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320 Cards in this Set

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What would you suspect in an ER patient with blood in the urethral meatus or a high riding prostate?
bladder rupture or urethral injury -- Dont put in a catheter
What type of acute renal failure would you suspect in a patient with a FENa<1%?

Fractional Excretion of Sodium (FENa) = (PCr * UNa ) / (PNa x UCr) %

Fractional excretion of sodium (FENa) is the amount of salt (sodium) that leaves your body through urine compared to the amount filtered and reabsorbed by the kidney.

FENa is not a test, but rather a calculation based on the concentrations of Na & Cr in your blood and urine. Urine and blood samples are necessary to perform this calculation.
pre-renal disease
loss of volume, dehydration, loss of blood

Prerenal: Anything that causes ↓ effective renal perfusion: Hypovolemia, CHF, Renal Artery Stenosis, Sepsis, etc. Remember, contrast-induced nephropathy will often look pre-renal.
What are the protein and LDH critera for an exudative effusion?
Pleural:serum protein ration >0.5
&
pleural LDH: serum LDH >0.6

note: Definitions of the terms "transudate" and "exudate" are the source of much confusion. Briefly, transudate is produced through pressure filtration without capillary injury while exudate is "inflammatory fluid" leaking between cells.

Transudative pleural effusions are defined as effusions that are caused by systemic factors that alter the pleural equilibrium, or Starling forces. The components of the Starling forces–hydrostatic pressure, permeability, oncotic pressure (effective pressure due to the composition of the pleural fluid and blood)–are altered in many diseases, e.g., left ventricular failure, renal failure, hepatic failure, and cirrhosis. Exudative pleural effusions, by contrast, are caused by alterations in local factors that influence the formation and absorption of pleural fluid (e.g., bacterial pneumonia, cancer, pulmonary embolism, and viral infection).
What is the cause of muscle rigidity, fever, and rhabdomyolysis in a schizophrenic patient?
Neuroleptic malignant syndrome

A mnemonic used to remember the features of NMS is FEVER:
F – Fever
E – Encephalopathy
V – Vitals unstable
E – Elevated enzymes (elevated CPK)
R – Rigidity of muscles

think - antidopaminergic drugs - esp Haloperidol (Haldol) and Chlorpromazine (Thorazine)
what is the cause of BILIOUS emesis in a newborn within hours after the first feeding?
Duodenal atresia

note: NON-bilious projectile vomiting → pyloric stenosis
Duodenal atresia

note: NON-bilious projectile vomiting → pyloric stenosis
A 60-year old woman leaks urine when laughing or coughing --> what are her non-surgical options?
she has stress incontinence
kegel exercises
estrogen (oral or vaginal cream) will thicken up that tissue to reduce stress incontinence
pessarie placement
What is the MCC of HTN in young women?
Oral Contraceptive pills
What is the MCCs of seizures in children aged 2-10?
Febile seizures, Infections, trauma, Idiopathic (no specific order)
(+) p-ANCA is a/w what conditions?
Pauci immune glomerular nephritis
microscopic Poly-angitis
Churg-stauss syndrome
What organism is known for causing infection in BURN victims?
pseudomonas
A pt presents with a painless, puritic papule with regional lymphadenopathy that evolves over 7-10 days into a necrotic ulcer with a black eschar --> what is the dx and tx?
dx: cutaneous anthrax
tx: penicillin V or G, Ampicillin, Doxycycline
What is the late, life threatening complication of CML?
What complaints & findings would lead you to suspect this condition?
blast crisis

(1) Fever
(2) bone pain (joint, hip pain)
(3) splenomegaly (causing pain on the left side)
(4) pancytopenia (esp thrombocytopenia - low platelets → easy bruising) - realize that in blast crisis, the body is pumping out a bunch of the blast cells, and there is significant loss of normal WBC & platelets
Which hernia carries the higest risk of incarceration: Indirect, direct, or femoral?
femoral
not as common, but highest risk of incarceration
What cause of aplastic anemia is associated with thumb abnormalities, diffuse hypo- or hyperpigmentation, cafe-au-lait spots, and short stature?
Fanconi's anemia (Constitutional Aplastic Anemia)

Fanconi anemia is a syndrome characterized by defective DNA repair that is caused by a variety of genetic mutations. Inheritance is Aut Rec. Hematologic manifestations usually begin with thrombocytopenia or neutropenia and subsequently progress over the course of months or years to pancytopenia. Typically the diagnosis is made between ages 2 and 10 years.
what biostatic calculation looks at individuals with and without a disease and determines the likelihood of exposure to a risk factor
odds ratio
which antidiabetic agent is a/w lactic acidosis?
metformin (Glucophage)

Note: onset of lactic acidosis may be subtle & include nonspecific sxs such as malaise, myalgia, respiratory distress, somnolence, abdominal distress

lab findings = ↓pH, ↑ blood lactate, ↑ anion gap
what is cradle cap?
seborrheic dermatitis
tx: selsin blue (selenium sulfide) or topical antifungal
what disease causes glomerulonephritis wih deafness?
alport's syndrome
what is the preferred diagnostic test for a PE?
spiral CT with IV contrast (note with IV contrast, the clot is  dark)

if pt has renal dz, or is on metformin and cant take IV contrast, then use VQ scan
spiral CT with IV contrast (note with IV contrast, the clot is dark)

if pt has renal dz, or is on metformin and cant take IV contrast, then use VQ scan
What rash presents with a herald-patch followed by a christmas-tree pattern?
pityriasis rosea
What is Becks triad for cardiac tamponade
Hypotension, Distant heart sounds, and JVD
Hypotension, Distant heart sounds, and JVD
What lab findings are characteristic of Hashimoto's thyroiditis?
High TSH
Low T4
Anti microsomal antibodies

note: Serum anti-thyroperoxidase (anti-TPO), antimicrosomal, antithyroglobulin antibody tests often positive
If you want to know if maternal age affects infant mortality rate, but most of the variation in infant mortality is predicted by socio-economic status, then SES is a ....______
SES is a confounding variable
What are the top 3 reasons for involuntary psychiatric hospitalization?
#1 patient is a danger to self
#2 patient is a danger to others
#3 patient gravely disabled (catatonic)
What is Charcot's triad in the case of gall bladder disease?

