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Week 1 Flashcards

1
Q

Can abduct one eye but not adduct the other simultaneously, bilateral defect abducting eye has nystagmus? D/P

A

Internuclear opthalmoplegia due to damage to heavily myelinated fibers in MLF from MS

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2
Q

Internuclear opthalmoplegia unilaterally

A

Lacunar stroke or MS

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3
Q

Symptom: Fluctuating and fatigable proximal muscle weakness worsening later in the day: ptosis, diplopia, dysphagia, dysarthria, and even respiratory crisis. D/BT/Tr

A

Best next test: Acetylcholine receptor antibodies with CT scan for thymoma
Treatment: AChEi like pyridostigmine, immunotherapy, and thymectomy

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4
Q

Unexplained fever in someone undergoing severe surgery with grimace to RUQ palpation? (D/BT)

A

Acalculous cholecystitis - first ultrasound then CT or HIDA if needed for diagnosis - due to stasis of gallbladder

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5
Q

Level that prolactin typically reaches in prolactinoma? Effect on LH? Effect on TSH?

A

>

  1. LH low by feedback. TSH may or may not be low by mass effect
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6
Q

Dyspnea in DS patient while feeding after 6 weeks with murmurs at LUSB and LLSB (D/P)

A

complete av-septal defect - loud S 2, systolic ejection murmur from ASD, holosytolic murmur of VSD

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7
Q

Bilateral foot deviation of newborn firstborn which can be pasively and actively moved laterally (D/Tr)

A

metatarsus adductus - no intervention necessary

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8
Q

Rigid position of foot medial/upward deviating forefoot and hindfoot with hyper-plantar flexion (D/Tr)

A

Club foot - manipulation and casting, surgery if it doesn’t work

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9
Q

Who to screen for diabetes?

A

> =45 or risk factors

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10
Q

When to begin low-dose CT screening for lung cancer? How many pack years to qualify?

A

55-80, >30 pack years who have quit <15 years ago

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11
Q

Pap test years division?

A

3 years 21-29, can switch to PAP and HPV every 5 for 30-65

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12
Q

Respiratory failure after infection or fluoroquinolone (or other antibiotic use) - (D/Tr)

A

myasthenic crisis - ICU for airway protection

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13
Q

Management of acute exacerbation of COPD? Sputum cultures?

A

O2 with low target, bronchodilators, systemic glucocorticoids, antibiotics if >=2 cardinal symptoms - 3-7 days, oseltamivir if flue, NPPV if vent failure
DON’T collect sputum cultures unless patient at risk for Pseudomonas

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14
Q

Cardinal symptoms of COPD

A

Increased dyspnea, increased cough, sputum color or volume change

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15
Q

Most common valve issue leading to IE

A

mitral valve prolapse

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16
Q

Was it right for me to start on omeprazole for reflux?

A

Yes, because I had laryngopharyngeal involvment. Otherwise, I would have done lifestyle changes and H2 blocker

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17
Q

Tdap schedule

A

single dose at 11-18 or later if not receiving it then, then vaccine every 10 years and during eachc pregnancy

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18
Q

Blood tinged sputum in young patient who just had a virus with no smoking history and no TB risk factors

A

Bronchitis - reassurance and no further workup

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19
Q

Side effect of haloperidol related to movement in Parkison’s patients?

A

Worsening

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20
Q

Benzos for elderly?

A

No, high risk for withdraw, dependence, motor effects, and paradoxical agitation

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21
Q

Triad of wernicke encephalopathy?

A

Encephalopathy, ocular dysfunction, gait ataxia

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22
Q

Treatment for Wernicke encephalopathy?

A

Thiamine before glucose

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23
Q

Is colposcopy and cervical biopsy performed during pregnancy for high grade cervical carcinoma?

A

Yes

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24
Q

When to use HPV cotesting when evaluating squamous change?

A

Triage atypical squamous cells and low grade

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25
Q

Effects of dopamine antagonism of 2nd gen antipsychotics like risperidone?

A

Tubuloinfundibular - hyperprolactinemia
Nigrostriatal - parkinsonism
Mesolimbic - antipsychotic effect

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26
Q

What happens to FSH and LH levels in menopause?

A

Elevated

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27
Q

How long amennorhea to be considered menopause?

A

1 year

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28
Q

What is premature ovarian failure

A

menopause before 40

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29
Q

Amenorrhea in normal SH and LH setting

A

Check for obesity

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30
Q

Placenta previa precautions and follow-up

A

No intercourse, no digital cervical examination, inpatient admission for any bleeding

Do not need weekly ultrasounds, if not resolved in third trimester ultrasound then C section 36-37 weeks as labor can cause bleeding

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31
Q

Causes of methemoglobinemia

A

Dapsone, n itrites, LOCAL AND TOPICAL ANESTHETICS

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32
Q

Why low O2 sats in methemoglobinemia

A

Absorption spectrum of mehemo - PaO2 is normal

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33
Q

Why methylene blue for methgbemia

A

Reducer for NADPH

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34
Q

Question type: An opacity with minimal fluid layering on lateral decubitus film”

A

fluid question - asking what to do with large and small effusions - small effusions without respiratory distress get oral antibiotics and close follow-up, large get intervention

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35
Q

Cause of HIV-Associated Neurocognitive disorder?

A

Replication of HIV in central nervous system

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36
Q

Precipitous drop in blood pressure in young person with medical Jc of asthma, eczema, pneumonia recurrence after transfusion (D/P)

A

Selective IgA deficiency, lack of IgA allows for formation of antibodies against IgA so if there’s any in a blood transfusion, it can cause anaphylaxis

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37
Q

Palpable purpura, proteinuria, hematuria +non-specific symptoms (D/Associated virus/Lab finding

A

mixed cryoglobulinemia, Hep C, hypocomplementemia

Restudy kidney

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38
Q

What is the most common cause for isolated proteinuria in children and what is the follow up?

A

Transient proteinuria - repeat disptick on two later occassions

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39
Q

Microcephaly, microagnathia, overlapping fingers, rocker bottom feet, and absent palmar crease in newborn?

A

Trisomy 18 (Edwards syndrome)

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40
Q

Heart defect with Edwards?

A

VSD

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41
Q

Is acrocyanosis always pathologic?

A

no, central cyanosis is more predictive

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42
Q

Short term treatment of hypercalcemia for severe, moderate, and assymptomatic?

A

Severe - >14 or symptomatic - NS plus calcitonin short term, bisphosphonate long term.

Moderate (12-14)/Assymptomatic - usually no treatment required unless symptomatic

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43
Q

Antibiotic for trachoma

A

azithromycin

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44
Q

Back pain, normocytic anemia, and arm pain with osteolytic lesion in elderly patient (D/BT)

A

Multiple Myeloma, SPEP/UPEP

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45
Q

When is splenic rupture most likely in mono?

A

3-4 weeks

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46
Q

Pt. with gout presents with a hot red joint, what are two important differentiators? -

A

is this typical for a gout flare, how long did it take to come on (12-24 hours to maximal onset with gout attack)

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47
Q

Do crystals appear in joints when not having active gout attacks?

A

Yes

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48
Q

Claudication like symptoms with postural relief and normal ABI? Most common cause?

