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STEP 2 > UW11 > Flashcards

UW11 Flashcards

1
Q

What is the best tx for Phyllodes tumor of breast?

A

Wide local excision; these are large polylobated tumors that look histologically like a fibroadenoma but can be benign or malignant

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1
Q

What is the gold standard to diagnose nephrotic syndrome

A

24 hour urine collection showing > 5 g of protein; note this is just to dx the nephrotic syndrome not the underlying etiology

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2
Q

How do you tx magnesium sulfate toxicity?

A

Calcium gluconate (i.e. decreased DTR or resp. depression, pulm edema)

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3
Q

What are 3 common risk factors for chorioamnionitis?

A

Nulliparity, Prolonged labor, multiple digital exams

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3
Q

What are 2 renal diseases lithium can be assoc with?

A

Nephrogenic DI; Membranous nephropathy (Tx is steroids and if severe, cyclophosphamide)

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3
Q

What is the issue with smoking when you have CML?

A

Increases risk of developing blast crisis

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3
Q

How do you tx Type I RTA

A

Potassium citrate and sodium bicarbonate (recall, assoc. with SLE and other autoimmune phenomena)

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4
Q

What is the MC complication of an interscalene nerve block?

A

Blocking the phrenic nerve which can lead to respiratory distress though more likely due to phrenic nerve block than ptx still check CXR

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5
Q

How do you tx mild comedonal acne?

A

Benzoyl peroxide and if that fails then topical retinoids

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6
Q

How do you tx severe PCP PNA? What are the indications (3)

A

IV TMP-SMX and steroids; PaO2 35

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6
Q

If you have a positive Thompson test and wish to confirm the dx what do you do? What is the tx?

A

MRI (achilles tendon rupture); long leg cast in plantarflexion for 6 weeks

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6
Q

Where is proper endotracheal tube placement in an adult?

A

4 cm above the carina

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6
Q

What is a major AE of the oral hypoglycemics that can cause weight loss

A

i.e. GLP-1 agonists cause pancreatitis

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6
Q

When is an annual low dose CT recommended for lung CA screening

A

pts 55-80 with a 30 pack year smoking Hx who are currently smoking or who have quit in the last 15 years

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7
Q

How do you tx acute bleeding in Hemophilia A?

A

Cryoprecipitate

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7
Q

What dz has the pencil in cup deformity of PIP and DIP

A

Psoriatic arthritis also look for pitting of nails

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7
Q

What is Heyde’s syndrome?

A

Angiodysplasia of the colon with Aortic Stenosis and CKD

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7
Q

What if the HIV viral load in a woman in labor is >1000

A

That is an indication for c section

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7
Q

What is the best mgmt of ACL tear?

A

PT to strengthen quads then surgery

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8
Q

Which ovarian tumors is inhibin the marker for? LDH?

A

Granulosa cell; Dysgerminoma

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9
Q

What is the first line nonpharmacologic tx of OA? Pharmacologic?

A

Exercise and weight loss; Acetaminophen

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11
Q

How do you tx pityriasis rosea? What else should you rule out

A

No tx it is self-limiting; check RPR or VDRL to rule out secondary syphilis

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12
Q

What if you have a microcytic anemia refractory to iron therapy in a mediterranean pt?

A

Likely thalassemia

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14
Q

What if a pt with meningococcal meningitis refuses tx

A

You can hospitalize them against their will bc it is highly communicable dz

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14
Q

What do Burton’s lines in the gums suggest?

A

Lead poisoning

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14
Q

Who gets erythrasma?

A

i.e. corynebacterium minitussiumum and it is normal skin flora that complicates DM and IC pts

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15
Q

What is the MC cause of hypertrophic osteoarthropathy

A

Adenocarcinomas of the lung

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15
Q

What is the main concern in a pt who is developing Erythema multiforme?

A

That it will progress to SJS or TEN

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15
Q

Describe Stage 0 through Stage 4 breast CA

A

0 = no ca, I = tumor less than 2 cm II a = tumor less than 2 cm with 1-3 nodes, II b = tumor 2-5 cm no nodes, III =more than 2 cm with nodes IV = distant mets

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17
Q

What is chordee? Assoc?

A

Ventral curvature of the penis, assoc. with hypospadias

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18
Q

How do you look for sperm after rape?

A

Saline prep for sperm is done and often check with a Wood’s lamp? YOU DO THIS EVEN IF THE WOMAN HAS SHOWERED

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19
Q

How do you tx Kaposi sarcoma?

A

HAART

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21
Q

What is the classic EKG finding assoc with hypothermia?

