1
Q
TB effusions breakdown?
A
EXUDATIVE
- High protein levels (>4)
- Lymphocytic leukocytosis
- Low glucose levels (500)
- low pH
2
Q
Empyema has high amount of what type of cells in effusion fluid?
A
neutrophils
3
Q
reactive nonstress test (pregnancy)
A
- baseline fetal HR 110-160
- Mod variability (6-25/min)
- > =2 acceleration in 20 min each peaking >-15/min above baseline and lasting >=15 sec
4
Q
HSV encephalitis findings in CSF?
A
- lymphocytic predominance
- WBC elevated, but not severely
- inc protein
- elevated RBC count (high)
- nL glucose
5
Q
Acute bacterial meningitis CSF pattern?
A
- HIGH WBCs (1000s)
- Neutrophil predominence
- low glucose
- elevated protein
6
Q
Chronic bacterial meningitis (ie TB) CSF findings?
A
- inc WBCs (100s)
- Lymphocytic predominence
- Very low glucose
- inc protein
7
Q
neurogenic claudication is?
A
low extremity pain w/ extension of spine (walking, prolonged standing, etc)
8
Q
neurogenic claudication (pseudoclaudication) - think?
A
spinal stenosis
9
Q
pain on walking and prolonged standing w/ relief w/ leaning forward or walking up hill, think?
A
spinal stenosis
10
Q
ACTH is what type of molecule
A
polypeptide
11
Q
Calcitrol is what type of molecule?
A
Sterol vitamin
12
Q
Cortisol is what type of molecule
A
steroid hormone
13
Q
name some arachidonic acid derivatives?
A
- leukotrienes
- prostaglandins
14
Q
AA derived hormone examples?
A
- serotonin
- NE
- Epi
15
Q
amniotomy is aka?
A
artificial rupture of membranes
16
Q
> =2 on CHADVASC w/ afib treat how?
A
oral anticoagulants
17
Q
1 on CHADVASC w/ afib treat how?
A
none, aspirin, or oral anticoagulants – discretionary
18
Q
prophylaxis against MAC for CD4
A
Azithromycin
19
Q
headache worse when leaning forward - think?
A
SVC syndrome
20
Q
facial and upper extremity swelling, JVD, no peripheral edema, headache worse when leaning foward - think?
A
SVC syndrome
21
Q
most common cause of SVC syndrome?
A
malignancy (lung or lymphoma)
22
Q
Primary treatment for malignancy related SVC syndrome?
A
radiation therapy
23
Q
concern for aspiration pna do what?
A
- diet modification
- elevated head of bed
- jejunal feeding can dec aspiration risk, but others (NG tube, PEG actually INC risk of aspiration)
24
Q
greater than 250 neutrophils in ascitic fluid is?
A
Spontaneous bacterial peritonitis
25
subepidermal cleavage is?
bullous pemphigoid
26
intraepidermal clevage is?
pemphigus vulgaris
| +acantholysis
27
neurodermatitis?
skin picking disorder
28
Ab against hemisdesmosomes?
bullous pemphigoid
29
Ab against desmosomes?
--> acantholysis
Pemphigus vulgaris
30
treatment of bullous pemphigoid?
high potency topical glucocorticoids
31
brain mets look like what on MRI?
peripheral, circumscribed, enhancing lesions w/ vasogenic edema surrouding
32
tension pneumothorax cardiovascular effect?
HypOtension due inc intrathoracic pressure --> DEC Venous return
33
evidence of denervation think what type of gen neuro disease?
LMN disease
| m. atrophy, fasciculations
34
hyperreactive reflexes, UMN or LMN?
UMN
35
muscle atrophy, UMN or LMN?
LMN
36
complex seizures involve?
loss of consciousness
37
partial seixure involve
seizure activity w/in focal area of brain
38
Initial treatment for stable monomorphic V tach?
Loading dose of IV Amiodarone
39
adenosine used to treat what cardiac issue?
Supraventricular tachycardia
40
Pt w/ chest pain, hematemesis, SOB, L pleural effusion, post esophageal procedure -- think?
esophageal rupture
41
Associated w/ esophageal rupture (2)?
- pleural effusion (esp L)
| - Pneumomediastinum --> mediastinitis
42
chronic pancreatitis usually due to?
alcoholism
43
simple non invasive test for Peripheral vascular disease?
Ankle brachial Index
1 - 1.3 = nL
0.4 - 0.9 = PVD
44
pts w/ strep gallolyticus endocarditis should also have what done?
Colonoscopy
45
strep gallolyticus infx inc risk for what two things?
