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Week 2 Flashcards

1
Q

Treatment of uncomplicated cdiff?/ what about fulminant? -

A

oral vanc or fidaxomicin, high dose oral vanc and iv metronidazole

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2
Q

Most likely Septic arthritis bugs birth to 3 months (plus treatment)

A

Staph, GBS, gram neg bacillus - Naf or vanc PLUS gent or cefotaxime

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3
Q

> 3 mo septic arthritis bugs and antibiotics

A

Staph, GAS, strep pneumo - Naf, clinda, cefazolin, or van

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4
Q

How can HS purpura increase the risk of intussusception?

A

Formation of small bowel hematoma from autoimmune vasculitis

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5
Q

4 T’s of anterior mass

A

Thymoma, teratoma, thyroid neoplasia, and terrible lymphoma

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6
Q

Differentiate seminomatous and nonseminomatous germ cell tumor in med?

A

AFP is essentially always normal in seminomatous tumors, nonseminomatous germ cell generally have levated AFP and b-hcg

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7
Q

Systolic murmur at apex that shortens with squatting in young healthy woman with chest pain?

A

Mitral valve prolapse

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8
Q

Murmurs that worsen with valsalva strain? Why?

A

HCM - decreased preload causes noisier murmur

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9
Q

The confusion murmur pattern of MVP?

A

Louder with decreased preload because murmur extends over longer period, softer with increased preload because murmur happens later/shorter in cycle

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10
Q

Murmurs that worsen with squatting? Why?

A

Aortic regurg, mitral regurg, VSD - up venous return, afterload, and regurgitant fraction

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11
Q

Murmurs that get worse with handgrip

A

AR, MR, VSD - up afterload, up blood pressure, up regurgitant fraction

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12
Q

Murmurs that get better with squatting

A

HCM, MVP - presumed opposite of valsalva strain

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13
Q

Murmurs that get better with handgrip?

A

HCM and AS

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14
Q

Most dangerous component of hereditary angioedema? What levels are depressed?

A

Laryngospasm. C4 levels depressed due to C1 complex cleavage

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15
Q

Examples of Type II (antibody mediated) hypersensitivity

A

Immune hemolytic anemia, Rh disase of newborn. IgG or IgM react with cell-bound antigens

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16
Q

Examples of Type IV hypersensitivity

A

tuberculin skin test and allergic contact dermatitis

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17
Q

IgE-mediated hypersensitivity examples

A

anaphylaxis caused by mast cell and basophil degranulation

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18
Q

Example of Type III hypersensitivity

A

Antibody complex as in serum sickness - causes joint swelling, fever, and rash

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19
Q

Cyclophosphamide side effects on bladder

A

Hemorrhagic cystitis and bladder cancer from metabolite

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20
Q

Acute symmetrical arthralgias with mild synovitis involving the small joints of the hands and normal ESR

A

likely viral parvo B19 - related to anti-parvovirus IgM levels

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21
Q

Guanfacine, clonidine mechanism of action?

A

Alpha 2 adrenergic receptor agonists

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22
Q

Venlafaxine mech of action

A

SNRI

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23
Q

Clomipramine mech of action

A

TCA

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24
Q

Preferred drug of treatment for refractory tourette’s

A

Risperidone - first gen approved but second gen studied

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25
Q

Treatment of macroprolactinoma’s/ symptomatic tumors?

A

Dopaminergic agonists (like cabergoline and bromocriptime) both can normalize prolalctin and potentially reduce tumor size

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26
Q

Normocytic anemia, thrombocytopenia, and acute renal injury following diarrheal illness (Cl/Path/Tr)

A

HUS - Ecoli O157H7), fluid and electrolyte management, blood transfusions, dialysis

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27
Q

Path of HUS:

A

Shiga toxin damages renal glomeruli, leading to platelt agregation, microthrombi formation, and microangiopathic hemolytic anemia

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28
Q

Dangerous polyp signs -

A

adenomatous, vilious, high grade dysplasia, large, and high number

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29
Q

Finding a sessile polyp and treatming, what next?

A

Careful follow-up as sessile polyps can indicate synchronous advanced neoplasia

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30
Q

Differentiate glucocorticoid myopathy and statin myopathy

A

Statin myopathy hurts and has elevated CK

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31
Q

How does high estrone levels produce infertility?