*BONUS* what disease is this seen in?
RUQ pain, Jaundice, and fever/chills

seen is Ascending Cholangitis
What is the treatment for Idiopathic Thrombocytopenic Purpura (ITP) in children?
It usually resolves spontaneously, but you can use:
IVIG & Cortiosteroids

Signs/Symptoms:
● Mucocutaneous bleeding manifestations may be present, depending on the platelet count
● Spontaneous bruising, nosebleeds, gingival bleeding, or other types of hemorrhage generally do not occur until the platelet count has fallen below 20,000–30,000/mcL
●Additional disease-specific findings may be present in persons with secondary immune thrombocytopenia (such as due to collagen vascular disease, HIV or HCV infection, or lymphoproliferative malignancy)
What infection causes aplastic crisis in sickle cell disease?
Parvo B19
Elderly pt presents with bony pain and states his favorite Saints hat no longer fits...
Dx:
Labs:
Tx:
Classic for Pagets dz
Labs: ↑ alk phos
Tx: bisphosphonate
What test is used in the 10th week of gestation to screen for chromosomal abnormalities?
CVS: chorionic villous sampling

can be done sooner than amniocentesis
What is the cause of 2ndary amenorrhea with a normal PRL, no response to estrogen/progesterone challenge, and hx of D&C?
Asherman's Syndrome

The previous D&C has caused scarring so the endometrium does not shed like it is supposed to
What causes a Crescent shaped hyperdensity on CT of the head that does not cross the midline?
Subdural hematoma
MC pathogen causing Croup?
Parainfluenza virus
What causes a transudative pleural effusion?

(Pleural to serum protein ratio < 0.5, pleural to serum LDH ratio < 0.6, and pleural LDH < 2/3 the upper limit of normal for serum LDH)
CHF, Cirrhosis, Nephrotic Syndrome, Peritoneal Dialysis

Think: things that lose protein

bottom line: osmotic imbalance d/t pressure or no protein in the blood
Patients have characteristic facies with broad nose, kyphoscoliosis and osteoporosis, and eczema. The primary teeth erupt normally but do not deciduate, often requiring extraction. Patients develop recurrent sinopulmonary and cutaneous infections that tend to be much less inflamed than appropriate for the degree of infection and have been referred to as "cold abscesses." Characteristically, pneumonias cavitate, leading to pneumatoceles.
Job's Syndrome (hyper-immunoglobulin E syndrome)

characterized by elevated levels of IgE (> 2000 IU/mL)
What is the tx for opioid overdose?
Naloxone/ Naltrexone (Narcan)
What is the treatment for septic shock?
fluids
antibiotics
norepinephrine (NE)- causes vasoconstriction to tx the vasodilation caused by the septic shock
Most serious s/e of clozapine (Clozaril)?
agranulocytosis
5 basic criteria for metabolic syndrome
Abdominal obesity
↑ TG
↓ HDL
HTN
Insulin resistance
What type of bias is present when the physician is aware of the type of treatment his patient received?
Observational bias
Sentinel loop (periumbilical bowel loop) on abdominal X-ray is...
Acute pancreatitis
What are the imaging studies in a trauma series?
AP chest
AP and lateral C-spine
AP pelvis
What do an ↑ EPO, ↑ HCT, and normal O2 sat suggest?
EPO producing tumor such as renal cell carcinoma. needs to be evaluated with CT scan
Hampton's hump on X-ray is associated with _____
Pulmonary Embolus

The xray on the right shows what could easily be called a right lower lobe pneumonia-end of story, home on Levaquin and albuterol. But the consolidation at the lower lung border is a sign called Hampton's Hump, a pleural based consolidation caused by a clot. The CT on the left confirmed a large pulmonary embolus. She also had pneumonia on top of it all.
a mother who is frustrated with her child yells at her husband, what tipe of defense mech is this?
Displacement
In which immunodeficiency are there chronic respiratory infections and a (+) Nitroblue tetrazolium test?
Chronic Granulomatous dz (CGD)
what is the natural histroy of a leiomyoma?
Typically regress after menopause (when estrogen levels have decreased)
Which antihypertensives are used in a pt with severe pre-eclampsia?
if SBP> 160-170 or DBP > 105-110, give:
(1) Labetalol - start 10mg or 20mg IV x1 - if not effective w/in 10 min, double dose to 20mg or 40mg, may give 80mg IV if needed for max dose of 300mg/24hr
(2) Nifedipine (Procardia) - 10-20mg po q 30min for max dose of 50mg
(3) Hydralazine - 5-10mg IV q 15-20min for max dose of 20mg
(4) Sodium nitroprusside (Nitropress)
What type of headache causes unilateral, severe periorbital headache with tearing?
Cluster Headache
What type of back pain is exacerbated by standing and walking, and relieved with sitting and hyperflexion of the hips?
spinal stenosis

note: Spinal Stenosis = worse with Standing
a pt presents with acute-onset monoarticular joint pain and bell's palsy --> what is the likely diagnosis, how did he get it, and what is the tx?
lyme disease d/t bite of ixodes tick, tx'd with doxycycline
A teenage girl presents with prolonged bleeding after dental surgery and with menses --> labs reveal a normal PT, normal or ↑ PTT, and ↑ BT --> what is the dx and tx?
dx: Von Wilderbrand's dz
tx: Desmopressin. acutely you can use FFP or cryoprecipitate
what is the MCC of Travelers diarrea?
E.coli ETEC
In what cirumstances should confidentiality not be protected?
real threat of harm to 3rd parties.

