Step 2 Ck/dit

Front 1

Spinal tract that governs voluntary motor command from motor cortex to head/neck

Back 1

corticobulbar

Front 2

What does an FEV1/FVC ratio < 80% imply?

Back 2

obstructive lung pathology

Front 3

What are the criteria for diagnosis of major depressive episode? 5 of these. 2 weeks.

Back 3

Sleep disturbance
Interest loss
Guilt, feelings of worthlessness

Energy loss

Concentration loss
Appetite/weight change
Psychomotor retardation or agitation
Suicidal ideations
Depressed mood

Front 4

Spinal tract important for postural adjustments and head movements

Back 4

vstibulospinal

Front 5

What does an FEV1/FVC ratio normal or > 80% imply?

Back 5

restrictive lung pathology

Front 6

What are the criteria for diagnosis of mania? 3 of these. 1 week.

Back 6

Distractability
Irresponsibility -- seeks pleasure w/o regard to consequences
Grandiosity

Flightof ideas
Activity
Sleep need decrease
Talkatuce ness

Front 7

Contralateral hemiballismus

Back 7

subthalamic nuclei

Front 8

What is a normal A-a gradient?

Back 8

5-15 mmHg

Front 9

What is major depressive disorder?

Back 9

recurrent -- requires 2 or more major depressive episode with a symptom free interval of 2 months.

Front 10

eyes look toward side of the lesion

Back 10

frontal eye fields

Front 11

What does is mean for a pathology to present with an increased A-a gradient? Examples?

Back 11

Hard time getting O2 to arteries

Increased gradient seen in PE, pulmonary edema, R-->L vascular shunts

Front 12

What is the sleep pattern of depressed patients?

Back 12

decreased slow-wave sleep
decreased REM latency (fall into REM faster)
increased REM early in sleep cycle
increased total REM sleep
repeated nighttime awakenings
early-morning awakening (important screen question)

Front 13

eyes look away from side of lesion

Back 13

PPRF

Front 14

How to manage viral influenza?

Back 14

treat symptoms; fluid intake.

self-limited, but zanamivir and oseltamirvir can be used to shorten course before 48 hours of onset.

Front 15

When do post partum blues tend to clear?

Back 15

2 weeks

post partum depression is basically major depressive disorder (can go on for a long period of time)

Front 16

paralysis of upward gaze

Back 16

superior colliculi (parinaud)

Front 17

Pain over face
Purulent nasal discharge
Maxillary toothache pain

Causes?

Back 17

Sinusitis -- pneumococcus, heam, morax, viral

Front 18

What are the risk factors for suicide completion?

Back 18

Sex (male)
Age (teen or elder)
Depression

Previous attempt
Ethanol or drug use
Rational thinking loss
Sickness (medical illness)
Organized plan
No spouse
Social support lacking

Front 19

hemispatial neglect syndrome

Back 19

nondominant parietal lobe (usually right)

Front 20

What are the diagnostic feathres of acute bacterial sinusitis that distinguish it from the common cold?

Back 20

Lasts more than 7 days and presents with nasal discharge, maxillary tooth or facial pain.

Front 21

What is serotonin syndrome?

Back 21

hyperthermia
muscle ridgitiy
CV collapse
flushing
diarrhea
seizures

Front 22

coma

Back 22

reticular activating system

Front 23

What is the treatment for acute bacterial sinusitis?

Back 23

Observation, symptoms relief, Abx (amoxicillin, augmentin, ceph)

Front 24

What are the drugs a/w serotonin syndrome?

Back 24

with any drugs that increase serotonin

SSRIs, SNRIs, MAOi
St. John's wort, kava kava
Sibutramine
Tryptophan
Cocaine, amphetamines

Front 25

poor repetition (repeating a heard sentence)

Back 25

Arcuate fasciculus

Front 26

What is the treatment for chronic bacterial sinusitis? (>3 mo of symptoms)

Back 26

Oral steroids
Oral ABx
Intranasal saline irrigation
Intranasal steroids

Front 27

How to treat serotonin syndrome?

Back 27

take med away
cooling, benzos
cyproheptadine if severe

Front 28

poor comprehension

Back 28

wenicke's

Front 29

Complications of sinusitis?

Back 29

Meningitis
Abscess
Orbital cellulitis
Ostomyelitis

Front 30

What are SNRIs for?

Back 30

depression, but

1. venlafaxine is also used in generalized anxiety disorder

2. duloxentine also indicated for diabetic peripheral neuropathy

Front 31

poor vocal expression

Back 31

Broca's

Front 32

What is the tox of MAOi?

Back 32

hypertensive crisis with tyramine inghestion (in many foods, esp aged foods) and b-agonists

tyramine stimulates NE release; MAO inhbited will lead to no degradation

Front 33

Common causes of acute bronchitis?

Back 33

nonsmokers -- mycoplasma

smokers -- pneumococcus, haemophilus

Front 34

resting tremor

Back 34

basal ganglia

Front 35

How does maprotiline work?

Back 35

blocks NE reuptake

atypical antidepression -- sedation, orthostatic hypotension

Front 36

Which class of antihypertensives are contraindicated in advanced renal failure?

Back 36

K sparking diuretic
ACEi with hyperkalemia

Front 37

intention tremor

Back 37

cerebellar hemispherer

Front 38

What is the mech for mirtazapine?

Back 38

a2-antagonist (increases releease NE and serotonin) and potent 5-HT receptor antagonist

tox: sedation, increased appetitde, weight gain, dry mouth

Front 39

Which class of antiHTN are c/i in gout?

Back 39

thiazide
loop diuretics

Front 40

hyperorality, hypersexuality, disinhibited behavior

Back 40

amygdala

Front 41

Causes of penumonia in 1-4 mo old? Treatment?

Back 41

RSV
Chlamydia trachomatis
Parainfluenze
Bordetella
Pneumococcis
S.areus

MACROLIDES +/i cefotamine

Front 42

What is the mech for trazadone?

Back 42

primarily inhib serotonin reuptake

used for insomnia -- increases REM sleep, as high doses are needed for antidepressant effects

tox: sedation, nausea, pripism, postrual hypotension

Front 43

personality changes

Back 43

frontal lobe

Front 44

Causes of pneumonia in 4m - 4y? Treatment?

Back 44

RSV/viral, pneumococcus, H.influ, mycoplasma, s.aureus

amoxillicin/augmentin

Front 45

Difference b/w acute stress disorder and PTSD?

Back 45

acute stress -- 2 months and 1 month

PTSD -- longer than a month

Front 46

dysarthria

Back 46

cerebellar vermis

Front 47

Causes of pneumonia in 5y - 15y? Treatment?

Back 47

Pneumococcus
Mycoplasma
C.pneumonia
Viral

1. augmentin
2. azithromycin
3. amoxicillin + doxycyline

Front 48

How is buspirone used? Mech?

Back 48

Stimulates 5=HT receptor

does not cause sedation, addiction, or tolerance.

Takes a week to work

Front 49

agraphia & alcalculia (inability to write and to do math)

Back 49

dominant parietal lobe (usually left)

Front 50

gram + cocci in clusters

Back 50

staph aureus

Front 51

Differentiate timeframe with generalized anxiety disorder, adjustment disorder?

Back 51

general -- (nonspecific) for at least 6 months

adjustment -- (specific) for < 6 months; < 6 months in presence of chronic stressor

Front 52

Lesion/disease that causes fasciculations and spastic paralysis (aka flaccid and spastic paralysis)

Back 52

ALS, affecting ventral horn and corticospinal tract

Front 53

gram cocci + in pairs

Back 53

pneumococcus

Front 54

What are SNRIs for?

Back 54

depression, but

1. venlafaxine is also used in generalized anxiety disorder

2. duloxentine also indicated for diabetic peripheral neuropathy

Front 55

Lesion/disease that causes impaired proprioception AND pupils do not react to light

Back 55

syphillis

Front 56

gram - rods

Back 56

e.coli

Front 57

What is the tox of MAOi?

Back 57

hypertensive crisis with tyramine inghestion (in many foods, esp aged foods) and b-agonists

tyramine stimulates NE release; MAO inhbited will lead to no degradation

Front 58

bilat loss of pain and temp below lesion and hand weakness

Back 58

syringomyelia

Front 59

gram + cocci in neonate (not in clusters)

Back 59

GBS

Front 60

How does maprotiline work?

Back 60

blocks NE reuptake

atypical antidepression -- sedation, orthostatic hypotension

Front 61

bilat loss of vibration sense and spastic paralysis of legs THEN arms

Back 61

B12

Front 62

Causes of symmetrical IUGR?

Back 62

early in utero insults:

chromosomal
TORCH
teratogens
toxins

Front 63

What is the mech for mirtazapine?

Back 63

a2-antagonist (increases releease NE and serotonin) and potent 5-HT receptor antagonist

tox: sedation, increased appetitde, weight gain, dry mouth

Front 64

bilat loss of pain/temp below lesion + bilat spastic paralysis below lesion + bilat flaccid paralysis at the level of lesion

Back 64

anterior spinal artery syndrome

Front 65

Causes of asymmetrical IUGR?

Back 65

later in utero (head spared):

malnutrition
smoking
(utero-placental insuffiency; secondary to maternal disease)

HTN
autoimmune dz
abruption
TTTTS
(placental dysfunction)

Front 66

What is the mech for trazadone?

Back 66

primarily inhib serotonin reuptake

used for insomnia -- increases REM sleep, as high doses are needed for antidepressant effects

tox: sedation, nausea, pripism, postrual hypotension

Front 67

ipsilateral loss of vibration and discrimination (below lesion), isilateral spastic paralysis (level of lesion), contralateral loss of pain and temp (below lesion)

Back 67

Brown Sequard (all tracts on one side of the cord affected)

Front 68

What lab findings would greatly suggest PCP as the cause for pneumonia?

Back 68

CD4 < 200

LDH > 220

Front 69

Differentiate timeframe with generalized anxiety disorder, adjustment disorder?

Back 69

general -- (nonspecific) for at least 6 months

adjustment -- (specific) for < 6 months; < 6 months in presence of chronic stressor

Front 70

1. facial paralysis (facial nucleus)
2. deafness/tinittus (V/C nuclei)
3. nystagmus/vertigo
4. absence of loss of motor and light touch

Back 70

AICA infarction

Front 71

How is the diagnosis of active TB made?

Back 71

- sputum acid-fast
- sputum culture
- bronchoscopy with bronchoalveolar lavage

Front 72

How to treat opiod intox?

Back 72

1. buprenorphine -- opioid partial agonist; sublingual; 1-3 half life; use in combo with naloxone, naltrexone (also used for relapse prevention of alcohol)
2. clonidine -- pallative; α2 adrenergic agonist and a guanidine receptor agonist

Front 73

What are the signs of opioid withdrawal?

Back 73

sweating, dilated pupils, piloerection, fever, rhinorrhea, nausea, stomach cramps

lasts 7-10 days

Front 74

1. spinothalamic -- contralateral loss

2. trigeminothalamic -- ipsilateral face

3. nucleus ambiguus -- hoarseness, dysphagia, loss of gag reflex

4. vestibular: vertigo, nystagmus, nausea/vomiting

5. inferior cerebral peduncle: ipsilateral cerebellar defect (ataxia, past pointing)

Back 74

PICA infarction

Front 75

Common causative agent for pneumonia in alcoholics/patients with other health problems

Back 75

Klebsiella, though pneumococcus is MORE common (but not relatively)

Front 76

What are the signs of barbituate intox? How to treat?

Back 76

marked resp depression

symptom management

Front 77

What supplies the lateral surfaces and temporal lobes?

Back 77

MCA

-- motor + sensory of face, arms, hands

-- Broca's, Wernicke's

Front 78

Q fever

Back 78

coxiella

Front 79

What are the signs of barbituate withdrawal?

Back 79

delirium, life-threatening CV collapse, tremors, hallucinations, anxiety, fever, insomnia, grand mal seizures (treat with benzos) due to decreased GABA

Front 80

What supplies the inferior surfaces and occipital lobes?

Back 80

PCA

-- motor and sensory of legs, feet

Front 81

Common bacterial cause of COPD exercerbation

Back 81

Haemophilus

Front 82

What are the signs of benzo intoxication? How to treat?

Back 82

ataxia, minor respi depression.

Treatment -- flumazenil (competative GABA antagonist)

Front 83

Cranial nerve -- eye opening

Back 83

oculomotor

Front 84

Atypical pneumonia + slow onset of nausea, diarrhea, confusion, or ataxia

Back 84

Legionella

Front 85

What are the nonspecific signs of stimulant intoxication and withdrawal?

Back 85

1. intox -- mood elevation, pyschomotor agitation, insomnia, cardiac arrhythmias, tachycardia, anxiety

2. with -- post-use crash, including depression, lethargy, weight gain, headache

Front 86

cranial nerve -- taste from anterior 2/3 of tongue

Back 86

facial

Front 87

Atypical pneumonia common in very and elderly, frequent sinusitis.

Back 87

chladymia pneumonia

Front 88

What are the signs of amphetamie intox? Withdrawal?

Back 88

releases DA

intox -- impaired judgement, pupillary dilation, prolonged wakefulness and attention, delusions, hallucinations, fever, nightmares

with -- stomach cramps, hunder, hypersomnolence

Front 89

cranial nerve -- muscles of mastication

Back 89

trigeminal

Front 90

How to treat fungal pneumonia?

Back 90

Histoplasmosis, Blasto -- itraconazole

Coccidio -- Fluconazole

Front 91

What are the signs of cocaine intox? withdrawal? How to treat intox?

Back 91

prevents reuptake of DA

intox -- impaired judgment, pupillary dilation, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death; treat with benzos, antipsychotics

with -- suicidality, hypersomnolence, malaise, severe psychological craving

Front 92

Mechanical ventilation settings to manage ARDS

Back 92

PEEP
increased inspiratory times
FiO2 adjusted to maintain O2 > 90%
low TV

Front 93

cranial nerve -- monitoring carotis body and carotid sinus chemoreceptors and baroreceptors

Back 93

IX glossopharyngeal

Front 94

What are the signs of nicotine withdrawal? What are smokers more susceptible to? Why?

Back 94

2x more likely to develop depression -- agonist @ ACh receptors, activates NAC pathway, speeds and intensifies flow of glutamate

with -- depression, insomnia, anxiety, craving

Front 95

Mild intermittent asthma. Tx?

Back 95

< 2 daytime/wk
< 2 night/mo

albuterol (b2-adrenergic receptors)

Front 96

Empiric ABx for meningitis in < 1 mo

Back 96

amp + gent

Front 97

What are palllitive treatments for smokers?

Back 97

1. buprupion -- antidepressant for smokers with underlying depression

2. varenicline -- binds to Nic receptor, taking away from the pleasurable effects of nicotine

3. bromocriptine -- makes quitting easier

Front 98

Mild persistent asthma. Tx?

Back 98

3-6 day/wk
3-4 night/mo

albuterol + low dose inhaled steroid

Front 99

Empiric ABx for meningitis in 1 mo - 60 yr

Back 99

Ceftriaxone
Vancomycin
Dexamethasone (if over 6 wk)

Front 100

What treatment can be used to control a PCP patient?

Back 100

haliperidol

Front 101

Moderate persistent asthma. Tx?

Back 101

daily daytime eps
> 1 night ep/wk

albuterol + mod dose inhaled steroid
(+ long acting b-agonst)

Front 102

Empiric ABx for meningitis in > 60 yr

Back 102

Ampicillin
Ceftriaxone
Vancomycin
Dexamethasone

Front 103

What are heroin users more at risk for?

Back 103

hepatitis, abscesses, overdose, hemorrhoids, AIDS, and right-sided endocarditis

Front 104

Severe persistent asthma. Tx?

Back 104

continual day
frequent night

albuterol + high dose inhaled steroids + long-acting b2 agonist + PO steroid

Front 105

What is the rational for dosing dexamethasone prior to or along with the first dose of ABx for empiric treatment of bacterial meningitis?

Back 105

1. reduces neurologic sequelae (hearing loss) in children with meningitis, especially in cases of haemophilus or TB

2. in adults with bacterial meningitis, dexamethasone reduces both morbidity and mortality esp in pneumococcus

Front 106

Besides methodone, what other methods exists to treat heroin addication?

Back 106

suboxone -- naloxone + buprenorphine (partial agonist); long acting with fewer withdrawal symptoms than methadone. Naloxone is not active when taken orally so withdrawal symptoms occur only if injected

Front 107

How to differentiate via labs emphysema and chronic bronchitis?

Back 107

DLco is normal in chronic bronchitis but is decreased in emphysema

Front 108

What organism in meningitis?

- small, pleomorphis gram neg coccobacilli

Back 108

haemophilus

Front 109

How does disulfram work?

Back 109

nausea, chest pain, hyperventilation, tachycardia, vomiting b/c of accumulation of acetylaldehyde -- to condition an alcoholic to cease desire to drink

Front 110

Complications of COPD

Back 110

chronic respiratory decompensation, cor pulmonale, frequent respiratory infections, frequent comorbid lung cancer

Front 111

What organism in meningitis?

- gram positive diplococci

Back 111

pneumococcus

Front 112

How does acamprosate aid in treatment for alcholism?

Back 112

helps prevent relapse, lowers activity of receptors for glutamate (chronic alcohol abuse leads to increase in number of these receptors)

Front 113

Possible etiologies for bronchiectasis?

Back 113

50% unknown
CF
immunodeficiency
dyskinetic cilia: Kartagener (dextrocardia, sinusitis, bronchiectasis), ADPKD
pulmonary infxn (TB, fungal, lung abscess)
Other: FBA, RA, Sjorgen, allergic bronchopulmonary aspergillosis, smoking

Front 114

What organism in meningitis?

- gram pos rods and coccobacilli

Back 114

listeria

Front 115

How does topiramate aid in treatment for alcholism?

Back 115

helps support abstinence; stimulates GABA --> blocks action of glutamate --> slows release of DA on NAC pathway

Front 116

Prophylaxis for close contacts of meningitis?

Back 116

rifampin or ciprofloxacin

Front 117

What heart defect is a/w chromosome 22q11 deletion

Back 117

truncus arterosis/TOF

Front 118

How does benzos aid in treatment for alcholism?

Back 118

helps prevent seizures

Front 119

When should a CT scan be performed as a next step instead of an LP in a patient suspected to have meningitis?

Back 119

1. sign of focal neurologic defect, seizure

2. papilledema

3. pupil asymmetry

4. soft tissue infection

5. bleeding diathesis

6. cardiopulmonary instability

Front 120

What heart defect is a/w congentinal rubella?

Back 120

PDA, pulmonary artery stenosis

Front 121

How does naltrexone aid in treatment for alcholism?

Back 121

given to recovering alcoholics; reduces craving. drinks don't taste as good

on it, relapse = 50%
without, relapse = 95%

Front 122

What is the treatment for viral meningitis?

Back 122

1. acetaminophen for pain

2. IV fluids as pain

3. empiric antibiotics bacterial can be excluded, unless < 3 yrs, severely, or immunocomprised, continue ABx until bacterial culture confirm nonbacterial

4.

Front 123

What heart defect is a/w Marfan?

Back 123

aortic insufficiency
MVP

Front 124

How does flumaeznil aid in treatment for alcholism?

Back 124

benzos receptor antagonist, can help prevent relapse

Front 125

What are the most common sequlae of meningitis in children?

Back 125

1. long term seizure

2. hearing loss

3. mental retardation

4. spastic paralysis

Front 126

Characteristics favoring benign lesion in a solitary pulmonary nodule? What is the next best step?

Back 126

< 35 years old

no change from prior films

central, uniform lesion with smooth margins on CT

< 2 cm

no evidence of lymphadenopathy

--> follow with CXR in 3-6 mo

Front 127

What are the CNS stimulates? How do they work? What are they used for?

Back 127

methylphenidate, ampheatmine

increases catecholamines at the synaptic cleft, especially NE and dopamine

use for ADHD, narcolespy, apetite control

Front 128

You suspect an AIDS patient may have meningitis. What specific CSF preparation should be ordered in addition to usual CSF analysis, graim culture, culture?

Back 128

india ink for cryptococcus

Front 129

Characteristics favoring cancerous lesion in a solitary pulmonary nodule? What is the next best step?

Back 129

smoker

> 45 years old

new or progression lesion

no calcifications or irregular calcificatiosn on CT

> 2 cm

irregular margins

--> FDG-PET, biopsy, or immediate resection depending on clinical likelihood of malignangy

Front 130

What are the antipsychotics? What are the mechanisms?

Back 130

Haloperidol (first line for acute aggresion)
--azine

all typical antipsychotics block dopamine D2 receptor (increased cAMP)

Front 131

Headache
Malasise
Back pain
myalgia
Anorexia for 3-6 ("flu-like" illness)

severe sx 1/150: meningitis +/- encephalitis including muscle weakness and flaccid paralysis (via anterior-horn involvement), alteration in consciousness, possibly death

Diagnose?

Back 131

Dx: serology IgM antibodies
Tx: Supportive

West Nile Virus

Front 132

Lung mets are most commonly a/w which primary cancers?

Back 132

breast
colon
prostate
endometrial
cervical cancer

Front 133

What are the toxicities of antipsychotics?

Back 133

1. highly lipid soluble and stored in body fat; thus, very slow to be removed from body

2. extrapyramidal system side effects (decrease DA); treat w/anti Parkinson's

3. endocrine side effects (e/g/ DA receptor antagonism --> prolatinemia --> galactorrhea)

4. side effects arising from blocking muscarinic (dry mouth, constipation), a (hypotension), and histamine (sedation) receptors

Front 134

How to treat Reye Syndrome?

