Uworld Pass 2a Flashcards
nonhemolytic tranfusion reaction? Management
1-6 hours after transfusion
transient fevers, chills, malaise
Management: stop transfusion -> use leukoreduction for all future transfusion
CMV vs. rubella?
Rubella has cardiac defects, CMV does not
Long-term treatment for cocaine?
12 step program and individual therapy
painless muscle weakness associated with weight gain, bone loss, hypertension, hirsutism?
Hypercortisolism (Cushing’s syndrome)
Leading cause of diabetes retinopathy in the US? Signs?
Diabetic retinopathy
Types: 1. microaneurysms, hemorrhages, exudates, retinal edema
- cotton wool spots
- newly formed vessesl
Most common causes of aortic regurgitation in developed countries?
Dilation of the aortic root, congenital bicuspid valve
Signs of opiod overdose
reduction in both respiratory rate, tidal volume, respiratory acidosis, hypothermia
Side effects of mirtazapine?
SNRI, dedating, increase apetite
Signs of testicular torsion?
bell-clapper deformity (high riding testes) decreased crenasteruc refkex
abdominal pain, emesis, 24-36 hours after blunt abdominal trauma in children? Diagnostic method?
duadenal hematomas
Ct imaging is diagnostic
Contraindications in the infant for breast feeding?
Galactosemia
Probenecid MoA?
Increases uric acid secretion in the kidneys
Most common injury in a midshaft humerus fracture?
Radial nerve
Causes of idiopathic intracranial hypertension?
growth hormone, tetracyclines, excessive vitamin A (and derivatives)
Breath sounds in consolidations?
Increased
How does a pheochromocytoma act?
increased catecholamine secretion
What is an Ergot?
5-HT agonist
When to expect Shy-Drager syndrome (multiple system atrophy?)
Person with Parkinsonism experiences orthostatic hypotension, impotence, incontinence, or other autonomic symptoms
bright red, firm, friable, exophytic nodules in HIV infected patient?
bacillary angiomatosis, caused by Bartonella, a Gram-negative bacillus
Should natrexone and naloxone be given for opiod withdrawals?
No, they worsen them
Features of 11beta-hydroxylase?
Ambiguous gentialia in firls, fluid and salt retention, hypertension
Signs of mitral regurgitation?
sever pulmonary edema, hypotension, with hyperdynamic precordium
When is cholithiasis risk increased in TPN?
> 2 weeks of TPN admission -> increased cholestasis
Wernicke encephalopathy presentation?
altered mental status, ataxia, nystagmus
Polyarteritis nodose
skin lesions and myalgias, and necrotizing vasculitit
extranodal marhinal zone b lymphoma in mmucosa-associated lympnoid tissue (MALT) of the stomach risk factor?
H. pylori
What is a confounding error?
mixing up of the effet of exposure with the effect of an extraneous factor, must have properties linking it with the exposure of interest
What affect do diuretics and vomiting have on pH? Bicarb levels?
Metabolic alkylosis, increased serum bicarb
Pseudoallergic reaction
NSAID reactions are not IgE-mediated
asthmatic symptoms, basal and ocular symptoms, facial flushing 30 minutes to 3 hours after NSAID ingestion
Vitamin deficienies in Cf?
ADEK
COntraindications to amnionfusion?
Previous uterine surgery
Nerve damage being risked in anterior dislocation of the shoulder?
Axillary
Name this image and treatment?
Regular, wide complex tachycardia consistent with monomorphic ventricular tachycardia
Treatment: Amiodarone
Central cord syndrome
Hyperextention of the neck -> upper extremity weakness
Most common sign of meckel’s diverticulum?
painless, hematochezia
How to confirm the diagnosis of ankylosing spondylitis?
X-ray of the sacroiliac joints
Neonatal disorder associated with peripheral cyanosis?
polycythemia
Systolic mumur over the apex that prolongs with valsalva?
mitral valve prolapse
Emphyseatous cholecystiti Treatment?
emergency cholecystectomy, broad spectrum abx (including clostridium (am-
Cardiac manifestations of alcohol abuse? Method to improve?
Dilated cardiomyopathy
Improve with EtOH abstience
Mosquito prophylaxis in central emerica, caribbea?
Chloroquine
Yellow streaks in hands? with mily blood samples? Cause? Risk? Treatment?
xanthomas with severe hypertriglyceridemia
Cause: familial dusbetalipoproteinmia
Risk: Pancreatisi
Treatment: fenofibrate
Abx treatment for aspiration pneumonia?
Clindamycin
Managment of suspected bacterial meningitis in children
Lumber puncture, abx
No need for imaging because the fontanelle is open and herniation is unlikely
Hashimoto thyroiditis? Lab findings?
High TSH, low T4
polymyalgia rheumatica-characteristics, labs? Treatment? Associates risk?
Characteristics >50, stiffness > pain in shoulders, hip girdle, neck
Labs Elevated ESR, CRP
Treatment: glucocorticoids (rapid improvment)
Associated risk: Giant cell (temporal) arteritis
Cardiac changes in sarcoidosis?
complete AC block (most common, restrictive cardiomyopathy (early), dilated cardiomyopathy (late)
Most common organisms in central line-associated bloos stream infections?
coagulase-negative staph
Pappollary thyroid cancer characteristics
slow spread into local tissues and regional lymph nodes
path findings: large cells with group glass cytoplasm, pale nuclei, inclusion bodies , and central groovin and hrainy, lamellated calficiations (psammoma bodies
When GBS is diagnosed, what critical test must be done?
Spirometry (specifically forced vital capacity
Presentation on esophageal performation
left-sided eggusion (dullness/diminished breath sounds)
mediastinal emphysema -> mediastinitis -> septic shock -> death
Physical manifestations of pancreatic cancer?
obstructive jaundice (congated hyperbilirumia), epigastric pain, weight loss, pancreatic mass on CT
how is congenital toxoplasmosis spread?
Raw or undercooke meat, unwashed fruits, vegetables, cat feces
Tension pneumothorax signs?
acute severe dyspnea, tachycardia, tachypnea, hypotension, neck vein distention
Esophageal performation
chest/abdominal pain, ubcutaneous emphysema, hamman sign (crunching on chest auscultation
Tuberculosis effusions
high protein (<4), lymphocytic leukocytosis, low glucose
Smudge cells are associated with that disease?
chronic lymphocytic leukemia
Arterial emoboli vs arterial thrombosis
thrombosis - form from atherosclerotic plaques, due to collatorals are less severe, and see acute
Emboli- from the heart, (left atrial/ventricular) following myocardial infarction, infective endocarditis
Signs of lactase deficiency?
diarrhea, abdominal pain, flatulence after milk, etc
Risk associated with claudation of the limbs?
coronary arter disease (MI), only 1-2% need ampulation of limb
ANOVA use?
Three or more outcomes
When to do c-section vs oxytocin
C-section when no cervical change for 4 hours (6 with inadequate labor contractions)
Oxytocin is for inadequate labor strenght
Where are pheochromocytomas located?
Adrenal medulla
Diagnosis?
