Step 2 Review

Front 1

Nephritic syndrome following upper respiratory syndrome

Back 1

IgA Nephropathy

Front 2

Most common cause of nephrotic syndrome in children?

Back 2

Minimal change disease

Front 3

Oliguria, azotemia, elevated BUN and Cr, RBC casts, HTN, hematuria, often post URI.

Back 3

nephritic syndrome

Front 4

Nephritic syndrome with RBC casts, edema and HTN

Back 4

Glomerulonephritis

Front 5

Muddy brown casts and renal failure

Back 5

Acute Tubular necrosis

Front 6

papillary necrosis, polyurea with sterile pyuria, patient taking NSAID

Back 6

analgesic nephropathy. Also can be caused by hemophilia, DM, cirrhosis or CHF.

Front 7

cystic liver on u/s, patient is on dialysis, palpable kidneys.

Back 7

polycystic kidney disease

Front 8

infant with hypocalcemic seizures, congenital heart disease, anomalies of great vessels, MR, esophagela atresia, low set ears

Back 8

DiGeorge's Disease. Due to defect in pharyngeal pouches.

Front 9

X linked disease presents after 6 months of age with incapsulated invections ie H flu and S. pneumoniae, low Ig levels and few B cells on smear.

Back 9

Bruton's Agammaglobulinemia. Similar presentation to CVID but CVID not sex linked, presents in teenage years and normal B cell number.

Front 10

Predisposing factors of Acute/Subacute Bacterial Endocarditis?

Back 10

-MVP
-Deg Vasc disease
-IV Drug Use
-Prosthetic Valves
-Congenital abnormalities

Front 11

How long does etoh withdrawal take?

Back 11

presents 12-24 hours after last dirnk with DTs 2-4 days out. Autonomic instability, tachycardia, fever, sweating, tremor and hyper reflexia.

Front 12

What is a Charcot's Joint?

Back 12

Neurogenic arthropathy ... joint destruction due to loss of pain, temp and proprioception. Due to diabetes, spinal cord injiury, peripheral nerve disease or tabes dorsalis.

Front 13

Strokes
1. happening during exercise with focal neuro signs, HTN
2. previous TIA, hyperlipidemia, DM
3. severe headache

Back 13

1. hemorrhagic
2. ischemic
3. SAH

Front 14

Acid fast filamentous branching rod causing pulmonary or cranial cavitary lesions.

Back 14

Norcardia. Not TB. TB is a GNR acid fast bacilli no branching.

Front 15

Treatment of hypercalcemic crisis?

Back 15

IV lasix and fluids.

Front 16

NTD are seen with what drug?

Back 16

Valproic acid predisposes to neural tube defects and cardiac anomalies, midface hypoplacia and cleft lip.

Front 17

Cough with hemoptysis and infiltrates + proteinuria and ARF and dysmorphic RBCs. What test do you do to confirm?

Back 17

Goodpastures. Do renal biopsy showing IgG on Glom BM

Front 18

Prophylaxis for pertussis?

Back 18

erythromycin for 2 weeks for everyone! Even if immunized. 75% of people get symptoms.

Front 19

Mid diastolic rumbling murmur loudest at the apex of the heart

Back 19

Mitral Stenosis most commonly from rheumatic heart disease.

Front 20

Direct vs Indirect Coombs Test

Back 20

Direct- for hemolytic anemia, put washed RBCs in coombs reagent, if they agglutinate there was bound Ig = +
Indirect- Looking for free Ig against RBC ie Rh status in pregnancy.

Front 21

How do you test for paroxysmal nocturnal hemoglobinuria?

Back 21

Sugar water test

Front 22

5 types of lactate dehydrogenase?

Back 22

1 heart and RBC (hemolytic anemia)
2. reticuloendothelial
3 lungs
4 placenta,kidneys, pancreas.
5 liver and muscle

Front 23

Most common presentation of heterozygous sickle cell trait?

Back 23

painless hematuria
HbS usually 40%

Front 24

Treatment of fibromyalgia

Back 24

TCA at night low dose amytriptyline.

Front 25

Treatment of cat bite? Concerning organism and possible complication?

Back 25

Bacillary angiomatosis ... skin lesion with growth of blood vessels due to Bartonella a gram negative rod from cat bites that needs treatment with erythromycin.

Front 26

major side effect of olanzapine (atypical antipsychotic)

Back 26

weight gain... diabetes

Front 27

major side effect of clozapine (atypical antipsychotic)

Back 27

agranulocytosis.

Front 28

Headache following OM ... next step in management.

Back 28

Concerning for intercranial abscess get head CT for ring enhancing lesions.

Front 29

palsy following a seizure... treatment?

Back 29

Todd's palsy will resolve no tx

Front 30

+ Romberg's sign indicates what?

Back 30

peripheral nerve damage causing sensory ataxia. Can also indicate cerebellar disorder will falls toward the affected side.

Front 31

You note hypersegmented neutrophils and a megaloblastic anemia. How do you differentiate between folate vs coalbamin B12 deficency?

Back 31

Coalbamin is needed to conver methylmalonyl co A to succinal Co A so if B12 is low there will be increased methylmalonic acid levels as well as elevated homocysteine levels (B12 and folate are both needed for conversion of homocysteine to methionine)

Front 32

Treatment of stable angina?

Back 32

1 BB
2 CCB

Front 33

What disease process causes paratracheal adenopathy and noncaseating pulmonary granulomas as well as anterior uveitis, polyarteritis and erythema nodosum (vasculitis)? What is tx?

Back 33

Sarcoid.
Treatment is with glucocorticoids.

Front 34

Pulmonary lesions in person traveling to Ohio/Missippi River Valley to go Spelunking?

Back 34

Histoplasmosis. Treatment wiht Itraconazole.

Front 35

Infliximab

Back 35

TNF alpha blocker, treats IBS, Ankylosing spondylitis and RA

Front 36

You note an elevated alk phos, bone pain and mosaic pattern of lamellar bone in an elderly gentleman. What are you concerned about?

Back 36

Pagets disease of bone. Increased bone turnover due to osteoclast hyperactivity.

Front 37

Interpret high vs low alk phos values.

Back 37

High alk phos- either liver injury ie stones or bone ie Paget's
Low alk phos- incidicates CML or paroxysmal nocturnal hemoglobinurea

Front 38

Brick red maculopapular rash, moving from face down, conjunctivits, fever, coryza. What is it and what vit do you give?

Back 38

Measles. Give Vit A.

Front 39

LAD especially posterior cervical and posterior occipital, low fever, red maculopapular rash starting on face moving down.

Back 39

Rubella. More L's = lower fever more lymphadenopathy.

Front 40

Strawberry tongue and red red eyes in a child.

Back 40

Kawasaki's Disease medium vessel vasculitis.

Front 41

Loss of pain and temperature in cape like distribution. Seen in many pt after spinal cord injury ie MVA with wiplash.

Back 41

Syringomyelia due to cust of CSF fluid.

Front 42

What tract?
vibration and position
pain and temp
motor

Back 42

vibraiton and position = dorsal column
pain and temperature = spinothalamic
muscle/motor strength = lateral corticospinal tract, decending

Front 43

Loss of pain/temp contralaterally below lesion, loss of motor, proprioception and vibration ipsilaterally.

Back 43

Brown Sequard hemisection of cord.

Front 44

paraplegia, incontinence, saddle anesthesia

Back 44

cauda equina syndrome

Front 45

2 Drugs of choice treating HTN in pregnancy.
What if pre eclampsia?

Back 45

Treat BP with hydralazine (direct vasodilator) and labetalol. Avoid diuretics.
If pre eclampic also use M but this is to decrease risk of future seizures not to treat BP, important distinction.!

Front 46

Treatment of uncomplicated UTI in nonpregnant patient?

Back 46

Bactrim

Front 47

Goal tidal volume for ventilator?

Back 47

6 ml/kg

Front 48

crecendo decrescendo systolic ejection murmur at 2nd intercostal space on the right radiating to the carotids.

Back 48

Aortic stenosis- also radiates to the carotids, weak S2, often LVH and S4 and displaced PMI due to LVH.

Front 49

wavy lines acorss the vision with loss of central vision.

Back 49

wet macular degeneration due to new blood vessels

Front 50

patient experiences tunnel vision. fundoscopic exam shows cupping of the optic disc

Back 50

open angle glaucoma... high IOP with tunnel vision and cupping of optic disc.

Front 51

Sudden loss of vision "shade like" darkness

Back 51

emergency! retinal detachment, usually with myopic patients and after trauma.

Front 52

Location of lesion for patient presenting with expressive aphasia ie Brocas

Back 52

left frontal lobe consider left MCA infarct

Front 53

pathophysiology of Zenker's diverticulum?

Back 53

esophageal herniation due to dysmotility and incoordination between esophagus and pharynx. older individual presenting with neck mass when dirinking fluids.

Front 54

definition of fetal deceleration

Back 54

decrease in fetal HR of at least 15 beats for 15 seconds

Front 55

infant with colickly abdominal pain, vomiting, red jelly stools, feel saussage shaped mass in abdomen. Treatment?

Back 55

Give air contrast enema for intrasusseption.

Front 56

Organism most likley causal for osteomyelitis? What if sickle cell?

Back 56

1. S. aureus (less likely GBS, E coli , S pyogenes)
2. Salmonella in sicle cell

Front 57

Drug cause of priapism?

Back 57

prazosin causes priapism.
(alpha blocker)
Second most likely cause is Trazadone then trauma, neurogenic, sickle cell or leukemia.

Front 58

Soft S1 3 days after MI, murmur loudest at apex with radiation to axilla, pansystolic.

Back 58

Suspect mitral regurgitation to to papillary muscle rupture. Biggest risk 3-7 days after MI for free wall rupture and papillary rupture.

Front 59

This acid fast filamentous branching rod causes pulmonary cavitary lesions and infections in the immunocompromised. Treatment is with Bactrim. Not TB!

Back 59

Norcardia =acid fast branching rod
TB = acid fast bacilli

Front 60

Baby is born with neural tube defects, cardiac anomalies, dysmorphic facies, cleft lip and midface hypoplasia. What drug was he exposed to inutero?

Back 60

Valproid acid exposure leads to NTD.

Front 61

Side effect of clozapine?

Back 61

agranulocytosis

Front 62

Main side effect of olanzapine?

Back 62

seight gain.

Front 63

How does CML present?

Back 63

CML presents with leukocytosis, anemia, increased neutrophils and bands on peripheral smear. Usually older individual with night sweats, malaise, feer, weight loss, anorexia and bone pain. Often low alk phos.

Front 64

This disease is due to oxidative damage to th elens with aging resulting in thickening and clouding of the lens.

Back 64

cataracts.

Front 65

What is Boorhave syndrome?

Back 65

spontaneous rupture of esophagus usually seen in slcoholics after severe vomiting with patient having severe retro sternal pain.

Front 66

Name 3 tests that look at liver function

Back 66

liver function, PT, bilirubin, albumen, cholesterol synthesis.

Front 67

Name tests that look at structural integrity of the liver.

Back 67

GGT, LFTs and alk phos. Marked increase indicates ongoing tissue destruction. Progressive decrease indicates few functional hepatocytes. Look for 2:1 ratio of AST to ALT in ETOH.

Front 68

variable deceleraitons are due to what?

Back 68

fetal cord compression = variable decels

Front 69

early deceleraitons (same time as the uterine contraction, uniform in shape) indicate what?

Back 69

fetal head compression during the ocntraction = early decel

Front 70

What does early fixed splitting of the heart sounds indicate?

Back 70

ASD- blood is flowing from the LA to the RA so the pulmonic valve takes longer to close due to the increased pressure gradient.

Front 71

Pulses parvus et tardus (slow late carotid pulse) indicates what?

Back 71

aortic stenosis

Front 72

What is Kussmal's sign

Back 72

increase in JVP with inhalation indicating pericarditis or right ventricle infarction, backing up of blood into venous system.

Front 73

Why are SGA infants at higher risk for polycythemia?

Back 73

increased hypoxemia results in more erythopoietin and more RBCs.

Front 74

Reglan (metocloperamide), typical antipsychotics, prochlorperazine can all cause what side effect?

Back 74

Torticollis.

Front 75

Your patient is in shock but has an elevated PCWP > 10 with hypotension. What do you give?

Back 75

The patient is in cardiogenic shock. Give lV fuids and then ionotropes to increase CO. Elevated LA pressure is due to backup pressure from heart failure.

