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What will the Ceruloplasmin level be in Wilson's Diease?associated with decreased Ceruloplasmin (copper carrying protein)What is the "orphan medication" used to treat Huntington's?TetrabenzineDescribe the relationship of Methylmalonic Acid and Homoncysteine levels in B9/B12 deficiencyMethylmalonic acid is elevated in B12 deficiency, NOT folate defience. Both have elevated homocysteine.When should infertility workup be initiated? What is the first step?Initiate at 12 months, start with semen analysisWhen should Rhogam be given?Rh negative mother's should get Rhogam at 28 weeks (unless dad is also Rh negative), and 72 hours after delivery if baby Rh+What is the GERD cancer association in the Esophagus?AdenocarcinomaWhat is the smoking/alcohol cancer association in the Esophagus?Squamous Cell CarcinomaWhat is the most common type of Breast Cancer?Invasive Ductal CarcinomaWhat physical exam finding will you have with Central Retinal Artery Occlusion?Cherry Red MaculaTransient vision loss with a normal exam is most likely caused by what?TIAWhat is the most common carpal bone injured in a FOOSH?ScaphoidWhat are the symptoms of Galactosemia? What are these patients at risk for?Poor feeding, hepatomegaly, cataracts, mixed hyperbili. At risk for E. coli sepsis.What is the inheritance of familial hypertrophic cardiomyopathy?Autosomal DominantDoes nephrotic syndrome typically have hematuria?NoSymptoms of Granulomatosis with polyangiits (Churg Strauss)? ANCA Association?p-ANCA with Eosinophilia, autoimmune vasculitis with allergic rhinitis/asthma symptomsSymptoms of Goodpasture's? Antibody Association?Anti-GBM antibodies, lung and kindey involvementKimmelstiel-Wilson nodules are associated with what disease?DiabetesDermatomyositis vs Polymyositis, symptoms, antibody status, what differentiates them?Both have symmetric proximal muscle weakness, dysphagia, ANA/Anti-Jo +. Only dermatomyositis has skin findings (Gottron's papules, shawl sign)Polymyalgia Rheumatica symptoms and associated complicationSymmetric muscle pain, associated with Giant Cell ArteritisGout vs. PseudogoutGout: yellow, needle shaped crystals, negatively bifringent. Psuedogout: blue, rhomboid shaped crystals, positively bifringent.What is Fomepizole used for?Methanol and Ethylene Glycol poisoningWhat do you treat Aspirin/Tricyclic Antidepressant poisoning with?BicarbonateWhat is the Triad of Tricyclic Antidepressant poisoning?Coma, Convulsions, Cardiac AbnormalitiesNMS vs. Serotonin SyndromeNMS has hyperthermia, lead pipe rigidity, diaphoresis, AMS, autonomic instability, elevated CK (Typicals more common precipitant than atypicals) Serotonin syndrome hyperthermia, AMS, myoclonus, hypertension, hyperreflexia, dilated pupils, tremor.What is a Krukenberg Tumor?GI tumor that metastasizes to ovariesGout treatment (acute vs. maintenance)Acute: NSAIDs Maintenance: AllopurinolMedical therapy for PheochromocytomaAlpha blockage (Phenoxybenzamine), then beta blockageWhat are the symptoms of alcohol withdrawal? Treatment?Tachycardia, diaphoresis, anxiety, hallucinations, seizures. Acute: Benzos Maintenance: Thiamine BEFORE glucose to replace thiamine storesInheritance pattern of Hemophilia A?X-Linked Recessive (50% chance of passing down in male patient)Hookworm symptoms and bugAncylostoma duodenale and Necantor americanus can cause "ground itch", foot lesion, and GI symptoms with anemiaWhat is the FEV1/FVC finding in restricting lung diseasenormal or elevatedWhat will the peripheral smear of DIC show?Schistocytes from hemolysisWhat are patients with Klinefelter Syndrome at risk for?Extragonadal Germ Cell TumorsWhat will you seen on a smear of CLL?Smudge CellsPap Smear testing guidelinesStart at age 21, every 3-5 years thereafter (HPV testing at age 30)Preferred imaging to diagnosed Renal Cell CarcinomaCTParkinson's Disease and the relationship to DopamineDecreased Dopamine is an etiology for Parkinson's, we want to increased Dopamine activity and decrease Dopamine breakdown. Also want to increase Anti-Cholinergic activityWhat is Budd-Chiari syndrome and treatment?Thrombosis