Step 2 - Medicine

Front 1

Complete di vs. partial

Back 1

complete - urine osmolal under 300

partial - osmolal btwn 300 adn 600

Front 2

tx nephrogenic DI

Back 2

salt restrict and stop offending agent (e.g. lithium)

Front 3

Anaphylaxis to blood products

Back 3

IgA deficiency?

Front 4

Trimethoprim can cause which electrolyte abnormality

Back 4

Hyperkalemia

Front 5

sensitivity equation

Back 5

tp/tp+fn

Front 6

specificity equation

Back 6

tn/tn+fp

Front 7

Tx of acute exac of MS

Back 7

IV corticosteroids

Front 8

Meds used to delay recurrence of MS exacerbations

Back 8

beta-interferon and glatiramer acetate (only in those with RR or secondary progressive forms)

Front 9

Sun tan lotion protects against...

Back 9

non-melanoma skin cancers (e.g. squamous)

Front 10

Antibodies in pt's with Hashimoto's

Back 10

anti-thyroid peroxidase and anti-thyroglobulin

Front 11

Verapamil - actions

Back 11

Negative inotrope
Rate control in afib

Front 12

Dizziness vs. vertigo

Back 12

Dizzy - Unsteady on feet
Vertigo - Sensation that head is spinning

Front 13

Crystal shapes and light pattern of gout and psedogout

Back 13

Gout - needle shaped, negatively birefringent
Pseudo - Rhomboid. positively birefringement

Front 14

Newly diagnosed pt with MG - next step

Back 14

Do a chest CT to look for thymoma

Front 15

Old person on many meds with new bullae and itching

Back 15

Bullous pemphigoid - IgG and C3 at DE junction (autoimmunity to hemidesmosomes)

Front 16

Pemphigus vulgaris

Back 16

Intraepidermal blister - more fragile than bullous pemphigoid

Front 17

Dx acromegaly

Back 17

GH levels after oral glucose load (should suppress it)

Front 18

Newborn or adults have higher rate of chronic hep B after infxn?

Back 18

Newborn

Front 19

squamous cell ca of lung - which elec abn

Back 19

hypercalc

remember, sCa++mous cell ca of lung

central lesion

Front 20

small cell ca of lung - which paraneoplastic syndromes

Back 20

SIADH and ACTH prod

central lesion

Front 21

if pt on ventilator is in resp alk - next course of action

Back 21

decrease RR

Front 22

Allergic rhinitis - dx?

Back 22

with smear for nasal eosinophils

Front 23

Flat velvety lesion on anus - dx and tx?

Back 23

Condyloma lata - syphilis - penicillin

Front 24

Verrucous pink papilliform lesions on anus - dx and tx?

Back 24

condyloma acuminata (hpv warts)

tx - 5-fu epi gel, podophylin, trichloroacetic acid

or immune therapy or surgery

Front 25

Tx of aortic dissesction

with and without HTN

Back 25

with - treat the HTN
without - TEE, CT chest, xray (mediastinal enlargement)

Front 26

Choriocarcinoma - when to suspect, dx, where it likes to met

Back 26

Suspect with vag bleeding 8 weeks post partum (also worry about gestational trophoblastic neoplasia, but that isn't malignant) - these two are both forms of genestational trophoblastic disease

dx with beta hcg

mets to lungs

Front 27

Tinea versicolor vs. corporis

Back 27

versicolor - areas that won't tan

corprois - "ring-worm" - rings with central clearings

Front 28

Tx for a pt with symptomatic PVCs

Back 28

beta blockers

sign of PVCs is wide qrs

Front 29

Warfarin mech of action

Back 29

Inhibits vit k dep factors (2, 7, 9, 10)

Also inhibits proteins C and S (anticoagulants)

ProtC half life is very short, so in first days of warfarin therapy, lose those anticoagulants and get a hypercoaguable state. (can lead to skin necrosis if pt has prot C deficiency)

Front 30

Causes of avascular necrosis of femoral head

Back 30

chronic steroids, alcohol, hemoglobinopathies

worry abt this with progressive hip pain but normal range of motion

Front 31

Fat girl with headache

Back 31

consider pseudotumor cerebri (benign intracranial htn) - can't reabsorb csf at arachnoid villi

worst complication is blindness

tx - weight loss, acetazolamide.

Front 32

work up of pt<50 with minimal BRBPR

Back 32

office-based anoscopy or proctoscopy. if negative, consider sigmoidoscopy or colo

Front 33

Med to increase appetite in cancer pts

Back 33

Progestins - e.g. megestrol acetate or medroxyprogesterone

Front 34

Types of alcoholic insults to liver that are reversible

Back 34

Fatty liver, alcoholic hepatitis (mallory's hyaline, neutrophilic infiltrate, liver cell necrosis, perivenular inflammation), early fibrosis/cirrhosis.

Front 35

Which bilirubin is soluble in water?

Back 35

conjugated. the unconj is bound to albumin.

Front 36

Rotor syndrome

Back 36

benign condition - defect in storing conj bili and it leaks into plasma

Front 37

Gilbert's syndrome

Back 37

Unconj hyperbilirubinemia

Stressors can trigger this.

Usually get mild malaise/abd pain and not much more

Front 38

Bactrim ppx in aids pts helps with...

Back 38

Toxo (cd4 < 100)
PCP

Front 39

Azithromycin ppx in aids pts helps with....

Back 39

mycobacerium avium complex (cd4<50)

Front 40

Fluconazole ppx in aids pts helps with...

Back 40

Candida infxns, crytococcus neoformans and coccidoides immitis

Front 41

Pathologic sign of true irrev liver cirrhosis

Back 41

Regenerative nodules

Front 42

Dx test of choice for MS

Back 42

MRI

Front 43

Rheum fever - common cardiac sequelae

Back 43

Mitral stenosis --> LA dilatation --> a fib

Front 44

Next step in a pt with hematemesis and decreased consciousness

Back 44

intubate them and protect their airway

Front 45

FEV1/FVC ratio in obstructive vs restrictive

Back 45

Obstructive - <80%

Front 46

How to tx TCA overdose? Best way to measure how much drug is in system?

Back 46

Sodium bicarb to reduce chance of ventricular arrythmia.

Measure via QRS duration (longer is bad)

Front 47

Dietary recs for pt with recurrent renal calculi

Back 47

Lots of fluids
More calcium
Less protein/oxalate
Less sodium

Front 48

Most common inherited renal disease

Back 48

AD PCKD

half of people present with HTN

pts have hematuria and often a positive family hx

Front 49

Check for ___ in a pt with glomerulonehritis if you want to know if they recently had strep

Back 49

Antistreptolysin O

Front 50

pt with stroke-like symptoms and headache adn loss of consciousness

Back 50

subarachnoid hemorrhage - get a ct without contrast

if unsure if it is hemorrhage or ischemic - DO NOT ANTICOAGULATE!!! get non contrast ct

Front 51

Central retinal vein occlusion

Back 51

painless loss of vision in one eye (not as sudden as central retinal artery occlusion)

Optic disc swelling, cotton wool spots, dilated veins, retinal hemorrhages in the eye

Front 52

Central retinal artery occlusion

Back 52

sudden painless loss of vision in 1 eye.

pallor of optic disc, cherry red fovea, boxcar segmentation of blood in theretinal veins.

Front 53

Sporotrichosis

Back 53

Gardeners

Goes up lymphatics and causes more ulcers or subq nodules under the skin

Front 54

Young black male presents with painless hematuria

Back 54

think of ssickle cell trait

Front 55

Best way to eval liver damage in acute hepatitis? Chronic?

Back 55

Acute - Viral serologies and liver enzymes

Chronic - Biopsy

Front 56

Melanosis coli

Back 56

Dark brown colon with lymph follicles shining through as shiny patches. A sign of laxative abuse

Can also dx laxative use with evidence of pigment of the macrophages in the lamina propria

Front 57

Tumors that met to bone (5)

Back 57

Lung, breast, prostate, thyroid, kidney

Front 58

COPD pt has sudden dyspnea and unilat chest discomf

Back 58

secondary pneumothorax

Front 59

Chronology of rubella:

Back 59

Fever, malaise, subocciptal adenitis 14-21 days after exposure

rash 1-5 days later starting at face then spreading to trunk and arms.

in adults - polyarthralgia

Front 60

Tx of choice for Paget's

Back 60

bisphosphonates - but not necc if asymp and not in weight bearing bones

Front 61

levels of calc, phos, alk phos, and urine hydroxyproline in pt with paget's

Back 61

normal calc and phos, elev AP and urine hydroxyproline

Front 62

levels of calc, phos, AP andurine hydroxyproline in pt with hyperparathy

Back 62

high calc, low phos, inc alk phos, normal hydroxyproline

Front 63

Test to dx paroxysmal nocturnal hemoglobinuria

Back 63

sugar-water test

Front 64

Most common cause of hypercalcemia in hospitalized pts

Back 64

Malignancy

Front 65

Rule out b12/folate def? before starting b12/folate?

Back 65

rule out b12 deficiency before starting folate therapy

Front 66

Tx for empyema

Back 66

Empyema is infection of the pleural space

SURGERY!!!

Front 67

drug-induced interstitial nephritis - red cell casts or white?

Back 67

white
common with penicillins, cephs, sulfonamides

Front 68

when lying on side - which lung gets the most ventilation?

Back 68

the dependent one

Front 69

Dx membranoproliferative glomerulonephritis (type 2)

Back 69

C3 immunofluor. - due to anti-IgG against C3 converatse resulting in persistent activation of alternative complement pathway

Front 70

pulsus paradoxus

Back 70

fall in systolic bp > 10 during inspir (cardiac tamp)

Front 71

glatiramer acetate

Back 71

mixture of polypeptides in myelin - induces TRegs - used in pt's with MS

Front 72

Tx model for Parkinson's

Back 72

youg - DA agonist (e.g. bromocriptine)
old - L-DOPA

anticholinergics - only good to tx the tremor - not recommended in the elderly, demented, or those without tremor

amantadine - for mild disease

Front 73

tx restless leg syndrome

Back 73

da agonists or levodopa

Front 74

Which electrolyte abn in pts with severe heart failure

Back 74

hyponatremia (water retention)
tx by giving water!

Front 75

Which meningitis has skin lesions?

Back 75

N. Meningitidis (meningococcus)
as opposed to penumococcus

Front 76

pruritic pustules and vesicles that present in runs in wrist, web spaces of hands, nipples in women, penis/scotum in males...

Back 76

scabies

Front 77

Black man has nocturia

Back 77

Consider hyposthenuria - common in pt's with sickle cell disease and sometimes trait too

kidneys are poor at concentrating urine bc sickling in vasa recta of inner medulla so poor free water reabsorption

Front 78

Tx of primary billiary cirrhosis

Back 78

remember, this is antimitochondrial abs

urodeoxycholic acid

Front 79

most thyroid nodules are what?

Back 79

colloid nodules

Front 80

MCC CAP in adullts

Back 80

s. pneumoniae

Front 81

Stroke leading to hemiparesis - where is it?

Back 81

puramen/int capsule

eyes will deviate awya from affected side

Front 82

Pt takes aspirin gets severe wheezing - diagnosis?

Back 82

Aspirin exacerbated respiratory disease - it is a pseudoallergy

assoc with polyps (sx are bland food and sensation of dripping in back of throat)

can happen with nsaids too

Front 83

Tx options for Graves

Back 83

Radioactive iodine ablative (preferred in US)

Drugs (e.g. PTU or methimazole)

Thyroidectomy

Front 84

Main side effects of propylthiouracil and methimazole (individually and both)

Back 84

ptu - dose indep - hepatitis and anca vasculitis

mmi - cholestatic jaundice

both - agranulocytosis

Front 85

Optic disc hyperemia and increased gap acidosis

Back 85

methanol pois

Front 86

kidney damage and increased gap acidosis

Back 86

ethylene glycol

because glycolic acid injures renal tubules and oxalate precipitates calcium in the kidneys (so you get hypocalcemia too)

Front 87

Cupping of optic disc and loss of periph vision

Back 87

glaucoma (probably open) - open v. common in african americans

Front 88

retropharyngeal infxn carry high risk of...