A

J wave (Osborn wave)

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22
Q

What does erythrasma look like on Wood’s lamp? What is the bug? G stain? Tx?

A

Coral red; Corynebacterium minitussimum; Gram positive club shaped rod, erythromycin

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22
Q

What CN is usually responsible for poor suckle response in a neonate?

A

CN XII

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24
Q

How do you tx chancroid?

A

Ceftriaxone

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24
Q

What are the empiric abx tx for NEONATAL meningitis?

A

Ampicillin and gentamicin

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24
Q

What is the most sensitive and specific test for ANY myasthenia gravis?

A

Single Fiber EMG

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24
Q

What is the MOA of topiramate (used for migraine ppx)

A

Inhibits voltage gated Na channels

25
Q

What is a major differentiator in the hx of a pt with preseptal cellulitis vs. orbital cellulitis?

A

Orbital cellulitis often has diplopia (MC predisposing factor is bacterial sinusitis)

26
Q

What are the indications for steroids in addition to tmp smx for PCP pna?

A

PaO2 35

28
Q

What is the separation of the nail from the nail bed?

A

Onycholysis

28
Q

What is the preferred tx for hypocalcemia

A

IV calcium gluconate by SLOW INFUSION

29
Q

How do you deal with a misplaced central line? i.e. ended up in the subclavian

A

Place a new one and then after confirming placement of the new one, retrieve the old one

30
Q

What anti-inflammatory meds should be avoided in Crohns dz? Why? What serum abs are often positive in Crohn’s?

A

NSAIDs can induce flares; Anti-Saccharomyces cerevisiae abs

31
Q

What end tidal CO2 on waveform capnography indicates that a pt coding is receiving adequate resuscitations? What indicates return of spontaneous circulation?

A

10-25 mmHg indicates adequate resuscitation; 35-40 indicates ROSC

32
Q

Why would a pt whose mother took DES while pregnant have repeated abortions?

A

There is an increased risk of cervical incompetence as well as vaginal adenocarcinoma

33
Q

What if a CT scan of solitary pulmonary nodule has high risk features?

A

Do surgery, skip the bronchoscopy

35
Q

What are the earliest vasooclusive crises to present in sickle cell? How do you prevent?

A

Dactylitis (Swelling of hands and feet); Hydroxyurea

37
Q

In what position does a post-dural puncture headache get better? What is the most effective tx?

A

When lying down (these are from accidental puncture of the dural membrane); Epidural blood patch

38
Q

What dz is assoc with seropositivity for anti-saccharomyces cereviseae abs

A

Crohn’s dz

39
Q

What is the most likely cause of bloody vaginal discharge in a newborn

A

Circulating maternal estrogens, same deal if a newborn boy has little breast buds

41
Q

Is glucosuria a normal finding in pregnancy?

A

Yes assuming glucose levels are normal, if they are elevated though you want to suspect GDM

43
Q

Define Fever of Unknown Origin

A

T > 101 on several occasions greater than 3 weeks in duration with failure to reach a dx despite 1 week of inhospital tx

45
Q

How do you tx heavy acute uterine bleeding?

A

High dose estrogen

46
Q

Name 3 extrahepatic sequelae of hcv

A

Mixed essential cryoglobulinemia; Porphyria cutanea tarda; and membranoproliferative glomerulonephritis

46
Q

What is a normal Q angle? What does a Q angle greater than this suggest?

A

14-17, if greater than 17 think genu valgum

47
Q

After a pt with a primary relative is screened initially for colon CA how often should they be re-screened?

A

i.e.. Dad had CA at 50 then initial screening of son is at 40 and then EVERY FIVE years rather than q10

49
Q

How do you tx critical aortic coarctation?

A

i.e. presents early in life with cardiogenic shock and radiofemoral delay, give PGE1 to keep the ductus arteriosus open

50
Q

What 3 drugs can be given for CAP in outpt setting?

A

macrolide, doxycycline, or quinolone

50
Q

What is Sever’s dz? Tx?

A

Osteochondritis at the insertion of the achilles on the calcaneal tuberosity in skeletally immature pts; conservative tx preferred

51
Q

Where does sympathetic innervation to the lower extremities come from?

A

T11-L2

52
Q

Why is there increased risk of Alzheimers in downs?

A

APP is on chromosome 21, they get a 3rd helping

54
Q

How do you treat Lyme meningitis?

A

IV ceftriaxone

56
Q

How can you tx hypotension in the setting of PE? What should you NOT give?

A

Inotropes; do NOT give fluids as it can worsen RV strain

57
Q

What effect can hypothyroidism have on the voice?

