Step 2

Front 1

Drug of choice for trigeminal neuralgia?

Back 1

Carbamazapine

Front 2

A patient has increased ICP, what drug can you give?

Back 2

Mannitol

Front 3

Diuretic most often causing hypokalemia?

Back 3

Loop Diuretic

Front 4

Ototoxicity is caused by which diuretic class?

Back 4

Loop Diuretic

Front 5

What side effect caused by Mannitol would be a contraindication in patients with CHF presenting with increased ICP from a head trauma?

Back 5

Pulmonary Edema

Front 6

Inheritance of Huntington's Dz?

Back 6

AD

Front 7

Earlier onset of Huntington's Dz (age 20) is most likely from Autosomal Dominant inheritance from mom or dad?

Back 7

Dad

--------------------------------------------------

This is paternal anticipation and the CAG repeat sequence is far less stable in spermatogenesis than oogenesis which leads to earlier onset of Huntington's

Front 8

This Autosomal Dominant syndrome presents with Vascular lesions to the retina and CNS. It also causes renal carcinoma/failure and pheochromocytoma.

Back 8

von-Hippel Lindau

Front 9

What type of brain tumor is most prevalant in Von-Hippel Lindau?

Back 9

Hemangioblastoma (SUB-tentorial) ---------------------------------

Autosomal Dominant Vascular lesions of Retina and CNS Increased risk of Renal Cell Carcinoma and failure Increased risk of pheochromocytoma

Front 10

A woman with anoxeria is admitted to te hospital and TPN is started. What metabolic derrangement must you be careful of?

Back 10

HYPOphosphatemia --------------------------------------------

Basal metabolic rate is depressed, but increases once re-feeding occurs. There is not enough Phosphate available for the higher demand for ATP. This can cause multiple organ system problems (confusion, Arrythmias, MSK)

Front 11

A woman with anoxeria is admitted to te hospital and TPN is started. What must you be careful of?

Back 11

Re-feeding Syndrome --> Hypophosphatemia

Front 12

Patient is hit in the head with a bat. Experiences a brief loss of consciousness. Regains consciousness and is lucid. Has headache and slowly begins to have an altered mental status.

Back 12

Epidural Hematoma

Front 13

Vasculature damaged in Epidural Hematoma?

Back 13

Middle Meningeal a.

Front 14

Vasculature damaged in Subdural Hematoma?

Back 14

bridging veins

Front 15

Most common locations for berry aneurysms in patients with Sub-arachnoid hemmorhage?

Back 15

Anterior Communicating Artery **(M/C)** and Posterior Communicating Artery

Front 16

Convex deformit on CT scan with a skull fracture

Back 16

Epidural Hematoma

Front 17

Patient presents after head trauma: CT shows a concave, crescent- shaped hyperdensity

Back 17

Subdural Hematoma

Front 18

What is the systolic BP goal for a patient with a hematoma/brain bleed?

Back 18

< 160 mm Hg

Front 19

A 40-year-old man is brought to the hospital by his wife after he came into the house salivating and complaining of diarrhea and nausea. He was out all day on his farm working with the corn crops. On physical examination, he is wheezing, and his pupils are constricted but reactive to light. Which of the following is the best next step in managing this patient? A. Administer naloxone B. Give diphenhydramine C. Immediately give pralidoxime D. Provide activated charcoa E. Remove all of the patient's clothing

Back 19

E. Remove all of the patient's clothing ----------------------------------------------------------- Then, pralidoxime (and atropine if needed)

Front 20

Treatment of choice for acute MS?

Back 20

IV Methylprednisolone --------------------------------------

Prednisone taper is given after high dose IV Methylprednisolone

Front 21

In Bipolar I: Patients have mania for at least _______

Back 21

1 week ------------------------

Causes significant impairment

Front 22

In Bipolar II: Patients have HYPOmania for at least _______

Back 22

4 days -------------------------------- No significant impairment

Front 23

If lithium cannot be used to treat Bipolar disorder, what is the next first-line treatment?

Back 23

Valproic Acid (Valproate)

Front 24

Why is Buproprion contraindicated in Anorexia?

Back 24

Risk of Seizure

Front 25

Pharmacotherapy for Bulemia nervosa?

Back 25

SSRI (fluoxetine, duoexetine,paroxetine, citalopram, sertaline)

Front 26

What class of Psych drugs: imipramine, amitriptyline, desiparmine, nortriptyline

Back 26

TCA's

Front 27

What class of Psych drugs: fluoxetine,paroxetine, citalopram, sertaline

Back 27

SSRIs

Front 28

What class of Psych drugs: venlafaxine, duloxetine

Back 28

SNRIs

Front 29

What class of Psych drugs: phenelzine, isocarboxazid, tranylcypromine, selegiline

Back 29

MAO Inibitors

Front 30

What atypical antipsychotic commonly caused weight gain and dyslipidemia?

Back 30

Olanzapine

Front 31

Which psych drugs cause Neuroleptic Malignant Syndrome?

Back 31

High-potency antipsychotics (haloperidol, droperidol, fluphenazine, thiothixene)

Front 32

Patient starts an antipsychotic medication and within a few DAYS begins to have: Fever Muscle Rigidity "lead pipe" decreased consciousness increased BP Tachycardia

Back 32

Neuroleptic Malignant Syndrome

Front 33

Normal bereavment lasts for no more than _____ months

Back 33

6 months

Front 34

High voltage "triphasic spikes" on EEG in a patient with acute progressive dementia and myoclonus

Back 34

Creutzfeldt-Jakob disease

Front 35

History of stroke within ___ months is an absolute contraindication to thrombolytic therapy in a patient with suspected stroke

Back 35

3 months

-------------------------------------------------------

Other contraindications:

* -Surgery w/in 14 days
* -Intracranial Hemorrhage
* -Severe uncontrolled HTN
* -AVMs
* - Intracranial tumor

Front 36

Thrombolytic therapy must be given within ____ hours of suspected stroke

Back 36

3 hours

------------------

**Recombinant thrombolytics must be given within 4.5 hours**

Front 37

A patient presents with HYPOnatremia, low serum osmolarity and highly concentrated urine. What is the Dx?

Back 37

SIADH

------------------------------------------

Anti-diuretic Hormone

Front 38

First-line treatment for a patient with status epilepitcus?

Back 38

Lorazepam

Front 39

What studies confirm amyotrophic lateral sclerosis (ALS)?

Back 39

Nerve conduction and electromyography (will show wide-spread muscular denervation and motor block)

Front 40

Patient presents with both UMN and LMN symptoms. Electromyography shows wide-spread muscular denervation and motor block. What is the diagnosis?

Back 40

ALS

Front 41

Schizophreniform disorder is diagnosed when a patient has symptoms of schizophrenia for less than ___ months

Back 41

6 months

------------------------

More than 6 mo = Schizophrenia

Front 42

A patient is diagnosed with a social phobia (fear of embarassment in social situations, dreads going into public)

What is the first line pharmacological Tx?

Back 42

SSRI/SNRI

---------------------------------------

Beta-blockers and Benzo's are useful for performance situations (public speaking)

Front 43

Bilateral trigeminal neuralgia in a young female patient?

Back 43

Multiple Sclerosis

Front 44

Two drugs you can use to treat NMS?

Back 44

Dantrolene

Bromocriptine

Front 45

Torticollis due to SCM contracture is defined as:

Myoclonus

Dystonia

Akathesia

Back 45

Dystonia

Front 46

_________ is the painless loss of vision from emboli and is a warning sign of impending stroke.

Back 46

Amaurosis fugax

-------------------------------------

Emboli commonly come from the bifurcation of the carotid a. Do a duplex carotid U/S

Front 47

In patient's with suspected Acetomeniphen overdose, a serum acetomeniphen level should be obtained ______ hours after ingestion to determine the next step in treatment

Back 47

4 hours

(you can use activated charcoal during these 4 hours)

---------------------------------------------

N-acetylcistine is the antidote

Front 48

Always suspect _____________ when a pt w/ Parkinson-like symptoms experiences postural hypotension, impotence or incontinenc

Back 48

Multiple System Atrophy

(Shy-Drager Syndrome)

-----------------------------------------------------------------

Characterized by:

1-Parkinsonism

2-Autonomic dysfunction (Postural hypotension, abnormal sweating, bowel or bladder control problems, abnormal salivation or lacrimation, Impotence or gastroparesis) 3-Widespread neurological signs

Tx: Intravascular Volume Expansion (incr. BP/Volume, high salt diet)

Front 49

Elderly patient presents with gradual onset of:

1) Confusion

2) Ataxia

3) Urinary Incontinence

Back 49

Hydrocephalus

------------------------------------------------

"Wet, Wild and Whacky"

Front 50

Shizophrenia:

Fluphenazine & Haloperidol (both are typical antipsychotics & long acting and injectable) are the tx of choice in pts who suffer relapses due to ____________________.

Back 50

Non-compliance

------------------------------------------

These are given as 2 injections/month

Front 51

Shizophrenia is characterized by (high/low) Dopamine

and

(high/low) Glutamate

Back 51

High Dopamine

Low Glutamate

Front 52

Schizophrenic patients who are catatonic (extreme rigidity) should be given ____________

Back 52

Benzodiazepines

(Lorazepam)

Front 53

A patient is brought to the ED after losing consciousness while standing in line. A bystander says he witnessed the fall and the patient was making jerking movements. What is the next best step

Back 53

non-Contrast CT (if clear) ---> MRI or CT w/contrast

(You have to rule out hemorrhage, even in the case of syncope or seizure)

Front 54

______________ is a focal weakness in part of the body after a seizure

Back 54

Todd's Paralysis

Front 55

What is the Tx of choice for seizure?

Back 55

Benzo's

(lorazepam -> diazepam -> midazolam)

--------------------------------------------------

If benzo's don't work use phenytoin

[phenytoin can also be used for prophylaxis]

Front 56

Sudden onset, PAINLESS & mostly unilateral photophobia and floaters, the most classic description is "a curtain coming down over my eyes"

Back 56

Retinal Detachment

Tx: laser and cryotherapy

Front 57

Most commonly by HSV & VZV (rare) in HIV pts. Associated with pain keratitis, uveitis and peripheral pale lesions

Back 57

Acute Retinitis

------------------------------------------------

If CMV is the cause, it's painless, there is no keratitis or conjunctivitis

Front 58

HIV patient's right eye presents as yellowish-white patches of retinal opacification and retinal hemorrhages & is painless

Their CD4 count is < 50.

Back 58

CMV retinitis

Tx: Ganciclovir, Foscarnet

Front 59

Most common cause of retinitis in HIV patients?

Back 59

HSV

Front 60

Treatment for cluster headaches?

Back 60

100 % pure O2

Front 61

Best treament for a patient with a social phobia?

Back 61

CBT, add an SSRI if necessary

Front 62

Best treatment for a patient with a fear of flying?

Back 62

CBT, add an SSRI if necessary

Front 63

67 yr old post-op patient is complainng of increasing abdominal pain with bloody diarrhea the day after an Abdominal Aortic Aneurysm repair graft. The graft was taken from the inferior mesenteric artery. His LLQ is painful to palpation, his temperature is 101 F, his respirations are 22, BP is 110/65. Femoral pulses are intact bilaterally.

What is causing this?

Back 63

Sigmoid Colon Ischemia

--------------------------------------------

(1-7% incidence in Abdominal Aorta Surgeries)

The inferior mesenteric artery supplies the Sigmoid Colon and can fail after it is used for a graft.

Front 64

Pt. presents with a painful, watery, red eye that has been persistent for 2 days. Slit lamp examination reveals vesicles and dendritic ulcers of the cornea.

Most likely diagnosis?

Back 64

Herpes Keratitis

Front 65

Contact lens wearers are at increased risk for what corneal issue?

Back 65

Bacterial Keratitis

--------------------------

Central ulcer with an adjacent stromal abscess

Front 66

An elderly patient complains of fever, malaise, and a burning itchy sensation in his left periorbital area. Examination reveals a vesicular rash in the distribution of the cutaneous branch of the V1 devision of the Trigeminal nerve.

The left eye has conjunctivitis and corneal ulcers. What is going on?

Back 66

Herpes zoster ophthalmicus

Front 67

A construction worker present to the ER after sanding wood all day. His left eye is extremely painful and he states that light makes it worse.

What is the most likely diagnosis?

Back 67

Corneal Abrasion

------------------------------------

Intense pain with photophobia

Front 68

Are patients presenting with DKA hyper/or/hypo kalemic?

Back 68

(Paradoxical) HYPERkalemia

--------------------------------------------

Intracellular potassium crosses into the serum in exhange for hydrogen ions and hyperosmalrity (K is actually lost, but it is all extracellular in the serum!!!)

Insulin usually drives the K back into the cell! (but there is no insulin action in patients with DM 1 in DKA)

Must hydrate, give insulin and K+ because insulin will drive what little K+ is left back into the cells and the patient will become Hypokalemic...

Front 69

A patient is crushed under a log. What metabolic complication can be expected?

Back 69

Hyperkalemia

-----------------------------------

Damaged cells spill K+ into the serum

Front 70

A previously healthy 2 month old infant presents with bilateral ptosis, sluggish pupillary response to light, poor suck reflex, poor gag reflex and a descending paralysis of all 4 limbs.

Baby has not ingested any foods, and especially not honey. Mom likes to take baby on walks around their newly constucted neighborhood.

Back 70

Clostridium botulinum

------------------------------------------------------------

(Floppy Baby)

Toxin blocks ACh release at presynaptic neuromuscular junctions

Spores can be ingested from dust: IV Human-derived botulism immune globulin

Spores can also be ingested from honey: IV Equine-derived botulism immune globulin

**DDX: Guillan Barre has ascending paralysis**

Front 71

A child presents with symmetric proximal muscle weakness and hyporeflexia. Weakness is greater in the lower extremities. Pupils are unaffected.

Back 71

Werding Hoffman disease

(Spinal Muscular Atrophy)

Front 72

Difference between food-borne and infantile botulism?

Back 72

Foodborne: Ingestion of toxin, prodrome of nausea/Vomiting and abdominal pain

Infantile: Inhalation of spores from soil dust (m/c in California, Utah, and Pennsylvania)

Front 73

What is a pharmacologic treatment proven to help patients with hoarding disorder that are alseo receiving cognitive-behavioral therapy?

Back 73

SSRI's

Front 74

What's a good reason to withhold diagnosis information from a patient?

Back 74

Patient is depressed and at risk of suicide

Front 75

Crescendo-decrescendo murumur systolic ejection murmur that in the right 2nd intercostal space that radiates to the carotid arteries.

Back 75

Aortic Stenosis

--------------------------------------------

May hear pulsus parvus et tardus

-(weak/small (parvus), and late (tardus) relative to its usually expected character)

weak S2, and S4 may also be present

Front 76

A pregnant woman presents for prenatal care. She is estimated to be at 28 weeks gestation.

She has moved to your state and states that she has been negative for HIV, Chlamydia, gonorrhea and urine cultures were negative.

Her blood type is A negative and she is Rh (D) negative.

What should be done at this time?

Back 76

Rh (D) antibody test

----------------------------------------------------------

Rhesus Isoimmunization

This results in formation of Anti-Rh antibodies in the mother's after the 1st pregnancy and they cross over to baby's circulation and cause hemolysis of baby blood. In severe cases it causes Hydrops Fetalis. In mild cases it causes, jaundice, w/i the first 24hr after birth. Any incident that causes bleeding can cause this (amniocentesis, CV Sampling, abortion, ectopic pregnancy, labor and delivery.)

The best tx is to prevent mother's immune system to be in contact with fetus blood cells, the best thing is AntiD-gammaglobin (Rho-GAM) which prevents contact by decreasing availablity of fetal RBC in maternal circulation. In case mother was not sensitized (antibody titers <1:6) RhoGAM is still indicated. It should be given to ALL Rh-negative women at 28 weeks and w/i 72 hours AFTER DELIVERY (NOT BEFORE!!) any procedure of incident (ie. abortion) and delivery

Front 77

When do you give AntiD-gammaglobin (Rho-GAM) to a Rh (-) mother with an Rh (+) fetus?

Back 77

Small dose at 28 weeks

72 hours AFTER DELIVERY (NOT BEFORE!!) any procedure of incident (ie. abortion)

Front 78

Most common indication for hysterectomy?

Back 78

Uterine fibroids

Front 79

Woman presents with dysmenorrhea, heavy menses and an enlarged uterus. What is the cause?

Back 79

Utine fibroids

--------------------------------------------

These are estrogren dependent tumors!

- increase in size with OCP's

- increase in size during pregnancy

- decrease/regress after menopause

Front 80

A patient is involved in a highspeed MVA where his car hit a concrete barrier. Chest X-ray shows a widened mediastinum, left hemothorax, deviation of the mediastinum to the right.

What is the diagnosis?

Back 80

Aortic Injury

Front 81

Patient is in an MVA and presents to the emergency department with Hypotension, distended neck veins, muffled heart sounds

Back 81

Cardiac Tamponade

-------------------------------------

Need a pericardiocentesis to drain blood surrounding the heart!

Beck's Triad: Hypotension, distended neck veins, muffled heart sounds

Front 82

Patient is involved in an MVA:

Presents with abdominal pain that travels to the right shoulder, vomiting and difficulty breathing.

X-rays show abdominal viscera above the diaphram

Back 82

Ruptured Diaphragm

Front 83

A woman presents with with mood swings, irritability, bloating and headaches and breast tenderness. These occur monthly and often she has to take a day or two off of work.

She is not sure if her symptoms coincide with menstruation.

What is the next best step in order to diagnose PMS?

Back 83

A menstrual diary can confirm that these symptoms arise 1-2 weeks before menstruation

----------------------------------------------------

Premenstrual Dysmorphic D/o is a severe varient of PMS and presents with prominent irritability and anger symptoms

Front 84

Gold standard for diagnosing endometriosis?

Back 84

Laparoscopy

Front 85

Woman presents with pelvic and back pain that is worse during her premenstrual period, sex and defecation.

Back 85

Endometriosis

--------------------------------------------

Laparoscopy is the gold standard for Dx

Front 86

Most common sequalae of Endometriosis?

Back 86

Decreased fertility/Infertility

---------------------------------------------

Up to 30% of females with infertility are found to have endometriosis

Front 87

An HIV-positive patient presents with altered mental status. He is lethargic, disoriented and has loss of recent memory.

CD4 count is 40/microL

Brain MRI shoes a weakly ring enhancing mass in the periventricular region.

PCR of CSF shows EBV DNA.

What is the most Likely Dx?

Back 87

Primary CNS Lymphoma

------------------------------------

Presence of EBV in CSF is specific in this condition.

MRI shows a weakly ring enhancing mass in the periventricular region

Front 88

HIV positive patient presents with an altered mental status.

Brain MRI shows multiple, ring enhancing spherical lesions in the basal ganglia.

Back 88

Toxoplasmosis

-----------------------------------------------

Note: A positive Toxoplasma serology is common in normal subjects and therefore is not specific in toxoplasmosis

Front 89

An HIV positive patient presents with an altered mental status.

MRI shows cortical and subcortical atrophy and secondary ventricular enlargement

Back 89

AIDS dementia

Front 90

False Negatives will ___________ when the cut-off level of a diagnostic test is raised.

Back 90

False Negatives

Increase!!

Front 91

During a study, subjects change their behavior because they know they are being observed.

What is this called?

Back 91

Hawthorne Effect

Front 92

Screening tests have (high/low) sensitivity

Back 92

Screening tests have high sensitivity

-------------------------------------------------

as a result, screening tests have LOW specificifty

Front 93

Which of the following has not been proven to increase survival in patients with CHF?

-ACE Inhibitors

-ARBs

-Beta-blockers

- Digoxin

-Aspirin

-Spironolactone

Back 93

Digoxin has not been proven to improve survival in patients with CHF

----------------------------------------

Digoxin is a cardiac glycoside that helps improve the contractility of the heart. It helps resolves dyspnea and fatigue. It has been shown to decrease hospitalization time with no benefit in mortality.

[Digoxin and Loop diuretics only treat symptoms of CHF but do not improve survival]

Front 94

Which of the following has not been proven to increase survival in patients with CHF?

-ACE Inhibitors

-ARBs

-Beta-blockers

- Loop Diuretics

-Aspirin

-Spironolactone

Back 94

Loop Diuretics have not been proven to improve survival in patients with CHF

--------------------------------------------------

Used for symptomatic relief. The only class of diuretics proven to increase survival in pts with CHF are are aldosterone antagonists (spironolactone, eplerenone)

[Digoxin and Loop diuretics only treat symptoms of CHF but do not improve survival]

Front 95

A 60 year old male patient presents with fever, back pain, and focal spinal tenderness. He had a UTI 2 weeks ago. His urinary symptoms have resolved. His labs show increased WBCs, ESR and C-reactive protein.

He has a history of BPH, and the digital rectal exam shows an enlarged, non-painful prostate with no nodules or irregularities.

Spinal x-ray shows no abnormalities.

What is the next best step?

Back 95

MRI of spine

-------------------------------------------

You're looking for osteomyelitis. Likely cause is from a Staph aureus UTI in this case.

If MRI shows osteomyelitis, the next step is a CT-guided bone biopsy

Front 96

A mother presents with her 2 year old child who is having vomiting, and aggitation. While in the ER, the patient develops lethargy and stupor.

Mom says that the child had a cold which she treated with aspirin.

Most likely diagnosis?

Back 96

Reye Syndrome

-----------------------------------------

Characteristic lab findings are hyperammonemia, normal or slighly increased bilirubin and Alk Phos, increased prothrombin time, hypoglycemia, moderate to severe elevations in AST and ALT, and increased LDH

treatment is supportive

Front 97

An immigrant mother brings her 3 year old son into the ED for stridor and acute onset of high fever. The patient appears toxic and is leaning forward and drooling.

The child has had no immunizations since immigrating to the U.S.

You suspect epiglottits caused by which organism?

Back 97

H. influenzae Type B

-----------------------------------------------

All children in the US are vaccinated for HiB.

Front 98

A mother brings her 3 year old son into the ED for stridor and acute onset of high fever. The patient appears toxic and is leaning forward and drooling.

Diagnosis?

Back 98

Epiglottitis

----------------------------------------------------------

Next step is endotracheal intubation with prep for a tracheostomy (tubing these kids is difficult)

Front 99

a 65 year old man complains of difficulty hearing in high-noise environments such as restaurants. He has no history of exposure to loud noises.

Most likely diagnosis?

Back 99

Presbycusis

------------------------------------

Bilateral sensorineural hearing loss often seen in the 6th decade. High-frequency hearing loss occurs. Patint shave difficulty hearing in noisy, crowded environments

Front 100

Overdose:

Patient has tachycardia, aggressive behavior, ataxia, mild hypertension and multi-directional nystagmus

Back 100

PCP overdose

Front 101

Overdose:

Tachycardia, hypertension, dilated pupils (mydriasis), sense of euphoria, increased arousal.

