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UWorld Step 2 Notes Flashcards

1
Q

Defect in b-cell tyrosine kinase

A

Bruton agammaglobulinemia

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2
Q

Skin infections
Mucosal infections
Poor wound healing
No pus

CBC lab?

A

Leukocyte adhesion deficiency

Neutrophilia

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3
Q

Increased C2b and bradykinin

A

C1 inhibitor deficiency

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4
Q

Low C1q

A

Acquired angioedema (over 30 y/o)

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5
Q

Causes of pericarditis

A

Cards surgery, TB, radiation, malignancy, uremia, virus, idiopathic, connective tissue disorders

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6
Q

Kussmaul’s sign

Sign of?

A

No decrease in JVP on inspiration

Defective/restricted RV

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7
Q

Systolic HTN, normal diastolic BP

A

Elderly w/ stiff vessels

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8
Q

Lipid lowering therapy guidelines

A
  1. Clinical atherosclerosis (moderate if over 75, high if under 75)
  2. LDL > 190 (high)
  3. 40-75 w/ DM (high if over 7.5% risk, moderate if under 7.5% risk)
  4. 10 year risk > 7.5%
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9
Q

High intensity statins

A

Atorvastatin (high dose)

Rosuvastatin (high dose)

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10
Q

Risk factors for PACs (4)

A

Caffeine, smoking, EtOH, stress

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11
Q

Signs of AS + thrill above sternum

What else will they have? Why?

A

Supravalvular AS

Exercise-induced ischemia 2/2 coronary artery stenosis

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12
Q

Papillary muscle rupture…which infarct?

A

RCA

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13
Q

Free wall rupture…which infarct?

A

LAD

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14
Q

Endocarditis –> aortic regurg and AV block

A

Perivalvular abscess

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15
Q

Gross hematuria after sudden severe pain in upper abdomen + Hypotension

A

AAA rupture –> fistula w/ IVC –> retroperitoneal vein backup –> bladder vein rupture

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16
Q

Post-op…fever…cloudy fluid…widened mediastinum

Tx?

A

Acute mediastinitis

Surgery + Abx

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17
Q

Chest pain + stable…workup/tx?

A
  1. Aspirin (unless dissection)
  2. EKG
  3. CXR
  4. Treat problem
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18
Q

STEMI - tx?

A

Emergency cath or thrombolysis

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19
Q

NSTEMI - tx?

A

Anticoagulation

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20
Q

Exertional syncope…cause?

A

Outflow obstruction

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21
Q

B/l hip, thigh, butt claudication + impotence + b/l LE atrophy

A

Occlusion at aortoiliac junction (Leriche syndrome)

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22
Q

Hypertrophic cardiomyopathy…genetic inheritence?

A

AD

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23
Q

Most common arrhythmias after an MI

A

V tach

V fib

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24
Q

A fib…assess what?

A

Clot risk via CHA2DS2 VASc

CHF
HTN
Age > 75 (2)
DM
Stroke/TIA/TE (2)
Vascular dz
Age 65-74
Sex category (female)
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25
Q

CHADS-VASc…when to anticoagulate?

Use what?

A

2+

Warfarin, NOT aspirin

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26
Q

S4 after severe chest pain

A

MI –> myocardial stiffening

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27
Q

DeGeorge symptoms

A 
CATCH 22...
Conotruncal cardiac defects (truncus arteriosus)
Abnormal facies
Thymic aplasia
Cleft palate
HYPOCALCEMIA
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28
Q

When to do surgery for carotid atherosclerosis (3)

A
  1. Men > 50% w/ symptoms
  2. Men > 60%
  3. Women > 70%
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29
Q

Adenosine…used in what?

Why?

A

SVTs

Slows supraventricular and AV conduction, revealing P waves

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30
Q

Order of most important things to lower BP

A
  1. Weight loss
  2. DASH diet
  3. Exercise
  4. Sodium restriction
  5. Alcohol restriction
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31
Q

Systolic murmur at lower sternal border that increases w/ respiration

A

Tricuspid regurg

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32
Q

Firm hyperpigmented nodule on lower extremity that dimples in the center when pinched

A

Dermatofibroma

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33
Q

Firm mobile cyst or nodule that recurs

A

Epidermal inclusion cyst

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34
Q

Chronic, relapsing skin condition w/ abscesses and sinus tracts and scarring

A

Hydradenitis suppurative

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35
Q

Red plaques w/ vesicles or pustules, Candida

A

Intertrigo

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36
Q

Furuncle = what?

A

Staph abscess

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37
Q

Pituitary mass + increased prolactin + decreased everything else

A

Non-secreting macroadenoma

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38
Q

Pituitary mass + decreased LH + increased prolactin

A

Prolactin-secreting microadenoma (Prolactin suppresses GnRH)

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39
Q

HTN, taking diuretic –> develops low K+ and still has HTN

A

Primary hyperaldosteronism (prone to diuretic-induced hypoK)

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40
Q

Cabergoline…MoA?

