USMLE World Qs - Explanations

Question Id	Notes
38	Suspect DKA in stuporous pts w/rapid breathing and h/o weight loss, polydipsia, and polyuria. 1st step: fingerstick glucose, Chemistry, CBC, ABG.
58	Most important causes of thyrotoxicosis w/low radioactive iodine uptake: 1) subacute painless thyroiditis 2) subacute granulomatous thyroiditis 3) iodine-induced thyroid toxicosis 4) levothyroxine overdose 5) struma ovarii
94	Pts. w/acute pyelonephritis usu present w/fever, chills, N/V, flank/suprapubic pain, CVAT. UA: bacteriuria and pyruia. Tx: empiric abx before c/s. Hosptialization and IV abx for complicated cases(systemic manifestations, vomiting, hypotension).
98	IgA nephropathy is mc glomerulonephritis in adults - quicker onset, 5days, after URI vs post-streptococcal glomerulonephritis a/w low serum complement levels.
100	Mixed Essential Cryoglobulinemia - palpable purpura, proteinuria, hematuria, arthralgias, hepatosplenomegaly, hypcomplementemia. A/w HCV.
107	Acute Epididymitis d/t (1) sexually transmitted - C. trachomatis or N. gonorrhea (2) non-sexually transmitted - E.coli or psuedomonas.
113	acalculous cholecystitis occurs in critically ill pts. Gallbladder distention, thickening of gallbladder wall, pericholecystic fluid. Tx-emergent percutaneous cholecystostomy f/u cholecystectomy when stable.
150	Complex partial seizure = brief episodes of impaired consciousness, failure to respond to stimuli, staring spells, automatisms, and post-ictal confusion - a/w normal EEG or brief discharges. Lennox-Gastaut Syn = childhood seizures of multiple types, impaired cognitive fxn, slow spike-and-wave EEG.
162	Clindamycin is MC fo anaerobic lung infxn (foul-smelling sputum, aspiration, post GI endoscopy).
170	PE signs: S1Q3T3 Hampton's hump Westermark's sign
213	Postpericardiotomy Sx: fever, leukocytosis, tachycardia, chest pain. Autoimmune, usu few weeks following pericardium incision. Tx: pericardial puncture, aspirin or corticosteroids. Mediastinitis is serious & requires drainage, debridement, and Abx.
217	Erythrocyte scintigraphy w/technetium99 is useful for identifying lower GI bleed w/-colonoscopy - then treat w/repeat colonoscopy or angiography.
219	MCC of acute pancreatitis: gallstones (choledocolithiasis), EtOH, hypertriglyceridemia, recent ERCP. Tx: supportive w/IV fluids, NG tube suction, NPO, analgesia, (abx), monitor Ca * Mg. Dx Choledocolithiasis via US.
219	Acute pacreatitis is MCC by gallstones and EtOH. US is preferred test for gallstones.
242	Acute Blood Loss 25-30% (>1500 mL in 70 kg man) requires blood transfusion. Crystalloid for 25%. If 2L of crystalloid does not stop hemodynamic instabiility - transfuse blood.
250	Bowel ischemia is known complication of AAA repair d/t loss of IMA and inadequate collaterals. C.difficile usu takes 4-5 days post Abx tx to develop and is less commonly bloody diarrhea.
251	Todd's paralysis = transient unilateral weakness following a tonic-clonic seizure. Posterior dislocation of glenohumeral joint classically occurs during a tonic-clonic seizure or electrocution.
291	Breech presentation 37 wks needs no intervention, normally convert to vertex before 37th wk. ECV (external cephalic version is indicated if breech >37 wk, if fails then C-section is indicated.
313	Severe dehydration in neonate w/ Hyponatremia, Hyperkalemia, Hypoglycemia, Metabolic acidosis -> CAH (congential adrenal hyperplasia)/salt wasting 21-hydroxylase deficiency.
314	1st Step for infant w/suspected congenital diaphragmatic hernia is orogastric tube placement w/continuous suction- to prevent bowel distension and further lung compression.
349	Suspect Milk protein intolerance in neonate w/bloody diarrhea, eosinophils in stool, and +atopy famHx. Otherwise normal exam.
398	Clozapine - agranulocytosis & decr seizure threshold. Chlorpromazine - jaundice Quetiapine - cataracts Thioridazine - pigmentary retinopathy
406	Alzheimer's dz is most likely in elderly pt w/gradually progressive memory loss and 1+: apraxia, aphasia, agnosia, disturbed executive fxn.
424	Antepartum hemorrhage w/fetal heart changes from tachy to brady to sinusoidal pattern occurring suddenly after rupture of membranes suggest vasa previa. This is fetal hemorrhage and crash c-section is indicated. A/w 75% fetal mortality.
450	In cases of mild preeclampsia, if pregnancy is remote from term or fetal lungs are not yet mature, the pt. is best managed w/bed rest and close observation. Magnesium sulfate is used for prevention of pre/ecclamptic seizures w/admin during labor and w/in 24 hrs of delivery.
480	FAP (familial colonic polyposis) requires elective procto-colectomy d/t 100% cancer risk.
518	Migratory thrombophlebitis "Trousseau's Syn" is a/w occult malignancy. Look at other signs/sx to determine appropriate investigation.
526	Cervical dysplasia in high risk(post-adolescent, premenopausal) pt. should be investigated w/colposcopy to r/o CIN 2 or 3. Refelx HPV for post-menopausal.
527	Suspect squamous (sCa++mous) cell carcinoma of lungs in pt. w/smoking hx, hypercalcemia, and hilar mass. Hypercalcemia d/t PTHrP.
537	Step-wise approach to breaking bad news to pt: 1)Make sure pt is in a quiet, private, comfortable environment. 2)Ask pt how much he knows, or what he thinks he might have - gives pt. expectations. 3)Ask pt how much he wants to know. 4)Give pt a warning shot. 5)Break the news if pt wants. 6)Give pt prognosis, but always keep aware of options available 7)Try to explain everything as clearly and simply as possible.
540	Glucagonoma: Hyperglycemia, necrotizing dermatitis "necrolytic migratory erythema", weight loss. Malignant pancreatic tumor of islet cells, Liver mets possible. Dx: incr fasting glucose and glucagon, CT-pancreatic tumor. Tx: surgical removal (no chemoTx).
553	First few days of warfarin tx a/w paradoxical pro-coagulant effects via protein C production -> skin necrosis 2ndry to thrombus formation. Protein C t1/2 (9hrs) Factors II, IX, X t1/2 (60hrs).
623	Variant angina Tx - CaCB/nitrates to prevent coronary vasoconstriction. Avoid BB and ASA which can promote vasoconstriction.
626	Pts w/inferior Mi may suffer RV infarction -> right sided heart failure. Sx: hypotension, JVD, and clear lung fields - suspect RV infarct. Tx: IVF and avoid preload reducers (nitrates & diuretics).
