_Dit 2 Rpr

Front 1

What statistical calculation looks at true positives and divides them by the number of pts with the disease?

Back 1

Sensitivity

Front 2

Which type of renal tubular acidosis (RTA) is associated with abnormal H+ secretion and nephrolithiasis?

Back 2

Type 1 RTA

Front 3

A 55 yr-old man has sudden onset of pain in his first metatarsophalangeal joint after a night of drinking red wine. What is the diagnosis, workup, and how can it be treated chronically?

Back 3

Dx: Gout
Chronic tx: allopurinol, or colchicine, probenecid.

Front 4

What would you suspect in an ER patient with blood in the urethral meatus or a high riding prostate?

Back 4

bladder ruptrue or urethral injury -- Dont put in a catheter

Front 5

What is the treatment for neuroleptic malignant syndrome?

Back 5

Dantrolene!

+/- dopamine agonist like bromocriptine

Front 6

What is Becks triad for cardiac tamponade**

Back 6

Hypotension, Distant heart sounds, and JVD

Front 7

What does a fall in systolic BP of >10 mmHg with inspiration indicate?

Back 7

Pulsus paradoxus ==> cardiac tamponade, and hyperinflation d/o like COPD and asthma

Front 8

What are the imaging studies in a trauma series?

Back 8

AP chest
AP and lateral C-spine
AP pelvis

Front 9

What is the first line tx for pediculosis pubis and pediculosis capitis?

Back 9

permethrin

Front 10

What is the tx of cardiogenic shock?

Back 10

Dobutamine**

Front 11

What type of shock cuases decreased cardiac output, decreased PCWP, and decreased peripheral vascular resistance?

Back 11

Septic, anaphylactic or neurogenic

Front 12

What is the classic ECG appearance in atrial flutter?

Back 12

Saw tooth of P waves

Front 13

What method is used to calculate fluid repleation in burn patients?

Back 13

Parkland formula
4ml/kg/% burned

Front 14

What autoimmune complication occurs 2-4 wks after an MI?

Back 14

Dressler's syndrome

fever, pericarditis, increased ESR

Front 15

What is the tx for ventricular fibrilation (VF)?

Back 15

Immediate cardioversion 360 Joules

drug: Epinephrine or Vasopressin, then Epi every 3-5

Front 16

A 15 yr old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?

Back 16

No. principal consent is not nesecary in pregnant minors

Front 17

What are the causes of hypervolemic hyponatremia?

Back 17

Cirrhosis, CHF, nephrotic syndrome

Front 18

Patient presents with a history of lithium use with copious ammts of dilute urine. What condition is this?

Back 18

Nephrogenic diabetes insipidus

Front 19

What type of acute renal failure would you suspect in a patient with a FENa<1%?

Back 19

pre-renal disease
loss of volume, dehydration, loss of blood

Front 20

A child has flesh-colored, umbilicated lesions on the face. what are these lesions, and where do the appear in adults?

Back 20

Musculosum contagiosum

adults: groin (perigenital, perianal)

Front 21

What lab findings are characteristic of Hashimoto's thyroiditis?

Back 21

High TSH
Low T4
Anti microsomal antibodies

Front 22

What laproscopic findings can be seen in endometriosis?

Back 22

Powder burns, or chocolate cysts

Front 23

What do an elevated EPO, elevated HCT, and normal O2 sat suggest?

Back 23

EPO producing tumor such as renal cell carcinoma. needs to be evaluated with CT scan

Front 24

*Which immunodeficiency would you suspect in a pt with recurrent infections, thrombocytopenia, and eczema?

Back 24

wiscott aldrich! - classic triad

Front 25

What systemic dz's can cuase nephritic syndrome?

Back 25

diabetes, systemic lupus, amyloidosis

Front 26

What is the MC form of nephritic syndrome?

Back 26

Membranous glomerulonephritis

Front 27

A 60-yr old obease patient presents with dirty, velvety patches on the back of the neck ---> what is the diagnosis and what is the initial workup?

Back 27

Acanthosis niagricans
fingerstick blood glucose test for DM
and thourough H&P for signs of a visceral malignancy

Front 28

Salicylate ingestion results in what type of acid-base abnormality?

Back 28

its mixed= Respirary alkolosis + Metabolic acidosis and elevated anion gap

Front 29

What name is given to stress-related hair loss? what is the tx?

Back 29

Telogen effluvium

Tx: reassurance - hair returns a few weeks after stressor leaves

Front 30

What skin blistering disease has a postive nikolsky sign?

Back 30

Pemphigous vulgaris

Front 31

A patient is unable to inspire completely d/t pain during palpation of the RUQ. What is this sign? What is the diagnosis?

Back 31

sign: Murphy's sign
Dx: Acute Cholecystitis

Front 32

A burn patient presents with cherry-red flushed skin and coma. O2 saturation is normal, but carboxyhemoglobin is elevated. What is the tx?

Back 32

100% 02 maks, hyperbaric oxygen

Front 33

A male with a testicular mass is found to have an elevated B-HCG. What is the diagnosis?

Back 33

Testicular chorionic carcinoma

Front 34

What are the protein and LDH critera for an exudative effusion?

Back 34

Pleural:serum protein ration >0.5
&
pleural LDH: serum LDH >0.6

Front 35

Which medication is used more than any other in the treatment of parkinsons?

Back 35

Senimet (levidopa + crabidopa)

Front 36

If you want to know if maternal age affects infant mortality rate, but most of the variation in infant mortality is predicted by socio-economic status, then SES is a ....______

Back 36

SES is a confounding variable

Front 37

HTN + Hypernatremia + hypokalemia and metabolic alkalosis?

Back 37

primary hyperaldosteronism

d/t Conn's syndrome or Bilateral adrenal hyperplasia

Front 38

hampton's hump on X-ray is associated with _____

Back 38

Pulmonary Embolus

Front 39

What causes a child to have mental retardation, microcephaly, microopthalmia, short palpebral fissures, midfacial hypoplasia, and cardiac defects?

