Step 3

Front 1

Possible complication of blood transfusion in patients with shock, hypothermia, renal failure, hepatic failure

Back 1

Hypocalcemia due to impaired ability to metabolize citrate into lactate

Front 2

Splenic vein thrombosis can be a complication of ___ and causes ___

Back 2

- Chronic recurrent pancreatitis
- Isolated gastric varices (not esophageal), portal hypertension, ascites, splenomegaly with pancytopenia

Front 3

Test for meniscal injury in knee

Back 3

McMurray maneuver: knee flexed, tibia externally rotated and knee slowly extedned. Positive it there is a click or pop.

Front 4

Presentation of fat embolism

Back 4

Respiratory insufficiency, neurological impairment, petechial rash

Front 5

Treatment for pregnant woman with active TB

Back 5

INH/rifampin/ethambutol
Only add pyrazinamide if concern for MDR-TB because unclear data on safety in pregnancy
Do not use streptomycin (fetal ototoxicity)

Front 6

- Drug that increases risk of gout
- Mechanism

Back 6

- Cyclosporine
- Decreasing renal urate excretion

Front 7

Type of crystals in pseudo-gout
Most commonly affected joint
Other name

Back 7

Positively birefringent, rhomboid
Knee
Calcium pyrophosphate dihydrate deposition dz (CPPD)

Front 8

Type of crystals in oxalate-induced arthritis
Patients at risk

Back 8

Calcium oxalate crystals - bipyramidal, variable birefringence
Patients with ESRD

Front 9

When to treat subclinical hypothyroidism

Back 9

- Presence of antithyroid antibodies
- Abnormal lipid profile
- Symptoms of hypothyroidism
- Ovulatory and menstrual dysfunction

Front 10

Common anticholinergic toxic agents

Back 10

- Tricyclic antidepressants
- Plants including Datura stramonium
- Mushrooms

Front 11

Skin finding in anticholinergic toxicity

Back 11

Dry skin

Front 12

Toxic agents causing excessive salivation

Back 12

Pesticides/insecticides (Organophosphates, carbamates)

Front 13

Treatment for UTI in pregnant women

Back 13

Cephalexin, amox or nitrofurantoin

Front 14

Management of pyelo in pregnancy

Back 14

Hosp, IV abx (eg CTX or amp+gent) until afebrile x24-48 hours, then continue PO course x total 10-14 days

Front 15

MRI findings of PML

Back 15

Non-enhancing, demyleninating lesions with no mass effect

Front 16

Anti-pseudomonal antibiotics (8)

Back 16

- Cefepime
- Ceftaz
- Amikacin
- Imipenem/meropenem
- Cipro
- Zosyn
- Aztreonam
- Colistin

Front 17

Valve problem in Marfan syndrome

Back 17

Mitral insufficiency

Front 18

When to treat post-AOM effusion

Back 18

- Bilateral
- Persistent symptoms
- Lasts >3 months

Front 19

2nd line abx for AOM (3)

Back 19

- Augmentin
- Cefuroxime
- IM CTX

Front 20

Management of epidural spinal cord compression

Back 20

High-dose corticosteroids
MRI followed by radiation or surgery

Front 21

Presentation of scleroderma renal crisis

Back 21

Severe hypertension and renal failure in pt with evidence of underlying scleroderma (e.g. Raynaud phenomenon, GERD)

Front 22

Treatment of hypertension in scleroderma renal crisis

Back 22

ACE inhibitors (esp captopril)
+IV nitroprusside if CNS manifestations are present

Front 23

Normal distribution:
% within 1 SD
% within 2 SDs
% within 3 SDs

Back 23

68%
95%
99.7%

Front 24

Post-exposure prophylaxis for HIV:
- Low viral load
- High viral load

Back 24

- Two nucleoside reverse transcriptase inhibitors x4 weeks
- " " plus a protease inhibitor

Front 25

Antihypertensives that are safe to take with lithium

Back 25

Beta blockers
Calcium channel blockers

Front 26

- Goal blood pressure after tPA for ischemic stroke
- Meds to achieve this

Back 26

- 180/105
- IV labetalol, nitroprusside, nicardipine

Front 27

- Electrolyte derangement associated with surgery, esp major surgery with extensive transfusions
- Manifestations

Back 27

- Hypocalcemia
- Hyperactive DTRs, muscle cramps, convulsions

Front 28

Drugs that can exacerbate psoriasis (5)

Back 28

Beta blockers
ACE inhibitors
NSAIDs
Antimalarials
Lithium

Front 29

Evaluation of pancreatic cyst

Back 29

Endoscopic ultrasound with aspiration

Front 30

Therapy for chronic prostatitis

Back 30

Quinolone or Bactrim x6-12 weeks

Front 31

High-grade squamous intraepithelial lesions of cervix include

Back 31

CIN II to III
Moderate and severe dysplasia
Carcinoma in situ

Front 32

- Drugs that cause an isolated increase in serum Cr (3)
- Mechanism

Back 32

- Cimetidine, probenecid, trimethoprim
- Decreased tubular secretion of creatinine

Front 33

Adrenal incidentaloma:
- Initial evaluation
- Which to excise

Back 33

- Lytes, dexamethasone suppression test, 24-hr urine catecholamine, metanephrine, VMA and 17-ketosteroids
- Functional tumors, malignant tumors, tumors >4cm

Front 34

Test for CAD in patient unable to exercise

Back 34

Adenosine myocardial perfusion test

Front 35

Testing of children with family history of hypercholesterolemia or premature CAD

Back 35

Begin testing at 2 years.
- If relative has TChol >240, get random chol. If <170, repeat in 5 years. If >200, order FLP
- If relative has h/o premature CAD, order FLP.

