CK

Question 1

Subarachnoid hemorrhage –> and other realted consequences by timeline !

Answer 1

rebleeding 24hrs

vasospasm - first week

circle of willis by-products from degraded blood causes vasospasm and meningeal irritation(stiff neck)

Question 2

Hydrocephalus from any reason

Answer 2

see multiple neurodeficits

Question 3

tods palsy

Answer 3

happens after a focal motor seizure

Question 4

Back pain that’s exacerbated by standing And Relieved with “sitting” and “hyperflexion” Of the hips?

Answer 4

Spinal stenosis

Question 5

Rheumatod Athritis and what joints of hand effected

Answer 5

Meta carpals and Proximals distal joints are spared

Question 6

Joint pain and stiffnes = gets worst by the course of the day

Answer 6

Osteoarthritis

Question 7

Multiple fractures and blue sclera

Answer 7

Osteogenesis imperfecta

Question 8

Hip Pain Back pain plus stiffness= that improves by the course of the day and gets worst at rest ? diagnosis test?

Answer 8

Ankylosing Spondylitis Test for HLA-B27

Question 9

Young men comes and has problems with urination (urethritis) red eyes (conjunctivitis) Bone pain (Arthritis)

Answer 9

Reactive Reiters M/c Chlamydia also Camplylobacter Shigella and Salmonella ,Ureaplasma

Question 10

55 y/o Sudden and excuciating pain MTP After drinking Red wine

Answer 10

Gout (N&N) Negatively bifringent and needle shaped

Question 11

Positively bifringent

Answer 11

pseudogout = rhomboid shaped

Question 12

Anemia and Increased ESR Elderly woman Hip and shoulder joint pain and stiffness

Answer 12

Polymyalgia Rheumatica

Question 13

Fall on outstretched hand= what bone fractured

Answer 13

Distal radius=colles also check scaphoid

Question 14

Humoral fracture= what signs present if radial nerve damaged

Answer 14

Wrist drops Thumb cant abduct

Question 15

Most common “ primary” and “malignant” tumor of bone?

Answer 15

Multiple Myeloma

Question 16

Unilateral “PeriOrbit pain” Tearing and “Erythema” on conjuctiva

Answer 16

Clustered by Cluster Headache

Question 17

Unilateral “PeriOrbit pain” Tearing and “Erythema” on conjuctiva

Answer 17

Clustered by Cluster Headache

Question 18

SubArachnoid Hemorrhage Most Common Cause is

Answer 18

TRAUMA second m/c cause is Aneurysm

Question 19

Middle age man with Acute broken speech What type of aphasia? What Lobe? What Is the Artery?

Answer 19

Broca Frontal Lobe Left Middle Carotid Artery Distribution

Question 20

Hyperdensity is Crescent shaped Does not cross Midline Which hemorrhage

Answer 20

Subdural Bridging Vein Torn

Question 21

Initially, Altered mental status Then a Lucid Interval

Answer 21

Epidural Hematoma Middle Meningeal Artery Treatment = Neurosurgical Evacuation

Question 22

CSF in SubArachnoid Hemorrhage

Answer 22

Increased ICP RBC Xanthochromia

Question 23

TCA Overdosed Effect on heart?

Answer 23

Anticholinergic effect Tachycardia Hypotension Wide P and R Wide QRS Wide Q and T Arrhythmia

Question 24

Anticholinergic Overdose Therapy

Answer 24

Supplemental Oxygen and Intubation IV Sodium Bicarbonate for QRS widening or Ventricular Arrhythmia

Question 25

Hypotension with Respiratory Depression Tachycardia and/or with Arrhythmia Dry mouth Dilated Pupil Blurry Urinary retention flushing and hyperthermia

Answer 25

TCA overdose Anticholinergic effects

Question 26

problem initiating swallowing

Answer 26

Oropharyngeal Dysphagia-- drools, nasal regurgitation, lungs regurgitation, recurrent aspirational Pneumonia ( mostly right lobe) usually liquids parkinson stroke Myasthenia prolonged intubation zenkers test -Do VideoFluorodic Barium Swallow

Question 27

Swalloing is ok but after few seconds feels sensation of food getting stuck

Answer 27

Esophageal Dysmotility or obstruction Achalasia Scleroderma spasm obstruction from goiter, strictures, Atrial enlargement

Question 28

Swalloing is ok but after few seconds feels sensation of food getting stuck

Answer 28

Esophageal Dysmotility or obstruction Achalasia Scleroderma obstruction from goiter, strictures, Atrial enlargement

Question 29

Hydralazine and Nitrates dilate what?

Answer 29

Hydralazine dilate ARTERIOLES Nitrates dilate VEINS

Question 30

Radiation Anthracycline chemo

Answer 30

Can cause pericarditis and it can take upto 20 years

Question 31

shiga toxin--\> how does it causes hemolysis

Answer 31

activates platelets (due to renal endothelial damage) ---\> platelets form microthrombi---\>microangiolytic hemolysis

Question 32

AVPR2

Answer 32

Hereditary Nephrogenic DI

Question 33

AVPR2

Answer 33

Hereditary DI

Question 34

renal artery stenosis and hypertension--\> how to diagnose?

Answer 34

doppler ultrasound duplex, only if abnormal urianalysis or high creatinine

Question 35

factors that precipitate HEPATIC ENCEPHALOPATHY

Answer 35

Hypokalemia sedatives, narcotics infecttion porto systemic shunt

Question 36

Alkalosis and nitrogen (LIVER problem)

Answer 36

excess bicarbonates converts nh4 to nh3 NH3 enters brain

Question 37

Beta 2

Answer 37

Releases insulin

Question 38

uvea

Answer 38

middle layer--\>between sclera and retina

Question 39

Bipolar 1 Drugs = How many?

Answer 39

four drugs for bipolar 1 Lithium and valproate Quietapine and Lamotrigine

Question 40

Lithium ContraIndication?

Answer 40

If Creatinine is more than 1.2

Question 41

Headache and momentarily vision loss and increasing blind spot

Answer 41

Increasing blond spot means OPTIC NERVE HEAD is INCREASING. Normally optic nerve head is a blindspot. ICP and Vision loss= pappilaedema

Question 42

Elderly and aldosterone relation

Answer 42

Increased Aldosterone elderlies--\>decreased baroreceptor reflex(autonomic crash) --\> hypotension--\>orthostatic Syncope---\>Renal Hypoperfusion--\>RAAS activated in response

Question 43

Severe coughing paroxysm?

Answer 43

can cause subcutaneous emphysema increased idntraalveolar pressure causes the air to leak out --\>pneumothorax--\>chest x ray

Question 44

Hemoptysis systemic causes

Answer 44

Wegener goodpasture SLE Vasculitis

Question 45

Hemoptysis Cardiac cuases

Answer 45

Mitral stenosis Acute Pulmonary Edema

Question 46

Low PLATELETS Elevated liver enzymes Hypertension Anemia

Answer 46

HELLP Don't worry about elevated Alkaline Phosphatase (pregnancy related elevation)

Question 47

HELLP

Answer 47

See Anemia Low platelets elevated liver enzymes--\> causes swelling of liver capsule

Question 48

Tilted uterus tender

Answer 48

Adhesions caused by ectopic endometrial implanted tissue ENDOMETRIoasis

Question 49

M Tuberoculosis Lymphadenopathy

Answer 49

Non Tender Mostly cervical

Question 50

papule and tender lymphadenopathy and pet exposure

Answer 50

Bartonella hansellae

Question 51

Bloor Urea Nitrogen

Answer 51

7-18

Question 52

TSH

Answer 52

0.5 to 5.0

Question 53

white, grey or tan discharge

Answer 53

Bacteria

Question 54

alpha 3 chain of collagen 4

Answer 54

goodpasture

Question 55

IgM Cold Aggluttins

Answer 55

EBV Mycoplasma WaldenStrom

Question 56

Hematocrit Male

Answer 56

41% to 53%

Question 57

Hematocrit female

Answer 57

36% to 46%

Question 58

fork in middle of head

Answer 58

weber test vibration heard better and compensatory amplified my middle hear in absence of air conducted ambient sound. person lateralizes to the affected ear in web

Question 59

WIdened Medistinum + Pericardial effusion + Syncope

Answer 59

Aortic Dissection

Question 60

Silent murmur

Answer 60

Ovale

Question 61

Most common infant cyanotic

Answer 61

Transposition of great vessels Give indomethacin to keep Arteriosis open to mix oxygenated blood into pulmonary artery

Question 62

Av Nodal Acting drugs for fibrillation

Answer 62

Digoxin Adenosine Beta blockers Calcium blockers They act on problem that arises from Av node in wolf --\>there is accessory pathway and AV is bypassed--\> give Procainamide or Ibulitide

Question 63

tet spell

Answer 63

Pulmonary stenosis in TOF--\>spasmed during tension--\> cyanosis due to increased PVR--\>blood flows through VSD from Right ventricle to LEft VEntricle

Question 64

acuminata ( condiluminata)

Answer 64

6 and 8 = low risk hpv they bleed

Question 65

lichen planus

Answer 65

T cell-mediated reaction against epithelial cells.

Question 66

HIGH FEVER leukopenia thrombocytopenia Elevated liver enzymes and also Lactate Dehydrogenase + TICK BITE

Answer 66

Ambylomomma Ehrlichiosis monocytes got mulberry like inclusions Empiric = Doxicycline

Question 67

Athlete/ runner/ dancer Underweight woman Point tenderness on bone/leg

Answer 67

Stress fracture of tibia overweight = diffuse pain ( not point )--\> shin splints

Question 68

CRYSTALS in tubules after drug intake

Answer 68

Acyclovir Sulfonamides methotrexate ethylene gycol protease inhibitors in hiv

Question 69

Frothy and yellowish or greenish discharchage with malodorous tinge to it

Answer 69

Motile truckomonas Give metro

Question 70

Offwhite fishy odor

Answer 70

gardarenella clue

Question 71

normal chloride

Answer 71

95-105

Question 72

perisistent vomiting and nystagmus

Answer 72

give thiamine

Question 73

sudden glaucoma\>

Answer 73

closed angle

Question 74

african with diabetes and cupping of optic disk

Answer 74

gradual open angle glaucoma

Question 75

social anxiety DSM5 = Perfomance related

Answer 75

Beta blockers on as needed basis benzo can be given but sedation will impact the presentation or performances try to control the symptoms like tremors, tachycardia and diaphoresis by a beta blocker

Question 76

Anteverted Uterus

Answer 76

curves down to push the bladder--\> incontinence

Question 77

DKA

Answer 77

monitor serum Anion gap give iv insulin iv potassium

Question 78

barky cough rhinorrhea congested

Answer 78

Croup steepling --\>laryngotracheitis parainfluenza virus give steroid for milder case add nebulized epinephrine for stridor at rest (serious)

Question 79

drooling, dysphagia, resp dristressed

Answer 79

Epiglotittis = H.I tripod sign

Question 80

age less than 5 lips or tongue mucositis conjuctivits fever not responding to anti pyretics strawberry tongue blanching maculopapular rash

Answer 80

kawasaki disease

Question 81

3 hurtz wave on eeg no postictal period lost in staring Easily provoked by hyperventilation lasts about 20 seconds

Answer 81

Absence seizure both hemispheres

Question 82

Lost in stare plus a postictal state 2-3 minute episode normal eeg

Answer 82

Focal seizure

Question 83

HyperEsthesia

Answer 83

Excessive sensitivity to the touch to skin

Question 84

Rash head to trunk spares palms and soles darkens/coalescense high fevers longer duration

Answer 84

ola measle

Question 85

fever leaves but rash comes

Answer 85

roseola

Question 86

pinkish rash head to trunk well appearing child milder fever

Answer 86

ella-rub

Question 87

most common cause of spontaneous lobar hemorrhage in elderlies

Answer 87

Amyloid angiopathy amyloid protein gets deposited in the vessel walls and causes the weakening of the vessels --\> leads to formation of the hematoma ( increased ICP ) or Rupture most common lobes are parietal lobe and occipital lobe parietal lobe rupture=somatosensory zone affected--\>contralateral Hemisensory loss

Question 88

high cholesterol low sodium

Answer 88

hypothyroidism it is hypotheized that low thryoid slows metablosim of cholesterol and increases adh or decreases gfr

Question 89

Normal albumin

Answer 89

4

Question 90

below 200 cells in HIV whats the prophylaxis

Answer 90

TMP-SMX for =PCP and tox Azithromycin = Avium

Question 91

ELDERLY+ diabetic+ gradual decline in sensorium

Answer 91

hyperosmlolar = Hyperosmolar hyperglycemic state due to hopovolemic state led decrease in gfr

Question 92

pulsus paradox

Answer 92

systemic blood pressure that drops during inspiration is more than 10 1) heart constricted due to cardiac temponade, the pericardial sac 2) lyngs hyperinflated and pushe heart from both sides and not let it accomodate blood so, during inspiration the venous return comes to the right heart --\> pushes the interventricular septum in to the left ventricle--\>decreases stroke volume

Question 93

Acute Unilateral swollen lump on neck non toxic appearcing age less than 5 years

Answer 93

Lymphadenitis due to aureus no systemic symptoms Bilteral is EBV with systemic

Question 94

Crystal violet dye on PERIPHERAL SMEAR

Answer 94

detects insoluble hemoglobin precipitated in rbc , in wake of g6pd deficiency

Question 95

pain on hip 'flexion' pain on hip extension

Answer 95

septic joint psoas sign

Question 96

Tocolytics

Answer 96

Indomethacin B2 agonist nifedipine Magnesium= weak tocolytic but used for fetal Neuroprotection in \<32 weeks

Question 97

unilateral swelling of a lymph node plus tender

Answer 97

aureus adenitis Markedly tender and Erythematous Unilateral = Bacterial Bilateral = Viral = Adenovirus, EBV, CMV

Question 98

African American urinating frequently despite decreasing intake

Answer 98

Hyposthenuria Sickle cell trait or disease if trait, cells sickle in hypoxic and hyperosmolar conditions of vasa recta in renal medulla------\>impairs free water reabsorption and also impairs counter-current exchange ( low gravity urine/unconcentrated)

Question 99

CoPD AND Edema Relation

Answer 99

Copd = hypoxic lung problem---\>Vasoconstricted pulmonary vasculature-----\>pressure backs up \>\>Pulmonary Artery\>\>\>Right Ventricle\>\>\>\>Veins\>\>\>\>\>\>Edematous conditions Isolated Right heart failure due to Pulmonary Disorder--\> Cor Pulmonale see = Jugular Wave AKA a wave Congested Liver tricuspid regurgitates

Question 100

Answer 100

Pulmonary capillary wedge pressure measures left ventricular end diastolic pressure

Question 101

Poisoning case pills on the floor Opacities seen on abdomen Xray Hypotensive and Hematemesis Labs show low CO2

Answer 101

Iron ( Not Aspirin) Biggest clue= Opaque 30 mins= Abdominal pain, Vomits, diarrhea and Hypotensive shock 2 days= liver necrotic 2-8 weeks = Pyloric Stenosis Iron = vasodilatory--\> hypotensive--\> unperfused body--\>lactic acid buildup--\> anion gap acidosis---\> respiratory compensation

Question 102

Painless monoocular vision loss and Painful monocular vision loss

Answer 102

Painless = emboli with matching history Painful = Angle-closure Glaucoma ( will see red eye too) Embolized Central retinal Artery= Retina Whitening---\> ocular massage with high flow oxygen is most rapid for close angle glaucome==Topical pilocarpine or beta blocker topically

Question 103

Monospot Heterophile test

Answer 103

Comes negative in first week (25%)

Question 104

catching or locking feeling no pain on rotation/extension/flexion of the knee no ligamentous laxity patient played soccer and came with joint pain--\>later had a swelling

Answer 104

meniscal tear

Question 105

Vertical cesarean or history of myomectomy

Answer 105

precaution on uterus rupturing

Question 106

lack of empathy entitlement

Answer 106

Narcisstic

Question 107

Dramatic Seeks Attention

Answer 107

Histrionic

Question 108

Chaotic relationships Labile mood Impulsive Inner emptiness and self harm

Answer 108

Border

Question 109

Odd Thoughts odd perceptions odd Beliefs

Answer 109

Schizotypal

Question 110

apgar scores

Answer 110

Question 111

VDRL RPR

Answer 111

Treponema Pallidum syphilis

Question 112

Rhinorrhea Abnormal long bone radiographs Diffuse MaculoPapular rash that desquamates

Answer 112

congenital Syphilis see blueberry muffin =due to extramedullary hematopoiesis jaundice and hepatosplenomegaly--\>due to activated reticuloendothelial system

Question 113

Toddler with UTI Treated for and now is well what next?