Avascular necrosis
Gonioscopy diagnoses? Findings?
acute closure gaucoma
severe eye pain, headache, nausea, vomiting, dilated and fixed pupil
What injury risks the radial nerve?
Mid humerus fractures
Vasovagal syncopy signs?
nausea, pallor, diaphoresis leading to falls
Can be associated with micturition syncopy that occurs when urinating
When to use antibiotic prophylaxis for dental work?
Prosthetic heart valve, previous IE, structually abnormal valve in a transplanted heart, congenital heart disease
Cause of amaurosis fugax?
painless, rapid, transient monoocular vision loss causd by atherosclerotic emboli originating from the ipsilateral carotid artery
Effective method to prevent episodes of torsades de pointe
magnesium
Most common organisms in brain acscess?
Strep viridans, s. aureus
Risks of sotalol?
QT prolongation -> TdT
Complications from CLL?
infections, autoimmune hemolytic anemia, secondary malignancies (richter transformation)
Lab findings in hemophilia? Treatment
pprolonger aPPT, decreased or absent factor VIII, IX
Treatment: replace missing factors
Signs of cataract? Earliest sign of cataract?
painless blurring of vision, halos around lights, , worsening of distance vision,
Loss of red reflex
Most common cause of pneumonia in sickle cell patients? Sepsis, meningitis
Strep. pneumoniae
causes of reactive thrombocytotis?
cytrokine release driven by inflammatory states (infection, recent surgery, malignancy) sometimes pneumonia
Risks accociated with combined contraceptives?
venous thromboemvolism, hypertension, hepatic adenoma, very rate stroke and myocardial infarction,
Onion-skin appearance of bone tumor in children
X-ray shows osteolytic lesions with periosteal reaction that prodces layers of reactive bone
Ewing
Less likel due to lower prevalence and poor x-ray characteristics
Cause of HTN when mixing triptans and ergots?
prolonged vasoconstrition -> HTN, Mi, stroke
What valve is most commonly damaged in infective endocarditis? What abnormality?
Mitral valve, mitral valve prolapse
Urine pH > 8, suspect? MoA
urease -prudcing bacterium (proteus mirabilis, klebsiella pneumoniae) because urease splits urea into ammonia and carbon dioxide, which alkalizes the urine
Type A vs type B adverse drug reaction?
Type A is dose dependent,
Type B is dose independent
REM sleep behavior disorder?
repeated episodes of complex motor behaviors or vocalization during REM sleep
TRALI reaction to blood?
respiratory distress and signs on noncardiogenic pulmonary edema
within 6 hours of transfusion
Caused by doner anti-leukocyte antibodies
First step in evaluating thyroid nodule?
TSH, US, clincal evaluation
First step of HIV testing?
HIV p24 antigen and HIV antibodies
If negative with high clinical suspicion, order HIV RNA
Scratching the anal region at bedtime, not during day, type of infection?
Helminth, specifically enterobius vermicularis
What masses are in the anterior mediastinum?
Thymoma, teratoma, retrosternal thyoi, terrible lymphoma
Boerhaave syndrome
Spontaneous esophageal rupture
precipitating factors for hepatic encephalopathy?
infection, electrolyte abnormalities, high nitrogen states (GI bleeds, dietary changes
Lipid profile measurements in people with 7.5% cardiac risk index should be measures?
Every 5 years
Progressive duspnea, orthopnea, lower extremitiy edema, bibasilar lung crackles
decompensated congestive heart failure
suppurative infection of the thyroid glan
rare condition -> high grade fever, pain at the thyroid, patients are euthyroid
What should an 18 month old be anle to do?
running, kicking a ball, walk without support
What is this? What does it increase the risk for?
Hereditary spherocytosis -> increased risk for gallstones
Treatment for bullous pemphigoid?
high potency steroids
How does risperidone cause prolactinoma?
agonism of dopamine
x-ray findings in osgood-schlatter disease?
anterior soft tissue swelling, lifting of the tubercle from the shaft, irregularity or fragmentation of the tubercle
thrombocytopenia, decreased fibrinogen, increased INR
Disseminated intravascular coagulation
Milk or soy protein induced proctocolits signs? Treatment?
Signs-eczema, regurgitation, vomiting and/or painless bloody stools
Treatment: eleiminate all dairy and soy friom diet, switch to hydrolyzed formula
How to treat cyanide poisoning?
Hydroxocobalamine or sodium thiosulfate
Anaphylatic blood transfusion reaction?
Rapid onset of shock, angiodema, within seconds to minutes of tranfusion, caused by anti-IgA antiibodies in the recipient blood
What conditions can cause basophilic stippling?
Lead poisoning, alcohol abuse, thalassemias
medication use in a depressed patient with poor sleep and appetite
mirtazapine
parallel study
randomized one treatment to one group and a different treatment to another
Ferritin serves as an
acute phase reactant
Name this image and treatment
Supraventricular tachycardi, adenosine
Breath sounds in mucous plugging?
Absent
What type of vasculitis is granulomatosis with polyangiitis?
nexrotizing vasculitis
ovalomacrocytosis and neutrophils with reduced segmentation, think?
myelodysplastic syndrome
Perofrm bone marrow biopsy
Cause of falls in parkinson disease?
dopaminergic neuron degeneration
Prophylatic treatment for rheumatic fever
intramuscular penicillin G every 4 weeks
Side effects of nifedipine as tocolytics? When to use?
tachycardia, palpitations, nausea, flushing, headaches
32-34 weeks
First line for COPD?
Long acting anticholinergic inhaler
De Quervain tenosynovitis
Occurs post pregnancy due to overused to the extensor pollicis vrevis and abductor pollicis longus “baby wrist”
If a minor has active plans of suicide, what is the course of action?
Inform parents, admit with/without permission
CYP450 inhibitors (increased warfarin activity)
Acetaminophen, NSAIDS, antibiotics/antifungals, amiodarone, cimetidine, cranberry juice, omeprazole, throid hormone, SSRI
Signs of arrhythmias?
Sudden-onset syncope without prodrome
What test can be used to diagnose spherocytosis?
eosin-5-maleimide binding test
If no heart tones on doppler in pregnancy, what should the next step be?
Ultrasound
When does the risk of endometrioma decrease?
After menopause
With a non-viable fetus, what delivery should be used?
vaginal, no point in risking mother
Postprandial right UQ pain with radiation to the shoulders post Roux-en-y? Complication
cholecystitis
Complications: gallstones due to rapid weight loss
What is the cause of the second heart sound?
aortic valve closure
CML Pathogenesis, treatment?
BCR-ABL, imatiman inhibits the product
Osgood-schlatter disese
13-14 year old males
AKA :traction apophysitis
HCTZ- use?
hypertension, congestive heart failure
Diagnosing warn autoimmune hemolytic anemia? Treatment?
direct antiglobulin (Coombs) test - IgG, or completment components (C3)
Treatment: high dose glucocorticosteroids (decrease autoantibody production)
“knife-crasp” grip is seen in?
puramidal tract disease
Treatment for severe depression when not eating?
Electroconvulsive therapy
Tuberculosis meningitis CSF findings?
markedly low glucose, elevated protein, lymphocytic pleocytosis
Laboratory findings in alcoholic hepatitis?
