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460 Cards in this Set

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Classic ECG finding in atrial flutter.
“Sawtooth” P waves
Definition of unstable angina.
Angina is new, is worsening, or occurs at rest
Antihypertensive for a diabetic patient with proteinuria.
ACEI
Beck’s triad for cardiac tamponade.
Hypotension, distant heart sounds, and JVD
Drugs that slow AV node transmission.
β-blockers, digoxin, calcium channel blockers
Hypercholesterolemia treatment that → flushing and pruritus.
Niacin
Treatment for atrial fibrillation.
Anticoagulation, rate control, cardioversion
Treatment for ventricular fibrillation.
Immediate cardioversion
Autoimmune complication occurring 2–4 weeks post-MI.
Dressler’s syndrome: fever, pericarditis, increased ESR
IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
Treat existing heart failure and replace the tricuspid valve
Diagnostic test for hypertrophic cardiomyopathy.
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
A fall in systolic BP of > 10 mmHg with inspiration.
Pulsus paradoxus (seen in cardiac tamponade)
Classic ECG findings in pericarditis.
Low-voltage, diffuse ST-segment elevation
Definition of hypertension.
BP > 140/90 on three separate occasions two weeks apart
Eight surgically correctable causes of hypertension.
Renal artery stenosis, coarctation of the aorta, pheochromocytoma, Conn’s syndrome, Cushing’s syndrome, unilateral renal parenchymal disease, hyperthyroidism, hyperparathyroidism
Evaluation of a pulsatile abdominal mass and bruit.
Abdominal ultrasound and CT
Indications for surgical repair of abdominal aortic aneurysm.
> 5.5 cm, rapidly enlarging, symptomatic, or ruptured
Treatment for acute coronary syndrome.
Morphine, O2, sublingual nitroglycerin, ASA, IV β-blockers, heparin
What is the metabolic syndrome?
Abdominal obesity, high triglycerides, low HDL, hypertension, insulin resistance, prothrombotic or proinflammatory states
Appropriate diagnostic test? A 50-year-old male with angina can exercise to 85% of maximum predicted heart rate.
Exercise stress treadmill with ECG
Appropriate diagnostic test? ■ A 65-year-old woman with left bundle branch block and severe osteoarthritis has unstable angina.
Pharmacologic stress test (e.g., dobutamine echo)
Signs of active ischemia during stress testing.
Angina, ST-segment changes on ECG, or ↓ BP
ECG findings suggesting MI.
ST-segment elevation (depression means ischemia), flattened T waves, and Q waves
A young patient has angina at rest with ST-segment elevation. Cardiac enzymes are normal.
Prinzmetal’s angina
Common symptoms associated with silent MIs.
CHF, shock, and altered mental status
The diagnostic test for pulmonary embolism.
V/Q scan
An agent that reverses the effects of heparin.
Protamine
The coagulation parameter affected by warfarin.
PT
A young patient with a family history of sudden death collapses and dies while exercising.
Hypertrophic cardiomyopathy
Endocarditis prophylaxis regimens.
Oral surgery—amoxicillin; GI or GU procedures—ampicillin and gentamicin before and amoxicillin after
The 6 P’s of ischemia due to peripheral vascular disease.
Pain, pallor, pulselessness, paralysis, paresthesia, poikilothermia
Virchow’s triad.
Stasis, hypercoagulability, endothelial damage
The most common cause of hypertension in young women.
OCPs
The most common cause of hypertension in young men.
Excessive EtOH
“Stuck-on” appearance.
Seborrheic keratosis
Red plaques with silvery-white scales and sharp margins.
Psoriasis
The most common type of skin cancer; the lesion is a pearly-colored papule with a translucent surface and telangiectasias.
Basal cell carcinoma
Honey-crusted lesions.
Impetigo
A febrile patient with a history of diabetes presents with a red, swollen, painful lower extremity.
Cellulitis
+ Nikolsky’s sign.
Pemphigus vulgaris
- Nikolsky’s sign.
Bullous pemphigoid
A 55-year-old obese patient presents with dirty, velvety patches on the back of the neck.
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
Skin lesions in a dermatomal distribution.
Varicella zoster
Flat-topped papules.
Lichen planus
Iris-like target lesions.
Erythema multiforme
A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
Contact dermatitis
Presents with a herald patch, Christmas-tree pattern.
Pityriasis rosea
A 16-year-old presents with an annular patch of alopecia with broken-off, stubby hairs.
Alopecia areata (autoimmune process)
Pinkish, scaling, flat lesions on the chest and back. KOH prep has a “spaghetti-and-meatballs” appearance.
Pityriasis versicolor
Four characteristics of a nevus suggestive of melanoma.
Asymmetry, border irregularity, color variation, large diameter
Premalignant lesion from sun exposure that can → squamous cell carcinoma.
Actinic keratosis
“Dewdrop on a rose petal.”
Lesions of 1° varicella
“Cradle cap.”
Seborrheic dermatitis. Treat with antifungals
Associated with Propionibacterium acnes and changes in androgen levels.
Acne vulgaris
A painful, recurrent vesicular eruption of mucocutaneous surfaces.
Herpes simplex
Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women.
Lichen sclerosus
Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.
Squamous cell carcinoma
The most common cause of hypothyroidism.
Hashimoto’s thyroiditis
Lab findings in Hashimoto’s thyroiditis.
