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UWorld 1 Flashcards

1
Q

tx: lyme dz

A

mild: doxy
severe (encephalitis/carditis): ceftriaxone
preg/lactating: amoxicillin
< 8: amoxicillin or cefuroxime

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2
Q

if test is negative, what is chance of having the dz

A

1 - NPV

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3
Q

false negative/positive ratio

A

false negative: 1 - sensitivity

false positive: 1 - specificity

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4
Q

when to use DBT

A

borderline, self injury pts

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5
Q

mgmt: preterm labor by dates

A

34 - 36.6: +/- corticosteroids (betamethasone), PCN if GBS(+)/unknown
32 - 33.6: add tocolytics (indomethacin, nifedipine)
< 32: add magnesium sulfate

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6
Q

why do you give mg sulfate for preterm labor

A

fetal neuroprotection (eg cerebral palsy)

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7
Q

delayed and diminished carotid pulse (name/a/w)

A

pulsus parvus et tardus

AS

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8
Q

prominent capillary pulsations in fingertips

A

AR (from widened pulse pressure)

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9
Q

> 10 mm Hg change in systolic with inspiration

A

pulsus paradoxus
cardiac tamponade
severe asthma/COPD

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10
Q

risks of tamoxifen

A 
hot flashes (MC)
endometrial CA
DVTs
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11
Q

tx: hypercalcemia

A

malignancy: bisphosphonates
CHF/renal fail: loops
granulomatous dz: corticosteroids

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12
Q

hypertonic newborn, feeding difficulty, spasms

A

think neonatal tetanus

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13
Q

age for febrile seizures

A

3 mo to 5 yrs

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14
Q

newborn: FTT, b/l cataracts, jaundice and hypoglycemia

A

galactosemia (galactose-1-phosphate uridyl transferase def)

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15
Q

when do you get surgery involved in c. diff

A

toxic megacolon/severe ileus
WBC > 20,000
lactate > 2.2

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16
Q

strep viridans species

A 
s. sanguinis
mitis
oralis
mutans
sobrinus
milleri
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17
Q

when to cervical cerclage

A

cervix < 2.5 cm

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18
Q

cause of zenker diverticulum

A

UES dysfxn and esophageal dysmotility

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19
Q

when do you see low and high DLCO?