Back 88

mediastinal involvement

Front 89

parapharyngeal infxn carry high risk of...

Back 89

infxn of carotid sheat (artery or a IJV thrombophlebitis)

Front 90

Tx polymyalgia rheumatica

Back 90

low dose prednisone

high dose if there is giant cell/temporal arteritis

Front 91

meds that cause poor folate abs in SI

Back 91

methotrexate, phenytoin, trimethoprim, phenobarb, primidone

Front 92

isoniazid antagonizes which vitamin?

Back 92

B6 (pyridoxine)

can cause a sideroblastic anemia

Front 93

How to tx pt with afib AND WPW

Back 93

need to cardiovert - rate control will only increase conduction through access pathway

e.g. procainamide

Front 94

lidocaine with heart is used for...

Back 94

ventricular arrythmias but it increases chance of asystole.

Front 95

can use only iv aminoglycosides in pt with endocarditis?

Back 95

NO!`

Front 96

adenosine and digoxin - av node blocker or antiarrythmic?

Back 96

av nodal block

Front 97

hyper/hypothyroid cause systolic or diastolic htn?

Back 97

hyper - systolic
hypo - diastolic htn because increased PVR

Front 98

what to give a pt in vtach but hemodynamically not compromised

Back 98

iv lidocaine or amiodarone to convert them to NSR

Front 99

diff btwn supraventric tachycadia and vtach on ekg

Back 99

supra - narrow R waves
vtach - wide r waves

Front 100

winters formula

Back 100

paco2=1.5*bicarb + 8

Front 101

common side effect of calcium entry blockers

Back 101

edema - this is not an allergic rxn but due to the vasodilation effects. stop if it is excessive

Front 102

dreaded complic after ocular surgery

Back 102

endophthalmitis (infection of the vitreous)

Front 103

neurofibromatosis 2 - 3 characteristics

Back 103

acoustic neuromas (deafness)
cafe-au-lait spots
subcut neurofibromas

Front 104

pt has moderate-minimal amt of pain and really deformed joints

Back 104

neurogenic arthropathy (Charcot joint)

can't feel - traumatize the joints - grow back in weird ways

Front 105

tx of supraventric tachycardia

Back 105

carotid massage

Front 106

which ca entry blocker has least effect on av node

Back 106

nifedipine (confirm this in my step1 book)

Front 107

Tx of CHF due to ARegurg

Back 107

not beta blockers (more time in diastole and more regurg)

should reduce afterload with ace or nifedipine

Front 108

Masses found inmiddle mediastinun?



posterior?

Back 108

middle - bronchogenic cyst, tracheal tumors, aortic arch aneur

Front 109

masses in post mediastinum

Back 109

post - neurogenic tumors (e.g. meningocele, esophageal things, aortic aneur) - need MRI for posterior

Front 110

masses in ant mediastinum

Back 110

ant - thymoma, retrosternal thyroid, teratoma - can cause hoarseness or Horner's syn

Front 111

diabetic bp goals

Back 111

systolic - 130
diastolic - 80

Front 112

indications for tube thoracostomy to drain parapneumonic effusion

Back 112

ph<7.2 or glucose < 60

Front 113

+ prussian blue stain indicates the presence of...

Back 113

hemosiderin - marker of hemolysis

Front 114

neurocysticercosis

Back 114

due to Taeniae solium pork tapework - fluid filled cysts in brain parenchyma causing HA and seizures

Front 115

peptic stricture in esophagus due to gerd - causes weight loss?

Back 115

no

Front 116

iron intoxication stages

Back 116

n/v and hematemesis - then asymptomatic - then shock and metab acidosis - then hepatotoxicity.

can get scarring of git to cause obstruction

Front 117

management of malt lymphoma with evidence of mets

Back 117

triple therapy (omeprazole, clarithro, amoxicillin) to rid h. pylori

Front 118

Abx choice for outpt CAP
inpt?

Back 118

outpt - azithromycin or doxy

inpt - new gen fluoroquinolones (levofloxicin or moxi) - cipro has poor pneumococcus coverage

Front 119

abx choice for aspiration pneumo

Back 119

clindamycin

Front 120

Tx of choice in pt with mild-mod hypercalcemia due to metastatic disease (PTHrP)

Back 120

bisphosphonate (e.g. zolendronic acid)

Front 121

Pt who works outside has corneal vesicles and dendritic ulcers - symptoms similar to conjunctivitis

Back 121

Herpes simplex keratitis

Front 122

Pt with COPD shuold be put o nsystemic steroids?

Back 122

yes - for acute episodes

Front 123

Intrahepatic cholestasis of preg - signs/sx/labs and tx

Back 123

intense pruritis - 2nd or 3rd trim of preg - high serum total bile acids and very high ast and alts. high alk phos with GGTP not really that high...

Tx - ursodeoxycholic acid for sx relief and deliver baby as soon as lungs are mature. resolves after delivery - not too bad for the mother

Front 124

Asthma classification

Back 124

Intermitt - bothers them <2/week, <2 at night/month, need inhaler <2/week - tx with short acting beta2 agonist

Mild - tx with short beta2 and inhaled steroids

mod - everyday and weekly nighttime awakenings. tx with short and long beta2 and inhaled steroids

severe - throughout the day. tx with oral prednisone as well.

Front 125

Reye syndrome AKA..

and tx?

Back 125

fatty liver with encephalopathy

glucose with FFP and mannitol

nb - will see high ammonium levels

Front 126

Xanthelasmas

Back 126

yellow chol. plaques on medial aspects of eyelids b/l - seen idiopathic or with prim biliary cirrhosis - benign lesions

Front 127

Chalazion

Back 127

chronic, sterile granulomatous inflammation of the meibomian glands

if recurrent - could be malignant (sebaceous/meoibian carcinoma) or confused with basal call ca - get histopath examination

Front 128

Hordeolum

Back 128

purulent infxn of an eyelid gland - caused by staph usualy

Front 129

molloscum contagiosum

Back 129

caused by poxvirus. seen in normal children or immunocomp (e.g. HIV, poor cell-mediated immunity)

looks like firm raised flesh colored nodules with central umbilication

Front 130

stye

Back 130

bump on eyelid involving Zeis or Moll's glands

Front 131

Dry, end-insp crackles shuold make you consider....

Back 131

idiopathic pulm fibrosis

Front 132

Common causes of priapism (4

Back 132

Sickle cell
Perineal/genital trauma (laceration of cavernous artery)
Neurogenic lesions (cauda equina, spinal cord inj)
meds (trazadone or prazosin)

Front 133

Tx of chronic hep b (persis elev ALT or chronically elevated hep b markers)

Back 133

interferon or lamivudine

Front 134

Leukemoid rxn

Back 134

increase in leukocytes due to infxn or inflamm

Front 135

leukocyte alk phos score - up or down in CML? leukemoid rxn?

Back 135

cml - down (unless secondarily infected)
leukemoid - up

Front 136

how to disting btwn cml and leukemoid rxn on periph blood smear?

Back 136

can't

you need lekocyte alk phos score (LOW WITH CML)

Front 137

Cause of osteomyelitis in pt with prosthetic

Back 137

S. epidermitis

(normally would be s. aureus)

Front 138

Muffled voice and deviation of uvula in pt with strep-throat like sx...pt also has unlilat LAD and trouble swallowing

Back 138

tonsillar abscess complicating a tonsillitis

Front 139

When to use clopidogrel

Back 139

in pt with unstable angina (for one year) or post percutaneous coronary intervention (for 1 month if bare metal, for 1 year if drug eluting)

Front 140

pt with continued ear drainage after abx therapy - you should consider.....

Back 140

cholesteotoma

Front 141

carbamazepine affect on kidneys?

Back 141

intensifies response to ADH - so it is similar to SIADH

Front 142

Thiazides affect on cholesterols and glucose

Back 142

can cause increase in LDL and TGs, and increase in blood glucose

Front 143

Infant presentation of nf1?
nf2?

Back 143

NF1 - cafe au lait, macrocephaly, feeding problems, short, learning disabilities

NF2 - bilat acoustic neuromas adn cataracts

Front 144

nerve resp for interosseous muscle strength in hand

Back 144

ulnra

Front 145

PMN count greater than ___ of peritoneal fluid suggests spont bacterial peritonitis

Back 145

250

Front 146

thenar atrophy assoc with which nerve

Back 146

median - can see it in carpal tunnel

Front 147

HIV pt gets a PNA - cxr shows big pleural effusion

Back 147

due to s. pneumoniae - not PCP (wihch has no effusion - presents as dry cough and dyspnea)

Front 148

eosinophilia causes

Back 148

neoplasm
allergy
asthma
addisons
collagen vasc diseases
parasites

Front 149

with cerebral lesions, gaze deviation is to the ___ side of the lesion and motor deficits are to the ____

Back 149

gaze - deviate to the lesion
motor - deficits on the opposite side

Front 150

Malar rash and raccoon eyes and prox muscle weakness and heliotrope sign (periorbital swelling)

Back 150

Dermatomyositis - assoc with malig

Front 151

phenytoin AEs

Back 151

SJS/TEN

hirsutism, gigival hyperplasia, LAD

Front 152

simple sinus bradycardia - tx?

Back 152

if symptomatic, treat them with IV atropine

if hemodyn unstable, give epi (to raise BP)

Front 153

Strawberry vs. cherry hemangiomas

Back 153

straw - children - regress
cherry - adults - permanent

Front 154

when to use digoxin

Back 154

pts with heart failure and atrial fib/flutter because it increases av nod refractoriness (so slow ventric rate) and is an inotrope.

Front 155

Diff btwn atopic conjunctivitis and atopic keratoconjunctivits

Back 155

atopic conj - no vz change
atopic keratoconj - blurry vz

Front 156

AE of cyclosporin

Back 156

nephrotoxicity, viral infxns, lymphoma

Front 157

AE of azathioprine

Back 157

pancreatitis, liver toxicity, Bone marrow suppression

Front 158

Suspect ___ with newly dx diabetes, arthropathy and hepatomegaly

Back 158

hemochromatosis (iron studies reveal increased iron, ferritin and transferrin)

Front 159

most common malignant tumor of the eyelid

Back 159

basal cell ca

Front 160

Acute inferior wall MI - where is the blockage?

Back 160

R coronary artery - will also see bradycardia and hypotension bc sa node and RV are involved

Front 161

pericarditis - ekg profile?

Back 161

diffuse st elev in all leads

Front 162

EBV in CSF in aids pt - dx?

Back 162

primary cns lymphoma

Front 163

Progressive multifocal leukenceph - virus that causes it and appearance on imaging

Back 163

JC virus

on imaging, non-enhancing lesions that don't prduce mass effects (issue with myelin)

Front 164

Tx of ethylene glycol pois

Back 164

fomepizole or ethanol

Front 165

Tx of beta blocker intoxication

Back 165

glucagon

Front 166

R sided valve defects increase with insp or exp?

Back 166

inspiration

Front 167

HOCM - murmur increases with what?

Back 167

valsalva - because less preload so heart is smaller and more of the ejection is obstructed

Front 168

Paradoxical splitting of S2 - dx?

Back 168

LBBB (delayed closure of aortic valve)

Front 169

lp of a pt with ms

Back 169

normal total levels of everything, but relative increase in antibodies making up the proteins (IgG especially)

Front 170

glioblastoma multiforme or astrocytoma - which one is cnotrast enhancing?

