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Week 3 Flashcards

1
Q

Antibiotics if kid meets all CENTOR criteria?

A

No, must be confirmed on rapid stress or culture as opposed to adults

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2
Q

Pneumatosis intestinalis in a neonate?

A

NEC

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3
Q

Treatment for enuresis

A

Behavior modification ->enuresis alarms (take 3-4months to be effective ->oral desmopressin for immediate help (not meant as monotherapy)

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4
Q

White granular patch on buccal mucosa of patient with tobacco and alcohol use? Leukoplakia - precancerous lesion

A

How to treat leukoplakia and when to biopsy? Stop tobacco and it will disappear in 2-3 weeks, biopsy if you see ulcers or induration

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5
Q

Large, painful liver mass in a young woman with signs of obstruction?

A

Hepatic adenoma, common with OCP vs. focal nodular hyperplasion, less common and will have arterial flow evidence

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6
Q

Prophylaxis for GBS in patient’s who have not been screened

A
  1. <37 weeks gestation
  2. Intrapartum fever
  3. ROM >18 hrs
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7
Q

Blurring of grey white matter interface after blunt trauma

A

Diffuse axonal injury - rotational force at area of decreased density results in vegetative state out of proportion to CT finding

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8
Q

Cause of hypogonadotropic hypogonadism

A

oss of pulsatile GnRH secretion precipitated by weight loss, stress, or chronic illness

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9
Q

chronic anesthetic, macular (often hypopigmented) skin lesions with raised well-demarkated borders and nearby nodular and tender nerves (D/BT)

A

Leprosy (mycobacterium leprae) - full thickness biopsy

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10
Q

Treatment for minimal lesion leprosy? Treatment with extensive lesions?

A

Limited - dapsone or rifampin, extensive dapsone/rifampin AND clofazimine

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11
Q

Treatment of rheumatic fever and follow up after?

A

Benzathine pen G until adulthood

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12
Q

Rapidly progressive cellulitis of submandibular space (D/P/serious complication/BT/Tr)

A

Ludwig angina - usually dental infection - polymicrobial, can result in airway compromise, CT scan of the neck, IV antibiotics and removal of inciting tooth - does not need drainage

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13
Q

Hemolytic anemia following sulfa drugs (D/P)

A

G6PD deficiency, X-linked genetics

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14
Q

Cape distribution sensory loss with preservation of vibration and proprioception neuro cause (D/P/associated disease). Why would there be areflexia?

A

Synringomyelia - fluid filled cavity that may represent dilation of central canal or separate cavity - Arnold Chiari type I - areflexia and weakness from compression of anterior horn gray matter

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15
Q

Affect of anesthesia on pheochromocytoma

A

Catecholamine surge - sudden huge hypertension

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16
Q

Affect of b-blockers on pheochromocytoma-

A

unnopoosed alpha adrenergic stimulation

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17
Q

Mild megaloblastic anemia on phenytoin, primidone, or phenobarbitol (Path)? Other causes of this deficiency?

A

Impaired folic acid absorption, folic acid supplementation. Other drugs - Trimethoprim and Methotrexate - dihydrofolate reductase inhibitors - need folinic acid (leucovorin) to reverse anti-folate effect of methotrexate)

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18
Q

Elevation in folate and cobalmin deficiency? Distinguishing elevation?

A

Elevation of homocysteine (decreased conversion to methionine), methylmalonic acid concentration elevated in cobalamin deficiency due to decreased conversion to succinyl coA

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19
Q

Biphasic respiratory distress in an infant which improves with neck extension

A

vascular ring

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20
Q

Differentiate vascular ring and laryngomalacia?

A

Place patient prone - laryngomalacia should improve

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21
Q

Why have ankylosing spondylitis patients do PFT’s?

A

To check for restritive pattern due to rib fixation - residual volume normal or increased due to rib fixation in inspiratory position

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22
Q

MRO chest injury from fall or blunt trauma?

A

Blunt aortic injury

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23
Q

anticoagulation, symptoms of weakness and dizziness, evidence of anemia and tachy with significant back pain -

A

> internal hemmorhage, consider retroperitoneal which can occur at normal INR’s spontaneously

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24
Q

Hypertension in pregnancy after 20 weeks without nephropathy?

A

Gestational hypertension

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25
Q

Chronic hypertension pregnancy risks?

A

Preeclampsia, PPH, GDM, placental abruption, fetal growht resitriction, perinatal mortality, preterm delivery, oligohydramnios

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26
Q

Workup for sleep terrors?

A

None - typically resolve in 1-2 years

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27
Q

Thyroid issue affecting 1/15 women after childbirth? Description?

A

Postpartum thyroiditis - brief hyperthyroid phase followed by hypothyroid phase with bradycardia, diastolic hypertension, lower extremity edema and possible coarse facies

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28
Q

Associated antibody with postpartum thyroiditis

A

anti-thyroid peroxidase - variant of Painless/silent thyroiditis - return to euthyroid state over several months

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29
Q

Syncope, hypotension, and new right bundle branch block when recovering from major operation?

A

Massive PE

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30
Q

Fetal nontender head swelling that does not cross suture lines?

A

Cephalohematoma - subperiostial

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31
Q

Fetal nontender head swelling that does cross suture lines?

A

Caput succedaneum

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32
Q

Treatment of tardive dyskinesia

A

d/c or switch drug - Clozapine has least EPS

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33
Q

If suspicion is high enough for arterial occlusion, do what first?

A

Heparin

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34
Q

Cause of putaminal hemmorhage in chronic hypertension <60

A

Charcot-Bouchard aneurysms

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35
Q

Atopic dermatitis presentation difference in infants vs. children/adults?

A

Intant - itchy scaly crusted lesions on extensor surfaces, trunks, cheeks, scalp
Child/adult- Lichenified plaques in flexural creases

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36
Q

Stuttering episodes of nausea, vomitting, with pneumobillia

A

Gallstone ileus

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37
Q

Differentiate pneumobilia from gallstone ileus?

A

Hypoactive bowel sounds pneumobilia, hyperactive bowel sounds gallstone ileus

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38
Q

Can polymyositis cause dysphagia?

A

Yes

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39
Q

Managing substance induced cardiac ischemia?

A

Benzo’s for blood pressure and anxiety, aspirin, nitro and calcium channel blockers fine, Beta-Blockers CONTRAINDICATED, unopposed alpha effect of cocaine, catheterization if needed

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40
Q

Risk of pulmonary toxicity with amiodarone correlates to what measure of drug intake?

A

Total cumulative dose

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41
Q

profound back pain, hematuria, hypotension, and coronary ischemia on EKG?

A

AAA rupture - gross hematuria from bladder venogongestion

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42
Q

Impaired taste, impaired wound healing, immune dysfunction, alopecia, skin rash for someone on parenteral nutrition

A

Zinc deficiency

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43
Q

Fragile hair, skin depigmentation, neuro dysfunction like B12, and sideroblastic anemia

A

Copper deficiency

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44
Q

Dermatitis (hyperpigmented), diarrhea, dementia (pellagra)

A

Niacin (B3) deficiency

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45
Q

Deficiency leading to thyroid dysfunction and cardiomyopathy?

A

Selenium deficiency

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46
Q

Pure hemisensory loss stroke location

A
  • Thalamus, VPL and VPN
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47
Q

Ipsilateral face and contralateral body pain/temp loss, ipsilateral bulbar muscle weakness, vertigo, and horner’s (D/P)

A

Lateral medullary infarction, PICA occlusion

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48
Q

Ipsilateral oculomotor palsy, ataxia, and contralateral hemiparesis

A

Midbrain stroke- ataxia from superior cerebellar peduncle, hemeparesis from cerebral peduncle

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49
Q

Signs that a stroke may be cortical?

