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OBGYN > Uworld step 2 > Flashcards

Uworld step 2 Flashcards

1
Q

Medical treatment of urge incontinence

A

Oxybutinin (antimuscarinic)

Mirabegron (beta 3 agonist)

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2
Q

How do you diagnose VUR in children?

A

Renal US: hydro

Voiding cystourethrogram: ureteral filling and dilated collecting system

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3
Q

Complication of untreated VUR

A

renal scarring and CKD

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4
Q

treatment of myasthenia crisis

A

intubation if can’t breathe, IVIG w/ plasmaphoresis or corticosteroids.

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5
Q

hemodynamic changes in mitral stenosis

A

increased systolic and diastolic pulmonary artery pressures, normal LV diastolic pressure, enlarged RA.

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6
Q

RTA type 1

A

DCT fails to secrete H+ into urine
urine pH > 5.5
hypokalemia

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7
Q

what nerve deficits will you see in a Colle’s fracture

A

Fracture of distal radius –> median n
Carpal tunnel like
loss of innervation to opponents policies and abductor policies brevis.

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8
Q

how does acute ischemic stroke present in children under 6?

A

headache, altered mental status, non localizing symptoms, generalized or focal seizures.

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9
Q

what is the best way to diagnose acute ischemic stroke

A

MRI with MR angio

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10
Q

Clinical features of DiGeorge

A 
C: conotruncal cardiac defects
A: abnormal facies
T: Thymus aplasia
C: craniofacial deformalities
H: hypocalcemia/hypoparathyroidism
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11
Q

symptoms of Choanal atresia

A

turning blue with feeds
noisy breathing
can’t pass catheter past nasopharynx

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12
Q

how do you confirm choanal atresia

A

CT scan or nasal endoscopy

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13
Q

Treatment of choanal atresia

A

oral airway then surgical repair

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14
Q

sjorgens syndrome increases your risk for what type of cancer

A

non-hodgkin lymphoma

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15
Q

homocystinuria

A 
marfinoid body habitus
stretchy skin
scoliosis
intellectual disability
downward lens dislocation
megablastic anemia
AR
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16
Q

Fabrys disease (a-galactosidase)

A

angiokeratomas, peripheral neuropathy, asymptomatic corneal dystrophy

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17
Q

Krabbe disease

A

lysosomal storage disorder.
galactocerebrosidase deficiency
intellectual disability, blindness, deafness, neuropathy, seizures.

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18
Q

treatment of mild ulcerative colitis

A

5-ASA (mesalamine, sulfasalazine)

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19
Q

Giant cell tumor of bone

A

Xray- eccentric lytic lesion

epiphysis of long bones

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20
Q

sequela of OSA

A

erectile dysfunction and arterial HTN

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21
Q

when is surgical decompression recommended for cerebellar hemorrhage

A

> 3 cm
neurologic deterioration
brainstem compression, obstructive hydrocephalus.

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22
Q

what patients is carboprost contraindicated in and why?

A

can cause bronchial spasm so don’t give to people with asthma

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23
Q

first line treatment for uterine atony

A

uterine massage
oxytocin
tranexamic acid

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24
Q

first step management of acute limb ischemia

A

anticoagulant (heparin)

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25
Q

what bug usually causes onychomycosis (thickening of the nails)?

A

Trichophyton rubrum

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26
Q

first line treatment of onychomycosis

A

terbinafine or itraconazole

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27
Q

RV enlargement causes what

A

tricuspid annular dilation and tethering of chordae tendonae which leads to tricuspid regurg

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28
Q

how does duodenal atresia present on US

A

double bubble: fluid filled stomach and dilated duodenum

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29
Q

most likely cause of empyema

A
  1. oral anaerobic bacteria

2. strep pneumo or staph aureus

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30
Q

management of empyema

A

chest tube drainage
intra pleural fibrolytic drugs (tPa)
surgical decortication

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31
Q

symptoms of splenic sequestration crisis

A

LUQ pain, pallor, flow murmur, splenomegaly

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32
Q

lab findings of splenic sequestration crisis

A

increased reticulocytes, thrombocytopenia, normocytic anemia.

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33
Q

how can you diagnose lumbar stenosis

A

MRI of spine

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34
Q

posture dependent symptoms of lumbar stenosis

A

made worse by extension (standing, walking upright), better with flexion (leaning forward, walking uphill).

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35
Q

first line treatment for idiopathic intracranial HTN

A

acetazolamide

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36
Q

X ray finding of rickets

A

metaphysial widening with cupping and fraying, costochondral joint widening

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37
Q

presentation of peritonsillar abscess

A

hot potato voice, can’t open mouth fully due to inflammation of pterygoid muscles, dysphasia, unilateral swelling of soft palate with uvula deviation.

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38
Q

how do you treat osteomyelitis in a child with sickle cell?

A

Clindamycin (staph) and 3rd gen cephalosporin (salmonella)

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39
Q

symptoms of mycoplasma pneumonia

A

indolent headache, fatigue, cough, rash, pharyngitis

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40
Q

treatment of H pylori

A

amoxicillin, clarithromycin, PPI

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41
Q

risk factors for amniotic fluid embolism

A 
advanced age
>5 births
C section or instrumental delivery
placenta previa or abruption
preeclampsia
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42
Q

Clinical presentation of amniotic fluid embolism

A

shock
hyperemic respiratory failure
DIC
Coma, seizures

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43
Q

management of amniotic fluid embolism

A

intubate, vasopressors, transfusions to correct DIC

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44
Q

symptoms of neuroblastoma

A 
median age <2
abdominal mass
periorbital ecchymosis 
spinal cord compression from epidural invasion
opsoclonus-myoclonus syndrome
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45
Q

echo findings of infants with hypertrophic cardiomyopathy

A

increased thickness of inter ventricular septum, decreased LV chamber size

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46
Q

treatment of hypertrophic cardiomyopathy in infants

A

IV fluids and beta blockers to increase LV blood volume.

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47
Q

what complication can occur several months after a STEMI

A

ventricular aneurysm

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48
Q

risk factors for MS

A 
low vit D
female, white
cold climate
smoking
EBV
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49
Q

late onset vit K deficiency bleeding

A

occurs between 2-6 weeks old.

increased ICP, obstructive hydrocephalus, budging fontanelle

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50
Q

treatment of impetigo

A

localized: topical muproprion
extensive: oral cephalexin

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51
Q

indications for external cephalic version

A

breach/transverse presentation at

> or equal to 37 weeks

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52
Q

treatment of anal fissures

A

stool softeners, sitz baths, high fiber diet, topical anesthetics and vasodilators (nifedipine, nitro)

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53
Q

sialadeuosis is most common in which patients

A

alcoholics, bulimics, malnuroished, can also be from diabetes.