A

High estrone levels cause more frequent GnRH and preferentially produce LH resulting in imbalance in LH and FSH, resulting in FAILURE of folicular maturation and oocyte release

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32
Q

Nausea, vomiting, uterine fundal tenderness with PROM - suspect

A

Chorioamnionitis

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33
Q

Dx of chorioamnionitis

A

maternal fever plus either fetal tachy >160 for 10 minutes, maternal leukocytosis, maternal tachy, or purulent amniotic fluid

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34
Q

Standard Ob indications for C-section

A

nonreassuring fetal tracing, breech presentation, prior uterine surgeries

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35
Q

Treatment for uncomplicated chorio

A

broad spectrum antibiotics and expedited delivery

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36
Q

Clicking sensation when palpating space between 3rd and 4th toes in a runner -

A

Morton neuroma - mechanically induced neuropathic degeneration of the interdigitdal nerve

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37
Q

Phenytoin effect on fetus

A

Hydantoin syndrome - orofacial clefts, microcephaly, nail/digit hypoplasia, cardiac defects, dysmorphic faces

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38
Q

Age >65, monoarticular arthritis, chondrocalcinosis in knees or ankles

A

pseudogout

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39
Q

Constochondral joint hypertrophy in an infant - “rachitic rosary”, large anterior fontanel, femoral and tibial bowing, and craniotabes

A

Ricketts- deficiency of vitamin D or calcium

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40
Q

Risk factors for Rickets

A

breast milk alone or homeamde baby food - need vitamin D supplementation

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41
Q

Rickets X-ray finding

A

genu varum, enlargement of costochondral joints, and metaphyseal cupping and fraying

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42
Q

Large anterior fontanel, lethargy, feeding difficulties, and macroglossia

A

congenital hypothyroidism

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43
Q

Frontal bossing, anterior bowing of shins, saddle nose deformity, and notched, gap teet

A

Hutchinson teeth

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44
Q

Lab findings of Ricketts

A

low/normal calcium, phosphorous, elevated alkaline phosphatase, elevated PTH, low Vit D

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45
Q

Secondary causes of psuedogout?

A

Hyperparathyroidism, hypothyroidism, hemochromatosis

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46
Q

Bronze diabetes?

A

Hemochromatosis

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47
Q

Most common cause of septic arthritis in a young, sexually active individual?

A

Migratory asymmetric polyarthralgias

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48
Q

Migratory asymmetric polyarthralgias

A

Differentiate gonococcal and non-gonococcal septic arthritis?
Nongonococcal is usually a single joint

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49
Q

Comorbidity with ankylosing spondylitis?

A

Anterior uveitis

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50
Q

Risk factors for compressive neuropathy?

A

Obesity, diabetes, hypothyroidism, and pregnancy

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51
Q

Muscle biopsy in polymyositis?

A

Mononuclear infiltrate surrounding necrotic regenerating muscle fibers

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52
Q

Chronic malabsorptive diarrhea, protein enteropathy, weight loss, and migratory non-deforming arthritis with lymphadenopahty,with small intestinal biopsy showing PAS-positive macrophages with non-acid fast gram-positive bacilli

A

Whipples - watch for CNS, myocardium, or eye

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53
Q

Workujp for developmental hip dysplasia -

A

hip ultrasound

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54
Q

Loss of abduction and internal rotation of the hip in a 12 year old boy?

A

SCFE

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55
Q

Catching during loaded rotation or etension of the knee

A

medial meniscus tear

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56
Q

Adverse effects of methotrexate:

A

Macrocytic anemia 0 inhibits dihydrofolate reductase - interfering with the cellular utilization of folic acid and causing folic acid depletion

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57
Q

Mechanism of action of succinylcholine

A

depolarizing neuromuscular blocker - causes influx of sodium ions and efflux of potassium ions

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58
Q

When to avoid succinylcholine

A

crush, burn, disuse muscle atrophy, and denervation injury - upreg of acetylcholine receptors and hyperkalemia at baseline - use nondepolarizing neuromuscular blockers instead

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59
Q

Side effect of halothane

A

hepatoxic intermediary compounds

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60
Q

Who to avoid using etomidate

A

elderly and critical illness patients, inhibits 11b-hydroxylase leaving to insufficient stress reaction

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61
Q

NO reaction with B12

A

inhibition, can lead to serious neurotoxicity if used in someone with preexisting vitamin deficiency

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62
Q

Propofol effect on blood pressure?