Back 170

astrocytoma

Front 171

med that can raise HDL

Back 171

nicotinic acid (niacin)

Front 172

normal anion gap

Back 172

6-12

Front 173

dx with renal insuff, hyperkal, non-gap acidosis

Back 173

type iv renaltubular acidosis (malfunc of aldo)

Front 174

drug used to tx huntington's chorea

Back 174

haldol

Front 175

immunocomp pt with pulm nodule that has a halo sign

Back 175

aspergillosis

Front 176

area for histoplasmosis

Back 176

south east, midatlantic and central US

Front 177

blastomycosis area

Back 177

south central or north central USA

Front 178

coccidiomycosis area

Back 178

southwest USA - can get erythema nodosum or multiforme or arthralgias with this one

Front 179

Tx of IBD-induced toxic megacolon

Back 179

IV steroids and surgery if it doesn't resolve

Front 180

Colon CA - presenting sx of r sided vs. l sided

Back 180

r - anemia
l - obstruction

Front 181

Mechanism by which paroxysmal supraventrical tachycardia occurs

Back 181

re-entry pathway into av node

Front 182

MCC spinal stenosis

Back 182

Degen joint dz - when spinal disc or facet joint osteophytes impinge on cord.

Front 183

what to follow in a pt with guillaine-barre

Back 183

vital capacity (amt of air expelled after max inspiration)

Front 184

elderly diabetic with ear discharge and maybe even CN invovlement/skull osteomyelitis - dx and organism?

Back 184

malignant otitis externa - pseudomonas auruginosa

Front 185

nitroglycerin - does it decrease preload?

Back 185

yes

Front 186

hep b is assoc with which nephritis

Back 186

membranous glomerulonephritis...and polyarteritis nodosa by the way

Front 187

MCCauses of nephrotic/itic syn in adults (2)

Back 187

focal segmental glomerulosclerosis and membranous glomerulonephritis

Front 188

Test to dx rotator cuff tendonitis/impringement

Back 188

passive motion of arm above head --> pain and guarding

lidocaine injection should alleviate sx (unlike other rotator cuff issues)

Front 189

Characteristics of dementia with lewy bodies vs. alzheimers

Back 189

visiospatial dysfunction is early and memory loss is late

Front 190

pt with cervical intraepith neoplasia - how often get paps?

Back 190

3 consec neg ones every 6 months, then annually

Front 191

How often Td vaccine?

Back 191

every 10 years after 18
and a single TdaP btwn 19 and 64

Front 192

how often pneumococcal vaccine in adults

Back 192

once after age 65
if comorbidities (incl diabetes, chronic CV dz), before 65 and then again 5 years later

Front 193

Tx of acne (non-inflamm, mild, moderate, nodulocystic with scarring)

Back 193

non-inflamm - topical retinoids
mild - topical benzoyl peroxide, topical abx, or a combo of those
moderate - oral abx
nodulocystic with scarring - oral isotretinoin

Front 194

remember to avoid nsaids in pts with...

Back 194

renal dysfunc!

Front 195

with teratoma, increase in which serum markers may occur?>

Back 195

afp or beta hcg

Front 196

sumatriptan - can take it with pregnancy? with coronary issues?

Back 196

no and no

Front 197

most common contrib factor to foot ulcers

Back 197

diabetic neuropathy

Front 198

normal cardiac output

Back 198

5-8 L/min

Front 199

affect of enoxaparin and aPTT

Back 199

no effect!

Front 200

liver issue in a pt with long hx of OCP use

Back 200

hepatic adenoma - benign - if symptomatic, resect it

Front 201

Pt ingests lye - management?

Back 201

endoscopy to see how much damage occurred because all the damage happens instantly. don't bother with charcoal, ipecac, etc.

Front 202

obesity hypovent syndrome - aka? abg?

Back 202

aka pickwikian syndrome
abg is chronically messed up (high paco2, low o2)

Front 203

Peds pt with synopal episodes, hearing difficulties, fam hx...consider?

Back 203

familial long qt syn - tx with beta blocker

if symptoms other than syncope - needs a pacemaker

Front 204

Kidney dx and upper and lower resp tract dz - consider...? and test of choice?

Back 204

wegener's granulomatosis

c-ANCA

Front 205

How often mammogram in women btwn 50-74

Back 205

every 2 years

Front 206

how often pap in woman btwn 65-70 who had 3 consec normal paps?

Back 206

never again

Front 207

how often check lipids in a non-worrismoe pt?

Back 207

every 5 years

Front 208

best conservative way to decrease BP

Back 208

weight loss

Front 209

when to use PEEP

Back 209

when FiO2 is already high (>40%) and the pt is adequately ventilated, but not getting a good pa02 value

Front 210

what FiO2 is too high

Back 210

>40% is bad - can get pulmonary toxicity

Front 211

what is more resistant to dexamethasone suppression - pituitary adenoma or ectopic acth?

Back 211

ectopic acth - completely resistant. dexa won't suppress cortisol at all.

Front 212

Cushing dz vs. syndrome

Back 212

dz - pituitary adenoma making acth
syndrome - too much cortisol in blood

Front 213

MCC death in a pt on dialysis

Back 213

CV dz

Front 214

Chronic diseases needs lots of time for exposure until the outcome is observed - what kind of phenomenon explains this?

Back 214

latent period

Front 215

Location of anserine and prepatellar bursa

Back 215

anserine - anteromedial below the knee

prepatellar - directly over patella

Front 216

pharm tx of status epilepticus

Back 216

first try benzos, then phenobarb

Front 217

Amantadine and rimantadine - effective against which flu?

Back 217

influenza a

Front 218

Zanamivir and oseltamivir - what class of drugs - effective against which flu?

Back 218

neuraminidase inh - a and b

Front 219

measles or rubella? which has arthralgias?

Back 219

rubella - note that both of their rashes starts at face then moves down extremities

Front 220

tx of choice for fibromuscular dysplasia cause renal artery stenosis

Back 220

angioplasty with stent placement

Front 221

conjunctivitis, keratitis, eye pain and vz loss in a pt with HIV - dx?

Back 221

herpes simplex virus retinitis or varicella zoster

Front 222

painless visual problem in a pt with HIV - consider what?

Back 222

CMV retinitis

Front 223

rubella - has LAD?

Back 223

yes - occipital/posterior

Front 224

pt with broad differential for dysphagia - best test to get first

Back 224

barium swallow

don't do a motility study until after barium swallow and endoscopy!

Front 225

GERD is present in 75% of pts with ___ and is a primary trigger for it

Back 225

asthma

Front 226

Zenker's diverticulum - presentation?

Back 226

regurg, dysphagia, foul smelling breath

Front 227

handgrip will increase murmur of mitral regurg? or aortic stenosis?

Back 227

mitral regurg

Front 228

Cardiac rhabdomyomas assoc with which neurocut syndrome

Back 228

tuberous sclerosis

Front 229

pt with 0-1 risk factors, when is ldl too high?

Back 229

160. drugs at 190, lifestyle mod before that

Front 230

don't forget to associate ARDS with...

Back 230

pneumonia

Front 231

when to start and how often mammograms?

Back 231

age 50 - every 2 years

Front 232

MCC blindness in industrialized countries

Back 232

macular degen - way to test it is a grid with lines and the vertical ones look wavy

Front 233

how to distinguish mono from hiv on physical exam

Back 233

mono - diarrhea and rash is less likely

hiv - tonsillar exudates are uncommon

Front 234

Hallmarks of cat scratch dzand tx

Back 234

pustules at site of contact and regional lymphadenopathy that is tender

tx - oral azithromycin

Front 235

tx of toxoplasmosis

Back 235

sulfadiazine and pyrimethamine

NOT PROPHYLAXIS!!!

Front 236

Test to dx chronic pancreatitis

Back 236

Stool elastase - amylase and lipase are often normal

Front 237

Tx of supraventric tachycardia

Back 237

1.) vagal maneuvers (e.g. dunk head on cold water)
2.) block av node (e.g. adenosine)
3.) dc cardiovert if hemodynamically unstable

Front 238

diabetic drugs that cause weight gain

Back 238

sulfonylureas (e.g. glipizide)
thiazolidinediones
insulin

NB - metformin causes wt loss

keep this in mind with diabetic mgmt

Front 239

pt with focal neuro signs, ring enhancing lesions, and fluid in maxillary sinuses - cause?

Back 239

brain abscess secondary to maxillary sinusitis (anaerobic bacteria)

Front 240

pt with MS can't move R eye medially when looking to left and vice-versa - where is lesion and what is this called?

Back 240

itnernuclear ophthalmoplegia and it is due to demyelination in medial longitudinal fasciculus

Front 241

lesion in medial lemniscus will affect what?

Back 241

touch and vibration b/l

Front 242

Shunting and v/q mismatch - is A-a gradient low or high? will it correct with 100% O2?

Back 242

High

Shunting will not correct with 100% O2, V/Q mismatch will

Front 243

How to calculate A-a gradient

Back 243

PAO2=FiO2 (usually 21%)* 713-PaCO2/0.8

then subtract the arterial O2 value

over 30 is elevated or >15 in young person

Front 244

history of RA, enlarged kidneys, and hepatomegaly should make you consider...

Back 244

amyloidosis

Front 245

when to do colonoscopy's in a pt with UC?

Back 245

once they had dz for 8 years and then every 1-2 years after that

Front 246

tx of uncomplicated pyelonephritis

Back 246

IV abx (e.g. ciprofloxacin) and then switch to oral in 48-72 hours

Front 247

pt with hodgkin's lymphoma has swelling, proteinuria, low albumin - dx?

Back 247

probably has minimal change dz - may be focal sclerosing glomerulonephritis - these two are pretty common with HL

Front 248

Most common malignancy in pt's with asbestosis

Back 248

bronchogenic carcinoma
#2 is mesothelioma

Front 249

enthesitis - where does it occur - associated with what?

Back 249

it is inflammation and pain at tendon insertion sites - hlab27

heels, iliac crests, tibial tuberosities.

assoc with ankylosing spondylitis

Front 250

infectious mononucleosis - a potential complication (hematology) is (2)....

Back 250

autoimmune hemolytic anemia and thrombocytopenia

Front 251

pt with myasthenia gravis has breathing difficulty - dx and tx?

Back 251

myasthenic crisis
tx is intubation and stopping anticholinesterases for a few days

Front 252

what is the esophagus issue with scleroderma?

Back 252

lower esoph sphincter loses tone - you can get reflux esophagitis and stricture formation

Front 253

uses for n-acetylcysteine

Back 253

protection of kidneys from contrast
mucolytic
acetminophen OD

Front 254

where do hypertensive intraparenchymal hemorrhages occur?

Back 254

BG, pons, thalamus, cerebellum

Front 255

Pt without hep b vaccine in past gets stuck from pt with active hep b - tx?

Back 255

hep b ig and vaccine

Front 256

a lung lesion that moves around with position change

Back 256

fungus ball (because it lies free in the cavity) - so it is a cavitary lesion

Front 257

tx of acute migraine

Back 257

antiemetics (chlorpromazine, prochlorperazine, metoclopramide) with or without triptans and nsaids

nb - tcas and beta blockers are for ppx

Front 258

positive Igs in a pt with scleroderma

Back 258

anti-topoisomerase I and ANA

Front 259

anti-smooth muscle abs assoc with...

Back 259

autoimmune hepatitis

Front 260

anti-mitochondrial abs associated with...

Back 260

primary biliary cirrhosis

Front 261

pt has syncope and on ekg has long pr and qrs durations - cause of syncope?

Back 261

bradyarrythmia - a prolonged qrs means a bundle branch block

Front 262

indicators of a very severe asthma attack

Back 262

normal or increase pco2 (should be low), speech diff, diaphoresis, altered sensorium, cyanosis, silent lungs.

Front 263

pt with new sx and history of tx for hodgkin's lymphoma with chemo and radiation - consider...

Back 263

secondary malignancy (usually lung or breast)

Front 264

the only illicit drug that can cause vertical nystagmus

Back 264

PCP

Front 265

Tx of PCP in AIDS pt

Back 265

bactrim IV and prednisolone (oral) if PaO2 is < 70

Front 266

pt has pleural effusion - next step?

Back 266

determine if transudate or exudate via thoracentesis.

if classic signs/sx for CHF, can do a diuretic trial before that

Front 267

what does lupus anticoagulant do to a specific lab value?