of hepatic vein/IVC, RUQ pain, jaundice, ascites are presenting symptoms. Diagnose with US, treat with thrombolytics, diuretics, and anti-coagulationWhat is Wernicke-Korsakoff's?Neurologic complication from thiamine deificiency (think alcoholics). COAT: confusion, opthalmaplegia, ataxia, thiamine deficiencyWhat are the symptoms of Behet's Disease?Vasculitis with recurrent genital ulcers, concurrent uveitis, arthralgias, skin nodules, GI symptoms, CNS deficitsWhat is a normal fetal heart rate?110-160 BPM. Bradycardia can be caused by cord compression, cord prolapse, fetal hypoxia, congential heart block. Tachycardia can be caused by infection, anemia, fetal hypoxia (also bradycardia)Erb Duchenne Palsy/Klumpke Pasly affected nerve rootsErb Duchenne: C5-C6, Klumpe: C8-T1What are the 4 "D"s of Niacin (B3) DeficiencyDermatitis, Diarrhea, Dementia, DeathWhich type of ulcer is relieved by food consumption?DuodenalWhat does TRH stimulate?TSH and ProlactinWhat are the comorbid conditions anti-depressants can treat?Mirtazapine: Insomina and low weight, TCAs: Chronic Pain, Buproprion: Smoking Cessation, SSRIs: Premature EjaculationWhat is Dysthymic Disorder?Mild depressed mood for 2 yearsWhat lab abnormalities will you see with Renal Cell Carcinoma?Hypercalcemia, PolycythemiaWhat are the 4 phases of clinical trials?1- healthy volunteers, 2- small number of disease sufferes, 3- large scale, 4- surveillance following releaseWhat is Pre-Eclampsia defined by?Hypertension after 20 weeks, proteinuria, and/or end organ damageWhat is the difference between Schizophrenia and Shizophreniform Disorder?Schizophreniform <6 months duration of symptoms, but otherwise the sameRapidly progressive dementia with myoclonusCreutzfeldt-Jakob diseaseDementia with visual hallucinationsLewy body dementiaWhat is the physical exam finding of glaucoma? How do you differentiate between open angle and closed angle glaucoma?Increased cup to disk ratio. Open angle is more gradual vision loss, closed angle is more acute and is painfulWhat are the two murmurs that increase with valsalva and standing?Hypertrophic Cardiomyopathy, Mitral Valve ProlapseWhat is the medical treatment for Sub Arachnoid Hemorrhage?Nimodipine (calcium channel blocker)What is first line therapy for TTP?Plasma ExchangeWhen do you do US vs. MRI for breast mass workup?Under 30 or pregnant US, over 30 MRITreatment for latent TBIsoniazid with Pyridoxine to prevent peripheral neuropathyTreatment for restless leg syndrome?Pramipexole (Dopamine Agonist)How to differentiate between the various types of RTA?Elevated K= Type IV, Urine pH <5.5= Type II, Urine pH >5.5= Type IWhat is the most specific lab test for Rheumatoid Arthritis?Anti-CCPHow often should women over 50 receive a mammogram?Every 2 yearsDoes a varicocele or hydrocele transilluminate?HydroceleWhat is first line treatment for Torsades?Magnesium SulfateHow do you differentiate between Akathesia and Tardive Dyskinesia?TD: onset is months to years after initiation of anti-psychotic, Akathesia is hours to days of onset.What is first line anti-hypertensive therapy in African Americans >60 years old?Thiazide Diuretic or Calcium Channel BlockerHow long does CK-MB remain elevated? Troponin?CK-MB for 1-2 days, Troponin for 1-2 weeksWhat should clue you into Lynch Syndrome?Hereditary Colon cancer with associated development of several other cancers (ovarian, gastric, biliary tract, brain, prostate, skin, endometrial)What is Gardner's Syndrome?Variant of familial adenomatous polyposis (FAP) associated with benign bone growths and cutaneous lesions (lipomas, cysts, fibromas). Think: "Gardner's skin gets dirty"How do you tell the difference between Hypoparathyroidism and Pseudohypoparathyroidism?Psuedo is due to kidney unresponsiveness to PTH, so PTH will be high. PTH will be low in true hypoparathyroidism.How do you tell the difference between positively and negatively skewed distribution?Positive: mean>median>mode. Negative: mean<median<modeWhat are the absolute 5 interventions for Acute Coronary Syndrome?Aspirin, Beta Blocker, Heparin, Nitroglycerin, Percutatenous Coronary InterventionWhat