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770 Cards in this Set

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Q001. A 24yo complains of a stuffy nose in the aftermath of a viral cold of 5 days duration. he has taken a nasal spray for self- treatment for the past 3 days and has noted that the stuffiness has become bilateral and now interferes with his sleep. Tx? (3 together)
A001. 1. Discontinue the present spray;; 2. use Inhaled Glucocorticoids briefly;; 3. Humidification; (the Sx are due to "Rhinitis Medicamentosa": rebound bogginess caused by local tissue refractory effects due to a topical decongestant; produces opposite effect of the medication)
Q002. A 15yo patient has recurrent nose bleeds on the left side. Dx?; Tx?
A002. Dx: Anterior Epistaxis; Tx: cauterize with Silver Nitrate
Q003. what virus has the greatest possibility to lead to Otitis Media?
A003. RSV
Q004. You have a new 52yo male patient without any recent medical records. What are the (2) main tests to screen for CV disease?; (2) for cancer?; (2) immunizations?
A004. CV:; 1. Blood Pressure (every visit);; 2. Lipid Profile Cancer:; 1. Fecal Occult Blood;; 2. Prostate exam Immunizations:; 1. Tetanus (if not had in 10 years);; 2. Influenza vaccine (in fall months)
Q005. when should a patient be screened for an abdominal aortic anneurism?; what test?
A005. at age 65 or over; by an Ultrasound
Q006. If there is no History of a Td (tetnus and diphtheria), what is the dosage schedule?
A006. 2 injections of vaccine at least 4 weeks apart;; followed by a third 6-12 months later;; normal boosters every 10 years
Q007. what is the schedule for the pneumococcal vaccine?
A007. at age 65 unless the patient has a chronic disease. with chronic disease, give vaccination then a one-time revaccination 5 years later
Q008. Tx for acute exacerbation of COPD with coughing green and without fever?; (3 together)
A008. 1. Antibiotics; 2. Bronchodilators; 3. Corticosteroids
Q009. what are the PFT levels for Stage I of COPD?; Name (2) med Tx and classes
A009. Stage I: FEV1/FVC < 70%; FEV1 > 80% Tx: Short-acting inhaled Bronchodilators; 1. Beta2 agonist: Albuterol or; 2. Anticholinergic: Ipratropium
Q010. what are the PFT levels for Stage II of COPD?; Name (2) additional med Tx and classes
A010. Stage II: FEV1/FVC < 70%; FEV1 50 - 80%; Tx: ADD a Long-acting inhaled Bronchodilator; 1. Beta2-agonist: Salmeterol or; 2. Anticholinergic: Tiotropium; (still use short-acting PRN)
Q011. what are the PFT levels for Stage III of COPD?; Name additional med Tx
A011. Stage III: FEV1/FVC < 70%; FEV1 30 - 50%; Tx: Add inhaled steroids
Q012. what are the PFT levels for Stage IV of COPD?; Name additional Tx
A012. Stage IV: FEV1/FVC < 70%; FEV1 < 30%; Tx: add oxygen therapy
Q013. A 45yo man presents with a sudden onset of monoarticular, nontraumatic join pain. He is an alcoholic and takes HCTZ for his HTN. Dx?; Tx for acute attacks? (2 possible); Maintenance therapy? (3 possible)
A013. Dx: Gout Acute attacks:; 1. Colchicine; 2. NSAIDs (not aspirin) Maintenance:; 1. Alkalinization of urine; 2. Probenicid; 3. Allopurinol
Q014. Chronic inflammation (as in RA) predisposes the joint to infection by what organism?; In active young adults?; what (2) tests should be done with both?
A014. Chronic: Staph Aureus; Young adults: N. Gonorrhea Tests:; 1. Joint culture; 2. Blood culture; (also urethral swab if positive for gonorrhea)
Q015. A child has a few painful, swollen joints with prolonged morning stiffness. He also has uveitis and a negative rheumatoid factor. Dx?
A015. Juvenile RA; (rheumatoid factor is often negative in children. Key is the Uveitis)
Q016. Dx: Joint pain with "pannus"; Unique joint affected?; Tx for symptomatic relief?; Tx for bad flare-ups?; other meds used and class? (4)
A016. Rheumatoid Arthritis (MCP effected); Symptomatic Tx: NSAIDs; Bad flare: Corticosteroids Other meds:; 1. DMARDS (Methotrexate, Sulfsalazine); 2. Anti-cytokines (Infliximab, Etanercept)
Q017. Main Sx of a septic joint that distinguishes it
A017. Limited ROM
Q018. what are (3) bugs seen in a HIV patient joint?
A018. 1. Pneumococcal; 2. Salmonella; 3. H. Influenza
Q019. What valvular repair surgery is assoc with highest mortality?
A019. Mitral Valve replacement
Q020. on exam a 59yo woman has a new low-pitched, rumbling, diastolic murmur that is heard loudest at the apex. Dx?
A020. Rheumatic Heart Disease
Q021. MC complication of Mitral Stenosis
A021. Systemic Embolization; (LA is rgeatly enlarged with MS causing A-fib and leading to a 80% increase in systemic emboli)
Q022. MC complication of Aortic Stenosis
A022. Syncope
Q023. How do you differentiate a Paroxysmal Atrial Tachycardia from an AV nodal Reentry Tachycardia?
A023. Carotid massage; (no effect on PAT, but can convert AVNRT)
Q024. what is the physiologic first goal of treatment of an acute A- fib?
A024. Reduce Ventricular response (rate control); (reduce rate with Digoxin, Beta-blocker or Ca channel blocker)
Q025. What is the rule for anticoagulation therapy for A-fib?
A025. Should be Anticoagulated (Warfarin) if rate continued for > 2 days
Q026. what does the pattern of a QS in leads II, III and AVF indicate?
A026. Previous Inferior MI
Q027. Dx:; Crescendo-decrescendo murmur that decreases with squatting
A027. Hypertrophic Cardiomyopathy; (IHSS)
Q028. What does Insipration and squatting do to blood?
A028. Increases venous return
Q029. What does Expiration and standing do to blood?
A029. Decreases Venous return
Q030. what murmur is increased with squatting?
A030. Mitral regurg
Q031. MCC of peripheral emboli?; 2nd MCC?
A031. 1. A-fib; 2. MI
Q032. MCC of an Ascending Aortic Aneurysm
A032. Cystic Medial Necrosis; (or syphillis)
Q033. MCC of a Descending Aortic Aneurysm
A033. Atherosclerosis
Q034. Medication for mild Claudication that increases RBC flexibility
A034. Pentoxifylline
Q035. What are the (3) main risk factors for the rupture of an AAA?
A035. 1. HTN; 2. Large Diameter of AAA; 3. COPD
Q036. what symptom must be present when diagnosing Otitis Media?
A036. Conductive hearing loss in affected ear
Q037. What is the defining characteristic of Malignant Otitis Media?
A037. Osteomyelitis of the bony canal
Q038. Dx:; Conductive hearing loss in patient with an otherwise normal exam
A038. Otosclerosis
Q039. (2) Sx that differentiate Mononucleosis from Strep Pharyngitis
A039. Mono:; 1. Non-Tender Lymph nodes; 2. No Fever
Q040. What is the children's mean age at the eruption of the last if the deciduous teeth?
A040. 27 months; (starts at about 7 months)
Q041. MC bug of oral cellulitis
A041. Beta-hemolytic Strep Pyogenes
Q042. Dx:; Abrupt and severe HA in Occipital area and Upper Neck; HTN; confusion; No cervical spine tenderness
A042. Subarachnoid aneurysm; (note lack of cervical tenderness)
Q043. 60yo man has 1 week History of mild HA accompanied by pain in his jaw with chewing. He denies any visual change, BP is normal, take no meds, exam is otherwise normal; Dx?; Next step?
A043. Dx: Temporal Arteritis (does not always present with eye problem; jaw pain is more common); Next step: Sedimentation Rate
Q044. MC presenting Sx of Intracerebral AV malformation
A044. Intracranial Hemorrhage; (more then HA, seizure, etc)
Q045. What is eye problem is most often assoc with crossed-eyes (Esotropia)?
A045. Hyperopia; (farsightedness)
Q046. What eye problem is most often assoc with lateral gaze or "cock-eyed" (Exotropia)?
A046. Myopia; (nearsightedness)
Q047. With respect to "red eye" a speedy diagnosis is urgent because of the possibility of what eye problem?; What is a specific finding for this problem?
A047. Acute-angle Glaucoma; sign: Ipsilateral Dilated Pupil
Q048. Dx:; patient presents with a red eye, ipsilateral miotic pupil and photophobia
A048. Iritis
Q049. A 45yo obese mother of 5 children complains of HA. Her bp is normal and fundoscopy reveals papilledema. A lumbar tap shows an Increased CSF pressure, but otherwise normal. A CT comes back normal. Dx?
A049. Pseudotumor Cerebri; (assoc with use of Vitamin A, oral contraceptives, and tetracycline)
Q050. MC type of ankle sprain?; MC ligament injured?
A050. Sprain: Inversion of ankle that is Plantar Flexed; Ligament injured: Anterior Talofibular ligament
Q051. What are the Ottawa Ankle Rules used to rule out?; (2); What are the (2) main rules?
A051. 1. Malleolar fracture; 2. Mid-foot fracture Rules:; 1. Unable to bear weight immediately or during the exam; 2. Bony tenderness over the distal Medial or Lateral Malleolus
Q052. Difference b/t Sprain and Strain?
A052. Sprain: Ligament stretch/tear; STrain: TENDON stretch/tear
Q053. what is the MCC of stiff or painful joint following a sprain?
A053. Inadequate rehabilitation
Q054. Describe the "Empty Can test"; What does it test?
A054. ECT: arm abducted, elbows extended, thumbs pointing down, patient elevates arm against resistance; tests: Supraspinatus (for rotator cuff injury)
Q055. Describe the "Lift-off Test"; What does it test?
A055. LOT: patient places dorsum of hand on lumbar back and attempts to lift hand off of back; tests: Subscapularis (rotator cuff injury)
Q056. Definition:; 1. A small blister <0.5cm; 2. A blister >0.5cm
A056. 1. Vesicle; 2. Bulla (pleural: bullae)
Q057. Definition:; a discoloration of the skin that is neither raised nor depressed
A057. Macule
Q058. MC type of Melanoma
A058. Superficial Spreading Melanoma
Q059. MC type of Melanoma in elderly
A059. Lentigo Maligna; (although least common of the four types)
Q060. MC type of Melanoma in African Americans and Asians
A060. Acral Lentiginous Melanoma
Q061. Most aggressive type of Melanoma
A061. Nodular Melanoma
Q062. A 25yo woman complains of vaginal itching and burning. The pH of the vaginal discharge is 4. Dx?
A062. Candida; (Trich, BV and Candida cause 90% of all vaginal Sx; both Trich and BV have a pH > 4.5)
Q063. A previously healthy 26yo man presents with abdominal cramping and fever for 2 days. He has 10 stools in last 24 hours. The specimen has blood and WBC. Dx?
A063. Shigellosis; (inflammatory process...food poisoning does not have WBC)
Q064. A 30yo obese woman presents with RUQ pain, slight fever, myalgias, fatigue and anorexia for 2 weeks that has increasingly become worse. Now she also has N/V and she is mildly jaundiced. LFTs show inc AST/ALT and total and conjugated billirubin and blood shows a mild elevation of WBC. Dx?; Initial step? (2 together)
A064. Hepatitis initial step:; 1. Continue oral fluids and bed rest; 2. order Hepatitis profile to determine type
Q065. a 76yo patient has a Hb of 7 and dec MCV, inc TIBC and dec Ferritin. Cause of Anemia?
A065. Iron Deficiency Anemia; (usually bowel-related bleed at that age)
Q066. What is the first line of therapy for Acne patients?; What is reserved for severe Acne?
A066. first: Tretinoin (Retin-A); severe: Isotretinoin (Accutane)
Q067. Which MCV anemia causes neurological Sx?; What Dx is it most commonly assoc with?
A067. B-12 deficiency; MC assoc with: Pernicious Anemia
Q068. How can you tell the difference b/t bleeding from colon cancer vs bleeding from diverticulosis by CBC?
A068. Colon CA: Microcytic, Hypochromic anemia; Diverticulosis: RBC indices are normal (both have decreased Hb)
Q069. First Dx test for possible Diverticulitis?
A069. CT Scan; (colonoscopy and barium enema could possibly cause perforation)
Q070. What is the first Tx for recurrent Otitis Media?
A070. Antibiotics for the acute otitis and then prophylactic Abx for 6 months; (tube placement for those who fail this suppressive therapy)
Q071. After a patient is treated for H. pylori and is asymptomatic, what is the next step?
A071. Endoscopy (EGD); (to confirm that the ulcer did not represent a gastric CA)
Q072. A 23yo woman complains of the room spinning and on exam has vertical nystagmus unaffected by position. What should she be tested for?
A072. test for: Multiple Sclerosis; (with MRI of the brain)
Q073. If there is a patient undergoing a vascular surgery, what pre- surgical test besides a CBC, CMP and x-ray should be performed?
A073. Cardiac Stress Test; (vascular surgery is a high risk for cocomitant CAD)
Q074. when should a child be screened for high cholesterol?; (2)
A074. At Age 2 if there is a family History of CV disease in parent/grandparent at age < 55 or; parental History of hypercholesterolemia
Q075. what other virus is most like the Sx of mononucleosis?
A075. CMV
Q076. A 10yo with asthma begins to wake from sleep about once a week. He is currently taking albuterol. what meds should he now take given the new Sx?
A076. 1. Long-Acting Beta-Agonist; 2. Inhaled Steroid
Q077. a 45yo has come into the office for the second time with HTN. Aside from the bloodwork, what (2) lab tests should be performed on this visit?
A077. 1. ECG; 2. CXR
Q078. *92 y/o with inc RBC count, inc platelet, most likely CLL; What is the next step?
A078. Observation
Q079. *pt with inc WBC count and inc RBC; what is the mechanism for erythrocytosis?
A079. abnormal Stem Cell Proliferation
Q080. *pt with lung cancer has hyponatremia with dec osmolarity; Next step?
A080. Water restriction
Q081. *Dx:; Asymptomatic 18 y/o with symmetric t-wave inversion on v1-v3
A081. Juvenile pattern of T-wave inversion
Q082. *Pt with tender 2 month duration nodule in RUQ; US shows cysytic mass. Next step?
A082. Aspiration of cyst
Q083. *Pt with chronic alcoholic abuse present with positive Romberg test (eyes open good balance, eyes closed loses balance). Next step?
A083. Check B-12 level
Q084. *Pt with non-blanching purpura on buttocks and legs. If you were to biopsy, what would you see?
A084. IgA
Q085. *Pt with irregularly irregular heart rate >24 hours; Next step? (2)
A085. 1. Rate control (beta-blocker or Calcium blocker); 2. Anticoagulate with Warfarin for 3 weeks before electrical Cardioversion (less then 24 hours can cardiovert electrically or with IV Procainamide)
Q086. *MC type of kidney stone?
