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UWorld 8/11 Flashcards

0
Q

Dilated bronchi on CT scan?

A

-think: bronchiectasis

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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
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2
Q

What should be done if Parkinsonism develops in response to tx with atypical antipsychotics?

A

-give benztropine (anticholinergic)

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3
Q

After what week can HTN in pregnancy be considered preeclampsia?

A

-after 20 wks

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4
Q

What is the most common risk factor for placental abruption?

A

-HTN

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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

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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

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7
Q

What should be given to keep PDA open?

A
  • prostaglandin E1

- to “pop” the ductus open!

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8
Q

What should be given to close a PDA?

A
  • indomethacin

- “inhibits” ductus from popping open!

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9
Q

What happens in nursemaid’s elbow?

A

-subluxation of radial head

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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

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11
Q

Muddy brown casts?

A
  • seen with acute tubular necrosis

- which is typically seen with any cause of hypovolemia

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12
Q

RBC casts?

A

-seen in glomerulonephritis

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13
Q

WBC casts?

A

-seen in interstitial nephritis and pyelonephritis

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14
Q

Fatty casts?

A

-seen in nephrotic syndrome

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15
Q

Broad and waxy casts?

A

-seen in chronic renal failure

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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!
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17
Q

Tx for trichotillomania?

A

-CBT

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18
Q

5 Ssx of heat stroke?

A
  1. Temp > 105*F
  2. AMS
  3. Hypotention
  4. Tachycardia
  5. Tachypnea
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19
Q

Pancytopenia following drug intake, exposure to toxin, or viral infection?

A

-think: aplastic anemia

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20
Q

3 tx options for MG?

A
  1. Acetylcholinesterase inhibitors = neostigmine or pyridostigmine
  2. Immunosuppressive agents
  3. Thymectomy
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21
Q

What is commonly the underlying dz seen with Paget’s disease of the breast?

A

-adenocarcinoma (ductal carcinoma)

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22
Q

What location of neck abscess is at the highest risk of spreading to mediastinum?

A

-retropharyngeal abcess

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23
Q

What is the most important prognostic factor in breast cancer?

A

-TNM staging to determine tumor burden

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24
Q

Slowly growing, nontender, indurated mass that can form an abscess, fistula, or draining sinus tract most commonly on mandible? Tx?

A
  • Think: bacterial actinomyces cervicofacial infection

- tx: penicillin

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25
Q

What cancer does GERD increase the risk for?

A

-adenocarcinoma of the esophagus (not squamous cell!)

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26
Q

What cancer can Barrett’s lead to?

A

-adenocarcinoma of the esophagus

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27
Q

Rapidly progressive dementia w/ myoclonus? Tx? Seen on EEG?

A
  • think: cretuzfeldt-jakob disease
  • rapidly progressive demenitia
  • no tx, usually die w/in 12 mnth
  • see bi or triphasic sharl wave complexes on EEG
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28
Q

Diet recommendations for kidney stone prevention?

A
  1. Decrease protein and oxalate
  2. Decrease sodium
  3. Increase fluids
  4. Increase calcium
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29
Q

Where is Coccidiomycosis?

A
  • Southwestern US + central & south america

- esp Arizona or California

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30
Q

Where is Histoplasmosis?

A

-most common in SE, midatlantic, and central US

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31
Q

Where is blastomycosis?

A
  • south-central and north-central US
  • esp in vacinity of great lakes, mississippiriver, and ohio river basin
  • highest infection rate in Wisconsin!
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32
Q

Caustic poisoning? Ssx? Tx?

A
  • 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)
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33
Q

High alk phos in pt over 40? Tx?

A
  • 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
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34
Q

Traveler with persistent (> 2 wks) non bloody, watery, diarrhea?

A

-cryotosporidium

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35
Q

What is the most common vaccine preventable dz in travelers?

A

-Hep A!

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36
Q

Low back pain in an elderly pt that is relieved by leaning forward?

A

-lumbar spinal stenosis

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37
Q

Chronic back pain and neurologic dysfunction in a preadolescent child?

A
  • 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
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38
Q

Constant gnawing epigastic pain that is worse at night, anorexia, and wt loss?

A

-think: pancreatic cancer

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39
Q

Delayed or absent puberty and anosmia?

A
  • kallman syndrome!
  • x-linked recessive
  • XX or XY!
  • low FSH and LH, bc d/o with migration of GnRH
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40
Q

Why do vagal maneuvers help with supraventricular tachycardia?

A
  • increase vagal tone = decrease conduction through AV node

- SVT is usually due to re-entry through AV node

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41
Q

What electrolyte abnormality can be a complication of a SAH?

A

-hyponatremia due to cerebral-salt waisting syndrome

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42
Q

2 most common bacterial causes if sinusitis? Tx?

A
  1. Strep pneumo
  2. H. Influenzae
    - Tx: amoxicillin-clavulanic acid
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43
Q

3 causes of primary amenorrhea with female phenotype, but no normal vagina and uterus? Karyotypes?

