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471 Cards in this Set
- Front
- Back
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Classic ECG finding in atrial flutter
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‘Sawtooth’ P waves
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Definition of unstable angina
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Angina is New, Worsening, or occurs at Rest
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Antihypertensive for a diabetic patient with proteinuria
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ACE inhibitor
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Beck’s triad for cardiac tamponade
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Hypotension, distant heart sounds, and JVD
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Drugs that slow AV node transmission
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B-blockers, Digoxin, CCB
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Hypercholesterolemia treatment that leads to flushing and pruritus
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Niacin
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Murmur – hypertrophic obstructive cardiomyopathy (HOCM)
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Systolic ejection murmur heard along the lateral sternal border that increase with Valsalva maneuver and standing
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Murmur – Aortic insufficiency
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Diastolic, decrescendo, high-pitched, blowing murmur that is best heard sitting up; increase with decrease preload (handgrip maneuver).
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Murmur – aortic stenosis
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Systolic crescendo/decrescendo murmur that radiates to the neck; increase with increase preload (Valsalva maneuver)
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Murmur – mitral regurgitation
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Holosystolic murmur that radiates to the axillae or carotids
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Murmur – mitral stenosis
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Diastolic, mid- to late, low-pitched murmur
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Treatment for atrial fibrillation and atrial flutter
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If unstable, cardiovert. If stable or chronic, rate control with calcium channel blockers or B-blockers
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Treatment for ventricular fibrillation
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Immediate cardioversion
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Autoimmune complication occurring 2-4 weeks post-MI
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Dressler’s syndrome: fever, pericarditis, increase ESR
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IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
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Treat existing heart failure and replace the tricuspid valve
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Diagnostic test for hypertrophic cardiomyopathy
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Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
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A fall in systolic BP of >10 mmHg with inspiration
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Pulsus paradoxus (seen in cardiac tamponade)
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Classic ECG findings in pericarditis
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Low-voltage, diffuse ST-segment elevation
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Definition of hypertension
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BP > 140/90 on three separate occasions two weeks apart
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Eight surgically correctable causes of hypertension
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Renal artery stenosis, coarctation of aorta, pheochromocytoma, Conn’s syndrome, Cushing’s syndrome, unilateral renal parenchymal disease, hyperthyroidsim, hyperparathyroidism
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Evaluation of a pulsatile abdominal mass and bruit
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Abdominal ultrasound and CT
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Indications for surgical repair of abdominal aortic aneurysms
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>5.5 cm, rapidly enlarging, symptomatic, or ruptured
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Treatment for acute coronary syndrome
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Morphine, O2, sublingual nitroglycerin, ASA, IV B-blockers, heparin
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What is metabolic syndrome?
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Abdominal obesity, high triglycerides, low HDL, hypertension, insulin resistance, prothrombotic or proinflammatory states
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Appropriate diagnostic test?
-A 50 yo man with angina can exercise to 85% of max predicted HR -A 65 yo woman with left bundle branch block and severe osteoarthritis has unstable angina |
-Exercise stress treadmill with ECG
-Pharmacologic stress test (eg, dobutamine echo) |
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Target LDL in a patient with diabetes
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<70
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Signs of active ischemia during stress testing
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Angina, ST-segment changes on ECG, or decrease BP
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ECG findings suggesting MI
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ST-segment elevation (depression means ischemia), flattened T waves, and Q waves
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Coronary territories in MI
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Anterior wall (LAD/diagonal), inferior (PDA), posterior (left circumflex/oblique, RCA/marginal), septum (LAD/diagonal)
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A young patient has angina at rest with ST-segment elevation. Cardiac enzymes are normal
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Prinzmetal’s angina
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Common symptoms associated with silent MI’s
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CHF, shock, and altered mental status
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The diagnostic test for pulmonary embolism
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V/Q scan
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An agent that reverses the effects of heparin
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Protamine
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The coagulation parameter affected by warfarin
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PT
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A young patient with a family history of sudden death collapses and dies while exercising
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Hypertrophic cardiomyopathy
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Endocarditis prophylaxis regimens
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Oral surgery – amoxicillin; GI or GU procedures – ampicillin and gentamicin before and amoxicillin after
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The 6 P’s of ischemia due to peripheral vascular disease
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Pain, pallor, pulselessness, paralysis, paresthesia, poikilothermia
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Virchow’s triad
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Stasis, hypercoagulability, endothelial damage
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The most common cause of hypertension in young women
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OCPs
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The most common cause of hypertension in young men
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Excessive EtOH
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‘Stuck-on’ appearance
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Seborrheic keatosis
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Red plaques with silvery-white scales and sharp margins
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Psoriasis
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The most common type of skin cancer; the lesion is a pearly-colored papule with a translucent surface and telangiectasias
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Basal cell carcinoma
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Honey-crusted lesions
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Impetigo
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A febrile patient with a history of diabetes presents with a red, swollen, painful lower extremity
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Cellulitis
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Positive Nikolsky’s sign
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Pemphigus vulgaris
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Negative Nikolsky’s sign
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Bullous pemphigoid
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A 55 yo obese patient presents with dirty, velvety patches on the back of the neck
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Acanthosis nigricans. Check fasting blood glucose to rule out diabetes
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Dermatolmal distribution
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Varicella zoster
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Flat-topped papules
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Lichen planus
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Iris-like target lesions
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Erythema multiforme
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A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry
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Contact dermatitis
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Presents with a herald patch, Christmas-tree patterns
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Pityriasis rosea
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A 16 yo presents with an annular patch of alopecia with broken-off, stubby hairs
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Alpecia areata (an autoimmune process)
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Pinkish, scaling, flat lesions on the chest and back; KOH prep has a ‘spaghetti-and-meatballs’ appearance
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Pityriasis versicolor
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Four characteristics of a nevus suggestive of melanoma
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Asymmetry, border irregularity, color variation, and large diameter
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A premalignant lesion from sun exposure that can lead to squamous cell carcinoma
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Actinic keratosis
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‘Dewdrops on a rose petal’
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Lesions of primary varicella
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‘Cradle cap’
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Seborrheic dermatitis. Treat with antifungals
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Associated with Propionibacterium acnes and changes in androgen levels
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Acne vulgaris
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A painful, recurrent vesicular eruption of mucocutaneous surfaces
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Herpes simplex
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Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women
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Lichen sclerosus
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Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer
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Squamous cell carcinoma
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The most common cause of hypothyroidism
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Hashimoto’s thyroiditis
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Lab findings in hashimoto’s thyroiditis
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High TSH, low T4, antimicrosomal antibodies
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Exophthalmos, pretibial myxedema, and decrease TSH
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Graves’ disease
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The most common cause of Cushing’s syndrome
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Iatrogenic corticosteroid administration. The second most common cause is Cushing’s disease
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A patient presents with signs of hypocalcemia, high phosphorus, and low PTH
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Hypoparathyroidism
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‘Stones, bones, groans, psychiatric overtones’
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Signs and symptoms of hypercalcemia
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A patient complains of headache, weakness, and polyuria; exam reveals hypertension and tetany. Labs reveal hypernatremia, hypokalemia, and metabolic alkalosis
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Primary hyperaldosteronism (due to Conn’s syndrome or bilateral adrenal hyperplasia)
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A patient presents with tachycardia, wild swings in BP, headache, diaphoresis, altered mental status, and a sense of panic
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Pheochromocytoma
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Should alpha- or beta-antagonist be used first in treating pheochromocytoma?
