Uworld step 2 Flashcards
1
Q
Medical treatment of urge incontinence
A
Oxybutinin (antimuscarinic)
Mirabegron (beta 3 agonist)
2
Q
How do you diagnose VUR in children?
A
Renal US: hydro
Voiding cystourethrogram: ureteral filling and dilated collecting system
3
Q
Complication of untreated VUR
A
renal scarring and CKD
4
Q
treatment of myasthenia crisis
A
intubation if can’t breathe, IVIG w/ plasmaphoresis or corticosteroids.
5
Q
hemodynamic changes in mitral stenosis
A
increased systolic and diastolic pulmonary artery pressures, normal LV diastolic pressure, enlarged RA.
6
Q
RTA type 1
A
DCT fails to secrete H+ into urine
urine pH > 5.5
hypokalemia
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.
8
Q
how does acute ischemic stroke present in children under 6?
A
headache, altered mental status, non localizing symptoms, generalized or focal seizures.
9
Q
what is the best way to diagnose acute ischemic stroke
A
MRI with MR angio
10
Q
Clinical features of DiGeorge
A
C: conotruncal cardiac defects A: abnormal facies T: Thymus aplasia C: craniofacial deformalities H: hypocalcemia/hypoparathyroidism
11
Q
symptoms of Choanal atresia
A
turning blue with feeds
noisy breathing
can’t pass catheter past nasopharynx
12
Q
how do you confirm choanal atresia
A
CT scan or nasal endoscopy
13
Q
Treatment of choanal atresia
A
oral airway then surgical repair
14
Q
sjorgens syndrome increases your risk for what type of cancer
A
non-hodgkin lymphoma
15
Q
homocystinuria
A
marfinoid body habitus stretchy skin scoliosis intellectual disability downward lens dislocation megablastic anemia AR
16
Q
Fabrys disease (a-galactosidase)
A
angiokeratomas, peripheral neuropathy, asymptomatic corneal dystrophy
17
Q
Krabbe disease
A
lysosomal storage disorder.
galactocerebrosidase deficiency
intellectual disability, blindness, deafness, neuropathy, seizures.
18
Q
treatment of mild ulcerative colitis
A
5-ASA (mesalamine, sulfasalazine)
19
Q
Giant cell tumor of bone
A
Xray- eccentric lytic lesion
epiphysis of long bones
20
Q
sequela of OSA
A
erectile dysfunction and arterial HTN
21
Q
when is surgical decompression recommended for cerebellar hemorrhage
A
> 3 cm
neurologic deterioration
brainstem compression, obstructive hydrocephalus.
22
Q
what patients is carboprost contraindicated in and why?
A
can cause bronchial spasm so don’t give to people with asthma
23
Q
first line treatment for uterine atony
A
uterine massage
oxytocin
tranexamic acid
24
Q
first step management of acute limb ischemia
A
anticoagulant (heparin)
25
what bug usually causes onychomycosis (thickening of the nails)?
Trichophyton rubrum
26
first line treatment of onychomycosis
terbinafine or itraconazole
27
RV enlargement causes what
tricuspid annular dilation and tethering of chordae tendonae which leads to tricuspid regurg
28
how does duodenal atresia present on US
double bubble: fluid filled stomach and dilated duodenum
29
most likely cause of empyema
1. oral anaerobic bacteria
| 2. strep pneumo or staph aureus
30
management of empyema
chest tube drainage
intra pleural fibrolytic drugs (tPa)
surgical decortication
31
symptoms of splenic sequestration crisis
LUQ pain, pallor, flow murmur, splenomegaly
32
lab findings of splenic sequestration crisis
increased reticulocytes, thrombocytopenia, normocytic anemia.
33
how can you diagnose lumbar stenosis
MRI of spine
34
posture dependent symptoms of lumbar stenosis
made worse by extension (standing, walking upright), better with flexion (leaning forward, walking uphill).
35
first line treatment for idiopathic intracranial HTN
acetazolamide
36
X ray finding of rickets
metaphysial widening with cupping and fraying, costochondral joint widening
37
presentation of peritonsillar abscess
hot potato voice, can't open mouth fully due to inflammation of pterygoid muscles, dysphasia, unilateral swelling of soft palate with uvula deviation.
38
how do you treat osteomyelitis in a child with sickle cell?
Clindamycin (staph) and 3rd gen cephalosporin (salmonella)
39
symptoms of mycoplasma pneumonia
indolent headache, fatigue, cough, rash, pharyngitis
40
treatment of H pylori
amoxicillin, clarithromycin, PPI
41
risk factors for amniotic fluid embolism
```
advanced age
>5 births
C section or instrumental delivery
placenta previa or abruption
preeclampsia
```
42
Clinical presentation of amniotic fluid embolism
shock
hyperemic respiratory failure
DIC
Coma, seizures
43
management of amniotic fluid embolism
intubate, vasopressors, transfusions to correct DIC
44
symptoms of neuroblastoma
```
median age <2
abdominal mass
periorbital ecchymosis
spinal cord compression from epidural invasion
opsoclonus-myoclonus syndrome
```
45
echo findings of infants with hypertrophic cardiomyopathy
increased thickness of inter ventricular septum, decreased LV chamber size
46
treatment of hypertrophic cardiomyopathy in infants
IV fluids and beta blockers to increase LV blood volume.
