uworldnotesstep2 Flashcards
1
Q
primary reason to screen AFP
A
for neural tube defects
2
Q
treatment for secondary pneumothorax in COPD
A
observation and O2 if minoremergent tube thoracotomy if serious
3
Q
most likely reason for a ↓AFP
A
trisomy 18/21
4
Q
side effects of azathioprine
A
dose related disarrhea, leukopenia, hepatoxicity
5
Q
lab results that would suggest rhabdomyolysis
A
↑ K
↑ CPK
6
Q
pt with alcohol hx and develops postural instability and wide based gait what is the dysfunction
A
decrease in purkinje cells in the cerebellar vermis
7
Q
“proximal muscle weakness”
“can’t walk upstairs”
A
polymyositis
8
Q
pt with hx of stomach ulcers and kidney stones - what genetic disease does this suggest
A
MEN1
primary hyperparathyroidism causing hypercalcemia
9
Q
treatment for polymyositis
A
glucocorticoids (prednisone)
glucocorticoid-sparing agent - methotrexate or azathioprine
10
Q
cancer assocated with lambert easton
A
small cell lung CA
11
Q
pt presents with small kidneys and elevated BUN/Cr - most likely chronic dx
A
HTN
12
Q
tan colored lesions on the eyes
A
NF1 - lisch nodules, tan colored hamartomas
13
Q
side effects of what drug - nephrotoxicity, HTN, glucose intolerance, gingeval hypertrophy, hirsuitism, and GI manifestation
A
cyclosporine
14
Q
pt with dementia - sudden onset with myoclonus
A
prion diseae
15
Q
general ways to get a thrombocytopenia
A
decreased platelet production increased platelet destruction Other
16
Q
what are these?non immune direct effect that starts within 2 days of commencing heparinantibody to platelet factor 4 causing platelet aggregation, thrombocytopenia, thrombosis, platelets decreased by at least 50% 5-10 days after starting heparin
A
HIT 1 and HIT 2
17
Q
50% loss of platelets and antibody to platelet factor 4
A
HIT2
18
Q
67 year old man with no health problems and does not take any medications - which vaccines does he need
A
PCV13 + PPSV23 at a later time because he is ≥65
19
Q
pt with loss of sensation fo the foot dorsum - nerve
A
common peroneal/fibular nerve on the anterolateral leg
20
Q
up until what point can you administer charcoal following toxic acetaminophen exposure
A
up to 4 hours
21
Q
coming from a low income country is highly indicative of which bacterial infection
A
h. pylori
22
Q
in a quad screen - decreased AFP, beta hcg, estriol
A
Edwards (trisomy 18)
23
Q
most common cause of purpura in a child
A
Henoch Schonlein purpura (HSP)
24
Q
proximal muscle weakness with ↑CRP
A
polymyositis
25
risk factors for developing acute otitis media
formula intake, exposure to cigarette smoke
26
immunoglobulin associated with celiac disease
IgA - anti-epidermal transglutaminase antibodies are IgA associated
27
who should receive Tdap/Td?
all adults should receive one Tdap and Td boosters every 10 years. If vaccination hx is unknown, replace one Td with Tdap
28
when should a quad screen be done
15-20 weeks
29
what drug should you never give in uremic pericarditis
heparincan cause a hemorrhage
30
hyperdense biconvex lesion that does not cross suture lines
epidural hematoma
31
what two organ dysfunctions would you see in cocaine OD - why?
Renal failure and heart failure
renal because of **↑K** and ↑CPK causing rhabdomyolysis
cardiac failure because of valvular damage and **↑K**
32
difference in meconiums bt hirschprungs and ileus
ileus - inspissated and viscous causing obstructionhirscprung - normal
33
pt with pH of 7.28, CO2 of 38 - what is this and what shouldn't you give them
metabolic acidosis - don't give bicarb becuase they are compensated if the pH is \<7.2
34
cancer associated with actinic keratosis
squamous cell carcinmona
35
coronary artery aneurysm in a child
kawasaki disease
36
what dysfunction can you diagnose by rocking the pt back and forth at the hips
gastric outlet syndrome
37
loss of glomerular capsule, glomerular and peritubular fibrosis, microhematuria and proteinura
glomerulosclerosis
38
most common causes of ESRD
1) diabetic nephropathy2) HTN
39
what life treatning condition is found comorbid with cocaine overdose in \>20% of cases
rhabdomyolysis - ↑CPK, ↑K
40
differentiate in symptoms between cauda equina and conus medullaris syndrome
cauda equina - saddle anesthesia, hyporeflexia, gradual onset of pain, lower motor neuronconus medularis - fast onset, perineal anesthesia, hyperreflexia, symmetrical weakness
41
expain why this isn't mets:extra axial well circumscribed/round homogeneously enhanced dural lesion
mets to brain would have multiple ring enhancing lesions at the gray-white matter junction
42
which is the worse of the HIT's
HIT 2
43
what does a decrease of angiotensin II/aldosterone cause with Na
increase in naturiesis
44
only vasculitis with normal platelet counts
HSP
45
what should you do before starting vasopressors in someone with septic shock
give IV saline 0.9%
46
pt with prolonged QRS and prolonged PR
bradyarrhythmia
47
drug use that increases your risk for rhabdomyolysis
cocaine abuse especially if the pt was imobilized for some time before being found
48
what arrhythmia would you see with digitalis toxicity
atrial tachycardia w/AV block
49
pt with CPK \>35,000IU/L
most likely dx
rhabdomyolysis with acute renal failure
50
what will you see on microscopy of diabetic nephropathy
increased extracellular matrix, basement membrane, mesangial expansion
51
50 year old patient with no reliable vaccination hx - Td or Tdap?
Tdap and then Td every 10 years!
52
what is meconium illeus virtually diagnostic for
cystic fibrosis
53
when someone is in septic shock what are the appopriate steps to take
1) secure the airway 2) IV 0.9% saline with CRYSTALLOID 3) treat the infection
54
production of a reactive oxygen species by interaction of drug metabolites and UV
phototoxic reaction
55
pt with recent onset optic neuritis, intranuclear opthalmoplegia and fatigue
MS
56
what causes jaundice by decreased activity of the UDP-glucuronyltrasnferase enzyme
gilbert syndrome
57
pt presents with decreased DTRs, symmetrical proximal muscle weakness, and autonomic dynsfunction - dx?
Lambert Easton secondary to small cell lung cancer
58
dysfunctions that cause decreased platelet production leading to thrombocytopenia
EBV, CMV, chemo, myelodysplastic syndrome, alcohol, Fanconi anemia, vitamin B12/folate deficiency
59
pt presents with extra axial well circumscribed and round and homogenously enhanced dural lesion - dx
meningioma - calcification, hyperdense, dx with non contrast CT
60
which nerve is affected by a hit to the anterior thigh
femoral nerve
61
palpable purpura mostly contained to the buttocks, legs, and thighs
HSP
62
who should receive which pneumococcal vax
adults 19-64 with no medical hx: NO vaccine necessary adults 19-64 with heart disease, DM, or liver disease should have PPSV23 adults 19-64 who have CSF problems, cochlear implants, sickle cell anemia, asplenia or HIV should have PCV13 and then PPSV23 at a later date All patients over 65 should have PCV13 + PPSV23 at a later date
63
which one is which?high fever (\>104)cervical lymphadenopathycecphalocaudal rash with gradual spreadlow fever (\<104)post auricular and suboccipital lymphadenopathycephalocaudal rash with rapid onsetarthralgias (esp in women)
first: measlessecond: rubella
64
renal vascular lesions in HTN
arteriolosclerosis of afferent and efferent renal arterioles
65
what is the precipitating factor that makes toxic shock syndrome so dangerous
massive release of cytokines
66
10 year old female patient with pruritic anal and vaginal areas particularly at night - dx
pinworm infection (enterobius vermicularis)
67
where is the defect in hirscprungs vs meconium ileus
H - sigmoid-rectum (will find meconium in the rectal vault)MI - ileum
68
most effective primary meds for parkinsons
levodopa/carbidopa
69
what kind of AKI will show a ≥50% increase in Cr from normal
prerenal AKI
70
how does the RAAS system work in response to hypoperfusion
hypoperfusion causes the juxtaglomerular apparatus to release renin. Renin cleaves angiotensin into angiotensin I. ACE converts angiotensin I to angiotensin II which is a potent vasoconstrictor and causes adrenal cortex to produce aldosterone which retains Na/H20 and secretes K in order to increase BP
71
s/e of mycophenelate
bone marrow suppression
72
pt has persistant pneumothorax and pneumomediastinum following chest tube placement
tracheobronchial rupture
73
pt complaining of morning stiffness and has elevated CRP and sed rate what won't you see on PE
joint inflammation - this patient has polymyalgia rheumatica
74
pt with non painful and non pruritic skin lesions increasing gradually in size on the trunk
NF1
75
diastolic murmur at the apex in a young woman
mitral stenosis
76
other than azithromycin and TMP-SMX - what other potential prophylaxis for HIV with CD4 \<50
pt lives in ohio river valley - histoplasma, tx: itraconazolept has herpes hx - acyclovirpt with yeast flare - fluconazole
77
treatment for complicated gallstone disease (acute cholecystitis, choledocholilithiasis, gallstone pancreatitis)
cholecystectomy within 72 hours
78
what is this
osgood schlatter disease with fractured tubercle
79
what increases your risk of developing impetigo following a bacterial infection
eczema, abrasions, insect bites
80
what are some causes of pseudothrombocytopenia
platelet clumping due ot EDTA abciximab inadequate sample
81
pt with GI pain, weight loss of 10 lbs, recent onset memory deficits, peripheral neuropathy, and microcytic anemia - dx
acute lead poisoning
82
progressive dyspnea, decreased exercise tolerance, Afib, rapid ventricular response, LV systolic dysfunction
tachycardia mediated cardiomyopathy
83
what can help LV function in someone with tachycardia
rate control drugs
84
less likely but still common reaosns for ↑AFP in pregnancy
ventral wall defects - oomphalocele, gastroschisis
85
most likely cause of a phototoxic drug reaction
doxycycline (tetracyclines)
86
pt ingested toxic levels of acetominaphen in the last 2 hours - next steps
administer charcoal (if within 4 hours) + take acetaminophen level
based on level determine whether n-acetylcysteine is needed
87
what disease process does this describe
parathyroid hyperplasia or adenomas with symptomatic hypercalcemia from primary hyperparathyroidism, burning upper abdominal pain from zollinger ellison syndrome and pituitary adenomas
MEN1
88
40 year old pt with no relevant medical hx presents with thrombocytopenia seemingly unrelated to anything - potential casue
HIV - 5-10% of patients present initially with this
89
what is the mechanism of renal failure in cocaine use
ATN secondary to rhabdomylosis from excessively filtered myoglobin
90
definitive diagnosis for polymyositis
muscle biopsy
91
pt with increased aPTT, new thrombocytopenia and arterial thrombosis
heparin induced thrombocytopenia
92
what echo finding would you expect with mitral stenosis
left atrial dilation
93
what are the two main dx for non passage of meconium
1) Hirschprungs disease2) meconium ileus
94
nerve on the medial thigh
obturator
95
what labs might you find in kawasaki disease
↑CRP, sed rate leukocytosis with neutrophilia, thrombocytosis, sterile pyuria
96
next step after finding an ↑AFP
u/s
97
complications of impetigo
PGSN
98
male patient with hx of COPD has sudden onset of chest pain and hyperresonance with unilateral decrease in breath sounds
COPD with acute exacerbation with secondary spontaneous pneumothorax - chronic destruction of alveolar sacs causes large alveolar blebs and rupture/leak of air
99
best way to diagnose turners
KARYOTYPE not Barr bodeis
100
causes of uterine atony
prolonged laborover distended uterusmultiple gestationforcep assistedHTN
101
where does aldosterone work
on the distal collecting duct to increase Na/H20 and blood volume
102
most common cause of post partum hemorrage
uterine atony
103
12 year old male presents with increased indirect bilirubin following surgery for appendicitis with overt scleral icterus
diagnosis
Gilbert syndrome
104
paraneoplastic syndrome associated with presynaptic volatage gated Ca channels
lambert easton - small cell lung cancer
105
how does TSST-1 differ from RMSF
in RMSF the petechiae rash starts in the extremities
106
what should you look for on xray when you suspect secondary pneumothorax in COPD
visceral pleural line beyond which no pulmonary markings exist
107
treatment for rhabdomyolysis
aggressive hydration
manitol and urine alkalinazation
108
main danger associated with CPK \>20,000IU/L
acute renal tubular necrosis from myoglobinuria
109
what cardiac condition frequently coexists with mitral stenosis
Afib - 70% co-occurrence
110
posterior shoulder dislocation associations
the 3 E'sElectricityEpilepsyEtoh
111
when is suction curretage the right answer in an abortion
when the woman is hemodynamically unstable from heavy bleeding or sepsis - expectant management otherwise
112
pt with no medical hx is newly diagnosed with ITP what commonly coexisting condition should you also check for
HIV
113
mutation most associated with polycythemia vera
JAK2 mutation
114
when is AFP measured
16-18 weeks
115
why is tacrolimus better with side effects than cyclosporine
no hirsuitism or gingival hypertrophy in tacrolimus
116
if someone is in prerenal AKI how do you know whether to give fluids or diurese
give fluids if there are no obvious signs of fluid overload (e.g. ↑JVD, crackles) - give isotonic if not fluid overloaded
117
treatment for impetigo
muprocin
118
23 year old female with sickle cell - which vaccine(s) does she need
PCV13 + PPSV23 at a later time because she is immunocompromised
119
femoral nerve damage could result in what dysfunctions
knee extension and hip flexion
120
pt with asymmetric t wave inversion in V5-V6 with an increase in glucose, BUN of 90 and creatinine of 5.6 - dx
uremic pericarditis - anytime you see chest pain and BUN \> 60 that's what it is
121
why do you go for rate control and not typical drugs from CHF in someone with tachycardia induced cardiomyopthy
tachy induced cardiomyopathy is potentially reversible - the key is to try and get the person back to a normal sinus rhythm
122
why does cocaine cause ischemia, seizures, agitation
it is a potent vasoconstrictor
123
in a quad screen - decreased AFP, estriol, increased beta hcg and inhibin A
downs
124
treatment for lambert easton
guanidine or 3,4-diaminopyridine
125
drug types (2) that cannot be given to people on PDE5-I. Why?
