UWorld 8/11 Flashcards
0
Q
Dilated bronchi on CT scan?
A
-think: bronchiectasis
1
Q
Loss of P/T bilaterally in upper back & arms?
A
- Think: Syringomyelia!
- dilated central canal in the spinal cord
- caused by tumor or can be fluid-filled
- can be due to trauma, tumor, or congenital
- ssx: also have muscle atrophy and loss of reflexes
2
Q
What should be done if Parkinsonism develops in response to tx with atypical antipsychotics?
A
-give benztropine (anticholinergic)
3
Q
After what week can HTN in pregnancy be considered preeclampsia?
A
-after 20 wks
4
Q
What is the most common risk factor for placental abruption?
A
-HTN
5
Q
What is the most important intervention to prevent transmission of HIV to baby throughout pregnancy?
A
- have mom on HAART tx throughout pregnancy
- plus zidovudine to neonate for >6 wks
6
Q
What are infants born to mothers with surgical tx for graves at risk for? Why?
A
- at risk for thyrotoxicosis
- bc TSH immunoglobulins can pass through to the placenta
7
Q
What should be given to keep PDA open?
A
- prostaglandin E1
- to “pop” the ductus open!
8
Q
What should be given to close a PDA?
A
- indomethacin
- “inhibits” ductus from popping open!
9
Q
What happens in nursemaid’s elbow?
A
-subluxation of radial head
10
Q
What renal condition can be seen post hypovolemic shock? What can be seen in UA?
A
- see Acute Tubular Necrosis
- can see muddy brown casts in UA
11
Q
Muddy brown casts?
A
- seen with acute tubular necrosis
- which is typically seen with any cause of hypovolemia
12
Q
RBC casts?
A
-seen in glomerulonephritis
13
Q
WBC casts?
A
-seen in interstitial nephritis and pyelonephritis
14
Q
Fatty casts?
A
-seen in nephrotic syndrome
15
Q
Broad and waxy casts?
A
-seen in chronic renal failure
16
Q
Palpable purpura, arthralgias, abdominal pain, & hematuria?
A
- think: H-S P
- IgA mediated vasculitis of small vessels
- see IgA deposits on kidney bx (not necessary for dx) usually clinical dx!
17
Q
Tx for trichotillomania?
A
-CBT
18
Q
5 Ssx of heat stroke?
A
- Temp > 105*F
- AMS
- Hypotention
- Tachycardia
- Tachypnea
19
Q
Pancytopenia following drug intake, exposure to toxin, or viral infection?
A
-think: aplastic anemia
20
Q
3 tx options for MG?
A
- Acetylcholinesterase inhibitors = neostigmine or pyridostigmine
- Immunosuppressive agents
- Thymectomy
21
Q
What is commonly the underlying dz seen with Paget’s disease of the breast?
A
-adenocarcinoma (ductal carcinoma)
22
Q
What location of neck abscess is at the highest risk of spreading to mediastinum?
A
-retropharyngeal abcess
23
Q
What is the most important prognostic factor in breast cancer?
A
-TNM staging to determine tumor burden
24
Slowly growing, nontender, indurated mass that can form an abscess, fistula, or draining sinus tract most commonly on mandible? Tx?
- Think: bacterial actinomyces cervicofacial infection
| - tx: penicillin
25
What cancer does GERD increase the risk for?
-adenocarcinoma of the esophagus (not squamous cell!)
26
What cancer can Barrett's lead to?
-adenocarcinoma of the esophagus
27
Rapidly progressive dementia w/ myoclonus? Tx? Seen on EEG?
- think: cretuzfeldt-jakob disease
- rapidly progressive demenitia
- no tx, usually die w/in 12 mnth
- see bi or triphasic sharl wave complexes on EEG
28
Diet recommendations for kidney stone prevention?
1. Decrease protein and oxalate
2. Decrease sodium
3. Increase fluids
4. Increase calcium
29
Where is Coccidiomycosis?
- Southwestern US + central & south america
| - esp Arizona or California
30
Where is Histoplasmosis?
-most common in SE, midatlantic, and central US
31
Where is blastomycosis?
- south-central and north-central US
- esp in vacinity of great lakes, mississippiriver, and ohio river basin
- highest infection rate in Wisconsin!
32
Caustic poisoning? Ssx? Tx?
- drinking of acids or alkaline solutions (ex drain cleaner)
- ssx: from the mechanical injury of the tissues = dysphagia, severe pain, heavy salivation, mouth burns
- tx: flush out the caustics with high water volumes (DONT try to use the opposite acid/base)
33
High alk phos in pt over 40? Tx?
- think: Paget's disease
- can be asymptomatic and found with radiograph that shows lytic and osteoblatsic lesions from the simultaneous breakdown and repair of bone
- tx: bisphosphanates
34
Traveler with persistent (> 2 wks) non bloody, watery, diarrhea?
-cryotosporidium
35
What is the most common vaccine preventable dz in travelers?
-Hep A!
36
Low back pain in an elderly pt that is relieved by leaning forward?
