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Step 2 > UWorld 1 > Flashcards

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
Q

MTX rescue

A

leucovorin

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26
Q

felty syndrome

A

severe, long standing RA

neutropenia + splenomegaly

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27
Q

therapy for phobias

A

exposure therapy (behavioral)

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28
Q

BUN/Cr and GI bleeds

A

BUN and BUN/Cr increased in upper (but not lower) GI bleeds

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29
Q

how to monitor DKA tx

A

serum anion gap

direct assay of beta-hydroxybutyrate (ketone)

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30
Q

mgmt: uterine inversion

A 
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
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31
Q

malaria prophylaxis for people going to India

A

mefloquine
atovaquone-proguanil
doxy

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32
Q

when to give mefloquine

A

2 weeks before, all during, 4 wks after

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33
Q

when can you give chloroquine

A

S America/caribbean

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34
Q

things that cause pain when you have sphincter of Oddi problems

A

fatty meals

opioids

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35
Q

catching sensation in knee

A

meniscal tear

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36
Q

tests for meniscal tear

A

Thessaly

McMurray

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37
Q

tx: strabismus

A

patch or blur the normal eye to make them use the bad one

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38
Q

urticaria, fever, joint pain, 1 wk post PCN or TMP-SMX

A

serum sickness-like reaction (type III h/s)

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39
Q

GCS things

A

eye opening
verbal response
motor response

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40
Q

GCS: eye scale

A

1: none
2: to pain
3: to verbal
4: spontaneous

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41
Q

GCS: verbal scale

A

1: none
2: incomprehensible sounds
3: inappropriate words
4: disoriented/confused
5: oriented

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42
Q

GCS: motor scale

A

1: none
2: extension
3: flexion
4: withdraws
5: localizes
6: obeys

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43
Q

causes of normal anion gap metabolic acidosis

A 
diarrhea
RTAs
carbonic anhydrase inhibitors
fistulas
ureteral diversions
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44
Q

MC complication of flu

A

secondary bacterial pneumonia

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45
Q

MCCs post-flu pneumonia

A

staph aureus

strep pneumo

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46
Q

anemia of chronic disease: which arthropathies

A

RA
SLE
(not OA!)

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47
Q

Gottron’s papules

A

violaceous, scaly papules over joints

a/w dermatomyositis

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48
Q

meniere’s triad

A

tinnitus
episodic vertigo
sensorineural hearing loss

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49
Q

cause of meniere’s

A

increased vol/P of endolymph

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50
Q

dx: CGD

A

abnormal oxidative burst (dihydrorhodamine)

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51
Q

greatest RF for suicide

A

prior attempt

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52
Q

rough, scaly, non healing ulcer by scar

A

squamous cell carcinoma

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53
Q

increased calcitonin

A

medullary thyroid cancer

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54
Q

psammoma bodies

A

papillary thyroid cancer

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55
Q

thyroid nodule invades tumor capsule/blood vessels

A

follicular thyroid cancer

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56
Q

tx: aortic dissection

A

labetalol, or other BB

hydralazine and nitroprusside can have reflex tachy

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57
Q

acid base in mesenteric ischemia

A

metabolic acidosis (from high serum lactate)

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58
Q

illness anxiety d/o vs somatic symptom d/o

A

fear of having a serious illness despite few/no sx and negative tests
vs
anxiety or preoccupation w/ 1+ sx

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59
Q

toddler milestones: ages

A 
12 mo
18 mo
2 yr
3 yr
4 yr
5 yr
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60
Q

toddler milestones: gross motor

A 
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)
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61
Q

toddler milestones: fine motor

A 
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
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62
Q

toddler milestones: language

A 
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
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63
Q

toddler milestones: soc/cog

A

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

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64
Q

warning signs for HA (when to MRI)

A

neuro: seizure, FND, LOC
changes from before/new kind
new onset > 40 yo

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65
Q

ruddy baby w/ hyperglycemia, hyperbili, resp distress

A

neonatal polycythemia (> 65% crit)

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66
Q

causes: neonatal polycythemia

A 
intrauterine hypoxia (mom w/ DM, HTN, smoker), IUGR
or genetic/metabolic
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67
Q

electrolytes in addisons

A

hyponatremia, hyperkalemia (renal Na loss, no aldosterone)

hypoglycemia (no cortisol)

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68
Q

CSF: bact meningitis

A

WBC > 1000

glucose: < 40
protein: > 250

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69
Q

CSF: viral meningitis

A

WBC 100 - 1000
glucose: 40 - 70
protein < 100

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70
Q

CSF: Guillain Barre

A

WBC: 0 - 5

glucose: 40 - 70
protein: 45 - 1000

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71
Q

when is baby reflux pathologic?

