Medicine

Front 1

Vit K dependent coagulation factors

Back 1

Factors 2, 7, 9 and 10

Protein C and S

Front 2

Causes of high reticulocyte anemia

Back 2

# acute blood loss (trauma, GIB)
# hemolysis (destruction)

Front 3

Causes of low retic count anemia

Back 3

Mirocytic/low MCV
# Iron deficiency
# thalassemia
# Anemia of chronic disease
# Sideroblastic Anemia (usually hereditary)

Front 4

Causes of macrocytic anemia

Back 4

# B12 deficiency
# folate deficiency
# EtOH abuse
# Liver dz
# Myelodysplastic syndrome
# sever hypothyroidism
# acquire sideroblastic anemia
# Drug effects

Front 5

Causes of Normocytic Anemia

Back 5

# anemia of chronic dz
# anemia of renal failure
# aplastic anemia
# multiple myeloma
# myelophthisis
# hypothyroidism

Front 6

Causes of sideroblastic anemia

Back 6

# EtOH abuse
# lead poisening
# INH use
# pyrodoxine deficiency

Front 7

Iron deficiency anemia in patients with no apparent source of blood loss

Back 7

Celiac Dz

Front 8

Causes of B12 Deficiency

Back 8

# Atrophic gastris (usually in elderly)
# Pernicious Anemia (will have anti-IF Ab)
# Chrohn's Dz (no absorption in terminal ileum)
# Blind intestinal loop syndrome (as in bacterial overgrowth which decreases the amount of B12 available for absorption)

Front 9

Schilling Test

Back 9

# Step 1: load body with IM B12 shot and ingestion of radioactive B12. Failure to renally excrete radioactive B12 means the body lacks absorption capacity

# Step 2: administer B12-IF together. Renal excretion of B12 here confirms lack of IF (pernicious anemia). Failure to excrete here suggests malabsorption

# Step 3: if malabsorption dorrects after antibiotics, blind loop syndrom

Front 10

Factors tested in PT

Back 10

Extrinsic p'way
- factor 7 and tissue factor-dependent)

Front 11

Factors tested in aPTT

Back 11

Intrinsic p'way
- factors 8, 9, 11 and 12 and high molecular weight kininogen and prekallikrein.

Front 12

Quick reversal of Warfarin anticoagulation

Back 12

Vitamin K SC
For more rapid reversal: FFP (contains all needed factors)

Front 13

Indications for platelet transfusions

Back 13

Thrombocytopenia and active bleeding present or if a procedure is planned

Front 14

Longterm treatment for ITP

Back 14

1. Prednisone 1 mg/kg/day
2. IVIG (temporary solution in patients who do not respond to Prednisone)
3. Splenectomy if thrombocytopenia recurs after steroids are withdrawn)
4. Retuximab (+/- anti-CD20 monoclonal Ab)

Front 15

Treatment for uremia-related thrombocytopenia

Back 15

dDAVP (only for several hours)

Front 16

Treatment for quantitative defect in vWD (type 1)

Back 16

Intranasal dDAVP

Front 17

Types of animals that warrant post-exposure rabies ppx

Back 17

1. Bats
2. wild carnivores (raccoons, skunks and foxes, etc.)
3. any animal suspected of being rabid

Front 18

Example of dihydropyridine Ca-channel antagonists and common side effect and

Back 18

Amlodipine, peripheral edema

Front 19

Right sided holosystolic murmur that increases with inspiration

Back 19

Tricuspid regurg

Front 20

Common cause of endocarditis in IVDUs and tx

Back 20

Staph Aureus, including MRSA

Vancomycin

Front 21

Tickborne illness w/o rash

Back 21

Ehrlichiosis

Front 22

Endemic area for ehrlichiosis

Back 22

Southeastern
South Central
Upper Mid-West
Mid-Atlantic
California

Front 23

Treatment for Ehrlichiosis

Back 23

Empiric Doxycycline

Front 24

Correlation coefficient

Back 24

shows the strength and direction of linear assocciate b/w 2 variables, between -1 and 1.
Closer to either extreme is stronger association

Front 25

Renal insufficiency, microscopic hematuria and/or RBC casts
+
Upper and Lower respiratory tract disease

Back 25

Wegener's granulomatosis

Front 26

c-ANCA positivity

Back 26

Wegener's granulomatosis

Front 27

Sx of gout + pruritis a/w hot baths

Back 27

Myeloproliferative d/os cause gout b/c of elevated production of uric acid
Polycythemia vera causes itchiness with hot baths because of histamine released from an increased number of circulated basophils

Front 28

Treatment for idiopathic benign intracranial hypertension

Back 28

Acetazolamide

Front 29

Anorexia, fatigue, GI complaints, weight loss and hypotension

Back 29

Adrenal insufficiency

Front 30

Electrolyte disturbances commonly a/w adrenal insufficiency

Back 30

MC: hyponatremia followed by hyperkalemia

Front 31

Abrupt onset of fever + impaired mental status w/o meningeal signs

Back 31

HSV encephalitis

Front 32

Insensate, hypopigmented patch of skin a/w signs of peripheral nerve damage (muscle atrophy, e.g.)

Back 32

Leprosy (Mycobacterium leprae)

Front 33

First line DMARD in RA

Back 33

MTX

Front 34

Hemolytic anemia and thrombocytopenia and next diagnostic step

Back 34

TTP and Peripheral smear looking for schistocytes

Front 35

Palpable purpura in adults with HSM, proteinuria, hematuria and systemic symptoms

Back 35

cyoglobulinemia

Front 36

Indications for anticoagulation therapy in pts with atrial fibrillation

Back 36

Based on CHADS2 score:
# 0, just aspirin
# > 2, warfarin
# 1-2 asprin or warfarin

Front 37

Most common cause of ring enhancing lesions on CT in an AIDS pt and treatment

Back 37

toxplasmosis
sulfadiazine and pyrimethamine

Front 38

bilateral loss of central vision in pts over 50

Back 38

age-related macular degeneration

Front 39

HTN, bilateral palpable abdominal masses and microhematuria

Back 39

Autosomal Dominant Polycystic Kidney Dz (ADPKD)

Front 40

MC extrarenal manifestation of ADPKD

Back 40

Hepatic cysts, but watch out for berry aneurysms

Front 41

Pt with a pmh of joint pain/swelling, and DM who p/w low libido and lethargy and who has hepatomegaly and testicular atrophy on exam

Back 41

Hereditary hemochromatosis
Systemic dz that can cause cirrhosis, pancreatic fibrosis (DM) and increased skin pigmentation (bronze diabetes)

Front 42

+ Pronator drift

Back 42

UMN lesion, think stroke

Front 43

Location of CNS lesion:
Unilateral motor hemiparesis of face, arm and leg without any higher cortical dysfunction and visual field abnormalities

Back 43

Posterior limb of internal capsule

Front 44

Location of CNS lesion:
right-sided hemiplegia, leftward eye deviation, hemianesthesia, hononymous hemianopia and aphasia

Back 44

Left MCA occlusion

Front 45

Location of CNS lesion:
Left-sided hemiplegia, rightward eye deviation, hemianesthesia, hononymous hemianopia and hemineglect

Back 45

Right MCA occlusion

Front 46

UC or CD: anywhere from mouth to anus

Back 46

CD

Front 47

Location of CNS lesion:
unilateral weakness that predominantly affects the lower extremity, abulia, akinetic mutism, emotional disturbances, contralateral deviation of the head and eyes, sphincter incontinence

Back 47

ACA occulsion

Front 48

UC or CD: rectal sparing

Back 48

CD

Front 49

Location of CNS lesion:
unilateral hemiplegia and contralateral cranial nerve involvement

Back 49

vertebrobasilar system

Front 50

Stepwise approach of the tx of ascites

Back 50

1. Na and water restriction
2. Spironolactone
3. Furosemide
4. Paracentesis

Front 51

UC or CD: perianal dz (skin tags, anal fissures, perirectal abscesses and anorectal fistulae)

Back 51

CD

Front 52

Neurological sx + Systemic systems + cardiac murmur and a mass on echo

Back 52

Atrial Myxoma

Front 53

UC or CD: Skip lesions

Back 53

CD
area of normal mucosa with focal ulcerations interspersed ("skip lesions")

Front 54

Dimensions of postive PPD in HIV pt and management

Back 54

> 5 mm, required Tb ppx with INH and pyridoxine (for INH-induced neuropathy) for 9 months

Front 55

Type of Seizure:
# brief periods of impaired consciousness +/- automatisms
# no post-ictal state
# Hyperventilation produces EEG changes (slow spike-and-wave pattern)

Back 55

typical absence seizure

Front 56

Type of Seizure:
# longer periods of impaired consciousness
# no post-ictal state
# hyperventilation produces EEG changes (faster spike-and-wave changes)

Back 56

atypical absence seizure

Front 57

Type of Seizure:
# adolescent
# unilateral or bilateral myoclonic jerks
# usually in mornings and may be precipitated by sleep deprivation

Back 57

Juvenile myoclonic epilepsy

Front 58

Type of Seizure:
# childhood seizures
# impaired cognitive function
# slow spike-and-wave activity on EEG

Back 58

Lennox-Gestaut syndrome

Front 59

Type of Seizure:
# brief episodes of impaired consciousness
# staring spells, automatisms
# positive post-ictal state
# no EEG changes

Back 59

Complex partial seizures

Front 60

Absolute indications for dialysis

Back 60

1. fluid overload refractory to medical management
2. hyperkalemia refractory to medical management
3. uremic pericarditis
4. refractory metabolic acidosis
5. Uremic encephalopathy or neuropathy
6. Coagulopathy due to renal failure

Front 61

Contraindications to hemodialysis

Back 61

1. debilitating chronic disease
2. severe irreversible dementia

Front 62

Elderly person with uncontrolled DM who presents with ear pain and drainage with visible granulation tissue in the ear canal and treatment

Back 62

Malignant Otitis Media caused by Pseudomonas aeruginosa

Tx: Cipro

Front 63

1st step in a work up of a thyroid nodule

Back 63

TSH, if low -> radioisotope scan; if normal or high -> diagnostic US

Front 64

HA, visual problems and sexual dysfunction

Back 64

Craniopharyngioma- the sexual dysfunction should be part of hypopituitarism

Front 65

Drug of choice in stable angina and HTN

Back 65

Beta blocker

Front 66

Abs suggestive of celiac dz

Back 66

1. IgA Ab to gliadin (ELISA
2. IgA Ab to endomysium (IF)
3. Ab to tissue transglutaminase

Front 67

Anti-Scl-70

Back 67

Scleroderma

Front 68

Anti-centromeric Ab

Back 68

Crest syndrome

Front 69

Anti-mitochondrial Ab

Back 69

PBC

Front 70

Testing for EBV

Back 70

1. heterophile Ab test
2. anti-EBV Ab

Front 71

Anti-centromeric Ab

Back 71

Crest syndrome

Front 72

Anti-mitochondrial Ab

Back 72

PBC

Front 73

Malabsorption + Fe deficiency anemia

Back 73

Celiac Dz

Front 74

Testing for EBV

Back 74

1. heterophile Ab test
2. anti-EBV Ab

Front 75

HA, vision changes, n/v, changes in awareness and/or focal neurologic deficits, HTN and bradycardia

Back 75

Intracranial HTN (ICH)
HTN + Bradycardia = Cushing's reflex

Front 76

Way to monitor recovery in DKA

Back 76

Arterial pH or anion gap

Front 77

Guidelines for screening for AAA

Back 77

One-time abdominal US in male pts 65-75 who are former or active smokers

Front 78

pain and stiffness of the shoulders and pelvic girdle with an elevated ESR

Back 78

Polymyalgia Reumatica (PMR)

