Step 3 P-O-W-E-R

Front 1

A high _____ increases the negative predictive value (NPV) of a test.

Back 1

High Sensitivity

"SnNOut"

A screening test must have hight sensitivity to rule out disease by decreasing the number of false-negatives and increasing the NPV.

Front 2

In patients with thyroid cancer in remission, how is the dose of levothyroxine adjusted?

Back 2

Levothyroxine is adjusted to suppress the TSH below normal range, usually between 0.1 - 0.3 microU/mL

Front 3

TREATMENT:

Acute Streptococcal Group A (GAS) Tonsillopharyngitis

Back 3

Oral Penicillin
or
Oral Amoxicillin

Front 4

What does the American Academy of Pediatrics advise for breasfeeding newborns?

Back 4

Breastfeed on Demand

10-20 minutes on each breast

Interval of every 2-3 hours

Many newborns cluster feed during growth spurts and may need to feed more often

Front 5

What lab abnormality is a very important finding during aplastic crisis in a sickle cell patient?

Back 5

Virtual absence of reticulocytes!

Aplastic crisis represents a transient failure of erythropoiesis with an abrupt reduction in the blood hemoglobin and the number of erythroid precursors in the bone marrow.

The typical cause of aplastic crisis in children is Parvovirus B19 infection.

Front 6

What arrhythmia is characterized by the presence of 3 or more P wave morphologies?

Back 6

Multifocal or Multiform Atrial Tachycardia (MAT)

QRS complexes are narrow

PR Segments & RR Intervals are variable

Heart rate can reach up to 200

Front 7

2 Most Common Causes:

Multifocal or Multiform Atrial Tachycardia (MAT)

Back 7

1) Hypoxia

2) COPD

3) Hypokalemia

4) Hypomagnesemia

5) Coronary/Hypertensive/Valvular Disease

6) Medications:
Theophylline, Aminophylline, Isoproterenol

Front 8

TREATMENT:

Multifocal or Multiform Atrial Tachycardia (MAT)

Back 8

Therapy is aimed at correcting the underlying cause.

For example, rapid correction of hypoxia, hypokalemia, or hypomagnesemia may eliminate the arrhythmia.

If therapy is not effective and there are no contraindications, beta-blockers can be used.

In patients with asthma or COPD, verapamil (CCB) is the drug of choice.

Front 9

How soon after an acute MI can low risk patients safely resume sexual activity.

Back 9

Within 3-4 weeks (Princeton Guidelines) and possibly as early as 1 week (American Heart Association Guidelines)

Front 10

EKG FINDINGS:

Torsade de pointes

Back 10

1) Ventricular rate greater than 100 beats/min (often 160-250/min)

2) Frequent variations in the QRS morphology

3) Peaks of the QRS complexes appear to "twist" around the isoelectric line ("twisting of points")

Front 11

TREATMENT:

Torsade de pointes
(Polymorphic Ventricular Tachycardia)
WITH Hemodynamic Compromise

Back 11

Immediate Nonsynchonized Electric Defibrillation
+
IV Magnesium Sulfate

Front 12

TREATMENT:

Torsade de pointes
(Polymorphic Ventricular Tachycardia)
in Stable Patient

Back 12

IV Magnesium Sulfate

Normal serum magnesium levels cannot rule out the possibility of hypomagnesemia, because may only reflect only normal total magnesium levels in the serum, even if the ionized fraction is low.

Front 13

TREATMENT:

Torsade de pointes
(Polymorphic Ventricular Tachycardia)
if IV Magnesium Sulfate fails

Back 13

Temporary Transvenous Overdrive Pacemaker

Front 14

Torsade de pointes is associated with?

Back 14

Congenital or Acquired QT Prolongation

ACQUIRED:
Hypokalemia
Hypomagnesemia
Macrolides, Antihistamines, Psychotropics

Front 15

Common fungal infection in bone marrow transplant recipients?

Back 15

Invasive Aspergillosis

Typically involves the respiratory tract, including lungs and sinuses.

Front 16

Most common cause of sudden death in steering wheel injuries?

Back 16

Aortic Injury

- Ligamentum Arteriosum
- Aortic Root
- Diaphragmatic Hiatus

Front 17

What is highly sensitive for direct identification of organisms in HIV-positive patients suspected of having Pneumocystis jirovecii pneumonia?

Back 17

Fiberoptic Bronchoscopy with Bronchoalveolar Lavage

Front 18

TREATMENT OF CHOICE:

All Patients with Suspected or Documented PCP (Pneumocystis jirovecii pneumonia)

Back 18

IV Trimethoprim-Sulfamethoxazole (TMP-SMX)

Should be converted to oral therapy when the patient has signs of clinical recovery.

Front 19

What has been shown to decrease the mortality rate and the rate of respiratory failure in patients with moderate to severe Pneumocystis pneumonia (PCP)?

Back 19

Early Use of Corticosteroids

Front 20

What are the criteria for the early use of corticosteroids in patients with Pneumocystis pneumonia?

Back 20

Moderate to Severe PCP

ON ROOM AIR:
1) Alveolar-Arterial Oxygen Gradient of 35mmHg or more
and/or
2) Arterial Oxygen Tension (PaO2) of 70mmhg or less

Front 21

MOST COMMON CAUSE:

Tampon-Related TSS

Back 21

98% of Menstrual or Tampon-related TSS cases are due to Staphylococcus aureus

Staphylococcal Exotoxin:
TSS Toxin-1

Front 22

PATHOPHYSIOLOGY:

Tampon-Related TSS

Back 22

1) Widespread Activation of T Cells by Exotoxins acting as Superantigens

2) Massive Cytokine Production and Release

Superantigens do not need to be processed by antigen-recognition cells, but can activate T cells directly.

Front 23

TREATMENT:


Tampon-Related TSS

Back 23

1) Supportive Therapy is the Mainstay of Treatment
- patients may require extensive fluid replacement of up to 20L per day!

2) Physicians generally administer Clindamycin with or without Nafcillin

Front 24

SIGN OF ACUTE APPENDICITIS:

Tenderness at the point 2/3 between the umbilicus and right anterior superior iliac spine

Back 24

McBurney's Sign

Front 25

SIGN OF ACUTE APPENDICITIS:

Transmission of pain from the left to the right lower quadrant

Back 25

Rovsing's Sign

Front 26

SIGN OF ACUTE APPENDICITIS:

RLQ pain on passive extension of the right hip

Back 26

Iliopsoas Sign

Front 27

COMPLICATIONS:

Third Trimester Pregnant Woman with Acute Appendicitis

Back 27

3RD TRIMESTER APPENDICITIS

Appendix Perforation with Peritonitis and Pylephlebitis

Pylephlebitis is infectious thrombosis of the portal veins

Front 28

COMPLICATIONS:

Second Trimester Pregnant Woman with Acute Appendicitis

Back 28

2ND TRIMESTER APPENDICITIS

Around 14% of pregnant women in the second trimester can have premature delivery

Front 29

COMPLICATIONS:

First Trimester Pregnant Woman with Acute Appendicitis

Back 29

1ST TRIMESTER APPENDICITIS

Around 1/3 of pregnant women in the first trimester may experience abortion

Front 30

DIAGNOSIS:

Eosinophilia with Diarrhea

Back 30

1) Intestinal Parasitosis due to Helminths

2) Eosinophilic Gastroenteritis

3) Addison's Disease

Front 31

TREATMENT:

Helminthiasis

Back 31

Albendazole or Mebendazole

HELMINTHIASIS/NEMATODES:
Ascaris lubricoides (Roundworm)
Trichuris trichiura (Whipworm)
Necator americanus (Hookworm)
Ancylostoma Duodenale (Hookworm)

Front 32

TREATMENT:

Parasitosis such as Giardia or amoeba infections

Back 32

Metronidazole

Front 33

TREATMENT:

Gram-Negative Infections

Traveler's Diarrhea

Back 33

Ciprofloxacin
or
TMP-SMX

Front 34

LIGAMENT INJURY:

Common in young athletes, especially women who participate in noncontact sports requiring rapid direction changes or pivots on the lower extremities (eg, soccer, basketball, tennis)

Back 34

Anterior Cruciate Ligament (ACL) Tear

Front 35

LIGAMENT INJURY:

"Popping" sensation in the knee at the time of injury, followed by the development of rapid-onset hemarthrosis and feeling of joint instability with weight bearing.

Back 35

Anterior Cruciate Ligament (ACL) Tear

Front 36

2 Maneuvers that are highly sensitive and specific for ACL injuries?

How is the diagnosis confirmed?

Back 36

1) Lachman Test

2) Anterior Drawer Test

The diagnosis is usually confirmed on magnetic resonance imaging.

Front 37

LIGAMENT INJURY:

Commonly occur following injuries in which the knee is struck from the lateral side with the foot planted.

Back 37

Medical Collateral Ligament (MCL) Tears

Front 38

Complication Coronary Angiography:

Patient presents with history of extreme fatigue, shakiness, weight loss, and palpitations.

Back 38

Iodine-Induced Thyrotoxicosis

2/2 Iodine administration during coronary angiography

Front 39

IODINE-INDUCED THYROTOXICOSIS:

Physical Exam Findings

Back 39

1) Firm, Irregular Thyroid (possibly Multinodular Goiter)

2) Tachycardia despite Beta-Blocker use

Symptoms occur a few weeks after coronary angiography

Front 40

IODINE-INDUCED THYROTOXICOSIS:

Patient's at Highest Risk

Back 40

Patients with Nodular Goiter

Excess iodine can serve as a substrate for excessive thyroid hormone formation

Front 41

IODINE-INDUCED THYROTOXICOSIS:

Radioactive Iodine Uptake

Back 41

Typically low radioactive iodine uptake

Thus, Radioactive Iodine Ablation (RIA) is ineffective

Front 42

VULVOVAGINITIS:

KOH Prep with pseudohyphae

Back 42

Candidiasis

Front 43

VULVOVAGINITIS:

KOH Prep with Clue Cells

Back 43

Bacterial Vaginosis

Front 44

VULVOVAGINITIS:

KOH Prep with Trichomonads and many PMNs

Back 44

Trichomoniasis

Front 45

HAZARD RATIO:

1.00

< 1.00

> 1.00

Back 45

Hazard Ratio is a measure of effect used in survival analysis (or time-to-event analysis)

1.00 = No difference in risk between the two study groups

<1.00 = Protective Effect

>1.00 = Detrimental Effect

Front 46

DIAGNOSIS:

1) Speech Abnormalities
2) Impaired Executive Functioning
3) Irritable Mood
4) Hyper-Oral Behavior
5) Disinhibition

Back 46

Pick's Disease

Slowly progressive frontal lobe dementia

Front 47

PICK'S DISEASE:

Nuroimaging Study Findings

Back 47

Classic finding of prominent symmetric atrophy of the frontal and/or temporal lobes

Front 48

DIAGNOSIS:

1) Varying Cognitive Function and Alertness
2) Persistent Visual Hallucinations
3) Some Motor Features of Parkinsonism
- Rigidity, Intention Tremor

Back 48

Lewy Body Dementia

2nd Most common form of neurodegenerative dementia after Alzheimer's.

Front 49

First step in evaluation of males with testicular swelling?

Back 49

Scrotal Ultrasound to differentiate intra- and extra-testicular lesions

Cystic or fluid-filled lesions are unlikely to be cancerous.

Front 50

Next steps if testicular lesion appears suspicious on ultrasound?

Back 50

1) CT Scan of the Abdomen and Pelvis
To detect retroperitoneal lymph node metastasis

2) Measure Serum Tumor Markers:
- AFP

If positive, Radical Inguinal Orchiectomy is done to provide a histological diagnosis
- Beta hCG

Front 51

DIAGNOSIS:

Ischemic Stroke in a young patient in the setting of a lower extremity DVT

Back 51

Paradoxical Embolus

INTRACARDIAC SHUNT:
- Patent Foramen Ovale
- Atrial Septal Defect

Front 52

Test for Paradoxical Embolus

Back 52

Transthoracic or Transesophageal Echocardiogram with Bubble Study

Front 53

DIAGNOSIS:

Subacute Combined Degeneration of the Dorsal and Lateral Spinal Columns:
1) Impaired vibration sensation
2) Hyperreflexia

Back 53

Vitamin B12 Deficiency

Reversible cause of dementia

Front 54

Result of intense erythroid hyperplasia in the bone marrow of patients with vitamin B12 deficiency?

Back 54

Erythroid precursors do not mature normally, and these subsequently die in the bone marrow, causing:

1) Anemia

2) Indirect Hyperbilirubinemia

Front 55

H. Pylori Triple Therapy

Back 55

2 WEEK "PAC/PMC" TRIPLE THERAPY:

1) Proton Pump Inhibitor (PPI):
Pantroprazole

2) Amoxicillin 1g bid
- Metronidazole 500mg bid if penicillin allergy

3) Clarithromycin 500mg bid

Front 56

H. Pylori Quadruple Therapy

Back 56

2 WEEK PBTM QUADRUPLE THERAPY:

1) PPI: Pantropazole

2) Bismuth

3) Tetracycline

4) Metronidazole

Front 57

Test to Confirm Eradication of H. pylori

Back 57

4-6 WEEKS AFTER TX:

1) Urea Breath Test

2) Stool Antigen Testing

Front 58

DRUG OF CHOICE:

Controlling Hypertension and Preventing Progression of Renal Failure in ADPKD Patients

Goal Blood Pressure?