homocide, suicide, abuse (child or elder) and infectious dz's
what is the only indication for administering hypertonic saline to a pt with SIADH?
active seizures.
Rash with dermatomal distribution?
Hepes zoster
what is the next best step in the evaluation of a pulsitile abdominal mass and bruit?
Abdominal Ultrasound to look for AAA
Flat topped purpulish, puritic, papules?
The P's of Lichen planus**
what is the definition of maternal mortality?
the number of deaths during pregnancy including until 90 days post-partum PER 100,000 live births
Auer rods are associated with________.
Leukemia, AML***
What is the cause of joint pain and stiffness that worsens over the course of the day and is relieved by rest?
Osteoarthritis
What is the tx of cardiogenic shock?
Dobutamine**
What systemic dz's can cuase nephritic syndrome?
diabetes, systemic lupus, amyloidosis
Hypoxemia + pulmonary edema + normal pulmonary capillary wedge pressure?
Note: normal PCWP tells you that there is no back-up of blood into the left atrium = this is not heart failure

Dx: acute respiratory distress syndrome (ARDS)
What disorder is present in a teenager with a hx or theft, vandalism, and violence toward family pets?
Conduct disorder
Continuous machine like murmur?
Patent Ductus Arteriosus (PDA)
what would you suspect in a woman with preeclampsia in the first trimester?
molar pregnancy
what CSF findings would you see in a case of subarachnoid hemorrhage
blood in all CSF samples
elevated CSF pressure

xanthochromia if it was a few days ago, as the hemoglobin is converted to bilirubin
what acid-base disturbance is commonly seen in pregnant women?
respiratory alkalosis
A husband asks his wife not be told about her recently discovered lung cancer --> what do you do?
you still have to tell the patient
Does a case-control study measure incidence or prevelance?
neither. A case-control is just one study
what is the first line tx for growth hormone secreting pituitary adenoma?
trans-spenoidal tumor resection
what are the indications for surgical repair of an AAA?
greater than 5.5 cm
rapidly enlarging
symptomatic
ruptured
what characteristics of a nevus suggest that it may actually be melanoma?
ABCD
asymetry
border irregularity
color
diameter, larger than a pencil eraser
Low urine specific gravity in the presence of high serum osmolality --> what is the dx?
diabetes insipidus
what is the tx of atrial fibrilation of unknown duration?
rate control and anticoagulation

rate control: Beta-blockers, verapamil and/or digoxin

anticogulation: warfarrin and heparin, and then later with just warfarin
which lung cancer is assoc with SIADH?
small cell lung cancer
what important side effects are common to many of the atypical antipsychotics?
weight gain
and assoc with that is the development of DM2
what is the most common location for an ectopic pregnancy>
ampulla of the falopian tube
uterine bleeding at 18 wks gestation + no products expelled + membranes ruptured + cervical os open --> what dx?
inevitable abortion
ICU patient is awake and alert but cannot move anything but the eyes and eyelids --> what is the dx?
locked in syndrome
What type of shock cuases decreased cardiac output, decreased PCWP, and decreased peripheral vascular resistance?
Septic, anaphylactic or neurogenic
What is the inital tx for a child presenting with acute asthma attack?
Albuterol and IV steroids
+/- Oxygen
What is the MC form of nephritic syndrome?
IgA nephropathy (Berger's Disease)
What type of psychotherapy is used in treating phobias, OCD, and panic disorder?
Cognitive behavioral therapy
What is the underlying cause of neonatal respiratory distress syndrome?
Decreased surfactant
What is the first test in the assessment of a woman presenting with secondary ammenorrhea?
B-HCG

the #1 cause is pregnancy
What are the components of HELLP syndrome?
Hemolysis
elevated liver enzymes
Low platelets
What medication is used to diagnose symptomatic myasthenia gravis?
Edrophonium (Tensilon Test)
An 11-yr old obease African American boy presents with sudden onset of a limp. What is teh most likely dx, and what imaging studies would confirm this?
slipped capital femoral epiphisis

AP and frog leg latteral is the imaging studies to order
What organism is associated with dog or cat bites?
Pasturella multocida
How is polycythemia vera distinguishable from secondary polycythemia?
Both have elevated Hgb, Hct and RBC mass

Polycythemia vera is NOT due to low O2 saturation or due to elevation of EPO, so you will have:
- Low or normal EPO level
- Normal O2 saturation
What is the medical tx for hepatic encephalopathy
Lactulose (allows ammonia in the colon to be bound so it can be excreted better)

Neomycin (an antibiotic, used to wipe out gut bacteria and decrease the formation of toxic metabolites)
A young child presents in status epilepticus, but her parents refuse treatment on religous grounds --> what do you do?
this is an immediate threat to the child's life, so you tx the patient and then seek a court order

Note: there was a WTQ in which the child had been diagnosed with ALL & pts were refusing chemotherapy - the right choice (which you got!) was to seek a court order before starting chemo
What percentage of values falls within one standard deviation of the mean? Two SD? Three SD?
1 SD: 68%
2 SD: 95%
3 SD: 99.7%
In which endocrine disorder might weight loss completely eliinate the need for medication?
DM Type II
Polycystic Ovarian Syndrome (PCOS)
What rash is classically described as "dew drops on a rose petal"?
Primary Varicella (Chicken Pox)
what is the classic endocarditis prophylaxis regimen?
Oral surgery: give amoxicillin before and after the procedure

GI/GU surgeries: Ampicillin + Gentamicin before procedure, just amoxicillin after procedure
Cafe-au-lait spots on skin are characteristic of_______.
neurofibromatosis type I

this was a WTQ!!
note: type 1 = cafe-au-lait spots, macrocephaly, feeding problems, short stature, learning disabilities

