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A2 > Uworld Review > Flashcards

Uworld Review Flashcards

1
Q

What will an SPEP show with multiple myeloma?

A

M-spike

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2
Q

What bone marrow bx finding is diagnostic of multiple myeloma?

A

More than 10% clonal plasma cells

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3
Q

What are the bone marrow bx findings of aplastic anemia?

A

Hypoplastic fat-filled marrow

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4
Q

What are the six steps of asthma pharmacotherapy (increasing in severity)?

A
  1. SABA only
  2. SABA + low dose ICS
  3. LABA + low dose ICS
  4. LABA and medium dose ICS
  5. High dose ICS + LABA
  6. High dose ICS + LABA + oral corticosteroid
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5
Q

How many nighttime awakenings and daytime symptoms classify mild, intermittent asthma?

A

Less than 2 /day and 2 nights / month

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6
Q

What are the classic EEG findings of prion diseases?

A

Intermittent sharp waves

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7
Q

What are the classic s/sx of prion disease?

A

Rapidly progressing dementia with myoclonus

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8
Q

What is malignant otitis externa, and what is the treatment (drug and route)?

A

Severe infection of the external auditory canal, caused by pseudomonas.

IV ciprofloxacin

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9
Q

What is the pathophysiology of pemphigus vulgaris and bullous pemphigoid?

A

Pemphigus vulgaris = abs against hemidesmosomes

BUllous pemphigoid = abs against desmosomes

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10
Q

What is the treatment for refractory ITP?

A

Splenectomy

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11
Q

When is IVIG indicated for the treatment of ITP?

A

Newly diagnosed with severe bleeding

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12
Q

What is the goal platelet count when treating ITP?

A

over 30,000

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13
Q

What is the MOA and route of Liraglutide?

A

Injectable GLP-1 agonist

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14
Q

What is the MOA and route of sitagliptin?

A

DPP-4 inhibitor

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15
Q

What drugs should be acoided in pts with a h/o intracranial hemorrhage?

A

Nitrates because may increased ICP and risk another rupture

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16
Q

What are the CSF findings of Guillain-barre syndrome? What is the term for this/what does it mean?

A

Elevation in CSF proteins, without elevation in WBC count

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17
Q

What are the two major side effects of cimetidine?

A

Pancytopenia and renal failure

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18
Q

When does autism screening begin?

A

at 18 months and 2 years

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19
Q

How many wet diapers a day is common in a neonate? Stools?

A

8 wet diapers

2 stools

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20
Q

Under what age should a child never receive straight cow’s milk? Why?

A
  • Under 12 months
  • Infants do not tolerate the protein mixture of unaltered cow’s milk and may develop colitis, causing microscopic bleeding and gradually worsening anemia.
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21
Q

Most babies lose a little weight right after birth, then may regain their birth weight as early as 1 week of age, but are definitely expected to have regained their birth weight by when?

A

2 weeks

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22
Q

What type of testicular cancer produces beta hCG?

A

Seminomas and choriocarcinomas

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23
Q

What type of testicular cancers produce afp?

A

Choriocarcinomas

embryonal cell carcinomas

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24
Q

What type of testicular cancers produces LDH?

A

Seminomas

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25
Q

Prolongation of life in pts with CHF has been documented with which 5 medications?

A 
ACEIs
ARBs
Beta blockers
Aldosterone antagonists (spironolactone)
Hydralazine + nitrate
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26
Q

Strokes to the left superior middle cerebral artery lead to what language problems?

A

Brocas

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27
Q

Strokes to the left inferior middle cerebral artery lead to what language problems?

A

Wernicke’s

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28
Q

What happens to renin activity with diuretic use?

A

Increased since the kidney is seeing too much volume being wasted

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29
Q

What is the aldosterone escape seen in Conn syndrome?

A

Aldosterone initially induces sodium and water retention; this is followed within a few days by a spontaneous diuresis, which returns excretion to the level of intake and partially lowers the extracellular fluid volume toward normal.

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30
Q

What is the effect of beta blockers on bg levels?

A

Decreases, since blocks the breakdown of glycogen to glucose

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31
Q

Squamous cell bladder cancer in an immigrant means infection with what?