Back 134

1. Discontinue salicylate (e.g. aspirin)

2. hospilization (ICU) for cardiorespiratory monitoring (+/- mechanical ventilization), supportive care, fluid and eletrolyte management

3. maintain euglycemia

4. maintain isovolemia

5. reduce brain swellings: avoid hypo-osmotic fluids, elevate head of bed, +/- corticosteroids, +/- ICP monitor

6. if seizure --> phenytoin

Front 135

Treatment of idiopathic lung disease.

Back 135

corticosteroid combined with imuran or cyclophosphamide

lung disease

Front 136

What are toxicities of antipyschotics? How to treat

Back 136

Neuroleptic malignant syndrome -- rigidity, myoglobinuria, autonic instability, hyperpyrexia

weight gain, memory problem, orthastatic hypotension, bad taste in mouth, vomiting (esp with smoking), altered body response to temperature

treat: dantrolene, agonists (e.g. bromocriptine)

Front 137

How should you treat a patient that has been bitten by an an animal suspected of having rabies or an animal that cannot be observed for 10 days?

Back 137

empiric --
rabies immunoglobulin
wound cleaning
tetanus prophylaxis

Front 138

Diseases characterized by granulomas

Back 138

2.1 Tuberculosis
2.2 Leprosy
2.3 Schistosomiasis
2.4 Histoplasmosis
2.5 Cryptococcosis
2.6 Cat-scratch disease
2.7 Sarcoidosis
2.8 Crohn's disease
2.9 Pneumocystis pneumonia
2.10 Aspiration pneumonia
2.11 Rheumatoid arthritis
2.12 Granuloma annulare

Front 139

What is the most severe toxicity of antipsychotics?

Back 139

tardive kinesia -- stereotypical oral-facial movement due to long-term antipsychotic use. Often irreversive

Front 140

A patient is brought into the ER with progressive muscle weakness, retained sensation, headache, vomiting, neck pain, and fever. CSF analysis show increased lymphocytes and normal glucose and protein. What life threatening complication can result if this disease progression?

Back 140

respiratory weakness

(Polio)

Front 141

Cough, malaise, weight, dyspnea, arthritis (knees, ankles), chest pain, fever

erythema nodosum, lymphadenopathy, vision loss, cranial palsies

Lab values?

Back 141

Sarcoidosis

increased ACE
increased Ca2+
increased ALP
increased ESR
decreased WBC

Front 142

In terms of potency, how is haliperidol and its relation to EPS and anticholinergic effects?

Back 142

High potency
high EPS and low anticholin

Front 143

What normal values CSF?

Back 143

Pressure -- 50

WBC < 5

Glucose 40-70

Protein 20-45

Front 144

A smoker has rapid onset JVD, facial swelling, and altered mental status. What is the treatment?

Back 144

endovascular stenting

Front 145

In terms of potency, how is chlorpromazine and its relation to EPS and anticholinergic effects?

Back 145

Low potency
low EPS and high anticholin

Front 146

How to treat tension headache?

Back 146

NSAIDs
can also try ergots, sumatriptan, relaxation exercises

Front 147

A patient presents with chronic sinusitis, hemoptysis, and hematuria. What is the treatment?

Back 147

cytotoxic therapy (cyclophosphamide)

steroids

Front 148

What are the side effects of chlorpromazine

Back 148

corneal deposits
thioridazine
retinal deposits

Front 149

How to treat cluster headaches? Contraindications?

Back 149

100% O2
sumatriptan
diahydroergotamine (DHE 45)

-- causes vasoconstraction, do not give to CAS, Prinzmetal Angina, pregnancy

Front 150

A patient with lung siease is found to have anti-gomerular BM antibodies. What is the treatment?

Back 150

plasmaphoresis
steroids
immunosuppressants

Front 151

What is the evolution of EPS side effects?

Back 151

1 week -- dystonia (muscle spasm, stiffness, oculogyric crisis)

2 weeks -- akinesia (parkinsonian symptoms)

3 weeks -- rigidity

6 weeks -- tremor

10 weeks -- akathisia (restlessness, subjective)

18 weeks -- Pisa and Rabbit syndromes

6 months -- tardive dyskinesia

Front 152

How to treat migrane headaches?

Back 152

sumatriptan
DHE 45
NSAIDs and antiemetics (chloropromazine, metoclopramide)

Front 153

Which type of pneumoconiosis leads to an increased risk of TB?

Back 153

silicosis

Front 154

What is the pneumonic for NMS?

Back 154

Fever
Encephalopathy
Vitals unstable
Elevated enzymes
Rigidity of muscles

Front 155

What agents can be used for prophylaxis of migrane headache?

Back 155

1. CCB -- verapamil (often first-line b/c safe and well-tolerated)

2. b-blockers

3. TCA

4. NSAIDs (good choice if menstrual migraine or comorbid osteoarthritis or other pains that could benefit from NSAIDs)

5. anticonvulsants: valproic acid (good if history of bipolar)

Front 156

Which vasculitis is c-ANCA + and involves the lungs?

Back 156

Wegener granulomatosis

Front 157

What are the atypical antipsychotics?

Back 157

Olanzapine
Clozapine
Risperidone

Front 158

What headache symptoms would lead you suspect a brain tumor as a cause a headache?

Back 158

- mild headache hich progressively worsens over days to weeks

- new onset after age 50

- papilledema worsened by bending, lifting, cough, of valsalva

- associated seizures, confusion, altered seizures, confusion, altered mental status

- abnormal neurlogoic signs and symptoms (i.e. focal numbnss or weakness)

- disturbs sleep or present immediately upon awakening

- vomiting precedes headache

- known systemnic illness (i.e. cancer, HIV, collagen vascular disorder)

Front 159

What is the next step once a brain tumor has been identified on CT or MRI of the head?

Back 159

Look for source (CT chest/ab/pelvis)

Front 160

What is the mechanism of atypical antipsychotics? What are the clinical uses?

Back 160

Blocks 5-HT, dopamine, a, and H1

Schizophrenia -- both positive and negative symptoms

Olazapine is also used for OCD, anxiety, depression, mania, Tourette's syndrome

Front 161

What are the characteristics of pseudotumor cerebri?

Back 161

young obese woman with daily headache worse in the morning

pulsatile, possible nausea/vomiting, possible retrocular pain worsened by eye movement

papilledema

CT shows absence of ventricular dilation

CSF: > 250 in non-obese, > 200 in obese

Front 162

What is the classic (but rare) EKG finding in PE? What does it indicate?

Back 162

only in 20%

S1 (wide S in lead I)
Q3 (large Q in lead III)
T3 (inverted T in lead III)

right ventricular increased pressure and volume

Front 163

What are the toxicities of atypical antipsychotics?

Back 163

Fewer EPS and anticholin side effects. Olan and cloza may cause significant weight gain and diabetes. Clozapien may cause agrunulocytosis.

apriprazole -- adjunct for depression

Front 164

What treatment options are available for managing pseudotumor cerebri?

Back 164

- confirm absence of other pathology w/CT and MRI of head (r/o central venous thrombosis)

- discontinue any inciting agents (e.g. vit A, accutane, long-term tetracyclines, withdrawal from corticosteroids)

- weight loss in obese patients

- acetozolamide is first line

INVASIVE
- serial lumbar punctures
- optic nerve sheath decompression
- lumboperitoneal shunting (CSF)

Front 165

What is the most common EKG finding in PE?

Back 165

sinus tachycardia +/- nonspecific ST changes

Front 166

What is the mech and use of TCAs?

Back 166

block reuptake of NE and serotonin

major depression, bedwetting (imipramine), OCD (clomipramine), fibromyalgia

Front 167

headache + extraocular muscle palsies

Back 167

cavernous sinus thrombosis

Front 168

PTT target in PE?

Back 168

hepatin to 1.5 - 2.5 and then eventually 2-3 for 3-6 mo (switch to warfarin)

Front 169

What are the SSRIs?

Back 169

fluoxetine
paroxetine
sertaline
citalopram

Front 170

thrombolytic indications?

Back 170

1. STEMI (<12 hrs)
2. thrombotic stroke (<3 hrs)
3. massive PE

Front 171

What is the mech and clincal SSRIs?

Back 171

serotonin-specific reuptake inhibitors

depression, OCD, bulimia, social phobias

Front 172

How is LMWH monitored?

Back 172

anti-factor Xa

Front 173

Causes of pulmonary HTN

Back 173

1. Idiopathic

2. PE, valvular disease (MS, MR), left to right shunt, COPD

Front 174

What are the toxicities what SSRIs?

Back 174

fewer than TCAs. GI distress, sexual dysfunction (anorgasmia)

Front 175

How does PHTN present?

Back 175

dyspnea
fatigue
deep chest pani
cough
syncope
cyanosis
digital clubbing
JVD
hepatomegaly

Front 176

What are the MAO inhibitors? What are the mechs?

Back 176

Phenelzine, tranylcypromine, selegiline (selective MAO-B inhibitor)

mech: nonselective MAO inhibition increased levels o amine neurotransmitters (NE, serotonin, dopamine). reduces MAO activity by 80%

Front 177

How to treat idiopathic PHTN?

Back 177

Prostanoids

Endothelin receptor antagonists --
bosentan, ambrisentan

sildenafil

nifedipine

Front 178

What are the clinical uses and toxicities of MAO inhibitors? What are the contraindications?

Back 178

use: atypical depression, anxiety, hypochondriassis

tox: hypertensive crisis with tyramine ingestion (in many foods, such as wine, cheese, chocolate, avocados) and b-agonists; CNS stimulation. Contraindications -- SSRIs or meperidien (to prevent serotonin syndrome)

occipital headache, stiff neck, nausea, and vomiting, chest pain, dilated pupils, nose bleeds, elevated BP

Front 179

A patient presents to the ER after a MVC with hypertension, bradycardia, and abnormal respirations. After ABC's, what's the next step in management?

Back 179

CUSHING'S TRIAD: HTN, bradycardia, Kussmaul breathing
-- indication of high ICP

HOB, hyperventilation, mannitol

Front 180

How to diagnose alcoholism?

Back 180

Cut back
Annoyed
Guilt
Eye-opener

Front 181

How to treat pulmonary edema?

Back 181

Loop diuretics
Morphine
Nesiritide (cardiac cause -- recombinant BNP)
Oxygen
Pressors (if perfusion inadequate)

Front 182

Post-op constipation and/or resp depression

Back 182

Opioid intox

Front 183

Characteristics of transudative pleural effusion. Causes?

Back 183

pleural: serum protein < 0.5

pleural: serum LDH < 0.6

CHF, cirrhosis, kidney disease (nephrotic syndrome)

Front 184

severe dpression, headache, fatigure, insomnia/hypersomnia, hunger

Back 184

amphetamine
cocaine withdrawal

Front 185

Characteristics of exudative pleural effusion. Causes?

Back 185

pleural: serum protein > 0.5

pleural: serum LDH > 0.6

inflammation (infection, cancer, vasculitis)

Front 186

pinpoint pupils
nausea & vomiting
seizures

Back 186

opiod intox

Front 187

How to treat pleural effusion?

Back 187

treat underlying conditions

relieve pressure on lung with thoracocentesis and chest tube placement

empyema requires chest tube

if recurrent malignant effusion occurs, use pleurodesis to scar the pleural layers together

Front 188

rebound enxiety
tremors
seizures (life-threatening)

Back 188

alcohol
benzo
barb withdrawal

Front 189

How to treat open PTX? tension PTX?

Back 189

1. open with small would treated with chest tube and occlusive dressing

2. open with larger wounds reated with attempted closure and should carry low threshold for intubation

3. tension needs immediate needle decompression + chest tube

Front 190

Major side effect of clonidine

Back 190

dry mouth
sedation
severe rebound hypertension

Front 191

How to treat malignant mesothelioma?

Back 191

extrapleural pneumonectomy with adjuvant chemo and radiation therapy; chemo alone if unresectable

Front 192

What are 1st generation anti-histamines? What are 2nd generation anti-histamines? What are they used for?

Back 192

1st -- diphenhydramine, dimenhydrinate, chlorpheniramine
Allergy, motion sickness, sleep aid

2nd -- Loratadine, Fexofenadine, Desloratadine, Cetirizine
allergy; less sedating than 1st gen b/c of decreased entry into CNS

Front 193

What medication is used prior to intubation in head injury patients?

Back 193

lidocaine (to blunt ICP elevations)

Front 194

What drugs can lead to agranulocytosis?

Back 194

clozapine
carbamazepine
colchcine
PTU
methimazole
dapsone

Front 195

nasal congestion
cough
respiratory distress
wheezing
fever
tachypnea
crackles
hyperresonance on percussion

How to treat?

Back 195

Bronchiolitis

supportive care (O2, IVf)
albuterol or epi (if it works)
ribavirin used in those RSV susceptible

Front 196

Treatment for trigeminal neuralgia?

Back 196

carbamazepine

baclofen, phenytoin, gabapentin, valroate, clonazepam, or other anticonvulsants; surgical decompression of nerve maybe help

Front 197

What is the treatment for croup?

Back 197

epi
cool air
O2
steroids

Front 198

What medical conditions can cause severe depression?

Back 198

hypothrydoid
hyperparathyroid
parkinson
stroke
CNS neoplasm
pancreatic cancer

Front 199

What CXR characteristics distinguish neonatal RDS from TTN?

Back 199

RDS -- low lung volume, diffuse ground glass appearache with air bronchogram

TTN -- increased lung volmes w/flattening of the diaphragms, prominent vascular marking from the hilum

Front 200

What medications are known for causing symptoms of depression in patients?

Back 200

1. sedatives: alcohol, benzos, antihistamines

2. stimulant withdrawal

3. methyldopa

4. first gen antipsych

5. antinausea drugs including metochlopramide and prochlorperazine

6. glucocorticoids

7. insufficient thyroid

8. a-interferon (used for viral hep)

Front 201

How is CF diagnosed?

Back 201

1. sweat cl > 160 in kids; 80 adults on two or more occasions

2. genetic testing (90% cases)

Front 202

wHICH DRUGS SHOULD NOT BE TAKEN WITH ssriS B/C OF THE RISK OF SEROTONIN SYNDROME?

Back 202

other SSRIs
SNRIs
MAOis
TCA
St john

tryptophan
levodopa
triptams
cocaine,meth,E

Front 203

What are the general strategies for treating the pulmonary component of CF?

Back 203

b2 agonist (albuterol, salmeterol)

DNase I to decrease sputum viscosity

hypertonic saline for chronic cough

phyiotherapy

azithromycin

Front 204

What are the characterisitc features of serotonin syndrome?

Back 204

1. mental status changes (anxiety, agitation, delerium, restlessness, disorientation)

2. autonomic dysfxn (diaphoresis, tachycar, hyperthem, HTN, vomiting diarrhea)

3. NM hyperactivity (tremor, muscle rigidity, hyperreflexia)
- ocular clonus - slo, continusous horizontal eye mvmt
- spontaneous or inducible
- babinki bilat

Front 205

What are the general strategies for managing GI component of CF?

Back 205

pancreatic enzymes

vitamins A, D, E, K

nutritional therapy

Front 206

Tx serotonin syndrome

Back 206

1. discontinue agents

2. supportive care (if tx for HTN needed, use esomolol or nitroprusside)

3. sedation ith benxo

4. if t > 41.1 --> sedation, paralysis, and ET tube --> mechanical cooling (e/g/ ice, cooling blankets, misting fans)

5. if agitation depiate benzos --? serotonin antagonist (cyproheptadine)

Front 207

What are the characteristic features of a patient presenting with pericarditis?

Back 207

pain relieved by leaning forward

diffuse ST elevation

pericardial friction rub

JVD

pulsus paradoxus

cough

dyspnea

Front 208

What are the sx of TCA ovrdose?

Back 208

1. cardiotox-- tachycard, hypotension,conduction abnorm

2. CNS tox -- sedation, obtundation, coma, seizures

3. anticholinergic (mydriasis, xerostomia, ileus, urinary retention)

Front 209

What is an acceptable urine output in a trauma patient?

Back 209

> 1.5 - 2 cc/min; 50 cc/hr

Front 210

Ho is TCA OD managed?

Back 210

1. ABCs

2. activated charcoal

3 continuous cardiac monitor

4. frequent neuro checks

5. if ingstion < 2 hrs, gastric lavage

6. if hypotnsion, IVF or NS;; NE

7. if QRS > 100 msec, try sodium bicarb

benzos,barbs,propofol for seizuires

Front 211

Diarrhea transmitted from pet feces

Back 211

yersina pestis

Front 212

What are the indications for ECT?

Back 212

1. severe debilitating depression refrac to dersssion

2. psychotic depression

3. severe suicidailty

4. catatonia

5. depression with food refusal, leading to nutritional compromise

6. pregnancy & deression

7. previous response to ECT

8. medical condition preventing use of antidepressants

9. bipolar disorder/mania

10.schizophrenia/psychosis

Front 213

Antidepressant

SE priaprism

Back 213

trazadone

Front 214

Mild intestinal infection that can become neurocystierosis

How to treat?

Back 214

tinea solium from undercooked pork -- mild diarrhea, CNS symptoms

praziquantel
albendazole if CNS
steroids if > 5 cysts

Front 215

Antidepressant

works well with SSRIs and increases REM sleep

Back 215

bupropion

Front 216

food poisoning from an undercooked hamburger

Back 216

s.aureus, e.coli

Front 217

What are three important distinctions of dysthymic disorder that distinguish it from MDD in making dx?

Back 217

1. symtptoms cannot include suicidal ideation

2. symptomatic > 2 years

3. no hx of MDD

Front 218

bloody diarrhea from poultry

How to treat?

Back 218

campylobacter jejuni (erythromycin)

salmonella
(try not to treat, but FQ if MUST)

Front 219

How is depression managed in patient with bipolar disorder?

Back 219

1. mild depression --> lithium or lamotrigine

2. moderate depression --> add a second mood stabilizer (lamotrigine) or add an atypical antipsychotic (olanzapine, quetiapine, or resperidone)
- lamotrigine has significant drug interactions with valproate and carbamazepine

3. severe --> ECT

Front 220

diarrhea + pink eye

Back 220

adenovirus

Front 221

What are the potention side effects of lithium?

Back 221

1. CNS (depression, tremor, cognitive dulling)

2. thyroid

3. nephrogenic DI

4. GU (nausea, vomiting, diarrhea, metallic taste changes, weight gain)

Front 222

Which form of diarrhea has a risk of HUS?

Back 222

Shigella

{thrombocytopenia

microangiopathic hemolytic anemia

hematuria}

Front 223

What are the diagnostic criteria for adjustment disorder?

Back 223

1. clinically significant emotional or behavioral reaction causing marked distrss or impaired in social or occupational functioning

2. symptoms develop in resonse to identifiable psychosocial stressor

3. symptoms begin ithin 3 mo, disapear by 6 mo
(chronic if > 6 mo)

4. stressor other than bereavemnet

Front 224

Acid fast stain of stool shows parasites in HIV patient

Back 224

cryptosporidium

Front 225

What is the difference b/w major depressive disorder and adjustment disorder w/depressed mood?

Back 225

identifiable stessor

Front 226

fever
myalgias
periprbital edema
eosinophilia
diarrhea

how to treat?

Back 226

trichinella spiralis from undercooked pork

albendazole
mebendazole if CNS or cardiac symptoms

Front 227

How is acute stress disorder different than PTSD?

Back 227

within 30 days

Front 228

Complications of HBV?

Back 228

5% of adults , 90% develop chronic hepatitis

3-5% develop HCC

1% fulminant hepatic failure

Front 229

What are the treatment options for PTSD?

Back 229

1. psychotherapy
2. SSRI (first line)
3. other antide -- TCA, MAOs
4. mood stabilizer for impulsive behavior, arousal, and flashbacks
5. a-blocker improveds nightmares and sleep disturbance
6. atypical antipsychotics

Front 230

Complications of HCV?

Back 230

80% chronic

50% cirrhosis

slightly increased risk of HCC

Front 231

TX generalized anxiety disorder

Back 231

SSRI
benzo
buspirone
venalafaxine

Front 232

How does the treatment for HBV differ from HCV?

Back 232

HBV: INF-a + lamivudine

HCV: INF-a + ribavirin

Front 233

Bipolar patient who is treated with mood stabilizaer has concurrent depression. Tx?

Back 233

atypical antisych

Front 234

Pathophys of achalasia

Back 234

impaired peristalisis and decreased LES relaxation

Front 235

cranial nerve deficits
altered mental status/coma
contralat full body eakness and decreased sensation
vertigo, loss of coordination, difficulty speaking, visual changes

Back 235

basilar artery stroke

Front 236

A patient presents with pyspahgia, and the barium swallow shows a corkscrew pattern of the esophagus. What is the dx?

Back 236

DES

manometry shows nonperistaltic, uncoordinated contractions

Front 237

What are the diagnostic criteria for schizophrenia?

Back 237

At least 2 of the folloing during a 1 mo period:
- delusions (irrational belief that cannot be changed by rational argument)
- hallucinations (most common type is auditory)
- disorganized speech (e.g. frequent derailment or incoherence)
- grossly disorganized or catatonic behavior
- negative symptoms (e.g.flat affect, poverty of speech, lack of emotional reactivity)
(only one of the above is rqd if delusions are bizzare or hallucinations consist of a voice keeping a running commentary on the person's behavior or thoughts, or two voices conversing with each other)

- social/occupations dysfunction
- at least 6 mo

Front 238

How to treat DES?