A

Aphasia, agnosia

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50
Q

Contralateral hemiparesis, sensory loss, and conjugate gaze palsy

A

putaminal damage with corresponding internal capsule

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51
Q

Area responsible for spatial organization?

A

Non-dominant (usually right) parietal lobe

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52
Q

Fatigue, weight loss, hypotension, inability to breast feed after complicated pregnancy?

A

Sheehan’s syndrome - ischemic infarction and necrosis of pituitary

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53
Q

What to check for after loss of consciousness

A

POSTICTAL STATE

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54
Q

Pulsus paradoxus after severe chest pain radiating to back and widened mediastinum?

A

Aortic dissecion with cardiac tamponade

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55
Q

Lab finding of antiphospholipid syndrome?

A

Paradoxical Prolonged PTT that does not correct when diluted with normal plasma as it binds the phospholipids used in assays

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56
Q

preferred long term oral anticoagulant in end-stage renal disease?

A

Warfarin

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57
Q

Intrauterine demise with multiple limb fractures and hypoplastic thoracic cavity (D/P)

A

Type II Osteogenesis Imperfecta - AD disorder related to type 1 collagn synthesis

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58
Q

New onset spinal signs in a 6 yo girl with down syndrome?

A

Atlantoaxial instability

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59
Q

First line bipolar medications?

A

Lithium, valproate, quetiapine, lamotrigine

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60
Q

Nausea, vomitting, weight loss, and signs of dehydration in gestational mom of twins? Differentiator from typical N/V of pregnancy?

A

Hyperemesis gravidarum - differentiate by presence of ketones in the urine

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61
Q

Rapid onset <1 year hirsuitism with virilization (D/BT)?

A

Androgen-secreting neoplasm, get serum testosterone and DHEAS levels - elevated test normal DHEAS - ovarian source, DHEAS elevatedd - adrenal tumor

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62
Q

Fatigue, anorexia, hypoglycemia with testicular atrophy and cold intolerance, constipation, mild hyponatremia and hypotension.

A

Panhypopituitarism - fatigue, anorexia, hypoglycemia (low cortisol) testicular atrophy (hypogonadotropic hypogonadism) cold intolerance, constipation (hypothyroidism), hyponatremia/hypotension (ADH/decreased peripheral artery

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63
Q

What adrenal hormone is unaffected by panhypopituitarism?

A

Aldosterone

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64
Q

Diagnosis of HIT type 2:

A

Heparin exposure >5 days AND

  1. Platelet count reduction >50%
  2. New thrombosis/expanding thrombosis
  3. Necrotic skin lesions
  4. Anaphylaxis
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65
Q

Diagnosis of Type 2 HIT

A

Serotonin release assay

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66
Q

Alternatives to heparin in HIT:

A

Argatroban, fondiparinux, eventually warfarin

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67
Q

Antibodies for lupus (sensitive then specific)

A

ANA sensitive, anti-dsDNA and anti-Sm (specific)

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68
Q

Felty syndrome

A

RA PLUS splenomegaly and neutropenia

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69
Q

First test in alkali ingestion in absence of perf or respiratory distress?

A

Endoscopy to assess for esophageal damage

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70
Q

Do studies show steroids help after esophageal damage?

A

No

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71
Q

PCOS with normal testosterone?

A

Can appear normal due to decreased levels of sex hromone binding globulin,elevated free testosterone not measured

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72
Q

Second line for bipolar treatment

A

Lithium or valproate with a second gen antipsychotic

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73
Q

Standard vitamin supplementation with measles?

A

Vitamin A - promotes antibody producing cells and regenteration of epithelium

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74
Q

Vit E deficiency symptoms?

A

Hemolytic anemia, neuro complications like ataxia

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75
Q

Phases of pertussis

A

Catarrhal (1-2 weeks) - mild cough, rhinitis
Paroxysmal (2-6 weeks) - whoop, postussive emesis
Covalescense (weeks - months) gradual resolutions

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76
Q

Treatment for pertussis

A

Macrolides

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77
Q

Blood findings with pertussis

A

marked lymphocytosis

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78
Q

Do you need pallor or pulselessness to diagnose compartment syndrome?

A

NO, unusual finding

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79
Q

Metabolic abnormalities of hypothyroidism?

A

Hyperlipidemia, hyponatremia, assymptomatic elevations of CK and serum transaminases

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80
Q

Painless, rapid, and transient vision loss with “curtain descending” (D/ most common cause)

A

Amaurosis fugax - most commonly caused by atherosclerotic emboli from ipilateral carotid artery

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81
Q

Age of onset of neonatal conjunctivits and treatment?

A

<24 hours -silver nitrate chemical - eye lubricant
2-5 days - gonococcal - IM ceftriax
5-14 days - chlamydial - PO macrolide

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82
Q

Cause of Lesch-Nyhan syndrome?

A

X-linked recessive cause by deficiency of hypoxanthine guanine phosphoribosyltrasnsferase - accumulation of hypoxanthine and uric acid

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83
Q

6 mo girl regressing in speech and motor function with hand wringing?

A

Rett syndrome

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84
Q

Important cause of hypocalcemia in alcoholics (D/P)

A

Hypomagnesemia - decreased release of PTH but not associated with elevated phos levels

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85
Q

Correction for albumin level via calcium

A

0.8 for every 1 gm/L decrease in albumin

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86
Q

Be careful giving sildenafil with what?

A

Alpha blocker (doxazosin) due to possibility of severe hypotension

Nitrates - severe hypotension

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87
Q

Leading cause of euvolemic hyponatremia in someone taking lithium?

A

Diabetes insipidus

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88
Q

Difference between complete and partial DI?

A

Complete - urine mOsm/kg <300 (often less than 100)

Partial - urine osmols from 300-600

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89
Q

Causes of nephrogenic DI?

A

Severe hypokalemia, hypercalcemia, meds (lithium, demeclocycline, foscarnet, cidofovir, amphotericin

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90
Q

Treatment of nephrogenic DI due to lithium?

A

Salt restriction and d/c lithium

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91
Q

Criteria for IBS

A

Recurrent abdominal pain/discomfort >3 days/month for 3 months with 2/3 of the following:

  1. Symptom improvement with bowel movement
  2. Change in stool frequency
  3. Change in form of stool
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92
Q

HIT rate higher with fractionated or unfractionated heparin? How to tell the difference?

A

unfractionated, markedly elevated aPPT with unfractionated heparin

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93
Q

Why irregular cycles in adolescents?

A

Immature and insufficient - confirmed with menarche after exogenous progesterone administration

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94
Q

target blood glucose levels in gestational DM

A

Fasting <=95, 1 hr postprandial <=140, 2 hr postprandial <=120

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95
Q

Managing shoulder dystocia

A

BE CALM - breathe (don’t push), elevate legs and flex hips, call for help, suprapubic pressure, enlarge vaginal opening with episiotomy, maneuvers

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96
Q

McRoberts maneuver value in shoulder dystocia

A

relieves almost half

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97
Q

Cyanide toxicity mechanism of action?

A

potent inhibitor of cytochrome oxidase a3 and inhibits reduction to ferrous iron

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98
Q

Main toxins of smoke?

A

Hydrogen cyanide and carbon monoxide

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99
Q

Treating cyanide toxicity

A

hydroxocobalamin or sodium thiosulfate

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100
Q

Delusions, tactile hallucinations, aggression, poor dentition, excoriations

A

methamphetamine use disorder

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101
Q

Severe GI symptoms, confusion, ataxia, and tremors with CNS irritability like seizures for bipolar patient? What medication change might have happened?