A

low: emphysema, pulm fibrosis
high: asthma

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20
Q

delayed umbilical cord separation

A

leukocyte adhesion deficiency

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21
Q

baby/toddler: leukocytosis with neutrophilia

A

LAD

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22
Q

baby: tons of cat+ dz, normal leuk/B/T levels

A

chronic granulomatous dz

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23
Q

tx: RA

A

DMARDs
MTX
TNF-Is
sulfasalazine

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24
Q

AEs: MTX

A 
hepatotoxicity
stomatitis (mouth ulcers)
pancytopenia
lung fibrosis
alopecia
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25
MTX rescue
leucovorin
26
felty syndrome
severe, long standing RA | neutropenia + splenomegaly
27
therapy for phobias
exposure therapy (behavioral)
28
BUN/Cr and GI bleeds
BUN and BUN/Cr increased in upper (but not lower) GI bleeds
29
how to monitor DKA tx
serum anion gap | direct assay of beta-hydroxybutyrate (ketone)
30
mgmt: uterine inversion
``` immediate manual replacement if can't replace, try uterotonics uterotonics once it's replaced (remove placenta after it's replaced if still attached) if nothing works -- laparotomy ```
31
malaria prophylaxis for people going to India
mefloquine atovaquone-proguanil doxy
32
when to give mefloquine
2 weeks before, all during, 4 wks after
33
when can you give chloroquine
S America/caribbean
34
things that cause pain when you have sphincter of Oddi problems
fatty meals | opioids
35
catching sensation in knee
meniscal tear
36
tests for meniscal tear
Thessaly | McMurray
37
tx: strabismus
patch or blur the normal eye to make them use the bad one
38
urticaria, fever, joint pain, 1 wk post PCN or TMP-SMX
serum sickness-like reaction (type III h/s)
39
GCS things
eye opening verbal response motor response
40
GCS: eye scale
1: none 2: to pain 3: to verbal 4: spontaneous
41
GCS: verbal scale
1: none 2: incomprehensible sounds 3: inappropriate words 4: disoriented/confused 5: oriented
42
GCS: motor scale
1: none 2: extension 3: flexion 4: withdraws 5: localizes 6: obeys
43
causes of normal anion gap metabolic acidosis
``` diarrhea RTAs carbonic anhydrase inhibitors fistulas ureteral diversions ```
44
MC complication of flu
secondary bacterial pneumonia
45
MCCs post-flu pneumonia
staph aureus | strep pneumo
46
anemia of chronic disease: which arthropathies
RA SLE (not OA!)
47
Gottron's papules
violaceous, scaly papules over joints | a/w dermatomyositis
48
meniere's triad
tinnitus episodic vertigo sensorineural hearing loss
49
cause of meniere's
increased vol/P of endolymph
50
dx: CGD
abnormal oxidative burst (dihydrorhodamine)
51
greatest RF for suicide
prior attempt
52
rough, scaly, non healing ulcer by scar
squamous cell carcinoma
53
increased calcitonin
medullary thyroid cancer
54
psammoma bodies
papillary thyroid cancer
55
thyroid nodule invades tumor capsule/blood vessels
follicular thyroid cancer
56
tx: aortic dissection
labetalol, or other BB | hydralazine and nitroprusside can have reflex tachy
57
acid base in mesenteric ischemia
metabolic acidosis (from high serum lactate)
58
illness anxiety d/o vs somatic symptom d/o
fear of having a serious illness despite few/no sx and negative tests vs anxiety or preoccupation w/ 1+ sx
59
toddler milestones: ages
``` 12 mo 18 mo 2 yr 3 yr 4 yr 5 yr ```
60
toddler milestones: gross motor
``` 12 mo: stands, first steps, throws a ball 18 mo: runs, kicks ball 2 yr: stairs (2 feet), jump 3 yr: stairs, tricycle 4 yr: balance/hop on one foot 5 yr: skip, catch ball (2 hands) ```
61
toddler milestones: fine motor
``` 12 mo: pincer grasp 18 mo: 2-4 cube stack, strip 2 yr: 6 cubes, copy line 3 yr: copy circle, utensils 4 yr: copy cross 5 yr: copy square, tie shoelace, dress/bathe, letters ```
62
toddler milestones: language
``` 12 mo: 1st real words (not mama/dada) 18 mo: 10 - 25 words, 1+ body part 2 yr: 50+ words, 2 word phrases 3 yr: 75% intelligible, 3 word sentences 4 yr: colors, 100% intelligible 5 yr: count to 10, 5 word sentences ```
63
toddler milestones: soc/cog
12 mo: separation anx, follow 1 step commands 18 mo: mine, pretends 2 yr: 2 step commands, parallel play, start potty train 3 yr: knows age/gender, imaginative play 4 yr: cooperative play 5 yr: friends, potty trained
64
warning signs for HA (when to MRI)
neuro: seizure, FND, LOC changes from before/new kind new onset > 40 yo
65
ruddy baby w/ hyperglycemia, hyperbili, resp distress
neonatal polycythemia (> 65% crit)
66
causes: neonatal polycythemia
