1
Q
post traumatic shoulder pain w/ limited active abduction - think?
A
rotator cuff tear
2
Q
rotator cuff tear, typical trauma –> ?
A
fall on an outstretched arm
3
Q
signs of rotator cuff tear? (3)
A
- drop arm sign
- weakness w/ external rotation (passive range nL)
- pain worsened by raising arm overhead or w/ ext rotation
4
Q
treatment of rotator cuff tear?
A
surgery w/ best results if performed w/in 6 wks of injury
5
Q
MSK suggestions of a pancoast tumor? (4)
A
- shoulder pain
- radicular pain radiating to wrist
- atrophy of muscles
- compressive symptoms (ie edema)
6
Q
infant nL @ birth but graudally dev apathy, weakness, hypOtonia, large tongue, sluggish movement, abdominal bloating, difficult breathing, jaundice, hypOthermia, umbilical hernia, refractory macrocytic anemia - think
A
congenital hypOthyroidism
7
Q
causes of floppy baby syndrome (2)?
A
- Botulism
- Werdnig-Hoffman syndrome
8
Q
Werdnig Hoffman syndrome is?
A
- AR disorder
- Degeneration of ant. horn cells and cranial motor nuclei
- symp prior to 6mo (ie generalized m. weakness, hypOtonia, hypermobility of joints, absent tendon relfexes, fasiculation of tongue, etc)
9
Q
m. weakness, atrophy of distal m. of upper and lower extremities, inc tone, testicular atrophy, and baldness - think?
A
Myotonic congenital myopathy
10
Q
nikolsky sign is?
A
top layer of skin slips away from lower layers when slightly rubbed
11
Q
nikolsky sign is positive w? (3)
A
- Scalded skin syndrome (Staph aureus - exfoliative toxin)
- Toxic epidermal necrolysis
- Pemphigus vulgaris (absent in bullous pemph)
12
Q
complication of kawasaki disease (2)?
A
- Coronary artery aneurysms
- MI
13
Q
What should be done at time of dx and post kawasaki disease?
A
Echocardiography
14
Q
reye syndrome is?
A
hepatic encephalopathy due to aspirin use in children during influenza or varicella infx
15
Q
sickle cell pt w/ stroke, treatment?
A
- Exchange transfusion (to dec # of sickle RBCs)
- Continue hydroxyurea
- Note: this does not reverse stroke, prevents any further strokes
- note: fibrinolytic therapy not likely to help bc 2ndary to sludging of sickle cell not thrombus/emboli
16
Q
twisting force w/ foot fixed –> popping sound, what injured?
A
medial meniscus
17
Q
palpable locking, catching, clicking when joint is internally or externally rotated and is then flexed or extended – think?
A
meniscal tear
18
Q
forceful hyperextension of knee or noncontact torsional injury during deceleration –> ?
A
ACL tear
19
Q
blow to the lateral knee or forceful leg abduction –>?
A
Medial collateral ligament tear
20
Q
patellofemoral pain syndrome presents? (3)
A
- chronic ant. knee pain
- worsened by activity or prolonged sitting/flexion
- crepitus w/ motion of patella
21
Q
gold standard confirmatory test for HIT?
A
Serotonin release assay
22
Q
necrotic lesions at heparin injection sites –> think?
A
HIT (Ab mediated)
23
Q
supracondylar fracture concern for entrapment of what? (2)
A
- Brachial artery
- Median nerve
24
Q
anti-topoisomerase 1 antibody?
A
Scleroderma
25
Antimitochondrial Ab?
Primary biliary cirrhosis
26
Anti-smooth muscle Ab?
autoimmune hepatitis
27
salvage therapy is?
treatment for a disease when a standard treatment fails
28
treatment for a disease when a standard treatment fails is called?
salvage therapy
29
adjuvant therapy is?
treatment given in ADDITION to standard therapy
| ie radical prostatectomy + radiation at same time
30
treatment given in addition to standard therapy is?
adjuvant therapy
31
consolidation therapy is?
therapy given after induction therapy to further reduce tumor burden (consolidate our gains)
32
induction therapy is?
an initial dose of a treatment to rapidly kill tumor cells and send pt into remission
33
initial dose of a treatment meant to kill tumor and cause remission?
induction therapy
34
therapy given after induction therapy to further reduce tumor burden?
consolidation therapy
35
maintenance therapy is?
given after induction and consolidation therapies to kill any residual tumor cells and keep pt in remission
36
neoadjuvent therapy is?
a treatment given BEFORE the standard therapy for a particular disease
37
a treatment given before the standard therapy for a particular disease is?
neoadjuvent therapy
38
initial treatment for DKA?
- nL saline
- IV regular insulin
- correct electrolyte abnl
- treat precipitating cause
39
DKA requirements for dx?
- blood gluc >250
| - serum pH
40
most appropriate next step in management of progressive pain in pt w/ prostate CA and bony mets after androgen ablation (orchiectomy)?
radiation therapy
41
gastroparesis symp?
- anorexia
- n/v
- early satiety
- postprandial fullness
42
treatment of pts w/ diabetic gastroparesis?
- optimize DM control
- dietary modifictation (small frequent meals, inc fiber)
- meds to improve gastric emptying (ie metoclopramide)
43
prokinetic and antiemetic med to help w/ diabetic gastroparesis?
metoclopramide
44
what meds can help w/ diabetic gastroparesis?