A

Lithium toxicity - Thiazide diuretics decrease secretion of lithium

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102
Q

Meds that increase lithium levels

A

ACEi, NSAIDS, tetracyclines, metronydazole

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103
Q

Classic lab finding in poststreptococcal glomerulonephritis and related path

A

Immune complex deposition gets attacked by complement, leading to C3 in glomeruli and low complement C3 in serum

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104
Q

Treatment of PGSN?

A

Supportive and blood pressure control

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105
Q

Most common cause of renal vein thrombosis and path?

A

Membranous glomerulonephropathy - loss of ATIII

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106
Q

Anemia, low haptoglobin, elevated bilirubin, elevated LDH - intravascular hemolysis

A

Hepatic vein thrombosis with hemolysis - paroxysmal nocturnal hemoglobinuria

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107
Q

BT for paroxysmal nocturnal hemoglobinuria and path?

A

Flow cytometry, shows abscence of CD 55 and CD 59 due to genetic defect in GPTD anchor - lack of complement inhibition allows membrane attack complex to form

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108
Q

Mono-like illness with persisten fever, malaise, fatigue, absodlute lymphocytosis and >10% atypical lymphocytes

A

CMV

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109
Q

Differentiate CMV from EBV

A

Usually mild or absent pharyngitis, lymphadenopathy, and splenomegaly - supported by negative monospot and positive CMV IgM serology

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110
Q

what causes pain in primary amenorrhea?

A

Release of prostaglandins from endometrium causes uterine contractions - treat with NSAIDS

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111
Q

NMS non dantrolene management?

A

Bromocriptine or amantadine that can reverse dopamine block

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112
Q

Treatment of severe serotonin syndrome?

A

Cryoheptadine

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113
Q

Treatment of antipsychotic dystonias and EPS?

A

Benztropine

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114
Q

Major causes of sudden death?

A

CAD, cardiomyopathy, arrhthmia, congenital heart defect

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115
Q

Difference between Stevens-Johnson syndrome and Toxic epidermal necrosis?

A

<10%, SJS, >30% body involvement, TEN

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116
Q

Causes of TEN?

A

Antibiotics, anticonvulsants, allopurinol

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117
Q

Loop diuretic sensory side effect? what primes this effect?

A

Ototoxicity, concurrent aminoglycosides or renal insufficiency

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118
Q

Monocular vision loss, afferent pupillary defect, and central sotoma in a young woman -

A

Optic neuritis often due to MS

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119
Q

When to perform antepartum fetal surveillance?

A

high risk pregnancies like maternal hypertension, DM, or fetal post-term pregnancy or growth restriction

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120
Q

Common way to conduct antepartum fetal surveillance for gestational hypertension

A

Weekly BPP’s starting at 32 weeks

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121
Q

BPP score of 6/10

A

Equivocal, repeat in 24 hours

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122
Q

Definition of latent Tb -

A

no signs on chest x-ray, nfiltrate, lymphadenopathy, or symptoms

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123
Q

Treatement for latent TB

A

oniazid and Pyridoxine (to prevent isoniazid neuropathy)

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124
Q

Mono plus mucocutaneous ulcers plus skin rahs plus diarrhea?

A

HIV

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125
Q

Genital warts medical name?

A

Condylomata acuminata

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126
Q

HPV strains causing genital warts?

A

6 and 11

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127
Q

Nonsurgical treatment for genital warts?

A

Podophyllin resin, trichloroccetic acid

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128
Q

Condylomata lata vs. acumunata?

A

Lata - syphillis, acuminata - warts

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129
Q

Most common complication for sickle cell trait?

A

Microscopic gross hematuria and hyposthenuria (impairment concentrating urine)

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130
Q

Differential for liver abscess?

A

Entamoeba histolyica - young person with dyssentery
Echinoccocus - usually assymptomatic, frequent contact with animals, may have eosinophilia
Bacterial - older diabetic or liver disease patient

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131
Q

Test for entomoeba histolytica? Treatment?

A

Serologic testing (stool microscopy insensitive at liver stage) treatment with metronidazole AND a luminal agent like paromomycin

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132
Q

Entamoeba vs echinococcus which to drain -

A

drain echinococcus and give albendazole, don’t drain entamoeba

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133
Q

Murmur in aplastic crisis? Usually cause in sickle cell?

A

Functional systolic murmur due to hyperdynamic blood flow. Parvo B19, can happen even without preceding viral symptoms

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134
Q

Pulmonary vasoocclusion and infection, fever, chest pain, and new radiographic infiltrate in sickle cell?

A

Acute chest syndrome

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135
Q

After O2, best treatment for cluster headaches?

A

Subcutaneous sumatriptan

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136
Q

Hypertension, bradycardia, and respiratory depression in the face of head trauma?

A

Cushing’s reflex, elevated ICP

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137
Q

Signs of uncal herniation and cause?

A
  1. . Contralateral crus cerebri against tentorial edge - ipsilateral hemiparesis
  2. Compression of ipsilateral oculomotor nerve - Early mydriasis - late - down and out puil (unopposed trochlear and abducens)
  3. Contralateral homonymous heminopsia - compression of ipsi posterior cerebral artery
  4. Altered level of consciousness - reticular formation
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138
Q

Distinguished polymalgia rheumatica and fibromyalgA

A

PR has elevated ESR, CRP, PR usually only tender due to bursitis or synovitis, more commonly stiff shoulders and pelvic girdle

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139
Q

Major adverse effect of hydroxyurea?

A

Myelosuppression

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140
Q

Normal percentage of HbF in sickle cell patient?

A

5-15%, increases with hydroxyurea

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141
Q

Side effects of second gen antipsychotic olanzapine and clozapine?

A

Weight gain, dyslipidemia, hyperglycemia, increased risk for diabetes

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142
Q

Henoch Schonlein purura path and manifestations

A

IgA mediated leukocytoclastic vasculitis, gravity dependent palpable purpura, arthritis, and renal disease similar to IgA nephropathy
Normal platelet count and coag studies, commonly find hematuria +-RBC casts +- Proteinuriea

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143
Q

Treatment for HSP

A

Supportive unless severe, then glucocorticoids and hospitalization

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144
Q

thyroid changes in pregnancy?

A

Increased thyroxine binding globulin and increased thyroxine production resulting in total thyroid hormone level with minial increase to T4 = if already hypothyroid can worsen hypothyroid state

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145
Q

Bartholin cyst location and presentation

A

Vulvar vestibule at 4 and 8 oclock - large cysts can cause vaginal pressure and discomfort with motion but clinically cyst is small, mobile, nontender, cystic mass behind the posterior labium majora with extension to vagina

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146
Q

Differentiate bartholin cyst vs bartholyn abscess?

A

Abscess indurated and tender

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147
Q

What causes staph toxic shock syndrome?

A

Toxin 1- superantigen

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148
Q

High PTH, high calcium, low urine calcium excretion?

A

Familial hypercalcemic hypocalciuria, defect in calcium-sensing receptor, UCCR <0.01 comparedto >0.02 in HPTH

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149
Q

Workup for primary autoimmune insufficiency?

A

8 am serum cortisol and plasma ACTH

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150
Q

What is the ACTH stim test?

A

Cosyntropin given, should have a rapid rise of cortisol but will have low (central insufficiency) or insignificant rise

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151
Q

Basal cortisol low, ACTH high, minimal response to cosyntropin - primary adrenal insufficiency

A

Basal cortisol low, ACTH low, minimal response to cosyntropin - secondary or tertiary adrenal insufficienct

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152
Q

Difference between PPSV23 and PPCV13

A

PCV13 is conjugated and induces T-cell dependent B-cell response

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153
Q

Hypertonic and hyperrreflexia lower extremities in infant with lower extremity feet pointing inwards? Risk factors?

