UWorld Incorrects Flashcards
What affect can calcineuron inhibitors (tacrolimus, cyclosporine) have on the kidneys? What is the mechanism of this side effect?
Renal toxicity caused by vasoconstriction.
Urinalysis typically shows pre-renal etiology.
What drug can cause a false positive for PCP on UDS?
Dextromethorphan, diphenhydramine, ketamine, tramadol, venlafaxine.
What drugs can cause a false positive for Amphetamines on UDS?
Atenolol, propranolol, buproprion, nasal decongestants.
What is the management of intrahepatic cholestasis of pregnancy?
Ursodeoxycholic acid and delivery at 37 weeks.
What are symptoms of Zinc deficiency? What are physical exam findings?
Hypogonadism, impaired wound healing, impaired taste, and immune dysfunction.
Alopecia, and skin rash of erythematous pustules around body orifices and on the extremities.
When are pregnant patients screened for gestational DB? What are patients with gestational diabetes at risk for developing later?
24-28 weeks gestation.
T2DB.
What is the recommended postpartum screening for patients with gestational diabetes?
Postpartum screening with 2-hour (75g) oral glucose tolerance test performed 6-12 weeks after delivery.
If screening is negative, repeat screen every 3 years.
What is post-op endopthalmitis? What are the symptoms?
Bacterial or fungal infection of the eye (particularly the vitreous) that usually occurs within 6 weeks of surgery.
Pts have: decreased visual acuity, swollen eyelids and conjuntiva, hypopyon, and corneal edema and infection.
What is the major result of uremic coagulopathy?
Increased bleeding time due to platelet dysfunction.
What is the management of acute dystonia?
Anticholinergics: benztropine or diphenhydramine
What is the management of akasthesia?
Beta blocker, benzo, benztropine.
What is the management of medical induced parkinsonism?
Benztropine or amantadine.
What is the management of tardive dyskinesia?
Valbenzine, deutetrabenazine.
What does a Quad screen show in trisomy 18?
Decreased AFP
Decreased bhCG
Decreased estriol
Normal inhibin A
What does a quad screen show in trisomy 21?
Decreased AFP
Decreased estriol
Increased bhCG
Increased inhibin A
When are antibiotics indicated in a COPD exacerbation?
What are the cardinal features of an exacerbation?
Mod-severe exacerbation (ie 2 or more cardinal features)
OR mechanical ventilation requirement.
Cardinal features: increased dyspnea, increased cough, increased sputum production.
Adolescents commonly have what symptom of major depression?
Irritability (as opposed to sadness).
What is the most common cause of non-hereditary sensorineural hearing loss in children?
Congenital CMV infection.
The majority of cases of erysipelas are caused by what organism?
Strep pyogenes
Keep in mind erysipelas has raised, well-demarcated boreders
What substances can cause methemoglobinemia?
Dapsone, nitrites, and local/topical anesthetics.
What happens in methemoglobinemia at a molecular level?
At least one of the oxygen in Hb is oxidized to he Fe3 state (ferric). This ferric oxygen is unable to bind oxygen and also causes the other ferrous sites to bind oxygen more tightly, resulting in a left shift and therefore decreased oxygen delivery to tissues.
What does methemoglobinemia do to the pulse ox reading? What does the ABG show?
It shows ~85% no matter what the true oxygen saturation is. Supplemental oxygen does NOT improve cyanosis or the pulse ox reading.
ABG measures unbound oxygen so it will show a falsely elevated oxygen saturation level and thus a normal PaO2.
What medications have been proven to have long term survival benefits in patients with LV systolic dysfunction?
ACEi/ARBs
BBs
Mineralocorticoid receptor antagonists (spironolactone and eplerenone) - because aldosterone has bad effects on the heart
What long-term effects can analgesics have on the kidney?
CKD caused by tubulointerstitial nephritis and hematuria due to papillary necrosis.
How do you prevent the maternal immune system from developing anti-D antibodies?
Anti-D immunoglobulin given at 28 weeks gestation and then again within 72 hours of delivery.
What type of bacteremia is associated with colon cancer?
Clostridium septicum and Strep Bovis
Why are estrogen-containing BC methods avoided in women who are <1mo postpartum?
Increased risk of thromboembolism.
Negatively impact breastfeeding.
How do you treat a patient who is stable with wide-complex tachycardia?
Antiarrythmics such as amiodarone, rocainamide, sotalol, or lidocaine.
If they are severely symptomatic then synchronized cardioversion is necessary.
What are clinical signs of craniopharyngioma?
Option chiasm compression causing bitemporal hemianopsia
Pituitary stalk compression causing endocrinopathies such as growth failure (decreased TSH or GH), pubertal delay in children or sexual dysf in adults (decreased LH and FSH), and DI (decreased ADH).
What is REM sleep behavior disorder? What type of dementia is it associated with?
Dream enactment during REM sleep.
Most patients with idiopathic REM sleep behavior disorder eventually develop a disorder of alpha-synuclein, most commonly Parkinsons (or dementia with Lewy bodies)
What is genitourinary syndrome of menopause? What are symptoms and signs for diagnosis?
Aka atrophic vaginitis.
When decline in estrogen causes decreased blood flow and therefore loss of epithelial elasticity and atrophy.
There will be sparse pubic hair, loss of reguae, pallor, and a shortened vagina. Vaginal pH >5 can help confirm diagnosis. May also see some blood on tissue from tissue injury.
What marker of HepB infection is present during the window period?
IgM Anti-HBc
What markers are used to establish a diagnosis of acute hepB infection?
HBsAg and Anti-HBc because they are both present in the inital infection, and Anti-HBc will remain elevated during the window period.
In evaluation of a thyroid nodule, when do you do scintigraphy?
When there is low TSH, to determine the level of functioning of the nodule.
If it’s hypOfunctional, then get FNA.
In eval of a thyroid nodule, when do you get an FNA?
Consider FNA when there’s normal or elevated TSH and has concerning features:
size >1cm with high risk features (calcifications, irregular margins, or any non-cystic nodule >2cm
What symptoms can be caused by a leydig cell tumor?
Gynecomastia due to production of estrogen by tumor cells. This causes secondary inhibition of FSH and LH.
What AIDs defining malignancy is association with Epstein Barr virus?
Primary CNS lymphoma and Non-Hodgkin’s Lymphoma.
What are symptoms and imaging findings in primary CNS lymphoma?
Progressive confusion, lethargy, seizure, or FND in the setting of a solitary, irregular, non-hemogenous ring0enhancing lesion on MRI.
What are the findings for breath sounds, tactile fremitus, and percussion in consolidation (lobar pneumonia)?
BS: increased
TF: increased
Percus: decreased
What are the findings for breath sounds, tactile fremitus, and percussion in pleural effusion?
BS: decreased or absent
TF: decreased
Percus: dullness
What are the findings for breath sounds, tactile fremitus, and percussion in pneumothorax?
BS: decreased or absent
TF: decreased
Percus: hyperresonance
What are the findings for breath sounds, tactile fremitus, and percussion in atalectasis?
BS: decreased or absent
TF: decreased
Percus:dullness
What effect does VitD deficiency have on PTH and calcium levels?
Hypocalcemia elevated PTH.
What murmur is associated with infective endocarditis from IVDU?
Tricuspid regurgitation: holosystolic murmur that increases in intensity on inspiration.
How does the cervix change during the active phase of labor (6-10cm)?
1 or more cm every 2 hours with adequate contractions (200 MV units every 10 minutes)
What is active phase arrest of labor?
Active phase of labor is when the cervix is 6-10 cm dilated.
Arrest during this phase is when there’s no cervical change in 4 hours with adequate contractions OR no cervical change in 6 hours with inadequate contractions.
What is the treatment for CIN3?
Conization.
What is the mechanism of action of tamoxifen?
Estrogen receptor antagonist at the breast, estrogen AGONIST in the uterus.
This puts women who are taking tamoxifen to treat breast cancer at risk for endometrial cancer.
What are symptoms and the management of severe hypercalcemia (>14 or sympatomatic)?
Weakness, GI distress, confusion, stupor, coma, typically patients are volume depleted.
Aggressive IV saline hydration + calcitonin. Bisphosphonates later for long-term treatment.
What is the typical presentation of immune thrombocytopenia purpura?
Petechiae, ecchymosis, and mucosal bleeding (peistaxis, heavy menstrual bleeding), normal liver span and non-palpable spleen.
The patient will have normal PT, PTT, and fibrinogen. They will have isolated thrombocytopenia.
How does ITP differ from von Willebrands?
Both have mucosal bleeding; however, in von WB disease the platelet count will be normal.
In ITP there is isolated thrombocytopenia.
How does ITP differ from TTP?
In TTP, there is thrombocytopenia + microangiopathic hemolytic anemia.
In ITP, there is isolated thrombocytopenia.
How do you differentiate polyuria from DI vs primary polydipsia?
Both will result in dilute urine (low urine osm), but in primary polydipsia the patient is usually hyponatremic (<137).
Therefore a patient with dilute urine who is not hyponatremic indicates it’s likely DI.
What causes of post-op fever occur within 0-6 hours?
Tissue trauma, blood products, malig hypertherm
What causes of post-op fever occur within 24hrs to 1 week?
Nosocomial infection, surgical site infections from GAS or clostridium perfringes, non-infectious (MI, PE, DVT).
What causes of post-op fever occur within 1 week to 1 month?
Surgical site infections from organisms other than GAS/clostridium.
C. diff infection
Drug fever
PE/DVT
What causes of post-op fever occur in >1 months time?
Viral infections and surgical site infections from indolent organisms.
How can you tell the difference between a confounding variable and effect modification?
Stratification of the data removes the confounder; while stratification makes the effect of effect modification more apparent (ie the relative risk will be much different between the two groups when stratified).
What are the risk factors for preterm prelabor rupture of membranes (PPROM)?
