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43 Cards in this Set
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A 73 year old male presents to your clinic complaining of weakness, fatigue and malaise.
Physical exam is pertinent for splenomegaly with the absence of lymphadenopathy. Flow cytometry confirms a group of cells that stain positive for tartrate-resistant acid phosphatase. What is the best initial treatment for this patient? All-trans retinoic acid Imatinib Interferon-alpha Splenectomy Nucleoside analogs |
Nucleoside analogs
Pts. with Hairy Cell Leukemia respond best to nucleoside analogs TRAP is a sign of HCL, along with SPLENOMEGALY, weakness, fatigue, wt loss and LACK OF LYMPHADENOPATHY Splenectomy and interferon-alpha may improve blood counts in pts with HCL, but nucleoside analogs are the initial treatment Imatinib is the Philadelphia chromosome inhibitor, thus it is used for CML |
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Aphysician from another state is being considered for a job at your hospital.
You wish to determine if this physician has engaged inunprofessional behavior or had malpractice litigation. The mostappropriate agency to use is the: Joint commission Centers for Medicare and Medicaid services National committe for quality assurance Healthcare integrity and protection data bank National practitioner data bank |
National practitioner data bank
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A23-year-old female presents to the hospital with nausea that occurs onlyin the morning hours.
A urine pregnancy test is ordered and comes back positive. A subsequent ultrasound reveals findings consistent with a12-week old intrauterine pregnancy. The patient is very surprised bythis and states she has been using a levonorgestrel intrauterine device for birth control, which is still in place. Which of the following is the most appropriate treatment at this time? Oral methotrexate Manual removal of the IUD by applying gentle traction on the string D&C Immediate transfer to the OR for surgical removal of the IUD Reassure the pt and leave the IUD intact |
Manual removal of the IUD by applying gentle traction on the string
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A 6 year old boy was recently diagnosed with attention deficit and hyperactive disorder (ADHD).
During a visit at your office, his mother expresses concern about her child’s future social development. She says her brother was diagnosed with the same disorder at a young age and is now in prison. You tell her there is evidence that having ADHD puts her son at an increase risk for developing: Schizoaffective disorder Anorexia nervosa Antisocial personality disorder Seperation anxiety Heart disease |
Antisocial personality disorder
Kids with ADHD have an increased risk of developing antisocial personality disorder, oppositional defiant disorder, conduct disorder, and bipolar disorder. |
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A 67 year old man, with a history of diabetes and hypertension, presents with a new onset of gait disturbance.
He has difficulty initiating movements and frequent falls. His wife states that he has been more forgetful lately. He has been forgetting to take his medication and the names of his grandchildren. History reveals that he also has trouble controlling his urine. Which of the following is most likely to be seen on an image of the head? Normal findings Dilated ventricles without cortical atrophy Dilated ventricles with significant cortical atrophy Diffuse white matter lesions with lacunar infarcts Cortical atrophy most predominant in the frontal and temporal lobes |
Dilated ventricles without cortical atrophy
This pt presents with gait disturbances, forgetfullness, and urinary incontinence...all signs of NORMAL PRESSURE HYDROCEPHALUS ("wet, wabbly, wacky") Cortical atrophy most predominant in the frontal and temporal lobes is consistent with Pick's disease, which would present with dysinhibition, poor judgement, apathy, behavioral problems, fetishes, and compulsions. Diffuse white matter lesions with lacunar infarcts suggests vascular dementia Dilated ventricles with cortical atrophy is Alzheimer's |
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A 67 year old man, with a history of diabetes and hypertension, presents with a new onset of gait disturbance.
He has difficulty initiating movements and frequent falls. His wife states that he has been more forgetful lately. He has been forgetting to take his medication and the names of his grandchildren. History reveals that he also has trouble controlling his urine. Which of the following will likely be the most helpful in managing this patient? Lumbar puncture Glatiramer acetate Craniotomy Tight BP control Donepezil |
Lumbar puncture
Patients with normal pressure hydrocephalus respond well to relief of CSF pressure via lumbar puncture or shunt Donepezil is an acetylcholinesterase inhibitor that is used for Alzheimer's Tight BP control would be good for pts with stroke risk Craniotomy would be utilized to remove an intracranial mass Glatiramer acetate helps reduce the frequency of relapses of MS |
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A 7 year old boy is brought to the emergency department by his parents because of severe dyspnea and a persistent productive cough.
