Carestandard Set 8

Front 1

systemic sclerosis
anti-smooth mm antibodies

Back 1

anti-topoisomerase-I antibodies & antinuclear
autoimmune hepatitis

Front 2

determine activity level of Paget's ds:

Back 2

total serum alkaline phosphatase activity

Front 3

acts on prostatic epithelium
acts on prostate & bladder sm mm

Back 3

finasteride
alpha-1-blockers

Front 4

displaced femoral neck fracture tx

Back 4

primary arthroplasty

Front 5

senile purpura (ecchymosis) cause

Back 5

perivascular connective tissue atrophy

Front 6

cyanosis in 1st 24 hrs of life, associated with diabetic mothers & males
cyanosis present a few years after birth

Back 6

transposition of the great vessels (MC cyanosis in 1st 24 hrs of life)
ToF

Front 7

Establish dx of ulcerative colitis:

Back 7

Proctosigmoidoscopy & biopsy

Front 8

schizophrenia
schizophreniform disorder
brief psychotic disorder

Back 8

sx for 6 mo or longer
sx for 1 mo but less than 6
sx for 1 day but less than 1 month

Front 9

x-rays are nl in 1st 2 to 3 weeks in osteomyelitis, so use:

Back 9

three phase technetium bone scan

Front 10

tx for accute vasoocclusive crisis in sickle cell ds

Back 10

exchange transfusion
(don't perform surgery on a SS+ person with painful erection !)

Front 11

cytotoxic agent which elevates HbF
used when a pt w/ sickle cell suffers from frequent, disruptive, painful episodes

Back 11

hydroxyurea

Front 12

Manage osteomyelitis:

Back 12

1. blood cultures & IV ABX
2. X-rays
3. 3 phase technetium scan if x-rays are negative. Needle biopsy to ID organism if cultures are negative.

Front 13

1st line for pseudotumor cerebri after weight loss fails
what if medical options fail ?

Back 13

acetazolamide
optic nerve sheath decompression & lumboperitoneal shunting

Front 14

Describe renal compensation for respiratory alkalosis (low PaCO2)

Back 14

kidneys retain protons (H+)
kidneys excrete bicarbonate (HCO3-)
increased urinary HCO3- alkalinizes the urine.

Front 15

why does asthma cx pulsus paradoxus ?

Back 15

high negative intrathoracic pressures on inspiration increase RV venous return which bends the septum & decreases LV filling, which in turn decreases systolic pressure. Maybe that's why I have so much trouble recovering between supersets when I'm not using my inhaler ?

Front 16

inhibits NE and dopamine reuptake
blocks serotonin reuptake at presynaptic nerve terminal

Back 16

bupropion - no sexual dsyfunction
sertraline

Front 17

ER pt s/p fall or MVA - 1st test after initial resuscitation ?

Back 17

X-ray of the spine (5-10% have C-spine injury)
1/3 at C2
1/2 at C6 or C7
most fatal injuries at craniocervical junction, C1 or C2

Front 18

benign bony mass (exostosis) on hard palate of unk etiology requiring only reassurance

Back 18

torus palatinus

Front 19

isolated axillary hair growth before 6:
premature pubarche (pubic hair before 8):

Back 19

premature adrenarche (androgens from adrenals - no clinical significance)
associated in 50% of cases w/ CNS disorder
NOTE: the reticularis develops at 6-8 years of age thus starting adrenarche

Front 20

premature adrenarche (axillary hair) & thelarche (breasts)
premature pubarche (pubic hair b4 8)

Back 20

- no clinical significance
- requires workup - CNS disorder 50% of the time

Front 21

first feeding choking, always think:

Back 21

esophageal atresia

Front 22

large thymic shadow on chest radiograph of children < 2

Back 22

sail sign
"normal cardiothymic silhouette"

Front 23

SLE & autoimmune hepatitis
PBC

Back 23

antinuclear antibodies
antimitochondrial antibodies

Front 24

poor language development and social isolation:
repetitive behaviors think:

Back 24

hearing impairment (not ADHD)
autism

Front 25

Wisconsin, ulcerated skin lesions, lytic bone lesions in a non-immunocompromised male

Back 25

blastomycosis - visualize a rocket "blasting" off from Oshkosh then broadly budding as it ascends.

Front 26

vertical infection rate of Hep C in pregnancy ?
ok for mom with Hep C to nurse ?
Hep A & B vaccines ok in pregnancy ?

Back 26

2-5 % C-section is not indicated
yes
yes

Front 27

interferon-alpha and ribavirin for Hep C ok in pregnancy ?
Hep C sexual transmission rate ?