Other one like it?

A

Dopamine agonist

Bromocriptine

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41
Q

Sudden onset symptomatic hyperkalemia…think what?

A

Malignancy

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42
Q

2 Ab types in hypothyroidism

Which one has large thyroid and recurrent pregnancy loss?

A

Anti-TPO
TSH receptor-blocking

Anti-TPO

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43
Q

Hyperthyroid drug major side effect

Others?

A

Agranulocytosis

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44
Q

Child, distal extremity myotonia, testicular atrophy, baldness

A

Myotonic congenital myopathy (AR)

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45
Q

Diabetic gastroparesis…tx?

A

Metoclopramide

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46
Q

Small vs large fiber DM neuropathy

A

Small - pain, paresthesias

Large - numb, loss of prop/vib, loss of reflexes

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47
Q

How to calculate attributable risk?

A

(RR-1)/RR

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48
Q

Symptomatic bradycardia…Tx?

A

IV atropine
IV epi or Dopamine if bad
Pacing is worst case

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49
Q

Fusion/capture beats…rhythm?

A

V tach

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50
Q

Tx stable V tach

A

Amiodarone

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51
Q

Tx SVT stable

A

Carotid massage
Rate control (esmolol, dig)
Adenosine if super fast

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52
Q

Tx SVT unstable

A

Cardiovert

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53
Q

Best way to slow DM nephropathy

A

BP control (ACEI/ARB)

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54
Q

Intense glc control in DM…purpose?

A

Prevent nephropathy and retinopathy (MICROvascular issues)

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55
Q

CT contrast –> proptosis, lid lag, fever, delirium, vomiting

A

Thyroid storm precipitated by IV iodine in person w/ hidden hyperthyroidism

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56
Q

Corrected Ca for low albumin

Low albumin = what for Ca?

A

Ca + (.8)(4-alb)

Low TOTAL Ca++ but normal IONIZED Ca++

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57
Q

Secondary amenorrhea…workup?

A
  1. Pregnancy test
  2. TSH/Prolactin/FSH
  3. Scope if prior surgery or infection
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58
Q

Hashimoto’s vs. Painless vs. Grave’s

A

Hashimotos - diffuse painless goiter

Painless - brief hyperthyroid, small goiter, then recovery, DECREASED iodine uptake

Grave’s - INCREASED iodine uptake

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59
Q

Things that cause ox. stress in G6PD

A 
Sulfa drugs
Fava beans
Nitrofurantoin
Antimalarials
Infections
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60
Q

Heinz body

Seen in what? (4)

A

Damaged, clumped hemoglobin

G6PD, Alpha thal, Chronic liver dz, NADPH deficiency

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61
Q

Prussian blue positive urine stain

A

Hemosiderin - G6PD

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62
Q

Atypical glandular cells on pap…workup?

A

Colp + ECC + EMB

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63
Q

McCune-Albright…symptoms (3)

A

Cafe-au-lait spots
Polyostotic fibrous dysplasia
Endocrine hyperfunction (precocious puberty, etc.)

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64
Q

Kallman syndrome…genetics?

A

X-linked

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65
Q

Indications for endometrial biopsy

A

Under 45 w/ AUB and cause for extra estrogen OR failed medical management OR Lynch syndrome

Over 45 w/ AUB or PMB

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66
Q

Ovarian torsion…abdominal exam?

A

MASS

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67
Q

Severe (sick) PID…tx?

A

Hospital
IV cef + Oral Doxy
(IV clinda + IV gent)
Metro if TOA present

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68
Q

Why does estrogen cause HTN?

A

Increased angiotensinogen by liver –> increased aldosterone

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69
Q

Hirsutism vs. Virilization

A

Hirsutism - excess body hair

Virilization - clitoromegaly, aggressive, deep voice

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70
Q

Endometriosis - Tx?

A
  1. NSAIDs, OCPs

2. Laparoscopy

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71
Q

Condyloma accum - Tx?

A

Topical acetic acid

Podophyllin resin

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72
Q

Genital lesion w/ broad base, velvety, lobulated or plaque like

A

Condyloma lata

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73
Q

Pt had Roux-en-Y bypass surgery –> 5-6x per day fatty diarrhea, abdominal pain, weight loss, anemia, vitamin deficiency, flatulence

How to diagnose?