A

Cerebral palsy - prematurity

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154
Q

2-8 week old with regurgitation, painless bloody stools, and eczema

A

Milk/soy protein induced enterocolitis - eliminatie milk and soy from maternal diet or initiate hydrolyzed formula - spontaneously resolves in a year

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155
Q

Sudden onset of vaginal bleeding in pregnant woman with high frequency, low-intesnity contractions and hypertonic, tender uterus?

A

Abruptio placentae - retroplacental bleeding

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156
Q

Risk to mother of placental detachment? Risk to baby?

A

DIC and shock to mother, hypoxia and preterm delivery to baby

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157
Q

Treatment for bullous pemphigoid?

A

High potency topical glucocorticoid

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158
Q

Saline responsive vs saline unresponsive metabolic alkalosis

A

Saline unresponsibe - typically hypervolumia (hyperaldosteronism, Cushing syndrome, excess black licorice) OR kidney issue (Barter’s, Gitelman’s) - not corrected by saline and elevated levels of urinary chloride
Saline unresponsive - loss of gastric secretions - volume depletion and low serum Cl/low urinary chloride

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159
Q

Risk in infant <2 mo of bronchiolitis?

A

Apnea or recurrent wheezing

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160
Q

What to give exceptionally high risk kids with bronchiolitis?

A

Palivizumab

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161
Q

Most common bacteria colonized in CF’r before age 20? After age 20?

A

Staph aureus, pseudomonas

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162
Q

Hypernatremia and dilute urine?

A

Think diabetes insipidus

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163
Q

Do central or nephrogenic DI patients compensate better?

A

Nephrogenic - no decreased thirst

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164
Q

Cause of pericarditis in kidney failure? Treatment? Level at which it occurs?

A

Uremia, dialysis, usually BUN > 60mg/dL

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165
Q

Major gluconeogenic amino acid and what is it converted to?

A

Alanine to pyruvate

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166
Q

Main substrates of gluconeogenesis?

A

Alanine, glutamine, lactate, and glycerol 3-phosphate

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167
Q

Opsonization?

A

Antibody mediated phagocytosis conducted by the spleen - patients with asplenia at high risk of pneumococcal, meningococcal and Hib

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168
Q

Umbillicus sensory level?

A

T10

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169
Q

Low MCV, RDW, Mentzer index <13, target or teardrop cells:

A

thalassemia

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170
Q

Differentiate iron deficiency anemia and thal minor

A

thal has higher reticulocyte count and normal RDW

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171
Q

Parkinson’s symptoms on risperidone but can’t back down the dose?

A

Add benztropine (appropriate to switch to clozapine for tardive)

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172
Q

First or second generation antihistamines for postnasal drip causing cough?

A

First gen - who knows why, no response in 2-3 weeks warrants further workup

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173
Q

Intraductal papilloma bening or malignant?

A

Benign

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174
Q

Differentiate intraductal papilloma and infiltrating ductal carcinoma?

A

Mass, microcalcification, and lymphadenopathy

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175
Q

Inflammatory arthritis, splenomegaly, and neutropenia

A

Felty syndrome

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176
Q

what has a dose-dependent causal effect on breast cancer?

A

Alcohol

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177
Q

Is vaginal bleeding/fissures normal in menopause?

A

Yes

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178
Q

Rett syndrome gene and major comorbidity

A

X-linked MECP2, seizures

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179
Q

Hyperandrogenism of pregnancy with bilateral cysts?

A

Either luteomas or theca lutein cysts, luteomas confer risk of virilization to female fetus but theca lutein cysts do not, both managed expectantly

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180
Q

Painless extensive bleeding during pregnancy?

A

Placenta previa

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181
Q

Differentiate placenta previa from vasa previa?

A

Vasa previa has rapid deterioration of fetal well being due to fetal bleeding

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182
Q

Common bug in febrile neutropenia?

A

Pseudomonas and other gram positives due to disruption of mucosal barriers

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183
Q

Therapy for febrial neutropenia?

A

Antipseudomonal agent - cefepime, meropenam, pip-tazo

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184
Q

Mitral valve dysfunction in HOCM?

A

Systolic anterior motion of mitral valve contacts thickened septum and causes LVOT

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185
Q

Bacterial of fungal infection within the eye?

A

Endopthalmitis - usually postoperative

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186
Q

CML gene and translocation?

A

BCR-ABL between 9;22 - leukemogenesis due to constantly activated tyrosine kinase, inhibited by imatinib

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187
Q

AML M3 variant treatment

A

Vitamin A

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188
Q

AML exposures:

A

Benzene, radiation, or past CML with blast crisis

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189
Q

Markers for ALL?

A

cALLA and Tdt

190
Q

Treatment for ALL? Test?

A

Chemo plus ARA-c for CNS prophylaxis +/- radiation. LP to see if CNS, then need radiation

191
Q

Leukemia you die with? Treatment?

A

CLL - chemo only for young (stem cell transplant) or old and symptomatic

192
Q

Cause of spider angiomas and palmar erythema in cirrhosis?

A

Hyperestronism - impaired metabolism of circulating estrogen - effects vascular wall dilation

193
Q

Cause of dupuytren contracture?

A

fibroblast proliferation and collagen deposition

194
Q

COPD and cirrhosis run in the family?

A

Alpha-1 antitrypsin disease

195
Q

AAT liver risk?

A

Hepatocellular carcinoma

196
Q

Bilateral lung infiltrates, confusion/ataxia, and diarrhea following travel? (D/Tr)

A

Legionella, treat with macrolides or fluoroquinolones

197
Q

Aortic stenosis signs in a young person and unequal blood pressures?

A

Supravalvular aortic stenosis due to congenital left ventricular outflow obstruction - palpable thrill in sternal notch

198
Q

Cause of Hyper-IgM syndrome

A

X-linked defect in CD40 - Tcells have trouble binding to B cells to induce class switching

199
Q

Differentiate hyper-IgM from Brutons X-linked agammaglobulinemia and Common variable immunodeficiency

A

Low B cells in bruton’s and low IgM, normal B-cells in common variable and low IgM

200
Q

Low IgG levels in 3-6 month old?

A

nadir of maternally derived antibody - transient

201
Q

Management of preterm labor by week period

A

<32 weeks - betamethasone, tocolytics, magnesium sulfate, penicillin if unknown GBS

32-<34 weeks - betamethasone, tocolytics, penicillin if unkown GBS

34-<37 weeks - maye betamethasone, penicillin if GBS unknown

202
Q

Why don’t we use tocolytics after 34 weeks?

A

Indomethacin - closure of DA and oligohydramnios, nifedipie - maternal hypotension, tachy

203
Q

Cause of nasopharyngeal carcinoma? Risk population?

A

EBV, southern china

204
Q

Aflatoxin cancer association?

A

Hepatocellular carcinoma

205
Q

Muscular dystrophy onsets:

A

Duchenne 2-3, gower sign and cal hypertrophy, X-linked recessive deletion of dystrophin, death by 20-30 from respiratory or heart failure

Becker 5-15- missing dystrophin, less severe Duchenne’s (decreased dystrophin, not absent)

Myotonic - 12-30 - facial weakness, hand grip, myotonia, dysphagia, autosomal dominant expansion of CTG in DMPK gene

206
Q

Wilms tumor associated syndrome

A

WAGR - wilm’s, aniridia, genitourinary, retardation
Beckwith-Wiedemann
Denys-Drash

207
Q

Treatment of Wilm’s

A

tumor excision and chemo, maybe radiation

208
Q

Mammography schedule?

A

women 50-75 every 2 years

209
Q

Pap schedule

A

21 to 65 every 3 years

210
Q

HLD screening?

A

Men 35+ lipid panel every 5 years

211
Q

Most common hypercoagulable disorder?