nitratesalpha blockers (-zosin)cause hypotension
126
treatment for cauda equina and conus medularis syndromes
IV glucocorticoids and neurosurgery consult
127
when would you need to use a catheter during a u/a
when the pt is \<2 years of age
128
pt with dementia - presents with trouble walking, urinary incontinence, and dementia
NPH
129
pt presents with +ANA and +anti-Jo-1
polymyositis
130
woman being treated for acne presents, after a day at teh beach, with a rash covering her face, arms, chest and legs - why isn't this a reaction to benzoyl peroxide
benzoyl peroxide would only cause the rash to the face - this is systemic, therefore she is being treated with doxy for acne
131
pt with no hx of alcohol use but elevated LFTs and acute pancreatitis - dx and tx
gallstone pancreatitis - remove gall bladder
132
woman with UTI and pyelonephritis - what are the U/A findings
nitrates and leukocyte esterase
133
damage to the posterior thigh might damage which nerve
tibial nerve
134
what syndrome can you diagnose by hearing a succession splash 3+ hours after last meal
gastric outlet syndrome
135
most common reason for someone in septic shock to have metaboic acidosis
lactic acidosis from organ failure
136
pt with pain in the eye presenting with photophobia, blurred vision, tearing, redness, corneal vesicles, dendritic ulcers
herpes simplex keratitis
137
pt with recent cold and chronic warfarin use presents with INR of 5.6
why
pt was probably taking acetaminophen for the cold symptoms and that increased the amount of warfarin in the system
138
dysfunctions that cause platelet destruction
SLE, heparin use, ITP, TTP-HUS, antiphospholipid syndrome
139
most common bilirubin disorder of inheritance
gilbert syndrome
140
pt with back pain and breathing difficulties and PFTs showing restrictive respiratory distress
ankylosing spondylitis - chest wall motion restriction from spinal spondylitis that causes decreased VC and decreased TLC
141
pt with negative nikolsky, fever of 6 days in duration, red eyes, bright red tongue, polymorphous rash, desquamation of the palms and soles and cervical lymphadenopathy
Kawasaki disease!
142
what type of cancer is Paget's disease of the breast
adenocarcinoma
143
pt with myalgias, fever, vomiting, diarrhea, hypotension, diffuse maculopapular rash that looks like a sunburn - dx
toxic shock syndrome from s aureus
144
treatment for uremic pericarditis
dialysis - will reduce chest pain and effusion
145
management of vtach?
pulseless vtach - defibrillation
vtach with a pulse - syncronized cardioversion
146
anti hypertensive that increases natiuresis, decreases serum ATII, and aldosterone
direct renin inhibitor
147
treatment for neuroleptic malignant syndrome
stop the offending agent
bromocriptine or dantrolene
148
what is the danger of leukoplakia
1-20% progress to squamous cell carcinoma
149
MCC of urinary retention after labor
bladder atony
150
what do nitrates and leukocyte esterase signifiy on a U/A
nitrates: enterobacteriacae (shifting nitrates to nitrites) esterase signifies pyuria
151
how TSST-1 differs from meningococcemia
in TSS there are no bullae or necrotic petichiae rash
152
pt with dementia - early loss of short term memory and decreased hippocampal volume
alzheimers
153
pt on psychoactive medication presents with leukocytosis and elevated CK
neuroleptic malignant syndrome most likely from a first generation anti psychotic
154
when is an epidural hematoma treated surgically
when its symptomatic
155
how does the FEV1/FVC ratio change in a restrictive vs obstructive pattern
obstructive - FEV1/FVC: \<70 of normalrestrictive - FEV1/FVC: \>70 of normal
156
two drugs that are calcineurin inhibitors
cyclosporin and tacrolimus
157
treatment for prerenal AKI
IV fluid
158
MOA of cyclosporine
inhibits transcription of IL-2
159
pt with dementia - visual hallucinations and parkinsons
lewy body dementia
160
contact lens users with conjunctivitis
pseudomonal keratitis, tx with broad spectrum abx
161
pt with middle ear effusion, bulging tympanic membrane - dx and tx
acute otitis media tx: amoxicillin or if it doesn't work after 10 days; augmentin
162
which nerve deals with adduction of the thigh
obturator
163
what is an elevated CPK level
\>20,000IU/L
164
what is a potentially toxic dose of acetominaphen
\>7.5g
165
causes of syncope
sinus bradycardia, SA block, AV block, sinus pauses, non-sustained vtach, increased or decreased QTc
166
where is the orthopedic fault in osgood-schlatter disease
traction apophysis of the tibial tubercle which causes anterior soft tissue swelling, lifting of the tubercle and fragmentation of the tubercle
167
most common comorbid condition in meconium ileus
cystic fibrosis
168
treatment for polycythemia vera
serial phlebotomy and hydroxyurea
169
what does nephrosclerosis lead to if untreated
glumerulosclerosis
170
drug OD that causes ↑HTN, seizures, hyperthermia, vertical nystagmus
PCP
171
pt who ingested caustic substances - tests
serial CXR/KUB to check for perforationwhen perforation is ruled out - upper GI endoscopy in 12-24 hours
172
pt presents with hearing loss and frequent discharge; granulation tissue and skin debris is seen in the ear canal
cholesteatoma
173
what kind of IV fluids should you give for hypernatremia
intially normal saline
174
white granular patch on the buccal mucosa in a pt with a hx of alcoholism or smoking
leukoplakia
175
what organ dysfunctions might be seen in a ↑AFP neonate
congenital nephrosis and obstructive uropathy
176
pt with chronic pancreatitis with wt loss and abdominal pain - what sx would lead you to which pancreatic diagnoses
jaundice suggests pancreatic head cancer no jaundice suggests pancreatic cancer of the tail or body
177
treatment for bladder atony lasting more than 6 hours
indwelling catheter placement
178
how to differentiate between uterine atony and retained placenta
on u/s if there is a "thin uterine stripe" this means the uterus is empty and cannot have retained products
179
vast increase in Cr, decreased urine output, BUN:Cr \>20:1, oliguria (\<500ml/24hrs)
prerenal AKI
180
loss of sensation to the plantar foot - nerve?
tibial nerve
181
vasculidity most similar to IgA nephropathy that presents with purpura
HSP
182
most common causes of acute otits media
s pneumo h flu (non typable) moraxella
183
10 year old girl with chronic ear drainage despite aggressive antibiotic therapy over the last few weeks
cholesteatoma
184
treatment of tachycardia induced cardiomyopathy
aggressive rate control with AV nodal blocking agents, antiarrhythmic drugs, catheter ablation of arrhythmia
185
"soft and boggy uterus" - dx
uterine atony
186
pt who is 6 hours post partum has not voided since labor and is leaking urine
diagnosis
bladder atony
187
pt is pregnant with second child and fetus dies in utero, mother is AB(-), mother is hemodynamically stable. What is the next best course of action
give RhoD because the mother is AB(-)
188
how do you treat a meningioma
surgical resection
189
ectopy and AV block together are basically specific for what diagnosis
digitalis toxicity
190
loss of sensation to the plantar foot? dorsum of foot?
