Usmle Step 2 Rapid Review

Front 1

Classic ECG finding in atrial flutter.

Back 1

“Sawtooth” P waves

Front 2

Definition of unstable angina.

Back 2

Angina is new, is worsening, or occurs at rest

Front 3

Antihypertensive for a diabetic patient with proteinuria.

Back 3

ACEI

Front 4

Beck’s triad for cardiac tamponade.

Back 4

Hypotension, distant heart sounds, and JVD

Front 5

Drugs that slow AV node transmission.

Back 5

β-blockers, digoxin, calcium channel blockers

Front 6

Hypercholesterolemia treatment that → flushing and pruritus.

Back 6

Niacin

Front 7

Treatment for atrial fibrillation.

Back 7

Anticoagulation, rate control, cardioversion

Front 8

Treatment for ventricular fibrillation.

Back 8

Immediate cardioversion

Front 9

Autoimmune complication occurring 2–4 weeks post-MI.

Back 9

Dressler’s syndrome: fever, pericarditis, increased ESR

Front 10

IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?

Back 10

Treat existing heart failure and replace the tricuspid valve

Front 11

Diagnostic test for hypertrophic cardiomyopathy.

Back 11

Echocardiogram (showing thickened left ventricular wall and outflow obstruction)

Front 12

A fall in systolic BP of > 10 mmHg with inspiration.

Back 12

Pulsus paradoxus (seen in cardiac tamponade)

Front 13

Classic ECG findings in pericarditis.

Back 13

Low-voltage, diffuse ST-segment elevation

Front 14

Definition of hypertension.

Back 14

BP > 140/90 on three separate occasions two weeks apart

Front 15

Eight surgically correctable causes of hypertension.

Back 15

Renal artery stenosis, coarctation of the aorta, pheochromocytoma, Conn’s syndrome, Cushing’s syndrome, unilateral renal parenchymal disease, hyperthyroidism, hyperparathyroidism

Front 16

Evaluation of a pulsatile abdominal mass and bruit.

Back 16

Abdominal ultrasound and CT

Front 17

Indications for surgical repair of abdominal aortic aneurysm.

Back 17

> 5.5 cm, rapidly enlarging, symptomatic, or ruptured

Front 18

Treatment for acute coronary syndrome.

Back 18

Morphine, O2, sublingual nitroglycerin, ASA, IV β-blockers, heparin

Front 19

What is the metabolic syndrome?

Back 19

Abdominal obesity, high triglycerides, low HDL, hypertension, insulin resistance, prothrombotic or proinflammatory states

Front 20

Appropriate diagnostic test? A 50-year-old male with angina can exercise to 85% of maximum predicted heart rate.

Back 20

Exercise stress treadmill with ECG

Front 21

Appropriate diagnostic test? ■ A 65-year-old woman with left bundle branch block and severe osteoarthritis has unstable angina.

Back 21

Pharmacologic stress test (e.g., dobutamine echo)

Front 22

Signs of active ischemia during stress testing.

Back 22

Angina, ST-segment changes on ECG, or ↓ BP

Front 23

ECG findings suggesting MI.

Back 23

ST-segment elevation (depression means ischemia), flattened T waves, and Q waves

Front 24

A young patient has angina at rest with ST-segment elevation. Cardiac enzymes are normal.

Back 24

Prinzmetal’s angina

Front 25

Common symptoms associated with silent MIs.

Back 25

CHF, shock, and altered mental status

Front 26

The diagnostic test for pulmonary embolism.

Back 26

V/Q scan

Front 27

An agent that reverses the effects of heparin.

Back 27

Protamine

Front 28

The coagulation parameter affected by warfarin.

Back 28

PT

Front 29

A young patient with a family history of sudden death collapses and dies while exercising.

Back 29

Hypertrophic cardiomyopathy

Front 30

Endocarditis prophylaxis regimens.

Back 30

Oral surgery—amoxicillin; GI or GU procedures—ampicillin and gentamicin before and amoxicillin after

Front 31

The 6 P’s of ischemia due to peripheral vascular disease.

Back 31

Pain, pallor, pulselessness, paralysis, paresthesia, poikilothermia

Front 32

Virchow’s triad.

Back 32

Stasis, hypercoagulability, endothelial damage

Front 33

The most common cause of hypertension in young women.

Back 33

OCPs

Front 34

The most common cause of hypertension in young men.

Back 34

Excessive EtOH

Front 35

“Stuck-on” appearance.

Back 35

Seborrheic keratosis

Front 36

Red plaques with silvery-white scales and sharp margins.

Back 36

Psoriasis

Front 37

The most common type of skin cancer; the lesion is a pearly-colored papule with a translucent surface and telangiectasias.

Back 37

Basal cell carcinoma

Front 38

Honey-crusted lesions.

Back 38

Impetigo

Front 39

A febrile patient with a history of diabetes presents with a red, swollen, painful lower extremity.

Back 39

Cellulitis

Front 40

+ Nikolsky’s sign.

Back 40

Pemphigus vulgaris

Front 41

- Nikolsky’s sign.

Back 41

Bullous pemphigoid

Front 42

A 55-year-old obese patient presents with dirty, velvety patches on the back of the neck.

Back 42

Acanthosis nigricans. Check fasting blood sugar to rule out diabetes

Front 43

Skin lesions in a dermatomal distribution.

Back 43

Varicella zoster

Front 44

Flat-topped papules.

Back 44

Lichen planus

Front 45

Iris-like target lesions.

Back 45

Erythema multiforme

Front 46

A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.

Back 46

Contact dermatitis

Front 47

Presents with a herald patch, Christmas-tree pattern.

Back 47

Pityriasis rosea

Front 48

A 16-year-old presents with an annular patch of alopecia with broken-off, stubby hairs.

Back 48

Alopecia areata (autoimmune process)

Front 49

Pinkish, scaling, flat lesions on the chest and back. KOH prep has a “spaghetti-and-meatballs” appearance.

Back 49

Pityriasis versicolor

Front 50

Four characteristics of a nevus suggestive of melanoma.

Back 50

Asymmetry, border irregularity, color variation, large diameter

Front 51

Premalignant lesion from sun exposure that can → squamous cell carcinoma.

Back 51

Actinic keratosis

Front 52

“Dewdrop on a rose petal.”

Back 52

Lesions of 1° varicella

Front 53

“Cradle cap.”

Back 53

Seborrheic dermatitis. Treat with antifungals

Front 54

Associated with Propionibacterium acnes and changes in androgen levels.

Back 54

Acne vulgaris

Front 55

A painful, recurrent vesicular eruption of mucocutaneous surfaces.

Back 55

Herpes simplex

Front 56

Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women.

Back 56

Lichen sclerosus

Front 57

Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.

Back 57

Squamous cell carcinoma

Front 58

The most common cause of hypothyroidism.

Back 58

Hashimoto’s thyroiditis

Front 59

Lab findings in Hashimoto’s thyroiditis.

Back 59

High TSH, low T4, antimicrosomal antibodies

Front 60

Exophthalmos, pretibial myxedema, and ↓ TSH.