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Alph-antagonist (phentolamine and phenoxybenzamine)
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A patient with a history of lithium use presents with copious amounts of dilute urine
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Nephrogenic diabetes insipidus(DI)
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Treatmetn of central DI
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Administration fo DDAVP decrease serum osmolality and free water restriction
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A postoperative patient with significant pain presents with hyponatremia and normal volume status
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SIADH due to stress
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An antidiabetic agent associated with lactic acidosis
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Metformin
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A patient presents with weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
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Primary adrenal insufficiency (Addison’s disease). Treat with replacement glucocorticoids, mineralocorticoids, and IV fluids
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Goal HbA1c for a patient with DM
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< 7.0
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Treatment of DKA
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Fluids, insulin, and aggressive replacement of electrolytes (eg, K+)
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Why are B-blockers contraindicated in diabetics?
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They can mast symptoms of hypoglycemia
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Bias introduced into a study when a clinician is aware of the patient’s treatment type.
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Observational bias
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Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death
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Lead-time bias
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If you want to know if geographical location affects infant mortality rate but most variation in infant mortality is predicted by socioeconomic status, then socioeconomic status is a _______.
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Confounding variable
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The number of true positives divided by the number of patients with diasease is _.
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Sensitivity
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Sensitive tests have few false negatives and are used to rule ____ a disease
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Out
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PPD reactivity is used as a screenign test because most people with TB (except those who are anergic) will have a postive PPD. Highly sensitive or specific?
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Highly sensitive for TB
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Chronic diseases such as SLE-higher prevalence or incidence?
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Higher prevalence
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Epidemics susch as influenza – higher prevalence or incidence?
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Higher incidence
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Cross-sectional survey – incidence or prevalence?
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Prevalence
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Cohort study – incidence or prevalence?
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Incidence and prevalence
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Case-control study – incidence or prevalence?
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Neither
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Describe a test that consistently gives identical results, but the results are wrong
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High reliability, low validity
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Difference between a cohort and a case-control study
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Cohort studies can be used to calculate relative risk (RR), incidence, and/or odds ratio (OR). Case control studies can be used to calculate an OR.
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Attributable risk?
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The incidence rate (IR) of a disease in exposed – the IR of a disease in unexposed.
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Relative risk?
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The IR of a disease in a population exposed to a particular factor / by the IR of those not exposed
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Odds ratio?
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The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
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Number needed to treat?
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1 / (rate in untreated group – rate in treated group)
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In which patients do you initiate colorectal cancer screening early?
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Patients with IBD; those with familial adenomatous polyposis (FAP) / hereditary nonpolyposis colorectal cancer (HNPCC); and those who have first-degree relatives with adenomatous polyps (<60 years of age) or colorectal cancer.
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The most common cancer in men and the most common cause of death from cancer in men
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Prostate cancer is the most common cancer in men, but lung cancer causes more deaths
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The percentage of cases within one SD of the mean? Two SDs? Three SDs?
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68%, 95.4%, 99.7%
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Birth rate?
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Number of live births per 1000 population in one year
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Fertility rate?
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Number of live births per 1000 females (15-44 years of age) in one year
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Mortality rate?
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Number of deaths per 1000 population in one year
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Neonatal mortality rate?
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Number of deaths from birth to 28 days per 1000 live births in one year
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Postnatal mortality rate?
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Number of deaths from 28 days to one year per 1000 live births in one year
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Infant mortality rate?
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Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality) in one year
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Fetal mortality rate?
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Number of deaths from 20 weeks’ gestation to birth per 1000 total births in one year
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Perinatal mortality rate?
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Number of deaths from 20 weeks’ gestation to one month of life per 1000 total births in one year
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Maternal mortality rate?
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Number of deaths during pregnancy to 90 days postpartum per 100,000 live births in one year
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True or false: Once patients sign a statement giving consent, they must continue treatment
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False. Patients may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and patients without decision-making capacity
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A 15 yo pregnant girl requires hospitalization for preeclampsia. Is parental consent required?
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No. parental consent is not necessary for the medical treatment of pregnant minors
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A doctor refers a patient for an MRI at a facility he/she owns.
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Conflict of interest
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Involuntary psychiatric hospitalization can be undertaken for which three reasons?
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The patient is a danger to self, a danger to others, or gravely disabled (unable to provide for basic needs)
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True or false: Withdrawing a nonbeneficial treatment is ethically similar to withholding a nonindicated one.
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True
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When can a physician refuse to continue treating a patient on the grounds of futility?
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When there is no rationale for treatment, maximal intervention is failing, a given intervention has already failed, and treatment will not achieve the goals of care
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An eight yo child is in a serious accident. She requires emergent transfusion, but her parents are not present
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Treat immediately. Consent is implied in emergency situations
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Conditions in which confidentiality must be overridden.
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Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
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Involuntary commitment or isolation for medical treatment may be undertaken for what reason?
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When treatment noncompliance represents a serious danger to public health (eg active TB)
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A 10 yo child presents in status epilepticus, but her parents refuse treatment on religious grounds
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Treat because the disease represents an immediate threat to the child’s life. Then seek a court order
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A son asks that his mother not be told about her recently discovered cancer
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A physician can withhold information from the patient only in the rare case of therapeutic privilege or if the patient requests not to be told. A patient’s family cannot require the physician to withhold information from the patient.
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A patient presents with sudden onset of severe, diffuse abdominal pain. Exam reveals peritoneal signs, and AXR reveals free air under the diaphragm. Management?
