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Week 4 Flashcards

1
Q

Mechanism of action of clopidogrel?

A

P2y12 receptor blocker

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2
Q

NSTEMI drug eluting stent rec?

A

Dual anticoagulation therapy for 12 months

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3
Q

Mechanism of action of colchicine and role in cardio?

A

Tubulin inhibitor - can be involved with pericarditis treatment

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4
Q

Hip pain mostly with pressure while sleeping in middle age man?

A

Trochanteric bursitis

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5
Q

Elevations of transaminases with skin findings of PCT?

A

Suspect HCV

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6
Q

Diagnosis of suspected PCT

A

increased plasma and urine porphyrins

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7
Q

Extrapulmonary TB sites?

A

Lymph nodes, liver, bones, CNS

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8
Q

Most common cause of viral meningitis?

A

Enterovirus (coxackie B)

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9
Q

After getting high level of fingerstick lead in child, what follow up test?

A

Venous lead - high false positive in fingerstick

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10
Q

When to chelate for lead?

A

> 45 ug/dL

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11
Q

Pink stains or brick dust in neonatal diapers

A

uric acid crystals, normal in newborn

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12
Q

Normal amount of weight ot lose in first 5 days of life?

A

Up to 7%

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13
Q

Brick urine with other abnormalities

A

Lesch Nyan syndrome

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14
Q

AD characteristic neuroimaging finding?

A

Medial temporal lobe atrophy

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15
Q

Altered mental status, oculomotor dysfunction, and gait ataxia with hyperemesis gravidarum?

A

wernicke’s encephalopathy - thiamine

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16
Q

Major blood finding of hyperemesis gravidarum?

A

Hypochloremic metabolic alkalosis, hypoglycemia, elevated liver enzymes

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17
Q

Effusion with highly elevated triglycerides?

A

Chylothorax from dysruption of lymph flow - lymph has T cell lymphocytes, immunoglobulins, and lipi-transporting chylomicrons

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18
Q

How does glucagon counteract too much b-blockade or calcium channel blockade?

A

Increases intracellular levels of cAMP

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19
Q

Treatment of over b-blockagde

A

First IV fluids and atropine, then IV glucagon

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20
Q

Liver cyst and bloody diarrhea after travel?

A

E. histolyica - treat with metronidazole and paromycin

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21
Q

What labor related drug can cause seizures?

A

Oxytocin, related to ADH in structure and can cause water toxicity

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22
Q

How to treat organophosphate toxicity

A

atropine and remove clothing as organophosphate can be absorbed through skin

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23
Q

First line for treatment of PCP intoxication?

A

Benzodiazepines

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24
Q

Huntington’s chorea MRI finding?

A

Atrophy of the caudate nucleus

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25
Q

Retinoblastoma path?

A

Inactivation of RB1 - tumor suppressor gene

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26
Q

Adult onset seizure or increased ICP with cystic lesion with surrounding enhancement and edema at various stages of development (D/Tr)

A

Neurocystercosis due to ingested eggs hatching and invading - treat with antiepileptics, albendazole, and corticosteroids

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27
Q

Rapid pain relief from cancerous bony mets?

A

Radiation therapy

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28
Q

Fever >39 in child <3?

A

Think occult UTI - do a straight cath

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29
Q

CURB-65?

A

Confusion, Urea Nitrogen >20, respirations >30, Blood pressure hypotensive, >65 yo, >3 hospitalized for pneumonia with fluoroquinolone or beta-lactam and macrolide

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30
Q

Outpatient treatment of CAP?

A

Macrolide or doxy for healthy, fluoroquinolone or betalactam + macrolide in comorbidity

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31
Q

Distinguish primary adrenal insufficiency from steroid use -

A

PAI usually has hyperkalemia due to concurrent mineralocorticoid deficiency

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32
Q

Dosage of steroids needed for adrenal suppression?

A

> =20mg/day

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33
Q

On top of CAP with CNS or GI dysfunction, what other findings are classic for Legionaire’s disease?

A

Hyponatremia, brady relative to fever, and mild hepatits

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34
Q

Treatment for Legionairre’s

A

macrolide or fluoroquinolone

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35
Q

Hyposthenuria?

A

Inability of the kidneys to concentrate urine

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36
Q

Hyposthenuria in SCD path?

A

Blood cells sickle in the vasa recta, impairing free water reabsorption and countercurrent exchange

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37
Q

Distinguish hyposthenuria from DI?

A

Normal serum sodium in hyposthenuria due to intact function of ADH

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38
Q

Trimethoprin electrolyte deregulation in HIV patient?

