Step 3, Usmle World

Front 1

HIV, low CD4 count with multiple, discrete, red-colored papules of varying size and slight central umblications.

Back 1

Cutaneous Cryptococcous; cryptococcus neoformans (fungi) --> early sign of disseminated infection check CXR, blood and CSF Cx

Front 2

small, sharply marginated, reddish brown papillose with gelatinous consistency (apple-jelly) lesions with central atrophy

Back 2

MC form of cutaneous tuberculosis (lupus vulgaris)

Front 3

How to diagnose Cutaneous Cryptococcosis

Back 3

Biopsy, histology: graulomatous inflam run with multinucleated giant cells, histiocytes, lymphocytes, neutrophils, and plasma cells with numerous yeast-like organisms

stains like PAS (periodic acid schiff) and Gomori's meth silver nitrate help identify

Front 4

Stain for CSF with suspected Cryptococcosis

Back 4

India Ink

Front 5

Low RAIU (radioactive iodine uptake) vs Increased RAIU

Back 5

thyroditis =low

graves synd (increased thyroid synthesis dzs) and toxic adenoma=increased

Front 6

Postpartum thyroiditis

- presentation?

- RAIU?

-anything else?

-painful vs painless?

Back 6

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

Front 7

Thyroid issue with Pain in thyroid

Back 7

Subacute granulomatous thyroiditis (DeQuervain's)

Front 8

Iritis

Back 8

Aka Anterior Uveitis

pain, redness, variable visual loss and constricted and irregular pupil

visualization of leukocytes in anterior segment confirms diagnosis

Front 9

leukocytes in anterior segment of eye

Back 9

Iritis aka anterior uveitis

Front 10

increased PTH and hypercalcemia

-urinary ca >200mg/day = ?

-urinary ca <100 mg/day= ?

Back 10

-urinary ca >200mg/day = primary hyperparathyroidism

-urinary ca <100 mg/day= familial hypocalcuric hypercalcemia

Front 11

actinic keratosis

-cause?

-look?

-associated with?

Back 11

- cause: sunlight

- look: unexposed areas, small, rough, erythematous and keratotic papules

-associated with squamous cell carcinoma (SCC)

Front 12

HIV; what are CD4 count indicator of? what is viral load indicator of?

Back 12

CD4: indicator of current level of immunosuppression, "the immunologic damage that has already occurred"

Viral load: good marker of disease activity or potential for future damage, "the damage that is about to occur"

Front 13

exposed to TB, PPD today negative, what to do next?

Back 13

repeat PPD 3 months

Front 14

Two step approach for screening and diagnosing GDM

Back 14

-At 24-28 weeks GA

- Step 1: 50g oral glucose check 1 hr later --> if <140 fine, no more tx; equal to or >140 then move to Step 2

-Step 2: 100g oral glucose load, check fasting serum glucose & each hr until 3 hrs --> dx with 2 abnormal values: fasting >95, 1h >180, 2 hr >155, 3 hr >140

Front 15

Treatment in GDM decreases risk for what for baby?

Back 15

- reduce risk of fetal macrosomia and shoulder dystocia

-do NOT reduce the risk of neonatal metabolic outcomes such as hypoglycemia

Front 16

If mom hx of HSV, when start antiviral therapy?

Back 16

36 weeks GA

Front 17

case fatality ratio definition

Back 17

proportion of people with a particular condition who end up dying from the condition

Front 18

Mortality rate definition

Back 18

general population's likelihood of dying from the disease

Front 19

treatment for SBP

Back 19

fluoroquinolone (ofloxacin, norfloxacin or ciprofloxacin) for 7-10 days

Front 20

patients with recent variceal bleeding, complications that lead to increased mortality are:

Back 20

-infections, hepatic encephalopathy, and renal failure

-MC complication is infection: UTI, SBP, respiratory infection, aspiration PNA, or primary bacteremia

Front 21

HUS associated with which infection

Back 21

E coli 0157:H7; shiga toxin

Front 22

DKA treatment: serum glucose <200 but still elevated anion gap, do what?