High TSH, low T4, antimicrosomal antibodies
Exophthalmos, pretibial myxedema, and ↓ TSH.
Graves’ disease
The most common cause of Cushing’s syndrome.
Iatrogenic steroid administration. The second most common cause is Cushing’s disease
A patient presents with signs of hypocalcemia, high phosphorus, and low PTH.
Hypoparathyroidism
“Stones, bones, groans, psychiatric overtones.”
Signs and symptoms of hypercalcemia
A patient complains of headache, weakness, and polyuria; exam reveals hypertension and tetany. Labs reveals hypernatremia, hypokalemia, and metabolic alkalosis.
1° hyperaldosteronism (due to Conn’s syndrome or bilateral adrenal hyperplasia)
A patient presents with tachycardia, wild swings in BP, headache, diaphoresis, altered mental status, and a sense of panic.
Pheochromocytoma
Should α- or β-antagonists be used first in treating pheochromocytoma?
α-antagonists (phentolamine and phenoxybenzamine)
A patient with a history of lithium use presents with copious amounts of dilute urine.
Nephrogenic diabetes insipidus (DI)
Treatment of central DI.
Administration of DDAVP ↓ serum osmolality and free water restriction
A postoperative patient with significant pain presents with hyponatremia and normal volume status.
SIADH due to stress
An antidiabetic agent associated with lactic acidosis.
Metformin
A patient presents with weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
1° adrenal insufficiency (Addison’s disease). Treat with replacement glucocorticoids, mineralocorticoids, and IV fluids
Goal hemoglobin A1c for a patient with DM.
< 7.0
Treatment of DKA.
Fluids, insulin, and aggressive replacement of electrolytes (e.g., K+)
Why are β-blockers contraindicated in diabetics?
They can mask symptoms of hypoglycemia
Bias introduced into a study when a clinician is aware of the patient’s treatment type.
Observational bias
Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
Lead-time bias
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 _____.
Confounding variable
The number of true positives divided by the number of patients with the disease is _____.
Sensitivity
Sensitive tests have few false negatives and are used to rule _____ a disease.
Out (SnOut and SpIn)
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?
Highly sensitive for TB
Chronic diseases such as SLE—higher prevalence or incidence?
Higher prevalence
Epidemics such as influenza—higher prevalence or incidence?
Higher incidence
Cross-sectional survey—incidence or prevalence?
Prevalence
Cohort study—incidence or prevalence?
Incidence and prevalence
Case-control study—incidence or prevalence?
Neither
Describe a test that consistently gives identical results, but the results are wrong.
High reliability, low validity
Difference between a cohort and a case-control study.
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
Attributable risk?
The incidence rate (IR) of a disease in exposed minus the IR of a disease in unexposed
Relative risk?
The IR of a disease in a population exposed to a particular factor ÷ the IR of those not exposed
Odds ratio?
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Number needed to treat?
1 ÷ (rate in untreated group − rate in treated group)
In which patients do you initiate colorectal cancer screening early?
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
The most common cancer in men and the most common cause of death from cancer in men.
Prostate cancer is the most common cancer in men, but lung cancer causes more deaths
The percentage of cases within one SD of the mean? Two SDs? Three SDs?
68%, 95.5%, 99.7%
Birth rate?
Number of live births per 1000 population
Fertility rate?
Number of live births per 1000 women 15–44 years of age
Mortality rate?
Number of deaths per 1000 population
Neonatal mortality?
Number of deaths from birth to 28 days per 1000 live births
Postnatal mortality?
Number of deaths from 28 days to one year per 1000 live births
Infant mortality?
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Fetal mortality?
Number of deaths from 20 weeks’ gestation to birth per 1000 total births
Perinatal mortality?
Number of deaths from 20 weeks’ gestation to one month of life per 1000 total births
Maternal mortality?
Number of deaths during pregnancy to 90 days postpartum per 100,000 live births
True or false: Once patients sign a statement giving consent, they must continue treatment.
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
A 15-year-old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
No. Parental consent is not necessary for the medical treatment of pregnant minors
A doctor refers a patient for an MRI at a facility he/she owns.
Conflict of interest
Involuntary psychiatric hospitalization can be undertaken for which three reasons?
The patient is a danger to self, a danger to others, or gravely disabled (unable to provide for basic needs)
True or false: Withdrawing life-sustaining care is ethically distinct from withholding sustaining care.
False. Withdrawing and withholding life are the same from an ethical standpoint
When can a physician refuse to continue treating a patient on the grounds of futility?
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
An eight-year-old child is in a serious accident. She requires emergent transfusion, but her parents are not present.
Treat immediately. Consent is implied in emergency situations
Conditions in which confidentiality must be overridden.
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Involuntary commitment or isolation for medical treatment may be undertaken for what reason?
When treatment noncompliance represents a serious danger to public health (e.g., active TB)
A 10-year-old child presents in status epilepticus, but her parents refuse treatment on religious grounds.
Treat because the disease represents an immediate threat to the child’s life. Then seek a court order
A son asks that his mother not be told about her recently discovered cancer.
A patient’s family cannot require that a doctor withhold information from the patient
Patient presents with sudden onset of severe, diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Emergent laparotomy to repair perforated viscus, likely stomach
The most likely cause of acute lower GI bleed in patients > 40 years old.
Diverticulosis
Diagnostic modality used when ultrasound is equivocal for cholecystitis.
