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USMLE step 3 > uworld stuff! > Flashcards

uworld stuff! Flashcards

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USMLE® Step 1 flashcards
1
Q

infant of mother with pregestationa diabetes, presents with cyanosis and structural abnormality on second trimester ultrasound

A

hypoplastic left ventricle syndrome

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2
Q

infant with weak femoral pulses and decresed postductal oxygen saturation

A

coarctation of aorta

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3
Q

diaphoresis, cool extremities, JVD, pulmonary crackles, hyperdynamic impulse, apical decrescendo murmur, rapid onset pulmonary edema, heart failure

A

acute mitral valve prolapse from chordae tendinae rupture

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4
Q

easy bruising, velvety skin with atrophy and scarring, MVP, scoliosis

A

ehlers-danlos syndrome

biggest give away is the velvet skin and atrophy

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5
Q

mid systolic murmur at the left upper sternal boarder with right atrial and ventricular dilation

A

atrial septal defect , secundum type

wide fixed splitting of second heart sound

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6
Q

heart failure patients with EF <40 should get what

A

ACE inhibitor

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7
Q

trastuzumab cardiotoxicity is reversible or irreversible

A

irreversible

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8
Q

nonejection click and murmur that vary in timing depending on body position

A

Mitral valve prolapse

worse with decreased venous return

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9
Q

ejection crescendo-decresendo systolic murmur

A

aortic or pulmonic valve stenosis

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10
Q

harsh holosystolic murmur with maximal intensity over the left thrid and fourth intercostal space with a palpable thrill

A

VSD

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11
Q

SOB, fatigue, palpitations, cough while laying down, anxious, fatigue, loud fst heart sound with short apical low pitched diastolic rumble. broad notched P wave in lead II with right axis deviation

CXR showing pulmonary edema, elevaton of the left mainstem bronchus, left atrial enlargement with flattening of the left heart boarder

what is this and what can cause this 10 - 20 years after the initial event

A

mitral stenosis

rheumatic heart disease

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12
Q

progressive dyspnea, fatigue, JVD, lower extremity edema

poor sign is early right ventricular collapse

A

pericardial tamponade

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13
Q

person has ASCVD risk factors, ACS, angina, arterial revascularization (CABG), stroke, TIA, PAD. what do they need

A

statin

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14
Q

young person, chest pain and palpitation, lightheadedness that pass out after overexertion, prolonged QT, dies of sudden cardiac death

A

anomalous aortic origin of coronary arteries

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15
Q

how does bicarb work to treat TCA overdose

what about salicilate overdose

A

inhibition of fast sodium channels to decrease QRS duration and prevent arrhythmia

alkalynize urine to promote excretion

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16
Q

what medication do you give to people with Afib with RVR (variable R-R) interval

A

metoprolol, do not give adenosine

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17
Q

PAD disease treatment course

A

smoking cessation, comorbidity control, statin
exercise program
cilostazol
angioplasty

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18
Q

treatment of cocaine overdose

A

benzodiazepine, do not give b-blockers previous studies where conducted poorly and are unreliable. can lead to unopposed alpha vasocontriction

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19
Q

suspect this in cocaine overdose in patient with controlled vitals but has persistent chest pain, and new development of neurologic symptoms

A

aortic dissection

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20
Q

give this medication to acute heart failure patients that are hypertensive and fluid overload

A

nitroglycerin

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21
Q

what complication is the most common with compartment syndrome

A

AKI due to myoglobin release

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22
Q

what pressure indicates compartment syndrome

A

30 or greater

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23
Q

ekg showing narrow complex tachycardia, regular r-r interval and retrograde p waves

A

psvt

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24
Q

s3 is highly specific for what

A

heart failure

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25
Q

loud harsh, holosystolic murmur in 4th left intercostal space with palpable thirll

A

VSD

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26
Q

polymorphic VT such as torsades is usually precipitated by what

A

bradycardia

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27
Q

what is contraindicated in acute decompensated heartfailure (CP, nausea, weakness, lightheadedness) due to causing decreased contractility of the heart causing worsening of pulmonary edema

A

b-blockers

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28
Q

edema, ascities, hepatic congestions, elevated JVP with prominent “y” decent, pericardial knock, with CXR showing pericardial thickening or calcification typically after cardiac surgery

A

constrictive pericarditis

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29
Q

fix this arrhythmia with treatment of underlying lung pathology

A

multifocal atrial tachycardia,

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30
Q

s4 with systolic murmur along left sternal boarder that increases with valsalva

A

HOCM

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31
Q

treatment for heart failure with LVOT obstruction

A

b-blocker or ccb

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32
Q

difference between acute pericarditis and dressler syndrome

A

dressler occurs several weeks after MI

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33
Q

treatment of peri-infarction pericarditis

A

aspirin

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34
Q

digoxin toxicity is caused by what four medications

A

verapimil, amiodarone, quinadine , spironolactone

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35
Q

aortic jet velocity, transvalvular gradient, and valve area that indicated aortic stenosis

A

> 4 sec, >40mmHg, and <1cm

if they have shortness of breath, angina, syncope, CABG, or EF <50 then replace

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36
Q

HOCM patients die from what and need what to prevent it

A

sudden cardiac death and ICD

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37
Q

what indicates severe AS as far as the sound of the murmur

A

loud and late peaking single sound on inspiration

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38
Q

biggest modifiable risk factor for AAA

A

smoking cessation

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39
Q

INR goal of mitral valve

INR goal of aortic valve

A

m - 2.5 to 3.5

a - 2 to 3

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40
Q

lower leg claudication, upper extremity HTN

murmur can be interscapular and persistent, left sternal border with brachio-femoral delay

A

coarctation , associated with turners syndrome

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41
Q

syncope with no prodrome is likely related to what

A

cardiogenic

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42
Q

syncope triggered by prolonged standing, acute stress, or pain typically with nausea, flushing, warmth, pallor, and sweating that resolves in minutes

A

vasovagal syncope

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43
Q

holosystolic murmur at the apex with a click

A

mitral regurgitation

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44
Q

low pitch diastolic murmur over cardiac apex with emboli

A

atrial myxoma

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45
Q

treatment of cocaine overdose

A

benzos

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46
Q

bp control from acute ischemic stroke
with TPA
without TPA

A

<185/105 but greater >140/90

<220/120

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47
Q

vertigo, dizziness, unable to walk, dysarthria, numbness, and visual disturbance

A

vertebrobasilar insufficieny

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48
Q

cognition waxes and wanes, parkinsonism like symptoms, and hallucinations in older person with frequent falls can also have delusions, depression, and autonomic dysfunction

A

dementia with lewy bodies, antipsychotics but this can cause things to get worse

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49
Q

bilateral polyspike and slow wave discharges, absoncse, morning myoclonus

A

juvinile myoclonic epilepsy, valproic acid which can cause thrombocytopenia, hepatotoxicity, and panceatitis