Back 267

prolongs aPTT - because it binds the phospholipids used in the assay

Front 268

all pts with cirrhosis should be screened for....

Back 268

varices via endoscopy

Front 269

rough guide to correct Ca for albumin

Back 269

for every 1mg/dl change of albumin from 4, the ca will change 0.8.

and when you lose albumin, you lose Ca with it...but it's not Ca that really matters much

Front 270

tx of pancreatic pseudocyst

Back 270

leave it alone unless it is there > 6 weeks (surgery)

Front 271

athlete has high hematocrit, gynecomastia, HTN...dx?

Back 271

steroid abuse

Front 272

AIDS pt with CD4<50 needs ppx with and for...

Back 272

azithro or clarithro for mycobacterium avium complex

Front 273

can have normal mixed venous o2 sat with septic shock?

Back 273

yes - the CO is misdistributed so it does not mean adequate tissue perfusion

Front 274

low normal mixed venous o2 sat with hypovolemic or neurogenic shock?

Back 274

yes

Front 275

with hypoalbuminemia causing decrease in total serum ca, does the pt have symptoms?

Back 275

no

Front 276

how does renal failure affect parathyroid hormone

Back 276

causes secondary hyperparathyroidism - high ca, low phos

Front 277

how to dx HSV meningitis

Back 277

PCR! but if suspicion is there, start treatment asap

Front 278

exposure odds ratio (in a case control study) vs. relative risk (in a follow-up study) - can assume their ratios are equal if...

Back 278

the prevalance of the given dz is low!

Front 279

hypo or hypermag associated with diuretic use?

Back 279

hypomagnesemia

Front 280

how long does troponin T stay elevated? CK-MB?

Back 280

trop T - 10 days
CK-MB - 1-2 days

Front 281

Secondary amyloidosis - risk factors, signs/sx

Back 281

RF - chronic inflammation (causes deposition of acute phase reactants) like IBD, psoriasis, RA,

Can get nephrotic syndrome, hepato and renalmegaly

Front 282

Stroke in post limb of int capsule (lacunar)

Back 282

motor impairment or parasthesia without anything else really

Front 283

middle cerebral artery stroke

Back 283

contralat hemiplegia, eyes deviate to the lesion side, hemianesthesia, homonymous hemianopia, aphasia if dominant hemispphere and neglect if non-dom

Front 284

ant cerebral artery occlusion

Back 284

contralat weakness (mainly in lower extrem), abulia, akinetic mutism, emotional changes, head and eyes move towards lesion, sphincter incontinence

Front 285

vertebrobasilar stroke (supplying brain stem)

Back 285

alternate syndromes with contralat hemiplegia and ipsilat cranial nerve involvement.

Front 286

pt presents with complicated GERD - next step in mngmnt?

Back 286

esophagoscopy +/- biopsy

Front 287

diffuse telangiectasias, digital clubbing, recurrent epistaxis, widespread AVMs on skin, mucus membranes or GItract - dx?

Back 287

Osler-Weber-Rendu syndrome or hereditary telangiectasias

they get a reactive polycythemia due to AVMs shunting blood from r heart to left.

Front 288

post-mi - pt gets a cold leg that is not swollen - dx?

Back 288

thrombus from the akinetic ventricle resulting into the leg vascvulature.

Front 289

most common genetic hypercoaguable state

Back 289

factor v leiden

Front 290

pathogen of graves ophthalmopathy

Back 290

autoimmune attack of EOMs causing edema, lymphocytic infiltration, fibroblast prolif, depos of glycosaminoglycosides.

Front 291

congenital adrenal hyperplasias - what happenens when you are missing...
21-hydroxylase
17-hydroxylase
11-beta-hydroxylase
3-beta hydroxysteroid dehydrogenase

Back 291

21 - increase 17hydroxyprogesterone - increased androgens, and salt wsting if the most severe kind

17 - delayed puberty and excess aldo

11 - excess androgens and excess aldo

3 - increase DHEA-S and decreased testos and aldo

Front 292

my mnemonic for CAHs

Back 292

11beta-hydroxylase def - HTN and increased sex hormones because you are afraid of getting caught masturbation (age 11)

17-alpha hydroxylase def - HTN but no sex hormones because you are nervous now that you have your driving license (age 17 in jersey), and can't pick up chicks (and thus have sex) at highschool parties bc you are always the DD. - delayed puberty

21-hydroxylase deficiency - no more HTN because you've had your license for a while, but increased sex hormones because now you can go out to bars and pick up chicks.

Front 293

causess of pulsus paradoxus and definition

Back 293

drop in systolic > 12 with inspiration

severe asthma, taponade, tension pneumo, pericardial effusion

Front 294

ventricle size on mri of pseudotumor cerebri

Back 294

small - not large!

Front 295

pt with splenomegaly and RUQ pain - consider....

Back 295

hemolysis - e.g. spherocytosis

Front 296

triad of renal cell ca

Back 296

abd mass, flank pain, hematuria

Front 297

patients with iron overload - at risk for which infections?

Back 297

listeria monocytogenes, yersinia enterocolitica, vibrio vulnificus

Front 298

pt has elevated monoclonal protein - workup?

Back 298

need to r/u MM - so you need to check for anemia, lytic bone lesions, hypercalcemia, and renal insuff.

Front 299

which more commonly has hyperviscosity? waldenstroms or MM?

Back 299

waldenstroms (igm)

Front 300

best tx for frostbite

Back 300

rapid rewarming in warm water

Front 301

pt has sudden loss of vision in one eye, exam shows loss of fundus details, floating debris and a dark red glow - dx?

Back 301

vitreous hemorrhage - assoc with diabetes

Front 302

work up of suspected primary hyperaldosteronism

Back 302

1.) plasma renin to aldo ratio
2.) aldo suppression test (suppress with IV saline or or salt load)
3.) CT adrenals looking for adrenal adenoma

Front 303

Chagas disease - manifestations, who to suspect in
due to what bug?

Back 303

megacolon/esoph and myocarditis

in latin america

due to trypanosoma cruzi (in Latin America)

Front 304

Pt has vesicles on an erythematous base after an atopic dermatitis exacerbation - dx? tx?

Back 304

eczema herpeticum -

in infant, need to be treated with acyclovir

Front 305

Tx for crytococcal neoformans meningitis in a pt with AIDS

Back 305

amphotericin + flucytosine

Front 306

pt with dietary vit d deficiency - levels of 25vit d and 1,25?

Back 306

25 - low
1,25 - low, normal or high

they get lower phos compared to Ca++ because PTH gets activated

Front 307

what stimulates parathyroid glands?

Back 307

low calcium

Front 308

renal failure - levels of Ca and phosphate?

Back 308

calcium - low
phosphate - high

Front 309

pt has MENIIa - features of this dz and mngmt

Back 309

pheos, medullary ca of thyroid, parathyroid hyperplasia

tx - total thyroidectomy

Front 310

cryptosporidium parvus - how to dx - who gets it

Back 310

acid fast stain of stool showing oocysts

in immmunocomp or suppressed - they get severe diarrhea

Front 311

Histology, signs/sx of Whipple's disease, what kind of bug?

Back 311

PAS positive macrophages

diarrhea, fever, weight loss, arthritis

Non acid-fast bacilli

Front 312

diabetic pt with azotemia - best way to preserve kidneys?

Back 312

strict BP management (<130/80)

Front 313

Pt has descending paralysis - consider what dx?

Back 313

botulism

Front 314

Electrolyte abnormalities with tumor lysis syndrome

Back 314

high phosphate and potassium, high uric acid.

low calcium because the phosphate binds it up

Front 315

pt has pheochromocytoma - give them a beta blocker?

Back 315

NO!!!! block alpha receptors first or else the catecholamines will hit the alphas and BP will go even higher

Front 316

painless blisters on dorsum of hands, skin fragility, hyperpigmentation and hypertrichosis of face -dx?

Back 316

porphyria cutanea tarda

Front 317

bone marrow transplant recipient with lung and intestinal involvement - consider what dx?

Back 317

CMV pneumonitis

Front 318

bone marrow transplant has skin lesions - dx?

Back 318

probably GVHD

Front 319

pt with giant cell arteritis - f/u with serial ____

Back 319

CXRs - at risk for AAA

Front 320

pt with severe pain but previous opioid addict - what to do for pain control?

Back 320

give them the narcotic - they deserve the same standard of care

Front 321

Proximal muscle weakness in a pt with tachycardia, fatigue, weight loss, anxiety, irritability

Back 321

hyperthyroidism - thyroid myopathy affects proximal muscles.

note - hypotyhroidism can have elev CK and proximal musc weakness too

Front 322

ear issue in pt with AIDS

Back 322

serious otitis media due to HIV lymphadenopatyh or obstructing lymphoma

Front 323

Pt has unexplained elevation of serum CK and hyporeflexia - consider what dx?

Back 323

hypothyroidism

Front 324

you get howell-jolly bodies because of...

get heinz bodies because of...

Back 324

splenectomy - not removing the nuclear remnants anymore (due to hereditary spherocytosis

heinz - hemoglobin precip due to G6PD

Front 325

MCC of non-traumatic subarachnoid hemorrhage

Back 325

rupture of saccular aneurysm

Front 326

Chronic smoker gets clubbing and sudden-onset joint arthropathy (espec hands and wrists)- dx?

Back 326

hypertrophic osteoarthropathy - correlated with lung CA, TB, bronchiectasis, emphysema

Front 327

high leukocyte alk phos, low epo, normal O2 sat - dx?

Back 327

polycythemia vera (may have high platelets with it)

Front 328

thiazides cause hyper or hypomagnesemia

calcium?

Back 328

hypo

and hypercalcemia

Front 329

poor glycemic control affects CN III - how will it present

Back 329

only somatic fibers affected - eye looks "down and out", ptosis.

accommodation and response to light remains intact (parasympathetic not involved)

Front 330

genetic causes of increased unconj bilirubin

Back 330

Crigler Najjar 1 - v. serious, need liver transplant
Type 2 - less serious - apparent in adulthood

Gilbert - not v. serious - has specific stressors

Front 331

genetic causes of conj bilirubinemia

Back 331

dubin johnson
rotor

Front 332

pt in the early 80s received blood products - what should they be screened for?

Back 332

hep b and c

Front 333

relative risk vs. odds ratio

Back 333

odds ratio looks retrospectively, with relative risk you follow pts over time

Front 334

child has painful eye with decreased acuity and proptosis - orbital cellulitis or preseptal?

Back 334

orbital

Front 335

cavernous sinus thrombosis - unilat or bilat?

Back 335

often bilateral!

Front 336

one part of lung has louder breath sounds on expiration - what is going on?

Back 336

if airways patent - there is consolidation there

if airways not patent - consolidation on the other side

Front 337

serum test if you suspect alergic bronchopulmonary aspergillosis

Back 337

serum IgE

Front 338

tests contraindicated in a pt with diverticulitis

Back 338

sigmoidoscopy, colonoscopy, barium enema, etc.

Front 339

what part of spine affected in RA?

Back 339

cervical spine

Front 340

non-caseating granulomas - UC or crohns?

Back 340

crohns

Front 341

can UC affect terminal ileum?

Back 341

yes - backwash ileitis

Front 342

crypt abscesses - crohns or uc?

Back 342

uc

Front 343

MCC papillary necrosis of the kidney

Back 343

analgesic abuse

Front 344

pt has flashes of light, floaters. on exam there is grey, elevated retina - dx?

Back 344

retinal detachment

Front 345

pt has sudden photophobia, eye pain, HA, nausea, pupil is non-reactive and mid-dilated - test to do?

Back 345

tonometry bc they have acute glaucoma

Front 346

best predictor of vertebral osteomyelitis -

Back 346

pain with percussion over the spine - fever or elev white count is not very sensitive

Front 347

can pts with cirrhosis have HPA axis dysfunction?

Back 347

yes

Front 348

pna in a pt - growing mucoid colonies in upper lobe and an encapsulated gram negative dx? what else does the pt have?

Back 348

klebsiella
alcoholism

Front 349

psuedomonas encapsulated?

