1
Q
spinal A synd –> affects what areas of spinal cord? (4)
A
- corticospinal tract
- spinothalamic tract
- ventral horn
- lat gray matter
2
Q
spinal A synd –> presentation? where?
A
- bilat loss of pain/temp –> 1 level below lesion
- bilat spastic paresis –> below lesion
- bilat flaccid paralysis –> at level
3
Q
spinal A synd –> what area of spinal cord spared?
A
dorsal column
4
Q
amyotrophic lat sclerosis –> affects what areas of spinal cord (2)?
A
- corticospinal tract
- ventral horn
5
Q
poliomyelitis –> affect what area of spinal cord? results in what presentation?
A
ventral horn –> flaccid paralysis
6
Q
vitB12 def –> –> affects what areas of spinal cord (2)?
A
- corticospinal tract
- dorsal column
7
Q
Brown-Sequard synd –> affect what area of spinal cord?
A
all tracts on 1 side of spinal cord
8
Q
what nerves responsible for taste? on what areas of tongue?
A
- facial N –> ant 2/3
- glossopharyngeal –> post 1/3
9
Q
what nerve responsible for parotid gland?
A
glossopharyngeal N
10
Q
violent flailing mvmts on 1 side of body is called?
A
hemiballimus
11
Q
hemiballimus –> caused by lesion at?
A
subthalamic nucleus
12
Q
CN III palsy –> results in what position of eye?
A
down & out
13
Q
upward gaze paralysis –> caused by lesion at what?
A
sup colliculi
14
Q
upward gaze paralysis –> seen in what condition?
A
parinaud synd
15
Q
location of stroke: contralat LE & trunk –> weak
A
ACA
16
Q
location of stroke:
- contralat face & UE –> weak, decreased sens
- aphasia
- neglect
- bilat visual abnormal
A
MCA
17
Q
location of stroke: contralat visual abnormal
A
PCA
18
Q
location of stroke:
- focal motor/sens deficit
- loss of coordination
- difficult speak
A
lacunar A
19
Q
location of stroke:
- vertigo
- loss of coordination
- difficult speak
- visual abnormal
- coma
A
basilar A
20
Q
lacunar A infarct –> 5 synd
A
- pure motor hemiparesis
- pure sensory stroke
- ataxic hemiparesis
- sensory/motor
- dysarthria clumsy hand synd
21
Q
1ary amenorrhea –> normal 2ndary sex charact –> should look for what conditions (2)?
A
- anatomical abnormal
- XY genotype
22
Q
1ary amenorrhea –> no 2ndary sex charact –> high FSH, LH –> should look for what conditions (2)?
A
- gonadal agenesis/dysgenesis
- ovarian fail
23
Q
1ary amenorrhea –> no 2ndary sex charact –> low FSH, LH –> should look for what conditions (2)?
A
- prolactinoma
- hypo-pit dysfx
24
Q
2ary amenorrhea –> normal thyroid, prolactin –> neg progestin, estrogen-progesterone challenge –> what condition?
A
Asherman synd
25
2ary amenorrhea --> normal thyroid, prolactin --> neg progestin, pos estrogen-progesterone challenge --> high FSH, LH --> what condition?
ovarian fail
26
2ary amenorrhea --> normal thyroid, prolactin --> neg progestin, pos estrogen-progesterone challenge --> low FSH, LH --> what condition?
hypo-pit dysfx
27
2ary amenorrhea --> normal thyroid, prolactin --> pos progestin --> hirsutism --> should look for what conditions (4)?
- PCOS
- ovarian tumor
- adrenal tumor
- Cushing synd
28
2ary amenorrhea --> normal thyroid, prolactin --> pos progestin --> no hirsutism --> should look for what conditions (2)?
- anorexia nervosa, exercise, stress
| - hypo-pit dysfx
29
which IBD presents w watery diarrhea? which w bloody diarrhea?
- Crohn's --> watery
| - UC --> bloody
30
which IBD can present w abd mass?
Crohn's
31
Crohn's --> extraintestinal manifestations (5)?
- arthritis
- ankylosing spondylitis
- uveitis
- primary sclerosing cholangitis
- nephrolithiasis
32
which IBD can lead to toxic megacolon?
both
33
which IBD can lead to bowel obstruct?
UC
34
UC --> extraintestinal manifestations (6)?
- arthritis
- ankylosing spondylitis
- uveitis
- primary sclerosing cholangitis
- erythema nodosum
- pyoderma gangrenosum
35
which IBD can present w lead pipe on barium enema?
UC
36
which IBD has sig increased risk of colon CA?
UC
37
59M --> 10day intermittent abd cramp, diarrhea 30min after eat --> also N, weak, palpitation, diaphoresis --> 3 wks ago distal gastrectomy for perforated peptic ulcer --> normal abd exam, surg incision healing well --> what condition?
dumping synd
38
dumping synd --> pathophys
pyloric sphincter --> injury/surg bypass --> loss of normal axn --> hypertonic gastric content --> quickly empty into duodenum, small intestine --> fluid shift from intravasc space to small intestine:
- hypotension
- stim autonomic reflex
- release intestinal vasoactive peptides
39
dumping synd --> tx
dietary modification
40
sinus bradycardia --> initial tx
atropine
41
1ary amenorrhea --> no 2ndary sex charact --> uterus is present --> next step? why?