``` intrauterine hypoxia (mom w/ DM, HTN, smoker), IUGR or genetic/metabolic ```
67
electrolytes in addisons
hyponatremia, hyperkalemia (renal Na loss, no aldosterone) | hypoglycemia (no cortisol)
68
CSF: bact meningitis
WBC > 1000 glucose: < 40 protein: > 250
69
CSF: viral meningitis
WBC 100 - 1000 glucose: 40 - 70 protein < 100
70
CSF: Guillain Barre
WBC: 0 - 5 glucose: 40 - 70 protein: 45 - 1000
71
when is baby reflux pathologic?
GERD: FTT significant irritability Sandifier syndrome milk allergy: vom/eczema/bloody stool
72
baby complications of DM mom (1st TM)
congenital heart dz NTD small L colon spontaneous abortion
73
baby complications of DM mom (2/3 TM)
``` hyperinsulinemia polycythemia (up met demand --> hypoxia) organomegaly hypoglycemia brachial plexopathy, clavicle frx, perinatal asphyxia (macrosomia, shoulder dystocia) ```
74
what is an S4 from
blood entering a stiff ventricle (hypertrophy, MI)
75
erysipelas vs cellulitis
``` streg pyo vs strep or staph superficial vs deep raised vs not sharp borders vs not rapid vs slow ```
76
whats a furuncle (hint, its not a dog/family member)
folliculitis into dermis --> abscess
77
HACEK orgs
``` haemophilus aphrophilus aggregatibacter actinomysetemcomitans cardiobacterium hominis E corrodens kingella kingae ```
78
when do you have mild EtOH withdrawal (and what constitutes that?)
6 - 24 hr | anxiety, tremor, sweating, GI, palpitations
79
when can you have seizures from EtOH withdrawal
12 - 48 hrs
80
alcoholic hallucinosis vs delirium tremens
12- 48 hr vs 48 - 96 | stable vitals vs fever, tachy, HTN, AMS
81
path: trigeminal neuralgia
compression of nerve root
82
patchy, alveolar infiltrate, not restricted by anatomical borders
pulmonary contusion
83
-pulmonary contusion
tachypnea tachycardia hypoxia
84
when do you give tetanus immune globulin?
only to people who are uncertain or had < 3 toxoid doses with dirty/severe wound
85
pulm HTN criteria
mean pulm arterial P > 25 mmHg @ rest or | 30 with exercise
86
meds that cause hyperkalemia
``` non selective BB ACE/ARBs K-sparing diuretics cardiac glycosides (Digoxin) NSAIDs ```
87
livedo reticularis, with possible AKI or pancreatitis
cholesterol embolism (atheroembolism)
88
chronic giardiasis
IgA def
89
preeclampsia: baby risks
chronic uteroplacental insuff --> growth restriction/LBW | not hypoxia, which is due to acute UPI
90
preeclampsia: mom risks
placental abruption DIC eclampsia
91
panic d/o vs somatic sx d/o
panic is acute/episodic vs somatic is continuous
92
mgmt: subcutaneous emphysema
get a CXR to make sure the air hasn't caused a pneumo
93
drugs causing NMS
anti-psych antiemetics (dopa ants) dopa ag withdrawal
94
tx: NMS
stop drug (or restart dopa ags) supportive (IVF, cooling) dantrolene or bromocriptine
95
viral vs bacterial pneumonia
less leuks < 15 vs more > 15 | b/l diffuse infiltrate vs lobar infiltrate
96
H/S: poison ivy
type IV (delayed, T cell/mac mediated)
97
H/S: AI hemolytic anemia
type II (cytotoxic, IgG/IgM Ab mediated)
98
H/S: Goodpasture syndrome
type II (cytotoxic, IgG/IgM Ab mediated)
99
H/S: uticaria
type I (immediate, IgE mediated)
100
H/S: PSGN
type III (immune complex, Ab-Ag deposition)
101
H/S: PPD
type IV (delayed, T cell/mac mediated)
102
H/S: serum sickness
type III (immune complex, Ab-Ag deposition)
103
H/S: SLE GN
type III (immune complex, Ab-Ag deposition)
104
fetal non-stress test: what is a reactive result?
``` 110 - 160 bpm mod variability (6 - 25/min) 2+ accelerations in 20 min (each 15+ high and 15+ s long) ```
105
causes of non-reactive non-stress test
fetal sleep (MC) fetal hypoxia (from UPI) fetal cardiac abnormalities fetal neuro abnormalities
106
mgmt: nonstress test
reactive? great, 20 min is good nonreactive? extend to 40 - 120 min (feti only sleep 40 min at a time) all nonreactive need follow up biophysical profile or contraction stress test
107
what makes a pleural effusion complicated?
bacteria cross into pleural space (as opposed to sterile exudate)
108
uncomplicated vs complicated pulm eff pleural fluid analysis
uncomp: pH > 7.2 glucose > 60 WBC < 50,000 comp: pH < 7.2 glucose < 60 WBC > 50,000 both have negative gram stain/Cx (tho comp is usually false due to low bact count)
109
complicated pleural effusion vs empyema
same fluid analysis: pH < 7.2 glucose < 60 WBC > 50,000 but empyema has frank pus (gross) and positive gram stain/Cx
110
tx: pleural effusions
uncomplicated: Abx complicated: Abx + drainage (paracentesis?) empyema: Abx + chest tube
111
time frames gonococcal vs chlamydial neonatal conjunctivitis
GC: 2 - 5 days | chlam chlam: 5 - 14 days