A

neurogenic (rather than vascular) claudication - osteoarthritis of the spine

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49
Q

Stages of Lyme disease with treatment:

A

Early - erythema migrans, fatigue, headache, myalgias, arthralgias - early oral doxy

Early disseminated - multiple erythema migrans, unilatera/bilateral CN palsy, Meningitis, carditis, migratory arthralgias - IV ceftriaxone

Late - arthritis, encephalitis, peripheral neuropathy - IV ceftriaxone

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50
Q

High fever, polyarthralgia, and pustular rash (D/Test finding)

A

Disseminated gonococcal infection, normally negative blood cultures due to fastidious growth requirements of N gonorrhoeae

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51
Q

Thyroid levels in any patient with acute, severe illness

A

euthyroid sick syndrome - fall in T3 and T4 from multiple levels

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52
Q

Treatment for papillary thyroid cancer

A

Surgical resection - radioiodine abltation if increased risk of tumor recurrence and thyroid replacement to suppress TSH

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53
Q

Most common fracture in pediatrics from fall on an outstretched hand

A

supracondylar fractures

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54
Q

What is at risk in supracondylar fractures (D/Cl)

A

brachial artery injury or median nerve entrapment - test for neuro and brachial/radial pulses before and after

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55
Q

Differentiate myoclonus due to seizure vs myoclonus due to syncope

A

presence of trigger, presence of aura, head deviation or body posturing, tongue laceration, prolonged postictal phase

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56
Q

What electrolyte level mirrors CHF severity (D/P)

A

hyponatremia, renal hypoperfusion results in release of renin and secretion of ADH

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57
Q

CHF poor prognostic factors? Clinical, Lab, electrocardiography, echocardiography, associated conditions.

A

Clinical - Higher NYHA class, resting tachy, S3 gallop, elevated JVP, Low blood pressure (<100/60), mitral regurg, low peak VO2

Laboratory - Hyponatremia, elevated pro-BNP, renal insufficiency

Electrocardiography - >120 msec QRS, left bundle branch block

Echo - severe LV dysfunction, Concomitant diastolic dynsfunction, reduced RV function, PHTN

Associated conditions - anemia, afib, DM

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58
Q

Why would a mother alloimmunize to Rh factor if she was given the standard dose of anti-D immune globulin?

A

50% of mothers need more than the standard dose of anti-D immune globulin, if placental abruption or other exposures, should perform Kleihauer-Betke test

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59
Q

Very athletic thin female with ammenorhia (D/P/BT)

A

Functional hypothalamic amenorrhea - Hypothalmaic suppression of GnRH, LH, FSH, and ultimately estrogen, does not respond to medroxyprogesterone acetate challenge

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60
Q

Urethritis, asymmetric oligoarthritis, and conjunctivitis, especially with mucocutaneous lesions or Achilles tendon pain (D/Tr)

A

Reactive arthritis - NSAIDS

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61
Q

Flank pain with intermittent episodes of high volume urination

A

renal calculi

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62
Q

Decrease in renal function in cirrhotic patient which does not respond to fluids (D/P)

A

Hepatorenal syndrome - dilation of the splanchnic artery causing activation of the RAS system

Write this down as learning issue

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63
Q

Three risks of cryptorchidism and what can be done about them.

A

Testicular torsion, infertility, and testicular cancer - all three improve with orchipexy before age 1, although cancer risk remains elevated but improved detection with surgical fixation

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64
Q

Extended aggression, agitation, combativeness, psychosis, delerium, myoclonus, and sometimes seizures with unremarkable urine drug screen?

A

Bath salts

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65
Q

Awakening in first 1/3 of night without responsiveness to comfort or recall of dream content

A

sleep terror

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66
Q

What happens to the ovaries when you have a hydatidiform mole?

A

Proliferative trophoblastic tissue secretes B-hCG, causing hyperstimulation of ovaries and formation of theca lutein cysts - bilateral, multilocular ovearian cysts

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67
Q

How to treat a hyatidiform mole

A

dilatation, suction, and curetage or hysterectomy after decrease of B-hCg

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68
Q

What is the maternal analogue of B-HCG

A

LH

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69
Q

yperemesis gravidarum, a large uterus compared to last menstruation, and bilaterally enlarged ovaries? (D)

A

Hyatidiform mole

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70
Q

Multilocular, bilateral 10-15 cm ovaries in face of elevated b-hcg

A

theca lutein cysts

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71
Q

three causes of theca lutein cysts

A

gestational trophoblastic disease, multifetal gestation, interftility treatment

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72
Q

Lower abdominal pain migrating into pleuritic RUQ pain

A

perihepatitis (Fitz-Hugh_curtis) from pelvic inflammatory disease

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73
Q

Treatment for PID

A

Third generation cephalosporin plus azithromycin OR doxy

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74
Q

Complications of PID

A

tubo-ovarian abscess, infertility, ectopic pregnancy, perihepatitis

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75
Q

Why urinary urgency in diverticuluitis?

A

Bladder irritation from inflamed sigmoid colon

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76
Q

Workup for suspected esophageal perf?

A

CXR or CT scan, or water-soluble contrast esophagogram to find leak site - PPI, broad spectrum antibiotics, nutrition, and surgery

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77
Q

HOCM genetic inheritance, clinical manifestation, increase the murmurs

A

Genetic: autosomal dominant
Clinical: Systeloic ejection and dual upstroke pulse due to midsystolic obstruction
Murmur increase: Anything reducing preload - valsalva strain, abrupt standing. Decrease with increased preload OR afterload - squatting, leg raise, hand grip

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78
Q

Role of head thrust test?

A

Detecting vestibulopathy

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79
Q

Cause of oscillopsia

A

bilateral vestibular injury

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80
Q

Inability to recall important personal information after traumatic or stressful event (with travel qualifier)

A

Dissociative amnesia with dissociative fugue

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81
Q

Multiple personality

A

dissociative identity disorder

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82
Q

Anterograde amnesia resolving after 24 hours -

A

transient global amnesia

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83
Q

Spot Hashimoto’s in a question stem

A

Chronic hypothyroidism, +antithyroid peroxidase antibodies

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84
Q

Rapidly enlarging goiter with compressive symptoms with hx of Hashimoto’s

A

thyroid lymphoma , especially common in Hashimoto’s population - retrosternal extension

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85
Q

treatment for slowly progressive, nonpainful swelling of mandible with sulfur granule sinus tracks after dental procedure?

A

Penicillin for 2-6 months with surgery reserved for severe disease

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86
Q

Female athlete triad for stress fracture?

A

Low caloric intake, hypomenorrhea/amenorrhea, low bone density

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87
Q

Clinical presentation of stress fracture? Contrast to shin splints

A

Insidious onset of localized pain, point tenderness, possible negative x-ray - as opposed to shin splints which is diffuse areas of tenderness usually in overweight individuals

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88
Q

Most common cause of meningitis in young infants?

A

Group B strep

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89
Q

Meningitis in infant at 8 days?

A

Horizontally transmitted GBS

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90
Q

Most common cause of recurrent UTI’s in infants and children? (D/BT)

A

Vesicoureteral reflux - voiding cystourethrogram

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91
Q

Most common cause of chronic renal insufficiency/failure?

A

Posterior urethral valves

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92
Q

Large flank masses, respiratory distress, and Potter faces?

A

Autosomal dominant polycystic kidney disease

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93
Q

When is intermittent strabismus a problem?

A

After 4 months of age

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94
Q

Swollen hands and feet with only soft tissue swelling in AA descent w/t low grade fever?

A

Initial presentation of vaso-occlusive crisis in sickle cell anemia

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95
Q

Acute or subacute pain with focal pain at 1 site and positive blood culture in SS?

A

Osteomyelitis

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96
Q

Chronic worsening pain with absence of fever, warmth, or erythema is SS?

A

Avascular necrosis

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97
Q

ARP calculation

A

(risk in exp-risk in unexp)/risk in exp OR (RR-1)/RR

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98
Q

Bilateral hilar adenopathy in middle aged woman (especially AA)?

A

Sarcoidosis

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99
Q

Type of inflammation in sarcoidosis

A

Type of inflammation in sarcoidosis

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100
Q

Evaluation of patient with abdominal pain radiating to the groin with vomiting and unremarkable exam? Why not others?

A

Ultrasound for cheap non-dangerous, spiral CT for detailed information
X-ray - some stones not visible
Contrast CT - contrast not necessary for visualization
IVP - once was test of choice, noncontrast CT better without contrast risks

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101
Q

Most common cause of oculomotor nerve palsy? Differentiator - no parasympathetic change (pupil dilation) but somatic change

A

Ischemic neuropathy - somatic fibers more internal and prone to ischemia

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102
Q

How can loop diuretics cause AGMA?

