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STEP 2 CK! > UWORLD > Flashcards

UWORLD Flashcards

1
Q

conduct disorder

A

(can turn into antisocial disorder once >18)
patterns of behavior that violate the social rights of others with o sign of remorse. They destroy property, seal, get arrested and run away from home and they are <18

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2
Q

Conduct Disorder

A

angry and irritable teenager who is angry towards authority figures. They are normal with their peers but they are aggressive towards adults. They do not actually break he law

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3
Q

describe femoral neck stress fracture

A

this is a common fracture in adult athlete runners when they train extensively. Pain will be worse with activity and with passive internal and external rotation

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4
Q

vitamin d deficiency can cause what bone problem and why

A

it can cause osteomalacia due to low vitamin d levels from malabsorption, intestinal bypass, celiac or chronic liver/kidney disease.

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5
Q

thinning of the bone cortex and pseudo fractures is seen in what diagnosis

A

osteomalacia

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6
Q

CAlcium: low
Phosphorus: low
PTH: High

A

this is vitamin D deficiency that is why both calcium and phosphorus are low while PTH is high

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7
Q

hepatorenal syndorme

A

this is when there is cirrhosis which causes a generalized vasodilation and that decreases the amount of perfusion to the kidney which makes the kidney turn on renin (thinking that there is low blood volume) which further increases water retention, worsening the vasodilation.

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8
Q

Lateral Medullary infarct, due to blockage of the vertebral arteries that causes falling of the patient to the side of the lesion, nystagmus, loss of pain and temperature on the ipsilateral face and contralateral limb and difficulty sitting without support

A

Wallenberg Syndrome

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9
Q

How do oxalate forms stone

A

patients with malabsorption issues like celiac cannot correctly absorb calcium. Calcium is usually bound to oxalate, but when there is a lot of fat present in the colon, calcium binds this instead of oxalate, leaving oxalate to build up in the system firming stones

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10
Q

what med would you give to a patient who needs pain relief on a daily basis

A

transdermal Fentanyl patch

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11
Q

opiod addicts who require pain management after breaking a limb or intense surgery should receive what kind of analgesic

A

they should receive the same opioid management that others would get

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12
Q

HBsAg+ IgM anti-HBc

A

acute hep b infection

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13
Q

anti-HBs + anti-HBe + antiHBc

A

recovery stage of HEP B

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14
Q

copper deficiency presnets with

A

brittle hair, skin depigmentation, osteoporosis, sidereoblastic anemia and peripheral neuropathy

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15
Q

selenium deficiency presents with

A

`thyroid, cardiac and immune problems

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16
Q

who can get a cholesterol emboli

A

patients with high cholesterol who undergo PCI, it will cause lived reticular, acute kidney injury, acute pancreatitis and mesenteric ischemia

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17
Q

High dose IV Acyclovir can cause?

A

Acute kidney injury because in high doses it causes crystalurria because it has poor ruin solubility which leads to renal tubular obstruction

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18
Q

a bright red rash around the anus of a child that is associated with fissures, pain and bleeding, and a possible contact who had a strep infection

A

Strep Perianal Dermatitis

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19
Q

a man from south America eats undercooked pork meat and experiences seziures

A

neurocysticercosis

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20
Q

treatment for neurocysticercosis

A

albendazole and phenytoin for the seizure

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21
Q

when on lithium always check what

A

thyroid levels

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22
Q

constant depression for more than 2 years without more than 2 months of no depression

A

persistent depressive disorder

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23
Q

more than 2 years of periods of both hypomania and depression

A

cyclothymic disorder

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24
Q

MEN 1

A

parathyroid
pancras
pituitary

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25
Q

MEN 2A

A

parathyorid
medullary thyroid CA
pheochomocytoma

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26
Q

MEN 2B

A

mucosal/neuroma tumors
medullary thyroid CA
pheochromocytoma

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27
Q

von hippel lindau presents with?

A

hemangioblastoma, renal cell clear cell CA, pheochromocytoma and pancreatic neuroendocrine tumors

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28
Q

if you suspect cervical ca in a pregnant woman how do you manage this

A

first do a colposcopy to visualize the cervix, if there is nothing wrong then leave them alone BUT if there is CIN then you would do a LOOP.

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29
Q

what is the treatment for warts (HPV 6 and 11)

A

trichloroacetic acid

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30
Q

what can causes a reticulocyte count <1% in a sickle cell patient

A

parvovirus B19 ( there may be no sign of viral symptoms, don’t let this throw you off)

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31
Q

what drug has a low risk of hypoglycemia, is weight neutral and can be used in CKD

A

DPP-4 drugs (sitagliptin)

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32
Q

what drugs cause weight loss, decrease the risk of hypoglycemia and are the second line agent to use after metformin

A

GLP-1 drugs (exenatide)

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33
Q

iron poisoning, give

A

deferoxamine (Un-do-the iron-from-me)

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34
Q

copper top, give? (Wilsons)

A

penicillamine

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35
Q

TCA overdose, give

A

sodium bicarb

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36
Q

torsades de pointes, give?

A

magnesium

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37
Q

lithium toxicity, do?

A

dialysis

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38
Q

lead poisoning, give?

A

calcium EDTA

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39
Q

hyperkalemia, give?