112
ppx protocol for neonatal conjunctivitis
everyone gets topical erythromycin within an hour of being born to prevent GC
113
causes of fetal tachycardia
maternal fever maternal hyperTh meds (terbutaline) placental abruption
114
mgmt: lead poison suspicion in kid
(you can fingerstick to screen if you want but still have to do this) 1. draw venous blood lead levels - undetectable: do nothing - mild (5-44): repeat in < 1 month - mod (45-69): DMSA (succimer) - severe (>70): dimercaprol + EDTA
115
all humoral immuno is normal, but IgE is up
Job syndrome (hyper-IgE syndrome)
116
all humoral immuno is low
Bruton's (X-linked) agammaglobulinemia
117
hyper IgM (CD40 ligand) def vs common variable immunodef
hyper IgM has high IgM | CVI has low IgM
118
immune cells affected in DiGeorge
T cells (not B)
119
SCID vs Bruton's agammaglobulinemia
SCID has low B, Igs and T | Bruton has low B, Igs (T fine)
120
criteria for home O2
PaO2 < 55 or SaO2 < 88% if have cor pulmonale, RHF, or crit > 55: PaO2 < 59 or SaO2 < 89
121
mgmt: suspect VSD
echo: small defects may close on their own (75% do by 2) large may need surgery
122
when is papilledema a contraindication for LP?
non-communicating/obstructive hydrocephalus | mass lesion
123
brain mass looks like heterogenous butterfly
glioblastoma multiforme
124
multiple round brain masses
think mets
125
uniform contrast enhancement brain mass
think abscess
126
SCC from burn wound
Marjolin ulcer
127
whooshing sound in the ear (name)
pulsatile tinnitus
128
OSA: path of complications
apnea --> hypoxia --> up EPO production --> polycythemia | up CO2 --> acidosis --> retain bicarb (down Cl)
129
what happens when you eat tyramine foods w/ MAO-Is
HTN crisis (HTN, diaphoresis, blurry vision)
130
mgmt: chronic HCV
sofosbuvir (if can) | if not, prevent further liver damage w/ Hep A/B vaccinations and keeping an eye on complications (cirrhosis, varices)
131
definition of fetal growth restriction
U/S estimated weight < 10th percentile for gestational age
132
symmetric vs asymmetric fetal growth restriction
symmetric: see it 1st TM; global growth lag asymmetric: see in 2nd/3rd; head-sparing growth lag
133
causes of fetal growth restriction
symmetric: chromosome abnorm, congenital infection asymmetric: UPI, maternal malnutrition
134
normal preg physio: kidneys
up renal blood flow, GFR, BM permeability --> down serum BUN, Cr up renal protein excretion
135
ddx hirsutism
PCOS 21-hydroxylase def androgen secreting tumors (often ovarian) Cushing syndrome
136
MCC congenital hypothyroidism
thyroid dysgenesis
137
dx: biliary atresia
1. U/S (absent/weird GB) 2. scintigraphy (no tracer from liver to bowel) 3. *GS: cholangiogram
138
tx: biliary atresia
``` Kasai procedure (hepatoportoenterostomy) eventually liver transplant ```
139
loss of pain/temp in "cape" distribution
syringomyelia (fluid filled cavity in spinal cord)
140
syringomyelia a/w
arnold chiari malformation type 1
141
vit def: angular cheilosis, stomatitis, glossitis, seborrheic dermatitis
riboflavin (B2)
142
vit def: punctate hemorrhages, gingivitis, corkscrew hair
vit C (ascorbic acid)
143
vit def: cheilosis, stomatitis, glossitis, confusion
pyridoxine (B6)
144
vit def: dermatitis, glossitis, diarrhea, delusions
niacin (B3)
145
why do you get hyponatremia in CHF
low CO --> up renin, NE and ADH --> retains water, dilutes blood
146
sunburn rash w/ palm/sole desquamation
TSS
147
coalescing erythematous macules, desquamation, bullae and mucositis
SJS (<10%)/TEN (>30%)
148
when not to give nitrates in MI
hTN RV infarct severe AS
149
seborrheic dermatitis a/w
HIV | Parkinsons
150
intra and extrahepatic biliary duct dilation
pancreatic cancer (head)
151
CT: double duct sign
pancreatic cancer
152
mgmt: kid with proteinuria
repeat dipstick at 2 other times to test for transient proteinuria
153
dietary recommendations for people with kidney stones
more fluids less sodium normal Ca
154
ruptured berry aneurysms -->
SAH
155
MCC intraparenchymal brain hemorrhage in kids
AVMs
156
cerebral amyloid angiopathy -->
lobar/cortical hemorrhage (usually old people)
157
MCC spontaneous deep intracerebral hemorrhage
HTN vasculopathy of small penetrating branches of cerebral arteries (next is amyloid angiopathy)
158
Charcot-Bouchard aneurysms (cause)
chronic HTN
159
MC locations of intracerebral adult hemorrhages
BG (putamen) cerebellar nuclei thalamus pons
160
fundoscope: central retinal artery occlusion
cherry red spot and whitened retina
161
fundoscope: HTN retinopathy
hard exudates, AV nicking, flame hemorrhages, silver wiring
162
fundoscope: blood and thunder diffuse hemorrhages