A

Severe hypotension, watch out in cardiac patients

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63
Q

Intense pruitus after hot bath, headaches, hepatosplenomegaly? Common comorbidity?

A

Polycythemia vera. Gout

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64
Q

Polycythemia vera. Gout

A

5-7

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65
Q

Groin and upper thigh pain with weight bearing and activity in an elderly gentleman?

A

OA

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66
Q

What is osteitis deformans?

A

Paget’s disease

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67
Q

Why use bisphosphonates in RA?

A

Pain makes activity level low raising risk of osteoporosis

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68
Q

Examination findings of Ankylosing spondylitis

A
  • Reduced chest expnasion
  • Enthesitis
  • Dactylitis
  • Uveitis
  • Arthritis
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69
Q

Complications of Ank Spon

A
  • Osteoporosis/vertebral fractures
  • Aortic regurg
  • Cauda equina
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70
Q

What is polymyalgia rheumatica?

A

Pain and stiffness of neck, shoulder, and hip muscles in patient over 50

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71
Q

Fevers and symmetric polyarthralgia in young person which resolves over the course of weeks?

A

Parvo

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72
Q

Nephrotic syndrome with palpable kidneys, hepatomegaly, and ventricular hypertrophy in the setting of chronic inflammation is likely due to….

A

Secondary amyloidosis - aim to resolve the chronic disease

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73
Q

Supportive labs for Kawasaki’s

A

ESR, CRP, thrombocytosis, and sterile pyuria

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74
Q

Treatment for Kawasaki

A

Aspirin plus IVIG

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75
Q

Echo for kawasaki

A

at time of diagnosis then 6-8 weeks later

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76
Q

Pain at the inferior pole of the patella with overuse?

A

Patellar tendonitis

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77
Q

Overuse knee injury with worsening pain with descending steps or hills?

A

Patellofemoral stress syndrome

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78
Q

Traction apophysitis of tibial tubercle?

A

Osgood- Schlatter

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79
Q

Innapropriate response to local skin trauma with underlying inflammatory disease?

A

Pyoderma gangrenosum

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80
Q

Diagnosis of adhesive capsulitis

A

decreased passive and active range of motion <50%

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81
Q

What can you use for chronicc paraspinal pain?

A

TCA’s or duloxetine - avoid opioids

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82
Q

What can loop diuretics cause heart wise? What other medication side effects can it potentiate?

A

Loop diuretics can cause hypokalemia and hypomagnesemia leading to v tach, potentiates side effects of digoxin

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83
Q

First line therapy for torsades in conscious stable patients?

A

IV mag

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84
Q

Acute termination of paroxsysmal supraventricular tachy?

A

Adenosine

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85
Q

Torsades due to quinine?

A

Sodium bicarb

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86
Q

Macrolides, fluoroquinolones, antifungals effect on the heart?

A

Prolonged QT

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87
Q

How to confirm amyloidosis

A

Abdominal fat pad tissue biopsy

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88
Q

What is the strongest predictor of stent thrombosis?

A

Premature discontinuation of antiplatelet therapy

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89
Q

Unique drug to improve mortality in AA patients in Heart failure?

A

hydralazine and nitrates

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90
Q

Temp of 104 after collapse with CNS dysfunction? Can be accompanied by?

A

Exertional heat stroke, DIC or hepatic/renal fialure

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91
Q

Hypertension in an otherwise well woman of child bearing age?

A

Check for oral contraceptive use, can cause hypertension

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92
Q

What is the primary mechanism of action of nitrates?

A

Systemic vasodilation and decrease in cardiac preload - reduction in left ventricular wall stress - arteries are already vasodilated by phsiologic properties

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93
Q

How does niacin cause flushing and pruitius?

A

Prostaglandin-reated reaction through drug induced release of histamine and prostaglandins - can be improved by aspirin prophylactically before

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94
Q

165/75 regular blood pressure?

A

Isolated systolic hypertension due to reduced compliance of aorta

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95
Q

How does adenosine stress testing work?

A

Adenosine is a coronary vasodilator - preferentially dilates non-stenosed vessels

96
Q

Management of Acute decompensated heart failure

A

IV furosemide and nitroglycerin if patient does not have hypotension

97
Q

Symptoms of acute dig toxicity?