serum FSH --> determine hypo-pit (central) dysfx vs gonadal (peripheral) abnormal
42
1ary amenorrhea --> no 2ndary sex charact --> uterus is present --> high FSH --> indicates what cause?
peripheral cause --> hypergonadotropic amenorrhea
43
1ary amenorrhea --> no 2ndary sex charact --> uterus is present --> low FSH --> indicates what cause?
central cause --> hypogonadotropic amenorrhea
44
1ary amenorrhea --> no breast dev --> next step?
serum FSH
45
1ary amenorrhea --> low FSH --> next step?
pit MRI
46
1ary amenorrhea --> high FSH --> next step?
karyotype
47
36M --> painless nodules & lrg wartlike lesions on R forearm, back of neck --> 2mo dry cough w mild malaise --> lives in southern Wisconsin --> 4-5cm warty heaped up skin lesions w violaceous hue, lesion on neck has small peripheral ulcer --> wet prep shows yeast --> what condition?
blastomycosis
48
15M --> progressive muscle weak --> 2mo increasing difficult facial expression, swallow --> no pain --> previously healthy, adopted --> ptosis, temporal waste, emaciated extremities, testicular atrophy --> normal neuro exam --> what condition?
myotonic muscular dystrophy type 1 (Steinert dz)
49
3 types of muscular dystrophy
- Duchenne
- Becker
- myotonic
50
MC adol/adult-onset muscular dystrophy
myotonic
51
myotonic muscular dystrophy --> mode of inheritance
AD
52
Duchenne muscular dystrophy --> mode of inheritance
XR
53
what is myotonia
delayed muscle relax
54
myotonic muscular dystrophy --> presentation (4)
- grip myotonia (delayed muscle relax)
- facial weak
- foot drop
- dysphagia
55
myotonic muscular dystrophy --> comorbidities (4)
- cardiac conduction anomaly --> arrythmia
- cataract
- testicle atrophy/infertile
- bald
56
young sex active F --> pharyngitis, fever, low abd pain --> what condition?
gonococcal pharyngitis + PID
57
what is Charcot triad
- RUQ pain
- jaundice
- pain
58
Charcot triad --> indicates?
cholangitis
59
nonstress test --> what is normal (reactive) test?
in 20min: >2 15bpm accelerations --> last >15sec
60
fetal heart rate trace --> cause of deceleration:
- early
- late
- variable
- early: head compression
- late: uteroplacental insuff
- variable: umbilical cord compress
61
fetal heart rate trace --> recurrent late deceleration --> indicates?
fetal hypoxia
62
fetal heart rate trace --> recurrent late deceleration --> next step?
prompt delivery
63
APGAR --> what is score of 1 for each compt?
- appearance: pink torso, blue extremities
- pulse: <100
- grimace: grimace
- activity: some mvmt
- resp: poor, weak cry
64
APGAR --> what is score of 2 for each compt?
- appearance: pink
- pulse: >100
- grimace: strong cry
- activity: active mvmt
- resp: good strong cry
65
52F --> intense itch & fatigue --> hepatomegaly, no jaundice, bilat xanthelasma --> high chol, high alk phos, high bili --> US normal common bile duct --> what condition?
primary biliary cholangitis
66
primary biliary cholangitis --> pathophys
autoimmune --> destroy small bile ducts --> intrahep cholestasis
67
primary biliary cholangitis --> whom?
middle age F
68
primary biliary cholangitis --> presentation (4)
- fatigue
- pruritis
- hepatomeg
- elevated alk phos
69
primary biliary cholangitis --> how confirm dx
anti-mito Ab titer
70
hyperCa --> PTH is elevated or inapprop normal --> MC indicates?
1ary hyperPTH
71
28M --> want help for anxiety --> every time board plane, heart pound, can't catch breath --> new job requires lots of travel, worried can't fly --> has been fearful of planes since uncle died in plane crash 15yr ago --> what condition?
specific phobia
72
specific phobia --> tx
CBT w exposure
73
42M --> sz --> h/o gen tonic-clonic sz --> stopped taking valproate 6mo ago --> pt w confused, lethargic --> Na 140, K 4, Cl 103, Bicarb 17 --> what condition?
postictal lactic acid
74
postictal lactic acid --> pathophys
sz (esp tonic clonic) --> skeletal muscle hypoxia --> sig raise serum lactic acid level
75
postictal lactic acid --> tx? why?
self-limited --> typically resolve in 90min
==> observe --> repeat chem panel in 2hr
76
acute MI --> MC cause of sudden cardiac arrest in immed post-infarct period?
reentrant V arrhythmia --> ie V-fib
77
pneumonia --> hypoxemia --> pathophys
pneumonia --> alveolar consolidation --> marked impair vent --> RtoL intrapulm shunting, extreme vent/perfusion (V/Q) mismatch --> hypoxemia
78
vent (V) & perfusion (Q) are highest in what area of lung? why?
lung bases: gravity create hydrostatic pressure acting on both air & blood
79
acute pneumonia on L --> 94% O2 when lie on R, 89% when lie on L --> pathophys
lie on L --> gravity --> increase blood flow to L lung --> worsen vent/perf mismatch --> worse RtoL intrapulm shunt --> worse hypoxemia
80
66M --> 3mo R arm pain --> progressive worse, no relief w NSAID --> also back pain, HA --> CBC normocytic anemia --> XR osteolytic lesions --> what condition?
mult myeloma
81
suspect mult myeloma --> next step?
screening test --> serum protein electrophoresis (SPEP) --> elevated serum monoclonal protein (M-spike)
82
mult myeloma --> screening tests (3)
- serum protein electrophoresis
- urine protein electrophoresis
- free light chain analysis
83
mult myeloma --> how confirm dx?
