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Step 2 CK z > UW mix 2 > Flashcards

UW mix 2 Flashcards

1
Q

Acute headache, nausea, blurry vision, sluggish and dilated pupil, and conjunctival injection

A

Acute angle closure glaucoma! Emergency, can cause permanent optic nerve damage in hours

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2
Q

Triggers for acute angle closure glaucoma?

A

Decongestants, antiemetics, anticholinergics (including trihexyphenyl used for the tremor in parkinson’s)

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3
Q

Parkinson’s treatments

A

Levodopa (DA precursor), pramipexole (DA agonist), and entacapone (increases DA stimulation), and selegiline (MAOI b)

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4
Q

7 year old girl, precocious puberty, ovarian mass -

A

Granulosa cell tumor - malignant, estrogen - secreting tumor.

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5
Q

Rule of 2’s

A

For Meckel’s diverticulum - 2% prevalence, 2% symptomatic at age 2, 2:1 male to female ratio, within 2 feet of the ileocecal valve

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6
Q

How to diagnose Meckel’s

A

Technicium 99 scan - with patient with painless hematochezia

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7
Q

Fancy names for disturbances in cerebellar lesions

A

Dysdiadochokinesia - difficulty w/ rapid alternating movements
Dysmetria - past-pointing on finger-to-nose testing
Limb ataxia
Intention tremor

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8
Q

Dextromethorphan - uses, mechanism, SEs

A

Cough suppressant, NMDA antagonist, can cause dissociation

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9
Q

Ptosis, down and out gaze, diplopia, and normal pupillary response? Cause? Common etiology? What if had no pupillary dilation to light?

A 
Ischemic oculomotor (CNIII) nerve palsy, usually from diabetes causing ischemic neuropathy
- If also pupillary response gone - involves inner and outer (parasympathetic) fibers of CNIII nerve - would be lacunar infarct
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10
Q

Poison Ivy - what type of hypersensitivity reaction?

A

Type IV (IVy!) - delayed, T-cell mediated response. Requires previous exposure. Like contact dermatitis.

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11
Q

Name 4 types of hypersensitivities?

A

Type I: immediate, IgE mediated
Type II: cytotoxic, IgG and IgM
Type III: immune complex deposition (PSGN, SLE)
Type IV: delayed, T cell mediated

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12
Q

DeQuervain tenosynovitis - classic population and findings

A

New mothers that hold babies with thumbs up. Pain at radial/dorsal base of thumb

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13
Q

Pure motor hemiparesis, sudden onset - most likely?

A

Lacunar stroke - no cortical signs (aphasia, agnosia, ataxia, etc). Maybe in BG or internal capsule

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14
Q

internal carotid artery problem like dissection - sx

A

maybe neck pain, thunderclap headache, sx of ischemic stroke (hemiparesis, facial droop, aphasia).
Can be from orofacial trauma)

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15
Q

When to not use amitriptyline?

A

Patients >65 due to anticholinergic effects; also pt with pre-existing cardiac disease due to conduction abnormalities exacerbated

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16
Q

Erythema nodosum - what to look for?

A

Could be idiopathic. BUT always check for systemic things - TB, sarcoid, strep, coccidiodomycosis, IBD and Behcet

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17
Q

Wallenberg syndrome - site of infarct; artery involved; symptoms

A

Infarct - lateral medullary infarct
Artery - occlusion of posterior inferior cerebellar or vertebral artery
Symptoms - loss of pain and temp ipsilateral face and contralateral body; ipsi bulbar weakness, vestibulocerebellar impairment (vertigo, nystagmus), and Horner’s syndrome.
Motor - normal

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18
Q

First versus second line in BPH

A

1: alpha 1 blockers (terazosin, tamsulosin) - rapid response, relax bladder neck and prostate smooth muscle
2: 5 alpha reductase inhibitors - take 6-12 mo to work, inhibit conversion of T to dihydroT, reduces prostate size

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19
Q

Hard signs of vascular trauma; what to do about it

A

Signs: observed pulsatile bleeding, expanding hematoma, or signs of distal ischemia (cold limb, no pulses)
Do: urgent exploration (dont’ wait for imaging)

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20
Q

Main substrates for gluconeogenesis

A

alanine, lactate - these get converted to pyruvate

also glutamine and glycerol-3-phosphate involved

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21
Q

Fatigue, constipation, nephrolithiasis — think of?

A

Hypercalcemia - suggestive of hyperparathyroidism. Can also have pseudogout with CPPD - calcium pyrophoshate crystals. Rhomboids, positively birefringent. On joint x ray can see chondrocalcinosis in joint spaces.

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22
Q

hypoplastic fingers and nails + cleft lip + concern for bleeding at birth

A

Fetal hydantoin syndrome. Pregnant women on phenytoin. In final trimester, get vitamin K to prevent neonatal bleeding, since phenytoin increases rate of fetal vit K degradation

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23
Q

morning vomiting, nocturnal headaches - concern for?

A

Intracranial pathology

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24
Q

poor feeding, irritability, head circumference %ile increasing, decreased activity, vomiting

A

Hydrocephalus - see tense and bulging fontanelle, prominent scalp veins, wide sutures

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25
Q

Temporal pattern of paralysis in stroke

A

Start with flaccid paralysis. Eventually turns to spastic.

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26
Q

What are the extrapyramidal signs?

A

rigidity, bradykinesia, tremor, and chorea. lesions of subcortical nuclei like BG.

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27
Q

impaired abduction at the shoulder w/ pain and after falling on outstretched hand. And what if you do a drop arm test, and half way down, their arm falls?

A

rotator cuff tear! usually supraspinatus.

Drop arm test, and arm falls: complete supraspinatus tendon tear

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28
Q

inability to do extreme shoulder abduction

A

serratus anterior / long thoracic nerve, winged scapula problem. From penetrating trauma or chest tube insertion, etc

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29
Q

Transverse myelitis - when do you see it, and what does it look like?

A

In MS - see motor and sensory loss below lesion level, including bowel and bladder. First flaccid paralysis, then spastic.