-lumbar spinal stenosis
37
Chronic back pain and neurologic dysfunction in a preadolescent child?
- think: spondylolisthesis = developmental d/o with forward slip of vertebrae
- ssx: low back pain, neurologic dysfctn (ex urinary incontinence), palpable "step-off" in lumbosacral area
38
Constant gnawing epigastic pain that is worse at night, anorexia, and wt loss?
-think: pancreatic cancer
39
Delayed or absent puberty and anosmia?
- kallman syndrome!
- x-linked recessive
- XX or XY!
- low FSH and LH, bc d/o with migration of GnRH
40
Why do vagal maneuvers help with supraventricular tachycardia?
- increase vagal tone = decrease conduction through AV node
| - SVT is usually due to re-entry through AV node
41
What electrolyte abnormality can be a complication of a SAH?
-hyponatremia due to cerebral-salt waisting syndrome
42
2 most common bacterial causes if sinusitis? Tx?
1. Strep pneumo
2. H. Influenzae
- Tx: amoxicillin-clavulanic acid
43
3 causes of primary amenorrhea with female phenotype, but no normal vagina and uterus? Karyotypes?
1. Mullerian agenesis = XX
2. Androgen insensitivity = XY
3. 5-alpha reductase deficiency = XY
44
95% is how many SD?
-2
45
What percent is 1 SD?
-68%
46
Tx of choice for lyme dz in a child?
- amoxicillin
| - DONT use doxy in a child < 8 yrs old (or in pregnant women)! --> can slow bone growth & cause staining of teeth
47
What orthopedic injury can be seen following a tonic-clonic seizure?
-posterior shoulder dislocation!
48
BUN > 60?
- uremia
- seen in ESRD
- can have uremic pericarditis as a cimplication!
- tx = hemodyalisis
49
What is one of the most frequent complications in mumps in adults?
-orchitis
50
What ages are febrile seizures common?
-6mnths - 6 yrs
51
Most common nephropathy seen with hodgkin lymphoma?
-minimal change dz
52
Which nephrotic syndrome is most commonly associated with malignancies?
- membranous glomerulopathy
| - esp with solid cancers
53
Inferior wall infarct: What is seen in EKG? What structure is usually affected? Tx?
- EKG: see ST elevations in leads II, III, AVF
- usually RV is affected
- Tx: fluid resucitation, AVOID nitrates
53
Reactive arthritis triad?
1. Joint pain --> seronegative spondyloarthropathy
2. Ocular findings - uveitis, conjunctivitis
3. Genital abnormalities - urethritis, balanitis
Occurs secondary to:
1. Inflam bowel dz
2. STD
3. GI infection
54
Ssx of RV infarct?
-clear lung feilds
-hypotension
-CO is decreased bc the SV of RV is decreased --> so dont give tx that will decrease preload!
Tx: fluid bolus first
54
Tx if reactive arthritis?
-NSAIDs
55
What are ascending thoracic aortic aneurysms usually due to?
-cystic necrosis (occurs with aging) or connective tissue d/o (Marfans)
55
Stroke v Bell's palsy?
- stroke = ONLY lower half of face effected, pt can wrinkle forehead
- bells = ENTIRE side of face effected, can't wrinkle forehead!
56
What are descending thoracic aortic aneurysms usually due to?
-atherosclerosis --> risk factors: HTN, smoking, hypercholesterol
56
Tx for a symptomatic subconjunctival hemorrhages?
-observation
57
Reactive arthritis triad?
1. Joint pain --> seronegative spondyloarthropathy
2. Ocular findings - uveitis, conjunctivitis
3. Genital abnormalities - urethritis, balanitis
Occurs secondary to:
1. Inflam bowel dz
2. STD
3. GI infection
58
Tx if reactive arthritis?
-NSAIDs
59
Stroke v Bell's palsy?
- stroke = ONLY lower half of face effected, pt can wrinkle forehead
- bells = ENTIRE side of face effected, can't wrinkle forehead!
60
Tx for a symptomatic subconjunctival hemorrhages?
-observation
61
Tx for trigeminal neuralgia?
-carbamazepine or oxcarbazepine
62
What do ABGs usually show in atalectasis?
1. Hypoxemia
2. Hypocapnia
3. Resp alk
63
Tx for preeclampsia?
1. Mg sulfate --> seizure prevention
2. Hydralazine --> BP control
3. Deliver baby
64
Pica?
- appetite for items other than food
| - seen in IRON DEF anemia (esp with ice)
65
What is impaired in pts without a spleen?
-phagocytosis of encapsulated bacteria
66
What does synovial fluid in lyme dz look like?
-inflammatory w/ leukocyte count of 25,000
67
Protein and glucose in CSF of bacterial and viral meningitis?
- bacterial: low glucose, high protein
| - viral: normal glucose, normal (or slightly high) protein
68
Infant that has syncopal episodes with crying, but no incontinence , cyanosis, or post ictal period?
- think: breath holding spells
- benign --> only tx is reassurance
- self limited
69
What is the major nutrient lacking in "tea and toast" diet?
-folic acid!