A

Hyperkalemia by blocking ENaC (and also causes non-AKI Cr bump) - check potassium serially

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39
Q

Acute shortness of breath, obstipation, abdominal distension, with pelvic/abdominal pain with a firm, nonmobile pelvic mass with nodularity and BRCA positive?

A

Suspect epithelial ovarianc cancer, needs exploratory laporotamy and CA125 levels - don’t biopsy due to possible rupture and spread

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40
Q

How to prevent preterm delivery in hx of preterm labor or rupture of membranes?

A

Intramuscular progesterone, serial cervical length measurements, potentially cerclage

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41
Q

Blue bulging vaginal mass and cyclical lower abdominal pain in a girl who has not yet menstruated?

A

Imperforate hymen

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42
Q

Associated neoplasms of Lynch syndrome?

A

Colorectal, endometrial, ovarian

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43
Q

Associated neoplsasms of FAP?

A

Colorectal, desmoids/osteomas, brain tumors

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44
Q

A1ssociated neoplasms of von Hippel-Lindau?

A

Hemangioblastomas, clear cell renal carcinoma, pheochromocytoma

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45
Q

Cause of Lynch syndrome

A

DNA mismatch repair gene

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46
Q

Assymptomatic scattered erythematous macules, papules, and pustules on a neonate?

A

Erythema toxcicum neonatorum - bening and no treatment

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47
Q

Do OCP’s cause weight gain?

A

No, can cause hypertension, venous thromboembolism, or cervical cancer

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48
Q

Treatment of choice for adjustment disorder?

A

Psychotherapy

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49
Q

Acute MS exacerbation?

A

First glucocorticoids - plasmapheresis only if refractory

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50
Q

Infectious hepatic cyst if patient is afebrile with daughter cysts to initial cys?

A

Echinococcus grandulosum - treat with albendezole, dx with IgG serology

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51
Q

Signs of renovascular disease?

A

Diffuse atherosclerosis, asymmetric kidney size, recurrent flash pulmonary edema, elevation in serum Cr >30%

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52
Q

Erythema of nasal mucosa with increased energy and mood changes as well as weight loss?

A

Cocaine

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53
Q

Neuro deficits and palpable step off in a kid with back pain?

A

Spondylolisthesis - forward slip of vertebrae, usually L5 over S1

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54
Q

Who should be screenied for chlamydia and gonorrhoeae?

A

All sexually active women <24 yrs old

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55
Q

Neck pain and limited rotation with sensory deficit in arms?n

A

Cervical sponylosis - sensory deficits caused by osteophye-induced radiculopahty

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56
Q

Mass causing precocious puberty? Probably granulosa cell tumor -

A

Look for estrogen and inhibi

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57
Q

Cardiomyopathy in the face of persistent tachycardia?

A

Aggressive rate control or restoration of sinus rhythm

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58
Q

Why is there signs of hemolysis on B12 deficiency?

A

INcreased intramedullary hemolysis of megaloblasts

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59
Q

How does clubbing occur?

A

Megakaryocytes that skip pulmonary circulation - trapped in distal fingers and release VEGF and PDGF

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60
Q

Keep a PDA open? close it?

A

PGE1 to keep it open, indomethacin to close

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61
Q

How does supplement O2 cause seizures in chronic COPD?

A

Loss of compenatory vasocontriction of lungs - increased oxyhemoglobin reduces uptake of CO2, decreased respiratory drive - causes cerebral vasodialtion and can alter consciousness level via upreg of GABA/glutamine

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62
Q

Main risk factors of aneurysm expansion?

A

Cigarette smoking, hypertension only has weak association with AAA

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63
Q

Indeterminate TVUS for elevated B-hCG -

A

Check B-hCG in 2 days - should be approx 1500-2000

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64
Q

Atypical glandular cells on a Pap test?

A

Cervical or endometrial adenocarcinoma - colposcopy, endocervical currettage, and endometrial biopsy

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65
Q

Back pain during testicular cancer?

A

Retroperitoneal lymph nodes

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66
Q

Interstitial infiltrates, serous pleural effusion, and a rash (D/Tr)

A

Mycoplasma pneumoniae - azithromycin

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67
Q

Persistent ST-segment elevations in the months following an MI with symtoms of heart failure?

A

Ventricular aneurysm

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68
Q

Side effect of malabsorption like Crohn’s?

A

Increased oxalate absorbtion due to decreased fat absorbtion as calcium binds the fat and oxalate is free to be absorbed

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69
Q

Complication of mono?

