftriazone
407
since bleeding between mother and fetus is a concern in trauma, what actions should be taken once the pt and fetus are stabilized
test Rh status -- give RhoGAM for Rh-negative
408
major causes of post-op fever in pt who just underwent neurosurgery
UTI
meningitis
DVT
409
primary tx for malignant hyperthermia
stop inhaled anesthetics (stop succinyl choline)
dantrolene
100% O2 (increased ventilation)
410
7 year old who avoids going to school to stay home with parent
separation anxiety disorder
411
antidote benzo
flumazenil
412
antidote barbituates
bicarbonate
HD
charcoal
413
antidote CO
100% O2
414
antidote arsenic
dimercaprol
succimer
penicillamine
415
60 F experiences leakage of urine with laughing and coughing, nonsurgical options
kegel exercises
estrogen PO or vaginal
pessary
416
definition mild persistent asthma and outpatient tx
>3-6 day episodes in a week
>3-4 night episodes in a month
tx: SABA and low ICS
417
PFTs in asthma exacerbation
overall increased lung volumes
| FEV1/FVC < 80%
418
indications for chronic COPD to qualify for home O2
O2 sats < 88%
polycythemia
peripheral edema
pulmonary HTN
419
SE from theophylline overdose
seizures --> hyperthermia
hypotension
tachyarrhythmias
420
next step polmonary nodule
previous CXR
| not not, then CT
421
antidote for digoxin
activated charcoal within 1st 24 h
| digoxin ab fragments
422
antidote BB
calcium
glucagon
insulin and D5
423
sarcoidosis mnemonic
A GRUELING Disease
```
increased sACE
Gamaglobulinemia
RA
Uveitis
Erythema nodosum
Lymphadenopathy (bilateral hilar)
Idiopathic
Noncaseating
Granulomas
increased vitamin D --> activated my macrophages in granulomas --> increased sCa2+ (hypercalcemia)
```
424
tx for idiopathic pulmonary fibrosis
anticollagen: pirfenidone
anti-tyronsine kinase Rec: nintedanib
anti-pulmonary HTN: sildenafil
425
lung disease: noncaseating granulomas and associated with aerospace manufacturing
berylliosis
426
lung disease: noncaseating granulomas and erythemia nodosum
sarcoidosis
427
lung disease: associated with sandblasting
silicosis
428
lung disease: "eggshell"calcifications of hilar LNs, inc susp TB, inc rsk lung cancer
silicosis
429
causes chronic bronchitis but not increaesed risk lung cancer
coal miner lung
430
what is anthracosis
asx
city swellers
mild black lung
431
small fibrotic lung nodules in coal miner
simple coal worsers' disease
432
lung disease: caseating granulomas and positive c-ANCA
GPA
433
honeycombign/reticular lung imaging associated with which lung dz
idiopathic pulmonary fibrosis
434
tx for MI due to cocaine overdose
no BB
benzos
CCB to inhibit vasoCNX
435
common presenting features of tuberous sclerosis
```
hamartomas
phakoma
adenoma sebaceum (facial angiofibromas)
distinctive brown fibrous plaque on forehead in infancy
shagreen patch
ash leaf sponts
sub-ependymal giant cell astrocytoma
cardiac rhabdomyoma
renal angiofibrolipoma
ID
seizures
```
436
A-a gradient calculation and normal range
A-a = 700 - FiO2 - (PaCO2/0.8) - PaO2
nL 5-15 mmHg
437
Increased A-a gradient with...
PE
pulmonary edema
R to L shunt
increased FiO2
(hard time getting O2 from alveoli to arteries)
438
VQ scan: defect in venteliation = ____, defect in perfusion = ____.