668	Excisional biopsy for possible melanoma.
670	Angioedema: rapid onset non-inflammatory edema of face, acral extremities, genitals, trachea, and abd organs. D/t C1 esterase inhibitor deficiency -> incr edema-producing factors (C2b and bradykinin).
774	HS (Hereditary Spherocytosis) +reticulocyte count, +bilirubin, -Coombs test, +spherocytes. AD trait (MC hereditary hemolytic anemia in whites) Sx: anemia, jaundice, splenomegaly. Dx: osmotic fragility test, blood smear. Sugar water test for PNH (paroxysmal nocturnal hemoglobinuria)
794	Smudge cells are a/w CLL and thrombocytopenia indicates poor prognosis in CLL. MCC of death is infxn in CLL pts.
807	SBP (spontaneous bacterial peritonitis) should be suspected w/cirrhosis and ascites w/low fever, abd pain, altered mental status. Paracentesis w/PMN>250 and +culture confirms dx.
825	a-1-antitrypsin deficiency a/w panacinar emphysema and cirrhosis.
838	Hepatic adenoma (benign tumor) often in young F taking OCPs. Intra-tumor hemorrhage adn malignant transformation are most dreaded complications. Sheets of enlarged adenoma cells w/glycogen and lipid, absent hepatic architecture. FNH (focal nodular hyperplasia) common non-malignant hepatic tumor - hyperplastic response to hyperperfusion by anamalous arteries a/w sinusoids and Kupffer cells.
844	Wilson's dz dx: decr serum ceruloplasmin, incr urinary copper, Kayser-Fleischer rings seen on slit lamp. Sx: children/adolescents present w/liver dz, young adults neuropsychiatric dz (tremor, rigidity, depression, paranoia, catatonia).
871	Hypertriglyceridemia, >1000mg/dL, can cause acute pacreatitis. Check fasting lipid profile.
874	Entamoeba histolytica is a protozoan a/w amebic liver abscess. Tx: metronidazole. Dx: stool exam for torphozoites, serology, and liver imaging.
899	Febrile neutropenia is med emergency -> empiric Tx immediately w/broad-spectrum abx w/Pseudomonas coverage. (ceftazidime, imipenem, cefepime, or meropenem) or combination Tx (aminoglycoside + anti-pseudomonal beta-lactam).
910	Start IV acyclovir for symptomatic aseptic meningitis (HSV), confirm Dx w/CSF PCR for HSV DNA.
918	Augmentin (amoxicillin-clavulanate) is abx of choice for human bites.
920	Vancomycin is 1st line empiric Tx for suspected staph infxn. such as IVDA w/new murmur.
928	Asbestosis a/w lung cancer (bronchogenic carcinoma then mesothelioma)
946	Bronchiectasis Sx: cough, mucopurulent sputum, hemoptysis - usu abx responsive. CXR: linear atelectasis, dilated/thickened airways. Dx: HRCT (high res CT)- airway dilatation, bronchial thickening, lack of airway tapering. -> Obstructive pattern PFTs and decr. DLCO (diffusion lung capcity of carbon monoxide).
973	Spherocytosis is AD defect in spectrin. Sx: anemia, spherocytosis, splenomegaly, incr erythrocyte osmotic fragility. A/w: cholelithiasis, cholecystitis, chronic leg ulcers, aplastic crisis. Folic acid supplementation is encouraged for pts at high risk of aplastic crisis.
976	Chagas disease is a chronic protozoal dz (Trypanosoma cruzi). Sx: Megacolon/megaesophagus, cardiac dz(CHF, myocarditis).
978	Pernicious anemia is MC in elderly, but may affect younger pts in a/w other autoimmune conditions. Dietary deficiency of folate, not usu B12 (4-5 yr of stores) may cause macrocytic anemia.
983	Central Cord Syn d/t hyperextension injuries esp. in elderly. Sx: weakness UE>LE a/w localized deficits in pain and temp sensation.
986	Somogyi effect = counterregulatory hormones (epi, norepi, glucagon) react ot nocturnal hypoglycemia -> early morning hyperglycemia.
1008	Digitalis toxicity a/w incr.ectopy and incr. vagal tone = atrial tachy w/AV block.
1011	Increased extracellular pH (e.g. respiratory alkalosis) can cause incr affinity of serum albumin to calcium, thereby incr levels of albumin-bound calcium and decr levels of ionized calcium -> hypocalcemia (crampy pain, paresthesias, carpopedal spasm).
1013	Malignancy a/w Hypercalcemia d/t: cytokines, PTHrP, calcitriol, and ectopic PTH. Mets to bone (esp. lung & breast CA)-> osteolysis via cytokines (IL-1, TNF) PTHrP MCC of hypercalcemia in nonmetastatic solid tumors, a/w low PTH. Hodgkin's dz a/w calcitriol -> hyperCa. Ectopic PTH - ovarian tumors, lung CA, neuroectodermal tumors.
1018	No case reports of congenital rubella syn in women inadvertently vaccinated during early pregnancy. Recommendation is wait 28 days from vaccination.
1025	BPP (biophysical profile) evaluated fetal well being: -Nonstress test (reactive) (2) -Fetal tone (flexion and extension of an extremity)(2) -Fetal movements (at least 2 in 30 min)(2) -Fetal breathing movements (at least 20 in 30 sec)(2) -Amniotic fluid volume (single pocket >2cm in vertical axis)(2) BPP 4: delivery if fetus >26 wks. BPP 6 + oligohydramnios: deliver if >32 wks BPP 6 - oligohydramnios: deliver if >37 wks, otherwise repeat in 24 hr and deliver if unimproved
1052	Acetaminophen Overdose Sx: non-specific, N/V, anorexia. Tx: w/in 4hrs - activated charcoal. @4hrs - serum level. by 8 hrs - N-acetylcysteine if indicated.
1077	Hereditary hemochromatosis a/w incr. risk of Listeria monocytogenes. Iron overload is also risk for Yersinia enterocolitica and septicemia w/Vibrio vulnificus.
1082	Ankylosing Spondylitis a/w anterior uveitis 25-40%. M>F 2:1, 20-30 yo. a/w HLA-B27.
1095	Free air under diaphragm - sign of perforation of abd viscus. Perf peptic ulcer - severe epigastric pain becoming generalized -> chemical peritonitis. a/w free air under diaphragm.
1096	Paralytic (Adynamic) Ileus - absent bowel sounds w/gaseous distentino of bothe the small and large bowels. Usu after abd surgery ore retroperitoneal hemorrhage a/w vertebral fracture. Small bowel obstruction a/w "tinkling" hyperactive bowel sounds w/perstaltic waves present on abd wall.
1099	Pelvic Abscess Tx - CT guided percutaneous drainage, surgical if fails.
1123	CTS (carpal tunnel syn) in hypothryodism - matrix accumulation in median nerve/tendons fo carpal tunnel "myxedema"(widespread deposition of acid mucopolysaccharides, matrix substances, mucin). Tenosynovial inflammation CTS a/w rheumatoid arthritis. Synovial tendon hyperplasia CTS a/w acromegaly. Accumulation of fluid CTS a/w pregnancy.