Type 2 = bilateral acoustic neuromas & cataracts
think - you have 2 ears & 2 eyes
What is the tx for mild unconjugated hyperbilirubinemia? Severe unconjugated hyperbilirubinemia?
- Tx for mild → Phototherapy
- Tx for severe cases → exchange transfusion
What number is needed on bacteria culture of a clean catch specimen to dx a UTI?
10^5 bacteria/ ml = 100,000
What is the classic ECG appearance in atrial flutter?
Saw tooth pattern of the P waves
A 60-yr old obease patient presents with dirty, velvety patches on the back of the neck ---> what is the diagnosis and what is the initial workup?
Dx: Acanthosis niagricans

w/u: finger stick blood glucose test for DM and thorough H&P for signs of a visceral malignancy
What is the MCC of hypothyroidism
Hashimoto's Thyroiditis
What are the exceptions to informed consent?
Emergency situations
Pt without decision making capacity
Pt who signed waiver to right of informed consent
Which type of bias is introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death?
Lead time bias
A 19 yr old man presents with a palpable flank mass and hematuria and U/S shows bilateral enlarged kidney's with cysts ---> what brain abnormality is a/w this condition?
Autosomal Dominant Polycystic Kidney Disease (ADPKD) = berry aneurysms
What are the four main causes of microcytic anemia?
“TAILs”
Thalassemia
Anemia of Chronic Disease
Iron deficiency anemia
Lead poisoning
Sideroblastic anemia
What are four signs and symptoms of streptococcal pharyngitis?
1. fever
2. pharyngeal erythema
3. tonsillar exudates
4. lack of rhinorrea and cough
In which region of the US is Lyme disease endemic?
north-eastern
Which joints in the hand are affected by rheumatoid arthritis?
MCP and PIP, not DIP!
Xerostomia + parotid enlargement + xerophthalmia + anti-La antibodies?
Shogren's syndrome (think elderly females)
What are the MCC's of seizures in young adults (18-35)
Trauma, alcohol withdrawal, brain tumors
What is the MCC of non-obstetric post partum death?
thromboembolic dz

like DVTs that become PE
Uterine bleeding at 18 wks gestation + no products expelled + cervical os closed ---> what is the dx?
Threatened abortion
Which immunodeficiency presents with ezcema, thrombocytopenia, and high levels of IgA?
Wiscott-Aldrich Syndrome
Which defense mechanism is displayed when a woman calmly describes a gory murder in great detail?
Isolation
what is tx for mild, persistant asthma?
Inhaled low dose Beta-Agonists, and Inhaled corticosteroids
EKG with peaked T waves and widend QRS?
hyperkalemia
What is the tx for iron overdose?
deFEroxime

iron on the periodic table = Fe
What is the acceptable minimum urine output in a stable pt?
30cc / hr

What are the two measures of how severe the hypotension is in shock? Urine Output & mental status
What method is used to calculate fluid repleation in burn patients?
Parkland formula
4ml/kg/% burned
Salicylate ingestion results in what type of acid-base abnormality?
its mixed= Respirary alkolosis + Metabolic acidosis and elevated anion gap
What medication is used most commonly to induce ovulation?
Chlomiphene citrate (might also be able to use pulsatile leuprolide)
Psychiatric condition in which a person travels a long distance, takes a new name, and has no memory of his prior life?
Dissociate fugue
Which congenital infection might present with a "blueberry muffin" rash?
Rubella
which type of breast cancer increases the future risk of invasive carcinoma in both breasts?
lobular carcinoma insitu (LCIS)
What is the classic symptom of placenta previa?
painless vaginal bleeding in the 3rd trimester
An active 14 yr old boy has anterior knee pain --> what is the most liekly dx?
osgood schatter dz
Joint aspirate reveals rhomboid shaped, positively birefringent crystals --> what is the dx?
pseudo gout

calcium pyrophosphate crystals
What type of oral infection has branching rods when examined microscopically?
actinomyces israelii
What is the next step in the evaluation of a pt with two consecutive pap smears with atypical sqamous cells of undetermined significance (ASCUS)?
colposcopy with endocervical currettage
A 45-yr old obease female with pruritis, clay colored stools, and dark urine has an elevated alkaline phosphate and elevated bilirubin --> what is the most likely cause?
biliary tract obstruction
What infection can cause diarrhea and pseudoappendicitis?
yerisina enterocolitica
Which is more ethically unfavorable in a DNR pt: withdrawing life support, or withholding care?
Both are equally unfavorable from an ethical standpoint
What is the most likely cause of acute lower GI bleed in pts older than 40?
Diverticulosis
What is the most common underlying cause of pathologic fractures in elderly, thin women?
Osteoporosis
What is the causitive agent in pitytiasis versicolor?
Malassia furfur
What is the cause of chest pain in a young pt that has angina at rest with ST-segment elevation but normal cardiac enzymes?
prinzmetals angina
Which hypercholesterolemia treatment causes flushing and pruritis?
Niacin
Target lesions with a red center, pale zone, and dark outer ring appearing on the palms and soles with a prodrome of malaise and myalgias?
Erythema multiforme -- classic!
What autoimmune complication occurs 2-4 wks after an MI?
Dressler's syndrome

fever, pericarditis, increased ESR
What name is given to stress-related hair loss? what is the tx?
Telogen effluvium

Tx: reassurance - hair returns a few weeks after stressor leaves
What is the MCC of cushing's syndrome?
Steroid use

2nd: pituitary ATCH secreting tumor (cushing's dz)
What is the most likely cuase of galactorrhea, impotence (or menstrual dysfunction), and decreased libido in a pt with a hx of schizophrenia?
Dopamine antagonist (haloperidol)
What ethical problem exists when a doctor refers a pt for an MRI at a facility he owns?
Conflict of interest
Patient presents with sudden onset of severe, diffuse abdominal pain (AXR reveals free air under the diaphragm) --> what is the next step in mgmt?
Emergency laparotomy

repair the perf'ed viscera
What are the two most common foodborne bacterial GI tract infxns in the US?
#1: Salmonella

#2: campylobacter
What is the diagnostic test for hereditary spherocytosis
Osmotic fragility test
What bullous skin dz has a negative Nikolsky's sign?
bullous pemphigoid

nikolsky's sign (pemphigus vulgaris) is when the bullous scrapes off with gentle touch
A 25 year old male presents with white plaques on his tongue and the back of his throat that scrape off with a tongue depressor --> what is the dx? what should he be screened for?
Dx: candidal thrush

screen for HIV
Young male with hip and back pain along with stiffness that improves with activity and worsens at rest ---> what is the most likely dx?
ankylosing spondylitis -- classic.