He has a history of seasonal allergies. He has attacks of wheezing after playing baseball outside and ingesting aspirin. The pathogenesis of this condition can be defined by: Bronchoconstriction triggered by high parasympathetic activity Accumulation of mucus that is too viscous Permanent dilation of air spaces Proteolytic destruction of alveolar walls Hyperplasia of mucus-secreting glands |
Bronchoconstriction triggered by high parasympathetic activity
The boy is suffering from exercise-induced asthma. The pathogenesis involves hyperactive airway inflammation and bronchoconstriction mediated by the parasympathetic nervous system. Hyperplasia of mucus-secreting glands describes chronic bronchitis, which is associated with COPD and is more common in adults Proteolytic destruction of alveolar walls describes emphysema, another COPD variant Permanent dilation of air spaces describes bronchiectasis Accumulation of mucus that is too viscous describes CF |
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A 56-year-old female presents to the emergency department with shortness of breath and chest pain on deep inspiration.
She reports to you that last week she underwent right total knee replacement and has been immobilized at home ever since. The patient has a respiratory rate of 22/min and a heart rate of 110/min. The most likely ECG abnormality to be seen is: Right bundle branch block S1Q3T3 Diffuse ST elevation Sinus tachycardia Sinus bradycardia |
Sinus tachycardia
PE ECG will most likely show sinus tachycardia more than any other rhythm S1Q3T3 may be descriptive of PE, but it is NOT the most likely rhythm |
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A 23 year old football player presents to the emergency room complaining of left sided chest pain.
He states that he was kicked in the ribs after a play was over. His vitals are: BP 100/65, HR 110, RR 18 and oxygen saturation of 98%. Physical exam shows bruising over the left 8th rib and pain to palpation. As he returns from a CT scan he begins to complain of left shoulder pain. What nerve root(s) is most likely responsible for his left shoulder pain? Intercostal nerve Phrenic nerve Radial nerve Suprascapular nerve Axillary nerve |
Phrenic nerve
The phrenic nerve may become irritated by blood within the peritoneum (from a ruptured spleen in this case) and cause pain radiation to the shoulder. This is known as Kehr's sign |
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A 17 year old female is brought to your office for dizziness and frequent cramping during exercise.
Her mother expresses concern that her symptoms are due to a recent move into a new school district and believes they will likely subside once she gets acclimated to her new environment. The patient is in the 75th percentile for both height and weight in her age group. Physical examination reveals erosion of the tooth enamel and parotid enlargement. Which of the following physical exam findings would further support your diagnosis? Grey-Turner's sign Russel sign Courvoisier's sign Chvostek's sign Cullen's sign |
Russel sign
Pts with bulimia nervosa may have callus formation on the dorsal surface of the index finger and long finger of the hand from repetitive contact with the teeth during self-induced vomiting = Russel sign Cullen's sign = Peri-umbilical bluish coloration, a sign of poor prognosis in Acute Pancreatitis Chvostek's sign = Indication of hypocalcemia when tapping of the facial nerve elicits contraction of the ipsilateral facial muscles Courvoisier's sign = Palpable, non-painful gallbladder, a sign of Pancreatic Cancer in the head of the pancreas Grey-Turner's sign = Bluish coloration of the flank, a sign of poor prognosis in acute pancreatitis |
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A 58 year old male presents to the emergencyroom with fever, altered mental status, and malaise.
Furthermore, uponphysical examination, he is found to be hypotensive with an elevatedWBC and left shift. A wound on his leg is rapidly expanding and causing necrosis of the tissue. Due to his deteriorating clinicalcondition, he is taken to the operating room for surgical debridement and bacterial cultures. What would be the most common single organism isolated from this condition? Pseudomonas Staph Epidermidis Staph Aureus Group A Strep Enterobacteriaceae |
Group A Strep
Necrotozing fascitis is most commonly caused by quickly spreading Group A Strep (Strep Pyogenes). |
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While on your pediatrics rotation you are called to the NICU to examine a newborn baby.