Front 36

Thyroglossal duct cyst:
- Presentation
- Management

Back 36

- Midline neck mass that moves with protrusion of tongue
- Pre-op imaging (ideally CT) as this may be the only functional thyroid tissue

Front 37

- Danger with metformin
- Conditions in which metformin should be avoided (5)
- Situation in which to hold metformin

Back 37

- Lactic acidosis
- Renal failure, hepatic dysfunction, alcoholism, sepsis, CHF
- Administration of IV contrast (or other situation with risk of renal failure)

Front 38

When to perform correction of cleft lip

Back 38

- 10 lbs
- 10 weeks
- 10g Hgb

Front 39

PE finding suggestive of thyroid as source of esophageal obstructive symptoms

Back 39

Pemberton's sign: facial plethora or neck vein distention when arms raised

Front 40

Criteria for resolution of DKA (4)

Back 40

- Glucose <200
- Gap <12
- Bicarb >17
- Ability to eat

Front 41

Lab/electrolyte findings in adrenal insufficiency

Back 41

- Hyponatremia
- Hyperkalemia
- Hyperchloremic metabolic acidosis

Front 42

What to rule out first (and how) with concern for diabetic gastroparesis

Back 42

Gastric outlet obstruction, with endoscopy or upper GI (then can do scintigraphic gastric emptying study)

Front 43

Raloxifene: periop management

Back 43

Stop 4 weeks pre-op, restart post-op once stable with decreased risk of thromboembolism

Front 44

Patients with hyperparathryoidism in whom to do parathyroidectomy (5)

Back 44

- Symptomatic
- Ca >1 mg/dL above normal
- CrCl <60 mL/min
- T-score < -2.5 on densitometry or previous fragility fracture
- Age <50

Front 45

Initial management of pheochromocytoma

Back 45

Alpha blockade to control HTN and restore intravascular volume x10-14 days before surgery
*Alpha blockade BEFORE beta blockade

Front 46

Management of intraop hypotension in patient with pheochromocytoma

Back 46

Normal saline bolus

Front 47

Use of phentolamine IV bolus

Back 47

HYPERtension during surgery

Front 48

Which neonatal head swelling crosses suture lines?

Back 48

Caput succedaneum

Front 49

Characteristics of androgen insensitivity (5)

Back 49

- Primary amenorrhea
- Bilateral inguinal masses
- Breast development without pubic/axillary hair
- Blind vaginal pouch
- 46 XY

Front 50

Achalasia:
- LES tone
- Histopath
- Peristalsis
- Esophagogram
- Therapy

Back 50

- High tone of LES
- Hypertrophied inner circular muscle; absence/degeneration of ganglia in Auerbach's plexus
- Absence of peristalsis
- Dilated esophagus with bird's beak narrowing distally
- Balloon dilation or surgery

Front 51

Diffuse esophageal spasm:
- Peristalsis
- LES tone
- Esophagogram
- Treatment

Back 51

- High amplitude peristaltic contractions (may be intermittent)
- LES tone normal
- Corkscrew esophagogram
- Antispasmodics, dietary modulation, psych counseling

Front 52

Condition with high LES tone

Back 52

Achalasia

Front 53

Condition with low LES tone

Back 53

Scleroderma

Front 54

Scleroderma in esophagus:
- Peristalsis
- LES tone
- Esophageal smooth muscle
- Symptoms

Back 54

- Loss of distal peristalsis
- Low LES tone
- Atrophy of esophageal smooth muscle and fibrosis
- Reflux esophagitis, stricture

Front 55

Condition with corkscrew esophagus

Back 55

Diffuse esophageal spasm

Front 56

NF1: Diagnostic criteria (7)

Back 56

2+ of:
- First degree relative
- >6 CALMs (5mm in children, 15mm in adults)
- >2 neurofibromas
- Lisch nodule
- Optic glioma
- Bone dysplasia
- Axillary freckling

Front 57

Management after removal of a large (>2cm) sessile polyp or if there is concern that a large adenoma has not been completely removed

Back 57

Follow-up colonoscopy in 3-4 months

Front 58

Time interval for surveillance colonoscopy for most patients after removal of adenomatous polyp

Back 58

3 years

Front 59

HIV prophylaxis after sex with an infected person

Back 59

- Within 72 hours
- Two nucleoside reverse transcriptase inhibitors x4 weeks

Front 60

Nucleoside reverse transcriptase inhibitors for HIV (4)

Back 60

- Zidovudine
- Lamivudine
- Tenofovir
- Emtricitabine

Front 61

Side effect of licorice

Back 61

Hypercortisolism (HTN, hypokalemia, metabolic alkalosis)

Front 62

Risk with ginkgo

Back 62

Interaction with aspirin or warfarin --> spontaneous bleeding

Front 63

Risks with kava

Back 63

- Increased sedation with EtOH/benzos/etc
- Hepatotoxicity

Front 64

Risk with black cohosh

Back 64

Hypotension

Front 65

Risk with horse chestnut

Back 65

Increased risk of bleeding in patients on ASA or warfarin

Front 66

Findings in sarcoidosis (5)

Back 66

- Peripheral nerve disease
- Erythema nodosum
- Hepatic compromise
- Hilar node enlargement
- Hypercalcemia

Front 67

EKG findings in multifocal atrial tachycardia

Back 67

- Narrow QRS
- 3+ morphologies of P waves
- Variable PR segments and RR intervals

Front 68

Causes of multifocal atrial tachycardia (6)

Back 68

- Hypoxia
- COPD
- Hypomag
- Hypokalemia
- Heart disease
- Aminophylline, theophylline, isoproterenol

Front 69

- When to treat MAT with drugs
- Which drugs

Back 69

- Once correctable underlying causes have been addressed
- Beta blockers (or verapamil in pts with asthma/COPD)

Front 70

Nelson's syndrome:
- Patients
- Presentation
- Treatment

Back 70

- Post-bilateral adrenalectomy
- Pituitary enlargement, hyperpigmentation, visual field defect
- Surgery and/or radiation

Front 71

Management of acute arterial occlusion

Back 71

Immediate IV heparin therapy

Front 72

Type of inguinal hernia in pediatric patients

Back 72

Indirect, due to failure of processus vaginalis to obliterate

Front 73

Meralgia paresthetica
- What is?
- Symptoms
- Treatment

Back 73

- Entrapment of lateral femoral cutaneous nerve
- Area of decreased sensation over anterolateral thigh without weakness or DTR changes
- Weight loss, avoid tight-fitting garments