A086. Calcium Oxalate
Q087. *Pt with sickle cell anemia(normocytic). what do you give as a supplement?
A087. Folate supplements
Q088. *What is the mechanism of damage behind ototoxicity from Aminoglycosides?
A088. Inner ear damage (to vestibular and cochlear apparatus)
Q089. *Pt with upper neuron CN 7 damage (forehead is OK but left face is drooping) and pt has dizziness, loss of balance, rhinitis. Dx?
A089. Acoustic Neuroma
Q090. *Pt with FH of stroke at age 55, BP 160/102, LDL 140 (overall ratio is OK), sedentary, obese. What is the most probable cause of a stroke?
A090. Hypertension
Q091. (2) Possible Tx for Barrett's esophagus
A091. 1. Esophagectomy; 2. Photodynamic therapy
Q092. *Pt with accentuated S2, bilateral edema, normal ejection fraction. What is the cause?
A092. Primary Pulmonary HTN
Q093. Pt with cirrhosis, non-bleedning varices, and other findings. Which med is the best for long term use?
A093. Propranolol (for varices)
Q094. First test to order when suspecting PCOS?
A094. US of the pelvis
Q095. *Pt with headache, low grade fever, joint pain and muscle pain. What is the next step?
A095. ESR (to rule-out Temporal Arteritis)
Q096. *Pt went to woods, rash with center clearing and joint pain. Drug Tx? (2 possible)
A096. 1. Doxycycline; 2. Amoxicillin (Penicillin or Cephalosporins if cardiac or neural involvement)
Q097. Dx:; Patient has joint pain in various joints without any positive lab results
A097. Degenerative Joint Disease (otherwise known as OA)
Q098. What can be used in both adults and children for up to 8 weeks as daily prophylaxis during an Influenza outbreak?
A098. Amantidine
Q099. Treatment for a 10 cm enlarging hematoma adjacent to the episiotomy site in a baby who you delivered 6 hours ago
A099. removal of the sutures and clots, and ligating the bleeding sites
Q100. Common cause of Retinal Detachment
A100. Posterior detachment of the Vitreous; Vitreous detachment is very common after age 60 and occurs frequently in younger persons with myopia. The separation of the posterior aspect of the vitreous from the retina exerts traction on the retina, with the attendant risks of a retinal tear and detachment. Symptoms of retinal detachment may include light flashes(photopsia), a sudden appearance or increase in “floaters,” or peripheral visual field loss, any of whichshould prompt an ophthalmology referral. Cataract surgery can result in premature shrinkage of the vitreous and thereby poses an increased risk, but vitreous detachment resulting from other processes is more common. Hyphema, glaucoma, and diabetic retinopathy are not specific risk factors for retinal detachment.
Q101. Treatment of choice for a 4 year old with suspected Pertussis?
A101. Erythromycin, Azithromycin, or Clarithromycin
Q102. What vitamin has been shown to reduce the risk of falling in the elderly?
A102. Vitamin D
Q103. What is an effective treatment for Bulimia nervosa?
A103. Fluoxetine; A number of placebo-controlled, double-blind trials have demonstrated the effectiveness of a variety of antidepressants in the treatment of bulimia nervosa. Fluoxetine has FDA approval for this indication. The other agents are not used for treating bulimia.
Q104. The Health Insurance Portability and Accountability Act (HIPAA); A)sets a federal minimum on the protection of privacy; B)requires that privacy notices be acknowledged and signed at eachofficevisit; C)allows the patient to inspect and obtain a copy of his/her record without exception; D)requires privacy notices prior to giving emergency care
A104. ANSWER: A; HIPAA regulations set a minimum standard for privacy protection. Privacy notices must be provided at the first delivery of health services, and written acknowledgement is encouraged but not required. Exceptions to patient inspections include psychotherapy notes and instances where disclosure is likely to cause substantial harm to the patient or another individual in the judgment of a licensed health professional. Although it is not necessary to provide patients with a privacy notice at the time of rendering emergency care, it is required that patients be provided with a privacy notice after the emergency has ended.
Q105. What is the most common cause of visual loss in children?
A105. Amblyopia = Amblyopia refers to diminished vision in either one or both eyes, for which no cause can be discovered upon examination of the eye. ★ - Amblyopia is the medical term used when the vision in one of the eyes is reduced because the eye and the brain are not working together properly. ★ - The eye itself looks normal, but it is not being used normally because the brain is favoring the other eye. ★ - This condition is also sometimes called lazy eye ★ - Evaluation of visual symptoms in children canbe challenging, but is important for identifying correctableconditions.Amblyopia, or“lazy eye,”is the most common cause of visual loss, with a prevalence of 2% inchildhood. ★ - It isoftenrelated to strabismus, in which the image from one eye is suppressed in order toeliminate diplopia. ★ - Iritis is unusual and may have minimal symptoms; it isfrequently associated withjuvenile rheumatoid arthritis. ★ - Glaucoma does occur in children, oftenaftercataract surgery. ★ - Eye trauma isrelatively common, especially in boys. ★ - They may sustain abrasions, foreign bodiesandpenetrating injuries. ★- Conjunctivitis will usually resolv
Q106. What tumor marker is used to detect the recurrence of colon cancer?
A106. CEA; Carcinoembryonic antigen (CEA) is a marker for colon, esophageal, and hepatic cancers. It is expressed innormal mucosal cells and is overexpressed in adenocarcinoma, especially colon cancer. Though not specific for colon cancer, levels above 10 ng/mL are rarely due to benign disease. CEA levels typically return tonormal within 4–6 weeks after successful surgical resection. CEA elevation occurs in nearly half of patientswith a normal preoperative CEA level that have cancer recurrence.
Q107. Tumor marker for Ovarian Cancer?
A107. CA-125
Q108. What levels are elevated in PCOS?
A108. Testosterone; LH and FSH (usually 3:1); This patient presented with classic symptoms of polycystic ovary syndrome (PCOS)—oligomenorrhea, infertility, hirsutism, and acne—reflecting hyperandrogenic anovulation. The underlying pathophysiology of PCOS includes insulin resistance leading to increased ovarian androgen production. LH and FSH levels are often elevated in PCOS, with the LH:FSH ratio often being greater than 3:1. Prolactin is usually normal, although mild elevations are possible.
Q109. What is the most effective drug used for the treatment of Alcohol dependence?
A109. Naltrexone (ReVia); * opioid receptor antagonist
Q110. What method most reliably detects a ureteral stone?
A110. Helical CT scan of the abdomen and pelvis without contrast; An unenhanced helical CT scanof the abdomen and pelvis is the best study for confirming the diagnosis of a urinary tract stone in a patient with acute flank pain, supplanting the former gold standard, intravenous pyelography. A CT scan may also reveal other pathology, such as appendicitis, diverticulitis, or abdominalaortic aneurysm. Although abdominal ultrasonography has a very high specificity, it is still not better than CT, and its sensitivity is much lower; thus, its use is usually confined to pregnant patients with a suspected stone. Plain abdominal radiographs may show the stone if it is radiopaque, and are useful for following patients with radiopaque stones. CT will reveal a radiopaque stone. While most patients with stones will have hematuria, its absence does not rule out a stone.
Q111. What method has been shown to prolong survival in cases of COPD?
A111. oxygen therapy
Q112. Radiologic evaluation of the cervical spine shows an air- fluid level in the Sphenoid sinus. What facial fracture would this be consistent with?
A112. Basilar Skull Fracture
Q113. Facial fracture associated with double vision, fluid in the Maxillary sinus, an air-fluid level in the maxillary sinus, and diplopia?
A113. Orbital floor fractures
Q114. Facial fractures more visible in Towne's view and have characteristic swelling and lateral orbital bruising
A114. Zygomatic arch fractures
Q115. Facial fractures associated with dental misalignment or bleeding
A115. Mandible fractures
Q116. Which vitamin reverses the effect of Warfarin?
A116. Vitamin K
Q117. What class of antihypertensives may help preserve bone mineral density?
A117. HCTZ
Q118. What drug would be used for first-line treatment of OCD with a depressive episode?
A118. Fluoxetine or other SSRI's; Escitalopram; Sertraline (Zoloft); Paroxetine (Paxil); Clonazepam would be 2nd line
Q119. Pain during rest and exercise and the presence of swelling and soreness behind the knee and in the calf is found in those with?
A119. Baker's cysts
Q120. What finding would support the diagnostic impression of peripheral vascular disease?
A120. Treadmill arterial flow studies showing a 20-mm HG decrease in ankle systolic blood pressure immediately following exercise
Q121. Read question 31 on Exam Book 1
A121. -
Q122. What medications are most effective for Restless Leg Syndrome?
A122. Carbidopa/Levodopa (Sinemet); or Ropinirole (Requip)or Pramipexole (Mirapex); Dopamine agonists used in Parkinson's disease
Q123. What are the key factors in the diagnosis of Streptococcal pharyngitis?
A123. 1. fever > 100.4; 2. Tonsillar exudates; 3. Anterior Cervical LAD; 4. absence of cough
Q124. Imiquimod (Aldara) is approved by the FDA for the treatment of what?
A124. External genital and perianal warts in pts 12 year and over; BUT it is also used off-label for plantar warts, flat warts, periungual warts, and mollucsum contagiosum
Q125. What is used prophylactically after total knee or hip replacements to prevent DVT's?
A125. LMW-heparin (Enoxaparin 30 mg subQ q 12h) and adjusted dose Warfarin; *these can be augmented by intermittent pneumatic compression
Q126. What is Black Cohosh?
A126. Herbal preparation widely used in the treatment of Menopausal symptoms and menstrual dysfunction
Q127. What medication class is the most appropriate for treating patients with Post-traumatic stress disorder?
A127. SSRI's due to low side-effect profile; Sertraline, Escitalopram, Paroxetine
Q128. What drug class is contraindicated in the treatment of patients with cocaine-arrhythmias? Why?
A128. Beta-blockers (Metoprolol); b/c they have been shown to exacerbate coronary vasospasm
Q129. A 3 yo female is brought to your office for evaluation of mild intoeing. The child's patellae face forward, and her feet point slightly inward. What is the most appropriate thing to do? What is the cause of this?
A129. Reassurance; Internal Tibial Torsion is believed to be caused by sleeping in the prone position, and sitting on the feet. In 90% of cases, the condition gradually resolves without intervention by the age of 8.
Q130. When is it recommended to screen women for Gestational Diabetes?
A130. 24-28 WGA; *pt is given 50-g oral glucose load followed by glucose determination 1 hour later
Q131. What co-morbidity is Sleep Apnea associated with? By improving sleep apnea this condition may also be improved.
A131. Hypertension
Q132. What medication can provide rapid relief of the symptoms of a patient in severe panic disorder?
A132. Alprazolam (Xanax) - works in hours
Q133. After how many weeks is a pregnancy termed "post-date or post-term"? What is the signifigance?
A133. 42 weeks; b/c perinatal mortality doubles at 42 WGA
Q134. A 36 yo member of the National Guard who has just returned from Iraq consults you b/c of several "boils" on the back of his neck that have failed to heal over the last 6 months, despite 2 week-long courses of cephalexin. you observe 3 1-to-2-cm raised minimally tender lesions with central ulceration and crust formation. He denies any fever or systemic symptoms. What is the most likely cause?
A134. Leishmaniasis
Q135. What is the earliest presenting symptoms in most older patients with open-angle glaucoma?
A135. Tunnel vision = gradual loss of peripheral vision
Q136. DOC's for Premenstrual Dysphoric Disorder
A136. SSRI's; Fluoxetine, Sertraline
Q137. Why should patients with CHF avoid taking NSAID's?
A137. b/c they cause Sodium and water retention, as well as increase systemic vascular resistance which may lead to cardiac decompensation
Q138. A pregnant patient is positive for Hepatitis B surface antigen. What is the most appropriate therapy for the infant?
A138. Hepatitis B immune globulin (HBIG) and Hepatitis B vaccine at birth; Testing for seroconversion is recommended at 9-12 months of age
Q139. What is the amount of RhoGam administered to an Rh negative mother if she has an ectopic pregnancy/spontaneous/therapeutic abortion at less than 12 WGA? > 12 WGA?
A139. < 12 WGA = 50 g RhoGAM; > 12 WGA = 300 g
Q140. What is the leading cause of death among women?
A140. Cardiovascular disease
Q141. Describe "postpartum blues"
A141. affect up to 85% of women and typically resolve by the 10th day postpartum
Q142. Describe Postpartum Depression
A142. may not occur until 6 months following delivery (as opposed to postpartum blues, which resolves by 10 days postpartum); Can be treated with SSRI's
Q143. Describe GER in infants; is it normal?; is it harmful?
A143. It is common & self-limited and represents a physiologic process of "spitting up"; Occurs in the absence of poor weight gain, irritability, cough, pain, or anemia...majority are thriving; Usually resolves by 1 year of age
Q144. What is the most frequent etiologic agent of occult bacteremia in children?
A144. S. pneumo
Q145. What is the cause of Kaposi's Sarcoma?
A145. HHV-8
Q146. How long is the Nuvaring kept in place before removing it?
A146. 3 weeks and then removed for 1 wk so that withdrawal bleeding occurs; new ring is then inserted; If for some reason the ring is out of the vagina for more than 3 hours, back-up contraception should be used until the device has been in place for 7 days
Q147. What is the prophylactic treatment for an outbreak of Menigococcal disease in a day care center?
A147. Rifampin
Q148. What is the most common cause of chronic, unilateral nasal obstruction in adults?
A148. Nasal septal deviation
Q149. What is the most common cause of nasal obstruction in all age groups?
A149. Common cold; usually bilateral and intermittent
Q150. What is the most common tumor or growth to cause nasal obstruction?
A150. Adenoidal hypertrophy followed by nasal polyps
Q151. List the 4 diagnostic criteria for Delerium
A151. 1. disturbances of consciousness with reduced ability to focus, sustain, or shift awareness; 2. A change in cognition (memory, disorientation, language disturbance) or development of a perceptual disturbance that is not better accounted for by a preexisting, established, or evolving dementia; 3. Development over a short period of time with a tendency to fluctuate during the course of a day; 4. Evidence from the history, PE, or lab findings that indicated the disturbance is caused by direct physiologic consequences of a general medical condition
Q152. What treatment is recommended for intravaginal genital warts in pregnant women?
A152. Cryotherapy with liquid nitrogen
Q153. A 25-year-old white truck driver complains of 1 day of throbbing rectal pain. Your examination shows a large, thrombosed external hemorrhoid. What is your treatment?
A153. Elliptical excision of the thrombosed hemorrhoid
Q154. How long should a pharmacologic treatment of depression last?
A154. minimum of 6 months
Q155. What is the best definition of Specificity?
A155. true-negative rate, or how well the test correctly identifies patients without disease
Q156. What is the best definition of Sensitivity?
A156. True-positive rate, or how well the test correctly identifies patients with disease
Q157. What is most bleeding in Meckel's diverticulum secondary to?
A157. heterotrophic gastric mucosa causing acid-induced ileal ulceration
Q158. What is the most common cause of proteinuria in children? Describe...