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50
Q

medication that causes gingival hyperplasia

A

phenytoin

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51
Q

dopamine agonist used for parkinsons treatment

A

pramipexol or bromocriptine

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52
Q

wet, wobbly, wacky

A

normal pressure hydrocephalus, LP then VP shunt if LP resolves symptoms

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53
Q

progressive weakness, sensory loss, urinary retention after URI

A

transverse myelitis

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54
Q

headache under stress, bandlike or bilateral lasting 30 minutes to 7 days

A

tension headache

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55
Q

patient wakes up during sleep, pain behind one eye, lacrimation, flushing, pupillary changes, and nasal congestion

A

cluster headache, verapamil for prevention

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56
Q

unilateral, aura, pulitile, phonophobia, photophobia, nausea

A

migraine headache

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57
Q

vertigo, diplopia, horizonta and vertical nystagmus, sensory loss, dysphagia, hoarsness, ipsilateral horners syndrome

A

wallenberg syndrome usually caused by occluded intracranial vertebral artery

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58
Q

these brain lesions affect the sensory loss in the contralateral face and body

A

thalamus or cortex

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59
Q

lesion associated with aphasia, neglect, and agrapesthesia

A

cortical lesion

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60
Q

lesions that affect the ipsilateral face and contralateral body

A

brainstem

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61
Q

these two drugs are disease modifying agents for relapsing and remitting MS

A

beta interferon, glatiramer acetate

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62
Q

pt with seizures that develops horizontal nystagmus, blurred vision, diplopia, ataxia, slurred speech, lethargy

A

phenytoin toxicity

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63
Q

severe, sudden onset headache with nausea, ptosis, mild anisocoria, and nuchal rigidity

A

SAH due to posterior communicating artery aneurysm

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64
Q

used in treatment of opioid withdrawal in hospital setting vs rehab

A

clonidine

methadone

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65
Q

three acetylcholinesterase inhibitor meds and one NMDA receoptor antagonist used for dementia related cognitive impairment

A

ace - donepezil, rivastigimine, galantamine

nmda - memantine

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66
Q

constant tremor in arms that is worse with movement

A

benign essential tremor, propranolol

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67
Q

hypertonia, hyperreflexia, clonus, delayed motor milestones, MRI shows periventricualr leukomalacia, basal ganglia lesions

A

cerebral palsy

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68
Q

progressively worsening severe back pain, mid-thoracic level and wraps around upper abdomen in band like fashion, with weakness, numbness, and tingling in both lower extremities. can also have bowel and bladder incontinence

A

epidural spinal cord compression, high dose steroids

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69
Q

staring spells, preserved muscle tone, short in duration, 3Hz spike and wave discharges. associated with ADHD, anxiety, and depression

A

childhood absence epilepsy, ethosuximide

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70
Q

gradually progessive symptoms that impact memory and language first, while behavioral symptoms become more prominent late in disease course

A

Alzheimer disease, cholinesterase inhibitors slow disease

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71
Q

headache that is different form the past, often with nausea, vomiting, LOC, focal deficits, meningial signs, usually from berry anurysm

A

SAH, LP definitively excludes SAD if CT is negative

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72
Q

loss of pupillary light reaction, vertical gaze paralysis, loss of optokinetic nystamus, and ataxia. often cause headache due to obstructive hydrocephalus

A

Parinauds syndrome from pineal tumor

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73
Q

frequent headaches, rhythmic pulsating sound in ears when he bends over, when standing up his vision dims in both eyes, opthalamic exam shoes peripapillary flame hemorrhages, venous engorgement, and hard exudates

A

pseudotumor cerebri

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74
Q

autosomal dominant disorder with hypopigmented skin lesions “ash leaf spots”, shagreen patches, CNS lesions, epilepsy, intellectual disability

A

tuberous sclerosis complex

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75
Q

initially presents as asymmetric weakness in one limb, cramping, then progresses over time to atrophy and fasciculations and bulbar involvement causing fasciculation of face

A

ALS, riluzole which is a glutamate inhibitor

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76
Q

pneumonic for OSA

A 
snoring
tired
observed apnea
pressure (htn)
bmi >35
age >50
neck >17
gender male
2 - low
5 - high
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77
Q

what do you measure to assess muscle weakness in the lungs as it relates to neurological disease that cause difficulty breathing

A

vital capacity at bedside

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78
Q

fever, severe focal back pain, and neurologic deficits

A

spinal epidural abscess

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79
Q

stroke in the non dominant parietal lobe is called what and what cant the patient do?

A

construction apraxia, copy line drawings, or will get dressed on half the body

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80
Q

stroke to the dominant parietal lobe is called what and what cant the person do?

A

gerstmann syndrome, presents with acalculia, finger apraxia, and left vs right confusion

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81
Q

lesions of nondominant temporal lobe cause what

A

homonymous upper quadrantanopia

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82
Q

lesions of the dominant temporal lobe causes what

A

homonymous upper quadrantanopia and wernickies aphasia

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83
Q

carbamazepine causes what

A

bone marrow suppression

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84
Q

think about this in pts with atherosclerotic disease, present with hematochezia, diarrhea, leukocytosis, lactic acidosis. ct shows fat stranding, endoscopy shows edematous and friable mucosa. acute crampy abdominal pain with fecal urgency thats followed by bloody diarrhea

A

colonic ischemia, bowel rest and abx

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85
Q

acute pancreatitis patients that get worse or develop sepsis do what?

A

CT scan for necrotizing pancreaitis

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86
Q

decreased tone or excessive transient relaxations of LES

A

GERD

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87
Q

diffuse abdominal pain in ascities or pt with peritoneal dialysis cath

A

SBP
rocephin for tx
prophylaxsis give fluoroquinolone

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88
Q

how to calculate saag

A

serum albumin - ascities albumin = number
>1 infectious
<1 pressure

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89
Q

what decreases the incidence of mortality in SBP? what if that doesnt work

A

IV albumin

treat hepatorenal syndrome with octreotide or midodrine

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90
Q

when will you see HBV core antibody

A

window period, (subclinical hepatitis), years after HBV recovery

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91
Q

people who dont improve after 2-3 days after acute diverticulitis should get what

A

CT scan to evaluate for abscess because this would need surgical intervention

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92
Q

suboptimal breasstfeeding with signs of dehydration

A

breastfeeding failure jaundice

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93
Q

adequate breastfeeding with normal examination with unconjugated hyperbilirubinemia

A

breast milk jaundice

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94
Q

diabetic patients with recurrent hypoglycemia episodes with sweating during meals, postural dizziness, postprandial fullness, early satiety and constipation

A

gastroparesis, erythromycin or metoclopramide

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95
Q

person with gastric ulcer perforation should get what after a chest xray confirms the diagnosis

A

IV antibiotics, broad spectrum

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96
Q

nonbloody, nonbilious , projectile vomiitng immediately after feeding with the infant that is hungry following the episode of emesis, weight loss and signs of dehydration,?
what is a major risk factor for developing this

A

infantile hypertrophic pyloric stenosis

macrolides like azithromycin and erythromycin

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97
Q

what metabolic derangement do you see with severe pyloric stenosis

A

hypokalemic, hypochloremic metabolic alkalosis

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98
Q

patient has discomfort after eating typically 30-40 minutes after meals, coffee makes it worse, complains of back pain, dry cough, and constipation