47
what complication can occur several months after a STEMI
ventricular aneurysm
48
risk factors for MS
```
low vit D
female, white
cold climate
smoking
EBV
```
49
late onset vit K deficiency bleeding
occurs between 2-6 weeks old.
| increased ICP, obstructive hydrocephalus, budging fontanelle
50
treatment of impetigo
localized: topical muproprion
extensive: oral cephalexin
51
indications for external cephalic version
breach/transverse presentation at
| > or equal to 37 weeks
52
treatment of anal fissures
stool softeners, sitz baths, high fiber diet, topical anesthetics and vasodilators (nifedipine, nitro)
53
sialadeuosis is most common in which patients
alcoholics, bulimics, malnuroished, can also be from diabetes.
54
management of complicated diverticulitis with abscess
<3 cm--> IV antibiotics and bowel rest
| >3cm--> percutaneous drainage via CT guidance, if symptoms persist a few days then surgical debridement.
55
pulmonary stenosis murmur
harsh, crescendo-deconcendro systolic murmur over the left upper sternal border.
56
what's the most common arrhythmia responsible for sudden cardiac arrest in acute MI?
ventricular arrhythmias
57
symptoms of laryngalmalacia
inspiratory stridor that worsens when supine, peak age 4-8 months
58
symptoms of hereditary hemorrhagic telangiectasia
```
recurrent nose bleeds
hemoptysis due to AVM formation in lung
Iron deficient anemia due to GI bleed
pulmonary bruit
high output heart failure
```
59
what's the most common stroke syndrome caused by a lacunar stroke
pure motor hemiparesis
60
symptoms of rotator cuff tendinopathy
pain with abduction and external rotation (over head)
| strength is normal
61
symptoms of rotator cuff tear
pain with abduction or external rotation
| weaknesss
62
symptoms of adhesive capsulitis
decreased passive and active shoulder ROM
63
symptoms of AC joint sprain
pain over AC joint
| passive shoulder adduction causes pain
64
symptoms of biceps tendinopathy
pain over bicipital groove
65
most common cause of concentric LV hypertrophy
chronic HTN
66
risk factors for acute urinary retention
```
male
old
history of BPH
recent surgery
history of neurologic disease
```
67
how do you treat pyelonephritis in pregnancy
PCN, cephalosporins, fosfomycin.
| Once infection is cleared, they need prophylactic cephlahexin or nitrofurantoin the rest of the pregnancy.
68
diagnostic test for pts with renal insufficiency or hemodynamic instability with suspected aortic dissection
trans esophageal echo
69
diagnostic test for pts with suspected aortic dissection that are stable
CT angio
70
diagnostic test for secondary polycythemia
abdominal CT scan looking for renal or hepatic tumors
71
first line treatment for chemo induced nausea
5-HT3 receptor antagonists (ondansetron)
72
what medications can cause methemoglobinemia
topical anesthetics (benzocaine), dapsone, nitrates (in infants)
73
Symptoms of ALS
dysphagia, dysarthria, tongue atrophy and fasciculation's, diaphragmatic weakness leading to paradoxical breathing and elevated diaphragm.
74
PFT results of ALS
decreased FVC
decreased maximal inspiratory pressure
normal diffusing capacity
75
treatment of postpartum endometritis
clindamycin and gentamicin
76
risk factors for calciphylaxis
ESRD
hypercalcemia, hyperphosphatemia
hyperparathyroidism
oral anticoagulants (warfarin)
77
how do you diagnose legg-calve-perthes
Xray (early on may not show anything)
| MRI (avascular femoral head)
78
Classic congenital adrenal hyperplasia is due to what
decreased 21 hydroxylase
| results in increase in 17- hydroxyprogesterone
79
symptoms of CAH
dehydration and salt wasting --> hypotension, hyponatremia, hyperkalemia.
visualization in female infants
80
what is the monoclonal antibody in waldenstorm macroglobulinemia
IgM
81
what is the monoclonal antibody in multiple myeloma
IgG and IgA
82
symptoms of beta blocker toxicity
hypotension, bradycardia, bronchospasm, AMS, seizure, hypoglycemia
83
management of beta blocker overdose
IV fluid bolus
IV glucagon
IV atropine
84
in addition to glucocorticoids, how else should you manage polymyositis
age appropriate cancer screenings.
85
how can you diagnose postcholesectomy syndrome
ERCP or MRCP
86
how would a fractured clavicle or humerus present in shoulder dystocia
crepitus/bony irregularity
decreased moro reflex on affected side due to pain
intact biceps and grasp reflex
87
how does klumpke palsy present
claw hand
horners syndrome
intact moro and biceps reflexes
88
what nerves are damaged in klumpkes
8th cervical nerve and T1
89
how does TB meningitis look on imaging
bibasilar meningeal enhancement
90
leriche syndrome
- b/l hip, thigh, and butt claudication
- absent or diminished femoral pulses
- impotence
91
lab findings in alports
UA: + protein, RBC, RBC casts
serum: normal C3/C4, increased creatinine
92
lab findings in post infectious glomerularnephritis
UA: + protein, RBC, RBC casts
Serum: decreased C3 and CH50, decreased or normal C4, increased creatinine
93
what organism is most likely responsible for Erysipelas
strep pyogenes
94
management of NEC
NPO, IVF, broad spectrum antibiotics, blood culture
95
symptoms of renal cell carcinoma
hematuria, flank pain, palpable flank mass, left sided varicoceles, paraneoplastic symptoms (anemia or erythrocytosis, thrombocytosis, fever, hypercalcemia, cachexia)
96
what should be given to patients with varies to decrease risk of hemorrhage
nonselective beta blocker
97
risk factors for abdominal compartment syndrome
massive fluid resuscitation, major intra-abdominal surgery
98
symptoms of abdominal compartment syndrome
distende abdomen, hypotension, tachycardia, increased vent requirements, decreased urine output, increased CVP
99
what is the most common cause of sudden cardiac death after an MI
ventricular arrhythmia