Back 238

CCB, nitrates (relieve pain but not in GERD), TCAs

Front 239

What might be seen on neuroimaging of a patient with schizophrenia?

Back 239

enlargement of ventricles (lateral + 3rd)

reduction in cortical volume (cortical thinking)

Front 240

What are the three types of esophageal diverticula?

Back 240

Zenker -- upper

Traction -- mid

Epiphrenic -- lower

Front 241

What are the low potency typical antipsychotics?

Back 241

chlorpromazide
thioridazine

Front 242

How to treat hiatal hernia?

Back 242

1. sliding hernia can be treated with reflux control

2. paraesophageal hernia may need surgical repair (e.g. gastropexy, Nissen fundoplication)

Front 243

What are the atypical antipsychotics?

Back 243

Olanzapine
Risperidone
Quetiapine
Clozapine
Aripiprazole

Front 244

How to treat acute gastritis? Causes?

Back 244

NSAIDS, alcohol, ingestion of corrosive materials, stress from serve illness

treat as PUD and stop alcohol and offending medication; give H2/PPI to patient with severe illnesses.

Front 245

How to treat acute dystonia?

Back 245

diphenhydramine
benztropine

Front 246

How to treat chronic gastritis? Causes?

Back 246

1. Type A (autoantibodies for parietal cells in fundus) requires B12 replacement

2. Type B (H.pylori infxn affecting antrum) required readication of H.pylori through mulitdrug treatment (PPI, clarithromycin, and either amoxicillin or metronidazole)

Front 247

What are the sign and symptoms and NMS?

Back 247

- mental status change - initinal symptom in most patients (aitated delerium with confusion rather than psychosis)
- muscular rigidty -/+ tremor
- hyperthermia > 38-40 C
- autonomic instability -- tachycardia, labile, or high pressure, tachypnea, diaphoresis
- rhabdomyolysis appearing over 1-3 d

Front 248

Complications of PUD?

Back 248

hemorrhage (posterior ulcers may erdode into gastroduodenal artery)

perforation

Front 249

What is the treatment for NMS?

Back 249

- stop offending medication
- supportive care in the ICU
- dantrolene, bromocriptine, amantadine

Front 250

What is the next step in the management of a patient with recurrent with duodenal ulcers seen on at least two EGDs?

Back 250

H.pylori biopsy

Front 251

What is first-line tx for acute otitis media?

Back 251

1. amoxicillin for 10 d
2. augmentin
3. cephalosporin

Front 252

An EGD with biopsy in a 65 year od man reveals ggastric cancer? What is the next step?

Back 252

stage (CT ab and pelvis)

Front 253

What tx are effective in preventing alcoholic relapse?

Back 253

couseling
disulfram
topiramate
naltrexone

Front 254

What is the treatment for gastric cancer

Back 254

subtotal gastrectomy if distal 1/3

total gastrectomy if middle, upper stomach

adjuvant chemo and radtiaon

Front 255

Sx a/ delerium tremens?

Back 255

tonic-clonic seizure
delerium/hallucination
agitation
tachycardia
HTN
diaphoresis

Front 256

A female patient whas a known DU that has been refractory to high dose PPI therapy. What two tests may diagnose her disease?

Back 256

gastrin levels

secretin stimulation test

Front 257

severe depression
headache
fatigue
insomnia/hypersomnia
hunger

drug?

Back 257

amph/coke withdrawal

Front 258

A recent Cubam immigrant with symptoms of malabsorption is found to also have megaloblastic anemia. What is the disease and treatment?

Back 258

tropical sprue (folic acid)

tetracycline

Front 259

pinpoing pupils
n/v
seizures

drug?

Back 259

opoid OD

Front 260

What is the most likely cause of malabsorption in a patient with a (+) sudan stain in the stool sample and a normal D-xylose test?

Back 260

pancreatic insufficiency

Front 261

anxiety
piloerection
yawning
fever
rhinorrhea
nausea
diarrhea

Back 261

opoid withdrawal

Front 262

What is the treatment for Whipple disease?

Back 262

TMP-SMX

Front 263

What is the downside of buproprion./

Back 263

decreases seizure threshold
increases risk of servere HTN

Front 264

When should surgery for appendicitis be delayed?

Back 264

if symptoms present for more than 5 days.

give antibiotics, IVf, bowel rest, then appendectomy 8 weeks later

Front 265

What is the tx for benign paroxysmal position vertigo?

Back 265

epley maneuver
semont maneuver

Front 266

What is the classic presentation of gallstone ileus?

Back 266

impaction of gallstone in the ileum after passage through a biliary-enteric fistula

classically presents as an episodic subacute obstruction in an elderly women --> vague, recurrent ab pain and vomiting that recurs as the stone repeatdly lodges and dislodges

Front 267

What are the characteristics of refeeding syndrome?

Back 267

hypophosphatemia
CV collapse
rhabdomyolysis
confusion
seizurs

Front 268

elderly patient presents to the ER with vomiting and ab pain and distention. AXR reveals two distinct but sequential portions of bowerl in the sigmoid colon that are distended with air. What is the treatment?

Back 268

colonoscopy

(volvulus)

Front 269

What is the difference b/c "sundowning" and delerium?

Back 269

delerium has no previous a/w dementia

sundooning is the deterioration of behavior during evening hours in patients w/dementia

Front 270

What is the classic time-frame for which post-op ileus resolves in the different parts of the gut?

Back 270

small gut 24 hr

stomach 48-72 hr

colon 3-5d

Front 271

What are the comorbidities with ADHD?

Back 271

up to 50%...

ODD
conduct
learning disability
depression
bipolar
anxiety disorder

Front 272

What is the treatment for normal pressure hydrocephalus?

Back 272

ventriculoperitoneal shunt

Front 273

What is the treatment for pseudotumor cerebra?

Back 273

weight loss

acetozolamide

serial lumbar

shunting of CSF

Front 274

What are risks for successful suicide attempts?

Back 274

ge

45 yr, violentbehavior,
drug use,
prior suicidalattempts, existence of a suicideplan, male gender, recent loss,
depression, unemployment, or being single, widowed, or divorced.

Front 275

What is the treatment for mild diverticulitis?

Back 275

liquid dite

ABx: FQ + flagyl; TMP-SMX + flagyl

Front 276

Side effect of SSRIs?

Back 276

equire
3-4 weeks
of administrationbefore they take effect; sexual dys-function, decreased platelet aggrega-tion, may increase risk of suicidalideation in
adolescents

Front 277

What is the treatment for carcinoid syndrome?

Back 277

somatostatin analog (octreotide) +/- IFN-a

Front 278

SE of SNRIs

Back 278

Nausea, dizziness, insomnia, sedation,constipation,
HTN
; side effects morebenign than TCAs

Front 279

What type of immunodeficiency increases the risk of anaphylactic transfusion reaction?

Back 279

IgA deficiency

Front 280

SE of TCAs

Back 280

Easy to overdose and may be
fatal atonly 5 times therapeutic dose
(due to cardiac QT interval prolonga-tion that causes arrhythmias), seda-tion, weight gain, sexual dysfunction,
anticholinergic symptoms

Front 281

What are the next steps in management of a patient that present to the ER with massive lower GI bleed?

Back 281

Assess and Stablize
NGT to r/o massive UGI bleed
Surgery consult for admission (colonoscopy +/- surgical intervention)

if non diagnostic/nonfeasible, radionucleotide scan and/or angiogram

Front 282

SE of MAOIs

Back 282

ry mouth, indigestion, fatigue,headache,
dizziness
; consumptionof foods containing
tyramine
(cheese, aged meats, beer) cancause
hypertensive crisis

Front 283

What lab is often elevated in patients with an UGI bleed?

Back 283

BUN (b/c breaking down Hg)

Front 284

SE of bupropion

Back 284

Headache, insomnia, weight loss

Front 285

What is the most common etiology of UGI bleeds?

Back 285

55% PUD

Front 286

SE of trazodone

Back 286

Hypotension, nausea,
sedation
, priapism; seizure risk at high doses

Front 287

What is the most common etiology of lower Gi bleed?

Back 287

diverticulosis

Front 288

SE of mirtazapine

Back 288

Dry mouth, weight gain, sedation

Front 289

What is the most sensitive and specific lab test for the dx of chronic pancreatitis?

Back 289

low fecal elastase level

Front 290

h/p dysthymic disorder

Back 290

Diagnosis requires depressed mood plus two or more of the symptoms below for most days for 2 yr and no history of major depressive episodes:
a. Feelings of hopelessness
b. Change in sleep patterns
c. Change in appetite
d. Fatigue
e. Inability to concentrate
f. Low self-esteem

Front 291

What type of patient is at high risk of acalulous cholecystitis?

Back 291

TPN

critically ill (r.g. burn patients, sepsis, mechanical ventilation)

Front 292

types of bipolar

Back 292

I: depression with the history of at least one manic epidsode

II: depression with history of at least one hypomanic episode

Front 293

h/p bipolar disorder

Back 293

Manic ep:
(1) elation or irritability > 1 wk
(2)Three or more of the following symptoms: grandiosity, pressured speech,
decreased need for sleep
, flight of ideas,
easy distractibility
, psychomotoragitation, engaging in risky pleasurable activity

[hypomania] (3)Episode
does not
cause significant impairment of ability to function
c.Episodes cannot be caused by substance use or a medical conditiond.Diagnosis requires history of
at least one
manic or hypomanic episode andrecurrent
major depressive episodes

Front 294

Charcot's triad and Reynold's pentad?

Back 294

RUQ
jaundice
fever
shock
mental status changes

Front 295

Tx of bipolar disorder and SE

Back 295

a.Patients should be hospitalized if psychotic or judged to be a risk to themselvesor others until they can be stabilized

b.
Mood stabilizers
(e.g., lithium, carbamazepine, valproic acid, gabapentin, topira-mate)are used to control and prevent manic and hypomanic episodes

c.Lithium is frequently the first-line drug for long-term treatment of mania; itsmechanism is unknown but likely involves inositol triphosphate activity
(1)Adverse effects associated with lithium include hypothyroidism, polyuria,tremor, weight gain, renal insufficiency, teratogenesis, and confusion
(2)Carbamazepine and valproic acid are more effective than lithium in patientswith rapid cycling

d.
Antidepressants
are used to treat depression

e.Antipsychotic medications may be required for some patients with rapid cyclingor refractory disease

Front 296

How does the interventional component of treatment of cholecystitis differ from that of cholangitis?

Back 296

Cholecystitis --> cholecystectomy

Cholangitis --> ERCP drain THEN cholecystectomy

Front 297

What is cyclothymia? h/p?

Back 297

1.Rapid cycling of hypomania and mild depression lasting greater than 2 yr without a period ofnormal mood

2 months

2.Mood level does not impair ability to function

3.
H/P

symptoms of dysthymia that alternate with hypomanic episodes

4.
Treatment

psychotherapy or mood stabilizers

Front 298

antimitochondrial antibodies

Back 298

PBC

Front 299

What is adjustment disorder with depressed mood? h/p? tx? how does it differ from bereavment?

Back 299

1.Behavioral and mood changes that occur within 3 months of a
stressful event
(e.g.,death in family, assault, divorce) and cause
significant impairment
of ability tofunction

2.
H/P

a.
Distress in excess
of what is expected following a stressful event, inability toconcentrate,
self-isolation,
change in sleep patterns, change in appetite
b.Symptoms
begin within 3 months
of stressful event and
end 6 months after
endof stressor
3.
Treatment

psychotherapy; antidepressants can be used if psychotherapy alone isunable to effect normal daily functioning

Adjustment disorder
differs from
bereave-ment
in that the patient’s abilityto function normally is
impaired
in the
former
but
not
in the
latter.

Front 300

What distinguishes PBC from PSC?

Back 300

PBC: anti-mitochrondrial, ANA, > women, autoimmune

PSC: p-ANCA, > men, ERCP beads on a string

Front 301

What is OCD? h/p?

Back 301

1.Significant, recurrent
obsessions
(e.g., feeling unclean, need for organization,recurrent images) and
compulsions
(e.g., counting, frequent or repetitive hand-washing, placing items in a certain order) that
affect daily life
and function; typi-cally begins in adolescence

2.
H/P

a.Defined recurrent obsessions and compulsions that significantly affect ability tofunction and may take up considerable time in daily activity

b.Patients are aware of behaviors, but feel unable to control them

c. stressfuul events can exacerbate behaviors

Front 302

What is the treatment for hepatic encephalopathy?

Back 302

lactulose, neomycin

protein restriction

Front 303

How to treat OCD?

Back 303

psychotherapy
pharmacologic (SSRI or clomipramine)

Front 304

What Abx can be used to treat SBP?

Back 304

cefotaxime
ceftriaxone

Front 305

h/p PTSD/ treatment?

Back 305

1.Syndrome of anxiety symptoms that occurs following exposure to
a significantlystressful event;
symptoms typically begin within 3 months of event

2.
H/P

a.
Vivid dreams
or
recurrent intrusive thoughts
of traumatic event
b.Avoidance of activity or settings associated with event, anhedonia, feelings of
detachment
, increased state of arousal, survivor guilt, social withdrawal
c.Diagnosis requires patient to have been exposed to a traumatic event
thatcaused significant distress, symptoms of reliving the eventthrough dreams orintrusive thoughts,
avoidance
of associations with the event, and increasedarousal
(e.g., insomnia, irritability, difficulty concentrating) lasting
at least 1 month inacute cases and >3 months in chronic cases

3.
Treatment

SSRIs, MAOIs, or mood stabilizers; psychotherapy may also be help-ful in eliminating intrusive thoughts

Front 306

ascites

hepatomegaly

jaundice

Back 306

Budd Chiari

Front 307

Generalized anxiety disorder
h/p
tx?

Back 307

1.Excessive, persistent
anxiety that impairs ability to function and occurs more daysthan not for >
6 months; typically begins in early adulthood

2.
Risk factors
women twice as likely affected than men

3.
H/P

a.Feeling of restlessness or being on edge, inability to concentrate, restlessness,insomnia, irritability, muscle tension
b.Diagnosis requires excessive anxiety for most days, impairment of ability tofunction, and three of the symptoms listed in a. for >6 months

4.
Treatment

psychotherapy and anxiolytics improve symptoms;SSRIs are emerging as a promising treatment because of their lower rate of sideeffects compared with benzodiazepines

Front 308

antismooth muscle antibody

Back 308

autoimmune hepatitis

Front 309

Prognostic factors for schizophrenia?

Back 309

1.Excessive,
persistent
anxiety that impairs ability to function and occurs more daysthan not for

6 months; typically begins in early adulthood2.
Risk factors

women twice as likely affected than men3.
H/P

a.Feeling of restlessness or being on edge, inability to concentrate, restlessness,insomnia, irritability, muscle tensionb.Diagnosis requires excessive anxiety for most days, impairment of ability tofunction, and three of the symptoms listed in a. for

6 months4.
Treatment

psychotherapy and anxiolytics improve symptoms (see Table 14-3);SSRIs are emerging as a promising treatment because of their lower rate of sideeffects compared with benzodiazepines

Prognostic factors for a worse outcome include predominantly negative symp-toms, motor or sensory neurologic signs, and poor support system

Front 310

What antibiotic is contraindicated in neonates with hyperbilirubinemia and why?

Back 310

ceftriaxone

displaces bilirubin from albumin and increases likelihood of kernicterus

Front 311

What is the anticoagulant of choice in a patient with a hix of stroke or TIA given the following scenarios?

1. first TIA
2. TIA/stroke due to a fib
3. TIA/stroke + CAD
4. repear TIA/stroke while on aspirin

Back 311

1. ASA

2. warfarin

3. plavix

4. plaxix or aggrenox (Dipyridamole + ASA)

Front 312

Atypical antipsychotics

Back 312

clozapine, risperidone,olanzapine, sertindole,quetiapine, ziprasidone,paliperidone)

Block
dopamine
and
serotonin
receptors

Front 313

What types of fractures would prompt a search for a ruptured thoracic aorta?

Back 313

rib
scapular
sternal fractures

Front 314

What are the classic signs and symtoms of carotid artery stenosis?

Back 314

bruits
TIAs
syncope
reversible ischemic neurologic deficits lasting up to 3 days
CVAs

Front 315

Indications for atypical antipsychotics

Back 315

•
First-line
drugs for maintenancetherapy for psychotic disorders
•
Clozapine is most effective neu-roleptic, but is reserved for re-fractory psychosis because of riskof agranulocytosis

Front 316

What's the difference b/w a Monteggia fracture and a Galeazzi fracture?

Back 316

Monte: proximal ulnar fracture w/anterior dislocation of radius

Galea: radial fracture w/dislocation of distal ulnar radial joint

Front 317

What are the surgical indications for carotid endarterectomy?

Back 317

Symptomatic carotid stenosis > 70% -- strong benefit

Symptomatic carotid stenosis 50-60% -- marrginal benefit (more so in men and if performed w/i 2 wks of stroke/TIA)

Asymptomatic patients w/80-90% stenosis who are expected to live > 5 yrs by a surgeon with a perioperative complication rate less than 3%

Front 318

SE of atypical antipsychotics

Back 318

Anticholinergic effects, weight gain, ar-rhythmias, seizures;
clozapine
carriesrisk of
agranulocytosis;
frequencyand severity of side effects is signifi-cantly
less
than seen with traditionalneuroleptics

Front 319

Common dashboard knee injury injury in an MVA

Back 319

PCL

Front 320

What are the important nonsurgical treatments for carotid artery stenosis?

Back 320

1. HTN control to < 140/90

2. dysliidemia control
- LDL < 100, HDL > 35, Tg < 200
(statins; niacin reduces carotid intinma thickness)

3. DM control to fasting glucose < 125 mg/dL and HbA1C < 7%

4. smoking avoidance, consider varenicline

5. increased physical activity to at least 30-60 min 4 times weekly

6. alcohol consumption up to 2 drinks daily is beneficial

7. eval for CAD and PAD

8. ASA, but if history of TIA/stroke while on ASA, use aggrenox of plavix instead

Front 321

Traditional high-potency

Back 321

haloperidol, droperidol,fluphenazine,thiothixene)

Block
D
2
dopamine
receptor

Front 322

Back pain, pain increases with passive straight leg raise

Back 322

degenerative

Front 323

Wakness and numbness of the face, arm, and leg on one side of the body + absent cortical signs (such as aphasia, neglect, and visual field defects)

Back 323

Sensorimotor Stroke

(lacunar syndrome)

Front 324

Non-high potency antipsychotics

Back 324

(trifluoper-azine, perphenazine)

(thioridazine, chlorpro-mazine

Front 325

Back pain, pain lessens with flexion at the hips (e/g/ bending over a shopping cart)

Back 325

spinal stenosis

Front 326

Weakness of face, arm, leg on one side of the body + absent sensory or cortical signs

Back 326

Pure motor stroke

(50% of lacunar strokes)

Front 327

Anorexia Nervosa h/p

Back 327

body weight <
85% ideal body weight,
fixation on prevention of weightgain,
severe body image disturbance, amenorrhea, cold intolerance, hypothermia,dry skin, lanugo hair growth (i.e., fine, short hair similar to that in the newborn),bradycardia

Front 328

Back pain, elderly, weight loss, pain constant but worse when supine

Back 328

spinal tumor

Front 329

Sensory loss of face, arm, leg on one side of the body + absent motor or cortical signs

Back 329

Pure sensory stroke

Front 330

Bulimia h/p

Back 330

a.Episodes of binge eating accompanied by a sense of loss of controlb.Episodes of binging are followed by some type of compensatory behavior (e.g.,purging, excessive exercise, laxative use)c.Binging-compensation episodes occur at least two times per week for <
3months

Front 331

Back pain, acute urinary retention

Back 331

cauda equina

Front 332

Facial weakness.dysarthria, hysphagia, and slight weakness and clumsiness of one hand + absent sensory or cortical signs

Back 332

dysarthria clumy hand stroke

Front 333

Euphoria,
paranoia, psy-chomotor retardation, im-paired judgment, increased appetite,
conjunctival injection,
dry mouth

Back 333

marijuana

Front 334

Back pain, loss of foot dorsiflexion and pain on crossed straight leg raise

Back 334

disc herniation

Front 335

Ipsilateral weakness and limb ataxia out of proportion to the motor defect, possible gait deviation to the affected side + absent cortical signs

Back 335

ataxia hemiparesis stroke

Front 336

Euphoria,
slurred speech,
pupillary constriction,
inattentiveness, decreased consciousness,
respiratory depression

Back 336

opiods

Front 337

What are the signs suggesting radial nerve damage with a humeral fracture?

Back 337

limp wrist

loss of thumb abduction

Front 338

In what timeframe must thrombolytic theray be instituted in cases of ischemic stroke?

Back 338

3 hrs

Front 339

Hyperactivity,
psychomo-tor agitation,
pupillarydilation,
tachycardia,HTN, psychosis

Back 339

Amphetamines (methamphetamine, methylphenidate, etc.)

Front 340

In cases of an XR and unavailable MRI, what 3 studies can be used to make the dx of osteomyelitis?

Back 340

bone scan

tagged WBC scan?

Front 341

What is the principle cause of a lacunar infart?