Front 79

UC or CD: nicotiene decreases risk

Back 79

UC

Front 80

Symmetric proximal muscle weakness and mild pain with an elevated CK

Back 80

Plolymyositis

Front 81

UC or CD: bloody diarrhea more common

Back 81

UC

Front 82

Joint pain w/o swelling + fatigue + IBS and depression without radiographic or lab abnormalities

Back 82

Fibromyalgia

Front 83

UC or CD: inflammation of all layers of bowel

Back 83

CD

Front 84

Pathogenesis of hepatic encephalopathy

Back 84

# Accumulation of ammonia in blood
# production of false neurotransmitters
# increased sensitivity of the CNS to inhibitory NTs like GABA
# Zinc deficiency

Front 85

Precipitating factors for hepatic encephalopathy

Back 85

# high protein diet
# diuretic tx
# extensive GIB
# narcotis, hypnotics and sedatives
# Extensive paracentesis
# portocaval shunts

Front 86

Condition to ppx against in HIV pt with CD4 count < 100 and ppx measure

Back 86

Toxoplasmosis and PCP
Bactrim (Dapsone is an alternative agent for PCP PPX)

Front 87

Condition to ppx against in HIV pt with CD4 count < 50

Back 87

MAC and CMV (if also have a positive CMV IgG or bx positive for CMV)
Azithromycin and Gancyclovir

Front 88

Individuals for whom a PPD > 5 mm is positive

Back 88

1. HIV + pts
2. recent contact with TB+ person
3. Individuals with signs of TB on CXR
4. Organ transplant pts or pts on immunosuppression

Front 89

Individuals for whom a PPD > 10 mm is positive

Back 89

1. pts who emigrated from endemic area for TB
2. IVDUs
3. Residents/employees in high-risk settings
4. Pts with DM, CKD, hematologic malignancy or fibrotic lung dz
5. Children < 4 yo or teens exposed to hi-risk adults

Front 90

Individuals for whom a PPD > 15 mm is positive

Back 90

healthy ppl with no risk factors for TB

Front 91

Management for pt with + PPD, but no evidence of active TB on CXR

Back 91

INH for 6 mo
INH + pyridoxine for 6 mo

Front 92

MC vaccine preventable disease among travelers

Back 92

Hep A

Front 93

Tx for mild manifestation of a drug allergy

Back 93

Anti-histamines and discontinuing the offending agent and

Front 94

Appearance of elevated K on EKG

Back 94

1. Peaked T waves
2. Lengthening of PR interval
3. Widening of QRS
4. Sine-wave

Front 95

Drugs that commonly cause hyerkalemia

Back 95

NSAIDS, ACEi, K-sparing diuretics (spironolactone or amiloride)

Front 96

Back pain, low-grade fever, elevated ESR +/- local tenderness on percussion over lower back and paravertebral muscle spasm

Back 96

Vertebral Osteomyelitis

Front 97

Potential metabolic side effects of thiazide diuretics

Back 97

hyperglycemia, elevated LDL and TGs

Front 98

Potential electrolyte abnormalities caused by thiazide diuretics

Back 98

hyponatremia, hypokalemia and hypercalcemia

Front 99

HSM, LAD, anemia, easy bruisability and an IgM spike on SPEP

Back 99

Waldenstrom's Macroglobulinemia

Front 100

Signs of hyperthyroidism, low TSH, high T3 and T4, decreased iodine uptake on 24-hr uptake study and follicular atrophy on bx

Back 100

Factitious thyrotoxicosis

Front 101

Factors that increase cerebral blood flow and their mechanism

Back 101

Hypercapnia, increased metabolic demand and hypoxia all work to increase intracranial vasodilation

Front 102

MC type of thyroid nodules

Back 102

Benign colloid nodule

Front 103

Back pain + anemia + renal dysfunction + constipation + elevated ESR

Back 103

Multiple myeloma (the constipation is caused by hypercalcemia from bone lysis)

Front 104

Rhomboid shaped crystals

Back 104

Pseudogout

Front 105

Negatively birefringent crystals

Back 105

Gout

Front 106

Needle-shaped crystals

Back 106

Gout

Front 107

Positively birefringent crystals

Back 107

Pseudogout

Front 108

Radiographic evidence of chondrocalcinosis

Back 108

Pseudogout

Front 109

Material composing crystals in pseudogout

Back 109

Calcium pyrophosphate dehydrate (CPPD)

Front 110

Management of pts with BPH based on history and DRE

Back 110

Urinalysis and Serum creatinine to assess for UTI, obstruction and hematuria

Front 111

Mechanism of Action for metochlopramide and potential side effect

Back 111

Dopamine receptor antagonist and EPSs such as dystonia

Front 112

Gait in Parkinsonism: narrow-based or wide-based

Back 112

narrow

Front 113

Exertional dyspnea, syncope and angina + systolic ejection murmur

Back 113

Aortic Stenosis

Front 114

RBC casts

Back 114

Glomerular dz or vasculitis

Front 115

WBC casts

Back 115

Interstitial nephritis or pyelonephritis

Front 116

Muddy brown/granular casts

Back 116

ATN

Front 117

Fatty asts

Back 117

Nephrotic Syndrome

Front 118

Broad and waxy casts

Back 118

Chronic renal failure

Front 119

Young male with low back pain and restrictive pattern on PFTs

Back 119

Ankylosing Spondylitis

Front 120

FEV1/FVC ratio in restrictive dzs

Back 120

> 80%

Front 121

Type of lung dz (restrictive or obstructive) and effect on FRC that may be seen in AS

Back 121

Restrictive b/c of fusion of the costovertebral joints
FRC is usually normal or increased b/c the chest wall is fixed in an inspiratory position due to this fusion

Front 122

Classic tetrad of multiple myeloma

Back 122

CRAB:
# Calcium (hypercalcemia-> constipation)
# Renal impairment
# Anemia
# Bone (pain, lytic lesions, fxs)

Front 123

Findings on renal bx in pts with RA that have nephrotic syndrome

Back 123

Apple Green birefringence 2/2 to amyloidosis

Front 124

Persistant cough, elevation of the left main-stem bronchus

Back 124

Mitral stenosis; think rheumatic fever

Front 125

PNA with weight loss and pleuritic chest pain +/- erythema multiforme, eythema nodosum and arthralgias after trip to Southwestern Us, Centra land South America

Back 125

Coccidiodomycosis

Front 126

Acute pneumonia after trip to Southeastern, mid-Atlantic, and centrral US

Back 126

Histoplasmosis

Front 127

PNA with hemoptysis, cavitary lesions on cxr, and lesions with halo sign on CT in an immunocompromised patient

Back 127

Invasive Aspergillosis

Front 128

Meningoencephalitis in HIV pts with CD4 count < 200

Back 128

Cryptococcus

Front 129

Lung, skin, bone, joints and prostate sx in an immunocompromised pt afte a trip to the south- central or north-central US

Back 129

Blastomycosis

Front 130

When is the relative risk and the odds ratio approximately the same?

Back 130

If the out-come is not common in the population

Front 131

Types of studies where it is possible to calculate Relative Risk

Back 131

Case Series- where long-term follow up is conducted

Front 132

Types of studies in which you can calculate an odds ratio

Back 132

Case control studies

Front 133

Common complication of cardiac catheterization that causes elevated creatinine and discoloration of toes and abdominal tenderness

Back 133

"Blue toe syndrome" caused by atheromatous emboli from dislodged cholesterol plaques

Front 134

Type of cancer a/w with pernicious anemia and amount of elevated risk

Back 134

Gastric cancer; 2x relative risk of general pop

Front 135

Asx pt with microcytosis, mild anemia and target cells on peripheral smear

Back 135

Alpha/Beta thalassemia minor

Front 136

Contraindication to succinylcholine use in rapid-sequence intubation and alternative induction agents

Back 136

Pts at risks for hyperkalemia such as burn and crush injury patients and patients with prolonged demyelination like Guillain-Barre;
Vecuronium or rocuronium (non-depolarizing agents)

Front 137

Common risks of untreated hyperthyroidism

Back 137

1. Bone loss (thyroid hormones increase osteoclastic activity)
2. Cardiac arrhythmias

Front 138

Bite cells and heinz bodies on peripheral smear

Back 138

G6PD deficiency

Front 139

Spherocytes on peripheral smear and a positive Coombs test

Back 139

Autoimmune hemolysis

Front 140

Hormone elevated specifically in adrenal tumor patienst

Back 140

Dihydroepiandrosterone-Sulfate (DHEA-S)

Front 141

AMS, focal neurological deficit, glucosuria, and dehydration: condition and pathogenesis of these sx

Back 141

Non-Ketotic Hyperosmolar Syndrome (NKHS);
The glycosuria and dehydration is caused by severe hyperglycemia (> 600) and the AMS and focal neurological deficits are caused by hyperosmolality

Front 142

Neck pain, fever, limited neck mobility and inability to open the mouth normally (trismus) and treatment

Back 142

Retropharyngeal Abscess treated with broad spectrum IV abx

Front 143

Tense bullae with pruritus,and urticarial plaques and pathogenesis

Back 143

Bullous pemphigoid
Autoimmune blistering caused by IgG against the hemidesmosome and activation of compliment cascade causing inflammation (IgG and C3 seen on IF)

Front 144

Way to decrease probability of developing a febrile, non-hemolytic transfustion reaction

Back 144

Leukodepletion of the blood, such as by cell washing

Front 145

Characterization of the bruit in RAS

Back 145

systolic-diastolic abdominal bruit

Front 146

Attributable risk percent

Back 146

ARP represents the excess risk in the exposed population that can be attributed to the risk factor
ARP = (RR-1)/RR

Front 147

HA, vision changes, n/v, changes in awareness and/or focal neurologic deficits, HTN and bradycardia

Back 147

Intracranial HTN (ICH)
HTN + Bradycardia = Cushing's reflex

Front 148

Pruritic, elevated, serpiginous lesious on the skin often acquired after contact with sand

Back 148

Cutaneous larva migrans

Front 149

Lymphocytes with fine, hair-like irregular projections and a tartrate-resistant acid phosphatase (TRAP) stain with a dry BM bx and management

Back 149

Hairy cell leukemia Cladribine (purine analog toxic to BM)

BM tap is dry because the the BM becomes fibrotic

Front 150

Varicoseles that fail to empty when the patient is recumbent

Back 150

RCC

Front 151

Polycythemia, thrombocytosis in a pt with hematuria and constitutional sx

Back 151

RCC

Front 152

Flank pain, hematuria and a palpable abdominal renal mass

Back 152

RCC

Front 153

Neurological deficits that can't be explained by a single lesion

Back 153

Multiple sclerosis

Front 154

Internuclear ophthalmoplegia

Back 154

Think MS

Front 155

Fever, rash, acute renal dysfunction and eosinophiluria with WBC casts

Back 155

Interstitial nephritis usually 2/2 drug reaction

Front 156

PPX measures against Lyme disease

Back 156

1. light colored clothing to be able to spot ticks on clothes before attaching
2. tucking pants into socks and long sleeve shirts
3. DEET and permethrin to clothes and DEET to exposed skin

Front 157

Acute, severe retroorbital pain that wakes the pat from sleep and may be a/w redness of the ipsilateral eye, tearing, stuffed or runny nose and ipsilateral Horner's and management

Back 157

# cluster HA
# for acute attacke: 100% oxygen and SC sumatriptan
# PPX: verapamil, lithium and ergotamine

Front 158

Approved Tx for ALS, MOA and benefit

Back 158

Riluzole, glutamate inhibitor
may prolong survival and time to tracheostomy

Front 159

Acute severe anemia with absent reticulocytosis in sickle cell pts and offending agent

Back 159

Aplastic crisis usually a/w infection the most common of which is Parvovirus B19

Front 160

Mallory bodies on Liver bx

Back 160

# alcohol liver injury
# Wilson's Dz

Front 161

Criteria for diagnosing ARDS

Back 161

1. acute onset of respiratory distress in the setting of a predisposing condition (sepsis, PNA, aspiration, toxic ingestions, trauma and/or burns)
2. PaO2/FiO2 < 200
3. bilateral infiltrates on cxr
4. normal PCWP

Front 162

Predisposing conditions for ARDS

Back 162

Sepsis
PNA
aspiration
toxic ingestions
trauma
burns

Front 163

Pulmonary renal syndrome for which emergent plasmapheresis is required

Back 163

Goodpasture's syndrome

Front 164

Regular, narrow QRS complex tachycardia w/o P waves, management

Back 164

SVT, Adenosine is treatment of choice.
May also use carotid massage

Front 165

Wide QRS tachycardia

Back 165

Amiodarone, lidocaine

Front 166

Test that should be obtained before starting treatment with trastuzumab

Back 166

Echo because of potential cardiotoxicity

Front 167

Fever, hypotension and generalized erythema that desquemates

?? offending agent

Back 167

Toxic shock syndrome caused by exotoxin-producing strains of S. aureus sometimes a/w recent foreign body exposre such as nasal packing or tampon use

Front 168

Location of stroke:
hemi-sensory loss with sever dysesthesia of the affected area

Back 168

Thalamic Stroke
This is called thalamic pain syndrome
Eponym: Dejerine-Roussy syndrome

Front 169

Acute glaucoma: treatments, MOA and meds that should be avoided

Back 169

1. Mannitol IV (first line, osmotic diuresis)
2. Acetazolamide (carbonic anhydrase inhibitor decreases aqueous humor production)
3. Pilocarpine topical (opens canals of Schlemm and allows drainage of acueous)
4. Timolol topical (decreases production of aqueous)

AVID: mydriatics like atropine because it dilates the pupil and exacerbates glaucoma.