A

calcium gluconate (Cardioprotective)

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40
Q

mild lead poisoning can be treated with

A

oral succorer

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41
Q

heparin toxicity, treat with

A

protamine sulfate

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42
Q

marfan’s is associated with what heart complication

A

aortic dissection and aortic regurgitation

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43
Q

causes of bronchiectasis

A

decreases clearance of the lungs (antitrypsin def, or CF) or repeated infections

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44
Q

purulent sputum and hemoptysis and a chronic cough are the sxs of

A

bronchiectasis

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45
Q

you suspect bronchiectasis, what is first management step

A

CT scan, shows bronchial wall thickening

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46
Q

tanner 1

A

<10

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47
Q

tanner 2

A

10-11.5, breast buds

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48
Q

tanner 3

A

prepubescent (13-15

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49
Q

tanner 4

A

puberty (13-15)

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50
Q

tanner 5

A

adult (>15)

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51
Q

tx for HSV encephalitis

A

acyclovir IV

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52
Q

Acute interstitial nephritis takes how many days to form and what are the common causes

A
  • 7-10 days

- causes by drugs like penicillin, beta lactam drugs

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53
Q

what is a characteristic lab that you HAVE to see for the dx to be AIN

A

eosinophils

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54
Q

beefy red rash in the genital region of a child or baby that is present in the SKIN FOLDS and has SATELLITE lesions

A

candida

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55
Q

causes itching in the anal region at night in children and there is no perianal erythema present, what is the dx

A

pinworms ( Echinoccus Vermicularis)

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56
Q

what is the transmission of Neurocystercosis

A

parasitic eggs in contaminated food and water (fecal oral transmission)

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57
Q

in order to have toxo encephalitis the CD4 has to be?

A

<100

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58
Q

multiple ring enhancing lesions in an HIV patient with a CD4<100

A

toxoplasma encephalitis

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59
Q

a patient who is being treated for OM but seems to be having worsening ear pain, headaches upon wakening and vomiting in the morning as well as pain in the temple/neck or swollen mastoid is suspicious for

A 
Brain abscess (morning HA and vomiting should clue into this) OM and Mastoiditis are risk factors for brain abscess 
DX Brain Abscess: CT Scan 
* do this before you do a mastoidectomy
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60
Q

a teenager is recently diagnosed with schizophrenia and the dad wants to know how to make sure their life is the same, what do you advise

A

family therapy (to minimize stress for the patient)

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61
Q

who is psychodynamic therapy for

A

this is used for patients who need to tap into the unconscious patterns that may have begun in childhood that cause anxiety (rape, abuse)

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62
Q

how do you differentiate cryptococcal infection vs. toxo infection in an aids patient

A

cryptococcal won’t have any brain lesions

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63
Q

what diseases has ventricular enhancement and micronodules but no ring enhancing lesions

A

cmv encephalitis

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64
Q

what is a complication to watch out for on hydroxycholorquine

A

Retinal Toxicity, make sure to get serial eye exams in these patients because blindness can occur after 5 years

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65
Q

what baseline exam should you get when starting hydroxychloroquine

A

basic eye exam

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66
Q

what are the adverse effects of amiodarone

A

hyper/hypothyroidism

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67
Q

what lab work do you order when someone is on amiodarone

A

thyroid levels

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68
Q

13 yo with delayed growth, short stature, delayed puberty with tall parents, dad has a hx of slow puberty onset

A

constitutional growth delay

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69
Q

management for constitutional growth delay

A

follow up in 6 months don’t give hormones or they will not grow to their full potential

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70
Q

how to differentiate hypothyroidism from constitutional growth delay

A

hypothyroidism would also have signs of brittle hair, fatigue, constipation and cold intolerance in addition to the shorter height

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71
Q

how to tx first degree heart block

A

atropine

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72
Q

how to treat mobitz type 1 (stable)

A

atropine

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73
Q

how to treat mobitz II

A

pacemaker

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74
Q

how to treat 3rd degree heart block

A

pacemaker

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75
Q

continuous prolongation of the PR interval leading to a dropped QRS

A

MObitz type 1

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76
Q

random drop of QRS without any prolongation of pr interval

A

MOBITZ II

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77
Q

QRS waves and pr don’t match up at all

A

3rd degree heart block

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78
Q

how do you treat someone with dvt and ESRD

A

unfractioned heparin ( it is not metabolized through the kidney, LMWH is) and then bridge to warfarin

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79
Q

what are causes of fetal RDS

A

maternal diabetes can cause fetal hyperglycemia and this will cause an increase in insulin. Insulin decreases cortisol therefore decreasing

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80
Q

a man with hx of pyelonephritis, current pyuria a new murmur and janway lesions

A

infective endocarditis due to enterococci

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81
Q

bacteria associated with infective endocarditis with utilization history

A

enterococci

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82
Q

s. epidermis is associated with what kind of infective endocarditis

A

indwelling catheters

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83
Q

what infection causes Q fever

A

Coxiella Burnetti

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84
Q

what is an adverse side effect of OCP

A

tworsening HTN because it increases the risk for thromboembolism, stoke and MI

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85
Q

what are the two things that are decreased with the use of OCP

A

the chance of endometrial cancer (progesterone keeps the endometrium from being stimulated by estrogen) and ovarian cancer due to decreased ovulation

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86
Q

hyper echoic breast mass with a biopsy that shows foamy machrophages, the patient has a hx of a double mastectomy, what is the diagnosis and how do you manage it

A
  • fat necrosis of the breast which is common after surgery or trauma, the mass will be firm and calcified
  • management includes reassurance and f/u
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87
Q

