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+ Nikolsky’s sign.
Pemphigus vulgaris
You give someone a blister. That's almost abuse: it's barbaric and "vulgar."
- Nikolsky’s sign.
Bullous pemphigoid
Primarycauses of third-trimester bleeding.
Placental abruption and placenta previa
A 10-year-old boy presents with fever, weight loss, and night sweats. Examination shows anterior mediastinal mass. Suspected diagnosis?
Non-Hodgkin’s lymphoma
A 10-year-old child presents in status epilepticus, but her parents refuse treatment on religious grounds.
Treat because the disease represents an immediate threat to the child’s life. Then seek a court order
A 13-year-old male has a history of theft, vandalism, and violence toward family pets.
Conduct disorder
A 14-year-old girl presents with prolonged bleeding after dental surgery and with menses, normal PT, normal or increased PTT, and increased bleeding time. Diagnosis? Treatment?
von Willebrand’s disease; treat with desmopressin, FFP, or cryoprecipitate
A 15-year-old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
No. Parental consent is not necessary for the medical treatment of pregnant minors
A 16-year-old presents with an annular patch of alopecia with broken-off, stubby hairs.
Alopecia areata (autoimmune process)
A 17-year-old female has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found.
Conversion disorder
A 20-year-old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
Cerebral berry aneurysms (AD PCKD)
A 21-year-old male has three months of social withdrawal, worsening grades, flattened affect, and concrete thinking.
Schizophreniform disorder (diagnosis of schizophrenia requires ≥ 6 months of symptoms)
A 24-year-old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
A 25-year-old African-American male with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?
O2, analgesia, hydration, and, if severe, transfusion
A 25-year-old Jewish male presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibias.
Crohn’s disease
A 30-year-old woman has unpredictable urine loss. Examination is normal. Medical options?
Anticholinergics (oxybutynin) or β-adrenergics (metaproterenol) for urge incontinence.
A 35-year-old male has recurrent episodes of palpitations, diaphoresis, and fear of going crazy.
Panic disorder
A 40-year-old obese female with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine, and clay-colored stools.
Biliary tract obstruction
A 49-year-old male presents with acute-onset flank pain and hematuria.
Nephrolithiasis
A 50-year-old male presents with early satiety, splenomegaly, and bleeding. Cytogenetics show t(9,22). Diagnosis?
CML
A 50-year-old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids, O2, analgesia, and “tincture of time”
A 50-year-old woman leaks urine when laughing or coughing. Nonsurgical options?
Kegel exercises, estrogen, pessaries for stress incontinence
A 55-year-old man has sudden, excruciating first MTP joint pain after a night of drinking red wine. Diagnosis, workup, and chronic treatment?
Gout. Needle-shaped, negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
A 55-year-old man is diagnosed with prostate cancer. Treatment options?
Wait, surgical resection, radiation and/or androgen suppression
A 55-year-old man presents with irritative and obstructive urinary symptoms. Treatment options?
Likely BPH. Options include no treatment, terazosin, finasteride, or surgical intervention (TURP)
A 55-year-old man who is a smoker and a heavy drinker presents with a new cough and flulike symptoms. Gram stain shows no organisms; silver stain of sputum shows gram-negative rods. What is the diagnosis?
Legionella pneumonia
A 55-year-old obese patient presents with dirty, velvety patches on the back of the neck.
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
A 55-year-old patient presents with acute “broken speech.” What type of aphasia? What lobe and vascular distribution?
Broca’s aphasia. Frontal lobe, left MCA distribution
A 60-year-old African-American male presents with bone pain. Workup for multiple myeloma might reveal?
Monoclonal gammopathy, Bence Jones proteinuria, “punched-out” lesions on x-ray of the skull and long bones
A “blueberry muffin” rash is characteristic of what congenital infection?
Rubella
A burn patient presents with cherry-red flushed skin and coma. SaO2 is normal, but carboxyhemoglobin is elevated. Treatment?
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
A child has loss of red light reflex. Diagnosis?
Suspect retinoblastoma
A condition associated with red “currant-jelly” stools.
Intussusception
A congenital heart disease that cause Secondaryhypertension.
Coarctation of the aorta
A crescent-shaped hyperdensity on CT that does not cross the midline.
Subdural hematoma—bridging veins torn
A doctor refers a patient for an MRI at a facility he/she owns.
Conflict of interest
A fall in systolic BP of > 10 mmHg with inspiration.
Pulsus paradoxus (seen in cardiac tamponade)
A febrile patient with a history of diabetes presents with a red, swollen, painful lower extremity.
Cellulitis
A first-born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
Developmental dysplasia of the hip. If severe, consider a Pavlik harness to maintain abduction
A five-month-old girl has decreased head growth, truncal dyscoordination, and decreased social interaction.
Rett’s disorder
A four-year-old child presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
Hemolytic-uremic syndrome (HUS) due to E. coli O157:H7
A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely etiology? Treatment?
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
A homeless child is small for his age and has peeling skin and a swollen belly.
Kwashiorkor (protein malnutrition)
A late, life-threatening complication of chronic myelogenous leukemia (CML).
Blast crisis (fever, bone pain, splenomegaly, pancytopenia)
A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
Contact dermatitis
A man has repeated, intense urges to rub his body against unsuspecting passengers on a bus.
Frotteurism (a paraphilia)
A man unexpectedly flies across the country, takes a new name, and has no memory of his prior life.