A

SIBO

  • Jejunal aspirate
  • Carbohydrate breath testing
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74
Q

High homocysteine

Normal methylmalonic acid

A

Folate deficiency

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75
Q

Microvesicular steatosis

A

Reye syndrome

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76
Q

Macrovesicular steatosis

A

EtOH hepatitis

NAFLD

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77
Q

Periportal eosinophilic inclusion bodies

A

A1ATD

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78
Q

Sinusoidal congestion, hemorrhagic necrosis

A

CHF liver

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79
Q

Bile plugs, portal edema, fibrosis

A

Biliary atresia

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80
Q

Pancreatic CA w/ jaundice…U/S or CT?

A

U/S

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81
Q

Pancreatic CA w/o jaundice…U/S or CT?

A

CT

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82
Q

3 requirements for acute liver failure diagnosis

A

Elevated LFTs
Signs of hep enceph.
INR > 1.5

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83
Q

3 requirements for ARDS diagnosis

A

B/l alveolar infiltrates
PaO2/FiO2 < 200
PCWP < 18

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84
Q

PBC…tx?

A

Ursodeoxycholic acid

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85
Q

Autoimmune hep…ab?

Tx?

A

Anti-smooth muscle

Steroids

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86
Q

Causes of niacin deficiency

A 
Prolonged INH
Alcoholism
Chronic illness
Carcinoid syndrome
Hartnum dz
Nutritional def.
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87
Q

Cyclic vomiting syndrome…look for what?

A

FHx of migraines

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88
Q

Angiodysplasia…usually diagnosed in who?

A

vWD
Renal failure
Aortic stenosis

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89
Q

When will bilirubin be in the urine?

A

Conjugated hyperbilirubinemia (unconjugated is bound to albumin, not excreted)

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90
Q

Low vs. high stool osmotic gap

A 
Low = secretory
High = osmotic
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91
Q

Why do you get NAFLD in DM?

A

No insulin response –> peripheral lipolysis –> TG synthesis and hepatic uptake of FFAs –> oxidative stress on liver –> NAFLD

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92
Q

DES or Achalasia…Tx?

Why do they work?

A

CCBs or Nitrates

Relax smooth muscle (esophageal too)

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93
Q

Duodenal villous atrophy…dx?

Look for?

A

Celiac dz

Iron deficiency

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94
Q

When do you take the colon out in FAP?

A

Significant increase in polyps (20s) or malignancy

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95
Q

Fatty stools, weight loss, ulcers in duodenum and jejunum…why these symptoms?

A

Zollinger-Ellison

Gastric acid inactivates pancreatic enzymes in duodenum

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96
Q

Impaired glucose control in DM…what vitamin deficiency?

A

Chromium

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97
Q

Brittle hair, skin depigmentation, neuro issues, sideroblastic anemia, osteoporosis…what vitamin deficiency?

A

Copper

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98
Q

Thyroid issue, cardiomyopathy, immune dysfunction…what vitamin deficiency?

A

Selenium

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99
Q

Alopecia, pustular rash, hypogonadism, impaired wound healing, impaired taste, immune dysfunction…what vitamin deficiency?

A

Zinc

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100
Q

Acalculous cholecystitis…what is it?

A

Trauma or illness or surgery –> stasis or ischemia of GB –> inflammation

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101
Q

Jaundice, fever, RUQ pain

A

Charcot triad – cholangitis

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102
Q

Air-fluid level in GB, air in biliary tree, crepitus on palpation over GB

Tx?

A

Emphysematous cholecystitis

Emergent cholecystectomy + Unasyn abx

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103
Q

Reversible risks for pancreatic cancer

A

Smoking

Obesity

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104
Q

Hepatic hydrothorax

A

Peritoneal fluid passes through defects in R diaphragm into pleural space (cirrhosis)

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105
Q

3 reasons for physiologic jaundice

A
  1. High RBC turnover
  2. Slow hepatic UGT
  3. Sterile gut = no bacteria to break down bilirubin = gets reabsorbed
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106
Q

C diff…tx for mild, severe, and horrible

A 
Mild = Oral metro
Severe = Oral vanc, IV metro
Horrible = surgery
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107
Q

At 1 year old, where should height and weight be?

A 
Weight = tripled
Height = 1.5x
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108
Q

Folic acid supplement –> progressive LE neuro damage

What will be fixed?

A

SCD (need B12 too)

Megaloblastosis

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109
Q

Hereditary spherocytosis –> cholecystitis…why?

A

RBC breakdown –> bilirubin collection –> pigment gallstones

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110
Q

Sideroblastic anemia, dimorphic RBC population

Causes?

A

Low B6

Low pyridoxine**
Lead poisoning**
Copper deficiency
Antimicrobials
Zinc excess
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111
Q

Unexplained thrombocytopenia…check what?

A

HIV

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112
Q

Factor V Leiden = what?

A

Protein C resistance

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113
Q

Causes of acquired AT deficiency? (3)

A

DIC
Cirrhosis
Nephrotic syndrome

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114
Q

Anabolic steroids…what to see for H/H, LDL, HDL, LFTs

A

High H/H
High LDL
Low HDL
High LFTs (hepatotox.)