Front 170

Pt who presents with syncope and has elevated JVD, distant heart sounds and has enlargement of the cardiac silhouette in the setting of a recent URI
? Characteristic EKG findings and offending agent

Back 170

Pericardial effusion showing as electrical alternans on EKG caused by viral pericarditis

Front 171

Managenet of febrile neutropenia

Back 171

hosptial administration, blood samples for culture and IV ceftaz or cefepime for gram neg coverage particularly p. aeruginosa

Front 172

Sudden loss of vision and onset of floaters and cause

Back 172

Vitreous hemorrhage, MCC is diabetic retinopathy

Front 173

Intensely pruritic and erythematous rash with vesicles at multiple areas of exposed skin

Back 173

Contact dermatitis

Front 174

Epidemiological parameter that is affected by disease prevalance

Back 174

PPV and NPV. As the prevalence of the disease increases the PPV increases and the NPV decreases

Front 175

Work-up for b/l brown nipple discharge that is guaiac negative

Back 175

Galactorrhea
r/o pregnancy
measure serum PRL and TSH
+/- brain MRI to r/o prolactinoma

Front 176

Worrying conditions to monitor that are often a/w ADPCKD

Back 176

Intracerebral aneurysms

Front 177

# Skin lesion that evolves through vesicular, erythematous, and papular phases a/w localized and regional tender LAD
# offending agent
# managmenet

Back 177

# cat scratch dz
# Bartonella henselae
# 5d of azithromycin

Front 178

B/l gynecomastia and testicular nodule

Back 178

Leydig cell tumor

Front 179

Elevated serum levels in the following gonadal-associated tumors:
1. Choriocarcinoma
2. Seminoma
3. Yolk Sac tumor
4. Leydig cell tumor

Back 179

1. Estrogen
2. Beta-hCG
3. +/- beta-hCG
4. serum AFP

Front 180

Symmetric duskiness and coolness in all fingertips in ICU pt and other potential complications

Back 180

# Vasospasm caused by pressors such as norepi in pts that already have reduced distal perfusion
# mesenteric ischemia, renal failure

Front 181

Epidemiological phenomenon when the effect of the main exposure on the outcome is modified by the level of another variable

Back 181

Effect modification

Front 182

Firm, non-tender, solitary lymph node in head/neck area in an older person w/ significant smoking hx and managment

Back 182

Likely SCC, needs prompt bx

Front 183

Contraindications to AC tx in pts with a DVT

Back 183

1. recent surgery
2. hemorrhagic stroke
3. bleeding diathesis
4. active bleeding

Front 184

Low back pain a/w leg pain that worsens with sitting and produces a positive straight leg raise test

Back 184

Herniated disc

Front 185

Low back pain a/w leg pain that improves with sitting or lying still and has a negative straight leg raise test

Back 185

Lumbar spinal stenosis

Front 186

Way to screen for and confirm the dx of Duchenne muscular dystropy

Back 186

Screen: CK and aldolase are elevated
Confirm: muscle bx and genetic study (gold standard)

Front 187

Type of bilirubin that ends up in the urine

Back 187

Conjugated

Front 188

Syndrome in which an asymptomatic person p/w jaundice, scleral icterus and elevated urine bilirubin and management

Back 188

Rotor syndrome- defect in hepatic storage of conjugated bili. Tx is unnecessary

Front 189

Intermittent wide QRSs with bizarre morphology followed by a compensatory pause, management

Back 189

1. PVCs
2. Even in a post-MT pt, no tx is necessary unless they are symptomatic -> beta blocker

Front 190

MOA of oseltamivir and indications for use

Back 190

1. neuraminidase inhibitors
2. abrupt onset of fevers, chills, malaise, myalgias, cough and coryza last 48 hrs

Front 191

Areas of depigmentation in skin a/w no other sx, hypothesized pathagenesis, other associated condiations

Back 191

1. Vitiligo
2. auto-immune attack against melanocytes
3. Other auto-immune dzs, particularly: pernicious anemia, auto-immune thyroid dz, DMI, primary adrenal insuff, hypopit, and allopecia areata

Front 192

Potential tx for fibromyalgia

Back 192

TCAs (amitriptyline) or cyclobenzaprine

Front 193

Wide based gait

Back 193

Neurosyphilis or destruction of posterior columns

Front 194

Festinating gait

Back 194

Hurried, Parkinsonism

Front 195

Waddling gait

Back 195

Muscular dystrophy

Front 196

Ipsilateral ataxic gait

Back 196

Cerebellar tumor

Front 197

Gait in which one arm remains adducted and ipsilateral leg remains extended and is swung out in semi-circle

Back 197

Hemiparisis (stroke)

Front 198

EBV DNA in CSF

Back 198

Primary CNS lymphoma

Front 199

Solitary, weakly ring enhancing periventricular mass on MRI in HIV pt

Back 199

Primary CNS lymphoma

Front 200

Multiple ring-enhancing, spherical lesions on MRI in HIV pt

Back 200

Toxoplasmosis

Front 201

#Substance in stored RBCs that can cause e'lyte abnormalities
# abnormality it can cause
# resulting sx
# amount of RBCs needed to cause abnormality

Back 201

# citrate
# hypocalcemia and hypomagnesemia
# paresthesias
# > 1 blood volume in 24 hrs

Front 202

Meaning of HbSAg

Back 202

indicated infectivity

Front 203

Meaning of HBsAb

Back 203

successful vaccination and indicates non-infectivitity/immunity

Front 204

Meaning of HBcAb

Back 204

Elevated IgM fraction is most specific marker for acute HBV

Front 205

Meaning of HBeAg

Back 205

If persistantly elevated for 3 months = chronic infection

Front 206

Sudden painless loss of monocular vision and management

Back 206

Central Retinal Artery Occlusions (CRAO) usually 2/2 embolism
# ocular massage and high-flow oxygen

Front 207

Tx for kidney stones that are radiolucent in a pt with acidic urine

Back 207

Alkalinization wit potassium bicarb or potassium citrate

Front 208

Ppx and Treatment after a human bite wound and offending agents

Back 208

Amoxicillin-clavulinate for gram pos, gram neg and anaerobes

Front 209

Definition of saline responsive metabolic alkalosis

Back 209

Urine Cl < 20 mEq/L and hypovolemia or GI proton loss from vomiting

Front 210

Non-renal problems nephrotic syndrome puts people at higher risk for

Back 210

1. accelerated atherosclerosis
2. hypercoagulability

Two together = increased risk for stroke and MI

Front 211

Mechanism of dangerously high temp during exercise in extreme heat in a healthy individual

Back 211

Exertional heat stroke from failure of thermoregulation

Front 212

Middle ear effusion and a dull, hypomobile TM without signs of infection in an HIV pt

Back 212

Serous otitis media from a eustachian tube dysfunction 2/2 to HIV LAD or obstruction lymphoma

Front 213

MCC of traveler's diarrhea

Back 213

Enterotoxigenic E. coli

Front 214

Morning stiffness, dactylitis, deformity and nail involvement

Back 214

Psoriatic arthritis

Front 215

GI complaints followed by perioorbital edema, myositis and eosinophilia

Back 215

trichinosis

Front 216

Steps in management of non-ketotic hyperglycemic coma

Back 216

1. MOST IMPORTANT: NS replacement followed by 1/2 NS when euvolemic
2. Regular Insulin
3. 5% dextrose once glucose lowered to 250
4. potassium supplementation once potassium reaches normal range

Front 217

Management of caustic ingestion

Back 217

ensurance of airway patency, followed by serial abdominal and CXRs to look for perforation. If none, then assessing the extent of the injury with upper endoscopy
DO NOT ATTEMPT TO NEURTRALIZE

Front 218

Back pain, weakness, dizziness, tachycardia and evidence of anemia in a pt on warfarin

Back 218

Suspect retroperitoneal hematoma

Front 219

PNA in alcoholics that affects the upper lobes and grows mucoid colonies

Back 219

Klebsiella (encapsulated gram negative rod)

Front 220

Fever, chest pain, leukocytosis, wound drainange and mediastinal widening on CXR s/p cardiac surgery and management

Back 220

Mediastinitis
Immediate drainage, surgical debridement and prolonged Abx

Front 221

Peripheral neuropathy that develops after folate supplementation for folate deficiency anemia

Back 221

B12 deficiency- if both folate and B12 are deficient, then just replacing folate will exacerbate the B12 deficiency and cause neuropathy

Front 222

Type of nephrotic syndrome associated with active HBV infection

Back 222

Membranous Glomerulonephritis (particularly with HBeAg)

Front 223

Syncope in a young pt with a crescendo-decrescendo murmur at the LLSB

Back 223

Hypertrophic Cardiomyopathy

Front 224

Cause of chronic rhinosinusitis, nasal discharge and anosmia in a pt with Aspirin or NSAID-induced bronchospasm

Back 224

Nasal polyps

Front 225

Antidote for TCA or aspirin OD

Back 225

Sodium Bicarb

Front 226

Treatment for Lithium toxicity

Back 226

Hemodialysis

Front 227

Treatment for lead poisoning

Back 227

Calcium EDTA for moderate to severe lead poisoning
Succimer for mild to moderate

Front 228

Type of lung cancer a/w SIADH

Back 228

Small cell lung cancer

Front 229

Allopecia, skin lesions abnormal taste and impaired wound healing in a pt on TPN

Back 229

Zinc deficiency

Front 230

Sx of digoxin toxicity

Back 230

N/V/D, vision changes and arrhythmias

Front 231

How to calculate risk

Back 231

divide the number of diseased pts by the number at risk, or the number of those with the disease by the number who were exposed

Front 232

Encephalopathy, oculomotor dysfunction and gait ataxia in a person with long-term alcohol abuse and pathogenesis

Back 232

Wernicke's encephalopathy caused by thiamine (B1) deficiency

Front 233

Cause of iatrogenic Wernicke's encephalopathy

Back 233

administration of glucose without thiamine in a pt susceptible to thiamine deficiency