Back 22

rate of infusion should be halved and dextrose (D5) added to the IV fluids to prevent hypoglycemia

Front 23

Anion Gap calculation

?normal

Back 23

Serum Na- (serum Cl + Serum K)

normal value: 7-13

Front 24

when to add K to treatment when DKA treatment

Back 24

add IV fluids if serum K levels are <5.2

Front 25

Corrected Serum Sodium with DKA/high glucose and what values mean what

Back 25

*measured sodium + 0.016 (measured glucose-100)

* if corrected Na <135, continue NS

* if corrected Na >or = 135, change to half NS 0.45%

Front 26

When to start SQ insulin vs IV during DKA

Back 26

*switch to SQ insulin for the following: able to eat, glucose <200, anion gap <12, serum Hco3 >15

*overlap SQ and IV insulin by 1-2

Front 27

When to consider bicarb for DKA

Back 27

When pH <6.9

Front 28

When to give K for DKA

Back 28

*add IV K if serum K <5.2

*hold insulin for serum K <3.3

Front 29

Dx of pheochromocytoma

Back 29

*plasma free metanephrine

OR

*24-hour urine collection for measurement of catecholamine and metanephrine

Front 30

Tx of pheochromocytoma in attack

Back 30

alpha-adrenergic 1st then beta; if do beta first can worsen HTN bc unopposed alpha would cause vasoconstriction

Front 31

Reasons to test for pheochromocytoma

Back 31

*family hx of pheochromocytoma

*episodic headaches, diaphoresis or tachycardia

*early-age onset of HTN

*refractory HTN

*familial syndromes (eg MEN2, NF-1, von Hippel-Lindau)

*adrenal mass discovered incidentally on imaging

*idiopathic dilated cardiomyopathy

*paroxysmal HTN and/or tachycardia during common procedures

Front 32

Next step if Dx with pheochromocytoma

Back 32

MRI or CT of abdomen

*+ then sx eval, genetic testing, alpha and beta blockade prior to sx, MIBG scan if tumor >5cm and suspicion of extra adrenal disease

*- then consider further imaging: MIBG scan, octreotide scan, whole body MRI, PET scan

Front 33

Tx for Tourettes

Back 33

antipsychotics like risperidone

Front 34

Dx for Rocky Mountain Spotted Fever

Back 34

-treat empirically don't wait for confirmation of diagnosis

- delayed tx associated with increased mortality

Front 35

Tx for Rocky Mountain Spotted Fever

Back 35

Doxycycline

-if pregnant, then chloramphenicol

Front 36

RMSF rash

Back 36

petechial rash begins on ankles and wrists, and spreads to palms and soles and to the central body

Front 37

initial diagnostic test for polycythemia

Back 37

EPO

-low: suggests polycythemia vera

-high: suggests secondary cause of polycythemia vera like chronic hypoxia or a hormone producing neoplasm (commonly RCC)

Front 38

most common association complication from compartment syndrome

Back 38

acute renal failure due to rhabdomyolysis in limb causing myoglobin release and damage kidney leading to ARF (esp if volume depleted)

Front 39

Compartment syndrome diagnosis

Back 39

measurement of tissue pressures: >30 mm Hg or delta pressure (diastolic BP-compartment pressure) <20-30mmm Hg

Front 40

Male puberty delay

Back 40

*dx if he does not have testicular enlargement by 14 yoa, or if testicles are 2.5 cm or less in diameter

*another criteria: delay of development for 5 or more years from onset of genitalia enlargement

Front 41

MCC of delayed puberty

Back 41

constitutional delay

Front 42

Delayed puberty initial testing

Back 42

*bone age XR L wrist

*if bone ages older or equal to age then need to rule out chromosomal abnormality and endocrine causes

* growth chart

*tanner staging

Front 43

Dx test for esophageal perforation

Back 43

esophagogram with water-soluble contrast

-CT ok but would miss small tears

-NEVER GI endoscopy

Front 44

hypocalcemia symptoms

Back 44

perioral numbness, muscle cramps, carpopedal spasm, + Chvostek sign (same side contraction of facial mm on tapping angle of jaw) and + Trousseau's sign

severe: mental status changes and seizures

Front 45

Lab findings in SIADH

Back 45

hyonatremia, decreased plasma or serum osmolality, increased urine osmolality (bc excessive fluid retention), urinary sodium concentration of >40 mEq/L and normal renal, adrenal and thyroid functions

Front 46

MAOIs

Back 46

Monoamine oxidase inhibitors

-phenelzine, tranylcypromine

Front 47

SSRI

Back 47

selective serotonin reuptake inhibitors

-fluoxetine, paroxetine, sertraline, citalopram

Front 48

Serotonin syndrome symptoms

Back 48

mental status change, autonomic dysregulation (diaphoresis, tachycardia, HTN, hyperthermia, D, mydriasis) and neuromusclar hyperactivity (eg hyperreflexia, tremor, rigidity, myoclonus, ocular clonus)