Increased AST: ALT (2:1), GGT, ferritin
How to treat generalized anxiety disorder?
SSRI and CBT
What ALT is suggestive of gallstone pacreatits? Treamtnet?
150U/L, cholecystectomy after medically stable
Ciprofloxacine coverage
gram-negative
First step in the workup of hypertension and hypokalemia?
Plasma aldosterone and renin ratio
lung mass with progressive dyspnea, coough, sputum, wheezing
Bronchogenic carcinoma
A child exposed to varicella-zoster that is not immune mean? What should be the next step? When is vaccination done?
Non-immune, has not received 2 doses of vaccination, no prior exposure)
Vaccination occurs at 1 and 4 years
If exposed, give vaccine
If exposured and immunicompromised, give immuniglobulin
Side effects of indomethacin as tocolytics? Use?
Maternal: gastritis, platelet dysfunction
fetal: oligohydramnios, closure of ductus arteriosus
<32 weeks duration
What is the normal amylase content of pleyral effusions?
Very high, due to saliva
anterior cord syndrome?
bilateral hemiparesis, dimished bilateral pain and temperature, intact bilateral proprioception, vibratory, and light touch
Pancoast tumor presentation
shoulder pain, horner syndrome, altrophy of intrinsic hand muscles, 4/5th finger paresthesias, supraclavicular lymph node enlargement, weight loss
Signs of lumbar stenosis?
lower extremity pain with extension, relieved by leaning forward, walking uphill,
Regular schedule for meningococcal vaccination? High risk?
primary vaccination 11-12, booster 16-21. if primary before 16
High risk (vaccinate even if >21):
complement deficiency, asplenia, college studies in housing, travel to endemic areas, exposure
Bisphosphonate MoA
inhibit osteoclast and suppress bone turnover and are the preferred therapy
Best prognostic indicator in astrocytoma?
degree of anaplasia, rarely developes mets
Best drug for depression, quit smoking, and weight loss?
Bupropion
What cancers do OCPs reduce the risk for? Increase?
Decrease: Ovarian and endometrial cancer
Increase: cervical and breast
Greatest risk for adverse clinical events during shift change overs? how to combat?
communication failures between providers
implementing a signout checklist overcomes there errors
mallory-Weis trear?
sudden increase in intraabdominal pressure (retching) leading to a mucosal trear and hematemesis
Rash associated with celiac disease? Description of rash
dermatitis herpetiformis
erthematous papules, vescicles, bullae that occur symmetrically in groups clusters on the extensor surfaces of the elbows, knees, buttocks
Autoimmune dermal reaction due to dietary gluten
NF type 2? chromosome?
bilateral acoustic neuromas
Chromosome 22
pleuritic chest pain, long-distance flight, hemoptysis, tachypnea, tachycardia, oral contraceotive use?
Pulmonary embolism -> pulmonary infarction
Test used to compare 2 means?
Two-sample t test
Name this structure
Aspergilloma
Child with palable, nonblaching, symmetric purpuric lesions on the buttocks and lower extremities with joint pain? Other findings? Path findings?
henoch-Schonlein purpura
Other signs: abdominal pain and renal failure
Path IgA deposition and neutroogukuc snakk vessek vasculitis in the post capillary venules
Diagnosis?
Seborrheic keratosis
Ethylene glycol crystals?
calcium oxylate crystals in urine
Most comon cause of spinal epidural abscess?
S. Aureus
cirrhosis, lethargy, asterixis hepatic encephalopathy
hepatic encephalopathy
How to confirm brain abscess?
gadolinium enhances brain MRI
leukocytosis with variant lymphoctes with a large, vacuolated cytoplasm (atypical lymphocytes)
Infectious mononucleosis
Risk factors for esophageal performation
malignant strictures, sever esophagitis, history of radiation therapy, prior perforation
In a patient with several weeks of lower abdominal pain, bloody diarrhea, fecal urgency, suspect? If also fever, abdominal distention, leukocytosis and tachycardia?
Inflammatory bowel disease
Toxic megacolon
Contraindications in bipolar?
SSRI- creates mood instability
Findings in pagent disease? Pathogeneisis? Imaging findings?
Increased alkaline phosphatase and focal bone pain
Path: abnormal osteoclast activity leading to increased bone turnover and disordered bone remodeling
Imaging: increased cortical thickennig and osteolytic of mixed lyic/sclerotic lesions on x-ray
Complications fo roux-en-Y gastric bypass surgery?
Early: anastomotic leak (sepsis), bowel ischemia
Late: anastomotic stricture, marginal ulcer, cholecystitis, dumping syndrome
Cause of DKA
insulin deficiency
Long term management of laryngomalacia?
Reassurance
pericardial thickening murmur?
Friction rub
Contraindications to yellow fever vaccination
allergy to components (eggs)
AIDS, immunodeficiencies, immunosuppressive therapies
Opiod withdrawal treatment?
Buprenophine
Common cause of acute pancreatitis?
gallstones, alcohol
Factorial design study?
2 + experimental interventions with 2 + variables being studies independently
What drugs treat bladder obstruction disorders?
alpha-adrenergic antagonist (terazosin, doxazosin)
dolutegravir MoA? side-effects?
integrase stand transfer inhibitor
side effects: hyperglycemia, increased transaminases
Abacavir and lamivudine MoA, side effects?
nucleoside reverse transciptase inhibitors
side effects: insomnia, depression, lactic acidosis, hepatotoxicity
Abacavir is also associated with potentially fatal hypersensitivity reactions
What drugs can increase the levels of digoxin?
Amiodarone (reduce digoxin level 25-50% when using), verapamil, quinidine, propagenone
When do yse leukoreduced blood?
Chronically transfused patients
CMV seronegative at-risk patients (AIDS)
potential transplant recipients
previous febrile non-hemolutic transfusion reaction
How does ADH work?
Promotes reabsorption on water
Most common cause of chronic sinusitis?
S. aureus
granulomatous vasculitis is seen in?
akayasu arteritis, graulomatosis with pokyangiitis, eosinophilic granulomatosis with pokyangiitis
loss of intramural neurons in the lower esophagus is found in?
Achalasia
atrial septal defect cardiac findings?
- wide and fixed splitting S2
- mid-systolic or ejection murmur over the left upper sternal boarder (increased flow across pulmonary valve)
- mid-diastolic rumble (across tricuspid valve)
Reaction formation
Turning something negative into something positive
Gi complications of systemic sclerosis
smooth muscle atrophy and fibrosis, hyomotility and incompetence of the lwoer esophageal sphincter
E,physematous cholecystitis?
Fever, right upper quadrant pain, nasea/vomiting, creitus in abdominal wall adjacent to gallbladder
adenosine deaminase deficiency
impaired t-cell development -> severe combined immunodeficiency
patient experiences severe, recurrent viral, fungal, bacterial, failure to thrive
Risk factors for peripheral artery disease? Diagnostic test?
decreases distal extremity sensation, atherosclerosis, hypertension, diabetes
Diagnosis is by ankle-brachial index
modalities for diagnosing ureteral stones?
