1
Q
CDC vax guidlines for north africa (ie Egypt)?
A
HAV
HBV
typhoid
polio booster
2
Q
when is yellow fever vax recommended?
A
sub-saharan africa and central/south america travel
3
Q
clubbing and sudden onset joint arthropathy in a chronic smoker is suggestive of?
A
hypoertrophic osteoarthropathy (pulmonary disease caused subset)
- associated w/ lung CA –> need to get CXR to rule out malignancy
4
Q
post menopausal women w/ new onset breast tenderness and thickened endometrial stripe w/ large ovarian mass - what tumor are we thinking?
A
Granulosa cell tumor (secrets estrogen)
5
Q
dopaminergic agonists used in med management of prolactinoma?
A
- carbergoline
- bromocriptine
6
Q
carbergoline and bromocriptine are what and both can be used in what situation?
A
- dopamine agonist
- used in med management of prolactinomas
7
Q
newborns of moms w/ active HBV should receive what at birth?
A
- HBIG
- HBV vax
BOTH!
8
Q
small for gestational age infants may have what complications (5)?
A
- hypoxia
- polycythemia (bc inc EPO response to hypoxia)
- hypoglycemia
- hypothermia
- hypoCalcemia
9
Q
beckwith wiedemann syndrome is due to?
A
deregulation of gene expression in chromosome 11p15 (which codes for insulin like growth factor 2)
10
Q
phys findings at birth w/ beckwith wiedemann syndrome?
A
- macrosomia (rapid growth until late childhood)
- macroglossia
- hemihyperplasia (one side bigger than other)
- medial abdominal wall defects (ie umbilical hernia, omphalocele)
+/- visceromegaly
11
Q
what is beckwith wiedemann syndrome?
A
overgrowth disorder –> predisposition to neoplasms
12
Q
beckwith wiedemann syndrome inc risk for?
A
- Wilms tumor
- Hepatoblastoma
13
Q
what is surveillance for beckwith wiedemann newborns?
A
at birth: monitor for hypoglycemia
birth - 4 yo: screening abd u/s and alpha-getoprotein levels from birth (looking for malignancy)
4-8yo: abd u/s every 3 mo
8- adolescence: renal u/s
14
Q
bradycardia, AV block, hypotension, and diffuse wheezing - suggest what type of overdose?
A
Beta blocker overdose
15
Q
wheezing w/ overdose – think?
A
beta blocker overdose
bc beta 2 blockade!
16
Q
treatment of beta blocker overdose?
A
1) secure airway, IV fluids
2) Atropine to treat hypotension and bradycardia
3) if hypotension profound or refractory give IV glucagon
17
Q
Main P2y12 receptor blocker to know?
A
- clopidogrel
18
Q
what is action of clopidogrel?
A
P2y12 receptor blocker
19
Q
main medical therapy to improve morbidity and mortality in pts w/ CHD?
A
- Dual antiplatelet therapy (aspirin and clopidogrel)
- Beta blockers
- ACE-i/ARBs
- HMG-CoA reductase inhibitors (statins)
- Aldosterone antagonists (sprionolactone, eplerenone) - in pts w/ V EF
20
Q
phosphodiesterase 5 inhibitors are used for what and do what?
A
- erectile dysfunc
- vasodilators
21
Q
phosphodiesterase 5 inhib are contraindicated in pts also on what med?
A
nitrates (risk of hypotension)
22
Q
milrinone is what type of med and who is it contraindicated for?
A
- selective phophodiesterase inhib
- contraindicated in pts w/ HF (inc mortality)
23
Q
statins are what type of med?
A
HMG-CoA reducatse inhibitors
24
Q
differences b/t the various prostatitis? (ie chronic bacterial, inflammatory, non inflammatory, acute bacterial)
A
Afebrile w/ irritative voiding symp (ie urgency, freq, discomfort)
- Chronic Bacterial: secretions inc WBC w/ growth on cx
- Inflammatory: secretions w/ inc WBC, cx neg
- Non-Inflammatory: nL secretions and cx
Acute bacterial: FEBRILE, exquistely tender prostate, U/A w/ bacteriuria and pyuria (+/- irritative voiding symp)
25
essential tremor + HTN - what med best?
```
beta blocker (ie propranolol)
- can treat both
```
26
aminoglycosides can cause what organ issue?