Back 39

Fetal Alcohol Syndrome

Front 40

Hypoxemia + pulmonary edema + normal pulmonary capillary wedge pressure?

Back 40

no back up of blood into the left atrium = acute respiratory distress syndrome

Front 41

What type of psychotherapy is used in treating phobias, OCD, adn panic disorder?

Back 41

Cognitive behavioral therapy

Front 42

What is the MCC of hypothyroidism

Back 42

Hashimotos

Front 43

What medication is used most commonly to induce ovulation?

Back 43

chlomaphine citrate (might also be able to use pulsitile leuprolide

Front 44

What is the MCC of cushing's syndrome?

Back 44

Steroid use

2nd: pituitary ATCH secreting tumor (cushing's dz)

Front 45

What is the MC inherited cause of hypercoagulability?

Back 45

Factor 5 leiden

Front 46

What is the reversal agent for heparin?

Back 46

Protamine sulfate**

Front 47

What is the tx for Delerium Tremens?

Back 47

Benzo's
chlordiazepoxide (librium)

Front 48

What are the cardinal movements of labor?

Back 48

Engagement, Descent, Flexion, Internal rotation, Extension, External rotation, Expulsion.

Front 49

What is the cause of muscle rigidity, fever, and rhabdomyolysis in a schizophrenic patient?

Back 49

Neuroleptic malignant syndrome

Front 50

What diagnostic test differentiates central from nephrogenic diabetes insipidus?

Back 50

DDAVP (desmopressin)

If it gets better with desmopressin, its central DI

Front 51

What are the top 3 reasons for involuntary psychiatric hospitalization?

Back 51

#1 patient is a danger to self
#2 patient is a danger to others
#3 patient gravely disabled (catatonic)

Front 52

What is the LDL goal in a pt with diabtetes?

Back 52

<100

if Hx of vessel dz, then <70

Front 53

a mother who is frustrated with her child yells at her husband, what tipe of defense mech is this?

Back 53

Displacement

Front 54

An 18 yr old female with no history of abnormal pap, now has an ASCUS. How should this be managed?

Back 54

repeat pap in 1yr

Front 55

What disorder is present in a teenager with a hx or theft, vandalism, and violence toward family pets?

Back 55

Conduct disorder

Front 56

What is the underlying cause of neonatal respiratory distress syndrome?

Back 56

Decreased surfactant

Front 57

Which type of bias is introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death?

Back 57

Lead time bias

Front 58

Psychiatric condition in which a person travels a long distance, takes a new name, and has no memory of his prior life?

Back 58

Dissociate fugue

Front 59

What is the most likely cuase of galactorrhea, impotence (or menstrual dysfunction), and decreased libido in a pt with a hx of schizophrenia?

Back 59

Dopamine antagonist (haloperidol)

Front 60

Which genetic disorder is associated with multiple fractures and is commonly mistaken for child abuse?

Back 60

Osteogenesis imperfecta

Front 61

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

Back 61

Sulfonimides, Primaquin, High dose aspirin, Isoniazid, Nitrofurantoin, Dapsone, Fava beans

Front 62

What is the most common cause of postpartum hemorrhage?

Back 62

Uterine atony. This is why you massage the uterus after delivery and give oxytocin IV after the delivery of the placenta

Front 63

50 year old female smoker presents with hematuria. What do you suspect?

Back 63

Bladder CA

Front 64

what is the cuase of bilious emesis in a newborn within hours after the first feeding?

Back 64

Duodenal atresia

Front 65

a postop pt w/ significant pain presents with hyponatremia and normal volume status. what is the diagnosis?

Back 65

SIADH d/t stress

Front 66

What is Charcot's triad in the case of gall bladder disease?

*BONUS* what disease is this seen in?

Back 66

RUQ pain, Jaundice, and fever/chills

seen is ascending cholangitis

Front 67

An 8 year-old child was in a motor vehicle accident and now requires emergency blood transfusion. Her parents are not present, but the child states that she is a Jehovah's witness. what do you do?

Back 67

Give the blood. It is a life-saving procedure and you don't need parental authorization

Front 68

what is the natural histroy of a leiomyoma?

Back 68

after menopause, after estrogen levels have decreased, these 'uterine fibromas' decrease in size

Front 69

What are the mgmt options of a first time ASCUS pap in a nonadolescent?

Back 69

reflex HPV
high risk--> colposcopy
low risk --> re-pap in 6m

option 2) re-pap in 6mo
option 3) colposcopy

Front 70

Continuous machine like murmur?

Back 70

PDA

Front 71

What is the first test in the assessment of a woman presenting with secondary ammenorrhea?

Back 71

B-HCG

the #1 cause is pregnancy

Front 72

A 19 yr old man presents with a palpable flank mass and hematuria and U/S shows bilateral enlarged kidney's with cysts ---> what brain abnormality is a/w this condition?

Back 72

Autosomal dominant polycystic kidney disease = berry aneuryisms

Front 73

Which congenital infection might present with a "blueberry muffin" rash?

Back 73

Rubella

Front 74

What ethical problem exists when a doctor refers a pt for an MRO at a facility he owns?

Back 74

Conflict of interest

Front 75

What is the MCC of bloody nipple discharge?

Back 75

Intraductal papilloma

Front 76

Which antibiotics should be avoided during pregnancy d/t potential teratogenic effects?

Back 76

Flouroquinolones & tetracyclines are the big ones, also know not to give immunoglycosides, sulfonimides

Front 77

What medications can be given to a pregnant woman with cystitis?

Back 77

Amoxicillin/Ampacillin, Nitrofurantoin, cefalexin (1st or 2nd gen cephalosporin)

Front 78

Which drugs block transmission through the AV node?

Back 78

Beta blockers, digoxin, and calcium channel blockers like verapamil and dilteazem

Front 79

What therapies are used in treating PCOS?

Back 79

#1 weight loss
oral contraceptive pills, spironolactone for the hirsutism.
Metformin has shown benefit too

Front 80

A 60-year old woman leaks urine when laughing or coughing --> what are her non-surgical options?

