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Step 2 high yield review > U world Q 3 > Flashcards

U world Q 3 Flashcards

1
Q

A chronic TIIDM comes to urgent care for unilateral painful facial swelling. The swelling is well demarcated. Pt’s temp is 100.
Most likely dx and causitive agent?

A

Erysipelas; specific type of cellulitis seen in diabetics with prominent swelling and sharply demarcated
Group A Beta hemolytic or GAS (usually Strep pyogenes)

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2
Q

A 35yoF comes to clinic with symptoms suggestive for premature ovarian failure. What would you expect to see with her FSH, LH and FSH/LH ratio?

A

FSH and LH are both increased

>1 FSH/LH ratio seen bc FSH is cleared from circulation slower

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3
Q

A 20 wk gravida 1 para 0 comes to urgent care with signs suggestive for pyelonephtritis… what test do you order ot confirm diagnosis?

A

US of kidneys and abdomen

CT is standard but contraindicated in preggers

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4
Q

Pt presents with cp and a.fib—> proceeds to lose consiousness and you cannot find pulse on exam. Still see a.fib on monitor. What do you do?

A

Pt has pulseless electrical activity; organized rhythm but not measurable pulse–> you need to start chest compressions! Get IV access and give Epi every 3-5 mins

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5
Q

When is defibrillation the therapy of choice?

A

In patients with ventricular fibrillation and pulseless VT

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6
Q

When do we provide immediate synchronized cardioversion?

A

Symptomatic or sustained monomorphic Ventricular tachycardia or hemodynically unstable pts with A.fib with RVR (as soon as pt devos PEA you start compressions)

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7
Q

Pt comes in with abnormal uterine bleeding, pain with sex, heavy menses. You suspect either adenomyosis or Leiomyomata (fibroids). How do you tell the difference?

A

Adenomyosis = endometrial glands in uterus causing smooth symmetrical enlargement
Fibriods are proliferation of smooth muscle cells causing IRREGULAR/BULKY enlargment

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8
Q

Why would you give someone Tamsulosin to help with kidney stone passage

A

its’ an alpha1 blocker; prevents spasms (therers alpha 1 receptors on the kidney ureters)

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9
Q

Which drugs are the best to treat Tourettes?

A

2nd gen antipyschotics–> risperidone or use alpha adrenergic receptor agonist (clonidine, guanfacine)

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10
Q

Dx that shows follicular conjuctivitis and pannus (neovascularization) formation in the cornea with concurrent infection in nasopharnx.

A

Trachoma; from chlamydia trachomatis

tx w/ oral azithormycin or tetracycline

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11
Q

Pt comes in with pain, photophobia and decreased vision in her eye. You see dendritic ulcers on exam.

A

Herpes simplex keratitis

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12
Q

3 days after birth baby comes into hospital with mucoid secreations. Mom has no prenatal care.

A

Gonococcal conjuctivitis– tx w/ ceftriaxone

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13
Q

pt with contrast induce ATN has FUCKED UP LABS!!! While we expect >1%FeNa and Urine Na >20mEq/L you actually see low urine sodium and high specific gravity— why?

A

bc contrast causes spasm of afferent arterial causing reabsorption of water and sodium.

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14
Q

Woman presents with hirsitism, balding and acne. PE shows clitoral enlargment. What’s the next best test?

A

Get serum testosterone and DHEAS levels; find site of excess androgen production
Elevated DHEAS with normal testosterone=Adrenal source

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15
Q

Pt comes in with renal colic. you see a 5mm stone in the right ureter and several smaller stones in both pelvices. His urine pH is 4.5 (normal 5-6) and the stone is 100% uric acid when he passes it. What do you do for treatment?

A

Hydration and alkalinze the urine! Give pt Potassium citrate if there is acidic urine with uric acid stones

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16
Q

best imaging to diagnos Acoustic Neuromas? (MEN2 syndromes)

A

MRI with gandolinium

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17
Q

What happens to serum haptoglobin, LDH and Bilirubin in intravascular hemolytic anemia like mechanical destruction or microangiopathic hemolytic anemia (DIC, HUS, TTP)

A

LDH and indirect Bilirubin will INCREASE

destruction results in increased free hemoglobin which Haptoglolbin BINDS TO thus DECREASED HAPTOGLOBIN

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18
Q

What happens to these values during PREGANCY
TSH
Free T4
Total T4

A

TSH unchanged
Free T4 unchanged
Total T4 INCREASED

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19
Q

What standard deviations do you use for 68%, 95% and 99%

A

68% lie within +/- 1 standard deviation
95% lie within +/- 2 standards
99% w/in +/-3 standards

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20
Q

MCC of PNA in community
MCC of PNA in child with CF
MCC of PNA in adult with CF

A

Strep. pneumo
Staph.Aureus in CF kiddos
Pseudomonas in CF adults

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21
Q

Criteria for SIRS

A

Temp >101.3 OR 90
RR > 20
WBC >12,000 or

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22
Q

Why do we see hypocalcemia in alcoholics?