A158. Orthostatic Proteinuria
Q159. What is the most appropriate treatment for asymptomatic chlamydial infection during the 2nd trimester of pregnancy?
A159. Azithromycin
Q160. What is the general notion regarding the use of automated external defibrillators by lay persons in out-of-hospital settings?
A160. It has been shown to contribute to significant gains in full neurologic and functional recovery
Q161. What is the most accurate parameter during the 2nd trimester to assess Gestational Age? During the 1st trimester?
A161. Biparietal diameter; Crown-rump length
Q162. What is the leading cause of congenital hearing loss?
A162. CMV
Q163. Define the 2nd stage of labor
A163. Period from complete cervical dilation to complete delivery of the baby
Q164. Define the 3rd stage of labor
A164. delivery of the baby and ends with delivery of the placenta
Q165. When are secondary causes of N/V during pregnancy usually suspected?
A165. after 9 WGA
Q166. What can be given safely during pregnancy for N/V?
A166. Metoclopramide is not associated with an increased risk of adverse effects on the fetus
Q167. A 12-year old wrestler comes to your office c/o of recurrent painful rash on his arm. There appear to be several dry vesicles. What is the most likely diagnosis?
A167. Herpes gladiatorum caused by herpes simplex
Q168. In a patient with Atrial Fibrillation, what confers the greatest risk of stroke?
A168. Previous history of a stroke or TIA; other factors are: CHF, Hypertension, Age greater than 75, DM; CHADS is the mnemonic
Q169. In a patient with HIV infection, the threshold for initiating treatment for TB after PPD screening is an induration greater than or equal to:
A169. 5 mm
Q170. What symptoms are most suggestive of CHF in a 6-mo old white male presenting with tachypnea?
A170. Diaphoresis with feeding
Q171. What pain reliever should be avoided when managing chronic pain in the elderly? Why?
A171. Propoxyphene; Its efficacy is similar to that of aspirin or acetaminophen alone, but drug accumulation, neurotoxicity effects, and ataxia or dizziness may add unnecessary morbidity in older patients. Acetaminophen, hydrocodone, oxycodone, and hydromorphone are options for treating chronic pain in elderly
Q172. 20 year old female runner has a 1 week history of constant groin pain. There is limited hip motion on flexion and internal rotation of the right hip. Radiographs of the hip and pelvis are normal. What is the most likely diagnosis?
A172. Stress fracture of the right femoral neck
Q173. A runner has stinging pain over the lateral femoral epicondyle. What is the most likely diagnosis?
A173. Iliotibial band syndrome
Q174. A distance runner presents with pain in the anterior pelvic area and tenderness over the symphisis pubis. Diagnosis?
A174. Osteitis pubis
Q175. Uterine rupture is a potential complication of attempted VBAC. The most reliable indication that uterine rupture may have occurred is what?
A175. Fetal Bradycardia
Q176. A 14 year old AA female presents for a routine evaluation. On exam, you note a rubbery, well-defined, nontender breast mass approximately 2 cm in diameter. The patient denies any history of breast tenderness, nipple discharge, or skin changes. Diagnosis?
A176. Fibroadenoma; slow growing, nontender, rubbery, well-defined mass, most commonly in the upper, outer quadrant
Q177. Breast disease found in older adolescents and is characterized by bilateral nodularity and cyclic tenderness
A177. Fibrocystic disease
Q178. Spongy, tender breast mass with symptoms exacerbated by menses
A178. Benign breast cyst; frequently multiple and spontaneous regression occurs in 50% of patients
Q179. Firm, rubbery breast mass that may enlarge rapidly and is associated with skin necrosis.
A179. Cystosarcoma phyllodes
Q180. When is the probability of pregnancy after unprotected intercourse the highest?
A180. 1 day before ovulation
Q181. Patients with Wolff-Parkinson-White syndrome who have episodic symptomatic supraventricular tachycardia or Atrial fibrillation benefit most from what treatment?
A181. Radiofrequency catheter ablation of bypass tracts
Q182. A moderately obese 50 year old AA female presents with colicky right upper quadrant pain that radiates to her right shoulder. What is the most likely diagnosis? What is the best study to confirm the cause?
A182. Cholelithiasis; Abdominal sono
Q183. A 62 yo female with numbness in the LE and macrocytosis has a normal serum folate level and serum B12 level of 200 pg/mL (N 150-800). What lab finding would confirm diagnosis of B12 deficiency?
A183. elevated Methylmalonic Acid
Q184. What is a reduced haptoglobin level useful to confirm?
A184. Hemolytic anemia
Q185. What 2 things can lead to an elevated free erythrocyte protoporphyrin level?
A185. Lead poisoning and Iron deficiency
Q186. In what disease is an elevated ACE found?
A186. Sarcoidosis
Q187. What 2 drug classes have been found to decrease mortality after MI?
A187. Beta-blockers; ACE inhibitors
Q188. How often should young adults (until age of 40) have a routine physical exam?
A188. every 3-5 years
Q189. At what age are mammograms recommended?
A189. after age 40
Q190. A 23 yo hispanic female at 18 wks gestation presents with a 4 wk history of a new facial rash. She noticed worsening with sun exposure. On exam, you note symmetric, hyperpigmented patches on her cheeks and upper lip. Diagnosis?
A190. Melasma (Chloasma)
Q191. A rare polymorphous skin eruption of unknown origin occurring in late pregnancy that is more common on the extremities than on the trunk. It may recur during each subsequent pregnancy.
A191. Herpes gestationis
Q192. Treatment of asymptomatic chlamydial infections in women reduces their risk of developing these 4 things
A192. 1. PID; 2. Tubal infertility; 3. Ectopic pregnancy; 4. Chronic pelvic pain
Q193. What is the DOC for chlamydial infections in women?
A193. Azithromycin
Q194. Sexual contacts of a woman with chlamydial infection during what preceding number of days should be treated empirically or test for infection and treated if positive?; How long should a patient avoid intercourse after initiation of treatment?
A194. 60 days; 7 days
Q195. Cellulitis in patients after breast lumpectomy is thought to be related to lymphedema. What 2 things predispose to these infections?; What is the most common organism associated with this infection?
A195. Axillary dissection & Radiation; Non-group A hemolytic strep
Q196. What 3 drugs are used to treat Acute uncomplicated cystitis?
A196. Bactrim; Fluoroquinolone; Nitrofurantoin
Q197. Describe the McRoberts maneuver for managing shoulder dystocia
A197. Maximal flexion and abduction of the maternal hips
Q198. What would be the most appropriate empiric therapy for nursing home-acquired pneumonia in a patient with no other underlying disease?
A198. Levaquin
Q199. What criteria define Severe Preeclampsia?
A199. BP 160/110 on two occasions > 6 hrs apart; Proteinuria > 5 g / 24h; Thrombocytopenia with platelet count < 100,000; Liver enzyme abnormalities; Epigastric or RUQ pain; Alteration of mental status
Q200. What criteria define MILD Preeclampsia?
A200. BP > 140/90 on two occasions > 6 h apart; Proteinuria >300 mg / 24 h
Q201. What is the best initial screening test for Hereditary Hemochromatosis?; What are the symptoms of this disease?
A201. Serum Transferrin Saturation; Bronze skin pigmentation, glucose intolerance, hypogonadism, arthropathy of the MCP joints, heart failure, or cirrhosis
Q202. When is the median age of closure for the anterior fontanelle in newborns?
A202. 13.8 months of age
Q203. Describe the mechanism of Vasovagal syncope
A203. Period of high sympathetic tone (often induced by pain or fear), followed by sudden sympathetic withdrawal, which then triggers a paradoxical vasodilation and hypotension
Q204. What test is useful in diagnosing Vasovagal Syncope?
A204. Tilt testing, which causes pooling in the legs; Demonstrates Hypotension and Bradycardia
Q205. What is the antibiotic of choice for a dog bite?
A205. Amoxicillin/Clavulanate
Q206. When evaluating a patient with a solitary thyroid nodule, what are red flags indicating possible thyroid cancer? (8)
A206. 1. Male gender; 2. < 20 years or > 60 years; 3. rapid growth of nodule; 4. Symptoms of local invasion such as dysphagia, neck pain, & hoarseness; 5. History of head or neck radiation; 6. FH of thyroid CA; 7. hard, fixed nodule > 4 cm; 8. Cervical lymphadenopathy
Q207. In a euthyroid patient with a palbable nodule, what is the first test that should be ordered?
A207. Fine-needle aspiration
Q208. Studies have shown that Epidural analgesia during labor increase the incidence of these things
A208. 1. increase length of both First and Second stage of labor; 2. increase rate of instrument-assisted delivery; 3. Fourth degree laceration; 4. likelihood of maternal fever
Q209. A positive flexion abduction external rotation (FABER) test that elicits posterior pain indicates involvement of which joint?; Anterior pain?
A209. Sacroiliac; Hip involvement
Q210. What is the most effective long-term management of the majority of patients with Bipolar disorder?
A210. Lithium
Q211. What is the most appropriate therapy for a patient with DVT? What should the INR be maintained at?
A211. Initial SQ LMW-heparin (Enoxaparin) followed by PO Warfarin for 3-6 months; INR: 2-3
Q212. What should the INR be maintained at for patients with mechanical heart valves?
A212. 2.5-3.5
Q213. Gamekeeper's thumb is associated with a sprain of what?; How does it occur?
A213. Ulnar Collateral Ligament; Hyperextension and Hyperabduction of the thumb, usually as a result of a fall; *also called Skier's thumb
Q214. This is seen in a patient with a history of hypertriglyceridemia and severe abdominal pain with vomiting over the last 6 hours. WBC of 20,000; Glucose 295; AST 333; LDH 375; Most likely diagnosis?; What is the name of the sign shown in the picture? What does it indicate?
A214. Acute Pancreatitis; Grey Turner's sign indicates hemorrhage and a mortality rate approaching 50%
Q215. What effects does Estrogen have on the laboratory results of HDL and LDL?
A215. HDL -> increased; LDL -> decreased
Q216. Antidote to Atropine poisoning
A216. Physostigmine
Q217. Antidote for Cyanide poisonig
A217. Amyl nitrate
Q218. Antidote for Magnesium poisoning
A218. Calcium carbonate
Q219. Antidote for Ethylene glycol poisoning
A219. Ethanol and Pyridoxine
Q220. Antidote to Organic phosphates
A220. Atropine
Q221. What can be taken 45 minutes prior to Niacin administration to decrease flushing?
A221. Aspirin
Q222. What joint is usually affected in gout? What is this called?; What are the crystals in Gout?
A222. Metatarsophalangeal Joint; Podagra; Monosodium urate crystals
Q223. Antibiotic recommended in the treatment of a Brown Recluse spider bite?
A223. Dapsone
Q224. What can be done to distinguish Atrial Flutter from Sinus Tachycardia
A224. Carotid Massage; Atrial Flutter = regular, rapid cardiac rhythm characterized by an ectopic focus that gives rise to atrial rates from 280-350 per minute. Usually impulses are only transmitted to ventricles every 2nd, 3rd, or 4th impulse
Q225. DOC for Trigeminal Neuralgia?
A225. Carbamazepine (others are Phenytoin and Baclofin)
Q226. What ADR's have Methicillin and Nafcillin been associated with?
A226. Interstitial Nephritis with Renal Tubular Acidosis
Q227. What is the most common inherited bleeding disorder?; How can it be diagnosed?; Treatment for bleeding episodes?
A227. von Willebrand's disease (autosomal dominant); normal PT, prolonged PTT resulting from Factor 8 deficiency (vWF carries Factor 8); Ristocetin cofactor assay measures ability of vWF to agglutinate platelets in vitro in the presence of ristocetin; Cryoprecipitate or Factor 8 concentrate; or DDAVP (vasopressin) causes release of vWF from endothelial cells
Q228. This murmur is associated with severe chronic aortic regurgitation and may be middiastolic or presystolic. It occurs when there is backflow of blood from the aorta into the LV and flow into the LV from the LA. The regurgitant stream often prevents the full opening of the mitral valve, thus obstructing flow into the ventricle.
A228. Austin Flint murmur
Q229. This murmur affects children and is described as a humming or musical-sounding systolic murmur that is loudest at the left sternal border. It is a benign murmur. The murmur is usually heard in children 3-7 years of age and disappears before the onset of puberty
A229. Still's murmur
Q230. What ECG findings may be found in a patient with a Pulmonary Embolism? (3)
A230. Right Axis Deviation; S1-Q3-T3 pattern; Right Bundle Branch Block
Q231. When are children allowed to go back to school or daycare after having Strep Throat?
A231. After having taken the antibiotic for 24 hours and temperature has returned to normal
Q232. A 17 year old girl presents to your office. She had a URI 1 wk before the visit. She now complains of severe vertigo. Diagnosis?
A232. Vestibular Neuronitis = Acute Labrinthitis
Q233. Where is the most common location for the development of Morton's Neuroma?
A233. interdigital nerves b/w the 3rd and 4th metatarsal heads
Q234. What characterizes PVC's (premature ventricular contractions)? What can make them disappear?
A234. wide QRS complexes without a preceding P wave; Exercise
Q235. Severe complication of Warfarin that is unrelated to bleeding?
A235. Skin necrosis
Q236. Alternate name for Shin Splints?
A236. Medial Tibial Stress Syndrome; Physical examination reveals tenderness along several centimeters at the posteromedial border of the tibia, whereas a more focal anterior tibial tenderness suggests a stress fracture
Q237. Treatment of choice for Pyoderma Gangrenosum?
A237. Steroid therapy; Pyoderma gangrenosum also may develop in surgical scars, fistulas, and ostomy sites. However, pyoderma gangrenosum is an immune-mediated, inflammatory condition commonly associated with inflammatory bowel disease and immunodeficient states. These ulcers are painful with well-demarcated, undermined edges. They have a purulent, dusky purple base, surrounding erythema, and satellite pustules
Q238. Best treatment for chronic allergic rhinitis?
A238. Intranasal steroids
Q239. A 72 y/o smoker with a positive history of severe DJD, diabetes, and CVD presents c/o bilateral leg pain that occurs after walking 200 yards. He reports that rest improves his Sx's. Diagnosis and testing
A239. Claudication + Ankle/Brachial indices
Q240. 36 y/o runner presents with pain associated with the anterior heel. The pt reports his Sx's are worse on awakening and improve as the day progresses. Diagnosis?
A240. Plantar Fascitis
Q241. 52 y/o man is seen for fevers & wt loss. CXR shows mediastinal lymphadenopathy. Labs show hypercalcemia, elevated Alk Phos, and elevated ACE. Diagnosis?
A241. Sarcoidosis
Q242. What EKG finding is associated with Hypothermia?
A242. J (Osborne) wave = positive deflection after the QRS complex
Q243. A BUN:Cr ratio greater than 20 indicates?
A243. Prerenal causes; hypovolemia; cardiogenic shock; sepsis; anaphylaxis; drugs; renal artery stenosis; FeNa < 1% because kidneys are trying to conserve Na
Q244. What test is used in the initial evaluation of persistent hemoptysis
A244. CXR then if mass is noted then do flexible bronchoscopy; Hemoptysis = bright red blood and alkaline from the lungs
Q245. Progressive motor neuron disease that affects the corticospinal tracts &/or anterior horn cells &/or bulbar motor nuclei = ?