Front 74

PE findings in obturator nerve lesion

Back 74

- Sensory loss over medial thigh
- Weakness in leg adduction

Front 75

Typical symptoms in myasthenia gravis

Back 75

Weakness in ocular and bulbar muscles (double vision, ptosis, dysphagia, dysarthria) worsening over the day

Front 76

Concern in refractory or rapidly progressive osteoporosis

Back 76

Multiple myeloma

Front 77

Skin problem with thiazides

Back 77

Photosensitivity (because are sulfonamides)

Front 78

Neuro sx of lithium toxicity

Back 78

Slurred speech
Confusion
Tremors
Ataxia

Front 79

Medications that can increase serum lithium levels

Back 79

- Diuretics (incl thiazides)
- NSAIDs

Front 80

Management of biopsy-proven CIN 1 with satisfactory coloposcopic exam

Back 80

- Repeat cytology at 6 & 12 months
or
- HPV DNA at 12 months

Front 81

Typical presentation of invasive aspergillosis

Back 81

- Fever
- Pulmonary sx
- Sinus sx (incl HA and nasal bleeding)

Front 82

Treat asx carriers of Giardia?

Back 82

Only in outbreak control and for prevention of household transmission by toddlers to pregant women and pts with hypogammaglobulinemia or CF

Front 83

Patello-femoral pain syndrome:
- Presentation
- Exam findings

Back 83

- Anterior knee pain provoked by climbing stairs or prolonged sitting
- Retropatellar pain, crepitation on vigorous patellar compression

Front 84

Patellar tendonitis
- Other name
- Affected patients
- Exam finding

Back 84

- Jumper's knee
- Volleyball and basketball players
- Local infra-patellar tenderness

Front 85

Symptoms of prepatellar bursitis

Back 85

Anterior knee pain and swelling

Front 86

Pathophys of Osgood-Schlatter

Back 86

Epiphysitis of tibial tuberosity

Front 87

Symptoms of anserine bursitis

Back 87

Medial knee pain and local tenderness

Front 88

Subacute thyroiditis
- Presentation
- Pathophys

Back 88

- Thyrotoxicosis with low radioactive iodine uptake
- Release of stored thyroid hormone

Front 89

Treatment of subacute thyroiditis

Back 89

NSAID + beta-blocker

Front 90

Management of thyroid nodule

Back 90

Obtain TSH
- If TSH is normal, do a FNAC
- If TSH is decreased, do a radioisotope scan. If hot nodule, observation.

Front 91

Management of papillary thyroid cancer

Back 91

- Near total thyroidectomy
- Then radioactive iodine

Front 92

Treatments for postherpetic neuralgia

Back 92

- Tricyclic antidepressants (e.g. amitriptyline)
- Topical capsaicin
- Gabapentin
- Long-acting oxycodone

Front 93

When to check serologies in baby born to mother with HBV

Back 93

3-4 months after third vaccination dose (or 9-15 months of age)

Front 94

Symptoms of Candida endophthalmitis (4)

Back 94

Ocular pain
Photophobia
Scotomas
Fever

Front 95

Treatment of candida endophthalmitis with vitreal involvement

Back 95

Vitrectomy and systemic antifungal tx (amphotericin B and/or fluconazole)

Front 96

Setting for IgA nephropathy
Symptoms
Urine finding

Back 96

- Often follows URI
- Gross hematuria, flank pain
- Dysmorphic RBCs in urine

Front 97

Post-strep GN
- Delay between infection and onset
- Symptom
- Lab findings (2)

Back 97

- 10 days
- HTN
- Urine RBCs/RBC casts, low complement levels

Front 98

Metabolic/electrolyte abnormalities with IV pentamidine (5)

Back 98

- Hyperkalemia
- Hypokalemia
- Hyperglycemia
- Hypoglycemia
- Hypocalcemia

Front 99

Lab tests helpful in diagnosis of RA

Back 99

RF
Anti-cyclic citrullinated peptide (CCP)

Front 100

Which antibody is specific for SLE?

Back 100

Anti-ds DNA

Front 101

DMARDs for RA, incl first choice (6)

Back 101

*Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Azathioprine
TNF inhibitors (etanercept and infliximab)

Front 102

CSF findings in MS

Back 102

Elevated IGs, with IGg disproportionately elevated (oligoclonal band)

Front 103

Treatment of acute MS exacerbation

Back 103

IV steroids

Front 104

Treatment of relapsing or secondary progressive MS, and safety in pregnancy

Back 104

Interferon or glatiramer acetate
Teratogenic, but therapeutic abortion not indicated

Front 105

Positive prognostic indicators for MS

Back 105

- Early age of onset
- Female gender
- Relapsing disease
- Sensory or cranial nerve sx (esp optic neuritis) as first presentation

Front 106

Autoimmune hepatitis:
- LFT results
- Antibodies

Back 106

- Elevated AST/ALT, normal alk phos and bili
- ANA and anti-SM

Front 107

Condition with elevated ANA and anti-SM antibodies

Back 107

Autoimmune hepatitis

Front 108

Antibodies in PBC

Back 108

Antimitochondrial

Front 109

Condition with antimitochondrial antibodies

Back 109

PBC

Front 110

LFT result in PBC

Back 110

Elevated alk phos

Front 111

T-score cutoffs for
- osteopenia
- osteoporosis

Back 111

-1.0 to -2.5
< -2.5

Front 112

Hemosiderin-laden macrophages seen in

Back 112

Diffuse alveolar hemorrhage syndromes (Wegener's, Goodpasture's, other systemic vaculitides)

Front 113

Treatment of PE
- HDS
- Unstable

Back 113

- Heparin
- IV fibrinolysis

Front 114

Concern with unilateral headache and Horner's syndrome

Back 114

Carotid dissection

Front 115

Initial evaluation for carotid dissection

Back 115

MRA

Front 116

In which cardiac patients should beta blockers be started?

