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1
Q

Immune mechanism of hereditary angioedema?

A

C1 inhibitor deficiency, destruction, or dysfunction

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2
Q

Medical treatment options for acute abnormal uterine bleeding?

A
  • High dose oral estrogen
  • High dose combined OCPs
  • High dose progestin
  • Tranexamic acid
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3
Q

Most common cardiac abnormality associated with Down’s Syndrome?

A

Complete AV Septal Defect (CAVSD), aka Endocardial Cushion Defect

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4
Q

Derm condition of infancy and adulthood

  • Erythematous plaques or yellow greasy scales
  • Scalp and face
A

Seborrheic dermatitis

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5
Q

Causes of iron def anemia in infants?

A
  • Maternal Fe def
  • Premie
  • Introduction of cow’s milk before 12 mo (occult bleed)
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6
Q

What is anemia of prematurity (AOP)?

A

Caused by decrease in EPO and lesser survival of RBCs

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7
Q

What is the cause of herpangina?

A

Cocksackie A

- gray vesicles on posterior oropharynx

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8
Q

What is the cause of gingivostomatitis?

A

HSV 1

- clusters of small vesicles on anterior oropharynx

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9
Q

Peds condition assoc w craniotabes, rib notching, genu varum

A

Rickets

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10
Q

Peds disorder of overgrowth characterized by:

  • Macrosomia
  • Macroglossia
  • Hemihyperplasia
  • Abd wall defects
A

Beckwith-Wiedemann

ch 11p15

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11
Q

What tumors are associated with Beckwith Wiedemann?

A

Wilm’s

Hepatoblastoma

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12
Q

Type of poisoning characterized by:

  • Abd pain
  • Hematemesis
  • Hypotensive shock
  • Metabolic acidosis

And radiopaque pills

A

Iron

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13
Q

Disease in children presenting with:

  • Loss of motor milestones
  • Hypotonia
  • Feeding difficulty
  • Cherry red macula
  • HSM
  • Areflexia
A

Niemann Pick

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14
Q

Enzyme def assoc with Niemann Pick

A

Sphingomyelinase def

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15
Q

Disease in children presenting with:

  • Loss of motor milestones
  • Hypotonia
  • Feeding difficulty
  • Cherry red macula
  • Hyperreflexia
A

Tay Sachs

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16
Q

Enzyme def assoc with Tay Sach’s

A

B-hexosaminidase

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17
Q

Characterized by absent B cells, normal T cells

A

Bruton’s agammaglobulinemia

  • Sinopulmonary infections
  • GI infetions
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18
Q

Characterized by defect of NADPH oxidase

A

Chronic Granulomatous Disease (CGD)

- Impaired killing of catalase + organisms like Staph aureus and Serratia

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19
Q

Characterized by hypogammaglobulinemia

A

Common variable immunodeficiency (CVID)

  • Sinopulmonary infections
  • GI infections
  • Less severe than Bruton’s
  • Normal B cell count
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20
Q

Characterized by T cell dysfunction

A

Wiskott Aldrich

  • WATER
  • Thrombocytopenia
  • Eczema
  • Recurrent infections (bacterial, viral)
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21
Q

Characterized by defective T cell maturation

A

SCID

  • Viral, fungal, bacterial
  • Low lymphocyte concentrations
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22
Q

3 most common causes of neonatal bacterial sepsis

A

GBS
E coli
Listeria

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23
Q

When does breast feeding jaundice occur?

A

First week of like (f for first)

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24
Q

What is the cause and pathophys of breast feeding jaundice?

A

Suboptimal feeding
Decreased bili elimination
Increased enterohepatic circulation