plantar loss - tibialdorsum loss - common peroneal
191
in a quad screen - increase in AFP
neural tube deficits
192
what type of saline should you give in compensated metabolic acidosis
if met acidosis is \>7.2 give isotonic saline
193
what would you see on epithelial scraping of herpes simplex
multi nucleated giant cells
194
most likely reason to see an ↑ AFP
neural tube defect
195
pt with gradual onset of severe back pain, bilateral pain, saddle anesthesia, hyporeflexia, bowel/bladder dysfunction and assymmetrical weakness - what is the dx
cauda equina syndrome
196
new diagnosis of polymyositis should be a red flag for what
cancer
polymyositis is often part of a paraneoplastic syndrome
197
why should you give someone in septic shock crystalloid saline
because crystalloid is more like albumin and allows for more fluid uptake
198
disease where rapid growth in adolescent has the quadriceps muscle put traction on the apophysis of the tibial tubercle
diagnosis
Osgood-Schlatter disease
199
other name for common peroneal
fibular nerve
200
what is the Uhthoff phenomenon in MS
symptoms worsen in hot weather
201
pt who has recently had an T2 MRI shows: multifocal, oviod, subcortical, inperventricular, juxtacortical, and infratentorial lesions in the spinal cord
MS
202
most common causes of nonbillious impetigo
s aureus group A strep s pyogenes
203
neural tube defects and abdominal wall defects are characterized by what lab result
↑AFP
204
what is this
leukoplakia
205
RUQ pain and tenderness, fever, leukocytosis, +Murphy sign
acute cholecystitis
206
morning stiffness in the shoulders, neck, pelvic girdle
polymyalgia rheumatica
207
pt with progressive weakness, difficulty swallowing and mildly decreased strength in the deltoid muscle; otherwise unremarkable PE
polymyositis
208
pt with recent onset transient visual disturbances, HTN, thrombosis, itching after the shower, facial plethora, splenomegaly, normal oxygen sats and decreased EPO
polycythemia vera
209
what is this?palpable purpura, arthralgias, abdominal pain, renal dysfunction
HSP
210
pt with dementia - white matter change and executive dysfunction
vascular dementia
211
main side effect with early levodopa/carbidopa use
hallucination
212
medical treatment for dermatitis herpeteformis
dapsone
213
which drug should you give in a PCP OD
benzodiazapines
214
patient who initially had an eruption of papules has had a sudden progression to pustules and honey colored crusting around the mouth - dx
impetigo
215
pt with dementia - presents with personality change and disinhibition
frontotemporal dementia
216
difference in treatment between large and small thyroid cancer
large - surgery + radioactive iodinesmall - surgery
217
what age group has the most presenting epidural hematomas
children and adolescents
218
how does TSST-1 differ from SJS
SJS has purpura and necrosis and more influenza like symptoms initially
219
treatment for actinic keratosis
cryotherapy for small lesionsfluorouracil for larger lesions
220
gold standard diagnosis for MS
T2 MRI
221
urine dipstick tests + for blood but no RBCs are seen on microscopy
diagnosis
rhabdomyolysis
222
explain the physiology of the increased resorption of urea in prerenal AKI
↓ perfusion → ↓GFR → ↑Cr → ↑tubular resorption of Na/H20 which leads to ↑resorption of urea
223
what are these lab findings suggestive of: microcytic anemia, and ↑ zinc protoporhyrin
acute lead poinsoning
224
pt with thrombocytopenia without coexisting anemia or leukopenia
ITP
225
what poisoning would you commonly see hyperuricemia
lead poisoning
226
pt with morning stiffness in the neck and shoulders, 10lb weight loss, ESR of 77, ↑CRP, normocytic anemia - dx and association
polymyalgia rheumatica - giant cell arteritis!
227
34 year old woman with T2DM - which vaccines does she need
PPSV23 because she is immunocompromised by being diabetic
228
how does TSS differ from scarlet fever
in scarlet fever the pt will be a child and the rash has a flexural pattern
229
renal microscopy of HSP
deposition of IgA in the mesangium
230
differentiate between pneumothorax and atelectasis
if it were atelectasis there would be foreign body aspiration, pneumonia with mucous plug, malignancy and tracheal deviation. Pneumothorax is from a ruptured bleb and rarely is seen with tracheal deviation
231
how does 3,4-diaminopyridine help pt with lambert easton
improves ACh circulation
232
which imaging modality should you use for pancreatic cancer of the head? of the tail?
head - u/stail - CT
233
most superior drug in treating treatment resistant schizophrenia
clozapine
234
in a quad screen - fluctuation of inhibin A
trisomy 13/Patau
235
treatment for polymyalgia rheumatica
glucocorticoids - prednisone 10-20mg
236
stages of treatment for uterine atony
1) bimanual massage2) IVF/O23) oxytocin4) methylgonavine/carboprost (not in asthma!)5) hysterectomy in unstable or heavy blood loss
237
symptoms of graves disease - differentiate from a paraneoplastic syndrome
Graves - wt loss, tachycardia, proptosis, impaired extraocular motion, decreased convergence, diplopia, orbital tissue expansion, lymphocytic infiltrationparaneoplastic: myasthenia gravis/lambert easton would not have occular irritation, painful movement, or proptosis
238
hypertrophy and intimal medial fibrosis of renal arterioles
nephrosclerosis
239
initial therapy for warfarin associated hemorrhage
IV vitamin K
prothrombin complex concentrate (2, 7, 9, 10)
FFP if PCC is not available
240
most common co-morbid condition with hirschprungs disease
downs
241
pt with HIV and CD4 \<50 - prophylacic measures
TMP-SMX for PCP pneumoniaazithromycin for MAC
242
25 year old female pt with fever, joint pain, rash that started on the face and moved rapidly to the body that has spared the palms and soles with posterior auricular and suboccipital lymphadenopathy
Rubella - German measles
243
when would you see HIV associated dementia
CD4 \<200
long standing HIV
poor HIV control
244
pt with ↑ apathy, ↓ attention, subcortical dysfunction, ↓ smooth limb movement, ↓ number of cortical neurons, ↓ memory
this happened rather quickly (6 months)
HIV associated dementia
245
39 year old female pt presents with heavy periods, dysmenorrhea, chronic pelvic pain, and what was described as "tender, boggy, globular uterus"
dx and tx
adenomyosis
hysterectomy
246
pt with infertility and irregular menses is ______ until proven otherwise
PCOS
247
what hormone pattern will you see in a pt with PCOS
imbalance of LH/FSH → leading to failure of follicle maturation
248
what hormonal pattern will you see in PCOS
hyperandrogenism
↑ ovarian steroids
↓ estrone
↓ sex binding hormone
LH/FSH imbalance
249
treatment for infertile woman with PCOS
weight loss
clomiphene
250
pt with hepatic steatosis, no history of alcohol use at all, AST/ALT \<1; u/s of the liver reveals a hyperechoic texture
NAFLD
251
treatment for NAFLD
diet/exercise
consider bariatric surgery if BMI ≥ 35
252
abnormal LFTs + metabolic syndromes + no alchol consumption (ever)
NAFLD
253
hepatic steatosis in the absence of secondary hepatic fat accumulation
NAFLD
254
hepatomegaly + AST/ALT ratio of \<1 with hyperechoic u/s texture
NAFLD
255
pt is recently postpartum presents with pain on the lateral side of the wrist and has passive thumb stretching pain
DeQuervains tenosynovitis
256
tendons involved in deQuervains tenosynovitis
abductor pollicis longus
extensor pollicis brevis
257
you suspect your pt has Sjogrens; they also have significant difficulty swallowing solid food lately
how to diagnose
even with esophageal motility issues diagnose based on + antiRO(SSA) and + antiLA(SSB)
258
what is a schrimer test for
in the diagnostic process of sjogrens and schirmer test will show ↓ lacrimation on filter paper under the lower eyelid
259
lymphocytic infiltrate of the salivary glands is most likely part of what disease process
sjogrens
260
most common gyenocological malignancy
endometrial cancer
261
most important risk factor for development of endometrial cancer
obesity
262
explain how obesity contributes to the development of endometrial cancer
↑ estrogen (in adipose tissue) ↑ hyperplasia → adenocarcinoma
263
most likely cause of a retroperitoneal hematoma (especially when the patient has been in the hospital)
cardiac catheterization
264
diagnostic imaging for retroperitoneal hematoma
CT non contrast for abdomen and pelvis
265
acsending flaccid paralysis and muscle weakness with respiratory involvement
diagnosis
Guillian Barre
266
when you suspect Guillian Barre what else should you measure
PFTs - 30% of pts will have respiratory failure
267
gold standard for measuring respiratory failure in GBS
FVC
≤ 20mL/kg demonstrates impending respiratory arrest
268
baby is born 6 weeks premature - when should her vaccines be given
chronologically or gestationally
ALL vaccines should be given chronologically
269
what vaccine cannot be given if a premature baby is \<4lbs 6oz
Hep B
270
pt with fever, vomiting, nausea, abdominal pain, jaundice, pruritis, dark urine, pale stools, tender hepatomegaly, AST/ALT \>1000 U/L, ↑ alk phos and bilirubin
diagnosis
HAV
271
treatment for HAV
self limited, treat supportively
3-6 weeks recovery
272
when is HAV less likely to be self limited
\>50
preexisting liver condition
273
which hepatitises are symptomatic in the acute phase
HAV is usually symptomatic (\>70%)
HBV/HCV are usually asx
274
presence of an S3 and ↑BNP is diagnostic of
LV dysfunction in CHF
275
how is BNP created
proBNP cleaves into two to create the active BNP and inactive N-terminal proBNP
276
what lab is elevated in LV systolic dysfunction in CHF
BNP
277
low frequency sound best heard over the cardiac apex
S3
278
99% of people with CHF also have this
S3 heart sound
279
most common precipitating bacterial infection prior to developing GBS
c jejuni
280
2/3 of the time _______ started with a respiratory or GI infection
Guillian Barre
281
circumfrential burn to the esophaagus
pill induced esophagitis
282
main causes of pill induced esophagitis
tetracyclines (doxy)
NSAIDs
bisphosphanates
potassium Cl
Iron
283
difference in mechanisms as to why tetracyclines and NSAIDs cause pill induced esophagitis
tetracyclines cause this from the acid effect
NSAIDs disrupt the GI protective barrier
284
pt presents with a recent onset tremor that is worse with action motions and worse in the upper extremities; pt has no noticible neurological deficits
essential tremor
285
treatment for essential tremor
propranalol
2nd line = anticonvulsants like primidone and topiramate or benzodiazepines like alprazolam
286
most affected brain regions by strokes precipitated by HTN
basal ganglia
thalamus
pons
287
stroke type - atherosclerotic risk factors and fluctuating symptoms
ischemic thrombotic type
288
stroke type - hx of cardiac dz, abrupt but worse at the start, multiple infarcts seen on CT
ischemic embolic type
289
stroke type - uncontrolled HTN, illicit drug use, sx get worse after starting, presents with vomiting and headache, bradycardia and decreased alertness
intracerebral hemorrahage
290
stroke type - pt with hx of berry aneurysm/AVM presents with stiff neck and severe headache
subarachnoid hemorrhage
291
left sided weakness and slurred speech
affected area
left cerebral hemisphere lesion - motor cortex/Broca's
292
pt with painless purple skin on the legs, AKI and occular problems, labs show eosinophilia and hypocomplementemia
cholesterol crystal embolism
from disruption of atherosclerotic aortic plaques
293
most common cause of cholesterol crystal embolism
disruption of atherolsclerotic plaques most likely from cardiac catheterization or intraaortic balloon pump
294
skin finding in cholesterol crystal embolism
livedo reticularis
painless purple skin that blanches
also called "blue toe"
295
1 year old child drinks cows milk more than anything else
iron deficiency anemia
296
most common nutritional deficiency in children
iron
297
2 year old female pt diagnosed as iron deficient
next steps
give PO iron
298
2 year old female pt who was diagnosed as iron deficient has not imporved after 3 months of PO iron
next step?