defect in ventelation = PNA
defect in perfusion = PE
439
PE on CXR
Hamptom's hump (wedge)
440
most appropriate next step in r/o PE in pt deemed unlikely to have PE
D-dimer
441
vasodilators used to treat primary pulmonary HTN
CCB nifedipine
endotheli Recc antag (bosetan)
PDE antagones (sildenafil)
PG (traprsotanol)
442
congential heart defect assoc with Li during pregnancy
Ebstein anomaly:
- hypoplastic RV
- tricuspid anterior displacement
- TS/TR
- 80% PFO with R to L shunt
443
ER in respiratory distress frollowing MVC, CXR shows pleural effusion, next step
chest tube for hemothorax
444
causes transudative pleural effusion
CHF
cirrhosis
nephrosis
445
size PTX requires chest bue placement
>15%
446
kid, limp, asymm and sclerosis of right femoral head, widening of joint space, dx
Legg-Calves_perthes dz
| avascular necrosis
447
MC congenital neck cyst
thyroglossal duct cyst
448
si/sx peritonsillar abscess
uvula deviation
muffled "hot potato" voice
trismus
drolloing
449
MC causes of post-influenza bact pneum
s. pneumo
| s. aureus
450
MC cause PNA in neonates
GBS
451
MC cause of viral pneumonia
flu and RSV
452
antidote for tPA
aminocaproic acid
453
antidote for mercury
dimercaprol
succimer
penicillamine
454
sx with rifampin and insoniazid
```
hepatotoxicity
peripheral neuropathy (i)
```
455
first line tx for PCP in HIV patients
TMP-SMX x 21 d
Add sterioids if:
- RA PO2 < 70mmHg
- A-a gradient > 35 mmHg
456
standard tx for latent TB
isoniazid QD x 9 mo
OR
isoniazid and rifampin weekly x 3 mo
457
common cause of fungal PNA in immunocompromised patients
PCP
458
PNA in spelunker
histoblasmosis
459
induction agents commonly used in intubation
sedative: etomidate, propofol, midazolam, ketamine
paralytic: succinylcholine, rocuronium
460
dx characteristics of ARDS
PaO2:FiO2 ratio < 200
no evidence cardiac origin
PCWP < 18 mmHg
461
in pt with pulmonary edema, how distinguish ARDS from cardiogenic edema
```
PCWP < 18 in ARDS
PCWP incrsed (LA presure increased) in cardiogenic edema
```
462
hallmark CXR in pt with sarcoidosis
bilateral hilar lymphadenopathy
463
labs help distinguish type 1 from type 2 diabetes
C-peptide low in T1, nL to high in T2
| antibodies: Oh GAD = anti-glutamic acid decarboxylase antibodies
464
two diagnositc studies to eval stable pt with suspected ectopic
```
TVUS
quant BhCG (if <1500, repeat in 48h)
```
465
causes exudative pleural effusion
```
PE
TB
pancreaeatitis (amylase high)
cancer
infection
vasculitis
```
466
goal tx DKA
close aniongap
467
goal tx HHS
nL sugars
| nL serum osmolality
468
serum electrolyties low in KDA
```
Na (peudohyponatremia)
K
Ca
Phos
Mg
```
469
old man , ran out of diabets medications, electrolytes deranged, aniongap, BG 413, how further eval dx
1. ABG
| 2. urine or serum ketones
470
types diabetic retinopathy
non-prolierative (MC) impaired blood flow (cotton wool spots, hard exudates, microaneurysms, tortuous vessels)
prolieferative - ischemia --> neovascularization, AV nicking
471
tx for prolierative diabetic retinopathy
1. panretinal photocoagulation (PRP) to avoid hemorrhage
| 2. injectived VEGF-i
472
#1 COD in T2DM
ASCVD (cardiac)
473
best tx for Goodpasture syndrome
steroids
| plasmapheresis
474
diabetes drug MOA: decreases GI absorption of starch and disaccharides
acarbose
475
diabetes drug MOA: stimulates insulin release by inhibiting K-ATP channels
TZDs, meglinitides
476
diabetes drug MOA: increases tissue glucose uptake and improves insuling sensitivity
TZDs, metformin
477
diabetes drug: MC SE is hypoglycemia
sulfonylureas
| meglitinides
478
diabetes drug: not safe in setting of severe CHF
TZDs
| SGLT-2 inhibitors
479
diabets drug: acceptable choice in pt with mild-mod renal dz
TZDs
| DPP-4i
480
chemotherapeuti agent mainstay of tx for choriocarcinoma
methotrexate (folate antagonist)
481
clinical features of strep pharyngitis
tender anterior cervical lymphadenopathy