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115
Q

Aplastic anemia
Ear problem
Skin spots

A

Fanconi anemia

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116
Q

High metamyelocytes

High myelocytes

A

Leukemoid reaction

CML

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117
Q

Abnormal eosin-5 maleimide binding test

A

Hereditary Spherocytosis

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118
Q

Protein - Albumin > 4

A

Multiple myeloma until proven otherwise

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119
Q

Hydroxyurea side effect

A

Myelosuppresion (neutropenia, etc.)

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120
Q

Sounds like G6PD, G6PD assay is normal

A

G6PD

Deficient RBCs are destroyed, reticulocytes have normal G6PD

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121
Q

What causes the destruction in G6PD?

A

RBCs cannot bind the oxidative metabolites –> membrane instability + Hgb denaturation

122
Q

CO poisoning - risk factor?

A

Smoking - already higher carboxyHgb

123
Q

Premie w/ low Hb/Hct and low retic count

Why?

A

Anemia of prematurity

Decreased EPO + short RBC life span + frequent phlebotomy in NICU

124
Q

Transplant –> pruritic rash on face, hands, feet; diarrhea; abnormal LFTs

Cause?

A

Acute graft-vs-host dz (skin, intestine, liver)

Donor T cells vs. Host HLA antigens

125
Q

ESRD - anticoagulation options

A

Warfarin ONLY (others are metabolized by kidneys)

126
Q

On warfarin but struggle w/ dietary restrictions and/or anticoag appt’s

A

Oral 10A inhibitors

127
Q

Leukoreduced blood…for what?

A

Remove WBCs and cytokines -> prevent nonhemolytic febrile reaction

128
Q

Washed blood…for what?

A

Remove IgA –> prevent IgA deficiency anaphylaxis

129
Q

AKI (high BUN/Cr)
Thrombocytopenia
Hemolytic anemia (schistocytes)

A

HUS or TTP

130
Q

Best way to confirm elevated lead level

When to give a chelator?

A

VENOUS

Over 45 (DMSA)
Over 70 (Dimercaprol + EDTA)
131
Q

60 year old man w/ weight loss, nighttime cough, smoking history, difficulty swallowing solids and liquids…..Barium shows widened mediastinum w/ dilated esophagus and smooth tapering of distal esophagus

Do what?

A

PSEUDOachalasia 2/2 cancer

Endoscopic evaluation for differentiation from actual achalasia

132
Q

Basophilic stippling, macrocytic megaloblastic anemia

A

B12 or folate

133
Q

MCV over 110, anisocytosis, poikilocytosis…what type of anemia?

A

Macrocytic MEGALOBLASTIC (B12 or folate)

134
Q

Acute HIV can present as a ____-like syndrome

How to differentiated it by symptoms?

A

Mononucleosis

HIV = painful oral ulcers, skin rash, prolonged diarrhea

135
Q

Can chronic bronchitis have hemoptysis?

136
Q

Lumbar spinal stenosis…how to dx?

A

MRI (can see bone AND nerves)

137
Q

Non-biologic DMARDs (5)

A 
Methotrexate
Hydroxychloroquine
Sulfasalazine
Leflunomide
Azathioprine
138
Q

Biologic DMARDs (5)

A 
Etanercept
Infliximab
Adalimumab
Tocilizumab
Rituximab
139
Q

In general, best drug for RA

Not in who?

Must do what before starting it?

A

Methotrexate

Pregnant, planning, renal dz, liver dz, EtOH

Test for Hep B, Hep C, TB

140
Q

If Methotrexate does not cause symptom remission for RA…?

A

Add biologic after 6 months

141
Q

Unconscious patient w/ weak pulse, elevated RAP, elevated PAP, normal PCWP

A

MASSIVE PE causing R-heart dysfunction and decreased preload to L heart –> obstructive shock

142
Q

Todd paralysis

A

Complete or incomplete hemiplegia after a seizure

143
Q

Endocarditis suspected…management?

A

BLOOD CULTURES, then echo and abx

144
Q

Pt w/ ToF has “tet” spells during feeding or exertion or crying…why?

A

All of these cause increased pulmonary vascular resistance –> complete RVOT obstruction

145
Q

Which is better in anaphylaxis…IM or IV epi?

Why?

A

IM

Less chance of adverse effects (arrhythmias, etc.)

146
Q

Gilbert syndrome…genetic cause?