Acute renal failure
27
amikacin is what type of med?
aminoglycoside
28
multi-drug resistent pyelonephritis likely caused by what group of bugs?
gram neg rods
29
spasticity, UMN or LMN?
UMN
30
bulbar symp, UMN or LMN?
UMN
31
fasciculation, UMN or LMN?
LMN
32
hyperreflexia DTR, UMN or LMN?
UMN
33
cortical and subcortical atrophy disproportionately greater in temporal and parietal lobes -- think?
Alzheimers
34
personality changes & loss of social restraint w/ dementia --> becomes mute, immobile, and incontinent - think?
Frontotemporal lobe dementia
35
pt w/ asthma attack become hypokalemic -- why?
inhaled beta-2 agonist use (ie albuterol)
| --> stim K shift into cells + release of insuline which further inc intracellular K shift
36
how long does a pt w/ mono have to refrain from sports?
>= 3 wks (regardless of symp as this is period w/ greatest splenic rupture risk)
37
common side effect of dihydropyridine CCB?
peripheral edema (due to dilated peripheral BV -- NOT allergy)
38
Triggers for SJS/TEN?
Drugs:
- allopurinol
- Abx (sulfonamides
- Antconvulsants (ie carbamazepine, lamotrigine, phenytoin)
- NSAIDs
- Sulfasalazine
- Mycoplasma pneumonia
- Vax
- Graft-vs host disease
39
clinical features of SJS/TEN?
- acute influenza like prodrome
- necrosis & sloughing of epidermis
- mucosal involvement
- rapid onset erythematous macules, vesicles, and bullae
40
adjustment disorder?
emotional or behavior symp dev w/in 3 mo of an identifiable stressor that last no longer than 6mo once stressor ends
41
prussian blue stain indicates?
prescence of hemosiderin -- found in urine during hemolytic episodes
42
common meds than can precipitate a hemolytic epi in G6PD deficiency (3)?
- sulfa drugs
- antimalarials
- nitrofurantoin
43
most common location for medulloblastoma?
cerebella vermis
| - imp location for balance or gait coordination
44
common symp of medulloblastoma?
- truncal or gait instability (ie ataxia, bc most common location is in cerebellar vermis which is imp for balance and gait coordination)
* can also cause obstructive hydrocephalus
45
most common cerebral hemisphere tumors in kids?
low grade astrocytomas
46
craniopharyngiomas are found where?
suprasellar masses
47
two most common posterior fossa tumor (ie cerebellar)?
- cerebellar astrocytoma
| - medulloblastoma
48
what is parinaud syndrome?
- limited upward gaze w/ downward preference
- b/l eye lid retraction
- light-near dissociation
49
what tumors cause parinaud syndrome?
pineal tumors (bc pressure on pretectal region of midbrain)
50
PNA w/ CNS and GI features -- think
legionnaires
51
PNA w/ hypOnatremia, hepatic dysfunction, diarrhea, fever and gram stain of sputum w/ a lot of PMNs but no organisms -- think?
legionella
52
most common way to confirm dx of legionella?
urine antigen testing
53
treatment for legionnaires disease?
Macrolide or fluoroquinolone
54
leuprolide is and can treat what?
- GRH agonist
| - can treat symptomatic endometriosis --> but can lead to menopausal symp
55
adolescent w/ nasal obstruction, visible nasal mass w/ bony erosion, and frequent noseleeds - think?
Juvenile angiofibroma
56
chronic epigastric pain radiating to the back that improves with sitting up or leaning forward - think?
chronic pancreatitis
57
blood smear w/ RBC w/ single, round, blue inclusions on Wright stain - think?
Howell Jolly bodies (likely to due to hyposplenism)
58
hemoglobin precipitation inclusions are what and found when?
- Heinz Bodies
| - G6PD deficiency under crystal violet stain
59
recurrent skin and mucosal bacterial infx w/o pus and with poor wound healing and CBC w/ neutrophilia - think?
leukocyte adhesion deficiency
60
leukocyte adhesion deficiency caused by?
defective integrins on leukocyte surface --> can't adhere to vasc endothelium --> can't migrate to site of infx/inflam
61
delayed umbilical cord separation (age>3 wks) - think?
leukocyte adhesion deficiency
62
adenosine deaminase is an AR form of what?