Back 80

she has stress incotenance
kegel exercises
estrogen (oral or vaginal cream) will thicken up that tissue to reduce stress incotenance
pessarie placement

Front 81

A child presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. What is the most likely diagnosis and infectious cause?

Back 81

Hemolytic Uremic Syndrome

d/t hemorragic E.coli 0157h7

Front 82

What is the treatment for Idiopathic Thrombrocytopenic Purpura (ITP) in children?

Back 82

It usually resolves spontaneously, but you can use:
IvIg
Cortiosteroids

Front 83

*A 25-year old male presents with pain and watery diarrhea after meals. Exam shows fistuals between the bowel and skin and nodular lesions on his tibias, what is the Dx?

Back 83

Crohn's disease - Classic!

Front 84

Which antihypertensives are used in a pt with severe pre-eclampsia?

Back 84

there are 4: Hydralazine, nifedipine, labetalol, sodium nitropresside.

Front 85

What is the treatment for a clavicle fx?

Back 85

figure 8 strap, or sling

Front 86

what would you suspect in a woman with preeclampsia in the first trimester?

Back 86

hiadiaform mole
molar pregnancy

Front 87

What are the components of HELLP syndrome?

Back 87

Hemolysis
elevated liver enzymes
Low platelets

Front 88

What are the four main causes of microcytic anemia?

Back 88

iron deficiency, thallasemis, ACOD, lead posioning

Front 89

which type of breast cancer increases the future risk of invasive carcinoma in both breasts?

Back 89

lobular carcinoma insitu

Front 90

Patient presents with sudden onset of severe, diffuse abdominal pain (AXR reveals free air under the diaphragm) --> what is the next step in mgmt?

Back 90

Emergency laprotomy

repair the perf'ed viscera

Front 91

Antihistone antibodies are seen in what condition?

Back 91

Drug induced lupus. such as with Hydralazine

Front 92

A patient presents with limb pain on passive movement, pallor, poikilothermia, paresthesias, paralysis and pulselessness. What is the tx?

Back 92

Dx: compartment syndrome
Tx: fasciotomy

Front 93

What skin lesion causes a pearly-colored papule with a translucent surface and telangiectasias?

Back 93

basal cell carcinoma

Front 94

What type of bone fx is most likely to result from a fall on an outstretched hand?

Back 94

Collies - dital radius fx

Front 95

What is the MCC of HTN in young women?

Back 95

Oral Contraceptive pills

Front 96

An elderly female presents with pain and stiffness of the shoulders and hips. She cannot lift her arms above her head. Labs show an elevated ESR. What is the Dx?

Back 96

Polymyalgia Rheumatica, Classic!

Front 97

What infection causes aplastic crisis in sickle cell disease?

Back 97

Parvo B19

Front 98

A 40-year old female presents with a discrete area of complete hair loss on the scalp that has worsened over weeks. What is the treatment?

Back 98

Dx: Allopecia areata

Tx: Steroid shots into the scalp.

Front 99

What type of back pain is exacerbated by standing and wallking, and relieved with sitting and hyperflexion of the hips?

Back 99

spinal stenosis**

Front 100

*A 40 year old female has persistent erythema on her nose and cheeks and recurrent facial flushing especially with alcohol and spicy foods. what is the dx?

Back 100

rosecea - classic!

Front 101

what CSF findings would you see in a case of subarachnoid hemorrhage

Back 101

blood in all CSF samples
elevated pressure

xanthochromia if it was a few days ago, as the hemoglobin is converted to bilirubin

Front 102

What medication is used to diagnose symptomatic myasthenia gravis?

Back 102

Edrophonium (tensilim)

Front 103

What are four signs and symptoms of streptococcal pharyngitis?

Back 103

1. fever
2. phyrengeal erythema
3. tonsillar exudates
4. lack of rhiniorea and cough

Front 104

What is the classic symptom of placenta previa?

Back 104

painless vaginal bleeding in the 3rd trimester

Front 105

What are the two most common foodborne bacterial GI tract infxns in the US?

Back 105

#1: Salmonella

#2: campylobacter

Front 106

Infectious cause of aplastic crisis in sickle cell disease?

Back 106

Parvo B19

Front 107

What complication may arrise from overly rapid correction of hyponatremia?

Back 107

Central Pontine Mylinosis

Front 108

What type of infection causes honey-crusted lesions usually around the nose or mouth?

Back 108

Impetigo (Step or Staph)

Front 109

A 16 year old female has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found. What is the dx?

Back 109

Conversion disorder.

V for voltage, these patients have neurological sxs

Front 110

What is the MCC's of seizures in children aged 2-10?

Back 110

Febile seizures, Infections, trauma, Idiopathic (no specific order

Front 111

An 11 yo boy presents with fever, weight loss, and night sweats. Radiology reveals an anterior mediastinal mass. What do you suspect? What if the pt was 30?

Back 111

Non-hodgins lymphoma

30+: Hodgkins

Front 112

Elderly pt presents with bony pain and states his favorite Saints hat no longer fits...
Dx:
Labs:
Tx:

Back 112

Classic for Pagets dz
Labs:elevated alk phos
Tx: bisphosphonate

Front 113

*CSF analysis shows low glucose, elevated neutrophils, and gram (+) diplococci. What is the Dx?

Back 113

Strep Pneumo meningitis

(If it were Gram (-) it would be Nisseria Meningitis)

Front 114

a pt presents with acute-onset monoarticular joint pain and bell's palsy --> what is the likely diagnosis, how did he get it, and what is the tx?

Back 114

lyme disease d/t bite of ixodes tick, tx'd with doxycycline

Front 115

A pt with cirrhosis presents again to teh ER to have his ascites drained. Analysis if the ascites fluid reveals an absolute neutrophil ct greater than 250cells/mm3. what is the dx?

Back 115

Spontaneous Bacterial Peritonitis (SBP) - the most feared complication..

Front 116

what acid-base disturbance is commonly seen in pregnant women?