A245. ALS
Q246. 32-year-old man presents with recurrent oral and genital ulcers. He also has had arthalgias. Recently he was administered a tetanus vaccination and developed a sterile abscess at the site of the injection. Most likely diagnosis?
A246. Behcet's Syndrome; Behçet's disease is a multisystem inflammatory condition, probably of autoimmune origin, that is triggered by infectious antigens or other antigens in genetically predisposed persons. Recurrent, painful ulcerations of the oral and genital mucosa are the most common symptoms. Therapeutic agents, such as topical or intralesional corticosteroids, generally are used only for palliative therapy. Sucralfate, which is commonly used in the treatment of peptic ulcers, can also heal ulcers of the gastrointestinal tract. However, its effectiveness in healing oral and genital ulcerations is unknown. Behçet disease (BD), also known as Behçet syndrome, is a chronic form of vasculitis (inflammation of the blood vessels) involving four primary symptoms: oral and genital ulcers, ocular inflammation, and arthritis.
Q247. A boy who plays Little League baseball presents with swelling over the lateral elbow and pain with valgus and varus stress while flexing and extending the elbow. The patient reports locking of the elbow. Radiographs show the presence of loose bodies. Diagnosis?
A247. Osteochondritis dissecans; In osteochondritis dissecans, a loose piece of bone and cartilage separates from the end of the bone because of a loss of blood supply. The loose piece may stay in place or fall into the joint space, making the joint unstable. This causes pain and feelings that the joint is "catching" or "giving way."; These loose pieces are sometimes called "joint mice."; Osteochondritis dissecans usually affects the knees and elbows.
Q248. Describe Ludwig's Angina; What is a serious complication?
A248. Infection invloving the sublingual and submaxillary space usually due to poor dental hygiene, tooth extraction, or trauma; Tongue displacement upwards compromising the airway
Q249. A 28 year old homosexual man presents to your office c/o of nonproductive cough, SOB, fever, chills. CXR shows bilateral interstitial infiltrates. Diagnosis? Treatment?
A249. Pneumocystis; IV Bactrim
Q250. What is the treatment for a patient suspected of Wernicke- Korsakoff Syndrome?
A250. Thiamine followed by IV Dextrose
Q251. What is the name of the test that confirms Benign Positional Vertigo?
A251. Dix-Hallpike maneuver = turn patient's head to the side while having them go from a sitting to lying position with head positioned below the level of the bed; BPV = severe episodes of vertigo that usually last less than 1 minute and are precipitated by certain head movements. Nystagmus is usually associated. Pathophysiology: caused by free-floating particulate matter in the semi-circular canals, usually the posterior canal (the most dependent structure of the labyrinth). movement of this debris causes endolymph movement/pressure and cupular deflection; this causes an imbalance in the signals from the labyrinths resulting in vertigo; the particles are calcium carbonate crystals and are referred to as “ otoliths”
Q252. If an elderly man is diagnosed with Myasthenia Gravis what else should you suspect?
A252. Thymoma
Q253. A 60-year-old woman presents with complaints of diffuse proximal muscle pain, low-grade fevers, and generalized fatigue. Labs show elevated ESR and mild anemia. Diagnosis? Rx?
A253. Polymyalgia Rheumatica; inflammatory disease with pain and stiffness associated with proximal muscles; more common in women; symmetrical pain and morning stiffness in neck, shoulders, and hips; fever, generalized fatigue, anorexia, & wt. loss; elevated ESR and anemia of chronic disease; Rx = oral corticosteroids (prednisone)
Q254. A 16 yo girl presents c/o throat pain, difficulty swallowing, and trismus (spasm of jaw muscles). PE shows redness and enlargement of the left tonsillar pillar. The patient holds her head to the left side and has muffled speech. Diagnosis?
A254. Peritonsillar abscess
Q255. A 65 year old man c/o gynecomastia and galactorrhe with erectile dysfunction. Most likely diagnosis? Rx?
A255. Prolactinoma; Dopamine agonist; Cabergoline, Bromocriptine, Pergolide
Q256. MCC of chronic cough?
A256. Postnasal drip
Q257. A 62 yo woman presents c/o joint pain, polyuria, polydipsia, and generalized fatigue. The woman reports a history of recurrent kidney stones and depression. Radiographs show osteopenia and subperiosteal resorption on the phalanges. What blood test may help determine the cause of her symptoms?
A257. Parathyroid hormone level for Primary Hyperparathyroidism
Q258. What is the treatment for someone under the age of 35 who has a + PPD test but no evidence of disease (including a - CXR)?
A258. INH for 6 months
Q259. What is the name of a test that can be performed to diagnose Raynaud's phenomenon?
A259. Allen's Test = occlude the radial and ulnar arteries while the patient makes a fist, the hand is the opened and one side of the wrist is released. Blood flow to the hand should be detected by color, which is restored to the hand. If the hand remains pale and cyanotic with either of the 2 sides, Raynaud's phenomenon should be suspected
Q260. Recurrent vertigo, tinnitus, and hearing loss are all hallmark findings of what? What is the treatment?
A260. Meniere's Disease = endolymphatic hydrops (increased fluid pressure within the inner ear); Salt restriction + HCTZ
Q261. DOC for Cryptococcal meningeal infection?
A261. Amphotericin B & Flucytosine
Q262. A 28 year old man presents to your office c/o pain in the perirectal area for the last week. Exam shows an area of tenderness, redness, and induration (hardened) lateral to the anus. The area is warm and fluctuant. Most likely diagnosis? Treatment?
A262. Pilonidal cyst; Surgical incision and drainage
Q263. A 78 year old retired carpenter presents c/o gradually increasing right-sided shoulder pain. Pt is unable to sleep on his right side and has difficulty raising right arm. PE shows ROM is significantly restricted. X-rays show osteopenia of humeral head. Most likely diagnosis?
A263. Adhesive capsulitis
Q264. What supplement has been associated with an increased risk of lung cancer in smokers?
A264. Beta-carotene
Q265. What 3 groups of people should be treated for Asymptomatic Bacteriuria?
A265. 1. pregnant women; 2. pts with renal transplants; 3. pts who are about to undergo GU tract procedures
Q266. A 2 cm nodule is found on the left lobe of the thyroid in a healthy 40 year old woman. What is the most appropriate management at this time?
A266. Fine-needle aspiration
Q267. A 38 year old describes severe rectal pain associated with pallor, diaphoresis, and tachycardia that lasts for only a few minutes. The pain occurs mostly at night and are described as spasms. Diagnosis?
A267. Proctalgia fugax is a unique anal pain. ★ - Patients with proctalgia fugax experience severe episodes of spasm-like pain that often occur at night. ★ - Proctalgia fugax may only occur once a year or may be experienced in waves of three or four times per week. ★ - Each episode lasts only minutes, but the pain is excruciating and may be accompanied by sweating, pallor and tachycardia. ★ - Patients experience urgency to defecate, yet pass no stool. ★ - No specific etiology has been found, but proctalgia fugax may be associated with spastic contractions of the rectum or the muscular pelvic floor in irritable bowel syndrome. ★ - Reassurance that the condition is benign may be helpful, but little can be done to treat proctalgia fugax. ★ - Medications are not helpful since the episode is likely to be over before the drugs become active. ★ - Sitting in a tub of hot water or, alternatively, applying ice may provide symptomatic relief. ★ - A low dose of diazepam (Valium) at bedtime may be beneficial in cases of frequent and disabling proctalgia fugax
Q268. A 21 yo returns from a camping trip early c/o dull numbness affecting his upper left extremity He recalls a sharp pinprick sensation before the development of symptoms. The pt now describes a cramping pain & muscle rigidity of the back and chest area. A red, indurated area is found on the distal left arm. The pt has profuse sweating, nausea, vomiting, and SOB. Diagnosis?
A268. Black Widow spider envenomation
Q269. A 75 year old man presents to your office c/o flashes of light and blurred vision. He reports no pain. In-office exam reveals no findings other than decreased visual acuity. Most likely diagnosis?
A269. Retinal detachment; painless; dark floaters; flashes of light; blurred vision; REFER TO OPHTHALMOLOGIST
Q270. Subnormal visual acuity in one or both eyes despite correction of refractive error = ?
A270. Amblyopia; lazy eye; results when a child suppresses the vision in one eye to avoid diplopia; most common cause is strabismus (misalignment of the eyes)
Q271. 12 year old boy presents c/o gradual, increasing hip pain that radiates to the thigh and knee. PE shows an obese boy with pain associated with hip abduction and adduction. Radiographs show evidence of acetabular dysplasia. Diagnosis?
A271. Slipped Capital Femoral Epiphyses; femoral head slips posteriorly and inferiorly exposing the anterior and superior aspects of the metaphysis of the femoral neck
Q272. Idiopathic aseptic necrosis of the femoral head is also known as?
A272. Legg-Calve-Perthes disease
Q273. The most common cause of a limp in a 5 year old boy is?
A273. Transient Synovitis of the hip; Transient synovitis is the most common cause of hip pain in children. Many children will have a history of recent minor trauma, although this is obviously nonspecific in this age group. Transient synovitis typically affects young children who present with a limp of acute onset. On examination, the child will often refuse to use the affected leg and will have pain with any motion. Most children rapidly improve over two to three days, and more serious conditions such as a septic arthritis or juvenile rheumatoid arthritis should be considered if this rapid improvement is not seen.
Q274. What is the most common bacterial pathogen associated with lung infections in adolescents? Rx?
A274. Mycoplasma pneumonia -> malaise, sore throat, coryza, myalgias, and increasing productive cough of mucopurulent or blood-streaked sputum; Erythromycin
Q275. What 3 criteria can define boys as having "delayed sexual maturation"?
A275. 1. no testicular development by age 13.5 years; 2. no pubic hair by age 15 years; 3. more than 5 years between initial and completed growth of the genitalia
Q276. Describe Posterior Urethral Valves
A276. Valves are secondary to abnormal folds in the prostatic urethra that enlarge with voiding and cause obstruction of the urethral lumen; Symptoms include decreased urinary stream, overflow incontinence, and UTI's with dysuria.
Q277. What is the most common curvature in scoliosis?
A277. to the right in the thoracic spine, causing the right shoulder to be higher than the left
Q278. The most common cause of septic joint in an immigrant 3- year-old boy with no prior immunizations would be?
A278. H. influenza
Q279. A newborn is cyanotic shortly after birth and CXR shows the characteristic "egg on a string". Diagnosis?
A279. Tranposition of Great Vessels
Q280. A 3-month-old girl is brought in b/c she has been having excessive non-purulent tearing from the left eye for the past 4 weeks. Diagnois and treatment?
A280. Dacryostenosis; Massage the duct twice daily as it usually resolves by 6 months of age
Q281. Transient Cortical Blindness:; Cause?; How long before resolves?; CT and EEG findings?
A281. Cause: mild head trauma; Resolves within 24 hours; CT: unremarkable; EEG: initially shows slowing but resolves as blindness dissipates
Q282. A painless, cystic structure in the scrotum that transilluminates but is not associated with the presence of sperm is most likely?
A282. Hydrocele; (vs. a Varicocele, which is an enlargement of the pampiniform plexus due to incompetent valves of the veins)
Q283. Explain Tick Paralysis
A283. Dermacentor and Amblyomma have been linked to tick paralysis that causes muscle weakness, anorexia, lack of coordination, lethargy, nystagmus, and an ascending flaccid paralysis; Caused by inoculation of a neurotoxin found in the tick's salivary gland; Antibiotics are not indicated, but symptomatic treatment is
Q284. Syringomyelia may expand during adolescent years. Typically, what is the first neurologic deficit seen?
A284. Pain and temperature sensation
Q285. Are high or low frequency sounds affected first in Presbycusis?
A285. High frequency sounds; Pt. usually c/o trouble hearing normal conversations in crowds
Q286. Describe each of the 4 stages of pressure ulcers
A286. 1. localized area of nonblanchable, red skin; 2. break in the skin with surrounding redness and induration; 3. full-thickness ulcer that extends to the subcutaneous layer but not thru the underlying fascia; 4. ulcer penetrates the deep fascia exposing bone or underlying muscle
Q287. A 79 year-old woman with a history of atherosclerosis and HTN is seen in the ER. The pt reports she suddenly lost her vision in her left eye on awakening this morning. She reports no pain associated with the eye and has no other symptoms. Funcuscopic examination shows disk swelling, extensive retinal hemorrhages, and cotton-wool spots. The most likely diagnosis is?
A287. Central Retinal Vein Occlusion
Q288. What is the triad characteristic of Normal Pressure Hydrocephalus?
A288. 1. Dementia; 2. Gait ataxia = stuttering gait in which the initiation of gait is hesitant but gives way to walking; 3. Urinary incontinence Due to inadequate absorption of CSF
Q289. How to treat rhinitis medicamentosa
A289. stop offending agent and start inhaled/oral corticosteroids to wean off of steroids
Q290. who gets anterior epistaxis? how is it treated?
A290. young people with chronic nosebleeds, treat by cauterizing with silver nitrate
Q291. who gets posterior epistaxis? how to treat
A291. elderly, hypertensives. Pt. needs referral to ENT
Q292. Of the following, which is a risk factor in developing Otitis Media:; Tonsillar hypertrophy; Adenoidal hypertrophy
A292. Adenoidal hypertrophy
Q293. What percent chance of developing otitis media is associated with:; RSV?; Adenovirus/Influenza
A293. RSV - 33%; Adeno/Inf. - 28%
Q294. What precent of otitis media bugs are PCN/Amox resistant?
A294. 20-30%
Q295. How long can a middle ear effusion take to resolve following otitis media?
A295. up to 16 weeks
Q296. What other anomaly is found in half of people with coarctation?
A296. Bicuspid aortic valve
Q297. What are the top 3 valvular abnormalities caused by Rheumatic Fever?
A297. 1. MR; 2. AS; 3. AS+MS
Q298. What is the most common problem that Mitral Stenosis causes?
A298. Systemic embolus due to left atrial enlargement.
Q299. What is the mortality rate associated with a first heart attack?
A299. 0.25
Q300. Patients with unstable angina have a __% chance of MI in 2 years.
A300. 0.12
Q301. What drugs are good to treat prinzmetal's angina? what is a poor choice to treat it?
A301. Calcium channel blocker and ACE inhibitor. Beta blockers are a poor choice because they may aggravate small vessel spasm
Q302. What is a good test to differentiate Paroxysmal Atrial Tachycardia with block from AVNRT?
A302. Vagal maneuvers (carotid sinus massage/valsalva) cause an AV node block. Since supraventricular tachycardias occur independent of the AV node, there will be no response. So, PAT with block will not be slowed while AVNRT could be converted with a vagal maneuver.
Q303. PAT can be due to toxicity from what drug?
A303. Digoxin
Q304. 55 year old woman who is unable to lie flat because of SOB. No edema. 50% EF. what drug treatment is best?
