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AV_Step 3 UWORLD > VENI VIDI VICI 2 > Flashcards

VENI VIDI VICI 2 Flashcards

1
Q

Femoral nerve injury presentation

A
  • weakness in quadriceps group ( inability to extend the knee against resistance)
  • sensory loss in the anterior and medial quadriceps extends to the mid shin and towards arch of foot due to saphenous nerve ( root of femoral nerve)
  • decrease or absence of knee jerk
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2
Q

sciatic nerve injury presentation

A
  • weakness of lower leg musculature including harmstrings.
  • loss of sensation of lower leg
  • knee jerk normal
  • ankle jerl absent
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3
Q

MCC of sciatic nerve injury

A 
trauma
   hip disclocation, freacture, replacement
wayward buttock injection 
compression external sources
deep seated mass in pelvis.
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4
Q

obturator nerve injury

A

weakness with adduction

sensory loss in small area of medial thigh

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5
Q

common peroneal nerve injury presentation

A

acute foot drop

wekaness in dorseiflexion and eversion

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6
Q

causes of bacterial enteritis- bloody stools

A

shigella, salmonella, campylobacter, E.coli, Yersinia

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7
Q

Antibiotic treatment of E. coli O157:H7 can lead to HUS

A

true

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8
Q

high risk patients for pancreatitis ( 5 groups)

A
  1. HF or HTN ( Thiazides, furosemide, enalapril, losartan)
  2. Autoimmune diseases (azathioprine, mesalamine, corticosteroids)
  3. chronic pain(acetaminophen, opiates, NSAIDs)
  4. Severe seizure disorder(VPA, CBZ)
  5. HIV (lamivudine, TMPX, didanosine)
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9
Q

diuretics that cause pancreatitis

A

chlorthalidone, hydrochlorothiazide, furosemide

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10
Q

Effects of parathyroidectomy ( 1 gland or 31/2 glands)

A

hypocalcemia

  1. Relative hypopTH- suppression of PTH by increased Ca levels in blood. Is transient and recovers in a couple od fays.
  2. Hungry bone syndrome: sudden PTH withdrawal causes Ca influx into the bone- causing hypocalcemia- in days 2-4 pop.

Hypocalcemia sings ( perioral cyanosis, chvosteck, trousseau, are ALWAYS BILATERALLY SYMMETRIC)

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11
Q

HIV triple PEP therapy

A

there are many combinations but tenofovir emtricitabine, raltegravir low SE profile initiate within 72 hrs and for 4 weeks.

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12
Q

How does botulinum toxin works

A

in the presynaptic NM . inhibit release of ACH in the synaptic cleft by cleaving SNARE proteins

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13
Q

tto of botulism

A

equine derived heptavalent antitoxin, only for >1 years of age.

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14
Q

colonic ischemia presentation

A

hematochezia, diarrhea, leukocytosis, lactic acidosis

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15
Q

CT and colonoscopy in colonic ischemia

A

CT: Increased wall thickness, pneumatosis, fat stranding
Endoscopy: edematous, friable mucosa, scattered pale patches

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16
Q

Treatment for colonic ischemia

A

IV fluids, bowel rest( NG tube )
Anitbiotics (cipro/levo +MTZ)
Colonic resection if necrosis develops

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17
Q

RF angiodysplasia of colon

A

Aortic stenosis
VonWillebrand disease
CKD

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18
Q

Organisms causing pseudomembranous colitis

A

C.dif and Salmonella

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19
Q

fat embolism presentation

A

triad: respiratory insufficiency + neurologic impairment + petequia
can also have fever, tachycardia, AMS

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20
Q

Why does petechiae occur in fat embolism

A

there is occlusion of the dermal capillaries by fat globules, and extravasation of the RBCs.

There is no abnormalities with platelets.

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21
Q

tto of fat embolism

A

supportive, early immobilization and operative fixation of fractures prevent more fat embolism.

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22
Q

which systemic disorder is associated with pseudogout?

A

hemochromatosis

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23
Q

patient with DM, with arhtralgia, now with knee pain with rhomboid shaped crystals, hepatomegaly

A

hemochromatosis

2nd and 3rd MCP are more commonly affected , also knees, ankles and shoulders.

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24
Q

Endocrine manifestations of hemochromatosis

A

DM, hypogonadism, hypothyroidism

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25
Q

Patients with hemochromatosis are susceptible to which infections

A

Listeria, Vibrio Vulnificus, Yersinia

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26
Q

treatment of hemochromatosis

A

serial phlebotomies- but it does not help arthropathy

- reduces risk of hepatocellular carcinoma

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27
Q

complications of hemochromatosis

A

20 fold risk of hepatocellular carcinoma

accounts for up to 45% deaths

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28
Q

Light criteria

A

Exudate:

  1. Pleural protein/serum protein > 0.5 OR
  2. Pleural LDH/Serum LDH >0.6 or
  3. Pleural LDH > 2/3 of the upper limit of normal serum
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29
Q

Causes of exudate

A 
Infection (TB, pneumonia)
Malignancy
Connective tissue disease
PE
Pancreatitis
Post CABG
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30
Q

Causes of transudate

A 
nephrotic syndrome 
cirrhosis 
HF
cONSTRICTIVE PERICARDITIS 
Hepatic hydrothorax
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31
Q

What is hepatic hydrothorax, why does it happen?

A

occurs in decompensated cirrhosis
pleural effusion occurs due to passage of peritoneal ascitis to the right pleura ( right sided diaphragm is thinner and more porous)
transudative

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32
Q

tto hepatic hydrothorax

A

tto:furosemide, spironolactone, Na restriction
if refractory - transjugular intraheptic portosystemic shunt placement.
is bad so start looking for liver transplant.

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33
Q

Pleurodesis is effective for exudative but not transudates.

A

transudates will recurr.

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34
Q

Who should undergo endoscopic screening for metaplastic changes in esophagus

A 
chronic GERD >5 years
At least 2 risk factors: 
> 50 
male
caucasian
hiatal hernia
obesity or increased waist circumference (>102)
current or former tabacco
first degree relative with Barret or gastric adenocarcinoma
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35
Q

RF for Barret esophagus

A 
> 50 
male
caucasian
hiatal hernia
obesity or increased waist circumference (>102)
current or former tabacco
first degree relative with Barret or gastric adenocarcinoma 
GERD
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36
Q

dyspepsia vs. GERD

A

dyspepsia: postprandial fullness, early satiety, epigastric pain. - H.pylori

GERD: heartburn that worsens at bedtime, with coffee,

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37
Q

coin as foreign objects are considered low risk- nontoxic material and round. Management?

A

Weekly follow-up X rays.

IF no transti endoscopic removal.

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38
Q

When is a CT indicated in foreign body aspiration

A

When pt is symptomatic and the event was unwitness

or if in X rays it is not possibly to define if the object is high risk

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39
Q

treatment for oral candidiasis

A

nystatin suspension or clotrimazole troches

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40
Q

SE of amiodarone

A 
photosensitivity
skin discoloration 
LFTs
Thyroid
Pulmonary toxicity
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41
Q

Pulmonary toxicity by Amiodarone presentation

A

Interstitial pneumonitis MC – nonproductive cough, fever, pleuritic chest pain, fever, weight loss, dyspnea. Chest X ray with interstitial/diffuse or alveolar opacities.

can also present with
pneumonia
respiratory distress
and rarely, solitary pulmonary nodule.

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42
Q

Pulmonary toxicity by Amiodarone

A

removal of the amiodarone is mainstay

steroids can be used in severe cases

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43
Q

High risk characteristics of pulmonary nodule

A 
large size >2 cm 
advanced age
female
active or previous smoking
family or personal hx of cancer
upper lobe location
spiculated
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44
Q

organophosphates poisoning mechanism and presentation

A 
inhibit Acetylcholinesterase - so high Ach 
Muscarinic effects:
Diarrhea
Urination
Miosis
Bradycardia
Bronchospasm
Emesis
Lacrimation
Salivation

Nicotinic effects:
muscle weakness, paralysis, fasciculations

CNS effects: Respiratory failure, seizure, coma

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45
Q

organophosphates poisoning ttto

A

atropine (competitive inhibitor)

pralidoxime ( regenerates achase if given early)

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46
Q

antimuscarinic toxicity presentation

A 
fever
dry/flushed skin 
dry mouth
cyclopegia
constipation
disorientation

Elderly: acute angle closure glaucoma
urinary retention

Infants: hypertheramia

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47
Q

antimuscarinic toxicity antidote

A

physostigmine

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48
Q

H. pylori treatment

  • standard
  • if allergy to penicillin
  • if failure after 1 course
A
  1. If no allergy to penicillin: Amoxi, Clarithromyicin + PPI for 10-14d
  2. If allergy to penicillin: MTZ , Clarythromycin +PPI for 10-14 days

3 If failure or high resistance to macrolide or MTZ:
- MTZ, bismuth, tetracyclin, PPI for 10-14 days.

  • *Advice stoping NSAIDs while in therapy
    • PPI just used during the treatment timeframe
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49
Q

H. pylori causes which diseases

A

Peptic ulcer disease
gastric cancer
MALT: Mucosa associated lymphoid tissue lymphoma

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50
Q

patient with treated H,pylori infection comes after a month with persistent symptoms. next step?

A

stool antigen testing for h. pylori
or urea breath

testing is done >=4 weeks after treatment to conform erradication

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51
Q

In which patients should you confirm H.pylori erradication

A

persistent symptoms
h.pylori associated ulcer in endoscopy
evidence of h.pylori associated malignancy (ie. malt)

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52
Q

polymiositis vs. PMR

A

polymyositis (inflammatory myopathy): PAINLESS, PROXIMAL MUSCLE WEAKNESS, elevated CK and inflammatory markers- trigger is unknown, possibly viral
difficulty climbing stairs, combing the hair, getting in or out of a car ( age >40)

PMR: Stiffness and pain rather than weakness age < 50s), fever, ESR, systemic signs and symptoms, improve with steroids

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53
Q

Polymyositis can also involve esophageal musculature leading to dysphagia, regurgitation, and aspiration

A

true

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54
Q

definitive diagnosis of polymyositis

A

muscle biopsy - endomysial infiltrate patchy necrosis

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55
Q

tto of Polymyalgia rheumatica

A

steroids

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56
Q

tto of polymyositis

A

corticosteroid sparing agents (methotrexate, azathioprine

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57
Q

Pt with polymyositis with shortness of breath, bibasilar fine crackles. Dx and next step

A

interstitial lung disease- do pulmonary function tests

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58
Q

Complications of polymyositis

A

Interstitial lung disease ( associated wiht Jo-1) - on CT would be likeground glass opacities, reticular changes, honeycombing pattern.
drug induced pneumonitis ( methotrexate induced)
respiratory weakness

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59
Q

say kyphosis and scoliosis algorithms

A

say it

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60
Q

why symptoms of lactose intolerance are higher with milk and icecream , than yogurt or cheese

A

milk and ice cream have higher lactose content

dx: lactose breath hydrogen test

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61
Q

Mono, recs for sports

A

3 weeks from all sports since symptom onset

4 weeks contact sports

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62
Q

smoking cessation at least 4 weeks prior to surgery decreases the risk of posoperative pulmonary complications

A

true

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63
Q

treatment for latent TB if resistance to INH

A

Rifampin 4 months

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64
Q

acute gout treatment in CKD

A

intra articular steroids or if multiple joints involved then oral steroid

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65
Q

acute gout tto

A

NSAIDs and colchicine

IN CKD: intra articular steroids or if multiple joints involved then oral steroid

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66
Q

Why does porcelain gallbladder occur?

A

chronic gallbladder stones and inflammation

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67
Q

Patients with porcelain gallbladder are at increased risk of

A

gallbladder cancer

prophylactic surgery if symptomatic or punctuate calcifications.

If curvilinear no increased risk, and no need for surgery

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68
Q

treatment of toxic megacolon (> 6cm diameter in transverse colon)

A

if caused by C.diff: antibiotics- IV MTZ and PR Vancomycin

If not caused by C. diff: steroids

** do not give sulfazalazine as they can precipitate attack.

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69
Q

treshold for transfusion in stable pts with upper GI bleeding

A

<7 as it is associated with less complications

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70
Q

treshold for transfusion in adults

A

< 7 if stable, and even with GI bleeding

< 8 if stable cardiovascular disease, malignancies,

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71
Q

Characteristics of functional abdominal pain

A

chronic >= 2 months
poorly localized or peri umbilical
no vomiting, diarrhea, weight loss
negative guaiac

next step: symptom diary

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72
Q

suspect gout, next step

A

arthrocentesis

uric acid level is not as sensitive because it can be normal or even low in gout.

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73
Q

RF for gout

A 
volume depletion 
diuretics
high protein or high fat 
increased alcohol consumption
recent surgery or trauma
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74
Q

contraindications of NSAIDs when considering gout tto

A 
Kidney disease
anticoagulated
PUD
CHF
NSAID sensitivity
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75
Q

Diverticulosis can cause hematochezia. while diverticulitis doesnt

A

diverticulosis - ok to do colonoscopy

diverticulitis - contraindicated to do colonoscopy due to risk of perforation

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76
Q

complications of GERD

A

Esophageal: erosive gastrtitis, Barrets, stricture

Non esophageal: asthma, laryngitis

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77
Q

GERD management

A

8 week trial of low dose PPI( Daily)

If they fail- and no risk factors: can do high dose ( BID) for other 8 weeks prior to ordering further testing

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78
Q

Patient with recent MI with sudden onset periumbilical pain severe and constant. Dx, next step?

A

acute mesenteric ischemia

CT Angiography

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79
Q

acute mesenteric ischemia can have elevated amylase and phosphate, in addtion to lactic acidosis and leukocytosis

A

true

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80
Q

one to two thirds of ADHD adolescentes will have it in adulthood

A 
if untreated: 
social underachievement
underemployment
antisocial behavior
substance use 
motor vehicle collisions
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81
Q

Stimulant therapy in ADHD does increase risk for substance abuse?

A

NOO! - Stimulants are the first line treatment for adolescents and school aged > 6 years .

Even if the patient has a family history of substance abuse.
However, if the patient had. PERSONAL history of substance abuse ( more than just trying some drugs) may consider non stimulants drug

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82
Q

clinical features of meniscal tear

A

small effusion
locking sensation
inability to extend
positive mcMurray test ( push medially knee and pull ankle)

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83
Q

management of meniscal tear

A

if uncomplicated can be managed with RICE Rest, Ice Compression, Elevation
Most cases are managed non operatively

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84
Q

Best initial approach to difficult conversations of fear to die with cancer diagnosis is open ended question

A

true

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85
Q

patient with HIV afraid of telling fiancee

A

first step is always to encourage them to tell the third parties.

physicians should always report the HIV case to the Department of Public Health, but the disclosure to third parties varies among states

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86
Q

contraindications for going to hospice care

A

none

even if the patient is ill enough that is not able to decide to go to hospice, family works as surrogate deciison maker.

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87
Q

forced sterilization is considered unethical even if patient is intellectual disable

A

she must decide, and if she doesnt want other contraceptive methods should be discussed instead

also is important to identify guardanship for deicision making.

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88
Q

patient with mild intelectual disability who is her own guardian, asking about contraceptive methods. After physician explains, she says whatever you decide Dr. Next step?

A

Assess Capacity- tell me your understanding about the options we just discussed

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89
Q

Which are the systemic ss and cervical involvement seen in RA

A

Systemic symptoms: fatigue, weight loss, anemia

Cervical involvement: subluxation, and cord compression

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90
Q

antibodies of rheumatoid arthritis

A

RF and anti-cyclic citrullinated peptide - associated with accelerated destruction

If negative, less severe disease

BUT RA can present with negative antibodies! So clinic suspicion is important and even if negative is OK to start methotrexate

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91
Q

MOA methotrexate

A

inhibits dihydrofolate reductase

inhibits purine synthesis and DNA

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92
Q

SE of Methotrexate

A

Hepatotoxicity, stomatitis, bone marrow suppression

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93
Q

Patients with RA started on Methotrexate should receive supplementation with

A

Folate acid

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94
Q

Predictors of poor outcome/worse severity in pancreatitis

A 
Age > 55
Obesity BMI>30
Hematocrit >44
CRP >150
BUN >20

CHAO-B

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95
Q

scores for pancreatitis

A

Ranson criteria
APACHE II
SIRS
Bedside indext for severity of pancreatitis

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96
Q

Which patients can have catatonia

A

severely ill patients with:
schizophrenia
bipolar disorder with psychotic features
major depression with psychotic features
autism
medical conditions (infectious, metabolic , neuro, rheumatologic)

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97
Q

treatment of catatonia

A

BZD (especially lorazepam) and/or ECT

Lorazepam challenge (1-2 mg ) pt improve within 10-15 min. If does not respond doesnt rule out catatonia and patient may need multiple doses.

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98
Q

WHEN IS Dantrolene used

A

neuroleptic malignant syndrome

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99
Q

neuroleptic malignant syndrome presentation

A 
recent exposure to antipsychotics
muscle rigidity 
fever
altered mental status
autonomic instability 
CK and leukocytosis
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100
Q

cocaine in urine

A

only indicates recent use, the last 2-3 days

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101
Q

patient who comes for asthma follow-up and is in a hurry, mentions that he left his home, moved with friends, lost school, and at exam septum perforated. Next step

A

brief counseling intervention

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102
Q

Combination of psychotherapy and antidepressants is more effective than either alone in depresssion

A

true

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103
Q

Treatment of Tourette

A

Habit reversal training ( form of behavioral training)
Tetrabenazine ( dopamine depleter)
antipsychotics ( Risperidone, aripiprazole)
alfa 2 adrenergic receptor agonist (Clonidine, guanfacine)

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104
Q

Bordeline personality

A

unstable relationship, suicide attempt after finishing relationship, long standing mood instability, marked impulsivity
often have splitting– saying first best things of boyfriend and then the opposite

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105
Q

tto Bordeline personality

A

Primary tto is DIALECTICAL BEHAVIORAL THERAPY

and sometimes can add antipsychotics (2nd generation-risperidone, aripiprazole) and mood stabilizers

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106
Q

Lithium can be used in pregnancy?