1147	Orotracheal intubation -> surgical cricothyroidectomy -> needle cricothyroidectomy. Order of Tx for emergent apneic pt, even if neck injury; benefits outweigh risks.
1150	DDx of normotensive pt w/hypokalemia and met. acidosis: 1) diuretic use 2) surreptitious vomiting 3) Bartter Syn - polyuria, polydipsia, growth/mental retardation. Defect in Na/Cl reabsorption -> hypovolemia -> incr renin/angiotensin aldosterone system (RAAS) -> hypokalemia, metabolic alkalosis. 4) Gitelman Syn
1164	Erythema chronicum migrans in pt w/tick bite Hx warrants immediate Tx w/doxycycline. Serologic testing is not necessary to confirm Lyme Dz w/classic EM.
1167	PPD + in HIV pt. >5mm Tx: Inactive - isoniazid and pyridoxine x9mos. Active - 3+ drugs, Rifampin, isoniazid, pyrazinamide, ethambutol x6mos
1168	Suspect ehrilichiosis in pt from endemic region, tick bite w/systemic sxs, leukopenia/thrombocytopenia, incr LFTs. Tx: doxycycline.
1173	HIV pts. w/CD450 require MAC prophylaxis w/Azithromycin or Clarithromycin. Bactrim for CD4200. Histoplasmosis endemic areas: CD4100 get itraconazole prophylaxis.
1178	Tx of choice for early localized lyme dz in pregnant pt is Amoxicillin, Penicillin G is an alternative. IV cephalosporin (3rd gen) are indicated for early disseminated and late lyme dz. Doxycycline is 1st line in non-pregnant or peds pts. (it also treats coexistent human ehrlichiosis)
1180	Malaria prophylaxis: start 1 wk prior, cont 4 wks post travel. -Primaquine for P. vivax or ovale -chloroquine for sensitive P. falciparum -Mefloquine for chloroquine-resistant P. falciparum (sub-Saharan Africa and India)
1184	Sudden onset of sharply-demarcated, erythematous, edematous, tender skin lesion with raised border in a febrile pt suggests Erysipelas. MC d/t group A b-hemolytic streptococcus. Post puncture wound - pseudomonas. Child - H. influenza. Rare - S. aureus, S. pneumoniae, Enterococci.
1187	Suspect rubella when pt presents w/fever, rash, occipital/posterior cervical lymphadenopathy, and arthritis. Even if Hx mentions other items(promiscuity)
1188	Suspect trichinellosis in a pt w/GI complaints followed by triad of periorbital edema, myositis, and eosinophilia. Also a/w subungual splinter hemorrhages, conjunctival/retinal hemorrhages.
1223	Diffuse axonal injury shows many minute punctate hemorrhages w/blurring of grey-white interface on CT. Severe Sx - loses consciousness instananesouly and later dvelops persistent vegetative state.
1242	DMARDs indicated once RA is diagnosed (1st line - methotrexate).
1246	Systemic sclerosis or scleroderma w/organ involvement is a/w GERD, RHF, HTN, +Antinuclear Abs and +Anti-topoisomerase-I Abs.
1246	Anti-nuclear Abs and Anti-topoisomerase-I Abs a/w systemic sclerosis or scleroderma w/organ involvement.
1277	Posterior urethral injury Signs: blod at urethral meatus, inability to void, high-riding prostate on DRE. A/w perineal/scrotal hematomas from pelvic fx. Dx: Retrograde urethrogram.
1287	Weight gain has not been a/w use of combination OCPs. Medroxyprogesterone is a/w weight gain, though not proven.
1311	Adjustment disorder Tx: cognitive or psychodynamic psychotherapy.
1333	US (4 months old) or X-ray (>4 months old) for Dx of DDH (Developmental Dysplasia of the Hip). Tx: hip harness or spica cast.
1345	Volkmann's ischemic contracture - final sequel of compartment syn. = dead muscle -> fibrous tissue.
1350	Carotid intimal flap - surgery recommended to repair vessel. Can lead to occlusions, ischemia, stroke, etc.
1357	Suspect leprosy in Asian pt. w/insensate, hypopigmented patch of skin. Dx: lesion biopsy -> acid-fast bacilli.
1364	PCWP (pulmonary cap wedge pressure) >18 = pulmonary edema d/t impaired LV fxn. PCWP 18 = non-cardiac etiology pulmonary edema. ARDS - inflammatory damage to alveoli, e.g. Sepsis, Severe bleeding, Trauma, Toxic injury. ARDS Dx: acute dyspnea, inciting event, bilat infiltrates PCWP 18, PaO2/FiO2 ratio 200.
1365	ARDS may require PEEP upto 15 cmH2O to improve oxygenation. Ideal TidalVolume ~6ml/kg. IV fluids must be used sparingly -> incr hydrostatic pressures -> incr pulmonary edema. PEEP can -> barotrauma and tension pneumothorax.
1367	Pts. w/Crohn dz or other small intestinal fat malabsorption disorders are predisposed to hyperoxaluria -> oxalate stone formation.
1389	SCC (squamous cell carcinoma) may arise in chronically wounded, scarred, or inflamed skin. Suspect in all non-healing wounds. Early Dx key to prevent metastasis. SCC in burn wound ="Marjolin ulcers"
1396	Pts w/compartment syn. c/o severe pain, pain w/PROM, paresthesias, pallor, paresis. Presence of pulses does not r/o compartment syndrome. Fasciotomy is Tx - urgently.
1413	Abd pain in young F mid-cycle w/benign Hx and clinical exam is most likely mittelschmerz (midcycle pain).
1416	Hyperlipidemia, unexplained hyponatremia, incr serum muscle enzymes, and anemia are indications for thyroid fxn tests.
1420	PTU (propylthiouracil) SEs (dose-independent): allergic rxn, agranulocytosis, hepatitis, ANCA vasculitis. MMI (methimazole) SEs (dose-dependent): allergic rxn, agranulocytosis, cholestatic jaundice. Other Grave's Dz Tx: Radioactive iodine ablation(MC), Thyroidectomy
1423	Osteomalacia - defective mineralization of bone. Rickets - defective mineralization of bone and growth plate cartilage. Paget's Dz - disorderd skeletal remodeling. Osteoporosis - low bone mass w/normal mineralization per unit volume. Vit D deficiency -> defective bone mineralization.
1435	Gastgrografin contrast esophagogram for Dx of esophageal perforation. Sx= acute-onset substernal pain (exacerbated by swallowing), subQ emphysema (neck, heart "Hamman's sign"). Tx: broad-Abx & surgical repair.
1436	Tracheobronchial perforation Sx: subcutaneous emphysema, persistent pneumothorax, pneumodmediastinum. Dx: high-res CT, bronchoscopy, surgical exploration. Tx: surgery.
1484	Ruptured AAA is always Tx via emergent surgery.
1490	All pts. w/clavicular fx. should have a careful neurovascular exam to r/o injury to brachial plexus and subclavian arter - esp. lateral 1/3 fx.