70
Tx for stabismus?
-patching or penalizing (blurring) the vision of the good eye
71
What should be done if a pt with known immunity to hep B is exposed to hep B?
- no tx is needed
| - just reassurance!
72
Gout v septic arthritis on H&P?
- indistinguishable!
- tap it!
- always tap a mono-inflammed joint! --> dont want to miss an infection!
73
Causes of epidydimytis in young men v older men?
- young = c. Trachomatis or n. Gonorrhea
| - old = gram-neg rods (e. Coli)
74
Most effective way to prevent firearm injuries?
-remove ALL firearms from the home
75
What tendon problem is commonly seen in new mothers?
- De Quervian tenosynovitis
- in moms who hold their infant with thumb outstretched
- finkelstein test will be positive: passively stretching the affected tendon by grasping the flexed thumb into the palm with fingers = pain
76
Most important tx of lactic acidosis from septic shock?
- IV normal saline to maintain intravascular pressure
| - plus antibiotics for underlying infection
77
What derm dz is termed "lizard skin"?
-icthyosis vulgaris
78
Definition of malignant hypertension?
- severe HtN >180/120
| - retinal hemorrhages, exudates, or papilledema
79
Removal of ventilator in a brain dead pt?
- not necessary
| - just need to confirm brain death with 2 physicians
80
What lab test should be done on pleural fluid to determine if it needs to be drained?
- pH
| - if less than 7.2, then its likely infected = empyema --> drain it!!
81
Purplish skin discoloration and gangrenous changes?
-think: necrotizing fascitis!
82
Sudden pulse-lessness in a pt 5 days -2 wks post MI?
-think: free wall rupture!
83
Hyperglycemia + red plaques with central clearing?
- think: glucagonoma
| - rash = necrolytic migratory erythema
84
DM, weight loss, diarrhea, + necrolytic migratory erythema?
-think: glucagonoma
85
Severity of DM in glucagonoma?
- mild DM
- easily controlled with oral agents & diet changes
- usually doesnt require insulin
86
Crampy diffuse abdominal pain + green vomit?
- think: small bowel obstruction
- emesis is usually billious
- pain is usually poorly localized
87
What tests to get before starting a pt on lithium?
-creatinine & TSH
88
Initial tx for afib?
-beta blocker or ccb (ex diltiazem or verapamil)
89
What should be measured in a pt that an adrogen-secreting tumor is suspected?
-DHEA-S
90
Acute asymmetric arthritis in an adult that works with children?
-can be caused by parvovirus B19
91
Tx for minimal change disease?
-prednisone
92
What is functional hypothalamic amenorrhea? What can it be due to? What are they at risk for?
- suppression of hypothalamic-pituitary-ovarian axis
- bc of strenuous exercise, anorexia, marijuana use, stress, depression, or chronic illness
- at risk for bone loss bc of estrogen deficiency
93
When is tactile fremitus increased on physical exam?
- ONLY when there is consolidation of the lung (ex. Lobar pneumonia)
- sound travels faster in solids than in air
94
Calcium and phosphorus in secondary hypoparathyroidism?
- ca: decreased
- phos: increased
- can be caused by renal failure
95
What causes hypocalcemia + hypophosphetemia?
-vitamin D malabsorption
96
How is MS dx?
-clinical suspicion + MRI of brain
97
Placental abruption w/ moderate bleeding and reassuring fetal tracings?
-can proceed with vaginal delivery
98
4 diagnostic test results of lactose intolerance?
1. Positive hydrogen breath test
2. Positive stool test for reducing substances
3. Low stool pH
4. Increased stool osmotic gap
99
Steatorrhea in lactose intolerance?!
-NO!
100
What to do if a battery is swallowed?
- if its in the esophagus --> remove it ASAP
| - if its past the esophagus --> leave it alone, usually passes okay in its own
101
What does an anaphylactic rxn to a blood transfusion look like? Who is at risk? Tx?
- respiratory distress and hypotension within seconds to minutes
- pts with IgA deficiencies are at risk for this!
- epi
102
What medications are known to cause peripheral edema?
-dihydropyridine = calcium channel antagonists --> amlodipine
103
Elderly pt with: anemia, renal failure, + hypercalcemia?
-think: multiple myleoma!
104
At what CD4 count is pneumocystits usually seen?
-BELOW 200
105
Most common cause of pneumonia in HIV pts?
-ecapsulated bacteria, esp strep pneumo
106
What should be done to test for acute Hep B infection?
1. HBsAg
| 2. Anti-HBc
107
What happen to maternal vital signs with a rupture of vasa previa?
-maternal vital signs remain stable while the fetus exsanguinates
108
Discharge in BV v trichomoniasis?
- BV: thin, off-white, fish odor
| - trich: thin, gray-green, malodorous, frothy
109
What type of anemia can be caused by NSAID use?
- iron deficiency anemia
| - bc of chronic GI bleed
110
Ssx of hypoTH with elevated thyroid hormones?
-generalized resistance to thyroid hormones
111
Most common cause of bacterial meningitis in kids and daukts?