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54
Q

management of complicated diverticulitis with abscess

A

<3 cm–> IV antibiotics and bowel rest

>3cm–> percutaneous drainage via CT guidance, if symptoms persist a few days then surgical debridement.

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55
Q

pulmonary stenosis murmur

A

harsh, crescendo-deconcendro systolic murmur over the left upper sternal border.

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56
Q

what’s the most common arrhythmia responsible for sudden cardiac arrest in acute MI?

A

ventricular arrhythmias

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57
Q

symptoms of laryngalmalacia

A

inspiratory stridor that worsens when supine, peak age 4-8 months

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58
Q

symptoms of hereditary hemorrhagic telangiectasia

A 
recurrent nose bleeds
hemoptysis due to AVM formation in lung
Iron deficient anemia due to GI bleed
pulmonary bruit
high output heart failure
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59
Q

what’s the most common stroke syndrome caused by a lacunar stroke

A

pure motor hemiparesis

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60
Q

symptoms of rotator cuff tendinopathy

A

pain with abduction and external rotation (over head)

strength is normal

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61
Q

symptoms of rotator cuff tear

A

pain with abduction or external rotation

weaknesss

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62
Q

symptoms of adhesive capsulitis

A

decreased passive and active shoulder ROM

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63
Q

symptoms of AC joint sprain

A

pain over AC joint

passive shoulder adduction causes pain

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64
Q

symptoms of biceps tendinopathy

A

pain over bicipital groove

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65
Q

most common cause of concentric LV hypertrophy

A

chronic HTN

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66
Q

risk factors for acute urinary retention

A 
male
old
history of BPH
recent surgery 
history of neurologic disease
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67
Q

how do you treat pyelonephritis in pregnancy

A

PCN, cephalosporins, fosfomycin.

Once infection is cleared, they need prophylactic cephlahexin or nitrofurantoin the rest of the pregnancy.

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68
Q

diagnostic test for pts with renal insufficiency or hemodynamic instability with suspected aortic dissection

A

trans esophageal echo

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69
Q

diagnostic test for pts with suspected aortic dissection that are stable

A

CT angio

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70
Q

diagnostic test for secondary polycythemia

A

abdominal CT scan looking for renal or hepatic tumors

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71
Q

first line treatment for chemo induced nausea

A

5-HT3 receptor antagonists (ondansetron)

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72
Q

what medications can cause methemoglobinemia

A

topical anesthetics (benzocaine), dapsone, nitrates (in infants)

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73
Q

Symptoms of ALS

A

dysphagia, dysarthria, tongue atrophy and fasciculation’s, diaphragmatic weakness leading to paradoxical breathing and elevated diaphragm.

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74
Q

PFT results of ALS

A

decreased FVC
decreased maximal inspiratory pressure
normal diffusing capacity

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75
Q

treatment of postpartum endometritis

A

clindamycin and gentamicin

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76
Q

risk factors for calciphylaxis

A

ESRD
hypercalcemia, hyperphosphatemia
hyperparathyroidism
oral anticoagulants (warfarin)

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77
Q

how do you diagnose legg-calve-perthes

A

Xray (early on may not show anything)

MRI (avascular femoral head)

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78
Q

Classic congenital adrenal hyperplasia is due to what

A

decreased 21 hydroxylase

results in increase in 17- hydroxyprogesterone

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79
Q

symptoms of CAH

A

dehydration and salt wasting –> hypotension, hyponatremia, hyperkalemia.

visualization in female infants

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80
Q

what is the monoclonal antibody in waldenstorm macroglobulinemia

A

IgM

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81
Q

what is the monoclonal antibody in multiple myeloma

A

IgG and IgA

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82
Q

symptoms of beta blocker toxicity

A

hypotension, bradycardia, bronchospasm, AMS, seizure, hypoglycemia

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83
Q

management of beta blocker overdose

A

IV fluid bolus
IV glucagon
IV atropine

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84
Q

in addition to glucocorticoids, how else should you manage polymyositis

A

age appropriate cancer screenings.

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85
Q

how can you diagnose postcholesectomy syndrome

A

ERCP or MRCP

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86
Q

how would a fractured clavicle or humerus present in shoulder dystocia

A

crepitus/bony irregularity
decreased moro reflex on affected side due to pain
intact biceps and grasp reflex

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87
Q

how does klumpke palsy present

A

claw hand
horners syndrome
intact moro and biceps reflexes

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88
Q

what nerves are damaged in klumpkes

A

8th cervical nerve and T1

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89
Q

how does TB meningitis look on imaging

A

bibasilar meningeal enhancement

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90
Q

leriche syndrome

A
  • b/l hip, thigh, and butt claudication
  • absent or diminished femoral pulses
  • impotence
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91
Q

lab findings in alports

A

UA: + protein, RBC, RBC casts
serum: normal C3/C4, increased creatinine

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92
Q

lab findings in post infectious glomerularnephritis

A

UA: + protein, RBC, RBC casts
Serum: decreased C3 and CH50, decreased or normal C4, increased creatinine

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93
Q

what organism is most likely responsible for Erysipelas

A

strep pyogenes

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94
Q

management of NEC

A

NPO, IVF, broad spectrum antibiotics, blood culture

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95
Q

symptoms of renal cell carcinoma

A

hematuria, flank pain, palpable flank mass, left sided varicoceles, paraneoplastic symptoms (anemia or erythrocytosis, thrombocytosis, fever, hypercalcemia, cachexia)

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96
Q

what should be given to patients with varies to decrease risk of hemorrhage

A

nonselective beta blocker

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97
Q

risk factors for abdominal compartment syndrome

A

massive fluid resuscitation, major intra-abdominal surgery

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98
Q

symptoms of abdominal compartment syndrome

A

distende abdomen, hypotension, tachycardia, increased vent requirements, decreased urine output, increased CVP

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99
Q

what is the most common cause of sudden cardiac death after an MI

A

ventricular arrhythmia

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100
Q

when after an MI is a myocardial free wall rupture likely to happen

A

5days - 2 weeks

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101
Q

when after and MI is a papillary muscle rupture likely to happen

A

3-5 days

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102
Q

risk factors for euthyroid sick syndrome (low T3 syndrome)