1494	Cervicofacial actinomycosis - slowly progressive, non-tender, indurated mass -> evolves into multiple abscesses, fistulae, and draining sinus tracts w/sulfur granules (yellowish). Tx: high-dose penicillin x6-12wks
1497	Arthroplasty over internal fixation of displaced femoral neck (Garden type 4) fx's in elderly d/t risk of avascular necrosis of femoral head. Internal fixation for Garden 2-3 in young pt's - trying to save femoral head.
1501	Tx of femoral shaft fx - closed intramedullary fixation of shaft w/medullary reaming and intramedullary nailing. Allows early mobilization.
1514	Suspect tropical spure w/chronic diarrhea h/o living in endemic areas >1mo. Sx: malabsorption (VitB12, Folic acid -> megaloblastic anemia), glossitis, cheilosis, protuberant abd, pallor, pedal edema, fatty diarrhea, cramps, gas, fatigue, weight loss. Dx: small intestinal mucosal biopsy-blunting of villi and infiltration of chronic inflam cells (lymph, plasma, and eosinophils).
1532	CAH (congenital adrenal hyperplasia) 21-hydroxylase MC (90+%) 17-a-hydroxyprogesterone accumulates; can be complete or partial (no salt wasting) deficiency
1541	DVT prophylaxis: Heparin and warfarin unless contraindicated, e.g. intracerebral hemorrhage. Then use IVC (inferior vena cava) filter.
1576	Topical mupirocin or oral erythromycin is Tx of choice for local impetigo. Alternative tx in severe cases: oral cephalexin, dicloxacillin, and ampicillin.
1578	CSF findings in MS: oligoclonal bands, normal pressure, protein, and cell count.
1582	-Howell-Jolly bodies: a/w asplenia - sickle cell, splenectomy, truama, ITP. -Heinz bodies: a/w G6PD deficiency, a-Thalassemia. -Helmet cells: a/w traumatic hemolysis -DIC, HUS, TTP, -Basophilic stippling: a/w thalassemia, lead/heavy metal poisoning,Fe deficiency, anemia of chronic dz.
1585	Case control study AKA retrospective study. The cases and controls are assessed retrospectively to look for the presence of risk factors.
1601	Parinaud's syn (paralysis of vertical gaze +-pupillary disturbances) and Collier's sign (eyelid retraction) usu indicate a lesion in the rostral midbrain, MC pinealoma or germinoma.
1602	SAH can be caused by intraventricular hemorrhage, common in premature infants. Accumulation of blood in subarachnoid space ~> destruction of arachnoid villi and cisterns -> block flow or decr absorption of CSF -> communicating hydrocephalus. SAH is MCC of communicating hydrocephalus.
1611	Malaria: cold phase w/chills/shivering, hot phase w/high fever, sweating phase. N/V, HA, anorexia, malaise, and myalgia, hypotension, tachycardia. Anemia and splenomegaly are common.
1618	Metronidazole w/EtOH causes disulfiram-like reaction.
1627	Tx of heat stroke is induction of evaporative cooling to reverse hyperthermia.
1643	Bacterial vaginosis: profuse ivory/gray malodorous discharge pH 5-6.5 w/fishy odor(KOH), clue cells (wet mount). Tx: Metronidazole (ok in pregnancy).
1649	MCC of anemia in sickle cell pts. is chronic hemolysis, followed by iron, folate def, chronic dz.
1653	PE Tx..anticoagulation w/heparin should be initiated immediately in any pt. w/high likelihood of PE and respiratory distress, before diagnostic tests are complete to confirm Dx.
1660	Syringomyelia: areflexic weakness in upper extremities and dissociated anesthesia in "cape" distribution. Cord cavity is MC feature. ~a/w caudal displacement of 4th ventricle or cerebellar tonsils, and focla cord enlargement may occur.
1667	Diaphragm Rupture following blunt/penetrating trauma -> chest pain radiating to shoulder, SOB, abd pain, respiratory distress. Dx: x-ray bowel gas/loops above diaphragm, elevated hemidiaphragm, mediastinal deviation, lower lobe atelectasis. Barium Swallow or CT w/oral contrast. Tx: surgery.
1694	Peds Conjunctivits - 24 hrs - chemical -> silver nitrate 2-5 day - gonococcal -> ceftriaxone PO 5-14+ day - chlamydia trachomatis -> erythromycin PO
1705	Amiodarone SEs: -Pulmonary toxicity - pulmonary fibrosis -Thyroid dysfxn - hypothyroidism -Hepatoxicity - transient incr LFTs -Corneal deposits - -Skin changes - blue-gray skin esp. on face.
1706	Osteogenesis imperfecta - type I collagen defect. Marfan Syn - fibrillin I gene defect.
1713	Norepi and pressors can cause ischemia of distal fingers/toes 2ndry to vasospasm - usu symmetric duskiness w/coolness.
1720	Spinal Cord Injury, 1st Tx - high-dose steroids - improved outcome (motor and sensory). Then MRI, surgery, etc. Surgery 1st if impingement by foregin bodies, herniated disks, bony fracture fragments, or epidural hematoma.
1766	Cystic Fibrosis a/w pneumonia d/t: Haemophilus, Pseudomonas, and Staphylococcus. Gram+ diplococci - S. pneumoniae Gram+ cocci in clusters - Staphylococcus Gram- cocci - Neisseria Gram+ rods - Listeria and Bacillus Gram- rods - Pseudomonas, Haemophilus, Klebsiella, Legionella
1787	Duodenal hematoma will usu resolve spontaneously in 1-2 wks, but NG suction and parenteral nutrition is required and in some cases surgery. MRI will not provide additional info, CT w/oral contrast is best modality for Dx.
1788	MRI is test of choice for Dx of multiple sclerosis (cerebral or cerebellar plaques in periventricular regions, corpus callosum, deep white matter and basal ganglia). Sx: Painful loss of vision (central) w/normal fundoscopy. Sensory abn, ext weakness.
1811	Idiopathic central precocious puberty Tx: GnRH agonist - prevent premature fusion of epiphyseal plates. Should have brain imaging to r/o underlying CNS lesion. Danazol (progestin-like) Tx of endometriosis and fibrocystic breast dz.
1812	Frostbite Tx: rapid rewarming with 40-44C water.
1835	DI (diabetes insipidus): polyuria, polydypsia, excretion of dilute urine w/incr serum osmolality. Primary polydipsia "psychogenic polydipsia": dilute plasma and urine SIADH: hyponatremia, low serum osmolality, inappropriately high urine osmolality.
1842	Pertussis prevention: erythromycin x14d for all close contacts regardless of age, immunizations, or Sxs. Should also be vaccinated. Respiratory isolation for 1st 5 days of erythromycin tx. Hospitalization 3 mos old.
1849	Androgen resistance present w/amenorrhea, normally developed breasts, absent pubic and axillary hair, absent internal organs, and 46XY. Serum testosterone is in range for typical males. Internal reproductive organs don't develop d/t testes secretion of mullerian inhibiting factor.