Upon arrival to the unit you observe a neonate that is cyanotic. An echocardiogram reveals no opening between the right atrium and right ventricle. Which of the following is most likely associated with this neonate’s condition? Lithium Uncontrolled diabetes Down's syndrome Tet spells Fixed split S2 |
Lithium
The most likely dx is tricuspid atresia, also known as Ebstein's anomaly. Tricuspid atresia is one of the cyanotic heart diseases diagnosed at birth, other include Truncus arteriosis, Tetralogy of Fallot, Transposition of the Great Vessels, Total anomalous pulmonary venous return. Ebstein's is classically associated with maternal LITHIUM use A fixed split S2 is associated with ASD and would NOT present with cyanosis at birth Tet spells are associated with Tetralogy of Fallot Down's syndrome is most commonly associated with VSD, and is NOT cyanotic at birth Uncontrolled diabetes is associated with Transposition of the Great Vessels and would present with cyanosis |
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A12-year-old boy is brought to the emergency department by a neighborafter suffering a laceration to the forehead while playing outside.
Bothparents are notified and are on their way to the hospital. Physicalexamination reveals a 4-cm laceration that will require suturing. In this situation, it is most appropriate to: Suture the laceration and obtain consent after both parents arrive Consent is not necessary to perform suturing in this scenario Hold pressure dressing and delay suturing until consent is obtained from one parent Permit the neighbor to give consent as a temporary legal guardian Allow the boy to consent to the procedure himself |
Hold pressure dressing and delay suturing until consent is obtained from one parent
Consent IS required in non-emergent situations such as this |
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A23-year-old female complains of vaginal pruritis and burning withurination.
Physical examination reveals vulvar edema with scant vaginaldischarge, which is sampled on a cotton swab. Microscopic analysis shows pseudohyphae with branching, budding yeast. The most specific test for the identification of this organism is: Wright's staining Culture on Sabouraud's agar Gram staining KOH prep Culture on Thayer-Martin chocolate agar |
Culture on Sabouraud's agar
The most specific test for the diagnosis ofvaginal candidiasis is culture of Candida albicans on Sabouraud's agar Thayer-Martin chocolate agar is used to ID N. Gonorrhoeae KOH preparation andgram-staining are sensitive tests, but culture of the organismremains the most specific. Wright's staining is used to identify blood types |
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An 8 month old female presents to your office with regurgitation following meals.
The child is in the 23rd percentile for both length and weight and has been “spitting-up” curdled milk in small amounts. There is no projectile vomiting present. The most appropriate study to confirm the most likely diagnosis is: Endoscopy Esophageal manometry Abdominal ultrasound Barium swallow 24-hour esophageal pH monitoring |
24-hour esophageal pH monitoring
The infant in the above case is demonstrating findings consistent with GERD. The gold standard for confirming reflux is 24-hour esophageal pH monitoring. Infant reflux typically presents with symptoms of failure to thrive which is evident in this case. Although barium swallow and manometry are useful in the work-up of GERD, they are not the confirmatory studies for this condition. Abdominal ultrasound is the gold standard for confirming pyloric stenosis, however, the absence of projectile vomiting makes this diagnosis unlikely. Endoscopy may reveal loss of lower esophageal sphincter tone with GERD, but would not be the confirmatory test for diagnosis |
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An 8 month old female presents to your office with regurgitation following meals.
The child is in the 23rd percentile for both length and weight and has been “spitting-up” curdled milk in small amounts. There is no projectile vomiting present. The initial approach to improving this condition would include: Initiation of a PPI Initiation of an H2 antagonist Initiation of cow's milk Supplemental iron Formula thickening |
Formula thickening
This infant is demonstrating signs of GERD, which should be approached initially with conservative measures. Formula thickening is recommended to prevent regurgitation and to promote digestion. Only after the failure of conservative therapy should medical treatment be initiated. You should begin with antacids (first-line) followed by H-2 antagonists such as ranitidine (second-line) and lastly incorporate PPIs. |
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A 42 year old obese female with a history of anaphylaxis to prednisone and cirrhosis presents to the ER complaining of a headache and blurry vision.