Front 234

MOA and use of chlorpheniramine

Back 234

H1 receptor blocker used for allergic rhinitis

Front 235

Polycythemia, nausea, dizziness and headaches

Back 235

Carbon Monoxide poisoning

Front 236

MCC of painless hematuria in adults in the US

Back 236

Bladder tumors

Front 237

Low calcium and elevated phosphorus in the presence of normal renal function

Back 237

hypoparathyroidism

Front 238

Fatigue, DOE, muscle wasting, elevated JVP, ascities with sharp x and y descents and a early heart sound after S2 and MCC in US and elsewhere

Back 238

Constrictive pericarditis
MCC in 3rd world countries: TB
MCC in the US: idiopathic, virus, radiation

Front 239

A pt with intermittant hemoptysis and a mobile cavitary mass in the lung

Back 239

Aspergilloma

Front 240

Treatment of heat stroke

Back 240

Evaporation colling: spraying the patient with water and blowing fans on him/her

Front 241

Lower abdominal pain, malaise, low-grade fever and a tender pelvic mass on rectal exam and potential cause

Back 241

Pelvic abscess from ruptured appendicitis in younger pts and diverticulitis or cancer in older pts

Front 242

MOA and main uses for ipratroptium and tiotropium

Back 242

inhaled anticholinergics for COPD

Front 243

Tx for early-disseminated or late Lyme disease

Back 243

IV ceftriaxone

Front 244

Causative agent and Tx for pt who p/w meningeal signs and encapsualted yeast on CSF cx

Back 244

Cryptococcus
IV Amphotericin B and oral flucytosine

Front 245

Vaccination recommendations for adults with chronic liver dz

Back 245

Tdap
Influenza
HAV
HBV
Pneumococcal vaccine

Front 246

Pathophysiologic mechanism of Paget's dz

Back 246

Abnormal bone remodeling

Front 247

MC extraarticular manifestation of AS

Back 247

Anterior uveitis

Front 248

Short systolic murmur at the apex that decreases with squatting

Back 248

MVP

Front 249

Trihexyphenidyl

Back 249

Anti-cholinergic agent sometimes used in the tx of Parkinson's disease, especially in younger pts when tremor is the primary sx

Front 250

Ab found in pts with scleroderma

Back 250

Antinuclear Ab
Anti-topoisomerase I Ab

Front 251

Young female w/ b/l trigeminal neuralgia

Back 251

MS

Front 252

Bright, red, firm, friable, exophytic nodules in an HIV pt

Back 252

bacillary angiomatosis

Front 253

Chronic neck pain, limited rotation and lateral bending, and bone spurs and sclerotic facet joints on xray

Back 253

Cervical Spondylosis

Front 254

Sudden onset of vertigo, vomiting and occipital headache in a hypertensive patient

Back 254

Cerebellar hemorrhage

Front 255

Major toxicity of azathioprine

Back 255

Dose related diarrhea
leukopenia
Hepatotoxicity

Front 256

Major toxicity of mycophenolate

Back 256

Bone marrow suppression

Front 257

Major side effects of Cyclosporine

Back 257

1. nephrotoxicity
2. hyperkalemia
3. gum hypertropy
4. hirsutism
5. tremor
6. HTN

Front 258

Major side effects of tacrolimus

Back 258

1. Hyperkalemia
2. tremor
3. HTN
4. nephrotoxicity

Front 259

First step in the care of a patient with new onset SLE

Back 259

Renal bx

Front 260

Anti-dsDNA

Back 260

SLE

Front 261

Sudden onset of non-inflammatory edema of the face, acral extremities, genitals, trachea and abdominal organs
# pathogenesis

Back 261

Angioedema
# C1 inhibitor deficiency or dysfunction leading to build up of C2b and bradykinin

Front 262

Paroxysmal, lightning-like pain on the face and management

Back 262

Trigeminal neuralgia and carbamazepine

Front 263

Clear lung fields, hypotention and JVD in the setting of an inferior wall MI and management

Back 263

RV infarct; fluid resuscitation and avoid nitrates

Front 264

Neck space that carries the highest risk of mediastinal involvement

Back 264

retropharyngeal space

Front 265

Non-anion gap acidosis, hyperkalemia and renal insufficiency in a diabetic

Back 265

RTA (type 4- Aldosterone insensitivity or tubular insensitivity)

Front 266

Dry cough and systemic sx lasting for mo with b/l ground glass opacities on cxr

Back 266

Cryptogenic organizing PNA

Front 267

Shoulder and arm pain in a pt w/ significant smoking hx

Back 267

"Pancoast syndrome" - apical lung neoplasm-

Front 268

Syncopal episode preceded by nausea, diaphoresis, tachycardia and pallor
? inciting incidents

Back 268

Neurocardiogenic syncope (AKA vasovagal)
# pain, stress, needles/blood and urination

Front 269

Times when Metformin should be d/c'd and why

Back 269

Acute renal failure, hepatic failure or sepsis b/c they all increase the chance of developing lactic acidosis

Front 270

Tremor and muscle weakness in a pt being treated for acute asthma exacerbation

Back 270

Likely Hyopkalemia 2/2 to high dose beta-2 agonists

Front 271

Condition and management for an HIV pt and CD4 < 200 who p/w fever, dry cough, DOE, hypoxia and b/l interstitial infiltrates on cxr

Back 271

IV TMP-SMX and prednisolone

Front 272

Abrupt onset of palpitations w/ a HR of 160 in a person w/ no h/o of structural heart dz
# MOA
# management

Back 272

PSVT is MCC of paroxysmal tachycardia in these cases
# AV nodal reentry
# carotid massage, valsalva, immersion in cold water (or adenosine)

Front 273

Hypokalemia, alkalosis and normotension

Back 273

# if urine chloride is low, suspect surreptitious vomiting
# If urine chloride is high, suspect diuretic abuse, but could also be Bartter/Gitelman's syndrome (genetic defect in renal tubular function)

Front 274

Definition of Sepsis

Back 274

SIRS criteria with a known infection
Severe sepsis: + evidence of end-organ dysfunction, thrombocytopenia, metabolic acidosis, or hypoxemia

Front 275

Course of action when a someone is exposed to HBV

Back 275

# if vaccination hx is unknown: HBV vaccine and IVIG
# if vaccinated, only need reassurance

Front 276

Approach to a pleural effusion

Back 276

If undiagnosed, must do thoracentesis. If clear-cut evidence of CHF, trial of diuretic is warranted

Front 277

First line intervention for newly diagnosed stage I HTN

Back 277

Lifestyle modifications:
1. if obese, then weightloss
2. if not obese, then DASH diet
3. low-salt diet

Front 278

Location of the pathologic process in pt with lung cancer-assciated paraneoplastic syndrome causing a rash and decreased proximal muscle strength with intact sensation and reflexes

Back 278

Muscle fibers

Front 279

MCC of lactic acidosis in pts with atherosclerotic dz and afib

Back 279

Bowel Ischemia

Front 280

RQ for main sources of fuel

Back 280

CHO ~ 1.0
protein ~ 0.8
lipid ~ 0.7

Front 281

Ring-shaped scaly patches with central clearing and distinct borders
# tx

Back 281

Tinea Corporis
# Oral griseofulvin, topical terbinafine

Front 282

What else appears on the peripheral smear of sickle cell pts besides sickle cells?

Back 282

Reticulocytes

Front 283

Hemolytic anemia, venous thrombosis, diminished hematopoiesis

Back 283

Paroxysmal nocturnal hemoglobinuria

Front 284

Drug of choice for chemotherapy induced n/v and MOA

Back 284

Odansetron- 5HT3 blockers

Front 285

Positive straight leg raise

Back 285

Suggests herniated disk

Front 286

Red flags in a pt c/o back pain

Back 286

1. age greater than 50
2. pain for longer than 1 month
3. h/o cancer
4. unexplained weight loss
5. Neurological sx
6. no response to specific therapy
7. nighttime pain causing difficulty sleeping

Front 287

High fever, chills, tenosynovitis, migratory polyarthralgiea and a small number of pustular lesion on the extremities in a sexually active person

Back 287

Disseminated Gonococcemia

Front 288

When is it safe to start anticoagulation for DVT after surgery?

Back 288

48-72 hours

Front 289

Cough productive of foul-smelling sputum and fever after an UGI or instrumentation of upper airway and tx

Back 289

Anaerobic lung infection
Clindamycin

Front 290

Crackles on pulmonary exam in a pt that presents with paroxysmal nocturnal dyspnea and has a h/o of uncontrolled HTN
# and Tx

Back 290

Cardiogenic pulmonary edema
# Nitroglycerin is the most rapid acting relief of sx

Front 291

Asymptomatic elevation of conjugated (direct) bilirubin

Back 291

Rotor and Dubin-Johnson's syndrome
If Jewish (Sephardic), likely Dubin-Johnson.
If both direct and indirect elevated, likely Rotor

Front 292

Malabsorption a/w a h/o abdominal surgery

Back 292

Bacterial overgrowth syndrome

Front 293

Prominent pulmonary arteries and enlarged right heart on CXR and RAD on EKG in a pt that p/w DOE

Back 293

Pulmonary HTN

Front 294

Types of vaccines that induce a T-cell-independent B-cell response

Back 294

Polysaccharide based vaccines

Front 295

Type of immune cell response (T-cell-dependent/independent B-cell response) utilized in the Pneumonia vaccine and why

Back 295

T-cell-independent because the Pneumococcal capsule is made out of polysaccharides

Front 296

Types of vaccines that induce a T-cell-dependent B-cell response

Back 296

Protein based vaccines

Front 297

Unilateral eye pain, redness and a dilated pupil that does not respond to light +/- n/v

Back 297

Acute angle closure glaucoma

Front 298

Treatment for cancer induced cachexia

Back 298

Progestins are first line, but corticosteroids are another alternative

Front 299

Management of AF

Back 299

# hemodynamically stable pt: Pharmacological tx- amiodarone, digoxin
# hemodynamically unstable pts: immediate cardioversion

Front 300

Yellow-white patches of retinal opacification and hemorrhages in an HIV pt who p/w a CD4 < 50 and management

Back 300

CMV retinitis; ganciclovir or foscarnet

Front 301

Pt who p/w painful and itchy red streaks that are TTP, erythematous and cord-like on exam

Back 301

Migratory thrombophlebitis (think occult malignancy)

Front 302

Condition that causes easy bruising, excessive bleeding after tooth extraction and joint swelling and the pathogenesis of persistent joint pain

Back 302

Hemophilia; deposit of hemosiderin and iron in the joint space causes cytokine-mediated synovial thickening with fibrosis and cartilage injury

Front 303

Warty, stuck-on appearing skin lesion that enlarges slowly

Back 303

Seborrheic keratosis

Front 304

Fever, night sweats, LAD, arthralgias, and diarrhea

Back 304

HIV

Front 305

Initial evaluation of patients with elevated MCV, elevated MHC and normal MCHC

Back 305

Measure B12 and Folate levels

Front 306

Sudden onset of cardiac failure in a healthy person with a recent h/o a URI and echo findings

Back 306

Viral myocarditis caused by Coxsackie B infection leading to dilated cardiomyoapathy. Echo will show dilated ventricles and diffuse hypokinesia

Front 307

A pt from Africa or Asia with high-grade periodic fevers and chills who is anemic and has splenomegaly on exam

Back 307

Malaria

Front 308

Bad prognostic indicator for pts with heart failure

Back 308

Hyponatremia- portends poor prognosis

Front 309

Nerve the innervates the muscles of the anterior compartment of the thigh (knee extension and hip flexion) and sensation to the anterior thigh and medial leg

Back 309

Femoral nerve for motor, sensation via the saphenous branch

Front 310

Nerve that innervatees the muscles of the posterior compartment of the thigh, posterior compartment of hte leg and plantar muscles (knee flexion, digits and plantar flexion and sensation to the lateral leg and plantar foot