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30
Q

Internuclear ophthalmoplegia

A

In MS (if bilateral) - demyelination of medial longitudinal fasciculus - cannot adduct affected eye, and contralateral eye abducts with nystagmus (says ‘come on!’ to the other eye)

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31
Q

Treatments for idiopathic intracranial hypertension (And other name)

A

Pseudotumor cerebri -
Acetazolamide (inhibits choroid plexus carbonic anhydrase, so makes less CSF)
Repeated LPs (short term only)
VP shunt + optic nerve sheath decompression

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32
Q

What is multiple system atrophy?

A

Shy Drager syndrome:

  1. Parkinonism (rigidity, bradykinesia)
  2. Autonomic dysfunction (orthostasis), incontinence, impotence, etc
  3. Widespread neuro sx (Cerebellar, LMN, etc)
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33
Q

Horner syndrome

A

Regional autonomic dysfunction - anhydrosis, miosis, and ptosis

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34
Q

Guillain barre - sx? muscles? reflexes? tx?

A

ascending polyradiculoneuropathy. Ascending flaccid paralysis, sometimes paresthesias. Weak or absent DTRs. Autonomic dysfunction, too.
Albuminocytologic dissociation
Tx: IVIG or plasmapheresis

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35
Q

Dementia with Lewy Body disease - sx

A

Visual hallucinations
Spontaneous parkinsonism - resting tremor, muscle rigidity (severe sensitivity to dopamine antagonists/antipsychotics)
Fluctuating cognition

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36
Q

Normal pressure hydrocephalus

A

ataxia early in disease
urinary incontinence
dilated ventricles

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37
Q

Frontotemporal dementia

A

early personality changes, apathy, disinhibition, compulsive behaviors

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38
Q

Name this syndrome: hypotension, pigmentation, hyponatremia, hyperkalemia, eosinophilia, high ACTH, low serum cortisol

A

primary adrenal insufficiency!

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39
Q

focal bone pain + elevated alk phos? - oh, and has a new hearing aid, and headaches

A

Paget’s disease! also look for hearing loss or enlargement of cranial bones
- from osteoclast dysfunction, increased bone turnover!

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40
Q

risk factors for brain abscess

A

cyanotic heart diseases, R to L shunts (bacteria bypasses pulmonary circulation, where a lot of macrophages live); recurrent sinusitis;

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41
Q

Brain abscess triad

A

fever, headache (nocturnal or morning), and focal neuro deficits

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42
Q

what do you do with a solid testicular mass?

A

Remove first, assess for cancer later. I.e. just radical orchiectemy

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43
Q

Pattern in essential tremor?

Parkinson’s tremor?

A

Essential - occurs during activity

Parkinson’s tremor - occurs at rest, better with activity - most common presentation is asymmetric, distal extremity

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44
Q

Open angle glaucoma - eye exam? sx? tx?

A

cupping of optic disk; loss peripheral vision; beta blocker drops like timolol

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45
Q

Nerve responsible for facial motor activity? Facial sensation?

A

VII facial nerve - motor (upper and lower face = lower CN VII lesion, below the pons) - will also see inability to close the eye) —- vs central lesion = forehead spared (since above eyebrows has bilateral upper motor neuron innervation and would be spared)
SENSATION = CN V, trigeminal

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46
Q

Menierre’s disease

A

increased volume or pressure of endolymph
- recurrent episodes >20 min, sensorineural hearing loss, tinnitus, fullness in ear
TX = restrict sodium, caffeine, nicotine, alcohol. Consider diuretic.

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47
Q

High fever; then rash (maculopapular) as the fever abates

A

Roseola (no vesicles

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48
Q

monocular vision loss in 60 yo; also has unilateral headache, jaw claudication - what test to get? then what?

A

Concern for Giant Cell Arteritis. Get ESR. Then get biopsy.
May also have polymyalgia rheumatica, fever, fatigue, etc

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49
Q

woman <50 yo with monocular vision loss, pain with eye movement - think of? how will pupils be?

A

Concern for optic neuritis (in woman with MS) - often with afferent pupillary defect, and optic disk swelling

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50
Q

enzyme mutated in galactosemia?

A

galactose 1 phosphate uridyl transferase deficiency!

Sx: FTT, bilateral cataracts, jaundice, and hypoglycemia

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51
Q

galactokinase deficiency =/= what condition

A

galactosemia. The kinase deficiency gets cataracts only, no other sx

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52
Q

main acid base disorder in diarrhea?

A

Metabolic ACIDosis - loss of organic anions and bicarbonate. Get hyponatremia and hypokalemia

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53
Q

xray and microscopy findings in pseudogout? What about in Gout?

A

xray - chondrocalcinosis - calcification of cartilage in joint space
micro - rhomboid pos biref crystals

GOUT - punched out erosions with rim of cortical bone; needle shaped neg biref crystals

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54
Q

where is broca’s area? supplied by what artery? associated physical sx?

A

dominant FRONTAL lobe - middle cerebral artery. Dominant cortex for verbal and written language function
- usually w/ right hemiparesis of face and UE

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55
Q

Where is Wernicke’s area? Sx? Associated physical sx? Artery involved?

A

dominant temporal lobe (receptive aphasia).
right superior visual field defect
Dominant (left) MCA - also get UPPER limb neuro deficits
(vs R MCA gets hemineglect)

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56
Q

Something to do for young woman with heavy vaginal bleeding, dysfunctional uterine bleeding from irregular/infrequent menstrual cycles?

A

high dose oral contraceptives (or IV estrogen). D&C + transfusion only if hemodynamically unstable

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57
Q

lab to check to confirm menopause?

A

FSH. Probably also get TSH to rule out hypothyroid

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58
Q

preferred imaging for presumed ureteral stone?

A

US, or CT WITHOUT contrast

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59
Q

main risk factor for endometrial cancer?

A

unopposed estrogen! (early menarche, no pregnancies, no OCPs, obesity)

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60
Q

name 2 aminoglycosides

A

tobramycin, gentamicin, amikacin, streptomycin, neomycin

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61
Q

notable missing feature in a lacunar stroke?