A

GERD:
FTT
significant irritability
Sandifier syndrome

milk allergy:
vom/eczema/bloody stool

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72
Q

baby complications of DM mom (1st TM)

A

congenital heart dz
NTD
small L colon
spontaneous abortion

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73
Q

baby complications of DM mom (2/3 TM)

A 
hyperinsulinemia
polycythemia (up met demand --> hypoxia)
organomegaly
hypoglycemia
brachial plexopathy, clavicle frx, perinatal asphyxia (macrosomia, shoulder dystocia)
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74
Q

what is an S4 from

A

blood entering a stiff ventricle (hypertrophy, MI)

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75
Q

erysipelas vs cellulitis

A 
streg pyo vs strep or staph
superficial vs deep
raised vs not
sharp borders vs not
rapid vs slow
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76
Q

whats a furuncle (hint, its not a dog/family member)

A

folliculitis into dermis –> abscess

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77
Q

HACEK orgs

A 
haemophilus aphrophilus
aggregatibacter actinomysetemcomitans
cardiobacterium hominis
E corrodens
kingella kingae
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78
Q

when do you have mild EtOH withdrawal (and what constitutes that?)

A

6 - 24 hr

anxiety, tremor, sweating, GI, palpitations

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79
Q

when can you have seizures from EtOH withdrawal

A

12 - 48 hrs

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80
Q

alcoholic hallucinosis vs delirium tremens

A

12- 48 hr vs 48 - 96

stable vitals vs fever, tachy, HTN, AMS

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81
Q

path: trigeminal neuralgia

A

compression of nerve root

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82
Q

patchy, alveolar infiltrate, not restricted by anatomical borders

A

pulmonary contusion

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83
Q

-pulmonary contusion

A

tachypnea
tachycardia
hypoxia

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84
Q

when do you give tetanus immune globulin?

A

only to people who are uncertain or had < 3 toxoid doses with dirty/severe wound

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85
Q

pulm HTN criteria

A

mean pulm arterial P > 25 mmHg @ rest or

30 with exercise

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86
Q

meds that cause hyperkalemia

A 
non selective BB
ACE/ARBs
K-sparing diuretics
cardiac glycosides (Digoxin)
NSAIDs
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87
Q

livedo reticularis, with possible AKI or pancreatitis

A

cholesterol embolism (atheroembolism)

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88
Q

chronic giardiasis

A

IgA def

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89
Q

preeclampsia: baby risks

A

chronic uteroplacental insuff –> growth restriction/LBW

not hypoxia, which is due to acute UPI

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90
Q

preeclampsia: mom risks

A

placental abruption
DIC
eclampsia

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91
Q

panic d/o vs somatic sx d/o

A

panic is acute/episodic vs somatic is continuous

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92
Q

mgmt: subcutaneous emphysema

A

get a CXR to make sure the air hasn’t caused a pneumo

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93
Q

drugs causing NMS

A

anti-psych
antiemetics (dopa ants)
dopa ag withdrawal

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94
Q

tx: NMS

A

stop drug (or restart dopa ags)
supportive (IVF, cooling)
dantrolene or bromocriptine

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95
Q

viral vs bacterial pneumonia

A

less leuks < 15 vs more > 15

b/l diffuse infiltrate vs lobar infiltrate

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96
Q

H/S: poison ivy

A

type IV (delayed, T cell/mac mediated)

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97
Q

H/S: AI hemolytic anemia

A

type II (cytotoxic, IgG/IgM Ab mediated)

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98
Q

H/S: Goodpasture syndrome

A

type II (cytotoxic, IgG/IgM Ab mediated)

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99
Q

H/S: uticaria

A

type I (immediate, IgE mediated)

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100
Q

H/S: PSGN

A

type III (immune complex, Ab-Ag deposition)

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101
Q

H/S: PPD

A

type IV (delayed, T cell/mac mediated)

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102
Q

H/S: serum sickness

A

type III (immune complex, Ab-Ag deposition)

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103
Q

H/S: SLE GN

A

type III (immune complex, Ab-Ag deposition)

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104
Q

fetal non-stress test: what is a reactive result?

A 
110 - 160 bpm
mod variability (6 - 25/min)
2+ accelerations in 20 min (each 15+ high and 15+ s long)
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105
Q

causes of non-reactive non-stress test

A

fetal sleep (MC)
fetal hypoxia (from UPI)
fetal cardiac abnormalities
fetal neuro abnormalities

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106
Q

mgmt: nonstress test

A

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

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107
Q

what makes a pleural effusion complicated?