A

UDPGT mutation

147
Q

Alcoholic, anion gap acidosis, vision loss, coma, hyperemic optic disc

A

Methanol poisoning

148
Q

Alcoholic, anion gap acidosis, acute kidney failure

A

Ethylene glycol poisoning

149
Q

MC cause of death in ESRD patient

A

Cardiovascular disease (many reasons AND common other predisposing medical conditions)

150
Q

Reasons for CV disease in dialysis patient

A
  1. ESRD in general
  2. Anemia
  3. Metabolic abnormalities
  4. Increased homocysteine
  5. Uremia-induced accelerated atherogenesis
  6. Increased Ca uptake -> coronary calcification
  7. Inhibition of N.O.
151
Q

Unilateral motor impairment, no sensory or cortical deficits…what stroke?

A

Lacunar infarct

152
Q

Unilateral sensory and motor deficit of face, arm, and leg; eye deviation away from affected side, homonymous hemianopia…what stroke?

153
Q

Unilateral sensory and motor deficit, worse in lE, urinary incontinence, emotional disturbances, primitive reflexes…what stroke?

154
Q

Ipsilateral CN dysfunction, Contralateral hemiplegia possible ataxia…what stroke?

A

Vertebrobasilar system

155
Q

Why urinary incontinence in ACA stroke?

A

Cortical micturition centers in mesial frontal lobe

156
Q

How do you diagnose toxic megacolon?

A

Abdominal XRAY

157
Q

Meningococcal vaccination recommendations

A
  1. First dose between 11-18 (11-12 is ideal)
  2. Booster at 16 if initial was before that
  3. Adult booster if high risk (immunodeficient, college, military, travel to endemic Africa/Saudi Arabia)
158
Q

AIDS diarrhea… (4)

A 
MAC = fever > 102, watery, CD4 under 50
CMV = intermittent bloody, CD4 under 50
Crypto = severe watery, low grade fever, CD4 under 180
Micro/Iso = watery, no fever, CD4 under 100
159
Q

Hyperthyroid (High T4, Low TSH), diffusely decreased iodine uptake…options?

How to differentiate?

A

Thyroiditis or Exogenous thyroid hormone

Serum thyroglobulin…LOW = exogenous, HIGH = endogenous

160
Q

How to calculate A-a gradient in a person breathing room air

How to calculate expected A-a gradient

A

150 - (PaCO2/0.8)

(Age/4) + 4

161
Q

AIDS, severe watery diarrhea, low fever

A

Cryptosporidium

162
Q

AIDS, watery diarrhea, no fever

A

Isospora/Microspora

163
Q

AIDS, watery diarrhea, high fever over 102.2

164
Q

AIDS, intermittent bloody diarrhea

165
Q

Pinworm…tx?

A

Albendazole, Pyrantel

166
Q

Chagas…tx?

A

Benznidazole

167
Q

Strongyloides…tx?

A

Ivermectin

168
Q

Onchocerciasis…tx?

A

Ivermectin

169
Q

Pneumonia symptoms
Arthralgias
Erythema nodosa

A

Valley fever - Coccidioides

170
Q

Empiric abx for human bite

Bugs?

A

Augmentin

Strep, staph, anaerobes, other

171
Q

Unilateral LAD…bugs?

A

Staph
Strep
MAC
Bartonella

172
Q

Empiric abx for baby w/ systemic bacterial sepsis (can’t tell why yet)

Workup?

A

Ampicillin + Gentamicin

CBC, cultures, LP, U/A, urine culture

173
Q

Why to hospitalize in pyelo? (5)

A 
Vomiting
Elderly
Septic
DM
Obstruction
174
Q

Thick and thin blood smears, giemsa stain

175
Q

Infection of upper dermis, warm tender red RAISED w/ SHARP BORDERS

Classic location to differentiate from cellulitis

A

Erysipelas (GABHS)

External ear (no lower dermis)

176
Q

Possible disseminated gonococcal infection syndromes

A

Purulent monoarthritis, AND/OR

Tenosynovitis, dermatitis, migratory polyarthralgias

177
Q

Vitamin A…functions besides in eye

A

Turnover of mucosal cells

B-cell production promotion

178
Q

Young patient, post-viral bacterial pneumonia, multilobar w/ cavitary infiltrates, leukopenia, hemoptysis

179
Q

Rash, elevated LFTs, thrombocytopenia, lymphopenia, polyarthralgias…recently traveled

A

Chikungunya fever (Aedes)

180
Q

Gray lesions on posterior oropharynx, summer or fall

A

Coxsackie herpangina/HFM

181
Q

Arthralgias, porphyria cutanea tarda, fatigue

182
Q

Lung cavitation w/ TB/staph/fungus, IV drug user, no murmur

A

Tricuspid endocarditis (no murmur b/c low flow)

183
Q

TB symptoms, ulcerated skin lesions, lytic bone lesions

184
Q

Meningitis…normal glc, normal lymphocytes, low protein

A

Viral (enteroviruses - coxsackie or echo)

185
Q

What do you do for rabies PEP for a pet bite vs low risk animal bite vs high risk animal bite?