do you treat mercury poisoning with?DimercaprolGranulosa-Theca cell tumors vs. Sertoli-Leydig tumors, what do they secrete, how to differentiate?Granulosa-Theca: secrete estrogen, present with precocious puberty, irregular menses, or bleeding (depending on if pre-pubertal vs premenopausal vs menopausal). Sertoli-Leydig are androgen secreting, look for virilizationDoes Central or Nephrogenic DI respond to Desmopressin?CentralWhat is the best confirmatory test for Graves Disease?Thyroid Stimulating Immunoglobulin Study-What is the most common etiology of pancreatitis?GallstoneWhat is first line treatment for Narcolepsy?ModafinilStages of Labor?Stage 1: Up to 10cm dilation of cervix, Stage 2: Dilation to delivery of fetus, Stage 3: Delivery of fetus to delivery of placentaHow do you differentiate between the murmurs of Tricuspid and Mitral Stenosis?Both are diastolic murmurs, but TS increased with inspiration (due to increased flow to right heart). MS is increased with exhalation.Diabetes diagnosis criteria (there are 4 of them)A1c > 6.5, fasting glucose >125, glucose >200 after 75g of glucose, random glucose >200 with diabetes symptomsWhat is the classic triad of Behcet's Syndrome?Recurrent Apthous Ulcers, Recurrent Genital Ulcers, Uveitis. Can also have systemic inflammation with skin manifestations, arthralgias, CNS deficitsWhen does osteoporosis testing screening for women start?Age 65, younger if risk factors presentWhat test diagnoses BPPV? What treats it?Diagnose with Dix Hallpike, Treat with Epley Manuever.What is the most sensitive test for SLE? Most specific?Sensitive: Antinuclear antibody, Specific: Anti-ds DNAHow do you tell the difference between Multile Myeloma and Waldenstrom's Macroglobuinemia?MM: IgG spike, lytic lesions, WM: IgM spike, NO lytic lesionsCancer Associations with these markers: AFP CA-125 CA 19-9 TSH CEAAFP: Hepatocellular Carcinoma CA-125: Ovarian Cancer CA 19-9: Pancreatic Cancer TSH: Choriocarcinomas CEA: Colorectal CarcinomaSymptoms of beta blocker overdose, treatmentHypotension, bradycardia, PR interval prolongation. Treat with IV GlucagonSymptoms of Peutz-Jeghers syndromePigmented spots on lips, oral mucosa, GI mucosa. Colonoscopy will show multiple hamartomasDoes buproprion or busprinone help with smoking cessation?BuproprionDoes RA have morning stiffness, or stiffness with activity? What is the most specific biomarker?Morning stiffness is present. Most specific biomarker is Anti-CCPWhat is cosyntropin testing used for?Addison's Disease diagnosisWhat is the workup for cushing's syndrome?24 hour urine collection, dexamethasone suppression test, or late night cortisol testingDescribe the dexamethasone suppression testDexamethasone is a potent glucocorticoid that should suppress ACTH, and therefore Cortisol. If Cortisol is not suppressed, we can call it Cushing's. Measuring ACTH will tell us if this is a Pituitary or Ectopic Pituitary issue. High dose should suppress pituitary tumor, but not adrenal or small cell lung cancer.How to differentiate between multifocal atrial tachycardia vs. wandering pacemaker?MAT: 3 or more P wave morphologies in the same lead, WITH HR >100 Wandering pacemaker will have same morphology but HR <100What is the classic lab finding of Acute Leukemoid Reactionincrease leukocyte alkaline phosphataseIf CD4 count is less that 200 what should you start? Less than 100? Less than 50?<200: Bactrim, to prevent PJP <100: Bactrim, to prevent Toxo (would already be on it for PJP) <50: Azithro to prevent MACWhat is the antidote for Serotonin Syndrome? NMS? Acute Dystonia?SS: Cyproheptadine NMS: Bromocriptine or Dantrolene Acute Dystonia: BenztropineStudy Decels in delivery Sinusoidal: Early Decels: Variable Decels: Late Decels: Fetal Bradycardia:Just do it Sinusoidal: Fetal Anemia Early Decels: Head Compression Variable Decels: Umbilical Cord Compression Late Decels: Uteroplacental Insufficiency Fetal Bradycardia: Congenital Heart BlockWhat are AIDS-defining illnesses?Candidiasis of bronchi, trachea, or lungs Candidiasis esophageal (but not oral) Cervical cancer (invasive) -cervical dysplasia or carcinoma in situ are