- endocarditis
| - colorectal cancer
46
most common organisms that can cause epiglottitis in adults (esp unvax)?
Hib
| Step pyogenes
47
rupture of maternal dcidual vessels -->?
placental abruption
48
vaginal bleeding + hypertonic, distended, tender uterus -- think?
placental abruption
49
substances that inc risk of placental abruption?
cocaine
| tobacco
50
painless vaginal bleeding after ROM - think?
vasa previa
51
painful 3rd trimester bleeding?
- placental abruption
| - uterine rupture
52
painless 3rd trimester bleeding?
- vasa previa
| - placenta previa
53
risky sex --> papule --> painless ulceration w/ painless inguinal denopathy -- think?
syphilis
54
painful ulcer + painful lymphadenopathy - think?
Chancroid (h. ducreyi)
55
painless genital ulcer w/ red, beefy base and NO adenopathy - think?
Granuloma inguinale (Klebsiella caused)
56
differences b/t granuloma inguinale and syphilis caused chancre?
S: adenopathy & ulcer will resolve on own w/o treatment (moving to 2nd stage of syphilis)
GI: NO adenopathy, will NOT resolve w/o abx
57
recurrent sinopulmonary and GI infx beginning after 6mo w/ small tonsils suggests?
X-linked agammaglobulinemia (Bruton's)
58
x-linked aggamaglobulinemia due to? causes?
defect in tyrosine kinase --> prevents dev of mature B cells
--> dec immunoglobulins and B cells (nL T cells) & NO response to vax
59
treatment of x-linked agammaglobulinemia?
monthly IVIG
| +/- prohylactic abx (only if IVIG not protective enough)
60
what vaccines are contraindicated in x-linked agammaglobulinemia?
LIVE vax
can give others, but won't generate meaningul Ab response
61
which bugs associated w/ complement deficiencies?
disseminated bacterial infx particularly w/ ENCAPSULATED bacteria (ie strep pneumo, neisseria)
62
which ingx associated w/ CGD?
recurrent skina nd pulm infx w/ CATALASE-positive org (staph, serratia, etc)
63
adenosine deaminase deficiency effects what cells?
impaires T cell dev --> SCID
64
most common predisposing factor for acute bacterial sinusistis?
Viral upper respiratory infx
65
First line treatment for acute bacterial sinusisits?
Amoxicillin w. clavulanic acid
66
low PCWP, low RA pressure, inc SVR, and low mixed oxygen venous sat -- what type of shock?
Hypovolemic
67
inc RA pressure, inc PCWP, inc SVR, dec mixed venous osxygen sat - what type of shock?
cardiogenic
68
slight dec RA pressure and PCWP, dec SVR, inc mixed venous oxygen sat - what type of shock?
Septic shock
69
nL avg RA pressure?
4mm Hg
70
nl avg PCWP pressure?
9mm Hg
71
RA pressure and PCWP pressure can indicate what overall vascular situation?
preload
72
SVR indicates what greater vascular situation?
afterload
73
most common bacterial infx for kids w/ CF?
staph aureus! (20)
74
First line antiHTN meds in pregnancy?
- Beta blocker (labetalol)
- Methyldopa
- Hydralazine
*Calcium channel blockers (nifedipine) -- other 3 more common
75
contradindicated HTN meds in pregnancy?
- ACE inhibitors
- ARBs
- Aldosterone blockers
- Furosemide
- Direct renin inhibitors (aliskiren)
76
most common septic arthritis organisms birth - 3mo old?
- staph
- GBS
- Gram neg bacilli
77
abx for septic arthritis birth - 3mo old?
- antistaph agent (ie nafcillin or vanco)
AND
- Gentamicin or cefotaxime (cover for gram negs)
78
Most common septic arthritis organisms >3mo?
- staph
- strep A
- Strep pneumo
79
abx for septic arthritis >3mo?
Nafcillin clinda, cefazolin, or vanco
80
gradual loss resulting in tunnel vision think?
open angle glaucoma
81
cupping of optic disc - think?
open angle glaucoma
82
retinal detachment presents how?
unilateral blurred vision that progressively worsens
83
retina hanging in vitreous w/ unilateral blurred vision that has progressively been worsening?
retinal detachment
84
macular degeneration effects where in the vision?
central vision
85
distorted vision and central scotoma - think?
macular degernation
86
multiple sores in macular region w/ central scotoma?
atrophic macular degernation
87
new blood vessels in retina that are bleeding or scarring the retina w/ central scotoma think?
exudative macular degeneration
88
sudden, unilateral visual impairement usually noted upon waking in the morning - think?