SCID - lack of mature B and T lymphocytes
63
pts w/ complement deficiency are at an inc risk for what?
disseminated bacterial infx esp w/ encapuslated bacteria (strep pneumo, HiB, Neisseria, etc)
64
peridontal infx w/ hx of many cellulitis and sinus infx and CBC shows very high WBC w/ neutrophilia - think?
leukocyte adhesion deficiency
65
pulm nodule w/ halo sign on CT in pt on steroids/chemo - think?
aspergillosis
66
pulm lesion w/ air crescent on CT in immuncompromised pt- think?
aspergiollosis
67
where can aspergillus be in lung?
ANYWHERE
68
histoplasmosis findings on CXR?
- hilar adenopathy
| - areas of pneumonitis
69
fever, cough, SOB, hemoptysis in immunocompromised pt. CXR finds cavitary lesion and CT show pulm nodules w/ halo - think?
aspergillosis
70
tamoxifen and raloxifene are?
selective estrogen receptro modulators
| estrogen agonist
71
side fx of SERMs?
- Hot flashes (bc estrogen agonist)
- Venous thromboembolism
- Tamoxifen ONLY: endometrial hyperplasia and CA
72
chronic steroid use has risk of what to bones (2)?
- Osteopenia/Osteoperosis
| - AVN of femoral head (osteonecrosis)
73
signs of osteonecrosis of femoral head?
- pain in groin, thigh, or butt worse w/ activity and relieved by rest (eventually will progress to rest pain too)
- reduced range of motion (abduction and internal rotation)
- joint instability
74
best imaging of AVN of femoral head?
MRI most sensitive, xray can look nL
75
vision impairing opacification of the lens?
cataract
76
painless blurred vision w/ glare and often halos around lights (make night driving hard) - think?
cataract
77
acute/subacute loss of vision w/ swollen disc, venous dilation w/ tortuosity, diffuse retinal hemorrhages, +/- cotton wool spots - think?
Central retinal vein occlusion
78
Macular degeneration affects where in the vision?
central
79
2 primary forms of macular degeneration?
- atrophic (dry): slow progressive b/l vision loss
| - exudative/neovascular (wet): agressive, unilateral vision loss
80
open angle glaucoma presents?
insidious onset w/ gradual loss of peripheral vision and consequent tunnel vision
81
gradual loss of peripheral vision, high intraocular pressures, and cupping of optic disc - think?
open angle glaucoma
82
open angle glaucoma finding on opthalmoscopic exam?
cupping of optic disc
| ie cup to disc ratio >0.6 - bc cup enlarged
83
sudden unilateral loss of part or all of visual field as if "a curtain fell over the eye" - think?
retinal detachment
84
treatment of absence seizures?
- Ethosuximide
| - valproate
85
initial drug for partial seizures?
Phenytoin
86
most common predisposing factor for orbital cellulitis?
bacterial sinusitis
87
pain w/ eye movements, proptosis, ophthalmoplegia, and diplopia - think?
orbital cellulitis
88
persistent depressive disorder (dysthemia) needs?
- chronic depressed mood >= 2 yrs (1 yr in kids/adolescent)
- no symptom free period for >2 mo
- at least 2 of the following:
- poor appetite/overeating
- insomnia/hypersomnia
- low energy or fatigue
- low self-esteem
- poor conc/diff making decisions
- feelings of hopelessness
89
delusional disorder is?
- >=1 delusion for >= 1 mo
- no other psychotic symp
- can function apart from delusion (behavior not obviously bizarre/odd)
90
delusions are?
fixed beliefs that are firmly held despite conflicting evidence
91
when hypothyroid pt get preg how do you adjust levothyroxine dose?
increase by approx 30%
92
ovarian mass with absent doppler flow think?
ovarian torsion
93
contraindications to radioactive iodine treatment?
- pregnancy
| - very severe ophthalmopathy
94
what is henoch schnlein purpura?
IgA mediated leukocytoclastic vasculitis
95
clinical manifestations of HSP? (4)
- palpable pupura (usually lower limbs)
- arthritis/arthralgia
- abd pain, intussuceptions
- renal disease similar to IgA nephropathy
96
Treatment for HSP?
most: supportive (hydration and NSAIDs)
severe --> hospitaliztion and systemic steroids
97
HSP effecting kidneys would show what on biopsy?
deposition of IgA in mesangium (similar to IgA nephropathy)
98
palpable purpura on lower extremities, arthralgias, abdominal pain, and renal disease - think?
HSP
99
risk factors for necrotizing enterocolitis (4)?