A

-AKI -> uremia

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103
Q

Compensation from chronic respiratory acidosis of COPD?

A

-Metabolic alkalosis from high bicarb

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104
Q

Treatment of assymptomatic bacturia in pregnancy? (P/BT) What treatments to avoid?

A

Treatment: cephalexin, amoxicillin-clavulonate, or nitrofurantoin with repeat urine culture to confirm clearance after regimen
Why: Progesterone causes smooth muscle relaxation increasing pylonephritis risk and preterm delivery
What to avoid:
Fluoroquinolones - fetal bone deformities
Doxy - grey teeth and bone development
Bactrim: ONLY SECOND TRIMESTER, first trimester messes with folic acid and third due to neonatal kernicterus

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105
Q

recent catheterization, anticoagulation with heparin, sudden onset of hypotension, tachcardia, flat neck veins, and back pain

A

Retroperitoneal hematoma from arterial acess site bleeding

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106
Q

Most common complication of cardiac catheterization?

A

Complication at catheter insertion site

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107
Q

Signs of smoke inhalation injury

A
  1. Burns on the face
  2. Singed eyebrows
  3. Oropharyngeal inflammation
  4. Carbonaceous sputum or blistering carbon deposity
  5. Stridor
  6. Carboxyhemoglobin level >10%
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108
Q

Role of intubation, glucocorticoids, and antibiotics in inhalation injury:

A

Intubation - low threshold, protects against airway edema due to supraglottic injury

Glucocorticoids - contraindicated - diabetogenic and immunosuppressive effects

Prophylactic Antibiotics - not indicated despite increased psuedomonal infection risk

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109
Q

Initial workup for symptomatic children with rapidly increasing head circumference?

A

CT or MRI - not LP

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110
Q

Are SSRI’s safe in pediatric OCD?

A

Yes

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111
Q

Irritant contact dermatitis vs. allergic contact dermatitis

A

Nonimmunologically related vs immunologically related
Similar clinical presentation
Mostly chronic symptoms

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112
Q

Dysmenorrhea with heavy menstrual bleeding that starts in later reproductive years progressing to chronic pelvic pain (D/BT/Tr)

A

Adenomyosis, MRI or pelvic ultrasound, hormonal methods followed by hysterectomy

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113
Q

Heavy menstrual bleeding in endometriosis?

A

No

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114
Q

Unilateral abdominal pain with sudden onset and adnexal mass and lack of doppler flow on ultrasound?

A

Ovarian torsion

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115
Q

With polyneuropathy, pancytopenia, and mild transaminase elevation, can also include hyper/hypopigmentation and hyperkeratosis of palms and soles what exposure should you be watching for (D/Tr)

A

Arsenic, chelation with dimercaprol

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116
Q

Places you might find arsenic?

A

Mining, pesticide, metalwork, antique pressure treated wood

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117
Q

Describe the pubertal development of women by age and phys

A
  1. Activate hypothalmic-pituitary-ovarian axis with pulsatile secretion of GnRH
  2. Breast development 8-12 from estrogen, then pubic hair
  3. Menarche around Tanner stage 4 - 2-2.5 after initial breast bud development, <15 considered normal if everything else changing appropriately
  4. Often growth spurt 6 month before
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118
Q

How to treat ADHD when substance abuse/misuse is a concern? Mechanism of action?

A

Atomoxetine - NE reuptake inhibitor
Buproprion
TCA

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119
Q

Severe PID requiring hospitalization treatment:? What qualifies for inpatient?

A

IV cefoxitin plus oral doxy. High fever, inability to take oral antibiotics, pregnancy, risk of nonadherence, complication

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120
Q

Markedly elevated aminotransferases, signs of hepatic encephalopathy, and synthetic liver dysfunction in setting of acetaminophen and alcohol (D/P/Tr)-

A

ALF, NAPQI, N-acetylcysteine

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121
Q

Wisconsin man has upper lobe consolidation, lytic lesions in anterior ribs, and well-circumscribed verrucous crusted lesions (D/BT/Tr)

A

Blastomycosis, budding yeast from sputum culture, itraconazole or amph B

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122
Q

ever >5 days, conjunctivitis, oral mucosal changes (erythema, fissured lips, strawberry tongue), rash, extremity changes, and cervical lymphadenopathy of >1.5 (D/Tr/BT

A

Kawasaki Disease (Fever +4/5 above), treat with IVIG with 10 days to prevent coronary artery aneurysms, and aspirin. Follow up with echo

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123
Q

Scarlett fever rash vs. kawasaki rash

A

Scarlett fever - sanddpaper, kawasaki, maculopapullar

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124
Q

CONSTIPATIOn, abdominal pain, and polydispia -

A

hyercalcemia in patient using vitamins for osteoporosis (D/P)

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125
Q

Milk-alkali induced hypercalcemia

A

causes renal vasoconstriction and impaired ADH potency -> hypovolemia

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126
Q

Medications raising risk of MAS

A

thiazides, ACEi’s, NSAIDS

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127
Q

Electrolyte imbalance of MAS

A

metabolic alkalosis, hypophosphatemia, hypomagnesemia, AKI, low PTH

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128
Q

what happens in TCA overdose?

A

Cardiac toxicity due to fast sodium channel inhibition in the His-Purkinje system - prolongs repolarization and refractory period - results in hypotension, vtach

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129
Q

Indication for sodium bicarb in TCA overdose? Mechanism of action?

A

QRS > 100 msec. Increased pH causes decreased drug avidity, increased sodium effects TCA’s binding to fast channels

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130
Q

Sodium bicarb for aspirin overdose?

A

increases salicyclate excretion through urine alkalinazation

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131
Q

Elevated opening pressure, low white blood cell count, low glucose, elevated protein (D/Tr) in face of HIV (CD4 count)

A

Cryptococcus meningitis, AmB and flucytosine for 2 weeks then fluconazole for 8 weeks first dose, maintenance for a year. < 100

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132
Q

Respiratory distress, neurologic dysfunction, and petechial rash after fracture of large bones

A

Fat Embolism syndrome

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133
Q

Symptoms of internal capsule ischemia plus vomitting, lethargy, headache?

A

Putaminal hemmorhage

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134
Q

Hypoglycemia in insulin dependent diabetics after meals with dysphagia and uncomfortable fullness (D/Tr)

A

Diabetic gastroparesis - dietary modification and metoclopramide or erythromycin

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135
Q

Most common extracranial solid tumor of childhood? (D/Cl)

A

Neuroblastoma, urine and serum catecholamine elvation

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136
Q

Horner’s syndrome in child with harlequin sign and paravertebral mass -

A

neuroblastoma

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137
Q

Why use ACEi in unilateral RAS?

A

ACEi reduces angiotensin II levels dilating glomerular efferent arterioles - this makes the stenotic kidney RBF fall but the unaffected kidney compensates by not being subject to vasoconstriction

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138
Q

Most sensitive lab value for orthostatic hypotension

A

decreased urine sodium

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139
Q

Colon cancer screening options:

A

Starting at 50 (or 10 years before first degree relative diagnosis)

  1. FOBT annually OR
  2. Sigmoidoscopy q5 years and FOBT q 3 years OR
  3. Colonoscopy every 10 years
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140
Q

Arching of back, frequent spit-ups, poor weight gain in infant

A

GERD

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141
Q

Blood-streaked, mucousy, loose stools or severe constipation

A

Milk protein allergy

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142
Q

Pill induced esophagitis causes

A

tetracyclines, NSAIDs, bisphosphonates, potassium chloride, iron

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143
Q

Agoraphobia and recurrent, spontaneous anxiety attacks? Difference between this and social anxiety disorder?

A

Panic disorder. Social anxiety has specific fear of social humiliation

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144
Q

Not sexually active guy wants STD test

A

HIV screening, 4th gen assay for HIV p24 antigen and HIV antibodies

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145
Q

Partial response to antidepressent for patient who is unable to lose weight and feels fatigued?