Front 49

Anticholinergic toxicity symptoms

Back 49

dry skin, flushing, fever, mydriasis, altered mental status

Front 50

Neuroleptic malignant syndrome

Back 50

a rare idiosyncratic reaction to dopamine antagonists; like serotonin syndrome but no hyperreflexia or clonus. also has "lead pipe" muscular rigidity

Front 51

Mono workup dx

Back 51

1st monospot

-if + stop Dx

-if - then EBV specific AB (+IgM and +IgG viral capsid antigen= acute infection; if +IgG EBV nuclear Ag then NOT acute it is chronic/past, only appears 6-12 weeks after onset)

Front 52

recumbent position

Back 52

lying down

Front 53

Only treatment for Mono and when

Back 53

if patient develops severe complications (eg airway obstruction, overwhelming infection, aplastic anemia, thrombocytopenis) then tx with corticosteriods (IV)

Front 54

Pressure ulcer stages

Back 54

1- nonblanchable erythema of intact skin

2- superficial ulcers causing a partial thickness loss of epidermis, dermis or both

3- deeper ulcers causing a full thickness loss with damage to subcutaneous tissue that may extend to, but not through, underlying fascia

4- very deep ulcers causing full thickness loss and extensive tissue destruction of mm, bone or structures

Front 55

Symptoms of femoral nerve lesion

Back 55

anterior and anteromedial thigh paresthesia with quad mm weakness and decreased knee jerk reflex

Front 56

Symptoms of L5 and S1 Radiculopathies

Back 56

back pain that radiates down the lateral or posterior aspect of the leg. Also weakness of corresponding segments also noted

Front 57

Symptoms of obturator nerve lesion

Back 57

sensory loss over medial thigh and weakness in leg adduction

Front 58

symptoms of Meralgia paresthetica

Back 58

-entrapment of lateral femoral cutaneous nerve

-decreased sensation over anterolateral thigh without any muscle weakness or DTR abnormalities

Front 59

Clinical features of Tuberculosis

Back 59

-recurrent PNA (upper lobe/apical)

-recent immigrant

-institutionalized patient

-homeless/lower SES

Front 60

Clinical features of Post-obstructive cause of recurrent PNA

Back 60

-cause is polymicrobial

-hemoptysis

-weight loss/cachexia

-PNA in same location

Front 61

Clinical features of Recurrent PNA due to aspiration

Back 61

- pt has hx of seizures, dysphagia, alchohol intoxication

- causes anaerobes, polymicrobial

- R middle lobe/lower lobe PNA

- Dysphagia/dysarthria

- Altered mentation

Front 62

CSF findings normal

Back 62

WBC 0-5

Glucose 40-70

Protein <40

Front 63

CSF findings in bacterial meningitis

Back 63

WBC >1000

glucose <40

protein >250

Front 64

CSF findings in tuberculosis meningitis

Back 64

WBC: 5-1000

Glucose: <10

Protein: >250

Front 65

CSF findings in Viral meningitis

Back 65

WBC 100-1000

Glucose 40-70

Protein <100

Front 66

CSF findings in Guillain-Barre

Back 66

WBC 0-5

Glucose 40-70

Protein 45-1000

Front 67

Cryptococcal Meningitis CSF findings

Back 67

elevated opening pressure (>250-300)

lymph predominant with low WBC (<50)

elevated protein and low glucose

+ India Ink prep or cryptococcal Ag test

**be careful of increased ICP if pt also has HA, blurry vision etc

Front 68

Tx of Cryptococcal Meningitis

Back 68

-Induction Tx: amphotericin B and flucytosine for 10-14 days

-If clinical improvement then discontinue and start fluconazole for maintenance therapy and prevent recurrence

Front 69

Cardiac complications of infectious endocarditis

Back 69

-valvular insufficiency- common cause of death

-Perivalvular abscess

-conduction abnormalities

-mycotic aneurysm

Front 70

Neuro complications of infectious endocarditis

Back 70

-embolic stroke

-cerebral hemorrhage

-brain abscess

-acute encephalopathy or meningoencephalitis

Front 71

Renal complications of infectious endocarditis

Back 71

-renal infarct

-glomerulonephritis

-drug-induced acute interstitial nephritis from therapy

Front 72

Musculoskeletal complication of infectious endocarditis

Back 72

-verterbral osteomyelitis

-septic arthritis

-musculoskeletal abscess

Front 73

lifestyle interventions to manage acne

Back 73

-water based skin products (non oil based)

-ph neutral detergent cleansers

-low glycemic index diet

-avoidance of saturated fats, dairy, and refined carbs

Front 74

Tx tinea capitis

Dx?