- prematurity
| - very low birth weight (breast milk)
100
clinical signs of necrotizing enterocolitis
- VS instability
- Lethargy
- Vomiting
- Bloody stools
- Abd distension/tenderness
101
most common effected site by NEC?
terminal ileum and colon
102
feeding intolerance, abd distension, bloody stools, vomiting in a full term newborn w/ congenital heart disease causign cyanosis - think?
necrotizing enterocolitis
103
xray findings w/ NEC? (3)
- pneumatosis intestinalis (gas in bowel wall)
- portal venous gas
- pneumoperitoneum (free air in abd)
104
Treatment of NEC?
- supportive care (bowel rest, parenteral hydration/nutrition)
- broad-spectrum IV abx
+/- surgery
105
elderly man w/ agitation onset around time of taking this type of med -- what is the type of med?
Benzo's
| --> paradoxical agitation
106
indications that the SBO is complicated and warrants emergency abd exploration?
- change in character of the pain
- fever
- hemodynamic instability
- guarding
- leukocytosis
- significant metabolic acidosis
107
yellow-white fluffy hemorrhagic lesions along the vasculature in pt w/ HIV and CD4 count
CMV retinitis
108
CMV retinitis findings?
- full thickness retinal inflammation that moves along vasculature (--> edema & scarring)
- blurred vision
- floaters
- photopsia (sensation of flashing lights)
109
CMV retinitis can inc risk of?
- blindness (esp lesions near fovea and optic n.)
| - retinal detachment (esp w/ lots of scarring)
110
newborn w/ dec lung markings on CXR and left axis deviation, tall peaked p waves, and minimal R waves in precoridal leads on ECG - think?
tricuspid atresia
111
subdural hematoma occurs when?
shearing forces tear bridging veins
112
subdural hematoma finding on CT?
crescent shaped hyperdensity (acute) or hypOdensity (chronic) crossing suture lines
113
how to tell b/t methanol and ethylene glycol poisoning?
what they hurt!
Methanol -> eye damage (think moonshine)
Ethylene glycol (antifreeze) - kidney damage
114
easiest reverisble risk factor for pancreatic CA?
stop smoking!
115
typical signs of cerebellar degeneration? (6)
- gait dysfunction
- truncal ataxia
- nystagmus
- intention tremor/dysmetria (limb-kinetic tremor when attempting to touch a target)
- impaired rapid alternating movements (dysdiadochokinesia)
- pendular knee reflex (m hypotonia --> persistent swinging)
116
clasp knife phenomenon seen in what pts?
pts w/ hypERtonia due to pyramidal tract disease
117
hypothyroidism despite high levels fo T4 and T3 and nL levels fo TSH - think?
receptor defects in peripheral tissues --> generalized resistance to TH
118
primary hypothyroidism has what T4/3 and TSH levels?
low T4/3
High TSH
issue at thyroid gland
119
secondary or tertiary hypothyroidism - where and what T4/3 and TSH levels?
low T4/3
low/inappropriately nL TSH
2ndary: pituitary gland
tertiary: issue at hypothalamus
120
amaurosis fugax is?
painless loss of vision from emboli
121
amaurosis fugax can be a sign of?
impending stroke
122
nontraumatic sub arachnoid hemorrhage usually results from?
saccular or berry aneurysm rupture
123
elevated opening pressure on MP and unexplained xanthochromia (yellowish color of CSF indicating bilirubin indicating hemolysis) - think
subarachnoid hemorrhage
124
amyloid angiopathy --> bleeding where?
intracerebral hemorrhage
125
HTN associated w/ what type of hemorrhages?
intraparenchymal or intracerebral hemorrhage
126
kaposi sarcoma associated w/ what virus?
HHV-8
127
dendritic ulcers in eye - think?
herpes simplex keratitis
or
Herpes zoster ophthalmicus
tell diff by presentation
- HSK - pain, photophobia, blurred vision, tearing, redness
- HZO: elderly, fever, malaise, burning, itching w/ periorbital rash
128
on cephalosporin, pt has fever, rash, arthralgias hematuria, sterile pyuria, eosinophilia/uria w/ WBC casts - think?
drug induced intersittial nephritis
*happens w/ penicillina, cephalosporins, NSAIDs, sulfonamides, rifampin, phenytoin, and allopurinol
129
maj difference b/t OCPD and OCD?
OCPD - ego- syntonic (thinks beliefs are good)
OCD: ego-dystonic (compulsions cause anxiety)
130
dev of new conduction abnormality in pt w/ IE -- think?
perivalvular abscess
131
early diastolic murmur - think?