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25
What is the cause and pathophys of breast milk jaundice?
High levels of b-glucuronidase in breast milk deconjugates bili
26
When does breast milk jaundice occur?
Peaks at 2 weeks (when more mature, m for milk)
27
Syndrome characterized by recurrent gross hematuria and proteinuria, associated with splitting of the glomerular basement membrane
Goodpasture's
28
What sensory loss symptom is associated with Goodpasture's
sensorineural hearing loss
29
What is the treatment for strep impetigo?
Topical mupirocen
30
What is the most common cause of hip pain in kids?
Transient synovitis, treated with rest and ibuprofen
31
What is the rx for mild croup?
Corticosteroids
32
What is the treatment for moderate to severe croup?
Corticosteroids and nebulized epi
33
Fetal infection associated with cataracts, hearing loss, and PDA
Rubella
34
What's the Potter Sequence?
Urinary tract anomaly leads to anuria, leads to oligohydramnios, producing: - Pulmonary hypoplasia - Flat facies - Limb deformities
35
What are the tests for CGD?
Dihydrorhodamine and Nitroblue tetrazolium neutrophil function tests
36
What is the screening tool for developmental dysplasia of the hips?
Ultrasound of hips
37
What is the rx for old rheumatic fever (not acute)?
Penicillin | - Still prophylax because of risk of recurrence!
38
What rash affects the hemidesmosomes at the junction, and causes blisters that can rupture?
Bullous pemphigoid | - Not found in the mouth
39
What rash affects the desmosomes at the BM and causes blisters that can rupture (including the mouth)
Pemphigous vulgaris
40
What the difference between keloids and hypertrophic scars?
Keloids grow outside the margin of the original injury
41
What is the rx for keloids and hypertrophic scar?
Intralesional corticosteroid injection
42
Facial flushing rash that does affect the nasal bridge; patient's often complain people think they are shy
Rosacea
43
Butterfly rash that does not affect the nasal bridge; many systemic sx
Lupus
44
Heliotrope violaceous rash, Gottron's Papules
Dermatomositis
45
What type of melanoma is large and flat?
Superficial spreading, the most common melanoma
46
What type of melanoma presents as one large nodule?
Nodular melanoma, not common but more dangerous
47
Genetic disease characterized by lizard-like, scaling skin
Icthyosis vulgaris
48
Anti smooth muscle Ab
Autoimmune hepatitis
49
Anti centromere Ab
CREST
50
Anti scl 70 Ab
Scleroderma (systemic sclerosis)
51
Anti histone Ab
Drug induced lupus
52
Anti mitochondrial Ab
Primary biliary sclerosis
53
Anti microsomal Ab
Hashimoto's
54
Anti TGT, gliadin, endomysial Abs
Celiac
55
Anti glutamate decarboxylase
Type 1 DM
56
What is the rx for Paget's?
Bisphosphonates
57
Two tendons that cause tenosynovitis
Extensor pollicis brevis and abductor pollicis longus
58
What is a common cause of hand pain after pregnancy?
De Quervain's Tenosynovitis | - Gripping the baby too much
59
RA or OA? Erosions
RA
60
RA or OA? Osteophytes
OA
61
RA or OA? Subchondral cysts
OA
62
RA or OA? Subchondral sclerosis
OA
63
What 2 bugs are classic for causing reactive arthritis?
Campylobacter and Chlamydia
64
What are the sx of reactive arthritis?
Conjunctivitis, urethritis, arthritis | Can't see, can't pee, can't climb a tree
65
Anti LA and Cardiolipin Abs
Antiphospholipid syndrome
66
Empiric Rx for Septic Arthritis
Vanc and Cef Vanc for Staph Cef or Neisseria
67
What disease is associated with Heberden's Nodes (HeberdeEND, at the end/DIP) and Bouchard's Nodules (at the middle knuckle (PIP)?
OA (not RA!)
68
What is the Rx for Chlamydia?
Doxy
69
What is the Rx for Gonorrhea?
Ceftriaxone
70
Anti Jo Ab
Polymyositis
71
Treatment for Fibromyalgia
Low dose exercise Amytriptiline FM AM radio Fibromyalgia Amytriptiline
72
Positive birefringence, Rhomboid crystals | What disease and crystal?
Psuedogout | CPPD
73
Negative birefringence, nNeedle shaped crystals | What disease and crystal?
Gout, Monosodium urate
74
Which is more sensitive for lupus: ANA or ds-DNA?
ANA (first test)
75
Which is more specific for lupus: ANA or ds-DNA?
ds-DNA (second test)
76
When would you give home O2 for COPD?
If PO2
77
Peripheral lung cancer(s)
Adeno
78
Central lung cancer(s)
Small Cell, Squamous
79
Paraneoplastic syndromes assoc w Small Cell lung ca
Lambert Eaton ACTH SIADH
80
Paraneoplastic syndrome assoc w Squamous Cell lung ca
PTHrP
81
Rx for Mild Allergic Rhinitis
Oral Loratidine (antihistamine)
82
Rx for Mod Allergic Rhinitis
Intranasal steroid
83
Rx for Severe Allergic Rhinitis
Oral steroid
84
Incidence of ca in women
1. breast 2. lung 3. colon
85
Death from ca in women
1. lung 2. prostate 3. colon
86
Incidence of ca in men
1. prostate 2. lung 3. colon
87
Death from ca in men
1. lung 2. prostate 3. colon
88
What is the difference between Raloxifene and Tamoxifen (side effects)?
Tam causes endometrial hyperplasia, Ral does not
89
EKG change caused by hyperK
peaked T
90
EKG change caused by hypoK
U waves
91
EKG change caused by TCA drugs
wide QRS
92
What is the prophylaxis required for contacts of a child with Bordatella Pertussis?
5 days of Azithromycin for babies and adults, regardless of age, immunizations, or symptoms
93
What is the first step in managing bacterial endocarditis?
Draw blood cultures THEN initiate antibiotics
94
What is the management of hypovolemic hypernatremia?
Normal Saline
95
What is a main cause of hypovolemic hypernatremia?
Nephrogenic DI (ADH resistance)
96
What is the Rx for DVT?
Heparin acutely Warfarin long term NOT tPA to lyse the clot
97
How long after surgery can you use anticoagulants?
Safe after 48-72 hrs
98
Symptoms such as cutaneous lesions on the palms and soles, HSM, jaundice, anemia, and rhinorrhea indicate what congenital infection?
Syphilis
99
What is the cause of systolic HTN in thyrotoxicosis?
Caused by hyperdynamic circulation resulting from increased myocardial contractility and heart rate
100
What is the definitive diagnosis of lichen sclerosus and why do you perform it?
Vulvar punch biopsy | - Want to rule out squamous cell carcinoma, as lichen sclerosis is a precursor
101
What is the rx for lichen sclerosus?
High-potency topical corticosteroids
102
What is the etiology of increased hematocrit in OSA?
Increased EPO 2/2 transient hypoxemia
103
Unilateral bloody nipple discharge is the hallmark presenting feature of what breast disease?