HIDA scan
Sentinel loop on AXR.
Acute pancreatitis
Risk factors for cholelithiasis.
Fat, female, fertile, forty, flatulent
Inspiratory arrest during palpation of the RUQ.
Murphy’s sign, seen in acute cholecystitis
Identify key organisms causing diarrhea: ■ Most common organism
Campylobacter
Identify key organisms causing diarrhea: ■ Recent antibiotic use
Clostridium difficile
Identify key organisms causing diarrhea: ■ Camping
Giardia
Identify key organisms causing diarrhea: ■ Traveler’s diarrhea
ETEC
Identify key organisms causing diarrhea: ■ Church picnics/mayonnaise
S. aureus
Identify key organisms causing diarrhea: ■ Uncooked hamburgers
E. coli O157:H7
Identify key organisms causing diarrhea: ■ Fried rice
Bacillus cereus
Identify key organisms causing diarrhea: ■ Poultry/eggs
Salmonella
Identify key organisms causing diarrhea: ■ Raw seafood
Vibrio, HAV
Identify key organisms causing diarrhea: ■ AIDS
Isospora, Cryptosporidium, Mycobacterium avium complex (MAC)
Identify key organisms causing diarrhea: ■ Pseudoappendicitis
Yersinia
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.
Crohn’s disease
Inflammatory disease of the colon with ↑ risk of colon cancer.
Ulcerative colitis
Extraintestinal manifestations of IBD.
Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, 1° sclerosing cholangitis
Medical treatment for IBD.
5-aminosalicylic acid +/− sulfasalazine and steroids during acute exacerbations
Difference between Mallory-Weiss and Boerhaave tears.
Mallory-Weiss—superficial tear in the esophageal mucosa Boerhaave—full-thickness esophageal rupture
Charcot’s triad.
RUQ pain, jaundice, and fever/chills in the setting of ascending cholangitis
Reynolds’ pentad.
Charcot’s triad plus shock and mental status changes, with suppurative ascending cholangitis
Medical treatment for hepatic encephalopathy.
↓ protein intake, lactulose, neomycin
First step in the management of a patient with acute GI bleed.
Establish the ABCs
A four-year-old child presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
Hemolytic-uremic syndrome (HUS) due to E. coli O157:H7
Post-HBV exposure treatment.
HBV immunoglobulin
Classic causes of drug-induced hepatitis.
TB medications (INH, rifampin, pyrazinamide), acetaminophen, and tetracycline
A 40-year-old obese female with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine, and clay-colored stools.
Biliary tract obstruction
Hernia with highest risk of incarceration—indirect, direct, or femoral?
Femoral hernia
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?
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids, O2, analgesia, and “tincture of time”
Four causes of microcytic anemia.
TICS—Thalassemia, Iron deficiency, anemia of Chronic disease, and Sideroblastic anemia
An elderly male with hypochromic, microcytic anemia is asymptomatic. Diagnostic tests?
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Precipitants of hemolytic crisis in patients with G6PD deficiency.
Sulfonamides, antimalarial drugs, fava beans
The most common inherited cause of hypercoagulability.
Factor V Leiden mutation
The most common inherited hemolytic anemia.
Hereditary spherocytosis
Diagnostic test for hereditary spherocytosis.
Osmotic fragility test
Pure RBC aplasia.
Diamond-Blackfan anemia
Anemia associated with absent radii and thumbs, diffuse hyperpigmentation, café-au-lait spots, microcephaly, and pancytopenia.
Fanconi’s anemia
Medications and viruses that → aplastic anemia.
Chloramphenicol, sulfonamides, radiation, HIV, chemotherapeutic agents, hepatitis, parvovirus B19, EBV
How to distinguish polycythemia vera from 2° polycythemia.
Both have ↑ hematocrit and RBC mass, but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Thrombotic thrombocytopenic purpura (TTP) pentad?
Pentad of TTP—“FAT RN”: Fever, Anemia, Thrombocytopenia, Renal dysfunction, Neurologic abnormalities
HUS triad?
Anemia, thrombocytopenia, and acute renal failure
Treatment for TTP.
Emergent large-volume plasmapheresis, corticosteroids, antiplatelet drugs
Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Which of the following are ↑ in DIC: fibrin split products, D-dimer, fibrinogen, platelets, and hematocrit.
Fibrin split products and D-dimer are elevated; platelets, fibrinogen, and hematocrit are ↓.
An eight-year-old boy presents with hemarthrosis and ↑ PTT with normal PT and bleeding time. Diagnosis? Treatment?
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
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?
von Willebrand’s disease; treat with desmopressin, FFP, or cryoprecipitate
A 60-year-old African-American male presents with bone pain. Workup for multiple myeloma might reveal?
Monoclonal gammopathy, Bence Jones proteinuria, “punched-out” lesions on x-ray of the skull and long bones
Reed-Sternberg cells
Hodgkin’s lymphoma
A 10-year-old boy presents with fever, weight loss, and night sweats. Examination shows anterior mediastinal mass. Suspected diagnosis?
Non-Hodgkin’s lymphoma
Microcytic anemia with ↓ serum iron, ↓ total iron-binding capacity (TIBC), and normal or ↑ ferritin.
Anemia of chronic disease
Microcytic anemia with ↓ serum iron, ↓ ferritin, and ↑ TIBC.