AR
132
when AR is due to valvular disease best heard where?
Left sternal border (3rd and 4th intercostal space)
133
mitral valve perforation presents how?
- acute CHF
| - systolic murmur of MR
134
tricuspid IE usually has what murmur?
holosystolic murmur of TR accentuated w/ inspiration
135
muddy brown cast found w/?
Acute Tubular Necrosis
136
RBC casts found w/?
Glomerulonephritis
137
WBC casts found w/?
Interstitial nephritis or pyelonephritis
138
Fatty casts found w/?
Nephrotic syndrome
139
Broad and waxy casts found w/?
Chronic renal failure
140
- BUN/CR -> 20:1
- UOsm 300-350
- UNa >20
- FeNa >2%
what is this?
ATN
141
hepatic encephalopathy likely due to?
inability to break down ammonia into urea
142
bronchoalveolar lavage very useful to work up what lung infx?
Pneumocysitis PNA
143
brochoalveolar lavage useful in evaluation of what? (2)
- malignancy
| - opportunistic infx (ie PCP)
144
ethelyne glycol toxicity --> clinical findings?
- high anion gap metabolic acidosis
- hypoCalcemia
- Calcium oxlate crystal deposition in kidneys --> AKI, hematuria, flank pain
145
Fomepizole treats?
ethylene glycol overdose
146
very high anion gap w/ very low bicarb level (
- ethlyene glycol overdose
| - methanol overdose
147
sodium thiosulfate treats?
cyanide poisoning
148
ethlyene glycol overdose, treat w/?
Fomepizole
149
pt w/ painful blurred vision and fixed, mid dilated eye w/ headache and nausea -- think?
Acute angle closure glaucoma
150
patchy redness on white of eye w/ mild pain and discharge in pt w/ autoimmune disorder - think?
Episcleritis
151
atopic dermatitis aka ?
eczema
152
eczema aka?
atopic dermatitis
153
PAS positive - think? (2)
- Whipple's disease
| - Lymphoblasts (ie ALL)
154
rash that spreads from face to trunk to extremities w/ viral appearing prodrome and leukopenia and thrombocytopenia - think?
measles
155
what has been shown to reduce the morbidity and mortality in pts w/ measles?
Vit A
156
mag sulf toxicity findings?
- neuromuscular depression (m paralysis, dec/absent DTRs)
- dec resp effort/apnea
- somnolence
- visual distrubances
157
nL skin at birth that gradually progresses to dry scaly skin - think?
Icthyosis vulgaris
158
icthyosis vulgaris' nickname?
"lizard skin"
159
MAOI + tyramine --> what?
HTN crisis
160
PAS positive macrophages in lamina propria containing non-acid fast gram positive bacilli - think?
Whipple's disease (Tropheryma whippelii)
161
diarrhea, migratory non-deforming arthritis, lymphadenopathy, weight loss, and low grade fever w/ small intestine bx showing PAS positive macrophages - think?
Whipple's disease
162
Add abx to COPD exacerbation if?
2 or more of following:
- inc SOB
- inc cough (more freq or severe)
- Change in sputum prod (inc vol or change in color)
OR
Mechanical ventilation requirement
163
what is time frame to treat most pts w/ oseltamivir or zanamivir by?
w.in 48 hrs of influenza symptom onset
164
which pts if they presented w/ influenza you would still provide oseltamivir even if outside 48hrs? (7)
- >65yo
| - pregnant or
165
1st stage of labor (active) is ?
6-10cm cervical dilation
166
1st stage of labor (latent) is?
0-6cm cerivcal dilation
167
2nd stage of labor?
complete dilation to delivery
168
3rd stage of labor is?
delivery of baby to expulsion of placenta
169
arrested labor in the first stage is diagnosed when?
>6cm dilation w/ ROM and 1 of the following:
- no cervical change >=4hrs despite adequate contractions (>=200montevideo untis for >= 2 hrs)
OR
- No cervical change for >=6hrs w/ inadequate contractions
170
adequate contractions are?
adequate contractions = >=200 Montevideo units for >=2hrs
171
contraction strength =?
peak mmHg - baseline mmHg
172
montevideo unit = ?
of uterine contractions in 10 min x contraction strength
173
fetal renal agenesis indicates?
not compatible w/ life bc there will be severe pulm hypoplasia
174
lower back pain that is worse at night but improves w/ physical activity think?
inflammatory spondyloarthopathy
| ankylosing spondylitis, psoriatic, reactive, or IBD arthritis
175
inflammation of ligamentous insertion?
enthesitis
176
envelope shaped kidney stones?