Ophthalmologic exam reveals papilledema. A CT scan of the head is negative. She has a normal mental status exam and no focal neurologic signs on physical exam. Which of the following can be used to prevent blindness in this patient? Acetazolamide Corticosteroids Tamoxifen Vitamin A Optic nerve sheath fenestration |
Optic nerve sheath fenestration
This pt presents with symptoms of PSEUDOTUMOR CEREBRI or Benign Intracranial Hypertension (BIH) (obese, unexplained headache, blurry vision, papilledema in the absence of tumor or CSF obstruction, normal PE & mental staus exam). BIH risk factors = Vit A, hypothyroidism, Cushing's, isotretinoin, & tamoxifen use. Tx begins with CARBONIC ANHYDRASE INHIBITORS (ACETAXOLAMIDE) & SYSTEMIC CORTICOSTEROIDS to decrease CSF pressure Since this pt has cirrhosis, acetazolamide can't be used |
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A 47 year old obese woman complains of worsening stiffness and pain in her hands and knees for the past 8 months.
The pain is worse in the evening and with activity. Physical exam reveals nodular enlargement of the proximal interphalangeal joints of both hands and crepitus in the left knee. Radiology will most likely reveal: Widened joint spaces Thick subchondral bone Pencil-to-cup deformity Lytic lesions Bone erosion |
Thick subchondral bone
This pt has signs of OA Eroded cartilage with thickened underlying bone is typical of OA Bone erosion is more typical of RA Lytic lesions, think MM or bone mets Pencil-to-cup deformity = Psoriatic Arthritis Joint space narrowing occurs with OA |
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You are asked to provide local health care professionals with information on how to properly interpret PPD results.
Which of the following group of patients would have a positive PPD with an induration 6 mm? Residents of long-term care facilities African American females with diabetes Children younger than age 4 Foreign-borne persons from high TB-endemic areas Persons with organ transplant |
Persons with organ transplant
Results >5 mm & <10 mm are positive in: HIV persons, Recent contacts of active TB, Persons with radiographic findings suggestive of TB, Pts with organ transplant or other immunocompromisation Results >10 mm & <15 mm are positive in: Immigrants from high-prevalence countries, IV drug users, Residents of prisons, nursing homes, shelters, hospitals, Pts with DM, leukemia, renal failure, or malnutrition, Children <4 yo Results >15 are positive in: Everyone else |
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A 5-year-old male with a hydrocephalus shunt presents to the ED with fever, headache and vomiting for the past 24 hrs.
Complete blood count indicates a leukocytosis with a left shift. Which of the following is most likely associated with his infection? Acid-fast positive CSF Herpes encephalitis Gram-negative bacteria Viral meningitis A coagulase-negative Staph |
A coagulase-negative Staph
Coagulase-negative Staph = S. Epidermidis The most likely cause of this boys infection is an infected hydrocephalus shunt, most likely caused by S Epidermidis Viral causes are unlikely, since the CBC showed a left shift (more neutrophils), a viral CBC would have a right shift (more leukocytes) Acid-fast CSF suggests TB Gram-negative bacteria suggests N Meningitidis |
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During your third year clinical schedule, you have decided to pursue a research month working with the biochemistry department, which is currently working on a collaboration project with the Orthopaedic Surgery department.
One of your responsibilities includes the biostatiscal calculations for the research study. Which of the following terms best describes the probability of finding a significant statistical association in your study if one truly exists? Alpha level Beta error (type 2) Alpha error (type 1) Power Relative risk |
Power
Power is an estimation of the probability of finding a statistically significant association in a study when one truly exists. Normal power value = 80%, which is calculated by (1-Beta error) 80% means that if the study works, it has an 80% chance of detecting a disease and a 20% chance of randomly missing it RR = Risk of the disease in epople exposed to a risk factor Alpha error = Rejecting the null hypothesis when infact it should have been accepted(false positive) Stating that tthere is an effect or difference when none exists Beta error = Wrongfully accepting a null hypothesis when infact it should be rejected (false negative) Stating that there is not an effect or difference when infact one exists |
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During your third year clinical schedule, you have decided to pursue a research month working with the biochemistry department, which is currently working on a collaboration project with the Orthopaedic Surgery department.
One of your responsibilities includes the biostatiscal calculations for the research study. Which of the following terms best describes the estimated range of values which likely includes an unkown population parameter? Confidence interval Standard deviation Mode Variance Incidence |
Confidence interval
CI is the interval estimate of a population parameter that is used to indicate the reliability of an estimate. If the CI for a mean of 2 variables includes 0, there is no significant difference and the null hypothesis is accepted If the CI for odds ratio or relative risk includes 1, then the null hypothesis is not rejected If the CI between 2 groups overlaps, then the groups are not significantly different and the null is accepted Variance is the measure of how far a set of numbers is spread out Standard deviation shows the dispersion of data from an aferage |
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A 17 year old boy presents to the hospital complaining of constipation.