fever
eudates on tonsils
no cough
482
insulin used in continues influsion insulin pumps and in treatment of DKA
regular
OR
rapid acting
483
2nd stage of labor, woman develops fever, tachy, uterine tenderness + fetal tachycardia + dx and managment
chorioamnionitis
IV broa-spectrum abx (amp and gent)
continue delivery
484
five categories of metabolic syndrome for dx
```
abd wasit circumference
TG
HDL
BP
BGs
```
485
ddx hypoglycemia in patient without diabetes
```
insulinoma
malingering
alcohol
pituiatry insufficiency
reactive
liver dz
adrenal dz/insufficiency
gastric bypass
```
486
examples restrictive lung dz and FEV1/FVC ratio
FEV1/FVC =>80%
pulmonary fibrosis
pneumonconiosis
scoliosis
Pickwickian syndrome
487
19 F @ 34w GA, sudden onset painful vaginal bleeding and contractions, recurrent late decels. dx and risk factors for this complication
placental abruption
```
RF: previous abruption
HTN
trauma
smoking
cocaine***
```
488
64 M COPD, seizure, N/V, abd pain after taking too much of one of his meds, hypotensive, tachycardic, abnL cardiac rhythm --> dx
theophylline OD
489
medication causes of hypothyroidism
amiodarone (pt w/ arrhth)
lithium (bipolar)
TKi (imatinib, CML or RCC)
490
goiter in Hashimoot
painless
491
goiter in subactue thyroiditis (DeQuervain)
painful
492
tx DeQuervain thyroiditis
NSAIDs
| steroids
493
goiter in Riedel thyroiditis
fixed
hard, rock-like
painless
(young pt with rockhard thryoid)
494
presentation untreated congenital hypothyroidism
```
lethargy
porr feeding
thick, protuding tongue
constipation
umbilical hernia
ID
```
495
preferred dx test for pt with suspected PE if renal insufficiency (can't get contrast)
V/Q scan
496
mech of Graves dz
AI (antibiodies stimulate TSH receptor , TSI - thyroid stimulateing immunoglobulin)
NOT destruction of thyroid!
497
thyroid changes in early pregnancy
TSH mildly decreased
Total T4 increased
TBG increased
Free T4 nL
498
non-thyroidal manifestations fof Graves dz
exophthalmos
| pretibial myxedema
499
iatrogenic sources of iodine might cause thyrotoxicosis
amiodarone
| IV contrast
500
tx nephrogenic DI caused by Li toxicity
1. stop lithium
2. HCTZ
3. amiloride
501
FR thryoid nodule is cancer
```
age <30, >60
neck radiation
smoker
FHx thyroid cancer
US:
-hypoechoic
irregular margins
microcalcifications
taller than wide
```
502
next step newly identifid tyroid nodule in pt with hyperthyroidism
TSH
| then RAIU
503
medullary thyroid cancer assoc with which syndrome
MEN IIa and IIb
504
Gene assoc with medullary carinoma
Ret gene
505
indications for surgical PTHectomy in primary hyperparathyroidism
```
hypercalcemia sx (bones, kidney stones, groans, psych tones)
sCa2+ >1.0 above upper limit normal
Cr clearance <60/kidney dysfxn
decrased DEXA t-score/osteoporosis
Age < 50
```
506
medical manage primary hyperparathyroidism
cinacalcet (inc sensitivity of Ca rec on PTH gland)
507
MC cause 2* hyperPTH
chronic renal disease
then vit D def
then Ca 2- def
508
why PTH elevated in renal dz
lack phosphate secretion = hyperphosphetemia AND increased fgf-23 --> decreased vit D3 --> dec caclium reabsorption from intestine --> inc PTH
509
PTH, sCa, sPhos, and VitD in pt with: primary hyperPTHN
PTH increased***
sCA increased
sPhos decreased
VitD nL
510
PTH, sCa, sPhos, and VitD in pt with: vitamin D def (rickets in children, osteomalacia in adults) aka 2* hyperPTH
PTH increased
sCa decreased
sPhos decreased
VitD decreased***
511
PTH, sCa, sPhos, and VitD in pt with: 2* hyperPTH from renal dz
PTH increased
sCa decreased
sPhos increased***
VitD decreased
512
PTH, sCa, sPhos, and VitD in pt with: hypoparathyroidsim
PTH decreased***
sCa decreased
sPhos increased
VitD decreased
513
PTH, sCa, sPhos, and VitD in pt with: Pseudohypoparathyroidism
PTH increased*** but receptors don't work
sCa decreased
sPhos increased
VitD decreased
514
vitamin D def labs and mech