Back 349

yes - GNR too

Front 350

lacunar infarcts - what causes them, risk factors, what structures they affect leading to what issues?

Back 350

small vessel hyalinosis
HTN and diabetes
usually internal capsule so motor defects

Front 351

pronator drift suggests...

Back 351

UMN lesion

Front 352

COPD exacerbation,, ARDS - resp acidosis or alkalosis?

Back 352

acidosis for chf
ards - alkalosis

Front 353

thalamic stroke - characteristics?

Back 353

contralateral hemianesthesia with hemiparesis, athetosis or ballistic movements. can have severe pain on one side too

Front 354

milk-alkali syndrome

Back 354

seen in pts taking old meds of peptic acid dz

triad of hypercalcemia, alkalosis and renal failure

Front 355

tropical sprue - histology and who to suspect in

Back 355

same histo as celiac - blunting of villi, infiltration of chronic inflam cells like lymphocytes, plasma cells, eosinophils

Front 356

eye is red in glaucoma?

Back 356

yes

Front 357

in pt with low albumin, will Ca be high or low? how about renal failure?

Back 357

low and low

Front 358

pt is immobilized for long time - what to tx for their hypocalcemia?

Back 358

bisphosphonates

Front 359

two important thing to do in pt with organophosphonate poisoning

Back 359

give atropine (to block the acetylcholine excess) and remove clothes to prevent more absorption (if it is soaked in vomit)

Front 360

Lambert-Eaton syndrome - assoc with what and pathophys

Back 360

Small cell ca of lung and autoantibodies against presynaptic calcium channels so poor release of acetylcholine

they get proximal muscle weakness

Front 361

baby has rash over face, scalp, chest, ext surfaces of extremities, not in diaper region - dx?

Back 361

atopic dermatitis (note not in extensor surfaces like adults)

Front 362

pt with ANC < ___ needs to be hospitalized and started on something with ___ coverage

Back 362

1500; pseudomonas (e.g. cefepime - 4th gen; or ceftazidime - 3rd gen)

Front 363

in general, if pt not responding to abx and they should be, next step in action?

Back 363

image them looking for an abscess

Front 364

Tx hep c

Back 364

must have elevated ALT, detectablne HCV rna, and moderate grade hepatitis by bx

tx is interferon and ribavirin
if PT is elevated and albumin is abnormal, they need liver transplant

Front 365

tx of hep b

Back 365

interferon and lamivudine

Front 366

pheochromocytoma - what is made and in the adrenal medulla or cortex?

Back 366

medulla and NE

Front 367

ichthyosis vulgaris - clinical features

Back 367

very dry scaly lizard-like skin in a pt that had normal skin at birth. often the extensor surfaces of limbs with face spared - worse in winter

Front 368

metoclopramide - what used for, mech of action, AEs and how to treat one specific one

Back 368

anti-nausea
DA antagonist
can have agitation, lloose stools, dystonic rxn (neck pain and movements treated with benztropine or diphenhydramine)

Front 369

how to track treatment of DKA

Back 369

arterial pH and serum anion gap

Front 370

cavernous sinus thrombosis sx

Back 370

proptosis, ophthalmoplegia, chemosis, visual loss

Front 371

what is sympathetic ophthalmia?

Back 371

damage to one eye after injury to the other - due to uncovering of hidden antigens - often presents as uveitis

Front 372

multiple stromal abscesses on slit lamp exam should make you think of...

Back 372

fungal keratitis (often in agricultural workers or immunosuppressed)

Front 373

optic neuroma/glioma consistent with NF1 or 2?

Back 373

1

Front 374

retinal hamartomas assoc with what genetic do

Back 374

tuberous sclerosis

Front 375

Thayer-martin media used for...

Back 375

gonococcus

Front 376

Conjunctivitis in newborn causes
in 1st 24h -
days 2-5 -
days 5-15 -

Back 376

chemical (due to silver nitrate drops) - usually no purulent discharge
gonococcus
chlamydia

Front 377

what forms the ophthalmic artery?

Back 377

it is the first intracranial branch of the internal carotid

Front 378

Ophthalmologic chlamydia trachoma - findings, risk factors?

Back 378

international/immigrant

main cause of blindness worldwide

not sexually transmitted (contrast to inclusion chlamydial conjunctivitis)

will see pannus on the cornea (neovascularization) and follicular conjunctivitis.

concurrent infxn in nasopharynx

dx with Giemsa stain

Front 379

When to get head CT with or without contrast?

Back 379

without - looking for intracranial hemorrhage

with - worried abt brain tumors, toxo, lymphoma, etc.

Front 380

steps of workup in a normal pt who has a seizure

Back 380

look for intracranial hemorrhage (head ct without contrast). if that is negative, look head ct with contrast or mri for CA or focal lesion

Front 381

Different types of mono - how they present

Back 381

EBV - pharyngitis, cervical LAD
CMV - no pharyngitis or cervical LAD; atypical lymphocytes, negative heterophile test.

Front 382

Pt has GI bug after mexico (bloody). Now has RUQ pain worse with inspiration and a cyst on R superior lobe liver - dx?

Back 382

entamoeba histolytica causing an amebic liver abscess.

Front 383

cause of hydatid cyst (in liver or lungs)

Back 383

echinococcus granulosis infection (dog contact)

Front 384

Immunosuppressed person has lung sx. Sputum shows partially acid-fast, filamentous, branching rods.

Dx and tx?

Back 384

Nocardia asteroides

Tx with bactrim

Front 385

Causes of cavitary lesions in HIV-infected patient

Back 385

Mycobacterium tuberculosis, atypical mycobacterium, Nocardia, GNRs, anaerobes

Front 386

When can a person with mono do contact sports again?

Back 386

When spleen is no longer palpable.

Front 387

Elderly person has elevated alk phos. MCC?

Back 387

Paget's disease (even if they are having no sx)

Front 388

Statins can cause increase in which blood labs?

Back 388

ALT and AST

Front 389

Things that improve mortality as outpts in pts who have CHF

Back 389

ace inh, beta blockers, spironolacton, ARBs

Front 390

Pt has dyspepsia symptoms - next step?

Back 390

If alarming sx - weight loss, vomiting, dysphagia, blood, odynophagia (pain with swallowing), fam hx of GI cancer - upper endoscopy

without these sx - H. pylori testing if high prev in the area or empiric PPI

Front 391

pt with mono - high or low relative proportion of lymphocytes?

Back 391

high

Front 392

agents causing subacute bacterial endocarditis and important considerations for them

Back 392

enterococcus - urinary tract source
strep viridans (types are mitis, sanguis, mutans, and salivarius) - throat/dental proc
coag neg staph - skin/prosthetic valves
staph aureus - acute presentation in pt with normal valves

Front 393

steps in workup of compartment syndrome

Back 393

see the comp pressure and if there are pulses.

if worried, incision through eschar. if still no help, do fasciotomy to relieve compartment pressure

Front 394

Arrythmia you may see in an alcoholic

Back 394

they have low magnesium, so this increases the QT and can cause torsades de points

tx with magnesium

Front 395

what does sotalol and amiodarone do to the QT interval

Back 395

prolongs it

Front 396

adenosine is used in arrythmia to...

Back 396

block av node

Front 397

causes of constrictive pericarditis

Back 397

intl - TB
USA - viral, idiopathic, radiation, cardiac surgery, CT disorders

Front 398

tx of dermatitis herpetiformis

Back 398

dapsone

Front 399

tx of scabies

Back 399

1% lindane

Front 400

jaundice after the 3rd day and within the 1st week of life suggests...

Back 400

sepsis or UTI in the baby

Front 401

tests to order to work-up BPH (2)

Back 401

creatinine
UA

Front 402

acute treatment of a stroke in a sickle cell pt

Back 402

exchange transfusion to prevent further strokes from the sickled cells

Front 403

what to do if pt has needle stick from hiv + pt

Back 403

draw blood and start 2-3 antiretrovitals immediately as prophylaxis

Front 404

with cocaine overdose, what lab study should you get?

Back 404

cpk - high risk of rhabodomyolysis bcause of the vasoconstriction and direct toxic effect

Front 405

winter's formula

Back 405

the PaCO2 value should be 1.5*bicarb + 8

Front 406

differences in who it infects and lung findings for histoplasmosis and blastomycosis

Back 406

histo - affects immunocomp. lungs are hilar LAD with or without pneumonitis

blastomycosis - lungs show nodules or dense consolidation on cxr. doesn't infect immunocomp

Front 407

pt has lupus nephritis - next step?

Back 407

biopsy because there are different stages of it with different treatments

Front 408

cauda equina carries upper motor neurons or lower?

Back 408

lower

Front 409

when to operate on carotid artery stenosis

Back 409

asymp - >80%
symp - >60%

Front 410

most sensitive test to dx disseminated histo

tx?

Back 410

antigen in the urine or serum

itraconazole if mild-mod. amphotericin then itracon if very severe

(IDA AND DAN TSE)

Front 411

tx of crytococcus or candida

Back 411

flucytosine

Front 412

most common site for lacunar stroke

Back 412

diabetes and htn

posterior internal capsule (pure motor)

can also aaffect sensory fibers in other areas of the brain

Front 413

pt inhaled something and now has a bitter almond odor - dx?

Back 413

cyanide poisoning

Front 414

pt has nephritis after a URI - how to tell post-infectious vs. iga?

Back 414

timeline
<5 days - iga (normal complement levels)
about 10 days - post-infectious (low complement levels)

Front 415

tx of a solitary brain met

Back 415

resection and then whole brain radiation

Front 416

tx of multiple brain mets

Back 416

palliative whole brain radiation

Front 417

in an exudative pleural effusion, is glucose increased or decreased

Back 417

decreased bc high metab activity of leukocytes in the fluid

Front 418

what is in cryoprecipitate?

Back 418

factor 8, fibrinogen, vwf, factor 13

Front 419

usefulness of atropine in a pt with myasthenia gravis

Back 419

can block the cholinergic side effects in pts taking pyridostigmine

Front 420

most effective lifestyle thing you can do if not obese but want to lower BP

Back 420

more fruits and veggies

Front 421

tx protocol for prostate cancer with bony mets

Back 421

first do orchiectomy to get rid of androgens.

then radiation if you have to.

Front 422

pt has stroke and one side of face is affected, cranial nerves, and contralat body - where is lesion?

Back 422

brainstem

Front 423

pt has stroke and one half of face is affected and same half of body - where is lesion?

Back 423

thalamus or cortex

Front 424

med that can tx essential tremor that can precipitate acute intermittent porphyria

Back 424

primidone

Front 425

high levels of lthium can cause...

Back 425

hypothy

Front 426

initial screening for hepatocellular carcinoma - afp level or ascites fluid aspiration?

Back 426

afp is a good screening tool. fluid won't tell you much

Front 427

most common causes of nephrotic syndrome in adults (2)

which one is more common in african americans?

Back 427

FSGS (AAs, obesity, heroin use)

and membranous nephropathy

Front 428

most common valvular complication of rheumatic fever

Back 428

mitral stenosis

Front 429

tx of cauda equina syndrome

Back 429

EMERGENCY!!! take them to the OR

Front 430

MM - does it cause hyper or hypocalcemia?

Back 430

hyper (with normal or low PTH levels)

Front 431

type of heme synthesis defect assoc with hepatic disease

Back 431

porphyria cutanea tarda

Front 432

can alcohol abstinence reverse dilated cardiomyopathy?

Back 432

yes

Front 433

pt with nephrotic syndrome has sudden abd pain, fever, hematuria - dx and which syndrome is it most associated with?

Back 433

renal vein thrombosis

membranous glomerulonephritis (although it is a nephrotic type)

Front 434

runner has pain btwn third and 4th toes and it is reproduced with palpation on PE - dx?

Back 434

morton neuroma

Front 435

tx trigeminal neuralgia

Back 435

carbamazepine

Front 436

pt has atypical PNA with skin rash. doesnt gram stain - dx?