A thorough workup reveals a mass near the illeocecal valve which is subsequently biopsied. Biopsy results reveal cells consistent with burkitt’s lymphoma. Which of the following is the best treatment for this patient’s lymphoma? Abciximab Busulfan Trastuzumab Imatinib Rituximab |
Rituximab
Burkitts is assocaited with EBV. It's African form is associated with jaw lesions, whereas the American form is associated with abdominal lymphoma Histologically it is described as sheets of lymphocytes with interspersed macrophages (AKA starry sky pattern) Imatinib is used to treat CML Trastuzumab is used to treat HER2 positive breast cancer Busulfan is used to treat CML Abciximab is a MAB which binds to the GP IIb/IIIa receptor on platelets and inactivates them, thereby preventing PLT aggregation |
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A 50 year old woman, with a history of complicated diabetes and hypertension, complains of transient blindness in her left eye.
She explains that the loss of vision came on suddenly, lasted a few minutes followed by a complete recovery of vision. She is in no distress. Physical exam reveals a carotid bruit on the left and left jugular venous distention. Chest exam reveals rales and a displaced point of maximum impulse. Which of the following is the next best step? US of the carotid arteries Head CT Fundoscopic exam Electrocardiogram Carotid angiography |
Ultrasound of the carotid arteries
This pt is suffering from amaurosis fugax, which is a transient monocular loss of vision lasting a few minutes and followed by complete recovery. The most common cause is retinal emboli that dislodge from the ipsilateral carotid artery. Duplex ultrasound of the carotids is the best non-invasive screening procedure Carotid angiography would provide the definitive diagnosis |
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A 49-year-old female presents with a well-marginated, erythematous plaque with silvery-white scales on the extensor surface of her elbows.
Physical examination reveals similar plaques on her knees and heels, which are non-pruritic. The most likely nail bed abnormality in this patient would be: Onycholysis Paronychia Onychorrhexis Pterygium Koilonychia |
Onycholysis
Onycholysis is painless seperation of the nail from the nail-bed and is a common finding, along with nail pitting, in psoriais pts. Koilonychia is caused by IDA where the nails have raised ridges and become thin/concave Pterygium is an inward advance of skin over the nail plate usually caused by trauma Onychorrhexis refers to brittle nails that are split vertically, a result of exposure to household cleaning products Paronychia is an infection of the nail fold |
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A32-year-old female with a known history of diabetes presents to yourgynecologic clinic for contraceptive advice.
The patient currently takes an estrogen-containing oral contraceptive and has had elevatedtriglyceride levels for several years. During the visit, it is appropriate to inform the patient she is at the most risk for developing: Myositis Acute renal insufficiency Acute peripheral arterial occlusion Sudden cardiac death Acute pancreatitis |
Acute pancreatitis
Estrogen medications, hypertriglyceridemia, & diabetes are all major risk factors for acute pancreatitis (as well as alcohol and gallstones of course) |
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A 24-year-old man presents with dizziness and a strange feeling in his chest.
He denies any chest pain and his blood pressure is 120/70mmHg. The paramedics say there was no response to vagal maneuvers. An ECG is obtained and shows SVT. The most appropriate treatment is: Epinephrine Atropine Adenosine Immediate cardioversion Immediate defibrillation |
Adenosine
SVT is treated initially with vagal maneuvers, if these fail the next option is adenosine Cardioversion or defibrillation is used for unstable pts (systolic <90, chest pain, SOB, confusion) who have VT or Vfib |
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A 24-year-old man presents with dizziness and a strange feeling in his chest.
He denies any chest pain and his blood pressure is 120/70mmHg. The paramedics say there was no response to vagal maneuvers. An ECG is obtained and shows SVT. Which of the following best describes the type of activity and location of the nerve fibers involved? Hyper-parasympathetic activity, S2-S4 on the right Hyper-parasympathetic activity, vagus nerve on the left Hyper-parasympathetic activity, vagus nerve on the right Hyper-sympathetic activity, T1-T5 on the left Hyper-sympathetic activity, T1-T5 on the right |
Hyper-sympathetic activity, T1-T5 on the right
Hyper-sympathetic activity of the right side of the heart innervates the SA node. Since SVT is a nodal arrhythmia, the hypersympathetic activity must be coming from the right Hyper-sympathetic activity, T1-T5 on the LEFT will hyper-stimulate the AV node, leading to a malignant ventricular arrhythmia |
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A premature newborn presents with respiratory distress, lethargy and dry mucous membranes.