Answer 113

do Ultrasound of bladder and kidneys to rule out any anatomic problems

Question 114

Pertusis case in family

Answer 114

give macrolides to every family member azithromycin clarithromycin Erythromycin

Question 115

Answer 115

Lobar pneumonia = increased fremitus Strep Klebsiella in alcoholics Legionella = severe pneumonia

Question 116

Herniated disk pain

Answer 116

Radiates to the thighs Positive straight leg test

Question 117

Lumbosacral strain

Answer 117

back pain with negatives negative = straight leg test Negative = Babinski Deep tendon reflexes = normal

Question 118

Compression fracture of Vertebrae

Answer 118

Intense back pain + Local spinal Tenderness Postmenopausal or senile cases

Question 119

Urine Sodium is more than (----) in hyopvolemic patient in (----) & FENa is (----), along with urine osmolarity of (-----) see what casts

Answer 119

20 In Acute Tubular Necrosis FENa = more than 2% Urine Osmolarity is always more than 300 Dark ( muddy brown cast)

Question 120

Muddy Brown cast what urine osmolarity is mostly seen ?

Answer 120

Always more than 300 case of Acute Tubular Necrosis

Question 121

Chronic Renal Failure and what casts

Answer 121

Broad casts ( waxy) CRF---\> Reduces renal Mass---\>Tubules dilate and nephrons enlarge to compensate--\>This is where broad casts originate

Question 122

Fatty casts

Answer 122

Nephrotic syndrome

Question 123

subtract the risk (exposed) from risk (unexposed) divide it by risk (exposed)

Answer 123

Attributable risk percent

Question 124

Attributable Risk

Answer 124

a/a+b - c/c+d The difference in risk between exposed and unexposed

Question 125

Relative Risk?

Answer 125

Risk of developing the disease in the exposed group Divided by risk of developing the disease in the unexposed group a/a+b divided by c/c+d Cohort

Question 126

Cohort Studies

Answer 126

Compares two groups one group has a risk factor or a exposure second group is totally without it Exposed vs non exposed

Question 127

Unable to respond to protein C

Answer 127

Factor 5 Leiden Autosomal Dominant White Population

Question 128

Erythema Nodosum

Answer 128

Inflammation of fat cells under the skin results in tender red nodules or lumps IBD, behcet, Sarcoidosis (african) infection= strep, mycoplasma,ebv,histo,cocco,yersinia,catscratch

Question 129

ST depression in Lead I & aVL

Answer 129

Posterior MI RCA

Question 130

Left Anterior Descending artery

Answer 130

Leads V1-V6 ----\>Anterior Heart ischemia

Question 131

Bacterial Meningitis above 50 y/o

Answer 131

Listeria (Ampicillin) Strep (Cefepime-pseduomonas,HI,neisseria) neisseria Cefepime, Vancomycin, Ampicilin

Question 132

Incomplete fusion of MULLERIAN duct

Answer 132

Bicornuate or a heart shaped uterus --\> more chances of Cornuate/ interstitial ectopic pregnancy Cornuate area has abundant blood supply--\> Uterine and ovarian vessels ---\> hemorrhage here can be life-threatening

Question 133

Infant sneezing tachypneic diaphoretic irritated poor sleep tremors

Answer 133

mom abused Heroin Opioids have the most dramatic effects of withdrawal seen on infant Mother addicted to heroin should be put on Methadone---\> later infant can be controlled

Question 134

Infant showing jitteriness Hyperactive Moro Refelx excessive sucking

Answer 134

Cocaine Placental Abruption

Question 135

Answer 135

Painless Bright blood bleeding that ceases in 1-2 hours with or without uterine contractions Transabdominal/Transvaginal ultrasonography first give tocolytics if premature then give betamethason and deliver with C-section

Question 136

TNF and Interleukin 1 inhibitor

Answer 136

Sulfasalazine ( liver toxic and hemolytic anemia, stomatitis) hydroxychloroquine ( Retinopathy )

Question 137

Tissue Necrosis Factor Inhibitors

Answer 137

Certoli Etanercept Infliximab Golimumab Adalimumab

Question 138

Collision---\> Direct blow ---\> lower abdomen and pelvis diffuse pain in the abdomen dull pain in the shoulder CT scan of the abdomen and pelvis will most likely has impact on

Answer 138

Dome of the bladder ( bordered by the peritoneal cavity--\>phrenic nerve--\>shoulder) Increased intravesical pressure--\>crushes cure is always obtained upon suturing without sequelae

Question 139

High riding prostate on digital rectal exam

Answer 139

Posterior Urethral injury (---\> bulbourethral junction or membranous urethra) Extraperitoneal

Question 140

Normal Potassium values

Answer 140

3.5 --\>5.0 Beta agonists and Insulin causes Hypokalemia ---\> by shifting potassium into the cells K+ channel blocking antiarrhythmics= Ibutilide, sotalol, dofetilide, Amiodarone

Question 141

Normal Bicarbonate

Answer 141

22-28

Question 142

Back pain or Abdominal Pain hypotension Syncope

Answer 142

Possible Abdominal Aortic Aneurysm can spill into RetroPeritoneum--\>can cause aortocaval fistula--\>with Inferior Vena Cava---\> Venous Congestion in retroperitoneum---\>like bladder---\>fragile and distended veins in bladder rupture---\> Gross Hematuria

Question 143

Chronic blockade of Dopamine receptors

Answer 143

leads to D2 receptor upregulation and supersensitivity-----\> Tardive Dyskinesia (TD, or could be from Excitotoxic destruction of GABA neurons in Striatum)

Question 144

Preoccupied with details sense of control preoccupation with orderliness and perfectionism

Answer 144

Obsessive-compulsive personality disorder versus OCD = ritualistic behaviour

Question 145

how to evaulate fetus hypoxia or not ( in case if there is lesser fetal movements reported by mother )

Answer 145

Biophysical profiling Non-stress test= fetus showing an increase of at least 15 beats to its normal graph upon stimulation (mother should be monitored on lateral tilt) Contraction test= FHR is monitored via spontaneous or induced ( nipple/oxytocin)--\>good if negative --\>no late decelerations Contraction test contraindicated in volatile membrane cases BPP = scoring --\>Fetal tone, fetal breath, fetal movement, amniotic fluid Volume, Fetal NST score of 2 for all== 8 or above is ok

Question 146

Utero-placental insufficiency

Answer 146

causes fetal decelerations

Question 147

Barky Cough Inspiratory stridor rhinorrhea congested

Answer 147

Croup --\> URI--\>Subglottic space narrowed---\> Steeple sign--\>inflammation of Larynx--\>Laryngotracheobronchitis---\> Hoarse Voice & Inspiratory stridor that worsens with agitation IM Corticosteroid & Nebulized Epinephrine Single stranded negative sense helical ParaInfluenza

Question 148

Time of the year= Fall/Winter Crackles and coarse sounds (washing machine) Increased Respiratory Rate CXR may show hyperinflated Lungs, Interstitial infiltrates & Atelectasis

Answer 148

RSV--\> Bronchiolotis 2-4 days of prodromal fever with rhinorrhea MILD fever vs bacterial pneumonia(toxic looking) Lower Respiratory Track Corticosteroid no help

Question 149

Inspiratory and Expiratory Stridor (Biphasic) Improves with Neck Extension (decreases tracheal compression) Worsens when prone

Answer 149

Vascular Sling Stridor plus dysphagia, Vomiting and difficulty feeding seen very early at age = \<1 y/o

Question 150

Chronic Inspiratory only stridor that improves with prone position

Answer 150

Laryngomalacia collapse of supraglottic structures

Question 151

drooling and stridor difficulty in handling oral secretions

Answer 151

swelling of epiglottis H.influenzae nontypable and strep serious & progressive(lifethreatening) dysphagia,muffled voice cyanosis inspiratory retractions To maximize air entry --\> patients sit like sniffing dog position ---\> tripod --\> neck extended and chin protruding DO not examine the throat (may cause laryngospasm) in absense of anesthesiologisy/otolaryngologist Xray--\>Thumb print sign true emergency --ABC--\> secure airway--\>intubate/tracheostomy--\>IV antibiotic( ceftriaxone/cefuroxamine

Question 152

Glomerular hematuria facts

Answer 152

Microscoping and not Gross PSGN IGA nephropathy Alport Dysmorphic RBC cast

Question 153

BRCA

Answer 153

BRCA 1 = 60% Breast and ovarian cancer after birth, do bilateral prophylactic Salpingo-Oophorectomy (BSO)

Question 154

secondary Raynaud

Answer 154

caused by SLE (ANA) Scleroderma( Anti TP-1) Thromboangiitis obliterans

Question 155

tugging on ear ear pain Bulging or Retraction Of TM

Answer 155

Acute Otitis Media High Dose Amoxicillin Chronic Otitis Media---\>Tympanostomy Tube

Question 156

Otitis Media Complications

Answer 156

Meningitis TM perforation Mastoiditis Cholesteatomas

Question 157

-1 Station

Answer 157

Question 158

Breech fetus

Answer 158

Question 159

Anovulation

Answer 159

Progesterone defect Progestin challenge--\> WIthdrawal bleed---\>if bleeds than due to nonCyclic GnRH problem or PCOS

Question 160

Progestin Challenge

Answer 160

give for 10 days--\> if bleeds---\> Then noncyclic gnrh or PCOS If doesnt bleed--\> ovaries not secreting estrogen

Question 161

Exenatide Liraglutide

Answer 161

Glucagon-Like peptidase---\>decreases the release of Glucagon Weight loss also is seen no HYPOGLYCEMIC risk given mostly after Metformin failure Pancreatitis (Ar)

Question 162

Action on Glucagon | (Antidiabetic)

Answer 162

Exenetide Liraglutide Adverse reactions--\> Weight loss, Pancreatitis

Question 163

Adverse Reactions Edema Fractures Heart Failure

Answer 163

Glitazone Pioglitazone Rosiglitazone

Question 164

AntiDiabetic Contraindicated in Renal Failure

Answer 164

Acarbose Miglitol (Intestinal Brush Border)

Question 165

CXR = Enlarged Pulmonary Arteries Echo=RVH--\> comes with RHF--\>Edema, JVD, Abdominal Distention

Answer 165

Cor pulmonale Due to Idiopathic Pulmonary Htn M/c is due to COPD

Question 166

Envelop Shaped or Dumbbell-shaped Stone

Answer 166

Calcium Oxalate Ethylene Glycol, crohns Happens when citrate is sent less to the kidneys (Hypocitarturia)

Question 167

Anion Gap

Answer 167

S-BC = 10 to 14 is normal Sodium minus Total of (HCO3 and Chloride)

Question 168

hemolysis leukopenia fever jaundice hepatosplenomegaly tonsils with exudates

Answer 168

EBV Viral suppresses WBC splenic congestion--\>platelet sequestration--\>thrombocytopenia hemolysis--\>jaundice EBV induced cross-reactivity--\>antibodies also act on RBC & platelets ( increased reticulocytes and thrombocytopenia)

Question 169

Macroglossia hemyHYPERPLASIA hyperinsulinism Omphalocele

Answer 169

Beckwith-Wiedemann syndrome plus Wilms Tumor WT 2 mutation

Question 170

Early sclerosis--\>diffuse--\>of mesangium--\>early age Nephrotic plus dysgenesis of gonads(pseudohermaphroditism) plus Wilms tumor

Answer 170

Denys-drash Syndrome

Question 171

Unilateral Palpable mass (flank)

Answer 171

Wilms loss of function of WT1 or 2 on chromosome 11

Question 172

cherry red spot

Answer 172

Macula receives blood supply from ciliary arteries that arise from the ophthalmic artery rest of the eyeball receives from the central retinal artery that also branches off from the Ophthalmic artery

Question 173

Peripheral nerve disorders?

Answer 173

Guillain Barre diabetic neuropathy Myeloma--\>Amyloid neuropathy Lead poisoning

Question 174

Upper Motor Neuron Disorders

Answer 174

Vasculitis Leukodustrophy B12 deficiency Brain Mass

Question 175

Answer 175

tonsillar exudate cervical adenitis strep

Question 176

post Anesthesia--\>major hypertension tachycardia pale History of hypertension and headaches

Answer 176

Pheochromocytoma Paraganglionomas produce catecholamines from chromaffin cells Episodes can be brought on by pressure on the stomach like from palpation or position changes//Anesthetic drugs//Surgical procedures

Question 177

syphilis plus antibiotic treatment

Answer 177

problem Post Spirochetal treatment ---\> Jarisch-herxheimer reaction Rapid destruction of spirochetes--\>febrile illness---\>typically within 12 hrs--\> headache, sweating,hypotension plus syphilitic rash--\> diffuse and macular on palms and soles

Question 178

Premenopausal Woman premenstrual pain of breast bilateral multifocal

Answer 178

Fibrocystic change' case fluid filled--\> duct dilation--\>simple cysts that are nonproliferative lesions

Question 179

Most common cause of nipple discharge---\> serous or bloody

Answer 179

Intraductal papilloma

Question 180

Estrogen containg drugs for migraine patient!

Answer 180

contraindicated

Question 181

Four most common drugs that cause WBC to increase in urine with maculpapular rash

Answer 181

Interstitial nephritis TMP-SMX Cephalosporin NSAID Penicillin

Question 182

Tender Warm Erythematous Rash Raised boundaries Fever

Answer 182

Erysipelas Group A pyogenes

Question 183

Otitis Media vs Externa

Answer 183

Media= Haemophilus influenzae, Strep, Moraxella Externa = Pseudomonas Aeruginosa

Question 184

Bilateral Patchy inflitrates post trauma

Answer 184

ARDS

Question 185

Nikolsky positive

Answer 185

SJS Toxic epidermal Necrolysis- more than 20% of the body plus mucus gland involvement Pemphigus Vulgaris Staphylococcal scalded skin syndrome

Question 186

Meningitis case management

Answer 186

LP--\>IV antibiotics

Question 187

Waking up with headche blurry nausea vomiting

Answer 187

DO MRI | (not just the migraine case)

Question 188

Cluster

Answer 188

Oxygen and verapamil

Question 189

COPD family

Answer 189

Bronchitis (Mucus glands hypertrophied and at least 3 months of a productive cough) Emphysema Asthma FEV1/FVC --\> less than .7 Maximum inspiration--\>expire maximally=VC

Question 190

Renal failure plus creatinine very high and parathyroid mechanism

Answer 190

Excess Phosphorus & low calcium--\>secondary HyperParathyroid----\>raises calcium from bones and excretes phosphorus Secondary hyperparathyroidism ( chrnonically, in ESRD--\> does lead to tertiary primary hyperparathryodism)

Question 191

TB mimicking infections living in granulomas

Answer 191

Histoplasmosis Blastomycosis

Question 192

Hilar Lymphadenopathy Mediastinal lymphadenopathy erythema nodosum caseating granuloma

Answer 192

Histoplasmosis = Mississippi and Ohio river basin Organism targets histiocytes and reticuloendothelial system---\>Lymphadenopathy, pancytopenia, and hepatosplenomegaly

Question 193

Patient with splenectomy and tick fever chils and sweats tender and palpable liver edge

Answer 193

Babesiosis case Hemolytic Anemia--\> Intravascular hemolysis --\>dark urine,jaundice, reticulocytosis, increased lactate dehydrogenase, Indirect Hyperbilirubinemia Thrombocytopenia Organisms live in rbc--\>MALTESE cross Atovaquone plus azithromycin severe--\>clindamycin plus quinine

Question 194

fever rash that spreaded centripetally on palms and soles

Answer 194

RMSF

Question 195

Juvenile Idiopathic Arthritis young patients come with multiple joint pain

Answer 195

Chronic Inflammation of more than one joints--\>symmetric--\>atleast 6 weeks Inflammation--\>hepcidin hides iron--\>anemia hyperferritinemia Hypergammaglobulinemia chronic inflammation--\>vitamins and iron used up by WBC--\>anemia thrombocytosis increased ESR Increased CRP

Question 196

Which one is gall bladder in this ct scan

Answer 196

Round green is gall bladder

Question 197

Pan tri regurg (systolic murmur) Parasternal heave Ascites Hepatomegaly JVD Abdominal Distention/pain

Answer 197

Right heart failure could be due to Pulmonary Hypertension PH could be due to COPD, Raynaud's

Question 198

Structural abnormalities in Orbitofrontal cortex and basal ganglia ?