A304. This woman has LV CHF with Diastolic dysfracturen (EF>40%). This is best treated with a Calcium channel blocker because of their anti-ischemic actions, preload reduction, BP control, LVH regression potential, and HR control which allows increased coronary filling during prolonged diastolic relaxation.
Q305. What is systolic dysfunction defined as (2 things) and what drug is best used to treat it?
A305. EF < 40%, dilated heart. Digoxin + a thiazide is best to treat a symptomatic (orthopnea, neck veins, edema) person with CHF. ACE inhibitors work well also
Q306. Name 3 drug classes used to slow down A-fib with RVR
A306. Digoxin, Beta Blocker, Calcium channel blocker
Q307. When should patients be anticoagulated before A-fib conversion?
A307. when they have had A-fib for > 2 days
Q308. Is LVH a characteristic of diastolic or systolic dysfunction?
A308. Diastolic
Q309. Why are calcium channel blockers and beta blockers relatively contraindicated in systolic dysfunction?
A309. they have negative inotropism
Q310. What are some characteristics of systolic dysfunction
A310. 1. Reduced EF; 2. Increased end diastolic pressure; 3. Increased resistance to flow
Q311. Name one other cause of a systemic embolism besides Afib.
A311. MI
Q312. Would you suspect embolism or thrombosis in a patient with Afib, MS, LAE, Claudication
A312. Embolism in AF, MS, LAE; Thrombosis in Claudication
Q313. What is the earliest sign and most sensitive indicator of chronic occlusive disease?
A313. ABI < .9
Q314. What causes a descending (2) vs. ascending (2) AAA?
A314. Descending - atherosclerosis, trauma (rarely); Ascending - cystic medial necrosis, syphilis
Q315. How does the caliber, length and flow rate of vessels affect 5 year patency rates of balloon angioplasties?
A315. High flow rate, larger caliber, and occluded segment < 3cm are associated with higher patency rates
Q316. How much does treatment of DVT with anticoagulants decrease the risk of PE?
A316. by 50%
Q317. How do you treat a superficial thrombophlebitis with no extension to deep venous systems?
A317. Heat + NSAIDS (excision not indicated)
Q318. What sign is most consistent with a hemorrhagic stroke?
A318. severe headache
Q319. What complication has the greatest morbidity in patients with subarachnoid hemorrhage? how can it be treated?
A319. Vasospasm - treat with a calcium channel blocker
Q320. What is reflex sympathetic dystrophy?
A320. syndrome of burning pains, tenderness, vasomotor skin changes, hyperesthesia, and edema usually to a hand or foot following trauma, peripheral nerve injury, or stroke
Q321. What is a major side effect of Ticlopidine when used in a patient with a recent ischemic stroke?
A321. Neutropenia
Q322. What is the stroke risk in a male with 70% carotid stenosis? How much does a carotid endarterectomy decrease the risk?
A322. 2% per year. Endarterectomy will reduce risk by 53%
Q323. How does a chronic subdural hematoma usually present?
A323. headache or confusion, patients don't usually present with neuro defecits
Q324. What is the post traumatic hematoma that can appear anytime within 24 hours of the trauma?
A324. epidural
Q325. A musical murmur in childhood that usually disappears by puberty
A325. Still's murmur
Q326. Most common congenital heart defect
A326. VSD
Q327. What two populations are normal pulmonary flow murmurs heard in?
A327. 3rd trimester and adolescents
Q328. What is a jugular venous hum?
A328. A buzz like noise heard throughout the cardiac cycle in some kids. It is produced by cerebral blood flow hitting the right angle at the innominate vein. There is no clinical siginificance
Q329. Harsh murmur at the 2nd left intercostal space that radiates to the back
A329. PS
Q330. How can the severity of PS be evaluated on physical exam?
A330. degree of RVH
Q331. What physical exam finding best correlates with the severity of AS?
A331. Palpable thrill in the suprasternal notch
Q332. How is a PDA treated in newborns?
A332. A PDA should be given 48 hours of observation to close on its own, after that indomethacin can be used. If indomethacin is not successful, surgical ligation can be used
Q333. How should a carotid bruit in a child be treated?
A333. No treatment, they aren't a big deal
Q334. When is a PVC concerning in children?
A334. when they occur in couplets or triplets, they are more likely to go into vtach
Q335. What are the two heart defects that cause cyanosis in infancy and when are they usually cyanotic?
A335. Transposition - becomes cyanotic withn the first few days of life after the ductus arteriosus closes; Tetralogy - more likely to be cyanotic within the first few weeks of life
Q336. What is the largest risk factor for HTN?
A336. DMII
Q337. What percent of newly diagnosied HTN is secondary?
A337. 5-10%
Q338. Primary aldosteronism is due to an adenoma ____% of the time (rather than idiopathic hyperplasia)
A338. 70-90%
Q339. When and how much does CrCl begin to decrease in life?
A339. CrCl falls by 1ml/min/1.73m2/year beginning at age 30-35
Q340. What is an acceptable range of microalbuminuria:; in HTN?; in DM?
A340. HTN - 200-500 mg/24hrs; DMII - 30-300 mg/24hrs
Q341. What is the rate of renal decline once PCKD begins to affect renal function
A341. CrCl declines by half every 36 months
Q342. What is the blood pressure target for:; Non African americans/non diabetics?; African americans/diabetics?
A342. non AA/non DM - < 130/80; AA/DM - < 125/75
Q343. What meds does HTN in the elderly typically respond to and which don't they respond to?
A343. Typically, HTN in the elderly is less sensitive to beta blockers and more sensitive to diuretics.
Q344. New onset diastolic HTN in the elderly suggests what?
A344. It suggests changing physiology such as reovascular processes (renal artery obs. chronic GN, or nephrosclerosis) and high renin states.
Q345. How does HTN and treatment differ between high renin, low renin, and normal renin?
A345. High renin (10% of HTN)- These patients will respond better to beta blockers and ACE inhibitors; Low renin (30-40% of HTN)- lower than normal renin activity for a given salt intake leads to "salt sensitive" HTN. These patients can best be treated with thiazied diuretics. Normal renin - (55% of HTN) These patients respond to both families of drugs, and often better when diuretics are combined.
Q346. How can hyperinsulinemia increase vascular tone (4)?
A346. 1) Promotes Na+ retention; 2) Promotes hypertrophy or hyperplasia of vascular smooth muscle; 3) modifying ion transport leading to an increase in intracellular Ca++; 4) Sympathetic activation
Q347. What are the side effects of HCTZ (4) and at what dose do they usually occur?
A347. > 25 mg/day; 1) hyperlipidemia; 2) hyperuricemia; 3) hypokalemia; 4) carbohydrate intolerance
Q348. How does the efficacy of HCTZ change with age/race?
A348. HCTZ is effective in the majority of african americans / elderly populations. HCTZ is effective in only 30-40% of caucasians
Q349. List the four leading causes of ESRD.
A349. Diabetic nephropathy; Hypertensive nephropathy; Chronic GN; PCKD
Q350. What percent of pts. is a thiazide used as a first line drug effective?
A350. 30-40%
Q351. Differentiate between broca's and wernicke's aphasia and the location of the lesion in each.
A351. Broca's - lesion in the lower posterior frontal lobe and presents with good comprehension but non-fluent effortful speech often associated with Right hemiparesis. Wernicke's aphasia - Posterior/Superior frontal lobe. Presents with poor comprehension, abundant, fluid, well articulated speech that makes no sense.
Q352. How does a sensory defect affect Alzheimer's disease
A352. Alzheimer's disease is exacerbated in the presence of another sensory defect.
Q353. How does Parkinson's disease usually begin?
A353. unilateral tremor
Q354. What are some autonomic dysfunctions associated with Parkinson's?
A354. Orthostatic hypotension, constipation, and impotence.
Q355. Tacrine - use? major side effect?
A355. Tacrine is a cholinesterase inhibitor used to treat Alzheimer's and its major side effect is elevation of serum transaminases.
Q356. Benztropine. Mech? use?
A356. anticholinergic used to reduce the tremor in PD
Q357. What are two drugs that reduce the rigidity associated with Parkinson's Disease?
A357. Levodopa and Amantidine
Q358. What are two drugs that can treat absence seizures? when do absence seizurs usually stop occurring?
A358. Valproic acid and ethosuximide. Absence seizures usually resolve around adolescence.
Q359. What are two firstline treatments for generalized or focal seizures?
A359. Phenytoin and phenobarbitol
Q360. What are 3 pulmonary bugs that can complicate a viral infection?
A360. Strep pneumo, H flu, Staph aureus
Q361. What virus is most likely to cause pneumonia?
A361. Influenza
Q362. What is the criteria for a fluid to be considered an exudate?
A362. Pleural fluid : serum protein > .5; Pleural fluid : serum LDH >.6
Q363. What does retrosternal airspace suggest in CXR?
A363. COPD
Q364. What drug is the first line agent to treat COPD?
A364. Ipratropium bromide is preferred over corticosteroids, beta agonists, and theophylline because of a better side effect profile.
Q365. Most bronchiolitis cases are caused by ___?
A365. RSV
Q366. What viral infection can lead to asthma later in life if a child is infected multiple times?
A366. RSV
Q367. What 2 bugs are responsible for the majority of respiratory infections from birth to 3 months?
A367. Chlamydia trachomatis and GBS
Q368. What 2 bugs are suspected in lobar pneumonia in a 4 year old? Which one causes a monoarticular arthritis?
A368. H flu and S. pneumo. H flu causes the arthritis. (treat with ceftriaxone)
Q369. What is the best empiric treatment of URI in a 3 month - 5 year old
A369. Erythromycin because of its effectiveness against S. pneumo, Chlamydia pneumoniae, and Mycoplasma
Q370. What causes croup, what is the peak age range, and what is the hospitalization rate for kids?
A370. Parainfluenza; 3 months - 6 years; <10% hospitalization rates
Q371. Muffled speech, drooling, stridor, and agitation with the child's head held in a sniffing position.
A371. Epiglottitis
Q372. Epiglottitis:; Diagnostic Xray sign?; Treatment?
A372. Thumb sign on lateral neck CXR; Treat with ceftriaxone or ampicillin
Q373. What are the indications for adding a daily anti-inflammatory to an asthmatic
A373. Use of beta agonist >3x/week; 20% variance in twice daily peak flows; < 80% of predicted peak flow; < 80% of patient's peak flow history
Q374. Differentiate the etiologies of the following causes of dysphagia:; difficulty swallowing solids and liquids; rapidly progressing dysphagia with weight loss; slowly progressing dysphagia over months to years; Intermittent acute sx or spasmodic obstruction; odynophagia of recent onset
A374. -esophageal motor disorder; esophageal cancer; benign stricture; esophageal ring; ulcerative esophagitis
Q375. What is the best treatment for GERD?
A375. PPI's (esp. omeprazole) are the most potent and reliably successful therapy in treating GERD
Q376. What are some risk factors for esophageal carcinoma?; (race, sex, other Ca, health conditions, social history)
A376. Nasopharyngeal Ca; Long standing achalasia; Tylosis (hyperkeratosis); Male; Alcohol use; Blacks
Q377. What percent of chest pain is caused by GI?
A377. 40%
Q378. What NSAID has the most ulcerogenic properties?
A378. ASA
Q379. What is the average 5 year recurrence rate of Crohn's after surgical treatment?
A379. 75%
Q380. What percent of patients with diverticulosis will develop diverticulitis?
A380. 20%
Q381. What are three diseases known to be associated with UC?
A381. Pyoderma gangrenosum,; Cholangitis,; arthropathies
Q382. What bug is responsible:; 1. incubation 6-48 hours, 33% of all bacterially caused food poisoning; 2. incubation 3-6 hours, vomiting/diarrhea, sx last 24-48 hours. ham, pork, canned beef, cream filled pastry; 3. incubation 8-24 hours, lasts < 24 hours. beef, turkey, chicken; 4. watery diarrhea, seafood; 5. Incubation 9-18 hours, Diarrhea or Vomiting, lasts 3 days
A382. 1. Salmonella; 2. Staph aureus; 3. C. pergringens; 4. Vibrio parahaemolyticus; 5. B. cereus
Q383. does the obturator sign suggest appendicitis or hernia
A383. appendicitis
Q384. What is the most common cause of bowel obstruction in the first two years of life and what are some presenting signs (5)?
A384. Intussusception which presents as colicky abd pain, currant jelly stools, reflex vomiting, leukocytosis, and a palpable mass
Q385. What does a first degree relative of CCA or adenomatous polyp do to your chance of getting colon cancer
A385. It raises it from 2.5% to 7-7.5%
Q386. An elevated GGT in the presence of normal AlkPhos is _____ until proven otherwise
A386. Alcohol
Q387. What is the most specific diagnostic criterion for PBC?
A387. AMA
Q388. _____ is associated with 60% of patients who have PSC
A388. IBD
Q389. recent history of jaundice and fever, no h/o alcohol use, homosexuality, or IVDA. Negative GB ultrasound, negative hepatitis screen,; elevated ALT, AST, Alk Phos, and Tbili and conjugated bili; AMA; Resolution with ABX; How is the dx confirmed?
A389. Primary Sclerosing Cholangitis - confirmed by ERCP
Q390. What are the three diseases included under Autoimmune liver disease?
A390. Autoimmune hepatitis - involves the parenchyma rather than the collecting system. 75% of cases. Treatment with steroids is effective; PSC, PBC are the other two
Q391. Ascites with a serum albumin:peritoneal fluid albumin ratio of 1:1 suggests what etiology?
A391. Cirrhosis
Q392. What should you suspect in a cirrhotic patient with fever and abdominal pain? What two tests should be ordered?
A392. Spontaneous Bacterial Peritonitis. Order a diagnostic peritoneal tap and CBC
Q393. Which hepatitis is most dangerous in pregnancy?
A393. Hep E
Q394. How do you treat acute bacterial prostatitis
A394. 2 week course of Fluroquinolones
Q395. What bacteria produces struvite stones?
A395. The urea splitting organisms which is usually proteus, but can also be ureaplasma
Q396. How does a patient with hemorrhagic cystitis present?
A396. Dysuria, frequency, urgency prior to or with the hematuria
Q397. When is the only time when males are more likely to get UTIs than females?
A397. during the first year of life, uncircumsized males are more likely to get UTIs
Q398. What study would be most likely to demonstrate VUR in a child?
A398. Radionuclide cystogram
Q399. What is the most common urinart tract abnormality in kids?
A399. VUR
Q400. How is a 3 year old with newly diagnosed VUR treated?
A400. With prophylactic ABX because most cases will resolve within a year
Q401. What is the most common presenting sign of pyelo?
A401. Fever
Q402. What type of amenorrhea will respond to a methylprogesterone challenge?
A402. Anovulatory cycle - this condition involves appropriate estrogen priming of the endometrium, but no egg release and thus no progesterone phase and no menstruation
Q403. Define Asherman's syndrome
A403. an obstruction to uterine outflow usually due to fibrous tissue development in response to infectionn, endometrial instrumentation, or therapeutic abotion
Q404. What is the underlying problem when a patient fails to respond to a progesin challenge, but does respond to a reproduction of the estrogen/progestin cycle.
