Usmle Step 2 Superset (Part 2)

Front 1

What is the key workup when a patient presents with:

30yo F has wrist pain and a black eye after tripping, falling, and hitting her head on the edge of a table. She looks anxious and give an inconsistent story

Back 1

- XR - wrist
- CT - head
- Urine toxicology

Front 2

What are the key elements of the patient history when a patient presents with abuse?

Back 2

- Establish confidentiality; directly question about physical, sexual, or emotional abuse and about fear, safety, backup plan
- History of frequent accidents/injuries, mental illness, drug use
- Firearms in the home

Front 3

What are the key elements of the patient physical when a patient presents with abuse?

Back 3

- Vital signs
- Complete exam +/- pelvic

Front 4

What is the key differential when a patient presents with:

- 30yo F presents with wrist pain and a sensation of numbness and burning in her palm and the first, second and third fingers of her right hand. The pain worsens at night and is relieved by loose shaking of the hand. There is sensory loss in the same fingers. Exam reveals a positive Tinel's sign.

Back 4

- Carpal tunnel syndrome
- Median nerve compression in forearm or arm
- Radiculopathy of nerve roots C6 & C7 in cervical spine

Front 5

What is the key workup when a patient presents with:

- 30yo F presents with wrist pain and a sensation of numbness and burning in her palm and the first, second and third fingers of her right hand. The pain worsens at night and is relieved by loose shaking of the hand. There is sensory loss in the same fingers. Exam reveals a positive Tinel's sign.

Back 5

- Nerve conduction study
- EMG

Front 6

What is the key differential when a patient presents with:

- 28 yo F presents with pain in the interphalangeal joints of her hands together with hair loss and a butterfly rash on her face.

Back 6

- Systemic lupus erythematosus (SLE)
- Rheumatoid arthritis
- Psoriatic arthritis
- Parvovirus B19 infection

Front 7

What is the key workup when a patient presents with:

- 28 yo F presents with pain in the interphalangeal joints of her hands together with hair loss and a butterfly rash on her face.

Back 7

- ANA, anti-dsDNA, ESR, C3, C4, rheumatoid factor (RF), CBC
- XR - hands
- UA

Front 8

What is the key differential when a patient presents with:

- 28 yo F presents with pain in the matacarpophalangeal joints of both hands. Her left knee is also painful and red. She has morning joint stiffness that lasts for an hour. Her mother had rheumatoid arthritis.

Back 8

- Rheumatoid arthritis
- SLE
- Disseminated gonorrhea
- Arthritis associated with inflammatory bowel disease
- Osteoarthritis

Front 9

What is the key differential when a patient presents with:

- 28 yo F presents with pain in the matacarpophalangeal joints of both hands. Her left knee is also painful and red. She has morning joint stiffness that lasts for an hour. Her mother had rheumatoid arthritis.

Back 9

- ANA, anti-dsDNA, ESR, RF, CBC
- XR - hands, left knee
- Cervical culture
- Arthrocentesis & synovial fluid analysis

Front 10

What is the key differential when a patient presents with:

18yo M presents with pin in the interphalangeal joins of both hands. He also has scaly, salmon-pink lesions on the extensor surface of his elbows and knees.

Back 10

- Psoriatic arthritis
- Rheumatoid arthritis
- SLE

Front 11

What is the key workup when a patient presents with:

18yo M presents with pin in the interphalangeal joins of both hands. He also has scaly, salmon-pink lesions on the extensor surface of his elbows and knees.

Back 11

- RF, ANA, ESR
- CBC
- XR - hands
- XR - pelvis/sacroiliac joints
- Uric acid

Front 12

What is the key differential when a patient presents with:

65yo F presents with inability to use her left leg and bear weight on it after tripping on a carpet. Onset of menopause was 20 years ago and she did not receive HRT or calcium supplements. her left leg is externally rotated, shortened, and adducted, and there is tenderness in her left groin.

Back 12

- Hip fracture
- Hip dislocation
- Pelvic fracture

Front 13

What is the key workup when a patient presents with:

65yo F presents with inability to use her left leg and bear weight on it after tripping on a carpet. Onset of menopause was 20 years ago and she did not receive HRT or calcium supplements. her left leg is externally rotated, shortened, and adducted, and there is tenderness in her left groin.

Back 13

- XR - hip/pelvis
- CT or MRI - hip
- CBC
- Serum calcium & Vit. D
- Bone density scan (DEXA)

Front 14

What is the key differential when a patient presents with:

40yo M presents with pain in the right groin after a motor vehicle accident. His right leg is flexed at the hip. adducted, and internally rotated.

Back 14

- Hip dislocation - traumatic
- Hip fracture

Front 15

What is the key workup when a patient presents with:

40yo M presents with pain in the right groin after a motor vehicle accident. His right leg is flexed at the hip. adducted, and internally rotated.

Back 15

- XR - hip
- CT or MRI - hip
- CBC
- PT/PTT
- Blood type & cross match
- Urine toxicology and blood alcohol level

Front 16

What are the key elements of patient history when a patient presents with low back pain?

Back 16

- Location, quality, intensity, radiation
- Context: moving furniture, bending/twisting, trauma
- Timing: disturbs sleep
- Associated symptoms: especially constitutional, incontinence
- Exacerbating & alleviating factors
- History of cancer
- Recurrent UTIs, diabetes, renal stones, IV drug use, smoking

Front 17

What are the key elements of patient physical when a patient presents with low back pain?

Back 17

- Vital signs, neurologic exam (esp. L4-S1 nerve roots)
- Back palpation & range of motion
- Hip exam
- Rectal exam

Front 18

What are the key elements of patient history when a patient presents with a child with fever?

Back 18

- Severity, duration
- Associated localizing symptoms
- Appetite
- Rash
- Sick contacts
- Day care
- Immunizations
- Past history

Front 19

What are the key elements of patient history when a patient physical with a child with fever?

Back 19

- Vital signs
- HEENT
- Neck
- Heart & Lungs
- Abdominal
- Skin exam

Front 20

What are the key elements of patient history when a patient presents with a child with behavioral problems?

Back 20

- Onset
- Severity
- Duration
- Triggers
- Physical violence or use of weapons
- Substance use
- Developmental history
- Changes in environment/school performance

Front 21

What are the key elements of patient physical when a patient presents with a child with behavioral problems?

Back 21

- Vital signs
- Neurological exam

Front 22

What is the key differential in a patient that presents with:

56yo obese F presents with right knee stiffness and pain that increases with movement. Her symptoms have gradually worsened over the past 10 years. She noticed swelling and deformity of the joint and is having difficulty walking.

Back 22

- Osteoarthritis
- Pseudogout
- Gout
- Meniscal or ligament damage

Front 23

What is the key workup in a patient that presents with:

56yo obese F presents with right knee stiffness and pain that increases with movement. Her symptoms have gradually worsened over the past 10 years. She noticed swelling and deformity of the joint and is having difficulty walking.

Back 23

- XR - knee
- CBC
- ESR
- Knee arthrocentesis & synovial fluid analysis: cell count, Gram stain, culture, crystals)
- MRI - knee

Front 24

What is the key differential when a patient presents with:

45yo M presents with right knee pain with swelling and redness.

Back 24

- Septic arthritis
- Gout
- Pseudogout
- Lyme arthritis
- Trauma
- Reiter's arthritis

Front 25

What is the key workup when a patient presents with:

45yo M presents with right knee pain with swelling and redness.

Back 25

- CBC
- Knee arthrocentesis and synovial fluid analysis (cell count, gram stain, culture, crystals)
- Blood, urethral cultures
- XR - knee
- Uric acid
- Lyme antibody

Front 26

What is the key differential when a patient presents with:

65yo M presents with right foot pain. He has been training for a marathon.

Back 26

- Stress fracture
- Plantar fasciitis
- Foot sprain or strain

Front 27

What is the key workup when a patient presents with:

65yo M presents with right foot pain. He has been training for a marathon.

Back 27

- XR - foot
- Bone scan - foot
- MRI - foot

Front 28

What is the key differential when a patient presents with:

65yo M presents with pain in the heel of the right foot that is most notable with his first few steps and then improves as he continues walking. He has no known trauma.

Back 28

- Plantar fasciitis
- Heel fracture
- Splinter/foreign body

Front 29

What is the key workup when a patient presents with:

65yo M presents with pain in the heel of the right foot that is most notable with his first few steps and then improves as he continues walking. He has no known trauma.

Back 29

- XR - heel
- Bone scan

Front 30

What is the key differential when a patient presents with:

55yo M presents with pain in the elbow when he plays tennis. His grip is impaired as a result of the pain. There is tenderness over the lateral epicondyle as well as pain on resisted wrist dorsiflexion (Cozen's test) with the elbow in extension.

Back 30

- Tennis elbow (lateral epicondylitis)
- Stress fracture

Front 31

What is the key workup when a patient presents with:

55yo M presents with pain in the elbow when he plays tennis. His grip is impaired as a result of the pain. There is tenderness over the lateral epicondyle as well as pain on resisted wrist dorsiflexion (Cozen's test) with the elbow in extension.

Back 31

- XR - arm
- Bone scan
- MRI - elbow

Front 32

What is the key differential when a patient presents with:

27yo F presents with painful wrists and elbows, a swollen and hot knee joint that is painful on flexion, a rash on her limbs, and vaginal discharge. She is sexually active with multiple partners and occasionally uses condoms.

Back 32

- Disseminated gonorrhea
- Rheumatoid arthritis
- SLE
- Psoriatic arthritis
- Reiter's arthritis

Front 33

What is the key differential when a patient presents with:

27yo F presents with painful wrists and elbows, a swollen and hot knee joint that is painful on flexion, a rash on her limbs, and vaginal discharge. She is sexually active with multiple partners and occasionally uses condoms.

Back 33

- Knee arthrocentesis & synovial fluid analysis (cell count, Gram stain, culture)
- ANA, anti-dsDNA, ESR, RF, CBC
- Blood, cervical cultures
- XR - knee

Front 34

What is the key differential when a patient presents with:

60yo F presents with pain in both legs that is induced by walking and is relieved by rest. She had cardiac bypass surgery 6 months ago & continues to smoke heavily.

Back 34

- Peripheral vascular disease (intermittent claudication)
- Leriche's syndrome (aortoiliac occlusive disease)
- Lumbar spinal stenosis (pseudoclaudication)
- Osteoarthritis

Front 35

What is the key workup when a patient presents with:

60yo F presents with pain in both legs that is induced by walking and is relieved by rest. She had cardiac bypass surgery 6 months ago & continues to smoke heavily.

Back 35

- Ankle-brachial index
- Doppler U/S - lower extremity
- Angiography
- MRI - lumbar spine

Front 36

What is the key differential when a patient presents with:

45yo F presents with right calf pain. Her calf is tender, warm, red, and swollen compared to the left side. She was started on OCPs 2 months ago for dysfunctional uterine bleeding.

Back 36

- DVT
- Baker's cyst rupture
- Myositis
- Cellulitis
- Superficial venous thrombosis

Front 37

What is the key workup when a patient presents with:

45yo F presents with right calf pain. Her calf is tender, warm, red, and swollen compared to the left side. She was started on OCPs 2 months ago for dysfunctional uterine bleeding

Back 37

- Doppler U/S - right leg
- CBC
- CPK
- D-dimer
- PT, aPTT, fibrinogen
- XR - right leg

Front 38

What is the key differential when a patient presents with:

60yo F c/o left arm pain that started while she was swimming and was relieved by rest.

Back 38

- Angina/MI
- Tendonitis
- Osteoarthritis
- Shoulder dislocation

Front 39

What is the key workup when a patient presents with:

60yo F c/o left arm pain that started while she was swimming and was relieved by rest.

Back 39

- CPK-MB, troponin, ECG
- CBC
- ESR
- XR - shoulder
- CXR
- Echocardiography
- Stress test

Front 40

What is the key differential when a patient presents with:

50yo M presents with right shoulder pain after falling onto his outstretched hand while skiing. He noticed deformity of his shoulder and had to hold his right arm.

Back 40

- Shoulder dislocation
- Fracture of the humerus
- Rotator cuff injury

Front 41

What is the key workup when a patient presents with:

50yo M presents with right shoulder pain after falling onto his outstretched hand while skiing. He noticed deformity of his shoulder and had to hold his right arm.

