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UWORLD FM Flashcards

1
Q

Uterine Sarcoma RF

A
  • RF: Post menopausal, Tamoxifen, radiation
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2
Q

Compartment syndrome clinical features

A

POOP, Inc pain with stretch, paraesthesia, rapidly increasing swelling and tense

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3
Q

IUD contraindications

A
  • Progestin + Copper (unexplained vag bleeding, endometrial/cervical ca, preg/gestational trophoblastic Dx, distorted uterus, active PID)
  • Progestin (liver Dz, br ca)
  • Copper (wilson)
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4
Q

Traveller’s Diarrhea Tx

A
  • Adults: Quinolones
  • Kids: Azithromycin
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5
Q

Gold standard for assessing dehydration

A

weight loss

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6
Q

Incontinence Treatment

A
  • Stress (pee with inc abd pressure): pelvic Sx or exercises, pessary
  • Urgency (bladder training, anti-muscaranics)
  • Overflow (trouble emptying bladder and dribbling): cholinergic agonists, self cath
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7
Q

Benign vs harsh murmurs

A
  • Benign: Mid systolic/early, Grade 1-2, decrease with standing/valsalva
  • Path: Diastolic/holosystolic, >Grade 3, persist with valsalva/standing
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8
Q

Prolonged QT syndrome

A
  • Etiology: Congenital, electrolytes (hypo-ca/mag/kalemia), Drugs (quinolones, macrolides, opioids like oxy, zofran, antipsychotics)
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9
Q

Pneumonia in children- criteria for admission

A

Hypoxia <90, mod-severe distress, failed OP Tx, dehydration, complicated (effusion)

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10
Q

Causes of vertigo

A
  • BPPV
  • Migraine (associated with h/a)
  • vestibular neuritis (after URI, lasts days)
  • Cerebellar stroke (persistent, >50 with RFs, non-suppresable nystagmus)
  • Meniere’s
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11
Q

Treatment of PAD

A
  • First: Smoking, HTN, DM, ASA+Statin
  • First: Exercise program
  • Second: Cilastazole
  • Third: Surgery (Angio with stent or bypass)
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12
Q

Factors concerning for thyroid malignancy

A
  • > 1cm
  • Microcalcification, inc vascularity, hypoechoic, elevated/normal TSH
  • Relatives, radiation, rapid growth, cervical LNpathy
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13
Q

Prophylaxis for Lyme disease Criteria (must meet all)

A
  • Attached tick adult
  • Attached >36 hours
  • PPx within 72 hours of tick bite
  • No C/I to doxy
  • Borrelia infection rate >20% (new england)
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14
Q

Etiology for IE

A
  • S. Aureus (IVDU, prosthetic valves, catheters, implantable devices)
  • S. epi (same as staph Aureus but no IVDU)
  • Candida (long Abx, immunosup)
  • Enterococci (UTIs)
  • Strept (Respiratory or dental)
  • S. Gallalyticus (Colon Ca, IBD)
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15
Q

Treatment for Lichen Sclerosis

A

High potency steroids.

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16
Q

Treatment for severe opioid induced constipation.

A

methylnatrexone

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17
Q

When should tamoxifen be stopped before surgery?

A

2-4 weeks as it can cause thrombosis.

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18
Q

Post partum urinary retention

A

Pudendal nerve injury. Self resolves in a week.

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19
Q

Pregnancy Rhinitis

A
  • Nasal congestion and often epistasix
  • Treat with saline sprays and exercise. Flonase only helps if they had underlying seasonal allergies
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20
Q

Absolute C/I to OCPs

A

Migraine, >15 cigs + >35y, heart disease, clots, pregnancy, diabetes, liver disease, immobilization, Hx of stroke, APL syndrome

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21
Q

Tourrett’s syndrome Tx

A

Behavioral is first line. Pharm is antipsychotics

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22
Q

HOCM

A
  • Presents with CP, dyspnea, syncope
  • Sys ejection murmur
  • EKG: depo (Q waves) and repol (T wave inversions) and Echo (LVH)
  • Tx: BB/CCBs, avoid dehydration and vaso, ICD maybe, ablation/transplant
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23
Q

Lactose intolerance test of diagnosis

A

Lactose hydrogen breath test

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24
Q

Common causes of esophagitis in HIV pts

A
  • Candida (pseudohyphae on Bx)
  • HSV (Multinuclei on Bx)
  • CMX (intracytoplasmic/nucleic inclusions)
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25
Q

Ankylosing spondylitis

A
  • <40 years, low back pain, hip/butt pain IMPROVES with exercise. Uveitis. Limited lumbar spine and chest expansion. Sacroilitis on imaging
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26
Q

Congenital Toxoplasmosis

A
  • Through undercooked meat, vegetables, cat feces
  • Chorioretinitis, seizures, intellectual disability, hearing issues, hydrocephalus
  • Tx Spiramycin
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27
Q