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Emergent laparotomy to repair perforated viscus
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The most likely cause of acute lower GI bleed in patients > 40 years of age
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Diverticulosis
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Diagnostic modality used when ultrasound is equivocal for cholecystitis
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HIDA scan
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Risk factors for cholelithiasis
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Fat, female, fertile, forty, flatulent
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Inspiratory arrest during palpation of the RUQ
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Murphy’s sign, seen in acute cholecystitis
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The most common cause of SBO in patients with no history of abdominal surgery
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Hernia
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The most common cause of SBO in patients with a history of abdominal surgery
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Adhesions
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-Pseudoappendicitis
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Most common organism -causing diarrhea
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Campylobacter
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Recent antibiotic use -causing diarrhea
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Clostridium difficile
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Camping -causing diarrhea
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Giardia
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Traveler’s diarrhea -causing diarrhea
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ETEC
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Church picnics/mayonnaise -causing diarrhea
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S. aureus
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Uncooked hamburgers -causing diarrhea
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E coli O157:H7
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Friend rice -causing diarrhea
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Bacillus cereus
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Poultry/eggs -causing diarrhea
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Salmonella
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Raw seafood -causing diarrhea
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Vibrio, HAV
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AIDS -causing diarrhea
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Isospora, Cryptosporidium, Mycobacterium avium complex(MAC)
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Pseudoappendicitis -causing diarrhea
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Yersinia
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A 25 yo Jewish man presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibias
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Crohn’s disease
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Inflammatory disease of the colon with increase risk of colon cancer
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Ulcerative colitis (greater risk than Crohn’s)
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Extraintestinal manifestations of IBD
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Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, primary sclerosing cholangitis
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Medical treatment for IBD
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5-ASA agents and steroids during acute exacerbation
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Difference between Mallory-Weiss and Boerhaave tears.
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Mallory-Weiss – superficial tear in esophageal mucosa; Boerhaave – full-thickness esophageal rupture
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Charcot’s triad
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RUQ pain, jaundice, and fever/chills in the setting of ascending cholangitis
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Reynolds’ pentad
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Charcot’s triad plus shock and mental status changes, with suppurative ascending cholangitis
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Medical treatment for hepatic encephalopathy
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Decrease protein intake, lactulose, rifaximin
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First step in the management of a patient with an acute GI bleed
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Establish the ABC’s
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A four yo child presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
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Hemolytic-uremic syndrome (HUS) due to E. coli O157:H7
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Post-HBV exposure treatment
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HBV immunoglobulin
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Classic causes of drug-induced hepatitis
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TB medications (INH, rifampin, pyrazinamide), acetaminophen, and tetracycline
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A 40 yo obese woman with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine, and clay-colored stools
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Biliary tract obstruction
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Hernia with highest risk of incarceration – indirect, direct, or femoral?
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Femoral hernia
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A 50 yo man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?
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Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make the patient NPO and give IV fluids, O2, analgesia, and ‘tincture of time’
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Four causes of microcystic anemia
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TICS – Thalassemia, Iron deficiency, anemia of Chronic disease, and Sideroblastic anemia
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An elderly man with hypochromic, microcytic anemia is asymptomatic, Diagnostic tests?
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Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
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Precipitants of hemolytic crisis in patients with G6PD deficiency
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Sulfonamides, antimalarial drugs, fava beans
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The most common inherited cause of hypercoagulability
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Factor V Leiden mutation
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The most common inherited bleeding disorder
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Von Willebrand’s disease
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The most common inherited hemolytic anemia
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Hereditary spherocytosis
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Diagnostic test for hereditary spherocytosis
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Osmotic fragility test
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Pure RBC aplasia
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Diamond-Blackfan anemia
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Anemia associated with absent radii and thumbs, diffuse hyperpigmentation, café au lait spots, microcephaly, and pancytopenia
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Fanconi’s anemia
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Medications and viruses that lead to aplastic anemia
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Chloramphenicol, sulfonamides, radiation, HIV, chemotherapeutic agents, hepatitis, parvovirus B19, EBV
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How to distinguish polycythemia vera from secondary polycythemia
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Both have increase hematocrit and RBC mass, but polycythemia vera should have normal O2 saturadatiion and low erythropoietin levels
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Thrombotic thrombocytopenic purpura (TTP) pentad?
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‘FAT RN’: Fever, Anemia, Thrombocytopenia, Renal dysfunction, Neurologic abnormalities
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HUS triad?
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Anemia, Thrombocytopenia, and Acute renal failure
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Treatment for TTP
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Emergent large-volume plasmapheresis, corticosteroids, antiplatelet drugs
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Treatment for idiopathic thrombocytopenic purpura (ITP) in children
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Usually resolves spontaneously; may require IVIG and/or corticosteroids
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Which of the following are increase in DIC: fibrin split porducts, D-dimer, fibrinogen, platelets, and hematocrit
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Fibrin split products and D-dimer are elevated; platelets, fibrinogen, and hematocrit are decreased.
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An eight yo boy presents with hemarthrosis and increase PTT with normal PT and bleeding time. Diagnosis? Treatment?
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Hemophilia A or B; consider desmopressin (for hemophilia A) or factor 8 or 9 supplements
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A 14 yo girl presents with prolonged bleeding after dental surgery and with menses, normal PT, normal or increase PTT, and increase bleeding time. Diagnosis? Treatment?
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Von Willebrand’s disease; treat with desmopressin, FFP, or cryoprecipitate
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A 60 yo African-American man presents with bone pain. Workup for multiple myeloma might reveal?
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Monoclonal gammopathy, Bence Jones proteinuria, ‘punched-out’ lesions on xray of the skull and long bones
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Reed-Sternberg cells
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Hodgkin’s lymphoma
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A 10 yo boy presents with fever, weight loss, and night sweats. Exam shows an anterior mediastinal mass. Suspected diagnosis?
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Non-Hodgkin’s lymphoma
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Microcytic anemia with decrease serum iron, decrease total iron-binding capacity (TIBC), and normal or increase ferritin
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Anemia of chronic disease
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Microcytic anemia with decrease serum iron, decrease ferritin, and increase TIBC
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Iron deficiency anemia
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An 80 yo man presents with fatigue, lymphadenopathy, splenomegaly, and isolated lymphocytosis. Suspected diagnosis?
