studying

Question 1

severe htn lvls

Answer 1

> 180/120 either and or

Question 2

Encapsulated bacteria

Answer 2

SHiNE SKiS

• streptococcus pneumonia
• hemophilus pneumonia
• Neisseria meningitidis
• E. Coli
• Salmonella
• Klebsiella
• group b Strep

Question 3

indinavir
MOA
USE
SE

Answer 3

protease inhibitor
HIV therapy

SE: crystal nephropathy by drug precipitation in urine, 8% of users w/urinary symptoms

Question 4

HIV-drug life threatening side effects
didanosine-
abacavir-
NRTI-
NNRTI-
nevirapine-

Answer 4

didanosine (adenosine analog, NRTI)- pancreatitis
abacavir (NRTI)- hypersensitivity syndrome/DRESS
NRTI-lactic acidosis
NNRTI-SJS
nevirapine (NNRTI)- liver failure

Question 5

Hyperkalemia
EKG manifestations
Cardiac abnormalities

Answer 5

sign’s/symptoms usually >7 in chronic hyperK, may occur with lower lvl in acute.

• peaked T, prolonged PR -> ST elevation, peaked T, loss P wave -> sine wave
• sinus node dysfunction (bradycardia/arrest), AV block, ventricular arrhythmia’s

1st: IV calcium to stabilize cardiac membrane
- insulin helpful for temporary HyperK decrease

long term: diuretics, hemodialysis, cation exchange resins (sodium polystyrene sulfonate - aka kayexelate)

Question 6

%chronic cough with ACEi’s

Answer 6

20%

Question 7

abciximab is what?

ebtifibatide is what?

Answer 7

gp2b3a inhibitor, used sometimes for short course with PCI

abciximab: monoclonal antibody (mab)
ebtifibatide: A heptapeptide derived from venom in a rattlesnake

Question 8

fluphenazine?

Answer 8

typical antipsychotic, used in schizophrenic’s with poor compliance. injection q2-3 weeks. More powerful than haldol.

SE: inhibit shivering/autonomic thermoregulation

Question 9

Acyclovir SE in kidney

Answer 9

In IV form, causes Crystal induced AKI as it is excreted in urine but has poor solubility. Causes intratubular obstruction. occurs within 24-48hrs.

Question 10

cyclosporine

MOA
USE
SE

Answer 10

MOA: Inhibit transcription IL-2 and activation of T-lymphocytes by IL-2

USE: immunosuppression: psoriasis, Rheumatoid Arthritis, organ transplant prophylaxis/tx,

SE: nephrotoxicity (most common), HTN, hyperglycemia, , infection, malignancy (scc and lymphoproliferative disorters), GI (anorexia, N/V/D), gingival hypertrophy, hursitism.

Question 11

Azathioprine

MOA
USE
SE

Answer 11

MOA: purine analog enzymatically converted to 6-mercaptopurine, which is incorporated into replicating DNA and halts replication. Also blocks purine synthesis…

USE: Renal transplant rejection ppx, Rheumatoid Arthritis, crohn’s, and other autoimmune

SE: Major = dose related diarrhea, leukopenia, hepatotoxicity. Rare= neoplasia

Question 12

Mycophenolate

MOA
USE
SE

Answer 12

MOA: inhibits inosine monophosphate dehydrogenase (IMPDH), a rate limiting enzyme in purine (guanosine) synthesis. Cytostatic for T and B lymphocytes, which require this pathway

USE: organ transplant rejection ppx, use in conjuction with cyclosporine and steroids.

SE: Major = bone marrow suppression

Question 13

Vitamin A deficiency

Answer 13

Blindness, dry skin, impaired immunity.

Think likely 2/2 Celiac’s disease,
May have assoc problems with with B12, vit D, vit K, vit E, calcium, folate, zinc

*traditionally the beta carotene eyesight vitamin

Question 14

Zinc deficiency

Answer 14

may occur from TPN

alopecia, impaired taste, bullous/pustular lesions around orifices and or extremities, impaired wound healing

Question 15

selenium deficiency

Answer 15

may occur from TPN

may cause cardiomyopathy

Question 16

cannibinoid usefuleness in cachexia/anorexia

Answer 16

Shown benefit in HIV cachexia,

cancer related benefit is small over placebo

progesterone > corticosteroid is better

Question 17

Donepezil

MOA
USE

Answer 17

Acetylcholinesterase inhibitor

USE: Alzheimer Dementia

Question 18

pulsus parvus et tardus

Answer 18

slow rising, low amplitude pulse found in aortic stenosis

Question 19

Hairy cell leukemia

• population
• cell
• characteristic under microscopy
• stain
• Tx

Answer 19

• elderly
• B-cell tumor, often with fibrotic marrow and dry tap, cytopenia/pan, +- leukocytosis
• Stain TRAP (tartrate-resistant acid phosphatase) positive
• Tx; cladribine, a purine analog

Question 20

Doxycycline
MOA
USE
SE

Answer 20

MOA: tetracycline (30s inhibitor)
USE: CAP, zoonic infections like lyme disease, acne, chlamydia, early syphilis only (though pcn G 1st line)

SE: NOT safe in pregnancy, crosses placenta, accumulates in long bones and teeth. Photosensitivity (as are all tetracyclines)
NOT toxic to kidneys

Question 21

Azythromycin

Answer 21

MOA: macrolide (50s inhib)
USE: CAP, sinus infections, strep pharyngitis, chlamydia

*safe in pregnancy

Question 22

Chlamydia tx

Answer 22

azythromycin* 1g x1, or doxycycline 100mg BID x7 days.

Cotreat with ceftriaxone* 250mg x1 for neisseria gonorrhea.

• recommended to use in pregnancy
• • doxy is NOT safe
• **N gonorrhea always needs both tx due to cephalosporin resistance increasing, but chlamydia only needs one

Dx: both N/gonnorrhea and chlamydia with nucleic acid amplification test (NAAT)

Question 23

What proportion of patients have a posterior descending artery derived from the LEFT coronary?

Answer 23

LCA 10%, the rest are RCA (90%)

Question 24

MAP definition using pressures as well as systemic equations (ie. CO)

Answer 24

MAP= CO x TPR
MAP= DPB + 1/3(DBP-SBP)

Question 25

What artery supplies the SA and AV nodes?

Answer 25

RCA supplies SA and AV nodes

Question 26

What arteries supply the Interventricular septum?

Answer 26

LAD supplied anterior 2/3 of interventricular septum, the posterior descending artery supplies the posterior 1/3

Question 27

Homocysteine relation to atherosclerosis

Answer 27

High serum homocysteine increases atherosclerotic risk threefold

Question 28

Gold Standard for identifying CAD

Answer 28

Coronary angiography, but more invasive so used somewhat judiciously

Question 29

Stress test HR goal

Answer 29

max HR= 220-age | Goal Stress HR is 85% of max

Question 30

if considering bblocker overdose, what to give after atropine? Will pacing work?

Answer 30

S/S: Bradycardia, hypotension, AV block Bblocker also with hypoglycemia, wheezing, delirium, seizures Tx: Secure airway, IVFB, IV atropine -> glucagon, +- IV calcium, vasopressors, insulin&glucose *** pacing is indicated later in this case (usually try after atropine) because it is less effective in BB/CCB poisoning, particularly because of the decreased inotropy. Otherwise it is typically used as second line to atropine in symptomatic bradycardia not assoc w/overdose. *CCB, digoxin, cholinergic agents may cause similar symptoms. But they are less likely to cause wheezing (maybe except the cholinergic?)

Question 31

Glucagon MOA USE

Answer 31

MOA: stimulates adenylate cyclase to produce increased cellular cAMP ->promotes hepatic glycogenolysis and gluconeogenesis + Elevations in cAMP increase the intracellular pool of calcium available for release during depolarization, augmenting contractility. USE: BB toxicity, CCB toxicity, hypoglycemia, anaphylaxis (for pt. on BBlocker) SE: vomiting common, counter ppx with ondansetron

Question 32

Digoxin MOA USE SE

Answer 32

MOA: -HF: inhibit Na/K atpase, thereby transiently increaseing intracellular Na -> increased Na:Ca exchange -> more Ca intracellularly = contractility -Supraventricular arrhythmias: directly suppresses AV node USE: - Rate control in Afib (offlabel) - Heart failure ( - SVT

Question 33

Digoxin toxicity

Answer 33

fatigue, nausea, anorexia, abdominal discomfort, blurred vision, disturbed color perception, cardiac arrythmias tx; Digoxin specific antibody (Fab)

Question 34

bumetanide?

Answer 34

loop diuretic

Question 35

torsemide?

Answer 35

loop diuretic

Question 36

HFrEF pharm tx

Answer 36

optimal in all patients +- loop 1) loop + ACE/ARB 2) BBlocker (metoprolol, bisoprolol, carvedilol) If still refractory 3) if NYHA class II-IV and EF spirinolactone/eplerenone 4) Digoxin if persistent symptoms * * LVEF .150, NYHA III/IV => CRT

Question 37

Type A aortic dissection mortality | tx:

Answer 37

1-2%/hr from symptom onset | tx: morphine pain control, systolic BP 100-120, HR labetolol/propranolol

Question 38

Esmolol

Answer 38

Selective B1, short half life. | Duration 10-30min

Question 39

Labetolol

Answer 39

alpha1, B1&B2 blocking

Question 40

Propranolol

Answer 40

B1 &B2, - NO alpha 1 blocking * **care in prinzmetals angina and cocaine induced vasospasm/htn

Question 41

Carvedilol

Answer 41

alpha1, B1&B2 blocking

Question 42

Hydralazine

Answer 42

MOA: direct vasodilation arterioles (not venules) decreases systemic resistance. unclear mechanism USE: HTN Duration: up to 12 hrs SE:reflex tachy w/increased BP/wall stress

Question 43

Nitric Oxide MOA

Answer 43

NO diffuses readily across cell walls -> smooth muscle -> activates guanalyl cyclase -> cGMP -> protein kinase G -> activates myosin phosphatases -> inactivate myosin light chain through dephosphorylation

Question 44

High output cardiac failure causes explanations s/s

Answer 44

Causes: - congenital or otherwise AVF - cancer AVF - Hyperthyroidism: thyroid hormone itself is chrono/inotropic, also activates sympathetic autonomic system - anemia - thiamine deficiency (BeriBeri): unknown mechanism vasodilation and augmented venous return requires heart to work harder - paget disease (bone) In case of AV fistula, there is high preload, -normal-high cardiac output, but despite this cannot maintain perfusion/oxygen demand to peripheral tissue because of the constant shunting to the venous side. s/s may have pulmonary/venous congestion => edema, dyspnea, tachycardia, bounding/quick upstroke of arteries, wide pulse pressure, midsystolic murmer from high flow

Question 45

``` paget disease of bone (osteitis deformans) What is it? s/s dx tx ```

Answer 45

Local abnormality in bone metabolism in older population causing accelerated bone remodling s/s: majority asymptomat, but otherwise -> pain, either from primary lesion(s) or from their overgrowth effect on surrounding tissue. May develop fractures, nerve impingement, tumor Dx: radiologic tx: bisphosphanates can reduce pain and resoption **excessive bone remodling especially in multiple sites increases vascularity and can sometimes led to high output heart failure (rarely) or bleeding at site during surgery.

Question 46

Hypersensitivity syndrome/DRESS | some drugs that cause

Answer 46

drug reaction with rash, fever, multiorgan failure. | Caused by anti epileptics, allopurinol, abacavir, dapsone, minocycline, vancomycin, SMX...among others

Question 47

Name 4 P2Y12 inhibitors

Answer 47

P2Y12 is the ADP receptor on platelets Direct competitive inhibitors clopidogrel (plavix) ticlodipine (ticlid) prasugrel (effient) Allosteric inhibitor ticagrelor

Question 48

IBD peak

Answer 48

Bimodal, most in 20's-30's, but a second peak at 60's.

Question 49

What intestines does the following supply? SMA: IMA:

Answer 49

SMA: entire small intestine except proximal duodenum, also ascending and transverse colon IMA: sigmoid, descending colon... some rectum, though a lot comes from branches off iliacs there * acute mesenteric ischemia refers to small intestinal ischemia * *colonic ischemia refers to well... colonic ischemia * **occurs from embolus (50%), thrombus 20%, and hypoperfusion (30%)... small % from venous thrombus

Question 50

Hemophilia A&B genetics s/s Dx Tx

Answer 50

x-linked recessive - hemarthrosis, intramuscular hematomas - GI bleeding - GU bleeding (hematuria) A is missing factor VIII B is missing factor IX Dx: Both prolonged PTT and missing respective factor Tx; factor VIII or IX, desmopressin for A

Question 51

``` Von Willebrand Disease genetics s/s Dx Tx ```

Answer 51

Autosomal dominant (most common bleeding disorder, 1% of population). Decreased/impaired VWF which binds collagen-> Gp1b s/s mucosal bleeding (menorrhagia, epistaxis, GI). easy bruising/skin bleeding No deep tissue bleeding Dx: ristocetin cofactor assay (binds vwf to gp1b readily forming platelet clumps), ptt normal to increased (depending on degree of factor VIII loss) Tx; desmopressin (releases vwf in weibel palade bodies from endothelium)

Question 52

Drugs that cause bronchospasm in asthmatics

Answer 52

ASA | Beta blockers, even selective may do so in high doses

Question 53

factor V leiden

Answer 53

autosomal dominant mutation where factor V is resistant to cleavage by activated protein C. Thus prothrombotic. Most common inherited hypercoagulability in whites

Question 54

Vitamin B3 - alternate name? - deficiency caused by? - deficiency name/s/s

Answer 54

vitamin B3 = niacin pellagra = diarrhea, dermatitis (sunburnesque), dementia - abdominal discomfort, glossitis - occurs in malnutrition (3rd world/bowel diseasE)

Question 55

cyanocobalamin

Answer 55

B12 deficiency = macrocytic anemia + peripheral neuropathy Body stores 3-4 years, strict vegans may become deficient, crohns, celiac?, pernicious anemia, + others -found in eggs, milk, meat, fish, poultry. NOT IN PLANTS

Question 56

pyridoxine

Answer 56

B6: Deficiency = irritability, depression, stomatitis, glossitis, dermatitis, increased homocysteine, neuropathy/ataxia/paresthesias , may cause cheilosis **rare deficiency, but isoniazid use can cause as it competes for a cofactor spot to participate in production of synaptic neurotransmitters

Question 57

Riboflavin

Answer 57

B2: cheilosis (dry cracked skin on angle of mouth), glossitis, pharyngitis, seborrheic dermatitis, ANEMIA -occurs in malnutrition, anorexia, avoidance of dairy (good source), phenobarbital use

Question 58

folate

Answer 58

B9: macrocytic anemia in deficiency found in green vegetables and liver. inactivated in cooking. deficient in 3-4 months *recommended as daily supplement for all those with SCD due to constant RBC turnover.