central retinal vein occlusion
163
painful ulcer w/ purulent base and violaceous borders
pyoderma gangrenosum
164
hemorrhagic pustules --> necrotic ulcers
ecthyma gangrenosum (think pseudomonas)
165
Cr and urinary obstruction
doesn't usually go up with unilateral stones | does with bilateral or BPH
166
downs kid: incontinence, UMN signs, torticollis, behavior changes, dizziness
think atlantoaxial instability
167
how do you get psoas abscess
intraabdominal infection | or seed from distant infxn (skin, etc)
168
dx: psoas abscess
CT
169
dx: HIV in newborn
PCR (< 18 mo) - may still have mom's Abs | Abs past 18 mo is confirmatory
170
recommended preggo vaccines
Tdap inactivated flu Rho(D)
171
preggo vaccines (for high risk pts)
``` Hep A/B pneumococcus H flu Meningococcal Varicella-zoster Ig ```
172
RFs for uterine atony
prolonged labor induction of labor operative delivery fetal weight > 4000 g
173
spontaneous abortions with closed os
missed threatened complete
174
empty sac = which spontaneous abortion
missed
175
Tx: asx bacteriuria in pregnancy
cephalexin amox-clav nitrofurantoin NO cipro/TMP-SMX
176
types of solid liver masses
``` focal nodular hyperplasia hepatic adenoma regenerative nodules (eg from cirrhosis) HCC liver mets ```
177
liver tumor with up AFP
HCC
178
hemolytic anemia, jaundice, splenomegaly
hereditary spherocytosis
179
dx: hereditary spherocytosis
fragility? acidified glycerol lysis eosin-5-maleimide binding test
180
tx: warfarin associated intracerebral hemorrhage
vit K (takes 12-24 hrs) prothrombin complex concentrate (PCC) (mins + hours) FFP if PCC not available
181
tx: polymyalgia rheumatica
low dose glucocorticoids
182
biggest RF for pancreatic cancer
smoking
183
PTH and Ca levels in familial hypocalciuric hypercalcemia
high Ca but normalish PTH (mutation of Ca sensing receptor needs way high levels to adjust PTH)
184
familial hypocalciuric hypercalcemia vs primary hyperparathyroidism
use urine Ca/Cr clearance ratio (UCCR) (CaU/CaS)/(CrU/CrS) < 0.01 = FHH > 0.02 = primary hyperparathyroidism
185
tx: peritonsillar abscess
needle aspiration IV Abx surgery if its huge/can't be aspirated
186
HTN pt with thunderclap HA, N/V/photophobia
non-traumatic SAH
187
RFs for PACs
smoking, EtOh, coffee, stress
188
cupping of the optic disc
open angle glaucoma
189
preterm infant supplements
may need iron earlier
190
dx: suspected malignancy --> LBP
x-ray
191
calcification of articular cartilage
think pseudogout
192
pseudogout aka
acute calcium phosphate arthritis
193
complication post eye surgery (+sx)
``` postop endophthalmitis (< 6 wks postop) pain, bad acuity, swollen eyelids, conjunctiva ```
194
ball mass: peritoneal fluid collection btwn layers of tunica vaginalis
hydrocele
195
ball mass: changes size w/ laying down/valsalva, doesn't transilluminate
varicocele
196
ball mass: painless mass @ superior pole, transilluminates
spermatocele
197
tx: varicocele
young: gonadal vein ligation | old, don't want kids: scrotal support + NSAIDs
198
drugs for EtOH addiction
naltrexone: down cravings, enjoy drinking less, ok if still drinking acamprosate: maintain abstinence disulfiram: makes you sick if you drink
199
fever, severe/focal back pain, neuro sx
think spinal epidural abscess
200
MCC spinal epidural abscess
staph aureus (distant infxn, IVDA, spinal procedure)
201
facial palsy: peripheral vs central
``` peripheral = Bells = Both top and bottom droop Sentral = Spares top ```
202
when can you quad screen
15 - 22 wks
203
what preg screening can you do @ 10 wks
cell-free fetal DNA CVS PaPP, beta HCG, nuchal translucency
204
mutation @ fibrillin-1 gene
marfans
205
mutation @ fibrillin-2 gene
congenital contractural arachnodactyly
206
recent URI with persistent cough w/ yellow/blood tinged spututm
bronchitis | cough > 5 days
207
when do you give rhogam
``` 28 - 32 wks < 72 hrs after delivery < 72 hrs after abortion 2nd/3rd TM bleeding CVS/amnio ```
208
how to tell if diarrhea is osmotic vs secretory
stool osmotic gap = plasma osm - 2x (stool Na + stool K) elevated (> 125) = osmotic low (< 50)= secretory
209
diarrhea: large daily stool volumes, or diarrhea that occurs during fasting or sleep
secretory
210
diarrhea: lactose intolerant
osmotic
211
diarrhea post bowel resection or chole
secretory
212
acute renal failure, fever, rash
AIN
213
drugs that cause AIN
PCN cephalosporins TMP-SMX NSAIDs
214
biggest RF aortic aneurysm and rupture
smoking
215
dx: wilms tumor
abd u/s | CT abd/chest (check for mets)
216
wilms tumor vs neuroblastoma
kidney vs adrenal usually asx vs sx neuroblastoma crosses the midline