Dissociative fugue
A middle-aged man presents with acute-onset monoarticular joint pain and bilateral Bell’s palsy. What is the likely diagnosis, and how did he get it? Treatment?
Lyme disease, Ixodes tick, doxycycline
A neonate has meconium ileus.
CF or Hirschsprung’s disease
A newborn female has continuous “machinery murmur.”
Patent ductus arteriosus (PDA)
A nonsuppurative complication of streptococcal infection that is not altered by treatment of Primaryinfection.
Postinfectious glomerulonephritis
A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C peptide.
Factitious disorder (Munchausen syndrome)
A painful, recurrent vesicular eruption of mucocutaneous surfaces.
Herpes simplex
A patient complains of headache, weakness, and polyuria; exam reveals hypertension and tetany. Labs reveals hypernatremia, hypokalemia, and metabolic alkalosis.
Primaryhyperaldosteronism (due to Conn’s syndrome or bilateral adrenal hyperplasia)
A patient continues to use cocaine after being in jail, losing his job, and not paying child support.
Substance abuse
A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?
S. aureus or S. epidermidis.
A patient fails to lactate after an emergency C-section with marked blood loss.
Sheehan’s syndrome (postpartum pituitary necrosis)
A patient from California or Arizona presents with fever, malaise, cough, and night sweats. Diagnosis? Treatment?
Coccidioidomycosis. Amphotericin B
A patient has increased vaginal discharge and petechial patches in the upper vagina and cervix.
Trichomonas vaginitis
A patient hasn’t slept for days, lost $20,000 gambling, is agitated, and has pressured speech. Diagnosis? Treatment?
Acute mania. Start a mood stabilizer (e.g., lithium)
A patient presents with pain on passive movement, pallor, poikilothermia, paresthesias, paralysis, and pulselessness. Treatment?
All-compartment fasciotomy for suspected compartment syndrome
A patient presents with recent PID with RUQ pain.
Consider Fitz-Hugh–Curtis syndrome
A patient presents with signs of hypocalcemia, high phosphorus, and low PTH.
Hypoparathyroidism
A patient presents with tachycardia, wild swings in BP, headache, diaphoresis, altered mental status, and a sense of panic.
Pheochromocytoma
A patient presents with weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
Primaryadrenal insufficiency (Addison’s disease). Treat with replacement glucocorticoids, mineralocorticoids, and IV fluids
A patient with a history of lithium use presents with copious amounts of dilute urine.
Nephrogenic diabetes insipidus (DI)
A postoperative patient with significant pain presents with hyponatremia and normal volume status.
SIADH due to stress
A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Diagnosis? Treatment?
Tardive dyskinesia. decreased or discontinue haloperidol and consider another antipsychotic (e.g., risperidone, clozapine)
A significant cause of morbidity in thalassemia patients. Treatment?
Iron overload; use deferoxamine
A six-year-old girl presents with a port-wine stain in the V2 distribution as well as with mental retardation, seizures, and leptomeningeal angioma.
Sturge-Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
A son asks that his mother not be told about her recently discovered cancer.
A patient’s family cannot require that a doctor withhold information from the patient
A tall white male presents with acute shortness of breath. Diagnosis? Treatment?
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
A two-month-old presents with nonbilious projectile emesis. What are the appropriate steps in management?
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
A violent patient has vertical and horizontal nystagmus.
Phencyclidine hydrochloride (PCP) intoxication
A woman who was abused as a child frequently feels outside of or detached from her body.
Depersonalization disorder
A young child presents with proximal muscle weakness, waddling gait, and pronounced calf muscles.
Duchenne muscular dystrophy
A young patient has angina at rest with ST-segment elevation. Cardiac enzymes are normal.
Prinzmetal’s angina
A young patient with a family history of sudden death collapses and dies while exercising.
Hypertrophic cardiomyopathy
A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Acceptable urine output in a stable patient.
30 cc/hour
Acceptable urine output in a trauma patient.
50 cc/hour
Acid-base disorder in pulmonary embolism.
Hypoxia and hypocarbia
Acid-base disturbance commonly seen in pregnant women.
Respiratory alkalosis
Acute-phase treatment for Kawasaki disease.
High-dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Administer to a symptomatic patient to diagnose myasthenia gravis.
Edrophonium
After a minor fender bender, a man wears a neck brace and requests permanent disability.
Malingering
Albuminocytologic dissociation.
Guillain-Barre (increased protein in CSF with only a modest increased in cell count)
Amenorrhea, bradycardia, and abnormal body image in a young female.
Anorexia
AML subtype associated with DIC.
M3
An 11-year-old obese, African-American boy presents with sudden onset of limp. Diagnosis? Workup?
Slipped capital femoral epiphyses. AP and frog-leg lateral view
An 80-year-old man presents with fatigue, lymphadenopathy, splenomegaly, and isolated lymphocytosis. Suspected diagnosis?
Chronic lymphocytic leukemia (CLL)
An active 13-year-old boy has anterior knee pain. Diagnosis?
Osgood-Schlatter disease
An agent that reverses the effects of heparin.
Protamine
An antidiabetic agent associated with lactic acidosis.
Metformin
An autosomal-recessive disorder with a defect in the GPIIbIIIa platelet receptor and decreased platelet aggregation.
Glanzmann’s thrombasthenia
An eight-year-old boy presents with hemarthrosis and increased PTT with normal PT and bleeding time. Diagnosis? Treatment?
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
An eight-year-old child is in a serious accident. She requires emergent transfusion, but her parents are not present.