Back 74

-clinical dx, confirmed with KOH prep

-tx: oral griseofulvin and terbinafine

Front 75

Pernicious anemia

Back 75

megaloblastic anemia --> atrophic gastritis (autoimmune destruction of gastric parietal cells and inactivation of intrinsic factor) --> lack of IF and vit b12 deficiency

*test for anti-IF antibodies

Front 76

Pernicious anemia associated with what gastritis

Back 76

autoimmune metaplastic atrophic gastritis (AMAG): glandular atrophy (of fundus and gastric body), intestinal metaplasia and inflammation

Front 77

Type I vs Type II error

Back 77

Type 1 error (alpha): false positive (reject null but it is true)

Type 2 error (beta): false negative (fail to reject null but null is false)

Front 78

Power=

Back 78

1- Beta error

Front 79

Erysipelas caused by

Back 79

Group A strep

Front 80

Acute stress disorder vs PTSD

Back 80

acute stress: 3 days - 1 month after event

PTSD: >1 month after event

Front 81

lead time bias

Back 81

when screening test detects the disease at an earlier point in time (making it look like the survival rate increased), but associated prognosis does not change

-let those with the disease known earlier, but doesnt change the diagnosis

Front 82

hospice vs palliative care

Back 82

-hospice is a model of palliative care offered to patients at end of life when life-prolonging therapy is NO LONGER INDICATED

-palliative care can be done concurrently with disease-modifying medical therapies

Front 83

CO poisoning symptoms

Back 83

throbbing HA, nausea, malaise, and dizziness

-esp if multiple simultaneously present with a HA

Front 84

mentzer index

Back 84

ratio of MCV/total RBC

high mentzer >13 = iron deficiency anemia

low mentzer < thalassemia

Front 85

H pylori treatment

Back 85

Pantoprazole, clarithromycin and amoxicillin

if allergic to penicillin then substitute metronidazole for amoxicillin

Front 86

meningococcal ppx for close contacts/dr who intubated

Back 86

rifampin (4 PO doses)

Ceftriaxone 1 IM, can be used in reg

Ciprofloxacin (PO once; not in children)

Front 87

Sickle cell anemia lab values and peripheral blood smear findings

Back 87

low Hct, high reticulocytes, high serum low-density lipoprotein, increased unconjugated bilirubin

-peripheral smear: sickled red cells, howell-jolly bodies

Front 88

Acute Chest Syndrome, Dx and Tx

Back 88

*in sick cell

*Dx: new pulmonary infiltrate on CXR PLUS >1 of the following:

-increased work of breathing, cough, tachypnea, wheezing

-temp >38.% C (101.3F)

-hypoxemia

-chest pain

*initial treatment: ceftriaxone+azithromycin

IV fluids and pain control

Front 89

EKG findings in paroxysmal SVT

Back 89

narrow and regular QRS complexes and no P waves

Front 90

EKG findings in sinus tachycardia

Back 90

P waves, along with narrow QRS complexes

Front 91

EKG Findings in atrial fibrillation

Back 91

arrhythmic arrhythmia; rhythm is irregular and P wave is absent

Front 92

EKG findings in ventricular tachycardia

Back 92

wide QRS complexes (more than 0.12 sec)

Front 93

EKG findings in atrial flutter

Back 93

"flutter waves" in a saw tooth pattern; the HR of 'typical' atrial flutter with 2:1 conduction is usually around 150 bpm

Front 94

EKG findings in Wolf-Parkinson White Syndrome

Back 94

slurred upstroke of the initiation of QRS/ventricular activation (called delta wave)

PR interval of <0.12 sec

Front 95

Uses and Side effects of Ginko biloba

Back 95

-memory enhancement

-increases bleeding risk

Front 96

Uses and Side effects of Ginseng

Back 96

-increased mental performance

-increased bleeding risk

Front 97

Uses and Side effects of saw palmetto

Back 97

-BPH (benign prostatic hyperplasia)

-SE: mild (stomach discomfort) and increased bleeding risk

Front 98

Uses and Side effects of Black cohosh

Back 98

-post-menopausal symptoms (hot flashes and vaginal dryness)