217
mcc cancer in first year of life
neuroblastoma
218
iron studies in thalassemia
``` (exactly opposite iron def anemia) iron up TIBC down ferritin up transferrin sat up ```
219
a/w myasthenia gravis
thymoma
220
what happens if you fix the folate but not the B12
neuro sx (but megaloblastosis is fixed)
221
tx: CKD anemia
``` EPO iron dextran (good for HD) ```
222
lady stuff + liver things
think Fitz-Hugh-Curtis
223
how does TB cause acid-base problems
TB --> addisons --> aldo def --> non-gap HK hNa acidosis (retain H+s)
224
which fibers involved in DM neuropathy
small fiber = (+) sx (pain, paresthesias) | large = (-) sx (numbness, loss of proprio)
225
PE: severe AS
pulsus parvus et tardus mid- to late- peaking systolic murmur soft single second heart sound
226
sunburst pattern in bone
osteosarcoma
227
onion skin bone
ewing sarcoma
228
codman triangle in bone
osteosarcoma
229
positive prussian blue stain
hemosiderin
230
renal papillary necrosis a/w
sickle cell
231
kid: hemolytic anemia, thrombocytopenia, acute kidney injury
HUS
232
haptoglobin in hemolytic anemia
decreased (it's busy picking up all the Hgb floating around)
233
complications of PBC
malabsorption (fat sol vit) metabolic bone dz (osteoporosis, osteomalacia) HCC
234
schizoid vs avoidant PD
schizoids are happy, are loners on purpose | avoidants actively avoid due to fear of rejection/criticism
235
screening test for GC/Chlam
nucleic acid amplification test (NAAT)
236
supracondylar frx MC complication
entrapment of brachial artery and median nerve
237
when do you get Volkmann contracture
compartment syndrome from simultaneous supracondylar and forearm frx
238
back pain with extensive motor and sensory loss, absent rectal tone, urine retention
think acute spinal cord compression | depending on sensory could be cauda equina
239
back pain with bladder/rectal dysfxn
conus medullaris
240
back pain (radicular) w/ saddle anesthesia, weakness and bowel/bladder dysfxn
cauda equina syndrome
241
suspected orgs in osteomyelitis after UTI
klebsiella | pseudomonas
242
illnesses that affect anterior horn
spinal muscular atrophy (infants) polio ALS
243
dz of NMJ
botulism myasthenia gravis lambert eaton organophosphate poisoning
244
fungal infection with pancytopenia
think disseminated histo (HIV pts)
245
tx: histoplasmosis
disseminated: amphotericin B (then itraconazole for maintenance) normal: itraconazole
246
tx: aspergillosis
disseminated: amphotericin B normal: voriconazole
247
tx: cryptococcus
flucytosine and amphotericin B | fluconazole for maintenance
248
tx: coccidioidomycosis
- conazoles for normal | disseminated: amphotericin B
249
tx: mucormycosis
amphotericin B
250
mgmt: suspect scaphoid frx
1. X-ray if negative: 2a. wear thumb spica splint and repeat x-ray in 7 - 10 days 2b. get CT/MRI to confirm frx
251
tx: syphilis (pt has severe PCN allergy)
primary: doxy x 14 secondary: doxy x 14 latent: doxy x 28 tertiary: ceftriaxone x 14 preggo: desensitize then PCN
252
knee injury "popping" sensation and rapid onset hemarthrosis
ACL
253
knee injury "popping" sensation but feel ok
meniscus
254
genetics for HCM
auto dom
255
what does valsalva do to heart
down preload
256
what does squatting do to heart
up preload | up afterload
257
complication of pernicious anemia (besides anemia sx)
gastric cancer
258
murmur, BP diff in arms
AS
259
parasite causes liver cysts
echinococcus granulosus (dogs/sheep)
260
parasite causes liver abscess
entamoeba histolytica
261
parasite causes hematuria/bladder CA
schistosoma haematobium
262
joint problems in rheumatic fever
migratory arthritis
263
JONES in rheumatic fever
``` joints <3 carditis nodules erythema marginatum sydenham chorea ```
264
tx: hyperosmolar hyperglycemic state
IVF (start with NS) IV insulin (regular) give K as needed
265
MC complication of sickle cell trait
hematuria
266
sickle cell trait vs dz (Hgb electrophoresis)
trait: 50 - 60% Hb A; 35 - 45% Hb S, < 2% F dz: 0% A, 85 - 95% S, 5 - 15% F
267
hormones in PCOS
T up (or norm) E up LH (up or norm)/ FSH imbalance
268
tx: tinea capitis
oral griseofulvin or terbinafine
269
cancer pain treatment ladder
mild: NSAIDs, tylenol mod: weak opioids (codeine, hydrocodone) +/- nons (tramadol) severe: strong short (morphine, hydromorphone) eventually switch to long acting (fentanyl/oxy) + breakthrough short
270
shin splints vs stress fractures
diffuse vs point tenderness
271
bone pain, deformity, mixed lytic/sclerotic lesions
think Paget's
272
levels in pagets
Ca, Phos normal alk phos high urine hydroxyproline high
273