Question 59

vitamin E

Answer 59

deficiency, mostly only caused by fat malabsorption. Vegans/vegetarians ok RBC fragility/hemolysis Neuromuscular: hyporeflexia, weakness, ataxia ->through subacute combined degeneration on spinal cord *used on scars to help heal

Question 60

nikosloki sign

Answer 60

skin sloughing with gentle lateral pressure seen in staph scalded skin syndrome

Question 61

erythema multiforme

Answer 61

immune mediated, target like skin lesions, self limited. Rare ocular involvement. occur over 2-5 days, resolve over 2 weeks. when infectious, occur days after disease began. Cause: infection =90%, HSV most common, mycoplasma pneumonia causes a lot too also may be medications (NSAID, sulfa, antiepileptic, antibiotics), autoimmune disorders, malignancy

Question 62

cerebral salt wasting

Answer 62

Cause: traumatic injury/surgery, SAH, pathophys: somehow CNS disruption -> altered neural input to kidneys. Also natriuretic ?BNP? released. There is some debate about if CSW is real, or if body is appropriately excreting sodium. findings: hypovolemia, hyponatremia, high urine Na >20meq

Question 63

Can you use antidepressants in bipolar disorder

Answer 63

generally no, they cause mood destabilization Bipolar I has manic and usually depressive episodes Bipolar II has hypomanic (no manic) and depressive episodes difference is essentially whether hospitalization or significant impairment occurs

Question 64

absence seizure last how long? treatment? classic EEG?

Answer 64

avg 10sec, generally ethosuxide 3hz spike wave

Question 65

Cluster headache s/s tx ppx

Answer 65

s/s: ipsilateral ptosis/miosis, sudden, intense retroorbital pain, tearing, runny nose, facial swelling/sweating, last (15-180min) 2hrs avg, cluster in 6-8 wk intervals with remissino up to 1yr. NORMAL vision tx; 100% oxygen and sumatriptan, intranasal lidocaine ppx; lithium, verapamil (nondihydropyridine), ergotamine

Question 66

why does high volume transfusion lead to hypocalcemia?

Answer 66

citrate preservative in blood binds calcium ** hypocalcemia rare if normal liver (citrate metabolized), however if poor synthetic function (cirrhotic)--> bad news

Question 67

carbon monoxide half life in humans

Answer 67

5hrs room air | 1-2hrs with 100% oxygen

Question 68

cardinal parkinsonism signs

Answer 68

tremor (4-6hz), rigidity (lead pipe/cogwheel with passive movement), bradykinesia (slow, low amplitude, difficulty initiating movments), postural instability

Question 69

Inflammatory Breast Carcinoma

Answer 69

s/s "peau d'orange" = superficial dimpling and fine pitting, itching, axillary lymphadenopathy, +- nipple retraction/flattening, breast mass +- *NO fever Dx: US/mammography depending age 30+-> biopsy for definitive dx

Question 70

uvea

Answer 70

middle portion of eye: anterior part comprised of ciliary body and iris, posterior is the choroid

Question 71

keratitis+ conjunctivitis = keratoconjunctivitis

Answer 71

keratitis is inflammation of cornea | conjunctivitis is inflammation of conjunctiva

Question 72

huntingtons chorea ``` genetics onset s/s imaging/path Tx: ```

Answer 72

autosomal dominant, trinucleotide CAG repeats, chromosome 4 onset 40's-50's s/s movement disorder (chorea), behavioral disturbance, depression common, dementia late path/imaging: atrophy of caudate/putamin (neostriatum) nucleus, seen as enlargement of lateral ventricles Tx: tetrabenazine (inhibits synnaptic vesicle uptake of monoamines) -> atypical antipsychotics -> typical antipsychotics *off-label amantadine used *increases in dopamine, decreases in GABA and Ach. pathophys has to do with glutamate excess-> NMDA toxicity

Question 73

Imipramine

Answer 73

tricyclic antidepressant

Question 74

Tricyclic antidepressant cardiotoxicity and tx what other toxicity?

Answer 74

TCA -l fast Na channels in purkinje system -> decreased conduction velocity, increased absolute refractory period, prolongs repolorization. which creates QRS prolongation, hypotension, ventricular arrhythmias tx: bicarb indicated if QRS >.10, to increase pH to 7.50-7.55 and create more extracellular Na. Increased pH decreases TCA avidity to Na channels, and increased extracellular Na increases electrochemical gradient (and competes for TCA sites) ** CNS (seizures coma), anticholinergic

Question 75

vast majority of head and neck cancer is?

Answer 75

SCC

Question 76

weight loss in neonates

Answer 76

up to 7% in first 5 days | regain weight by 10-14days

Question 77

wet diaper normal

Answer 77

wet diaper = days of life until 1 week. then about 6/day is normal * the red of uric acid is normal if dehydrated * * do not have to worry about lesch-nyhan (self mutilation) purine metabolism problem if growing normally * **feed q2hrs x15min/side for first month of life

Question 78

``` Nitroprusside MOA USE Onset Duration ```

Answer 78

MOA: breaks down into NO -> peripheral vasodilation through direct action on arteriolar/venous smooth muscle USE: acute HTN/crisis, 2nd line uncommon use for aortic dissection Onset: less than 2min Duration: 1-10min

Question 79

idiopathic intracranial hypertension (pseudotumor cerebri) s/s cause Dx tx

Answer 79

s/s: HA, visual loss/changes, pulsatile tinnitus, diplopia, papilledema, CN VI palsy risks/causes: overweight women, medications: tetracycline (doxy/mino), isotretinoin, growth hormone, OCP's Dx; high opening pressure with otherwise normal LP. tx: weight loss, stop offending agent, acetazolamide for idiopathic cases

Question 80

Histoplasma capsulatum ``` location path s/s Dx Tx ```

Answer 80

mold=fungi present in soil, bird, bat droppings Endemic: mississippi/ohio river basin = mississipi, arkansas, illinois, indiana, ohio, missouri, alabama, texas, oklahoma, iowa, kentucky, tennesse... Histo is for the Hicks Path: histo HIDES within macrophages (smaller than rbc), caseating or noncaseating granuloma formation (mimics tb which can have either as well). s/s: pulmonary symptoms, mediastinal/hilar lymph nodes, arthralgias, erythema nodosum * If immunocompromised -> disseminates: hepatosplenomegally, pancytopenia, lymphadenopathy * *HIV CD4 less 100 disseminates bad * * amphotericin B for severe 1-2wks, itraconazole for less severe/transition to for 1yr **If thinking sarcoid then CONSIDER histoplasmosis!

Question 81

``` Blastomycosis dermatiditis location path s/s Dx Tx ```

Answer 81

East of mississippi and Central America within wood/soil path: same size as rbc, outside macros, blasto buds broadly s/s pulmonary, skin lesions, osteolytic bone lesions, prostate involvement, granulomas possible Dx;culture tx: amphotericin B, most ppl do need tx

Question 82

``` coccidiomycosis location path s/s Dx Tx ```

Answer 82

location: southwest US, california, especailly after earthquakes path: spherules filled with endospores s/s: meningitis, pneumonia, bone, skin, may show erythema nodosum dx:serum, histology of tissue, culture, tx; none -> ampho B

Question 83

ca 19-9

Answer 83

pancreatic cancer antigen, used to follow/treat, not diagnose

Question 84

ca-125

Answer 84

ovarian cancer antigen, not widely used other than after a postmenopausal adnexal mass is found

Question 85

endometriosis symptoms

Answer 85

dysmenorrhea (especailly at start of menses), dyspareunia, dyschezia, chronic pelvic pain, INFERTILITY, cervical motion tenderness, adnexal mass (can be only finding), uterosacral ligament nodules, posterior cul-de-sac nodules tx; 1st medical (nsaid/ estrogen OCP) 2nd line surgery **DO NOT NEED TX IF ASYMPTOMATIC dx; direct visualization, though may tx without this

Question 86

Niemann-pick disease Deficiency? s/s histology

Answer 86

Lysosomal storage disease Deficiency in sphingomyelinase -> accumulates sphingomyelin s/s: progressive neurodegeneration/loss of motor milestones (2-6mo), HEPATOSPLENOMEGALLY, CHERRY RED SPOT on macula, AREFLEXIA, hypotonia Histology: foam cell (w/zebra body) *Children die early, almost universally by age two * *most lysosomal disease are autosomal recessive except fabry's and hunters * *differentiate from tay-sachs by hepatosplenomegally and areflexia

Question 87

Tay-sachs disease Deficiency? s/s

Answer 87

lysosomal storage disease Defieciency: hexosaminidase A leads to excess gm2 ganglioside s/s: progressive neurodegeneration/loss of motor milestones, hypotonia, cherry red spot on macula, NO HEPATOSPLENOMEGALLY, HYPERreflexia, *Life expectancy 2-5yrs, usually die by pneumonia Histology: lysosomes with onion skin/whorled inclusions

Question 88

Gaucher disease Deficiency s/s histology tx

Answer 88

lysosomal storage disease *most common of them Deficiency: glucocerebrosidase -> accumulate glucosylceramide s/s: hepatosplenomegally, aseptic necrosis of femur, bone crises (pain), pancytopenia. NO LOSS OF MILESTONES Histology: Gaucher cells (crumped tissue paper), PAS + (note that if it's bacteria that's whipples disease) tx: one of the few lysosomal storage disease can be treated with enzyme replacement therapy

Question 89

Niemann-pick vs tay-sachs

Answer 89

Niemann-pick has hepatosplenomegally and areflexia Tay-sachs has NO hepatosplenomegally and has HYPERreflexia

Question 90

do craniopharyngiomas often have calcifications?

Answer 90

yep, whereas a pituitary adenoma would not... and may have pituitary hormone secretion (prolactin w/amenorrha and galactorrhea)

Question 91

Nephrotic vs Nephritic clinical features

Answer 91

Nephrotic: edema, proteinuria >3.5g/day, hypoalbuminemia, frothy urine, NO blood, hyperlipidemia, fatty casts, hypercoaguability (loss of ATIII), increased risk infection (loss IG) Nephritic: hematuria, RBC casts, azotemia, oliguria, HTN (2/2 salt retention), proteinuria, periorbital edema (esp postinfectious glomerulonephritis)

Question 92

Hepatitis B and C are a risk factor for which renal syndrome(s)?

Answer 92

membranous nephropathy, which is a nephrotic syndrome. less common but also membranoproliferative glomerulonephritis (which can be nephritic/nephrotic) *Membranous nephropathy also caused by SLE, NSAIDS/drugs, tumors, and other infections

Question 93

renal syndromes in SLE

Answer 93

membranoproliferative glomerulonephritis (MPGN) which is nephrotic/nephritic or Diffuse proliferative glomerulonephritis which is nephritic may also have membranous nephropathy

Question 94

Focal segmental glomerulosclerosis (FSGS) is associated with what diseases? nephritic or nephrotic?

Answer 94

Nephrotic syndrome -HIV, heroin abuse, massive obesity, Interferon tx, CKD, sickle cell

Question 95

CNIII | ischemia vs compression

Answer 95

somatic and parasympathetic fibers run in this BUT NOT sympathetic. Sympathetic not affected by compression or ischemia, it comes in seprately. ischemia: causes somatic injury (leaving only CN VI and IV and giving down and out gaze w/ptosis (levator palpebrae)... but pupil still reactive) BECAUSE blood supply is different for somatic/parasympathetic fibers compression: affects somatic and parasympathetic fibers --> addition of fixed dilated eye without accommodation.

Question 96

hypoxemia causes | 5

Answer 96

Normal A-a high elevation: duh hypoventilation: opioids high A-a V/Q mismatch: COPD diffusion limitation: pulm fibrosis shunt: pulm edema, congenital, airway obstruction

Question 97

IgA Nephropathy (Berger's Disease) syndrome? prevalence? cause?

Answer 97

Nephritic syndrome prevalence: most common Glomerulonephritis in adults cause: often presents/flares with URI, pharyngitis, or acute gastroenteritis. Will flare wtihin 5 days of illness * associated with henoch-schonlein purpura

Question 98

Renal papillary necrosis | causes

Answer 98

NSAID NSAID's, sickle cell, acetamenophen/analgesic, infection (pyelo), diabetes **acetamenophen is more long term abuse

Question 99

lumbar stenosis | pain relief with flexion or extension?

Answer 99

spinal flexion

Question 100

saline responsive vs nonresponsive metabolic alkalosis

Answer 100

check urine chloride. If high, not responsive, if low it is responsive.

Question 101

most notable opportunistic infections after organ transplant

Answer 101

PCP (pulmonary symptomcs, but not GI/hepatic) CMV (pneumonitis, Gastroenteritis, hepatitis)

Question 102

metabolic syndrome

Answer 102

3/5 of the following 1) abdominal obesity, men>40 women >35 inches by sex 2) fasting glucose 100-110 3) BP >130/80 4) triglicerides >150 5) HDL low, men

Question 103

Takayasu arteritis ``` Path population s/s Dx Tx ```

Answer 103

Large artery vasculitis, primarily involving aorta and its branches population: women less than 40, asian s/s: constitutional (fever, weight loss), arthralgias, myalgias, arterio-occlusive ( arm claudication, ulcers), pulse deficits, bp inconsistencies (right to left), bruits dx: elevated ESR/CRP, anemia possible - CXR: aortic dilation/wide mediastinum, - CT/MRI: wall thickening/narrowing lumen Tx: glucocorticoids

Question 104

Kawasaki Disease ``` path population s/s Dx Tx ```

Answer 104

Acute vasculitis illness in children s/s fever, mucositis, conjunctivitis, rash, cervical lymphadenopathy, acral edema cardiac: tachycardia, coronary artery dilation, delayed CA aneurism (day 10+) self limited, resolves 1-2 weeks Dx: fever 5+ days and 4/5: conjuntival injection, mucositis, acral edema/erythema, rash, cervical adenopathy Tx: IVIG + ASA, to decrease chance of CA dilation

Question 105

Giant Cell Arteritis (temporal arteritis) ``` path population s/s Dx Tx ```

Answer 105

Large vessel vasculitis older peoople, 50+y/o, incidence rises with age peak in 70's. Almost never occurs in younger than 50 s/s scalp tenderness, low grade fever 1/2, headache 2/3, jaw claudication, amaurosis fugax uni/bilateral ->blindness in 25-50%untreated, aortic aneurism, rarely aortic dissection, chronic pain/stiffness shoulders/hips/neck (ie. coexisting polymyalgia rheumatica) Dx: symptoms as above, elevated ESR/CRP, --> temporal artery biopsy tx: steroids, high dose then taper for 1 year

Question 106

Hydroxychloroquine MOA: USE: SE:

Answer 106

MOA: TNF/IL-1 suppressor among other things USE: SLE, malaria, RA SE: Retinopathy most common after 5-7 years (ophthamologic testing at baseline and after 5 yrs)

Question 107

Tx syphilis

Answer 107

``` dx: RPR/VDRL & antibody test Early 1st line: PCN G 2nd: Tetracycline (like doxy), 3rd: ceftriaxone (poor data, results not great) 4th: azithromycin (poor results) ``` tertiary/neurosyphilis PCN G, must desensitize if allergic to pcn. * *Must desensitize pcn allergic females if pregnant as no other options are good * *Tx for syphillis if typical chancre even if RPR negative

Question 108

Are antihistone antibodies seen in idiopathic SLE?