Ultrasonography, noncontrast spiral CT
cluster analysis
randomization at the level of groups, instead of individuals
Diagnosis?
Squamous cell carcinoma
Best modality to evaluate pituitary mass?
MRI
Cirrhosis with fever, ascites, diffuse abdominal tenderness, tachycarida, mental status changes, think? Pathogenesis?
Spontaneous bacterial peritonitis
Pathogenesis: translation of bacteria across the intestinal wall and seeding of peritoneal cavity
Signs of carbon monoxide poisoning
Headache, confusion, dizziness
Prolactin levels that is diagnostic of prolactinoma?
>200ng/mL
Most common cause of sterile pyuria (WBC without bacteria) and urethritis in females?
Chlamydia trachomatis
At faster hear rates, what drugs can cause widening of the QRS complex?
Class 1 antiarrhytmic drugs (flecainide and propafenone
Roseola signs? Alternative name?
Human herpesvirus 6
3-5 days high fever followed by blanching maculopapular rash
Imaging characteristic of chronic pancreatitis?
Calcifications
Atlantoacial instability? Associations?
Excessive lacity in the posterior transver ligament, -> increased mobility between the atlas and the axis (C1, C2)
Signs: behavioral changes, torticollis, urinary incontinence, vertebrobasilar symptoms (dizziness, vertifo, diplopia), clonus is often present
Association: Down syndrome
Tension pneumothorax can compress what structure?
Superior vena cava
Most common complication of influenze?
Pneumonia
Bullous pemphigoid-pathogeneisi
autoimmune blistering with subepidermal cleavage at the basement membrane of hemidesmosomes
aspriin-exacerbated respiratory disease-pathogenesis?
arachidonic acid -> shunted to leukotrienes via 5-lipooxygenase pathway (COX1, COX2)
Chronic lymphocytic leujemia Clinical presentation? Treatment?
lmpadenopathy, hepatosplenomegaly, mild thrombocytopenia and anemia, lymphocytic predominent leukocytosis
Pathogenesis: Rituximab, against CD20 on B lymphoctytes
Erythema multiforme signs?
Targetoid rash
intersitial lung disease
progressive duspnea, nonproduct cough, find bibasilar crackles,
x-ray demonstrated reticular or nodular opacities
Light’s criteria for exudative?
Pleural fluid protein:serum ration >0.5
Lactate dehydrogenase:serum LDH is > 0.6
Pleural fluid LDH > 2/3 upper limit of normal LDH
pH is notmally 7.4-7.55 for systemic causes
Signs on decreased ionized calcium?
crampy pain, paresthesias, carpopedal spasm
17alpha-hydrozylase deficiency
phenotypically female, fuid and salt retention, hypertension
Most common brain tumor in adults?
Astrocytoma
Primary vs secondary adrenal insufficiency?
Primary - severe, hyperpigmentation, hyperkalemia, hyponatremia, hypotension
Seconary- less severe, no HTN, no hyperkalemia, possible hyponatremia
neuroleptic malignant syndrome signs? Cause?
Signs: mental status change, rigidity, fever, autonomic dysregulation
Cuase: dopamine antagonist medications
If the ANA is positive in Raynaud’s what is the next step?
Order specific antiboies (anti-topoisomerase-1 for systemic sclerosis)
high leukocyte alkaline phosphatase score, late neurtophil precursors (metamyelocyes, bands; rather than promyelocytes, myelocytes)
leukomoid reaction
What can be administered to reduce the risk of gallstones post Roux-en-Y?
ursodeoxycholic acid
Metyrapone
cortisol synthesis inhibitor, used to treatment Cushing syndrome while waiting for definitive surgery
hyperthyroidism post viral infection with neck pain?
subacute thyroiditis (dequavian
Miliary TB chest x-ray findings?
diffuse retulonodulary pattern
Physical exam findings of severe aortic stenosis?
- pulsus parvus and tardus (dimished and delayed carotid pulse
- mid- to late- peaking systolic murmur
- soft and single second heart sound
Diagnosis of atlantoacial instability? Treatment?
X-ray (mouth open)
Treatment: surgical fusion of C1 and C2
Signs of cerebellar dysfunction
progressive gait dysfunctrion, truncal ataxia, nystagmus, intention tremor or dusmentria (limb-kinetic tremor)
Amp-gent coverage
Gram-negative aerobes
Side effects of terbutaline? MoA?
MoA: beta agonist
side effects: tachycardia/arrhythmias, hypotension, hyperglycemia, pulmonary edema
Most common arrhmthmia associated with digoxin?
atrial tachycardia with AV block
Treatment for Atrial fibrillation?
Rate control - beta-blocker, diltiazam, verapamil
anticoagulation
thin, shiny, hairless skin on extremtiies with non-healing ulcer?
peripheral vascular disease
Is a bag of worms in the testicles chronic or urgent?
Chronic, no urgent evaluation needed
X-ray findings in cardiac temponade?
enlarged cardiac shadow
constipation, polyuria, possible abdominal pain with a Ca2+ of 11.4?
hypercalcemia
Initial treatment for myasthenia gravis?
Pyridostigmine, acetylcholinesterase inhibitor
Tenderness at the tibial tuberacle, suspect?
Osgood-schlatter disease
noew-onset intense back pain unaffected by movement and hypotension?
Reuptured abdomainl aneurysm
When should a woman get a mammogram? How often?
50-70 years of age
every 2 years
Complications of interstitial lung disease?
digital clubbing cor pulmonale
Benefits for breast feeding to the mother?
Reduced risk of breast and ovarian cancer
Diagnose? Cause?
Early decelerations, head compression
GI discomfort, malabsorption, arrival from resource-limited country, with pulmonary symptoms and eosinophilia? Diagnostic test?
ancylostoma duedenale, necator americanus
Diagnosis: stool and ova parasite
Recommended first line therapy for bipolar? Alternative/
First line- Lithium, valproate, quetiapine, lamotrigine
Alternative: lithium of valproate combined with a second generation antipsychotic (quetiapine)
Glomerulonephirtis findings on urinalysis?
nrphritic syndrome, hematuria (RBC casts), edema, HTN, proteinuria
Optic neuritis
monocular vision loss, “washed-out” colors, afferent pupillary defect, centeral scotoma
Associated with MS
Which beta-blockers have been shown to improve CHF long-term survival?
metoprolol succinate, carvedilol, bisoprolol
Quickest way to decrease pain in myocardial ischemia?
venous dilation (nitrates MoA)
Cause of Raynaud phenomenon?
upopposed alpha activity in the peripheral vasculature that may promote vasoconstriction
Beside antipsychotics, which other drugs can cause extrapyramidal symptoms?
antiemetics: metocloramide, prochlorperazine, prmethazine
Signs of hyperthyroidism?
wieght loos, palpitations, hypertension, menstral irredulaties, onycholysis (separation of the nail from the bed), nail clubbing, mild hypercalcemia
How to diagnose zenker’s diverticulum? Contraindicated methods?
contrast esophogram
Contraindicated: upper GI endoscopy due to concern for perforation
Methanol poisoning signs? Labs?