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Chronic lymphocytic leukemia (CLL)
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The lymphoma equivalent of CLL
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Small lymphocytic lymphoma
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A late, life-threatening complication of chronic myelogenous leukemia (CML)
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Blast crisis (fever, bone pain, splenomegaly, pancytopenia)
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Auer rods on blood smear
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Acute myelogenous leukemia (AML)
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AML subtype associated with DIC
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M3
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Electrolyte changes in tumor lysis syndrome
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Decrease Ca2+, Increase K+, Increase Phosphate, Increase Uric Acid
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Treatment for AML M3
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Retinoic acid
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A 50 yo man presents with early satiety, splenomegaly, and bleeding. Cytogenetics show t(9,22). Diagnosis?
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CML
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Heinz bodies?
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Intracellular inclusions seen in thalassemia, G6PD deficiency, and postsplenectomy
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An autosomal-recessive disorder with a defect in the GP2b3a platelet receptor and decrease platelet aggregation
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Glanzmann’s thrombasthenia
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Virus associated with aplastic anemia in patients with sickle cell anemia
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Parvovirus B19
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A 25 yo African-American man with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?
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O2, analgesia, hydration, and, if severe, transfusion
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A significant cause of morbidity in thalassemia patients. Treatment?
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Iron overload; use deferoxamine
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Infectious Disease
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The three most common causes of fever of unknown origin (FUO)
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Infection, Cancer, and Autoimmune disease
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Four signs and symptoms of streptococcal pharyngitis
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Fever, pharyngeal erythema, tonsillar exudate, lack of cough
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A nonsuppurative complication of streptococcal infection that is not altered by treatment of primary infection
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Postinfectious glomerulonephritis
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Asplenic patients are particularly susceptible to these organisms
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Encapsulated organisms – Pneumococcus, Meningococcus, Haemophilus influenza, Klebsiella
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The number of bacteria on a clean-catch specimen to diagnose a UTI
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10^5 bacteria/mL
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Which healthy population is susceptible to UTIs?
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Pregnant women. Treat this group aggressively because of potential complications
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A patient from California or Arizona presents with fever, malaise, cough, and night sweats. Diagnosis? Treatment?
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Coccidioidomycosis. Amphotericin
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Nonpainful chancre
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Primary syphilis
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|
A ‘blueberry muffin’ rash is characteristic of what congenital infection?
|
Rubella
|
|
|
Meningitis in neonates. Causes? Treatment?
|
Group B strep, E coli, Listeria. Treat with gentamicin and ampicillin
|
|
|
Meningitis in infants. Causes? Treatment?
|
Pneumococcus, meningococcus, H influenza. Treat with cefotaxmine and vancomycin
|
|
|
What should always be done prior to LP?
|
Check for increase ICP; look for papilledema
|
|
|
CSF findings: -Low glucose, PMN predominance
|
-Bacterial meningitis
|
|
|
CSF findings: -Normal glucose, lymphocytic predominance
|
-Aseptic (viral) meningitis
|
|
|
CSF findings: -Numerous RBCs in serial CSF samples
|
-Subarachnoid hemorrhage (SAH)
|
|
|
CSF findings: -Increase gamma globulins
|
-MS
|
|
|
Initially presents with a pruritic papule with regional lymphadenopathy; evolves into a black eschar after 7-10 days. Treatment?
|
Cutaneous anthrax. Treat with penicillin G or Ciprofloxacin
|
|
|
Findings in tertiary syphilis
|
Tabes dorsalis, general paresis, gummas, Argyll Robertson pupil, aortitis, aortic root aneurysms
|
|
|
Characterisitcs of secondary Lyme disease
|
Arhtralgias, migratory polyarthropathies, Bell’s palsy, myocarditis
|
|
|
Cold agglutinins
|
Mycoplasma
|
|
|
A 24 yo man presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
|
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
|
|
|
Begin Pneumocystis jiroveci (formerly P carinii) pneumonia prophylaxis in an HIV-positive patient at what CD4 count? Mycobacterium avium-intracellulare (MAI) prophylaxis?
|
=< 200 for P jiroveci (with TMP-SMX); =< 50-100 for MAI (with Clarithromycin/Azithromycin)
|
|
|
Risk factors for pyelonephritis
|
Pregnancy, vesicoureteral reflux, anatomic anomalies, indwelling catheters, kidney stones
|
|
|
Neutropenic nadir postchemotherapy
|
7-10 days
|
|
|
Erythema migrans
|
Lesion of primary Lyme disease
|
|
|
Classic physical finding for endocarditis
|
Fever, heart murmur, Osler’s nodes, splinter hemorrhages, Janeway lesions, Roth’s spots
|
|
|
Aplastic crisis in sickle cell disease
|
Parvovirus B19
|
|
|
Ring-enhancing brain lesion on CT with seizures
|
Taenia solium (cysticercosis)
|
|
|
organisms: -Branching rods in oral infection
|
-Actinomyces israelii
|
|
|
organisms: -Painful chancroid
|
-haemophilus ducreyi
|
|
|
organisms: -Dog or cat bite
|
-Pasteurella multocida
|
|
|
organisms: -Gardener
|
-Sporothrix schenckii
|
|
|
organisms: -Pregnant women with pets
|
-Toxoplasma gondii
|
|
|
organisms: -Meningitis in adults
|
-Neisseria meningitidis
|
|
|
organisms: -Meningitis in elderly
|
-Streptococcus pneumoniae
|
|
|
organisms: -Alcoholic with penumonia
|
-klebsiella
|
|
|
organisms: -‘Currant jelly’ sputum
|
-Klebsiella
|
|
|
organisms: -infection in burn victims
|
-Pseudomonas
|
|
|
organisms: -Osteomyelitis from foot wound puncture
|
-Pseudomonas
|
|
|
organisms: -Osteomyelitis in a sickle cell patient
|
-Salmonella
|
|
|
A 55 yo man who is a smoker and a heavy drinker presents with a new cough and flulike symptoms. Gram stain shows no organisms; silver stain of sputum shows gram-negative rods. What is the diagnosis?
|
Legionella pneumonia
|
|
|
A middle-aged man presents with acute-onset monoarticular joint pain and bilateral Bell’s palsy. What is the likely diagnosis, and how did he get it? Treatment?
|
Lyme disease, Ixodes tick, doxycycline
|
|
|
A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organisms is suspected?