Intraductal papilloma | - no associated LAD
104
Marfanoid body habitus + fair eyes and hair + developmental delay + thrombosis is concerning for:
Homocystinuria
105
What is the missing enzyme in homocystinuria?
cystathionine synthase
106
What is the Rx for homocystinuria?
Vitamin (B6 and B12) supplementation and anticoagulation
107
What is the imaging of choice for ureteral stones?
ultrasound
108
Anterior knee pain in a young woman, worse with climbing stairs, not improved by NSAIDs
Patellofemoral sydrome
109
What is the test of choice for patellofemoral syndrome?
Patellofemoral compression test, extending the knee while compressing the patella XRay shows nothing Rx = exercises to stretch and strengthen thigh muscles
110
What is the Rx for Central Retinal Artery Occlusion?
Ocular massage and high flow O2
111
What is the risk of abruptly discontinuing a short acting benzo?
Seizures
112
What hormone can help to differentiate primary vs secondary adrenal insufficiency?
Aldosterone - Will be low in primary - Will be normal in secondary (due to steroid withdrawal--aldo not affected here bc primarily regulated by RAAS)
113
How does vitamin D deficiency impact: - Calcium - Phos - PTH
Vitamin D helps to absorb Ca and Phos from the gut. Without it: - Ca low - Phos low - PTH is high in reaction
114
What are the 3 most common causes of epiglottitis in kids?
1. Hib (H flu B) 2. Strep 3. Staph
115
What is the Rx for acute cholecystitis?
Lap Chole within 72 hrs
116
What is the test to evaluate esophageal rupture?
Water soluble contrast esophagogram (would see leak at perforation site) - If not definite, barium study
117
What do acute chest pain, subQ emphysema, and L sided pleural effusion post endoscopy entail?
Esophageal rupture
118
Nephrotic syndrome seen in: - AA/Hispanic - Obese - HIV - Heroin use
FSGS
119
Nephrotic syndrome seen in: - Adenocarcinoma of breast, lung - NSAID use - Hepatitis B - SLE
Membranous
120
Nephrotic syndrome seen in: - Hep B and C - Lipodystrophy
Mebranoproliferative
121
Nephrotic syndrome seen in: - NSAIDs - Lymphoma
Minimal change
122
Nephrotic syndrome seen in: | - URI
IgA
123
What is the difference in tearing between Mallory-Weiss and Boerhaave syndrome?
M-W is an incomplete mucosal tear | Boerhaave involves rupture of the esophagus (subQ emphysema)
124
What is the major risk factor for nasopharyngeal carcinoma?
Epstein Barr Virus
125
What is the Rx for chorio?
Abx and Delivery
126
What are the renal complications of sickle cell TRAIT
No clinical sx of sickle cell disease BUT - Painless hematuria caused by papillary necrosis - UTIs - Renal medullary cancer
127
Dysmenorrhea and heavy menstrual bleeding with boggy, globular, tender, enlarged uterus on exam indicates:
Adenomyosis
128
Most common cause of seizure in pregnant women
Eclampsia
129
What is a contraindicated substance while taking Metronidazole, and why?
Alcohol could precipitate a disulfuram-type reaction: N/V, hypotension, flushing
130
Breast disease with painful, itchy, eczematous, or ulcerated skin around the nipple that spreads to the areola
Paget's disease
131
What type of cancer is Paget's disease of the breast associated with?
Breast adenocarcinoma
132
What is the differential for an anterior mediastinal mass?
4Ts - Thymoma - Teratoma - Thyroid neoplasm - Terrible lymphoma
133
Hashimoto's thyroiditis is associated with what type of thyroid cancer?
Lymphoma
134
What is the definition of pre-eclampsia?
BP > 140/90 (either sys or diastolic) PLUS proteinuria and/or signs of end organ damage at >=20wks gestation
135
What is the best means of measuring proteinuria in preeclampsia?
Urine prot:cr ratio or 24 hr urine collection for total protein
136
What is the screening test for AAA?
Abd ultrasound in men 65-75 with any smoking history
137
Triple bubble sign and gasless colon in a baby, presenting with bilious vomiting
Jejunal atresia
138
Presentation of polyarthralgia, tenosynovitis, and vesicopustular lesions
Disseminated gonoccocemia
139
MI location and vessel: | some or all of V1-6
anterior, LAD
140
ST elevations in II, III, aVF
inferior MI, RCA or LCX
141
ST depressions in V1-3
posterior, LCX or RCA
142
ST elevations in I, aVL, V5, V6 | ST depressions in II, III, and aVF
Lateral, LCX
143
ST elevations in V4-6R
Right ventricle, RCA
144
Pure sensory stroke
Lacunar (in the thalamus)
145
Pure motor stroke
Internal capsule
146
Stroke with: - Ipsi occulomotor nerve palsy - Ataxia - Contralateral hemiparesis
Midbrain
147
Stroke with: - Contralateral sensory loss - Hemiparesis - Aphasia - Agnosia
MCA or ACA
148
Area of the brain affected by stroke caused by hypertensive intraparenchymal brain hemorrhage
Putamen
149
What is the only case in which you would give Tetanus Ig in addition to toxoid vaccine?
Dirty, severe wound AND unclear or incomplete immunization history
150
What is the definition of pre-eclampsia?
New onset elevated BP at >=20 wks AND Proteinuria or signs of end-organ damage
151
What is the definition of gestational HTN?
New onset elevated BP at >= 20 wks gestation | No proteinuria or end-organ damage
152
What is the definition of eclampsia?
Preeclampsia + new onset grand mal seizures
153
What are the maternal risks due to HTN?
``` Superimposed preeclampsia Postpartum hemorrhage Gestational diabetes Placental abruption C/S delivery ```
154
What are the fetal risks due to HTN?
Fetal growth restriction Perinatal mortality Preterm delivery Oligohydramnios
155
What is given for ppx of Chlamydia vs treatment of known infection in neonates?
Topical erythro in the eyes vs. Oral erythromycin
156
What to suspect in a patient with iron deficiency anemia and solitary liver mass?
Colon cancer with mets to liver
157
Bug causing IE with prosthetic valves, pacemakers, intravascular catheters, and in IVDU
Staph aureus
158
Bug causing IE with dental procedures, or incision and biopsy of the respiratory tract
Strep viridans - Strep mutans - Strep sanguinis
159
Bug causing IE with intravascular catheters, prosthetic valves, pacemakers or defibrillators
Coagulase negative Staph | - Staph epidermitis
160
Bug causing IE from nosocomial UTI
Eterococci
161
Bug causing IE associated with colon ca and IBD
Strep bovis
162
Bug causing IE in an immunocompromised host, chronic indwelling cath, prolonged abx therapy
Fungi
163
What are the side effects of methotrexate?