A

absence of cortical signs! (aphasia, agnosia, neglect, apraxia, seizure)
- do see pure motor or sensory stroke,, ataxic hemiparesis, etc

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62
Q

what can cause spinal stenosis? = neurogenic claudication = pseudoclaudication

A

congenital, degenerative disk disease, degenerative arthritis (spondylosis)

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63
Q

by what age should kids be walking?

A

17-18 months

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64
Q

Postpartum fever lasting >24 hrs is most likely?

A

postpartum endometritis ; it’s polymicrobial, so give clindamycin + gentamicin

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65
Q

Most likely area of pure sensory stroke

A

posterolateral thalamus! can have post stroke, deep thalamic pain syndrome

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66
Q

TImecourse for gestational diabetes? Preeclampsia?

A

Onset after 20 weeks gestation -

Preeclampsia is onset >20 weeks + proteinuria or end organ damage

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67
Q

Fever >5 days + what other symptoms = kawasako

A

4 of: conjunctivitis; mucositis (strawberry tongue, injected lips), cervical lymphadenopathy; rash (erythematous generalized or morbilliform); erythema of hands and feet

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68
Q

fever, sandpaper rash sparing palms/soles, and pharyngeal exudate?

A

scarlet fever in poorly treated strep throat

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69
Q

how to treat sarcoidosis when symptomatic?

A

(cough, dyspnea, chest pain, hypercalcemia with lithiasis, constitutional)
- use glucocorticoids

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70
Q

parvovirus b19 infection in older adult - main symptoms?

A

arthritis / arthralgia, symmetric = may mimic RA **(polyarticular and symmetric; hands, feet, wrists)

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71
Q

flushing, diarrhea, + bronchospasm - what syndrome? what primary site?

A

carcinoid syndrome. GI tract malignancy (small intestine)

- carcinoid cells make serotonin from tryptophan, which uses up your niacin

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72
Q

VIPoma syndrome = where is primary tumor site?

A

(pancreatic cholera) = diffuse watery diarrhea, muscle weakness (hypokalemia), and hypochlorhydria; also flushing
- primary tumor in pancreatic tail

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73
Q

Syndrome during gastrinoma?

A

Zollinger-Ellison syndrome; multiple gastric ulcers and dyspepsia (tumor is in pancreas)

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74
Q

PID treatment

A

ceftriaxone + azithromycin

can see pelvic sx and maybe RUQ liver from Fitz hugh curtis

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75
Q

Dry vs wet beri beri

A

Dry = symmetrical peripheral neuropathy w/ motor + sensory often
Wet = same plus cardiac involvement (myopathy, CHF, edema, etc)
- Thiamine deficiency

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76
Q

recently had URI, now with palpable purpura (lower extremity), arthritis/arthralgia, abd pain, renal disease/hematuria (+/- scrotal swelling)

A

HSP Henoch Schonlein purpura (immune mediated small vessel vasculitis)
- watch for IgA-like nephropathy; intussuception

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77
Q

antibody to post synaptic acetylcholine receptor

A

myasthenia gravis - fluctuating mm weakness worse w more use. Can have diplopia, ptosis. Proximal muscle weakness, normal reflexes.

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78
Q

antibody to presynaptic voltage gated calcium channel

A

Lambert Eaton = paraneoplastic = proximal mm weakness, dimished DTRs; autonomic dsfnx (dry mouth), ptosis

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79
Q

weight gain + proximal muscle weakness + HTN + agitation/insomnia/psych + hyperglycemia = syndrome. What other associated syndrome in women?
How to test?

A

Cushing syndrome (=hypercortisolism from steroids or from ACTH from tumor or adrenal)
Also see easy bruisability, dermal atrophy, striae
Some hyperandrogen in women
Test: late night salivary cortisol OR 24hr free cortisol OR overnight low-dose dexamethasone suppression test

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80
Q

female athlete triad, running a lot more lately, now has tenderness to palpation in foot

A

stress fracture!

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81
Q

first and final treatments for pituitary prolactinoma?

A

Med: bromocriptine or cabergoline (DA agonists)
Surgical: last, only if large and sx

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82
Q

old lady with visual flashers, floaters, and curtain of darkness coming down?

A

retinal detachment

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83
Q

most common cause nephrotic syndrome in kids? what to do about it?

A

minimal change disease (T cell mediated podocyte injury)- give prednisone

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84
Q

ptosis that improves with 2 minutes of ice pack on eyes?

A

Myasthenia gravis (cold inhibits breakdown of Ach) - antibody mediated degredation of Ach receptors

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85
Q

postpartum - now with seizure, coma, and hyponatremia - what med caused it?

A

oxytocin toxicity! cause low sodium, HTN

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86
Q

Magnesium toxicity

A

hyporeflexia, lethargy, headache, respiratory failure, cardiac arrest (everythign including reflexes SLOWS DOWN)

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87
Q

acute onset focal neurologic sx; followed by nausea, vomiting, headache, confusion? - cause?

A

acute stroke! Probably from hypertensive intracerebral hemorrhage, then increased ICP

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88
Q

inflammatory arthritis + splenomegaly + neutropenia +/- skin lesions

A

Felty syndrome! Long standing rheumatoid arthritis (10+ yrs)- then get severe joint disease, rheumatoid nodules, vasculitis with mononeuritis multiplex, necrotizing skin lesions
- the neutropenia is important here.

bonus - labs = anti-CCP and RF, very high ESR

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89
Q

headache, bilateral periorbital edema and bilateral CN 3,4,5 and 6 nerve deficits

A

(infectious) cavernous sinus thrombsis

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90
Q

when do you see anti-scl-70 (topoisomerase 1) and anti-RNA pol III?

A

diffuse cutaneous scleroderma / systemic sclerosis

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91
Q

adnexal mass with lack of doppler flow?

A

ovarian torsion! needs emergent surgery

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92
Q

most common primary immune deficiency ? what happens when they get blood transfusion?

A

Selective IgA deficiency. Can have severe reaction to transfusion (pt has anti- IgA antibodies!)

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93
Q

food borne illness, early onset (few hours) having nausea and vomiting - type of pathogen?