A

Pet - wait 10 days, observe pet
LR - nothing
HR - kill animal and test, or rabies PEP if no access to animal

186
Q

Adult: Pharyngitis + other symptoms…how to know how to treat/test?

A

Centor criteria…fever, anterior LAD, tonsillar exudates, NO cough

0-1 = treat like viral
2-3 = tb test
4+ = treat as strep
187
Q

Child w/ pharyngitis…how to test?

A

Rapid strep antigen…follow negative result w/ throat culture

188
Q

Child under 20 w/ CF + pneumonia…bug?

A

Staph aureus

189
Q

Adult over 20 w/ CF + pneumonia…bug?

A

Pseudomonas

190
Q

Child has pertussis…what to do about family?

A

Prophylax (Z-pack) EVERYONE

191
Q

Pain on gentle palpation of spine, chronic and slowly progressing back pain

A

Vertebral osteomyelitis

192
Q

Echinococcus tx?

A

Metro + luminal paromomycin

193
Q

Umbilical stump infection, hypertonicity

A

Neonatal tetanus

194
Q

Rash in neck/axillae/groin, then spreads everywhere, then desquamates from head down

A

Scarlet fever

195
Q

Terazosin, Tamsulosin…MoA?

A

Alpha blockers

196
Q

Finasteride, Dutasteride…MoA?

A

5-alpha reductase blockers

197
Q

When to test for chlamydia and gonorrhea if not symptomatic

A

Under 24, sexually active

198
Q

Parkinsonism, autonomic symptoms, widespread other neuro symptoms

A

Multiple system atrophy (Shy-Drager syndrome)

199
Q

T-wave inversion…causes?

A

MI, myocarditis, old pericarditis, myocardial contusion. digoxin toxicity

200
Q

Friedreich ataxia…genetics?

201
Q

Carbamazepine…what to monitor?

A

Leukopenia, aplastic anemia (CBC)

202
Q

Cataracts only…what type of galactosemia

A

Galactokinase deficiency

203
Q

Cataracts + HSM + jaundice + seizures…what type of galactosemia

A

G1PUT deficiency

204
Q

Cataracts + HSM + jaundice + deafness + hypotonia…what type of galactosemia

A

UDG4E deficiency

205
Q

Chronic alcoholic w/ wide-based gait and postural instability, no anemia…cause?

A

“Alcoholic cerebellar degeneration” - purkinje cell degeneration in cerebellar vermis

206
Q

Solitary met to brain…cancer?

A

Breast, colon, renal

207
Q

Multiple mets to brain…cancer?

A

Lung, melanoma

208
Q

Central scotoma, washed-out color appearance, dilation on direct light stimulation

A

Optic neuritis (MS)

209
Q

Pain after lacunar infarct

A

Thalamic pain syndrome

210
Q

Tay Sachs vs Neimann Pick…differences?

A

Tay Sachs - Hex A - HYPERreflexia

NP - Sphingomyelinase - HYPOreflexia, HSM

211
Q

Time frame for tPA in ischemic stroke

A

3 hours, no contraindications

212
Q

HSV vs. CMV retinitis

A

HSV - CORNEA…
keratitis/conjunctivitis 1st, then retinal necrosis w/ many peripheral lesions

CMN - RETINA…
fluffy/granular lesions near vessels w/ hemorrhages, only 1 phase

213
Q

Contact-lens associated keratitis…bugs?

A

Pseudomonas, Serratia

214
Q

Sudden loss of vision, floaters, dark red glow on exam, obscured fundus on exam

A

Vitreous hemorrhage

215
Q

Periorbital burning, itching, vesicles, conjunctivitis, dendriform corneal ulcers

A

Herpes zoster ophthalmicus

216
Q

What does NaHCO3 do to the CV system? (2)

A

Increased BP

Decreased QRS duration

217
Q

Abdominal pain, N/V, diarrhea, hematemesis, anion gap acidosis…radiopaque tablets in stomach

A

Iron poisoning

218
Q

Explain iron poisoning

A

Iron is vasodilator and toxic to cellular processes, causing hypotensive shock and AGMA

219
Q

Long-term risk of iron poisoning

A

Hepatic necrosis, pyloric stenosis

220
Q

Aspirin vs. Iron on abd XRAY

A

Aspirin - radiolucent

Iron - radiopaque

221
Q

Hyperemesis gravidarum…labs to see?

A

Ketonuria
Hypokalemia
Met. alkalosis

222
Q

Hypoplastic thoracic cavity, limb fractures, growth restriction

223
Q

Pregnancy + b/l ovarian masses + hirsutism and acne

Risk?