Answer 198

seen in Obsessive Compulsive Disorder

Question 199

Infant with accelerated head growth Increased head volume

Answer 199

Autism

Question 200

Atrophied ( red in picture)

Answer 200

Huntington CAG decreased Ach and GABA Increased Dopamine Aggression depression and then dementia

Question 201

Schizophrenia Plus Mood

Answer 201

SchizoAffective hallucinations/delusions (schizophrenia) happened at least once in The absence of MOOD symptoms

Question 202

narrowed airways or inflammation

Answer 202

whistling sound --\> wheezing

Question 203

Chronic Cough

Answer 203

post nasal drip (Airway cough Syndrome) GERD Asthma ace i NonAsthmatic eosinophilic bronchitis Chronic Bronchitis Bronchiectasis Malignancy Parenchyma of Pulmonary problems

Question 204

Bleeding ectopic pregnancy--\>where to see the blood

Answer 204

the pouch of Douglas ( cul-de-sac) Recto-Uterine Pouch do culdocentesis

Question 205

Ageing man central vision problem versus peripheral vision problem

Answer 205

Central aka Scotoma--\> Macular degeneration (oxidatve,chroidal neovascularization VEGF)--\>distortion/metamorphsia peripheral pressure---\> Glaucoma ( open angle--\> years) opacification of lens--\>(diabetes) Cataract

Question 206

progesterone analogs magstrate medroxyprogesterone

Answer 206

for cachexic patients to increase appetite

Question 207

Metoclopramide

Answer 207

Prokinetic for gastroparesis and Antiemetic too Erythromycin ---\> IV --\>acute exacerbation of diabetic gastroparesis

Question 209

Promethazine

Answer 209

Antihistamine

Question 210

M3

Answer 210

Gq Increases secretions Increases Gut Peristalsis Increases Bladder Contractions releases insulin miosis constricts bronchioles(methcholine--\>challenge test for asthma) Used by --\>Ach,Neostigmine,Bethanecol Carbachol(open angle glaucoma)--\>constrics pupil--\>humor lets flow Pilocarpine-\>for closed angle--\>contracts sphincter of pupil and cililary muscle--\>for open angle

Question 211

Too much of lucency of lungs on CXR

Answer 211

Air filled lungs--\>too much lucency means extra air in lungs--\> emphysema Lower bases--\> Panacinar --\>AAT deficiency Upper base--\>Centrilobular--\>Smoking

Question 212

Marfanoid fair skin and hair and blue eyes slurry speech w/ left sided weakness seen ophthalmologist

Answer 212

Homocystinuria ( fair skin and hair) marfanoid habitus ectopic lentis chances of thromboembolic events --\> stroke

Question 213

seizuric patient urine labs show--\>large blood but low or non rbc

Answer 213

Rhabdomyolysis standard urinalysis cannot differentiate between myoglobin and hemoglobin Large amount of myoglobin --\>leads to renal failure

Question 214

4 Month Old Severe Hypoglycemia Increased Lactic Acid Round face like a doll history--\>episodes of infection/otitis media physical--\>lethargic & flat anterior fontanelle

Answer 214

Glucose-6-phosphatase deficiency Glucose --- X---\> Glucose 6 Phosphate Glycogen stored up Hepatomegaly Renomegaly Severe Hypoglycemia--\>Seizures The liver does not pump out Glucose--\> increased lactic acid and triglycerides Increased Uric Acid--\> Gout

Question 215

Infant--\>infection--\> --\>hypoglycemic--\> --\>sudden death

Answer 215

MCAD can't use fatty acids to make ketones during fasting or during infection ( increased demand)

Question 216

MCAD deficiency See what on lab

Answer 216

Hyperammonemia fatty acyl carnitines in blood seizures coma Liver dysfunction Avoid fasting

Question 217

What two deficiencies cause Hypoketotic Hypoglycemia

Answer 217

Systemic primary Carnitine deficiency Medium Chain Acyl-CoA Dehydrogenase Deficiency

Question 218

Cell Type Infection or Drug----\> hemolytic anemia Cells without cental pallor=

Answer 218

Spherocytosis

Question 219

Howell-Jolly Bodies

Answer 219

Spleen Problem Nuclear Remnants Normally removed by the spleen seen in #Asplenia or functional #hyposplenia

Question 220

Excess Iron in Mitochondria

Answer 220

Sideroblastic Anemia Basophilic Stipple--\> peripheral smear Directly in Bone Marrow--\>special stain--\>Prussian Blue

Question 221

Bone Pain Cytopenia Hepatosplenomegaly

Answer 221

GlucoCEREBROsidase def--\> Gaucher

Question 222

Normal Blood Urea and Nitrogen

Answer 222

7-18

Question 223

Prothrombin Time

Answer 223

1 2 5 7 EXTRINSIC 10 INR--\> Measures PT--\> if increased PR--\> Extrinsic 7 defect 1 is normal aPTT--\> all factors except 7 and 13 --\> Intrinsic defect if increased

Question 224

Partial Thro

Question 225

Cirrhotic patient comes with variceal bleed

Answer 225

Volume repletion with IV --\> Give antibiotics to gastrointestinal bleed for infection complications ---\> Give octeoride to inhibit vasodilatory hormones --\> Endoscopy--\>in 12hrs--\> to diagnose and treat active bleed --\>Uncontrollable bleed case--\>put temporary balloon tamponade

Question 226

Myeloblasts

Answer 226

peroxidase positive

Question 227

Mouth ulcers Nonbloody diarrhea Abdominal Pain arthritis Rash--\>erythema nodosum

Answer 227

Crohns cobble stone and skip strictures and bowel wall thickens

Question 228

SBO proximal

Answer 228

Early Vomiting Abnormal Contrast filling on CXR

Question 229

Mid or Distal SBO

Answer 229

Colicky Abdominal Pain Prominent Abdominal Distension Dilated Loops on CXR Hyperactive bowel sounds Constipation-Obstipation

Question 230

SBO Most common cause

Answer 230

Adhesions --\>Post surgery or inflmmation processing COngenital--\> Ladd in Infants

Question 231

Fundal Placenta

Answer 231

Attached at top of the uterus

Question 232

pain on heel most intense in morning --\>first steps--\>gets better later patient is a runner or stood for long time on hard surface

Answer 232

Plantar fasciitis

Question 233

ELderly Patient acute ankle pain swelling and warm progressive pain involved joint has effusion articular cartilage has chronic calcification

Answer 233

Pseudogout acute cases Calcium pyrophosphate--\>Positive bifringent Rhomboid shaped Chondrocalcinosis usually present effusion has inflammatory cells--\>inflammation causes warmth and tenderness

Question 234

Synovial fluid Analysis effusion 15000-30,000 cells/mm3

Answer 234

Pseudogout

Question 235

Synovial fluid effusion WBC --\> upto 50,000 cells/mm3

Answer 235

Urate Gout More than 50,000 cells/mm3 --\> Septic Arthritis

Question 236

Cauda equina roots

Answer 236

Not part of spinal cord counts in the Peripheral Nervous system Below L1-L2 --\>L4 to S5 Send out Parasympathetic flow--\> bladder and lower bowel Urethral and Anal Sphincter sensorium to saddle area

Question 237

Cauda equina vs Conus Medullaris

Answer 237

Cauda equina --\>L4 to S3 Gradual--\> Lower tail like fibers--\> Assymetric involvment of ROOTS--\> LMN roots--\>peripheral--\>hyporefelxia --\> Saddle anesthesia,leg involvement and radiculopathy --\> most likely Cauda equina Conus--\>ENds at L3--\>Bladder dysautonomia--\>Injury to the spinal region and also the roots--\>UMN and peripheral --\>

Question 238

Bacterial endocarditis management

Answer 238

Obtain serial blood cultures from three different Venipuncture sites prior to starting an antibiotic therapy to ensure the microorganism is identified

Question 239

Patient with history of PVD +atherosclerosis (High Cholesterol) or Alcohol comes with epigastric pain increased amylase or lipase mottled skin

Answer 239

Pancreatitis Atheros--\>give antiplatelet only--\>IV only--\>nothing given by mouth supportive care

Question 240

Antiarrhythmic drugs slow binding and slow rate of dissociation

Answer 240

1C Flecainide & Propafenone Binds to tissue in action and potentiate QRS widening Contraindicated in Post-MI & Structural heart abnormalities

Question 241

Patient in emergency Post trauma respiratory distress in 10 hrs no rash

Answer 241

Pulmonary contusion Non-lobular pneumonia--\> not dependent on anatomic landmarks more than 10 hrs--\> plus rash = fat emboli from broken bone--\> Rash accompanies too

Question 242

Fever leukocytosis bloody stool with mucus Abdominal Distension

Answer 242

Xray check for toxic megacolon post difficile or IBD

Question 243

Normal Oxygen Saturation

Answer 243

95---\>100% PAo2= Alveolar Pao2=Arterial

Question 244

Passive VAccine!!

Answer 244

Preformed Antibodies IgG --\> crosses placenta IgA--\> in breast milk Humanized Monoclonal Antibodies

Question 245

Passive Vaccinations for--?

Answer 245

Tetnus Diptheria Hepatitis B Rabies Varicella Botuli

Question 246

Oscillopsia---\>?

Answer 246

Gentamicin Aminiglycoses next level of vertigo ototoxicity/cochlea cells damaged + motion sensitive vestibular cells in the inner ear damaged aka vestibulopathy--\>both end organs damaged--\>No left right imbalance--\>patients don't feel vertigo Oscillopsia--\> see the objects moving Abnormal head thrust test--\>eyes miss the target--\>get to the target after a bit

Question 247

whats the fracture--\> of what bone--\> what important structures --\>

Answer 247

Supracondylar fracture of the Humerus Median nerve and Brachial artery at risk

Question 248

FInger Clubbing Mechanism

Answer 248

Megakaryocytes skip the Pulmonary route --\>That fragments them Instead goes to the microcirculation --\>nail beds --\>gets stuck in there due to size--\> release --\> PDGF & VEGF Cases Right --\> Left Shunt Cystic FIbrosis Lung MAlignancies

Question 249

Humid vacation comes back with hypopigmented spots

Answer 249

Tinea Versicolor Malassezia Globosa if multiple Malassezia Multicularis

Question 250

A patient comes in winter no erythema no exudates

Answer 250

Icthyosis Vulgaris attributed to dryness at young age gets worse as you age a defect in a filaggrin gene give keratolytics or topical retinoids

Question 251

Progressive muscle weakness difficulty making facial expressions atrophy of thenar and hypothenar Testicular Atrophy Delayed relaxation on the contraction of thenar and hypothenar

Answer 251

CTG Myotonic Chromosome 19 Arrhythmia Balding Cataract Infertility death from respiratory failure or cardiac --\> Weakness of Skeletal(face forearm foot drops), Cardiac(conduction) and Smooth muscles(Dysphagia)

Question 252

Becker vs dystrophin

Answer 252

Both XLR Dystrophin starts earlier--\>age2 Becker at 6 Both have Cardiomyopathy--\>Dystrophin has scoliosis too

Question 253

X linked Dominant Big testes

Answer 253

Fragile X Long face and Large Jaw with MVP Hypermethylated FMR1 Gene--\>stops expressing Most Common cause of --\>Inherited --Intellectual Disability

Question 254

Chronic Major depression with psychosis Patient won't eat or drink

Answer 254

ECT or antidepressive with antipsychotic

Question 255

M3

Answer 255

BronchoConstriction AntiMuscarinics--\>Ipratropium, Toptropium (Long Acting) -------------\>COPD Antimuscarinic AR (Mioisis blocked--\>dilated pupil, accomodation blocked--\>glaucoma danger)

Question 256

Anti-Saccharo myces cerevisiae antibody

Answer 256

Th1--\>Non Caseating--\>Crohns

Question 257

Crypt Abscesses P-ANCA Blood in stool or tissue

Answer 257

Ulcerative colitis ( Check for colorectal carcinoma--both crohn and UC)

Question 258

woman gravida 5 Coughing/laughing---\>Pee

Answer 258

Stress with normal post voidal urine vol little voiding post sneezing/cough --\>weak pelvic floor levator ani damaged --\>u shaped sling that holds--\> urthera and bladder in place damaged sling--\> hypermobile or prolapsing urethra or bladder

Question 259

Performance anxiety tremors and tachycardia to use as need basis

Answer 259

Beta-blocker propranolol sole perfomance anxiety avoid drowsiness of benzos

Question 260

Chronic Sinopulmonary infections with infertility

Answer 260

Cystic fibrosis--\> absent vas deferens--\>Azoospermia Primary ciliary dyskinesia---\>immotile sperm

Question 261

Prophylactic therapy for ARF

Answer 261

Benzathine IM Penicillin G Every 4 weeks

Question 262

Loud S1

Answer 262

atrial doors delay in natural closing during end of ventricular diastole---\> ventricular systole then closes it delay--\>either by increased atrial pressure or short diastole in tachycardia stenotic valve

Question 263

Breast swelling w/pain diffusely warm & erythematosus with dimpling

Answer 263

Inflammatory Breast Carcinoma Rapid onset Edematous cutaneous thickening Rare but aggressive Next step is to screen--\>Mammography & Ultrasound but biopsy confirms peau de orange

Question 264

Prostate Cancer bone lesions ?

Answer 264

Osteoblastic Osteolytic--\>Multiple Myeloma

Question 265

Toddler--\> 12th month old

Answer 265

Pincer Grasp Stands well Walks first step in independence Says more than mama and dada 18th month----\> runs and kicks a ball (10-25 words)

Question 266

Radioactive Iodine Therapy

Answer 266

taken up by thyroid or extra tthyroid tissue( toxic nodula or adenoma) Beta emission --\>induces slow necrosis of follicular cells--\> 90% get permanent hypothyroid ( in case thyroid uptake --\>extra tissue case stays normal)

Question 267

Brain stem models

Answer 267

T--\>M--\>P---\>M Thalamus--\>Midbrain--\>Pons--\>Medulla Basilar Artery--\>P--\>M--\>Lower medulla Basilar--\>AICA--\>Pons--\>Facial Droop Subclavian--\>Vertebral--\>PICA--\>Lateral Medulla--= 9/10/11-\>Hoarseness) ( spinothalamic-\> pain & temp from contralateral)

Question 268

Hoarseness and Contralateral Pain and Temperature loss

Answer 268

PICA--\>Lateral Medulla smoked Subclavian----------\>Vertebral---\>PICA 9-10-11 Smoked---------\>Dysphagia+Hoarseness ST smoked---------\>Contralateral Pain and temp Sympathetic fibers smoked---\>Ipsilateral Horners Inferior cerebellar peduncle smoked---\> Dysmetria, Ipsilatera Ataxia

Question 269

Patient C/W Decreased sweating droopy eyelid Arm undershooting or overshooting--\>missing target Vomiting and vertigo

Answer 269

Lateral Medulla smoked PICA ( basilar) Intraprenchymal bleed Also --\>labyrinthe artery impacted--\>ipsilateral sensorineural deafness--\>Vertigo

Question 270

Patient c/w tongue falling onto one side and paralysis of other side of body

Answer 270

Medial Medulla smoked Anterior spinal artery Lateral Cortico Spinal tract( c/paralysis) Medial Leminiscus ( c/proprioception)

Question 272

Lateral Medulla

Answer 272

cranial Nerves 9 --10----11 PICA

Question 273

Smoked --\> Sympathetic fibers 9 10 11 CN Labyrinth artery

Answer 273

Lateral Medulla PICA

Question 274

Patient C/w Contralateral paralysis But w/ The absence of cortical signs--\>aphasia or visual loss

Answer 274

Lentriculostriate artery Chronic HTN-----\>hyalinized-----\>Charcot-Bouchard Aneurysm---\>Lacunar Infarct

Question 275

Patient c/w atrophied hand muscles and ischemic pain

Answer 275

Thoracic outlet syndrome

Question 276

Nonreactive fetal stress test

Answer 276

with normal fetal movements--\>possibly fetal sleep h/ of no fetal movements--\>placental insufficiency umbilical cord compression

Question 277

Holosystolic Murmurs

Answer 277

Tr Mr VSD Handgrip ----\>Increased Afterload----\>Increases sound of Holosystolic Murmurs

Question 278

Inspiration--\>Murmur

Answer 278

Increases Right heart sounds Increased Venous Return

Question 280

HIT

Answer 280

Take it off heparin give direct thrombin inhibitors--\>Argatroban,Dabigatran or factor Xa inhibitors--\>Fondaparinux if platelets are down 150,000--\> dont give warfarin

Question 281

Polycythemia Vera

Answer 281

normally hypoxia--\>EPO--\>jak--\>proliferation PV--\>jak mutated--\>turned on low EPO

Question 282

Patient c/w spasticity and fasciculations also with hyperreflexia and atrophy of same muscles but no bladder or bowel dysfunction

Answer 282

ALS

Question 283

treatment-resistant schizophrenia

Answer 283

Clozapine

Question 284

2 Week old infant mild eyelid swelling bilaterally draining eyes

Answer 284

Chalmydia Conjuctivitis PO Macrolide

Question 285

FIrst week of life for infant Profusely draining eyes markedly eyelid swelling corneal ulceration or edema

Answer 285

Gonococcal conjuctivits IM 3rd gen cephalosporin--\>single dose (cefotaxime) severer than chlam(macrolide)

Question 286

draining ulcers but odorless patient is gardener none lymphadenopathy lesions were seen along the line of lymphatic drainage

Answer 286

Sporotrichosis dimorphic fungus that sits on decaying plants Several months of Itraconazole cures it

Question 287

**Fever** and sore throat after fish bone **scratched the throat** posterior pharyngeal wall--\>**red--\>& Bulging** **The neck is stiff** w/ reduced motion Neck's **lateral radiographing**--\>shows increased _thickening_ of _Paravertebral soft tissue_

Answer 287

Trauma to the **posterior pharynx**-------\>Retropharyngeal Abscess buccopharyngeal fascia--\>Pharynx--\> _retropharyngeal space--\>Alar Fascia--\>Danger_ space--\>paravertebral fascia if it passes through alar fascia--\>it can rapidly transmit to posterior mediastinum--\> to the level of diaphragm--\>Acute necrotizing mediastinitis

Question 288

Drooling Dysphagia Odynophagia fever the case of infected tooth

Answer 288

Ludwig Angina see the red and warm mouth w/ bilateral cellulitis of submental, sublingual and submaxillary spaces

Question 289

Shoulder Dystocia Management

Answer 289

BE CALM Breath ( dont push) Elevate legs--\> thighs against abdomen Call for help Apply suprapubic pressure Larger vaginal opening--\>epsiotomy Maneuvers

Question 290

Be Calm Maneuvers ?