Lung abscess

A
  • Fever, night sweats, weight loss, putrid sputum
  • Ampicillin-sulbactam alt- clinda
  • Cultures are not helpful
  • Air-fluid level on imaging
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28
Q

SJS and TEN

A
  • BSA: <10 (SJS), 10-30 (overlap) and >30 TEN
  • 4-28D after exposure, erythema/vesicles/macules, necrolysis and epidermal sloughing
  • Causes (Abx- sulfa, phenytoin, carbamezapine, allopurinol, NSAIDs)
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29
Q

Eating Disorder treatments

A
  • Anorexia: CBT, NT and OLANZAPINE
  • Bulimia: CBT, NT and SSRI (Fluoxetine)
  • Binge-eating: SSRI, Lisdexamphetamine
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30
Q

Cutaneous Larva Migrans

A
  • usually from caribean, south Asia
  • Cutaneous serpengious rash on feet
  • “Hook worm”
  • Ivermectin> albendazole
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31
Q

Internal hemorrhoids

A
  • <40 without red flags: Anoscopy, 40-49 without red flags: sigmoidoscopy, >50 with red flags: Colonoscopy
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32
Q

ECT Indications and risk

A
  • For dep with psychosis, resistant depression, wont eat/drink, suicide risk
  • Risk: recent MI/stroke, unstable aneurysm
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33
Q

Burns in children

A
  • Intentional: will not splash marks, will be uniform with sharp borders, spares creasing
  • 2nd/third degree burns- transfer out
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34
Q

Rhinitis medicamentosa

A

Recurrent rhinitis after using decongestant >5 days. usually treat with flonase.

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35
Q

Screening for Diabetes

A
  • BG levels (more accurate that A1c): Fasting >126. Repeat on 2 different occasions. >200 PP
  • A1c: >6.5
  • OGTT: Most sensitive
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36
Q

Antiplatelet therapy after stent placement

A
  • Should continue DAPT for at least 6-12 months in DES/metal stent. Ideally 30 months.
  • If elective, postpone until minimum requirement met (6 months for DES and 1 mo for metal)
  • usually continue ASA indefinatley
  • Continue plavix unless high bleeding procedure (brain surgery)
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37
Q

Macular degeneration

A

Most common cause of vision loss in elderly. Can be wet (unilateral, exudative) or dry (atrophic). First sign is way/bendy lines)

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38
Q

lactose malabsorption

A
  • Can handle some dairy. Should be given calcium and vitamin D supplementation
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39
Q

Statin side effects

A

Can increase risk for diabetes due to increase in BG levels. A rare side effect is rhabdo, more common in simvastatin.

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40
Q

post-partum sadness

A
  • PP Blues <10 days: self-limiting
  • PP dep: >2 weeks
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41
Q

Vaginal bleeding DDx

A
  • Placenta Abruptio: Bleeding BEFORE delivery, uterine tenderness, painful contractions
  • Uterine rupture: Painful bleeding, uterine tenderness, NO contractions
  • Placenta accreta: Hard to remove placenta AFTER delivery
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42
Q

Recognizing adrenal insufficiency

A
  • Hyperkalemia, hyponatremia, eosinophilia, azotemia,
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43
Q

T.bili for phototherapy in newborns

A

> 9 at 12 hours or 10-12 at 24 hours

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44
Q

FHR etiologies

A
  • Fetal tachy: Infection (prolonged labor), terbutaline, hypothyroidism
  • Decels: placenta abruptio, umbilical cord prolapse, uterine rupture
  • Brady: Mag sulfate
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45
Q

Evaluation of adrenal incidentaloma

A
  • Always do hormonal work up (Cushing- DST, Pheochroma- catecholamines, Primary hyperaldo- renin-aldo ratio)
  • > 4 cm or suggestive of Ca: FNA, if not, conservative follow up
  • If hormones are elevated: Adrenalectomy
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46
Q

Side effects of Carbidopa/Levodopa

A

Hallucinations, headaches, agitation and dyskinesis/dystonia 5-10 years after treatment.

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47
Q

Sickle cell prophylaxis

A

Antibiotics from 2 months to 5 years.
Needs pneumococcal, meningococcal and flu vaccines

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48
Q

Infertility tests

A
  • Male: Semen analysis
  • Ovarian reserve: Clomifene challenge or day 3 measurement of FSH and estradiol
  • Ovulatory function: 21 day progesterone challenge
  • Uterine evaluation: sonohysterogram
  • Fallopian evaluation: Hysterosalphingogram
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49
Q

PNA management in kids

A
  • Pre-school (S.Pneumo): Amox
  • Older kids (Mycoplasma): Azithro
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50
Q

Neurocystericosis

A

T.Solium. Calcified nodules in brain. Can cause headache and new-onset seizures. Albendazole +/- Steroids.