Back 101

Cocaine Overdose

Front 102

Overdose:

Tachycardia, hypertension, dry mouth, conjunctival injection, increased appetite

Back 102

Marijuana Overdose

Front 103

An expectant mother experiences a stillbirth. Baby is small in size, has multiple fractures and limb deformities, and blue sclerae

Back 103

Osteogenesis Imperfecta Type II

--------------------------------------------------

* Autosomal Dominant
* Defects in gene coding for type I collagen
* Commonly results in fetal or perinatal death

Front 104

Use of which drug during pregnancy is associated with craniofacial abnormalities, fingernail hypoplasia, growth deficiency, developmental delay, cardiac defects and facial clefts?

Back 104

Phenytoin

Front 105

2 year old is brought to the ED due to cough and a "whistling sound" while breathing.

Two days ago, he developed a hoarse cry and a harsh "barky" cough and rhinorrhea.

Lateral x-rays show a mildly narrowed subglottic region.

Diagnosis?

Back 105

Croup

----------------------------------------------

* M/C cause is parainfluenza virus

Front 106

Most common cause of croup?

Back 106

parainfluenza virus

Front 107

What 2 heart murmurs get louder during Valsalva and standing?

Back 107

Hypertrophic Cardiomyopathy

Mitral Valve Prolapse

Right Sided heart murmurs also increase during LATE VALSALVA

(↓ Venous Return)

(↓ LV Volume)

--------------------------------------------

All other murmurs ↓ during Valsalva and Standing

Front 108

What heart murmurs get louder during squatting or hand gripping?

Back 108

Aortic Regurgitation

Mitral Regurgitation

VSD

(↑ Venous return, ↑ Afterload by kinking femoral arteries, ↑ reverse flow)

Front 109

What happens to the murmurs heard in HCM and MVP when a patient squats?

Back 109

Murmurs decrease in HCM and MVP when a patient squats.

Front 110

A patient has Hypertrophic Cardiomyopathy. What effect will hand gripping have on the murmur?

Back 110

Murmur will get softer

Front 111

A patient has a short diastolic cardiac murmur at the cardiac apex that goes away with squatting. A non-ejection click is present.

Back 111

MVP

------------------------------------

Murmur may also present with a non-ejection click or mid-to-late systolic murumur

Front 112

Loud holosystolic murmur with maximal intensityover the 3rd or 4th left intercostal space. The intensity of the murmur increases with squatting

Back 112

Ventricular Septal Defect

Front 113

Most common cardiac deformity caused by Rheumatic Heart Dz?

Back 113

Mitral Stenosis

Front 114

A young obese woman is being treated for acne using isotrnitoin cream. She complains of headaches, blurred vision and a whooshing sound in her ears that has gotten worse over the past 2 weeks. Exam shoes papilledema.

CT imaging is normal. An LP is performed and no abnormalities are noted other than an opening pressure of 260mm/Hg.

Diagnosis

Back 114

Pseudotumor-cerebri

(Idiopathic Intracranial Hypertension)

---------------------------------------------

Drugs that cause IIH:

* Growth Hormone
* Tetracyclines (minocycline, doxycycline)
* Excess Vitamin A and derivatives (isotenitoin, all -trans-retionic acid)

Front 115

A positive Trendelenburg sign shows drooping of the contralateral hemipelvis below its normal horizontal level. It is caused by weakness off the _____________ muscles which are innervated by the _______ nerve

Back 115

It is caused by weakness off the gluteus medius and minimus muscles which are innervated by the Superior gluteal nerve

Front 116

A newborn infant fails to feed for the first time 3 hours after birth. The infant has choking, drooling, and coughing.

An attempt is made to place an enteric tube but X-ray shows it stops in the proximal esophagus.

What is the most likely diagnosis

Back 116

Esophageal Atresia with tracheoesophageal fistula.

Front 117

A patient with obstructive sleep apnea has a Hemocrit of 65%.

What causes polycythemia in patients with obstructive sleep apnea?

Back 117

↑ erythropoeitin production

Front 118

A tanned patient presents with palve, velvety hypopigmented macules that do not tan, and do appear scaly but do scale with scraping.

What is the diagnosis?

Back 118

Tinia Versicolar

------------------------------------------------------

Malassezia furfur

Scrapings viewed on KOH staining can show large, blunt hyphae and thick walled budding spored (spaghetti and meatballs)

Tx: selenium sulfide cream or ketoconazole shampoo

**EXTREMELY HIGH-YIELD**

Front 119

A patient presents with oval, fawn-colored lesions that measure 2cm in diameter and occur in a christmas tree pattern on his back.

Diagnosis?

Back 119

Pityriasis rosea

--------------------------------------

The initial lesion is a herald patch and generalized eruption occurs in 2 weeks

Front 120

Most common presenting symptom of Pancost tumor?

Back 120

Shoulder Pain (most common)

also can see Horner's Syndrome

Front 121

What is the most common extraarticular manifestation of Ankylosing Spondylitis?

Back 121

Anterior Uveitis

-------------------------------

Bilateral SI joints, HLA-B27 (+)

Front 122

Glutamic acid decarboxylase antibodies are seen in 70% of patients diagnosed with _________

Back 122

Type I Diabetes

Front 123

A patient of Northern European descent presents with hemolytic anemia, jaundice and splenomegaly. His urine is cola-colored.

Bloodwork shows a decreased hemoglobin, but a normal MCV with a decreased Reticulocyte count.

He is also having acute symptoms of cholecystitis and ultrasound reveals pigment gallstones.

Diagnosis?

Back 123

Hereditary Spherocytosis

---------------------------------------------

Inherited deficiency of ankrin and spectrin

Mis-shaped RBCs get trapped in the spleen

Short lifesplan of these RBCs causes rapid turnover and excess bilirubin that overloads the system --> cola-colored urine d/t hyperbilirubinemia

Patients can develop an acute cholecystitits with pigmented gallstones, Tx is a cholecystectomy

Other treatments are folate as chronic hemolysis consumes folate and ultimately a splectomy

Front 124

When treating an episode of depression, the antidepressant should be continued for ________ following the patient's response.

Back 124

6 months

Front 125

A 45 yo female presents with excessive hair growth over her face and body. Her hirsutism rapidly developed over 6 months. She has not menstruated in 3 months.

She has hairgrowth on her face, she is masculine in appearance with a large clitoris. She has significant temporal balding.

What test should be ordered?

Back 125

Serum testosterone and DHEAS

------------------------------------------

Rapid progression of her symptoms indicate a likely ovarian or adrenal tumor.

Elevated testosterone with with a normal DHEAS indicates an ovarian source

Normal testosterone with with elevated DHEAS indicates an adrenal source

Front 126

What type of cancer most commonly causes hypercalcemia by producing PTHrp (Parathyroid Hormone related peptide)?

Back 126

Breast CA

Front 127

How do tumor cells cause bone resorption that results in hypercalcemia?

Back 127

Secrete factors that activate osteoclasts

Front 128

Best imaging modality to use for suspected confirming Diaphragmatic rupture or avulsion?

Back 128

CT of chest

Front 129

The most beneficial therapy to reduce progression of Diabetic Nephropathy in presence of renal insufficiency is to ___________________

Back 129

Control Blood Pressure

(ACEi or ARBs)

Front 130

Biggest risk for thryoid cancer?

Back 130

Previous neck radiation therapy

Front 131

Hashimoto Thyroiditis can lead to increased risk of what cancer?

Back 131

Thyroid Lymphoma

Front 132

_______________________ is the most common pediatric renal malignancy. It presents in a toddler with a firm, smooth, unliateral abdominal mass that does not cross the midline and hematuria

Back 132

Wilm's Tumor

---------------------------------------------

Versus:

A neuroblastoma is the most common cancer in the first year of life. It presents as an abdominal mass that does cross the midline and presents with sympathetic symptoms.

Front 133

Toddler with a firm, smooth, unliateral abdominal mass that does not cross the midline and hematuria

Back 133

Wilm's Tumor

----------------------------------------

Most common pediatric renal malignancy

Can be assosciated with:

WAGR syndrome = Wilms tumor + Aniridia + GU anomalies + Mental retadation

Beckwith-Wiedemann syndrome = Wilms tumor + organomegaly, macroglossia, & neonatal hypoglycemia (excess insulin)
- think of it as an overgrowth disorder

Front 134

10 month old with an abdominal mass that crosses the midline, fever, weight loss, hepatomegaly and HTN

Back 134

Neuroblastoma

---------------------------------------

Most common malignancy in the 1st year of life

dx is made by measuring urinary cathecholamine products

Front 135

Most serious side effectfor PTU and Methimazole for Hyperthyroidism?

Back 135

Agranulocytosis

Front 136

Hyperthyroidism:

Methimazole vs. PTU

Which is safe in the 1st trimester of pregnancy?

Back 136

PTU

Front 137

Imaging study of choice for a pregnant lady with nephrolithiasis?

Back 137

Ultrasound

-----------------------------------------------

Don't zap the baby with radiation using a CT scan!

Front 138

Test of choice to diagnose a kidney stone?

Back 138

CT w/o contrast

Front 139

Which type of mutation leads to a more serious form of disease:

Nonsense mutation

or

Missense mutation

Back 139

Nonsense mutations

Front 140

A man loses his job and silently packs up his office. When he gets home, his children are excited to see him and want to play. He begins yelling and swearing at them.

What type of defense mechanism is he displaying?

Back 140

Displacement

Front 141

A man being treated for acute diverticulitis is back in the ER two days after discharge complaining of worse symptoms. A CT scan of his abdomen shoes a peritoneal abscess with more than 3 cm of fluid collection next to the sigmoid colon.

What is the next best step?

Back 141

CT guided drainage

----------------------------------------------

If that doesn't work, next step is surgical debridement

Front 142

The _________ bursa is located anteriomedially over the tibial plateau just below the joint line of the knee.

Back 142

Anserine bursa

Front 143

Asymptomatic lesion is noted on a chest x-ray of a patient who grew up in either the Mississippi or Ohio River valleys or Central America.

Back 143

Histoplasmosis

Front 144

Chorionic Villus sampling offers the advantage of an early diagnosis. It can be done between ____ and _____ weeks of gestation.

Back 144

10 to 12 weeks

--------------------------------------------

BEST for detecting fetal chromosomal abnormalities in the first trimester

Gestation Age of fetus is the most significant risk factor for fetal limb injury. CVS before 10 weeks is associated with greater risk

Front 145

What test is the best for confirming fetal chromosomal abnormalites during the 1st trimester?

Back 145

Chorionic Villus Sampling

Front 146

Post-term pregnancies (>42 weeks) are assosciated with a greater risk for:

Oligohydramnios?

or

Polyhydramnios?

Back 146

Oligohydramnios

------------------------------------------------

Mothers must be moniored twice weekly

Front 147

Treatment for impetigo?

Back 147

Topical mupirocin

or

Oral erythromycin

Front 148

Pelvic ultrasound shows streak ovaries and an infantile uterus in a 15 year old girl with amenorrhea.

Back 148

Turner Syndrome (45 XO)

Front 149

Patient presents with primary amenorrhea, delayed puberty, short stature, broad-shaped chest and a bicuspid aortic valve

Back 149

Turner Syndrome (45 XO)

------------------------------------------------------------

U/S may show streak ovaries

Front 150

Common cardiac valve defect seen in Turner Syndrome (45 XO)?

Back 150

bicuspid aortic valve

-----------------------------------

also commonly have:

-coarctation of aorta

-Horseshoe kidney

Front 151

Bug that causes osteomyelitis in patients with Sickle cell?

Back 151

Salmonella

Front 152

Children with sickle cell anemia should be on prophylactic _________ until 5 years of age

Back 152

Penicillin

Front 153

Pharmacological treatment for primary biliary cirrhosis?

Back 153

Ursodeoxycholic acid

-------------------------------------------------

PBC is a chronic liver disease characterized by autoimmune destruction of intrahepatic bile ducts and cholestasis

- Middle aged women

-Pruritus is first symptom and can be extreme appearing mostly at night

-xanthomatous lesions on the eyelid, skin or tendons

-Jaundice, steotorrhea, portal hypertension, and osteopenia may develop

Front 154

A diabetic patient is 3 days post-op and complains of intense pain at the incision site. Exam shows decreased sensitivity around the edges of the wound, cloudy grey discharge and crepitus of the skin.

What is the next best step?

Back 154

Surgical exploration of the wound

--------------------------------------------

This is a necrotizing skin infection and surgery is essential

Front 155

What is the heterophile antibody test used to diagnose?

Back 155

Infectious Mononucleosis

-----------------------------------------

This is also known as the Mono-spot test!

Front 156

A child is brought to you for hyper-phagia and temper tantrums when his parents try and stop him from eating. He is short in stature and is in the 99th percentile for weight. He has almond-shaped eyes, a narrow forehead and a down-turned mouth.

His mother says her pregnancy was uncomplicated and that he did have poor suck and feeding problems during infancy.

What is the Dx?

Back 156

Prader-Willi Syndrome

-----------------------------------------------

This is due to a maternal uniparental disomy.

* inherited both copies of chromosome 15 from mom
* there was a deletion of the paternal copy of chromosome 15

One of the most common complications of PWS is Sleep Apnea (70%), followed by DM 2 (20%)

Front 157

A child is brought to your office for her short stature and evaluation of a suspected intellectual disability. SHe frequently smiles and laughs for no apparent reason, and constantly flaps her hands. Her past medical history is significant for ataxia and seizures.

Back 157

Angelman Syndrome

----------------------------------------------------

This is due to a paternal uniparental disomy.

* inherited both copies of chromosome 15 from dad
* there was a deletion of the maternal copy of chromosome 15

Front 158

Test of choice to Dx Amyloidosis?

Back 158

Abdominal Fat Pad Biopsy

Front 159

WHich has longer morning stiffness?

RA or Osteoarthritis?

Back 159

Rheumatoid Arthritis

--------------------------------------------

Morning stiffness in patients with RA lasts longer than 30-60 minutes

Front 160

Best test to find lytic bone lesions associated with Multiple Myeloma?

Back 160

Skeletal Survey (X-ray)

Front 161

Where would you see:

Bone pain (m/c presentation)

Increased ESR (typically over 100)

Bence Jones Proteins in urine (free monoclonal or light chains)

M-spike on immunoelectrophoresis

Back 161

Multiple Myeloma

--------------------------------------------

Complications include: Renal failure, Hypercalcemia, hyperviscosity syndrome.

Complete work-up includes: CBC with differential and morphology, serum electrolytes, kidney and liver screening, skeletal survey, serum plasma electrophoresis & urinary plasma electrophoresis (SPEP & UPEP!!) are the NEXT steps and BM biopsy (definitive) which shows over production of plasma cells (>10%)!.

Front 162

How would you find the mean in this data set?

20, 22, 21, 22, 18

Back 162

Add them all up, and divide by 5

20.6

Front 163

How would you find the median in this data set?

20, 22, 21, 22, 18

Back 163

You find the number in the data set that separates the low from the high. So you have to put the numbers in ascending order:

18, 20, 21, 22, 22

Front 164

How would you find the mode in this data set?

20, 22, 21, 22, 18

Back 164

It's the number that occurs the most!

22

Front 165

Most common cause of conjunctivitis in a newborn?

Back 165

Chemical Conjunctivitis from silver nitrate drops!

Front 166

Both Hereditary spherocytosis and Autoimmune Hemolytic Anemia have spherocytes on peripheral blood smear.

Which one has a (+) Coomb's test?

Back 166

AIHA

---------------------------

Will have a negative family history

Front 167

Both Hereditary spherocytosis and Autoimmune Hemolytic Anemia have spherocytes on peripheral blood smear.

Which one has a (-) Coomb's test?

Back 167

Hereditary Spherocytosis

--------------------------------------

(+) family history! It is Autosomal Dominant!

Front 168

In what hemolytic disease would you see Heinz Bodies?

Back 168

G6PD-deficiency

Front 169

Rheumatic heart disease most commonly affects which heart valve?

Back 169

Mitral valve ---> Mitral Stenosis

------------------------------------------

Can cause A-fib due to left atrium dilation

Front 170

A patient is experiencing an acute dystonic reaction ( like torticollus) after he was administered haloperidol for an acute psychotic episode.

What drug can be given to reverse the dystonia?

Back 170

Anticholinergic

(benztropine)

Antihistamine

(Diphenhydramine)

Front 171

Most common nephrotic syndrome in children?

Back 171

Minimal Change Dz

Front 172

What empiric therapy is started for any child with suspected Minimal Change Disease?

Back 172

Steroid therapy (Prednisone)

Front 173

Treatment of choice for Minimal change Disease?

Back 173

Steroids! (prednisone)

--------------------------------------------

Do not do a renal biopsy!

Front 174

A patient is diagnosed with meningococcal meningitis.

What drugs should you use for prophylaxis in close contacts of the patient?

Back 174

Rifampin

or

Ciprofloxacin

Front 175

A 22 year old runner presents with amenorrhea for 6 months. She has been training for olympic trials in that time.

She has a BMI of 20, and a negative pregnancy test. Prolactin levels are normal. FSH and LH levels are low.

The patient has the greatest risk of developing what disorder?

Back 175

Decreased bone mineral density

---------------------------------------------------------

HPO axis is suppressed due to low BMI, low leptin

and

elevated Grehlin, neuropeptide Y, GABA, beta-endorphin, corticotropin

Front 176

What disease causes upper and lower motor neuron symptoms without loss of sensation?

Common symptoms are muscle twitching, weakness and cramping

Back 176

ALS

Front 177

10 hour old infant has a scalp swelling limited to one cranial bone. There is no discoloration or pulsation.

Back 177

Cephalohematoma

--------------------------------------------

-Subperiosteal hemorrhage, does not cross suture lines

Most cases do not require treatment and will resolve in 2-3 months

Front 178

10 hour old infant has a diffuse, ecchymotic scalp swelling that extends across the midline and suture lines

Back 178

caput succedaneum

------------------------------------------------------

Extends across suture lines. Is ecchymotic in appearance

Front 179

Tamoxifen increases the risk for what cancer?

Back 179

Endometrial Cancer

Front 180

Ramoxifen is a selective estrogen receptor modulator (SERM)

It has mixed agonist/antagonist effects of estrogen receptors. In breast and vaginal tissue, it is an antagonist. In bone tissue, it is an agonist.

It is a first-line treatment for osteoporosis and decreases breast cancer risk.

It is contraindicated in patients with a history of _________________

Back 180

DVT/Thromboembolism

Front 181

A 34 year old female presents with amenorrhea for 3 months. She is experiencing hot flashes, atrophic vaginitis, breast atrophy and some irritability.

You suspect premature ovarian failure.

A markedly increased _________ level in a patient under 40 who is experienced > 3 months of amenorhhea confirms diagnosis of premature ovarian failure.

Back 181

A markedly increased FSH level in a patient under 40 who is experienced > 3 months of amenorhhea confirms diagnosis of premature ovarian failure.

------------------------------------------------------------------

Studies will show ↓ estrogen, ↑↑FSH, ↑LH

Front 182

In children, over 90% of medulloblastomas develop in the ______________

Back 182

Cerebellar vermis

----------------------------------------------------

Second most common posterior fossa tumor (behind cerebellar astrocytoma)

Children develop posterior vermis syndrome (unbalanced gait, trunk dystaxia, horizontal nystagmus, papilledema)

Front 183

What is the fluid of choice for initial fluid rescusitation in patients with severe hypovolemic hypernatremia?

Back 183

Normal Saline (0.9%)

or

Lactated Ringers

--------------------------------------------

These are isotonic solutions

Hypotonic solutions --> Contraindicated

* Quickly exit the intravascular system
* Lower sodium too rapidly
* can cause cerebral edema

I

Front 184

_____________ antibodies are seen in over 90% of patients with primary biliary cirrhosis, a chronic liver disease characterized by autoimmune destruction of intrahepatic bile ducts and cholestasis

Back 184

Antimitochondrial antibodies

-----------------------------------

Severe pruritis is the most common initial symptom and often seen at night.

Front 185

Furosemide is the drug of choice if a patient having an MI develops ___________________

Back 185

Flash pulmonary edema

--------------------------------------------

Metoprolol is contraindicated in this setting of acute CHF! Even if the patient is having an MI.

Furosemide rapidly relieves pulmonary edema by decreasing cardiac preload, thereby decreasing pulmonary capillary pressure

Front 186

A Mexican man presents with RUQ pain for the past 12 days. The pain migrates to his right shoulder. Deep inspirations make it worse. He provides a history of bloody diarrhea 6 months ago after travel to Mexico to visit family.

He has RUQ tenderness but no jaundice. An U/S reveals a single, thin-walled cyst in the right lobe of his liver.

Most likely diagnosis?

Back 186

Entamoeba Histolytica liver abscess

--------------------------------------------------------

-Primary infection is through colon which produces bloody diarrhea

-Amebic liver abscesses are generally single and located in the right lobe of the liver.

-Diagnosis can be confirmed b trophozoites in the stool, serology and liver imaging

Treat with Metronidazole

Front 187

What electrolyte abnormality may occur after treating a patient with severe asthma with high-dose beta-2-agonists (Albuterol)?

Back 187

HYPOkalemia

----------------------------------

Albuterol drives K+ into cells

Front 188

Statins _______ the number of hepatic LDL receptors

Back 188

increase

Front 189

Statins decrease _____________ synthesis, which is involved in muscle cell energy production and possibly contributes to statin-induced myopathy

Back 189

coenzyme Q-10

Front 190

Patient with a history of chronic duodenalulcer presents with upper right quadrant pain.

Endoscopy shows prominent gastric folds and a duodenal ulcer, and an upper jejunal ulceration (damage beyond duodenal bulb)

what is the most likely Dx?

Back 190

Zollinger-Ellison syndrome (Gastrinoma)

--------------------------------------------

All patients need a fastin serum gastrin level

- a level >1000pg/mL is diagnostic

If gastrin test is non-diagnostic, a secretin stimulation test should be done

Front 191

What is the most common cause of infertility in women less than 30 with normal menstruation?

Back 191

PID

Front 192

WTF? Congenital syndrome:

Syncopal episode w/o following disorientation.

There is a hearing impairent, normal PE, and family hx of sudden cardiac death

What is the Diagnosis?

Back 192

Jervell and Lange-Nielsen syndrome

(Congenital Long QT Syndrome, Autosomal recessive)

------------------------------------------------------------------

Treatment is with 𝞫 -blocker (Propanolol) and pacemaker to prevent cardiac arrest

Avoid electrolyte derrangements, medications that block K+ channels (Torsades), and vigorous physical activity

-------------------------------------------------------------------

Romano-Ward Syndrome is the Autosomal Dominant version

Front 193

Cardiac ausculation reveals mid-diastolic rumble with opening snap best heard at the apex

Back 193

Mitral Stenosis

Front 194

Which virus causes Molluscum contagiousum?