Answer 290

Posterior arm--\> deliver _Rotate_ posterior shoulder--\> apply pressure to ***anterior aspect*** of the posterior shoulder--\>woods screw apply pressure to the ***posterior aspect*** of the *posterior shoulder-*-\>_Adduct_ posterior fetal shoulder Mother _on All Four_ _Re place_ fetal head into the mothers pelvis

Question 291

Prenatal visit tests

Answer 291

RhoD and hemoglobin and hct, MCV Viral --\>Vdrl,RPR,Hiv Immunity to rubella vericella vaccine to influenza PAP AND PCR FOR CHLAM Urine culture and protein

Question 292

Toddler Patient c/w failure to thrive--\> not been able to gain weight weight is \<5percentile Urine labs show alkaline urine Family Hx of nephrolithiasis

Answer 292

All type of RTA--\>failure in growth _RTA -----\> body is acidic_----\> Cells cant grow and divide properly in an acidic environment either due to increased excretion of hco3 (RTA2) or **decreased excretion of acid** (RTA1) _Type 2_ is linked with _Fanconi_ --\> along with _hco3 expulsion_--\> aciduria and phosphaturia

Question 294

hydroxyurea side effects

Answer 294

Myelosuppression neutropenia anemia thrombocytopenia

Question 295

Increased Conversion Fe2+ ------\>fe3+

Answer 295

Methemoglobinemia oxidizing fe2+===\>Fe3+ fe3+ does not dissociate from o2 --\>Cyanotic Dapsone Anesthetics--\>Benzocaine Methemo--\>is created to hold and trap cyanide Tx--\> methylene blue, Vit C

Question 296

Anion Gap caused by what?

Answer 296

\>12 Mud Piles Methanol uremia diabetic ketoacidosis propylene glycol iron tabs isoniazid tx lactic acidosis salicylates

Question 297

Pralidoxime is given with

Answer 297

Atropine

Question 298

**_Multiple_** lesions on Liver

Answer 298

Metastatic seeded from some other primary cancer

Question 299

Unobliterated processus Vaginalis--\>

Answer 299

Infant--\> patent processus vaginalis--\> hydrocele or Inguinal hernia

Question 300

Patient w/ HIV floaters and blurry vision

Answer 300

CMV Retinitis _Full-thickness_ retinal inflmmation--\>Moves centripetally--\> along the vessels--\>edema and scarring--\>Blurring, floaters & photopsia scarring/edema--\> retinal detachment Intravitreal Injection if the lesion is close to the fovea or optic nerve Photopsia= sensation of flashing lights centripetally= moving towards the center

Question 301

Toxoplasmosis eye

Answer 301

chorioretinitis Nonvascular pattern comes with **_EYE PAIN_**

Question 302

Chorioretinitis

Answer 302

Toxoplasmosis --\>with eye pain, congenitally comes with a triad CMV--\>congenital--\>sexual or organ transplant--\>c/w hearing loss, periventricular calcifications Syphilitic--\> c/w uveitis and almost always w/ Meningitis Herpes--\>Simplex--\>keratitis--\>_Corneal_, tearing and discharge Herpez--\>zoster--\>Cornea or Iris--\> Vesicular Eruption

Question 304

Cholecystectomy

Answer 304

postoperative diarrhea due to Insufficient bile absorption by terminal ileum CholeDOcholithiasis--\>stone in CBD--\>ERCP to remove stone--\>then do cholecystectomy stone from CBD--\>travels to vater--\>can block both pancreatic and gall flow to intestine

Question 305

Bronchiectasis

Answer 305

_dilated_ airways///& or Bronchial wall _damage_ due to _chronic_ inflammation from Infections or structural airway defect Inflammation//structural defect//masses --\> cause **_obstruction_** Do high res CT scan ==\>\> Obstructive disease

Question 306

Answer 306

Achrocordon skin tag

Question 307

Answer 307

seborrheic keratosis stuck on can be flat, raised or velvety and greasy

Question 308

Answer 308

actinic keratosis premalignant lesion dry and scaly base is erythematous sun exposed areas

Question 309

Answer 309

Basal cell carcinoma pearly or waxy//shiny BCC flat or rolled border ((SCC ==\>\>firm red pimple)) papule --\> or a nodule Overlying Telangiectasia Ulcerates

Question 310

Seborrheic keratosis vs Melanoma

Answer 310

Seborrheic keratosis quite similar to melanoma but melanoma is on sun-exposed areas and its not greasy and melanoma does not have rubbery texture

Question 311

Normal WBC in CSF

Answer 311

0-5 wbc per mm3

Question 312

post cardiac surgery --\>CABG patient has increased diastolic pressures in right heart and increased PCWP plus sign of Cardiogenic Shock

Answer 312

the patient is in cardiac tamponade rare, but Important situation post CABG Fluid accumulated in pericardial sac Management Echocardiograph to size up--\>Immediate percutaneous or surgical drainage

Question 313

Tumor lysis

Answer 313

cells are destroyed --\> Intracellular ions--\> potassium and phosphate--\> are liberated hyperkalemia--\> arrhytmia Hyperphosphatemia --\> Binds and traps calcium--\> hypocalcemia uric acid increased too due to increased destructions of cells and nucleic acids

Question 314

Patient was treated for lung malignancy before the age of 30

Answer 314

Lung cancer treatment in patient \<30 y/0 18.2 % chances to secondary malignancy from chemo or radiation therapy later in life

Question 315

Answer 315

Post radiation--\>fibrosis lungs lose volume

Question 316

Answer 316

Lung cancer X-Ray

Question 317

Answer 317

aspergilloma occur in normal immunity patients with structurally defect lungs ( pre-existing cavities// Cysts ) Air crescent is seen along the periphery of the cyst

Question 318

Answer 318

Apical Cavities comes with consolidation and Lymphadenopathy--\>Lobar pneumonia

Question 319

facial plethora and Hypertension

Answer 319

Cushing Syndrome with central obesity and proximal muscle weakness

Question 320

Parathyroid increased

Answer 320

calcium and kidney stones w/ Neuropsychiatry--\> confusion, depression,psychosis

Question 321

Pericarditis

Answer 321

MI & dressler Aortic Dissection Rheumatic fever viral Uremic Neoplasms Collagen Vascular disease --\>RA, SLE

Question 323

Petechial rash--\>vesicles, bullae progressed to gangrenous Pt has fever and vomiting

Answer 323

Meningococcemia

Question 324

Answer 324

Macule m/c Rubella measles Tuberous sclerosis actinic keratosis

Question 325

Answer 325

papule

Question 326

Answer 326

bulla

Question 327

Pulmonary EMbolism

Answer 327

ABG will show Hypocapnia (response --\>tacgypnea) hypoxemia --\> less O2 in arterial blood increased alveolar to arterial gradient Massive embolism --\>hypercapnia

Question 328

Postoperative pulmonary complications

Answer 328

Atelactasis Bronchospasm Prolonged ventilation

Question 329

acanthosis nigrican

Answer 329

skin folds --\> thick and velvety DM PCOS Obesity Cushing Disease Paraneoplastic Adenocarcinoma Metabolic syndrome--\>NAFLD

Question 330

MAcrovascular fat deposition --\>peripheral displacement of nuclei

Answer 330

NAFLD

Question 331

A pervasive distrust and suspiciousness personality--\>that subtly has that kind of impact

Answer 331

Paranoid "personality"

Question 332

Gallstones with no symptoms tx

Answer 332

No treatment _elective_ laparoscopic cholecystectomy--\>if some symptoms present urgent cholecystectomy--\>if choledocholithiasis, cholecystitis, gall stone pancreatitis

Question 333

cervic bleeds on swab

Answer 333

cervicits due chlam or gonorrhea

Question 334

Breastfeeding contradictions

Answer 334

Active Varicella herpetic breast active untx tb active substance abuse maternal hiv chemo/radiation

Question 335

Alcoholic Cirrhotic patient w/ flapping tremor comes with fever and Gas in Small and Large Bowel

Answer 335

SPontaenous bacterial peritonitis do paracentesis to verify

Question 336

normal b cells low immunoglobins

Answer 336

Common Variable Delayed presentation--\> after 2nd year or later sinopulmonary infections bronchiectasis

Question 337

migratory arthralgia variable joint pain months ago--\>went to NE usa

Answer 337

Lyme Lyme's several months-years later--\> Arthritis =years Encephalitis==years Peripheral Neuropath===years some months= carditis Meningitis CN 7 palsy

Question 338

Answer 338

crusted sores beneath which ulcers form

Question 339

elderly patient on medication factor X inhibitors hx of htn altered consciousness focal occipital headache

Answer 339

stroke non-contrast ct scan ( contrast is difficult to differentiate from blood--\> do non contrast) white hyperdense

Question 341

Irregular bump Normal overlying epidermis (skin) doesn't regress

Answer 341

Question 342

firm nodule **_on lower extremities_** the fibrous component that causes dimpling when pinched

Answer 342

Question 343

Firm and freely movable nodule with central punctum

Answer 343

semisolid core keratin and lipid epidermis lodged in dermis due to trauma or comedones can increase in size or cheezy white discharge usually, resolve spontaneously

Question 344

patient with Micrognathia & Lymphopenia

Answer 344

Normal Thymic Sail Sign absence --\> 22q11 microdeleted ===\>\> DiGeorge Conotruncal defect Abnormal face Hypocalcemic ===\>\>\> tetany, Seizures, Arrhythmia

Question 345

valsalva leaning forward cough

Answer 345

increases intracranial pressure

Question 346

Coarctation of aorta ovarian failure

Answer 346

Turner

Question 347

Answer 347

Crown to Rump length w/ first trimester Ultrasound is most accurate method to determine gestational age

Question 348

Antipsychotic patient highly febrile and stiff

Answer 348

NMS post dopamine blockage by antipsychotics Tx of NMS===\>Dopaminergic---\>Bromocriptine, Amantadine

Question 349

**_Very Short_** acting **_Depolarizing_** muscle relaxant to induce---\>Paralysis during anesthesia

Answer 349

Succinylcholine Anesthetics A/r --\>Malignant Hyperthermia

Question 350

Cholinesterase Inhibitor

Answer 350

Saves Ach from acetylcholinesterase =====\>\>\>Ach increases Physostigmine===\>\>\>\>\>\>Ach

Question 351

young patient hypertensive bruits Increased Renin and Aldosterone

Answer 351

Fibromuscular Dysplasia or Renal Artery Stenosis ===\> both decreases renal perfusion FMD--\>Bruits can be closer to mandible angle--\>Vertebral or at renal FMD==\>\>\>\>\>\> Renal--Vertebral--Carotid

Question 352

EBV Lymphadenopathy

Answer 352

Tender and mobile Patient==\>\>\>Hemolytic anemia & Thrombocytopenia

Question 353

\>25% of Lymphoblasts

Answer 353

ALL see in Down syndrome t 12:21 ===\>\>\>\>CNS testes T cell ALL----\>\>\>\>Medistinal mass

Question 354

adhd

Answer 354

do not deceit ppl do not act violently

Question 355

\>40 y/o patient c/w Dysmenorrhea Menorrhagia w/ no Adnexal Mass

Answer 355

Adenomyosis Endometrial glands==IN==\>\> uterus muscle Symmetrically enlarged Uterus + \>40y/o =Adeno

Question 356

Cystic mass on ovary young woman Noncyclic pain exacerbated by movement//exercise Dysmenorrhea

Answer 356

Chronic pelvic pain---\>\>reproductive woman --\>\>cystic Endometriosis Infertility\>\>Dyschezia Locations Recto-Vaginal Septum posterior cul-de-sac Uterosacral Ligament

Question 357

Pelvic mass Calcified and hyperechoic

Answer 357

Mature Teratoma no infertility concern

Question 358

Sickle cell bugs

Answer 358

Encapsulated bugs Neisseria streptococcus haemophilus vaccine===\>\>\> fixed Neisseria and haemophilia cases But Strep is difficult to trap for an SCD patient

Question 359

Sickle bone pain

Answer 359

Aureus or salmonella--\>osteomyelitis

Question 360

Patient comes w/Renal Dysfunctioning & fragmented cells Fever ,Neurologic signs w/ **_Low_** **_wbc_** **_,_****_Low_** **_Platelets_** and Low hemoglobin

Answer 360

Thrombotic Thrombocytopenic Purpura _Microangiopathic_ hemolysis==\>\> Decreased haptoglobin _fever_+_renal_+neuro+hemolysis Emergent plasma exchange

Question 361

Young patient --\>\>High serum Calcium --\>\>High-Normal Parathyroid Hormone But Low urine Calcium

Answer 361

Familial hypocalciuric Hypercalcemia Calcium-sensing receptor problem

Question 363

Acquired Genetic defect leading to hemolysis and hypercoagulability --\>\>\>abdominal pain and dark urine

Answer 363

Paroxysmal nocturnal hemoglobinuria Procoagulant microparticles generated through complement dependent damage of platelets and venous endothelium

Question 364

Prosthetic joint ==\>\>\>Joint pain ===\>\> 3 to 12 months

Answer 364

Coagulase Negative Staph Epidermidis

Question 365

granulomas

Answer 365

Non caseating -- occupational Sarcoidosis Crohns Caseating===\>\> Central necrosis===\>\>\>Infectious cases

Question 366

The whole fetus is small==\>\>

Answer 366

Symmetric FGR Congenital insults Asymmetric --\>\>Placental insufficiency Asymmetric --\>\>Various sizing paramenters tell different gestation age

Question 367

toddler arches the back during or after feeding

Answer 367

GERD

Question 368

Opioid Antagonist

Answer 368

No to opioids Naloxone Naltrexone Methyl-Naltrexone

Question 369

Opioid _Partial_ Agonist

Answer 369

BuproNorphine Heroin Maintainance===\>\>\>Give w/ opioid antagonist OR Methadone

Question 370

Actinomyces

Answer 370

Not like Nocardia Not Aerobic Not Acid-fast Tx with Penicillin G Act==\>\> Filamentous and gram-positive

Question 371

Irregular uterus Globular and Firm mass pelvic pressure several protuberances on the mass

Answer 371

Leiomyomata uteri ===\>\> fibroids Palpated Nodular & immobile uterus==\> endometriosis

Question 372

Intermenstrual Spotting Uterus Enlarged

Answer 372

No prolonging of Menses Polyps in the uterus ( Endometrium)

Answer 373

costal MArgin T8 T10 Umbilicus

Question 374

Decreased Maternal Serum Alpha-Fetoprotein

Answer 374

Aneuploidy 18 & 21

Question 375

Answer 375

Adenopathy===\>\> Large and Swollen Lymph Nodes Bilateral==\>\>\> Sarcoidosis

Question 376

CXR shows Thickening at hilum bilaterally Erythema nodosum Migratory Polyarthralgia Fever

Answer 376

Sarcoidosis---\>\>LofGren Syndrome

Question 377

Reproductive woman comes w/ Sudden lower abdomen pain _=====\>\>\>\>\>\> Unilateral_ without _====\>\>\>\>Leukocytosis_

Answer 377

Ovarian Torsion differential appendicitis or ectopic ==\>\> have leukocytosis

Question 378

Glasgow

Answer 378

==\>\>Eye Opening --\> out of 4 ==\>\> Verbal Response---\> out of 5 ==\>\>Motor Response--\> out of 6

Question 379

Myasthenia Gravis

Answer 379

The 3rd decade in a woman 6th or 8th in Man Ach receptor destroyed Bulbar--\>\>Chewing difficulty, nasal speeching Ocular Proximal Limbs--\>Arms Respiratory muscles MG===\>\> Gets precipitated By drugs--\> Quinolones, Macrolides, Beta Blockers and Infections

Question 380

Live attenuated vaccine contradiction for CD4 cells below===??