Back 27

No. Ribavirin is highly teratogenic.
< .1% annually - barrier protection has not even been recommended

Front 28

low MVO2 due to increased O2 extraction by hypoperfused tissue
normal MVO2
(MVO2 is "mixed venous oxygen")

Back 28

neurogenic & hypovolemic shock
septic shock - results from hyperdynamic circulation and improper distribution of cardiac output - is not indicative of normal tissue perfusion in this case

Front 29

autoantibodies against voltage-gated Ca2+ channels in presynaptic motor nerve terminal.

Back 29

Eaton-Lambert syndrome
small cell CA
- loss of DTRs
- mm strength increases with repitition (remember, Lambert would get stronger if he exercised)
- severe weakness in proximal mms
- tx: plasmapheresis & immunosuppressives

Front 30

antagonizes muscarinic acetylcholine receptors, suppressing parasympathetic input to the heart

Back 30

atropine

Front 31

measure serum amylase & lipase before CT in:

Back 31

acute pacreatitis

Front 32

paradoxical splitting of S2

Back 32

occurs in pts w/ LBBB due to delayed Ao valve closure

Front 33

systolic murmur that increases on inspiration

Back 33

tricuspid regurgitation
- suspect SBE (subacute bacterial endocarditis)

Front 34

major cause of chronic diarrhea in HIV-infected pts with CD4 < 180

Back 34

cryptosporidium parvum
"parvus" means small
so as a linguistic note: pulsus parvus et tardus means "pulse weak and late"

Front 35

GVHD (2 wks after bone marrow transplant)

Back 35

activation of donor T lymphocytes

Front 36

multiple ring-enhancing lesions on CT in an AIDS pt
- tx ?

Back 36

- toxoplasmosis
- sulfadiazine and pyrimethamine
- TMP-SMX is for prophylaxis

Front 37

panic disorder associated with: (DAGS)

Back 37

depression - test answer
agoraphobia
generalized anxiety
substance abuse

Front 38

used to examine the small bowel

Back 38

capsule endoscopy
- after negative upper & lower endoscopy

Front 39

monotherapy for complicated (ruptured) appendix:
alternate bitherapy:
organisms involved:

Back 39

cefotetan - test answer
fluoroquinolone + metronidazole
Gram-negatives + anaerobes

Front 40

effective against G+, but do not cover G- or anaerobes

Back 40

erythromycin & vancomycin

Front 41

Suggests systemic inflammation and is consistent with SLE:

Back 41

elevated ESR

Front 42

pathogenesis of OA

Back 42

cartilage degredation

Front 43

C. diff tx ?
C. diff cytotoxin (detected by assay) is toxic to:
Untreated mortality rate ?

Back 43

metronidazole - or -
oral vanc (expensive, assoc w/ VRE)
intestinal epitheliocytes
20%

Front 44

MC gastroenteritis between 6 mo & 2 yr ?
- expect 20 non-bloody, non-mucoid diarrhea episodes in 20 hrs

Back 44

rotavirus

Front 45

associated with inussusception:

Back 45

FDA-withdrawn tetravalent rotavirus vaccine
- pentavalent and monvalent in use now

Front 46

MC traveler's diarrhea bug:
MC cause of adult diarrhea in the US:
2nd MC cause of adult diarrhea in the US:

Back 46

E. Coli
Campylobacter jejuni (remember G.B. association !)
Shigella (bloody)

Front 47

Formed from Heinz bodies when phagocytes extract denature hemoglobin:

Back 47

bite cells

Front 48

assoc w/ traumatic hemolytic conditions like DIC, HUS & TTP.

Back 48

helmet cells
schistocytes

Front 49

seen in thalassemias & lead poisoning

Back 49

basophilic stippling
- blue granules of ribosomal precipitates in the cytoplasm of RBCs

Front 50

pathophysiologic cause of WAS

Back 50

impaired platelet production

Front 51

Describe ETOH-induced cardiomyopathy.