A

bacteria cross into pleural space (as opposed to sterile exudate)

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108
Q

uncomplicated vs complicated pulm eff pleural fluid analysis

A

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)

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109
Q

complicated pleural effusion vs empyema

A

same fluid analysis:
pH < 7.2
glucose < 60
WBC > 50,000

but empyema has frank pus (gross) and positive gram stain/Cx

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110
Q

tx: pleural effusions

A

uncomplicated: Abx
complicated: Abx + drainage (paracentesis?)
empyema: Abx + chest tube

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111
Q

time frames gonococcal vs chlamydial neonatal conjunctivitis

A

GC: 2 - 5 days

chlam chlam: 5 - 14 days

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112
Q

ppx protocol for neonatal conjunctivitis

A

everyone gets topical erythromycin within an hour of being born to prevent GC

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113
Q

causes of fetal tachycardia

A

maternal fever
maternal hyperTh
meds (terbutaline)
placental abruption

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114
Q

mgmt: lead poison suspicion in kid

A

(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
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115
Q

all humoral immuno is normal, but IgE is up

A

Job syndrome (hyper-IgE syndrome)

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116
Q

all humoral immuno is low

A

Bruton’s (X-linked) agammaglobulinemia

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117
Q

hyper IgM (CD40 ligand) def vs common variable immunodef

A

hyper IgM has high IgM

CVI has low IgM

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118
Q

immune cells affected in DiGeorge

A

T cells (not B)

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119
Q

SCID vs Bruton’s agammaglobulinemia

A

SCID has low B, Igs and T

Bruton has low B, Igs (T fine)

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120
Q

criteria for home O2

A

PaO2 < 55 or SaO2 < 88%

if have cor pulmonale, RHF, or crit > 55:
PaO2 < 59 or SaO2 < 89

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121
Q

mgmt: suspect VSD

A

echo:
small defects may close on their own (75% do by 2)
large may need surgery

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122
Q

when is papilledema a contraindication for LP?

A

non-communicating/obstructive hydrocephalus

mass lesion

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123
Q

brain mass looks like heterogenous butterfly

A

glioblastoma multiforme

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124
Q

multiple round brain masses

A

think mets

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125
Q

uniform contrast enhancement brain mass

A

think abscess

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126
Q

SCC from burn wound

A

Marjolin ulcer

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127
Q

whooshing sound in the ear (name)

A

pulsatile tinnitus

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128
Q

OSA: path of complications

A

apnea –> hypoxia –> up EPO production –> polycythemia

up CO2 –> acidosis –> retain bicarb (down Cl)

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129
Q

what happens when you eat tyramine foods w/ MAO-Is

A

HTN crisis (HTN, diaphoresis, blurry vision)

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130
Q

mgmt: chronic HCV

A

sofosbuvir (if can)

if not, prevent further liver damage w/ Hep A/B vaccinations and keeping an eye on complications (cirrhosis, varices)

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131
Q

definition of fetal growth restriction

A

U/S estimated weight < 10th percentile for gestational age

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132
Q

symmetric vs asymmetric fetal growth restriction

A

symmetric: see it 1st TM; global growth lag
asymmetric: see in 2nd/3rd; head-sparing growth lag

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133
Q

causes of fetal growth restriction

A

symmetric: chromosome abnorm, congenital infection
asymmetric: UPI, maternal malnutrition

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134
Q

normal preg physio: kidneys

A

up renal blood flow, GFR, BM permeability –>
down serum BUN, Cr
up renal protein excretion

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135
Q

ddx hirsutism

A

PCOS
21-hydroxylase def
androgen secreting tumors (often ovarian)
Cushing syndrome

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136
Q

MCC congenital hypothyroidism

A

thyroid dysgenesis

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137
Q

dx: biliary atresia

A
  1. U/S (absent/weird GB)
  2. scintigraphy (no tracer from liver to bowel)
  3. *GS: cholangiogram
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138
Q

tx: biliary atresia

A 
Kasai procedure (hepatoportoenterostomy)
eventually liver transplant
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139
Q

loss of pain/temp in “cape” distribution

A

syringomyelia (fluid filled cavity in spinal cord)

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140
Q

syringomyelia a/w

A

arnold chiari malformation type 1

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141
Q

vit def: angular cheilosis, stomatitis, glossitis, seborrheic dermatitis

A

riboflavin (B2)

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142
Q

vit def: punctate hemorrhages, gingivitis, corkscrew hair

A

vit C (ascorbic acid)

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143
Q

vit def: cheilosis, stomatitis, glossitis, confusion

A

pyridoxine (B6)

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144
Q

vit def: dermatitis, glossitis, diarrhea, delusions

A

niacin (B3)