A

Airway obstruction

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70
Q

Hawthorne effect

A

tendency of a study population to affect the outcome due to being studied

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71
Q

Normal at birth but then develop apathy, weakness, hypotonia, large tongue, abdominal bloating?

A

Hypothyroidism, screened for in all states

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72
Q

Therapy for central precocious puberty that has no findings on MRI?

A

GnRH

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73
Q

Percentage of hypothyroid patients presenting with myalgias/myopathy

A

1/3

74
Q

Lithium exposure to infant?

A

Ebsteins abnormality (atrialization of right ventricle) in first trimester, goiter and transient neuromuscular dysfunction in 2nd and 3rd

75
Q

Abdominal pain, lower extremity purpura, arthritis, and hematuria in a kid -

A

Henoch-Schonlein purpura, IgA medited vasculitis of small vessels

76
Q

Antipsychotic with highest potential to increase prolactin?

A

Risperidone

77
Q

Painful and painless genital ulcers?

A

Painful and small - herpes
Painful and large - h. ducreyi
Painless and single - syphilis
Painless and small shallow - chlamydia L1-L3 (lymphogranuloma venereum, can progress to buboes)

78
Q

Med to help pass a kidney stone?

A

Alpha blocker

79
Q

Reduce risk of microvascular complications -

A

macrovascular not firmly established

80
Q

Closed fists with overlapping fingers?

A

Edwards syndrome

81
Q

Absence of epidermis over skull, holoprosencephaly, microopthalmia, omphalocele?

A

Trisomy 13

82
Q

Mortality rate in edwards first year

A

95%

83
Q

Hyperviscosity, neuropathy, and infiltrative disease (end organ damage) with a monoclonal M-spike of IgM?

A

Waldenstom’s macroglobulinemia - need to see >10% clonal B cells on bone marrow biopsy

84
Q

What are examples of tissue infiltration symptoms?

A

Hepatosplenomegaly, lymphadenopathy, cytopenias

85
Q

P/F in ARDS

A

<300 mmHg

86
Q

Are PAC’s a big deal?

A

No, stop stimulation and only work up in absence of obvious precipitants

87
Q

Mono symptoms with leukocytosis and variant lymphocytes with a large vacuolated cytoplasm?

A

Mono - heterophile antibodies specific b ut not sensative in early course of illness

88
Q

Leukmoid vs leukemia?

A

High leukocyte alkaline phosphatase score suggests leukmoid - also more late neutrophils and lack of absolute basophilia

89
Q

Why does follicular thyroid cancer typically mets?

A

Key feature is invasivenes to blood vessels

90
Q

Exogenous thyroid hormone finding?

A

Decreased serum thyroglobulin

91
Q

After reprefusion of a limb, what should you be watching for?

A

Compartment syndrome

92
Q

Source of exophtalmos in Grave’s?

A

T cell activation and stimulation of orbital fibroblasts by TRAB

93
Q

Use dependence of class 1C antiarryhtmic drug

A

flecainide used in afib blocks sodium channels inhibiting phase 0 - with faster heart rates, drug has less time to dissociate so it blocks more channels and widens QRS complex - mechanism of efficacy controlling supraventicular arryhtmias

94
Q

Risk factor for achilles tendonopathy?

A

Fluoroquinolone use, corticosteroids, organ transplant

95
Q

Fluoroquinolone mechanism of action?

A

Direct inhibition of DNA synthesis

96
Q

When to get CA-125 level?

A

With the pelvic ultrasonography

97
Q

Pain and knee crepitus with overuse in young female?

A

Patellofemoral pain syndrome - quad strengthening exercises

98
Q

Chronic oligoarthritis, daily fever, and rash in a young child?

A

Systemic-onset juvenile idiopathyic arthritis

99
Q

Findings of juvenile arthritis?

A

Leukocytosis, thrombocytosis, elevated ESR and CRP and anemia

100
Q

When to do chorionic villus sampling vs. fetal karyotyping?

A

CVS - 10-13 weeks, after, fetal karyoptyping, both DIAGNOSTIC tests

101
Q

Intolerable itching during pregnancy? Lab findings? Treatment?

A

Intrahepatic cholestasis of pregnancy - highly elevated liver enzymes and total bile acid - treat with ursodeoxycholic acid and early delivery - still need to rule out hepatitis

102
Q

Severe liver issues with nausea and vomitting, hypoglycemia, and encephalopahty in third trimester of pregnancy?