Back 41

- XR - shoulder
- XR - arm
- MRI - shoulder

Front 42

What is the key differential when a patient presents with:

55yo M presents with crampy bilateral thigh & calf pain, fatigue, and dark urine. He is on simvastatin and clofibrate for hyperlipidemia.

Back 42

- Rhabdomyolysis due to simvastatin or clofibrate
- Polymyositis
- Inclusion body myositis
- Thyroid disease

Front 43

What is the key workup when a patient presents with:

55yo M presents with crampy bilateral thigh & calf pain, fatigue, and dark urine. He is on simvastatin and clofibrate for hyperlipidemia.

Back 43

- CBC
- CPK
- Aldolase
- UA
- Urine myoglobin
- TSH

Front 44

What is the key differential when a patient presents with:

45yo F presents with low back pain that radiates to the lateral aspect of her left foot. Straight leg raising is positive. The patient is unable to tiptoe.

Back 44

- Disk herniation
- Lumbar muscle strain
- Tumor in the vertebral canal

Front 45

What is the key workup when a patient presents with:

45yo F presents with low back pain that radiates to the lateral aspect of her left foot. Straight leg raising is positive. The patient is unable to tiptoe.

Back 45

- XR - L-spine
- MRI - L-spine

Front 46

What is the key differential when a patient presents with:

45yo F presents with low back pain that started after she cleaned her house. The pain does not radiate, & there is no sensory deficit or weakness in her legs. Paraspinal muscle tenderness and spasm are also noted.

Back 46

- Lumbar muscle strain
- Disk herniation
- Abdominal aortic aneurysm
- Vertebral compression fracture

Front 47

What is the key workup when a patient presents with:

45yo F presents with low back pain that started after she cleaned her house. The pain does not radiate, & there is no sensory deficit or weakness in her legs. Paraspinal muscle tenderness and spasm are also noted.

Back 47

- XR - L-spine

Front 48

What is the key differential when a patient presents with:

45yo M presents with pain in the lower back and legs during prolonged standing and walking. The pain is relieved by sitting and leaning forward (e.g. pushing a grocery cart).

Back 48

- Lumbar spinal stenosis
- Lumbar muscle strain
- Tumor in the vertebral canal
- Peripheral vascular disease

Front 49

What is the key workup when a patient presents with:

45yo M presents with pain in the lower back and legs during prolonged standing and walking. The pain is relieved by sitting and leaning forward (e.g. pushing a grocery cart).

Back 49

XR - L-spine
MRI - L-spine (preferred)
CT - L-spine
Ankle-brachial index

Front 50

What is the key differential when a patient presents with:

17yo M presents with low back pain that radiates to the left leg and began after he fell on his knee during gym class. He also describes areas of loss of sensation in his left foot. The pain and sensory loss do not match any known distribution. He insists on requesting a week off from school because of his injury.

Back 50

- Malingering
- Lumbar muscle strain
- Disk herniation
- Knee or leg fracture
- Ankylosing spondylitis

Front 51

What is the key workup when a patient presents with:

17yo M presents with low back pain that radiates to the left leg and began after he fell on his knee during gym class. He also describes areas of loss of sensation in his left foot. The pain and sensory loss do not match any known distribution. He insists on requesting a week off from school because of his injury.

Back 51

- XR - L-spine/knee
- MRI - L-spine

Front 52

What is the key differential when a patient presents with:

20-day old M presents with fever, decreased breast/feeding, and lethargy. He was born at 36 weeks as a result of premature rupture of membranes.

Back 52

- Neonatal sepsis
- Meningitis
- Pneumonia
- UTI

Front 53

What is the key workup when a patient presents with:

20-day old M presents with fever, decreased breast/feeding, and lethargy. He was born at 36 weeks as a result of premature rupture of membranes.

Back 53

- Physical exam
- CBC, electrolytes
- UA
- Urine culture
- Blood culture
- CXR
- LP - CSF analysis

Front 54

What is the key differential when a patient presents with:

3yo M presents with a 2-day history of fever and pulling on his right ear. He is otherwise healthy, and his immunizations are up to date. His older sister recently had a cold. The child attends a day care center.

Back 54

- Acute otitis media
- URI
- Meningitis
- UTI

Front 55

What is the key workup when a patient presents with:

3yo M presents with a 2-day history of fever and pulling on his right ear. He is otherwise healthy, and his immunizations are up to date. His older sister recently had a cold. The child attends a day care center.

Back 55

- Physical exam (including pneumatic otoscopy)
- CBC
- UA

Front 56

What is the key differential when a patient presents with:

12-month-old M presents with fever for the last 2 days accompanied by maculopapular rash on his face and body. He has not yet received the MMR vaccine.

Back 56

- Measles (or other viral exanthem)
- Rubella
- Roseola
- 5th disease
- Varicella
- Scarlet fever
- Meningitis

Front 57

What is the key workup when a patient presents with:

12-month-old M presents with fever for the last 2 days accompanied by maculopapular rash on his face and body. He has not yet received the MMR vaccine.

Back 57

- Physical exam
- CBC
- Viral antibodies/titers
- Throat swab for culture
- LP

Front 58

What is the key differential when a patient presents with:

4yo M presents with diarrhea, vomiting, lethargy, weakness, and fever. The child attends a day care center where several children have had similar symptoms.

Back 58

- Gastroenteritis (viral, bacterial, parasitic)
- Food poisoning
- UTI
- URI
- Volvulus
- Intussusception

Front 59

What is the key workup when a patient presents with:

4yo M presents with diarrhea, vomiting, lethargy, weakness, and fever. The child attends a day care center where several children have had similar symptoms.

Back 59

- Physical exam
- Stool exam & culture
- CBC
- Electrolytes
- UA, urine culture
- AXR

Front 60

What is the key differential when a patient presents with:

9yo M presents with a 2-year hisotry of angry outbursts both in school and at home. His mother complains that he runs around "as if driven by a motor". His techer reports that he cannot sit still in class, regularly interrupts his classmates, and has trouble making friends.

Back 60

- Attention-deficit hyperactivity disorder (ADHD)
- Oppositional defiant disorder
- Manic episode
- Conduct disorder

Front 61

What is the key workup when a patient presents with:

9yo M presents with a 2-year hisotry of angry outbursts both in school and at home. His mother complains that he runs around "as if driven by a motor". His techer reports that he cannot sit still in class, regularly interrupts his classmates, and has trouble making friends.

Back 61

- Physical exam
- Mental status exam

Front 62

What is the key differential when a patient presents with:

12yo F presents with a 2-month history of fighting in school, truancy, and breaking curfew. Her parents recently divorced, and she just started school in a new district. Before her parents divorced, she was an average student with no behavioral problems.

Back 62

- Adjustment disorder
- Substance intoxication/abuse/dependence
- Manic episode
- Oppositional defiant disorder
- Conduct disorder

Front 63

What is the key workup when a patient presents with:

12yo F presents with a 2-month history of fighting in school, truancy, and breaking curfew. Her parents recently divorced, and she just started school in a new district. Before her parents divorced, she was an average student with no behavioral problems.

Back 63

- Physical exam
- Mental status exam
- Urine toxicology

Front 64

What is the key differential when a patient presents with:

15yo M presents with a 1-year history of failing grades, school absenteeism, and legal problems, including shoplifting. His parents report that he spends most of his time alone in his room, adding that when he does go out, it is with a new set of friends.

Back 64

- Substance abuse
- Conduct disorder
- Oppositional defiant disorder
- Adjustment disorder

Front 65

What is the key workup when a patient presents with:

15yo M presents with a 1-year history of failing grades, school absenteeism, and legal problems, including shoplifting. His parents report that he spends most of his time alone in his room, adding that when he does go out, it is with a new set of friends.

Back 65

- Urine toxicology
- Mental status exam

Front 66

What is the key differential when a patient presents with:

5yo M presents with 6-month history of temper tantrums that last 5-10 minutes and immediately follow a disappointment or a discipline. He has no trouble sleeping, has had no change in appetite, and does not display these behaviors when he is at day care.

Back 66

- Age-appropriate behavior
- ADHD
- Oppositional defiant disorder

Front 67

What is the key workup when a patient presents with:

5yo M presents with 6-month history of temper tantrums that last 5-10 minutes and immediately follow a disappointment or a discipline. He has no trouble sleeping, has had no change in appetite, and does not display these behaviors when he is at day care.

Back 67

- Physical exam
- Mental status

Front 68

Which hep virus is a circular, partially double-stranded DNA virus?

Back 68

Hep B

Front 69

What is the incubation period & route of transmission for Hep B?

Back 69

- Incubation: 1-6m
- Transmission: parenteral, sexual, perinatal

Front 70

What are the 2 markers of HBV infection?

Back 70

- HBsAg
- IgG anti-HBc Ab

Front 71

What hep virus is ss(+) RNA virus?

Back 71

HCV

Front 72

What is the incubation period & route of transmission for HCV?

Back 72

- 15-150 days
- Parenteral, Sexual, Perinatal

Front 73

What Hep virus is incomplete RNA and requires co-infection or superinfects with HBV?

Back 73

HDV (Deltaviridae)

Front 74

Where is HDV usually contracted?

Back 74

- Amazon Basin
- Central Africa
- Mediterranean Basin
- Middle East

Front 75

What is the difference in diagnosis between and HDV co-infection with HBV & a superinfection (also with HBV)?

Back 75

Co-infection: IgM anti-HBc Ab (+)
Superinfection: IgM anti-HBc Ab (-)

Front 76

Which Hep virus has recent be found in solid organ-transplant recipients?

Back 76

HEV

Front 77

Which Hep viruses require more than symptomatic therapy?

Back 77

- Hep B - IF infection is severe
- Hep C - (PEG)INF-alpha
- Hep D - Vaccination against HBV

i.e. Hep A & E are symptomatic only

Front 78

Which Hep is especially dangerous for pregnant women?

Back 78

Hep E

Front 79

What are the extrahepatic manifestations of HBV infection?

Back 79

- Polyarteritis nodosa
- Glomerulonephritis
- Cryogobulinemia

Front 80

What are the extrahepatic manifestations of HCV infection?

Back 80

- Glomerulonephritis
- Cryogobulinemia
- Idiopathic thrombocytopenia purpura
- Lichen Planus
- Raynaud syndrome
- Sjogren's syndrome
- Porphyria cutanea tarda
- Necrotizing cutaneous vasculitis
- Non-Hodgkin's lymphoma

Front 81

What is the DOC for chronic Hep B?

Back 81

interferon (W/O ribavirin)

Front 82

What is the 2nd choice treatment for Hep B?

Back 82

Choose an oral analog:
- Lamivudine
- Adefovir
- Entecavir
- Tenofovir
- Tebivudine

Front 83

What is the best choice treatment of chronic Hep C?

Back 83

PEG-INF + RBV

Front 84

What are the 2 top causes of cirrhosis in the USA?

Back 84

- Hep C
- Alcoholic Liver disease
- Hep C + alcoholic liver disease

Front 85

What type of vaccine is the HBV vaccine and what is the schedule?

Back 85

- HBsAg
- 0-1-6 month schedule
- Protective immunity: anti-HBsAb greater than 10IU/L

Front 86

What is the preventive therapy for perinatal HBV transmission?

Back 86

- HbIg (0.06mL/kg)
- HBV vaccine within 12 hours of birth (then 1-6-12m later)
- Efficacy = 95%

Front 87

What are the 2 causes of reactive lymphadenopathy?

Back 87

- Infectious disease
- Noninfective disease
- Infiltrative disease

Front 88

What types of infectious orgs can cause lymphadenopathy?

Back 88

- Viral: mono, rubella
- Bac: cat-scratch
- Mycobac: TB
- Spirochetal: syphilis, leptospirosis
- Chlamydial: lymphogranuloma venerum
- Fungal: Coccidioidomycosis
- Parasitic: Toxo

Front 89

What noninfectious diseases cause lymphadenopathy?

Back 89

- Sarcoidosis
- Connective tissue diseases: SLE
- Kawasaki's disease
- Drug hypersensitivity: phenytoin
- Silicone breast implantation

Front 90

What types of diseases result in infiltrative lymphadenopahty?

Back 90

Malignant: mets, melanoma, germ cell tumor, leukemia

- Lipid storage diseases: Gaucher's
- Amyloidosis

Front 91

What are the 2 causes of primary lymphoproliferative lymphadenopahty?

Back 91

- Lymphoma: Hodgkin's, non-Hodgkin's
- Malignant histiocytosis

Front 92

What causes lymphadenopathy in 60% of cases of adults over 50 years of age?