A

Although it causes ebstein abnormality in baby it can be used.

However if bipolar pregnant with suicidal thoughts, is better to pursue ECT - acts faster

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107
Q

Etiology of reactive arthritis

A

Gastroenteritis : Salmonella, shigella, yersinia, campylobacter, C. diff
Genitorurinary infection: Chlamydia trachomatis

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108
Q

extra MSK manifestations of reactive arthirits

A

ocular: uveitis, conjunctivitis
Genital: urethritis, cervicitis, prostatitis
skin: keratoderma blennorrhagica, circinate balanitis
oral ulcers

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109
Q

NAAT for chlamydia is done in URINE not from lesions

A

true

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110
Q

Tto of reactive arthritis

A

antibiotics for chlamydia or non self resolving GI tract infection
NSAIDs (naproxen, ibuprofen, indomethacine)
If NSAIDs not helpful or contraindicated may add: intraarticular steroids
or systemic steroids

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111
Q

patient with acute diverticulitis who is on cipro and mtz but persists with abdominal painafter a week. next step

A

repeat CT scan to assess for complications: abscess, obstruction, fistula, perforation

*pts usually improve with antibiotic therapy by 2-3 days

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112
Q

most common complication of diverticulitis

A

colonic abscess - require percutaneous drainage and IV antibiotics followed by elective partial colectomy several weeks later

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113
Q

when would be prudent make a colonoscopy in a pt with diverticulitis

A

6-8 weeks after resolution of ss

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114
Q

patients who are actively suicidal and refusing treatment should be placed in 1:1 observation and hospitalize under involuntary status

A

true

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115
Q

thyroglobulin and radioiodine intake in pt taking exogenous hormone

A

low and low

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116
Q

drugs that cause serotonin syndrome

A

SSRiS interacting with IMAO (Phenelzine)or linezolid
Intentional overdose with SSRIs
MDMA

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117
Q

CYPROHEPTADINE MOA

A

Serotonin antagonist

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118
Q

tto of serotonin syndrome

A

Discontinuation of serotonin medications
supportive care, sedation with BZDs
Can give serotonin antagonist (cyproheptadine) if tto fails.

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119
Q

serotonin syndrome presentation

A 
triad of 
mental status changes ( Anxiety, delirium, confusion, restlessness)
autonomic dysregulation (diaphroesis, hypertension, hyperthermia)
neuromuscular hyperactivity( hyperreflexia, tremor, clonus)
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120
Q

switch from SSRI to IMAO needs how many weeks to dont cause serotonin syndrome

A

5 weeks

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121
Q

2 most common comorbidities in Tourette

A

ADHD, OCD

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122
Q

HISTRIONIC PATIENT

A

excessive superficial emotionality and attention seeking. They may also have sexually provocative behavior

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123
Q

when do you indicate cholecystectomy in gallbladder pancreatitis

A

if mild disease- usually within 7 days- so in the same hospitalization

if severe disease is better to wait until inflammation has gone down, and there is resolution of complications. these patients need preoperative ERCP

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124
Q

first line tto for ADHD in pre-school ages

A

nonpharmacological therapy - parent child behavioral therapy

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125
Q

prior to prescribing methylphenidate the physician need to assess for

A

cardiac history and physical exam

  • assess for sudden death in the family
  • no need for routine ECG
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126
Q

if no significant improvement with stimulants, or report od side effects, best option is to switch to another medication.

A

true

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127
Q

Difference between somatic symptom disorder and illness anxiety disorder

A

somatic: excessive anxiety or preoccupation with >=1 unexplained symptom >=6 months
illness: fear of having a serious illness despite few or no ss, and multiple negative evaluations.

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128
Q

Difference between factitious disorder and malingering

A

factitious: intensional falsification of ss without external gain
malingering: falsification or exaggeration of ss with external gain

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129
Q

treatment of somatic symptom disorder

A

schedule regular visits with same physician
develop a patient-physician relationship
focus on functional improvement

-limit workup and unnecessary testing/referrals

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130
Q

lithium toxicity (5)

A

N/V/ diarrhea

slurred speech
confusion
tremor
ataxia

therapeutic levels 0.8-1.2
toxicity >1.5

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131
Q

Meds that increase risk of lithium toxicity

A

Thiazides ( chlorthalidone)
ACEis
NSAIDs (not aspirin)

  • also volume depletion/renal insufficiency
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132
Q

Management of lithium toxicity

A 
lithium levels every 2-4 hrs
IV hydration (0.9%NS)
Hemodialysis: 
  > 4 mEq
  > 2.5 with ss or renal failure
  increasing levels despite IV fluids
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133
Q

Patient with depression who was started on fluoxetine comes 2 weeks after initiation of treatment. Reports feeling better but has some nausea, anxiety and insomnia. Next step in tto?

A

Wait and re-evaluate at the 6 month period

  • pt is clinically improving
  • pt has mild SE of SSRIs for which is common develop tolerance and they will go away with time*

** SSRI erectile dysfunction is the only thing that will not go away and that warrants assessing other med.

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134
Q

Pt with anterior knee pain, pain worse when squatting, prolonged sitting, climbing or descending stairs. Dx?

A

patellofemoral syndrome -

+ patellofemoral compression test : pain elicited by extending the knee while compression of patella

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135
Q

patellofemoral syndrome vs patellar tendonitis

A

patellofemoral syndrome:anterior knee pain, pain worse when squatting, prolonged sitting, climbing or descending stairs.+ patellofemoral compression test

patellar tendonitis: episodic pain and tenderness at interior patella and inferior tendon

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136
Q

patellofemoral syndrome tto

A

exercises that strenghthen quadriceps

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137
Q

prepatellar bursitis complication

A

septic bursitis by S.aureus

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138
Q

presetnation of anserine bursitis

A

medial knee pain

ss are acute/episodic

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139
Q

Osgood Schlatter syndrome

A

pain at the insertion of the patellar tendon in the anterior tibial tubercle

in children/adolescent growth spurt
localized pain at the tibial tubercle

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140
Q

evaluation of acute dysentery ( bloody diarrhea)

A

stool pathogen panel, Shiga toxin, fecal leukocytes

low leukocyte count- amebiasis

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141
Q

Why antibiotics are adviced for all causes of acute dysentery except for EHEC?

A

antibiotic therapy in EHEC has been associated with high risk of HUS

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142
Q

Antipsychotic extrapyramidal effects timing and tto

A

Acute Dystonia (4h-4d) Benztropine, dyphenydramine
Akathisia (any time) - propanolol
parkinsonism (4d-4m)- benztropine, amantadine
Tardive Dyskinesia (1-6 m) - clozapine, valbenazine

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143
Q

antibodies and their course in celiac disease

A

anti tissue transglutaminase
anti gliadin antibody

correlate with disease activity
should decline by 50% in 8 weeks and normalize in 12 weeks after gluten free diet.

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144
Q

beer can have gluten

A

true

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145
Q

woman with menopause should be encouraged to have vit D and calcium supplementation

A

true

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146
Q

Clozapine SE

A 
agranulocytosis ( pts should have weekly ANC checks for 6 months and then every other week for 6 months, and then monthly)
weight gain
metabolic syndrome 
seizures 
pulmonary embolism
myocarditis
excessive salivation 
constipation
ileus
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147
Q

Indications for hospitalization in anorexia nervosa

A 
hemodynamic instability: syncope, orthostasis, BP < 80/60, HR<40, hypothermia
Refeeding syndrome
< 70% of expected weight, or BMI<15
Acute food refusal
suicidal, psychosis
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148
Q

tto of anorexia

A

psychotehrapy and nutritional rehab

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149
Q

clinical manifestations of refeeding syndrome

A

hypophosphatemia, hypokalemia, hypoMg, low thiamine

Arrhythmia
Congestive heart failure( pulmonary edema, peripheral edema)
seizures
Wernicke Korsakoff

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150
Q

woman wit refeeding syndrome who has pulmonary edema as manifestation. tto?

A

replete electrolytes- phosphate.

no need of diuretics- would worsen electrolyte derrangement

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151
Q

3 types of colonic polyps

A

Hyperplastic - mucosal proliferation
Hamartomas - juvenile and Peutz Jeghers
Adenomas( pre-malignant)

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152
Q

cancerous characteristics of polyps

A

sessile, villous

villous> tubulovillous> tubular

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153
Q

patient with small rectal hyperplastic polyps, when should be the next colonoscopy?

A

10 years

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154
Q

patient with 1-2 small (<1cm) tubular adenoma, when should be the next colonoscopy?

A

5 years

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155
Q

patient with the following, when should be the next colonoscopy?

  • 3-10 adenomas
  • any adenoma >1cm
  • adenoma with high grade dysplasia or VILLOUS
A

3 YEARS

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156
Q

large sessile polyp or with adenoCa, next colonosocpy?

A

2-6 months

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157
Q

anual colonoscopy is indicated in which patients

A

familial adenomatous polyposis

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158
Q

First line treatment for insomnia

A

cognitive behavioral therapy

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159
Q

Postcholecystectomy diarrhea and post short bowel syndrome diarrhea -underlying mechanism and tto

A

bile salt induced diarrhea

Cholestyramine is a bile acid sequestrant

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160
Q

history of attemted suicide is the strongest risk factor for suicide.

A

true

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161
Q

pregnant women with gallstones but asymptomatic, next step?

A

reassurance, pregnant women are predisposed to gallstone formation.

  • if asymptomatic no surgery
  • if ss- IV fluids, pain control. If not able to control cholecystectomy in 2ND SEMESTER
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162
Q

What happens in developmental hip dysplasia

A

abnormal acetabular development
shallow hip socket and inadequate support for the femoral head.
-hip clunk, asymmetric leg creases

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163
Q

developmental hip dysplasia in adults that were not diagnosed

A 
leg lenght discrepancy
toe walking on affected side
 trendelenburg gait 
osteoarthritis
activity related pain in the hip and groin
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164
Q

antiseizure medications that decrease efficacy of OCPs

A

phenytoin, CBZ, ethosuximide, phenobarbital,topiramate

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165
Q

Ovarian insufficiency can cause amenorrhea and likely presents with hypoestrogenism signs (vaginal dryness, hot flashes)

A

T

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166
Q

Patient that calls the office with concerns for vaginitis , pruritus, discharge, malodour. next step?

A

Ask her to come to clinic, diagnosis of vaginitis ALWAYS NEED WET MOUNT MICROSCOPY OR NAT.

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167
Q

Clues for metastatic brain tumor

A

multiple, well circumscribed areas ( can be enhancing lesions) with significant vasogenic edema as compared with the lesion.

  • small cell lung cancer has early metastasis to brain.
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168
Q

presence of cremasteric reflex DOES NOT exclude testicular torsion

A

In testicular lesion moderate to severe always get doppler

-significant swelling and or marked pain

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169
Q

Testicular FNA is used to retrieve sperm in pts with male infertility but its not used for testicular evaluation of injury.

A

true

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170
Q

Absent cremasteric reflex

A

is nonspecific finding- can or not occur in testicular torsion, can occur in testicular trauma, or jsut a normal variant.

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171
Q

presence of cremasteric reflex does not exclude testicular torsion or trauma

A

T

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172
Q

Management of scrotal trauma

A

mild- conservatively with angalgesics, ice

moderate to severe- US to assess for testicular injury.

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173
Q

antenatal findings of PUV

A

Bilateral hydronephrosis, thickened and dilated bladder- olignohydramnios, dilation of anterior urethra

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174
Q

PUV can cause POTTER Sequence

A

So babies with PUV that in the first hours of life have transient tachypnea think about that.

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175
Q

PUV prsentation

A

besidesBilateral hydronephrosis, thickened and dilated bladder- olignohydramnios, dilation of anterior urethra

can have: recurrent UTIs, respiratory distress, POTTER sequence, WEAK URINE STREAM

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176
Q

What is the best dx study for posterior urethral valves?

A

voiding cystourethrogram - dx confirmed with dilation of proximal urethra when the catheter is removed.

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177
Q

Next steps after VCUG confirms PUV

A

Foley cath to relieve obstruction

Then cystoscopy to allow direct visualizations and ablation of the valve

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178
Q

tto of panic disorder

A

acute:BZD

long term SSRI AND/OR cognitive behavioral therapy

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179
Q

Postmenopausal women need topical estrogen for vaginal dryness. SSRIs for postmenopausal ss wont help that

A

true

assess particularly in the woman who complains about their sexual life.

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180
Q

nightmares vs night terrors

A

nightmares: REM disorder, second half of the night. Will recall dream and have complete awakenings

night terrors: non REM disorder, first half of the night, crying incosolably

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181
Q

prognosis and tto of night terrors

A

resolve in 1-2 years

tto is reassurance , unless there is high frequency in episodes or impairment of day function- low dose BZD

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182
Q

MOA Tamoxifen and Raloxifen

A

SERS - Selective Estrogen receptor modulators
- competitive inhibitor of estrogen binding
mixed agonist/antagonist options

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183
Q

Indications of Tamoxifen /Raloxifen

A

tamoxifen: adjuvant tto in breast Ca
raloxifen: postmenopausal osteoporosis

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184
Q

SE Tamoxifen /Raloxifen

A

Hot flashes, DVT

Tamoxifen only: endometrial hyperplasia and Ca

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185
Q

How to monitor for side effects of tamoxifen

A

thinking of endometrial hyperplasia, only if ss develop endometrial US or biopsy would be useful. Otherwise NOT!

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186
Q

Woman who wants a bariatric surgery and then get pregnant, recommendation?

A

bariatric surgery and space pregancy for a year.
Stabilize nutritional status prior to pregnancy.

If during year of bariatric surgery can have bad outcomes in fetus (neural tube deffects due to poor folate)

After the year risks of fetus are same than general population

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187
Q

appendicitis can present with fever

A

true

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188
Q

Pregnant women have atypical presentations of appendicitis

A

True- displacement of appendix by uterus

May not present with peritoneal signs or McBurney point

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189
Q

imaging of choice for dx appendicitis in pregnancy

A

US

-when results are unconclusive-MRI

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190
Q

complication of appendicitis/diverticulitis

A

pyeliphlebitis- infective suppurative portal vein thrombosis (portal vein drains all the abdomen)

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191
Q

Pain management of opioid dependent pt who is victim of MVA

A

Obtain consent, discuss risks,

prescribe opioids- given tolerance this may be higher doses than usual for pain

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192
Q

Dx of acute hemolytic transfusion reaction

A

positive direct coombs test
pink plasma
hemoglobinuria
repeated cross match showing mismatch.

  • flank pain, hemoglobinuria, DIC
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193
Q

Complications of breast implants

A 
capsular contracutre (pain)
distortion of shape
implant deflation or rupture
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194
Q

Silicone breast implants DO NOT CAUSE autoimmune, rheumatologic, or neuro complications

A

DO NOT CAUSE THAT

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195
Q

Mammograms in women with breast implant

A

same as non-breast implant

50 to 54 years should get mammograms every year.
55 years and older every 2 years, or have the choice to continue yearly screening.

In addition breast mplant: every 2-3 years MRI to assess for asymptomatic breakdown

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196
Q

Presentation Henoch schonlein

A

palpable purpura
arthralgias
abdominal pain/intussusseption
renal disease

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197
Q

labs Henoch schonlein

A

Normal coagulation/plts.
Normal to increased creatinine
Hematuria, RBCs, Protein

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198
Q

tto Henoch schonlein

A

supportive

In severe cases: steroids

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199
Q

Hypothyroidism can produce hypoNa

A

true

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200
Q

Evaluation of hyponatremia algorithm

A

say it

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201
Q

postpartum thyroiditis presentation

A

brief thyrotoxic, then hypothyroid and then eu.

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202
Q

Meds that interfere with folate metabolism leading to macrocytic anemia

A

MTX, TMP, phenyotin

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203
Q

always that you guve mtx supplement with

A

Folinic acid (Leucovorin)

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204
Q

How does BZD withdrawal present?

A

Elderly that has been on BZDs, discontinued due to fall or other SE

Then presents with confusion, restlessness, hallucinations, psychosis, AUTONOMIC INSTABILITY

TTO BZD- and then taper off.

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205
Q

tto of keloids

A

intralesional glucocorticosteroids

but 30% recur

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206
Q

patient on ACEi who develops edema, next step

A

stop ACE and give ARB

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207
Q

first line tto for UTI in pregnancy

A

Nitrofurantoin for 5-7 days
Cephalexin 3-7 days
Amoxi-clavulanate 3-7
Fosfopmycin single dose

**always repeat urine culture and analysis after a week to assure for cure

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208
Q

tto of acute pyelo during pregnancy

A

complete course of antibitoics, then prophylactic dose durng and 6 weeks after birth to prevent recurrence

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209
Q

first line tto for UTI in non pregnancy

A

TMP-SMX

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210
Q

Why TMP SMX cannot be used in pregnancy

A

1st trim: neural tube defects

3rd : kernicterus

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211
Q

test for scabies

A

skin scrapings for exam under light microscopy –reveal mites, ova, and feces

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212
Q

tto scabies

A

5% permethrin cream

oral ivermectine also alternative

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213
Q

pt GBS positive in first trimester. next step?

A

treat with amoxi now, and then penicillin prophylaxis at labor

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214
Q

Indications of GBS prophylaxis in labor

A

GBS bacteriuria or UTI in current pregnancy(regardless of tto)
GBS positive rectovaginal culture during pregnancy
Unknown GBS status PLUS one of the following:
a. < 37w
b. Intrapartum fever
c. ROM> 18
Prior infant with early onset GBS infection

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215
Q

hypokalemia from loop diuretics can cause ILEUS

A

TRUE

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216
Q

POTTER sequence

A

P: pulmonary hypoplasia. O: oligohydramnios. T: twisted skin (wrinkly skin) T: twisted face (Potter facies: low set ears, retrognathia, hypertelorism)

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217
Q

Diversion of medication

A

transferring medication that was prescribed to you, to another individual

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218
Q

Misuse of medication

A

using higher doses to achieve euphoric effects, mixing with other drugs.