Answer 108

YEs, up to 80% of cases

Question 109

where are carotid arteries in relation to mouth?

Answer 109

directly posterior and lateral to tonsilar pillars (those folds by the tonsils)

Question 110

Give dopamine agonist to stop milk production after infant demise?

Answer 110

That would be bromocriptine, but don't do it, because USFDA said it's not approved. but yes dopamine -l prolactin production. so just give NSAID to help poor woman with pain

Question 111

Pulmonary HTN groups

Answer 111

1) Idiopathic and misc 2) Left heart disease 3) Chronic lung disease (COPD, ILD, chronic hypoxia) 4) thromboembolic occlusion of vasculature 5) multifactorial

Question 112

Bosentan MOA USE

Answer 112

MOA: endothelin receptor antagonist USE: idiopathic PAH SE: inhibits spermatogenesis

Question 113

Sildenafil MOA USE

Answer 113

MOA: phosphodieterase-5-inhib USE: erectile dysfunction, idiopathic PAH, SE: hypotension, esp with nitrates

Question 114

Shoulder distocia

Answer 114

When during delivery, after head delivery, anterior shoulder has significant trouple delivering below pubic symphysis.

Question 115

Where to sympathetic fibers originate on spine?

Answer 115

T1-L2/3

Question 116

Erb-Duchenne palsy

Answer 116

"waiters tip": extended elbow (loss of bicep), pronated forearm, flexed wrist/fingers - brachial plexus injury C5-6 (shoulder distocia) - grasp reflex intact - LOSS OF BICEP

Question 117

klumpke's palsy

Answer 117

"claw hand" - wrist extension, supination, mcp extension, pip/dip flexion - Brachial plexus c8-T1 injury (traumatic birth/pulled out by arm or catching oneself while falling out a tree) - may have sympathetic injury -> horner's syndrome

Question 118

Empiric osteomyelitis treatment children with Sickle Cell disease (microinfarcts in bone => nidus for infection)

Answer 118

``` In SCD Treat for both Salmonella (2/3 of cases): ceftriaxone Staph aureus (1/4 cases): vancomycin ``` **IF no SCD, staph aureus is primary bug, salmonella extremely rare.

Question 119

caudate nucleus atrophy = lenticulate nucleus atrophy = diffuse cerebral cortex atrophy = frontal/temporal atrophy =

Answer 119

``` caudate = huntingtons lenticulate = wilsons diffuse cerebral cortex = alzheimers frontotemporal = pick's disease PArkinsonism: no good radiographical findings ```

Question 120

wilson's disease (hepatolenticular degeneration) genetics/pathophys dysfunctions

Answer 120

Autosomal Recessive: defective cellular copper transport such that copper cannot be excreted in bile duct -> build up copper prominently liver -> dysfunction & eventual cirrhosis cornea -> brown/grey-green deposition = kayser-fleischer rings brain -> psychiatric disturbances, parkinsonism, tremor, dysarthria... various labs: low serum ceruloplasm, high serum copper, tx: D-penicillamine (chelator)

Question 121

second generation antipsychotic greatest agranulocytosis/leukopenia risk

Answer 121

clozapine

Question 122

corrigan pulse

Answer 122

"water hammer", from aortic regurge, wide PP, rapid upstroke and downstroke of pressure

Question 123

medical abortion regimen

Answer 123

mifepristone (progesteron antagonist) followed 24-48hrs later by misoprostol (prostaglandin E1 -> uterine contraction) +- antibiotic ppx (doxycycline)

Question 124

progesterone as contraceptive

Answer 124

* prevents ovulation as plan B by -l LH surge. * Long term (as OCP) increases cervical mucous (barrier to sperm entry) *Plan B = levonorgestrel

Question 125

pleurodesis

Answer 125

medical obliteration of pleural space

Question 126

tickborne paralysis vs guillane barre

Answer 126

ticks: ascending paralysis hours-days, not necessarily symmetrical, no prodrome, hyporeflexia, no autonomic dysfunction, normal CSF. ticks must feed 4-7 days and then release a neurotoxin (find them and remove them!) guillane barre: ascending paralysis, symmetric, mostly normal sensation, hyporeflexia, CSF with high protein but few cells (may not show early but 90% prevalence by 1 week) = albuminocytologic dissociation, prodromal illness, autonomic dysfunction (tachycardia, urinary retention, arrhythmias). Tx: IVIG OR plasmapheresis. they are equivalent in efficacy multiple causes: CAMPYLOBACTER most common, cmv, ebv, IN general often URI's or GI illnesses.

Question 127

primary dermatomyositis; polymyositis commonalities/presentations s/s labs antibody

Answer 127

-symmetrical/increasing proximal muscle weakness (difficulty getting up from seated/climbing stairs/carrying groceries) -elevated muscle enzymes: CK, aldolase, LDH, AST -anti-jo-1 (also anti Mi-2) -electromyography abnormalities

Question 128

valgus vs varus

Answer 128

L in valgus = lateral movement of distal part varus would be medial movement

Question 129

choanal atresia

Answer 129

congenital nasal malformation where the posterior part of the nasal passages do not canalize completely. * cyanotic/distressed while feeding * improve with crying (breathing through mouth)

Question 130

phenelzine MOA USE SE

Answer 130

MOA: monoamine oxidase inhibitor (MOI), prevents breakdown of monoamines (epi, dopamine, seratonin) USE: depression SE: tyramine (wine, cheese, cured meats, aged things) metabolism is inhibited by MOI's. tyramine is a sympathomimetic that can facilitate release of other monoamines --> HYPERTENSIVE CRISIS -hypotension as SE -> tx with phentolamine/nitroprusside

Question 131

heliotrope rash (around eyes) and gottrons papules (over joints)

Answer 131

both nearly pathognomonic for dermatomyositis they are violacious, scaly

Question 132

Edwards syndrome genetics s/s

Answer 132

Trisomy 18, "Election age is 18" and you watch Edwards scissor hands (with clenched hands/overlapping fingers) s/s mental retardation, rocker bottom feet, vsd/congenital heart issues, micrognathia (small jaw), CLENCHED HANDS, PROMINENT OCCIPUT, LOW SET EARS. Death usually by 1years old but some live into school age. *most common trisomy resulting in live birth after trisomy 21

Question 133

Patau's syndrome genetics s/s

Answer 133

Trisomy 13, puberty at age 13 s/s rocker bottom feet, sever mental retardation, congenital heart disease, cleft liP/Palate, holoPROSENCEPHALY, POLYDACTYLY death usually by 1 year

Question 134

Digeorge syndrome genetics s/s

Answer 134

CATCH-22 microdeletion chromosome 22q11 Cleft Palate, Abnormal facies, THYMIC APLASIA -> Tcell deficiency, Cardiac defects (truncus arteriosus, tetrology of fallot, transposition, asd/vsd), HypoCALCEMIA (second to parathyroid aplasia) * normal to impaired cognition. may live to adulthood * aberrant 3rd/4th branchial puches

Question 135

congenital infection: rubella neonatal manifestations

Answer 135

PDA (or pulmonary artery hypolasia), cataracts, deafness commonality with others +- blueberry muffin rash hepatosplenomegally jaundice

Question 136

congenital infection: toxoplasma gondii manifestations

Answer 136

chorioretinitis, hydrocephalus, intracranial calcifications commonality muffin rash hepatosplenomegally jaundice

Question 137

first line tx OCD

Answer 137

1) SSRI | + CBT

Question 138

ESR points

Answer 138

increases with age upper limit normal roughly = age/2 in men (age+10)/2 in women CKD, particularly ESRD elevates ESR, as does obesity and anemia

Question 139

most common cause of hip pain in children

Answer 139

transient synovitis most common ages 3-10 Etiology: unknown, but commonly post viral/mild trauma *Rule out: bony lesions/fx/legg-calve-perthes with plain radiographs Tx: NSAID/rest -> recovery in 4 weeks contrast to septic arthritis by inflammatory/infectious markers and FEVER

Question 140

Legg-calve-perthes disease what is it? s/s

Answer 140

Syndrome of idiopathic avascular necrosis (osteonecrosis) of hip in children s/s acute or insidious hip pain/limp usually between ages 3-12 tx: difficult hah!

Question 141

kleptomania tx

Answer 141

``` CBT +- SSRI's lithium naltrexone anticonvulsants ```

Question 142

DM1 onset

Answer 142

Bimodal, most in age 4-6 and then at puberty

Question 143

threatened abortion defenition

Answer 143

any vaginal bleeding prior to 20weeks with a closed cervix/os, and an alive fetus - inevitable abortion is one with an open cervix, vaginal bleeding, often with visualization of products of conception - incomplete has products of conception within cervical canal/vagina. - missed abortion is one in which there is fetal demise cervical os is closed inevitable, incomplete, and missed abortion can all be managed with similar efficacy with expectant management, medical (misoprostol), or D&C stillbirth = miscarriage at 20+ weeks

Question 144

hyposthenuria

Answer 144

Inability of kidneys to concentrate urine. *such as occurs in sickle cell disease/trait when sickling of cells in vasa rectae of inner medulla injures and subsequently impairs countercurrent exchange and free water absorption.

Question 145

winters formula | *you idiot

Answer 145

metabolic acidosis: PaCO2= 1.5 (bicarb) + 8 +- 2 ``` Metabolic alk (not winters) PaCO2= .9(bicarb)+16 +-2 ```

Question 146

argatroban

Answer 146

direct thrombin inhibitor

Question 147

fondaparinux

Answer 147

direct thrombin inhibitor

Question 148

HIT when presents? concern?

Answer 148

After 5+ days of therapy, usually 5-10 antibodies to neoantigen (from platelet factor 4 interaction with Heparin) attack platelets ->thrombocytopenia 50% or more -> procoagulable state: skin necrosis, venous > (Greater than) arterial thrombosis *heparin potentiates ATIII -> inactivates thrombin (& FIX, X, XI, XII)

Question 149

DLCO in asthma vs bronchitis | *also whats a positive bronchodilator challenge in PFT

Answer 149

DLCO normal/increased in Asthma, normal (bronchitis)/decreased(emphysema) in COPD +challenge is FEV1 improvement 12% or more, and 200+mL Asthma will usually have a + bronchodilator test with complete reversability, COPD may respond, but not completely

Question 150

legionella pneumonia syndromes: dx/imaging tx:

Answer 150

aerosol transmission from environmental water sources, no person to person. syndromes: - CAP/HAP - legionaires: pneumonia, fever, GI (N/V/D), lethargy, HA - pontiac fever: mild flu-like syndrome Dx: - sputum clt AND urine antigen test - xray: interstitial pneumonia - hyponatremia tx: macrolide (azithro) or quinolone (levofloxacin)

Question 151

venous vs arterial thrombosed extremity

Answer 151

venous: warmth, swelling, tenderness, erythema arterial: mottled, cold, no swelling, pulseless

Question 152

brief psychotic disorder

Answer 152

psychosis for one or more days, less than one month * schizophrenoform is 1-6months * schizophrenia timeframe must be six months or more

Question 153

Amiodarone toxicity

Answer 153

Cardiac: sinus Brady, AV block, proarrhythmia-QT prolongation and risk of torsades Pulmonary: chronic interstitial pneumonitis & pulmonary fibrosis, can occur from as little as 2 days, and up to year after use (half life up to like half a year, lipophillic) Endocrine: hypo/hyperthyroid Hepatic: elevated transaminases/hepatitis ocular: optic neuropathy, corneal microdeposits Derm: blue-grey skin neuro: peripheral neuropathy * 50% on long term amio will develop significant side effects * *1/5 will discontinue drug due to toxicity

Question 154

vaccination schedule for preterm infants

Answer 154

vaccinate by chronologic, not gestational age.

Question 155

Allergic interstitial nephritis a subset of acute interstitial nephritis cause? s/s labs tx:

Answer 155

Usually caused by medications 5days to weeks after exposure, less commonly by infection - NSAIDs - PCN (nafcillin) - cephalosporin - TMP-SMX - diuretics s/s maculopapular rash, fever, +- arthrlgias labs: hematuria, mild proteinuria, WBC casts, eosinophilia, urinary eosinophils tx: discontinue offending agent, +- steroids

Question 156

follicular vs papillary carcinoma of thyroid

Answer 156

follicular carcinoma: encapsulated, invades through capsule and into blood vessels (vs the adenoma) -> brain, bone, lung papillary carcinoma: non-encapsulated, psammoma bodies... good prognosis

Question 157

P450 inducers/inhibitors

Answer 157

INDUCERS (decrease bleeding risk) *momma barb steals phen-phen and refuses greasy carbs chronically -modafinil (stimulant/shift work), barbituates, st.john wart, phenytoin, rifampin (tb), griseofulvin (antifungal), carbamazepine, chronic alcohol use +ginseng INHIBITORS (increase bleed risk as increased coumadin lvls) MAGIC RACKS GQ -macrolides (not azithro), amiodarone, grapefruit juice, isoniazid, cimetidine (H2blocker for GERD), ritonavir, acute alcohol abuse, cipro, keoconazole, sulfonamides, gemfibrozil (fibrate), quinidine, +NSAIDS, ACETAMENOPHEN, OMEPRAZOLE, SSRI, Thyroid supplementation, vitamin E

Question 158

Adenosine MOA

Answer 158

inhibit L type calcium channels, decreasing conduction velocity at AV node -> av block

Question 159

Nitroglycerine MOA USE SE onset duration

Answer 159

MOA: ->NO, peripheral venous greater than artery dilation. primarily reduces myocardial O2 demand by decreasing preload, but also has coronary dilatory effects (which may cause paradoxical decreased perfusion pressure across stenotic lesions bc they are already maximally dilated), modest afterload effects. USE: angina, ACS, CHF SL onset: 1-3min, peak 7min duration: 25min+ IV onset: immediate duration: 3-5min SE: hypotension !!! no Phosphdiesterase inhibs! (sildanefil, vardenafil, tadalifil) *preload reduction -> decreased EDV/ESV

Question 160

chlordiapoxide MOA USE

Answer 160

aka. librium MOA: benzodiazapine USE: alcohol withdrawal

Question 161

promethazine MOA USE

Answer 161

trade: phenergan MOA: H1 blocker AND Dopamine blocker (phenothiazine) USE: antiemetic, motion sickness

Question 162

clonidine MOA USE

Answer 162

MOA: alpha 2 agonist, involved in negative feedback. stimulates inhibitory neurons -> reduces sympathetic outflow, and certain excitatory neurotransmissions USE: HTN (esp in renal disease), ADHD,

Question 163

methadone MOA: USE:

Answer 163

MOA: opioid (binds these receptors) USE: opiate replacement therapy *It is still a full potent opioid

Question 164

spinothalamic tract/anterolateral tract

Answer 164

pain, temperature, crude touch

Question 165

dorsal/posterior column (medial lemniscus)

Answer 165

fine touch, vibration, proprioception

Question 166

Major depression dx

Answer 166