Signs: visual blurring, central scotomata, afferent pupillary defect, altered mentaiton
labs: high osmolar gap, increased anion gap, metabolic acidosis
Stroke on aspirin therapy, add?
dypridamole or clopidogrel
Demential with lewy body- histology findings?
round, eosinophilic, intracytoplasmic inclusions in the neuron of the substantia nigra
Lab findings in ethylene glycol poisoning?
metabolic acidosis with increased gap, very low bicarbonate and compensatory drop in pCO2
Africa, Oceania, Asia malaria chemophrophylaxis?
Mefloquine 2 weeks before until 2 weeks afterwards
Signs of HSV encephalitis?
normal glucose, RBC elevation (hemorrhagic destruction of frontotemporal lobes), lymphocytic pleocytosis, elevated protein
Digeorge syndrome? Order immediately?
Conotruncal Cardiac defects
abnormal facies
thymic aplasia.hypoplasia
Cleft palate
hypocalcemia
CATCH-22
Order calcium level, echo
Tactile fremitus in effusion vs consolidation?
Increased in consolidation, decreased in effusion
chi-square test
categorical data and proportions
jaundice, weight loss, abdominal discomfort (without prominent abdomain pain), fullness in the upper right quadrant?
Pancreatic cancer
Gastrin-secreting pancreatic tumor signs?
chronic diarrhea, weight loss, dyspepsia
Autoimmune hemolytic anemia vs hereditary spherocytosis
AIHA- negative family history, positive coombs (warm agglutinin) IgG autoantibody
Hereditary- postive family history, negative coombs
Lymphocytic hypophysitis?
lymphocytic infiltration of the pituitary gland
What is efairenz? side effects?
non-nucleoside reverse transcriptase inhibitor
Side effects: sizziness, insomnia, vivid or bizarre dreams, anxiety or depression
What viral HIV load should get a c-section?
>1,000
nephrotic syndrome patients are at an increased risk for?
infection (loss of immunoglobins), thrombosis (antithrombin, plasminogen), and protein malnutrition
low leukocyte alkaline phosphatase score, peripheral smear with absolute basephilia and early neutrophil precursor cells
Chronic myelogenous leukemia
CMV retinitis complications
blindness, retinal detachment
Risk associated with endoscopic stricture dilation
esophageal performation
Treatment for urge incontinence?
bladder training, oxbutynin (antimuscarininc or anticholinergic) that relaxes detrussor muscles and reduces spasms
Risk associated with nitrate use?
profound hypotension, treat with NS bolus
flat and gradmented left femoral head with alternative regions of lucency and density?
avascular necrosis
Murmur in aortic regurgitation?
decrescendo diastolic murmur
Best heart of the left sternal border at the third and fourth intercostal spaces
If dilated aortic root, it moves toward the right side
late systolic murmur in the cardiac apex?
mitral valve prolapse
After stabilization, next step in managing acetaminophen overdose?
Refer to transplant center
Role of pyridoxine in synthesis? Laboratory signs?
Protoporphyrin synthesis -> microcytic anemia
Laboratory signs: “dimorphic RBC” population - microcytic and normacytic
Diagnosis? Syndrome, if in children? Treatment
QT prolongation
Syndrome: Jervell-Lange-Nielsen syndrome (autosomal recessive) -> defects in K+ channels
Treatment: normalize Ca2+, K+, MG2+, beta blockers, pacemaker
Hazard ratio
chance of an event occurring in the treatment group compared to the chance in the control group over a set period
< 1 = more likely in the control group
Pathophysiology of hypertrophic cardiomyopathy?
Mutations in sacromere protein genes
lennox-Gastaut syndrome
Children less than7 with wide array of seizure types accompanies by mental retardation
right upper sternal border mumur that radiates to the carotids?
aortic stenosis
Orthostatic hypertension? Medication causes?
prodromal dizziness and blurred vision in the setting of rapidly transitioning from supine to standing
Medications: antihypertensive, alpha blockers
Common causes of carpal tunnel syndrome?
diabetes, hypothyroidism, pregnancy
What happens to calcium in alkalosis? Acidosis?
Decreased ionized calcium
Acidosis: increased ioninzed calcium
holosystolic murmur heard best at the left sternal border wall?
VSD
High fevers, severe polyarthralgias, lymphopenia, throbocytopenia, caribbean recently?
Chikungunya fever
Bilious emesit in a neonate workup?
Abdominal X-ray -> water soluble contast enema
Management of akathsia?
Decrease antipsychotic, treat symptoms with beta blocker or benzotropine
Central cord syndrome?
decreased sensation, motor dunction in the arm with relateive sparing of lefs after forced hyperextention
Significant demographic risks for h. pylori?
low income country, high prevalence
Signs of leukocytes adhersion deficiency?
impaired neutrophil migration, delayed umbilical cord sepration, recurrent non-purulent skin infections, severe periodontitis, marked neutrophilia
ECG manifestions of hypoekalemia
broad, flat T waves, U waves, ST despression, premature ventircular beats
Also, a fib, TdP, ventricular fibrillation
Risk factors for the development of abdominal aortic aneurysm?
olger age (>60), cigarette smoking, family history, white race, atherosclerosis
Cardiac defect strongly associated with digeorges syndrome?
truncus arteriosis
High fever, maculopapular rash, following cough, conjuctivity, coryza? Treatment?>
Rubeola (measles)
Treatment: supportive, vitamin A for hospitalized patients
First line therapy for a specific phobia?
Behavioral therapy, exposure
Hurthle cells
follicular thyroid cancer, but nonspecific
Signs of autoimmune hemolytic anemia?
elevated indirect bilirubin, increased serum lactate dehydrogenase, decreased haptoglobin, splenomegaly, spherocytes, reticulocytosis
Enzyme elevated in liver parenchyma?
aminotransferases
hypokalemia and impaired renal bicarbonate absorption?
Type II renal tubular acidosis
Signs of adrenal insufficiency?
Weakness, abdominal pain, loss of appetite, mild hyponatremia, postural hypotension, hyperkalemia
Dilated left ventricle and apical hypokinesis and engorgement of the inferior vena cava?
cardiogenic shock
Signs of dessiminated tuberculosis?
back pain, subacute illness with intermittent fevers, radiographic evidence of pulmonary and spinal disease with normocytic anemia and chronic inflammation
Lab findings after splenic removal?
dramatic thrombocytosis (failure to remove bad ones)
Congenital Toxoplasmosis treatment
Pyrimethamine, sulfadiazine, folate
Comorbities in CF?
Chronic rhinosinusitis, infertility (mostly males), pancreas enzyme deficiency
Diagnosis
Slipped Capital fermoral epiphysis
Diagnosis? Treatment?
Basal cell carcinoma
Mihs micrographic surgery
pancreatic pseudocyst
days to weeks after blunt abdominal trauma
Best diagnosis of meniscal tear?
MRI
What amino acids are converted to pyruvate during fasting states?
Lactate, Alanine
Use for TNF-alpha inhibitors?
rheumatoid arthritis, chron disease
Isopropyl alcohol ingestion signs? Lab?