A

ICU admission, severe acute illness, high dose glucocorticoids

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103
Q

management of euthyroid sick syndrome

A

observe without treatment, recheck when pt is no longer sick

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104
Q

adverse affect of amiodarone

A

hypothyroidism

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105
Q

management of epiglottis

A
  1. secure airway w/ intubation

2. ceftriaxone and Vanco

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106
Q

symptoms of supravalvular aortic stenosis

A 
systolic murmur
unequal BP in UE
palpable thrill at subprasternal notch 
unequal carotid pulses
increased oxygen demand with exercise--> ischemia--> chest pain
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107
Q

long term complication of supravalvular aortic stenosis

A

LV hypertrophy and coronary artery stenosis

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108
Q

treatment of tinea versicolor

A

ketoconazole, terbinafine, selenium sulfide

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109
Q

clinical presentation of emphysematous cholecystitis

A

RUQ pain, fever, N/V, crepitus in abdominal wall next to gallbaldder

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110
Q

how do you diagnose emphysematous cholecystitis

A

air fluid levels in gallbladder, gas in gallbladder wall (CT> US)
cultures with gas forming clostridium or e coli
unconjugated hyperbili, slightly elevated liver enzymes

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111
Q

treatment of emphysematous cholecystitis

A

urgent cholesecectomy

antibiotics w clostridium coverage (pip-tazo)

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112
Q

treatment of jock itch

A

clotrimazole, tolnaftate

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113
Q

symptoms of perilymphatic fistulas

A

progressive sensorineural hearing loss

episodic vertigo with nystagmus w/ increases in pressure (valsalva)

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114
Q

distinguishing factors of bacterial sinusitis

A

fever greater than or equal to 3 days OR
new/recurrent fever after initial improvement OR
symptoms >10 days

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115
Q

first line treatment for IBD induced toxic megacolon

A

IV corticosteroids

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116
Q

how can you diagnose esophageal perforation

A

Xray
CT: esophageal widening, mediastinal fluid collection
esophagography with water soluble contrast

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117
Q

management of esophageal perforation

A

NPO, IV antibiotics and PPIs

emergent surgery consult

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118
Q

in addition to surgery consult and pain control, what should you give to a patient with acute aortic dissection

A

beta blockers

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119
Q

hemodynamics of a thyroid storm

A

decreased SVR
increased cardiac output
increased PCWP

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120
Q

symptoms of hypothyroid myopathy

A

myalgia, proximal muscle weakness, elevated CK, fatigue, delayed reflexes

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121
Q

symptoms of testicular torsion

A

pain that doesn’t improve with elevation of the testicles, sudden onset pain, lower abdominal pain, erythematous and swollen scrotum.

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122
Q

who should you give prophylactic PCN until age 5 to?

A

kids with sickle cell

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123
Q

symptoms of myotonic dystrophy

A

myotonia, muscle weakness and atrophy, ptosis, flat affect, cataracts, testicular atrophy, sleep issues

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124
Q

symptoms of congenital mobile cecum

A

increased risk of cecal volvulus, younger, can report many previous episodes of self resolving abdominal pain

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125
Q

management of cecal volvulus

A

dx: CT
Tx: emergency ex-lap

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126
Q

indications for lower limb amputation

A

acute limb ischemia without the ability to revascularize.
unsalvageable soft tissue.
life threatening infection.

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127
Q

why are postmenopausal women at greater risk of UTI

A

estrogen deficiency

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128
Q

symptoms of photokeratitis

A

severe, progressive bilateral eye pain, photophobia
foreign body sensation in the eye
decreased vision
conjunctival erythema, chemises, tearing

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129
Q

symptoms of Reye syndrome

A

acute liver failure (hepatomegaly without jaundice)

rapidly progressive encephalopathy

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130
Q

symptoms of salicylate toxicity

A 
hyperventilation
hyperthermia
N/V
altered mental status
anion gap metabolic acidosis
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131
Q

treatment of salicylate toxicity

A

activated charcoal if within 2 hours of consumption
IV sodium bicarb
hemodialysis for severe ingestion

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132
Q

symptoms of C6 radiculopathy

A

weak wrist extension, thumb sensory loss

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133
Q

if your trauma pt is found to have a fracture of the cervical spine, what is the next step in management

A

CT scan of the entire spine.

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134
Q

symptoms of acute diverticulitis

A

LLQ abdominal pain
N/V
urinary frequency, sterile pyuria (positive leuk esterase but neg nitrates)
alteration in bowel habits

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135
Q

epidemiology of hepatic adenoma

A

benign epithelial liver tumor

seen in young women on oral contraceptives

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136
Q

treatment of hepatic adenoma

A

asymptomatic and <5 cm–> stop oral contraceptives

symptomatic and >5 cm –> surgical removal

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137
Q

complication of hepatic adenoma

A

malignant transformation

rupture and shock

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138
Q

symptoms of rocky mountain spotted fever

A

nonspecific headache, fever, myalgia
macular and petechial rash on hands and legs
can get encephalitis, pulmonary edema, bleeding, shock

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139
Q

treatment of rocky mountain spotted fever

A

doxycycline

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140
Q

symptoms of septal hematoma

A

recent nasal trauma

soft, fluctuant swelling of septum bilaterally

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141
Q

management of septal hematoma

A 
incision and drainage
nasal packing
NSAIDs and ice
antibiotics
referral to ENT
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142
Q

US findings with placenta accreta

A

previa, numerous placental lacunae, myometrial thinning

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143
Q

management of placenta accreta

A

cesarian hysterectomy

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144
Q

symptoms of renal artery stenosis

A

resistant HTN

flash pulmonary edema

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145
Q

what are the progressive EKG changes in hyperkalemic emergency

A

peaked T waves –> absent P waves –> wide QRS –> sine wave pattern –> asystole

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146
Q

management of hyperkalemic emergency

A

calcium gluconate

insulin and glucose

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147
Q

WAGR syndrome

A

deletion of 11p13

Wilms tumor
Aniridia
Genital abnormalities
Retardation

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148
Q

triad of symptoms for disseminated gonhorrea

A

tenosynovitis, migratory polyarthralgia, dermatitis

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149
Q

treatment of papillary thyroid cancer

A

surgical resection

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150
Q

causes of exudative pleural effusions

A

empyema
chylothorax
malignancy
TB

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151
Q

clinical features of glucocorticoid induced myopathy

A

progressive proximal muscle weakness and atrophy without pain. more likely to affect LE.
Normal CK and ESR

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152
Q

what is a severe side effect of prolonged use of oxytocin

A

severe hyponatremia leading to seizures

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153
Q

triggers of complex regional pain syndrome

A

trauma (fracture, sprain) or surgery

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154
Q

symptoms of complex regional pain syndrome

A

severe regional pain, burning/stinging, edema, abnormal sweating, patchy osteopenia on xray

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155
Q

when is aortic stenosis considered severe

A

if diameter is <1cm

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156
Q

pathogenesis of hyper IgM syndrome

A

X linked R defect in CD40L so you cannot do any Ig class switching.