A

Luteoma

Virilization of baby

224
Q

Pregnancy + b/l ovarian masses + molar pregnancy or twins

A

Theca luteum cyst

225
Q

Pregnancy + b/l ovarian masses + weight loss

A

Krukenberg tumor

226
Q

Methylergonovine…use?

Risk?

A

Uterotonic

HTN

227
Q

Carboprost…use?

Risk?

A

Uterotonic

Bronchoconstriction

228
Q

Symmetric growth restriction

A

Chromosomal or infection

229
Q

Asymmetric growth restriction

A

Utero-placental insufficiency or malnutrition

230
Q

Pregnant woman w/ previous transvaginal myomectomy…labor trial?

A

NO - not after uterine cavity entry

231
Q

ECV - when can you try it?

A

After 37 weeks

232
Q

When should you induce for a dead fetus?

A

Over 24 weeks

233
Q

When is an MMSE score very specific for dementia/delirium?

234
Q

Timeline for EtOH withdrawal shit

A

Day 1 = withdrawal s/s
Day 1-2 = seizures/hallucinosis
Day 3 = DTs

235
Q

Tourette’s…tx?

A

Alpha 2 agonists (guanfacine, clonidine)

Antipsychotics

236
Q

Intubation –> BP drop and CVP rise…cause?

A

Pneumothorax (mediastinal compression)

237
Q

Intubation –> atelectasis of L lung

A

R main bronchus

238
Q

SIADH tx

A

Fluid restriction + salt tablets

Hypertonic saline if super severe

239
Q

Pulmonary nodule w/ high risk for malignancy…tx?

A

Resection right away

240
Q

Why is a PE painful?

A

Causes small pleural effusion (exudative) which irritates the pleura

241
Q

Recurrent pneumonia in same lung region…test?

A

CT - look for bronchial obstruction or compression

242
Q

PE highly likely…first thing?

A

Anticoagulation (heparin, etc.)

243
Q

Best thing to do in COPD for mortality

A

Stop smoking

244
Q

COPD + O2 sat under 88%…best thing to do for mortality

A

Home O2 therapy

245
Q

Ankylosing spondylitis…FRC and RV

A

Ribs stuck UP –> increased FRC and RV

246
Q

Asthma exacerbation + increased PaCO2…do what?

247
Q

Positive bronchodilator response in asthma means what?

A

12%+ increase in FEV1

248
Q

HTN, nephrotoxicity, gum hypertrophy, hyperkalemia, hirsutism, tremor…what drug?

A

Cyclosporin toxicity

249
Q

Diarrhea, leukopenia, hepatotoxicity…what drug?

A

Azathioprine toxicity

250
Q

HTN, nephrotoxicity, hyperkalemia, tremor, normal gums and skin…what drug?

A

Tacrolimus

251
Q

Causes of clubbing

A

Malignancies
CF
R->L shunts

252
Q

Bronchiectasis w/ upper lung infections…cause

253
Q

High Ca, high-normal PTH

A

Familial hypocalciuric hypercalcemia

254
Q

Treatment ladder for enuresis

A
  1. Behavior mod and non pharma
  2. Desmopressin
  3. TCA
255
Q

AKI 2/2 obstruction (BPH, etc.)…next?

A

Look for other causes and hydronephrosis (CT)

256
Q

Post-URI glomerulonephritis…5 days after, young adult

10-21 days after, child

A

IgA nephropathy

PSGN

257
Q

Kidney stone…med management?

A

Alpha blockers (Tamsulosin) – alpha receptors on ureter and bladder and urethra

258
Q

Fat malabsorption –> kidney stones…why?

A

Increased oxalate absorption –> stone formation

259
Q

Chronic use of aspirin or NSAID –> renal failure

A

Analgesic nephropathy (TIN or papillary necrosis)

260
Q

Hyperkalemia on ECG

A

Peaked T waves, prolonged PR, prolonged QRS

261
Q

Vomiting/diarrhea –> metabolic alkalosis…why?

A

Contraction alkalosis (RAAS –> H+ loss and HCO3 reabsorption)

262
Q

Treating PCP pneumonia –> hyperkalemia…why?

A

Trimethoprim blocks collecting duct Na channels

263
Q

Metabolic acidosis…how to judge CO2

A

1.5(HCO3) + 8 +/- 2

264
Q

Metabolic alkalosis…how to judge CO2

A

Add 0.7 for every 1 HCO3 rise

265
Q

Respiratory acidosis…how to judge HCO3

A

Add 1 for every 10 CO2 rise

266
Q

Respiratory alkalosis…how to judge HCO3

A

Subtract 2 for every 10 CO2 fall

267
Q

Osteitis fibrosa cystica

268
Q

Polyostotic fibrous dysplasia

A

McCune-Albright

269
Q

Osteitis deformas

A

Paget’s dz of bone

270
Q

Spondyloarthropathies…symmetric or asymmetric arthritis?