Back 341

narrowing of lumen due to thickening of vessel wall (HTN)

Front 342

Euphoria,
tachycardia,psychomotor agitation,pupillary dilation, hyper-tension, paranoia,
grandiosity

Back 342

cok

Front 343

What neuro deficit would be seen with an infarction in the basilar artery?

Back 343

CNS abnormalities

contralat full body weakness

coma/alterations in consciousness

decreased sensation

vertigo, loss of coordination, difficulty speakingg, vusual abnormalities

Vertebrobasilar insufficiency may happen when the neck is overextended back into a sink during hairwashing, damaging the blood vessels in the neck and disrupting the blood flow to the brain, resulting in a potential stroke.
Vertigo (commonly described as the environment spinning or as if the person is twirling in space) is the most recognizable and quite often the sole symptom of decreased blood flow in the vertebrobasilar distribution. The vertigo due to VBI rarely is brought on by head turning, which could occlude the ipsilateral vertebral artery and result in decreased blood flow to the brain if the contralateral artery is occluded. When the vertigo is accompanied by double vision (diplopia), graying of vision, and blurred vision, patients often go to the ophthalmologist. If the VBI progresses, there may be weakness of the quadriceps and, to the patient, this is felt as a buckling of the knees. The patient may suddenly become weak at the knee and crumple (often referred to as a “drop attack”). Such a fall can lead to significant head and orthopedic injury, especially in the elderly.
Transient ischemic attacks due to VBI will, by definition, have symptoms resolved within 24 hours. More often, however, the symptoms are very brief, lasting a few seconds to half an hour. Though uncommon and thought to affect only people with already weakened neck arteries, the syndrome has been at the centre of a debate in several recent stroke deaths.

Front 344

What is the empiric treatment for septic arthritis?

Back 344

IV vancomycin

IV ceftriaxone

Front 345

depression, anxiety,
stom-ach cramps, nausea,vomiting,
diarrhea, myalgias

Back 345

opiod withdrawal

Front 346

What is the tx for a SAH?

Back 346

1. discontinue all anticoagulant and reverse anticoagulation

2. SBP < 150 only if cognitive fxn intact (adequate cerebral perfusion pressure) until the aneurysm is clipped or coiled to prevent rebleeding. If the cerebral perfusion pressure is not adeuqate, then lowr bP increase risk of infxn

- LABETALOL PREFERED, avoid ntroprusside + nitroglycerin

3. nimodipine to prevent vasospasm

4. prevent physiologic derangements that may worsen brain injury
- avoid hypoxia and hyperglycemia; maintain normal pH, euvolemia, normothermia

5. ventriculostomy, surgical clipping or metal coiling

Front 347

What are the most common causes of bony mets?

Back 347

breast
lung
prostate
RCC
thyroid
lymphoma

Front 348

anxiety, insomnia, tremor,
seizures

Back 348

benzo/alcohol withdrawal

Front 349

What neuro deficit would be seen with an infarction in the ACA?

Back 349

legs, feet -- motor & sensory

Front 350

positive p-ANCA is a/w what conditions?

Back 350

Ulcerative colities

pauci0immune GN
miscroscopic polyangitis
chrug strauss

Front 351

h/p somatization disorder

Back 351

a.Two gastrointestinal (GI) symptoms: nausea, vomiting, diarrhea, indigestion

b.One sexual symptom: decreased libido, erectile dysfunction, menorrhagia

c.One pseudoneurologic symptom: ataxia, weakness, urinary retention, paresthe-sias, hallucinations

d.Pain at multiple body regions

e.Symptoms cannot be explained by medical conditions and are unintentional

Front 352

In which scenario is seizure prohylaxis with anticonvulsants recommended? SAH or parenchymal hemorrhage?

Back 352

parenchyam ASA
SAH only if seizures occur

Front 353

RA DOESN'T affect what joint?

Back 353

DIP

Front 354

Convasion disorder
h/p
tx

Back 354

1.Development of sensory
or motor deficits following stress without associated medical conditions or intention

2.
H/P

onset of sensory (e.g., paresthesias, blindness, deafness) or motor (e.g.,paralysis, loss of voice) deficits or pseudoseizures that generally
follow stressfulsituations
; symptoms cannot be linked to any findings on examination but cannotbe shown to be intentional

3.
Treatment

psychotherapy helps identify stressors with reactions and encouragesnormal responses to stressful situations; frequent self-resolution of symptoms

Front 355

What are 3 feared complications of parenchymal hemorrhage?

Back 355

SAH
uncal herniation
CSF obstuction
death

Front 356

What meds are first-line tx for RA?

Back 356

NSAIDs
DMARDs (MTX, sulfasalazine, hydroxychloroquine, etc)

Front 357

f/p factitious disorder

Back 357

a.Patient reports symptoms or signs of a given disease and attempts to induce dis-ease process (e.g., self-injections of insulin or excrement, attempts to becomeinfected by a pathogen, induction of GI illness, etc.)

b.Diagnosis requires
intentional production of symptoms or signs
by patient,
denial
of intention,
wandering
of patient from one physician to another, and
noclear incentive
for patient’s actions

Front 358

What neuro deficit would be seen with an infarction in the PCA

Back 358

inliat heminopia w/macular swelling

Front 359

Which diseases are a/w RF?

Back 359

RA
SLE
Sjorgen

Front 360

Delirium can be secondary to...

Back 360

Drugs
(e.g., alcohol, corticosteroids, benzodiazepines, oral contraceptive pills,antipsychotics, nonsteroidal anti-inflammatory drugs [NSAIDs], chemothera-peutics, isoniazid, anticholinergics, antihistamines, antiarrhythmics
Infection,
hypoxia
, or CNS abnormalities

Front 361

Which medications or medication withdrawal are known for causing seizures?

Back 361

1. lower threshold
- burpropion
- buspirone
= enflurane

2. withdrawal
- benzo
- barb
- alcohol
- antoconvuls

3. overdose
- theophylline

4. INH, B6 deficiency

Front 362

Anti Scl 70 antibodies

Back 362

scleroderma

Front 363

h/p of delirium

Back 363

acute fluctuating cognitive function with decreased level of consciousness.

usually aware of self.
though production disorganized, flight of ideas; may be delusions, hallucinations.

short-term memory impairment.

1)Altered level of consciousness with inattentiveness and confusion
(2)Change in cognition is not caused by preexisting dementia
(3)Changes in cognition develop quickly and fluctuate over course of day
(4)Changes are related to disease, medication, or drug use

b.Psychomotor agitation or retardation, disturbance of sleep patterns

c.Emotional instability

Front 364

What drugs are known for causing steven-johnson syndrome?

Back 364

antibiotics (sulfa, pen)

anticonvulsants (esp laotrigine)

allopurinol

Front 365

Anti Jo 1 antibodies

Back 365

dermatomyositis

Front 366

Mini-mental state examination.

Back 366

1. Orientation to time-—ask patient to identify year, season, date,day, and month (1 point each, 5 total)

2. Orientation to place—ask patient to name country, state, town,hospital, floor (1 point each, 5 total)

3. Registration—name 3 words and ask patient to repeat them (1 point for each correct repeat, 3 total)

4. Attention and calculation—ask patient to spell “world” backwardsor to count backward from 100 by 7s (5 points total)

5. Language (9 points total)
a. point at a pen and a watch and ask patient to name them (1 point each)
b. ask patient to repeat phrase “No ifs, ands, or buts”(1 point
)c. give patient a sheet of paper and ask to hold it in the right hand, fold it in half, and put it on the floor(1 point for each activity
)d. ask patient to close eyes (1 point)
e. ask patient to write a sentence (1 point)
f. ask patient to copy design b

Front 367

Which drugs are knon for inducing p450, thereby speeding up metabolism for other drugs such as OCPs and warfarin?

Back 367

quinidine
barbs
st. john's woth
phenyton

rifampin
griseofulvin
carbamazepine

Front 368

anti rnp

Back 368

mctd

Front 369

Etiologies of dementia

Back 369

a.
Alzheimer’s disease
: most common cause (>
70% of cases)

b.
Vascular dementia:
dementia caused by multiple cerebral infarcts (15% ofcases); features
neurologic symptoms
in addition to dementia

c.
Parkinson’s dementia:
dementia associated with Parkinson’s disease; risk fordementia significantly higher in patients with this disease than in those without it

d.
Alcohol-induced:
caused by chronic alcoholism; typically associated with aphasias

e.Less common causes: Huntington’s disease, normal pressure hydrocephalus,endocrine diseases, metabolic diseases, neoplasms, infection

Front 370

Status epilepticus work up

Back 370

CBC, electrolytes, glucose
LFTs
BUN, CR
urine
tox screen
hx of trauma, meds

CT -- hemorrhage, trauma, neoplasm
LP

Front 371

What is the treatment for SCFE?

Back 371

avoid weight bearing w/bed rest, crutches, and/or wheelchair until surgically repaired (surgical pinning)

Front 372

h/p of dementia

Back 372

a.
Key features
(1)Impaired memory
(2)Presence of either aphasia (i.e., impaired speech), apraxia (i.e., impairedpurposeful movement), agnosia (i.e., impaired recognition of objects), orimpaired executive function
(3)Impaired ability to function
(4)Unrelated to delirium

b.Symptoms are initially mild and progress gradually (weeks to months)

c.MMSE shows impaired cognitive function

Front 373

What is the empiric tx for brain abscess?

Back 373

drain & culture
abx -- cefatoxime, vancomycin
corticosteroids

Front 374

What is the empiric threatment for meningitis?

Back 374

ampicillin is added for patients over 55, immunocompromised patients, and patients taking corticosteroids

Front 375

Etiology of delerium?

Back 375

V vascular
I infxn
N neoplasm
D degenerative
I intoxication
C congential (epilepsy)
T trauma
I intraventricular (normal pressure hydroceph)
V vitamin deficiency
E endocrine (thryoid, Cushing, Addison, para)

M metals
A anoxia
D depression

Front 376

At what point does grief/bereavment become pathological?

Back 376

1. depression criteria met for at least 2 wks after the first 2 mo following the loss

2. generalized feelings of bitterness toward the deceased, detachment, agitation

3. distressing feelings that do not diminish in intenisty by 6 mo

4. inability to move on, trust others, and reengage in life by 6 mo

Front 377

potential complications of acute pancreatis

Back 377

exudative left-sided pleural effusion when the amylase concentration is high, abdominal compartment syndrome, intraabdominal hemorrhage, shock, diabetes, pancreatic pseudocyst formation, and abdominal pseudo aneurysm

Front 378

How to treat dementia?

Back 378

a.Treat underlying cause in rare cases of reversibility (e.g., metabolic, endocrine,infectious causes)

b.Cholinesterase inhibitors (e.g., tacrine, donepezil, rivastigmine) and memantinehelp to optimize remaining cognitive function; vitamin E supplementation mayalso help maintain cognitive function

c.
Occupational therapy
and
cognitive psychotherapy
is helpful for extendingindependence, maximizing function, and preventing accidents

d.Eventually, patient frequently require supervised care

e.Antipsychotics can be used to treat symptoms of psychosis; antidepressants canbe used to treat associated depression

f.Frequent reorientation of patient may help optimize function

Front 379

Neurotransmitter

anxiety disorders

Back 379

increased NE

decreased GABA, serotonin

Front 380

toxicity of FQ in children

Back 380

cartilage destruction and growth retardation in children

Front 381

ADHD h/p

Back 381

a.
Inattention
:
decreased attention span, difficulty following instructions,
care-lessness in tasks, easily losing items, forgetful, poor listening, easy distractibility,difficulty organizing activity, avoidance of tasks requiring prolonged focus

b.
Hyperactivity
: fidgetiness,
inappropriate activity,
excessive talking, unable toremain quiet, unable to remain seated at times when prolonged sitting is required, constantly “on the go”

c.
Impulsivity:
difficulty waiting turn to speak, interrupts others, answers ques-tions before they are completed

d.Children exhibit behaviors in
multiple setting

e.Diagnosis requires child to have
six
inattention symptoms
orsix
hyperactivity orimpulsivity symptoms
before 7 yr of age
that
limit ability to function
in social,educational, or organized settings

Front 382

Neurotransmitter

mania

Back 382

increased NE, serotonin

Front 383

When is immediate treatment for hyperkalemia deemed necessary?

Back 383

cardiac toxicity, muscular paralysis, K+>6.5

Front 384

Tx of ADHD

Back 384

a.Psychostimulants (e.g., methylphenidate, pemoline) or atomoxetine improveability to focus and control behavior

b.Bupropion, a-agonists, and TCAs are used in refractory cases

c.Psychotherapy used to address child’s self-esteem and help modify behavior

d.Adjustments may need to be made in selecting an educational setting to optimizeability to learn and participate

e.Limit consumption of food high in caffeine or sugar

Front 385

Neurotransmitter

parkinson disease

Back 385

increased ACh

decreased dopamine

Front 386

How does SSS present?

Back 386

erythema on face that generalizes within 24-48 hours. superficial flaccid blisters soon develop, with flexural accentuation and perioral crusting. Nikolsky signs positive. Subsequent scaling and desquamation continue for 5 days --- entire process lasts 1-2 weeks

Front 387

Conduct disorder
h/p
tx
complications

Back 387

1.Repetitive disruptive and antisocial behavior that violates others’ rights and socialnorms

2.
H/P

aggressive behavior
to people or animals,
destruction of property
,
deceit-fulness
or theft,
violation of serious rules
; diagnosis requires one of above behav-iors before
< 10 yr of age and three behaviors > 10 yr of age

3.
Treatment

psychotherapy involving family and parent management training;psychostimulants are helpful when comorbid ADHD is diagnosed; mood stabilizersmay be used in severe cases

4.
Complications

increased risk of substance abuse,
antisocial personality disorder

Front 388

Neurotransmitter

schizophrenia

Back 388

increased dopamine, serotonin

decreased GABA

Front 389

single, round, blue inclusions on Wright stain in RBCs

Back 389

Howell Jolly Bodies (nuclear remnants within RBCs that are usually removed by the spleen)

Front 390

Tourette's syndrome
h/p
tx

Back 390

1.Chronic tic disorder beginning in childhood; associated with ADHD and OCD

2.
H/P

multiple motor
(e.g., blinking, twitching, etc.) and
vocal
(e.g., sounds,words)
tics
that occur every day and worsen with stress; location, frequency, andseverity of tics change over time; diagnosis requires presence of tics for >
1 yr andbeginning before patient is 21 yr of age

3.
Treatment

psychotherapy with family addressing nature of tics; low-dosefluphenazine, pimozide, or tetrabenazine may reduce tic occurrence; SSRIs are use-ful in treating comorbid behavioral disorders

Front 391

Neurotransmitter

depression

Back 391

decreased NE, dopamine, serotonin

Front 392

Classic tetrad of MM

Back 392

calcium, renal impairment, anemia, bone problems
--> increased risk of infxn due to a total decrease in functional antibodies and leukopenia secondary to bone marrow crowding with malignant plasma cells

Front 393

h/p learning disabilities

Back 393

1.
Impairment in educational development
in a
healthy
child with
no
otherpsychiatric diagnosis or cognitive pathology (e.g., Down syndrome, fragile Xsyndrome)

2.Disorder can be specific to ability to read, perform mathematics, or expressthoughts

3.
H/P

a.Child demonstrating otherwise
normal intelligence
with
delays in certain aca-demic goals
b.Child frequently has poor self-esteem
c.Disabilities can include language delays, impaired coordination, poor memory,inattentiveness, spatial or temporal ordering skills

4.
Labs

scores on standardized tests are consistently lower than normal range

5.
Treatment

special education and therapy focusing on the specific learning disor-der can help the child to improve his or her ability to learn; parent education;child’s strengths should be recognized and encouraged

Front 394

Neurotransmitter

alzheimer's

Back 394

decrased ACh

Front 395

Common findings in SLE

Back 395

fatigue, painless oral ulcers, non-deforming arthritis, and hematologic abnormalities

Front 396

h/p autism

Back 396

a.
Impairedsocialinteractions
:impairedusedofnonverbalbehaviors,failuretodeveloppeerrelationships,failuretoseeksocialinteraction,lackofsocialreci-procity

b.
Impaired communication
: developmental language delays, poor initiation orsustenance of conversation, repetitive language, lack of imaginative or imitativeplay for age

c.
Restricted behavior
: inflexible routines, preoccupation with a restricted patternof interest, repetitive motor mannerisms, preoccupation with parts of objectsd.

Delays in language, imaginative play, and social interaction <3 yr of age

e.Diagnosis requires at least six abnormal patterns of interpersonal interactions,including at least two impaired social interactions and at least one of bothimpaired communication and restricted behavior

Front 397

Neurotransmitter

Huntington's

Back 397

decreased ACh, GABA

Front 398

How does head elevation lower ICP?

Back 398

Increased venous outflow from the head

Front 399

tx autism

Back 399

a.Behavior, speech, and social psychotherapy with peers and family may helpimprove social interaction

b.Aggressive behavior can be treated with antipsychotics

c.Supervised environment is usually required long term

Front 400

Comparing ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage, hat are the different BP goals and medications?

Back 400

ISCHEMIC STROKE
<220/120
use labetalol, nicardipine

Intracerebral hemorrhage
SBP < 140-160
use labetalol, nitroprusside

SAH
SBP < 150
use labetalol, nimodipine

Front 401

How does sedation lower ICP?

Back 401

decreased metabolic demand and control of HTN

Front 402

What is the tx of choice of mania w/psychosis?

Back 402

atypical antipsychotics

Front 403

How does IV mannitol lower ICP?

Back 403

extraction of free water out of the brain tissue --> osmotic diuresis

Front 404

What are the medications used in the management of Parkinsonian symptoms?

Back 404

- levodopa and carbidopa
- selegiline (MAOb inhib) used in early disease, has neuroprotective effects
- dopamine agonists:
-- bromocritine (ergot compound)
-- non-ergot D3 stimulators -- pramipexole, ropinirole, rotigotine (transdermal)
-- apomorphine (subQ) rescue therapy for sudden akinetic episodes

- COMT inhibitors to potentiate levodopa: entacapone, tolcapone

- anticholinergics for tremor: thrihexyphenidyl, benztropine

- amantadine to increase DA release. use in short-term monotherapy in mild disease

Front 405

How does hyperventilation lower ICP?

Back 405

CO2 washout, leading to cerebral vasoconstriction

Front 406

What are characteristic featurs of ALS? What are the initial presenting symptoms?

Back 406

wealness, but with normal sensation

initial presenting sx:
- asymmetric lumb weakness in hands and fingers, shoulder girdle, foot drop, or pelvic girdle(80%)
- dysarthria, dysphagia (20%)

UMN signs
LMN signs
cognitive defects
neuromuscular resp failure after months to years (avg. survival time from dx is 3-5 years)

Front 407

PT/PTT with lupus anticoagulant?

Back 407

PTT may be slightly prolonged because it is an IgM or IgG immunoglobulin that prolongs the PTT by binding the phospholipids used in the assay. Strictly a lab artifact and does not actually promote bleeding. PTT will not correct in a mixing test. Russell viper venom test is designed to test for the lupus anticoagulant.

Front 408

What are UMN symptoms?

Back 408

movement stiffness, slowness, and incoordination; spasticity and hyperreflexia (spastic paralysis); slowed rapid alternating moevments; gait disorder

- bulbar UMN: dysarthria, dysphagia
- pseudobulbar affect ith inappropriate laughing, crying, yawning

Front 409

Causes of anterior cord syndrome? How is it characterized?

Back 409

commonly a/w brust fracture of the vertebra and is characterized by total loss of motor function below the level of lesion with loss of pain and temp sensation on both sides below the lesion and with intact proprioception

Front 410

What are LMN symptoms?

Back 410

weakness, gait disorder, reduced reflexes (spastic paralysis), muscle atrophy and fasciculations

Front 411

Anterior mediastinal masses:

Back 411

thymoma
retrosternal thyroid
teratoma
lymphoma

Front 412

What are the C's of Huntington's

Back 412

CAG repeat disorder on chromosome Cuatro

Caudate and putamen atrophy on MRI

aCh decrease, GABA increase

CRAZY (dementia)
Choreoform movements
Cuarenta (40) age of onset

Front 413

Posterior mediastinal masses:

Back 413

neuroblastoma
meningocele
enteric cysts
lymphomas
diaphragmatic hernia
esophageal tumors
aortic aneurysms

Front 414

What medication is used to treat ALS?

Back 414

riluzole

Front 415

Wegeners

Back 415

triad -- systemic vasculitis, upper and lower airway granulomatous inflammation, and glomerulonephritis.
Disease onest usually around 40
granulomatous inflammation in the nasopharynx causes epistaxis, purulent rhinorrhea, otitis, sinusitis, saddle nose deformity due to destruction of nasal cartilage
+C-ANCA

Front 416

dementia with behavioral and personality changes, progressive aphasia

Back 416

Pick disease

Front 417

Constrictive pericarditis complications

Back 417

hepatogmegaly, ascites, and increased JVP due to decreased diastolic filling and impairment of CO. Common causes include radiation therapy, viral pericarditis, and cardiac surgery.

Front 418

dementia with bradykinesia, Parkinsonian gait, cogwheel rigidity.

visual hallucinations

repeated syncopal episodes

Back 418

Lewy body dementia

Front 419

Which UTI drugs are recommended in pregnancy?

Back 419

nitrofurantoin, amoxicillin, augmentin, cephalexin

Front 420

what are the components of a dementia work up?