A

GERD, consider screening EGD for barrett esophagus

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99
Q

intermittent abdominal pain for 6 months, sharp and located across his mid-abdomen, relieved with sitting upright. post prandial bloating and discomfort. pain gets worse recently. lasts minutes and then resolves. frequent large loose stools that are fatty in nature. multiple hospitalizations in the past. 15lb weight loss over the last 6 months, drinks 4-5 beers daily with some liqour occassionaly. Alk phos is elevated

A

chronic pancreatitis , pain may be relieved by sitting up or leaning forward.

test of choice is MRCP, alternative would be CT scan

five small frequent meals plus pancreatic enzyme supplementation

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100
Q

the presence of air in the distal colon makes the diagnosis of what less likely

A

complete bowel obstruction

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101
Q

what is associated with increased risk of death in a patient that presents with acute pancreatitis

A

BUN greater that 20

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102
Q

pt has bloody bm, urge to defecate followed by blood loss in stool but then self resolves. pts have painless hematochezia that is self liitied

A

diverticular bleeding,

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103
Q

pt tired, bilateral xanthelasmata, elevated alk phos, transamonitis. can also have pruritus, arthritis, hyperpigmented skin, RUQ pain?

what test confirms this

imaging shows fibrosis and obliteration of intrahepatic bile ducts

A

primary biliary cholangitis, ursodeoxycholic acid

anti-mitochondrial antibody

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104
Q

PBC has what issues with bones

A

osteopenia and osteoporosis

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105
Q

diarrhea, mucus discharge, tenesmus after radiation. can be associated with stricture, fistula formation, and rectal bleeding. sigmoidoscopy shows

A

pale rectal mucosa, serpinginous telangiectasisa, and small area of mucosal hemorrhage

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106
Q

high saag is related to what?

what about low saag?

A

high pressure aka portal hypertension

cancer or infection

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107
Q

if the patient has sensations of food getting stuck on the esophagus or lower chest what is the best test to order

A

this is esaophageal dysphagia , thest is nasopharyngeal laryngoscopy due to visualization of obstruction/mass

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108
Q

angiodysplasia is associated with this

A

ESRD

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109
Q

untreated celiac disease can lead to what in the jejunum

A

enteropathy associated t-cell lymphoma

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110
Q

watery diarrhea and emesis, abdomen is otherwise benign, dehydration

A

viral gastroenteritis

give a regular diet and avoid fruit juice and sugar

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111
Q

multiple bloody bowel movmeents and severe abdominal pain, what is the diagnosis and what do you have to evaluate for with a KUB

A

ulcerative colitis, toxic megacolon

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112
Q

UC patient with multiple air fluid levels on KUB

A

toxic megacolon, give glucocorticoids and consult surgery

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113
Q

triple and quad therapy for h.pylori

A

clarithromycin, pantoprazole, amoxicillin

quad - pantoprazole, bismuth, metro, tetracycline

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114
Q

pts with GERD over the age of 60 should get what

A

EDG looking for cancer because they are high risk

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115
Q

if a patient has gall stones on imaging and symptoms how are they managed

A

elective lap choley

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116
Q

seen with short bowel syndrome and post choley with daily diarrhea that is water

A

bile salt induced diarrhea, cholestyramine

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117
Q

pleural protein/ serum protgein is >0.5 or pleural LDH/serum LDH >0.6 or pleural LDH >2/3 upper limit of normal of serum LDH

A

exudative pleural effusion, inflammation due to infection malignancy, connective tissue disease, pulmonary embolism, pancreatitis, post cabg

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118
Q

transudative causes of pleural effusion

A

restrictive pericarditis, nephrotic syndrome, HF, and cirrohsis

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119
Q

treatment for decompensated cirrhosis

A

sodium restriction, lasix, and spironolactone

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120
Q

abdominal pain, diarrhea, nausea, vomiting, dizziness, sweating, and dyspnea after gastric sleeve or other gastic surgery

A

dumping syndrome, start high protein diet

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121
Q

pt with progressively increasing lower leg pain over shins, weight loss, with a normal diet and family history of hypothyroidism. pt has hypochromic and microcytic rbc. has iron deficiency and vitamin d deficiency. what is diagnosis and what is the antibody testing

A

celiacs disease, anti endomysia antibody and anti tissue transglutaminase

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122
Q

pt with intermittent dysphagia for months with sensation of food and water getting stuck on chest several seconds after swallowing with chest pain. also has iron deficiency anemia, . manometry shows premature and simultaneous contractions of the distal esophagus

A

diffuse esophageal spasm, esophageal shows corkscrew pattern treat with CCB or nitrates

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123
Q

pt with gastrointestinal hemorrhage and isolated gastric varicies, anemia, thormbocytopenia in the setting of pancreatitis likely has what

A

splenic vein thrombosis

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124
Q

well demarcated lesion of the liver that has peripheral enhancement likely made worse by OCP

A

hepatic adenoma
>5 surgery
<5 stop OCP

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125
Q

epigastric fullness and nausea with no other findings or meds, or history

A

dyspepsia, get h.pylori testing

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126
Q

full term infant with failure to pass meconiu, abdominal distension, poor feeding, bilious emesis, xray shows absense of rectal air and contrast enema shows transition zone

A

hirschsprung disease, dx with rectal mucosal suction biopsy

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127
Q

prevention of esophageal varicies

A

propranolol

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128
Q

enlarged liver, elevated alkaline phasphatase and ggt with hypercalcemia, and hilar adenopathy

A

hepatic sarcoidosis, steroids

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129
Q

pts admitted for variceal bleeding are at increased risk of what and should recieve what to treat it in order to decrease mortality

A

infection like spontaneous bacterial peritonitis, ceftriaxone 7 days

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130
Q

when is one of the few times to get stools studies,

A

chronic diarrhea

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131
Q

inguinal hernia in kids are at increased risk of what

A

bowel ischemia

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132
Q

acute diarrhea with visible blood or mucous

A

dysentery, rehydration until EHEC is suspected

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133
Q

prior to definitive treatment of a toxic thyroid nodule a patient needs what

A

pretreatment with antithyroid drugs like methimazole to achieve chemical euthryoidism

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134
Q

reduced 21 hydroxylase activity causing excess androgen production causing advanced bone age, acne, pubic hair development in young boys with precocious puberty.

girls with have hirsutisim and menstrual irregulaties with elevated 17 hydroxyprogesteron levels on acth stim test

A

nonclassic congenital adrenal hyperplasia, hydrocortisone

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135
Q

all adrenal tumors >4cm or that are functional require this

A

surgery

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136
Q

pt has hypercalcemia and after repeat testing you get PTH

3 things if it is high normal or elevated

if it is suppressed then measure PTHrP and vitamin d. major causes here are

A

primary or tertiary hyperparathyroidism, family hypercalcemia, lithim

malignancy, granulmatous diseases, thiazides, milk alkali syndrome, thyrotoxicosis, immobilization

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137
Q

hypercalcemia of malignancy

decreased PTH with increase PTHrP

decreased everything

decreased PTH and increased vitamin D

A

SCC, renal/blader, breast

breast, multiple myeloma,

lymphoma

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138
Q

weight loss, abdominal pain, amenorrhea, fatigue, weakness, poor appetite, muscle tenderness, decreased axillary and pubic hair, hyperpigmentation, hyponatremia, hyperkalemia, hyperchloreic metabolic acidosis

A

addisons disease or chronic adrenal insufficiency

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139
Q

NPH causes what more so than basal bolus insulin

A

hypoglycemia

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140
Q

first step in evaluating thyroid nodule is what?

when is the only time to do iodine scintigraphy?