A

Schistosoma haematobium

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32
Q

What is the treatment for schistosoma?

A

Praziquantel and prednisone

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33
Q

Why is there pain at the end of urination with a schistosoma infection?

A

Extrusion of eggs

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34
Q

What is the PaO2 / FiO2 ratio for ards?

A

Less than or equal to 300

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35
Q

What are light’s criteria for diagnosing an exudative pleural effusion?

A
  1. if pleural fluid protein / serum protein is over 0.5
  2. If pleural LDH / serum LDH is over 0.6
  3. if pleural LDH is over 2/3 normal
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36
Q

What is the imaging test of choice to diagnose an aortic dissection in a hemodynamically unstable pt?

A

US

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37
Q

What is the treatment for symptomatic coccidioidomycosis localized to the lungs in an immunocompromised pt?

A

Oral fluconazole x 12 months

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38
Q

Which s/sx of Grave’s disease is not usually seen in young pts?

A

Pretibial myxedema

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39
Q

What is the recommended screening test for adrenal insufficiency?

A

Cosyntropin stimulation test

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40
Q

What is the first step in treatment of acute lung rejection after stabilization?

A

Bx of the bronchi to r/o CMV and/or other infectious causes of lung disease

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41
Q

What is the order of drugs that should be tried with symptomatic bradycardia?

A 
Atropine
Transcutaneous pacing
Dopamine
Epi
Isoproterenol

(“All Trained Dogs Eat Iams”)

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42
Q

What drug should be avoided in pts with an inferior MI (RV)?

A

Nitro

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43
Q

What are the antibodies associated with primary biliary cirrhosis?

A

Antimitochondrial antibodies

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44
Q

What are the antibodies associated with autoimmune hepatitis?

A

Antismooth muscle antibodies

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45
Q

What are the antibodies associated with primary sclerosing cholangitis?

A

p-ANCA

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46
Q

With what comorbidities is indomethacin contraindicated for the treatment of an acute gout flare?What is used instead?

A

Renal failure of GI bleeds

Colchicine

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47
Q

What electrolyte abnormality is common with Amp B useage?

A

Hypokalemia (type I RTA)

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48
Q

How many weeks post tick bite are ELISA testing unreliable for Lyme disease?

A

2 weeks or less

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49
Q

What is the first line agent for treating cardiogenic shock in the setting of an acute MI?

A

Norepi

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50
Q

What is the metyrapone stimulation test?

A

Metyrapone blocks the last step in the synthesis of cortisol at the level of the adrenal gland, and induces a rapid fall of serum levels, which normally leads to increases in ACTH secretion. In pts with tertiary AI, metyrapone stimulation fails to produce a rise in ACTH levels

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51
Q

What is the most sensitive radiographic sign of hyperparathyroidism?

A

Subperiosteal bone resorption of the phalanges

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52
Q

What is the difference between hyperparathyroidism 2/2 primary disease vs renal disease in terms of phosphate levels?

A

Primary = depressed

Renal disease = elevated

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53
Q

What is the treatment for IgA nephropathy?

A

ACEIs

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54
Q

What is the treatment for Goodpasture syndrome?

A

Plasmapheresis to reduce abs

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55
Q

What are the muscle bx findings of inclusion body myositis?

A

beta-amyloid deposits

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56
Q

What is always true in polymyositis that is not always true of dermatomyositis and inclusion body myositis?

A

CK is elevated in polymyositis

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57
Q

What is the drug of choice in treating cysteine renal stones?

A

Penicillamine

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58
Q

What are the amino acids that cannot be reabsorbed in cystinuria?

A

Cystine
Ornithine
Arginine
Lysine

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59
Q

What is the prophylactic treatment for preventing uric acid renal stones?

A

Allopurinol

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60
Q

What is the immunostaining pattern on renal bx associated with Alport syndrome?

A

Basketweave appearance (splitting of the lamina densa of the glomerular BM)

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61
Q

What is the inheritance pattern of Alport syndrome?

A

XLR

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62
Q

What is the classic triad of symptoms of Alport syndrome?

A

Sensorineural hearing loss
Nephritis
anterior lenticonus

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63
Q

What type of diuretics can increase the chances of uric acid stones?