-SE: hepatic injury and increased bleed risk (anti platelet properties)

Front 99

Uses and Side effects of St John's wort

Back 99

-for: depression and insomnia

-SE: drug interactions like antidepressants (serotonin syndrome), OCP, anticoagulants (decreased INR), digoxin

Front 100

Uses and Side effects of kava

Back 100

for: anxiety and insomnia

SE: severe liver damage

Front 101

Uses and Side effects of Licorice

Back 101

for: stomach ulcers, bronchitis/viral infectionsSE: hypertension and hypokalemia

Front 102

Uses and Side effects of Echinacea

Back 102

-for: treatment and prevention of cold and flu

-SE: anaphylaxis (more common in asthma pts)

Front 103

Uses and Side effects of Ephedra

Back 103

-for: treatment of cold and flu & weight loss and improved athletic performance

-SE: hypertension, arrhythmia/MI/sudden death, stroke and seizure

Front 104

VSD physical exam

Back 104

loud, harsh holosystolic murmur in 4th L intercostal space and a palpable thrill

-large nonrestrictive VSD ass with softer murmur

Front 105

TOF 4 characteristic anatomical features

Back 105

right ventricular outflow tract obstruction, overriding aorta, right ventricular hypertrophy, and VSD

Front 106

Proximal weakness with increased CPK

Back 106

indicated a muscle disorder

-inflammatory myositis may lead to increased serum ferritin levels (acute phase protein)

Front 107

Tx inflammatory myositis

Back 107

high dose glucocorticoids

Front 108

POEMS syndrome

Back 108

Polyneuropathy, Organomegaly, Endocrinopathy, M-proteins, and skin changes

-do SPEP to look for M-spike

Front 109

Pernicious anemia

Back 109

Vit B12 deficiency (due to lack of intrisic factor secretion in stomach)

Front 110

when treating pernicious anemia what do u watch for

Back 110

when starting treatment with vit b12 within the first 48 hours watch serum K level, they are at risk for severe hypokalemia (bc lots of new RBC being made and suck up potassium)

Front 111

Initial treatment for pulmonary embolism in hemodynamically stable vs non stable patients

Back 111

stable: anticoagulation with LMWH or heparin

unstable: IV fibrinolytic therapy

Front 112

what should be ruled out in inital presentation/eval of dementia

Back 112

hypothyroidismm, vit b12 deficiency, and depression

also check glucose

Front 113

septum in the uterus associated with?

Back 113

recurrent pregnancy loss (up to 60%), usually 1st trimester

needs surgical treatment to correct to decrease future miscarriage risks (metroplasty via hysteroscopy TOC)

Front 114

when to give platelets

Back 114

<50,000 platelets with life-threatening bleeding

Front 115

when to give RBC packed

Back 115

-if have risk of morbidity in setting of severe anemia (eg unstable coronary artery disease) then <9 Hb

-normally <7 Hb

Front 116

common cause of bacterial infections in contact lens wearers

Back 116

pseudomonas

Front 117

mc pathogen isloated from cultures of corneal foreign bodies

Back 117

coag neg staph (CONS)

Front 118

RAIU in exogenous hyperthyroidism

Back 118

low bc thyroid gland is intrinsically making a lower level of thyroid hormone

-thyroglobulin should be low too

Front 119

what is a unique finding in patients with disseminated gonococcal infection

Back 119

tenosynovitis (painful tendons along the ankle and toe joints)

Front 120

most important single risk factor for osteoporosis and osteoporotic bone fracture

Back 120

age

Front 121

who is more susceptible to osteoporosis: caucasians or african americans

Back 121

caucasians

Front 122

primitive idealization

Back 122

someone is seen as perfect, part of splitting (defense mech), seen in Borderline personality disorder

Front 123

reaction formation

Back 123

person deals with stress by subsituting thoughts, feelings, or behaviors that are the exact opposite of what the person believes, which is considered uncomfortable (example homo man that is homophobic)

Front 124

most successful way of treating borderline personality disorder

Back 124

dialectical behavior therapy (behavior modification and building of skills)

-TCA CI due to high suicide AE

Front 125

Hep B and pregnancy

Back 125

-screen all preg women for hepB at 1st prenatal visit AND at delivery (if unknown status OR risk factors during preg)

-IF have ACTIVE infection: give hep B vaccine and antiviral therapy to preg woman; then when baby born give both hep B vaccine and HBIG