CNS depsression, disconjugate gaze, absent ciliary reflex
Labs: high osmolar happ, no increased anion gap, no metabolic acidosis
Role of haptoglobin?
binds free hemoglobin and promotes exretion by the reticuloendothelial system
pyoderma gangrenosum?
inglammatory papule/pustule that progresses to painiful olcer
Doagmpse. Treatment?
Ichthosis vulgaris, scaly skil
Treatment: emollients or keratolytics (coal tar, salicyclic acid)
When to use washed platelets?
IgA deficiency
Complement-dependent autoimmune hemolytic anemia
Continued allergic reaction dispite antihistamine
Nummular eczema?
scattered round eczematous plaques on the back and extremities
Where is the mass located in Bartholin glands?
labium majus
Signs of digoxin toxicity
Anorexia, nausea and vomiting, abdominal pain, fatigue, confusion, weakness, color vision alterations
Chronic granulomatous disease- cause?
Oxidative burst defect
enlarging nodule with thicked, rough surface or ulcerated with crusting and bleeding?
squamous cell carcinoma
After diagnosing adenocarcinoma, what should be the next step?
CT to stage
Risks for being sickle cell trait
Isosthenuria (inability to concentrate urine)
hematuria
Characteristic presentation of Grave’s disease?
diffuse goiter and eophthalmopathy (porptosis, periorbital edema, extraocular muscle weakness)
SLE manifestations: physical? Lab?
Constitutional: Fever, fatique, weight loss
Symmetrical, migratory arthritis
butterfly rash & photosensativity
serositis: pleurisy, pericarditis, peritonitis
Lab: low C3/C4 complement levels, ana + (sensitive), dsDNA + and anti-Sm (specific), proteinuria and elevated creatinin (renal involvement)
gamma-glutamyltransferase location?
Liver and other cells
Cause of sickle cell disease?
beta globin gene has a valine in place of a glutamic acid
Cause of renal damage in multiple myeloma?
myeloma cast nephropathy, monoclonal light chains clog the renal tubules
pulmonary, facial edema, hypertension, abnormal urinalysis with proteinuria and microscopic hematuria suggests?
Acute nephritic syndrome with fluid overload
Caridac features on untreate acromegaly?
cardiomyopathy, hypertension, heart failure, valvular disease (mitral and aortic regurgitation)
D-xylose
Tests absorption in the proximal small intestine, tests for celiac disease
Reaction associated with lamotrigine?
Steven-Johnson syndrome
delayed hemolytic blood transfusion reaction?
mild fever, hemolytic anemia
2-10 after transfusion
positive direct coombs test, positive new antibody screen
caused by anamnestic antibody response
Lab findings in DKA?
hyperglycemia (>200), low serum bicardonate (<15), elevated anio gap (>14)
First step in managing a fever in a chemo patient?
Broad spectrum abx
How to reduce the risk of aspiration pneumonia?
elevate the head of the bed
Are c-sections used in chorioamnionitis?
No, not unless fetus is breached
first-like treatment for acute episode of glaucome?
mannitol intravenously
How to diagnose CLL?
monoclonal C cell lymphocytes on flow cytometry
CPY450 induces (decrease warfarin effect)
carbamazepine, phenytoin, genseng, st. john wart, ora contraceptives, phenobarbital, rifampin
Skin findings in carbon monoxide poisoning?
pinkish-red skin hue
Major components exposed to during a house fire?
hydrogen canide, carbon monoxide
X-linked agammaglobulinemia vs common variable immunodeficiency
X-linked agammaglobulinemia contains low B cells, whereas common variable has normal b cell count
Cause of early decelleratoins?
Head compression
Sensitivity
correctly identify people with disease
Accomodative esotropia
strabismus that arisis in children <2, eye deviation when trying to focus on objects
How to diagnose echinococcus granulosus? Treatment
positive serology (sensitivity) and/or ultrasound
Treatment: <5cm albendazole
larger require percutaneous therapy or surgery
Kernig sign
inability to extend kneees > 135 while hip in flexed
Most common coagulopathy in patients with malignancies?
DIC
Breast feeding benefits to the infant
Improved immunity, prevention of otitis media, respiratory illnesses, URI, gastroenteritis, decreased risk of childhood cancer, MD type 1, necrotizing enterocolitis
When does muscular dystrophy present?
Childhood
How to contraol rapid a fib?
beta blockers or CCB
Signs of hypokalemia?
Muscle weakness, paresthesia
Where does the acid in septic shock come from?
LActic acid production in peripheral tissues due to inadquate O2 delivery
Best treatments to reduce COPD symptoms?
inhaled bronchodilators, especially anti-cholinergic medications (ipratroprium, tiotropium)
Familial dysautonomia
autosomal recessive disease in children of Ashkenazi Jewish ancestory Characterized by gross dysfunction of the autonomic nervous system with severe orthostatic HTN
Small bowel overgrowth signs? reatment?
Signs: abdominal pain, diarrhea, bloating, flatulence, malabsorption, weight loss, vitamin deficiency
Treatment: dietary changes (low-carb, high-fat, antibiotics (rifaximin, amox-clau)
Medications that can predispose towards gallstones?
oral contraceptives, ceftriaxone, octreotide
Risk factors for preterm labor?
Prior spontaneous preterm labor (major risk)
multiple gestations, short cervical length, cervical surgery, cigarette use
electromyography diagnoses?
neuropathy, normally done via physical exam
Signs of alcohol poisoing? Labs?
Sympathetic overactivity-tachycarida, elevated blood pressure, restlessness, tremulousness
epigastric tenderness, GI bleeds
Labs: elevated liver enzymes
Long term risk of pagent’s disease?
hearing loss
Pharmacological therapy for cocaine use disorder?
None
Temporal lobe epilepsy vs absence
Temporal lobe- post-ictal stage
Absence- no post ictal stage, children
Treatment target in rheumatoid arthritis?
interleukin-1
IgA vs postinfection glomerulonephritis
IgA - normal serum components, mesangial IgA deposits on kidney biopsy
PIGN=- low C3, elevated anti-streptolycin O and/or anti-DNAse B, kidney biopsy shows subepithelial humps consisting of C3 complement
Follicular thyroid cancer characteristics
invasion fo the tummor capsule and/or blood vessels, metastasize via hemotogenous spread
When to use hypertonic saline?
hyponatremia (<130(_ with coma and seizure (or other severe symptoms)
milk-alkali syndrome
hypercalcemia, renal insufficiency, mentabolic acidosis
Indications for electroconvulsive therapy?
treatment resistance, psychotic heatures, emergency conditions (pregnancy, refusal to eat/draink. imminent risk for suicide
Chron’s disease vs ulcerative cholitis
Chron’s fistulas (transmural inflammation and nonbloody diarrhea
UC- bloody diarrhea and toxic mega colon
Signs of digoxin toxicity?