HUS occurs after what kind of infection

A

E.Coli 0157 diarrhea

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88
Q

what are the sxs of HUS

A

acute kidney injury, thrombocytopenia, microangiopathic hemolytic anemia

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89
Q

autoimmune hemolytic anemia will show…

A

schistocytes

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90
Q

what is decreased in CKD and shows burr cells on smear

A

EPO

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91
Q

what is the most common brain tumor in children

A

pilocytic astrocytoma

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92
Q

what are the infratentorial tumors that are in children and present with ataxia

A

craniopharyngeoma, ependymioma, medulloblastoma

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93
Q

what are the child tumors that occur in the ventricles and spinal cord (mainly 4th ventricle)

A

ependymoma

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94
Q

can HCV patients breastfeed

A

yes, it doesn’t transmit the virus (only don’t breast feed if there is bleeding in the nipple)

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95
Q

what are the medication treatments for hep c

A

ribacvarin and interferon

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96
Q

what determines the transmission of Hep C

A

the viral load, not delivery

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97
Q

what is the difference between eczema herpaticum and impetigo

A

Eczema herpeticum is an HSV superimposed infection on someone with atopic dermatitis, it will present with painful vesicles on an erythematous base and will have LAD

Impetigo is due to staph (bullous) or strep and it will show yellow crusting, instead of the hemorrhagic crusting seen in e. herpeticum, and there will be no LAD

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98
Q

trichophyton ruburm (tinea) more commonly happens in patients who have?

A

atopic dermatitis

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99
Q

what is the 1st step in management in a patient with PROM <34 weeks, fetal compromise with an unknown GBBS

A
  1. Antibiotics
  2. Steroids
  3. Magnesium (<32 weeks) “neuroprotective”
  4. DELIVER!!
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100
Q

what is the 1st step in management in a patient with PROM <34 weeks, NO fetal compromise with an unknown GBBS

A
  1. Antibiotics
  2. Steroids
  3. Fetal Surveillance (do not immediately deliver, give the baby more time)
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101
Q

what is the 1st step in management in a patient with PROM 34-37 weeks, with an unknown GBBS

A
  1. Antibiotics
  2. Steroids
  3. DELIVER!!!!
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102
Q

When should amnioinfusion be used

A

where there is variable deceleration (indicating umbilical cord compression) DURING labor

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103
Q

do you use amnioinfusion when there is PROM?

A

NO

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104
Q

how do you manage a fetus that is in a transverse lie before 37 weeks

A

expectant management with an US at term to determine the fetal presentation
- by term (37 wks) most babies spontaneously rotate into a longitudinal lie (Cephalic Presentation) head toward the cervix

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105
Q

when can external cephalic version be reformed

A

only AFTER 37 weeks (most preterm babies, <37 weeks will spontaneously turn)

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106
Q

why should you not perform an external cephalic version before 37 weeks

A

there is a large risk of PROM and abruptio placenta

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107
Q

what is “Shock Liver” ?

A

this is when a patient is very hypotensive to the point that they need many transfusions and they develop Ischemic Hepatic Injury

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108
Q

what are the clinical clues in ischemic hepatic injury

A

rapid elevated trasnaminiases (in the thousands)

- liver enzymes return to normal within 1-2 weeks

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109
Q

AST seen in alcoholic liver will usually be around what ranged

A

<300

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110
Q

what patient usually gets autoimmune hepatitis

A

women (young)

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111
Q

granulomatous liver diseases due to sarcoidosis and tb will show chronic hepatic damage but NOT?

A

massive elevations in transaminase

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112
Q

why do OCP cause HTN

A

because of the effects of estrogen on the liver which increases how much angiotensin the liver makes

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113
Q

a 3o year old woman with HTN after being on an OCP for years, what do you do

A

stop the OCP

  • do not do a CT angiogram of the abdomen (only do this in difficult to control HTN)
  • only coach diet and exercise if you take the patient off the OCP and they still have HTN after a year
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114
Q

a patient who has a reaction to a bee sting who receives epinephrine but is still having hives, wheezing and vomiting should receive what med

A

another does of IM epi

-steroids is not the answer, they decrease inflammation but they have a delayed onset of action

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115
Q

what can an allergist give a patient with hymenoptera sting allergy to reduce the risk of repeat insect sting anaphylazxis

A

venom immunotherapy

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116
Q

what is the only antidepressant advised for use in the pediatric population

A

SSRI

-not bupropion, venlafaxine, or mirtazipine

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117
Q

what is the MOST common predisposing factor for an acute bacterial sinusitis

A

a viral upper resp infection, because the bacteria cannot be cleared due to the inflammation from the viral infection which leads to a secondary viral infection

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118
Q

first line treatment for sinusitis

A

amoxicillin plus clavulonic acid

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119
Q

longitudinal tears at the gastroesophageal junction that are present when there is increased intrabdominal pressure like retching

A

Mallory Weiss tear

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120
Q

stress gastritis is usually seen when

A

in ICU patients or Burn victims

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121
Q

what is Tick Paralysis

A

this is when a tick is attached for 4-7 days and it causes a progressive ascending paralysis over hours to days and it can be more pronounced in 1 leg or arm. There is a normal CSF exam and NO fever and no autonomic dysfunction (tachycardia, urinary retention) like in Guillan Barre

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122
Q

what is the next step in management if tick paralysis is suspected

A

meticulous search for the tick - removal usually results in improvement within an hour and complete recovery in several days