Front 76

Causes for elevated PCWP? Normal PCWP 8-10.

Back 76

cardiogenic shock or obstrution. Anything preventing the forward flow of blood.

Front 77

What does a low mixed venous oxygen concentration mean (MVo2)?

Back 77

increased oxygen extraction by hypoperfused tissues as in neurogenic or hypovolemic shock. In septic shock MVo2 can be normal as their is a distribution inequality along the tissues.

Front 78

Most comon cancer from aspestos exposure? (pulmonary fiborsis, weight loss, wheezing, dypsnea, pleural plaques).

Back 78

Bronchogenic carcinoma. Arsenic exposure occurs with mining, ship building, insulation, pipe work.

Front 79

Sturge Weber Syndrome?

Back 79

Port wine stain along trigeminal nerve, seizures and retardation. Often intercranial calcificaitons resembling a tramline . Defect is proliferation of arteries in teh brain resulting in ulilateal hemaniopsia and hemiparesis.

Front 80

Cut off for neutropenia?

Back 80

ANC < 1500. If below 1500 always give abx even with simple fever and no s/s of infection.

Front 81

pale velvity pink or white patches, scale when you scrape them and don't tan.

Back 81

Tinea versicolor. Treat with ketoconazole or selenium sulfide.

Front 82

what aretery is teh first division of the internal carotid?

Back 82

opthmologic artery. If retinal artery occlusion at terminal branch amarosis fugax can occur. Treat with 100% O2 and massage.

Front 83

Diastolic decrescendo murmur along the LL sternal border.

Back 83

aortic regurgitation.

Front 84

How does the respiratory quotient depend on the fuel being consumed for energy?
RQ = CO2/O2 use.

Back 84

If RQ is close to 1 = carbs
Proteins = 0.8
Lipids 0.7
If excessive feeding of venitilated patients with carbs they are more difficult to wean due to additional CO2 production.

Front 85

Fever, cough, coryza, conjunctivitis and Koplik (blue /white spots on red background) spots = ?

Back 85

Measles = koplik blue spots

Front 86

Slapped cheeks rash?

Back 86

5th's disease due to parvovirus B 19. Sicle cell crisis can be caused.

Front 87

This X linked disorder (seen in males) is characterized by eczema, thrombocytopenia and hypogammaglobulinemia.

Back 87

Wiskott Aldrich Syndrome

Front 88

treatment of Tourette's?

Back 88

typical antipsychotics such as haloperdol and pimozide treat Tourette's.

Front 89

Triad of congenital toxoplasmosis ?

Back 89

chorioretinitis, hydrocephalitis, intercranial calcificaitons (contrast with Rubella which has cardiac defects and deafness)

Front 90

Triad of congenital Rubella?

Back 90

deafness, cardiac defects, cataracts. (contrast with toxo which has intercranial calcifications)

Front 91

If you push on a child's medial canthus and expell pus what is the infection?

Back 91

Dacryocystitis- infection of the lacramal sac

Front 92

Absess on the upper eyelid by s. aureus?

Back 92

Hordeolum.

Front 93

Chronic granulomatous infection of the meibomian gland- hard painless uppe reyelid nodule?

Back 93

Chalazion.

Front 94

Older woman with dysuria, painful sexual interourse and deficaiton, white polygonal macules and patches. Vulva is thin, whte and dry. What do you suspect and why must you get a biopsy?

Back 94

Concern is for SCC of teh vulva. Most likely Lichen sclerosis but still need to biopsy. Then streat with steorids.

Front 95

What does it mean if the relative risk crosses 1?

Back 95

No association between the risk factor and the disesae.

Front 96

What does it mean if the conficence interval contains the value 1.0?

Back 96

The value 1.0 is null such that there is no significance if CI contains 1.0

Front 97

When do you give Tetanus toxoid vs. Ig

Back 97

Ha s the patient had 3 or more vaccinations withing the last 10 years. If yes then you only need to give TT if the wound is dirty. If last vaccination >5 years ago then give TT even if wound clean. If the wound is dirty and the patient has had < 3 vaccinations give TT and tetanus Ig.

Front 98

What causes paresthesias after a patient gets multiple RBC transfusions?

Back 98

Citrate chelates the calciumin teh blood causing transietn hypocalcemia after transfuions.

Front 99

An infant has conjunctivitis. Based on time of presentation how do you determine what it is (gonococcal, allergic or chlamydial)

Back 99

allergic - first 24 hours
Gonococcal 2-5th day (ceftriaxone)
Chlamydial- day 5-14, purluent discharge and RN (oral erythromycin due to risk of PNA)

Front 100

Treatment of resting tremor, bradykineska and rigidity of parkinson's disease

Back 100

Anticholinergics such ans benzotropie increase ACh which helps improve PD tremor.

Front 101

How Teat for autoimmune hemolytic anemia?

Back 101

Coombs test. Anemia is uaully preceeded by URI in children 2-12 yo.

Front 102

Your patient has dilated pupils, ileus, seizures and long QRS. What do you give them and what did htey OD on?

Back 102

PD on TCA ie amytriptalyine.
Give bicarbonate to improve BP and to narrow th QRS to reduce risk of arrhythmia.

Front 103

Treatment for patients with Torsades due to a long QR interval?

Back 103

Mg Sulvate treats long QT interva..

Front 104

How do you treat the SLUDGE of organophosphate poisioning?

Back 104

Atropine and pralidoxine.
Pralidoxine binds to Acetylcholinesterase so that available ACh is not degraded.
Atropine increases BP and HR.
Also Benzos to reduce risk of seizure.

Front 105

Common findings in anorexic patients

Back 105

Anorexia associated illness
osteoporosis
elevated cholesterol and carotene
long QT
euthyroid sick syndrome
anovulation and amenorrhea
hyponatremia- due to increased H20 intake.

Front 106

What causes stress fractures?

Back 106

repeated exhertion ie on heel from running

Front 107

Age >40, triad of systemic vaculitis, upper and lower airway granulomas and GN.
(epitaxis, nonhealing granulomatous lesions, pyoderma, RBC casts proteinuria, ANCA positive)

Back 107

Wegner's granulomatosis
treat with cyclophosphamide

Front 108

puncture wound through rubber shoe = infection with?
Tx?

Back 108

pseudomonas. Treatment with FR such as levofloxacin.

Front 109

What is a counterindication to giving a SERM such as Raloxifene?

Back 109

Prior DVTs are counterindicated with raloxifene. Serms are a mixed agonist in the bone and an estorgen antagonist in the breast and vaginal tissue.

Front 110

Do SERMS increase the risk for breast or endometrial cancer?

Back 110

Tamoxifen increases the risk of endometrial cancer. Raloxifene and Tamoxifen reduce the risk of breast cancer and improve bone density.

Front 111

Differential for T wave inversion:

Back 111

MI, myocarditis, old pericarditis, myocardial contusion, digoxin toxicity

Front 112

10 yo boy comes in with multiple skin infections from s. aureus in his history. What immune defect do you suspect?

Back 112

Suspect defect of phagocytic cell to make oxidative burst with NADPH- test with nitro blue tetrazolium.

Front 113

Young boy with eczema, thrombocytopenia and bacterial infection with H. flu or other encapsulated organism. He bruises easily and antibody levels are variably decreased.

Back 113

Wiscott Aldrich syndrome
x linked immunodeficency
eczema, thrombocytopenia and recurrent encapsulated bacterial infections.

Front 114

Girl with absent thymic shadow, lymphopenia, recurrent fungal and bacterial infections in first year of life.

Back 114

SCID- severe combined immune deficency

Front 115

patient has multiple pulmonary infections and diarrheas as well as a recent reaction to blood products.

Back 115

IgA deficiency. Deficient mucosal border protection as well as anaphylaxis to blood products.

Front 116

Kartanger's syndrome

Back 116

ciliary dysfunction resulting in recurrent otitis, sinusitis, URIs and infertility

Front 117

Addison's disease

Back 117

hyponatremia, hyperkalemia, anemia, esoinophilia, weakness, increased pigmentation, anorexia. Test with cosyntropin test (ACTH analogue) see if there is primary or secondary adrenal insufficency.

Front 118

tall stature, crowded teeth, long limbs, arachnodactly, mutation of fibrillin...

Back 118

Marfan's (AD with variable penetrance)

Front 119

Ehler's danlos is a mutation in what?

Back 119

Mutation in collagen resulting in poor healing, hyperflexible joints, easybruising and hyper elastic skin.

Front 120

Baby with rocker bottom feet, small head and low ears.

Back 120

Edwards trisomy 18

Front 121

first line treatment of generalized anxiety?

Back 121

Buspirone (Buspar) partial serotonin agonist. then consider venlafaxine (serotonin andNE reuptake inhibitor) or Lexapro (SSRI)

Front 122

What kind of bias is caused by losing patients to follow up?

Back 122

Selection bias- possibility those individual lost to follow up differin their development of the outcome measure - perhaps more compliant patients to treatment are less likely lost to follow up.

Front 123

Why do patients with renal failure have platelet dysfunciton?
How do you treat it?

Back 123

uremic toxins cause platelet dysfunciton prolonging bleeding time (Pt,PTT, INR are normal). Treat with desmopressin which releases BIII and Von Willebrand factor from storage.

Front 124

Name 4 causes of a macropapular rash.

Back 124

Macropapular rash seen in scarlet fever, measles, parvovirus andheat rash.

Front 125

vibration and proprioception?
motor ?
pain and temp?

Back 125

vibration and proprioception are posterior dorsal columns cross in medulla
Lateral corticospinal tract is muscle strength which crosses in medulla and is descending.
Spinothalamic tract is pain and temperature and crosses within two spinal segments.

Front 126

Definition of pre eclampsia

Back 126

HTN >160/110, proteinuria <5g/24 hrs, pulmonary edema, thrombocytopenia and elevated liver enzymes

Front 127

Describe assist control ventilator setting.

Back 127

In AC a tidal volumeis delivered to the patient whenever the patient initiates a breath or at a baseline rate if the patient fails to trigger the vent.

Front 128

Murmur? Crescendo decrescendo systoli cejection murmur at the 2nd intercostal space on the right, radiating to teh carotids. dyspnea, syncope, angina on exhertion.

Back 128

Aortic Stenosis.

Front 129

How does retinal detachment present

Back 129

like a shade falling in front of the eye, sudden loss of vision.

Front 130

Disorder of cilia, results in otitis, sinusitis and repeated URIs

Back 130

Kartagener's syndrome- dysfunctional cilia.

Front 131

Patient has hyponatremia, hyperkalemia, weakness, pigmentatino, anorexia. ??

Back 131

Addison's. Diagnose by cosyntropin test. If cortisol rises you can rule out primary adrenocortical insufficency.

Front 132

In addition to aspirin what drug decreases mortality after an episode of unstable angina or NSTEMI?

Back 132

Patient should be on both clopidogrel and aspirin for 12 months.

Front 133

What is anoscopy?

Back 133

Visualizes teh rectum to look fo hemorrhoids.

Front 134

Symptoms of a pinealoma?

Back 134

The pineal gland makes melatonin so tumor can cause insomnia, also precocious puberty and paralysis of CN III.

Front 135

Patient presents with diarrhea, leg cramps 2/2 hypokalemia and low stomach acid. Termed teh pancreatic cholera.

Back 135

VIP oma causes diarreha and hypokalemia.

Front 136

liver cysts + blood diarrhea + foreign travel.

Back 136

Amebiasis Histoliticus-. Due to trophozoites. Test stool. Treat with metronidazole.

Front 137

Treatment of chlamydia

Back 137

single dose azithromycin or 14 days of doxycycline

Front 138

Treatment of Gonorrhea

Back 138

ceftriaxone .

Front 139

Endocrine disorder (immunologic, testicular atrophy, baldness, hypothyroidism) and proximal and distal muscle weakness (thin face, temporal wasting)

Back 139

Myotonic muscular dystrophy (is autosomal dominant)

Front 140

What typical antipsychotic can cause hypothermia by inhibiting the shivering mechanism?

Back 140

Fluphenazine.

Front 141

Most common cause of communicating hydrocephalus in premature infants?

Back 141

Sub arachnoid hemorrhage.

Front 142

Treatment of cryptoccal meningitis.

Back 142

IV amphoteracin and flucytosine.

Front 143

Treatment of cat bites with concern for Pasturella moltocida?

Back 143

amoxicillin and clavulanate for 5 days.