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157
Q

presentation of hyper IgM syndrome

A

recurrent sinopulmonary infections caused by encapsulated bacteria, frequent viral infections, increased risk of opportunistic infections.

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158
Q

what are the potassium sparing diuretics

A 
ENaC blocker (amiloride) 
aldosterone receptor antagonist (spironolactone)
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159
Q

what is the preferred type of fluids for burn victims

A

LR bc it is isotonic and balanced

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160
Q

presentation of SLE nephritis in pregnancy

A

edema, malar rash, arthralgia, hematuria

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161
Q

clinical features of blastsmycosis

A 
acute and chronic pneumonia 
wart like skin lesions with violacious hue
osteomyolitis
prostatitis 
meningitis
epidural abscess
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162
Q

symptoms of putamen hemorrhage

A

usually involves the internal capsule also so you get contralateral hemiparesis and hemianesthsia

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163
Q

what is the most common cause of spontaneous intraparachymal hemorrhage in the basal ganglia

A

hypertensive vasculopathy

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164
Q

what is the most common cause of lobar/cortical hemorrhages

A

cortical amyloid angiopathy

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165
Q

clinical features of hyper IgE syndrome

A 
recurrent skin infections
eczema 
noninflammatory (cold) abscess 
recurrent sinopulmonary infections 
dysmorphic faces
retained primary teeth
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166
Q

management of a small spontaneous pneumothorax

A

observation and oxygen administration

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167
Q

management of a large spontaneous pneumothorax

A

needle aspiration or chest tube

168
Q

what is a frequent complication of rib fracture

A

pneumonia bc pain causes people to take shallow breaths –> atelectasis

169
Q

damage to choclear hair cells leads to what type of hearing issue

A

high frequency sensorineural hearing loss

170
Q

treatment of epithelial ovarian cancer

A

exploratory lap and chemo

171
Q

best management of NSTEMI

A

dual anti platelet therapy (aspirin + P2Y12 inhibitor)

172
Q

pathogenesis of food protein-induced allergic proctocolitis

A

non IgE immune reaction in which a protein in the infants diet causes eosiniphillic inflammation in the distal colon and rectum

173
Q

how can you measure intraabdominal pressure

A

measure bladder pressure

174
Q

side effects of phenytoin

A

folic deficiency

gingival hyperplasia

175
Q

best way to hear a aortic regurg murmur

A

early diastolic, left sternal border, 3/4 ICS, while pt is holding in breath during exhalation

176
Q

management of warfarin associated intracerebral hemorrhage

A

reverse warfarin: give vit K and prothrombin complex concentrate, can consider FFP

177
Q

extra hepatic manifestations of drug induced hepatitis

A

rash, arthralgia, fever, leukocytosis, eosinophilia

178
Q

presentation of lung abscess

A

indolent fever, cough productive of foul smelling sputum, night sweats, weight loss, cavitary lesion

179
Q

femoral nerve

A

innervates muscles of anterior compartment of thigh, knee extension, hip flexion, sensation to anterior thigh and medial leg

180
Q

large volume crystalloid fluid resuscitation increases the risk of what things

A

coagulopathy
hypothermia
acidosis
mortality

181
Q

symptoms of anterior cord syndrome

A

bilateral hemiparesis
diminished bilateral pain and temp sensation
intact bilateral proprioception, vibratory sensation, and light touch

182
Q

symptoms of acute closure angel glaucoma

A

headache, decreased visual acuity, fixed dilated pupils, conjunctival redness, pain, N/V

183
Q

treatment of acute closure glaucoma

A

multiple topicals: pilocarpine, timolol, apraclonidine.

Systemic: acetazolamide.

184
Q

what is the most common cause of ocular N palsy

A

ischemic neuropathy due to uncontrolled diabetes.

185
Q

presentation of CN 3 palsy

A

“down and out”, paralysis of levator muscle (ptosis), preserved pupillary response

186
Q

symptoms of bladder cancer

A

hematuria
voiding issues
hydronephrosis

187
Q

management of sigmoid volvulus

A

flexible sigmoidoscopy (detorsion) or colectomy if that doesn’t work or if there’s perforation

188
Q

clinical features of felty syndrome

A

RA
neutropenia
splenomegaly

189
Q

diagnostic criteria for infective urethritis

A

at least one of the following:

  • mucopurulent penile discharge
  • > 2 leukocytes per field on urethral swab gram stain
  • positive leukocyte on dipstick
190
Q

pathogenesis of minimal change disease

A

T cell mediated injury to podocytes–> increased permeability to albumin

191
Q

management of severe (>14) hypercalcemia

A

Short term: NS hydration plus calcitonin, avoid loop diuretics unless in heart failure
Long term: bisphosphonates

192
Q

most common causes of unilateral cervical lymphatiniditis

A

staph aureus and strep pyo

anaerobic from the mouth

193
Q

treatment of cervical lymphatinitis

A

clindamycin

194
Q

symptoms of transverse myelitis

A

motor weakness that progresses from flaccid to spastic with UMN.
autonomic dysfunction: loss of bowels/incontinence, sexual dysfunction.
sensory dysfunction with a distant sensory level.

195
Q

treatment of transverse myelitis

A

high dose glucocorticoids

196
Q

what is a renal complication of sjorgens syndrome

A

RTA type 1

197
Q

symptoms of congenital toxoplasmosis

A

chorioretinitis
diffuse intracranial calcifications
micro or macrocephaly
seizures

198
Q

massive transfusion protocols should be initiated if patients meet >2 of the following criteria

A

penetrating mechanism of injury
positive FAST scan
systolic <90
pulse >120

199
Q

massive transfusion protocols dictates pts should receive how many blood products

A

ratio of 1:1:1 of PRBC, FFP, platelets

or whole blood (PRBC + plasma)

200
Q

do pts with diarrhea from E coli usually present with fever?