Back 436

mycoplasma pneumoniae (erythema multiforme)
no cell wall so no staining

Front 437

drugs that are caustic and can cause esophagitis

Back 437

tetracyclines, asa, nsaids, alendronate, KCl, quinidine, iron

Front 438

tumors in body or tail of pancreas present with which symptoms?

head?

Back 438

pain and wt loss

head - steatorrhea, wt loss, jaundice

Front 439

known risk factors for pancreatic ca

Back 439

chronic pancreatitis, fam hx, smoking, dm, obesity, high fat diet

note that gallstones, alcohol are not risk factors

Front 440

pt has symptomatic aortic stenosis - do an exercise stress test?

Back 440

no! don't want to induce an arrythmia

Front 441

tx of legionnaires disease

Back 441

erythromycin

Front 442

pt with parkinsonian symptoms has autonomic dysfunction (hypotension, impotence, incontinence, etc.) - dx?

Back 442

Shy-Drager syndrome / multiple system atrophy

Front 443

pt has low back and leg pain with walking. normal pulses. dx?

Back 443

lumbar spinal stenosis

Front 444

pt with homocystinemia - what else should they be on

Back 444

b6 (pyridoxine) and b12 if deficient to drive homocysteine to cystathionine

Front 445

clopidogrel used for arterial or venous thromboses?

Back 445

arterial

Front 446

tx of cocaine-related cardiac ischemia (3)

Back 446

asa, nitrates, and benzos (to chill them out)

Front 447

can your baby get rubella if you were just immunized for it?

Back 447

no - likely not. but the rule is to wait 28days before getting pregnant

Front 448

sputum gram stain reveals partially acid fast gprs that are branching - dx?

what if it was acid fast, non-branching, and didn't stain?

Back 448

first was nocardia, second was tb

Front 449

kid has abx exposure then a week later has hives, arthralgias, fever, LAD - dx?

Back 449

serum sickness-like reaction due to the antibiotic. it is not a true drug allergy.

Front 450

shoulder pain and limited ROM resolves after lidocaine injection - dx?

Back 450

tendonitis rather than a tear

Front 451

what med decreases freq of relapse and disability in pts with relapsing recurring MS?

Back 451

interferon beta

Front 452

most kidney stones are composed of ___

Back 452

calcium oxalate

Front 453

pt is overheated, has DIC and ARDS - dx?

Back 453

heat stroke (>40.5 celsius)

Front 454

how to prevent complication of cyclophosphamide

Back 454

mesna and lots of fluids to prevent hemorrhagic cystitis or bladder ca

Front 455

how to prophylactically treat for TB

Back 455

isoniazid and pyridoxine for 9 months

Front 456

effect of growth hormone o ninsulin sensitivity

Back 456

makes insulin less effective

Front 457

which can have renal involvement - amyloidosis or sarcoidosis?

Back 457

amyloidosis

Front 458

risk of ___ is incredibly higher in pts with hashimotos thyroiditis

Back 458

thyroid lymphoma

Front 459

what test is used to compare two means?

proportions?

Back 459

means - 2 sample t or z test
prop - chi squared

Front 460

drug used to slow progression of ALS

Back 460

riluzole

Front 461

with cerebellar lesion, do you fall towards or away from the lesion?

Back 461

towards

Front 462

pt has gait with wide spaced legs, slapping sounds and feet hit floor, dx?

Back 462

tabes dorsalis from neurosyph

Front 463

pt has gait that is straight leg on one side with swinging in a semicircle as the pt walks - dx?

Back 463

hemiparesis from a stroke

Front 464

MCC death in acromegaly

Back 464

cardiac issues (reversible once dz is controlled)

Front 465

tx of PCP

Back 465

bactrim + steroids if PaO2 <70 or A-a gradient > 35
nb - you get pcp with cd4 count < 200

Front 466

difference btwn desmopressin and demeclocycline

Back 466

desmopressin - that is adh (like vasopressin)

demeclocycline - inhibits adh effect

Front 467

tx of nephrogenic DI

Back 467

indomethacin and hctz
if lithium induced, amiloride

Front 468

complications from epo therapy

Back 468

worsening of htn, HA, flu like syndrome, red cell aplasia

Front 469

when to consider TIPS placement?

Back 469

hepatic hydrothorax (transudative effusion) that is refractory to salt restriction and diuretics

or with variceal hemorrhage

Front 470

life threatening reactions assoc with HIV therapy (5)

Back 470

didanosine - pancreatitis
abacavir - hypersensitivity
nucleoside reverse transcriptase inhibitors - lactic acidosis
non-NRTIs - SJS
nevirapine - liver failure
indinavir - crystal-induced nephropathy

the "navirs" are protease inhibitors

Front 471

amiodarone side effects (5)

Back 471

lungs - pulm fibrosis
thyroid - hypo usually, but hyper too
liver - asymp aminotransferase increases
corneal deposits
blue-grey skin changes (face often)

Front 472

cyclosporine side effects (8) (for transplants)

and how it works

Back 472

nephrotoxicity
htn
neurotoxicity
glucose intol
infxn
malignancy
gigival hypertrophy/hirsutism
gi manifestations

decreases txpn of il-2 so t helpers are messed up

Front 473

major toxicity of mycophenolate

Back 473

bone marrow suppression

Front 474

major toxicity of azathioprine and how it works

Back 474

dose-related diarrhea, leukopenia, hepatotoxicity

is converted to 6-mercaptopurine and then inhibits purine synth

Front 475

why do you stop nsaids before giving iv contrast?

Back 475

nsaids cause renal vasoconstriction so you can have worse outcomes

Front 476

first line tx of RA

Back 476

methotrexate - treat with this initially so you get an early remission

Front 477

dx test of choice for PE

Back 477

ct angiography. vQ scan if renal issues

Front 478

Conn's syndrome - is bicarb high or low?

Back 478

high

Front 479

polyuria and polydipsia can also be signs of overdose of what vitamin?

Back 479

d

Front 480

what is amiloride?

Back 480

k+ sparing diuretic

Front 481

in a metastatic solid tumor, what is the mechanism of hypercalcemia

Back 481

cytokines causing lytic bone lesions

Front 482

presence of EBV DNA in CSF of pt with HIV is specific for...

Back 482

primary cns lymphoma

Front 483

earliest renal change seen in diabetes

Back 483

glomerular hyperfiltration

Front 484

drug for malaria ppx

Back 484

mefloquine

Front 485

pts with RA are also more likely to have this bone disease

Back 485

osteoporosis/penia

Front 486

pt is 5 days out of mi and has pansystolic murmur with rad to the axilla - heard at the apex - dx?

Back 486

mitral regurg (ruptured ventricular septum would be head at L sternal border with a thrill and not radiating to axilla)

Front 487

ehrlichiosis - when to suspect and tx?

Back 487

pt has tick bite and has systemic sx, leukopenia, thrombocytopenia, elevated aminotransferases

tx with doxy as early as you can

similar regions as histoplasmosis and coccidio and deep south

Front 488

interesting thing about flecainide

Back 488

class 1c meds - e.g. flecainide - binds sodium channels and prolongs qrs duration

this is called use dependednce - also see it with other class i meds (to a lesser extent) and class 4 meds

Front 489

pt has systemic disease, pulmonary sx, skin lesions and lytic bone lesions - dx?

Back 489

blastomycosis

Front 490

what skin lesion associated with sarcoidosis?

Back 490

erythema nodosum (tender red nodules on shins)

Front 491

surgical indications for removing parathyroid in primary hyperparathyroidism and how to find the adenoma

Back 491

symptomatic
age <50
calcium level >1mg/dl of upper lim of normal
bone mineral density < 2.5T from any site
poor renal function

find the adenoma with a sestamibi scan

Front 492

which anca is positive in primary sclerosing cholangitis

Back 492

p-anca

Front 493

which anca is positive in wegener's?

Back 493

c-anca

Front 494

drug that can induce digitalis toxicity

Back 494

calcium entry blockers (e.g. verapimil)

Front 495

most common side effects of digitalis toxicity

Back 495

GI stuff (naus, vomiting, anorexia)

Front 496

pt can not have ARDS if PCWP is over...

Back 496

18

Front 497

pt has palpable purpura, proteinuria, hematuria, arthralgias, HSMegaly, and hep c or MM - dx?

Back 497

mixed cryoglobulinemia

Front 498

can you give interferon-alpha and ribavirin to control hep c chronic in a pregnant pt?

Back 498

no - teratogenic

Front 499

what risk factor has the strongest assoc with stroke?

Back 499

htn

Front 500

signs of theophylline toxicity

Back 500

cns stimulation, gi disturbances, arrythmias

Front 501

what are two meds that can decrease clearance of theophylline?

Back 501

ciprofloxacin and erythromycin

Front 502

most specific marker for diagnosing acute hep b infxn

Back 502

igm anti hepbcore antigen - this is because the surface antigen is gone but the anti surface antibody has not appeared yet.

Front 503

need to have sx for ___ before diagnosing rheum arth

Back 503

6 weeks

Front 504

pt has actopic atrial beats (tachy) and av block - dx?

Back 504

digitalis toxicity

Front 505

multifocal atrial tachycardia is a consequence of...

Back 505

pulmonary dz

Front 506

pH benchark to distinguish transudate vs exudate

Back 506

trans - >7.3

Front 507

stds that have painless ulcers

Back 507

syphilis

lymphogranuloma venerum - LAD is not at same time as ulcer (contrast to ssyphilis)

granuloma inguinale - inguinal LAD (similar to syphilis thouhg...)

Front 509

empiric tx of meningitis in an elderly pt

Back 509

vanc (strep pneum), ceftriaxone (s. pneum, neisseria menin., h flu), and ampicillin (listeria)

Front 510

using ceftriaxone in a baby can cause...

Back 510

biliary sludging. cefotaxime is better

Front 511

empiric tx of meningitis in pt < 3 mo

Back 511

cefotaxime and ampicillin

Front 512

Tx of HIV esophagitis (3)

Back 512

candida (assume this one first and tx empirically the first time you see esophagitis which is cd4<50) - fluconazole

hsv - acyclovir
cmb - ganciclovir

Front 513

inheritance of HOCM

Back 513

aut dom

Front 514

which skin cancer more likely on the lip?

Back 514

scc

basal can rarely be on the upper lip though. never on the lower.

Front 515

with hydroxychloroquine or ethambutol, you worry about...

Back 515

optic neuritis/retinopathy

Front 516

good anesthetic to use in pt with liver or renal failure

Back 516

atracurium - metab in plasma

Front 517

does PE cause transudative effusion or exudative?

Back 517

exudative (almost always)

Front 518

if suspicion for dvt is low but you still want to check for it, what to order?

Back 518

d-dimer

Front 519

tx of cervicofacial actinomyces

Back 519

iv penicillin

Front 520

distinguishing characteristic of cohort studies

Back 520

subjects are free of the outcome when the study begins!!! (even if retrospective)

Front 521

another name for case control study?

Back 521

retrospective study - which is different that retrospective cohort study

Front 522

diabetic elderly pt has severe ear pain, granulation tissue there, worse with chewing - dx and bug?

Back 522

malignant otitis externa due to pseudomonas

Front 523

methylmalonic acid levels will be ___ with folate def but ___ with b12 def

Back 523

with folate def - normal
with cobalamin def - increased

this is bc b12 converts methylmalonyl coa to succinyl coa

Front 524

what is technical term of kayexelate

Back 524

sodium polystyrene sulfonate

Front 525

pathologic type of damage seen with malignant htn

Back 525

fibrinoid necrosis

Front 526

greatest risk factor for VARIANT angina

Back 526

smoking

Front 527

pt is on isoretinoin and has HAs - dx?

can also happen with vit a toxicity

Back 527

pseudotumor cerebri from the med

Front 528

PE, atelectasis, pulm edema and pleural effusion - how to they effect pao2 and paco2?

Back 528

decrease both of them!

Front 529

pt has secondary pneumonia after recovering from uri - what possible bugs and which can cause cavitations?