Back 92

malignancy

Front 93

What are the causes of inguinal lymphadenopathy?

Back 93

- Chacroid
- Lymphogranulma venerum
- Syphilis
- Genital herpes
- Granuloma ingiunale

Front 94

What are the major causes of mediastinal & hilar lymphadenopathy?

Back 94

- TB
- Endemic mycoses: Histo, Coccidio, Paracoccidio

Front 95

What are the 2 main causes of acute suppurative lymphadenitis?

Back 95

1) Staph aureus
2) Group A strep

Nodes involved: submandibular, cervical, ingiunal, axillary

Front 96

What causes Cat-scratch disease?

Back 96

Bartonella henselae

Front 97

What is Parinaud's sign?

Back 97

conjunctivitis with ipsilateral preauricular lymphadenitis

- seen in Cat-Scratch disease

Front 98

What is the most common form of extrapulmonary TB?

Back 98

- mycobacterial lymphadenitis
- if cervical = called scrofula
- location: unilateral on upper border of sternocleidomastoid muscle or supraclavicular, sometimes in the axilla

Front 99

Is mycobacterial lymphadenitis painful?

Back 99

no: uliateral, firm, red & painLESS

Front 100

What are the top 3 causes of mycobacterial lyphadenitis?

Back 100

1) M. bovis
2) M. tuberculosis
3) M. avium complex (MAC)

Front 101

What are the symptoms of miliary TB?

Back 101

- Systemic
- Generalized lymphadenopathy outside of the cervical chain

Front 102

What are the 2 diseases that can cause inguinal lymphadenopathy?

Back 102

- STDs: chancroid (H. ducreyi), C. trachomatis, syphilis, herpes, donovanosis
- Metastaic genital neoplasms

Front 103

What often co-infects with H. ducreyi (Chancroid)?

Back 103

- HSV or C. trachomatis

Front 104

What is the inguinal lymphadenopathy of chancroid like?

Back 104

- enlarged, painful, tender,(mostly unilateral) nodes

Front 105

What is the inguinal lymphadenopathy of lymphogranuloma venerum like?

Back 105

C. trachomatis
- vesicular lesion 1st
- 1-6 weeks later: unilateral, painful nodes
- IF untreaded: nodes rupture & a nonhealing fistula forms

Front 106

What is the Groove sign?

Back 106

- Cleavage of the enlarged nodes by the inguinal ligament
- Seen in lymphogranuloma venerum (C. trachomatis)

Front 107

What are the symptoms of 2ndary syphilis?

Back 107

- Generalized lymphadenopathy
- Skin lesions

- Appear 2-8 weeks after chancre heals

Front 108

When does the chancre of syphilis appear?

Back 108

14-30 days post inoculation

Front 109

What are the lesions of genital herpes?

Back 109

- vesicles: macules & papules followed by vesicles & ulcers
- Inguinal lymphadenopathy (uni or bilateral)

Front 110

What sites in women are affected by genital herpes?

Back 110

- Vulva + cervix
- Perineum
- Vagina
- Buttocks
- Perineal region

Front 111

What sites in men are affected by genital herpes?

Back 111

- Buttocks
- Anal & perianal area

Front 112

What causes granuloma inguinale?

Back 112

Calymmatobacterium granulomatis

Front 113

What are the symptoms of grauloma inguinale (donovanosis)

Back 113

- Papules on the penis within days of inoculation
- Rapidly ulcerate to form red, granulomatous painless ulcers that bleed easily on contact

Front 114

What is oculogradular syndrome?

Back 114

Tularemia symptom:
- conjunctivits
- conjunctival ulceration & papules on the eyelids
- inflammation of the Head & Neck lymph nodes.

Front 115

What type of lymphadenopathy is almost universal in kids with primary TB?

Back 115

Ipsilateral

Front 116

What areas have endemic histoplasmosis?

Back 116

- Mississippi river valley
- OhiO river valley

Front 117

What areas have endemic coccidioidomycosis?

Back 117

- Southwest US, Mexico & Central & South America

- Mediastinal & hilar lymph nodes

Front 118

What areas have endemic paracoccidioidomycosis?

Back 118

- Mexico, Central & South America

- Cervical, axillary & mediastinal with/out fistual formation

Front 119

What often accompanies the bilateral symmetric hilar lymphadenopathy of sarcoidosis?

Back 119

Paratracheal adenopathy

Front 120

If a patient with aids presents with generalized lymphadenopathy, what should you think about?

Back 120

- Lymphoma
- Kaposi's sarcoma

Front 121

What drugs can cause lymphadenopathy?

Back 121

- Phenytoin
- Carbamazepine

Front 122

What vaccines can cause lymphadenopathy?

Back 122

- Measles
- BCG

Front 123

What autoimmune diseases can cause lymphadenopahty:

Back 123

- Rheumatoid arthritis
- Juvenile rheumatoid arthritis
- active SLE

Front 124

What is mucocutaneous lymph node syndrome?

Back 124

lymphadenopathy due to Kawasaki's disease

Front 125

What is ulcerograndular syndrome?

Back 125

Tularemia infection: ulcer or pustule develops after up to 10 days post-exposure

Front 126

What are the 4 main causes of generalized lymphaedenopathy?

Back 126

1) Infective mono
2) HIV
3) Human T-lymphocyte leukemia virus 1
4) Tropical diseases

Front 127

What tropical diseases cause lymphadenopathy?

Back 127

- Leishmaniasis
- Filariasis
- Onchocerciasis
- Wuchereria bancrofti
- African trypanosomiasis
- (Chagas') tyrpanosomiasis

Front 128

What are the sites (2+) where lymph node enlargement equals generalized lymphadenopathy?

Back 128

- Posterior cervical
- Occipital
- Submandibular
- Axillary

Front 129

What are the signs/symptoms of HTLV-1?

Back 129

- Lymphadenopathy (most common)
- Skin lesions
- Hepatosplenomegaly
- Hypercalcemia
- Lymphocytosis
- Hyperimmunoglobulinemia

Front 130

EKG "Sawtooth" P waves

Back 130

- Classic ECG finding in atrial flutter.

Front 131

Define unstable angina.

Back 131

- Angina is new, is worsening, or occurs at rest

Front 132

ACEI =

Back 132

- Antihypertensive for a diabetic patient with proteinuria.

Front 133

Beck's triad for cardiac tamponade.

Back 133

- Hypotension, distant heart sounds, and JVD

Front 134

3 Drug types that slow AV node transmission.

Back 134

- β-blockers
- Digoxin
- Calcium channel blockers

Front 135

What hypercholesterolemia treatment that → flushing and pruritus?

Back 135

Niacin

Front 136

What is the treatment for atrial fibrillation?

Back 136

Anticoagulation, rate control, & cardioversion

Front 137

What is the treatment for ventricular fibrillation?

Back 137

Immediate cardioversion

Front 138

What is the autoimmune complication occurring 2-4 weeks post-MI?

Back 138

Dressler's syndrome: fever, pericarditis, ↑ ESR

Front 139

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

Back 139

Treat existing heart failure and replace the tricuspid valve

Front 140

What is the diagnostic test for hypertrophic cardiomyopathy?

Back 140

Echocardiogram (showing thickened left ventricular wall and outflow obstruction).

Front 141

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

Back 141

Pulsus paradoxus (seen in cardiac tamponade)

Front 142

Low-voltage, diffuse ST-segment elevation are _____

Back 142

- Classic ECG findings in pericarditis.

Front 143

What is the definition of hypertension?

Back 143

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

Front 144

What are the eight surgically correctable causes of hypertension?

Back 144

- Renal artery stenosis
- Coarctation of the aorta
- Pheochromocytoma
- Conn's syndrome
- Cushing's syndrome
- Unilateral renal parenchymal disease
- Hyperthyroidism
- Hyperparathyroidism

Front 145

What tests are used to evaluate a pulsatile abdominal mass and bruit?

Back 145

Abdominal ultrasound and CT

Front 146

What are the indications for surgical repair of abdominal aortic aneurysm?

Back 146

> 5.5 cm, rapidly enlarging, symptomatic, or rupture

Front 147

What is the treatment for acute coronary syndrome?

Back 147

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

Front 148

What is metabolic syndrome?

Back 148

- Abdominal obesity
- High triglycerides
- Low HDL
- Hypertension
- Insulin resistance
- Prothrombotic or proinflammatory states

Front 149

Exercise stress treadmill with ECG
What is the appropriate diagnostic test?
- A 50-year-old male with angina can exercise to 85% of maximum predicted heart rate.

Back 149

Exercise stress treadmill with ECG

Front 150

What is the appropriate diagnostic test?
- A 65-year-old woman with left bundle branch block and severe osteoarthritis has unstable angina.

Back 150

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

Front 151

What are the signs of active ischemia during stress testing?

Back 151

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

Front 152

What ECG findings suggest an MI?

Back 152

ST-segment elevation (depression means ischemia), flattened T waves, and Q waves
ECG findings suggesting MI.

Front 153

What's the dx?
- A young patient has angina at rest with ST-segment elevation. Cardiac enzymes are normal.

Back 153

Prinzmetal's angina

Front 154

What are the common symptoms associated with silent MIs?

Back 154

CHF, shock, and altered mental status

Front 155

What is the best diagnostic test for pulmonary embolism?

Back 155

V/Q scan

Front 156

What agent reverses the effects of heparin?

Back 156

Protamine

Front 157

What coagulation parameter is most affected by warfarin?

Back 157

PT

Front 158

What is the Dx?
- A young patient with a family history of sudden death collapses and dies while exercising.

Back 158

Hypertrophic cardiomyopathy

Front 159

Describe endocarditis prophylaxis regimens.

Back 159

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

Front 160

What are the 6 P's of ischemia due to peripheral vascular disease?

Back 160

- Pain
- Pallor
- Pulselessness
- Paralysis
- Paresthesia
- Poikilothermia

Front 161

What is Virchow's triad?

Back 161

- Stasis
- Hypercoagulability
- Endothelial damage

Front 162

What is the most common cause of hypertension in young women?

Back 162

OCPs

Front 163

What is the most common cause of hypertension in young men?

Back 163

Excessive EtOH

Front 164

What skin lesion has a "Stuck-on" appearance?

Back 164

Seborrheic keratosis

Front 165

What presents with red plaques with silvery-white scales and sharp margins?

Back 165

- Psoriasis

Front 166

What is the most common type of skin cancer?

Back 166

Basal cell carcinoma: the lesion is a pearly-colored papule with a translucent surface and telangiectasias.

Front 167

What's the Dx?
- Honey-crusted lesions.

Back 167

- Impetigo

Front 168

What is the Dx?
- A febrile patient with a history of diabetes presents with a red, swollen, painful lower extremity.

Back 168

- Cellulitis

Front 169

+ Nikolsky's sign =

Back 169

- Pemphigus vulgaris

Front 170

- Nikolsky's sign =

Back 170

- Bullous pemphigoid

Front 171

What's the Dx?
- A 55-year-old obese patient presents with dirty, velvety patches on the back of the neck.

Back 171

- Acanthosis nigricans.
- NB: Check fasting blood sugar to rule out diabetes

Front 172

Dermatomal distribution = ____

Back 172

- Varicella zoster

Front 173

Flat-topped papules =

Back 173

Lichen planus

Front 174

Iris-like target lesions = ___

Back 174

Erythema multiforme

Front 175

What's the Dx?
- A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.

Back 175

- Contact dermatitis

Front 176

What's the Dx?
- Presents with a herald patch, Christmas-tree pattern.

Back 176

- Pityriasis rosea

Front 177

What's the Dx?
- A 16-year-old presents with an annular patch of alopecia with broken-off, stubby hairs.

Back 177

- Alopecia areata (autoimmune process)

Front 178

What's the Dx?
- Pinkish, scaling, flat lesions on the chest and back. KOH prep has a "spaghetti-and-meatballs" appearance.

Back 178

- Pityriasis versicolor

Front 179

What's the Dx?
- Premalignant lesion from sun exposure that can → squamous cell carcinoma.

Back 179

- Actinic keratosis

Front 180

What's the lesion?
- "Dewdrop on a rose petal."

Back 180

Lesions of 1° varicella

Front 181

What's the Dx?
- "Cradle cap."

Back 181

- Seborrheic dermatitis
- Treat with antifungals

Front 182

What's the Dx?
- Associated with Propionibacterium acnes and changes in androgen levels.