Treat immediately. Consent is implied in emergency situations
An elderly female presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and increased ESR.
Polymyalgia rheumatica
An elderly male with hypochromic, microcytic anemia is asymptomatic. Diagnostic tests?
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
An infant has a high fever and onset of rash as fever breaks. What is he at risk for?
Febrile seizures (roseola infantum)
Anemia associated with absent radii and thumbs, diffuse hyperpigmentation, cafe-au-lait spots, microcephaly, and pancytopenia.
Fanconi’s anemia
Annual screening for women with a strong family history of ovarian cancer.
CA-125 and transvaginal ultrasound
Antibiotics with teratogenic effects.
Tetracycline, fluoroquinolones, aminoglycosides, sulfonamides
Antidepressants associated with hypertensive crisis.
MAOIs
Antihypertensive for a diabetic patient with proteinuria.
ACEI
Aplastic crisis in sickle cell disease.
Parvovirus B19
Appropriate diagnostic test? ■ A 50-year-old male with angina can exercise to 85% of maximum predicted heart rate.
Exercise stress treadmill with ECG
Appropriate diagnostic test? ■ A 65-year-old woman with left bundle branch block and severe osteoarthritis has unstable angina.
Pharmacologic stress test (e.g., dobutamine echo)
Arthritis, conjunctivitis, and urethritis in young men. Associated organisms?
Reactive (Reiter’s) arthritis. Associated with Campylobacter, Shigella, Salmonella, Chlamydia, and Ureaplasma
Asplenic patients are particularly susceptible to these organisms.
Encapsulated organisms––pneumococcus, meningococcus, Haemophilus influenzae, Klebsiella
Associated with Propionibacterium acnes and changes in androgen levels.
Acne vulgaris
Attributable risk?
The incidence rate (IR) of a disease in exposed − the IR of a disease in unexposed
Auer rods on blood smear.
Acute myelogenous leukemia (AML)
Autoimmune complication occurring 2–4 weeks post-MI.
Dressler’s syndrome (fever, pericarditis, increased ESR)
“Cradle cap.”
Seborrheic dermatitis. Treat with antifungals
“Dewdrop on a rose petal.”
Lesions of Primaryvaricella
“Doughy skin.”
Hypernatremia
“Stones, bones, groans, psychiatric overtones.”
Signs and symptoms of hypercalcemia
“Stuck-on” appearance.
Seborrheic keratosis
increased CO, decreased PCWP, decreased PVR.
Septic or anaphylactic shock
increased risk of what infection with silicosis?
Mycobacterium tuberculosis
decreased CO, increased PCWP, increased PVR.
Cardiogenic shock
decreased CO, decreased pulmonary capillary wedge pressure (PCWP), increased peripheral vascular resistance (PVR).
Hypovolemic shock
Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.
Spinal stenosis
Beck’s triad for cardiac tamponade.
Hypotension, distant heart sounds, and JVD
Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV-positive patient at what CD4 count? Mycobacterium avium-intracellulare (MAI) prophylaxis?
≤ 200 for PCP (with TMP); ≤ 50–100 for MAI (with clarithromycin/azithromycin)
Bias introduced into a study when a clinician is aware of the patient’s treatment type.
Observational bias
Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
Lead-time bias
Bilious emesis within hours after the first feeding.
Duodenal atresia
Birth rate?
Number of live births per 1000 population
Blood in the urethral meatus or high-riding prostate.
Bladder rupture or urethral injury
Bone is fractured in fall on outstretched hand.
Distal radius (Colles’ fracture)
Breast cancer type that increased the future risk of invasive carcinoma in both breasts.
Lobular carcinoma in situ
Breast malignancy presenting as itching, burning, and erosion of the nipple.
Paget’s disease
Cafe-au-lait spots on skin.
Neurofibromatosis 1
Cannon “a” waves.
Third-degree heart block
Case-control study—incidence or prevalence?
Neither
Cause of amenorrhea with normal prolactin, no response to estrogen-progesterone challenge, and a history of D&C.
Asherman’s syndrome
Cause of neonatal RDS.
Surfactant deficiency
Causes of drug-induced SLE.
INH, penicillamine, hydralazine, procainamide
Causes of exudative effusion.
Think of leaky capillaries. Malignancy, TB, bacterial or viral infection, pulmonary embolism with infarct, and pancreatitis
Causes of hypoxemia.
Right-to-left shunt, hypoventilation, low inspired O2 tension, diffusion defect, V/Q mismatch
Causes of transudative effusion.
Think of intact capillaries. CHF, liver or kidney disease, and protein-losing enteropathy
Characteristics favoring carcinoma in an isolated pulmonary nodule.
Age > 45–50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Characteristics of SecondaryLyme disease.
Arthralgias, migratory polyarthropathies, Bell’s palsy, myocarditis
Charcot’s triad.
RUQ pain, jaundice, and fever/chills in the setting of ascending cholangitis
Chromosomal pattern of a complete mole.
46,XX
Chronic diseases such as SLE—higher prevalence or incidence?
Higher prevalence
Chvostek’s and Trousseau’s signs.
Hypocalcemia
Class of drugs that may cause syndrome of muscle rigidity, hyperthermia, autonomic instability, and extrapyramidal symptoms.
Antipsychotics (neuroleptic malignant syndrome)
Classic causes of drug-induced hepatitis.
TB medications (INH, rifampin, pyrazinamide), acetaminophen, and tetracycline
Classic CXR findings for pulmonary edema.