Back 116

- Stable angina
- Prior ACS
- LV dysfunction

Front 117

Rx to maintain NSR in pt with paroxysmal afib and structural heart disease

Back 117

Amiodarone

Front 118

Treatment of uncomplicated cystitis in healthy nonpregnant woman

Back 118

Bactrim x3 days
If Bactrim allergic: quinolone x3 days

Front 119

Criteria for complicated cystitis (7)

Back 119

-Male
-Diabetes
-Anatomic abnormality
-Indwelling catheter
-Sx >7 days
-Recurrent
>65

Front 120

Treatment of complicated cystitis

Back 120

Bactrim x7 days

Front 121

Treatment of cystitis in pregnancy

Back 121

- Nitrofurantoin x7 days
-If allergic, Augmentin x7 days
*Avoid Bactrim (folate antagonist) and quinolones

Front 122

Initial therapy for UC with mild proctitis

Back 122

Topical 5-ASA (mesalamine suppository)

Front 123

Initial therapy for UC with moderate proctitis in order of initiation

Back 123

1) Oral 5-ASA compounds (sulfasalazine, mesalamine)
2) Steroids
3) Immunomodulators (azathioprine, 6-MP)

Front 124

How long to continue antidepressants in pt with first episode of depression

Back 124

6 months

Front 125

Common meds for meningococcal ppx in contacts of pt with meningitis (5)

Back 125

- Oral rifampin*
- Cipro*
- CTX*
- Sulfonamides
- Minocycline

Front 126

Poor prognostic indicators in PE (2)

Back 126

- Elevated troponin
- Hypotension

Front 127

First-line tx for conjunctivitis in non-contact lens wearers (3)

Back 127

- Erythromycin ointment
- Sulfa drops
- Polymyxin/trimethoprim drops

Front 128

Treatment for roundworm, hookworm, whipworm, pinworms

Back 128

Albendazole or mebendazole

Front 129

Helminths (4)

Back 129

- Ascaris lumbricoides (roundworm)
- Trichuris trichiura (whipworm)
- Necator americanus
- Ancylostoma duodenale (hookworm)

Front 130

Rx for pt with asx LV dysfunction to prevent progression to heart failure

Back 130

ACE inhibitor

Front 131

Type of cancer associated with Sjogren's syndrome

Back 131

B-cell lymphoma

Front 132

Most sensitive test for Vitamin D

Back 132

25,hydroxyvitamin D

Front 133

When to give anti-D immune globulin in pregnancy

Back 133

28 weeks

Front 134

Tinel's sign
- What?
- Seen in?

Back 134

- Worsening of median nerve paresthesia with tapping of palmar aspect of wrist
- Carpal tunnel syndrome

Front 135

Chvostek's sign
- What is?
- Seen in?

Back 135

- Contraction of facial muscles with tapping of facial nerve
- Hypocalcemia

Front 136

Treatment of ecthyma gangrenosum

Back 136

IV abx (no surgical debridement)

Front 137

Typical regimens for PsA bacteremia

Back 137

Aminoglycoside (tobramycin, amikacin)
plus
piperacillin or ceftaz/cefepime

Front 138

TCA overdose: presentation (4)

Back 138

- Hypotension
- Anticholinergic sx
- CNS manifestations
- Cardiac arrhythmias

Front 139

TCA toxicity:
- Treatment of cardiotoxic effects
- Treatment of ventricular dysrhythmias

Back 139

- Sodium bicarb
- Lidocaine

Front 140

First step in management of septic shock

Back 140

Fluid resuscitation to CVP of 8-12 mmHg

Front 141

Findings in femoral nerve injury (3)

Back 141

- Inability to extend knee against resistance
- Loss of knee jerk reflex
- Sensory loss over anterior and medial thigh, medial shin, arch of foot

Front 142

Nerve injury causing sensory loss over anterior and medial thigh

Back 142

Femoral nerve injury

Front 143

Symptoms of sciatic nerve injury (2)

Back 143

- Sensory loss in lower leg
- Loss of ankle jerk

Front 144

Presentation of common peroneal nerve injury

Back 144

- Acute foot drop
- Weakness in dorsiflexion and inversion
- Sensory changes over dorsum of foot and lateral shin

Front 145

Normal thyroid hormone change in pregnancy

Back 145

Elevated TBG --> elevated total T3 and T4

Front 146

Initial labs in pt with c/f lead poisoning

Back 146

CBC, retic, iron, ferritin

Front 147

Test for monitoring cardiotoxicity of anthracycline chemo

Back 147

Radionuclide ventriculography (MUGA scan)

Front 148

When can a noncontact athlete return to sports after a clavicle fracture?

Back 148

4-6 weeks

Front 149

MAOIs (2)

Back 149

Tranylcypromine
Phenelzine

Front 150

Meds (2) for hypertensive crisis complicated by acute pulmonary edema

Back 150

IV nitroglycerine
IV nitroprusside

Front 151

Typical finding in patient with posterior communicating artery aneurysm

Back 151

Cranial nerve III palsy

Front 152

Symptoms with PICA aneurysm

Back 152

Ataxia
Bulbar dysfunction

Front 153

Typical symptoms of subarachnoid hemorrhage

Back 153

- Sudden onset headache
- Nausea
- Nuchal rigidity

Front 154

Cluster headache prevention: 1st line and two 2nd line meds

Back 154

1st: Verapamil
2nd: Lithium, pred

Front 155

Acute management of cluster headache

Back 155

100% O2.
Can also try sumatriptan, ergots, or NSAIDs

Front 156

Paraneoplastic syndrome with small cell lung cancer

Back 156

SIADH

Front 157

Paraneoplastic syndrome with squamous cell lung cancer

Back 157

Parathyroid-like hormone production --> hypercalcemia

Front 158

Medications for severe refractory SIADH

Back 158

Furosemide
Then demeclocycline or lithium

Front 159

Indications for tx of Paget's (6)