-neisseria meningitides
112
Meningitis with a rash?
-neisseria meningitides
113
What drugs can cause drug-induced vascular spasm?
-cocaine & methamphetamines
114
Ludwig angina?
- infection of the submadibular and sublingual glands
- ssx: fever, dysphagia, odynophagia, & drooling
- source of infection is usually an infected tooth --> usually strep or anaerobes
- asphyxiation is the most common cause of death --> intubate if necessary!!
115
Tx of primary hyperaldo?
1. Laproscopic resection if unilateral
2. Aldo antagonists if bilateral or not surgical candidate:
- eplerenone
- spironolactone
116
Water hammer pulse?
-aortic regurgitation
117
Uterine bleeding without cervical dilation in pregnancy? Tx?
- threatened abortion
- before 20 wks preg
- tx: bed rest and pelvic rest
118
What is a common complication of temporal arteritis?
-aortic aneurysm
119
Difficulty breathing in ore-eclampsia?
-pulmonary edema is a complication!
120
During the first week of life how many wet diapers should a newborn have a day?
- the number of how many days old they are
| - 5 days = 5 diapers
121
Jaundice in a breast fed infant in the first week of life? Tx?
- breast feeding failure jaundice
| - tx: optimize breast feeding
122
Breast feed infant with jaundice in the first 2-3 wks of life? Tx?
- breast milk jaundice
| - tx: switch to formula feeding until jaundice goes away, then breast feeding can resume
123
Recommendations for mamograms?
- every 2 yrs after age 50
| - not necessary beyond age 75
124
Recommendations for hyperlipidemia screening?
-lipid pannel every 5 yrs when > 20 yrs old
125
Null value?
= 1.0
126
What does it mean when the confidence interval includes the null value?
- null value = 1.0
| - means the study is NOT statistically significant
127
What does a wide confidence interval mean?
-smaller sample size
128
Newborn with abdominal distention, bloody diarrhea, and leukocytosis?
-think: necrotizing enterocolitis
129
Best test for reocclusion?
-CK-MB
130
What can panhypopituitaryism cause?
1. ACTH deficiency --> due to 2ndary adrenal insufficiency
2. Hypothyroidism --> central
3. Gonadotropin deficiency
131
In what 2 scenarios should you worry about an aortic tear?
1. MVA
| 2. Fall from > 10 ft
132
What usually presents with painless hematuria?
-renal cancer!
133
Where is the lesion in broca's aphasia?
-dominant frontal lobe!
134
Proximal muscle weakness + rash on dorsum of hands?
-dermatomyositis
135
Whatrenal problem is commonly seen in chrons? Why?
- nephrolithiasis with oxalate stones
- malabsorption of calcium leaves more oxalate around to be absorbed --> calcium usually binds to oxalate so it cant be absorbed
136
What is the most common cause of pneumonia in nursing home residents?
-strep pneumo!
137
What is the risk for developing clear cell adenocarcinoma of vagina and cervix?
-DES exposure in utero
138
Conjunctivitis in an infant btwn days 2-5 of life?
-gonorrheal conjunctivitis
139
Conjunctivitis in newborn in days 5-14 of life?
-chlamydial conjunctivitis
140
What are the 3 common causes if conjunctivitis in newborns in order?
1. Chemical
2. Gonorrhea --> days 2-5
3. Chlamydia --> 5-14 days
141
Next step after solitary pulmonary nodule is found on CXR?
-chest CT
142
What kidney problem can acyclovir cause? How can it be prevented?
- can cause crystalline neohropathy
| - adequate hydration can help avoid this
143
What are pedal edema, ascities, bilateral gynecomastia, and spider angioma a sign of?
-cirrhosis!
144
What are the 2 most common causes if cirrhosis in the US?
1. Chronic alcohol abuse
| 2. Viral hepatitis
145
Tx of PCP?
-TMP-SMX + steroids
146
What are the 2 most common causes of cellulitis?
1. Beta-hemolytic strep
| 2. Staph aureus
147
Tx for cellulitis when there are systemic sx?
1. IV nafcillin
| 2. IV cefazolin
148
Tx of choice for primary hyperparathyrodism? What if pt refuses surgery and has hx if osteopenia?
1. Surgery
| 2. Bisphosphonate tx --> if not surgery
149
What is postop endophthalmitis? When does it present? Ssx?
- corneal infection
- usually occurs within 6 wks of surgery
- ssx: pain, decreased visual acuity, swollen eyelids, corneal edema
150
Tx for cholelithiasis if pt refuses surg or poor surg candidate?
-ursodeoxycholic acid + avoid fatty foods
151
Upper motor neuron ssx below a specific level of spinal cord? Dx?
- think: spinal cord compression via malignancy, disk herniation, abscess (esp in IV drug user)
- dx: MRI of spine
152
Upper motor neuron injury ssx (3)?
1. Wkness
2. Hyperreflexia
3. Babinski
153
Tx for symptomatic BPH?
-alpha-1 blockers = doxazosin or tamsulosin alone or in combo with finesteride (5-alpha reductase inhibitors)
154
What drug most commonly causes priapism?