malabsorption vit D
prolonged vit D def --> reduce Ca intestinal reabs --> increased PTH --> decrased sPhos and increaesed urine phos --> bones become deineralized
515
pt with scoliosis higher risk of deveoping which type of infection
TB
516
MC presentation hyperprolactinemia
postmeno F: asx, vision changes (bad)
premno F: hypogonadism = amenorrhea
male: hypogonadism = ED
517
next step in managment of pt found to have absent pituitary on MRI (empty sellla)
reassure if no sx
| or provide Hormones
518
complications can result from acromegaly
```
cardiac failure (cardiomyopathy, HTN)
spinal ord ompression
diabetes
compression optic N --> vision loss
oganomegaly
```
519
tx localized non-small cell lung cancer
surgical resection + chemo
520
s of basilar artery stroke
PONS
- cranial nerve defects
- RAS --> AMS/coma
- contralateral full body weak
- sensory deficits
- poss vertigo, loss coord, defif speaking
521
layers of adrenal cortex and hormones
GFR
Gromerulosa: SALT: mineralocorticoids (aldosterone)
Fasiculata: SUGAR: glucocorticoids (cortisol)
Reticularis: SEX: angrogens (testonsterone, DHEA-S)
522
causes of Cushing syndrome
MC: low ACTH - exogenous steroid medications
low ACTH - adrenal adenoma or hyperplasia
high ACTH - pituitary adenoma producing ACTH (cushing disease)
high ACTH - ectopic production of ACTH (small cell lung cancer, carcinoid tumor)
523
Cushing syndrome mnemonic
```
Buffalo hump
Amenorrhea
Moon facies
Clots (thromboembolic)
Cardiac dz
Crazy (psychosis, agitation)
Ulcers (PUD)
Skin changes - striae, acne, easy bruising
Hirsutism
HTN
Hypokalemia
Infection
Necrosis of femoral head
Glaucoma and cataracts
Osteoporosis
Immune suppression
Diabetes
```
524
tx Conn syndrome
surgery of adenoma OR spironolactone
525
58 F cushingoid sx + low dose dex in evening and morning after there is not a decresae in cortisol --> next step
ACTH level (or exogenous cortisol)
526
most specific lab finding in making dx of primary hyperaldoseronism
increased PAC:PRA ratio
PAC: aldosterone
PRA: renin (low renin because aldosterone is already high)
527
55 M + hypertension, hypokalemia, metabolic alkalosis, inc alosterone, decreased renin activity --> dx? med used until definitieve
primary hyperalsdo
528
non-aldoersone mineralocorticoid casuing HTN, hypokalemia, metabolic alkalsis
Cushing syndrome
| Licorice!!!
529
inital tx for child presnting with acute asthma attack
SABA
IV glucocorticoids
O2 if sat < 90%
530
Adrenal isuff ciris sx
severe weakness, fevere, AMS, SHOCK, hyperpigmentation
531
CAH: first number is 1 means...
HTN
532
CAH: second number is 1 means...
increased androgen production (virilization in baby girl, precocious puberty in boy)
533
CAH 21 alpha-hydroxylase deficeincy presentation
```
increased androgen production
mineralocorticoid deficiency (aldo def) = hypotension and salt wating (dec Na and increased K)
```
ex: female infant with virilization of genitalia and hypotension
534
17 alpha-hydroxylase def labs
inc na
dec K
inc aldo = HTN
535
hypercalcemia
PUD
acromegaly
MEN1 (pituiatry, PUD/ZE, inc PTH)
536
AIDS associated malignancies
Kaposi sarcoma (lymphatic endothelium, HHV-8) <250
Invasive cervical cancer (HPV) <200
Non-Hodgkin lymphoma (EBV, 1*CNS lymphoma) <100
537
tx for septic abortion
1. D&C
| 2. unasyn (pip/tazo) or gent/clinda
538
antiretrovial HIV class SE: hyperglycemia, DM, and lipid abnormalities
Protease inhibitors
539
rate of transmission of HIV through needle stick incident
0.3%
540
drugs given if appreciable risk transmission HIV in needle tick incident
post-exposure ppx:
tenofovir (NRTI)
emtricitabine (NRTI)
raltegravie (II)
541
antiretroviral drug SE - bone marrow suppression with megaloblastic anemia
zidovudine
542
potentially fatal hypersensitivity reaction
abacavir
543
neuropsychiatric sx
efavarenz
544
hyperbilirubinemia, jaundice
atazanavir
545
teratongeic
efavarenz
546