Back 194

Poxvirus

Front 195

Which virus causes Kaposi Sarcoma?

Back 195

Human Herpes virus 8

Front 196

A patient presents with Charcot's Triad of fever, severe jaundice and right upper quadrant pain.

Back 196

Acute Ascending Cholangitis

----------------------------------------------------------

It’s an infection of the COMMON BILE DUCT (NOT THE CYSTIC DUCT!!!!), generaly 2ndary to OBSTRUCTION OF CBD with a stone leading to DILATATION OF CBD**** (seen on imaging).

Broad spectrum antibiotics (cover gram – rods & anaerobes!!) should be started immediately, however, its very important to decompress the billiary duct and provide their drainage (USING ERCP!!).

Most common pathogens involved are E.coli & Klebsiella (gram – rods; NOT enterococci…which are gram +

Front 197

A woman presents with 3 months of worseing pain in her right knee. No medications have helped

On examination the knee is swollen and tender with decreased range of motion.

X-ray shows an expansible and eccentrically placed lytic area in the epiphysis of the distal femur.

Serum chemistries and CBC are completely normal.

Diagnosis?

Back 197

Giant Cell Bone Tumor

------------------------------------

-Pain, swelling, decreased range of motion in joint

usually in the epiphyses of bone – “soap bubble” apearance

-Surgery is 1st line Tx

Front 198

Knee pain due to over-use injury caused by repetitive strain.

Typically seen in children and adolescents who have recently undergone a growth spurt.

Xray shows avulsion of the apophysis of the tibeal tubercle.

Back 198

Osgood Schlatter

Front 199

External cephalic version is indicated if breech presentation is persistent at _________ weeks gestation.

Back 199

37 weeks

-------------------------------------------

If external cephalic version fails, plan for a C-section....

Most breech presentations resolve spontaneously by 37 weeks. No attempts to convert are needed before then

Front 200

On an EKG, you see the PR interval gradually lengthening until a beat is dropped

Back 200

Mobitz I (Wenchebach)

----------------------------------

Impaired AV Node conduction

Front 201

Hypercalcemia is the most common paraneoplastic syndrome assosciated with ________ type cancers

Back 201

Squamous Cell Cancers

(eg, Squamous Cell Lung CA)

---------------------------------------------------

PTHrP is released by the malignancy and stimulates PTH receptors

↑Calcium, ↓Phosphate, Normal or ↓ PTH

Front 202

What is the earliest manifestation of vaso-occlusive syndrome in patients with Sickle-cell?

Back 202

Dactylitis

-------------------------------------------------

Usually presents between ages 6 mo and 2 years with acute onset pain and swelling of hands and feet

Front 203

Pathology involves a point mutation which results in the substitution of valine for glutamic acid on the surface of the Hb S molecule on the 6th codon of the beta-globulin chain

Back 203

Sickle Cell

Front 204

HY

_______ are benign suprasellar tumors which present with signs of hypopituitarism, headaches and bitemporal blindness

Back 204

Craniopharyngioma

-----------------------------------------------

Seen in sella tursica

characterized with cystic structure with calcification.

Front 205

Do these Meds cause HYPER or HYPO K+?

-Propanolol

-Lisinopril

-Losartan

-Triamterene

- Digoxin

- Aspirin

Back 205

Hyperkalemia

----------------------------------------------

Non-selective 𝞫-antagonists (Timolol, Propanolol)

- interfere with 𝞫-2 mediated intracellular K+ uptake

ACE-I's

- Inibit angiotensin II formation which ↓ aldosterone production

ARB's

-Block AT1 receptor which ↓ aldosterone production

K+ Sparing Diuretics (spironlolactone, triamterene)

-Block epithelial Na channel (ENaC) or aldosterone receptor

Cardiac Glycosides (Digoxin)

-Inhibit Na+/K+-ATPase pump

NSAIDs

- ↓ prostaglandin synthesis --> ↓ renin + aldosterone

Front 206

What is the treatment of choice for Slipped capital femoral epiphysis (SCFE)?

Back 206

Surgical Pinning to prevent further slippage and avascular necrosis

Front 207

An obese, 11 year old male presents with right knee, groin and hip pain.

Physical exam reveals a normal knee. Hip exam reveals a loss of ABduction and internal rotation of the hip as well as external rotation of thigh when the hip is being flexed.

Back 207

Slipped capital femoral epiphysis (SCFE)

----------------------------------------------------

Surgical pinning is indicated

Frog-leg lateral hip xray is imaging modality of choice

Front 208

What is the most commonly identified risk factor for placental abruption?

Back 208

Hypertension!

-----------------------------------------

Risk factors are:

1-HT and preecclampsia,

2-Placental abruption in previous pregnancy, 3-trauma,

4-short umbilical cord,

6-COCAINE abuse

Placental abruption is the most common cause of DIC in pregnant women

Front 209

Treatment of choice for asymptomatic Chlamydia?

Back 209

Azithromycin (single dose)

or

Doxycycline (7 days)

Front 210

Treatment for Gonorrhea?

Back 210

cetriaxone

Front 211

Most significant risk factor for stroke?

Back 211

HTN

Front 212

Mutation of type I collagen

Back 212

Osteogenesis Imperfecta

Front 213

Mutation of fibrillin-I gene?

Back 213

Marfan Syndrome

Front 214

Patient presents with blue sclera and recurrent fractures

Back 214

Osteogenesis imperfecta

Front 215

A 3 month old patient presents with jaundice and acholic (pale ) stools

Back 215

Biliary Atresia

Front 216

GI manifestation seen with neonates with Down Syndrome

Back 216

Duodenal Atresia/Stenosis

---------------------------------------------

Duodenal Atresia is the m/c anomaly associated with Down Syndrome, in xray you see a double bubble sign (dialated stomach & duodenum).

Prenatal U/S shows polyhydramnios due to an inability to swallow and remove amniotic fluid

Front 217

M/C cause of death in neonates or children with Down Syndrome?

Back 217

Heart Failure

------------------------------------------

Due to endocardial cushion defects (ASD/VSD)

Front 218

What would you see on a Quad Screen to diagnose Down Syndrome?

Back 218

LOW AFP & unconj Estriol; High BHCG & inhibin

Front 219

Cardiac problem assosciated with Turner Syndrome?

Back 219

Coarctation of Aorta

--------------------------------------------

May see high BP in arms, low BP in legs

Rib notching on chest x-ray

Front 220

__________ is characterized by osteonecrosis of the femoral head. It presents in boys ages 4-10 with insidious onset hip or knee pain with an atalgic gait.

Back 220

Legg-Calve-Perthes Disease

-----------------------------------------------------

Front 221

In what disease do you see Howell-Jolly bodies?

Back 221

Sickle Cell Anemia

Also seen in Autosplenectomy

-----------------------------------------------------

On peripheral smear you will see Sickle Cells, Howell-Jolly Bodies and Polychtomasia(from reticulocytosis)

Front 222

Most common drugs to cause Stevens Johnson Syndrome?

Back 222

NSAIDs

Sulfa Drugs

Phenytoin

Front 223

A patient is treated with TMP-SMX after being diagnosed with a UTI. After 3 days of medicine, he presents with the sudden onset of fever and a mucocutaneous rash involving the mouth, throat, trunk arms and feet. He appears toxic and complains the sores in his mouth and throat are extremely painful

The lesions are erythematous and blistered and have a target-appearance.

Back 223

Stevens-Johnson Syndrome

-------------------------------------------------

NSAIDs

Sulfa Drugs

Phenytoin

Front 224

A patient presents with an acute exacerbation of COPD. She is tachycardic and tachypnic. She is in moderate distress. Pulse Oximetry shows 84% on 2L O2 by nasal canula.

She is given additional oxygen, a nebulizer treatment, intravenous levofloxacin and methylprednisolone. She still remains dyspneic and bedridden.

Chest X-ray shows emphysema but no pulmonary edema, consolidation, pleural effusion, or pneumothorax.

Arterial blood gas shows a pH of 7.2, PCO2 of 60 mm Hg, and PO2 of 52 mm Hg.

What is the next best step?

Back 224

Non-invasive positive pressure ventilation

(NPPV)

----------------------------------------

. *****Non Invasive Positive Pressure Ventilation is the best option for pts with COPD exacerbation. It should be tried before intubation and mechanical ventilation in COPD pts with CO2 retention. ******

Front 225

_________________ is an autoimmune disorder involving muscles and the skin. Skin eruption is dusty red in color. Edema around the eye and the heliotrope rash of the eyelid are more specific.

Proximal muscle weakness & Gottron’s papules (skin over the back of knuckles show non-scaly violaceous erythematous eruption) = “dark papules over the dorsum of hands”

- Labs show an elevated creatinine kinase, since it’s an inflammatory reaction in muscles.

Back 225

Dermatomyositis

--------------------------------------------

Over 10% of patients will develop an internal malignancy. Most common is ovarian cancer

Age-appropriate cancer screening is essential. Especially in women.

Front 226

_____________ is characterized by shoulder pain, which is absent at rest but present at overhead activity.

Range of movement is limited by pain. Neer sign (pain on passive pronation of the arm and forward flexion at shoulder) is present.

Back 226

Subacromial Bursitis

Front 227

Patient presents with heat intolerance, weight loss, and increased appetite.

There is some painless swelling in the front of her neck.

Labs show:

decreased TSH

increased Total T4

increased Free T4

A radioactive iodine uptake scan shows very low uptake of radioiodine.

Most Likely Diagnosis?

Back 227

Painless (Lymphocytic) Thyroiditis

-----------------------------------------------

**may follow pregnancy**

Front 228

This form of nephrotic syndrome is more common in African Americans and Hispanics

It is associated with obesity, HIV and heroin use

Back 228

Focal Segmental Glomerulosclerosis

-------------------------------------------------

M/C form of nephrotic syndrome in adults

Front 229

Positive predictive value _________ with an increase in prevalance of a disease

Back 229

increases

-----------------------------------

The more common the disease, the more likely a patient that tests positive has the disease

Front 230

Negative predictive value __________ with a decrease in prevalance of a disease.

Back 230

increases

------------------------------------

The more rare the disease in a population, the more likely patients that patients who test negative for a disease actually do not have the disease

Front 231

What is the best surgical option for a patient with a appendiceal rupture with a contained abscess?

Back 231

Wait 6-8 weeks and return for an appendectomy on an elective basis ("interval appendectomy")

Front 232

HY

Best treatment option for a single metastatic brain lesion?

Back 232

Surgical resection

↓

Followed by whole-brain radiation

Front 233

HY

Best treatment options for a patient with multiple brain metastases?

Back 233

Pallative whole-brain radiation

Front 234

Drug of choice in a patient with OCD?

Back 234

SSRI

or

Clomipramine

Front 235

A patient falls from his roof and lands on his back. He sustaines a burst fracture of the T4 vertebra. He has a total paralysis of both legs (paraplegia). He also has loss of pain and temperature in both of his legs, although proprioception is spared.

Dx?

Back 235

Anterior Cord Syndrome

(best visualized with MRI)

---------------------------------------------------------------

DDX:

Central Cord Synd: Burning pain and paralysis in upper extremities with relative sparing of lower extremities. Seen in elderly due to hyperextension of the neck injury.

3-Brown Sequard synd: Ipsilateral motor (at the level of lesion), ipsilateral UMN sx below the level of lesion, ipsilateral proprioception/touch/vibration loss below level of lesion and contralateral loss of pain below the level of lesion.

Front 236

What is the preferred sceening test for HIV?

What is the preferred confirmatory test for HIV?

Back 236

Screen: HIV ELISA (99.9% sensitivity)

Confirmatory: Western Blot (99% specificity )

Front 237

A patient with increased homocysteine levels develops a DVT.

What can you give her to decrease homocysteine levels?

Back 237

Vitamin B6 (Pyridoxine)

Front 238

A 10 year old girl is brought in for a follow-up visit. She has been previously diagnosed with viesicourethral reflux, and has had multiple UTIs in the past.

Intravenous pyelography (IVP) reveals bilateral focal parenchymal scarring and blunted calyces.

Most Likely DX?

Back 238

Chronic pyelonephritis

Front 239

What drug should you never give to a patient with suspected closed-angle glaucoma?

Back 239

Atropine (a pupil dilator)

---------------------------------------------

Reduce pressure with:

Mannitol (1st-line)

Acetozolamide

Timolol

Pilocarpine

Front 240

A child presents with fever, dysphagia, drooling, inability to extend the neck, muffled voice.

Lateral x-ray shows a widened paravertebral space

Back 240

Retropharyngeal Abscess

--------------------------------------------------

Front 241

Osteoporosis predominantly involves the (DIP or PIP) joints

Back 241

DIP joints

Front 242

What hand joints are classically affected by Rheumatoid Arthritis?

Back 242

PIP

MCP

Front 243

Preferred antibiotic therapy for mastitis?

Back 243

Dicloxacillin or Cephalexin

(Covers methicillin-sensitive Staph a.)

---------------------------------------------------

Women with risk factors for MRSA (recent antibiotic therapy, residence in prison, HIV infection) should be treated with clindamycin, TMP-SMX or vancomycin

Front 244

A patient is started on warfarin due atrial fibrillation.

She returns two days later with skin necrosis.

What is going on?

Back 244

Warfarin blocks Protein C & S, and initially causes a hypercoagulable state which can lead to Warfarin Induced Skin Necrosis

------------------------------------------------------------------

UWorld states that protein C deficiency is the cause. It's half-life is only 9 hours, so it becomes deficient quick and can lead to hypercoagubility!

Front 245

This condition is seen in premature/low-birth-weight infants. Pt presents with pallor, cyanosis, hypotension, seizures, focal neurologic signs, bulging or tense fontanels

Back 245

Intraventricular Hemorrhage of Newborn

---------------------------------------------------------

-transfontanel US is mandatory for all infants with risk factors.

-Drug given to mom before birth to reduce the risk: corticosteroids (betamethasone/dexamethasone)

Front 246

HY

What class of drugs can slow diabetic nephropathy?

Back 246

ACE-I's

---------------------------------

Front 247

A woman who was recently diagnosed with hypothyroidism consults her physician about her dose of levothyroxine.

She wants to get pregnant and wonders how her pregnancy will affect her levothyroxine dosage.

Back 247

She will need an increased dose of levothyroxine

Front 248

A patient presents with a 4-5 Hz resting hand tremor that goes away with intentional movement.

On examination his arms are rigid

Back 248

Parkinson's

--------------------------------------------------

The resting hand tremor with muscle rigidity is often one of the earliest signs!

Front 249

You suspect a child has swallowed a coin and it is lodged in the esophagus.

What diagnostic modality is the next best step?

Back 249

Flexible endoscopy

---------------------------------------------------------

Can directly visualize foreign body and manipulate it. Can also visualize gastric mucosa and inspect for damage

Front 250

Procedure of choice for foreign body aspiration?

Back 250

Rigid bronchoscopy

Front 251

You suspect a child has swallowed a coin. How long can you observe the child before attempting flexible endoscopy?

Back 251

24 hours

-----------------------------------------------

Objects that are smooth and nontoxic may pass through on their own. Wait 24 hours and check an x-ray.

Batteries, magnets and sharp objects need to be removed immediately with flexible endoscopy

Front 252

Complication of iron poisoning :

2 days: ________________

2-8 weeks ______________________

Back 252

2 days: Hepatic necrosis

2-8 weeks: Pyloric stenosis from gastric scarring

Front 253

A 3 year old boy presents with acute N/V/D and abdominal pain. GI bleeding (hememesis) and anion-gap metabolic acidosis develop. Hypotensive shock is noted after arrival to the ED.

Abdominal X-ray shows radioopaque objects in the stomach.

What is going on?

Back 253

Iron Poisoning

-------------------------------------------------

Stabilize and treat with deferoxamine

Front 254

Treatment for iron poisoning?

Back 254

Stabilize, and then deferoxamine

Front 255

HY

In patients with suspected hyperthyroidism, _______________ is used for symptomatic relief until the underlying cause is identified and treated.

Back 255

Propanolol

Front 256

When does post-operative atelelectasis typically become most severe?

Back 256

2nd postoperative night

-----------------------------------------

- can last up to 5 days

-As compensation for hypoxemia, patients hyperventilate and develop respiratory alkalosis and ↓PCO2

-Acute post-op Pulmonary embolism can also present this way.

Front 257

Before surgery, it is recommended that patients stop smoking at least _________ weeks before surgery

Back 257

8 weeks

-------------------------------------------------------------

-Not always the case. Must have them stop smoking immediately to ↓ post-op pulmonary problems

Front 258

What should be done to prevent post-op atelectasis?

Back 258

Breathing excercises/Inscentive spirometry

---------------------------------------------------

Other strategies:

-Epidural analgesia instead of IV opiods

- CPAP

- Smoking cessation 8 weeks before surgery

Front 259

Is pain better or worse in a patient with endometriosis during her menses?

Back 259

Pain is worse during menses

Front 260

17 year old girl has primary amennorhea, bilateral inguinal masses (or labial), and breast development without pubic or axillary hair.

On exam she has a blind vaginal pouch and no uterus/fallopian tubes/or ovaries are visualized by U/S.

Karyotyping reveals 46 XY

What is the diagnosis?

Back 260

Androgen insensitivity syndrome

(X-linked recessive)

--------------------------------------------------------

-Mutation of the androgen receptor (AR) gene making peripheral tissues unresponsive to androgens

-Patients are phenotypically female (despite being 46 XY) and breast development occurs from testosterone conversion to estrogen. However, there is no axillary or pubic hair. There is a blind vaginal pouch and NO uterus/ovaries/fallopian tubes

-Testes are located in either the inguinal canal or within the labia majora --> surgical removal after the completion of puberty is reccommended to protect against testicular cancer

-Wait until after puberty for patient to finish breast development and grow to adult height

Front 261

What is the treatment of choice for Mucormycosis?

Back 261

Surgical debridement and amphotericin B

--------------------------------------------------

- Commonly seen in biabetic patients with DKA.

-Caused by Rhizopus fungi

Front 262

What is the most common cause of Mucormycosis in patients with DM Type 1 and DKA?

Back 262

Rhizopus

Front 263

Whicdh atypical antipsychotic is most likely to cause extrapyramidal side effects?

Back 263

Risperidone

------------------------------------------------

Remember to treat with an antimuscarinic like beztropine

- Also remember that atypical antipsychotics can cause ↑ prolactin

Front 264

A child is diagnosed with pinworms (Enterobius vermicularis).

What is the drug of choice?

Back 264

Albendazole or Mebendazole

---------------------------------------------

2nd line- Pyrantel pamoate

Can't use albendazole or mebenazole in pregnant patients!

Front 265

A patient experiences hyperactive reflexes after an abdominal surgery with many transfusions for a liver laceration.

What is the electrolyte abnormality?

Back 265

HYPOcalcemia

-------------------------------------

Hypocalcemia can occur during or right after SURGERY, especially if transfusion is involved.

First manifestation is increased DTR.

-muscle cramps, possibly convulsions

Front 266

Formula to calculate anion gap?

Back 266

Anion Gap =Na - Cl - HCO3

(Normal = 8-12)

Front 267

HY

What is the most common cause of abnormal hemostasis in patients with Chronic Renal Failure?

Back 267

Platelet dysfunction

-Uremic toxins such as guanidinosuccinic acid have been implicated in pathogenesis

Desmopressin (DDAVP) is the treament of choice

* ↑ release of Von-Willebrand factor and factor VIII from endothelial storage sites

-----------------------------------------------------------------------

Will see normal PT, PTT and platelet count.

There will be an ↑Bleeding time (BT)

Front 268

A patient with a history of IV drug use has a holosystolic murmur that increases in intensity with inspiration.

What is the murmur?

Back 268

Tricuspid regurgitation

Front 269

A patient with a history of IV drug use presents with fatigue and fever.

Ausculation reveals a holosystolic murmur that increases in intensity with inspiration.

What empiric antibiotic should be started?

Back 269

Vancomycin

-------------------------------------------------------------

Here you should suspect right-sided bacterial endocarditis due to history of IV drug use and presence of tricuspid regurgitation

- Staph aureus is most common organism

Front 270

Most common murmur seen in patients with IV drug use?

Back 270

Tricuspid Regurgitation

Front 271

What should be ordered first in all patients who undergoe a central-venous catheterization?

Back 271

Chest X-ray to confirm placement

Front 272

Drug of choice for syphilis?

Back 272

Penicillin

Front 273

𝞫 blocker overdose causes AV Block, bradycardia, hypotension, wheezing and potential cardiogenic shock.

Atropine and IV fluids are first-line treatments. If they do not completely reverse cardiac symptoms, what is the next therapy of choice?

Back 273

Glucagon

Front 274

This disease can cause megacolon, megaesophagus and cardiac dysfunction

Back 274

Chagas Disease

(Trypanosoma Cruzi)

Front 275

What class of drugs can limit ventricular remodeling after a myocardial infarction?

Back 275

ACE-I's

-------------------------------------------------------------

ACE-I's should be initiated within 24 hours of MI in all patients witout a contraindication

Front 276

Small bowel biopsy shows villous atrophy in a patient who has been having frequent, foul-smelling, bulky stools and weightloss for the past 6 months. He has fatigue and occasional joint pain.

Most Likely Diagnosis?

Back 276

Celiac Disease

-------------------------------------------------------

(+) IgA anti-tissue transglutaminase

(+) IgA anti-endomysial antibodies

However, man patients with biopsy-confirmed celiac disease will have negative results on IgA antibody testing due to an associated IgA deficiency (must measure total IgA)

Front 277

What is a key feature of the CSF analysis of Guillan-Barre syndrome?

Back 277

Elevated pressure

Elevated protein

Low WBCs

-------------------------------------------------------

This is called albuminocytologic dissociation

Front 278

What causes an anaphylactic reaction to a blood transfusion?

-------------------------------------------------------

Immediate reaction

Shock, angiodema/uticaria and resp. distress

Back 278

recipient anti-IgA antibodies

Front 279

What is the cause of febrile nonhemolytic blood transfusion reaction?

------------------------------------------------------------

(Most common transfusion reaction)

-1-6 hrs after transfusion

- Causes fever/chills

Back 279

Build-up of inflammatory cytokines during blood storage

Front 280

Most common cause of chronic iron deficiency anemia?

Back 280

Chronic Blood Loss

Front 281

A patient presents one week after an acute upper respiratory infection with shortness of breath, weakness and an increased, "water bottle" silhouette on chest x-ray.

EKG shows low voltage in all leads and there is a non-palpable point of maximal impulse.