100
when after an MI is a myocardial free wall rupture likely to happen
5days - 2 weeks
101
when after and MI is a papillary muscle rupture likely to happen
3-5 days
102
risk factors for euthyroid sick syndrome (low T3 syndrome)
ICU admission, severe acute illness, high dose glucocorticoids
103
management of euthyroid sick syndrome
observe without treatment, recheck when pt is no longer sick
104
adverse affect of amiodarone
hypothyroidism
105
management of epiglottis
1. secure airway w/ intubation
| 2. ceftriaxone and Vanco
106
symptoms of supravalvular aortic stenosis
```
systolic murmur
unequal BP in UE
palpable thrill at subprasternal notch
unequal carotid pulses
increased oxygen demand with exercise--> ischemia--> chest pain
```
107
long term complication of supravalvular aortic stenosis
LV hypertrophy and coronary artery stenosis
108
treatment of tinea versicolor
ketoconazole, terbinafine, selenium sulfide
109
clinical presentation of emphysematous cholecystitis
RUQ pain, fever, N/V, crepitus in abdominal wall next to gallbaldder
110
how do you diagnose emphysematous cholecystitis
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
111
treatment of emphysematous cholecystitis
urgent cholesecectomy
| antibiotics w clostridium coverage (pip-tazo)
112
treatment of jock itch
clotrimazole, tolnaftate
113
symptoms of perilymphatic fistulas
progressive sensorineural hearing loss
| episodic vertigo with nystagmus w/ increases in pressure (valsalva)
114
distinguishing factors of bacterial sinusitis
fever greater than or equal to 3 days OR
new/recurrent fever after initial improvement OR
symptoms >10 days
115
first line treatment for IBD induced toxic megacolon
IV corticosteroids
116
how can you diagnose esophageal perforation
Xray
CT: esophageal widening, mediastinal fluid collection
esophagography with water soluble contrast
117
management of esophageal perforation
NPO, IV antibiotics and PPIs
| emergent surgery consult
118
in addition to surgery consult and pain control, what should you give to a patient with acute aortic dissection
beta blockers
119
hemodynamics of a thyroid storm
decreased SVR
increased cardiac output
increased PCWP
120
symptoms of hypothyroid myopathy
myalgia, proximal muscle weakness, elevated CK, fatigue, delayed reflexes
121
symptoms of testicular torsion
pain that doesn't improve with elevation of the testicles, sudden onset pain, lower abdominal pain, erythematous and swollen scrotum.
122
who should you give prophylactic PCN until age 5 to?
kids with sickle cell
123
symptoms of myotonic dystrophy
myotonia, muscle weakness and atrophy, ptosis, flat affect, cataracts, testicular atrophy, sleep issues
124
symptoms of congenital mobile cecum
increased risk of cecal volvulus, younger, can report many previous episodes of self resolving abdominal pain
125
management of cecal volvulus
dx: CT
Tx: emergency ex-lap
126
indications for lower limb amputation
acute limb ischemia without the ability to revascularize.
unsalvageable soft tissue.
life threatening infection.
127
why are postmenopausal women at greater risk of UTI
estrogen deficiency
128
symptoms of photokeratitis
severe, progressive bilateral eye pain, photophobia
foreign body sensation in the eye
decreased vision
conjunctival erythema, chemises, tearing
129
symptoms of Reye syndrome
acute liver failure (hepatomegaly without jaundice)
| rapidly progressive encephalopathy
130
symptoms of salicylate toxicity
```
hyperventilation
hyperthermia
N/V
altered mental status
anion gap metabolic acidosis
```
131
treatment of salicylate toxicity
activated charcoal if within 2 hours of consumption
IV sodium bicarb
hemodialysis for severe ingestion
132
symptoms of C6 radiculopathy
weak wrist extension, thumb sensory loss
133
if your trauma pt is found to have a fracture of the cervical spine, what is the next step in management
CT scan of the entire spine.
134
symptoms of acute diverticulitis
LLQ abdominal pain
N/V
urinary frequency, sterile pyuria (positive leuk esterase but neg nitrates)
alteration in bowel habits
135
epidemiology of hepatic adenoma
benign epithelial liver tumor
| seen in young women on oral contraceptives
136
treatment of hepatic adenoma
asymptomatic and <5 cm--> stop oral contraceptives
| symptomatic and >5 cm --> surgical removal
137
complication of hepatic adenoma
malignant transformation
| rupture and shock
138
symptoms of rocky mountain spotted fever
nonspecific headache, fever, myalgia
macular and petechial rash on hands and legs
can get encephalitis, pulmonary edema, bleeding, shock
139
treatment of rocky mountain spotted fever
doxycycline
140
symptoms of septal hematoma
recent nasal trauma
| soft, fluctuant swelling of septum bilaterally
141
management of septal hematoma
```
incision and drainage
nasal packing
NSAIDs and ice
antibiotics
referral to ENT
```
142
US findings with placenta accreta
previa, numerous placental lacunae, myometrial thinning
143
management of placenta accreta
cesarian hysterectomy
144
symptoms of renal artery stenosis
resistant HTN
| flash pulmonary edema
145
what are the progressive EKG changes in hyperkalemic emergency
peaked T waves --> absent P waves --> wide QRS --> sine wave pattern --> asystole
146
management of hyperkalemic emergency
calcium gluconate
| insulin and glucose
147
WAGR syndrome
deletion of 11p13
Wilms tumor
Aniridia
Genital abnormalities
Retardation
148
triad of symptoms for disseminated gonhorrea
tenosynovitis, migratory polyarthralgia, dermatitis
149
treatment of papillary thyroid cancer
surgical resection
150
causes of exudative pleural effusions
empyema
chylothorax
malignancy
TB
151
clinical features of glucocorticoid induced myopathy
progressive proximal muscle weakness and atrophy without pain. more likely to affect LE.