Front 144

Why are Floroquinolones not used in children?

Back 144

risk of tendon reupture.

Front 145

In a low pH environment is free calcium high or low?

Back 145

Calcium is released from albumen in low pH environmentt so unbound Ca would be higher.
In a alkaline environment ie altitude claicum is bound to albumen resulting in transient paresthsias

Front 146

MEN II a syndrome
Due to Ret oncogene.

Back 146

medullary thyroid cancer, pheochromocytoma, parathyroid hyperplasia.

Front 147

Men IIB

Back 147

medullary thyroid cancer, pheo, mucosal neuromas.

Front 148

Virchack's node, elevated bilirubin, increased alk phos, weight loss, epigastric pain, jaundice.

Back 148

pancreatic cancer. Get abdominal CT to evaluate.

Front 149

Signs of Niacin B3 deficency

Back 149

pellagra- dermatitis, dementia and diarrhea

Front 150

Glasgow Coma Scale

Back 150

Eye opening 1(none to spontaneous 4
Verbal none 1 to oriented 5
Motor none to obeying command 6

Front 151

Treatment of dystonia from haloparadol?

Back 151

antihistamines or anticholinergics ie diphenhydramine or benzotropine.

Front 152

Patient with nasal polyps, chronic sinusitis, anosmia, nasal obstruction and shortness of breath.

Back 152

Suspect NSAID induced bronchospasm ie from Aspirin.

Front 153

Triad of parkinson's disease

Back 153

bradykinesia, resting tremor, rigidity

Front 154

Eczema, thrombocytopenia (bleeding and bruising) and recurrent respiratory infections ... male child.

Back 154

Wiskott Aldrich Syndrome

Front 155

Boy with recurrent infections with staph aureus and pseudomonas and other catalase positive organisms. What test do you want.

Back 155

Nitroblue tetrazolium dye tesst for chronic granulomatous disease. X linked due to NADPH oxidase inactivity.

Front 156

Most common infection with complement deficencies?

Back 156

Neisseria.

Front 157

Recurrent staph infections of the skin, fair hair, eczema, high IgA levels.

Back 157

Job hyper IgE syndrome

Front 158

albinism and dysfunctional neutrophils with giant granules?

Back 158

Chediak Higashi Syndrome due to a defect in microtubule polymerization.

Front 159

Patient has rigidity, mutism, obtundaiton, agitation, high fever, high creatine phosphokinase, sweating , myoglobinuria and is on an antipsychotic. Waht do you do?

Back 159

Give dantrolene just like in malignant hyperthermia.

Front 160

side effect of antipsychotic Thioridazine?

Back 160

retinal pigment dposits

Front 161

side effect of antipsychotic clozapine

Back 161

agranulocytosis

Front 162

side effect of antipsychotic chlorpromazine

Back 162

causes jaundice and photosensitivity

Front 163

personality disoder of bizarre beliefs, likes witchcraft, superstitious.

Back 163

Schizotypal personality disorder

Front 164

The classic loner, no friends and no interest in having them

Back 164

Schizoid personality disorder

Front 165

No friends but wants to have them, afraid of criticism or rejection, inferiority complex.

Back 165

Avoidant perosnality disorders.

Front 166

Tratment for narcolepsy?

Back 166

Modafinil or amphetamines.

Front 167

First line tratment for gerneralized anxiety disorder?

Back 167

Buspirone then SSRI then Benzos.

Front 168

Treatment for ADHD

Back 168

stimulants such as modafinil, methylphenidate (ritalin) or dextroamphetamine.Use drug holidays when possible to decrease side effect.

Front 169

What is the best test for comparing two means?
What about two percentages?

Back 169

t test compares means
Chi square test compares 2 percentages.

Front 170

Treatment of chlamydia in pregnant woman?
In non pregnant women?

Back 170

erythromycin or amoxicillin if pregnant.
Doxycycline if not pregnant.

Front 171

Single dose treatment for chlamydia?

Back 171

1 g oral dose of azithromycin.

Front 172

Malodorous vaginal discharge with fishy smell on KOH, clue cells. Treatment

Back 172

Treat with metronidazole for Gardnerella vaginialis.

Front 173

Treatment of Neisseria gonorrhoeae for mucopuruent cervicitis with gram neg diplococci on smear.

Back 173

Ceftraixone or ciprofloxacin. Always treat for assumed Chlamydial infection with doxycycline as well. If patient has Chlamydia then you don't need to assume gonorrhea!

Front 174

Painless chancre, spirochete on dark field microscopy, treatment?

Back 174

Treatment ofr primary syphilis is penicillin.

Front 175

Condyloma lata, maculopapular rash on palms, treatment?

Back 175

Treat secondary syphilis with penicillin.

Front 176

Pale frothy watery discharge with strawberry cervix. Bugs can be seen swiming under microscope. Treatment?

Back 176

Metronidazole for Trichomonas vaginalis.

Front 177

What is the most common defect in CAH?
-salt wasting (low Na)
-hyperkalemia
-hypotension
-elevated 17 hydroxyprogesterone

Back 177

21 Hydroxylase deficency.

Front 178

PAtient with "bunch of grapes" protrusion from vagina?

Back 178

sarcoma botryoides a rhabdomyosarcoma malignant tumor

Front 179

Most common cause of secondary amenorrhea?

Back 179

prengnacy.

Front 180

What is Chadwick's sign?

Back 180

Blue dark discoloraiton of the vulva and vaginal walls inpregnancy.

Front 181

Congenital Rubella syndrome?

Back 181

deafness, cataracts, cardiac abnormalitis.

Front 182

Positive tripple screen in pregnancy with low AFP, low estriol, high hCG means?

Back 182

Downs syndrome.

Front 183

What is the fourth value in a quad screen of pregnancy and what value (high/low) indicates Downs?

Back 183

High inhibin A indicates Down's.

Front 184

What does a low AFP mean?
High AFP?

Back 184

NTD is high AFP while Down's is Low AFP

Front 185

What do you do if a tripple screen is positive at 16-20 weeks?

Back 185

Do an amniocentesis.

Front 186

Earliest screen at 9-12 weeks?

Back 186

chorionic villus sampling, reserved for women with previously affected offspring or known genetic disease.

Front 187

Most common TORCH infection: small eyes, cerebral calificaitons, deafness

Back 187

CMV infection.

Front 188

What is potter's disease?

Back 188

Fetal bilateral renal ageneiss. cause of oligohydramnios. Often presentatino is with hypoplastic lungs and acute respiratory distress first.

Front 189

Early sign of Mg toxicity?

Back 189

hyporeflexia followeed by respiratory depression, coma and death.

Front 190

What test determines fetal vs maternal blood incases of painless vaginal bleeding during pregnancy?

Back 190

The apt test. Concern for vasa previa or velamentous insertion of the cord.

Front 191

Amniotic Fluid Indes < 5 is vs > 25

Back 191

polyhydramnios vs oligohydramnios. Measures the four biggest vertical pockets of fluid in each quadrent.

Front 192

Treatment of chorioamnionitis?

Back 192

Ampicillin.

Front 193

Treatment of mastitis... most common organism is staph aureus.

Back 193

cephalexin or dicloxacillin

Front 194

What is a real number?

Back 194

A real number is the set of numbers that includes all members of the set of rational numbers and all members of the set of irrational numbers.
Real Numbers = Rational Numbers + Irrational Numbers

Front 195

vertigo+ tinnitus + hearing loss =

Back 195

Meniere's disease. Treat with anticholinergics and antihistamines.

Front 196

How many Hep B vaccinations and Hib before 1.5 years

Back 196

3 doses by 1.5 yrs for Hep B and 4 doses HiB

Front 197

DTP how many doses by 6 years?

Back 197

5 doses by 6 tears

Front 198

Polio how many doses by 6 years?

Back 198

4 doses

Front 199

HWhen do you give Varicella vaccinatoin and when do you avoid it?

Back 199

Avoid if immunosupressed due ot live vaccine oterhwise give at 1-2 years

Front 200

What vaccines have eggs ?

Back 200

Influenza, MMR all have eggs.

Front 201

+ Babinskis

Back 201

upward fanning of the toes, indicates UMN disesae

Front 202

Beck's triad

Back 202

JVD, mufflec heart sounds, hypotension. Indicates pericarditis

Front 203

Cushing's reflex

Back 203

HTN, bradycardia and irregular respirations make you think of hemorrhage or increased ICP

Front 204

Homan's sign.

Back 204

calf pain with forced dorsiflexion of foot with DVT

Front 205

Kehr's signq

Back 205

left shoulder pain with ruptured spleen (any irritation of the diaphram)

Front 206

Murphys sign

Back 206

arrest of inspiration when palpating the RUQ in cholecystitis.

Front 207

Verner Morrison syndrome

Back 207

watery diarrhea, achlorydia and hypokalcemia due to pancreatitic tumor secreating VIP (VIPoma)

Front 208

Bitot's spots

Back 208

Vit A deficency

Front 209

Bronze diabetes

Back 209

hemochromatosis look for cardiac and liver dysfunction

Front 210

cherry red maculaa

Back 210

tay sach's or niemann pick (self injury and HSM)

Front 211

friction rub ?

Back 211

pericarditis

Front 212

heliotrope rash

Back 212

dermatomyositis

Front 213

increased hemoglobin A2 + anemia (basophilic stipling and target cells

Back 213

thalassemia

Front 214

meconium illeus , salty baby, rectal prolapse

Back 214

CF

Front 215

freckling around lips and increased risk for colon cancer

Back 215

peutz jeghers disease.

Front 216

Does the pneumococcal vaccine require T, B or both cell response?

Back 216

pneumococcal induces a T cell independent response due to itspolysaccharide capsule whcih independently activates B cels.

Front 217

What do you need to remove a foreign body from the lung?

Back 217

A RIGID bronchoscope.

Front 218

Tick bite + wrists and ankles rash, fever, malaise, HA, leukopenia and thrombocytopenia

Back 218

Erlichosis aka RM spotted fever

Front 219

Northeaster US, jaundice, hemmoglobinurea, renal failure and death possible. Worse if older and asplenic. Look for atypical lymphocytes, anemia and abnormal LFTs

Back 219

Babesiosis due to tick. causes direct RBC hemolysis due to the parasite.

Front 220

Treatment of UTI in pregnancy?

Back 220

amoxicillin, nitrofurantoin or cephalosporin.

Front 221

Treatment of pylonephritis
?

Back 221

ciprofloxacin.

Front 222

+ Tzanck smear?

Back 222

Herpes virus

Front 223

If your HIV patient with pneumonia is allergic to sulfa what do you give?

Back 223

Can't give bactrim so give pentamiddine for PCP.

Front 224

Flu like syndrome with hepatitis and pneumoniae in an animal exposed person ie vet or goat herder, what is it?

Back 224

Q fever from Coxiella.

Front 225

You have a young patient suddenly present with CHF. What do you suspect?

Back 225

Myocarditis usually with Coxsackie B virus.

Front 226

Desert rheumatism of SW US aka Valley fever seen in Arizona, Texas is due to what?

Back 226

Coccidiomycosis00 fungal infection causes flue like symptoms, pneumonia and rashes.

Front 227

Person indifferent to friendships, magical thinking, aloof.

Back 227

schizoid personality disorder.

Front 228

Nasty enlarged tender inguinal lymph nodes ?

Back 228

Lymphogranuloma venereum, aspirate the node, treat with doxycycline, watch for drainage tracts.

Front 229

Yellow purluent urethritis, what is it and tx?

Back 229

Gonorrhea. Give single dose azithromycin or ceftriaxone.

Front 230

What is tenosynovitis and give example.

Back 230

Tenosynovitis ins inflamamtion of fluid filled sheath of the synovium around the tendon (tendon tethers muscle to bone) example is De Quervain tenosynovitis of thumb or trigger finer.

Front 231

Most common cause and location of endocarditis in IVDU

Back 231

tricuspid valve R heart with S. aureus. Normally think mitral valve with S. viridans.

Front 232

Liver enzymes in ETOH hepatitis

Back 232

AST/ALT > 2/1

Front 233

psammoma bodies, ground glass cytoplasm, good prognosis as far as thyrroid cancer is concerned.

Back 233

Papillary thyroid cancer = psammoma bodies

Front 234

this thyroid cancer has early hematogenous spread and invades blood vessels.

Back 234

follicular thyroid cancer. BAD news.

Front 235

Most common cause of hypothyroidism in US ?

Back 235

hypoplasia or dysgenesis.