Back 60

Graves’ disease

Front 61

The most common cause of Cushing’s syndrome.

Back 61

Iatrogenic steroid administration. The second most common cause is Cushing’s disease

Front 62

A patient presents with signs of hypocalcemia, high phosphorus, and low PTH.

Back 62

Hypoparathyroidism

Front 63

“Stones, bones, groans, psychiatric overtones.”

Back 63

Signs and symptoms of hypercalcemia

Front 64

A patient complains of headache, weakness, and polyuria; exam reveals hypertension and tetany. Labs reveals hypernatremia, hypokalemia, and metabolic alkalosis.

Back 64

1° hyperaldosteronism (due to Conn’s syndrome or bilateral adrenal hyperplasia)

Front 65

A patient presents with tachycardia, wild swings in BP, headache, diaphoresis, altered mental status, and a sense of panic.

Back 65

Pheochromocytoma

Front 66

Should α- or β-antagonists be used first in treating pheochromocytoma?

Back 66

α-antagonists (phentolamine and phenoxybenzamine)

Front 67

A patient with a history of lithium use presents with copious amounts of dilute urine.

Back 67

Nephrogenic diabetes insipidus (DI)

Front 68

Treatment of central DI.

Back 68

Administration of DDAVP ↓ serum osmolality and free water restriction

Front 69

A postoperative patient with significant pain presents with hyponatremia and normal volume status.

Back 69

SIADH due to stress

Front 70

An antidiabetic agent associated with lactic acidosis.

Back 70

Metformin

Front 71

A patient presents with weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?

Back 71

1° adrenal insufficiency (Addison’s disease). Treat with replacement glucocorticoids, mineralocorticoids, and IV fluids

Front 72

Goal hemoglobin A1c for a patient with DM.

Back 72

< 7.0

Front 73

Treatment of DKA.

Back 73

Fluids, insulin, and aggressive replacement of electrolytes (e.g., K+)

Front 74

Why are β-blockers contraindicated in diabetics?

Back 74

They can mask symptoms of hypoglycemia

Front 75

Bias introduced into a study when a clinician is aware of the patient’s treatment type.

Back 75

Observational bias

Front 76

Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.

Back 76

Lead-time bias

Front 77

If you want to know if race affects infant mortality rate but most of the variation in infant mortality is predicted by socioeconomic status, then socioeconomic status is a _____.

Back 77

Confounding variable

Front 78

The number of true positives divided by the number of patients with the disease is _____.

Back 78

Sensitivity

Front 79

Sensitive tests have few false negatives and are used to rule _____ a disease.

Back 79

Out (SnOut and SpIn)

Front 80

PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a +PPD. Highly sensitive or specific?

Back 80

Highly sensitive for TB

Front 81

Chronic diseases such as SLE—higher prevalence or incidence?

Back 81

Higher prevalence

Front 82

Epidemics such as influenza—higher prevalence or incidence?

Back 82

Higher incidence

Front 83

Cross-sectional survey—incidence or prevalence?

Back 83

Prevalence

Front 84

Cohort study—incidence or prevalence?

Back 84

Incidence and prevalence

Front 85

Case-control study—incidence or prevalence?

Back 85

Neither

Front 86

Describe a test that consistently gives identical results, but the results are wrong.

Back 86

High reliability, low validity

Front 87

Difference between a cohort and a case-control study.

Back 87

Cohort studies can be used to calculate relative risk (RR), incidence, and/or odds ratio (OR). Case-control studies can be used to calculate an OR

Front 88

Attributable risk?

Back 88

The incidence rate (IR) of a disease in exposed minus the IR of a disease in unexposed

Front 89

Relative risk?

Back 89

The IR of a disease in a population exposed to a particular factor ÷ the IR of those not exposed

Front 90

Odds ratio?

Back 90

The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed

Front 91

Number needed to treat?

Back 91

1 ÷ (rate in untreated group − rate in treated group)

Front 92

In which patients do you initiate colorectal cancer screening early?

Back 92

Patients with IBD; those with familial adenomatous polyposis (FAP)/hereditary nonpolyposis colorectal cancer (HNPCC); and those who have first-degree relatives with adenomatous polyps (< 60 years of age) or colorectal cancer

Front 93

The most common cancer in men and the most common cause of death from cancer in men.

Back 93

Prostate cancer is the most common cancer in men, but lung cancer causes more deaths

Front 94

The percentage of cases within one SD of the mean? Two SDs? Three SDs?

Back 94

68%, 95.5%, 99.7%

Front 95

Birth rate?

Back 95

Number of live births per 1000 population

Front 96

Fertility rate?

Back 96

Number of live births per 1000 women 15–44 years of age

Front 97

Mortality rate?

Back 97

Number of deaths per 1000 population

Front 98

Neonatal mortality?

Back 98

Number of deaths from birth to 28 days per 1000 live births

Front 99

Postnatal mortality?

Back 99

Number of deaths from 28 days to one year per 1000 live births

Front 100

Infant mortality?

Back 100

Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)

Front 101

Fetal mortality?

Back 101

Number of deaths from 20 weeks’ gestation to birth per 1000 total births

Front 102

Perinatal mortality?

Back 102

Number of deaths from 20 weeks’ gestation to one month of life per 1000 total births

Front 103

Maternal mortality?

Back 103

Number of deaths during pregnancy to 90 days postpartum per 100,000 live births

Front 104

True or false: Once patients sign a statement giving consent, they must continue treatment.

Back 104

False. Patients may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and patients without decision-making capacity

Front 105

A 15-year-old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?

Back 105

No. Parental consent is not necessary for the medical treatment of pregnant minors

Front 106

A doctor refers a patient for an MRI at a facility he/she owns.

Back 106

Conflict of interest

Front 107

Involuntary psychiatric hospitalization can be undertaken for which three reasons?

Back 107

The patient is a danger to self, a danger to others, or gravely disabled (unable to provide for basic needs)

Front 108

True or false: Withdrawing life-sustaining care is ethically distinct from withholding sustaining care.

Back 108

False. Withdrawing and withholding life are the same from an ethical standpoint

Front 109

When can a physician refuse to continue treating a patient on the grounds of futility?

Back 109

When there is no rationale for treatment, maximal intervention is failing, a given intervention has already failed, and treatment will not achieve the goals of care

Front 110

An eight-year-old child is in a serious accident. She requires emergent transfusion, but her parents are not present.

Back 110

Treat immediately. Consent is implied in emergency situations

Front 111

Conditions in which confidentiality must be overridden.

Back 111

Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse

Front 112

Involuntary commitment or isolation for medical treatment may be undertaken for what reason?

Back 112

When treatment noncompliance represents a serious danger to public health (e.g., active TB)

Front 113

A 10-year-old child presents in status epilepticus, but her parents refuse treatment on religious grounds.

Back 113

Treat because the disease represents an immediate threat to the child’s life. Then seek a court order

Front 114

A son asks that his mother not be told about her recently discovered cancer.