hemoglobin electrophoresis
colonoscopy
serum creatinine
299
most common urinary tract onstruction in newborn males
posterior urethral valves
300
pt presents for prenatal u/s and results are concerning for bladder distention, bilateral hydroureters, and bilateral hydronephrosis
most likely diagnosis
posterior urethral valves
301
baby is still born at 16 weeks gestation and autopsy finds bilateral hydronephrosis, oligohydramnios, flattened facies, abdominal distention and club feet
diagnosis
Oligohydramnios with Potter sequence most likely secondary to posterior urethral valves
302
most common location of ectopic foci for afib generation
pulmonary veins
303
reentrant circuit around the tricuspid annulus
cardiac sound
atrial flutter
304
female pt with fever, fatigue, wt loss, migratory non deforming arthralgias is also found to have ↓C3/C4
SLE
305
pt with arthralgias and a non tender ulcer of the buccal mucosa and cervical lymphadenopathy
SLE
306
pt with fever, wt loss, pleurisy, athralgias, and proteinuria
SLE
307
pt presents with advanced RA + splenomegaly + neutropenia
Felty syndrome
308
infant pt presents with poor urinary stream, straining with voiding, urosepsis, failure to thrive and renal failure
how to make the diagnosis
voiding cystourethrogram and cytoscopy
309
treatment for posterior urethral valves
ablation and urinary diversion
early surgical intervention in utero (permanent kidney damage can occur)
310
oligohydramnios can cause what
pulmonary hypoplasia, postnatal respiratory distress
311
pt with 15lb weight loss, lower extremity edema, gynecomastia, spider angiomas, distended abdomen with shifting dullness
diagnosis
cirrhosis - probably from HCV (more than HBV), chronic alcoholism, NAFLD, hemochromotosis
312
pt with pedal edema, ascities, bilateral gynecomastia, spider angiomata - why isn't this cor pulmonale
will cause fatigue and leg edema but not gynecomastia or spider angiomata
313
first suspicion in someone with ascites, spider angiomatas, gynecomatia, splenomegaly
cirrhosis - most likely viral hepatitis
314
reasons you might see early post operative period renal transplant dysfunction
uretral obstruction, acute rejection, cyclosporine toxicity, vascular obstruction, acute tubular necrosis
315
subtypes of systemic sclerosis
limited (better)
diffuse (worse)
316
type of scleroderma interstitial lung disease is associated with
diffuse cutaneous - \>40%
317
esophageal dysmotility is seen in what kind of scleroderma
both diffuse and limited
318
what kind of scleroderma is skin thickening seen in
diffuse cutaneous
319
which scleroderma has a worse prognosis
diffuse cutaneous because it has organ involvement
320
systolic-diastolic abdominal bruit + ↑BP
renovascular HTN
321
how can you diagnose RAS
renal duplex Doppler u/s
CT angio
MR angiography
322
pt has resistant HTN with ≥ 3 drugs (1 is a diruetic at max dose)
RAS
323
risk of developing which cancers in cryptorchid gonads
dysgerminoma or gonadoblastoma
324
give the X,Y for a phenotypically female individual with androgen insensitivity syndrome
46 X,Y
325
recomendation for phenotypic female with androgen insensitivity syndrome
bilateral gonadectomy after puberty
326
why is gonadectomy recommended AFTER puberty in androgen insensitivity disorder
attainment of full height
327
pt with cough, wheezing, nasal polyps; current med list: aspirin, atorvastatin, metformin, benadryl
cause of exacerbation
aspirin exacerbated respiratory disease
328
asthma like symptoms and flushing and wheezing 90 mins after taking _______ is \_\_\_\_\_\_\_\_
aspirin
aspirin exacerbated respiratory disease
329
↑ production of proinflammatory leukotrienes and ↓ production of anti inflammatory prostoglandins and arachodonic acid is diverted to produce leukotrienes via the 5-lipoxygenase pathway
what is this
AERD mechanism
330
non IgE mediated reaction that results in asthma like symptoms or exacerbation of existing symptoms
AERD
331
treatment of AERD
desensitization and use of leukotriene receptor antagonists
332
pt with hx of gout has 3 day hx of progressively worsening pain, swelling, and redness of the knee, no hx of trauma. Fever of 101, HR is 110/bpm, hx is positive for recent travel to New Hampshire for camping
differentiate between septic arthritis, gout and Lyme disease
this is probably septic arthritis - you should do a synovial fluid analysis first
could be gout or lyme disease but septic arthritis is far more serious and needs to be ruled out before proceeding!
333
pt has hx of untreated HTN and DM2, presents with **2 months** of left sided weakness, gait dysfunction with frequent falls, and **nausea and vomiting**
what is this? why isn't it the other?
this is a brain tumor
this is not a lacunar infarct because of the nausea/vomiting because that is the result of ↑ICP which is not involved in chronic results from a stroke
334
pt with 2 months of left sided weakness, and gait dysfunction presents with this finding - diagnosis
brain tumor
that is papilledema suggesting ↑ICP
335
why would someone in HHS have normal to elevated K
total body K is decreased from excessive urinary loss - pseudohyperkalemia
336
pt with hx of DM2 presents with weakness and blurred vision
K 5.9, glucose 1070, bicarb 22, serum osmolality 480
why is the K normal
total body K is being depleted and pushed into cells
337
what can make things worse for someone in HHS
aggressive insulin therapy to correct the hyperglycemia can cause even more total body K depletion
338
in additon to modafinil, pt with cataplexy narcolepsy should also take what medications
antideprresant and sodium oxybate to suppress REM sleep
339
initial treatment for narcolepsy
sleep hygiene, scheduled naps, avoidance of alcohol and drugs that cause drowsiness
if these don't work move to modafanil
340
most likely explanation for a pt who presents with recent onset of digital clubbing
occult malignancy
341
conditions commonly assocated with digital clubbing
bronchogenic carcinoma, metastatic cancer, malignant mesothelimona, lymphoma
lung absess, empyema, bronchiectasis, cystic fibrosis, chronic cavitary infections
pulmonary fibrosis, asbestosis, AVM
cyanotic congential heart disease
342
most common causes of digital clubbing
lung malignancies
cystic fibrosis
right to left shunt
343
mechanism of digital clubbing
megakaryocytes skip the normal route because of a lung tumor in the pulmonary circulation and enter systemic circulation getting lodged in the fingers releasing PDGF and VEGF causing hypertrophy of the surrounding tissue
344
what doesn't cause digital clubbing
hypoxemia
345
what is often found at the finger tips with digital clubbing
enlarged joint capsules (painful)
346
pt with painful pulsatile mass in the groin area
femoral artery aneurysm
347
most common peripheral artery aneurysms
1) popliteal artery
2) femoral artery
348
gross hematuria with normal appearing RBCs - where is the defect
extra-renal
349
17 year old AA male pt presents with one episode of gross hematuria that resolved spontaneously; U/A shows many normal RBCs with no other findings
renal papillary necrosis secondary to sickle cell trait
350
pt with dysuria and increased urinary frequency, U/A shows WBCs and bacteria with +nitrate and +leukocyte esterase
acute cystitis
351
pt with hematuria and a hx of HTN + U/A shows dysmorphic RBCs and proteinuria
acute glomerulonephritis
352
pt with eosiniphilia, increased creatinine, U/A shows increased WBCs, w/o gross hematuria
AIN
353
pt with AKI from ischemic insult with elevated creatinine, U/A shows granular casts, hematuria, and renal tubular epithelial cells w/o gross hematuria
ATN
354
renal complications of sickle cell trait
painless hematuria, urinary tract infections, renal medullary cancer
355
46 year old female pt presents with early satiety and abdominal distention, lab findings indicated an elevation in CA-125
epithelial ovarian carcinoma
356
AR mutation of ATP7B
wilsons disease
357
25 year old pt with tremors, depression, elevated LFTs
Wilsons disease
358
treatment for Wilsons disease
copper chelators like D-pencillamine
359
maintenance therapy for Wilsons disease
Oral zinc
360
neuropsychiatric symptoms + liver problems
Wilsons disease
361
6 year old pt presents with fever, toxicity, pharyngitis, sandpaper like rash, strawberry tongue
Scarlet fever - group A strep
362
treatment for scarlet fever
penicillin V
363
preferred medicaiton for ADPKD
ACE-I
364
most common reasons for flank pain in someone with ADPKD
renal calculi, cyst rupture, hemorrhage or upper urinary tract infections
365
extrarenal features of ADPKD
cerebral aneurysms
hepatic and pancreatic cysts
cardiac valve disorders
366
diaphragm that is more prone to traumatic injury
Left side
367
pt with fatigue, pruritis, and elevated alk phos and +MPO-ANCA
primary sclerosing cholangitis
368
pt with elevated alk phos, hx of UC, and fibrous obliteration of bile ducts with an onion skin appearance on bx
primary sclerosing cholangitis
369
MR cholangiopancreatography shows multifocal narrowing with intrahepatic and extrahepatic duct dilation
primary sclerosing cholangitis
370
differentiate between perforated PUD and acute cholecystitis
BOTH would show upper abdominal pain, fever, leukocytosis
CHOLE would have +Murphy's sign
PUD perforation would have +stool guaiac test
371
diagnosis for PUD with perforation
upright abdominal/CXR showing free intraperitoneal air under the diaphragm
372
pathogenesis of MCD
T-cell mediated injury to podocytes causes molecular permeability to albumin
373
3 year old pt with edema, fatigue and NO hematuria
MCD
374
4 year old boy with edema around his eyes in the morning and moves to legs/genitals by evening
MCD
375
dx for MCD
24 hour urine collection - one time level can be used as well
376
treatment for MCD
steroids
377
painless loss of monocular vision
hx of DM and HTN
central retinal artery occlusion
378
treatment for central retinal artery occlusion
occular massage and high flow oxygen
379
explain why you see a V/Q mismatch in pneumonia
pneumonia causes hypoxemia due to left to right intrapulmonary shunting and an extreme ventilation/perfusion mismatch
380
why don't you see alveolar hypoventilation in pneumonia
alveolar hypoventilation is a uniform fall in ventilation because of a decrease in tidal volume or respiratory rate
381
when would you see alveolar hypoventilation
narcotic overdose and neuromuscular weakness
382
pt with metabolic alkalosis and a urine chloride of 7 - cause?