1850	OCPs can cause 2ndry HTN, simple D/C can correct the problem. Believed to be caused by estrogen-mediated incr in angiotensinogen synthesis in the liver.
1865	Suspect Primary Hyperaldosteronism in young pt w/HTN, muscle weakness, and numbness. Most specific lab value is high aldosterone/renin ratio.
1875	ADPKD (autosomal dominant polycystic kidney dz) a/w: -intracranial berry aneurysm (5-10%) -hepatic cysts (MC) -valvular heart dz (MVP and AR) -colonic diverticula -abd wall/inguinal hernia
1883	Effect Modification - natural, cannot be corrected (not a bias) but must be explained. Present when effect of main exposure is modified by the level of another variable.
1898	Vasovagal syncope is MCC of syncope, frequently recurrent. Dx: upright tilt table testing to confirm. 24hr monitoring or invasive electrophysiologic testing for arrhythmia. Echocardiography for hypertrophic cardiomyopathy ro vavlular defects. EEG for seizures.
1914	Erythropoietin SE's: Worsening of HTN, HAs, Flu-like syn, Red cell aplasia. Indicated in anemia (normocytic normochromic) Hb 10g/dL d/t ESRD(end-stage renal dz) .
1916	Cyclosporin (immunosuppressant)Inhibits transcription of IL-2. SEs: Nephrotoxicity, HTN, Neurotoxicity, Glucose intolerance, Infxn, Malignancy, Gingival hypertrophy, Hirsutism, GI (anorexia, N/V/D).
1925	Correlation coefficient shows strength and direction of linear association between 2 variables - does not necessarily imply causality.
1934	Two-sample t test: compare 2 means of sample variance Two-sample z test: compare 2 means of population variance ANOVA: compare 3+ means chi-square: categorical data and proportions Meta-analysis: pooling data for statistical power
1948	Norcardiosis dx: crooked, branching, beaded, gram+, partially acid-fast filaments on microscopy. Bactrim (Tx of choice). MC in immunocompromised.
1962	CVD is MCC of death in dialysis and renal transplant pts.
1964	Atracurium - metabolized in plasma & hydrolyzed by serum esterases - safe in renal and liver dysfxn. Pancuronium, Mivacurium - excreted unchanged in urine. Rocuronium - cleared mostly by liver.
1970	Crystalloids: dehydration. Colloids: (ablumin) burns, hypoproteinemia. PRBCs: hemorrhagic situations.
1979	Bipolar Tx: lithium or valproate single manic episodes - long-term maintenance fore 1+ year. 3+ relapses - life-long maintenance therapy
1981	One should have low threshold for beginning SSRI given SEs and potential benefit to pt. Major depressino should be considered in pts w/prominent somatic Sxs of depression, guilt, hoplessness, or suicidal thoughts.
1984	Theophylline toxicity usu manifests as CNS stimulation (HA, insomnia), GI disturbances (N/V), and cardiac toxicity (arrhythmia). Ciprofloxacin and erythromycin decr clearance and raises plasma concentration.
1987	Dysthymia is depressed mood majority of days for >2 years - sx similar to MDD but less severe.
1993	CSD (Cat Scratch Dz) Tx: Azithromycin x5d.
1998	Dumping syn is common postgastrectomy complication. Sx usu diminish over time. Tx: dietary changes, in resistant cases-octreotide, retractable cases-reconstructive surgery.
2009	The pH of parpneumonic effusions should always be assessed. Low pH (7.2) indicates empyema and needs throacostomy for fluid removal. Glucose 60 is also indication for tube thoracostomy.
2010	Crohn's Dz: non-caseating granulomas, transmural involvement of colon, skip lesions, cobblestone appearance of colon, creeping fatty appearance of mesentery, fistulas, and perianal dz. Ulcerative Colitis: rectum, abd pain, bloody diarrhea, crypt abscesses, mucosal involvement.
2011	Empyema - localized, complex, thick rim. A/w hemothorax, lung abscess, bronchopleural fistula, penetrating trauma, thoracotomy, infxn from hepatic/subphrenic abscess, ruptured viscus(esophagus). Sx: low-grade fever, dyspnea Dx: chest CT Tx: surgery
2012	Topical retinoids are 1st-line for mild acne, then Topical Abx. Moderate - oral Abx. Severe - isotretinoin.
2013	Acute Adrenal Insufficiency more common w/exogenous steroids and stressful situations = acute N/V/abd pain/hypoglycemia/hypotension.
2021	Angiodysplasia is a common cause of intermittent and occult lower GI bleeding in pt.s over 5. Often seen on colonoscopy, can be missed. Controversial association with aortic stenosis. Angiography is gold standard Dx.
2029	MCC of death in Acute MI: reentrant ventricular arrhythmia (VFib). Incr automaticity -glycoside intoxication.
2038	Necrotized surgical infxn - intense pain, decr. sensitivity, cloudy-gray discharge, crepitus. Early surgical exploration is essential.
2041	Indicators of severe asthma attack: - normal or incr. PCO2 (normally decr. d/t hyperventilation) - speech difficulty - diaphoresis - altered sensorium - cyanosis - "silent" lungs
2051	PCP is opportunistic pathogen - important cause of pneumonia in immunocompromised pts (HIV, chemoTx). Sx: bilateral diffuse interstitial infiltrates beginning in perihilar region, dyspnea, fever, nonproductive cough, tachypnea, tachycardia, cyanosis. May disseminate outside lung to lymph nodes, spleen, liver, bone marrow.
2053	Internal carotid artery dissection is a potential cause of stroke in children a/w H/o trauma to soft palate w/foreign body.
2054	Aspiration pneumonia riskF: 1)altered consciousness - seizures, EtOH, Rx overdose, CVA 2)Dysphagia 3)Neurologic disorder 4)Sedation
2066	Shy-Drager Syn (multiple sys atrophy): - Parkinsonism - Autonomic dysfxn(postural hypotension, sweating, abn bowel/bladder control, abn salivation/lacrimation, impotence, gastroparesis) - Widespread neuro signs (cerebellar, pyramidal, LMN) also a/w bulbar dysfxn and laryngeal stridor (fatal) Tx: intravascular volume expansion w/fludrocortisone, Salt, a-adrenergic agonists, constrictive garments to LEs.
2073	Flight of Ideas: loosley assoc. thoughts w/rapid move from topic to topic. Tangentiality: abrupt, permanent deviation from current subject - never returns to subject. Loose associations: lack of logical connection (severe tangentiality). Perseveration: repetition of words/ideas during a conversation. Circumstantiality: provide unnecessarily detailed answers, deviate from topic but remain related, eventually return to subject.
2074	Prolonged placement of central lines ~> subclavian vein thrombosis -> arm swelling (pale w/pulses). Tx: remove catheters, duplex US, anticoagulate, symptomatic.
2076	USPSTF recommends routine screening for chlamydia infxn in all sexually active women 24yo and high risk asymptomatic women.