A

TSH level and US

when TSH is low, all the other times do a FNA

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141
Q

hot vs cold nodule treatment

A

hot - treat hyperthyroidism

cold - FNA

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142
Q

goiter, HTN, tremor, hyperreflexia, proximal muscle weakness, lig lag, atrial fibrilation

long term complications, 3 in total

A

hyperthyroidism

arrhythmia, cardiomyopathy, osteoporosis

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143
Q

first line drugs for diabetic neuropathy

A

duloxetine, pregabalin, tricyclic antidepressantsw

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144
Q

what does amiodarone do to thyroid function

A

everything and anything if there is undetectable RAIU then give glucocorticoids because its causes destructive thyroiditis

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145
Q

bitemporal hemianopsia and hyperpigmentation following abdominal operation (bilateral adrenalectomy for cushings syndrome)

A

nelsons syndrome, prevention is with radiation to the pituitary but this causes hypopituitarism

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146
Q

episodic headaches, diaphoresis, tachycardia, palpitations, pallor, resistant hypertension, orthostatic hypotension, blurry vision, and weight loss

if suspicition is high what is the next step

A

pheochromocytoma, do preoperative alpha blockade

abdominal MRI/CT if negative do MIBG scan and if >5cm likely have extra adrenal disease

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147
Q

newborn with lethargy, poor feeding, constipation, and hypotonia, born at home with no prenatal screening. these have been progressive and werent present when born

A

congenital hypothyroidism

148
Q

increased urinary cortisol level, nonsuppressible hight dose dexamethasone suppression test, and undetectable ACTH levels.

weight gain, tired, weak, difficulty climbing the stairs and in combing her hair, HTN, DM, fat distributed in the trunk, face round and plethoric, buffalo hump

A

cushings syndrome secondary to an adrenal etiology

149
Q

diffuse goiter, afib rvr, bone loss with mild hypercalcemia, vasospasm, and hight output heart failure

A

thyrotoxicosis, bblocker first then thyroid hormone synthesis

150
Q

young female started developing breasts, no mensturation, growth spurt, fatigue, with no pubic and axillary hair most likely diagnosis

A

androgen insensitivity syndrome, 46 xy

151
Q

difference between androgen insensitivity syndrome and abnormal mullerian development

A

androgen insensitivity syndrome looks like a woman and is 46,xy but has no pubic hair development

abnormal mullerian development is female looking 46 xx but has pubic hair development

152
Q

new born girl with dehydration, hypotension, and ambiguous genitalia, hyponatremia, hyperkalemia

what else will be elevated

what is the treatment

A

congenital adrenal hyperplasia specifically 21 hydraxylase deficiency aka salt wasting syndrome

17 hydroxyprogesterone

tx is hydrocortisone

153
Q

hypertension with hypokalemia and ambiguous genitalia in girls

A

11b-hydroxylase

154
Q

hypertension, hypokalemia, ambiguous genitalia in boys, absent puberty

A

17a-hydroxylase

155
Q

mutations of calcium sensing receptor with CCCR > 0.02

A

familial hypocalciuric hypercalcemia

156
Q

amenorrhea, hypogonadism, decreased LH and FSH but increased alpha subunits in someone with blurry vision

A

nonfunctioning pituitary adenoma, do surgery

increased alpha subunit is the give away

157
Q

elevated calcium with suppressed PTH, in a person that is quad

A

parathyroid hormone independent hypercalcemia, due to immobilization give bisphosphonates

158
Q

oral glucose control that has a risk of hypoglycemia

A

sulfonylureas (glyburide, glipizide, glimepirde)

meglitinides (nateglinide, repaglinide)

159
Q

major risk factor for untreated acromegaly

A

cardiovascular disease

160
Q

elevated TSH with normal free thyroxine, irregular menses, depression, lethargy, poor sleep

when to treat?

in women can cause what

A

subclinical hypothyroidism, Hashimoto

goiter, high TPO antibody

recurrent spontaneous miscarrage

161
Q

with increased levels of estrogen, what do you have to do to levothyroxine?

A

increase the dose because estrogen increases thyroxine binding globulin

162
Q

is lithium induced hypothyroidism an indication to stop lithium

A

no, increase levothyroxine

163
Q

delayed puberty in boys due FSH, LH, and testosterone levels

elevated FSH and LH

if they are low to normal

A

primary hypogonadism likely klinefelter syndrome

secondary hypogonadism any other cause essential, constituational delay, illness, hypothyroidism, kallmann syndrome, craniopharyngioma

164
Q

lethargy, weight loss, nausea, vomiting, constipation, prolonged relaxation time to ankle reflexes, hyponatremia, hypoglycemia, low TSH, low T4, low am cortisol

if cortisol information wasnt available what would this be?

A

adrenal insufficiency

central hypothyroidism, if you give leveothyroxine during uncorrected adrenal insufficiency you could trigger adrenal crisis

165
Q

amennorrhea can lead to what if untreated

A

osteoporosis

166
Q

after starting antithyroid medication what do you need to follow to assess how well meds are working

A

t3 and t4

167
Q

pt has early secondary sexual development

advanced bone age with high LH and then with low LH

normal bone age with isolated breast development and then with isolated pubic hair

A

precocious puberty

central precocious puberty then peripheral precocious puberty

premature thelarche, premature adrenarche

168
Q

after thyroid cancer treatment how low should you titrate TSH to with meds

A

low normal to super low depending on the aggresiveness of cancer

169
Q

low T3

A

euthyroid sick syndrome

170
Q

loss of proprioception, brisk reflexes, loss of ankle jerk, tingling and numbness in distal lower extremities, fatigue, babinski present, romberg in someone who has hashimoto
thyroiditis

A

pernicious anemia, further autoimmune destruction of parietal cells

171
Q

treating b12 deficiency can cause what

A

hypokalemia

172
Q

hyperthyroidism with fever, neck pain, tender goiter, ESR elevation often after upper respiratory infection

A

subacute thyroiditis (de quervain) will have low radioiodine uptake on thyroid scintigraphy, give nsaids and beta blocker

173
Q

sexual dysfuntion, no notournal erections, hx DM, dark complexion with sparse body hair, liver enlarged 1 cm below right costal margin, decreased testicular volume, alk phos elevated, transaminitis, decreased FSH and LH and low testosterone

A

hereditatary hemochromotosis,

therapeutic phlebotomy

174
Q

recurrent hypoglycemia or has symptomatic hypoglycemia, low blood glucose, resolution after glucose administration (whipple triad)

low c-peptide

positive hypoglycemic drug assay

everything elevated to normal

A

exogenous insulin

oral hypoglycemic agent

insulinoma

175
Q

elevated parathyroid hormone, abdominal pain, neuro symptoms, kidney stones, elevated urinary calcium exretion

what if urine calcium was <200

A

primary hyperparathyroidism, parathyroidectomy

familial hypocalciuric hypercalcemia

176
Q

thyroid symptoms with low RAIU and low thyroglobulin but has hyperthyroidism

A

exogenous thyrotoxicosis from supplements

177
Q

untreated prolactinoma causes what i women long term

A

osteoporosis

178
Q

oral diabetes medication that will causes orthopnea, hypoxia, pulmonary edema

A

pioglitazone

179
Q

uncontrolled hypertension, DM, mood swings, hypokalemia, metabolic alkalosis with evidence of osteopenia