Back 310

Tibial nerve

Front 311

Nerve that innervates the muscles of the anterior leg and sensation to the anterolateral leg

Back 311

Superficial nerve (branch of the common peroneal/fibular nerve

Front 312

Nerve that innervates the muscles of the lateral leg and provides sensation to the dorsum of the foot

Back 312

Deep peroneal nereve (branch of the common peroneal/fibular nerve)

Front 313

Tx for urge incontinence

Back 313

Oxybutynin

Front 314

Tx for overflow incontinence

Back 314

Bethanechol

Front 315

Urethral discharge, right knee pain, right heel pain, low-back pain and mouth ulcers with a synovial tap showing WBC of 10 and many PMNs with a negative gram stain

Back 315

Reactive Arthritis; NSAIDS
Not gonococcal because afebrial

Front 316

Sudden onset of target-shaped, mucocutaneous lesions adn system signs of toxicity and pathogenesis

Back 316

Stevens Johnson syndrom; immune complex mediated HS rxn

Front 317

MCC of ductopenia in adults

Back 317

PBC

Front 318

Sorte throat, hyperemic and edematous oropharyngeal mucous membranes, chilitis, stomatitis, glossitis, normocytic-normochromic anemia, seborrheic dermatitis and photophobia

Back 318

Riboflavin (Vitamin B2 deficiency)

Front 319

Type of BP readings seen in patients with thyrotoxicosis and MOA

Back 319

Systolic hypertension with an increase in pulse pressure and caused by hyper dynamic circulation

Front 320

Mass involving the mandible or abdominal viscera with a high mitotic index and a starry sky appearance on histologic exam
# Associated conditions
# type of cells involved

Back 320

Burkitt Lymphoma
# a/w EBV infx
# it is a neoplasm of mature B cells

Front 321

Child with infection, LAD, splenomegally with many blasts on differential with PAS positive material and positive immunostaining for TdT
# types of cells involved

Back 321

# Acute lymphoblastic leukemia
# TdT is expressed only by pre B and pre T cells

Front 322

Characteristics of basal cell carcinoma

Back 322

1. open sore that bleeds, oozes or cursts and remains open for > 3 wks
2. Reddish patch or irritated area
3. Shiny bump or nodule that is pearly or translucent and often pink, red or white
4., Pink growth with slightly elevated rolled border and a crusted indentation in center
5. Scar-like area which is white, yellow or waxy and often has poorly defined borders

Front 323

Treatment for BCC

Back 323

Cauterization, cryosurgery, radiation or surgical removal (Mohs with 1-2 mm margin)

Front 324

Personality changes, memory loss and cortical atrophy on CT scan

Back 324

Alzheimer's dementia

Front 325

Ssteps in the management of symptomatic sinus bradycardia

Back 325

1. IV atropine to increase HR by decreasing vagal output
2. If a med is a responsible, switch
3. Transcutaneous pacing
4. permanent pacemaker if necessary

Front 326

Nephrotic range proteinuria and hematuria with C3 deposits seen on IF of renal bx and pathogenesis

Back 326

# Membranoproliferative glomerulonephritis, type 2 (AKA dense deposit disease)
# persistent activation of alternative complement pathway

Front 327

Unremitting epistaxis, ruby-colored, partially-blanching oral lesions with clubbing and polycythemia

Back 327

Hereditary Telengiectasia (Osler-Weber-Rendu syndrome)
# clubbing and polycythemia likely from hypoxia 2/2 pulmonary AVMs causing a right to left shunt

Front 328

Insidious onset of dyspnea and dry cough in the absence of constitutional symptoms with a h/o of anterior uveitis

Back 328

Sarcoidosis

Front 329

Proximal muscle weakness and absent DTRs in a smoker and pathogensis

Back 329

Lambert-Eaton syndrome as a paraneoplastic syndrome a/w small cell lung cancer
# autoantibodies againse pre-synaptic voltage gated Ca channels

Front 330

Low luekocyte alkaline phosphatase with leukocytosis

Back 330

Chronic Myelogenous Leukemia

Front 331

Auer Rods

Back 331

Seen in Acute Myelogenous Leukemia

Front 332

Imaging modality of choice to diagnose kidney stones

Back 332

Spiral Ct without contrast

Front 333

Young adult who p/w thrombocytopenia, microangiopathic hemolytic anemia, neuroloic disturbances, renal dysfunction and fever

Back 333

Thrombotic thrombocytopenic purpura

Front 334

Ototoxic drugs

Back 334

1. Aminoglycosides
2. CTx drugs
3. Loop diuretics (furosemide)

Front 335

Cardiac causes of acute Afib

Back 335

1. acute ischemia
2. heart failure
3. myopericardial inflammation
4. Valve disease
5. surgery

Front 336

Metabolic conditions that can cause acute afib

Back 336

1. catecholamine surge
2. hypothyroidism

Front 337

Pulmonary causes of acute afib

Back 337

1. acute lung dz (e.g. pneumonia)
2. pulmonary emboli
3. hypoxia

Front 338

Drugs that can cause acute afib

Back 338

1. EtOH
2. cocaine
3. amphetamines
4. theophylline

Front 339

Affect of placing a consolidated lung segment in the dependent position and explanation

Back 339

It would decrease the pt's oxygenation because the consolidated portion is now dependent and receiving more of the pulmonary blood flow thereby increasing right-to-left shunt

Front 340

CHD risk-equivalents

Back 340

1. DM
2. symptomatic carotid artery dz
3. AAA
4. PAD
5. 10 yr risk of CHD of > 20%

Front 341

Affect of placing a consolidated lung segment in the dependent position and explanation

Back 341

It would decrease the pt's oxygenation because the consolidated portion is now dependent and receiving more of the pulmonary blood flow thereby increasing right-to-left shunt

Front 342

CHD risk-equivalents

Back 342

1. DM
2. symptomatic carotid artery dz
3. AAA
4. PAD
5. 10 yr risk of CHD of > 20%

Front 343

Acute massive increases in AST and ALT with milder associated increases in total bilirubin and alk phos in a recently hypotensive pt

Back 343

Ischemic hepatic injury AKA "shock liver"

Front 344

Sudden onset of sharply demarcated, erythematous, edematous, tender skin lesion with raised borders in a febrile pt
# causative agent

Back 344

Erysipelas
GAS/S. pyogenes

Front 345

Pulsatile, holocranial headaches that wake the pt from sleep a/w a "whooshing" sound, n/v, blurry vision, with papilledema, 6th nerve palsy, but not meningisumus or sinus tenderness

Back 345

Idiopathic Intrcranial Hypertension/pseudotumor cerebri

Front 346

Criteria for diagnosis of IIH/Pseudotumor cerebri

Back 346

1. Signs of increased ICP in an alert patient
2. absence of any focal neurological signs except a 6th nerve palsy
3. Normal CSF exam except for elevated opening pressure (< 20 mm)
4. Absence of any ventricular abnormality other than reduction in size (slit-like ventricles) or other causes of increased ICP (masses, e.g.)

Front 347

The most common histologic lesion in diabetic nephropathy

Back 347

Diffuse glomerulosclerosis
Nodular glomerulosclerosis (Kimmelstiel-Wilson nodules) is pathognomonic

Front 348

Rapid impairment of vision in on eye marked by a central scotoma, afferent pupillary defect, changes in color perception and decreased visual acuity and associated condition

Back 348

Optic Neuritis; often a/w MS

Front 349

Conditions pts with HIT need to be monitored for

Back 349

Arterial and venous clots

Front 350

CT scan showing Dilation of the entire ventricular system with distinct enlargement of hte subarachnoid space over the cerbral cortex

Back 350

Communicating hydrocephalus most commonly caused by SAH

Front 351

Management of a pt < 55 yo with new onset of dyspepsia w/o weight loss dysphagia or persistent vomiting

Back 351

H. Pylori serology test OR empiric treatment with PPIs

Front 352

Tx for moderate to severe acne that is predominantly nodulocystic form

Back 352

Oral isotretinoin

Front 353

Tx for acne in pts that have developed scars

Back 353

Oral isotretinoin

Front 354

Common skin findings in pts with PBC, pathogenesis and histological appearance

Back 354

# Xanthelasma- cholesterol filled yellow plaques on the medial aspects of the eyelids bilaterally
# due a reduced ability to absorb and store fat-soluble vitamins.
# lipid filled macrophages in the dermis

Front 355

Management of an alcoholic pt who p/w pain raidiating to his back, markedly elevated amylase and lipase after binge drinking

Back 355

Analgesics, IVF and NPO

Front 356

Pulmonary parameter that can be estimated in a ventilated pt by performing end-inpiratory hold maneuver

Back 356

Lung compliance, b/c the end inspiratory pressure is the product of elastance and the gas delivered and since compliance is inversely related to compliance, a decrease in compliance would show up as an increase in elastic pressure

Front 357

Pulmonary parameter that can be calculated by examining the peak airway pressures

Back 357

Airway resistance

Front 358

A pt that p/w skin necrosis several days after starting warfarin

Back 358

Congenital Protein C deficiency

Front 359

MCC of mesenteric ischemia is an embolus from the heart

Back 359

Embolus from the heart

Front 360

Swollen joint with a WBC of 2,000-50,000 in synovial fluid

Back 360

Gout

Front 361

Tense abscess and intense throbbing pain in the distal volar space.
# what is it called
# who gets it
# tx

Back 361

# Felon
# tailors (from needle punctures)
# cephalosporins

Front 362

Throbbing pain in the distal pulp space, swelling, and tenderness with non-purulent vesicles
# what is it called
# who gets it
# tx

Back 362

# herpetic whitlow
# health care workers exposed to orotracheal secretions
# no real tx, can you oral acyclovir or topical bacitracin to prevent secondary infx

Front 363

Lobe of the brain involved in a pt with hemineglect

Back 363

Right (non-dominant) parietal lobe

Front 364

Lobe of brain involved if a pt presents with a hemiparesis

Back 364

non-dominant frontal lobe

Front 365

Lobe of brain involved if a pt presents with a hemiparesis and misarticulated speech

Back 365

Dominant frontal lobe

Front 366

Increased RBC mass, mild granulocytosis, elevated platelet count, mild HTN, peptic ulceration, gouty arthritis, plethoric face and splenomegaly

Back 366

Polycythemia Vera

Front 367

MCC of pancreatitis

Back 367

In men: alcohol abuse
In women: gallstones

Front 368

Location of lesion based on when hematuria happens

Back 368

Beginning: urethra
End: prostate or bladder
Entire: ureters or kidneys

Front 369

Painless terminal hematuria with clots

Back 369

Bladder disease

Front 370

Prevention of malignant melanoma

Back 370

Protective clothing

Front 371

Types of nerves involved in diabetic neuropathy and treatment

Back 371

Small fiber neuropathy is suggested by pain.
# TCAs, but if urinary sx or orthostatic hypotension are a concern, then gabapentin

Front 372

Dull aching and swelling of the left side of scrotum that does not transilluminate and increases in size during valsalva

Back 372

Varicocele

Front 373

Rapid onset of wheezing then respiratory distress and LOC during a blood transfusion and suspected underlying condition

Back 373

Anaphylactic reaction; suspect IgA deficiency

Front 374

Urinary cyanide nitroprusside test

Back 374

Looks for elevated cysteine levels

Front 375

Pt p/w sx of a kidney stone, a pmh and fhx of stones, hexagonal crystals on urinalysis and pathogenesis, positive urinary cyanide nitroprusside test and pathogenesis

Back 375

Cysteinuria 2/2 abnormality in amino acid transport

Front 376

Potential complication of Hashimoto's thyroiditis

Back 376

Lymphoma of the thyroid

Front 377

UC or CD: non-caseating granulomas

Back 377

CD

Front 378

UC or CD: creeping fat

Back 378

CD

Front 379

Dry eyes, dry mouth, difficulty swallowing, dental caries and b/l firm submandibular swellings.
# tests to order to confirm dx
# histologic appearance of swellings