Back 116

respiratory alkalosis

Front 117

An 11-yr old obease African American boy presents with sudden onset of a limp. What is teh most likely dx, and what imaging studies would confirm this?

Back 117

slipped capital femoral epiphisis

AP and frog leg latteral is the imaging studies to order

Front 118

In which region of the US is Lyme disease endemic?

Back 118

north-eastern

Front 119

An active 14 yr old boy has anterior knee pain --> what is the most liekly dx?

Back 119

osgood schatter dz

Front 120

What is the diagnostic test for hereditary spherocytosis

Back 120

Osmotic fragility test

Front 121

Tachycardia + wild fluctuations in BP + Headache + diaphoresis + panic attacks

Back 121

Pheochromocytoma - classic!

Front 122

A 60-yr old patient presents with an acute onset of broken speech. What type of aphasia is this? what lobe and vascular distribution has been affected? What is the first step in the work up?

Back 122

Dx: Brocas aphasia
Artery: Frontal lobe, Left MCA
1st step: CT scan head to r/o hemorrhage

Front 123

What causes hypocalcemia, high phosphorous, and low PTH?

Back 123

hypOparathyroidism

Front 124

What is the MC pituitary tumor and its treatment?

Back 124

Prolactinoma.

Tx: Bromocriptine -DA agonist to inhibit Prl secretion.

Front 125

Positive p-ANCA is associated with what conditions?

Back 125

pauci immune glomerular nephritis
microscopic poly-angitis
Churg-stauss syndrome

Front 126

What prophylactic medication is indicated in an HIV pt with a CD4 less than 100?

Back 126

CD4<200: TMP-SMX, dapsone, pentamidine for PCP

CD4<100: azithromycin or clarithromycin for MAC

Front 127

What test is used in the 10th week of gestation to screen for chromosomal abnormalities?

Back 127

CVS: chorionic villous sampling

can be done sooner than amniocentesis

Front 128

What are the characteristic findings in tertiary syphilis?

Back 128

Tabes dorsalis - degeneration of the dorsal column producing foot drop and loss of vibratory sense

Gummas on bone
Argyle robertson pupil
Aortitis - treebarking, aortic regurgiation

Front 129

A teenage girl presents with prolonged bleeding after dental surgery and with menses --> labs reveal a normal PT, normal or increased PTT, and increased BT --> what is the dx and tx?

Back 129

dx: Von Wilderbrand's dz
tx: Desmopressin. acutely you can use FFP or cyropercipitate

Front 130

Otoscopy in a child presenting with acute onset of ear pain reveals large reddish vesicles on the TM. What is the Dx, typical organism, and tx?

Back 130

bollus meringitis
mycoplasma
macrolides

Front 131

A husband asks his wife not be told about her recently discovered lung cancer --> what do you do?

Back 131

you still have to tell the patient

Front 132

What organism is associated with dog or cat bites?

Back 132

Pasturella multocida

Front 133

Which joints in the hand are affected by rheumatoid arthritis?

Back 133

MCP and PIP

Front 134

Joint aspirate reveals rhomboid shapped, positively biorefringent crystalls --> what is the dx?

Back 134

pseudo gout

calcium pyrophosphate cyrstalls

Front 135

What bullous skin dz has a negative Nikolsky's sign?

Back 135

bullous pemphigoid

nikolsky's sign (pemphigus vulgaris) is when the bullous scrapes off with gentle touch

Front 136

What should always be done prior to LP?

Back 136

check for increased ICP, by Checking for papiledema

Front 137

What are the MC primary sources of mets to the brain

Back 137

Lung, breast, skin, renal and GI

Front 138

What causes stones, bones, groans, and psychiatric overtones?

Back 138

Hypercalcemia, usually d/t hyperparathyroidism or can be d/t bony malignancies

Front 139

a 30 year old female african american immigrant presents with hematuria. What do you suspect?

Back 139

Schistosoma hematobium

Front 140

What organism is known for causing infection in burn victims?

Back 140

pseudomonas

Front 141

What is the MC testicular CA?

Back 141

Seminoma

Front 142

What is the cause of 2ndary amenorrhea with a normal PRL, no response to estrogen/progesterone challenge, and hx of D&C?

Back 142

Asherman's Syndrome

The previous D&C has caused scarring so the endometirum does not shed like it is supposed to

Front 143

A young child presents with thigh muscle weakness, a waddling gait, and pronounced calf muscles. What is the Dx?

Back 143

Duchenes muscular dystrophy

Front 144

What is the first line treatment for moderate hypercalcemia?

Back 144

1) IV hydration
2) loop diuretics

Front 145

what is the MCC of Travelers diarrea?

Back 145

E.coli ETEC

Front 146

What is the tx for a pilonidal cyst?

Back 146

Incision and drainage

Front 147

Does a case-control study measure incidence or prevelance?

Back 147

neither. A case-control is just one study

Front 148

How is polycythemia vera distinguishable from secondary polycythemia?

Back 148

Both have elevated Hgb and Hct and RBC mass

polycythemia vera is not due to low O2 or due to elevation of EPO, so you will have a low or normal EPO and O2 will be normal too.

Front 149

Xerostomia + parotid enlargement + xerophthalmia + anti-La antibodies?

Back 149

Shogren's syndrome

elderly females

Front 150

What type of oral infection has branching rods when examined microscopically?

Back 150

actinomyces israelii

Front 151

A 25 year old male presents with white plaques on his tongue and the back of his throat that scrape off with a tongue depressor --> what is the dx? what should he be screened for?

Back 151

Dx: thrus

screen for HIV

Front 152

What is the next step in the dx of cholecystitis when U/S is equivocal?

Back 152

Hyda scan

Front 153

What is the tx for mastitis ina pt that is breast feeding?

Back 153

Continue breast feeding and give oral abx

Front 154

What is the first line tx for acute otitis media

Back 154

Amoxicillin for 10 days

Front 155

A two-month old presents with projectile, nonbilious emesis. What is the first step in mgmt?

Back 155

Pyloric stenosis
Check for and correct metabolic abnormalities first, then get an abdominal U/S, and tx with a pylorotomy.