A

Factor V Leiden - does not respond to protein C - continued thrombin formation

212
Q

Ways to improve oxygenation

A

FiO2 or PEEP only

213
Q

Best strategy in improving ARDS survival?

A

High PEEP

214
Q

Resembles a DVT but has a medial malleoulus crescent sign?

A

Probably a popliteal cyst rupture but get an ultrasound just in case

215
Q

How to transfuse an IgA deficient individual?

A

Washed red cell products

216
Q

First line treatment for PMS?

A

Selective serotonin reuptake inhibitors

217
Q

Brief transient euphoria, loss of consciousness, dermatitis around the mouth

A

Inhalent abuse

218
Q

When to give hypertonic saline for hyponatremia?

A

CNS symptoms (signalling risk of cerebral edema)

219
Q

Rate of increase of sodium?

A

<8meq/L over 24 hours

220
Q

Night blindness, photophobia, dry scaly kin, dry eye, wrinkled, cloudly cornea -

A

vitamin A deficiency

221
Q

Symptoms of early pregnancy, belief to be pregnant, no evidency on ultrasound or urine

A

pseudocyesis - somatization of stress- often will interpret negative pregnancy tests to be positive

222
Q

Typical place for brain cancer metastasis?

A

white gray matter junction

223
Q

Percentage of lung cancer patients presenting first with brain mets?

A

30%

224
Q

Ugly duckling sign (appearance different than the other) of a mole?

A

90% sensitive for melanoma

225
Q

Painless purpura, fatigue, weakness, fleeting joint pains, low C4 factor

A

Cryoglobulinemia

226
Q

Differentiate mixed cryoglobulinemia from TTP

A

TTP has much more severe anemia and thrombocytopenia, non-palpable purpura

227
Q

Anti-cyclic citrullinated peptide and RF

A

Rheumatoid arthritis

228
Q

3-4 month old with doll-like face, thin extremities, short stature, protuberant abdomen?

A

Glucose-6-phosphatase deficiency (Von Gierke’s) - cannot convert glycogen to glucose - get glycogen buildup, seizures, lactic acidosis, hyperuricemia

229
Q

MS worsening factor of environment?

A

High temperature weather

230
Q

LP finding in MS?

A

Oligoclonal IgG bands

231
Q

Cause of Prader-Wili - deletion of parental copy of chromosome 15q11

A

Cause of Angelman syndrome - paternal uniparental disomy (mamma’s boy, daddy’s girl)

232
Q

Thiazide effect on those with diabetes and metabolic syndrome

A

Hyperglucose, hypertriglyceride

233
Q

Hemolytic anemia, increased mean corpuscular hemoglobin, jaundice, splenomegaly?

A

Hereditary spherocytosis

234
Q

Fatigue, weakness, GI symptoms but no vomitting or diarrhea, and low BP?

A

Primary adrenal insufficiency

235
Q

Signs of AS:

A

Weak slow rising pulse (parvus and tardus), single soft S2, mid-tolate peaking systolic murmur

236
Q

abdominaal pain worse at night, weight loss and fatigue, migratory thrombophlebitis

A

Pancreatic cancer

237
Q

Cushing ulcer typical presentation?

A

prominent gastric bleeding, acute onset

238
Q

RA hot swollen single joint with fever?

A

Septic arthritis, RA is more at risk

239
Q

Sail sign in child <3

A

Thymus

240
Q

Treating bradycardia in hypothermia?

A

Active rewarming

241
Q

What is tachysystole?

A

> 5 contractions in 10 minutes, usually induced by labor inducers which can also cause tetanic contractions

242
Q

Side effect of tachysystole

A

fetal heart rate trace abnormalities due to less blood flow 2/2 less relaxation, generally well tolerated

243
Q

Side effects of oxytocin?

A

Tachysystole, hyponatremia, hypotension

244
Q

Achalasia with slowly worsening symptoms and B signs?

A

Psuedoachalasia due to esophageal cancer

245
Q

Back pain/perineal pain for >-3 months with irritative voiding symptoms and unidentifiable cause and normal urine culture?

A

Chronic prostatitis/chronic pelvic pain syndrome, inflammatory if leukocytes in urinalysis - diagnosis of exclusion, treat with antibiotics and usual antiprostate drugs

246
Q

Eczematous ulcerating rash of the nipple -

A

Paget’s disease of the breast - usually due to adenocarcinoma

247
Q

5 days post-MI for anterior infarction be watching for?

A

Ventricular free wall rupture

248
Q

Common manifestation of Lyme carditis?

A

AV node conduction block

249
Q

How to diagnose Lyme?

A

B burgdorferi serology (ELISA and western blot

250
Q

Subacute to chronic lateral elbow pain with history of repetitive or forceful wrist extension, pain with passive wrist flexion

A

Lateral epicondylitis “tennis elbow” - normal treatment + counterforce bracing

251
Q

Goodpasture antibody target?

A

Type IV collagen

252
Q

Arteries affected by fibromuscular dysplasia?

A

Renal and internal carotid arteries

253
Q

Subauricular systolic bruit?

A

nternal carotid artery - usually not affected by atherosclerosis like the carotid bulb

254
Q

Livideo reticularis, blue toes, kidney injury, ocular spots, eosinophilia in urine post cardiac catheterization

A

Cholesterol crystal syndrome

255
Q

Preferred diagnostic study for aortic dissection in patient with renal failure

A

transesophageal echocardiography

256
Q

Test of choice for aortic dissection in hemodynamically stable patients?

A

Transesophageal echo

257
Q

What to check in potential hypertensive emergency?

A

Check for retinal hemmorhages, papilledema

258
Q

Worst case scenario in a posterior oropharyngeal injury?

A

Internal carotid artery dissection

259
Q

Most common cause of congenital aplastic anemia? Short stature, hypopigmentation, hypoplastic thumbs (D/P)

A

Fanconi anemia - DNA repair defect

260
Q

Vaccines for premes with chronilogical or gestational age? Exception?

A

Chronilogical. Exception is hep B, should be >=2 kg before

261
Q

Goal age of delivery for PPROM?

A

34 weeks EGA

262
Q

Goal date for delivery with preeclampsia with severe features?

A

> =34 weeks

263
Q

Severe hypertensive crisis in pregnant mother treatment?

A

Hydralazine or labetalol - don’t use labetalol if bradycardic or nifedipine (oral)

264
Q

Viral prodrome followed by chest pain, respiratory distress, S3 gallop, and holosystolic murmur?

A

Myocarditis resulting in dilated cardiomyopathy

265
Q

Acute fevers chills and myalgias 6-48 hrs after treatment for early syphillis, lyme, or leptospirosis?

A

Jarish-Herxheimer - support with IV fluids, acetaminophen, NSAIDS

266
Q

Carcinoid secretions?

A

Histamine, serotonin, VIP

267
Q

Deficiency in carcinoid and mechanism?

A

All cellular tryptohan used for production of serotonin, tryptophan is also used for niacin - can result in pellagra (diarrhea, dermatitis, glossitis, angular stomatitis, dementia)

268
Q

Nephrotic syndrome in AA or Hispanic obese IV drug user?

A

FSGS

269
Q

Nephrotic syndrome in pt. with hx of hep b or c and lipodystrophy?

A

Membranoproliferative glomerulonephritis

270
Q

Most common cause of acute epidydimitis in patients >35?

A

E. Coli/coliform ascending bacteria related to bladder outlet obstruction

271
Q

Treatment for coliform epidydimits?

A

Levofloxacin

272
Q

Afib and pleuritic chest pain?

A

Think PE

273
Q

Progressive ataxia in adolescence with kyphoscholiosis and pes cavus?

A

Fredereich ataxia - GAA tinucleotide repeat in frataxin gene

274
Q

Cuase of ataxia-telangectasia and risks?