Prior PPROM
Genitourinary infection (Asympt. bacteruria, BV, gonorr)
Antepartum bleeding
What complications can occur when a baby is small for gestational age (SGA)? Define SGA.
SGA is weight under 10th percentile.
Hypoxia, polycythemia, hypoglycemia, hypothermia, hypocalcemia.
What clinical findings are seen in galactosemia?
Jaundice, hepatomegaly, vomiting, poor feeding, FTT, cataracts, increased risk for E. coli sepsis, decreased glucose, metabolic acidosis, and increased urine reducing substrates.
How do you treat preterm labor at <32 weeks?
Corticosteroids (betamethasone) to decrease ARDs risk
Tocolytics (indomethacin or nifedipine)
Magnesium sulfate for fetal neuroprotection (CP)
Who gets a one time abdominal US for AAA?
Men 65 to 75 who have ever smoked.
What is the screening recommendation for mammography?
Every 2 years from ages 50-74.
What is the recommendation for pap screening?
Women 21-65 every 3 years.
Women ages 30-65 may substitute screening with high-risk HPV testing, with or without pap.
What is the recommended colon cancer screening?
Adults age 50-75, yearly FOBT or FIT.
OR
Colonoscopy every 10 years.
What are the symptoms of anterior cord syndrome?
Distal bilateral flaccid paralysis, loss of pain/temp and crude touch sensation, and urinary retention.
What method of dealing with leiyomyomata uteri (fibroids) helps to decrease INfertility and decrease heavy periods?
Hysteroscopic myomectomy.
What is the Weber test?
Tuning fork placed in the middle of the forehead; the sound carried by bone conduction is normally heard equally in both ears.
What does the Weber test show in sensorineural hearing loss? What is an example of sensorineural hearing loss?
Lateralization to the UNaffected ear, because thee inner ear is unimpaired and can therefore hear the sound better.
Presbycusis: loss of cochlear hair cells.
What does the Weber test show in conductive hearing loss? What is an example of conductive hearing loss?
Lateralization to the affected ear because the conductive deficit masks the ambient nose in the room, allowing sound to be better heard.
Otosclerosis: stiffening and fixation of the stapes.
What lab findings can be seen in hyperemesis gravidarum?
Ketonuria, hypochloremic metabolic alkalosis, hypokalemia, hemoconcentration.
How do you diagnose and treat normal pressure hydrcephalus?
Improved gait with high-volume LP. Definitive treatment is ventricular shunt.
What is the vaginal pH of trich and BV?
> 4.5
What is the vaginal pH of candidiasis?
Normal 3.8-4.5
Patients with hemochromatosis can develop what type of cancer?
Hepatocellular carcinoma.
What are the findings in neurofibromatosis type 1?
Cafe au lait spots Inguinal and axillary freckling Lisch nodules Neurofibromas Optic glioma
What exam finding strongly suggests patellofemoral pain syndrome?
Pain with isometric contraction of the quadriceps (squatting).
Also pain with running, stairs, and commonly has atrophy or weakness of the quadriceps and hip abductors.
What is the tretment for greater trochanteric pain syndrome?
Exercise, PT, NSAIDs, and corticosteroid injections.
Describe angle-closure glaucoma?
Acute onset severe eye pain and blurred vision associated with nausea and vomiting. Usually in 55-70 yos.
Exam shows red eye with steamy cornea and moderately dilated pupil that’s non-reactive to light.
What is the onset of open angle glaucoma?
Insidious onset with gradual loss of peripheral vision, resulting in tunnel vision.
Increasing IO pressure and cupping of the optic disk.
What are symptoms of primary adrenal insufficiency?
Orthostasis Hyponatremia Hyperkalemia Hypoglycemia Eosinophilia
What are the symptoms of anterior uveitis?
Painful, red eye with photophobia, tearing, and reduced visual acuity.
Exam shows hyperemia concentrated at the junction of the sclera and cornea, pupillary constriction, hazy flare in the aqueous humor, and a layering of white cells in the anterior chamber (hypopyon).
What conditions are associated with anterior uveitis?
Systemic inflammatory diseasees and certain infections:
herpesvirus, toxo, sarcoidosis, spondyloarthritis (ankylosing and reactive arthritis), and inflammatory bowel disease.
Define exertional heat stroke?
Body temperature >104 with CNS dysfunction or other tissue/organ dysfunction
How can you differ polymyositis from Lambert-Eaton myasthenic syndrome?
Polymyositis has proximal muscle weakness with elevated CK and PRESRVED reflexes.
LEMS has proximal muscle weakness with reduced or absent deep tendon reflexes. Dry mouth and erectile dysfunction are also common.
What medication is used to treat postpartum endometritis?
Clinda + gent
What does the physical exam show in otitis media with effusion?
Air fluid levels, poor TM mobility on pneumatic insufflation.
Important: the TM will NOT be erythematous and NOT be purulent. TM will likely look gray and translucent.
How can all renal tubular acidosis present?
Growth failure, low serum bicarb, and normal anion gap metabolic acidosis.
What lab findings are seen in pagets disease of the bone?
Normal calcium, normal phosphorus, high alk phos, and high urine hydroxyproline.
What is the most common type of hip fractures in older adults due to falls?
Femoral neck or intertrochanteric fractures.
What infants are at risk for ABO hemolytic disease? What is the result of this incompatability?
Infants with blood type A or B with mothers who are blood type O.
Mild hemolytic disease of the newborn.
What is the most important predictor of overall survival in patients with out of hospital cardiac arrest?
Time to rhythm analysis and defibrillation if indicated.
What are the components in CHARGE syndrome?
Coloboma Heart defects Artresia Choanae Retardation of growth GU anomolies Ear anomolies
May also have cleft lip/palate, anosmia, hypotonia.
What are the signs of Gaucher’s disease?
Severe hepatomegaly and splenomegaly
Anemia, thrombocytopenia
Bony pain
FTT, delayed puberty
How does posterior urethral valves present?
Bladder distension, decreased urine output, and respiratory distress due to oligohydramnios and subsequent lung hypoplasia.
How do the ulcers of hemophilus ducreyi differ from those of HSV?
HSV: small vesicles or ulcers on erythematous base
Ducreyi: large deep ulcers with grey/yellow exudate
Both diseases are associated with tender lymphadenopathy, but in ducreyi the nodes may suppurate
What types of IVF should be used in burn patients? Which is preferred and why?
Isotonic crystalloid such as LR or nor normal saline.
LR is preferred because it contains near-physiologic levels of ions needed to help correct acidosis and maintain blood pH. NS may result in hyperchloremic metabolic acidosis.
What deficits are seen in lateral medullary syndrome?
Loss of pain and temp in the ipsi face and contra body., ispi bulbar weakness, vertigo, nystagmus, and horner’s syndrome.
Motor function of the face and body is typically spared.
What are the only contraindications to the DTaP vaccine?
Encephalopathy (coma, prolonged seizures) or unstable neurological disorders such as infantile spasms or uncontrolled epilepsy within one week of vaccine dose.
Anaphylaxis to vaccine component
(note - uncomplicated seizures are NOT a contraindication)
What is the most common malignancy to present with bloody ascites?
HCC - from tumor eroding nearby blood vessels.
How do you calculate NNT?
1/ARR
What is the proper prophylaxis to a traveler going to a country with known chloroquine resistance?
Mefloquine for 2 weeks prior, continued during the stay, and discontinued 4 weeks AFTER they get home.
What are the criteria for MDD?
5 of the following:
Sleep disturbance, loss of Interest, Guilt, decreased Energy, impaired Concentration, Appetite disturbance, Psychomotor agitation/retardation, Suicidal ideation.
When should an intrauterine pregnancy be seen on TVUS?
When the BhCG is 1500-2000.
Asplenia or functional aplenia results in what finding on peripheral blood smear?
Howell Jolley Bodies - made of retained nuclear remnants (red blood cell precursor nuclei)
Seen with the WRIGHT stain.
What finding is seen on peripheral blood smear in patients with G6PD deficiency?
Heinz bodies - hemoglobin that becomes oxidized and percipitates into insoluble particles. They appear as peripheral blue inclusions when seen with CRYSTAL VIOLET staining.
What is aspirin -exacerbated respiratory disease?
A pseudoallergic reaction (NOT IgE mediated) to NSAIDs that typically occurs in patients with asthma, chronic rhinosinusitis with nasal polyposis, or chronic urticaria.
Usually presents with asthma symptoms, nasal and ocular symptoms, and facial flushing 30 min - 3 hours after NSAID ingestion.
Trimethoprim can cause what lab abnormality?
Hyperkalemia
Name the contraindication to each med:
- Methylergonovine
- Carboprost tromethamine
- Tranexamic acid
- hypertensive patients
- asthma
- hypercoagulability
Elevated testosterone with normal DHEAS is normally a ______ source.
Ovarian
Elevated DHEAS and normal Testosterone is normally due to a _____ source.
Adrenal
First line treatment options for uncomplicated cystitis?
Nitrofurantoin
Fosfomycin
TMP-SMX
Pronator drift is a relatively sensitive and specific finding for what type of disease?
UMN or pyramidal tract disease affecting the upper extremities.
What is thought to be the cause of Bells Palsy?
Neurotrophic (HSV), virus induced nerve inflammation, edema, and generation of the myelin sheath.
Heparin-induced thrombocytopenia results in blood _____.
CLOTTING (thrombosis) because the HIT antibodies activate platelets and cause them to aggregate.
What is the most common cause of constrictive pericarditis in developing countries?
Tuberculosis.
If there is a retained placenta and uterine inversion, what do you do first?
Replace the uterus THEN remove the placenta.
Loss of follow-up in prospective studies can result in what type of bias occurring?
A type of selection bias known as attrition bias.
Qualifications for a manic episode?
1 week or more or irritable mood or increased energy/activity AND 3 or more of the following: Distractability Impulsivity Grandiosity Flight of ideas Increased Activity Decrease need for Sleep Talkative/presured speech
What do you do for asystole/PRA?