not considered AIDS defining illnesses, because these latter cervical lesions are common, frequently do not progress to invasive disease and can be difficult to diagnose Coccidioidomycosis, disseminated or extrapulmonary Cryptococcosis, extrapulmonary Cryptosporidiosis, chronic intestinal for longer than 1 month Cytomegalovirus disease (other than liver, spleen or lymph nodes) Encephalopathy (HIV-related) Herpes simplex: chronic ulcer(s) (for more than 1 month); or bronchitis, pneumonitis, or esophagitis Histoplasmosis, disseminated or extrapulmonary Isosporiasis, chronic intestinal (for more than 1 month) Kaposi's sarcoma Lymphoma Burkitt's, immunoblastic or primary brain (but not leukemia) Mycobacterium avium complex Mycobacterium, other species, disseminated or extrapulmonary Pneumocystis jiroveci pneumonia (formerly Pneumocystis carinii) Pneumonia (recurrent) Progressive multifocal leukoencephalopathy Salmonella septicemia (recurrent) Toxoplasmosis of the brain Tuberculosis Wasting syndrome due to HIVWhat is the most common type of familial hyperlipidemia?IIa (high LDL)When should the herpes zoster vaccine be given?1 dose to individuals 50 years and olderWhen should adults get hepatitis A vaccine? Hepatitis B?A: If you work with children in an edemic area, will travel to an endemic area, if you are a MSM with IV drug use B: If you are in the healthcare fieldMammogram screening guidelinesevery 2 years 50-74 or start 10 years before 1st degree relative diagnosedRhinorrhea and lacrimation are classic symptoms of what substance withdrawl?OpiodsHuntington's disease will have what kind of brain anatomy changes?Caudate head atrophyTuberous sclerosis features (name 5)Seizures Mental Retardation Ash-Leaf Spots Facial angiofibromas cutaneous neviHow do you differentiate between Osteopenia and Osteoperosis?Osteopenia: DEXA T score of -1 to -2.5 Osteoperosis: DEXA T score of less that -2.5In HIV, what is PJP ppx? Tx? What about Toxo ppx? tx?PJP PPX: Bactrim PJP Tx: Bactrim Toxo PPX: Bactrim Toxo Tx: Pryimethamine and SulfadiazineWhen do you use Lovenox vs. Thrombolysis in PE?If HDS, use Lovenox If not HDS, use ThrombolysisAntibody effect location in MG vs. BotulismMG: Nicotinic post synaptic Botulism: Nicotinic pre-synapticNicotinic receptor are only found in ________ muscle. Muscarinic are found ________.Nicotinic: Skeletal Muscle Muscarinic: Smooth muscle, cardiac, glandsInheritance of Duchenne muscular dystrophy.X-linked recessiveSpinal muscular atrophy inheritanceautosomal recessive (also, tongue fasciculations may be present)What is the most common type of kidney stone?Calcium oxalateWhat is Shizoaffective Disorder?Combined psychosis and mood disorderHow does polyarteritis nodosa present? Does it involve the lungs?Polyneuropathy, weight loss, lacy rash (levido reticularis), myalgias, diastolic HTN, glomerulonephritis Does NOT involve the lungsWhen do you use Estrogen+Progesterone vs. Estrogen alone in women with menopausal symptoms? What does each therapy put the woman at risk for?Combined: If woman has a uterus, at risk for breast cancer Estrogen only: If woman does not have a uterus, at risk for endometrial cancerFirst line therapy for Dermatitis HerpetiformisDapsoneIs placental abruption painful?YesIs placenta previa painful?No (placenta overlies cervical os)Is vasa previa painful?No (fetal vessel overlying cervix)Wrist drop is caused by damage to what nerve? What are the affected nerve rootsRaidal nerve (C5-T1)What are the most specific antibodies for Lupus?Anti Smith and Anti DS DNAToxo vs. CMV, where are the calcifications?Toxo: Anywhere, but basal ganglia is common CMV: PeriventricularWhat are the most common causes of epididymitis in ages <35? >35?<35: Gonorrhea/Chlamydia >35: E. coliWhat is Plummer-Vinson syndrome?syndrome of: 1. esophageal web 2. iron-deficiency anemia 3. dysphagia 4. spoon-shaped nails 5. atrophic oral and tongue mucosa typically occurs in elderly women; 10% develop squamous cell carcinomaRib Muscle Energy rib/muscle associations?1: Anterior Scalene 2: Posterior Scalene 3-5: Pec Minor 6-9: Serratus Anterior 10-11: Lat dorsi 12: Quad Lomborum