He has fever and tachycardia. His abdomen is distended and there is blood in his stool. Which of the following radiographic findings is most likely: Displaced ligament of Trietz Twisted bowel Free air in the bowel wall Free air under the diaphragm Diffuse dilated loops of bowel |
Free air in the bowel wall
This premature child most likely has NECROTIZING ENTEROCOLITIS (NEC). NEC occurs when a portion of the bowel undergoes necrosis due to vascular disturbance. It most commonly occurs in premature infants with symptoms of FEEDING INTOLERANCE, DELAYED GASTRIC EMPTYING, ABDOMINAL DISTENTION, AND BLOODY STOOLS. The pathognomic finding is PNEUMONATOSIS INTESTINALIS which is the presence of free air in the bowel wall. Diffuse dilated loops = ILEUS Free air under the diaphragm = PERFORATED VISCUS Twisted bowel loops = VOLVULUS Displaced ligament of Trietz = MALROTATION |
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A 75 year old African American male with well-controlled hypertension and type 2 diabetes mellitus presents for his scheduled screening colonoscopy.
His examination revealed a 2-cm, sessile polyp approximately 6 centimeters above the dentate line not amenable to endoscopic polypectomy. The most important next step in therapy should include: Oral and IV contrast-enhanced CT scan of the abdomen and pelvis Multiple endoscopic biopsies of the polyp at the time of initial colonoscopy Neoadjuvant chemoradiation then appropriate operative intervention Low anterior resection, total mesorectal excision, and adjuvant chemoradiation therapy Abdominoperineal resection with adjuvant chemoradiation therapy |
Multiple endoscopic biopsies of the polyp at the time of initial colonoscopy
This pt has a single colon polyp that is suspicious of being cancerous (2-cm sessile polyp) but it has NOT yet been proven to be cancerous. In order to make a diagnosis for treatment, biopsy must be made (either by excision or multiple biopsies). Thus multiple biopsies is the correct answer All other answers are options for treatment once a dx is made |
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A nurse calls you to evaluate a 27 year old male who is currently seizing.
The nurse tells you that the patient has a known history of seizure disorder. When you arrive at the patient’s room, he is no longer seizing and he is post-ictal. The nurse reports that the seizure lasted nearly five minutes. While you are examining the patient, he begins seizing again. Following your initial treatment, there is no improvement in the patient's condition. The most appropriate medication to be given at this time would be: Levetiracetam Second dose of Lorazepam Phenytoin Valproic acid Phenobarbital |
Phenytoin
Status epilepticus is initially treated with benzos (lorazepam, diazepam, midazolam). If benzos do not work, the second-line drug is PHENYTOIN. If the pt doesn't respond to phenytoin, then PHENOBARBITAL may be attempted Acute treatment of seizure is BENZOS (1st), PHENYTOIN (2nd), BARBS (3rd) Chronic treatment of seizure is VALPROIC ACID (1st) & LEVETIRACETAM (2nd) |
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An 18 year old man with no medical history presents to your clinic complaining of excessive bleeding when he brushes his teeth and excessive bruising.
He tells you that his brother, uncle, grandmother and grandfather have a “blood disorder” and he thinks he might have it too. His symptoms get even worse if he takes aspirin. You suspect he has the most common inherited bleeding disorder. Which of the following laboratory patterns do you expect to see? Normal PLT count, normal PT, normal PTT, normal bleeding time Low PLT count, prolonged PT, prolonged PTT, prolonged bleeding time Normal PLT count, prolonged PT, prolonged PTT, normal bleeding time Low PLT count, normal PT, normal PTT, prolonged bleeding time. Normal PLT count, normal PT, prolonged PTT, prolonged bleedint time |
Normal PLT count, normal PT, prolonged PTT, prolonged bleeding time
This pt has VWD which causes deficient or defective vWF with low levels of factor VIII and is inherited AD. vWF carries factor VIII. Most pts with VWD are asymptomatic until they take an aspirin Diagnosis can be made with a RISTOCETIN cofactor assay |
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An 18 year old man with no medical history presents to your clinic complaining of excessive bleeding when he brushes his teeth and excessive bruising.