Calcium oxalate
177
radioopaque kidney stones?
- Calcium (oslate and phosphate)
- Struvite (ammonium, Mg, phos)
- Cystine
178
radiolucent kidney stone?
uric acid
179
precipitates at low pH kidney stones?
- Ca oxalate
- Uric acid
- Cystine
180
precipitates at high pH kidney stones?
- Ca phosphate
| - Struvite
181
coffin lid shaped kidney stones?
struvite
182
rhomboid or rosette shaped kidney stones?
uric acid
183
hexagonal shaped kidney stones?
cystine
184
kidney stones cause by infx w/ urease bugs (ie proteus, klensiella, staph sapro etc)?
struvite
185
commonly form staghorn calculi?
struvite or cystine kidney stones
186
which kidney stone have a postive sodium cyanide nitroprusside test?
cystine
187
which kidney stones are related to a family inborn error?
cystine
188
treatment of infant botulism from environmental spores?
human derived botulism immune globuline
189
foodborne botulism treatment?
equine derived botulism antitoxin
190
treatment of guillain barre syndrome?
pooled human immune globulin
191
botulinum toxin does what?
blocks acetylcholine release at presynaptic NMJ
192
face and arm swelling w/ weight lost new onset SOB w/ smoking hstory and anterior wall veins engorgement - think?
SVC syndrome likely due to malignancy causing obstrution
193
bright red firm friable vascular exophytic nodule in an HIV pt - think?
bacillary angiomatosis
194
bacillary angiomatosis caused by?
bartonella - gram neg bacillus
195
treatment of bacillary angiomatosis?
oral erythromycin
196
common etiologies of crystal induced AKI? (5)
- acyclovir
- sulfonamides
- methrotrexate
- ethylene glycol
- protease inhibitors
197
preferred initial DMARD in pts w/ mod to severe RA?
methotrexate
198
indications of methotrexate toxcity?
- oral ulcers
- acute rise in serum transaminases
- bone marrow suppression (macrocytic anemia, leukopenia, thrombocytopenia)
199
felty syndrome?
clinical disorder seen in pts w/ severe long standing (>10yrs) RA that is characterized by neutropenia and splenomegaly
200
treatment of polymyalgi rheumatica?
low dose prednisone
201
treatment for giant cell artertitis?
high dose prednisone
202
treatment for fibromyalgia
initial: exercise and good sleep hygiene
next: TCAs
203
fatigue, stiffness, poor sleep w/ point tenderness at mid trapezius, lateral epicondyle, costochondral junction of chest and greater trochanter w/ otherwise nL phys exam and nL labs (incl ESR) - think?
fibromyalgia
204
bipolar pts w/ inadequate response to monotherapy and/or severe episode maintenance treatment is?
combo therapy w/:
- Lithium or valproate
AND
- a second gen antipsychotic (ie quetiapine)
205
PCV13 followed by PPSV23 6-12mo later recommended for pts
very high risk comoborbidities (ie sickle cell, HIV, CKD, etc)
206
PPSV23 alone for pts
- current smokers
| - chronic med conditions (ie heart, lung, liver, DM)
207
pneumococcal conjugat vaccine is?
PCV13
208
pneumococcal polysaccharide vaccine is?
PPSV23
209
pneumococcal 23 valent vax is what type
polysaccharide
210
pneumococcal 13 valent vax is what type?
conjugate
211
pt w/ chronic headaches now w/ elevated Cr w/ painless hematuria and sterile pyuria w/ WBC casts and small kidneys b/l w/ renal papillary calcifications on CT - think?
analgesic nephropathy
212
Analgesic nephropathy causes what type of kidney injury?
tubulointerstitial nephritis
213
management of somatic symptom disorder?
- regularly scheduled visits w/ same provider
- limit unnecessary workup
- focus on stress reduction and improving coping strategies
- legitimize symp but make funtional improvement the goal
214
burning of rubber or plastic can cause?
cyanide inhalation/toxicity
215
bitter almond breath indicates?
inhaled cyanide
216
what presents similar to CO exposure but is due to burning of rubber or plastic?
cyanide inhalation
217
what is presenting physical skin findings in methemoglobinemia?
cyanosis and bluish discoloration of skin and MM
218
magnesium is solely excreted by?
