1
Q
pt come in for insomnia, anxiety –> increased liver enzyme, macrocytosis –> condition?
A
chronic alcohol use
2
Q
prolonged hypotension –> leads to what kidney condition?
A
acute tubular necrosis
3
Q
indicates what conditon?
- muddy brown granular cast
- RBC cast
- WBC cast
- fatty cast
- broad and waxy cast
A
- muddy brown granular cast: acute tubular necrosis
- RBC cast: glomerulonephritis
- WBC cast: intersistial nephritis, pyelonephritis
- fatty cast: nephrotic synd
- broad and waxy cast: chronic renal fail
4
Q
BUN:Cr ratio –> values and what they indicate
A
> 20:1 –> pre-renal
<20:1 –> intra-renal
5
Q
post-menopause –> vag bleed –> next step?
A
think of endometrial hyperplasia or cancer:
pelvic US –> eval endometrial thickness, assess for other pelvic pathology
6
Q
post-menopause –> vag bleed –> when do endometrial bx?
A
pelvic US –> endometrial thickness >4mm –> bx to eval for malig
7
Q
whipple dz –> MC presenting ssx (5)
A
- chronic malabsorptive diarrhea
- wt loss
- migratory non-deforming arthritis
- LAD
- low grade fever
8
Q
what meds increase risk of diverticulosis?
A
ASA, NSAID
9
Q
cervical intraepithelial neoplasia 3 –> next step?
A
cervical conization (type of excisional bx)
10
Q
what are howell-jolly bodies?
A
RBC –> nuclear remnant
11
Q
howell-jolly bodies –> seen in what condition?
A
asplenia (ie sickle cell)
12
Q
morton neuroma –> charact
A
- distal forefoot –> metatarsal heads to 3rd & 4th toes –> numb, ache, burn
- Mulder sign: crepitus bw 3rd & 4th toes
13
Q
morton neuroma –> who? pathophys?
A
usu runner –> mech-induced neuropathic degen of interdigital N –> ssx worse when walk on hard surface, wear tight/high heel shoes
14
Q
morton neuroma –> tx?
A
metatarsal support or padded shoe insert
15
Q
transudate vs exudate
A
transudate:
- increased hydrostatic pressure
- decreased oncotic pressure
- -> low protein
exudate: inflamm –> increase vasc permeability
- -> high protein, lactate dehydrogenase
16
Q
regular schedule for meningococcal vaccine
A
- primary vaccine –> 11-12yo
- booster at 16yo
17
Q
first stage of labor –> consists of what phases?
A
- latent phase: gradual cervical dilation
- active phase: rapid dilation
18
Q
what constitutes arrest of active labor?
A
cervical dilatrion >6cm:
- no cervical change for >4hr w adeq contractions
- no cervical change for >6hr w inadeq contractions
19
Q
arrest of active labor –> next step?
A
C-section
20
Q
osteoarthritis –> PE findings (3)
A
- bony enlrgment, tenderness
- crepitus w mvmt
- painful, decreased ROM
21
Q
glasgow coma scale –> who? for what? assesses?
A
all trauma pt:
- estimate severity of neuro injury
- predict prognosis of coma & other conditions (bact meningitis, traumatic brain injury, subarachnoid hemorrhage)
Assess:
- eye opening
- verbal resp
- motor resp
22
Q
ARDS –> pathophys? results in?
A
infect, trauma, other –> lung injury –> alveolar space –> release proteins, inflamm cytokines, neutrophils –> blood, proteinaceous fluid –> into alveoli –>
- lose surfactant –> alveoli collapse
- diffuse alveolar damage
Results in:
- impair gas exchange
- decreased lung compliance
- pHTN
23
Q
abruptio placentae –> RF (3)
A
- # 1 HTN
- cocaine
- maternal trauma
24
Q
abruptio placentae –> presentation
A
- abd/back pain
- fetal heart rate abnormal
- variable vag bleed
25
what is modified wells criteria?
pretest probability of PE:
<4 --> PE unlikely
>4 --> PE likely
26
sickle cell dz --> aplastic crisis --> pathophys? charact?
parvovirus B19 --> sudden halt in RBC production
- severe anemia
- low retic (<1%)
- no HSM
27
cause of ascending aortic aneurysm? descending?
ascending: cystic medial necrosis, connective tissue disorder
descending: atherosclerosis
28
duration of:
- brief psychotic disorder
- schizophreniform disorder
- schizophrenia
- brief psychotic disorder: 1day-1mo
- schizophreniform disorder: 1-6mo
- schizophrenia: >6mo
29
what is: placenta accreta
placenta attach directly to myometrium
30
uterine inversion --> management
1) aggressive fluid replace
2) manual replace uterus
3) remv placenta, uterotonic drug
31
newborn --> conjugated hyperbili + hepatomegaly --> condition?
biliary atresioa
32
biliary atresia --> 1st step in eval? result?
abd US --> absent/abnormal gallbladder
33
biliary atresia --> tx?
Kasai procedure (hepatoportoenterostomy) --> eventually liver tx
34
ALL --> how dx?