CPR
Binge eating disorder and bulemia can both be treated with what? How do they differ?
SSRI!
Bulemia shows compensatory behavior, while binge eating disorder does not.
What results in peripheral neuropathy, B12 or folate deficiency?
B12
What is essential tremor? How can it be treated?
Action tremor that worsens at the end of goal-oriented movements. Also commonly involves the head.
B-blockers are first line.
Hypospadius warrants what type of investigation?
Karyotype and pelvic US - it may be due to a DSD.
What lung cancer produces PTHrp?
Squamous cell carcinoma.
What lung cancer can produce SIADH or ACTH?
Small cell carcinoma
How do you manage a suspected herniated disk?
NSAIDs, do not need MRI or imaging because it won’t change management.
What would a liver biopsy show in a patient with Reyes syndrome?
MICROvesicular fatty infiltration
What is the mechanism of food poisoning for bacillus cereus?
Ingestion of preformed enterotoxin (same as staph aureus).
A pure sensory stroke originates where?
Thalamus
What triad is seen in Sheehan syndrome? What is the mechanism by which this occurs?
Amenorrhea
Lactation failure
Persistent hypotension
Infarction and necrosis of the anterior pituitary
What are the recommendations for ventilating someone with ARDS?
Low tidal volume (6ml/kg) to prevent over-distending alveoli
Increase PEEP to maintain PaO2 at 55-80 or keep SpO2 between 88-95%
Epitrochlear lymphadenopathy and grey mucosal lesions indicate which STI?
Syphilis
Chondrocalcinosis is associated with what disease?
Hereditary hemochromatosis
Laryngeomalacia causes what type of stridor?
Inspiratory stridor.
What is more preferable in critically ill patients, TPN or enteral nutrition?
Enteral nutrition because it helps maintain gut integrity and reduces infections.
TPN is typically given to patients with contraindications to EN because early initiation may lead to increased infections and prolonged hospital stay.
What is the cause of diabetic opthalmoplegia?
Central infarction of CN3 fibers that impacts the inner somatic fibers that the extraocular eye muscles and levator muscle.
What is seen on exam in diabetic opthalmoplegia?
“Down and out”
Normal size, reactive pupil
Ptosis
What is the management of TACO?
Diuresis (furosemide)
What are symptoms of phenytoin toxicity?
Horizontal nystagmus Ataxia (wide-based gait) Dysmetria (finger to nose) Hyperreflexia AMS
What drugs can interact with phenytoin?
TMP-SMX
Fluconazole
Valproic acid
How does glomerulonephritis present?
Hematuria RBC casts Acute renal failure HTN Edema
Why do patients with HELLP have abdominal pain?
Distension of the liver capsule.
How does AFLP differ from HELLP?
AFLP is more likely to have extrahepatic manifestations such as leukocytosis, hypoglycemia, and acute kidney injury.
Single S2 is heard in what congenital heart disase?
Transposition
What are common findings of langerhans cell histiocytosis?
Lytic bone lesion
Eczematous rash
Central DI
(Can also have lymphadenopathy, hepatosplenomegaly, cough)
How does primary ciliary dyskinesia differ from CF?
CF: pancreatic INsufficiency, infertile from absent vas deferens, FTT
PCD: Situs inversus, infertile from immotile sperm, normal growth
In which patients should you expect amyloid cardiomyopathy?
Unexplained CHF
Proteinuria
LVH in the absence of HTN history
When is a chi-square test used?
To compare proportions.
When is a two sample t or z test used?
To compare two MEANS.
When is a ANOVA test used?
To compare the means of 3 or more variables.
Which second generation antipsychotics have a low risk of metabolic syndrome/weight gain?
Lurasidone
Aripiprazole
Ziprasidone
Which second gen antipsychotic has the highest risk of EPS?
Risperidone.
What is the follow up following cervical conization for CIN3?
Pap + HPV testing at 1 and 2 years.
What is the management of footling breech or frank (butt first) breech presentation?
Offered external cephalic version.
If there’s a contraindication to labor (classical prior CS), they should get CS at 37 weeks.
What is the first-line treatment for OCD?
SSRIs
How long should patients with a single episode of major depressive disorder be treated with an SSRI? What about those with recurrent depression?
An additional 6 months following acute response of symptoms.
If recurrent episodes: 1-3 yrs or indefinitely
What does neuroimaging show in Alzheimers disease (later in the course)?
Temporal lobe atrophy
What are symptoms of subacute (dequervains) thyroiditis?
Fever
Neck pain
Tender goiter following URI
Hyperthyroid phase followed by hypothyroid phase with eventual return of thyroid function
What medication can be used to induce ovulation in patients with PCOS?
Letrozole, an aromatase inhibitor.
What are symptoms of chronic bacterial prostatitis?
Recurrent UTIs
Pain with ejaculation
Prostate exam may be normal (or swollen/tender)
What do you need to diagnose pneumonia?
CHEST X RAY
What is the most common pathogen responsible for bacterial conjunctivitis in adults?
S. Aureus
What are the manifestations of Wernicke’s encephalopathy? What is the treatment?
Ataxia
Encephalopathy
Oculomotor dysfunction (nystagmus, gaze palsies)
Tx: thiamine
Post-partum thyroiditis is associated with which auto-antibodies?
Anti-thyroid peroxidase.
What is the triad of acute cholangitis?
Fever
Jaundice
RUQ pain
What are symptoms of small intestinal bacterial overgrowth?
Bloating, flatulence watery diarrhea.
Malabsorption (steatorrha) and nutritional deficiencies (macrocytic anemia) may occur.
At the initial prenatal visit, all patients undergo screening for which STIs?
HIV, HepB, Syphillis
High risk patients also get these additional prenatal screenings done? Define high risk?
Gonorrhea and chlamydia.
Age <25, prior STI, high risk sexual activity (multiple partners, sex worker).
What are symptoms of internal carotid artery dissection?
Partial horner syndrome: ptosis and miosis, unilateral headache/neck pain, TIA or stroke.
What is the treatment of choice for primary biliary cholangitis?
Ursodeoxycholic acid.
What are the treatments for lead levels:
<45
45-69
>70
<45: Nothing
45-69: Succimer (aka dimercaptosuccinic acid)
>70: Dimercaprol + EDTA
How do you treat MAC?
Macrolide + ethambutol
What are the three lab findings in primary hyperaldostronism?
Hypernatremia
Hypokalemia
Metabolic alkalosis (high serum bicarb)
What are the characteristics of systemic juvenile idiopathic arthritis?
Arthritis for 6 or more weeks and fever for 2 or more weeks.
Hepatosplenomegaly and lymphadenopathy are common and quotidian fevers (spiking once daily) are often followed by a pink rash.
What are the two best predictors of post-op outcomes following lung resection surgery?
FEV1 and DLCO.
What do you do if you find endometrial cells on a pap?
<45yo: nothing, common finding
>45yo: perform endometrial biopsy to assess for endometrial hyperplasia/cancer.
First line therapies for OCD?
SSRI
CBT
What are three common symptoms of lymphoma?
Generalized lymphadenopathy
Splenomegaly
Constitutional symptoms (weight loss, fatigue)
Nuchal cords are associated with which type of decels?
Variable
What causes late decels?
Uteroplacental insufficiency
How can you differentiate between transposition and Tetrology?
Transposition presents with immediate cyanosis.
What are two heart sounds are heard in tetralogy?
crescendo-decrescendo systolic murmur over the left upper sternal border (pulm stenosis)
single S2
What is the management of internal hemorrhoids?
High fiber diet
What diagnostic testing is used for suspected acute appendicitis?
Child or pregnant: US +/- MRI
Anyone else: CT
What medication should be avoided in a pregnant patients with myasthenia gravis?
Magnesium sulfate: may trigger a myasthenic crisis
What is the platelet count in HSP?
NORMAL
freaking NORMAL
What is a dose-dependent side effect of venalafaxine?
Hypertension (by inhibiting reuptake of norepi at higher doses)
Electrical alternans is relatively specific for what pathology?
Pericardial effusion.
How do you treat magnesium sulfate toxicity?
Calcium gluconate.
What changes occur in the kidney during pregnancy?
Increased RBF, GFR, and urine protein excretion.
This results in a decrease in BUN and Cr.
What are the lab findings in subclinical hypothyroidism (chronic lymphocytic thyroiditis aka hashimotos) ? What antibodies can be seen?
Normal thyroxine with mild elevation in TSH and a symmetrically enlarged, non-tender thyroid.
Antithyroid peroxidase antibodies
How can you treat someone with BB overdose?
IV fluids + atropine
For refractory hypotension: glucagon.
Patients who experience sexual assault are at high risk for developing what?
PTSD
Depression
Suicidality
How do you manage delivery in pregnant patient with HIV?
Based on viral load.
<1,000: deliver vaginally b/c low risk of vertical transmission (do not need zido)
>1,000: c-section + intrapartum zidovudine
Patients with new onset afib should be checked for underlying ______.
Hyperthyroidism
Polytrauma patients with peritonitis should undergo ______.
Laparotomy.
Polytrauma patients with NO peritonitis should undergo ______.
FAST exam.
Patients with DB with elevated A1c despite normal fasting BG may have ________.
Post-prandial hyperglycemia.
Bone pain and pancytopenia in a child are concerning for ____.
ALL
What medications are used to treat unstable angina or NSTEMI?
Anti-platelets (aspirin, clopidogrel) Anticoagulants (heparin) B-blockers Nitrates Statins
What differentiates stable from unstable angina?
Stable: with exertion
Unstable: at rest
What differentiates unstable angina from N-STEMI?
Unstable angina: no elevation in troponins (non-specific ECG)
NSTEMI: elevation in troponins (ST depression, T wave inversions)
What are the findings in behcet syndrome?
Recurrent painful oral ulcers and genital ulcers.
Skin (erythema nodosum) + ocular (uveitis) involvement is common. Thrombosis is major cause of morbidity.
What are symptoms of milk-alkali syndrome?