A

Buproprion

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146
Q

Dysuria, suprapubic tenderness, and dyschezia

A

Endometriosis on bladder and rectovaginal septum

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147
Q

Uterine sign of potential endometrial implants? Common complication of endometriosis?

A

Fixed in retroversion due to scarring. Infertility

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148
Q

Endometriosis dx and treatment

A
  • Definitive - direct visualization with laparoscopy and surgery
  • Conservative - oral contraseptives and NSAIDS
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149
Q

Assymptomatic adnexal fullness resulting in ultrasound with hyperechoic nodules and calcifications?

A

Dermoid ovarian cyst

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150
Q

Pulmonary nodules after pregnancy?

A

Choriocarcinoma

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151
Q

Simple, thin wall cysts observable in first half of menstrual cycle?

A

Follicular cysts

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152
Q

Homogenous cystic mass with dysmenorrhea?

A

Ovarian endometrioma

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153
Q

Irregular or absent menses with ovaries ringed with multiple simple cysts?

A

PCOS

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154
Q

Multiloculated cystic mass with distortion of normal adnexal structures and systemic symptoms

A

tubo-ovarian abscess

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155
Q

Pelvic pain in a patient with a known ovarian mass?

A

Ovarian torsion until proven otherwise

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156
Q

Pain, fatigue, paresthesias of extremity with concurrent dizziness, ataxia, dysequilibrium worsened with exercise (D/P)

A

Subclavian steal syndrome (severe stenosis) with reverse flow in vertebral artery on same side

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157
Q

Extra gastric symptoms of Crohn’s -

A

uveitis, scleritis, erythema nodosum

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158
Q

Hematuria with scrotal varices and polycythemia (D/BT0

A

Renal cell carcinoma (classic flank pain, hematuria, and palpable abdominal renal mass rare). CT scan of the abdomen best test

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159
Q

Symptom cuttoff for ADHD?

A

Before age 12

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160
Q

Maternal serum quadruple test at 15-20 weeks shows low AFP, low estriol, elevated B-hcg, elevated inhibit? Follow-up test?

A

Down’s. cell-free fetal DNA and ultrasound

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161
Q

Maternal quad screen when tested?

A

15-20 weeks EGA

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162
Q

Maternal quad screen up AFP and normal estriol, B-HcG, inhibin?

A

Open neural tube defects or abdominal wall defects

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163
Q

Maternal quad screen low AFP, estriol, and Bhcg, normal inhjibin?

A

Tri 18

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164
Q

Hyper or hypothermia in cirrhotic patients?

A

Hypothermia, fever should be investigated

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165
Q

SAAG score for SBP?

A

> =1.1 consistent, <1.1 makes SBP unlikely

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166
Q

Fever, RUQ, and gas in gallbladder in patient with vascular compromise, or immunosuppression (D/P/Tr)

A

Emphysematous cholecystitis - Clostridium, surgical resection and parenteral antibiotics

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167
Q

2 year cough with copious sputum production, no smoking history, crackles and wheezing on PE and bilateral atelectasis on CXR (D/P/BT/Tr)

A

Recurrent bronchiectasis, infectious insult with impaired clearance resulting in cyclical bacterial proliferation, airway dilation, airway plugging. HRCT scan for initial diagnosis followed by f/u testing. Need antibiotics unlike viral bronchitis

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168
Q

New intermittent headache in young white overweight female on OCP’s with papilledema? (D/P/Tr)

A

Benign intracranial hypertension, decreased CSF absorbtions, weight reduction followed by acetazolamide if ineffective

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169
Q

Hereditary spherocytosis risk, inheritance, pathogenesis, Lab findings, treatment

A

Northern european descent, autosomal dominant, defect in ankryin gene, up mean hemoglobin, increased MCH concentration and negative Coombs test, folic acid supplementation, blood transfusions, and splenectomy for treatment

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170
Q

Complications of hereditary spherocytosis

A

Pigment gallstones and aplastic crisis from parvo

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171
Q

Tests for hereditery spherocytosis

A

Osmotic fragility on acidified glycerol lysis, abnormal eosin-5-maleimide binding

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172
Q

Paroxysmal nocturnal hemoglobinuria path?

A

Absent CD55

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173
Q

Megacolon and cardiac disease in a brazillian migrant (D/P)

A

Chagas disease, protozoan trpanosoma cruzi resulting in destruction of nerves controlling GI smooth muscle and prolonged myocarditis,

174
Q

Ecephalopathy, hepatic dysfunction, cerebral edema, and increased intracranial pressure in infant with viral infection? Most common cause of death?

A

Reye syndrome, kids treated with salicyclates FOR a viral infection. Cerebral edema

175
Q

PCOS infertility treatment?

A

Clomiphene citrate -SERM that induces ovulation

176
Q

Painless ulcer on sole of foot at head of first metatarsal bone? (D/P/BT)

A

Likely a neuropathic ulcer, develops due to insensible pain due to large fiber damage and autonomic dysregulation leading to dry feet. Best test is HbA1c

177
Q

Ulcer at tips of digits with diminished pulses, skin pallor, or loss of hair (D/BT) -

A

arterial ulcer, ABI

178
Q

Ulcer on medial malleoulus with edema (D/BT)

A

venous ulcer, duplex sonography

179
Q

Anogenital warts virus cause?

A

HPV

180
Q

First step of evaluation of precocious puberty and why - complication

A

Bone age- androgens stimaluate increased bone formation and cartilage growth - premature fusion and short for age

181
Q

Differentiate central PP from peripheral PP

A

-Elevated LH either at baseline or after GnRH stim - means centrally located LH reponse and not periopheral secretion

182
Q

Central PP risk and resulting test?

A

-Usually idiopathic but can be caused by hypothalmic hamartoma, pituitary adenoma, or mass effect - need MRI of head

183
Q

Precocious puberty with advanced bone age and increased basal LH treatment (D/BT/Tr) -

A

Central precocious puberty, MRI for masses, GnRH agonist therapy, helps stop epiphyseal plate fusion

184
Q

Precocious puberty with advanced bone age with no LH response to GnRH stim test (D/BT)

A

Peripheral precocious puberty - Adrenal and pelvic CT evaluates for adrenal or gonadal tumors

185
Q

Premature breast development with normal bone age D/Tr

A

Premature thelarche, reassurance

186
Q

Most common cause of vitamin B12 deficiency? Presenting signs vs. folate?

A

Decreased intrinsic factor, megaloblastic anemia with neuro issues

187
Q

Biochemistry of B12/folate deficiency and why anemia can respond to folate if B12 deficient

A

Folate and cobalmin both cofactors from homocysteine to methionine - folate can improve anemia but does not help neuro

188
Q

Marfanoid habitus with acute chest pain (D/Cl/P)

A

Acute aortic dissection, early diastolic murmur due to aortic regurg, fibrillin-1 AD mutation

189
Q

Fever, urticaria, lymphadenopathy and polyarthralgia one week after beta-lactams or bactrim(D/P/Tr/labs)

A

erum sickness-like reaction - immune complex formation - remove offending agent - hypocomplementemia and elevated inflammatory markers like all Type III reactions

190
Q

Does Acute rheumatic fever typically occur with appropriate antibiotic therapy

A

No

191
Q

What is the EGA after which preeclampsia can be diagnosed?

A

20 weeks

192
Q

Hypocalcemia symptom and most likely cause?

A

Muscle twitching, tetany, and hypotension, hypoparathyroidism or renal disease

193
Q

Hypoglycemic seizures vs ecclamptic seizures?

A

-Anxiety, diaphoresis, tremor

194
Q

Additional risks of ecclampsia? Tr?

A

-Maternal mortality (10% of pregnancy related mortality), abruptio placentae, DIC, cardiopulmonary arrest
Magnesium sulfate followed by expedient delivery

195
Q

Excessive cow’s milk at 1?