A

norexia, nausea, vomiting, pain, weakness, and confusion.

98
Q

Symptoms of chronic dig toxicity

A

more pronounced neuro than gi, lethergy, fatigue, confusion and visual issues

99
Q

What to do with digoxin when starting amiodarone?

A

Decrease by 25%-50%

100
Q

Effect of green veggies on warfarin?

A

Lots of vit K, decrease effect

101
Q

CYP p450 inhibitors -

A

all the common drugs - acetaminophen, NSAIDS, antibiotics/antifungals, omeprazole, SSRI’s
Outliers - thyroid hormone, amiodarone, cimetidine

102
Q

Diminished pulses in all lower extremity areas with claudication signs - sight of occlusion?

A

Aortoilliac occlusion (Leriche syndrome) at the bifurcation

103
Q

Altered mental status, lactic acidosis, seizures, and coma in a patient who is being treated for volume overload HFrEF

A

Cyanide toxicity

104
Q

splitting inccreasing with inspiration, high pitched noise after S1, and crescendo decrescendo systolic murmur over left second intercostal space in a 18 yo F

A

Pulmonic stenosis

105
Q

Elevation and equalization of intracardiac diastolic pressures?

A

Cardiac tamponade

106
Q

Triad of hypotension, elevated JVP, distant heart sounds?

A

Beck’s triad, cardiac tamponade

107
Q

Medication causes of SIADH?

A

Carbamazepine, SSRI’s, NSAIDS

108
Q

Non medication causes of SIADH

A

Lung disease, ectopic ADH from SC lung cancer

109
Q

Lab findings of SIADH

A

hypotonic blood <275 mOsm/kg, hypertonic urine >100 mOSM/kg, Urine sodium >40

110
Q

Who is at risk of INH induced peripheral neuropathy?

A

Pregnant, diabetes mellitus, comorbidity resulting in reduced stores of pyridoxine

111
Q

Can PCP be cultured?

A

No

112
Q

Placental abruption vs placental accreta

A

abruptions - placenta prematurely separates leadign to bleeding beedtween placenta and decidua - uterus distended, tender, vaginal pbleeding, fetal hypoxia
Accreta - placenta into myometrium, PPH

113
Q

Keep eating in end stage colon cancer?

A

Megesterol acetate

114
Q

Watery diarrhea with facial flushing, lethergy, muscle weaknesses/cramps and pancreatic mass (D/BT)? Check for?

A

VIPoma, VIP level (>75), hyperthyroidism as part of MEN syndrome

115
Q

Sturge Weber chromosome, path, diagnosis, managment -

A

GNAQ, leptomeningeal capillary-venous malformation resulting in seizures, visual field defects, glaucoma delay, MRI of brain w/t contrast, laser therapy and IOP reduction

116
Q

Iron levels in thalassemia?

A

Elevated

117
Q

TIBC in anemia of chronic disease?

A

Decreased (trying to hide the iron

118
Q

Confirmation of priamry schlerosing cholangitis?

A

ERCP or MRCP

119
Q

What to do for medium to large sized non-bleeding esophagela varices

A

nonselective beta blockers - decreases portal flow through alpha mediated vasoconstriction- can do ligation as alternate

120
Q

Tremors, agitation, anxiety, delirium, psychosis, seizures, tachy, palpitations

A

Alcohol or benzo’s

121
Q

Opiod withdrawal onset

A

within 6-12 hours, peak within 3 days

122
Q

Causes of symmetric fetal growth restriction

A

Fetal growth anomalies and first trimerster infection

123
Q

Assymettric fetal growth restriction cause

A

-Abdominal growth restriction more pronounced dthan head growth restriction due to fetal adaption to chronic insufficiency

124
Q

Sjogran’s syndrome diagnostic antibodies

A

anti-Ro, anti-La

125
Q

Flank pain and hematuria after blunt trauma workup -

A

contrast enhanced CT then IV pyelography if surgery needed

126
Q

Most common cause of spontaneous lobar hemmorhage in adults >60

A

Cerebral amyloid angiopathy - amyloid deposition leads to arterial weakness - related to Alxheimer disease

127
Q

All children < 2yo with their first febrile UTI should undergo what test?