Hypercalcemia, metabolic alkalosis, AKI.
Can be seen in patients taking calcium bicarb for osteoporosis.
What is the initial test of choice for kids with suspected hydrcephalus?
CT scan of the brain.
How can you prevent uric acid stones?
Alkalinize urine with potassium citrate.
What are the dietary recommendations for those with calcium stones?
Increase fluid intake
Decrease sodium intake
Normal dietary calcium intake
What are the characteristics of a normal non-stress test?
2 or more accels that are 15 or more beats above baseline and 15 or more seconds long during a 20 min period.
What is the score of a normal biophysical profile?
8-10.
What is the treatment for kids that are bleeding who have ITP?
Glucocorticoids, anti-D immune globulin (If RH+ and coombs -), or IVIG
If not bleeding then just observe regardless of platelet count.
How can you differentiate between polymyositis and polymyalgia rheumatica?
Polymyositis: proximal muscle weakness (pain absent), elevated CK.
Polymyalgia rheumatica: Stiff ness and pain in the shoulders, hip girdle, neck. Elevated ESR and CRP.
When should you treat PCP with concomitant steroids?
When PaO2 <70, alveolar, arterial oxygen gradient >35, or pulse ox <92% on room air.
What is the treatment for body dysmorphic disorder?
SSRI and/or CBT
What is the treatment for campylobacter gastroenteritis?
Supportive treatment only. Usually self-limited.
What type of study is best for determining incidence of disease?
Cohort.
What reduces BP more, DASH or smoking cessation?
DASH
When treatment regimen for a patient depends on severity of the patients condition, a type of _____ bias occurs called _____ bias.
A form of selection bias, known as susceptibility bias.
What renal manifestations can occur after a URI? How do they differ?
IgA nephropathy (within 5 days of URI) and post-infectious glomerulonephritis (10-21 days after)
What are fetal complications of preeclampsia?
Oligohydramnios, fetal growth restriction/small for gestational age due to uteroplacental insuff.
How do you calculate attributable risk percent?
(Relative risk - 1)/Relative risk
Characteristics of exudative pleural effusions?
Fluid protein/serum protein >0.5
Fluid LDH/Serum LDH >0.6
Fluid LDH >2/3 upper limit of normal serum LDH
What is the treatment for duodenal atresia?
Surgical repair.
How can you manage variable decels from umbilical cord compression?
Reposition mom or amnioinfusion.
What antibiotic is contraindicated in patients with AAA or those with substantial risk for aoritc aneurysm (marfans, ehlers danlos)?
Fluoroquinolones bc they upregulate cell matrix metalloproteases, leading to increased collagen degredation. This could lead to rupture of the aneurysm.
________ increases the risk for stroke more than any other risk factor.
Hypertension more than any other risk factor, including hypercholesterolemia, DB, smoking, and sedentary lifestyle.
What are the three main principles of managing hyperkalemia?
Stabilizing cardiac membrane with calcium
Shifting K into cells
Decreasing total body K
What is the fastest way to lower serum K+ concentration?
Insulin + glucose (this is even faster than dialysis)
How do you treat hyperkalemia is there are ECG changes?
Calcium gluconate to stabilize cardiac myocyte membranes.
What are the findings in a missed abortion?
Closed cervix
Decreasing b-hCG
US showing non-viable IUP (no heartbeat/no fetal pole {no embryo})
What organisms are responsible for most deep infections from puncture wounds?
Staph aureas and pseudomonas
Pseudomonas more common in those through the sole of the shoe since it’s warm and wet.
What are the initial tests to evaluate for cushings syndrome?
Late-night salivary cortisol
24-hour urine free cortisol
and/or
Overnight low dose dexamethasone suppression test
Once increased cortisol is confirmed, ACTH can be tested to determine if it’s ACTH dependent or independent.
How can you treat aggression and agitation caused by PCP intoxication?
BENZOS.
What is the mainstay of treatment for Bells Palsy?
Glucocorticoids
What are risk factors for respiratory distress syndrome in a newborn?
Prematurity and maternal diabetes.
(high levels of insulin in baby antagonize cortisol and and thus block maturation or sphingomyelin and thus surfactant production)
What are some manifestations of porphyria cutanea tarda?
Photoseensitivity with blisters and skin fragility.
Associated with Hep C.
What are the characteristics of mixed connective tissue disease?
Features of SLE, systemic sclerosis, and polymyositis which occur sequentially.
Antibodies for U1 ribonucleoprotein are highly sens and spec.
Fournier’s gangrene, what is it and how is it treated?
Nec fasc of the perineal, scrotal, and lower abdominal skin.
Treatment is immediate surgical exploration and debridement.
What is the management of uncomplicated preterm prelabor ROM?
(ie less than 34 weeeks)
Prophylactic latency abx
Steroids
Inpatient monitering
Delivery is at 34 weeks, earlier if complications arise.
What do you always forget about for giving Anti-D immunoglobulin?
Gotta give it for ectopics and threatened abortions and molar pregnancies too.
Also for CVS and amniocentesis.
Also any 2nd or 3rd trimester bleeding.
When do papillary muscle rupture and interventricular septum rupture occur following an MI?
3-5 days
When does free wall rupture occur following an MI?
5 days to 2 weeks
When does LV aneurysm occur following an MI?
Up to several months
95% of a data set falls within ____ standard deviations.
2!!!!
68% is within one
95% within two
99.7% within threee
What is the initial treatment of afib due to hyperthyroidism?
Beta blockers
What sleep changes are seen in patients with MDD?
Decreased REM sleep latency, decreased slow-wave sleep, and increased REM sleep duration and density.
Increased serum cortisol too.
What do non-seminomatous germ cell tumors produce?
AFP and b-hCG
How can you evaluate for adrenal insufficiency?
8am serum cortisol and plasma ACTH
+
ACTH stimulation test (cosyntropin)
What are the “hard signs” that a vascular injury is in need of urgent surgical repair?
Pulsatile bleeding
Bruits or thrills over the injury
Expanding hematoma
Signs of distal ischemia (absent pulse, cool extremities)
A prominent V wave on jugular venous pulsation is highly specific for what pathology?
Tricuspid regurgitation
How should you manage a patient with blunt abdominal trauma who has a negative FAST exam?
If high suspicion of intra-abdominal injury: CT
If low suspicion: serial physical exams
How do you treat pertussis close contacts?
Macrolide, regardless of immunization status.
What is the best diagnostic test for acute diverticulitis?
Abd CT with contrast
What are the three characteristics of aspirin-associated respiratory disease?
Asthma
Bronchospasm
Chronic rhinosinusitis with nasal polyposis
Secondary adrenal insufficiency caused by glucocorticoids causes decrease in what?
ACTH and Cortisol
Aldosterone will be normal
What is the first step in treating epidural spinal cord compression caused by malignancy?
Glucocorticoids then MRI
Polycythemia vera can result in what complication?
Budd Chiari syndrome: hepatic vein thrombosis
Presents as progressive abdominal pain ascites, and hepatosplenomegaly.
What is the preferred diagnostic study to confirm aortic dessection in patients with renal insufficiency or hemodynamic instability?
TEE
CT angio if they are hemodynamically stable without renal insuff
What are common adverse affects of MTX use?
Macrocytic anemia and hepatotoxicity.
What are the symptoms of acute hemolytic transfusion reaction? What test can confirm this?
Within minutes to hours:
Flank pain, dark red urine, fever, tachy, hypotension.
Will be direct coombs positive.
This is due to ABO incompatability
Presbyopia is caused by age-related changes to what structure?
Decreased lens elasticity that leads to difficulty with near vision.
How can you differentiate hypothyroid myopathy from polymyositis?
Polymyositis: myalgias mild or absent and DTR are normal.
Hypothyroid myopathy: myalgias, fatigue, delayed reflexes.
Both have elevated CK and proximal muscle weakness.
What is the treatment of frostbite?
Rapid rewarming in a hot water bath.
What is the cause of neonatal thyrotoxicosis? How is it treated?
When a woman with graves disease has TSH receptor antibodies that cross the placenta
Methimazole + beta blocker
Lead poisoning causes _____ anemia.
microcytic.
What arrythmia is relatively specific for digitalis toxicity?
Atrial tachycardia with AV block (from increased ectopy and increased vagal tone).
Numbness of the fourth and fifth digit + hand weakness indicates an injury where?
Ulnar nerve at the ELBOW.
What are indications for immediate ex lap in a penetrating abd trauma?
Hemodynamic instability
Peritonitis (rigiditiy, rebound tenderness)
Evisceration (externally exposed intestines)
Impalement
Headache + pupillary dilation + ptosis = ?
Subarachnoid hemorhage from ruptured saccular aneurysm.
(Cluster headache causes miosis not dilation).
Absent uterus, cervix, and upper 2/3 of vagina = _________. What else should you do to investigate?
Mullarien agenesis.
Renal ultrasound to evaluate for urogenital abnormalities.
What is the first-line therapy for reactive arthritis?
NSAIDs.
What does a negative correlation coefficient mean (ie -0.25)? What makes a correlation coefficient stronger?
As one variable goes up, the other goes down.
The closer r is to 1 or -1, the stronger it is.
What antibody is associated with systemic sclerosis?
Anti-topoisomerase-1 (anti-Scl-70)
What antibody is associated with primary autoimmune hepatitis?
Anti-smooth muscle antibodies
What is ulipristal?
A progestin receptor blocker that prevents pregnancy by delaying ovulation and impairing implantation.
Can be taken up to 120 hours after unprotected sex.
How can you differentiate androgen insensitivity syndrome from 5a reductase deficiency?
Patients with androgen insensitivity syndrome have breast tissue development, while 5a reductase deficiency do not.
Both appear phenotypically female but are male internally.
What murmurs are heard in pulmonic stenosis?
Ejection click followed by crescendo-decrescendo systolic murmur over left sternal border (2nd intercostal space), and widened splitting of S2.