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219
Q

SE of stimulants

A

weight loss, decreased appetite, dry mouth, irritability

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220
Q

Why do patients take St.Johns wort?

A

depression, insomnia

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221
Q

SE/Risks of St. Johns wort

A
  • Interaction with drugs ( decreased efficacy of OCPS)nticoagulants,
  • Can cause serotoninergic syndrome (SO SSRIs + St Johns wort is contraindicated)

-In depression the results are inconsistent-European study show that it may work for mild to moderate depression.

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222
Q

When to administer anti D immunoglobulin

A

RH - moms, Rh + infant
at 28 weeks and < 72 hours postpartum

Generally 300 micrograms

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223
Q

What is the dose of anti D immunoglobulin ? how to calculate

A

standard dose is 300 micrograms
If fetomaternal hemorrhage it has to be adjusted.
1st rosette test to assess presence of fetomaternal hemorrhage
If positive, then Kleihaure Betke to calculate the increase in dose based onpercentage of the RBCs in the maternal circulation

  • so if a mom received immunoglobulin and has low titersfrom previous pregnancy is because the dose was wrong after birth.
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224
Q

When is early prophylaxis with anti D immunoglobulin indicated

A

If there is hemorrhage , vaginal bleeding or trauma < 28 weeks.

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225
Q

psedofolliculitis barbae tto

A

pic, is painful

- stop shaving

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226
Q

Complications of psedofolliculitis barbae

A

hyperpigmentation
secondary bacterial infection
keloid formation

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227
Q

Role of vit E in alzheimer

A

It does NOT prevent it- nothing prevents it

But there has been some benefit in slowing progression in mild to moderate AD

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228
Q

Clinical presentation of Duchennes muscular dystrophy

A 
2-3 years old 
Proximal muscle weakness (Gower sign,calf psudohypertrophy)
hyporeflexia achilles
waddling gait
Dilated cardiomyopathy
Scoliosis
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229
Q

Diagnosis of Duchenne’s

A

High CK level
Genetic test: dystrophin deletion on X gene
Muscle biopsy: fat, fibrosis, muscle degeneration

GENETIC TESTS CONFIRM DX

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230
Q

tto of Duchennes

A

Steroids

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231
Q

Prognosis of duchenne

A

Wheel chair dependence by adolescence

Death at age 20-30 from heart or respiratory failure

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232
Q

Characteristics of fibroadenoma

A

<30
unilateral, rubbery, mobila
outer quadrant
hormonal fluctuation

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233
Q

The most common adverse events in non surgical and surgical patients

A

surgical- related to surgery ( wound infection, bleeding, DVT)

non-surgical: adverse drug reactions

2nd most common cause for both is hospital acquired infections.

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234
Q

Why do patients with PCOS have anovulation and infertility

A

chronically elavated estrogen due to peripheral conversion from androgens to estrone in adipose tissue , which contributes to anovulation and infertility

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235
Q

womam with PCOS and infertility , next step

A

weight loss

letrozole (aromatase inhibitor) for ovulation induction

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236
Q

tto for stress urinary incontinence

A 
lifestyle modifications
pelvic floor exercises 
pessary 
sometimes SSRIs
surgery
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237
Q

tto for urgency urinary incontinence

A

lifestyle modifications
timed voids (every 3-4 hours) and bladder training
antimuscarinic ( OXYBUTININ)

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238
Q

tto for overflow urinary incontinence

A

bethanecol
(cholinergic)
intermittent cath

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239
Q

location of lichen planus lesions

A 
Flexural areas (wrists) - very itchy
oral (Wickham striae)
genital area (glans of penis,vulvar area)
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240
Q

Dx of lichen planus

A

skin biopsy

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241
Q

tto of lichen planus

A

antihistamines, steroids

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242
Q

lichen planus is associated with which condition

A

HCV

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243
Q

triad of mixed cryoglobulinemia syndrome

A

palpable purpura
weakness - peripheral neuropathy also frequent
arthralgia

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244
Q

Mixed cryoglobulinemia is associated with which condition

A

Hep C (MCC)

BUT can also be seen in Hep B, HIV, rheumatologic diseases

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245
Q

labs in mixed cryoglobulinemia

A

elevated RF
hypocomplementemia
glomerulonephritis
and high serum cryoglobulins

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246
Q

In which disease do you see antiglomerular basal membrane antibodies

A

Good pasteur

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247
Q

tto of mixed cryoglobulinemia

A

two parts:

  1. initial immunosuppresive therapy- targers glomerulonephritis- rituximab and steroids
  2. treat underlying cause- antivirals for Hep c
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248
Q

risk factors for abruptio placenta

A

abdominal trauma, hypertension, cocaine, tobacco use

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249
Q

Pt with abnormal Newborn screen with hypothyroidism

A

start immediately hormone replacement to prevent developmental delay if not started within 2 weeks

order us of thyroid and refer to endocrine

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250
Q

presentation of congenital hypothyroidism

A

at birth normal
age <1 month: jaundice, poor feeding, hypothermia
age 1-4 m: FTT, constipation

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251
Q

If a patient is diagnosed with Turner, next step

A

Echocardiogram- coarctation of aorta, bicuspid valve, hypoplastic heart, MVP

Visual/hearing
TSH
renal US

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252
Q

presentation of uterine rupture while in labor

A

loss of fetal station
fetal parts in abdomen
loss of intrauterine pressure( seen in the contractions)
decelerations

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253
Q

RF for uterine rupture

A

previous C section, myomectomy,advanced maternal age, fetal macrosomia, interpregnancy interval < 18 months.

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254
Q

tto uterine rupture

A

emergent laparotomy

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255
Q

treatment of mild to moderate plaque psoriasis

A

HIGH potency topical steroids( fluocinonide, augmented bethametasone)

ORAL STEROIDS are not recommended because risk of developing pustular psoriasis
Low potency steroids ( hydrocortisone) only for face or intertriginous areas

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256
Q

treatment of severe plaque psoriasis

A

methotrexate or phototherapy

ORAL STEROIDS are not recommended because risk of developing pustular psoriasis

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257
Q

guttate psoriasis tto

A

observation ( no tto)

phototherapy

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258
Q

Patient who had resection of medullary cancer , and after 6 months still has elevated calcitonin. Next step?

A

CT neck and chest to evaluate metastasis

  • parafollicular cells do not store iodine so iodine scan not useful.
  • US bad to pick up metastasis
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259
Q

turtle sign

A

retraction of the fetal head into the peritoneum once outside due to shoulder dystocia

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260
Q

tto of shulder dystocia

A 
BECALM
Breath and push
Elevate and flex legs to abdomen ( McRoberts)
Call for help
Apply pressure in suprapubic area
EnLarge - episitomy
Manuevers
- deliver the posterior arm
-rotate the posterior shoulder ( Woods screw)
-Adduct posterior fetal shoulder(Rubin)
Mother in 4 (Gaskin)
Replace fetal head into pelvis for cesarean delivery (Zavanelli)
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261
Q

RF for shoulder dystocia

A 
prior shoulder dystocia
macrosomy
DM
Maternal obesity
post term pregnancy 
Operative vaginal delivery
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262
Q

Physicians attending conferences cannot accept subsides from pharmaceuticals on travel, lodging, or other personal expenses.

While physicians presenting can, but not medical slides and full disclosure is needed .

A

true

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263
Q

prognosis of alopecia areata

A 
hair can grow eventually, but there is high risk of recurrence despite successful treatment 
Particularly in patients: 
- longer duration of disease
-onset in prepuberty
-more extensive disease
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264
Q

cause of alopecia areata

A

exact mechanism is unknown

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265
Q

is alopecia areata associated with lymphoma?

A

NOOO!

Is associated with some autoimmune diseases- vitiligo, pernicious anemia, thyroid disease

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266
Q

tto of alopecia areata

A

topical or intralesional corticosteroids

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267
Q

Complications of systemic sclerosis

A

lungs: interstitial lung disease, pulmonary arterial HTN
renal: HTN, Microangiopathic hemolytic anemia
Heart: heart fibrosis, pericarditis, pericardial effusion

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268
Q

pelvic pain exacerbation with bowel movement, rectovaginal nodularity, ovarian mass

A

endometriosis

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269
Q

why there is infertility in endometriosis

A

pelvic adhesions and inflammations

tto: surgical resection or in vitro fertilization

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270
Q

first line management for uterine atony

A

massage and oxytocin

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271
Q

Victim of MVA who says that he doesnt want for him and his daughter blood transfusion given Religion, next step

A
  • For the dad: try to do everything possible without blood transfusion
  • For kid: transfuse if needed, independent of parent wishes
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272
Q

pruritus in pregnant , differential

A

pregnancy induced skin changes- due to hormonal changes, its focal. +/- transaminitis, normal bile.

intrahepatic cholestasis of pregnancy- generalized pruritus, involves hands and foot. elevated bile and transaminases. Can lead to fetal demise, so delivery by 37. tto ursodeoxycholic acid, antihistamines

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273
Q

dx of pemphigus gestationis

A

skin biopsy

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274
Q

tto of pemphigus gestationis

A

topical high potency steroids- triamcinolone
anti histamines

if unresponsive systemic steroids and less common immunosuppresants cyclosporin, azathioprine

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275
Q

Patient with lupus + glomerulonoephritis, next step?

A

US guided renal biopsy to classify it

there are 6 categories

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276
Q

TTO OF LUPUS NEPHRITIS

A

Type I and II: nothing
Type III and IV: immunosupression with steroids (MP), and mycophenolate or cyclophosphamide
Type V: immunosuppression only if proliferative lesions
Type VI: no benefit of immunossupresion

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277
Q

How can you monitor active renal involvement and progression in lupus

A

Anti dSDNA and complement levels(low)

lupus nephritis is a immune complex glomerular injury. Immune complexes mainly of Anti dsDNA and they deposit in different parts of the kidney

immune complex deposition lead to complement fixation- so circulating complement is low

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278
Q

lack of menses in < 15 years is normal if there are secondary characteristics ( breast developed)

A

true

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279
Q

when doese thelarche and menarch occur

A

telarche 8-12

menses 2-2.5 years after

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280
Q

Causes of delayed puberty

A

Primary hypogonadism: Klinefelter
Secondary:
Constitutional, chronic illness, malnutrition
Hypothyroidism, Kallman Sx, Craniopharyngioma

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281
Q

Initial workup of delayed puberty

A

FSH, LH, Prolactin , testosterone, TSH

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282
Q

treatment of primary dysmenorrhea (pain with menses)

A

NSAIDs e.g,Naproxen -in non sexually active

then OCPs

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283
Q

treatment of immune thrombocytopenia

A

if asymptomatic nothing
if bleeding ( even if its just mucosa), or platelet count
30,000 give IVIG

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284
Q

Best contraceptive method for PCOS

A

PROGESTIN only

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285
Q

patient with worsened acne, mood changes, and increased hirsutism, erythropoyesis ( elevated Hb and Hcto) that also goes to the gym

A

anabolic use

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286
Q

SE of anabolic steroids

A 
Mood changes, increased agressiveness
worsening acne
hirsutism
men: decreased testicular size, sperm count, gynecomastia
women eating disorder, bilateral temporal hair loss, 
ERYTHROPOYESIS
hepatic dysfunction 
ovarian dysfunction 
decreased HDL
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287
Q

Dx of cyclothymic disorder

A

2 years of hypomania and depressive ss

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288
Q

Streptococcus treatment

A

10 days of penicillin
if not able to tolerate oral: a single dose of IM Penicillin
If allergic to penixillin - 5 days of azithro

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289
Q

Strongest risk factor for PID

A

Multiple sexual partners

MORE THAN

  • Prior PID
  • Inconsistent condom use
  • Partner with sexually transmitted infection
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290
Q

tto of PID

A

Inpatient and outpatient: Ceftriaxone plus Doxycycline

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291
Q

treatment of hepatic encephalopathy

A

lactulose, if it doesnt work in 48 hrs can change to Rituximab.

its often triggered by hypokalemia and metabolic acidosis so if the patient already has lactulose treat electrolyte imbalance

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292
Q

new onset psychosis in a patient, next step

A

first assess if this is substance related

and medical causes

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293
Q

rupture ectopic pregnancy, next step

A

emergency laparoscopy

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294
Q

ectopic pregnancy and hemodynamically stable, next step

A

iF B-HCG< 1500: repeat BHCG in 2 days

If bHCG > 1500: Repeat BHCH and transvaginal US in 2 days

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295
Q

patient that presents with renal colic and has history of opioid/NSAIDS use. Dx

A

analgesic nepropahty - papillary necrosis

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296
Q

Penicillin is indicated as prophylaxis in women < 37 weeks if unknown status

Corticosteroids < 37 weeks ( or < 34 in DM)
Magnesium < 32

A

true

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297
Q

tto of acute bacterial prostatitis

A

TMP/SMX or Cipro

And empty bladder - often have urinary retention

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298
Q

anterior uveitis ( iritis) presentation

A 
red eye
pain
variable visual loss
photophobia
CONSTRICTED AND IRREGULAR IRIS
LEUKOCYTES IN ANTERIOR SEGMENT OF EYE SEEN IN SLIT LAMP
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299
Q

ACUTE CLOSED ANGLE GLAUCOMA PRESENTATION

A 
red eye
pain
variable visual loss
photophobia
PLUS INCREASED INTRAOCULAR PRESSURE
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300
Q

Suspect testicular cancer, next step?

presenting with enlarged testicle, hard, no translumination

A

bilateral US of testicle

If solid lesion- order AFP, BhCG
and CT chest , chest Xray to stage

**dont biopsy due to risk of lymphatic spread and recurrence

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301
Q

tto testicular cancer

A

radical orchiectomy plus chemotherapy is often curative

5 year survival 95%

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302
Q

varicocele does NOT transluminate

A

true

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303
Q

management of subchorionic hematoma

A

expectant +/- serial US

it will be described as crescent hypoechoic lesion adjacent to gestational sac

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304
Q

Indications of Kleihauer Betke test

A

IN MOM RH NEGATIVE AND
hemorrhage at delivery,
maternal trauma
first trimester bleeding

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305
Q

complications of subchorionic hematoma

A 
spontaneous abortion
abruptio placenta
preterm delivery
 PPROM
fetal growth restriction
Intrauterine fetal demise
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306
Q

patient with cryptoorchidism , next step

A

referral to surgery is indicated by 6 months( corrected for gestation) - no role of imaging.

Early orchiopexy by 1 year optimizes fertility, testicular growth and decreases risk of testicular torsion

risk of testicular cancer is decreased but not eliminated

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307
Q

patient with cryptoorchidism , next step

A

referral to surgery is indicated by 6 months( corrected for gestation)

Early orchiopexy by 1 year optimizes fertility, testicular growth and decreases risk of testicular torsion

risk of testicular cancer is decreased but not eliminated

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308
Q

patient with painless hematochezia( 2 episodes) and history of diverticulosis and internal hemorrhoids. cause of hematochezia

A

arterial erosion due to mucosal outcropping

diverticulosis: outpouching in the weakest point, where vasa recta penetrate- so these are exposed. LARGE AMOUNT OF BLOOD

hemorrhoids- SMALL amount of blood that covers the stool, and mucous, perianal itching, and mild fecal leakage.

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309
Q

tto of colonic diverticulosis bleeding

A

if slef-limiting: fluids, and transfusion of products as needed

if persistent: colonoscopy for cauterization or angiographic embolization

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310
Q

RF and presentation of photoaging

A

UV lights, cirgarrete, genetics

deep wrinkles
leathery skin
variable pigmentation of skin
telangiectasias
brown spots
ACTINIC KERATOSIS
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311
Q

RF and presentation of photoaging

A

UV lights, cirgarrete, genetics

deep wrinkles
leathery skin
variable pigmentation of skin
telangiectasias
brown spots
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312
Q

What is erythrasma and what is the cause

A

infection of skin that occurs in intertriginous areas
Red patches

Corynebacterium minutissimum
Wood lamps: coral red/pink fluorescence

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313
Q

tto of photoaging

A

Tretinoin
- all trans retinoic acid

decreases wrinkles, mottled hyperpigmentation and roughness of facial skin
reduces actinic keratosis

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314
Q

who qualifies for home health care services

A

it has to meet criteria for “homebound”

  • use of supportive device ( crutch, can, wheelchair, walker)
  • ability to leave home only with assistance
  • medical contraindication to leave home

non-skilled care such as bathing, grooming- if person is not able to do ADLs

skilled-medication adherence, OT, PT , wound care

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315
Q

who qualifies for home health care services

A

it has to meet criteria for “homebound”

  • use of supportive device ( crutch, can, wheelchair, walker)
  • ability to leave home only with assistance
  • medical contraindication to leave home
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316
Q

Patient on warfarin with intracranial hemorrhage who needs reversal of warfarin. What are the options?

A

Warfarin reversal

  1. Prothrombin complex concentrates: contains vit K dependent factors and reverses warfarin < 10 minutes
  2. Vit K: takes 12-24 hrs, but maintains reversal. It does not come with clotting factors so these are replaced concomitantly
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317
Q

Patient on warfarin with intracranial hemorrhage who needs reversal of warfarin. What are the options?