BM bx
84
what is electrical alternans
varying amp of QRS
85
electrical alternans w sinus tachy --> what condition?
large pericardial effusion
86
26M --> wks of low abd pain, bloody diarrhea, fecal urgency --> ssx more severe in last 2 days --> fever, abd distention, leukocytosis, hypotension, tachycardia --> what condition?
IBD --> toxic megacolon
87
35F --> few days mult painful oral sores --> previously occured 3mo ago --> recently ant uveitis, recurrent genital lesions --> hyperpigment skin lesion, tender indurated areas on legs --> what condition?
behcet synd
88
behcet synd --> whom? (2)
- YA
| - Turkish, middle east, Asian
89
behcet synd --> presentation (4)
- reucrrent oral aphthous ulcers
- genital uclers
- uveitis
- erythema nodosum
90
what is pathergy
exagg ulcerating skin response following minor injury (needlestick)
91
behcet synd --> major cause of morbidity
thrombosis
92
18mo M --> blood in stool --> no previous bleed, h/o recurrent otitis media/herpes labialis/pneumonia --> eczema, scattered petechiae --> low platelet count, small platelets --> what condition?
Wiskott-Aldrich synd
93
Wiskott-Aldrich synd --> mode of inheritance?
XR
94
Wiskott-Aldrich synd --> triad
- thrombocytopenia
- eczema
- recurrent infect
95
Wiskott-Aldrich synd --> pathophys
WAS protein defect --> impaired cytoskeleton in leukocytes, platelets
96
Wiskott-Aldrich synd --> tx
hemat stem cell transplant
97
mod-severe croup --> tx
corticosteroid + nebulized epinephrine
98
27F --> unable to conceive for 1yr --> normal periods, normal semen --> h/o hosp for pelvic infect in late teens --> next step? why?
hysterosalpingogram --> look for anatomic cause of infertility --> tubal scar/obstruct from PID
99
MC fracture in ped pop
supracondylar fracture of humerus
100
supracondylar fracture of humerus --> MC comp (2)
entrapment of:
- brachial A
- median N
101
craniopharyngioma --> what is? location?
pit stalk --> rathke pouch --> epithelial remnant --> low grade malig --> in suprasellar region adj to optic chiasm
102
craniopharyngioma --> presentation (3)
compress:
- optic chiasm --> bitemporal hemianopsia --> run into corners of walls/furniture
- pit stalk --> mult endocrinopathies --> GH def, DI
103
craniopharyngioma --> imaging finding
suprasellar calicified mass
104
24-28wk gestation --> prenatal screen
50g 1hour glucose challenge
105
what is Kussmaul sign
increase in jugulovenous pressure on inhalation
106
Kussmaul sign --> assoc w what condition (2)
- constrictive pericarditis
| - restrictive cardiomyopathy
107
acute coronary synd --> assoc w what heart sound
S4
108
what is pulsus paradoxus
decrease >10mmHg BP on inspiration
109
pulsus paradoxus --> assoc w what condition
cardiac tamponade
110
leads V2-4 --> assoc w what area of heart?
LV --> ant wall
111
inf wall of heart --> assoc w what leads?
II, III, aVF
112
mortality at 1 yr after event: inf wall MI vs ant wall MI
inf: <5%
ant: 30-40%
113
PR interval >200ms --> what condition?
1st deg AV block
114
MI --> PVC --> tx? why?
don't trt PVC --> tx worsens outcome
115
post wall MI --> assoc w what leads?
V1-2
116
which is worse: RBBB vs LBBB
LBBB
117
acute MI --> 1st step in management? why?
ASA --> lower mortality
118
acute STEMI --> 2nd step in management?
angioplasty
119
pt w CP --> measure serum troponin --> what can cause false pos result?
renal insuff
120
MI --> alt if ASA allergy
clopidogrel
121
acute NSTEM --> 2nd step in management after ASA? why?
LMWH --> prevent clot from growing further
122
tPA (thrombolytic) --> beneficial for STEMI, NSTEMI, or both?
STEMI only
123
heparin --> best for STEMI or NSTEMI?
NSTEMI
124
acute coronary synd: GPIIb/IIIa inh --> whom? (2)
- NSTEMI
| - PCI, stenting
125
which is better for mortality benefit: unfractionated hep or LMWH?
LMWH
126
NSTEMI --> all meds given --> but not pt not better --> next step?
urgent angiography
127
MI --> symptomatic bradycardia --> tx
atropine
128
MI --> symptomatic bradycardia --> atropine not effective --> tx
pacemaker
129
R coronary A supplies what (3)
- RV
- AV node
- inf wall of heart
130
RV infarct --> tx
high vol fluid replace
131
what comp of acute MI shows:
- bradycardia
- cannon A waves
3rd deg AV block
132
acute MI -->
- bradycardia
- no cannon A waves
==> what condition?
sinus bradycardia
133
acute MI -->
- sudden loss of pulse
- jugulovenous distention
==> what condition?
- cardiac tamponade
| - free wall rupture
134
```
acute MI -->
- inf wall MI
- clear lungs
- tachycardia
- hypotension w nitroglycerin
==> what condition?