Back 420

MMSE
CBC, chemitry
urinalysis
RPR (syphillis)
HIV
thyroid
vit B12
CT or MRI of head

Front 421

What is Osgood-Schattler?

Back 421

rapid growth in which the quad tendon puts traction on the apophysis of the tibial tubercle where the patellar tendon inserts.
aka traction apohysitis

Front 422

what medications are used in the treatment of Alzheimer

Back 422

AChE inhibitors

rivastigmine, donazepil, galantamin, memantine

Front 423

Tamoxifen carries the risk of what malignancy?

Back 423

Endometrial cancer?

Front 424

What is the most sensitive test for MS?

Back 424

MRI

LP shows oligioclonal bands

Front 425

Rapidly progressive dementia, myoclonus and sharp, triphasic, synchronous discharges on EEG.

Back 425

CJD (spongiform encephalopathy)

Front 426

What is the classic presentation of Guillan Barre?

Back 426

progressive, symmetric, ascending muscle weakness that progrsses over days to one month.

no fever, may be preceeded by campylobacter jejuni diarrheal illness, HIV infection, CMV or EBV, mycoplasma infection, other viral infxns, or immunization

Front 427

When does breast milk engorgement occur?

Back 427

common the the 1st 24-72 hours after childbirth secondary to milk accumulation, typically peaks 3-5 days postpartum and improves spontaneously in most patients

Front 428

Ho is the dx of guillain barre made?

Back 428

clinical presentation

CSF analysis shows albuminocytologic dissociation (elevated protein and normal WBCs)

electrodiagnostic studies: nerve conduction studies and EMG reveal demyelination

Front 429

What is the mechanism behind cold water immersion in treating PSVT?

Back 429

Vagal maneuvers, wuch as Valsalva, carotid sinus massage, and immersion in cold water increase vagal tone and decrease conduction through the AV node. Slows the HR and can often break the rhythm.

Front 430

What is the prognosis in gullain barre?

Back 430

spontaneous regression and complete recovery by 1 year in 80-90%

relapse in 10%

prolonged disease with delayed or incomplete recovery in 5-10%

death despite ICU care in 5%

Front 431

When should suspicion be raised for gestational trophoblastic disease?

Back 431

irregular vaginal bleeding >8wks post partum, enlarged uterus, pelvic pain, frequent metastatic spread to the lungs

Front 432

What is the tx for guillan barre?

Back 432

hospitalization, ventilation if necessary, ICU monitoring if necessary

plasmapheresis or IVIG can shorten time to independent walking by 50%

NO STEROIDS

physical rehab

Front 433

How are gout and polycythemia vera related?

Back 433

Gout results from either overproduction or under excretion of uric acid. Myeloproliferative disorders commonly cause uric acid overproduction b/c there is increased catabolism and turnover of purines.

Front 434

What is rqd to make dx of Bell's palsy?

Back 434

Clinical:

1. diffuse involvement of the entire facial nerve -- facial muscle paraylsis (upper and lower)

r/o Lyme by history of tick bite, heart blocl,arthritis, vertigo,haring loss

r/o otitis media by inspection

r/o stroke by looking for other neurologic deficits

2. acute onset 1-2 days,progressively worsening weakness for 3 weeks, recovery w/i 6 mo

3. anything other than the above presentation rqs CT and/or MRI and screening blood tests to r/o other pathology

Front 435

When to suspect trichinellosis?

Back 435

Suspect trichinellosis (parasitic infection caused by roundworm acquired by eating undercooked pork) in a patient who presents with Gi complains followed by the characteristic triad of periorbital edema, myositis, and eosinophilia. Other clues include subungal hemorrhages and conjunctival or retinal hemorrhages

Front 436

Causes for Bell's palsy?

Back 436

my Lovely Bell Had an STD

Lyme
Herpes
Sarcoid
Tumor
Diabetes

Front 437

In an exudative pleural effusion, how are glucose values used?

Back 437

glucose < 30 suggests empyema or rheumatic effusion
glucose 30-50 indicates effusion due to malignancy, lupus, esophageal rupture, or TB
glucose concentration is thought to be decreased in exudative pleural effusions due to high metabolic activity of leukocytes (and/or bacteria) in the fluid.

Front 438

What is the treatment for Bell's palsy?

Back 438

1. eye care to prevent corneal trauma
- artifical tears hourly while awake,patching eye at night

2. glucocorticoids

3. +/- vacyclovir

Front 439

How to treat/manage CGD?

Back 439

CGD treatment includes prevention of infxn daily with TMP-SMX and gamma-interferon three times a week

Front 440

What are the treatment options ofor benign esential tremor?

Back 440

b-blocker
primidone
xlonazeam
talamotomy or deep brain stimulation in refractory cases

Front 441

Cardiac risks for a poor surgical candidate?

Back 441

EF < 35%: increased risk for non cardiovascular
Recent MI: must defer the surgery 6 mo
CHF: medically optimize the patient with ACE inhibitor, beta-blockers, and spironolactone to decrease mortality

Front 442

How can Bell's palsy be easily differentiated from a motor cortex stroke?

Back 442

Facial paraylsis --
Bells demonstrates complete unilateral facial paralysis (upper and lower face)

Stroke stems from a lesion in the motor cortex, there will only be lower face paralysis as the upper face is innervated by both sides of the motor cortex

Front 443

What is the most common cyanotic lesion during the neonatal period?

Back 443

transposition of great arteries

Front 444

Compare changes in sleep patterns of the elderly to the changes in slee patterns seen in depressed patients

Back 444

elderly --
less REM sleep
increased REM latency
decreased slow wave sleep (stage 3/4)

DEPRESSED
early morn awaken, nighttime awake
increased total REM
decreased REM latency
decreased slow wave

Front 445

How to diagnose choanal atresia?

Back 445

CT

Front 446

What is Pickwickian syndrome?

Back 446

obesity hypoventilation syndrome characterized by hypersomnolence, dyspnea, hypoxemia (resulting in cyanosis, polycythemia, and plethora), and pulmonary hypertension (leading to right-sided) heart failure --> peripheral edema

decreased chest wall compliance

Front 447

diptheria == membranous inflammation of pharynx

Back 447

due to bacterial invasion by corneyumbacterium diphtheria; gray highly vascular pseudomembranous plaques on the pharyngeal wall; do not scrape; culture small portion of superficial membrane -- antitoxin

Front 448

What is the tx for narcolepsy?

Back 448

avoidance of drugs that cause sleepiness

scheduled naps -- once or twice a day 10-20 minutes

stimulants -- modafinil, methylphenidate, or pemoline

suport group

if cataplexy --> venlafaxine, fluoxetine, or amtomoxetine

Front 449

fifth disease

Back 449

== erythema infectious = parvo B19

Front 450

What are treatments for restless leg syndrome? causes for RLS other than idiopathic?

Back 450

pramipezole or ropinirole or levodopa/varbidopa, iron replacement, avoid caffeine, xlonazepam, gabapentin, opiods

iron deficiency, end-stage renal disease, diabetic neuropathy, parkinson disease, pregnancy, RA, varicose veins, caffein

Front 451

Roseola

Back 451

HHV 6/7

Front 452

What EEG waveforms correspond to the different stages of sleep?

Back 452

Stage 1 light, theta waves; fast, low amp

Stage 2 intermediate; sleep spindles and k-complexes; decreased frequency, increasing amplitude

Stage 3 deep; slow delta wave; low frequency, high amplitude

REM
beta wave; high requency, low amplitude

Front 453

When is Legg-Calve-Perthes disease seen?

Back 453

ages 2-8

Front 454

How does SCFE present? Treatment?

Back 454

painful limp and EXTERNALLY rotated leg

internal fixation with pinning

Front 455

What measurements make for a positive tilt test?

Back 455

increased in HR > 20 BPM while standing

drop in SBP > 20 points while standing

stop in DBP > 10 points while standing

Front 456

Up to what GA should steroids me giving in prevention of ARDS?

Back 456

33 weeks

Front 457

What is the DD for a patient presenting to the ER for loss of consciousness?

Back 457

AEIOU TIPS

Alcohol
Epilepsy/environmental
Insulin
OD/opoids
Uremia

Trauma
Infection
Psychogenic
Stroke

Front 458

Stages of labor

Back 458

Stage 1 (latent & active):
ONSET OF LABOR --> FULL DILATION OF CERVIX
primi -- 6-18 hours
multi -- 2-10

Latent phase:
ONSET OF LABOR --> 4 cm
6-7 hr; 4-5 hr

Active phase:
4cm dilation --> full dilation
1 cm per hour; 1.2 cm per hour

Stage 2:
full dilation of cervix --> delivery of neonate
30 min - 3 hr; 5 min -30 min

Stage 3:
delivery of neonate --> delivery of placenta
30 min

Front 459

What should you think about for initial empiric therapy in a patient coming into the ER with loss of consciousness?

Back 459

thiamine, then glucose, nalaxone

Front 460

What is the treatment for JIA?

Back 460

NSAID
DMARDs (MTX)
steroids

Front 461

Why is thiamine given in a glucose infusion to alcoholics with hypoglycemia?

Back 461

flucose administration in the absence of thamine can theretically exacerbate damage to the mammillary bodies and worsen wernicky encephalopathy

Front 462

7 year old wtih growth delay and inner thigh pain

Back 462

LCP

Front 463

What are the elbows doing in decorticate position?

Back 463

flexing

Front 464

Claw hand

Back 464

ulnar

Front 465

What is arnold chiari malformation? What are neuro anomalies a/w it?

Back 465

downward displacement of the cerebellar tonsils and medulla through the foramen magnum

type I most common and often asymtomatic. manifestations may include headaches and/or cerebellar symptoms

type II usually accompanied by other neurologic abnormalities --
syringomyelia
hydrocephalus
myelomeningocele

Front 466

Ape hand

Back 466

median

Front 467

What does cerebral palsy look like in a neonate?

Back 467

lethagry
decreased spontaneous movement
hypotonia

Front 468

Unable to wipe botten

Back 468

tharcodorsal

Front 469

describe what light reflexes will be seen in both eyes if the right optic nerve is damaged prior to the retectal nucleus? (aka afferent defect)

Back 469

no constriction in either right of left eye

constriction in both eyes when light shines in left eye

Front 470

Loss of forearm pronation

Back 470

median

Front 471

hat light reflexes will be seen in both eyes if the right oculomotor nerve is damaged (aka efferent defect)?

Back 471

right eye will not constrict under any cirumstance

left eye will constrict when light is shone in either eye

Front 472

Cannot abduct or adduct fingers

Back 472

ulnar

Front 473

What is amblyopia and hat are the signs/symtomes?

Back 473

decreased vision due to a disruption in normal develoement of vision usually from strabismus, cataracts, or refreactive error prior to age 10

possible presentations: esotropia, exotopia, diploia,and/or refractory error not corrctable ith lenses

Front 474

Loss of shoulder abduction

Back 474

ulnar

Front 475

What is themost common cause of blindness in the adults?

Back 475

over 55 macular degeneration

under 55 DM

blacks of any age glaucoma

Front 476

Weak external rotation of arms

Back 476

suprascap/axillary

Front 477

Which cause of red eye may indicate collagen vascular disorder?

Back 477

uvetis or scleritis

Front 478

loss of elbow and wrist flexion

Back 478

musculocutaneous

Front 479

Which cause of red eye has the potential serious complication of corneal ulceration?

Back 479

HSV

Front 480

Trouble INITIATING should abduction

Back 480

supraspinatus

Front 481

Which cause of red eye presents with colored halos?

Back 481

acute angly closure glaucoma

Front 482

Unable to abduct arm beyond 10 degrees

Back 482

axillary

Front 483

Which cause of red eye presents with preauricular lymph node enlargement?

Back 483

viral

Front 484

Unable to raise arm above horizontal

Back 484

long thoracic/spinal accessory

Front 485

What is the treatment for orbital cellulitis?

Back 485

1. immediate IV vancomycin + IV cefotaxime until afebrile and clinically improved (3-5 d) then oral abx (based on sensitivity) for 2-3 weeks

2. consult opthamology and ENT for recommendations and consideration for need of surgical debridement

Front 486

What is the treatment for acromegaly?

Back 486

octreotide

cromocriptine/cabergoline

pegvisomat

surgery

Front 487

What is the classic presentation of a patient that has a cataract?

Back 487

painless, progressive decrease in vision manifested ith difficulty driving at night, reading road signs, or reading fine-print

- usually bilateral bur often unilateral

- near0sightedness oftn an ealy manifestation

ossible disabling glare in bright sunlight or from oncoming headlights (more likely with steroid induced cataracts)

Front 488

What type of diuretic is ethracrynic acid? metolazone?

Back 488

loop

thiazide
(useful for edema a/w nephrotic syndrome)

Front 489

What is a major exam finding in open angle glaucoma?

Back 489

cupping of the optic disc (>50%)
bilaterl
gradual loss of visual fields (periheral to central)

Front 490

How to manage calcium nephrolithiasis? When to use shock wave?

Back 490

If < 4mm, will spontaneously pass
--> drink water, tamsulosin, nifedipine, NSAIDs, repeat CT in 4 weeks to make sure all stones have passed.

shock for stones in renal pelvis or upper ureter

Front 491

hat is the treatment for closed angle glaucoma?

Back 491

acteozolamide
pilocarpine
laser irdiotomy

Front 492

How to treat Staghorn calculi

Back 492

percutaneous nephrolithotomy

Front 493

What disease would you suspect in a 35 year old woman with new-onset rapid loss of vision and pain when moving the eye? How to treat?

Back 493

MS

IV stroids

Front 494

What are the dietary recommendations in the threatment of nephrolithiasis?

Back 494

adequate dietary Ca
increased fluid intake
decreased sodium
decreased dietary protein and oxalate

Front 495

What is the treatment for macular degeneration? What is the treatment for retinal detachment?

Back 495

macular degen -- vitamins C, E, Cu, Zn, intravitreal ranibizumab, laser photocogaulation of the lenses

retinal detatchment -- surgery, cryotherapy

Front 496

What is the treatment for uric acid renal stones?

Back 496

alkanaize urine

Front 497

What is the DD for dislocation of the lens of the eye?

Back 497

Marfan (upward)
Homocystinuia (downward)
Alport Syndrome

Front 498

What renal pathology can result from uncorrected serve benign prostatic hypertrophy?

Back 498

hydronephrosis

Front 499

What is the pattern of vision loss in glaucoma vs. macular degeneration?

Back 499

Glaucoma -- loss from peripheral to centra

Macular degeneration -- loss from central to peripheral

Front 500

What cardiac anomalies are a/w ADPKD?

Back 500

MVP

Front 501

When is observation without antibiotics appropriate for a child with acute otitis media?

Back 501

- age 6 mo - 2 yrs + the diagnosis is questionable + illness not severe + appropriate follow-up available + abx can be started promptly if symptoms worsen

- age > 2 yrs + illness is not severe + appropriate follow-up available + antibiotics can be started promptly if symptoms worsen

- abx should be started if improvements is not noted in 48-72 hours

Front 502

A 60 year old male smoker is found to have a varicocele that does not empty when the patient is recumbent. What should you be suspicious of in the this patient?

Back 502

RCC

Front 503

What are the classic signs and symptoms of bullous myringitis?

Back 503

bullous myringitis is a bullous/vesicular inflammation of the tympanic membrane that may occur in a/w acute otitis media. Manifests as
- more painfaul than usual acute otitis media
- otoscopy: large, reddish vesicles on TM

Front 504

What is the greatest risk factor for RCC?

Back 504

smoking

Front 505

hat is the tx for bullous myringitis?

Back 505

mycoplasma pneumonia is a common organism, treat with oral macrolides and toocal analgesics

Front 506

Hyaline casts

Back 506

not indicative of disease -- dehydration

Front 507

What are the diagnostic features of mastoiditis?

Back 507

symptoms occur days to weeks after developing acute otitis media

erythema, edema, tenderness behind the ear

external ear displaced

diagnosis made from CT scan of the mastoid process

Front 508

Granular casts

Back 508

chronic renal disease

Front 509

What are the distinguishing features of acute labyrinithitis?

Back 509

- acute onset of vertigo, nausea, vomiting, and nystagmus
- HEARING LOSS
- lasts days to weeks, often preceded by a viral URI

nystagmus -- horizontal, suppressed with visual fixation, and has a fast phase from the affected size

abnormal head thrust test: when examiner rapidly turns the patient's head to the affected side, the patient is unable to maintain visual fixation

gait instability but preserved ambulation

absence of focal nurologic defects

Front 510

Red cell casts

Back 510

GN or vasculitis

Front 511

Acute onset of vertigo, nausea, vomiting, nystagmus

AUDITORY FUNCTION PRESERVED

Back 511

vestibular neuritis

Front 512

White cell casts

Back 512

pyelonephritis, acute interstitial nephritis

Front 513

What is the treatment for acute labyrinithis?

Back 513

Typically subsides spontaneously within weeks.

steroid tapering

symptomatic treatment -- only in the first 48 hours of illness
- scopolamine, meclizine, metochloropramide, or promethazine
- long-term recovery is theoretically delayed if long-term use

vestibular rehabilitation exercises

MRI if > 60, headache, focal neuro signs, vascular risk factors, or sustained veritgo inconsistent with acute labyrinithitis

Front 514

Epithelial cell casts

Back 514

"muddy brown"

ATN, acute GN

Front 515

What is the underlying cause of benign paroxysmal positional vertigo?

Back 515

dislodgement of otolith in inner, interfering with semi circular canal stabilization

Front 516

IF: granular pattern of immune complex deposition

LM: hypercellular glomeruli

Back 516

postinfectious GN

Front 517

What is the most common causee of conductive hearing loss in adults?

Back 517

conductive -- otosclerosis
sensorineural -- prebycusis

Front 518

IF: linear pattern of immune complex deposition

Back 518

Goodpasture

Front 519

What is a cholestaetoma? What are causes? How does it present on physical exam? What is treatment?

Back 519

- overgrowth of desquamated keratin debris within the middle ear sace that may eventually erode the ossicular chain and external auditory canal

- causes: negative middle ear pressure (chronic retraction pocket) from eustachian tub dysfxn or direct growth of epithelium through a TM perforation

- commonly a/w chronic middle ear infxn

- PE: grayish-white pearly lesion behind or involving the TM, conductive hearing loss,vertigo

- tx: surgical removal usually involving tympanomastoidectomy and reconstruction of the ossicular chain

Front 520

Nephrotic syndrome a/w HBV

Back 520

membranoprolieferative

Front 521

What is the tx for Ramsay Hunt syndrome? (What is it?)

Back 521

herpes zoster oticus

analgesia
steroids
antiviral therapy

Front 522

Apple-green birefringence with Congo-red stain under polarized light

Back 522

renal amyloidosis

Front 523

Explain ho the Weber test can help distinguish conductive hearing loss from sensorineural hearing loss.

Back 523

If conductive hearing loss, sound will concentrate to affected side.

If sensorineural hearing loss, sound will lateralize to the unaffected side

Front 524

positive ANCA glomerular disease

Back 524

crescentic

Front 525

hat is the tx for bullous myringitis?

Back 525

mycoplasma pneumonia is a common organism, treat with oral macrolides and toocal analgesics

Front 526

EM: spike and dome pattern of BM

Back 526

membranous

Front 527

What are the diagnostic features of mastoiditis?

Back 527

symptoms occur days to weeks after developing acute otitis media

erythema, edema, tenderness behind the ear

external ear displaced

diagnosis made from CT scan of the mastoid process

Front 528

what is the ACLS treatment for systole?

Back 528

CPR 30:2

epi 1 mg Q 3-5 min
consider vasopression

eval and treat cause

Front 529

What are the distinguishing features of acute labyrinithitis?

Back 529

- acute onset of vertigo, nausea, vomiting, and nystagmus
- HEARING LOSS
- lasts days to weeks, often preceded by a viral URI

nystagmus -- horizontal, suppressed with visual fixation, and has a fast phase from the affected size

abnormal head thrust test: when examiner rapidly turns the patient's head to the affected side, the patient is unable to maintain visual fixation

gait instability but preserved ambulation

absence of focal nurologic defects

Front 530

A patient is found to have fever, rash, elevated Cr, and esosinophilia. What is the dx?

Back 530

acute interstitial nephritis

Front 531

Acute onset of vertigo, nausea, vomiting, nystagmus

AUDITORY FUNCTION PRESERVED

Back 531

vestibular neuritis

Front 532

In prerenal acute renal failure, what is the value for the fraction excretion of sodium (FENa)? For the BUN:Cr ratio?

Back 532

< 1%

> 20

Front 533

What is the treatment for acute labyrinithis?

Back 533

Typically subsides spontaneously within weeks.

steroid tapering

symptomatic treatment -- only in the first 48 hours of illness
- scopolamine, meclizine, metochloropramide, or promethazine
- long-term recovery is theoretically delayed if long-term use

vestibular rehabilitation exercises

MRI if > 60, headache, focal neuro signs, vascular risk factors, or sustained veritgo inconsistent with acute labyrinithitis

Front 534

What medications are necessary in patients with end stage renal disease?

Back 534

glucose control
looop
daily ASA
statin
cit S
iron + epo
phosphate binders

Front 535

What is the underlying cause of benign paroxysmal positional vertigo?

Back 535

dislodgement of otolith in inner, interfering with semi circular canal stabilization

Front 536

What is the most common cause of death in dialysis patients?

Back 536

CV disease

Front 537

What is the most common causee of conductive hearing loss in adults?