A

NO

201
Q

HIV post exposure prophylaxis

A

test blood and start on a 3 ART drug treatment

202
Q

what are postop complications of Nissen fundoplication surgery

A

dysphagia
gas bloat syndrome
gastroparesis

203
Q

how can you diagnose gallstone pancreatitis

A

RUQ US, if that doesn’t show anything can do ERCP

204
Q

how can hypocalcemia present in a neonate

A

jitteriness, respiratory symptoms, if severe seizures

205
Q

what DVT prophylaxis should you use in a pt with CKD

A

unfractionated heparin

206
Q

what pts are most susceptible to acute subdural hemorrhage

A

elderly and alcoholics bc they have brain atrophy which causes the bridging veins to stretch

207
Q

what is the mechanism of flushing seen with niacin

A

drug induced release of histamine and prostaglandins

208
Q

what can you give with niacin to help reduce the risk of flushing

A

low dose aspirin

209
Q

symptoms of ascending cholangitis

A

RUQ pain, jaundice, fever (charcoids triad)

+ hypotension and confusion (Reynolds)

210
Q

management of a pt with charcods triad and elevated liver enzymes

A

ERCP to drain biliary tree

211
Q

symptoms of tricuspid atresia

A

cyanosis from birth, single heart sound, LV hypertophy, RA enlargement

212
Q

first line treatment for ankylosing spondylitis

A

NSAID

213
Q

treatment of A fib with RVR

A

non-dihydropyradine calcium channel blocker (diltiazem or verapamil) or beta blocker (metoprolol, propranolol, esmolol)

214
Q

how do you treat epidural hematoma

A

craniotomy with evacuation of the clot

215
Q

management of a pt with >75% carotid artery stenosis who is symptomatic

A

carotid endarterectomy

216
Q

when should you do an aortic valve replacement on a pt with aortic stenosis

A

if they are symptomatic and have an EF <50%

217
Q

best test to diagnose a SBO

A

abdominal radiograph, lateral and upright

218
Q

treatment of rib fractures in pts >65 with respiratory compromise

A

thoracic epidural anesthesia

219
Q

Erbs palsy is due to damage of which bracial plexus trunk

A

superior

220
Q

classic presentation of carotid artery dissection

A

unilateral head or neck pain with Horners syndrome

221
Q

most common causes of secondary digital clubbing

A

lung malignancies, cystic fibrosis, right to left cardiac shunts

222
Q

treatment of ethylene glycol ingestion

A

IVF with bicarb
fomepizole (or alcohol)
hemodialysis

223
Q

what is an early finding in macular degeneration

A

distortion of vertical lines where they appear wavy

224
Q

how can symptomatic atlantoaxial instability present

A

weakness, gait changes, urinary incontinence, dizziness, vertigo, imbalance, diplopia, UMN signs (babinski, spasticity, hyperreflexia)

225
Q

causes of masses in anterior mediastinal compartment

A

thyme neoplasm
lymphoma
germ cell tumors
thyroid tissue

226
Q

causes of masses in middle mediastinal compartment

A

sarcoidosis, lung cancer, lymphoma
pericardial cyst, bronchogenic cyst
vascular masses
esophageal tumors

227
Q

causes of masses in posterior mediastinal compartment

A

neurogenic tumor
spinal masses
lymphoma

228
Q

symptoms of duodenal ulcer

A

pain with fasting, nausea, pain that wakes you up at might, postprandial bloating

229
Q

what is a good physical test to look for disc herniation

A

crossed leg straight leg test (pain in affected leg when you raise the opposite leg)

230
Q

cancers that cause increased PTHrP

A

squamous cell (head, neck, lung), renal, bladder, breast, ovarian

231
Q

what is the best imaging to see avascular necrosis

A

MRI

232
Q

risk factors for avascular necrosis of femoral head

A 
SLE
sickle cell
glucocorticoids
alcohol abuse
antiphospholipid syndrome
infections
renal transplant
233
Q

first line treatment of keloids

A

intralesional triamcinolone (steroid)

234
Q

what specialty tests can you use to diagnose a rotator cuff tear

A

painful arc: pain over 90 degree
drop arm test: can’t control adduction from 90 degrees
weakness in external rotation

235
Q

diagnostic workup for acute lung transplant rejection

A

bronchiolar lavage and biopsy to rule out infection

236
Q

initial workup for primary adrenal insufficiency

A

morning cortisol test and ACTH stimulation test

237
Q

triad of spinal epidural abscess

A

spinal pain with progression to radiculopathy.
neurologic deficits
fever

238
Q

treatment of meningioma

A

surgical resection

239
Q

triad of symptoms for a fat embolism

A 
respiratory distress
neurologic dysfunction
petechial rash (in 50% of patients)
240
Q

causes of metabolic alkalosis with low urine chloride

A

vomiting

diuretic overuse

241
Q

what specialty test can you use for achilles tendon rupture

A

calf squeeze test- absence of plantar flexion when the calf is squeezed shows that tendon is ruptured.

242
Q

symptoms of cryptococcus neoformans infection

A

increased ICP (headaches, dizziness)
N/V
abducens nerve palsy
umbillicated skin lesions

243
Q

how can you diagnose leprosy

A

skin biopsy from edge of lesion

244
Q

symptoms of transposition of great arteries

A

cyanosis within first 24 hours of life, single S2, tachypnea.

usually no murmur unless also has VSD

245
Q

how can you differentiate hypo plastic left heart from transposition?

A

HPLH presents days after birth once the PDA closes, transposition occurs within first 24 hours.

246
Q

diagnosis and management of tracheobronchial injury

A

dx: bronchoscopy
tx: surgical repair

247
Q

what is the Neers test and what does it test for

A

internally rotate pt shoulders and forearm pronated, arm is passively raised in front of pt. Reproduction of pain is positive.

Tests for tendinopathy and impingement.