A

Warfarin reversal

  1. Prothrombin complex concentrates: contains vit K dependent factors and reverses warfarin < 10 minutes
  2. Vit K : takes 12-24 hrs, but maintains reversal. It does not come with clotting factors so these are replaced concomittantly
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318
Q

reversal of dabigatran

A

idarucizumab, a monoclonal antibody

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319
Q

indicaitions and SE of ephedra

A

weight loss

SE:cardiovascular risk HTN, MI , Stroke

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320
Q

Normal Weber and Rinne tests findings

A

Rinne: AC>BC in both ears

Weber : midline

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321
Q

Weber and Rinne tests findings in conductive hearing loss

A

Rinne: BC>AC in affected ear, AC>BC in UNaffected ear
Weber: lateralizes to AFFECTED ear

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322
Q

Weber and Rinne tests findings in sensorineural hearing loss

A

Rinne: AC>BC in both ears
Weber: lateralizes to UNAFFECTED ear

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323
Q

Weber and Rinne tests findings in mixed hearing loss

A

Rinne: BC>AC in affected ear, AC>BC in UNaffected ear
Weber: lateralizes to UNAFFECTED ear

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324
Q

patient with sudden sensorineural hearing loss, no PE findings. Next step

A

Urgent referral to ENT
MRI and formal audiogram
likely plus steroids!-ideally within 24 hrs

causes: may include viral infection, microvascular events, autoimmune process, tumor

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325
Q

When do you use aural irrigation( ear)

A

to remove cerumen

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326
Q

Labs in SIADH

A

Hyponatremia
Serum osmolality <275 (hypotonic)
Urine osmolality >100
Urine Na > 40

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327
Q

tto fo SIADH

A

fluid restrictuon+/- salt tablets

hypertonic saline for severe hyponatremia

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328
Q

Stimuli for SIADH

A

Osmotic: if serum osmolarity> 185
Non osmotic:
Nausea, pain, physical emotional stress, hypotension, hypovolemia, hypoglycemia

seen in POP

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329
Q

siadh can be caused after surgery

A

due to nausea, pain, hypovolemia

those are stimuli for ADH secretion

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330
Q

pregnancy, painless vaginal bleeding after 20 weeks

A

placenta previa

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331
Q

RF for placenta previa

A

prior placenta previa
multiple gestations
prior cesarea
tobacco

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332
Q

RF for placenta previa

A

prior placenta previa
multiple gestations
prior cesarea

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333
Q

placenta previa is an absolute contraindication for vaginal delivery, needs cesarea

A

true

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334
Q

bleeding can cause fibronectin test a false positive

A

true,

and is indicated only in < 34 weeks to assess for preterm delivery

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335
Q

presentation of amniotic fluid embolism

A

hypoxia, hypotension, DIC ,coma or seizures

during labor or immediately postpartum
RF: Cesarea, placenta previa, abruptio placenta

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336
Q

tto of amniotic fluid embolism

A

supportive

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337
Q

patient with bone metastasis due to prostate cancer, on high dose narcotic but persistent pain. Next state

A

external beam radiation therapy

338
Q

patient with obstructive urolithiasis causing infection and hemodynamic instabilitity, next step

A

percutaneous nephrostomy or retrograde urethral stent

339
Q

tto of alcohol withdrawal

A

benzodiazepines

340
Q

presentation of urethral diverticulum

A

dysuria, dispareunia, postvoid dribbling, anterior vaginal wall mass.

  • can cause multiple UTI
  • touching diverticulum leads to bloody, purulent discharge in urethra
  • can have hematuria
341
Q

causes of urethral diverticulum

A 
multiple UTIs
pelvic trauma ( vaginal delivery) or surgery
342
Q

Evaluation of urethral diverticulum

A

urinalysis and culture

TOCONFIRM: MRI of pelvis or TVUS

343
Q

tto of urethral diverticulum

A

manual decompression, needle aspiration, or surgery

344
Q

positive Q tip test

A

used to diagnose urethral hypermobility
in stress urinary incontinenece
> 30 degrees angle of movement

345
Q

suppurative otitis media -what is it

A

acute otitis media + tympanic membrane perforation

fluid in middle ear infected by nasopharynx bacteria
infection causes increased pressure

RUPTURE OF TYMPANIC MEMBRANE IS MORE COMMON WITH INFECTIONS BY S.PYOGENES

346
Q

definition of serous otitis media

A

when there is effusion (fluid) in the middle ear canal without inflammation or infection– typically follows episodes of suppurative otitis media

347
Q

drugs that cause photosensitivity

A

SHAT for photo

Sulfonamides
Hydroclorothiazide
Amiodarone
Tetracyclins

348
Q

natural history and tto of infantile hemangioma

A

0-1year grow
age 1-9 regress

tto: observations
topical propanolol for ulcerative or cosmetic areas( face) , or airway, or vision areas

349
Q

Most important factors in matching recipient and donor of kidney transplant

A

HLA and ABO compatibility

** living donors have better outcomes than deceased

350
Q

labs in hemolysis

A

normocytic anemia with increased reticulocyte count
indirect hyperbilirrubinemia
low haptoglobulin
high LDH

351
Q

in which condition do you see bite cells and chystocytes

A

G6PD

Also heinz bodies - denatured Hb

352
Q

Dx of G6PD

A

LOW G6PD- but given that it can be a false positive repeat test 1-2 weeks after infection, or removal of drug

353
Q

triggers for G6PD

A

fava beans, sulfa drugs(TMP-SMX)

354
Q

gentics of G6PD

A

X linked disorder

355
Q

hematochezia +hemodynamic instability, think of …..

A

upper GI bleeding
Do first IV fluids and then an esophagodiodenoscopy

if EGD fails to identify source, then colonoscopy should be performed

356
Q

NF2 vs. NF1 presentation

A

NF1: hyperpigmented areas, can have unilateral acoustic neuromas, cutanepus neurofibromas, axillary freckling, lisch nodules, optic glioma, pheochromocytomas

NF2: hypopigmented, BILATERAL acoustic neuromas (aka schwannomas) , issues with balance, juvenile cataracts, meningioma, ependymoma

357
Q

Spetic aboption tto

A

dilation and curettage + antibiotics

occurs when retained products of conception become infected by ascending vaginal flora in the setting of prolonged bleeding or recent instrumentation

358
Q

Constitutional growth delay

A 
short stature
normal growth velocity
delayed bone age 
delayed secondary characteristics
family hx of late bloomers
359
Q

Patient with constitutional growth delay concerned with his image, next step

A

although it is normal, is important to explore psychologic issues in these patients in a solo-interview

360
Q

Definition of polycythemia vera

A

Hct >=65% or Hb> 22

361
Q

polycythemia vera in newborn, next step?

A

if it was taken in the heel prick, then collect a peripheral venous blood

362
Q

complications of polycythemia vera

A

hyperbilirrubinemia, hypoglycemia, hyperviscosity, hypoperfusion, tissue hypoxia

363
Q

Pt with polycythemia vera that develops letharfy, poor oral intake, hypotonia, APNEA, and no focal neuro exam

A

think of hyperviscosity

fluids and tto for hyperglycemia
PARTIAL EXCAHNGE TRANSFUSION ( removing blood from baby and infusing NS)

364
Q

Routine initial prenatal labs

A 
Hb/Hct, MCV
Rh, antibody screen
HIV, RPR/VDRL, HbAgs
Varicella and rubella immunity
Pap smear
Chlamydia 
Urinalysis and culture
365
Q

prenatal labs 24-28

A

hb/hcto
antibody screen in Rh-
50 g 1 hrGOT

366
Q

prenatal labs 35-37

A

GBS

367
Q

Prsentation of gestational thrombocytopenia

A 
70-150000
Asymptomatic
 No prior history of thrombocytopenia
2nd and 3rd trimester
No associated fetal thrombocytopenia
Resolution after delivery
368
Q

Contraindications for epidural

A

thrombocytopenia < 70,000 or rapidly progressing droplet count

** CI due to the risk of spinal epidural hematoma

369
Q

Does a minor < 18 is able to do kidney donation

A

No!

Contraindications: < 18
lack of mental ability to make a decision
uNCONTROLLED HTN, HIV infection, DM
Active or partially treated Cancer 
acute infection
substance abuse
 suspected coercion
370
Q

treatment of dactylitis in sickle cell

A

often isthe first sign in kids 6m-4 y

Oral NSAIDs and oral opiates( oxy)
if fails- IV opiates

***Cold compresses can trigger vasocclusive crisis

371
Q

Untreated depression is associated with increased morbidity and mortality from cardiovascular disease

A

SSRIs are safe in cardiovascular disease

372
Q

tto for nightmares in PTSD

A

Prazosin

373
Q

tto PTSD

A

trauma focused cognitive therapy
Antidepressants (SSRIs, SNRIs0
Prazosin for nightmares

374
Q

Pre-septal vs. orbital Septal

A

orbital: painful eyemov, ophtalmoplegia , proptosis

375
Q

MC predisposing factor to orbital cellulitis

A

sinusitis - S. PNEUMONIA, S.aureus

376
Q

MC Pre-septal vs. orbital Septal

A

preseptal: S.aureus, S. pyogenes
Orbital: S.aureus, S.pneumonia

377
Q

tto orbital cellulitis

A

inhosp abc management ( if abscess: drain)

Ceftriaxone or Amp-Sulba ( May add Vanco if suspicion of MRSA)

cover for all potential causes of sinusitis:
S.pneumonia, nontypable-H.influenza, S.aureus

378
Q

tto acute paronychia

A

warm soaks in aluminum acetate,1% acetate
mupirocin

If abscess drain

379
Q

tto PMS

A

SSRIs

380
Q

PMS is assocaited to which condition

A

Depression/mood disorders

381
Q

first line contraceptive in adolescents

A

IUDs or Contraceptive implants (99%)

IUDs:

  • Copper - 10 years
  • Progrstine- 5 years- for patients with dysmenorrhea or heavy bleeding

Contraceptive implant - subdermal implant every 5 years

382
Q

Order of efficacy of contraceptives ( highest to lowest)

A

IUD/Implant (99%)>Injection(95%)>Pills, patch, ring (91%) > condom (80%)> withdrawal 75%

** injection is every 3 months

383
Q

Patient 57 years with HTN not controlled by 2 meds, what should you consider

A

refractory HTN,

Secondary cause: Renovascular HTN

Do MR angiography of renal arteries

384
Q

Presentation of renovascular HTN

A 
Refractory HTN to 2 meds 
has associated atherovascular disease ( carotid bruit, decreased pulses)
Abdominal bruit
iNCREASED CREATININE
NILATERAL KIDNEY ATROPHY
385
Q

How do you confirm dx of Renovascular HTN

A

MR angiography of renal arteries

386
Q

difference between adjustment disorder and acute distress disorder

A

adjustment disorder does NOT have intrusive recollections ( nightmares, flashbacks, distressing memories)

387
Q

Why do people often request euthanasia

A

loss of autonomy and control
loss of dignity
loss of ability to engage in pleasurable activities

388
Q

Diaper rash: contact dermatitis vs fungal

A

contact dermatitis: spares creases and skin folds
petrolatum or zinc oxide

Candida: involves creases, and has satelite lesions
nystatin, clortrimazole

389
Q

presentation of tinea capitis

A

hair loss
eczema, pruritus, scaly
can have cervical LAD

390
Q

Dx and tto of tinea capitis

A

KOH examination
ORAL GRISEOFULVIN OR TERBINAFINE!
NOT TOPICAL!!

391
Q

TTO of bacterial conjunctivitis

A

no lenses:

  • Topical erythromycin
  • Topical Polymixin- trimetropin drops
  • Azithromycin drops

Lenses: ciprodex

bacterial conjunctivits is usually self-limited but Abcs are prescribed to shorten ss duration and decrease contagious.

392
Q

Cause of bacterial conjunctivitis

A

S.pneumonia, S.aureus, H.influenza, Moraxella catarrhalis

393
Q

complication of bacterial conjunctivitis in person with lenses

A

keratitis-inflammation of the cornea

394
Q

What is endophtalmitis and how does it occur

A

infection of vitreus

result from trauma/surgeryor hematogenous spread

395
Q

if suspecte keratitis, next step

A

urgent referral to ophtalmo

396
Q

SE of tamoxifen

A

endometrial hyperplasia

uterine sarcoma

397
Q 
abnormal/postmenopausal bleeding
pelvic pressure/pain
increased urine frequency 
uterine mass
ascites( fluid in posterior cul-de-sac)
A

uterine sarcoma

398
Q

tto of uterinesarcoma

A

hysterectomy

399
Q

dx of uterine sarcoma

A

US but needs biopsy, as is impossible to differentiate from leiomyoma

400
Q

RF for uterine sarcoma

A

tamoxifefn

pelvic radiation

401
Q

nicotine addiction tto

A

nicotine patches/gums
behavioral therapy

**bupropion is good for patients who want to decrease weight gain, but CI in seizure disorder and eating disorder

Varenicline is superior to nicotine replacement and bupropion but has cardiovascular effects

402
Q

varenicline

A

partial nicotine receptor agonist

403
Q

Role of anti TNF alpha( Infliximab) in RA

A

Helps with anemia of chronic disease

404
Q

structures in Kiesselbachs plexus

A

anterior nose

sphenopalatine artery, greater artery, anterior ethmoid, and superior labial arteries

405
Q

Patient with nose bleeding that doesnt stop with pressure

A

oxymetazoline applied with a cotton pledget or squirt bottle

recommend nasal saline, humidifier-

406
Q

Indications for HPV vaccine

A

Girls and women 11-26( but may be given up to 45y)
Men 11-21 ( up to 26 for men who have sex with men)
11-26: immunocompromised
NOT INDICATED IN pregnant women

recommended time for first dose is 11-12, but can be given as early as 9

407
Q

At what ages do you give 2 vs 3 doses of HPV vaccine

A

< 15 only 2 doses- studies suggest that early they produce a higher immune response

> =15 3 doses

408
Q

Dx of chronic prostatitis

A

urinalysis and culture before and after prostate massage

> 20 leukocytes
10 fold increase from pre to post

409
Q

presentation of chronic prostatitis

A 
> 3 months
dysuria
pain in genitoruinary region
pain with ejaculation
prostate exam is generally normal but can have hypertrophy, edema.
410
Q

if suspecting chronic prostatitis and urinalysis show 20 leukos but culture negative. DX?

A

chronic prostatitis /chronic pelvic pain syndrome

if culture is negative

411
Q

pain when bladder is full and improves with voiding

A

interstitial cystitis

412
Q

chronic prostatitis /chronic pelvic pain syndrome

A

meds for hypertrophy prostate ( alpha blockers) terazosin, tamsulosin

antibiotics
psychotherapy

413
Q

neutropenic patient, had Central venous access for TPN, and day 4 develops eye pain, light sensitivity, eye exam shows several large, off white lesions with irregular borders, hazy vitreous. Dx?

A

Candida endophtalmtitis

414
Q

Infection by MAC- presentation

A

pulmonary or disseminated disease

fever, night sweats,weight loss

415
Q

tto of candida endophtalmitis

A

vitrectomy and amphotericin B (4-6 weeks)

*Ketoconazole doesnt reach vitreous

416
Q

Management of cystic lesions in pancreas

A

Endoscopic US with aspiration

417
Q

patient with fluoxetine for depression, states that mood has improved but is experiencing insomnia and jitteriness, next step?

A

Another SSRI- escitalopram

Fluoxetin has activating ss

418
Q

Management of preterm labor <32 weeks

A

magnesium
bethamethasone
tocolytic
Penicillin if GBS + or unknown

419
Q

Management of preterm labor <34 weeks

A

bethamethasone
tocolytic (nifedipine)
Penicillin if GBS +or unknown

420
Q

Management of preterm labor > 34 weeks

A

bethamethasone

Penicillin if GBS +or unknown

421
Q

Emergency contraceptions

A

Copper IUD- 0-5 Days (CI: infection, severe uterine cavity disortion, wilson disease, complicated organ failure). > 99%

ULIPRISTAL (antiprogestin)0-5 days ( no CI) 98-99%
Levonogestrel 0-72 -59-95%
Oral contraceptives 0-72h - (47-89%)

422
Q

tto rosacea

A

Topical brimodinida

If papulopustular TOPICAL metronidazole , azoleic acid

oral mtz is sometimes used for worse cases

423
Q

Complications of rosacea

A

ocular– chalazion

424
Q

MMR Administration ages and CI

A

1 AND 4
anaphylaxis to prior MMR vaccine, neomyicin, or gelatin
Immunodef or pregnancy

SE: Rash, fever, LAD

425
Q

ocd TTO

A

Exposure and response prevention therapy

SSRIs

426
Q

Menieres triad

A

episodeic vertigo
unilateral hearing loss
vertigo

427
Q

Patient in postpartum with dyspnea, pulmonary edeam hypertension, and end organ damage ( hyperreflexia, increased creatinine)

A

pre-eclampsia

can go in the postpartum period up to 12 weeks

428
Q

tto of postpartum pre-eclampsia

A

magnesium for seizure prophylaxis and BP control

if pulmonary edema: LMNO

429
Q

Elderly 60 yo who quit smoking will have decrease in all cause mortality and cardiovascular events in 5 years

A

true

reduced risk of osteoporosis in 10 years

430
Q

Treatment of hyperK with ECG changes

A

calcium gluconate or calcium chloride

431
Q

EKG changes in HyperK

A
  • Peaked T waves
  • prolongation of PR and QRS
  • disappearance of P waves
  • presence of sine wave
432
Q

tetanus prophylaxis and wounds

A

say it

433
Q

calcium concentration decreases by 0.8 with every 1 decrease in albumin

A

true

434
Q

corrected formula for calcium and albumin

A

Total calcium + 0.8(4- albumin)

435
Q

Most frequent cause/trigger of asthma

A

house dust mites

436
Q

management of ectopic pregnancy

A

if unstable: surgery
stable : TVUS
if diagnostic methrotexate
if non diagnostic ( LIKELY NOT VISIBLE)
BhCG< 1500: repeat in 2 days
BhCG > 1500: repeat in 2 days and also do TVUS

437
Q

DEFICIENCY IN PORPHIRIA CUTANEA TARFA

A

uroporphyrinogen decarboxylase

438
Q

porphyria cutanea tarda presentation

A

painLESS blisters
skin fragility
facial hypertrichosis and hyperpigmentation

Dx: elevation urine uroporphyrins

439
Q

porphyria cutanea tarda tto

A

Avoid exposures (alcohol, estrogen, primidone, other hepatotoxins)
Sunscreen use
Iron removal by phlebotomy – first line
reduces hepatic iron stores – produces remission
if phlebotomy not available, deferoxamine
Hydroxychloroquine
increases excretion of uroporphyrin

440
Q

medical futility but family insists in making a procedure

A

hospital ethics committee

441
Q

Medicare, who does it cover

A

65 and older
permanent disability
ESRD
Neurodegenerativ diseases

442
Q

Part A, B, C,D medicare

A

Part A- Inhospital ( hospital, nursing facility, hospice)
Part B -Outpatient services ( including hospital observation status)
Part C -Medicare advantage - allows private health insurance to provide medicare advantages
Part D- Prescription drugs.