``` symptoms majority of time for 2+ weeks 5+ of SIGECAPS, must include one of * sadness* interest loss* guilt energy decrease concentration problems appetite change psychomotor retardation/agitation sleep increase/decrease ```

Question 167

mirtazapine MOA USe SE

Answer 167

MOA:atypical, alpha 2 antagonist, noradrenergic, serotinergic, H1 blocker USE: depression SE: drowsiness, increased appetite/weight gain

Question 168

sertraline

Answer 168

Zoloft SSRI

Question 169

citalopram

Answer 169

Celexa SSRI

Question 170

paroxetine

Answer 170

Paxil SSRI

Question 171

``` granuloma inguinale (donovanosis) ``` what? dx:

Answer 171

cause: Klebsiella, transmission by sexual contact with open sores Genital NONPAINFUL, extensive/progressive ulcerative lesions, NO LYMPHADENOPATHY dx: (wright giemsa) deeply staining gram negative intracytoplasmic cysts (donovan bodies) * vs syphillis is single well circumscribed ulcer, nonpainful, bilateral lymphadenopathy, corkscrew by darkfield light microscopy tx: doxy or azithro

Question 172

Beçet syndrome presentation

Answer 172

thought to be vasculitis *painful aphthous ulcers, genital ulcers (painful), systemic symptoms +uveitis, skin lesions (erythema nodosum, acneophorm lesions), thrombosis, pathergy (exagerated skin response to minor trauma like needlestick -> ulcer)

Question 173

Tularemia cause s/s Tx

Answer 173

Francisella Tularenesis, gram negative aerobic bacterium. Zoonotic spread (handling rabbits, hamsters, or bit by ticks) also by biting flies, mosquitos s/s fever, chills, HA, malaise, ulcer(s) at site of bite but can also spread/random, lymphadenopathy dx:serologic antibodies tx: streptomycin (aminoglycoside) or ciprofloxacin (qunolone), doxycycline if meningitis

Question 174

renal insufficiency

Answer 174

is basically CKD/ renal failure

Question 175

voiding cystoureterogram how work? indication? what can it tell you

Answer 175

contrast injected into bladder -> xray during filling/voiding-> see if there is reflux Indication in children if 2+ febrile UTI's or a UTI with organism other than E. Coli. 25% children w/first UTI have VUR tells you if: VUR primarily, but show bladder shape/emptying/posterior urethral valve in males... not as helpful with say... urinary stasis

Question 176

ecthyma

Answer 176

impetigo that penetrates into the dermis and causes ulceration with scab looking on top

Question 177

molluscum contagiosum

Answer 177

poxvirus flesh colored papules, central umbilication, SPARES palms/soles +- pruritic, nonpainful tx: none, self-limited

Question 178

IF infant gets HSV, what then?

Answer 178

may be life threatening -> systemic acyclovir

Question 179

wernicke's encephalitis what? tx?

Answer 179

- thiamine (B1) deficiency - eyes (primary horizontal nystagmus/conjugate gaze palsy/oculomotor dysfunction), lies (confabulation/encephalopathy), capsize (ataxia) - glucose & thiamine

Question 180

disorder of internuclear ophthalmoplgia, affects what?

Answer 180

medial longitudinal fasciculus (MLF) damage, common in Multiple Sclerosis. This occurs because CNVI directs the lateral rectus on the ipsilateral side, then sends information to CN III nucleus via the MLF to the contralateral medial rectus. When MLF damaged, you won't get the medial rectus to move.

Question 181

sheep parasitic transmission

Answer 181

echinococcus (tapeworm) -> invade hematologically through intestines -> liver/pulmonary, and other visceral invasion -> see cysts on imaging (especially common in liver)

Question 182

neurocysticercosis

Answer 182

from pigs by taenia solium (tapeworm) -most carriers of tapeworm do not develop cysticercosis, it is human fecal->oral transmission with the eggs that leads to this. Ingestion of the meat only gives you intestinal tapeworm. s/s seizures, hydrocephalus, may infect muscle/SQ tissue which is largely asymptomatic, ocular (pain, diplopia) tx:albendazole

Question 183

breastfeed after alcohol timeframe

Answer 183

2-3hrs

Question 184

galactosemia

Answer 184

enzyme deficiency/defect (galactose-1-phosphate-uridyl transferase GALT), infants cannot breastfeed. Usually present in first few days with jaundice, vomiting, hepatomegally, failure to thrive, lethargy, hypotonia, cataracts.

Question 185

osgood-schlatter disease

Answer 185

apophysitis of the tibial tubercle, typically overuse/adolescent inflammation of patellar tendon/apophysis apophysis is a secondary ossification center used for tendon insertion

Question 186

Diamond-Blackfan anemia (congenital hypoplastic anemia) genetics pathology s/s/labs

Answer 186

genetics: spontaneous/autosomal dominant/recessive path: defect in erythroid progenator cells which increases apoptosis s/s webbed neck, shield chest, PALLOR, TRIPHALANGEAL FINGERS, MACROCYTIC ANEMIA (not megaloblastic), LOW RETIC COUNT,

Question 187

Wiscott-aldrich syndrome genetics s/s/labs

Answer 187

X-linked impaired WAS protein gene: impaired cytoskeleton regulation microthrombocytopenia (may have petechiae/purpura/bleeding), eczema, hypogammaglobulinemia/immunodeficiency (high IgA and IgE, low normal IgG/IgM) w/recurrent infections tx:hematopoetic stem cell transplant

Question 188

Fanconi's anemia genetics s/s/labs

Answer 188

Autosomal recessive *progressive pancytopenia/macrocytosis s/s cafe-au-lait spots, microcephaly, microphthalmia (small eyes), short stature, horseshoe kidney, ABSENT thumbs

Question 189

most common hypertensive cerebral hemorrhages in order

Answer 189

basal ganglia (putamen... which may involve internal capsule), contralateral symptoms, contralat homonymous hemianopsia cerebellum: ipsilateral ataxia, stiff neck, HA, nystagmus thalamus: eyes deviate TOWARD lesion, upgaze palsy, nonreactive miotic pupils, contralateral symptoms (internal capsule?) pons (coma, pinoint reactive pupils) cerebral cortex: contralateral symptoms, contralateral homonymous hemianopsia (occipital lobe), eyes deviate AWAY

Question 190

lateral geniculate nucleus

Answer 190

damage will cause contralateral homonymous hemianopsia, it is prior to optic chiasm * located dorsal thalamus * as will any damage prior to hitting the optic chiasm (as in optic tract but NOT optic nerve)

Question 191

bitemporal hemianopsia

Answer 191

damage/compression optic chiasm (as in pituitary tumors or craniopharyngioma)

Question 192

wernicke's aphasia

Answer 192

aka receptive aphasia damage to temporal lobe, usually left cannot understand spoken/written language, will speak fluently but in "word salad" that doesntt make sense *if nondominant wernicke's: sensory dysprosody -> inability to comprehend tone, pitch, rhythm, emotion of speech

Question 193

broca's aphasia

Answer 193

aka expressive aphasia frontal lobe damage, usually left, can understand, cannot speak well though knows what want to say

Question 194

reactive arthritis

Answer 194

aka reiters syndrome - HLA-B27 associated reactive arthropathy - incited by infection: GU (chlamydia) or GI: shigella (GI/diarrhea/gastroenteritis), salmonella, yersinia, campylobacter, c diff - "can't see, can't pee, can't climb a tree" - conjunctivitis, urethritis, arthritis (acute/oligoarthritis) tx: by cause/symptomatology

Question 195

cancer arising from chronic wounds/scars/inflammation called what from burn wound?

Answer 195

SCC *If from burn = marjolin ulcer

Question 196

size concern form melanoma

Answer 196

over 6mm a:asymmetric b:order irregular c:olor variation diameter evolution

Question 197

kaposi sarcoma

Answer 197

HHV 8 and HIV, angioproliferative, brown/violacious

Question 198

hepatojugular reflux definition

Answer 198

constant pressure on upper abdomen elicits over 3cm jvd elevation that is sustained during applied pressure = right heart failure

Question 199

how often US for cirrhotic liver?

Answer 199

every 6 months

Question 200

cefazolin

Answer 200

``` ancef 1st generation ROUTE: IV (not oral) -think skin infections in hospital -perioperative ppx ```

Question 201

cephalexin

Answer 201

keflex 1st generation oral skin infections/impetigo/MSSA cellulitis

Question 202

augmentin

Answer 202

amox/clav

Question 203

unasyn

Answer 203

ampicillin/sulbactam

Question 204

zosyn

Answer 204

pip/taz

Question 205

Utility of measuring DHEAS when evaluating hyperandrogenism

Answer 205

DHEAS is only produced in the adrenals, thus points to primary adrenal source/tumor notably, DHEA IS made in gonads * in contrast to simply elevated testosterone which could be testes/ovaries/adrenals * * DHEA(S) are good measures but have negligible androgenic activity (but they're powerful when converted to androstenedione and testosterone)

Question 206

cutaneous larva migrans

Answer 206

the "creeping eruption" caused by helminth hookworm Ancylostoma braziliense infection by contact with soil soiled by cat/dog feces: SANDBOXES/FECES begin as elevated papules -> serpinginous redish/brown streaks that elongate several mm daily tx: ivermectin preferred or albendazole

Question 207

scabies

Answer 207

parasitic (mite) infection by sarcoptes scabiei transmission by close contact with infected individuals, not through soil or anything else s/s pruritic skin infection volar wrist/interdigitary spaces, elbows, penis. burrows are short/wavy lines with possible papules/vesicles/pustules and eczema/plaque skin findings dx: skin scraping tx: ivermectin or topical permethrin

Question 208

menopause symptoms

Answer 208

vulvar dryness/itching, dyspareunia | URINARY FREQUENCY! URGENCY! INCONTINENCE! *bladder trigone, urethra, pelvic floor all have estrogen receptors

Question 209

edinger westphal nucleus

Answer 209

preganglionic PARASYMPATHETIC nucleus that provides innervation to the eye damage -> fixed dilated pupil

Question 210

miller fisher syndrome

Answer 210

guillane barre variant with -ophthalmoplegia, ataxia, areflexia: 1/4 -> extremity weakness -other variant includes oropharyngeal, neck, shoulder muscle weakness, swallowing difficulty --> a bulbar variant includes the above two, (acute bulbar palsy) -there are even more

Question 211

botulism tx

Answer 211

antitoxin

Question 212

lesch-nyhan genetics

Answer 212

x-linked recessive defect: hypoxanthine-guanine phosphryposyl transferase -> purine metabolism defect -> uric acid accumulation presents at 6mo+ s/s self mutilation, spasticity, dystonia, choreoathetosis, vomiting, mental retardation, gout, obstructive nephropathy tx: allopurinol

Question 213

how to tell if urine is dilute

Answer 213

urine osm less than 1/2 serum osm

Question 214

nonsulfa loop diuretic

Answer 214

ethacrynic acid

Question 215

displacement as defense mechanism

Answer 215

transfer concern or feeling to a safer object (yelling at wife instead of kids, or worrying about patient instead of yourself if you have a disease)

Question 216

reaction formation defense mechanism

Answer 216

move unacceptable feelings to something acceptable and opposite if scared of death -> act as if you are immortal and fearless

Question 217

chalazion

Answer 217

occurs tear gland becomes obstructed - >subacute/chronic inflammatory, - red & painful swelling->nonpainful rubbery nodule tx: hot compress, usually resolves - IF recurrent/persistent -> biopsy for histopathology (possible Sebacious cell carcinoma, basal cell carcinoma, meibomian gland carcinoma)

Question 218

Hordeolum

Answer 218

"stye" - acute inflammation eyelid - tx warm compress +- antibiotics (for staph)

Question 219

4th generation cephalosporine

Answer 219

cefepime: can tx pseudomonas

Question 220

5th generation cephalosporine

Answer 220

ceftaroline: cannot tx pseudomonas, VRE,

Question 221

MRSA tx options

Answer 221

Bacteremia: Vancomycin/daptomycin Linezolid and BActrim are inferior ``` skin/soft tissue Clindamycin Doxycycline/minocycline TMP-SMX (Bactrim) Linezolid ```

Question 222

Labor 1st stage, active vs latent | when is labor arrest

Answer 222

latent is prior to active, which occurs at 6cm+ dilation Labor arrest is Active phase, when no cervical change for 4+ hrs despite adequate contractions (200MVU's in 10min) --> C-section indicated * may try oxytocin rather than c-section if there are inadequate contractions (less than 200 MVU's) * MVU = # contractions x strength over 10 minutes

Question 223

amnioinfusion

Answer 223

instillation of fluid into uterus to tx variable decelerations

Question 224

basophilic stipling

Answer 224

precipitates of rRNA: - lead (also ringed sideroblasts) and microcytic - alcohol (macro/normo/microcytic) - thallassemias - anemia of chronic disease

Question 225

acanthocyte

Answer 225

spur cell | assoc with liver disease, uremia, microagniopathic

Question 226

anisocytosis

Answer 226

variable side RBC's

Question 227

poikilocytosis

Answer 227

abnormal shaped RBC's

Question 228

kartagener syndrome

Answer 228

autosomal recessive cause: ciliary diskinesia triad: recurrent sinopulmonary infections, situs inversus bronchiectasis

Question 229

amikacin

Answer 229

aminoglycoside (30s inhibitor), primarily GNR, *anaerobes are inherently resistant USE: 2nd line serious GNR infection including (pseudomonas, klebsiella, proteus, E. Coli), ie meningitis, pyelonephritis... SE: nephrotoxic, ototoxicity (sensorineural)

Question 230

gentamicin

Answer 230

aminoglycoside

Question 231

streptomycin

Answer 231

aminoglycoside

Question 232

neomycin

Answer 232

aminoglycoside

Question 233

tobramycin

Answer 233

aminoglycoside

Question 234

Felty Syndrome

Answer 234

Complication of severe RA, may precede RA dx Triad: splenomegaly, neutropenia, inflammatory arthritis other s/s rheumatoid nodules, vasculitis (necrotizing skin lesions) Dx: Anti-ccp (citrullinated peptide 50% sens, 90% specific RA), RF (ab against Fc of IgG) sens 70%, spec 85%,

