Uworld Notes

Question Id

Main Division

Sub Division Notes

2157 Internal Medicine Cardiology Murmur radiating to axils with soft s1 -> MR

2161 Internal Medicine Dermatology impressive cellulitis -> anceph (cefazolin) which is IV vs. cellulitis + pus or in area of high MRSA ->

add Vanco

2164 Internal Medicine Cardiology loop diuretics -> hypo-k and -mg -> Vtach -> get electrolytes and check digoxin level

2165 Internal Medicine Endocrinology

hyper-ca with unsuppressed pth and no urinary increase in calcium excretion -> receptor sensing problem in parathyroid and kidney -> familial hypocalciuric hypercalcemia vs. hyper-ca with unsupressed pth and increased urinary excretion -> primary hyperparathyroidism

2176 Internal Medicine Endocrinology Very high calcium, low PTH -> malignancy vs. High calcium, high PTH -> primary

hyperparathyroidism

2178 Internal Medicine Endocrinology sore throat and fever on PTU? -> check WBC for agranulocytosis!!

2180 Internal Medicine Endocrinology dilute blood + concentrated urine -> EUVOLEMIC hyponatremia 2/2 SIADH (NSAIDS potentiate

ADH) vs. renal failure/ kidney problem -> HYPERVOLEMIC hyponatremia

2184 Internal Medicine Endocrinology DKA diagnosis: blood glucose >250, blood ketones, acidosis (decreased pH or bicarb)

2190 Internal Medicine Endocrinology diabetic nephropathy -> control your BP to maintain GFR !!! 140/90 OK. Ace-i best (when starting,

monitor decline in GFR and hyper-K)

2191 Internal Medicine Endocrinology hormone OD, iodine OD, subacute painless lymophocytic, post-delivery -> thyrotoxicosis

(inflammed follicles leak thyroid hormones) -> decreased radioactive iodine uptake

2203 Internal Medicine GIT PRESSURE during vomiting -> ruptures submucosal ARTERIES in distal eso -> MALLORY WEISS

TEARS vs. eso varices-> submucosal VEINS from portal hypertension

2221 Internal Medicine Genitourinary left sided scrotal varicocele + blood in urine + polycythemia -> RCC???? -> CT that.

2228 Internal Medicine Genitourinary kidney stone? -> probs Calcium oxalate!! especially if fat malabsorption problem

2229 Internal Medicine Genitourinary Blood in UA but no cells -> rhabdo?

2236 Internal Medicine Genitourinary culture negative urethritis -> chlamydia (is cloaked!!)

2256 Internal Medicine Hem&Onc + VDRL -> confirm with ABs. lots of false postivies with SLE antiphospholipid AB syndrome

2269 Internal Medicine ID ALL SORTS OF THINGS can give you diarrhea in HIV-> send your stool for analysis before

picking an antibx...

2270 Internal Medicine ID CMV = Can't See Me on Monospot test. Also, usually no sore throat/lymphadenopathy.

2282 Internal Medicine Neurology LEWY body dementia -> see LIONS. FLUCTUATING cognitive impairment, parkinsonism motor

sx..

2287 Internal Medicine Neurology tremor that increases in intensity while reaching for object -> ESSENTIAL TREMOR, AD ->

Propranolol

2292 Internal Medicine Respiratory

gram negative -> CIPRO vs. anaerobe -> CLINDA (anaerobes above the diaphragm). CAP -> z-pack vs. levo (less healthy pt) vs. HCAP-> vanc (+) + zosyn (broad, pseudo) + cipro(-, pseudo) vs. ICU -> add gentamicin or imipenem?

2295 Internal Medicine Respiratory very sick alcoholic coughing -> aspiration pneumonia -> right lower lobe (can be upper if lying

down)

2305 Internal Medicine Rheumatology air or cartilage erosion -> crepitus. *osteoarthritis -> tylenol!

2582 Internal Medicine Hem&Onc UC -> surveillance colonoscopy every year after 8th year!!

2589 Internal Medicine Hem&Onc testicular cancer -> KILL FIRST AND INVESTIGATE LATER (surgery + chemo)-> high cure rate!!

:) **(NO BIOPSY OR NEEDLE ASPIRATION OR CANCER CELLS/SPERM WILL SPILL OUT)

2599 Internal Medicine Hem&Onc

if calcium >12 -> BAD hypercalcemia -> calcitonin, bisphosphonates, NS. *cancer -> parathyroid hormone related protein -> makes your bones break down -> hypercalcemia CALCIUM BREAKS YOUR BONES.

2602 Internal Medicine Respiratory ptosis -> eyelid droop (myasthenia, horner's) vs. proptosis/exopthalmous-> eye props out (grave's)

2608 Internal Medicine Hem&Onc Do you TRUST HER??? TRASTuzumab for HER2+ breast cancer. *cardiotoxic so echo before

starting. chemo/radiation after surgery = adjuvant.

2613 Internal Medicine Hem&Onc ONLY If positive for BRCA -> screen for Ovarian cancer with U/S +/- CA125

2615 Internal Medicine Hem&Onc most common type of lung cancer- > ADENOcarcinoma (solitary and in periphery), & remarkable

has NO ASSOCIATION WITH SMOKING!!

2616 Internal Medicine Hem&Onc febrile neutropenia -> PIPTAZ empirically after blood culture to get pseudo, or meropenem or

cefepime

2630 Internal Medicine Hem&Onc kidney stones + ulcers -> AD MEN 1 (hyperparathyroidism, pancreatic tumor/gastrinoma/

zollinger-ellison syndrome, pit tumor)

2632 Internal Medicine Hem&Onc constipation + thirsty -> HYPERcalcemia -> PTHrP???

2641 Internal Medicine Hem&Onc PO43- binds Ca2+, so tumor lysis syndrome -> increased everything except calcium.

2645 Internal Medicine Hem&Onc DM + DERMATITIS (NECROLYTIC MIGRATORY ERYTHEMA) + DIARRHEA -> GLUCAGONOMA

(PANCREATIC NEUROENDOCRINE TUMOR)

2645 Internal Medicine Hem&Onc mild DM + nec rash/diarrhea/anemia/weight loss -> glucagonoma!

2646 Internal Medicine Hem&Onc Progesterone before Pot for anorexia....does the pill make you fat?!?!

2649 Internal Medicine GIT tumor with diarrhea in small intest -> carcinoid syndrome vs. tumor with diarrhea in pancreas ->

VIPoma

2659 Internal Medicine Cardiology GET MAD (MAG) FOR TORSADES. if unstable-> defrilltate instead.

2662 Internal Medicine Poisoning dry as a bone, full as a flask, blind as a bat, mad as a hatter -> anticholineric tox -> give

physostigmine (cholinesterase inhibitor)

2663 Internal Medicine Cardiology brady + wheezing + hypotension -> BB overdose -> 1. atropine + fluids 2. glucagon 3. epinephrine

2695 Internal Medicine Cardiology systolic mumur radiation going to axilla + S3 + palpitations -> most likely Afib from MR from MVP

2731 Internal Medicine Cardiology month after MI -> LV aneurysm or pericarditis

2737 Internal Medicine Cardiology Troponin T Takes TEN days to return to normal. so use CK-MB (returns to normal within 1-2 days)

for recurrent heart attack.

2741 Internal Medicine Cardiology CHF in young person -> myocarditis 2/2 coxsackie B virus???

2745 Internal Medicine Cardiology STEMI: PTCA (door to ballon time < 90 min) better outcomes than fibrinolytics (door to needle

time <30 min).

2745 Internal Medicine Cardiology door to balloon time < 90 minutes (Percut transluminal coronary angioplasty PTCA)

2747 Internal Medicine Dermatology URI then herald patch-> xmas tree pattern -> pityriasis rosea

2760 Internal Medicine Dermatology elaine's painful stye from local process -> Hordeolum -> Hot compresses, I&Dvs. painless

granuloma rxn from obstructed gland-> chalazion -> if recurrent, biopsy to R/O gland cancer

2775 Internal Medicine Dermatology IgG against desmoglein in epidermis -> flacci blistering bullae -> pemphigus VULGARIS vs. IgG

and C3 at dermal epidermal junction (DEEPER) -> HARD blisters -> bullous pemphiGOLD

2775 Internal Medicine Dermatology Dig deeper for gold ( igG in dermal-epidermal layer for tense bulbous pemphigoid) Vs. Vulgaris

(vulgar, flaccid, superficial)

2786 Internal Medicine Electrolytes pneumonia -> hypoxia -> tachypnea, respiratory alkalosis -> renal compensation by decreasing

bicarb

2790 Internal Medicine Electrolytes pneumonia -> respiratory acidosis ( if COPD exacerbation) & metabolic acidosis (production of

lactate). are the lungs compensating for a metabolic acidosis? arterial pCo2= 1.5xbicarb +8

2796 Internal Medicine Electrolytes Winter's formula for respiratory compensation for DKA or metabolic acidosis: PaCO2 = 1.5xbicarb

+8

2812 Internal Medicine Electrolytes hypotension from septic shock (acidosis, low urine output, fever, tachypnea): 1. NS bolus 2.