Toxo causes ring enhancing lesions

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51
Q

Wound management

A
  • Close with primary closure (suture, adhesive tape or staples) within up to 18 hours and up to 24 for face. If late, immunocomp, crush injuries or bites- secondary closure
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51
Q

Systemic Sclerosis

A

2 types: limited cutaneous (hands, feet, neck, face) and diffuse (abdomen, chest)
Limited: better prognosis. CREST syndrome. More prone for pulm HTN as opposed to renal failure/heart which is more common in diffuse.

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51
Q

Asthma exacerbation in kids management

A
  • Mild: neb albuterol (3 doses in an hour) and PO steroids
  • Mod: neb albuterol + ipratropium and PO/IV steroids
  • Severe: above + mag and IV steroids
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51
Q

ADHD
Symptoms

A

Rule of 6. More than 6 symptoms of inattention and/or hyperness for >6 months. Presents mostly before 12. Present in 2 settings. Functional impairment.

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52
Q

Vulvar masses

A

Bartholin cysts are usually benign but if appear nodular or irregular in an especially post menopausal woman, it needs biopsied.

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53
Q

Intussception

A
  • RF: viral illness, rotavirus, HSP, celiac
  • Presents with episodic crampy abdominal pain, current jelly stools
  • Crescent sign on Xray and target sign on USG
  • Tx: Enema vs sx
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54
Q

Anti-depressant with-drawl syndrome

A

usually due to abrupt stoppage of drug causing irritability, fatigue, anxiousness, GI upset and flu symptoms. Re-start old and taper before starting new.

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55
Q

Indications for TRUS prostate Bx

A
  • Do it before MRI which can be used for staging
  • Indications: Nodule, irregularity, asymmetry on DRE, PSA 1st check >7 and >2 in 2nd check.
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56
Q

Tocolytics options and C/I

A
  • <32wks: Indomethacin, <34: Nifidepine/Terbutaline
  • ONLY to delay pre-term delivery
  • C/I: Fetal death, fetal anomaly, pre-eclampsia, HD instability, pelvic infection
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57
Q

Whitlow finger

A
  • Caused by HSV
  • Tx: supportive in immunocompetent and acyclovir for immunosuppressed.
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58
Q

Infectious tenosynovitis

A
  • Kanavel signs: Sausage finger, pain with extension, tenderness along the tendon sheath
  • Incision and drainage with Abx.
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59
Q

Acute Paronychia

A

Swelling, erythema, tenderness in medial part of finger. Localized bacterial infection. Treat with warm soaks and topical Abx.

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60
Q

Chronic SDH

A

Presents with fluctuating/insidious symptoms like confusion, irritability. Present after a fall. Older people. Neuroimaging necessary. Tx: Watch if <10mm and surgery (>10mm, herniation, midline shift)

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60
Q

Metabolic Alkalosis
(What happens to Cl)

A
  • If urine Cl is low: Body trying to save Cl in hypovolemic states (Dehydration)
  • IF urine Cl is high: It represents renal wasting. I.e. Barter and Gitleman syndrome (hypovolemic) and Cushing, hyperaldo (hypervol)
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60
Q

Meningitis in USA

A
  • Most commonly caused by S.Pneumo, N.men, H.influenza, Listeria
  • Only add dexa to Abx if S.pneumo
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60
Q

Traumatic Hyphema

A
  • Usually eye injury with blunt trauma.
  • Presents with photophobia, eye pain, blood in ant chamber, unequal pupils
  • Tx: Bed rest or limit activity, eye shield, monitor IOP, steroid/cyclopegic eyes drops
  • Complications: Permanent vision loss, glauma, rebleeding
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61
Q

RSV prevention

A

Nervisemab for all infants <8 months.

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62
Q

Disseminated gonococcal infection

A
  • Triad of tenosynovitis, migratory polyathralgia and pustular skin lesions. Treat chlamydia too.
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63
Q

Blunt chest trauma

A
  1. Bones (Clavicle, sternum, ribs, scapula)
  2. Flail chest >3 adjacent ribs, each fractures in 2 places
  3. Internal injury
    - Aortic: Widened mediastinum
    - Pulm contusion: opacity on pulm parenchyma
    - Pneumothorax
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64
Q

Parvovirus in pregnant women

A
  • Can cause fetal demise <20 weeks and >20 week need to be monitored with USG for hydrops fetalis
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65
Q

Pediatric sepsis

A
  • <28D (GBS, E.coli, Listeria). Treat with Ampi+Genta
  • > 28D (S.Pneumo, N.men). Treat with Vanc + Rocephin
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66
Q

RA risks

A
  • Cardiovascular mortality has been shown to be increased.
  • DRUGS SIDE EFFECTS
    1. Methotrexate (hepatotoxicity, stomatitis, cytopenias)
    2. Leflumide (Hepato, cytopenia)
    3. Hydroxychloroquine (retinopathy)
    4. TNF inhibitors (infxn, ca, CHF)
    5. Sulfasalzine (Hepato, hemolytic anemia stomatitis)
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67
Q

Coxsackie Myocarditis

A

Most common. It is post URI. Can lead to dilated cardiomyopathy and lead to heart failure.