A

Acute fatty liver of pregnancy

103
Q

Red papules with striae sparing the umbillicus in third trimester of pregnancy?

A

Pruitic urticarial papules and plaques of pregnancy

104
Q

Distinguish Bruton’s agammaglobulinemia from common variable immunodeficiency?

A

B cells levels - Bruton’s low due to tyrosine kinase defect

105
Q

Genetics of Brutons

A

X-linked

106
Q

Post-exposure prophylaxis for pertussis?

A

Macrolides

107
Q

Endocarditis prothestic most likely colonization?

A

Staph aureus or epidermidis

108
Q

Endocarditis gingival manipulation?

A

Strep viridans

109
Q

Endocarditis with uti?

A

Enterococcus

110
Q

Who gets prophylaxed for dental procedures?

A

Past IE

111
Q

Cause of folate deficiency in alcoholics?

A

Disrupts enterohepatic cycle and inhibits absorbtion

112
Q

Effect of estrogen on thyroid

A

Increase T4-binding globulin - increased total T4

113
Q

Effect of estrogen on thyroid?

A

Increase T4-binding globulin - increased total T4

114
Q

Cirrhosis effect on hormones

A

Hypogonadism

115
Q

Pancreatitis path after stenting?

A

Cholesterol emboli

116
Q

Path of Kallmann syndrome?

A

Disorder of migration of fetal olfactory and GnRH celsl

117
Q

TSH in pregnancy?

A

Down - hCG stimulates TSH on its own

118
Q

First line treatment for diffuse esophageal spasm?

A

Calcium channel blockers

119
Q

What if intramuscular epinephrine does not fully control anaphylaxis?

A

Give it again

120
Q

Intermittent claudication is a strong predictor of future what?

A

Cardiovascular morbidity and mortality

121
Q

Drug for treating urge incontinence?

A

Antimuscarinics like oxybutynin

122
Q

First line treatment for chemotherapy induced nausea?

A

Serotonin receptor antagonists like odansetron

123
Q

Complications of subarachnoid hemmorhage by timing:

A

24 hours- Rebleeding

3-10 days: Vasospasms

124
Q

Prevention of vasospasm after SAH

A

Nimodipine

125
Q

Diagnostic criteria of acute liver failure?

A

Severe acute liver injury evidenced by elevated denzymes, signs of hepatic encephalopathy, and impaired synthetic function (INR>=1.5)

126
Q

Differentiate ALF from acute hepatitis?

A

Presence of epatic encephalopathy

127
Q

Liver mass in old man with exposure to toxins

A

Hepatic angiosarcoma

128
Q

Biliary obstruction, jaundice, pruritus, light-colored stool, and liver mass

A

Cholangiocarcinoma

129
Q

Most common primary liver cancer?

A

Hepatocellular carcinoma in chronically inflamed liver

130
Q

Low grade fever, violaceous water skin lesions, and moderate pulmonary infection. Other sites of infection?

A

Blastomyces dermatiditis. Bone, prostate, CNS

131
Q

Can disseminated infection occur in blasto in immunocompoetent patients?

A

Yes

132
Q

Dx of fetal arrest?

A

No cervical change for >= 4 hours with adequate contractions, no cervical change >=6 hours with inadequate contractions

133
Q

Empiric prophylaxis for bacterial meningitis per age group:

A

2-50 - strep pneumo and neisseria - vanc and cefepime
>50 - add amp for listeria
Immunocompromised - add amp - also suspect GNR’s
Neurosurgery/penetrating trauma - vanc and cefepijme

134
Q

First line for narcolepsy?

A

Modafinil - nonamphetamine wakefulness drug

135
Q

Causes of secondary hypogonadism?

A

Mass lesions (prolactinemia), long term use of glucocorticoids or opiods, or severe systemic illness

136
Q

Most common cause of constrictive pericarditis in developing countries?

A

TB

137
Q

Refractory hypokalemia

A

check magnesium - mg inhibits renal secretion via ROMK channels and low levels leads to excess secretion

138
Q

Normal growth by 1 year?

A

Triple weight, height increase by 50%

139
Q

Bright, sharply demarkated erythema in the perianal region

A

Streptococcal perianala dermatitis from GAS

140
Q

Differentiate GBS from tick nuerotoxin disease?

A

GBS usually has autonomic dysfunction

141
Q

Treatment for EPS effects of antipsychotics by type:

A

Dystonia: Benztropine or diphenhydramine
Akasthisia: B-blocker, benzo, or benztropine
Parkinsons: Benztropine or amantadine
Tardize: Valbenazine

142
Q

First line for neuropathic pain control in patient >65?