Front 156

A pt presents with a painless, puritic papule with regional lymphadenopathy that evolves over 7-10 days into a necrotic ulcer with a black eschar --> what is the dx and tx?

Back 156

dx: cutaneous antrax
tx: penicillin V or G, Ampacillin, Doxycycline

Front 157

A child presents with palpable purpura on the legs, abdominal pain and arthritic pain in numerous joints. What is the Dx and the Tx?

Back 157

Henoch Shoelin Puprua

Steroids for GI sxs, but self limited

Front 158

What causes a Cressent shaped hyperdensity on CT of the head that does not cross the midline?

Back 158

Subdural hematoma

Front 159

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

Back 159

Developmental Dysplasia of the Hip

pavlic harness to maintain hips in abduction

Front 160

A 45 yo male presents with acute-onset flank pain and hematuria --> what is the most likely etiology?

Back 160

Nephrolithiasis

Front 161

In which immunodeficiency are there chronic respiratory infections and a postitive Nitroblue tetrazolium test?

Back 161

Chronic Granulomatous dz

Front 162

What is the Tx for a rectal fistula?

Back 162

fistulotomy

Front 163

what is the first line tx for growth hormone secreting pituitary adenoma?

Back 163

trans-spenoidal tumor resection

Front 164

What is the inital tx for a child presenting with acute asthma attack?

Back 164

Albuterol and steroids

Front 165

What are the exceptions to informed consent?

Back 165

Emergency, pt does not have capacity to inform, and pt has already signed a waiver of concent

Front 166

What is the next step in the evaluation of a pt with two consecutive pap smears with atypical sqamous cells of undetermined significance (ASCUS)?

Back 166

colposcopy with endocervical currettage

Front 167

Young male with hip and back pain along with stiffness that improves with activity and worsens at rest ---> what is the most likely dx?

Back 167

ankylosing spondylitis -- classic.

HLA-B27

Front 168

What is the clinical definition of HTN?

Back 168

bp>14/90 on three seperate occasions at least 3 weeks apart **

Front 169

What characteristics favoring carcinoma in an isolated pulmonary nodule?

Back 169

smoker, age >45, new lesion or larger lesions than previous, absence of calcification/ irregular calcification, size >2cm, or irregular margins***

Front 170

Does a cohort study identify incidence or prevelence

Back 170

Both incidence and prevelance bc you are seeing the pt over time

Front 171

A pt presents to the ER after a MVA with HTN, bradycardia, and abnormal respirations. After ABC's what is the next step in mgmt?

Back 171

this Cushing tirad for increased ICP....so....raise the head of the bed, hyperventilate, give manitol, consult neurosurgery

Front 172

What is the late, life threatening complication of CML?

Back 172

blast crisis
fever, bone pain, splenomegaly, and pancytopenia

Front 173

Anticentromere antibodies are associated with what condition?

Back 173

CREST

Front 174

MC pathogen causing Croup?

Back 174

Parainfluenza virus

Front 175

Head injury --> altered mental status --> resolution of mental status for a few hours --> now with reemerging altered mental status. what is the Dx, underlying injury, and treatment?

Back 175

Lucid Interval

epidural hematoma

neurosurg evacuation of blood

Front 176

What test is used to r/o urethral injury?

Back 176

Retrograde cystourethrogram

Front 177

What type of headache causes unilateral, severe periorbital headache with tearing?

Back 177

Cluster Headahce

Front 178

A pt on isotretinoin for acne begins to develop daily, persistent , pulsitile headaches. Exam reveals papilledema. What is the diagnosis?

Back 178

pseudotumor cerebrii

never combine tetracycline with isotretinoin

Front 179

what are the indications for surgical repair of an AAA?

Back 179

greater than 5.5 cm
rapidly enlarging
symptomatic
ruptured

Front 180

What is the medical tx for hepatic encephalopathy

Back 180

Lactulose

allows ammonia in the colon to be bound so it can be excreted beter

abx like Neomycin can be used to wipe out gut bacteria and decrease the formation of toxic metabolites

Front 181

What are the MCC's of seizures in young adults (18-35)

Back 181

Trauma, alcohol withdrawal, brain tumors

Front 182

A 45-yr old obease female with pruritis, clay colored stools, and dark urine has an elevated alkaline phosphate and elevated bilirubin --> what is the most likely cause?

Back 182

Obx of the biliary tract

Front 183

Cold water is flushed into a pt's ear and the fast phase of nystagmus is toward the opposite side --> where is the lesion

Back 183

no lesion - this is normal

Front 184

What are the most common causes of fever of unknown origin?

Back 184

Infection, cancer, autoimmune diseases

Front 185

In which disease would you find atrophy of the mamillary bodies?

Back 185

Wernike's encephalopathy

Front 186

When can a physician refuse to continue treating a patient on the grounds of futility?

Back 186

no rationale for tx, the maximal intervention has already failed, or when the tx is ineffective.

Front 187

A normalizing PCO2 in a pt having an asthma exacerbation may indicate what problem?

Back 187

sign of fatigue and impeding respiratory failure.

Front 188

Which hernia carries the higest risk of incarceration: Indirect, direct, or femoral?

Back 188

femoral
not as common, but highest risk of incarceration

Front 189

Hyperphagia, hyperorality, hyperdocilitiy and hypersexuality --> what is the Dx?

Back 189

Kluver-Bucy syndrome

bilateral amygdala infarct

Front 190

What causes a transudative pleural effusion?

Back 190

CHF
Liver or kidney dz
Protein loosing enteropathy

bottom line: osmotic imbalance d/t pressure or no protein in the blood

Front 191

What medication is given for seizure prophylaxis in severe preeclampsia?

Back 191

IV Mag-sulfate

Front 192

A 75 yo man presents with fatigue, lymphadenopathy, splenomegaly, and isolated lymphocytosis. What diagnosis do you suspect?

Back 192

CLL

Front 193

In what cirumstances should confidentiality not be protected?