Hepatotox Stomatitis Cytopenias
164
Patient with renal failure, blue toes, mottled skin of lower extremity, and low complement on labs, after cardiac cath. What do you suspect?
Cholesterol crystal emoblism (atheroembolism)
165
Intense itching with elevated liver enzymes and bile acids in pregnancy
Intrahepatic cholestasis of pregnancy
166
How does Risperidol work?
Serotonin 2A and dopamine D2 receptor blockade
167
What is Ersipelas
Specific type of cellulitis caused by swelling of the dermis, usually caused by Strep pyogenes (beta hemolytic strep)
168
What are the risk factors for aortic dissection (approx in order)?
Hypertension Marfan's Ehler Danlos Note atherosclerosis predisposes to aneurysms, which themselves predispose to dissection
169
What is the first line Rx for maintenance therapy of bipolar disorder?
Lithium or valproate monotherapy + 2nd gen antipsychotic (quetiapine) if refractory or serious features. Lamotrigine also approved. L/V + Clozapine if refractory
170
Treatment options for acute bipolar depression
``` Lithium Valproate Quetiapine Lamotrigine These are mood stabilizers/2nd gen antipscyhotics. ``` Avoid antidepressants because it could precipitate mania.
171
Early decels - What time in relation to the contraction? - What do they represent?
Symmetric to contraction | Fetal head compression (can be normal)
172
Variable decels - What time in relation to the contraction? - What do they represent?
Not necessarily associated with contraction Cord compression 2/2 to: - Oligohydramnios - Cord prolapse
173
Late decels - What time in relation to the contraction? - What do they represent?
After contraction | Uteroplacental insufficiency
174
What is the management of a teenager with proteinuria and no symptoms?
May be transient, orthostatic, or persistent - Repeat dipstick on 2 subsequent occasions - Follow up with nephrologist if persistent
175
What is the management of a narrow complex tachycardia?
Adenosine or vagal maneuvers (carotid massage, eyeball pressure, valsalva) to slow conduction in the AV node, as these are generally superventricular
176
What cancer is associated with PCOS?
Endometrial carcinoma Unopposed estrogen without progesterone causes repeated endometrial hyperplasia > cancer
177
How does hypothyroidism cause hyperprolactinemia?
Hypothyroidism: increased TRH and TSH TSH stimulates prolactin
178
Disorders associated with neoplasms: Down's syndrome
ALL
179
Disorders associated with neoplasms: Xeroderma pigmentosum
Basal cell and squamous cell carcinoma of skin
180
Disorders associated with neoplasms: Tuberous sclerosis
Astroytoma and cardiac rhabdomyoma
181
Disorders associated with neoplasms: Actinic keratosis
Squamous cell carcinoma of skin
182
Disorders associated with neoplasms: Barrett's esophagus (chronic GI reflux)
Esopageal adenocarcinoma
183
Disorders associated with neoplasms: Plummer Vinson syndrome (atrophic glossitis, esophageal webs, anemia, due to iron deficiency)
Squamous cell carcinoma of the esophagus
184
Disorders associated with neoplasms: H. pylori
MALT lymphoma
185
Disorders associated with neoplasms: Cirrhosis
Hepatocellular carcinoma
186
Disorders associated with neoplasms: Ulcerative colitis
Colon adenocarcinoma
187
Disorders associated with neoplasms: Paget's disease of bone
Osteosarcoma and fibrosarcoma
188
Disorders associated with neoplasms: Immunodeficiency states
Malignant lylmphomas
189
Disorders associated with neoplasms: AIDS
Aggressive malignant non-Hodgkins lymphoma and Kaposi sarcoma
190
Disorders associated with neoplasms: Myasthenia gravis
Thymoma
191
Disorders associated with neoplasms: Acanthosis nigricans
Visceral malignancy (stomach, lung, breast, uterus)
192
Disorders associated with neoplasms: Multiple dysplastic nevi
Malignant melanoma
193
In what diseases can you find pulsus paradoxus?
Cardiac tamponade AND | Severe asthma and COPD
194
What heart condition is associated with Digitalis toxicity?
AV block with atrial tachycardia
195
Child is born with small head, small chin, overlapping fingers, and rocker bottom feet. What is the syndrome and what heart condition is associated?
Edward's Syndrome, Trisomy 18 | VSD, holosystolic murmur at LLSB
196
What is a local vascular complication of cardiac cath that presents as sudden hemodynamic instability and back pain?
Retroperitoneal hematoma (at the access site) - Get non con CT abd or abd US - Supportive treatment with rest, fluids, monitoring
197
What are congenital heart problems associated with Turner's syndrome?
``` Bicuspid aortic valve (20-30%) Aortic coarctation (3-10%) ```
198
What cardiomyopathy is expected in a patient with recent URI and new onset CHF?
Dilated cardiomyopathy
199
What is the difference in management of Type A and Type B aortic dissections? What is the acute rx for both?
Type A is ascending aorta: surgery and medical therapy (b-blocker) Type B: can be managed with b-blocker only Treat both acutely with IV labetolol
200
What is a treatment for b-block and CCB toxicity?
Glucagon
201
Bradycardia, AV block, hypotension, and wheezing are suspicious for toxicity of what med?
B-blocker
202
What is the rx of acute cocaine toxicity and myocardial ischemia?
Supplemental oxygen and IV benzos
203
What is the most common cause of sudden cardiac arrest in the immediate post-infarct period?
Vfib (reentrant ventricular arrhythmias)
204
What is the cause of culture-negative urethritis?
Chlamydia Rx Azithromycin or Doxy (+ Ceftriaxone if Neisserria not ruled out)
205
What serum and urine osmolarity (high/low) do you expect to see in HONK?
- Infection = increase in cortisol and catechols - These counterregulate insulin - Spill glucose and lots of water - HYPO osmolar urine - NO ketones in the urine - HYPER osmolar serum
206
What happens to calcium (free ionized and bound to albumin) in acidosis? In alkalosis?
Acidosis: more H+ leaves serum and binds albumin, so less Ca is bound - Increased ionized Ca Alkalosis: H+ wants to be the serum than bound, so more Ca is bound - Decreased ionized Ca
207
What EKG changes would be seen with aortic coarctation?
Increased QRS voltage bc of LV hypertrophy | ST and T wave changes in the left precordial leads
208
What physical exam should be performed when suspecting aortic coarctation?
Take upper and lower extremity BP - Upper HTN - Lower hypOtn
209
What bone problem is associated with Turner's Syndrome?