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123
Q

what is the paralysis pattern in botulin positing

A

descending paralysis and early cranial nerve involvement (pupil problems)

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124
Q

signs of theophylline toxicity

A

headache, insomnia, seizures, nausea, vomiting and arrhythmia

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125
Q

meds that cause theophylline toxicity

A
  • cipro
  • verapimil
  • eryhtromycin
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126
Q

theophylline is cleared through the ________ so problems with this organ can cause toxicity

A

liver

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127
Q

flumazinil is given for overdose with

A

benzo

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128
Q

explain the findings in Brown Sequard Syndrome

A
  • ipsilateral hemiparesis
  • diminished proprioception, vibration and light touch on ipsilateral side
  • CONTRALATERAL loss of pain and temperature 1-2 levels BELOW the lesion
    (a lesion at T8 will have LST problems at T10 and below)
  • use where the LST problems are to determine what dermatome area was injured (it will be two above)
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129
Q

symptoms of anterior cord syndrome

A
  • loss of pain and temperature and motor function on BOTH sides
  • proprioception, light touch and vibration are intact because they are in the posterior cord
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130
Q

biggest risk factor for antiphospholipid syndrome is

A

SLE

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131
Q

Antiphospholipid can have a false positive ___ and why

A

RPR the RPR testing for syphilis also contains cardiolipin

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132
Q

two antibodies seen in antiphosphoilipd syndrome

A

anticardiolipin and anti-beta2 glycoprotein-1

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133
Q

1 kg loss of weight in a baby, equals how much fluid loss

A

1L

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134
Q

how do you manage a child or baby who is dehydrated and needs fluid replacement

A 
with isotonic (normal) saline only! 
- don't give d50 because first you need to fix the dehydration, then you can give dextrose later for maintenance
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135
Q

a cyanotic newborn with left axis deviation, and small/absent R waves should make you think

A

Tricuspid Atresia

  • normal babies have a R axis deviation because the systemic circulation relies on the Right heart when the patent ductus is still open
  • L axis deviation means that the right heart is hypo plastic
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136
Q

hypo plastic right ventricle and the underdevelopment of the pulmonic valve and artery is what dx?

A

tricuspid Atresia (hypo plastic Heart syndrome)

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137
Q

IN tricuspid atresia, there is a decreased amount of blood moving into the r ventricle which causes under circulation of the lungs, what will this show on X ray

A

CXR: decreased pulmonary markings

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138
Q

what is necessary for a baby to live with Tricuspid Atresia

A

ASD and VSD so that O2 blood will mix with deoxygenated blood to provide some oxygen rich blood to the circulation

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139
Q

Tricuspid valve atresia is common in patients with

A

a hx of congenital heart disease in the family

140
Q

what condition has a defect that causes there to be an opening between both ventricles and their atriums, leading to cardiomegaly and excessive pulmonary blood flow

A

Complete atrioventricular canal defect

141
Q

what are CXR findings in complete atrioventricular canal defect

A

increased pulmonary markings (because the atrium and ventricles are connected so more blood goes through the pulmonic artery)

142
Q

right atrial enlargement because of the displaced tricuspid valve into the right ventricle

A

Ebsteins anomaly

143
Q

Tall p waves and right axis deviation can be seen in what cardiac anomaly

A

Ebsteins Anomlay, because there is R atrial enlargement due to tricuspid regurg, making the right heart bigger

144
Q

what is the difference between tricuspid valve atresia and TEF

A

TEF will have a normal right axis deviation and TVA will have left axis deviation

145
Q

condition where all four pulmonary veins do not connect to the left atrium like they should and instead sends blood to the R atrium

A

total anomalous pulmonary venous return

146
Q

what will ECG show in total anomalous pulmonary venous return

A

right axis deviation sure to R heart hypertrophy from blood coming from the pulmonary veins and from systemic circulation

CXR will show increased pulmonary markings

147
Q

trunks arteriousus is associated with

A

digeorge syndrome

148
Q

both ventricles give blood to both aorta and pulmonic artery

A

truncus arteriosus

149
Q

complete atrioventricular canal defect is associated with

A

downs

150
Q

placental ablution predisposes the mom to??

A

DIC because of the release of tissue factor from the decimal bleeding

151
Q

if you suspect malignancy in the spine, what is the test you should order

A

Plain X Ray films not MRI, because X ray is faster

152
Q

When should you get an MRI of the spine if you think malignancy

A

after you get an X-ray and it is abnormal or ESR is abnormal

153
Q

patients with neurological deficits, epidural abscess and features of caudal equine syndrome (saddle anesthesia, urine retention) should get what diagnostic test

A

MRI of the spine

154
Q

what test should be done in suspected MM in regards to the bones?