Diarrhea, nausea, fatiqgue, confusion, weakness
Signs of primary hyperaldosterone? Diagnosis? Managmenet?
hypertension, hypohkalemia alkalosis
diagnosis: elevated plasma aldosterone, best sccreening test is morning plasma aldosterone concentration
Managment: CT scan to determine unilateral or bilater
unilater (adrenalectomy), bilateral (aldosteron antagonists such as spironolactone, eplerenone)
low glucose, elevated protein, nutrophilic pleocytosis in CSF?
acute bacterial meningitis
First step in managment of a subacute cough (<8 weeks) after URI?
anti-histamines
Primary deficiency electrolyte required for energy in refeeding syndrome?
Phosphorus
Signs of epidural abscess?
fever back pain, and/or neurological deficits, and tenderness to palpation of the vertebrae or paraspinal muscles
Treatment for pagent’s disease?
Bisphosphonates
What type of vancomycin in affective again C. Diff
Oral. IV is not excreted in the colon
partially acid-fast gram positive, branching rods?
Norcadia
Comfirmatory test for amyloidosis?
Tissue biopsy, abdominal fat pad
Repeat soft tissue and skin abscesses with a variety of catalase-positive organisms? Diagnostic methods? Organisms?
Chronic granulomatous disease
Diagnostic methods: dihydrorhodamine 123 test, nitroblue tetrazolium text
Organisms: S. Auerus, Serratia, Burkholeria, Aspergillus
What medicaiton should be avoided in acute angle glaucoma?
Atropine (causes dilation of the pupil and worsening of the glaucoma
large ovarian mass with thich septations, solid components, pree peritoneal fluid
malginacy signs, think epithelial ovarian carcinoma
Diagnostic workup for amenorrhea?
FSH (if not breast development)
Pituitary MRI if FSH is decreased
karyotyping if FSH is increased
Trimethoprim-sulfamethoxazole coverage
gram positve and gram negative poor anaerobic
21-hydrozylase deficiency
ambiguous genitalia in girls, salt wasting (vomiting, hypotension, hyponatremia, hyperkalemia)
Course of action when endrometriosis is found incidentally?
Observation
Best diabeted drug if weight gain is desires?
GLP=1 receptor agonists (Exenatide)
Cause of red blood cell casts?
glomerular etiology
How to diagnose PE in pregnanc?
V/Q is first step, followed byy CT angiogram of the chest, if V/Q is abnormal
Rosl factors for pancreatic cancer?
cigarette, smoking, chronic pancreatitis, obesity
cholestyramine -MoA, use?
MoA bile acid-binding resin that reduces LDL
gold-standard for 21 hydroxylase partial deficiency diagnosis?
cosyntropin stimulation test
two sample z test
compare two means, but population variances are employed (not usually known, so rarely used
Most common heart disease with Rheumatic Fever?
Mitral stenosis
How to diagnose Meckel’s diverticulum?
Technetium-99m pertechnetate scan
How to approach someone with body dysmorphic disorder that desires surgery?
Acknowledge the surgery, suggest other treatment that may help
Spinal epidural abscess triad?
fever, focal back pain, neurologic deficits
When does the odds ratio approximately the relative risk?
When the disease is rare
Antibiotics for spinal epidural abscess?
Vancomycin plus ceftriaxone
Recent URI with sudden onset of cardiac failure in otherwise healthy patient
Dilated cardiomyopathy -> secondary to acute viral pericarditis
Masses found in the middle mediastinum?
Bronchogenic cyst (benign), lymphoma, pericardial cysts, tracheal tmors, lymphnode enlargement, aortic aneurysms
Patellofemoral stress syndrome
Overuse injury seen in runners, anterior knee pain that worsen upon descending steps or hills. Pain locatedes to the patella
Statin use
lower cholesterol via 3-OH-3-methylflutaryl coenzyme A
What factors should be avoided in premature atrial contractions?
tobaxxo, alcohol, smoking, caffeine
Polymyositis antibodies?
Anti-Jo-1, ANA
Signs of respiratory failure in asthma? Managment?
decreased pO2 and pH
Increased pCO2
altered mental status, persistent hypoxemia, hypercarbia
Intubation
spirometry for restrictive diseases?
Decreased FEV1, FCV, total lung capacity, normal FEV1:FVC
What are chemotherapy- immunocompromise patients at an increased risk of infection from?
Gram negative organism
Ecthyma gangrenosum organism? Description? Treatment?
Pseudomonas aeruginosa
painless ulcer with black center after bulla reptured
Pathogenesis: bacterial invasion through the media and adventitia of blood vessels
Treatment: antipseudomonal penicillin
Asbestosis increases the risk for what cancers?
Bronchogenic (most common), mesothelioma
Choledocholithiasis means?
Gallstones in the bile duct
Contraindications to trial of labor?
classical c-section, abdominal myomectomy with uterine cavity entery, abdominal myomectome without uterine cavity entry
Congenital signs of rubella?
sensorineural hearing loss, cataracts, PDA
uninary frequency, nocturia, frequent leakage?
urinary overflow
Chagas disease? Signs?
Caused by trypanosoma cruzi
megacolon/megaesophagus (destruction of nerves in smooth muscle) and cardiac disease
Causes of restrictive cardiomyopathy?
amyliodosis, sarcoidosis, hemochromatosis
Signs of chronic pulmonary aspergillosis? Treatment
> 3 months of fever, weight loss, fatigue, cough, hemotpysis, and/or duspnea
Cavitary lesions containing debris, fluid, or an aspergilloma
Positive aspergillus IgG
Treatment: itraconazole, verizonazole, surgery, bronchial arter embolization (sever hemotpysis with extensive disease)
Bluish discoloration of the lips, tongue, nailbeds,tachypnea and diaphoresis while breast feeding? Cause?
Central cyanosis
Cause: congenital heart disease
x-ray findings for bronchogenic carcinoma?
bibasilar reticulonodular ingiltrates, honeycombing (cystic areas surrounded by parechymal fibrosis, pleural plaques
Febrile nonhemolytic transfusion reaction
most common, occurs between 1-6 hours, transient fever, chills, malaise
What does cyanide inhibit?
cytochrome oxidase a3, which binds ferric iron (Fe3+)
Child with viral illness that develops vomiting, delirium, hyperventilation, hepatomegaly likely took?
Aspirin
Heterophile antibodies test for?
Infectious mononucleosis, negative in 25% of the cases during the first week of infection
Hemophilia inheritance pattern?
X-linked recessive
Cutaneous larva migrans? Signs? Treatment?
Hookwork larve from contaminated sand or soil
Intensely pruritic, redish-brown cutaneous tracks,
ivermectin is treatment
What benefits are dound with intensive glycemia control of DM type 2?
Microvascular complications (nephropathy, retinopathy
Diagnosing spontaneous bacterial peritonitis? Treatment?
ascitic fluid neutrophil count >250, cultures are usually negative
Treatment: third generation cephalosporins, fluoroquinolones
Side effects of sulfonylureas?
weight gain, hypoglycemia
unexplained heart failure, proteinuria, easy bruisability, increase ventricular wall thickness with normal left ventricular cavity
amyloidosis
leukocyte alkaline phosophatase score, use?
measure cytochemically normal neutrophils
Anit-hypertensives for pregnancy?
labetalol and methyldopa
Factious disorder vs malingering?