aplastic anemia, weird thumbs, cafe au lait spots (or hyper/hypo pigment), strabismus, ear problems
fanconi anemia
274
general muscle weakness, ptosis, difficulty swallowing, dyspnea
myasthenic crisis
275
meds that can start myasthenic crisis
aminoglycosides FQ macrolides BB
276
anticoag post stroke
< 4 hrs after onset w/o contra: IV altepase stroke w/ no prior antiplatelet: ASA stroke on ASA: ASA + dipyridamole or clopiidogrel stroke w/ afib: warfarin, NOAC
277
OCP AEs
DVT HTN hepatic adenoma rare: stroke/MI
278
Nikolsky sign
easy separation of epidermis (pemphigus vulgaris)
279
immunofluorescence vulgaris vs pemphigoid
vulgaris: chicken wire intracellular IgG/C3 pemphigoid: linear IgG @ BM
280
biggest RF for preterm birth
previous preterm birth
281
cervix things that increase risk of preterm birth
short cervix cold knife conization LEEP (maybe) laser ablation DOES NOT
282
pus in mediastinum post surgery
acute mediastinitis (prob from intraoperative contamination)
283
tx: acute mediastinitis
drainage, surgical debridement, closure, prolonged Abx
284
uncomplicated vs uncomplicated acute pylo
uncomp: otherwise healthy (+ not preggo); usually e. coli comp: old, septic, DM, urinary obstruction, immunosuppressed, got in hospital
285
tx: uncomp vs comp pylo
uncomp: oral FQs comp: IV FQ, aminoglycoside, etc. after 48 hrs improved, they can be switched to culture-guided orl abx
286
corrected Ca level
Ca + 0.8 x (4 - alb)
287
unvaccinated person exposed to hep B
gets HB immunoglobulin and vaccine
288
empiric Abx for bacterial meningitis: groups
2 - 50 >50 immunocompromised neurosurg/penetrating trauma
289
empiric Abx for bacterial meningitis: 2 - 50
vanc + 3rd gen cephalosporin
290
empiric Abx for bacterial meningitis: > 50
vanc + 3rd gen cephalosporin + ampicillin
291
empiric Abx for bacterial meningitis: immunocompromised
vanc + amp + cefepime
292
empiric Abx for bacterial meningitis: neurosurg/penetrating trauma
vanc + cefepime
293
joints: morning stiffness, better by afternoon
RA
294
joints: worse as day goes on
OA
295
RA: which joints
small knees, elbows later cervical spine can --> spine subluxation
296
dx: spinal stenosis
MRI
297
back pain better with activity/hot showers
ankylosing spondylitis
298
HIV pt: ring enhancing lesions w/ edema
toxo
299
HIV pt: unilateral temporal lobe-enhancing lesion w/ mass effect
HSV encephalitis
300
HIV pt: well-defined, enhancing focal lesion
primary CNS lymphoma
301
HIV pt: white matter lesions w/o enhancement or edema
progressive multifocal leukoencephalopathy (JC virus)
302
most effective dating method/time (gestational age)
crown-rump length @ 7 - 10 wks (first TM)
303
kidney problem a/w renal vein thrombosis
membranous glomerulopathy
304
most sensitive test for achalasia
manometry
305
tx: aspiration pneumonia
clindamycin MTZ w/ amoxicillin amox-clav carbapenem
306
tx: pancreatic pseudocyst
asx: do nothing | sx/complications: endoscopic drainage
307
hos often do you do a lipid panel
q 5 years
308
MC leukemia in US
CLL
309
dx: midgut volvulus
biliary vomiting --> abd x-ray no free, air, dilation, double bubble --> upper gi series (barium swallow)
310
tx: midgut volvulus
Ladd procedure
311
tx: catatonia
benzos | ECT
312
labs in diuretic abuse
hyponatremia hypokalemia hypochloremia up urine Na, K
313
mgmt: suspect SLE
get ANA | if (+) get anti-dsDNA
314
how can mechanical ventilation --> cardiac arrest
ventilation increases intrathoracic pressure if you're in hypovolemic shock, there's already decreased central venous pressure so --> no preload --> no CO --> cardiac arrest
315
mouth pain, drooling, tongue displaced up
ludwig angina (cellulitis of submandibular space)
316
tx: ludwig angina
IV abx, remove offending tooth
317
paCO2 and brain swelling
hyperventilation --> down CO2 --> down blood flow to brain --> decreases ICP
318
methods to unswell a brain
``` head elevation sedation hyperventilation remove CSF mannitol (osmotic) ```
319
anti-dopa drugs: where do they show effects
mesolimbic: antipsych nigrostriatal: EPS tuberoinfundibular: hyperprolactinemia
320
reasons to start clozapine
tx refractory schizo | schizo a/w suicidality
321
best studies to compare incidence
cohort
322
mgmt: short cervix (with no previous preterm)
vaginal progesterone
323
mgmt: short cervix (with previous preterm)
IM progesterone @ 2nd TM serial TVUS to check for short short --> cerclage
324
tylenol before vaccines?
stoppit | doesn't prevent fever/seizures and may make vaccine less effective
325
cyanosis, pulse ox ~ 85, chocolate blood
methemoglobinemia
326
methemoglobinemia labs
pulse ox low and doesn't move w/ O2 | PaO2 is normal (overestimates)