A

think staph aureus, pre-formed toxin. In dairy products (mayo in potato salad).
Also bacillus cereus if fast onset but from starch product

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94
Q

short stature + aortic coarctation makes you think…

A

Turner syndrome (estrogen deficient, risk of osteoporosis)

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95
Q

subclinical hypothyroid + miscarriages; name the dx and antibody involved

A

chronic Hashimoto’s thyroiditis

antithyroid peroxidase and antithyroglobulin antibodies

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96
Q

can’t see can’t pee can’t climb a tree

A

reactive arthritis but its usually chlamydia (vs in younger kids it’s often a diarrheal illness like salmonella)

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97
Q

thyroid stimulating immunoglobulins; disease; antibody name

A

Graves disease = hyperthyroid

Antibody: TSH receptor antibody

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98
Q

what nerve gets injured by anterior shoulder dislocation?

A

axillary nerve - innervates deltoid and teres minor; get weak shoulder abduction

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99
Q

deep axillary laceration / lymph node dissection may cause what nerve problem?

A

long thoracic injury, innervates serratus anterior - causes winged scapula

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100
Q

most common nephrotic syndrome in adults?

A

FSGS (localized mesangial sclerosis and BM changes)

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101
Q

subacute thyroiditis - other name? tx?

A

de quervain thyroiditis, post-viral, painful and hyperthyroid, high ESR and CRP
Tx: betablockers for thyrotoxic sx and NSAID for pain

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102
Q

CHARGE syndrome

A

Coloboma, Heart defect, Atresia (choanal), Retardation of growth, Genitourinary, and Ear problems)

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103
Q

triad: hemolytic anemia, thrombocytopenia, AKI

A

Hemolytic uremic syndrome HUS, from EHEC or Shigella with bloody diarrhea, e.g.. But 10% had strep pneumo

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104
Q

unopposed estrogen places pt at increased risk of what malignancy?

A

endometrial hyperplasia and cancer

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105
Q

immediate anaphylactic response to blood transfusion?

A

recipient probably has no IgA, and thus has anti-IgA antibodies.

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106
Q

Which 4 vaccines you cannot give in pregnancy

A

HPV, MMR, live attenuated flu (nasal), and varicella

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107
Q

most common extracranial solid tumor in childhood? urine markers?

A

Neuroblastoma - see urine HVA and VMA

Neural crest as precursor to sympathetic chain and adrenal medulla (tumors can be here)

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108
Q

signs of increased ICP and also focal neuro deficits

A

intracranial tumor! not just stroke

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109
Q

FTT + normal anion gap acidosis; urine alkalotic

A

Renal tubular acidosis! (inability to excrete H+ or to reabsorb bicarb)

110
Q

Man with AIDS has blurred vision, floaters; funduscopy has fluffy yellow lesions along vasculature

A

CMV retinitis

111
Q

tremor of hands with action, better after alcohol

A

essential tremor

112
Q

resting tremor that decreases with movement

A

parkinson’s

113
Q

alcoholic hallucinosis

A

occurs between 12-36 hrs after drinking; hallucinations with stable vitals

114
Q

neonate with sensorineural hearing loss, cardiac defect (PDA), and cataracts

A

congenital rubella syndrome (in 1st trimester exposure)

115
Q

eczema or ulcer on breast, by nipple, itching and burning - concerning for what?

A

Paget’s disease of breast - often adenocarcinoma (since it’s the most common type of breast cancer overall) - due to cancer blocking lymph drainage, inflammatory breast disease

116
Q

signs of complicated small bowel obstruction (when do you need to operate)?

A

change in character of pain; new fever, hemodynamic instability, guarding, leukocytosis, metabolic acidosis

117
Q

recurrent skin and mucosal bacterial infections (no purulence), severe periodontal disease? kiddo?

A

Leukocyte adhesion defect! Delayed umbilical separation. Low leukocytes (leukocytosis with lots of PMNs)

118
Q

what immune deficiency gets recurrent sinupulmonary and GI infections? low b cell? oh, and they have low Ig levels?

A

x linked agammaglobulinemia - bruton’s. defective B cell maturation.

119
Q

what bacteria are involved in chronic granulomatous disease?

A

catalase + organisms - staph aureus, serratia, burkholderia.
Impaired respiratory burst for intracellular killing in phagocytes.

120
Q

baby with retinal hemorrhage?

A

almost pathognomonic for abusive head trauma. shaken baby. can have shearing of subdural veins causing subdural bleed, large head, and seizures

121
Q

what if you have thyroid nodule with high calcitonin - what are you concerned about? what associated findings shoudl you look for?

A

get biopsy - see medullary thyroid cancer
Concern for MEN1 and MEN2 - look for pheo (plasma metanephrines) (and consider RET mutation testing) - if found, pheo should be removed prior to thyroid!

122
Q

some causes of idiopathic intracranial hypertension?

A

young obese women; growth hormone; tetracyclines (Doxy, mino), excess vitamin A (Retinoids)

123
Q

diagnose a patient with RA - they’re already taking ibuprofen. What do you do?

A

Start a DMARD like methotrexate! Always, early. Prevent future joint damage.

  • before starting a DMARD (including biologic) test for TB, hep B and hep C
  • step up therapy (after 6 months if not improved) - biologic
124
Q

most common cause of corneal blindness in US?

A

HSV infection of the eye. Painful. Can cause retinitis and vision loss, too. With keratitis and conjunctivitis, too.
(vs CMV is painless)

125
Q

macrocytosis in SCD patient?

A

Probably a folate deficiency - used up in compensation for anemia

126
Q

24 hour old neonate, hasn’t passed meconium, signs of obstruction; CF in family; what to do

A

KUB to rule out obstruction. Concern for meconiium ileus - nearly pathognomonic for cystic fybrosis. Get contrast enema to break it up (and also to visualize). Could also show Hirschprung’s.

127
Q

risk factors for cervical cancer

A

HPV, smoking, early sexual activity, OCPs, immunosuppression

128
Q

main concern for untreated hyperthyroidism?

A

rapid bone loss, osteoporosis

129
Q

old person, shoulder and hip pain, stiffness in morning for 1 hr; some systemic things - fatigue; high ESR/CRP - this is? what to do?