HLA-B27
Cold water is flushed into a pt's ear and the fast phase of nystagmus is toward the opposite side --> where is the lesion
no lesion - this is normal
What findings would you expect to see in a post-term pregnancy beyond 42 wks gestation?
oligohydraminos, meconium in amniotic fluid, neonate has dry peeling skin, very mature and calcified placenta
What annual screening is recomended for women with a strong family hx of ovarian ca?
CA-125 and transvaginal US
A one year old is able to cruise, use two-finger pincer grasp, babble, and imitate actions, what part of his development is delayed?
language delay - should have 2-3 words
which defense mechanism is a person who subconsciously pushed memories of past abuse out of his conscious mind using?
repression
What are some of the causes of an exudative pleural effusion?
malignancy, TB, bacterial infxs, pulmonary emboli, and pancreatitis.

What would see in the pleural fluid of a pt with pancreatitis?....amylase!
What would you suspect with eosinophillic casts in the urine?
AIN- Acute Interstital Nephritis... sometimes referred to as Allergic Interstital Nephritis... usually d/t drug reactions
What are the s/e of corticosteroids?
acne, osteoperosis, immunosupression*, thin skin*, mania and insomina*, buffalo hump, pruple striae, cataracts*
What is an acceptable urine output in a trauma pt?
normal 30cc/hr