Back 114

A patient’s family cannot require that a doctor withhold information from the patient

Front 115

Patient presents with sudden onset of severe, diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?

Back 115

Emergent laparotomy to repair perforated viscus, likely stomach

Front 116

The most likely cause of acute lower GI bleed in patients > 40 years old.

Back 116

Diverticulosis

Front 117

Diagnostic modality used when ultrasound is equivocal for cholecystitis.

Back 117

HIDA scan

Front 118

Sentinel loop on AXR.

Back 118

Acute pancreatitis

Front 119

Risk factors for cholelithiasis.

Back 119

Fat, female, fertile, forty, flatulent

Front 120

Inspiratory arrest during palpation of the RUQ.

Back 120

Murphy’s sign, seen in acute cholecystitis

Front 121

Identify key organisms causing diarrhea: ■ Most common organism

Back 121

Campylobacter

Front 122

Identify key organisms causing diarrhea: ■ Recent antibiotic use

Back 122

Clostridium difficile

Front 123

Identify key organisms causing diarrhea: ■ Camping

Back 123

Giardia

Front 124

Identify key organisms causing diarrhea: ■ Traveler’s diarrhea

Back 124

ETEC

Front 125

Identify key organisms causing diarrhea: ■ Church picnics/mayonnaise

Back 125

S. aureus

Front 126

Identify key organisms causing diarrhea: ■ Uncooked hamburgers

Back 126

E. coli O157:H7

Front 127

Identify key organisms causing diarrhea: ■ Fried rice

Back 127

Bacillus cereus

Front 128

Identify key organisms causing diarrhea: ■ Poultry/eggs

Back 128

Salmonella

Front 129

Identify key organisms causing diarrhea: ■ Raw seafood

Back 129

Vibrio, HAV

Front 130

Identify key organisms causing diarrhea: ■ AIDS

Back 130

Isospora, Cryptosporidium, Mycobacterium avium complex (MAC)

Front 131

Identify key organisms causing diarrhea: ■ Pseudoappendicitis

Back 131

Yersinia

Front 132

A 25-year-old Jewish male presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibias.

Back 132

Crohn’s disease

Front 133

Inflammatory disease of the colon with ↑ risk of colon cancer.

Back 133

Ulcerative colitis

Front 134

Extraintestinal manifestations of IBD.

Back 134

Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, 1° sclerosing cholangitis

Front 135

Medical treatment for IBD.

Back 135

5-aminosalicylic acid +/− sulfasalazine and steroids during acute exacerbations

Front 136

Difference between Mallory-Weiss and Boerhaave tears.

Back 136

Mallory-Weiss—superficial tear in the esophageal mucosa Boerhaave—full-thickness esophageal rupture

Front 137

Charcot’s triad.

Back 137

RUQ pain, jaundice, and fever/chills in the setting of ascending cholangitis

Front 138

Reynolds’ pentad.

Back 138

Charcot’s triad plus shock and mental status changes, with suppurative ascending cholangitis

Front 139

Medical treatment for hepatic encephalopathy.

Back 139

↓ protein intake, lactulose, neomycin

Front 140

First step in the management of a patient with acute GI bleed.

Back 140

Establish the ABCs

Front 141

A four-year-old child presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?

Back 141

Hemolytic-uremic syndrome (HUS) due to E. coli O157:H7

Front 142

Post-HBV exposure treatment.

Back 142

HBV immunoglobulin

Front 143

Classic causes of drug-induced hepatitis.

Back 143

TB medications (INH, rifampin, pyrazinamide), acetaminophen, and tetracycline

Front 144

A 40-year-old obese female with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine, and clay-colored stools.

Back 144

Biliary tract obstruction

Front 145

Hernia with highest risk of incarceration—indirect, direct, or femoral?

Back 145

Femoral hernia

Front 146

A 50-year-old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?

Back 146

Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids, O2, analgesia, and “tincture of time”

Front 147

Four causes of microcytic anemia.

Back 147

TICS—Thalassemia, Iron deficiency, anemia of Chronic disease, and Sideroblastic anemia

Front 148

An elderly male with hypochromic, microcytic anemia is asymptomatic. Diagnostic tests?

Back 148

Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer

Front 149

Precipitants of hemolytic crisis in patients with G6PD deficiency.

Back 149

Sulfonamides, antimalarial drugs, fava beans

Front 150

The most common inherited cause of hypercoagulability.

Back 150

Factor V Leiden mutation

Front 151

The most common inherited hemolytic anemia.

Back 151

Hereditary spherocytosis

Front 152

Diagnostic test for hereditary spherocytosis.

Back 152

Osmotic fragility test

Front 153

Pure RBC aplasia.

Back 153

Diamond-Blackfan anemia

Front 154

Anemia associated with absent radii and thumbs, diffuse hyperpigmentation, café-au-lait spots, microcephaly, and pancytopenia.

Back 154

Fanconi’s anemia

Front 155

Medications and viruses that → aplastic anemia.

Back 155

Chloramphenicol, sulfonamides, radiation, HIV, chemotherapeutic agents, hepatitis, parvovirus B19, EBV

Front 156

How to distinguish polycythemia vera from 2° polycythemia.

Back 156

Both have ↑ hematocrit and RBC mass, but polycythemia vera should have normal O2 saturation and low erythropoietin levels

Front 157

Thrombotic thrombocytopenic purpura (TTP) pentad?

Back 157

Pentad of TTP—“FAT RN”: Fever, Anemia, Thrombocytopenia, Renal dysfunction, Neurologic abnormalities

Front 158

HUS triad?

Back 158

Anemia, thrombocytopenia, and acute renal failure

Front 159

Treatment for TTP.

Back 159

Emergent large-volume plasmapheresis, corticosteroids, antiplatelet drugs

Front 160

Treatment for idiopathic thrombocytopenic purpura (ITP) in children.

Back 160

Usually resolves spontaneously; may require IVIG and/or corticosteroids

Front 161

Which of the following are ↑ in DIC: fibrin split products, D-dimer, fibrinogen, platelets, and hematocrit.

Back 161

Fibrin split products and D-dimer are elevated; platelets, fibrinogen, and hematocrit are ↓.

Front 162

An eight-year-old boy presents with hemarthrosis and ↑ PTT with normal PT and bleeding time. Diagnosis? Treatment?

Back 162

Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements

Front 163

A 14-year-old girl presents with prolonged bleeding after dental surgery and with menses, normal PT, normal or increased PTT, and increased bleeding time. Diagnosis? Treatment?

Back 163

von Willebrand’s disease; treat with desmopressin, FFP, or cryoprecipitate

Front 164

A 60-year-old African-American male presents with bone pain. Workup for multiple myeloma might reveal?

Back 164

Monoclonal gammopathy, Bence Jones proteinuria, “punched-out” lesions on x-ray of the skull and long bones

Front 165

Reed-Sternberg cells

Back 165

Hodgkin’s lymphoma

Front 166

A 10-year-old boy presents with fever, weight loss, and night sweats. Examination shows anterior mediastinal mass. Suspected diagnosis?