A

polymyalgia rheumatica. Give glucocorticoids/steroids!

Normal physical exam - no decreased ROM or focal inflammation.

130
Q

name upper motor neuron signs

A

spasticity, bulbar symptoms, hyperreflexia

131
Q

name lower motor neuron signs

A

fasciculations; atrophy; flaccid paralysis

132
Q

recurrent UTI in young girl? young boy? (anatomic only, not social)

A

girl - vesicoureteral reflux

boy - posterior urethral valve(s) - only in boys!

133
Q

patient with down syndrome presenting with unknown upper motor neuron signs

A

concern for atlantoaxial instability

- hyperreflexia, + babinski, dizziness, diplopia, vertigo, behavioral change, torticollis

134
Q

how to differentiate lichen sclerosis from atrophic vaginitis from estrogen deficiency

A

lichen sclerosis spares the vagina; atrophy will show decreased vaginal rugae

135
Q

hyperpigmentation of palmar creases, dehydration, hypotension

A

Addison’s - primary adrenal insufficiency, hypocortisolism - hyponatremia, thus hyperkalemia

136
Q

glucose 6 phosphatase deficiency (=/= G6PD deficiency!)

A

can’t convert glycogen to glucose, get lots of glycogen, present at 3-4 months, hypoglycemia and seizure

137
Q

after which antibiotic should you warn patients of a disulfiram like reaction?

A

metronidazole

138
Q

hypercalcemia, and you already know PTH is low. How does phosphate help you?

A

if low phosphate, probably had high PTHrP

if high phosphate with high calcium, probably from high vitamin D problem (like in sarcoid)

139
Q

most common cancer in kids?

A

ALL

140
Q

what syndrome has “failure of follicle maturation” and infertility?

A

PCOS

141
Q

triad: encephalopathy, ocular dysfunction, gait ataxia

A

Wernicke encephalopathy - chronic thiamine (b1) deficiency

bilateral abducens palsy, horizontal nystagmus

142
Q

recurrent respiratory and GI infections, no response to vaccines? tx?

A

CVID - impaired B cell diff, hypogammaglobulinemia

Tx: IVIG

143
Q

CD19 =? CD3 =?

what if you’re low on T cells and also have low IgG?

A

CD19 is B cells
CD3 is T cells
low on both is SCID - needs stem cell transplant

144
Q

major toxicity of azathioprine?

A

dose-related diarrhea, leukopenia, and hepatotoxicity

145
Q

major toxicity of mycophenolate?

A

bone Marrow suppression

146
Q

cyclosporine toxicity?

How does tacrolimus toxicity differ?

A

cyclosporine: nephrotoxic, hyperkalemia, HTN, gum hypertrophy, hirsutism, tremor
Tacrolimus: all of above EXCEPT no hirsutism or gum hypertrophy

147
Q

third world country, crowded, eye redness, follicular conjunctivitis?

A

trachoma - chlamydia trachomatis serotypes A,B,C - can cause scarring. Leading cause of blindness worldwide.

148
Q

recurrent pulmonary abscesses, cutaneous abscesses with organism filled PMNs? what is it? how to test?

A

CGD chronic granulomatous disease - failure of oxidative burst (catalase + organisms, X linked dz)
Test PMN function for oxidative burst - use dihydrorhodamine 123 or nitroblue tetrazolium test)

149
Q

test to determine total complement concentration?

A

CH50

150
Q

rapid onset angioedema, without urticaria

A

hereditary angioedema

deficiency of C1 inhibitor - get high C2b and bradykinin

151
Q

Pontine vs thalamic stroke?

Basal ganglia? (IC or putamen)

A

Pons has Pinpoint reactive pupils + deep coma. Not good.
Thalamus has eyes deviating Toward hemiparesis
Basal ganglia - contralateral hemiparesis and sensory loss, conjugate gaze deviation Toward lesion

152
Q

short stature, primary amenorrhea, and no thelarche?

A

concern for turner syndrome - XO - premature ovarian failure - so low E, but high LH and FSH trying to turn it on

153
Q

most common organisms in brain abscess (not immunosuppressed)?

A

staph aureus, viridans group strep

from direct extension of sinus infection, get ring enhancing lesion

154
Q

three categories causing wernicke’s encephalopathy?

A

chronic alcoholism
chronic malnutrition (anorexia)
hyperemesis gravidarum

155
Q

medication interaction risk with sildenafil or other PDE5 inhibitors?

A

hypotension combined with alpha blockers like doxazosin

also with nitrates - severe hypotension

156
Q

signs of trigeminal neuralgia, but bilateral

A

concern for MS

157
Q

what cranial nerves go through cavernous sinus?

A

III, IV, V (V1 and V2) and VI

158
Q

what other things are in HELLP aside from its name?

A

severe variant of preeclampsia - n/v, headache; liver swelling, capsule distended - abdominal pain
HTN with signs of hemolysis
with preeclampsia, generalized arterial spasm - high afterload - concern for pulmonary edema

159
Q

costochondral joint hypertrophy (rachitic rosary) + genu varum + large anterior fontanelle + craniotabes (soft skull)

A

concern for rickets, vitamin D or calcium deficiency

160
Q

patient started on carbidopa/levodopa
early side effects?
late?

A

early - hallucinations, agitation, drowsiness

late - involuntary movements (after years)

161
Q

lateral epicondylitis - common name? 2/2 overuse of what action?

A

tennis elbow. overuse of wrist extension.

On exam, reproduced by straight elbow with flexion of wrist

162
Q

how is QT in HYPERcalcemia?

A

short QT

163
Q

appears septic (hypotensive, tachycardic), febrile, diffuse macular rash on body and palms and soles

A

Toxic shock syndrome! tampon use, recent surgery

Bacteria (like staph aureus) have pre-formed toxins

164
Q

kid has prolonged QT - what to do?

A

beta blocker + pacemaker

165
Q

most likely adverse effect of having benign intracranial hypertension (see papilledema)?

A

blindness. Try weight loss, acetazolamide. Then may need shunting or optic nerve sheath fenestration to prevent blindness.