Pressors only if NS fails

2813 Internal Medicine Electrolytes

vomiting: 1. lose gastric juice (HCl, NaCl)-> pancreas doesn't release bicarb -> bicarb increases in blood. 2. lose blood volume -> kidneys sense decreased Q -> aldosterone -> lose H+ and K+. -> hypokalemic, hypochloremic metabolic alkalosis

2817 Internal Medicine Electrolytes NON-AG metabolic acidosis with hyperkalemia and hyponatremia -> aldosterone deficiency->

addison's disease -> autoimmune vs. TB vs. hemorrhage vs. met cancer?

2821 Internal Medicine Electrolytes seizure -> chem panel 2 hours after. has lactic acidosis resolved?????

2821 Internal Medicine Electrolytes seizures -> muscles release lactic acid -> Anion Gap METABOLIC ACIDOSIS -> repeat labs in 2

hours

2837 Internal Medicine ID MYYYY AMINOGLYCOSIDE (GENTAMICIN, TOBRAMYCIN..........) -> MY EAR HAIR CELLS

A-DYING

2842 Internal Medicine ENT AERD (aspirin exacerbated respiratory disease) after NSAIDS is associated with nasal polyps.

2858 Internal Medicine Ophthalmology chalazion just chills there. vs. hordeolum hurts. vs. dacryocystitis (infected lacrimal sac) needs

antibiotics.

2877 Internal Medicine Hem&Onc iINCREASED TIBC microcytic anemia -> IRON DEF

2880 Internal Medicine Hem&Onc cirrhosis, bronze diabetes, dilated heart failure -> AR hemochromatosis -> genetic testing dx;

serial phelbotomy trx

2885 Internal Medicine Hem&Onc low leukocyte alkaline phosphatase (cells fucked up and not making enzyme)-> CML vs. high w/

PV or leukemoid reaction/ infection

2888 Internal Medicine Hem&Onc Smudge the CLLs

2889 Internal Medicine Hem&Onc back pain with anemia-> multiple myeloma?!?!?

2895 Internal Medicine Hepatology President Wilson on the copper penny-> dx liver biopsy + ceruloplasmin levels in blood; trx:

chelators, zinc, transplant

2901 Internal Medicine GIT

Antibiotics before LP vs. Antibiotics after paracentesis!!! ** high SAAC (serum albumin- ascites albumin) > 1.1 -> portal htn/ liver problem/ sbp. -> probs just need antibx if bacterial peritonitis is SECONDARY (from ruptured appendicitis for example) -> you'd see MULTIPLE types of bacteria, sUPER LOW GLUCOSE, SUPER HIGH LDH & PRTN -> get IMAGING and CONSULT SURGERY

2920 Internal Medicine GIT PBC is in WOMEN. vs. PSC associated with UC. (dx: cholangiogram and liver biopsy)

2924 Internal Medicine Hepatology Bodgan the Jew has Dubin-Johnson syndrome. Asymptomatic but shockingly black. Conjugated

hyperbilirubinemia. Rotor similiar but normal color.

2924 Internal Medicine Hepatology CONJUGATED hyperbili -> DJ Rotor!!! (Dubin-J - guiness colored liver), (Rotor-lacks color) vs.

UNconjugated hyperbili -> Gilbert (gentle) or Crigler-Najjar (this is the EVIL one, need transplant)

2934 Internal Medicine GIT ACUTE PANCREATITIS DIAGNOSIS: (2/3) -PAIN RADIATING TO BACK -ENZYMES 3X

-IMAGING (CT CONTRAST OR U/S) SHOWING ENLARGED PANCREAS

2936 Internal Medicine GIT PT (11-15) - teens PTT (25-40) - middle aged

2938 Internal Medicine Hepatology neuropsych sx and basal ganglia -> slit lamp that shit and get ceruloplasmin levels for WILSON'S

DISEASE

2950 Internal Medicine Hepatology "only people who wear lipstick get PBC. how did you get it??"

2953 Internal Medicine Hepatology hypokalemia/diuretic use -> ammonium (NH4+ -> NH3 which crosses BBB) ->hepatic

encephalopathy -> replace potassium + albumin

2961 Internal Medicine Hepatology hep B trx (even if decompensated cirrhosis)-> entecavir or tenofovir

2968 Internal Medicine Hepatology cutie amoeba protozoas! -> bloody diarrhea but only get 1 liver cyst and trx is metronidazole.

2977 Internal Medicine GIT dark urine/ + urine bili -> conjugated -> rotor's syndrome -> no trx

2986 Internal Medicine Hepatology HEP B is NBD. 90% recover some -> chronic. somse -> fulminant (encephalopathy within 8weeks

of acute liver failure) -> need transplant!!!

2995 Internal Medicine ID hilar nodes-> sarcoidosis, histoplasmosis (histo in ohio)

2995 Internal Medicine ID ANY TIME THEY GIVE YOU A LOCATION -> PAY SOME FUCKING ATTENTION TO ENDEMIC

DISEASES. TB looks like histo and blasto and sarcoidosis!

3011 Internal Medicine ID human or dog bites-> amoxi-clav (d-augmentin)

3012 Internal Medicine ID acute infective endocarditis -> 3 blood cultures, then empiric antibx. vs. subacute -3 blood cultures

spaced further apart + tailored antibx once cultures back

3014 Internal Medicine ID healthcare associated endocarditis -> staph vs. community-acquired -> strep

3021 Internal Medicine Respiratory pleural plaques if b/l -> likely due to asbestosis vs. if unilateral -> mesothelioma

3024 Internal Medicine Respiratory asthma presenting in adulthood or after lying down -> GERD

3029 Internal Medicine Respiratory Pneumonia in same location -> bronchogenic CA?? -> CT +/- bx

3042 Internal Medicine Respiratory pulse ox (O2 sat) < 88%, abg Pa02<55%, hematocrit >55% -> start OXYGEN trx

3062 Internal Medicine Hem&Onc

ankyrin scaffolding protein on RBC fucked up -> AD hereditary spherocytosis -> increased osmotic fragiliility on acidified glyceorl lysis test and abnormal binding test. coombs test negative-> folate, transfusions, splenectomy or else pigment gallstones + aplastic crises

3069 Internal Medicine Cardiology arthymmia from WPW -> IV procainamide or cardioversion (AV nodal blockers like BB, CCB,

adenosine, digoxin will send them into VFib!!!!)

3083 Internal Medicine Endocrinology constipation -> hyper-ca?? -> hyper- vitamin D???

3083 Internal Medicine Endocrinology FAD DIET -> VIT D TOX -> HYPERCALCEMIA

3085 Internal Medicine Electrolytes orthostatic hypotension with loss of Na+ and K+ in urine -> DIURETIC ABUSE????!?!?!?

3086 Internal Medicine GIT 4 mos -> folate def 4yrs -> b12 def

3090 Internal Medicine Cardiology Young ppl with chest pain -> AS from bicuspid aortic valve?!?!?!??! vs. HCM

3096 Internal Medicine Cardiology atrial tach (from increased ectopy) + AV block (increased vagal tone) -> digitalis TOXICITY

3099 Internal Medicine Endocrinology Hyperventilation -> resp alkalosis-> hypocalcemia (more bound to albumin, less free) ->

paresthesias, spasm

3105 Internal Medicine ID ALL TRANSPLANT pts need TMP-SMX to prevent PCP (pneumocystis pneumonia).

3131 Internal Medicine ID EBV -> Monospot dx (My one spot Bar). ABs against EBV can attack RBCs and plts-> coombs test

positive hemolytic anemia

3149 Internal Medicine Rheumatology synovial fluid analysis to distinguish: septic arthritis vs. gout vs. pseudogout.

3150 Internal Medicine Rheumatology gout PREVENTION-> allopurinol and probenecid

3150 Internal Medicine Rheumatology Prevent gout with probenecid & alloPurinol

3153 Internal Medicine Rheumatology suspicious joint fluid -> inflammatory vs. outrageous joing fluid -> septic. (purulent arthritis in

person having sex -> GONORREA until proven otherwise)

3157 Internal Medicine Rheumatology exertion -> exacerbates vascular claudication vs. posture (extension)-> exacerbates neurogenic

claudication

3161 Internal Medicine Poisoning METHANOL (anti-freeze) MESSES WIth YOUR VISION. vs. ETHYLENE (sweet radiator fluid)

EFFS UP YOUR KIDNEYS. *trx- fomepizole or ethanol. B1, B6, Folate

3161 Internal Medicine Poisoning IF THEY GIVE YOU A CHEM PANEL -> DO YOU THINK YOU NEED TO CALCULATE AN ANION

GAP?!?!?!?!?