A

Skeletal survey, they will show lytic lesions everywhere, don’t get a Bone Scan

155
Q

what is the path in Wiskott Aldrich Syndrome

A

impaired cytoskeleton changes in leukocytes and platelets

156
Q

what are the sxs of Wiskott Aldrich

A

thrombocytopenia
eczema
recurrent infections (bacterial, viral and fungal)

157
Q

tx for wixkott aldrich

A

stem cell transplant

158
Q

x linked recessive defect in WAS gene

A

wiskott aldrich syndrome

159
Q

what is wrong with the WBC in wiskott aldrich

A

the cytoskeleton in the WBC is abnormal which causes immune dysfunction due to impaired cell migration and immune synapses formation

160
Q

what is wrong with the platelets in wiskott aldrich

A

there is a problem with he cytoskeleton making them small and in decreased amounts

161
Q

what is the problem in ataxia telangiectasia

A

there is a deficiency in T cells due to DNA repair problems , patients have cerebellar degeneration and have a high risk for cancer

162
Q

severe T cell deficiency and decreased maturation of t cells in the thymus is seen in

A

SCID

163
Q

New onset of psychiatric and neurological abonormalities accompanied by unexplained abdominal pain is seen in

A

acute intermittent porphyria

164
Q

the common age for acute intermittent porphyria is

A

30-40

165
Q

Acute intermittent porphyria affects

A

the nervous system causing neuropathy, pain in stomach and tachycardia

166
Q

what is elevated in acute intermittent porphyria

A

urinary porphobilinogen

167
Q

what is the most common psychiatric manifestation of Wilsons

A

depression

168
Q

what does copper affect in wilsons

A

liver problems

brain (psychiatric and neurologic) and the eye

169
Q

disorder involving alterations in heme biosynthesis which causes intermittent neurovisceral symptoms

A

Acute Intermittent Porphyria

170
Q

Hepatic Hydrothorax is seen in who

A

patients who have cirrhosis and portal hypertension

171
Q

what is hepatic hydrothorax

A

a pleural effusion that is not due to cardiac or pulmonary problems

172
Q

why does hepatic hydrothorax occur

A

because of small defects in the diaphragm in someone with cirrhosis and portal HTN, causing a transudate fluid in the lung (peritoneal fluid pass into to the pleural space)

173
Q

fever associated with the use of drugs like antibiotics and anticonvulsants take how long to occur

A

1-2 weeks

174
Q

what is the net step for any patient who is suicidal and has a risk of harming themselves if you send them home

A

immediately hospitalize them for close monitoring, you don’t need consent

175
Q

muscle WEAKNESS and elevated CK is seen in

A

polymyositis

176
Q

muscle TENDERNESS of trigger points and a normal CK is seen in

A

Fibromyalgia

177
Q

muscle STIFFNESS and elevated CK as well as an association with giant cell arteries is sen in

A

polymyalgia rehumatica

178
Q

what can neuroinvasive west nile infection cause

A

myelitis, which causes an acute asymmetric flaccid weakness in the lime

179
Q

what do you give to patients with an acute MS attack who are not responding to IV steroids

A

plasma exchange

180
Q

long term disease suppression of MS is treated with

A

interferon beta and galatiramer

181
Q

what is the process called when the right ventricle becomes part of the right atrium due to abstains anomaly

A

atrialization

182
Q

how high do TG need to be to cause acute pancreatitis

A

> 1000 (xanthomas are seen when TG is this high)

183
Q

patients who have a strong family hx of ovarian cancer can be tested using what

A

BRACA1 and 2

184
Q

what is the deficiency in galactosemia that leads to elevated levels of galactose

A

galactose 1 phosphate uridyl transferase

185
Q

patients with galactosemia are at risk for

A

E coli neonatal sepsis

186
Q

baby with cataracts, jaundice, vomiting, failure to thrive and hypoglycemia

A

galactose 1 phosphate uridly transferase deficiny (galactosemia)

187
Q

baby with only cataracts

A

galactokinase deficiency

188
Q

baby with cataracts, jaundice, vomiting, hypoglycemia, neural Deafness, and Hypotonia

A

uridyl diphosphate galactose-4-epimerase deficiency

189
Q

treatment for galactosemia can prevent

A

cirrhosis and mental retardation

190
Q

bacteria that cause reactive arthritis

A
  • salmonlela
  • shigella
  • campy
  • yersinia
191
Q

three causes of Guillan Barre that aren’t camp

A
  • HSV
  • Mycoplasma
  • H Flu
192
Q

breast fed infants have a lower rate of

A

infection (OM, gastroenteritis, UTI and rep infections)

193
Q

breast feeding reduces the risk of which cancers and why

A
  • breast
  • ovarian
  • endometrial
    because of the decreased estrogen exposure
194
Q

tx for otitis externa

A

fluoroquinolone drops (antipseudomonal)

195
Q

what species is involved with otitis that is due to foreign bodies like hearing aids

A

candida

196
Q

what should patients who have a cath done be advised

A

to avoid strenuous activity or lifting heavy things for a week to avoid local hemotoma

197
Q

most cases of spinal epidural abscess are caused by

A

iv drug use spread of infection or cellulitis

198
Q

the tighter the confidence interval the ______ results

A

more precise

199
Q

what is characteristic about the syphilis rash

A

it includes the palms and the soles

200
Q

what is the initial workup for osteomyeltits

A
  • CBC
  • blood culture
  • ESR/CRP
  • plain xray films
201
Q

what is the best diagnostic test for osteomyeltitis

A

MRI of the spine

202
Q

what heart condition is associated with PE

A

Afib

203
Q

tx for IE due to viridian’s strep

A

penicillin G

204
Q

multiple small lesions in the grey white matter junction in the brain of a smoker

A

metatsitc lung cancer

205
Q

diarrhea, LAD, fever, migratory arthritis

A

Whippels disease

206
Q

what condition is uncommon but is seen in patients with Hashimotos and presents with a rapidly enlarging thyroid, firm goiter and compressive symptoms (hoarseness and dysphagia and facial congestion with arm elevation)

