World Questions Flashcards by David Cherian

2 week old female w/ ambiguous genitalia. Hyponatremia, hyperkalemia. Decreased cortisol, aldosterone. Increased testosterone. Increased 17-hydroxyprogesterone. Diagnosis?

21-hydroxylase deficiency

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Acute medical management of aortic dissection?

IV beta-blockers. Reduce SBP to 100-120 and HR to <60

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HIV patient with CD4 less than 200 should receive prophylaxis with what medication? To prevent what?

Trimethoprin/Sulfamethoxazole

To prevent PCP

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HIV patient with CD4 less than 50 should receive prophylaxis with what medication? To prevent what?

Azithromycin or Clarithromycin

To prevent MAC

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American Academy of Neurology recommends ruling out these 2 disorders before diagnosing dementia?

B12 deficiency
Hypothyroidism
(alcoholics should also have B1 levels checked)

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First line agents for Alzheimer’s dementia?

Acetycholinesterase inhibitors (donepezil, tacrine)

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Indications for bariatric surgery?

BMI >40 who have failed medical management

BMI >35 with obesity related comorbid conditions

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Management of porcelain gallbladder?

Elective cholecystectomy. Risk of developing gallbladder carcinoma

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What is Morrison’s pouch?

Space in the upper abdomen, hepatorenal space. Blood noted here means there may be up to 500 cc of blood in the abdomen

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Respiratory distress, AMS, and petechial rash in a patient suffering from bone fractures. Diagnosis?

Fat embolism

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Symptoms of benzo withdrawal?

Anxiety, agitation, confusion, seizures, psychosis, elevated blood pressure, tachycardia, and elevated body temperature

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Philadelphia chromosome associated with?

Chronic Myeloid Leukemia

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Chronic Myeloid Leukemia treatment?

Tyrosine Kinase Inhibitors (imatinib)

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Arthrocentesis of gout patient shows?

Negatively birefringent needle shaped crystals

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First line treatments for gouty attacks?

Indomethacin and Colchicine

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Contrandication to colchicine use?

renal failure

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Indications for treatment of subclinical hypothyroidism?

Antithyroid antibodies

- Abnormal lipid profile

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Hypercalcemia, normal PTH, and urinary calcium less than 100. Diagnosis?

Familial Hypocalciuric Hypercalcemia

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Treatment for Lyme disease?

28 day course of amoxicillin or doxycycline

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Contraindications to MMR vaccine?

Anaphylaxis to neomycin
Anaphylaxis to gelatin
Pregnant
Immunodeficient

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Most common anatomic risk factor for Mallory-Weiss tears?

Hiatal hernia

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Clinical findings of Pick’s disease?

Speech abnormalities, Executive functioning impairment, irritable mood, hyper-oral behavior, disinhibition

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CT brain findings in Pick’s disease?

Symmetric atrophy of frontal and temporal lobes

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Vertical nystagmus in an awake or agitated patient, concern for?

PCP overdose

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Children with constipation, after increased fiber-intake, next line agent?

Magnesium hydroxide (milk of magnesia)

Pediatric sepsis less than 1 month old. What organisms do you target? What antibiotics?

E. coli and GBS | Ampicillin + Gentamicin or Cefotaxime

Healthcare worker with needlestick from known HIV-patient. What do you do next?

Immediate HIV test and 2 NRTI drug regimen (Zidovudine, Lamivudine, Tenofivir, Emtricitibine)

What is the difference between Premenstrual Sydnrome and Premenstrual Dysphoric Disorder?

Premenstrual syndrome - Emotional and Physical symptoms that occur in the second half of the menstrual cycle and are relieved by menses. Premenstrual Dysphoric Disorder - Severe form of PMS characterized by anger and irritabiilty

First-line and Second-line agents for treatment for Premenstrual Syndrome or Premenstrual Dysphoric Disorder?

1. SSRI's | 2. Try a difference SSRI or OCPs

Cancers that most frequently metastasize to brain, in order of frequency?

1. Lung 2. Breast 3. Unknown primary 4. Melanoma 5. Colon cancer

Earliest sign of phenytoin toxicity? | Other signs?

Earliest - Horizontal nystagmus on far lateral gaze Other signs - Blurred vision, diplopia, ataxia, slurred speech, lethargy and decreased mentation which can progress to coma.

Usual therapeutic range of phenytoin?

10-20 mcg/mL

Anterior uveitis (iritis) characterized by?

Eye, pain, redness, variable vision loss, constricted irregular pupil, visualization of leukocytes in anterior segment on slit-lamp exam.

How many weeks after a clavicle fracture can a patient return to non-contact sports?

4-6 weeks

How do you differentiate diaper dermatitis from candidal dermatitis?

Candida dermatitis - tomato-red, satellite papules, involves crural folds, also may have history of recent antbiotic use.

Hydrophobia (fear of drinking fluids because of pharyngeal spasms mimicking drowning) pathognomonic for?