166
Q

first and second line tx for enuresis in kiddo?

A

1: desmopressin
2: tricyclics (imipramine) just as effective, more SEs

167
Q

hemorrhagic stroke / intracerebral bleed in a patient on warfarin? what to do?

A

reverse the warfarin urgently - okay to use PCC / Kcentra and vitamin K (Takes too long)

168
Q

infant with meningococcemia, has sudden vasomotor collapse, hypotension… has skin rash with large purpuritic lesions on flank… what happened?

A

adrenal hemorrhage - Waterhouse Friderichsen syndrome. Almost 100% mortality.

169
Q

contents of most common morning after pill

A

levonorgestrel. can use ulapristal

170
Q

breast cancer risk factors - modifiable

A

alcohol, nulliparity, hormone replacement therapy (bad), older age at first birth

171
Q

when to check BRCA?

A

relative with breast cancer <50 or any ovarian cancer dx

172
Q

what birth control thing shouldn’t be given to a woman with migraines with aura?

A

estrogen containing OCPs

173
Q

when to give corticosteroids with woman in early labor? what about magnesium sulfate?

A

steroids - before 37 (definitely if before 34 weeks) weeks, to reduce prematurity related m/m
Magnesium - before 32 weeks to reduce risk of cerebral palsy

174
Q

arrest of labor - when is it, and what to do

A

no cervical change for 4 hours with adequate contractions, or 6 hours without - need C section

175
Q

Rh - mother without antibodies - when to consider giving anti-D immune globulin (Rhogam)?

A

At 28-32 weeks gestation, and again within 72 hours of delivery if baby is Rh+

176
Q

what to do about placenta previa?

A

pelvic rest (no sex, digital cervical exam; needs c section at 36-37 weeks)

177
Q

metabolic acidosis, dehydration, polyuria, LOC, and diffuse abdominal pain.. is? recently had an infection?
what happens to urine solute levels?
total body potassium?

A

DKA, even in undiagnosed T1DM
urine solutes increase (osmotic diuresis, glucose, ketones)
Total body potassium is DOWN (net renal loss), but shifted extracellular due to acidemia and decreased insulin activity

178
Q

infant, episodic abdominal pain, currant jelly stool, lethargy - what is it? what to do?

A

intussusception

get ultrasound-guided air contrast enema

179
Q

EBV/mono - pharynx? lymphadenopathy?
What about gonococcal pharyngitis?
Strep throat - adenopathy?

A

EBV has exudative pharyngitis with TENDER lymphadenopathy cervical
GC pharynx with some edema, no exudate, and NONtender adenopathy - but likely to have PID symptoms
Strep - TENDER adenopathy

180
Q

what does estrogen replacement therapy do for TBG / thyroxine binding globulin?

A

increase TBG levels - thus will have lower thyroid levels, and need higher dose of thyroxine

181
Q

what can trigger crisis in pheochromocytoma?

A

surgical procedure, anesthetic agent, intra-abdominal pressure; nonselective beta blockers cause state of unopposed alpha - cause vasoconstriction and paradoxical hypertension

182
Q

when do you see antithyroid peroxidase antibodies?

A

autoimmune / hashimoto thyroiditis, with palpable goiter, clinical hypothyroidism (sometimes transient hyperthyroid first)

183
Q

new LBBB - what to be concerned of?

A

STEMI

184
Q

Leads V1-V4?
II, III, aVF?
I, aVR, V6?

A

V1-V4 is LAD, LV
II, III, aVF is RCA, inferior
I aVR and V4-V6 is left circumflex

185
Q

T2DM on metformin, A1c still high - what to add? what if they also want weight loss? what A1c would you add insulin?

A

sulfonylurea usually.
try GLP1 agonist like exenatide if want weight loss
add insulin >8.5, but may cause weight gain

186
Q

large genital ulcers, deep, with severe lymphadenopathy that may suppurate - will there be pain? what is it?

A

chancroid - haemophilus ducreyi

painful

187
Q

nevus flammeus (port wine stain, very red area, flat, usually since birth) - associated with what?

A

Sturge Weber syndrome, also get seizures. Congenital unilateral cavernous sinus hemangioma - get hemianopia, hemiparesis, etc. And intracranial calcifications.

188
Q

axillary freckles and lisch nodules (on iris) in a kiddo?

A

Neurofibromatosis 1 - may get neurofibromas, even in brain

189
Q

one week old, blotchy erythematous papules, move around, asymptomatic

A

erythema toxicum neonatorum - just supportive cares

190
Q

CGG’ trinucleotide repeats plus macroorchidism - called? what else do you see?

A

fragile X - most common genetic MR

191
Q

thrombocytopenia (with low MPV) in young male?

A

likely wiscott aldrich (cytoskeleton problem in both platelets and white cells, impaired cellular migration)

  • – X linked recessive, eczema, recurrent infections
  • – Tx: stem cell transplant
192
Q

CD40 ligand mutation - can’t do what? causes?

A

T cells can’t induce B cell class switching - all stay IgM - hyper IgM syndrome

193
Q

cherry red macula, loss of developmental milestones - main two things on differential?

A
  • –Neimann Pick disease - also has areflexia and hepatosplenomegaly - sphingomyelinase deficiency
  • –Tay Sach’s - hyperreflexia - b-hexosaminidase A deficiency

(both more in Ashkenazi Jew’s - think of Sarah Neimann, she was jewish and had Red food dye allergy) - and didn’t work out much, so was hypotonic

194
Q

treatment for catatonia, even in a patient already with bipolar on antipsychotics?

A

benzodiazepine like lorazepam! even try ECT

- caution, antipsychotics can worsen it!

195
Q

SSRI + what drug of abuse at a party can lead to serotonin syndrome?

A

Ecstasy

196
Q

antipsychotics causing the most weight gain?

A

olanzapine, clozapine

197
Q

on antipsychotic, now has amenorrhea - guess the drug

A

risperidone, causing hyperprolactinemia (or paliperidone)

198
Q

new onset psychiatric symptoms and neuro abnormalities, also abdominal pain- concern for? (has a family history of same)

A

acute intermittent porphyria (GI + neuro)

199
Q

dysphoria, yawning, myalgia, abdominal cramping? drug abuse hx?