```
RV infarct
135
acute MI -->
- new murmur
- rales/congestion
==> what condition?
valve rupture
136
acute MI -->
- new murmur
- increase in O2sat on entering RV
==> what condition?
septal rupture
137
acute MI -->
- loss of pulse
==> what condition?
- V tachy
| - V fib
138
acute MI --> treated in hosp --> what test does everyone get prior to discharge? why?
stress test --> detect residual ischemia
139
positive stress test --> next step?
angiography
140
which IBD is assoc w masses and obstruction?
Crohns
141
+ANCA --> which IBD?
UC
142
+antisaccharomyces cerebesiae Ab (ASCA) --> which Ab?
Crohns
143
IBD --> tx for chronic maintenance of remission
5-ASA derivatives --> mesalamine
144
perianal Crohn's --> tx
cipro + metronidazole
145
IBD --> severe exacerbation --> trt w steroid --> stop steroid --> severe recurrence --> should have used what to what to wean off steroid?
azathioprine/6-mercaptopurine + Ca + vitD
146
IBD --> fistula --> tx
- anti-TNF (infliximab)
| - surg if not respond to anti-TNF
147
which steroid is specific for IBD?
budesonide
148
bact meningitis --> CSF findings:
- cell count
- protein
- glucose
- cell count: 1000's PMNs
- protein: elevated
- glucose: decrease
149
cryptococcus/lyme/rickettsia meningitis --> CSF findings:
- cell count
- protein
- glucose
- cell count: 10-100's lymphocytes
- protein: possibly elevated
- glucose: possibly decreased
150
TB meningitis --> CSF findings:
- cell count
- protein
- glucose
- cell count: 10-100's lymphocytes
- protein: markedly elevated
- glucose: may be low
151
viral meningitis --> CSF findings:
- cell count
- protein
- glucose
- cell count: 10-100's lymphocytes
- protein: usu normal
- glucose: usu normal
152
bact meningitis --> best initial tx
ceftriaxone + vanco + steroid
153
MC neuro deficit or untreated bact meningitis?
CN 8 deficit --> deaf
154
pt diagnosed w cirrhosis --> EGD nonbleeding varices --> prophylactic tx for varices?
nonselective BB --> propranolol, nadolol --> reduce risk:
- progress to large varices
- variceal hemorrhage
155
>60yo --> MC cause of spont lobar hemorrhage
amyloid angiopathy
156
thrombocytopenia without anemia or leukopenia --> what condition?
ITP
157
all pt w presumed ITP --> should be tested for what?
HIV & HVC
158
presumed ITP --> why test for HIV?
may be presenting finding in 5-10% chronic HIV infect
159
HTN & hypoK --> suspect what condition?
1ary hyperaldos
160
suspect 1ary hyperaldos --> preferred initial screening test
plasma aldos conc to plasma renin activity ratio (PAC/PRA ratio) --> >20
161
suspect 1ary hyperaldos --> +screening test PAC/PRA ratio >20 --> confirm dx?
adrenal suppression testing
162
1ary hyperaldos confirmed by adrenal suppression test --> next step?
adrenal imaging
163
1ary hyperaldos --> no discrete unilat mass --> next step? why?
adrenal venous sampling --> most sensitive test for differentiate adrenal adenoma vs bilat adrenal hyperplasia
164
65F --> 2day difficult eating --> food drop out of mouth, discharge in L ear --> h/o DMII, HTN, hyperlipid --> poorly compliant --> granulations in ear, facial asymm, L angle of mouth deviate down --> what condition?
malig otitis externa
165
malig otitis externa --> classic clinical feature
granulation tissue in ear canal
166
what is intrauterine fetal demise
fetal death at >20wk
167
24F --> 28k gestation --> intrauterine fetal demise --> next step?
vag delivery --> can be delayed til pt is ready
168
myasthenia gravis --> best initial test
AchR Ab
169
systemic sclerosis --> most specific test
SCL-70 (topoisomerase Ab)
170
anti-Jo --> assoc w what condition?
polymyositis, dermatomyositis
171
anti-Ro --> assoc w what condition?
Sjogren
172
systemic sclerosis --> tx
methotrexate
173
systemic sclerosis --> pulm fibrosis --> tx
cyclophosphamide
174
CF --> PFT shows what pattern?
mixed obstructive + restrictive patterns
175
CF --> PFT findings:
- FVC
- TLC
- FVC: decreased
| - TLC: decreased
176
CF --> sputum culture is likely to grow what org (4)?
- H flu
- pseudomonas
- S aureus
- Burkholderia cepacia
177
pleural effusion --> exudate --> assoc w what conditions? (2)
- infect
| - cancer
178
pleural effusion --> what findings suggest exudate:
- LDH
- protein
- LDH: >60% of serum
| - protein: >50% of protein
179
pleural effusion --> pH<7.2 --> suggest what?
empyema
180
lung cancer screen --> what ages?