Back 51

dilated

Front 52

progressive proximal mm weakness
normal reflexes despite mm wasting
tachycardia
tremor
wt loss

Back 52

hyperthyroid myopathy

Front 53

resting tremor & bradykinesia
choreiform movements
ataxia & dysmetria

Back 53

Parkinson's disease
Huntingtons' disease
cerebellar disease

Front 54

muscle weakness that worsens with activity

Back 54

Myasthenia gravis

Front 55

DVT vs Cellulitis

Back 55

DVT temp does not exceed 38.5C (101.3 F) and there is no inguinal lymphadenopathy

Front 56

leukocytosis
anemia
increase segmented neutrophils & bands

Back 56

CML
- decreased LAP (CML "can't make LAP")

Front 57

AST: ALT > 2

Back 57

alcoholic liver disease
- absolute values of AST & ALT always less than 500 IU / L

Front 58

the 3 antiphospholipid Abs

Back 58

1st - causes false positive syphilis
2nd - lupus anticoagulant (falsely elevated APTT) - give heparin and aspirin to a pregnant mom w/ hx of 2nd trimester abortions & incr APTT
3rd - anticardiolipin

Front 59

wide QRS
bizarre morphology
compensatory pause
tx if asymptomatic ?
tx if symptomatic ?
what is second line tx ?

Back 59

PVCs - an intermittent arrythmia
- observation if asymptomatic
- B-blockers if symptomatic
- Amiodarone is second line for symptomatic PVCs

Front 60

motor impairment without any higher cortical dysfunction and no visual field abnormalities

Back 60

posterior limb of internal capsule
- lacunar infarct

Front 61

vestibulobasilar system lesion (midbrain &amp; pons) - these are also referred to as the brainstem)
think "MPCHIC"

Back 61

'alternate' syndromes with Contralateral Hemiplegia and Ipsilateral Cranial nerve involvement

Front 62

motility disorder workup

Back 62

1. barium swallow
2. esophagoscopy
3. esophageal manometry

Front 63

Indications for TMP-SMX + Steroids in HIV PCP

Back 63

PaO2 < 70 or A-a gradient > 35 mm Hg

Front 64

systolic murmur increasing on inspiration

Back 64

tricuspid regurg (expect SBE + emboli)

Front 65

S4 in left lateral decubitus position

Back 65

hypertensive cardiomyopathy
- nl finding in children & young adults

Front 66

diastolic murmur best heard with pt sitting up

Back 66

Ao regurg

Front 67

systolic murmur increasing when pt stands up

Back 67

HOCM
- hypertrophic obstructive cardiomyopathy

Front 68

paradoxical S2 splitting

Back 68

LBBB causing delayed closure of Ao valve

Front 69

pathognomonic favoring Crohn's vs UC

Back 69

Non-caseating granulomas

Front 70

pseudomonas tx

Back 70

piperacillin-tazobactam or
cefepime (4th gen ceph)

Front 71

fever
chills
flank pain
DIC, ARF, shock

Back 71

ABO mismatching

Front 72

IgA deficiency

Back 72

anaphylactic rxn to blood products

Front 73

Anamnestic Ab response to a minor RBC antigen
(def: anamnestic response - renewed rapid production of an AB on the second (or subsequent) encounter with the same Ag)

Back 73

delayed (2-10) day hemolytic transfusion rxn

Front 74

skin condition observed in Parkinsonism and HIV

Back 74

seborrheic dermatitis

Front 75

10 yo w/ vesicoureteral reflex and IVP showing bilateral focal parenchymal scarring and blunted calyces.

Back 75

chronic pyelonephritis

Front 76

decribe hydronephrosis on IVP

Back 76

dilation of the collecting duct system including the calyces, pelvis & ureter depending on the level of obstruction

Front 77

high-pitched, blowing, early diastolic, descrescendo murmur, heard best in the 3LICS intensified by handgrip.
Pt presents with worsening dyspnea on exercise.
Tx:
Pulse pressure finding ?
CXR finding ?

Back 77

Ao regurgitiation.
Nifedipine
Pulse pressure is widened (ex. 140/56) !
CXR: prominent cardiomegaly

Front 78

How do B-blockers worsen AR ?

Back 78

They extend time in diastole, which is when regurgitation takes place.

Front 79

MC endophthalmitis ?

Back 79

postoperative
- usu occurs w/in 6 wks

Front 80

untreated hyperthyroidism leads to:

Back 80

rapid bone loss

Front 81

proptosis only occurs in:
it does not occur in:

Back 81

Graves ds
Hyperthyroidism due to toxic adenoma

Front 82

Sequelae of mitral stenosis
- sweet !!

Back 82

middiastolic murmur & opening snap
left atrial hypertrophy on EKG
eventual RV hypertrophy leading to:
RV heave secondary to pulmonary htn

Front 83

concentric hypertrophy
(Thickening of the walls of the heart or any cavity with apparent diminution of the capacity of the cavity.)