Back 58

ACEI

Goal BP < 130/80

Front 59

MOST COMMON:

Extrarenal Manifestation of ADPKD

Back 59

Hepatic Cysts

Front 60

MOST EFFECTIVE SCREENING TOOL:

ADPKD in Asymptomatic Family Members

Back 60

Ultrasonography is the most cost-effective screening procedure.

The presence of >3-5 cysts in each kidney is required to make the diagnosis of ADPKD

Front 61

TREATMENT:

Cate Bite with Coverage for Pasteurella multocida

Back 61

Amoxicillin/Clavulanate x 3-5 days

the incidence of infection complicating a cat bite is close to 50%

Front 62

Effect of Photoaging on the Skin

Back 62

Photoaging is a combination of intrinsic aging and damage by UV light.

Results in course, deep wrinkles on a rough skin surface.

May be accompanied by actinic keratoses, telangiectasias, and brown (liver) spots.

Front 63

TREATMENT:

Photoaging

Back 63

All-Trans-Retinoic Acid (Tretinoin)

Emollient cream approved by the FDA for reduction of fine wrinkles, mottled hyperpigmentation, and roughness of the facial skin.

Also reduces actinic keratoses and brown spots.

Front 64

Cause of Carpal Tunnel Syndrome (CTS)

Back 64

Entrapment of the Median Nerve on the Volar Surface of the Wrist

Front 65

Conditions Associated With Carpal Tunnel Syndrome (CTS)

Back 65

Carpal Tunnel Syndrome (CTS)
1) Wrist Trauma or Fracture
2) Diabetes Mellitus
3) Rheumatoid Arthritis
4) Hypothyroidism
5) Acromegaly
6) Pregnancy
7) Menopause
8) ESRD / Dialysis
9) Obesity
10) Fibromyalgia

Front 66

TREATMENT:

Carpal Tunnel Syndrome (CTS)

Back 66

Continuous Wrist Splinting

Simple and effective way to keep the wrist in neutral position, and reduce the pressure on the nerve. It is especially useful to reduce the nighttime symptoms.

Front 67

Prophylactic Treatment for Individuals in Close Contact with Invasive Meningococcal Infection by Neisseria meningitidis

Back 67

Rifampin 600mg po bid x 4 doses is the standard treatment

Ciprofloxacin 500mg po x1 dose is acceptable alternative for adult patients that can not tolerate Rifampin. For example, women on OCPs.

Front 68

Statistical Significance Level of a Study

Back 68

Alpha = 0.05

If the p value of the study is less than the present statistical significance level, the null hypothesis is rejected and the difference detected is considered statistically significant.

Front 69

Best Measure of Central Tendency in Strongly Skewed Distributions

Back 69

The Median is a better measure than the median

Negative Skew:
Tail to the Left
Mean < Median < Mode

Positive Skew:
Tail to the Right
Mean > Median > Mode

Front 70

TREATMENT:

Patients with Hypertension and Chronic Kidney Disease who have Proteinuria in excess of 500-1000mg/day

Back 70

ACE Inhibitor or ARB

Goal to reduce Proteinuria to <500mg/day or a minimum reduction of 60%.

Front 71

Classic Triad for Hemochromatosis

Back 71

HEMOCHROMATOSIS
"BRONZE DIABETES"

1) Liver Cirrhosis

2) Diabetes Mellitus

3) Skin Pigmentation

3)

Front 72

Treatment for Hemochromatosis

Back 72

Therapeutic Phlebotomy

Removal of approximately 1 unit of blood each week until iron stores normalize.

Front 73

What is the risk of developing hepatitis B in infants born to mothers with hepatitis B with and without prophylaxis?

Back 73

30% Without Prophylaxis, 25% risk of developing liver cirrhosis or hepatocellular carcinoma in adulthood

2% With Hepatitis B Immunoglobulin and Hepatitis B Vaccine Prophylaxis 12 hours after birth

Front 74

When do serologies need to be check for infants that received Hepatitis B Immunoglobulin and Hepatitis B Vaccine Prophylaxis?

Back 74

Serology controls must be done 3-4 months after the third dose, or when the infant is between 9-15 months old

Front 75

What is the main benefit of Meta-Analysis?

Back 75

Increases the sample size by pooling the data from several studies, thereby increasing the statistical power.

Front 76

DIAGNOSIS:

CT scan of head shows thickened calvarium with an inhomogeneous bone density or "cotton wool" appearance

Back 76

Paget Disease of Bone (PDB)

Front 77

Next step in diagnosis after finding possible evidence of Paget Disease of Bone on head CT?

Back 77

1) Obtain Calcium & Alkaline Phosphatase levels
= Patients with PDB have an elevated Alkaline Phosphatase and normal Calcium.
= Elevated alkaline phosphatase may be differentiated from hepatobiliary disease by measuring the bone-specific fraction.

2) Patients with PDB should have Radionuclide Bone Scan to identify other involved sites.

Front 78

TREATMENT:

Paget Disease of Bone (PDB)

Back 78

Bisphosphonates: prevention and treatment of osteoporosis, osteitis deformans ("Paget's disease of bone"), bone metastasis (with or without hypercalcaemia), multiple myeloma, primary hyperparathyroidism, osteogenesis imperfecta, fibrous dysplasia

Alendronate, Risedronate

Front 79

Paget Disease of Bone (PDB)

Common complication?

Treatment?

Back 79

Hearing Loss

Calcitonin or Bisphosphonates can slow the progression of hearing loss but is unlikely to reverse hearing loss that has already occurred.

Front 80

Catch Scratch Disease

Causative agent?

Most Common Complication?

Back 80

Bartonella henselae

Suppuration of the Lymph Nodes (10%)

Other complications: visual loss due to neuronitis, encephalopathy, fever of unknown origin, hepatosplenomegaly

Front 81

Mechanism of Acute Compartment Syndrome

Back 81

When tissue pressure in the enclosed compartment exceeds the perfusion pressure

Compromised blood flow to the muscles and nerves inevitably lead to ischemic tissue necrosis

Front 82

Presentation of Acute Compartment Syndrome

Late features?

Back 82

Severe pain out of proportion to extent of injury.

Pain worsened by passive movements of involved muscles.

Sensory nerves usually affected before motor nerves, leading to decreased vibration sense and two-point discrimination, numbness, or hypoesthesia.

Late features include extremity paralysis and absent distal pulsation (pulseless paralysis).

Front 83

Most Common Life-Threatening Complication of Acute Compartment Syndrome?

Labs?

Back 83

Rhabdomyolysis & Renal Failure

Tissue necrosis, muscle infarction, and rhabdomyolysis release myoglobin, which is directly toxic to renal tubules, leading to acute tubular necrosis and acute renal failure.

Labs show markedly elevated Creatinine Kinase and presence of Myoglobin in the urine.

Front 84

Diagnostic Procedure of Choice for Suspected Acute Compartment Syndrome?

Back 84

Compartment or Tissue Pressure

The current general consensus for the threshold value is >30 mmHg.

Front 85

Treatment for Acute Compartment Syndrome

Back 85

Emergent Fasciotomy
("Compartment Release")

Within 6-10 hours of the initial symptoms.

Front 86

Definition of Neonatal Polycythemia

Back 86

Hematocrit >65%
or
Hemoglobin >22g/dL

If heel prick (capillary blood) is elevated, remeasure using venous blood. Peripheral venous hematocrit is usually 5-15% lower.

Front 87

Neonatal Polycythemia

Signs and Symptoms?

Cause of S/S?

Back 87

Irritability, drowsiness, poor feeding, abdominal distention, hypotonia, and peripheral cyanosis.

Can be life-threatening, causing hypoglycemia, hyperbilirubinemia, jaundice, apnea, and cardiac and respiratory compromise.

Due to blood hyperviscosity, which decreases the blood flow to tissues, including brain and gut.

Front 88

Treatment for Neonatal Polycythemia

Back 88

1) Intravenous Hydration

2) Partial Exchange Transfusion

Front 89

Causes of Acute Decompensated Heart Failure (ADHF)

Back 89

1) Hypertensive Crisis

2) Acute Valvular Heart Disease

3) Acute Coronary Syndrome

4) Other Causes of Primary Fluid Overload

Front 90

Treatment for Acute Decompensated Heart Failure (ADHF)

Back 90

IV Loop Diuretics
- Furosemide

Volume overload and elevated filling pressures are central to the pathophysiology of most ADHFs.

Front 91

2 Most Common Antihypertensives used in the management of Hypertensive Crisis complicated by Acute Pulmonary Edema

Back 91

1) IV Nitroglycerine

2) IV Nitroprusside

Front 92

Treatment for Cardiogenic Shock complicated by Hypotension

Back 92

Dopamine

Front 93

All Patients with Flash Pulmonary Edema of Unknown Etiology should be evaluated with?

Back 93

Echocardiogram

Mitral Stenosis and Acute Aortic or Mitral Regurgitation can present with Flash Pulmonary Edema

Front 94

First Step in Management of Patients (especially children) with Sickle Cell Crisis

Back 94

IV Fluids

IV Morphine is the most common analgesic.

Front 95

What should be obtained immediately in sickle cell disease patients who present with abdominal pain and splenomegaly?

Back 95

Complete Blood Count

In Splenic Sequestration Crisis (SSC), a dramatic fall in hemoglobin concentration occurs 2/2 vaso-occlusion within the spleen and splenic pooling of RBCs.

The spleen can enlarge rapidly and the patient can experience hypovolemic shock.

Front 96

Cause of Rapidly Spreading Cellulitis and Necrotizing Fasciitis in Most Healthy Young Patients

Back 96

Type II Necrotizing Fasciitis

Group A Streptococci (GAS)
Streptococcus pyogenes

Front 97

Treatment of Necrotizing Fasciitis

Back 97

1) Surgical Exploration and Debridement

2) Clindamycin
DOC for Necrotizing Fasciitis/Myonecrosis due to GAS

Front 98

Treatment of Acute Exacerbation of Asthma

Back 98

Bronchodilator Therapy:

Inhaled Beta-2 Adrenergic Agonists

Front 99

Treatment for Status Asthmaticus and Signs and Symptoms of Impending Respiratory Failure

Back 99

Intubation

Front 100

Preferred Method to Evaluate Upper GI Bleeding

Back 100

Upper Gastrointestinal(GI) Endoscopy

It has therapeutic applications such as photocoagulation or local injection of vasoconstrictor agents.

Front 101

DIAGNOSIS:

Patient age >65, bone pain or fracture, renal insufficiency, hypercalcemia, anemia, and hyperproteinemia.

Back 101

Multiple Myeloma (MM)

Clonal proliferation of plasma cells that usually produces monoclonal protein that can be identified on serum or urine protein electrophoresis.

Front 102

How can Multiple Myeloma diagnosis be confirmed?

Back 102

Bone Marrow Biopsy

>10% sheets and clusters of monoclonal plasma cells in most cases.

Front 103

What should be performed in patients diagnosed with Multiple Myeloma?

Back 103

Complete X-Ray Skeletal Series

To assess the extent of skeletal involvement and identify impending pathologic fractures.

Typically reveals "punched-out" lytic lesions, diffuse osteopenia, or fractures in 80% of patients.

Front 104

6 Complications of Multiple Myeloma

Back 104

1) Hypercalcemia

2) Renal Insufficiency

3) Infections (pneumonia, UTI)

4) Skeletal Lesions

5) Hyperviscosity Syndrome
- more common in Waldenstrom's Macroglobulinemia due to elevated IgM

6) Thrombosis

Front 105

When should the HPV vaccination series be started?

Back 105

1st Dose: 11-12 Years of Age
2nd Dose: 1-2 months after 1st
3rd Dose: 6 months after 1st

Bivalent HPV Vaccine (Cervarix)
HPV 16, 18

Quadrivalent HPV Vaccine (Gardasil)
HPV 6, 11, 16, 18

Front 106

What should be done if the HPV vaccination schedule is interrupted?

Back 106

Pick up where the patient left off. The entire vaccine series does not need to be restarted.

Should not be given to pregnant women, but okay for lactating women.

Front 107

Treatment for Dumping Syndrome

(A common complication of gastrectomy)

Back 107

1) High-Protein & Low-Carbohydrate Diet

2) Smaller & More Frequent Portions

To decrease the speed of passage of fluids and food into the small

Front 108

Cause of Crystal-Induced Nephropathy?

Back 108

Indinavir Therapy
(Protease Inhibitor)

Caused by precipitation of the drug in the urine and obstruction of urine flow.

Front 109

5 Common Acute Life-Threatening Reactions a/w HIV Therapy

Back 109

1) Didanosine-Induced Pancreatitis

2) Abacavir-Related Hypersensitivity Syndrome

3) Lactic Acidosis: Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

4) Stevens-Johnson Syndrome: Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

5) Nevirapine-Associated Liver Failure

Front 110

When should Cervical Cancer Screening be started?

Routine HPV testing?

Back 110

Age 21 in Most Women, regardless of age at onset of sexual activity

Exceptions: HIV, SLE, organ transplant, immunocompromised state

Routine HPV testing is not indicated for women <30.