Back 182

- Acne vulgaris

Front 183

What's the Dx?
- A painful, recurrent vesicular eruption of mucocutaneous surfaces.

Back 183

- Herpes simplex

Front 184

What's the Dx?
- Inflammation and epithelial thinning of the anogenital area, predominantly in in postmenopausal women.

Back 184

- Lichen sclerosus

Front 185

What's the Dx?
- Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.

Back 185

- Squamous cell carcinoma

Front 186

What's the most common cause of hypothyroidism?

Back 186

- Hashimoto's thyroiditis

Front 187

What's the Dx?
- High TSH, low T4, antimicrosomal antibodies

Back 187

- Hashimoto's thyroiditis.

Front 188

What's the Dx?
- Exophthalmos, pretibial myxedema, and ↓ TSH.

Back 188

- Graves' disease

Front 189

What's the most common cause of Cushing's syndrome?

Back 189

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

Front 190

What's the Dx?
- A patient presents with signs of hypocalcemia, high phosphorus, and low PTH.

Back 190

- Hypoparathyroidism

Front 191

What's the Dx?
- "Stones, bones, groans, psychiatric overtones."

Back 191

- Hypercalcemia

Front 192

What's the Dx?
- A patient complains of headache, weakness, and polyuria; exam reveals hypertension and tetany. Labs reveals hypernatremia, hypokalemia, and metabolic alkalosis.

Back 192

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

Front 193

What's the Dx?
- A patient presents with tachycardia, wild swings in BP, headache, diaphoresis, altered mental status, and a sense of panic.

Back 193

- Pheochromocytoma

Front 194

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

Back 194

- α-antagonists: phentolamine and phenoxybenzamine

Front 195

What's the Dx?
- A patient with a history of lithium use presents with copious amounts of dilute urine.

Back 195

- Nephrogenic diabetes insipidus (DI)

Front 196

What's the treatment of central DI?

Back 196

- Administration of DDAVP ↓ serum osmolality and free water restriction

Front 197

What's the Dx?
- A postoperative patient with significant pain presents with hyponatremia and normal volume status.

Back 197

- SIADH due to stress

Front 198

Which antidiabetic agent is associated with lactic acidosis?

Back 198

- Metformin

Front 199

What's the Dx & Tx?
- A patient presents with weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show hyponatremia and hyperkalemia.

Back 199

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

Front 200

What's the goal hemoglobin A1c for a patient with DM?

Back 200

< 7.0

Front 201

What's the treatment of DKA?

Back 201

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

Front 202

Why are β-blockers contraindicated in diabetics?

Back 202

They can mask symptoms of hypoglycemia.

Front 203

What bias is introduced into a study when a clinician is aware of the patient's treatment type?

Back 203

Observational bias

Front 204

Name the bias.
- Introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.

Back 204

- Lead-time bias

Front 205

Name the 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 _____.

Back 205

- Confounding variable

Front 206

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

Back 206

- Sensitivity

Front 207

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

Back 207

- Out

Front 208

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 208

Highly sensitive for TB

Front 209

Chronic diseases such as SLE—higher prevalence or incidence?

Back 209

Higher prevalence

Front 210

Epidemics such as influenza—higher prevalence or incidence?

Back 210

- Higher incidence

Front 211

Cross-sectional survey—incidence or prevalence?

Back 211

- Prevalence

Front 212

Cohort study—incidence or prevalence?

Back 212

- Incidence and prevalence

Front 213

Case-control study—incidence or prevalence?

Back 213

Neither

Front 214

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

Back 214

High reliability, low validity.

Front 215

What's the difference between a cohort and a case-control study.

Back 215

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 216

Attributable risk?

Back 216

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

Front 217

Relative risk?

Back 217

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

Front 218

Odds ratio?

Back 218

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

Front 219

Number needed to treat?

Back 219

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

Front 220

In which patients do you initiate colorectal cancer screening early?

Back 220

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

Front 221

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

Back 221

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

Front 222

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

Back 222

68%, 95.5%, 99.7%

Front 223

Birth rate?

Back 223

Number of live births per 1,000 population

Front 224

Fertility rate?

Back 224

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

Front 225

Mortality rate?

Back 225

Number of deaths per 1000 population

Front 226

Neonatal mortality?

Back 226

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

Front 227

Postnatal mortality?

Back 227

Number of deaths from 28 days to one year per 1,000 live births

Front 228

Infant mortality?

Back 228

Number of deaths from birth to one year of age per 1,000 live births (neonatal + postnatal mortality)

Front 229

Fetal mortality?

Back 229

Number of deaths from 20 weeks' gestation to birth per 1,000 total births

Front 230

Perinatal mortality?

Back 230

Number of deaths from 20 weeks' gestation to one month of life per 1,000 total births

Front 231

Maternal mortality?

Back 231

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

Front 232

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

Back 232

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 233

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

Back 233

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

Front 234

What's the ethical issue?
- A doctor refers a patient for an MRI at a facility he/she owns.

Back 234

- Conflict of interest

Front 235

Involuntary psychiatric hospitalization can be undertaken for which three reasons?

Back 235

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

Front 236

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

Back 236

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

Front 237

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

Back 237

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 238

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

Back 238

Treat immediately. Consent is implied in emergency situations.

Front 239

Conditions in which confidentiality must be overridden.

Back 239

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

Front 240

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

Back 240

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

Front 241

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

Back 241

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

Front 242

What's to do?
- A son asks that his mother not be told about her recently discovered cancer.

Back 242

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

Front 243

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

Back 243

Emergent laparotomy to repair perforated viscus, likely stomach

Front 244

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

Back 244

- Diverticulosis

Front 245

Diagnostic modality used when ultrasound is equivocal for cholecystitis.

Back 245

HIDA scan

Front 246

Sentinel loop on AXR.

Back 246

Acute pancreatitis

Front 247

What are risk factors for cholelithiasis?

Back 247

Fat, female, fertile, forty, flatulent

Front 248

Inspiratory arrest during palpation of the RUQ means ____.

Back 248

Murphy's sign, seen in acute cholecystitis

Front 249

Identify key organisms causing diarrhea:
- Most common organism

Back 249

- Campylobacter

Front 250

Identify key organisms causing diarrhea:
- Recent antibiotic use

Back 250

- Clostridium difficile

Front 251

Identify key organisms causing diarrhea:
- Camping

Back 251

Giardia

Front 252

Identify key organisms causing diarrhea:
- Traveler's diarrhea

Back 252

ETEC

Front 253

Identify key organisms causing diarrhea:
- Church picnics/mayonnaise

Back 253

- S. aureus

Front 254

Identify key organisms causing diarrhea:
- Uncooked hamburgers

Back 254

E. coli O157:H7

Front 255

Identify key organisms causing diarrhea:
- Fried rice

Back 255

- Bacillus cereus

Front 256

Identify key organisms causing diarrhea:
- Poultry/eggs

Back 256

- Salmonella

Front 257

Identify key organisms causing diarrhea:
- Raw seafood

Back 257

Vibrio, HAV

Front 258

Identify key organisms causing diarrhea:
- Patient has AIDS

Back 258

- Isospora
- Cryptosporidium
- Mycobacterium avium complex (MAC)

Front 259

Identify key organisms causing diarrhea:
- Pseudoappendicitis

Back 259

- Yersinia

Front 260

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 260

- Crohn's disease

Front 261

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

Back 261

Ulcerative colitis

Front 262

Extraintestinal manifestations of IBD =

Back 262

- Uveitis
- Ankylosing spondylitis
- Pyoderma gangrenosum
- Erythema nodosum
- 1° sclerosing cholangitis

Front 263

Medical treatment for IBD.

Back 263

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

Front 264

The difference between Mallory-Weiss and Boerhaave tears is

Back 264

- Mallory-Weiss: superficial tear in the esophageal mucosa

- Boerhaave: full-thickness esophageal rupture

Front 265

Charcot's triad =

Back 265

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

Front 266

Reynolds' pentad:

Back 266

Charcot's triad plus shock & mental status changes, with suppurative ascending cholangitis

Front 267

Medical treatment for hepatic encephalopathy.

Back 267

- ↓ protein intake
- lactulose
- neomycin

Front 268

What is the 1st step in the management of a patient with acute GI bleed?

Back 268

Establish the ABCs

Front 269

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

Back 269

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

Front 270

Post-HBV exposure treatment.

Back 270

HBV immunoglobulin

Front 271

Classic causes of drug-induced hepatitis.

Back 271

- TB medications (INH, rifampin, pyrazinamide)
- Acetaminophen
- Tetracycline

Front 272

What's the Dx?
- A 40-year-old obese female with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine, and clay-colored stools.

Back 272

Biliary tract obstruction

Front 273

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

Back 273

- Femoral hernia

Front 274

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 274

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 275

Four causes of microcytic anemia.

Back 275

TICS:
- Thalassemia
- Iron deficiency
- anemia of Chronic disease
- Sideroblastic anemia

Front 276

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

Back 276

Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer

Front 277

Precipitants of hemolytic crisis in patients with G6PD deficiency:

Back 277

- Sulfonamides
- Antimalarial drugs
- Fava beans

Front 278

The most common inherited cause of hypercoagulability.

Back 278

Factor V Leiden mutation

Front 279

The most common inherited hemolytic anemia.

Back 279

Hereditary spherocytosis

Front 280

The diagnostic test for hereditary spherocytosis is ___.

Back 280

Osmotic fragility test

Front 281

Diamond-Blackfan anemia is ___

Back 281

- Pure RBC aplasia.

Front 282

Which anemia is associated with absent radii and thumbs, diffuse hyperpigmentation, café-au-lait spots, microcephaly, and pancytopenia?

Back 282

- Fanconi's anemia

Front 283

Medications and viruses that → aplastic anemia.

Back 283

MEDS: Chloramphenicol, sulfonamides, radiation, chemotherapeutic agents

VIRUSES: HIV, hepatitis, parvovirus B19, EBV

Front 284

How to distinguish polycythemia vera from 2° polycythemia.

Back 284

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

Front 285

Thrombotic thrombocytopenic purpura (TTP) pentad?

Back 285

Pentad of TTP—"FAT RN":

- Fever
- Anemia
- Thrombocytopenia

- Renal dysfunction
- Neurologic abnormalities

Front 286

HUS triad?

Back 286

Anemia, thrombocytopenia, and acute renal failure

Front 287

Treatment for TTP.

Back 287

Emergent large-volume plasmapheresis, corticosteroids, antiplatelet drugs

Front 288

What is the treatment for idiopathic thrombocytopenic purpura (ITP) in children?

Back 288

Usually resolves spontaneously; may require IVIG and/or corticosteroids

Front 289

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

Back 289

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

Front 290

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

Back 290

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

Front 291

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

Back 291

- von Willebrand's disease
- Treat with desmopressin, FFP, or cryoprecipitate

Front 292

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

Back 292

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

Front 293

Hodgkin's lymphoma histo =

Back 293

Reed-Sternberg cells

Front 294

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

Back 294

Non-Hodgkin's lymphoma

Front 295

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

Back 295

- Anemia of chronic disease

Front 296

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

Back 296

Iron deficiency anemia

Front 297

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

Back 297

Chronic lymphocytic leukemia (CLL)

Front 298

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

Back 298

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

Front 299

Auer rods on blood smear.

Back 299

Acute myelogenous leukemia (AML)

Front 300

AML subtype associated with DIC.

Back 300

M3

Front 301

Electrolyte changes in tumor lysis syndrome:

Back 301

↓ Ca2+
↑ K−
↑ phosphate
↑ uric acid

Front 302

What's the treatment for AML M3?

Back 302

Retinoic acid

Front 303

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

Back 303

CML

Front 304

Intracellular inclusions seen in thalassemia, G6PD deficiency, and postsplenectomy?

Back 304

- Heinz bodies

Front 305

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

Back 305

Glanzmann's thrombasthenia

Front 306

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

Back 306

Parvovirus B19

Front 307

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

Back 307

- O2
- Analgesia
- Hydration

- and, if severe, transfusion

Front 308

A significant cause of morbidity in thalassemia patients. Treatment?

Back 308

Iron overload; use deferoxamine

Front 309

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

Back 309

Infection, cancer, and autoimmune disease

Front 310

Four signs and symptoms of streptococcal pharyngitis.

Back 310

Fever, pharyngeal erythema, tonsillar exudate, lack of cough

Front 311

A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1° infection.