Front 236

Young fat female on Isotretinoin with headaches.

Back 236

Think pseudotumor cerebri, VitA predisposes.

Front 237

Midsystolic click=

Back 237

mitral valve prolapse

Front 238

diffuse ST elevation, PR segment elevation in aVR, pericardial friction rub

Back 238

pericarditis. Pericarditis 2/2 renal failure get dialysis.

Front 239

Microcytic anemia MCV < 80 with basophilic stipling

Back 239

Lead posioning

Front 240

Anemia with elevated MCV and hypersegmented neutrophils, basophilic stippling, poikocytes, low reticulocyte count

Back 240

B12 deficency or folic acid eficency.

Front 241

Bullous pemphgoid

Back 241

tense blisters at flextural areas, elderly patient with uticaria. UV radiation, abx or NSAID use. Pattern of C3 and IgG linear deposits at dermal epidermal junction.

Front 242

IgG deposits intracellularly causing blistering with flaccid bullae including in the oral mucosa

Back 242

pemphigus vulgaris.

Front 243

pituitary dysgenesis with anosmia?

Back 243

Kallman's syndrome = hypogonadotropic hypogonadism

Front 244

cafe au lait spots + polyostotic fiberous dysplasia and precocious puberty (possibly other endocrine disorders) often MR

Back 244

McCune Albright.

Front 245

afraid but wants friendships, feels inferior, sensitive to criticism

Back 245

Avoidant personality disorder.Avoids failures.

Front 246

High levels of androgens and estrogens predisposes women with PCOS to what type of cancer?

Back 246

Endometrial cncer - think unopposed estrogen. These women have very low progesterone.

Front 247

Normal <18 PCWP, respiratory difficulty, PaO2/FiO2 <200. bilateral fluffy infiltrates.

Back 247

ARDS due to inflammatory mediators incresing alveolar permeability.

Front 248

Hemolysis after primaquine or sulfa drugs in person from Mediterranean origin?

Back 248

Glucose 6 phosphate dehydrogenase deficency.

Front 249

Risks of drug treatments for Graves PTU vs Methimazole

Back 249

PTU can cause dose independent hepatitis and vasculitis whiel Methimazole causes dose dependent cholestatic jaundice.

Front 250

apraxia vs agnosia

Back 250

difficulty carying out activities is apraxia while agnosia is difficulty recognizing objects.

Front 251

weird, wet and wobbly.

Back 251

normal pressure hydrocephalus.

Front 252

Neer's sign = impingment sign = pain when raising arm after pretending to pour out beer means?

Back 252

Subacromial bursitis. Seen in repetative overhead movements ie tennis.

Front 253

Most common cause of SAH in children?

Back 253

AVM with rupture.

Front 254

acid base derangements in seizures?

Back 254

1. post ictal hypovenitlation causes respiratory acidosis.
2. lactic/metabolic acidosis from prolonged muscle contractions.

Front 255

Normal AFP, young woman with OCP use and single liver mass.

Back 255

Hepatic adenomas.

Front 256

Treatment of SIADH 1 and 2

Back 256

1. fluid restriction
2. Demeclocycline by causing DI

Front 257

chelitis (chapped lips), stomatitis( inflammed mouth) glossitis (swollen tongue) + anemia. What vitamin is lacking?

Back 257

Riboflavin B2 deficency. Rare unless celiac or anorexic.

Front 258

Night blindness, dry corneas, dry scaly skin, bitot silver spos on conjucntiva = what vit deficency

Back 258

Vit A

Front 259

fruity breath is ?

Back 259

either keytones ie DKA or ammonia and liver failure

Front 260

Risk of inheriting bipolar disorder

Back 260

-5-10% if first degree relative
up to 60% if both parents have bipolar
only 1% in general population.

Front 261

triad of ataxia, skeletal deformities and cardiac deformities.

Back 261

Friederich ataxia, note scoliosis, hammertoe, HOCM, dysarthria, gait ataxia.

Front 262

2 causes of non anion gap metabolic acidosis

Back 262

Diarrhea and renal tubular acidosis

Front 263

Causes of metabolic acisosis with anion gap?

Back 263

MUDPILES- methanol, uremia, DKA, paraldehyde, INH, lactic acidosis, salicylates.

Front 264

Causes of metabolic alkalosis

Back 264

vomiting and hyperaldosteronism

Front 265

Diarrhea, most common cause in
1. young child <2 yo
2. adults
3. bloody diarrhea
4. travelers

Back 265

1. rotavirus
2. campylobacter
3. Shigella
4. E coli

Front 266

What is coronary steal?

Back 266

CCB can't dilate diseased sclerotic blood vessels so other regions are better perfused.

Front 267

First step in primary amenorrhea workup?

Back 267

Get FSH. If FSH is high get Karyotype since pituitary axis is working... concern for male gonadal agenesis or Turner's.

Front 268

Splenomegaly, thrombocytopenia, anemia, older patient with lymphadenopathy. SMUDGE CELLS.

Back 268

CLL = Smudge cells

Front 269

Marfans + mental retardation + thromboembolic events = ?

Back 269

homocysteinuria. Treat with high dose vitamin B6. Autosomal recessive disease

Front 270

phenylalanine hydroxylase deficency, buildup of phenylalanine, mental retardation, fair complexion, ecxama, musty body odor

Back 270

PKU

Front 271

cherry red macula, weakness, seizures, mental retardation. Due to hexosaminidase A deficency.

Back 271

Tay Sach's (sphingolipidosis)

Front 272

mental retardation, blindenss, deafness, paralysisi, neuropathy, eizures. Absence of myelin sheath due to galactosidase deficency.

Back 272

Krabbe's Disease

Front 273

PAtient has acne,erythrocytosis, gynecomastia, azospermia, decreased testicular size, cholestasis, hepatic failure and dyslipidemia. What do you expect levels of FSH, LH and GnRH to be?

Back 273

Expect low FSH, LH, GNRH and testosterone levels. Endogenous testerone does not show up.

Front 274

This chromosomal disorder causes decreased axial skeletal growth, gynecomastia, azospermia and primary hypogonadism. Expect high FSH and LH but low testosterone due to testicular fiborsis and seminiferous tubule dysgenesis.

Back 274

Kleinfelter syndrome XXY

Front 275

What is the abnormality with Factor V Leiden?

Back 275

Point mutation in Factor V causing resistance to inactivation by protein C. Most common hypercoagulable disorder often DVT risk is the herald or multiple miscarriages.

Front 276

If you are concerned about alcoholic verices what medication do you give?

Back 276

BB

Front 277

Most common form of CAH?

Back 277

21 hydroxylase deficency has excess of 17 alha dydroxyprogesterone which regults in virilizism and hyponatremal and hyperkalemia (salt wasting)

Front 278

Most common cause of nephritic syndrome in children?

Back 278

minimal change disease is the most common cause of nephritic syndrome in children. Respond dramatically to steorids.

Front 279

Most common cause of nephritic syndrome in adults, note thickening of basement membrane and subepithelial spikes on EM.

Back 279

Membranous glomerular nephritis.

Front 280

3 diseases where you see noncaseating granulomas.

Back 280

1. Chrons
2. TB
3 Sarcoid
4. Yersinia

Front 281

IBD with skip leisons, colon involvement, cobblestoneing, creeping fat, fistuals , perianal disease, rectal sparing, noncaseating granulomas.

Back 281

Chron's Disease

Front 282

Cause of polyurea... associated hyponatremia, low serum osmolarity and high urine osmolarity.

Back 282

SIADH

Front 283

Elevated serum osmolarity, dilure urine with low osmolarity <3000, polyurea cause?

Back 283

DI - resistance to ADH nephrogenic or no ADH production (central)

Front 284

Preterm infants with respiratory distress who present with increased gastric residues.

Back 284

Necrotizing enterocolitis. Present wiht bloody stools.

Front 285

PFTs, obstructive vs restrictive disease?

Back 285

obstructive ie asthma or emphysema has a low FEV1/FVC <0.80, while restrictive disease ie fibrosis has ratio >0.8.
In both cases FEV1may be decreased but in obstructie disease it is more reduced.

Front 286

Causes of restrictive lung disease

Back 286

RA, AS, smoking, scleroderma, bleomycin, chest wall problems.

Front 287

How does the FRC differ in emphysema and fiborosis?

Back 287

In emphysema there is elevated FRC due to air trapping. In fibrosis the scarred down lung tissue results in reduced FRC. You can only meausre this by helium dilution techniques.

Front 288

IgE mediated hypersensitivity when two IgE molecules are cross linekd and attached to a mast cell resulting in immediate anaphylasix.

Back 288

Type 1 hypersensitivity reaction.

Front 289

What type of hypersensitivity reaction is Rh disease of the newborn or hemolytic anemia.

Back 289

Type 2 hypersensitivity whihch is due to IgG or IgM which is preformed after exposures.

Front 290

This form of hpersensitivity reaction is due to immune complexes which activate complement and inflammation.

Back 290

example is Arthus reaction after vaccinations or serum sickness.

Front 291

Cell mediated immunity which requires multiple exposures such as poison ivy and contact dermatitis is what kind of reaction?

Back 291

type 4 hypersensitivity which is cell meditaed.

Front 292

high ANCA, GN, normal serum complement, nosebleeds, hearing loss, conjunctitis, coin lesions in lung, arthritis, rash.

Back 292

Wegners small vessel vasculitis

Front 293

<eltzers triad of palpable purpura, myalgias and arthralgias + likely Hep C or Multiple myeloma

Back 293

cryoglobulinemia

Front 294

tachycardia, tachypnea, cough and CP

Back 294

PE

Front 295

majoeelectrocyte disorder in DKA

Back 295

hypokalemia

Front 296

PDA connects the ?

Back 296

pulm arteries to the aorta

Front 297

Exudate or transudate?
clear, low protein, no cells, very high albumen compared to blood, glucose/serum glucose level is low <0.8

Back 297

Transudate. High protein (albumen, low sugar)

Front 298

Transudate or exudate?
cloudy, cells, high protein due to cells but albumen is low, fluidprotein/serum proetin is high and fluid glucose/serum glucose is high > 0.8

Back 298

High protein and high glucose in Exudate. Light's criteria.

Front 299

Patient became mute after witnessing a murder is an example of _____

Back 299

conversion disorder, the stress of the event was converted into a physical ailment.

Front 300

Hyperbilirubinemia which is mostly conjugated indicates the stone is where?

Back 300

Stone is most likely in the cystic duct, if it blocks the liver in the CBD you don't see the conjugated bilirubin and if the alk phos is not elevated it is less likely to be obstructing the pancreas.

Front 301

An AA male from Greece has his urine stain with hemosiderin blue after getting an antibiotic. Why?

Back 301

He has glucose 6 phosphatse deficency (oxidative injury to RBC) Culprits are sulfa drugs, antimalarials and nitrofurantoin.

Front 302

3 conditions where you see pulses paradoxis (drop in SBP with inspiration > 12)

Back 302

cardiac tamponade, tension pneumothorax and asthma.

Front 303

What vaccinations are required by kids (4yo) going into kindergarten?

Back 303

4 doses of pneumococcal, 4 doses polio, 2 doses MMR, 1 dose varicella, 2 doses Hep A, 5 doseses DTaP and 4 doses HiB

Front 304

2 causes of first degree heart block with prolonged PR interval.

Back 304

Digitalis and increased vagal tone.

Front 305

How does NTG releave anginal pain in patients with athrosclerosis hint it's not by increasing coronary blood flow (only shown in healthy hearts).

Back 305

NTG increaseses teh size of capacitance vessels (aka veins are dilated more then arteries) which reduces pooling of blood in heart vessels.

Front 306

Treatment of pulseless electrical activity (pt has no pulse but EKG shows rhythm)

Back 306

start CPR and give ACLS drugs ie epi, atropine and vasopressin

Front 307

If a patient is in V fib or V tach do you give ACLS drugs or shock them

Back 307

Shock them. Give ACLS drugs in PEA.

Front 308

Treatment of lone A fib when patient has no other health problems.

Back 308

Only an aspirin. If there are any other comorbidities ie DM, HTN, HF, TIA, age >75 start warfarin.

Front 309

Patient diagnosed with pharyngitis who gets ampicillin or amoxicillin and develops a rash has?

Back 309

EBV. Not strep.

Front 310

MOA of Metoclopramide

Back 310

Antiemetic which enhances gastric emptyig due to its promotility effects as a dopamine antagonist.