Front 111

Features of Glomerular Bleeding on Urinalysis

Back 111

1) Red Cell Casts

2) Dysmorphic Red Cells

3) Associated Proteinuria

Front 112

What is one of the more common adverse effects of INH (indicated for treatment of latent tuberculosis)?

Back 112

Severe Hepatitis

Increased Risk: daily alcohol, existing liver disease, age >50.

Front 113

Ligament Injury that commonly occurs during skiing or contact sports, when a force is applied to the knee from the lateral to medial direction?

Back 113

Medial Collateral Ligament Injury

A/w pain and tenderness along the medial joint line

Injury involving valgus (abductor) stress to partially flexed knee with the foot fixed.

Front 114

Ligament injury associated with little pain or alteration in range of motion.

For example, dashboard being struck by anterior of the flexed knee in a motor vehicle accident or from hyperextension.

Back 114

Posterior Cruciate Ligament Injury

Posterior Drawer Test Positive

Uncommon

Front 115

Ligament injury involving dramatic varus (adductor) stress?

Back 115

Lateral Collateral Ligament Injury

A/w tenderness and pain along the lateral joint line.

Front 116

Cause of Meralgia Paresthetica

Back 116

Entrapment of the Lateral Femoral Cutaneous Nerve

Small, purely sensory nerve that can be compressed as it courses from the lumbar plexus, through the abdominal cavity, under the inguinal ligament, and into the subcutaneous tissue of the thigh.

Front 117

Physical Exam Findings of Meralgia Paresthetica

Back 117

Area of decreased sensation over the anterolateral thigh without any muscle weakness or deep tendon reflex abnormalities.

Front 118

Meralgia Paresthetica

Common causes?

Treatment?

Back 118

1) Obesity
2) Tight Garments around the Waist

1) Weight loss
2) Avoid tight-fitting garments
3) Reassurance (this is not a serious condition)

Front 119

Treatment of Penicillin-Allergic Patients with Syphilis

Back 119

Penicillin Desensitization with incremental doses of Oral Penacillin V

Front 120

Which patients are good candidates for Hospice Care?

Back 120

Patients with advanced metastatic cancers or other terminal illnesses with a life expectancy of <6 months.

Front 121

What describes the dispersion around the mean in a distribution curve?

Back 121

Standard Deviation

Wider distributions have larger SDs

1 SD = 68% of Observations
2 SD = 95% of Observations
3 SD = 99.7% of Observations

Front 122

A study organized by selecting a group of individuals, determining their exposure status, then following them over time for development of the disease of interest.

Back 122

Prospective Cohort Study

The cohort is then followed for a certain period and observed for development of the outcome.

Front 123

A study designed by selecting patients with a particular disease and patients without that disease and then retrospectively determining their exposure status.

Back 123

Case-Control Study

Front 124

Study characterized by the simultaneous measurement of an exposure and outcome within a specific population.

Back 124

Cross-Sectional Study
(Prevalence Study)

"Snapshot Study" that frequently uses surveys, making it relatively inexpensive and easy to perform.

Front 125

A study in which subjects are assigned to treatment group or control group and then monitored for development of the outcome of interest.

Back 125

Randomized Clinical Trial

Directly compares 2 or more treatments.

Front 126

PREVENTATIVE MEDICINE:

Prevention of risk factors themselves.

Back 126

Primordial Prevention

For example, discouraging children from adopting harmful lifestyles.

Many risk factors for CVD (eg, obesity, hypertension) have their origins in childhood as this is the time when lifestyles and habits (eg, eating patterns, physical exercise) are formed.

Front 127

PREVENTATIVE MEDICINE:

Action taken before a patient develops the disease and is targeted at preventing the disease itself.

Back 127

Primary Prevention

Ex: Treatment of elevated lipids for the prevention of cardiovascular disease (CVD).

Front 128

PREVENTATIVE MEDICINE:

Action that halts or delays the progression of a disease at its initial stage and prevents complications.

Back 128

Secondary Prevention

Ex, statin use in a patient with CVD.

Front 129

PREVENTATIVE MEDICINE:

Taking all actions available to limit impairments and disabilities.

Back 129

Tertiary Prevention

Ex: Cardiac rehabilitation and revascularization (eg, CABG) in a patient with significant CVD.

Front 130

PREVENTATIVE MEDICINE:

The set of health activities that mitigate and/or limit the consequences of unnecessary or excessive intervention by the health system.

Back 130

Quaternary Prevention

Ex: Use of a shared electronic medical record in order to limit unnecessary, repeat cardiac catheterization procedures.

Front 131

DIAGNOSIS:

Skin lesions that are shiny, discrete, intensely pruritic, polygonal shaped violaceous plaques and papules that are usually present on the flexural surfaces (most commonly the wrists) of the extremities, buccal mucosa or external genitalia.

Back 131

Lichen Planus

A characteristic whitish lacy pattern (Wickham's striae) is often seen on the surfaces of the papules and plaques.

Mucous membranes of the mouth, nails, and external genitalia can also be involved.

Front 132

Histological Findings in Lichen Planus

Back 132

Hyperkeratotic epidermis with irregular acanthosis and focal thickening in the granular layer of epidermis.

The lower epidermis has degenerating keratinocytes (called colloid bodies or Civatte bodies) with liquifactive degeneration and linear fibrin deposition in the basal layer.

Front 133

Virus a/w Lichen Planus

Back 133

Advanced Liver Disease due to Heptitis C Virus (HCV)

Front 134

When is lung cancer screening recommended for smokers?

Back 134

Lung Cancer Screening by Annual Low-dose Helical CT Scan:

Patients age 55-80 who have a >= 30-pack-year smoking history & are current smokers or quit within the last 15 years.

Front 135

What does smoking cessation lower the risk of?

Back 135

Smoking cessation reduces the risk of developing lung cancer and worsening chronic obstructive pulmonary disease, even in long-term heavy smokers.

Front 136

What changes in T3 and T4 are seen in pregnancy?

Back 136

The level of thyroxine-binding globulin (TBG) increases during pregnancy, resulting in higher total T3, T4.

Human chorionic gonadotropin (hCG) stimulates the production of thyroid hormones by binding to thyrotropin (TSH) receptors on thyroid follicular cells.

Front 137

What is the best initial screening test for evaluating thyroid function during pregnancy?

Back 137

TSH

Trimester-specific reference ranges should be used during pregnancy.

Measurement of total thyroid hormone levels is reliable during pregnancy, with normal levels 1.5 times higher than the nonpregnant adult range.

Front 138

Common Causes of Hyperthyroidism in Pregnancy

Back 138

1) Grave's Disease

2) Gestational Transient Thyrotoxicosis

Front 139

What diagnosis should be considered in patients with osteoporosis that do not respond to bisphosphonate therapy (alendronate, risedronate)?

Back 139

Multiple Myeloma should be considered in elderly patients who do not respond to conventional antiresorptive therapy, particularly those who progress very rapidly with multiple fractures.

Serum and urine protein electrophoresis should be used to screen for MM.

Front 140

Most appropriate study design to investigate an outbreak of an acute infectious disease?

Back 140

Case-Control Study

If cases are more likely to be exposed than the controls (odds ratio is >1), then an association between the exposure and the disease can be established.

It allows for the quick localization of the source of the outbreak.

Front 141

DIAGNOSIS:

Cotton-wool spots, intraretinal hemorrhages, microvascular changes, and hard exudates without the presence of neovascularity.

Back 141

Nonproliferative Retinopathy

There is transient worsening of diabetic retinopathy when aggressive insulin therapy is first instituted, so close ophthalmologic monitoring is warranted.

Front 142

TREATMENT:

Severe Proliferative Retinopathy

Back 142

Panretinal Photocoagulation

Front 143

Patient with history of substance dependence develops mydriasis, nausea, vomiting, abdominal cramps, watery eyes, and yawning.

Diagnosis?

Treatment?

Back 143

Opioid Withdrawal

Methadone or other opioids such as Buprenorphine

Front 144

Mydriasis is an indicator of what illicit substances?

Back 144

1) Opioid Withdrawal

2) Cocaine, Amphetamine, TCA Overdose

Front 145

Perivascular bacterial invasion of the media and adventitia of arteries and veins, followed by ischemic necrosis.

Lesions of the skin or mucous membrane that rapidly worsen and evolve into nodular patches marked by hemorrhage, ulceration, and necrosis.

Diagnosis?

Likely agent?

Back 145

Ecthyma Gangrenosum

Pseudomonas aeruginosa

Front 146

Most common organisms causing cellulitis?

Back 146

1) Streptococcus pyogenes

2) Staphylococcus aureus

Front 147

Highly contagious, pyogenic skin infection most commonly found in children.

Back 147

Impetigo

Bullous impetigo is primarily caused by Staphylococcus aureus, while nonbullous impetigo is caused by S. aureus, Streptococcus pyogenes, or a combination of the two.

Front 148

Most commonly found on the legs and is characterized by deep ulcers with violaceous borders.

Atypical presentations have lesions on the hands, arms, or face and are superficial ulceration that have vesiculopustular borders.

Back 148

Classical/Atypical
Pyoderma Gangrenosum

Thought to be due to immune system dysfunction, and particularly improper functioning of neutrophils. Often associated with diseases such as ulcerative colitis, rheumatoid arthritis, and multiple myeloma.

Front 149

TREATMENT:

Pseudomonas aeruginosa Bacteremia

Back 149

Aminoglycoside (Tobramycin, Amikacin)
+
Extended-Spectrum Antipseudomonal Penicillin (Piperacillin)
or
Antipseudomonal Cephalosporin (Ceftazidime or Cefepime)

Front 150

What is the major contributor of increased bleeding in patients with renal failure?

Treatment?

Back 150

Platelet Dysfunction

Desmopressin, which acts by increasing the release of factor VIII:von Willebrand Factor multimers from the endothelium.

Front 151

Who should receive antibiotic prophylaxis to prevent the spread and development of meningococcal meningitis?

Back 151

All persons with prolonged, close contact or direct exposure to the respiratory secretions of a patient with meningococcal meningitis.

For example, physicians who have suctioned or intubated the patient should receive chemoprophylaxis.

Front 152

Recommended Prophylaxis to prevent colonization of the nasopharynx by meningococci?

Back 152

Rifampin 600mg q12h x4 doses

Others: Ciproflaxacin 500mg single dose, sulfonamides, ceftriaxone, and minocycline.

Front 153

3 Common Causes of Guillain-Barre Syndrome?

Back 153

1) Campylobacter jejuni #1

2) Epstein-Barr Virus (EBV)

3) Herpes Simplex Virus (HSV)

Front 154

Indications for Plasmapharesis in GBS?

Back 154

1) Severe Flaccid Paralysis

2) Bulbar Palsy

3) Progressive Respiratory Failure

4) Patients on Ventilation

Front 155

Gram-negative anaerobe often causing soft tissue infections from human bites?

Back 155

Eikenella corrodens

Front 156

Treatment for Human Bites

Back 156

Ampicillin-Sulbactam (Unasyn)

Provides broad-spectrum coverage for both aerobes and anaerobes, including Eikenella corrodens.

Also parenteral drug of choice of cat and dog bites.

Front 157

Treatment of Sulfonylurea (eg, Glyburide) Poisoning?

Back 157

1) Dextrose

2) Octreotide is a somatostatin analog that decreases insulin secretion.

Sufonylureas cause increased insulin secretion and may cause hypoglycemia.

Front 158

Antihypertensive useful in the treatment of opioid withdrawal?

Back 158

Clonidine

Centrally-acting Antihypertensive

Front 159

What patients with chest pain indicative of acute myocardial infarction are eligible for thrombolytic therapy?

Back 159

1) If they present within 12 hours of symptom onset

2) If EKG demonstrates ST segment elevations >1mm in two contiguous leads.

Front 160

Treatment of Community-Acquired Pneumonia?

Back 160

IV Ceftriaxone
+
Macrolide (Azithromycin, Clarithromycin)

Provides coverage for typical (S. pneumoniae) & atypical (Legionella) agents.

Front 161

Relative contraindication for the use of Combined Oral Contraceptives (COCPs)?

Back 161

1) Age >35

2) History of migraine headaches

Risk of stroke with COCPs is greater in patients with focal symptoms or an aura, which should be considered an absolute contraindication.

Also induce mild insulin resistance and glucose intolerance.

Front 162

When is a lymph node biopsy indicated in patients with mononucleosis?

Back 162

Patients with localized lymphadenopathy should be observed for 3-4 weeks.

Biopsy should be performed if the nodes fail to resolve after 4 weeks, as it may be a sign of underlying lymphoma.

Front 163

Common Causes of Thyroiditis with Pain and Tenderness?

Back 163

1) Subacute Thyroiditis, aka Quervain's or Granulomatous Thyroiditis (postviral inflammation)

2) Infections (bacterial suppuration)

3) Radiation Thyroiditis

4) Vigorous Palpation- or Trauma-induced Thyroiditis

Front 164

Thyroiditis characterized by a mixed inflammatory thyroid infiltrate consisting of lymphocytes, neutrophils, histiocytes, and multinucleated giant cells.

Back 164

Subacute Thyroiditis, aka de Quervain's or Granulomatous Thyroiditis

(postviral inflammation)

Front 165

Thyroiditis with predominantly lymphocytic infiltration?