A

DNA repair deficits, malignancy

275
Q

Does GBS affect vibratory or position senses?

A

No

276
Q

Most common cause of inherited intellectual disability and genetics?

A

Fragile X, CGG trinucleotide repeats in X chromosome

277
Q

SUPER high white count and hepatosplenomegaly in a pneumonia patient?

A

Check for CLL with flow cytometry

278
Q

Hepatic encephalopathy acidosis or alkalosis?

A

Alkalosis - promotes conversion from ammonium to ammonia which can enter CNS and drives down potassium - treate with potassium repletion and IV volume repletion

279
Q

New mother with a thumb issue?

A

De Quervain tenosynovitis, inflammation of abductor pollicis longus and extensor pollicis brevis

280
Q

Patent ductus arteriousus, sensineural hearing loss, and cataracts in an infant?

A

Rubella

281
Q

Chorioretinitis, hydrocephalus, and diffuse intracranial calcifications in an infant?

A

Congenital toxo

282
Q

Chorioretinitis with periventricular calcifications in a newborn?

A

CMV

283
Q

Hepatomegaly, nasal discharge,osteoarticular destruction, and maculopapular rash in newborn?

A

Congenital syphillis

284
Q

Postgastrectomy nausea, diarrhea, cramping, sweating, palpitations after eating?

A

Dumping sndrome - rapid emptying of gastric contents into duodenum

285
Q

Treatment for aspiration pneumonia?

A

Clindamycin, amoxicillin-clavulanate

286
Q

Cause of Zenker diveticulum?

A

Eosophageal dysmotility leads to posterior herniation above the upper esophageal sphincter

287
Q

Where to start for infertility workup?

A

Semen analysis

288
Q

AFP in gastroischesis?

A

Elevataed, passes through the exposed bowel wall into amniotic fluid

289
Q

Isolated or comorbid gastroischesis usually?

A

Isolated

290
Q

Positive RPR workup?

A

Need fluorescent treponemal antibody test - postive tests require confirmation from other method

291
Q

Hydrophobia, aerophobea, pharygneal spasm, spastic paralysis, agitation, and ascending flaccid paralysis?

A

Rabies - most common in bats in US, dogs in developing world, need rabies immune globulin and vaccine immediately

292
Q

Why are CF men infertile?

A

Inspissated mucus obstructs development of vas deferens, resulting in congenital absence

293
Q

What causes the peripheral insulin resistance of increased pancreatic B cell hyperplasia of pregnancy?

A

Human placental lactogen (hPL), a somatomammotropin

294
Q

Fever, rash, or arthralgia with peripheral eosinophilia, hematuria, sterile pyura, eosinophiluria?

A

Drug induced interstitial nephritis

295
Q

Delayed bleeding after minimal trauma in 3 yo, especially hemarthrosis (D/P/BT)

A

Hemophilia, A is VIII deficiency and B is IX deficiency, X-linked recessive disorder, BT is coagulation study which will show elevated PTT, normal PT, absent or lowered factors

296
Q

How to treat hemophilia for extensive bleeding

A

Factor replacement, desmopressin for mild hemophilia

297
Q

Patient got a tan and has hypopigmented mildly itchy lesions (D/Path finding)

A

Tinea versicolor due to malazessia, KOH shows budding yeast (spaghetti and meatballs), treat topically with selenium sulfide or ketoconazole

298
Q

PBC relationship to Lipids?

A

HLD

299
Q

Asbestosis carcinoma cancer risk multiplier?

A

Smoking

300
Q

Location of emphysematous changes in COPD and AAT

A

COPD - centriacinar selective to upper lobes, AAT panacinar of lower lobes

301
Q

Common side effect of medroxyprogesterone (the contraceptive shot?)

A

weight gain

302
Q

How to test for lactose intolerance?

A

Rise of hydrogen in breath test indicating carb metabolism

303
Q

Which dystophy is autosomal dominant trinucleotide expansion?

A

Myotonic dystrophy, DMD and Becker’s are X-linked

304
Q

Symptoms of myotonic dystrophy?

A

Dysphagia (most dangerous), myotonia, cardiac conduction problems, cataracts, testicular atrophy, frontal baldness, insulin resistance

305
Q

Screening with BWS?

A

Abdominal ultrasound and AFP for Wilms and hepatoblastoma

306
Q

How does thyrotoxicosis cause hypertension?

A

Leads to positive inotropic and chroniotropic changes leadign to tachycardia, systolic hypertension, widened pulse pressure, afib adn aflutter

307
Q

Thyrotoxic effects on heart?

A

Rhythm issues, systolic hypertension, heart failure, angina symptoms

308
Q

Middle mediastinal mass w/o warning signs?

A

Bronchogenic cyst, tracheal tuor, pericardial cyst

309
Q

Where are neurogenic mediastinal masses located?

A

Posterior mediastinum

310
Q

Indications for home O2 in COPD’r

A

PaO2<55 mmHg, SaO2 <88%, slightly higher in those with cor pulmonale

311
Q

Diarrhea occuring even during fasting or sleep?

A

Secretory diarrhea

312
Q

Distinguish osmotic from secretory diarrhea?

A

Stool osmotic gap

313
Q

Typical finding of SCC biopsy

A

keratin pearls

314
Q

Bladder part injury that leads to peritonitis?

A

Bladder dome

315
Q

Is HFpEF the same as high output heart failure?

A

No, high output heart failure occurs ins severe anemia, hyperthyroidism, beri beri, and Paget’s

316
Q

Part of bowel resection that can contribute to gallstone?

A

Ileum

317
Q

Most common predisposing factor for acute bacterial sinusitis in a child?

A

Viral infection

318
Q

Fluid of choice for hypernatremia?

A

NS

319
Q

How long to d/c SSRI before starting MAOI?

A

2 weeks

320
Q

Mental status changes, autonomic dysregulation, and neuro hyperactivity in psych patient?

A

Check serotonin syndrome

321
Q

New onset GI symptoms, confusion, ataxia, tremor in hospitalized schizoaffective patient?

A

Think lithium toxicity from some other given drug reducing renal clearanc

322
Q

Insomnia, fatigue, weight gain in a woman of childbearing years

A

Expect pregnancy

323
Q

Where is Dxylose absorbed? Does it need enzymes?

A

Functional proximal intestines, no enzymes needed

324
Q

Treatment for toxo?

A

Sufadiazine and pyrimethamine plus leucovorin to prevent hemmorhage - initiate ART 2 weeks after beginning treatment

325
Q

Treatment of MAC GI/pulm

A

clarithromycin and ethambutol

326
Q

Vaginal bleeding, pelvic pain, nausea, vomitting?

A

Think ectopic pregnancy

327
Q

Peritoneal irritation from ovulation follicular fluid?

A

Mittelscmirtz

328
Q

Active panic attack acute treatment?

A

Benzodiazepine

329
Q

Diverticular abscess in stable patient?

A

CT percutaneous drainage

330
Q

First line treatment for cognitive AD symptoms?

A

Cholinesterase inhibitors - donepezil, rivastigmine

331
Q

Methimazole side effects:

A

Agranulocytosis, teratogen in 1st trimester

332
Q

Propylthiouracil side effects:

A

Hepatic fialure, ANCA-vasculitis

333
Q

Radiodine side effects

A

worsening of opthalmopathy

334
Q

Preferred treatment for nephrogenic DI?

A

HCTZ

335
Q

Right sided motor and sensory issues predominant in lower extremity WITH urinary incontinence and WITHOUT visual defects?

A

ACA stroke, urinary incontinence unlikely in lacunar stroke, visual defects likely in MCA stroke

336
Q

Ammenorhea with negative BhCG workup?