A

cushings syndrome

180
Q

causes of hypocalcemia pt will have bilateral cataracts and basal ganglia calcifications, tetany, seizures, muscle cramping hyperreflexia,

phos low PTH high

phos High PTH low

phos and PTH high

what if they have all of the above and have dysmorphic features like short stature, round faces, short 4-5 metacarpals

A

vitamin d deficiency

hypoparathyroidism

seudohypoparathyroidism or hyerphosphatemia

albright hereditary osteodystrophy

181
Q

pt has exertional dyspnea, orthopnea, PND, hemoptysis, pulomonary edema, right sided heart failure and a new murmur opening snap with middiastolic rumble at the apex

A

mitral stenosis , commonly seen in people with rheumatic heart disease

182
Q

biggest difference between febrile seizures and meningitis

A

meningitis will have headache, vomiting, bulging fontanelle (increased ICP), nuchal rigidity, petechial rash but most importantly the post ictal state is >10 minutes

183
Q

pt is hypocalcemic after vitamin d therapy what do you add to the treatment regimen

A

thiazide diuretic

184
Q

if concerned about thyroid cancer when is the only time not to do a FNA

A

if you see a hyperfunctional hot nodule (TSH will be low)

185
Q

what do you give in sulfonylurea overdose when dextrose doesnt work

A

octreotide

186
Q

amenorrhea at age <40, hot flashes, increased FSH and decreased estrogen

A

primary ovarian insufficiency, estrogen therapy (conjugated equine estrogen with medroxyprogesterone acetate

187
Q

back pain, low phos, high alk phos, bariatric surgery, osteomalacia, fractures

A

vitamin d deficiency, cholecalciferol D3

188
Q

polyuria, polydipsia, hypertensive, hypokalemia

A

hyperaldosteronism

189
Q

pt has hashimoto’s thyroiditis and has acute enlargement of thyroid gland

A

thyroid lymphoma

190
Q

new cases that develop in a population over a certain period of time

10,000 cases
1000 already have it
two years of follow up 200 people die and 200 people get the disease

whats the early incidence

A

incidence

100/9000

when calculating incidence do not take into account the number of cases that already existed in the populaton before the counting period.

then in the denominator only include the people at risk of developing disease. so in this part people that have the disease are excluded

191
Q

total number of cases (new and old) measured at a particular point in time

A

prevalence

192
Q

chronic disease treatments that prolong patient survival do what to prevalence

A

increase due to accumulation of cases over time, this is usually due to improved quality of care

193
Q

improved diagnostic accuracy does what to incidence and prevalence

A

increased

194
Q

how do you decreased incidence and prevalence

A

primary prevention

195
Q

What do second generation antipsychotics cause

A

Metabolic syndrome and hyperglycemia

196
Q

scaling of the webs of the fingers, wrists, and upper arms

A

scabies, permethrin

197
Q

colitis with diarrhea, bloody stool, abdominal pain, RUQ pain, fever, liver abscess that is well defined hypoechoic mass in the right hepatic lobe.

A

entamoeba histolytica, diagnose with stool ova and parasites

tx metronidazole

198
Q

man with UTI symptoms plus perineal discomfort or bladder obstruction

A

acute bacterial prostatitis

199
Q

difference between coin and button battery on xray

A

button battery will have double ring

200
Q

when to remove a coin that is swallowed

A

unknown time of ingestion, or symptomatic or >24 ingestion and lodged

201
Q

when to do parathyroidectomy

A

pt <50 or has symptomatic hypercalcemia

202
Q

circular discoid plaques, that combine together in places in spots and others as they get bigger will start to clear. typically with flu like prodrome

what is this associated with

A

erythema multiforme

HSV infection, mycoplasma pneumonia, abx, allopurinol

203
Q

first step with a palpable breast mast if malignancy hasnt been excluded

A

ultrasound

204
Q

pt has HCC

is AFP high or low or normal

what cells are mutated

A

high

liver parenchyma

205
Q

brief transiety euphora, lethargy, poor coordination, LOC lasting 15-45 minutes typically seen in children and adolescents with rash around nostrils and mount

A

inhalant abuse

206
Q

treatment of a cough that has inspiratory whoop, postussive emesis lasting weeks to months

A

pertussis, azithromycin which is also used as prophylaxsis despite vaccine status

207
Q

when to fix inguinal hernia in children when asymptomatic

A

1-2 weeks elective surgery

208
Q

pt started on new medication and now has muscle pain and elevated CK what is most likely cause

A

statin

209
Q

normal PT and prolonged PTT is a sign of what

these are rare in women so if see in them think

A

hemophilia a (8) and b (9)

aqcuired coagulation inhibior

210
Q

pt has exertional shortness of breath, decrease stamina, small joint pain, HTN, GERD, tachycardia, telangiectasias, heave along lower sternum

what antibody is associated

A

scleroderma, anti centromere

211
Q

common infection in people with saphenous venectomy

A

tineas pedia causing cellulitis

212
Q

HTN management in gout

A

losartan or ccb

213
Q

what electrolyte causes confusion and shortened QT interval, can also lead to nephrogenic SIADH

A

hyperglycemia

214
Q

how long does it take troponin to raise after STEMI chest pain

A

2-3 hours

215
Q

aching pain and stiffness that involves shoulders, neck, and or hip girdle that is worse in the morning, pts have difficulty getting dressed, malaise, fatigue, weight loss. muscle strength is intact but range of motion is reduced. inflammatory markers are elevated

A

plymyalgia rheumatica, steroids which provides symptomatic relief

216
Q

normocytic anemia, hypercalcemia, renal insufficiency, chronic back pain

how do you diagnosis this and what does it show

A

multiple myeloma

24 hour urine protein electrophoresis shows monoclonal protein

217
Q

soft scrotal mass that decreases while supine and increased with standing or valsalva

what can this cause if not treated

A

varicocele, gonadal vein ligation or scrotal support in older men

infertility and testicular atrophy

218
Q

infant with noisy breathing and cyanosis during feeding, mouth breather

how do you diagnosis this

A

choanal atresia (narrowing or obstruction of the posterior nasal passages), needs surgical repain

pass a samll catheter via each nostril, confirm with CT

219
Q

coloboma, heart defects, atresia choanae, growth retardation, genital and ear abnormalities

A

charge syndrome

220
Q

levels of lead toxicity

A

> 70 severe –> dimercaprol and EDTA
<44 mild - observe and move people from home

between is moderate - DMSA (succimer)

221
Q

indolent onset of fever, dry cough, dyspnea, weight loss in HIV pt

first line diagnostic modality

A

PCP pneumonia, typically requires blood gas analysis

induced sputum

222
Q

hodgkin lymphoma places you at risk for was

A

secondary malignancies

223
Q

people with prior MI and LVEF <30% or that have new york heart association class II or III heart failure and LVEF <35% should get what