Iron deficiency anemia
An 80-year-old man presents with fatigue, lymphadenopathy, splenomegaly, and isolated lymphocytosis. Suspected diagnosis?
Chronic lymphocytic leukemia (CLL)
A late, life-threatening complication of chronic myelogenous leukemia (CML).
Blast crisis (fever, bone pain, splenomegaly, pancytopenia)
Auer rods on blood smear.
Acute myelogenous leukemia (AML)
AML subtype associated with DIC.
M3
Electrolyte changes in tumor lysis syndrome.
↓ Ca2− , ↑ K− , ↑ phosphate, ↑ uric acid
Treatment for AML M3.
Retinoic acid
A 50-year-old male presents with early satiety, splenomegaly, and bleeding. Cytogenetics show t(9,22). Diagnosis?
CML
Heinz bodies?
Intracellular inclusions seen in thalassemia, G6PD deficiency, and postsplenectomy
An autosomal-recessive disorder with a defect in the GPIIbIIIa platelet receptor and ↓ platelet aggregation.
Glanzmann’s thrombasthenia
Virus associated with aplastic anemia in patients with sickle cell anemia.
Parvovirus B19
A 25-year-old African-American male with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?
O2, analgesia, hydration, and, if severe, transfusion
A significant cause of morbidity in thalassemia patients. Treatment?
Iron overload; use deferoxamine
The three most common causes of fever of unknown origin (FUO).
Infection, cancer, and autoimmune disease
Four signs and symptoms of streptococcal pharyngitis.
Fever, pharyngeal erythema, tonsillar exudate, lack of cough
A nonsuppurative complication of streptococcal infection that is not altered by treatment of primary infection.
Postinfectious glomerulonephritis
Asplenic patients are particularly susceptible to these organisms.
Encapsulated organisms––pneumococcus, meningococcus, Haemophilus influenzae, Klebsiella
The number of bacterial culture on a clean-catch specimen to diagnose a UTI.
105 bacteria/mL
Which healthy population is susceptible to UTIs?
Pregnant women. Treat this group aggressively because of potential complications
A patient from California or Arizona presents with fever, malaise, cough, and night sweats. Diagnosis? Treatment?
Coccidioidomycosis. Amphotericin B
Nonpainful chancre.
1° syphilis
A “blueberry muffin” rash is characteristic of what congenital infection?
Rubella
Meningitis in neonates. Causes? Treatment?
Group B strep, E. coli, Listeria. Treat with gentamicin and ampicillin
Meningitis in infants. Causes? Treatment?
Pneumococcus, meningococcus, H. influenzae. Treat with cefotaxime and vancomycin
What should always be done prior to LP?
Check for ↑ ICP; look for papilledema
CSF findings: ■ Low glucose, PMN predominance
Bacterial meningitis
CSF findings: ■ Normal glucose, lymphocytic predominance
Aseptic (viral) meningitis
CSF findings: ■ Numerous RBCs in serial CSF samples
Subarachnoid hemorrhage (SAH)
CSF findings: Increased gamma globulins
Multiple sclerosis
Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7–10 days. Treatment?
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Findings in 3° syphilis.
Tabes dorsalis, general paresis, gummas, Argyll Robertson pupil, aortitis, aortic root aneurysms
Characteristics of 2° Lyme disease.
Arthralgias, migratory polyarthropathies, Bell’s palsy, myocarditis
Cold agglutinins.
Mycoplasma
A 24-year-old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV-positive patient at what CD4 count? Mycobacterium avium-intracellulare (MAI) prophylaxis?
≤ 200 for PCP (with TMP); ≤ 50–100 for MAI (with clarithromycin/azithromycin)
Risk factors for pyelonephritis.
Pregnancy, vesicoureteral reflux, anatomic anomalies, indwelling catheters, kidney stones
Neutropenic nadir postchemotherapy.
7–10 days
Erythema migrans.
Lesion of 1° Lyme disease
Classic physical findings for endocarditis.
Fever, heart murmur, Osler’s nodes, splinter hemorrhages, Janeway lesions, Roth’s spots
Aplastic crisis in sickle cell disease.
Parvovirus B19
Ring-enhancing brain lesion on CT with seizures
Taenia solium (cysticercosis)
Name the organism: ■ Branching rods in oral infection.
Actinomyces israelii
Name the organism: ■ Painful chancroid.
Haemophilus ducreyi
Name the organism: ■ Dog or cat bite.
Pasteurella multocida
Name the organism: ■ Gardener.
Sporothrix schenckii
Name the organism: ■ Pregnant women with pets.
Toxoplasma gondii
Name the organism: ■ Meningitis in adults.
Neisseria meningitidis
Name the organism: ■ Meningitis in elderly.
Streptococcus pneumoniae
Name the organism: ■ Alcoholic with pneumonia.
Klebsiella
Name the organism: ■ “Currant jelly” sputum.
Klebsiella
Name the organism: ■ Infection in burn victims.
Pseudomonas
Name the organism: ■ Osteomyelitis from foot wound puncture.
Pseudomonas
Name the organism: ■ Osteomyelitis in a sickle cell patient.
Salmonella
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?
Legionella pneumonia
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?
Lyme disease, Ixodes tick, doxycycline
A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?
S. aureus or S. epidermidis.
A patient presents with pain on passive movement, pallor, poikilothermia, paresthesias, paralysis, and pulselessness. Treatment?
All-compartment fasciotomy for suspected compartment syndrome
Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.