Back 166

Non-Hodgkin’s lymphoma

Front 167

Microcytic anemia with ↓ serum iron, ↓ total iron-binding capacity (TIBC), and normal or ↑ ferritin.

Back 167

Anemia of chronic disease

Front 168

Microcytic anemia with ↓ serum iron, ↓ ferritin, and ↑ TIBC.

Back 168

Iron deficiency anemia

Front 169

An 80-year-old man presents with fatigue, lymphadenopathy, splenomegaly, and isolated lymphocytosis. Suspected diagnosis?

Back 169

Chronic lymphocytic leukemia (CLL)

Front 170

A late, life-threatening complication of chronic myelogenous leukemia (CML).

Back 170

Blast crisis (fever, bone pain, splenomegaly, pancytopenia)

Front 171

Auer rods on blood smear.

Back 171

Acute myelogenous leukemia (AML)

Front 172

AML subtype associated with DIC.

Back 172

M3

Front 173

Electrolyte changes in tumor lysis syndrome.

Back 173

↓ Ca2− , ↑ K− , ↑ phosphate, ↑ uric acid

Front 174

Treatment for AML M3.

Back 174

Retinoic acid

Front 175

A 50-year-old male presents with early satiety, splenomegaly, and bleeding. Cytogenetics show t(9,22). Diagnosis?

Back 175

CML

Front 176

Heinz bodies?

Back 176

Intracellular inclusions seen in thalassemia, G6PD deficiency, and postsplenectomy

Front 177

An autosomal-recessive disorder with a defect in the GPIIbIIIa platelet receptor and ↓ platelet aggregation.

Back 177

Glanzmann’s thrombasthenia

Front 178

Virus associated with aplastic anemia in patients with sickle cell anemia.

Back 178

Parvovirus B19

Front 179

A 25-year-old African-American male with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?

Back 179

O2, analgesia, hydration, and, if severe, transfusion

Front 180

A significant cause of morbidity in thalassemia patients. Treatment?

Back 180

Iron overload; use deferoxamine

Front 181

The three most common causes of fever of unknown origin (FUO).

Back 181

Infection, cancer, and autoimmune disease

Front 182

Four signs and symptoms of streptococcal pharyngitis.

Back 182

Fever, pharyngeal erythema, tonsillar exudate, lack of cough

Front 183

A nonsuppurative complication of streptococcal infection that is not altered by treatment of primary infection.

Back 183

Postinfectious glomerulonephritis

Front 184

Asplenic patients are particularly susceptible to these organisms.

Back 184

Encapsulated organisms––pneumococcus, meningococcus, Haemophilus influenzae, Klebsiella

Front 185

The number of bacterial culture on a clean-catch specimen to diagnose a UTI.

Back 185

105 bacteria/mL

Front 186

Which healthy population is susceptible to UTIs?

Back 186

Pregnant women. Treat this group aggressively because of potential complications

Front 187

A patient from California or Arizona presents with fever, malaise, cough, and night sweats. Diagnosis? Treatment?

Back 187

Coccidioidomycosis. Amphotericin B

Front 188

Nonpainful chancre.

Back 188

1° syphilis

Front 189

A “blueberry muffin” rash is characteristic of what congenital infection?

Back 189

Rubella

Front 190

Meningitis in neonates. Causes? Treatment?

Back 190

Group B strep, E. coli, Listeria. Treat with gentamicin and ampicillin

Front 191

Meningitis in infants. Causes? Treatment?

Back 191

Pneumococcus, meningococcus, H. influenzae. Treat with cefotaxime and vancomycin

Front 192

What should always be done prior to LP?

Back 192

Check for ↑ ICP; look for papilledema

Front 193

CSF findings: ■ Low glucose, PMN predominance

Back 193

Bacterial meningitis

Front 194

CSF findings: ■ Normal glucose, lymphocytic predominance

Back 194

Aseptic (viral) meningitis

Front 195

CSF findings: ■ Numerous RBCs in serial CSF samples

Back 195

Subarachnoid hemorrhage (SAH)

Front 196

CSF findings: Increased gamma globulins

Back 196

Multiple sclerosis

Front 197

Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7–10 days. Treatment?

Back 197

Cutaneous anthrax. Treat with penicillin G or ciprofloxacin

Front 198

Findings in 3° syphilis.

Back 198

Tabes dorsalis, general paresis, gummas, Argyll Robertson pupil, aortitis, aortic root aneurysms

Front 199

Characteristics of 2° Lyme disease.

Back 199

Arthralgias, migratory polyarthropathies, Bell’s palsy, myocarditis

Front 200

Cold agglutinins.

Back 200

Mycoplasma

Front 201

A 24-year-old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?

Back 201

Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension

Front 202

Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV-positive patient at what CD4 count? Mycobacterium avium-intracellulare (MAI) prophylaxis?

Back 202

≤ 200 for PCP (with TMP); ≤ 50–100 for MAI (with clarithromycin/azithromycin)

Front 203

Risk factors for pyelonephritis.

Back 203

Pregnancy, vesicoureteral reflux, anatomic anomalies, indwelling catheters, kidney stones

Front 204

Neutropenic nadir postchemotherapy.

Back 204

7–10 days

Front 205

Erythema migrans.

Back 205

Lesion of 1° Lyme disease

Front 206

Classic physical findings for endocarditis.

Back 206

Fever, heart murmur, Osler’s nodes, splinter hemorrhages, Janeway lesions, Roth’s spots

Front 207

Aplastic crisis in sickle cell disease.

Back 207

Parvovirus B19

Front 208

Ring-enhancing brain lesion on CT with seizures

Back 208

Taenia solium (cysticercosis)

Front 209

Name the organism: ■ Branching rods in oral infection.

Back 209

Actinomyces israelii

Front 210

Name the organism: ■ Painful chancroid.

Back 210

Haemophilus ducreyi

Front 211

Name the organism: ■ Dog or cat bite.

Back 211

Pasteurella multocida

Front 212

Name the organism: ■ Gardener.

Back 212

Sporothrix schenckii

Front 213

Name the organism: ■ Pregnant women with pets.

Back 213

Toxoplasma gondii

Front 214

Name the organism: ■ Meningitis in adults.

Back 214

Neisseria meningitidis

Front 215

Name the organism: ■ Meningitis in elderly.

Back 215

Streptococcus pneumoniae

Front 216

Name the organism: ■ Alcoholic with pneumonia.

Back 216

Klebsiella

Front 217

Name the organism: ■ “Currant jelly” sputum.

Back 217

Klebsiella

Front 218

Name the organism: ■ Infection in burn victims.

Back 218

Pseudomonas

Front 219

Name the organism: ■ Osteomyelitis from foot wound puncture.

Back 219

Pseudomonas

Front 220

Name the organism: ■ Osteomyelitis in a sickle cell patient.

Back 220

Salmonella

Front 221

A 55-year-old man who is a smoker and a heavy drinker presents with a new cough and flulike symptoms. Gram stain shows no organisms; silver stain of sputum shows gram-negative rods. What is the diagnosis?