Severe hypertension and recurrent flash pulmonary edema in the setting of diffuse atherosclerosis suggests what?
renal artery stenosis.
How should levothyroxine dosing change when a person becomes pregnant?
Increased: estrogen increases thyroxine-binding globulin, therefore requiring an increase in the amount of thyroid hormone needed to saturate the binding sites.
(Although there is an increase in total thyroid hormone during pregnancy, there is a minimal increase in free thyroid hormone)
What are two potential complications of giant cell arteritis?
Vision loss
Aortic aneurysm from large-vessel involvement
What can fat embolism look like on chest CT?
Ground glass opacities.
(FYI no pulmonary artery filling defects will be seen because the emboli obstruct the capillaries, which are too small to be seen on CT).
How should you treat pts with small bowel obstruction who become hemodynamically unstable?
Surgery.
What are symptoms of subclavian steal syndrome?
Upper extremity ischemia (pain, fatigue, parathesias) Vertebrobasilar insufficiency (dizziness, ataxia, dysequillibrium) due to
What are the features of dubin-johnson syndrome>?
Fluctuating conjugated hyperbilirubinemia due to a defect in hepatic excretion into the biliary system.
What type of cancer is indolent and can be present for months to years, causing painless peripheral lymphadenopathy? What are symptoms?
Follicular lymphoma, a type of non-hodgkins lymphoma.
Hilar and mediastinal lymphadenopathy are common and B symptoms are generally absent.
Marker is overexpression of BCL2.
What are characteristics of acute cellular rejection (within first 3 months) following liver transplant?
Mixed inflamm infiltrate of portal tracts w/ eosinophils, PMNs, lymphocytes
Interlobular bile duct destruction
Endothelitis (lymphocytic sybendothelial invasion of portal and hepatic veins)
What is is the more common organism for infected prosthetic joints in thefollowing time periods:
within 3 months
3-12 months
<3 months: staph aureus GNR, anaerobes
3-12 months: coag-negative staph (epidermidis), propionibacterium species, enterococci.
What are the joint findings in OA?
Joint narrowing and osteophytes.
What are reversible risk factors for PACs?
Tobacco and alcohol.
What birth injury can result in a claw hand and ipsilateral horner’s syndrome?
Klumpke’s Paralysis: injury to 8th cervical and 1st thoracic nerves
Erbs palsy results in ______ position and is caused by injury to _______.
Waiter’s tip position
5th and 6th cervical nerve injury
True or false: weight gain is a common side effect of OCPs?
FALSE: OCPs do NOT cause weight gain.
How can you differentiate mullerian agenisis from androgen insensitivity syndrome?
MA: Absent uterus, cervix, upper vagina, but NORMAL ovaries and normal axillary and pubic hair.
AIS: absent uterus, cervix, ovaries. Minimal or absent axillary/pubic hair.
What isthe karyotype of Androgen insensitivity syndrome vs Mullarian agenesis?
AIS: 46XY
MA: 46XX
How do you differentiate a pseudoaneurysm from an AV fistula?
Pseudoan: pulsatile MASS, SYSTOLIC BRUIT
AV fistula: No mass, CONTINUOUS BRUIT.
Candidemia is most common in ICU patients with ______.
IntraVASCULAR catheters such as a central venous catheter.
Contact lens keratitis is most often caused by which organisms?
Gram negatives such as pseudomonas and serratia.
What is the initial management of abrupted placenta?
IVF for aggressive fluid resuscitation to optimize maternal circulation with crystalloids and place in left lateral decubitus position to maximize CO.
What is the threshold for phototherapy in a healthy, full-term, 4 day old infant? What about for the same baby for exchange transfusion?
Phototherapy: Bili >20
Exchange transfusion: >25 or neuro dysfunction
How can acute appendicitis present in a pregnant patient?
Right to mid-to-upper quadrant or flank pain.
AS symptoms usually aren’t severe until the valve area is ____.
<1cm^2
What CV findings are associated with Marfans?
Aortic dilation, aortic regurg or dissection, MVP.
Aortic root disease is the primary cause of morbidity and mortality in patients with marfans.
When are women screened for gestational DB?
24-28 weeks.
What do you do next in a child with precocious puberty, advanced bone age, and high basal LH?
MRI of the brain.
What do you do next in a child with precocious puberty, advanced bone age, with low basal LH?
GnRH stim test.
Low LH is peripheral precocious puberty.
High LH is central precocious puberty.
Patients >___ weeks are offereed external cephalic version.
37 weeks.
How do you treat cat bites?
Amox-clauv
What can be done to reduce risk for long-term opioid miususe?
Query drug monitoring program at each visit
Random drug screens
Regular follow-up
Initial workup for dementia?
Cognitive testing CBC CMP TSH B12 Neuroimaging
Early septic shock is associated with a _________ CV state.
Hyperdynamic cardiovascular state which occurs in response to peripheral vasodilation and cap. leak.
Leads to increase SV, HR, and pulse pressure with bounding pulses.
Acyclovir can cause what type of kidney injury?
Crystalloid induced kidney injury: results in renal tubular obstruction.
Giving IVF can help prevent this.
How do you initially evaluate mixed urinary incontinence?
Voiding diary.
Marfans syndrome is caused by what defect?
Mutation in fibrillin 1 gene.
FIBRILLIN 1!!!!!!
Marfan’s syndrome is associated with _____ lens dislocation?
UPWARD.
What is pseudocyesis?
When a patient has symptoms of early pregnancy and believes herself to be pregnant but is not.
Non-psychotic patient who believes she is pregnant. May even interpret a negative home preg test as positive.
When do you perform an endometrial biopsy?
Postmenopausal bleeding and endometrial stripe >4 cm.
How can you treat pain in chronic pancreatitis?
Lipase supplementation.
Oxytocin has a structure similar to that of _____ and can therefore can cause _______.
ADH.
Can cause hyponatremia and resulting cerebral edema/seizures when used for prolonged period.
How can you differentiate median nerve compression at the wrist vs forearm?
Compression at the wrist (carpal tunnel) will have loss of sensation in the hand and pain may radiate up the forearm. Sensation over thenar eminence remains intact.
Compression at the level of the forearm would result in forearm pain and entire lateral palm sensory loss including the thenar eminence.
How can you diagnose/treat VAP?
Lower respiratory tract sampling (gram stain + culture) and empiric antibiotics.
What is the first line treatment for polyarticular juvenile idiopathic arthritis?
Naproxen (NSAIDs)
Carcinoid syndrome can result in ______ deficiency?
Niacin.
What is the first line treatment for patients with renovascular hypertension due to renal artery stenosis?
ACEi/ARBs
Stenting or revascularization is reserved for patients with resistant hypertension or recurrent flash pulmonary edema.
What antibiotic should be used to treat infective endocarditis due to IVDU?
Vanc.
What organs are impacted by GVHD? What is occurring at a cellular level?
Skin, intestines, liver.
Recognition of host major and minor HLA antigens by donor T cells and the consequent cell-mediated immune response.
What type of opioids are not detected on standard UDS?
Semi-synthetic: hydrocodone, hydromorphone, oxycodone
Synthetic: Fentanyl, meperidine, methadone, tramadol
Which patients are at a higher risk of pre-E?
Multiple gestation
T1DB
Chronic HTN
SLE
For patients who are at higher risk of pre-E, what do we do?
At first prenatal visit, do 24 hour urine for total protein to get a baseline.
Begin daily aspirin at 12 weeks.
What are the diagnostic criteria for dementia with lewy bodies?
Dementia (ie cog impairment) plus 2 of the following: Parkinsonism Hallucinations REM sleep behavior disorder Fluctuating cognition
What is the first step in treatment of sinus bradycardia?
IV Atropine!
If that doesn’t work, then IV epi or dopamine or transcutaneous pacing.
Hydroxychloroquine can cause _____ toxicity?
Retinal!!!!
Therefore patients should get a basic ophthalmic exam and regular reassessment.
How should you first evaluate a post-meno ovarian mass?
Pelvic US and CA-125 level.
first line treatment for papulopustular rosacea?
Topical metro, azelaic acid, or ivermectin.
When is initiating antiretrovirals for HIV not recommended?
During an acute infection, because it can cause immune reconstitution syndrome.
For example: antiretroviral therapy should be deferred for 2-8 weeks after completing induction antifungal therapy for cryptococcal meningitis.
What is the most common cause of pneumothorax in patients with chronic obstructive lung disease?
Rupture of alveolar blebs.
What medication can help facilitate ureteral stone passage?
Tamsulosin an alpha-1-blocker that reduces muscle tone and reduces ureteral spasms secondary to stone impaction.
Bethanechol is used to treat which problems?
Cholinergic agent used to treat urinary retention and atonic bladder
Auer rods are seen in what leukemia?
AML
After alcohol and gallstones have been excluded from the cause of pancreatitis, what else should be explored?
Lipid panel for elevated triglycerides.
Unilateral lymphadenitis (lymph node infection) should be treated with what?
Clinda: covers staph strep and anaerobes
What is epidermolysis bullosa?
Inherited disorder of epithelial fragility triggered by trauma. Friction induced blisters of the hands and feet. Infants may have oral blisters from bottle feeding.
May also have thickened skin of feet.
When does pree-E occur?
Exclusively at 20 or more weeks of pregnancy.
Inevitable abortion occurs at less than ___ weeks.
<20 weeks
Hyperventilation has what effect on ionized calcium?
Increased pH causes H to dissociate from albumin, allowing more calcium to bind albumin.
Therefore hyperventilation causes decreased ionized (free) calcium.
Chronic mesenteric ischemia should be expected in patients with what three symptoms?
Unexplained chronic abdominal pain
weight loss
food aversion
What is prolonged post-op ileus and how is it managed?
Delayed return of bowel function after surgery (>72 hours).
It’s typically self-resolving and is treated with bowel rest and serial examinations.
What is hypoparathyroidism?
Low calcium and high phosphorus in the absence of impaired renal function (normal creatinine)
What are the two add-on agents for T2DB that reduce CV morbidity and mortality and promote weight loss?