A

implantable cardioverter-defibrillator

224
Q

pts with moderate to severe heart failure, LVEF <35% and wide QRS complex should get what

A

biventricular pacer and cardiac resynchronization

225
Q

most common inherited thrombophilia that is due to resistance of anithrombic effects of protein C

A

factor V leiden, look for coagulopathy in health person with no risk factors

226
Q

normal RDW is an indication of what

what about increased

A

thalassemia

iron deficiency

227
Q

nephritis in renal transplant recipient that is immunosuppressed with renal tubular damage and basophilic intranuclear insclusions

A

BK - virus indueced nephropathy (polyomavirus)

228
Q

muscle pain and weakness associated with elevated CK, AST, ALT, pins and needles sensation, normocytic anemia, mild hyponatremia, HLD, creatinine elvation

A

hypothyroid myopathy

229
Q

looks like healed grease burn, pruritic, planar, polygonal and purple located on flexor surfaces, lesions can have wickham stiae

A

lichen planus

230
Q

pts with severe nephrotic syndrome are predisposed to what

A

thrombotic events typically chronic renal vein thrombi and DVT

231
Q

pt has fever but had joint pain for several days and is now starting to notice a faint, diffuse rash (lace-like) after having son that had the same type of thing earlier in the week. can have red cell aplasia or aplastic crisis

what does this cause to a fetus

A

parvovirus b19

fetal demise, anemia, hydrops fetalis do ultrasound which will show fluid accumulation, can also do middle cerebral arteyr doppler

if severe do intrauterine blood transfusion

232
Q

most dangerous complication of granulomatosis with polyangitis

A

diffuse alveolar hemorrhage

233
Q

what medications causes hyperglycemia and metabolic syndrome

A

clozapine and olanzapine (second generation anti psychotics)

234
Q

neonate with mild cyanosis at birth followed by rapid clinical deterioration on day of life 1 is due to what disease and process.

marked by severe cyanosis, respiratory distress, and cardiogenic shock

A

hypoplastic left heart syndrome which is a ductal dependent congenital heart defect PFO and PDA, give prostaglandin E1

235
Q

pt has dyspnea, fatigue/weakness, exertional angina, syncope, abdominal pain found to have left parasternal lift and right ventricular heave, tricuspid regurgitation, JVD, ascites, right heart failure

A

pulmonary hypertension, get transthoracic echocardiography

236
Q

most important factor in OSA

A

neck circumference

237
Q

growing pains, pathologic fracture, splenomegaly, anemia, thrombocytopenia, FTT, delayed puberty

A

gaucher disease AR lysosomal storage disorder due to glucocerebrosidase deficiency

238
Q

decompensation after protein feeding

A

maple syrup urine disease, PKU

239
Q

early childhood with hypoglycemia and hepatomegaly, muscle pain and weakness with no bone pain

A

Von Gierke Disease, glycogen storage disorder

240
Q

self mutilation, arthritis, immunodeficiency

A

nucleotide metabolism disorders, Lesch-Nyhan disease, gout, ada deficiency

241
Q

oliogmenorrhea, hyperandrogenism, ultrasound showing enlarged ovaries

A

PCOS, get glucose tolerance test

242
Q

indications for mitral valve repair

A

chronic primary valve issue (issue with valve itself)

LVEF 30-60%

243
Q

purulent monoarthritis, tenosynovitis, dermatitis, mifratory polyarthralgia

A

disseminated gonococcal infection, ceftriaxone

244
Q

periarticular osteopenia, joint effusions, and symmetric joint space narrowing

A

RA, cytotoxic medications like methotrexate and hydroxychloroquine

245
Q

eosinophilia and eosinophiluria

A

atherosclerotic embolism to kidney

246
Q

muddy brown casts

A

contrast induced nephropathy

247
Q

young female athlete with poorly localized knee pain that is worse with standing from and sitting position after extended periods of time. squatting reproduces the pain

A

patellofemoral pain syndrome, exercise to strengthen hip and knee muscles

248
Q

effect of the main exposure is mixed with the effect of extraneous factors

A

confounding bias

249
Q

results from inaccurate estimation of exposure and/or outcome

A

measurement bias

250
Q

subjects selected for the study are not representative of the study population

A

selection bias

251
Q

selecting control subjects for a case control study from hospitalized patients

A

Berkson fallacy

252
Q

patients are sampled from specialized medical centers

A

referral bias

253
Q

in cohort studies when people are lost to follow up

A

selection bias

254
Q

incidence of disease is estimated based on prevalence and date becomes skewed by selective survival

A

prevalence bias or neyman bias

255
Q

bias seen in case control studies

A

recall bias

256
Q

investigators decision is adversely affected by knowledge of the exposure status

A

observer bias

257
Q

how do you limit confounding bias

A

randomization, matching, and stratified analysis

258
Q

this treats confounding and susceptibility bias

A

randomization

259
Q

how to minimize placebo effect

A

single blinding

260
Q

how to treat observer bias

A

double blind

261
Q

how to deal with selective non-compliance

A

intention to treat approach

262
Q

what to do if patients change treatment groups

A

use as treated rule

263
Q

wrongfully concluding that there is an association between exposure and disease when there is non

A

type 1 error, described as alpha and p value (they are the same thing)

264
Q

wrongfully concluding that there is no association between exposure and outcome when there is one

A

type II error

265
Q

alpha level and beta level (power of the study) are inverse or converse

A

converse

266
Q

how do you increase B or the power of the study

A

meta analysis

267
Q

probablity of commiting type II error

A

1 - B which is probability of detecting an association if it exists in reality

268
Q

error explained by chance and is unpredictable

A

random error

269
Q

the reliability and reproducibility of measurements is called

A

precision

270
Q

caused by flows in study design and/or analysis and is not a product of chance

A

systematic error which compromises the validity of the study

271
Q

cancer patient with hodgkin lymphoma that has progressive shortness of breath with chest pain, recieved chemotherapy and radiation therapy. 2/4 diastolic murmur at left sternal border, large left atrium, EF >60%, diastolic dysfunction, mitral and aortic valves are sclerotic and calcified, aortic regurgitation, ostial narrowing of the right and left main coronaries

what causes dose dependent decline in ejection fration leading to dilated cardiomyopathy

A

radiation cardiotoxicity

anthracycline chemo

272
Q

pt with frequent RBC transfusions but blood grouping and cross matching cant find a suitable blood match. what is the cause

A

alloantibodies typically seen in patients with sickle cell anemia or myelodysplasia

273
Q

first step for evaluation of normocytic/normochromic anemia

A

reticulocyte count which is also the first thing that responds to treatment of anemia resulting in increase in reticulocyte count

274
Q

child with pallor, microcytic anemia, elevated RDW with HbS and HbA in blood, associated with prematurity, lead exposure, exclusive breast feeding after 6 months >24 oz of cows milk per day

A

iron deficiency anemia although HbS with HbA is also consistent with sickle cell trait which doesnt cause anemia

275
Q

side effect of IVC filters

A

recurrent DVT

276
Q

when is the only time Rh incompatibility is possible

A

Rh negative mother and Rh positive father

277
Q

presents with target cells, and appears like iron deficiency anemia but has normal RDW

how do you tell them apart

A

thalassemia minor, hemoglobin electrophoresis with have incrase HgA2 in b-thalassemia, alpha thalassemia will be normal

278
Q

pt has bleeding, everything is normal except bleeding time is prolonged, what is the next best step. this is typically seen in renal failure

A

IV desmopressin, release of VIII:von willebrand factor multimers from endothelium.