3168 Internal Medicine Rheumatology diagnose rotator cuff tendinitis -> improvement with lidocaine!!

3173 Internal Medicine Rheumatology Hydroxychloroquine cleans out your (retina)-screen

3203 Internal Medicine Rheumatology different pathophysiologies for CTS.

3208 Internal Medicine Rheumatology dermatomyositis -> cancer????

3211 Internal Medicine Rheumatology pain with flexion, SLR (also flexing)-> pressure on anterior herniation -> HERNIATED DISK. vs.

pain with extension -> spinal facet problem -> SPINAL STENOSIS.

3230 Internal Medicine Endocrinology young person w/ HTN and diuretic-induced hypo-k -> PRIMARY HYPERALDOSTERONISM????

-> morning aldosterone: renin >20, and plasma aldos >15

3231 Internal Medicine Endocrinology aldosterone:renin over 20 -> 1* HYPERALDOSTERONISM -> CT and cut adrenal tumor out or

aldosterone antags

3245 Internal Medicine ID immunocompromised or old -> vanc + amp + cephalosporin for bacterial meningitis (amp gets

listeria)

3246 Internal Medicine ID tb prophylaxis -> 9 months isoniazid + B6 +liver fx tests vs. active, sx tb treatment -> combo drug

regimen

3248 Internal Medicine ID bloody diarrhea -> EHEC, Shigella, or Campylobacter

3256 Internal Medicine ID PCN allergic pt with syphilis -> doxy unless pregnant

3261 Internal Medicine ID Dirty (maculopapular rash) hands and soles -> syphilis

3263 Internal Medicine ID erysipelas -> group A strep

3266 Internal Medicine ID rubella (rapidly spreading) + joint problems or postinfectious encephalitis vs. measles (migrates

over days)

3267 Internal Medicine ID eosinophils <1% normally

3267 Internal Medicine ID Eosinophils < 3%

3317 Internal Medicine Rheumatology Osteoarthritis morning stiffness is ONLY 30 min or less. Vs. rheumatoid/inflammatory is really long.

3449 Internal Medicine ENT ENDOlymph in INNER ear -> menIERE's

3462 Internal Medicine Neurology transient arm weakness -> ACS? MS?

3483 Internal Medicine Endocrinology hypercholesterol/TG -> make sure no hypothyroidism before prescribing statins!


you DONT need to FNA everyone with a fucking thyroid nodule!! only those with cancer risk factors or suspicious U/S findings or normal/high TSH. Low TSH -> scan -> if hot nodule most likely benign so just treat for hyperthyroidism; if cold nodule -> FNA that shit too.

3489 Internal Medicine Endocrinology vit D deficiency -> decreased calcium + phosphate absorbtion -> PTH -> bone resorption and

lower phosphate-> bone pain and osteomalacia

3490 Internal Medicine Endocrinology vit D deficiency -> decreased Ca and Phos absorption -> osteomalacia, secondary

hyperparathyroidism

3492 Internal Medicine Endocrinology bromocriptine, cabergoline -> DA AGONISTS for prolactinomas before surgery.

3493 Internal Medicine Endocrinology functioning pituitary adenoma -> prolactin >200 vs. nonfunctionig -> inert substantces +

compression effects (decreased TSH) *hypothyroidism ddx

3496 Internal Medicine Endocrinology anti-TPO ABs -> high risk Hashimoto's

3498 Internal Medicine Endocrinology Papillary thyroid cancer is most Popular. Radiation, family hx risk factors. Best prognosis.

3498 Internal Medicine Endocrinology Carcinoma-> lymphatics (except HCC, rcc, follicular, choriocarcinoma) Vs. Sarcoma -> blood

(connective tissue)

3499 Internal Medicine Endocrinology if i had to choose a thyroid cancer it would be PAPILLARY with PSAMMOMA bodies.

unencapsulated but FUCKING FANTASTIC prognosis even with mets!! :)

3499 Internal Medicine Endocrinology You want to see psamomma bodies -> papillary thyroid cancer good prognosis :]

3502 Internal Medicine GIT air in thorax -> eso perf -> gastrographin (barium inflammatory) vs. blood in thorax -> aortic

dissection

3506 Internal Medicine Cardiology restrictive lung disease -> NO AMIODARONE vs. obstructive lung disease -> NO BETA BLOCKERS

3518 Internal Medicine Endocrinology increased alk phos + mixed lytic/blastic lesions + hat size + secondary aosteoarthritis -> paget's

disease -> bone scan + bisphosphates if sx

3520 Internal Medicine Endocrinology MEN 1 -> 3Ps (pit, pancreas, PTH) vs. MEN 2a -> PTH, medullary thryoid cancer, adrenal pheo

vs. MEN 2b -> marfanoid and mucosal stuff, medullary thyroid cancer, adrenal pheo

3526 Internal Medicine Cardiology warmth/swelling/tenderness -> venous thrombosis (HIT) vs. lose pulses -> arterial clot (LV

thrombus after MI, LA thrombus from AFib, aortic atherosclerosis)

3561 Internal Medicine ID ANaerobic gram+ branching in face with sulfure granules and draining sinuses -> actinomyces ->

PCN vs. aerobic gram+ branching -> nocardia -> Bactrim

3585 Internal Medicine GIT Pain or anorexia w/ jaundice -> obstruction -> U/S for biliary obstruction/dilation vs. without

jaundice -> CT w/ contrast

3619 Internal Medicine Neurology migraine headache -> COMPAZINE(prochlorperazine) +/- ketoralac *metoclopramide 2nd line

*sumatriptan only good for prophylaxis

3635 Internal Medicine Cardiology pericaridial scarring (kussmaul's sign, sharp x and y descents-imparied relaxation, pericardial

knock, diastolic dysfunction)-> 2/2 viruses/radiation/surgery in US vs. TB in developing countries

3637 Internal Medicine Neurology pseudotumor -> bridging therapy (LP, steroids) + then ACETAZOLAMIDE (decreases actual CSF

production)

3648 Internal Medicine Genitourinary acute renal failure -> hyperkalemia, brady -> IV calcium gluconate to protect heart membranes

3680 Internal Medicine Hem&Onc back pain worse lying down -> cord compression vs. improved with recumbency ->msk

3693 Internal Medicine Genitourinary nitrites in urine (just like in smoked meats you eat) -> enterobacteria vs. LEUK esterase -> pyuria

(bacterial infection)

3698 Internal Medicine Cardiology

no QRS -> VF -> first debibrillator (CPR if unwitnessed or >5 min) -> then epinephrine/Q3min while CPR ongoing -> debrillator again-> antiarrhythmics (amiodarone, lidocaine, magnesium) if warranted.

3717 Internal Medicine Respiratory high suspicion PE in unstable pt-> IV heparin, don't wait for CTA

3729 Internal Medicine Endocrinology polyuria w/: -high glucose -> DM. -concentrated urine -> DI (central ro renal resistance). -dilute

urine -> polydipsia

3738 Internal Medicine Neurology dominant (L) frontal lobe -> broca's aphasia, contralateral weakness, look to lesion

3778 Internal Medicine Rheumatology DIURETICS MAKE GOUT WORSE!!!!!!!!! diuretics -> hypovolemia -> increased uric acid levels

3829 Internal Medicine Cardiology PVCs: -> nothing if asymptomatic -> BB -> amiodarone

3863 Internal Medicine

Preventive Medicine

50-74 women -> 2 boobs Q2 years until you're too fucking old. 21-65 women -> 3 hole area check Q3 years. 65+ -> DEXA

3873 Internal Medicine ID MMR ok in AIDs if CD4+ >200

3874 Internal Medicine Respiratory hoarse voice/persistent cough with afib and elevated left main bronchus-> left atrial

enlargement?? -> MS from rheumatic fever???

3890 Internal Medicine GIT bronze diabetes-> hemochromatosis!!!! (high ferritin and high transferrin saturation)

3892 Internal Medicine ID when you're 65 years old -> PCV13, then PPSV23 or just PPSV23 if you're comorbidy

3895 Internal Medicine Genitourinary eating protein bars BAD -> increased Ca2+ kidney stones.

3918 Internal Medicine GIT types of polyps: hyperplastic-nbd. vs. hamartomatous-nbd. vs. adenoma-small risk premalignant

(increased if sessile (structurally) or villous (histologically)). **Villous Villian Adenoma!!!!!**

3930 Internal Medicine Hem&Onc alcoholics can get folate deficiency in four weeks!

3936 Internal Medicine GIT NSAIDs -> GI bleeding -> iron def anemia

3945 Internal Medicine Cardiology nitrates -> dilate veins -> decrease preload -> decrease O2 requirement of heart

3951 Internal Medicine Genitourinary

nosebleeds, bruising, all sorts of bleeding during chronic renal failure -> due to platelet dysfunction (BT prolonged, but everything else normal) -> give DESMOPRESSIN (increases vWF release). DESMOPRESSIN FOR DAT FUCKING PLATELET DYSFUNCTION.