BM bx --> >25% lymphoblasts
35
gallstone + typical biliary colic ssx --> tx?
elective lap chole
36
acute cholecystitis --> tx?
chole in 72hr
37
suspect achalasia --> next step?
endoscopy to r/o malig (pseudoachalasia)
38
bursitis --> how affect active ROM? passive?
active: decreased or painful
passive: normal
39
prepatellar bursitis --> presentation (3)?
- ant knee pain, tender
- erythema
- localized swelling
40
acute prepatellar bursitis --> pathophys
- penetrating trauma
- repetitive friction
- local cellulitis
--> S. aureus infect bursa
41
acute prepatellar bursitis --> how confirm dx?
aspirate bursal fluid --> cell count & Gram stain
42
absence sz --> comorbidity (2)?
- ADHD
| - anxiety
43
postmenopause --> large adnexal mass + vag bleed + endometrial hyperplasia --> condition?
granulosa cell tumor of ovary
44
granulosa cell tumor of ovary --> vag spot --> why?
secrete estrogen --> endometrial hyperplasia --> postmenopausal bleed
45
granulosa cell tumor of ovary --> endometrial hyperplasia --> next step? why?
endometrial hyperplasia --> risk of endometrial cancer --> endometrial bx
46
8yo M --> staring episodes --> tilt head, chew, not respond to name/touch --> confused for 20min after --> condition?
focal sz w LOC
47
focal sz --> presentation?
- motor (headturning), sensory (paresthesia), or autonomic ssx (sweat)
- may have LOC & automatism (chewing)
48
how can provoke absence sz?
hypervent
49
UA --> positive leukocyte esterase --> indicates?
significant pyuria
50
UA --> positive nitrite --> indicates?
presence of Enterobacteriaceae (E.coli --> convert nitrate in urine to nitrite)
51
polysaccharide vaccine --> how induce immunity?
Tcell-indep Bcell response:
| polysacc --> bind Ab on Bcell --> mod level of interm-affinity Ab
52
conjugate vaccine --> how induce immunity?
Tcell-dep Bcell response:
polysacc-protein conjugate --> bind Ab on Bcell --> protein component activate Tcell receptor --> high levels of high-affinity Ab + memory cell formation
53
pneumococcal vaccine --> what kind for:
- infant
- young child
- <65yo + predisposing comorbid
- immunocomp
- >65yo
- infant: PCV13
- young child: PCV13
- <65yo + predisposing comorbid (chronic heart/lung dz, DM, cirrhosis): PPSV23
- immunocomp: PPSV23 + PCV13
- >65yo: PPSV23 + PCV13
54
tachycardia-mediated cardiomyopathy --> how to improve LV fx?
restore sinus rhythm or aggressive ctrl ventricular rate
55
what is: missed abortion
preg loss at <20wk gestation prior to expulsion of gestational tissue
56
missed abortion --> presentation
- usu asymptomatic
but can present w:
- loss of preg ssx
- light vag bleed
57
missed abortion --> findings (3)
- closed cervix
- decreasing B-hCG
- US: no fetal heartbeat
58
spherocytosis --> lab findings:
- MCHC
- MCV
- peripheral smear
- Coombs test
- acidified glycerol lysis test
- eosin-5-maleimide binding test
- MCHC: increase (d/t membrane loss & RBC dehydration)
- MCV: low
- peripheral smear: spherocytes
- Coombs test: neg
- acidified glycerol lysis test: increase osmotic fragility
- eosin-5-maleimide binding test: abnormal
59
spherocytosis --> increase risk for what conditions (2)?
- bilirubin gallstones
| - parvovirus B19 --> aplastic crisis
60
spherocytosis --> presentation --> classic triad
- hemolytic anemia
- jaundice
- splenomegaly
61
spherocytosis --> tx
supportive: folic acid, transfusion for severe anemia
62
spherocytosis --> what does splenectomy do for pt? what does it not do?
- improve anemia
- reduce gallstone risk
not change increased MCHC
63
anti-D immune globulin --> when administered during preg?
28wk gestation + w/in 72hr of delivery
64
what is: Kleihauer-Betke test
determine if need higher than standard dose of anti-D immune globulin after delivery
65
sickle cell trait --> #1 comp
painless hematuria (d/t sickling in renal medulla)
66
chronic renal fail --> phlebotomy --> not stop bleed --> why?
platelet dysfx --> abnormal hemostasis
67
chronic renal fail --> platelet dysfx --> lab findings:
- PT
- PTT
- platelet count
- BT
- PT: normal
- PTT: normal
- platelet count: normal
- BT: prolong
68
chronic renal fail --> platelet dysfx --> tx? MOA?
DDAVP --> increase release of factor VIII-vWF multimers from endothelial storage sites
69
lung cancer --> paraneoplastic synd --> muscle weak --> what paraneoplastic synd could it be (3)?