A

Loop

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64
Q

What is the treatment for disseminated cryptococcus neoformans?

A

Amp B + 5FU

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65
Q

How often should pts with UC have a colonoscopy?

A

1-3 years

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66
Q

What is the marker for following recurrence of: colon cancer

A

CEA

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67
Q

What is the marker for following recurrence of: hepatocellular carcinoma

A

alpha-fetoprotein

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68
Q

What is the marker for following recurrence of: Ovarian cancer?

A

CA-125

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69
Q

What is the marker for following recurrence of: hCG

A

Gestational trophoblast disease and germ cell tumors

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70
Q

What is the drug for prophylaxis of cystinuria? MOA? Side effect?

A

potassium bicarb–alkalinization of the urine increases solubility of cystine

This, however, increases the risk for Ca stones

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71
Q

What comorbid condition may increase the likelihood of lactic acidosis in a pt taking metformin?

A

HF

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72
Q

What comorbidity increases the disease severity of RA?

A

Smoking

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73
Q

What is the amount of protein lost in the urine with nephrotic syndromes?

A

over 3 g / day

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74
Q

Loss of protein S and C with nephrotic syndrome leads to what hemodynamic change?

A

Hypercoagulability

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75
Q

What is the classic side effect of ethambutol?

A

Optic neuritis

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76
Q

What is the classic pentad of TTP?

A
  • hemolytic anemia
  • thrombocytopenic purpura
  • neurological abnormalities
  • Fever
  • renal disease
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77
Q

What hemodynamic changes occur with OSA?

A

During apneic episodes, increased negative internal thoracic pressure increases LV afterload, and adversely affecting LV function

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78
Q

What are the two labs that are elevated with diamond blackfan anemia?

A

Hb F

Erythrocyte adenosine deaminase (eADA)

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79
Q

What is the inheritance pattern of diamond blackfan anemia?

A

AD

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80
Q

What type of anemia is Diamond blackfan anemia (macro/normo/microcytic)

A

Normocytic to macrocytic

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81
Q

What is the drug of choice for postsplenectomy sepsis?

A

Levaquin

82
Q

What is the indication for a splenectomy in a pt with ITP?

A

Failure with medical therapy for 6 weeks

83
Q

What are the histological characteristics of mycosis fungoides?

A

Clusters of atypical lymphocytes (pautrier’s abscesses) aligned along the basal layer and epidermal microabscesses with normal dermis

84
Q

What are the two most important risk factors for SAH?

A

Smoking and HTN

85
Q

What causes pulmonary edema in the setting of SAH?

A

Increased intracranial pressure and severe over-activation of the SNS

86
Q

What is the treatment for bacillary angiomatosis (caused by bartonella henselae)?

A

Erythromycin

87
Q

What is the treatment for strongyloides infection?

A

Ivermectin

88
Q

What is the treatment for onchocerciasis?

A

Ivermectin

89
Q

What is the causative agent of spelunker’s disease? Treatment?

A

Histoplasma

Itraconazole

90
Q

What is a major environmental risk factor for developing an acoustic neuroma?

A

Chronic exposure to loud noises

91
Q

What are the s/sx of gastroparesis 2/2 DM?

A

Postprandial n/v, fullness, and lightheadedness (from hypoglycemia)

92
Q

Which class of abx is classically nephrotoxic?

A

Aminoglycosides

93
Q

What is the technical definition of infertility?

A

Inability to conceive after 12 months of unprotected sex

94
Q

What is the difference between primary and secondary infertility?

A

Primary = never had kids before

95
Q

What is the technique used to detect congenital anomalies of the uterus?

A

Hysterosalpingogram

96
Q

What is the treatment for infertility 2/2 hypogonadism in women?

A

Clomiphene

97
Q

Where is the mass with a bartholin’s cyst?

A

Mass at the medial labia majora or lower vestibular area on PE

98
Q

What is the treatment for symptomatic and asymptomatic bartholin cysts?

A 
Asymptomatic = warm soaks
Abscess = I+D
99
Q

When are abx indicated in the treatment of a bartholin gland abscess?