|
S aureus or S epidermidis
|
|
|
Musculoskeletal
|
|
|
|
Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips
|
Spinal stenosis
|
|
|
Joints in the hand affected in rheumatoid arthritis
|
MCP and PIP joints; DIP joints are spared
|
|
|
Joint pain and stiffness that worsen over the course of the day and are relieved by rest
|
Osteoarthritis
|
|
|
Genetic disorder associated with multiple fractures and commonly mistaken for child abuse
|
Osteogenesis imperfecta
|
|
|
Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
|
Suspect ankylosing spondylitis. Check HLA-B27
|
|
|
Arthritis, conjunctivitis, and urethritis in young men. Associated organisms?
|
Reactive (Reiter’s) arthritis. Associated with campylobacter, Shigella, Salmonella, Chlamydia, and Ureaplasma
|
|
|
A 55 yo man has sudden, excruciating first MTP joint pain after a night of drinking red wine. Diagnosis, workup, and chronic treatment?
|
Gout. Needle-shaped, negatively, birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
|
|
|
Rhomboid-shaped, positively birefringent crystals on joint fluid aspirate
|
Pseudogout
|
|
|
An elderly woman presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and increase ESR
|
Polymyalgia rheumatica
|
|
|
An active 13 yo boy has anterior knee pain. Diagnosis?
|
Osgood-Schlatter disease
|
|
|
Bone is fractured in a fall on an outstretched hand.
|
Distal radius (Colles’ fracture)
|
|
|
Complication of scaphoid fracture
|
Avascular necrosis
|
|
|
Signs suggesting radial nerve damage with humeral fracture
|
Wrist drop, loss of thumb abduction
|
|
|
A young child presents with proximal muscle weakness, waddling gait, and pronounced calf muscles
|
Duchenne muscular dystrophy
|
|
|
A first-born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
|
Developmental dysplasia of the hip. If severe, consider a Pavlik harness to maintain abduction
|
|
|
An 11 yo obese African-American boy presents with sudden onset of limp. Diagnosis? Workup?
|
Slipped capital femoral epiphysis. AP and frog-leg lateral view
|
|
|
The most common primary malignant tumor of bone
|
Multiple myeloma
|
|
|
Unilateral, severe periorbital headache with tearing and conjunctival erythema
|
Cluster headache
|
|
|
Prophylactic treatment for migraine
|
Antihypertensives, antidepressants, anticonvulsants
|
|
|
The most common pituitary tumor. Treatment?
|
Prolactinoma. Dopamine agonists (eg bromocriptine)
|
|
|
A 55 yo patient presents with acute ‘broken speech.’ What type of aphasia? What lobe and vascular distribution?
|
Broca’s aphasia. Frontal lobe, left MCA distribution
|
|
|
The most common cause of SAH
|
Trauma; the second most common is berry aneurysm
|
|
|
A crescent-shaped hyperdensitive on CT that does not cross the midline
|
Subdural hematoma-bridging veins torn
|
|
|
A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely source? Treatment?
|
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
|
|
|
CSF findings with SAH
|
Elevated ICP, RBSs, xanthochromia
|
|
|
Albuminocytologic dissociation
|
Guillian-Barre syndrome (increase in CSF without significant increase in cell count
|
|
|
Cold water is flushed into a patient’s ear, and the fast phase of nystagus is toward the opposite side. Nomral or pathologic
|
Normal
|
|
|
The most common primary sources of metastases to the brain
|
Lung, breast, skin (melanoma), kidney, GI tract
|
|
|
May be seen in children who are accused of inattention in class and confused with ADHD
|
Absence seizures
|
|
|
The most frequent presentation of intracranial neoplasm
|
Headache
|
|
|
The most common cause of seizures in children (2-10 yo
|
Infections, febrile seizures, trauma, idiopathic
|
|
|
The most common cause of seizures in young adults (18-35 yo)
|
Trauma, alcohol withdrawal, brain tumor
|
|
|
First-line medication for status epilepticus
|
IV benzodiazepine
|
|
|
Confusion, confabulation, ophthalmoplegia, ataxia
|
Wernicke’s encephalopathy due to a deficiency of thiamine
|
|
|
What % lesion is an indication for carotid endarterectomy?
|
Seventy % if the stenosis is symtomatic
|
|
|
The most common causes of dementia
|
Alzheimer’s and multi-infarct
|
|
|
Combined UMN and LMN disorder
|
ALS
|
|
|
Rigidity and stiffness with resting tremor and masked facies
|
Parkinson’s disease
|
|
|
The mainstay of Parkinson’s therapy
|
Levodopa/carbidopa
|
|
|
Treatment for Guillain-Barre syndrome
|
IVIG or plasmapheresis
|
|
|
Rigidity and stiffness that progress to choreiform movements, accompanied by moodiness and altered behavior
|
Huntington’s disease
|
|
|
A 6 yo girl presents with a port-wine stain in the V2 distribution as well as with mental retardation, seizures, and ipsilateral leptomeningeal angioma
|
Sturge-Weber syndrome. Treat symptomatically. Possible focal cerebral resection of the affected lobe
|
|
|
Café au lait spots on skin
|
Neurofibromatosis type 1
|
|
|
Hyperphagia, hypersexuality, hyperorality, and hyperdocility
|
Kluver-Bucy syndrome (amygdala)
|
|
|
May be administered to a symptomatic patient to diagnose myasthenia gravis
|
Edrophnium
|
|
|
Obstetrics
|
|
|
|
Primary causes of third-trimester bleeding
|
Placental abruption and placenta previa
|
|
|
Classic ultrasound and gross appearance of complete hydatidiform mole
|
Snowstorm on ultrasound. ‘Cluster-of-grapes’ appearance on gross examination
|
|
|
Chromosomal pattern of a complete mole
|
46, XX
|
|
|
Molar pregnancy containing fetal tissue
|
Partial mole
|
|
|
Symptoms of placental abruption
|
Continuous, painful vaginal bleeding
|
|
|
Symptoms of placenta previa
|
Self-limited, painless vaginal bleeding
|
|
|
When should a vaginal exam be performed with suspected placenta previa?