A

Pregabalin, less side effects

143
Q

First line for generalized anxiety disorder:

A

SSRI’s OR SNRI’s like venlafaxine

144
Q

How does the kidney adapt to pregnancy?

A

How does the kidney adapt to pregnancy?

145
Q

Pentad of TTP?

A

Thrombocytopenia, MAHA, renal insufficiency, neuro changes, fevers

146
Q

Stork bite in infant?

A

Nevus simplex

147
Q

Type of hemangioma that gets bigger in first year of life? Treatment if in a bad spot?

A

Superficial, infantile hemangioma, b-blockers

148
Q

Why are MM patients prone to infection?

A

Hypogammaglobulinemia due to bonemarrow infiltration of neoplastic cells

149
Q

Dx of gram negative sepsis in burn patient?

A

Quantitative wound culture and biopsy for histopathology

150
Q

Snuffles, maculopapular rash, and abnormal long-bone radiographs in neonate with hepatosplenomegaly?

A

Congenital syphillis

151
Q

Differentiate Giant cell arteritis from Takayatsu’s?

A

Age >50 for giant, <50 for takayasu’s

152
Q

Constitutional symptoms and cardio complications with mass in right atrium?

A

Cardio myxoma

153
Q

Preterm labor management by week:

A

<32 weeks - betamethasone, tocolytics, magnesium sulfate

32-34.0 - betamethasone and tocolytics

154
Q

Patient is prematurely in labor, what to give?

A

Magnesium sulfate - reduces incidence of CP

155
Q

Tocolytics?

A

Indomethicin first line, nifedipine second line

156
Q

Dx of malaria?

A

Thick and thin blood smears with Giemsa stains

157
Q

Vascular cuntaneous lesions in HIV+ homeless person?

A

Bacilliary angiomatosis from bartonella due to lice

158
Q

Kind of Cushing’s that produce hypokalemia?

A

Ectopic ACTH producing tumors

159
Q

Hepatic hydrothorax

A

Pleural effusions from small defect in diaphram

160
Q

Isoniazid hepatitis management?

A

If it looks bad, d/c immediately, if not too bad, don’t worry about it

161
Q

After stroke, give what?

A

Aspirin, plus clopidogrel if recurrent stroke (or dipyridamole)

162
Q

Treating symptomatic polycythemia in infant?

A

NS trasfusion

163
Q

Length of cervix, visa vi preterm labor risk, is established by what test?

A

Transvaginal ultrasound

164
Q

Most common hematologic finding in polyarticular juvenile idiopathic arthritis?

A

Anemia

165
Q

Can neisseria gonorrhoeae cause pharyngitis?

A

Yes

166
Q

Antithyroid immune side effects?

A

Agranulocytosis due to immune destruction of granulocytes

167
Q

Testing for a child post bacterial meningitis?

A

Audiologic testing for common damage to cochlea

168
Q

pyloric stenosis workup?

A

Ultrasonography

169
Q

Symptoms of hypocalcemia during repiratory alkalosis?

A

Due to increased binding of calcium on albumin as hydrogen dissocaites

170
Q

Advise patients with recurrent kidney stones to do what?

A

Lower salt in diet

171
Q

Why do SS patients get hematuria?

A

Renal papillary necrosis

172
Q

Injury for hemicord with sensory loss to belly button?

A

T8, remember that spinothalamic tract decussates 1-2 levels before crossing

173
Q

How do CCB’s cause edema?

A

Preferential dilation of precapillary vessels

174
Q

What can be given with CCB’s to reduce risk of edema?

A

ACEi’s, postcapitallary venodilation

175
Q

Expansile and eccentric lytic area of bone (“soap bubble”)

A

Giant cell tumor

176
Q

Multiple “brown” tumors and cysts

A

osteitis fibrosa cystica

177
Q

Bloody diarrhea with no fever? Best test

A

E. Coli, stool assay for Shiga toxin

178
Q

Prolonged diffuse diarrhea causes?

A

Giardia, cryptosporidium parvum, and cyclospora

179
Q

Prolonged, profuse travellers diarrhea?

A

Cryptosporidium parvum

180
Q

Cafe au lait spots, bone fractures, and precocious puberty?

A

McCune-Albright - G protein activiation

181
Q

Pronator drift indication?

A

Pyramidal/corticospinal tract disease - UMN’s cause more weakness in supinators than pronators

Step 2 (6 decks)

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