Back 193

real threat of harm to 3rd parties.

homocide, suicide, abuse (child or elder) and infectious dz's

Front 194

*An 18 yr old male is found to have a systolic heart murmur heard at the apex and left lower sternal border that increases in intensity while standing after squatting. What diagnosis do you suspect?

Back 194

Hypertrophic cardiomyopathy - classic!

Front 195

what characteristics of a nevus suggest that it may actually be melanoma?

Back 195

ABCD
asymetry
border irregularity
color
diameter, larger than a pencil eraser

Front 196

A young child presents in status epilepticus, but her parents refuse treatment on religous grounds --> what do you do?

Back 196

this is an immediate threat to the child's life, so you tx the patient and then seek a court order

Front 197

What is the MCC of non-obstetric post partum death?

Back 197

thromboembolic dz

like DVTs that become PE

Front 198

What infection can cause diarrhea and pseudoappendicitis?

Back 198

yerisina enterocolitica

Front 199

What findings would you expect to see in a post-term pregnancy beyond 42 wks gestation?

Back 199

oligohydraminos, meconium in amniotic fluid, neonate has dry peeling skin, very mature and calcified placenta

Front 200

What is the most feared complication of a scaphoid fracture?

Back 200

Avascular necrosis of the scaphoid

Front 201

What term describes heavy bleeding during and between menstrual periods?

Back 201

Menometroragia

Front 202

A violent patient with vertical and/or horizontal nystagmus has been exposed to what substance?

Back 202

PCP

Front 203

A pt has dyspnea, hilar lymphadenopathy on CXR, and hypercalemia. What is the dx?

Back 203

Sarcoidosis

Front 204

What cuase of aplastic anemia is associated with thumb abnormalities, diffuse hypo- or hyperpigmentation, cafe-au-lait spots, and short stature?

Back 204

Fanconi's anemia

Front 205

After a car accident, a woman wears a neck brace and requests permanent disability, what is the most likely diagnosis

Back 205

that bitch cray, malingering.

Front 206

immunodeficiency with doughy skin

Back 206

Job's Syndrome (hypper-immunoglobulin E syndrome)

Front 207

What is the cause of erythroblastosis fetalis?

Back 207

Rh factor (-) in mom, (+) in baby

Front 208

Meningitis is diagnosed in a neonate. What are the most likely organisms, and what is the empiric treatment?

Back 208

GBS, E. Coli, Listeria

Tx: Amp and Gent

Front 209

what is the only indication for administering hypertonic saline to a pt with SIADH?

Back 209

active seizures.

Front 210

What disorder classically presents with the triad of cognitive impairment, urinary incotinence, and abnormal gait?

Back 210

Normal Pressure Hydrocephalus

Front 211

Low urine specific gravity in the presence of high serum osmolality --> what is the dx?

Back 211

diabetes insipidus

Front 212

What percentage of values falls within one std of the mean?
Two std?
Three std?

Back 212

1: 68%
2: 95%
3: 99.7%

Front 213

Uterine bleeding at 18 wks gestation + no products expelled + cervical os closed ---> what is the dx?

Back 213

Threatened abortion

Front 214

Which is more ethically unfavorable in a DNR pt: withdrawing life support, or withholding care?

Back 214

both are bad.

Front 215

What annual screening is recomended for women with a strong family hx of ovarian ca?

Back 215

CA-125 and transvaginal US

Front 216

Albuminocytologic dissociation (increased protein in CSF with only modest increase in cell ct)

Back 216

guillan barrett disease

Front 217

What is the MC type of TE fistula?

Back 217

Esophageal atrsia (blind esophageal pouch) and the distal egsophagus is conected to the trechea. (85%)

Front 218

What diarrheal illness is associated with church picnics/myonnaise?

Back 218

staph aureus - food poisoning

Front 219

Which type of renal tubular acidosis is associated with abnormal HCO3 and rickets?

Back 219

Type 2 RTA

Front 220

what biostatic calculation looks at individuals with and without a disease and determines the likelihood of exposure to a risk factor

Back 220

odds ratio

Front 221

What medication is given to accelerate fetal lung maturity?

For how long is it given? at what gestational age is it no longer necessary?

Back 221

Steroids- Betamethasone or dexamethasone
Given for 48 hrs
Not required after 34 weeks

Front 222

What is the tx for opioid overdose?

Back 222

Naloxone/ Naltrexone (Narcan)

Front 223

Describe the treatment of HTN in cases of pheochromocytoma?

Back 223

Give a-blocker first, then B-blocker

give phentolamine, then Beta-blocker.

Front 224

What pathology causes an onion skin appearance of the bone on x-ray?

Back 224

Ewing's sarcoma

Front 225

Rash with dermatomal distribution?

Back 225

Hepes zoster

Front 226

What is the underlying cause of late fetal decelerations on contraction stress test?

Back 226

utero-placental insufficiency

Front 227

what is the tx of atrial fibrilation of unknown duration?

Back 227

rate control and anticoagulation

rate control: Beta-blockers, verapamil and/or digoxin

anticogulation: warfarrin and heparin, and then later with just warfarin

Front 228

In which endocrine disorder might weight loss completely eliinate the need for medication?

Back 228

DM2
PCOS

Front 229

Which immunodeficiency presents with excema, thrombocutopenia, and high levels of IgA?

Back 229

Wiscott-Aldrich

Front 230

What is the most likely cause of acute lower GI bleed in pts older than 40?

Back 230

Diverticulosis

Front 231

A one year old is able to cruise, use two-finger pincer grasp, babble, and imitate actions, what part of his development is delayed?

Back 231

language delay - should have 2-3 words

Front 232

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

Back 232

Cystic Fibrosis and Hirschprungs dz

Front 233

What is the tx for Kawasaki dz in acute-phase?

Back 233

IvIg, high dose aspirin

Front 234

What is a cause of congenital pure RBC aplasia?

Back 234

diamond-blackfan anemia

Front 235

Chovstek's and Trousseau's signs are assoc with what metabolic abnormality?