Cardiomegaly, prominent pulmonary vessels, Kerley B lines, “bat’s-wing” appearance of hilar shadows, and perivascular and peribronchial cuffing
Classic ECG finding in atrial flutter.
“Sawtooth” P waves
Classic ECG findings in pericarditis.
Low-voltage, diffuse ST-segment elevation
Classic physical findings for endocarditis.
Fever, heart murmur, Osler’s nodes, splinter hemorrhages, Janeway lesions, Roth’s spots
Classic ultrasound and gross appearance of complete hydatidiform mole.
Snowstorm on ultrasound. “Cluster-of-grapes” appearance on gross examination
Cohort study—incidence or prevalence?
Incidence and prevalence
Cold agglutinins.
Mycoplasma
Cold water is flushed into a patient’s ear, and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Normal
Combined UMN and LMN disorder.
ALS
Common symptoms associated with silent MIs.
CHF, shock, and altered mental status
Complication of overly rapid correction of hyponatremia.
Central pontine myelinolysis
Complication of scaphoid fracture.
Avascular necrosis
Conditions in which confidentiality must be overridden.
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Confusion, confabulation, ophthalmoplegia, ataxia.
Wernicke’s encephalopathy due to a deficiency of thiamine
Contraceptive methods that protect against PID.
OCP and barrier contraception
Criteria for exudative effusion.
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Cross-sectional survey—incidence or prevalence?
Prevalence
CSF findings with SAH.
Elevated ICP, RBCs, xanthochromia
CSF findings: increased gamma globulins
MS
CSF findings: Low glucose, PMN predominance
Bacterial meningitis
CSF findings: Normal glucose, lymphocytic predominance
Aseptic (viral) meningitis
CSF findings: Numerous RBCs in serial CSF samples
Subarachnoid hemorrhage (SAH)
Defect in an X-linked syndrome with mental retardation,
Lesch-Nyhan syndrome (purine salvage problem with
Definition of hypertension.
BP > 140/90 on three separate occasions two weeks apart
Definition of unstable angina.
Angina is new, is worsening, or occurs at rest
Dermatomal distribution.
Varicella zoster
Describe a test that consistently gives identical results, but the results are wrong.
High reliability, low validity
Diagnostic modality used when ultrasound is equivocal for cholecystitis.
HIDA scan
Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.
Endometrial biopsy
Diagnostic test for hereditary spherocytosis.
Osmotic fragility test
Diagnostic test for hypertrophic cardiomyopathy.
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Difference between a cohort and a case-control study.
Cohort studies can be used to calculate relative risk (RR), incidence, and/or odds ratio (OR). Case-control studies can be used to calculate an OR
Difference between Mallory-Weiss and Boerhaave tears.
Mallory-Weiss—superficial tear in the esophageal mucosa Boerhaave—full-thickness esophageal rupture
Differential of hypervolemic hyponatremia.
Cirrhosis, CHF, nephritic syndrome
Drowsiness, asterixis, nausea, and a pericardial friction rub.
Uremic syndrome seen in patients with renal failure
Drugs that slow AV node transmission.
β-blockers, digoxin, calcium channel blockers
Dyspnea, lateral hilar lymphodenopathy on CXR, noncaseating granulomas, increased ACE, and hypercalcemia.
Sarcoidosis
ECG findings suggesting MI.
ST-segment elevation (depression means ischemia), flattened T waves, and Q waves
Eight surgically correctable causes of hypertension.
Renal artery stenosis, coarctation of the aorta, pheochromocytoma, Conn’s syndrome, Cushing’s syndrome, unilateral renal parenchymal disease, hyperthyroidism, hyperparathyroidism
Electrolyte changes in tumor lysis syndrome.
decreased Ca2− , increased K− , increased phosphate, increased uric acid
Elevated erythropoietin level, elevated hematocrit, and normal O2 saturation suggest?
RCC or other erythropoietin-producing tumor; evaluate with CT scan
Endocarditis prophylaxis regimens.
Oral surgery—amoxicillin; GI or GU procedures—ampicillin and gentamicin before and amoxicillin after
Eosinophils in urine sediment.
Allergic interstitial nephritis
Epidemics such as influenza—higher prevalence or incidence?
Higher incidence
Erythema migrans.
Lesion of PrimaryLyme disease
Evaluation of a pulsatile abdominal mass and bruit.
Abdominal ultrasound and CT
Exophthalmos, pretibial myxedema, and decreased TSH.
Graves’ disease
Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.
Squamous cell carcinoma
Extraintestinal manifestations of IBD.
Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, Primarysclerosing cholangitis
Fertility rate?
Number of live births per 1000 women 15–44 years of age
Fetal mortality?
Number of deaths from 20 weeks’ gestation to birth per 1000 total births
Findings in Tertiary syphilis.
Tabes dorsalis, general paresis, gummas, Argyll Robertson pupil, aortitis, aortic root aneurysms
First step in the management of a patient with acute GI bleed.
Establish the ABCs
First-line medication for status epilepticus.
IV benzodiazepine
First-line pharmacotherapy for depression.
SSRIs
First-line treatment for moderate hypercalcemia.
IV hydration and loop diuretics (furosemide)
First-line treatment for otitis media.
Amoxicillin × 10 days
Flat-topped papules.
Lichen planus
Four causes of microcytic anemia.
TICS—Thalassemia, Iron deficiency, anemia of Chronic disease, and Sideroblastic anemia
Four characteristics of a nevus suggestive of melanoma.
Asymmetry, border irregularity, color variation, large diameter
Four signs and symptoms of streptococcal pharyngitis.