-prazosin
155
What is usually the presenting ssx of PKD? Tx?
- early onset HTN
| - tx ACEi
156
What does pronator drift usually mean?
- UMN lesion
| - could be due to stroke
157
What is the most common cause of painless hematuria in adults?
-bladder cancer
158
Initial tx of chronic venous dz (3)?
1. Leg elevation
2. Exercise
3. Compression stockings
159
Gardener stuck with rose thorn?
-think: sporothrix schenckii
160
Presentation of midgut volvulus (3)?
- child less than 1mnth old
1. Bilious vomiting
2. Abdominal distention
3. Blood stained stool
161
HypoCa + hyperPhos + normal kideny fctn?
- think: hypoPTH
| - usually complication of prior neck surgery, but if not surgical, most often caused by autoimmune dz
162
Toxoplasmosis prophylaxis?
- screen HIV pts at dx for toxoplasmosis antibodies
| - if antibodies should be tx with TMP/SMX (also helps prevent PCP)
163
What is the most common valvular abnormality seen in pts with infective endocarditis?
-MVP w/ MR
164
3 most common causes if avascular necrosis of hip in adults?
1. Chronic steroid use
2. Alcholism
3. Hemoglobinopathy
165
Tx of yeast infection?
-oral fluconazole (or other azole)
166
Most common cause of infertility of a woman in her 40s who is still menstrating?
-age-related decreased ovarian reserve
167
What is the recommendation for vision screening in kids?
-vision test for screening of strabismus, ambylopia, and refractive error s should be done in all kids aged 0-5
168
Tx for vfib?
-immediate cardioversion with defibrillator (unsynchronized)
169
Painless GI bleeding, anemia, and aortic stenosis murmur?
-think: angiodysplasia (AV malformation) of GI tract
170
What does matching do in studies?
-helps decrease confounding
171
Pure motor stroke?
-lacunar infarct
172
Most common testicular cancer?
-germ cell seminoma
173
Testicular tumor with elevated beta-HCG + elevated alpha fetoprotein? Where does it commonly met to?
- think: nonseminomatous germ cell tumor
| - can met to lungs --> see lg mediastinal mass
174
What is the primary risk factor for ovarian torsion?
-ovarian enlargement --> due to pregnancy or tumors
175
Tx of fulminant hepatic failure?
-only tx is transplant
176
Tx for hairy cell leukemia?
1. Cladribine
| 2. Pentostatin
177
What can markedly decreased breath sounds on the left after intubation mean?
-right mainstem bronchus intubation --> fix by repositioning
178
Definition of intrauterine fetal demise? What test should be done after?
- fetal death after 20wks and before delivery
| - autopsy should be done on fetus and placenta to try to determine cause for future pregnancies
179
Arreflexia, loss of vibratory/position sense, & cardiomyopathy in 5-15 yr old?
-think: Friedrich ataxia
180
Cause of proptosis in Graves?
-retro-orbital tissue expansion
181
"Sail sign" seen on a CXR of an infant?
- thymus
| - very prominent bc of its relatively lg size compared to the infants small thorax
182
Absent lymph nodes, tonsils, and thymus?
-think: SCID
183
Tx of choice for impetigo? Both mild and severe?
- mild: topical mupirocin
| - severe: oral erythromycin
184
2 possible causes of hypercalcemia + intractable ulcers?
1. Hyperparathyroidism --> increased calcium stimulates gastrin = ulcers
2. Zollinger-Ellison syndrome
185
5 possible complications for newborns who are below 10th percentile for weight?
1. Hypoxia
2. Polycythemia
3. Hypoglycemia
4. Hypothermia
5. Hypocalcemia
186
Antibiotic of choice for prophylaxis/tx of infections caused by human bite?
-amoxicillin-clavulante
187
What opthamology disorder presents with the distortion of stright lines into wavy/bent lines?
-macular degeneration
188
Headache, nausea, & dizziness?
-think: CO poisoning, esp if there is environmental exposure!
189
Bloody diarrhea with liver cyst found months later? Tx?
- amebic liver abscess
| - tx: metronidazole
190
Liver cyst seen in a pt with close contact with dogs?
-hydatid cyst
191
Screening recommendations for DM2?
- should start at age 45 in person with no risk factors, start earlier if have risk factors
- use one of these tests: HbA1c, fasting blood glucose, random glucose level, oral glucose tolerance
192
Acyclovir?
-antiviral used to tx herpes and shingles
193
What test should be done on a woman who you suspect is going through menopause?
-check TSH and FSH levels
194
What is used for prophylaxis for GBS in pregnancy?
-penicillin
195
Acaluculous cholecystitis: what is it? 5 situations where it is commonly seen?
- inflammation of GB in the absence of gallstones
- commonly seen w/
1. Extensive burns
2. Severe trauma
3. Prolonged TPN
4. Prolonged fasting
5. Mechanical ventilation
196
Houses built before what year are worrisome for lead poisoning?
-1978!
197
What is the most rapid test for histoplasmosis?