self induced vomiting
low serum Cl- impairs renal HCO3- excretion and further worsens alkalosis
correct with isotonic saline
383
why aren't you in metabolic alkalosis from diarrhea
causes persistant HCO3- loss and leads to non gap metabolic acidosis
384
differentiate between saline responsive and saline non responsive metabolic alkalosis
saline responsive is less \<20
saline non responsive is \>20
385
what is the most beneficial way to stop diabetic neuropathy
strict BP control
386
multiple liver lesions
metastatic colon cancer
387
cancers that mets to the liver
breast, lung, colon
388
left shift leukocytosis
more young cells are present indicating an infection
389
most common reason for acute cholecystitis
gallstone impaction in the cystic duct
390
pt with left pleural effusion with/out pneumothorax, subcutaneous and mediastinal emphysema, and widened mediastinum. Pleural fluid is exudative with lots of amylase
diagnosis and imaging
Boerhaave syndrome/esophageal rupture
CT contrast with gastrografin
391
most effective method post heat stroke to bring temperature down
ice bath
392
treatment for osteomyelitis in child with sickle cell
cover for s aureus AND salmonella
low likelihood of MRSA - nafcillin/oxacillin or cefazolin
high liklihood of MRSA - clindamycin or vancomycin
PLUS
3rd gen cephalosporin - ceftriaxone or cefotaxime
393
in a pt with a fixed defect on technetium-99 stress test what is the best next step
prescribe antiplatelet therapy like aspirin
394
diagnosis of acute liver failure - pick 1/3
elevated transaminases \>1000
hepatic encephalopathy
INR \> 1.5
395
what differentiates acute hepatitis from acute liver failure
hepatic encephalopathy
396
acute superinfection with hepatitis D on B carries what risk
acute liver failure
397
8 year old child with a 3 day hx of recurrent vomiting. This has happened before where the pt vomits several times over a few days and then not again for months
diagnosis
cyclical vomiting syndrome
linked to parents with migraines - may progress to migraines when the child matures
398
pt with hypopigmented patch with tingling and numbness distal to the patch, nerves at the distal end are thickened
leprosy
399
treatment for leprosy
dapsone and rifampin
400
leprosy with extensive lesions - treatment
dapsone + rifampin + clofazimine
401
pt with patch on arm and thickened nerves distal to lesion resulting in decreased sensation - why is this one diagnosis and not the other
this is leprosy - not lyme
it is not lyme because the thickened nerves are characteristic of leprosy
402
pt has peripheral nerve involment where the nerves have become nodular, painful, with deformations and diminished sensory activity
leprosy
403
what should you suspect when someone with a hx of malignancy develops back pain and motor and sensory abnormalities with possible bowel/bladder dysfunction
epidural spinal cord compression
404
pt presents following exercise with knee and calf pain, swelling in the calf and an arc of ecchymosis is often visible distal to the medial malleolus "crescent sign"
burst popliteal baker cyst
405
chronic painless bulge behind the knee in the medial popliteal space prominent on extension
popliteal baker cyst
406
\_\_\_\_\_\_\_ is converted to _______ during gluconeogenesis
alanine, pyruvate
407
how does the liver maintain glucose levels in the blood
glycogenolysis and gluconeogenesis
408
what plays a role in fasting states in the first 12 hours? After 24 hours?
glycogen drops dramatically in the first 12 hours, gluconeogenesis picks up after that
409
what are the main substrates for gluconeogenesis
gluconeogenic amino acids (from muscle breakdown)
lactate (from anaerobic glycolysis)
glycerol 3-phosphate (from tiacylglycerol in adipose)
410
what is the main gluconeogenic amino acid in the liver
alanine
411
what is acute cholecystitis
obstruction of the gallbladder due to obstruction of the cystic duct by a gallstone
412
pt with fever, bacteremia, within one week of surgery
MCC
s epidermidis from catheter
413
MCC of blood stream infection post surgerical intervention
s epidermidis because of skin disruption
414
infection not contamination
fever, hypotension, leukocytosis, tenderness at catheter site, culture within 48 hours is an/aerobic, 2+ cultures grow the same organism
415
simple ovarian cyst and free fluid in the posterior cul-de-sac
normal effects of pregnancy
416
pain, bleeding, dilated cervix, POC in lower uterus
spontaneous abortion
417
bleeding and closed cervix
threatened abortion
418
pt with mild scleral icterus after appendectomy with total bilirubin of 3.3
Gilberts
419
responsible for bilirubin conjugation in the liver
UDP-glucuronosyltransferase enzyme
420
increased unconjugated bilirubin with normal liver function
Gilbert
421
decreased detrusor tone after labor
bladder atony
422
pudendal nerve palsy and pelvic floor injury post labor
urinary retention not from bladder atony
423
pt is unable to void 6 hours after vaginal delivery
bladder atony
424
diagnosis and treatment of bladder atony
try analgesics or ambulation
urethral catheterization
425
someone has a plethoric appearance, what is going on
polycythemia
426
heavy menses, constipation, urinary frequency, pelvic pain or heaviness, enlarged uterus
fibroids
427
dysmenorrhea, pelvic pain, heavy menses, bulky, globular, tender uterus
adenomyosis
428
obesity, nulliparity, anovulation, nontender uterus
endometrial CA
429
woman with incresaed testosterone and estrogen and there is an imbalance of LH/FSH
PCOS
430
most frequent associations with digital clubbing
malignancy
cystic fibrosis
R-L cardiac shunt
431
1 day old infant with bilatterally enlarged mammary glands, swollen labia, and blood tinged vaginal discharge
normal effects of maternal estrogen
432
imaging for palpable adnexal mass
pelvic u/s
433
headache, blurred vision, AMS, RUQ/epigastric pain, SOB, proteinuria, HTN, seizurw
eclampsia
434
pathogenesis of Wilson disease
AR mutation of ATP7B
hepatic copper accumulatin
leaks from damaged hepatocytes
deposits in tissues (basal ganglia and cornea)
435
decreased ceruloplasmin, increased urinary copper excretion and copper in liver on bx
Wilson disease
436
short and long term treatments for Wilson disease
D-penicillamine
zinc
437
decreased elasticity in aorta and arterial walls
isolated systolic HTN
438
sandpaper rash with gray-white pharyngeal exudates
Scarlett fever
439
rash that spares the mouth area (circumferential palor)
Scarlet fever
440
early onset HTN with different BP in the arms and abdominal masses
ADPKD
441
diagnostic imaging for ADPKD
abdominal u/s
442
treatment for ADPKD HTN
ACE-I
443
time line of diaphragmic rupture in a child
can take months or years to manifest
444
imaging modality if you suspect a diaphragmic rupture
CT of the chest and abdomen
445
42 year old man with progressive fatigue, abdominal pain, diarrhea with blood, negative colonoscopy, increased alk phos (816), sed rate is 102, and MPO-ANCA is +
diagnosis
primary sclerosing cholangitis
(fatigue and pruritis and increased alk phos)
often with comorbid UC
increased IgM, positive MPO-ANCA
446
how to diagnose primary sclerosing cholangitis
cholangiopancreatography
447
onion skin fibrosis on hepatic bx
primary sclerosing cholangitis
448
acute onset severe abdominal pain, fever, tachycardia, peritonitis (guarding, rigidity, reduced bowel sounds)
perforated viscus
449
diagnostic imaging for perforated viscus
upright XR of the chest and abdomen which will show free intraperitoneal air under the diaphragm
450
pathogenesis of minimal change disease
t cell mediated injury to podocytes causes increased molecular permeability to albumin
451
treatment for central retinal artery occlusion
occular massage and high flow oxygen
452
first branch of the internal carotid - what does a problem here cause
first branch is the opthalmic artery - embolism in this artery can cause CRAO (central retinal artery occlusion)
453
what is the most common cause of retinal stroke
embolism to the retinal artery
454
when do you see an acute right to left pulmonary shunt
in consolidative pneumonia the alveoli fill with inflammatory exudate leading to impairment of alveolar ventilation in that part of the lung and thus a V/Q mismatch and right to left shift
there will be an inability to corect hypoxemia
455
will increasing oxygen when there is a right left intrapulmonary shunt do anything
no
oxygen will not correct hypoxemia from a right to left shunt in V/Q mismatch
456
what is happening here
treatment
uneven T99 SPECT stress test at rest and activity shows iscemia of the heart
antiplatelet therapy like aspirin
457
most important risk factor for stroke
HTN
458
diagnostic requirements for ALF
1) AST/ALT \>1000
2) hepatic encephalopathy
3) INR \>1.5
459
hepatitis B and D together can cause what
acute liver failure
460
most common cause of acute liver failure
drug tox
acute viral hepatitis
461
vitamin K dependant clotting factors
10, 9, 7, 2 and protein C
462
labs when vitamin K is decreased
PT/PTT are both elevated
463
treatment for cyclical vomiting syndrome
anti-emetics and IVF
464
recurrent vomiting that is bilious
intestinal malrotation with possible hypovolemic shock
465
how to diagnose leprosy
skin bx - leprosy is not culturable
466
how is leprosy spread
respiratory droplets
467
other non conventional way leprosy is spread
armadillos
468
what type of disease is leprosy
chronic granulomoatous
469
pt with gradually worsening back pain over 2 months that is worse at night or when he is lying down with bladder dysfunction this week
spinal cord compression
470
late findings in spinal cord compression
bladder or bowel findings
471
reason for using glucocorticoids in spinal cord compression
decrease vasogenic edema
472
how to diagnose spinal cord compression
MRI
473
most common time to rupture a popliteal cyst
strenous exercise
474
why do a u/s after a ruptured popliteal cyst
rule out DVT
475
most common reason for well defined medial knee pain that is subacute
pes anserinus syndrome
476
what drops first in first 12 hours of fasting
glycogen stores
477
substrates for gluconeogenesis
muscle breakdown?
anaerobic glycolysis?
triacylglycerol in adipose?
muscle breakdown - gluconeogenic aa
anaerobic glycolysis - lactic acid
triacylglycerol in adipose - glycerol 3 phosphate
478
main gluconeogenic aa in liver
alanine
479
alanine is converted to pyruvate by
alanine aminotransferase
480
pt with a hx of gallstones
jaundiced
vs
non-jaundiced
jaundiced - stone is lodged in bile duct
non-jaundiced - stone is lodged in cystic duct
481
pt with hx of gallstones
mild increase in alk phos
major increase in alk phos
minor - probably stone in cystic duct
major increase - probably in bile duct
482
differentiate
esophagel mucosal tear vs transmural tear
mucosal - mallory weiss
transmural - Boerhaave
483
how to diagnose mallory weiss vs boerhaave
EGD for mallory weiss
CT or ECG with gastrograafin for boerhaave
484
pt with vomiting, subcutaneous emphysema, increased amylase, widened mediastinum, decreased pH
boerhaave
485
how to treat a pt with heat stroke over 104
ice bath
486
tx for osteomyelitis
s aureus
vs
salmonella
s aureus: nafcillin/oxacillin/clidamycin/vancomysin
s enteridits: that + ceftriaxone
487
timeline for s/p infections with
GAS/c perfringens
others
indolent
24hrs to 1 week
1 week to 1 month
\>1 month
488
most common cause of spontaneous abortion
chromosomal abnormality
489
treatment for inevitable abortion
prostoglandin admin
suction and curretage
depands on pts wishes and hemodynamic stability
490
management stages for cancer pain
mild
moderate
severe
severe intractable
mild: acetaminophen/NSAIDs
moderate: weak opiates like tramadol, codeine, hydrocodone (NORCO 5/10)
severe: short acting opioids like morphine or hydromorphone
severe intractable: long acting like fentanyl patch or oxycodone
491
age when you reach adult levels of bilirubin
2 weeks
492
how long should physiologic jaundice last
1-2 weeks
493
treatment for physiologic jaundice
if bilirubin is rising quickly
if \>20-25
frequent feedings, natural sunlight
phototherapy
exchange transfusion
494
most common reason for drug induced psychosis
glucocorticoids
495
if pt cannot be removed from antipsychotics but is having EPS
move to clozapine
496
next steps in palpable breast mass by age
\<30
\>30
\< 30 = u/s then mammogram
\> 30 = mammogram then u/s
497
edema and ulceration on medial malleolus of the foot
venous HTN with stasis dermatitis
498
maternal fever with uterine tenderness, m/f tachycardia, malodorous amniotic fluid, purulent vaginal discharge
chorioamnionitis
probably from prolonged rupture of membranes
499
treatment for chorioamnionitis
broad spectrum abx (clindamycin, gentamicin, or ampicillin)
+ delivery with oxytocin
500
what should you do for someone with prolonged rupture of membranes
oxytocin and rapid vaginal delivery
501
is chorioamnionitis an inidication for c section
no
502
patient is an elderly male, with agitation, suprapubic tenderness, s/p surgery
acute urinary retention
503
liklihood of developing AUR s/p surgery is greatest in what population
\>80yo males
VERY uncommon in women
504
diagnose AUR?