Spinal stenosis
Joints in the hand affected in rheumatoid arthritis.
MCP and PIP joints; DIP joints are spared
Joint pain and stiffness that worsen over the course of the day and are relieved by rest.
Osteoarthritis
Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Osteogenesis imperfecta
Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Suspect ankylosing spondylitis. Check HLA-B27
Arthritis, conjunctivitis, and urethritis in young men. Associated organisms?
Reactive (Reiter’s) arthritis. Associated with Campylobacter, Shigella, Salmonella, Chlamydia, and Ureaplasma
A 55-year-old man has sudden, excruciating first MTP joint pain after a night of drinking red wine. Diagnosis, workup, and chronic treatment?
Gout. Needle-shaped, negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Rhomboid-shaped, positively birefringent crystals on joint fluid aspirate.
Pseudogout
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.
Polymyalgia rheumatica
An active 13-year-old boy has anterior knee pain. Diagnosis?
Osgood-Schlatter disease
Bone is fractured in fall on outstretched hand.
Distal radius (Colles’ fracture)
Complication of scaphoid fracture.
Avascular necrosis
Signs suggesting radial nerve damage with humeral fracture.
Wrist drop, loss of thumb abduction
A young child presents with proximal muscle weakness, waddling gait, and pronounced calf muscles.
Duchenne muscular dystrophy
A first-born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
Developmental dysplasia of the hip. If severe, consider a Pavlik harness to maintain abduction
An 11-year-old obese, African-American boy presents with sudden onset of limp. Diagnosis? Workup?
Slipped capital femoral epiphyses. AP and frog-leg lateral view
The most common 1° malignant tumor of bone.
Multiple myeloma
Unilateral, severe periorbital headache with tearing and conjunctival erythema.
Cluster headache
Prophylactic treatment for migraine.
β-blockers, Ca2+ channel blockers, TCAs
The most common pituitary tumor. Treatment?
Prolactinoma. Dopamine agonists (e.g., bromocriptine)
A 55-year-old patient presents with acute “broken speech.” What type of aphasia? What lobe and vascular distribution?
Broca’s aphasia. Frontal lobe, left MCA distribution
The most common cause of SAH.
Trauma; the second most common is berry aneurysm
A crescent-shaped hyperdensity on CT that does not cross the midline.
Subdural hematoma—bridging veins torn
A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely etiology? Treatment?
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
CSF findings with SAH.
Elevated ICP, RBCs, xanthochromia
Albuminocytologic dissociation.
Guillain-Barré (↑ protein in CSF with only a modest ↑ in cell count)
Cold water is flushed into a patient’s ear, and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Normal
The most common 1° sources of metastases to the brain.
Lung, breast, skin (melanoma), kidney, GI tract
May be seen in children who are accused of inattention in class and confused with ADHD.
Absence seizures
The most frequent presentation of intracranial neoplasm.
Headache
The most common cause of seizures in children (2–10 years).
Infection, febrile seizures, trauma, idiopathic
The most common cause of seizures in young adults (18–35 years).
Trauma, alcohol withdrawal, brain tumor
First-line medication for status epilepticus.
IV benzodiazepine
Confusion, confabulation, ophthalmoplegia, ataxia.
Wernicke’s encephalopathy due to a deficiency of thiamine
What % lesion is an indication for carotid endarterectomy?
Seventy percent if the stenosis is symptomatic
The most common causes of dementia.
Alzheimer’s and multi-infarct
Combined UMN and LMN disorder.
ALS
Rigidity and stiffness with resting tremor and masked facies.
Parkinson’s disease
The mainstay of Parkinson’s therapy.
Levodopa/carbidopa
Treatment for Guillain-Barre syndrome.
IVIG or plasmapheresis
Rigidity and stiffness that progress to choreiform movements, accompanied by moodiness and altered behavior.
Huntington’s disease
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.
Sturge-Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Café-au-lait spots on skin.
Neurofibromatosis 1
Hyperphagia, hypersexuality, hyperorality, and hyperdocility.
Klüver-Bucy syndrome (amygdala)
Administer to a symptomatic patient to diagnose myasthenia gravis.
Edrophonium
1° causes of third-trimester bleeding.
Placental abruption and placenta previa
Classic ultrasound and gross appearance of complete hydatidiform mole.
Snowstorm on ultrasound. “Cluster-of-grapes” appearance on gross examination
Chromosomal pattern of a complete mole.
46,XX
Molar pregnancy containing fetal tissue.
Partial mole
Symptoms of placental abruption.
Continuous, painful vaginal bleeding
Symptoms of placenta previa.
Self-limited, painless vaginal bleeding
When should a vaginal exam be performed with suspected placenta previa?
Never
Antibiotics with teratogenic effects.
Tetracycline, fluoroquinolones, aminoglycosides, sulfonamides
Shortest AP diameter of the pelvis.
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Medication given to accelerate fetal lung maturity.
Betamethasone or dexamethasone × 48 hours
The most common cause of postpartum hemorrhage.
Uterine atony
Treatment for postpartum hemorrhage.
Uterine massage; if that fails, give oxytocin
Typical antibiotics for group B streptococcus (GBS) prophylaxis.
IV penicillin or ampicillin
A patient fails to lactate after an emergency C-section with marked blood loss.