2084	Serum BUN and Cr are usu decr in pregnant pts d/t incr renal plasma flow and GFR.
2097	Febrile Transfusion rxn(non-hemolytic): d/t abs in pts plasma reacting w/donor's leukocytes. Tx: leukocyte depletion (cell washing).
2100	Mitral regurgitation is MC valvular abn a/w infective endocarditis, not related to IVDA.
2103	Strep pneumoniae is MC of pneumonia in nursing home pts. Pts. w/neurologic disorders(dementia, Parkinson's, stroke) have incr risk of aspiration pneumonia d/t anaerobes.
2120	MC mutation -> cystic fibrosis is deletion of three base pair fo phenylalanine (DF508) in CFTR gene on chromosome 7.
2123	Immunize healthy adults/children w/varicella vaccine w/in 3-5 days of exposure. Postexposure prophylaxis w/varicella-zoster IVIG for susceptible high-risk pts w/in 96(72 preferable)hrs of exposure.
2128	Phosphodiesterase inhibitors: 1) sildenafil is CI in pts on nitrates, and pts hypersensitive to sildenafil 2) Sildenafil ~> priapism 3) erythromycin, cimetidine, etc -> prolong sildenafil half-life. 4) while combining w/a-blocker, must give drugs >4 hrs apart to decr risk of hypotension.
2145	A-a gradient: Elevated by any process of impaired gas exchange. E.g. PE, interstitial diseas. PE often incr A-a gradient and decr PaCO2.
2155	Neurofibromatosis Type 2: SubQ neurofibromas, hyperpigmented cafe-au-lait spots, deafness usu bilat (d/t acoustic neuromas), famHx. D/t AD chrom 22 defect
2156	All pts w/primary amenorrhea and high FSH need to have a karyotype determination.
2157	Amenorrhea eval: Hx, PE, hCG(pregnancy), FSH (ovarian failure), Prolactin (hyperprolactinemia), TSH (hypo/hyperthyroidism).
2167	Granulosa cell tumors produce excess estrogen, can present w/precocious puberty in younger children and postmenopausal bleeding in elderly pts. Must be differentiated from heterosexual precocious puberty or virilizing sxs a/w excessive androgens.
2170	Legionella pneumonia (atypical or typical Sx's) + prominent GI Sx's, Hyponatremia, LFT abnormalities. Dx: urinary Antigen test or culture Tx: quinolone or macrolide
2188	Pts 5 days post appy infxn onset Tx w/ IV hydration, abx (gram- and anaerobes), and bowel rest.
2189	Local therapy is rarely curative in pts w/metastatic breast CA, but should be tried in pts w/a resectable solitary metastatic focus w/o sign of systemic involvement.
2195	Immediate anaphylactic rxn, encephalopathy, or CNS complication w/in 7d of administration of DTaP vaccine is contraindication for future administration. DT should be substituted for DTaP since adverse rxns are usu d/t pertussis component.
2202	Bacterial meningitis: CSF -incr WBC, incr protein, decr glucose. Petechiae and purpura, myalgias, HA, nuchal rigidity, etc.
2217	Pancreatic cancer riskF: famHx, chronic pancreatitis, smoking, DM, obesity, high fat diet.
2219	MOE (Malignant Otitis Externa) dt pseudomonas aeruginosa. Tx - IV ciprofloxacin
2220	2ndry amenorrhea a/w elite F athletes - estrogen deficiency.
2225	Meds -> hyperkalemia: ACEI, NSAIDs, K+ sparing diuretics (amiloride, spironolactone).
2229	Splenic trauma d/t blunt injury depends on hemodynamic status and IV fluid response. If stable - CT, unstable - emergent exploratory laparotomy.
2241	Primary hyperparathyroidism is MCC of hypercalcemia in ambulatory pts, d/t incr PTH. Secondary hyperPTH seen in mod-severe renal insufficiency, a/w normal-low Ca2+ -> incr PTH.
2243	Primary adrenal insufficiency: d/t TB (MC in developing countries), fungal infxn, CMV, autoimmune adrenalitis(MC in US), adrenal hemorrhage Adrenal calcification - Adrenal TB.
2244	UnTx'd hyperthyroid pts are at risk for rapid bone loss d/t incr osteoclastic activity; also at risk of tachyarrhythmias (esp Afib).
2250	Photo-protection: 1)sun avoidance 2)Sunscreens 15-60 min prior to sun exposure.
2254	Cat bites -> Pateurella multocida infxn quickly...a/w pain, erythema, swelling, cellulitis, ~systemic (fever, lymphadenopathy) Prophylaxis after bite: augmentin (amoxicillin/clavulanate) x5d.
2259	Parkinsonism is a/w hypokinetic gait. Wide-based gate a/w multiple system atrophy, spinocerebellar atrophies, multi-infarct gait disorders, sensory ataxia, cerebellar disorders, and muscular dystrophies.
2264	Indinavir (Protease inhibitor) SEs: crystal-induced nephropathy -> nephrotoxicity. Common Acute Life-Threatening Rxns: Didanosine -> induced pancreatitis Abacavir -> related hypersensitivity syn. NRTIs -> lactic acidosis NNRTIs -> Stevens-Johnson syn Nevirapine -> liver failure
2275	TTP (thrombotic throbmocytopenic purpura): thrombocytopenia, hemolytic anemia, renal failure, altered mental status, low-grade fever. Usu schisotcytes on blood smear. Tx: plasma exchange.
2289	Firm, solitary lymph nodes highly suspicious for lymph node metastases, esp. in older pts w/smoking Hx. Non-tender, solitary nodes in head/neck are concerning for squamous cell carcinoma. Biopsy is indicated.
2301	Complete SBO (small bowel obstruction) Sx= N/V/abd bloating, dilated loops of bowel on x-ray. Adhesions (post-op) are MC etiology.
2305	MRI is most specific and sensitive, but should be done after X-ray unless acute pathology warrants it.
2307	Ankylosing spondylitis is seronegative spondyloarthropathy usu men40yo. Low back pain worse in morning, gradually improves through day.
2310	Hemorrhagic papular reddish vascular lesions in HIV pt. +-fever is likely d/t Bartonella hensalae. "Bacillary Angiomatosis" Non-hemorrhagic more likely Karposi's sarcoma.
2325	IVDA w/pulmonary infxn suspect for septic embolism from tricuspid endocarditis (S. aureus). -> CXR: nodular infiltrate w/cavitation
2328	Spinal cord compression: UMN dysfunction distal to site of compression (weakness, hyperreflexia, extensor plantar response. Cord compression is med emergency, requires prompt Dx by spinal MRI.
2373	Hyposthenuria (impairment in kidney's ability to concentrate urine) is common in pts w/sickle cell anemia.
2374	Hemolytic anemia in a pt. w/malignant lymphoproliferative disorder is likely warm autoimmune type d/t anti-RBC IgG abs. Tx: prednisone -> splenectomy.
2399	Air under the diaphragm indicates perforated viscus - surgical emergency! Obtain surgical consult for emergent exploratory laparotomy.