Back 281

pericardial effusion

Front 282

A child displays poor communication and reduced verbal expression at school 1 month after beginning kindergarten but behaves normally at home.

Back 282

Select Mutism

-------------------------------------------

- at least 1 month duration

- consistently fails to speak in specific situations

- no attributable lack of knowledge or ↓ hearing

Front 283

A patient presents with GI complaints for one week followed by muscle pain, swelling and weakness.

Examination shows presence of of subungul splinter hemorrhages , conjunctival and retinal hemorrhages, periorbital edema and eosinophilia.

Back 283

Trichinosis

---------------------------------------------------------------

- Roundworm infection from eating undercooked pork

- Phase 1: abdominal pain, N/V/D

-Phase 2: Larva migrate and induce a hypersensitivity rxn, "splinter hemorrhages", conjunctival and retinal hemorrhages, periorbital edema and chemosis

-Phase 3: Larvae enter skeletal muscle and cause muscle pain, tenderness, swelling and weakness.

Front 284

Most common antibiotic class to cause photosensitivity?

Back 284

Tetracyclines

Front 285

Rare condition characterized by precoscious puberty, cafe au lait spots and mutliple bone defects

Back 285

McCune Albright Syndrome

--------------------------------------------------

3 P's:

-precoscious puberty

- pigmentation

- polyostotic fibrous dysplasia

Front 286

In patients with influenza, neuraminidase inhibitors (oseltamivir and zanamivir) must be started within ______ hours to be effective

Back 286

48 hours

Front 287

Most common thyroid cancer?

Back 287

Papillary Carcinoma

-------------------------------------------------------

-Fine Needle Biopsy shows psammoma bodies

- Large cells with ground glass cytoplasm, and pale nuclei with inclusion bodies and central grooving

Front 288

Which thyroid cancer is encapsulated?

Back 288

Follicular Thyroid Carcinoma

------------------------------------------------------------------

Demonstration of invasion of the capsule and blood vessels is necessary to differentiate follicular cancer from follicular adenomas!

-Follicular thyroid cancers like to invade blood vessels and metastasize to distal organs

Front 289

Most common electrolyte abnormalities observed with Cushing Syndrome?

Back 289

HYPOkalemia and HYPERnatremia

-------------------------------------------------------

-There is corticosteroid excess

- Corticosteroids will bind to aldosterone receptors in the kidney and cause potassium wasting

Front 290

Most common risk factor for plancental abruption?

Back 290

Maternal HTN

Front 291

An incidental renal cyst is noticed on an abdominal CT.

What features of the cyst would require more studies for further evaluation?

Back 291

-Thick, irregular wall

- Multilocular with multiple septae

- Contrast enhancement on CT/MRI

------------------------------------------------------

These types of cysts are associated with malignant transformation.

Unlike simple renal cysts, these may cause symptoms such as hematuria, pain or hypertension

Front 292

First line treatment for PMS/PMDD?

Back 292

SSRIs

Front 293

______ should be included as secondary prevention following unstable angina/NSTEMI for at least 12 months.

It hsould also be prescribed for 30 days (bare metal stents) to 1 year (drug eluting stents) following percutaneous coronary intervention (PCI), as it has been shown to help prevent subacute stent thrombosis

Back 293

Clopedigrel

-------------------------------------------------------

Belongs to a class of drugs known as Thienopyridines which includes ticlopidine.

Has an anti-platelet effect and acts by blocking ADP

Front 294

Hydroxychloroquine is used for patients with SLE that have significant skin and joint involvement.

What is its most serious side effect?

Back 294

Retinopathy

----------------------------------------------------

Need eye exams q 6 months!

Front 295

How does squatting affect the murmur heard in a child with Tetrology of Fallot?

Back 295

The murmur will increase

------------------------------------------------------

Squatting (↑ afterload and ↑PVR) decreases the right to left ventricular shunting associated with the VSD and will improve cyanosis!

Front 296

Digoxin toxicity is more common in patients with what electrolyte deficiency?

Back 296

HYPOkalemia

---------------------------------------------------

Digoxin competes with K+ for the Na/K pump

Front 297

What is the first step in a workup of acromegaly?

Back 297

Measure serum IGF-1 first

Then, Oral glucose supression if IGF-1 is ↑

(GH will decrease)

-------------------------------------------------

Even though they most likely have a pituitary tumor, you should do IGF-1 first --> Glucose supression --> MRI

Front 298

Hemochromatosis can lead to what type of cancer?

Back 298

Hepatocellular Carcinoma

Front 299

First line treatment for hypertrophic cardiomyopathy?

Back 299

Beta-blockers or Diltiazem

Front 300

Several small, teardrop shaped lesions on the vulva. Application of trichloroactic acid results in complete resolution of lesions

Back 300

Genital warts (condyloma accuminata)

Front 301

A patient is found on the floor and unresponsive after several hours.

He has an elevated K+, elevated CPK, and history of cocaine abuse.

What are we worried about as a result of his cocaine abuse?

Back 301

Rhabdomyolysis --> immobilization + cocaine

--------------------------------------------------------------------

↑CPK d/t rhabdo can lead to acute renal failure

Front 302

What is the best way to prevent HIV/AIDs tranmission between a mother and fetus?

Back 302

HAART triple antiviral therapy throughout pregnancy

----------------------------------------------------------

3-drug HAART:

- 2 nucleoside reverse transcriptase inhibitors

PLUS

-Non-nucleoside reverse transcriptase inhibitor OR protease inhibitor

NRTIs with good placental transfer are Zidovudine and tenofovir

Zidovudine should be administered to the neonate for up to or more than 6 weeks

Front 303

What should you monitor in patients taking 2nd-generation antipsychotics --> Olanzapine or Clozapine?

Back 303

Fasting glucose and lipid panels

(d/t ↑weight gain and dyslipidemia and hyperglycemia)

-------------------------------------------------------

Clozapine is also associated with agranulocytosis

Front 304

What is the first line treatment for noninflammatory (comedonal) acne?

Back 304

Topical Retinoids

----------------------------------------------------

Inflammatory Acne --> topical retinoids AND benzoyl peroxide

Moderate to Severe Inflammatory Acne

- ADD topical antibiotics (doxycycline)

Severe or Recalcitrant Acne

- Oral antibiotics and isotrenitoin

Front 305

First step in work-up of achalasia?

Back 305

Barium swallow

-----------------------------------------------

However, if you suspect and obstruction from a tumor, you could start with an endoscopy. But generally, you would do barium swallow first

Front 306

An athlete suffers a clavicular fracture. A loud bruit is heard underneath the clavicle.

Next step?

Back 306

Angiography

-------------------------------------------------------

Need to rule out damage to subclavian artery and brachial plexus

Front 307

HY

_____________ and tacrolimus have the same mechanism of action (calcineurin-inhibitors) that inhibit the transcription of interleukin-2 and several other cytokines.

The major side effects include nephrotoxicity, hyperkalemia, hypertension, gum hypertrophy, hirsutism and tremor.

Tacrolimus has similar toxicities, but lacks hirsutism and gum hypertrophy.

Back 307

Cyclosporin

---------------------------------------------------------

Immunosuppresant side effects:

azathioprine--> dose related diarrhea, leukopenia, hepatotoxicity

mycophenolate --> bone marrow suppression

Front 308

What is the best way to prevent bacterial UTI in a patient with chronic neurogenic bladder?

Back 308

Intermittant catheterization

-----------------------------------------------------

Although each passage of the catheter has risk of bacterial induction, indwelling catheters have a higher risk of infection due to bacterial biofilm that can develop along the catheter wall

Front 309

Prophylactic treament for patients with non-bleeding, small esophageal varices?

Back 309

non-selective 𝞫-blockers

(Propanolol or nadolol)

-----------------------------------------------------------------

Mechanism involves decreased andrenergic tone in mesenteric arterioles that causes unopposed alpha-vasocontriction and decreased portal vein flow

Front 310

Multiple duodenal ulcers with the presence of a jejunal ulcer

Back 310

Zollinger-Ellison Syndrome

------------------------------------------------------

Characterized by multiple severe drug resistant ulcerations in the GI track. The mcc of ZES is a gastrin-producing pancreatic tumor.

As a result of uncontrolled gastrin production, parietal cell hyperplasia occurs and stomach acid production is significantly increased. Multiple Duodenal ulcer are typical, and a Jejunal ulcer is almost pathognomonic for this condition.

Dx = secretin test (if a pt has a gastrinoma, an IV Bolus of secretin should cause a huge rise in gastrin).

Steatorrhea may develop because increased production of stomach acid inactivates pancreatic enzymes. Tx of choice is K-H ATPase inhibitor Omeprazole, indefenitely until surgery. If meds fails we have to go to a total Gastrectomy.

*Is Associated with MEN-I…so if someone presents with a gastrinoma…also look for these other tumors = Hyperparathyroidism and Pituitary tumors causing varius symptoms such as acromegaly, etc (+Pancreatic carcinoma/gastrinoma)

- To Dx a gastrinoma – can use an octreotide scan to localize the tumor!

Front 311

Method of choice for diagnosing lactose intolerance?

Back 311

Hydrogen breath test

--------------------------------------------------

(+) test is characterized by a rise in exhaled hydrogen after administration of lactose, which indicates bacterial lactose metabolism

Front 312

Most common cause of UTI-acquired infectious endocarditis?

Back 312

Enterococcus faecalis

Front 313

Common rash seen on extensor surfaces in patients with Celiac Disease?

Back 313

Dermatitis herpetiformis

--------------------------------------------------

Treat with dapsone

Front 314

Surgery for stress incontinence?

Back 314

urethroplexy

------------------------------------------------

Kegel Excercises should be done first!

Urethral hypermobility = >30 degrees angle with cotton swab test and increased intrabdominal P

Front 315

Most common shoulder injury after a tonic-clonic seizure?

Back 315

Posterior shoulder dislocation

-------------------------------------------------

patient holds arm ADducted and internally rotated

Front 316

What maneuver will worsen the murmur heard in hypertrophic cardiomyopathy?

Back 316

Valsalva

---------------------------------------------------

Valsalva --> ↓ preload --> ↓ size of ventricular cavity --> worsens outflow obstruction

Most murmurs will decrease when there is decreased venous return (↓preload) since there is less flow through the heart

Front 317

HY

In infant presents with cyanosis while feeding that resolves when he is crying

Back 317

Choanal atresia

Front 318

The common presentation of cryoglobulinemia includes palpable purpura, glomerulonephritis, arthralgias, hepatosplenomegaly, peripheral neuropathy and hypocomplementemia.

Most of these patients also have an infection with what virus?

Back 318

Hepatitis C

Front 319

Seizure medication assosciated with acute pancreatitis?

Back 319

Valproic Acid

--------------------------------------------------------------

Other Drugs associated with acute pancreatitis:

1. Diuretics (furosemide, thiazides)
2. IBD drugs (sulfasalazine, 5-ASA)
3. Immunosupressive agents (azathioprine)
4. HIV- medications (didanosine, pentamide)
5. Antibiotics (metronidazole, tetracycline)

Front 320

_________ is diagnosed by the presence of crooked, branching, beaded, Gram (+) and partially Acid-fast filaments on microscopy.

Back 320

Nocardia

----------------------------------------------------------

Tx: TMP-SMX

Can present with pulmonary, CNS or cutaneous manifestations.

-Patients with deficient cell-mediated immunity (HIV, lymphoma, transplant patients) are at increased risk

Front 321

Best treatment for hypercalcemia with symptoms?

Back 321

Bisphosphonates (zolendroic acid)

+

Normal saline

+

Calcitonin

--------------------------------------------------------

Bisphosphonates are used long term in patients with malignancy causing hypercalcemia

Front 322

Carotid endarterectomy is recommended for patients with "symptomatic" carotid stenosis of more than ______%

Back 322

more than 70%

Front 323

HIV patient with a CD4 count <180 has severe, watery diarrhea, abdominal cramps and an inability to eat.

Acid fast stain of stool specimen shows 4-6mm oocysts.

Diagnosis?

Back 323

Cryptosporidium parvum

----------------------------------------------------

Causes diarrhea in immunocompromised patients

Front 324

Pleural effusion:

Exudative effusion is caused by ______________

Back 324

increased capillary permeability

----------------------------------------------------------------

Increased permeability allows LDH to leak from capillaries

Transudative effusion: increased hydrostatic P or decreased oncotic P

Front 325

Pleural effusion:

Transudative effusion is caused by ___________

Back 325

increased hydrostatic pressure (CHF)

or

decreased oncotic pressure (liver failure)

----------------------------------------------------------------

Exudative effusion: increased capillary permeability (Infection, neoplasm, Autoimmune Dz)

Front 326

Transudative pleural effusion in CHF is caused by

_________________

Back 326

increased hydrostatic pressure

Front 327

Transudative pleural effusion seen in liver failure is caused by _________________________

Back 327

decreased oncotic pressure

Front 328

Where is the most frequent origin of the ectopic foci that cause atrial fibrillation?

Back 328

pulmonary veins

Front 329

Most common cause of atrial flutter stems from a re-entry circuit located where?

Back 329

tricuspid annulus --> cavotricuspid isthmus

Front 330

Sinus Tachycardia stems from increased sympathetic/decreased vagal influences on the _____ node

Back 330

SA node

Front 331

Treatment for patients with immune thrombocytopenia?

---------------------------------------------------------------------

Most common in patients 2-5 yrs old.

Follows a viral infection

Asymptomatic petechiae and echymosis most common

Can cause mucosal bleeding (GI, epitaxis, hematuria)

Labs show Thrombocytopenia < 100,000 and megakaryocytes on peripheral smear with no other abnormal findings

Back 331

Skin manifestations only: observation

Bleeding: IVIg or Glucocorticoids

------------------------------------------------------------------

When this occurs in adults, you can observe if the platelet count is <30,000

If platelet count < 30,000 or there is bleeding:

-IVIg or Glucocorticoids

Front 332

Most common malignant cancer of the liver?

Back 332

METASTASIS from another source

Front 333

Hyperventilation causes what acid-base disorder?

Back 333

Respiratory Alkylosis

----------------------------------------------------

Seen in hyperventilation with pneumonia, altitude sickness and salicylate poisoning

Front 334

This skin condition of infancy presents with pruritis and skin lesions typically distributed symmetrically over the scalp, chest and extensor surfaces of the extremeties.

The diaper area is typically spared

Back 334

Atopic Dermatitis

-------------------------------------------------

Treatment improves the skin barrier through the use of mild cleansers and thick bland emollients + topical antiinflammatory ointments

Front 335

A patient presents with an acute abdomen and you suspect a perforated viscus. He is on warfarin for a-fib.

He requires an emergent laparotomy. Since he is on warfarin, reversal of anticoagulation must be rapidly achieved by infusion of ___________

Back 335

Fresh Frozen Plasma

---------------------------------------------------------------

FFP normalizes prothrombin time (PT) and resores vitamin K clotting factors

Front 336

HY

The risk of sepsis by encapsulated bacteria (Pneumococcal, Haemophilus, Menningococcal) but especially Strep pneumo is present up to ____ years after splenectomy

Back 336

30 years

---------------------------------------------------

Asplenic patients need :

Anti pneumococcal + meningococcal +Haemophilus vaccinations several weeks befroe surgery

Daily penicillin prophylaxis for 3-5 years following splenectomy

Front 337

What special precautions do patients undergoing splenectomy need in order to gaurd against encapsulated bacterial sepsis?

Back 337

Anti pneumococcal + meningococcal +Haemophilus vaccinations several weeks befroe surgery

Daily penicillin prophylaxis for 3-5 years following splenectomy

Front 338

Watery diarrhea after eating raw or undercooked seafood?

Back 338

Vibrio parahaemolyticus

Front 339

A patient from Greece has a microcytic anemia that is non-responsive to iron therapy.

Back 339

𝞫-Thalassemia

--------------------------------------------------

There is reduced hemoglobin synthesis due to point mutations on the 𝞫-hemoglobin genes

𝞫-Thalassemia minor: defect in one gene

-will see a modest anemia

𝞫-Thalassemia Major: defect in both genes

-will see severe anemia and likely transfusion dependence at an early age

Front 340

Metformin is contraindicated in patients with which 2 diseases?

Back 340

Renal failure

Liver failure

---------------------------------------------------

Increased risk of lactic acidosis

In conditions with an increased BUN, lactic acidosis will only cause more problems

Front 341

A patient presents with an insenasate (no sensation), hypopigmented lesion on his forearm. He has muscle weakness and wasting of his upper arm and shoulder.

Skin biopsy shows acid-fast bacilli.

Back 341

Mycobacterium leprae

(Leprosy)

--------------------------------------------------------------------

Front 342

Fetal monitor shows recurrent variable decelerations. What is the next best step?

Back 342

1. Administer O2
2. Place Mom in lateral decubitus position

Front 343

20 year old female presents with copius malodorous vaginal that is Greyish-green color, thin and frothy.

She also has vaginal pruritis, dysurea and dyspareunia. Petechial pathes on the cervix show "strawbery cervix".

Dx by microscopic obervation of flagellar, pear-shaped organism in wet mount preparation

Back 343

Trichomonas vaginalis

-----------------------------------------------------------------

treat BOTH partners with metronidazole

Front 344

Fluphenazine is a "typical" psychotic medication used to inject schizophrenic patients every 2-3 weeks due to poor compliance.

What is a special climate situation a patient taking fluphenazine should try to avoid?

Back 344

Cold climates ---> HYOTHERMIA

-----------------------------------------------------------------

Fluphenazine disrupts the shivering mechanism

Front 345

Most common bug to cause pneumonia in nursing home residents?

Back 345

Strep pneumonia

---------------------------------------------------

Also m/c cause of community pneumonia

Front 346

Immunocompromised patient presents with fever, cough, dyspnea and hemoptysis.

Chest CT shows pulmonary nodules with a halo sign.

Back 346

Aspergillosis

-------------------------------------------------------

X-ray may show cavitary lesion

Chest CT shows pulmonary nodules with a halo sign or lesions with an air crescent

Front 347

What 2 drugs can be used to decrease the frequency of exacerbations in patients with relapsing-remitting Multiple Sclerosis?

Back 347

Beta-interferon

Glatiramer

----------------------------------------------------------

"Beta take interferon, you'll be glat you did"

Front 348

fetal monitor tracings

Back 348

Front 349

A schizophrenic patient is meeting with her psychiatrist. During conversation she seems to have disorganized thought and speech.

Her responses are irrelevant, but detailed. Her answers drift away from the subject but eventually return. Her answers deviate from the topic of conversation but remain vaguely related and there is an eventual return to the original subject.

What is she demonstrating?

Back 349

Circumstantiality

(comes back to original topic eventually)

-------------------------------------------------------------

"Flight of ideas"-loosely associated thoughts that move from topic to topic.

Tangentiality- thought process in which there is abrupt, permanent deviation from current topic. New thought process is minimally relevant and never returns to origninal subject

Loose Assosciations - best described as a lack of logical connection between thoughts or ideas. It is a more severe form of tangentiality where one statement follows another but there is no clear assosciation between sentences.

Preservation - repetition of words or ideas during a conversation

Front 350

Aminoglycosides are used for serious gram-negative infections.

What side effect do you have to be aware of before treating a patient?

Back 350

Nephrotoxicity

----------------------------------------------------------------

-Amikacin was used as an example

Tobramycin, Gentamycin, Neomycin, Streptomycin

Front 351

Radiation exposure during the first _____ days of conception can cause fetal death and resorption

Back 351

14 days

Front 352

What should you do for household contacts of a patient recently diagnosed with Pertussis?

Back 352

Macrolide prophylaxis for ALL household members DESPITE vaccination status

---------------------------------------------------------------

Age < 1 month: Azithromycin x 5 days

Age > 1 month:

Azithromycin x 5 days

or

Clarithromycin x 7 days

or

Erythromycin x 14 days

Front 353

A homeless man presents with tingling lips, and muscle pain. He is an alcoholic and has been drinking a lot lately.

His serum calcium and phosphorous are both low.

What could be causing his hypocalcemia?

Back 353

Malabsorption

---------------------------------------------------

He is predisposed to malabsorption d/t pancreatitis. Vitamin D malabsorption causes hypocalcemia and hypophosphatemia because active 1,25-dihydro cholecalciferol usually would raise levels of both calcium and phosphorous.

Front 354

Acid-base disturbance seen in Aspirin overdose?

Back 354

Respiratory Alkalosis with Metabolic acidosis

-------------------------------------------------------------------

Respiratory alkalosis is due to increased respiratory drive (hyperventilation)

Metabolic acidosis is caused by increased production and decreased renal elimination of organic acids (lactic acid, ketoacidosis)

Front 355

Leukemia:

(+) Tartate-resistant acid stain (TRAP)

(+) CD11c

Back 355

Hairy Cell Leukemia

------------------------------------------------

B-lymphocytic derived chronic leukemia.

-TARTRATE-RESISTANT ACID PHOSPHATASE (TRAP) STAIN is Dx.

****Picture looks like hairy projections of large cells (lymphocytes)***

Bone marrow may become fibrotic so BM aspirate are frequently unsuccessful (Dry Tap).

Tx DOC are = Nucleoside analogs. It’s toxic to BM, & causes neurological and kidney damage.

Front 356

(+) Reed Sternberg cells (Owl's Eye cells) are diagnostic for __________________

Back 356

Hodgkin's Lymphoma

Front 357

What test is commonly used to compare the means of two groups of subjects?

Back 357

t-test

Front 358

What test is commonly used to compare the means of three or more groups of subjects?

Back 358

ANOVA (Analysis of Varience)

Front 359

A 15 year old boy comes to his physician with a new onset of facial muscle weakness, dysphagia, upper extremity muscle wasting, and an inability to release hand with handshake (myotonia).

Back 359

Myotonic Muscular Dystrophy

(Steinert Disease)

-Autosomal Dominant

-----------------------------------------------------------

2nd mcc of muscular dystrophy, after Duchenne. Autosomal Dominant, wheras Duchenne and Becker are X-linked recessive

-A trinucleotide expansion disease:

* CTG trinucleotide repeat in DMPK gene on chromosome 19

ALL muscle in body atrophy, lip looks like a V. Its .

It’s defined as delayed mucle relaxation, characteristic is not being able to release the hand after hand shake.

- Cardiac manifestations = cardiomyopathy & arrhythmias

- Occular manifestations = cataracts

- Also presents with gonadal atrophy and balding

Front 360

Inheritance for Duchenne and Becker Muscular Dystrophies?

Back 360

X-linked recessive

Front 361

A physician is assessing a patient for brain death and reveals that the patient still has intact DTRs despite no signs of brainstem function.

What is going on?

Back 361

DTRs reveal an intact spinal cord

The spinal cord may still be intact, but the patient is brain dead....

Front 362

Most common cause of non-sexually transmitted epididymitis?