GLP-1 agonists (-tides) SGLT2 inhibitors (-flozins)
Suspected stable ischemic heart disease can be initially diagnosed and stratified using what?
Stress ECG.
Long-standing diabetic foot ulcers require further evaluation for what?
Imaging to look for osteo (even when no signs of soft tissue infection are present)
What findings are more common in Chrons than UC?
Rectal sparing
Noncaseating granulomas
Fistulas
Hyperparathyroidism can cause what type of joint disease?
Pseudogout (rhomboid shaped crystals)
How can you treat open angle glaucoma?
Topical agents that lower IO pressure such as a topical prostaglandin (latanoprost, bimatoprost), which increases drainage of aqueous humor in the anterior chamber.
If prostaglandins are ineffective at treating open angle glaucoma, what can be added?
timolol (topical b-blocker)
What is the primary valvular defect in patients with HCM?
Systolic anterior motion of the mitral valve, leading to anterior motion of the mitral valve leaflets towards the septum, leading to left ventricular outflow tract obstruction.
Most stones less than or equal to ___ mm pass spontaneously.
5 mm
What warrants concern for malignancy for a parotid glad mass?
Presence of a facial droop or facial numbness, this would indicate the mass has invaded the facial or trigeminal nerves.
What is the initial management of acute angle-closure glaucoma?
Combo therapy with multiple topical agents: timolol, pilocarpine, apraclonidine.
In addition, acetazolamide reduces further production of aqueous humor.
OCPs can cause _____tension.
Hypertension
Pts who develop HTN while on OCPs should discontinue the medication.
Opioids can cause secondary hypogonadism resulting in what symptoms?
Low libido
Erectile dysfunction
Low serum testosterone
Low or inappropriately normal LH
When do you do if you do FNA with nonbloody aspirate on a breast cyst and it doesn’t resolve?
Core biopsy
If it does resolve with FNA, just repeat US in 4-6 weeks
How do you treat thalassemia minor?
You don’t. They are usually asymptomatic and require no treatment.
In patients with cervical trauma, cervical spine injury should be performed on anyone with at least one of the following:
Neuro deficit AMS Spinal tenderness Intoxication Distracting injury
What is constitutional growth delay?
Delayed growth spurt
Delayed puberty
Delayed bone age
Tremor that worsens with caffeine intake is likely a _____ tremor.
physiologic tremor
Also worse with stress.
How do you make the diagnosis of bronchiectasis?
high resolution CT
What is the first and second line management of migraine in pregnancy?
1st: non-pharm such as rest, hydration, heat
2nd: Acetaminophen
How should you treat migraine in pregnancy when acetaminophen is ineffective? And what if those don’t work (ie fourth line?)
Antiemetics such as promethazine, codeine, caffeine/butalbital
If those don’t work, then NSAIDS (2nd trimester only)
Last line is opioids.
How do you treat patients with graves disease who come in with thyroid hormone levels >2-3x normal?
Anti-thyroid medication (PTU or Methimazole) + beta blocker to stabilize.
They will likely eventually need definitive therapy with Radioactive iodine or thyroidectomy.
By 12 months, infants weight _____ and height usually increases by ____%.
Weight triples and height increases by 50%
A patient with erythema nodosum should be evaluated for what?
Sarcoidosis, with a CXR.
Regardless of whether or not they have respiratory symptoms.
What is carbohydrate breath testing used to diagnose? What is the treatment?
Small intestine bacterial overgrowth.
Tx: Rifaximin or neomycin
How does the treatment of pneumothorax change based on size?
Small: supplemental oxygen
Large with hemo stability: needle thoracostomy
Large with hemo instability: tube thoracostomy
What should you do if someone is experiencing the activating side effects of an SSRI?
Reduce the dose. This is more common in those with anxiety.
Patients with possible ACS should receive ______ as soon as possible.
aspirin
What are the treatments for anal fissures?
Increased fiber and fluid intake Stool softeners Sitz baths Topical anesthetics Vasodilators (nifedipine, nitrates)
What does CMV retinitis look like?
Blurred vision
Floaters
Yellow-white exudates near the retinal vessels
How does CMV retinitis differ from that caused by Toxo?
Toxo retinitis appears in a nonvascular (not perivascular) distribution.
A holosystolic murmur at the left lower sternal border is characteristic of ______.
VSD
What negative impacts can indomethacin (used for tocolysis) have on the baby?
Decreases prostaglandin production, leading to fetal vasoconstriction.
This causes decreased renal perfusion and resulting oligohydramnios with prolonged administration.
When should adults with HIV be vaccinated against HepA?
Men who have sex with men
Chronic liver dz (incl. HepB or C)
IVDU
The most common cause of an isolated, asymptomatic elevation in alk phos in an elderly patient is what?
Paget’s disease.
What markers will be seen in a patient with a beta cell tumor (insulinoma)?
elevated C-peptide levels
proinsulin leveels >5
What markers are seen in someone surreptitiously taking insulin?
Very high serum insulin
Low c-peptide
What markers are seen in patients surreptitiously taking sulfonureas?
Elevated insulin
Elevated c-peptide (because they increase your body’s own production of insulin).
Can be very different to differentiate between this and insulinoma, so you can get a sulfonurea level to differentiate.
Anticholinergic agents such as _______ can be used to treat resting tremor, but may result in _______.
Trihexyphendyl
Acute angle closure glaucoma
What are the two inherited deficiencies of UGT?
Criglar Najar and Gilbert
Both result in an unconjugated hyperbilirubinemia
How is myotonic dystrophy inherited?
Aut dom.
What do the brain lesions of PML look like?
Asymmetric white matter lesions with no enhancement or edema.
What vessels are blocked in an anterior wall MI and what leads are elevated?
LAD
Some or all of V1-V6
What vessels are blocked in an inferior MI? What leads are elevated?
RCA or LCX
II, III, avf
What vessels are blocked in a posterior wall MI? What leads are elevated?
LCX or RCA
Depression in V1-V3
Elevation in I and avL (LCX)
Depression in I and avL (RCA)
What vessel is blocked in a lateral MI? What leads are elevated?
LCX, diagonal
Elevation in I, avL, V5, V6
Depression in II, III, avf
When is a voiding cystourethrogram indicated in a child with UTI?
2 or more febrile UTIs, abnormal renal US, or signs of CKD.
Femoral nerve is responsible for which leg movements? where does it provide sensation to?
Knee extension and hip flexion
Sensation to the anterior and medial thigh.
What test is used to confirm transient proteinuria?
Normal first morning protein/Cr ratio and normal repeat urinalysis once provoking factor is removed
What are the findings of tabes dorsalis (late neurosyphillis)?
Sensory ataxia
Lancinating pains
Reduced/absent DTR
How does a fistula change CO, preload, and afterload.
Increase CO and preload.
Decrease afterload.
What is the language development of a two year old?
> 50 words and 2 word phrases
What are features of chronic pancreatitis in patients with pancreatic cancer?
Normal plt counts and coag times, but increased risk for venous and arterial thrombosis and mucocutaneous bleeding.
How can you differentiate primary hyperparathyroidism from familial hypocalciuric hypercalcemia?
FHH has a urine calcium to creatinine ratio of <0.01
PH has a ratio of >0.02
What are the common features of a Wilm’s Tumor?
Unilateral abd mass
Hematuria
HTN
Abdominal pain
Usually asx tho
What is the initial treatment of patients with intercranial HTN following traumatic brain injury?
Hypertonic saline or mannitol, because they draw water out of the edematous brain tissue.
Victims of smoke inhalation injury should be treated empirically for what?
Cyanide poisoning with hydroxycobolamin or sodium thiosulfate.
This is because hydrogen cyanide and CO are the two major products of combustion in closed spaces.
Cyanide poisoning causes _____ acidosis.
lactic
What setting does AA amyloidosis develop in?
Chronic inflammation, such as RA.
Lactose intolerance can be confirmed with what test?
Hydrogen breath test, positive stool reducing substances, low stool pH, and increased osmotic gap.
What symptoms can indicate a brain tumor?
Dull headache associated with 1 or more of the following:
N/V from increased ICP
Focal neuro manifestations
Symptoms worse during the night or with bending/coughing (increased ICP)
B12 deficiency can cause what neuro complication?
SCD: ataxia, symmetric parasthesias, loss of vibration and proprioception sensation.
Pain and vesicles in the auditory canal is likely what?
Herpes zoster oticus (ramsey hunt syndrome)
Vesicular ear rash + facial droop
In premenopausal women, adenexal masses are usually _____.
Benign, related to ovulation, and resolve spontaneously.
Risk factors for developing AOM in kids ages 6-18 months?
Lack of breastfeeding
Daycare attendance
Smoking exposure
What is the management of emphysematous cholecystitis?
Urgent cholecystectomy.
Vs cholecystectomy prior to discharge, ideally within 72 hours, with normal acute cholecystitis
What are the side effects of lithium therapy?
Hyperparathyroidism with hypercalcemia Nephrogenic DI CKD Thyroid dysfunction Teratogenic effects
How can you treat narrow complex tachycardia?
ADENOSINE!!!!!!!!!
What is SVT?
Tachycardia originating from the His bundle
What rhythms are SVTs?
Sinus tach Multifocal atrial tach A flutter A fib AVNRT AVRT Junctional tach
How do you manage stable patients with SVT?
Vagal maneuvers such as carotid massage, valsalva, eyeball pressure
or
Adenosine
These serve to slow conduction through the AV node and can aid in diagnosis by unmasking hidden p waves in patients with Afib or flutter. They can also cause transient AV node block to terminate AV-node dependent arrythmias like AVNRT or AVRT.
Features of fat embolism do NOT occur until at least ____ hours following the injury.
12-24 hours.
How should you treat a mildly symptomatic or asymptomatic person with hyponatremia from SIADH?