Back 311

Postinfectious glomerulonephritis

Front 312

Asplenic patients are particularly susceptible to these organisms.

Back 312

Encapsulated organisms:
- Pneumococcus
- Meningococcus
- Haemophilus influenzae
- Klebsiella

Front 313

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

Back 313

- 105 bacteria/mL

Front 314

Which healthy population is susceptible to UTIs?

Back 314

- Pregnant women
- Treat this group aggressively because of potential complications

Front 315

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

Back 315

- Coccidioidomycosis.
- Rx: Amphotericin B

Front 316

Nonpainful chancre.

Back 316

1° syphilis

Front 317

A "blueberry muffin" rash is characteristic of what congenital infection?

Back 317

- Rubella

Front 318

Meningitis in neonates. Causes? Treatment?

Back 318

- Dx: Group B strep, E. coli, Listeria.
- Tx: ampicillin & gentamicin

Front 319

Meningitis in infants. Causes? Treatment?

Back 319

Causes: Pneumococcus, meningococcus, H. influenzae.

Tx: cefotaxime & vancomycin

Front 320

What should always be done prior to LP?

Back 320

Check for ↑ ICP; look for papilledema

Front 321

Bacterial meningitis CSF findings:

Back 321

Low glucose
PMN predominance

Front 322

Aseptic (viral) meningitis
CSF findings:

Back 322

- Normal glucose
- Lymphocytic predominance

Front 323

Subarachnoid hemorrhage (SAH)
CSF findings:

Back 323

- Numerous RBCs in serial CSF samples

Front 324

MS CSF findings:

Back 324

- ↑ gamma globulins

Front 325

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

Back 325

- Cutaneous anthrax.
- Treat with penicillin G or ciprofloxacin

Front 326

Findings in 3° syphilis.

Back 326

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

Front 327

Characteristics of 2° Lyme disease.

Back 327

- Arthralgias
- Migratory polyarthropathies
- Bell's palsy
- Myocarditis

Front 328

Cold agglutinins =

Back 328

Mycoplasma

Front 329

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

Back 329

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

Front 330

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

Back 330

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

Front 331

Risk factors for pyelonephritis.

Back 331

- Pregnancy
- Vesicoureteral reflux
- Anatomic anomalies
- Indwelling catheters
- Kidney stones

Front 332

Neutropenic nadir postchemotherapy.

Back 332

7-10 days

Front 333

Lesion of 1° Lyme disease:

Back 333

- Erythema migrans.

Front 334

Classic physical findings for endocarditis.

Back 334

- Fever
- Heart murmur
- Osler's nodes,
- Splinter hemorrhages
- Janeway lesions
- Roth's spots

Front 335

- Aplastic crisis in sickle cell disease.

Back 335

- Parvovirus B19

Front 336

Ring-enhancing brain lesion on CT with seizures:

Back 336

Taenia solium (cysticercosis)

Front 337

Name the organism:
- Branching rods in oral infection.

Back 337

Actinomyces israelii

Front 338

Name the organism:
- Painful chancroid.

Back 338

Haemophilus ducreyi

Front 339

Name the organism:
- Dog or cat bite.

Back 339

Pasteurella multocida

Front 340

Name the organism:
- Gardener.

Back 340

Sporothrix schenckii

Front 341

Name the organism:
- Pregnant women with pets.

Back 341

Toxoplasma gondii

Front 342

Name the organism:
- Meningitis in adults.

Back 342

Neisseria meningitidis

Front 343

Name the organism:
- Meningitis in elderly.

Back 343

Streptococcus pneumoniae

Front 344

Name the organism:
- Alcoholic with pneumonia

Back 344

Klebsiella

Front 345

Name the organism:
- "Currant jelly" sputum.

Back 345

Klebsiella

Front 346

Name the organism:
- Infection in burn victims

Back 346

Pseudomonas

Front 347

Name the organism:
- Osteomyelitis from foot wound puncture.

Back 347

Pseudomonas

Front 348

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

Back 348

Salmonella

Front 349

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 349

Legionella pneumonia

Front 350

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 350

- Dx: Lyme disease
- Cause: Ixodes tick
- Rx: Doxycycline

Front 351

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

Back 351

S. aureus or S. epidermidis

Front 352

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

Back 352

All-compartment fasciotomy for suspected compartment syndrome

Front 353

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

Back 353

Spinal stenosis

Front 354

Joints in the hand affected in rheumatoid arthritis.

Back 354

MCP and PIP joints
DIP joints are spared

Front 355

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

Back 355

Osteoarthritis

Front 356

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

Back 356

Osteogenesis imperfecta

Front 357

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

Back 357

Suspect ankylosing spondylitis. Check HLA-B27

Front 358

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

Back 358

- Campylobacter
- Shigella
- Salmonella
- Chlamydia
- Ureaplasma

Front 359

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 359

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

Front 360

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

Back 360

Pseudogout

Front 361

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 361

Polymyalgia rheumatica

Front 362

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

Back 362

Osgood-Schlatter disease

Front 363

Bone is fractured in fall on outstretched hand.

Back 363

Distal radius (Colles' fracture)

Front 364

Complication of scaphoid fracture.

Back 364

Avascular necrosis

Front 365

Signs suggesting radial nerve damage with humeral fracture.

Back 365

Wrist drop, loss of thumb abduction

Front 366

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

Back 366

Duchenne muscular dystrophy

Front 367

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

Back 367

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

Front 368

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

Back 368

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

Front 369

The most common 1° malignant tumor of bone.

Back 369

Multiple myeloma

Front 370

Unilateral, severe periorbital headache with tearing and conjunctival erythema.

Back 370

Cluster headache

Front 371

Prophylactic treatment for migraine.

Back 371

β-blockers, Ca2+ channel blockers, TCAs

Front 372

The most common pituitary tumor. Treatment?

Back 372

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

Front 373

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

Back 373

- Broca's aphasia
- Frontal lobe, left MCA distribution

Front 374

The second most common is berry aneurysm.
The most common cause of SAH.

Back 374

Trauma

Front 375

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

Back 375

Subdural hematoma—bridging veins torn

Front 376

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

Back 376

Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation

Front 377

CSF findings with SAH.

Back 377

Elevated ICP, RBCs, xanthochromia

Front 378

Albuminocytologic dissociation.

Back 378

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

Front 379

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 379

Normal

Front 380

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

Back 380

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

Front 381

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

Back 381

Absence seizures

Front 382

The most frequent presentation of intracranial neoplasm.

Back 382

Headache

Front 383

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

Back 383

Infection, febrile seizures, trauma, idiopathic

Front 384

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

Back 384

Trauma, alcohol withdrawal, brain tumor

Front 385

First-line medication for status epilepticus.

Back 385

IV benzodiazepine

Front 386

Confusion, confabulation, ophthalmoplegia, ataxia.

Back 386

Wernicke's encephalopathy due to a deficiency of thiamine.

Front 387

What % lesion is an indication for carotid endarterectomy?

Back 387

Seventy percent IF the stenosis is symptomatic.

Front 388

The most common causes of dementia.

Back 388

Alzheimer's and multi-infarct

Front 389

Combined UMN and LMN disorder.

Back 389

ALS

Front 390

Rigidity and stiffness with resting tremor and masked facies.

Back 390

Parkinson's disease

Front 391

The mainstay of Parkinson's therapy.

Back 391

Levodopa/carbidopa

Front 392

Treatment for Guillain-Barré syndrome.

Back 392

IVIG or plasmapheresis

Front 393

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

Back 393

Huntington's disease

Front 394

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 394

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

Front 395

Café-au-lait spots on skin.

Back 395

Neurofibromatosis 1

Front 396

Hyperphagia, hypersexuality, hyperorality, and hyperdocility.

Back 396

Klüver-Bucy syndrome (amygdala)

Front 397

Administer to a symptomatic patient to diagnose myasthenia gravis.

Back 397

Edrophonium

Front 398

1° causes of third-trimester bleeding.

Back 398

Placental abruption & placenta previa

Front 399

Classic ultrasound and gross appearance of complete hydatidiform mole.

Back 399

Snowstorm on ultrasound. "Cluster-of-grapes" appearance on gross examination.

Front 400

Chromosomal pattern of a complete mole.

Back 400

46,XX

Front 401

Molar pregnancy containing fetal tissue.

Back 401

Partial mole

Front 402

Symptoms of placental abruption:

Back 402

Continuous, painful vaginal bleeding

Front 403

Self-limited, painless vaginal bleeding

Back 403

Symptoms of placenta previa.

Front 404

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

Back 404

Never

Front 405

Antibiotics with teratogenic effects.

Back 405

- Tetracycline
- Fluoroquinolones
- Aminoglycosides
- Sulfonamides

Front 406

Shortest AP diameter of the pelvis.

Back 406

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

Front 407

Medication given to accelerate fetal lung maturity.

Back 407

Betamethasone or dexamethasone × 48 hours

Front 408

The most common cause of postpartum hemorrhage.

Back 408

Uterine atony

Front 409

Treatment for postpartum hemorrhage.

Back 409

Uterine massage; if that fails, give oxytocin

Front 410

Typical antibiotics for group B streptococcus (GBS) prophylaxis.

Back 410

IV penicillin or ampicillin

Front 411

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

Back 411

Sheehan's syndrome (postpartum pituitary necrosis)

Front 412

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

Back 412

Inevitable abortion

Front 413

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

Back 413

Threatened abortion

Front 414

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

Back 414

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

Front 415

Term for heavy bleeding during and between menstrual periods.

Back 415

Menometrorrhagia

Front 416

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

Back 416

Asherman's syndrome

Front 417

Therapy for polycystic ovarian syndrome.

Back 417

Weight loss and OCPs

Front 418

Medication used to induce ovulation.

Back 418

Clomiphene citrate

Front 419

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

Back 419

Endometrial biopsy

Front 420

Indications for medical treatment of ectopic pregnancy.

Back 420

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

Front 421

Medical options for endometriosis.

Back 421

OCPs, danazol, GnRH agonists

Front 422

"Chocolate cysts," powder burns

Back 422

Laparoscopic findings in endometriosis.

Front 423

The most common location for an ectopic pregnancy.

Back 423

Ampulla of the oviduct

Front 424

How to diagnose and follow a leiomyoma.

Back 424

Ultrasound

Front 425

Natural history of a leiomyoma.

Back 425

Regresses after menopause

Front 426

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

Back 426

Trichomonas vaginitis

Front 427

Treatment for bacterial vaginosis.

Back 427

Oral or topical metronidazole

Front 428

The most common cause of bloody nipple discharge.

Back 428

Intraductal papilloma

Front 429

Unopposed estrogen is contraindicated in which cancers?

Back 429

Endometrial or estrogen receptor-
breast cancer

Front 430

A patient presents with recent PID with RUQ pain.

Back 430

Consider Fitz-Hugh-Curtis syndrome

Front 431

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

Back 431

Paget's disease

Front 432

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

Back 432

CA-125 and transvaginal ultrasound

Front 433

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

Back 433

Kegel exercises, estrogen, pessaries for stress incontinence

Front 434

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

Back 434

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

Front 435

Lab values suggestive of menopause.

Back 435

↑ serum FSH

Front 436

The most common cause of female infertility.

Back 436

Endometriosis

Front 437

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

Back 437

Colposcopy and endocervical curettage

Front 438

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

Back 438

Lobular carcinoma in situ

Front 439

Nontender abdominal mass associated with elevated VMA and HVA.

Back 439

Neuroblastoma

Front 440

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

Back 440

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

Front 441

Not contraindications to vaccination.

Back 441

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

Front 442

Tests to rule out shaken baby syndrome.

Back 442

Ophthalmologic exam, CT, and MRI

Front 443

Diagnosis?
- A neonate has meconium ileus.

Back 443

CF or Hirschsprung's disease

Front 444

Bilious emesis within hours after the first feeding.

Back 444

Duodenal atresia

Front 445

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

Back 445

- Correct metabolic abnormalities. - Then correct pyloric stenosis with pyloromyotomy

Front 446

The most common 1° immunodeficiency.

Back 446

Selective IgA deficiency

Front 447

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

Back 447

Febrile seizures (roseola infantum)

Front 448

Acute-phase treatment for Kawasaki disease.

Back 448

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

Front 449

Treatment for mild and severe unconjugated hyperbilirubinemia.