Back 235

Hypocalemia

chovstek- cheek
trousseau - tighten the cuff and get carpal spasm

Front 236

which antidiabetic agent is associated with lactic acidosis?

Back 236

metformin**

Front 237

Patients with silicosis are at higher risk for what type of infection?

Back 237

TB

Front 238

What is the treatment for septic shock?

Back 238

fluids
antibiotics
norepinephrine- causes vasoconstriction to tx the vasodilation caused by the septic shock

Front 239

A 7 year old boy presents with hemarthrosis. Lab work shows increased PTT and normal PT and bleeding time.

Back 239

Hemophelia A or B

A: 8; give desmopressin, and replace factor 8
B: 9; replace factor 9

Front 240

Which skin cancer classically presents with varying degrees of scaling or ulcerations?

Back 240

Squamous

Front 241

what is the next best step in the evaluation of a pulsitile abdominal mass and bruit?

Back 241

Abdominal Ultrasound to look for AAA

Front 242

A middle aged man presents for knee pain and x-ray shows bilateral calcification of the articular cartiledge. what is the treatment?

Back 242

pseudogout: tx with NSAIDs or colchicine

Front 243

which lung cancer is assoc with SIADH?

Back 243

small cell lung cancer

Front 244

What rash is classically described as "dew on a rose petal"

Back 244

vericella zoster

Front 245

Which defense mech is displayed when a woman calmy describes a gory murder in great detail?

Back 245

Isolation

Front 246

What is the most common underlying cause of pathologic fractures in elderly, thin women?

Back 246

Osteoperosis

Front 247

which defense mech is a pedophile that enters a monastery using?

Back 247

reaction formation

Front 248

Immunideficiency with a postitive nitroblue tetrazolium test?

Back 248

Chronic granulomatous disease

Front 249

What is considered first line pharmacotherapy for depression?

Back 249

SSRI's

Front 250

What is the pentad of thrombocytopenic purpura (TTP)?

Back 250

1. thrombocytopenia
2. hemolytic uremic syndrome
3. renal failure
4. fever
5. neurologic sxs

Front 251

A young pt who's father died at 30 in a MVA suddenly collapses and dies while exercising. What is the cause of death?

Back 251

Hypertrophic cardiomyopathy causing ischemic heart dz

Front 252

what is cradle cap?

Back 252

sebhorric dermatitis
tx: selsin blue (selenium sulfide) or topical fungalcide

Front 253

A pt has exopthalmos, pretibial myxedema, and a decreased TSH.

Back 253

Graves, Classic!

Front 254

Most serious s/e of clozapine?

Back 254

agranulocytosis

Front 255

A young child has loss of the red-reflex. what is the Dx?

Back 255

Retinoblastoma

Front 256

What is the treatment for pre-malignant lesion from sun exposure that can lead to squamous cell skin cancer?

Back 256

5-FU, or cyroablation

Aktinic keratosis

Front 257

Flat topped purpulish, puritic, papules?

Back 257

The P's of Lichen planus**

Front 258

What is the next step in the mgmt of a positive PPD

Back 258

chest x ray

Front 259

what important side effects are common to many of the atypical antipsychotics?

Back 259

weight gain
and assoc with that is the development of DM2

Front 260

what is the classic endocarditis prophylaxis regimen?

Back 260

Oral surg: give amoxicillin before and after the procedure

GI/GU: Ampacillin + Gentimycin before and after five amoxicillin

Front 261

what is tx for mild, persistant asthma?

Back 261

Inhaled low dose Beta-Agonists, and Inhaled corticosteroids

Front 262

What is the causitive agent in pitytiasis versicolor?

Back 262

Malasia furfur

Front 263

What are some of the causes of an exudative pleural effusion?

Back 263

malignancy, TB, bacterial infxs, pulmonary emboli, and pancreatitis.

What would see in the pleural fluid of a pt with pancreatitis?....amylase!

Front 264

Pediatric patient with red "current jelly" stools

Back 264

Intussiception

Front 265

Which antidepressants are associated with hypertensive crisis? What substance can exacerbate this effect?

Back 265

MAOI + tyramine

Front 266

A patient that visited the SW US presents with fever, malaise, cough, and night sweats. What is the dx and tx?

Back 266

dx: coccidomycosis
tx: fluconizole

Front 267

Gyn exam of a postmenopausal woman reveals inflammation and epithelial thinning of the anogenital area. What is the dx?

Back 267

classic for lichen sclerosis

Front 268

what disease causes glomerulonephritis wih deafness?

Back 268

alport's syndrome

Front 269

PFTs show decreased FEV1/FVC. what is the dx?

Back 269

Obstructive Lung Dz

Asthma, Emphysema, COPD

Front 270

5 basic criteria for metabolic syndrome

Back 270

Abdominal obesity
High Triglycerides
Low HDL
Hypertension
Insulin resistance

Front 271

A 22 year old male has 4 months of social withdrawal, worsening grades, decreased emotional expression, and decreased concrete thinking. What is the Dx?

Back 271

Schizopreniform d/o; it has been less than 6mo

Front 272

What is the general treatment for DKA?

Back 272

Fluids, Insuin, vit. K, Mg, P

once the glucose is back down to normal, continue with the insulin and add glucose until the anion gap is normal

finally, check for ketones

Front 273

what is the definition of maternal morality?

Back 273

the number of deaths during pregnancy including until 90 days post-partum. PER. 100,000 live births

Front 274

A 25 year old male is diagnosed with a solid testicular mass by ultrasound. what is the next step in the management?

Back 274

remove it, don't bother biopsy

Front 275

what is the most common location for an ectopic pregnancy>

Back 275

ampulla of the falopian tube

Front 276

Cafe-au-lait spots on skin are characteristic of_______.

Back 276

neurofibromatosis type I

Front 277

EKG with peaked T waves and widend QRS?

Back 277

hperkalemia

Front 278

What is the cause of chest pain in a young pt that has angina at rest with ST-segment elevation but normal cardiac enzymes?

Back 278

prinzmetals angia

Front 279

What would you suspect with eosinophillic casts in the urine?