A
  1. Mullerian agenesis = XX
  2. Androgen insensitivity = XY
  3. 5-alpha reductase deficiency = XY
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44
Q

95% is how many SD?

A

-2

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45
Q

What percent is 1 SD?

A

-68%

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46
Q

Tx of choice for lyme dz in a child?

A
  • amoxicillin

- DONT use doxy in a child < 8 yrs old (or in pregnant women)! –> can slow bone growth & cause staining of teeth

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47
Q

What orthopedic injury can be seen following a tonic-clonic seizure?

A

-posterior shoulder dislocation!

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48
Q

BUN > 60?

A
  • uremia
  • seen in ESRD
  • can have uremic pericarditis as a cimplication!
  • tx = hemodyalisis
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49
Q

What is one of the most frequent complications in mumps in adults?

A

-orchitis

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50
Q

What ages are febrile seizures common?

A

-6mnths - 6 yrs

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51
Q

Most common nephropathy seen with hodgkin lymphoma?

A

-minimal change dz

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52
Q

Which nephrotic syndrome is most commonly associated with malignancies?

A
  • membranous glomerulopathy

- esp with solid cancers

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53
Q

Inferior wall infarct: What is seen in EKG? What structure is usually affected? Tx?

A
  • EKG: see ST elevations in leads II, III, AVF
  • usually RV is affected
  • Tx: fluid resucitation, AVOID nitrates
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53
Q

Reactive arthritis triad?

A
  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
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54
Q

Ssx of RV infarct?

A

-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

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54
Q

Tx if reactive arthritis?

A

-NSAIDs

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55
Q

What are ascending thoracic aortic aneurysms usually due to?

A

-cystic necrosis (occurs with aging) or connective tissue d/o (Marfans)

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55
Q

Stroke v Bell’s palsy?

A
  • stroke = ONLY lower half of face effected, pt can wrinkle forehead
  • bells = ENTIRE side of face effected, can’t wrinkle forehead!
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56
Q

What are descending thoracic aortic aneurysms usually due to?

A

-atherosclerosis –> risk factors: HTN, smoking, hypercholesterol

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56
Q

Tx for a symptomatic subconjunctival hemorrhages?

A

-observation

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57
Q

Reactive arthritis triad?

A
  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
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58
Q

Tx if reactive arthritis?

A

-NSAIDs

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59
Q

Stroke v Bell’s palsy?

A
  • stroke = ONLY lower half of face effected, pt can wrinkle forehead
  • bells = ENTIRE side of face effected, can’t wrinkle forehead!
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60
Q

Tx for a symptomatic subconjunctival hemorrhages?

A

-observation

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61
Q

Tx for trigeminal neuralgia?

A

-carbamazepine or oxcarbazepine

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62
Q

What do ABGs usually show in atalectasis?

A
  1. Hypoxemia
  2. Hypocapnia
  3. Resp alk
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63
Q

Tx for preeclampsia?

A
  1. Mg sulfate –> seizure prevention
  2. Hydralazine –> BP control
  3. Deliver baby
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64
Q

Pica?

A
  • appetite for items other than food

- seen in IRON DEF anemia (esp with ice)

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65
Q

What is impaired in pts without a spleen?

A

-phagocytosis of encapsulated bacteria

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66
Q

What does synovial fluid in lyme dz look like?

A

-inflammatory w/ leukocyte count of 25,000

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67
Q

Protein and glucose in CSF of bacterial and viral meningitis?

A
  • bacterial: low glucose, high protein

- viral: normal glucose, normal (or slightly high) protein

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68
Q

Infant that has syncopal episodes with crying, but no incontinence , cyanosis, or post ictal period?

A
  • think: breath holding spells
  • benign –> only tx is reassurance
  • self limited
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69
Q

What is the major nutrient lacking in “tea and toast” diet?

A

-folic acid!

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70
Q

Tx for stabismus?

A

-patching or penalizing (blurring) the vision of the good eye

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71
Q

What should be done if a pt with known immunity to hep B is exposed to hep B?

A
  • no tx is needed

- just reassurance!

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72
Q

Gout v septic arthritis on H&P?

A
  • indistinguishable!
  • tap it!
  • always tap a mono-inflammed joint! –> dont want to miss an infection!
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73
Q

Causes of epidydimytis in young men v older men?

A
  • young = c. Trachomatis or n. Gonorrhea

- old = gram-neg rods (e. Coli)

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74
Q

Most effective way to prevent firearm injuries?

A

-remove ALL firearms from the home

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75
Q

What tendon problem is commonly seen in new mothers?

A
  • 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
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76
Q

Most important tx of lactic acidosis from septic shock?

A
  • IV normal saline to maintain intravascular pressure

- plus antibiotics for underlying infection

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77
Q

What derm dz is termed “lizard skin”?

A

-icthyosis vulgaris

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78
Q

Definition of malignant hypertension?