Back 362

E. Coli

-------------------------------------------------------------

Most frequent in older men

Front 363

Most common cause of sexually-transmitted epididymitis?

Back 363

Chlamydia or Gonnorrhea infection

-------------------------------------------------------------------

More frequent in younger males

Front 364

Most common cause of viral "pinky eye" conjunctivitis?

Back 364

Adenovirus

------------------------------------------------------------

Commonly seen in children (and care-takers) in daycare or school settings in late summer/early fall.

Tx:

Warm/Cool compresses

+/- Antihistamine or decongestant drops

DO NOT use Steroid Eye drops for Viral eye infections

Front 365

A child with known TOF is having a "tet" spell. What position should he be placed in to increase systemic vascular resistance to reduce the degree of right-to-left shunting, and increase pulmonary bloodflow, and resolve symptoms and cyanosis.

Back 365

Knees-to-Chest position

----------------------------------------------------------

Tetralogy of Fallot:

"Tet" spells are hypoxic episodes characterized by rapid breathing. Rapid breathing increases pulmonary vascular resistance which causes a shunting of unoxygenated blood from the right ventricle across the VSD and into the aorta. This causes cyanosis

Immediate tx is Oxygen and put the child in a Knee-Chest position, followed by fluids, morphine, propranolol

Squatting and Knee-to-chest positions increase systemic vascular resistance to reduce the degree of right-to-left shunting, and increase pulmonary bloodflow, and resolve symptoms and cyanosis.

Front 366

What is the drug of choice to treat Lyme disease in Pregnant women, breast-feeding women, or children <8 years old?

Back 366

Amoxicillin

---------------------------------------------------------

Doxycycline is a tetracyline antibiotic that can cause tooth discoloration and decreased bone growth in children and fetuses

Front 367

A patient with chronic alcoholism and cirrohsis presents with fever and acute abdominal pain. Abdominal exam shows shifting dullness and diffuse tenderness to palpation.

You suspect peritonitis. What is the next best step for diagnosis?

Back 367

Paracentesis

----------------------------------------------------------------

(+) Ascites fluid culture for most commonly E. Coli or Klebsiella

AND

PMN level greater than 250 make the diagnosis

Front 368

A 32 year old woman presents with intermittent blood staining on her bra from her left breast. She has not felt any bumps or masses

Physical examination reveals no breast mass, lymphadenopathy or skin changes.

U/S of the breast is within normal limits

Back 368

Intraductal Papilloma

--------------------------------------------------------

Benign breast disease

Most are situated beneath the aereola and difficult to palpate

Often no larger than 2mm so U/S won't pick it up

Front 369

Diagnostic test for Heparin-induced Thrombocytopenia?

Back 369

Serotonin Release Assay

Front 370

Treatment for Heparin-induced Thrombocytopenia?

Back 370

1) STOP ALL HEPARIN DRUGS

2) Start a direct thrombin inhibitor (argatroban)

or

fondaparinux (synthetic pentasaccharide)

----------------------------------------------------------------

Warfarin is usually started after treatment with a non-heparin anticoagulant and platelet count recovery > 150,000 u/L

Front 371

34 year old African American man presents with cough, intermittant chest pain, and fatigue for 2 months duration.

He denies alcohol, tobacco or drug use. He has not traveled out of the country and has not been incarcerated.

Auscultation reveals patchy crackles.

Chest X-ray shows several lung nodules and mediastinal adenopathy.

A biopsy of lung nodules shows non-caseating granulomas

Back 371

Sarcoidosis

-----------------------------------------------------------

Systemic steriods are the DOC for Sarcoidosis. They are indicated in pt’s with disabling systems (visual disturbances, cough, shortness of breath) and organ dysfunction.

Pt has bilateral Hillar lymphadenopathy (organ derangement). Steroids suppress activated T-induced cell process at disease site. Asymptomatic pts need no tx.

****Cxr shows granular Hilar opacity in lungs bilaterally (midiastinum adenopathy). Once midiastinum adenopathy is seen on CXR, the next step is to perform mediastinal bronchoscopy and obtain tissue for biopsy.

Ca++ & ACE are increased (macrophages in the granuloma’s convert Vit D to calcium, irrespective of PTH or Ca levels in the blood!) and

Steriods are tx of choice for SYMPTOMATIC pts.****Pt with no symptoms but dyspnea that has gotten worse and joint pain with cxr showing hilar adenopahty and non-caseating granuloma.****

Skin manifestation of rash is found in 30% of pts, to Dx Scintigraphy, to Confirm biopsy and non-caseating granulomas.

-Triad of: bilateral hilar lymphadenopathy, polyarthralgia, & erythema nodosum (esp knees)

Front 372

Therapy of choice in patients with acute bleeding and Chronic Liver Failure?

Back 372

Fresh Frozen Plasma

------------------------------------------------------------------

Contains Vit K dependent factors: II, VII, IX, X

that the liver cannot synthesize due to failure.

Front 373

A patient with a history of Hepatitis C and chronic liver failure presents with fatigue and shortness of breath.

Exam reveals decreased breath sounds at the right lung base, significant abdominal distension, 2+ peripheral edema. Periumbilical venout distension is appreciated.

Chest X-ray shows a moderate to severe right pleural effusion and a small left pleaural effusion. Thoracentesis reveals a transudative exudate.

What is the best way to manage his hepatic hydrothorax?

Back 373

Initial treatment is diuretics and salt restriction

If perfusion persists, then a Transjugular Intrahepatic Portosystemic Shunt (TIPS) should be placed

Front 374

Which renal-pulmonary syndrome is treated with emergency plasmaphoresis?

Back 374

Goodpasture's

---------------------------------------------------------

Plasmapharesis is requires to remove the anti-glomerular basement membrane antibodies (anti-GBM) in order to minimize kidney damage!

Front 375

Treatment for Wegener's Disease?

Back 375

Cyclophosphamide and Steroids

(c-ANCA --> Cyclophosphami

------------------------------------------------------------

Hematuria+Hemoptysis+Sinusitis.

Underlying pathology involves Necrotizing vasculitis with granuloma formation.

Postive c-ANCA (aka antiproteinase 3 Ab).

Typical Xray shows nodular cavities.

****Demonstration of Anti Neutrophil Cytoplasmic Antibodies confirm dx

Front 376

What steps should you take to prevent contrast nephropathy in a patient with increased risk (Diabetes, Renal insufficiency)?

Back 376

1) Adequate IV hydration with either normal saline or sodium bicarbonate

2) Acetylcysteine (Vasodilation + antioxidant)

--------------------------------------------------------------------

Contrast Nephropathy presents as a Creatinine spike within 24 hours of contrast administration, with a return to normal renal function 5-7 days later

Diabetics already have a high baseline Creatinine and are at an increased risk

Front 377

What is asymmetric intrauterine growth restriction in a fetus?

Back 377

Asymmetric interuterine growth restriction is the result of a later exposure to a maternal factor that does not allow for fetal growth.

It is characterized by normal or near normal head size, and a reduced abdominal circumfrence.

Maternal Factors:

hypertension, smoking, hypoxia, vascular disease, preeclampsia

Front 378

What is symmetric intrauterine growth restriction in a fetus?

Back 378

In symmetric growth restriction, the insult to the fetus occurs before 28wks gestation, and growth of the head and body are similarly lagging behind in dates

It is caused by fetal factors such as chromosomal abnormalities, congenital infections (TORCH) and congenital anomolies

Front 379

Pt presents with massive hemoptosis, weight loss, hematuria and proteinuria.

Blood tests show Anti-GBM antibodies

Back 379

Goodpastures

Front 380

Acid-base disorder you would expect to see in an infant with pyloric stenosis?

Back 380

Hypochloremic Metabolic Alkalosis

Front 381

Study used to confirm pyloric stenosis in an infant?

Back 381

Abdominal Ultrasound

Front 382

A 33 year old morbidly obese female presents with amenorrhea for 9 months. She had her last child 2 years ago and had a tubal ligation afterwards. Her menses were normal until about 18 months ago and then started to skip every other month.

She did not breastfeed, and was not on any medicines. Initial bloodwork, serum TSH, prolactin, FSH and LH were all within normal limits.

What is causing her amenorrhea?

Back 382

Anovulation secondary to morbid obesity

-------------------------------------------------------------------

Normal FSH and LH levels show that the ovaries are still producing estrogen.

However, progesterone is not being produced normally at post ovulation levels. No progesterone withdrawl means no menses

Front 383

A 2 week old neonate is brought to the office for poor feeding and persistent vomiting. He is irritable and jaundiced. His liver and spleen are enlarged. Bilateral cataracts are evident.

What is the condition? What enzyme is deficient?

Back 383

Galactosemia

Galactose-1-phosphate uridyl transferase

(GPUT)

-----------------------------------------------------------

Symptoms include failure to thrive, bilateral cataracts, jaundice and hypoglycemia.

Early dx and tx by removing galactose from diet are mandatory. Must be put on SOY milk

It’s a metabolic disorder caused by Galactose-1-Phosphate Uridyltransferace def. That leads to increased levels of Galactose-1-P. Infants are at an increased risk for E. Coli neonatal sepsis

DDX: Galactokinase Deficiency ---> bilateral cateracts but are otherwise asymptomatic!

Front 384

An infant is brought to the office for a well visit. His mother reports no concerns. He is eating, gaining weight and producing an appropriate amount of wet and dirty diapers.

Physical exam is normal except for bilateral cataracts noted on ophthalmic exam.

What enzyme is deficient?

Back 384

Galactokinase

Front 385

A patient is found to have needle shaped crystals in his urine. They were not present on U/S or abdominal X-ray.

What test can be used to visualize these crystals?

Back 385

Uric Acid Stones

CT Abdomen

Intravenous pyelogram

Front 386

This form of emergency contraception is 99% effective if used within 120 hrs.

Back 386

Copper IUD

---------------------------------------------------------------

Causes an inflammatory response that is toxic to sperm and egg. Can be taken up to 5 days (120hrs) after unprotected intercourse.

Front 387

What test can be used to differentiate between fetal and maternal blood if there is a suspected rupture of an umbilical vessel?

Back 387

Apt Test

Front 388

DOC for a cat bite?

(Or dog bite)

Back 388

Amoxicillin/Clavulanate

(Augmentin)

-------------------------------------------------------------

Cat/Dog Bite: Pasturella Multicoda

Gram (-) Coccobacillus

Front 389

DOC for a cat scratch?

Back 389

Azithromycin

--------------------------------------------------------------

Bartonella henslae

Gram (-) bacillus

Can develop vesicular erythema at scratch site and tender lymphadenopathy 3-14 days after scratch

Front 390

What is the treatment of choice for central retinal artery occlusion?

Back 390

Gentle Massage of the globe and highflow O2

----------------------------------------------------------------------

Massage helps to dislodge the emboli and the highflow O2 (CO2 : 5% / O2 95%) is thought to cause opthalmic vessel vasodilation

Front 391

Painless loss of vision in one eye. Fundoscopic examination shows a pale retina (maybe cherry red spots)

Back 391

Central Retinal Artery Occlusion

Front 392

Treatment for Torsades De Pointes?

Back 392

Magnesium Sulfate

Front 393

Treatment for hyperkalemia with tall, peaked T-wave?

Back 393

Calcium Gluconate

Front 394

Presence of Philadelphia Chromosome (t[9;22])

Back 394

CML

-------------------------------------------------------------

May also see BCR-ABL fusion gene

May also see Low leukocyte alkaline phosphatase

Front 395

Presence of Auer Rods

Back 395

AML

Front 396

Absence of measurable erythropoetin in urine

Back 396

Polycythemia Vera

Front 397

Low leukocyte alkaline phosphatase is classic for which leukemia?

Back 397

CML

Front 398

Atypical antipsychotic most likely to cause extra-pyramidal symptoms?

Back 398

Risperidone

Front 399

Most common pituitary tumor?

Back 399

Prolactinoma

Front 400

Arises from Rathke's cleft formed during pituitary development

Back 400

Craniopharyngioma

Front 401

A patient has overdosed on TCAs. She is hypotensive and obtunded.

EKG shows QRS elongation.

What drug should you give?

Back 401

Sodium Bicarbonate

-------------------------------------------------------------

Improves hypotension

Narrows QRS

Decreases risk of Ventricular Arrythmia

Front 402

A patient complains of hip and groin pain for 2 weeks. Medical history is significant for SLE diagnosed 7 years ago.

She is currently taking prednisone, hydroxychloroquine and lansoprazole

Exam shows no local tenderness or decreased ROM. Hip X-ray is normal.

What is the next best step?

Back 402

MRI of the hip to rule out avascular necrosis

-----------------------------------------------------------------

The well known causes of non-traumatic avascular (aseptic) necrosis are chronic corticosteriod therapy, alcoholism and hemoglobinopathies.

Pt presents with progressive hip pain w/o restriction of motion and normal Xray.

MRI is the gold standard.

Front 403

Thyroid cancer with worst prognosis?

Back 403

Anaplastic Thyroid Cancer

Front 404

Thyroid cancer that arises from parafollicular C-cells?

Back 404

Medullary Thyroid Cancer

-------------------------------------------------

Seen in MEN 2a and MEN 2b

Front 405

Most common thyroid malignancy?

Back 405

Papillary Thyroid cancer

Front 406

Most common cause of otitis externa?

Back 406

Pseudomonas

Front 407

A patient has hypoglycemia, high insulin levels, and low C-peptide.

Diagnosis?

Back 407

Exogenous Insulin Use

Front 408

A patient has hypoglycemia, high insulin, and high C-peptide levels

Diagnosis?

Back 408

Insulinoma (Beta-cell Tumor)

-------------------------------------------------------------------

Insulin pruduced by the body has C-peptide cleaved off of it. As a result, C-peptide levels increase as the body makes and uses more insulin.

Exogenous insulin DOES NOT have a c-peptide to be cleaved. C-peptide will be low with exogenous insulin use

Front 409

Klumpke's Palsy affects which nerves?

Back 409

C8 and T1

-----------------------------------------------------------------

"Claw" hand and forearm supination

-Horner's Syndrome due to sympathetic damage to C8 and T1

Front 410

What is Ludwig's Angina?

Back 410

Potentially life-threatening cellulitis or connective tissue infection, of the floor of the mouth, usually occurring in adults with concomitant dental infections.

An infection of submandibular and sublingual glands and source of infection is most often the 2nd or 3rd mandibular molar.

Pt presents with inflamed mouth, drooling and fever and dysphagia. Infection can spread to pharynx or tongue and cause death by asphyxiation

Tx is IV penicillin with anaerobic coverage.

Front 411

What is occuring in patients with Paroxysmal Nocturnal Hemoglobinuria?

Back 411

The cell membrane anchor protein GP1 is abnormal. This prevents the binding of cell surface molecules such as CD55 and CD59, which normally help to inhibit destruction on RBCs.

RBCs without CD55 and CD59 are attacked by complement, which leads to hemolytic anemia that occurs in paroxysms.

Since RBC is more suseptable to hemolysis in acidic environment and serum is more acidic at night, lysis occurs at night and morning urine shows red urine

Front 412

Best test for Paroxysmal Nocturnal Hemoglobinuria?

Back 412

Flow cytometry

---------------------------------------------------------

Will show ↓ CD55 + CD59 on RBC surface

(leads to hemolysis by complement during sleep)

Other tests not as heavily favored:

- Sugar Water Test

-Acidified Hemolysis test (HAM test; checks whether red blood cells become more fragile when they are placed in mild acid),

Front 413

Asbestos exposure increases the risk of what cancer?

Back 413

Bronchogenic Carcinoma

(NOT MESOTHELIOMA)

--------------------------------------------------------

-risk is increased 59 fold with smoking

Front 414

Lung biopsy shoes (+) ferrungious bodies that stain with Prussian Blue

Back 414

Asbestos Fibers

---------------------------------------------------------------------

-Get coated with protein and iron --> (+) Prussian Blue

Front 415

Where do more than 90% of acutePulmonary embolisms come from?

Back 415

PROXIMAL Deep Veins of the Lower Extremity

(Popliteal, Iliac, Femoral veins)

-----------------------------------------------------------

-these are above the knee

Front 416

Pulmonary Embolisms that arise from the renal veins are most likely to be seen in patients with _____________ syndrome

Back 416

Nephrotic Syndrome

Front 417

Patient presents with:

-Pelvic fracture

-Blood in the urethral meatus

-Inability to urinate and suprapubic pain

-Scrotal pain and swelling

- High-riding prostate

Back 417

Posterior Urethral injury

(Prosatic and Membranous urethra)

-------------------------------------------------------------------

Commonly associated with pelvic fractures

Front 418

Patient presents with:

- Straddle Injury

- Painful perineal hematoma

- Inability to urinate

-Blood in urethral meatus

- Normal prostate

Back 418

Anterior Urethral Injury

Front 419

LH vs. FSH in PCOS

Back 419

↑ LH

↓ FSH

-------------------------------------------------------------------

Excess LH stimulates ↑ androgen production by ovarian theca cells resulting in hirsutism, male estucheon, acne and androgenic alopecia.

Anovulation is caused by LH/FSH imbalance and insulin resistance!

Front 420

Common nerve problem following removal of a parotid gland tumor?

Back 420

Facial Nerve (CN VII) palsy --> facial droop

---------------------------------------------------------------------

The 2 lobes of the parotid gland are separated by the facial nerve.

Front 421

A patient presents with flushing and feelings of warmth, valvular heart disease and diarrhea.

Abdominal exam shows hepatosplenomegaly.

Urine analysis shows ↑5-HIAA

Back 421

Carcinoid Syndrome

-----------------------------------------------------------------

Seen when a carcinoid tumor metastasizes to liver

Carcinoid tumors secrete serotonin. 5-HIAA, is a serotonin metabolite.

Front 422

A mother brings a 2 week old child in for "noisy breathing". It is loudest when the child is lying supine or crying

It dimishes when the child is prone.

Laryngoscopy shows collapse of supraglottic structures with inspiration and an omega-shaped eppiglotis

What is the diagnosis?

Back 422

Laryngomalacia

----------------------------------------------------------

-Very common condition of infancy, in which the soft, immature cartilage of the upper larynx collapses inward during inhalation. Increased laxity of supraglottic structures

-Worse when supine or crying, better when prone

- Begins in neonatal period, peaks at 4-8 months, resolves by 8-12 months

-Reassurance is indicated for most cases. Never feed baby while lying down

-Severe cases may need a Supraglottoplasty

(poor weight gain, apnea, cyanosis)

Front 423

Treatmeant for an infant born with Transposition of the great vessels?

Back 423

Prostaglandin E --> Maintains patency of ductus arteriosis

Front 424

Patients with Wolf-Parkinson-White syndrome who develop atrial fibrillation should be treated with cardioversion or antiarrythmics like __________

Back 424

Procainamide

-----------------------------------------------------------------

AV nodal blockers used in A-fib include:

Beta-blockers, CCBs, digoxin and adenosine

These are CONTRAINDICATED IN WPW because they cause increased conductance through accessory pathway

Front 425

HY

Where is the most common site of ulnar nerve entrapment?

Back 425

Elbow

(Where ulnar nerve lies at epicondylar groove)

------------------------------------------------------------------

Decreased sensation of 4th and 5th digits

Weak Handgrip from weakened interosseous hand muscles

Front 426

Most common cause of bright red, firm, friable nodules in an HIV patient?

Back 426

Bacillary Angiomatosis

--------------------------------------------------------

caused by Bartonella, gram (-) bacillus

Tx: Erythromycin

Front 427

Nodular and papilar cutaneous lesions of the external auditory meatus in a patient with HIV

Back 427

Pneumocystis jirovecci

(extrapulmonary)

------------------------------------------------------

Tx: TMP-SMX

Front 428

You suspect a patient has SLE. You confirm with (+) anti-DS antibodies.

What test should you order next?

Back 428

Renal biopsy

Front 429

Antihistone antibodies suggest __________?

Back 429

Drug induced lupus

Front 430

24 year old male has severe hypertension (180/110), headaches, epistaxis, and evidence of LVH on EKG.

Back 430

Suspect Coarctation of Aorta

------------------------------------------------------------------

-Check BP in upper and lower extremities

* if BP higher in arms --> get an ECHO to diagnose

Front 431

Nephrotic syndrome (proteinuria, hypoabluminemia and edema) is a well known complication of Hodgkin's Disease.

It is usually caused by _______________

Back 431

Minimal Change Disease

Front 432

After stabilizing a patient who has ingested caustic acid, what is the next best step?

Back 432

Endoscopy

-----------------------------------------------------------------

Needs to be done within 24 hrs.

Remember to remove clothes as well

Front 433

A patient with a past history of IV drug use and endocarditis presents with Right arm weakness, a drooping right lower face, and a (+) extensor plantar reflex on the right side.

What caused his symptoms?

Back 433

Septic Emboli from infected heart valve

Front 434

A woman presents for a PPD test reading. She has 12mm induration.

She has never had Tuburculosis. Never traveled outside the U.S., is not a healthcare worker, and has never been incarcerated.

Next Step?

Back 434

No intervention necessary

--------------------------------------------------------------------

Healthy Individuals with no h/o TB are not treated unless induration is >15mm

Healthcare workers, prison workers/prisoners, Diabetes, Children under 4, Recent immigrants leukemia patients require no treatment unless induration is > 10mm

HIV (+), recent TB contacts, Organ transplant recipients and patients with Nodular or Fibrotic chest x-ray findings do not require treatment unless induration >5mm

Front 435

Blood tests show:

↑ Mean corpuscular Hemoglobin Concentration

↑ Osmotic fragility on acified glycerol lysis test

Abnormal eosin-5-maleimide binding test

Back 435

Hereditary Spherocytosis

(Autosomal-Dominant)

--------------------------------------------------------------------

Will also see (+) Spherocytes and (-)Coombs

Jaundice, Splenomegaly, Hemolytic Anemia

Front 436

Why has TB infection increased 10% since 1985?

Back 436

HIV Epidemic

Front 437

In hereditary spherocytosis, what gene is mutated?

Back 437

Ankryn gene --> leads to decreased spectrin

Front 438

Heart defect that occurs with a massive PE?

Back 438

Right Ventricular Dilation

---------------------------------------------------

Can also see:

-new onset Right Bundle Branch Block

-Right Axis Deviation

Front 439

New onset Left Bundle Branch Block in a patient presenting with dyspnea, sweating and chest pain indicates ______________

Back 439

Acute MI

Front 440

First-line drug for fibromyalgia?

Back 440

TCAs (Amitriptyline)

----------------------------------------------------------

Pregabalin, duloxetine and milnacipran can be used in patients not responding to TCAs

-Good Sleep hygiene and Aerobic excercise should be initiated first

Front 441

A 27 year old male presents with increased fastigue and weightloss

Chest X ray shows a mediastinal mass.