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68
Q

MMR vaccine

A
  • Infants at 12 months and then 4 years
  • If they are travelling internationally, then can receive before 12 months but will have poor immune response so 2 dose needs to be administered.
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69
Q

Conduct and Anti-social disorder

A

Conduct is <18 years and anti-social >18 years

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70
Q

Polycythemia Vera

A

Myleproliferative disorder which causes erythropoietin derived increased erythrocytes. Presents with transient vision loss, burning face, hepato-splenomegaly. Low erythropoeitin. <60 years can be treated with ASA and phlebotomy. >60y need hydroxyurea.

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71
Q

Strept throat treatment

A

Penicillin.
If mild allergy, cephalosporin
If anaphylaxis, azithromycin or clindamycin

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72
Q

Polymorphic eruptions of pregnancy

A

Urticarial rashes on abdomen and spare the peri-umbilical region. Steroid is treatment.

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73
Q

Classic congenital adrenal hyperplasia

A
  • 21-hydroxylase deficiency- Elevated 17-Hydroxyprogesterone
  • Causes hyperkalemia, hyponatremia and hypoglycemia
  • Treat with mineralocorticoid and glucocorticoid
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74
Q

Pemphigus Vulgaris

A
  • Erythematous bullae that begin in mouth and then to the body
  • +ve Nikolsy sign (burst on contact)
  • Dx: Desmoglein Ab and skin bx
  • Tx: Systemic steroids
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75
Q

ADHD medication titration

A

Increased weekly as long as not getting side effects

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76
Q

Sudden onset heavy proteinuria and hypoalbuminemia in adults

A
  • MCD: Nothing on UA. After URI. Need renal Bx. Treat with steroids
  • Focal segmental glomerulonephrosis: Crescent formation
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77
Q

ABI interpretation

A

<0.9: Diagnosis of PAD
>1.3: Calcified can falsely elevate ABI

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78
Q

Most accurate way to determine exact due date

A

USG in 1 month, calculate crown rump length

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79
Q

Smoking cessation

A
  1. Varenicline- BEST. Can cause abnormal dreams
  2. Nicotine gum and patch- Reduces craving and safe
  3. Bupropion- Reduces weight gain post cessation.
80
Q

TSH ranges in pregnancy for Hypothyroidism

A

1st trimester: 0.1-2.5, 2nd: 0.2-3 and 3rd: 0.3-3.
Increase dose by 30% and repeat labs every 4 weeks.

81
Q

Vision changes in diabetic patients

A
  1. Nuclear Cataracts: Loss of distant vision BEFORE hazy lens formation
  2. Diabetic Retinopathy: Slow blurry vision, spots and flashy lights
82
Q

Varicella Zoster in exposed newborns

A

IF mother has symptoms 5 days before or 2 days after delivery and newborn is asymptomatic, then isolate. give immunoglobulin and monitor for 21 days
If newborn has symptoms then treat with Acyclovir.

83
Q

Ascites

A
  • SAAG: Serum albumin - Fluid albumin
  • > 1.1 indicated portal HTN (Cirrhosis, heart failure)
  • <1.1: TB, Ca, nephrotic
84
Q

Capnography

A

Earliest sign of ROSC is sudden rise in ECO2

85
Q

Reactive Arthritis causes and treatment

A
  • Shigella, Salmonella, Yersinia, Chlamydia
  • NSAIDs first line. 2nd line: DMARDs, Steroids. Abx just in chlamydia
86
Q

Preventative care for SCD patients.

A

Transcranial doppler (2-16 years): If there is high flow, they would need chronic erythrocyte transfusion.

87
Q

Acute Otitis Externa Tx

A
  • Mild: Acidifying solution like acetic acid
  • Moderate: Topical antibiotics and wick if canal occluded
  • Severe: Broad spectrum Abx (Cipro) and +/= debridement
88
Q

When to reduce testosterone dosage

A

When Hgb is >16 or Hct >54%

89
Q

Bloody diarrhea causing organisms

A

Shigella, E.coli and campylobacter

90
Q

Elderly cognition

A
  • Normal Aging: Losing fluid intelligence (learning new concepts)
  • Mild Cog impairment: Sometimes memory affected and still able to function independently
  • Dementia: Cannot function independently.
91
Q

Improper positioning of ET tube.