Back 165

1) Silent (Painless) Thyroiditis

2) Hashimoto Thyroiditis (generally painless)

Front 166

THYROIDITIS:

Predominant hypothyroid features

Diffuse goiter

Back 166

Hashimoto Thyroiditis

Front 167

THYROIDITIS:

Mild, brief hyperthyroid phase
Spontaneous recovery
Small, nontender goiter
Variant of Hashimoto thyroiditis

Back 167

Silent (Painless) Thyroiditis

Front 168

THYROIDITIS:

Likely from postviral inflammatory process
Prominent fever & hyperthyroid symptoms
Painful/tender goiter

Back 168

Subacute (de Quervain's) Thyroiditis

Front 169

THYROIDITIS:

Elevated ESR & CRP

Low radioiodine uptake

Back 169

Subacute (de Quervain's) Thyroiditis

Front 170

THYROIDITIS:

Low Radioactive Iodine Uptake

Back 170

1) Silent (Painless) Thyroiditis
2) Subacute (de Quervain's) Thyroiditis
3) Postpartum Thyroiditis
4) Surreptitious Thyroid Hormone Abuse
5) Iodine-Induced Thyroiditis

Front 171

What does a "hot" nodule within a "cold" thyroid on radioiodine uptake scan indicate?

Back 171

Hyperfunctioning Adenoma

Patient have symptomatic hyperthyroidism, but are less likely to have fever or thyroid tenderness and would have nodular rather than diffuse enlargement.

Front 172

THYROIDITIS:

Diffusely increased iodine uptake.

Back 172

Grave's Disease

Due to anti-thyrotropin (TSH) recepter autoantibodies that stimulate iodine uptake and thyroid hormone synthesis.

T3 > T4

Front 173

THYROIDITIS:

T4 > T3

Back 173

Subacute (de Quervain's) Thyroiditis

Reflecting the ratio of T4 to T3 in preformed thyroid hormones within the thyroid gland.

Front 174

THYROIDITIS:

Increased patchy radioiodine uptake.

Back 174

Toxic Multinodular Goiter (TMG)

Most common in older patients. Thyrotoxic symptoms are generally subtle, if present at all.

Usually not tender.

Front 175

Treatment of Subacute (de Quervain's) Thyroiditis?

Back 175

Usually self-limited condition, and treatment is primarily supportive.

Most cases managed with NSAID to relieve pain and Beta Blocker to minimize hyperthyroid symptoms.

Systemic glucocorticoids may be necessary when pain is especially severe or does not respond to NSAID.

Front 176

THYROIDITIS:

Radioiodine Thyroid Ablation

Back 176

Chronic Hyperthyroid Conditions:

Grave's Disease

Front 177

Definition of Treatment-Resistant Depression?

Back 177

Major Depressive Disorder that does not respond to an adequate trial of 2 antidepressants.

Nonresponders generally benefit from swtiching to a different antidepressant.

Partial responders generally benefit from augmentation (eg, SGA, antidepressant with different mechanism, or occasionally lithium)

Front 178

Activating antidepressant that does not cause weight gain or sexual side effects.

Back 178

Buproprion (Wellbutrin)

Front 179

What are the most easily accessible lesions for biopsy in patients with suspicious clinical and radiographic findings for the diagnosis of sarcoidosis?

Back 179

1) Lacrimal Glands

2) Salivary Glands including Parotid Glands

3) Skin Lesions other than Erythema Nodosum

4) Palpable Superficial Lymph Nodes

Front 180

Most common congenital heart lesion in patient's with Down's Syndrome?

Most useful diagnostic evaluation?

Back 180

Endocardial Cushion Defects

Echocardiography

Front 181

Conditions that occur with higher frequency in Down's Syndrome?

Back 181

1) Acute Leukemia later in life

2) Alzheimer-like Dementia in 3-4th decade

3) Autism

4) Depressive Disorder

5) Seizure Disorder

Front 182

What should a physician do if a patient does not want to tell his spouse about his positive HIV status?

Back 182

Persuade to tell spouse.

If refuses, some states allow for the physician to inform the at-risk spouse.

Front 183

Most Common First-Line Treatment in Symptomatic Essential Tremor

Back 183

Beta Blockers

Propranolol

Front 184

Goal of Long-term management of Rheumatoid Arthritis?

Back 184

1) Control Synovitis

2) Slow/Stop Progression of Joint Destruction

Front 185

TREATMENT:

Rheumatoid Arthritis

Back 185

1) Disease-Modifying Anti-Rheumatic Drugs (DMARDs):
- Methotrexate

If non-responsive, switch to or add:
2) Anti-Cytokine:
- Infliximab, Etanercept
- higher incidence of opportunistic infections, screen for latent TB

Front 186

Study for monitoring patients on cardiotoxic anthracycline chemotherapy?

Eg, Doxorubicin, Daunorubicin

Back 186

Radionuclide Ventriculography

MUGA (Multigated Acquisition) Scan

High accuracy and reproducibility for measuring ejection fractions.

Front 187

Test for HCV during the acute phase of infection?

Back 187

HCV RNA by PCR

Anti-HCV Antibodies are frequently negative during the acute phase of the infection.

Front 188

Mainstay of therapy for herpes zoster?

Back 188

Acyclovir or Valacyclovir x 7-10 days

Varicella zoster virus establishes latent infection in the sensory dorsal root ganglion following primary infection.

Front 189

Contact precautions for localized herpes zoster?

Back 189

Localized herpes zoster in an immunocompetent host is only transmitted via direct contact with open lesions.

There is no need to put patients in the community setting in strict isolation.

Strict isolation is recommend for hospitalized, immunocompromised, or patients with disseminated zoster given higher risk of disease transmission.

Front 190

Treatment of Postherpetic Neuralgia (PHN)?

Back 190

1) TCA: Desipramine, Amitriptyline

2) Topical Capsaicin

3) Gabapentin

4) Long-acting Oxycodone

Front 191

The incidence of herpes zoster recurrence increases with?

Back 191

1) Advancing Age

2) Co-morbid Disease Conditions

3) Trauma

4) Chemotherapy

5) Immunosuppression

6) Any Other Stressful Situations

Front 192

Adults with mental retardation are allowed to make decisions for themselves unless?

Back 192

1) Guardianship has been established

2) If the patient lacks capacity

Front 193

Best Method for diagnosing Parkinson's Disease?

Back 193

Physical Examination demonstrating at least 2/3 cardinal Parkinson's Disease manifestations?

1) Tremor
2) Bradykinesia
3) Rigidity

Unilateral side of onset and persistent asymmetry of symptoms are also suggestive.

Front 194

Initial Treatment for Parkinson's Disease?

Back 194

Dopamine Agonist: Pramipexole

Particularly in younger patients due to concerns about the long-term efficacy and side effects of levodopa (eg, levodopa-related dyskinesia).

Front 195

Medication used to prolong the effects of levodopa?

Back 195

Entacapone

Catechol-O-Methyl Transferase (COMT) Inhibitor

Front 196

What are the indications for antiviral medications for influenza infections?

Back 196

Oseltamivir

1) Patient requires hospitalization
2) Develops lower respiratory symptoms
3) Has underlying high risk medical conditions
4) Started within 48 hours of symptom onset

Front 197

Increased Radioactive Iodine Uptake (RAIU) is associated with?

Back 197

1) Grave's Disease

2) Toxic Adenoma

Where there is increased synthesis of thyroid hormone, whereas thyroiditis involves the release of preformed thyroid hormone 2/2 an inflammatory or destructive process.

Front 198

THYROIDITIS:

Exquisitely tender thyroid gland and history of recent viral infection.

Back 198

Subacute Granulomatous (DeQuervain's) Thyroiditis

Front 199

THYROIDITIS:

Initially results in hyperthyroidism, followed by hypothyroidism, has a low RAIU, is painless, and may have positive anti-TPO antibodies.

Back 199

Postpartum Thyroiditis

Low RAIU = Thyroiditis

High RAIU = Thyroid Hormone Synthesis

Front 200

What is Subclinical Thyrotoxicosis?

Back 200

Suppressed TSH Levels with Normal Thyroid Hormone Levels

Front 201

Most common causes of Subclinical Thyrotoxicosis?

Back 201

1) Treatment with Levothyroxine

2) Grave's Disease

3) Thyroiditis

Front 202

Management of patients with subclinical thyrotoxicosis (mildly suppressed TSH, but normal T4, T3), no symptoms, normal heart rhthym, and normal bone density?

Back 202

Recheck thyroid function test in 6-8 weeks.

Not intensively investigated because there is a high chance of normalization of TSH levels.

Front 203

What is most strongly associated with abdominal aortic aneurysm (AAA) formation, expansion, and rupture?

Back 203

#1 Cigarette Smoking

2) Male
3) Older Age
4) White
5) Family h/o AAA
6) Atherosclerotic Disease

Front 204

DIAGNOSIS:

Dyspnea, persistent cough, facial fullness and neck pain that progresses into hoarseness, dysphagia, chest pain and syncope.

Back 204

Superior Vena Cava Syndrome (SVCS)

80% of cases are due to bronchogenic carcinoma

Front 205

Best diagnostic test for Superior Vena Cava Syndrome (SVCS)?

Back 205

Contrast CT scan of chest and neck

Front 206

When is Carotid Endarterectomy (CEA) indicated?

Back 206

Patients with symptomatic carotid artery stenosis >70% since it results in reduced risk of stroke and death.

Front 207

Management of patients with mild acute pancreatitis?

Back 207

Conservatively with adequate pain control and IV fluid resuscitation.

Front 208

TREATMENT:

Severe Necrotizing Pancreatitis

Suspected Pancreatic Infection

Back 208

Imipenem

People rarely use the combination of:
Ampicillin + Gentamycin + Metronidazole

Front 209

DIAGNOSIS:

Lower extremity petechiae and isolated thrombocytopenia

Back 209

Immune Thrombocytopenic Purpura (ITP)

- Platelet Autoantibodies, most often directed against membrane proteins (eg, GPIIb/IIIa)

Front 210

DIAGNOSIS:

Thrombocytopenia, schistocytes on peripheral smear, elevated lactate dehydrogenase, acute renal failure, and neurologic abnormalities.

Back 210

Thrombotic Thrombocytopenic Purpura (TTP)

Microangiopathic Hemolytic Anemia

Front 211

Immune thrombocytopenic purpura (ITP) is acute and self-limiting in children, but usually becomes a chronic disorder in adults.

When is corticosteroid therapy indicated?

Back 211

Patients with symptoms and/or platelet count <30,000/uL

IVIG can be considered in patients who have failed or have contraindications to steroid therapy or require a more rapid increase in platelet counts.

Front 212

COMMON ASSOCIATION:

New Onset RBBB

Back 212

Large Pulmonary Embolism

Front 213

COMMON ASSOCIATION:

New LBBB on EKG in patient with acute chest pain

Back 213

Suggestive of Acute Myocardial Infarction

Should be managed aggressively with Coronary Angiography and medical therapy.

Front 214

Main supply to left bundle branch?

Back 214

Left Anterior Descending Artery (LAD)

Complete blockage of the artery can cause a new LBBB on EKG (New Anterior MI)

Immediate Coronary Angiography

Front 215

Most helpful test for diagnosing Intussusception?

Treatment?

Back 215

Ultrasound
Nearly 100% Sensitive and Specific

Air or water soluble contrast enema

Front 216

Initial test of choice in women <30 with a breast mass on clinical exam?

Back 216

Ultrasound in Women <30

Simple Cyst: Needle Aspiration (optional)

Complex Cyst/Mass: Core Needle Biopsy

Front 217

Initial test of choice in women >30 with a breast mass on clinical exam?

Back 217

Mammogram & Ultrasound

Suspicious for Malignancy: Core Needle Biopsy

Front 218

CRITERIA:

Spontaneous Bacterial Peritonitis (SBP)

Back 218

>250 neutrophils/mm3 in ascitic (peritoneal) fluid of patient with nephrotic syndrome or cirrhosis

Front 219

TREATMENT:

Spontaneous Bacterial Peritonitis (SBP)

Back 219

1) Lactulose

2) Empiric Antibiotic Therapy while culture results are pending

Front 220

Most commonly used calculation to predict mortality in patients with liver disease?

Back 220

Model for End-Stage Liver Disease (MELD)

90 Day Mortality

Bilirubin, INR, Serum Creatinine

Assess candidates for Liver Transplant and TIPS placement

Front 221

Allergen most frequently associated with asthma?

Back 221

1) House Dust Mites

2) Cat Allergens
3) Dog Allergens
4) Cockroach Allergens

Front 222

When do swallowed button batteries need to be removed under direct endoscopic visualization?

Back 222

Button batteries lodged in the esophagus.

Batteries in the stomach usually pass without complications.

Front 223

DIAGNOSIS:

Bleeding between the endometrium and the gestational sac

Back 223

Subchorionic Hematoma

Appear on sonography as crescent-shaped hypoechoic regions adjacent to the gestational sac

Most commonly identified source of first trimester bleeding.

Front 224

MANAGEMENT:

Subchorionic hematoma discovered on ultrasound

Back 224

Repeat ultrasound in one week

Front 225

Women with subchorionic hematoma are at increased risk of?