Sheehan’s syndrome (postpartum pituitary necrosis)
Uterine bleeding at 18 weeks’ gestation; no products expelled; membranes ruptured; cervical os open.
Inevitable abortion
Uterine bleeding at 18 weeks’ gestation; no products expelled; cervical os closed.
Threatened abortion
The first test to perform when a woman presents with amenorrhea.
β-hCG; the most common cause of amenorrhea is pregnancy
Term for heavy bleeding during and between menstrual periods.
Menometrorrhagia
Cause of amenorrhea with normal prolactin, no response to estrogen-progesterone challenge, and a history of D&C.
Asherman’s syndrome
Therapy for polycystic ovarian syndrome.
Weight loss and OCPs
Medication used to induce ovulation.
Clomiphene citrate
Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.
Endometrial biopsy
Indications for medical treatment of ectopic pregnancy.
Stable, unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks’ gestation
Medical options for endometriosis.
OCPs, danazol, GnRH agonists
Laparoscopic findings in endometriosis.
“Chocolate cysts,” powder burns
The most common location for an ectopic pregnancy.
Ampulla of the oviduct
How to diagnose and follow a leiomyoma.
Ultrasound
Natural history of a leiomyoma.
Regresses after menopause
A patient has ↑ vaginal discharge and petechial patches in the upper vagina and cervix.
Trichomonas vaginitis
Treatment for bacterial vaginosis.
Oral or topical metronidazole
The most common cause of bloody nipple discharge.
Intraductal papilloma
Contraceptive methods that protect against PID.
OCP and barrier contraception
Unopposed estrogen is contraindicated in which cancers?
Endometrial or estrogen receptor–  breast cancer
A patient presents with recent PID with RUQ pain.
Consider Fitz-Hugh–Curtis syndrome
Breast malignancy presenting as itching, burning, and erosion of the nipple.
Paget’s disease
Annual screening for women with a strong family history of ovarian cancer.
CA-125 and transvaginal ultrasound
A 50-year-old woman leaks urine when laughing or coughing. Nonsurgical options?
Kegel exercises, estrogen, pessaries for stress incontinence
A 30-year-old woman has unpredictable urine loss. Examination is normal. Medical options?
Anticholinergics (oxybutynin) or Beta-adrenergics (metaproterenol) for urge incontinence.
Lab values suggestive of menopause.
↑ serum FSH
The most common cause of female infertility.
Endometriosis
Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow-up evaluation?
Colposcopy and endocervical curettage
Breast cancer type that ↑ the future risk of invasive carcinoma in both breasts.
Lobular carcinoma in situ
Nontender abdominal mass associated with elevated VMA and HVA.
Neuroblastoma
The most common type of tracheoesophageal fistula (TEF). Diagnosis?
Esophageal atresia with distal TEF (85%). Unable to pass NG tube
Not contraindications to vaccination.
Mild illness and/or low-grade fever, current antibiotic therapy, and prematurity
Tests to rule out shaken baby syndrome.
Ophthalmologic exam, CT, and MRI
A neonate has meconium ileus.
CF or Hirschsprung’s disease
Bilious emesis within hours after the first feeding.
Duodenal atresia
A two-month-old presents with nonbilious projectile emesis. What are the appropriate steps in management?
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy
The most common 1° immunodeficiency.
Selective IgA deficiency
An infant has a high fever and onset of rash as fever breaks. What is he at risk for?
Febrile seizures (roseola infantum)
Acute-phase treatment for Kawasaki disease.
High-dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms
Treatment for mild and severe unconjugated hyperbilirubinemia.
Phototherapy (mild) or exchange transfusion (severe)
Sudden onset of mental status changes, emesis, and liver dysfunction after taking aspirin.
Reye’s syndrome
A child has loss of red light reflex. Diagnosis?
Suspect retinoblastoma
Vaccinations at a six-month well-child visit.
HBV, DTaP, Hib, IPV, PCV
Tanner stage 3 in a six-year-old female.
Precocious puberty
Infection of small airways with epidemics in winter and spring.
RSV bronchiolitis
Cause of neonatal RDS.
Surfactant deficiency
What is the immunodeficiency? ■ A boy has chronic respiratory infections. Nitroblue tetrazolium test is +.
Chronic granulomatous disease
What is the immunodeficiency? ■ A child has eczema, thrombocytopenia, and high levels of IgA.
Wiskott-Aldrich syndrome
What is the immunodeficiency? ■ A four-month-old boy has life-threatening Pseudomonas infection.
Bruton’s X-linked agammaglobulinemia
A condition associated with red “currant-jelly” stools.
Intussusception
A congenital heart disease that cause 2° hypertension.
Coarctation of the aorta
First-line treatment for otitis media.
Amoxicillin × 10 days
The most common pathogen causing croup.
Parainfluenza virus type 1
A homeless child is small for his age and has peeling skin and a swollen belly.
Kwashiorkor (protein malnutrition)
Defect in an X-linked syndrome with mental retardation,
Lesch-Nyhan syndrome (purine salvage problem with
Defect in an X-linked syndrome with mental retardation, gout, self-mutilation, and choreoathetosis.
Lesch-Nyhan syndrome (purine salvage problem with HGPRTase deficiency)
A newborn female has continuous “machinery murmur.”
Patent ductus arteriosus (PDA)
First-line pharmacotherapy for depression.
SSRIs
Antidepressants associated with hypertensive crisis.