A404. This would rule out uterine obstruction and would likely be an absence of estrogen stimulation of the uterus
Q405. Will PCOS patients bleed in response to progesterone withdrawal? What are PCOS patients at risk for?
A405. PCOS patients have amenorrhea secondary to anovulatory cycles, so they will respond to progesterone withdrawl. Their unopposed estrogen stimulation poses a risk for endometrial hyperplasia
Q406. What are women with hypothalamic amenorrhea at increased risk for?
A406. Osteoporosis
Q407. What level of FSH confirms the dx of ovarian failure (usually due to menopause)? What step is taken at this point?
A407. >20 IU, begin HRT
Q408. What is the change found most often after surgical rather than natural menopause?
A408. Loss of libido is more in a surgical hysterectomy
Q409. What is the most significant predicted benefit of HRT?
A409. 50% reduction in CAD
Q410. When is ERT contraindicated?
A410. When the uterus is present
Q411. What should be done if a patient is still experiencing uterine bleeding after 6 months of HRT?
A411. Endometrial Bx since postmenapausal bleeding is the hallmark for endometrial carcinoma
Q412. What percent of patients with unilateral bloody nipple discharge will end up having cancer?
A412. 33%
Q413. What age range does the largest percentage of breast cancer occur?; List the percentages that occur in each age group.
A413. >65 years old (>50%); 50-65 (25%); <50 (25%)
Q414. What is the most common cause of complaint of breast pain?
A414. Costochondritis
Q415. What is the size limit for lumpectomy + radiation?
A415. 5 cm
Q416. Orchitis due to mumps spreads to the testes by what route?
A416. Hematogenous spread is the usual route by which viruses spread to produce orchitis
Q417. What testicular abnormality is often associated with infertility?
A417. Varicocele - a varicosity of veins in the pampiniform plexus
Q418. What condition is a contraindication to the use of a vacuum device to achieve an erection?
A418. Sickle Cell
Q419. What is an important side effect of papavrine?
A419. Priapism
Q420. What are the top two cancer deaths in men?
A420. Lung and Prostate
Q421. When should annual PSA/DRE begin in asymptomatic AA men?
A421. 40
Q422. What type of cancer is most common associated with cryptochordism? Does surgically descending the testical decrease cancer risk?
A422. Seminoma - descending does not reduce risk of cancer, but it allows for earlier detection
Q423. What test is the best to confirm testicular torsion?
A423. Testicular scintillation scan
Q424. What are two sexual changes that are not considered normal in elderly men
A424. Testicular atrophy and decrease in libido
Q425. What cervical nerve roots are most affected by cervical disc herniation and spondylosis?
A425. C6, C7
Q426. What physical exam finding would lead most strongly to the diagnosis of cervical radiculopathy?
A426. Atrophy of hand/arm muscles
Q427. What is the preferred imaging modality to evaluate cervical radiculopathy?
A427. C-spine xrays (not MRI)
Q428. Pain experienced upon active abduction at the shoulder is indicative of what?
A428. Rotator cuff tendonitis
Q429. What fracture is seen in anterior dislocations of the humerus?
A429. posterolateral humeral head fracture
Q430. A positive Finklestein's test is indicitive of what?
A430. De Queverian's tenosynovitis
Q431. What is the general rule to determine if a humerus fracture requires ORIF?
A431. >45 degrees of displacement or a fracture through pathologic bone
Q432. A football player who develops hip pain after being tackled and has pain with rotation and lateral bending of the trunk would most likely have an injury to what part of the hip?
A432. Iliac Crest (hip pointer)
Q433. Differentiate between Osgood Schlatter and Patellofemoral Instability
A433. Osgood Schlatter - pain at the tibial tubercle; Patellofemoral - Pain in activities where the knee is flexed. No jointline or patella tenderness
Q434. What additional injury is likely to be found with an acl tear?
A434. MCL tear
Q435. How does tibial stress syndrome usually present? What is a risk factor?
A435. Posteromedial tibial pain lasting 1-2 hours after resuming a running program. A risk factor is a flat foot. If the pain does not improve after 1-2 hours, evaluation for a stress fracture is required
Q436. The most commonly sprained ligament in the ankle
A436. Anterior talofibular ligament
Q437. How does treatment of a sprain with an avulsion fracture differ from treatment of a sprain
A437. They are treated the same
Q438. What movement is painful in a patient with a fracture of the posterior process of the talus?
A438. Plantar flexion
Q439. What location (1st - 5th) of a metatarsal stress fracture requires more aggressive management?
A439. The 5th metatarsal, it is more likely to become a complete fracture with non union
Q440. What are the top 3 most common underlying factors in recurrent otitis media?
A440. Atopic Constitution; Adenoid hypertrophy; Congenital palatal deformity
Q441. How does passive motion affect OA?
A441. It exacerbates it.
Q442. What are some signs of ehlers Danlos syndrome?
A442. Hyperextensibility of joints, soft stretchy skin, open gaping wounds, easy bruisability. Patients can also develop arthralgias from overuse aggrivated by loose joint capsules.
Q443. RA postinactivity swelling lasts a minimum of ____ minutes
A443. 30
Q444. How long does RA remain monoarticular?
A444. up to 5 years
Q445. What is the first line agent for OA?
A445. Acetaminophen
Q446. What are 3 typical xray findings in OA?
A446. Joint space narrowing; Bone Spurs; Subchondral new bone formation
Q447. Subperiosteal bone resorption is indicative of what? Where is this best visualized?
A447. HyperPTH - best seen in radiographs of the fingers where, on the radial side of the phalanyx, the cortex has undergone resorption
Q448. Calcification of hyaline and fibrous cartilage is indicative of what?
A448. Pseudogout
Q449. What 3 things can precipitate Gout (2 drugs, 1 IV agent)
A449. Aspirin,; Thiazides,; IV dye
Q450. Between Gout and Psuedogout, which is limited to the weight bearing joints? Which is more likely to be polyarticular?
A450. Gout is limited to weight bearing joints; Pseudogout can be polyarticular
Q451. Why is aspirin not a good choice for patients with an acute gout attack?
A451. ASA in low doses decreases renal uric acid excretion. All other NSAIDs are excellent first line agents
Q452. Why is Colchicine not a good choice for Acute gout attack?
A452. because it may cause diarrhea, nausea, and emesis before an effective dose can be achieved
Q453. Developmental dysplasia of the hip has a family history in ___% of cases. What screening tool should be used in these kids?
A453. 20% have a fhistory, use ultrasonographic screening
Q454. What is the age cutoff of nonsurgical treatment of developmental dislocation of the hip?
A454. 6 months
Q455. With respect to delayed development of the hip, what percentage of the time is:; Left hip alone affected?; Both hips affected?; Right hip alone affected?; Is it more common in females or males?
A455. Left hip - 60%; Both hips - 20%; Right hip 20%; Females are more common
Q456. Legg-Calves-Perthes disease is characterized by what?
A456. Avascular necrosis of the femoral head
Q457. What is the most significant risk factor in postchlamydial infectious arthriris?
A457. H/O multiple sex partners
Q458. What injury would you suspect from a patient who is repeatedly kneeling throughout the day?
A458. Prepatellar bursitis
Q459. At what age range could you expect Osgood Schlatter disease to remit?
A459. When the tubercle fuses between 9 and 15 years old
Q460. In patients with hip pain, what tests are necessary to rule out Legg-Calves-Perthes disease or a slipped femoral capital epiphysis?
A460. serial X-rays
Q461. What patter of ANA is most specific for SLE?
A461. Rim or peripheral pattern
Q462. What Ab is most commonly associated with neonatal lupus?
A462. Anti SS-A (anti ro)
Q463. What antibodies correlate most specifically with Limited Systemic Sclerosis?
A463. Anticentromere
Q464. What cancers are most commonly associated with dermatomyositis?
A464. Lung (most common), Stomach, Breast, ovary
Q465. Decribe the classic presentation of dermatomyositis.
A465. Proximal muscle weakness, violaceous plaques on the dorsal aspect of interphalangeal joints, edema and violaceous coloring of upper eyelids.
Q466. What are some blood tests that are elevated in polymyositis, how is a definitive dx established?
A466. Elevated LDH, CPK, SGOT. An open muscle bx is req'd for dx.
Q467. What antibody tests are most specific for Sjrogrens syndrome?
A467. Anti SS-A and SS-B (ro and la)
Q468. What are two findings (one clinical and one serologic) needed to dx mixed CTD?
A468. Clinical evidence of more than 2 CTDs and elevation of anti- RNP
Q469. How is Henoch-Schonlein purpura started?
A469. Viral respiratory infection
Q470. Claudication, Angina, cold extremities in a young adult woman
A470. Takayasu's arteritis
Q471. PMR:; How long does it last?; How is it treated?; What age range?
A471. Lasts 6-9 months and is treated by moderate amounts of glucocorticoids; Over 50 years old
Q472. What percent of Behcet's patients have ocular manifestations?
A472. 90%
Q473. Wegners:; What gender is it most common?; What age range?; Triad of sx?
A473. Males; Middle age; Triad includes clinical disease in:; upper resp (nose bleeds, sinusitis); lower resp (hemoptysis); kidney
Q474. Define Grade I, II, and III concussions and when the patient can return to activity
A474. Grade I - Confusion, no amnesia. Return to normal activity in 20 min if sx are absent; Grade II - Confusion with Amnesia. Return to play in 1 week if sx absent; Grade III - LOC. Take to hospital, may return to conditioning after 1 asymptomatic week, return to play 1 month after 2 asymptomatic weeks
Q475. what is the official definition of AIDS?
A475. CD4>200
Q476. When are HIV patients more likely to get thrush?
A476. 200-500, also more likely to get diarrhea and weight loss
Q477. When are HIV patients more likely to get sebhorrea and folliculitis?
A477. 500-1000
Q478. What is the only fluid excreted by the body that contains a significant amount of HIV virus?
A478. Vaginal secretions
Q479. What health maintenance is necessary in HIV pts with:; CD4 < 500?; CD4 < 200?; CD4 50-75?
A479. <500: Check CD4/Viral load every 3 months; <200: PCP prophylaxis; 50-75: Mycobacterium avium prophylaxis
Q480. What AIDS patient population is more likely to develop Kaposi's sarcoma? What is the effect of treatment?
A480. Homosexual men are most likely and treatment only helps cosmetically by diminishing the size of the lesions.
Q481. What HIV drug can cause pancreatitis?
A481. Didanosine
Q482. How does treatment of TB change with HIV infected patietns
A482. INH treatment time doubles from 6 months to 1 year
Q483. What are the likely organisms responsible for the following symptoms in an HIV patient:; 1) 2 day h/o Occipital HA, fever, malaise in pt. with AIDS; 2) Space occupying lesion with focal neuro defecits; 3) retinitis, visual disturbance; 4) TB like pulmonary sx
A483. 1) Cryptococcus; 2) Toxo; 3) CMV; 4) Mycobacterium
Q484. What 3 opportunistic infections are seen in CD4<200?
A484. PCP, Kaposi, CMV retinitis
Q485. What test allows legoinnaire's disease to be distinguished from other pneumonitidies?
A485. elevated CK
Q486. What is the indicated treatment for Legionnaire's disease?
A486. Erythromycin with Rifampin. Other macrolides or sulfamethoxazole can also be used.
Q487. What is the minimum exposure time to a tick in order to be exposed to lyme disease?
A487. 24 hours
Q488. Describe stage 1, 2 and 3 of lyme disease. When does each stage begin?
A488. Stage 1 - erythema chronicum migrans (lasts 7 days); Stage 2 - dermal, CNS, MS systemic symptoms, begins 30 days after exposure; Stage 3 - First degree AV block among some stage 2 symptoms
Q489. What is the largest risk factor for TB?
A489. IVDA
Q490. What are the incubation periods of the following:; RMSF?; Lyme disease?
A490. RMSF - 4 days; Lyme - 7 days
Q491. What is the estimated prevalence (in millions) of DM in the US? What percent is undiagnosed?
A491. 10-20 million, 50% are undiagnosed
Q492. What HLA types are associated with DM I?
A492. DR3, DR4
Q493. How many calories per gram are carbohydrates, protein, and fat? What percent of each is recommended in a diet?
A493. 55% Carbs: 4 cal/gram; 15% Protein: 4 cal/gram; <33% Fat: 8 cal/gram
Q494. How many units per kg are usually req'd in a diabetic?
A494. .5-1 U/kg
Q495. What is the recommended protein intake for diabetics to prevent renal failure? (in g/kg/day)
A495. .75 g/kg/day
Q496. What is the most sensitive diagnostic indicator of diabetic peripheral neuropathy? (found on PE)
A496. Loss of ankle jerk
Q497. What type of DM is Gestational diabetes most similar to? What causes it? When is an appropriate time to test women for it?
A497. most like type II, placental lactogen causes it and is at its highest during the beginning of the 3rd trimester of pregnancy, so testing should be done between 24-28 weeks.
Q498. What is the treatment for gestational diabetes?
A498. Insulin therapy
Q499. What is the general rule for approximating Creatinine clearance in people? (without using a formula)
A499. For young adults, the CrCl is usually around 100, and subtract 1 ml/hr for every year over 20.
Q500. What clinical scenario is direct measurement of free T3 (as opposed to calculation) most appropriate?
A500. T3 toxicosis - because T4 is normal in this situation
Q501. What is the cause of the widened palpebral fissures in thyrotoxicosis?
A501. elevated catecholamine state
Q502. How can you differentiate endogenous thryotoxicosis from exogenous thyrotoxicosis?; Name 1 way on PE and one lab value
A502. Endogenous thyrotoxicosis will have a palpable thyroid and will have a decreased I123 uptake.
Q503. What drug is best suited to give rapid relief of thryotoxicosis?
A503. Non selective beta blocker
Q504. What is the first lab abnormality to appear in hypothyroidism
A504. increasing TSH
Q505. What is the most common type of hypothyroidism in the US?
A505. Post ablative hypothyroidism due to surgery or radioiodine therapy
Q506. How long does treatment of hypothyroidism with levothyroxine take to achieve full effect?
A506. 1 month
Q507. What type of thyroid cancer results from childhood irradiation to the neck?
A507. Papillary
Q508. How much stronger is Dexamethasone than Prednisone?
A508. 10x
Q509. How will Primary vs Secondary adrenal insufficiency differ in response to ACTH?
A509. Primary - No change, since defect is in the adrenals; Secondary - Adrenals will be stimulated since defect is lack of ACTH secretion
Q510. What is a positive dexamethosone suppression test?
A510. >50% suppression of 17-hydroxycorticosteroid in the overnight suppression test
Q511. What is suspected when there is no response to low dose dexa suppression test but a response to high dose
A511. Cushing's disease - Pituitary tumor secreting ACTH
Q512. What effect does primary aldosteronism have on renin?
A512. low renin due to the effect of hypervolemia and sodium retention
Q513. What is the best way to test for pheo?