A

Only if cellulitis or STI present

100
Q

True or false: BV is an infx

A

False-shift in vaginal flora

101
Q

What are the risk factors for:

  • BV
  • Trichomonas
  • Yeast infx
A
  • BV = Douching, female sexual partner, pregnancies
  • Trich = unprotected sex
  • Yeast = DM, abx use, prego, steroids
102
Q

What are the s/sx of:

  • BV
  • Trich
  • Yeast
A
  • BV = smelly
  • trich = d/c pruritus, dysuria
  • Yeast = pruritus
103
Q

Which cause of vaginitis will produce a positive whiff test?

A

BV

104
Q

What is the treatment for BV?

A

Vaginal metronidazole or clindamycin

105
Q

What is the treatment for trichomonas?

A

Metronidazole or tinidazole

106
Q

What is the treatment for a vaginal yeast infx?

A

Topical azole or fluconazole

107
Q

What is the normal vaginal d/c for the midcycle estrogen surge?

A

Clear, elastic mucoid secretion

108
Q

What is the normal vaginal d/c for the luteal phase/pregnancy?

A

Thick and white secretions that adhere to the vaginal wall

109
Q

What are the four diagnostic criteria for the dx of BV? How many are needed?

A 
(three of four are required): 
■ Abnormal whitish-gray discharge 
■ Vaginal pH > 4.5 
■ ⊕ amine (whiff) test 
■ Clue cells comprise > 20% of epithelial cells on wet mount
110
Q

What are the four most common causes of cervicitis?

A
  • GC/Chlamydia
  • Trich
  • HSV
111
Q

What are the s/sx of cervicitis?

A

Yellow-green d/c with CMT

112
Q

What are the characteristics of the ulcer with haemophilus ducreyi?

A

Deep, painful ulcer with irregular borders

113
Q

True or false: smoking increases the risk of PID

A

True

114
Q

What are the s/sx of PID?

A
  • lower abdominal pain
  • f/c
  • Menstrual disturbances
  • Purulent cervical d/c
115
Q

What is relative positive and negative predictive value of leukocytosis in the diagnosis of PID?

A

Low for both

116
Q

What are the components of the A ROPE mnemonic for causes of abdominal pain?

A 
Appendicitis
Ruptured ovarian cyst
Ovarian torsion
PID
Ectopic pregnancy
117
Q

What is the treatment for PID?

A

Ceftriaxone IM OR cefoxitin + probenecid plus doxycycline

118
Q

What is the surgical treatment for PID?

A

Drainage of a tubo ovarian/pelvic abscess or TAH/BSO if severe

119
Q

What are the s/sx of fitz-hugh-curtis syndrome?

A
  • RUQ pain
  • Perihepatitis
  • elevated LFTs
120
Q

What is the toxin that causes toxic shock syndrome?

A

TSST-1

121
Q

How does toxic shock syndrome present?

A

■ Presents with abrupt onset of fever, vomiting, and watery diarrhea.
■ A diffuse macular erythematous rash is also seen.
■ Nonpurulent conjunctivitis is common.
■ Desquamation, especially of the palms and soles, generally occurs during recovery within 1–2 weeks of illness.

122
Q

What is the treatment for toxic shock syndrome?

A 
Rapid rehydration
Empiric abx (clindamycin + vanco)
123
Q

What are the s/sx of leydig cell tumors?

A

Increased aromatase expression leading to increased estrogen production, and inhibited LH/FSH

124
Q

What serum marker is found with choriocarcinomas?

A

beta-hCG

125
Q

What serum marker(s) is/are found with teratomas?

A

Either AFP or beta-hCG

126
Q

What serum marker(s) is/are found with seminomas?

A

None usual,y, but sometimes beta-hCG

127
Q

What serum marker(s) is/are found with yolk sac tumors?

A

AFP

128
Q

What is the treatment for Hep C infection for people who cannot afford a cure?

A

Vaccination with HAV, HBV, and avoidance of EtOH

129
Q

What are the classic skin manifestations of leprosy?

A

Chronic, anesthetic, macular, hypopigmented skin lesions with raise, well demarcated borders. Nearby nerves become nodular and tender, with resultant loss of sensation.

130
Q

How do you diagnose leprosy?

A

Skin bx

131
Q

What is the treatment for leprosy?

A

Dapsone and rifampin

132
Q

What are the histological findings of Crohn’s disease?