|
Never
|
|
|
Antibiotics with teratogenic effects
|
Tetracycline, fluoroquinolones, aminoglycosides, sulfonamides
|
|
|
Shortest AP diameter of the pelvis
|
Obstetric conjugate: between the sacral promontory and the midpoint of symphysis pubis
|
|
|
Medication given to accelerate fetal lung maturity
|
Betamethasone or dexamethasone x 48 hrs
|
|
|
The most common cause of postpartum hemorrhage
|
Uterine atony
|
|
|
Treatment for postpartum hemorrhage
|
Uterine massage; if that fials, give oxytocin
|
|
|
Typical antibiotics for group B streptococcus (GBS) prophylaxis
|
IV penicillin or ampicillin
|
|
|
A patient fails to lactate after an emergency C-section with marked blood loss
|
Sheehan’s syndrome (postpartum pituitary necrosis)
|
|
|
Uterine bleeding at 18 weeks’ gestation; no products expelled; membranes ruptured; cervical os open
|
Inevitable abortion
|
|
|
Uterine bleeding at 18 weeks’ gestation; no products expelled; cervical os closed
|
Threatened abortion
|
|
|
The first test to perform when a woman presents with amenorrhea
|
B-hCG; the most common cause of amenorrhea is pregnancy
|
|
|
Term for heavy bleeding during and between mentrual periods
|
Menometrorrhagia
|
|
|
Cause of amenorrhea with normal prolactin, no response to estrogen-progesterone challenge, and a history of D&C
|
Asherman’s syndrome
|
|
|
Therapy for polycystic ovarian syndrome
|
Weight loss and OCPs
|
|
|
Medication used to induce ovulation
|
Clomiphene citrate
|
|
|
Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding
|
Endometrial biopsy
|
|
|
Indications for medical treatment of ectopic pregnancy
|
Stable, unruptured ectopic pregnancy of <3.5 cm at <6 weeks’ gestation
|
|
|
Medical options for endometriosis
|
OCPs, danazol, GnRH agonists
|
|
|
Laparoscopic findings in edometriosis
|
‘Chocolate cysts,’ powder burns
|
|
|
The most common location for an ectopic pregnancy
|
Ampulla of the oviduct
|
|
|
How to diagnose an dfollow a leiomyoma
|
Ultrasound
|
|
|
Natural history of a leiomyoma
|
Regresses after menopause
|
|
|
A patient has increase vaginal discharge and petechial patches in the upper vagina and cervis
|
Trichomonas vaginitis
|
|
|
Treatment for bacterial vaginosis
|
Oral or topical metronidazole
|
|
|
The most common cause of bloody nipple discharge
|
Intraductal papilloma
|
|
|
Contraceptive methods that protect against PID
|
OCPs and barrier contraception
|
|
|
Unopposed estrogen is contraindicated in which cancers?
|
Endometrial or estrogen receptor-positive breast cancer
|
|
|
A patient presents with recent PID with RUQ pain
|
Consider Fitz-Huge-Curtis syndrome
|
|
|
Breast malignancy presenting as itching, burning, and erosion of the nipple
|
Paget’s disease
|
|
|
Annual screening for women with strong family history of ovarian cancer
|
CA-125 and transvaginal ultrasound
|
|
|
A 50 yo woman leaks urine when laughing or coughing. Nonsurgical options?
|
Kegel exercises, estrogen, pessaries for stress incontinence
|
|
|
A 30 yo woman has unpredictable urine loss. Examination is normal. Medical options?
|
Anticholinergics (oxybutynin) or B-adrenergics (metaproterenol) for urge incontinence
|
|
|
Lab values suggestive of menopause
|
Increase serum FSH
|
|
|
The most common cause of female infertility
|
Endometriosis
|
|
|
Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow-up evaluation?
|
Colposcopy and endocervical curettage
|
|
|
Breast cancer type that incrase the future risk of invasive carcinoma in both breasts
|
Lobular carcinoma in situ
|
|
|
Pediatrics
|
|
|
|
Nontender abdominal mass associated with elevated VMA and HVA
|
Neuroblastoma
|
|
|
The most common type of tracheoesophageal fistula (TEF). Diagnosis?
|
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
|
|
|
Not contraindications to vaccination
|
Mild illness and/or low-grade fever, current antibiotic therapy, and prematurity
|
|
|
Tests to rule out shaken baby syndrome
|
Ophthalmologic exam, CT, and MRI
|
|
|
A neonate has meconium ileus
|
CF or Hirschsprung’s disease
|
|
|
Bilious emesis within hourrs after the first feeding
|
Duodenal atresia
|
|
|
A two month old baby presents with nonbilious projectile emesis. What are the appropriate steps in management?
|
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
|
|
|
The most common primary immunodeficiency
|
Selective IgA definiciency
|
|
|
An infant has a high fever and onset of rash as fever breaks. What is he at risk for?
|
Febrile seizures (roseola infantum)
|
|
|
-A boy has chronic respiratory infections. Nitroblue tetrazolium test is postive.. What is the immunodeficiency?
|
-Chronic granulomatous disease
|
|
|
-A child has eczema, thrombocytopenia, and high levels of IgA What is the immunodeficiency?
|
-Wiskott-Aldrich syndrome
|
|
|
-A four month old boy has life-threatening Pseudomonas infection. What is the immunodeficiency?
|
-Bruton’s X-linked agammaglobulinemia
|
|
|
Acute-phase treatment for Kawasaki disease
|
High-dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
|
|
|
Treatment for mild and severe unconjugated hyperbilirubinemia
|
Phototherapy (mild) or exchange transfusion (severe)
|
|
|
Sudden onset of mental status changes, emesis, and liver dysfunction after taking aspirin
|
Reye’s syndrome
|
|
|
A child has loss of red light reflex. Diagnosis?
|
Suspect retinoblastoma
|
|
|
Vaccinations at a six-mont well-child visit
|
HBV, DtaP, Hib, IPV, PCV
|
|
|
Tanner stage 3 in a 6 yo girl
|
Precocious puberty
|
|
|
Infection of small airways with epidemics in winter and spring
|
RSV bronchiolitis
|
|
|
Cause of neonatal RDS
|
Surfactant deficiency
|
|
|
A condition associated with red ‘ currant-jelly’ stools
|
Intussusception
|
|
|
A congential heartt disease that causes secondary hypertension
|
Coarctation of aorta
|
|
|
First-line treatment for otitis media
|
Amoxicillin x 10 days
|
|
|
The most common pathogen causing croup
|
Parainfluenza virus type 1
|
|
|
A homeless child is small for his age and has peelign skin and a swollen belly
|
Kwashiorkor (protein malnutrition)
|
|
|
Defect in an X-linked syndrome with mental retardation, gout, self-mutilation, and choreoathetosis
|
Lesch-Nyhan syndrome (purine salvage problem with HGPRTase deficiency)
|
|
|
A newborn girl has a continuous ‘machinery murmur’
|
Patent ductus arteriosus (PDA)
|
|
|
Name the defense mechanism: -A mother who is angry at her husband yells at her child
|
-Displacement
|
|
|
Name the defense mechanism: -A pedophile enters a monastery
|
-Reaction formation
|
|
|
Name the defense mechanism: -A woman calmly describes a grisly murder
|
-Isolation
|
|
|
Name the defense mechanism: -A hospitalized 10 yo begins to wet his bed
|
-Regression
|
|
|
Life-threatening muscle rigidity, fever, and rhabdomyolysis
|
Neuroleptic malignant syndrome
|
|
|
Amenorrhea, bradycardia, and abnormal body image in a young female
|
Anorexia
|
|
|
A 35 yo man has recurrent episodes of palpitations, diaphoresis, and fear of going crazy
|
Panic disorder
|
|
|
The most serious side effect of clozapine
|
Agranulocytosis
|
|
|
A 21 yo man has three months of social withdrawal, worsening grades, flattened affect, and concrete thinking.