A

Prolactin, TSH, FSH

337
Q

Severe auditory canal infection and base of skull infection with granulation tissue and an edematous external auditory canal

A

Pseudomonas aeruginosa

338
Q

IV drug of choice for pseudomonal MOE?

A

Ciprofloxacin

339
Q

Adult-onset disral muscular weakness and atrophy with dysphagia?

A

Inclusion body myositis

340
Q

Typical symptoms of GBS?

A

Ascending flaccid paralysis with distal parethesias

341
Q

typical finding of CSF in GBS?

A

Albuminocytologic dissociation - normal WBC, high protein

342
Q

Immunocompromised, febrile, productive cough, low PO2, 2/6 Left upper border HM?

A

Pneumonia, fever causes hyperdynamic heart state

343
Q

Preferred enema style for intussuception?

A

Air enema - safer cleaner than contrast enema

344
Q

Action tremor with no additional signs?

A

Essential tremor

345
Q

Marked hypertension and acute kidney injury in setting of systemic schlerosis? (D/Path)

A

Scleroderma renal crisis - upt to 20% of patients with diffuse cutaneous sclerosis. Increased vascular permeability, activation of coagulation cascade, increased renin along with microangiopathic hemolytic anemia - schizocytes and thrombocytopenia

346
Q

Burr cell meaning?

A

End stage renal disease, liver disease

347
Q

Howell-Jolly body meaning?

A

Asplenia or splenectomy

348
Q

Target cell meaning?

A

Thalasemmia or chronic liver disease

349
Q

Pyrexia, tachy, delirium, and vomitting on hyperthyroidism after CT?

A

Thyroid storm due to iodine load from contrast

350
Q

How to treat boodborne botulism?

A

Horse-derived antitoxin

351
Q

What does botulin toxin inhibit?

A

Presynaptic acetylcholine release at NMJ

352
Q

Tetanus infection or toxin?

A

Toxin - blocks release of GABA and glycine

353
Q

Cut down on alcohol craving?

A

Naltrexone or acamprosate

354
Q

Basic lab analysis for suspected essential hypertension?

A

Urinalysis, chemistry panel, lipid profile, baseline EKG

355
Q

MEN1 three P’s

A

Parathyroid adenoma/hyperplasia, gastrointenstinal/pancreatic tumors (ZE), pituitary adenomas

356
Q

Smudge cells?

A

Pathognomoic for CLL

357
Q

Cause of gilberts?

A

UDPglucuronosyltransferase

358
Q

If pet is available for quarantine, does dog bite require prophylaxis for rabies?

A

No, dogs develop full symptoms in 5-10 days vs humans for 1-3 months

359
Q

When to give tetanus immunoglobulin? Unimmunized, dirty wound

A

Dirty wound last tetanus update? Within 5 years

360
Q

Infant chronic diarrhea, lymphadenopathy, and failure to trhive PLUS opportunitstic infections?

A

Consider T lymphocyte deficiency

361
Q

Differentiate HIV infection with ADA deficiency in infant?

A

ADA deficiency has profound lymphopenia

362
Q

Recurrent severe infections from staph A., serratia, and aspergillus?

A

chronic granulomatous disease, impaired phagocytosis means catalase + infections proliferat

363
Q

Path of toxic megacolon in UC?

A

Subset get inflammation to smooth muscle layer leading to colonic dilation

364
Q

Treatment for IBD toxic megacolon?

A

IVF, broad spectrum antibiotics, bowel rest, and IBD specific corticosteroids

365
Q

Hemolysis, bite cells, Heinz bodies

A

G6PD deficiency

366
Q

Right sided pleural effusion with moderate lymphocytosis and elevated protein?

A

Suggestive for TB

367
Q

Key enzyme to produce estrone/estogren from androstenedione?

A

Aromatase

368
Q

Hormones in Kallmann syndrome

A

hypogonadotropic hypogonadism

369
Q

Why avoid prolonged high FiO2?

A

Oxygen toxicity

370
Q

Brain complication of ADPKD?

A

Cerebral aneurysms

371
Q

Preferred med for ADPKD hypertension?

A

ACEi

372
Q

vWD have bleeding into tissue?

A

No, normally mucosa, think hemophilia for tissue bleeding or hemarthrosis

373
Q

Herpangina vs. HSV

A

Herpangina, Coxackie A, summer/early fall, gray vesicles on tonsillar pillars and posterior oropharynx

374
Q

HSV

A

mostly oropharynx and lips

375
Q

Age cut off for likey sjogren’s

A

middle age, unusual for initial presentation after 65

376
Q

> 65 sjogren’s presentation but no antibodies?

A

Age-related sicca syndrome due to decreased exocrine output from glands

377
Q

How quickly does RAI therapy ablate thyroid follicles?

A

weeks to months

378
Q

Why does lymphedema transition from pittingto nonpitting?

A

Deposition of subcutaneous collagen and adipose tissue

379
Q

Inability to lift skin off of dorsum of foot?

A

Stemmer sign, highly specific for lymphedema

380
Q

Differentiate RDS of newborn vs transient tachypnea?

A

Lung volumes - low lung volumes in RDS

381
Q

Path cause of TTN? Delayed resoprtion of alveolar fluid

A

Chest x-ray finding of transient tachypnea of newborn?

Fluid in interlobar fissures

382
Q

Highly sensitive syphillis test?

A

FTA-ABS (treponemal)

383
Q

Drugs that cause a phototoxic drug reaction -

A

Tetracyclines - exagerated sunburn reactions with erythema,edema, and vesicles

384
Q

Hard to visual fundus, dark red hue, sudden loss of vision

A

Vitreous hemorrhage - treat with upright position during sleep

385
Q

Pancytopenia, spenomegaly due to clonal B-cell neoplasm?

A

Hairy cell leukemia - look for “hairy cell projections””, dx with bone marrow biopsy

386
Q

Differentiating test between CML and leukmoid reaction?

A

Decreased leukocyte alkaline phosphatase score in CLL

387
Q

Auer rods in all myelocytic leukemias?

A

No, only AML

388
Q

Rapidly progressing dementia and myoclonus?

A

Creutzfelt-Jacob

389
Q

CSF fluid finding for Creutzfelt-Jakob disease?

A

14-3-3 regulatory proteins

390
Q

Dermatomyositis classic violaceous poikiloderma locations

A

Heliotrope, shawl, and gottron’s (on knuckles)

391
Q

Gottron’s papules?

A

Scaly papules over joints pathognomonic for dermatomyositis

392
Q

Classic autoantibodies for dermatomyositis?

A

Anti-Jo, anti-Mi-2

393
Q

Common comorbidity with dermatomyositis?

A

Internal malignancies

394
Q

Risk factor for hypergonadotropic hypogonadism -

A

hypothyroidism

395
Q

Limited upward gaze, upper eyelid retraction, prostitutes pupil?

A

Parinaud syndrome - pineal gland mass (can also add obstructive hydrocephalus signs)

396
Q

Length of QT interval?

A

2 big boxes

397
Q

Elongated QT interval treatment?

A

Maintain levels of calcium, potassium, and magnesium pharmacotherapy, Beta blockers, may need pacemaker

398
Q

CD19 and CD3 association?

A

19-Bcells, 3-T cells

399
Q

Differentiate breastfeeding jaundice and breast milk jandice

A

Breastfeeding - insufficient intake with suboptimal breastfeeding and dehydration around 1 week - causes less bilirubin output
Breastmilk - 3-5 days to 2 weeks, high levels of B-glucoronidase in breast milk - everything else normal

400
Q

Cause of Kaposi sarcoma?

A

HHV8

401
Q

Bone pain worse at night relieved by NSAIDS with a small round lucency on Xray

A

Osteoid osteoma

402
Q

Ewing sarcoma finding on Xray?