Question 235

penicillin prophylaxis in SCD

Answer 235

PCN ppx should be given to all SCD (anti-capsular vaccinations) until age 5 at least

Question 236

kwashiorkor vs marasmus

Answer 236

kwashiorkor is protein deficiency but otherwise adequate energy intake-> enlarged abdomen marasmus is inadequate energy intake ->cachexia

Question 237

Paget Disease Breast

Answer 237

erythema, itching, eczematous/ulcerating skin changes beginning at nipple and radiating outward to areola, +- bloody/yellow discharge, +- nipple retraction 85% have underlying cancer, usually adenocarcinoma. But cancer not always found. **SCC of breast EXTREMELY rare

Question 238

why does weber test lateralize to affected ear

Answer 238

because that ear (with conductive defect) does not hear ambient noise, it will pick up vibration easier. -it won't lateralize to a sensorineural defect bc there wont be transmission of nerve impulse (duh)

Question 239

cause of conductive hearing loss

Answer 239

infection, cerumen, middle ear fluid, bony tumor, decreased movement of bones in ear

Question 240

otosclerosis

Answer 240

possibly autoimmune conductive hearing loss common in 20-30's with slight female predominance otic capsule is remodeled and the stapes fixed

Question 241

presbycusis | presbyopia

Answer 241

sensorineural hearing loss due to aging presbyopia: age related visual acuity (lense elasticity loss), difficulty with myopia (changing lense to accomodate for near objects)

Question 242

Adolescent: Nasal mass, bony erosion, recurrent epistaxis

Answer 242

JNA: juvenile angiofibroma, usually in males, arises from maxillary artery (in posterior nasopharynx) - benign but potentially dangerous given blood supply and possibility of major bleeding. - tx may not be required, but surgical resection is common WITH SPECIALISTS

Question 243

incubation period giardia

Answer 243

1-2weeks (diarrhea, bloating, foul smelling, diarrhea) -> minority become chronic with malabsoption/weight loss/GI issues dx: stool antigen assay/ microscopy for oocytes/trophozoites tx: metronidazole

Question 244

size ob pneumothorax to observe vs tx

Answer 244

2cm or less observation is ok (6+hrs, then dc home ok if not enlarging). Size is measured from chest wall to pleural line on chest radiograph. other sources say 20% or less obs is ok

Question 245

``` Essential HTN management pregnancy 1st line vs contraindicated Methyldopa furosemide BB (propranolol) hydralazine CCB (nifedipine) clonidine HCTZ ACEi/ARB aldosterone R blockers ```

Answer 245

``` 1st line methyldopa (alpha 2 agonist) hydralazine (arteriodilator, unk mech) Beta blockers (propranolol) CCB (nifedipine) ``` 2nd clonidine (alpha 2 agonist) HCTZ ( -l NaCl resorption) CONTRAINDICATED ACEi/ARB aldosterone R blockers (spirinolactone/eplerenone) furosemide (lasix, -l NaK 2Cl)

Question 246

polyarteritis nodosa

Answer 246

***

Question 247

``` Joint fluid normal OA RA/inflammatory septic ```

Answer 247

Normal: WBC less than 200, PMNless than 25% OA: 200-2000, PMN 25% Inflammatory/RA/crystal:2000-100,000 PMN 50%+ septic:50,000+ , PMN80%+

Question 248

Baker Cyst

Answer 248

Popliteal cyst from communication posterior synovium into gastrocnemius bursa. Arises behind knee common in OA, RA, and meniscal tears

Question 249

pseudogout dx: xray findings

Answer 249

path: calcium pyrophosphate crystals cause s/s: large joints, classically knee, swelling, pain,erythema dx: weakly Positively birefingent, blue with parallel light, rhomboid. -XRAY: chondrocalcinosis, calcification of joint cartilage tx: NSAID, steroids, colchicine

Question 250

gout path: monosodium urate crystal precipitation 2/2 hyperuricemia cause: lesch-nyhann, cell turnover, thiazides. mostly due to underexcretion, alcohol, red meat s/s: asymmetric , red, swollen joint. classic MTP. tophi (ear, olecranon, achilles) dx: NEGATIVELY birefringent (yellow with parallel light) xray: PUNCHED OUT EROSIONS with rim of cortical bone tx:

Answer 250

tx: NSAID (indomethacin), steroids, colchicine. CHRONIC: allopurinol (xanthine oxidase inhib)

Question 251

RA xray

Answer 251

*periarticular osteopenia with erosion of joint margins

Question 252

secondary amenorrhea definition dx

Answer 252

3+ missed cycles or 6+ months without menses in women who menstruated previously B-hCG -> TSH/prolactin/FSH TSH high -> hypothyroidism prolactin high -> pituitary adenoma -> think MRI LH/FSH high -> premature ovarian insufficiency (hypergonadotropic hypogonadism) (if under 40yo) = early menopause, will have low estradiol. FSH is greater than LH... FSH has slower systemic clearance *if hirsutism -> US for PCOS

Question 253

asherman syndrome

Answer 253

intrauterine adhesions, usually 2nd to surgical intervention/D&C, with symptoms such as amenorrhea, hypomenorrhea, infirtility, recurrent pregnancy loss * occasionally 2/2 infection dx: hysteroscopy

Question 254

cervical cancer screening

Answer 254

None until 21 21-30 pap q3yr 30-64 pap q3yr OR pap+HPVq5yr 65+ no screening * high risk HPV 16 (50% cervical cancer), 18 , there are more * *if atypical squamous cells- undetermined significance ASC-US or Low grade -> under 25, retest in 1 year. If 25+, test HPV -> if + -> colposcopy * **If ASC-H , then -> colposcopy

Question 255

when to give HPV vaccine

Answer 255

``` all women 9-26 all men 9-21 (to 26 if MsexM) *regardless of sexual activity or HPV status *Don't give pregnant women *do give to 26yo for immunocompromised ```

Question 256

ebstein's anomoly

Answer 256

rare congenital defects with higher incidence in mothers taking lithium in early pregnancy -malformed tricuspid valves assoc with: +- ASD, VSD, PDA, coarctation, and others * In pregnant women needing lithium, should continue at lowest possible dose * *controversy about breastfeeding, as it is present in breast milk * **lithium can also cause hypercalcemia through stimulating PTH

Question 257

valproic acid teratogenicity

Answer 257

BAD: including neural tube defects, cardiac anomolies, dysmorphic faces...

Question 258

levodopa/carbidopa side effects

Answer 258

Immediate: somnolence, confusion, agitation, hallucinations | Long term use: Dyskinesia, dystonia- within several years, 50% have motor dysfunction after 5-10yrs

Question 259

Small for gestational age

Answer 259

below 10th percentile

Question 260

gonococcal vs chlamydia conjunctivits in newborn

Answer 260

gonooccal presents 2-5 days tx: ppx by topical erythromycin eye drops at birth no matter dx (does not treat chlamydia) tx: acute -> IV ceftriaxone chlamydia 5-14days (up to 50% dvlp), and can develop into pneumonia (up to 30%)*** so get tx mama! tx: oral erythromycin (though risk of pyloric stenosis) *chemical conjunctivitis is within 24hrs (such as with use of silver nitrate in areas where that is more effective bc of gonococcal resistance with penicillinase)

Question 261

Acute rheumatic fever dx tx

Answer 261

2/2 molecular mimmickry to M-protein from GAS (strep pyogenes) ``` Need 2 major criteria -JONES: Joints: migratory arthritis O: pericarditis N: Subq nodules E: erythma marginatum S: sydenham chorea ``` ``` or 1major + 2 minor fever arthralgia ESR/CRP elevation prolonged pr ``` sequelae: mitral regurge/stenosis, also can involve aorta tx: long acting IM PCN G

Question 262

Evaluation of suspected acromegally | If IGF-1 elevated, what test next?

Answer 262

Next do glucose suppression test, normal people will suppress IGF-1, but not if there is an ectopic GH source --> next do MRI brain of pituitary (most likely)

Question 263

leukemoid reaction

Answer 263

= when leukocytosis exceeds 50,000, not really useful except it is used to differentiate btw CML and infection ** ie both with neutrophilia Leukemoid is 50,000+, leukocyte alkaline phosphate is high (LAP), late neutrophil precursors (bands) CML 100,000+, LAP low (cytologically abnormal cells), earlier/less mature cells

Question 264

``` Food poisoning Staph Aureus Bacillus Cereus Clostridium Perfringens salmonella ```

Answer 264

N/V/D - Staph Aureus: preformed toxins, onset 1-6hrs: dairy, salad, meat, eggs - Salmonella (nontyphoidal, aka GI): ingestion of organism, 8-72hrs, N/V/D, fever, abd cramps; resolves 3-10days: undercooked meat/poultry, raw egg, fresh produce (sprouts, spinach...)***Not really a toxin related poisoning...more just infection - Bacillus Cereus: preformed (heat-stable) toxins, onset 1-6hrs: under-refrigerated cooked rice - Clostridium Perfringens: organisms produce toxin WITHIN guy, onset 8-14hrs: meats/poultry/gravy *campylobacter in undercooked meat, incubation 2-5days

Question 265

can OCP's cause HTN

Answer 265

nyep

Question 266

CPK # for REAL danger zone for ARF 2/2 acute tubular necrosis with myoglobinuria/emia

Answer 266

CPK: 20,000

Question 267

weird ear thing with HIV

Answer 267

serous otitis media: auditory tube dysfunction from lymphadenopathy/obstructing lymphoma. has poor drainage -> conductive hearing loss *it's a noninfectious effusion

Question 268

HTN pathology effect kidneys

Answer 268

Afferent hyaline arteriosclerosis (more than efferent, though there is some), glomerular capillary tufts, DM may have hyaline arteriosclerosis, but will be afferent and efferent, whereas HTN is primarily afferent

Question 269

DM pathology effect kidneys

Answer 269

Predominant Efferent arteriole nonenzymatic glycosylation, thickening --> pressure/NEG -> GBM thickening, mesangial expansion Due to pressure and NEG: over time, GFR up, then -> normal -> microalbuminuria -> nephropathy

Question 270

bence jones protein

Answer 270

seen in Multiple myeloma, is the light chain, may -> renal insufficiency

Question 271

Sickle cell disease avg lifespan

Answer 271

20 days (contrast to normal 120) predominant extravascular (spleen/bone/liver) hemolysis, though always some intravascular, so modest elevation LDH and indirect bili, low haptoglobin, and reticulocytosis

Question 272

cancers common to affect spine

Answer 272

breast, lung, prostate, multiple myeloma, renal

Question 273

brainstem ischemic stroke classic

Answer 273

ipsilateral CN deficit with contralateral motor deficit

Question 274

Fifth disease

Answer 274

Aka erythema infectiosum caused by Parvovirus B19 acute: coryza, HA, nauseua, diarrhea --> 2-5days later with slapped cheek malar rash --> few days later may have reticular trunk/extremities complication: transient aplastic anemia (self limited), often not associated with typical malar rash - BAD in sickle Cell!

Question 275

coryza

Answer 275

similar to rhinorrhea, inflammation of nares with drainage

Question 276

primary sclerosing cholangitis

Answer 276

chronic, progressive inflammation/fibrosis/stricture of INTRA AND EXTRAHEPATIC biliary system. - associated with ulcerative colitis (90%) - complications liver failure, malnutrition, vitamin deficiency, portal hypertension - risk of cholangiocarcinoma labs: elevated alk phos (cholestatic pattern), mild transaminases, +- ESR elevation, +- p-ANCA imaging: ERCP or MRCP

Question 277

primary biliary cholangitis

Answer 277

middle aged women, + anti-mitochondrial antibodies ONLY INTRAHEPATIC/INTRALOBULAR damage -otherwise similiar s/s to PSC

Question 278

charcot triad

Answer 278

bacterial cholangitis: fever, RUQ pain, jaundice,

Question 279

livedo reticularis

Answer 279

Skin finding in polyarteritis nodosa, necrotizing medium vessel vasulitis. -w/renal disease, arthralgia/myalgia, neuropathy

Question 280

trichinellosis

Answer 280

TRIAD: periorbital edema, myositis, eosinophilia Caused by ingestion of raw meat (usually pork) of roundworm Trichinella. - week 1 (GI): abdominal pain, N/V/D - week 1-4, momma worm has -> babies invade mucosa-> striated muscle: myosititis, periorbital edema, eosinophilia +- fever, splinter hemorrhages, retinal/conjunctival hemorrhage, elevated CPK

Question 281

Typhoid Fever

Answer 281

From typhoidal salmonella typhi/paratyphi week 1: fever week 2:abdominal pain, salmon-colored rash (diarrhea uncommon) week 3: hepatosplenomegally with GI complications (bleeding, perforation) transmission: food/water contaminated with feces ppx: typhoid vaccination, though not completely effective, esp not against paratyphi tx: - mild disease: oral ciprofloxacin or if drug resistance (asia) give azithromycin or ceftriaxone - severe: IV ceftriaxone

Question 282

normal nonstress test fetus

Answer 282

2+ accelerations over 20min, watch for at least 40min up to 120min 2/2 sleep cycle this is better after 32weeks **high negative predictive value

Question 283

positive acceleration

Answer 283

15+ rise BPM for 15seconds, (2+ in 40min is normal) *Normal HR: baseline HR should be 110-160, moderate variability 6-25bpm

Question 284

antepartum fetal surveillance

Answer 284

nonstress test- > biophysical profile 20-40 minutes 8+ is normal, repeat in 1wk if on a schedule 6 is equivical, repeat in 24hrs 0-4 is abnormal/fetal hypoxia with placental dysfunction 2pts each - appropriate amniotic fluid volume (fluid index 5+ or 2+x1cm single pocket) - fetal breathing movement (1+ for 30+sec) - fetal movement 3+ - fetal tone (1+ flexion/extension spine/limbs) - nonstress test

Question 285

tinea capitis path s/s dx tx

Answer 285

cutaneous dermatophyte (eat keratin) infection; mycoses central clearing widening, pruritic, scaly, erythematous, +- lymphadenopathy dx: KOH prep tx: - 1st line griseofulvin - 2nd terbinafine, itraconazole, or fluconazole

Question 286

alopeia areata

Answer 286

smooth circular hair loss associated with autoimmune diseases

Question 287

vitiligo

Answer 287

chronic relapsing depigmintation due to loss of melanocytes. No clear etiology -tx steroids and UV light during flare ups/rapid progression

Question 288

Sturge-weber syndrome

Answer 288

neurocutaneous (phakamatosis) syndrome presentation: seizures, unliateral cavernous hemangioma (nevus flammeus) along trigeminal nerve territory. skull xray with "tram line" gyriform intracranial calcifications, hemianopia, ipsilateral glaucoma, hemiparesis, hemisensory disturbance. mental retardation. pheochromocytoma tx: control seizures and reduce IOP.

Question 289

Tuberous sclerosis

Answer 289

``` neurocutaneous disorder AD HAMARTOMAS (tissue of origin grown unorganized, benign) -Hamartoma CNS/skin -adenoma sebaceuml (cutanous angiofibroma) -mitral regurge -ash-leaf spots -cardiac rhabdomyoma -tuberous sclerosis -autosoma dOminant -mental retardation -renal Angiomyolipoma -seizures ```

Question 290

neurofibromatosis

Answer 290

neurocutaneous disorder von recklinghausen's diseaseI: cafe-au-lait spots, lisch nodules (pigmented hamartoma), neurofibroma of skin, optic gleoma, pheochromocytoma, AD II: bilateral acoutstic neuroma's, may have some type I manifestations

Question 291

charcot joint

Answer 291

deformed foot due to peripheral neuropathy and damage (as in diabetics)

Question 292

tabes dorsalis

Answer 292

2/2 neurosyphilis, lesion of posterior column with ataxia, paresthesias, loss of proprioception.