|
Schizophreniform disorder (diagnosis of schizophrenia requires >= 6 months of symptoms)
|
|
|
Key side effects of atypical antipsychotics
|
Weight gain, type 2 Dm, QT prolongation
|
|
|
A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?
|
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
|
|
|
Medication to avoid in patients with a history of alcohol withdrawal seizures
|
Neuroleptics
|
|
|
A 13 yo boy has a history of theft, vandalism, and violence toward family pets
|
Conduct disorder
|
|
|
A five month old girl has decrease head growth, truncal dyscoordination, and decrease social interaction
|
Rett’s disorder
|
|
|
A patient hasn’t slept for days, lost $20,000 gambling, is agitated, and has pressured speech. Diagnosis? Treatment?
|
Acute mania. Start a mood stabilizer (eg Lithium)
|
|
|
After a minor fender bender, a man wears a neck brace and requests permanent disability
|
Malingering
|
|
|
A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C-peptide
|
Factitious disorder (Munchausen syndrome)
|
|
|
A patient continues to use cocaine after being in jail, losing his job, and not paying child support
|
Substance abuse
|
|
|
A violent patient has vertical and horizontal nystagmus
|
Phencyclidine hydrochloride (PCP) intoxication
|
|
|
A woman who was abused as a child frequently feels outside of or detached from her body
|
Depersonalization disorder
|
|
|
A man has repeated, intense urges to rub his body against unsuspecting passengers on a bus
|
Frotteurism (a paraphilia)
|
|
|
A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Diagnosis? Treatment?
|
Tardive dyskinesia. Decrease or discontinue haloperidol and consider another antipsychotic (eg risperidone, clozapine)
|
|
|
A man unexpectedly flies across the country, takes a new name, and has no memory of his prior life
|
Dissociative fugue
|
|
|
Risk factors for DVT
|
Stasis, endothelial injury, and hypercoagulability (Virchow’s triad)
|
|
|
Criteria for exudative effusion
|
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
|
|
|
Causes of exudative effusion
|
Think of leaky capillaries. Malignancy, TB, bacterial or viral infection, pulmonary embolism with infarct, and pancreatitis
|
|
|
Causes of transudative effusion.
|
Think of intact capillaries. CHF, liver or kidney disease, and protein-losing enteropathy
|
|
|
Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
|
Fatigue and impending respiratory failure
|
|
|
Dyspnea, lateral hilar lymphadenopathy on CXR, noncaseating granulomas, increase ACE, and hypercalcemia
|
Sarcoidosis
|
|
|
PFTs showing decrease FEV1/FVC
|
Obstructive pulmonary disease (eg asthma)
|
|
|
PFTs showing increase FEV1/FVC
|
Restrictive pulmonary disease
|
|
|
Honeycomb pattern on CXR. Diagnosis? Treatment?
|
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help.
|
|
|
Treatment for SVC syndrome
|
Radiation
|
|
|
Treatment for mild, persistent asthma
|
Inhaled B-agonists and inhaled corticosteroids
|
|
|
Treatment for COPD exacerbation
|
O2, bronchodilators, antibiotics, corticosteroids with taper, smoking cessation
|
|
|
Treatment for chronic COPD
|
Smoking cessation, home O2, B-agonists, anticholinergics, systemic or inhaled corticosteroids, flu and pneumococcal vaccines
|
|
|
Acid-base disorder in pulmonary embolism
|
Hypoxia and hypocarbia (respiratory alkalosis)
|
|
|
Non-small cell lung cancer (NSCLC) associated with hypercalcemia
|
Squalmous cell carcinoma
|
|
|
Lung cancer associated with SIADH
|
Small cell lung cancer (SCLC)
|
|
|
Lung cancer highly related to cigarette exposure
|
SCLC
|
|
|
A tall white male presents with acute shortness of breath. Diagnosis? Treatment?
|
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
|
|
|
Treatment of tension pneumothorax
|
Immediate needle thoracostomy
|
|
|
Characteristics favoring carcinoma in an isolated pulmonary nodule
|
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
|
|
|
Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure
|
ARDS
|
|
|
Sequelae of asbestos exposure
|
Pulmonary fibrosis, pleural plaques, bronchogenic carcinoma (mass in lung field), mesothelioma (pleural mass)
|
|
|
Increase risk of what infection with silicosis?
|
Mycobacterium tuberculosis
|
|
|
Causes of hypoxemia
|
Right-to-left shunt, hypoventilation, low inspired O2 tension, diffusion defect, V/Q mismatch
|
|
|
Classic CXR findings for pulmonary edema
|
Cardiomegaly, prominent pulmonary vessels, Kerley B lines, ‘bat’s-wing’ appearance of hilar shadows, and perivascular and peribronchial cuffing.