Osteoporosis - Low estrogen levels from gonadal dysgenesis - Estrogen replacement therapy is given for normal maturation but also is protective from osteoporosis
210
What change in the BUN: Cr would be seen in hypovolemia?
Increased BUN: Cr ratio, >20:1 Decline in the GFR Increase in urea reabsorption - This is pre-renal azotemia
211
What is the confirmatory test for Duchenne's muscular dystrophy?
Genetic testing showing deletion of the dystrophin gene on Xp21
212
What is the next step in management for a pt with all the typical clinical features of appendicitis?
Straight to surgery (lap appy) Do US or CT if the clinical signs are equivocal
213
How do beta-adrenergic agonists (like albuterol given in a COPD or asthma exac) change serum K levels?
Cause intracellular shift of K, lowering the serum K
214
What is the most common cause of anemia in patients who are taking both NSAIDs and aspirin?
Iron deficiency - Gastritis and gastric ulcers caused by both of these meds together - GI blood loss - Depletion of iron stores
215
What congenital infection presents as hydrocephalus, chorioretinitis, microcephaly, HSM, and cerebral calcifications?
Toxo
216
What types (bugs) of bacteremia should be expected in a child with sickle cell?
Functionally asplenic so, encapsulated organisms like: - Strep pneumo (*especially*) - H flu - Neisseria
217
What are the two preferred treatments for Hep B?
Tenofovir (most potent, preferred) OR Entecavir (decompensate liver failure, or when T is not available)
218
When is interferon used in the rx of Hep B?
Only in younger pts with compensated disease, and then only for a short term (Tenofovir or Entecavir preferred)
219
What is the preferred treatment for Hep C?
IFN-a + ribavarin
220
What is the confirmatory test for Histoplasma?
Urine or serum assay | - Can do culture but it takes way longer
221
What is the most common cause of food poisoning of rapid onset with vomiting as the main symptom?
Staph aureus | - Preformed toxin
222
What type of infection is suspected with fevers, chills, and left upper quadrant pain?
Splenic abscess May also see left sided chest pain, left pleural effusion, and splenomegaly
223
What are the 3 most common bugs that cause splenic abscess (hint: SSSpleen)
Staph Strep Salmonella
224
What other infection is splenic abscess often associated with?
Infective endocarditis
225
What is the management of splenic abscess?
Splenectomy (poor recovery with abx alone) | - Abscess drainage if poor surgical candidate
226
Infectious illness associated with lymphopenia, thrombocytopenia, polyarthralgia, and high fever (hint: mosquito borne illness found in Caribbean)
Chikungunya fever
227
What is the rx for a small ureteral stone?
Hydration Analgesics Alpha blocker (tamsulosin)
228
What is the best way to obtain a urine sample for culture and analysis in a toddler or younger baby?
Straight cath, because diapers will contaminate
229
How does contraction alkalosis come about?
Kidney is less perfused bc of hypovolemia Increases aldosterone retain Na and water This gets rid of KCl - HypoK - Increases the alkalosis
230
What are the two main analgesic nephropathies?
Papillary necrosis | Chronic tubulointerstitial nephritis
231
What is the rx of a simple renal cyst?
Reassurance
232
Why is coagulopathy a common complication of nephrotic syndrome?
Increased urinary loss of antithrombin III Changes in protein C and S levels Increased platelet aggregation Hyperfibrinogenemia due to liver synthesis Impaired fibrinolysis
233
What is the most common manifestation of coagulopathy due to nephrotic syndrome?
Renal vein thrombosis - May see PE - Can also see arterial manifestations
234
What drug given for hypertensive emergencies can cause cyanide toxicity?
Sodium nitroprusside - Contains 5 cyanide groups that rapidly convert - Use small dose for a short time
235
What is the most sensitive test to screen for diabetic nephropathy?
Random urine for microalbumin/creatinine ratio
236
What is the rx for mild, moderate, and severe SIADH?
Mild: fluid restriction +/- loop Mod: hypertonic saline + above when Na > 120 Severe: bolus of hypertonic saline +/- vasopressin receptor antags (conivaptan)
237
Wat is the mechanism of atherosclerosis resulting from nephrotic syndrome?
Low plasma oncotic pressure results in liver lipoprotein synthesis
238
What are the 2 main complications of nephrotic syndrome?
Hypercoag - RV thrombosis, PE Atherosclerosis - MI, stroke
239
Pt with acute headache and CT showing illumination in the cisterns. What do you suspect?
SAH
240
What is the most common cause of a non-traumatic SAH?
ruptured Berry aneurysm
241
If SAH is suspected and CT is negative, what is the next step in evaluation?
LP to rule out SAH | - Would see xanthochromia if it were SAH
242
What is vasa previa?
Fetal vessels overlay the internal cervical os | - Can be compromised, leading to swift fetal distress
243
What is the rx for Guillan Barre?
IVIG or plasmaphoresis
244
What is the first treatment for spinal cord compression?
IV glucocorticoids, stat!
245
Antipsychotic extrapyramidal effects (what do they have, and how do you treat it?): Sudden sustained contraction of the neck, tongue, eye muscles
Acute Dystonia Benztropine or diphenhydramine
246
Antipsychotic extrapyramidal effects (what do they have, and how do you treat it?): Subjective restlessness, inability to sit still
Akathisia Beta blocker (propanolol) or Benzo (lorazepam)
247
Antipsychotic extrapyramidal effects (what do they have, and how do you treat it?): Gradual onset tremor, rigidity, bradykinesia
Parkinsonism Benztropine (anticholinergic antiparkinsonian medication) or Amantadine
248
Antipsychotic extrapyramidal effects (what do they have, and how do you treat it?): Gradual onset after prolonged therapy (> 6 mo) Dyskinesia of the face, mouth, trunk, extremities
Tardive Dyskinesia No definitive treatment Try Clozapine
249
What are some triggers of thyroid storm?
``` Surgery Trauma Infection Childbirth Iodine contrast ```
250
What withdrawal syndrome: N/V, abdominal cramping, muscle aches, dilated pupils, yawning, piloerection, lacrimation, hyperactive bowel sounds
Heroin
251
What withdrawal syndrome: tremors, agitation, anxiety, delirium psychosis, seizures, tachycardia, palps
Alcohol
252
What withdrawal syndrome: Tremors, anxiety, perceptual disturbances, psychosis, insomnia, seizures, tachy, palps