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145
Q

why do you get hyponatremia in CHF

A

low CO –> up renin, NE and ADH –> retains water, dilutes blood

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146
Q

sunburn rash w/ palm/sole desquamation

A

TSS

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147
Q

coalescing erythematous macules, desquamation, bullae and mucositis

A

SJS (<10%)/TEN (>30%)

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148
Q

when not to give nitrates in MI

A

hTN
RV infarct
severe AS

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149
Q

seborrheic dermatitis a/w

A

HIV

Parkinsons

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150
Q

intra and extrahepatic biliary duct dilation

A

pancreatic cancer (head)

151
Q

CT: double duct sign

A

pancreatic cancer

152
Q

mgmt: kid with proteinuria

A

repeat dipstick at 2 other times to test for transient proteinuria

153
Q

dietary recommendations for people with kidney stones

A

more fluids
less sodium
normal Ca

154
Q

ruptured berry aneurysms –>

155
Q

MCC intraparenchymal brain hemorrhage in kids

156
Q

cerebral amyloid angiopathy –>

A

lobar/cortical hemorrhage (usually old people)

157
Q

MCC spontaneous deep intracerebral hemorrhage

A

HTN vasculopathy of small penetrating branches of cerebral arteries
(next is amyloid angiopathy)

158
Q

Charcot-Bouchard aneurysms (cause)

A

chronic HTN

159
Q

MC locations of intracerebral adult hemorrhages

A

BG (putamen)
cerebellar nuclei
thalamus
pons

160
Q

fundoscope: central retinal artery occlusion

A

cherry red spot and whitened retina

161
Q

fundoscope: HTN retinopathy

A

hard exudates,
AV nicking,
flame hemorrhages,
silver wiring

162
Q

fundoscope: blood and thunder diffuse hemorrhages

A

central retinal vein occlusion

163
Q

painful ulcer w/ purulent base and violaceous borders

A

pyoderma gangrenosum

164
Q

hemorrhagic pustules –> necrotic ulcers

A

ecthyma gangrenosum (think pseudomonas)

165
Q

Cr and urinary obstruction

A

doesn’t usually go up with unilateral stones

does with bilateral or BPH

166
Q

downs kid: incontinence, UMN signs, torticollis, behavior changes, dizziness

A

think atlantoaxial instability

167
Q

how do you get psoas abscess

A

intraabdominal infection

or seed from distant infxn (skin, etc)

168
Q

dx: psoas abscess

169
Q

dx: HIV in newborn

A

PCR (< 18 mo) - may still have mom’s Abs

Abs past 18 mo is confirmatory

170
Q

recommended preggo vaccines

A

Tdap
inactivated flu
Rho(D)

171
Q

preggo vaccines (for high risk pts)

A 
Hep A/B
pneumococcus
H flu
Meningococcal
Varicella-zoster Ig
172
Q

RFs for uterine atony

A

prolonged labor
induction of labor
operative delivery
fetal weight > 4000 g

173
Q

spontaneous abortions with closed os

A

missed
threatened
complete

174
Q

empty sac = which spontaneous abortion

175
Q

Tx: asx bacteriuria in pregnancy

A

cephalexin
amox-clav
nitrofurantoin
NO cipro/TMP-SMX

176
Q

types of solid liver masses

A 
focal nodular hyperplasia
hepatic adenoma
regenerative nodules (eg from cirrhosis)
HCC
liver mets
177
Q

liver tumor with up AFP

178
Q

hemolytic anemia, jaundice, splenomegaly

A

hereditary spherocytosis

179
Q

dx: hereditary spherocytosis

A

fragility?
acidified glycerol lysis
eosin-5-maleimide binding test

180
Q

tx: warfarin associated intracerebral hemorrhage

A

vit K (takes 12-24 hrs)
prothrombin complex concentrate (PCC) (mins + hours)
FFP if PCC not available

181
Q

tx: polymyalgia rheumatica

A

low dose glucocorticoids

182
Q

biggest RF for pancreatic cancer

183
Q

PTH and Ca levels in familial hypocalciuric hypercalcemia

A

high Ca but normalish PTH (mutation of Ca sensing receptor needs way high levels to adjust PTH)

184
Q

familial hypocalciuric hypercalcemia vs primary hyperparathyroidism

A

use urine Ca/Cr clearance ratio (UCCR)
(CaU/CaS)/(CrU/CrS)
< 0.01 = FHH
> 0.02 = primary hyperparathyroidism

185
Q

tx: peritonsillar abscess

A

needle aspiration
IV Abx
surgery if its huge/can’t be aspirated

186
Q

HTN pt with thunderclap HA, N/V/photophobia

A

non-traumatic SAH

187
Q

RFs for PACs

A

smoking, EtOh, coffee, stress

188
Q

cupping of the optic disc

A

open angle glaucoma

189
Q

preterm infant supplements

A

may need iron earlier

190
Q

dx: suspected malignancy –> LBP

191
Q

calcification of articular cartilage

A

think pseudogout

192
Q

pseudogout aka

A

acute calcium phosphate arthritis

193
Q

complication post eye surgery (+sx)