Fever, pharyngeal erythema, tonsillar exudate, lack of cough
Galactorrhea, impotence, menstrual dysfunction, and decreased libido.
Patient on dopamine antagonist
Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Osteogenesis imperfecta
Glomerulonephritis with deafness.
Alport’s syndrome
Glomerulonephritis with hemoptysis.
Wegener’s granulomatosis and Goodpasture’s syndrome
Goal hemoglobin A1c for a patient with DM.
< 7.0
gout, self-mutilation, and choreoathetosis.
HGPRTase deficiency)
Heinz bodies?
Intracellular inclusions seen in thalassemia, G6PD deficiency, and postsplenectomy
Hematuria, flank pain, and palpable flank mass.
Renal cell carcinoma (RCC)
Hematuria, hypertension, and oliguria.
Nephritic syndrome
Hernia with highest risk of incarceration—indirect, direct, or femoral?
Femoral hernia
Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Suspect ankylosing spondylitis. Check HLA-B27
Honey-crusted lesions.
Impetigo
Honeycomb pattern on CXR. Diagnosis? Treatment?
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
How to diagnose and follow a leiomyoma.
Ultrasound
How to distinguish polycythemia vera from Secondarypolycythemia.
Both have increased hematocrit and RBC mass, but polycythemia vera should have normal O2 saturation and low erythropoietin levels
HUS triad?
Anemia, thrombocytopenia, and acute renal failure
Hypercholesterolemia treatment that → flushing and pruritus.
Niacin
Hyperphagia, hypersexuality, hyperorality, and hyperdocility.
Kluver-Bucy syndrome (amygdala)
Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure.
ARDS
Identify key organisms causing diarrhea: AIDS
Isospora, Cryptosporidium, Mycobacterium avium complex (MAC)
Identify key organisms causing diarrhea: Camping
Giardia
Identify key organisms causing diarrhea: Church picnics/mayonnaise
S. aureus
Identify key organisms causing diarrhea: Fried rice
Bacillus cereus
Identify key organisms causing diarrhea: Most common organism
Campylobacter
Identify key organisms causing diarrhea: Poultry/eggs
Salmonella
Identify key organisms causing diarrhea: Pseudoappendicitis
Yersinia
Identify key organisms causing diarrhea: Raw seafood
Vibrio, HAV
Identify key organisms causing diarrhea: Recent antibiotic use
Clostridium difficile
Identify key organisms causing diarrhea: Traveler’s diarrhea
ETEC
Identify key organisms causing diarrhea: Uncooked hamburgers
E. coli O157:H7
If you want to know if race affects infant mortality rate but most of the variation in infant mortality is predicted by socioeconomic status, then socioeconomic status is a _____.
Confounding variable
In which patients do you initiate colorectal cancer screening early?
Patients with IBD; those with familial adenomatous polyposis (FAP)/hereditary nonpolyposis colorectal cancer (HNPCC); and those who have first-degree relatives with adenomatous polyps (< 60 years of age) or colorectal cancer
Indications for medical treatment of ectopic pregnancy.
Stable, unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks’ gestation
Indications for surgical repair of abdominal aortic aneurysm.
> 5.5 cm, rapidly enlarging, symptomatic, or ruptured
Infant mortality?
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Infection of small airways with epidemics in winter and spring.
RSV bronchiolitis
Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women.
Lichen sclerosus
Inflammatory disease of the colon with increased risk of colon cancer.
Ulcerative colitis
Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7–10 days. Treatment?
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Inspiratory arrest during palpation of the RUQ.
Murphy’s sign, seen in acute cholecystitis
Involuntary commitment or isolation for medical treatment may be undertaken for what reason?
When treatment noncompliance represents a serious danger to public health (e.g., active TB)
Involuntary psychiatric hospitalization can be undertaken for which three reasons?
The patient is a danger to self, a danger to others, or gravely disabled (unable to provide for basic needs)
Iris-like target lesions.
Erythema multiforme
IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
Treat existing heart failure and replace the tricuspid valve
Joint pain and stiffness that worsen over the course of the day and are relieved by rest.
Osteoarthritis
Joints in the hand affected in rheumatoid arthritis.
MCP and PIP joints; DIP joints are spared
Key side effects of atypical antipsychotics.
Weight gain, type 2 DM, QT prolongation
Lab findings in Hashimoto’s thyroiditis.
High TSH, low T4, antimicrosomal antibodies
Lab values suggestive of menopause.
increased serum FSH
Laparoscopic findings in endometriosis.
“Chocolate cysts,” powder burns
Life-threatening muscle rigidity, fever, and rhabdomyolysis.
Neuroleptic malignant syndrome
Low urine specific gravity in the presence of high serum osmolality.
DI
Lung cancer associated with SIADH.
Small cell lung cancer (SCLC)
Lung cancer highly related to cigarette exposure.
SCLC
Macrocytic, megaloblastic anemia with neurologic symptoms.
B12 deficiency
Macrocytic, megaloblastic anemia without neurologic symptoms.
Folate deficiency
Maternal mortality?
Number of deaths during pregnancy to 90 days postpartum per 100,000 live births
May be seen in children who are accused of inattention in class and confused with ADHD.
Absence seizures
Medical options for endometriosis.
OCPs, danazol, GnRH agonists
Medical treatment for hepatic encephalopathy.
decreased protein intake, lactulose, neomycin
Medical treatment for IBD.
5-aminosalicylic acid +/− sulfasalazine and steroids during acute exacerbations
Medication given to accelerate fetal lung maturity.