Back 225

Spontaneous Abortion

Other adverse outcomes of first trimester bleeding:
preterm births, premature rupture of membranes, growth restriction

Front 226

DIAGNOSIS:

Aggressive, malignant cancer in the uterus that only occurs after pregnancy

Back 226

Gestational Trophoblastic Disease

Common symptoms: continued vaginal bleeding in a women with recent history of hydatidiform mole, abortion, or term pregnancy.

Increased risk with large size, increased maternal age, and earlier gestational age.

Front 227

The probability that a positive test correctly identifies an individual who actually has the disease.

Back 227

Positive Predictive Value (PPV)

High specificity increases the PPV.

"SpPin"

Front 228

What increases the NPV of a test?

Back 228

High Sensitivity increases the NPV

Rules Out the Diagnosis

"SnNout"

Front 229

The probability for a given test result to occur in a patient with the target disorder compared to the probability for the same result to occur in a patient without the target disorder.

Back 229

Likelihood Ratio (LR)

LR+ = Sensitivity / (1 - Specificity)
(Likelihood for a positive result)

LR- = (1-Sensitivity) / Specificity

Front 230

What are the advantages for Likelihood Ratios?

Back 230

The Likelihood Ratio (LR) is the only epidemiological testing parameter that has both direct clinical significance and does not change as the prevalence changes.

Can also be used to grade the clinical significance of various results when more than two different test results are possible.

Front 231

Bias that occurs when a study selectively verifies (or excludes) by gold standard testing a positive (or negative) result of preliminary testing.

Back 231

Verification (Workup) Bias

This can result in overestimates of sensitivity (or specificity)

Front 232

Bias that occurs when an observer responsible for recording results is influenced by prior knowledge or details of the study.

How is this bias reduced?

Back 232

Observer Bias

Blinded studies

Front 233

Bias that occurs when the control group unintentionally receives the treatment or the intervention, thereby reducing the difference in outcomes between the control and treatment group.

Back 233

Contamination Bias

Front 234

Bias that results from the manner in which study participants are selected or lost to follow-up.

What decreases this bias?

Back 234

Selection Bias

Randomization

Front 235

Bias where experimental and control groups differ from a prognostic standpoint, possibly due to unforeseen confounding variables.

How is this bias reduced?

Back 235

Susceptibility Bias
(type of selection bias)

Randomization

Front 236

What is chorionic villus sampling (CVS) useful for?

Back 236

CVS is done by performing a biopsy of the placenta for DNA or chromosomal analysis.

Useful for prenatal diagnosis of genetic disorders such as Down's Syndrome.

Front 237

MANAGEMENT:

Newborn with spina bifida

Back 237

Immediate Neurosurgical Evaluation

Lesion must be closed within first 24-48 hours

Front 238

Testing for Lyme Disease?

Back 238

1) ELISA

2) Western Blot for confirmation

Front 239

TREATMENT:

Lyme Disease

Back 239

LOCALIZED LYME DISEASE
Oral Doxycycline, Amoxicillin or Cefuroxime

IV Ceftriaxone is required if there is carditis or neurologic symptoms other than cranial nerve palsy.

Front 240

When is NPV highest?

Back 240

NPV is high if the pre-test probability of the disease is low.

EX: the NPV is higher for a woman with a negative HIV test from the low-risk group, than from the high-risk group.

Front 241

What is indicated for the treatment of renal osteodystrophy & hypoparathyroidism?

Back 241

Calcitriol
(1,25 Dihydroxy Vitamin D)

Front 242

Indications for treatment of Paget's Disease?

Back 242

1) Bone pain
2) Weightbearing bones
3) Neurological compromise
4) Hypercalcemia
5) Hypercalciuria
6) CHF

Front 243

Treatment for Paget's Disease?

Back 243

Bisphosphonates

Alendronate
Risedronate
Pamidronate

Front 244

TREATMENT:

Agnogenic Myeloid Metaplasia (AMM)

Back 244

Allogenic Hematopoietic Cell Transplantation (allo-HCT)

Front 245

MICROCYTIC ANEMIA:

↑ Iron
↑ Ferritin
↓TIBC
↑↑ % Saturation
↓↓ MCV

Back 245

MICROCYTIC ANEMIA:

THALASSEMIA
↑ Iron
↑ Ferritin
↓TIBC
↑↑ % Saturation
↓↓ MCV

Front 246

MICROCYTIC ANEMIA:

↓ Iron
↓ Ferritin
↑TIBC
↓ % Saturation
↓ MCV

Back 246

MICROCYTIC ANEMIA:

IRON DEFICIENCY
↓ Iron
↓ Ferritin
↑TIBC
↓ % Saturation
↓ MCV

Front 247

MICROCYTIC ANEMIA:

↓ Iron
Nl or ↑ Ferritin
↓ TIBC
Nl or ↓ % Saturation
Nl or ↓ MCV

Back 247

MICROCYTIC ANEMIA:

ANEMIA OF CHRONIC DISEASE (ACD)
↓ Iron
Nl or ↑ Ferritin
↓ TIBC
Nl or ↓ % Saturation
Nl or ↓ MCV

Front 248

MEDICATION:

Counteracts the effects of antifolate drugs such as methotrexate used in autoimmune disorders and cancer.

Back 248

Folinic Acid (Leucovorin)

Front 249

Indications for Plasmapheresis?

Back 249

Reduces levels of circulating autoantibodies:

1) Guillain-Barre Syndrome
2) Myasthenia Gravis
3) TTP

Front 250

Indications for Splenectomy?

Back 250

Patients with hypersplenism and hemolytic anemia:

1) Autoimmune hemolytic anemia

2) Hereditary Sperocytosis

Front 251

MEDICATION:

Improve anemia of chronic disease (inflammation) in patients with rheumatoid arthritis

Back 251

Anti-TNF-α Agents

Infliximab

Front 252

Clues to metastatic brain lesions versus primary brain tumors on radiographic imaging?

Back 252

Contrast-Enhanced MRI:

1) Presence of multiple, well-circumscribed lesions

2) Relatively large amount of vasogenic edema as compared to the size of the lesion

Front 253

What is the recommendation for pilots taking Viagra before flights?

Back 253

US Federal Aviation Authority (FAA) recommends waiting for a period of 6 hours before a flight after taking Viagra.

Due to side effect on blue-green color vision ("blue haze") and inability to distinguish blues and greens in the cockpit instruments.

Front 254

Normal response of caloric stimulation of the vestibular apparatus, performed by irrigation of the external auditory canal with cold water?

Back 254

Normal Response:
Transient, conjugate, slow deviation of gaze to the side of the stimulus (brainstem-mediated), followed by saccadic correction to the midline (cortical correction).

Front 255

How can psychogenic coma be diagnosed?

Back 255

Normal Oculovestibular Response with Caloric Stimulation Testing.

A caloric response cannot be voluntarily suppressed.

Front 256

Primary physical exam finding in patients with idiopathic intracranial hypertension?

Back 256

Idiopathic Intracranial Hypertension
(Pseudotumor cerebri)

Papilledema on Ophthalmoscopic Examination

Often present with headaches, typically seen in overweight women of childbearing age.

Negative neuroimaging study (except an empty sell) and an elevated opening pressure on lumbar puncture can help to confirm the diagnosis.

Front 257

BACK PAIN:

Brief and shooting back pain provoked by bending forward and straining.

Positive straight-leg raising test at 60 or less is usually present.

Back 257

Nerve Root Irritation (Radiculopathy)

Front 258

BACK PAIN:

Neurogenic claudication

Pain increases with extension of the spine and decreases with flexion of the spine

Back 258

Spinal Stenosis

Front 259

BACK PAIN:

Night pain

Back 259

Night pain is considered an "alarm" symptom and may indicate the presence of malignancy, infection, or vertebral fracture.

Front 260

BACK PAIN:

Morning stiffness

Back 260

Inflammatory Disease

Front 261

BACK PAIN:

Trigger points

Back 261

Fibromyalgia

Front 262

UTI:

If the infecting organism is different from that of the original infection

Back 262

Recurrence

Front 263

UTI:

If the infecting organism is the same original infecting organism within 2 weeks of completion of treatment.

Back 263

Relapse

Front 264

UTI:

If an infection with the same organism occurs 2 weeks after completion of antibiotic therapy.

Back 264

Recurrent infection

Front 265

When are prophylactic antibiotics indicated for patients with recurrent UTIs?

Back 265

When patients experience at least 2 infections in 6 months, and are used for periods ranging from 6-12 months.

Front 266

When should urine cultures be performed for patients with recurrent UTIs?

Back 266

Before and after antibiotic treatment.

Should ensure that the urine culture is negative before starting prophylactic antibiotics.

Front 267

Side effects associated with Gingko biloba?

Back 267

Gingko is most notorious for increasing the risk of bleeding and its potentiation of the effects of anticoagulant therapy through various mechanisms, including inhibition of platelet-activating factor.

Seizures, Headaches, Irritability, Restlessness, Diarrhea, Nausea, and Vomiting.

Front 268

ACUTE OTITIS MEDIA (AOM):

3 Common Bacteria

Back 268

1) Streptococcus pneumonia

2) Nontypeable Haemophilus influenzae

3) Moraxella catarrhalis

Front 269

ACUTE OTITIS MEDIA:

Clinical Features

Back 269

1) Middle Ear Effusion

2) Bulging Tympanic Membrane

Front 270

ACUTE OTITIS MEDIA (AOM):

Treatment

Back 270

Initial: Amoxicillin

Recurrent AOM:
- Amoxicillin-Clavulanic Acid
- beta-lactamase resistance

Front 271

ACUTE OTITIS MEDIA (AOM):

Complications

Back 271

1) Conductive Hearing Loss

2) Mastoiditis

3) Meningitis

Front 272

DIAGNOSIS:

Chronic, autoimmune inflammatory condition that primarily affects the lacrimal glands (keratoconjunctivitis sicca) and salivary glands (xerostomia).

Back 272

Sjogren's Syndrome

Front 273

DIAGNOSIS:

"Gritty, burning sensation" and conjunctival irritation in patients with Sjogren's Syndrome

Back 273

Keratoconjunctivitis Sicca

2/2 abnormal tear production by the lacrimal glands.

May also present with prominent bulbar blood vessels and stringy discharge from the eyes.

Front 274

Antibodies a/w Sjogren's Syndrome?

Back 274

Anti-Ro/SSA

Anti-La/SSB

Front 275

Test used to confirm the diagnosis of keratoconjunctivitis sicca?

Back 275

Schirmer Test

Filter paper placed along the lower eyelid and wetting of the paper is measured after a defined period of time.

Front 276

DIAGNOSIS:

Focal submandibular mass in patient with Sjogren's syndrome

Back 276

B-Cell Non-Hodgkin's Lymphoma

Sjogren's disease results in polyclonal B cell activation and infiltration of the salivary glands, which can develop into B-cell lymphoma.

Front 277

MANAGEMENT:

If a perimenopausal patient complains of an episode of heavy dysfunctional bleeding or of 6 or more months of irregular menses.

Back 277

Vaginal Ultrasound to ensure endometrial thickness is <4mm
or
Endometrial Biopsy

Front 278

First-line Psychotherapy for OCD?

Back 278

Exposure and Response Prevention

Form of CBT

Front 279

TREATMENT:

Obsessive-Compulsive Disorder (OCD)

Back 279

SSRI Antidepressants & TCA Clomipramine

Fluoxetine, Sertraline, Paroxetine, Fluvoxamine, Citalopram, Escitalopram

High doses and prolonged therapeutic trials are typically required. Gradual up-titration is necessary to enhance tolerability.

Front 280

Testing that should be initially performed in all persons exposed to patients with tuberculosis?

Back 280

Tuberculin Skin Testing (PPD)

Front 281

Risk Factors for Ovarian Torsion?

Back 281

1) Pregnancy
2) Ovulation Induction during Infertility Treatment
3) Ovarian Masses

Right-sided torsion is more common due to the longer length of the right utero-ovarian ligament and because the rectosigmoid colon occupies the space around the left ovary.

Front 282

Essential laboratory studies in a patient with an adrenal mass?

Back 282

1) Serum electrolytes
2) Dexamethasone suppression testing
3) 24-hour urine catecholamine
4) Metanephrine
5) Vanillylmandelic acid
6) 17-Ketosteroid

Front 283

Surgical excision is recommended for what types of adrenal tumors?

Back 283

1) Functional Tumors

2) Malignant Tumors: demonstrating a characteristic heterogeneous appearance on imaging

3) Tumors >4cm

Front 284

What is the progression of herpes zoster?

Back 284

1) Prodromal phase: fever, malaise, headache, localized pain

2) Vesicular Eruption several days later
- Vesicles appear along thoracic and lumbar dermatomes
- Evolve into pustules before crusting in about 7-10 days

Front 285

TREATMENT:

Herpes Zoster

Back 285

Acyclovir

Treatment should be initiated based on clinical suspicion within 48 hours of the onset of rash for maximum efficacy.

Front 286

Relative Risk (RR) Equation

Back 286

RR =

Risk Exposed
--------------------------
Risk Unexposed

Front 287

Attributable Risk Percent (ARP) Equation

Also called Etiologic Fraction, and is a measure of excess risk.

It estimates the proportion of the disease in exposed subjects that is attributed to exposure status.