Front 126

MC cause of proteinuria in adolescents; how to Dx; and tx

Back 126

Orthostatic proteinuria; split (day and night) 24 hour urine collection, showing elevated daytime but normal nighttime protein excretion rates

-tx: benign, resolves spont; not a predictor for development of renal abnormal; tx with nothing

Front 127

fibromyalgia tx

Back 127

lifestyle: aerobic exercise, sleep hygiene

meds: TCA, SNRI

Front 128

when should HIV pt be given PCP ppx, and what is it

Back 128

Trimethoprim/sulfamethoxazole; <200 CD4 count

Front 129

when should HIV pt be given MAC ppx, and what is it

Back 129

azithromycin; (mycobacterium avium complex); CD4 <50 (or clarithromycin)

Front 130

when should HIV pt be given CMV ppx, and what is it

Back 130

ganciclovir; CD4 <50; THIS ONE NOT WIDELY RECOMMENDED, no increased survival advantage

Front 131

neonatal chlamydial infections

Back 131

-Conjunctivitis: age at onset 5-14days, watery, mucopurulent, or blood-stained discharge, TX oral erythromycin 14d

-PNA: age at onset 4-12 weeks; staccato cough, hyperinflation on CXR, tx oral erythromycin 14d

Front 132

staccato cough

Back 132

series of short, dry coughs; ass with chlamydial PNA

Front 133

NNT

Back 133

number needed to treat:

ARR(absolute risk reduction)=control group event rate-experimental group event rate

NNT= 1/ARR

Front 134

MC precipitant of Guillian-Barre Syndrome

Back 134

Campylobacter jejuni (bloody diarrhea)

Front 135

TX of varicose veins

Back 135

-1st: leg elevation, weight reduction and compression stockings

- if this failed after 3-6 months, then try injection sclerotherapy w saline, with or without local anesthetics

-those pt with large symptomatic varicose veins with ulcers, bleeding or recurrent thromophlebitis --> surgical ligation and stripping

Front 136

severe preeclampsia tx

Back 136

hydralazine or labetalol AND MgSO4 then delivery

Front 137

MCC of massive lower GI bleeding in elderly pts; ?association

Back 137

angiodysplasia or diverticulosis

-angiodysplasia associated with aortic stenosis and ESRD

Front 138

refeeding chronic alcoholic patients at risk for?

Back 138

hypophosphatemia (in general have low phosphate secondary to decreased Vit D and phosphate intake --> pt body maintains normal levels via extracellular shift normally --> when in hospital and get "refed"/IV hydration it shifts phosphate into the cell and shows the true level

Front 139

angioedema with ACE inhib (pril)

Back 139

switch to ARB (Sartan) bc doesnt effect kinin system

Front 140

solitary, painful, lytic bone lesion with overlying swelling and hypercalcemia

Back 140

langerhans cell histiocytosis (histiocytosis X or granulomatous)

conservative tx, resolves on own

Front 141

Adult Still's

Back 141

inflam disorder with recurrent high fevers (102), rash and arthritis

Front 142

Rheumatic fever give ? <3 MC

Back 142

mitral stenosis --> increased risk of atrial fib and cardiac emboli

Front 143

positive apnea test to confirm brain death

Back 143

absent respiratory response off the ventilator for 8-10 minutes with PaCO2 >60mmHg (or >20mm from baseline) and a final arterial pH od <7.28

Front 144

high calcium --> test PTH--> if PTH low ?do next

Back 144

-measure PTHrP, 25(OH)D and 1,25(OH)D

-*if elevated PTHrP: eval for solid tumor malignancy

*if elevated 1,25(OH)D: CXR for possible lymphoma, sarcoid

*Elevated 25(OH)D: Vitamin D toxicity

*Normal labs: causes hyperthryroidism, multiple myeloma, adrenal tumor, acromegaly, vitamin A toxicity, immobilization, milk-alkali syndrome

Front 145

1st line tx for nongonococcal urethritis

Back 145

azithromycin or doxycycline

Front 146

MC tx of gonorrhea

Back 146

1 dose Ceftriaxone

Front 147

when to treat STD G vs Chlamyd

Back 147

-if have gonorrhea also treat Chlamydia

Front 148

Throid nodule workup:

Back 148

*1st do TSH and thyroid US

* if US fine:

-Low TSH: do Iodine-123-scintigraphy

-if hyperfunctional ("hot") nodule: tx hyperthyroidism

-if hypofunctional ("cold") or undetermined nodule: FNA

* If US fine and high or normal TSH: FNA

* if US suspicious: FNA

Front 149

Colloid goiter

Back 149

thyroid enlargement in adolescent girls with normal thyroid function and neg anti-TPO

Front 150

Medullary thyroid cancer typically has elevated ?