Back 537

conductive -- otosclerosis
sensorineural -- prebycusis

Front 538

What is the next step in the diagnosis of cholecystitis when the US is equivocal?

Back 538

HIDA scan

Front 539

What is a cholestaetoma? What are causes? How does it present on physical exam? What is treatment?

Back 539

- overgrowth of desquamated keratin debris within the middle ear sace that may eventually erode the ossicular chain and external auditory canal

- causes: negative middle ear pressure (chronic retraction pocket) from eustachian tub dysfxn or direct growth of epithelium through a TM perforation

- commonly a/w chronic middle ear infxn

- PE: grayish-white pearly lesion behind or involving the TM, conductive hearing loss,vertigo

- tx: surgical removal usually involving tympanomastoidectomy and reconstruction of the ossicular chain

Front 540

Normal pH range

Back 540

7.35 - 7.45

Front 541

What is the tx for Ramsay Hunt syndrome? (What is it?)

Back 541

herpes zoster oticus

analgesia
steroids
antiviral therapy

Front 542

Normal PCO2 range

Back 542

35-45

Front 543

Explain ho the Weber test can help distinguish conductive hearing loss from sensorineural hearing loss.

Back 543

If conductive hearing loss, sound will concentrate to affected side.

If sensorineural hearing loss, sound will lateralize to the unaffected side

Front 544

Normal O2 range

Back 544

75-105

Front 545

What are two important symptoms in Meniere disease to remember in addition to vertigo, decreased hearing, nausea, and vomiting?

Back 545

tinitus

ear fullness

Front 546

Normal CO2 range

Back 546

22-28

Front 547

Type I RTA

urine pH
serum K
serum HCO3

Back 547

distal RTA

urine pH > 5.3
serum K low
serum HCO3 variable

Front 548

Type II RTA

urine pH
serum K
serum HCO3

Back 548

proximal RTA

urine pH variable
serum K low
serum HCO3 low

Front 549

Type IV RTA

urine pH
serum K
serum HCO3

Back 549

hyporeninemic hypoaldosteronism

urine pH < 5.3
serum K high
serum HCO3 normal

Front 550

What is the DD for metabolic acidosis with a normal anion gap? How can serum K be useful in narrowing the DD?

Back 550

Low K:
RTA (I&II)
diarrhea
Fanconi syndrome

High K:
Addison disease
RTA (IV)
hyperalimentation

Front 551

What urine and serum osmolality would you expect to see with SIADH?

Back 551

Urine Na > 20

Urine osmolality increased/concentrated (>100)

Front 552

What urine and serum osmolality would you expect to see with psychogenic polydipsia?

Back 552

Urine Na < 20

Urine osmolality decreased/dilute (<100)

Front 553

What urine and serum osmolality would you expect to see with thiazides?

Back 553

increased urine Na

increased urine Osm

Front 554

What urine and serum osmolality would you expect to see with alcoholism?

Back 554

decreased urine Na

decreased urine Osm

(blocks ADH)

Front 555

What urine and serum osmolality would you expect to see with hypothyroidism?

Back 555

increased urine Na

increased urine osmolality

Front 556

What is the DD for hypovolemic hyponatremia based on urine Na levels?

Back 556

< 10
extrarenal losses -- GI losses, fluid sequestion (peritonitis, pancreatitis), insensible loss (sweating, extensive burns)

> 10
renal losses -- diuretics, salt-losing renal disease, partial urinary tract obstruction, adrenal insufficiency

Front 557

What is the DD for hypervolemic hyponatremia based on urine Na?

Back 557

< 10 CHF, cirrhosis, nephrotic syndrome

> 20 renal failure

Front 558

What is the consequence of correcting hyperNa? How rapidly can it safely be corrected?

Back 558

cerebral swelling

max Na reduction 12mEq/d

Front 559

What is the consequence of correcting hypoNa? How rapidly can it safely be corrected?

Back 559

central pontine myelinosis

rehydrate < 12 mEq/d

Front 560

What is the treatment for nephrogenic DI?

Back 560

salt restriction
increased H2O intake
thiazide
treat underlying conditions

Front 561

Causes for K shift out of cells (hyperkalemia)

Back 561

b-blockers
low insulin
acidosis
digoxin
cell lysis

Front 562

Causes for K shift into calls (hypokalemia)?

Back 562

insulin
b-agonists
alkalisus
cell creation/proliferation

Front 563

A 72 year old smoker presents with painless gross hematuria. What study should be ordered to confirm the diagnosis of bladder cancer?

Back 563

urine cytology
biopsy and cytoscopy

Front 564

What are the treatment options for urge incontinence?

Back 564

anticholinergics (oxybutynin)
imipramine
duloxetine

Front 565

What are the common causes of overflow incontinence?

Back 565

bladder outlet obsturction
- benign prostatic hyperplasia
- uretal strictures

neurogenic bladder

Front 566

Name two classes of prescription medications used to treat BPH

Back 566

a blocker (tamsulosin)

5a reductase inhibitor (finestaride)

Front 567

Treatment of epididymitis

Back 567

Under 35, ceftriax + doxy

Over 35, FQ

Front 568

necrotizing granulomas of lung and necrotizing GN?

Back 568

Wegener

Front 569

necrotizing immune complex inflammation of visceral/renal vessels

Back 569

PAN

Front 570

What is the treatment for SVC syndrome?

Back 570

radiation
steroids

Front 571

What two disorders should come to mind when a neonate has meconium ileus?

Back 571

CF
Hisrchsprung

Front 572

what is the classic presentation of the most common renal tumor in children?

Back 572

most common age < 4
palpable flank mass
ab pain
hematuria
hypertension
possibly other congenital malform (WAGR)

Front 573

What is the treatment for hereditary spherocytosis?

Back 573

folic acid
splenectomy

Front 574

What are the iron study values in anemia of chronic disease?

Back 574

increased ferritin

Front 575

What would you see on a blood smear of a patient with anemia due to lead poisoning?

Back 575

sideroblasts
basophilic stippling

Front 576

List three acquired causes of sideroblastic anemia

Back 576

lead toxicity
alcohol
INH

Front 577

What complication occurs in 10% of patients with sideroblastic anemia?

Back 577

acute leukemia

Front 578

Which vaccines are important in children with sickle cell disease?

Back 578

pneumococcal
HiB
meningo
influ
HBV

Front 579

What drugs are known for causing elevated prolactin levels?

Back 579

bromocriptine
antipsychotics
methyldopa
verapamil

Front 580

What substances are known to cause hemolysis in patients with G6PD deficiency?

Back 580

fava
antimalarial
sulfaABx
INH
nitrofurantoin

Front 581

What is the DD for serum esosinophilia?

Back 581

Drugs
Neoplasm
Allergies, asthma (Chrug-Strauss), allergic broncopulmonary aspergillosis
Adrenal insufficiency (Addison disease)
Acute interstitial nephritis
Collagen vascular disease (PAN, dermatomyosistis)
Parasites

Front 582

What is the mechanism for steptokinase?

Back 582

fibrinolysis

Front 583

What is the mechanism for aspirin?

Back 583

inhibits platelet aggregation via COX inhibitor

Front 584

What is the mechanism for clopidogreal?

Back 584

blocks ADPr, suppress fibrinogen

Front 585

What is the mech for abiciximab?

Back 585

bind GIIIb/IIa

Front 586

What is the mechanism for tirofiban?

Back 586

thrombin inhibitor

Front 587

What is the mechanism for exoxaparin

Back 587

bind factor Xa

Front 588

What is the mechanism for epitifibatide?

Back 588

GpIIIb/IIa inhibitor

Front 589

What is the classic pentad for TTP?

Back 589

hemolytic anemia
thrombocytopenia
uremia
neurologic disease
fever

Front 590

What lab test is used to monitor warfarin?

What heparin?

LMWH?

Back 590

PT/INR

PTT

antifactor Xa

Front 591

What are the most common causes of DIC?

Back 591

Sepsis
Trauma
OB complications
Pacreatitis

Malignancy
Transfusions

Front 592

HUS or TTP

Platelet Count
Bleeding Time
PT
PTT

Back 592

Platelet Count DECREASED
Bleeding Time INCREASED
PT none
PTT none

Front 593

Von Willebrand disease

Platelet Count
Bleeding Time
PT
PTT

Back 593

Platelet Count no change
Bleeding Time INCREASED
PT no change
PTT INCREASED

Front 594

DIC

Platelet Count
Bleeding Time
PT
PTT

Back 594

Platelet Count no change
Bleeding Time INCREASED
PT INCREASED
PTT INCREASED

Front 595

What is the most common mutation that predisposes to venous thrombosis in white patients?

Back 595

factor V leiden

Front 596

A post op patient has poor urine output, a BUN of 85, Cr of 3, and clear lungs. What is the next step in the management of this patient?

Back 596

BUN:Cr > 20, indicating dehydration/prerenal

IVf
cath
UA
vitals

Front 597

What do an elevated epo, elevated Hct, and normal O2 sat suggest?

Back 597

renal hypoperfusion or epo-producing tumor

Front 598

What are the criteria for SIRS

Back 598

fever > 38 or hypothermia < 36

tachypnea

tachycardia

leukocytosis > 12,000 or leukopenia < 4000

Front 599

Which antriretroviral?
SE: lactic acidosis

Back 599

NRTI (AZT, ddI, ddC, d4T, 3TC, and abacavir)

Front 600

Which antriretroviral?
SE: GI intolderance

Back 600

PI

Front 601

Which antriretroviral?
SE: pancreatitis

Back 601

zalcitabine, stavudine, didanosine, ritanovir

Front 602

Which antriretroviral?
SE: peripheral neuropathy

Back 602

zalcitabine
stavudine
didanosine

Front 603

Which antriretroviral?
SE: megaloblastic anemia

Back 603

zidovudine

Front 604

Which antriretroviral?
SE: rash

Back 604

Viramune (Nevirapine)
Rescriptor (Delavirdine)
Sustiva (Efavirenz)

Front 605

Which antriretroviral?
SE: hyperglycemia, DM, and lipid abnormalities

Back 605

PI

Front 606

Which antriretroviral?
SE: bone marrow suppression

Back 606

zidovudine

Front 607

a 25 year old man is diagnosed with HIV and must begin a HAART regimen. What classes of rugs should his regimen include initially?

Back 607

2 NRTI + protease inhibitor or non-NRTI

Front 608

What is the treatment for polycythemia vera?

Back 608

phlebomtomy
hydroxyurea if at high-risk for thrombosis
ASA

Front 609

Translocation 14;18

Back 609

follicular large cell lymphoma

Front 610

Most common lymphoma in the US

Back 610

diffuse B cell

Front 611

Translocation 9;22

Back 611

CML
15% adult ALL

Front 612

Most common form of Hodgkin lympoma

Back 612

nodular sclerosis

Front 613

What medication is a/w remission in 95% of patients with CML?

Back 613

imatinib

Front 614

Which vaccines should not be given to an HIV positive patient?

Back 614

VZV
influenza
oral polio
yellow fever
anthrax
smallpox

MMR as long as CD4 > 200

Front 615

When should antibiotics be used to treat a skin abscess?

Back 615

> 5 cm
high risk complications (DM, immunosuppressed)

Front 616

A 44 yeAR OLD AFRICAcan american woman is in the office for evaluation of an area of inflammation in her left axilla. She said that initially the area was simply itchy but has now become painful. On exam the area has about six papules and nodules that are erythematous, indurated, and warm. The skin is fluctuant, and drainage is noted at some of the lesions. How will this patient need to be treated?

Back 616

hidradenitis

Incision and draininage
ABx

Front 617

unexplained, excruciating pain in the absence of or beyond areas of cellulitis

erythema with blister and bullae formation and possible crepitus

DM patient with foot cellulitis and signs of systemic toxicity

loss of sensation in involved tissue

perineal cellulitis with abrupt onset and rapid spread

Back 617

necrotizing fasciitis

Front 618

What is the general treatment for necrotizing fasciitis

Back 618

Immediate, extensive surgical debridement

Antibiotics (imipenem +/- vancomycin empiric; penicillin G + clindamycin if strep or clostridium)

Front 619

Cause of wet gangrene

Back 619

venous blood stasis

Front 620

Cause of dry gangrene

Back 620

arteriosclerosis

dry, distal area

Front 621

What is the treatment for a limb with dry gangrene?

Back 621

Autoamputation

Angiography to eval the extent and location of PAD --> distal bypass of stenotic areas --> if circulation improves and healing is adequate, then amputation of the affected region

Front 622

What is the treatment for a wet gangrene infection?

Back 622

emergency debridement or amputation of infected portion of the foot then revision to a below or above knee amputation 72 hours later

ABx if cellulitis or gas gangrene

Front 623

What are characteristic features of necrotizing fasciitis?

Back 623

unexplained excruciating pain beyond cellulitis

erythema, blister, bullaw

crepitus

discoloration

loss of sensation

Front 624

How to treat impetigo?

Back 624

oral erythromycin
ceph
diclox
topical mupirocin

Front 625

Which acne medication is known for causing photosensitivity?

Back 625

tetracycline

Front 626

A 15 year old girl is brought to the dermatologist for treatment of her acne. What is the causative organism?

Back 626

proprionibacterium acne

Front 627

What side effects from oral isoretinoin?

Back 627

depression
dry, cracked skin
teratogen
hepatotoxicity
pseudotumor cerebri w/tetracycline

Front 628

What medications are used in the treatment of postherpatic neuralgia?

Back 628

gabapentin

pregabalin

TCAs

lidocaine patch

capsacin

Front 629

What is the treatment for rosascea?

Back 629

topical: sulfacetamide, metronidazole

systemic: tetracycline, doxycycline, minocyclin, isoretinoin

Front 630

What is the appearance of mollscum contagiousum? What is the treatment?

Back 630

shiny papules w/central umbilication

self-limited disease

Front 631

What is the treatment for tine capitis?

Back 631

griseo
terbafine
itraconazole

Front 632

An obese, 42 year old diabetic woman complains of a pruritic rash under her boobs. Erythematous patchy rash. WHat diagnostic study would be helpful? What would be seen?

Back 632

KOH prep pseudohyphae

Candida

Front 633

Target lesions in different shapes that develop over 10+ days from macule to papule to vesicles/bullae. How to treat?

Back 633

eythema multiform

Stop medications, symptomatic treatment

Front 634

What is the treatment for seborrheic dermatitis?

Back 634

selenium sulfide shampoo twice a week

olive oil

Front 635

What diseases are a/w an increased incidence of seborrheic dermatitis?

Back 635

Parkinson, HIV, psoriasis, immunocompromised patients

exacerbations are common in emotion stress and hospitalizations

Front 636

What infections are a/w an increased likelihood of lichen planus?

Back 636

HIV
HCV

Front 637

What is the treatment for lichen plans?

Back 637

Corticosteroids of medium to high petency -- topical or intralesion

acitretin

Front 638

What is the treatment for pemphigus vulgaris?

Back 638

steroids

Front 639

chronic blistering lesions on sun-exposed areas

facial hypertrichiosis and hyperpigmentation

pseudoscleroderma with cutaneous thickening, scarring and calcification.

elevated LFTs

Associations? Treatment?

Back 639

hepatitis C infection common

treat with phlebotomy
low-dose chloroquine or hydroxychloroquine
avoidance of alcohol, estrogens, iron supplements
sunscreen use

Front 640

What are the treatment options for actinic keratosis?

Back 640

topical 5-FU or imiquimod

cryotherapy

Front 641

pearly papule with fine vascular markings, telecangiectasias

Back 641

basal cell cancer

Front 642

painless, erythematous papule with scaling or keratinzied growths in sun exposed area

Back 642

squamous cell cancer

Front 643

circular rash with central clearing on the trunk or arms

Back 643

tinea corporis

Front 644

Comorbidities a/w vitiligo

Back 644

graves
autoimmune thyroiditis
pernicious anemia
type I DM
adrenal insufficiency
hypopituitarism
alopecia acreta
autoimmune hepatitis

Front 645

Premature menopause is defined as?

Back 645

< 40

Front 646

What is required for a diagnosis of menopause?

Back 646

12 months of amenorrhea over the age of 45

Front 647

What are the non-hormonal options for the treatment of menopausal hot flashes?

Back 647

venlafaxine

clonidine

Front 648

A middle-aged man presents for knee pain, and x-ray reveals bilateral calficiatiosn of the articular cartilage. What is the treatment?

Back 648

chondrocalcinosis --> pseudogout

NSAIDs, colchicine

Front 649

What are the absolute contraindications for OCPs?

Back 649

DVT, hypercoagulability

smoker > 35

CVD, CAD

hepatic disease

migrane w/aura

estrogen dependent tumor

Front 650

A female neonate who was born in breech position is found to have asymmetric inguinal and gluteal skin folds on her newborn exam. What is the diagnosis and treatment?

Back 650

DDH

Pavlik harness

Front 651

Which STD can be mistaken for IBD due to its association with fistula formation?

Back 651

lymphogramuloma venerum

Front 652

What is the presentation of the various stages of syphillis?

Back 652

1. painless chancre

2. rash palms and soles; flu-syptoms

3. neuro symptoms, tabes dorsalis, gummas, ataxia, argyl

Front 653

A patient with a painless, pruritic with regional lymphadenopathy that evolves over 7-10 days into a necrotic ulcer with a black eschar. What is the diagnosis and treatment?

Back 653

cutaneous anthrax

penicillin V/G
amp/doxy

Front 654

What is the next step in management of AN AGUS pap smear?

Back 654

colposcopy with endocervical curettage

if > 35 or RF, endometrial biopsy

Front 655

What is the treatment for a lesion found to be HSIL on biopsy?

Back 655

repeat colposcopy 6 mo

Front 656

What are the symptoms of ovarian cancer?

Back 656

ab pain
fatigue
weight loss
ascites

Front 657

What ultrasound findings are consistent with benign ovarian tumors?

Back 657

cystic
smooth lesion edges
few septa

Front 658

What is the treatment for ductal carcinoma in situ of the breast?

Back 658

lumpectomy + possible radiation therapy

Front 659

Once you have r/o invasive cancer, what is the management of LCIS? Why is drug therapy so effective?

Back 659

close observation + tamoxifen, raloxifene (E, P+)

Front 660

Most common breast cancer?

Back 660

infiltrating ductal

Front 661

most common mass in patient 35-50

Back 661

fibrocystic changes

Front 662

most common tumor in teen and young women

Back 662

fibroadenoma

Front 663

breast mass accompanied by redness, pain, and warmth

Back 663

inflammatory carcinoma

Front 664

What is the next step in the evaluation of penetrating injuries to the different zones of the neck?

Back 664

zone 1 -- 4 vessel CT angiogram and triple endoscopy

zone 2 -- surgical exploration

zone 3 -- 4 vessel CT angiogram

Front 665

An IV drug user has JVD and a holosystolic murmur at the LSB. What is the diagnosis and treatment?

Back 665

right-sided HF due to bacterial endocarditis (suspected)

ABx + valvuloplasty

Front 666

When do children first exhibit stranger anxiety?

Back 666

6-9 mo

Front 667

How would you expect weight to increase in the first 2 years of life?

Back 667

quadruples

Front 668

When can children begin to eat solid foods?

Back 668

4 mo

Front 669

When can children drink cow's milk?

Back 669

1 year

Front 670

Wat is the first solid food parents should give their child?

Back 670

iron-fortified cereal

Front 671

At what age is the meningococcal vaccine indicated?

Back 671

11-12 years

asplenia

Front 672

Why should cow's milk not be given before 1 year of age?

Back 672

risk of allergy

hemorrhage in the gut

iron def anemia

Front 673

How many calories are present in an ounce of breast milk? How many calories are present in an ounce of formula?

Back 673

20kcal/oz

Front 674

What are the caloric needs for an infant younger than 6 mo?

Back 674

100-120 kcal/kg/d

Front 675

What w/u should be performed on a newborn with a single umbilical artery?

Back 675

renal US

Front 676

What are the most common problems that arise in premature infants?

Back 676

RDS
hypoglycemia
persistent PDA
infection/sepsis
retinopathy of prematurity
intraventricular hemorrhage

Front 677

What vitamin can be used to treat psoriasis

Back 677

vit A, D

Front 678

Which children need a work up in UTI?

Back 678

child 2 mo - 2 years

male of any age

female < 3 years

febrile or recurrent UTI

Front 679

What are some causes of desquamation of the hands and feet?

Back 679

Kawasaki
TSS
SSS
mercury tox
scarlet fever
steven johnson

Front 680

thombocytopenia and purpura

eczema

recurrent pyogenic infections

Back 680

Wiskott Aldrich

Front 681

IgA deficiency

cerebellar ataxia, and poor smooth pursuit of moving target w/eyes

telangiectasias of face > 5 yo

increased cancer risk: lymphoma and acute leukemias

radiation sensitivity

Back 681

ataxia-telangiectasia

Front 682

1. partial albinism

2. recurrent respiratory tract and skin infections

3. neurologic disorders

Back 682

Chediak Higashi

Front 683

1. eczema

2. recurrent cold staph aureus

3. course facial features: broad nose, prominent forehead ("frontal bossing"), deep set eyes, and "doughy" skin

hyper IgE and esosinophils
also common to have retained primary teeth resulting in 2 rows of teeth

Back 683

Job Syndrome

Front 684

abnormal integrins --> inability of phagocytes to exit circulation

delayed separation of umbilicus

Back 684

LAD

Front 685

congenital heart defect + low calcium + recurrent infection

Back 685

DiGeorge

Front 686

chronic mucocutaneous candidiasis + chronic diarrhea + FTT

Back 686

SCID

Front 687

negative nitroblue tetrazolium test

Back 687

CGD

Front 688

poor smooth pursuit of eyes and elevated AFP after 8 months

Back 688

ataxia-telecangiectasis

Front 689

What GI complications are a/w Down syndrome?