Back 159

- Bone pain
- Involvement of weight-bearing bones
- Neuro compromise
- Hypercalcemia
- Hypercalciuria
- CHF

Front 160

Rx for HTN in pt with BPH

Back 160

Alpha-1-block (prazosin, terazosin)

Front 161

Positive side effects of alpha-1-blockers

Back 161

Increase insulin sensitivity
Decrease LDL
Increase HDL

Front 162

CSF findings in cryptococcal meningitis (4)

Back 162

- Elevated opening pressures (often >200)
- WBC <50 with mononulear/lymphocyte predominance
- Elevated protein
- Low glucose

Front 163

Initial treatment of cryptococcal meningitis

Back 163

Amphotericin B + flucytosine

Front 164

Maintenance therapy for cryptococcal meningitis after induction

Back 164

Fluconazole

Front 165

Dangerous side effect of nitroprusside

Back 165

Cyanide toxicity

Front 166

Presentation of cyanide toxicity (3)

Back 166

- Tachycardia
- Lactic acidosis
- Change in mental status, coma, sz

Front 167

Treatment for cyanide toxicity

Back 167

Sodium thiosulfate

Front 168

Effect of OCPs on pt with hypothyroidism

Back 168

- Increased TBG --> increased total T4, decreased free T4.
- May need to increase dose of levothyroxine

Front 169

Management of intraocular melanoma

Back 169

Surgical enucleation or radiotherapy

Front 170

S/S of PBC (6)

Back 170

- Jaundice
- Steathorrhea
- Fatigue
- Hyperlipidemia withxanthomas
- Osteoporosis/osteomalacia
- Hyperpigmentation

Front 171

Medical tx for PBC

Back 171

Ursodeoxycholic acid

Front 172

Next step in woman >21 with ASCUS

Back 172

HPV testing; if positive colpo, if negative repeat Pap in one year

Front 173

Next step in woman >21 with ASC-H

Back 173

Colpo

Front 174

- Pts at high risk for colorectal cancer
- When to do first colonoscopy

Back 174

- First degree relative with colorectal cancer or advanced adenoma before age 60
- 10 years before relative's dx or age 40 (whichever earlier)

Front 175

Drugs (2) used for prevention of esocophageal variceal hemorrhage

Back 175

- Nonselective beta blockers (nadolol, propranolol)
- Oral nitrates

Front 176

Findings in pseudohypoparathyroidism

Back 176

B cataracts
Calcificiation of basal ganglia
Elevated PTH
Low Ca
High phos (5)

Front 177

Varenicline
- Mechanism
- Use

Back 177

- Partial agonist at a subunit of nicotinic acetylcholine receptor
- Smoking cessation

Front 178

Patients in whom to avoid verenicline

Back 178

Unstable psych sx or h/o SI

Front 179

Contraindication to bupropion

Back 179

Seizures

Front 180

Strongest known risk factor for male breast cancer

Back 180

Klinefelter's (47 XXY)

Front 181

Evaluation of testicular swelling

Back 181

Ultrasound
If suspicious: CT abd/pelvis, AFP, beta hCG
If still suspicious: Radical orchiectomy (risk of iatrogenic local spread with testicular biopsy)

Front 182

Initial treatment of hyperthyroidism with afib

Back 182

Beta-blocker

Front 183

Symptom of hyperthyroidism in elderly patients

Back 183

Fatigue

Front 184

Most common ophthalmic manifestation of sarcoidosis

Back 184

Anterior uveitis (acute onset of red eye, photophobia, blurred vision, pain)

Front 185

Rx for carotic stenosis (2)

Back 185

- ASA
- Clopidogrel

Front 186

Tx of chlamydia during pregnancy (2)

Back 186

- Erythromycin base (not erythryomycin estolate)
- Azithromycin 1gm

Front 187

Tx of chlamydia (not in pregnancy)

Back 187

Azithromycin 1gm
Doxycycline 100mg PO BID x7d
Quinolone

Front 188

Symptoms of refeeding syndrome

Back 188

Edema
Heart failure

Front 189

Echo finding in cardiac tamponade

Back 189

Collapse of RA and RV during diastole

Front 190

Normal change in systolic BP during inspiration

Back 190

Drop of 10-12 mmHg

Front 191

Blood pressure finding in inspiration in cardiac tamponade

Back 191

Drop of >20 mmHg

Front 192

EKG finding in pericarditis

Back 192

Diffuse ST segment elevations in all leads

Front 193

Beck's triad
- Seen in what?
- What is?

Back 193

- Cardiac tamponade
- Hypotension, distant heart sounds, elevated JVP

Front 194

Factors incorporated in MELD score

Back 194

Bilirubin
INR
Creatinine

Front 195

Treatment of sulfonylurea poisoning

Back 195

1) Dextrose
2) Octreotide (somatostatin analog) if severe

Front 196

Glyburide
- Class
- Mechanism

Back 196

- Sulfonylurea
- Increases insulin production

Front 197

PPX for meningococcal meningitis exposure

Back 197

- Rifampin x4 doses
- Cipro x1 dose if cannot tolerate rifampin (eg on OCPs)

Front 198

Lab test in Wegener's

Back 198

C-ANCA

Front 199

Dz in which C-ANCA is positive

Back 199

Wegener's

Front 200

Other name for Wegener's

Back 200

Granulomatosis with polyangiitis

Front 201

Most common cause of acquired essential mixed cryoglobulinemia

Back 201

Hepatitis C

Front 202

Presentation of mixed cryoglobulinemia (7)

Back 202

- Nonspecific systemic symptoms
- Arthralgias
- Palpable purpura
- LAD
- HSM
- Peripheral neuropathy
- Renal disease

Front 203

Tx of Hep C-associated cryoglobulinemia

Back 203

Anti-viral tx for HCV

Front 204

Associated problems in Turner's syndrome (4)

Back 204

- Cardiac defects (coarct, biscupid aortic valve, MVP, hypoplastic heart)
- Visual and hearing impairment
- Hypothyroidism
- Renal malformations (horseshoe kidney)