Malingering has an external reward (avoiding work responsibilities)
Inheritance of Fredricks atarix?
Autosomal recessive, GAA expansion, chromosome 9
When to use irradiated blood?
Bone marrow transplant recipients
Acquired of congenital cellular immunodeficiency
blood components donated by first or second degree relatives
Cholinergic agonist treat what type of urinary leakage
neurogenic bladder
Windows for therapeutic thombolytic therapy?
3-4.5 hours
Displacement
Transferring emotions from one object to a safer one
How does lithium cause nephrogenic diabetes insipidus?
induced ADH resistance by impairing water reabsorption in the collecting duct
What is the translocation for CML?
9:22, BCR-ABL
Risk factors for acute urinary retention?
Male, increasing age, history of neurologic disease, BPH, surgery
What cancer produced 1,25 (OF) vitamin D?
lymphoma
If a patient cannot take oxybutinin due to anticholinergic side effects, what pharmacotherapy is available?
mirabegron, a beta33 adrenergic receptor that can relax the bladder
Post-menopausal cancer risk with urinary frequency, pain, bloating, abdominal distention?
Epithelial ovarian cancinoma
Signs of esophageal dysmobility?
Food sticking in throat
Affect of nitrates on preload?
decrease systemic afterload and preload
decreases left ventricular volume
Anticoagulation for transient ischemic attack from thromboembolism in the setting of a flutter?
warfarin or nonvitamin K antagonist oral anticoagulation (Rivaxoaban) (if non-valvular)
Diagnosis? Cause?
pleural plaques, asbestosis
Malrotation X-ray? Treatment?
duodeum abnormally located in the right abdomen, cecum in the left
Treatment: surgical intervention
Managment for meniscus tear?
Minimal limitations and short-term-observation
longer-term or limitation -> MRI consider for surgery
Specificity
rules out a disease
colitis and liver abscess, fever, right upper quandrant pain, smooth cystic subcapsular mass
entamoeba histolytica
How to manage a patient with irregularly irregular, narrow complex tachycardia with fine fibrillatory waves? A fib with RVR that is hemodynamically unstable?
Synchronized cardioversion
Signs of macular degeneration
central vision afftected, distorted vision and central scotoma
Inc. risk from cigarette smokint
Common extrainterstinal symptoms of Chron’s?
uveitis, scleritis, erythema nodosum
Sickle cell trait hemoglobin pattern? Inheritance? Risk?
50-60% hemoglobin A
35-45% hemoglobin S
< 2% hemoglobin F
Autosomal recessive, hematuria
Tumor is the metaphyses of long bones without systemic signs?
tender, soft tissue mass
x-ray shos sunburst pattern, periosteal elevation?
Treatment?
Osteosarcoma
Treatment: surfical excision and chemotherapy
What artery is torn in epidural hematoma?
middle meningeal artery
Signs of cardiac tamponade?
pulse dissappears during inspiration (systolic blood pressure decrease) “pulsus paradoxus”, weakness, dizziness, syncope
Sphincter of Odi dysfunction? Drug causes? Gold standard diagnosis?
dusepisodic right upper quadrant pain, aminotransferase and alkaline phosatase elevations, dilated common bile duct in the absence of stones
Drugs-opiods can cause sphincter contractions
Gold standard: manometry
Delayed transfusion reactions
repeated transfusion with blood that is not properly mached, results in hemolytic anemia, jaundice, lactic acidosis, renal insufficiency, confusion, decreased mental status
Signs of neurofibromatosis type 1?
Cafe–au-lait spots, multiple neurofibromas, lisch nodules, low-grade optic pathway gliomas
Chromosome 17
Contraindications for selective estrogen receptor modulators? Name two.
Taxoxifen, ralocifene
Adverse effects: Hot flashes, venous thromboembolism
endometrial hyperplasia and carcinoma (tamoxifen only)
acute hemolytic blood transfusion reaction
fever, flank pain, hemogloninuria, renal failure, DIC
within 1 hour, positive direct coombvs test, pink plasma
caused by ABO incompatibility
Caues of tubuloinsterstitial nephritis in older woman? Urinalysis findings?
Tubulointerstitial nephritis
WBC casts, proteinuriam impaired urinary concentration
microscopic hematuria and renal colic may follow
Adverse effect of hydroxyurea?
Myelosuppression
diastolic collapse (dfailure of ventricular filling)?
cardiac temponade
Signs of immunity due to natural HBV infection
Hepatitis C surface antibody +
Hepatitis B core antibody + (HBcAb)
Psoriasis characteristics? Treatment/
hyperkeratosis, erythematous plaques with white or silver sclae on the extensor surfaces
Treatment: high dose corticosteroids, cit D derivatives (Calcipotriene)
Skin findings in methemoglobunemia?
Bluish and cyanosis
Chronic granulomatous disease
Diagnosis?
X-linked recessive, recurrent pulmonary and cutaneous infections by catalast positive organisms
Diagnosis: Testing neutrophil function
- dihydrorhodamine 123 test
- nitrovlue tetrazolium test
Multisystem atrophy
- Parkinsonism, autonomic dysfunction, widespread neurological signs
child between 4-10 with hip, groin, knee pain plus antalagic gait?
avascular necrosis
Hazard rate
Chance of an event occuring in one of the study groups during set period
Atomoxetine
norephinephrine reuptake inhibitor used to treat ADHD
Projection
Attributing feelings to someone else
blurred vision, floaters, photopsia (flashing light sensation) in HIV patient with yellow-white, fluffy, exudated adjactent to vasculature
CMV retinitis
If unable to locate a primary tumor but find a lymph node in the neck that is cancerous?
Panendoscopy
Low-grad optic neuromas?
decreased visual acuity, alternation in color vision, optic nerve atrophy, proptosis
Most common disease cause of superior vena cava syndrome?
malignancy, especially small cell, lymphoma
In likely DVT, what is the initial step in managment?
Compression ultrasound
hyposthenuris? Assocations?
impairment in the kidney’s ability to concentrate urine
Associated with sickle cell trait/sickle cell disease
Injuries sustained from blunt abdominal trauam?
Laceration (liver, splenic)
ocular toxoplasmosis?
chorioretinitis (eye pain, decreased vision, lesion in non-vascular distribution
When should an amniotomy be performed?
Getal presenting part is well into the cervix
Fractures, diarrhea, and microcytic anemia?
Celiac disease
Risk when refeeding with inadequate electrolye repletion?
Cardiopulmonary failure
Gold standard for diagnosising placenta previa?
Transabdominal ultrasound
mallory-Weiss tear
incomplete mucosal tear at the gastroesophageal junction, usually due to protracted vomiting
self-limiting hematemesis without pneumomediastinum
ITP
isolated thrombocytopenia with normal hematocrit and leukocyte count
normal fibrinogen and prothrombin time
idioopathic thrombocytopenic purpura
Caused by IgG again megakaryoctye production due to IgG against the platelet membrane glycoproteins
Measles and rubella rash characteristics?
Erythematous macules and papules that start of the face and spread down the the body, fever is concurrent
Bronchial breath sounds are associated with?
pneumonia