Back 689

duodenal atresia
celiac
annular pancreas
Hirschsprung

Front 690

cleft lip/palate

life expectancy < 1 yr

polydactyly

Back 690

trisomy 13

Front 691

lactic acidosis, hyperlipidemia, hyperuricemia in a child

Back 691

GS I

VonGierke

Front 692

diaphragm weakness --> respiratory failure in child + acidosis

Back 692

GS II

Pompe

Front 693

increased glycogen in liver, serve fasting hypoglycemia in child

Back 693

vongierke

Front 694

hepatomegaly, hypoglycemia, hyperlipidemia in child

normal kidneys, lactate and uric acid

Back 694

GS type III

Cori

Front 695

painful muscle cramps, myoglobinuria with strenuous exercise

Back 695

GS type V

McArdle

Front 696

hepatomegaly, hypoglycemia, hyperlipidemia in child

normal kidneys, lactate and uric acid

Back 696

GS type III

Cori

Front 697

painful muscle cramps, myoglobinuria with strenuous exercise

Back 697

GS type V

McArdle

Front 698

hepatomegaly, hypoglycemia, hyperlipidemia in child

normal kidneys, lactate and uric acid

Back 698

GS type III

Cori

Front 699

painful muscle cramps, myoglobinuria with strenuous exercise

Back 699

GS type V

McArdle

Front 700

hepatomegaly, hypoglycemia, hyperlipidemia in child

normal kidneys, lactate and uric acid

Back 700

GS type III

Cori

Front 701

painful muscle cramps, myoglobinuria with strenuous exercise

Back 701

GS type V

McArdle

Front 702

hepatomegaly, hypoglycemia, hyperlipidemia in child

normal kidneys, lactate and uric acid

Back 702

GS type III

Cori

Front 703

painful muscle cramps, myoglobinuria with strenuous exercise

Back 703

GS type V

McArdle

Front 704

Common causes of acquired torticollitis in children

Back 704

URI
minor trauma
cervical lymphadenitis
retropharyngeal abscess
atlantoaxial subluxation

Front 705

What is the reason for hematologic abnormalities in SLE patients?

Back 705

formation of antibodies against blood cells (type II hypersensitivity) -- AIHA

--> spherocytosis, positive direct Coombts test, and extravascular hemolysis

Front 706

How to manage febrile neutropenoa?

Back 706

Empiric therapy should be croad-based and cover pseudomonas.

Monotherapy: ceftazidime, imipenem, cefepine, or meropenem

Combination: AG anti-pseudomonal beta-lactam

Front 707

If a patient has CAD risk equivalent or has CAD, what is the LDL goal? At which levels should drug therapy start IN ADDITION TO lifestyle changes?

Back 707

> 100 mg/dL

drug therapy starts at > 130

Hint 707

< 100 mg/dL

drug therapy > 30

Front 708

If a patient has two risk factors for CAD, LDL goal? When to initiate drug therapy?

Back 708

> 130

drug therapy at 160

Front 709

If a patient has 0-1 risk factors for CAD, LDL goal? When to initiate drug therapy?

Back 709

> 160

drug therapy starts at > 190

Front 710

Risk factors for CAD?

Back 710

male > 45
female > 55
hypertension
cigarette smoking
HDL < 40
family history of premature CAD (male < 55yrs, female < 65)

Front 711

What are CAD risk equivalents?

Back 711

DM
symptomatic carotid artery disease
AAA
PAD
10 year risk of CAD of 20% or greater

Front 712

What is low albumin?

How to correct for free calcium levels in the setting of low albumin?

Back 712

Low albumin < 3.5

Correct Ca2+ = 0.8(normal albumin - measured albumin) + measured Ca

*normal albumin = 4*

Front 713

When does breast milk jaundice present?

Back 713

Usually presents after the 1st week of life

Front 714

How to deal with a needlestick injury from an HIV patient?

Back 714

draw blood for HIV serology and start single-drug antiretroviral therapy while awaiting the results of HIV serology

Front 715

What is the management of an omphalocele/gastroschisis?

Back 715

sterile wrapping of the bowel

insertion of an orogastric tube

stabilizing the airway

establishing peripheral venous access

Front 716

What are indications that neonatal jaundice should be evaluated?

Back 716

1. jaundice appears in the first 24-36 hours of life.

2. serum bilirubin rising at a rate faster than 5 mg/dL/24 hours

3. serum bilirubin greater than 12 mg/dL in full-term; 10-14 in preterm

4. jaundice persists 10-14 days after life

5. presence of signs of symptoms

Front 717

MRI shows bilateral, mutlifocal, asymmetric contrast enhancement in the periventricular white matter, a finding characteristic of what?

Back 717

MS

Front 718

How to treat severe hyponatremia?

Back 718

plasma sodium < 120 meq/L with CNS symptoms require aggressive management with hypertonic saline

Front 719

How to manage HIT?

Back 719

stop heparin and provide danaparoid or a direct thrombin in hibitor (lepirudin, argatroban)

Front 720

Man with painless intermittent visual loss. Episodes last a few seconds, next best step in management of patient?

Back 720

amaurosis fugax is painless loss of vision from emboli. cholesterol particles may be seen in eye.

warning sign of impending stroke. underlying embolic disease almost always present.

most emboli occur from carotid bifurcation; duplex us

Front 721

What type of dementia?

Personality changes
Compulsive behaviors
Impaired memory

Back 721

Frontotemporal dementia

Front 722

dementia that features bizarre visual hallucinations

Back 722

Lewy body dementia

Front 723

How can complications of an MI lead to PEA?

Back 723

PEA common in left ventricular free wall rupture and is the result of pericardial tamponade

Front 724

What are red flags in back pain?

Back 724

age > 50

history of previous cancer

unexplained weight loss

pain greater than one month duration

nighttime pain causing difficulty with sleep

no response to previous therapy

neurologic symptoms

Front 725

What respiratory disorder is a/w with postop atelectasis?

Back 725

respiratory alkalosis

Front 726

What is the ideal maternal fasting glucose?

Back 726

75-90

Front 727

How to manage central retinal artery occlusion?

Back 727

ocular massage and high-flow oxygen administration

Front 728

What accounts for 80% of nephrotic syndrome in children under 16?

Back 728

minimal change disease

Front 729

increased bone turnover due to osteoclast activity leadin to the replacement of lamellar bone with abnormal woven bone

Back 729

Paget's disease of the bone/
osteitis deformans

Front 730

severe complication of pancreatitis

Back 730

systemic hypotension and shock (increased vascular permeability dye to locally released and acived pancreatic enzymes)

Front 731

What is the pathophys of warfarin induced skin necrosis?

Back 731

protein c deficiency someones a/w condition.

most commonly, females on breasts, buttocks, thighs, and abdomen. initial complaint is pain, followed by bullae formation and skin necrosis. Occurs within weeks after starting therapy. use vitamin K

Front 732

How to treat a cat-bite?

Back 732

augmentin

Front 733

fever, erythema/desquamation, headache, nausea/vomiting, and myalgias

negative blood cultures

Back 733

TSS

Front 734

high fever
tenosynovitis
migratory polyarthralgias
purpuric or pustular lesions with hemorrhagic companent and occasionally central necrosis

sexually active

Back 734

disseminated gonococcal infection

Front 735

Which antiarrhythmic medications lead to prolonged QRS?

Back 735

IC: flecanide, propafenone, moricizine

Front 736

fundoscopy shows elevated retina with folds and/or tear

Back 736

retinal detachment

Front 737

fundoscopy reveals loss of fundus details, floating debris, and a dark red glow

Back 737

vitreous hemorrhage

Front 738

disk swelling
venous dilation and tortuosity
retinal hemorrahges
cotton wool spots

sudden painless unilateral loss of vision

Back 738

central retinal vein occlusion

Front 739

What do fever, chills, and deep abdominal pain a while after abdominal trauma duggest?

Back 739

retroperitoneal abscess (pancreatic)

Front 740

Which bacterium are particularly common in patients with chronic indwelling catheters? How to differentiate?

Back 740

proteus, candida, pseudomonas, klebsiella.

proteus is the only one that makes alkaline urine

Front 741

What electrolyte abnomality is particularly dangerous in CHF?

Back 741

hyponatremia

water retention and the associated reduction in the plasma sodium concentration parallel the serverity of the heart disease; they reflect the degree of neurohumoral activation in patients with heart failure. low serum sodium level is a/w high levels of renin, aldosterone, vasopression and NR

Front 742

When can children be given doxycycline?

Back 742

> 9 years old

Front 743

What are the most common etilogic agents of acute bacterial sinusitis?

Back 743

step

nontypable h.influ

moraxella

Front 744

cause of Diffuse increase in pulmonary vascular markings on CXR

Back 744

left to right shints can cause shunt vascularity

Front 745

Patient walks with legs wide apart. Feet lifted higher than usual, making a slapping sound when they come in contact with floor.

Back 745

destruction of posterior columns (loss of proprioception)

Front 746

Which nerve lesion leads to decreased corneal sensation?

Back 746

trigeminal

Front 747

What are extrahepatic sequelae of HCV?

Back 747

cryoglobulinemia

porphyria cutanea tarda

glomerulonephritis

Front 748

How often should a colonoscopy be performed in someone with UC?

Back 748

every year after 8 years of disease

Front 749

How long does it take for warfarin to achieve therapeutic anticoagulation?

Back 749

5-7 days

Front 750

poor feeding, irritability, decreased activity, vomiting

tense and bulging fontanelle, prominent scalp veins, widely spaced cranial sutures, rapidly increasing head circumference

Back 750

hydrocephalus

Front 751

Which drugs are most effective in the treatment of fibromyalgia?

Back 751

amitruptyline

cyclobenzaprine

Front 752

Patients with hemochromatosis and cirrhosis at at risk of increased infection for?

Back 752

Listeria

Yerniia

Vibrio vulnificus

Front 753

Define oliguria

Back 753

<250 mL urine in 12 hours

Front 754

How often mammogram?

Back 754

b/w 50 - 74, every 2 years.

Front 755

How often to check cholesterol? When to start?

Back 755

men 35
women 45

check every 5 years

Front 756

Finger clubbing in the backdrop of simple of COPD is suggestive of what?

Back 756

lung malignancy

Front 757

What is the most common site of hypertensive hemorrhage? How does it present?

Back 757

putaman & internal capsule

hemiparesis, hemi-sensory loss, homonymous hemianopsia, stupor and coma. eyes deviate away from paralytic side

Front 758

What types of drugs cause pill esophagitis?

Back 758

Tetracyclines

Aspirin & NSAIDs

alendronate (bisphosphonates)

potassium chloride, quinidine, and iron

Front 759

What are the most reliable indicators of metabolic recovery while monitoring treatment response to insulin and IV fluids in DKA?

Back 759

arterial pH

anion gap

Front 760

Which leukemia is characterized by Auer rods?

Back 760

APML

Front 761

Which leukemia is characterized by positive sidan black and many monocytes?

Back 761

AML FAB M5

Front 762

Most common cause of osteomyelitis

Back 762

s.aureus

Front 763

s/p bone marrow transplant three months ago

fever, dyspnea, ab pain, diarrhea

CXR shows patchy infiltrates

Back 763

consider CMV pneumonitis

BAL is diagnositc

Front 764

How to establish control of variceal bleeding if it does not stop on its own?

Back 764

vasoconstrictors like terlipresson, octreotide, somatostatin

Front 765

What is the most common etiology of acute unlateral lymphadenitis?

Back 765

staph aures

group A strep

Front 766

nausea
diaphoresis
tachycardia
pallor immediately prior to syncope

Back 766

neurocardiogenic syncope (vasovagal)

can be diagnosed with tilt table test

Front 767

How is PaCO2 affected in restrictive lung disease?

Back 767

more likely to cause hypoezmia than hypercarbia. Usually low until end-stage disease occurs

Front 768

Immunodefiencies than can present with recurrent staph aureus infections

Back 768

LAD
CGD
hyper IgE

Front 769

Up until when is high blood pressure in pregnancy representative of chronic hypertension?

Back 769

< 20 weeks

Front 770

How to evaluate a patient with probable benign prostatic hyperplasia?

Back 770

UA

serum Cr

to assess for UTI, obstruction, or hematuria

Front 771

What is the drug of choice in treating dermatitis herpetiformis?

Back 771

dapsone

Front 772

How to manage PVCs?

Back 772

if asymptomatic, no treatment.

if symptomatic, b-blockers

Front 773

What is chloride resistant metabolic alkalosis? What can it be caused be?

Back 773

urinary chloride level > 20mEq/d and ECF volume expansion

primary hyperaldosteronism
Bartter syndrome
Gitelman's
excessive black licorice

Front 774

What are the five warning signs of basal cell carcinoma

Back 774

1. open sore that bleeds, oozes, or crusts and remains open for three or more weeks.

2. reddish patch or irritated area

3. shiny bump or nodule that is pearly or translucent and is often pink, red, or white

4. pink growth with slightly elevated rolled border and a crusted indentation in the center

5. scar-like area which is white, yellow or waxy, and often has poorly defined borders

Front 775

new ascites & pedal edema accompanied by stigmata of chronic liver disease

Back 775

suspect chronic alcohol abuse or chronic viral hepatitis --> cirrhosis

Front 776

Which electrolyte abnormality can lead to loss of DTR?

Back 776

hypocalcemia

Front 777

How is restless leg syndrome treated?

Back 777

dopaminergic agonists (pramipexole and ropinerole) or levodopa

Front 778

congenital heart disease in child with new onset eadaches and focal neurological changes

Back 778

increased risk of developing brain abscesses

Front 779

If a high-risk patient presents with positive PPD but clear CXR, how to treat?

Back 779

INH + pyridoxine for 9 mo

Front 780

unlateral eye pain
redness
dilated pupil with poor light response

Back 780

acute angle closure glaucoma

Front 781

What are risk factors for secondary amyloidosis?

Back 781

chronic inflammation --

chronic infection
psoriasis
IBD
autoimmune diseases e.g. RA

*look for additional hepatomeglay, which would not manifest in a nephropathy*

Front 782

How to manage bradycardia (stable)?

Back 782

In symptomatic (dizziness, light-headedness, syncope, fatigue, and worsened angina), IV atropine -- provides an immediate increase in the heart rate by decreasing vagal input.

Then, transcutaneous pacing. If does not resolve, permanent pacemaker.

Front 783

Causes of bradycardia?

Back 783

exaggerated vagal activity
sick sinus syndrome
hypoglycemia
certain medications (e.g. digitalis, b-blockers, CCB)

Front 784

How to manage bradycardia (unstable)?

Back 784

epinephrine

Front 785

Signs and symptoms of Waldenstrom's Macroglobulinemia?

Back 785

1. increased size of the spleen, liver, and some lymph nodes

2. tiredness, usually due to anemia (too few red blood cells)

3. tendency to bleed and bruise easily

4. night sweats

5. headaches and dizziness

6. visual problems

7. pain and numbess in the extremities due to a predominantly demyelinating sensorimotor neuropathy

Front 786

congenital deafness
loss of consciousness without following confusion

young boy, family history

Back 786

congenital prolonged QT

Front 787

What is the most common cause of death in patients with acute MI?

Back 787

reentrant ventricular arrhythmia (v.fib)

Front 788

What is the most likely treatment to increase chance of neurological recovery in an ischemic stroke?

Back 788

intravenous alteplase (tPA) within 3-4.5 hours of symptom onset

antiplatelet therapy with aspirin in those who are not candidates for thrombolytic therapy.

Front 789

How can amyloidosis, in addition to restrictive pericarditis (increased wall thicknesss), lead to proteinuria and increased brusability?

Back 789

deposition of amyloid fibrils in the kidney can cause proteinuria

binding of amyloid firbils to the liver can inhibit the synthesis of coagulation factors, resulting in increased brusability.

Front 790

How to treat ventricular tachycardia?

Back 790

Stable -- amiodarone or lidocaine

Unstable -- cardioconversion

Front 791

HIV patients
slow onset of neurological symptoms

On CT, can be multiple, hypodense, non-enhancing lesions with no mass effect in cerebral white matter

Back 791

Progressive multifocal leukoencephalopathy (JC virus)

Front 792

What are the criteria for MGUS?

Back 792

must be an absence of...

anemia
lytic bone lesions
hypercalcemia
renal insufficiency

Front 793

repeated falls
syncope
transient loss of consciousness
fluctuating cognition
visual hallucinations/delusions
spontaneous motor features of Parkinsonism

Back 793

Lewy body dementia

Front 794

What is the treatment for acute hypercalcemia?

Back 794

IV saline hydration

loop diuretic

Front 795

How do metastatic malignancies lead to hypercalcemia?

Back 795

tumors that are metastatic to bone cause local osteolysis by production of cytokines such as IL-1 and TNF. The most frequent tumors that produce hypercalcemia by this mech are lung and breast cancer.

Front 796

Which drugs have been implicated in causing optic neuritis?

Back 796

ethambutol

hydroxychloroquine

Front 797

Which drugs have been implicated in causing digital vasospasm?

Back 797

b-blockers

ergotamine

Front 798

What are side effects of cyclophosphamide?

Back 798

acute hemorrhagic cystitis

bladder carcinoma

sterility

myelosuppression

Front 799

How does scleroderma present on diagnostic exams?

Back 799

absence of peristalsis in lower 2/3 of esophagus

decrease in LES

Front 800

toxoplasmosis congenital

Back 800

hydrocephalus
chorioretinitits
microcephaly
hepatrosplenomegaly
cerevral calcifications
---
microphtalmia
microcephaly
hepatomegatly
diffuse lymphadenopathy
jaundice
diffuse petechiae

Front 801

infant with paralysis of the left hand and ipsilateral Horner synrome (miosis and ptsosis)

Back 801

result from in jury to the 7th and 8th cervical nerve and first thoracic nerve, which is Klumpke's paralysis.

Front 802

How to manage suspected disc herniation?

Back 802

early mobilization and NSAIDs/muscle relaxants.

if the pain persists after 4-6 weeks of conservative treatment or progressive neurological deficit evolves, use imaging.

Front 803

recurrent miscarriages
positive VDRL
prolonged PTT
thrombocytopenia
during pregnancy

How to manage?

Back 803

low dose aspirin + LMWH to avoid pregnancy loss

Front 804

What is postop cholestatis?

Back 804

hypotension, extensive blood loss into tissues, massive blood resplacement. jaundice.

Front 805

Which are the four tumors that never metastasize to the brain?

Back 805

1. non-melanomatous skin cancer

2. oropharyngeal cancer

3. esophageal carcnoma

4. prostate cancer

Front 806

When to attempt an external cephalic version of a breech baby?

Back 806

at 37th week

Front 807

HIV
CD4 < 50

yellow-white patches of retinal opacification and hemorrhage
loss of vision

Back 807

CMV retinitis

Front 808

Why do steroids cause adrenal insufficiency after they are stopped?

Back 808

glucocorticoids suppress CRH release from the hypothalamus, and it takes time for the ability to secrete to recover

Front 809

recurrent oral ulcers
uveitis
recurrent culters in genital area
erythema nodosum

how to manage?

Back 809

Behcet syndrome

corticosteroids offer relief from most symptoms but do not protect from prgression to dementia or blindness

Front 810

How is lactose intolerance characterised?

Back 810

positive hydrogen breath test

positive stool test for reducing substances

low stool pH and increased stool osmotic gap

Front 811

What is prophylaxis against MAC?

Back 811

azithromycin

Front 812

27 year old man
recurrent nose bleed
red, blanching papules
increased Hct

Back 812

hereditary telangectasis (osler-weber-rendu)

AVMs tend to occur in mucous membranes, skin, GI tract; liver, brain, and lung. AVMs in the lungs can shunt blood from the right to the left side of the heart, cauing chronic hypoxemia and reactive polycythemia

Front 813

foul-smelling sputum and right lower love pneumonia

Back 813

aspiration pneumonia

Front 814

What is the cause of Zenker's?

Back 814

upper esophageal sphincter dysfunction and esophageal dysmotility

Front 815

What is the most common preventable cause of FGR in the US?

Back 815

smoking

Front 816

What are the criteria to hospitalize a patient with PID?

Back 816

high fever
failure to respond to ABx
inability to take oral medications due to n/v
pregnancy
noncompliance

Front 817

Inpatient management of PID?

Back 817

cefoxitin/doxyxycline

cefotetan/doxycycline

clindamycin/gentamycin

Front 818

Outpatient management of PID?

Back 818

Cefoxitin + Probenecid + doxycycine

Ceftraixone/Doxycycline

Front 819

DD of lytic bone lesion in a child

Back 819

Infectious (brodie abscess from osteomyelitits)

endocrine (hyperparathyroid osteitis fibrosa cystica)

neoplastic (ewing sarcoma, langerhans cell histiocytosis, mets)

idiopathic (benign bone cyst, aneuysmal bone cyst)

Front 820

What is chondricalcinosis?

Back 820

calcification of articular cartilage

Front 821

What is the antibiotic of choice in a human bite?