Front 205

Rash in RMSF and when it appears

Back 205

- Petechial rash on ankles/wrists --> palms, soles, central body
- 3rd-5th day of illness

Front 206

Arthropathy of hemochromatosis:
- Joints affected
- XR findings
- Clinical findings
- Fluid examination

Back 206

- 2nd and 3rd MCPs
- Osteoarthritic changes
- Morning stiffness for <30 min
- CPPD crystals

Front 207

Tx for mucormycosis

Back 207

Debridement & amphotericin B

Front 208

Pioglitazone
- Class
- Mechanism

Back 208

- Thiazolidinedione
- Increases insulin sensitivity

Front 209

Goal of intention-to-treat analysis

Back 209

Preserve randomization

Front 210

Rx for narcolepsy

Back 210

Methylphenidate
Antidepressants

Front 211

Distinction between Trichophyton tonsurans and Microsporum canis

Back 211

Microsporum canis fluoresces bright green under Wood's lamp

Front 212

Presentation of transverse myelitis (4)

Back 212

Usually after a URI
Rapidly progressive paraplegia
Sensory loss
Pelvic organ dysfunction

Front 213

First test in evaluation of transverse myelitis

Back 213

MRI

Front 214

Biopsy finding in celiac

Back 214

Villus blunting with lymphocytic and plasma cell infiltration

Front 215

Biopsy finding in Crohn's

Back 215

Transmural inflammation of mucosa

Front 216

Biopsy finding in UC

Back 216

Superficial mucosal inflammation with infiltration of plasma cells

Front 217

PE findings of cutaneous cryptococcosis

Back 217

Multiple discrete reddish papules with central umbilication

Front 218

Diagnosis of cutaneous cryptococcosis

Back 218

Histopath of biopsy

Front 219

Symptom of duodenal ulcer

Back 219

Pain on an empty stomach

Front 220

Antipsychotics available in long-acting injectable form (3)

Back 220

- Haloperidol decanoate
- Risperidone
- Fluphenazine

Front 221

Presentation of rupture of chordae tendineae

Back 221

Flash pulmonary edema a/w acute mitral regurg

Front 222

Characteristics of acute MR murmur (5)

Back 222

- Systolic murmur in apex, radiating to axilla
- Increased with grip
- Decreased with Valsalva
- Decreased 1st heart sound
- Fourth heart sound

Front 223

Treatment of acute gout (3)

Back 223

- NSAIDs (1st line)
- Colchicine
- Glucocorticoids

Front 224

Chronic gout treatment

Back 224

Allopurinol
Probenecid

Front 225

Sources of septic pulmonary emboli (2)

Back 225

- Septic thrombophlebitis
- Tricuspid endocarditis

Front 226

Medical management of acute aortic dissection

Back 226

- IV propranolol or labetalol
- Can add sodium nitroprusside (never use alone 2/2 reflex sympathetic activation)

Front 227

Levels in hemolysis of
- LDH
- Haptoglobin

Back 227

- LDH increased
- Haptoglobin decreased

Front 228

Treatment of lead poisoning:
- Mild
- Moderate
- Severe

Back 228

- Mild: oral DMSA or d-penicillamine (or no tx)
- Moderate (45-70): oral DMSA or IV EDTA
- Severe (l>70 and/or acute encephalopathy): IV dimercaprol and EDTA

Front 229

Does likelihood ratio change with prevalence?

Back 229

No

Front 230

Prophyria cutanea tarda
- Presentation
- Associations
- Diagnosis
- Manageent

Back 230

- Painless blisters, fragile skin on dorsum of hands, facial hypertrichosis and hyperpigmentation
- Ethanol, estrogens, Hep C
- Elevated urinary uroporphyrins
- Phlebotomy, hydroxychloroquine, interferon-alpha for HCV

Front 231

Skin condition a/w gluten-sensitive enteropathy

Back 231

Dermatitis herpetiformis

Front 232

For which mechanical valve pts is the INR goal
- 2-3
- 2.5-3.5
- 2.5-3.5 with low-dose ASA

Back 232

- 2-3: AVR with normal rhythm
- 2.5-3.5: MVR, AVR with aFib
- 2.5-3.5+ASA: Mechanical valve and systemic embolism despite anticoagulation

Front 233

MI pts who are candidates for thrombolytic tx

Back 233

- Present within 12 hrs of sx onset
- ST elevations >1mm in two contiguous leads or new LBBB

Front 234

Medication used in cocaine chest pain

Back 234

Benzos

Front 235

Medication to avoid in cocaine chest pain

Back 235

Beta-blockers

Front 236

Management of HTN in cocaine chest pain

Back 236

1) Benzo
2) (if needed) Phentolamine (1st choice), nitroprusside, nitroglycerine

Front 237

Murmur in mitral stenosis

Back 237

Low-pitched rumbling diastolic murmur at apex

Front 238

Valvular lesion that can cause hemoptysis

Back 238

Mitral stenosis

Front 239

Crescendo-decrescendo murmur

Back 239

Aortic stenosis

Front 240

Indications for surgery in AAA (3)

Back 240

- Diameter >5cm
- Symptoms
- Rapid enlargement

Front 241

Post-MI acute pericarditis:
- Time frame
- Management

Back 241

- 1-4 days post-MI
- Pain control with ASA (usually transient)

Front 242

Time frame for post-MI chordae tendineae or papillary muscle rupture

Back 242

2-8 days post-MI

Front 243

Dressler's syndrome
- Time frame
- Mechanism
- Presentation (4)

Back 243

- Weeks-months after MI
- Autoimmune
- Fever, leukocytosis, pleuritic CP, pericardial rub

Front 244

Acne medication that can cause hypertrigyceridemia and pancreatitis

Back 244

Isotretinoin

Front 245

Most deadly toxicity of amiodarone

Back 245

Pulmonary toxicity

Front 246

Shampoo ingredients for seborrheic dermatitis (4)