55-80
181
adrenal insuff --> what is a common CBC abnormality?
eosinophilia
182
adrenal insuff --> lab findings:
- glucose
- K
- acid-base status
- Na
- BUN
- glucose: hypo
- K: hyper
- acid-base status: metab acid
- Na: hypo
- BUN: high
183
most specific test for adrenal fx
cosyntropin stim test
184
what is cosyntropin
synthetic ACTH
185
why is kidney stone assoc w Crohn's dz?
increased oxalate absorption
186
what kind of kidney stones are not visible on XR?
uric acid
187
how was cystine kidney stones managed?
alkalinize urine
188
kidney stone --> 5-7mm --> tx?
nifedipine + tamsulosin to help them pass
189
what diuretic increases Ca resorption?
thiazide
190
cardiac tamponade --> Beck triad
- hypotension
- elevated JVD
- distant heart sounds
191
cardiac tamponade --> cardiac catherization finding
elevated and equilization of intracardiac diastolic pressures
192
suspect cardiac tamponade --> how confirm dx
urgent echo
193
missed abortion:
- vag bleed
- cervix
- fetal cardiac activity
- POC
- vag bleed: none
- cervix: closed
- fetal cardiac activity: absent
- POC: not passed
194
threatened abortion:
- vag bleed
- cervix
- fetal cardiac activity
- POC
- vag bleed: yes
- cervix: closed
- fetal cardiac activity: present
- POC: not passed
195
inevitable abortion:
- vag bleed
- cervix
- fetal cardiac activity
- POC
- vag bleed: yes
- cervix: dilated
- fetal cardiac activity: present or absent
- POC: not passed
196
incomplete abortion:
- vag bleed
- cervix
- fetal cardiac activity
- POC
- vag bleed: yes
- cervix: dilated
- fetal cardiac activity: absent
- POC: some passed
197
complete abortion:
- vag bleed
- cervix
- fetal cardiac activity
- POC
- vag bleed: yes or none
- cervix: closed
- fetal cardiac activity: absent
- POC: completely expelled
198
neuroleptic malig synd --> tx
dantrolene or bromocriptine
199
candida vulvovaginitis --> tx
azole --> oral fluconazole
200
sickle cell dz --> MC cause of sepsis
Strep pneumo
201
sickle cell dz --> sepsis prophylaxis? til what age?
PCN --> 5yo
202
adenomyosis --> presentation
dysmenorrhea + heavy bleed --> progress to chronic pelvic pain
203
stroke --> hemineglect --> what lobe was affected?
R (non-dominant) parietal lobe
204
65M --> sudden painless loss of vision in R eye --> 5hr ago similar but transient loss of vision in the same eye --> h/o HTN, DM, hyperchol, PVD, ant wall MI 6yr ago --> R eye visual acuity 20/60, retinal whitening --> what condition?
central retinal A occlusion (CRAO)
205
central retinal A occlusion (CRAO) --> tx
ocular massage + high flow O2
206
what arrhythmia is most specific for digitalis toxicity?
atrial tachycardia w AV block
207
digitalis toxicity --> what 2 digitalis effects cause atrial tachycardia w AV block?
- increased ectopy
| - increased vagal tone
208
thyrotoxicosis --> HTN --> pathophys
increased myocardial contract & HR --> hyperdynamic circulation
209
6M --> difficult moving R arm & leg --> had been playing alone in room --> mom heard "thud" and found him unconscious --> awake & alert, normal speech & beh, unable to mv R arm & leg --> gradually regain motor fx --> what condition?
1st time sz w Todd paralysis
210
what is Todd paralysis
self-limited focal weak that occur after focal/gen sz --> postictal period --> partial/complete hemiplegia of ipsilat upper & lower ext --> resolve w/in 36hr
211
28M --> MVA --> SBP 60, HR 130, RR 30 --> neck veins flat, abd distended, altered mental status --> after intubated & mech vent --> cardiac arrest --> pathophys?
internal hemorrhage --> hypovol shock --> decreased central venous pressure --> mech vent --> acute increase intrathoracic pressure --> cut off venous return --> sudden loss of RV preload --> loss of cardiac output --> cardiac arrest
212
Conn's synd --> lab findings:
- BP
- Na
- K
- acid/base
- BP: HTN
- Na: mild hyper
- K: hypo
- acid/base: metab alk
213
what is iodinated contrast material (iopanoic acid, ipodate) given in thyroid strom?
- block peripheral conversion of T4 to T3
| - block release of existing hormone
214
palpate nodule on thyroid --> next step
T4, TSH
215
palpate nodule on thyroid --> normal T4, TSH --> next step
FNA
216
nodule on thyroid --> normal T4, TSH --> FNA indeterminate --> next step
excisional bx
217
nonstress test --> nonreactive --> next step?
BPP or CST
218
nonreactive nonstress test --> how choose bw BPP vs CST?
BPP if CST is CI --> ie CI to labor --> placenta previa, prior myomectomy
219
what is a normal biophysical profile
1) NST: reactive
2) amniotic fluid vol: >2x1cm fluid pocket, AFI >5
3) fetal mvmt: >3
4) fetal tone: >1 flex/extend
5) fetal breathing mvmt: >1 for >30sec
220
BPP --> score 0-4/10 --> indicates?
fetal hypoxia d/t placental dysfx/insuff
221
BPP --> score 0-4/10 --> next step? why?
prompt delivery d/t high probability of fetal demise
222
62F --> difficult remember important dates & appts --> poor conc, daytime sleepy, easy fatigue --> decreased appetite but gained 4 lb in 3mo --> visited ENT for hoarseness, laxative for constipation, ASA for knee pain --> what condition?