A

Renal and bladder ultrasound

128
Q

Newborns < 1 month with UTI or children with recurrent UTI’s or non ECOLI UTI what test?

A

Voiding cystourethrogram

129
Q

Diffuse hypertonicity and difficulty feeding in unimmunized infant?

A

Neonatal tetanus

130
Q

Treatment for neonatal tetanus?

A

Penicillin and tetanus IgG

131
Q

Lambert Eaton spot of dysfunction

A

voltage gated calcium channels in presynaptic motor nerve terminal

132
Q

LE associaton?

A

Small cell lung cancer in up to 50%

133
Q

Sideroblastic anemia vitamin malfunction/deficiency

A

pyridoxine - B6 (INH can bind)

134
Q

HCV during pregnancy increases risk for what?

A

Gestational diabetes, cholestasis, preterm delivery

135
Q

Gradual onset of back pain, unilateral radiculopathy, saddle area numbness, hyporeflexia, marked assymetric lower-extremity weakness- what is compressed?

A

Cauda equina syndrom - spinal nerve roots

136
Q

CES compared to conus medullarus syndrome

A

bladder distrubances happen earlier, motor weakness more symmetric and involves hyperreflexia (some upper lesion)

137
Q

Succusion splash

A

pyloric stricture

138
Q

What to do for ethylene glycol poisoning?

A

Fomepizole - prevents preakdown of ethylene glycol to toxic metabolites - may need hemodialysis

139
Q

Flank pain, hematuria, oliguria, and severe AGMA

A

ethylene glycol intoxication- also calcium oxalate stones

140
Q

Fever, chills, flank pain after transfusion (D/BT)

A

ABO incompatibility, Direct coombs test

141
Q

Differentiate ABO incompatibility and IgA def transfusion -

A

gA deficiency has anaphylaxis at seconds to minutes with andioedema, hypotension, and difficulty breathing, not fever, flank pain, chills within hours

142
Q

Define intrauterine fetal demise

A

death of fetus at >20 weeks

143
Q

What is the second stage of labor?

A

Starts when cervix is fully dilated (10 cm), ends with delivery

144
Q

How long wihthout progress before second stage of labor considered arrested?

A

> 3 hours nulliparous, >2 hours multiparous

145
Q

Solitary periventricular weakly ring enhancing mass with EBV DNA in the CSf

A

CNS lymphoma

146
Q

Niemann-Pick vs Tay-Sachs differentiators

A

NP has hepatosplenomegaly and areflexia, Tay-Sachs has no hepatosplenomegaly and hyperreflexia

147
Q

Progressive loss of motor milestones at 2-6 months iwht hepatosplenomegaly and one other finding

A

NPD, cherry red macula, missing sphingomyelinase

148
Q

Developmental regression, hypotonia, and areflexia with no cherry red spot

A

Krabbe - “the galactic crab stole the cherry - galactocerebrosidase deficiency

149
Q

Anemia, thrombocytopenia, and hepatosplenomegaly due to biochem?

A

Gaucher disease - glucocerebrosidase defieincy

150
Q

6 mo to 2 yo with coarse features, hernias, corneal clouding, and hepatosplenomegaly?

A

hurler syndrome, lysosomal hydrolase deficiency

151
Q

Prodrome of cough, coryza, and conjunctivitis followed by maculopapular rash?

A

Measles

152
Q

Changed vaccination for planned international travel for measles?

A

Additional dose at 6-11 months before the doses at age 1 and 4

153
Q

Loss of movement of upper extremities after MVA with history of degenerative changes in cervical spine

A

Central cord syndrome - happens with hyperextension in elderly patients, selectively damages the central portion of anterior spinal cord, such as the central corticospinal tracts and decussating lateral spinothalamic tract

154
Q

Medication that can cause Idiopathic Intracranial hypertension?

A

Growth hormone, tetracyclines, and excess vitamin A (or isoretinoin)

155
Q

Infant or newborn with failure to thrive, bomiting, convulsion bilateral cataracts, jaundice, and hypoglycemia (D/P/increased risk)

A

Galactosemia - galactose-1-phosphate Uridyl transferase deficiency. Increased risk for E.Coli neonatal sepsis

156
Q

“Galactokindase”

A

galactokinase deficiency only results in cataracts, not terrible other consequences

157
Q

HIV prophylaxis for contact:

A

28 days of 3 drug regimen, two NRTI’s and a protease inhibitor, integrase inhibitor or NNRTI

158
Q

Preventative meds for migraines?