443
Q

Patient with unilateral LAD, that says that has it since mono infection 8-12 weeks ago. you palpate unilateral cervical LAD

A

Refer for surgical biopsy, is abnormal that he has unilateral and persistence.
Assess for lymphoma

444
Q

2 antibodies in pernicious anemia

A

anti parietal and anti IF, always start testing with IF

  • if pernicious anemia low B12 and low cobalamin
445
Q

recommended test for pernicious anemia

A

anti IF antibodies

446
Q

what would you see with endoscopy in pernicious anemia

A

loss of rugae in the fundus– AUTOIMMUNE METAPLASTIC ATROPHIC GASTRITIS

Glandular atrophy, intestinal metaplasia and inflammation

mainly affects fundus and body

447
Q

Once one spontaneous abortion (< 20 weeks) there is risk of another one

A

yes,

other RF include substance abuse and maternal age

448
Q

Suspect thalassemia, next step

A

electrophoresis

electrophoresis is normal in Alpha
is abnormal in B tahlassemia, due to increased A2

449
Q

Partners of pregnant women with thalassemia should also be tested to determine risk for baby

A

true

450
Q

nadir of physiologic anemia in pregnancy

A

late 2 to early 3rd trimester

451
Q

suspect perforated ulcer, next step

A

abdomen x ray if stable

452
Q

management of peptic ulcer

A

is surgery but in preparation give always ANTIBIOTICS FIRST AND IV PPI

453
Q

Ogilvie’s syndrome

A

acute colonic pseudo-obstruction

dilation of the cecum and the right colon in abscence of mechanical obstruction

454
Q

How CKD causes hyperparathyroidism

A

CKD-leads to decrease vit D ( no conversion from 25 to 1,25) which leads to decrease Ca absorption in the intestine

CKD- causes phosphorus retention- leads to low Ca DUE TO Binding Phos-Ca

low Ca leads to high PTH.

455
Q

Indications for parathyroidectomy in tertiary hyperPTH ( ckd scenario)

A
  1. Persistently elevated ca(>10.5), phosphorus and PTH
  2. Soft tissue calcification, or vascular calcification with necrosis
  3. intractable bone pain or pruritus
456
Q

SE of glucocorticoids at high doses

A

poor sleep
restlessness
loss of memory
– sobretodo a higher doses

457
Q

tto of hypocalcemia due to binding to citrate in transfusion

A

same as any hypocalcemia

IV calcium gluconate or calcium chloride

458
Q

initial tto of chronically malnourished children, hemodynamicall stabl

A

oral rehydration is preferred, and if not try NG

IV hydration should be tried to be avoided due to the risk of volume overload and heart failure

If unstable: give a 20 cc/kg over 30-60min

459
Q

SSRIs treats both depression and associated insomnia

A

true

460
Q

Management of ADPKD

A

ACE inhibitors preferred for HTN
Control RF for CV and CKD
If ESDR, Dialysis

**only the patients who have a history in the family of intracranial bleeding or personal should undergo MRI

461
Q

Mom recently diagnosed with ADPKD, is concerned about her son, next step?

A

Patients >= 18 with a family hx of ADPKD should be screened with renal US with prior counseling.

462
Q

if rhabdomyolysis is suspected CK is better than myoglobulin

A

true

463
Q

If patient hemodynamically stable with rhabdo comes and there is association with exercise, next step

A

repeat urinalysis in 1 week

464
Q

If a peaitnet refuses a treatment and he is at high risk , assess their mental capacity, even if they look ok

A

true

465
Q

neck mass that moves with swallowing

A

thyroglossal duct cyst

  • -sometimes it can become aparent after a respiratory illness
  • protrussion of the tongue can also move it
466
Q

if patient has thyroglossal duct cyst , next step prior to definitive tto?

A

US thyroid to identify ectopic thyroid tissue

- because if resection may contribute to hypothyroidism

467
Q

definitie tto of thyroglossal duct cyst

A

surgical ressection of cyst, associated tract, and central portion of the hyoid.

468
Q

All antidepressants can induce hypomania, and then should be discontinued before de-escalation to mania

A

patient with depression, treated with fluoxetine and at the follow-up appt shows signs of mania. DISCONTINUE FLUOXETINE

If the ss persist after discontinueation then think about adding lithium but not initially.

469
Q

Patient with mania already in lithium having sexual behaviors, aggressiveness, psychotic ss next step

A

add an antipsychotic

470
Q

patient with sciatica tto

A

NSAIDs trial, no need to do imaging first

    • MRI only if neuro deficits and thinking of cauda equina, epidural abscess
    • Xray only if suspecting vertebral metastasis or compression fracture
471
Q

Renal stenosis should be considered in pts with resistant hypertension, flash pulmonary edema, and progressive loss of renal function

A

true

472
Q

suspect nephrolithiais in pregnant women, next step

A

renal and pelvic US

Most nephrolithiasis in pregnancy occur in second and third trimester

  • is often supportive and monitor for pain
  • if obstructive -then surgery is required
473
Q

Benefits of breastfeeding in infants

A
  • decreased infection (GI, Respiratory NEC, OMA)

- decreased risk of Ca

474
Q

Rh incompatibility disorder is only possible in an Rh negative mom and Rh positive dad

A

true!

Even if the baby is negatove and mom is positive there is no risk

475
Q

how to idfferentiate iron def anemia vs. thalassemia

A

Mentzer index MCV/RBC > 13 IRON DEF ANEMIA

If < 13 thalassemia

476
Q

trstogenic effect of valproate

A

spina bifida

477
Q

pt with hallucinations, lauekopenia and edema and pain in wrists,

A

SLE

478
Q

thin white wrinkled skin in vuvlar, vaginal area. Excoriations, dysuria, painful defecatiosn. dx and tto

A

vulvar lichen sclerosus and topical steroids

479
Q

are antibiotics indicated for ulcers?

A

no, unless there are signs of infection/cellulitis. oTHERWISE, TTO IS DEBRIDEMENTE.

480
Q

RF Pre-eclampsia

A

nulliparity and advanced age

481
Q

Management of pre-eclampsia

A

no severe features: devlivery at >=37
severe features : delivery at >=34
but always hidralazine and magnesium first!

severe features:
>160/110
visual ss
pulmonary edema
increased creatinine/increased transaminases 
thrombocytopenia
482
Q

management for negative symptoms ( apathy, withdrawan, flat affect) in schizophrenia?

A

social skills training, with psycotherapy

483
Q

management of renal stones

A

< 5mm: generally pass spontaneously

stones + urosepsis, Acute renal failure and complete obstruction: urology

> = 10 mm urology
<10: hydration, pain control, alpha blockers(tamsulosin)strain urine and d/c

If uncontrolled pain, or no passage of stone in 4-6 weeks referral to urology

484
Q

Causes of elevated AFP (>2.5MoM)

A

Open neural defects (open spina bifida, anencephaly)
Ventral wall defects (omphalocele)
Multiple gestation

A normal AFP does not exclude neural tube defect, as closed spina bifida can have it

485
Q

Causes of decreased AFP

A

Aneuploidies 18-21

486
Q

If a patient has high AFP , next step

A

obstretic US

487
Q

if suspecting sickle cell disease , next step

A

Hb electrophoresis ( high HbS, and HbA low)

488
Q

Acute and maintenance management in sickle cell

A

Acute: hydration analgesia, +/- transfusion
Maintenance:Pneumococcal vaccine, Penicillin until they are 5 years old, Folic acid supplementation, hydroxyurea

489
Q

suspect ovarian torsion, next step

A

pelvic US with Doppler

490
Q

Poor prognostic factors in CLL

A

Thrombocytoenia, organomegaly, LAD, anemia,

491
Q

Patient with polycythemia, next step

A

EPO level

Polycythemia + high EPO: polycythemia due to chronic hypoxia (lung disease), or hormone producing neoplasma ( renal cell carcinoma)

Polycythemia + low EPO: chronic myeloproliferative disorder

492
Q

algorithm of breast mass

A

if < 30 UD +/-mammography: if cyst then FNA if, compelx cyst/amass image guided core biopsy

if>= 30 mammography- if suspicion of malignancy core biopsy

493
Q

Management of cleft lip with or without palate

A

common teratogen es alcohol

repair is done 10s:
10 lbs of weight
10 weeks( 3 months)
10 Hb

494
Q

recurrence risk of cleft lip on subsequent pregnancies

A

50%

495
Q

Van der Woude syndrome

A

AD form of cleft lip palate

496
Q

The major problem that leads to difficulties finding crossmatched blood in patients with a history of multiple transfusions is alloantibodies.

A

true

497
Q

evaluation of nipple discharge- algorithm

A

if bilateral: evaluate for pregnancy/galactorrhea
if unilateral < 30 : US +/- mammogram
>30 : mammogram + US

498
Q

MCC of pathologic nipple discharge

A

intraductal papilloma tumor

499
Q

What is the first thing that increases upon initiation of iron in iron deficiency

A

increase reticulocytes by 1-2 weeks
after a month Hct, and Hg by 1

Ferrous sulfate should be maintained for 2-3 months after hb normalization to replenish iron stores

500
Q

high ALP what does it mean

A

marker of bone turnover and biliary disease

In the setting of vit D deficiency it is more likely to be due to increased bone turnover

501
Q

Reasons of risk of DM in renal cancer transplant

A
  1. Immunosuppresive therapy - glucocorticoids decrease insulin sensitivity
  2. Improved renal function : transplanted kideny causes increased insulin secretionnd is capable of increasing gluconeogenesis.
502
Q

Rf of risk of DM in renal cancer transplant

A

increased age > 45
increased BMI> 30
Family Hx of diabetes

503
Q

treatment of allergic contact dermatitis

A

high potency steroids ( betamethasone, triamcinolone, fluocinonide)

tacrolimus (calcineurin inhibitors) can be used in areas where steroids are not recommended like the face

504
Q

Patients have the right to refuse genetic information unless it involves a treatable condition for the child.

A

Patient with Huntington’s disease (fatal) who refuses to know. and has childrens.

505
Q

Indications for intrapartum GBS prophylaxis

A
  1. GBS bacteriuria or GBS UTI in current pregnancy despite tto
  2. GBS positive rectovaginal culture in current pregnancy
  3. GBS unknown PLUS either:
    < 37 weeks gestation
    Intrapartum fever
    ROM >=18
  4. If prior infant had GBS infection
    • IV penicillin at least 4 hours prior to delivery
  • no utility of performing a GBS swab intrapartum as results wont be back prior to delivery
506
Q

Does Cesarean delivery decreases risk of neonatal GBS?

A

NO!

507
Q

Neonatal complications of tobacco during pregnancy

A

DAOS

Diabetes
Asthma
Obesity
Sudden Infant Death Syndrome

508
Q

Obstetric complications of tobacco during pregnancy

A 
spontaneous abortion 
fetal demise
IUGR
 Preterm ROM
Placenta previa, abruptio placenta  
Pre-eclampsia, 
low birth weight
509
Q

there is no data of buproprionand varenicicline in pregnant women

A

true

510
Q

persistent, intrussive, recurrent thoughts ( ie. to kill the children, but doesnt want to)

A

OCD

  • this is different from psychosis
511
Q

tto of OCD

A

SSRIs, cognitive behavioral therapy

  • OCD typically starts in adolescence but could have been
512
Q

Duration of brief psychotic disorder

A

< 1 month

513
Q

Long-acting injectable antipsychotics how often are they administered?

A

2-4 weeks

514
Q

Absolute contraindications to OCPs

A 
Migraine with aura
HEAVY smokers ( >=15 cigarettes in > 35 yo)
HTN >=160/100
heart disease, DM, stroke
thromboembolic disease, antiphospholipid
Breast Cancer
Cirrhosis and liver Ca
Mayor surgery with prolonged immobilization 
Use < 3 weeks postpartum
515
Q

Actinic keratosis increases the risk of which cancer?

A

Squamous cell carcinoma

Any actinic keratosis lesions should be removed or destroyed
Individual lesions- liquid nitrogen cryosurgery, surgical excision or curettage
Multiple lesions: Field therapy 5 fluoracil, topical diclofenac, imiquimod)

516
Q

Basal vs. squamous cell carcinoma

A

basal: MC cancer. upper face ( nose, upper lip)
pearly nodule umbilicated with telangiectasis
“ Palidasing nuclei)
Mohs surgery

Squamous cell carcinoma: MC cancer in immunosupressed, transplanted , prior scars,burns. 
lower lip, hands, ears. 
"Keratin pearls"
Actinic keratosis is precursor
Keratoacanthoma

both assocaited with sun exposure

517
Q

Diagnostic evaluation of suspected lung cancer

A

CT head, chest and abdomen

THen a biopsy should be done
If patient only have lung/mediastinal lymph nodes involvement - biopsy that area

If multiple metastasis: look if supraclavicular or escalene Lymph nodes are involved, if not biopsy the distal site of metastasis (ie. liver, bone)

518
Q

Associated conditions to skin tags

A

Insulin resistance
Pregnancy
Chron’s disease (Perianal)
metabolic syndrome

519
Q

Associated conditions to acanthosis nigricans

A

Insulin resistance

GI malignancy

520
Q

Associated conditions to severe seborrheic dermatitis

A

HIV

Parkinson

521
Q

oral vit K is as effective as IV vitK in lowering the INR in 24 hours.

A

true

since IV VitK has risk of anaphylaxis oral route is preferred

522
Q

maNAGEMENT OF SUPRATHERAPEUTIC inr

A

If no or minimal bleeding:
INR < 5- Hold Warfarin for 1-2 days, or decrease the dose
INR 5-9- Hold warfarin and resume when INR is therapeutic. Give low dose (1-2.5) vit K if increased risk of bleeding
INR> 9 - Hold warfarin and administer high dose 2.5-5 mg of vit K
all above are ORAL VIT K

if bleeding:
Hold warfarin and administer
IV 10 mg vit K, or FFP, Or recombinant VIIa, or prothrombin complex concentrate

523
Q

Motherwort uses and CI

A

anxiety, menses regulation, cardiovascular conditions. (tachycardia, hypertension)

CI in pregnancy - miscarriages

Otherwise- is safe and there are no interactions with other meds

524
Q

Patients with pancoast tumor can develop spinal metastasis and this is an urgency as to preserve neurologic function.

A

true

525
Q

Complications of pancreatic pseudocysts

A 
mass effect
biliary and pancreatic obstuction 
fistula to other organs and even vessels causing pseudoaneurysms
GI hemorrhage
infection
526
Q

management of pseudocyst

A

often supportive unless symptomatic /sings of infection where drainage may be required.

527
Q

what organism is most commonly cultured from corneal foreign bodies

A

s.aureus

528
Q

laNGUAGE DELAY IN ANY CHILD WARRANTS AUDIOLOGY EVALUATION

A

TRUE

529
Q

breach of privacy of patients- what to do next?

A

provider must notify through a WRITTEN report what was shared and who received that information , and what actions are being done to prevent that

530
Q

tto for plantar warts

A

salicylic acid - requires frequent use and may take up to 2-3 weeks to improve , and. tto should be continued for 1-2 weeks after

soak in warm water 10-20 min the foot. Then salicylic acid and cover it with tape, then 48 hrs-72 hrs, then remove patch

alternative: liquid nitrogen

**topical imiquimod doesnt help

531
Q

good prognostic factors in schizophrenia

A 
later-onset
female
acute onset with precipitant
predominantly positive symptoms(delusions, hallucinations)
no family history 
short duration of active ss
532
Q

poor prognostic factors schizophrenia

A 
onset in childhood, adolescence 
male
gradual onset  , no precipitant
predoninantly negative ss
family hx
long duration of untreated psychosis
533
Q

age to start Pap Smear, despite prior vaccines or sexual activity

A

21 yo until 65

Routine HPV testing is not recommended in < 30

534
Q

Recommended vaccines during pregnancy

A 
DTAP  ( if pt has not vaccinated before- >=28 weeks as it provides passive immunization to baby)recommended 
inactivated Influenza( recommended at any trimester)
Rho GAM
535
Q

ci VACCINES IN PREGNANCY

A

MMR, Varicella, HPV, Live attenuated influenza

536
Q

Cause and tto of malignant otitis media

A

pseudomona

IV ciprofloxacin - can be converted to oral upon good inflammatory markers, but therapy 6-8 weeks

537
Q

tto of poison ivy contact dermatitis

A

supportive, topical corticosteroids

oralsteroids if seere or involvement face or genitalia
*antihistamines are not effective

538
Q

when is biopsy indicated in actinic keratosis

A 
unclear dx
> 1cm diameter
indurated
painful
ulceration
growing rapidly
fail to respond to adequate tto
539
Q

which vaccines require asking about egg allergy

A

influenza and yellow fever

influenza: if anaphylaxis to egg give influenza in the medical setting. The only contraindication for influenza is allergy to the vaccine itself

540
Q

inactivated influenza is preferred rather than life attenuated whi is no longer given

A

true

541
Q

MOA BUPROPRION

A

ne, dopamine reuptake inhibitor

does not cause weight gainor sexual side effets

542
Q

MOA Mirtazapin and SE

A

NaSSA
Noradrenergic and serotoninergic

increased appetite, weight gain, sedation

543
Q

Definition of antidepressant treatment resistant

A

failure to 2 adequate trials of antidepressant

Strategies:

  1. Augmentation
    - either adding a second generation antipsychotic
    - adding another antidepressant of different mechanism
  2. Switch to alternative monotherapy

non-responders: switch
partial responders: augmentation

544
Q

Inactivated intramuscular influenza is recommended, life attenuated influenza vaccine is not as effective

A

true

545
Q

Indications of IVC filer

A 
contraindications of anticoagulation: 
recent surgery
hemorrhagic stroke
bleeding diathesis 
active bleeding
546
Q

Acute complicationsof IVC filter

A
  • guidewire entrapment within the filter

- Post procedural complications: acute insertion site thrombosis, hematoma, AV fistula

547
Q

Long term complications of IVC

A

Recurrent DVTs

IVC prevents progression of the thrombus to pulmonary embolism but does not prevent future DVTs or treats the underlying thromboembolic disease

IVC does not affect overall mortality

548
Q

squamous cell carcinoma in head and neck, that is not operable. What is the alternative

A

Combined radiotherapy and chemotherapy - increases 5 year survival

549
Q

Valproate in pregnancy- if pregnant already do not change. If planning to get pregnant it should be trialed off 6 months prior to pregnancy

A

always give high dose folic acid ( with any AED)

and offer alpha fetoprotein screening.