Back 221

Legionella pneumonia

Front 222

A middle-aged man presents with acute-onset monoarticular joint pain and bilateral Bell’s palsy. What is the likely diagnosis, and how did he get it? Treatment?

Back 222

Lyme disease, Ixodes tick, doxycycline

Front 223

A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?

Back 223

S. aureus or S. epidermidis.

Front 224

A patient presents with pain on passive movement, pallor, poikilothermia, paresthesias, paralysis, and pulselessness. Treatment?

Back 224

All-compartment fasciotomy for suspected compartment syndrome

Front 225

Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.

Back 225

Spinal stenosis

Front 226

Joints in the hand affected in rheumatoid arthritis.

Back 226

MCP and PIP joints; DIP joints are spared

Front 227

Joint pain and stiffness that worsen over the course of the day and are relieved by rest.

Back 227

Osteoarthritis

Front 228

Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.

Back 228

Osteogenesis imperfecta

Front 229

Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?

Back 229

Suspect ankylosing spondylitis. Check HLA-B27

Front 230

Arthritis, conjunctivitis, and urethritis in young men. Associated organisms?

Back 230

Reactive (Reiter’s) arthritis. Associated with Campylobacter, Shigella, Salmonella, Chlamydia, and Ureaplasma

Front 231

A 55-year-old man has sudden, excruciating first MTP joint pain after a night of drinking red wine. Diagnosis, workup, and chronic treatment?

Back 231

Gout. Needle-shaped, negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid

Front 232

Rhomboid-shaped, positively birefringent crystals on joint fluid aspirate.

Back 232

Pseudogout

Front 233

An elderly female presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and ↑ ESR.

Back 233

Polymyalgia rheumatica

Front 234

An active 13-year-old boy has anterior knee pain. Diagnosis?

Back 234

Osgood-Schlatter disease

Front 235

Bone is fractured in fall on outstretched hand.

Back 235

Distal radius (Colles’ fracture)

Front 236

Complication of scaphoid fracture.

Back 236

Avascular necrosis

Front 237

Signs suggesting radial nerve damage with humeral fracture.

Back 237

Wrist drop, loss of thumb abduction

Front 238

A young child presents with proximal muscle weakness, waddling gait, and pronounced calf muscles.

Back 238

Duchenne muscular dystrophy

Front 239

A first-born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?

Back 239

Developmental dysplasia of the hip. If severe, consider a Pavlik harness to maintain abduction

Front 240

An 11-year-old obese, African-American boy presents with sudden onset of limp. Diagnosis? Workup?

Back 240

Slipped capital femoral epiphyses. AP and frog-leg lateral view

Front 241

The most common 1° malignant tumor of bone.

Back 241

Multiple myeloma

Front 242

Unilateral, severe periorbital headache with tearing and conjunctival erythema.

Back 242

Cluster headache

Front 243

Prophylactic treatment for migraine.

Back 243

β-blockers, Ca2+ channel blockers, TCAs

Front 244

The most common pituitary tumor. Treatment?

Back 244

Prolactinoma. Dopamine agonists (e.g., bromocriptine)

Front 245

A 55-year-old patient presents with acute “broken speech.” What type of aphasia? What lobe and vascular distribution?

Back 245

Broca’s aphasia. Frontal lobe, left MCA distribution

Front 246

The most common cause of SAH.

Back 246

Trauma; the second most common is berry aneurysm

Front 247

A crescent-shaped hyperdensity on CT that does not cross the midline.

Back 247

Subdural hematoma—bridging veins torn

Front 248

A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely etiology? Treatment?

Back 248

Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation

Front 249

CSF findings with SAH.

Back 249

Elevated ICP, RBCs, xanthochromia

Front 250

Albuminocytologic dissociation.

Back 250

Guillain-Barré (↑ protein in CSF with only a modest ↑ in cell count)

Front 251

Cold water is flushed into a patient’s ear, and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?

Back 251

Normal

Front 252

The most common 1° sources of metastases to the brain.

Back 252

Lung, breast, skin (melanoma), kidney, GI tract

Front 253

May be seen in children who are accused of inattention in class and confused with ADHD.

Back 253

Absence seizures

Front 254

The most frequent presentation of intracranial neoplasm.

Back 254

Headache

Front 255

The most common cause of seizures in children (2–10 years).

Back 255

Infection, febrile seizures, trauma, idiopathic

Front 256

The most common cause of seizures in young adults (18–35 years).

Back 256

Trauma, alcohol withdrawal, brain tumor

Front 257

First-line medication for status epilepticus.

Back 257

IV benzodiazepine

Front 258

Confusion, confabulation, ophthalmoplegia, ataxia.

Back 258

Wernicke’s encephalopathy due to a deficiency of thiamine

Front 259

What % lesion is an indication for carotid endarterectomy?

Back 259

Seventy percent if the stenosis is symptomatic

Front 260

The most common causes of dementia.

Back 260

Alzheimer’s and multi-infarct

Front 261

Combined UMN and LMN disorder.

Back 261

ALS

Front 262

Rigidity and stiffness with resting tremor and masked facies.

Back 262

Parkinson’s disease

Front 263

The mainstay of Parkinson’s therapy.

Back 263

Levodopa/carbidopa

Front 264

Treatment for Guillain-Barre syndrome.

Back 264

IVIG or plasmapheresis

Front 265

Rigidity and stiffness that progress to choreiform movements, accompanied by moodiness and altered behavior.

Back 265

Huntington’s disease

Front 266

A six-year-old girl presents with a port-wine stain in the V2 distribution as well as with mental retardation, seizures, and leptomeningeal angioma.

Back 266

Sturge-Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe

Front 267

Café-au-lait spots on skin.

Back 267

Neurofibromatosis 1

Front 268

Hyperphagia, hypersexuality, hyperorality, and hyperdocility.

Back 268

Klüver-Bucy syndrome (amygdala)

Front 269

Administer to a symptomatic patient to diagnose myasthenia gravis.

Back 269

Edrophonium

Front 270

1° causes of third-trimester bleeding.

Back 270

Placental abruption and placenta previa

Front 271

Classic ultrasound and gross appearance of complete hydatidiform mole.

Back 271

Snowstorm on ultrasound. “Cluster-of-grapes” appearance on gross examination

Front 272

Chromosomal pattern of a complete mole.

Back 272

46,XX

Front 273

Molar pregnancy containing fetal tissue.

Back 273

Partial mole

Front 274

Symptoms of placental abruption.

Back 274

Continuous, painful vaginal bleeding

Front 275

Symptoms of placenta previa.

Back 275

Self-limited, painless vaginal bleeding

Front 276

When should a vaginal exam be performed with suspected placenta previa?

Back 276

Never

Front 277

Antibiotics with teratogenic effects.

Back 277

Tetracycline, fluoroquinolones, aminoglycosides, sulfonamides

Front 278

Shortest AP diameter of the pelvis.

Back 278

Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis

Front 279

Medication given to accelerate fetal lung maturity.