Benzos
253
What withdrawal syndrome: increased appetite, hypersomnia, intense psychomotor retardation, severe depression (crash)
Stimulants - Amphetamine - Cocaine
254
What withdrawal syndrome: Dysphoria, irritability, anxiety, increased appetite
Nicotine
255
How does insulin resistance cause NASH?
Insulin resistance in the periphery leads to more lipolysis, and the fat builds up on the liver (increased hepatic uptake of fatty acids)
256
HIV patient with EBV DNA in the CSF and weakly enhancing solitary mass in the brain. Diagnosis?
CNS lymphoma | - EBV DNA is diagnostic
257
Common post-gastrectomy complication characterized by GI symptoms (nausea, diarrhea, abd cramps) and vasomotor symptoms (diaphoresis). What is the rx for symptom control?
Dumping syndrome Dietary modification--sx will diminish over time
258
What is the standard treatment for OCD?
High dose SSRI and CBT
259
To which complications of diabetes can one reduce the risk through tight HA1C control of 6-7 (microvascular, macrovascular)?
Microvascular - Retinopathy - Nephropathy
260
What are the causes of osteomalacia?
Anything that can cause vitamin D deficiency, such as: - Malabsorption - Intestinal bypass surgery - Celiac sprue - Chronic liver disease - Chronic kidney disease
261
What are the lab values associated with osteomalacia?
``` Increased ALP, PTH Decreased/normal serum Ca Decreased urinary Ca Decreased serum Phos Decreased vitamin D ```
262
Describe the bone problem seen in osteomalacia
Impaired osteoid matrix mineralization
263
Treatment of endometriosis: 1st step 2nd step
1st: NSAIDS +/- OCPs 2nd: Laparoscopic resection
264
What is the definitive diagnosis of endometriosis?
Direct visualization and surgical biopsy
265
What is the most common presenting sx of endometriosis?
infertility other sx include: - dyspareunia - dysmenorrhea - chronic pelvic pain - infertility - dyschezia
266
In DKA what is the total body K (low/high) and the serum K (low/high)?
Serum K is high because of decreased insulin activity, causing K to move extracellularly Total body K is low due to renal losses with ketones/sugars
267
What is the treatment for Polycythemia Vera?
Plasmaphoresis
268
What is the classic history and triad of sx associated with trichinella?
History: - Pork consumption - Travel (Mexico, China, Thailand) Symptoms: - Periorbital edema - Myositis - Eosinophilia (>20%)
269
What are the three causes of hyperandrogenism in pregnancy?
1. Luteoma 2. Theca lutein cyst 3. Krukenberg tumor
270
Diagnosis: Pregnant pt with hirsuitism Bilateral ovarian cysts Association with molar pregnancy and multiple gestation
Theca lutein cyst - Low risk of fetal virilization - Regress spontaneously after delivery
271
Diagnosis: Pregnant pt with hirsutism Yellow or brown masses (+ areas of hemorrhage) of large lutein cysts Solid ovarian masses (50% bl)
Luteoma - High risk of fetal virilization - Regress sponteanously after delivery
272
Diagnosis: Pregnant pt with hirsutism Bilateral solid ovarian masses Mets
Krukenberg tumor - High risk of fetal virilization - Mets from GI tumor
273
Management of pt with luteoma, lutein cysts, or Krukenberg tumor
Observation and reassurance
274
What are two toxic substances produced in house fires?
CO and HCN | Carbon monoxide and hydrogen cyanide
275
What is the rx for cyanide poisoning?
hydroxocobalamine OR sodium thiosulfate bind directly to cyanide
276
What kid of poisoning? ``` Dry mouth and skin Blurry vision/mydriasis Hyperthermia Urinary retention Decreased bowel sounds Delirium or hallucinations ```
Anticholinergic! - Think diphenhydramine ``` Dry as a bone Blind as a bat Hot as a hare Full as a flask Mad as a hatter ```
277
What is the most common cause of death in dialysis patients?
Cardiovascular disease | - Risk factors not related to dialysis. Many pts on dialysis have multiple risk factors for V disease
278
What is the main risk associated with oxytocin overdose in labor?
Tachysystole - Too many contractions - May stop blood flow from reaching the placenta - Fetal hypoxia
279
What is the gold standard test for evaluating cervical length in pregnancy?
TVUS
280
What vitamin deficiency is present with carcinoid?
Niacin (B1) because tryptophan that forms B1 is also needed for serotonin, which is formed and secreted in excess in carcinoid
281
When are pregnant women usually screened for GBS?
35-37 weeks - Any infection previous to this may be transient - Screen with rectal and vaginal cultures
282
When is prophylaxis for GBS given (when necessary), and what med is used?
4 hours before delivery Penicllin
283
Who should receive prophylaxis?
Prior birth of an infant affect with early onset GBS disease GBS bacteremia or UTI any tie during pregnancy GBS + within 5 wks of labor Unknown GBS status PLUS 1: - = 18 hrs
284
Muffled or "hot potato voice" with deviation of uvula and prominent unilateral LAD
Peritonsillar abscess
285
Management of peritonsillar abscess
Needle aspiration of abscess | IV abx
286
Drug overdose associated with serotonin syndrome (high fever, AMS, autonomic dysregulation, neuromuscular irritability) and hyponatremia
MDMA (Ecstasy/Molly)
287
When can you do a cardiac cath in pts with acute STEMI?
Within 12 hrs of symptom onset AND: - 90 mins from hosp arrival to PCI OR - 120 mins when transport to another facility is required
288
Child presents with precocious puberty OR postmeno woman presents with bleeding/endometrial hyperplasia +large adnexal mass Diagnosis?
Granulosa Cell Tumor
289
What hormones are produced: Granuolsa Cell Tumor
Estrogen
290
What hormones are produced: Dysgerminoma
LDH or bHCG
291
What hormones are produced: Sertoli-Leydig Tumor
Androgens
292
What hormones are produced: Teratoma
None! Benign
293
What hormones are produced: Serous cystadenoma
None! Benign
294
When should a patient with a simple breast cyst be seen again after aspiration of cyst fluid?
2-4 mo No risk for malignancy but fluid can build up again If it's normal at this time, resume q1 yr breast exams
295
Modifiable breast ca risks:
HRT Nullip Increased age at first live birth Alcohol consumption
296
Non-modifiable breast ca risks:
``` Genetics Breast ca in 1st degree rel White race Increasing age Early menarche or late menopause ```
297
How does a complete mole form?
2 sperm fertilize an egg lacking genetic material Trophoblastic tissue with no fetal tissue