Back 287

ARP =

Risk Exposed - Unexposed
------------------------------------------
Risk Exposed


ARP = (RR-1)/RR

Front 288

Population Attributable Risk Percent (PARP) Equation

Back 288

PARP =

Risk Total Population -
Risk Exposed
-------------------------------------
Risk Total Population

Risk Total Population =
(Prevalence Exposed x RE) + (Prevalence Exposed x RU)

Front 289

What is a good alternative source of calcium (vs. milk) for patients with lactose intolerance?

Back 289

Yogurt

Fermented milk and live cultures in yogurt contain beta-galactosidase, which is well tolerated in these patients.

Front 290

Exercise recommendations in pregnancy?

Back 290

All healthy pregnant women with uncomplicated pregnancies are encourage to exercise for 30 minutes daily at a moderate intensity that allows the mother to carry on conversation while exercising.

Scuba diving is not recommended during pregnancy.

Front 291

Most common cause of infant botulism, a flaccid neuropathy?

Back 291

Ingestion of microscopic environmental dust containing Clostridium botulinum spores.

High soil botulism spore counts are highest is California, Pennsylvania, and Utah, especially in areas where soil is disturbed (construction or farming).

Front 292

What are the clinical manifestations of infant botulism?

Back 292

1) Constipation
2) Cranial nerve palsies (ptosis, pupillary paralysis, weak suck)
3) Progressive hypotonia
4) Loss of deep tendon reflexes

Front 293

TREATMENT:

Infant Botulism

Back 293

1) Supportive Care

2) IV Human-Derived Botulism Immune Globulin

Antibiotics (especially aminoglycosides) should not be administered due to potential lysis of colonic Clostridium botulinum and increase in toxin absorption.

Front 294

PROGNOSIS:

Infant Botulism

Back 294

A complete recovery can be expected if the diagnosis of infant botulism is made early in the course of the illness and human-derived botulism immune globulin, nasogastric tube feeds, respiratory support (if needed), and intensive care are provided promptly.

Most infants will require hospitalization for 1-3 months.

Front 295

Gold Standard for Diagnosis of Upper GI Hemorrhage caused by Mallory-Weiss Tear?

Typical Finding?

Back 295

Endoscopy

Longitudinal tear at the gastro-esophageal junction

Also allows for therapeutic interventions (thermal coagulation, sclerotherapy and band ligation) to stop the bleeding.

Front 296

MANAGEMENT:

Patient with Mallory-Weiss tear that is not actively bleeding

Back 296

Observation

Supportive Care

Front 297

What is the most common anatomical predisposing risk factor for Mallory-Weiss tear?

Back 297

Hiatal Hernia

Precipitating factors include retching, vomiting, straining, hiccuping, coughing, primal scream therapy, blunt abdominal trauma, cardiopulmonary resuscitation, and diagnostic or therapeutic manipulation (eg, endoscopy).

Front 298

TREATMENT:

Patient on anticoagulation with symptoms of venous thrombosis and non-therapeutic INR

Back 298

Start on IV Heparin or SQ LMWH until a therapeutic INR is achieved with Warfarin.

Such cases should not be considered anticoagulation failures that warrant placement of an IVC filter.

Front 299

Most common forms of intentional head trauma (IHT)?

Mechanism?

Back 299

Shaken Baby Syndrome (SBS)

Acceleration-Deceleration Injuries as the brain collides against the inside of the cranium.

Front 300

Common finding in the majority of infants with shaken baby syndrome?

Back 300

Bilateral Retinal Hemorrhage

Front 301

Best method for evaluating infants with intentional head trauma?

Back 301

CT Head is fast and cost effective.

It can detect subdural, subarachnoid intracerebral hemorrhages, and cerebral edema.

Front 302

Diagnostic Test of Choice for Pulmonary Embolism

Back 302

CT Angiogram of the Chest

Unless the patient has an elevated creatinine or contrast allergy.

Front 303

What cardiac enzyme may be elevated in patients with large PE?

Back 303

Troponin in the case of large pulmonary emboli with resulting right heart strain.

Front 304

The most important prognostic factor in pulmonary embolism patients?

Back 304

1) Hypotension, which is seen in patients with massive emboli.

2) Elevated Troponins suggest a large embolus causing right heart strain and myocyte death.

Front 305

TREATMENT:

Pulmonary Embolism

Back 305

Anticoagulation initially with low molecular weight heparin (LMWH) or unfractionated heparin followed by initiation of warfarin.

Front 306

When is fibrinolytic therapy used in patients with pulmonary embolism?

Back 306

Persistent hypotension after receiving heparin therapy.

Front 307

When are IVC filters used in patients with pulmonary embolism?

Back 307

In patients with contraindication to anticoagulation.

Front 308

MANAGEMENT:

Hemoptysis in patients with pulmonary embolism?

Back 308

A small amount of hemoptysis is normal, particularly if infarction has occurred.

The treatment regimen should not be altered for a small amount of hemoptysis.

Front 309

What are the 5 stages in the Stages of Change Model used in Motivational Interviewing?

Back 309

STAGES OF CHANGE MODEL

1) Precontemplation
2) Contemplation
3) Preparation
4) Action
5) Maintenance

Front 310

What effect does Amiodarone have on thyroid function?

Back 310

Amiodarone decreases the conversion of T4 to T3, which leads to ↓T3 and ↑T4 levels.

Can also cause hypothyroidism and thyrotoxicosis (↓TSH) due to high iodine content.

Front 311

Which beta blocker is preferred in thyrotoxic emergencies?

Back 311

Propranolol, a non-cardioselective beta blocker, which decreases the conversion of T4 to T3.

Front 312

What labs indicate that a patient has been exposed to Hepatitis B and not just the vaccine?

Back 312

anti-HBc

Exposure to the vaccine only produces antibodies to the surface component and not the core component.

Front 313

What labs should be ordered in patients with an isolated elevated level of anti-HBc antibody?

Back 313

1) Repeat Hepatitis B Panel to r/o false positive result

2) Check anti-HBc IgM and Liver Function Tests to determine acuity of the infection.

Front 314

What may be the only positive result in the Hepatitis B Panel in patients with acute infection during the "window period?"

Back 314

anti-HBc

Front 315

What is the best evaluation for suspected osteoporosis?

Back 315

Central Bone Density Measurement (hip and lumbar spine) using DEXA.

Dual-Energy X-ray Absorptiometry (DXA, previously DEXA) is a means of measuring bone mineral density (BMD)

Front 316

What are the bone mineral density scores used in postmenopausal Caucasian women for:

Normal
Osteopenic
Osteoporosis

Back 316

T-SCORES FOR BMD:

Normal: >1.0

Osteopenic: -1.0 to -2.5

Osteoporosis: < -2.5

Front 317

What is the recommended treatment for all patients with less than normal T-scores for bone mineral density?

Back 317

Optimal Calcium & Vitamin D Intake

Front 318

When is antiresorptive therapy indicated for patients with low bone mineral density T-scores?

Back 318

Antiresorptive Therapy is indicated in all patients with fragility fractures, irrespective of bone mineral density.

Front 319

What is the most important step in the evaluation of monoarticular joint effusion?

Back 319

Synovial Fluid Aspiration

To r/o destructive forms of bacterial arthritis.

In endemic areas, Lyme serology (ELISA, then Western Blot) should be performed on all patients.

Front 320

TREATMENT:

Lyme Arthritis

Back 320

Oral Amoxicillin or Doxycycline

28-Day Course

Front 321

PROGNOSIS:

Lyme Arthritis

Back 321

Most patients are disease-free within 6-12 months with 28-Day Course of Oral Amoxicillin or Doxycycline.

Front 322

TREATMENT:

Onychomycosis

Back 322

1) Oral Terbinafine (Lamisil)
2) Itraconazole

Considered superior methods. Previously Griseofulvin was the drug of choice.

Front 323

Highest Risk Factor for Pelvic Inflammatory Disease (PID)?

Back 323

Multiple Sexual Partners
- 4.6-20 fold increased risk

Other Risk Factors:
Lack of barrier contraception, age <35, h/o previous episodes of PID, and possibly vaginal douching.

Front 324

TREATMENT:

Asymptomatic Patient with Gallstones

Back 324

Observation

Front 325

TREATMENT:

Patient with Small Gallstones and Mild Symptoms

Back 325

Ursodeoxycholic Acid

Front 326

TREATMENT:

Patient with Large Symptomatic Cholesterol Gallstones

Back 326

1) Extracorporeal Lithotripsy

2) Cholecystectomy

Front 327

TREATMENT:

High-Risk Patients with Gallstones

Non-Cholesterol Gallstones

Back 327

Endoscopic Electrohydraulic Lithotripsy

Front 328

When should screening for breast cancer with regular mammography begin?

Back 328

Age 50

Front 329

MANAGEMENT:

Restore Fertility in Patient with Polycystic Ovarian Syndrome (PCOS)

Back 329

Weight Reduction in Overweight or Obese Patients

If weight reduction fails, Clomiphene Citrate can be tried.

Front 330

What is the power of a study?

How can it be increased?

Back 330

Power of a study is the ability to detect the difference between two groups (treated vs non-treated, exposed vs non-exposed).

Increasing the sample size increases the power of a study. As a result, the confidence interval of the point estimate (eg, odds ratio) becomes tighter.

Front 331

HIV patients with CD4 levels <200/μL should receive what prophylaxis?

Back 331

PCP Prophylaxis

TMP-SMX

Front 332

HIV patients with CD4 levels <50/μL should receive what prophylaxis?

Back 332

MAC Prophylaxis

Azithromycin or Clarithromycin

Front 333

TREATMENT:

Lactating Women Infected with Trichomonas

Back 333

Metronidazole 2g PO x1

Discontinue Breastfeeding for 12-24 hours.

Front 334

what must the workup for dementia include?

Back 334

Reversible causes of cognitive decline must first be ruled out, including Hypothyroidism and B12 Deficiency.

Front 335

TREATMENT:

Alzheimer's Dementia

Back 335

Acetylcholinesterase Inhibitors (ACEIs)

Donepezil, Tacrine

Patients have decreased levels of Ach due to degeneration of the basal nucleus of Meynert and diffuse deficiency of choline acetyltransferase, which is responsible for synthesis of acetylcholine.

Front 336

What advantages does Donepezil offer over Tacrine for treatment of Alzheimer's Dementia?

Back 336

DONEPEZIL

- Once a day dosing

- More improvement in behavioral and cognitive domains

- Fewer side effects

Front 337

DIAPER RASH:

Tomato-red plaques

Satellite papules

Back 337

Candidal Diaper Rash

Front 338

TREATMENT:

Candidal Diaper Rash

Back 338

ANTIMYCOTIC CREAM:

1) Clotrimazole

2) Nystatin

Front 339

How can candidal diaper rash be distinguished from diaper dermatitis?

Back 339

Candidal Diaper Rash has compromise of genitocrural folds.

Diaper dermatitis affects the same area, but usually spares the crural folds.

Front 340

TREATMENT:

Diaper Dermatitis

Back 340

Zinc Oxide Creams

Petrolatum Ointment

Front 341

What patient population is typically effected by Hemophilia?

Back 341

Hemophilia is an X-linked recessive disorder that occurs almost exclusively in males.

A female may acquire it only if her father is a hemophiliac and her mother is a carrier who transmits the abnormal allele to her.

Front 342

What chance do sons have of getting Hemophilia if their father is a hemophiliac?

Back 342

None.

He will transmit his abnormal X gene to all his daughters and they will all be carriers.

Front 343

If a mother is a carrier for Hemophilia, what are the chances that her sons will get the disease?

Her daughters?

Back 343

Her daughters have a 50% chance of being carriers.

Her sons have a 50% chance of getting the disease.

Front 344

DIAGNOSIS:

Hypopigmented spots and family history of bilateral deafness

Back 344

Neurofibromatosis Type 2 (NF-2)

The cafe-au-laits spots are hypopigmented, unlike the hyperpigmented spots in NF-1.

Deafness is caused by bilateral acoustic neuromas.

Front 345

DIAGNOSIS:

Congenital hypopigmented maculae (ash-leaf spots), glial proliferation, several organ hamartomas/cysts.

Back 345

Tuberous Sclerosis

Front 346

DIAGNOSIS:

Facial port-wine stain and leptomeningeal angiomatosis

Back 346

Sturge-Weber Syndrome

Front 347

DIAGNOSIS:

Multiple telangiectasias and vascular lesions of the CNS.

Back 347

Osler-Rendu-Weber Syndrome

Front 348

Complication of Bacterial Conjunctivitis?

Back 348

Keratitis

Inflammation of the cornea, which can occur by direct spread of the infection from the overlying conjunctiva and should be suspected in patients with photophobia, foreign body sensation in the eyes, or corneal opacities/ulcerations.

Front 349

What is the difference between Keratitis and Conjunctivitis?

Back 349

Conjunctivitis involves only the thin conjunctival membrane overlying the cornea.

Keratitis is inflammation of the cornea and is more common in patients who wear contact lenses.

Front 350

DIAGNOSIS:

Acquired through an open wound to the eye (post-cataract surgery, post-traumatic) or a systemic route and involves the deeper components of the eye including the vitreous and aqueous humors.

Back 350

Endophthalmitis

Front 351

Lens dislocation is associated with?

Back 351

1) Trauma

2) Marfan Syndrome

3) Ehlers-Danlos

4) Homocystinuria

Front 352

DIAGNOSIS:

Red eye, decreased vision, seeing halos around lights, and severe headache and eye pain.