Back 150

calcitonin

Front 151

Pemberton's sign

Back 151

presence of facial plethora or neck vein distension when the arms are raised and confirms an enlarged thyroid gland as the cause of esophageal obstructive symptoms

Front 152

what is a anatomical predisposing factor for Mallory-Weiss syndrome?

Back 152

Hiatal Hernia

Front 153

Thompson test

Back 153

observes plantar flexion when the calf is squeezed; the absence of plantar flexion signifies complete rupture of achilles tendon and +test result

Front 154

gastrostomy

Back 154

means putting in a PEG tube (percutaneous gastrostomy)

Front 155

Charcot's triad

Back 155

fever, RUQ pain and jaundice --> suggestive of ascending cholangitis

Front 156

what to give pt wotj HTN and CKD (chronic kidney dz) who has proteinuria?

Back 156

if excess 500-1000mg/day

-start ACE inhib or ARB

Front 157

Nipple discharge: pathologic vs physiologic

Back 157

-Pathologic: unilateral, bloody or serous, lump changes or skin changes and W/U is mamogram +/- US and surgical eval

-Physiological: bilateral, milky/nonbloody, no skin or lump changes, and W/U is Urine HCG and Serum TSH, prolactin

Front 158

MCC of pathologic nipple discharge

Back 158

papillary tumor (eg papilloma)

Front 159

"atypical lymphocytes" on peripheral smear is a clue to?

Back 159

EBV

Front 160

dermatitis herpetiformis associated with?

Back 160

celiac disease

Front 161

baby born to mom with Hep B; you give Hep B and HIg at birth; when do you test serology?

Back 161

-2nd Hep B vaccine: 1-2months old; 3rd dose at 6 months

*3-4 months after the 3rd hep B vaccine; so about 9-15 months old

Front 162

leading cause of mortality in pts with SLE

Back 162

cardiovascular events; SLE is a significant (50x) risk factor for development of premature coronary atherosclerosis

Front 163

ALS

Back 163

-LMN and UMN loss of motor neurons

-weakness associated with progressive wasting, atrophy of muscles, and spontaneous twitching or fasciculation of motor units

-ocular motility, sensory, bowel, bladder and cognitive functions preserved

Front 164

pyoderma gangrenosum ass with?

Back 164

inflam bowel disease

Front 165

explosive onset of muliple itchy seborrheic keratoses ass with?

Back 165

gastrointestinal malignancy

Front 166

severe seborrheic dermatitis ass with

Back 166

HIV infection and parkinson disease

Front 167

porphyria cutanea tarda and cutaneous leukoclastic vasculitis (palpable purpura) secondary to cryoglobinemia ass with?

Back 167

hep c

Front 168

multiple skin tags associated with?

Back 168

insulin resistance and pregnancy and if perianal, crohn disease

Front 169

acanthosis nigricans ass with?

Back 169

insulin resistance and gastrointestinal malignancy

Front 170

osteonecrosis of femoral head

-ass with?

-staging and treatment

Back 170

-ass with SLE esp when on high steriods

-Stage 1 or 2: core decompression (+radiographs without femoral head collapse)

-stage 3

-stage 4 (flattening of femoral head and joint space narrowing): total hip replacement

Front 171

Pruritis in pregnancy:

- physiologic changes of skin:

- pruritis folliculitis:

- pustular psoriasis:

- herpes gestationis:

- PUPPP (papular urticartial papules and plaques of pregnancy):

Back 171

- physiologic changes of skin: common, no path process, tx with topical steroids, antihistamines, oatmeal baths

- pruritus folliculitis: acne-like lesions

- pustular psoriasis: erythematous plaques with surrounding pustules

- herpes gestationis: urticarial plaques, papules, and vesicles surrounding the umbilicus; tx topical steriods

- PUPPP (papular urticarial papules and plaques of pregnancy): common preg-ass dermatosis, pruritic erythematous papules within striae gravidarum, can spread to extremities, tx topical steriods

Front 172

inital lab w/u for suspected lead poisoning

Back 172

CBC, serum iron and ferritin and reticulocyte count

Front 173

how many weeks of persistent lymphadenopathy before referral?