A

opioid withdrawal

- see mydriasis (dilated), lacrimation, increased bowel sounds, piloerection

200
Q

polyarthralgia, tenosynovitis, and painless vesicular/pustular rash ?

A

disseminated gonococcal arthritis

201
Q

patient being treated for RA, now has oral ulcers = why?

A

methotrexate toxicity (GI sx, oral ulcers, hepatotoxicity, BM suppression, rash) - try adding folic acid

202
Q

hypertension + hypokalemia = concern for? how to differentiate?

A

hyperaldosteronism! check renin and aldosterone levels
High renin activity: secondary hyperaldo -
Low renin: primary hyperaldosteronism (either adrenal hyperplasia or adrenal adenoma). Also mild hypernatremia, metabolic alkalosis

203
Q

ACE inhibitor effect on K? Creatinine?

A

Increase K
Increase Cr
due to decreased GFR

204
Q

should you combine niacin with a statin? what if someone has super super high triglycerides?

A

No. (Not for reducing trigs) Doesn’t add any benefit, and have more GI side effects.
= if needed, use fibrate, most effective, only if super severe

205
Q

asian woman, <40 yo, has arm pain/claudication, fatigue, and weight loss?

A

Takayasu arteritis - inflammation of large vessels, aorta = arterioocclusive symptoms

206
Q

gangrene of digits, superficial thrombophlebitis, in an old guy who is a smoker?

A

Thromboangiitis obliterans - Buerger disease

207
Q

don’t forget about multifocal atrial tachycardia

normal or not?

A

3 or more distinct looking p waves

not a good sign

208
Q

how to treat WPW? what not to use

A

procainamide

DON”T USE - AV nodal blockers like adenosine, digoxin, CCBs (verapamil and diltiazem), beta blockers

209
Q

electrolyte stuff causing torsades?

A

low K, low Mg; Li or tricyclic overdose

210
Q

other things associated with peaked T waves?

A

hyperkalemia -

widened QRS, short QT, prolonged PR

211
Q

low voltage EKG + undulating things, pulsus paradoxus

A

electrical alternans - worry about cardiac tamponade; distant heart sounds

212
Q

conus medullaris vs cauda equina syndrome? vs spinal cord?

A

Conus - symmetric motor weakness, hyperreflexia (UMN lesion), back pain
Cauda equina - asymmetric weakness, hyporeflexia, severe radicular pain

213
Q

most common cause of vitreous hemorrhage?

A

diabetes (sudden vision loss, floaters, red glowing fundus)

214
Q

kiddo with strabismus of left eye (left moves in when R is covered) - what to do?

A

Left is lazy - patch the GOOD eye! (or blur out the good eye)

215
Q

old person with DIP joint involvement

A

Probably OA (not RA) even if PIP and DIP both involved.

216
Q

which antibiotic class causes ototoxicity? what about isolated vistibulotoxicity?

A

aminoglycosides (amikacin, gentamicin, tobra, etc)

- for vestibulotoxicity, specifically think of gentamicin

217
Q

14-3-3 protein?

A

Creutzfeldt Jakob, prion disease

218
Q

hyperthyroidism + low TSH - what to check next?

A

thyroid radioiodine scintigraphy

low I uptake suggests release of preformed thyroid hormone, not chronic new production

219
Q

name 4 things in hereditary hemochromatosis?

A

hyperpigmentation, diabetes, joint spaces (arthritis, arthralgia, chondrocalcinosis), cirrhosis, restricted cardiomyopathy
(iron goes to skin, pancreas, joints, muscles, heart, liver)
(a secondary cause of pseudogout!)

220
Q

what is surveillance bias

A

exposed group has more surveillance - more likely to pick something up

221
Q

acute rheumatic fever follows what?

A

UNtreated strep pharyngitis

222
Q

fever, urticaria, and polyarthralgia - no mucosal involvement. 1-2 weeks after treatment with beta lactams, penicillin/amoxicillin, or bactrim

A

serum sickness - type III immune complex hypersensitivity

223
Q

symptoms of mono - treated, now have morbilliform rash on trunk. what happened?

A

were treated with amoxicillin!

224
Q

proximal muscle weakness + red/purplish rash over dorsum of fingers (Gottron’s sign)

A

dermatomyositis - but can also be a paraneoplastic syndrome - still get heliotrope rash

225
Q

Patient has afib with HFrEF - new onset fatigue, memory loss, constipation, weight gain, dry skin — what happened? syndrome? med that caused this?

A

signs of hypothyroidism

  • in this patient, look to amiodarone-induced hypothyroidism
  • AMIO also causes chronic interstitial pneumonitis, blue/grey skin, heart block, and elevated transaminases, and eye problems
226
Q

Patient is on amiodarone therapy - what things should you monitor (SEs)?

A

LFTs (hepatitis), TSH (hypothyroid)

  • low threshold for CXR for pulmonary sx
  • low threshold for ophtho
227
Q

signs of a stroke, more pronounced in LOWER than upper limbs? maybe some urinary incontinence?

A

anterior cerebral artery (ACA) stroke

because lacunar infarcts equally impact upper and lower.. full side, since BG is so small

228
Q

what do loop diuretics do to calcium?

A

loops lose calcium (thiazides save it)

229
Q

treatment for psoriasis? what not to give?

A

DON”T use systemic steroids

OK to use PUVA, methotrexate, NSAIDs for arthritis

230
Q

patient has several tiny waxy papules, central umbilication - what’s the likely cause - and what to go looking for?

A

poxvirus causing molluscum contagiosum - but watch out for HIV

231
Q

which of the dermatophyte infections requires ORAL treatment?

A

tinea capitis needs systemic antifungal

232
Q

neurologic consequence of prolonged seizure?

A

excitatory neurotoxicity - cortical laminar necrosis

233
Q

niacin deficiency ?

A

dermatitis, diarrhea, and dementia (pellagra) with glossitis, angular stomatitis

234
Q

Polymyositis - SIGNS?