A

Extensive bony involvmenet and onion skinning

403
Q

HIV dementia has what sort of dysfunction along with apathy and impaired attention?

A

Subcortical dysfunction such as slow movement and difficulty with movement

404
Q

Common lung manifestation of systemic sclerosis

A

Pulmonary artery hypertension

405
Q

Mechanism of PAH in systemic sclerosis

A

hyperplasia of intimal smooth muscle ratio and unaffected lungs

406
Q

Method of action of dobutamine in meth cardiomyopathy?

A

Increase myocardial contractility/decrease in left ventricular end-systolic volume - primarily B1 action

407
Q

Psych symptoms with neuro symptoms in a child with abnormal liver function test?

A

Wilson’s disease

408
Q

Other places fibromuscular dysplasia occurs outside of renal arteries?

A

Carotid, vertebral (amaurosis fugax, Horner’s, TIA)

409
Q

Dx for fibromuscular dysplasia?

A

CT angiogram or duplex ultraosound

410
Q

Which diabetes medication can aid in weight loss?

A

GLP-1 agonists (exenatide, liraglutide

411
Q

GLP-1 risk?

A

Acute pancreatitis

412
Q

Irregular vaginal bleeding, englarged uterus, and chest pain 6 mo after pregnancy (D/BT)

A

Choriocarcinoma, quantitative B-hCG

413
Q

Management of postictal lactic acidosis if seizures are controlled?

A

Recheck after 2 hours, lactic acid AGMA due to skeletal muscle hypoxia

414
Q

Findings from central retinal artery occlusion?

A

Whitened retina (edam) and red fovea (cherry red spot) as well as defect in afferent pupil reflex

415
Q

Hypokalemia alkalosis and normotension differential?

A
  1. Surreptitious vomiting
  2. Diuretic abuse
  3. Bartter syndrome
  4. Gitelman’s syndrome
416
Q

Nontender 2x2 chronic hard palate mass in a young healthy patient?

A

Congenital torus palatinus - bony growth that only has intervention if symptomatic

417
Q

What agents to avoid in glaucoma?

A

Atropine - further dilates the pupil and can worsen glaucoma

418
Q

How does Guillain Barre syndrome cause damage?

A

Demyelination of peripheral nerve fibers

419
Q

What neuromuscular illnesses involve the anterior horn cells?

A

Spinal muscular atrophy (infants), poliomyelitis, and ALS

420
Q

where is Broca’s area located?

A

Frontal lobe

421
Q

How soon to become vitamin K deficient in acutely ill person with reduced liver stores?

A

7-10 days

422
Q

subacute fever, chills, malaise, headache with bilateral hilar lymphadenopathy and granulomas with narrow based budding yeast?

A

Histoplasmosis

423
Q

Emperic treatment of choice for menningococcal meningitis?

A

Ceftriaxone and vanc, dexamethasone does NOT help

424
Q

RMSF manifestation of CSF?

A

Seems like viral meningitis

425
Q

Parkinsons med that can cause acute closure glaucoma?

A

Trihexyphenadyl - anticholinergic

426
Q

Symptoms of refeeding syndrome? Primary deficiency electrolyte?

A

Pancreatic insulin surge after starvation, shift of magnesium, potassium into cells causing cardiac arythmias, congestive heart failure, and seizures, potassium is primary deficiency due to need for ATP

427
Q

Risk of inverted uterus?

A

Hemorrhagic shock and lower abdominal pain

428
Q

Path of aortic coarctation?

A

Thickening of tunica media of aortic arch

429
Q

Physiological findings in depression?

A

Increased cortisol from hyperactivity of hypothalamic-pituitary-adrenal axis, decreased hippocampal and frontal lobe volumes

430
Q

Nonspecific symptoms with splenomegaly and elevated alk phos and very low CD4 count?

A

Think dissemeinated MAC

431
Q

Prophylaxis for MAC

A

Azithromycin

432
Q

Concave abdomen, barrel shaped chest, pulmonary distress in infant?

A

Think CD4

433
Q

Treatment for bony tumors outside of chemo to prevent pathologic fractures and malignant hypercalcemia?

A

Bisphosphonates

434
Q

Unexplained superficial venous thrombosis and upper GI issues?

A

Think trousseau’s syndrome (migratory superficial thrombophlebitis) related to pancreatic carcinoma

435
Q

PTHrP cancer producer:

A

sCa++amous - squamous cell carcinoma

436
Q

SIADH from cancer type?

A

Small cell carcinoma

437
Q

ectopic ACTH production?

A

Suspect small cell carcinoma

438
Q

Most important predisposing factor to aortic dissection?

A

Systemic hypertension

439
Q

weakness and tremors after asthma attack?

A

Albuterol potassium shifts

440
Q

First line treatment for blood pressure control in aortic dissection?

A

IV beta blockers - reduce cardiac and aortic wall stress

441
Q

Treatment for TCA toxicity with QRS>100 msec?

A

Sodium bicarb

442
Q

How does late gestation cause oligohydramnios?

A

Preferential redistrubtion during placental insufficient shunts blood to brain

443
Q

Signficant air leak after chest tube placement post chest trauma?

A

Tracheobronchial rupture

444
Q

Hx of RA with enlarged kidneys and hepatomegaly nephropathy cause?

A

Amyloid deposition - stain apple-green birefringent with Congo red

445
Q

Most common cause of AA amyloidosis in US?

A

RA

446
Q

Leukopenia, thrombocytopenia, and elevated aminotransferases ofter tic bite?

A

Ehrlichosis

447
Q

Periorbital edama, myositis, and eosinophilia?

A

Trichonillosis

448
Q

Diagnosis of celiac?

A

Anti IgA transglutaminase and IgA anti-endomysial antibodies

449
Q

Blackfan association?

A

Only red cell line underdevelopment

450
Q

Fanconi anemia

A

pancellular failure

451
Q

Cyclosporine mechanism of action and side effects?

A

Inhibiting transcription of IL-2 - nephrotoxicity, hypertension, nuerotoxicity, glucose intolerance, gingival hypertrophy and hisuitism

452
Q

Distinguish cyclosporine vs tacrolimus side effects?

A

Tacrolimus does not cause hisutism or gingival hyperplasia

453
Q

Azathiaprine mech of action and side effects?

A

Purine analog converted to 6-mercaptopurine inhibiting purine synthesis - dose related diarrhea, leukopenia, and hepatotoxicity

454
Q

Mycophenolate mech of action and side effect?

A

Reversible inhibitor of inosine monophosphate - inhibits purines - depresses MARROW

455
Q

Drug stimulant with seizures and hyponatremia?

A

Ecstasy

456
Q

Treatment of PBC?

A

Ursodeoxycholic acid - decreases biliary injury by bile acids

457
Q

Aortic stenosis patient has GI bleeding?

A

Angiodisplasia related to acquied vW factor deficieny

458
Q

Treatment for norcadia?

A

TMP-SMX and carbapenems if brain involvement

459
Q

Anticentromere antibody?

A

Limited cutaneous systemic sclerosis

460
Q

Anti-RNA polymerase II antiboday

A

Diffuse cutaneous sclerosis

461
Q

Elevated homocysteine?

A

Give B6 and folate

462
Q

Anti CCP

A

RA

463
Q

Anticentromere

A

CREST

464
Q

anti dsDNA

A

SLE

465
Q

Antihistone

A

Drug induced lupus

466
Q

AntiJo1

A

Polymyositis/dermatomyositis

467
Q

Antimitocondrial

A

PBC

468
Q

Anti-Scl-70

A

Systemic sclerosis

469
Q

Anti Sm

A

SLE

470
Q

Anti smooth muscle

A

Autoimmune hepatitis

471
Q

Antitopoisomerase I

A

Systemic sclerosis

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