Back 529

s pneum
h flu
staph aureus - cavitations

Front 530

steps to reverve beta blocker overdose

Back 530

1.) atropine and iv fluids
2.) glucagon

Front 531

when should you transfuse PRBCs?

Back 531

normally under 7
if pt has preexisting heart condition, under 10

Front 532

main difference btwn lewy body dementia and PD

Back 532

lewy - early loss of cognition, hallucinations

PD - early loss of motor skills

Front 533

pt just got over a uri and on cxr their heart looks big and like a "water bottle" - dx?

Back 533

pericardial effusion without tamponade

Front 534

two parkinsons drugs that have serious anticholinergic effects

Back 534

trihexyphenidyl or benztropine

Front 535

to prevent serotonin syndrome, don't give this parkinsons drug with ssris or tcas

Back 535

selegeline (mao-b inhibitor)

Front 536

tx of mucormycosis and what is the bug?

Back 536

Rhizopus
amphotericin B (with surgical debridement if necc)

Front 537

what is bartter/gitelman syndrome

Back 537

defect in sodium and chloride reabsorption so you end up with hypokalemia and metabolic acidosis (increased RAAS signaling)

Front 538

will urinalysis/cx detect chlamydial urethritis?

Back 538

no - because intracellular?

Front 539

tx of carcinoid tumor that can't be resected

Back 539

octyreotide

Front 540

pt has diarrhea and plauqe-like deposits of fibrough tissue on endocardium of right side of heart - dx?

Back 540

carcinoid syndrome

Front 541

Hyperactive DTRs seen with __ calcium and ___ magnesium

Back 541

low calcium and magnesium

magnesium has this effect because low levels of it decrease PTH secretion/responsiveness

Front 542

steps in management of a pt who has a renal stone that is radiolucent

Back 542

it is uric acid stone (precipitated by low ph of urine due to poor ammonium excretion) - alkalinize the urine with potassium citrate or potassium bicarb.

Front 543

meds that can cause ototoxicity

Back 543

loop diuretics, aminoglycosides, asa, chemotherapy

Front 544

this skin condition occurs more freq in pts with parkinsons or hiv

Back 544

seborrheic dermatitis

Front 545

pt has HER2 positive breast ca and is getting trastuzumab - what to watch for?

Back 545

cardiac toxicity when combined with chemo

Front 546

indications to check thyroid function tests

Back 546

hyperlipidemia, unexplained hyponatremia (siadh with thyroid dz) and elev serum muscle enzymes

Front 547

howto determine type of anticoag in a pt with atrial fib

Back 547

chads2 score

chf, hypertension, age>=75, DM, stroke in past (2)

>2=warfarin. <2=asa

Front 548

tx of small cell lung ca

Back 548

different than other lung cancers. tx this with chemo rather than surgery

Front 549

do you have low c3 levels with membranoproliferative glomerulonephritis? post-streptococcal?

Back 549

low c3 with both. can also have htn with both

Front 550

study has two or more interventions for the groups and each group has two or more possible end points to meet - type of study?

Back 550

factorial design

Front 551

what is tick borne paralysis?

Back 551

progressive ascending paralysis with normal sensation. occurs over hours to days. need to find the tick and remove it!

Front 552

lacunar stroke in the posterior limb of internal capsule - manifestations?

Back 552

unilat motor deficit, arm/leg incoordination, dysarthria.

no sensory, visual or higher cortical dysfunction

Front 553

lacunar stroke in VPL of thalamus - manifestation?

Back 553

unilat numbness, paresthesia, hemisensory deficit

Front 554

lacunar stroke in basis pontis - manifestiation? (basal pons)

Back 554

hand weakness, mild motor aphasia. no sensory abnormalities

Front 555

which thyroid cancer has psammoma bodies?

Back 555

papillary (most common thyroid malignancy) - good px - unencapsulated (contrast to follicular)

Front 556

mitral valve prolapse - will squatting increase or decrease the murmur?

Back 556

will decrease it bc more preload

Front 557

vsd - murmur increases or decreases with squatting?

Back 557

increases (more preload)

Front 558

skin lesions more common in histoplasmosis or blastomycosis?

Back 558

blasto (warty heaped-up lesions)

Front 559

tx of status epilepticus

Back 559

benzos or phenytoin

Front 560

Turcot's syndrome

Back 560

assoc between brain tumors (mudulloblastomas and gliomas) and FAP or HNPCC

Front 561

in atrial flutter, what type of heart block to expect?

Back 561

2:1 block - if more than that (less p waves are conducting, suspect av node conduction deficit)

Front 562

can you use adenosine or amiodarone for supraventricular tachy?

Back 562

adenosine (or carotid massage)

amiodarone or lidocaine can be used for wide qrs things (e.g. v tach)

Front 563

pt has aids and purple skin lesions - on biopsy it bleeds like crazy - dx?

Back 563

bacillary angiomatosis (not kaposi's)

due to bartonella

may also see GI lesions with this

Front 564

why does inspiration worsen symptoms of cardiac tamponade?

Back 564

negative intrathoracic pressure --> more blood into right heart --> septum moves to the left and then even less LVEDV

Front 565

tx of prolactinoma

Back 565

DA agonist (e.g. bromocriptine or cabergoline)

Front 566

tx of metastatic breast ca

Back 566

surgery! regardless of the receptor status (if it is resectable and no systemic involvement)

Front 567

sx of erythema nodosum and common causes

Back 567

painful skin lesions on shins

recent strep infxn, sarcoidosis, tb, histoplasmosis, IBD

Front 568

which vitamin can increase warfarin's activity?

Back 568

e

Front 569

when do you want a pt on warfarin to have inr btwn 2.5 - 3.5?

Back 569

prosthetic heart valve

Front 570

pt has overdosed on tylenol - when to draw levels and give n-acetylcysteine

Back 570

draw levels at 4 hours (not earlier).
give n-acetylcsteine within 8 hours - can withold it until you get your level back.

can give activated charcoal initially as well.

Front 571

tx of primary biliary cirrhosis

Back 571

ursodeoxycholic acid

Front 572

what is Kussmaul's sign

Back 572

increase in JVP after deep inspiration (seen with constrictive pericarditis or RV infarction)

Front 573

pt has hepatitis and you see a rise in their PT time and decrease in transaminase levels - what hapepned?

Back 573

fulminant failure (not enough hepatocytes to get a high transaminase level and not enough synth of clotting factors to keep PT down)

Front 574

post-seizure anion gap metabolic acidosis is due to..

Back 574

lactic acidosis

usually resolved on its own

Front 575

adrenal calcification and failure is usually due to..

Back 575

tb

Front 576

pt has leukemia with lots of blasts, promonocytes,, positive alpha-naphthyl esterase rxn - dx?

Back 576

acute monocytic leukemia

Front 577

pt has leukemia with lots of hypergranular myelocytes and DIC - dx?

Back 577

acute promyelocytic leukemia

Front 578

when to start bactrim ppx in an hiv pt?

Back 578

when cd4<200

Front 579

pt just dxed with gastric ca - next step?

Back 579

ct to evaluate extent of dz

Front 580

h pylori associated with gastric adenocarcinoma or lymphoma?

Back 580

lymphoma

Front 581

pt has renal failure - will bleeding time, PT, or PTT be messed up?

tx?

Back 581

bleeding time - platelets become dysfunctional bc of metabolite building up to affect platelet adhesion

tx with DDAVP (desmopressin)

Front 582

sheep farmer has liver or lung cyst - dx?

Back 582

echinococcus causing a hydatid cyst

Front 583

first step in tx of severe hypercalcemia

Back 583

HYDRATION!

Front 584

when prescribing narcotics, start with short-acting or long-acting?

Back 584

short

Front 585

what does leukocyte esterase and nitrites mean on the dipstick?

Back 585

LE - significnat pyuria
nitrites - presence of enterobacteriaceae (as in e. coli)

Front 586

MCC megaloblastic anemia in an alcoholic

Back 586

folate def

Front 587

factors on the ventilator that mainly affect paco2

Back 587

tidal volume and resp rate

Front 588

pt was on vacation, now has PNA with high fever, GI sx, neuro sx. sputum gram stain only shows tons of neutrophils - dx and tx?

Back 588

legionella (intracellular)

azithromycin or levofloxacin

Front 589

MCC erysipelas

Back 589

GAStrep

Front 590

tx of most causes of pericarditis

Back 590

nsaids

Front 591

pt has heparin induced thrombocytopenia and it is severe with sx - tx?

Back 591

plasmapheresis

Front 592

what med can cause first degree heart block

Back 592

digitalis

Front 593

difference in appearance of cmv esophagitis and hsv

Back 593

cmv - shallow and superficial ulcerations with intranuclear/cytoplasmic inclusions

hsv - multiple small volcano-like ulcers with eosinophilic intranuclear inclusions

Front 594

things that can increase endolymphatic retention and thus predispose to meniere's dz

Back 594

alcohol, caffeine, nicotine, high salt

Front 595

heavy smoker has episodes of cough and sputum production that respond to abx over the course of years - how to distinguish btwn bronchiectasis and chronic bronchitis?

Back 595

bloody=bronchiectasis

get CT to confirm

Front 596

is cognition affected in ALS?

Back 596

no

Front 597

what symptoms can pts have after radioactive iodine for thyuroid?

Back 597

hyperthyroid as the dying cells secrete thyroid hormone

Front 598

tx of hairy cell leukemia and what stain

Back 598

TRAP positive
tx with cladribine

you may see smudge cells with this

Front 599

tx of CLL

Back 599

chlorambucil and prednisone

Front 600

pt has afib - when to do cardioversion vs rate control?

Back 600

if <48 of duration, cardiovert

if >48h, risk of thromboembolism with cardioversion so do rate control and 3-4 weeks of anticoagulation

Front 601

pt has signs of RA, splenomegaly, granulocytopenia - dx?

Back 601

Felty syndrome - need to have all 3!!!

Front 602

pt complains of GI issues, poor concentration, anemia - you should consider..

Back 602

lead pois

Front 603

levels of beta hcg and afp in a seminoma

Back 603

only beta hcg is high

Front 604

best screening test for suspected primary adrenal insuff

Back 604

cosyntropin stimulation test (acth analog)

Front 605

best screening test for Cushing's syndrome

Back 605

24 hour urinary cortisol or low-dose dexa supp test

Front 606

cavernous hemangiomas on brain/viscera is associated with...

Back 606

von-Hippel-Lindau disease

Front 607

monitor the following in a pt on amiodarone

Back 607

TFTs, LFTs, PFTs

Front 608

pt has tick bite from NEastern USA and now has hemolysis and jaundice - dx?

Back 608

babesiosis from ixodes tick

Front 609

tick borne diseases

Back 609

ehrilichiosis - leukopenia and thrombocytopenia (may have a rash)

babesiosis - hemolysis/jaundice

lyme

Front 610

pt is a dog owner and has a liver cyst with egg shell calcifications - dx?

Back 610

echinococcus causing a hydatid cyst in liver

Front 611

when do you see the following casts
muddy brown
rbc
wbc
fatty
broad/waxy

Back 611

muddy brown - ATN
RBC - glomerulonephritis
WBC - interstitial nephritis and pyelo
fatty - nephrotic
broad/waxy - chronic renal failure

Front 612

AEs of succinylcholine and which pts not to use it in

Back 612

hyperkalemia and arrythmias

don't use in pts with rhabdo, demyelinating syndromes, or tmor lysis syndrome (causes of hyperk)

Front 613

is clubbing normal in COPD?

Back 613

no! suggests malignancy

Front 614

in general, best antibiotic for infectious diarrhea

Back 614

cipro

Front 615

pt has hemolytic anemia and hepatic vein thrombosis for no good reason - dx?

Back 615

paraxysmal nocturnal hemoglobinuria

Front 616

what electrolyte abn can potentiate side effects of digoxin?

Back 616

hypokal

Front 617

should you give a dihydropyridine CEB in a pt having a stemi?