|
|
|
Renal tubular acidosis (RTA) associated with abonormal H+ secretion and nephrolithiasis
|
Type I (distal) RTA
|
|
|
RTA associated with abnomral HCO3- and rickets
|
Type II (proximal) RTA
|
|
|
RTA associated with aldosterone defect
|
Type IV (distal) RTA
|
|
|
‘Doughy’ skin
|
Hypernatremia
|
|
|
Differential of hypervolemic hyponatremia
|
Cirrhosis, CHF, nephritic syndrome
|
|
|
Chvostek’s and Trousseau’s signs
|
Hypocalcemia
|
|
|
The most common causes of hypercalcemia
|
Malignancy and hyperparathyroidism
|
|
|
T-wave flattening and U waves
|
Hypokalemia
|
|
|
Peaked T waves and widened QRS
|
Hyperkalemia
|
|
|
First-line treatment for moderate hypercalcemia
|
IV hydration and loop diuretics (furosemide)
|
|
|
Type of ARF in a patient with FeNa < 1%
|
Prerenal
|
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A 49 yo man presents with acute-onset flank pain and hematuria
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Nephrolithiasis
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The most common type of nephrolithiasis
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Calcium oxalate
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A 20 yo man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
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Cerebral berry aneurysms (Autosomal Dominant PCKD)
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Hematuria, hypertension, and oliguria
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Nephritic syndrome
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Proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, and edema
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Nephrotic syndrome
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The most common form of nephritic syndrome
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Membranous glomerulonephritis
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The most common form of glomerulonephritis
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IgA nephropathy (Berger’s disease)
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Glomerulonephritis with deafness
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Alport’s syndrome
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Glomerulonephritis with hemoptysis
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Wegener’s granulomatosis and Goodpasture’s syndrome
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Presence of red cell casts in urine sediment
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Glomerulonephritis/nephritic syndrome
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Eosinophils in urine sediment
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Allergic interstitial nephritis
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Waxy casts in urine sediment and Maltese crosses (seen with lipiduria)
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Nephrotic syndrome
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Drowsiness, asterixis, nausea, and a pericardial friction rub
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Uremic syndrome seen in patients with renal failure
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A 55 yo man is diagnosed with prostate cancer. Treatment options?
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Wait, surgical resection, radiation and/or androgen suppression
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Low urine specific gravity in the presence of high serum osmolality
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Diabetes insipidus
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Treatment of SIADH?
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Fluid restriction, demeclocycline
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Hematuria, flank pain, and palpable flank mass
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Renal cell carcinoma (RCC)
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Testicular cancer associated with B-hCG, AFP
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Choriocarcinoma
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The most common type of testicular cancer
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Seminoma, a type of germ cell tumor
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The most common histology of bladder cancer
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Transitional cell carcinoma
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Complication of overly rapid correction of hyponatremia
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Central pontine myelinolysis
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Salicylate ingestion occurs in what type of acid-base disorder?
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Anion gap acidosis and primary respiratory alkalosis due to central respiratory stimulation
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Acid-base disturbance commonly seen in pregnant women
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Respiratory alkalosis
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Three systemic diseases that lead to nephrotic syndrome
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DM, SLE, and amyloidosis
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Elevated erythropoietin level, elevated hematocrit, and normal O2 saturation suggest?
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RCC or other erythropoietin-producing tumor; evaluate with CT scan
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A 55 yo male presents with irritative and obstructive urinary symptoms. Treatment options?
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Likely BPH. Options include no treatment, terazosin, finasteride, or surgical intervention (TURP)
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Class of drugs that may cause syndrome of muscle rigidity, hyperthermia, autonomic instability, and extrapyramidal symptoms
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Antipsychotics (neuroleptic malignant syndrome
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Side effects of corticosteroids
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Acute mania, immunosuppression, thin skin, osteoporosis, easy bruising, myopathies
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Treatment for delirium tremens (DTs)
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Benzodiazepines
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Treatment for acetaminophen overdose
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N-acetylcysteine
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Treatment for opioid overdose
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Naloxone
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Treatment for benzodiazepine overdose
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Flumazenil
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Treatment for neuroleptic malignant syndrome and malignant hyperthermia
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Dantrolene
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Treatment for maligant hypertension
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Nitroprusside
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Treatment for atrial fibrillation
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Rate control, rhythm conversion, and anticoagulation
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Treatment of supraventricular tachycardia
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If stable, rate control with carotid massage or other vagal stimulation; if unsuccessful, consider adenosine
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Causes of drug-induced SLE
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INH, penicillamine, hydralazine, procainamide, chlorpromazine, methyldopa, quinidine
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Macrocytic, megaloblastic anemia with neurologic symptoms
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B12 definiciency
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Macrocytic, megaloblastic anemia without neurologic symptoms
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Folate deficiency
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A burn patient presents with cherry-red flushed skin and coma. SaO2 is normal, but carboxyhemoglobin is elevated. Treatment?
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Treat CO poisoning with 100% O2 or with hyperbaric O2 if poisoning is severe or the patient is pregnant
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Blood in the urethral meatus or high-riding prostate
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Bladder rupture or urethral injury
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Test to rule out urethral injury
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Retrograde cystourethrogram
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Radiographic evidence of aortic disruption or dissection
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Widened mediastinum (>8 cm), loss of aortic knob, pleural cap, tracheal deviation to the right, depression of left main stem bronchus
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Radiographic indications for surgery in patients with acute abdomen
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Free air under the diaphragm, extravasation of contrast, severe bowel distention, space-occupying lesion (CT), mesenteric occlusion (angiography)
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The most common organism in burn-related infections
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Pseudomonas
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Method of calculating fluid repletion in burn patients
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Parkland formula (body wt kg x percentage burn area {50% max} x 4 cc/hr = fluid for 24 h [50% in 8 hr, 50% in 16 hr]), plus 2 L of D5W first day, 1 L second day, estimate 1 L per hr approximately if urine output 1-2cc/kg/hr
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Acceptable urine output in a trauma patient
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50 cc/hr
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Acceptable urine output in a stable patient
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30 cc/hr
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Cannon ‘a’ waves
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Third degree heart block
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Signs of neurogenic shock
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Hypotension and bradycardia
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Signs of increase ICP (Cushing’s triad)
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Hypertension, bradycardia, and abnormal respirations
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Decrease CO, decrease pulmonary capillary wedge pressure (PCWP), increase peripheral vascular resistance (PVR).
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Hypovolemic shock
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Decrease CO, increase PCWP, increase PVR
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Cardiogenic (or obstructive) shock
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Increase CO, decrease PCWP, decrease PVR
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Septic or anaphylactic shock
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Treatment of septic shock
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Fluid and antibiotics
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Treatment of cardiogenic shock
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Identify cause; pressors (eg dopamine)
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Treatment of hypovolemic shock
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Identify cause; fluid and blood repletion
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Treatment of anaphylactic shock
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Diphenhydramine or epinephrine 1:1000
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Supportive treatment for ARDS
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Continuous positive airway pressure
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Signs of air embolism
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A patient with chest trauma who was previously stable suddenly dies
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Trauma series
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AP chest, AP/lateral C-spine, AP pelvis
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