Normal CK and ESR
152
what is a severe side effect of prolonged use of oxytocin
severe hyponatremia leading to seizures
153
triggers of complex regional pain syndrome
trauma (fracture, sprain) or surgery
154
symptoms of complex regional pain syndrome
severe regional pain, burning/stinging, edema, abnormal sweating, patchy osteopenia on xray
155
when is aortic stenosis considered severe
if diameter is <1cm
156
pathogenesis of hyper IgM syndrome
X linked R defect in CD40L so you cannot do any Ig class switching.
157
presentation of hyper IgM syndrome
recurrent sinopulmonary infections caused by encapsulated bacteria, frequent viral infections, increased risk of opportunistic infections.
158
what are the potassium sparing diuretics
```
ENaC blocker (amiloride)
aldosterone receptor antagonist (spironolactone)
```
159
what is the preferred type of fluids for burn victims
LR bc it is isotonic and balanced
160
presentation of SLE nephritis in pregnancy
edema, malar rash, arthralgia, hematuria
161
clinical features of blastsmycosis
```
acute and chronic pneumonia
wart like skin lesions with violacious hue
osteomyolitis
prostatitis
meningitis
epidural abscess
```
162
symptoms of putamen hemorrhage
usually involves the internal capsule also so you get contralateral hemiparesis and hemianesthsia
163
what is the most common cause of spontaneous intraparachymal hemorrhage in the basal ganglia
hypertensive vasculopathy
164
what is the most common cause of lobar/cortical hemorrhages
cortical amyloid angiopathy
165
clinical features of hyper IgE syndrome
```
recurrent skin infections
eczema
noninflammatory (cold) abscess
recurrent sinopulmonary infections
dysmorphic faces
retained primary teeth
```
166
management of a small spontaneous pneumothorax
observation and oxygen administration
167
management of a large spontaneous pneumothorax
needle aspiration or chest tube
168
what is a frequent complication of rib fracture
pneumonia bc pain causes people to take shallow breaths --> atelectasis
169
damage to choclear hair cells leads to what type of hearing issue
high frequency sensorineural hearing loss
170
treatment of epithelial ovarian cancer
exploratory lap and chemo
171
best management of NSTEMI
dual anti platelet therapy (aspirin + P2Y12 inhibitor)
172
pathogenesis of food protein-induced allergic proctocolitis
non IgE immune reaction in which a protein in the infants diet causes eosiniphillic inflammation in the distal colon and rectum
173
how can you measure intraabdominal pressure
measure bladder pressure
174
side effects of phenytoin
folic deficiency
| gingival hyperplasia
175
best way to hear a aortic regurg murmur
early diastolic, left sternal border, 3/4 ICS, while pt is holding in breath during exhalation
176
management of warfarin associated intracerebral hemorrhage
reverse warfarin: give vit K and prothrombin complex concentrate, can consider FFP
177
extra hepatic manifestations of drug induced hepatitis
rash, arthralgia, fever, leukocytosis, eosinophilia
178
presentation of lung abscess
indolent fever, cough productive of foul smelling sputum, night sweats, weight loss, cavitary lesion
179
femoral nerve
innervates muscles of anterior compartment of thigh, knee extension, hip flexion, sensation to anterior thigh and medial leg
180
large volume crystalloid fluid resuscitation increases the risk of what things
coagulopathy
hypothermia
acidosis
mortality
181
symptoms of anterior cord syndrome
bilateral hemiparesis
diminished bilateral pain and temp sensation
intact bilateral proprioception, vibratory sensation, and light touch
182
symptoms of acute closure angel glaucoma
headache, decreased visual acuity, fixed dilated pupils, conjunctival redness, pain, N/V
183
treatment of acute closure glaucoma
multiple topicals: pilocarpine, timolol, apraclonidine.
| Systemic: acetazolamide.
184
what is the most common cause of ocular N palsy
ischemic neuropathy due to uncontrolled diabetes.
185
presentation of CN 3 palsy
"down and out", paralysis of levator muscle (ptosis), preserved pupillary response
186
symptoms of bladder cancer
hematuria
voiding issues
hydronephrosis
187
management of sigmoid volvulus
flexible sigmoidoscopy (detorsion) or colectomy if that doesn't work or if there's perforation
188
clinical features of felty syndrome
RA
neutropenia
splenomegaly
189
diagnostic criteria for infective urethritis
at least one of the following:
- mucopurulent penile discharge
- >2 leukocytes per field on urethral swab gram stain
- positive leukocyte on dipstick
190
pathogenesis of minimal change disease
T cell mediated injury to podocytes--> increased permeability to albumin
191
management of severe (>14) hypercalcemia
Short term: NS hydration plus calcitonin, avoid loop diuretics unless in heart failure
Long term: bisphosphonates
192
most common causes of unilateral cervical lymphatiniditis
staph aureus and strep pyo
| anaerobic from the mouth
193
treatment of cervical lymphatinitis
clindamycin
194
symptoms of transverse myelitis
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
treatment of transverse myelitis
high dose glucocorticoids
196
what is a renal complication of sjorgens syndrome
RTA type 1
197
symptoms of congenital toxoplasmosis
chorioretinitis
diffuse intracranial calcifications
micro or macrocephaly
seizures
198
massive transfusion protocols should be initiated if patients meet >2 of the following criteria
penetrating mechanism of injury
positive FAST scan
systolic <90
pulse >120
199
massive transfusion protocols dictates pts should receive how many blood products
ratio of 1:1:1 of PRBC, FFP, platelets
| or whole blood (PRBC + plasma)
200
do pts with diarrhea from E coli usually present with fever?