248
Q

how will a femur neck fracture present

A

shortened leg, externally rotated

249
Q

patients with acute promylocytic leukemia are at in creased risk of what

A

pulmonary/cerebrovascular hemorrhage due to consumptive coagulopathy

250
Q

why do you give sodium bicarb to patients with TCA overdose

A

helps cardiac stability and decreased hypotension

251
Q

symptoms of riboflavin deficiency

A

chelitis, glossits, sebhorratic dermatitis

252
Q

symptoms of pyridoxine deficiency

A

irritation or depression, glossitis, peripheral neuropathy, sebhorratic dermatitis

253
Q

what drugs decrease clearance of theophylline

A

cimetidine, ciprofloxacin, erythromycin, clarithromycin, verapamil

254
Q

short term management of unstable angina or NSTEMI

A 
dual anti platelet (aspirin and clopidogrel)
anticoagulation (heparin) 
beta blocker
nitrates prn
high dose statin
255
Q

how do you manage vfib

A

defibrillate, if it doesn’t work after several attempts then amiodarone.
epic every 3-5 min after defibrillates.

256
Q

symptoms of primary biliary cirrhosis

A

hyperpigmentation, puritis, fatigue, hepatomegaly

257
Q

calcium homeostasis in pts with sarcoidosis

A

increased calcitriol
decreased PTH
increased urinary calcium

258
Q

how can you differentiate plantar fasciitis from calcaneal stress fracture

A

stress fracture will have a positive squeeze test (pain when you squeeze media lateral heel)

259
Q

most common cause of amaurosis fugax (rapid and transient mono vision loss)

A

retinal ischemia due to atherosclerotic emboli from ipsilateral carotid artery

260
Q

what lung condition will present with tracheal deviation towards the affected lung?

A

atelectasis

261
Q

skeletal muscle necrosis in pts with high electrical burn injury are at increased risk of what conditions?

A

rhabdomyolysis, AKI, acute compartment syndrome

262
Q

causes of increased maternal AFP in pregnancy

A

abdominal wall defects
multiple gestations
open neural tube defects

263
Q

management of febrile neutropenia

A

blood and urine cultures, immediate broad spectrum antibiotics (pip-tazo, cefepime, miropenem)

264
Q

complications of traumatic hyphema (eye injury)

A

rebreeding, increased intraocular pressure –> optic nerve atrophy, permanent vision loss

265
Q

management of stroke in pts with sickle cell

A

exchange transfusion

266
Q

how can you measure recurrance of medullary thyroid cancer

A

serum calcitonin

267
Q

symptoms of HSV keratitis

A

acute onset eye pain, photophobia, blurred vision,

268
Q

what will you see on slit lamp exam of HSV keratitis

A

dendritic ulcers- branching linear lesions

269
Q

envelope shaped calcium oxalate crystals are usually due to ingestion of what

A

ethylene glycol

270
Q

how long after delivery can preeclampsia be present for?

A

up to 6 weeks

271
Q

symptoms of measels

A

rash, coryza, cough

272
Q

treatment of papulopustular rosacea

A

first line: topical metro, azeliac acid, ivermectin.

Second line: oral tetracyclines

273
Q

management of a pt with hypotension, JVD, decreased breath sounds on one side

A

immediate needle thoracotomy- likely a tension pneumo

274
Q

first line treatment for mild/moderate myasthenia graves

A

pyridostigmine

275
Q

treatment for patients with agitation due to acute delirium

A

low dose haloperidol

276
Q

gold standard for diagnosing kidney stone

A

non-contrast helical CT scan

277
Q

optimal treatment for hepatocellular carcinoma

A

surgical resection of the mass

278
Q

what screenings are recommended at an initial prenatal visit and during 3rd trimester for high risk patients

A 
HIV
RPR
chlamydia 
gonhorrea
Hep B&C
279
Q

symptoms triad of invasive aspirgillous

A

fever, pleuritic chest pain, hemoptysis

280
Q

what will CT scan of lungs show in invasive aspirgilous

A

nodules with surrounding ground glass opacities

281
Q

acute dystopias (muscle stiffness, tongue protrusions, torticollis) can occur after administration of what drug class

A

dopamine antagonists (metoclopramide, prochlorperazine, antipsychotics)

282
Q

evaluation and treatment of PMS and premenstraul dysphoric disorder

A

symptoms diary for 2 consecutive cycles

tx: SSRI

283
Q

best test to diagnose blunt thoracic aortic injury

A

CT angio of chest

284
Q

how does iliotibial band syndrome present

A

poorly localized lateral knee pain, pain at lateral femoral epicondyle with flexion or extension

285
Q

presentation of vestibular neuritis

A

acute onset, singular episode that can last days. Vertigo, N/V. usually follows viral infection

286
Q

what is the only indication for hormone replacement therapy for women with menopause within the last 10 years who are <60 yo

A

vasomotor symptoms

287
Q

treatment of E granulosis cyst

A

albendazole
percutaneous therapy if >5cm
surgery

288
Q

side effects of trimethoprime

A

hyperkalemeia and increased creatinine

289
Q

what infection control do you need for measels

A

airborne precautions

290
Q

what is the most common cause of acquired angioedema

A

ACE inhibitors

291
Q

waht is a major complication of nephrotic syndrome due to loss of antithrombin 3

A

renal vein thrombosis and other thrombosis

292
Q

for a bipolar patient wishing to get pregnant, she should switch from valproic acid to what drug

A

lamotrigine

293
Q

management of a pt with charcoid triad and elevated liver enzymes

A

ERCP

294
Q

management of a pt with suspected ascending cholangitis but without complete charcoid triad

A

abdominal US

295
Q

side effects of first generation antihistamines (diphenhydramine, chlorphenamirine, hydroxyzine)

A

antimuscarinic–> dry eyes, dry mouth, urinary retention

296
Q

mechanism of how antimuscarinics cause urinary retention

A

impaired detrusser muscle contraction

297
Q

clinical manifestation of bronchiolitis obliterans

A

usually due to chronic lung transplant
obstructive disease
negative bronchoalveolar lavage and culture

298
Q

symptoms of uncal herniation

A

oculomotor nerve palsy (down and out)
contralateral hemiparesis
contralateral homonymous hemianopsia

299
Q

what is an indication for mitral valve repair in severe mitral regurg

A

if EF is between 30-60% regardless of symptoms

300
Q

what can be a symptom of pancreatic cancer that you always forget

A

back pain that is worse at night when laying down

301
Q

victims of smoke inhalation should be empirically treated for what

A

CO poisoning and cyanide poisoning

302
Q

following blunt abdominal trauma, what signs should raise your concern for pancreatic duct injury

A

persistent abdominal discomfort
vomiting
peri pancreatic fluid collection
serial increases in amylase

303
Q

symptoms of acute epididymitis in young pts

A

unilateral posterior testicular pain that gets better with elevation of the testicles
epididymal edema
dysuria, frequency

304
Q

first line treatment of CML

A

tyrosine kinase inhibitors like imatinib

305
Q

MOA of gabapentin and pregabalin

A

alpha-2-delta calcium channel ligands

306
Q

first line treatment of PCP induced agitation

A

benzos

307
Q

management of a pt with scoliosis with a cobb angle <20

A

observation

308
Q

management of increased ICP

A

elevate head of bed
hyperventilation
IV mannitol

309
Q

if you’re allergic to PCNs then what other antibiotic are you prob allergic to?