Back 352

Acute Angle Closure Glaucoma

Front 353

What is the rationale for antibiotic treatment of bacterial conjunctivitis, as it is usually a self-limiting disease?

Back 353

1) Shorten the course of the disease

2) Decrease person-to-person contact

3) Decrease risk of complications such as keratitis

Front 354

What is the key distinction between bacterial conjunctivitis and viral or allergic conjunctivitis?

Back 354

Mucopurulent Discharge makes bacterial conjunctivitis the most likely diagnosis.

It is important to differentiate the purulent discharge of bacterial conjunctivitis from the simple morning crusting followed by watery discharge that can be seen in viral or allergic conjunctivitis.

Front 355

What can help distinguish viral conjunctivitis from bacterial?

Back 355

Viral conjunctivitis, often caused by Adenovirus, frequently has other sytemic manifestations such as fever, pharyngitis, and upper respiratory symptoms.

It is also typically bilateral.

Front 356

Most common microbiologic causes of bacterial conjunctivitis?

Back 356

1) Staphylococcus aureus
2) Streptococcus pneumonia
3) Moraxella catarrhalis
4) Haemophilus influenzae

Front 357

TREATMENT:

Bacterial Conjunctivitis

Back 357

1) Erythromycin Ointment
2) Sulfa Drops
3) Polymixin/Trimethoprim Drops

1) Staphylococcus aureus
2) Streptococcus pneumonia
3) Moraxella catarrhalis
4) Haemophilus influenzae

Front 358

TREATMENT:

Bacterial Conjunctivitis for Contact Lens Wearers

Back 358

Fluoroquinolones such as Ciproflaxacin because of their increased activity against Pseudomonas, which is a common pathogen in these patients.

Front 359

What distinguishes Allergic Conjunctivitis from other causes of conjunctivitis?

Treatment?

Back 359

1) Watery discharge
2) Itching

Antihistamines

Front 360

What medication should be avoided in patients with conjunctivitis?

Back 360

Primary care providers should generally not prescribe corticosteroids in these cases without opthalmologic referral.

Front 361

How long should children with conjunctivitis wait before returning to school since bacterial conjunctivitis is so contagious?

Back 361

Ideally patients should stay away from work or school while discharge is present.

A minimum of 24 hours of antibiotic therapy is generally required by most institutions before the individual returns to school or work.

Front 362

DIAGNOSIS:

Bowel or bladder dysfunction, saddle anesthesia, and lower extremity weakness

Back 362

Cauda Equina Syndrome

These require urgent evaluation with MRI.

Front 363

What historical features raise the possibility of malignancy in patients with back pain?

What laboratory tests are helpful after imaging studies?

Back 363

1) Age >50
2) Smoking history
3) Symptoms worse at night

ESR and CRP, although nonspecific, are reasonably sensitive for spinal metastasis or significant inflammatory conditions (osteomyelitis, inflammatory arthritis, epidural abscess).

Front 364

DIAGNOSIS:

Back pain that improves with activity, worsens with rest and at night.

Back 364

Ankylosing Spondylitis (AS)

Associated with HLA-B27

Other symptoms: Limited spinal mobility, hip and shoulder pain, peripheral arthritis, and enthesitis.

Front 365

When is MRI recommended in patients presenting with back pain?

Back 365

If there is high suspicion for infection, history of malignancy, or back pain a/w neurologic deficits.

Also useful for patients with protracted back pain that are being considered for invasive interventions.

Front 366

DIAGNOSIS:

Low-grade fever, fatigue, maculopapular rash on the face, trunk, and extremities; headache; lymphadenopathy; pharyngitis; myalgias; arthralgias; GI symptoms; night sweats; and oral ulcers or thrush.

Back 366

Acute Retroviral Syndrome
(Primary HIV Infection)

The syndrome is similar to infectious mononucleosis.

Front 367

What testing should be done if acute retroviral syndrome is suspected?

Back 367

HIV ELISA testing if often negative initially

Can be supplemented by testing for HIV RNA or p24 antigen.

Front 368

What is an important determining factor for the feasibility of a sphincter-sparing surgical procedure in patients with rectal cancers?

Back 368

1) Location of the Tumor: Proximal

2) Non-metastatic

3) Mobile, non-ulcerated

Front 369

When should an asymptomatic patient with gallstones have a cholecystectomy?

Back 369

Patients with a porcelain gallbladder due to high risk of gallbladder carcinoma.

Front 370

DIAGNOSIS:

Viral infection involving the larynx, trachea, and sometimes bronchi.

Rhinorrhea, cough, and low grade fever that progresses to harsh, barking cough; inspiratory stridor; and hoarseness.

Back 370

Croup (Laryngotracheitis)

Front 371

What patient population is most at risk for croup (laryngotracheitis)?

When is it most common?

Back 371

Children under 6, with peak incidence around age 2.

Most common during fall and winter.

Front 372

TREATMENT:

Croup (Laryngotracheitis)

Back 372

1) Corticosteroids

2) Cool mist

3) Nebulized racemic epinephrine

Front 373

DIAGNOSIS:

Anogenital warts that can manifest with pruritis, bleeding, burning, tenderness, vaginal discharge, and pain.

Back 373

Condyloma Acuminata

Human Papilloma Virus (HPV), the most common viral sexually transmitted disease in the U.S.

Front 374

How is condyloma acuminata (HPV) diagnosed?

Back 374

Visual inspection with application of acetic acid, which usually turns white, is sufficient for making the correct diagnosis.

Front 375

TREATMENT:

Condyloma Acuminata

Back 375

1) Chemical or Physical Destruction
- Trichloroacetic Acid

2) Immunotherapy
- Systemic or Topical Interferon

3) Surgical Excision

Front 376

What is not indicated in the treatment of condyloma acuminata, especially in pregnancy?

Back 376

Podophyllin, which is not indicated for internal use.

Front 377

What are important measures to prevent infection in patients with splenic dysfunction?

Back 377

1) Pneumococcal Vaccination

2) Penicillin Prophylaxis (until age 5)

These are important measure to prevent pneumococcal infection.

Front 378

What is the leading cause of hypophosphatemia in hospitalized patients?

Back 378

Continuous Glucose Infusions

The patient are usually alcoholic or otherwise debilitated.

Front 379

What are some complications of hypophosphatemia?

Back 379

1) Respiratory muscle weakness, and inability to wean off of a respirator

2) Reduces cardiac contractility

3) Leftward shift of oxyhemoglobin curve due to depletion of 2,3 diphosphoglycerate, which makes oxygen less likely to be released.

Front 380

What is the progression of hyperkalemia on ECG?

Back 380

1) Peaked T waves

2) Prolongation of the PR interval → loss of P wave

3) Widened QRS with sine wave pattern

Front 381

FIRST-LINE TREATMENT:

Hyperkalemia if severe ECG manifestations are present (ECG changes more severe than peaked T waves)

Back 381

Calcium Gluconate or Calcium Chloride

Beta-Agonists or Combination of Glucose + Insulin are then given to reduce serum potassium by driving potassium intracellularly.

Front 382

DIAGNOSIS:

Infant presents with Coombs-negative unconjugated hyperbilirubinemia in the first 24 hours of life

Back 382

G6PD Deficiency is the most common red cell enzymopathy that can lead to hemolysis.

X-linked recessive hereditary disease characterized by abnormally low levels of glucose-6-phosphate dehydrogenase, a metabolic enzyme involved in the pentose phosphate pathway, especially important in red blood cell metabolism.

It is an X-linked disorder that should be suspected in a male infant of African, Mediterranean, or Asian descent.

Front 383

When does physiologic jaundice manifest?

Back 383

24 hours after birth

Front 384

What does the Coomb's Test evaluate?

Back 384

Test for Autoimmune Hemolytic Anemia (↓RBCs)

Front 385

TREATMENT:

Symptomatic carotid stenosis of <50%

Back 385

ANTITHROMBOTIC MEDICATION:

Aspirin or Clopidogrel

Combination of warfarin + aspirin/clopidogrel have not proven to be more efficacious than aspirin or clopidogrel alone and have a much higher bleeding risk.

Front 386

TREATMENT:

Stroke patient outside of the 3-4.5 hour window for fibrinolytic therapy

Back 386

1) Aspirin

2) Permissive Hypertension up to 220/120 mmHg

Front 387

MANAGEMENT:

Acute stroke patient that presents with dysarthria and has already had head CT and/or fibrinolytic therapy

Back 387

Bedside Swallow Evaluation

Stroke patients are often at risk for oropharyngeal dysphagia and should not be given anything by mouth (food, drink, medications) until a swallow evaluation is done.

Front 388

Common cause of morbidity and mortality in patients with acute stroke?

Prevention?

Back 388

DVT and subsequent Pulmonary Embolism, particularly in patients with dense hemiparesis

Low-dose Heparin or LMWH should be used as prophylaxis in most patients with acute stroke.

Full-dose heparin is given for treatment of DVT, no prophylaxis.

Front 389

Target blood pressure in patients with hemorrhagic stroke?

Back 389

SBP ~ 140 mmHg

Front 390

POISONING:

Throbbing headaches, nausea, malaise and dizziness.

May result in seizures, syncope, coma, and delayed neuropsychiatric syndrome.

Back 390

Carbon Monoxide Poisoning

Several people simultaneously presenting with a headache is an important clue.

Front 391

EVALUATION:

Carbon Monoxide (CO) Poisoning

Back 391

Carboxyhemoglobin Level

Front 392

What testing is performed prior to blood transfusion?

Back 392

1) ABO & Rh Compatibility

2) Pretransfusion Antibody Screening to detect any of the clinically significant RBC antibodies

Front 393

What is the major difficulty in finding cross-matched blood in patients with a history of multiple transfusions?

Back 393

Alloantibodies

The most common RBC antigens are E, L, K

Front 394

TREATMENT:

Superior Sagittal Sinus Thrombosis

With hemorrhagic infarction?

Back 394

The management of patients with venous sinus thrombosis typically includes adequate anticoagulation with heparin, even if an area of hemorrhagic infarction is demonstrated on CT.

Front 395

DIAGNOSIS:

Male infant aged 3-6 weeks who develops postprandial projectile vomiting and has an olive-shaped mass in the RUQ of the abdomen

Back 395

Infantile Hypertrophic Pyloric Stenosis (IHPS)

Front 396

LAB FINDINGS:

Infantile Hypertrophic Pyloric Stenosis (IHPS)

Back 396

1) Hypokalemia
2) Hypochloremic, Metabolic Alkalosis

2/2 to loss of gastric hydrochloric acid

Front 397

EVALUATION:

Infantile Hypertrophic Pyloric Stenosis (IHPS)

Back 397

1) Ultrasound

2) Upper Gastrointestinal (UGI) Contrast Study is preferred in some medical centers

Front 398

MANAGEMENT:

Infantile Hypertrophic Pyloric Stenosis (IHPS)

Back 398

FIRST: Correct Electrolyte Derangements & Dehydration

THEN: Pyloromyotomy

Front 399

What medications are associated with the development of Infantile Hypertrophic Pyloric Stenosis (IHPS)?

Back 399

1) ERYTHROMYCIN, which is typically given as postexposure prophylaxis for pertussis

2) Use of Macrolides in breastfeeding Women

Front 400

DIAGNOSIS:

Patient with abdominal pain that lays flat and motionless

Back 400

Peritonitis

Front 401

DIAGNOSIS:

Patient with abdominal pain that writhes in pain

Back 401

Renal Colic

Front 402

EVALUATION:

Suspected bowel perforation with peritonitis

Back 402

Upright CXR to look for pneumoperitoneum, typically seen as air under the diaphragm

Front 403

MANAGEMENT:

Patients with suspected or confirmed peptic ulcer perforation

Back 403

Emergent Exploratory Laparotomy with Surgical Repair of the Perforation

Front 404

What is Ogilvie's Syndrome?

Back 404

OGILVIE'S SYNDROME
(ACUTE COLONIC PSEUDOOBSTRUCTION)

Dilation of the cecum and right colon in the absence of a mechanical obstruction to the flow of intestinal contents.

It tends to involve the right side of the colon, and not the small intestine.

Front 405

Most common cause of small intestinal obstruction in patients with a h/o abdominal surgery?

Back 405

Postoperative Adhesions

Front 406

Uncommon, but well-recognized side effect of angiotensin-converting-enzyme (ACE) inhibitors such as Ramipril.

Back 406

Angioedema, leading to facial swelling with prominent lip and tongue swelling.

ACE catalyzes the degradation of bradykinin and use of ACEIs leads to elevated levels of bradykinin that can cause angioedema and dry cough.

Front 407

MANAGEMENT:

ACE Inhibitor-related Angioedema

Back 407

Switch to Angiotensin-Receptor Blocker (ARB)

The risk of angioedema with ARBs is low. They do not affect the bradykinin system and have benefits similar to ACE Inhibitors.

Front 408

What might a speech delay represent in a child with otherwise normal devlopment.

Back 408

May indicate hearing impairment.

Front 409

DIAGNOSIS:

Leg pain in a patients who suddenly increased their physical activity level and present with localized pain to palpation and swelling

Back 409

Tibial Stress Fracture

Plain X-ray is <50% sensitive for stress fractures, especially within 2-3 weeks after the onset of symptoms.