He tells you that his brother, uncle, grandmother and grandfather have a “blood disorder” and he thinks he might have it too. His symptoms get even worse if he takes aspirin. You suspect he has the most common inherited bleeding disorder. Which of the following should be used to treat future bleeding episodes in this pt? DDAVP Oral contraceptive pills Cryoprecipitate Heparin Warfarin |
DDAVP
DDAVP is a form of vasopressin that increases the release of stored vWF and factor VIII from PLTs Cryoprecipitate can treat acute bleeding disorders and consists of factors VIII and XIII, vWF, figrinogen, and fibronectin |
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A 66 year old man reveals that last week he experienced right hand weakness and loss of vision in his left eye.
The symptoms lasted for about 1-hour and then resolved completely. Which of the following is most likely consistent with his medical history? Atrial fibrillation Viral infection Optic neuritis Headaches Confusion |
Atrial fibrillation
TIAs are caused by stenosis of the carotid artery. They are commonly caused by emboli originating from the heart. A-fib is a common arrhythmia that can dislodge a thrombus from the heart to the carotids. |
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You are called to see a 17 year old male in the emergency department.
Upon your arrival, he is tachycardic and hypertensive. The patient is very combative towards the staff and complains of severe itching and formications. An EKG is performed showing sinus tachycardia, but is otherwise normal. Based on the above information, it is most likely the patient is suffering from intoxication with: Benzos Lysergic acid diethylamide Phencyclidine piperidine Cocaine Heroin |
Cocaine
Cocaine intoxication causes tachycardia, HTN, insomnia, aggression, psychosis, and formications ("cocaine bugs") Heroin causes the classic triad of decreased consciousness, pinpoint pupils (miosis), and respiratory depression PCP causes vertical and horizontal nystagmus, intense psychosis, violence, rhabdomyolysis, and hyperthermia LSD causes "enhanced sensation", colors are richer, music is more profound, and tastes are heightened Benzos are GABA agonists and cause respiratory depression, amnesia, and sleep |
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An elderly patient is brought by her friend to the hospital in severe respiratory distress.
The patient is unresponsive and her SpO2 is 83% on high-flow oxygen. There is no advance directive on the chart; however, the friend notes that the patient has previously mentioned that she did not want to be on a mechanical ventilator to maintain life. The most appropriate course of action is to: Increase FiO2 and then place on BiPAP with pressure support Bag-mask pt until hospital committee decides Bag-mask pt until family members arrive Obtain court order for mechanical ventilation Place on mechanical ventialtion |
Place on mechanical ventilation
Since there isn't an advanced directive present, nor a power of attorney, life-saving measures should be taken. Without solid evidence that this pt does not wish to live, everything should be done to keep the pt alive. Bag-masking the pt will only help support the pt's airway temporarily. A permanent airway support should be established |
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A 52 year old female presents to your office complaining of chronic shoulder pain.
Upon further questioning, the patient states that she has accidentally grabbed a pan off the stove the other day and did not realize that it was scalding hot until she saw that her hand was burned. She denies any recent trauma or infection to her upper extremity. Radiographic findings of the shoulder show a Charcot-like joint. Which of the following is the most common cause of her findings? Syphilis Syringomyelia Diabetes Alcoholism Uremia |
Syringomyelia
Syringomyelia is a post-traumatic cystic degeneration of the spinal cord. The syrinx expands and pts develop loss of pain and temperature sensation, flaccid paralysis, decreased DTRs, and fasciculations in a "CAPE-LIKE" distribution. Syringomyelia can lead to joint destruction ("Charcot-like" joints). Syphilis may lead to Tabes Dorsalis, but that would cause loss of touch and proprioception due to destruction of the DCML pathway |
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A 52 year old female presents to your office complaining of chronic shoulder pain.
Upon further questioning, the patient states that she has accidentally grabbed a pan off the stove the other day and did not realize that it was scalding hot until she saw that her hand was burned. She denies any recent trauma or infection to her upper extremity. Radiographic findings of the shoulder show a Charcot-like joint. Which of the following studies is most appropriate based on your diagnosis? VDRL & RPR Fasting plasma glucose Creatinine clearance & GFR MRI cervical spine AST, ALT, GGT |
MRI cervical spine
This pt has symptoms of SYRINGOMYELIA |
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A 22 year old football player presents to your clinic with right knee pain after suffering a hit to his anterior knee.