A513. 24 hour urine catecholamine and metanephrine levels. VMA is not nearly as sensitive
Q514. What is the most common type of CAH?
A514. 21 alpha hydroxylase deficiency
Q515. After infancy, children grow about ___ inches per year.
A515. 2" per year, but it occurs in spurts
Q516. What would elevated FSH indicate in the setting of delayed or failed puberty?
A516. a primary failure or primary gonadal failure as the cause.
Q517. What age ranges does puberty occur in boys and girls?
A517. Girls: 8-13; Boys: 8-14
Q518. What are the Tanner stages for Boys?
A518. I: no pubic hair, preadolescent genitalia; II: scant, slightly pigmented pubic hair, scrotum enlarged; III: small amt. of darker, coarser, curling pubic hair, longer penis, larger testes; IV: adult type pubic hair but less quantity, glans widened, testes approaching adult size, scrotum pigmented; V: pubic hair spread to thighs, adult genitalia
Q519. What are the tanner stages for girls?
A519. I: no pubic hair, preadolescent breasts (elevation of papilla only); II: Sparse, long straight, slightly pigmented hair on labia, visible or palpable breast buds, increased areolar diameter. III: small amt of darker, coarser, curlier hair spreading over mons pubis,enlargement of breast and areola with no separation of coutours; IV: Adult type, coarse, curly, pubic hair covering less area than adult, breast and papilla no separated by coutour; V: pubic hair forming inverted triangle, adult contoured breast with projection of the papilla only, areola more pigmented
Q520. What is the definition of delayed puberty?
A520. The continued absence of secondary sex characteristics by age 14 for boys and 12 for girls. Treatment is necessary to develop secondary sex characteristics and prevent short stature
Q521. What hormone would you use to treat central precocious puberty in a male?
A521. GnRH
Q522. At what age does Atopic dermatitis appear on cheeks?
A522. Infants
Q523. At what age does Atopic Dermatitis usually remit?
A523. Usually by age 20
Q524. What drug is a good choice for long time (30 hours) control of asthma symptoms?
A524. Salmeterol (B2 agonist)
Q525. What is the peak age range for seasonal allergies?
A525. 15-25
Q526. What is the measure of ability to diagnose presence of disease
A526. Sensitivity
Q527. What is the measure of the ability to be truly negative in the absence of disease?
A527. specificity
Q528. What is the max diastolic BP in hypertensive patients going to surgery?
A528. 110mmHg
Q529. What is the minimum time after a heart attack that a patient must wait for elective surgery?
A529. 3 months
Q530. What values of the following labs indicate severe malnourishment?; Albumin?; Transferrin?; Pre Albumin?; Lymphocytes?
A530. Albumin < 2.0; Transferrin < 100; Pre Albumin < 7; Lymphocytes < 1000
Q531. What delay is required for elective surgery following stabilization of CHF?
A531. 1 week
Q532. What age should you begin to order:; BUN/Cr?; Lytes/CXR?; Urinalysis/Albumin?; EKG?
A532. BUN/CR - >50; Lytes/CXR - >60; Urinalysis/Alb - >65; EKG - Women >50 Men >35
Q533. What screen is used for appropriate lung function to go to surgery?
A533. FEV1 > 2L
Q534. What is the one class of hypertensive meds that hypertensive patients must stop prior to surgery?
A534. Diuretics - to prevent hypokalemia
Q535. How long should the following blood thinners be stopped prior to surgery, and when can the patient begin to take them again after surgery?; Aspirin; Ticlopidine; Warfarin
A535. Aspirin - Stop 1 week prior; Restart 48 hours post; Ticlopidine - Stop 2 weeks pre; Restart 48 hours post; Warfarin - Stop 3-5 days pre; Restart 3-5 days post
Q536. What is an ideal TC:HDL ratio for a man?
A536. 4.5:1
Q537. How many calories per day does a very low calorie diet contain and who should go on it?
A537. 800 kcal per day for 12-16 weeks. Pts who are >30% overweight
Q538. What are the two effects of a fibrate on cholesterol?
A538. Decrease TG; Raise HDL
Q539. What type of cancer is reduced the soonest after smoking cessation?
A539. Bladder
Q540. After beginning a moderate exercise program, how long will it take to see a decrease in the resting pulse? How about an increase in endurance?
A540. 4-6 weeks for both
Q541. How long following an MI should exercise rehab begin?
A541. 2-4 weeks
Q542. What does silver nitrate prevent upon delivery?
A542. neonatal gonorrhea (chlamydia must be treated with erythromycin PO)
Q543. What type of Abs are provided in breast milk?
A543. IgA
Q544. what is an expected volume of food to feed a newborn and how many times per day?
A544. 1/2-1oz every 2 1/2-4 hours totaling 7 times per day.
Q545. What should be started by age 2 months in an infant with sickle cell disease?
A545. PCN because by age 2, they are functionally asplenis and at great risk for encapsulated organisms.
Q546. Differentiate between pathologic and physiologic jaundice in newborns
A546. Physiologic - unconjugated, peaks on 3rd or 4th day and declines by 1 week. Pathologic - appears within first 24 hours (or upon birth), conjugated, will last 7-10 days
Q547. What 4 inborn errors of metabolism must be screened for at birth?
A547. PKU, Galactosemia, biotinidase deficiency, hypothyroid
Q548. What age is associated with the highest death rate from drowning?
A548. 1-3 years old
Q549. What is increased hand to mouth activity suggest in kids?
A549. Lead poisoning
Q550. what type of anemia is seen in lead tox?
A550. microcytic, hypochromic anemia with basophilic stippling with a normal TIBC (which is what differentiates it from iron deficiency)
Q551. What age is MMR first given?
A551. 15 months
Q552. What are the top two leading causes of death in children?
A552. 1) MVA; 2) Fires and Burns
Q553. When should the first dose and booster of DTaP be given
A553. 1st - before 6 months; 2nd - 4-6 years old
Q554. When should the first dose of MMR and the booster be given?
A554. 1st dose - 12-15 months; booster - 4-6 years old
Q555. what is the attempted suicide rate among male adolescents?
A555. 10-15%
Q556. Of teenagers who smoke two cigarettes completely, what percent will eventually become regular smokers?
A556. 85%
Q557. When should Pap smears begin?
A557. after age 18
Q558. What is the recommended level of calcium intake for adolescents? adults?
A558. adolescents - 1200-1500mg/day; adults - 1500mg/day
Q559. What is the leading cause of cancer deaths in the 25-44 year old age group?
A559. Breast cancer
Q560. What percentage of premature deaths result from "unhealthy habits"?
A560. 50%
Q561. How often should a monogamous middle aged woman with 3 previous consecutive negative pap smears be getting a pap?
A561. every 3 years
Q562. How often should women in the 40-49 year age group get a screening mammography?
A562. every year
Q563. How does a family history of CCA change the screening guidelines?
A563. Changes the beginning of colonoscopy, FOBT, DRE from age 50 to age 40
Q564. When should DRE be initiated?
A564. age 40
Q565. What percent of 65 year olds have chronic dementia? 80 year olds?
A565. 65 years old - 5%; 80 years old - 20%
Q566. List some examples of basic ADLs
A566. eating, voiding, dressing, bathing
Q567. List some examples of instrumental ADLs
A567. shopping, telephone, preparing meals, housekeeping, doing laundry
Q568. What is the most serious common medical condition encountered in travel?
A568. Viral Hepatitis
Q569. What is the best choice of antibiotic for malaria prophylaxis in an area where there is chloroquine resistance?
A569. Mefloquine
Q570. What vaccination is recommended before travel to all developing countries?
A570. Influenza
Q571. When is the best time for a pregnant woman to travel?
A571. Second Trimester
Q572. What is the altitude where mountain sickness occurs in 25% of people? 50% of people
A572. 6500 feet and 10000 feet
Q573. What are the rules with Post MI and travel
A573. Not within 4 weeks of MI
Q574. For the following drugs, state how they work to prevent HACE/HAPE:; Dexamethosone; Acetazolamide; Nifedipine; Prochlorperazine
A574. Dexa - reduces cerebral edema; Acetazolamide - Increases ventilation thought induction of metabolic acidosis; Nifedipine - reduces pulmonary arterial pressure; Prochlorperazine - increases ventilatory drive
Q575. In an alcoholic with depression, which condition should be treated first?
A575. Alcoholism, then depression if it still exists 1 month after abstinence
Q576. What age range is depression the most common?
A576. 25-34
Q577. what percent of new mothers does post partum depression effect?
A577. 10%
Q578. What antidepressant would you give to someone who is also complaining of trouble sleeping?
A578. Amitriptyline
Q579. What are 4 common side effects of SSRIs?
A579. N/D, tremor, agitation
Q580. What antidepressant may cause dry mouth and sleepiness? how about nervousness and insomnia?
A580. Paroxetine; Fluoxetine
Q581. TCAs block the reuptake of what two neurotransmitters?
A581. Serotonin and Epinephrine
Q582. What is the most common method of suicide in teenagers?
A582. TCAs
Q583. What is the best choice to treat mixed anxiety and depression?
A583. TCAs
Q584. Which Benzo has the shortest half life?
A584. Alprazolam
Q585. What is the first line drug in panic attacks? What about if panic attacks are disabling?
A585. SSRIs are first line but use benzos if the attacks are disabling
Q586. What is first line for OCD?
A586. SSRIs
Q587. What drugs are first line for Generalized Anxiety Disorder?
A587. Azopirones (Buspirone)
Q588. What are the 3 criteria for somatization disorder?
A588. 1) multiple systems involved; 2) onset early in life; 3) abscence of abnormalities in tests
Q589. Describe a hypochondriac
A589. These patients fixate on a single disease and one persistent symptom at a time.
Q590. Which system does conversion disorder typically involve?
A590. Nervous System (sensory/motor)
Q591. Distinguish between Factitious disorder and Malingering
A591. Malingering - secondary gain (narcotics); Factitious disorder - patient has a less rational goal, patients often undergo many painful procedeures and only recieves the gain of "attention getting"
Q592. Describe somatic depressive equivalent
A592. Patients who have potentially serious symptoms (CP) and appear to be indifferent to the potentially serious symptoms.
Q593. Distinguish between hypochondriasis and somatic anxiety equivalent
A593. Hypochondriasis patients tend to focus on symptoms and are difficult to dissuade from their feared dx. The somatic anxiety patients focus on the disease, but are easily reassured with explanation
Q594. What disorder is implicated in a patient with symptoms that might have some serious implications, but the patient's body and facial language indicates a lack of concern
A594. Conversion disorder
Q595. sx of otitis externa; most common orgs
A595. pain on palpation of tragus or traction of the pinna; itchiness, prurulent d/c; pseudomonas, staph
Q596. tx of otitis externa
A596. acidic drops (less favorable environment for pseudo to thrive); ABx + steroids
Q597. tx for complete occlusion by cerumen
A597. H2O2; cerumenolytics; water irrigation (done after cerumenolytics); NEVER use curette to remove unless occlusion is incomplete
Q598. risk of topical nasal decongestant use
A598. rebound swelling after vasoconstrictuion wears off
Q599. what does weber test mean if it lateralizes to unaffected side?; if it lateralizes to affected side?
A599. sensorineural loss; conduction
Q600. tx of recurrent otitis media infection
A600. if <4 yo tympanostomy tubes; if >4 yo, adenoidectomy
Q601. when can kids return to school after starting ABx for strep throat
A601. after 24 hrs of tx
Q602. where is coccidiomycosis found
A602. 4 Corners
Q603. resp complication of chickenpox; tx?
A603. pneumonia, esp in pregnancy; IV acyclovir
Q604. pts who are susceptable to pseudomonas pneumonia
A604. pts with bronchiectasis; on steroids; pts recently taken broad spectrum ABx
Q605. pts susceptable to aspergillus pneumo
A605. those with prolonged neutropenia, immunosuppressed
Q606. most common causes for CAP
A606. S. pneumo; H, flu; M. pneumo
Q607. risk factors for legionella pneumo
A607. smokers; renal failure; CA; DM; COPD; immunosuppression
Q608. micro classification of legionella
A608. GNR
Q609. when does breast milk jaundice occur?; what is it and what is elevated?
A609. btwn 4-14 days; etiology is unknown, but something in breast milk inhibits bilirubin metabolism; unconjugated bili is elevated
Q610. what is breast feeding jaundice?; when does it occur
A610. jaundice caused by decreased volume of feeding; occurs on day 3 of life
Q611. tx fo breast milk jaundice
A611. continue breast feeding as long as possiblead increase frequency of feeds, this helps with conjugating the bili; phototherapy can be added; stopping breast feeding is a last resort
Q612. in what time frame would you expect to see pathologic jaundice
A612. within 24 hrs post-partum
Q613. tx for ABO incompatibility jaundice
A613. phototx then exchagne transfusion if absolutely necessary
Q614. progression of kernicterus
A614. increased bili is toxic to basal ganglia cells and brainstem nuclei --> hypotonicity and lethary, then CP, MR, and hypertonicity
Q615. who's got what blood type in ABO incompatibility of the infant and newborn
A615. mom has O and fetus has A, B, or AB
Q616. how frequently does jaundice of newborn develop
A616. 60%
Q617. when is phototherapy contraindicated in jaundice of the newborn
A617. when there is increased conjugated bilirubin; it can lead to bronze baby syndrome (permanent discoloration)
Q618. criteria for infantile colic
A618. unexplained fussiness x 3h/d, 3d/w, for longer than 3 wks, in an infant younger than 3 mo
Q619. physical findings in a colicky infant
A619. tense abdomen, clenched fists, flexed legs into abdomen, and flushing
Q620. which medication --> Reye's syndrome
A620. ASA
Q621. minimum weight gain during neonatal period
A621. >20 g/day
Q622. biological agents found in colostrum
A622. macrophages, complemetn, lysozymes, lactoferrin, AB vs bact/viruses
Q623. which class of AB is present in breast milk
A623. IgA
Q624. treatment of mastitis; which bacteria is usually implicated
A624. warm compresses and ABx (methicillin or cloxacillin); S. aureus; no need to stop breast feeding
Q625. what vitamin is human milk deficient in
A625. d
Q626. when is solid food added to diet
A626. 6 mo
Q627. major complications of formula feeding
A627. constipation; overfeeding
Q628. how to deal with constipation associated with formula feeds
A628. add increased fluid or corn syrup; if giving soy formula, switch to cow's
Q629. what is implicated in spitting up; how to reduce sx
A629. incompetent GE sphincter; sit infant up and increase burping frequency
Q630. noonan's syndrome
A630. a rare genetic disease, similar to turner's syndrome, with webbed neck and short stature, but no facial abnormalities
Q631. what are the recommendations for CIN II/III tx
A631. pap smear w or without colposcopy q6 mo until 3 negative results are obtained, then resume normal screening recommended by age.
Q632. how often should pap smears be performed in women <65 yo
A632. annually until there are 3 consecutive - smears in the setting of 1 monogamous partner
Q633. what immunizations should pts with cirrhosis receive?