Back 379

Sjogren syndrome
# antibodies to Ro/SSA or La/SSB
# lymphocytic infiltrates of swollen salivary glands

Front 380

Occaisional episodes of nocturnal substernal CP a/w ST elevations in I, aVL, V4-V6 and normal BP
# pathogenesis
# management
# meds to avoid

Back 380

Prinzmetal's angina/variant angina caused by vasospasm
# non-dihydropyridine CCBs (Dilt or Verapamil) and/or nitrates
# avoid non-selective BB and ASA

Front 381

Chemical agents used in perfusion scanning and their MOA

Back 381

Dipyrimadole or adenosine.
# "Coronary Steal" they cause non-diseased coronary vessel dilation which steals blood from diseased vessels allowing the identification of the areas supplied by the diseased vesselss

Front 382

Sudden onset of ataxia, vomiting, occipital HA, gaze palsy and facial weakness in a hypertensive pt

Back 382

Cerebellar hemorrhage

Front 383

MC side effects of digoxin

Back 383

GI (anorexia, nausea, vomiting)

Front 384

Drugs that increase digoxin concentrations

Back 384

Verapamil

Front 385

Type of bone abnormality in Osteomalacia

Back 385

defective bone mineralization 2/2 to decreased availability of Ca and Phos at mineralization sites

Front 386

Type of bone abnormality in Rickets

Back 386

Defective mineralization of bone and growth plate cartilatge

Front 387

Type of bone abnormality in Paget's dz of the bone

Back 387

Disordered skeletal remodeling in focal areas

Front 388

Type of bone abnormality in osteoperosis

Back 388

Low bone mass, but the bone that is there is normally mineralized

Front 389

Painful ulcers in mouth and painful flaccid blisters on skin with skin layers that separate with slight pressure
# histological hallmark
# pathogenesis

Back 389

# pemphigus vulgaris
# Intercellular IgG deposits in the epidermis
# autoantibodies to desmoglein (adhesion molecule)

Front 390

Sudden cessation of mental activity that last 30 sec and have abrupt return to consciousness w/ no automatisms or post-ictal state and may also recur several times a day
# how to diagnose

Back 390

# Absense/Petit Mal seizures
# diagnose w/ characteristic EEG pattern after provocation (hyperventilation, photic stimulation, sleep)

Front 391

Pathogenesis of normal pressure hydrocephalus

Back 391

Decreased CSF absorption

Front 392

Acute renal failure a/w arthralgia, a maculopapular rash, and WBC casts made mostly of Eos w/ a h/o recent bactrim use

Back 392

Drug induced interstitial nephritis

Front 393

Definition of null hypothesis

Back 393

a statement of "no relationship" b/w the exposure and the outcome

Front 394

Medical intervention that has the greatest likelihood of slowing AAA progression

Back 394

Smoking cessation

Front 395

Management of a pt who presents more than 5 days after onset of sx of appendicitis and have RLQ findings

Back 395

1. IV hydration
2. Bowel Rest
3. Abx with coverage for gram negatives and anaerobes- either a 3rd gen ceph (cefotetan) or a fluoroquinolone + metronidazole

Front 396

Fever, weight loss, and frequent diarrhea and bloody stools with evidence of colonic dilation on xray.
# management

Back 396

# UC with toxic megacolon
# IV fluids, bowel rest
# IV steroids
# +/- Abx

Front 397

The immune function that is impaired in asplenic patients

Back 397

Phagocytosis: the processing of Ab covered capsulated organisms by opsonization takes place in the spleen

Front 398

The immune function that is impaired in chronic ganulomatous dz

Back 398

Intracellular killing (defect in NADPH oxidase)

Front 399

The immune function that is impaired in SCID

Back 399

Ab production b/c of decreased circulating lymphocytes

Front 400

The immune function that is impaired in leukocyte adhesion defect

Back 400

Chemotaxis (auto-recessive defect in integrin Beta2)

Front 401

The immune function that is impaired in DiGeorge syndrome

Back 401

Cell mediated immunity because of thymic aplasia caused by a deletion in chromosome 22

Front 402

Pt who p/w 2 wk h/o f/c/generalized weakness and a pmh of pyelo, recent cystography for persistent dysuria, rheumatic fever. Exam: 2/6 systolic murmur and tender erythematous lesions on finger tips.

Back 402

SBE caused by enterococci introduced by cysto

Front 403

Pt w/ isolated asymptomatic thrombocytopenia

Back 403

Think HIV b/c low platelets is the initial presentation of HIV in 10% of pts

Front 404

Best cardiac biomarker to use to evaluate recurrent CP in the setting of recent tx for acute MI and why

Back 404

CK-MB because it returns to normal w/i 1-2 days

Front 405

Management of hyperthyroid

Back 405

Radioactive iodine to destroy thyroid follicular cells; important to pretreat with methimazole b/c dying thyroid cells release thyroid hormone

Front 406

Travel-associated PNA with high fever, cough, GI sx and confusion
# characteristic lab results
# tx

Back 406

Legionella pneumophila
# Sputum gram stain shows many PMNs but no orgs b/c it is a poorly staining GNR (should order urinary Ag)
# azith or levo

Front 407

Type of arrhythmias tx w/ procainamide and potential side effects

Back 407

# atrial and ventricular arrhythmias
# Nausea, drug-induced-lupus, agranulocytosis, and QT prolongation

Front 408

Type of arrhythmia treated with lidocaine, class of anti-arrhythmic and potential side effects

Back 408

# Ventricular arrhythmias
# Class IB anti-arrhythmic
# confusion, seizures and respiratory depression

Front 409

Type of arrhythmia treated with quinidine, class of anti-arrhythmic and potential side effects

Back 409

# atrial arrhythmias
# class IA anti-arrhythmic
# diarrhea, tinnitus, QT prolongation, torsades de pointes, hemolytic anemia and thrombocytopenia

Front 410

Type of arrhythmias tx w/ digoxin and potential side effects

Back 410

# atrial arrhythmias
# nausea, anorexia, AV block, and Ventricular and supraventricular arrhythmias

Front 411

Type of arrhythmia treated with Amiodarone, class of anti-arrhythmic and potential side effects

Back 411

# ventricular arrhythmia
# class III anti-arrhythmia
# Pulmonary fibrosis (**), hypo-and hyperthyroidism, hepatotoxicity, corneal deposits and skin discoloration

Front 412

Drugs shown to have proven mortality benefit in CHF

Back 412

ACEi (dose dependent), ARBs, BB and spironolactone

Front 413

Pt who p/w weakness and DOE who has muffled heart sounds, JVD, hypotension on exam
# pathophysiology for sx

Back 413

Beck's triad for cardiac tampenade
# sx caused by restriction in ventricular filling

Front 414

ABI values and their meanings

Back 414

# 1-1.3: normal
# < 0.9 sensitive and specific for >50% occlusion
# <0.4 c/w limb ischemia

Front 415

Management of overflow incontinence 2/2 epidural anesthesia

Back 415

Intermittent catheterization

Front 416

Mechanism of kidney damage in SLE patients

Back 416

Immune complex deposition in the glomeruli leading to complement activiation. Will see a decrease C3 level.
# same mechanism as in post-streptococcal glomerulonephritis

Front 417

Approach to a person who p/w with likely organophosphate overdose with bradycardia, miosis, rhonchi, muscle fasciculations, lacrimation, urination, defecation and covered in his own vomit

Back 417

Must give atropine immediately to counteract the cholinergic effects of the organophosphate, but must also remove clothing and scrub skin to prevent further transcutaneous exposure

Front 418

Test of choice when a pt p/w an unprovoked new-onset seizures

Back 418

CT of the head w/o contrast

Front 419

Common side effects of cyclophosphamide and way to avoid some serious

Back 419

1. Hemorrhagic cystitis
2. Bladder carcinoma
3. sterility
4. myelosuppression
(cystitis and carcinoma are caused by the acrolein metabolite and can be prevented by hydration and MESNA)

Front 420

Side effects of platinum chemotherapeutic agents and cancers they are used for

Back 420

Cochlear dysfunction
Testicular, ovarian and bladder

Front 421

Weight loss/f/ns/cough productive of purulent sputum that grows partially acid-fast gram-positive branching rods and a cavitary lesion on cxr in a pt on chronic steroid and tx

Back 421

Nocardiosis (N. asteroides)
TMP-SMX

Front 422

Pt who develops jaundice on POD2/ s/p complicated CABG in which he required 10 units of PRBCs and his elevated bili, alp and mildly elevated AST/ALT

Back 422

Post-operative cholestasis
May also p/w hypotenstion

Front 423

Maneuvers that will increase the intensity of a systolic ejection murmur in a pt with hypertrophic cardiomyopathy

Back 423

Valsalva maneuver and standing- it is one of the only murmurs that increases with a decrease in preload, this is because the obstruction is greater with less preload

Front 424

Effect on circulation of squatting

Back 424

Increases Venous return because it shortens vertical height of the blood column and it increases SVR.

Front 425

Effect on circulation of sustained handgrip

Back 425

Increases SVR and hence afterload;
Used to differentiate b/w:
Aortic stenosis: decreases
Mitral regurg: increases

Front 426

Effect on circulation of recumbency

Back 426

Increases venous return

Front 427

Most common malignant tumor of the eyelid which is a slow growing papule with pearly, rolled borders and overlying telengiectasias.
# management

Back 427

BCC
Needs excision because it can spread locally

Front 428

An obese African American IVDU pt w/ peripheral edema, periorbital edema, ascites and probable right-sided pleural effusion

Back 428

FSGS- more common cause of nephrotic syndrome in an AA adult, with obesity and heroin use

Front 429

Hemiparesis and disturbances in speech, gait and vision in an HIV pt with mutiple, hypodense, non-enhansing lesions and no mass effect in the cerebral white matter

Back 429

PML caused my JC virus (a human polyoma virus)

Front 430

Arthralgias, weight loss, fever, diarrhea, abdominal pain, chronic cough and a diastolic murmur with a small intestine bx that shows PAS material in the lamina propria

Back 430

Whipple's dz caused by Tropheryma whippelii

Front 431

MCC of endocarditis after dental procedures

Back 431

members of the S. Veridans group: S. mitis, S. sanguis, S. mutans, and S. Salivarius

Front 432

Bacteria that commonly cause dental carries

Back 432

S. mutans

Front 433

Common cause of prosthetic valve endocarditis

Back 433

S. epidermidis

Front 434

Palatal ulcers, HSM and pancytopenia in an immunocompromised pt from Missouri

Back 434

Histoplasmosis

Front 435

Female who p/w dull aching pain in the RUQ who has been on OCPs for 10 yrs and has a bx that shows enlarged hepatocytes containing glycogen and lipid deposits

Back 435

Hepatic adenoma

Front 436

Pt w/ epigastric pain and a mass at the pylorus that is positive for infiltrating, low-grade, gastrica MALT lymphoma that hasn't metastasized
# management

Back 436

Most likely because of H. pylori infx and manegement consists of PPI, clarithromycin, and amoxacillin

Front 437

Appropriate management in a female pt who p/w rapidly developing virilization

Back 437

Serum tetstosterone and DHEAS. Normal testosterone and high DHEAS indicates adrenal source; elevated testosterone and normal DHEAS suggests ovarian source

Front 438

Single round blue inclusions in RBCs on Wright stain.