Rabies

First line and second-line treatment for chronic prostatitis?

First-line - Quinolones (Cipro and Levaquin) | Second line - Bactrim

First-line and second-line treatment for squamous cell carcinoma?

First-line - Surgical excision | Second-line - Radiation therapy

Adverse effects of isoniazid?

Hepatotoxicity, peripheral neuropathy

Spina bifida managemet after delivery?

Neurosurgical consult for surgery in 24-48 hours

First-line treatment for condyloma accuminata?

Trichloroacetic acid application

Treatment for post-partum endometritis?

Clindamycin and gentamycin

Main risk factor for developing post-partum endometritis?

C-section

Which form of hyperbilirubinemia is typically pathologic, conjugated or non-conjugated?

Conjugated hyperbilirubinemia. Most serious form is biliary atresia

How high are CPK levels in rhabdomyelolysis?

At least 10,000

Pseudomembranous colitis found on sigmoidoscopy or colonoscopy. Diagnosis?

C. diff

Antibiotics most commonly implicated in causing C diff?

Most common is Flouroquinolones (Cipro, levaquin) also, --Extended-spectrum penicillins - cephalosporins - clindamycin

Best initial imaging of choice for pneumothorax?

Upright CXR PA view

Gingko Biloba main adverse effect?

Bleeding and platelet dysfunction. Caution in patients taking anticoagulants

Lacrimation, yawning, mydriasis. Withdrawal or overdose of what type of drug?

Opioid withdrawal

Which antibiotics are most commonly associated with CNS adverse effects, including seizures?

Beta-lactams: Penicillins, cephalosporins, monobactams, Carbapenems, and fluoroquinolones

MELD score for patients being considered for TIPS?

Less than 14 is most favorable outcome. Greater than 24 is contraindication.

What is the 90 day mortality for patients with MELD score of <15, 30, and 40?

MELD <15 = 5% mortality MELD 30 = 35% mortality MELD 40 = 90% mortality

Which 3 drugs interfere with folate metabolism and can lead to folate deficiency?

Trimethoprim Methotrexate Phenytoin

Drug of choice for treating chronic folate deficiency anemia in patients on methotrexate?

Folinic acid (Leucovorin). Folic acid is helpful but still requires dihydrofolate reductase to convert it which is inhibited by methotrexate.

First-line agents for pulmonary hypertension if vasoreactivity test shows favorable response? Second-line agents?

1. Calcium Channel Blockers | 2. Prostanoids, Endothelial receptor antagonists, or PDE-5 inhibitors

Treatment for herpes zoster?

Acyclovir 800 mg PO 5x/day for 7-10 days

Safe and rapid response treatment for Bipolar I disorder with a Manic episode with psychotic features during pregnancy?

ECT

Average sized adult, 1 unit of platelets raises platelet count how much?

5,000/microL

Average amount of time to see rate control response to diltiazem or metoprolol, or emsolol IV in a-fiv RVR patients?

5 minutes

Tourrete syndrome associated with what other psychiatric comorbidities?

ADHD and OCD

Treatment for relapsing or secondary progressive Multiple Sclerosis?

Beta-interferon or Glatiramer acetate

Suspicious for Hashimoto's thyroiditis, next diagnostic step?

Serum anti-TPO antibodies

What dyslipidemia is often seen with hypothyroidism?

Increased LDL and Triglycerides

6 week old infant with staccato cough, rales, and hyperinflated lungs on cxr. Diagnosis?

Chlamydial pneumonia

Infant with cough, wheezes and fever. Diagnosis?

RSV bronchiolitis

Infant chlamydial pneumonia presents at what age range? Treatment?

4-12 weeks. Treat with oral erythromycin for 14 days

Infants receiving oraly erythromycin have higher risk of?

Hypertrophic pyloric stenosis

Diarrhea and eosinophilia. Differential diagnosis?

Helminthic infection, eosinophilic gastroenteritis, Addison's disease

First and second line options for post-exposure chemoprophylaxis to meningococcus meningitis?

1. Rifampin | 2. Cipro

Medication regimen for hyperthyroidism in pregnancy?

PTU in first trimester. Switch to Methimazole in 2nd and 3rd trimester. (Prolonged PTU has risk of liver failure)

Management of asymptomatic, euthyroid, thyroid nodules based on size?

Less than 1 cm -> yearly ultrasounds | Greater than 1 cm -> FNA

Hypomagnesemia caused by?

Aloholism, prolonged nasogastric suction, diarrhea, diuretic use

Drugs that can cause digoxin toxicity if used with digoxin?

Amiodarone, verapamil, spironolactone, quinidine

DKA patient develops fouls smelling nasal discharge, facial swelling, fever, maxillary tenderness, headache. Diagnosis?

Mucormycosis, rapidly invasive fungal disease caused by zygomycetes. Need amphotericin B and stat surgical debridement

Unilateral headache and Horner's syndrome, rule out?

Carotid dissection