A

Hoarseness

58
Q

What is the adult TBSA for burns i.e. 1) Head 2) Arm 3) Leg 4) Trunk

A

1) Head is 9% as opposed to 18% in kids 2) Each arm is 9% just like kid 3) Each leg is 18% unlike 14% in kids 4) and the trunk is 36% with 18% anterior and 18% posterior same deal in kids

60
Q

How do you tx DT’s refractory to lorazepam? What is the next best step in a pt with status epilepticus refractory to lorazepam?

A

Barbiturates like phenobarbital; Fosphenytoin? Note the difference in pathology of DT vs status epilepticus

62
Q

How can you tell the difference between prolactinoma and antipsychotic induced hyperprolactinemia based on prolactin levels

A

Prolactin levels in prolactinoma are usually > 200 whereas antipsychotic levels are usually far lower

64
Q

What is Neer’s test used for

A

Rotator cuff pathology

66
Q

What is the TBSA for a little kid in a burn for 1) Head 2) Arm 3) Leg and 4) trunk

A

1 )Head is 18% (as opposed to 9 for adult) 2) arm is 9% just like adult 3) leg is 14% as opposed to 18 in adult and 4) trunk is 36% like in adult with 18% ant and 18% post

68
Q

5 cancers with psammoma bodies

A

Papillary thyroid CA, Meningioma, Mesothelioma, Endometrial CA, and serous cystadenocarcinoma

69
Q

What is the deal with the timing of prenatal visits?

A

Monthly until 28 weeks, biweekly until 35 weeks then weekly until birth

70
Q

Chronic NSAID abuse can lead to which RTA?

A

Type IV i.e. aldosterone def.

71
Q

What is the MOA of the drug that tx’s the dyskinesia of Huntington’s chorea?

A

VMAT-2 inhibitor the drug is tetrabenazine

72
Q

What is the best mgmt of acute aortic regurgitation?

A

Afterload reducers such as hydralazine and ACE-I

73
Q

How do you manage hemodynamic instability in a pt with penetrating abdominal wound

A

Immediate laparotomy

74
Q

What is the thompson test?

A

When you squeeze the calf and if no plantarflexion it indicates a positive test and a ruptured achilles tendon

75
Q

What is the best way to confirm a dx of carpal tunnel

A

EMG with nerve conduction study

77
Q

What HLA is DM I assoc with?

A

HLA DR3 and DR4

79
Q

What is a common cause of PID after insertion of IUD?

A

Actinomyces israelii, tx is PCN G ive also seen ampicillin

81
Q

What effect does scurvy have on coags and platelets

A

All normal

82
Q

What is TACO how do you tx?

A

Transfusion Associated Circulatory Overload; Furosemide

83
Q

What should you think in pt with advanced bone age, coarse axillary and pubic hair with severe cystic acne? Screening test? Confirm? Tx?

A

Non-Classical CAH due to partial 21 hydroxylase def; 17-OH-P, Cosyntropin stimulation test; Replace glucocorticoids and give fludricortisone

84
Q

In which dz will you see Pappenheimer bodies?

A

Sideroblastic anemia

85
Q

How do you tx a first eclamptic seizure? Recurrent?

A

Magnesium Sulfate; add diazepam

86
Q

What is a likely cause of low pleural LDH effusion in a pt with ascites?

A

Hepatic Hydrothorax; a transudative effusion that occurs due to the hypoalbuminemic state of cirrhosis

87
Q

What is the most common cause of folliculitis? What is the MC cause of hot tob folliculitis?

A

S. aureus; P. aeruginosa

88
Q

How do you tx black widow spider bites?

A

Antivenom

89
Q

What is the acute tx of nonsevere PCP pna?

A

IV TMP-SMX

90
Q

How much does each unit of PRBC increase Hgb by? What about Hct?

A

1 g; 3% recall that hct is essentially 3 times the hgb

91
Q

Formication is most strongly assoc with overdose on what drug?

A

Cocaine (cocaine bugs)

92
Q

What is the MC nerve injured during thyroidectomy? What muscle is paralyzed? How do you confirm the dx?

A

Recurrent laryngeal nerve; posterior cricoarytenoid; Fiberoptic laryngoscopy

93
Q

What clinical test can elucidate the cause of vasovagal syncope in unclear cases?

A

Upright Tilt Table Testing

94
Q

Why would a pt with aortic dissection have LE paraplegia?

A

Spinal ischemia due to occlusion of artery of Adamkiewicz

96
Q

What is the least radiosensitive tissue in the body?

A

Bone

97
Q

What is the difference between onycholysis and onychorrhexis?

A

Onycholysis is splitting of nail from nail bed; onychorhexis is splitting the nail itself

STEP 2 (13 decks)

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