Fluid restriction
(hypertonic saline is reserved for SEVERELY symptomatic patients, such as those with seizures, coma, or profound confusion).
How should you treat a fib with RVR (rate faster than 100bpm)?
Rate control with BB or CCB.
Synchronized cardioversion if hemo unstable.
What makes pre-E have “severe features”?
SBP >160 OR DBP >110 Thrombocytopenia Increased Cr Increased transaminases Pulm edema Visual/cerebral symptoms
What is the devliery for Pre-E with and without severe features?
With severe: 34 weeks
Without: 37 weeks
What are the first line drugs for maternal hypertensive crisis? What are the contraindications?
IV Hydralazine
IV Labetalol - contraindicatede in pts with brady
Oral nifedipine - contra if pt can’t tolerate oral (emesis)
Alpha 1 antitrypsin could be considered in pts with what?
Lack typical risk factors for COPD (<45) Atypical presentation (basilar predominant dz)
Who is bariatric surgery indicated for?
BMI >40 or >35 with additional weight-related comorbidity
After orchiplexy, patients are still at higher risk than the general population for what?
Testicular germ cell tumor
What are the clinical features of painless thyroiditis?
Mild, brief hyperthyroid phase
Small, nontender goiter
Spontaneous recovery
What diagnostic testing is done with painless thyroiditis?
Positive TPO antibody
Low radioiodine uptake
Organophosphates inhibit ______ leading to ______ symptoms.
Inhibit acetylcholinesterase, leading to muscarinic and nicotinic cholinergic hyperstimulation.
What are the symptoms of organophsphate poisoning?
Diarrhea Urination Miosis/muscle weakness Bronchorrhea Emesis Lacrimation Salivation/sweating
When can thrombolytics be used for ischemic stroke?
When it’s within 4.5 hours from symptoms onset
When a non-con head CT rules out hemorrhagic stroke
(make sure no other contraindications to thrombolytics are present)
What. is the exclusion criteria for thrombolytics for ischemic stroke?
Major surgery/trauma in the past 14 days MI in past 3 months GI/GU bleeding in past 21 days Seizure at stroke onset Pregnancy
Pregnant pts who are GBS positive but penicillin allergic with low risk of anaphylaxis should be treated with what abx?
Cefazolin
What is the most common cause of aortic regurg in developed countries?
Bicuspid aortic valve.
What is the first line treatment for idiopathic intracranial HTN?
Acetazolamide +/- furosemide.
Cerebellar hemorrhage results in ataxia on the ____ side of the lesion.
IPSI
What are the side effects of methimazole?
Agranulocytosis
1st trimester teratogen
Cholestasis
What are the side effects of propothiouracil (PTU)?
Agranulocytosis
Hepatic failure
ANCA-associated vasculitis
What is the mainstay of treatment for scleroderma renal crisis?
ACE inhibitors
How does the management of aortic dissection differ between a type A and type B?
Type A (ascending): emergent surgical repair
Type B (descending): medical management with pain and BP control (surgery only if organ malperfusion occurs).
Patients with penicillin-sensitive strains of strep viridans (mutans) infective endocarditis should be treated with what?
IV penicillin G or IV ceftriaxone
What are the clinical features of primary biliary cholangitis?
Fatigue, pruritus
Progressive jaundice, hepatomegaly, cirrhosis
Cutaneous xanthomas and xantholasmas
What is the treatment for PBC?
Ursodeoxycholic acid
What are complications of PBC?
Malabsorption, fat soluble vitamin deficiencies Bone disease (osteoporosis, osteomalacia) HCC
Cerebral amyloid angiography is the most common cause of spontaneous _________.
Lobar (parietal, occipital) hemorrhage
Particularly in the elderly
RA can cause ____ pleural effusions.
Exudative
Distal radial fracture can injure the _____ nerve leading to ______.
Median nerve
Acute carpal tunnel syndrome symptoms: parasthesias of thee lateral 3.5 digits and impaired thumb abduction
What is calciphylaxis?
Calcific uremic arteriolopathy characterized by systemic arteriolar calcification and soft-tissue calcium deposition with local ischemia and necrosis.
Primarily seen in patients with long-standing ESRD.
What are risk factors for calciphylaxis?
Hyperparathyroidism
Hyperphosphatemia
Hypercalcemia (although calcium is often normal)
What can cause post-viral necrotizing pneumonia with multilobar cavitary infiltrates?
S. aureas
What are risk factors for MS?
VitD deficiency, geographic location, HLA-DRB1 (genetic predisposition), and smoking.
What is the treatment of organophosphate poisoning?
Remove all contaminated clothing and irrigate skin, atropine, pralidoxime.
Untreated hyperthyroidism puts pts at risk for _____.
Rapid bone loss and cardiac tachyarrythmias such as afib
What are maternal complications of abrupted placenta?
Hypovolemic shock and DIC
Who may be susceptible to becoming copper deficient?
History of bariatric surg
IBD
Excessive zinc ingestion
What are symptoms of copper deficiency?
Similar of that to B12 def: slowly progressive myeloneuropathy (distal extremity parasthesias, numbness, sensory ataxia)
Anemia
Hair fragility
Skin depigmentation
Hepatosplenomegaly
Pre-E with severe features increases the risk of what?
Stroke due to endothelial damage, dysregulation of cerebral blood flow, cerebral vasospasm, and vascular microthrombi formation.
How should you treat TCA overdose?
ABCs
In pts with cardiac toxicity: sodium bicarb
What is the management of torsades de pointes induced by a long QT?
Magnesium sulfate
How do you calculate an anion gap in metabolic acidosis?
Na - (Cl + Bicarb)
Normal value is 12
What is the empiric treatment for UTI in a child?
Third gen cephalosporin
ie Cefixime
(no quinolones due to risk of cartilage damage)
Muddy brown casts =
ATN
Can be from prolonged hypotension
BUN:Cr ratio is usually 10-15 in ATN
RBC casts =
Glomerulonephritis
WBC casts =
Interstitial nephritis and pyelonephritis
Fatty casts =
Nephrotic syndrome
Broad and waxy casts =
Chronic renal failure
What is the general structure of case control studies?
Determine outcome first and then look for associated risk factors
What is the general structure of retrospective cohort study?
First ascertain risk factor exposure and then determine the outcome.
What is the first line therapy for bipolar disorder?
Lithium or valproate + second generation antipsychotic
Suprascapular nerve entrapment results in what symptoms?
Shoulder pain and weakness with abduction and external rotation.
How do you manage the airway of someone with a cervical spinal injury?
Orotracheal intubation with manual stabilization of the cervical spine.
What stats test is used to compare two means?
Two sample t test
Two sample z tests also compare two means, but the calculation requires use of population (not sample) variance so it’s not often used.
Uremic encephalopathy is an indication for ____?
Urgent hemodialysis
Randomization in a study is used to control ______.
Confounding variables.
Premature prelabor rupture of membranes requires inpatient management due to risk of what?
Placenta abruption
Intraamniotic infection
Umbilical cord prolapse
Preterm labor
How do you manage a parapneumonic effusion after a bacterial pneumonia when the patient is NOT in resp distress?
Oral abx and close outpatient follow up.
What effect can CO poisoning have on the brain?
Hypoxic brain injury, which can be seen as bilateral hyperdensity of the globus pallidus (an area highly sensitive to hypoxic conditions).
How do you confirm the diagnosis of PSC?
MRCP showing multifocal bile duct strictures alternating with regions of dilatation
What effect can anabolic steroids have on lab values?
Erythrocytosis, hepatotoxicity, dyslipidemia
Approximately 25% of patients treated with lithium will develop ______.
Hypothyroidism
Those on lithium require TSH monitoring q6-12 months. It’s generally treated with T4 instead of changing lithium.
Stable patients can be treated with anticoagulation as soon as _____ after surgery.
48-72 hours
What causes pulmonary artery hypertension in systemic sclerosis?
Intimal hyperplasia of the pulmonary arteries
Patients with ethylene glycol poisoning have ______ on urinalysis.
Calcium oxalate crystals (square, envelope shaped)
Ethylene glycol toxicity results in _______.
Renal failure
Methanol toxicity results in ______.
Blindness
Pregnant patients with early localized lyme disease are treated with _____
Amox
Ceftriax for later stages, but not needed in early localized because amoxicillin is highly effective.
What are the clinical findings in arsenic poisoning?
Painful sensorimotor polyneuropathy
Skin lesions (hyper and hypo pigmented)
Pancytopenia
Mild transaminitis
How do you calculate sensitivity using a 4 bow chart?
A/A+C
Vertical
_______ is an important cause of hypocalcemia?
Hypomagnesia
Particularly in alcoholics. It causes a decrease in PTH. Hypoparathyroidism induced by low magnesium is NOT associated with elevated phosphorus levels.
Most infections within the first month after a transplant are caused by _____.
BACTERIA
Infections 1-6 months post-transplant are usually caused by ______.
Opportunistic pathogens (in the setting of high-dose immunosupressants)
What is a complication of drowning (when they survive obvi)?
Respiratory insufficiency and ARDs because the water washes away the surfactant.
What medications can cause hypokalemia?
Insulin
B-adrenergic agonists (albuterol, epi)
A PPD test with an induration >____mm is considered positive for someone with HIV.
5 mm
Nitrofurantoin can cause _____ injury.
Pulmonary injury: hypersensitivity pneumonitis in the short term, leading to interstitial lung dz in the long-term.
Side effects of digoxin toxicity?
Life-threatening arrhythmias
Anorexia, N/V, Abd pain
Fatigue, confusion, weakness, color vision alteration
What is the first line therapy for metastatic bone pain in patients who have not responded to initial intervention?
Short-acting opioids (morphine, hydromorphone).
Strep sanguines belongs to what group? What is this associated with?
Viridans group : IE with viridans group strep is commonly encountered after dental procedures involving manipulation of gingival tissue or oral mucosa.
Violent muscle contraction (seizure, electrocution) can cause ______ shoulder dislocation. What does it look like on exam?