Back 246

- Ketoconazole
- Tar
- Zinc pyrithione
- Selenium sulfide

Front 247

Side effects of lindane

Back 247

- Seizures
- Aplastic anemia

Front 248

Acute treatment of symptomatic tachycardia in hyperthyroidism

Back 248

Beta blocker

Front 249

Medical tx of hyperthyroidism (2)

Back 249

Propylthiouracil (PTU)
Methimazole

Front 250

Max length to use glucocorticoids without having to taper

Back 250

3 weeks

Front 251

How long to continue warfarin after 1st episode of DVT

Back 251

3-6 months

Front 252

Start ___ before ___ in alcoholics to prevent ___

Back 252

Start thiamine before glucose to prevent Wernicke's encephalopathy from thiamine deficiency

Front 253

Electrolyte derangement that can cause paralytic ileus

Back 253

Hypokalemia

Front 254

Manifestations of glucagonoma

Back 254

- Mild diabetes
- Painful, itchy erythematous rash with central clearing

Front 255

Pellagra
- Deficiency of
- Manifestations

Back 255

- Niacin
- Dementia, diarrhea, dermatitis, stomatitis, cheilosis

Front 256

Ca/D/PTH in sarcoidosis

Back 256

Incr 1,25-OH D --> incr GI absorption of Ca --> hypercalcemia --> decr PTH, incr urinary calcium excretion

Front 257

Treatment of hypoparathyroidism

Back 257

- Ca and 25-OH D
- If low serum Ca and high urine Ca, add thiazide diuretic

Front 258

Most common cause of nonsustained VTach

Back 258

Structural heart disease

Front 259

Valve disease with midsystolic click

Back 259

MV prolapse

Front 260

Thyroid condition with elevated serum alpha subunits

Back 260

TSH-secreting pituitary adenoma

Front 261

Single most important predictor of adverse cardiovascular outcomes

Back 261

Diabetes

Front 262

Test of choice for diverticulitis

Back 262

CT

Front 263

Tx of mild diverticulitis

Back 263

Cipro + Flagyl

Front 264

Effect of amiodarone on TFTs

Back 264

Decreased conversion of T4 --> T3
Increased T4; decreased T3

Front 265

Meds used for diabetic neuropathy (3)

Back 265

- Tricyclic antidepressants
- Duloxetine
- Gabapentin and other anticonvulsants

Front 266

Next evaluation after diagnosis of familial adenomatous polyposis

Back 266

Endoscopy to look for gastric/duodenol adenomas/carcinomas

Front 267

Risks with ginseng

Back 267

- SJS
- Psychosis

Front 268

Treatment C. diff relapses after metronidazole tx:
- First
- Second

Back 268

- Metronidazole again
- Oral vanco

Front 269

Tx of acute Hep B

Back 269

Supportive measures

Front 270

Marker of high HBV infectivity

Back 270

HB eAg

Front 271

Rate of chronic Hep B in
- Infants with acute Hep B
- Adults with acute Hep B

Back 271

- 90%
- 5%

Front 272

Management of 3-vessel or left main CAD in diabetic patient

Back 272

CABG

Front 273

Biggest risk with compartment syndrome

Back 273

Rhabdo and renal failure

Front 274

Management of salicylate overdose

Back 274

Alkalinization of urine
Gastric lavage/charcoal

Front 275

Management of hyponatremia in advanced CHF

Back 275

Water restriction

Front 276

Bile-salt induced diarrhea:
- Seen in (2)
- Tx

Back 276

- Short gut, s/p cholecystectomy
- Cholestyramine (bile-acid binding resin)

Front 277

Diagnosis of brain death (correct)

Back 277

- CNS catastrophe
- No confounding factors
- Absent cortical and brainstem function
--> Then, apnea test

Front 278

Presentation of acute ischemic colitis

Back 278

Acute abdominal pain followed by bloody diarrhea

Front 279

Analgesic nephropathy
- Pathophys
- UA findings

Back 279

- Papillary damage
- Hematuria, pyuria, proteinuria

Front 280

Type of endocarditis that can cause conduction system abnormalities

Back 280

Aortic valve

Front 281

Management of acute hemolytic transfusion reaction

Back 281

Stop transfusion and hydrate with NORMAL SALINE only

Front 282

ATN:
- Presentation
- Lab findings (2)

Back 282

- Oliguria after a hypotensive episode
- Muddy brown casts, high FENa

Front 283

FENa in prerenal azotemia

Back 283

Low

Front 284

Fluid for oliguric, hyperkalemic, acidotic patient

Back 284

D5W with bicarb at slow rate (e.g. 50 mL/hr)

Front 285

Diagnosis of severe C diff colitis

Back 285

Limited sigmoidoscopy of unprepared bowel with minimal air inflation

Front 286

Med for tx of SVT

Back 286

Adenosine

Front 287

Abx associated with infantile hypertrophic pyloric stenosis

Back 287

Erythromycin

Front 288

LDL level at which to start a statin in diabetic pts

Back 288

>100

Front 289

When can Pap interval be decreased from every 2 to every 2-3 years?

Back 289

3 consecutive negatives or after age 30

Front 290

Rx for early localized Lyme

Back 290

Doxycycline
Amoxicillin
Cefuroxime

Front 291

Tx for H pylori

Back 291

Two weeks of:
- PPI
- Clarithromycin
- Amoxicillin (metronidazole if allergic)

Front 292

H. pylori treatment after failure of initial triple therapy

Back 292

Two weeks of:
- PPI
- Bismuth
- Tetracycline
- Metronidazole

Front 293

FEV1, FVC and FEV1/FVC in asthma

Back 293

FEV1: decreased (more)
FVC: decreased (less)
FEV1/FVC: decreased

Front 294

First-line tx for RLS

Back 294

Dopamine agonists (pramipexole or ropinirole)

Front 295

Anti-centromere antibodies seen in?

Back 295

CREST (scleroderma)

Front 296

Anti-smith antibodies seen in?