A
  1. If in lungs: Capnography will be normal. Will hear unequal lung sounds. retract ET tube
  2. If in esophagus: abnormal capnography. Take it out and re-insert.
92
Q

What defines Pre-term labor?

A

Before term gestation with frequent contracts and ONE of the following (Cervical dilation >3 cm or Length shorter than 20 mm)

93
Q

DMD

A
  • Usually presents with motor weakness, scoliosis, gowers sign, calf pseudohypertrophy
  • Measure CPK and gene study
  • Complications include restrictive lung disease and dilated cardiomyopathy (need serial ECGs, Echos and PFTs)
  • Treat with steroids
94
Q

Bluish tinge vision is seen in which condition?

A

PDE-5 inhibitor use

95
Q

When do you see dot blot hemorrhages and microaneurysms?

A

Diabetic retinopathy

96
Q

Generalized pustular psoriasis

A

Generalised spread of sterile pustules. Usually in pregnant patients or when withdrawn from steroids. Treat with high potency retinoids or immunosuppressive therapy

97
Q

RA associated cervical myelopathy

A
  • Symptoms (neck pain, spastic paresis, resp depression, hand and feet sensory deficits)
  • Signs (Protruding atlas, scoliosis, spastic paresis, babinski, hoffman sign)
98
Q

Juvenile myoclonic epilepsy

A
  • Symptoms (Myoclonic, gen tonic-clonic seizures, absence)
  • EEG: Bilateral polyspike and slow wave
  • Tx: Valproic acid
99
Q

Side effect of Lasix

A

OTOTOXICITY

100
Q

AAA mangement

A
  • ASA and statin, stop smoking
  • Need surgery if large >5.5cm or increasing in size rapidly (>0.5 in 6 months) or associated with PAD/aneurysm
101
Q

Patellar dislocation

A

Lateral displacement of patella. In flexion. Urgent closed reduction and brace after care.

102
Q

FHR

A

Late Decels: FGR and placental insufficiency
Variable Decels: Umbilical cord compression
Early Decels: Head compressions

103
Q

Charcot’s Arthropathy

A

Repeat joint trauma. With DM
Acute: Erythema, pain, swelling. Xrays usually negative. Treat with cast and non-weight bearing
Chronic: Stress fractures, ulcers, cellulitis. Treat with Abx, orthotic foot wear and surgery for alignment

104
Q

Recurrent Aphthous ulcers

A
  • Present as small vesicles. First line treatment is topic steroids. Conditions that cause it are HIV, behcets.
105
Q

Difference between JIA and Transient synovitis

A

JIA is in toddler girls with large joints except hip involved. Inflammatory markers elevated.
TS Boys, normal inflammatory markers. More in boys.

106
Q

GBS Prophylaxis indications

A
  • Infection during pregnancy despite treatment
  • Previous infant with GBS infection
  • Unknown GBS AND one of the following (<37 weeks, intra partum fever, ROM >18 hours )
107
Q

Precautions

A

AIRBONE: TB, Virus (measles, varicella)
DROPLET: Nisseria, Mycoplasma, H.influenza, Influenza
CONTACT: RSV, E.coli, VRE, MRSA, C. Diff, scabies

108
Q

Syphilis testing

A

Non-trepenomal (VDRL, RPR) tell us past or active infection. Detect earlier
Trepenomal (FTA-ABS): May remain positive even after treatment. Cant differentiate.

109
Q

Migraine treatment

A

Abortive: NSAIDs, ergotamine, triptans, anti-emetics
PPx: BB, Topamax, TCA (Amytriptiline), Venlafaxine, Menstrual (Frovatriptan), Kids (Riboflavin, cyproheptadine)

110
Q

Most common thrombophilia

A

Factor 5 Leiden Mutation (Protein C resistance)

111
Q

Prolonged Labor

A

> 20 hours in nulliparous and >14 hours in multi

112
Q

GDM diagnosis and treatment

A

If 2/4 values are elevated (95, 180-155-140)
-Tx: 1st lifestyle modification and then metformin or inuslin

113
Q

Difference between inflammatory and non-inflammatory diarrhea

A

Non-inflammatory usually watery large volume and inflammatory is small volume and may not contain mucus/blood.

114
Q

Exercise induced urticaria

A

usually triggered by exercise. Skin is flushed and with rashes. Can progress to anaphylaxis. Treat with H2 blockers like loratidine.