hypothyroid
223
1ary postpartum hemorrhage --> MCC
uterine atony (uterus fail to contract)
224
uterine atony --> RF (4)
- prolonged labor
- induction of labor
- operative vag delivery
- fetal wt >8.8lb
225
33F --> dull ache in RUQ abd --> OCP for 12yr --> US solitary hyperechoic 7cm lesion in liver --> what condition?
hepatic adenoma
226
adol --> MCC of short stature & pubertal delay
constitutional growth delay
227
constitutional growth delay --> natural progression
normal birth wt/ht --> 6mo-3yo --> growth velocity slow --> drop percentile on growth curve --> at 3yo --> regain normal growth velocity --> follow growth curve at 5-10th percentile --> delay puberty & adol growth spurt --> eventually puberty --> normal adult ht
228
constitutional growth delay --> bone age radiograph findings
delayed bone age
229
extra-axial well circumscribed dural-based mass --> partially calcified --> what condition?
meningioma
230
subarachnoid hemorrhage --> noncontrast CT finding
acute bleed around brainstem & basal cisterns
231
burkitt lymphoma --> chemotx --> develop hyperK --> why?
tumor lysis synd
232
hyperK --> 3 goals of therapy
1) stabilize cardiac membrane w Ca
2) shift K intracell
3) decrease total body K
233
hyperK --> rapid acting tx options (3)
- insulin w glucose
- B2-agonist
- sodium bicarb
234
lambert-eaton myasthenic synd --> assoc w what condition?
underlying malig --> small cell lung CA
235
Afib --> what tx is used to reduce risk of systemic thromboembolism?
anticoag:
- warfarin
- non-vitK ant oral anticoag --> apixaban, dabigatran, rivaroxaban
236
paroxsymal nocturnal Hb --> presentation (3)
- hemolysis --> fatigue
- cytopenia
- hypercoag state --> venous thrombosis --> intraabd, cerebral V
237
paroxsymal nocturnal Hb --> how confirm dx
flow cytometry --> absence of CD55 & CD59 proteins on RBCs
238
which lifestyle mod has greatest effect on high BP?
wt loss
239
which lifestyle mod has 2nd greatest effect on high BP?
DASH diet
240
what lifestyle mod most reduces risk of pancreatic cancer?
smoke cessation
241
what are environ RF of pancreatic cancer (3)
- smoke
- chronic pancreatitis
- obese
242
70M --> pain & stiff in neck, shoulder, pelvic girdle --> elevated ESR --> what condtition?
polymyalgia rheumatica
243
polymyalgia rheumatica --> tx
low dose prednisone
244
antral ulcer --> bx shows adenoCA --> next step? why?
most gastric cancer diagnosed at advanced stages ==>
CT --> stage (eval extent of cancer) --> determine prognosis & tx options
245
5M --> red tender fluctuant ant cervical mass 2cm --> what is causative org?
acute lymphadenitis --> MCC --> S aureus, Strep pyogenes
246
mumps --> presentation (2)
- fever
| - parotitis
247
mumps --> comp (2)
- aseptic meningitis
| - orchitis
248
65M --> MVA--> marked weak UE, can mv LE --> h/o OA, cervical spondylitis --> cervical spine XR mild degen arthritis --> what condition?
Central cord sync
249
Central cord synd --> how typically occur? In whom?
Elder --> cervical spine --> preexisting degen changes --> hyperext injury
250
Central cord synd --> presentation
- weakness more in UE than LE
| - UE --> loss of pain/temp
251
Ant (ventral) cord synd --> presentation
Bilateral spastic motor paresis distal to lesion
252
Ant spinal cord synd --> MCC
Occlusion of ant spinal A
253
Brown sequard synd -->presentation
- ipsi: weak, spastic, loss vibrate/propioception
| - contralat: loss pain/temp
254
Brown sequard synd --> MCC
Penetrating injury --> hemisection of cord
255
do OCP increase/decrease TBG? what happens to total T4?
increase TBG --> increase total T4
256
what is sodium ipodate/iopanoic acid used for?
severe hyperthyroid --> not respond to conventional therapy --> lower T3/T4 --> rapid improve hyperthyroid
257
thionamide --> 1 major AE
agranulocytosis
258
which thionamide is preferred for preg pt?
PTU
259
1ary hyperPTH --> what urine lab finding is markedly elevated?
cAMP
260
hyperCa --> tx --> how increase urinary excretion?
- IVF
| - furosemide --> inh Ca resorb
261
glucocorticoids are only effective for what 2 causes of hyperCa?
- vitD related mech (intoxication, granulomatous disorder)
| - mult myeloma
262
abd & diaphragm --> paradoxic mvmt on inspiration --> indicates what?
impending resp fail
263
asthma exacerbation --> ABG --> hypo or hyper carbia?
hypocarbia
264
asthma exacerbation --> PaCO2 is decreased, normal, or increased?
decreased
265
asthma exacerbation --> normal or increased PaCO2 --> indicates?
resp muscle fatigue or severe airway obstruct --> resp fail may ensue
266
what is forced vital capacity
total amt of air force-exhale after taking deep breath
267
asthma severity --> categories (4)
- mild intermittent
- mild persistent
- mod persistent
- severe persistent
268
asthma severity --> what is?