3958 Internal Medicine Cardiology dehydrated?? -> what's the BUN/Cr ?????? (>20 is very SENSITIVE but not specific for

hypovolemia)

3958 Internal Medicine Cardiology drop in 20/10 from supine to standing-> orthostatic hypotension 2/2 volume depletion (BUN/Cr

>20) OR baroreceptor sensitivity problem

3976 Internal Medicine Endocrinology Bb -> unoppposed alpha -> increases bp in cocaine tox and pheo

3977 Internal Medicine Cardiology severe HTN -> hypertensive urgency vs. severe HTN + papilledema/retinal bleed-> malignant htn

vs. severe HTN + cerebral edema/neuro sx -> hypertensive encephalopathy

3979 Internal Medicine Cardiology uremia ( increased BUN) -> pericarditis without EKG changes.

3987 Internal Medicine Genitourinary acyclovir -> not very soluble in urine -> crystal induced acute kidiney injury!!! -> give lots of FLUIDS

3994 Internal Medicine Cardiology old people -> lose elasticity -> increased systolic bp -> widened pulse pressure -> give anti-htn

med

4001 Internal Medicine Biostatistics RANDOMIZE to control for CONFOUNDING.

4003 Internal Medicine Cardiology wide pulse pressure-> decreased elasticity, AVM, AR vs. narrow pulse pressure -> AS,

tamponade, blood loss

4007 Internal Medicine Genitourinary chronic analgesic abuse -> papillary necrosis + tubuloinsterstitial nephritis (polyuria, sterile

pyuria/WBCs)

4024 Internal Medicine Respiratory pneumonia trx; outpt healthy-azithro vs. outpt unhealthy-levo vs. inpt/ICU- levo OR vanc+ zosyn +

levo OR CTX + azithro.

4027 Internal Medicine Genitourinary

stones invisible to X-ray: uric acid, xanthine, or super small calcium stones (<3mm). or maybe there's a blood clot or tumor!! Uric acid stone -> alkalinize urine w/ k-citrate (Urocit-K), low purine diet vs. calcium stones -> HCTZ (loops lose calcium) vs. xanthine stone (genetic)-> low purine diet vs. cysteine (genetic) or struvite (urease infection) stones -> staghorn -> surgery

4037 Internal Medicine Hem&Onc isoniazid -> B6 def -> sideroblastic anemia (microcytic/hypochromic anemia with increased iron,

decreased TIBC)

4040 Internal Medicine Respiratory Only intubate if face-mask fails (unstable, pH <7.1, )

4048 Internal Medicine Respiratory any sort of problem or change in health status-> theophylline toxicity?!?!?!??!?!?

4053 Internal Medicine Respiratory MORE PROTEIN AND LDH IN PLEURAL FLUID THAN SERUM + ACIDIC PH-> EXUDATE

(INFECTION, MALIGNANCY, INFLAMMATION, PE)

4054 Internal Medicine Cardiology coronary steal- tax cuts for the rich

4057 Internal Medicine ID cat scratch gram negative bartonella -> Z-pack


heart problems after virus (coxsackievirus)-> DILATED CARDIOMYOPATHY -> systolic dysfunction. vs. sudden cardiac death -> asymmetric septal hypertrophy vs. chronic pressure overload (HTN, AS)-> concentric hypertrophy vs. chronic volume overload (valvular regurg) -> eccentric hypertrophy

4068 Internal Medicine Cardiology amiodarone, lidocaine for vtach

4073 Internal Medicine Respiratory effusion with a low pH -> probs an empyema -> put in a chest tube (thoracostomy)

4078 Internal Medicine Rheumatology positive straight leg test & radiating pain -> HERNIATED DISK


Low Calcium? 1. Check albumin-> For every decrease in albumin by 1, calcium falls 0.8. 2. Check mag (alc-> low mag-> PTH resistance -> low Ca) 3. Check PTH (if low -> hypoparathyroidism vs. if high -> resistance, vit D def, inflammation)

4083 Internal Medicine Rheumatology

radicular pain + SLT -> herniated disk vs. pain worse with extension + better with shopping cart flexion -> stpinal stenosis vs. point tenderness after injury + normal neuro + osteooporosis hx -> vertebral compression fracture

4091 Internal Medicine Dermatology cone acne -> topical retinoids vs. any other type of acne -> 1.topical antibx 2. oral antibx 3. oral

retinoids

4099 Internal Medicine Ophthalmology Herpes (HSV) HURTS. even in the eye. CMV doesn't.

4120 Internal Medicine ID recent UTI/infection + FOCAL back pain -> osteomyelitis? -> esr/crp, X-rays -> if X-ray normal, get

MRI then biopsy

4123 Internal Medicine Rheumatology smoking hx -> cancer -> paraneoplastic syndromes -> MG, Lambert eaten, dermatomyositis

(gottron's papules, heliotrope rash..confirm with muscle bx)

4127 Internal Medicine Cardiology chronic angina -> BB. (+/-CCB) vs. acute angina -> nitrates.

4133 Internal Medicine Cardiology hepatojugular/abdominaojugular reflux -> rise in jvp w/ compression of abdomen -> means you/re

RV is failing

4139 Internal Medicine Neurology seizure in someone with fever and acting strangely -> HSV-1 encephalitis?!?! -> LP and PCR the

CSF

4147 Internal Medicine Hem&Onc Folate supplementation for phenytoin, tmp, methotrexate!

4150 Internal Medicine GIT inflammation, infection -> INCREASE in platelets (want to stick up/contain disease)

4161 Internal Medicine Endocrinology fractured penis -> venous ED (PENIS IS VENOUS) vs. fractured pelvis -> neurogenic ED

4163 Internal Medicine ID endocarditis in IV druggie -> R sided vs. endocarditis in heart mumur hx pt (mitral valve

problem)-> L sided

4206 Internal Medicine Neurology hemi-neglect syndrome -> right (non-dominant) parietal lobe

4216 Internal Medicine Electrolytes TRANSFUSIONS during surgery -> citrate binding -> HYPOCALCEMIA -> muscle cramps,

hyperactive DTR.. *hypomagnesemia -> PTH resistance -> mimics hypocalcemia

4228 Internal Medicine Endocrinology parasympa lets you pee (detrusor contracts, internal sphincter relaxes), so a neurogenic bladder

-> overflow incontinence (high post-void volume, dribbling, poor stream)

4233 Internal Medicine Respiratory hotels, cruise ships -> Legionella gram negative rod -> hyponatremia, brady with fever, hepatitis,

confusion, GI problems, pneumonia -> urine antigen testing, macrolide or fluoroquinolone

4236 Internal Medicine Electrolytes vomit = HCl + KCl -> hypochloremic hypokalemia with elevated bicarb

4257 Internal Medicine ID nail puncture in tennis shoes (mike burnim) -> PSEUDOMONAS

4266 Internal Medicine Genitourinary FACE OR ANKLE EDEMA -> LIKE YUJ!!! ..NEPHROTIC SYNDROME? -> HYPERCOAGULABLE

STATE. BEWARE RENAL VEIN THROMBOSIS.

4268 Internal Medicine Neurology

contralat sensory/motor deficit, conjugate eye deviation, homonymous hemianopia, aphasia/hemineglect (cortical signs) -> MCA occlusion vs. pure M or pure S or lacunar syndrome -> infarct in BG or subcortical white matter

4278 Internal Medicine Hepatology normal liver (<12cm) less than a dozen everything reversible (steatosis, alcoholic hepatitis, early

fibrosis) ..except cirrhosis! Respect SIR-cirrhosis.

4282 Internal Medicine ENT cipro gets pseudo!! (as does piptaz, aminoglycosides, penams, aztreonam)

4282 Internal Medicine ENT pseudo -> cipro, zosyn (pip-taz), AGs, pens CTX (3) none but CefTazidime(3) and cefepime(4) do

4297 Internal Medicine Respiratory 25% COPD pts -> Cor pulmonale -> edema, hepatomegaly/ascites, exertional sx, distant heart

sounds, increased jvp, tricuspid regurg. *MR, TR, VSD, AS -> all holo-systolic mumur

4303 Internal Medicine GIT Upper GI

4304 Internal Medicine Endocrinology hyperCa + hyperPTH ->primary hyperparathyroidism. vs. hyperCa + hypoPTH-> badness (cancer,

sarcoid, vit D tox)

4307 Internal Medicine Endocrinology hyperthyroid -> bone loss + afib complications


sitting for long periods of time -> BONES GET RESORBED!!!!! -> hypercalceima. especially if young, paget's disease, or chronic renal insuff ****give bisphosphonates and hydrate **albumin = 4, calcium =10; LOW ALBUMIN -> LOW CALCIUM; for every 1 decrease in albumin, -.8 for calcium

4309 Internal Medicine Endocrinology 4 weeks not moving -> clasts absorb bone (don't use it, you lose it). *prevent with H20 and

bisphosphonates.