Front 311

Autosomal dominant condition of hemangioblastomas in the cerebellum, spinal cord, kidney and retina. Associated with renal cell carcinoma and pheochromocytoma?

Back 311

Von Hippel Lindau Syndrome. Mutation of the tumor supressor gene.

Front 312

5 parts of Tetralogy of Fallot

Back 312

1. pulmonic stenosis
2. overriding aorta
3 VSD- pansystolic murmur loudest at LLSB
4. Right ventricular hypertrophy
5. ASD- fixed wide S2

Front 313

Most common bloody diarrhea at institutional settings ie nursing home or daycare

Back 313

Shigella

Front 314

Diarrhea from undercooked pork

Back 314

Yersiniosis

Front 315

Most common infectious diarrhea from poultry.

Back 315

Campylobacter

Front 316

Most common bloody diarrhea due to seafood

Back 316

Vibrio parahaemolyticus

Front 317

Do you want CT with or without contrast to look for a brain bleed?

Back 317

Without contrast CT for bleed

Front 318

stroke that affects lower extremities more then upper extremities motor and sensory affected what artery?

Back 318

anterior cerebral artery.

Front 319

What does a stroke of the middle cerebral artery effect?

Back 319

upper limb defects in motor and sensation > lower extremity. If left frontal lobe is aphasia, right frontal lobe is neglect.

Front 320

Stroke causing visual hallucinations, alexia, sensory symptoms (thalamus) 3rd nerve palsy with paralysis of vertical gaze, motor defects.

Back 320

STroke in posterior cerebral artery.

Front 321

Disease presents with recurrent lymphadenitis, hepatic abscesses, osteomyelitis with catalase positive organisms. What test and what is defect.

Back 321

Test with nitroblue erazolium to see the phagocytic cell defect in NADPH oxidative burst in Chronic Granulomatous Disease (catalase positive organisms include Serratia, Klebsiella, Aspergillus)

Front 322

Where does herpes encephalitis most often hit?

Back 322

The temporal lobes causing seizures and pesonality changs.

Front 323

Patient has used cocaine and presents with renal tubular necrosis due to myoglobinurea. What test do you want?

Back 323

CK. it will be highly elevated >20,000 in Rhabdomyolysis.

Front 324

Most likely cause of amarosis fugax.

Back 324

This monocular and transient curtain descending loss of sight is most often caused from emboli from the isilateral carotid artery.

Front 325

Complete painless loss of vision in one eye with optic disk showing venous dilation and disk swelling , retinal hemorrhages and cotton wool spots.

Back 325

Central retinal artery cclusion.

Front 326

A patient with diabetic eye disease presents with sudden loss of vision and onset of floaters due to?

Back 326

vitreous hemorhage

Front 327

Elevated ESR > 50 yo, stiffness in shoulders and hips, this disorder is related to what other condition.

Back 327

Polymyalgia rheumatica (key elevated ESR) also relatedto temporal arteritis (related to gialnt cell diseases)

Front 328

Your patient has an occipital headache associated with vomiting, gait ataxia, no sensory or motor abnormalities, associated with eye muscle dystonia aka blepherospasm, and conjugate deviation of gaze (due to 6th nerve palsy of LR)

Back 328

consider cerebellar hemorrhege, neurologic recovery is usually complete after surgcial evacuation of the hematoma... it evolves slowly over a few hours and is more common in patients wiht HTN

Front 329

Acute onset of vertigo and nystagmus without any other neurological defects.

Back 329

vestibular neuronitis

Front 330

vertigo, tinnitus and hearing loss which is progressive and unilateral. Associated with migranes.

Back 330

Meniere's disease which is due to endolymph fluid excess causing labrinthine dysfunction causes (vertigo, tinnitus, hearing loss)

Front 331

a hypoechoic mass on ultrasound vs hyperechoic mass (compare in terms of breast masses)

Back 331

hypoechoic mass more likely cyst or fat while hyperechoic mass is firm lesion.

Front 332

At what time point should you emergently deliver a fetus whose mother is suffering from HELLP?

Back 332

at 34 weeks gestaion deliver!

Front 333

What are the positive and negative features of schizophrenia

Back 333

+ are auditory hallucinations, delusions, disorganized speech and behavior. - features are flat affect, poverty of speech, apathy, a-sociality- inattention.

Front 334

Patient just returned from Southwest US ie Arizona or TX and has a cough and dypsnea.

Back 334

Soil born organism Coccidiomycosis . Will show Miliary pattern on CXR.

Front 335

This Latan American parasite is associated with cardiac disease and megacolon/megaesophagus

Back 335

Chagas! Due to Tympanosoma Cruzi = protozoa.

Front 336

3 ways to protect kidneys from contrast

Back 336

hydration
isotonic bicarbonate
acetylcysteine.

Front 337

This type of stroke is more common in people with HTN and diabetes. OFten CT is clean but ht epatient is uffering from either pure motor or pure sensory dysfunction (due to injury to the internal capsule)

Back 337

Consider Lacunar strokes due to microatheroma and lipohyalinosis of the smal penetrating arteries of the brain.

Front 338

Taking a MAOI such as phenelzine with foods such as tyramine (cheese or wine) can cause

Back 338

hypertensive crisis.

Front 339

weak interosseus muscles, hypothenar eminance, (Klumpke's palsy). Injury due to upward pulling of the arm is to what part of the brachial plexus?

Back 339

C8-T1 = ulnar nerve.

Front 340

Best test to look at hyperaldosteronism (HTN and hypokalemia)

Back 340

Aldosteorne to renin ratio is high.

Front 341

Treatment of uterine atony? 1-3

Back 341

1. uterine massage
2. oxytocin to increase contraction of myometrial fibers and retract myometrial blood vessels
3. emergent hysterectomy.

Front 342

Lich nodules on teh iris, bony lesions, axillary freckels and cafe au lait spots.

Back 342

NF Type 1 (type 2 associated with acoustic neuromas)

Front 343

Port wine stain on trigeminal nerve distribution, seizures, hemiparesis, angiomatous malformations of the brain

Back 343

Sturge Weber Syndrome

Front 344

Ash leaf hypo pigmented spots, cardiac rhabdomyomas, kidney angioleiomyomas, retardation, seizures

Back 344

Tuberous Sclerosis.

Front 345

treatment for hepatic cholestasis of pregnancy with normal GGTP, negative viral serologies although LFTs may be elevated.

Back 345

give ursodeoxycholic acid to promote bile flow.

Front 346

What 3 things cause elevated alk phos?

Back 346

placenta, liver and bone.

Front 347

this case of jaundice is associated with ulcerative colitis, RUQ pain, more common in males, associated with ANCA and increases risk of cholangiocarcinoma.

Back 347

Primary Sclerosisng Cholangitis (ANCA positive male ulcerative colitis)

Front 348

This cause of jaundice presents with pruritis, more common in females, elevated alk phos nad cholesterol, no association with IBD, more common in females and associated with ANA And AMA antibodies.

Back 348

Primary biliary cirrhosis (biliary = boobs more common in females) AMA, ANA)

Front 349

Risk factors for avascular necrosis of the hip are (name 3). You may not always see changes on XR, need MRI. Sometimes there is no pain on palpation or movement of the limb.

Back 349

Risk of avascular necrosis is increased sith sickle cell disesae, chronic steroids, alcoholism and hemoglobinopathies (anything that causes irregular sickling and immunosupression)

Front 350

Patient presents with multiple misscarriages, prolonged PTT but clotting not bleeding, She has Lupus and the Russell viper venom test is prolonged.

Back 350

Consider antiphospholipid antibody syndrome. This procoagulable state causes a paradoxical prolongation of PTT by IgM or IgG antibodies but actually results in DVTs or PE as well as miscarriages.

Front 351

Treatment of absence seizures when you can't use ethosuximide

Back 351

Valproic acid (also used for bipolar)

Front 352

Patient presents with GN (RBC casts) 10 days after pharyngitis or 20 days after impetigo. What are the serum complement levels?

Back 352

Post streptococcal glomerular nephritis presents with LOW serum complement

Front 353

Glomerular nephritis presenting 5 days after pharyngitis caused by IgA nephrology have what effect on complement?

Back 353

Serum complement in IgA nephropathy is normal while in post strep GN the time course is 10-20 days after infection and complement is LOW

Front 354

What is your BP goal for patients with Diabetes?

Back 354

SBP < 130 is more protective

Front 355

What is the difference between a cohort study and a case control study?

Back 355

cohort studies look for certain risk factors and classify patients as exposed or not exposed and then follow them to seeif they get the disese. In a case control study the subjects are classified as either having the disease ie case or not ie control and then their chart is analyzed to look for past exposures.

Front 356

Causes of microcytic anemia (name 3)

Back 356

iron deficency (TIBC high, serum ferritin and serum iron level are low)
Anemia of chronic disese (low TIBC, normal or increased ferritin- defective utilization of stores)
Reduced globin production as in thalassemias or lead poisioning.

Front 357

Uremia, thrombocytopemia and hemolytic anemia due to e coli toxin destroying colonic lining causing bloody diarrhea and red cell hemolysis causing jaundice in young children < 4 yo. Chief complaint usually abdominal pain, diarrhea, jaundice, hemolysis, renal insufficency.

Back 357

Hemolytic uremic syndrome (triad or uremia, thrombocytopenia, and hemolytic anemia) + abdominal pain and diarrhea in children.

Front 358

Male child age < 10 presenting with low serum antibodies, low B cell number, pyogenic pus forming infections with bacteria such as S. pneumoniae and H. flu

Back 358

Bruton's Agammaglobulinemia (S linked). Look for recurrent pyogenic infections with incapsulated bugs and low Ab and low B cell number.

Front 359

Similar presentation to Bruton's but patients are > 15 yo and present with recurrent bacterial infections.

Back 359

Common variable immunodeficency.

Front 360

Recurrent fungal and bacterial infections with absent thymus, abnormal T , B , and NK cells. Lymphopenia and early presentation < 1 yo.

Back 360

SCID

Front 361

Lymphadenitis, skin absesses, liver absesses, defect of phagocytic cells.

Back 361

Chronic Granulomatous Disease. Do Nitro Blue Tetrazolium test.

Front 362

Patient presents with eczema, thrombocytopenia and recurrent encapsulated bacterial infections (mengingococcemia, H flue and S. pneumo). Present with bleeding , ie bloody stools, and low IgM due to dysfunctional T cells as well as platelets.

Back 362

Wiscott Aldrich Syndrome (x linked recessive). Triad of eczema, thrombocytopenia and bacterial infections.

Front 363

Best way to increase FRC in post op patients?

Back 363

raise the head of the bed, the pat takes deeper breaths and more lung used so FRC increases.

Front 364

You have an alcoholi cpatient with low K and you replete but it doesn't budge. What are you missing.

Back 364

Concomitant hypomagnesemia, Mg is a cofactor needed for K uptake.

Front 365

In addition to MONA what other drugs do you consider in MI

Back 365

give BB to reduce risk of next MI
Heparin if there is cardiac thrombus, CHF or dyskinetic ventricle
ACE I if there is CHF with low EF < 40%

Front 366

Contrast angina with MI presentation

Back 366

NTG stops the pain of angina but doesn't touch the pain of an MI. Pain with angina lasts < 2o minutes but remains with MI. ST segment depression with angina will resolve when pain is under control while with MI it is perminant.

Front 367

What do you give the patient who transitioned from stable to unstable angina?

Back 367

LMW Heparin for anticoagulation and consider cath lab.

Front 368

Patient presents with diffuse ST segment elevation, elevated ESR, recent URI and now low grade fever. pericardial rub. What is the most common cause

Back 368

Coxsackie virus is most common cause of pericarditis followed bith malignancy, autoimmune diseases TB and uremia.

Front 369

Treatment of DVT

Back 369

start on heparin with gradual cross over to warfarin. Maintain on warfarin for 3-6 months min.

Front 370

Contrast vWF deficency with hemophilias.

Back 370

vWF is AD and it prolongs bleeding time and PTT both. Hemophilias only prolong PTT and are X linked.

Front 371

How does liver disease affect coagulation?

Back 371

Liver disease has elevated PT with +/- PTT. All factors are low.

Front 372

What do you use to follow heparin vs warfarin vs aspirin?

Back 372

heparin- follow intrinsic PTT path... reverse wtih FFP.
warfarin- follow extrincic PT pathway.
aspirin affects bleeding time (uremia also deactivates platelets)- reverse with platelet transfusion

Front 373

A patient has a BNP of 300 + signs of heart failure. Can you rule it in or out?