Back 449

Phototherapy (mild) or exchange transfusion (severe)

Front 450

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

Back 450

Reye's syndrome

Front 451

A child has loss of red light reflex. Diagnosis?

Back 451

Suspect retinoblastoma

Front 452

Vaccinations at a six-month well-child visit.

Back 452

HBV, DTaP, Hib, IPV, PCV

Front 453

Precocious puberty

Back 453

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

Front 454

Infection of small airways with epidemics in winter and spring.

Back 454

RSV bronchiolitis

Front 455

Cause of neonatal RDS.

Back 455

Surfactant deficiency

Front 456

What is the immunodeficiency?
- A boy has chronic respiratory infections.

Back 456

Chronic granulomatous disease
- Nitroblue tetrazolium test is +.

Front 457

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

Back 457

Wiskott-Aldrich Syndrome

Front 458

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

Back 458

Bruton's X-linked agammaglobulinemia

Front 459

A condition associated with red "currant-jelly" stools.

Back 459

Intussusception

Front 460

A congenital heart disease that cause 2° hypertension.

Back 460

Coarctation of the aorta

Front 461

First-line treatment for otitis media.

Back 461

Amoxicillin × 10 days

Front 462

The most common pathogen causing croup.

Back 462

Parainfluenza virus type 1

Front 463

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

Back 463

Kwashiorkor (protein malnutrition)

Front 464

Gout, self-mutilation, and choreoathetosis

Back 464

Lesch-Nyhan syndrome
- purine salvage problem with
defect in an X-linked syndrome with mental retardation, HGPRTase deficiency

Front 465

A newborn female has continuous "machinery murmur."

Back 465

Patent ductus arteriosus (PDA)

Front 466

First-line pharmacotherapy for depression.

Back 466

SSRIs

Front 467

Antidepressants associated with hypertensive crisis.

Back 467

MAOIs

Front 468

Galactorrhea, impotence, menstrual dysfunction, and ↓ libido.

Back 468

Patient on dopamine antagonist

Front 469

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

Back 469

Conversion disorder

Front 470

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

Back 470

Displacement

Front 471

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

Back 471

Reaction formation

Front 472

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

Back 472

Isolation

Front 473

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

Back 473

Regression

Front 474

Life-threatening muscle rigidity, fever, and rhabdomyolysis.

Back 474

Neuroleptic malignant syndrome

Front 475

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

Back 475

Anorexia

Front 476

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

Back 476

Panic disorder

Front 477

The most serious side effect of clozapine.

Back 477

Agranulocytosis

Front 478

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

Back 478

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

Front 479

Key side effects of atypical antipsychotics.

Back 479

Weight gain, type 2 DM, QT prolongation

Front 480

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

Back 480

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

Front 481

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

Back 481

Neuroleptics

Front 482

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

Back 482

Conduct disorder

Front 483

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

Back 483

Rett's disorder

Front 484

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

Back 484

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

Front 485

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

Back 485

Malingering.

Front 486

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

Back 486

Factitious disorder (Munchausen syndrome)

Front 487

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

Back 487

Substance abuse

Front 488

A violent patient has vertical and horizontal nystagmus.

Back 488

Phencyclidine hydrochloride (PCP) intoxication

Front 489

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

Back 489

Depersonalization disorder

Front 490

Frotteurism (a paraphilia)

Back 490

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

Front 491

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

Back 491

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

Front 492

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

Back 492

Dissociative fugue

Front 493

Risk factors for DVT.

Back 493

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

Front 494

Criteria for exudative effusion:

Back 494

- Pleural/serum protein > 0.5
- Pleural/serum LDH > 0.6

Front 495

Causes of exudative effusion.

Back 495

Think of leaky capillaries:
- Malignancy
- TB
- Bacterial or viral infection
- Pulmonary embolism with infarct
- Pancreatitis

Front 496

Causes of transudative effusion.

Back 496

Think of intact capillaries:
- CHF
- Liver or kidney disease
- Protein-losing enteropathy

Front 497

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

Back 497

Fatigue & impending respiratory failure

Front 498

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

Back 498

Sarcoidosis

Front 499

PFT showing ↓ FEV1/FVC.

Back 499

Obstructive pulmonary disease (e.g., asthma)

Front 500

PFT showing ↑ FEV1/FVC.

Back 500

Restrictive pulmonary disease

Front 501

Honeycomb pattern on CXR. Diagnosis? Treatment?

Back 501

- Diffuse interstitial pulmonary fibrosis.
- Supportive care.
- Steroids may help.

Front 502

Treatment for SVC syndrome.

Back 502

Radiation

Front 503

Treatment for mild, persistent asthma.

Back 503

Inhaled β-agonists and inhaled corticosteroids

Front 504

Acid-base disorder in pulmonary embolism.

Back 504

Hypoxia & hypocarbia

Front 505

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

Back 505

Squamous cell carcinoma

Front 506

Lung cancer associated with SIADH.

Back 506

Small cell lung cancer (SCLC)

Front 507

Lung cancer highly related to cigarette exposure.

Back 507

SCLC

Front 508

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

Back 508

- Spontaneous pneumothorax.
- Spontaneous regression.
- Supplemental O2 may be helpful

Front 509

Treatment of tension pneumothorax.

Back 509

Immediate needle thoracostomy

Front 510

Characteristics favoring carcinoma in an isolated pulmonary nodule.

Back 510

- Age 45-50 years
- Lesions new or larger in comparison to old films
- Absence of calcification or irregular calcification
- 2 cm; irregular margins

Front 511

Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure.

Back 511

ARDS

Front 512

↑ risk of what infection with silicosis?

Back 512

Mycobacterium tuberculosis

Front 513

Causes of hypoxemia.

Back 513

- Right-to-left shunt
- Hypoventilation
- Low inspired O2 tension
- Diffusion defect
- V/Q mismatch

Front 514

Classic CXR findings for pulmonary edema.

Back 514

- Cardiomegaly
- Prominent pulmonary vessels
- Kerley B lines
- "bat's-wing" appearance of hilar shadows
- Perivascular and peribronchial cuffing

Front 515

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

Back 515

Type I (distal) RTA

Front 516

RTA associated with abnormal HCO3 − and rickets.

Back 516

Type II (proximal) RTA

Front 517

RTA associated with aldosterone defect.

Back 517

Type IV (distal) RTA

Front 518

"Doughy skin."

Back 518

Hypernatremia

Front 519

Differential of hypervolemic hyponatremia.

Back 519

Cirrhosis, CHF, nephritic syndrome

Front 520

Chvostek's and Trousseau's signs.

Back 520

Hypocalcemia

Front 521

The most common causes of hypercalcemia.

Back 521

Malignancy and hyperparathyroidism

Front 522

T-wave flattening and U waves.

Back 522

Hypokalemia

Front 523

Peaked T waves and widened QRS.

Back 523

Hyperkalemia

Front 524

First-line treatment for moderate hypercalcemia.

Back 524

IV hydration and loop diuretics (furosemide)

Front 525

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

Back 525

Prerenal

Front 526

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

Back 526

Nephrolithiasis

Front 527

The most common type of nephrolithiasis.

Back 527

Calcium oxalate

Front 528

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

Back 528

Cerebral berry aneurysms (AD PCKD)

Front 529

Hematuria, hypertension, and oliguria.

Back 529

Nephritic syndrome

Front 530

Proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, edema.

Back 530

Nephrotic syndrome

Front 531

The most common form of nephritic syndrome.

Back 531

Membranous glomerulonephritis

Front 532

The most common form of glomerulonephritis.

Back 532

IgA nephropathy (Berger's disease)

Front 533

Glomerulonephritis with deafness.

Back 533

Alport's syndrome

Front 534

Glomerulonephritis with hemoptysis.

Back 534

Wegener's granulomatosis and Goodpasture's syndrome

Front 535

Presence of red cell casts in urine sediment.

Back 535

Glomerulonephritis/nephritic syndrome

Front 536

Eosinophils in urine sediment.

Back 536

Allergic interstitial nephritis

Front 537

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

Back 537

Nephrotic syndrome

Front 538

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

Back 538

Uremic syndrome seen in patients with renal failure.

Front 539

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

Back 539

Wait, surgical resection, radiation &/or androgen suppression

Front 540

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

Back 540

DI

Front 541

Treatment of SIADH?

Back 541

Fluid restriction, demeclocycline

Front 542

Hematuria, flank pain, and palpable flank mass.

Back 542

Renal cell carcinoma (RCC)

Front 543

Testicular cancer associated with β-hCG, AFP.

Back 543

Choriocarcinoma

Front 544

The most common type of testicular cancer.

Back 544

Seminoma: a type of germ cell tumor

Front 545

The most common histology of bladder cancer.

Back 545

Transitional cell carcinoma

Front 546

Complication of overly rapid correction of hyponatremia.

Back 546

Central pontine myelinolysis

Front 547

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

Back 547

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

Front 548

Acid-base disturbance commonly seen in pregnant women.

Back 548

Respiratory alkalosis

Front 549

Three systemic diseases → nephrotic syndrome.

Back 549

DM, SLE, & amyloidosis

Front 550

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

Back 550

RCC or other erythropoietin-producing tumor; evaluate with CT scan

Front 551

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

Back 551

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

Front 552

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

Back 552

Antipsychotics (neuroleptic malignant syndrome)

Front 553

Side effects of corticosteroids.

Back 553

- Acute mania
- Immunosuppression
- Thin skin
- Osteoporosis
- Easy bruising
- Myopathies

Front 554

Treatment for DTs.

Back 554

Benzodiazepines

Front 555

Treatment for acetaminophen overdose.

Back 555

N-acetylcysteine

Front 556

Treatment for opioid overdose.

Back 556

Naloxone

Front 557

Treatment for benzodiazepine overdose.

Back 557

Flumazenil

Front 558

Treatment for neuroleptic malignant syndrome.

Back 558

Dantrolene or bromocriptine

Front 559

Treatment for malignant hypertension.

Back 559

Nitroprusside

Front 560

Treatment of AF.

Back 560

Rate control, rhythm conversion, and anticoagulation

Front 561

Treatment of supraventricular tachycardia (SVT).

Back 561

Rate control with carotid massasge or other vagal stimulation

Front 562

Causes of drug-induced SLE.

Back 562

INH, penicillamine, hydralazine, procainamide

Front 563

Macrocytic, megaloblastic anemia with neurologic symptoms.

Back 563

B12 deficiency

Front 564

Macrocytic, megaloblastic anemia without neurologic symptoms.

Back 564

Folate deficiency

Front 565

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

Back 565

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

Front 566

Blood in the urethral meatus or high-riding prostate.

Back 566

Bladder rupture or urethral injury

Front 567

Test to rule out urethral injury.

Back 567

Retrograde cystourethrogram

Front 568

Radiographic evidence of aortic disruption or dissection.

Back 568

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

Front 569

Radiographic indications for surgery in patients with acute abdomen.

Back 569

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

Front 570

The most common organism in burn-related infections.

Back 570

Pseudomonas

Front 571

Method of calculating fluid repletion in burn patients.

Back 571

Parkland formula

Front 572

Acceptable urine output in a trauma patient.

Back 572

50 cc/hour

Front 573

Acceptable urine output in a stable patient.

Back 573

30 cc/hour

Front 574

Cannon "a" waves.

Back 574

Third-degree heart block

Front 575

Signs of neurogenic shock.

Back 575

Hypotension & bradycardia

Front 576

Cushing's triad:

Back 576

Signs of ↑ ICP: Hypertension, bradycardia, and abnormal respirations

Front 577

Hypovolemic shock

Back 577

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

Front 578

↓ CO, ↑ PCWP, ↑ PVR.

Back 578

Cardiogenic shock

Front 579

↑ CO, ↓ PCWP, ↓ PVR.

Back 579

Septic or anaphylactic shock

Front 580

Treatment of septic shock.

Back 580

Fluids and antibiotics

Front 581

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

Back 581

Treatment of cardiogenic shock.

Front 582

Identify cause; fluid and blood repletion

Back 582

Treatment of hypovolemic shock.

Front 583

Treatment of anaphylactic shock.

Back 583

Diphenhydramine or epinephrine 1:1000

Front 584

Continuous positive airway pressure

Back 584

Supportive treatment for ARDS.

Front 585

A patient with chest trauma who was previously stable suddenly dies

Back 585

Signs of air embolism.

Front 586

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

Back 586

Trauma series.

Front 587

Define Delusion of Reference.