2409	Suggested UTI Abx in pregnancy: amoxicillin, nitrofurantoin, oral cephalosporin.
2413	Pt. w/chronic liver dz. should be vaccinated against HAV, HBV, Influenza, invasive pneumococcal dz, Td/Tdap
2421	Aortic dissection: is most dangerous complication of Marfan's syn. Sx: tearing chest pain radiating to back and neck. a/w early diastolic murmur. Pulsus parvus et tardus: a/w AS(aortic stenosis). Kussmaul's sign: incr JVP w/deep inspiration, a/w RVF (constrictive pericarditis, RVinfarct).
2422	Stress Fx Tx - rest and analgesia. Not casting or Surgery.
2425	Tzanck smear for Herpes simplex virus. PID - inform sexual partners from past 60 days. Screen for HIV, syphilis, HBV, cervical cancer, HCV(if IVDA).
2436	Hemoyamically unstable pt. of MVA w/suspected blunt abd trauma Tx: cervical spine immobilization, IV hydration, FAST (focues assessment w/sonography for trauma). If US is inconclusive then diagnostic peritoneal lavage is indicated.
2445	Leriche Syndrome = aortoiliac occlusion. Sx: bilateral hip, thigh, and buttock claudication, Impotence, Symmetric atrophy of bilateral LEs d/t chronic ischemia.
2449	Skin atrophy, shiny skin, loss of hair on both legs below the knee = PVD. Dx: ABI (ankle-brachial index)
2458	Clubbing in COPD a/w malignancy! Clubbing a/w: lung abscesses, bronchiectasis, cystic fibrosis, interstitial lung dz, sarcoidosis, lung CA. (decr in angle between nail bed and nail fold).
2466	CDC recommends all pregnant women w/o CIs be vaccinated for influenza.
2473	Acute pancreatitis can cause ARDS in upto 15% of pts. 1st step in ventilator managment of ARDS is decr. FiO2 to relatively non-toxic values (60%). PEEP may be increased PRN to maintain adequate oxygenation after decr. FiO2.
2474	Pulmonary contusion complicates 30-75% of blunt trauma. Dx: dyspnea, tachypnea, chest pain, hypoxemia worsened by IV volume expansion, patchy-irregular alveolar infiltrates on CXR.
2479	Intermittent bloody discharge from one nipple = intraductal papilloma, benign breast dz, no masses appreciated.
2479	Intermittent bloody D/C from one nipple is classic presentation of intraductal papilloma, a benign breast dz. Masses are generally not appreciated. Abnlty is small, soft and located directly beneath the nipple. MC in perimenopausal women.
2485	Posterior urethral valves are MCC of congenital urethral obstruction. Sxs: male infant w/distended palpable bladdre and abn low urine output. Dx: VCUG(voiding cystourethrogram)
2486	Bronchoscopy is 1st step in Tx for massive hemoptysis. Localize and control site of of intrapulmonary bleed.
2487	SIRS (systemic inflammatory response syn.) 2/4 1. Fever or hypothermia 2. Tachypnea 3. Tachycardia 4. Leukocytosis, Leukopenia, or bandemia SIRS d/t bacteria = sepsis. Burn pts major morbidity/mortality is hypovolemic shock. Complication after/with fluid resuscitation is bacterial infxn -> septic shock.
2492	Fever, chills, and deep abd pain suggest retroperitoneal abscess. Blunt abd trauma may -> pancreatic contusion, crush injury, laceration or transection when pancreas compressed against vertebrae...if undetected (common w/CT during first 6 hrs) -> devitalized tissue or pseudocyst -> 2ndry infxn. Tx: immediate percutaneous drainage, culture, surgical debridement.
2494	Bladder dome is intraperitoneal - trauma able to cause a chemical peritonitis. Abuts the peritoneum.
2495	Don't be fooled by incidental Hx - Pancreatic Ca sx's are caused by pancreatic Ca. Sx: visceral epigastric pain radiating to back, jaundice, anorexia w/weight loss, fatigue.
2496	Flail Chest - look carefully at the ribs- Tx: intubation w/+pressure ventilation w/pain control and O2.
2509	Pts. w/rheumatoid arthritis are at incr risk of osteopenia and osteoporosis.
2522	AA (secondary amyloidosis) usu d/t chronic systemic inflammation a/w autoimmune disorders, chronic infxns, IVDA, etc. Affects Kidneys, GI, Heart, Musculoskeletal, PNS.
2533	Next step for solitary pulmonary nodule on x-ray is HResCT, unless lesion is high-risk for malignancy then biopsy via percutaneous or VATS (video assisted throacoscopic surgery).
2540	Acute pancreatitis w/hypotension ~ intravascular volume loss 2ndry to local and systemic vascular endothelial injury -> incr vascular permeability, leak plasma into retroperitoneum -> systemic vasodilation.
2543	Respiratory Quotient(RQ) depends on proportions of metabolic fuels. RQ~1.0:carbohydrates and net lipogenesis. RQ~0.8:protein. RQ~0.7:lipid
2544	Oliguria, azotemia, incr. BUN/creatinine ratio >20:1 in post-operative is most likely acute pre-renal failure from hypovolemia; must r/o urinary catheter obstruction. Dx/Tx: IV fluid challenge.
2545	Ischemia-reperfusion syndrome, follows 4-6hrs of ischemia = intracellular/intestitial edema w/reperfusion. A/w compartment syn. -> ischemia of muscles and nerves -> pain out of proportion to PE, exacerbated by passive stretch. Tx: fasciotomy. Compartment Syn 5 P's: Pain, Paresthesias, Pallor, Pulselessness, Paresis
2545	Extremities w/4-6hrs of ischemia can suffer intracellular/interstitial edema upon reperfusion. When edema -> 30+mmHg compartment pressure, compartment syn occurs -> further ischemic injury.
2550	Exudative vs. Transudative Pleural Effusions determined by RATIOS of proteinand LDH vs serum. Exudative effusions - pneumonia, TB, malignancy, PE, CT dz., iatrogenic.
2555	Signs of cerebellar dysfxn: ataxia, broad-based gait, dysmetria, intention tremor, difficulty with rapid alternating movements, nystagmus, muscle hypotonia.
2568	Complicated effusions (pH7.2, glucose 60 mg/dL, or pos. Gram stain/culture) require chest tube drainage or -> empyema.
2577	Acute pain and swelling of midline sacrococcygeal skin and subQ tissues are MC d/t pilonidal dz. Sx: infection of dermal sinus tract originating over coccyx.
2592	Cholecystitis more common w/sickle cell anemia d/t ongoing hemolysis. Tx: conservative w/observation and elective cholecystectomy during same hospital visit, volume resuscitation, abx, pain meds. Sx: RUQ pain, fever, leukocytosis. Emergent surgery for biliary gangrene or peroration. Percutaneous transhepatic gallbladder drainage for unstable or pt.s w/surgery contraindications.
2596	Paget's dz -osteoclast dysfxn -> "mosaic" pattern of lamellar bone, incr AlkPhos, femoral bowing, boin/joint pain, skeletal deformities, hearing loss, incr head size.