A

noncaseating granulomas

133
Q

Which has pseudopolyps: CD or UC

A

UC

134
Q

What is the drug of choice for treating mastitis in breastfeeding mothers?

A

Dicloxacillin

135
Q

What is the major side effect of TMP-SMX in pregnant women?

A

bilirubin is displaced from albumin, and may cause kernicterus

136
Q

What is a major side effect of azoles?

A

Inhibition of p450s

137
Q

How is phenytoin metabolized

A

p450 system

138
Q

What is the first line treatment for vaginal candidiasis?

A

Oral fluconazole

139
Q

What is cervical insufficiency?

A

Painless cervical changes that occur in the 2nd trimester and result in recurrent pregnancy loss

140
Q

What are the most common causes of intrauterine demise in the first, second, and third trimester?

A 
First = chromosomal abnormalities
Second = cervical insufficiency
Third = placental/cord complications and infx
141
Q

What is cerclage performed?

A

2nd trimester

142
Q

What is the effect of OCPs on maternal physiology?

A

Inhibition of mid-cycle LH surge 2/2 estrogen inhibition

143
Q

What type of ovarian cancer may lead to virilization?

A

Sertoli-leydig cell tumors

144
Q

Granulosa cell tumors secrete what type of hormone?

A

Estrogen

145
Q

What amount of weight gain is normal for a at-weight pregnant woman?

A

25-35 pounds

146
Q

What is the mainstay of treatment for sheehan syndrome?

A

Glucocorticoids

147
Q

How long after exposure to varicella in a pregnant woman is IVIG able to be given?

A

96 hours

148
Q

What is the treatment for a pregnant woman who has never had varicella before, who is recently exposed to it?

A

If less than 96 hours since exposure, then IVIG

IV acyclovir otherwise

149
Q

Is warfarin a contraindication to breast feeding?

A

No

150
Q

Fetal accelerations of how many BPM are reassuring?

A

Between 120-160 with 15-25 bpm variability

151
Q

What are the indications for an amnioinfusion?

A

Repetitive decelerations and treatment of chorioamnionitis

152
Q

What are the only two safe oral DM meds in pregnancy?

A

Metformin

Glyburide

153
Q

What is the technical definition of a terminal illness?

A

Less than 6 months to live

154
Q

What stage of labor is oxytocin given?

A

Stage I, active

155
Q

What is the latent stage of labor?

A

Start of contractions to 6 cm dilation

156
Q

What is the pharmacologic therapy for DUB that causes hemodynamic instability (after they’re stabilized)? Why?

A
  • High dose IV estrogen

- Decreases bleeding by promoting rapid regrowth of the endometrium over the denuded epithelial surface

157
Q

Why is progesterone not given in cases of excessive DUB?

A

Progestins inhibit the synthesis of estrogen receptors and increase estradiol dehydrogenase

158
Q

Is fertility preserved after uterine artery embolization?

A

yes

159
Q

When is external cephalic version offered to women?

A

After 36 weeks gestation

160
Q

What is the treatment for patellofemoral pain syndrome?

A

Quad strengthening

161
Q

What is the Kleihauer–Betke test?

A

a blood test used to measure the amount of fetal hemoglobin transferred from a fetus to a mother’s bloodstream. It is usually performed on Rh-negative mothers to determine the required dose of Rho(D) immune globulin (RhIg) to inhibit formation of Rh antibodies in the mother and prevent Rh disease in future Rh-positive children

162
Q

What tests should be ordered after a pregnancy loss?

A

Antiphospholipid antibody syndrome

Fetomaternal hemorrhage if appropriate

163
Q

What are the signs of feta; hydantoin syndrome?

A

Microcephaly
Midface hypoplasia
cleft lip/palate
digital hypoplasia

164
Q

CKD causes hyper or hypocalemia? Why?

A

Hypo since decreased production of 1,25-vit D

165
Q

When does gait disturbance appear with NPH: early or late in the disease course?

A

Early and most prominent symptom

166
Q

What parts of the brain are most affected with NPH?

A

Subcortical and frontal (thus apraxia and agnosia are uncommon)

167
Q

Which knee injury usually presents with hemarthrosis: ACL tears or MCL tears?