-urine or serum antigens!
198
Tx of histoplasmosis?
-itraconazole
199
Definition of resistant HTN?
-persistent HTN despite being on 3+ antihypertensive agents
200
What is the most common cause of resistant HTN?
- renovascular dz = renal artery stenosis
| - this condition is correctable!
201
New focal neurologic ssx 3-10 days after SAH? What couldve prevented this?
- vasospasm
| - nimodipine helps prevent this!
202
Bilateral hip, thigh, & buttock claudication + impotence + symmetric atrophy in lower extremities?
- think: leriche syndrome
- due to aortoilliac occlusive dz
- tx: aortoilliac bypass graft
203
What is the best dx test for primary biliary cirrhosis?
-anti-mitochondrial antibodies
204
Fleshy immobile mass on midline hard palate? Tx?
- in a young pt its usually torus palatinus = congenital bony growth
- tx: none, unless it becomes symptomatic or interferes with spee h or eating
205
Medication that is first given for tx of bleeding esophageal varicies?
- octreotide = somatostatin analogue
| - decreases portal pressure
206
2 causes of outflow obstruction in HOCM?
1. Hypertrophied intraventricular septum
| 2. Abnormality in the motion of the MV leaflets
207
What thyroid malignancy does hoshimotos thyroiditis increase the risk for?
-lymphoma of the thyroid
208
What type of conjunctivitis is most commonly bilateral?
-allergic!
209
What abdominal organ is most commonly lacerated in blunt abdominal trauma in an MVA?
-spleen!
210
What to do if a pt gets bit by a dog?
- confine the dog for 10 days and observe for rabies
- DONT give prophylaxis, unless:
1. Animal acted strangely
2. Bit pt with provocation
3. Rabies is prevalent in the area (rare) or rabies has been confirmed
211
Shat are the only 2 tx that are currently proven to decrease mortality kn pts with COPD?
1. Smoking cessation
| 2. Home oxygen
212
What is the location of the defect seen with hemi-neglect?
-the contralateral-parietal cortex
213
What is aplastic crisis?
- seen in pts with sickle cell anemia
- transient stop in erythropoiesis + virtually no retic count
- retic < 1%
- can be caused by infections, esp parvo B-19
214
T or F: howel jolley bodies can be seen in sickle cell anemia?
-true! Bc of functional asplenia!
215
Triple bubble sign on xray?
-jejunal atresia
216
Double bubble sign on xray?
-duodenal atresia!
217
Weight gain and OCPs?
-usually NOT a sfx
218
What test can be done during the first trimester to look for downs? When can it be done?
- chorionic villus sampling
| - done at wks 9-12
219
What disorders can chorionic villus sampling tell you about?
- genetic or chromosomal d/o only
| - cant tell about neural tube defects!
220
What can MSAFP detect? When is it done?
- can detect neural tube and abdominal wall defects and chromosomal anomalies
- done during second trimester
221
Acute stroke syndrome in a kid following an injury to the soft palate?
- think: internal carotid artery dissection
| - sx can be up to 24hrs after injury
222
What are the 2 tests to do first in a child with a suspected bleeding d/o?
1. Coagulation studies
| 2. Platelet count
223
Clavicle fractures in kids?
- usually due to accidental trauma, even minor falls
| - not very suspicious for child abuse
224
Dementia with alterations in alertness, visual hallucinations, and extraparamidal sx?
-think: lewy body dementia!
225
Hyperbilirubin with primarily elevated alk phos?
-think malignant biliary obstruction
226
Agrs of presentation for inflammatory bowel dz?
-Bimodal: 20s-30s & around age 60
227
What can be found on bx for both UC and chrons?
-neutrophilic cryptitis
228
What is the most common risk factor for an aortic dissection?
-HTN
229
When can clonic jerks be seen besides seizures?
-can also be seen in syncope caused by an arrhythmia is prolonged brain hypoxia
230
Constitutional sx, systemic embolization, & cardiovascular sx?
-think: cardiac myxoma
231
Cardiac myoma: what is it? Ssx?
- most common benign primary cardiac tumor, usually in LA
- ssx:
1. Constitutional = fatigue, low grade fever, wt loss
2. Systemic embolization = TIA, ischemic stroke, acute embolic arterial occlusion
3. Cardiovascular sx = dypnea, orthopnea, cough. Pulmonary ede a, hemoptysis
232
What is the most common benign cardiac tumor? Where is it usually located?
- cardiac myxoma tumor
| - usually located in LA
233
What would an MRI of the brain in Alzheimer's show?
- atrophy that is more prominent in the temporal and parietal lobes
- ONLY use imaging to exclude other causes of the dementia
234
Jaundice 2-3 days after surgery, bilirubin peaks in 10 days, alk phos markedly elevated, & ALS/AST levels normal or minimally elevated?
- think: postop cholestasis
| - benign, due to: hypotension, extensive blood loss into tissues, and massive blood replacement
235
What is the guthrie test?
- urine test that looks for metabolic products of phenylalanine in the urine
- test for PKU
236
Drug of choice for diabetic neuropathy?