Back 373

BNP < 100 rule out HF
BNP > 500 rule it in.
If between you can't say

Front 374

Name 3 signs of right sided heart failure.

Back 374

dypsnea, peripheral edema, pulmonary congestion, elevated JVD, heaptomegaly, ascites.

Front 375

3 causes of cor pulmonale

Back 375

Cor pulmonale is R ventricular enlargement due to PE, primary pulmonary HTN (young female), or COPD or even sleep apnea.

Front 376

3 causes of restrictive cardiomyopathy

Back 376

amyloidosis, sarcoidosis, hemochromatosis, myocardial fibroelastosis. Listen for pericardial rub and surgically remove pericardium.

Front 377

Treatment of frequent PVCs assuming patient not in HF.

Back 377

Give lidocaine.

Front 378

You notice a delta wave on EKG, you want to treat with procainamide or quinidine as antiarrhythmics and want to avoid AV block with what 2 meds.

Back 378

Avoid CCB ie verapamil and Digoxin

Front 379

Treatment of HOCM, what meds do you aovid.

Back 379

Treat HOCM with BB to allow time to fill. Avoid positive ionotrops, diuretics and vasodilators.

Front 380

At what location is fetal oxygen the highest

Back 380

Most oxygen at the fetal vein coming in, the two fetal arteries in the cord are deoxygenated blood.

Front 381

Murmur of PDA?

Back 381

continuous machine like murmur at the upper left sternal border. If not needed close with NSAID

Front 382

3 indications to intubate

Back 382

ph < 7.3
O2 <50
CO2 >50

Front 383

FEV1/FVC ratio in obstructive lung disease like COPD or asthma

Back 383

low. FEV1/FVC < 0.7 in obstruction. Normal or elevated in restrictive diseases although both may have decreased FEV1.

Front 384

You note prolonged expiratory phase indicating loss of lung elasticity as well as pursed lip breathing in a patient with decreased heart and breath sounds and scattered rhonchi. What is the treatment?

Back 384

Treat emphysema with smoking cessation, bronchodilator, anticholinergic like ipratropium and immunizations as well as Corticosteroids for acute exacerbations.

Front 385

Wheezing in young children < 2 in winter.

Back 385

RSV.

Front 386

Young patient with solitary pulmonary nodule (no old films), has not been in caves (histo), has not been to the SW (Coccidiomycosis), not a smoker, not immigrant (TB).

Back 386

Consider hamartoma. a disorganized overgrowth of local tissue that is not malignant in origin and that doesn't grow any faster then normal tissue. Get serial XR.

Front 387

PNA in college student (2)... which one is it if there are sexually active vs there are cold agglutinins

Back 387

Cold agglutinins are mycoplasma
Chlamydia other common cause in college aged students.

Front 388

Current jelly sputum in alcoholic with dypsnea

Back 388

Klebsiella... also be concerned about s aureus and anaerobes from aspiration in alcoholic.

Front 389

2 main causes of pna in CF

Back 389

s. aureus and pseudomonas@

Front 390

PAtient is a metal or pottery worker who is also an immigrant with cavitary lesions and recent fever and cough.

Back 390

Consider aspergillus infection of TB lesions.

Front 391

Patient with long smoking hisotry suddently with fever and cough. 2 most likely causes of PNA

Back 391

moraxella or H flu in COPD

Front 392

2 main causes of dypsnea when exposed to bird droppings

Back 392

if immunosupressed think crptococcus, otherwise think histoplasmosis if in ohio missippi river valley or exploring caves (bats)

Front 393

Child with dypsnea aged 2-5 vs age < 2. What different viruses

Back 393

Child < 2 think RSV
Child 2-5 think parainfluenza virus causing croup or epiglottis.

Front 394

What ulcer ihas less pain with eating.

Back 394

Duodenal ulcer's pain is releaved by eating.

Front 395

Severe or atypical ulcer presentation, resistant to teatment. What test do you get?

Back 395

Get gastrin levels to look for Zollinger Elison syndrome

Front 396

Tripple therapy for h. pylori

Back 396

amoxicillin, clarithromycin and PPI

Front 397

Camping trip, comes home with fatty, greasy malodorous stools tha tfloat. Treatment

Back 397

Treatment of Giardia is with Flagyl aka metronidazole.

Front 398

Patient has thrombocytopenia, renal failure and hemolytic anemia after having diarrhea ( e coli or shigella) what is the treatment?

Back 398

Hemolytic uremic syndromed with renal failure, thrombocytopenia and hemolytic anemia just need supportive treatment.

Front 399

IBD with cobblestoning, transmural skip lesions from mouth to anus, surgery worsens it

Back 399

Chron's Disease

Front 400

This IBD affects the rectus mostly and spares the anus, causes bloody diarrhea, only affects mucosa and submucosa, increases risk of colon cancer, toxic megacolon, pseudopolyps, and is associated with primary sclerosisng cholangigits. Surgery is usually curative.

Back 400

ulcerative colitis.

Front 401

Treatment of Hep B when you have high E marker of infectivity

Back 401

Treat with IFN alpha and Ribavirin to slow liver damage and progression.
Note you can only get Hep D with Hep B infection.

Front 402

Hepatitis in a woman < 40 yo, with anti smooth muscle or ANA Ab is treated with?

Back 402

This is idiopathic autoimmune hepatitis and is treated with steroids.

Front 403

Why does liver disease often cause hypoglycemia

Back 403

liver stores glycogena nd in liver disease glycogen stores are down.

Front 404

Nonsmoker with liver disease and emphysema

Back 404

Autosomal recessive alpha 1 antitrypsin deficency.

Front 405

you have a male patient with arthritis, impotence, dilated cardiomyopathy, bronze diabetes and cirrhosis, what type of inheritance is it?

Back 405

Hemochromatosis is autosomal recessive and is more common to benoted in males as they dont' menstruate

Front 406

Autosomal recessive disease where the serum ceruloplasm is low, urinary copper excretion is high. You note copper in the basal ganglia causing psychosis. What is treatment?

Back 406

Wilson's disease is autosomal recessive and is treated with penicillamine copper chelator.

Front 407

2 causes of unconjugated hyper bilirubinemia

Back 407

Gilber's and Hemolysis both cause increases in unconjugated bilirubin. While hepatobiliary disease is usually sa cause of conjugated hyper bili.

Front 408

Clay colored stools, dark urine, hyperbilirubinemia that is conjugated.

Back 408

Think hepatobiliary disease.

Front 409

A patient has esophageal dysmotility and Raynaud's ... what Ab do you look for and what otehr associated conditions are there

Back 409

CREST- calcinosis, Raynauds, Esoph dismotility, Sclerodactyly, telangectasias
Look for anticentromere antibody and positive ANA

Front 410

Scleroderma antibody?

Back 410

Anti-topoisomerase antibody is positive in scleroderma.

Front 411

2 main causes of pancreatitis

Back 411

alcohol and gallstones.

Front 412

< 2 years old with bilious vomit, currant jelly stools, belly pain, saussage shapped mass palpated. What do you do?

Back 412

Get contrast air enema for intrasusception.

Front 413

2 GI disorders seen with CF

Back 413

rectal prolapse and meconium ileus.

Front 414

Is omphalocele or gastroschisis assoicated with other syndromes of development?

Back 414

Omphalocele (intestines in sac) also associated with OTHER developmental abnormalities.

Front 415

Abdominal pain, arthritis, rash and hematuria/proteinurea. IgA antibodies are found on biopsy.

Back 415

Think Henosch Schonlein purpura. Consider HSP in cases or URI, rash on LE and buttocks that is purple, hematuria, proteinurea, GI bleeding, pain. Due to IgA antibodies in skin and kidney.

Front 416

At what level do you treat neonatal jaundice?

Back 416

If unconjugated bili is > 15 treat with lights. Peaks at 3-5 days.

Front 417

Severe unconjugated hyperbilirubinemia is caused by?

Back 417

Crigler Najjar causes severe unconjugated hyperbilirubinemia. Mild hyperbilirubinemia is caused by Gilber's or by hemolytic anemia.

Front 418

Treatment of sub acute thyroiditis (hypothyroidism) with diffuely tender thryoid gland after viral infection.

Back 418

Treat wiht NSAID self limiting.- Similar to sick euthryuroid syndrome with decreased T4 but normal TSH. Self limiting.

Front 419

Patient presents with pretibial myxedema, what is the treatment?

Back 419

See pretibial myxedema with Graves treat with radioactive iodine.

Front 420

Patient presents with skin pigmentation, weight loss, n/v, dizzy, syncopy, hyponatremia and hyperkalemia. How do you determine cause and what do you treat wtih.

Back 420

Treat adrenal insufficency with steroids. Determine if primary (addison's due to adrenal underproduction) or due to pituitayr underproduction of ACTH (no skin hyperpigmentation)

Front 421

Primary test for Cushing's?

Back 421

Test 24 hour urine for cortisole. Then do dexamethasone supression test to look for entral vs peripheral caue.

Front 422

What is the treatment of nephrogenic DI?

Back 422

Treat nephrogenic DI (no ADH reaction in the kidney) treat with THIAZIDE diuretics.

Front 423

Definition of ARF

Back 423

elevated BUN (>18 abnormal) and Cr, metabolic acidosis (low HCO3) due to inability of kidney to secrete H ions, hyperfvolemia, hyperkalemia.

Front 424

Patient with RF, > 40 yo, epitaxis, hemoptysis and high ANCA titer

Back 424

Wegner's granulomatosis- treat with cyclophosphamide immunosupressant.

Front 425

Name 3 nephrotoxic drugs

Back 425

Cisplatin, cyclosporine, aminogycosides ie gentamycin, methicillin, NSAIDS

Front 426

Indications for emergent dialysis

Back 426

uremic encephalopathy
pericarditis/ HF
pH < 7.25
Hyperkalemia and arrhythmias.

Front 427

Most common cause of nephrotic syndrome protein > 3.5g/d in children and in adults.

Back 427

In children nephrotic syndrome is usually due to minimal change disease with podocyte in jury. In adults suspect Diabetes (iother causes include hepatitis, amyloid, lupus, drugs ie gold and captopril)

Front 428

3 top causes of renal failure

Back 428

Diabetes, HTN, PCKD

Front 429

How does Chronic RF affect Ca

Back 429

Results in hypocalcemia and hyperphosphatemia due to imapired vit D production. Give phosphate binders ie calcium carbonate

Front 430

Compare radiological findings between RA and OA

Back 430

in OA note joint space narrowing and osteophyte bone spurs. While in RA there is a pannus of articular cartilage.

Front 431

Compare bireference in gout vs pseudogout?

Back 431

Gout- Negative birefringence. Use colchicine an dNSAIDS tfor acute attacks and Allopurinol for long term maintenance therapy.
Pseudo cout more often knees and elbows and note positive birefringence due to calcium pyrophosphate cyrstas.

Front 432

Can't see, pee or climb or a tree. Urethritis is due to Chlamydia, associated with HLA B27.

Back 432

Reiter's Syndrome.

Front 433

Treatment for Lyme disease with migratory rash? What if pregnant?

Back 433

Give doxycycline for Lyme's . If pregnant give Amoxicillin.

Front 434

Migratory polyarteritis with fever following strep pharyngitis is

Back 434

Rheumatic fever.

Front 435

Slipped capital femoral epiphysis is confirmed by XR?

Back 435

Legg Calve Perthes Disease

Front 436

Contrast Osgood Schlatter with Legg Calve Perthes Disease?

Back 436

Osgood Schlatter is osteochondritis aka inflammation of the bone at the tibial tubercle (young boy 10-15 yo) with tenderness at the knee. In Legg Calve Perthes there isa slipped femoral epiphysis requiring surgery not just NSAIDs and rest.

Front 437

Heliotrope rash, proximal muscle weakness, calcium deposits in tissue seen in XR. Often autoimune or due to malignancy. Can be associated with EBV and Lupus and you note a high CK.

Back 437

Dermatomyositis.

Front 438

Young child <5 with truncal rash which spreads to hands and feet, very red eyes, lymphadenopathy, fever, strawberry tongue. What is the treatment

Back 438

Kawasaki's diseaes treat with Aspirin and IV IG

Front 439

This disease is due to immune complex deposits in medium sized vessels. IT is associated with high ESR, abdominal pain, RF, neuropathy as well as anemia, leukocytosis and infection with hep B or cryoglobulinemia.