2608	Blood Transfusion Rxns: -Cytokines: febrile nonhemolytic rxn MC,Tx: leukoreduced, RBC washes. -IgA deficiency: anaphylactic rxn. Tx: IgA-deficient blood, extra washes. -Delayed hemolytic transfusion rxns - anamnestic Ab response to R-ag. Low-grade hemolysis 2-10d post. -ABO mismatch: acute hemolytic transfusion rxn (AHTR)d/t preformed recipient Abs, 60min, fever, chills, flank pain, hemoglobinuria, +direct Coombs, plasma free hemoglobin, hemoglobinuria, DIC, ARF, shock
2632	Atelectasis mc post-op days 2-3 post abd or thoracoabd surgery. Tx/Prevent: Incentive spirometry, pain control.
2633	Suspect blunt aortic trauma in deceleration trauma (MVA or fall >10')- CXR shows widening of the mediastinum.
2635	3-4% of pts. w/SCI (spinal cord injury) will develop post-traumatic syringomyelia - usu d/t whiplash - months to years later. MRI for Dx.
2646	Hemodynamically stable supraventricular tachycardia should be treated w/vagal maneuvers followed by adenosine and AV nodal blockers. Unstable pts. w/SVT should undergo DC cardioversion.
2651	In high-risk pts presenting w/fevers, chills, evidence of septic emboli(e.g. splenic fluid collection & LUQ pain), abscesses - infecitous endocarditis must be high on the DDx. Emboli common from LV to brain, kidneys, spleen, liver. from RV to septic pulmonary emboli.
2653	Massive PE can -> RV dilatation and failure -> hypotension, tachycardia, syncope, and SOB. Hemodynamic instability and is absolute indicaiton , and RV strain a relative indication for thrombolytics for PE.
2654	Pneumonia -> incr A-a gradient 2ndry to alveolar and interstitial inflamtion -> areas of V/Q mismatch. PCP important cause of progressive dyspnea and hypoxia w/HIV pts.
2667	Acute bacterial COPD Exacerbation Tx: 1)O2 2)inhaled bronchodilators (b2 agonists, anticholinergics) 3)broad-spectrum abx 4)2 wk corticosteroid taper 5)smoking cessation
2681	HIV often presents w/nonspecific Sxs: weight loss, malaise, neurologic changes - maintain high index of suspicion for HIV esp in pts w/known risk factors.
2684	Serum ascites albumin gradient (SAAG= serum albumin - ascites albumin) is used to distinguish between portal HTN and other causes of ascites. A SAAG of 1.1g/dL or greater is consistent with portal HTN.
2688	Initial hematuria -urethral damage. Terminal hematuria -bladder or prostatic damage. Total hematuria -kidney or ureter damage. Clots are not usu seen w/renal causes of hematuria.
2690	Glucose concentration is decreased in exudative effusions ~d/t high metabolic activity of leukocytes (and/or bacteria) in the effusion. 30 mg/dL - empyema or rheumatic effusion 30-50 mg/dL - malignancy, lupus, esophageal rupture, TB
2698	Acquired torticollis - Neck X-ray to r/o cervical fx or dislocation. Torticollis usu d/t URTIs, minor trauma, cervial lymphadenitis, retropharyngeal abscess.
2699	Bruton' sagammaglobulineam or X-linked agammaglobulinemia benifit from IVIG. Labs: normal T cells (CD3+), low B lymphs (CD19+) -> decr bacterial defense (less immunoglobulin).
2709	Massive PE can -> pulmonary HTN (incr. R atrial and pulmonary artery pressures) PE may also result in shock.
2731	Gestational diabetes -> macrosomia, hypocalcemia, hypoglycemia, hyperviscosity d/t polycythemia, respiratory difficutlies, cardiomyopathy, CHF. Polycythemia d/t hypoxia - incr. metabolic rate induced by hyperglycemia.
2738	Endometritis is polymicrobial infxn from Gram-/+ aerobic/anaerobic and others. Tx: IV clindamycin and IV gentamicin.
2766	Child 2yo CXR "sail" sign (usu R side) - thymus. may overlap the heart. Continues to grow until puberty and then atrophies. May be mistaken as cardiomegaly, lung infiltrates, atelectasis or mediastinal mass.
2770	MC viral meningitis is Echoviruses and Coxsackieviruses. CSF: pleocytosis, lymphocytic predominance, Protein N/high, glucose N, gram stain (-). Tx: supportive, usu resolves 7-10 days.
2785	Risperidone (dopamine, serotonin antagonist) -> weight gain, hyperprolactinemia(amenorrhea and galactorrhea).
2789	Congenital syphilis: hepatosplenomegaly, cutaneous lesions, jaundice, anemia, and rhinorrhea. Metaphyseal dystrophy and periostitis on x-ray. Congenital rubella: sensorineural hearing loss, cataracts, heart defects, hepatosplenomegaly, microcephaly, thrombocytopenic purpura. Congenital CMV: intrauterine growth retardation, hepatosplenomegaly, petechiae/purpura, microcephaly, chorioretinitis, sensorineural hearing loss, perventricular calcifications.
2789	Congenital syphilis: early hepatosplenomegaly, cutaneous lesions, jaundice, anemia, and rhinorrhea. Metaphyseal dystrophy and periostitis may be seen on radiography.
2794	4 criteria to differentiate septic arthritis from transient synovitis: 1) WBC >12,000 2) temp >39 (102) 3) ESR >40 4) refusal to bear weight. Tx(transent synovitis): rest & NSAIDs.
2802	Brain abscesses can present w/fever, HA, focal neurologic changes, seizure, spasticity, or signs of incr. ICP. Congential heart disease, head trauma, infxns of jaw/mouth, infxn of face/scalp, meningitis, and cranial instrumentation incr. the risk of developing a brain abscess.
2804	S. aureus pneumonia is a serious complication of influenza pneumonia.
2836	Antipsychotics -> hyperprolactinemia by blocking dopamine activity along the tuberoinfundibular pathway.
2844	Generalized anxiety disorder is characterized by excessive worry over many aspects of one's life that cause significant impairment in functioning. Addit'l Sxs: fatigue, restlessness, difficulty concentrating, irritability, sleep disturbance.
2859	Use-dependence antiarrhythmics (esp.Class IC) are more effective at high heart rates because there is not as much time between heartbeats for meds to dissociate from its receptor. Flecainide -> QRS prolongation, esp at incr HR.
2862	Oral rehydration is 1st Tx in mild-mod dehydration. IV bolus of isotonic fluid is 1st Tx in mod-severe dehydration. Dextrose containing fluids are not used for initial fluid resuscitation, but should be added to maintenance fluid.
2868	Postop atelectasis usu w/in 48 hrs of surgery. Sx: hypoxemia, respiratory alkalosis, abn CXR (upper triangle sign)- right LL collapse -> triangular opacity w/medial aspect pressing against the right heart border and obscuring the pulmonary artery.