- myasthenia gravis
- Lambert-Eaton synd
- dermatomyositis
70
what is: dermatomyositis
idiopathic inflamm myopathy --> immune-med muscle injury
71
dermatomyositis --> presentation
- symm proximal muscle weak
| - erythematous rash --> Gottron's sign, heliotrope rash
72
SLE --> lab findings on CBC (3)
- hemolytic anemia
- thrombocytopenia
- leukopenia
73
#1 RF for spont preterm delivery
h/o spont preterm delivery
74
h/o spont preterm delivery --> how to decrease risk of spont preterm delivery w next preg
- progesterone supplementation
| - serial cervical length measurements
75
supravalvular aortic stenosis --> exertional angina --> why?
aortic stenosis --> LV hypertrophy --> exercise --> increase myocardial O2 demand --> subendo ischemia --> angina
76
simple breast cyst --> aspirate clear yellow fluid --> next step?
f/u in 2-4 mo for clinical breast exam --> monitor for recurrence
77
ankylosing spondylitis --> exam findings (5)
- arthritis (sacroillitis)
- reduced chest expansion, spinal mobility
- enthesitis (tenderness at tendon insertion sites)
- dactylitis (swelling of fingers/toes)
- uveitis
78
preg --> elevated maternal serum AFP --> indicate what fetal conditions (3)?
- open neural tube defect
- ventral wall defect --> gastroschisis, omphalocele
- mult-gestation preg
79
preg --> elevated maternal serum AFP --> next step?
US --> eval fetal anatomy
80
preg --> decreased maternal serum AFP --> indicate what fetal condition?
aneuploidy
81
methamphetamine --> risk for what heart condition?
cardiomyopathy
82
milk-alkali synd --> symptoms
- N/V, constipation
- polyuria/polydipsia
- neuropsych ssx
83
milk-alkali synd --> pathophys
excess intake Ca & absorbable alkali --> hyperCa -->
- renal vasoconstrict --> decrease GFR
- renal lose Na & H2O --> hypovol --> increase resorb bicarb
84
milk-alkali synd --> lab findings (4)
- hyperCa
- metabolic alk
- acute kidney injury
- suppressed PTH
85
Turner synd --> CV abnormalities (3)
- bicuspid aortic valve
- coarcation of the aorta
- aortic root dilation
86
Turner synd --> karyotype
45, X
87
karyotype --> find 45, X --> next step?
eval for CV abnormalities --> 4-extremity blood pressure & echo
88
postpartum psychosis --> management
medical emergency --> increased risk of suicide & infanticide --> hosp --> antipsych med & trt underlying disorder
89
cold knife conization --> how eval risk of preterm delivery
gold standard: transvag US --> measure cervical length
90
nonhosp pt --> polyuria --> most likely dx (3)
- DM
- primary polydipsia
- DI
91
Na levels:
- primary polydipsia
- central DI
- nephrogenic DI
- primary polydipsia: low
- central DI: high
- nephrogenic DI: normal
92
central DI --> pathophys
pituitary --> decreased ADH --> kidney --> decrease water resorb --> water loss --> polyuria --> dilute urine & hyperNa
93
what is complicated cystitis
infect assoc w factors that increase risk for abx resistance or tx failure --> DM, CKD, preg, immunocomp, urinary tract obstruct, hosp-acq infect, infect assoc w procedure/indwelling foreign body
94
uncomplicated cystitis --> abx options (3)
- nitrofurantoin
- TMP/SMX
- fosfomycin
95
complicated cystitis --> next step?
urine culture --> then initiate tx
96
complicated cystitis --> tx
fluoroquinolone
97
pyelonephritis --> next step?
urine culture --> then initiate tx
98
cirrhotic patient on diuretic --> hepatic encephalopathy --> pathophys?
diuretic --> low intravasc vol despite total vol overload --> metab alk + hypoK --> increase NH3
99
cirrhotic patient on diuretic --> metab alk + hypoK --> hepatic encephalopathy --> tx?
- replete K
- replete intravasc vol
- ammonia-lowering meds: lactulose
100
1st trimester --> lab findings:
- total T4
- free T4
- TSH
- total T4: increased
- free T4: no change or mild increase
- TSH: decreased
101
preg --> increase thyroid hormone --> pathophys?
- estrogen --> stim thyroxine-binding globulin syn --> increase total TH
- hCG --> stim TSH receptor --> increase TH production
--> to cope w metabolic demands of preg
102
18mo M --> intussusception --> how dx?
US guided air contrast enema
103
primary influenza pneumonia --> CXR findings?
b/l diffuse interstitial infiltrates
104
dobutamine --> used to manage what condition?
severe heart fail assoc w severe LV systolic dysfx & cardiogenic shock
105
dobutamine --> MOA
stim B1 receptor --> increased myocardial contractility --> improve EF, reduce LV end systolic vol --> symptomatic improve decompensated heart fail
106
how does pneumonia cause hypoxemia?
inflamm exudate --> fill alveoli --> R to L intrapulm shunt (vent/perfusion mismatch: perfusion w/out vent)
107
hypoxemic --> increase FiO2 --> hypoxemia does not correct --> indicates?
absence of alveolar vent --> ie pneumonia d/t to intrapulm shunt
108
neonate --> <10% percentile for gestational age at birth --> comp (5)
- hypoxia
- polycythemia
- hypoglycemia
- hypothermia
- hypoCa
Step 2
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