NO
201
HIV post exposure prophylaxis
test blood and start on a 3 ART drug treatment
202
what are postop complications of Nissen fundoplication surgery
dysphagia
gas bloat syndrome
gastroparesis
203
how can you diagnose gallstone pancreatitis
RUQ US, if that doesn't show anything can do ERCP
204
how can hypocalcemia present in a neonate
jitteriness, respiratory symptoms, if severe seizures
205
what DVT prophylaxis should you use in a pt with CKD
unfractionated heparin
206
what pts are most susceptible to acute subdural hemorrhage
elderly and alcoholics bc they have brain atrophy which causes the bridging veins to stretch
207
what is the mechanism of flushing seen with niacin
drug induced release of histamine and prostaglandins
208
what can you give with niacin to help reduce the risk of flushing
low dose aspirin
209
symptoms of ascending cholangitis
RUQ pain, jaundice, fever (charcoids triad)
| + hypotension and confusion (Reynolds)
210
management of a pt with charcods triad and elevated liver enzymes
ERCP to drain biliary tree
211
symptoms of tricuspid atresia
cyanosis from birth, single heart sound, LV hypertophy, RA enlargement
212
first line treatment for ankylosing spondylitis
NSAID
213
treatment of A fib with RVR
non-dihydropyradine calcium channel blocker (diltiazem or verapamil) or beta blocker (metoprolol, propranolol, esmolol)
214
how do you treat epidural hematoma
craniotomy with evacuation of the clot
215
management of a pt with >75% carotid artery stenosis who is symptomatic
carotid endarterectomy
216
when should you do an aortic valve replacement on a pt with aortic stenosis
if they are symptomatic and have an EF <50%
217
best test to diagnose a SBO
abdominal radiograph, lateral and upright
218
treatment of rib fractures in pts >65 with respiratory compromise
thoracic epidural anesthesia
219
Erbs palsy is due to damage of which bracial plexus trunk
superior
220
classic presentation of carotid artery dissection
unilateral head or neck pain with Horners syndrome
221
most common causes of secondary digital clubbing
lung malignancies, cystic fibrosis, right to left cardiac shunts
222
treatment of ethylene glycol ingestion
IVF with bicarb
fomepizole (or alcohol)
hemodialysis
223
what is an early finding in macular degeneration
distortion of vertical lines where they appear wavy
224
how can symptomatic atlantoaxial instability present
weakness, gait changes, urinary incontinence, dizziness, vertigo, imbalance, diplopia, UMN signs (babinski, spasticity, hyperreflexia)
225
causes of masses in anterior mediastinal compartment
thyme neoplasm
lymphoma
germ cell tumors
thyroid tissue
226
causes of masses in middle mediastinal compartment
sarcoidosis, lung cancer, lymphoma
pericardial cyst, bronchogenic cyst
vascular masses
esophageal tumors
227
causes of masses in posterior mediastinal compartment
neurogenic tumor
spinal masses
lymphoma
228
symptoms of duodenal ulcer
pain with fasting, nausea, pain that wakes you up at might, postprandial bloating
229
what is a good physical test to look for disc herniation
crossed leg straight leg test (pain in affected leg when you raise the opposite leg)
230
cancers that cause increased PTHrP
squamous cell (head, neck, lung), renal, bladder, breast, ovarian
231
what is the best imaging to see avascular necrosis
MRI
232
risk factors for avascular necrosis of femoral head
```
SLE
sickle cell
glucocorticoids
alcohol abuse
antiphospholipid syndrome
infections
renal transplant
```
233
first line treatment of keloids
intralesional triamcinolone (steroid)
234
what specialty tests can you use to diagnose a rotator cuff tear
painful arc: pain over 90 degree
drop arm test: can't control adduction from 90 degrees
weakness in external rotation
235
diagnostic workup for acute lung transplant rejection
bronchiolar lavage and biopsy to rule out infection
236
initial workup for primary adrenal insufficiency
morning cortisol test and ACTH stimulation test
237
triad of spinal epidural abscess
spinal pain with progression to radiculopathy.
neurologic deficits
fever
238
treatment of meningioma
surgical resection
239
triad of symptoms for a fat embolism
```
respiratory distress
neurologic dysfunction
petechial rash (in 50% of patients)
```
240
causes of metabolic alkalosis with low urine chloride
vomiting
| diuretic overuse
241
what specialty test can you use for achilles tendon rupture
calf squeeze test- absence of plantar flexion when the calf is squeezed shows that tendon is ruptured.
242
symptoms of cryptococcus neoformans infection
increased ICP (headaches, dizziness)
N/V
abducens nerve palsy
umbillicated skin lesions
243
how can you diagnose leprosy
skin biopsy from edge of lesion
244
symptoms of transposition of great arteries
cyanosis within first 24 hours of life, single S2, tachypnea.
usually no murmur unless also has VSD
245
how can you differentiate hypo plastic left heart from transposition?
HPLH presents days after birth once the PDA closes, transposition occurs within first 24 hours.