A

thyroid lymphoma

207
Q

mild pain and tenderness in the thyroid gland, gland doesn’t move with swallowing

A

thyroid lymphoma

208
Q

what is a large clue that the problem is thyroid lymphoma and not subacute thyroiditis

A

there is retrosternal extension of the tumor which causes venous compression and distended neck veins and facial plethora when the arms are raised because they compress the subclavian between the clavicle and the large thyroid

209
Q

what is redial thyroiditis

A

progressive fibrosis of the thyroid and surrounding tissues

210
Q

thyroiditis that happens after a viral infection and causes fever, neck pain and a tender diffuse goiter

A

subacute thyroiditis

211
Q

thyroiditis that has fever, erythema and severe pain at the thyroid gland often with asymmetric goiter because of an abscess

A

suppurative (infectious) thyroiditis

212
Q

what are the three organs affected by GVHD

A

skin- rash
liver- jaundice
intestine- diarrhea

213
Q

what is the path in GVHD

A

donor T cells are activated against host HLA antigens

214
Q

rejection of the graft is done by

A

the HOST t cells

215
Q

what is the mechanism responbile for Immunoblastic Lymphoma in a patient with a BM transplant

A

virus- induced lymphocyte proliferation due to EBV

216
Q

what is the management for asymptomatic bartholin duct cyst `

A

observation, most drain by themselves

217
Q

management for symptomatic bartholin cyst

A

incision and drainage

218
Q

what is placed to decrease the chance of recurrence after the incision and drainage of a symptomatic bartholin duct cyst

A

word catheter

219
Q

what should be done for women who develop recurrent bartholin cyst

A

marsupialization which is when take the edges of the cyst and attach them to the mucosal edges to increase drainage

220
Q

referring syndrome is mainly due to what hormone

A

insulin

221
Q

describe the path of referring syndrome

A

TPN or carb ingestion after starvation causes the pancreas to release insulin which will decrease phosphorous, potassium and magnesium

222
Q

what is the main electrolyte deficiency in receding syndrome

A

phosphorus ( it is needed for energy)

223
Q

what can refeeding syndrome lead to that is life threatening

A

cardiopulmonary failure (low K and Mg lead to heart problems )

224
Q

what hormones are high during starvation

A

aldo and cortisol (they stimulate water reabsorption )

225
Q

crampy, postprandial epigastric pain, weight loss and an eversion to food is a sign of

A

mesenteric ischemia

226
Q

how do you dx mesenteric ischemia

A

CT angiography

227
Q

in an infant with meningococcemia what should you watch out for

A

waterhouse-friderichsen syndrome (sudden hypotension and skin rash - large purpuric lesions on the flank)

228
Q

what is the most likely cause of death in an infant with meningocococcemia

A

adrenal gland failure

229
Q

decreasing bHCG levels is indicative of

A

demise, like a missed abortion

230
Q

what is febrile neutropenia

A

when the neutrophil count is less than 1500 (20% neutrophils)

231
Q

what is the most common pathogen that can affect someone with febrile neutropenia

A

pseudommonas

232
Q

what is the medication to give if you see a patient with febrile neutropenia (common in chemo patients)

A

pip-tazo (anti-pseudommonal)

233
Q

anti-HBs means

and NO HBsAg

A

immune to HepB

234
Q

glycogen accumulation in the kidneys, liver and intestine in a 3-4 month baby with hypoglycemia

A

Von Gierke Disease (Glucose-6-phosphatase deficiency)

235
Q

what are the signs of glucose-6-phosphatase deficiency

A 
hypoglycemia
seizures
lactic acidosis 
doll-like face 
protuberant belly (hepatomegaly)
236
Q

glucocerebroside accumulation on the bone, liver and spleen macrophages causing cytopenias and bone pain is seen in

A

Gaucher Disease (glucocerecrosidase deficiency)

237
Q

hypoketotic hypoglycemia during fasting (illness)

A

MCAD (can’t break down fatty acids)

238
Q

what is the most common form of PSVT

A

atrioventricular nodal reentrant tachycardia

239
Q

what is the mechanism of cold water immersion on PSVT

A

it increases parasympathetic tone in the heart and slows the conduction in the AV node na increases the refractory period of the AV node

240
Q

what can be done to stop PSVT that sent medication

A
  • cold water
  • pressing on eyeballs
  • valsalva
  • carotid sinus massage
241
Q

how do you treat E histolytic (amebeosis)

A

oral metronidazole (DONT DRAIN)

242
Q

how do you treat Echinococcus cyst (large hydatid cyst)

A

aspiration and albendazole

243
Q

when a person manage unpleasant emotions through acts of service

A

altruism

244
Q

being mad at your dad but instead shouting at your dog

A

displacement

245
Q

attributing ones feelings onto another person

A

projection

246
Q

channeling unacceptable thoughts into impulses that are “socially acceptable” channeling aggression to athletics

A

sublimation

247
Q

what can TMP cause at high doses

A

increased potassium and an artificial increase in Cr

248
Q

tx for minimal change disease

A

steroids

249
Q

what is the test to evaluate renal function

A

renal scintigraphy

250
Q

trauma to the vulva can cause

A

bartholin duct cyst

251
Q

erythema and calling of the skin that causes bright red patches that gradually peel

A

erythroderma (exfoliative dermatitis)