trauma pt = 50cc/hr
What is the tx for ventricular fibrilation (VF)?
Immediate cardioversion (360 Joules)
Drugs: Epinephrine or Vasopressin, then Epi every 3-5min
What skin blistering disease has a postive nikolsky sign?
Pemphigous vulgaris
What is the MC inherited cause of hypercoagulability?
Factor 5 leiden mutation
Which genetic disorder is associated with multiple fractures and is commonly mistaken for child abuse?
Osteogenesis imperfecta
What is the MCC of bloody nipple discharge?
Intraductal papilloma
Which antibiotics should be avoided during pregnancy d/t potential teratogenic effects?
Flouroquinolones & tetracyclines are the big ones, also know not to give aminoglycosides, sulfonimides
Antihistone antibodies are seen in what condition?
Drug induced lupus. such as with Hydralazine
Infectious cause of aplastic crisis in sickle cell disease?
Parvo B19
Tachycardia + wild fluctuations in BP + Headache + diaphoresis + panic attacks
Pheochromocytoma - classic!
What should always be done prior to LP?
check for increased ICP, by Checking for papiledema
What is the next step in the dx of cholecystitis when U/S is equivocal?
HIDA scan
What is the clinical definition of HTN?
BP>140/90 on three separate occasions at least 2 weeks apart **
What are the most common causes of fever of unknown origin?
Infection, cancer, autoimmune diseases
What is the most feared complication of a scaphoid fracture?
Avascular necrosis of the scaphoid
Albuminocytologic dissociation (⬆protein in CSF with only modest ⬆ in cell ct)
Guillain- Barré syndrome
What two disorders should come to mind when a neonate has meconium ileus?
Cystic Fibrosis and Hirschprungs dz
Immunideficiency with a postitive nitroblue tetrazolium test?
Chronic granulomatous disease
Pediatric patient with red "current jelly" stools
Intussusception
A young female with amenorrhea, bradycardia, and abnormal body image?
Anorexia nervosa
What is the tx for superior vena cava syndrome?
Radiation to decrease the sz of the tumor. Steroids can also be used.
What statistical calculation looks at true positives and divides them by the number of pts with the disease?
Sensitivity
A 15 yr old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
No. parental consent is not necessary in pregnant minors
A patient is unable to inspire completely d/t pain during palpation of the RUQ. What is this sign? What is the diagnosis?
sign: Murphy's sign
Dx: Acute Cholecystitis
What is the reversal agent for heparin?
Protamine sulfate**
What substances are known to cause hemolysis in pts with G6PD deficiency?
Sulfonimides, Primaquin, High dose aspirin, Isoniazid, Nitrofurantoin, Dapsone, Fava beans
What medications can be given to a pregnant woman with cystitis?
Amoxicillin/Ampicillin, Nitrofurantoin, cefalexin (1st or 2nd gen cephalosporin)
A patient presents with limb pain on passive movement, pallor, poikilothermia, paresthesias, paralysis and pulselessness. What is the tx?
Dx: compartment syndrome
Tx: fasciotomy
What complication may arrise from overly rapid correction of hyponatremia?
Central Pontine Myelinosis
A 60-yr old patient presents with an acute onset of broken speech. What type of aphasia is this? what lobe and vascular distribution has been affected? What is the first step in the work up?
Dx: Broca's aphasia
Artery: Frontal lobe, Left MCA
1st step: CT scan head to r/o hemorrhage
What are the MC primary sources of mets to the brain
Lung, breast, skin, renal and GI
What is the tx for mastitis ina pt that is breast feeding?
Continue breast feeding and give oral abx
What characteristics favoring carcinoma in an isolated pulmonary nodule?
smoker, age >45, new lesion or larger lesions than previous, absence of calcification/ irregular calcification, size >2cm, or irregular margins***
In which disease would you find atrophy of the mamillary bodies?
Wernike's encephalopathy
What term describes heavy bleeding during and between menstrual periods?
Menometrorrhagia
What is the MC type of TE fistula?
Esophageal atresia (blind esophageal pouch) and the distal esophagus is connected to the trachea. (85%)
What is the tx for Kawasaki dz in acute-phase?
IVIG, high dose aspirin
What is considered first line pharmacotherapy for depression?
SSRI's
Which antidepressants are associated with hypertensive crisis? What substance can exacerbate this effect?
MAOI + tyramine
A 40 yr-old black female is found to have noncaseating granulomas of the lung and hypercalcemia. What is the dx?
Sarcoidosis
In what diseases might you find Cruschmann's spirals (whorled mucous plugs)?
Bronchial Asthma
Which type of renal tubular acidosis (RTA) is associated with abnormal H+ secretion and nephrolithiasis?
Type 1 RTA
What are the causes of hypervolemic hyponatremia?
Cirrhosis, CHF, nephrotic syndrome
A burn patient presents with cherry-red flushed skin and coma. O2 saturation is normal, but carboxyhemoglobin is elevated. What is the tx?
Dx: Carbon Monoxide Poisoning
Tx: 100% 02 mask, hyperbaric oxygen
What is the tx for Delirium Tremens?
Benzo's
chlordiazepoxide (librium)
What is the most common cause of postpartum hemorrhage?
Uterine atony. This is why you massage the uterus after delivery and give oxytocin IV after the delivery of the placenta
Which drugs block transmission through the AV node?
Beta blockers, digoxin, and calcium channel blockers like verapamil and dilteazem
What skin lesion causes a pearly-colored papule with a translucent surface and telangiectasias?
basal cell carcinoma
What type of infection causes honey-crusted lesions usually around the nose or mouth?
Impetigo (Step or Staph)
What causes hypocalcemia, high phosphorous, and low PTH?
hypOparathyroidism
What causes stones, bones, groans, and psychiatric overtones?
Hypercalcemia, usually d/t hyperparathyroidism or can be d/t bony malignancies
What is the first line tx for acute otitis media
Amoxicillin for 10 days
Does a cohort study identify incidence or prevelence
Both incidence and prevalence bc you are seeing the pt over time
When can a physician refuse to continue treating a patient on the grounds of futility?
when there is no rationale for tx, the maximal therapy has already failed, or when the tx doesn't achieve goals of care
A violent patient with vertical and/or horizontal nystagmus has been exposed to what substance?
PCP
What diarrheal illness is associated with church picnics/myonnaise?
staph aureus - food poisoning
What is a cause of congenital pure RBC aplasia?
diamond-blackfan anemia
What is the pentad of thrombocytopenic purpura (TTP)?
1. thrombocytopenia
2. hemolytic anemia
3. renal failure
4. fever
5. neurologic sxs
A patient that visited the SW US presents with fever, malaise, cough, and night sweats. What is the dx and tx?
dx: coccidomycosis
tx: fluconazole
Ring enhancing brain lesion on CT with seizures
Brain abscess.
(might be toxoplasmosis)
What are the classic physical findings in cases of endocarditis?
- "FROM JANE"
- Fever, chills, weakness, anorexia
- Roth Spots (retinal hemorrhages with clear central areas)
- Osler's Nodes (painful red nodules on finger & toe pads)
- Murmur - new regurgitation heart murmur or heart failure
- Mitral valve is most common
- Tricuspid is most common in IV drug users → septic pulmonary infarcts
- Janeway Lesions (erythematous macules on pals & soles)
- Anemia
- Nail-bed hemorrhages
- Emboli – signs of embolism:
- brain infarct → focal neuro defects
- Renal infarct → hematuria
- Splenic infarct → abdominal or shoulder pain
A 55 yr-old man has sudden onset of pain in his first metatarsophalangeal joint after a night of drinking red wine. What is the diagnosis, workup, and how can it be treated chronically?
Dx: Gout
Dx: based on joint fluid aspirate - needle shaped, negatively birefringent crystals
Chronic tx: allopurinol, or colchicine, probenecid.
Patient presents with a history of lithium use with copious ammts of dilute urine. What condition is this?
Nephrogenic diabetes insipidus
What is the MC pituitary tumor and its treatment?
Prolactinoma.

Tx: Bromocriptine -DA agonist to inhibit Prl secretion.
A male with a testicular mass is found to have an elevated B-HCG. What is the diagnosis?
Testicular choriocarcinoma
What are the cardinal movements of labor?
Engagement, Descent, Flexion, Internal rotation, Extension, External rotation, Expulsion.
50 year old female smoker presents with hematuria. What do you suspect?
Bladder CA
What therapies are used in treating PCOS?
Weight loss
Metformin
Oral contraceptive pills – to avoid hyperestrogenism
Spironolactone for the hirsutism
What type of bone fx is most likely to result from a fall on an outstretched hand?
Colles - distal radius fx
A two-month old presents with projectile, nonbilious emesis. What is the first step in mgmt?
Pyloric stenosis
Check for and correct metabolic abnormalities first, then get an abdominal U/S, and tx with a pylorotomy.
A 16 year old female has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found. What is the dx?
Conversion disorder.
A pt presents to the ER after a MVA with HTN, bradycardia, and abnormal respirations. After ABC's what is the next step in mgmt?
recognize this is Cushing's triad for increased ICP

next steps: raise the head of the bed, hyperventilate, give manitol, consult neurosurgery
A normalizing PCO2 in a pt having an asthma exacerbation may indicate what problem?
sign of fatigue and impeding respiratory failure.
A pt has dyspnea, hilar lymphadenopathy on CXR, and hypercalemia. What is the dx?
Sarcoidosis
Which type of renal tubular acidosis is associated with abnormal HCO3 and rickets?
Type 2 RTA
Chovstek's and Trousseau's signs are assoc with what metabolic abnormality?
Hypocalemia