A

cephalosporins

310
Q

what antibiotic should be given prophylactically for cardiac surgery

A

1st: cefazolizn
2nd: vancomycin or clindamycin

311
Q

symptoms and cause of lemierre syndrome

A

fusobacterium necrophorum.

prolonged duration of sore throat, high fevers, dysphagia, neck swelling, cavitation in the lungs.

312
Q

symptoms of C7 rediculopathy

A

weakness in wrist flexion and triceps extension, numbness of middle and index finger

313
Q

treatment of HIT

A

stop heparin

start direct thrombin inhibitor or fondaparinux

314
Q

management when purulent pericarditis is expected

A

urgent pericardiocentesis

315
Q

what is a consequence of rapid action intubation and why

A

aspiration of gastric contents bc propofol and succinylcholine impair gag reflex and epiglottis function

316
Q

what is a concerning sign of malignancy with a parotid gland tumor

A

involvement of the facial and trigeminal nerves

317
Q

management of auricular hematoma

A

drainage

pressure packing

318
Q

where does testicular cancer spread to first most likely?

A

retroperitoneal lymph nodes

319
Q

what intervention should you do for a pt with TBI and ICP

A

immediate osmotic therapy (hypertonic saline, mannitol) to extract water

320
Q

physical exam findings in quadriceps tendon rupture

A

low lying patella, palpable defect above the patella

321
Q

what antibiotic is usually used for an infected wound caused by human bite

A

amoxicillin-clauvunate

322
Q

side effect of succinycholine

A

can induce cardiac arrhythmia due to increased K

323
Q

what is a common side effect of thoracic abdominal aorta repair

A

spinal cord infarct–> anterior cord syndrome

324
Q

clinical features of posterior dislocation of the shoulder

A

arm held in adduction and internal rotation

prominance of coracoid and acromion

325
Q

first line treatment of invasive burn wound infection

A

pip-tazo or meropenom and Vanco

326
Q

first line treatment of noninvasive burn wound infection

A

cefazolin or clindamycin

327
Q

management of hemorrhagic stroke

A 
maintain BP (IV nifedipine or labetolol)
reverse anticoagulation
reduce ICP (elevate HOB, mannitol)
328
Q

what are the best predictors of postoperative complications following lung resection

A

FEV1 and DLCO

329
Q

after stabilizing a knee dislocation, what is an important next step?

A

documenting vascular status:
Get ABI
palpate politeal pulse
doppler US

330
Q

treatment of lymphangitis

A

cephalexin

331
Q

damage to the anterior bladder wall would cause fluid in what space

A

extraperitoneal- retropubic space

332
Q

damage to the dome of the bladder would cause fluid in what space

A

intraperitoneal

333
Q

causes of bile acid diarrhea

A

post cholesectomy

diseases involving ilium (chrons, abdominal radiation damage)

334
Q

treatment of bile acid diarrhea

A

bile acid binding resins (cholesterolstyramine, colestipol)

335
Q

treatment of chronic bacterial prostatitis

A

6 weeks of fluroquinilone (cipro)

336
Q

side effects fo CO2 gas insufflation

A

increased intraabdominal pressure leads to increased vagal tone –> bradycardia and heart block. Can also get increased BP.

337
Q

treatment of acute bacterial prostatitis

A

6 week fluroquinilone or bactrim

338
Q

treatment of pulmonary abscess

A

ampicillin-sulbactem

339
Q

migratory superficial thrombophlebitis (trousseau sign) is most likely associated with what?

A

pancreatic cancer

340
Q

symptoms of erythema nodosum

A

painful, violacious, erythematous nodules on the shin. Most commonly associated with IBD (chrons more likely)

341
Q

what paraneoplastic syndromes is small cell lung cancer associated with

A

ACTH and SIADH

342
Q

what paraneoplastic syndrome is squamous cell carcinoma associated with

A

PTHrP

343
Q

complications of supracondylar fractures?

A

injury to median n and brachial a

344
Q

what class of antibiotics are contraindicated in pts with AAA

A

fluroquinolones due to cartilage disruption

345
Q

why do all pts with a retropharyngeal abscess need lateral Xray

A

to exclude necrotizing mediastinitis

346
Q

what medication can you give to help pass a kidney stone

A

alpha blocker- tamsulosin

347
Q

symptoms of peri-infarction pericarditis

A

occurs within 4 days of MI.

Pleuritic chest pain that radiates to left shoulder, widespread ST elevation or PR depression.

348
Q

how can you confirm Conn’s syndrome

A

low plasma renin with high aldosterone

349
Q

what foes a low d-xylose test indicate

A

celiacs

350
Q

what is the timeframe for delayed hemolytic transfusion reaction?