Back 587

Events, objects, or persons in one's environment that are belieed to have particular personal significance

Front 588

Define Circumstantial thinking.

Back 588

Communication of unnecessary details before finally arriving at the central idea

Front 589

Define delusion.

Back 589

A false belief not supported by fact and cannot be challenged successfully by logic or reasoning

Front 590

Define Intermittent explosive disorder.

Back 590

Discrete episodes of aggression and destruction out of proportion with the precipitant stressor. EEG changes in 55%

Front 591

Define Illusion.

Back 591

A misinterpretation of a real sensory stimulus. common in ppl w.out psych disorders also. content affected by person's state of mind, wishes, and fears

Front 592

Normal pre and postnatal development but lose previously acquired purposeful hand skills between 5-30 mos. Stereotyped hand movements, poor coordination. A PDD

Back 592

Rett's disorder

Front 593

Define Orientation.

Back 593

State of awareness of time, place, identity of oneself and others

Front 594

Personality disorder
preoccupation with perfection, orderliness, and control. Lose main point of activity because they pay too much attention to details and rules

Back 594

OCPD/ obsessive compulsive personality disorder

Front 595

IQ 35-55%. function at preschool to second grade level

Back 595

moderate mental retardation

Front 596

Lose ability to form abstract concepts. nml in kids, also seen in MR, dementia, and schizophrenia

Back 596

Concrete thinking

Front 597

Voluntary assumption of an inappropriate or bizarre posture for long periods of time. usually seen in schizophrenia, esp catatonic type

Back 597

Catatonic posturing

Front 598

Psychotherapists transference response to the pt

Back 598

Countertransference

Front 599

Perception of a stimulus when none is present. auditory most common in psychosis; tactile, visual, gustatory, olfactory, or kinesthetic in neuro d/o's

Back 599

Hallucination

Front 600

Capacity to generalize and formulate concepts

Back 600

Abstract thinking

Front 601

Fluctuations in consciousness and disorientation. Also memory, language, sleep-wake disturbances

Back 601

Delirium

Front 602

Often precedes squamous cell carcinoma

Back 602

Actinic keratosis

Front 603

1° adrenocortical deficiency

Back 603

Addison's disease

Front 604

Polyostotic fibrous dysplasia, precocious puberty, café-au-lait spots, short stature, young girls

Back 604

Albright's syndrome

Front 605

↑ protein in CSF with only modest ↑ in cell count

Back 605

Albuminocytologic dissociation seen in Guillain-Barré

Front 606

Hereditary nephritis with nerve deafness

Back 606

Alport's syndrome

Front 607

Anti-basement membrane antibodies

Back 607

Goodpasture's syndrome

Front 608

Scleroderma (CREST)

Back 608

Anticentromere antibodies

Front 609

Anti-double-stranded DNA antibodies (ANA antibodies)

Back 609

SLE (type III hypersensitivity)

Front 610

Anti-epithelial cell antibodies

Back 610

Pemphigus vulgaris

Front 611

Antigliadin antibodies

Back 611

Celiac disease

Front 612

Drug-induced SLE

Back 612

Antihistone antibodies

Front 613

Anti-IgG antibodies

Back 613

Rheumatoid arthritis

Front 614

Antimitochondrial antibodies

Back 614

1° biliary cirrhosis

Front 615

Antineutrophil antibodies

Back 615

Vasculitis

Front 616

Antiplatelet antibodies

Back 616

Idiopathic thrombocytopenic purpura

Front 617

Arachnodactyly

Back 617

Marfan's syndrome

Front 618

Argyll Robertson pupil

Back 618

Neurosyphilis

Front 619

Cerebellar tonsillar herniation

Back 619

Arnold-Chiari malformation

Front 620

Aschoff bodies

Back 620

Rheumatic fever

Front 621

Atrophy of the mammillary bodies

Back 621

Wernicke's encephalopathy

Front 622

Auer rods

Back 622

Acute myelogenous leukemia (especially the promyelocytic type)

Front 623

Autosplenectomy

Back 623

Sickle cell anemia

Front 624

Babinski's sign

Back 624

UMN lesion

Front 625

Baker's cyst in popliteal fossa

Back 625

Rheumatoid arthritis

Front 626

Hyperreninemia

Back 626

Bartter's syndrome

Front 627

Basophilic stippling of RBCs

Back 627

Lead poisoning

Front 628

Becker's muscular dystrophy

Back 628

Defective dystrophin; less severe than Duchenne's

Front 629

LMN CN VII palsy

Back 629

Bell's palsy

Front 630

Multiple myeloma (kappa or lambda Ig light chains in urine), Waldenström's macroglobulinemia (IgM)

Back 630

Bence Jones proteins

Front 631

IgA nephropathy

Back 631

Berger's disease

Front 632

Defect in platelet adhesion

Back 632

Bernard-Soulier disease

Front 633

Bilateral hilar adenopathy, uveitis

Back 633

Sarcoidosis

Front 634

Birbeck granules on EM

Back 634

Histiocytosis X (eosinophilic granuloma)

Front 635

Bloody tap on LP

Back 635

Subarachnoid hemorrhage

Front 636

"Blue bloater"

Back 636

Chronic bronchitis

Front 637

Blue-domed cysts

Back 637

Fibrocystic change of the breast

Front 638

Blue sclera

Back 638

Osteogenesis imperfecta

Front 639

Tetralogy of Fallot; RVH

Back 639

Boot-shaped heart on x-ray

Front 640

PIP swelling 2° to osteophytes

Back 640

Bouchard's nodes found in Osteoarthritis

Front 641

Boutonnière deformity

Back 641

Rheumatoid arthritis

Front 642

Branching rods in oral infection

Back 642

Actinomyces israelii

Front 643

"Brown tumor" of bone

Back 643

Hemorrhage causes brown color of osteolytic cysts: 1. Hyperparathyroidism 2. Osteitis fibrosa cystica (von Recklinghausen's disease)

Front 644

Brushfield's spots

Back 644

Down syndrome

Front 645

X-linked agammaglobulinemia

Back 645

Bruton's disease

Front 646

Posthepatic venous thrombosis

Back 646

Budd-Chiari syndrome

Front 647

Small/medium-artery vasculitis

Back 647

Buerger's disease

Front 648

8:14 translocation; associated with EBV

Back 648

Burkitt's lymphoma (c-myc activation)

Front 649

Burton's lines

Back 649

Lead poisoning

Front 650

C-ANCA, P-ANCA

Back 650

Wegener's granulomatosis, polyarteritis nodosa

Front 651

Café-au-lait spots on skin

Back 651

Neurofibromatosis

Front 652

Gas emboli

Back 652

Caisson disease

Front 653

Calf pseudohypertrophy

Back 653

Duchenne's muscular dystrophy

Front 654

Call-Exner bodies

Back 654

Granulosa-theca cell tumor of the ovary

Front 655

Cardiomegaly with apical atrophy

Back 655

Chagas' disease

Front 656

Cerebriform nuclei

Back 656

Mycosis fungoides (cutaneous T-cell lymphoma)

Front 657

Chagas' disease

Back 657

Trypanosome infection

Front 658

Chancre

Back 658

1° syphilis (not painful)

Front 659

Haemophilus ducreyi

Back 659

Chancroid (painful)

Front 660

Multiple sclerosis (nystagmus, intention tremor, scanning speech), cholangitis (jaundice, RUQ pain, fever)

Back 660

Charcot's triad

Front 661

Charcot-Leyden crystals

Back 661

Bronchial asthma (eosinophil membranes)

Front 662

Phagocyte deficiency

Back 662

Chédiak-Higashi disease

Front 663

Cherry-red spot on macula

Back 663

Tay-Sachs, Niemann-Pick disease, central retinal artery occlusion

Front 664

Central apnea in CHF and ↑ intracranial pressure

Back 664

Cheyne-Stokes respirations

Front 665

Endometriosis (frequently involves both ovaries)

Back 665

"Chocolate cysts"

Front 666

Predisposition to gastric carcinoma

Back 666

Chronic atrophic gastritis

Front 667

facial muscle spasm upon tapping

Back 667

Chvostek's sign due to hypocalcemia

Front 668

DES exposure in utero

Back 668

Clear cell adenocarcinoma (CCA) of the vagina and cervix

Front 669

Clue cells

Back 669

Gardnerella vaginitis

Front 670

Codman's triangle on x-ray

Back 670

Osteosarcoma

Front 671

Cold agglutinins

Back 671

Mycoplasma pneumoniae, infectious mononucleosis

Front 672

Condylomata lata

Back 672

2° syphilis

Front 673

Continuous machinery murmur

Back 673

Patent ductus arteriosus

Front 674

Debranching enzyme deficiency

Back 674

Cori's disease

Front 675

Cotton-wool spots

Back 675

Chronic hypertension

Front 676

Cough, conjunctivitis, coryza

Back 676

Measles

Front 677

Councilman bodies

Back 677

Toxic or viral hepatitis

Front 678

Cowdry type A bodies

Back 678

Herpesvirus

Front 679

Rapidly progressive crescentic glomerulonephritis

Back 679

Crescents in Bowman's capsule

Front 680

Congenital unconjugated hyperbilirubinemia

Back 680

Crigler-Najjar syndrome

Front 681

Acute gastric ulcer associated with severe burns

Back 681

Curling's ulcer

Front 682

Currant-jelly sputum

Back 682

Klebsiella

Front 683

Curschmann's spirals

Back 683

Bronchial asthma (whorled mucous plugs)

Front 684

Acute gastric ulcer associated with CNS injury

Back 684

Cushing's ulcer

Front 685

D-dimers

Back 685

DIC

Front 686

basal ganglia disorder--rigidity, resting tremor, bradykinesia

Back 686

Depigmentation of neurons in
Parkinson's disease

Front 687

Dermatitis, dementia, diarrhea

Back 687

Pellagra (niacin, vitamin B3 deficiency)

Front 688

Diabetes insipidus + exophthalmos +

Back 688

Hand-Schüller-Christian disease

Front 689

Dog or cat bite

Back 689

Pasteurella multocida

Front 690

Donovan bodies

Back 690

Granuloma inguinale

Front 691

Congenital conjugated hyperbilirubinemia (black liver)

Back 691

Dubin-Johnson syndrome

Front 692

Deleted dystrophin gene (X-linked recessive)

Back 692

Duchenne's muscular dystrophy

Front 693

Eburnation

Back 693

Osteoarthritis (polished, ivory-like appearance of bone)

Front 694

Rocker-bottom feet, low-set ears, heart disease

Back 694

Edwards' syndrome: Trisomy 18

Front 695

Late cyanosis shunt (uncorrected L → R shunt becomes R → L shunt)

Back 695

Eisenmenger's complex

Front 696

Elastic skin

Back 696

Ehlers-Danlos syndrome

Front 697

Superior trunk brachial plexus injury ("waiter's tip")

Back 697

Erb-Duchenne palsy

Front 698

Erythema chronicum migrans

Back 698

Lyme disease

Front 699

Proximal tubular reabsorption defect

Back 699

Fanconi's syndrome

Front 700

Ferruginous bodies

Back 700

Asbestosis

Front 701

Colon polyps with osteomas and soft tissue tumors

Back 701

Gardner's syndrome

Front 702

Glucocerebrosidase deficiency

Back 702

Gaucher's disease

Front 703

Ghon focus

Back 703

1° TB

Front 704

Benign congenital unconjugated hyperbilirubinemia

Back 704

Gilbert's syndrome

Front 705

Defect in platelet aggregation

Back 705

Glanzmann's thrombasthenia

Front 706

Autoantibodies against alveolar and glomerular basement membrane proteins

Back 706

Goodpasture's syndrome

Front 707

Duchenne's (use of patient's arms to help legs pick self off the floor)

Back 707

Gowers' maneuver

Front 708

Idiopathic polyneuritis

Back 708

Guillain-Barré syndrome

Front 709

β-thalassemia, sickle cell anemia (extramedullary hematopoiesis)

Back 709

"Hair-on-end" appearance on x-ray

Front 710

Chronic progressive histiocytosis

Back 710

Hand-Schüller-Christian disease

Front 711

Thalassemia major

Back 711

HbF

Front 712

HbS

Back 712

Sickle cell anemia

Front 713

hCG elevated

Back 713

Choriocarcinoma, hydatidiform mole (occurs with and without embryo)

Front 714

Heberden's nodes

Back 714

Osteoarthritis (DIP swelling 2° to osteophytes)