298
How does a partial mole form?
2 sperm fertilize a normal haploid egg Abnormal placenta and fetal tissue with karyotype 69XXY, XXX, XYY
299
If TVUS is nondiagnostic for a suspected ectopic and the pt is stable, what is the next step?
serum bHCG - if > 1500 repeat bHCG and TVUS in 2 d - if
300
What breast ca presents as unilateral bloody nipple discharge?
Intraductal papilloma | - No associated mass or LAD
301
What is the follow up management of a threatened abortion?
Reassurance and outpatient follow up (no need to hospitalize)
302
What is the rx of uterine inversion?
Manual uterine replacement
303
What is the rx for duodenal hematoma following direct blunt trauma?
The duodenal hematoma causes obstruction, so do nasogastric suction and TPN - will resolve spontaneously in 2-3 wks
304
What nerve injury causes wrist drop?
Radial, associated with midshaft fracture of the humerus
305
Solid mass with thick septations is found in the ovaries. What is the diagnosis and management?
Epithelial ovarian carcinoma | Ex lap
306
What type of birth is contraindicated in pts with myomectomy?
vaginal > go straight to C/S bc risk of uterine rupture
307
What is the most common cause of pericarditis in developing nations?
TB
308
What hormone level indicates exogenous thyroid hormone abuse?
High thyroglobulin (with decreased uptake on RAIU)
309
What is the mechanism by which Fluphenazine (typical antipsychotic) causes hypothermia?
Inhibits autonomic thermoregulation and the body's shivering mechanism - Exposure to cold in this setting causes hypothermia
310
What is the cause of HIV esophagitis presenting without dysphagia?
Viral esophagitis
311
Viral esophagitis in HIV pt with deep, linear ulcerations:
CMV
312
Viral esophagitis in HIV pt with round, ovoid ulcers:
HSV
313
What features are associated with severe Aortic Stenosis?
1. Diminished and delayed carotid pulses (parvus et tardus) 2. Mid to late peaking systolic murmur Soft and single S2
314
What is a major side effect of DHP CCBs (Amolidipine, Nifedipine) and what is the mechanism?
Peripeheral edema Preferential dilation of precapillary vessels ACE-i, when added to CCBs, can significantly decrease edema, by also venodilating!
315
What is the next step in treating a pt with AFib who is unstable?
DC cardioversion (not medS)
316
Infant presents with a scrotal mass that is cystic and transluminates. What is it, and what is the management?
Hydrocele - Reassurance and observation - Will resolve by 12mo
317
What is the rx for penis fracture?
Retrograde urethrogram, then surgical exploration
318
Pt presents with elevated direct bili and only elevation in ALP. What is the next step in workup?
abd US --likely a cholestasis picture
319
Chondrocalcinosis with acute inflammation is likely due to...
CPPD crystal arthropathy aka pseudogout
320
What joints are usually affected in pseudogout?
Ankle or knee
321
Prolonged rupture (>24h) of membranes + maternal fever + fetal tachycardia (>160) is concerning for...
Chorioamnionitis
322
Child presents with sudden eipsode of excruciating abd pain, currant jelly stool, and target sign is seen on US. What is the dx?
Insussusception
323
What is the most common lead point that causes intussusception?
Meckel's diverticulum Other risk factors: - HSP - Celiac - Intestinal tumor - Polyps
324
Dark urine and light stool indicates conj or unconj bilirubin excretion?
Conjugated (it's water soluble)
325
How can metformin affect the kidney?
Can cause lactic acidosis in AKI and sepsis, so should be witheld
326
What is the definition of delusional disorder?
One or more persistent delusions without any prominent psychotic symptoms
327
What are 4 main fetal complications of 2nd trimester maternal hyperglycemia?
Hypoglycemia Organomegaly Macrosomia Polycythemia baby's bell has a HOMP
328
What are 4 main fetal complications of 1st trimester maternal hyperglycemia?
Congenital heart disease Neural tube defects Small left colon syndrome Spontaneous abortion
329
What are two treatments for absence seizures?
Ethosuxidmide AND | Valproate
330
Neuroimaging findings in psych disorders: Enlargement of cerebral ventricles
Schizophrenia
331
Increased total brain volume
Autism
332
Abnormal orbitofrontal cortex and striatum
OCD
333
Decreased vol of amygdala
Panic d/o
334
Decreased hippocampal vol
PTSD
335
Pt in withdrawal presents with alert sensorium and stable vitals, but visual hallucinations. What is this, and when does it happen?
Alcoholic hallucinosis Starts 24 hrs after last drink and resolves in 24-48 hrs
336
The presence of an aura indicates what kind of seizure?
Partial (with a neurologic focus), but this may generalize
337
Classic features of NF1
Cafe au lait spots Feeding problems Short stature Learning disabilities Patients go on to develop neurofibromas or different tumors
338
Classic features of NF2
Bilateral acoustic neuromas and cataracts
339
What features distinguish serotonin syndrome from NMS?
SS begins with diarrhea, restlessness, and autonomic instability Both involve high fevers and muscular rigidity
340
What med is first given when pt presents with suspected but not confirmed acute ACS?
ASA (Heparin after MI confirmed)
341
Most common cause of recurrent pyelo in boys/girls
Posterior urethral valves/Vesicoureteral reflux
342
What is the rx for cryptococcal meningitis?
Amphotericin + flucytosine
343
What is the rx for cryptococcal pneumonia?
Fluconazole
344
What does a rouleaux formation on blood smear indicate?
Stack of proteins indicative of elevated serum protein--think MM, Waldenstrom's
345
What is the SAAG and what does it indicate?
Serum ascites albumin gradient serum - ascites = X if X >= 1.1, then portal HTN
346
What blood disease is indicated by the presence of Heinz bodies and bite cells?
G6PD deficiency
347
What is menopausal genitourinary syndrome?
Vaginal atrophy and urinary symptoms due to hypoestrogenism. (atrophy of both the vagina and urethral mucosal epithelium)
348
What is the major risk factor for stroke?
HTN
349
Cavitary lesions in an IVDU who is not infected with HIV. What bug?
Staph aureus | - Infective endocarditis with septic emboli to lungs
350
Healthcare worker or dentist presents with bilateral rash on hands. What's the source and diagnosis?
Contact dermatitis form latex gloves
351