Bloodwork reveals and ↑ Beta-HCG and ↑ Alpha Feto protein.

Back 441

Nonseminomatous germ cell tumor

Front 442

Most common cause of elevated Alk Phos in an asymptomatic patient?

Back 442

Paget's Disease of Bone

(osteitis deformans)

Front 443

Tumors to which area of the brain cause ipsilateral ataxia, nystagmus, intention tremors and loss of coordination.

Back 443

Cerebellar Tumors

--------------------------------------------------------------

With Ataxia, patient falls TOWARD the side of the lesion.

Front 444

What is pulsus paradoxus?

Back 444

Fall in systemic BP >10mmHg during inspiration

Commonly seen in cardiac tamponade

Front 445

This systolic murmur increases with standing

Back 445

HOCM

Front 446

How does the colon look in a patient with IBS?

Back 446

Completely Normal!

Front 447

Crypt Abscesses are seen in _______

Back 447

Ulcerative Colitis

Front 448

How does the A-a gradient look in a patient with a Pulmonary Embolism?

Back 448

↑ A-a gradient in all instances of HYPOXIA

Front 449

25 year old patient comes in with a deep wound from a rusty piece of tin.

Last tetanus shot was 12 years ago.

Do you give Tetanus toxoid, tetanus immunoglobulin, or both?

Back 449

Tetanus toxiod

Front 450

Painless, monocular vesion loss. Fundoscopic exam shows optic disc swelling, retinal hemorrhage, dilated veins and cotton wool spots

Back 450

Central Retinal Vein Occlusion

---------------------------------------------------------------------

DDX: Centreal Retinal Artery Occlusion

-Sudden, painless loss of vision in one eye

-Fundoscope shows pallor of optic disc, cherry red fovea, and "boxcar segmentation" of blood in retinal veins

Front 451

When do you use diagnostic peritoneal lavage in a suspected peritoneal hemorrhage?

Back 451

Used when a FAST exam is unequivocal or poor quality in a hemodynamically unstable patient

-----------------------------------------------------------------------

If the FAST U/S finds blood in the abdomen, next step is emergency laparotomy. DPL is not needed...

Front 452

CT shows acute pacreatitis in a patient with NO heavy alcohol consumption. What is the next best step?

Back 452

RUQ Ultrasound

-----------------------------------------------------------------------

Acute pancreatitis is most commonly caused by heavy alcohol intake and gallstones. In the absence of heavy alcohol, a RUQ ultrasound is needed to look for gallstones since CT is poor at visualizing them

Front 453

Most useful intervention for patients with peripheral artery disease and claudication?

Back 453

EXCERCISE

------------------------------------------------------------------

Aspirin can be added to limit risk of MI, stroke, and cardiovascular mortality. Aspirin has no effect on the claudication.

Front 454

Recurrent pneumonia calls for what study?

Back 454

Chest CT --> Especially in smokers

---------------------------------------------------------------------

Peripheral Lesion --> CT guided needle Bx

Central Lesion --> Bronchoscopy

Front 455

Quad screen results expected for Down Syndrome?

B-HCG, MSAFP, Estriol, Inhibin A

(pg 263 SU2U)

Back 455

B-HCG: increased

MSAFP: decreased

Estriol: decreased

Inhibin A: increased

-----------------------------------------------------------------

New Test in 1st Trimester = Full Integrated Test

- Shows Decreased PAPP-A, High BCHG, Increased Nuchal translucency

Front 456

Nuchal translucency findings for:

Trisomy 21:

Trisomy 18:

Trisomy 13:

Back 456

Trisomy 21: ↑

Trisomy 18: ↑

Trisomy 13: ↓

Front 457

Times you should take Sildenafil and 𝞪-blockers?

Back 457

Take them at least 4 hours apart

Front 458

Periodic epigastric pain that is relieved by meals

Back 458

Duodenal Ulcer

Front 459

Patient has abdominal pain for 2 months that is worse at night while lying down.

Food intake does not improve pain and he has experienced a 10lb weight loss from anorexia.

Back 459

Pancreatic Cancer

--------------------------------------------------------------

-Smoking History

- Jaundice --> common bile duct obstruction

-Migratory thrombophlebitis --> Trousseau Sign

Front 460

Gold standard test to confirm Duchenne MD?

Back 460

Genetic Testing

--------------------------------------------------------------------

Muscle Biopsy is not gold standard for confirmation.

-may show fatty infiltration and fibrosis of the calf muscle. Immunostaining shows ABSENT DYSTROPHIN

Serum CPK and Aldolase levels are elevated in serum screening studies

Front 461

Most common cause of osteomyelitis in both infants and children?

Back 461

Staph aureus

------------------------------------------------------------

Other common causes:

GBBS + E. coli in infants

Strep pyogenes in children

Front 462

Most common cause of thyroid nodules?

Back 462

Colloid nodule

---------------------------------------------------------------

2nd most common: Follicular Adenoma

Front 463

Acute cholecystitis in an elderly, diabetic male

US shows no gallstones, but a gallbladder with air fluid-levels

Back 463

Emphysematous Cholecystitis

-----------------------------------------------------------------

- Clostridium, E. Coli, Staph, Strep Pseudomonas, Klebsiella all form gases and can cause this presentation.

-May have crepitus on palpation above the gallbladder

Front 464

Tea and toast diet produces a deficiency of _______

Back 464

Folic Acid

--------------------------------------------------------------------

- Folic acid is heat-sensitive, so cooked foods decrease folic acid

- Stores can come depleted in 4-5 months

-Causes macrocytic anemia

Front 465

Succinylcholine is contraindicated in patients presenting with what metabolic problem?

Back 465

Hyperkalemia

-------------------------------------------------

-Succinylcholine can cause signifcant K+ release and life threatening arrythmias

-Crush patients, patients with demyelinating syndromes (Guillan-Barre) and patients with tumor-lysis syndrome should be given vecuronium or rocuronium instead

Front 466

Scoring system used to determine if patients with new-onset A-fib should be on Anti-coagulants?

Back 466

CHADS2 Scoring System

Front 467

New drug used for anticoagulation in patients with A-fib?

Back 467

DABIGATRAN

(Pradaxa)

Front 468

A patient is presenting with symptoms highly suggestive of bacterial meningitis.

LP confirms this. You decide to start empiric therapy while waiting on the culture.

Along with Empiric antibiotics, what else should you give while waiting for the culture?

Back 468

Dexamethasone

(Corticosteroid)

-------------------------------------------------------------------

Discontinue if cultures r/o Strep. pneumoniae

Front 469

Bug that likes to infect burn victims?

Back 469

Pseudomonas

------------------------------------------------------------------

Gram (-) , aerobic coccobacillus.

It is citrate, catalase, and oxidase positive

[Burn victims can also be infected with Staph a.]

Front 470

A patient on warfarin is experiencing an intracranial bleed confirmed on CT.

Her INR is 4. What is the next best step?

Back 470

Fresh Frozen Plasma

------------------------------------------------------------------

-FFP offers the fastest reversal of warfarin anticoagulation.

-Works almost immediately and lasts a few hours

Front 471

What do you give for a heparin overdose?

Back 471

protamine sulfate

Front 472

What do you give for a warfarin overdose with no acute bleeding?

Back 472

Vitamin K

-------------------------------------------------------------

If patient is bleeding, give fresh frozen plasma it counteracts warfarin much quicker.

Front 473

Baby is born with hypoplasia of fingers and toes. Also has Microcephaly, hirsutism, and a cleft palate

Back 473

Fetal Hydantoin Syndrome

(Anticonvulsants, typically Phenytoin)

-----------------------------------------------------------------

Phenytoin and Carbamazapine are causes.

Carbamazapine (and Valproate) cause neural tube defects!

Front 474

Acid-base disorder most likely seen in CHF exacerbation?

Back 474

Respiratory Alkalosis

-CHF exacerbation can cause tachypnea as LV dyfunction allows fluids to pool in the lungs. This leads to pleural effusion and hypoxia.

-Tachypnea causes hypocapnia --> Resp. Alkalosis

Front 475

Best treatment for a premature infant with respiratory distress syndrome?

Back 475

Continuous Positive Pressure Ventilation

Front 476

Mother brings a 4-month old infant in who has been spitting up more frequently after breastfeeding. Yesterday, he also had a bloody stool.

Vital signs and physical exam are normal. Stool is positive for blood.

What is the best treatment?

Back 476

Elimination of Dairy and Soy from Maternal Diet

-------------------------------------------------

Milk or Soy-protein induced proctocolitis:

- baby has allergy to either soy or milk proteins

- Non-IgE mediated inflammatory resoponse to either maternal milk or formula

- (+) rectal and colonic inflammation

- Severe Vomiting/ Painless bloody stools

- Eczema may be present

-Breastfeeding encouraged if mom cuts out soy/dairy (Should clear up in 3 days). Some infants may need a hydrolyzed formula

- Self resolving after 1 year of age and child will probably not be allergic after then

Front 477

What is the urine calcium creatinine clearance ratio in patients with Familial Hypocalciuric Hypercalcemia?

Back 477

< 0.01 calcium creatinine clearance ratio

--------------------------------------------------------------------

- Autosomal Dominant disorder caused by abnormal calcium receptors on the parathyroid and renal tubules

- Patients develop asymptomatic hypercalcemia but have high-normal to borderline PTH levels.

- In contrast to patients with primary hyperparathyroidism, patients with FHH tend to very low levels of urinary calcium. The defective receptors cause excess Ca++ resorption.

- Hypercalcemia is benign and does not need treated

- Calcium Creatinine clearance in Primary Parahyperthyroidism is normally >.02

Front 478

Eye symptom that can present in patients with Sarcoidosis?

Back 478

Uveitis

(Most commonly, ANTERIOR UVEITIS)

Front 479

Treatment for an amebic liver abscess?

Back 479

Metronidazole

----------------------------------------------------------------

Try drugs first! DO NOT ASPIRATE!

DDX: Echinoccocal Hydatid Cyst

-Solitary liver lesion

- Sheep farmers/dogs

DO NOT ASPIRATE --> Anaphylaxis or seeding

Front 480

A 24 year old G1P0 at 35 weeks presents with lower abdominal pain. She states she is having contractions. They are short and irregular.

Exam shows a posterior and closed cervix. U/S shows a fetus with gestational age of 35 weeks in the vertex position. Fetal heart tones are heard

Her symptoms improve after mild sedation.

Whats going on?

Back 480

False Labor ---> reassure and send her home

-----------------------------------------------------------------

Short, irregular contractions without cervical changes. Contractions DO NOT increase in intensity

Common in the last 4-8 weeks of pregnancy

Front 481

Man complains of 3 months voluminous, greasy, foul-smelling stools that float on the top and are hard to flush. He has been having post-prandial epigastric pain after meals that radiates to the back.

He is thin and frail and faintly smells of alcohol.

Diagnosis?

Back 481

Chronic Pacreatitis

-------------------------------------------------------------------

He is experiencing steatorrhea, which occurs after the pancrease has lost 90% of its function and no longer releases enzymes

-Commonly seen in alcoholics

- Confirm with pancreatic function tests and monitor for steatorrhea (Sudan Stain, 72-hr collection)

Front 482

How does raising the cut-off point of a screening exam affect sensitivity and specificity?

Back 482

Sensitvity DECREASES

Specificity INCREASES

------------------------------------------------------------------

Increasing the cutoff point for a person to be diagnosed with the disease will result in fewer people testing positive.

Consequently, false and true positives will decrease and false and true negatives will increase

Front 483

Most patients with Paget's Disease of the breast have an underlying ___________________

Back 483

adenocarcinoma

Front 484

How often should women ages 50-75 get mammograms?

Back 484

Every 2 years

Front 485

A 68 year old male presents with painless blue mottling of the skin on both of his feet. He is also experiencing some nausea and vomiting

He had a coronary angiogram and coronary stent placement 5 days ago and was discharged the day after the procedure.

Labs show acute renal failure with a creatinine of 3.0. He has an increased eosinophil count as well as decreased complement levels.

Back 485

Cholesterol Embolization

----------------------------------------------------------

Or Atheroembolic disease, follows surgical or manipulation of arterial tree (ie. Angiography), due to showering of cholesterol from aorta or other major arteries. Its mc seen in elderly pt with evidence of diffused Atherosclerotic dis..

-Renal failure, Livedo reticularis, systemic eosinophilia, and low complement levels, should make you think of this. Physical exam shows painless, reddish blue mottling of the skin of the extremities (livedo reticularis)

Tx is conservative, antocoags should be stopped since it may prevent healing of the ruptured plaque.

Front 486

What is the most effective intervention for newly diagnosed Stage I Hypertension in obese patients?

Back 486

Weight loss

5-20 mmHg per 10-kg loss

----------------------------------------------------------------------

For patients with a normal BMI, DASH Diet is most effective

Front 487

A patient presents with dyspnea and cough, weight loss, easy fatigability, hypercalcemia and a right hilar lung mass on chest x-ray

Back 487

Small Cell Lung Cancer

------------------------------------------------------------------

-presents as a hilar mass

- Parathyroid Hormone-related peptide (PTHrP) causes hypercalcemia by binding to PTH receptors and causes increased bone resorption from the bones and increased resorption in the distal tubule of the kindeys.

Front 488

What is the lactic acid level like in patients with CO-poisoning from smoke inhalation?

Back 488

Lactic Acid is INCREASED

-Anion-Gap Metabolic Acidosis

--------------------------------------------------------------------

-- Carbon Monoxide poisoning can present with metabolic acidosis d/t tissue hypoxia!!

- on ABG…PaO2 is usually NORMAL because oxygen diffusion is not affected

-----------------------------------------------------

- CO binds to Hb with 260x more affinity than O2

-CO displaces O2 from Hb and causes a left shift in the oxygen dissociation curve from sigmoid to asymptoic

- This shift in Oxygen dissociation blocks the unloading of O2 from Hb in distal tissues. The result is tissue hypoxemia and lactic acidosis

Front 489

Most common metabolic condition associated with Thyroidectomy?

Back 489

Hypocalcemia from accidental Parathyroid removal

-------------------------------------------------------------

Phosphorous will be ELEVATED!!!

Front 490

____________ is a condition tat classically affects new mothers that hold their infants with the thumb outstretched (ABducted/extended)

The ABductor pollicus longus and extensor pollicis brevis tendons are affected; passive stretch of these tendons ellicits pain.

Back 490

De Quervain Tenosynovitis

Patients have a (+) Finkelstein Test

Front 491

A 30 year old business executive presents for increased anxiety and palpitations when in crowded spaces. He travels frequently and has high stress levels at work.

He takes no medications and has a negative family history. He drinks alcohol ocassionally, but denies illicit drug or tobacco use.

The vital signs, heart and chest examinations are normal. The liver span is 8 cm and there is no hepatosplenomegaly. There is no cervical lymphadenopathy or skin rash.

Lab results show a platelet count of 80,000/uL

Peripheral smear confirms a reduced platelet count without clumping or malignant cells.

What is the next appropriate exam for this patient?

Back 491

Hepatitis C and HIV Screening

--------------------------------------------------------------

This patient's presentation of thrombocytopenia without anemia or leukopenia suggests Idopathic Thrombocytopenic Purpura (ITP)

Thrombocytopenia may be a presenting finding in 5-10% of people with HIV

Therefore, it is recommended that all patients with thrombocytopenia and otherwise normal cell counts are screened for HIV and Hep. C

Front 492

HY

A 45 year old male presents with period difficulty breathing and wheezing. He visited an ENT for nasal blockage and polyps recently. His past medical history is significant for unstable angina 5 months ago.

His current medicines are aspirin, diltiazem, and pravastatin. He does not use tobacco, alcohol or drugs. Vital signs are normal.

What is the most likely cause of this patient's complaints?

Back 492

Aspirin Sensitivity Syndrome

--------------------------------------------------------------

This is considered a "pseudo-allergic reaction" since blockage of the COX1/COX2 pathway causes arachodonic acid to be shunted into a 5-lipoxygenase pathway which results in ↑↑ Leukotrienes

The imbalance of prostaglandins and leukotrienes causes bronchoconstriction and nasal polyps in susceptible patients.

Tx: Avoid NSAIDs, Leukotriene inhibitors

(-lukast's / zileutron)

Front 493

Metabolic complication that may occur in patients with subarachinoid hemorrhage?

Back 493

HYPOnatremia

Cerebral Salt-wasting Syndrome:

1) Inappropriate release of vasopressin causes ↑H20 retention

2) ↑ atrial/brain natriuretic peptide causes cerebral salt wasting

Front 494

Serum BUN and Creatinine are normally _______ in pregnant patients

Back 494

Decreased

- ↑ in renal plasma flow and GFR

Front 495

A patient is hospitalized for an acute anterior wall MI and and was treated with thrombolytic therapy 4 days ago. Today, he is experiencing very similar chest pain and dyspnea.

Vitals are all holding stable and lungs are clear to auscultation. S1/S2 are heard with no clicks or rubs.

What test should you order to see if he is having another MI?

Back 495

CK-MB

-CK-MB levels normalize within 1-2 days

-Troponin T, the most sensitive marker for MI, takes longer to return to normal

Front 496

What virus can cause aplastic crisis in patients with hereditary spherocytosis?

Back 496

Parvo-B19

Front 497

Gold standard test for HIV in a child less than 18 months old?

Back 497

PCR

Front 498

When do you do HIV testing for high-risk pregnant women?

(IV drug use/Multiple sexual partners)

Back 498

1st Trimester and 3rd Trimester

----------------------------------------------------------------------

Remember, there is a "window period" where HIV viral loads will be high, but anti-envelope antibodies will be low. IT TAKES 3 MONTHS FOR ANTIBODIES TO BE PRESENT

Front 499

Syndrome that carries an increased risk for male breast cancer?

Back 499

Klinefelter Syndrome (XXY)

Front 500

Rhomboid, positively birefringent crystals on joint aspiration

Back 500

Pseudogout

(calcium pyophosphate dehydrate crystals)

---------------------------------------------------------------

- occurs from sites of chondrocalcinosis (calcification of articular cartilage) into joint space

-Often occurs in the setting of recent surgery or medical illness

Positive birefringent = crystals are blue when aligned parallel with the slow ray of the compensator (yellow when perpendicular)

-------------------------------------------------------------

Gout: Uric acid Crystals

-Needle shaped, negatively birefringent (yellow)

Front 501

MEN Syndromes:

Tumors of:

Pituitary

Parathyroid (hypercalcemia)

Pancreas (Hypergastrinemia leads to recurrent peptic ulcers = ZES)

(pg 125 SUS2)

Back 501

MEN I

Front 502

MEN Syndrome:

Hyperparathyroidism

Thyroid medulary carcinoma

Pheochromocytoma

(pg 125 SUS2)

Back 502

Men IIa

------------------------------------------------------------

Medullary Thyroid Cancer: ↑ calcitonin, RET-Pro oncogene

Pheochromocytoma: ↑ urinary metanepharines

Total Thyroidectomy is recommended

Front 503

MEN Syndrome:

-Thyroid medulary cancer

-Pheochromocytoma

-oral/intestinal mucosal neuromas

-Marfanoid habitus

(pg 125 SUS2)

Back 503

MEN IIb

------------------------------------------------------------

Medullary Thyroid Cancer: ↑ calcitonin, RET-Pro oncogene

Pheochromocytoma: ↑ urinary metanepharines

Mucosal Neuromas: Tongue, GI tract

Front 504

Murmur heard in acute aortic dissection?

Back 504

Aortic regurgitation

(decrescendo diastolic murmur best heard on R)

Front 505

Best method to dx Aortic Dissection in a patient with Kidney disease?

Back 505

TEE

----------------------------------------------------------------

-Normally a CT w/ contrast could be used but is not recommended in patients with kidney disease

Front 506

Screening test for patients with suspected C. diff ?

Back 506

Stool studies for C. diff toxin

(Cytotoxin B/ Enterotoxin A)

Front 507

A 25 yr old patient presents with mono-nucleosis type symptoms for 2 weeks. He lacks pharyngitis or cervical adenopathy. He does have splenomegaly.

Heterophile antibody test is negative. Smear shows a lymphocyte predominance but the lymphocytes have an atypical appearance

Back 507

CMV-Mononucleosis

Front 508

Acid Base Disorder that is commonly seen in patients infected with TB from an endemic area?

Back 508

Hyperkalemic, Normal Anion Gap Metabolic Acidosis

-------------------------------------------------------------------

So, patients from endemic areas are more likely to have extra-pulmonary infections including of the adrenal gland. This creates an adrenal insufficiency (Addison Syndrome)

There is ↓ Cortisol, ↓ Adrenal Sex Hormones and ↓ Aldosterone

Aldosterone normally acts on the distal tubules to increase sodium reabsorption (saves sodium) and excrete K+ and H+ ions

If there is ↓ Aldosterone, sodium will be lost and K+ and H+ will be retained --> metabolic acidosis

Front 509

What can be given prophylactically to reduce the chance on pregnancy loss in a mother with antiphospholipid antibody syndrome?

Back 509

Low dose aspirin and Low-molecular weight Heparin

----------------------------------------------------------------

May see a false positve VDRL for syphilis

Front 510

A patient being treated for TB with isoniazid, rifampin, ethambutol and pyrazinamide presents with fatigue.

Blood tests show anemia with Elevated serum iron and a low TBIC.

You suspect the anemia is a side effect from isoniazid use and determine that the patient is deifcient in ___________________

Back 510

Pyridoxine (B6)

-------------------------------------------------------------------

-This is sideroblastic anemia

There is efective heme synthesis, most commonly due to pyridoxine-dependent impairment in early steps of protoporphrin synthesis.

Isoniazid is a well known pyridoxine antagonist

Front 511

25 year old patient, lower back pain worse at night and upon waking. Improves with movement throughout the day.

No rash, (-) straight leg test

(+) HLA-B27

Back 511

Ankylosing Spondylitis

-------------------------------------------------------------------

involves apophyseal joints (facet) joints

- may see anterior uveitis, enthesitis, hip or buttock pain

Other HLA-B27 (+) Arthritites:

- psoriatic arthritis

- reactice arthritis

- arthritis with IBD

Front 512

Infective endocarditis following a dental procedure is most likely caused by what bug?

Back 512

Strep viridans Group

- S. sanguinis

- S. mitis

- S. oralis

- S. mutans

- S. sobrinus

- S. milleri

Front 513

Patients treated with high doses of Trimethoprim (eg, TMP-SMX for Pneumocystis jirovecci) have to be monitored for changes in __________________

Back 513

Potassium --> HYPERkalemia

Front 514

DOC to treat Gestational DM?

Back 514

Insulin

--------------------------------------------------------------------

- Give insulin AFTER dietary changes have failed

Front 515

What causes a decreased O2 saturation in a patient with lung conolidation who is lying laterally on the side of the diseased lung?