Back 438

Howell-Jolly bodies which are nuclear remnants and indicative of physical or functional asplenism b/c they are typically removed by the spleen

Front 439

Test to confirm the diagnosis of polycythemia vera

Back 439

JAK2 mutation testing

Front 440

Test to order on a pt that p/w high fevers, confusion, productive cough who is found to have an extremely high WBC that is predominantly lymphocytes

Back 440

Flow cytometry will prove or disprove clonality

Front 441

Smudge cells on smear and an extremely high WBC in an individual > 70yo

Back 441

CLL

Front 442

Approach to a person with elevated direct bilirubin

Back 442

# if predominantly elevated AST/ALT, look for hepatocellular/intrahepatic causes
# if ALP is predominant, do ERCP or PTC to look for extrahepatic obstruction

Front 443

Chronic diarrhea and oocytes visible on acid fast stain of stool specimen in HIV pt with CD4 count < 180

Back 443

Cryptosporidium parvum

Front 444

Microcytic hypochromic anemia with hypochromic and normochromic RBCs on smeer

Back 444

Acquired sideroblastic anemia

Front 445

Microcytic hypochromic anemia with elevated serum Fe and decreased TIBC

Back 445

sideroblastic anemia

Front 446

Elevated JVD, hypotension, RBBB on ECG, along with CNS sx

Back 446

Suspect massive PE.
The PE causes RHF, then decreased CO leading the LHF -> bradycardia -> cardiogenic shock

Front 447

Red eye with lymphocytes in the anterior chamber in a pt with cough, SOB, fever

Back 447

Description of anterior uveitis and sarcoidosis

Front 448

Painful, swollen knee with a WBC count of 98,000 in a pt with a prosthetic joint and a fever of 104

Back 448

Staphylococcal septic arthritis; the prosthetic joint increases the risk of septic arthritis and a WBC > 50,000 separates this from crystal-induced arthritis

Front 449

AG acidosis in a homeless alcoholic with eye symptoms

Back 449

Methanol poisoning

Front 450

AG acidosis in a homeless alcoholic with evidence of renal injury

Back 450

Ethylene glycol poisening

Front 451

Approach to hypercalcemia in a pt that likely has MM who p/w abd pain and neuropsychiatric disturbances

Back 451

NS infusion: this is symptomatic hypercalcemia and the IVF + loop diuretics should bring calcium down

Front 452

Best test to order in a young person with hypertension, muscle weakness and numbness

Back 452

Aldo/renin ratio

Front 453

First step in the management of pt who presents with AKI with acute oliguria, azotemia and increased Cr level

Back 453

Foley catheterization to relieve possible urinary retention.

Front 454

Tx for ITP

Back 454

systemic immunosuppression with steroids

Front 455

Parameters to check for DIC

Back 455

Platelet count: down
PT: elevated
Fibrinogen: decreased

Front 456

Approach to a pt with detectable serum HBsAg, HBeAg, HBV DNA and anti- HBcAg IgG

Back 456

This is chronic HBV, treatment is recommended if ALT is elevated -> interferon or lamivudine

Front 457

Tx of an acute exacerbation of MS

Back 457

Corticosteroids

Front 458

Tx of MS to reduce frequency of exacerbations

Back 458

Beta-interferon or glatiramer acetate

Front 459

Common benign side effect of rifampin

Back 459

Red to orange discoloration of urine

Front 460

Type of liver injury caused by INH and features of injury

Back 460

Idiosyncratic- not dose-dependent and has a variable latent period and looks a lot like viral hepatitis histologically

Front 461

Anterior mediastinal mass

Back 461

4 Ts: thymoma, teratoma, thyroid neoplasm, terrible lymphoma

Front 462

Way to differentiate seminomatous tumors from non-seminomatous

Back 462

Seminomatous: 1/3 will have elevated beta-hCG and normal AFP
Non-seminomatous: elevated AFP and beta-hCG

Front 463

Initial therapy for rosacea

Back 463

Topical metronidazole

Front 464

Long term management for pts with hereditary spherocytosis and eplanation

Back 464

Folic acid supplementation. This is because they are more prone to deficiency and hence severe anemia as their erythopoiesis is ramped up

Front 465

MCC of megaloblastic anemia in alcoholics

Back 465

Folate deficiency- alcohol impairs its enterohepatic cycle and inhibiting its absorption

Front 466

Initial management of a pt that presents with symptomatic hyperthyroidism (racing heart, tachy, tremor, seating, anxiety)

Back 466

Propanolol until the underlying cause of the hyperthyroidism can be established and treated

Front 467

Infection that pts with hereditary hemochromatosis are at increased risk for

Back 467

Listeria monocytogenes because of impaired phagocytosis 2/2 to high iron overload in the reticuloendothelial cells and b/c Listeria love oxygen. Same goes for Yersinia septicimia and Vibrio vulnificus

Front 468

Approach to pt with high serum calcium and normal (inappropriately high) PTH levels

Back 468

Check urine calcium/creatinine ratio. Familial Hypocalciuric Hypercalcemia will have a low ratio while primary hyperparathyroidism has high urinary calcium excretion

Front 469

Neurofibrillary tangles

Back 469

Alzheimer's dementia

Front 470

Difference b/w Lewy Body Dementia and Alzheimer's Dementia

Back 470

Alzheimer's pts have more pronounced anterograde memory loss and lter hallucination and changes in alertness than LBD

Front 471

Alterations in consciousness, disorganized speech, visual hallucinations, EPSs (rigidity, e.g.) and early compromise of executive functioning and pathalogical feature

Back 471

Lewy Body Dementia; Lewy Bodies- eosinophilic intracytoplasmic inclusions representing accumulations of alpha-synuclin protein in the substantia nigra, locus ceruleus, dorsal raphe and substantia innominata

Front 472

Purpose of administering NaHCO3 in a TCA overdose

Back 472

Alleviate the cardio-depressant action on sodium channels

Front 473

Morning facial puffiness and b/l LE edema in a pt w/ a h/o IVDU, recurrent pulmonary infx, psoriasis who has hepatomegaly, palpable kidneys, high BP and an S4 on exam with a negative HIV test

Back 473

Amyloidosis: think Amyloidosis in a pt with multisystem complaints, especially neprhotic syndrome, who has a h/o of a chronic inflammatory dz or IVDU

Front 474

1st line tx in uncomplicated and complicated UTI

Back 474

# Uncomplicated: oral TMP-SMX, or nitrofurantoin
# Complicated: fluoroquinolone (Cipro or Levo)

Front 475

CSF findings: lymphocytic pleocytosis, increased number of erythrocytes, elevated protein in a pt that had a seizure and recent fevers and HA

Back 475

HSV encephalitis

Front 476

A post-BMT pt who p/w lung and intestinal problems

Back 476

CMV pneumonitis

Front 477

A person who prominently flexes his hip and knee and slaps that foot with each step

Back 477

Steppage gait as compensation for foot drop. The foot drop is caused by peripheral neuropathy to the nerve roots contributing to the common peroneal nerve: L4-S2

Front 478

Approach to cocaine-related cardiac ischemia

Back 478

Benzos to allay the anxiety, HTN and tachycardia, and aspirin and nitrates to prevent thrombus formation and reduce cardiac O2 demand

Front 479

Exact pathology of renal failure in a pt w/ chronic analgesic use and findings on urinalysis

Back 479

papillary necrosis and chronic tubulointerstitial nephritis; May have sterile pyuria (WBC casts)

Front 480

One exception to the rule that live viruses should not be given to HIV pts

Back 480

MMR vaccine should be given to any HIV pt w/ a CD4 > 200 and w/o a h/o an AIDS-defining illness

Front 481

Only to reverse heart failure in a person suffering from alcoholic dilated cardiomyopathy

Back 481

abstinence from drinking

Front 482

Type of lung cancer a/w hypercalcemia

Back 482

Squamous Cell (remember sCa++mous)

Front 483

Diastolic decrescendo murmur heard best at the 3rd left ICS that increases with hand grip and medical tx

Back 483

Aortic regurgitation; Afterload reduction with an ACEi or nifedipine

Front 484

Unexplained hemolytic anemia and thrombocytopenia in a pt with renal failure and neurologic sx and management

Back 484

TTP-HUS syndrom
Needs plasmapheresis (plasma exchange) as soon as possible to remove the offending antibody

Front 485

Pancystolic murmur that radiates to the axilla

Back 485

Mitral valve regurg

Front 486

MCC of mitral valve regurgitation

Back 486

Mitral valve prolapse

Front 487

Bilaterally symmetrical maculopapular rash involving the entire trunk and extremities including the palms and soles along with Condyloma lata in the anogenital area

Back 487

secondary syphillis

Front 488

Painless blisters and hyperpigmentation a/w HCV infx and estrogen ingestion

Back 488

Porphyria cutanea tarda

Front 489

Hyperglycemia, erythematous, scaly plaques on multiple area and diarrhea

Back 489

Suspect glucagonoma.

Front 490

Bilaterally symmetrical maculopapular rash involving the entire trunk and extremities including the palms and soles along with Condyloma lata in the anogenital area

Back 490

secondary syphillis

Front 491

Painless blisters and hyperpigmentation a/w HCV infx and estrogen ingestion

Back 491

Porphyria cutanea tarda

Front 492

Hyperglycemia, erythematous, scaly plaques on multiple area and diarrhea

Back 492

Suspect glucagonoma.

Front 493

Immunocompromised pt who p/w dry cough, fever, dyspnea who is found to be tachypneic, tachy and cyonotic on exam and show b/l diffuse interstitial infiltrates beginning in the perihilar region

Back 493

PCP pneumonia

Front 494

Nausea, vomiting, abdominal pain, diarrhea, arthralgias and myalgias in a pt w/ a h/o substance abuse who is hospotalized for another issue

Back 494

Opioid withdrawal. Can use methadone because the pt is being treated for a medical issue, not specifically for withdrawal

Front 495

Useful test to differentiate b/w liver and heart-related causes of LE edema in a pt with both heart and lung dz.

Back 495

Hepato-jugular reflex. IF positive, it suggests heart; if negative, it suggests liver

Front 496

What other condition are pts with nephrotic syndrome susceptible to?

Back 496

Hypercoagulability: arterial thrombosis and PE (Renal vein is most frequent)

Front 497

Intense itching, hyperemia, tearing, conjunctival edeam and eyelid edema in a pt with a personal or family h/o asthma; pathogenesis; management

Back 497

Allergic conjunctivitis; caused by exposure to allergens; it usually resolved in 24 hrs

Front 498

A pt that p/w deep abdominal pain, fever and chills several weeks after sustaining upper abdominal trauma at which time abd CT was neg

Back 498

Pancreatic laceration causing a retroperitoneal abscess

Front 499

Tx for active HCV

Back 499

interferon and ribavirin (HBV is lamivudine)

Front 500

A pt who p/w 1 year h/o watery diarrhea, abdominal cramps and frequent episodes of dizziness, flushing, wheezing and a feeling of warmth and hepatomegaly and a murmur;
# what vitamin or mineral will they become deficient in

Back 500

# this is serotonin syndrome
# they will become deficient in niacin because their body uses all of the tryptophan to synthesize serotonin rather than niacin

Front 501

Diarrhea, dermitits and dementia

Back 501

3 Ds of niacin deficiency

Front 502

Symmetric polyarthritis of acute onset and short duration a/w low-grade fever with a positive RF and weekly positive ANA

Back 502

Viral arthritis (not rheumatological) because it resolves quickly and b/c viruses such as hepatitis, HIV,mumps, rubella and parvovirus can have a positive RF

Front 503

Tx for acute PCP

Back 503

TMP-SMX and steroids

Front 504

Dietary recommendations for patients with renal calcula

Back 504

1. decreased dietary protein and oxalate
2. decreased sodium intake
3. increased fluid intake
4. INCREASE dietary calcim

Front 505

Approach to a pt with elevated transaminases in the setting of HCV infx, HBV immunity.