Back 173

localized lymphadenolpathy for 3-4 weeks should be referred to sx for biopsy to r/o lymphoma

Front 174

sensitivity

specificity

Back 174

-sensitivity (true positivie rate): TP/ (TP+FN) or TP/all sick

-specific (true negative rate): TN/ (TN+FP) or TN/all well

Front 175

Neg predicitive value

PPV

Back 175

PPV (precision): TP/ all positive tests

NPV: TN/ all neg tests

Front 176

MCC of idiopathic nephrotic syndrome in adults (50% of A-A pts)

Back 176

Focal segmental glomerulosclerosis (FSGS)

Front 177

age associated causes of secondary hypertension, children and adolescents (birth to age 18)

Back 177

renal parenchymal disease and coarctation of aorta

Front 178

age associated causes of secondary hypertension, young adults (age 19-39)

Back 178

thyroid dysfunction, fibromuscular dysplasia or renal parenchymal disease

Front 179

age associated causes of secondary hypertension, middle- aged adults (40-64)

Back 179

aldosteronism, thyroid dysfunction, obstructive sleep apena, cushing syndrome, or pheochromocytoma

Front 180

age associated causes of secondary hypertension, in older adults ( >65)

Back 180

atherosclerotic renal artery stenosis or renal failure

Front 181

signs of seconday hypertension

Back 181

frequent HA, exertional dyspnea, lower extemity edema, and severe HTN

Front 182

patient with right varicocele, varicocele that doesnt disappear in supine position, or bilateral vericocele (even if not at same time), what do you need to do

Back 182

CT scan of abdomen to rule of inferor vena caval obstruction (eg clot, tumor)

Front 183

vericocele is MC on which side and why

Back 183

left, bc the left spermatic vein enters the L renal vein at a 90-degree angle

Front 184

solitary pulmonary nodule on routine CXR, what to do?

Back 184

*if have previous CXR and stable lesion over 2-3 years, no further testing

*if no previous CXR OR possible nodule growth then do Chest CT

-if ct is benign: serial CT scans

-if CT highly suspicious: surgical excision

-if CT indeterminate or suspicious for malignancy: further investigation with bx or PET

Front 185

test for organophosphate poisoning and symptoms

Back 185

-confusion, lethargy, bradycardia, skin flushing, miosis and wheeze with garlic-like odor from clothing

-RBC cholinesterase activity level (confirmation and assess the degree of severity

Front 186

Dx criteria for multiple myeloma

Back 186

-monoclonal protein in serum or urine

->10% clonal plasma cells in bone marrow or soft tissue/bone plasmacytoma

-end organ damage (CRAB): Calcium elevated, Renal insufficiency, Anemia (usually normocytic), Bone Pain (usually due to lytic lesions) (or hx of back pain or fracture)

Front 187

what type of bone imaging should multiple myeloma patients get?

Back 187

Xray skeletal survery

-if bone pain and negative XRs then can move on to CT, MRI or PET

Front 188

complications of multiple myeloma

Back 188

-hypercalcemia (asympt or sympt with N, polyuria, constipation, weakness, confusion), tx with hydration and either dexamethasone (mild) or bisphophonates (mod to severe)

-renal insuff

-infections (highest risk during 1st 3-4 months of therapy

-skeletal bone lesions (bisphophonates for prevention)

-hyperviscosity syndrome

-thrombosis

Front 189

hyperviscosity syndrome in multiple myleoma

Back 189

nasal or oral bleeding, blurry vision, neuro symptoms (eg confusion, HA) and heart failure

-plasmapheresis in symptomatic patients

(this syndrome more common in Waldenstrom's macroglobulinemia (elevated IgM))

Front 190

mucosal hemorrhage a sign of?

Back 190

eg nasal or oral bleeding

-impaired platelet function

Front 191

adverse effect of thiazides (hydrochlorothiazide)

Back 191

photosensitivity rash

Front 192

bicuspid aortic valve

-etiology

-dx

-complications

-management

Back 192

-etiology: M>F, 30% of Turner's syndrome, 1% of general pop

-dx: screen echo for patient and 1st degree

-complications: infectious endocarditis, severe regurg or stenosis, aortic root or ascending aortic dilation; dissection

-management: f/u echo every 1-2 years; baloon valvuloplasty or surgery

Front 193

Cushing syndrome presentation and dx?

Back 193

Young patients with diabe