A

Asymmetric

271
Q

Who is more prone to vitamin D deficiency?

A

Dark skin, indoors

272
Q

Felty syndrome

Look for what?

A

RA
Neutropenia
Splenomegaly

Extra-articular manifestations (vasculitis, ulcers, etc)

273
Q

Ways to reduce gout risk

A 
Stop EtOH
Stop red meat and seafood
Lose weight
Stop refined sugars
Low-fat diet
Low-fat dairy and veggie products for protein
274
Q

Woman w/ DM has pain in inner knee for a few weeks, worse in morning or overnight

A

Anserine bursitis

275
Q

Blood/urine markers for Paget’s dz of bone (3)

A

Procollagen 1N propeptide
Urine hydroxyproline
Alk phos

276
Q

Drugs w/ ototoxicity

A

Aminoglycosides

Platinum chemo drugs

277
Q

Drug w/ retinopathy

A

Hydroxychloroquine

278
Q

1º vs 2º Reynauds

A 
1º = symmetric, no damage
2º = asymmetric, damage
279
Q

Crepitus btwn 3rd and 4th toes

A

Morton neuroma (Mulder sign)

280
Q

Fracture of middle metatarsal…do what?

A

Nothing, will be held in place by surrounding tissue

281
Q

Prepatellar bursitis…cause?

Do what?

A

Staph aureus

Aspirate for cell count and gram stain

282
Q

1st attack of gout…tx?

Recurrent…tx?

A

NSAIDs, colchicine, steroids

Allopurinol

283
Q

Chondrocalcinosis

Look for what?

A

Pseudogout

2º cause - hyperPTH, hypothyroid, hemochromatosis

284
Q

SLE criteria

A 
Serositis
Oral ulcers
Arthritis (non-destructive)
Photosensitivity
Blood (penias, hem anem)
Renal (protein and blood)
ANA
Immunologic (markers)
Neurologic
Malar rash
Discoid rash
285
Q

Acute stroke…dx steps?

A 
CT w/o contrast
EKG
CXR
CBC
PT, PTT
Electrolytes
Glucose level
B/l carotid U/S
Echo
286
Q

Acute ischemic stroke..tx steps?

A

W/in 3 hours = tPA (UNLESS contraindication)
Aspirin or Clopidogrel (unless getting tPA)
Control BP IF significantly elevated OR severe need OR receiving tPA

287
Q

How to prevent a stroke

A

Control HTN, DM, smoking, cholesterol, obesity
Aspirin
Carotid surgery if over 70% and symptomatic

288
Q

Do you use warfarin and heparin in ischemic strokes?

A

NO - no proven benefit

289
Q

How to treat hemorrhagic stroke?

A

Supportive - ABCs, control BP if very high (nitroprusside), reduce ICP if elevated

290
Q

Intracerebral hemorrhage…where is the lesion:

  • Pinpoint pupils
  • Poorly responsive pupils
  • Dilated pupils
A

Pons
Thalamus
Putamen

291
Q

Excruciating H/A, LP shows yellow CSF…dx?

A

Subarachnoid hemorrhage - yellow is broken down RBCs, so you know it’s not a traumatic tap

292
Q

When do you NOT do an LP?

A

Papilledema (cerebral edema) (repeat CT instead)

293
Q

After dx of SAH, what next?

A

Cerebral angiogram (see where to clip)

294
Q

How to prevent a vasospasm after a SAH?

A

Nifedipine (CCB)

295
Q

Like parkinson’s but w/o tremor and w/ ophthalmoplegia

A

Progressive supranuclear palsy

296
Q

HIV, dull hypomobile TM, u/l hearing loss

A

Serous OM - MC middle ear issue in HIV - 2/2 obstruction of auditory tube from LAD or obstructing lymphomas

297
Q

Akathisia tx

A

Decrease antipsychotic dose + benzo/propranolol/benztropine

298
Q

TCA toxicity…think what (symptoms)?

A
  • Neuro
  • Cardiac
  • Anticholinergic
299
Q

How to treat really bad TCA OD?

Why?

A

Sodium bicarb

  • TCAs block fast Na+ channels
  • Na+ causes increased gradient for Na+ channels
  • HCO3 raises pH and decreases drug affinity for channel
300
Q

Risk factors for NEC (4)

A

Premature
Low birth weight
Low perfusion to gut
Formula feeding

301
Q

Low total T3 and T4
Normal TSH
Gynecomastia and impotence in male

Why?

A

Cirrhosis - decreased TBG = normal TOTAL T3/T4, and associated w/ high estrogen from circulating androgens

302
Q

Why hypercalcemia/hypercalcuria in sarcoidosis?

A

Granulomatous inflammation –> increased 1-ALPHA HYDROXYLASE –> increased 1,25-vit D

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