252
Q

when should an oral glucose test be given in pregnancy

A

24-28 weeks

253
Q

antibodies against desmomsome s

A

pemphigus vulgaris

254
Q

antibodies against hemidesmasomes (BM)

A

bellos pemphigoid

255
Q

how should you treat patients with somatic symptom disorder

A

regular appointments to limit diagnostic testing (don’t waste time on reassurance because these patients don’t respond well to it)

256
Q

mutation in FGFR3 causes

A

achondroplasia

257
Q

mutation in fibrillar-1 cause

A

marfans

258
Q

why do blood transfusions cause hypocalcemia

A

becuase the citrate in the transfused blood binds ionized calcium which is the active form

259
Q

severe hyermagnesemia can cause what

A

hypocalcemia recuasse it inhibits PTH release, this is usually seen in magnesium infusions

260
Q

what is the treatment for tar dive dyskinesia for a patient who is on an antipsychotic already and they have to continue their antipsychotic

A

switch to clozapine or quetiapine

261
Q

drugs that cause tar dive dyskinesia

A

antipsychotics (DA blockers) and metoclopramide

262
Q

what is the tx for tar dive dyskinesia

A

Valbenazine (reversible inhibitor of vesicular monoamine transporter 2) VMAT2

263
Q

what can treat acute dystonia

A

benztropine

diphenhyrdamine

264
Q

treatment for akathisia (repeated leg crossing or pacing after antipsychotic)

A

beta blocker

265
Q

what is the main difference between atrophic vaginitis and lichen sclerosis

A

in atrophic, the vaginal mucosa is pale and thin, sclerosis doesn’t affect the vagina

266
Q

what is the first line treatment for vuvlovaginal atrophy

A

lubricants and moisturizers

267
Q

what is the treatment for modoert to severe vulvovaginal atrophy

A

local estrogen cream

268
Q

what is a key phrase for lichen sclerosis

A

wrinkled cigarette paper skin

269
Q

how to differentiate Kawasaki from viral myocarditis

A

kawasaki needs to also have

  • mucositisis
  • swelling palms and soles
  • conjunctivitis
  • rash
270
Q

a hazy area in the lung of someone with a hx of breast caner is?

A

malignant effusion (pleural effusion)

271
Q

what is the diagnostic difference between pleural effusion and consolidation

A

consolidation has increase tactile fremitus and pleural effusion has decreased tactile fremiuts

272
Q

increased breath sounds
increased fremitus
dull percussion

A

consolidation

273
Q

decrease breath sounds

decreased fremitus
dull percussion

A

pleural effusion

274
Q

dec breath sounds

hyperressonant percussion
decreased fremitus

A

pneumothorax

275
Q

what is the renin activity in primary hyperaldosteronism

A

low because of constant aldo simulation

276
Q

why don’t people with primary hyperaldosteronism have edema and very high sodium levels

A

because of the aldosterone escape mechanism which causes sodium loss

277
Q

what can cause apparent hypokalemia in a patient who has primary hyperaldosteronism

A

the use of a diuretic

278
Q

why does succinocholyine cause cardiac arrhythmia

A

because it causes severe hyperkalemia

279
Q

to avoid hyperkalemia caused by succinylcholine what medication should be used instead

A

vecuronium or rocuronium (nondeoplarizing neuromuscular blocking agents )

280
Q

why is halothane not used for anesthesia

A

because it causes acute liver failure

281
Q

what drug blocks 11B-hydroxylase and can lead to adrenal insufficiency

A

Etomidate

282
Q

why should propofol (sedation) not be used in patients with ventricular systolic dysfunction

A

because it causes myocardial depression and severe hypotension

283
Q

what is the treatment for SEVERE sebhorreic dermatitis

A

topical antifungals and steroids

284
Q

method used to compare two means

A

two sample t test

285
Q

used to compare three or more means

A

ANOVA

286
Q

first line tx for ovarian torsion

A

laparoscopy with detorsion

287
Q

how to dx ovarian torsion

A

US with Doppler flow

288
Q

what happens to a patient who is taking an MAIO and they eat tyramine (cheese/ wine)

A

they get severe HTN which presents first as a headache but can lead to intracranial bleed and death

289
Q

what happens when MAIO are had around the same time as an SSRI

A

serotonin syndrome which causes hyperreflesxia and myoclonus

290
Q

diffuse muscle rigidity in someone taking an antipsychotic

A

neuroleptic malignant syndrome

291
Q

what is a large side effect of hydroxyurea

A

myelosupression

292
Q

how do you diagnose an infant with HIV

A

DNA PCR not Elisa because they will have mom’s antibodies

293
Q

patients who are immunocompromised like those who have relied a transplant are at risk for what kind of infections

A

opportunistic ones like CMV and PCP

294
Q

which drug should be given to patients after a transplant to prevent opportunistic infections

A

TMP SMX and Gancyclovir to prophylaxis against CMV

295
Q

if you see hypokalemia after someone starts using a thiazide diuretic to treat their HTN and they are young, you think

A

primary hyperaldosteronsim

296
Q

what are the two things that should be ruled out in an adult with first time seizure

A

hypoglycemia/electrolyte disturbances and amphetamine use or bento/alcohol withdrawal

297
Q

malignant otitis externa is usually seen in what kind fo patient

A

old diabetics

298
Q

what is the cause of malignant otitis external

A

pseudomonas

299
Q

what is the characteristics manifestation of malignant otitis external

A

granulations in the ear canal

300
Q

facial drooping Causing food to fall from someones mouth with malignant otitis external is due to?