4316 Internal Medicine Hem&Onc decreased plts? -> HIT 2 ?!?!?!?!?!!?!??!?!?!

4331 Internal Medicine Hem&Onc no G6PD -> hb denatures into Heinz bodies- > bite cells

4338 Internal Medicine Hem&Onc PLATELETS PAYS THE DINNER BILL 150-400K. *LOW PLATELETS + ANEMIA + INCREASED

BILI -> TTP? -> PERIPHERAL BLOOD SMEAR FOR SCHISTOCYTES

4339 Internal Medicine Hem&Onc fragmented RBCs + low platelets (MAHA), bloody diarrhea, HTN, neuro findings, abdominal pain->

idiopathic TTP-HUS??? -> Plasmapheresis or pt will DIE (monitor plts and LDH)

4339 Internal Medicine Hem&Onc Random MAHA -> idiopathic ttp-hus -> plasmapheresis to take out auto-AB or DiE

4351 Internal Medicine Hem&Onc nodes <1cm -> nbd, just watch it.

4370 Internal Medicine Rheumatology

LOWER BACK PAIN: msk- spinal stenosis-shopping cart sign, slipped disk-radiating pain, fracture, mechanical- strain/spasm/degen. vs. inflamm- worse with rest, gradual, hla-b vs. malig- old, weight loss vs. infectious-fever, focal, IVDU, recent infection

4371 Internal Medicine Rheumatology chronic inflammation/stress -> increased platelets (reactive thrombocytosis) to help stick germs to

wbcs

4385 Internal Medicine GIT

just fibrinogen, VWF, or F8 deficiency -> Cryo vs. clotting factor def, DIC, or overdose warfarin -> FFP (ALL clotting facotrs) vs. platelets <50,000 in bleeding pt -> platelets vs. hg<9 in sx pt or hg<7 -> packed RBC


decreased breath sounds -> pleural effusion(dullness to percussion, egophony) or pneumothorax(hyperresonnant to percussion) or emphysema (hyperresonant, vesicular breathsounds) vs. bronchial breath sounds (louder, esp expiratory), dullness to percussion, egophony, crackles -> consolidation vs. vesicular breath sounds/crackles at end inspiration -> interstitial lung disease vs. no breath sounds -> COLLAPSED airway

4393 Internal Medicine Neurology GI loss, anorexia, hyperaldosteronism, diuretics-> hypokalemia -> flattened T waves, U waves, ST

depression, premature ventricular beats

4396 Internal Medicine Cardiology pleuritic chest pain -> PE????? vs. pericarditis????

4401 Internal Medicine Neurology Ach -> excitatory in skeletal muscle but inhibitory in heart muscle! so... anticholinergic -> dilated

vessels/flushing but tachy (loss of inhibition!)

4419 Internal Medicine Electrolytes steriods -> hypokalemia

4422 Internal Medicine Electrolytes it's easier to sweep potassium under the rug than get rid of it! (insulin + glucose works in 15

minutes!) fast but transient effect.

4425 Internal Medicine Electrolytes hypernatremia -> DIABETES INSIPIDUS ??? (central or peripheral)

4428 Internal Medicine Electrolytes For paralytic, SUCC SUCKS. ROC ROCKS. Succ-> hyperkalemia, brady, increased IOP. quick

recovery (10min) vs. Roc-> nothing too bad. just slower recovery but reversible.

4440 Internal Medicine Hem&Onc thalassemia -> hemoglobin chain weird but normal # RBCs and normal RDW (range of

size)...unlike iron deficieny


2nd heart sounds: ASD -> fixed split. ASD IS FIXED PROBLEM. vs. Right heart prb (PS, RBBB) -> Wide split. RIGHT IS WIDE. vs. Left heart prb (AS, LBBB) -> Paradoxical split. LEFT IS LOONY. ************ low bp, muffled sounds, distended vv -> Beck's triad -> TAMPONADE ************ tenneSEE -> S3 -> CHF vs. KEN-tucky -> stiff ventricles/ AS/HCM -> S4

4449 Internal Medicine Rheumatology 1/2 PV pts -> increased uric acid turnover -> gout

4450 Internal Medicine Cardiology SVT -> try some vagal stuff ( valsalva, carotid sinus massage, ice-water) or adenosine ->

decreaes conduction through AV node; break out of reentry

4459 Internal Medicine Cardiology increased pulse pressure -> decreased elasticity b/c you old vs. AV fistula???

4466 Internal Medicine Hem&Onc CRAB + paraprotein gap -> Multiple Myeloma

4469 Internal Medicine Cardiology LONE AF PEOPLE (CHADS VASC 0, < 65 YEARS, MALE, AND NO RISK FACTORS)-> NO

WARFARIN OR ORAL ANTICOAGULANTS NEEDED

4470 Internal Medicine ID + TB test if: >5mm induration for immunosuppressed people. >10mm induration for me. >15mm

for normal people.

4473 Internal Medicine Cardiology acetaminophens + NSAIDS -> BLEEDY

4474 Internal Medicine Genitourinary RIGHT kidney in ADPKD easier to palpate b/c LOWER.

4475 Internal Medicine ID

pneumo vaccine 13 for those more at risk: kids, elderly, and immunocompromised. vs. pneumo vaccine 23 for smoking/alc/less than healthy adults (smokers, DM, lung/liver/heart prb). vs. Sequential 13 + 23 for VERY HIGH RISK/DYING adults.

4477 Internal Medicine

Preventive Medicine Td booster every 10 years + Tdap every pregnancy.

4482 Internal Medicine Neurology deep lacunar strokes usually THROMBOTIC (embolism usually proximal; too big to make it

deeper), and may not see on CT b/c so fucking small.

4484 Internal Medicine Cardiology pulsus parvus et tardus -> AS vs. diastolic mumur -> AR

4487 Internal Medicine Poisoning anticholinergic effects + seizures + long QRS -> TCA OD -> Bicarb to treat hypotension

4487 Internal Medicine Poisoning tCA od -> biCArb

4489 Internal Medicine Respiratory Bicarb ~25 C02 ~35

4490 Internal Medicine Genitourinary Cr > 1.5 -> renal insufficiency -> non-ionic contrast CT

4513 Internal Medicine Neurology brain abscess from sinus infection -> STREP viridans or anaerobes/bacteroides vs. abscess from

surgery/trauma -> STAPH

4514 Internal Medicine Endocrinology DKA-> osmotic diuresis causes K+ loss, but redistribution from acidemia creates appearance of

hyperkalemia.

4516 Internal Medicine Ophthalmology infection/stress -> increased cortisol/cats -> insulin fucked up -> hyperglycemia -> osmotic

diuresis, ams, blurry vision (nonketotic hyperglycemia in DM2)

4522 Internal Medicine Poisoning neuroleptic malignant syndrome -> Dantrolene + Dopamine agonists (bromocriptine, amantadine)


radiation, TB, virus/idiopathic -> scarred pericardial sac-> CONSTRICTIVE PERICARDITIS, RHF -> hepatojug reflex, kussmaul's sign (JVP doesn't change with breath), pulsus paradoxus,pericardial knock (mid-diastolic), pericardial thickening/calcification

4524 Internal Medicine Cardiology Kussmaul- Inhaul -> paradox rise in neck veins (where you kiss) 2/2 right heart filling prb

4535 Internal Medicine Electrolytes Increased BUN -> GI BLEED?????????? (blood proteins get broken down to urea)

4536 Internal Medicine Respiratory If ABG shows pO2 really high: 1. Slowly decrease FiO2 to non-toxic levels (<60%). 21% is normal

sea level. 2. Increarse PEEP to maintain oxygenation GOAL : ABG pO2> 60

4564 Internal Medicine Rheumatology short-lived morning stiffness -> OA vs. lingering morning stiffness -> inflammatory


coughing up a little blood with no fever/concern for pneumonia -> probably ACUTE BRONCHITIS 2/2 virus, NBD. been there, done that. yellowish sputum can be from epithelial sloughing too, not neccessarily an infection.

4568 Internal Medicine Respiratory untreated pneumonia -> pus in pleural cavity (EMPYEMA) -> drainage and antibx

4572 Internal Medicine Rheumatology morning stiffness >1hr + systemic symptoms ->RA-> inflammation + RA treatment (steroids) ->

osteoporosis -> give bisphosphonates to kill osteoclasts!