A

Topiramate, divalproex sodium, tricyclic antidepressants, B-blockers

159
Q

Yellow-green frothy discharge with pruitus and pear shaped motile organisms on wet mount (D/Tr)?

A

Trich, Oral metronidazole for patient and partner

160
Q

What to avoid while taking metronidazole?

A

Alcohol consumption - disulfiram like reaction

161
Q

Lab findings of BV

A

Elevated pH > 4.5, Clue cells, positive whiff test (amine odor with KOH)

162
Q

Management of MG crisis?

A

Intubate, hold pyridostigmine to reduce risk of aspiration, and plasmapheresis and steroids

163
Q

What is the huge danger of status epilepticus?

A

Cortical laminar necrosis due to excitatory toxicity

164
Q

Gait dysfunction and headaches with nausea worse in the mornings and focal weakness? Difference between this and neuroglycopenia?

A

Intracranial tumor. Neuroglycopenia will only last minutes to hours

165
Q

Deep cat bite treatment prophylactiaccly?

A

Amox/clavulanate for P. multocida

166
Q

when is observation and close follow-up appropriate for a dog/human bite?

A

superficial wounds not on hands, feet, or genitalia

167
Q

Causes of acute cervical adenitis in kids

  1. Unilateral, very tender and red
  2. Unilateral, dental and gum disease
  3. Unilateral, papular nodular with cat bite
  4. Unilateral, nontender, gradual
  5. Bilateral with pharyngoconjunctivits
  6. Bilateral with signs of mononucleosis
A
  1. Staph aureus/pyogenes
  2. Anaerobic bacteria/prevotella
  3. Bartonella henselae
  4. Mycobacterium avium
  5. Adenovirus
  6. CMV/EBV
168
Q

Empiric antibiotic for uncomplicated unilateral lymphadenitis?

A

Clindamycin

169
Q

GBS Upper or lower? Sensory involvement?

A

LOWER motor neuron signs, sensory involvement very rare

170
Q

Prophylaxis for toxo?

A

Bactrim

171
Q

Mechanism of pressure increase in normal pressure hydrocephalus -

A

decreased CSF reabsorption

172
Q

How soon do thrombolytics need to be administered after stroke?

A

3-4.5 hours

173
Q

Exclusion criteria for thrombolytics

A
  1. Hemorrhage >33%
  2. Stroke/head trauma in last 3 months
  3. Any hx of intracranial hemmorhage, neoplasm, vascular malformation
  4. Recent neurosurgery
  5. Reent bleeding issues
  6. BP >185/110
  7. Low platelets or glucose
  8. INR>1.7
174
Q

Renal effect of infectious endocarditis

A

immune complex mediated glomerulonephritis

175
Q

Risk factors for brain abscess in a child

A

Right to left shunts (bypass pulmonary circulation) and recurrent sinusitis

176
Q

Fever, severe headache, focal neuro changes

A

triad of brain abscess

177
Q

Arthralgias and malaise with erythema nodosum, common cause, other causes? Best initial test?

A

Common cause - benign hypersensitivity reaction to antigens, self resolution in weeks. Other causes to work up, strep, sarcoid, TB, histo, IBD, and Behcet’s. Anti strep O, TB skin testing, CBC and BMP,and a chest x-ray looking for sarcoidosis (as high as 28% comorbidity)

178
Q

Intensely pruitic clusters of papules and vesicles on elbows, knees, back, or buttocks? Management?

A

Dermatitis herpetiformis, dapsone and gluten free diet (usually associated with celiac disease)

179
Q

what causes pemphigoid vulgaris?

A

Antibodies against desmogleins 1 and 3

180
Q

Why doesn’t the entire epidermis detatch in pemphigoid vulgaris

A

does not target hemidesmosomes connecting bottom row of cells to basement membrane

181
Q

How to differentiate between acute cholecystitis and common bile duct obstruction?

A

Alk phos, some mild elevation in bilirubin and liver transaminases as gallbladder sludge passes into common bile duct

182
Q

What is elevated in the “window period” 2-4 months after Hep B infection during the symptomatic period? What are the “frames” of the window?