Kidney
219
absolute contraindications to combined hormonal contraceptives? (8)
- migraine w/ aura
- >=15 cigs/dy & age >=35
- HTN >=160/100
- hx of venous thromboembolic disease, stroke, or ischemic heart disease
- BREAST CA
- Cirrhosis & LIVER CA
- Maj surgery w/ prolonged immobilization
-
220
common causes for priaprism (4)?
- sickle cell disease and leukemia - usual in kids/adolescents
- Perineal or genital trauma (laceration of cavernous a.)
- neurogenic lesion (cauda equina, spinal cord injury, etc)
- Meds: trazodone or prazosin
221
most common drug that causes priapism?
prazosin
222
initial hematura is?
bld at beginning of voiding cycle
223
total hermaturia is?
bld during entire voiding cycle
224
terminal hematuria is?
bld at end of voiding cycle
225
terminal hematuria suggests?
bleeding from prostate, bladder neck/trigone, or post. urethra.
(which can be concerning for CA)
226
terminal hematuria w/ clots indicates?
bleeding w/in bladder or ureters concerning for urothelial CA
227
initial hematuria causes? (2)
- urethritis
| - trauma (ie catheterization)
228
Terminal hematuria causes (5)?
- Urothelial CA
- cystitis (infx/post rad)
- Urolithiasis
- BPH
- Prostate CA
229
Total hematuria causes?
- Renal mass (bening/malignant)
- Glomerulonephritis
- Urolithiasis
- PCKD
- Pyelonephritis
- Urothelial CA
- Trauma
230
bedwetting before age what is normal?
5
231
you've identified small nonbleeding varices in an alcoholic cirrhotic pt, next treatment step?
Give non-selective beta-blockers (n and below)
*dec progression and risk of hemorrhage
232
treatment for cryptococcal meningoencephalitis?
Induction therapy w/ 2 wks of amphotericin B and flucytosine
Followed by consolidation therapy of 8wks of fluconazole and maintenance w/ it for at least 1 yr
233
Antiphospholipid syndrome - clinical features?
1) Thrombotic event (venous or arterial) OR Pregnancy morbitidy (loss, severe preeclampsia, placental insufficiency)
PLUS
2) positive for at least 1 of the following Ab:
a) Anticardiolipin
b) Anti-beta2-glycoprotein-I
c) Lupus anticoagulant
234
biggest risk factor fo antiphospholipid syndrome is?
Lupus
235
antiphospholipid syndrome can cause what to be a false positive?
VDRL and RPR test --> so you mistakenly think its syphilis!
236
Single S2 - think? (3)
- Transposition of great vessels (+/- VSD)
- Tricuspid atresia (has VSD)
- Truncus Arteriosis (w/ systolic ejection murmur)
237
cyanotic baby w/ Narrow mediastinum w/ "egg on a string" heart - think?
Transposition of great vessels
238
cyanotic baby w/ Harsh pulmonic stenosis murmur and VSD murmur - think?
Tetralogy of Fallot
239
Boot shaped heart in cyanotic baby - think?
Tetralogy of Fallot
240
cyanotic baby w/ single s2 and a systolic ejcetion murmu w/ edema - think?
Truncus arteriosis
241
Severe cyanotic baby in respiratory distress w/ pulm edema on CXR and enlarged supracardiac vens and SVC - think?
Total anomalous pulm venous retun w/ obstruction
242
ice bag test is for?
Myasthenia gravis
243
place ice bags on ptosis eyes and they improve indicates?
Myasthenia gravis
| cold inhib breakdown of acetylcholine at NMJ
244
bacterial meningitis in pt >1mo treatment?
IV vanco and ceftriaxone
(cefotaxime in pt
245
bacterial meningitis in pt
IV vanco and CEFOTAXIME
| >1mo can use ceftri
246
when do you add dexamethasone in bacterial meningitis treatment?
when causative agent likely is HiB -- protecting against sensoriuneural hearing loss
247
HIV pt CD4 count
Progressive disseminated histoplasmosis
248
disseminated histoplasmosis hits what parts of body?