4575 Internal Medicine Respiratory ESR SHOULD BE <20!!!! <20. <20. <20.

4585 Internal Medicine Rheumatology Chronic Inflammation -> secondary amyloidosis

4586 Internal Medicine Rheumatology knee pain with crepitus, coolness, calm mornings (resolves within 30 min) and can be

monoarticular-> OA and not something inflammatory

4593 Internal Medicine Cardiology COPD, diseases of lung -> pulm HTN -> right heart failure -> hepatic congestion + peripheral

edema

4611 Internal Medicine ID bactrim in HIV pts for prevention of toxo reactivation and PCP

4616 Internal Medicine Cardiology THROMBOSIS ON HEPARIN -> HIT (nonimmune vs. immune)

4620 Internal Medicine Neurology early gait problems -> hydrocephalus vs. late gait problems -> alzheimer's

4627 Internal Medicine Endocrinology elevated alk phos but normal everything else -> PAGET disease of bone.

4631 Internal Medicine Respiratory any one of lights criteria met -> EXUDATIVE effusion -> pneumonia? cancer? inflammation?

4639 Internal Medicine Cardiology erectile dysfunction + skin problems + joint problems + liver problems + DM + dilated CM->

hemochromatosis!!

4651 Internal Medicine Neurology WET, WOBBLY, WACKY -> NPH

4671 Internal Medicine Hem&Onc ABO mismatch -> within ONE HOUR: DIC, renal failure, fever (acute hemolytic transfusion rxn)

4679 Internal Medicine Cardiology S3 in older people-> too much blood or filling too rapidly with blood -> heart failure, restritive

cardiomyopathy vs. S4 in younger people -> stiff ventricles, acute MI

4686 Internal Medicine Biostatistics cohort-pick group based on RISK FACTOR. estimate incidence (# new cases of disease), allows

calculation of Relative RISK.

4700 Internal Medicine Neurology ams -> thiamine before dextrose

4700 Internal Medicine Neurology eyes, lies, capsize -> wernicke encephalopathy -> thiamine B1 def

4703 Internal Medicine Neurology temp over 105 and AMS (w/ tachy, coagulopathic bleeding, renal failure, ARDS..) in workers in

humid weather -> EXERTIONAL heat stroke.

4707 Internal Medicine Cardiology HTN -> elevated LV diastolic pressure -> LA dilates-> AFib. anemia, hyperthroidism, beriberi,

paget's, av fistulas -> ventricles work harder but can't compensate -> high-output heart failure.

4714 Internal Medicine ID splenic abscess (fever, wbc, LUQ pain) -> infective endocarditis??

4718 Internal Medicine Respiratory O2 saturation goal in COPD exacerbation -> 90-94% !!!!! (if higher, risk hypercapnia/Co2 narcosis

from V/Q mismatch)

4725 Internal Medicine Cardiology (No pulse????) PEA or Asystole -> ACLS (CPR/2min, IV acess + pressors/4min!!!!) vs. Vfib or VT

with no pulse -> defibrillate vs. unstable Afib w/ RVR or symptomatic VT-> cardiovert


ASA or BB -> bronchoconstriction. *I'm depressed when I'm ischemic!! (ST depression -> ANGINA/ischemia) * acute dyspnea-> arrhythmia, broncoconstriction, CHF/hypervolemia, infection, aspiration, pleural effusion, PE, anxiety

4753 Internal Medicine Respiratory if increased protein OR LDH in pleural fluid -> EXUDATE.

4771 Internal Medicine Cardiology INCREASED PRESSURE IN PERICARDIAC SAC ( tamponade, copd, severe asthma) -> pulsus

paradoxus: deep breath-> more Q to RH-> less to LH -> exaggerated systolic bp drop.

4859 Internal Medicine Hem&Onc clot -> trx w/ heparin -> HIT 2?!?!?!? -> more clots!!!. how ironic.

4866 Internal Medicine Electrolytes metabolic alkalosis: -saline responsive/vomiting or volume depletion (retaining chloride) vs. -saline

resistant/mineracorticoid problem (peeing lots of chloride out)

4902 Internal Medicine ENT rinne: + if you can feel ringing on mastoid but can 't hear it when next to ear. * confirm with weber.

fork in forehead-> noise louder in ear with conductive prb/wax

4920 Internal Medicine Cardiology Skinny QRS -> SVT -> vagal manuevers/ IV adenoSine vs. Wide QRS -> VTach -> amiodaTone,

lidocaine

8823 Internal Medicine Psychiatry no circadian rhythm -> shift work sleep disorder (my life) vs. takes forever to fall asleep. night owl

schedule-> delayed sleep phase syndrome -> light/behavioral therapy

8876 Internal Medicine Endocrinology Calcium should be 8-10. Low calcium -> 1. Check mag. 2. Check PTH.

8901 Internal Medicine Endocrinology GI disease-> vit D def -> hypo-calcemia and hypo-phos -> increased PTH

8905 Internal Medicine Respiratory fev1 decreases in both obstructive and restrictive lung disease, but fev1/fvc < 70% -> Obstructive

8926 Internal Medicine Ophthalmology fixed, dilated pupil + hazy cornea -> acute angle-closure glaucoma vs. inflammed iris -> anterior

uveitis

8933 Internal Medicine Rheumatology yellow lighting bolts -> GOUT

10146 Internal Medicine Poisoning smoke inhalation -> hydroxocobalamin antidote for HCN poisoning

10287 Internal Medicine Electrolytes blood and protein and casts in urine -> GLOMERULEAR cause.

10301 Internal Medicine ID

SCREENING for HIV -> AG and AB combo test for early detection (before ABs made). if + -> CONFIRM w/ AB differentiation assay... if negative blood tests but you still think person high-risk -> plasma RNA testing

10767 Internal Medicine Cardiology malignant htn + scleroderma -> scleroderma renal cris ( schistocytes and thrombocytopenia on

smear)

10780 Internal Medicine Neurology Dystonia Akathisia Parkinsonism Tardive dyskinesia

10958 Internal Medicine Endocrinology HTN + tachy + fever + lid-lag -> THYROID STORM???!?!?

11067 Internal Medicine GIT PPIs -> C-diff!!! Shafik watch out!!

2344 Obstetrics & Gynecology OBGYN S. Aureus -> dicloxacillni, cephalexin vs. MRSA-> Bactrim, Clinda, Vanc

2388 Obstetrics & Gynecology OBGYN

no boobs = no estrogen. like i've got no estrogen. don't even need to measure my estrogen levels. say i've never gotten a period. 1. U/S -> if no uterues, get karyotype & testosterone vs. if uterus, get FSH (if increased-> peri prb get karyotype vs. if decreased-> central problem get MRI)

2398 Obstetrics & Gynecology OBGYN urethral hypermobilitly (weakened pelvic floor muscles)-> over 30* swab test angle -> stress

incontinence-> kegel then urethropexy

2405 Obstetrics & Gynecology OBGYN meredith would totally get an amniotic fluid embolism.

2407 Obstetrics & Gynecology OBGYN placenta rips off a little (placenta abruption) -> pain, increased uterine tone, increased freq

2411 Obstetrics & Gynecology OBGYN ectopic with bHCG 1500-6500 1. transVAGINAL U/S 2. if negative, serial bHCGs

2412 Obstetrics & Gynecology OBGYN turn try to turn baby until 37th week (3 week notice to self-fix)

2419 Obstetrics & Gynecology OBGYN PMS -> SSRIs

2523 Obstetrics & Gynecology OBGYN PAINLESS PREVIEW (bleeding). placenta previa.

2533 Obstetrics & Gynecology OBGYN placenta previa->> painless bleeding vs. vasa previa->> painless bleeding + fetus deteriorates/dies

2536 Obstetrics & Gynecology OBGYN dilated OS -> incomplete or inevitable abortion

2563 Obstetrics & Gynecology OBGYN RBC CASTS -> TRUE NEPHRITIS. not just protein loss from HTN/preeclampsia.


increased AFP -> NT or abdominal wall defect or multiple gestation (increased levels of protein/protein spilling out of structural deformity!!!) vs. decreased AFP-> aneuploidies (your actual baby is fucked up chromosomally).

2568 Obstetrics & Gynecology OBGYN 2nd trimester quad screen/ 4 things: Hcg Inhibin AFP Estriol in down syndrome, high HI, low AE

2925 Obstetrics & Gynecology Hepatology PUPPP spares Palms (& soles & face) vs. intrahepatic cholestasis of pregnancy (dx of exclusion)

(itchy palms & soles, worse at night)

3110 Obstetrics & Gynecology OBGYN decreased fetal movements or high risk pregnancy -> NST (fetal heart rate: at least 2 accels of at

least 15 above baseline lasting at least 15 seconds?) -> if not, NOISE stimulation.