A 
postop endophthalmitis (< 6 wks postop)
pain, bad acuity, swollen eyelids, conjunctiva
194
Q

ball mass: peritoneal fluid collection btwn layers of tunica vaginalis

195
Q

ball mass: changes size w/ laying down/valsalva, doesn’t transilluminate

A

varicocele

196
Q

ball mass: painless mass @ superior pole, transilluminates

A

spermatocele

197
Q

tx: varicocele

A

young: gonadal vein ligation

old, don’t want kids: scrotal support + NSAIDs

198
Q

drugs for EtOH addiction

A

naltrexone: down cravings, enjoy drinking less, ok if still drinking
acamprosate: maintain abstinence
disulfiram: makes you sick if you drink

199
Q

fever, severe/focal back pain, neuro sx

A

think spinal epidural abscess

200
Q

MCC spinal epidural abscess

A

staph aureus (distant infxn, IVDA, spinal procedure)

201
Q

facial palsy: peripheral vs central

A 
peripheral = Bells = Both top and bottom droop
Sentral = Spares top
202
Q

when can you quad screen

A

15 - 22 wks

203
Q

what preg screening can you do @ 10 wks

A

cell-free fetal DNA
CVS
PaPP, beta HCG, nuchal translucency

204
Q

mutation @ fibrillin-1 gene

205
Q

mutation @ fibrillin-2 gene

A

congenital contractural arachnodactyly

206
Q

recent URI with persistent cough w/ yellow/blood tinged spututm

A

bronchitis

cough > 5 days

207
Q

when do you give rhogam

A 
28 - 32 wks
< 72 hrs after delivery
< 72 hrs after abortion
2nd/3rd TM bleeding
CVS/amnio
208
Q

how to tell if diarrhea is osmotic vs secretory

A

stool osmotic gap
= plasma osm - 2x (stool Na + stool K)
elevated (> 125) = osmotic
low (< 50)= secretory

209
Q

diarrhea: large daily stool volumes, or diarrhea that occurs during fasting or sleep

210
Q

diarrhea: lactose intolerant

211
Q

diarrhea post bowel resection or chole

212
Q

acute renal failure, fever, rash

213
Q

drugs that cause AIN

A

PCN
cephalosporins
TMP-SMX
NSAIDs

214
Q

biggest RF aortic aneurysm and rupture

215
Q

dx: wilms tumor

A

abd u/s

CT abd/chest (check for mets)

216
Q

wilms tumor vs neuroblastoma

A

kidney vs adrenal
usually asx vs sx
neuroblastoma crosses the midline

217
Q

mcc cancer in first year of life

A

neuroblastoma

218
Q

iron studies in thalassemia

A 
(exactly opposite iron def anemia)
iron up
TIBC down
ferritin up
transferrin sat up
219
Q

a/w myasthenia gravis

220
Q

what happens if you fix the folate but not the B12

A

neuro sx (but megaloblastosis is fixed)

221
Q

tx: CKD anemia

A 
EPO
iron dextran (good for HD)
222
Q

lady stuff + liver things

A

think Fitz-Hugh-Curtis

223
Q

how does TB cause acid-base problems

A

TB –> addisons –> aldo def –> non-gap HK hNa acidosis (retain H+s)

224
Q

which fibers involved in DM neuropathy

A

small fiber = (+) sx (pain, paresthesias)

large = (-) sx (numbness, loss of proprio)

225
Q

PE: severe AS

A

pulsus parvus et tardus
mid- to late- peaking systolic murmur
soft single second heart sound

226
Q

sunburst pattern in bone

A

osteosarcoma

227
Q

onion skin bone

A

ewing sarcoma

228
Q

codman triangle in bone

A

osteosarcoma

229
Q

positive prussian blue stain

A

hemosiderin

230
Q

renal papillary necrosis a/w

A

sickle cell

231
Q

kid: hemolytic anemia, thrombocytopenia, acute kidney injury

232
Q

haptoglobin in hemolytic anemia

A

decreased (it’s busy picking up all the Hgb floating around)

233
Q

complications of PBC

A

malabsorption (fat sol vit)
metabolic bone dz (osteoporosis, osteomalacia)
HCC

234
Q

schizoid vs avoidant PD

A

schizoids are happy, are loners on purpose

avoidants actively avoid due to fear of rejection/criticism

235
Q

screening test for GC/Chlam

A

nucleic acid amplification test (NAAT)