Back 279

Betamethasone or dexamethasone × 48 hours

Front 280

The most common cause of postpartum hemorrhage.

Back 280

Uterine atony

Front 281

Treatment for postpartum hemorrhage.

Back 281

Uterine massage; if that fails, give oxytocin

Front 282

Typical antibiotics for group B streptococcus (GBS) prophylaxis.

Back 282

IV penicillin or ampicillin

Front 283

A patient fails to lactate after an emergency C-section with marked blood loss.

Back 283

Sheehan’s syndrome (postpartum pituitary necrosis)

Front 284

Uterine bleeding at 18 weeks’ gestation; no products expelled; membranes ruptured; cervical os open.

Back 284

Inevitable abortion

Front 285

Uterine bleeding at 18 weeks’ gestation; no products expelled; cervical os closed.

Back 285

Threatened abortion

Front 286

The first test to perform when a woman presents with amenorrhea.

Back 286

β-hCG; the most common cause of amenorrhea is pregnancy

Front 287

Term for heavy bleeding during and between menstrual periods.

Back 287

Menometrorrhagia

Front 288

Cause of amenorrhea with normal prolactin, no response to estrogen-progesterone challenge, and a history of D&C.

Back 288

Asherman’s syndrome

Front 289

Therapy for polycystic ovarian syndrome.

Back 289

Weight loss and OCPs

Front 290

Medication used to induce ovulation.

Back 290

Clomiphene citrate

Front 291

Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.

Back 291

Endometrial biopsy

Front 292

Indications for medical treatment of ectopic pregnancy.

Back 292

Stable, unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks’ gestation

Front 293

Medical options for endometriosis.

Back 293

OCPs, danazol, GnRH agonists

Front 294

Laparoscopic findings in endometriosis.

Back 294

“Chocolate cysts,” powder burns

Front 295

The most common location for an ectopic pregnancy.

Back 295

Ampulla of the oviduct

Front 296

How to diagnose and follow a leiomyoma.

Back 296

Ultrasound

Front 297

Natural history of a leiomyoma.

Back 297

Regresses after menopause

Front 298

A patient has ↑ vaginal discharge and petechial patches in the upper vagina and cervix.

Back 298

Trichomonas vaginitis

Front 299

Treatment for bacterial vaginosis.

Back 299

Oral or topical metronidazole

Front 300

The most common cause of bloody nipple discharge.

Back 300

Intraductal papilloma

Front 301

Contraceptive methods that protect against PID.

Back 301

OCP and barrier contraception

Front 302

Unopposed estrogen is contraindicated in which cancers?

Back 302

Endometrial or estrogen receptor–
breast cancer

Front 303

A patient presents with recent PID with RUQ pain.

Back 303

Consider Fitz-Hugh–Curtis syndrome

Front 304

Breast malignancy presenting as itching, burning, and erosion of the nipple.

Back 304

Paget’s disease

Front 305

Annual screening for women with a strong family history of ovarian cancer.

Back 305

CA-125 and transvaginal ultrasound

Front 306

A 50-year-old woman leaks urine when laughing or coughing. Nonsurgical options?

Back 306

Kegel exercises, estrogen, pessaries for stress incontinence

Front 307

A 30-year-old woman has unpredictable urine loss. Examination is normal. Medical options?

Back 307

Anticholinergics (oxybutynin) or Beta-adrenergics (metaproterenol) for urge incontinence.

Front 308

Lab values suggestive of menopause.

Back 308

↑ serum FSH

Front 309

The most common cause of female infertility.

Back 309

Endometriosis

Front 310

Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow-up evaluation?

Back 310

Colposcopy and endocervical curettage

Front 311

Breast cancer type that ↑ the future risk of invasive carcinoma in both breasts.

Back 311

Lobular carcinoma in situ

Front 312

Nontender abdominal mass associated with elevated VMA and HVA.

Back 312

Neuroblastoma

Front 313

The most common type of tracheoesophageal fistula (TEF). Diagnosis?

Back 313

Esophageal atresia with distal TEF (85%). Unable to pass NG tube

Front 314

Not contraindications to vaccination.

Back 314

Mild illness and/or low-grade fever, current antibiotic therapy, and prematurity

Front 315

Tests to rule out shaken baby syndrome.

Back 315

Ophthalmologic exam, CT, and MRI

Front 316

A neonate has meconium ileus.

Back 316

CF or Hirschsprung’s disease

Front 317

Bilious emesis within hours after the first feeding.

Back 317

Duodenal atresia

Front 318

A two-month-old presents with nonbilious projectile emesis. What are the appropriate steps in management?

Back 318

Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy

Front 319

The most common 1° immunodeficiency.

Back 319

Selective IgA deficiency

Front 320

An infant has a high fever and onset of rash as fever breaks. What is he at risk for?

Back 320

Febrile seizures (roseola infantum)

Front 321

Acute-phase treatment for Kawasaki disease.

Back 321

High-dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms

Front 322

Treatment for mild and severe unconjugated hyperbilirubinemia.

Back 322

Phototherapy (mild) or exchange transfusion (severe)

Front 323

Sudden onset of mental status changes, emesis, and liver dysfunction after taking aspirin.

Back 323

Reye’s syndrome

Front 324

A child has loss of red light reflex. Diagnosis?

Back 324

Suspect retinoblastoma

Front 325

Vaccinations at a six-month well-child visit.

Back 325

HBV, DTaP, Hib, IPV, PCV

Front 326

Tanner stage 3 in a six-year-old female.

Back 326

Precocious puberty

Front 327

Infection of small airways with epidemics in winter and spring.

Back 327

RSV bronchiolitis

Front 328

Cause of neonatal RDS.

Back 328

Surfactant deficiency

Front 329

What is the immunodeficiency? ■ A boy has chronic respiratory infections. Nitroblue tetrazolium test is +.

Back 329

Chronic granulomatous disease

Front 330

What is the immunodeficiency? ■ A child has eczema, thrombocytopenia, and high levels of IgA.

Back 330

Wiskott-Aldrich syndrome

Front 331

What is the immunodeficiency? ■ A four-month-old boy has life-threatening Pseudomonas infection.

Back 331

Bruton’s X-linked agammaglobulinemia

Front 332

A condition associated with red “currant-jelly” stools.

Back 332

Intussusception

Front 333

A congenital heart disease that cause 2° hypertension.

Back 333

Coarctation of the aorta

Front 334

First-line treatment for otitis media.

Back 334

Amoxicillin × 10 days

Front 335

The most common pathogen causing croup.

Back 335

Parainfluenza virus type 1

Front 336

A homeless child is small for his age and has peeling skin and a swollen belly.

Back 336

Kwashiorkor (protein malnutrition)

Front 337

Defect in an X-linked syndrome with mental retardation,

Back 337

Lesch-Nyhan syndrome (purine salvage problem with

Front 338

Defect in an X-linked syndrome with mental retardation, gout, self-mutilation, and choreoathetosis.

Back 338

Lesch-Nyhan syndrome (purine salvage problem with HGPRTase deficiency)

Front 339

A newborn female has continuous “machinery murmur.”