Back 515

Physiologic Shunting

-------------------------------------------------------------------

Lying with the affected lung down causes more ventilation/perfusion on that lung. Since there is consolidation in the left lung in this patient, deoxygenated blood is being shunted to the heart because gas exhange cannot occur in a consolidated area of lung

Front 516

Pneumocystis pneumonia occurs in AIDS patients with a CD4 count less than _________

Back 516

CD4 < 200

------------------------------------------------------------------

Treat with TMP-SMX

Add a corticosteroid if PaO2 < 70mm Hg, or A-a gradiant > 35mm Hg

Front 517

Treatment for a patient with symptomatic bradycardia?

Back 517

Atropine

if that doesn't work

Transcutaneous Pacing

Front 518

Patients with PCOS have increased FSH or LH?

Back 518

LH

Front 519

What does respiratory alkalosis do to calcium levels?

Back 519

Decreased Calcium Levels

-------------------------------------------------------------------

Increased extracellular pH causes an increased affinity of albumin binding to calcium

Front 520

Diaphragmatic irritation can cause the Kehr sign

(Rupture/Bleeding spleen/blood in the abdomen).

What is the Kehr sign?

Back 520

Pain radiating to the Left Shoulder

Front 521

________ presents as a sudden loss of vision with floaters. Fundoscopic exam is obscurred and blurry. It occurs in patients with diabetic neuropathy.

Back 521

Vitreous Hemorrhage

Front 522

OCP use causes a reduction in risk of what cancers?

Back 522

Endometrial and ovarian cancer

Front 523

_______________is an uncommon benign liver tumor which is associated with the use of hormonal contraception with a high estrogen content

Back 523

Hepatocellular Adenoma

--------------------------------------------------------------------

- Frequently asymptomatic and untreated. May regress after stopping OCP or pregnancy.

DO NOT BIOPSY.. They will bleed a ton

Front 524

Microcytic anemia in a child with a RDW >20%

Back 524

Iron-deficiency Anemia

---------------------------------------------------------------

- Associated with increased cow's milk intake

Thalassemias

-Differentiate from 𝞫/𝞪 thalassemia using RDW. RDW in thalassemias is NORMAL

- Thalassemias will have normal/increased iron & ferritin

-Thalassemias has target cells

- Elevated Hb A2 on electrophoresis with 𝞫 thalassemia

Front 525

Treatment for thrombotic thrombocytopenic purpura (TTP)?

Back 525

Plasmapheresis (Plasma Exchange)

Front 526

What is the gold-standard test for Strep. Throat?

Back 526

Throat Culture

-----------------------------------------------------------------

-Rapid Strep Tests have a high specificity, but limited sensitivity. So (+) RSATs need to e followed by a throat culture

Front 527

A young boy is diagnosed with mumps. His parotid glands are swollen.

What other organ is the mumps virus most likely to affect?

Back 527

Testes

(Orchitis)

--------------------------------------------------------------------

Since normally the infection isn't bilateral, infertility isnt a huge concern.

Treat parotids and testes with cold compresses. All other treatment is supportive

Front 528

A 23 year old mother at 39 weeks gestation presents with a painful vesicular "bump" on her vulva.

She is 2 cm dilated and the cervix is 50% effaced.

What is the next step in her treatment?

Back 528

Immediate C-section

-----------------------------------------------------------------

- HSV in an infant can be fatal and neonates who are exposed through vaginal delivery are at greater risk.

Front 529

Which liver diseases are reversible with cessation of alcohol?

Back 529

1. Fatty Liver
2. Alcoholic Hepatitis
3. Early Fibrosis of the liver

---------------------------------------------------------------------

Cirrhosis (with regnerative nodules) is irreversible

Front 530

What drug is given as prophylaxis against Mycobacterium avium complex in AIDS patients with a CD4 count < 50?

Back 530

Azithromycin

--------------------------------------------------------

In patients with MAC, treat with Clarithromycin + Ethambutol

Front 531

Treatment of choice for Dressler Syndrome?

Back 531

NSAIDs

(Aspirin 1st, then Ibuprofen if ASA ineffective)

--------------------------------------------------------------------

Dressler Syndrome:

post-MI Pericarditis (immune-mediated)

-Peak occurence is 2-4 weeks after MI

- Non-specific/DIFFUSE ST elevation in most leads (classic in any pericarditis!!) with PR depression in certain leads.

Signs: pericardial & pleural friction rub, chest pain that’s worsened by leaning forward.

Front 532

Which portion of the spine is RA most likely to affect?

Back 532

Cervical Spine→subluxation→cord compression

Front 533

How do anticholinergics and H1-Antihistamines (diphenhydramine) cause urine retention?

Back 533

Detrusor muscle inactivity

Front 534

Empiric ABX therapy for patients who are febrile and neutropenic?

Back 534

ceftazidime (3rd generation)

or

cefepime (4th generation)

--------------------------------------------------------------------

These cephalosporins cover G(+), G(-) and pseudomonas!

Front 535

What is mitral regurgitation's effect on the Left atrium?

Back 535

Increased Left Atrial Pressure

Front 536

A breastfeeding mother wants contraception for 1 year until she is ready to concieve again. What is the best option?

Back 536

Progestins

-combined OCPs have estrogen which can

1) decrease lactation

2) Cross into the breast milk and affect baby

--------------------------------------------------------------

-IUDs - Copper/Progestin are an option for someone looking for longer protection

Front 537

What is the most important goal of managing a patient with rib fractures in the hospital/ED?

Back 537

Pain management

-------------------------------------------------------------------

-Allows for proper ventilation and reduces risk of atelectasis!!

Front 538

Newborn infant, billous vomiting, mom using cocaine at birth, no bowel movement, not feeding anymore

Abdominal X-ray shows a "tripple bubble" and a gasless colon

Back 538

Jejunal Atresia

----------------------------------------------------------------

Presents with bilious emesis in a newborn infant. Poor feeding, dehydration, absent bowel movements since birth, small for gestational age.

Atresia of the jejunum or ileum is thought to occur d/t a vascular accident in utero --> necrosis and resorption of the fetal intestine, seals off and leaves behind proximal ends of intestine so that the duodenum ends in a blind pouch.

Risk factors: Vasoconstrictive medications or cocaine or tobacco use. In contrast to duodenal atresia (Down Syndrome), it is NOT ASSOCIATED WITH A CHROMOSOMAL ABNORMALITY

Abdominal x-ray shows a “triple bubble sign” and gasless colon. There is airtrapping in the stomach, duodenum and jejunum.

Treatment is with rescusitation and surgical correction

Front 539

Most common cause of orbital cellulitis?

Back 539

Bacterial Sinusitis

----------------------------------------------------------------------

Patient will present with painful eye movements, proptosis, ophthalmoplegia, and diploplia...

Front 540

Patients with hemochromatosis are more susceptible to infections caused by _________________.

Back 540

Listeria monocytogenes

----------------------------------------------------------------

Iron overload is also a risk factor for Yersinia enterolitica and Vibrio vulnificus --> iron loving bugs

Front 541

HY

What do you monitor in patients with Guillan-Barre to make sure they aren't having respiratory failure?

Back 541

Vital Capacity

Front 542

Best study to find Squamous cell cancer source in a patient with a (+) SCC biopsy of cervical node?

Back 542

Panendoscopy

-----------------------------------------------------------------

esophagoscopy +laryngoscopy + bronchoscopy

Front 543

Describe breastfeeding jaundice

Back 543

Caused by breastfeeding failure (caused by maternal/infant factors)

Presents as jaundice in the 1st week of life

Results in: Decreased bilirubin elimination, increased enterohepatic circulation, failure to gain weight, dehydration

Maternal factors = inadequate milk supply, cracked/clogged nipples, engorgement, infrequent feeding

Infant factors = poor latch, ineffective suck, falling asleep

Dehydration may show brick red urate crystals in diaper, too few wet diapers.

Treatment: Breastfeed 15 mins per side, every 2-3 hours

Supplementation to a cow’s milk formula if there are failed breastfeeding attempts

Front 544

Best imaging modality for sinus and periorbital edema?

Back 544

CT

Front 545

Treatment for NMS?

Back 545

Dantrolene > Bromocriptine > Amantadine

Front 546

Most common ear pathology scene in patients with AIDS?

Back 546

Serous Otitis Media

(non-infectious effusion)

Front 547

Best study to determine incidence?

Back 547

Cohort

Front 548

Best study to determine odds ratio?

Back 548

Case-control

Front 549

Best study to determine disease prevalance at a given time?

Back 549

cross-sectional

Front 550

Gram (+), branching filaments, oral/buccal mass that is painless, extends forming an absces, fistula and sinus tract oozing yellow "sulphur granules"

Back 550

Actinomyces Israeli

-----------------------------------------

Tx: High-dose penicillin for 12 days

Front 551

DOC for Actinomyces israeli?

Back 551

High-dose penicillin for 12 days

Front 552

UTI with urine pH of 8.5

Back 552

Proteus mirabilis

-----------------------------------------------------------

Excretes urease which turns urea into ammonium and alkalizes the urine!

- Forms Staghorn Calculi (Struvite Stones)

along with Klebsiella, Morganella and Pseudomonas

Front 553

Brain MRI on elderly patient with dementia shows cortical and subcortical atrophy in the temporal and parietal lobes

Back 553

Alzheimers

Front 554

A patient gets chemicals in his eye. What should he do?

Back 554

No matter the chemical, he should continuously flush the eye for 15 min before seeking medical attention.

Front 555

What should a patient do if they have a cut/scratch/foreign body in their eye

Back 555

Seek medical attention. Do not flush it first.

Front 556

What are ACTH levels like in Addison's Disease (Primary Adrenal Insufficiency)?

Back 556

Increased ACTH

Cortisol and Aldosterone will be LOW due to autoimmune destruction of adrenal cortices

Front 557

A patient presents with hypotension, increased skin pigmentation, HYPERkalemia, eosinophilia, ↓cortisol levels, and ↑↑↑ACTH levels

Back 557

Addison's Disease

(Primary Adrenal Insufficiency)

----------------------------------------------------------------

Aldosterone def leads to non-anion gap hyperkalemic, hyponatremic metabolic acidosis.

***80% of pt have primary adrenal deficiency due to Autoimmune adrenalitis. These pts also present with autoimmune involvement of other glands as well, like thyroid, parathyroid, ovaries.

*** 70% of the Causes of Primary Adrenal Insufficiency autoimmune, mostly in developed countries. In underdeveloped countries TUBERCULOSIS, Fungal infection and CMV infection are the mcc, TB is the MCC in undeveloped countries.

Adrenal Calcification is a typical feature of TB PAI. Tx of TB does not result in normalization of adrenal gland.

PAI in HIV pt is common, mcc is CMV.

Sometimes Ketoconazole can cause it. PAI is very rare with adrenal tumor metastasis, even then calcification is not seen.

Pt presents with no rise in serum cortisol following injection of Cosyntropin (ACTH analog), CT shows calcification of adrenal glands.

- Serum cortisol levels are best checked in the morning between 6am-8am since cortisol levels are highest then

Front 558

Treatment for suspected Mycoplasma pneumoniae?

Back 558

Azithromycin

or

Levofloxacin

or

Moxifloxican

Front 559

Hydroceles that do not resolve spontaneously within 12 months put the patient at increased risk for _____________________

Back 559

inguinal hernia

Front 560

A 47 year old female has just undergone a hysterectomy. In the post-op recovery room, she develops nausea, vomiting and acute abdominal pain. Her BP is 70/40.

Past medical history is significant for SLE, uterine fibroids, type 1 diabetes and chronic low back pain.

Meds are Insulin, prednisone, hydroxycholroquine and acetomeniphen.

Labs show:

Na = 132

Potassium =5.1

Glucose = 50

What is causing this patient's condition?

Back 560

Acute Adrenal Insufficiency

Acute onset of nausea, vomiting, abdominal pain and hypoglycemia, hyponatremia, hyperkalemia andhypotension after a stressful event (surgery) in a pt who is steroid dependant is typical.

A clue is preoperative steroid use. Exogenous steroids depress pit-adrenal axis and a stressful situation can precipitate AAI.

Tx: Prevent with steroid dose before surgey "Stress dose"

Front 561

Aldosterone's effect on Potassium

Back 561

Aldosterone decreases potassium

Front 562

A previously unvaccinated nurse gets a needlestick when drawing blood from a patient with active Hepatitis B.

What measures should be taken?

Back 562

Hep. B Vaccination series as soon as possible

And

Hep. B immune Globulin immediately

Front 563

Active Hepatitis B infection:

HBsAg?

HBeAg?

Anti-Hbs?

Back 563

HBsAg (+)

HBeAg (+)

Anti-Hbs (-)

Front 564

Testicular Tumors:

In ____________, estrogen production is increased with inhibition of LH and FSH

Back 564

Leydig Cell Tumors

------------------------------------------------

Estrogen production is due to increased aromatase expression. Normally, Leydig cell tumors pump out lots of testosterone.

Front 565

_____________ is a chronic condition associated with pelvic pain worsened by bladder filling or sexual intercourse.

Accompanied by urinary frequency, urgency and nocturia.

Urinalysis is sometimes negative.

Back 565

Interstitial Cystitis

Front 566

Treatment of primary dysmenorrhea?

Back 566

NSAIDs

--------------------------------------------------------------------

Pt present with hx of lower abdominal pain, that radiates to upper thighs and back. The pain is colicky and starts a few hours prior to menses, lasting 3-4 days. It usually appears 6-12 months after menarche.

Tx is NSAID (1st) and also OCPs.

The pathology here is that menstural fluid has higher levels of prostaglandins (NSAID’s lower prostaglandin levels, so that’s why they are 1st line for dysmenorrhea!)

Front 567

A patient in labor is being given magnesium sulfate to prevent an eclamptic episode.

She develops a respiratory rate of 9 breaths/min and hypoactive DTRs.

What's going on? How do you treat?

Back 567

Magnesium Sulfate Toxicity

Tx: Stop Mg Sulfate, start Calcium Gluconate

---------------------------------------------------------------------

Magnesium causes toxicty by acting as a CNS depressant and blocking neuromuscular transmission

Front 568

Howell-Jolly Bodies are seen post- ____________

Back 568

splenectomy

(Nuclear inclusions in RBCs on Wright Stain)

Front 569

Race with a higher risk of Prostate Cancer?

Back 569

African Americans

Front 570

UC vs. Chron's:

- 30% of patients have granulomatous inflammation

Back 570

Chron's

Front 571

Seborrheic Dermatitis is found with increased frequency in patients with what 2 diseases?

Back 571

Parkinson's and HIV

-----------------------------------------------------------------

Erythematous plaques, with fine, loose, yellow and greasy-looking scales.

Pityrosporum ovale may play a role in pathogenesis. Treated with topical antifungals

Front 572

______________ is characterized by rosy hue with telangiectasia over the cheeks, nose and chin.

Flushing may occur due to hot drinks, heat, emotion.

Back 572

Rosacea

Front 573

MMR is a live vaccine. Can it be given to HIV patients?

Back 573

Yes! Make sure the CD4 count >200

Front 574

Vaccines contraindicated in patients with HIV?

Back 574

Live Vaccines

------------------------------------------------------------------

BCG, anthrax, oral typhoid, intranasal influnza, oral polio, yellow fever

Front 575

A patient involved in an MVA has multiple bruises on his chest. He is given 4L of fluids and stabilized. 6 hours later, he complains of dyspnea, tachypnea and chst pain.

Chest Xray shows patchy, irregular alveolar infiltrates

Back 575

Pulmonary Contusion

Adding the fluids causes pulmonary edema which causes hypoxemia

Front 576

Best test to order for a pregnant patient with renal colic?

Back 576

Ultrasound

Front 577

Anemia:

familial, pancytopenia, brown pigmentation, cafe au lait, short stature, upper limb abnormality, skeletal abnormality, it starts with thrombocytopenia then neutropenia and then anemia.

Back 577

Fanconi Anemia

Front 578

Anemia:

congenital RBC aplasia presents in the first three months of life w pallor and poor feeding. WBC and platelet counts are normal

Back 578

Diamond-Blackfan Anemia

Front 579

Virus that can cause aplastic anemia?

Back 579

Parvo-B19

Front 580

Small intesine biopsy shows foamy, PAS-positive macrophages in the lamina propria containing non-acid fast bacilli

Back 580

Whipple's Disease

----------------------------------------

Tropheryma whippelli gram (+) baccilus

caused by bacterium Tropheryma whippelli, affects men 30-60yo.

Presents with joint pain + abdominal pain + chronic foul smelling diarrhea + weight loss (malabsorption sx = Loss of Vit ADEK…so blurry vision d/t Vit A loss, etc).

PAS+, foamy macrophages containing a glycoprotein in intestine is Dx.

Also skin Hyperpigmentation. Untreated dz is fatal and progressive.

Tx is TMP-SMX (for 12 months!), penicillin G, or ceftriaxone.

*Dx is by PAS staining, it can be confirmed with upper GI endoscopy with biopsy of the small intestine.

***D-xylose absorption is abnormal in both Whipple and bacterial overgrowth. However, the test becomes normal after antibiotic tx.

(D-xylose absorption is a laboratory test to determine how well the intestines absorb a simple sugar (D-xylose)…it is abnormal in any disease process which damages the intestine mucosa. It’s abnormal in Celiac disease (sprue), Crohn's disease, Giardia Lamblia infestation, Hookworm infestation, Lymphatic obstruction, Radiation enteropathy, Small intestinal bacterial overgrowth, Viral gastroenteritis, & Whipple's disease; The test is normal in pancreatic insufficiency since there is a problem with fat absorption & there is no damage to the mucosa wall)

Front 581

Test you order in any child less than 24 months old with their first UTI

Back 581

Renal U/S

--------------------------------------------------------------------

Recurrent UTIs in Children: voiding cystourethrogram

Front 582

Drug for a patient presenting with aortic dissection?

Back 582

Labetalol

------------------------------------------------------------------

Beta-blockade decreases high BP and prevents reflex tachycardia that can increase shearing pressures on the aortic lumen

Front 583

Difference in type A and type B Aortic dissection?

Back 583

Type A: Ascending aorta --> surgery

Type B: Descending aorta --> Labetalol

Front 584

Best treatment for non-smoking patients with chronic cough and post-nasal drip for several months?

Back 584

Antihistamines

(Chlorpeniramine)

-------------------------------------------------------------

Post-nasal drip can cause a cough for a long time. Smokers need a chest x-ray if they've had a cough for that long!

Front 585

Best test to confirm osteonecrosis in a patient who has taken prednisone long-term?

Back 585

MRI

Front 586

Acute symmetrical joint pain in a daycare worker following 5 days of flu-like symptoms. The joints are not swollen or red. Non-specific rash on trunk.

Back 586

Parvo-virus B19

Front 587

Most common cause of aortic regurgitation in developed countries?

Back 587

Bicuspid Aortic Valve

--------------------------------------------------------------------

Most common in undeveloped countries: Rhuematic Fever

The murmur of aortic regurgitation is best heard along the left sternal border at the 3rd and 4th intercostals. It may be heard in some patients by having patient sit up, lean forward, and hold breath in full expiration.

Front 588

Electrolyte abnormality seen in multiple myeloma.

Causes severe constipation, anorexia, weakness, polyuria and neurologic symptoms (confusion/lethargy)

Back 588

Hypercalcemia

Front 589

________________ is a condition that is characterized by painless blisters, hypertrichosis, and hyperpigmentation.

It is often associated with Hepatitis C infection, and can be triggered by ingestion of ethanol or estrogens.

Back 589

Porphyria Cutanea tarda

Deficiency of uroporphryinogen decarboxylase

Elevated urinary porphyria confirms Dx.

Phlebotomy or Hydroxychloroquine provides releif.

Front 590

Inital treatment choice for myasthenia gravis?

Back 590

Oral Anti-ACh (Pyridostigmine)

For complete remission consider thymectomy or immunosuppressive agents.

Front 591

Painful retinal keratitis and uveitis in patients with HIV is most likely caused by __________

Back 591

HSV or VZV

Front 592

A patient is diagnosed with a HER2 breast cancer. Before starting treatment with Trastuzumab, what should you order?

Back 592

Echocardiogram ---> cardiac toxicity

Front 593

What do you do whe you suspect a VSD in a child less than 2 years old?

Back 593

Get an echocardiogram

-If it is a small VSD, normally it will close by age of 2

- Large/symptomatic VSDs need surgical correction

Front 594

DOC for Nocardiosis?

Back 594

TMP-SMX

Front 595

Morning stiffness greater than 30 mins is suggestive of ______________

Back 595

Inflammatory Arthritis

Front 596

Increased gastric residual volume, vomiting and abdominal distension in a premature neonate are highly suspicious for _________.

Abdominal x-ray may show pneumatosis intestinalis (intramural air) and portal venous air.

Back 596

Necrotizing Enterocolitis

Front 597

HY

Most common side effect of erythropoetin therapy in patients with normochromic, normocytic anemia and chronic kidney failure?

Back 597

HYPERTENSION (30%)

---------------------------------------------

Headaches (15%)

Flu-like Symptoms (5%)

Red-cell aplasia (rare)

Front 598

Treatment with acyclovir can cause crystalloid nephropathy if ____________ is not provided

Back 598

adequate hydration

Front 599

Most common cause of secondary Hypertension in Chidren?

Back 599

Fibromuscular Dysplasia --> renal a. stenosis

Front 600

HY

Treatment for a woman presenting with Occipital headache, hypertension (long-standing), and a right sided renal bruit?

Back 600

Angioplasty with Stent

---------------------------------------------------------------

Fibromuscular Dysplasia

Pt presents with Occipital HA, HT and renal bruit, suggestive of renovascular HT due to Renal Artery Stenosis. The usual cause in youner pt (30) is FMD.

In older pt its atheroslcerotic plaques. Goal of tx is decrease BP and restore perfusion to kidneys. Interventional therapy is better than medical mgmnt alone, so Angioplasty with stent replacemnt is best tx. If it fails then Surgery is indicated.

ACEI are reserved for Elderly pts who are not good candidate for surgery. Remember ACEI are CI in bilateral renal stenosis.

- ACEI are the tx of choice for unilateral renal stenosis!

- DX = Angiography is BEST test to confirm renal artery stenosis…NOT US!! Get electrolyte levels!! "String of beads" pattern on Angiography

-------------------------------------------------------------

Is the mcc of secondary HT in children. It responsible for 20% of the cases of renal HT. Its also seen in premenopausal women

PE shows a hum or bruit (soft to-and-fro bruit) in the right costovertebral angle due to well developed collaterals. The right renal artery is more affected than the left.

Angiography shows 'string of beads ' pattern in the renal artery****

Front 601

____________ is more common in African Americans. It is generally asymptomatic in the initial stages, followed by a gradual loss of peripheral vision over a period of years and eventually, tunnel vision...