3116 Obstetrics & Gynecology OBGYN arrest of labor: >6 cm dilated with ruptured membranes but no change over 4 hours despite good

effort/contractions vs. no change over 6 hours despite weaker/inadequate contractions


menorrhagia ddx: -bulky, boggy, globular, tender uterus -> adenomyosis vs. -pain with sex, infertility -> endometriosis vs. -postmenopausal or obese or nulliparity -> endometrial hyperplasia/cancer

3269 Obstetrics & Gynecology OBGYN for preterm labor: >34 weeks -> just floor it and deliver vs. 23-33 weeks -> steroids for lungs, mag

sulfate for neuro, +/- tocolytics vs. <23 weeks -> not viable

3273 Obstetrics & Gynecology OBGYN if fetus' kidneys fucked up-> gotta let it die

3337 Obstetrics & Gynecology OBGYN lochia: bloody, serous/pale, alba/white. foul-smelling-> endometritis, otherwise low-grade fever ok

3370 Obstetrics & Gynecology OBGYN during ovulatory phase, mucus CLEAR + THIN (stretches to 6 cm), more basic, ferns, vs. any

other time, mucus inhospitable (scant, thick, opaque)

3679 Obstetrics & Gynecology OBGYN pH >4.5 is increased for vagina -> BV or trich....(or both)

3745 Obstetrics & Gynecology OBGYN POSTERIOR vagina wall is where the penis goes (hpv 16,18, scc)

3868 Obstetrics & Gynecology OBGYN puberty before 8 years old -> precocious. advanced bone age. Central (high FSH,LH) vs.

peripheral-gonads/adrenal (low FSH, LH)

3869 Obstetrics & Gynecology OBGYN low amnioic fluid level, nuchal cord, cord proloapse -> cord compression -> variable decels -> if

RECURRENT, improve oxygenation, change mom's position, amnioinfusion

4124 Obstetrics & Gynecology Endocrinology pregnant -> INCREASED total, binding, AND free T3,4 -> negative feedback -> DECREASED TSH

4136 Obstetrics & Gynecology OBGYN menopausal or hyperthyroid? -High FSH vs. low TSH.

4148 Obstetrics & Gynecology OBGYN pregnant women- elevated alk phos. increased renal Q and gfr-> decreased serum BUN,

creatinine

4220 Obstetrics & Gynecology Endocrinology if i didn't get my period for 3 cycles..-> b-hCG for preg, prolactin for brain tumor, TSH for

hypothyroidism, FSH for premature ovarian failure

4221 Obstetrics & Gynecology OBGYN prolactin is inhibited by dopamine and stimulated by serotonoin and TRH.

4221 Obstetrics & Gynecology OBGYN Hypothyroid -> increased trh, tsh -> stimulates prolactin -> inhibits gnrh -> amenorrhea with

galactorrhea

4472 Obstetrics & Gynecology ID bacteria in urine in preggers -> not acceptable -> no bactrim, no cipro, nitrofurantoin, augmentin,

or cephalexin OK

4530 Obstetrics & Gynecology

Preventive Medicine All preggers need HIV, syphilis, and hep B screens for baby

4757 Obstetrics & Gynecology OBGYN 1st gen cephalosporins: cefazolin = ancef -> (Ancef Only IV) vs. cephalexin = keflex -> Eat keflex

on a kleenex. (oral available)

4758 Obstetrics & Gynecology OBGYN HGSIL on pap smear-> colposcopy to rule out invasive cervical cancer -> if negative, repeat 6 wks

after delivery

4759 Obstetrics & Gynecology OBGYN bHCG should DOUBLE/48 hrs if VIABLE. Slower rate if ectopic or nonviable. transvaginal U/S

1,500-2,000 -> you can see something

4767 Obstetrics & Gynecology OBGYN estrogen-> builds endometrium. withdrawal of progesterone from corpus luteum after ovulation ->

menses. if no ovulation, no progesterone, no real menses, just breakthrough bleeding.

4775 Obstetrics & Gynecology OBGYN <20 weeks -> spontaneous abortion vs >20 weeks -> intrauterine fetal demise -> autopsy to

prevent in future pregnancies


new-onset htn (140/90) + proteinuria OR other end-organ damage AFTER 20 WEEKS -> pre-eclampsia!! risk factors: multiple gestation, nulliparity, DM, being old, CKD, previous SEVERE if >160/110, decreased plts, creatitine >1.1 or increasing, tarnsaminitis, pulm edema, new neuro sx

4779 Obstetrics & Gynecology OBGYN acute infection -> inhibits plts severe preelampsia -> " vs. chronic inflammation -> increase plts.

4781 Obstetrics & Gynecology OBGYN HELP ME REMEMBER HELLP SYNDROME!! severe preeclampsia: hemolysis, elevated liver

zymes, low plts

4782 Obstetrics & Gynecology OBGYN preeclampsia -> arteries spazz out -> increased afterload -> pulmonary edema -> diuretics,

oxygen, fluid restriction

4791 Obstetrics & Gynecology OBGYN Silent Syphilis (ulcer doesn't hurt) vs. chancroid - purulent ulcers with painful lymphadenopathy vs.

herpes -burning/itching then vesicles

4796 Obstetrics & Gynecology OBGYN VERTEX is NORMAL. head down dumbass.

4802 Obstetrics & Gynecology OBGYN spontaneous abortion (<20wks) with CLOSED CERVIX -> Missed or Threatened. Missed or

Threatened. Missed or Threatened.

8917 Obstetrics & Gynecology OBGYN Yimu may well clear her infection. 50% sexually active women get HPV within 3 years; 50% clear

within 2 years.

8962 Obstetrics & Gynecology OBGYN VEAL CHOP variable decel-cord compression/prolapse early decel-head compression accel- OK

late decel- placental insuff

10441 Obstetrics & Gynecology OBGYN chromosomal screening at 10-12 weeks -> cell-free fetal DNA, then confirm with CVS. vs. at 15-20

weeks -> amniocentesis2439 Pediatrics Pediatrics T wave inversion -> MI, myocarditis, myocardial contusion, digoxin tox

2445 Pediatrics Endocrinology Shitty AR Developmental Diseases w/ cherry-red macula: Niemann Pick- (spingomyelinase def) )areflexia, hepatosplenomegaly vs. Tay-Sachs- (B-hexs def) hyperreflexia

2450 Pediatrics Pediatrics lupus dx-> anti-SMITH and dsDNA. Check Ms. Smith's DNA for SLE.

2465 Pediatrics GIT

bilious vomiting -> NPO, NG decompression, IVF, & XRAY: -if free air or unstable - > SURGERY. -if dilated loops bowel -> CONTRAST ENEMA to differentiate MECONIUM ILEUS vs. HIRSCHSPRUNG. -if double bubble -> DUODENAL ATRESIA. -if NG tube misplaced -> UPPER GI SERIES for malrotation/volvulus.

2468 Pediatrics Pediatrics Edward the vampire (Trisomy 18) has a hole in his heart (VSD).2485 Pediatrics Pediatrics babies heal their clavicles in 1 week!!! amazing.

2513 Pediatrics Genitourinary don't get depressed with your toddler's potty-training -> try desmopressin!!! (risk hyponatremic seizures though..)

2758 Pediatrics Dermatology Eczema = atopic dermatitis

2867 Pediatrics Hem&Onc MOST leukemias in kids are ALL. lymphoblastic (increased immature forms of B and T cells) which are PAS, TdT+

3192 Pediatrics Pediatrics von gierke's: G6P -X> glucose. glycogen accumulates in liver, kidney....hypoglycemic seizures, doll-face

3196 Pediatrics Pediatrics X-linked agammaglobulinemia: most eXtreme (decreased B cells and decreased Ig) vs. Common variable: B cells fine, all common Ig decreased

3284 Pediatrics Hem&OncpainLESS lymph nodes -> lymphoma?!?!?!?!?!?!??! widened mediastinum on cxr may be lymphadenopathy!! decreased plts-> petechiae. decreased RBC -> pallow. >25% blasts on bone marrow bx diagnostic.

3284 Pediatrics Hem&Onc leukEMIA??? -> blood + BONE MARROW BIOPSY (>25% blasts) -> lymph node bx if bone marrow negative or if worried about lymphOMA.