Central retinal vein occlusion
89
disc swelling, venous dilation and tortuiosity, retinal hemorrhages, and cotton wool spots - think?
central retinal vein occlusion
90
microaneurysms, hemorrhages, exudates, and retinal or macular edema - think?
simple retinopathy
91
microaneurysms, hemmorrhages, macular edema, w/ cotton wool spots think?
preprolierative retinopathy
92
microaneurysms, hemorrhages, macular edema, exudates w/ newly formed vessels think?
proliferative or malignant retinopathy
93
n/v, abd pain, diffuse muscle aches w/ dilated pupils, yawning, piloerections, and lacrimation - think?
heroin withdrawal
94
inc appetite, hypersomnia, fatigued, irritable, severe depression - think?
stimulant withdrawal
| (ie cocaine, meth)
95
epigastric pain w/ high BMI, ALT >150 and elevated alk phos -- think?
gallstone pancreatitis
96
hydrocele?
fluid collection w/in processus or tunica vaginalis
97
communicating vs non communicating hydrocele?
diff is whethere procesus vaginalis has obliterated or not
comm: PV NOT obliterated (so fluid can communicate w/ peritoneal fluid still - still a track there)
non comm: PV obliterated (canNOT communicate b/c no track, so just a fluid collection)
98
mass transilluminates in scrotum think?
hydrocele
99
treatment of hydrocele in infant?
reassure and observe, most will sponaneously resolve by 1yo
100
communicating hydrocele at 18 mo - treat?
surgical repair
communicating hydroceles that persist beyond 12mo of age are unlike to self resolve and --> inc risk of indirect inguinal hernia
101
1 episode of MDD that responds to acute treatment - how long due you treat for?
continue antidepressent for 4-9 months (continuation phase)
102
When do you choose maintenance phase for depression treatment and how long is it?
Maintenance treatment is 1-3 yrs on stable regimen
For:
- recurrent MDD (multi epi)
- chronic epi (>=2yrs)
- strong fam hx
- severe epi (ie suicide attempt)
103
when do you keep pts on antidepressants indefinitely?
Pt w/ hx of highly reccurent (>= 3 epi)
very severe, chronic maj depressive episodes (last a long time w/ severe symp - ie suicide attempt)
104
diff dx for t wave inversion? (5)
- MI
- Myocarditis
- Old pericarditis
- Myocardial contusion
- Digoxin toxcitiy
105
best treatment for acute low back pain likely due to disk herniation?
early mobilization and NSAIDs
| - get back to daily activities ASAP
106
what type of gait in parkinson's disease?
hypokinetic w. narrow base and stooped posture w/ short steps that cause shuffling
107
waddling gait --?
muscular dystrophy due to weakness of gluteal m.
108
acute COPD exacerbation treat w/?
- O2
- short acting bronchodilators (b2 adrenergic agonist or anticholinergic agent)
- SYSTEMIC steroids
- abx as needed
109
sialadenosis is?
benign, noninflammatory swelling of the salivary glands (non tender)
110
what is sialadenosis associated w/
- advanced liver disease
| - malnutrition (DM, bulemia, etc)
111
submandibular glandular swelling and pain w/ meals - think?
salivary gland stone
112
initial treatment of dermatitis herpetiformis?
Dapsone
113
atrophy of caudate nucleus - think?
huntington's
114
huntington typical finding on CT?
atrophy of caudate nucleus
115
diffuse atrophy of cerebral cortex feature of what disease?
alzheimer's
116
atrophy of lenticular nucleus feature of?
Wilson's disease
117
Atrophy of front and/or temporal lobes is a feature of ?
Pick's disease
118
Alzheimer's finding on CT head?
diffuse atrophy of cerebral cortex
119
bone pain + headache + unilateral hearing loss + femoral bowing - think?
Paget disease of bone
120
paget disease of bone due to?
osteoclast dysfunction --> inc bone breakdown and turnover
121
mosaic pattern of lamellar bone - most common?
Paget disease of bone (osteoclast dysfunction)
122
steatorrhea can --> bone pain, why?
stetorrhea --> malabsorption of vit D --> vid D deficiency --> 2ndary hyperparathyroidism (low Ca, low phos, high PTH) --> osteomalacia
123
urine hydroxyproline is from?
breakdown of collagen
124
what are levels of urine hydroxyproline in paget's disease?
elevated
125
paget disease serum Ca and Phosphate levels are?
NORMAL
126
high alk phos, high urine hydroxyproline, nL Ca and phos - think?
Paget disease of bone
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