115
Q

Common peroneal neuropathy

A

usually supplies dorsal foot and shin
Superficial helps with foot eversion
Deep helps foot dorsiflexion and toe extension

116
Q

Aortic Stenosis

A

Mild: gradient <20. Echo 3-5 years
Mod: gradient 21-39. Echo 1-2 years
Severe: gradient >40. Asx (6 months) and sx (AVR)

117
Q

Lights Criteria

A
  • It is for Exudative
  • Pleural protein/Serum protein >0.5, Pleural LDH/Serum LDH >0.6 or LDH 2/3 upper limit
  • Exudative (Infection, Ca, pancreatitis, PE) and transudative ( Nephrotic, cirrhosis, heart failure)
118
Q

When do Abx needed in addition to I&D for abscess

A
  • > 2cm, surrounding cellulitis, systemic symptoms, multiple abscesses, neutropenia, extreme of ages.
119
Q

Non-hogkins lymphoma complications

A

usually radiated. Increases risk of other malignancy especially breast cancer. So annual mammos 8 years later and no later than 40.

120
Q

Strabismus treatment

A

Cover unaffected eye, put corrective lens on affect eye.

121
Q

BB toxicity

A

Hypotension, hypoglycemia, bradycardia

122
Q

Treatment of Gout

A

PPx is with allopurinol (Start with 100 and then titrate slowly and in patients with renal disease)

123
Q

Evaluate hirsutism

A

Serum testosterone

124
Q

Centor criteria

A
  • Fever, tender cervical LNpathy, tonsillar exudates and absence of fever
  • If 2 or more: get the test
125
Q

Factors associated with increased mortality in patients with MVP

A

Degree of MR and EF <50%

126
Q

Eclampsia management

A

If <37 weeks then there is benefit to delay delivery. If at 37 or more, then deliver. Anti-hypertensives and Mag is given for stroke prevention when BP is over160/110

127
Q

Treatment of osteo in patients with severe GI symptoms

A

IV zalendronic acid infusion yearly.

128
Q

PPROM Management

A
  • If <34 weeks and uncomplicated then steroids and Abx with expectant management and if complicated then steroids, Abx, mag <32 wks plus deliver
  • 34-<37: GBS Ppx and deliver
129
Q

Evaluation of head trauma

A
  • GCS <14, AMS: HCT w/o con
  • GCS 15, abnormal behavior, hematoma, severe injury (>3 feet): Observe +/- HCT
  • GCS 15, No issues: Send home
130
Q

Recurrent HSV management in couples

A

Abstinence during outbreaks even with condoms. Daily suppressive therapy with Valacyclovir due to Asx viral shedding

131
Q

What are causes of hypercalcemia

A
  • PTH related: Primary hyperparathyroidism (Urine Ca>250), tertiary in renal failure, FHH
  • PrPTH: Malignancy, hyperthyroidism, adrenal insufficiency, sarcoidosis, immobilization, Vitamin D excess, medications
132
Q

Indications for hospitalization in Anorexia

A
  • Bradycardia, hypotension, hypothermia, BMI <15, Organ damage, electrolyte abnormalities
133
Q

Treatment of ITP

A
  • Kids: If cutaneous, just observe. Otherwise steroids, IVIG
  • Adults: If cutaneous and >30K, observe. Then steroids and IVIG.
134
Q

Skin cancers

A

Basal cell Ca: More common, face, nodular lesion with rolled margin
Squamous cell: Less common, usually arises from a precursor lesion

135
Q

Juvenile Dermatomyositis

A

Gottron’s papules, calcinosis, heliotropic rash, proximal muscle weakness. Elevated CK. Tx: Steroids +/- MTX

136
Q

Diagnosis of gastroparesis

A

Upper endoscopy to rule out obstruction and gastric emptying study.

137
Q

Amiodarone induced hypothyroidism

A

Continue Amio and start levothyroxine

138
Q

ITP co testing

A

Hep C and HIV. >60y then bone marrow aspiration to rule out myodysplastic syndrome

139
Q

Type 1 diabetes honeymoon phase

A

After initiating insulin, BG levels normalize and body starts to produce insulin. Requirement decreases for a brief period and starts to rise again.

140
Q

Transtumumab side effect

A

Cardiotoxicity. Echo before starting.

141
Q

Colonoscopy screening in UC

A

8-10 years after diagnosis and 1-3 years after that

142
Q

Emergency contraceptives in order of efficacy

A

Copper IUD, Prog IUD, Urlipristat (not in obese women), Progestin pills, OCPs

143
Q

How to treat craddle cap?

A

Brush hair after applying emollient

144
Q

Fragile X syndrome features

A

Long face, small chin, protruding ears, enlarged testicles

145
Q

Warning signs for IBS

A

Nocturnal diarrhea, bleeding, anemia, weight loss

146
Q

Impetigo treatment

A

Non-bullous: Localized can be treated with topical mucoporin and spreaded treat with Keflex.
Bullous keflex

147
Q

MYOPATHIES

A
  1. Steroid induced: LE weakness, normal CK/ESR
  2. PMR: Pain in proximal muscles. High ESR. Asso with GCA
  3. Polymyositis/Dermatositis: Weakness and elevated CK/ESR
  4. Statin induced: Pain, elevated CK
  5. Hypothyroid: weakness and pain. Elevated CK
148
Q