MAOIs
Galactorrhea, impotence, menstrual dysfunction, and ↓ libido.
Patient on dopamine antagonist
A 17-year-old female has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found.
Conversion disorder
Name the defense mechanism: ■ A mother who is angry at her husband yells at her child.
Displacement
Name the defense mechanism: ■ A pedophile enters a monastery.
Reaction formation
Name the defense mechanism: ■ A woman calmly describes a grisly murder.
Isolation
Name the defense mechanism: ■ A hospitalized 10-year-old begins to wet his bed.
Regression
Life-threatening muscle rigidity, fever, and rhabdomyolysis.
Neuroleptic malignant syndrome
Amenorrhea, bradycardia, and abnormal body image in a young female.
Anorexia
A 35-year-old male has recurrent episodes of palpitations, diaphoresis, and fear of going crazy.
Panic disorder
The most serious side effect of clozapine.
Agranulocytosis
A 21-year-old male has three months of social withdrawal, worsening grades, flattened affect, and concrete thinking.
Schizophreniform disorder (diagnosis of schizophrenia requires ≥ 6 months of symptoms)
Key side effects of atypical antipsychotics.
Weight gain, type 2 DM, QT prolongation
A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?
Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine
Medication to avoid in patients with a history of alcohol withdrawal seizures.
Neuroleptics
A 13-year-old male has a history of theft, vandalism, and violence toward family pets.
Conduct disorder
A five-month-old girl has ↓ head growth, truncal dyscoordination, and ↓ social interaction.
Rett’s disorder
A patient hasn’t slept for days, lost $20,000 gambling, is agitated, and has pressured speech. Diagnosis? Treatment?
Acute mania. Start a mood stabilizer (e.g., lithium)
After a minor fender bender, a man wears a neck brace and requests permanent disability.
Malingering
A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C peptide.
Factitious disorder (Munchausen syndrome)
A patient continues to use cocaine after being in jail, losing his job, and not paying child support.
Substance abuse
A violent patient has vertical and horizontal nystagmus.
Phencyclidine hydrochloride (PCP) intoxication
A woman who was abused as a child frequently feels outside of or detached from her body.
Depersonalization disorder
A man has repeated, intense urges to rub his body against unsuspecting passengers on a bus.
Frotteurism (a paraphilia)
A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Diagnosis? Treatment?
Tardive dyskinesia. ↓ or discontinue haloperidol and consider another antipsychotic (e.g., risperidone, clozapine)
A man unexpectedly flies across the country, takes a new name, and has no memory of his prior life.
Dissociative fugue
Risk factors for DVT.
Stasis, endothelial injury and hypercoagulability (Virchow’s triad)
Criteria for exudative effusion.
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6
Causes of exudative effusion.
Think of leaky capillaries. Malignancy, TB, bacterial or viral infection, pulmonary embolism with infarct, and pancreatitis
Causes of transudative effusion.
Think of intact capillaries. CHF, liver or kidney disease, and protein-losing enteropathy
Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Fatigue and impending respiratory failure
Dyspnea, lateral hilar lymphodenopathy on CXR, noncaseating granulomas, increased ACE, and hypercalcemia.
Sarcoidosis
PFT showing ↓ FEV1/FVC.
Obstructive pulmonary disease (e.g., asthma)
PFT showing ↑ FEV1/FVC.
Restrictive pulmonary disease
Honeycomb pattern on CXR. Diagnosis? Treatment?
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help
Treatment for SVC syndrome.
Radiation
Treatment for mild, persistent asthma.
Inhaled β-agonists and inhaled corticosteroids
Acid-base disorder in pulmonary embolism.
Hypoxia and hypocarbia
Non–small cell lung cancer (NSCLC) associated with hypercalcemia.
Squamous cell carcinoma
Lung cancer associated with SIADH.
Small cell lung cancer (SCLC)
Lung cancer highly related to cigarette exposure.
Small cell lung cancer
A tall white male presents with acute shortness of breath. Diagnosis? Treatment?
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
Treatment of tension pneumothorax.
Immediate needle thoracostomy
Characteristics favoring carcinoma in an isolated pulmonary nodule.
Age > 45–50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins
Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure.
ARDS
Increased risk of what infection with silicosis?
Mycobacterium tuberculosis
Causes of hypoxemia.
Right-to-left shunt, hypoventilation, low inspired O2 tension, diffusion defect, V/Q mismatch
Classic CXR findings for pulmonary edema.
Cardiomegaly, prominent pulmonary vessels, Kerley B lines, “bat’s-wing” appearance of hilar shadows, and perivascular and peribronchial cuffing
Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.
Type I (distal) RTA
RTA associated with abnormal HCO3 − and rickets.
Type II (proximal) RTA
RTA associated with aldosterone defect.
Type IV (distal) RTA
“Doughy skin.”
Hypernatremia
Differential of hypervolemic hyponatremia.
Cirrhosis, CHF, nephritic syndrome
Chvostek’s and Trousseau’s signs.
Hypocalcemia
The most common causes of hypercalcemia.
Malignancy and hyperparathyroidism
T-wave flattening and U waves.
Hypokalemia
Peaked T waves and widened QRS.
Hyperkalemia
First-line treatment for moderate hypercalcemia.
IV hydration and loop diuretics (furosemide)
Type of ARF in a patient with FeNa < 1%.
Prerenal
A 49-year-old male presents with acute-onset flank pain and hematuria.