Question 293

venous vs arterial ulcers

Answer 293

venous: medial, above medial malleolus & below knee, shallow, granulation tissue, irregular border, minimal pain, exudate arterial: toes, foot, ankle, deep/punched out, regular border, necrotic, more painful, minimal exudate

Question 294

excessive cow's milk in child

Answer 294

over 24oz/700mL per day

Question 295

neuroblastoma s/s imaging labs

Answer 295

arises from neural crest cells (adrenals/paravertebral sympatheic chain "retroperitoneal ganglia") s/s: abdominal pain, diarrhea, fever, weight loss, HTN (less likely), proptosis, Opsoclonus/myoclonus... others imaging: abdominal calcifications/hemorrhage labs: elevated serum and urine catecholamines and their metabolites (check serum or urine) - -> metanephrines (vanillylmandelic acid "VMA" and homovanillinic acid "HVA") *Not as commonly having palpitations, sweating, fainting, HTN as in pheochromocytoma

Question 296

wilms tumor

Answer 296

childhood tumor arising from renal metanephros (embryonic precursor to renal parenchyma)

Question 297

mesonephros

Answer 297

embryonic structure giving rise to -> ejaculatory duct, seminal vesicles, ductus deferens = vas deferens

Question 298

paramesonephros

Answer 298

--> fallopian tubes, uterus, part of vagina

Question 299

congenital infection: syphils

Answer 299

rhinorrhea, abnormal long bone radiographs (saber shins), desquamating/bullous rash, deafness shared with others: blueberry muffin rash, hepatosplenomegally, Jaundice, growth restriction

Question 300

Congenital infection: CMV

Answer 300

periventricular calcifications, hearing loss, seizure shared: hepatosplenomegally, jaundice, growth restriction

Question 301

prochlorperazine

Answer 301

aka compazine D2 receptor antagonist USE: antiemetic, migraine headache, antipsychotic

Question 302

migraine tx

Answer 302

1) NSAID + triptans (Sumatriptan ect... give early otherwise not great) 2) monotherapy: antiemetic/dopamine R antagonists (metoclopramide, prochlorperazine, chlorpromazine) 3) dihydroergotamine ppx: tricyclics (ie. amitryptaline), propranolol, or valproic acid (or topiramate)

Question 303

metoclopramide

Answer 303

aka reglan D2 receptor antagonist, enhanced upper GI motility and gastric emptying USE: antiemetic, migraine,

Question 304

chlorpromazine

Answer 304

thoraxine D2 receptor antagonist USE: antiemetic, migraine, antipsychotic

Question 305

dermoid cyst

Answer 305

= mature teratoma in ovary: has ectoderm (skin/hair), mesoderm (muscle), endoderm (lung ect.) *typically with calcifications

Question 306

Addisons disease

Answer 306

Primary! adrenal insufficiency (PAI) 2/2 atrophy/destruction (auto-immune, TB**, metastasis, adrenal hemorrhage) -Entire cortex affected, sparing medulla. Granulosa-aldosterone, Fasciculata-cortisol, reticularis-sex hormaones (ie androgens) -aldosterone loss: hypotension, hyponatremia, hyperkalemia -corisol loss: hypotension, skin hyperpigmentation (increased ACTH -> MSH) + weakness, fatigue, weight loss, GI SYMPTOMS dx: 1) 8am serum cortisol and plasma ACTH, with concurrent ACTH (cosyntropin) stimulation test. If ACTH stimulation does not provoke cortisol -> PAI, but if central adrenal insufficiency, may not respond well either 2/2 atrophy of adrenals cortisol low, ACTH low, cosyntropin stimulation low -> secondary/tertiary (central)... also look at other markers like hyperkalemia cortisol low, ACTH high, cosyntropin stimulation low -> primary

Question 307

waterhouse-friderichsen syndrome

Answer 307

primary adrenal insufficiency 2/2 adrenal hemorrhage 2/2 neisseria meningitidis septicemia, DIC, endotoxic shock.

Question 308

Secondary adrenal insufficiency

Answer 308

central cause decreased ACTH from pituitary. No skin hyperpigmentation, no hyperkalemia. zona granulosa (aldosterone) not really affected -causes: pituitary tumor, pituitary dmg from anything, weird ACTH deficiency, TBI, high dose progestin

Question 309

tertiary adrenal insufficiency

Answer 309

decreased CRH from hypothalamus - cure of cushings syndrome (removal of ACTH/cortisol producing tumor) - abrupt cessation of chronic high dose glucocorticoid administration

Question 310

pseudocyesis

Answer 310

usually present in women who strongly desire pregnancy, have many signs of pregnancy -breast enlargement/tenderness, report of + pregnancy test, amenorrhea, morning sickness, weight gain... thought to be possibly due to depression and hormonal changes from it, it is a somatic symptom disorder (has symptoms that cannot be explained) --but US shows nothing, pregnancy test is -

Question 311

blood transfusion reactions

Answer 311

- anaphylactic, immediate, 2/2 IgA deficiency - transfusion related lung injury, within 6 hrs, noncardiogenic respiratory distress and pulm edema 2/2 donor anti-leukocyte antibodies - primary hypotension reaction: immedieate, in pts taking ACEi, transient, 2/2 bradykinin present and not broken down - febrile nonhemolytic transfusion reaction, most common, 2/2 released cytokines in blood product, is transient -> fever, chills, malaise

Question 312

myotonic dystrophy genetics s/s

Answer 312

autosomal dominant trinucleotide repeats CTG onset puberty/20's s/s:facial weakness, dysphagia, thenar/hypothenar atrophy, myotonia delayed/inability to relax voluntary muscle after vigorous effort: (latency in releasing grip, such as after handshake), TESTICULAR ATROPHY, arrhythmias, cataracts, balding -death from respiratory/heart failure

Question 313

Duchenne/becker genetics

Answer 313

x-linked recessive deletion/truncation of dystrophin, Xp21

Question 314

malassezia globosa or furfur

Answer 314

``` tinea versicolor (aka pityriasis versicolor) dermatophyte infection ``` lab: KOH ->spaghetti and meatball tx: topical ketoconazole or topical selenium sulfide

Question 315

superior pulmonary sulcus tumor

Answer 315

= pancoast tumor SCC and lung adenocarcinoma are most common of pancoast tumors

Question 316

type II membranoproliferative glomerulonephritis (MPGN)

Answer 316

whereas type I common to HBV, HCV, SLE type II 2/2 C3 nephritic factor IgG is directed against c3 convertase ->stabilizes this and leads to persistent compliment activation --> kindey damage -will have low serum C3

Question 317

AAA association

Answer 317

low association with HTN, and BB/ACEi have not shown benefit SMOKING IS ASSOCIATED WITH FORMATION AND CONTINUED/RAPID EXPANSION indication for repair is 5.5cm+, or rapid expansion (1+cm /year) -normal abdominal aorta is 2cm, 3+cm is considered abnormal

Question 318

cardiac index

Answer 318

essentially = CO

Question 319

celecoxib

Answer 319

aka celebrex MOA: selective COX-2 inhib USE: RA, OA, anklosing spondylitis... SE: increase rate vascular incidents (MI, stroke ect)

Question 320

Rheumatoid arthritis 1st line tx

Answer 320

methotrexate if continued symptom 6+ months add a nonbiologic (sulfasalazine, hydroxychloroquine) or add step up tx with biologica (anti-TNF: etanercept, infliximab...) *continue methotrexate Acute flares: NSAIDs/celecoxib/steroid *hep B, C, Tb... must TEST BEFORE BEGINNING TX!!!!

Question 321

psuedomonas tx

Answer 321

anti-pseudomonal pcn: piperacillin, ticarcillin cephalosporin: ceftazidime (3rd gen), cefepime (4th gen) aminoglycoside: amikacin, gentamycin, tobramycin Flouroquinolone: ciprofloxacin, levofloxacin Monobactam: aztreonam (the only one) carbapenem: imipenem, meropenem

Question 322

malignant (necrotizing) otitis externa

Answer 322

IS NOT a neoplasm. just a severe infection, usually pseudomonas, of the external auditory canal. characterized by granulation tissue, severe pain, otorrhea. can extend and invade with osteonecrosis. USually occurs in elderly, diabetic or immunocompromised tx: systemic anti-pseudomonal therapy - 1st line ciprofloxacin, but if flouroquinolone resistance -> pipieracillin or ceftazidime

Question 323

EKG findings pericarditis

Answer 323

diffuse ST-elevation, also with depressed PR *pain relieved by leaning forward

Question 324

when is occasional strabismus abnormal

Answer 324

4mo+ age

Question 325

amblyopia

Answer 325

"lazy eye" -when the vision is decreased in one eye bc the brain and eye do not communicate well (2/2 disuse of eye). is a complication of untreated strabismus

Question 326

esotropia

Answer 326

when one or both eyes are turned inward

Question 327

myopia

Answer 327

near-sightedness (light focuses in front)

Question 328

hyperopia

Answer 328

far-sighted (light focuses in back of retina)

Question 329

scotoma

Answer 329

partial loss of vision due to blind spot in otherwise normal vision (may occur with choroidal hemorrhage/rupture)

Question 330

variable decelerations

Answer 330

abrupt, sharp, decelerations 2/2 cord compression

Question 331

late decelerations

Answer 331

long/slow downslope occur after contraction 2/2 transient hypoxia during uterine compression *this is the worst form, far worse than variable decels

Question 332

early decelerations

Answer 332

occur during contraction, thought 2/2 fetal head compression and autonomic response, mirror contraction

Question 333

Sodium correction from glucose

Answer 333

Na+ 1.6(glucose-100)=Na corrected

Question 334

tx for ms exacerbation

Answer 334

steroid burst (methylprednisolone) -> refractory -> plasma exchange

Question 335

when to test BRCA/HER2

Answer 335

breast cancer under 50, ovarian cancer any age

Question 336

adjustment disorder

Answer 336

develops within 3mo of stressor, rarely lasts longer than 6 mo, **significant functional impairment tx with psychotherapy. It is not dx if criteria of another psychiatric disorder is met

Question 337

chronic pancreatitis

Answer 337

will have calcium deposition, whereas apparently pancreatic carcinoma will not

Question 338

couvoisier's law/sign

Answer 338

a palpably enlarged but nontender gallbladder in the presence of mild jaundice is unlikely to be 2/2 gallstones. ie. more likely pancreatice carcinoma

Question 339

pancreatitis

Answer 339

* persistent severe epigastric pain pathophys: blockade of secretion pancreatic enzymes, continued proteolytic enzyme production -> intraacinar activation of enzymes-> autodigestion -> leak of enzymes to interstitium/vasculature -> leukocyte invasion/cytokine production + enzymes -> SIRS vasodilation/increased membrane permeability/organ dysfunction mild: no organ failure moderate: transient organ failure severe: persistent organ failure complications: pleural effusions, hypotension/shock, adult respiratory distress syndrome, fever, renal failure Tx: IVF, opioids, N/V

Question 340

pulsus paradoxus measurement

Answer 340

abnormal is 10mmHg+ drop in systolic BP with inspiration due to bowing of RV toward LV (less filling of LV thus less CO

Question 341

ankle-brachial index

Answer 341

measure systolic pressures, ratio ankle:brachial artery * 0.9-1.3 normal * under 0.9 indicates arterial occlusive disease (PAD)

Question 342

cirrhosis s/s

Answer 342

anorexia, jaundice, pruritis, fatigue, malaise, encephalopathy, palmar erythema, edema, Decreased synthetic function: low T3/T4 (but normal free T3/T4), prolonged PT/INR (major criterion) & PTT, low albumin, thrombocytopenia portal htn: UGI bleed, caput medusae, splenomegally, ascites increased estrogen effects: telengiectasia women: amenorrhea, irregular menses, annovulation men: gynecomastia, hypogonadism (decreased libido, hair loss, testicular atrophy)

Question 343

Hashimoto's Disease + antibody

Answer 343

anti-thyroid peroxidase (TPO) and anti-thyroglobulin antibodies

Question 344

Hashimoto's Disease + antibody

Answer 344

anti-thyroid peroxidase and anti-thyroglobulin antibodies

Question 345

Dubin-johnson syndrome

Answer 345

Autosomal recessive - defect in transferase, such that you have conjugated hyperbilirubinemia that cannot get into the bile collecting system - aysmptomatic except mild scleral icterus - liver has dark pigments *in contrast to Rotor syndrome, essentially the same thing, except liver looks normal

Question 346

Gilbert and crigler najjar

Answer 346

*both defects of UGT1A1 (UDP glucuronosyltransferase 1 A1), which conjugates bilirubin crigler najjar: -type I: AR, fatal -type II: AD, some increased indirect bili, nonfatal, relatively benign Gilbert: AR, common, benign, mild elevation indirect bili

Question 347

Blood transfusion before what year are an indication for Hep C screening with concerning symptoms

Answer 347

1992

Question 348

cushing syndrome

Answer 348

hypercortisolism (exogenous glucocorticoids, cush disease, ectopic ACTH, adrenal adenoma/carcinoma) s/s: weight gain (face/neck/trunk/abdomen), hirsutism, bone loss, HTN, muscle atrophy (proximal) 2/2 catabolic effects, increased libido, irregular menses, skin striae and thinning *if cushing's DISEASE = 2/2 ACTH secreting tumor

Question 349

abnormal post-void residual volume

Answer 349

50mL or more is abnormal = urinary retention 100mL or less is ok people greater than 65 * If someone on US has 300mL+ and is unable to void... likely urinary retention

Question 350

abnormal post-void residual volume

Answer 350

50mL or more is abnormal = urinary retention

Question 351

path of stasis dermatitis

Answer 351

valvular incompetency -> venule HTN -> capillary damage with extravasation of fluid/protein/RBC -> RBC hemosiderin gets deposited and gives classic blue/grey color

Question 352

xerosis

Answer 352

abnormally dry skin

Question 353

Reye's syndrome

Answer 353

path: mitochondiral dysfunction/MICROvesicular fatty inflitration (steatosis) Etiology: ASA use, esp in setting of influenza or varicella (or any viral illness) s/s: N/V, liver failure --> hyperammonemia -> encephalopathy/cerebral edema *MACROvesicular steatosis is in alcoholic hepatitis and NAFL/NASH

Question 354

emphysema histology smoking vs alpha-1-antitrypsin

Answer 354

smoking: centriacinar, upper regions of lung at beginning | alpha-1-antitrypsin: panacinar, predominant lower lobe

Question 355

Tx hypovolemic or euvolemic hypernatremia

Answer 355

Treat hypovolemia first, then treat the hypernatremia when hypovolemic with hemodynamic instability-> 0.9% NS -> once euvolemic tx D5w, max 12meq change in 24 hr, otherwise risk cerebral edema

Question 356

osmotic demyelination syndrome

Answer 356

Central pontine myelinolysis - > overly rapid correction of hyponatremia - when serum Na/osm fall brain compensates by dumping osmotically active substances, therefore if correct to fast --> ODS (which almost all cases is Na below 120) ODS: delayed symptoms 2-6 days, neuro problems: dysarthria, lethargy, paresis, coma, behavior problems SO if have hyponatremia for 2+ days: raise by 6meq/day

Question 357

amiloride

Answer 357

Blocks ENaC channel | K sparing diuretic

Question 358

hemodyalisis with lithium

Answer 358

Hemodyalisis when lvl 4meq/L+, or toxicity s/s (HF, renal disease)

Question 359

PCOS labs

Answer 359

LH up -> anovulation/no progesterone theca cells abnormal testosterone production imaging: enlarged bilateral cystic ovaries labs: LH(up), FSH (down), LH/FSH = 3:1, increased testosterone, increased estrogen (testic aromatization) risk: obesity, DMII increased risk of: endometrial cancer (from increased estrogen and no progesterone opposition) Tx: weight loss, OCP (-l LH), spironolactone (acne/hirsutism 2/2 antiandrogen effects), clomiphene (if wanting to get pregnant), metformin (if DM)

Question 360

clomiphene

Answer 360

-l hypothalamic estrogen receptors. Without that negative feedback --> GnRH becomes pulsatile again/normal in the case of PCOS --> leads to LH/FSH pulses and ovulation

Question 361

Law leplace

Answer 361

HEart: wall stress (force against myocytes) = (systolic pressure * radius)/wall thickness *reduce radius by reducing preload (nitrates) *reduce systolic pressure by reducing afterload **so reduce wall stress (preload/afterload/inotropy) and HR (chronotropy) to reduce myocardial oxygen demand Lung: Collapsing pressure= surface tension (decreased by surfactant)/radius

Question 362

varicella vaccine

Answer 362

give if 1+y/o, no previous infection, asymptomatic. Can give even with exposure within 2-5 days as the incubation period is 2-3weeks * varicella zoster is infectious 2 days prior to vesicle eruption until all vesicles are crusted * *contraindicated in immunocompromised and pregnant (live attenuated vaccine) neonates (under 1) and immunocompromised should receive VZIG within 10 days of exposure

Question 363

varicella vaccine

Answer 363

give if 1+y/o, no previous infection, asymptomatic. Can give even with exposure within 2-5 days as the incubation period is 2-3weeks

Question 364

associated conditions in tourrette's

Answer 364

ADHD (which occurs before 12) 60% OCD 27% tourrette symptoms -> 3-5yrs -> OCD

Question 365