236
Q

supracondylar frx MC complication

A

entrapment of brachial artery and median nerve

237
Q

when do you get Volkmann contracture

A

compartment syndrome from simultaneous supracondylar and forearm frx

238
Q

back pain with extensive motor and sensory loss, absent rectal tone, urine retention

A

think acute spinal cord compression

depending on sensory could be cauda equina

239
Q

back pain with bladder/rectal dysfxn

A

conus medullaris

240
Q

back pain (radicular) w/ saddle anesthesia, weakness and bowel/bladder dysfxn

A

cauda equina syndrome

241
Q

suspected orgs in osteomyelitis after UTI

A

klebsiella

pseudomonas

242
Q

illnesses that affect anterior horn

A

spinal muscular atrophy (infants)
polio
ALS

243
Q

dz of NMJ

A

botulism
myasthenia gravis
lambert eaton
organophosphate poisoning

244
Q

fungal infection with pancytopenia

A

think disseminated histo (HIV pts)

245
Q

tx: histoplasmosis

A

disseminated: amphotericin B (then itraconazole for maintenance)
normal: itraconazole

246
Q

tx: aspergillosis

A

disseminated: amphotericin B
normal: voriconazole

247
Q

tx: cryptococcus

A

flucytosine and amphotericin B

fluconazole for maintenance

248
Q

tx: coccidioidomycosis

A
  • conazoles for normal

disseminated: amphotericin B

249
Q

tx: mucormycosis

A

amphotericin B

250
Q

mgmt: suspect scaphoid frx

A
  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
Q

tx: syphilis (pt has severe PCN allergy)

A

primary: doxy x 14
secondary: doxy x 14
latent: doxy x 28
tertiary: ceftriaxone x 14
preggo: desensitize then PCN

252
Q

knee injury “popping” sensation and rapid onset hemarthrosis

253
Q

knee injury “popping” sensation but feel ok

254
Q

genetics for HCM

255
Q

what does valsalva do to heart

A

down preload

256
Q

what does squatting do to heart

A

up preload

up afterload

257
Q

complication of pernicious anemia (besides anemia sx)

A

gastric cancer

258
Q

murmur, BP diff in arms

259
Q

parasite causes liver cysts

A

echinococcus granulosus (dogs/sheep)

260
Q

parasite causes liver abscess

A

entamoeba histolytica

261
Q

parasite causes hematuria/bladder CA

A

schistosoma haematobium

262
Q

joint problems in rheumatic fever

A

migratory arthritis

263
Q

JONES in rheumatic fever

A 
joints
<3 carditis
nodules
erythema marginatum
sydenham chorea
264
Q

tx: hyperosmolar hyperglycemic state

A

IVF (start with NS)
IV insulin (regular)
give K as needed

265
Q

MC complication of sickle cell trait

266
Q

sickle cell trait vs dz (Hgb electrophoresis)

A

trait: 50 - 60% Hb A; 35 - 45% Hb S, < 2% F
dz: 0% A, 85 - 95% S, 5 - 15% F

267
Q

hormones in PCOS

A

T up (or norm)
E up
LH (up or norm)/ FSH imbalance

268
Q

tx: tinea capitis

A

oral griseofulvin or terbinafine

269
Q

cancer pain treatment ladder

A

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
Q

shin splints vs stress fractures

A

diffuse vs point tenderness

271
Q

bone pain, deformity, mixed lytic/sclerotic lesions

A

think Paget’s

272
Q

levels in pagets

A

Ca, Phos normal
alk phos high
urine hydroxyproline high

273
Q

aplastic anemia, weird thumbs, cafe au lait spots (or hyper/hypo pigment), strabismus, ear problems

A

fanconi anemia

274
Q

general muscle weakness, ptosis, difficulty swallowing, dyspnea

A

myasthenic crisis

275
Q

meds that can start myasthenic crisis

A

aminoglycosides
FQ
macrolides
BB

276
Q

anticoag post stroke

A

< 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
Q

OCP AEs

A

DVT
HTN
hepatic adenoma
rare: stroke/MI

278
Q

Nikolsky sign

A

easy separation of epidermis (pemphigus vulgaris)

279
Q

immunofluorescence vulgaris vs pemphigoid

A

vulgaris: chicken wire intracellular IgG/C3
pemphigoid: linear IgG @ BM

280
Q

biggest RF for preterm birth

A

previous preterm birth

281
Q

cervix things that increase risk of preterm birth

A

short cervix
cold knife conization
LEEP (maybe)
laser ablation DOES NOT

282
Q

pus in mediastinum post surgery

A

acute mediastinitis (prob from intraoperative contamination)