Answer 380

CD4 \<200

Question 381

OCD

Answer 381

Intrussive ritualistic thoughts

Question 382

depressed looking patient mask like facial expressation withdrawn less energetic stiff walk stooped posture resists passive flexion

Answer 382

Parkinson rigidity with bradykinesia stooped posture and hypokinetic stiff walk--\> short steps walk

Question 383

Hypomania vs MAnia

Answer 383

patient is able to perform with more energy at the office in hypomania Mania---\>\>\>patient ends up in hospital or gets noticed for highly jubilant

Question 384

smaller plateles cytoskeletan defect ====\>\>\> Antigen not presented

Answer 384

Wiskott IgA IgE increased but Low===\>\>\> IgG IgM

Question 385

Staph infection alongside Strep the patient comes w/ peripheral neuropathy

Answer 385

Chediak Lysosomal trafficking problem Lysosomal unable to fuse with ==\>Phagolysome progressive neurodegeneration & Albinism (partial) --\>LymphoHistioCytosis ---\> Milder COagulation problems too

Question 386

hyperpigmented macules vs hypopigmented

Answer 386

Hyperpigmented ===\>\>\>Neurofibramotosis HyP**_op_**igmented====\>\>\>Ash leaf==\>\>**_Tu_**berous

Question 387

NF1 Vs NF2

Answer 387

Nf2 ==\> 2 ears ringing 2 Intracranial tumor====\>\>Meningioma Ependymoma 2 eyes==\>\> Juvenile Cataract the heavier load is on NF1==\>\> Eyes nodules, peripheral sheath tumors freckles Intracranial mass Pheochromocytoma

Question 388

Microcephaly

Answer 388

13atau Cri-Du-Chat 5p- Maternal PKU Zika Xrays Fetal Alcohol w/ smooth philtrum Fetal Anticonvulsant Hydantoin w/ hirsutism Microephaly & cleft --\>Phenytoin

Question 389

Patient comes w/ **_dark urine_** & abdominal pain plus Scleral **_ICTERUS_** RUQ ===\>\>\>\> Palpable Mass No fever or any other concerns

Answer 389

**_Cyst_** ## Footnote BiLiarY ==\>\> Intra or Extrahepatic Most Common===\>\>Extrahepatic type 1 ===\>\>\>Congenital Dilation of BiLiary Tree Presents w/ _Cholangitis_ And maybe accompanied w/ **_Pancreatitis_** in older children Biliary Cysts ====\>\>\> Cholangiocarcinoma

Question 390

Recent UTI elevated ESR Normal Leukocytes Normal Temperature

Answer 390

Vertebral Osteomyelitis MRI

Question 391

A pulsating Headache Papilledema Increased CSF opening pressure Worse at night awaken her from sleep

Answer 391

pseudotumor cerebri IIH

Question 392

ELevated Direct Hyperbilirubinemia Elevated Alkaline Phosphatase

Answer 392

Cholestasis===\>\>\>\> Bile Duct Obstruction Bile duct = Alkaline Phosphatase

Question 393

Eye Pain Sensitivity to light blurry Repeated attacks

Answer 393

_Anterior_ Uveitis Turbidity of aqueous Ciliary muscle spasm===\>\> pain

Question 394

Stepwise decline in ===\>\>\>Executive functioning ( decisions ) ===\>\>\>\>forgetfulness

Answer 394

Vascular dementia White matter==\>\>cortex //subcortical Infarctions versus Early & Insidious onset of dementia==\>\>Alzheimer

Question 395

**_Medial Temporal Lobe Atrophy_** Early onset memory loss slowly progresses Language Visuospatial defects

Answer 395

Alzheimer

Question 396

ILLness anxiety disorder

Answer 396

**_No symptoms_** but patient keeps worrying

Question 397

A patient was resting comes w/ a new chest pain ===\>\> Occurs at rest that is progressively worsening ==\>\>\>Troponin is normal

Answer 397

**_Unstable_** Angina ST may be seen if not enzymes Tx==\>\> ASA, IV nitro,IV morphine Refractory to therapy===\>\> IV heparin, Schedule Angiography, Possible revascularization--\> PCI, CABG

Question 398

Hypotensive DIstant Heart Sounds JVD

Answer 398

Excess fluid in Pericardial sac======\>\>\>\>\>\> **_Cardiac Tamponade_** Rate of effusion/ fluid formation is important than the size

Question 399

Hx of SLE / Pericarditis / Malignancy / TB / Trauma

Answer 399

Fluid forms around the heart in a pericardial sac ===\>\>\> Tamponade

Question 400

Murmur that increases with less preload

Answer 400

Hypertrophic Cardiomyopathy

Question 401

Lithium===\>\> Congenital impact on fetus

Answer 401

Malformation of Tricuspid valve===\>\> atrialized RV + Atrial Septal Defect

Question 402

Mood Stabilizers Congenital Defects==\>\>

Answer 402

Cranio-Facial defect Neural Tube Genital Anomaly

Question 403

third-trimester patient==\>Clear purulent vaginal discharge w/ _fever_ uterine fundal tenderness _fetal tachycardia_ & Maternal Leukocytosis

Answer 403

IAI==\>Intraamniotic Infection IAI==\>aka==\>Chorioamnionitis Common==\>\> Patients with premature or prolonged rupture of membranes

Question 404

Macroglossia

Answer 404

Hypothyroid Beckwith-WiEDEman==\>\>hemihyperplasia amyloidosis mucopolysaccharidosis neurofibramotosis Vascular malformations==\>\>hemangioma

Question 405

Answer 405

stasis dermatitis venous valve incompetence==\>\> pooling of blood

Question 406

2-word phrases \>5o word vocabulary

Answer 406

2 year old

Question 407

Chronic MS care

Answer 407

Ibterferon _Beta_ Glatiramer Acute exacerbation/flare==\>\> Steroids

Question 408

serratia auerus burkholderia plus abscess ===\>\>\>\>\>\>\>\>\>

Answer 408

Chronic Granulomatous disease Defect in NADPH

Question 409

Non purulent infections

Answer 409

Leukocyte Adhesion Def Impaired neutrophil migration

Question 410

**_Gnawing_**===\>\>\> Insidious epigastric pain worst at **_night_** weight loss

Answer 410

Pancreatic **_Adenocarinoma_** _Duodenal_ ulcer==\>\> relived by _food_

Question 412

Walks upstairs==\>\>both feet on each step

Answer 412

2nd year

Question 413

Endemic area Upper lobe cavity hypoglycemic hypotensive eosinophilia hyperkalemia

Answer 413

Infection-induced Adrenal damage TB or fungus ==\> adrenal insufficiency==\> Retention of potassium (alkaline) & Hydrogen ( Acidic) ===\>\>\> Normal anion gap **_hyperkalemic**_ & hyponatremic _**Acidosis_**

Question 414

eye **_pain_** and blurry Dilated pupil not reactive to light

Answer 414

**_Glaucoma_**

Question 416

Hyperkalemia on ECG

Answer 416

Potassium more than 6.5 ==\>\>\>\> Delayed phase 0==\>\>Longer Action Potential===\>\>\> ^Widened _QRS_ & increased **_P------\>R_** interval ==\>\> Seen as Delayed InterVentricular & Atrioventricular communication =\>Apprears==\>\>\>**_LBBB/RBBB_** With The _narrow_ base of T wave but a _Peaked_ tower ==\>\>As hyperkalemia worsens==\>\>

Question 417

arm has higher Blood pressure than legs

Answer 417

Turner Streaked ovaries==\>\> Not going to produce Estrogen

Question 418

turner 5 things

Answer 418

1 Horseshoe kidney 2 Straked ovaries 3 Coarctation of aorta==\>\> upper limbs higher bp 4 palate= narrow with high arch 5 bicuspid

Question 419

Upgoing plantar reflex

Answer 419

**_Abnormal_** ===\>\> UMN injury Nociception==\>\>S1===\> Tibial nerve--\>Sciatic nerve---\> Roots--\>L5 S1==\>\> Synapses at Anterior Horn Anterior Horn==\>\> Motor response==\>back to the ==\>\>L5 S1==\>\>\>\>\>Sciatic nerve--\>\>bifurcations---\> Tibial Flexors and Deep peroneal nerve Extensors===\>\>\>\> **Loss** of ability to **suppress** Extensor==\>\> **_UPGOING FLEXION_**

Question 420

Leukocyte Alkaline Phosphate

Answer 420

Higher in Leukomoid rxn versus Lower in CML

Question 421

Metamyelocytes

Answer 421

Metamyelocytes higher than Myelocytes==\>LEUKOMOID Matures than Myelocytes higher in Leukomoid versus _Myelocytes_ are higher than Metamyelocytes in _CML_

Question 422

urinary _Incontinence_ with contralateral paralysis more pronounced in _Lower Limbs_

Answer 422

Anterior Cerebral artery stroke of **_frontal lobe_** mesial

Question 423

No organized P waves seen

Answer 423

Atrial Fibrillation Narrow complex QRS==Rapid ventricular Response Atrial Fibrillation==\>\>Supra Ventricle

Question 424

Stroke Suspicion do what next\>

Answer 424

figure out if stroke is Hemorrhagic or Ischemic Hemorrhagic ==\> SubArc or Intracranial bleed Ischemic ==\> emboli or clot

Question 425

Statin for LDL?

Answer 425

needs to be more than 190

Question 426

Hirsutism

Answer 426

In Woman Male pattern hair loss and Male pattern hair growth

Question 427

Period sharp waves on EEG Hypokinetic= Pyramidal Dysfunction Nor move nor speak ==\> Akinetic Mutism Rapid dementia

Answer 427

creutzfeldt-jakob twitching muscles and cerebellar dysfunctions also visual disturbances

Question 428

Amblyopia

Answer 428

Vision loss from disuse of deviated eye

Question 429

Suprapubic

Answer 429

Bladder==\>\>Pain==\> Cystitis==\> Nitrofuontain 5 days TMP-SMX 3 days Floxacin==for s_ulfa allergics_ or resistant Complicated cases like --\> diabetics, catheters, Uobstructions, CKD, pregnancy, Hospital Acquired==\>\> _Do culture in these cases_ iLiohypogastric nerve

Question 430

High Amylase high lipase high BMI High Alkaline Phosphatase High Alanine ALT

Answer 430

Acute pancreatitis fue to gall stone ==\>\>\>PAind radiates to the back

Question 431

T3 effect on vessels and heart

Answer 431

T3===\>\> _Decreases SVR_ and Increases Ionotropy and Increases Chronotropy By increasing _Sensitivity_ To Circulating Catecholamines And increases _B1 receptor_ Transcription

Question 432

CURB 65

Answer 432

5 BUN= More than 20 confusion respirations more than 30 BP if = systole less than 90 or diastole less than 60 Age more than 65 score out 5 more than 1===\>\>\>\> Admit in to the hospital

Question 433

NonSpecific signs of congenital Infection

Answer 433

Blueberry muffin Hepatoplenomegaly jaundice Growth restriction

Question 434

undercooked meat and congenital infection

Answer 434

Toxoplasmosis The mother might have swollen glands only ( Lymphadenopathy ) Infant==\>\> Intracranial calcifications ==\> **_Diffuse_** Hydrocephalus Chorioretinitis

Question 435

Mother had Rash and Arthritis and swollen glands and lymph nodes

Answer 435

**_Respiratory drops_**--\> Mom--\>Rubella-\> rash and arthritis Infant--\> Pulmonary Artery **_HYPOPLASIA_** **_Cataracts_** **Deafness**

Question 436

SAAG

Answer 436

Peritoneal fluid Albumin - Serum Albumin ==\>\>\> More than 1.1 = Portal Hypertension

Question 437

Answer 437

Tripod ==\>\> Epliglottis==\> Hemu Do Endotracheal Intubation

Question 438

Choriocarcinoma

Answer 438

Most commonly after Hyaditiform Mole Can happen after normal delivery or a spontaneous abortion

Question 439

Non Stimulatory ADHD medication Non stimulatory medication for Wakefulness and narcolepsy, cataplexy

Answer 439

Atomoxetine (NE) Modafinil (D)

Question 440

Second Generation Anti Psychotic has Partial D2 agonism

Answer 440

Ari-piprazole

Question 441

Very painful menses normal durations and periods but painful and lot of bleeding

Answer 441

Adenomyosis ==endometrial dinosaur trapped in Myometrium park ===\>\>\>Uniformed uterus

Question 442

Tenderness over Anterior Vaginal Wall

Answer 442

Bladder pain syndrome aka interstitial Cystitis Bladder hurts when filling up or voiding up ==\>\> dysuria and increased frequency

Question 443

Irregularly enlarged uterus with heavy bleeding but not painful

Answer 443

Fibroids

Question 444

Painful menses but no heavy bleeding ( Dysmenorrhea)

Answer 444

Endometriosis progresses to chronic pelvic pain due to accumulations of islands and ==\>\>adhesions

Question 445

Nuclear

Answer 445

jolly body

Question 446

Heinz

Answer 446

Denatured squished hemoglobin post hemo-lysis autoimmune hemolyziz makes heinz ketchup of hemoglobin

Question 447

COPD and acidosis

Answer 447

_COPD_ cases have "the gradual" increase in PaCO2 Gradualness lets kidneys compensate Renal tubules increase HCO3 retention

Question 448

1. TNF & IL1 inhibitor Adverse reaction

Answer 448

Hydroxycholoroquine ====\>\>\> Retinopathy

Question 449

2. IL 1 and TNF inhibitor Adverse Reaction

Answer 449

Sulfasalazine Hemolysis Hepatotoxic Stomatitis

Question 450

Only TNF Inhibitors Adverse RXN

Answer 450

5 TNF inhibitors exist Goli=Mumab Adali-Mumab Certoli-Zumab Inflixi-Mab Eta-nercept Adverse==\> Demyelination, CHF ==\>\> Malignancy

Question 451

Rebound Tenderness

Answer 451

Pain upon removal of pressure =\>Represents aggravation of parietal layer of Peritoneum by Stretching or Moving ==\>\>Indicates Peritonitis--\>\>Appendicitis//Ulcerative colitis AKA Blumberg Sign

Question 452

Chronic & episodic abdominal pain With Rebound Tenderness, suddenly worsens Xray shows ==

Answer 452

Xray will show free air under the diaphragm==\> just below the edge of the base of the lung =Perforated peptic ulcer Gastric secretions==\>\> released into the peritoneum ==peritonitis==\> rebound tenderness

Question 453

Persistent Severe Epigastric Pain Xray shows ileus of small intestines

Answer 453

Gallstone Pancreatitis comes with nausea and vomiting

Question 454

Episodic RUQ pain fatty meal

Answer 454

BiLiary COLIC(pain) Gallstones pressing against the opening of the cystic duct

Question 455

Minimal Change disease what tool to employ

Answer 455

Electron Microscopy biopsy and Immunofluorescence will yield nothing

Question 456

Answer 456

Cerebellar hemorrhage an occipital headache vermis=\> unstable trunk hemisphere==\> Limbs unstable repeated vomiting by patient and unstability to stand with no loss of consciuousness should raise suspicion Horizontal gaze palsy

Question 457

Hemineglect

Answer 457

hemineglect ==\> parietal lobe stroke

Question 458

Acute Coronary Syndromes

Answer 458

A spectrum of Clinical signs or syndromes Caused by Plaque disruption or Vasospasm that Leads to The Acute Myocardial Infarction ST segments/ Ecg/ S4 heard Unstable Angina or ST-elevated MI

Question 459

_Pleuritic_ chest pain With _FEVER_ Right Atrial Strain--\> minor _JVD_ O2 saturation less than 96% Irregular heartbeat tachycardic tachypneic narrow QR

Answer 459

Pulmonary EMbolism strains and obstructs flow out of the Right heart ==\> Fibrillation

Question 460

Answer 460

Discoid Plaque

Question 461

Answer 461

Erythematous Papules

Question 462

Ciprofloxacin TMP-SMX Tetracyclines Penicillin

Answer 462

Not good for Oral anaerobic

Question 463

Pain began in Lower Abdomen but progressed to upper vomit fever chills sexually active Irregular menses intermenstrual spotting negative pregnancy test

Answer 463

PID starts in lower quadrant may involve liver capsule--\> upper abdomen pain and vomit

Question 464

Patient comes with Hypercalcemia and pancytopenia

Answer 464

The typical presentation of Multiple Myeloma Volume depleted due to polyuria

Question 465

Patient in a trauma unit stuporous & reacts only to noxious BP is 6o systolic Asystole & Pulseless --\>post mechanical ventilation