246
diagnosis and management of tracheobronchial injury
dx: bronchoscopy
tx: surgical repair
247
what is the Neers test and what does it test for
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
how will a femur neck fracture present
shortened leg, externally rotated
249
patients with acute promylocytic leukemia are at in creased risk of what
pulmonary/cerebrovascular hemorrhage due to consumptive coagulopathy
250
why do you give sodium bicarb to patients with TCA overdose
helps cardiac stability and decreased hypotension
251
symptoms of riboflavin deficiency
chelitis, glossits, sebhorratic dermatitis
252
symptoms of pyridoxine deficiency
irritation or depression, glossitis, peripheral neuropathy, sebhorratic dermatitis
253
what drugs decrease clearance of theophylline
cimetidine, ciprofloxacin, erythromycin, clarithromycin, verapamil
254
short term management of unstable angina or NSTEMI
```
dual anti platelet (aspirin and clopidogrel)
anticoagulation (heparin)
beta blocker
nitrates prn
high dose statin
```
255
how do you manage vfib
defibrillate, if it doesn't work after several attempts then amiodarone.
epic every 3-5 min after defibrillates.
256
symptoms of primary biliary cirrhosis
hyperpigmentation, puritis, fatigue, hepatomegaly
257
calcium homeostasis in pts with sarcoidosis
increased calcitriol
decreased PTH
increased urinary calcium
258
how can you differentiate plantar fasciitis from calcaneal stress fracture
stress fracture will have a positive squeeze test (pain when you squeeze media lateral heel)
259
most common cause of amaurosis fugax (rapid and transient mono vision loss)
retinal ischemia due to atherosclerotic emboli from ipsilateral carotid artery
260
what lung condition will present with tracheal deviation towards the affected lung?
atelectasis
261
skeletal muscle necrosis in pts with high electrical burn injury are at increased risk of what conditions?
rhabdomyolysis, AKI, acute compartment syndrome
262
causes of increased maternal AFP in pregnancy
abdominal wall defects
multiple gestations
open neural tube defects
263
management of febrile neutropenia
blood and urine cultures, immediate broad spectrum antibiotics (pip-tazo, cefepime, miropenem)
264
complications of traumatic hyphema (eye injury)
rebreeding, increased intraocular pressure --> optic nerve atrophy, permanent vision loss
265
management of stroke in pts with sickle cell
exchange transfusion
266
how can you measure recurrance of medullary thyroid cancer
serum calcitonin
267
symptoms of HSV keratitis
acute onset eye pain, photophobia, blurred vision,
268
what will you see on slit lamp exam of HSV keratitis
dendritic ulcers- branching linear lesions
269
envelope shaped calcium oxalate crystals are usually due to ingestion of what
ethylene glycol
270
how long after delivery can preeclampsia be present for?
up to 6 weeks
271
symptoms of measels
rash, coryza, cough
272
treatment of papulopustular rosacea
first line: topical metro, azeliac acid, ivermectin.
| Second line: oral tetracyclines
273
management of a pt with hypotension, JVD, decreased breath sounds on one side
immediate needle thoracotomy- likely a tension pneumo
274
first line treatment for mild/moderate myasthenia graves
pyridostigmine
275
treatment for patients with agitation due to acute delirium
low dose haloperidol
276
gold standard for diagnosing kidney stone
non-contrast helical CT scan
277
optimal treatment for hepatocellular carcinoma
surgical resection of the mass
278
what screenings are recommended at an initial prenatal visit and during 3rd trimester for high risk patients
```
HIV
RPR
chlamydia
gonhorrea
Hep B&C
```
279
symptoms triad of invasive aspirgillous
fever, pleuritic chest pain, hemoptysis
280
what will CT scan of lungs show in invasive aspirgilous
nodules with surrounding ground glass opacities
281
acute dystopias (muscle stiffness, tongue protrusions, torticollis) can occur after administration of what drug class
dopamine antagonists (metoclopramide, prochlorperazine, antipsychotics)
282
evaluation and treatment of PMS and premenstraul dysphoric disorder
symptoms diary for 2 consecutive cycles
| tx: SSRI
283
best test to diagnose blunt thoracic aortic injury
CT angio of chest
284
how does iliotibial band syndrome present
poorly localized lateral knee pain, pain at lateral femoral epicondyle with flexion or extension
285
presentation of vestibular neuritis
acute onset, singular episode that can last days. Vertigo, N/V. usually follows viral infection
286
what is the only indication for hormone replacement therapy for women with menopause within the last 10 years who are <60 yo
vasomotor symptoms
287
treatment of E granulosis cyst
albendazole
percutaneous therapy if >5cm
surgery
288
side effects of trimethoprime
hyperkalemeia and increased creatinine
289
what infection control do you need for measels
airborne precautions
290
what is the most common cause of acquired angioedema
ACE inhibitors
291
waht is a major complication of nephrotic syndrome due to loss of antithrombin 3
renal vein thrombosis and other thrombosis
292
for a bipolar patient wishing to get pregnant, she should switch from valproic acid to what drug
lamotrigine
293
management of a pt with charcoid triad and elevated liver enzymes
ERCP
294
management of a pt with suspected ascending cholangitis but without complete charcoid triad
abdominal US
295
side effects of first generation antihistamines (diphenhydramine, chlorphenamirine, hydroxyzine)
antimuscarinic--> dry eyes, dry mouth, urinary retention
296
mechanism of how antimuscarinics cause urinary retention
impaired detrusser muscle contraction
297
clinical manifestation of bronchiolitis obliterans
usually due to chronic lung transplant
obstructive disease
negative bronchoalveolar lavage and culture
298
symptoms of uncal herniation
oculomotor nerve palsy (down and out)
contralateral hemiparesis
contralateral homonymous hemianopsia
299
what is an indication for mitral valve repair in severe mitral regurg
if EF is between 30-60% regardless of symptoms
300
what can be a symptom of pancreatic cancer that you always forget
back pain that is worse at night when laying down
301
victims of smoke inhalation should be empirically treated for what
CO poisoning and cyanide poisoning
302
following blunt abdominal trauma, what signs should raise your concern for pancreatic duct injury
persistent abdominal discomfort
vomiting
peri pancreatic fluid collection
serial increases in amylase
303
symptoms of acute epididymitis in young pts
unilateral posterior testicular pain that gets better with elevation of the testicles
epididymal edema
dysuria, frequency
304
first line treatment of CML
tyrosine kinase inhibitors like imatinib
305
MOA of gabapentin and pregabalin
alpha-2-delta calcium channel ligands
306
first line treatment of PCP induced agitation
benzos
307
management of a pt with scoliosis with a cobb angle <20
observation
308
management of increased ICP
elevate head of bed
hyperventilation
IV mannitol
309
if you're allergic to PCNs then what other antibiotic are you prob allergic to?