inhibits cytochromc P450
ritonavir
547
congenital heart defect + low calcium + recurrent infections
DiGeorge T cell deficiency
| thymic aplasia
548
chronic mucocutaneus candidiasis + chronic diarrhea + FTT
SCID ( and B)
549
negative nitroblue tetrazolium test
chornic granulomatous disease (phagocyte prob)
550
poor smooth pursuit of eyes + elevaeted AFT after 8 months
Ataxiia Telangiectasia
551
Partial albinism + recurrent URIs + neurological disorders
Chediak Hidashi
552
When do infection typially begin in children with immune disorders
3-6 mo
553
Wiskot-Aldrick syndrome
```
WAITER
Wiskott
Aldrich
Imuunodef
Thrombocytopenia and purpura
Eczema
Recurrent pyogenic infections
X0linked BOYS
```
554
eczmea + recurrent cold s.aureaus abscesses + coarse facial features + two rows of teeth
Job syndrome (HyperIgE syndrome)
555
delayed separation of umbilical cord
leukocyte adhesion deficiency syndrome (abnL integrins)
556
no thymic shadow on newborn CXR
```
thymic aplasia (DiGeorge 3rd and 4th pouches faill)
SCID (adenosine deaminase def)
```
557
next steps in pt with febrile neurtopenia due to chemo
1. adit to hosptial
2. panculture
3. start broad-sp abx (Zosyn)
558
Ddx serum eosinophilia
CANADA-P
Collagen vascular dz (PAN, dermatomyositis)
Atopic dz (allergies, asthma, churg-strauss, alergic bronchopulomary aspergillosis)
Neoplasm
Adrenal insufficiency (Addison dz)
Drugs (NSAIDs, penicillins, cephalosporins)
Acute intersitital nephritis
Parasites (strongyloides, Ascaris -- loffler esopin pneumonitis)
and HIV, hyperiGE, coccidioidomycosis
559
most likely dx in pt with sx thyrotoxicosis plus history of thryoidectomy or radioablation of thyroid
excess thyroid replacement
560
type of rejectin treated with immunosuppresive agents
acute
561
mechansim of acute rejection
innate immune reaction
anti-donor T cells against transplant
6d - 1 yr
562
drug do not want to combine with azathioprine
allopurinol
563
mech of GVHD
graft/donor WBCs attack host
| MC in bone marrow transplant
564
immunosuppressant SE: hydroxychloroquine
visual distrubances
| treats SLE and RA
565
immunosuppressent SE of tacrolimus
nephrotoxicity when given IV
566
immunosuppresssant SE of muromonab
leukopenia one time cytokine release
567
tx for hyperPTH due to parathyroid hyperplasia
surgical resection of 3/5 glands, with 1/2 clip or autotransplantation
568
NT derrangements in depression
dec NE
dec 5-HT
dec DA
569
tx for acromegaly
1. transphenoidal pituitary adenoma resection
2. if no surgery: Rx
- octreotide
- cabergoline
- GH Rec antagonist, pegvisomant
3. external beam radiation
570
firrstline tx for moderate hypercalcemia
1. NS (pee it out)
| 2. loop diuretics (loops lose ca2+)
571
indications for ECT
severe, debilitating depression refractory to antidepressants
psychotic depressoin
severes uicicidality
depression with food refusal leading to nutritional compresise
depression with catatonic stupor
rapid antidepres response if required (preganncy)
revious good repsonse
bipolar
schophernia
572
SS vs. NMS
BOTH: utonomic instability, hypertehremia, musclr probs
S: rapid onset, hyperkinesis, clonus
NMS: gradual onset, bradykinesis, leadpiperigidity, highter fever
573
GAD sx must be present for how long
6 months
574
dx criteria for schizophrenia
two of following during 1 mo perid (at least one of the first three)
- delusions
-hallucinations (MC auditory)
- disorganized speech
-grossly disorganized or catatnoic behavior
- ngetative sx (flat affect, poverty of speech, lack emotional reactivity, social withdrawal, poor grooming, throught blocking)
WITH social/occupational dysfunction
For at least 6 mo
575
Hashimoto thyroiditis assoc antibody
TPO = anti-thyroglobulin antibody
576
GVHD sx
```
maculopapular rash
abd pain
FNV diarrhea
recur infection
easy bleed
inc LFTs
decreased immunoglobulins
thrombocytoopenia
```
577
GVHD tx
steroids
tacrolimus
mycophenolate