Back 439

Polyarteris Nodosa- think of RF, abdoinal pain, and neruological problems. Type III hypersensitivity.

Front 440

Pulseless disease in young asian females?

Back 440

Takaysaus' arteritis. Affects large vessels so when aortic arch is affected one arm may only have faint pulse. Treat with steroids.

Front 441

Nosebleeds + hemoptysis/dypsnea + RF =

Back 441

Wegner's disease

Front 442

Patient with rapidly growing hat size, hearing problems, bone pain, paraplegia, high alk phos, normal Ca and normal phosphorous.

Back 442

Pagets disease , watch for increased risk of osteosarcoma.

Front 443

2 diseases that show Target cells on smear

Back 443

Thalassemia or liver disese

Front 444

TIBC and iron are both low, ratio is normal. Serum ferritin is elevated. MCV < 80. Do you give iron?

Back 444

This is anemia of chronic disese and ferritin is elevated because it is an acute phase reactant. Don't give Iron. Treat the underlying disease.

Front 445

Causes of and presenting signs of B 12 deficency.

Back 445

B12 deficency is a microcytic anemia MCV < 80. May be due to antiparietal cell antibodies, or anti IF antibodies, low Gastrin levels which result in achlorhydia and low absorption, may be due to vegan diet, pancreatitis or fish tapeworm (diphyllobothrium latum). Shilling's test can help.

Front 446

At what value to you give platelets if a patient is asymptomatic.

Back 446

AT 10,000. Higher if bleeding.

Front 447

If you patient has DIC or vWF what do you give them to stop bleeding?

Back 447

Give cryoprecipitate which contains both fibrinogen for clotting and factor VIII.

Front 448

Why does vWF have both a prolonged PTT and bleeding time?

Back 448

dysfunctional platelets and dysfuncitonal factor VIII give cryoprecipitate.

Front 449

Which pathway does warfarin affect?

Back 449

Warfarin affects vitamin K factor s including 2,7,9, 10 all inthe extrinsic PT pathway.

Front 450

After a viral infection patient starts making antibodies against platelets.

Back 450

Idiopathic thrombocytopenic purpura. Treat with splenectomy.

Front 451

Young adult with low RBC due to hemolysis, low platelets, renal failure, fever, jaundice, thrombocytopenia causing petechial rash.

Back 451

Thrombocytic Thrombocytopenic Purpura is an autoimmune disease where antibodies are made against RBC and platelets. Treat with plasmaphoresis. Don't give platelets as the Ab make them hypercoagulablel.

Front 452

This type of leukemia is seen in young children <5 yo, associated with Down's, positive periodic acid Schiff (PAS +),presentation is with fever, bleeding, pancytopenia, anemia.

Back 452

ALL = young children, acute, All leukemias have anemia, fever, pencytopenia

Front 453

Leukemia seen in adults >30 not children, DIC, AUER rods, pancytopenia, bleeding, fever.

Back 453

AML = aur rods. Peroxicase positve granuels in myeloblasts.

Front 454

Middle aged person presenting with high # WBC >50,000, splenomegaly, philadelphia chromosome.

Back 454

CML = philadelphia chromosome, middle aged, leukocyosis.

Front 455

Old person presenting with SMUDGE cells and lymphadenopathy. Most common leukemia

Back 455

CLL = old patient, SMUDGE cells.

Front 456

Stary sky cytology, assoc with EBV in africa, neoplasm of B cells with high mitotic index with a mass on abdominal viscera.

Back 456

Burkitt's lymphoma.

Front 457

Reed steinberg cells with owl eye

Back 457

Hodgkin's disese (young pt <30.

Front 458

Patient >40yo, Bence Jones proteins, high Calcium, IgM spike

Back 458

Multiple Myeloma

Front 459

parathyroid, pituitary and pancreas

Back 459

MEN I

Front 460

thyroid (medullary) parathyroid and pheochromocytoma

Back 460

MEMN IIa

Front 461

thyroid (medullary) pheochromocytoma and mucosal neuroma

Back 461

MEN IIb

Front 462

familial polyposis (CC risk) and soft tissue tumors

Back 462

Gardener's syndrome.

Front 463

freckles around mouth, GI polyps, non colon cancer risk

Back 463

Peutz Jegher's.

Front 464

seizures, retardation, renal angiomyolipomas, cardiac rhabdomyomas, ash leaf spots.

Back 464

Tuberous Sclerosis

Front 465

increased risk of leukemia (ALL)

Back 465

Down's and NF
NF 1 also increases risk of bone cysts, Wilm's tuor and Neurofibromas.

Front 466

Your patient has small cell lung cancer. Treatment with surgery or chemo or radiation?

Back 466

Always start chemotherapy. Early mets with SCLC.

Front 467

Unopposed estrogen incresaes the risk

Back 467

of endometrial cancer.

Front 468

alpha fetoprotein is a tumor marker for

Back 468

testicular and liver cancer.

Front 469

SIADH and hypercalcemia due to elevated PTH like hormone makes you concerned for what type of cancer

Back 469

Small cell cancer is associated with SIADH and hypercalcemia

Front 470

Most common cause of breast cancer?

Back 470

Invasive ductal carcinoma usually in older women. Check if Her2 neu positive as you can treat with trastuzumab antibody therapy.

Front 471

What meds can you treat with in progesterone sensitive breast cancer.

Back 471

SERMs like tamoxifen or letrozole.

Front 472

Hormonal treatment for prostate cancer mets?

Back 472

Second most fatal cancer in males. Treat with leuprolide a GnRH agonist or androgen receptor antagonist flutamide if there are mets.

Front 473

If you had a recurrence of colon cancer with mets to the liver what tumor marker would you look for?

Back 473

Look for carcinoembryonic antigen as it is assoiated with coon cancer. Adjuvant chemo with 5FU often used with mets.

Front 474

Most types of pancreatic cancer with epigastric pain, migriatory thrombophlebitis (Trosseau's syndrome of hypercoagulability), cholestatic symptoms.... due to

Back 474

Adenocarcinoma (ductal epithelium)
Also see insulinoma which is a beta cell tumor which causes LOC or stupor. Cehck glucose levels and if they are hypoglycemic with high C peptide then suspect insulinoma.

Front 475

This common cause of ovarian cancer shows psammoma bodies on histology and is more common in older women who have never used OCP.

Back 475

Serous cystadenocarcinoma is most common cause of ovarian cancer. OCP are protective for ovariana nd endometrial cancers.

Front 476

This tumor causes precocious puberty in girls while this tumor causes precocious puberty in boys or virilization.

Back 476

Granulosa cell tumor- estrogen producitng
Leydig or Sertoli tumor causes virilization due to testosterone.

Front 477

This cancer sends mets to the ovaries and looks like a ring.

Back 477

Krukenberg tumor is a stomach cancer which sends mets to the ovaries.

Front 478

Most common brain tumor in children, most common in adults.

Back 478

Children- infratentoral tumors ie cerebellar astrocytomas and ependymomas.
Adults get gliomas which are often intraparenchymal astrocytomas or meningiomas with calcifications.

Front 479

Most common brain tumors in kids 3

Back 479

cerebellar astrocytomas, meduloblastomas and ependymomas

Front 480

Most common brain tumors in adults 2

Back 480

if calcified think meningiomas
if not calcified think intraparenchymal astrocytomas (gliomas)

Front 481

If you find a hemangioblastoma what disorder are you thinking

Back 481

Von Hippel Linday Syndrome is associated with angioblastomas, renal cell carcinoma and pheochromocytomas due to tumor supressor gene mutation.

Front 482

Calcified tumor around the sella tursica interfering with a child's sight?

Back 482

Think of craniopharyngioma

Front 483

Lung carcinoids are common but do not present with the diarrhea, flushing, cramps seen with other carcinoid tumors, why?

Back 483

Carcinoid syndrome is only seen when the tumor has mets in the liver, otherwise these usually GI or lung tumors breakdown products of seronin are cleared by the liver befroe they enter the bloodstream.

Front 484

Type of bladder cancer seen with vinyl cloride exposure, painless hematurea

Back 484

Angiosarcoma.

Front 485

What cancer is associated with EBV in children

Back 485

Nasopharyngeal cancer is associated with children with EBV infection.

Front 486

The risk of cholangiosarcoma increases with what type of IBD?

Back 486

With ulcerative colitis cholangiosarcoma risk increases

Front 487

Sunburst pattern on XR of lower extremity, boy < 30 yo.

Back 487

osteosarcoma = sunburst bone pattern.

Front 488

Incidental finding in young child , unilateral flank mass

Back 488

Wilm's tumor.

Front 489

This neural crest cell is often calcified and arising from the adrenal gland children < 2 yo.

Back 489

Neuroblastomas. Think NF1

Front 490

Where does testicular cancer travel to?

Back 490

retroperitoneal lymph nodes

Front 491

What is Wipple's Disease?

Back 491

malabsorptive steatorrhea, migratory arthritis, lymphadenopathy, weight loss, fever. Due to bacteria R. whippelii.

Front 492

arthritis + diarrhea + weight loss=
arthritis + conjunctivitis and urethritis =

Back 492

Wipples
Reiter's

Front 493

Patient presents with weight loss. They have a migratory rash, diarrhea and hyperglycemia.

Back 493

Think glucagonoma cancer of the pancreas.

Front 494

Papillary breast cancer presents with?

Back 494

Nipple discharge and breast mass

Front 495

Pagets disease of the breast presents with?

Back 495

scaly itchy rash around the nipple and usually an underlying adenocarcinoma. PAthology shows large halos aorund cell nuclei

Front 496

How do you differentiate between a rotator cuff tear and rotator cuff impingement?

Back 496

Inject lidocaine. In cases of tendonitis and impingement there will be improvement when if there is a tear there will be no change. Caused by repetative movements over the head ie tennis.

Front 497

Frozen shoulder is aka

Back 497

Adhesive capsulitis, can't move arm above teh head

Front 498

Why does polycythemia vera often cause gout?

Back 498

Myeloproliferative disorders incresae uric acid levels, therefore very high rBC count also often means painful joint.

Front 499

Grout, behavioral problems and self injury, mental retardation, neurological dysfunction.

Back 499

Lesch Nyhan Syndrome due to HPRT deficency. Overproduction of uric acid.

Front 500

How do you increase fetal hemoglobin levels in patients with sickle cell disease?

Back 500

Hydroxyurea increaes fetal hemoglobin levels.

Front 501

Heinz bodies (hemoglobin specks in teh RBC showing up on peripheral smear) indicate this type of hemolytic anemia.

Back 501

G6PD deficency.

Front 502

A patient who is asplenic may have Howel Jolly Bodies on peripheral smear, why?

Back 502

Howell Jolly Bodies are nuclear remnants in RBCs which are usually cleared by the spleen. These small round blue inclusions on Wright Stein are seen in patients that are functionally asplenic.

Front 503

What is a schistocyte?

Back 503

Schistocytes are injured fragments of RBCs seen in hemolytic anemias.

Front 504

Risks of methotrexate (DMARD- disease modifying anti rheumatic drug)

Back 504

macrocytic anemia (inhibiton of folate), also why methotrexate is bad in pregnancy, causes stomatitis, alopecia, ILD, hepatitis, fever.

Front 505

Where is the location of De Quervain tenosynovitis

Back 505

At the base of the thumb.

Front 506

This organism causes PID and is a gram positive organism with sulfur granules

Back 506

Actinomyces causes PID bit is G +

Front 507

What stain do you use for cat scratch disease and PCP?

Back 507

Silver stain.

Front 508

Parrot pneumoniae

Back 508

Chlamydia psittaci

Front 509

BActeria often transmitted by animal bites? How about specifically cat scratch?

Back 509

Pasteurella molticida cellulitis causer from pet bites while Brucella is cat bites/scratch disease.

Front 510

Treatment for patchy XR showing pneumonia in college kid, xr looks really bad btu patient feels ok.

Back 510

Give azithromycin or other macrolide for mycoplasma. Test is for cold agglutinin antibodies.

Front 511

What pneumonia presents similar to mycoplasma but has negative agglutinin antibodies?

Back 511

Chlamydia pneumoniae. No cold agglutin antibodies.

Front 512

When is s. aureus pna seen?

Back 512

In IV drug users or aptients with CF (although pseudomonas is more common) or hospital acquired.

Front 513

Treatment of Klibesella, pseudomonas or H influenzae is?