A

Due to hypomagnesia which decrease PTH levels and increases PTH resistance

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23
Q

What type of study looks for disease prevalence?

A

Cross sectional; taken at a point in time

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24
Q

What type of study looks at disease Incidence by looking at past records?

A

Cohort study (retrospective)

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25
Q

What type of study looks at the risk factor associated with disease?

A

Case control

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26
Q

?Pt has right upper lobe infiltrate and foul smelling sputum. You suspect aspiration PNA. What do you use to tx

A

Clindamycin to cover for anerobes

also to metronidazole with amoxicillin or amox-clavulonate

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27
Q

What is the most appropriate therapy for pt with CAP that you will tx outpatient

A

Erythromycin or if suspect resistance use Doxy

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28
Q

If a pt comes in with swelling/effusion of a joint and you see chronic calcium around the cartilage- likely dx

A

Psuedogout or acute calcium phyrophostpate crystal arthritis

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29
Q

Pt presents with syncope, fatigue, wt loss and vague GI tenderness occuring for three months. Her BP is 90/65 and You notice hyperpigmentation on the palmar creases and suspect adrenal insufficiency. What do you expect to see with potassium and sodium levels?

A

HYPERkalemia from mineralcorticoid deficiency

HYPOnatremia from increased ADH release

30
Q

Pt presents with weakness in his left hand and decreased sensation on the 4th an 5th fingers. Not a smoker, doesn’t do drugs. PE shows weak grip. What’s the location of pathlogical process?

A

Ulnar nerve entrapment.

Elbow at medial epicondylar groove!

31
Q

How long are you at risk of sepsis from encapsulated bacteria after a splenectomy?

A

up to 30 years!!! even though you get the vaccine 2 weeks after or before the procedure you have big risk rest thus take oral penicillin for 3-5 yrs after treatment

32
Q

What murmur is associated with AS? What different heart sound do we end up hearing down the line as it progresses?

A

Has mid-systolic murmur in RUSB with delayed carotid pulses

Second heart sound becomes softer as it gets more severe.

33
Q

What happens to the serum calcium, serum phosphorus, alk phos and urine hydroxproline in Pagets?

A

Serum Calcium and Serum Phosphorous = Normal

Alk.Phos and Urine Hydroxyproline= Elevated

34
Q

Pt comes in with COPD exacerbation.. what do you do for management? (there are 4 things!)

A

Supplement )2 with goal of 88-92%
Inhaled bronchodialators
Systemic glucocorticoids (methpred)
Antibiotics

35
Q

What special test should women >35 have done in their newborn screening?

A

Should have cell free fetal DNA testing at 10 wks of gestation. Great for detective Downs, Edwards or Patau

36
Q

What screening is done 1st trimester for pregnant women?

A

DO pregnancy associated plasma protein, B-hCG and US with nuchal translucency.

37
Q

What screening is done in the 2nd trimester?

A

Quad screen: maternal serum alpha fetoprotein, B-hCG, unconjugated estriol and inhibin A levels

38
Q

Quad screen shows

Low AFP, Low B-hCG, low Estriol, normal inhibin A

A

Trisomy 18

39
Q

Quad screen shows

Low AFP, High B-hcG, Low Estriol, High inhibin A

A

Downs

40
Q

What is a complication to be aware of for central subclavian venous cath placement?

A

Tension pneumothorax–

rapid onset distension of neck, hypotension, tachycardia tachypnea

41
Q

Pt comes in with SOB and wts loss. CXR shows large pleural effusion. She has extensive smoking history. Whats the next most apporpriate step in management?

A

Get a thoracentesis unless it’s for sure CHF!

Any pt with undx pleural effusion needs to be tapped

42
Q

What is first line tx of ADHD

A

Atomoxetine
methylphenidate or dextroamphetamine
Alpha2 agonist–clonidine and guanfacine

43
Q

Tx for Tourettes

A

Haloperidol, Pimozide, Risperidone or meds such as clonidine adn Alpha 2 Agonists.