cephalosporins
310
what antibiotic should be given prophylactically for cardiac surgery
1st: cefazolizn
2nd: vancomycin or clindamycin
311
symptoms and cause of lemierre syndrome
fusobacterium necrophorum.
prolonged duration of sore throat, high fevers, dysphagia, neck swelling, cavitation in the lungs.
312
symptoms of C7 rediculopathy
weakness in wrist flexion and triceps extension, numbness of middle and index finger
313
treatment of HIT
stop heparin
| start direct thrombin inhibitor or fondaparinux
314
management when purulent pericarditis is expected
urgent pericardiocentesis
315
what is a consequence of rapid action intubation and why
aspiration of gastric contents bc propofol and succinylcholine impair gag reflex and epiglottis function
316
what is a concerning sign of malignancy with a parotid gland tumor
involvement of the facial and trigeminal nerves
317
management of auricular hematoma
drainage
| pressure packing
318
where does testicular cancer spread to first most likely?
retroperitoneal lymph nodes
319
what intervention should you do for a pt with TBI and ICP
immediate osmotic therapy (hypertonic saline, mannitol) to extract water
320
physical exam findings in quadriceps tendon rupture
low lying patella, palpable defect above the patella
321
what antibiotic is usually used for an infected wound caused by human bite
amoxicillin-clauvunate
322
side effect of succinycholine
can induce cardiac arrhythmia due to increased K
323
what is a common side effect of thoracic abdominal aorta repair
spinal cord infarct--> anterior cord syndrome
324
clinical features of posterior dislocation of the shoulder
arm held in adduction and internal rotation
| prominance of coracoid and acromion
325
first line treatment of invasive burn wound infection
pip-tazo or meropenom and Vanco
326
first line treatment of noninvasive burn wound infection
cefazolin or clindamycin
327
management of hemorrhagic stroke
```
maintain BP (IV nifedipine or labetolol)
reverse anticoagulation
reduce ICP (elevate HOB, mannitol)
```
328
what are the best predictors of postoperative complications following lung resection
FEV1 and DLCO
329
after stabilizing a knee dislocation, what is an important next step?
documenting vascular status:
Get ABI
palpate politeal pulse
doppler US
330
treatment of lymphangitis
cephalexin
331
damage to the anterior bladder wall would cause fluid in what space
extraperitoneal- retropubic space
332
damage to the dome of the bladder would cause fluid in what space
intraperitoneal
333
causes of bile acid diarrhea
post cholesectomy
| diseases involving ilium (chrons, abdominal radiation damage)
334
treatment of bile acid diarrhea
bile acid binding resins (cholesterolstyramine, colestipol)
335
treatment of chronic bacterial prostatitis
6 weeks of fluroquinilone (cipro)
336
side effects fo CO2 gas insufflation
increased intraabdominal pressure leads to increased vagal tone --> bradycardia and heart block. Can also get increased BP.
337
treatment of acute bacterial prostatitis
6 week fluroquinilone or bactrim
338
treatment of pulmonary abscess
ampicillin-sulbactem
339
migratory superficial thrombophlebitis (trousseau sign) is most likely associated with what?
pancreatic cancer
340
symptoms of erythema nodosum
painful, violacious, erythematous nodules on the shin. Most commonly associated with IBD (chrons more likely)
341
what paraneoplastic syndromes is small cell lung cancer associated with
ACTH and SIADH
342
what paraneoplastic syndrome is squamous cell carcinoma associated with
PTHrP
343
complications of supracondylar fractures?
injury to median n and brachial a
344
what class of antibiotics are contraindicated in pts with AAA
fluroquinolones due to cartilage disruption
345
why do all pts with a retropharyngeal abscess need lateral Xray
to exclude necrotizing mediastinitis
346
what medication can you give to help pass a kidney stone
alpha blocker- tamsulosin
347
symptoms of peri-infarction pericarditis
occurs within 4 days of MI.
| Pleuritic chest pain that radiates to left shoulder, widespread ST elevation or PR depression.
348
how can you confirm Conn's syndrome
low plasma renin with high aldosterone
349
what foes a low d-xylose test indicate
celiacs
350
what is the timeframe for delayed hemolytic transfusion reaction?