- Metoclopramide (prokinetic, antiemetic)
- Erythromycin (prokinetic properties; used for acute exacerbations)
- Cisapride (prokinetic, but risk of cardiac arrhythmias and death)
45
acute inflammatory arthritis + chondrocalcinosis - think?
pseudogout (Ca pyrophosphate dihydrate crystal arthritis)
46
chondrocalcinosis is?
calcification of articular cartilage
*found w/ pseudogout
47
anti-dss DNA Ab specific for?
SLE
48
anti smith Ab specific for?
SLE
49
anti-histone Ab is sensitive marker for what?
drug-induced lupus
| (less so for minocycline-induced)
50
anti-cyclic citrullinated Ab is specific for?
RA
51
paget disease of bone due to?
osteoclastic bone resorption --> focal enlargement, weakness, or fracture of bone
52
frontal bossing, headaches, hearing loss, bowing long bones, bone pain w/ inc alk phos and nL Ca and phosphate - think?
Paget's disease of bone
53
main treatment for paget's disease of bone?
bisphosphonates
54
what are pts w/ acromegaly most likely to die from?
cardiovascular complications
55
acute back pain w/ point tenderness after lifting suggests?
vertebral compression fracture
56
pain pattern w/ compression fracture?
pain w/ standing, walking, or lying on back
57
positive straight leg raise test indicates?
nerve root compression --> herniated disk, radiculopathy, etc
58
low back pain + neurological symptoms worse w/ spinal extension (ie walking, standing) but improved w/ leaning forward or lying down -- think?
lumbar spinal stenosis
59
treatment of alcohol withdrawal?
benzos
| - IV lorazepam preferred in hospital setting & those w/ liver disease (intermediate duration)
60
megacolon + cardiac disease - think?
Chagas disease (trypanosoma cruzi)
61
severe hyperCalcemia (>14) treatment?
Immediate:
- nL saline + calcitonin
- Avoid loop diuretics (unless vol overloaded)
Long term
- bisphosphonates (takes a few days)
62
loss of fetal station - think?
uterine rupture
63
painless vag bleeding on membrane rupture + fetal sinusoidal heart tracing (brady) - think?
vasa previa
64
most common type of spinocerebellar ataxia?
Friedreich ataxia
65
ataxia & dysarthria + scoliosis & hammertoes + concentric hypertophic cardiomyopathy - think?
Friedrich ataxia
| (neuro + skeletal + cardiac)
66
most common cause of death in pts w/ friedreich ataxia?
cardiomyopathy or respiratory complications
67
pronator drift sensitive and specific finding for?
Pyyramidal/corticospinal tract disease (UMN)
68
signs of drug induced hyperammonemia (ie valproate)?
- encephalopathy (confusion, lethargy, etc)
| - Neuromuscular findings (bradykinesia, asterixis, etc)
69
major complication concern for parapharyngeal space infx? (2)
- erosion into carotid artery
| - jugular thrombophlebitis
70
most feared complication of a retropharyngeal abscess?
spread of infx into mediastinum --> acute necrotizing mediastinitis
71
chest pain due to coronary vasospasm?
variant angina (Prinzmental)
72
greatest risk factor for variant (prinzmental) angina?
smoking
73
transient chest pain occur at night w/ transient ST elevations - think?
variant (prinzmental) angina
74
treatment of prinzmental (variant) angina?
- elimination of risk factors (ie smoking)
- Ca channel blockers
- Alternatively, nitrates
75
meds to avoid in variant (prinzmental) angina?
- aspirin
| - nonselective Beta blockers (ie propranolol)
76
what is a calcitonin producing tumor?
medullary thyroid cancer
77
Treament for guillen-barre?
IVIG or Plasmapheresis
78
cyclosporine and pyridostigmine can treat?
Myasthenia gravis
79
riluzole used in treatment of?
ALS
80
what type of meds may help with the passage of a kidney stone?
Alpha 1 receptor blockers (ie tamsulosin)
81
anticholinergic --> urinary what?
urinary retention
| - can use to treat overactive bladder (inc bladder capacity)
82
bethanechol is? can treat what nephro stuff?
cholinergic agent
treat urinary retention or atonic bladder
83
oxybutynin is
anticholinergic
84
maj subarchanoid hemorrhage complication in first 24 hrs if left untreated?
rebleeding (maj cause of death w/in 24hrs of presentation)
85
maj subarchanoid hemmorhage complication in 3-10days post?
Vasospasm (maj cause of morbidity and death)
86
Prophylaxis for subarachnoid hemorrhage pts to prevent vasospasm?
Nimodipine
87
Nimodipine
prophylaxis for subarachnoid hemmorrhage pts to prevent vasospams
88
when do you see todd's palsy?
post seizure
| - weakness one side of body for up to 48 hrs post seizure
89
n/v, pneumobilia, hyperactive bowel sounds, and dilated loops of bowel -- think?
gallstone ileus --> mechanical SBO
90
firstline treatment for OCD ?
high dose SSRIs and/or exposure and response CBT
91
young obese F w/ headache w/ nL imaging and inc ICP (ie papilledema) -
Pseudotumor cerebri (benign intracranial HTN)
92
treatment for pseudotumor cerebri
- weight reduction
- if weightloss doesn't work --> Acetazolamide
eye surgery if refractory to both
93
maj complication of pseudotumor cerebri?
blindness
94
spinal cord compression what initial treatment?
IV steroids
95
ventricular aneurysm ECG findings?
- Persistent ST seg elevation post recent MI (5dys-3mo)
| - Deep Q waves in same leads
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