Betamethasone or dexamethasone × 48 hours
Medication to avoid in patients with a history of alcohol withdrawal seizures.
Neuroleptics
Medication used to induce ovulation.
Clomiphene citrate
Medications and viruses that → aplastic anemia.
Chloramphenicol, sulfonamides, radiation, HIV, chemotherapeutic agents, hepatitis, parvovirus B19, EBV
Meningitis in infants. Causes? Treatment?
Pneumococcus, meningococcus, H. influenzae. Treat with cefotaxime and vancomycin
Meningitis in neonates. Causes? Treatment?
Group B strep, E. coli, Listeria. Treat with gentamicin and ampicillin
Method of calculating fluid repletion in burn patients.
Parkland formula
Microcytic anemia with decreased serum iron, decreased ferritin, and increased TIBC.
Iron deficiency anemia
Microcytic anemia with decreased serum iron, decreased total iron-binding capacity (TIBC), and normal or increased ferritin.
Anemia of chronic disease
Molar pregnancy containing fetal tissue.
Partial mole
Mortality rate?
Number of deaths per 1000 population
Name the defense mechanism: A hospitalized 10-year-old begins to wet his bed.
Regression
Name the defense mechanism: A mother who is angry at her husband yells at her child.
Displacement
Name the defense mechanism: A pedophile enters a monastery.
Reaction formation
Name the defense mechanism: A woman calmly describes a grisly murder.
Isolation
Name the organism: Alcoholic with pneumonia.
Klebsiella
Name the organism: “Currant jelly” sputum.
Klebsiella
Name the organism: Branching rods in oral infection.
Actinomyces israelii
Name the organism: Dog or cat bite.
Pasteurella multocida
Name the organism: Gardener.
Sporothrix schenckii
Name the organism: Infection in burn victims.
Pseudomonas
Name the organism: Meningitis in adults.
Neisseria meningitidis
Name the organism: Meningitis in elderly.
Streptococcus pneumoniae
Name the organism: Osteomyelitis from foot wound puncture.
Pseudomonas
Name the organism: Osteomyelitis in a sickle cell patient.
Salmonella
Name the organism: Painful chancroid.
Haemophilus ducreyi
Name the organism: Pregnant women with pets.
Toxoplasma gondii
Natural history of a leiomyoma.
Regresses after menopause
Neonatal mortality?
Number of deaths from birth to 28 days per 1000 live births
Neutropenic nadir postchemotherapy.
7–10 days
Non–small cell lung cancer (NSCLC) associated with hypercalcemia.
Squamous cell carcinoma
Nonpainful chancre.
Primarysyphilis
Nontender abdominal mass associated with elevated VMA and HVA.
Neuroblastoma
Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Fatigue and impending respiratory failure
Not contraindications to vaccination.
Mild illness and/or low-grade fever, current antibiotic therapy, and prematurity
Number needed to treat?
1 ÷ (rate in untreated group − rate in treated group)
Odds ratio?
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Patient presents with sudden onset of severe, diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Emergent laparotomy to repair perforated viscus, likely stomach
Peaked T waves and widened QRS.
Hyperkalemia
Perinatal mortality?
Number of deaths from 20 weeks’ gestation to one month of life per 1000 total births
PFT showing increased FEV1/FVC.
Restrictive pulmonary disease
PFT showing decreased FEV1/FVC.
Obstructive pulmonary disease (e.g., asthma)
Pinkish, scaling, flat lesions on the chest and back. KOH prep has a “spaghetti-and-meatballs” appearance.
Pityriasis versicolor
Post-HBV exposure treatment.
HBV immunoglobulin
Postnatal mortality?
Number of deaths from 28 days to one year per 1000 live births
PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a +PPD. Highly sensitive or specific?
Highly sensitive for TB
Precipitants of hemolytic crisis in patients with G6PD deficiency.
Sulfonamides, antimalarial drugs, fava beans
Premalignant lesion from sun exposure that can → squamous cell carcinoma.
Actinic keratosis
Presence of red cell casts in urine sediment.
Glomerulonephritis/nephritic syndrome
Presents with a herald patch, Christmas-tree pattern.
Pityriasis rosea
Prophylactic treatment for migraine.
β-blockers, Ca2+ channel blockers, TCAs
Proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, edema.
Nephrotic syndrome
Pure RBC aplasia.
Diamond-Blackfan anemia
Radiographic evidence of aortic disruption or dissection.
Widened mediastinum (> 8 cm), loss of aortic knob, pleural cap, tracheal deviation to the right, depression of left main stem bronchus
Radiographic indications for surgery in patients with acute abdomen.
Free air under the diaphragm, extravasation of contrast, severe bowl distention, space-occupying lesion (CT), mesenteric occlusion (angiography)
Red plaques with silvery-white scales and sharp margins.
Psoriasis
Reed-Sternberg cells
Hodgkin’s lymphoma
Relative risk?
The IR of a disease in a population exposed to a particular factor ÷ the IR of those not exposed
Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.
Type I (distal) RTA
Reynolds’ pentad.
Charcot’s triad plus shock and mental status changes, with suppurative ascending cholangitis
Rhomboid-shaped, positively birefringent crystals on joint fluid aspirate.
Pseudogout
Rigidity and stiffness that progress to choreiform movements, accompanied by moodiness and altered behavior.
Huntington’s disease
Rigidity and stiffness with resting tremor and masked facies.