279
Q

autoimmune destruction of parietal cells and detected by measurement of auto-antibodies against intrinsic factor in someone with macrocytic anemia and normal serum folate but suppresed cobalamin

what would endoscopy show

A

pernicious anemia - b12 deficiency.

absent rugae in the fundus

280
Q

pt with rash over her ankles that started 2 weeks ago and spread up her knees , exam shows fine petechiae and purpur around her ankles and lower legs, blood smear shows thrombocytopenia, after platelets her thrombocytopenia doesnt improve

A

antiplatelet antibodies caused by immune thrombocytopenia.
kids only if bleeding give steroids, IVIG, or anti D
adults >30k platelets observe or <30k same as kids

281
Q

isolated thrombocytopenia <100,000

A

ITP which is platelet destruction by antiplatelet autoantibodies against membrane proteins GPiib/IIIa

282
Q

thrombocytopenia and microangiopathic hemolytic anemia with schistocytes on peripheral smear and ELEVATED LACTATE DEHYDROGENASE, can also have renal failure, fever, and neurological abnormalities

A

thrombotic thrombocytopenic purpura

283
Q

pt has elevated hemoglobin and you get EPO level
high means what
low means what

A

chronic hypoxia or cancer like RCC

polycythemia vera, confirmed with Jak2 mutation,

284
Q

osteomylitis treatment in sickle cell child

A

clindamycin and ceftriaxone

285
Q

acute chest in sickle cell child

A

azithromycin and ceftriaxone

286
Q

rapid reversal of warfarin

A

PCC

287
Q

young child, abdominal mass, constipation, facial flushing, perspiration, weight loss, nontender, fixed mass in right mid abdomen. can cave periorbital ecchymosis (orbital metastases), spinal cord compression (dumbbell tumor), opsoclonus myoclonus syndrome, small round blue cells on cytology with N-myc gene amplification

A

neuroblastoma

288
Q

unilateral painful abdominal mass with hypertension and hematuria in young children

A

wilms tumor

289
Q

nasal or oral bleeding, blurry vision, confusion, headache, heart failure, other neurologic problems seen in cancers and vasculitis

A

hyperviscosity syndrome seen in multiple myeloma and waldenstroms macroglobulinemia (elevated IgM)

290
Q

fatigue, poor exercise tolerance, weight loss, abdominal discomfort, leukocytosis elevated incidentally on CBC

what chromosome abnormality

A

CML, tyroisine kinase inhibitor

phyladelphia chromosome 9:22 bcl/abl fusion protein

291
Q

most common cause of inherited or hereditary thrombophilia

A

factor V leiden

292
Q

difference in g6pd and abo incompatibility for timing of onset in newborn

A

g6pd is 2-3 days negative direct combs test

abo is 24 hours with positive direct combs test

293
Q

highest risk for colorectal cancer

A

alcohol

294
Q

keratosis pilaris tx

A

salicylic acid or urea cream

295
Q

what group causes tinea versicolor

A

malassezia species

296
Q

post viral rash with herald patch followed by smaller pink/tan lesions

A

pityriasis rosea

297
Q

painless blisters, increased skin fragility typically doral hand, facial hypertrichosis and hyperpigmentation

A

porphyria cutanea tarda

298
Q

first line for onychomycosis

A

terbinafine, itraxonazole

299
Q

facial flushing in response to hor or cold temps, emotion, spicy food. reddening of face, erythematous papulses on nose, telangiectasias

A

papulopustular rosacea, topical metronidazole, clindamycin, or peroxide

300
Q

pea sized nodule in eyelid associated with rosacea

A

chalazion, optho consult

301
Q

mild to mod plaque psoriasis tx
severe tx
facial tx

A

topical steroids
methotrexate
tacrolimus

302
Q

treatment for atopic dermatitis

A

topical glucocorticoids like triamcinolone

303
Q

tinea capitis tx

A

oral griseofulvin or terbinafine

304
Q

shiny, discrete, intensely pruritc, polygonal shaped violaceous plaques and papules that are most frequent on flexural surfaces

A

lichen planus, needs biopsy for diagnosis

also associated with hep c

305
Q

treatment for fine wrinkles, hyperpigmentation, reducing AKs, improving brown spots

A

tretinoin, all trans retinoic acid

306
Q

beefy red papules and plaques with satellite lesions

what if it involves skin folds

A

contact dermatitis from diaper rash, barrier cream

candida dermatitis, clotrimazle or nystatin cream

307
Q

what antihypertensive can cause sun burns to be worse

A

HCTZ

308
Q

random areas of hair loss on the scalp that resolve and then return

A

alopecia areata, corticosteroids intralesional

309
Q

dysuria, postvoid dribbling, dysparenunia, anterior vaginal mass, hematuria, recurrent UTI, stress incontinence . manipulation of urethra will express bloody purulent fluid

A

urethral diverticulum, dx with MRI or transvaginal US

310
Q

sudden, overwhelming, or frequent need to urinate

A

urge incontinence, bladder training and antimuscarinic medications

311
Q

constant dribbling of urine, incomplete bladder emptying

A

overflow incontinence, intermittent cath correct underlying issue

312
Q

bilateral flank pain with gross hematuria following flu like illness 3 days ago, also has CVA tenderness bilaterally

why is this not poststrep glomerulonephritis

A

igA nephropathy

poststrep glomerulonephritis happens more than 10 days after

313
Q

nighttime urinarly incontinence after age 5

A

primary nocturanl enuresis, enuresis alarm, desmopressing

314
Q

vasculitis due to immune complex deposition in small and medium size vessels, typically associated with hep C. presents with palpable purpura, weakness, arthralgias, glomerulonephritis, and hypocomplementemia

A

mixed cryoglobulinemia, treat with viral infection therapy

315
Q

abdominal pain, skin rashes, and joint inflammation in children with no neurologic changes

A

HSP

316
Q

fever, lymphadenopathy, sore throat, headache, fatigue, myalgia, painful mucocutaneous ulcers, maculopapular rash, leukopenia, thombocytopenia

A

acute HIV infection

317
Q

babys born to mothers with active Hep b should get vaccine when

A

at birth

318
Q

flu-like febrile illness with marked myalgias and joint pain (bone break fever) retro-orbital pain, rash, thrombocytopenia, spontaneous bleeding with a positive tourniquet test (causes petechiae)

what bug causes this

A

dengue fever, supportive care

aedes mosquito

319
Q

pt has palpitations and lightheadedness, has ventricular tachycardia, apical aneurysm. can also have biventricular heart failure, mural thrombosis, fibrosis leading ot conduction abnormalities, toxic megacolon or esophagus

what cases this

A

chagas disease, trypanosoma cruzi (protazoa)