Back 279

AIN- Acute Interstital Nephritis... sometimes referred to as Allergic Interstital Nephritis... usually d/t drug reactions

Front 280

A young female with amenorrhea, bradycardia, and abnormal body image?

Back 280

Anorexia nervosa

Front 281

A 40 yr-old black female is found to have noncaseating granulomas of the lung and hypercalcemia. What is the dx?

Back 281

Sarcoidosis

Front 282

Ring enhancing brain lesion on CT with seizures

Back 282

Brain abscess.
(might be toxoplasmosis)

Front 283

An IV drug user has JVD adn a holosystolic murmur at left sternal border. What is the tx?

Back 283

classic murmur for tricuspid regurg. this is bacterial endocarditis, give vancomycin. Treat the heart failure and ultimately replace the tricuspid valve

Front 284

what is the preferred diagnostic test for a PE?

Back 284

spiral CT with IV contrast
if pt has renal dz, or is on metformin and cant take IV contrast, then use VQ scan

Front 285

A postmenopausal female presents with vaginal bleeding for the last 5 days. What is the next step?

Back 285

Endometrial biopsy

Presume endometiral hyperplasia

Front 286

What type of bias is present when the physician is aware of the type of treatment his patient received?

Back 286

Observational bias

Front 287

Honeycomb pattern on CT of the chest. what is the Dx and treatment?

Back 287

Diffuse interstital pulmonary fibrosis

Tx: steroids + azothioprine + N-acetyl cystine

Front 288

A patient presents with weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show hyponatremia and hyperkalemia. What is the treatment?

Back 288

Hyperaldosteronemia - Addison's disease

treated with glucocorticoids and mineralocorticoids (fludrocortisone)

Front 289

Auer rods are associated with________.

Back 289

Leukemia, AML***

Front 290

A teenager on abx for acne presents with a severe sunburn. what antibiotic is he most likely taking?

Back 290

Tetracycline

Front 291

uterine bleeding at 18 wks gestation + no products expelled + membranes ruptured + cervical os open --> what dx?

Back 291

inevitable abortion

Front 292

What is the tx for mild unconjugated hyperbilirubinemia? Severe unconjugated hyperbilirubinemia?

Back 292

phototherapy

in severe cases: exchange transfusion

Front 293

What is the tx for iron overdose?

Back 293

deferoxime

Front 294

Which hypercholesterolemia treatment causes flushing and pruritis?

Back 294

Niacin

Front 295

What are the s/e of corticosteroids?

Back 295

acne, osteoperosis, immunosupression*, thin skin*, mania and insomina*, buffalo hump, pruple striae, cataracts*

Front 296

What is the tx for superior vena cava syndrome?

Back 296

Radiation to decrease the sz of the tumor. Steroids can also be used.

Front 297

In what diseases might you find Cruschmann's spirals (whorled mucous plugs)?

Back 297

Bronchial Asthma

Front 298

What are the classic physical findings in cases of endocarditis?

Back 298

fever, new heart murmur, osler's nodes, spliter hemorrhages, janeway lesions on hands palms and soles, roth spots, conjunctival hemorrhage

Front 299

What is the classic ECG finding in pericarditis?

Back 299

elevated ST in all leads

Front 300

What rash presents with a herald-patch followed by a christmas-tree pattern?

Back 300

pyteriasis rosea

Front 301

Which type of Lung CA is a/w hypercalcemia?

Back 301

Squamous cell

Front 302

sential loop on abdominal X-ray is...

Back 302

Acute pancriatitis

Front 303

A tall, white male presents with acute shortness of breath. What diagnosis do you suspect? what is the treatment?

Back 303

Spontaneous pneumothorax, chest tube if > 15%

Front 304

What diagnosis would you consider in a patient with sacroilitis?

Back 304

Ankylosing Spondylitis

Front 305

What is the cause of joint pain and stiffness that worsens over the course of the day and is relieved by rest?

Back 305

Osteoarthritis

Front 306

What is the next step in the mgmt of a female with poor uterine tine after delivery of the placenta?

Back 306

massage that uterus, give oxytocin

Front 307

ICU patient is awake and alert but cannot move anything but the eyes and eyelids --> what is the dx?

Back 307

locked in syndrome

Front 308

What number is needed on bacteria culture of a clean catch specimen to dx a UTI?

Back 308

10^5 bacteria/ ml = 100,000

Front 309

What is the acceptable minimum urine output in a stable pt?

Back 309

30cc / hr

Front 310

Target lesions with a red center, pale zone, and dark outer ring appearing on the palms and soles with a prodrome of malaise and myalgias?

Back 310

Erythema multiforme -- classic!

Front 311

What is an acceptable urine output in a trauma pt?

Back 311

normal 30cc/hr

trauma pt = 50cc/hr

Front 312

A child presents with a midline neck mass. what do you suspect?

Back 312

Thyroglossal duct cyst

Front 313

What are the two measures of how severe the hypotension is in shock?

Back 313

urine output
mental status

Front 314

What is the medical treatment for IBD?

Back 314

5-ASA w/ or w/o sulfa salazine

Mesalamine (5-ASA + salazine) only works in the colon

Front 315

What is the difference btw mallory weiss and Boerhaave?

Back 315

Mallory Weiss a tear in the submuscosa from vomiting

Boerhaave is a complete rupture

Front 316

What is the treatment for TTP?

Back 316

Plasmaphoresis, steroids, anti-platelet drugs

Front 317

Which of the following are elevated in DIC?

fibrin split products
D-dimer
Fibrinogen
Platelets
Hct

Back 317

fibrin split products
D-dimer

Front 318

What EKG finding is a/w hypothermia?

Back 318

J wave - small + deflection after QRS

Front 319

What infection is classically a/w cold agglutinins?

Back 319

Mycoplasma Pneumonia

Front 320

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

Back 320

weakness in extensors = wrist drop, loss of thumb abduction

Front 321

A child presents with a lateral neck mass. What do you suspect?

Back 321

Brachial cleft cyst