550
Q

Patient on antiepileptic drug, CI for breastfeeding?

A

no

551
Q

Sunburn tto

A 
mild-moderate:
supportive- cool compresses, calamine lotion, aloe vera
nsaidas
Severe:
hospitalization 
fluid
wound care
552
Q

Requirements prior to initiating isotretinoin

A

2 negative pregnancy tests

and commit to at least 2 contraceptive methods.

553
Q

treatment of melasma

A

FIRST MINIMIZE SUN EXPOSURE- Sunscreen

Then things to lighten skin- azaleic acid, retinoid creams

554
Q

RF for otitis media in children

A

abscence of breastfeeding
daycare attendance
use of pacifier
SECOND HAND SMOKE- alters cilia and mucosa, affecting clearance of fluids and microbes-predisposing to infection

555
Q

What is the most common pain pattern in rotator cuff tendinitis, impingement, d frozen shoulder?

A

lateral shoulder pain aggravated by movements requiring abduction and external rotationof the shoulder

556
Q

sudden vision loss, painless, cherry spot on fundoscopy

A

central retinal artery obstruction

557
Q

subacute sudden vision loss, painless,retinal hemorrhages, and edema optic disc ( blood and thunfer)

A

central retinal vein obstruction

558
Q

Acne treatment

A

Comedonal :
Topical retinoids, salicylic acid, azelaic acid,

Inflammatory:
Mild: topical retinoids + benzoylperoxidase
Moderate: topical antibiotics ( erythromycin, clinda)
Severe: oral antibiotics

Nodular(cystic)
topical retinoids+ benzoyl peroxidase + oral antibiotics
isotretinoin

topical retinoid therapy: adapalene, tretinoin, tazarotene

559
Q

Acne treatment in pregnant

A

topical erythro, clinda, and azaleic acid are safe

rest should be avoided

560
Q

middle ear effusion , persistent (> 3months), and uncompanied by signs of infection in an adult-

A

think about nasopharyngeal carcinoma

  • decreased hearing and ear fullness
  • classic triad not seen often- neck mass, nasal obstruction with epistaxis, unilateral persistent middle ear effusion
561
Q

durable power of attorney of healthcare takes preponderance over surrogates

A

normally prder of surrogate. is: wife, oldest childrent, parents, adult sibling, nearest living relative.

562
Q

RF for adenocarcinomacolon

A

family history
popylopsis syndromes
IBD
African american

ALCOHOL 2-3 drinks/day, and > 4 high risk!
Tobacco in long term users (> 30 years using)
obesity

563
Q

protective factors for adenocarcinoma of colon

A

high fiber, regular NSAIDs use, hormone replacement, regular exercise.

564
Q

conversion to cephalic position of fetus- timing

A

37 or more weeks,

565
Q

Contraindications to external cephalic version

A

active herpes, placenta previa, multiple gestations, IUGR

566
Q

protective factors aganst suicide

A

connection to family, pregnancy, parenthood, religion

567
Q

diaper rash that involves inguinal folds and have satellite lesions

A

candida

568
Q

diaper rash that does not involve inguinal folds, tto

A

contact dermatitis, zinc oxide paste/petrolatum

low potency steroid can be used if not improving

high potency isnot advice as it can be absorbed and cause adrenal insufficiency

569
Q

risks of woman havind sex with woman

A 
bacterial vaginosis
depression, anxiety
intimate partner violence 
cervical ( 2/2 lower vaccination rates/screening), ovarian, breast Ca
Obesity
DM, Cardiovascular disease
570
Q

Nail pitting is a common associated finding to alopecia areata

A

true

571
Q

Raw vulvar pain >=3 months, positive Qtip test (pain with touching vulva), pain with labial separation. dx and tto

A

Dx: vuvlodynia
tto: behavior modification, pelvic floor PT, cognitive behavioral therapy

patients often have associated depression, fibromyalgia, irritable bowel syndrome

572
Q

MCC of abnormal uterine bleeding after menarche

A

anovulation

endometrium builds up under the influence of estrogen ; however with no ovulation, there is no progesterone to slough the endometrium. But then menstrual like bleeding happensdue to estrogen breaktrhough bleeding- severe bleeding, passing clots.

573
Q

treatment for abnormal uterine bleeding due to anovulation

A

OCPs with high estrogen- high estrogen promotes hemostasis through further proliferation of disorder endometrium and estabilization of bleeding sites

574
Q

causes of abnormal uterine bleeding in non pregnant women, structural and non structural

A

Structural (PALM): Polyp, Adenomyosis, Leyomioma, malignancy/hyperplasia
Non structural: COEIN: coagulopathy, ovulatory dysfunction, Endometrial (infection, inflammation), Iatropgenic(anticoagulatns, Not yet classified

575
Q

small , densely pigmented lesion with irregular borders in the choroid on the eye exam. no ss. Dx and tto?

A

ocular melanoma

  • If < 10mm diameter, and < 3 mm in thickness and asymptomatic– observe for 3 months
  • if symptomatic and large: RADIOTHERAPY

Enucleation is only considered if the tumor is really large, has extrascleral involvement and causes sevre pain

576
Q

There is increased risk of death in patients with dementia who take antipsychotics

A

true
both 1st and 2nd generation
due to increased cardiac events, as well as complications such. asstroke, pneumoniafalls,

577
Q

treatment of anal abscess

-when should antibiotics be prescribed?

A

incision and drainage

- antibiotics should be prescribed in pts with DM, immunosuppressed, extensive cellulitis, valvular heart disease

578
Q

complication of anal abscess

A

fistula in 50% of cases

-often require surgical repair

579
Q

Suspecting bone metastasis from prostate Ca, next step?

A

is an osteoblastic lesions ( prostate, small cell lung, Hodgkin)
Do: Radionulide bone scan
If positive consider doing CT or MRI to assess cortical integrity and risk of fractures

580
Q

Assessment of bone metastasis from osteoblastic lesions

A

( prostate, small cell lung, Hodgkin)
Do: Radionulide bone scan
If positive consider doing CT or MRI to assess cortical integrity and risk of fractures

581
Q

Assessment of bone metastasis from osteolyticlesions

A

myeloma, non small cell, non Hodgkin

Do X ray and PET/CT

If positive consider doing CT or MRI to assess cortical integrity and risk of fractures

582
Q

Assessment of bone metastasis from primaily bothh osteolytic and osteoblastic lesions lesions

A

breast

PET/CT
MRI

If positive consider doing CT or MRI to assess cortical integrity and risk of fractures

583
Q

Pospartum blues vs depression

A

blues peaks by day 5 and resolves by 2 weeks

depression: persist by 2 weeks.

584
Q

bupropion id not considered a first choice for depression in pregnant bacause there is no safety data on that and breastfeeding

A

true

first line: sertraline and paroxetine

585
Q

first choice for depression in pregnancy

A

first line: sertraline and paroxetine

586
Q

Pain reatment for sickle cell anemia

A

morphine within 30 minutes of hospital arrival

outpatient: oxy

587
Q

All patients with Sickle cell disease who are febrile need blood cultures and anitbiotics- due to risk of encapsulated given asplenia

A

true

588
Q

Codeine is contraindicated in < 12 years

A

unpredictable metaboslims

589
Q

Diagnostic criteria for acute chest syndrome in sickle cell disease

A

new infiltraate in chest x ray PLUS AT LEAST 1 OF THE FOLLOWING:’

  • Increased work of breathing, tachypnea, wheezing
  • Fever >101.3
  • hypoxemia
  • est pain
590
Q

tto of acute chest syndrome in sickle cell

A

ceftriaxone plus azithromycin ( s.pneumonia, and mycoplasma coverage)
IV fluids
Pain control

591
Q

Causes of of acute chest syndrome in children

A

infection. sthma exacerbation and PE

592
Q

When does G6PD deficiency presents in neonate

A

usually day 2-3

anemia and indirect hyperbilirrubinemia

593
Q

biliary atresia presents with

A

jaundice ,DIRECT BILIRRUBIN ( It is conjugated)

594
Q

treatment of any pelvic organ prolapse

A

pessary placement and ssurgical repair

595
Q

complications of laser removal of tattoos

A

scar marks and hypo or hyper pigmentation

laser removal involves use of lasers of different wavelenghts, breaks up pigment into smaller particles that can be processed by macrophages

596
Q

MC techniques t for tattoo removal

A

dermabrasion - removes superficial dermis, pigment leaks out

and laser removal -use of la- sers of different wavelenghts, breaks up pigment into smaller particles that can be processed by macrophages

597
Q

MCC of osteomyelitis in helathy children and tto

A

S.aureus

If MRSA prevalence is low;: naficillin, or oxacillin or cefazolin
If MRSA prevalence is high:Clinda OR Vanco

598
Q

MCC of osteomyelitis in sickle cell children and tto

A

Salmonella
S.aureus

Ceftriaxone (gram negative cover) plus either:

If MRSA prevalence is low;: naficillin, or oxacillin or cefazolin
If MRSA prevalence is high:Clinda OR Vanco

599
Q

Patient with wasp sting, has hypoxia, bronnchospasm , skin lesions. Next step?

A

IM epinephrine.
This are signs of anaphylaxis- presentation is variable and hypotension can be delayed or absent.

After this send them to allergist for venom immunotherapy as it reduces the risk of future anaphylaxis from 60 to 5%.

600
Q

Why IV epinephrine is not often used in anaphylaxis , and IM is preferred?

A

IV is associated with increased risk for dosing errors and side effects (arrhythmias), its often reserved for refractory hypotension or bronchospasm

601
Q

Management of hip fractures

A

call immediately ortho
they will define if surgery or open reduction with internal fixation is needed

Patients who are stable and ambulatory and get surgery WITHIN 48 HOURS have lower mortality and decreased risk of pressure ulcers nd pneumonia.

Non operative management reserved for nonambulatory, dementia or are medically unstable

602
Q

Treating friends should generally be limited o emergency situationswhen no other care is available.

A

true

603
Q

tto of multinodular goiterretrosternal that is compressing the trachea

A

surgery removal

604
Q

Early physical signs of compartment syndrome

A

tightness of the area
muscle weakness
pain with passive stretching of the muscles

605
Q

Lofgren syndrome

A

acute clinical presentation of sarcoidosis:

fever, erythema nodosum, bilateral hilar lymphadenopathy

606
Q

Eye manifestations of sarcoidosis

A

Anterior/posterio uveitis ( photophobia)

Sicca

607
Q

Sarcoidosis can cause parotid gland swelling ?

A

yes

608
Q

Presentation of anterior uveitis

A

infalmmation of the iris and ciliary body

erythema at the limbus
constricted pupil
photosensitivity
blurred vision 
moderate eye pain
609
Q

Treatment for squamous cell carcinoma skin

A

surgery

but if patient refuses: cryotherapy, electrosurgery, RADIOTHERAPY

610
Q

iNDICATIONS OF braf kINASE INHIBITORS ( Vemurafenib)

A

in melanoma, can increase survival.

611
Q

Treatment of allergic rhinitis

A 
avoidance of triggers
intranasal corticosteroids (fluticasone)
612
Q

Pneumonia is a common precipitant of SIADH although mechanism is not understood. tto?

A

fluid restriction +/- salt tablets

613
Q

common precipitants of SIADH

A 
CNS ( stroke, hemorrhage, trauma)
Medications ( Carbamazepine, SSRIs, NSAIDs)
Lung disease ( Pneumonia)
Small cell carcinoma
Pain and Nausea
614
Q

tto postpartum endometritis

A

clindamycin + gentamicin
treatment is continued until the patient is afebrile for at least 24 hours

gentamicin covers gram negative and S.aureus

615
Q

RF of postpartum endometritis

A 
Cesarean delivery  (THE MOST )
Instrumental vaginal delivery 
Chorioamnionitis
GBS colonization 
Prolonged rupture of membranes
616
Q

Criteria for schizoaffective disorder

A
  1. Major depression or manic episode concurrent with schizophrenia ss
  2. hx of hallucinations/delusions >=2 weeks IN THE ABSCENCE of major depressive disorder
  3. More predominant mood disorder
  4. Not cause by substance. ordrugs
617
Q

schizoaffective disorder vs. major depressive or bipolar disorder with psychotic ss

A

the second one has always mood ss with psychotic ss at the same time.

schizoaffective:

  1. Major depression or manic episode concurrent with schizophrenia ss
  2. hx of hallucinations/delusions >=2 weeks IN THE ABSCENCE of major depressive disorder
  3. More predominant mood disorder
  4. Not cause by substance. ordrugs
618
Q

Maternal complications of adolescent pregnancy ( <19 yo)

A 
Hydatiform mole
pre-eclampsia
Anemia 
Post partum depression 
Operational vaginal delivery
619
Q

Fetal complications of adolescent pregnancy ( <19 yo)

A 
Gastroschisis
Omphalocele
Preterm labor ( inadequate nutrition and immature physiology)
Low birth weight 
Perinatal death
620
Q

RF for breech presentation

A

placenta previa
multiple gestations
polyhydramnios
advanced maternal age

621
Q

RF GDM

A 
Fx history diabetes
prior pregnancy with diaebtes
obesity 
multiple gestation 
maernal age >25
622
Q

tto of herpes zoster

A

oral valacyclovir for 7 days

oral acyclovir requires dosing 5 times a day, while valacyclovir is 3

623
Q

Varicella zoster postexposure prophylaxis

A

If immune ( had it, or received varicella vaccine x2): nothing

if not immune: varicella vaccine within 5 days of exposure
if not immune and pregnant or immunocompromised: varicella zoster Ig

624
Q

management of post herpetic neuralgia ( > 4 months after rash onset)

A

TCAs are the first line p but should be used with caution in elderly.

Gabapentin , TCAs, pregabalin
if despite all these may try opioids

625
Q

Types of pains after VZV and how. totreat

A

Acute pain < 30 days: NSAIDsanalgesics
Subacute pain > 30 days , less than 4 months: NSAIDs analgesics
Postherpetic neuralgia: > 4 months : TCAs, gabapentin, pregabalin

626
Q

Allergic vs non-allergic rhinitis

A

allergic: watery rhinorrhea, sneezing, watery eyes,
early onset
identifiable trigger, bluish or pale mucosa
tto: avoid trigger, intranasal steroid( fluticasone)

non-allergic: age> 20, nasal obstruction, rhinorrhea, postnasal drip. no trigger identified. worsen with seaseon
mucosa normal or boggy and erythematous
tto intransal steroid(fluticasone), , intranasal antihistamine (azelastine)

627
Q

Viral conjunctivitis is contagious?

A

Yes, it is contagious until eye discharge resolves

628
Q

Why do patients with poor glycemic control have blurry vision

A

swelling of optic lens due to osmotic changes- improving glycemic control can improve that

629
Q

Radiation induced cardiotoxicity can cause calcified valves, dyastolic dysfunction , MI,conduction defects

A

true

630
Q

anthracycline toxicity

A

dilated cardiomyopathy (decreased ejection fraction) but no valvular changes

631
Q

Patient with bipolar on lithium with suicide risk, what to do with lithium?

A

Continue lithium- it was been shown that it decreases risk of suicide.

632
Q

Causes of oligohydramnios (amniotic fluid index < 5)

A 
Pre-eclampsia
Abruptio placenta
uteroplacental insufficiency 
renal anomalies
NSAIDs
633
Q

Causes of polyhydramnios (amniotic fluid index >=45)

A 
anencephaly 
multiple gestations
esophageal/duodenal atresia
Congenital infection 
DIABETES MELLITUS
634
Q

TTP PRESENTATION

A 
Pregnancy  is assocaited with ADAMTs13 deficiency that becomes more pronounced with increased gestation age. 
rENAL FAILURE 
Neurologic manifestations
Fever
adbominal pain, nausea 
petequial rash

hemolytic anemia thrombocytopenia

635
Q

tto of thrombotic thrombocytopenic purpura

A

plasma exchange

636
Q

acute fatty liver of pregnancy

A

occurs in 3rd trimester , nausea, emesis, elevated transaminases

637
Q

Surgical management of renal cell carcinoma

A
  1. If extends through the capsule but not the Gerota’s facia: Radical nephrectomy - also with invesion of major vessels, adrenal mass
  2. If confined to the capsule: partial nehrectomy

If huge: debulking
If metastasis: chemtherapy and imunotherapy

638
Q

Patient with bilateral galactorrhea that labs are normal, and mammogram sand US are negative. Next step

A

reassurance and observation

639
Q

teenager with isolated proteinuria

A

orthostatic proteinuria
a higher than normal protein during the day ( while they are up) but normal at night

Dx with 24 hour split urine collection

640
Q

tto and prognosis of orthostatic proteinuriain adolescence

A

no intervention needed
will resolve by its woen
and DOES NOT PREDICT DEVELOPMENT OF FUTURE GLOMERULONEPHRITIS

641
Q

Why women who want to donate kidney should ideally be out of childbearing period?