bladder u/s
505
exudative effusion from lymphatic flow disruption
chylothorax
506
exudative effusion with increase in triglycerides
chylothorax
507
liquid effusion with T-cell lymphocytes, immunoglobulins, chylomicrons
chylothorax
508
how to treat a chylothorax
thoracentesis (or chest tube), decrease dietary fat, possible thoracic duct ligation
509
exudative effusion labs
pleural/serum protein = \>0.5
pleural/serum LDH = \>0.6
pleural LDH = \>2/3 of upper limit
510
causes of exudative pleural effusions
empyema, chylothorax, malignancy, TB
511
diagnosis for exudative pleural effusion with PMNs and gram (-)
empyema
512
diagnosis for exudative pleural effusion with milky white fluid and increased TGs
chylothorax
513
diagnosis for exudative pleural effusion with abnormal cytology
malignancy
514
diagnosis for exudative pleural effusion with acid fast bacteria
TB
515
pt with DM2, unilateral loss of facial expression and decreased taste sensation
MOE from p aeruginosa
516
diagnose a MOE
CT or MRI
517
treatment for MOE
oral cipro - topical cannot be used
518
treatment for bacterial meningitis in infant \>1 month
ceftriaxone or cefotaxime for s pneumo and n meningitidis
vanc for resistant s pneumo
519
cefotaxime vs ceftriaxone in infants \<1 month
use cefotaxime
ceftriaxone increases the risk of kernicterus by displacing bilirubin from albumin
520
decrease the risk of hearing loss in h flu type b meningitis
dexamethasone
521
empiric abx vs lumbar puncture in infants
lumbar puncture emergently when possible
522
agitation, irritability, psychosis without delirium, chest pain and palpitations, tachycardia, HTN, diaphoresis, mydriasis
amphetamine toxicity
523
PAS+ material in lamina propria of small intestine
Whipples
524
treatment for whipples
ceftriaxone for 1 week
TMP-SMX for one year
525
most common cause of HUS
shiga
526
pt presents with microangiopathic hemolytic anemia, thrombocytopenia, AKI
HUS
527
glucose 6 phosphatase deficiency is also known as
type 1 glycogen storage disease
von Gierkes
528
impaired conversion of glycogen to glucose
glucose 6 phosphatase deficiency
529
6 month old child with doll like face, thin extremities, rounded cheeks, short stature, hepatomegaly, hyperuricemia, hyperlipidemia
glucose 6 phosphatase deficiency
530
how to calculate B cells
lymphocytes - CD8 - CD4
531
all Ig levels are decreased, very few B cells
Brutons/XLA
532
why do Bruton's get sick after 6 months
maternal IgG wanes
533
16 month old pt with recurrent AOM, pneumo, GI problems
Brutons XLA
534
differentiate between SVID and Brutons
Brutons has decreased B cells and Ig
SVID has decreased Ig but normal B
535
pt with congenital heart problems, T cell deficiency, and hypocalcemia
DiGeorge
536
SCID vs Brutons
Brutons has low B cells
SCID has low T cells that leads to low B cells
537
infant with low IgG, normal B cells and spontaneously gets better at 11 months
transient hypogammaglobulinemia of infancy
538
RUQ pain and lower abdominal discomfort
PID with Fitz-Hugh-Curtis syndrome
539
hyperprolactinemia from antipsychotic use - which pathways involved
decreased dopamine in the TI pathway
540
why do you see gynecomastia in men on antipsychotics
TI pathway secretes less dopamine and so there is more prolactin release from the anterior pituitary
541
increased prolactin levels, gynecomastia, sexual dysfunction, while on antipsychotic - why
D2 antagonism of the TI pathway
542
posterior cervical lymphadenopathy with sore throat and fever
EBV - mono
do a monospot test
543
how long do EBV ab last
up to one year
544
treatment for bacillary angiomatosis
erythromycin
545
what causes bacillary angiomatosis
bartonella (gram negative)
546
most common cause of diabetic foot infection
polymicrobial by contiginous spread
547
organisms most likely involved in diabetic foot infections
mixture of gram positive - s aureus or s pyogenes
and gram negative - p aeruginosa or anaerobic
548
degeneration and atrophy of outer retina, retinal pigment epithelium, Bruch's membrane, choriocapillaries
age related macular degeneration
549
progressive bilateral central loss of vision in pt \>50
age related macular degeneration
550
best index to measure DKA
serum anion gap and BH
551
proper fluid treatment of DKA
0.9% saline
D5 when glucose is under 200
552
pt with DKA and K of 5.1
give IV K because they're still depleted
553
what must you do if a pt w/DKA and K of 3.0
hold insulin!
554
when should you give bicarb in DKA metabolic acidosis
pH \<6.9
555
why do you measure the anion gap in DKA
when the anion gap is low you lose the ketoacids
556
digital clubbing with sudden onset arthroplasty
hypertrophic osteoarthropathy from lung CA
557
how does macular degeneration occur
asx
unilateral
bilateral
558
pt with visual disturbance that seems like straight lines are squiggly and opthalmic exam shows drusen deposits
macular degenerations
559
pt with hx of liver transplant and immunosuppressive drugs develops pneumonia with elevated lactate and fever
PCP
560
how to diagnose PCP
bronchiolarlavage because it cannot be cultured
561
gait dysfunction, truncal ataxia, nystagmus, intention tremor, impaired alternating movements
cerebellar degeneration
562
morning vomiting, nocturnal headaches, recurrent OE
possible malignant OE
563
how to diagnose malignant OE
use CT or MRI
564
pt has been vomiting and getting headaches recently and now pt now cannot look R out of the R eye
malignant OE
565
hypochloremia, hypokalemia, increased bicarb with vomiting
gastrointestinal losses
566
what do you treat GI loss vomiting with
isotonic NaCl and K
567
nonsmoking pt with chronic cough with purulent sputum
bronchiectasis
568
most common etiology of bronchiectasis
CF and A1-AT deficiency, hypogammaglobulinemia, RA, sjogrens, lung cancer, recurrent aspiration, chronic lung infection
569
pt with dyspnea, sinus conhection, fever, wt loss, hemoptysis, mucopurulent sputum
bronchtiectasis
570
dx for bronchiectasis
high res CT
571
intermittent knee pain with catching of the joint and occasional limited ROM
meniscal tear
572
pt twisted foot while in a flexed position
meniscal tear
573
tests for meniscal tear
McMurry and Tressalay tests
574
carotid endarterectomy (CEA) is indicated in pts with stenosis of 70-99%
all other pts should be on antiplatelet agent with statins
575
elevated serum Cr and abnormal u/a (proteinura and RBCs)
renal parenchymal disease
576
severe HTN (180/120), \>55, flash pulmonary edema, increased Cr, abdominal bruit
renovascular
577
hypokalemia, hypernatremia, HTN with adrenal incidentaloma
primary aldosteronism
578
paroxysmal increase in BP with tachycardia, pouding headache, eccymosis, amenorrhea, HTN with adrenal incidentalomas
cushings
579
increased calcium, polyuria, polydipsia, kidney stones, neuropsychiatric issue
primary hyperparathyroidism
580
differentiatial HTN with brachial femoral pulse delay
coarctation of aorta
581
IE iwth prosthetic valves
with
IV catheter, pacemaker, IVDA
s aureus
582
IE with gingival manipulation, respiratory tract incision
viridans
583
IE with prosthetic valves, IV catheters, implants
s epidermidis
584
IE and nosocomial UTI
enterococci
585
IE and colon cancer with IBS
s bovis
586
IE and immunocompromised, IV catheter, prolonged abx
Fungi/candida
587
health care associated IE
s aureus
588
community acquired IE
strep
589
most important thing in rib fracture management
pain control
590
what can happen if adequate pain control in rib breakage isnt there
atelectasis and pneumo
591
tx for extensive rib fracture
inpatient with epidural
592
risk of using intercostal nerve block in broken ribs
can cause iatrogenic pneumothorax
593
tx for mild rib fracture
NSAIDs like ketoralac or ibuprofen or opiods
594
problem with using opioids in rib fracture
decreased respiration
595
dumping syndrome happens how often
50% of postgastrectomy
596
dumping syndrome cause
decrease in normal action of the pyloric sphincter
597
rapid emptying of hypertonic gastric contents into the duodenum and small intestine
dumping syndrome
598
pt is s/p surgery presents with nausea diarrhea, abdominal cramps, palpitations, diaphoresis
dumping syndrome
599
pt with hx of bipolar disorder presents with immobility and mutism
catatonia
treat with lorazepam
can also use ECT
600
when would you do a fetal non stress test
at risk pregnancies for fetal hypoxia and demise
601
what is a reactive fetal NST
\>2 accelerations
602
fetal sleep cycle lasts how long
40 mins
603
how long should a fetal NST be
20 mins unless no accelerations then 40-120 mins
604
naltrexone is contraindicated in
pt taking opiods, acute hepatitis, liver failure
605
first line meds for alchoholism
acamprosate
naltrexone
606
difference between acamprosate vs naltrexone
acamprosate - after abstinence
naltrexone - still drinking
607
vitiligo is associated with what
autoimmune disease like pernicious anemia, primary adrenal insufficiency, alopecia areta, RA, sjogrens
608
nonmalignant reasons for increased CA125
leiomyomata and endometriosis
609
how to dx PPROM
nitrazine and fern tests with clear fluid emerging
610
complications of PPROM
chorioamnionitis, endometritis, cord prolapse, abruptio placenta
611
red velvety rectal mucosal on posterior vaginal wall
rectovaginal fistula
612
8yo F pt with precocious puberty
granulosa cell tumor
613
pt with recurrent skin infestations and peridonitis with delayed wound healing and leukocytosis with neutrophilia
LAD
614
pt with recurrent wound healing and decreased pus
LAD
615
lymphopenia, decreased mature B/T lymphocytes, failure to thrive
AR adenosine deaminase deficiency
616
pt has recurrent disseminated infection like strep and staph, h flu, n meningitidis
complement deficiency
617
sinopulmonary and GI infections with decreased B cells
Brutons
618
pt with recurrent catalase positive organisms (s aureus, s marcesans, b cepacia)
CGD
619
Human milk contains
lactoferin, lysozyme, secretory IgA
620
main source of protein in human milk
whey
621
mast cell activation in the superficial dermis which increases the release of multiple mediators (histamine) that causes pruritis and localized swelling in upper layers of skin
urticaria
622
mast cell activation in the deeper dermal and subcutaneous tissues
angioedema
623
causes of acute urticaria
viral, bacterial, parasitic, NSAIDs, IgE, abx, insect bites, latex, food, narcotics, radiocontrast, muscle relaxers
624
causes of chronic urticaria
cold, skin pressure, serum sickness, autoimmune, vasculitis, malignancy
625
pt with pruritic, scaly, papules in patches in flexural areas and the face
atopic dermatitis
626
erythemetous papules and vesicles that developed over an afternoon
contact dermatitis
627