A633. HAV, HBV, pneumococcal, flu
Q634. meaning of dexa scans
A634. if t score <-1.5 + risk factor or <-2.0 with no risk factors should receive preventive meds (bisphosphonates or SERMS)
Q635. which cholesterol meds will raise HDL?
A635. fibrates and niacin
Q636. screening protocol for AAA
A636. in 65-70 yo men who smoke or have h/o smoking should receive a 1-time abdominal US; if aorta >5.5 cm, then repair
Q637. who receives pneumococcal vaccine
A637. adults >65 yo or adults with chronic cv, lung, liver, kiney, metabolic disease or immunosuppression
Q638. screening procedure for ovarian ca
A638. women with isolated family h/o ovarian ca should get transvaginal u/s and CA 125 screening. If strong family history, check brca 1/2 twice a year and CA 125 and transvaginal u/s
Q639. who should receive routine chlamydia screening
A639. all women <24 yo, if sexually active
Q640. contraindication for varicella vaccine
A640. immunosuppression... it's a live attenuated vaccine
Q641. recommended screening for bladder ca
A641. there is none, no good tests exist
Q642. what is the mortality rate for HAV
A642. 3%
Q643. what is the #1 cause of conjunctivitis in children
A643. adenovirus
Q644. organism that causes the croup
A644. parainfluenza
Q645. tx for cluster ha
A645. triptans, 100% O2 (don't use ergotamine... takes too long to work)
Q646. prevention of menstrual ha
A646. low dose estrogen supplements, NSAIDS, ergot, tripans (do not use sSris)
Q647. tx for analgesic rebound ha
A647. tcas
Q648. tx for absence seizure
A648. ethosuxamide; valproic acid; clonazepam
Q649. most common causes for new onset seizure in >40 yo
A649. tumors > stroke > trauma
Q650. most common causes for status epilepticus
A650. decreased compliance with meds, EtOH withdrawal, intracranial infection, neoplasm, metabolic d/o
Q651. risk factors for febrile seizures in children
A651. + family history, previous febrile convulsions
Q652. sequelae of febrile seizures
A652. 98% of kids with febrile seizure don't develop addl seizures in 5 yrs, but it can progress if there are developmental delays, CP, abnormal neuro development, + fam h/o epilepsy
Q653. tx of febrile seizures
A653. diazepam q8 h
Q654. definition of fuo
A654. fever >38 x 3 wks, without an underlying dx
Q655. orgs that most commonly --> bacteremia in kids
A655. s. pneumo > hib > n. meningitis
Q656. what ABx should be given if to prevent spread of meningitis
A656. none!
Q657. prodrome of acute meningitis in kids; what can indicate septicemia
A657. resp illness, st (precedes fever), ha, stiff neck, vomiting; rash
Q658. why should juices not be given for rehdration following diarrhea
A658. increased OSM from juices --> hypernatremia and exacerbated stool loss
Q659. #1 cause of bacterial gastroenteritis; presentation
A659. campylobacter; fever, malaise, n/v/d, ab pain, bloody bm
Q660. which ABx is most commonly associated with diarrhea
A660. ampicillin
Q661. which childhood illnesses might present first with diarrhea
A661. acute appendicitis; OM; UTI; PNA
Q662. describe clinical manifestations associated with slipped capital femoral epiphysis
A662. seen in overweight sedentary teenage boys, pain is in groin or medial side of knee; there is limited internal rotation of hip
Q663. tx of slipped capital femoral epiphysis
A663. it is an emergency and must be stabilized; AVN can result
Q664. what is a complication of capital femoral epiphysis
A664. AVN!!!!
Q665. clinical features of legg-calve-perthes
A665. idiopathic avn in kids; pain in hip/knee, limp with decreased ROM
Q666. tx for legg-calve-perthes
A666. braces or casting for 2 yr s; or surgery --> normal fracture in 4-6 mo
Q667. sequelae of legg-calve-perthes
A667. 50% need hip replacement after adulthood
Q668. osgood schlatter: clinical features
A668. tenderness over tibial tuberosity; traction apophysitis in tibial tuberosity
Q669. tx of osgood schlatter:
A669. NO steroids; tx w rest
Q670. sequelae of osgood-schlatter
A670. avulsion fracture if patellar tendon can pull off tibial tubercle
Q671. presentation of patellofemoral syndrome
A671. anterior knee pain, exp when walking up stairs, or running; crepitus and tender undersurface of medial patella
Q672. tx of patellofemoral syndrome
A672. vastus medialis exercises to help keep patellar tendon aligned
Q673. when should children have established bladder control
A673. 5 yo
Q674. tx of enuresis; pharm?
A674. behavior modifications; adh just treats sx, but doesn't tx underlying cause
Q675. presentation of whooping cough in adult
A675. can be a post-infection cough lasting 4-6 w post infection; post-tussive emesis is common
Q676. is methalcholine challenge test effective in exercise induced asthma
A676. no
Q677. clinical features of vocal cord dysfracturen
A677. presents as difficult to treat asthma with normal spirometry (doesn't respond to any of the asthma drug tx)
Q678. how does depression affect sleep
A678. causes you to go into early REM, makes you easy to awaken... therefore poor quality sleep
Q679. signs of interstitial lung disease
A679. crackles, clubbing and cxr changes
Q680. pathophys of rotator cuff impingement
A680. supraspinatus tendon impinges on undersurface of coracoacromial arch
Q681. tx of rotator cuff injury
A681. strengthening end ROM exercises, if not successful, steroid injections; if all else fails after 3-6 mo, arthroscopc subacromial decompression
Q682. tx of lateral epicondylitis
A682. rest, nsaids, possibly steroid injections; surgical debridement is a last resort
Q683. sx of dequervian's tenosynovitis
A683. stenosing tenosynovitis of 1st dorsal compartment of wrist; caused by repetitive grasping/use of thumb; tenderness to palpation of radial styloid
Q684. tx of de quervian's tenosynovitis
A684. thumb splint and immobilitization for 3 w
Q685. "grades" of sprains
A685. I: tear of a few ligament fibers. joint is tender and painful, no joint laxity; II: mod # of torn fibers; mod swelling/pain; little to no instability of joint; III: complete laxity of joint, no endpoint when joint is stressed. prominent swelling
Q686. what is the most common ligament injured in ankle sprains? how do they occur?
A686. talofibular joint; inversion type injuries occur most commonly; max tenderness occurs at lateral malleolus
Q687. tx of ankle sprain
A687. early wb --> hastened return of activity
Q688. effusion seen with ACL tear? why?
A688. ACL is very vascular --> effusion seen immediately
Q689. mechanism of whiplash
A689. lower c-spine extends; upper c-spine flexes
Q690. best tx of whiplash
A690. early exercise
Q691. definition of concussion
A691. clinical syndrome characterized by immediate and transient post-traumatic impairment of consciousness, vision changes, and equilib changes due to brainstem involvement
Q692. levels of concussions
A692. grade I: no LOC, amnesia <30 mins; grade II: LOC <5 min and/or amnesia >30 mins but <24 h; grade III: LOC > 5min, amnesia >24 h
Q693. second impact syndrome
A693. 2nd hit after not recovering from first concussion; autoregulation of brain is lost and there is reactive swelling and edema; >50% mortality; LIMIT ACTIVITIES OF ALL ATHLETES W SX AFTER HEAD INJURY!!!
Q694. who should be screened for osteoporosis?
A694. all women >65 yo; if risk factors, >60 women
Q695. how long do RA sx have to be present for dx
A695. 6 wks
Q696. who would get parvovirus? complication?
A696. adults working with kids; > arthritis
Q697. sx of dermatomyositis
A697. PMR + rash
Q698. is there weakness in fibromyalgia
A698. no, just muscle pain
Q699. sx of aortic stenosis
A699. angina, syncope, doe
Q700. what test should be avoided in as?; how is dx made?
A700. exercise tolerence tests; echo
Q701. pathophys of baker cyst; when are they seen?
A701. increased fluid production from synovium; fluid accumulates in popliteal bursa; seen in OA, RA, cartilage tears
Q702. another name for obesity hypoventilation syndrome; what is associated w it?
A702. pickwickian syndrome; obesity, thick neck, hypersomnolence, polycythemia (2/2 alveolar hypovent)
Q703. benefits of lidocaine; adverse effects of lidocaine
A703. decreased PVC frequency, decreased risk of v-fib,; asystole- therefore, only use if absolutely needed
Q704. steps to study the esophagus
A704. contrast study; esophagoscopy (to exclude mechanical causes of dysphagia); manometry to confirm dx
Q705. what is the only pharm intervention proven to prolong life in hypoxemic pts?; non-pharm?
A705. supplemental o2; quitting smoking, and lung volume reduction
Q706. which drugs prolong sx in copd
A706. BB,; ipratropium,; theophylline
Q707. what is the paO2 that supplemental O2 is helpful for?
A707. 55-60 in setting of cor pulmonale
Q708. what do early am ha signify in copd?
A708. nocturnal co2 retention (O2 won't help)
Q709. tx of HTN in pregnancy
A709. hydralazine; methyldopa
Q710. what happens to LDL levels following ischemic event
A710. LDL decreases 24-48 hrs following ischemic event and takes weeks to return to baseline; in pts with known ca, they should go on statins
Q711. what cholesterol meds are contraindicated in pts with high TGs
A711. bile acid sequesterants
Q712. which cholesterol med raises LDLl
A712. fibrates
Q713. which cholesterol drug worsens insulin r
A713. niacin
Q714. what heart sound is heard with WPW
A714. paradoxically split s2
Q715. which drugs slow conduction at the av node?
A715. atenolol; diliazem
Q716. what can result if BB and CCB are combined
A716. av block
Q717. which is worse: Mobitz I or Mobitz II? why?
A717. Mobitz II, usually associated with BBB
Q718. GI sx of DM; tx?
A718. post-prandial bloating, early satiety, constipation, diarrhea; metoclopramide
Q719. where are blebs normally found in lungs? what are they?; complication?
A719. apex (ruptured alveoli); apical fibrosis
Q720. indication for HIDA scan?
A720. dx acute cholecystitis
Q721. what is the risk of transmitting HBV from mother to fetus?; tx of fetus?
A721. if HBeAg +, then 90% risk of vertical transmission; HB Ig, follow with HB vaccine (Ig is insufficient alone)
Q722. sx of vitreous hemorrhage; cause?
A722. sudden loss of vision and onset of floaters, fundus is hard to visualize; usually DM
Q723. what effects does acute pancreatitis have on the lung?
A723. pleural effusion or ARDS (15%)
Q724. prophylaxis of breast ca
A724. 49% decrease in dx if tamoxifen is given
Q725. tx for claudication
A725. CCB
Q726. test for lactose intolerance
A726. lactose H-breath test, increase in H2 levels after lactose; + clinitest for reducing substrates; increased osmotic gap, acidic stool
Q727. what is transferring sat?
A727. Serum Fe/TIBC
Q728. relationship between athlete's foot and cellulitis?
A728. athlete's foot --> leg cellulitis (latter caused by staph or strep)
Q729. chalazion; complications?
A729. nodular rubbery lesion, granulomatous; from obstructed; tear gland; can turn into squamous cell carcinoma, must bx
Q730. saddle anesthesia
A730. cauda equina syndrome
Q731. tx for v-tach without cardiac compromise
A731. amiodarone
Q732. complications from hemochromatosis
A732. hypogonadism; arthropathy; pancreatic endocrine dysfracturen; dilated cmp; conduction abnormalities
Q733. how does pulmonary fibrosis affect; lung volume; dlco; FEV/FVC
A733. decrease; decrease; normal
Q734. S3; S4
A734. floppy ventricle, so systolic dysfunction; stiffened ventricle, so diastolic dysfunction
Q735. when should digoxin be used in CHF?
A735. in a-fib w rapid vent rate or with decreased ef
Q736. what is the first line HTN med for ppl without other complications
A736. thiazides
Q737. what HTN med should be used in pts with recurrent strokes
A737. ace i + thiazide combo
Q738. what HTN med should be used to decrease strokes in dm
A738. CCB
Q739. what HTN med should be used in the elderly
A739. diuretics
Q740. what is the most effective long-term med for chronic bronchitis
A740. ipratropium bromide (anti-cholinergic)
Q741. blue bloater; pink puffer
A741. bronchitis; emphysema
Q742. tx of prinzmetal's angina
A742. CCB and nitrates
Q743. tx for chlamydia
A743. azithromycin or doxycycline
Q744. tx for bacterial vaginosis
A744. metronidazole,; clindamycin
Q745. tx for pubic lice
A745. permethrin
Q746. tx for hsv
A746. -cyclovir
Q747. tx for yeast infection
A747. fluconazole/terconazole
Q748. tx for gc
A748. ceftriaxone or quinolones
Q749. tx for trichomonas
A749. metronidazole
Q750. tx for chancroid
A750. ceftriaxone,; azithromycin,; erythromycin
Q751. tx for syphilis
A751. penicillin G
Q752. tx of condyloma acumulatum
A752. podofilox,; imiquinod,; podophillin,; benzoin
Q753. when should a pt with gc/chlamydia be retested following tx
A753. never, unless there is reason to believe the tx didn't work
Q754. what, if given to a pt with mono --> rash
A754. PCN
Q755. describe streptococcal rash
A755. feels like sandpaper
Q756. when should tonsillectomy be considered
A756. if 3x documented strep throat within 3 mo
Q757. complications of strep throat
A757. post-strep GN; rheumatic heart disease; peritonsillar abscess
Q758. what bacteria can cause pharyngitis
A758. strep; diptheria; gonorrhea
Q759. most common pathogen for otitis externa
A759. staph
Q760. watchful waiting in AOM?
A760. if over the age of 6 mo, wait to see if it gets better in 2-3 days; otherwise, if 100% sure treat AOM
Q761. otitis media with effusion
A761. this is not AOM, this is just fluid behind tm
Q762. classic finding of als on muscle bx; clinical sx
A762. denervation and renervation; flaccid paralysis, foot drop, hand clumsiness, muscle wasting and fasciculations
Q763. pathology of guillan-barre
A763. ascending paralysis ==> demylenation of peripheral nerves
Q764. list the different types of incontinence
A764. stress incontinence; urge incontinence; overflow incontinence; functional incontinence; reflex incontinence
Q765. features of stress incontinence
A765. voiding of urine during laughing, sneezing, etc; caused by the urethra that gets pushed below the bladder so that when there is increased intraabdominal pressure, only the bladder gets squeezes, leading to leakage of urine
Q766. features of overflow incontinence
A766. incomplete voiding of bladder upon urination --> nocturia and frequent loss of small amounts of urine
Q767. features of urge incontinence
A767. involuntary detrusor contractions --> sudden urge to urinate, but can't make it to bathroom; loss of large volumes of urine
Q768. features of reflex incontinence
A768. usually associated w spinal cord injury... can't sense that you need to urinate
Q769. features of functional incontinence
A769. secondary to a disease
Q770. differential dx of lower back pain
A770. musculoligamentous back pain; herniated disc; degenerative disc disease; ankylosing spondylitis; spinal stenosis; malignancy; compression fracture; infection; cauda equina syndrome