327
tx: methemoglobinemia
methylene blue
328
whats on the biophysical profile (+norm)
``` continuous observation for 30 min non stress test (reactive) amniotic fluid vol (> 2 x 1 cm) fetal mvmts (> 3) fetal tone (> 1 flex/ext) fetal breathing mvmts (> 1 for > 30 s) ```
329
when do you deliver based on biophysical profile
4 or less
330
whats cradle cap
seborrheic dermatitis
331
fetal demise with limb fractures, hypoplastic thoracic cavity
osteogenesis imperfecta (II)
332
dx: pancreatic cancer
abd CT
333
multiple myeloma: path
monoclonal plasma cell proliferation | not enough IgG --> infections
334
tenderness at tendon insertion points (and a/w)
enthesitis (see in ankylosing spondylitis, psoriatic arthritis, reactive arthritis)
335
hemochromatosis at risk for
HCC | infections: listeria, vibrio vulnificus, yersinia enterocolitica
336
acid base protracted vomiting
hypochloremic hypokalemic metabolic alkalosis
337
kid: hip/knee pain with antalgic gait and thigh muscle atrophy
Legg-Calve Perthes (avascular necrosis of femoral capital epiphysis)
338
INH liver injury
worse in old, drinkers and pts with other liver problems | usually self limited
339
tx: acute angle glaucoma
mannitol, acetazolamide, pilocarpine or timolol | NOT atropine or other mydriatic agents
340
mass: makes AFP and betaHCG
nonseminomatous germ cell tumors
341
what do you need to check with low calcium
albumin
342
WTF is mixed cryoglobulinemia syndrome
path: immune deposits in small/ed vessels pt: fatigue, purpura, arthralgias, renal dz, peripheral neuropathies labs: serum cryoglobulins, low complement, +Rh, elevated LFT/Cr a/w: HCV, SLE
343
mgmt: blunt GU trauma
1. UA 2a. stable w/ hematuria --> CT w/ contrast 2b. hemodynamically unstable --> IV pyelography then surgical eval 3. consider bladder/pelvis stuff too
344
what can you give cholelithiasis pts if they're poor surgical candidates
ursodeoxycholic acid
345
when does elective chole tx change to chole in next 72 hrs
acute cholecystitis choledocholithiasis gallstone pancreatitis
346
tx: symptomatic bartholin cyst
I&D | Word catheter
347
dx: endometriosis
laparoscopy (usually don't need definitive dx)
348
risks of endometriosis
infertility
349
age for kawasaki's
< 5 | peak: 18 - 24 mo
350
criteria for kawasaki's
fever for 5 days + 4 of these: 1. conjunctivitis 2. oral mucosa changes 3. rash 4. extremity changes (erythema, edema, desquamation) 5. cervical lymphadenopathy
351
complications of kawasaki
coronary artery aneurysm | MI
352
baby: inspiratory stridor worse when supine, better when prone
laryngomalacia
353
tx: laryngomalacia
usually resolves can give PPIs for reflux supraglottoplasty for severe sx
354
SLE CNS effects (who knew?)
psych | seizures, neuropathy, strokes, chorea
355
elevated total T4 with normal TSH - how
increased TBG | causes: estrogens (OCPs), liver problems, meds
356
complications of giving NE (pressors)
NE vasospasm: - ischemia of distal fingers/toes - mesenteric ischemia - renal failure
357
how to know if a metabolic alkalosis is responsive to saline
urine Cl < 20
358
saline responsive causes of metabolic alkalosis
``` vomiting NGT diuretics laxative abuse low oral fluid intake ```
359
tx: fibromyalgia
1st: aerobic exercise and good sleep hygiene then TCAs then if TCAs don't work -- duloxetine, milnacipran or pregabalin
360
fundoscopy: swollen and pale disk with blurred margins
giant cell arteritis (temporal arteritis)
361
when do you use a pessary
stress incontinence (3rd line)
362
tx: bullous pemphigoid
clobetasol (high potency topical glucocorticoid)
363
labs: bulimia vs diuretic abuse/Bartter's/Gitelman's
all have hypokalemia, alkalosis, normotensive | only bulimia with have low urine Cl
364
when can you not give the NOACs (-xabans)
renal failure | DVT/PE from malignancy
365
pleural fluid pH: exudative vs transudative (also, normal)
normal: 7.6 transudative: 7.4 - 7.55 exudative: 7.3 - 7.45 (empyemas go < 7.3) more crap, more acid!
366
best way to reverse DCM from EtOH
stop drinking!
367
complications on vesicoureteral reflux
renal scarring
368
infective endocarditis org: MC nosocomial
staph aureus
369
infective endocarditis org: MC community acquired
strep
370
infective endocarditis org: nosocomial w/ UTI
enterococci
371
infective endocarditis org: resp tract bx
strep viridans
372
infective endocarditis org: prosthetic valves/IV catheters
think staph aureus or staph epidermidis
373
who do you defibrillate (not cardiovert)
VF | pulseless VT
374
MC org: parotitis
staph aureus

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