A 
it has consequences: 
fetal loss
pre-eclampsia
Gestational Diabetes
Gestational hypertension

This is not an absolute CI, but people need to know

642
Q

RCTs are efficacy trials by desing and are not powered to assess adverse evffects, especially if rare.

A

True , follow-up times are often short.

643
Q

The best test for screening has to have the highest sensitivity.

A

true

644
Q

Formula for SMR and what does SMR of 1.75 menas

A

SMR: Observed number of deaths/expected umber ofdeaths

1.75 indicates that the observed number of deaths among the miners is 1.75 times (75%) higher than would be expected if the miners had the same death rate as the general population.

645
Q

Effect modification results when an external variable has an effect on one of the risk factors on disease status. Stratification helps identify this effect modification and separate measures for outcome should be reported for each level of the effect modififer

A

true.
Example:
effect of erythropoyetin on survival in ESRD, controlled by age, sex, duration of disease.

among patients with Diabetes, epo use was associated with higher survival rates while patients without diabetes no association.

646
Q

Definition of maternal mortality rate

A

maternal deaths/live births

647
Q

crude mortality rate

A

number of deaths/total population size

648
Q

cause specific mortality rate

A

number of deaths from a particular disease by the total population size

649
Q

case fatality rate

A

deaths from specific disease/people with the disease

650
Q

Attack rate

A

number of patients with disease / total population at risk

651
Q

Crude birth date

A

live births/total population

652
Q

relationshop between plasma homocysteine level and folic acid intake , the correlation coefficient is -0.8.
how much variability in plasma homocyteine levels is explained by folic acid intake?

A

0.8x0.8: 0.64 or 64%

that is the coefficient of determination

653
Q

tto of seborrheic dermatitis

A

topic antifungals ( selenium sulfate, or ketoconazole shampoos)
topical glucocorticoids
topical calcineurin inhibitor( Pimerolimus)

654
Q

Cause of seborrheic dermatitis

A

Malassezia

655
Q

prognosis of seborrheic dermatitis

A

often a chronic relapsing condition, should be applied every 1-2 weeks to prevent recurrence

656
Q

steps for root cause analysis

A
  1. collect data
  2. Create causal factor flow chart
  3. Determine root cause
  4. Recommend change andimplement strategia
  5. Measure success of change
657
Q

how does hydatiform mole forms?

A

one empty egg and 2 sperms, or 1 sperm that replicates its content

658
Q

management of hydatiform mole?

A

suction and curettage + OCPS
then weekly bHCG until undetected
then weekly bHCG until 6 months without being detected

If at some point it becomes detected (Raising or plateauing)– then Dx of gestational trophoblastic neoplasia

If after 6 months remained undetected they can try pregnancy, the risk of neoplasia is low after 6 months.

659
Q

Patient with hydatiform mole resection with raising bHCG , Dx and next step?

A

gestational trophoblastic neoplasia

Do Pelvic US and Chest X ray

660
Q

PCP mode of action

A

NMDA receptor antagonist

661
Q

PCP intoxication presentation

A

aggressive, agitated, combative, bizarre– lasts for 8 hours
HTN, Tachycardia, NYSTAGMUS (horizontal, vertical, rotatory)

662
Q

First thing to do in patient with PCP intoxication who is aggresive

A

BZD
then physical constraint if pt does nto redirect verbally

In mild cases of intoxications-low stimulation environment.

663
Q

molluscum contagiosum virus type and transmission

A

enveloped DNA poxvirus

skin to skin contact, sexual transmission

Can be associated to other genital infections or with HIV so ALWAYS TEST FOR hiv ( particularly if they have lesions in the face)

664
Q

tto. ofmolluscum contagiosum

A

self limited 6-9 months.

Cryotherapy
topical podopylotoxin
curretage

665
Q

Risk factos for vulvar cancer?

A 
Tobacco
Vulvar lichen sclerosis
Vulvar/cervical intraepithelial neoplasia
Prior Cervical Ca
immunodeficiency

** presents as a plaque ( can be pigmented) - needs biopsy!

666
Q

presetnation of vulvar cancer

A

raised pigmented plaque in the vulva
dyspareunia
can have or not abnormal bleeding
vulvar pruritus

2 main causes: HPV persisten infection and chronic infkammation

667
Q

tto vulvar cancer

A

surgical resection and possible chemoradiation

668
Q

presentation of presbycusis

A

elderly
sensorineural hearing loss, affects HIGH FREQUENCY sounds.
are not able to hear in noisy, distracting environment.

669
Q

recurrent sinusitis can be caused by second hand smoke

A

true- cigarrettend air pollution damage the cilia.

Other causes in healthy subjects:

  • inadequately treated sinusitis
  • anatomic abnormalities in nasal septum or palate
  • allergic rhinitis
670
Q

Kartagener syndrome patophysiology and presentation

A

AR
dynein arm affecting cilia
chronic sinusitis, bronchiectasis, situs inversus, infertility, conductive hearing loss,

Increased risk of ectopic pregnancy in females

671
Q

screening test for Kartagener

A

nasal nitric oxide test

is reduced in kartagener

672
Q

Why can hypocalcemia occur in the setting of a recent surgery?

A

Two mechanissms:

  1. Volume expansion and hypoalbuminemia
  2. Transfusions: Blood products have citrate to anticoagulate the blood. Citrate chelates with Calcium and causes hypocalcemia
673
Q

With which electrolyte disturbance would you see increased deep tendon reflexes?

A

HypoCalcemia.

-also have Chvostek, Trousseau, muscle cramps, convulsions.

Hypomagnesemia can also mimic hypoCa, but is often seen with heavy alcohol use, diuretics, and prolonged NG tube suction /diarrhea

674
Q

Presentation of HyperMg

A

rare but can cause decreased tendon reflexes

a more severe form would cause: loss of reflexes,
muscle paralysis, flaccid quadriplegia, decreased respiration

675
Q

short and long term complications of female circumcision

A

short: hemorrhage and infection

long term: genital pain, scarring, infection, infertility, difficulty with coitus and vaginal delivery

676
Q

7 yo with malodorous vaginal discharge and vaginal spotting? Dx? TTO?

A

Vaginal foreign body

Warm irrigation and vaginoscopy under sedation

MC object is toilett paper, but toys too

677
Q

Gestational trophoblastic neoplasia ( i.e choriocarcinoma) can occur in hydatiform moles but also in a normal pregnancy likely due to high maternal age.
can be even after abortion, ectopic pregnancy

A

true, after normal pregnancy would present with persistent vaginal spotting, pelvic pain and pressure, high bHCG, and can have metastasis to lungs, vaginal, CNS, liver

678
Q

Evaluation of Gestational trophoblastic neoplasia ( i.e choriocarcinoma)

A

Pelvic US
Chest X ray
thryoid, hepatic and renal function tests

679
Q

tto of Gestational trophoblastic neoplasia ( i.e choriocarcinoma)

A

chemotherapy

hysterectomy

680
Q

how to differentiate an aplastic crisis and splenic sequestration in sickle cell disease

A

aplastic crisis: arrest in erythropoiesis due to parvovirus- so decreased reticulocyte count (<1%) and resultant acute, severe anemia. tto: blood transfusion in the meantime

splenic sequestration : splenic vasooclusion–rapidly enlarging spleen. severe anemia but HIGH reticulocytes

681
Q

presetnation of acute chest syndrome in sickle cell

A

fever, chest pain, new pulmonary infiltrate in chest X ray

682
Q

Complications of sickle cell anemia:

A

aplastic crisis ( parvovirus) arrest of erythropoyesis, decreased reticulocytes and severe anemia

Autosplenectomy: high risk of infection by encapsulated

Splenic crisis: hepatomegaly, increased reticulocytes, severe anemia

Salmonella osteomyelitis

Sickling in renal medulla ( decreased PO2)- Renal papullary necrosis0

683
Q

Prevention of pre-eclampsia recurrence

A 
low dose aspirin in the second trimester, at 12 weeks,  for patients with high risk: 
renal disease
DM
HTN
Prior pre-eclampsia
684
Q

When does pre-eclampsia occur?

A

> 20 weeks

caused by abnormal increase in platelet aggregation and vasoconstruction

685
Q

Do prenatal vitamins contain folic acid?

A

Yes 0.4 mg

But consider an increased dose 4 mg in patients with prior neural tube defect kids, or taking CBZ or valproate

686
Q

Which patients are at higher risk of pre-eclampsia recurrence?

A

renal disease
DM
HTN
Prior pre-eclampsia

687
Q

newborn with webbed neck posteriorly rotated ears, high arched palate, and edema ( lymphedema)

A

turner - NONDISJUNCTION , 45,X

688
Q

long term outcoms of turner syndrome

A

need screening for thyroid and celiac given increased risk of autoimmune diseases

are at increased risk of learning disabilities BUTIN GENERAL EXHIBIT NORMAL INTELLIGENCE

689
Q

Fragile X syndrome- associated with autism
Rett syndrome- developmental regression, microcephaly , epilepsy, stereotyped hand and movements
Trisomies 13 and 18-associated with epilepsy

A

true

690
Q

Patient with child with turner, worried about risk of recurrence in next child?

A

Random error so risk does not increase with maternal age or subsequent pregnancies.

Recurrence risk is same as general population

691
Q

treatment of tinea pedis

A

mild- respond well to topical terbinafine 1-2 weeks

but if more severe or with onycomycosis ORAL terbinafine is preferred.

692
Q

pregnant women that arrives for bleeding. At exam has aa mass that is concerning for cervical cancer and bleeds to touch. Next step?

A

punch biopsy

693
Q

characteristics of alcoholic ketoacidosis

A

anion gap acidosis, increased osmolal gap, ketonemia or ketonuria, with variable levels of glucose

in diabetic ketoacidosis glucose is often> 250

694
Q

tto of alcoholic ketoacidosis

A

Dextrose normal saline, and thiamine

Dextrose will lead to increased insulin secretion which will lead ketone metabolism to bicarb

695
Q

Most frequent complication of transurehtral resection of the prostate

A

retrograde ejaculation

696
Q

tto of hidradenitis suppurative

A

all pts: weight loss, stop smoking

Hurley classification:
Mild: topical clinda
intralesional corticosteroids for flares
Moderates( nodules, sinus tracts) : oral tetracycline ( doxy)
Severe: Infliximab, or surgical resection

697
Q

RF for hidradenitis suppurative

A

Family history of HS
obesity
smokers
mechanical stress in the skin ( friction, manipulation)

698
Q

patient who told another doctor that her PCP makes her undress to do breast exam, next step

A

talk to physician and if suspicion notify to the board

699
Q

Causes of anemia in ESRD

A

Mainly due to decreased erythropoietin production in kineys.

Other causes: iron deficiency, hyperparathyroidism ( increased resistance to erythropoietin), folate def, systemic inflammation, aluminum toxicity

iron def from frequent blood draws, GI blood loss(common in ESDR), or dyalisis

700
Q

When is erythropoietin recommended in ESRD

A

with Hb < 10 and a target of 10-11.5

Patients with transferring saturation =< 30%and ferritin =< 500require iron supplementation, preferable IV than oral

701
Q

Management of undescended testes

A

by 6 months if not descended sent for orchipexy, as decent is less likely to occur after this age.

without surgery complications are: inguinal hernias, testicular torsion, subfertility and testicular cancer

after orchopexy: there is still higher risk for cancer compared to the general population.

702
Q

Indications for endometrial biopsy

A

Age>=45 with suspected anovulatory bleeding
Age < 45 with risk factors for unopposed estrogen( obestiy, PCOS), Failed medical managementr persistent abnormal bleeding

703
Q

tto for anovulatory bleeding in the transition to menopause, once it has been ruled out endometrial hyperplasia

A

cyclic progestin therapy
low dose OCPs
levonogestrel

704
Q

RF for endometrial hyperplasia

A

obestiy, age > 45, anovulation, DM

705
Q

Pathogenesis and clinical presentation of neuroblastoma

A

neural crest origin, involves the adrenal medulla and sympathic chain

mean age < 2 years
abdominal mass ( depending of size can cause constipation, obstruction)
opsoclonus myoclonus syndrome
periorbital ecchymosis ( orbital metastasis)
Spinal cord compression ( dumbell tumor)
can cause HTN, flushing, sweating

706
Q

Dx of neuroblastoma

A

elevated catecholamines metabolites
samll round blue cells on histology
N-myc gene amplification

707
Q

MC extracranial tumor of the childhood

A

neuroblastoma

708
Q

Wilms tumpr

A

RENAL tumor
age < 5with unilateral, , PAINFUL, hematuria
HTN

WAGR

709
Q

Multiple drugs are a major cause of adverse drug reactions in the elderly.

A

true

710
Q

Caput vs. cephalohematoma vs. subgaleal

A

Caput is a scalp swelling that crosses sutures lines

subgaleal: between scalp and periostium and rapid expansion is dangerious due to hypovolemic shock ( happens with vacuum forceps) - monitor in the ICU for volume replacement and evaluation of coagulation studies
cephalohematoma: below periostium, does not cross suture , may lead to hyperbilirrubinemia secondary to red bloodcell breakdown – less commonly these can calcify or ossify leading to skull malformation.

711
Q

Presentation of psoriatic arthritis

A

morning stiffness thatis relieved by physical activity- distal interphalanges, axial ( sacroilitis)
nail pitting
skin change sin the fingers ( erythema in phalanges)

712
Q

tto of psoriatic arthritis

A

patients with plaque psoriasis without arthritis: topical glucocorticoids or vit D derivatives (calcipotriene)

But if arthritis: methotrexate

713
Q

Most common organisms causing otitis externa

A

S. aureus, pseudomonas

714
Q

tto of otitis externa

A

mild: topical acetic acid
moderate/sever ( pain, pruritus, occlusion due to edema): topical antibiotics (polymixin B neomycin, colistin/neomycin, ciprodex)
malignant otitis externa: IV cipro +/- debridement

715
Q

tto of otitis externa

A

mild: topical acetic acid, Domeboro solution x 7-10 days
moderate/sever ( pain, pruritus, occlusion due to edema): topical antibiotics (polymixin B neomycin, colistin/neomycin, ciprodex)
malignant otitis externa: IV cipro +/- debridement

716
Q

infectious outbreak causing hemorrhagic diarrhea. type of study needed to assess relation between exposure to one restaurant and breakout?

A

Case control

allows for quick localization of the source of outbreak

717
Q

Etiology of acute epididimytis

A

< 35 years: sexually transmitted ( Chlamydia, Gonorrhea)

> 35 years: bladder outlet obstruction ( Coliform bacteria)

718
Q

Unilateral testicular pain, mainly posterior, swelling, and that improves with elevation of testis?

A

Epididymtis

719
Q

Unilateral testicular pain, mainly posterior, swelling, and that improves with elevation of testis. Next step?

A

Likely epididymitis

Urinalysis/culture
NAAT for gonorrhea and chlamydia
and antibiotic

Ceftriaxone and Doxy if gonorrhea cannot be rule out

720
Q

Acute prostatitis vs. Chronic prostatisit

presentation and tto

A

Acute: fever, chills, malaise, pelvic pain, urgency, tender prostate
tto: TMP-smx OR Cipro for 4-6 weeks

Chronic: dysuria and increased frequency, recurrent UTI
tto Cipro

Culture of midstream sample to dx

721
Q

Causes of viral orchitis

A

mumps ( aseptic meningitis, parotitis)
rubella
parvovirus

722
Q

tto of keratosis pilaris

A

urea cream, salycilic acid cream

-can become pruritic in cold and dry weather

723
Q

suspect renovascular

A

abdominal dupplex doppler ultrasonography or CT/MRI angiography

due to risk of contrast induced nephropathy the 1st one is recommended in patients with renal insufficiency

724
Q

pelvic organ prolapse treatment

A

weight loss
pelvi floor exercises ( Kegel exercises)– not helpful in advanced pelvic prolapse
PESSARY placement ( severe cases, or poor surgical patients- with cardiovascular/pulmonary comorbidities)
Surgery

725
Q

RF factor Dupuytren contracture

A 
DM
male
age> 50
family history 
SMOKING, ALCOHOL USE
Northern Europe
726
Q

Dupuytren contracture what is it?

A

Fibrosis of the Palmar Facia - usually 3,4,5th

Discrete nodules along the flexor

727
Q

tto of Dupuytren contracture

A

mild: modification of hand tools
persistentor progressive disease: needle aponeurotomy or intralesional steroids
Surgery: for advance disease or contractures.

728
Q

Constant urine leakage nocturia, weak urinary stream, decreased perineal sensation and large postvoid residue (> 150mL)

A

Overflow incontinence

729
Q

antihistamines can worsen overflow incontinence

A

rue

730
Q

Dating a former patient is unethical?

A

yes, current or former is always unethical if psychiatric patients.

if other normal patients only current

731
Q

Definition of infertility

A

> =12 months.

For women > 35 years, >=6 months

732
Q

First step in evaluation of infertility

A

semen analysis

733
Q

Common drugs that cause urinary incontinence

A

alpha adrenergic antagonists ( relax urethra)
Anticholinergic, opiates
Ca channel blockers
diuretics

734
Q

First line treatment of alcohol disorder-wanting to spot

A

Naltrexone- mu opioid receptor antagonist ( reduces cravings, heavy drinking days, and increase sobriety days)

CI in pts taking opioids or with liver failure

Acamprosate glutamate modulator

735
Q

When do you use naltrexone vs. disulfiram in alcoholic pts

A

naltreoxine: patient who wants to stop drinking, decreases cravings, and increase sobriety days
disulfiram: is in patients ALREADY ABSTINENT-INHIBITS aldehyde dehydrogenase

736
Q

pathophysiology of familial hypocalciuric hypercalcemia

A

AD
inactivating mutations of Ca sensing receptor
Normally high concentrations of Ca suppress PTH, but here higher than the high normal are needed

1st step measure PTH which is high,
Calcium excretion

NORMAL FINDINGS AT EXAM

737
Q

Antihypertensive recommended in patients on lithium

A

Amlodipine

738
Q

Which antihypertensives are NOT recommended in a patient on lithium?