Back 339

Patent ductus arteriosus (PDA)

Front 340

First-line pharmacotherapy for depression.

Back 340

SSRIs

Front 341

Antidepressants associated with hypertensive crisis.

Back 341

MAOIs

Front 342

Galactorrhea, impotence, menstrual dysfunction, and ↓ libido.

Back 342

Patient on dopamine antagonist

Front 343

A 17-year-old female has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found.

Back 343

Conversion disorder

Front 344

Name the defense mechanism: ■ A mother who is angry at her husband yells at her child.

Back 344

Displacement

Front 345

Name the defense mechanism: ■ A pedophile enters a monastery.

Back 345

Reaction formation

Front 346

Name the defense mechanism: ■ A woman calmly describes a grisly murder.

Back 346

Isolation

Front 347

Name the defense mechanism: ■ A hospitalized 10-year-old begins to wet his bed.

Back 347

Regression

Front 348

Life-threatening muscle rigidity, fever, and rhabdomyolysis.

Back 348

Neuroleptic malignant syndrome

Front 349

Amenorrhea, bradycardia, and abnormal body image in a young female.

Back 349

Anorexia

Front 350

A 35-year-old male has recurrent episodes of palpitations, diaphoresis, and fear of going crazy.

Back 350

Panic disorder

Front 351

The most serious side effect of clozapine.

Back 351

Agranulocytosis

Front 352

A 21-year-old male has three months of social withdrawal, worsening grades, flattened affect, and concrete thinking.

Back 352

Schizophreniform disorder (diagnosis of schizophrenia requires ≥ 6 months of symptoms)

Front 353

Key side effects of atypical antipsychotics.

Back 353

Weight gain, type 2 DM, QT prolongation

Front 354

A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?

Back 354

Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine

Front 355

Medication to avoid in patients with a history of alcohol withdrawal seizures.

Back 355

Neuroleptics

Front 356

A 13-year-old male has a history of theft, vandalism, and violence toward family pets.

Back 356

Conduct disorder

Front 357

A five-month-old girl has ↓ head growth, truncal dyscoordination, and ↓ social interaction.

Back 357

Rett’s disorder

Front 358

A patient hasn’t slept for days, lost $20,000 gambling, is agitated, and has pressured speech. Diagnosis? Treatment?

Back 358

Acute mania. Start a mood stabilizer (e.g., lithium)

Front 359

After a minor fender bender, a man wears a neck brace and requests permanent disability.

Back 359

Malingering

Front 360

A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C peptide.

Back 360

Factitious disorder (Munchausen syndrome)

Front 361

A patient continues to use cocaine after being in jail, losing his job, and not paying child support.

Back 361

Substance abuse

Front 362

A violent patient has vertical and horizontal nystagmus.

Back 362

Phencyclidine hydrochloride (PCP) intoxication

Front 363

A woman who was abused as a child frequently feels outside of or detached from her body.

Back 363

Depersonalization disorder

Front 364

A man has repeated, intense urges to rub his body against unsuspecting passengers on a bus.

Back 364

Frotteurism (a paraphilia)

Front 365

A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Diagnosis? Treatment?

Back 365

Tardive dyskinesia. ↓ or discontinue haloperidol and consider another antipsychotic (e.g., risperidone, clozapine)

Front 366

A man unexpectedly flies across the country, takes a new name, and has no memory of his prior life.

Back 366

Dissociative fugue

Front 367

Risk factors for DVT.

Back 367

Stasis, endothelial injury and hypercoagulability (Virchow’s triad)

Front 368

Criteria for exudative effusion.

Back 368

Pleural/serum protein > 0.5; pleural/serum LDH > 0.6

Front 369

Causes of exudative effusion.

Back 369

Think of leaky capillaries. Malignancy, TB, bacterial or viral infection, pulmonary embolism with infarct, and pancreatitis

Front 370

Causes of transudative effusion.

Back 370

Think of intact capillaries. CHF, liver or kidney disease, and protein-losing enteropathy

Front 371

Normalizing PCO2 in a patient having an asthma exacerbation may indicate?

Back 371

Fatigue and impending respiratory failure

Front 372

Dyspnea, lateral hilar lymphodenopathy on CXR, noncaseating granulomas, increased ACE, and hypercalcemia.

Back 372

Sarcoidosis

Front 373

PFT showing ↓ FEV1/FVC.

Back 373

Obstructive pulmonary disease (e.g., asthma)

Front 374

PFT showing ↑ FEV1/FVC.

Back 374

Restrictive pulmonary disease

Front 375

Honeycomb pattern on CXR. Diagnosis? Treatment?

Back 375

Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help

Front 376

Treatment for SVC syndrome.

Back 376

Radiation

Front 377

Treatment for mild, persistent asthma.

Back 377

Inhaled β-agonists and inhaled corticosteroids

Front 378

Acid-base disorder in pulmonary embolism.

Back 378

Hypoxia and hypocarbia

Front 379

Non–small cell lung cancer (NSCLC) associated with hypercalcemia.

Back 379

Squamous cell carcinoma

Front 380

Lung cancer associated with SIADH.

Back 380

Small cell lung cancer (SCLC)

Front 381

Lung cancer highly related to cigarette exposure.

Back 381

Small cell lung cancer

Front 382

A tall white male presents with acute shortness of breath. Diagnosis? Treatment?

Back 382

Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful

Front 383

Treatment of tension pneumothorax.

Back 383

Immediate needle thoracostomy

Front 384

Characteristics favoring carcinoma in an isolated pulmonary nodule.

Back 384

Age > 45–50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins

Front 385

Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure.

Back 385

ARDS

Front 386

Increased risk of what infection with silicosis?

Back 386

Mycobacterium tuberculosis

Front 387

Causes of hypoxemia.

Back 387

Right-to-left shunt, hypoventilation, low inspired O2 tension, diffusion defect, V/Q mismatch

Front 388

Classic CXR findings for pulmonary edema.

Back 388

Cardiomegaly, prominent pulmonary vessels, Kerley B lines, “bat’s-wing” appearance of hilar shadows, and perivascular and peribronchial cuffing

Front 389

Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.

Back 389

Type I (distal) RTA

Front 390

RTA associated with abnormal HCO3 − and rickets.

Back 390

Type II (proximal) RTA

Front 391

RTA associated with aldosterone defect.

Back 391

Type IV (distal) RTA

Front 392

“Doughy skin.”

Back 392

Hypernatremia

Front 393

Differential of hypervolemic hyponatremia.

Back 393

Cirrhosis, CHF, nephritic syndrome

Front 394

Chvostek’s and Trousseau’s signs.

Back 394

Hypocalcemia

Front 395

The most common causes of hypercalcemia.

Back 395

Malignancy and hyperparathyroidism

Front 396

T-wave flattening and U waves.

Back 396

Hypokalemia

Front 397

Peaked T waves and widened QRS.

Back 397

Hyperkalemia

Front 398

First-line treatment for moderate hypercalcemia.