A

The window period is the time between the disappearance of HBsAg and appearance of anti-HBs, IgM anti-HBc is elevated during the window. Therfore, during initial infection, check for HBsAg (initial infection) or IgM anti-HBc (are we in the window

183
Q

Pain, jaundice, and palpable mass in a kid <10 (D/BT)

A

Biliary cyst, ultrasonography and surgical resection ( can use ERCP instead)

184
Q

Antiarryhtmic for afib in WPW?

A

Procainamide - no rate control!

185
Q

Maculopapular rash with cephalocaudal spread and postauricular and suboccipital adenopathy after prodrome of low fever, lymphadenopathy, and malaise

A

Rubella

186
Q

Rubella extra symptom in adolescents, particularly females?

A

Polyarthralgia

187
Q

Looks like strep throat then somebody gives amoxicillin and now they have a polymorphous maculopapular rash?

A

EBV - key look - hepatosplenomegaly

188
Q

Celiac sprue with bone pain and elevated PTH?

A

Osteomalacia - severe vit D deficiency

189
Q

Effect of osteomalacia on bones?

A

Impaired osteoid matrix mineralization

190
Q

When to use ultrasound and when to use CT in evaluation of pancreatic adenocarcinoma?

A

US in the head of the pancreas if evidence of obstructive jaundice, CT scan if no obstructive jaundice

191
Q

Causes of HIV related diarrhea:

  1. <180 / mm3, severe watery diarrhea and low grade fever?
  2. <100/mm3, watery diarrhea w/o fever
  3. <50 - HIGH fever and watery diarrhea
  4. <50 - Frequent small volume diarrhea with hematochezia and abdominal pain
A
  1. Cryptosporidium
  2. Microsporidium
  3. Mycobacterium avium
  4. CMV
192
Q

Best test for cryptosporidium?

A

Modified acid fast stain

193
Q

What to remember treating a 7 yo Lyme Disease patient

A

HE’S LESS THAN 8, DON’T USE DOXY, use oral amoxacillin

194
Q

Localized impetigo treatment. What if extensive or bullous?

A

Topical mupirocen. Then use oral antibiotics

195
Q

Vulvovaginitis in prepubertal girls with perianal scratching (D/Tr) -

A

pinworms (helminth) treat with albendazole or pyrantal pamoate as well as the household

196
Q

Acute hypertensive crisis in setting of CKD recently starting EPO?

A

Erythropoietin related hypertension, up to 30% of patients develop within 2-8 weeks of treatment

197
Q

How does epidural cause hypotension even without going into a vein?

A

Sympathetic nerve fibers responsible for vascular tone are blocked -> vasodilation -> decreased venous return to right side of heart -> decreased cardiac output - prevented by aggressive IV expansion and repositioning patient

198
Q

How to diagnose CO poisonin?

A

ABG plus cooximetry

199
Q

What abnormal sound can be heard in most patients during an acute coronary syndrome?

A

Abnormal S4 gallop due to ischemia induced myocardial dysfunction

200
Q

S3 sounds normal findings and abnormal meanings?

A

Rapid filling of ventricles, normal in children, young adults, and pregnancy, abnormal in >40, heart failure, restrictive cardiomyopathy, and high output states

201
Q

What if a FAST test is limited or equivocal?

A

Diagnostic periotoneal lavage

202
Q

When does ASD become PTSD?

A

1 month

203
Q

Intermittent foot trop with numbness/tingling over dorsal foot and lateral shin, impaired ankle dorsiflexion (walking on heels) and preserved plantar flexion?

A

Common fibular neuropathy

204
Q

Anticonvulsant/mood stabilizer med that can cause hepatotoxicity? Other effects?

A

Valproate - usually within first 6 months of treatment. Tremor, thrombocytopenia, and alopecia

205
Q

Buproprion risk?

A

Seizures

206
Q

Clozapine risk?

A

Severe neutropenia

207
Q

Seems like an absence seizure but lasts 2-3 minutes?

A

Focal seizures, absence only 10-20 s

208
Q

Tamoxifen effect on bone -

A

estrogen like, only antiestrogen at the breast

209
Q

Tamoxifen effect on uterus

A

estrogen agonists, increases risk of polyps, hyperplasia, cancer

210
Q

7 yo with 3 episodes vomitting in 6 month period with stereotypical timing lasting 1-10 days with >=4 times/hr at peak and no symptoms between vomitting episodes with family hx of migraines (D/Tr)

A

Cyclical vomitting syndrome, antiemetics and sumatriptan if migraine hx

211
Q

Colonic polyps and osteomas in family? Colorectal cancer risk? Follow-up?