Back 505

Vaccinate against Hep A b/c co-infection would cause acute hepatic failure

Front 506

Approach to a pregnant pt who p/w sx of aortic dissection and elevated BP

Back 506

Treat the BP first

Front 507

A patient who presents with acute delirium or ataxia in malnourished pt

Back 507

Suspect Wernicke's encephalopathy and give thimine

Front 508

Pain and stiffness in the neck, shoulders and hips, an eleveted ESR and morning stiffness lasting over an hour and management

Back 508

PMR low dose prednisone unless a/w GCA (then use high dose steroids and order temporal artery bx)

Front 509

A patient who presents with acute delirium or ataxia in malnourished pt

Back 509

Suspect Wernicke's encephalopathy and give thimine

Front 510

Pain and stiffness in the neck, shoulders and hips, an elevated ESR and morning stiffness lasting over an hour and management

Back 510

PMR low dose prednisone unless a/w GCA (then use high dose steroids and order temporal artery bx)

Front 511

Tx of histoplasmosis in an HIV pt

Back 511

IV amphotericin B and lifelong itraconazole

Front 512

Bloody diarrhea with abdominal pain, lack of fever, no travel hx

Back 512

EHEC O157:H7

Front 513

JVP, hepatomegally, ascites, distant heart sounds and LE edema w/o evidence of pulmonary congestion in a smoker

Back 513

Cor pulmonale 2/2 to COPD

Front 514

Steps to breaking bad news

Back 514

1. make sure pt is a quiet, comfortable and private environment
2. Ask the pt how much he knows or what he thinks he might have
3. Ask how much he wants toknow
4. Warn that the situation is more serious that I originally though
5. If he wants to know the dx, give him the dx, i.e. "advances lung ca."\
6. Give the prognosis, but make sure to tell him that options are available to keep him as comfortable as possible
7. try to explain everything as simply as possible

Front 515

Bleeding test results in a pt with SLE and evidence of VTE disease (DVT and PE)

Back 515

PTT will be spuriously prolonged b/c lupus anti-coagulant binds the phospholipids used in the assay.

Front 516

Possible presentations of gonococcal septic arthritis in young sexually active individuals

Back 516

1. Asymmetric polyarthritis with tenosynovitis and a skin rash
2. isolated purulent arthritis affecting one or a few joints

Front 517

Sudden onset of abdominal pain, fever and hematuria in a pt with improving nephrotic syndrome and likely pathophysiological process involved

Back 517

Renal vein thrombosis 2/2 to loss of anti-thrombin III in the urine; the most common variety of nephrotic syndrome a/w renal vein thrombosis is membranous glomerulopathy

Front 518

Diagnostic criteria of malignant HTN

Back 518

1. Papilledema, retinal hemorrhages and exudates
2. Malignant nephrosclerosis (fibrinoid necrosis of the capillaries and arterioles
3. CNS involvement: hemorrhages, infarcts, encephalopathy

Front 519

Metabolic process that involves both Cobalamin and Folate such that an elevated level of a substrate for the process is suggestive;
# how do you differentiate b/w deficiencies in them

Back 519

They are necessary for the converion of homocysteine to methionine, so a deficiency in either one will cause an elevated homocysteine.
Cobalamin is needed for the conversion of methylmalonyl-CoA to succinyl-CoA, so an elevated level of methylmalonic acid means that Cobalamin is low

Front 520

Systemic condition involving the upper and lower respiratory tracts and kidneys which may also present with cutaneous ulceration;
# how to diagnose
# treatment

Back 520

Wegener's; C-ANCA positive against proteinase-3
# cyclophosphamide

Front 521

Reason why lidocaine is not used prophylactically in pts with acute coronary syndrome

Back 521

It increases the risk of asystole

Front 522

Cervicofacial non-tener, indurated mass that slowly develops into multiple abscesses, that drains yellow fluid and grows gram positive branching bacteria and management

Back 522

Actinomycosis

High dose PCN for 6-12 wks

Front 523

Common cause of refractory hypokalemia in alcoholics

Back 523

hypomagnesemia

Front 524

Monomorphous erythematous papules without comedones on face arms and trunk in a pt w/ SLE who is taking prednisone for a flare

Back 524

Steroid acne

Front 525

Pseudofractures, blurring of the spine

Back 525

Osteomalachia: low/low normal Ca, low phosphate, elevated PTH

Front 526

most serious side effect of Anti-thyroid drug therapy (examples of drugs)

Back 526

Agranulocytosis
Methimazole, propylthiouracil

Front 527

Hepatic cyst following a bout of bloody diarrhea after a trip to Mexico

Back 527

Amebic liver abscess caused by Entamoeba histolytica

Front 528

MCC of pneumonia in nursing homes

Back 528

S. Pneumo

Front 529

A young person with a long h/o of headaches refractory to OTC analgesics and painless hematuria
# pathogenesis

Back 529

# analgesic nephropathy
# renal papillary necrosis caused by analgesic-induced vasoconstriction of the medullary blood vessels

Front 530

Differntiating b/w exudative and transudative pleural effusion

Back 530

Lights' criteria. If 1 is satisfied, then exudative:
1. pleural/serum protein > 0.5
2. pleural LDH/serum LDH > 0.6
3. pleural LDH > 2/3 upper limit of normal for serum LDH

Front 531

Differentiating b/w complicated and uncomplicated pleural effusion

Back 531

Complicated- needs chest tube if:
1. positive gram stain
2. positive culture
3. fluid pH < 7.2
4. glucose < 60

Front 532

Criteria for qualifying for home O2

Back 532

1. PaO2 < 55 or SaO2 < 88% on room air
2. Signs of cor pulmonale, pulm HTN or hct > 55%
3. hypoxia during exercise of sleep

Front 533

Goal of home O2 and suggested use

Back 533

Maintain SaO2 > 90 % during sleep, normal waking and at rest; Significant benefit if used more than 15 hrs/day

Front 534

Guidelines for initiating symptomaitc treatment for Parkinsonism

Back 534

For pts < 65yo, dopamine agonists (bromocriptine, ropinirole)
For pts > 65you levodopa/carbidopa

Front 535

Only medicine that can slow progression of parkinsonism

Back 535

Selegiline

Front 536

Tx for MS

Back 536

Glatiramer acetate

Front 537

Pulsus paradoxus

Back 537

Cardiac tamponade

Front 538

New cardiac finding in an acute MI

Back 538

S4 gallop because of diastolic dysfunction

Front 539

Arrhythmia suggestive of digitalis toxicity

Back 539

Atrial tachycardia with AV block

Front 540

MEdication prescribed for essential tremor that may cause abdominal pain, neurologic and psychiatric abnormailities.

Back 540

Primidone (can cause acute intermittent porphyria). Can be diagnosed by checking urine porphobilinogen

Front 541

Medicines that commonly cause Folic Acid deficiency and hence megaloblastic anemia

Back 541

Phenytoin, MTX, TMP-SMX

Front 542

Medications that can cause pseudotumor cerebri

Back 542

Isotretinoin
Vitamin A toxicity

Front 543

Cause of nephrotic range proteinuria, axotemia and normal sized kidneys in an HIV pt

Back 543

Focal segmental glomerulosclerosis

Front 544

Epidemiolog/biostatistical factor controlled for by matching

Back 544

Confounding

Front 545

Changes in memory a/w systemic changes such as weight gain, fatigue and constipation

Back 545

hypothyroidism

Front 546

Common CSF finding in pts with MS

Back 546

Oligoclonal bands- will have a normal protein level, but elevated immunoglobulins, particularly IgG

Front 547

High calcium and low phosphorus

Back 547

Hyperparathyroidism

Front 548

Monoarthritis in the setting of hypercalcemia

Back 548

Pseudogout caused by the deposition of Calcium Pyrophosphate Dihydrate crystals (CPPD)

Front 549

Synovial fluid analysis in a pt with hyperparathyroidism and monoarthritis

Back 549

Rhomboid shaped, positively birefringent

Front 550

Initial work-up in pts with HIV

Back 550

# VDRL
# PPD
# Hep A and B serology
# Toxo titer

Front 551

Hypotenstion pansystolic murmur that radiates to the axilla in a pt that is 3d s/p acute anterior wall MI

Back 551

Papillary muscle rupture leading to mitral regurgitation

Front 552

Management of solitary brain metastasis

Back 552

Surgical resection followed by whole brain radiation if extracranial dz is stable and there are not multiple lesions

Front 553

Management of multiple brain metastasis

Back 553

palliative whole brain radiation

Front 554

Management of an acute MI with bibasilar crackles and hypoxia

Back 554

This is flash pulmonary edema; beta blockers are contraindicated here and a diuretic should be used, particularly furosemide

Front 555

Sudden loss of vision with optic disk swelling ,retinal hemorrhage, dilated veins and cotton wool spots on funduscopic exam

Back 555

Central retinal VEIN occlusion

Front 556

Sudden painless loss of monocular vision and pallor of the optic disk, cherry red fovea and boxcar segmentation of the blood in the retinal veins

Back 556

Central retinal ARTERY occlusion

Front 557

Bradycardia, hypotension and wheezing in a suicide attempt in a pt who has HTN

Back 557

Most likely OD on BB.
1. IVF and atropine
2. If that doesn't work, try glucagon

Front 558

New onset CHF in a pt 1 mo s/p anterior wall MI who has a new apical pan-systolic murmur radiating to the axilla, persistant ST segment elevations and an echo that shows wall motion abnormality

Back 558

Ventricular aneurysm

Front 559

Normal skin at birth that gradually becomes more dry and scaley over the extensor surfaces and is worse in the winter

Back 559

Ichthyoisis

Front 560

Bacillary angiomatosis

Back 560

# caused by Bartonella spp in immunocompromised pt
# causes characteristic cutaneous and visceral angioma-like blood vessel growths that may hemorrhage on bx
# Abx

Front 561

Managment of hypercalcemia 2/2 to malignancy

Back 561

Bisphosphonates

Front 562

Diff b/w open angle glaucoma and angle closure glaucoma

Back 562

Open angle is insidious and p/w gradual loss of peripheral vision and cupping of the optic disk on funduscopic exam
# angle closure is sudden onset of blurred vision, eye pain, n/v with a red eye, hazy cornea and a fixed dilated pupil on exam

Front 563

Mechanism of arrhythmias in pts who die 2/2 to acute MI

Back 563

Reentry, e.g. vfib

Front 564

Indications for tx of Paget's dz of the bone (6)

Back 564

1. bone pain
2. hypercalcemia of immobilization
3. neurological deficit
4. high output cardiac failure
5. preparation for orthopedic surgery
6. involvement of weight-bearing bones (to prevent deformities)

Front 565

Pitting vs. non-Pitting edema

Back 565

# Pitting: caused by increased intravascular hydrostatic pressure, decreased plasma oncotic pressure, or increased capillary leak (burns, trauma, infx)
# non-Pitting: lymphatic obstruction (lymphedema) or the accumulation of albumin and other proteins w/ low or normal lymphatic flow (myxedema)

Front 566

Indications for transfusion in a pt with CHF

Back 566

Hb/Hct < 10/30

Front 567

Sx of ethylene glycol poisoning

Back 567

# Hematuria and flank pain because it causes a renal tubular damage and calcium oxalate crystals
# metabolic acidosis

Front 568

Sx of methanol poisoning

Back 568

# visual disturbances
# metabolic acidosis

Front 569

Type of lung cancer that produces ectopic ACTH

Back 569

Small cell lung cancer

Front 570

Paraneoplastic syndromes of Small Cell lung cancer

Back 570

SIADH
ACTH/Cushing's

Front 571

Bullous Pemphigoid vs. Pemphigus Vulgaris: Tense bullae

Back 571

BP

Front 572

Bullous Pemphigoid vs. Pemphigus Vulgaris: oral cavity involvement

Back 572

PV

Front 573

Bullous Pemphigoid vs. Pemphigus Vulgaris: intraepidermal blisters

Back 573

PV

Front 574

Bullous Pemphigoid vs. Pemphigus Vulgaris: linear Ig deposition along BM on IF

Back 574

BP