A

involvement of the cranial nerves due to osteomyelitis to the base of the skull

301
Q

Treatment for malignant otitis external

A

cipro

302
Q

facial nerve palsy and vesicles in the auditory canal and auricle is called

A

Ramsey Hunt (HSV in the ear)

303
Q

what is the treatment for ischemic colitis with no sign of necrosis

A

antibiotics, bowel rest and fluids

304
Q

why does ischemic colitis spare the rectum

A

because of dual circulation

305
Q

patients who have difficulty getting up early, and have excessive morning sleepiness, but left to their own they can sleep uninterrupted till 11am

A

delayed sleep-wake phase disorder

“night owls”

306
Q

inability to stay awake in the evening after 7 pm and early morning insomnia

A

Advanced sleep wake phase disorder

307
Q

difficulty initiating and maintain sleep and producing daytime sleepiness is seen in

A

shift work disorder

308
Q

what cancers are associated with Li Fraumeni syndrome (mutation in tp53-tumor suppressor gene)

A

adrenocortical carcinoma
brain tumors
breast cancer

309
Q

how do patients with non classic Congenital adrenal hyperplasia present

A

in teen years with irregular periods, acne and hirtusism (no virilizatoin)

310
Q

how do girls in classic congenital adrenal hyperplasia present

A

with salt wasting, virilization and a deficiency in 21-hydroxylase

311
Q

partial deficiency of 21 hydroxylase

A

non classic CAH

312
Q

what causes resistance to insulin in pregnancy

A

increased levels of placental somatomammotriopin (human placental lactose)

313
Q

what is the single most important prognostic factor in a cancer patient

A

TNM staging

314
Q

what level is increased in congenital adrenal hyperplasia

A

17 hydroxyprogesterone

315
Q

early activation of the hypothalamic pituitary axis causing a pulsatile GnRH secretion and elevated FSH and LH

A

central precocious puberty

316
Q

gonadal or adrenal release of excess sex hormones resulting in low FSH or LH due t negative feedback in someone with early puberty

A

peripheral precocious puberty

317
Q

excess conversion of testosterone into estrogen resulting in precocious puberty in girls with a low FSH and LH is in

A

aromatase excess

318
Q

how to diagnose vascular rings

A

barium shows compression of the trachea and esophagus

319
Q

what disease is associated with the curvature of the spine in 2 planes

A

turners

320
Q

what rules out white coat HTN

A

a high diastolic pressure

321
Q

a patient from China with elevated JVP, decreased heart sounds, and accentuated sound directly after the second heart sound in early diastole

A

Constricitve Pericarditis due to TB

322
Q

chugs disease causes what kind of heart failure

A

systolic and diastolic heart failure

323
Q

sxs of digoxin toxicity

A

nausea
anoerxia
abdominal pain

324
Q

color vision alterations are seen in toxicity with what

A

digoxin

325
Q

what drugs increase digoxin levels and leads to toxicity

A

amiodarone
verapamil
quinidine
propefenone

326
Q

what should be done if you start someone on amiodarone who is on digoxin

A

decease digoxin by 25-50% to avoid toxicity

327
Q

severe periumbilical pain out of proportion to PE findings

A

mesenteric ischemia

328
Q

Asbestos exposure, bibasilar reticulondular infiltrates, bilateral pleural thickening and pleural plaques

A

bronchogenic carcinoma

329
Q

explain peritoneal mesothelioma

A

due to asbestos, and causes abdominal pain, tenderness and ascites
nodular peritoneal thickening is seen

330
Q

explain pleural mesothelioma

A
  • asbestos exposure
  • unilateral pleural plaques
  • large pleural effusion
331
Q

explain bronchogenic carcinoma

A
  • asbestos exposure in a SMOKER
  • bilateral pleural plaques
  • reticulonodular infiltrates
  • parenchymal fibrosis
332
Q

what happens when genital HSV isn’t treated

A

they will recur but over time they will become less frequent

333
Q

what can severe primary genital HSV cause

A

radiculopathy in the sacral nerves that lead to urinary retention, loss of sensation and neuralgia

334
Q

what is Aprepitant

A

it is a P NK1 antagonist the is an antiemetic

335
Q

what medications cause acute dystonia in a chemo patient who is being treated for vomiting

A

dopamine antagonist metoclopramide or prochlorperazine

336
Q

what is hydroxyzine

A

an antihistamine that is an antiemetic

337
Q

a dural based mass in the brain is likely a

A

meningioma

338
Q

immobilization can cause what electrolyte abnormality

A

hypercalcemia due to increase osteoclastic bone resorption

339
Q

hypoalbumin is associated with what calcium trend

A

low calcium

340
Q

highalbumin is associated with calcium trend

A

high calcium

341
Q

what is dexmedetomidine

A

it is an alpha 2 agonist that is used for sedation

342
Q

what medication is used in severe cases of PCP intoxication

A

propofol

343
Q

atrophy of the caudate is associated with

A

huntingtons

344
Q

decreased volume of the hippocampus and the amygdala is seen in

A

schizophrenia

345
Q

accelerated head growth and increased total brain volume is seen in

A

autism

346
Q

structural abnormaliteit in the orbitofrontal cortex and basal ganglia are seen in

A

OCD

347
Q

in stable patients with retropharyngeal abscess what test should be done to show the size of the abscess

A

CT with contrast

STEP 2 CK! (2 decks)

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