Answer 465

Hypovolemic patient pre-ventilation==\> he is, either way, getting a lesser venous return to the right atrium 1) Positive pressure Mechanical Ventillation==\>\>Intrathoracic Pressure increases==\>\>\>\>\> collapses Venous capacitance vessels ( IVC) ==\>\>cuts off venous return 2) Pre-Intubation==\>\> Sedatives used==\>\>Relaxes Venous Capacitance Vessels==\>\> Also decreases Venous return

Question 466

spares palms and soles

Answer 466

Rubeola Measles pityriasis Rosea Ricketsia Typhus

Question 467

Rash on Palms And Soles

Answer 467

Secondary Syphilis Coxsackie Virus Rocky Mountain Spotted fever Acral Lentiguous Toxic shock desquamation Kawasaki desquamation

Question 468

Patient younger than 1 year old Took a International trip What infection can the baby spread

Answer 468

Rubeola Measles the vaccine is given at age 1 and 4

Question 469

Vesicles on outer ear and facial droop

Answer 469

Ramsay Hunt Syndrome Herpes===\>\> Bell's palsy

Question 470

Answer 470

Tophaceous Gout

Question 471

Answer 471

Osteoarthritis

Question 472

Answer 472

Question 473

Rotavirus

Answer 473

risk of Intussusception

Question 474

paradoxical agitation

Answer 474

Agitated after an hour of taking benzodiazepine

Question 475

altered state of consciousness

Answer 475

Postical post seizure

Question 476

severe trauma burns parentral nutrition long time

Answer 476

Severly ILL patients in ICU chole stasis ==\> Acalculous cholecystitis Seconday gall bladder infection--\>Pericholecystic fluid

Question 477

Examination finding==\>\> but pain is out of propoprtion and doesnt make sense segmental bowel thickening

Answer 477

Mesenteric Ischemia

Question 478

herniated disk

Answer 478

pain will **_radiate_**

Question 479

Answer 479

MACROLIDES FLUOROQUINOLONES ANTIFUNGAL ===\>\>\> QT PROLONGATION==\>\>TORSADES IV MAGNESIUM {{ one antiArrhythmic drug causes QT prolongation too==\>\> Sotalol}}

Question 480

Answer 480

Hidden P waves Adenosine==\>\>PSVT

Question 481

Chlamydia vs gonococcal conjuctivits

Answer 481

Chlam--\>\> watery and after 5 days of birth Gonococcal--\>\> copious and Purulent and same day

Question 482

Neonatal conjunctivitis with Copious and Purulent discharge

Answer 482

Gonococcal Conjuctivits

Question 483

No palpable fetal presenting part at the station but presentable abdominal fetal parts

Answer 483

Uterine rupture

Question 484

Answer 484

Multilayered onion texture Ewing sarcoma

Question 485

Answer 485

Osteoid Osteoma

Question 486

pulmonary embolism on ECG

Answer 486

Question 487

GBS screening

Answer 487

32-35 weeks

Question 488

Deleted vs reduced Dystrophin gene

Answer 488

Deleted in Duchenne reduced in Becker

Question 489

Myotonic discharges

Answer 489

Delayed muscle relaxation cataracts and heart conduction problem mostly facial and intrinsic hand muscles dysfunction Myotonic dystrophy

Question 490

essential tremor

Answer 490

worsons at end of activity (wehn approaching to pick up a remote) versus basal ganglia tremor ==\> that worsens when body is at rest and improves when trying to pick up a remote

Question 491

patient severe abdominal pain and vomiting history of previous abdominal surgery hasnt passed any flatulus peristaltic pain distanded and tympanic abdomen

Answer 491

SBO or mesenteric ischemia But SBO has an air-fluid level in distended loops of small bowel SBO--\>if severe==\>do emergent abdominal explorations urgery( due to risk of impending ischemia, strangulation) for mesenteric ischemia==\>\> do CT

Question 492

Anxiety panic treatment

Answer 492

Acute==\> benzodiazepine chronic maintenance = ssri keep in mind CBT and SSRI will ta ake month to kick in

Question 493

Answer 493

jejunal atresia cocaine

Question 494

Answer 494

nerves are missing enterocolitis, megacolon, bowel obstruction and intestinal perforation

Question 495

the holosystolic murmur that increases with squatting at 3rd to 4th left intercostal space

Answer 495

VSD

Question 496

Short systolic murmur disappears with squatting non ejection type click

Answer 496

MVP squatting--\> increased preload--\> delays prolapsed valve--\> late click and shorter murmur

Question 497

Infective endocarditis murmur

Answer 497

Systolic--\> MR

Question 498

PEEP Positive end expiratory pressure

Answer 498

Given in ARDS to keep alveoli from collapsing more positive than atmospheric pressure Ards( inflamed and damaged lung) peep damages already fragile lung tissue PEEP--\> Tension pneumothorax

Question 499

Answer 499

Tension Pneumothorax Air leaks out of lungs gets trapped in pleura ==\>\> pushes back the the collapsed lung ==\> compresses the mediastinum ==\>\> hypotensive patient

Question 500

Refractory hypokalemia in alcoholic

Answer 500

Hypomagnesemia Magnesium stops potassium secretion by Renal outer medullary potassium channels

Question 501

uterus larger than gestation age patient is hypertensive hyperthyroid and vomiting that increases RUQ pain Abnormally elevated hCG

Answer 501

Hyaditiform mole compare with fitz hurg curtis ==\>\> fever hypotension and sepsis

Question 502

What kind of fibroids don't cause miscarriage

Answer 502

Subserosal Fibroid and pedunculated

Question 503

Exudative pharyngitis vs non exudative

Answer 503

Exudative==\>\> EBV non Exudative ==\>\>\>\>\>Gonococcal

Question 504

High fevers vomiting and diarrhea headache and confusion Pulmonary manifestations==\>\>comes after systemic

Answer 504

Legionella Pneumophilia

Question 505

Medroxyprogesterone depot

Answer 505

Every 3 months inhibits the release of GnRH Suppresses ovulation weight gain breast tenderness spotting and menstrual irregularities

Question 506

Premenopausal // Young one adnexal fullness h_yperechoic nodules_ _cyst has calcifications_

Answer 506

Mature teratoma -- Cystic

Question 507

Multiseptated bilateral cystic masses Do not have calcifications or hyperechoic nodules

Answer 507

**_Theca lutein cysts_** happens in pregnancy due to ovarian stimulation by hCG

Question 508

neutropenia recurrent sinusitis splenomegaly stomatitis /gingivatitis

Answer 508

**_Felty syndrome(_**severe rheumatoid arthritis with vaculitis and skin ulcers) gaucher sarcoidosis

Question 509

Corticospinal tract in brain

Answer 509

Question 510

First gen antipsychotic given to a patient After a while he develops a sustained contraction/ spasm what medication to treat this

Answer 510

Acute dystonia--\> spasmed--\> torticollis or eyes looking up constantly or facial grimacing or tongue twisting or protuding ==\> develops in hours to days ==\>\> Treat with **_Anticholinergics_** **_or_** **_Antihistamines_** _Antipsychotic originated Spasm is treated with Anticholinergics_

Question 511

Post chemo patient is febrile and Neutropenic what drug==?

Answer 511

Tazobactam - piperacillin covers both gram-negative and positive Antipseudomonal beta-lactams cefepime meropenem piperacillin-tazobactam

Question 512

Vericella vaccines Chickenpox at what age

Answer 512

At Age 1 and 4

Question 513

Bacterial Pharyngitis criteria

Answer 513

Centor Fever by history Tender Anterior Cervical lymphadenopathy exudate on tonsil An absent cough ==\> if all 4 present==\>\> give antibioitcs ==\> if 2or 3 present==\>\> do Rapid strep test Bacterial Pharyngitis==\>\> Mostly Group A strep===\>\>\>\>\>\>Oral Penicillin or Amoxicllin

Question 514

Viral Symptoms

Answer 514

Cough Rhinorrhea Conjunctivitis Oral Ulcers Viral Pharyngitis==\>\> symptomatic treatment only

Question 515

Atrial fibrillation or ST-elevated MI and what?

Answer 515

Chances of atrial originated thrombus==\>\>Left Ventricular thrombus Do transthoracic Echocardiogram and Echocardiogram

Question 516

Aortic Regurgitation

Answer 516

Diastolic murmur Blood comes back to LV==\>\> Large volume in LV==\>\>LV stretches out to hold==\>\> bigger water hammer stroke volume to be pumped out==\>\>LV hypertrophies Hypertrophic heart==\>\>insufficiency takes birth==\>\> blood starts backing up into lungs==\>\> pulmonary cracksles heard==\>\> mostly bilateral

Question 517

Placenta previa vs Placenta Abruptio

Answer 517

Abruptio has constant pain although both bleed in mostly third trimester as the baby grows and put more stress on attachment of placenta to the endometrium

Question 518

cocaine vs paranoid personality disorder

Answer 518

see paranoia with sympathetic activation signs ( diaphoresis, tremor, vigilant)

Question 519

When you see various healed scars on the abdomen or history gunshot wounds or history of trauma or the history of an car accident

Answer 519

Think==\>\> Splenectomy==\>Impaired antibody faciliated Phagocytosis==\>\> **_Gram positive**_ cocci==\>\> that are _**Encapsulated_**

Question 520

splenic opsonization

Answer 520

Question 521

hyperkalemia and hypocalcemia

Answer 521

Hyperkalemia==\> PR prolongation _Wide QRS_ loss of **_P-wave_** **_Hypocalcemia==\>\>QT prolongation_**

Question 522

B12 forms what two biochemistry products

Answer 522

B12 produces Succinyl co A & Methionine Methylmalonyl Acid----b12 and folic----\>\>\>\>$uccinyl coA Homocysteine -----B12-----\>\>\>\>Meth

Question 523

Hepatosplenomegaly diffuse cervical or posterior lymphadenopathy develops a **_Rash after amoxicillin_**

Answer 523

EBV test is positively hetero

Question 524

PPSV 23

Answer 524

Under 65 with Heart conditions Diabetic Smoking Lung Disease

Question 525

Td vs Tdap

Answer 525

Tdap should be given atleast once in place of Every 10 yr booster of Td or Adults that are going to closer contact with kids

Question 526

Broad based gait Difficuty with heel to shin testing

Answer 526

Cerebellar lesion posterior circulation

Question 527

Psychodynamic therapy

Answer 527

Traces problems to their roots in childhood and An Unconscious conflict

Question 528

CBT plus Dialectical

Answer 528

For borderline personalities==\>\>mindfulness and proper emotion regulation

Question 529

Fishy and yellow

Answer 529

FY=T Fishy yellow=Trichomonas

Question 530

Prematurity Maternal Alcohol, tobacco

Answer 530

Risk of fetal Cerebral palsy ==\>\>epilepsy, Intellectual disability, strabismus, Scoliosis Cp==\>\>non progressive motor dysfunction three kinds Spasitc Diplegia-\>m/c in preterm infant==\>\>hypertonic and hyper reflexia of mostly lower limbs--\> both feet pointing down and inward--\>\>equinovorous deformity Dyskinetic Diplegia Ataxic Diplegia

Question 531

Shy-Drager Syndrome

Answer 531

Patient with parkinsonian symptoms (cerebellar and pyramidal dysfxn) comes with Impotence orthostatic hypertension abnormal sweating disturbance of bowel or bladder control impotence gastroparesis

Question 532

Ashkenazi jew gross dysfunction of ANS with severe hypotension

Answer 532

Riley Day syndrome==\>\> Familial Dysautonomia

Question 533

Crohns and Stone

Answer 533

Oxalate Stone increased fat in intestines steals calcium away from oxalate Alone oxalate gets reabsorbed more==\>\>stone Calcium prevents oxalate stone formation Fat malabsorption disorders promote oxalate stones

Question 534

seminoma germ cell tumor

Answer 534

produces only hCG

Question 535

AFP and B hCG

Answer 535

produced by only Nonseminoma germ cell tumor

Question 536

Copper

Answer 536

Depression hepatic dysfunction copper from liver spills==\>\> goes to basal ganglia==\>parkinsonian tremor

Question 537

atopic

Answer 537

scaly or papular rash

Question 538

contact dermatitis

Answer 538

vesicles and papules

Question 539

Duodenal ulcer

Answer 539

pain gets better with food food-D

Question 540

Young woman alternating diarrhea and constipation pain gets better after stooling mucus, loose stool

Answer 540

IBS

Question 541

bullous impetigo

Answer 541

Honey color crusted lesions staph aureus common in children

Question 542

rash thats limited to exposed skin makes linear streaks where skin has brushed against the plant leaves

Answer 542

vesicle and small bullae at site of exposure plants nickle dye leather rubber poison ivy atopic contact dermatitis eroded erythematous plaques with vesicles type 4

Question 543

upper abdominal systolic-diastolic bruit Also see, unexplained rise in serum creatinine after staring ACE inhibitors

Answer 543

Renal Artery Stenosis

Question 544

Eye redness of Medial **_Canthal_** Purulent discharge

Answer 544

Infection of lacrimal sac==\>_Dacro_**cystitis**

Question 545

Answer 545

Abscess over the eyelid ==\>\> could be upper or lower eye lid

Question 546

Answer 546

Orbital cellulitis happens behind the orbital septum ==\> comes with fever and restriction of Extraocular muscles movement red eye lids

Question 547

Gums growing ==\>gingival hyperplasia

Answer 547

Phenytoin I cell disease Cyclosporine Calcium channel blockers

Question 548

Eosiniphilia wbc cast hematuria sterile pyuria

Answer 548

interstitial nephritis penicillin, sulfonamides, cephalosporin

Question 549

15 -20 weeks definitive karyotypic

Answer 549

Amniocentesis invasive--\> risk of membranes rupture, fetal injury and pregnancy

Question 550

woman \> 35 first trimester--10th week

Answer 550

cell free fetal DNA

Question 551

reticular, peri hilar opacities--\> linear

Answer 551

surfactant deficiency

Question 552

hyperphagia almond eyes microphallus ---\>hypogonadism

Answer 552

dysmorphic facies of prader willi paternal deletion of 15q11

Question 553

11p15

Answer 553

_Beckwith-Wiedemann_ rapid growth macroglossia **_HEMIHYPERPLASIA_** Umbilical hernia

Question 554

15q11-q13

Answer 554

Angelman Syndrome short stature ever smiling hand flapping ataxia and seizure

Question 555

Ketoralac Meloxicam Peroxicam

Answer 555

NSAID

Question 556

Paget disease of the breast

Answer 556

Adenocarcinoma

Question 557

Exudative pleural effusion

Answer 557

==\> Pleural protein / serum protein = .5 ==\>\> Pleural LDH / Serum LDH = .6 ==\> Pleural LDH==\> more than 2/3rd the upper limit of serum LDh

Question 558

if bacteria gets into effusion (pleural)

Answer 558

makes it acidic with low glucose seen and more WBC are seen Empyema==\>\> have additional, frank pus

Question 559

Hypoalbunemia HF

Answer 559

Transudative effusion Bilateral

Question 560

Dopamine precursors leva/carba for elderlies

Answer 560

Adverse effects==\> somnolence, hallucination, confusion

Question 561

prevents breaking down of dopamine

Answer 561

COMT Entacapone and tolcapone adverse effects --\>choreiform dyskinesia

Question 562

Absent thelarche--\> absent breast short height what hormones are increased

Answer 562

FSH and Lh increased in turner due to absent estrogen and progesterone

Question 563

Edema =Angioedema==\> facial/periorbital/circumfurol

Answer 563

ACE inhibitors

Question 564

Sun-exposed body area non-healing ulcer rough and thickened patient is on chronic immunosuppressive agent

Answer 564

Squamous Cell Carcinoma

Question 565

Carotid pulse with dual upstroke

Answer 565

Hypertrophic Cardiomyopathy dual CAROTID stroke due to obstruction by ASSYMETRICAL HYPERTROPHIED HEARD

Question 566

Aminoglycosides gentamycin tobramycin neomycin

Answer 566

Severe Gram Negative Infections

Question 567

Clindamycin

Answer 567

Anaerobic bacteria above diaphragm Metronidiazole =\> below diaphragm

Question 568

trauma patients

Answer 568

Cervical immobilization spine stability Cardio-Respiratory stability Peripheral IV access Pelvic injury ( if not visible==\> insert a urinary catheter to assess urinary retention and prevent possible bladder injury from distension

Question 569

IV cefazolin

Answer 569

60 minutes before surgery ( prophylaxis)

Question 570

CHF creates what kind of murmur

Answer 570

MR==\>\>Holosystolic LV dilated or remodeled==\> dilation causes mitral annulus enlargement and remodeling causes papillary muscle displacement==\>\> MR

Question 571

Rotator cuff tear visualizing? Xray or MRI

Answer 571

MRI MRI scan==\> visualizes soft tissue around the bone==\> shows the tear in muscle Xray can show only calcification