- tricyclic antidepressants
- ex amitriptyline
- gabapentin can also be used
237
What is the most common cause of abnormal hemostasis in pts with CHF?
-platelet dysfunction
238
Tx of choice for fibromuscular dysplasia?
-angioplasty with stent placement
239
What is the cause of a varacocele?
-dilation of the pampiniform plexus
240
What is the name of the bursa anteriomedialy over the tibia, plateau?
-anserine bursa
241
Below what CD4 count is CMV retinitis usually seen?
-below 50!
242
Yellowish-white patches of retinal opacification and retinal hemorrhages in a pt with HIV?
- CMV retinitis
| - usually seen when CD4 < 50
243
Acute, anterior cervical unilateral lymphadenitis in a child?
-Usually caused by a bacterial infection, esp staph aureus
244
Pneumonia with prominent GI sx, hyponatremia, & LFT abnormalities?
-think: legionella!
245
Pneumonia with hyponatremia?
-think: legionella!
246
Shoulder dystonia with palsy + horner's syndrome?
-think: C8 and T1 injury, klumpke's palsy
247
Tx for pt with croup with resp distress?
- racemic epi
| - if not, intubate
248
How should immunizations be given to premies?
-according to chronological age!
249
Weakness in the legs that ascends upward to the chest, loss of DTRs, and resp muscle wkness?
- Think: guillain-barre syndrome
| - Autoimmune damage of multiple peripheral nerves
250
HTN, Hypercalcemia,renal stones, & neuropsych sx?
- think: hyperparathyroidism
| - uncommon secondary cause of HTN
251
Tx of stroke in sickle cell pt?
-exchange transfusion
252
What can cause oxygen toxicity with a ventilator and what can be done to avoid this?
- too much oxygen via high FIO2
| - decrease the FIO2 to 50-60% to help prevent this
253
What is a common cause of viral myocarditis?
-coxsackie B virus?
254
Acute CHF in a young pt with no coronary artery disease risk factors?
-think myocarditis, most commonly viral, esp from coxsackie B
255
Menorrhagia with a bulky, globular, & tender uterus?
-think: adenomyosis
256
Menorrhagia with a firm, irregularly enlarged uterus?
-think: leiomyomas (fibroids)
257
What is the best method for studying the incidence of a disease?
-cohort study
258
Tx for candidal esophagitis?
-oral fluconazole
259
What are the 2 acid-fast organisms?
1. Mycobacterium (TB)
| 2. Nocardia
260
Tx for nocardia?
-tmp/smx
261
Vaccines to give with liver dz (5)?
1. Tetanus
2. Influenza
3. Pneumococcal
4. Hep A
5. Hep B
262
Pt with HTN and palpable rt kidney on exam? Why just right?
- think: ADPKD
| - usually can feel the right kidney easier bc it lies lower than the left kidney!
263
Beta receptors and hyperkalemia?
-use beta-2-adrenoreceptor stimulators (ex albuterol) to drive excess K into cells
264
What 2 meds help reduce sx in CHF, but do NOT i prove survival?
1. Digoxin
| 2. Furosemide (loop diuretics)
265
Post MI what 4 meds should a pt go home on?
1. Aspirin (or clopidogrel if cant have aspirin)
2. Bb
3. Statin
4. ACEi
266
What should be given to a pt post MI who cant take aspirin?
-clopidogrel
267
What nerve is most commonly injured with midshaft humerus fracture?
-radial nerve
268
Injury to what nerve causes wrist drop?
-radial nerve
269
What acne med is highly teratogenic?
-isotretinoin!!
270
Next step for unstable pt with penetrating abdominal wound?
-ex lap!!
271
When is a diagnostic peritoneal lavage helpful?
-in a pt with BLUNT trauma and an inconclusive FAST exam
272
Next step: young woman with breast mass and no signs of malignancy?
- have her come back after her period to reevalute the mass
| - if decrease in size, likely to be benign
273
What is the acidified glycerol lysis test?
-the osmotic fragility test used for spherocytosis
274
Motor/sensory deficits in anterior v middle cerebral artery strokes?
- anterior = ssx more pronounced in upper limb
| - middle = ssx more pronounced in lower limb
275
Most common complication of PUD?
-hemorrhage
276
Sinus and lung problems?
- wegners
| - AKA: granulomatosis with polyangitis
277
Most common cause of anemia in premature and low birth weight babies?
-anemia of prematurity
278
Achilles tendonopathy is associated with which medications?
-fluoroquinolones
279
2 tx options for essential tremor?
1. Propranolol
| 2. Primidone (anticonvulsant)
280
Sfx of primidone?
-can cause acute intermittent porphyria --> check urine for porphobilinogen
281
Abdominal pain + hallucinations?
-think: porphyria
282
5 ssx of hyperestrogenism in a cirrhotic male?
1. Gynecomastia
2. Palmar erythema
3. Spider angiomas
4. Testicular atrophy
5. Decreased body hair
283
What are exudates? Transudates?