Front 410

MANAGEMENT:

Tibial Stress Fracture

Back 410

Conservative Management:

1) Complete cessation of aggravating activities for 4-6 weeks, with gradual return to activity

2) Pain control with NSAIDS

3) Support with crutches or brace while walking.

Front 411

Best 2 Ventilator Adjustments for improving Oxygenation (Hypoxia)

Back 411

1) ↑ FiO2

2) ↑ PEEP, which can prevent atelectatic alveoli from collapsing during expiration

Used to regulate PO2

Front 412

How is the effect of PEEP monitored?

Back 412

PEEP is monitored by following PaO2/FiO2 Ratio

PEEP should be used with caution because it can cause alveolar injury and worsen hypotension since it reduces preload.

Front 413

What is used to regulate CO2 in patient on a respirator?

Back 413

1) Respiratory Rate

2) Tidal Volume

Correlate with Ventilation, which is used to regulate CO2.

Front 414

What is the earliest change in Ankylosing Spondylitis (AS) that can be seen radiographically?

Back 414

Sacroiliitis on X-ray of the Sacroiliac Joint

Other radiographic abnormalities include erosions of the ischial tuberosity and iliac crest.

Front 415

3 Important Clinical Criteria for Diagnosis of Ankylosing Spondylitis?

Back 415

1) Presence of low back pain and stiffness for >3 months that improves with exercise or activity

2) Limitation in the range of motion of the lumbar spine (Schober Testing)

3) Limitation of chest expansion relative to the normal values

Plain x-ray of the sacroiliac joint is the next best step in management of a patient suspected of AS.

Front 416

What is used to monitor disease progression in patients with Ankylosing Spondylitis?

Back 416

1) Radiographs

2) Acute Phase Reactants (ESR)

Front 417

Most Common and Important Extraarticular Manifestations of Ankylosing Spondylitis?

Back 417

1) Acute Anterior Uveitis

2) Aortic Regurgitation

3) Apical Pulmonary Fibrosis (encourage smoking cessation)

4) IgA Nephropathy

5) Restrictive Lung Disease

Front 418

What improves overall functional status in patients with rheumatologic disorders like Ankylosing Spondylitis?

Back 418

Regular Aerobic Exercise improves joint stability, muscle strength, and overall functional status without an increase in disease activity.

Postural Training and Extension helps prevent spine fusion in a flexed position.

Front 419

What is the life expectancy for patients with ankylosing spondylitis?

Back 419

Most patients with ankylosing spondylitis do well and have no functional or employment disabilities.

There is no increased overall mortality or reduced life expectancy.

Front 420

DIAGNOSIS:

Progressive cholestasis and liver failure, hyperlipidemia with xanthomas, bone disease and autoimmune phenomena

Back 420

Primary Biliary Cirrhosis (PBC)

Chronic liver disease that is most common in middle-aged women.

Front 421

EVALUATION:

Primary Biliary Cirrhosis (PBC)

Back 421

Antimitochondrial Antibodies (AMA) have high sensitivity (>90%) and specificity (98%) for PBC.

Front 422

DIAGNOSIS:

Anti-Smooth Muscle Antibodies

Back 422

Type I Autoimmune Hepatitis

Elevation of the levels of aminotransferases is typical.

Front 423

TREATMENT:

Primary Biliary Cirrhosis (PBC)

Back 423

1) Ursodeoxycholic Acid can slow the progression of PBC, improve overall survival and maybe transplantation-free survival

2) Liver Transplant is the only curative treatment

Steroids and imunosuppressive drugs aren't useful, despite the disease's apparently autoimmune nature.

Front 424

What are important complications of long-standing cholestatic disease, and of PBC in particular?

Back 424

1) Osteomalacia
2) Osteoporosis

Screening with bone densitometry, calcium supplementation and eventual treatment with vitamin D and/or bisphosphonates are essential in the patients' follow-up.

Front 425

What disease process is paradoxically low in PBC?

Back 425

Incidence of atherosclerosis is low despite the high incidence of hyperlipidemia.

Front 426

What can cholestatis in PBC lead to?

Back 426

Malabsorption of fat-soluble vitamins A, D, E, K

Front 427

TREATMENT:

Metoclopramide-induced Acute Dystonia

Back 427

IV Diphenhydramine (Benadryl) or Benztropine (Cogentin) if Benadryl is ineffective.

Metoclopramide (Reglan) is an antiemetic (useful in treating vomiting) and gastroprokinetic agent.

Front 428

What has been associated with colon cancer?

Back 428

Significant alcohol intake and cigarette smoking.

Fibrous diets rich in fruit and vegetables, regular NSAID use, hormone replacement therapy, and regular exercise are protective factors.

Front 429

DIAGNOSIS:

Drooling, difficulty initiating a swallow, a cervical location of symptoms, coughing, and ear symptoms.

Back 429

Oropharyngeal Dysphagia
(vs. esophageal dysphagia)

Barium swallow study is indicated

Front 430

What esophageal cancer is associated with chronic gastroesophageal reflux (GERD)?

Back 430

Esophageal Adenocarcinoma

Front 431

What esophageal cancer is associated with chronic alcohol and/or tobacco use?

Back 431

Esophageal Squamous Cell Carcinoma

Front 432

DIAGNOSIS:

H/o chest pain that is worsened by exertion and relieved by rest

Back 432

Stable Angina

Front 433

What is the most beneficial way to stratify risk of coronary artery disease in a patients with stable angina?

Back 433

Stress Testing

Front 434

What patients with stable angina should proceed directly to coronary angiography versus initial stress testing?

Back 434

1) High Risk Patients

2) Underlying Heart Failure

Front 435

MANAGEMENT:

Symptomatic Peripheral Arterial Disease (PAD)

Back 435

1) Lipid-lowering Therapy:
- Atorvastatin, Rosuvastatin, Simvastatin

2) Antiplatelet Therapy
- Aspirin or Clopidogrel

3) Blood Pressure Control

4) Screening/Treatment of Diabetes

5) Supervised Exercise Program

Front 436

TREATMENT:

Peripheral Arterial Disease (PAD)

Persistent Claudication Despite Adequate Exercise

Back 436

1) Cilostazol

2) Revascularization

Front 437

EVALUATION:

Suspected Spondyloarthropathy

Back 437

X-ray of the lumbosacral spine to demonstrate sacroiliitis and spondylitis.

HLA-B27 is positive in a large number of patients with spondyloarthropathy, but is not useful in confirming the diagnosis.

Front 438

Triad of Reactive Arthritis

Back 438

REACTIVE ARTHRITIS

1) Conjunctivitis

2) Urethritis

3) Spondyloarthropathy (often HLA-B27 positive)

Chlamydial cervicitis or urethritis is the most common preceding infection.

Front 439

DIAGNOSIS:

Nodular lung densities with rheumatoid arthritis

Back 439

Caplan's Syndrome

Front 440

MANAGEMENT:

Reactive Arthritis

Back 440

1) Antibiotics for acute infection

2) Progressive exercise to improve joint mobility

3) Sulfasalazine & Methotrexate as a disease-modifying agent

Front 441

Chronic ingestion of what can cause or aggravate hypertension in patients?

Back 441

Chronic Ingestion of Licorice.

Inhibits the enzyme 11-beta hydroxysteroid, preventing the conversion of cortisol to cortisone. Cortisol binds to mineralocorticoid receptors and causes hypertension, hypokalemia, and metabolic acidosis (hypercortisolism).

Front 442

Warning for patients taking Ginkgo?

Back 442

Ginkgo can interact with aspirin or warfarin, leading to a potential risk of spontaneous bleeding.

Front 443

Warning for patients taking Kava?

Back 443

Use of Kava with alcohol, benzodiazepine, or other sedatives can potentiate their effect and cause excessive drowsiness or disorientation.

Front 444

Warning for patients taking Black Cohosh?

Back 444

Used for the treatment of premenstrual syndrome and menopausal symptoms.

Excessive use can cause hypotension.

Front 445

Warning for patients taking Horse Chestnut?

Back 445

Used in patients with venous insufficiency or chronic venous stasis.

Can cause bleeding in patients taking aspirin or warfarin.

Front 446

ADA Screening Tests for Diagnosing Diabetes?

Back 446

1) Hemoglobin A1c ≥6.5%

2) Fasting Blood Sugar (>8h) ≥126 mg/dL

3) Glucose ≥200 mg/dL after Oral Glucose Tolerance Test

4) Random Glucose ≥200 mg/dL in Symptomatic Patients

Asymptomatic patients with abnormal screening test require repeat testing.

Front 447

When is Hemolytic Disease of the Newborn due to Rh-Incompatibility possible?

Back 447

ONLY IF:

Mother is Rh-Negative
AND
Father is Rh-Positive

Also unlikely in the first pregnancy because the mother is not sensitized. The mother becomes sensitized as a result of fetomaternal hemorrhage at or near the end of pregnancy.

Front 448

How can the risk of sensitization of an Rh-negative mother be reduced?

Back 448

RhoGAM injection within 72 hours of the delivery.

Front 449

What treatment will improve the cardiac condition of patients with hyperthyroidism in a thyrotoxic state?

Back 449

1) Methimazole

2) Propylthiouracil (PTU)

Inhibit the enzyme thyroperoxidase (TPO).

Front 450

DIAGNOSIS:

"Necrolytic Migratory Erythema"

Back 450

Glucogonoma

Front 451

DIAGNOSIS:

Dementia, diarrhea, dermatitis, stomatitis, and cheilosis.

Skin rash is symmetrically distributed in sun-exposed areas, and often forms vesicles and blisters.

Back 451

Pellagra

Niacin Deficiency

Front 452

DIAGNOSIS:

Rare pancreatic tumor associated with mild diabetes and a classic skin rash

Back 452

Glucogonoma

Front 453

What types of gifts are physicians allowed to accept from pharmaceutical companies?

Back 453

Gifts that potentially offer a benefit to patients and are not of substantial value.

Examples: textbooks, modest meals, and other reasonable gifts that serve an educational function.

Front 454

When can a physician accept payment from a pharmaceutical company?

Back 454

Physicians may accept payment for preparing and delivering a lecture for a pharmaceutical company.

They cannot accept stipends for attending a lecture.

Front 455

FIRST-LINE MEDICATION:

Atrial Fibrillation with Rapid Ventricular Rate:

Irregularly Irregular Rhythm with Absent P Waves

Back 455

Paroxysmal Atrial Fibrillation:

1) Calcium Channel Blockers:
- Diltiazem

2) Beta-Blockers:
- Esmolol, Metoprolol, Propranolol
- Less effective than Diltiazem

Front 456

TREATMENT:

Symptomatic Pulmonary Disease is Sarcoidosis

Especially with systemic symptoms of severe fatigue, fever, and hypercalcemia

Back 456

Corticosteroids

Methotrexate may be indicated if corticosteroids are not effective or cause intolerable side effects.

Front 457

DIAGNOSIS:

Triad of respiratory insufficiency, neurological impairment, and petechial rash (most commonly on the trunk).

Other findings include fever, tachycardia, and altered mental status.

Back 457

Fat Embolism

Typically manifests 24-72 hours after trauma.

Front 458

How can the risk of fat embolism be reduced in patients with multiple complicated fractures?

Back 458

1) Early Immobilization

2) Operative Fixation

Front 459

TREATMENT OF CHOICE:

Akathisia

Back 459

Beta Blockers

Propranolol

Front 460

TREATMENT:

Deep Venous Thrombosis (DVT)

Back 460

1) Unfractionated or LMWH

2) Warfarin is continued for 3-6 months in the case of the first DVT

Front 461

TREATMENT:

Patient on HRT with DVT

Back 461

1) Discontinue HRT

2) Warfarin for 3-6 months

Front 462

Which HRT has a greater risk of DVT?

Back 462

Combination Progestin-Estrogen Hormone Replacement

But estrogen hormone replacement still confers an elevated risk compared to the general population.

Front 463

What patient population is most susceptible to Spontaneous Bacterial Peritonitis (SBP)?

Back 463

SBP almost exclusively affects patients with advanced cirrhosis and clinically detectable ascites.

Findings include low-grade fever, abdominal pain or discomvort, or altered metnal status.

Should have low threshold for obtaining a paracentesis.

Front 464

DIAGNOSIS:

Acute chest pain following episodes of repeated vomiting.

Pneumomediastinum and pneumothorax may be present.

Back 464

Esophageal Perforation
(Boerhaave's Syndrome)

Most tears occur in the distal third of the esophagus, which leads to pleural effusion.

Front 465

Why is urgent management of esophageal perforation needed?

Back 465

Risk of Mediastinitis, which carries a mortality rate of more than 40% if not properly diagnosed within the first 24 hours.

Front 466

Best diagnostic test for esophageal perforation?

Back 466

Esophagogram with water-soluble contrast.

Test provides a definitive diagnosis in 90% of cases.

Front 467

DIAGNOSIS:

Unsteady gait that progresses to ascending paralysis over hours to days.

Back 467

Tick Paralysis

Fever and pupillary abnormalities are uncommon.

Finding the attached tick on the skin is the most important diagnostic feature and will cause a substantial improvement of the paresis within several hours in most cases.

Front 468

DIAGNOSIS:

Descending paralysis

Back 468

Botulism