A

Iron deficiency anemia - screen all 1 year olds

196
Q

HTN longstanding in young person wit hepitaxis, headaches, or lower extremity claudication (D/Bt)

A

Aortic coarctation, simultaneous pulse palpation and UE and LE blood pressures

197
Q

Bacterila infection of the cornea with extended wear contacts (D/Path)

A

Contact-lense associated keratitis, usually psudomonas or serratia

198
Q

Differentiate anterior uveitis from keratitis?

A

Cornea is spared in anterior uveitis

199
Q

Tinea capitus path and management:

A

Dermatophyte infection due to Trichophyton or Microsporum - Oral griseofulvin or terbinafine

200
Q

dysphoria, fatigue, insomnia, and myalgias after d/c paroxetine (D/P)

A

Antidepressant discontinuation syndrome, happens with short half life SSRI’s suh as paroxetine or venlafaxine

201
Q

SSRI with long half life

A

Fluoexetine

202
Q

Symptoms of iron deficiency anemia

A

Syncope, palpitations, tachycardia

203
Q

Bipolar I vs. Bipolar II vs cyclothymia

A

Bipolar I - mania with or without major deptression
Bipolar II - major depressive episodes and hypomania
Cyclothymia - hypomania and dysthymia but no major episodes

204
Q

Decompensation 2 days after ischemic stroke? BT?

A

Hemorrhagic transmformation - occurs within 48 hours. Emergent CT for urgent surgical decompression

205
Q

Postpartum blues vs. postpartum depression. Which SSRI for postpartum depression?

A

Blues lasts 2 weeks, depression 4-6 weeks. Use sertraline as it is not in breast milk

206
Q

Normal scalp and hair shaft but losing hair rapidly? (D/BT)

A

Telogen effluvium, hair pull test >10-15% pull out

207
Q

Postoperative fever, tachy, ches pain, leukocytosis, and sternal wound discharge?

A

Bacterial mediastinitis - up to 5% of sternal surgeries

208
Q

Afib after CABG

A

Common and self resolving in <24 hours, treat with rate control

209
Q

Fever, leukocytosis, tachy, and chest pain several weeks after pericardium incision?

A

Postepericardiotomy syndrome - autoimmune - NSAIDS, steroids, and pericardial puncture if necessary

210
Q

Management of acute mania with psychotic features?

A

Antipsychotic - lithium would take a few days of titration

211
Q

Role of lamotrigine in bipolar disorder?

A

helpful with depressive episodes

212
Q

Nystagmus, hypertension, violence, and life threatening hyperthermia

A

PCP

213
Q

Elevated blood pressure and heart rate, increased alertness

A

Cocaine

214
Q

Anticholinergic poisoning with history of abuse

A

Jimson weed

215
Q

When does icthyosis vulgaris get worse? How to treat?

A

n winter and later in life. Emollients followed by keratolytics like coal tar and topical rertinoids

216
Q

Bite wound most common organisms and therapy?

A

Strep, staph, eikenella, Haemophilus. Amoxicillin-clavulonate for gram-positive, gram-negative coverage and surgical debridement

217
Q

Anemia, shiny tongue, broad based ataxia, and vitiligo -

A

ikely pernicious anemia (concommitant vitiligo as autoimmune disease) - can have thrombocytopenia or leukopenia as well

218
Q

Path of pernicious anemia

A

autoantibodies against gastric IF, confirmed by anti-IF antibodies

219
Q

Isoniazid side effects and distinction between B12 deficiency -

A

peripheral neuropathy, hepatotoxicity, and sideroblastic anemia (no atrophic tongue)

220
Q

Patient with early syphillis and penicillin allergy?

A

Doxy, single intramuscular penicillin G is usual test

221
Q

Confirming effective treatment in syphillis?

A

6-12 month RPR f/u showing 4 fold drop in titers

222
Q

Digeorge pentad

A

congenital heart disease, facial dysmorphia, thymic, cleft palate, hypocalcemia

223
Q

When DGS is suspected, what should be ordered?

A

Serum calcium levels (due to PT gland hypoplasia) and echo

224
Q

Strongly associated heart anomaly DGS?

A

Truncus arteriosis

225
Q

After splenic infarction, what is the most common cause of bacteremia in SS patients?

A

S. pneumoniae, by far, then other encapsulated organisms like Hib and Nieserria

226
Q

ow is salmonella related to SS?

A

OSTEOMYELITIS - not sepsis

227
Q

ALS approved treatment and mechanism of action?

A

Riluzole - glutamate inhibitor

228
Q

Vaccinations that decrease cancer risk?

A

HPV, Hep B

229
Q

Prolonged hypotension, BUN:Cr <20:1, high urine osmolality, high urine Na, high FENA (D/lab)

A

ATN, muddy brown casts on urinalysis

230
Q

Broad casts

A

chronic renal disease

231
Q

RBC casts

A

glomerular disease or vasculitis

232
Q

WBC casts

A

interstitial nephritis, pyelonephritis, or other kidney infection

233
Q

Fatty casts -

A

nephrotic syndrome

234
Q

Top three causes of AOM in kids?

A

Strep pneumo, nontypeable Hib, moraxella catarrhalis

235
Q

First and 2nd line treatment for AOM in kids

A

Amoxicillin, then amoxicillin-clavulanic acid

236
Q

When give antibiotics for kids >6 months?

A

High fever, severe pain, bilateral disease

237
Q

Treatment for vitiligo? Common comorbidity?

A

Topical corticosteroid for limited disease, oral corticosteroid or calcineurin inhibitors for extensive. Associated with autimmune diseases, especially thyroid disease, especially common

238
Q

MEN1 syndrome conglomerate

A

hyperparathyroidism, gastrin producing tumors, and pituitary tumors

239
Q

Mild thrombocytopenia with circulating Giant platelets and more bleeding than appropriate for platelet level?

A

Bernard-Soulier, AR due to glyco Ib

240
Q

Thrombocytopenia after transfusion of blood cells?

A

Dilutional thrombocytopenia

241
Q

Thrombocytopenia, microangiopathic hemolytic anemia, low clotting factor, prolonged PT and pTT

A

DIC

242
Q

Formation and deposition of platelet rich thrombi -

A

thrombotic microangiopathy - Related to DIC

243
Q

Prolonged Bleeding time and aPPT with normal platelets?

A

Von Willenbrand

244
Q

Substance accumulating in Parkinson’s

A

alpha snyuclein

245
Q

Secondary causes of hypertension and corresponding labs:

A

Renal parenchymal - urinalysis and Cr
Renovascular - Cr, abdominal bruit
Aldosteronism - Hypokalemia, adrenal incidentaloma
Pheo: BP up with tachy, adrenergism
Cushings: Cushingoid
Hypothyroidism: Dry skin, constipation, etc.
Hyperparathyroidism: confusion, psychosis, poluria, Kidney stones
Coarc - differential hypertension with brachiofemoral delay

246
Q

Significant hypertension with PHPT?

A

MEN2 - further eval

247
Q

Severe hypertension with flash pulmonary edema/resistant heart failure?

A

Renal artery stenosis

248
Q

Most common cause of postpartum hemmorhage?

A

Uterine atony

249
Q

Forceps delivery with large baby and soft and boggy uterus over the umbilicus with postpartum bleeding?

A

Uterine atony

250
Q

How to manage PPH

A

IV fluid support, bimanual uterine massage, oxytocin, then uterotonic agents like methylergonovine (contraindicated by hypertension) or carboprost (contraindicated by asthma - hysterectomy in unstable patients

251
Q

Yellow and blue crystals under polyrized microscopy of synovial fluid?

A

Negatively birefringent urate crystals from Gout

252
Q

Treating gout?

A

NSAIDS or colchicine in acute attacks, allopurinol long term

253
Q

Definition of pulmonary hypertension

A

Pressures >25 mmHg

254
Q

Difference between early/late decelerations and variable decelerations?

A

Drop from baseline to nadir is <30 s and not always associated with contractions

255
Q

Cause of variable decelerations?

A

Umbilical cord compression

256
Q

Maternal fever and fetal tachy?