``` Hepatitis B acute: window: chronic: high/low infectivity recovered immunized ```

Answer 365

``` acute: HBsAg & anti-HBc IgM Window: anti-HBc IgM (lose HBsAg) chronic: HBsAg, no anti-HBs, anti-HBc IgG -high infectivity: HBeAg, -low infectivity: anti-HBe ``` Recovered: anti-HBs + anti-HBc IgG Immunized: anti-HBs, no anti-HBc

Question 366

battery ingestion

Answer 366

in esophagus: remove | in stomach: observe

Question 367

Nasopharyngeal Cancer association | risk

Answer 367

STRONG association with EBV, can even track cancer therapy using EBV titers. *smoking also is associated

Question 368

Barrett's esophagus | risk

Answer 368

primary risk GERD, but also smoking, this is adenocarcinoma (lower 1/3 esophagus) * alcohol assoc with SCC esophagus (upper 2/3 esophagus), NOT adeno. otherwise primarily hepatocellular carcinoma. * *smoking is associated with both adeno/SCC, and many other cancers (pancreatic, lung, urinary)

Question 369

vaginal discharge neonate

Answer 369

physiologic 2/2 maternal estrogen for first 3 mo, may be blood tinged. will go away when maternal estrogen does

Question 370

isotretinoin sun

Answer 370

for acne, will increase propensity for sunburn, but is not truly a photosensitizer as doxycycline is. It does have photolability, so should be applied at night List of phototoxic drugs: tetracyclines, antipsychotics (chlorpromazine, prochlorperazine), furosemide, HCTZ, amiodarone, promethazine (phenergan), piroxicam

Question 371

``` Gait abnormalities hypokinetic/shuffling/festinating spastic gait antalgic gait en-bloc gait high stepping gait ```

Answer 371

hypokinetic: parkinsons spastic: UMN lesion antalgic: joint pain (limp, shortened stance relative to swing) en-bloc gait- vestibular disfunction or PD, multiple steps to turn, don't turn head high step: peroneal nerve damage

Question 372

common peroneal and tibial nerve damage

Answer 372

TIP PED TIP: tibial inverts and plantar flexes PED: peroneal everts and dorsiflexes

Question 373

alprazolam

Answer 373

aka xanax short (12hr) half life SE withdrawal seizure

Question 374

clomipramine

Answer 374

TCA

Question 375

lamotrigine

Answer 375

USE: bipolar (esp. depressive episodes), epilepsy

Question 376

lamotrigine

Answer 376

USE: bipolar, epilepsy

Question 377

malignant HTN

Answer 377

severe HTN w/ retinal hemorrhage, exudate, or papilledema

Question 378

wallenberg's syndrome

Answer 378

LATERAL MEDULLARY SYNDROME, IX/X involvement - posterior inferior cerebellar artery occlusion, off vertebral artery - vertigo,NYSTAGMUS, DYSPHAGIA, HOARSENESS, ipsilateral HORNERS/trigeminal nerve, contralateral spinothalamic tract( pain/temperature)

Question 379

seborrheic dermatitis

Answer 379

fungus plays a role -> topical antifungals | *assoc w/HIV and parkinsons disease

Question 380

primidone

Answer 380

barbiturate, analog of phenobarbital

Question 381

trihexyphenidyl

Answer 381

inhibitory of parasympathetic system, anticholinergic USE: parkinsons disease, control of extrapyramidal symptoms

Question 382

conduct disorder

Answer 382

consistent violation of major social norms for a year+, age under 18 18+ is antisocial personality disorder

Question 383

risperidone

Answer 383

aka risperdal atypical antipsychotic USE: schizophrenia, acute mania in bipolar disorder as monotherapy or combo with lithium or valproate, available in long acting SE: SJS

Question 384

carbamazapine

Answer 384

aka tegretol MOA: stabilizes Na channels making less likely to open, and also has GABA agonist USE: seizure disorders, trigeminal neuralgia, bipolar I disorder

Question 385

trigeminal neuralgia medication

Answer 385

carbamazapine

Question 386

cat bite

Answer 386

pasteurella multicida + anaerobes+staph/strep ppx: amox/clav (works for cat/dog/human bites) * bartonella henslae can be transmitted, but no ppx necesary, tx if s/s with azithromycin * * human bite may have eikenella corrodens

Question 387

depersonalization/derealization disorder

Answer 387

person feels detached from reality and/or self

Question 388

dissociative identity disorder

Answer 388

person has 2+ distinct identities that assume control of behavior

Question 389

dissociative amnesia

Answer 389

amnesia with inability to recall autobiographical info, usually related to stressful event

Question 390

dissociative amnesia

Answer 390

amnesia with inability to recall autobiographical info, usually related to stressful event

Question 391

factitious disorder

Answer 391

faking to assume sick role

Question 392

factitious

Answer 392

faking to assume sick role

Question 393

preterm labor

Answer 393

cervical dilation and painful regular contractions at less than 37 weeks

Question 394

what gestational age to give steroid if preterm labor

Answer 394

betamethasone under 37 weeks (=premature)

Question 395

management preterm labor 34-36 6/7 32-33 6/7 under 32

Answer 395

34-36 6/7 -> betamethasone + PCN (unk or + GBS) 32-33 6/7 -> betamethasone + tocolytics (nifedipine (risk maternal hypotension) or indomethacin (risk oligohydramnios and PDA closure)) under 32 -> betamethasone + tocolytic + mag

Question 396

rocky mountain spotted fever tx

Answer 396

cause: rickettsia reckettsii, tick borne fever, HA, myalgia, arthralgia, malaise, N/+-V,abd pain -> rash day 3-5 (blanching macules) wrists/ankles -> trunk/palms/soles) doxycycline

Question 397

ITP

Answer 397

platelet antibodies (often G2b/3a-> destruction/impaired production -thrombocytopenia, possible severe bleeding/anemia preceding infection may cause, or hematologic immunologic changed (CLL)

Question 398

henoch schonlein purpura

Answer 398

IgA vasculitis, more common in childhood, self limited tetrad: 1) palpable purpura on gravity dependent (buttocks/legs in walkers), WITHOUT THROMBOCYTOPENIA/COAGULOPATHY 2) arthralgia/arthritis 3) abdominal pain 4) renal disease, assoc w/ IgA nephropathy tx: none, supportive

Question 399

painless (silent) thyroiditis

Answer 399

``` variant of hashimotos, anti-TPO, resolves spontaneously, acute thyrotoxicosis (preformed thyroid hormone), reduced radioiodine uptake, painless mildly enlarged thyroid -suppressed TSH ```

Question 400

de quervains thyroiditis

Answer 400

aka subacute thyroiditis - postviral inflammatory, fever, hyperthyroid symptoms (preformed thyroid hormone) - elevated ESR/CRP - low radioiodine uptake, suppressed TSH - PAINFUL enlarged thyroid

Question 401

struma ovarii

Answer 401

rare thyrotoxicosis from thyroid hormone producte from ovarian teratoma, thyroid wouldn't be enlarged here

Question 402

renal biopsy children

Answer 402

if older than 10 or under 10 with nephritic syndrome or minimal change disease NOT responsive to steroids

Question 403

gastric bezoar

Answer 403

foreign body in stomach from accumulation of ingested material (like hair = trichobezoar, meds = pharmacobezoar)

Question 404

cimetidine

Answer 404

aka tagamet -H2 blocker used for heartburn SE: partial antiandrogenic (libido)

Question 405

some Ed dysfunction med causese

Answer 405

SSRI, HCTZ, spirinolactone, cimetidine (H2 blocker)

Question 406

subacute/chronic cough

Answer 406

``` subacute 3-8wk, chronic 8+wk If ACE (stop it), postnasal drip (H1 blocker), asthma (PFT), GERD (PPI) ``` If none of those or s/s don't improve after intervention -> CXR If smokin hx, purulent sputum, parenchymal disease, immunocompromised -> CXR

Question 407

subacute/chronic cough

Answer 407

``` subacute 3-8wk, chronic 8+wk If ACE (stop it), postnasal drip (H1 blocker), asthma (PFT), GERD (PPI) ``` If none of those or s/s don't improve after intervention -> CXR

Question 408

ondansetron

Answer 408

5HT3 blocker | -antiemetic

Question 409

H. Pylori tx

Answer 409

Triple therapy: PPI, clarithromycin, amoxicillin x14 days quadruple therapy (for retreatment): PPI, bismuth, metronidazole, tetracycline x14days

Question 410

when might diabetic gasroparesis start to be an issue

Answer 410

usually not until DM present for at least a decade

Question 411

acalculous cholecystitis | *when seen?

Answer 411

In critically ill patients, often in ICU * multiorgan failure, severe trauma, burns, sepsis, prolonged parenteral nutrition * *thought 2/2 ischemia and cholestasis and endothelial dmg -> infection * ** In critically ill perform immediate percutaneous cholecystsotomy followed by cholecystectomy when patient condition stabilizes.

Question 412

acalculous cholecystitis | *when seen?

Answer 412

In critically ill patients, often in ICU * multiorgan failure, severe trauma, burns, sepsis, prolonged parenteral nutrition * *thought 2/2 ischemia and cholestasis -> infection * ** In critically ill perform immediate percutaneous cholecystsotomy followed by cholecystectomy when patient condition stabilizes.

Question 413

bony exostosis on hard palate

Answer 413

torus palatinus "benign cartilaginous growth off bone" on hard palate, no need to tx unless grows too large and becomes symptomatic. may ulcerate due to poor blood supply *congenital

Question 414

``` antipsychotic extrapyramidal symptoms akathisia acute dystonia parkinsonism tardive dyskinesia ```

Answer 414

- akathisia:subjective restlessness, tx with BB/benzo - acute dystonia: sudden sustained contracture (neck, mouth, tongue, eye muscles), tx benztropine or diphenhydramine - parkinsonism: resting tremor, gait instability, bradykinesia, rigidity- tx benztropine/amantadine - tardive dyskinesia: gradual onset 6+ months, dykinesia of mouth (lip smacking/grimacing)/trunk/face/extremities (choreoathetoid movements) (no tx, but can try clozapine)

Question 415

benztropine

Answer 415

MOA: anticholinergic USE: parkinsons disease, parkinsonism, acute dystonia

Question 416

amantadine

Answer 416

MOA: confusing, NMDA antagonism, clinically anticholinergic effects, dopamine agonist type effects USE: extrapyramidal rxn (especially parkinsonism), parkinsons disease

Question 417

dantrolene MOA

Answer 417

inhibits Ryanodine receptors (incracellular ca channel receptors) in sarcoplasmic reticulum (smooth endoplasmic reticulum)

Question 418

continuation of antidepressants

Answer 418

for single acute depressive episode, achieve remission -> tx for additional 4-9 mo. pt with chronic, recurrent, or severe episodes should continue 1-3 yrs/indefinitely

Question 419

when to check doppler umbilical artery

Answer 419

when child is growth restricted (under 10% for GA)

Question 420

preecclamsia dx

Answer 420

HTN (140/90+) AND proteinuria (.3g+ in 24 hr or p:c ratio .3+) OR end organ dmg: plt under 100,000, cr 1.1 or doubled, AST/ALT doubled *1+ protein on dipstick needs to be further analyzed for preeclampsia (as above)

Question 421

pineal gland - function - tumor

Answer 421

- produces melatonin - pinealoma: - parinaud/dorsal midbrain syndrome: limited upward gaze, upper eyelid retraction (collier's sign w/sclera visible above corneal limbus), pupils nonreactive light (reactive to accomodation) - papilledema, HA (CSF obstruction of aqueduct of sylvius), N/V, ataxia

Question 422

medulloblastoma

Answer 422

more common pediatrics - located cerebellar vermis - ataxia/truncal instability from hydrocephalus/mass effect

Question 423

von hippel-lindau disease

Answer 423

AD mutation tumor suppressor VHL gene -cavernous hemangioma skin, mucosa, organs, bilateral RCC, hemangioblastoma of retina/brain stem, cerebellum, pheochromocytoma

Question 424

HCTZ MOA USE SE

Answer 424

MOA: -lNaCl resoption in early distal tubule, reduces diluting capacity of nephron and Ca excretion. USE: HTN, CHF, idiopathic hypercalciuria, nephrogenic diabetes insipidus. SE: hypokalemia, metabolica alkalosis, hyponatremia, hyperglycemia, hyperlipidemia, hyperuricemia (gout), hypercalcemia. sulfa allergy, hypomagnesemia hyperGLUC: glucose, lipidemia (hyper), ureic acid, calcium.