erythematous target shaped lesion with bullae that are painfull and pruritic on extensor surfaces and palms and soles
erythema multiforme
628
non pitting, non pruritic, edematous swelling of the subcutaneous tissues
idiopathic angioedema
629
pink colored patch 2 weeks after viral illness that is closely followed by eruption of multiple scaly/ovioid plaques on the back and flexar surfaces of UE
pityriasis rosacea
630
pt had fever and illness 2 days ago and now has non pruritic erythemetous maculopapular eruptions
viral exanthum
631
pt with spontaneous pain, odynophagia, for cold/hot food
diffuse esophageal spasm
632
dx for diffuse esophageal spasem
EGD
then manometry
633
what might EGD show for diffuse esophageal spasm
corkscrew shapes
634
what will esophageal manometry show for spasm
repetitive, non peristaltic increased amplitude contractions
635
episodes of dysphagia, regurgitaiton, and or chest pain precipitated by emoitional stress
esophageal motility disorder like diffuse esophageal spasm
636
5 yo pt with acute liver failure, encephalopathy, increased AST/ALT, increased PT/INR/PTT, increased amonium
Reye's
637
ASA use in which setting most commonly causes Reye's syndrome in children
influenzza B
varicella zoster vax adn flu A
638
mitochondrial toxin that can cause acute hepatic dysfunction in young individuals
ASA
639
what will you see on the liver bx of Reye's
microvesicular steatosis
640
exceptions to ASA use in children
Kawasaki
jeuvenile arthritis
641
fundoscopy shows yellow white fluffy hemorrhagic lesions along the vasculature
CMV retinitis
tx with valgancyclovir
642
pt complains of blurred vision, floaters, photpsia
CMV retinitis
643
mc organisms in "fight bite"
s aureus
strep
eikenella corrodens
h flu
644
tx for "fight bite"
augmentin
becuase of gram postiive and negative coverage and beta lactamase
645
how should a "fight bite" would heal
secondary intention
646
pt with cirrhosis is found to have medium sized non bleeding esophageal varicies
non selective beta blocker like propranolol
647
how do non selective beta blockers work on varicies
decrease adrenergic tone in mesenteric arterioles which leads to unopposed alpha mediated vasoconstriction and decrease portal venous flow
648
types of prevention in varicies
non selective beta blockers
endoscopic ligation
649
treatment with EPO can cause what
HTN
650
anemia in ESRD
normochromic normocytic from EPO deficiency
651
pt with ESRD and hematocrit \<30%
treat with EPO
652
tx of EPO caused HTN
dialysis and antihypertensives
653
tx for viral conjunctivitis
cool compress and antihistamines
654
mcc of viral conjunctivitis
adenovirus
655
micro vs macroprolactinoma
\<10mm vs \>10mm
656
when do you treat a prolactinoma
\>10mm or if less, symptomatic
657
why do you see oligomenorrhea in premenopausal women with sx prolactinoma
decrease in GnRH leads to a decrease in LH and a decrease in estrafiol
658
ppl who are less likely to see a prolactinoma
men and postmenopausal women
659
tx for prolactinoma
cabergoline or bromocriptine
660
medications causing hearing loss or tinitus
aminoglycosides
chemotherapy
ASA
loops
661
metabolic states that can exacerbate hepatic encephalopathy
hypokalemia and metabolic alkalosis
662
pt with hepatic encephalopathy needs what emergent theraputic interventions
potassium repletion
intravascular volume repletion
lactulose to decrease amonium levels
663
newoborn with cyanosis during feeding, relieved by crying
choanal atresia
664
pt with choanal atresia could be part of what larger syndrome
CHARGE
Coloboma
Heart defects
Atresia choanal
Retardation
GU anomalies
Ear abnormalites
665
infant pt with inability to pass catheter through nares
cholanal atresia
666
dx a cholanal atresia
CT shows narrow at level of pterygoid
667
tx for cholanal atresia
surgery or endoscopy
668
peripheral edema is a common side effect of what HTN meds
dihydropyridine CCBs (amlodipine)
669
eosinophilic intracytoplasmic inclusions with alpha synuclein protein
dementia with lewy bodies
670
tx for lewy body dementia
cholinesterase inhibitors
then low dose of 2nd gen antipsychotic
671
goal rate of plasma sodium correction
no more than 1mEg/L/hr
672
initial tx for severe hypovolemic hypernatremia
normal saline
can move to 1/2 normal saline once volume is restored
673
pts with mild hypovolemic hypernatremic are usually treated with what
1/2 normal saline + D5
674
dyspnea, orthopnea, lower limb edema, displaced apical impulse, and bilateral lung crackles
CHF from LV systolic dysfunction
675
what is a predictor of severity in CHF
hyponatremia caused by increased renin, norepi, ADH
676
tx for CHF induced hyponatremia
fluid restriction, ACE-I, loops
677
15 yo F with fever, headache, severe myalgias, nuchal rigidity
n meningitidis
678
CSF findings of N meningitidis
low glucose \<45
high protein \>500
neutrophilic leukocytosis \>1000
679
is dexamethsone useful in meningococcal meningitis
no
680
where will you find aspiration pneumo
supine - posterior segments of upper lobes or apical lower lobes
standing - lower lobes
681
tx for aspiration pneumonia
clindamycin, augmentin (good anaerobic coverage)
682
In hypovolemic shock what can happen when you start mechanical ventilation
acute loss of right ventricular preload, CO, and sudden cardiac death
683
severe hypovolemia leads to decreased CO how
hypovolemia → ↓central venous pressure → ↓venous return to RA → ↓CO
684
positive pressure mechanical ventilation can cause what negative effect
acute increase in intrathoracic pressure which can colapse the venous system (IVC)
685
drug type that can cause adverse pulmonary reactions in hypovolemia
sedatives becuase of acute loss of R ventricular preload
686
pt with erythematous papules that erode into painful penile ulcers with defined borders, purulent exudate, painful, inguinal lympahoid
h ducreyi
687
tx for h ducreyi
z pack
688
tx for clubfoot
if undertaken immediately - stretching, serial casting, manipulatin of the foot
689
hip fracture with increased risk of avascular necrosis
intracapsular fracture
690
hip fracture that requires more implants
extracapsular
691
when should surgery be done for a hip fracture
immediately but can be up to 72 hours to address other issues
692
pt is 80 yo and fell and broke hip but doesn't recall the incident
check cardiac enzymes, CT, EKG, CXR
693
spinal malformation seen in downs
atlantoaxial instability
694
downs pt with beahvioural changes, torticollis, dizziness, vertigo, leg spacticity, hyperreflexia and posiitve babinski
atlantoaxial instability
695
how to dx atlantoaxial instability
lateral radiographs of cervical spine in flexion, extension and neutral
696
tx for atlantoaxial instability
C/C2 fusion
697
downs syndrome with UMN sx
atlantoaxial instability
698
ASA toxicity metabolic results
initial respiratory alkalosis that becomes metabolic acidosis because of this pH will be near 7.4 but CO2 will be low and HCO3 will be low
699
low pH with low CO2 and low bicarb means
metabolic acidosis with respiratory alkalosis
700
how does anion gap metabolic acidosis occut
uncoupling of oxidative phosphorylation in the mitochondrion leading to anaerobic metabolism with resultant HCO3 from acid buildup
701
what does a normal pH in acid disturbance mean
mixed respiratory and metabolic acid base
702
pt with increased osmolar gap and increased anion gap with vision loss
metabolic acidosis with anion gap from methanol poisning
703
hypokalemia with anion gap metabolic acidosis in pt with alcholism
alcholism and vomiting
704
hemodynamically unstable pt after GSW
needs laparotomy if FAST is inconclusive or shows you need it
705
what should you do if you dont see a pregnancy with beta hcg of 1000
remeasure in 2 days because it will be 1500-2000 by then adn that should be visible on u/s
706
pt who is depressed and sleepy
buproprion because it is mildly stimulating
707
contraindication for raloxifene/tamoxifen
hx of VTE
708
increased risk of uterine hyperplastia/CA
tamoxifen
709
does not increase chance of endometrial CA
raloxifene
710
tamoxifene toxicity
uterus
711
7yo M with bloody diarrhea 1 week ago now has fatigue, pallor, shistocytes on smear with bruising and edema
HUS
712
% of children who get HUS after e coli
15%
713
electrolytes you lose from GI from vomiting
hypochloremic metabolic alkalosis with hypokalemia because GI is rich in H+, chloride, K
714
dx bronchiectasis
HRCT
715
lobar or segmental lung collapse
atelectasis (decreased lung volume)
716
accumulation of pharyngeal secretions, airway tissue edema, tongue collapsing into pharynx from surgery
atelectasis
717
how does pain lead to respiratory alkalsosis
pain decreases spontaneous coughing and deep breathing fail and cause atelectasis
718
atelectasis is more common following what kind of surgeries
abdominal
719
atelectasis can cause what
significant v/q mismatch leading to hypoxemia
720
atelectasis is most severe when
days 2-5 post op
721
2 post op pulmonary problems that cause similar ABGs
atelectasis
PE
both cause respiratory alkalosis
722
ABG of pt post op day 2 shows hypoxemia, hypocapnia, respiratory alkalosis
atelectasis
723
mc reasons for atelectaisis
retained airway secretions
decreased lung compliance
post op pain
opioids
724
normal reactive NST (fetal) should have how many accelerations
\>2, \>15bpm above baseline, \>15 seconds long within a 20 min period
725
how often should someone have a fetal NST
once a week if everything is normal in a high risk pregnancy
726
what score on a fetal NST rules out hypoxia
8-10/10
727
mcc of galactorhea is a woman taking antipsychotic
risperidone
728
hyperprolactinemia in an antipsychotic use vs prolactinoma
antipsychotic - 25-100ng/ml
prolactinoma - \>200ng/ml
729
pt with increased MCHC, hemolytic anemia, jaundice and splenomegaly in someone from northern europe
hereditary spherocytosis
730
pt with increased MCHC, splenomegaly, RUQ pain, positive murphy's sign, leukocytosis
hereditary spherocytosis with pigment gallstones
731
vitamin ppl with hereditary spherocytosis need
folate
chronic hemolysis consumes folate
732
pt with decreased GnRH, FSH, estrogen
hypothalamic hypogonadism - everything is decreased
733
differentiate between primary ovarian insufficiency and PCOS
POI - hypogonadotropic hypogonadism, increased GnRH, FSH, decreased estrogen
PCOS - increased GnRH, estrogen, normal FSH
734
best way to establish airway with no facial trauma
orotracheal
735
when is nasotracheal intubation contrindicated
apneic/hypotonic pts
basilar skull fracture
736
pt with parkinsons taking disease appropriate drugs develops acute headache, nausea, conjunctival redness
trihexyphenidyl
737
how to increase the murmur of HOCM
valsalva because of decreased preload and ventricular cavity size