283
Q

tx: acute mediastinitis

A

drainage, surgical debridement, closure, prolonged Abx

284
Q

uncomplicated vs uncomplicated acute pylo

A

uncomp: otherwise healthy (+ not preggo); usually e. coli
comp: old, septic, DM, urinary obstruction, immunosuppressed, got in hospital

285
Q

tx: uncomp vs comp pylo

A

uncomp: oral FQs
comp: IV FQ, aminoglycoside, etc. after 48 hrs improved, they can be switched to culture-guided orl abx

286
Q

corrected Ca level

A

Ca + 0.8 x (4 - alb)

287
Q

unvaccinated person exposed to hep B

A

gets HB immunoglobulin and vaccine

288
Q

empiric Abx for bacterial meningitis: groups

A

2 - 50
>50
immunocompromised
neurosurg/penetrating trauma

289
Q

empiric Abx for bacterial meningitis: 2 - 50

A

vanc + 3rd gen cephalosporin

290
Q

empiric Abx for bacterial meningitis: > 50

A

vanc + 3rd gen cephalosporin + ampicillin

291
Q

empiric Abx for bacterial meningitis: immunocompromised

A

vanc + amp + cefepime

292
Q

empiric Abx for bacterial meningitis: neurosurg/penetrating trauma

A

vanc + cefepime

293
Q

joints: morning stiffness, better by afternoon

294
Q

joints: worse as day goes on

295
Q

RA: which joints

A

small
knees, elbows later
cervical spine can –> spine subluxation

296
Q

dx: spinal stenosis

297
Q

back pain better with activity/hot showers

A

ankylosing spondylitis

298
Q

HIV pt: ring enhancing lesions w/ edema

299
Q

HIV pt: unilateral temporal lobe-enhancing lesion w/ mass effect

A

HSV encephalitis

300
Q

HIV pt: well-defined, enhancing focal lesion

A

primary CNS lymphoma

301
Q

HIV pt: white matter lesions w/o enhancement or edema

A

progressive multifocal leukoencephalopathy (JC virus)

302
Q

most effective dating method/time (gestational age)

A

crown-rump length @ 7 - 10 wks (first TM)

303
Q

kidney problem a/w renal vein thrombosis

A

membranous glomerulopathy

304
Q

most sensitive test for achalasia

305
Q

tx: aspiration pneumonia

A

clindamycin
MTZ w/ amoxicillin
amox-clav
carbapenem

306
Q

tx: pancreatic pseudocyst

A

asx: do nothing

sx/complications: endoscopic drainage

307
Q

hos often do you do a lipid panel

308
Q

MC leukemia in US

309
Q

dx: midgut volvulus

A

biliary vomiting –> abd x-ray
no free, air, dilation, double bubble –>
upper gi series (barium swallow)

310
Q

tx: midgut volvulus

A

Ladd procedure

311
Q

tx: catatonia

A

benzos

ECT

312
Q

labs in diuretic abuse

A

hyponatremia
hypokalemia
hypochloremia
up urine Na, K

313
Q

mgmt: suspect SLE

A

get ANA

if (+) get anti-dsDNA

314
Q

how can mechanical ventilation –> cardiac arrest

A

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
Q

mouth pain, drooling, tongue displaced up

A

ludwig angina (cellulitis of submandibular space)

316
Q

tx: ludwig angina

A

IV abx, remove offending tooth

317
Q

paCO2 and brain swelling

A

hyperventilation –> down CO2 –> down blood flow to brain –> decreases ICP

318
Q

methods to unswell a brain

A 
head elevation
sedation
hyperventilation
remove CSF
mannitol (osmotic)
319
Q

anti-dopa drugs: where do they show effects

A

mesolimbic: antipsych
nigrostriatal: EPS
tuberoinfundibular: hyperprolactinemia

320
Q

reasons to start clozapine

A

tx refractory schizo

schizo a/w suicidality

321
Q

best studies to compare incidence

322
Q

mgmt: short cervix (with no previous preterm)

A

vaginal progesterone

323
Q

mgmt: short cervix (with previous preterm)

A

IM progesterone @ 2nd TM
serial TVUS to check for short
short –> cerclage

324
Q

tylenol before vaccines?