A

Thiazides,
NSAIDs except aspirin
ACEs, ARBs,
Tetracycline and MTZ

they increase lithium levels

739
Q

antihypertensive that decreases lithium levels

A

K sparing diuretics

740
Q

6 medical contraindications for pregnancy

A 
prior peripartum cardiomyopathy
LVEF< 40
Severe HTN ( Eisenmenger sx)
HG NYHA Class III-IV
Severe obstructive cardiac lesions
unstable aortic dilation
741
Q

What contraceptive are recommended in patients with eisenmenger syndrome?

A

hysteroscopic sterilization or subdermal progestin implant

estrogen containing contraceptives are contraindicated due to risk of thromboembolism

742
Q

patient with recurrent rash in different parts of the body have been occuring for the last 6 months, recurs every 2-3 weeks last up to 24 hours and disappear. Next step?

A 
Chronic urticaria ( > 6 weeks) 
No ned of further evaluation 
Triggers: 80-90% idiopathic
Physical stimuli ( cold, skin pressure)
NSAIDs
Stress 
systemic disorders

40% associated with angioedema.

743
Q

tto for chronic urticaria

A

second generation antihistamine: daily cetirizine, loratadine

Refractory patients can try H1 blocker( hydroxyzine), montelukast ( leukotriene receptor antagonist), H2 blocker(ranitidine)

744
Q

long term prognosis of chronic urticaria

A

most patients will have spontaneous resolution within 2-5 years

30-50% show remission in the first year
70% at 5 year

745
Q

Patients with presbycusis often withdrawn from social life and exhibit isolation. Do not confuse with depression ( > 5/9), and there should be other signs such as seeing tv more close.

A

true

746
Q

treatment of bacterial vaginosis in pregnant and non pregnant

A

same!
Clindamycin

MTZ is contraindicated in the first trimester

747
Q

Why should we treat bacterial vaginosis during pregnancy

A 
symptomatic relief plus avoid complications:
preterm birth
preterm prom
chorioamnionitis 
postpartum endometritis
748
Q

initial treatment of squamous cell carcinoma limited to a vocal cord and no metastasis

A

radiotherapy first, laser excision, or partial vocal cordectomy

if tumor is in the comisure of vocal cords-partial or hemilaryngotomy

749
Q

how long should a patient be treated for a DVT

A

If DVT had a cause- for at least 3 months up to a maximum of 6 months

If DVT is idiopathic for at least 6 months, and at that point reassess if its needed more long term anticoagulation

750
Q

tto of condiloma acuminata

A

chemical:
if lesion is inside: trichloroacetic acid
if lesion is outside: podophylin ( is contraindicated. inpregnancy)

immunotherapy: cidofovir
and surgical excision

751
Q

When do kids realize about death

A

Preschool childrenbelieve death is temporary or reversible

> 7 years: understand that death is final

752
Q

Treatment of slipped capital femoral epiphysis

A

Non-weight bearing

Surgical pinning

753
Q

Dx of slipped capital femoral epiphysis

A

posteriorly displacedfemoral head on X ray

754
Q

RF for slipped capital femoral epiphysis

A

Obesity and adolescence

755
Q

Complications slipped capital femoral epiphysis

A

Avascular necrosis Osteoarthritis

756
Q

timing of adjustement disorder

A

onset within 3 months of trigger

757
Q

When do you consider antibiotic prophylaxis for UTI?

A

when there have been more than 2 UTIs in 6 months or more than 3 in a year

Can be continuous for several years or only after intercourse

Cipro, TMP-SMX, nitrofurantoin

758
Q

RF for Cerebral venous sinus thrombosis

A 
pregnancy 
OCPs
Malignancy
Infection 
Head trauma
759
Q

tto Cerebral venous sinus thrombosis for everyone even in pregnancy

A

low molecular weight heparin

although there can be some hemorrhage on imaging it is considered safe and the standard of care

760
Q

How do you monitor antracycline toxicity ( doxorubicin)

A

Radioncleide ventriculography– queantifies ejection fraction.

performed at baseline prior to initiating chemo, and then prior to subsequent cycles

Anthracyclin CI if LEVF is < 30 and a dose should be modified if < 50%.

761
Q

Severe seborrheic dermatitis is asscoaited with which conditions

A

HIV, Parkinson

762
Q

3 main risk factors for prostate cancer

A

age, race, , family history

763
Q

the best way to reduce pop pulmonary complications

A

stop smoking at least 8 weeks before the surgery

less importnat: pulmonary toilet, spirometry, minimal narcotic administration

764
Q

MC cause of POP fever in the first 24 hours

A

atelectasis

765
Q

If a patient has COPD as either very young or non smoker, what is the etiology

A

alpha 1 antitrypsin deficiency

766
Q

children of smoking parents are more likely to develop…

A

asthma , URI, otitis media

there is also risk for lung Ca and risk increases iwth exposure

767
Q

“salty tastin baby”, rectal prolapse, meconium ileum, failure to thrive

A

cystic fibrosis

cor pulmonale pancreatic insuff
infertility

768
Q

RF COPDS

A

Smoke cigarrete, secondhand smole, pccupational dust and chemical exposure, advancing age, Socioeconomic status

769
Q

Dx of COPD

A

Spirometry FEV1/FVC >0.7

770
Q

copd EXACERBATION TTO

A 
Albuterol (short acting b agonist)
Ipratropium ( short acting cholinergic) 
Prednsione 
Antibitoics if increased dyspnea, increased sputum
O2
771
Q

do not prescribe b blockers for asthma or COPD, WHY

A

they block the beta receptors that are needed to open airways

772
Q

In asthma, LABA Sshould never be prescribed as monotherapy due to increased risk of death.

A

true

773
Q

tto sarcoidosis

A

prednisone

774
Q

Leriche syndrome

A

PAD, Erectile dysufunction, absent or diminished femoral pulses

775
Q

Ankle Brachial index normal

A

SBP of dorsalis pedis or posterior tibial artery /SBP brachial artery normal: 0.91- 1.3
<0.9 PAD
>1.3- Suggests calcified or uncompressible veins

776
Q

mullerian agenesis waht is it

A

congenital abscence of proximal 2/3 of vagina with no uterus

777
Q

single greates risk factor for breast Ca in males

A

BRCA mutation and having Klinefelter syndrome

778
Q

Scombroid poisoning

A

histidine to histamine

flushing, throbbing head, palpitations, abdominal cramps, diarrhea, oral burning

devleops 10-30 min after ingestion and is self limited-can also have wheezinghypotnesion,

779
Q

Pufferfish poisoning

A 
neuro ss ( perioral tingling, incoordination , tingling
0
780
Q

Persons who need post exposure prophylaxis to N. meningitidis

A

Household members
Roomates
Child care center workers
Person directly exposed to respiratory or oral ( intubatio, kissing, mouth to mouth
Person sitting next to infected person > 8 hrs

781
Q

Postexposure prophylaxis for N. Meningitidis

A

Rifampin 600 mg BID x 2 days (preferred, but do not give to women with OCPs)
cipro 500 mg single oral dose
Ceftriaxone250 mg dose

782
Q

presence of orbital fat in eyelid laceration, indicates that the most likely affected structure is

A

septum injury and levator muscle

783
Q

treatment of tinea versicolor- Malassezia in fection

A

topical antifungals- topical ketoconazole, terbinafine, clotrimazole)

784
Q

patient with multiple episodes of emesis, x ray with multiple air levels in the small intestine, and some gas in distal colon. Dx? and management?

A

Partial small bowel obstruction

  • initially can be managed with observation and supportive treatment
  • If patient does not improve in the next 12-24 hours then consult surgery
785
Q

What is the best prognostic factor in patients with HIV who have primary CNS lymphoma

A

increase in CD4 count and decrease in viral load.

The degree of immunosupresion seems to be the major determinant in the prognosis of CNS lymphoma.

786
Q

if a patient wants to pursue alllife measures in tto and physician considers its futile, next step?

A

respect patients desire.

With the exception of treatments taht are really futile

787
Q

pregnant women with contractions, at arrival isnoticed to have condiloma acuminata. Next step?

A

expectant vaginal delivery. Cesarea does not decrease the risk of vertical transmission.

cesarea is only indicated if the lesions are large and may obstruct the birth canal.

788
Q

anti Parkinson drugs can cause hallucinations/psychosis due to increased dopamine. If patient is on multiple meds try to reduce the dose of the less potent med

A

true

789
Q

Patient who underwent FNA for cyst that yielded a greenish aspirate, and after that the cyst and ss resolved. Next step

A

Repeat US in 4-6 weeks.

Because if its recurrent/peristent a biopsy is needed as well as additional imaging

790
Q

Patient had a lobular carcinoma in situ identified by needle biopsy, next step

A

proceed with excisional biopsy as it has risk to progress to ductal carcinoma or invasive cancer.

791
Q

screening for lung Ca

A

55-80 years , yearly with low dose CT scan
patients with >=30 years smoking

or
current smoker or quit within the last 15 years.

792
Q

small cell cancer, location and associated with what paraneoplastic syndrome

A

center, smoking, paraneoplastic syndromes
most aggressive, oat cell Klutchitsky cell
ACTH-Cushing
SIADH
Lambert EAton
paraneoplastic myelitis, encephalitis, subacute combined denegernation

chemotherapy+/- radiation

793
Q

Types of non-small cell cancer

A

adenocarcinoma ( peripheral, non smoker, clubbing, arthropathy)
squamous cell carcinoma( central, hilar mass, necrotic, cavitation, hypercalcemia, smoking)
large cell carcinoma(peripheral, ginecomastia, galactorrhea, secretes bhcg)
bronchial carcinoid.

794
Q

prior to starting varenicline , patient should be assessed for

A

psychiatric ss,
it had a black box warning and is CI in current unstable neuropsychiatric status or recent suicidal ideation.

buproprion is an alternative but is contraindicated in seizures.

795
Q

treatment of heat stroke

A

augmentative evaporing cooling- wet sheet and fans. ideally decrease 0.2C/min

It is caused because the pt does not sweat enough to lower the temperature of the body.

796
Q

pregnant women with right adnexal mass concernign for ovarian tumor. next step?

A

surgical resection in the early second trimester and if pathology condfirms tumor that needs chemo then chemo during second and third trimester

** there is no role for tumor markers during pregnancy because the hormines may indicate other things ( ie. high AFP- neural tube defect instead of what is in the tumor)

797
Q

RF for ovarian cancer

A 
Age >=50
Early menarche/late menopause
genetic mutations ( BRCA1,2)
Endometriosis
Infertily
Hormone replacement therapy
798
Q

Protective factors for ovarian cancer

A

multiparity, OCPS

breastfeeding

799
Q

pelvic organ prolapse can cause erosions in vagina or cervix that may present as abnormal vaginal bleeding ( postcoital, postvoid)

A

true

tto is pessary surgery and vaginal estrogen. tohelp heal erosions

800
Q

RF for Pelvic organ prolapse

A

increased age
high multiparity
obesity
history of operative vaginal delivery

801
Q

patient with psychosis. onmarihuana

A

before diagnosing the patient with any psychiatric disorder, make sure that he is off any drug.

high potency marihuana has been associated with paranoia, depersonalization, hallucinations

802
Q

RF fo cervical insufficency

A 
CUCO
Collagen defects
 uterine abnormalities ( bicornuate or septate)
Cervical conization 
obstetric injury
803
Q

Dx of cervical insufficeincy

A

> =2 spontanous second trimester losses
or
current painlessadvanced cervical dilation at < 24 weeks.

804
Q

pregnant patient with cervical insufficiency with prolapsing amniotic membranes, prognosis?

A

very poor!
prolapsing amniotic membranes causes prolong expo to. vaginal flora-high risk of amniotic fluid, preterm membrane rupture, abruptio

prolapsing amniotic membrane is a relative contraindication for cerclaje

805
Q

when do prophylactic cerclage is done

A

12-14 weeks

806
Q

tto of hyperviscosity syndrome ( nasal, oral bleeding, blurry vision, ehadache) in MM

A

plasmapheresi s

807
Q

treatment and complications of impetigo

A

if localized: topical mupirocin
if generalized: orall cephalexin

complications: postrep glomerulonephritis

808
Q

cause of inguinal hernia

A

failed obliteration of the processus vaginalis.

809
Q

prior to initiating TMP SMX for cystitis, always do a pregnancy test!!

A

true

810
Q

treamtne of uncomplicated cystitis in non pregnant and pregnant

A

nonpregnant: nITROFURANTOIN FOR 5 DAYS
TMP/SMX for 3 days
Fosfomycin for a single dose

pregnant: nitrofurantoin
amoxicillin, amoxi clavulanate, fosfomycin, cephalexin

811
Q

Acute cystitis is a common cause of hematura

A

true

812
Q

pathophysiology of immune thrombocytopenia

A

Anti GPIIB/iiiA antibodies- slenic macrophages eat the platelets.
idiopathic or secondary to viral infection , HIV, HCV, SLE, CLL, drug reactions.

813
Q

side effects of combined hormonal contraceptives ( pills, patch, ring)

A

breakthrough bleeding, breast tenderness, nausea

814
Q

SE of depot medroxyrprogesterone acetate( injection)

A 
irregular bleeding initially 
amenorrhea
reversible bone loss
delayed return to fertility 
\+/- weigh gain
815
Q

SE of copper IUD

A

DYSMENORRHEA heavy menstruation

816
Q

SE of depot medroxyrprogesterone acetate( injection)

A 
irregular bleeding initially 
amenorrhea
reversible bone loss NOT ASSOCIATED WITH INCREASED RISK OF FUTURE OSTEOPOROSIS
delayed return to fertility 
\+/- weigh gain
817
Q

TTO OF ONYCOMYCOSIS

A

TFirst line: ORAL terbinafine, itraconazole

Second line: griseofulvin fluconazole

818
Q

TTO OF ONYCOMYCOSIS

A

TFirst line: ORAL terbinafine, itraconazole
Second line: griseofulvin fluconazole

Infection of the skin requires 6 weeks of tto, and of the nail 12 weeks.

819
Q

tto actinic keratosis

A

Tto: field therapy with 5 fluoracil cream for up to 6 weeks
Other treatments: imiquimod cream, topical diclofenac.

Liquid nitrogen cryosurgery ors urgical excision can be done for individual lesions. But is impractical when there are many.

820
Q

how long antidepressants aregiven for in a patient that has already started to feel good?

A

6 months following acute response

Patients with recurrent episodes of major depression, chronic episodes (>=2 years), family history or severe episodes should be considered to be at maintenance, usually 1-3 years.

821
Q

patient with erythrocytosis, that has hematuria. and is a smoker. next step

A

CT abdomen to assess for Renal cell carcinoma

- renal cell carcinoma can cause erythrocytosis.

822
Q

tto of renal cell carcinoma

A

nephrectomy

823
Q

complications of ovarian stimulation syndrome

A 
hemoconcentration respiratory distress
renal failure
DIC
hypotension 
thrombosis
824
Q

patient withdepression on SSRIs that comes at the 2 month follow-up complaining of erectile dysfunction, next step?

A

switch to another class
- bupropion or mirtazapine

SSRI Erectile dysfunction: decreased libido, anorgasmia, delayed ejaculation,

825
Q

antibodies for autoimmune hepatitis

A

ANA and ASMA
autoimmune hepatitis: mild elevation of transaminases. normal ALP,

Anti mitochondrial antibodies are for primary biliary cirrhosis ( high ALP, normal transaminases

826
Q

transient PSA elevation causes and what to do

A 
Urinary retention
Infection 
instrumentation 
digital prostate exam
recent ejaculation

repeat PSA levels in 4-6 weeks

827
Q

Sexually active women < 25 should be screened for cHLAMYDIA with NAAT

A

TRUE, if NAAT positive then screening for other STIs, including HIV should be done.

828
Q

treatment of gonococcal conjunctivitis (2-5) and chlamydia (5-14)

A

1 dose of IM Ceftriaxone or Cefotax

chlamydia: oral eitrho

829
Q

After HIT 2 what is the management of short term and long term coagulation therapy

A

stop all heparin products and give argatroban, bivalirudin.
Given that these are not oral, warfarin is more for long term only started once platelets >= 150,000
as rapidly dropping protein Clevels cause prothrombotic state

830
Q

CML tto

A

Imatinib, tyrosine kinase

831
Q

tto of ischemic priapism ( > 4 hours of erection)vs non-ischemic

A

paspiration of the cavernous corpora followed by irrigation with saline
phenyelphrine (alpha agonist)

non-ischemic( high flow priapism) - angiographic embolization

832
Q

which is the one single item screening fo alcohol abuse?

A

how many times in the past have you had more than 5 drinks?

833
Q

when they ask about the net clinical benefit of a medication you consider both the option that harm and the beneficial one.

A

true

834
Q

ITT approaach goal

A

preserve randomization, avoid effect of crossover and dropout

835
Q

colon cancer screening in average risk vs. high risk pts

A

colonoscopy every 10 years in average risk

high risk:
10 years before the age of relative and repeat every 3-5 years

836
Q

Dx OF SUPERIOR VENA CAVA SYMDROME

A

CT neck and chest

837
Q

Acute fatty liver of pregnancy

A

third trimester, presents with nausea, emesis, and elevation of transaminases ( 300-500s)

838
Q

hellp

A

elevated transaminases
thrombocytopenia ( < 100,000)
proteinuria

839
Q

fatigue, bruising, MAHA, normal coag studies, fever. Dx

A

TTP

840
Q

Anemia in pregnancy

A

< 11 in 1st and 3rd

< 10.5 in second

841
Q

Iron deficiency anemia is associated with increased risk of preterm delivery, cesarean delivery, and increased transfusion.

A

true

842
Q

TTO of TTP

A

pLASMAPHERESIS– remove antubodies agains metalloproteinase

, Glucocorticoids, rituximab

AV_Step 3 UWORLD (8 decks)

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