Posterior shoulder dislocation
Arm held in adduction and internal rotation
What are the typical feature of multiple myeloma?
Osteolytic lesoins/fractures
Anemia
Hypercalcemia
Renal insuff
What are the typical features of waldenstroms macroglobulinemia?
Hyperviscosity syndrome Neuropathy Bleeding Hepatosplenomegaly Lymphadenopathy
DKA is unlikely if there are no urinary _____.
Ketones
What are features of cerebellar dysfunction due to chronic alcohol abuse?
Gait instability Truncal ataxia Difficulty with rapid alternating movement Hypotonia Intention tremow
Decompensated CHF causes what effect on the renal arterioles?
Constriction of the efferent arteriole.
What is TCA overdose treated with and why?
Sodium bicarb, to alleviate the depressant action on myocardial sodium channels.
Nephrotic syndrome is a _____coagulable syndrome that can lead to _____.
Hypercoagulable syndrome that can lead to thrombosis (most frequently renal vein thrombosis but PE can also occur).
What effect does sarcoidosis have on FEV1, TLC, and DLCO?
FEV1: Normal
TLC: Decreased
DLCO: Decreased
Follows a restrictive pattern
Thrombocytopenia (ITP) can be the initial finding in 5-10% of patients with ____.
Chronic HIV infection
Labial adhesions (fused labia minora) in prepubertal girls is usually due to ______.
Low estrogen production: treat with estrogen cream
If adhesions are associated with vulvar atrophy, consider lichen sclerosis.
What benzo is used for alcohol withdrawl?
LORAZAPAMMMMMM
Patients who are undergoing “clean. procedures” (without infection or viscus entry) should receieve prophylaxis against which organisms? What antibiotic should be used?
Gram positives from skin flora
Ideally 3rd or 4th gen cephalosporin such as cephalexin.
If severely pen allergic, use vanc.
What imaging is preferred to diagnose ureteral stones?
US or non-con CT
If both are options, pick US because no radiation.
Undiagnosed pleural effusion is best diagnosed using what?
Thoracentesis.
_____ is the most common cause of gross lower GI bleed in adults.
Diverticulosis.
How do you treat torsadse?
Hemo stable: magnesium sulfate
Hemo unstable: defibrillation
Where is joint osteoarthritis pain typically felt?
Groin, buttock, or lateral hip (trochanteric)
Body stores of ____ are minimal and deficiency occurs quickly in those with significant alcohol abuse.
FOLATE
What are the levels of homocysteine and methylmalonic acid in folate deficiency?
Homocysteine: HIGH
Methylmalonic acid: NORMAL
What are the levels of homocystine and methylmalonic acid in B12 (cobalamin) deficiency?
Homocystine: HIGH
Methylmalonic acid: HIGH
What findings are seen in glucose-6-phosphatase (von gierke) deficiency?
3-4 mo of age with hypoglycemia (often seizures)
Lactic acidosis
Hyperuricemia
Hyperlipidemia
Doll-like face, thin extremities
Short stature
Protuberant abdomen (due to hepatomegaly)
What are indications for inpatient treatment of PID?
High fever
Inability to take oral meds
Risk of non-adherence to treatment
What are the imaging findings in bilateral hydronephrosis of pregnancy?
Bilateral renal enlargement (R>L) with dilated renal pelvises and proximal ureters.
It requires no treatment.
What are common causes of ogilvie syndrome?
Electrolyte disturbances
Autonomic disruption (surg, neuro dz, anticholinergics)
How many words should an 18 mo know?
10-25 words
How many words should a 2yo know?
50 or more
What is the single most non-pharm effective way to reduce blood pressure?
Weight loss
How does PPV change if you lower the cut off point for a disease?
It would increase the number of false positives and true positives, this decreasing the PPV.
What is the d-xyulose test and what is it used to dignose?
Absorbed inthe prox small intestine without the help of pancreatic or brush border enzymes.
Decreased absorption of D-xyulose is due to small intestine mucosal disease such as celiacs.
People with enzyme deficiencies will still be able to absorb D-xyulose.
What ECG changes are seen before and during vasovagal syncope?
Bradycardia and sinus arrest
Patients with signs of chorioamnitis require what type of management?
Induction of labor
S3 sounds like what
ken-tuc-KY
What electrolyte abnormalities can prolong the QT?
Hypocalcemia
Hypokalemia
What is Miller Fischer syndrome? What are the findings?
Varient of guillon barre that’s immune mediated and caused by molecular mimicry
Opthalmeplegia, ataxia, areflexia
Highly associated with Anti-GQ1b antibody
How can you differentiave thalasseemia from iron deficiency?
Iron deficiency has an increased RDW and low reticulocyte count.
Thalassemia has a normal RDW.
What things are associated with short interpregnancy interval (<6-18 mo)?
Preterm labor
PPROM
Low birth weight
Basal ganglia calcifications are associated with infection with what?
TOXO
What type of gifts are acceeptable?
Non-monetary gifts of minimal value that directly benefit the patient, such as unbiased educational material or drug samples.
Inpatient management of CAP is with what abx?
Fluoroquinolones (moxi) or b-lactam + macrolide (ceftirax + azithro)
Adults with HIV should get what vaccines?
Hepatitis A, B (unless documented immunity)
Zoster (unless documented immunity w/ antivericella IgG antibody)
Meningococcus
Streep pneumo
All adults:
Yearly influenza
Single dose of Tdap
What are markers of polymyalgia rheumatica?
Pain + stiffness in hip. girdle, shoulders, and/or neck
Elevated inflamm markers: ESR and CRP
(NO change in CK)
What is angiodysplasia associated with?
Renal dz
Von Willebrand dz
Aortic stenosis
What is an acute aplastic crisis in patients with sickle cell dz?
Acute drop in Hb, a reticulocyte count <1%, and no splenomegaly.
Parvo is the most common cause.
What lab findings are seen in bowel ischemia?
Leukocytosis
Elevated amylase and phosphate
Metabolic acidosis (from lactate elevation)
Travel associated diarrhea lasting >2 weeks is most likely _______.
Parasitic
What is the first step in evaluating scoliosis when a bend forward test is positive?
X ray
What conditions can cause pulsus paradoxus?
Cardiac tamponade
Asthma
COPD
Worsening global neuro symptoms such as vomiting, stupor, and bradycardia are associated with what brain pathology?
Intracranial hemorrhage.
What is the pentad of TTP?
Thrombocytopenia MAHA Renal insuff Neuro changes Fever
What physical exam findings are found in severe AS?
Diminished and delayed carotid pulses
Late-peaking, crescendo-decrescendo systolic murmur
Soft and single S2
What is the first line therapy for migraines in kids?
Aceetaminophen, NAIDS, supportive care
Triptans may be used if these are not effective
CLL is associated with what type of anemia?
Warm autoimmune hemolytic anemia
What physical exam findings are seen in cervical myelopathy? What is the most common cause of this in older adults?
LMN signs at the level of the lesion (arms)
UMN signs below the level of the lesion (legs)
Caused by spondylosis: degenerative spine disease that causes canal narrowing and cord compression
What causes pancytopenia in SLE?
Immune mediated destruction of all 3 cell lines
What is seen on lumbar puncture in MS?
Oligoclonal bands
What causes systolic HTN in thyrotoxicosis?
Hyperdynamic circulation caused by increased myocardial contractility and HR.
Phenytoin use can cause reduced _____ absorption?
Folic acid
What SAAG level indicates portal HTN?
> 1.1
What are signs of renal artery stenosis after kidney transplant?
Persistently elevated BP
Decline in renal function following admin of ACEi
Lateralizing abd bruit
Recurrent flash pulm edema
Renal vein thrombosis is associated with which renal disease?
Membranous nephropathy
What can help protect the articular cartilage in osteoarthritis of the knee?
Strengthening the quads, to reduce abnormal loading on the joint.
How can you treat flash pulmonary edema from acute MI?
Furosemide (as long as they are not hypotensive or hypovolemic)
When should you not use b-blocker in the setting of MI?
BB are standard therapy for MI unless they have: Hypotension Bradycardia Chronic heart failure Heart block
How does a branchial cleft cyst usually present?
Later in childhood after a URI when it becomes infected.
What are the most common bacterial causes of acute bacterial rhinosinusitis?
Nontypable H. flu
Strep pneumo
Moraxella
What findings are seen in erlichiosis?
Fever, myalgias, headache
Leukopenia, thrombocytopenia
What are findings in babesiosis?
Anemia due to intravascular hemolysis
Thrombocytopenia
Increased bili, LDH, LFTs
What three symptoms are seen in Hodgkin lymphoma?
Mediastinal mass
Elevated LDH
Eosinophilia
Patients with decreased albumin can have a resulting decrease in total _____.
Calcium
However, ionized calcium (physiologically active) is hormonally regulated and remains stable.
What are the two leading causes of lymphangitis? What is the treatment?
Strep pyogenes and MSSA
Cephalexin
How do you treat social anxiety disorder (social phobia)?
SSRI
How does eosinophilic esophagitis typically present?
Intermittent solid food dysphagia
What symptoms can present from sertoli-leydig cell tumors?
Rapid-onset virilization (bitemporal hair thinning)
Amenorrhea
Large pelvic mass
FYI they secrete testosterone
Adrenal insuff. often leads to what?
SIADH (and resulting hyponatremia)
Because cortisol acts as an inhibitor of ADH, without cortisol, you get too much ADH.
What lab findings are seen in central adrenal insuff. (sheehans)?
Disease of the hypothalamus or pituitary resulting in deficiency in ACTH.
Hyponatremia from SIADH
Normal potassium because RAA axis is intact.
What is the white, granular oral lesion that can progress to SCC?
Oral leukoplakia
CANNOT be scraped off.
What is seeen on PFTs in someone with chronic bronchitis? How is it defined?
Obstructive pattern: decresaed FEV1/FVC
Normal DLCO
Productive cough for 3 or more months over 2 consecutive years.