A

Familial adenomatous polyposis, almost universally develop colorectal cancer. Annual colonoscopies with proctocolectomy once high-grade dysplasia is reached

212
Q

CAP for >1 week+arthralgias+erythema nodosum?

A

Coccidioides - desert southwest - treat with fluconazole only if immunocompromised

213
Q

Early decrescendo murmur best heard with diahragm of stethoscope at upper sternal border especially when holding a full breath with expiration

A

Aortic regurgitation

214
Q

Treatment of thrush in HIV?

A

Oral fluconazole

215
Q

Focal substernal pain with large liniear ulcerations in distal esophagous and presence of intranuclear intracytoplasmic inclusions?

A

CMV esophagitis

216
Q

Primary HIV prophylaxis ladder:

A

< 200 - PCP - Bactrim
<100 - Toxo - Bactrim
<50 - MAC - Azithro
Endemic histo and <150 - Itraconazole

217
Q

Normal discharge after delivery

A

1-3 days - lochia rubra - red vaginal discharge from the shedding of the uterine decidua and blood
3-4 days - lochia serosa - thin, pink/brown
2-3 weeks - lochia alba, white or yellow

218
Q

Sudden vasomotor collapse on symptoms of meningococcemia -

A

Waterhouse-Friederichsen due to adrenal hemmorhage (10-20% of infants)

219
Q

Large fiber injuries symptom type?

A

negative symptoms - numbness, loss of proprioception and vibration

220
Q

Fungal infections affecting upper lobes of lungs and how to differentiate?

A

Aspergillus - acid fast hyphae, Norcardia - weakly acid fast filamentous rods

221
Q

Workup for suspected VAP?

A

First X-ray, then if positive gram stain and culture or respiratory secretions, start empiric antibiotics while waiting for return

222
Q

Photosensitivity with concomittant hep C?

A

Porphyria cutanea tardis - deficiency of uroporphyrinogen decarboxylase

223
Q

Thrombocytopenia, hemolytic anemia, essential with maybe renal insufficiency, neuro changes, and fever?

A

Thrombotic thrombocytopenic purpura

224
Q

Pathophys of TTP

A

decreased ADAMSTS13 level either due to autoantibody or hereditary sources

225
Q

Treatment of TTP?

A

Plasma exchange, glucocorticoids, rituximab

226
Q

Difference between TTP and HUS:

A

HUS related to Ecoli and primarily renal, TTP related to aDAMS and has neuro findings and fever

227
Q

Diffuse telangiectasias, recurrent epistaxis, and widespread AV malformations?

A

Hereditary telangiectasia (Osler-Weber-Rendu)

228
Q

when to use casting or internal fixation for stress fracture?

A

Only for the fifth metatarsal, 2,3,4 act as a self-splint

229
Q

Causes of hyperglycemic hyperosmolar syndrome

A

Infection, (glucocorticoids, thiazides, pentamidine, atypical antipsychotics), interruption of insulin therapy, trauma or acute illness

230
Q

lytic bone lesion, rash, signs of diabetes insipidus (D/P/Tr) -

A

Langerhans cell histiocytosis, proliferation of macrophages that can lead to lytic bone lesions, skin lesions, lymph node lesions, lungs (cough/pulm nodules), and CNS (central diabetes insipidus). Treat with chemo or curretage

231
Q

Where are Langerhans cell histiocytosis typically found?

A

Skull

232
Q

Cuttoff for normal MoCA score

A

<26/30

233
Q

What causes jejunal or ileal atresia?

A

vascular access in utero

234
Q

Impaired tandem walking but intact finger-nose testing?

A

Alcohol neurotoxicity

235
Q

What is damaged in alcoholic cerebellaropathy?

A

Purkinje cells - selective for truncal dycoordination

236
Q

Fever >24 hours postpartum, purulent lochia, and uterine tenderness (D/P/Tr)

A

Postpartum endometritis, polymicrobial infection of uterine cavity - treat with clindamycin + gent until patient is afebrile for 24 hours

237
Q

treatment of PPROM

A

expectant management until 34 weeks with steroids

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