Question 572

CD4 22 Diarrhea 3mm induration

Answer 572

AVIUM Azithromycin

Question 573

HIV diarrhea

Answer 573

180---\>\>50 180--\> crypto--\> Watery 100------\>Isosporodium----\>watery 50------\>Avium----\>watery 50=====\>\>\>\>CMV==\>\> Bloody

Question 574

Pregnant patient hyperandrogenic symptoms Ultrasound---\>\> bilateral cysts on ovaries

Answer 574

Observe and expectant management hyperandrogenic states mostly seen in african americans cysts form==\>\> luteoma 30% are asymptomatic

Question 575

Hypotension ==\>\> Decreased RBF--\>\>

Answer 575

Decreased RBF==\>\> Renal saves Na+ and Urea FeNa+ decreased Uxe decreased Hypotension==\>\>\>Prerenal

Question 576

Ischemia ( nephritis) or toxins to the tubules==\>\>

Answer 576

Intrinsic Renal Failure patchy necrosis--\>\>debris debris obstruct--\> builds a backflow--\> GFR decreases--\>\> impaired rabsorption too--\> excretion increases of Na and urea

Question 577

Urine gets darker after starting a drug regimen

Answer 577

Drug-induced Interstitial nephritis penicillin cephalo sulfonamides

Question 578

Peripheral eosinophilia eosinophiluria pyuria hematuria

Answer 578

Interstitial Nephritis Drug-induced

Question 579

ADh on sodium

Answer 579

Just deals with water

Question 580

Answer 580

Pain will be Bilateral that will radiate and get better on rest and get worst with ambulation **_OsteoArthritis of Spine_**

Question 581

Answer 581

Ground glass and bronchograms ( fluid) RDS in infant =\> prematurity Maternal diabetes= High glucose==\> Insulin==\> antagonizes cortisol==\> delays production of sufractant MAle gender and cesareon without labor is a risk too

Question 582

undercooked fish

Answer 582

clonorchis , diphyllobothrium latum Biliary problemo B12 problemo

Question 583

Answer 583

Bulging==\>\> hydrocephalus sunken==\> dehydration

Question 584

Vomiting hco3 = high or low

Answer 584

Vomiting==\> loses stomach acid ==\>alkalosis but volume also lost==\> contraction contraction==\> RAAS=\> K+ and H+ secreted into urine==\> contraction alkalosis

Question 585

Answer 585

Lichen planus pruritic flat topped plaques

Question 586

AFP and hCG elevated

Answer 586

**_Non seminoma_** germ cell tumors Seminoma= only hCG, not even some AFP elecated

Question 587

Augmenting Antidepressant medication to make the patient hit baseline function

Answer 587

Add antidepressant of different mechanism or add second generation antipsychotic or psychotherapy

Question 588

SiADH

Answer 588

If you give normal saline **water stay b**ut _kidneys will throw out the sodium_ _Hyponatremic Hypovolemia_

Question 589

Asymmetric oligoarthritis with conjunctivitis and mouth ulcers urethral discharge

Answer 589

Reactive arthritis initial therapy==\> NSAIDs

Question 590

reactive Arthritis Vs gonococcal septic arthritis

Answer 590

reactive will have conjunctivitis asymmetrical arthritis mouth ulcers enthesitis (Tendon pain, mostly Achilles)

Question 591

Osler nodes

Answer 591

painful fingertip nodules

Question 592

drugs that increase Potassium in the body

Answer 592

Beta blockers--\> block K+ uptake ace inhibitos cyclosporine heparin nsaids succinylcholine trimethoprim ( like amiloride, K+sparing)

Question 593

headaches

Answer 593

Mig --\>Pulsates and throbs-\> unilateral Cluster--\> sharp and behind one eye Tension--\> Band like, dull tight and persistent

Question 594

Duodenal ulcer

Answer 594

Worst at empty stomach acid drives into duodenum unopposed and drives it crazy

Question 595

Warty skin lesion Violaceous nodule peripheral ulcer midwest states

Answer 595

Blastomycosis bone pain and also genitourinary

Question 597

ALF most common cause of death

Answer 597

Cerebral edema

Question 598

gerd adenocarcinoma

Answer 598

Gerd for 20 years Gerd==\>\> most probably barrets==\>\> strectures strictures==\>\>symmetric==\>circumferential narrowing==\> distal esophagus strictures==\>\> progressive dysphagia to solids==\>may even block acid reflux due to narrowing

Question 599

achalasia

Answer 599

peristalsis issue ==\> shows dilated proximal esophagus both liquids and solids

Question 600

Fanconi Anemia vs Fanconi Syndrome

Answer 600

**_Fanconi Anemia_**==\> Bone marrow failed and cafe au lait spots, short stature, hypogonadism, skeletal anomalies **_Fanconi Syndrome_**==\> Proximal Convoluted Tubule doesn't reabsorbs shitt

Question 601

Macrocytic but Non-MegaloBlastic

Answer 601

Liver failure Diamond beclo Alcoholism

Question 602

Ectopic Pregnancy

Answer 602

hCG==\>\>Transvaginal Ultrasound

Question 603

Answer 603

Congenital Melanocytic Nevus

Question 604

Answer 604

Nevus Flameus

Question 605

HIIT confirmatory test

Answer 605

Serotonin release essay

Question 606

Disseminated Histoplasmosis

Answer 606

IV Liposomal Amphotericin B

Question 607

Cytokines from stored blood

Answer 607

Leukocytes--\>\> cytokines Non-Hemolytic Febrile Reaction ==\>\> Fever, Chills, And Malaise

Question 608

Diabetic--\>see bicarbonate--\>if low & hyperkalemia (with mild renal dysfunction)

Answer 608

H+ and K+ don't get secreted out by the collecting duct ==\> Type 4 RTA Diabetic +Elderly==\>\> JG apparatus damaged==\> Hypreninemic ==\> Hypoaldosteronism==\> H+ and K+ stay in body==\> metabolic acidosis H+ does not get secreted==\> Hco3 does not get generated

Question 609

Lithium

Answer 609

toxicity increases in dehydration thiazides ace whatever gets the reabsorption increased

Question 610

profound lymphopenia

Answer 610

SCiD

Question 611

Brutons and lymph

Answer 611

Absent Lymphoid Tissue

Question 612

A cough with laughing, night, exercise, steam Resembles common cold paroxysms of cough

Answer 612

Whoops pertusis Forceful coughing==\> vomit==\>weight loss Lymphocytosis may be seen Macrolides=\> decreases severity and contagion

Question 613

ectopic tachicardia and av block

Answer 613

digitalis toxicity

Question 614

Pendular reflex

Answer 614

Less brisk==\> cerebellar dysfunction

Question 615

Medial Cerebellar lesion

Answer 615

Truncal Ataxia Nystagmus dysmetria ( tremor when reaching for a target ) Impaired and rapid alternating movements ( Dysdiadochokinesia ) Muscle hypotonia--\> pendular knee

Question 616

Acute Pelvic pain

Answer 616

A ROPE Appendicitis--\> RLQ pain--\>\>fever and vomiting Ruptured Ovarian cyst===\>\> recent strenuous activity Ovarian Torsion Pid==Gradual Ectopic pregnancy

Question 617

myopathy

Answer 617

if with palpitations--\> thyroid with tenderness--\> Polymyositis facial or ocular weakness---\> MG CNS disorders plus lactic acids= MELAS mitochondrial--\>red ragged Daptomycin statins, fibrates,

Question 618

Newborn Scaphoid /concave abdomen in newborn Breathing emergency= (breath sounds not heard on left side) 70/40 BP Nasal flaring, grunting, barrel shaped chest

Answer 618

CdH Deviation of Abdominal Viscera into the thorax results in a concave/ scaphoid abdomen & barrel-shaped chest Emergent Intubation

Question 619

number of times woman has been pregnant regardless of outcome

Answer 619

Gravida

Question 620

Preeclampsia Diagnosis

Answer 620

Urine **_Protein/Creatinine_** ratio or 24 Hour collection for Total protein --\> Gold Standard

Question 621

patchy areas of demyelination AIDS patient

Answer 621

JC virus

Question 622

PTSD less than a month

Answer 622

Acute Stress Disorder If they persist more than a " Month" ==\>\> PTSD

Question 623

3 mm pupil size

Answer 623

NORMAL

Question 624

sternum angle

Answer 624

Below clavicle==\>\> CVP Above Clavicle ==\>\> Jvp CVP= 5 cm Jvp= 3 cm 6-8 cm = Normal

Question 625

Mitral classic finding

Answer 625

Loud S1 mid DIASTOLIC rumbling at apex

Question 626

a patient comes and tells that vaginal pain gets better with urination Exam-\> palpation of anterior vaginal wall elicits tenderness

Answer 626

relieved by voiding==\> Interstitial Cystitis Painful bladder syndrome painful in filling

Question 627

a middle age woman is waiting in room and tells you she is having painful intercourse hx-\> dental caries only

Answer 627

Sicca increase lubrication

Question 628

cyclophosphamide Adverse effect

Answer 628

Bladder Cancer

Question 629

150-500 Triglycerides

Answer 629

Decrease alcohol exercise weight loss fibrates ==\>\> if above 1000, and abstinence from alcohol

Question 630

patient tells you about recurring vertigo unilateral tinnitus and fullness and sensorineural hearing loss

Answer 630

Maniere

Question 631

Elderly patient comes tells you he cant tolerate loud sound in the room that others can! bilateral tinnitus

Answer 631

Presbycusis-\> sensorineural

Question 632

patient tells you that he gets dizzy with changing positions or when looking at upper shelf

Answer 632

BPPV dix-hallpike maneuver diagnoses it Epley maneuver fixes it

Question 633

dialysis related 7 causes of cardiovascular incidents

Answer 633

NO= inhibited accelerated atherogenesis= due to enhanced oxidant stress increased homocystein== not cleared out by the kidneys Hyperphosphatemia hypercacemia- given to fix excess phosphate Anemia- \> tachycardia ESRd

Question 634

Thiazides and calcium

Answer 634

A milder form of Hypercalcemia \<12 mg Severe form of hypercalcemia doesnt happen

Question 635

A patient comes to you with a history of smoking and now has Hypercalcemia, severe=\> more than 13mg

Answer 635

Malignancy related Hypercalcemia

Question 636

Alzheimers

Answer 636

Temporal and parietal lobes shrunken

Question 637

Young patient comes and tells he cant play basketball he has tenderness on proximal tibia, at the site of patellar tendon insertion

Answer 637

Traction Apophysitis ==\>\> Osgood-Schlatter RUnning, kneeling, playing --\> Quadriceps tendon puts traction on Apophysis of Tibial Tubercle Firm mass can be felt there due to the heterotropic bone formation

Question 638

Patellar Tendonitis

Answer 638

Point tenderness on Inferior pole of the patella (overused)

Question 639

Patient is a long time runner now feels pain while walking down hill or down the stairs

Answer 639

Patellofemoral Stress syndrome

Question 640

large thick multiloculated cystic mass on one of the adnexal area

Answer 640

if fever and high leukocytes==\> Tubo-ovarian abscess if not, or with weight loss =\> serous cystadenocarcinoma

Question 641

3 wk old Neonatal not pooping after initially pooping fine also bile vomits premature born nasogastric formula what will be seen on radiography

Answer 641

Necrotizing entrocolitis==\>\>Air in bowel wall and portal veins Premature--\> decreased bowel motility--\> bugs can born in stasis increased permability--\>inflammation---\> Leukocutosis intestinal ischemia--\> Metabolic acidosis Gas--\> from gas producing bacteria--\>\>gas in bowel wall and also the gas migrates to mesenteric and portal veins

Question 642

dilated abdoment and duodenum

Answer 642

double bubble sign in duodenal atresia==\>\> bilious vomiting

Question 643

failure to pass meconium within 48 hrs of birth

Answer 643

hirschsprung disease

Question 644

contrast and renal

Answer 644

Nephro-pathy Brownish casts ( Mud) granular texture CIN - resolves with in 3-5 days

Question 645

patient had coronoary stent placement --\> last week now has mottled skin of legs and increased BUN and Increased Eosinophils

Answer 645

cholestrol emboli

Question 646

paroxysmal Norcturnal Hemoglobuneria and coombs

Answer 646

negative Coombs because its complement-mediated hemolysis

Question 647

idiosynchratic hepatitis

Answer 647

inflammatory cells attack toxins from some drugs eosinophilia present but absent in==\> ==\>\>isoniazid induced hepatitis

Question 648

Autoimmune hepatitis

Answer 648

first rule out viral drugs toxins after that --\> do ANA test or anti smooth muscle antibody test

Question 649

Vaccination to yellow fever contraindicated in

Answer 649

live attenuated vaccine low immunity cases or where patient is taking methotrexate or biologicals

Question 650

meningococcal booster

Answer 650

at age 16-21 primary is at 11

Question 651

Menopause Genitourinary symptoms

Answer 651

urinary incontinence = due to less estrogenic firmness of vagina==\>\> weak closure pressure of urethra--\> recurrent UTI & incontinence Vulvovaginal dryness--\> irritation and pruritus

Question 652

IBS and colonoscopy indications

Answer 652

Post diagnosis= 8 years if rleft side of colon diagnosed= 12-15 years

Question 653

a patient comes into the trauma unit with loss of pain and temperature and also loss or weakness of motor function in lower limbs bilaterally

Answer 653

Anterior Cord Syndrome Anterior Spinal Artery==\> anterior portion of spinal cord is damaged but back one is ok back of spinal cord==vibration and touch will be ok

Question 654

Answer 654

Intussesption telescoped air enema==\>\> goes in from rectum==\> uses air or contrast==\>\> un-telescopes with the use of pressure

Question 655

Action tremor

Answer 655

Essential beta blockers mild alcohol Anticonvulsant= Primidone

Question 656

Trochlear groove

Answer 656

if you compress the patella into the trochlear groove==\>\> Patellofemoral pain syndrome Over use young adults dancers or athletes

Question 657

Hyperpigment and Velvety skin on flexures like axilla and groin

Answer 657

If patient lost weight==\>\> Undelrying malignancy==\>\> Acanthosis Migricans If patient gained weight==\>\>insuline resistant diseases==\>\> DIabetes mellitus, Polycystic ovary

Question 658

Lymphoma MaLT Marginal Zone-B cel Lymphoma

Answer 658

Bacterial--\> H Pylori

Question 659

nitro on stomach smoking High salt

Answer 659

Adeno carcinoma of stomach

Question 660

drugs that are not recommended for first line antihypertensives

Answer 660

Loop inhibitors Doxazosin

Question 661

Normal Liver span

Answer 661

@Midclavicular level = it spans 8 --\> 12 cm @Midsternum level = it spans 4 ---\> 8 cm

Question 662

ProPtosis

Answer 662

Question 663

Ptosis?

Answer 663

Drooping

Question 664

Anti Mitochondrial Antibody

Answer 664

Bile duct if blocked- - - - \>\>\> Cholangitis Sclerosing --\> P Anca Mitochondrial antibody- --\> PBC --\> autoimmune and granulomatous Direct

Question 665

Young patient More than 5 days of fever with Non exudative conjuctivits non exudative tonsill lips are fissured strawberry tongue lymph node in " Cervical Area " more than 1.2 cm in size

Answer 665

Kawasaki also hands- -- \> swelled feet-----\> swelled aneurysms----\> on Coronary artery

Question 667

rupture after a heart attack in 3 to 5 days

Answer 667

Pulmonary Edema ===\>\>\> Papillary muscle rupture --- Right Coronary Artery Shock And Biventricular Failure===\>\> **_Interventricular septum_** Apex--- Left anterior descending artery Basal---\> RIght Coronary Artery Left to Right ventricular flow==\>\> Blood causes harsh holosystolic murmur and a palpable thrill

Question 668

5 Second Generation Antipsychotics

Answer 668

Riseperidone Ziprasidone Queitapine Olanzapine Aripiprazole

Question 669

lochia rubra

Answer 669

blood looking fluid present after delivery= few days after 3-4 days==\>\>thin pinkish brown==\>lochia serosa after 2-3 weeks==\>\> yellow white discharge

Question 670

Muffled voice and drooling

Answer 670

Epiglottis H.Influenzae

Question 671

Casts or eosinophils

Answer 671

Interstitial Acute interstitial nephritis

Question 672

Antibiotic given FeNa increased no casts no eosinophils

Answer 672

Aminiglycosides Amikacin gentamicin neomicin tobramycin streptomycin

Question 673

Fever, Chills Bleeding from intravenous sites bleeding started after blood transfusion Just after an hour

Answer 673

Acute hemolytic Transfusion Reaction ---\>\> Renal Failure ---\>\> DIC

Question 674

Celiac tests Initial and gold standard

Answer 674

Initial =\> IgA Anti-tissue Transglutaminase IgA Anti-Endomysial DQ = 2 & 8 **_Gold standard= Biops_**y=\> Villous Atrophy or blunted and Hyperplasia of crypts Check for T-cell Lymphoma

Question 675

Crescendo---\>\>\>\>\>Decrescendo

Answer 675

Aortic Stenosis Hypertrophic heart ---\>\> Hypertrophied Interventricular Septum

Question 676

young patient Palpable rash on legs and buttocks bones hurt blood in the urine

Answer 676

Henoch vasculitis colicky abdominal pain---\>\> Intussusception cases Renal behaves like IgA nephropathy Arthritic arthralgic

Question 677

SiADH ==\> What saline?