A
  • severe HtN >180/120

- retinal hemorrhages, exudates, or papilledema

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79
Q

Removal of ventilator in a brain dead pt?

A
  • not necessary

- just need to confirm brain death with 2 physicians

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80
Q

What lab test should be done on pleural fluid to determine if it needs to be drained?

A
  • pH

- if less than 7.2, then its likely infected = empyema –> drain it!!

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81
Q

Purplish skin discoloration and gangrenous changes?

A

-think: necrotizing fascitis!

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82
Q

Sudden pulse-lessness in a pt 5 days -2 wks post MI?

A

-think: free wall rupture!

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83
Q

Hyperglycemia + red plaques with central clearing?

A
  • think: glucagonoma

- rash = necrolytic migratory erythema

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84
Q

DM, weight loss, diarrhea, + necrolytic migratory erythema?

A

-think: glucagonoma

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85
Q

Severity of DM in glucagonoma?

A
  • mild DM
  • easily controlled with oral agents & diet changes
  • usually doesnt require insulin
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86
Q

Crampy diffuse abdominal pain + green vomit?

A
  • think: small bowel obstruction
  • emesis is usually billious
  • pain is usually poorly localized
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87
Q

What tests to get before starting a pt on lithium?

A

-creatinine & TSH

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88
Q

Initial tx for afib?

A

-beta blocker or ccb (ex diltiazem or verapamil)

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89
Q

What should be measured in a pt that an adrogen-secreting tumor is suspected?

A

-DHEA-S

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90
Q

Acute asymmetric arthritis in an adult that works with children?

A

-can be caused by parvovirus B19

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91
Q

Tx for minimal change disease?

A

-prednisone

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92
Q

What is functional hypothalamic amenorrhea? What can it be due to? What are they at risk for?

A
  • 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
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93
Q

When is tactile fremitus increased on physical exam?

A
  • ONLY when there is consolidation of the lung (ex. Lobar pneumonia)
  • sound travels faster in solids than in air
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94
Q

Calcium and phosphorus in secondary hypoparathyroidism?

A
  • ca: decreased
  • phos: increased
  • can be caused by renal failure
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95
Q

What causes hypocalcemia + hypophosphetemia?

A

-vitamin D malabsorption

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96
Q

How is MS dx?

A

-clinical suspicion + MRI of brain

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97
Q

Placental abruption w/ moderate bleeding and reassuring fetal tracings?

A

-can proceed with vaginal delivery

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98
Q

4 diagnostic test results of lactose intolerance?

A
  1. Positive hydrogen breath test
  2. Positive stool test for reducing substances
  3. Low stool pH
  4. Increased stool osmotic gap
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99
Q

Steatorrhea in lactose intolerance?!

A

-NO!

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100
Q

What to do if a battery is swallowed?

A
  • if its in the esophagus –> remove it ASAP

- if its past the esophagus –> leave it alone, usually passes okay in its own

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101
Q

What does an anaphylactic rxn to a blood transfusion look like? Who is at risk? Tx?

A
  • respiratory distress and hypotension within seconds to minutes
  • pts with IgA deficiencies are at risk for this!
  • epi
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102
Q

What medications are known to cause peripheral edema?

A

-dihydropyridine = calcium channel antagonists –> amlodipine

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103
Q

Elderly pt with: anemia, renal failure, + hypercalcemia?

A

-think: multiple myleoma!

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104
Q

At what CD4 count is pneumocystits usually seen?

A

-BELOW 200

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105
Q

Most common cause of pneumonia in HIV pts?

A

-ecapsulated bacteria, esp strep pneumo

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106
Q

What should be done to test for acute Hep B infection?

A
  1. HBsAg

2. Anti-HBc

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107
Q

What happen to maternal vital signs with a rupture of vasa previa?

A

-maternal vital signs remain stable while the fetus exsanguinates

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108
Q

Discharge in BV v trichomoniasis?

A
  • BV: thin, off-white, fish odor

- trich: thin, gray-green, malodorous, frothy

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109
Q

What type of anemia can be caused by NSAID use?

A
  • iron deficiency anemia

- bc of chronic GI bleed

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110
Q

Ssx of hypoTH with elevated thyroid hormones?

A

-generalized resistance to thyroid hormones

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111
Q

Most common cause of bacterial meningitis in kids and daukts?

A

-neisseria meningitides

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112
Q

Meningitis with a rash?

A

-neisseria meningitides

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113
Q

What drugs can cause drug-induced vascular spasm?

A

-cocaine & methamphetamines

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114
Q

Ludwig angina?

A
  • 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!!
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115
Q

Tx of primary hyperaldo?

A
  1. Laproscopic resection if unilateral
  2. Aldo antagonists if bilateral or not surgical candidate:
    - eplerenone
    - spironolactone
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116
Q

Water hammer pulse?

A

-aortic regurgitation

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117
Q

Uterine bleeding without cervical dilation in pregnancy? Tx?