A

> 24 hrs - 1 month after transfusion

351
Q

empiric treatment of chlamydia and gonhorrhea

A

ceftriazone and doxy

352
Q

first line treatment of acute pericarditis due to SLE

A

NSAID

Corticosteroid if can’t take NSAID

353
Q

symptoms of galactosemia

A

jaundice and hepatomegaly
vomiting, poor feeding, failure to thrive
cataracts
increased risk of E. coli sepsis

354
Q

treatment of cryptococcal meningitis

A

IV amphotericin B and flucytosine for 2 weeks and then fluconazole for maintenance for a year

355
Q

what alternative antibiotic can you give to a pt with syphilis who is allergic to PCN

A

doxycycline

356
Q

what happens to total body potassium in DKA

A

decreased

357
Q

first line treatment for fibromyalgia

A

TCA

358
Q

what opioids should pts with kidney disease avoid

A

morphine
tramadol
meperidine
codeine

359
Q

what is defective in chronic granulomatous disease

A

decreased superoxide production

-increased risk of catalase positive organisms

360
Q

management of hypercalcemia of malignancy

A

bisphosphanates (zoledronic acid)

361
Q

EKG findings in anterior wall MI

A

leads V1-V6

LAD

362
Q

EKG findings in inferior MI

A

ST elevation in 2,3 AvF

RCA or LCX

363
Q

EKG findings in posterior MI

A

ST depression leads V1-3
ST elevation in 1 and AvL (LCX)
ST depression in 1 and AvL (RCA)

364
Q

EKG findings in lateral wall MI

A

ST elevation in leads 1, all, V5-6
ST depression in leads 2,3,AVF
LCX or diagonal

365
Q

management of pulmonary HTN due to left sided heart failure

A

optimize heart failure drugs

366
Q

management of pulmonary HTN due to connective tissue disorders

A

pulmonary artery vasodilators

367
Q

symptoms of chronic demyelinating polyneuropathy

A

proximal and distal muscle weakness
distal sensory loss
lower motor neuron signs (hyporeflexia, atrophy)

368
Q

MOA of graft versus host disease

A

donor T lymphocytes attack

369
Q

CNS manifestations of tuberous sclerosis

A

subependymal tumors, epilepsy (infantile seizures), intellectual disability

370
Q

what disease is associated with anti smooth muscle antibody

A

autoimmune hepatitis

371
Q

what is the difference between sleep terror disorder and nightmare disorder

A

sleep terror has incomplete awakenings, cannot be consoled, and does not remember the dream.

372
Q

what will an US of the liver show on a pt with nonalcoholic fatty liver disease

A

hyper echoic appearing liver

373
Q

hepatojugular reflex is highly specific for what

A

right sided heart failure

374
Q

how can you differentiate CML from a leukomoid reaction

A

LAP score will be low in CML

375
Q

pupil sparing CN 3 palsies due to microvascular ischemia is associated with what conditions

A

diabetes, HTN, hyperlipidemia, old age

376
Q

non-pupil sparing CN3 palsies are most likely do to what

A

intracranial aneurysm

377
Q

symptoms of CKD in a child

A

fatigue, poor growth, HTN, daytime and nighttime enuresis

378
Q

what is the cause of refeeding syndrome

A

increased insulin causes decreased potassium, phosphorus, and mg

379
Q

what is a common side effect of venlafaxine

A

HTN

380
Q

besides treating depression, what other conditions is mirtazapine good for?

A

stimulates appetite, helps with sleeping issues,

381
Q

Symptoms of Todd paralysis

A

weakness or paralysis of extremities following focal seizure activity.

382
Q

what happens to serum phosphorus in vit D deficiency

A

low

383
Q

symptoms of lithium toxicity

A

GI upset, N/V, tremors, ataxia, fasciculation’s, seizure

384
Q

treatment of myasthenia crisis

A

intubate for respiratory support

plasmapheresis or IVIG and corticosteroids

385
Q

treatment of acute dystonia from extraperimidal symptoms

A

benztropine

diphehydramine

386
Q

treatment of akathisia from extraperimidal symptoms

A

Beta blocker
BZD
benztropine

387
Q

treatment of parkinsonism from EPS

A

benztropine

amantadine

388
Q

treatment of tar dive kinesis from EPS

A

valbenazine

deutratabenzine

389
Q

symptoms of allergic interstitial nephritis

A

rash, fever, acute renal failure, WBC casts

390
Q

first line treatment fo acute bipolar depression

A

quetiapine or lurasidone

391
Q

how do you treat afib in pts with WPW

A

procainamide or ibutilide

392
Q

diagnosis criteria for dementia with Lewy bodies

A

dementia plus 2/4 of following:

  • parkinsonism
  • fluctuating cognition
  • visual hallucinations
  • REM sleep behavior disorder
393
Q

treatment of scleroderma renal crisis

A

ACE inhibitor

394
Q

what drug should you give to someone with MDD that is concerned about sexual side effects

A

bupropion

395
Q

management of acute splenic sequestration in SCD

A

isotonic fluid
packed red blood cells
possible splenectomy

396
Q

how can you distinguish between epilepsy and psychogenic non-epileptic seizures

A

measure prolactin level (seizure will have elevated prolactin)

397
Q

symptoms of temporal lobe epilepsy

A

can be associated with significant interichtal psychosis that is hard to differentiate from schizophrenia

398
Q

Indication for trazadone

A

MDD with insomnia or anxiety

399
Q

side effects of trazodone

A

orthostatic hypotension, priapism

400
Q

side effect of venlafaxine

A

HTN

401
Q

what drugs can you use to control acute symptoms of mania

A

olanzapine, aripiprazole, quetiapine, risperidone, ziprasidone

402
Q

what drug is used to manage withdrawal symptoms from benzo use

A

chlordiazepoxide (bc it has a long half life)

403
Q

side effects of clozapine

A

neutropenia, agranulocytosis, myocarditis, seizures

404
Q

what is the best combination therapy for bipolar

A

lithium or valproate plus a 2nd gen antipsychotic

405
Q

conus medullar is syndrome

A

L1-L2
UMN
low back pain, mild or absent radicular pain, bowel/bladder dysfunction.
symmetric motor weakness, hyperreflexia.

406
Q

what actions do you lose with C5 INJURY

A

elbow flexion and shoulder abduction

407
Q

what actions do you lose with C6 injury

A

elbow flexion, wrist extension, forearm pronation/supination

408
Q

what actions do you lose with C7 injury

A

elbow extension, wrist flexion, finger extension

409
Q

what actions do you lose with C8 injury

A

finger flexion and extention

thumb flexion and abbduction

410
Q

what actions do you lose with T1 injury

A

finger abduction and adduction

411
Q

how does a galctocele present

A

usually after stopping breast feeding- soft, mobile, nontender subareolar mass

412
Q

in an infant with 5 or more hemangioma, what should you evaluate?

A

liver ultrasound

413
Q

if a baby has hemangioma in the bears distribution what should you do?

A

laryngoscope

414
Q

if a baby has facial/segmental hemangioma what should you evaluate

A

echo and MRI of head

415
Q

aspirin overdose acid base status

A 
respiratory alkalosis (low CO2) (acute)
metabolic acidosis (low bicarb) (hours)

OBGYN (5 decks)

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