A

proximal muscle weakness, elevated CK, autoantibodies (ANA, anti-Jo); muscle biopsy with endomyosial infiltrate

vs ESR and CRP more elevated in polymyalgia rheumatica (with stiffness)

235
Q

carpal tunnel - which nerve involved?

A

MEDIAN nerve - can also get thenar weakness

236
Q

foodborne botulinum - what to do?

A

equine hepatavalent botulinum antitoxin.
- improperly canned foods; cured fish
- onset within 36 hrs of eating
Bilateral cranial neuropathies, facial weakness, symmetric DESCENDING weakness

237
Q

bone pain, history of malabsorption, muscle cramps or weakness. Concave vertebral bodies and pseudofractures of long bones

A

Osteomalacia - low vitamin D! (thus low Ca and low Phos - reflexively high PTH)

238
Q

most common cause hypothyroidism?

A

chronic lymphocytic thyroiditis - Hashimoto’s

239
Q

chronic alcohol and smoker, now with wide based gait, impaired heel to shin, normal finger to nose, poor coordination

A

alcoholic cerebellar degeneration - Tx: stop drinking! to stop disease progression

240
Q

most common cause sub arachnoid hemorrhage without trauma?

A

ruptured berry aneurysm

241
Q

name a BP med that wastes potassium? one that increases K?

A

thiazides lose K, cause hypokalemia

ACE inhibitors cause hyperkalemia

242
Q

hyperpigmentation - why? what was cortisol doing?

A

cortisol deficiency causes ACTH production in response, and this shares cosecretion with melanocyte stimulating hormone
- will NOT see this in exogenous glucocorticoid suppression of ACTH (steroid induced adrenal insuff)

243
Q

main side effect of hydroxychloroquine?

A

retinopathy

244
Q

pronator drift downward suggests?

A

pyramidal tract lesions

245
Q

lab findings with dermatomyositis?

A

high CPK, aldolase and LDH

anti-RNP, anti-Jo, anti Mi2

246
Q

MEN1 has what 3 P’s?

A

Pituitary adenoma
Primary hyperParathyroidism (90% of patients, have hypercalcemia)
Pancreatic/GI tumors like gastrinoma, cause Zollinger Ellison

247
Q

asymmetric POLYarthralgia?

A

gonoccoccal septic arthritis (usually w/ tenosynovitis and dermatitis)
vs nongonococcal usually single joint
(also consider rheumatic fever, a transient migratory arthritis of large joints)

248
Q

enlargement of hands and feet (old person), coarsening of facial features, pharyngeal crowding - what is this? what happens to heart? what hormone is up?

A

Acromegaly
Heart - concetric hypertrophy, diastolic dysfunction
GH increases liver production of IGF-1

249
Q

asymmetric thickening of IV septum is?

A

hypertrophic cardiomyopathy (HOCM)

250
Q

why (proximal) muscle weakness in hypercortisolism (Cushing’s - either ACTH tumor/ectopic or primary adrenal dz)?

A

direct catabolic effect on muscles - get muscle atrophy

251
Q

migratory, non-deforming arthritis, malabsorptive diarrhea, small intestine biopsy with PAS (periodic acid schiff) + macrophages - this is?

A

Whipple disease - tropheryma whippelii, g+ bacillusx

252
Q

when to consider tPA in acute stroke?

A

within 4.5 hours of onset, and only after noncontrast CT shows no bleed

253
Q

liver disease (even if mild) + some neuropsych things, even tremor, rigidity, paranoia, depression, catatonia, or drooling)

A

Wilson’s disease

254
Q

medullary thyroid, marfanoid, pheo, and mucosal neuromas

A

MEN2B

255
Q

superficial infantile hemangioma vs cherry angioma vs nevus simplex

A

superficial hemangioma - benign, appear in first few weeks, grow, then regress on own
Cherry angioma - benign, in adults, more palpable
Nevus simplex - cherry red port wine stain, usually nape of neck, blanchable

256
Q

CVID vs bruton’s agammaglobulinemia

A

CVID has normal B cell count, but low IGG/Ms,

Bruton’s has low B cells, also low IGs

257
Q

Tx acute dystonia? akathisia?

A

Dystonia - benztropine or diphenhydramine

Akathisia - B blocker or benzo

258
Q

Tx drug induced parkinsonism? TD?

A

Parkinsonism - benztropine or amantadine

TD- maybe switch to clozapine?

259
Q

anti-smooth muscle antibodies?

A

autoimmune hepatitis

260
Q

name 2 DMARDs that can cause stomatitis?

A

oral ulcers

- methotrexate, sulfasalazine

261
Q

patient has hyperkalemia (e.g. presumed from crush injury) and needs intubation - what med to not use for paralysis? what can you use?

A

Don’t use succinylcholine (depolarizing neuromuscular blocker)
Can use nondepolarizing - like rocuronium and vecuronium

262
Q

several years post accident - now has loss of pain/temperature sensation of arms, as well as muscle weakness?

A

syringomyelia

263
Q

name an infectious cause of nasopharyngeal carcinoma

A

reactivation of EBV - and note that NPC is endemic in China

264
Q

what does aflatoxin 1 exposure predispose to?

A

hepatocellular carcinoma

265
Q

chronic, nonhealing wound - concern for what type of cancer?

A

SCC - Marjolin ulcer if it’s from a burn

266
Q

antipsychotic least likely to cause EPS like TD?

A

clozapine (Surprisingly)

267
Q

how long of sx before diagnosing schizophrenia?

A

6 months

1-6 is schizophreniform

268
Q

PPX in HIV:

A

<200: bactrim for PCP (and <100 bactrim for toxo)
<50: azithromycin for MAC
<150 and endemic ohio and mississippi river valey - itraconazole for histo

269
Q

symptomatic prolactinoma - what to do?

A

try DA agonist (cabergoline, bromocriptime); only if needed, surgery

270
Q

which pneumococcal vaccine for adults with chronic conditions?

A

PPSV23

Then PCV13 at 65, then PPSV23 again lafter that

271
Q

how does dobutamine work?

A

beta 1 agonist; potent inotrope, increases contractility

Step 2 CK z (5 decks)

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