chovstek- cheek
trousseau - tighten the cuff and get carpal spasm
a 30 year old female african american immigrant presents with hematuria. What do you suspect?
Schistosoma hematobium
A young pt who's father died at 30 in a MVA suddenly collapses and dies while exercising. What is the cause of death?
Hypertrophic cardiomyopathy causing ischemic heart dz
Gyn exam of a postmenopausal woman reveals inflammation and epithelial thinning of the anogenital area. What is the dx?
classic for lichen sclerosis
An IV drug user has JVD adn a holosystolic murmur at left sternal border. What is the tx?
classic murmur for tricuspid regurg. this is bacterial endocarditis, give vancomycin. Treat the heart failure and ultimately replace the tricuspid valve
What is the classic ECG finding in pericarditis?
low voltage diffuse ST elevation in all leads
What is the tx for neuroleptic malignant syndrome (NMS)?
Dantrolene & Bromocroptine
A child has flesh-colored, umbilicated lesions on the face. What are these lesions, and where do they appear in adults?
Molluscum contagiosum

appear on the genitals in adults
Which medication is used more than any other in the treatment of Parkinson's?
Levodopa/carbidopa
What diagnostic test differentiates central from nephrogenic diabetes insipidus?
DDAVP (Desmopressin) & measure urine osmolality
A postop pt with significant pain presents with hyponatremia & normal volume status. What is the diagnosis?
SIADH (due to stress)
An elderly female presents with pain & stiffness of the shoulders and hips. She cannot lift her arms above her head. Labs show an elevated ESR. What is the dx?
Polymyalgia Rheumatica
A child presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. What is the most likely diagnosis and infectious cause?
HUS due to E. Coli (0157:H7)
An 11 yo boy presents with fever, weight loss, and night sweats. Radiology reveals an anterior mediastinal mass. What do you suspect? What if the pt was 30yrs old?
suspect non-Hodgkins lymphoma

if 30 yrs - would suspect Hodgkin's lymphoma
What prophylactic medication is indicated in an HIV pt with a CD4 ct <100?
TMP-SMX (Bactrim), Dapsone or Pentamidine for PCP
Clarithromycin or azithromycin for MAC
What is the most common testicular cancer?
Seminoma
A child presents with palpable purpura on the legs, abdominal pain, and arthritic pain in numerous joints. What is the dx and tx?
Dx: HS Purpura
Tx: self-limited
Anticentromere antibodies are assoc with what condition?
CREST Scleroderma
Hyperphagia, hyperorality, hyperdocility, and hypersexuality - what is the diagnosis?
Kluver-Bucy Syndrome
After a minor car accident, a woman wears a neck brace and requests permanent disability. What is the most likely diagnosis?
malingering
What medication is given to accelerate fetal lung maturity? For how long is it given? At what gestational age is it no longer necessary?
Betamethasone or Dexamethasone
give for 48hrs
no longer necessary after 34 wks gestation
Pts with silicosis are at higher risk for what type of infection?
Tuberculosis
A pt has exophthalmos, pretibial myxedema, and ⬇TSH. Dx?
Graves Disease
PFTs show ⬇ FEV1/FVC. Dx?
Obstructive lung disease
A postmenopausal female presents with vaginal bleeding for the last 5 days. What is the next step?
Endometrial biopsy
Which type of lung cancer is assoc with hypercalcemia?
Squamous Cell Carcinoma of lung
What does a fall in SBP of >10mmHg with inspiration indicate?
Pulsus Paradoxus

➜ cardiac tamponade, hyperinflation disorders
What laparoscopic findings can be seen in endometriosis?
chocolate cysts, Powder-burn lesions
HTN + hypernatremia + hypOkalemia and metabolic alkalosis ➔ what is the dx?
Primary Hyperaldosteronism
What is the LDL goal in a pt with diabetes?
LDL <100 for DM w/o other comorbidities
LDL < 70 if any h/o vessel disease
An 8yo child was in a MVC and now requires emergency blood transfusion. Her parents are not present, but the child states she is a Jehovah's witness. What do you do?
Tx the child (consent is implied) can get court order later
25yo M presents with pain and watery diarrhea after meals. Exam shows fistulas btw the bowel and skin and nodular lesions on his tibias. What is the diagnosis?
Crohn's Disease
40yo F presents with a discrete area of complete hair loss on the scalp that has worsened over weeks. What is the tx?
Alopecia Areata
tx: observation, intralesional steroids (topical steroids not very effective for this)
CSF analysis shows low glucose, elevated neutrophils, and gram(+) diplococci. Dx?
Strep pneumo meningitis
What are the characteristic findings in tertiary syphilis?
Tabes dorsalis
(+) Romberg sign
Loss of proprioception
Gumma formation
Argyll Robinson pupils
aortitis or aortic root aneurysm
A young child presents with thigh muscle weakness, a waddling gait, and pronounced calf muscles. What is the dx?
Duchenne Muscular Dystrophy
A female who was born in breech position is found to have asymmetric inguinal and gluteal skin folds on her newborn exam. What is the dx and tx?
Dx: Developmental Dysplasia of the hip
Tx: Pavlik harness
Head injury ➔ initial altered mental status ➔ resolution of mental status for a few hrs ➔ now with reemerging altered mental status. What is the dx, underlying injury, and treatment?
Epidural hematoma due to rupture of Middle Meningeal Artery
tx: neurosurgerical evacuation of hematoma
What medication is given for seizure prophylaxis in severe preeclampsia?
IV magnesium sulfate
What is the cause of erythroblastosis fetalis?
Maternal abs against the infants Rh(+) RBCs
Describe the tx of HTN in cases of pheochromocytoma
give α-blockers first, then β-blockers
A 7yo boy presents with hemarthrosis. Lab work shows ⬆ PTT and normal PT and bleeding time. What is the dx and tx?
Dx: Hemophilia A or B
If Hemophilia A = tx with Desmopressin, supplement deficient factors
A young child has loss of the red light reflex. What is the dx?
Retinoblastoma
22yo M has 4 months of social withdrawal, worsening grades, decreased emotional expression, and concrete thinking. What is the diagnosis?
Schizophreniform Disorder
(need 6 months to dx Schizophrenia)
Honeycomb pattern on CT scan of the chest. What is the dx & tx?
Dx: Diffuse Interstitial Fibrosis
Tx: Steroids, Azathioprine or Cyclophosphamide, N-acetylcysteine
A tall, white male presents with acute SOB. What diagnosis do you suspect? What is the tx?
Dx: Spontaneous pneumothorax
Tx: spontaneous regression, supplemental O2 as needed if PTX >15% places a chest tube
What is the frist line tx for moderate hypercalcemia?
IV hydration
45yo M presents with acute-onset flank pain & hematuria. What is the most likely etiology?
Nephrolithiasis
What test is used to r/o urethral injury?
Retrograde cystourethrogram
75 yo M presents with fatigue, lymphadenopathy, splenomegaly, and isolated lymphocytosis. What diagnosis do you suspect?
CLL
Meningitis is diagnosed in a neonate. What are the most likley organisms. and what is the empiric treatment?
GBS, E. coli, Listeria
tx: ampicillin
What pathology causes an onion-skin appearance of the bone on XRAY?
Ewing sarcoma
Which skin cancer classically presents with varying degrees of scaling or ulcerations?
Squamous cell carcinoma
What is the treatment for the premalignant lesion from sun exposure that can lead to squamous cell skin cancer?
Actinic Keratosis