Pressure ulcer stages and management

A

1: Intact skin with local redness
2: Shallow ulcer
3: Full skin gone with subq fat visible
4: Tendon and bone visible
5. Full thickness, base is visible and may have eschar
- Debridement only needed when there is infection as it can cause osteomyelitis

149
Q

C.dig toxic megacolon treatment

A

PO Vanc and IV Flagyl and urgent surgical intervention

150
Q

Common cause of acute scrotal pain

A

Epidydimis, scrotal abscess, testicular torsion or infarction

151
Q

Subclinical hyperthyroidism

A

Can get overt. Should be screened for heart failure, A.fib, osteoporosis. Treatment should be given if TSH <0.1 or >65 years

152
Q

Diagnosing COPD

A

Symptomatic need spirometry. Asymptomatic COPD patients dont.

153
Q

Roseola Infantum

A

Caused by HH-6. Maculopapular rash appears after resolution of high grade fever. Treat with supportive cares.

154
Q

Etiologies of tinnitus

A

Can be pulsatile (vascular) and non-pulsatile (usually has SNHL). Non-pulsatile needs audiometry.
U/L: Cerumen impaction, vestibular schwannoma
B/L: Presbycusis, otosclerosis, ototoxicity, vascular, Meniere’s, hypertension

155
Q

Pancoast tumor features

A
  • Shoulder pain (most common symptom)
  • Horner syndrome
  • Neuro (Weak hand muscles, 4/5th finger paresthesia)
  • Supraclavicular LNpathy
  • Weight loss
156
Q

Most likely cause of mortality in pregnant patients with Marfan syndrome

A

Most common is aortic disease which presents as dilation that can result in dilation and dissection.

157
Q

What helps with prognosis of MM

A

B-microglobulin and serum albumin

158
Q

Amiodarone side effects

A
  • Thyroid, pulmonary, bradycardia/QT prolongation, hepatitis, blue-grey skin discoloration, optic neuritis
159
Q

SIADH diagnosis

A
  • Patient should be euvolemic and not had diuretics in the last 24-48 hours
  • Serum osmolality low and urine osmolality is high
160
Q

Varicocele

A

“bag of worms” which improves lying down and prominent when standing. USG shows dilated pampiniform plexus and retrograde venous flow. Treatment gonadal vein ligation in kids and supportive in old men.

161
Q

Cancer pain

A
  • Mild is with non-opioid
  • Moderate: Short acting opioid (Oxy, morphine)
  • Severe: Long acting (Morphine ER, Fentanyl patch)
162
Q

Bug bites

A
  • Bug bites: Linear pruritic pattern
  • Spider: papule>pustule>wheal
163
Q

Treatment of inflammatory acne

A
  • There is papules and pustules <5 mm with redness
    1st: Benzoyl peroxide and topical retinoid
    2nd: Add topical Abx (clinda, erythromycin)
    3rd: Add Oral Abx
  • Nodular cystic acne: Nodules that appear cystic > 5mm and scarring. treat with benzoyl peroxide + topical retinoid + topical Abx, if severe add oral Abx and if unresponsive then oral isotret
164
Q

Non-inflammatory acne

A

Comedonal acne. may progress to inflammatory. treat with topical salicylic or azelaic acid.

165
Q

Small intestinal overgrowth syndrome

A
  • Related to motility disorders (DM, scleroderma), structural (surgery, stricture), chronic pancreatitis, PPI use, Ig A deficiency
  • Presents as bloating, flactulence, abdominal pain, fatty diarrhea
  • Treat with Amox or rifaximin
166
Q

AK

A

Presents as scaly erythematous macules or papules in sun exposed areas. Can progress to SCC. Treat with cryo or 5FU/imiquod.

167
Q

TIA

A

Use ABCD (Age>60, high BP, clinical presentation, duration>60 min and DM). if >3 points, then admission to hospital. Should present within 72 hours.

168
Q

PPH treatment

A

initially start Pitocin and bimanual massage.
Can use Methygorvine (C/I in HTN) or Carbaprost (C/I in asthmatics)
Tranexamic can be used if all fails

169
Q

Atypical Endometrial hyperplasia management

A
  • If women want fertility- treat with progestin and repeat biopsy in 3 months
  • If not, then hysterectomy
170
Q

DRESS syndrome

A
  • Presents 2-8 weeks after drug exposure (Sulfa, Anti-convulsants)
  • Presents as fever, generalised LNpathy, facial edema, erythmatous rash, organ involvement (kidney, liver, pulm) and eosinophilia.
171
Q

Pityriasis Rosea

A

pruritic plaques around trunk, neck and upper extremities. Supportive therapy but can give topical steroid and anti-histamines for itching or phototherapy if really bad.