A
  • threatened abortion
  • before 20 wks preg
  • tx: bed rest and pelvic rest
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118
Q

What is a common complication of temporal arteritis?

A

-aortic aneurysm

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119
Q

Difficulty breathing in ore-eclampsia?

A

-pulmonary edema is a complication!

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120
Q

During the first week of life how many wet diapers should a newborn have a day?

A
  • the number of how many days old they are

- 5 days = 5 diapers

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121
Q

Jaundice in a breast fed infant in the first week of life? Tx?

A
  • breast feeding failure jaundice

- tx: optimize breast feeding

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122
Q

Breast feed infant with jaundice in the first 2-3 wks of life? Tx?

A
  • breast milk jaundice

- tx: switch to formula feeding until jaundice goes away, then breast feeding can resume

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123
Q

Recommendations for mamograms?

A
  • every 2 yrs after age 50

- not necessary beyond age 75

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124
Q

Recommendations for hyperlipidemia screening?

A

-lipid pannel every 5 yrs when > 20 yrs old

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125
Q

Null value?

A

= 1.0

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126
Q

What does it mean when the confidence interval includes the null value?

A
  • null value = 1.0

- means the study is NOT statistically significant

127
Q

What does a wide confidence interval mean?

A

-smaller sample size

128
Q

Newborn with abdominal distention, bloody diarrhea, and leukocytosis?

A

-think: necrotizing enterocolitis

129
Q

Best test for reocclusion?

A

-CK-MB

130
Q

What can panhypopituitaryism cause?

A
  1. ACTH deficiency –> due to 2ndary adrenal insufficiency
  2. Hypothyroidism –> central
  3. Gonadotropin deficiency
131
Q

In what 2 scenarios should you worry about an aortic tear?

A
  1. MVA

2. Fall from > 10 ft

132
Q

What usually presents with painless hematuria?

A

-renal cancer!

133
Q

Where is the lesion in broca’s aphasia?

A

-dominant frontal lobe!

134
Q

Proximal muscle weakness + rash on dorsum of hands?

A

-dermatomyositis

135
Q

Whatrenal problem is commonly seen in chrons? Why?

A
  • 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
Q

What is the most common cause of pneumonia in nursing home residents?

A

-strep pneumo!

137
Q

What is the risk for developing clear cell adenocarcinoma of vagina and cervix?

A

-DES exposure in utero

138
Q

Conjunctivitis in an infant btwn days 2-5 of life?

A

-gonorrheal conjunctivitis

139
Q

Conjunctivitis in newborn in days 5-14 of life?

A

-chlamydial conjunctivitis

140
Q

What are the 3 common causes if conjunctivitis in newborns in order?

A
  1. Chemical
  2. Gonorrhea –> days 2-5
  3. Chlamydia –> 5-14 days
141
Q

Next step after solitary pulmonary nodule is found on CXR?

A

-chest CT

142
Q

What kidney problem can acyclovir cause? How can it be prevented?

A
  • can cause crystalline neohropathy

- adequate hydration can help avoid this

143
Q

What are pedal edema, ascities, bilateral gynecomastia, and spider angioma a sign of?

A

-cirrhosis!

144
Q

What are the 2 most common causes if cirrhosis in the US?

A
  1. Chronic alcohol abuse

2. Viral hepatitis

145
Q

Tx of PCP?

A

-TMP-SMX + steroids

146
Q

What are the 2 most common causes of cellulitis?

A
  1. Beta-hemolytic strep

2. Staph aureus

147
Q

Tx for cellulitis when there are systemic sx?

A
  1. IV nafcillin

2. IV cefazolin

148
Q

Tx of choice for primary hyperparathyrodism? What if pt refuses surgery and has hx if osteopenia?

A
  1. Surgery

2. Bisphosphonate tx –> if not surgery

149
Q

What is postop endophthalmitis? When does it present? Ssx?

A
  • corneal infection
  • usually occurs within 6 wks of surgery
  • ssx: pain, decreased visual acuity, swollen eyelids, corneal edema
150
Q

Tx for cholelithiasis if pt refuses surg or poor surg candidate?

A

-ursodeoxycholic acid + avoid fatty foods

151
Q

Upper motor neuron ssx below a specific level of spinal cord? Dx?

A
  • think: spinal cord compression via malignancy, disk herniation, abscess (esp in IV drug user)
  • dx: MRI of spine
152
Q

Upper motor neuron injury ssx (3)?

A
  1. Wkness
  2. Hyperreflexia
  3. Babinski
153
Q

Tx for symptomatic BPH?

A

-alpha-1 blockers = doxazosin or tamsulosin alone or in combo with finesteride (5-alpha reductase inhibitors)

154
Q

What drug most commonly causes priapism?

A

-prazosin

155
Q

What is usually the presenting ssx of PKD? Tx?

A
  • early onset HTN

- tx ACEi

156
Q

What does pronator drift usually mean?

A
  • UMN lesion

- could be due to stroke

157
Q

What is the most common cause of painless hematuria in adults?