- Systemic (f/c/weight loss)
- Pulm (cough, SOB)
- Mucocutaneous lesions (mouth ulcers, nodules, papules)
- Reticuloendothelial inflammation (ie hepatosplenomegaly, lymphadenopathy)
249
CXR findings for disseminated histoplasmosis?
reticulonodular or interstitial infiltrate
250
Treat disseminated histoplasmosis?
mild/maintenance: Itraconazole
mod-sever: Ampho B
251
dx of disseminated histoplasmosis confirm most rapidly w/?
serum or urine HIstoplasma antigen immunoassay
252
congenital rubella findings?
- sensorineural hearing loss
- intellectual disability
- Cardiac anomalies
- Cataracts, glaucoma
253
kid w/ los grade fever, conjunctivitis, coryza, cervical lymphadenopathy and w/ head to body spreading erythematous blanching maculopapular rash - thnk?
Rubella
254
valgus stress test is testing what ligament in knee?
medial collateral ligament
255
knock kneed is what knee deformity?
valgus
256
bow legged is what knee deformity?
varus
257
varus laxity - what injured ligament?
lateral collateral ligament
258
chronic overuse injury characterized by ant knee pain and tenderness?
pateller tenodonitis (jumper's knee)
259
hard, immobile, non-tender boney growth on hard palate of mouth - think? caused by?
- torus palatinus
| - congenital
260
gastric MALT lymphoma w/ no metastasis initial treatment?
abx to eradicate H. pylori (triple or quadruple therapy)
261
cocaine induce MI, what do you avoid?
Beta blockers (bc can make vasospasms worse)
262
cocaine induced MI, what med may you add?
CCB or alpha blockers (ie phentolamine) to help reduce vasospasms
263
most common cause of sudden cardiac arrest in the immediate post infarction period (w/in 1 hr) in pts w/ acute MI?
Reentrant ventricular arrhythmias (ie v fib)
264
down syndrome pt w/ torticollis, urinary incontinence, dizziness, diplopia, behavioral changes, hyperreflexia, positive babinski,a and ataxia - think?
atlantoaxial instability
265
young down syndrome pt w/ upper motor neuron findings - think?
atlantoaxial instability
266
infant w/ little prenatal care now w/ rhinorrhea, long bone abnlmalities, and diffuse maculopapular desquamating skin rash that can involve the palms and soles- think?
congenital syphilis
267
infant w/ little prenatal care now w/ sensorineural hearing loss, cataracts, and a PDA - think?
rubella
268
infant w/ little prenatal care now w/ periventricular calcifications -- think?
CMV
269
infant w/ little prenatal care now w/ diffuse intracranial calcifications, hydrocephalus, and severe chorioretinitis - think?
toxoplasmosis
270
crescendo decrescendo systolic murmur present at L sternal border that does NOT radiate to carotids - think?
HOCM (intervemtricular septal hypertrophy)
271
mitral regurg has what type of systolic murmu?
holosystolic
272
anterior MI now 5 days later w/ chest pain that progresse to pulseless electrical activity w/ tachy - think?
V wall rupture
273
5 days post MI w/ sudden onset hypotension, CHF symp, and a loud holosystolic murmur at LLSB - think?
Interventricular wall rupture
274
3 days post MI now w/ sudden onset hypotension and a new holosystoli cmumur at apex that radiates and pulm edema - think?
papillary muscle rupture
| ---> MR
275
TCA overdose w/ widening QRS treat w/?
sodium bicarb
276
anaphylaxis, IM or subQ epi injection?
IM! it has higher plasma and tissue levels
277
anal fissure treatment?
- high fiber diet w/ adequate fluid intake
- stool softeners
- sitz bath
- topical anesthetic
- topical vasodilators (ie nifedipine, nitroglycerin)
278
easy PAO2 formula?
PAO2 = 150 - (PaCO2/0.8)
*150 = (0.21 x [760-47]) = (FiO2 x[Patm -Ph20])
279
angina pectoris?
episodes of substernal pain provocked by emotion
280
episodes of substernal pain provoked by emotion?
angina pectoris
281
dipyrdamole and adenosine are coronary what?
coronary vasodilators
282
coronary steal is?
redistribution of coronary blood flow to "non-disease areas" and perfusion of "diseased areas" are diminshed
- can be utilized in myocardial perfusion scanning
283
how does dipyridamole help dx in myocardial perfusion scanning ?
coronary steal
284
post splenectomy pts are at inc risk for sepsis from encapsulated organisms due to?
impaired Ab-mediated opsonization in phagocytosis
285
imaging for psoas abscess?
CT scan
*u/s poor sensitivity due to deep nature and number of other organs and bones covering
Uworld Buzz step2
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