Front 715

Heinz bodies

Back 715

G6PD deficiency

Front 716

Hypersensitivity vasculitis associated with hemorrhagic urticaria and URIs

Back 716

Henoch-Schönlein purpura

Front 717

Heterophil antibodies

Back 717

Infectious mononucleosis (EBV)

Front 718

High-output cardiac failure (dilated cardiomyopathy)

Back 718

Wet beriberi (thiamine, vitamin B1 deficiency)

Front 719

HLA-B27

Back 719

Reiter's syndrome, ankylosing spondylitis

Front 720

HLA-DR3 or -DR4

Back 720

Diabetes mellitus type 1 (caused by autoimmune destruction of β cells)

Front 721

Homer Wright rosettes

Back 721

Neuroblastoma

Front 722

Interstitial fibrosis

Back 722

Honeycomb lung on x-ray

Front 723

Splenectomy (or nonfunctional spleen)

Back 723

Howell-Jolly bodies

Front 724

Caudate degeneration (autosomal dominant)

Back 724

Huntington's disease

Front 725

Hyperphagia + hypersexuality + hyperorality + hyperdocility

Back 725

Klüver-Bucy syndrome (amygdala)

Front 726

Hyperpigmentation of skin

Back 726

1° adrenal insufficiency (Addison's disease)

Front 727

Hypersegmented neutrophils

Back 727

Macrocytic anemia

Front 728

Hypertension + hypokalemia

Back 728

Conn's syndrome

Front 729

Hypochromic microcytosis

Back 729

Iron deficiency anemia, lead poisoning

Front 730

Increased α-fetoprotein in amniotic fluid/maternal serum

Back 730

Anencephaly, spina bifida (neural tube defects)

Front 731

Increased uric acid levels

Back 731

Gout, Lesch-Nyhan syndrome, myeloproliferative disorders, loop and thiazide diuretics

Front 732

Intussusception

Back 732

Adenovirus (causes hyperplasia of Peyer's patches)

Front 733

Janeway lesions

Back 733

Endocarditis

Front 734

Jarisch-Herxheimer reaction

Back 734

Syphilis—overaggressive treatment of an asymptomatic patient that causes symptoms due to rapid lysis

Front 735

Neutrophil chemotaxis abnormality

Back 735

Job's syndrome

Front 736

AIDS in MSM (men who have sex with men)

Back 736

Kaposi's sarcoma

Front 737

Dynein defect

Back 737

Kartagener's syndrome

Front 738

Kayser-Fleischer rings

Back 738

Wilson's disease

Front 739

Keratin pearls

Back 739

Squamous cell carcinoma

Front 740

Kimmelstiel-Wilson nodules

Back 740

Diabetic nephropathy

Front 741

Bilateral amygdala lesions

Back 741

Klüver-Bucy syndrome

Front 742

Koilocytes

Back 742

HPV

Front 743

Koplik spots

Back 743

Measles

Front 744

Gastric adenocarcinoma with ovarian metastases

Back 744

Krukenberg tumor

Front 745

Kussmaul hyperpnea

Back 745

Diabetic ketoacidosis

Front 746

Lens dislocation + aortic dissection + joint hyperflexibility

Back 746

Marfan's syndrome (fibrillin deficit)

Front 747

HGPRT deficiency

Back 747

HGPRT (hypoxanthine-guanine phosphoribosyl transferase) deficiency

Front 748

Lines of Zahn

Back 748

Arterial thrombus

Front 749

Lisch nodules

Back 749

Neurofibromatosis (von Recklinghausen's disease)

Front 750

Low serum ceruloplasmin

Back 750

Wilson's disease

Front 751

Lucid interval

Back 751

Epidural hematoma

Front 752

"Lumpy-bumpy" appearance of glomeruli on immunofluorescencee

Back 752

Poststreptococcal glomerulonephritis

Front 753

Lytic bone lesions on x-ray

Back 753

Multiple myeloma

Front 754

Mallory bodies

Back 754

Alcoholic liver disease

Front 755

Esophagogastric lacerations

Back 755

Mallory-Weiss syndrome

Front 756

Muscle phosphorylase deficiency

Back 756

McArdle's disease

Front 757

McBurney's sign

Back 757

Appendicitis

Front 758

MLF syndrome (INO)

Back 758

Multiple sclerosis

Front 759

Monoclonal antibody spike

Back 759

Multiple myeloma (called the M protein; usually IgG or IgA), MGUS (monoclonal gammopathy of undetermined significance), Waldenström's (M protein = IgM) macroglobulinemia

Front 760

Myxedema

Back 760

Hypothyroidism

Front 761

Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis

Back 761

Wegener's and Goodpasture's (hemoptysis and glomerular disease)

Front 762

Negri bodies

Back 762

Rabies

Front 763

Nephritis + cataracts + hearing loss

Back 763

Alport's syndrome

Front 764

Sphingomyelinase deficiency

Back 764

Niemann-Pick disease

Front 765

No lactation postpartum

Back 765

Sheehan's syndrome (pituitary infarction)

Front 766

Nutmeg liver

Back 766

CHF

Front 767

Occupational exposure to asbestos

Back 767

Malignant mesothelioma

Front 768

"Orphan Annie" nuclei

Back 768

Papillary carcinoma of the thyroid

Front 769

Osler's nodes

Back 769

Endocarditis

Front 770

Painless jaundice

Back 770

Pancreatic cancer (head)

Front 771

Palpable purpura on legs and buttocks

Back 771

Henoch-Schönlein purpura

Front 772

Bronchogenic apical tumor associated with Horner's syndrome

Back 772

Pancoast's tumor

Front 773

Pannus

Back 773

Rheumatoid arthritis

Front 774

Nigrostriatal dopamine depletion

Back 774

Parkinson's disease

Front 775

Periosteal elevation on x-ray

Back 775

Pyogenic osteomyelitis

Front 776

Benign polyposis

Back 776

Peutz-Jeghers syndrome

Front 777

Penile fibrosis

Back 777

Peyronie's disease

Front 778

Philadelphia chromosome (t(9;22); bcr-abl hybrid)

Back 778

CML (may sometimes be associated with AML)

Front 779

Emphysema (centroacinar [smoking], panacinar [α1-antitrypsin deficiency])

Back 779

"Pink puffer"

Front 780

Esophageal webs with iron deficiency anemia

Back 780

Plummer-Vinson syndrome

Front 781

Gout (MP joint of hallux)

Back 781

Podagra

Front 782

Minimal change disease

Back 782

Podocyte fusion

Front 783

Polyneuropathy, cardiac pathology, and edema

Back 783

Dry beriberi (thiamine, vitamin B1 deficiency)

Front 784

Polyneuropathy preceded by GI or respiratory infection

Back 784

Guillain-Barré syndrome

Front 785

Lysosomal glucosidase deficiency associated with cardiomegaly

Back 785

Pompe's disease

Front 786

Positive anterior "drawer sign"

Back 786

Anterior cruciate ligament injury

Front 787

Vertebral tuberculosis

Back 787

Pott's disease

Front 788

Pseudopalisade tumor cell arrangement

Back 788

Glioblastoma multiforme

Front 789

Pseudorosettes

Back 789

Ewing's sarcoma

Front 790

Rash on palms and soles

Back 790

2° syphilis, Rocky Mountain spotted fever

Front 791

Recurrent vasospasm in extremities

Back 791

Raynaud's syndrome

Front 792

Acute glomerulonephritis

Back 792

RBC casts in urine

Front 793

Recurrent pulmonary Pseudomonas and S. aureus infections

Back 793

Cystic fibrosis

Front 794

Red urine in the morning

Back 794

Paroxysmal nocturnal hemoglobinuria

Front 795

Reid index (increased)

Back 795

Chronic bronchitis

Front 796

Reinke crystals

Back 796

Leydig cell tumor

Front 797

Urethritis, conjunctivitis, arthritis

Back 797

Reiter's syndrome

Front 798

Renal cell carcinoma + cavernous hemangiomas + adenomas

Back 798

von Hippel-Lindau disease

Front 799

Renal epithelial casts in urine

Back 799

Acute toxic/viral nephrosis

Front 800

Rib notching

Back 800

Coarctation of aorta

Front 801

Congenital conjugated hyperbilirubinemia

Back 801

Rotor's syndrome

Front 802

Rouleaux formation (RBCs)

Back 802

Multiple myeloma

Front 803

Russell bodies

Back 803

Multiple myeloma

Front 804

S3

Back 804

- Left-to-right shunt (VSD, PDA, ASD)
- Mitral regurgitation
- LV failure (CHF)

Front 805

S4

Back 805

- Aortic stenosis
- Hypertrophic subaortic stenosis

Front 806

Schiller-Duval bodies

Back 806

Yolk sac tumor

Front 807

Cutaneous T-cell lymphoma

Back 807

Sézary syndrome

Front 808

Shwartzman reaction

Back 808

Neisseria meningitidis

Front 809

Signet-ring cells

Back 809

Gastric carcinoma

Front 810

Sipple's syndrome

Back 810

MEN type IIa

Front 811

Dry eyes, dry mouth, arthritis

Back 811

Sjögren's syndrome

Front 812

"Smudge cell"

Back 812

CLL

Front 813

Soap bubble on x-ray

Back 813

Giant cell tumor of bone

Front 814

Spike and dome on EM

Back 814

Membranous glomerulonephritis

Front 815

Spitz nevus

Back 815

Benign juvenile melanoma

Front 816

"Strawberry tongue"

Back 816

Scarlet fever

Front 817

String sign on x-ray

Back 817

Crohn's disease

Front 818

Subepithelial humps on EM

Back 818

Poststreptococcal glomerulonephritis

Front 819

Suboccipital lymphadenopathy

Back 819

Rubella

Front 820

Sulfur granules

Back 820

Actinomyces israelii

Front 821

Swollen gums, bruising, poor wound healing, anemia

Back 821

Scurvy (ascorbic acid, vitamin C deficiency): vitamin C is necessary for hydroxylation of proline and lysine in collagen synthesis

Front 822

Systolic ejection murmur (crescendo-decrescendo)

Back 822

Aortic valve stenosis

Front 823

t(14;18)

Back 823

Follicular lymphomas (bcl-2 activation)

Front 824

Tendon xanthomas (classically Achilles)

Back 824

Familial hypercholesterolemia

Front 825

Thumb sign on lateral x-ray

Back 825

Epiglottitis (Haemophilus influenzae)

Front 826

Thyroidization of kidney

Back 826

Chronic bacterial pyelonephritis

Front 827

"Tram-track" appearance on LM

Back 827

Membranoproliferative glomerulonephritis

Front 828

Trousseau's sign

Back 828

Visceral cancer, pancreatic adenocarcinoma (migratory thrombophlebitis), hypocalcemia (carpal spasm)

Front 829

Left supraclavicular node enlargement from metastatic carcinoma of the stomach

Back 829

Virchow's node

Front 830

Pulmonary embolism (blood stasis, endothelial damage, hypercoagulation)

Back 830

Virchow's triad

Front 831

Neurofibromatosis with café-au-lait spots

Back 831

von Recklinghausen's disease

Front 832

Osteitis fibrosa cystica ("brown tumor")

Back 832

von Recklinghausen's disease of bone

Front 833

PICA thrombosis

Back 833

Wallenberg's syndrome

Front 834

Adrenal hemorrhage associated with meningococcemia

Back 834

Waterhouse-Friderichsen syndrome

Front 835

Waxy casts

Back 835

Chronic end-stage renal disease

Front 836

WBC casts in urine

Back 836

Acute pyelonephritis

Front 837

WBCs in urine

Back 837

Acute cystitis

Front 838

Wermer's syndrome

Back 838

MEN type I

Front 839

Malabsorption syndrome caused by Tropheryma whippelii

Back 839

Whipple's disease

Front 840

Hepatolenticular degeneration

Back 840

Wilson's disease

Front 841

"Wire loop" appearance on LM

Back 841

Lupus nephropathy

Front 842

"Worst headache of my life"

Back 842

Berry aneurysm—associated with adult polycystic kidney disease

Front 843

Xanthochromia (CSF)

Back 843

Subarachnoid hemorrhage

Front 844

Xerostomia + arthritis + keratoconjunctivitis sicca

Back 844

Sjögren's syndrome

Front 845

Upper GI diverticulum

Back 845

Zenker's diverticulum

Front 846

Gastrin-secreting tumor associated with ulcers

Back 846

Zollinger-Ellison syndrome