Physical examination of the knee reveals negative Lachman’s and McMurray’s tests. Both anterior and posterior drawer testing is also negative. Osteopathic examination of the extremity reveals a proximal fibular head that resists anterior spring with an internally rotated talus. The correct approach to treating this pt using muscle energy would be: Patient supine, plantarflex and evert the foot to barrier and instruct patient to dorsiflex against isolytic resistance Patient prone, dorsiflex and evert the foot to barrier and instruct patient to plantarflex against isometric resistance Patient supine, dorsiflex and evert the foot to barrier and instruct patient to plantarflex against isotonic resistance Patient prone, dorsiflex and invert the foot to barrier and instruct patient to plantarflex against isometric resistance Patient prone, plantarflex and invert the foot to barrier and instruct patient to dorsiflex against isometric resistance |
Patient prone, dorsiflex and evert the foot to barrier and instruct patient to plantarflex against isometric resistance
The posterior fibular head barriers must be engaged (dorsiflexion, eversion). ME is accomplished through ISOMETRIC resistance |
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70-year-old female with a history of fibroids in her uterus reports to your office complaining of increasing abdominal pain.
Her gynecologist suggests a hysterectomy. During the operation the uterine artery is ligated. The uterine artery is located within the: Broad ligament Round ligament Suspensory ovarian ligament Fallopian tube Uterosacral ligament |
Broad ligament
The broad ligament is so broad that it contains 2 arteries, the UTERINE & OVARIAN The broad ligament attaches the uterus, fallopian tubes, and ovaries to the pelvis "The broads have the uterus" The suspensory ovarian ligament contains the ovarian arteries and veins The round ligament contains SAMPSON'S artery |
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A 75 year old male suddenly becomes dyspneic during central line cannulation of the right internal jugular vein.
Physical examination reveals breath sounds bilaterally with an audible “mill wheel” murmur over the precordium. A portable chest film is performed and found to be unremarkable. Vital signs include a temperature of 98.8 F, a pulse of 121 bpm, a respiratory rate of 19 breaths/min, and a blood pressure of 132/81 mm Hg. The most appropriate initial treatment for this condition is: Placement of pt in reverse Trendelenburg position with immediate chest tube placement Insertion of needle into the right fourth intercoastal space with aspiration of blood through the right ventricle Aspiration of catheter, 100% O2 and placement of pt in lateral position with left side down Rapid-induction endotracheal intubation with placement of pt in right lateral position Emergent placement of chest tube |
Aspiration of catheter, 100% O2 and placement of pt in lateral position with left side down
Venous air embolism is one of the most dangerous complications of central line placement. If suspected, it is appropriate to first attach a syringe to the hub of the catheter immediately to prevent further air entry and attempts should be made to aspirate air through the catheter. Placing the patient on the left side will theoretically prevent the air from entering the left heart, reducing the risk of embolization into the venous circulation. |
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A 72 year old female presents to your office with complaint of lumbar back pain that radiates to her right hip.
She reports difficulty with ambulation and tells you that she has never fully recovered from her right-sided hip replacement one year ago. Osteopathic structural exam reveals a right-sided anterior innominate and a left-sided posterior innominate. The sacral base is also lower on the right side. Which of the following landmarks should be used to correctly measure leg length? ASIS and medial malleolus AIIS and lateral malleolus Femoral head and lateral malleolus Pubic symphysis and medial malleolus PSIS and calcaneal tuberosity |
ASIS and medial malleolus
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A 10 year old boy presents to the pediatrician with difficulty walking.
He claims he loses his balance and falls a lot. Physical exam shows loss of vibratory and proprioception in his lower extremities, scoliosis and high plantar arches. Which of the following is associated with his most likely diagnosis? Seizures History of a complicated labor and delivery Immunodeficiency X-linked recessive inheritance Cardiomyopathy |
Cardiomyopathy
The most likely diagnosis is Friedreich's ataxia. This is a progressive degenerative disease affecting the dorsal columns and spinocerebellar tracts. HIGH PLANTAR ARCHES is a BUZZ WORD for FA More than 90% of these pts have an associated heart condition, most commonly HCM It is inherited via AR |