Baby presents with painful vesicles on an erythematous base, evolving to punched out lesions and hemorrhagic crusting. What is the cause and diagnosis?
Eczema herpeticum, HSV 1 superimposed on atopic dermatitis (eczema)
352
Patient has symptoms of GERD but with alarm symptoms or cancer risk factors. What is the next step?
Endoscopy to look for esophagitis. If esophagitis is present, consider causes and cancers. If not, do esophageal manometry.
353
Patient has symptoms of GERD with no alarm symptoms or cancer risk factors. What is the next step?
Trail of PPI for 2 mo | - If this doesn't work, consider endoscopy or esophageal pH monitoring
354
What is the difference between confounding and effect modification?
If you stratify based on the modulating factor, confounding shows no association and effect modulation shows stronger association.
355
Findings of electrical alternans on EKG:
Varying amplitude of QRS axis and amplitude | - This plus tachycardia indicates pericardial effusion
356
Which nephrotic syndrome most involves renal vein thrombosis as a complication?
Membranous glomerulopathy
357
What's the first step in caring for a pt with thermal inhalation injury to the upper airway (ex. house fire)?
Intubate! Could rapidly develop airway edema.
358
What is the rx for bacterial conjunctivitis?
Erythromycin ointment Polymixin-trimethoprim drops Azithromycin drops Fluoroquinolone drops preferred in contact lens wearers
359
What is the rx for viral conjunctivitis?
Warm or cold compress | Symptomatic management!
360
What is the rx for allergic conjunctivitis?
OTC antihistamine/decongestant drops for intermittent sx | Mast cell stabilizer/antihistamine drops for frequent episdoes
361
Most common cause of acute unilateral lymphadenitis in children under 5
Staph aureus
362
Cause of acute unilateral lymphadenitis in kid exposed to animal, kid has fever chills headache
Tularemia
363
Cause of acute unilateral lymphadenitis in older kid with history of periodontal disease
Peptostreptococcus
364
What test diagnoses CLL?
Flow cytometry, showing clonality of mature B cells
365
What is the appropriate treatment for lactation suppression?
Supportive bra Avoid nipple stimulation Ice packs and analgesics Bromocriptine no longer approved!
366
What is the key feature of schizoaffective d/o?
MDD or manic episode with sx of schizophrenia AND Delusions or hallucinations for >=2 wks in the absence of MDD or manic episodes
367
Cutoffs for DM testing - Fasting plasma glucose - 2 hr glucose tolerance test - Hbg A1c
FPG: >= 126 GTT: >=200 HA1C: >= 6.5
368
What is the ppx of a cat bite?
Amox Clav - Worried about Pasturella and oral anaerobes
369
What is the pathogenesis of gallstone ileus?
Gallstone passes through a biliary-enteric fistula and "tumbles" through the bowel causing periodic symptoms until it lodges in the ileum (narrowest portion), causing a mechanical SBO
370
Pt presents with progressive peripheral edema, ascites, elevated JVP, midsystolic heart sound, and calcifications surrounding the heart. What is the dx?
Pericarditis
371
What is the rx for asymptomatic Chlamydia?
Single dose azithromycin
372
What illness is associated with meconium ileus in an infant, and what kind of stool is expected?
Thick stool CF
373
What illness is associated with Hirschspuring's in an infant, and what kind of stool is expected
"Squirt sign" after rectal exam Down's syndrome
374
What is the confirmatory test for carpal tunnel?
Nerve conduction study | - Slowing of the median nerve at the wrist
375
What are Howell Jolly bodies, and in what illness are they seen?
Represent splenic dysfunction | Sickle Cell
376
Wha are the long term complications of radiation for Hodgkin's lymphoma?
Cardiac disease - Myocardial ischemia/infarct - Restrictive cardiomyopathy - CHF - Valvular abn - Conduction defects - Pericarditis! May present acutely, but years after, as a result of mediastinal radiation
377
Treatment for urge incontinence
1. Kegel/pelvic floor strengthening | 2. Antimuscarinics: oxybutinin
378
What is the major side effect of antithyroid drugs (thionamides)?
Agranulocytosis | PTU: also hepatic failure
379
What are the major side effects of radioiodine ablation?
Permanent hypothyroidism | Worsening of ophthalmopathy
380
What are light's criteria?
Serum/fluid album > 0.5 Serum/fluid LDH > 0.6 fluid LDH 2/3 ULN serum Any 1 criteria means exudate
381
What does an exudative effusion signify?
Infection Malignancy PE
382
What does a transudative effusion signify?
Hypoalbuminemia (cirrhosis, nephrotic syndrome) | CHF
383
What is the next step in evaluating a solid, frequently recurring nodule on the upper eyelid?
Histopathologic exam - Could be chalazion, with underlying sebacious carcinoma - Could be basal cell carcinoma
384
In the case of abd trauma: if the FAST exam is inconclusive, what do you do next?
Diagnostic Peritoneal Lavage
385
How do chemical stress test agents such as dipyridamole and adenosine work?
They maximally dilate coronary arteries. Should increase blood flow. But, arteries that are clogged are already max dilated, and won't show more flow. This is coronary steal.
386
Wha tis the appropriate imaging test for a psoas abscess (or any abscess)?
CT
387
What ist he rx for social anxiety d/o?
SSRI/SNRI CBT Beta blocker or benzo for performance only subtype
388
What is inside a baker's cyst?
Synovial fluid, often secreted by inflamed synovium due to RA, OA, or cartilage tears
389
Pt has hemineglect after a stroke. Where's the lesion?
Right parietal cortex
390
What is the rx for complicated diverticulitis with abscess formation?
CT guided drainage
391
Neonate presents with thick discharge form the eyes at 3 days. What is the illness and its time course of presentation?
Gonoccocal conjunctivitis 2-5 DOL - Prophylaxe with topic erythromycin at birth - Hospitalize and treat with CTX otherwise
392
Neonate presents with watery, mucoid discharge from the eyes at 10 days. What is the illness and its time course of presentation?
Chlamydial conjunctivitis | 5-14 DOL
393
What is the next treatment for a patient who fails SSRI rx for depression?
SNRI such as venlafaxine | Bupropion unless contraindicated by seizure hx
394
What cranial nerve is likely to be affected first in a rupture of the middle meningeal artery?
Uncal herniation results from bleed | Occulomotor is first affected

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