- exudates --> increased capillary permeability
| - transudates --> increased hydrostatic or decreased oncontic P
284
Painless vaginal bleeding in the third trimester?
-think: placenta previa!
285
Tx for stye?
-warm compress
286
What is a stye? AKA?
- staph abscess of eyelid
| - AKA: external hordeolum
287
What should be avoided while taking metronidazole?
-alcohol --> can cause disulfram-like rxn
288
Cavity lesion on CXR with halo sign in immunocomp pt?
-think: aspergillosis
289
Hypertrophic osteoarthropathy: what is it? What is it commonly seen with? Best initial study?
- clubbing of digits + sudden-onset arthropathy (commonly affecting wrists and hands)
- seen commonly with ling diseases such as lung cancer, TB, bronchiectasis,or emphysema
- initial study = CXR
290
Nail puncture wound on foot that results in osteomyelitis?
-think: pseudomonas aeruginosa
291
What is the next step for a solitary lung nodule that is highly suspicious (ex hx of malig)?
- surgical excision!
| - skip CT or PET
292
Cause of NPH?
-decreased absorption of CSF
293
Dx test for zollinger-ellison syndrome?
-fasting serum gastrin levels
294
Immunodef + Low platelets + eczema? Tx?
- think: wiscott-aldrich syndrome
- deficient in T lymphocytes
- only tx = bone marrow transplant!
295
Niemann-pick v tay-sachs: battle of the cherry red spots
- N-P= due to deficiency of sphingomyelinase --> hepatosplenomegaly, cervical lymphadenopathy, protruding abdomen
- T-S = due to deficiency of hexosaminidase A --> mental retardation, seizures, NO hepatosplenomegaly, NO cervical lymphadenopathy
296
Tx for dressler syndrome?
-NSAIDs
297
What is the most critical factor that determines overall patient survival in sudden cardiac arrest?
-elapsed time til rhythm analysis and defib
298
What is the most common cause of sepsis in pts with sickle cell anemia?
-strep pneumo
299
Tx for pancreatic pseudo cyst?
- should resolve spontaneously, no tx needed
| - drain if, persists longer than 6 wks, > 5cm in diameter, becomes infected
300
First line tx for adolescents with moderate to severe uterine bleeding who are hemodynamically stable?
-high dose estrogen --> helps regrown endometrium
301
Torticollis: what is it? What is it usually caused by? Dx?
- = twisted neck muscles
- usually seen in kids caused by:
1. URIs
2. Minor trauma
3. Cervical lymphadenitis
4. Retropharyngeal abscess
- do c-spine xray to make sure there is no underlying cause or fracture
302
What should be done when a white reflex is seen in an optho exam of a child?
- prompt referral to opthalmologist
| - retinoblastoma until proved otherwise!
303
Marfan-like pt with intelectual delay?
-think: homocystinuria
304
Marfan-like child with fair complexion?
-think: homocysteinuria
305
Fair haired, tall child, elastic skin, developmental delay w/ CVA?
-think: homocysteinuria
306
Dx & tx of herditary homocysteinuria?
- dx: elevated homocysteine and methionine levels
| - tx: vit B6, folate, and vit B12 --> to lower homocysteine levels
307
Which disorders commonly cause gouty attacks?
- myeloproliferative d/o bc of increased turnover of purines
| - ex polycythemia vera
308
Solitary ring enhancing lesion on brain CT + fluid collection in maxillary sinus?
-think: brain abscess from anaerobic bacteria
309
What is a major cause of morbidity and mortality in pts with cirhosis? What test should all pts dx with cirhosis undergo?
- GI bleeds from esophageal varacies
| - all cirrhotic pts should undergo am emdoscopy!
310
What is the most common leukemia in the western world?
-chronic lymphocytic leukemia (CLL)
311
What is important in ventilation for ARDS?
-need PEEP
312
First line tx for acute-closed angle glaucomma?
-IV acetazolamide!
313
Tx for pseudomonas?
-cefepime or piperacillin-tazobactam
314
What is hepatic hydrothorax? Tx?
- pleural effusion that is not due to cardiac or pulm abnormality
- due to small defects in diaphragm --> abdominal ascites passes into pleural space
- tx: liver transplant OR thoracentesis + low salt diet + diuretics --> TIPS
315
Prophylaxis for pregnancy loss in antiphospholipid syndrome?
-low molecular weight heparin + aspirin
316
Cold leg after an MI? Dx test? Tx?
- if the MI is lg a thrombus can form in the heart and embolize anywhere in the body (usually the leg)
- dx test: do an echo to identify the thrombus
- tx: treat thrombus with heparin
317
What pulmonary-renal syndrome requires an emergency plasmapheresis?
-goodpastures!
318
Recurrent pneumonia in the same area of the lung?
-suggests bronchial obstruction due to an underlying abnormality --> most concerning would be a bronchogenic carcinoma
319
What is the most dangerous complication of ESRD? Best tx?
- hepatorenal syndrome
| - best tx = liver transplant
320
When should prophylaxtic testing be done for GBS in pregnancy?
- 35-37 wks gestation
| - vaginal AND rectal cultures