>24 hrs - 1 month after transfusion
351
empiric treatment of chlamydia and gonhorrhea
ceftriazone and doxy
352
first line treatment of acute pericarditis due to SLE
NSAID
Corticosteroid if can't take NSAID
353
symptoms of galactosemia
jaundice and hepatomegaly
vomiting, poor feeding, failure to thrive
cataracts
increased risk of E. coli sepsis
354
treatment of cryptococcal meningitis
IV amphotericin B and flucytosine for 2 weeks and then fluconazole for maintenance for a year
355
what alternative antibiotic can you give to a pt with syphilis who is allergic to PCN
doxycycline
356
what happens to total body potassium in DKA
decreased
357
first line treatment for fibromyalgia
TCA
358
what opioids should pts with kidney disease avoid
morphine
tramadol
meperidine
codeine
359
what is defective in chronic granulomatous disease
decreased superoxide production
| -increased risk of catalase positive organisms
360
management of hypercalcemia of malignancy
bisphosphanates (zoledronic acid)
361
EKG findings in anterior wall MI
leads V1-V6
| LAD
362
EKG findings in inferior MI
ST elevation in 2,3 AvF
| RCA or LCX
363
EKG findings in posterior MI
ST depression leads V1-3
ST elevation in 1 and AvL (LCX)
ST depression in 1 and AvL (RCA)
364
EKG findings in lateral wall MI
ST elevation in leads 1, all, V5-6
ST depression in leads 2,3,AVF
LCX or diagonal
365
management of pulmonary HTN due to left sided heart failure
optimize heart failure drugs
366
management of pulmonary HTN due to connective tissue disorders
pulmonary artery vasodilators
367
symptoms of chronic demyelinating polyneuropathy
proximal and distal muscle weakness
distal sensory loss
lower motor neuron signs (hyporeflexia, atrophy)
368
MOA of graft versus host disease
donor T lymphocytes attack
369
CNS manifestations of tuberous sclerosis
subependymal tumors, epilepsy (infantile seizures), intellectual disability
370
what disease is associated with anti smooth muscle antibody
autoimmune hepatitis
371
what is the difference between sleep terror disorder and nightmare disorder
sleep terror has incomplete awakenings, cannot be consoled, and does not remember the dream.
372
what will an US of the liver show on a pt with nonalcoholic fatty liver disease
hyper echoic appearing liver
373
hepatojugular reflex is highly specific for what
right sided heart failure
374
how can you differentiate CML from a leukomoid reaction
LAP score will be low in CML
375
pupil sparing CN 3 palsies due to microvascular ischemia is associated with what conditions
diabetes, HTN, hyperlipidemia, old age
376
non-pupil sparing CN3 palsies are most likely do to what
intracranial aneurysm
377
symptoms of CKD in a child
fatigue, poor growth, HTN, daytime and nighttime enuresis
378
what is the cause of refeeding syndrome
increased insulin causes decreased potassium, phosphorus, and mg
379
what is a common side effect of venlafaxine
HTN
380
besides treating depression, what other conditions is mirtazapine good for?
stimulates appetite, helps with sleeping issues,
381
Symptoms of Todd paralysis
weakness or paralysis of extremities following focal seizure activity.
382
what happens to serum phosphorus in vit D deficiency
low
383
symptoms of lithium toxicity
GI upset, N/V, tremors, ataxia, fasciculation's, seizure
384
treatment of myasthenia crisis
intubate for respiratory support
| plasmapheresis or IVIG and corticosteroids
385
treatment of acute dystonia from extraperimidal symptoms
benztropine
| diphehydramine
386
treatment of akathisia from extraperimidal symptoms
Beta blocker
BZD
benztropine
387
treatment of parkinsonism from EPS
benztropine
| amantadine
388
treatment of tar dive kinesis from EPS
valbenazine
| deutratabenzine
389
symptoms of allergic interstitial nephritis
rash, fever, acute renal failure, WBC casts
390
first line treatment fo acute bipolar depression
quetiapine or lurasidone
391
how do you treat afib in pts with WPW
procainamide or ibutilide
392
diagnosis criteria for dementia with Lewy bodies
dementia plus 2/4 of following:
- parkinsonism
- fluctuating cognition
- visual hallucinations
- REM sleep behavior disorder
393
treatment of scleroderma renal crisis
ACE inhibitor
394
what drug should you give to someone with MDD that is concerned about sexual side effects
bupropion
395
management of acute splenic sequestration in SCD
isotonic fluid
packed red blood cells
possible splenectomy
396
how can you distinguish between epilepsy and psychogenic non-epileptic seizures
measure prolactin level (seizure will have elevated prolactin)
397
symptoms of temporal lobe epilepsy
can be associated with significant interichtal psychosis that is hard to differentiate from schizophrenia
398
Indication for trazadone
MDD with insomnia or anxiety
399
side effects of trazodone
orthostatic hypotension, priapism
400
side effect of venlafaxine
HTN
401
what drugs can you use to control acute symptoms of mania
olanzapine, aripiprazole, quetiapine, risperidone, ziprasidone
402
what drug is used to manage withdrawal symptoms from benzo use
chlordiazepoxide (bc it has a long half life)
403
side effects of clozapine
neutropenia, agranulocytosis, myocarditis, seizures
404
what is the best combination therapy for bipolar
lithium or valproate plus a 2nd gen antipsychotic
405
conus medullar is syndrome
L1-L2
UMN
low back pain, mild or absent radicular pain, bowel/bladder dysfunction.
symmetric motor weakness, hyperreflexia.
406
what actions do you lose with C5 INJURY
elbow flexion and shoulder abduction
407
what actions do you lose with C6 injury
elbow flexion, wrist extension, forearm pronation/supination
408
what actions do you lose with C7 injury
elbow extension, wrist flexion, finger extension
409
what actions do you lose with C8 injury
finger flexion and extention
| thumb flexion and abbduction
410
what actions do you lose with T1 injury
finger abduction and adduction
411
how does a galctocele present
usually after stopping breast feeding- soft, mobile, nontender subareolar mass
412
in an infant with 5 or more hemangioma, what should you evaluate?
liver ultrasound
413
if a baby has hemangioma in the bears distribution what should you do?
laryngoscope
414
if a baby has facial/segmental hemangioma what should you evaluate
echo and MRI of head
415
aspirin overdose acid base status
```
respiratory alkalosis (low CO2) (acute)
metabolic acidosis (low bicarb) (hours)
```