Back 617

no (e.g. nifedipine) - will cause vasodil and reflex tachy

Front 618

can you have the classic finding of eyes deviating away from paralytic side in a putamen/internal capsule lacunar hemorrhagic stroke?

Back 618

yes

Front 619

diabetic pt has early satiety and low glucose readings after meals - dx? tx?

Back 619

gastroparesis from autonomic neuropathy (if in SI --> bac overgrowth; LI --> constip)

tx is dopamine antagonist (e.g. metoclopramide or domperidone), bethanechol (parasympathomimetic), or erythromycin

Front 620

recurrent PNAs in the same area is very concerning for...

Back 620

bronchial obstruction (and thus bronchgenic CA)

Front 621

pt is type II diabetic with very very high glucose levels but focal neurologic defects - dx?

Back 621

nonketotic hyperosmolar syndrome - can have focal neuro defects!

Front 622

with massive hemoptysis, what do people usually die of?

Back 622

asphixiation on the blood - protect their airway first!

Front 623

pt is diagnosed with active goodpasture's dz - next step?

Back 623

plasmapheresis!!!

Front 624

pt has spherocytes and positive coombs test - dx?

Back 624

autoimmune hemolytic anemia

Front 625

pt has poor systolic function and htn - what med to control their htn with first?

Back 625

ace inhibitor to reduce afterload

Front 626

pt has urine sodium level 10mEq/L - is that low or high?

Back 626

<10 is very low

Front 627

unilateral obstructive uropathy - will you see increase in creatinine?

Back 627

usually no

Front 628

pt has alpha 1 antitrypsin def - what will TLC and diffusion capacity be?

Back 628

inc tlc, low diffusion capacity

(same as in emphysema)

Front 629

at what age does hemochromatosis present?

wilsons dz?

Back 629

hemochrom - 40s
wilsons - 20s

Front 630

what to use to tx agitation in elderly?
the young?

Back 630

old - haldol
young - lorazepam

Front 631

MCC guillain-barre syndrome

Back 631

campy jejuni

Front 632

HIV pt has bloody diarrhea with normal stool study - dx?

Back 632

probably CMV - do colonoscopy with biopsy to confirm (will see large cells with eosinophilic intranuclear and basophilic intracytoplasmic inclusions)

Front 633

MCC iron def anemia

Back 633

blood loss!!! always test for occult blood in stool

Front 634

tx of severe lithium toxicity

Back 634

hemodialysis

Front 635

tx of mild lead pois?

severe?

Back 635

mild - succimer

severe - edta

Front 636

MCC iron def anemia

Back 636

blood loss!!! always test for occult blood in stool

Front 637

tx of severe lithium toxicity

Back 637

hemodialysis

Front 638

tx of mild lead pois?

severe?

Back 638

mild - succimer

severe - edta

Front 639

pt has varicocele that doesn't empty when lying recumbent - should make you consider...

Back 639

renal cell ca

Front 640

most important factor contributing to NASH

Back 640

insulin resistance

Front 641

pts with central 7th nerve lesion ___ have facial furrowing

Back 641

will have it (peripheral provides contralat innervation)

Front 642

MCC death in pt with subarachnoid hemorrhage

Back 642

vasospasm with ischemia/infarction afterwards - prevent this with CEBs (e.g. nimodipine)

Front 643

pt is in sand in SE USA and has pruritc lesions on skin traveling proximally - dx?

Back 643

cutaneous larva migrans (ancylostoma braziliense) - from contact with dog/cat poop in the sand

Front 644

type of bruit heard in RAStenosis

Back 644

systolic-diastolic

Front 645

most DVTs are from...

Back 645

proximal vein thromboses (above the knee)

a much small proportion are from calf veins

Front 646

tx of acute hep b?
tx of fulminant hepatic failure?

Back 646

interferon or lamivudine

fhf - transplant

Front 647

pt has atypical pneumonia with hyponatremia - how to dx it?

Back 647

legionella - can do urine antigen test. culture isn't very reliable but you can do it if you have to.

Front 648

pathophys of malignant hyperthermia after halothane or succinylcholine admin

Back 648

uncontrolled efflux of calcium from sarcoplasmic reticulum

Front 649

bleeding from angiodysplasia (in colon) is controversially associated with...

Back 649

aortic stenosis

Front 650

what renal side effect does IV acyclovir have?

Back 650

crystalluria resulting in renal tubular obstruction

Front 651

if pt has bilateral symptoms of the lower extremity with UMN lesions - where is the lesion?

Back 651

spinal cord!

Front 652

what is Dressler syndrome and tx?

Back 652

post-MI pericarditis due to immunologic phenomenon.

tx with nsaids.

Front 653

causes of increased osmolar gap (expected osmolarity >10 compared to the measured)

Back 653

ethylene glycol pois (envelope/rectangular crystals), methanol, ethanol

Front 654

outflow obstruction in HOCM is due to...

Back 654

hypertrophic interventricular septum and amnormality in mitral valve leaflets

Front 655

what is leukoplakia?

Back 655

hard to remove white patches in oral mucosa often due to chronic irritation (smoking, alcohol, dentures) that can progress to SCCarvinoma

can't be removed by scraping

Front 656

MCC painless hematuria in an adult

Back 656

bladder tumor

Front 657

pt has cystinuria - what test is positive and what do the crystals look like?

Back 657

positive urinary cyanide nitroprusside test
hexagonal crystals

Front 658

extrarenal manifestations of ADPKD

Back 658

hepatic cysts. berry aneurysms. MV prolapse and aortic regurg.

Front 659

diffusion capacities in emphysema and chronic bronchitis

Back 659

decreased in emphysema (due to loss of alveoli)

normal in chronic bronchitis

Front 660

tx of acute phase of Reiter syndrome

Back 660

nsaids

Front 661

when can you use winter's formula?

Back 661

metabolic acidosis (not alkalosis)

for alkalosis, do PaCO2=(0.9 * bicarb) + 16

Front 662

what side murmurs increase on expiration?

Back 662

left

Front 663

can a pt with a PE have elevated cardiac enzymes?

Back 663

yes - assoc with poorer outcomes too

Front 664

what type of polyp is most likely to become malignant?

Back 664

sessile villous one

tubular is LEAST likely. tubulovillous is in the middle.

Front 665

De Quervain tenosynovitis typically affects...

Back 665

new mothers - due to holding baby with thimbs abducted and extended`

Front 666

how to confirm dx of vasovagal syncope?

Back 666

tilt table testing (possible with provocation with isoproterenol)

Front 667

does a benign teratoma make tumor markers? (e.g. afp or beta hcg)

Back 667

no

Front 668

type of cardiac manifestation of hereditary hemochrom

Back 668

dilated or restrictive cardiomyopathy leading to heart failure or conduction abn

Front 669

suspect melanoma - next step for the skin lesion?

Back 669

excisional biopsy of all of it with NARROW margins so you don't mess up the lymph and can ID the sentinal node later on if you have to

Front 670

how to tell if ascites fluid is transudate or exudate

Back 670

if ascites fluid albumin content is 1.1 greater than serum, it is transudate (portal HTN)

Front 671

common complication of CABG and how to tx it

Back 671

atrial fibrilliation

if unstable - DC cardioversion
if stable - pharm (e.g. digoxin)

Front 672

how to further differentiate partial seizures (discrete focus of brain is where it arises from)

Back 672

if loss of consciousness, it is either complex or has "secondary generalization"

complex - automatisms (e.g. chewing, moving hands, lip smacking)

secondary generalization - tonic-clonic (e.g. tongue biting)

Front 673

how do you confirm the dx of squamous cell ca of skin

Back 673

punch bx

Front 674

pt has GI complaints, then tons of edema, myositis, splinter hemorrhages, and eosinophilia. Dx?

Back 674

tichinellosis

Front 675

pt has CD4 count < 50 and needs MAC prophylaxis - what med?

Back 675

azithromycin

Front 676

which muscles are classically spared in polymyositis?

Back 676

mastication and facial expression

Front 677

how to dx goospastures dz

Back 677

renal biopsy - will see linear IgG against BM

Front 678

what is the chance of malignancy in a thyroid nodule that takes up lots of iodine?

Back 678

very low

Front 679

causes of foot drop (3)

Back 679

peripheral neuropathy
trauma to common peroneal nerve or radiculopathy to any of the spinal roots that contrib that the common peroneal nerve
congenital (e.g. Charcot-Marie-Tooth)

Front 680

most common cancers to met to liver

Back 680

GI tract cancers, lung, breast, skin (melanoma)

Front 681

levels of calcium, phosphorus, and PTH in pts who have osteoporosis or Pagets.

how about osteomalacia?

Back 681

osteopor or pagets - al lnormal

malacia - increased pth but low calcium and low phos (because low vit d is the real issue)

Front 682

do the spinothalamic tracts cross in the spinal cord?

Back 682

yes! they cross very early. so sx are contralat

Front 683

what meds can cause pancreatitis?

Back 683

valproic acid, diuretics, IBD drugs (sulphasalazine, 5-ASA), immunosupp. agents (azathioprine)

Front 684

important thing to remember regarding lab for G6PD activity

Back 684

it is often normal during the hemolytic episode (e.g. after sulfa or fava beans)

will see bite cells or Heinz bodies

Front 685

pt has basal cell ca with highrisk features or in functionally critical area - tx?

Back 685

mohs surgery (1-2 mm margin resection)

Front 686

Extra-hepatic complic of Hep C

Back 686

cryoglobulinemia
b cell lymphoma
plasmacytomas
Sjogrens syndrome/thyroiditis
lichen planus
porphyria cutanea tarda
ITP
membranoproliferative glomerulonephritis

Front 687

crypt abscesses seen with crohns or uc?

Back 687

uc

Front 688

normal anion gap

Back 688

6-12

Front 689

define the following stages of chemo

adjuvant
consolidation
induction
maint
neoadjuvant
salvage

Back 689

adjuvant - tx in addition to the standard (e.g. radiation + radical prostatectomy)

consol. - after induction to further decrease tumor burden

induction - intial dose to get <5% tumor burden

maint - after induc and consol (e.g. daily antiandrogen for prostate ca)

neoadjuvant - tx before standard treatment (e.g. radiotherapy BEFORE radical prostaectomy)

salvage - addtl tx after standard therapy fails

Front 690

skin lesion assoc with behcet syndrome

Back 690

erythema nodosum (also with ibd)

Front 691

test for behcets disease

Back 691

they have a positive pathergy test

Front 692

vit deficiency assoc with carcinoid syndrome

Back 692

need tryptophan to make all the serotonin. tryp also needed for niacin synthesis, so niacin levels are low

Front 693

if high suspicion for PE and no contraind for anticoag - next step?

Back 693

start heparin and THEN order the CT

Front 694

hiv pt has lesions that are bright red, firm, friable, exophytic (growing outward) - dx?

Back 694

bacillary angiomatosis

in contast, Kaposi lesions are plaque nodules that are light brown, pink, or dark violet.

Front 695

lumar osteoarthritis results from...

Back 695

disc degen.

in contrast, ank spond, which gets better as day goes on, is from apophyseal joint arthritis

Front 696

what is hepatolenticular degeneration

Back 696

wilsons dz

Front 697

manifestations of wilsons dz

Back 697

k-f rings
hemolytic anemia + neuropathy (fanconi syndrome)
parkinson-like features

Front 698

oral ___ can limit copper absorption

Back 698

zinc

Front 699

is aldo secretion dependent on acth

Back 699

no

Front 700

is ipratropium more effective in copd or asthma?

Back 700

copd

Front 701

pathologic change in kidneys in someone who chronically uses analgesics

Back 701

papillary necrosis (ischemia induced by vasoconstriction of medullary blood vessels)

Front 702

mucocut. ulcers and skin rash more likely with mono or hiv?

Back 702

hiv

Front 703

difference btwn central cord syn and ant cord syn

Back 703

central - just arms affected

ant - everything below the lesion

both mess up motor and pain/temp

Front 704

difference btwn inevitable abortio nand missed

Back 704

inev - cervix is dilated

missed - closed cervix