A

stoppit

doesn’t prevent fever/seizures and may make vaccine less effective

325
Q

cyanosis, pulse ox ~ 85, chocolate blood

A

methemoglobinemia

326
Q

methemoglobinemia labs

A

pulse ox low and doesn’t move w/ O2

PaO2 is normal (overestimates)

327
Q

tx: methemoglobinemia

A

methylene blue

328
Q

whats on the biophysical profile (+norm)

A 
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
Q

when do you deliver based on biophysical profile

330
Q

whats cradle cap

A

seborrheic dermatitis

331
Q

fetal demise with limb fractures, hypoplastic thoracic cavity

A

osteogenesis imperfecta (II)

332
Q

dx: pancreatic cancer

333
Q

multiple myeloma: path

A

monoclonal plasma cell proliferation

not enough IgG –> infections

334
Q

tenderness at tendon insertion points (and a/w)

A

enthesitis (see in ankylosing spondylitis, psoriatic arthritis, reactive arthritis)

335
Q

hemochromatosis at risk for

A

HCC

infections: listeria, vibrio vulnificus, yersinia enterocolitica

336
Q

acid base protracted vomiting

A

hypochloremic
hypokalemic
metabolic alkalosis

337
Q

kid: hip/knee pain with antalgic gait and thigh muscle atrophy

A

Legg-Calve Perthes (avascular necrosis of femoral capital epiphysis)

338
Q

INH liver injury

A

worse in old, drinkers and pts with other liver problems

usually self limited

339
Q

tx: acute angle glaucoma

A

mannitol, acetazolamide, pilocarpine or timolol

NOT atropine or other mydriatic agents

340
Q

mass: makes AFP and betaHCG

A

nonseminomatous germ cell tumors

341
Q

what do you need to check with low calcium

342
Q

WTF is mixed cryoglobulinemia syndrome

A

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
Q

mgmt: blunt GU trauma

A
  1. UA
    2a. stable w/ hematuria –> CT w/ contrast
    2b. hemodynamically unstable –> IV pyelography then surgical eval
  2. consider bladder/pelvis stuff too
344
Q

what can you give cholelithiasis pts if they’re poor surgical candidates

A

ursodeoxycholic acid

345
Q

when does elective chole tx change to chole in next 72 hrs

A

acute cholecystitis
choledocholithiasis
gallstone pancreatitis

346
Q

tx: symptomatic bartholin cyst

A

I&D

Word catheter

347
Q

dx: endometriosis

A

laparoscopy (usually don’t need definitive dx)

348
Q

risks of endometriosis

A

infertility

349
Q

age for kawasaki’s

A

< 5

peak: 18 - 24 mo

350
Q

criteria for kawasaki’s

A

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
Q

complications of kawasaki

A

coronary artery aneurysm

MI

352
Q

baby: inspiratory stridor worse when supine, better when prone

A

laryngomalacia

353
Q

tx: laryngomalacia

A

usually resolves
can give PPIs for reflux
supraglottoplasty for severe sx

354
Q

SLE CNS effects (who knew?)

A

psych

seizures, neuropathy, strokes, chorea

355
Q

elevated total T4 with normal TSH - how

A

increased TBG

causes: estrogens (OCPs), liver problems, meds

356
Q

complications of giving NE (pressors)

A

NE vasospasm:

  • ischemia of distal fingers/toes
  • mesenteric ischemia
  • renal failure
357
Q

how to know if a metabolic alkalosis is responsive to saline

A

urine Cl < 20

358
Q

saline responsive causes of metabolic alkalosis

A 
vomiting
NGT
diuretics
laxative abuse
low oral fluid intake
359
Q

tx: fibromyalgia

A

1st: aerobic exercise and good sleep hygiene
then TCAs
then if TCAs don’t work – duloxetine, milnacipran or pregabalin

360
Q

fundoscopy: swollen and pale disk with blurred margins

A

giant cell arteritis (temporal arteritis)

361
Q

when do you use a pessary

A

stress incontinence (3rd line)

362
Q

tx: bullous pemphigoid

A

clobetasol (high potency topical glucocorticoid)

363
Q

labs: bulimia vs diuretic abuse/Bartter’s/Gitelman’s

A

all have hypokalemia, alkalosis, normotensive

only bulimia with have low urine Cl

364
Q

when can you not give the NOACs (-xabans)

A

renal failure

DVT/PE from malignancy

365
Q

pleural fluid pH: exudative vs transudative (also, normal)

A

normal: 7.6
transudative: 7.4 - 7.55
exudative: 7.3 - 7.45 (empyemas go < 7.3)
more crap, more acid!

366
Q

best way to reverse DCM from EtOH

A

stop drinking!

367
Q

complications on vesicoureteral reflux

A

renal scarring

368
Q

infective endocarditis org: MC nosocomial

A

staph aureus

369
Q

infective endocarditis org: MC community acquired

370
Q

infective endocarditis org: nosocomial w/ UTI

A

enterococci

371
Q

infective endocarditis org: resp tract bx

A

strep viridans

372
Q

infective endocarditis org: prosthetic valves/IV catheters

A

think staph aureus or staph epidermidis

373
Q

who do you defibrillate (not cardiovert)

A

VF

pulseless VT

374
Q

MC org: parotitis

A

staph aureus

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