A

chorioamnionitis

257
Q

Sinusoidal FHR tracing?

A

Fetal anemia

258
Q

Cause of early decelerations?

A

Fetal head compression

259
Q

Cause of late decelerations?

A

Fetal hypoxemia

260
Q

What to do with recurrent variable decelerations?

A

Maternal repositioning, then amnioinfusion

261
Q

Argyll Robertson (prostitute’s) pupil and lancinating pains -

A

late neurosphyilis (tabes dorsalis)

262
Q

What are the neuro effects of tabes dorsales?

A

Posterior spinal columns (vibration and proprioception) as well as nerve roots

263
Q

Treatment for neurosyphillis

A

IV penicillin - 10-14 days

264
Q

Subacute combined degeneration and neurosyphillis -

A

B12 has spastic paresis and hypereflexia, neurosyphillis has reduced absent reflexes

265
Q

RLQ pain to diffuse unilateral abdominal pain and shoulder pain while on anticoagulatns after strenuous activity -

A

ruptured ovarian cyst with hemoparitoneum

266
Q

Unexplained neuropathy, abdominal pain, restlessness and tachy? BT?

A

Acute intermittent porphyria, check urinary porphobilinogen levels (elevated)

267
Q

High serum and low urine osmolality with lithium ingestion?

A

Lithium induced nephrogenic diabetes insipidus resulting in ADH resistance

268
Q

Path of hepatorenal syndrome

A

severe liver cirrhosis results in increased NO generation in splancnic circulation causing systemic vasodilation causing renal hypoperfusion resulting in RAAS system upreg worsening overload

269
Q

Does hepatorenal syndrome respond to IV fluids?

A

No

270
Q

How does nephrotic syndrome increase risk of atherosclerosis?

A

Low oncotic pressure increases hepatic lipoprotein synthesis, pts are also hypercoagulable due to loss of ATIII

271
Q

Cause of ileus in face of kidney stone?

A

Vagal reaction caused by uretal colic

272
Q

Is metabolic acidosis appropriately compensated (formula)

A

Winter’s formula - PaCO2 - 1.5*bicarb+8(+/-2)

273
Q

Tinnitus, fever, and tachypnea along with nausea and GI irritation after overdose

A

aspirin intoxication - respiratory alklosis and AGMA

274
Q

NAGMA causes:

A

Diarrhea
Fistula
CA inhibitors
Renal tubular acidosis

275
Q

Risk factors for RTA IV:

A

Diabetic old, damages jg apparatus

276
Q

Fatigue, weakness, borderline hypotension, electrolyte abnormalities, hyperkalemia, hypoglycemia in setting of granulomatous disease (especially TB)

A

primary adrenal insufficiency due to extrapulmonary TB

277
Q

What ingestion can cause a mixed respiratory alkalosis and metabolic acidosis?

A

Aspirin - due to stimulation of medullary respiratory center and AGMA due to decreased renal elimination of organic acids

278
Q

Most likely intervention transitioning a patient from acidemic to alkalemic?

A

Loop diuretic - increased H+ and K+ secretion

279
Q

Common dangerous complication of ADPKD?

A

Berry aneurysm rupture

280
Q

Most common complication of ADPKD?

A

Hepatic cysts

281
Q

Characterization of hypertensive nephropathy -

A

intimal thickening and luminal narrowing of renal arterioles with presence of sclerosis

282
Q

Characterization of diabetic neprhopathy

A

Increased extracellular matrix, basement membrane thickening, mesangial expansion, and fibrosis

283
Q

Sequence of pathology of DM CKD?

A
  1. Year 1 - glomerular hyperperfusion and renal hypertrophy, up GFR
  2. Year 2-5 - glomerular basement membrane thickening, hypertrophy, and mesangial volume expansion, GFR falls
  3. Year 5-10 - Microalbuminuria, later overt nephropathy
284
Q

Nephrotic range proteinuria and hematuria with dense intramembranous deposits staining for C3 (d/P)

A

Membranoproliferative glomerulonephritis Type 2 (Dense deposit disease) - unique that it is caused by IgG antibodies against C3 convertase - results in persistent complement activation and intramembranous deposits

285
Q

AA or hispanic, HIV or heroin -nephropathy

A

Focal segmental glomerulosclerosis

286
Q

Adenocarcinoma, NSAIDS, hep B, or SLE nephopathy

A

Membranous nephropathy

287
Q

Hep and C, lipodystrophy nephropathy -

A

membranoproliferative glomerulonephritis

288
Q

NSAIDS, lymphoma nephropathy -

A

NSAIDS, lymphoma nephropathy -

289
Q

HIV related nephropathy with azotemia and normal sized kidneys -

A

collapsing focal and segmental glomerulosclerosis

290
Q

HIV AND Hep B nephropathy

A

membranous glomerulonephritis

291
Q

Why are ACEi helpful in diabetic nephropathy

A

reduce intraglomerular hypertension and theraby glomerular disease

292
Q

Renal colic but nothing on CXR?

A
  1. Radioluscent stones (uric acid, xanthine)
  2. Calcium stones <1-3 mm in diameter
  3. Non stone obstruction - blood clot, tumor
293
Q

Treating uric acid stones (three steps)

A
  1. Hydration
  2. Alkalinzation of urine to 6-6.5 with oral potassium citrate
  3. Low purine diet
294
Q

Which diuretics hurt and help calcemic kidney stones?

A

Furosemide makes it worse, increases urine calcium. HCTZ makes it better, decreases urinary calcium (used for recurrent stones)

295
Q

Potassium sparing diuretics?

A

Amiloride, triamterene

296
Q

Meds that can cause hyperkalemia

A

b-blockers, K-sparing diuretics,ACE-i, angiotensin II blockers, and NSAIDS

297
Q

What needs to be d/c in AKI in diabetics?

A

Metformin

298
Q

Does low-dose aspirin need to be d/c’d in AKI’s?

A

No

299
Q

Why do we d/c metformin in hospital setting?

A

Contributes to acute renal fialure, liver fialure, and sepsis by increasing risk of lactic acidosis

300
Q

Acute renal failure after hospitalization for MDR pyelonephritis, what antibiotic?

A

Usually aminoglycosides (amikacin)

301
Q

Oliguria in elderly patient on amytriptyline? amitriptyline-induced urinary retention

A

anticholinergic properties, bladder empties under muscarinic control

302
Q

HTN and palpable kidneys (especially right because of anatomical location?) with recurrent bilateral flank pain?

A

Autosomal dominant polycystic kidney disease

303
Q

High CO2 and low bicarb in COPD setting?

A

Acute on chronic CO2 narcosis - normally high CO2 with high serum bicarb

304
Q

Cause of NAGMA in AKI?

A

impaired H+ secretion, ammonia generation, bicarb resorption

305
Q

Define oliguria in adults

A

<250 ml in 12 hrs, <0.5 ml/kg/hr

306
Q

Increased risk of postoperative urinary retention

A

surgical bladder distension, epidural anesthesia use

307
Q

First step in assessing postoperative oliguria

A

portable bladder scan, then catheterization if + or inconclusive

308
Q

Albuterol and beta-adrenergic shifts in electrolytes?

A

Potassium intracellular shift - Na-K ATPase pump and NaK2Cl cotransporter, as well as release of insulin

309
Q

Why does ADH remain “on” during hyponatremic dehydration?

A

Non-osmotic stimulation of ADH in response to ATII

310
Q

When to use sodium bicarb treatment?

A

Salicyclate toxicity, TCA antidepressant, severe metabolicc acidosis, hyperkalemia

311
Q

Causes of acute pericarditis (4)

A

Viral, automimmune, uremia, and Post-MI

312
Q

Treatment of uremic pericarditis

A

confirm no tamponade (>50%), then dialyze

313
Q

Adducted and internally rotated shoulder after seizure?

A

Posterior dyslocation

314
Q

Signs of magnesium toxicity?