A

ACL; rarely MCL

168
Q

True or false: polymyositis is usually painless

A

true

169
Q

What is the recommended screening process for HIV per the USPSTF?

A

Once in ages 15-65

170
Q

What is the current HIV screening test?

A

-24 antigen and HIV abs

171
Q

What are the abx to give to cases of suspected bacterial meningitis? (3) Why these?

A

Cefepime-most bacterial
Vanco-resistant strep
Ampicillin-covers listeria

172
Q

What is the abx of choice for listeria meningitis?

A

Ampicillin

173
Q

How do you calculate risk?

A

number of people exposed and with disease, over total exposed

174
Q

What are the criteria for getting home oxygen therapy?

A

Resting PaO2 less than or = to 55 mmHg

O2 sat less than or equal to 88%

175
Q

If a female has trich, do you need to test the male partner for trich prior to treating them? Why or why not?

A

No, since extremely likely they have it, and hard to get a good sample–just treat

176
Q

What lab value is abnormal with antiphospholipid antibody syndrome?

A

Prolonged PTT

177
Q

What is the diagnostic imaging modality of choice for a pt with an aortic dissection that has renal failure?

A

TEE

178
Q

Is the following characteristic more suggestive of conus medullaris syndrome, or cauda equina syndrome: radicular pain?

A

Cauda equina

179
Q

Is the following characteristic more suggestive of conus medullaris syndrome, or cauda equina syndrome: Sudden onset back pain

A

conus medullaris

180
Q

Is the following characteristic more suggestive of conus medullaris syndrome, or cauda equina syndrome: Saddle hypo/anesthesia

A

Cauda equina

181
Q

Is the following characteristic more suggestive of conus medullaris syndrome, or cauda equina syndrome: Perianal hypo/anesthesia

A

Conus medullaris

182
Q

Is the following characteristic more suggestive of conus medullaris syndrome, or cauda equina syndrome: Asymmetric motor weakness

A

cauda equina

183
Q

Is the following characteristic more suggestive of conus medullaris syndrome, or cauda equina syndrome: symmetric motor weakness

A

Conus medullaris

184
Q

Is the following characteristic more suggestive of conus medullaris syndrome, or cauda equina syndrome: Hypo or areflexia

A

Cauda equina

185
Q

Is the following characteristic more suggestive of conus medullaris syndrome, or cauda equina syndrome: Hyperreflexia

A

Conus medullaris

186
Q

Is the following characteristic more suggestive of conus medullaris syndrome, or cauda equina syndrome: Late onset bowel/bladder dysfunction

A

Cauda equina

187
Q

Is the following characteristic more suggestive of conus medullaris syndrome, or cauda equina syndrome: Early onset bowel/bladder dysfunction

A

Conus medullaris

188
Q

Which anti TB drug is associated with hepatitis?

A

All are, but INH in particular

189
Q

True or false: even with only mild elevations in LFTs from INH therapy, INH should be stopped for second line TB therapy

A

False

190
Q

True or false: oral ulcers and elevated ESR are common in celiac disease

A

False

191
Q

What does the body maintain first: volume status, or electrolyte status?

A

Volume

192
Q

High ADH and urine Na are characteristic of what disorder?

A

SIADH

193
Q

Low ADH and urine Na are characteristic of what disorder?

A

DI

194
Q

What are the two ways ADH can be stimulated?

A

Hypotonic

ANG II

195
Q

How long does it take for gout to flare completely?

A

12-24 hours

196
Q

True or false: trauma/surgery can precipitate a gout attack

A

True

197
Q

Pts with Chronic lymphocytic (Hashimoto’s) thyroiditis are at an increased risk for what malignancy?

A

Thyroid lymphoma

198
Q

What is the typical presentation of thyroid lymphoma?

A

Rapidly enlarging thyroid with compressive symptoms

Systemic B symptoms

199
Q

What causes the facial cyanosis when adducting a pts arms with thyroid lymphoma?

A

Compression of the subclavian vein against the thyroid

200
Q

What is the typical presentation of Subacute (de Quervain’s) thyroiditis?

A

Follows a recent viral infx
Painful goiter
Fever

A2 (26 decks)

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