Back 513

Amoxicillin or Ampicillin.

Front 514

Treatment for simple strep pneumoniae?

Back 514

cephalosporin ie cefotetan or other 3rd generation.

Front 515

Treatment for PCP PNA

Back 515

BActrim or if sulf allergic pentamidine.

Front 516

This test will show multinucleated giant cells in patients with varicella.

Back 516

Tzanck smear.

Front 517

This common disease in children is due to parvo B 19. It presents with a slapped cheek rash which proceedes to arms and legs. Child is feverish and tired.

Back 517

Erythema infectiosusm 5th Disease

Front 518

Koplik (blue ) spots on mucosa, fever, rash on head and neck moving down, conjunctivitis, runny nose and cough.

Back 518

Measles (Rubeolla) = koplik spots

Front 519

Tick bite on east coast, fever, HA, malaise, rash on wrists and ankles. Can cause DIC and delerium. Treatment?

Back 519

Treat Rocky Mountain Spotted Fever with doxycycline.

Front 520

Children < 3 yo, rash on chest and abdomen, high fever, due to Herpes Virus type 6.

Back 520

Roseola infantum.

Front 521

Sandpaper rash on trunk and abdomen, fever, rash stops when fever stops, strawberry tongue

Back 521

Scarlet fever

Front 522

prophylactic coverage for contacts of people exposed to Neisseria meningitis

Back 522

Ciprofloxacin, Ceftriaxone or rifampin.

Front 523

Bronchiolitis young children with wheezing, hyperinflamtion, crackes, due to RSF or parainfluenza. Treatment?

Back 523

Give ribivaran for RSV coverage.

Front 524

What virus casues Croup?

Back 524

Parainfluenza. URI, barking cough, stridor, steeple sign of sub glottin narrowing. Give ist tent and racemic epinephrine.

Front 525

Cause of epiglottitis?

Back 525

Due to H influenzae. Children <5yo, high feve,r toxic, drooling, thumb sign. Don't hesitate to intubate.

Front 526

Treatment of Strep B aka strep Agalactiae

Back 526

Causes meningitis in neonates. Treat mom with Amoxicillin or Ampicillin.

Front 527

LAD, exudative tonsilitis, fever, sore throat, absent cough!

Back 527

Strep pyogenes pharyngitis.

Front 528

What is erysipelas

Back 528

Superficial shiny red tender cellulitis.

Front 529

Treatment of animal bite with suspected Pasturella infection

Back 529

Ampicillin.

Front 530

You have a patient who has cellulitis but they are high risk so you don't want to just treat with PCN or Vanco... ie they have serious burns, trauma or diabetes and you're worried about pseudomonas. TX?

Back 530

Amoxicillin to cover G+ and Aminoglycoside like gent for G- and pseudomonas.

Front 531

Treatment for Lyme's disease

Back 531

doxycycline just like for gonorrhea.

Front 532

Post transplant patients need prophylaxis against?

Back 532

PCP just like HIV patients they need BActrim and possibly gangcyclovir for CMV prophylasix as well.

Front 533

Treatment of syphilis?

Back 533

Penicillin, if allergic give doxycycline.

Front 534

Baby with rhinorrhea, jaundice, anemia, HSM, lesions on palms and soles of feet.

Back 534

Congenital Syphilis.
-hand and foot rash, HSM, rhinorrhea

Front 535

Baby with HSM, choreoretiniitis, intercranial calcificaitons, and hydrocephalus.

Back 535

Congenital toxoplasmosis. - calcifications, HSM, retinitis

Front 536

Baby with cataracts, deafness, heart defects, blueberry muffin rash, thrombocytopenic purpura and HSM.

Back 536

Congenital rubella- deaf, cataracts, heart

Front 537

Signs of congenital CMV infection

Back 537

CMV infection causes IUGR, hearing loss, periventricular calcifications, microcephaly, HSM, petechiae.

Front 538

Two prenatal exposures that cause hearing problems for fetus.

Back 538

CMV causes hearing loss as well as congenital Rubella.

Front 539

Two prenatal exposures that cause intercranial calcifications

Back 539

CMV and toxoplasmosis both cause intercranial calcifications.

Front 540

Two prenatal exposures that cause vision problems.

Back 540

Toxoplasmosis causes retinitis. Congenital Rubella causes cataracts.

Front 541

In this bone marrow disease there is a very low ESR and a low EPO due to neg feedback.

Back 541

Polycythemia vera has a low EPO as the kideneys are telling teh BM to stop making so many RBC, ESR is also low.

Front 542

Give an example of contact dermatitis and what type of hypersensitivity reaction is it?

Back 542

Contact dermatitis is a type 4 cell mediated delayed hypersensitivity reaction to such items as nickel or poision ivy.

Front 543

Two drug causes and two diseases that cause hirsuitism

Back 543

Hirsuitism can be caused by minoxidil and phenytoin as well as PCOS and Cushing's.

Front 544

Treatment for pediculus capitis, corporis or pubis (lice)

Back 544

permetherin cream.

Front 545

Two types of fungal infections where you actually give systemic ie oral griseofulvin or fluconazole

Back 545

tinea unguium (nails) or tinea capitis

Front 546

purpuritic, purple planar polygonal papules

Back 546

Lichen planus treated with steroids.

Front 547

This skin disease results in bullae where there is "unglueing or the epidermis" due to antibodies to desmosomes. Associated with malignancy often on Hodgkins lymphoma.

Back 547

Pemphigus vulgaris

Front 548

Herald patch, followed by Christmas tree pattern of rash alon parallel skin clevage lines. Treatment?

Back 548

Pityriasis rocea. Self limiting about 6 weeks thought to be viral.

Front 549

silvery, scaling papules and plaques on extensor surfaces.

Back 549

psoriasis.

Front 550

Acne of middle age with eyelid inflammaiton aka blepharis and red nose.

Back 550

Rosacea. Treat with metronidazole or oral tetracycline.

Front 551

Itchy burrows in the finger web spaces and flexor surface of wrists due to

Back 551

Scabes = finger web spaces and flexor surfaces. Treat wtih permetherin cream.

Front 552

Dandruf aka

Back 552

Seborrheic dermatitis

Front 553

Recurrent otitis media, eczema and thrombocytopenia. X linked disorder.

Back 553

Wiskott Aldrich syndrome.

Front 554

Diffuse telangiectasias, epitxis, AV malformations, Hct is increased due to shunting.

Back 554

Osler Weber Rendu syndrome of AV malformations.

Front 555

Old man barnacles hwich appear stuck on and are often greasy, and slow growing

Back 555

Seborrheic keratosis.

Front 556

Cutaneous horns, slow growing, hard sand paper like flat areas on aged skin.

Back 556

Actinic Keratosis

Front 557

Patient presents with hyperparathyroidism (elevated Ca and low phos) as well as elevated gastrin and multiple GI ulcers. What two disorders are linked? What if he has a pheo or pituitary tumor too...

Back 557

MEN 1 + Zollinger Ellison Syndrome are linked

Front 558

Patient with new onset diabetes look for other diseased organ systems.... what if they also have arthralgias, restrictive heart disease, hypogonadism?

Back 558

rule out Hemochromatosis. Get iron studies first.

Front 559

Adolescent boy with recurrent nasal obstruction and nosebleeds, can erode into bone.

Back 559

Juvenile angiofibromas. Refer to ENT for removal. Dangerous to touch as they can exsanguinate.

Front 560

LP shows mostly neutrophils, low sugar.

Back 560

Bacterial meningitis.

Front 561

High lymphocytes in LP

Back 561

Think viral meningitis.

Front 562

LP with elevated protein but normal glucose and no cells.

Back 562

Think Guillian Barre,

Front 563

LP shows lymphocytes but sugar is Very LOW (normal is 50-100)

Back 563

Think of TB or fungal infections with lymphocytes and low sugar. Bacterial LP shows high neutrophils. Viral LP shows high lympohcytes.

Front 564

Signs of LMN lesions

Back 564

fasiculations, areflexia

Front 565

What are the temporal lobes responsible for... how about the parietal lobes.

Back 565

L temporal lobe = Werneckie's aphasia
R temporal lobe = aggression and hypersexuality
L parietal lobe = math, writing
R parietal lobe = hemineglect.

Front 566

CN III and IV are in ?

Back 566

the midbrain has CN III and IV

Front 567

CN V, VI, VII, VIII are in ?

Back 567

the pons hs CN V, VII, VIII

Front 568

CN IX, X, XI, xII are in ?

Back 568

are in cerebellum

Front 569

resting tremor or chorea as in huntingtons is due to damage to wehre?

Back 569

Basal ganglia

Front 570

Hemiballismus is due to damage at?

Back 570

subthalamic nucleus

Front 571

facial expression, anterior tongue taste, salivary glands are innervated by

Back 571

Facial nerve CN VII

Front 572

Muscles of mastication, facial sensation including the corneal reflex is?

Back 572

Trigeminal nerve CN V

Front 573

Drugs that cause damage to CN VIII manifested as tinnitus, deafness, vertigo include

Back 573

aminoglycosides, loop diuretics, aspirin, cisplatin. More commonly meningitis and not drugs in children.

Front 574

Damage to the accessory nerve means you can't turn toward or away from the affected side?

Back 574

Can't turn away from affected side

Front 575

Children with congenital heart defects are at risk for developing? hint they ahve HA, focal neurologic changes or seizure.

Back 575

intercranial abscenss. Risk increases with dental infections and head trauma as well.

Front 576

rash plus muscle weakness in teh setting of malignancy (elevated CK and EMG showing weakness)

Back 576

Dermatomyositis

Front 577

Treatment for MS which modulates T cell autoimmunityto myelin.

Back 577

Glatiramer.

Front 578

Patietn has axillary nerve injury, paralysis of deltoid and is holding arm in external rotation. Was there an anterior or posterior dislocation.

Back 578

Anterior dislocation results in external rotation.

Front 579

Autoimmune hemolytic anemia (caused by drugs like PCN, Sulfa or mehtyldopa), ITP, transfusion reactions, Good pastures, Myasthenia Gravis, Pernicious anemia and transplant rejection are all due to what type of immune hypersnesitivity?

Back 579

Type 4 cytotoxic response due to preformed IgG and IgM.

Front 580

Patient with abdominal pain, weight loss and arthritis. Disease is due to antibody complexes (type 3 immune reaction) being deposited in blood vessels causing thrombi and aneurysms.

Back 580

Polyarteritis Nodosa.

Front 581

What do you do when HIV pt
CD4 <350
CD4 <200
CD4 <100

Back 581

CD4 <350 start antiretroviral tx
CD4 <200 start bactrim prophylaxis pt hasAIDS now
CD4 <100 start azithromycin prophylaxis for mycobacterium avium and fluconazol for cryptococcus and candida.

Front 582

Cause of diarrhea in immunosupressed.

Back 582

Cryptosporidium.

Front 583

Recurrent lung and sinus infections in baby around 6 months when mothers antibodies are no longer around

Back 583

Brutons agammaglobulinemia.

Front 584

Eczema, thrombocytopenia and respiratory infections.

Back 584

Wiskott Aldrich Syndrome, x linked.

Front 585

People with complement deficencies are more likely to get what bacterial infection?

Back 585

Neisseria

Front 586

staph aureus and pseudomonas are both catalase positive organisms which are more likely to infect someone with what x linked disorder of NADPH

Back 586

Chronic Granulomatous Disesae

Front 587

Albinism with defect in microtubule polymerization affecting neutrophil chemotaxis.

Back 587

Chediak Higashi.

Front 588

Recurrent staph infections of the skin, high IgA, high IgE and eczema

Back 588

Job's syndrome.

Front 589

Steorid use can present as

Back 589

hypogonadism, hepatotoxicity, psychological disturbances, cardiac disease, coagulopathy, erythrocytosis, premature epiphyseal fusion and short stature.

Front 590

new cases / year =
new cases + old cases = total cases =

Back 590

incidence vs prevalance of a disdease

Front 591

# positive tests/ all those that have the disease aka ability of the test to detect the disease.

Back 591

sensitivity, rules in.

Front 592

# negative test/ all those that don't have the disease, ability to detect absence of the disease

Back 592

sensitivity , rules out

Front 593

Define positive predictive value.

Back 593

PPV is the chance that the person has a positive test result out of all people who have the disease.

Front 594

Define Negative predictive value

Back 594

NPV is the chance that a person has a negative test result out of all people who don't have the disease.