A

Somnolence, loss of deep tenden reflex, respiratory depression

315
Q

Prenatal lab tests first trimester (7)

A
  1. Antibody - RhD and antibody
  2. Anemia- Hg, Hct, and MCV
  3. Chronic STD - HIV, VDRL, HBsAg
  4. Immunity - Rubella, varicella
  5. Pap test - if due
  6. Quick std - Chlamydia PCR
  7. Urine - Culture and protein
316
Q

Prenatal tests at 24-28 weeks (3)

A
  1. Anemia - Hg/Hct
  2. Antibody (if RhD neg)
  3. 1 hr GCT
317
Q

Final visit tests prenatal (35-37 weeks)

A
  1. GBS
318
Q

Why GTT at end of 2nd trimester?

A

Placenta secretes hormones to increase maternal insulin resistance to make glucose available for baby. If at risk, should also be tested first trimester for underlying DM2

319
Q

What anticancer drug for hormone sensitive cancers can cause hot flashes? (D/P)

A

Tamoxifen, thermoregulatory dysfunction in anterior hypothalamus

320
Q

Where does tamoxifen exhibit estrogen agonist activity?

A

The endometrium, increases risk of cancer or polyps

321
Q

How long to delay antibiotics in favor of collecting blood cultures in acute IE?

A

1 hour

322
Q

Arthritis with intermittent diarhea and abdominal pain (D/Tr)

A

Spondylarthritis or sacroiliitis with IBD up to 75% - NSAIDS releive the pain but exacerbaate bowel disease

323
Q

Penile fracture with urinary symptoms?

A

Get a retrograde urtethrogram

324
Q

Management for penile fractures

A

Surgery

325
Q

Treatment of carotid stenosis?

A

Symptomatic with >70% stenosis - carotid endartectomy

Assymptomatic -antiplatelet and statin

326
Q

Most common cardiac anomalies in Turner’s?

A

Bicuspid aortic valve and aortic coarctation

327
Q

Metabolic alkalosis in chronic diarrhea?

A

Laxative abuse

328
Q

Melanosis coli - dark brown discoleration of the colon with pale patches of skin

A

due to regular laxative abuse

329
Q

First line treatment for Idiopathic intercranial hypertension?

A

Acetazolamine - CA inhibitor in coroid plexus

330
Q

Cyanosis aggravated by feedingand relieved by crying (D/BT)?

A

Choanal atresia. Pass a catheter, then CT

331
Q

When you see coanal atresia, what else should you look for?

A

CHARGE syndrome - Coloboma, Heart defects, atresia choanae, retardation of growth/development, genitourinary abnormalities, ear abnormalities/deafness

332
Q

Recurrent pregnancy loss with TIA in a young person?

A

Antiphopholipid syndrome with or without SLE

333
Q

Can a subserosal fibroid affect a pregnancy?

A

No, subserosal

334
Q

Infant jaundice, light-colored stools, hepatomegaly, and conjugated hyperbilirubinemia (D/BT/Tr)?

A

Biliary atresia, abdominal ultrasound then scintigraphy, Kasai procedure followed by liver transplant

335
Q

Drugs that can cause crystal induced kidney injuries (6)

A
  1. Acyclovir
  2. Sulfonamides
  3. Methotrexate
  4. Ethylene glycol
  5. Protease inhibitors
  6. Uric acid (tumor lysis syndrom)
336
Q

MRI for eye foreign body?

A

NEVER - can displace object

337
Q

Turner syndrome with systolic murmur at left infraclaviclar area?

A

Aortic coarc

338
Q

Turner syndrome endocrine

A

streak ovaries - no inhibition, elevated LH and FSH

339
Q

Hypoxemia, tachycardia, tachypnea without evidence of rib fracture in trauma patient and patchy alveolar infiltrate on CXR

A

Pulmonary contusion, get a CT (CXR takes a while to show

340
Q

What is the risk of not treating hyperthyroidism?

A

Bone loss and increased risk of fracture and cardiac tachyarrythmias

341
Q

Mechanism of action of heparin?

A

Binding antithrombin which inactivates Xa and prolongs aPPT

342
Q

Progress of a thrombus 5 days into heparin (D/P)?

A

Type 2 heparin-induced thrombocytopenia, conformational change to platelet surface PF4 causes immune system to form IgG antibody, resulting in thrombocytopenia AND activated platelets

343
Q

Heart failure in a young person months after a knife stabbing?

A

AV fistula - shunting of blood from arterial to venous system

344
Q

ABI < 0.9?

A

Diagnostic of occlusive PAD

345
Q

One time screening for men 65-75 w/t history of smoking?

A

Abdominal aortic aneurysm

346
Q

How to diagnose Hep C?

A

Two steps as almost half of patients spontenously clear - first serologic test for HCV antibody then confirmatory molecular test for Hep C

347
Q

ebrile wasting disorder in immunocompromised with pulmonary, mucucuntaneous, and reticuloendothelial manifestations and pancytopenia (D/BT)

A

Histo - serum or urine antigen immunoassay, not initial fungal cultures due to 4-6 weeks incubation

348
Q

Treatment for histo

A

IV amphotericin B then oral itraconazole for a year of maintenance

349
Q

Hypertension, hypokalemia, and undetectable renin in someone on multiple anti-hypertensive therapies (D/P)?

A

Hyperaldosteronism - adrenal adenoma or bilateral adrenal hyperplasia vs. Cushing’s vs. , hypokalemia often unmasked with diuretics

350
Q

What is aldosterone escape?

A

In response to aldosterone, body ups renal blood flow, GFR, and NA excretion through ANP

351
Q

Treatment of primary Raynaud’s?

A

CCB - B-blockers WORSEN condition

352
Q

Risk of congenital melanocytic nevus being cancerous?

A

Up to 5% depending on size

353
Q

Another name for Mongolian spots?

A

Congenital dermal melanocytosis

354
Q

Arteries that lead to interventricular septum

A

LAD or right coronary

355
Q

Differentiate papillary muscle rupture and ventricular wall rupture by clinical signs?

A

Mitral regurg - soft murmur with no palpable thrill

356
Q

REcommended vaccines during normal pregnancy

A

Tdap, inactivated influenze, RhoD

357
Q

High risk patient pregnancy vaccinations

A

Hep A, Hep B, Pneumococcus, Hib, Meningococcus, Varicella-zoster Immunoglobulin

358
Q

what is the q-tip test?

A

Diagnoses urethral hypermobility - angle of >= 30degrees from horizontal on increase of abdominal pressure

359
Q

What causes impetigo?

A

GAS and staph aureus

360
Q

treatment of impetigo?

A

Mupirocen (topical)

361
Q

Out of proportion abdominal pain, elevated amylate, and metabolic acidosis (D/Bt)

A

acute mesentaric ischemia, CT angio

362
Q

Continued ear drainage in a child with proper antibiotic therapy? Ear finding?

A

Cholesteotoma. Retraction pocket filled with debri

363
Q

CMV retinal presentation?

A

Full thickness inflammation that moves centripetally from the vasculature

364
Q

Yellow-white fluffly lesions along vasculature of eye -

A

CMV - diagnostic

365
Q

Treatment for CMV retinitis -

A

valganciclovir usually, intravitreal injections if near the nerve or feovea

366
Q

Mumps possible complications

A

parotiditis, orchitis, and aseptic meningitis

367
Q

Intermittent, fever, malaise, weight loss, chronic rhinosinusitis, lower respiratory tract involvement leading to tracheal narrowing, multiple lung nodules with cavitation, and renal envolvement

A

Wegeners/ granulomatosis w/t polyangiitis

368
Q

Complication of Wegener’s -

A

necrotizing crescentic pauci-immune glomerulonephritis

369
Q

Diagnosis of granulomatous polyangitis

A

p-ANCA and tissue biopsy

370
Q

Treatment of wegener’s

A

high dose corticosteroids and cyclophosphamide or rituximab

371
Q

Fever, lower abominal flank pain, and abdominal pain with hip extension

A
  • psoas abscess
372
Q

Best med to slow diabetic nephropathy?