tx: cryoablation, 5-FU
What is the general tx of DKA?
IVF, Insulin, Aggressively replace electrolytes (K+, Mg+, phosphates)
A pt presents with weakness, N/V, weightloss, and new skin pigmentation. Labs show hyponatremia and hyperkalemia. What is the tx?
Dx: Addison's Disease
Tx: Glucocorticoids and Mineralcorticoids (Fludrocortisone)
What dx would you consider in a pt with sacroilitis?
Ankylosing spondylitis
A child presents with a neckline mass. What do you suspect?
Thyroglossal Duct Cyst
A child presents with a lateral neck mass. What do you suspect?
Brachial cleft cyst
What is the medical treatment for inflammatory bowel disease?
5-Aminosalicyclic acid
+/- Sulfasalazine
steroids
What is the difference btw Mallory-Weiss and Boerhaave tears?
MW: superficial tear
B: full thickness rupture
What is the treatment for TTP?
Large volume plasmapheresis, steroids, anti-platelet drugs
Which of the following are elevated in DIC: fibrin split products, D-dimer, fibrinogen, platelets, Hct?
Fibrin split products & D-dimer
What EKG finding is assoc with hypothermia?
J-wave
What infection is classically assoc with cold agglutinins?
Mycoplasma pneumonia
What are the signs suggesting radial nerve damage with a humeral fracture?
wrist drop, loss of thumb abduction
What is the first-line treatment for pediculosis pubis & pediculosis capitis?
Permethrin
Which immunodeficiency would you suspect in a pt with recurrent infections, thrombocytopenia, and eczema?
Wiskott Aldrich Syndrome
What causes a child to have mental retardation, microcephaly, microphthalmia, short palpebral fissures, midfacial hypoplasia, and cardiac defects?
Fetal Alcohol Syndrome
An 18yo F with no history of abnormal pap smears now has a first time ASCUS pap. How should this be managed?
repeat pap in 1 year
What are the management options of a first time ASCUS pap in a non-adolescent?
(1) Reflex HPV (High risk ➜ colposcopy, low risk ➜ repeat pap in 6-12mos)
(2) repeat pap in 6-12mos
(3) colposcopy
What is the treatment for a clavicle fracture?
conservative management : Figure of 8 Sling
40yo F has persistent erythema on her nose and cheeks and recurrent facial flushing especially with alcohol and spicy foods. What is the diagnosis?
Rosacea
A pt with cirrhosis presents again to the ER to have his ascites drained. Analysis of the ascites fluid reveals an absolute neutrophil count greater than 250cels/mm3. What is the diagnosis?
Spontaneous Bacterial Peritonitis (SBP)
Otoscopy in a child presenting with acute onset of ear pain reveals large, reddish vesicles on the TM. What is the diagnosis, typical organism, and treatment?
- Bullous myringitis
- Mycoplasma
Tx: Erythromycin, or Clarithromycin
What is the treatment for a pilonidal cyst?
Incision & drainage
What is the treatment for a rectal fistula?
Fistulotomy
A pt on isotretinoin for acne begins to develop daily, persistent, pulsatile headaches. Exam reveals papilledema. What is the dx?
Pseudotumor Cerebri
18yo M is found to have a systolic heart murmur at the apex and LLSB that increases with intensity while standing after squatting. What diagnosis do you suspect?
Hypertrophic cardiomyopathy
What disorder classically presents with the triad of cognitive impairment, urinary incontinence, and abnormal gait?
Normal pressure hydrocephalus
What is the underlying cause of late fetal decelerations on contraction stress test?
Uteroplacental insufficiency
A middle aged man presents for knee pain and XRAY reveals bilateral calcifications of the articular cartilage. What is the tx?
Dx: Pseudogout
Tx: NSAIDs or colchicine
What is the next step in the management of a positive PPD?
CXR
25yo M is diagnosed with a solid testicular mass by ultrasound. What is the next step in the management>
orchictomy
A teenager on antibiotics for acne presents with a severe sunburn. What antibiotic is he most likely taking?
tetracycline
What is the next step in the management of a female with poor uterine tone after delivery of the placenta?
uterine massage, oxytocin