Nephrolithiasis
The most common type of nephrolithiasis.
Calcium oxalate
A 20-year-old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
Cerebral berry aneurysms (AD PCKD)
Hematuria, hypertension, and oliguria.
Nephritic syndrome
Proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, edema.
Nephrotic syndrome
The most common form of nephritic syndrome.
Membranous glomerulonephritis
The most common form of glomerulonephritis.
IgA nephropathy (Berger’s disease)
Glomerulonephritis with deafness.
Alport’s syndrome
Glomerulonephritis with hemoptysis.
Wegener’s granulomatosis and Goodpasture’s syndrome
Presence of red cell casts in urine sediment.
Glomerulonephritis/nephritic syndrome
Eosinophils in urine sediment.
Allergic interstitial nephritis
Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
Nephrotic syndrome
Drowsiness, asterixis, nausea, and a pericardial friction rub.
Uremic syndrome seen in patients with renal failure
A 55-year-old man is diagnosed with prostate cancer. Treatment options?
Wait, surgical resection, radiation and/or androgen suppression
Low urine specific gravity in the presence of high serum osmolality.
DI
Treatment of SIADH?
Fluid restriction, demeclocycline
Hematuria, flank pain, and palpable flank mass.
Renal cell carcinoma (RCC)
Testicular cancer associated with β-hCG, AFP.
Choriocarcinoma
The most common type of testicular cancer.
Seminoma—a type of germ cell tumor
The most common histology of bladder cancer.
Transitional cell carcinoma
Complication of overly rapid correction of hyponatremia.
Central pontine myelinolysis
Salicylate ingestion → in what type of acid-base disorder?
Anion gap acidosis and 1° respiratory alkalosis due to central respiratory stimulation
Acid-base disturbance commonly seen in pregnant women.
Respiratory alkalosis
Three systemic diseases → nephrotic syndrome.
DM, SLE, and amyloidosis
Elevated erythropoietin level, elevated hematocrit, and normal O2 saturation suggest?
Renal cell carcinoma or other erythropoietin-producing tumor; evaluate with CT scan
A 55-year-old man presents with irritative and obstructive urinary symptoms. Treatment options?
Likely BPH. Options include no treatment, terazosin, finasteride, or surgical intervention (TURP)
Class of drugs that may cause syndrome of muscle rigidity, hyperthermia, autonomic instability, and extrapyramidal symptoms.
Antipsychotics (neuroleptic malignant syndrome)
Side effects of corticosteroids.
Acute mania, immunosuppression, thin skin, osteoporosis, easy bruising, myopathies
Treatment for DTs.
Benzodiazepines
Treatment for acetaminophen overdose.
N-acetylcysteine
Treatment for opioid overdose.
Naloxone
Treatment for benzodiazepine overdose.
Flumazenil
Treatment for neuroleptic malignant syndrome.
Dantrolene or bromocriptine
Treatment for malignant hypertension.
Nitroprusside
Treatment of AF.
Rate control, rhythm conversion, and anticoagulation
Treatment of supraventricular tachycardia (SVT).
Rate control with carotid massasge or other vagal stimulation
Causes of drug-induced SLE.
INH, penicillamine, hydralazine, procainamide
Macrocytic, megaloblastic anemia with neurologic symptoms.
B12 deficiency
Macrocytic, megaloblastic anemia without neurologic symptoms.
Folate deficiency
A burn patient presents with cherry-red flushed skin and coma. SaO2 is normal, but carboxyhemoglobin is elevated. Treatment?
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant
Blood in the urethral meatus or high-riding prostate.
Bladder rupture or urethral injury
Test to rule out urethral injury.
Retrograde cystourethrogram
Radiographic evidence of aortic disruption or dissection.
Widened mediastinum (> 8 cm), loss of aortic knob, pleural cap, tracheal deviation to the right, depression of left main stem bronchus
Radiographic indications for surgery in patients with acute abdomen.
Free air under the diaphragm, extravasation of contrast, severe bowl distention, space-occupying lesion (CT), mesenteric occlusion (angiography)
The most common organism in burn-related infections.
Pseudomonas
Method of calculating fluid repletion in burn patients.
Parkland formula
Acceptable urine output in a trauma patient.
50 cc/hour
Acceptable urine output in a stable patient.
30 cc/hour
Cannon “a” waves.
Third-degree heart block
Signs of neurogenic shock.
Hypotension and bradycardia
Signs of ↑ ICP (Cushing’s triad).
Hypertension, bradycardia, and abnormal respirations
↓ CO, ↓ pulmonary capillary wedge pressure (PCWP), ↑ peripheral vascular resistance (PVR).
Hypovolemic shock
↓ CO, ↑ PCWP, ↑ PVR.
Cardiogenic shock
↑ CO, ↓ PCWP, ↓ PVR.
Septic or anaphylactic shock
Treatment of septic shock.
Fluids and antibiotics
Treatment of cardiogenic shock.
Identify cause; pressors (e.g., dobutamine)
Treatment of hypovolemic shock.
Identify cause; fluid and blood repletion
Treatment of anaphylactic shock.
Diphenhydramine or epinephrine 1:1000
Supportive treatment for ARDS.
Continuous positive airway pressure
Signs of air embolism.
A patient with chest trauma who was previously stable suddenly dies
Trauma series.
AP chest, AP/lateral C-spine, AP pelvis