Back 83

chronic pressure overload
(valvular Ao stenosis or chronic htn)

Front 84

eccentric hypertrophy
(thickening of the wall of the heart or other cavity, with dilation)

Back 84

chronic volume overload
(valvular regurgitation)

Front 85

Inhibits neutrophil activity and is used to tx flares of gouty arthritis

Back 85

colchicine

Front 86

presents with pain, not weakness.
treated with TCAs

Back 86

fibromyalgia

Front 87

anticholinesterase used to tx myasthenia gravis

Back 87

pyridostigmine

Front 88

incr ESR & CK
weakness
treated with high dose corticosteroids

Back 88

dermatomyositis, polymyositis

Front 89

used for Croup, not severe asthma:
what to do for a child with asthma not responding to IV steroids & nebulizer ?

Back 89

racemic epihephrine
intubate

Front 90

tx for Addison's ds ?

Back 90

hydrocortisone

Front 91

Cyclobenzaprine or TCAs for:

Back 91

fibromyalgia (pain, not weakness)
- increase stage 4 sleep

Front 92

No thrombolytics for DVT ! TX?

Back 92

heparin then warfarin to INR 2.0

Front 93

Asbestosis is not CA ! MC CA in pt with asbestosis ?

Back 93

bronchogenic CA

Front 94

dyspnea
tachypnea (ex. 26 / min)
low O2 sat (ex. 87 %)
S3
DX:
TX:

Back 94

left ventricular failure
IV diuretics
Remember "ken-tuc-KY"
KY is S3

Front 95

Cause of S3 ?

Back 95

LA inflow stikes blood already in ventricle. Occurs in LV failure.
Nl in young and athletes

Front 96

exposure to virus via resp. droplets
prodrome after 10 days (coryza, conjunctivitis, cough - 3 Cs !)
Koplik spots after 2-3 days
rash after 24 hrs - 1st face then trunk & extemities

Back 96

Measles (Paramyxovirus)

Front 97

illness starts w/ fever
after 4-5 days maculopapular trunk rash spreads peripherally

Back 97

Roseola infantum (HHV6)

Front 98

erythematous maculopapular rash w/ generalized lymphadenopathy
slight fever, polyarthritis (joint inflammation), polyarthralgia (joint pain)

Back 98

Rubella - 3rd ds

Front 99

prodrome of fever, malaise, anorexia
rash initially on trunk spreads peripherally
rash becomes vesicles, then scabs

Back 99

VZV (Chicken Pox)

Front 100

erythema of cheeks
rash appears on arms then spreads to trunk & legs

Back 100

parvovirus (erythema infectiousum)

Front 101

MC cause rhabdomyolysis ?
UA finding ?
Dipstick finding ?

Back 101

alcoholism
Cr disproportionately elevated relative to BUN
Hematuria, but microscopic analysis does not reveal RBCs.

Front 102

How does rhabdomyolysis cause ATN ?

Back 102

hemoglobin or myoglobin are endogenous nephrotoxic substances

Front 103

US shows active urinary sediment with RBC cell clumps and RBC casts.
Hypertension & oliguria observed.

Back 103

Post-infectious glomerulonephritis

Front 104

RCC

Back 104

dull flank pain, hematuria, fever
UA dipstick and microscopic examination will reveal hematuria.

Front 105

serum ascites albumin gradient (SAAG)

Back 105

serum albumin - ascites albumin
difference > 1.1 is 95% accurate in diagnosing a transudative process consistent with portal htn.

Front 106

decreased serum albumin
increased INR
- would not cause SAAG of 1.1 or greater

Back 106

liver failure

Front 107

exudative ascites cause

Back 107

increased capillary permeability
inconsistent w/ SAAG = 1.3

Front 108

increased GFR decreases:

Back 108

serum Cr

Front 109

does primary hyperaldosteronism cause edema ?
Why not ?

Back 109

No.
Spontaneous diuresis (aldosterone escape phenomena)

Front 110

distinguishes between portal htn & other causes of ascities

Back 110

SAAG

Front 111

Most important risk factor for breast CA ?
% of women diagnosed w/ breast CA who have a positive family hx ?
BRCA risk ?

Back 111

Age
10%
BRCA is in 5-10% of women & confers a 50% increased risk of br ca.

Front 112

Risk factor for 1st degree relatives of br ca pts (esp if ca was dx premenopausally and was bilateral)

Back 112

3X

Front 113

precipitating factors for acute angle closure glaucoma
if untreated ?

Back 113

antihcholinergic medication
sympathomimetic medication
dim light
permanent vision loss 2-5 hr after sx onset

Front 114

ESR usu > 50 mm / hr

Back 114

temporal (giant cell) arteritis