320
Q

involvement with salt water cuts, pt develops rapidly progressive ceellulitis with hemorrhagic bullae, also associated with raw oysters. can ultimately lead to septic shock quickly

A

vibrio vulnificus, ceftriaxone and doxycycline

321
Q

three main causes of nec fas

A

group A strep (pyogenes), staph aureus, clostridium perfringens

322
Q

fever, hypotension, swelling, erythema after a puncture wound. Notably the wound site is more painful to palpation that would be expected

what if there was crepitus on exam

A

nec fasciitis, broad spectrum
zosyn or carbapenem for group A strep and anaerobes
vancomycin - MRSA
clindamycin to inhibit toxin formation

clostridum perfingens

323
Q

fever,petechiae, IV drug use, holysytolic murmur at apex

what about if they have headache, lethargy, neckstiffness

A

infective endocarditis

subarachnoid hemorrhage secondary to mycotic aneurysm rupture

324
Q

acute otitis media treatment

A

first amoxicillin
second - augmentin
pcn allergic - clindamycin or azithromycin

325
Q

initially pt will have erythema migrans, fatigue, headache, myalgia, arthralgia

next with have multiple erythema migrans areas, CN 7 palsy, meningitis, AV block

late can have arthritis, encephalitis, or peripheral neuropathy

A

lyme disease caused by borrelia burgdorferi

ixodes scapularis, deer tick

326
Q

fever, headache, myalgia, arthralgia, macular and petechial rash, encephalitis, pulmonary edema, bleeding, shock, decreased platelets, sodium, transammonitis

A

rocky mountain spotted fever, doxycycline

327
Q

abx treatment for young kids pna

A

amoxicillin

328
Q

fever, sore throat, pseudomembraine and grey patches in throat with cervical lymphadenopathy, myocarditis, kidney disease

A

diphtheria, corynebacterium, tx is erythromycin or Pen G

329
Q

most common cause of gastroenteritis

A

norovirus

330
Q

meningitis with very high opening pressures

A

cryptococcal meningoencephalitis typically seen in HIV, do repeated lumbar munctures until symptoms abate

abx treatment is amphotericin B and flucytosine for >2 weeks until symptoms abate and CSF is sterilized

then high dose oral fluconazole 8 weeks

then low dose fluconazole for 1 year

331
Q

spinal tap looks normal but might have elevated protein

A

guillain barre syndrome

332
Q

tap has >500 wbc

A

bacterial meningitis

333
Q

tab has low glucose

A

tuberculous meningitis

334
Q

tap is just a little of normal in all catergories

A

viral meningitis

335
Q

sudden sore throat, fever, abdominal pain, headache, with no cough or rhinorrhea or congestion

tonsillar erythema, anterior cervical lymphadenopathy, and palatal petechiase

A

strep pharyngitis, PCN or amoxicillin

pcn allergy, cephalosporin, azithromycin, or clindamycin

10 day course to prevent rheumatic fever only, others arent prevented by treatment

336
Q

in fetus this causes sensorineural hearing loss, cataracts, and PDA

A

rubella aka german measles

337
Q

child has cephalocaudal spread of maculopapular rash and a fever, adults get this as well but have arthralgia as well

A

rubella aka german measles

338
Q

hepatosplenomeagly, purpuric leasions and sensorineural hearing loss in new boorn with periventricular calcifications

what about the same but with intracerebral calcifications

A

congenital cytomegalovirus, gangciclovir

congenital toxoplasmosis, pyrimethamine, sulfadiazine, spiramycin

339
Q

newborn with skin, eye, mouth vesicles, severe CNS infection

A

HSV congenital

340
Q

maculopapular skin rash on palsm and soles of newborn with lymphadenopathy, osteitis

A

syphilis, PCN

341
Q

repeated episodes of jaundice with stressors

A

gilbert syndrome

342
Q

persistent hyperbilirubinemia despite plasmapheresis and bili-light

A

cringar-nijar syndrome

343
Q

cough, coryza, conjunctivities and loplic sports, srash starts on the face and spreads down 2 days after symptoms start

A

measles - rubeola

344
Q

high spiking fevers for 3-5 days and then rash shows up on chest

A

roseola HHV 6 or 7

345
Q

fever, malaise, headache, anorexia, parotid swelling and orchitis

A

mumps

346
Q

fever, malaise, followed by vesicles on mouth, palms, and soles

A

HFM disease - coxsackievirus

347
Q

symptoms begin after 6 months with repeated encapsulated organisms like pseudomonas, s pneumoniae, haemophilus, can have absent tonsils

will have absent b cells

A

bruton agammaglobulinemia, ivig and abx

348
Q

all ig levels are low, decreased plasma cells, pyogenin upper and lower respiratory infections, increased risk of lymphom

A

common variable immunodeficieny, ivig

349
Q

recurrent respiratory and gi infections, anaphylactic reaction to ivig infusion

A

igA deficiency

350
Q

absence of CD 40 ligand, high levels of IgM, recurrent sinopulmonary infections

A

hyper IgM syndrome, abx and ivig

351
Q

infected with everything, xray shows absent thymic shadow

A

thymic aplasia (digeorge syndroem) needs bone marrow transplantation and ivig

352
Q

increase risk of malignancies of the blood and stomach, preogressive cerebellar ataxia, oculocutaneous telangiectasia

A

ataxia-telangiectasia, ivig

353
Q

lack of b and t cells, frequent bacterial infections, chronic candidiasis

A

severe combined immunodeficiency aka bubble boy disease, bone marrow transplantation and IVIG

354
Q

increase in IgE and A, decrease IgM, thrombocytopenia, bleeding, eczema, purpura

A

wiskott aldrich syndrome, bone marrow transplant

355
Q

clenched overlapping hands, cardiac defects, rocker-bottom feet

A

trisomy 18 - edwards

356
Q

cns malformations, polydactlyly, deafness, sloping forehead,

A

trisomy 13 pitau syndrome

357
Q

congenital heart disease, thymic hypoplasia, absent parathyroid glands, hypocalcemia

A

digeorge syndrome

358
Q

short female with shield chest, wide nipples, webbe neck, horseshow kidney, coarctation, hearing loss, infertility

A

turner syndrome, 45 XO

359
Q

macroorchidism, tall stature ro girls with learning disability form cgg repeat in fmr1 gene

A

fragile x syndrome

360
Q

hypogonadism, testicular atrophy, tall with long extremities

A

klinefelter 47 xxy, increase risk of breast cancer

361
Q

cafe au lait macules, freckling inguinal and axillary folds, lisch nodules, optic glimoa, acoliosis and arthosis

A

NF 1

362
Q

sensorineural hearing loss for bilateral acoustic schwannomas

A

NF2, peripheral nerve sheath cell

363
Q

inhibits bacterial cell wall synthesis

A 
pcn
cephalosporin
carbapenems
monobactam/aztremonam
vancyomycin
364
Q

inhibits dna synthesis

A

fluoroquinalones, metronidazole, bactrim

365
Q

inhibit bacterial protein syntesis

A 
macrolides/azitho
aminoglycocides/gent or tobramycin
clindamycin
linezolid
tetracyclines
most of these end with mycin

USMLE step 3 (2 decks)

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