Parkinson’s disease
Ring-enhancing brain lesion on CT with seizures
Taenia solium (cysticercosis)
Risk factors for cholelithiasis.
Fat, female, fertile, forty, flatulent
Risk factors for DVT.
Stasis, endothelial injury and hypercoagulability (Virchow’s triad)
Risk factors for pyelonephritis.
Pregnancy, vesicoureteral reflux, anatomic anomalies, indwelling catheters, kidney stones
RTA associated with abnormal HCO3 − and rickets.
Type II (proximal) RTA
RTA associated with aldosterone defect.
Type IV (distal) RTA
Salicylate ingestion → in what type of acid-base disorder?
Anion gap acidosis and Primaryrespiratory alkalosis due to central respiratory stimulation
Sensitive tests have few false negatives and are used to rule _____ a disease.
Out
Sentinel loop on AXR.
Acute pancreatitis
Shortest AP diameter of the pelvis.
Obstetric conjugate (between the sacral promontory and the midpoint of the symphysis pubis )
Should α- or β-antagonists be used first in treating pheochromocytoma?
α-antagonists (phentolamine and phenoxybenzamine)
Side effects of corticosteroids.
Acute mania, immunosuppression, thin skin, osteoporosis, easy bruising, myopathies
Signs of active ischemia during stress testing.
Angina, ST-segment changes on ECG, or decreased BP
Signs of air embolism.
A patient with chest trauma who was previously stable suddenly dies
Signs of increased ICP (Cushing’s triad).
Hypertension, bradycardia, and abnormal respirations
Signs of neurogenic shock.
Hypotension and bradycardia
Signs suggesting radial nerve damage with humeral fracture.
Wrist drop, loss of thumb abduction
Sudden onset of mental status changes, emesis, and liver dysfunction after taking aspirin.
Reye’s syndrome
Supportive treatment for ARDS.
Continuous positive airway pressure
Symptoms of placenta previa.
Self-limited, painless vaginal bleeding
Symptoms of placental abruption.
Continuous, painful vaginal bleeding
T-wave flattening and U waves.
Hypokalemia
Tanner stage 3 in a six-year-old female.
Precocious puberty
Term for heavy bleeding during and between menstrual periods.
Menometrorrhagia
Test to rule out urethral injury.
Retrograde cystourethrogram
Testicular cancer associated with β-hCG, AFP.
Choriocarcinoma
Tests to rule out shaken baby syndrome.
Ophthalmologic exam, CT, and MRI
The 6 P’s of ischemia due to peripheral vascular disease.
Pain, pallor, pulselessness, paralysis, paresthesia, poikilothermia
The coagulation parameter affected by warfarin.
PT
The diagnostic test for pulmonary embolism.
V/Q scan
The first test to perform when a woman presents with amenorrhea.
β-hCG; the most common cause of amenorrhea is pregnancy
The mainstay of Parkinson’s therapy.
Levodopa/carbidopa
The most common Primaryimmunodeficiency.
Selective IgA deficiency
The most common Primarymalignant tumor of bone.
Multiple myeloma
The most common Primarysources of metastases to the brain.
Lung, breast, skin (melanoma), kidney, GI tract
The most common cancer in men and the most common cause of death from cancer in men.
Prostate cancer is the most common cancer in men, but lung cancer causes more deaths
The most common cause of bloody nipple discharge.
Intraductal papilloma
The most common cause of Cushing’s syndrome.
Iatrogenic steroid administration. The second most common cause is Cushing’s disease
The most common cause of female infertility.
Endometriosis
The most common cause of hypertension in young men.
Excessive EtOH
The most common cause of hypertension in young women.
OCPs
The most common cause of hypothyroidism.
Hashimoto’s thyroiditis
The most common cause of postpartum hemorrhage.
Uterine atony
The most common cause of SAH.
Trauma; the second most common is berry aneurysm
The most common cause of seizures in children (2–10 years).
Infection, febrile seizures, trauma, idiopathic
The most common cause of seizures in young adults (18–35 years).
Trauma, alcohol withdrawal, brain tumor
The most common causes of dementia.
Alzheimer’s and multi-infarct
The most common causes of hypercalcemia.
Malignancy and hyperparathyroidism
The most common form of glomerulonephritis.
IgA nephropathy (Berger’s disease)
The most common form of nephritic syndrome.
Membranous glomerulonephritis
The most common histology of bladder cancer.
Transitional cell carcinoma
The most common inherited cause of hypercoagulability.
Factor V Leiden mutation
The most common inherited hemolytic anemia.
Hereditary spherocytosis
The most common location for an ectopic pregnancy.
Ampulla of the oviduct
The most common organism in burn-related infections.
Pseudomonas
The most common pathogen causing croup.
Parainfluenza virus type 1
The most common pituitary tumor. Treatment?
Prolactinoma. Dopamine agonists (e.g., bromocriptine)
The most common type of nephrolithiasis.
Calcium oxalate
The most common type of skin cancer; the lesion is a pearly-colored papule with a translucent surface and telangiectasias.
Basal cell carcinoma
The most common type of testicular cancer.
Seminoma—a type of germ cell tumor
The most common type of tracheoesophageal fistula (TEF). Diagnosis?
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
The most frequent presentation of intracranial neoplasm.
Headache
The most likely cause of acute lower GI bleed in patients > 40 years old.
Diverticulosis
The most serious side effect of clozapine.
Agranulocytosis
The number of bacterial culture on a clean-catch specimen to diagnose a UTI.
105 bacteria/mL
The number of true positives divided by the number of patients with the disease is _____.