738
pt has epidural and experiences hypotension
symptomatic nerve fibers are blocked and vascular tone decreases and leads to vasodilation
739
persistant hypotension during labor can lead to what
fetal acidosis
740
tx for epidural induced hypotension
turn mother on her L side
IV fluids or vasopressors
741
1st line treatment for bipolar disorder
quetiapine, lurisadone, lamotrigine
742
pt is dx with gastric adenocarcinoma next step
CT scan to stage
743
differentiate between primary and secondary hyperthyroidism
primary - TSH decreased, T3/T4 increased
secondary - TSH/T3/T4 increased
744
pt presents with nodular uptake on thyroid scan
toxic adenoma
745
pt presents with diffuse uptake of thyroidism
Graves
746
pharyngitis and fever and decreased abdominal pain
h meningitidis
747
pt is 67 yo male with hx of BPH, increased Cr
dx u/s renal for hydronephrosis
748
only IV fluids recommended for children
normal crystalloid
749
mc association bt eikenella corrodens and IE
dental problems (gram neg anaerobe)
750
pericardial effusion shows on EKG
electrical alternans
751
precocious puberty, cafe au lait spots, polyostotic fibrosis dysplasia
McCune Albrights
752
pt with precocious puberty, hyperthyroid, adrenal hypercortisolism with a defect in the G protein cAMP-kinase function in affected tissue
McCune Albright
753
McCune Albright vs NF1
MA - the cafe au lait spots are large with irregular borders
754
16 month old pt with recurrent severe sinopulmonary infection with increased IgM and decreased IgA and IgG
CD40 ligand dysfunction (hyper IgM)
755
genetic problem with CD40 ligand dysfunction
X-linked
756
why does CD40 ligand deficiency casue immunocompromise
prevents class switching and inhibits B cell and plasma cell maturation
757
types of infection CD40 ligand deficiency is at risk for
viral
PCP
acute otitis media
pneumonia
758
pt became severely dyspneic after ingesting naproxen and has seasonal allergies
AERD
759
AERD is commonly associated with which physical problem
nasal polyps
760
pt cant taste food well and has constant nasal drip
AERD with nasal polyps
761
pH of trichomonas
\>4.5
762
how to calculate anion gap
Na + bicarb - chloride
763
worst colonic polyps
sessile and villous
764
10 yo boy with headache, vomiting, limited upward gaze
pinealoma
765
pt is found to have a back up of CSF into the aqueduct of sylvius because of a mass
pinealoma
766
limitation of upward gaze, bilateral eyelid retractions, light-near dissociation
parinauds - pineal gland tumor
767
pt is experiencing pericarditis following infarction 1 week ago
Dresslers
tx with NSAIDs
768
what should you not give in Dresslers
anticoagulation because it can cause hemorrhagic pericardial effusion
769
heart condition association with acromegaly
concentric myocardial hypertrophy
770
acromegaly causes
concentric hypertrophy, diastolic dysfunction, LV dilation, global hypokinesia, valvular heart disease
771
pt with alarm systems with GERD
EGD with bx
772
773
774
pt with post surgical atelectasis would should what kind of ABG and why
respiratory alkalosis
lobar or segmental collapse and pharyngeal secretions taking up room and leading to V/Q mismatch
775
when is atelectasis the most severe
second s/p night
776
when pts become hypoxemic from atelectasis what happens
hyperventilation leading to respiratory alkalosis with a \>pH,
777
what has similar blood gas readings to atelectasis
PE
778
prevention techniques for atelectasis post surgery
breathing exercises, incentive spirometry, forced expiration techniques
pain control, CPAP, chest physical therapy
779
MC surveillance modality in high risk pregnancies
biophysical profile
780
781
best initial test in squamous cell head and neck CA
panendoscopy - esophageal, bronchial, laryngeal
782
pt with difficulty climbing stairs and combing hair
differentiate bt myasthenia gravis and polymyositis
MG - can involve bulbar symptoms and occular
Polymyositis - increased CK, symmetric proximal muscle weakness
783
MCC of lower extremity edema
venous insifficiency
784
pt with headaches (holocranial and pulsating), blurry vision when looking sideways, obesity, empty sella
pseudotumor cerebri
785
associated meds with pseudotumor cerebri
isotretoin, tetracyclines, growth hormon, increased vitamin A
786
present in 70% of pts with pseudotumor cerebri
empty sella
787
pt with opening CSF pressure of \>250
diagnostic for IIH/pseudotumor cerebri
788
breast mass in pt \<30 - tender, mobile, posterior acoustic enhancement
simple breast cyst
789
what does a biophysical profile show
NST + amnionic fluid volume, fetal breathing movement, fetal movement, fetal tone
790
when shouldnt you use a CST
placenta previa, myectomy
791
normal amniotic fluid on fetal NST
single pocket of \>2x1cm or amnionic fluid index \>5
792
score of 4/10 on biophysical profile
fetal hypoxia
793
risk factors for placental insufficiency
tobacco, age, HTN, DM
794
watery diarrhea in HIV +
cryptosporidium - +low grade fever
microsporidium - +no fever
MAC - +high fever
795
pt with HIV presents with fatigue, low grade fever, wt loss, frequent low volume stools with blood colonoscopy shows eosinophilic intranuclear and basophilic intracytoplasmic inclusions
CMV diarrhea
796
pt with TB, hyponatremia, hyperkalemia, hypoglycemia, fever, cough, eosinophilia
primary adrenal insufficiency - Addisons disease
797
what happens to kidney if aldosterone is deficienct
decreased Na
increased K
increased H+
metabolic acidosis, normal anion gap
798
pt with TB and metabolic acidosis with normal anion gap
Addisons
799
21 year old pt with diagnosis of chorioretinitis was likely asx for what as a neonate
toxoplasmosis
800
5 day old infant with intracerebral calcifications and ventriculomegaly
toxoplasmosis
801
pins and needles ascending pain
GBS
802
3 components of the glascow coma scale
eye opening
verbal response
motor respose
803
Glascow coma scale tells you
severity and prognosis
804
risk factors for febrile seizures
influenza, adenovirus, HHV6, bacterial, immunizations, family hx
805
work up needed for febrile seizures
none
806
pt with suspected bladder cancer - next step
CT with contrast and cytoscopy
807
MC helminth infection in the US
enterobius
808
tx for enterobius
albendazole
pyrantal pamoate
809
what you see on peripheral smear of someone with sickle cell \>5 yo
Howell Jolly bodies
810
blunt abdominal trauma - what first
alert? FAST scan
not-alert? CT
811
if FAST is limited or equivocal what is next
DPL
812
unstable pt with postive FAST
laparotomy
813
indications for corticosteroid use in PCP
PaO2 \<70
A-a \>35
814
massive PE can casue what cardiac malfunction
decreased RV output and increased O2 demand/wall tension
815
differentiate PE from RVMI
RVMI won't have dyspnea
816
acute increase in pulmonary resistance
PE
817
when would you give an RH(-) woman RhoD
2nd pregnancy
OR
in a first pregnancy: hemorrhage or abortion
818
tx for croup
moderate-severe?
mild?
moderate to severe - racemic epi
mild - dexamethasone
819
medications that should be held for 48 hours before a stress test
beta blockers
CCBs
nitrates
820
medications that cause UTI in elderly
alpha adrenergic
anticholingergic
opiates
CCBs
diuretics
821
which tests at initial prenatal exam
RhD, hemoglobin/hematocrit, HIV, VDRL, rubella, chlamydia, urine culture/protein
822
which prenatal tests at 24-28 weeks
hemoglobin/hematocrit, antibody screen in Rh(-), 50g glucose tolerance test
823
which prenatal tests at 35-37 weeks
GBS
824
herpes zoster that causes bells palsy
Ramsay Hunt
825
occipital headache, neck stiffness, nausea, vomiting, nystagmus, hemataxia on the R side
L intraparenchymal hemorrage
826
fatigue, weight loss, malaise, nausea, vomiting, patchy hyperpigmentism, hyponatremia, hyperkalemia
Addisions
827
what causes syncope in Addisons
volume depletion from hyponatremia
828
reason for hyperkalemia in Addisons
mineralocorticoid deficiency
829
reason for hyponatremia in Addisons
renal Na loss and increased ADH
830
what do you always give after premature preterm rupture of membranes
antibiotics
831
what drug should you give in PPROM at 34-37 weeks
penicillin if the mother hsn't had the GBS test yet
832
pulsatile tinnitus, neck pain, flank pain, TIA, abdominal bruit, subauricular systolic bruit
fibromuscular dysplasia
833
if FAST is postiive or DPL is positive what next
lapartotomy
834
indiciation on FAST for a laparotomy
intraperitoneal fluid
835
what symptoms does estrogen cause in cirrhosis
spider angiomatas, palmar erythema, gynecomastia, testicular atrophy
836
what effects vascular wall dilation in cirrhosis
estrogen
837
838
muscle bx that shows infiltrates scattered throughout the muscle
dermato/poly myositis
839
pt has sensory deficits and numbness and tingling in the foot
tarsal tunnel syndrome
840
celiac disease is found on the same gene locus as what other AI disease
T1DM
841
which test for celiac is no longer done because of poor sensitivity
anti gliadin
842
intestinal bx of someone with chronic diarrhea showing increased epithelial lymphacytes, epithelial apoptosis, crypt hyperplasia
gluten intolerance celiac disease
843
what virus is kaposi sarcoma the result of
HHV8 - herpes virus
844
HIV + person with purple papules - distinguish between causes
kaposi sarcoma (from HHV8)
bartonella henselae - from cats
845
medication that inhibits the H/K ATPase of the parietal ceclls
PPI
846
pt on chemo for leukemia has lung infiltrates, fever, dyspnea, with decreased TLC
bleomycin induced pneumonitis
don't forget this can cause FEVER!
847
correct procedure after finding a testicular tumor
inguinal orichectomy - NEVER simple becuase you could seed the tumor
848
first step in diagnosis with hypernatremia
urine osmalarity
849
urine osmolality \>700
hypernatremia from dehydration
850
urine osmolality test \<700 in someone with hypernatremia
water deprivation test with desmopressin to look for DI
851
first sign of phenytoin toxicity
vertical nystagmus
852
what can you use in place of ceftriaxone for n meningitidis
cefotaxime
853
pharmacological therapy for frontotemporal dementia
none
854
AI renal disease with no deposits
Wegners granulomatosis/granulomatosis with polyangittis
855
renal disease associated with hemoptysis
GPA and goodpastures
856
anti proteinase 3 antibodies and no glomerular deposits
GPA
857
pt with afib and bilateral crackles with ground glass appearance
amiodarone induced restrictive lung disease
858
pt with SOB, dyspnea, orthopnea, FEV1/FVC \>80%, decreased TLC, cough, crackles
restrictive pattern of interstitial lung disease
859
diagnosis for pulmonary HTN
right heart cath
860
what else is elevated in pagets disease
urine hydroxyproline
861
tx for pagets disease
bisphosphanates
862