Question 425

loop diuretics MOA USE SE

Answer 425

MOA: -l NaK 2Cl resorption in thick ascending loop of henle, abolishes hypertonicity of medulla ->cannot concentrate urine. Ca loss (loops lose calcium) USE:HTN, edematous states (CHF, nephrotic syndrome ect.), hypercalcemia SE: ototoxic, hypokalemia, dehydration, sulfa allergy, nephritis, gout

Question 426

pth independent hypercalcemia

Answer 426

top: malignancy, exogenous vit D, extra-renal Vit D conversion (sarcoid) also: drugs (HCTZ), vit A toxicity

Question 427

mccune-albright

Answer 427

sporatic mutation G protein triad: precocious puberty, large cafe-au-lait spots, bone defects (polyostotic fibrous dysplasia) *assoc with endocrine disorders (hyperthyroidism, prolactin/GH secreteing adenomas, adrenal hypercortisolism)

Question 428

peutz-jeghers syndrome

Answer 428

AD | -multiple nonmalignant hamartomas in GI tract, hyperpigmented mouth/lips/hands/genitalisa, increased risk CRC

Question 429

precocious puberty

Answer 429

girls is before 8, boys before 9

Question 430

finasteride

Answer 430

5alpha reductase inhibitor | *used in BPH and androgenic alopecia (male pattern baldness)

Question 431

hematochezia

Answer 431

bright red blood per rectum

Question 432

edema, elevated JVP, kussmaul sign (increase or lack of decrease JVP on inspiration), clear lung sounds

Answer 432

right heart failure | -pericarditis, PE, COPD, PAH, ILD, AMI

Question 433

normal 24hr protein excretions

Answer 433

less than .150g, usually 40-80mg

Question 434

splitting normal fixed split paradoxical

Answer 434

normal:S1-S2, with A2 -> P2, widened with inspiration fixed: ASD wide split: A2 ->-> P2 wider, 2/2 PAH/RBBB paradoxical: P2->A2, shortened with inspiration, 2/2 aortic stenosis/LBBB

Question 435

constrictive pericarditis

Answer 435

idiopathic, viral, surgery, radiation, Tb s/s fatigue, dyspnea on exertion, kussmaul's sign, pericardial knock (on diastole), pulsus paradoxus, increased JVP, peripheral edema xray: pericardial calcifications EKG: nonspecific, low voltage, afib JVP tracing, prominant x/y descents

Question 436

orthostatic hypotension

Answer 436

5min supine -> standing, test within 2-5min | + if 20sys or 10 diastolic drop

Question 437

type and screen

Answer 437

- type ABO and Rh(D) - screen for clinicall significant antibodies (indirect coombs with your serum and well characterized antigens) - match (indirect coombs) with your serum and chosen pRBC * all stepts done for all blood transfusions * *more complicated than that, but is essentially the structure

Question 438

EBV complications

Answer 438

- Morbilliform Rash (measles like) after admin of ampicillin/PCN - Oral Hairy Leukoplakia, premalignant, heavily assoc with HIV infection/immunodeficiency. - splenic rupture (not infarction) avoid contact sport x1mo - lymphproliferative disorders (such as Burkitt.cmyc dysregulation) - nasopharyngeal carcinoma - hepatitis, jaundice - guillane barre - IgM COLD Agglutinin anti-i: hemolytic anemia, thrombocytopenia (also occurs with mycoplasma pneumoniae, anti-l)

Question 439

Rosacea tx

Answer 439

- avoid triggers (alcohol, sun, spicy food...) - metronidazole for papulopustular type - laser or bromonidine, an alpha 2 agonist

Question 440

Asthma Tx steps

Answer 440

1) Intermittent= daytime symptoms/inhaler use 2- days/wk, normal PFT 2) Mild Persistent: symptoms 3+ days/wk, nighttime awakening 3-4/month, normal PFT 3) Moderate Persistent: Daily symptoms, weekly awakenings, FEV1 60-80% 4) Severe Persistent: symptoms throughout day, frequent nighttime awakening, FEV under 60% 1) B2-agonist-> 2) add low dose inhaled steroid -> 3) add LABA -> 4) replace with high-dose inhaled steroid -> 4+) add systemic steroid (prednisone)

Question 441

eczema herpeticum

Answer 441

superinfection of HSV on areas of severe eczema, +-fever

Question 442

erysipilas or cellulitis with systemic signs (aka fever)

Answer 442

treat with parenteral therapy erysipelas: ceftriaxone cellulitis: clinda... vanco...

Question 443

rotavirus vaccine

Answer 443

routine, rotavirus being the most common cause of gastroenteritis in young children worldwide. contraindicated with: SCID, hx intussusception, uncorrected Meckels diverticulum (or other predisposing congenital abdominal anomolies)

Question 444

COPD exacerbation management

Answer 444

- ALWAYS bronchodilators and systemic glucocorticoids - Antibiotics if 2+: increased cough, dyspnea, sputum production (volume/color) - oseltamivir if s/s influenza - NPPV (if use this, use Abx) - Mechanical vent possible, if so use Abx too - not recommended to collect sputum Abx to cover common pathogens (H. Flu, moraxella, strep pneumoniae) =macrolide (azithro), quinolone (levo), pcn/Blactamase (amox/clav) for 3-7 days

Question 445

Alarm symptoms for upper GI endoscopy

Answer 445

Age over 55 (not really alarm, but should probably do endoscopy anyways) -dysphagia, early satiety, weight loss, gross/occult bleeding, anemia, persistent vomiting **if household exposure or high prevalence area -> test H. Pylori

Question 446

lyme disease tx

Answer 446

doxycycline or amoxicillin

Question 447

kehr sign

Answer 447

pain in shoulder from blood/irritantatants irritating the diaphragm. On left => ruptured spleen, right => cholecystitis

Question 448

Edrophonium

Answer 448

Short acting acetylcholinesterase inhibitor. Can dx Myasthenia Gravis. Can differentiate MG with Lambert Eaton Myasthenic Syndrome (LEMS) because in that disease the antibodies are to the presynaptic Ca channels, preventing ACh release, thus there is no ACh to break down, ie. edrophonium cannot stop what's not happening *LEMS most commonly associated with Small cell carcinoma of lung

Question 449

Myasthenia Gravis tx of choice

Answer 449

* Pyridostigmine -> + steroid/azathioprine/mycophenolate/cyclosporine * Thymectomy if thymoma present, less clear if not present. Improvement occurs over years * IVIG in Myasthenic REspiratory Crisis * neostigmine is available but not widely used

Question 450

dyspepsia definition

Answer 450

1+ of any - postprandial fullness - early satiety - epigastric pain/burning

Question 451

can you get to BID PPI before endoscopy?

Answer 451

yes

Question 452

blood transfusion goal if remain hemodynamically stable

Answer 452

7-8g/dL * if symptoms or ischemia -> 10+g/dL * *may reassess as early as 15min after transfusion

Question 453

scrotal sac transillumination

Answer 453

hydrocele (from tunica vaginalis) transilluminates well as it is just fluid without much stuff in it -hematocele, mass, hernia, varicocele... do NOT transilluminate

Question 454

Bordetella Pertussis

Answer 454

100 day cough, whoop, post-tussive vomiting | tx: macrolides

Question 455

diarrhea derangements | vomiting derangements

Answer 455

diarrhea metabolic acidosis (loss Bicarb), usually normal anion gap -hyponatremia -hypokalemia vomiting - metabolic alkalosis (HCl) - hypochloridemia - hypokalemia anion gap: NA-(Cl+BicarB)

Question 456

acute stress disorder

Answer 456

is a panic disorder that only lasts less than 1 month (flashbacks, avoidance, hyperarouasal ect.)

Question 457

insomnia disorder

Answer 457

impaired sleep 3+ nights/wk, for 3+months

Question 458

A1C goal

Answer 458

young/healthy: 7% or less | Older (50+ish)/comorbidities: 8% or less

Question 459

fat embolism time frame

Answer 459

typicall delayed 12-72hrs | -respiratory distress/hypoxemia, AMS, petechial rash

Question 460

bladder injury trauma

Answer 460

most common extraperitoneal: bladder neck | Only intraperitoneal: bladder dome (prone to rupture if full and receives significant blunt pressures)

Question 461

HIV post-exposure prophylaxis

Answer 461

Triple therapy: two NRTI + another Standard: Tenofovir-emtricitabine + raltegravir (integrase inhibitor) Duration: 4 weeks -recheck serum at 6wk, 3mo, 6mo

Question 462

conversion vs somatic symptom disorder

Answer 462

conversion is neurologic symptoms motor/sensory, assoc w/stress somatic is excessive anxiety about unexplained symptoms

Question 463

rivastigmine

Answer 463

aka exelon MOA: cholinesterase inhibitor USE: Alzheimers

Question 464

memantine

Answer 464

MOA: NMDA antagonist USE: moderate-severe alzheimers

Question 465

presby word root

Answer 465

"old"

Question 466

hidradenitis suppurativa

Answer 466

aka acne inversa follicopilosebaceous unit blockage -> keratinocytes cannot shed -> inflammed/irritated/infected. Common in intertriginous areas. often chronic/relapsing. Risk smoking, DM, obesity.

Question 467

furuncle | carbuncle

Answer 467

``` furuncle= boil = small skin abscess of hair follicle carbuncle = coalesced furuncles ```

Question 468

intertrigo

Answer 468

candida superficial infection. often in intertrigienous areas.

Question 469

infant supplementation

Answer 469

Vitamin D immediately 400/day | Iron at 4mo until sufficient meat consumption

Question 470

infant benefits from breastfeeding

Answer 470

improved immunity, better gI function | specifcially: gastroenteritis, otitis media, UTI, resp illness, decreased risk cancer and DM1

Question 471

chlorthalidone

Answer 471

the thiazide diuretic that outperformed ACE and CCB in ALLHAT trial. but whatever... = ACCOMPLISH

Question 472

efavirenz

Answer 472

NNRTI for HIV

Question 473

tx hep C

Answer 473

pegylated IFN and ribavirin *telaprevir added to above if genotype 1 Hep C

Question 474

Hep B tx

Answer 474

INDICATION - clinical cirrhosis and high HBV DNA - Liver failure - prevent reactivation if immunosuppressed/chemo - w/o cirrhosis but ALT over 2x normal, HBV DNA above 20,000, +HBeAg Drug: 1st line Tenofovir

Question 475

USE dependent cardiac drugs - Class 1 (Na channel) - class 4 = CCB (nondihydropyridines)

Answer 475

- Esp class 1C, if tachycardic, slow dissociation of drug from Na channel -> widening QRS - --> Flecainide & propafenone CCB (verapamil or diltiazem): prolong AV node refractory period --> increased PR interval

Question 476

schizoid personality disorder

Answer 476

enjoy being alone, has no need for interaction -contrast to avoidant/social anxiety = fear of abandonment/rejection -

Question 477

schizotypal

Answer 477

eccentric, odd thoughts/behavior

Question 478

GGT and alk phos in liver disease 2/2 etoh

Answer 478

GGT high, alk phos low... normally they correlate well but not in this case ferritin is also high in alc liver disease... dunno y

Question 479

terbutaline

Answer 479

B2 agonist, asthma and tocolyitic

Question 480

mild and lethal form osteogenesis imperfecta

Answer 480

OI 1 is mild, OI 2 is fatal | *usually AD genetics

Question 481

laryngotracheitis

Answer 481

= croup | most common: parainfluenza virus

Question 482

Polycythemia Vera mutation

Answer 482

JAK2 labs: (EPO will be low), ESR low, often leukocytosis, thrombocytosis

Question 483

BCR:ABL

Answer 483

CML labs: severe leukocytosis , often anemia tx: imatinib (tyrosine kinase inhib)

Question 484

long acting injectable antipsychotics

Answer 484

Typical: haldol, fluphenazine atypical: risperidone, olanzapine, aripiprazole, paliperidone

Question 485

quetiapine

Answer 485

aka seroqeul MOAL atypical antipsychotic USE: schizophrenia, bipolar, depression..

Question 486

chiari I and II

Answer 486

I: tonsils + syringomyelia II: cerebellar vermis and usually myelomeningocele

Question 487

Serum osm calculation

Answer 487

serum osm= Nax2 + Gluc/18 + BUN/2.8

Question 488

envelope shaped calcium oxide crystals

Answer 488

ethylene glycol poisoning

Question 489

hemiballismus

Answer 489

classically from contralateral subthalamic lesion, in actuallity has many lesion causes

Question 490

AFP increased? | Decreased?

Answer 490

increased: neural tube defects, ventral defects (omphalocele/gastroschisis), multiple gestations Decreased: aneuploidies (trisomy 18, 21...)

Question 491

cystic fibrosis mutation

Answer 491

Aut Recessive | delta-F508

Question 492

Trisomy 21 and 18 labs

Answer 492

21: increased BHCG, inhibin A - low estrtiol, AFP 18: increased nothing low: BHCG, estriol normal: inhibin A

Question 493

compartment syndrome

Answer 493

5 P's ``` pallor paresthesia pulseless pain pressure ``` *nerve palsy is not common

Question 494

Brutons x linked agammaglobulinemia

Answer 494

sinopulmonary infections & GI infections

Question 495

CH50 test

Answer 495

for complement deficiencies (aka neisseria infections)

Question 496

CGD

Answer 496

infections with catalase +, staph and aspergillus, serratia... dx: tetrozolium blue ordihydrorhodamine

Question 497

acute glaucoma tx

Answer 497

mannitol osmotic diuretic, azetazolamide decrease aquous production, timolol (topical) decrease aqueous production, pilocarpine (topical) muscarinic alkaloid **AVOID anticholinergics~!!!

Question 498

pyridium

Answer 498

phenazopyridine | -urine analgesic