Back 296

SLE (but less sensitive than anti-dsDNA)

Front 297

Use of hydroxychloroquine in SLE

Back 297

Pts with arthralgias, serositis, cutaneous manifestations

Front 298

Antihypertensive used in opiate withdrawal

Back 298

Clonidine

Front 299

Tx of Graves' dz with ophthalmopathy

Back 299

Radioiodine ablation + steroids

Front 300

Drug for management of thyroid storm

Back 300

Glucocorticoids

Front 301

Mammography guidelines

Back 301

Every two years for women 50-74

Front 302

Calculation of plasma osmolality

Back 302

(2 x Na) + (glucose/18) + (BUN/2.8)

Front 303

Next step if Pap shows HSIL

Back 303

LEEP or colpo

Front 304

Test to confirm suspected 21-hydroxylase deficiency

Back 304

Elevated 17 alpha-hydroxyprogesterone

Front 305

Findings in CAH caused by 11-hydroxylase deficiency

Back 305

Hypertension
Hypernatremia
Hypokalemia

Front 306

Window for fibrinolytic therapy after ischemic stroke

Back 306

3-4.5 hours

Front 307

Febrile transfusion reaction:
- Cause
- Prevention
- Distinction from hemolytic reaction

Back 307

- Recipient antibodies to donor leukocytes
- Washing cells
- Absence of hemodynamic abnormalities and renal dysfunction

Front 308

CXR finding in pulmonary contusion

Back 308

Homogenous opacification of lung fields not conforming to a specific anatomic segment of the lung

Front 309

Most common cause of diverticular bleeding

Back 309

Erosion of the artery

Front 310

VZV vaccination of household contact of transplant patient

Back 310

Give vaccine and monitor for rash; isolate if rash appears

Front 311

Osteonecrosis of femoral head
- Other names (2)
- Patients at highest risk

Back 311

- Avscular necrosis, osteochondritis dissecans
- SLE patients on chronic high-dose steroids

Front 312

Mangement of AVN (osteonecrosis of femoral head)
- Stage 1-2
- Stage 4

Back 312

- Core decompression
- Total hip replacement

Front 313

Indinavir: class

Back 313

Protease inhibitor

Front 314

Side effect of indinavir

Back 314

Crystal-induced nephropathy

Front 315

HIV drug that can cause crystal-induced nephropathy

Back 315

Indinavir

Front 316

Risk with didanosine

Back 316

Pancreatitis

Front 317

HIV med with risk of pancreatitis

Back 317

Didanosine

Front 318

Risk with abacavir

Back 318

Hypersensitivity syndrome

Front 319

HIV drug with risk of hypersensitivity syndrome

Back 319

Abacavir

Front 320

HIV drug class that can cause lactic acidosis

Back 320

NRTIs

Front 321

HIV drugs that can cause SJS

Back 321

NNRTIs

Front 322

RIsk with nevirapine

Back 322

Liver failure

Front 323

HIV drug with risk of liver failure

Back 323

Nevirapine

Front 324

Percentage of HbA in:
- Sickle trait
- HgbS beta 0
- HgbS beta +

Back 324

- 60%
- 0%
- 3-25%

Front 325

Meds that can impair levothyroxine absorption

Back 325

Ca
Iron

Front 326

Meds for hyperthyroidism in pregnancy

Back 326

Propylthiouracil during 1st trimester (methimazole teratogen)
Can switch back to methimazole during 2nd and 3rd trimesters

Front 327

Evaluation in patient with B varicocele, R varicocele, or varicocele that does not disappear when supine

Back 327

CT to look for process causing IVF obstruction (e.g. clot, tumor)

Front 328

Treatment of symptomatic proximal ureteral calculi:
<10 mm
>10 mm

Back 328

- Shockwave lithotripsy
- Ureteroscopic removal

Front 329

Initial evaluation of patient with suspected ankylosing spondylitis

Back 329

X-ray of sacroiliac joint for evidence of sacroiliitis

Front 330

Extraarticular manifestations of ankylosing spondylitis (5)

Back 330

- Acute anterior uveitis
- Aortic regurgitation
- Apical pulmonary fibrosis
- Restrictive lung disease
- IgA nephropathy

Front 331

Lichen planus:
- Lesions
- Locations
- Diagnosis

Back 331

- Pruritic polygonal violaceous papules/plaques
- Flexural surfaces, esp wrists
- Skin biopsy

Front 332

Infectious associated with lichen planus

Back 332

HCV with advanced liver disease

Front 333

ART drugs to avoid in pregnancy (2)

Back 333

- Efavirenz
- Delaviridine

Front 334

HAART regimen

Back 334

- Two NRTIs
- One protease inhibitor or NNRTI

Front 335

Tx for catatonia in schizophrenia

Back 335

- Benzos
- ECT if benzos fail

Front 336

Post-exposure rabies ppx for people who have previously been vaccinated

Back 336

Vaccine (no Ig)

Front 337

Esophageal adenocarcinoma: location and risk factors
Esophageal squamous cell carcinoma: location and RF

Back 337

- Distal, GERD
- Proximal, smoking/alcohol

Front 338

Drug that must be administered at a 4 hour interval from sildenafil

Back 338

Alpha-blockers (e.g. doxazosin)

Front 339

Rx for ALS and class

Back 339

Riluzole (glutamate inhibitor)

Front 340

HBV serology in window period

Back 340

Anti-HBc Ab only

Front 341

Presentation of Meniere's disease

Back 341

- Periodic vertigo
- Unilateral hearing loss
- Tinnitus

Front 342

Subphrenic abscess: findings

Back 342

- 2-3 weeks after abdominal surgery
- Swinging fever
- Leukocytosis
- Cough
- Shoulder-tip pain

Front 343

Cancer with increased risk in celiac disease

Back 343

Intestinal T-cell lymphoma

Front 344

AK can develop into ___

Back 344

SCC of skin

Front 345

Management of venous sinus thrombosis

Back 345

Anticoagulation with heparin, even if an area of hemorrhagic infarction is seen on CT (b/c hemorrhagic foci are 2/2 venous hypertension)