Back 821

augmentin

Front 822

HIV < 100
Ohio river valley

fever, weight loss, night sweats, n/v, cough with shortness of breath.
diffuse lymphadenopathy, hepatosplenomegaly

most sensitive dx test?

Back 822

histoplasmosis antigen detection in urine or serum

Front 823

How to treat histoplasma?

Back 823

itraconazole

Front 824

male child
eczema
immune deficiency
thrombocytopenia
bloody diarrhea

What syndrome is this and why is there low platelet count?

Back 824

WAS

impaired platelet production

Front 825

What does the D-xylose test measure in urine?

Back 825

intestinal mucosal disease or bacterial overgrowth

Front 826

elevated CO2 with normal A-a gradient

Back 826

hypoventilation

Front 827

normal CO2 with normal A-a gradient

Back 827

low inspired oxygen

Front 828

normal CO2 and elevated A-a gradient that does not correct with administration of 100% oxygen

Causes?

Back 828

shunting

pulmonary edema, pneumonia, vascular shunt

Front 829

normal CO2 and elevated A-a gradient that does correct with 100% oxygen

Back 829

V/Q mismatch

Front 830

How to calculate the P(alveolar) O2 from the P(arterial) O2?

Back 830

149.73 - (P(arterial)CO2/.8)

Front 831

treatment for hepatic encephalopathy

Back 831

lactuolose, neomycin or rifaximin, laxatives

Front 832

Treatments of choice b/w actinomyces and nocardia? How to differentiate?

Back 832

Actinomyces -- penicllin G

Nocardia -- TMP-SMX

actinomyces more likely to cause cervicofacial disease and sinus and contains sulfur granules

Front 833

development at 6 mo

Back 833

babbling
sitting well unsupportive
ranking grasp
recognizes strangers

Front 834

What is the first line treatment for pseudotumor cerebri?

Back 834

acetozolamide

Front 835

What is the first-line treatment for essential tremor?

Back 835

propanolol

alternatives: primidone, topiramate

Front 836

What are hematological complcations of EBV-induced infectious mono?

Back 836

AIHA

thrombocytopenia

cross reactivity of EBV induced antibodies

Front 837

Difference between acute and chronic mitral regurgitation

Back 837

Acute -- MI may cause papillary muscle ischemia or rupture, leading to pulmonary edema and increased left atrial pressure

Chronic will also lead to increased left atrial size as it dilates to accomoate chronically increased left atrial pressure

Front 838

What acid-base disturbance may be seen in a patient suffering from TB and hypotension?

Back 838

normal anion gap, hyperkalemic, hyponatremia metabolic acidosis due to primary adrenal failure

Front 839

How to manage ITP?

Back 839

under 30,000 steroids

if recurrent, IVIG

Front 840

Stepwise approach of the treatment of ascites?

Back 840

1. sodium and water restriction
2. spironolactone
3. loop directic
4. frequent ab paracentesis as long as renal function is ok

Front 841

Which vaginal infection maintains its pH range in 5-6 range and presents with pruritis and inflammation?

Back 841

trichomonas

Front 842

How does anabolic steroid use by a man lead to infertility?

Back 842

suppressing production of
GnRH, LH, and FSH

Front 843

What is a complication of an untreated toxic adenoma?

Back 843

rapid bone loss due to increased osteoclastic bone resorption

Front 844

fever
diarrhea
post nasal drip, boggy nasal mucosa
eat drainage, difficulty hearing

Back 844

AOM

Front 845

How does diabetes lead to incontinence?

Back 845

autonomic neuropathy may lead to denervated bladder

Front 846

Management of peritonsillar abscess?

Back 846

inition -- aspiration and IV ABx

surgical intervention if purulent material cannot be removed

Front 847

conditions where one may have an increased BUN/Cr

Back 847

prerenal failure

GI bleeding (secondary to resorption of blood from the GI tract)

steroid administration

Front 848

What is the most likely cause of progressive visual loss and straight lines appearing wavy?

Back 848

macular degeneration

Front 849

When are solid foods introduced into a child's diet?

Back 849

4 mo

Front 850

When are fruit juices introduced into a child's diet?

Back 850

5-7 mo of age

Front 851

Lens dislocation in Marfan's vs homocystinuria?

Back 851

Marfan UPWARD

Homo DOWNWARD

Front 852

What is the most common cause of thyroid nodules? Second most common?

Back 852

Colloid nodules

Follicular adenoma

Front 853

Pain, itching and red streaks that move from one area of the body, disappear, reappear on another

mild epigastric tenderness

tender, erythematous, cord-like veins palpable

Back 853

migratory thromboplebitis

CT abdo warranted (pancreatic cancer(

Front 854

How to manage SVT?

Back 854

adenosine
carotid massage if not readily available
CCB, b-blocker, cardioconversion if unsuccessful

Front 855

Which arrhythmia is most specific for digitalis toxicity?

Back 855

atrial tachycardia with AV block

Front 856

lower ab pain that radiates to the thighs and back and begins hours before menstruation

Back 856

primary dysmenorrhea due to release of prostraglandins during breakdown of the endometrium

Front 857

What is the most common cause of glomergulonephritis in adults?

Back 857

IgA nephropathy, beginning several days after a URI

Front 858

What is the most common complication of PUD?

Back 858

hemorrhage

Front 859

Do absence seizures present with a post-ictal state?

Back 859

no

Front 860

Macrosomia
Macroglossia
Visceromegaly
Omphalocele
Hypoglycemia
Hyperinsulinemia

Prominent eyes, prominent occiput, ear creases, hyperpleasia of pancreas

Increased risk for which neoplasms?

Back 860

Beckwith-Widemann

Wilm's tumor
Hepatoblastoma
Gonadoblastoma

Front 861

Coagulase-negative staph

Back 861

staph epidermidis

saprophyiticus

Front 862

thombocytopenia
hemolytic anemia
renal impairment

fragmented RBCs

treatment?

Back 862

plasma exchange

Front 863

normal CD 3+ lymphocytes
low number of CD19+ lymphocyes
recurrent bacterial infections b/w 6-18

management?

Back 863

X-linked agammablobulinemia

IVIG

Front 864

DD of normotensive patients with hypokalemia and metabolic alkalosis

Back 864

1. diuretic use (>20 urine Cl)

2. surreptitious vomiting (< 10 low Cl)

3. Bartter/Gitelman syndrome (>40 very high urine Cl)

Front 865

How to diagnose ZE?

Back 865

1. fasting gastrin levels > 1000 diagnostic

2. secretin stimulation test should be done when the patient has non-diagnostic fasting serum gastrin (ZE will not be suppressed by secretin)

Front 866

What are the most common infectious agents of cellulitis?

Back 866

GAS

s.aureus

Front 867

How to manage an arterial occlusion?

Back 867

percutaneous thrombolysis

or

embolectomy

Front 868

What is the most important factor for survival in a man who collaspses outside?

Back 868

the leading cause of witnessed out of hospital cardiac arrests is a venticular arruthmia is either v.tach or v/fib; time to deffib is of critical importance

Front 869

How does the Weber test work?

Back 869

Conductive hearing loss -- lateralize to affected ear

Sensorineural hearing loss --
lateralize to unaffected ear

Front 870

Conductive hearing loss causes

Back 870

cerumen impaction
middle ear fluid/infection
decreased movement in the small bones of the ear
bony tumors in ear
otosclerosis (young women)

Front 871

What is otosclerosis?

Back 871

Abnormal remodeling of otic capsule thought to be possible autoimmune process

Front 872

diarrhea, nausea, decreased appetite, increasing fatigue, occasional palpitations

which medication is responsive?
METOPROLOL
DIGOXIN
FURODEMIDE
WARFARIN

Back 872

Digoxin

Front 873

SE Digoxin

Back 873

nausea
vomiting
decreased appetitie
confusion
weakness
scotomara
blurry vision with changes in color

Front 874

What does a glucose level < 60 in pleural effusion suggest?

Back 874

parapneumonic effusion
TB
RA

Front 875

What is normal pleural fluid pH.

1. < 7.3 suggests?
2. > 7.3 suggest?
3. < 7.2 suggests?

Back 875

1. < 7.3 suggests exsudative

2. > 7.3 suggests transudative

3. < 7.2 suggests parapneumonic effusions

Front 876

lung infection in immunocompromised

dissenminated disease with bowel infiltration and malabsorption

Back 876

MAC

Front 877

Oligoclonal bands in CSF

Back 877

MS

Front 878

Albumino-cytoloic dissociation in CSF

Back 878

Guillain Barre Syndrome

Front 879

burning, numbness, aching of plantar surface of foot or toes

Back 879

tarsal tunnel syndrome

Front 880

gestational diabetes glucose values

Back 880

Fasting > 95
One hour > 180
Two hour > 155
Three hour > 140

Front 881

perdiodic difficulty breathing and wheezing

persistent nasal blockage in a man with angina/headache

management?

Back 881

aspirin sensitivity -- pseudoallergic reaction (shunted activity to lekotrienes -- prostaglandin misblanace)

USE LEUKOTRIENE RECEPTOR ANTAGONISTS

Front 882

How to treat frostbite?

Back 882

rapid rewarming with warm water

Front 883

Causes of premature atrial complexes? How to manage?

Back 883

tobacco
alcohol
caffeine
stress

-- treat if symptomatic with b-blockers

Front 884

How to manage a hydrocele in an infant?

Back 884

will resolve spontaneously by the age of 12 mo and can be safely obseved

communicating hydroceles that persist beyond 12 mo are unlikely to reslove spontaneously and put the patient at increased risk indirect inguinal hernia -- surgery

Front 885

acute onset kidney disease in a patient being treated for pyelonephritis

Back 885

think of aminoglycosides (amikacin, gentamycin, vancomycin, erythromycin, azithromycin)

Front 886

Cause of metabolic alkalosis with respiratory compesation in a pregnant woman

Back 886

think of hyperemesis gravidarum

Front 887

How is BUN and Cr affected in pregnancy

Back 887

BUN and Cr decrease due to an increase in RPF

Front 888

adolescent with nasal obstruction, visible nasal mass, frequent nosebleeds

Complications? Management?

Back 888

angiofibroma

dangerous b/c composed of many blood vessels which may readily bleed. treatment is required if is continues to enlarge, obstructs airway, or causes chronic nosebleeds -- surgical treatment

Front 889

15 year old boy six month history with unstable gait, speech difficulty getting worse over time.

scoliosis
feet deformity
dysarthria, dysmetria, nystagmus, absence of deep plantar reflexes

Back 889

Friedreich ataxia -- AT

neurological manifestations from degeneration of sponal tracts
hypertrophic cardiomyopathy diabetes
skeletal deformaties

Front 890

increased ICP
bitemporal hemianopsia
calcified lesion about sella

Back 890

craniopharyngioma (remant of Rathke)

Front 891

How is the murmur of HCM affected?

Back 891

WORSENED BY maneuvers that decrease preload (Valsalva, standing)

gets louder

Front 892

How is the murmur of AS affected?

Back 892

MADE BETTER by decreased preload
(Valsalva, standing)

Front 893

How is MVP affected?

Back 893

MADE WORSE by decreasing preload (Valsalva, standing)

Front 894

Pathophys and presentation of lacunar stroke?

Back 894

small vessel hyalinosis, rarely embolic
often not appreciated on non-contrast CT

most common site -- posterior internal capsule, leading a pure motor stroke

others: ataxic hemiparesis, pure sensory, mixed senstory-motor

Front 895

hypoxia
hypocapnia
respiratory alkalosis in someone with fluid in lungs

Back 895

more likely to be CHF than COPD (measure BNP and PWCP)

COPD -- respiratory acidosis and hypoxia

Front 896

Severe or dirty wound in unimmunized or last Td booster > 10 years ago

Back 896

give Tetanus diptheria toxoi AND tetanus immuneglobulin

Front 897

Prophylaxis for toxo?

Back 897

TMP-SMX

Front 898

Malaria prophylax

Back 898

mefloquine

Front 899

pain on eye movement
color perception change
decreased visual acuity
sluggish afferent pulpillary response
swollen disc

Back 899

optic neurities (often MS)

Front 900

sudden onset of vertigo, vomiting, and occipital headache in hypertensive patient

Back 900

cerebellar hemorrage; look for 6th nerve paralysis, conjugate deviation, blepharospasm, coma

Front 901

recurrent vertigo
tinnutus
hearing problems
NO HEADACHE

Back 901

Menerie

Front 902

acute onset of vertigo and nystagmus without any other neurological
NO HEADACHE or HTN

Back 902

vestibular neuritis

Front 903

What substances are elevated in megaloblastic anemia?

Back 903

increased homocystine

if B12, increased methylmalonic acid

Front 904

Autoantibodies against postsynaptic receptors

OR

antibodies to voltage gated Ca channels

In WHICH is there a loss of deep tendon reflexes?

Back 904

Lambert Eaton

Front 905

sore throat a few week ago in young, now..

non-pruritic pink of trunk
knee pain that resolves, then tender ankles and wrists

Back 905

acute rheumatic dever

Joint pain, migratory
Carditis
Nodules (subcutaneous)
Erythema marginatus
Syndenham chorea

(fever, elevated APR, arthralgia, increased PR)

confirm with ASO

Front 906

How long must JRA be present for it to be diagnosed?

Back 906

6 weeks

Front 907

Lesion in the cerebellum

Back 907

nausea, vomiting, ataxia

Front 908

Lesion in the posterior columns

Back 908

ataxia

Front 909

lesion in the upper thoracic cord

Back 909

paraplegia, bladder and rectal inconteinence, absent sensation from nipple downwards

Front 910

Lesion int he lower thoracic spinal cord

Back 910

absent sensation from umbilicus downwards

Front 911

Which lesions are worsened (louder) with increased afterload (handgrip)?

Back 911

aortic regurg
mitral regurg
VSD
MVP

Front 912

Which lesions are bettered (quieter) with increased afterload (handgrap)?

Back 912

aortic stenosis
metrial stenosis
HCM

Front 913

hyperglycemia
necrotizing dermatitis
weight loss

Back 913

glucagonoma

surgical removal of tumor

Front 914

which yeast can lead to skin involved (multiple, well-circumscribed, verrucous, crusted lesions), lytic bone lesions?

Back 914

Blastomycosis (Great lakes, mississippi, Ohio river base -- wisconsin)

Front 915

How to treat cocaine-induced cardiac ischemia?

Back 915

benzo
ADA
nirtrates

Front 916

generalized lymphadenopathy
rash that extends to palms and soles
fever, malaise, sore throat

Back 916

spirochette infection

Front 917

severe headache, diffuse myalgias

maculopapular eruption on wrists and ankles that spreads to trunk, extremities, plans, soles

Back 917

rickettsial infection

Front 918

Guidelines for the active immunization with the varicella vaccine

Back 918

first 3-5 days, vaccine

postexposure with VZIG in high risk within 3 days

Front 919

Possible treatment for a young woman with dyspareunia, dysmenorrhea, dyschezia?

Back 919

OCPs

Front 920

Contraindications of triptans?

Back 920

unctonrolled HTN
CAD
Prinzmetal angina
pregnancy
ishemic stroke
migrane

Front 921

What are the indications to operate in hyperparathyroidism? What should be performed before surgery?

Back 921

1. Ca at least 1 g above upper limit
2. younge age < 50
3. BMD lower than T-2.5 at any site
4. reduced renal function (GFR < 60)

do a sestamibi scan

Front 922

What is a long term complication of pernicious anemia?

Back 922

gastric cancer

Front 923

Drugs that cause agranulocytosis?

Back 923

PTU
methimazole
clozapine
chlomamphenicol

Front 924

Eldery woman with taking both ACE inhibitors and ASA. Why prerenal azotemia?

Back 924

Dehydration
ACEi prevents action of abgiotensin
ASA inhibits prostaglanding

--> renal glomerular vasconstriction

Front 925

weeks after MI --> CHF, ventricular arrhytmia, mitral regurf

persistent ST elevations

how is this different from the presentation of a papillary muscle rupture?

Back 925

ventricular aneurysm

papillary --> 3-7 days after an infarct, does not typically cause persistent ST elevations

Front 926

Which HIV medication can lead to crystal-induced nephropathy

Back 926

protease inhbitor -- indinavir

Front 927

exophytic purple skin masses in HIV patient that easily hemorrhage

Back 927

bacillary angiomatosis

Bartonella

Front 928

Why edema in extremities in CHF?

Back 928

in HF, there is a decrease in effective circulating BV, leading to renal hypoperfusion Renal hypoperfusion activates renin-angiotensin-aldosterone system, causing increased concentration of both AII and aldosterone.

Angiotension II reduces renal blood flow by constricting effereft arteriold more than afferent arteriole

aldosterone enhances sodium reabsorption, leading to water retention and elevation of total body volme

Front 929

sudden, unilateral visual impairment

disc swelling, venous and tortuosity, retinal hemorrhages, cotton wool spots

Back 929

central retrinal vein occlusion

Front 930

How to manage complicated diveritculitis?

Back 930

Abscess, perforation, obstruction, or fistula

Fluid collection < 3 cm can be treated with IV Abx and obseration

> 3 cm should be drained; draingae and debridement if symptoms do not improve in 5 d

Front 931

How to manage simple or complex endometrial hyperplasia without atypia in premenopausal women?

Back 931

cyclic progestins

Front 932

fever and tremors during blood transfusion, no hemodynamic abnormalities or renal dysfunction

Back 932

febrile transfusion reaction (leukocyte reaction)

Front 933

Rapid enlarging fluctuant lymph node

Back 933

strep or staph

treat with dicloxacillin

Front 934

best acute treatment for migran?

Back 934

antiemetics (chlorpromazine, prochloperazine, metochlopromide)

Front 935

isolated, symmetric lower-extremitiy symptomes, including loss of sensation, signs of UMN disease

Back 935

think of spinal cord compression

Front 936

motor and sesory deficits (contralateral) more pronounced in lower limb than upper limb

may see urinary incontinence, gait distubance

Back 936

anterior cerebral artery stroke

Front 937

What is the cause of absence of in utero development of internal reproductive organs in androgen insensitivity syndrome?

Back 937

absence of MIF secretion will result in development of normal female internal organs

Front 938

Which medications can cause hyperK?

Back 938

non-selective b-blocker
cyclosproine
succinylcholine
trimethoprim

Front 939

Hormone levels in Turner's syndrome?

Back 939

ovarian dysgenesis, leading to low estrogen and loss of negative feedback --> high FSH, LH

Front 940

first three weeks of life, crying at the same time of day suddenly.

Back 940

infantile ******* ******** evil colic

resolves by 4 weeks

Front 941

What to treat acute execerbation of MS?

Back 941

IV steroids

Front 942

Anti-emetics like ondansetron

Back 942

serotonin antagonist

Front 943

GI malformations in Down's?

Back 943

Hisrchspring disease
esophageal atresia
pyloric stenosis
malrotation of the bowel

Front 944

How to treat uric acid stones?

Back 944

hydration

alkalinzation of urine with potassium bicardbonate or potassium citrate

low-purine diet with/without allopurinol,

Front 945

lithium toxicity

Back 945

tremor
hyperreflexia
ataxia
seizures

Front 946

sepsis in a neonate

Back 946

hypothermia
jaundice
lethagy
poor feeding

Front 947

hypotonie
hyperactive DTR
learning disbailities
low APGAR

Back 947

cerebral anoxia --> CP

Front 948

Prostate cancer with acute onset of back pain.

Next step?

Back 948

look at history -- look for neurological symptoms, fever

MRI

glucocorticoids (dexamethasone) to reduce sweeling and attempt to preserve neuro function

Front 949

cytotoxic antibodies in kidney disease

Back 949

Goodpasture

Front 950

immune complex damage in kidney disease

Back 950

SLE

Front 951

visual loss transient

zones of whiened, edematous retina

Back 951

retinal emboli from carotid

Front 952

treatment of acute symptomatic hyponatremia?

Back 952

hypertonic saline (3%)

Front 953

hexagonal crystals in urine?

Back 953

cystinuria

amino acid transport abnormality

Front 954

hypertension
hypokalemia
polydipsia
polyuria
muscle cramps

Back 954

primary hyperaldosteronism

aldosterone to renin level

Front 955

Treatment of CMV

Back 955

ganciclovir

Front 956

electrolyte levels in tumor lysis syndrome

Back 956

hyperkalemia
hyperphophoatemia
hypocalcemia
hyperuricemia
lactic acidosis

Front 957

values in osteomalacia

Back 957

low calcium
low phosphate
increased parathyroid

Front 958

Why constipation in MM?

Back 958

bone leysis leads to increased calcium

Front 959

How does acyclovir cause renal damage?

Back 959

poorly soluble in urine, easily precipitates in renal tubules, causing obstruction and renal failure

Front 960

How to differentiate septic arthritis from transient synovitis?

Back 960

WBC > 12000

T > 39

ESR > 40

refusal to bear weight

Front 961

Mainstays of COPD exacerbation treatment?

Back 961

inhale bronchodilators, especially antichol like ipratropium

b-agonists

Front 962

Absolute indications for dialysis

Back 962

1. fluid overload not responseive to medical management

2. hyperkalemia not responsive to medical management

3. uremic pericarditis

4. refractory metabolic acidosis

Front 963

Which pneumonia follows up with the flu?

Back 963

staph

Front 964

flashes of light
floaters

Back 964

retinal deatchemtn

Front 965

severe right sided ab pain
fever
gross hematoria

Back 965

renal vein thrombosis

(often a/w membranous)