44
Q

Best medication for Depression + Neuropathic pain

A

Duloxetine (SNRIs)

45
Q

Patient with depression, fearful of wt gain and sexual side effects

A

Buprorion (lowers seizure threshold)

46
Q

Patients with depression, decreased sleep and decreased appetite.

A

Mirtazapine

47
Q

Atypical anti that causes diabetes, wt gain, avoid in diabetics

A

Olanzapine

48
Q

Greater incidence of movement disorders from atyipcal antipsychotics

A

Risperidone

49
Q

Lower incidence of movement disorders thus best in patients with existing movement disorders

A

Quetiapine

50
Q

Atypical that causes Increase risk of prolongation of QT interval; avoid in patients with conduction defects

A

Ziprasidone

51
Q

Atypical that has high risk of agranulocytosis and need to monitor CBC–never use as first line

A

Clozapine

52
Q

Atypical that is a parital dopamine agonist and approved as adjuvant tx in major depression

A

Aripirazole

53
Q

The only antipyschotic that is Pregancy B category

A

Lurasidone

54
Q

First line treatment for panic disorder?

First line treatment for panic attack?

A

Disorder use SSRIs

Attach use Benzos

55
Q

Treatment of choice for OCD is either SSRI or this specific TCA

A

Clomipramine

56
Q

Tx of choice for hoarding OR Body Dysmorphic

A

SSRI or CBT

57
Q

What agent do you avoid in acute angle glaucoma

A

Atropine is BAD!
Safe is timolol (B-blocker decreases aqueos humor), Pilocarpine reduces pressure via opening canals of Schlemm. Acetazolamide is carbonic anhydrase inhibotor reduce prdocution

58
Q

What SE is seen with Nevirapine

A

Nevirapine associated liver failure

59
Q

What HIV drug can lead to lactic acidosis

A

any of the NRTIs

60
Q

Crystal induced nephropathy (bloody RBCs and crystals seen in urinalysis) caused by which HIV drug

A

Indinavir

61
Q

HIV drug that induces pancreatitis

A

Didanisone

62
Q

Ingestion: pt is homeless presents with flank pain, blood in urine, tetany (hypocalcemia). HIGH anion gap metabolic acidosis with calcium oxalate crystals in urine.
OD and Tx

A

OD is Ethylene glycol

Tx: Fomepizole or ethanol to block alcohol dehydrogenase and may need hemodialysis

63
Q

Ingestion: likely alcoholic. Have AMS, blurred vision with scotomata, anion gap metabolic acidosis

A

Tx same as ethylene glyclol with fomepizole or ethanol

Methanol affects Ma eyes

64
Q

Pt brought in by EMS from a house fire. Labs show elevated Lactate >10mEq/L. What’s going on and how do you treat it

A

Cyanide poisoning

Tx Sodium thiosulfate

65
Q

PT comes in with terrible headache, nausea and vomitting. Hx HTN and hyperlipidemia. CT shows subarachnoid hemorrhage. Coil intervention is done. What complications happen
24 hrs after surgery
3 days or more after surgery

A

w/in 24 hrs subarachnoid worry about REbleed
>3 days worry about Vasospasm causing stroke like sx
–tx with Nimodipine to reduce spasms

66
Q

HIV pt comes in with AMS, you see a solitary weakly ring enhancing periventricular mass on MRI. His CSF shows EBV DNA. What is the likely dx?

A

CNS lymphoma!!!!

67
Q

HIV pt comes in with AMS. Imaging shows cortical and subcortical atrophy and secondary ventricular enlargement. Dx

A

AIDS dementia complex

68
Q

Pt with AIDS comes to clinic with multiple ring-enhancing spherical lesions throughout the basal ganglia. What is the likely dx adn what medicine could have prevented this?

A

Toxoplasmosis

Should have been on TMP-SMX

69
Q

Pt has complaints of progressive DOE, fatigue and exertional syncope–suggestive of outflow obstruction. Pt comes in with delayed and diminished carotid pulses, a single soft second heart sound and a mid-late peaking systolic murmur heard at second right intercostal space radiating to carotids. Dx?

A

Severe Aortic Stenosis

70
Q

What are secondary causes of digital clubbing? (clubbing in adult)

A

Lung malignancy, CF or Right to left shunts, NEVER from COPD

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