Back 398

IV hydration and loop diuretics (furosemide)

Front 399

Type of ARF in a patient with FeNa < 1%.

Back 399

Prerenal

Front 400

A 49-year-old male presents with acute-onset flank pain and hematuria.

Back 400

Nephrolithiasis

Front 401

The most common type of nephrolithiasis.

Back 401

Calcium oxalate

Front 402

A 20-year-old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?

Back 402

Cerebral berry aneurysms (AD PCKD)

Front 403

Hematuria, hypertension, and oliguria.

Back 403

Nephritic syndrome

Front 404

Proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, edema.

Back 404

Nephrotic syndrome

Front 405

The most common form of nephritic syndrome.

Back 405

Membranous glomerulonephritis

Front 406

The most common form of glomerulonephritis.

Back 406

IgA nephropathy (Berger’s disease)

Front 407

Glomerulonephritis with deafness.

Back 407

Alport’s syndrome

Front 408

Glomerulonephritis with hemoptysis.

Back 408

Wegener’s granulomatosis and Goodpasture’s syndrome

Front 409

Presence of red cell casts in urine sediment.

Back 409

Glomerulonephritis/nephritic syndrome

Front 410

Eosinophils in urine sediment.

Back 410

Allergic interstitial nephritis

Front 411

Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).

Back 411

Nephrotic syndrome

Front 412

Drowsiness, asterixis, nausea, and a pericardial friction rub.

Back 412

Uremic syndrome seen in patients with renal failure

Front 413

A 55-year-old man is diagnosed with prostate cancer. Treatment options?

Back 413

Wait, surgical resection, radiation and/or androgen suppression

Front 414

Low urine specific gravity in the presence of high serum osmolality.

Back 414

DI

Front 415

Treatment of SIADH?

Back 415

Fluid restriction, demeclocycline

Front 416

Hematuria, flank pain, and palpable flank mass.

Back 416

Renal cell carcinoma (RCC)

Front 417

Testicular cancer associated with β-hCG, AFP.

Back 417

Choriocarcinoma

Front 418

The most common type of testicular cancer.

Back 418

Seminoma—a type of germ cell tumor

Front 419

The most common histology of bladder cancer.

Back 419

Transitional cell carcinoma

Front 420

Complication of overly rapid correction of hyponatremia.

Back 420

Central pontine myelinolysis

Front 421

Salicylate ingestion → in what type of acid-base disorder?

Back 421

Anion gap acidosis and 1° respiratory alkalosis due to central respiratory stimulation

Front 422

Acid-base disturbance commonly seen in pregnant women.

Back 422

Respiratory alkalosis

Front 423

Three systemic diseases → nephrotic syndrome.

Back 423

DM, SLE, and amyloidosis

Front 424

Elevated erythropoietin level, elevated hematocrit, and normal O2 saturation suggest?

Back 424

Renal cell carcinoma or other erythropoietin-producing tumor; evaluate with CT scan

Front 425

A 55-year-old man presents with irritative and obstructive urinary symptoms. Treatment options?

Back 425

Likely BPH. Options include no treatment, terazosin, finasteride, or surgical intervention (TURP)

Front 426

Class of drugs that may cause syndrome of muscle rigidity, hyperthermia, autonomic instability, and extrapyramidal symptoms.

Back 426

Antipsychotics (neuroleptic malignant syndrome)

Front 427

Side effects of corticosteroids.

Back 427

Acute mania, immunosuppression, thin skin, osteoporosis, easy bruising, myopathies

Front 428

Treatment for DTs.

Back 428

Benzodiazepines

Front 429

Treatment for acetaminophen overdose.

Back 429

N-acetylcysteine

Front 430

Treatment for opioid overdose.

Back 430

Naloxone

Front 431

Treatment for benzodiazepine overdose.

Back 431

Flumazenil

Front 432

Treatment for neuroleptic malignant syndrome.

Back 432

Dantrolene or bromocriptine

Front 433

Treatment for malignant hypertension.

Back 433

Nitroprusside

Front 434

Treatment of AF.

Back 434

Rate control, rhythm conversion, and anticoagulation

Front 435

Treatment of supraventricular tachycardia (SVT).

Back 435

Rate control with carotid massasge or other vagal stimulation

Front 436

Causes of drug-induced SLE.

Back 436

INH, penicillamine, hydralazine, procainamide

Front 437

Macrocytic, megaloblastic anemia with neurologic symptoms.

Back 437

B12 deficiency

Front 438

Macrocytic, megaloblastic anemia without neurologic symptoms.

Back 438

Folate deficiency

Front 439

A burn patient presents with cherry-red flushed skin and coma. SaO2 is normal, but carboxyhemoglobin is elevated. Treatment?

Back 439

Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant

Front 440

Blood in the urethral meatus or high-riding prostate.

Back 440

Bladder rupture or urethral injury

Front 441

Test to rule out urethral injury.

Back 441

Retrograde cystourethrogram

Front 442

Radiographic evidence of aortic disruption or dissection.

Back 442

Widened mediastinum (> 8 cm), loss of aortic knob, pleural cap, tracheal deviation to the right, depression of left main stem bronchus

Front 443

Radiographic indications for surgery in patients with acute abdomen.

Back 443

Free air under the diaphragm, extravasation of contrast, severe bowl distention, space-occupying lesion (CT), mesenteric occlusion (angiography)

Front 444

The most common organism in burn-related infections.

Back 444

Pseudomonas

Front 445

Method of calculating fluid repletion in burn patients.

Back 445

Parkland formula

Front 446

Acceptable urine output in a trauma patient.

Back 446

50 cc/hour

Front 447

Acceptable urine output in a stable patient.

Back 447

30 cc/hour

Front 448

Cannon “a” waves.

Back 448

Third-degree heart block

Front 449

Signs of neurogenic shock.

Back 449

Hypotension and bradycardia

Front 450

Signs of ↑ ICP (Cushing’s triad).

Back 450

Hypertension, bradycardia, and abnormal respirations

Front 451

↓ CO, ↓ pulmonary capillary wedge pressure (PCWP), ↑ peripheral vascular resistance (PVR).

Back 451

Hypovolemic shock

Front 452

↓ CO, ↑ PCWP, ↑ PVR.

Back 452

Cardiogenic shock

Front 453

↑ CO, ↓ PCWP, ↓ PVR.

Back 453

Septic or anaphylactic shock

Front 454

Treatment of septic shock.

Back 454

Fluids and antibiotics

Front 455

Treatment of cardiogenic shock.

Back 455

Identify cause; pressors (e.g., dobutamine)

Front 456

Treatment of hypovolemic shock.

Back 456

Identify cause; fluid and blood repletion

Front 457

Treatment of anaphylactic shock.

Back 457

Diphenhydramine or epinephrine 1:1000

Front 458

Supportive treatment for ARDS.

Back 458

Continuous positive airway pressure

Front 459

Signs of air embolism.

Back 459

A patient with chest trauma who was previously stable suddenly dies

Front 460

Trauma series.

Back 460

AP chest, AP/lateral C-spine, AP pelvis