A

-bladder cancer

158
Q

Initial tx of chronic venous dz (3)?

A
  1. Leg elevation
  2. Exercise
  3. Compression stockings
159
Q

Gardener stuck with rose thorn?

A

-think: sporothrix schenckii

160
Q

Presentation of midgut volvulus (3)?

A
  • child less than 1mnth old
    1. Bilious vomiting
    2. Abdominal distention
    3. Blood stained stool
161
Q

HypoCa + hyperPhos + normal kideny fctn?

A
  • think: hypoPTH

- usually complication of prior neck surgery, but if not surgical, most often caused by autoimmune dz

162
Q

Toxoplasmosis prophylaxis?

A
  • screen HIV pts at dx for toxoplasmosis antibodies

- if antibodies should be tx with TMP/SMX (also helps prevent PCP)

163
Q

What is the most common valvular abnormality seen in pts with infective endocarditis?

A

-MVP w/ MR

164
Q

3 most common causes if avascular necrosis of hip in adults?

A
  1. Chronic steroid use
  2. Alcholism
  3. Hemoglobinopathy
165
Q

Tx of yeast infection?

A

-oral fluconazole (or other azole)

166
Q

Most common cause of infertility of a woman in her 40s who is still menstrating?

A

-age-related decreased ovarian reserve

167
Q

What is the recommendation for vision screening in kids?

A

-vision test for screening of strabismus, ambylopia, and refractive error s should be done in all kids aged 0-5

168
Q

Tx for vfib?

A

-immediate cardioversion with defibrillator (unsynchronized)

169
Q

Painless GI bleeding, anemia, and aortic stenosis murmur?

A

-think: angiodysplasia (AV malformation) of GI tract

170
Q

What does matching do in studies?

A

-helps decrease confounding

171
Q

Pure motor stroke?

A

-lacunar infarct

172
Q

Most common testicular cancer?

A

-germ cell seminoma

173
Q

Testicular tumor with elevated beta-HCG + elevated alpha fetoprotein? Where does it commonly met to?

A
  • think: nonseminomatous germ cell tumor

- can met to lungs –> see lg mediastinal mass

174
Q

What is the primary risk factor for ovarian torsion?

A

-ovarian enlargement –> due to pregnancy or tumors

175
Q

Tx of fulminant hepatic failure?

A

-only tx is transplant

176
Q

Tx for hairy cell leukemia?

A
  1. Cladribine

2. Pentostatin

177
Q

What can markedly decreased breath sounds on the left after intubation mean?

A

-right mainstem bronchus intubation –> fix by repositioning

178
Q

Definition of intrauterine fetal demise? What test should be done after?

A
  • fetal death after 20wks and before delivery

- autopsy should be done on fetus and placenta to try to determine cause for future pregnancies

179
Q

Arreflexia, loss of vibratory/position sense, & cardiomyopathy in 5-15 yr old?

A

-think: Friedrich ataxia

180
Q

Cause of proptosis in Graves?

A

-retro-orbital tissue expansion

181
Q

“Sail sign” seen on a CXR of an infant?

A
  • thymus

- very prominent bc of its relatively lg size compared to the infants small thorax

182
Q

Absent lymph nodes, tonsils, and thymus?

A

-think: SCID

183
Q

Tx of choice for impetigo? Both mild and severe?

A
  • mild: topical mupirocin

- severe: oral erythromycin

184
Q

2 possible causes of hypercalcemia + intractable ulcers?

A
  1. Hyperparathyroidism –> increased calcium stimulates gastrin = ulcers
  2. Zollinger-Ellison syndrome
185
Q

5 possible complications for newborns who are below 10th percentile for weight?

A
  1. Hypoxia
  2. Polycythemia
  3. Hypoglycemia
  4. Hypothermia
  5. Hypocalcemia
186
Q

Antibiotic of choice for prophylaxis/tx of infections caused by human bite?

A

-amoxicillin-clavulante

187
Q

What opthamology disorder presents with the distortion of stright lines into wavy/bent lines?

A

-macular degeneration

188
Q

Headache, nausea, & dizziness?

A

-think: CO poisoning, esp if there is environmental exposure!

189
Q

Bloody diarrhea with liver cyst found months later? Tx?

A
  • amebic liver abscess

- tx: metronidazole

190
Q

Liver cyst seen in a pt with close contact with dogs?

A

-hydatid cyst

191
Q

Screening recommendations for DM2?

A
  • 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
Q

Acyclovir?

A

-antiviral used to tx herpes and shingles

193
Q

What test should be done on a woman who you suspect is going through menopause?

A

-check TSH and FSH levels

194
Q

What is used for prophylaxis for GBS in pregnancy?

A

-penicillin

195
Q

Acaluculous cholecystitis: what is it? 5 situations where it is commonly seen?

A
  • 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
Q

Houses built before what year are worrisome for lead poisoning?

A

-1978!

197
Q

What is the most rapid test for histoplasmosis?

A

-urine or serum antigens!