3289 Pediatrics Respiratoryinspiratory stridor + dysphagia + drooling + tripoding + high fever + thumbprint sign on x-ray -> epliglottis from Hib or other bacteria -> trach them vs. inspiratory stridor + barky cough + steeple sign of x-ray-> croup -> nebulized epinephrine

3404 Pediatrics Pediatrics insidious hip pain in 6 yr old boy -> Legg calve perthes vs. 13 yr old boy-> scfe3442 Pediatrics Pediatrics meningitis + rash -> ADRENAL HEMORRHAGE.3459 Pediatrics Respiratory pO2 >75 (75 to pass the exam)

3543 Pediatrics Cardiology turner syndrome girls have grade-A problems (bicuspid Aortic valve, coarct of Aorta, Aortic root dilatation)

3546 Pediatrics Cardiology

standing (blood to LE), valsalva (blood to pelvis)-> decreased VR -> everything less except MVP and HCM (decreased heart mumur -> INNOCENT/PHYSIOLOGICAL MUMUR :) vs. leg raise/squats (exercise)-> blood to heart -> increased preload -> everything stronger except MVP, HCM

3550 Pediatrics Neurology NF1- 1 cafe au lait pour moi vs. NF2-Bilateral acoustic neuromas

3554 Pediatrics Pediatricsscrotal/abdominal pain + palpable purpura + joint pain + kidney prbs after URI = VASCULITIS?????? SAY IgA-mediated HENOCH-SCHONLEIN PURPURA ?!?!?! -> supportive, steroids

3577 Pediatrics ID septic arthritis -> tap joint, then give IV VANC -> then adjust antibiotics3640 Pediatrics ID sickle cell??-> you basically don't have a spleen -> PCN until at least age 5

3658 Pediatrics Pediatrics most common cancer in kid: LEUKEMIA (ALL) vs. most common SOLID cancer in kid: BRAIN TUMOR (astrocytoma-benign so not gbm, infratentorial)

3669 Pediatrics Pediatrics Don't want Duchenne's. GOLD STANDARD is GENETIC STUDIES.3688 Pediatrics Genitourinary babies with AN UTI -? U/S vs. babies wtih RECURRENT UTIs -> voiding cystourethrogram3713 Pediatrics Hem&Onc acute infection-> inhibits/decreases plt production vs. chronic inflammation-> increased plts3755 Pediatrics Pediatrics nontender blue patches in ethnic baby -> mongolian spot (congenital dermal melanocytosis)

3758 Pediatrics Pediatrics chlaymida in your baby's eye -> ORAL erythromycin (to get it out of their throat too) vs. gonorrehea in your baby's eye -> IV or IM CTX

3867 Pediatrics Endocrinology secondary sex characteristics are different!! adrenals make androgen-> (hair and body odor, incr DHEA> test) vs. ovaries make estrogen-> (big boobs)

3875 Pediatrics Endocrinology advanced bone age? -> someting is FUCKED up => check LH -> if High, central prb, if low (inhibited), peri prb.

3875 Pediatrics Endocrinology if bone age is advanced -> there is a peri or central PROBLEM. not idiopathic. look at LH-> if high central prb, if low (even with GnRH stimulaion) peri prb.

3924 Pediatrics Pediatrics headaches + weak legs -> COARCT, collaterals, rib notching 3924 Pediatrics Pediatrics Murmur everywhere over chest -> collaterals -> coarctation

3926 Pediatrics Pediatrics -fat in stool -> pancreatic enzyme deficiency -> CYSTIC FIBROSIS??? -not growing +recurrent URIs -> CYSTIC FIBROSIS????

3991 Pediatrics Cardiology Left axis deviation in newborn -> tricuspid valve atresia (wimpy right heart)

4038 Pediatrics Pediatrics high fever and acute onset bone pain -> osteomyelitis! vs. gradual pain with no fever -> avascular necrosis!!

4064 Pediatrics Pediatrics anterior slip/ step off-> spondylolis(SLIP)thesis

4183 Pediatrics GIT thickened (ion channel dysfx) meconium obstructing ileum -> meconium ileus -> CF? vs. normal meconium obstructing colon -> hirschsprung disease -> DOWN SYNDROME?

4260 Pediatrics Cardiology most common cyanotic heart prb in newborns-> TRANSPOSITION (single S2) -> PGE4271 Pediatrics Neurology VC + RV = TLC (capacity = sum) (VC= TV + IRV +ERV)4290 Pediatrics GIT gastroschisis- naked bowel. usually isolated defect plastic wrap that shit and surgery immediately.4302 Pediatrics Pediatrics angular cheilitis, normocytic anemia, seborrheic dermatitis -> riboflavin B2 def4317 Pediatrics ID Cats dogs humans bite -> daugmentin4823 Pediatrics Pediatrics obj permanence at 6 months. ...which leads to -> sep anxiety around 1 year

4845 Pediatrics ID ptosis-> heavy lids (horner's syndrome, mg) vs. prOPTosis/EX-ophtalmos -> eye bulging OUT (graves, cellulitis)

4847 Pediatrics Hem&Onc decreased plts + recurrent infections + eczema => WAS8772 Pediatrics Hem&Onc Onion-skin Ewing Vs. Sunburst osteoSarc2482 Psychiatry Psychiatry Conduct disorder for Kids. vs. Antisocial for Adults.2508 Psychiatry Psychiatry brief psychotic disorder (1 day-1 month) schizophreniform (1-6 months) schizophrenia (>6 months)

2510 Psychiatry PsychiatryMANIC episodes w/ or w/out depressive episode -> bipolar 1 vs. hypomanic episodes (not hospitalized, not impairing fx, no psychosis) + depressive episode -> bipolar 2 vs. hypomanic + depressive symptoms for at least 2 years -> cyclothymic disorder

2518 Psychiatry Psychiatry EPS -> usually from typical antipsychotics + risperidone. can change to clozapine but last resort due to agranulocytosis risk

2521 Psychiatry Psychiatry illness anxiety disorder/hypochondriac = fear of getting disease but NO SX vs. somatic symptom disorder = anxiety w/ physical SX > 6 months

3147 Psychiatry Psychiatry schizoid andrea. avoidant swetha.3147 Psychiatry Psychiatry avoidant swetha. schizoid andrea. AS. SA.3185 Psychiatry Psychiatry rich and single and genetics-> increased risk bipolar.3375 Psychiatry Psychiatry tourettes act psychotic -> trx antipsychotics3470 Psychiatry Psychiatry Cataplexy -> modafinil stimulant3792 Psychiatry Psychiatry TELL ME MORE ABOUt thAT.4815 Psychiatry Psychiatry Chelsea has ocpd. Personality disorder. Ego-syntonic.2340 Surgery Surgery RBC scan less invasive than angiography. if colonoscopy neg for LGIB-> do RBC scan next.2476 Surgery GIT hernia-covered with skin vs. omphalocele- covered with peritoneum vs. gastroschisis-butt naked

3182 Surgery Surgery acute diverticulitis ->First ask, complicated vs. uncomplicated?? If complicated (abscess/perf/obstruction/fistula) -> then ask, <3cm (IV antibx) or >3cm (CT drain it)

3221 Surgery Surgery Blunt vs. penetrating trauma. If penetrating -> almost always exploratory lap

3223 Surgery Surgery CO. Colorless. Odorless. Cherry O lips. elevated carboxyhemoglobin level. pulse ox lies. give 100% O2.

3325 Surgery Surgery clean wound but uncertain vaccine status-> just give vaccine. dirty/severe wound -> give vaccine unless recent booster (5 years)

3435 Surgery Surgery crohn's disease: lose calcium bound to fat and can't absorb bile salts -> increased oxalate levels -> stones!

3572 Surgery Surgerylateral injury ("abduction injury")-> tear MCL -> dx valgus stress test vs. LCL doesn't really happen (medial force to knee??) vs. hyperextension/torsional injury-> ACL vs. dashboard injury-> PCL. *popping doesn't tell you anything. everything pops.

4293 Surgery Surgery femoral nerve4364 Surgery GIT SBO- usually caused ADHESIONS (congenital vs. iatrogenic vs. inflammation)

4501 Surgery Surgery back/flank pain after cardiac cath -> retroperitoneal hematoma!! -> dx non-con abd CT; trx supportive, prx don't lift heavy things after cath, and radial arter approach better

4527 Surgery Cardiology large left sided hemothorax after blunt trauma -> AORTIC INJURY (contained or else you'd be dead already)

4527 Surgery Cardiology left-sided hemothorax -> AORTIC INJURY. vs. pneumothorax that does not resolve with chest tube placement -> BRONCHIAL RUPTURE. vs. esophageal rupture-> don't really get with trauma.

4538 Surgery RespiratoryTAKE CARE OF PNEUMOTHORAX BEFORE INTUBATION. distended neck vv-> PT or cardiac tamponade. -> needle decompression and then chest tube placement (also treats hemothorax); if still unstable, FAST for pericardial tamponade

4541 Surgery Cardiology Increased pcwp -> Left heart failure

4552 Surgery Neurology Epidural hematoma -> uncal herniation -> ipsilateral oculomotor and contralateral cerebral peduncle

4554 Surgery Surgery Meniscal tears minimal sx: gradual swelling b/c indirecty perfused, Mcmurray's sign (snap with terminal extension) vs. lightning ligamentous tears: rapid swelling from blood in joint

4698 Surgery Neurology syrinomyelia kind of like central cord syndrome (UE motor and sensory deficits)

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