Sensitivity
The percentage of cases within one SD of the mean? Two SDs? Three SDs?
68%, 95.5%, 99.7%
The three most common causes of fever of unknown origin (FUO).
Infection, cancer, and autoimmune disease
Therapy for polycystic ovarian syndrome.
Weight loss and OCPs
Three systemic diseases → nephrotic syndrome.
DM, SLE, and amyloidosis
Thrombotic thrombocytopenic purpura (TTP) pentad?
Pentad of TTP—“FAT RN” (Fever, Anemia, Thrombocytopenia, Renal dysfunction, Neurologic abnormalities)
Trauma series.
AP chest, AP/lateral C-spine, AP pelvis
Treatment for acetaminophen overdose.
N-acetylcysteine
Treatment for acute coronary syndrome.
Morphine, O2, sublingual nitroglycerin, ASA, IV β-blockers, heparin
Treatment for AML M3.
Retinoic acid
Treatment for atrial fibrillation.
Anticoagulation, rate control, cardioversion
Treatment for bacterial vaginosis.
Oral or topical metronidazole
Treatment for benzodiazepine overdose.
Flumazenil
Treatment for DTs.
Benzodiazepines
Treatment for Guillain-Barre syndrome.
IVIG or plasmapheresis
Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Treatment for malignant hypertension.
Nitroprusside
Treatment for mild and severe unconjugated hyperbilirubinemia.
Phototherapy (mild) or exchange transfusion (severe)
Treatment for mild, persistent asthma.
Inhaled β-agonists and inhaled corticosteroids
Treatment for neuroleptic malignant syndrome.
Dantrolene or bromocriptine
Treatment for opioid overdose.
Naloxone
Treatment for postpartum hemorrhage.
Uterine massage; if that fails, give oxytocin
Treatment for SVC syndrome.
Radiation
Treatment for TTP.
Emergent large-volume plasmapheresis, corticosteroids, antiplatelet drugs
Treatment for ventricular fibrillation.
Immediate cardioversion
Treatment of AF.
Rate control, rhythm conversion, and anticoagulation
Treatment of anaphylactic shock.
Diphenhydramine or epinephrine 1:1000
Treatment of cardiogenic shock.
Identify cause; pressors (e.g., dobutamine)
Treatment of central DI.
Administration of DDAVP decreased serum osmolality and free water restriction
Treatment of DKA.
Fluids, insulin, and aggressive replacement of electrolytes (e.g., K+)
Treatment of hypovolemic shock.
Identify cause; fluid and blood repletion
Treatment of septic shock.
Fluids and antibiotics
Treatment of SIADH?
Fluid restriction, demeclocycline
Treatment of supraventricular tachycardia (SVT).
Rate control with carotid massasge or other vagal stimulation
Treatment of tension pneumothorax.
Immediate needle thoracostomy
True or false: Once patients sign a statement giving consent, they must continue treatment.
False. Patients may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and patients without decision-making capacity
True or false: Withdrawing life-sustaining care is ethically distinct from withholding sustaining care.
False. Withdrawing and withholding life are the same from an ethical standpoint
Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow-up evaluation?
Colposcopy and endocervical curettage
Type of ARF in a patient with FeNa < 1%.
Prerenal
Typical antibiotics for group B streptococcus (GBS) prophylaxis.
IV penicillin or ampicillin
Unilateral, severe periorbital headache with tearing and conjunctival erythema.
Cluster headache
Unopposed estrogen is contraindicated in which cancers?
Endometrial or estrogen receptor– breast cancer
Uterine bleeding at 18 weeks’ gestation; no products expelled; cervical os closed.
Threatened abortion
Uterine bleeding at 18 weeks’ gestation; no products expelled; membranes ruptured; cervical os open.
Inevitable abortion
Vaccinations at a six-month well-child visit.
HBV, DTaP, Hib, IPV, PCV
Virchow’s triad.
Stasis, hypercoagulability, endothelial damage
Virus associated with aplastic anemia in patients with sickle cell anemia.
Parvovirus B19
Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
Nephrotic syndrome
What % lesion is an indication for carotid endarterectomy?
Seventy percent if the stenosis is symptomatic
What is the immunodeficiency? ■ A boy has chronic respiratory infections. Nitroblue tetrazolium test is +.
Chronic granulomatous disease
What is the immunodeficiency? ■ A child has eczema, thrombocytopenia, and high levels of IgA.
Wiskott-Aldrich syndrome
What is the immunodeficiency? ■ A four-month-old boy has life-threatening Pseudomonas infection.
Bruton’s X-linked agammaglobulinemia
What is the metabolic syndrome?
Abdominal obesity, high triglycerides, low HDL, hypertension, insulin resistance, prothrombotic or proinflammatory states
What should always be done prior to LP?
Check for increased ICP; look for papilledema
When can a physician refuse to continue treating a patient on the grounds of futility?
When there is no rationale for treatment, maximal intervention is failing, a given intervention has already failed, and treatment will not achieve the goals of care
When should a vaginal exam be performed with suspected placenta previa?
Never
Which healthy population is susceptible to UTIs?
Pregnant women. Treat this group aggressively because of potential complications
Which of the following are increased in DIC: fibrin split products, D-dimer, fibrinogen, platelets, and hematocrit.
Fibrin split products and D-dimer are elevated; platelets, fibrinogen, and hematocrit are decreased.
Why are β-blockers contraindicated in diabetics?
They can mask symptoms of hypoglycemia