198
Q

Tx of histoplasmosis?

A

-itraconazole

199
Q

Definition of resistant HTN?

A

-persistent HTN despite being on 3+ antihypertensive agents

200
Q

What is the most common cause of resistant HTN?

A
  • renovascular dz = renal artery stenosis

- this condition is correctable!

201
Q

New focal neurologic ssx 3-10 days after SAH? What couldve prevented this?

A
  • vasospasm

- nimodipine helps prevent this!

202
Q

Bilateral hip, thigh, & buttock claudication + impotence + symmetric atrophy in lower extremities?

A
  • think: leriche syndrome
  • due to aortoilliac occlusive dz
  • tx: aortoilliac bypass graft
203
Q

What is the best dx test for primary biliary cirrhosis?

A

-anti-mitochondrial antibodies

204
Q

Fleshy immobile mass on midline hard palate? Tx?

A
  • 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
Q

Medication that is first given for tx of bleeding esophageal varicies?

A
  • octreotide = somatostatin analogue

- decreases portal pressure

206
Q

2 causes of outflow obstruction in HOCM?

A
  1. Hypertrophied intraventricular septum

2. Abnormality in the motion of the MV leaflets

207
Q

What thyroid malignancy does hoshimotos thyroiditis increase the risk for?

A

-lymphoma of the thyroid

208
Q

What type of conjunctivitis is most commonly bilateral?

A

-allergic!

209
Q

What abdominal organ is most commonly lacerated in blunt abdominal trauma in an MVA?

A

-spleen!

210
Q

What to do if a pt gets bit by a dog?

A
  • 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
Q

Shat are the only 2 tx that are currently proven to decrease mortality kn pts with COPD?

A
  1. Smoking cessation

2. Home oxygen

212
Q

What is the location of the defect seen with hemi-neglect?

A

-the contralateral-parietal cortex

213
Q

What is aplastic crisis?

A
  • 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
Q

T or F: howel jolley bodies can be seen in sickle cell anemia?

A

-true! Bc of functional asplenia!

215
Q

Triple bubble sign on xray?

A

-jejunal atresia

216
Q

Double bubble sign on xray?

A

-duodenal atresia!

217
Q

Weight gain and OCPs?

A

-usually NOT a sfx

218
Q

What test can be done during the first trimester to look for downs? When can it be done?

A
  • chorionic villus sampling

- done at wks 9-12

219
Q

What disorders can chorionic villus sampling tell you about?

A
  • genetic or chromosomal d/o only

- cant tell about neural tube defects!

220
Q

What can MSAFP detect? When is it done?

A
  • can detect neural tube and abdominal wall defects and chromosomal anomalies
  • done during second trimester
221
Q

Acute stroke syndrome in a kid following an injury to the soft palate?

A
  • think: internal carotid artery dissection

- sx can be up to 24hrs after injury

222
Q

What are the 2 tests to do first in a child with a suspected bleeding d/o?

A
  1. Coagulation studies

2. Platelet count

223
Q

Clavicle fractures in kids?

A
  • usually due to accidental trauma, even minor falls

- not very suspicious for child abuse

224
Q

Dementia with alterations in alertness, visual hallucinations, and extraparamidal sx?

A

-think: lewy body dementia!

225
Q

Hyperbilirubin with primarily elevated alk phos?

A

-think malignant biliary obstruction

226
Q

Agrs of presentation for inflammatory bowel dz?

A

-Bimodal: 20s-30s & around age 60

227
Q

What can be found on bx for both UC and chrons?

A

-neutrophilic cryptitis

228
Q

What is the most common risk factor for an aortic dissection?

A

-HTN

229
Q

When can clonic jerks be seen besides seizures?

A

-can also be seen in syncope caused by an arrhythmia is prolonged brain hypoxia

230
Q

Constitutional sx, systemic embolization, & cardiovascular sx?

A

-think: cardiac myxoma

231
Q

Cardiac myoma: what is it? Ssx?

A
  • 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
Q

What is the most common benign cardiac tumor? Where is it usually located?

A
  • cardiac myxoma tumor

- usually located in LA

233
Q

What would an MRI of the brain in Alzheimer’s show?

A
  • atrophy that is more prominent in the temporal and parietal lobes
  • ONLY use imaging to exclude other causes of the dementia
234
Q

Jaundice 2-3 days after surgery, bilirubin peaks in 10 days, alk phos markedly elevated, & ALS/AST levels normal or minimally elevated?

A
  • think: postop cholestasis

- benign, due to: hypotension, extensive blood loss into tissues, and massive blood replacement

235
Q

What is the guthrie test?

A
  • urine test that looks for metabolic products of phenylalanine in the urine
  • test for PKU
236
Q

Drug of choice for diabetic neuropathy?

A
  • tricyclic antidepressants
  • ex amitriptyline
  • gabapentin can also be used
237
Q

What is the most common cause of abnormal hemostasis in pts with CHF?