Back 601

Open-Angle Glaucoma

Front 602

Pancreatic cancer marked by SEVRE watery diarrhea?

Back 602

VIPoma

Front 603

Best diagnostic study for diverticulosis/itis?

Back 603

CT scan

Front 604

Leading risk factor for cerebral palsy?

Back 604

Prematurity

Front 605

Test to monitor LMWH (Enoxaparin)?

Back 605

antifactor Xa levels

Front 606

A normal A-a gradient is between ___ to ____ mm Hg

Back 606

5-15 mm Hg

Front 607

Conditions that cause a false-normal A-a gradient?

Back 607

Hypoventilation

High Altitude

Front 608

Patient has a high-pitched voice, throat pain, difficulty opening the mouth, and uvula deviation

Back 608

Peritonsillar Abscess

----------------------------------------------------

Uvula deviates away from abscess

Front 609

Drug of choice for most cases of bacterial Sinusitis?

Back 609

Amoxicillin

(2 weeks for acute)

(6-12 weeks for chronic)

Front 610

Type of necrosis in TB?

Back 610

caseous necrosis

Front 611

Higher risk of this bug causing pneumonia in patients with COPD or Sickle Cell

Back 611

H. influenzae

Front 612

(+) cold agglutin test

Back 612

Mycoplasma pneumoniae

Front 613

Chest X-ray finds a solitary pulmonary nodule..

next step?

Back 613

Compare to older x-ray

Front 614

Common complication of Cystic Fibrosis in men?

Back 614

INFERTILITY

--------------------------------------------------------

>95% of men with CF are infertile due to bilateral absence of vas deferens

- Accumulaiton of inspissated mucus causes failure of vas deferens development

If testes have descended, sperm cannot be ejaculated --> obstructive azoospermia

About 20% of women are infertile due to either uterine/vaginal aplasia or viscous cervical mucus

Front 615

Mechanical cause of infertility in men with Cystic fibrosis?

Back 615

>95% of men with CF are infertile due to bilateral absence of vas deferens

- Accumulaiton of inspissated mucus causes failure of vas deferens development

If testes have descended, sperm cannot be ejaculated --> obstructive azoospermia

Front 616

Study used to diagnose chronic pancreatitis?

Back 616

CT

Shows calcification of pancreas (can also be seen on X-ray)

Front 617

What form of tetanus prophylaxis should be given to a patient with a severe dirty wound and an unclear or incomplete vaccination history?

Back 617

Tetanus Toxoid + Tetanus IG

-----------------------------------------------------------------

Only tetanus toxoid needed for patients with severe or dirty wounds who recieved a booster more than 5 years ago, and those with minor clean wounds who recieved a booster more than 10 years ago

Front 618

Autosomal dominant disease defined by diffuse telangectasias, recurrent epistaxis, and wide-spread AV malformations.

Back 618

Hereditary Telangectasia

(Osler-Weber-Rendu)

-------------------------------------------------------

AVMs tend to occur in mucous membranes, skin and GI tract. Can also be present in the brain, liver and lungs!

AVMs in the lungs can cause a right to left shunt causing chronic hypoxia and polycythemia --> massive hemoptysis

Front 619

Portion of brain affected by HSV encephalitis?

Back 619

Temporal Lobe ---> necrosis

-------------------------------------------------------------------

May present acutely (<1 week duration), characteristic CSF findings are ↑lymphocytes, ↑RBCs, ↑Protein.

HSV polymerase chain reaction analysis of CSF is gold standard

Front 620

Gold standard for diagnosing herpes encephalitis?

Back 620

PCR of HSV DNA in CSF

Front 621

Pregnancy hormone that causes normal respiratory alkalosis of pregnancy?

Back 621

Progesterone stimulates the respiratory centers in the brain to cause increased tidal volume, increased minute ventilation, increased PaO2, and chronic compensated respiratory alkalosis

Front 622

Right ventricular infarction occurs with ______ wall MI. It presents with hypotension.

Back 622

inferior wall MI

Front 623

What drug is indicated in Sickle Cell patients with frequent, acute, painful crisises?

Back 623

Hydroxyurea

Increases Fetal Hemoglobin (HbF) levels by stimulating erythropoeisis in primitave RBC pre-cursors.

Sickled Hb, is then proportionaly decreased resulting in reduced polymerization of RBCs and less instances of occlusion

It's dose limiting side effect is myelosuppression, but it is relatively safe

Front 624

MCC of croup (laryngotracheobronchitis)?

Back 624

Parainfluenza Virus

-Types 1 and 2

Front 625

MCC of Epiglottitis?

Back 625

H. influenzae type B

Front 626

MCC of Bronchiolitis?

Back 626

RSV

Front 627

upward lens dislocation

Back 627

Marfans

Front 628

downward lens dislocation

Back 628

Homocystinuria

Front 629

MOST COMMON consequence of cardiac malformation in Down Syndrome?

Back 629

Complete Atrioventricular Septal Defect (40%)

-Heart failure within 6 months of age

-Loud S2 d/t pulmonary hypertension

VSD (30%)

ASD (15%)

Front 630

Before placing a trauma victim on positive pressure mechanical ventilation, what should always be done in order to decrease the chance of circulatory collapse induced by the increased intrathoracic pressure of positive pressure mechanical ventilation?

Back 630

Volume Rescusitation

PPMV inreases intrathoracic pressure, which decreased venous return to the heart and thereby decreases ventricular preload.

In patients in hypovolemic shock, this may cause cirulatory collapse

Front 631

Most common site of metastais in colon cancer?

Back 631

The liver

Front 632

Live vaccines safe to give to HIV patients if CD4 count >200?

Back 632

- MMR

-Varicella Zoster

Front 633

Most common causes of secondary digital clubbing?

Back 633

Lung malignancies, Cystic fibrosis, and Right-Left cardiac shunts

--------------------------------------------------------------------

COPD DOES NOT CAUSE CLUBBING --> if clubbing occurs you should look for malignancy

Front 634

MCC of Myocarditis?

Back 634

Coxsackie B Virus

Front 635

Haptoglobin levels in hemolytic anemias?

Back 635

Haptoglobin will be decreased

----------------------------------------------------------

Haptoglobin binds free Hb that is released from RBCs when they are destroyed. As more cells are destroyed, there is more free Hb in the plasma and Haptoglobin binds it up. As a result there is less free Haptoglobin

Front 636

Most SPECIFIC lab test is = anti-cyclic citrullinated peptide (anti-CCP)

Back 636

RA

Front 637

DOC for treatment-resistant Schizophrenia and schizophrenia assosciated with peristent suicidality?

Back 637

Clozapine

Front 638

You suspect a patient has acute pancreatitis. First test you should order?

Back 638

Serum Amylase and Lipase

-----------------------------------------------------------------

Serum amylase rises within 6-12 hours and may remain for 3-5days

Serum lipases rises within 4-8 hours and remains elevated longer (8-14days) so it is more sensitive than amylase

Front 639

MC non-melanoma skin cancer?

Back 639

Basal Cell Carcinoma

-Second most common is Squamous Cell!

Front 640

Hospitalized patient has normal TSH, Normal T4 and Low T3

What is this?

Back 640

Sick Euthyroid Syndrome

("Low T3 Syndrome")

Front 641

Involves C1 inhibitor deficiency, dysfunction or destruction

Back 641

Angioedema

------------------------------------------------------------

Low C1 inhibitor --> increased C2b and Bradykinin (which produce edema)

Front 642

Patients with Ankylosing Spondylitis for 20 years or more are at an increased risk for _____________

Back 642

vertebral fractures

Front 643

Effect of administering Lidocaine to a patient with head trauma before intubation?

Back 643

Blunt ICP increases

Front 644

Elevating the head of the bed, incentive spirometry, coughing and frequent ambulation all increase ________, which can decrease the chance of post-operative atelectasis

Back 644

Functional Reserve Capacity (FRC)

Front 645

Fetal monitoring shows Variable Decelerations

Back 645

Cord compression/prolapse, oligohydramnios

-------------------------------------------------------------------

VEAL-CHOP

Variable Decels--Cord compression/prolapse

Early decels ----Head compression

Accelerations ----- OK (normal fetal oxygenation)

Late Decels ----- Placental Insufficiency

Front 646

Fetal monitoring shows Early Decelerations

Back 646

Cord Compression

--------------------------------------------------------------------

VEAL-CHOP

Variable Decels--Cord compression/prolapse

Early decels ----Head compression

Accelerations ----- OK (normal fetal oxygenation)

Late Decels ----- Placental Insufficiency

Front 647

Fetal monitoring shows Late Decelerations

Back 647

Placental insufficiency/Hypoxia/Acidosis

-----------------------------------------------------------------

VEAL-CHOP

Variable Decels--Cord compression/prolapse

Early decels ----Head compression

Accelerations ----- OK (normal fetal oxygenation)

Late Decels ----- Placental Insufficiency

Front 648

Heinz bodies are seen in _____________?

Back 648

G6PD deficiency

Front 649

Howell-Jolly Bodies are seen in ___________?

Back 649

Sickle Cell Anemia/Asplenia

Front 650

A baby is born to a mother with an active Hepatitis B infection. What is the next best step?

Back 650

Administration of Hep. B immune globulin

followed by

Hepatitis B Vaccination

Front 651

A nonhealing, painless, bleeding ulcer associated with a chronic scar suggests ______________

Back 651

Squamous Cell Carcinoma

--------------------------------------------------------------------

Biopsy (punch/shave/excisional) is next step

Front 652

Parkinsonism causes an accumulation of _____ within the neurons of the substantia nigra pars compacta, which ultimately leads to the death of these neurons

Back 652

alpha synuclein

Front 653

Best test to order for pancreatic carcinoma?

Back 653

Abdominal CT

-----------------------------------------------------------------

CA 19-9 is more useful when evaluating post-op removal of pancreatic cancer

Front 654

Dementia that features visual hallucinations and motor features of Parkinsonism

Back 654

Lewy Body Dementia

Front 655

What's the other name for fronto-temporal dementia?

Back 655

Pick's Disease

Front 656

What are the only two treatments for COPD that LOWER MORTALITY?

Back 656

Smoking cessation

and

Home O2 Use

Front 657

Consequence of drinking alcohol while taking metronidazole?

Back 657

Disulfiram-like reaction

Front 658

DOC for Lyme disease in a child less than 8 years old?

Back 658

Amoxicillin

or

Cefuroxime

-----------------------------------------------------------------

Doxyclycline is a tetracycline that is contraindicated in children less than 8 (bone growth, teeth defects)

Front 659

Immunodeficiency:

-Absence of pus formation at sites of infxn

- Delayed Umbilical Cord Separation (>30days)

- Poor wound healing

- Recurrent skin + mucosal infxn

- Peridontitis

Back 659

Leukocyte Adhesion Deficiency

---------------------------------------------------------------------

Deficient CD18, an essential component of integrins present on leukocytes.

Inabolity of leukpcytes to migrate to areas pf infection or inflammation.

Results in leukocytosis with a neutrophil predominance and complete absence of PMNs in inflamed or infected tissue

Front 660

DOC for acute, cervical adentitis classically caused by Strep or Staph infection?

Back 660

Clindamycin (+) Incision and Drainage

Front 661

In a patient with IBD and signs of sepsis, you need to rule out ________________

Back 661

Toxic Megacolon

--------------------------------------------------

Get an abdominal x-ray

Front 662

Most common complication seen in patients with sickle cell trait?

Back 662

Painless hematuria

Front 663

HY

_____________ is the most common type of spinocerebellar ataxia. It features a combination of neurologic (ataxia,dysarthria), skeletal (scoliosis, "hammer toes"), and cardiac (HCM) manifestations.

The most common causes of death are cardiomyopathy and respiratory complications

Back 663

Friedrich Ataxia

---------------------------------------------------------------

Autosomal recessive, symptoms begin before 22 years of age

Degeneration of spinal tracts:

-Spinocerebellar

-Posterior Columns

-Pyramidal Tract

Front 664

Vitamin D Deficiency (malabsorption/diarrhea):

Calcium levels?

Phosphorus levels?

PTH levels?

Back 664

Low Calcium

Low Phosporus

High PTH

--------------------------------------------------------------------

Vitamin D deficiency d/t kidney failure:

Low Calcium

High PTH

High Phosporus (kidneys can't remove)

Front 665

Congenital absence of GnRH secretion associated with anosmia

Back 665

Kallaman Syndrome

Front 666

Treatment of CMV esophagitis in patients with HIV?

Back 666

GANCYCLOVIR

-----------------------------------------

Acyclovir is not useful against CMV as the virus does not encode thymidine kinase which activates Acyclovir

CMV Esophagitis

- Severe pain

- LINEAR ulcers on endoscopy

Presence of intranuclear and intracytoplasmic inclusions on biopsy

HSV Esophagitis

If ulcers are caused by HSV (tx is Acyclovir) they are multiple, well circumscribed and look like volcanos, may be vesicular

Front 667

Emperic treatment for esophagitis in an HIV patient?

Back 667

Fluconazole --> Candida

-Candida is the most common cause of HIV dysphagia

-----------------------------------------------------------------

If symptoms persist after fluconazole, must do an endoscopy to check for CMV (ganciclovir) or HSV (Acyclovir) ulcerative esophagitis

Front 668

Why would you see normal glucose-6-phosphatase levels in a patient with G6PD deficiency following a hemolytic episode?

Back 668

The RBCs that were G6PD deficient were hemolysed. Reticulocytes have normal G6PD and are abnormally high after an episode of hemolysis

Front 669

Renal vein thrombosis presents with sudden onset abdominal pain, fever and hematuria.

It is most likely to occur in this nephrotic syndrome.

Back 669

Membranous Glomerulonephritis

Front 670

DOC for in-patient treatment of Community acquired pneumonia?

Back 670

Levofloxacin or moxifoloxacin

(newer -quinolones have better coverage of Strep. pneumo and atypical pneumonias than older -quinolones such as ciprofloxacin)

Front 671

DOC for outpatient treatment of community acquired pneumonia?

Back 671

Azithromycin or Doxycycline

Front 672

________ is a monoclonal antibody aainst RSV that is used for prophylaxis in children < 2 years who are at exceptionaly high risk of complications of RSV infection (bronchopulmonary dysplasia, prematurity, severe congenital heart dz)

Back 672

Pavlivizumab

Front 673

DOC to treat hairy cell leukemia?

Back 673

Cladribine

Front 674

There are two types of post-infectious glomerulonephritis. Which one normally arises within 5 days of an upper respiratory tract infeciton?

Back 674

IgA Nephropathy

-----------------------------------------------------------------

The other is poststreptococcal GN, which presents 10-21 days after upper respiratory infection.

Front 675

HY

Anticonvulsant drug that impairs the absorption of folic acid

Back 675

Phenytoin

-----------------------------------------------------------------

-The most common cause of folic acid deficiency is nutritional due to poor diet/alchololism

-Drugs that antagonize folic acid effects

*Methotrexate

*Trimethoprim

Front 676

______________ is a multisystem inflammatory condition characterized by recurrent oral and genital ulcers and skin lesions. Seen most commonly in Turkish, Asian and Middle Eastern Population.

Diagnosis includes: Recurrent oral ulcers plus two of the following:

1. Recurrent genital ulcers
2. Eye lesions - anterior and posterior uveitis
3. Retinal vascularization
4. Skin lesions - erythema nodosum, acneiform nodules, papulopustular lesions
5. Positive pathergy test

Back 676

Bechet Syndrome

Front 677

Male infant is virtually asymptomatic for 6-9 months of age, after which he begins to experience recurrent pyogenic (Strep. pneumoniae & H. influenzae) infections.

Labs show decreased IgA, IgG, IgM and IgE along with markedly decreased B cells on the smear.

Back 677

X-linked Brutons Agammaglobinemia

Front 678

During the development of diabetic retinopathy, what pathologic change presents as the first sign of vision loss?

Back 678

Macular Edema

Front 679

DOC for agitation in an elderly patient?

Back 679

Haloperidol

------------------------------------------------------------------

Atypical Antipsychotics like quetiapine and risperidone may also be used

Front 680

At birth, classic findings include macrosomia, macroglossia, hemihyperplasia and abdominal wall defects (omphalacele/umilical hernia)

Increased risk of Wilm's tumor and hepatoblastoma

Back 680

Beckwith-Wiedemann Syndrome

associated with duplication of CH 11p, this region has the gene for IGF-2, which may explain macrosomia and hypoglycemia

Increased incidence of WILM'S TUMOR and HEPATOBLASTOMA:

-frequent monitoring of alpha-feto protein and abdominal ultrasounds

Front 681

Drug of choice for Scarlett Fever?

Back 681

Penicillin V

Front 682

Most common cause of pneumonia in a child with Cystic Fibrosis?

Back 682

Staph Aureus!!!

Pseudomonas is the mcc in adults!

Front 683

Most sensitive lab to show acute (fullminant) liver failure?

Back 683

INCREASED PT/INR

-Bilirubin may also increase

Liver enzymes are often decreased due to a small amount of living liver tissue

Front 684

A patient who is IgA deficient has had an acute anaphylactic reaction to blood transfusion in the past.

He needs another blood transfusion, what special step can be taken to reduce the risk of anaphylactic reaction?

Back 684

Washed Red Cell Products and IgA Deficient Plasma

Front 685

Common complication that occurs in nearly all patients with CF?

Back 685

Recurrent Sinus Infections

Front 686

Inspissated meconium is responsible for life-threatening obstruction at the level of the ileum

Back 686

Meconium ileus seen in Cystic Fibrosis

---------------------------------------------------------------------

Hirschsprung's Disease will show normal meconium at the level of the Rectosigmoid jxn

Front 687

A patient with a history of rheumatoid arthritis presents with enlarged kidneys, hepatomegaly, 4+ proteinuria and and weight gain.

Renal biopsy reveals deposits that show apple-green birefringence under polarized light after a Congo-red stain.

Back 687

Amyloidosis

Front 688

Most common site of ischemic colitis after in patients with atherosclerotic disease?

Back 688

Splenic Flexure

- supplied by endarteries of the superior mesenteric artery

Note: Rectosigmoid jxn is another common site

Supplied by inferior mesenteric a.

Front 689

patients with nephrotic syndrome are at increased risk for developing ___________ complications

Back 689

Atherosclerotic Complications

---------------------------------------------------------

Nephrotic syndrome alters lipid metabolism (increases LDL), and is associated with a hypercoaguable state.

Increased risk of MI or Stroke

Front 690

Most common primary lung cancer seen in smokers and nonsmokers. It is the most prominent type in nonsmokers

Back 690

Adenocarcinoma

------------------------------------

Located peripherally, may be seen as a solitary nodule

Front 691

Test used to identify ovarian/testicular torsion?

Back 691

Color Doppler Ultrasound

Front 692

When is the oral glucose tolerance test administered during a pregnancy?

Back 692

26-28 weeks

--------------------------------------------------------------------

1) 50g glucose administered, if over 140

↓

2) 100g glucose administered, then, fasting glucose and glucose each hour for 3 hours:

↓

Patient has gestational DM if,

Fasting glucose >95

1-hour > 180

2-hour > 155

3-hour > 140

Front 693

Whenever IV access can't be obtained during a pediatric emergency, _________ access should be tried next

Back 693

interosseous

Front 694

A patient in an automobile crash sustains what is thought to be a spelnic laceration as he has LUQ pain and blood in the left retroperitoneal space as seen on US.

He has recieved 4L of IV fluids and is hemodynamically stable.

What is the next best step?

Back 694

CT Scan

---------------------------------------------------------------

CT scan will show the extent of the splenic injury and the decision to operate can be made

If the patient is

hemodynamically unstable after FAST scan shows retroperitoneal blood --> emergent laparotomy

Front 695

How do these affect Warfarin? :

-Acetominophen/NSAIDs

- Amiodarone

- Antibiotics/Antifungals

- Cranberry Juice, ginko biloba, Vitamin E

- Omeprazole

- Thyroid Hormone

- SSRIs

Back 695

Increase the Warfarin effect --> ↑ bleeding

Front 696

How do these affect Warfarin? :

-Rifampin

-Carbamazapine

-Oral Contraceptives

-Ginseng

- St. John's Wort

- Green Leafy Vegetables (spinach/kale)

Back 696

Decrease Warfarin effect

↓ effect = hypercoaguability

Front 697

___________ is common in travelers in tropical regions (including Southeast US) and is characterized by pruritic, elevated, serpiginous lesions on the skin.

Infection is often acquired through contact with sand where dogs or cats have defecated

Back 697

Cutaneous larva migrans

Ancyclostoma braziliense

Helminthic disease caused by the larva of the dog and cat hookworm

Front 698

HY

ALL patients with Hepatitis C should also be vaccinated for _______ and ________ if not already immune

Back 698

Hep. A & Hep. B

- Even pregnant women

Also of note, the vertical transmission rate of Hepatitis C during pregnancy is 2-5%

Front 699

Vitamins deficient in patients with CF?

Back 699

A D E K --> fat soluble

Front 700

What is assosciated with the highest rate of Aortic Aneurysm expansion and rupture in patients with a dilated aortic aneurysm?

Back 700

Cigarette Smoking

Front 701

Patients with neutropenia due to chemotherapy are at a higher risk for mucositis of the GI tract due to __________________

Back 701

Pseudomonas

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Anti-pseudomonal empiric therapy:

- cefepime

- meropenum

- pipercillin-tazobactam

Front 702

HY

Treatment of acute renal transplant rejection?

Back 702

High-Dose IV Steroids

Front 703

Most common bacteria causing osteomyelitis following a puncture wound with a rusty nail?

Back 703

Pseudomonas

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Treat with Surgical debridement and FQs

Front 704

HY

Dietary Recommendations for patients with recurrent nephrolithiasis?

Back 704

1. Decreased protein and oxalate diet
2. Decreased sodium intake
3. Increased Fluid Intake
4. Increased Dietary Calcium

Front 705

Prophylaxis Treatment of choice for a HIV patient with a PPD of more than 5 mm?

Back 705

Isoniazid and Pyridoxine (B6) for 9 months

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Monitor LFTs, as INH is hepatotoxic

Remember that INH causes B6 deficiency

ANY Patient with a (+) PPD should be on INH and Pyridoxine for 9 months

Front 706

Most common cause of increased Maternal-Alphafeto Protein levels during inital laboratory studies of a pregnant patient?

Back 706

Gestational Age Error

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Must do an ultrasound to check for neural tube or gastric defects and determine gestational age

Front 707

DOC for patients diagnosed with Syphillis that have a penicillin allergy?

Back 707

Doxycycline

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If the patient has tertiary syphillis --> ceftriaxone

if the patient is pregnant --> desensitize and use PN G (benzathine penicillin)