- mild intermittent
- mild persistent
- mod persistent
- severe persistent
- mild intermittent: ssx 2 or less/wk
- mild persistent: 2 or more but not daily
- mod persistent: daily; freq exacerbations
- severe persistent: continual; freq exacerbations, limited physical activity
269
asthma --> long term ctrl
- mild intermittent
- mild persistent
- mod persistent
- severe persistent
- mild intermittent: none
- mild persistent: low dose inhaled steroid
- mod persistent: low steroid + LABA
- severe persistent: med/high steroid + LABA
270
erythema migrans --> hallmark of what condition?
lyme dz
271
which heart blocks require pacemaker implantation?
- 2nd deg heart block Mobitz type II
| - 3rd deg (complete) heart block
272
21M --> assaultive beh, reckless disregard for safety of self & others, lack of remorse --> what condition?
antisocial personality disorder
273
15M --> assaultive beh, reckless disregard for safety of self & others, lack of remorse --> what condition?
conduct disorder
274
antisocial personality disorder --> must be at least what age for diagnosis?
18
275
antisocial personality disorder --> must have a h/o what condition for diagnosis?
conduct disorder before 15yo
276
marijuana --> presentation (7)
- tachycardia
- tachypnea
- HTN
- dry mouth
- conjunctival injection
- increase appetite
- slow rxn time
277
increased ICP --> tx --> hypervent --> how does hypervent decrease ICP?
hypervent --> decrease cerebral PaCO2 --> rapid vasoconstrict --> decrease ICP
278
35F --> breast mass --> fixed, spiculated, calcifications --> h/o bilat reduction mammoplasty for mammary hyperplasia --> bx foamy macrophages & fat globules --> what condition?
fat necrosis of breast --> present very similar to breast cancer
279
68F --> painless jaundice, conj hyperbili, markedly elevated alk phos --> what condition?
biliary obstruct d/t pancreatic, biliary CA
280
bite cells & Heinz bodies --> what condition?
G5PD def
281
pt found to have chronic HCV infect --> goals of tx (2)
- trt underlying cause --> antiviral
| - prevent further liver damage --> avoid alcohol, hep A & B vaccine
282
22F --> RUQ pain, fever, chill, vomit --> started as low abd pain --> sex active w 1 partner, no contraception --> what condition?
PID w perihepatitis (Fitz-Hugh-Curtis)
283
55M --> mult falls, dry mouth, dry skin, ED --> recently diagnosed w resting tremor --> PE orthostatic hypotension, rigidity, bradykinesia --> what condition?
mult system atrophy (Shy-Drager synd)
284
Shy-Drager synd --> presentation (3)
- Parkinsonism
- autonomic dysfx
- widespread neuro signs
285
25F --> sore chest pain --> discomfort wearing sports bra --> LMP 3wk ago --> PE b/l nonfocal chest tender, diffuse cordlike thickening of breasts --> what condition?
fibrocystic change
286
62F --> worsening skin lesions --> 6days ago CABG for CAD --> receiving low dose subQ hep for DVT prophylaxis --> PE several lrg purple/black patches on periumbilical area surrounded by erythema --> what condition?
HIT type 2
287
subQ hep (enoxaparin) --> HIT --> classic presentation
skin necrosis at abd injection site
288
hep --> HIT --> alt tx for DVT prophylaxis?
alt anticoag:
- argatroban
- fondaparinux
289
80F --> fatigue --> h/o b/l knee OA that significantly limit mobility --> meds lisinopril, chlorthalidone, naproxen, ASA --> PE conjunctival pallor --> what condition?
iron def anemia: NSAID, ASA --> gastritis, gastric ulcer --> chronic GI blood loss
290
clobetasol --> type of drug?
steroid
291
bullous pemphigoid --> presentation
- pruritis
| - tense bullae
292
bullous pemphigoid --> tx
high potency topical glucocorticoid
293
middle age F --> found wandering streets w abnormal gait --> incoherent, not oriented to time or place --> T 97.3, BP 160/100, HR 100, RR 18, BMI 17 --> bitemporal wasting, dry mucus membranes, pupils 3mm & react slowly --> what condition?
Wernicke encephalopathy
294
Wernicke encephalopathy --> pathophys? who?
alcoholism & chronic malnutrition --> thiamine (vitB1) def
295
Wernicke encephalopathy --> classic triad
- encephalopathy
- ocular dysfx
- gait ataxia
296
47M --> fatigue, elevated liver enzyme, occasional jt pain, small vesicles & erosions on back of hands & arms --> what condition?
chronic HCV
297
what derm condition is high assoc w HCV?
porphyria cutanea tarda
298
43M --> freq epigastric burn not relieved by antacid --> brought on my heavy lifting at work, go away in 10-15min --> h/o SLE trt w prednisone, hydroxychloroquine --> normal PE, EKG --> what condition?
atypical angina: SLE --> accelerated atherosclerosis --> premature CAD
299
34M --> SOB, difficult swallow --> h/o difficult breath, food intolerance, skin allergies --> PE excessive resp muscle use, retract subclavicular fossa during inspiration, urticaria over upper body --> what condition?
food allergy --> larygneal edema --> upper airway obstruct
300
what is MEN I
3 P's:
- PTH
- pancreatic islet cell tumor --> ZES, insulinoma
- pit tumor
301
what is MEN IIA
PPM:
- PTH
- pheo
- medullary thyroid CA
302
what is MEN IIB
PMM:
- pheo
- medullary thyroid
- mucosal neuroma/marfanoid habitus
303
what is conn synd
adrenal adenoma --> produce aldos
304
1ary hyperaldos --> definitive dx
saline infusion or oral sodium load:
- normal: increase Na --> decrease aldos
- 1ary hyperaldos: increase Na --> aldos still high
305
1ary hyperaldos --> why important to differentiate cause b/w adrenal adenoma vs adrenal hyperplasia
different tx:
- adrenal adenoma --> resect --> improve/cure HTN
- adrenal hyperplasia --> spironolactone --> inh aldos axn --> bc b/l adrenalectomy --> HTN not improve
306
young F --> HTN --> MCC?
birth ctrl pill
307
HIT --> which is more common --> venous or arterial clots?
venous
308
young F --> HTN --> should do what before start HTN med?