A

-platelet dysfunction

238
Q

Tx of choice for fibromuscular dysplasia?

A

-angioplasty with stent placement

239
Q

What is the cause of a varacocele?

A

-dilation of the pampiniform plexus

240
Q

What is the name of the bursa anteriomedialy over the tibia, plateau?

A

-anserine bursa

241
Q

Below what CD4 count is CMV retinitis usually seen?

A

-below 50!

242
Q

Yellowish-white patches of retinal opacification and retinal hemorrhages in a pt with HIV?

A
  • CMV retinitis

- usually seen when CD4 < 50

243
Q

Acute, anterior cervical unilateral lymphadenitis in a child?

A

-Usually caused by a bacterial infection, esp staph aureus

244
Q

Pneumonia with prominent GI sx, hyponatremia, & LFT abnormalities?

A

-think: legionella!

245
Q

Pneumonia with hyponatremia?

A

-think: legionella!

246
Q

Shoulder dystonia with palsy + horner’s syndrome?

A

-think: C8 and T1 injury, klumpke’s palsy

247
Q

Tx for pt with croup with resp distress?

A
  • racemic epi

- if not, intubate

248
Q

How should immunizations be given to premies?

A

-according to chronological age!

249
Q

Weakness in the legs that ascends upward to the chest, loss of DTRs, and resp muscle wkness?

A
  • Think: guillain-barre syndrome

- Autoimmune damage of multiple peripheral nerves

250
Q

HTN, Hypercalcemia,renal stones, & neuropsych sx?

A
  • think: hyperparathyroidism

- uncommon secondary cause of HTN

251
Q

Tx of stroke in sickle cell pt?

A

-exchange transfusion

252
Q

What can cause oxygen toxicity with a ventilator and what can be done to avoid this?

A
  • too much oxygen via high FIO2

- decrease the FIO2 to 50-60% to help prevent this

253
Q

What is a common cause of viral myocarditis?

A

-coxsackie B virus?

254
Q

Acute CHF in a young pt with no coronary artery disease risk factors?

A

-think myocarditis, most commonly viral, esp from coxsackie B

255
Q

Menorrhagia with a bulky, globular, & tender uterus?

A

-think: adenomyosis

256
Q

Menorrhagia with a firm, irregularly enlarged uterus?

A

-think: leiomyomas (fibroids)

257
Q

What is the best method for studying the incidence of a disease?

A

-cohort study

258
Q

Tx for candidal esophagitis?

A

-oral fluconazole

259
Q

What are the 2 acid-fast organisms?

A
  1. Mycobacterium (TB)

2. Nocardia

260
Q

Tx for nocardia?

A

-tmp/smx

261
Q

Vaccines to give with liver dz (5)?

A
  1. Tetanus
  2. Influenza
  3. Pneumococcal
  4. Hep A
  5. Hep B
262
Q

Pt with HTN and palpable rt kidney on exam? Why just right?

A
  • think: ADPKD

- usually can feel the right kidney easier bc it lies lower than the left kidney!

263
Q

Beta receptors and hyperkalemia?

A

-use beta-2-adrenoreceptor stimulators (ex albuterol) to drive excess K into cells

264
Q

What 2 meds help reduce sx in CHF, but do NOT i prove survival?

A
  1. Digoxin

2. Furosemide (loop diuretics)

265
Q

Post MI what 4 meds should a pt go home on?

A
  1. Aspirin (or clopidogrel if cant have aspirin)
  2. Bb
  3. Statin
  4. ACEi
266
Q

What should be given to a pt post MI who cant take aspirin?

A

-clopidogrel

267
Q

What nerve is most commonly injured with midshaft humerus fracture?

A

-radial nerve

268
Q

Injury to what nerve causes wrist drop?

A

-radial nerve

269
Q

What acne med is highly teratogenic?

A

-isotretinoin!!

270
Q

Next step for unstable pt with penetrating abdominal wound?

A

-ex lap!!

271
Q

When is a diagnostic peritoneal lavage helpful?

A

-in a pt with BLUNT trauma and an inconclusive FAST exam

272
Q

Next step: young woman with breast mass and no signs of malignancy?

A
  • have her come back after her period to reevalute the mass

- if decrease in size, likely to be benign

273
Q

What is the acidified glycerol lysis test?

A

-the osmotic fragility test used for spherocytosis

274
Q

Motor/sensory deficits in anterior v middle cerebral artery strokes?

A
  • anterior = ssx more pronounced in upper limb

- middle = ssx more pronounced in lower limb

275
Q

Most common complication of PUD?

A

-hemorrhage

276
Q

Sinus and lung problems?

A
  • wegners

- AKA: granulomatosis with polyangitis

277
Q

Most common cause of anemia in premature and low birth weight babies?

A

-anemia of prematurity

278
Q

Achilles tendonopathy is associated with which medications?

A

-fluoroquinolones

279
Q

2 tx options for essential tremor?

A
  1. Propranolol

2. Primidone (anticonvulsant)

280
Q

Sfx of primidone?