A

ACEi

373
Q

CNS stimulation, GI disturbances, and Cardiac toxicity in COPD’r who recently took cipro?

A

Think theophylline toxicity, subject to cytochrome oxidase system

374
Q

NSCLC mets to brain in a patient <65 with good functional performance status and stable extracranial disease

A

Aggressive treatment, surgical resection followed by whole brain radiation therapy, no chemo in NSCLC

375
Q

Noncaseating GI tract granulomas

A

Crohn’s disease

376
Q

Treatment order for acne and path of acne

A

Path - increased sebum, follicular hyperkeratinization, bacterial colonization, and inflammation
Treatment - topical retinoids, benzoyl peroxide, then topical erythromycin

377
Q

Hard, unilateral, non-tender node in the submandibular or cervical region in an old smoker?

A

SCC - prompt biopsy

378
Q

What causes achalasia?

A

Impaired peristalsis and inability for LES to relax

379
Q

Best test for diagnosis of achalasia?

A

Manometry

380
Q

When not to use albuterol for hyperkalemia

A

active coronary artery disease

381
Q

Late stage complication of radiation therapy?

A

Constrictive pericarditis

382
Q

Findings of constrictive pericarditis?

A

Hepatojugular reflux, Kussmaul’s sign, and pericardial knock

383
Q

Differential for hematochezia in toddlerhood

A

hemorrhoids, infectious colitis, intussusception, Meckel’s and aIBD

384
Q

Cause of meckel’s

A

incomplete obliteration of vitelline duct

385
Q

Most frequent location of atopic foci causing Afib?

A

Pulmonary veins

386
Q

When is acanthosis nigricans concerning?

A

Sudden appearance in middle aged or elderly, especially if they have lost weight and in uncommon spots - suggestive of GI or GU malignancy

387
Q

If failing treatment with initial max dose SSRI, do what?

A

Switch to another first line like venlafaxine (SNRI)

388
Q

When is buproprion contraindicated?

A

Bulemia nervosa

389
Q

Nonreactive NST next step? What is it?

A

Biophysical profile - NST plus ultrasound of amniotic fluid index and fetal status.

390
Q

What is a contraction stress test -

A

administering oxy until 3 contractions every 10 minutes - contraindicated in placenta previa and prior myectomy

391
Q

Use of umbilical artery flow velocimetery?

A

Monitor fetal growth

392
Q

Components of BPP and negative test?

A 
Reactive HR (2), Amniotic lfuid folume (2, >2cmx1cm), Fetal movements >3 (2), >1 episode of flexion/extension (2), and >=1 breathing episode (2).
0-4/10 - fetal hypoxia due to placental insufficienc
393
Q

Meningococcal schedule -

A

initial at 11-2, booster age 16-21

394
Q

What kind of vaccine is yellow fever

A

Live attenuated

395
Q

Is acute prepatellar bursitis usually due to infection?

A

Yes- staph aureus, aspirate the fluid

396
Q

severe headache, abdominal pain, nausea, and vomitting with htn and +hcg in <20 week EGA

A

likely pre-eclampsia due to hyadatiform mold

397
Q

Signs of alcohol abuse

A

number of drinks, liver functions AST>ALT 2:1, macrocytosis

398
Q

Suprapubic pain radiating to back or hips made worse by weight-bearing after giving birth to large baby?

A

pubic symphasis diastesis

399
Q

White matter demylenation with no surrounding edema in HIV with low CD4 count?

A

Progressive multifocal leukencephalopathy due to JC virus

400
Q

New breast mass with foamy macrophages and fat globules and concordant path findings on excision?

A

Fat necrosis - reassurance and follow-up

401
Q

Serous otitis media in HIV+ path?

A

Lymphadenopathy or obstruting lymphomas

402
Q

Digitalis toxicity cardiac finding?

A

Atrial tachycardia with AV block - increases ectopy in atria while decreasing conduction through AV block

403
Q

Multifocal atrial tachycardia association?

A

Pulmonary disease

404
Q

Leading cause of blindness in the USA?

A

Diabetic retinopathy

405
Q

Findings of diabetic retinopathy? 3 types

A
  1. Microaneurysms, hemorrhages, exudates, and retinal edema
  2. Pre-proliferative reinopathy with cotton wool spots
  3. Proliferative/malignant retinopathy - newly formed vessels
406
Q

Side effect of terazosin -

A

orthostatic hypotension and dizziness

407
Q

Side effect of 5-alpha reductase inhibitors (“sterides”

A

decreased libido, ED

408
Q

Amiodarone side effects

A

Cardiac: Sinus brady, can be proarrhythmic, QT prolongation and torsades
Pulmonary: Chronic interstitial pneumonitis
Endocrine: Thyroid dysfunction
GI: Hepatitis
Ocular: Corneal microdeposits, optic neuropathy
Derm: Blue-gray skin
Neuro: Peripheral Neuropathy

409
Q

What causes anemia of prematurity?

A

Normally, EPO drops due to O2 concentration after delivery, resulting in blood nadir at 2-3 mo of life. For preterm infants, low EPO + short RBC life span +frequent phlebotomy can lead to frank anemia

410
Q

Medical causes of priapism?

A

Alpha-1 antagonists, TRAZADONE, some SSRI’s, PDE-i, meth and cocaine

411
Q

Non-medication causes of priapism?

A

Perineal trauma, sickle cell disease

412
Q

One of the most common non-pulm complications of CF?

A

Sinopulmonary disease - opacifications seen as early as 8 mo

413
Q

The 5 H’s and T’s of PEA:

A
  1. Hypovolemia Tension Pneumo
  2. Hypoxia Tamponade
  3. Hydrogen ions Toxins
  4. Hyper/Hypokalemia Thrombosis
  5. Hypothermia Trauma
414
Q

Treating PEA

A
  1. CPR then epinephrine
415
Q

Difference between treating PEA and pulseless Vtach

A

shock the Vtach

416
Q

Intense pruitus, dyspareunia, dysuria, and porcelain-white polygonal patches with atrophy?

A

Lichen sclerosis - still do a punch biopsy to rule out vulvur SCC as it is a premalignant lesion

417
Q

Treatment for lichen sclerosis

A

high-potency topical corticosteroid (clobestasol)

418
Q

High fever and rigidity on antipsychotic (D/Tr)

A

Neuroepileptic malignant syndrome - stop antipsycotics and use dantrolene if refractory

419
Q

Differentiated NMS from serotonin syndrome?

A

Lead pipe rigidity in NMS, not in serotonin syndrome

420
Q

Stuttering stroke progression with periods of improvement?

A

Thrombotic

421
Q

Abrupt and maximal at start?

A

Ischemic/embolic

422
Q

Progressive symptoms over minutes to hours with early focal neuro symptoms then intracranial pressure increase?

A

Intracerebral hemmorhage

423
Q

Severe headache with meningial irritation signs and no focal deficits?

A

Spontaneous subarachnoid hemmorhage

424
Q

Is afib automatically increased stroke risk?

A

No, need structural heart defect as well

425
Q

Low APGAR?

A

pulse ox and PEEP

426
Q

Electrolyte abnormality post thyroidectomy?

A

Possible hypocalcemia due to accidental removal of paratyhroid gland

427
Q

Elevated LDH and anemia with preeclampsia?

A

Microangiopathic hemolysis

428
Q

Most common complication of preeclampsia -

A

fetal grwoth restriction, low birth weight

429
Q

Fever and maculopapular rash one week after MMR vaccine?

A

Vaccine strain measles

430
Q

Signs of co-ingestion of alcohol with benzo’s

A

Bradycardia, hypotension, respiratory depression, or hyporeflexia

431
Q

Painful red eye with photophobia, tearing, and diminished visual acuity and abdominal symptoms

A

anterior uveitis

432
Q

Valproate effect on infants? Alternatives for bipolar use?

A

Neural tube defects, Lamotrigine is safe

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