UPT: thiazide, ACEI/ARB, CCB --> CI in preg
309
lepirudin --> what kind of drug?
anticoag --> direct thrombin inh
310
considered preterm labor at what gestation wks?
20-37
311
most commonly used tocolytic? what 2 other drugs can be used as tocolytic?
Mg sulfate
- CCB
- terbutaline
312
preterm labor --> Mg sulfate given as tocolytic --> should do what PE test? why?
check DTR --> b/c Mg toxicity can lead to resp dep & cardiac arrest
313
preterm labor --> Mg sulfate given as tocolytic --> should do what PE test? why?
check DTR --> b/c Mg toxicity can lead to resp dep & cardiac arrest
314
common peroneal neuropathy --> presentation ( 4)
- foot drop
- numb/tingle --> dorsal foot, lat shin
- weak --> ankle dorsiflex, great toe extend
- normal --> plantarflex, reflexes
315
black pt w HTN --> recommended tx?
- CCB
| - thiazide
316
CLL --> how dx?
flow cytometry --> clonal mature B cells
317
7M --> lyme dz --> tx
oral amoxi
318
brain abscess --> CT finding
single ring enhancing lesion w central necrosis
319
brain abscess --> MC org (2)
- strep viridans
| - s aureus
320
38F --> several episode L leg weak & numb --> tingle, then numb, then limp --> resolve spont in few hrs --> diminished pinprick to dorsal foot, weak big toe extend, cannot walk on heel --> what condition?
common peroneal/fibular neuropathy
321
common peroneal neuropathy --> pathopys
- leg immobilize (cast, bedrest)
- prolong leg cross
- prolong squat
--> compress N as cross fibular head
322
common peroneal neuropathy --> presentation ( 4)
- foot drop
- numb/tingle --> dorsal foot, lat shin
- weak --> ankle dorsiflex, great toe extend
- normal --> plantarflex, reflexes
323
late term and post term preg --> at risk for what comp?
uteroplacental insuff
324
what is positive predictive value (PPV)
TP / (TP + FP)
higher PPV --> positive result more likely to be true
325
leukemoid rxn --> hallmark
WBC >50,000
326
how differentiate bw leukemoid rxn vs CML:
- WBC count
- LAP score
- neutrophil precursors
- absolute basophilia
- WBC: >50,000 vs >100,000
- LAP: high vs low
- neutrophil precursors: late (metamyelocytes, bands) vs early (promyelocytes, myelocytes)
- basophilia: none vs yes
327
A-fib --> MCC origin/location of arrhythmia
pulm V
328
A flutter --> MCC origin/location of arrhythmia
reentrant circuit around tricuspid annulus
329
cocaine --> myocardial ischemia --> initial tx
- O2
| - BZD --> reduce SNS --> decrease anxiety/agitation, improve BP/HR, alleviate CV ssx
330
cocaine --> myocardial ischemia --> should BB be administered? why?
block B --> unopposed alpha --> worsen coronary vasoconstrict
331
32F --> fever, chills, pleuritic CP, SOB --> HIV+, IVDA --> CT lungs mult nodular lesions w small cavities
IVDA --> infective endocarditis --> septic emboli to lungs
332
severe aortic stenosis --> artificial valve prosthesis --> c/o fatigue --> blood smear schistocytes --> haptoglobin level is decreased or increased? why?
Haptoglobin --> bind free Hb --> promote Hb excretion by reticuloendothelial system
hemolytic anemia --> increase free Hb --> bind all avail haptoglobin --> decreased haptoglobin
333
25 black M --> nocturia for months despite restrict fluid intake --> no other ssx --> brother died of "blood disease at 10yo --> Hct 49% --> what condition?
sickle cell trait --> sickle in vasa recta --> impair concentrate urine --> hyposthenuria
334
55M --> 1yr progressive difficult walk/balance, freq falls --> DM2, HTN, heavy alcohol/tobacco, med noncompliance --> wide based gait, cannot tandem walk, abnormal heel knee shin test, normal finger nose test --> what condition?
alcoholic cerebellar degen: alcohol neurotoxic --> cerebellar vermis --> degen Purkinje fibers (truncal coordination)
335
alcoholic cerebellar degen --> pathophys
alcohol --> neurotoxic --> cerebellar vermis --> degen Purkinje fibers (truncal coordination) --> wide based gait, postural instability
336
alcoholic cerebellar degen --> PE cerebellar test findings? why?
- tandem gait
- finger nose test
- tandem gait (truncal coodination) impaired
| - finger nose test (limb coordination) normal
337
46M --> h/o DM well ctrl --> should also take what non-DM med? why?
40-75yo DM --> statin (regardless of lipid levels) --> reduce risk of cardiac events
338
lyme dz --> who should get amoxi instead of doxycycline?
- preg
| - <8yo
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