A

-can cause acute intermittent porphyria –> check urine for porphobilinogen

281
Q

Abdominal pain + hallucinations?

A

-think: porphyria

282
Q

5 ssx of hyperestrogenism in a cirrhotic male?

A
  1. Gynecomastia
  2. Palmar erythema
  3. Spider angiomas
  4. Testicular atrophy
  5. Decreased body hair
283
Q

What are exudates? Transudates?

A
  • exudates –> increased capillary permeability

- transudates –> increased hydrostatic or decreased oncontic P

284
Q

Painless vaginal bleeding in the third trimester?

A

-think: placenta previa!

285
Q

Tx for stye?

A

-warm compress

286
Q

What is a stye? AKA?

A
  • staph abscess of eyelid

- AKA: external hordeolum

287
Q

What should be avoided while taking metronidazole?

A

-alcohol –> can cause disulfram-like rxn

288
Q

Cavity lesion on CXR with halo sign in immunocomp pt?

A

-think: aspergillosis

289
Q

Hypertrophic osteoarthropathy: what is it? What is it commonly seen with? Best initial study?

A
  • 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
Q

Nail puncture wound on foot that results in osteomyelitis?

A

-think: pseudomonas aeruginosa

291
Q

What is the next step for a solitary lung nodule that is highly suspicious (ex hx of malig)?

A
  • surgical excision!

- skip CT or PET

292
Q

Cause of NPH?

A

-decreased absorption of CSF

293
Q

Dx test for zollinger-ellison syndrome?

A

-fasting serum gastrin levels

294
Q

Immunodef + Low platelets + eczema? Tx?

A
  • think: wiscott-aldrich syndrome
  • deficient in T lymphocytes
  • only tx = bone marrow transplant!
295
Q

Niemann-pick v tay-sachs: battle of the cherry red spots

A
  • 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
Q

Tx for dressler syndrome?

A

-NSAIDs

297
Q

What is the most critical factor that determines overall patient survival in sudden cardiac arrest?

A

-elapsed time til rhythm analysis and defib

298
Q

What is the most common cause of sepsis in pts with sickle cell anemia?

A

-strep pneumo

299
Q

Tx for pancreatic pseudo cyst?

A
  • should resolve spontaneously, no tx needed

- drain if, persists longer than 6 wks, > 5cm in diameter, becomes infected

300
Q

First line tx for adolescents with moderate to severe uterine bleeding who are hemodynamically stable?

A

-high dose estrogen –> helps regrown endometrium

301
Q

Torticollis: what is it? What is it usually caused by? Dx?

A
  • = 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
Q

What should be done when a white reflex is seen in an optho exam of a child?

A
  • prompt referral to opthalmologist

- retinoblastoma until proved otherwise!

303
Q

Marfan-like pt with intelectual delay?

A

-think: homocystinuria

304
Q

Marfan-like child with fair complexion?

A

-think: homocysteinuria

305
Q

Fair haired, tall child, elastic skin, developmental delay w/ CVA?

A

-think: homocysteinuria

306
Q

Dx & tx of herditary homocysteinuria?

A
  • dx: elevated homocysteine and methionine levels

- tx: vit B6, folate, and vit B12 –> to lower homocysteine levels

307
Q

Which disorders commonly cause gouty attacks?

A
  • myeloproliferative d/o bc of increased turnover of purines

- ex polycythemia vera

308
Q

Solitary ring enhancing lesion on brain CT + fluid collection in maxillary sinus?

A

-think: brain abscess from anaerobic bacteria

309
Q

What is a major cause of morbidity and mortality in pts with cirhosis? What test should all pts dx with cirhosis undergo?

A
  • GI bleeds from esophageal varacies

- all cirrhotic pts should undergo am emdoscopy!

310
Q

What is the most common leukemia in the western world?

A

-chronic lymphocytic leukemia (CLL)

311
Q

What is important in ventilation for ARDS?

A

-need PEEP

312
Q

First line tx for acute-closed angle glaucomma?

A

-IV acetazolamide!

313
Q

Tx for pseudomonas?

A

-cefepime or piperacillin-tazobactam

314
Q

What is hepatic hydrothorax? Tx?

A
  • 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
Q

Prophylaxis for pregnancy loss in antiphospholipid syndrome?

A

-low molecular weight heparin + aspirin

316
Q

Cold leg after an MI? Dx test? Tx?

A
  • 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
Q

What pulmonary-renal syndrome requires an emergency plasmapheresis?

A

-goodpastures!

318
Q

Recurrent pneumonia in the same area of the lung?

A

-suggests bronchial obstruction due to an underlying abnormality –> most concerning would be a bronchogenic carcinoma

319
Q

What is the most dangerous complication of ESRD? Best tx?

A
  • hepatorenal syndrome

- best tx = liver transplant

320
Q

When should prophylaxtic testing be done for GBS in pregnancy?

A
  • 35-37 wks gestation

- vaginal AND rectal cultures

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