172
Q

Cholesterol embolism

A
  • Would have co-morbid conditions and after a cath
  • S/S: Skin (livedo reticularis, blue toe syndrome), Acute/subacute kidney injury, GI symptoms. Can cause stroke
  • Diagnosis: Clinic or biopsy (Perivascular inflammation with eosinophils)
173
Q

Pediatric hypertension

A

Elevated in 3 separate visits. Initial work up is BMP, UA, CBC, echo. if suspecting secondary, then plasma renin and aldosterone, renal ultrasound, plasma/urine catecholamines

174
Q

Hyperaldosteronism

A
  • Primary: Increased aldo but low renin. Adrenals are the problem. Thiazides can exacerbate it
  • Secondary: Increased aldo and renin. Caused by diuretics, renovascular, malignant
175
Q

Nipple trauma

A

Cracked nipples are common during breast feeding. observe

176
Q

Chronic Paronychia

A

> 6 weeks. Treat with topical steroids. If acute, then keflex.

177
Q

Starting children on stimulant medications for ADHD

A

Obtain family cardiac history, if complex refer to ped cardiologist.

178
Q

Uterine Endometritis

A

Fever >24 hours. Uterine fundal tenderness. Purulent lochia. Treat with clinda and genta.

179
Q

Post MI pericarditis treatment

A

Only with HD ASA. Avoid NSAIDs and steroids.

180
Q

Tinea Capitis

A

Erythematous, scaly patch. May even develop kerion. Treatment oral Griseofulvin (kids preferred) or terbinafine. SS shampoo only asymptomatic

181
Q

Pink eye

A

Viral conjunctivitis. No treatment is necessary just supportive. Bacterial will have unremitting discharge and more pain

182
Q

Long term effects of Weed

A

Infertility, low testosterone, psychosis, cyclic vomiting syndrome, lung/bladder cancer, Amotivational syndrome

183
Q

Dermatosytosis

A

Have 5 fold increased risk of malignancy and should undergo age appropriate screening. Treated with high dose steroids

184
Q

Erythema Multiforme

A

Non-painful target lesions that appear with infections like HSV. Doesn’t have central clearing

185
Q

Myasthenia Gravis

A

Ocular and bulbar weakness as the day progresses. CPK is normal. CT chest to rule out thymoma.

186
Q

Abnormal AST/ALT evaluation

A

Think of alcohol, fatty liver, hepatitis, drugs, hemochromatosis. Then consider,
Hepatic: AI, a-1 trypsin def, wilsons
Non-hepatic: Muscle, thyroid, celiac, adrenal insufficiency

187
Q

Pathological vs pubertal gynecomastia in males

A

Physiological is usually around tanner stage 3-4 around 14 and pathological usually tanner stage 5

188
Q

Alopecia Areata

A

Patches of hairloss. Can be associated with autoimmune conditions like thyroiditis. Treat with intralesional steroids.

189
Q

Which factor does not CV factor does not change in healthy older adults?

A

Resting LVEF. Resting HR decreases.

190
Q

OA treatment

A

Weight loss and exercise
NSAID AS NEEDED and topical NSAID
Consider duloxetine, topical capsacin
Surgery

191
Q

Difference between Ecthyma gangrenosum and pyoderma

A

Ecthyma is pseudomonas
PG is the AI condition.

192
Q

Mullerian Agenesis

A

External genetalia and ovaries are unaffected. karyotype is normal. Uterus is missing and there is a bling vaginal pouch. Renal USG should be performed.

193
Q

Car seats

A

Usually rear-facing till 2-4 (have to grow out of it. Kids <13 sit in the back seat

194
Q

Antihypertensives that blood glucose levels

A

Thiazides but they reduce CV outcomes
BB too but not the cardio-selective

195
Q

Glucose challenge test in high risk patients

A

Done in first trimester

196
Q

Ectopic pregnancy management

A

HCG <5000: MTX
>5000: Surgery

197
Q

Acute closure glaucoma
Open angle Glaucoma

A

Acute: Presents with sudden eye pain, redness, mid-dilated pupil, decreased vision (Halos)
Open: Gradual peripheral vision loss with inc IOP

198
Q

Chalazion

A

Basically a painless stye

199
Q

Episcleritis

A

Sudden onset of irritation, redness and watering but NO vision issues or pain

200
Q

Keratitis

A

Fluroscein stain will be positive. Fb sensation. Pain, eyelid swelling, redness

201
Q

Anterior Iritis (Uveitis)

A

May have hypopyon. In younger patients. usually presents as UL painful and red eye.
Redness around eye

202
Q

Retinal Detachment

A

RF: >50, Fam Hx, cataract Sx, Myopia
Presents with sudden, progressive vision loss with floaters and flashing lights

203
Q

Amaurasis Fugax

A

Sudden “curtain” over eyes. Usually associated with CAD

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