Answer 677

3% saline for hypotonic patient

Question 678

High plantar arch decreased vibration position problem reflexes slow or absent unsteady gait cvs problems

Answer 678

Freidrich ataxia

Question 680

general anxiety vs panic vs social

Answer 680

general = multiple reasons and chronic social== while performing or being judged panic= sudden , without any reason

Question 681

Endocarditis and abdominal tenderness ( Had bowel movements )

Answer 681

Acute Mesenteric Ischemia bacterial emboli from heart went to Bowel blood supply

Question 682

Vitiligo vs versicolor

Answer 682

Vitiligo is without scaling

Question 683

Extra articular----\>\> TOPHI

Answer 683

Urate

Question 684

Increased MCHC

Answer 684

Spherocytosis Autosomal DOminant

Question 685

Seizure less than 20sec doesnt respond vocals or name being called Presence of automatism

Answer 685

Absence seizure

Question 686

Exudative formula

Answer 686

A) Protein in Pleural fluid / Protein in serum = more than .5 B) Pleural Fluid Lactate Dehydrogenase/serum Lactate Dehydrogenase = more than.6

Question 687

Wells Criteria

Answer 687

To Diagnose Pulmonary Embolism Clinical Signs of DVT = +3 points Alternate diagnosis not likely previous DVT or PE = 1.5 Tachycardic \>100 Recent surgery or immobilization Hemoptysis = +1 Cancer \>4 points ---\>\> PE

Question 688

Alkalotic body and its influence of Calcium

Answer 688

Alkalosis---\>\> hydrogen gets redistributed from bound albumin-calcium complex and makes it Unionized---\> calcium gets deposited more and more on albumin--\> hypocalcemic body--\> spasmatic

Question 689

papillary thyroid cancer

Answer 689

solitary nodule enlarges slowly

Question 690

Elevated direct bilirubin + the patient is febrile and hypotensive Increased Alkaline Phosphatase

Answer 690

Acute Cholangitis and ascending (infection)

Question 691

The patient was treated for tremors recently Now--\> comes with a dilated pupil and eye pain. and blood shot conjuctiva

Answer 691

Patient was probaly treated for parkinsons and treated with anticholinergic drug Anticholinergic drugs--\> block drainage of humor sudden eye plain--\> close angle glaucoma

Question 692

Answer 692

scaly Actinic Keratosis gets importance due to its progression to Squamous Cell Carninoma

Question 693

capsule vaccine

Answer 693

T-cell independent B-Cell response

Question 694

Psychosis Depression Personality changes Liver Enzymes high gait disturbance

Answer 694

Wilsons copper damages hepatocytes and basal ganglia

Question 695

Intramuscular Penicillin G

Answer 695

Syphilis - Treponema Pallidum Strep Actinomyces

Question 696

Pain upon removal of pressure on abdomen

Answer 696

Rebound Tenderness Peritonitis SBO Peritoneal Irritation Appendicitis

Question 698

pertussis

Answer 698

lymphocytosis Hospitalize if less than 6 months old

Question 699

Lymphocytosis

Answer 699

Pertussis EBV CLL

Question 700

Glasgow

Answer 700

below 3 is problems

Question 701

Nephrotic cases

Answer 701

Amyloidosis--\> Mostly with multiple myeloma or rheumatoid arthritis Membranous nephro--\> SLE, GOLD, NSAIDSSolid tumors, HBV, MAlaria FSsG- African-\>HIV HEroine or w/ Uncontrolled HTN Minimal CHange DIsease

Question 702

Patient has a history of AFib & Nonischemic cardiomyopathy now feels constipated, and gained weight difficulty concentrating and forgetful

Answer 702

Amiodarone-induced hypothyroidism

Question 703

Hematuria and Scrotal Vericocele That fails to empty when patient is recumbent

Answer 703

Renal cell Carcinoma Asymptomatic mostly and gets diagmosed really late tumor obstructs gonadal vein--\> Vericocele

Question 704

Normocytic Anemia

Answer 704

Membrane defects enzyme defects sickle cell extrinsic microangiopathic/macroangio infections Hbc

Question 706

scleroderma and lungs

Answer 706

Interstitial lung disease Anti Scl 70 anti RnA Pol 3 antibody

Question 707

if you oxidize hemoglobin

Answer 707

Heinz body gets removed by a bite

Question 708

FEV1/FVC in Restrictive

Answer 708

Normal

Question 709

Pain on hip abduction & Internal Rotation

Answer 709

Osteonecrosis ( Aseptic necrosis ) sickle cell case--\> adults have ( no more foveal artery like kids)

Question 710

Pulsatile groin mass in elderly pain in anterior thigh

Answer 710

Femoral Artery Aneurysm pain due to femoral nerve entrapment ( runs lateral to artery

Question 711

alcoholic patient in room care what to expect in his stay?

Answer 711

Seizures or Hallucinations = 12 to 48 Hrs Delerium Tremens = 48 to 96 hrs

Question 712

Cocaine vs Heroin withdrawal

Answer 712

Cocaine = Hypersomnia and hyper-eating Heroin = Diarrhea , cramps dilated pupils and yawning

Question 713

patient tells cant sleep kids left and make her sad she drinks wine two sleep but wakes up at 3 tremor is noted labs show high liver transimnases

Answer 713

Alcohol use disorder

Question 714

tick case in southern America patient has high fevers as well

Answer 714

not lyme lyme is not available south monocytic ehrilichiosis Leukopenia

Question 715

septation mass on ovary thick and solid

Answer 715

epithelial carcinoma of Ovary and fallopian tube and peritoneum

Question 716

breastfeeding delayed or failure

Answer 716

neonatal jaundice delayed breastfeeding--\> delayed feeding--\>\> delayed stooling----\>\> delayed bile removal Increased enterohepatic circulation--\> Indirect increased

Question 717

marfan and heart

Answer 717

Aortic dissection Aortic root dilation--\>\> Aortic regurgitation

Question 718

decrescendo

Answer 718

aortic regurgitation

Question 719

sudden and severe chest pain radiates to the back

Answer 719

Aortic Dissection if renal deficit--\> do TES if renal ok --\> give contrast--\> do CT Angiography

Question 720

Normal Bicarbonate

Answer 720

Age of Boy to Becoming man 22-----28

Question 721

Tension Pneumothorax

Answer 721

Immediate needle decompression in second intercostal space

Question 722

Digitalis Overdose what kind of tachycardia

Answer 722

Atrial tachycardia with AV block ( due to increased vagal tone)

Question 723

Hypertension case what is the test list

Answer 723

Electrocardiogram lipid panel ( coronary) urine analysis (any occult hematuria and protein /creatinine)

Question 724

Impaired tandem walking/heel-shin test with preserved finger nose testing wide based gait alcoholic for more than 10 years

Answer 724

Alcoholic cerebellar degeneration Vermis

Question 725

Wolff and AV node

Answer 725

AF disguised as Wolf bypasses Av block and creates an accessory pathway rapidly depolarizing ventricle professionally Cane the wolf by procainamide or cane its BUTt by Ibutilide

Question 726

check ups for elderly time period

Answer 726

every two years = mammography every three years = pap smear every ten years = colonoscopy

Question 727

panic disorder treatment

Answer 727

short term = benzodiazepine long term = ssri / cbt

Question 728

primidone

Answer 728

barb essential tremor

Question 729

Acholic stools Jaundice Hepatomegaly

Answer 729

Biliary atresia Pipe that connects liver to the intestine is missing (Atresia) Liver won't even be able to send " a tracer " to the Small bowel aka Scintiography Do Kasai Procedure

Question 731

sturge weber vs tuberous sclerosis

Answer 731

Seizures with retinal/ocular/ and cutaneous hypopigmented patches ==\>\>\>\> Tuberous sclerosis Seizures with port wine stain only and no hypopigmented patches==\> Sturge Weber

Question 732

Ischemic Stroke what can happen after two days

Answer 732

Hemorrhagic Transformaton repeat CT scan

Question 733

alcohol & tobacco--\>\> Leukoplacia and SCC DIfference?

Answer 733

Leukoplakia --\>\> Granular SCC---\>\> Ulcerated and Nodular and regional lymphadenopathy present probably

Question 734

Peritonitis how to check

Answer 734

Upright X-Ray of Chest & Abdomen ---\>\> Free Intraperitoneal Air

Question 735

Prednisone

Answer 735

Decreases CRH from hypothalamus

Question 736

Colicky pain Unable to pass gas Hyperactive sounds and sometimes no sounds Pain in "WAVES" Air/FLuid in bowels Change in "Character" of pain Fever Hemodynamic Instability

Answer 736

Short Bowel Syndrome Mild--\> bowel rest, suction and electrolyte fix Peristaltic rush in the beginning--\> hyperactive sounds as it gets severe--\> no sound Severe--\> urgent exploratory exploration

Question 737

Large amounts of purulent sputum numerous episodes of bronhitis Gets improved with antibiotics but returns again now see some blood

Answer 737

Atelctactic lung due to impaired clearing or blockage = Bronchiectasis High-resolution CT scan for Bronchiectasis

Question 738

Answer 738

Bronchial wall thickening first bronchitis episodes second atelactic lobe third chronic bronchitis

Question 739

Intraductal Papilloma Versus Infiltrating Intraductal carcinoma

Answer 739

Both bleed but IIC has a mass

Question 740

Depot Medroxyprogesterone for Contraception

Answer 740

Every 3 months

Question 741

patient comes with Stroke-like symptoms hemiplegic pain headache

Answer 741

Figure out if its Ischemic or hemorrhagic stroke

Question 742

tearing eye pain pupil size changed stabbing pain in eye unilateral

Answer 742

Cluster

Question 743

TCA effect on heart

Answer 743

QRS widening Treated with Sodium Bicarbonate Inhibits Fast Sodium channels of --\>\> His-Purnkinje & myocardium Decreases Conduction--\> Prolongs Absolute refractory period

Question 745

Methanol vs Ethanol Poisoning

Answer 745

Methanol--\>\> damages eyes Ethenal ( glycol) ----\>\> damages kidneys

Question 746

Edwards

Answer 746

Rocker bottom feet overlapping fingers clenched fist VSD MicroGnathia (nose area) Limited Abduction of hips Renal defects

Question 747

Vulvar PLAQUE intense itch post menopausal woman loss of labia minora clitoral hood shrunken very painful intercourse--\> penetration not possible

Answer 747

Lichen Sclerosus paper thin vulvar skin very high chances of SCC

Question 748

Watery conjunctivitis

Answer 748

Allergic and viral allergic------\>\> mandatory bilateral Viral-----\>\> prodrome

Question 749

Intraparenchymal hemorrhage

Answer 749

Sudden neurologic deficits--\> worsen--\> minutes Amyloid or Hypertension Amyloid---\> lobar--\> elderly hypertensive--\>

Question 750

When Uncle herniates after Epidural

Answer 750

Oculomotor compressed--\> mydriasis and ptosis crus cerebri compressed--\> hemiperesis--\> Ipsilateral Posterior Cerebral Artery compressed--\> Homonymous Hemianopsia--\> Contralateral Reticular formation compressed--\> lost consciousness--\> coma

Question 751

Pain and temperature impaired Upper extremity motor function impaired

Answer 751

Syringomyelia

Question 752

External Auditory meatus is edematous with purulent discharge granulation tissue is seen on the floor Tympanic Membrane is clear

Answer 752

Externa case Anti pseudomonals AMino= TAG Cipro levo ceftiaz-cefepime Ticar-Piperacillin

Question 753

NMS malignant hyperthermia Acute Dystonia

Answer 753

Antipsychotic ---\>\>Rigid muscle + HIGH Fever --\> NMS--\> Dantrolene Inhaled Anesthetic--\> fever+ muscle contracted--\>\>Dantrolene Antipsychotic--\> rigid muscle without fever--\> Diphenhydramine , Benztropine

Question 754

Placenta Previa vs Abruptio

Answer 754

Abruptio--\> uterus is very tender and in pain + fetal Heart rate abnormalities Previa --\> painless bleeding, normal FHR

Question 755

False Labor

Answer 755

Irregular contractions without pain weak in strenght reassure patient and discharge

Question 756

Panic disorder 7s

Answer 756

Recurring Derealization/Detachment sweating chilling or trembling Dizziness fear of losing control Worry about additional attacks Palpitations and shortness of breath

Question 757

Liver CT scan mass is seen

Answer 757

If weight loss--\> cancer Hx of bloody diarrhea--\> Amebic cyst---\>Entamoeba Hx of Animal Contact---\> Echinoccous Old man/ hx of peritonitis--\> Bacterial abscess

Question 758

Infant Respiratory distress causes?

Answer 758

Prematurity maternal diabetes cesarean without labor male sex See Air Bronchogram on radiograph--\> air filled alveoli is standing out, from surround alveoli that are opacified

Question 759

Ground glass ( reticlular) radiograph and bronchoghram

Answer 759

Respiratory distess (Infant)

Question 760

Viral prodrome slowly grown and scaled within a week --\> cluster develops in xmas tree pattern pruritic wrestler

Answer 760

pityriasis rosea

Question 761

wrestler

Answer 761

TInea corporis central clearing

Question 762

Callus

Answer 762

Question 763

Primary lung cancer and clubbing

Answer 763

Activating mutations of KRas, EGFR, ALK--\>\> growth--\> Adenocarcinoma on Periphery of Lung

Question 764

Focal Glomerulosclerosis

Answer 764

NephrOtic "He" hIv HEroin hEmoglobinopathy--\> Sickle RBc

Question 765

Nephrotic BCSS

Answer 765

membranous--\> Hep B Hep C SLE Syphilis

Question 766

Painless Genital ulcers

Answer 766

Granuoma Inguinale--\> klebsiella--\> extensive ulceration--\> granulation in base single --\> clean based ulcer--\> corkshaped Syphillis Shallow--\>\>small ulcers--\> venereum Chlam --\>lymphogranulama --\> Chlam is Coalesced

Question 768

Y descent

Answer 768

Relaxing descent Right atrium ORGASMs into RIght Ventricle

Question 769

X descent

Answer 769

tricuspid pushed back due to increased pressure generated from RV contraction

Question 770

toxoplasmosis --\> multiple or single

Answer 770

\<100 cells Multiple Tox--Multiplies--\>below 100 cells

Question 771

Solitary Ring C

Answer 771

CNS Lymphoma

Question 772

Spasm of The Coronary

Answer 772

Diltiazem AmloDipine FeloDipine Sublingual NitroGlycerin --Aborts the ongoing Episode

Question 773

Peridontal Group

Answer 773

HACEk Eikonella CorroDens kingella CArdiobacterium HOminiS Haemophilus Aphrophilus AggreGatiBacter

Question 774

swollen eye with conjuctival injection but no discharge

Answer 774

If pain with ocular movement--\> orbital cellulitis if no pain--\> preseptal cellulitis Orbital--\> IV antibiotic +- SUrgery Preseptal--\> Oral Antibiotic

Question 776

MCA stroke

Answer 776

Anosognosia--\> Lack of awarens of ones illness Hemi neglect Eye deviates--\> towards the lesion Upper limb affected Face

Question 777

Diabetic kidney timeline

Answer 777

H-T-E-N Hyperfiltration--\>BM thickening--\>Mesangium expansion--\>Nodular

Question 778

for depression and insomnia and to stimulate hunger ?

Answer 778

Mirtazapine

Question 779

6 year old consistent hip pain but normal xrays

Answer 779

Leg--calve-Perthes disease **_Idiopathic Avascular necrosis_** of "A Child"

Question 780

IgE mediated

Answer 780

histamine and inflammation No vesicles

Question 781

Linear allergic reaction vesicular some are crusted and some are still wet

Answer 781

Delayed takes time to linear formation varied presentation due to time elapsed T cell mediated type 4 attack

Question 782

Optic neuritis causing drugs

Answer 782

Ethambutol Hydroxychloroquine

Question 783

Most effective intervention to prevent post operative pneumonia

Answer 783

Incentive Spirometry Aim to promote lung expansion ( also,deep breathing and CPAP)

Question 784

Anti thrombotic tx criteria

Answer 784

CHA2D S2 VASc CHF--\>Htn--\>AGe75--\>Diabetes Stoke Vascular disease--\>Age65-74--\>Sex category

Question 785

Prostatitis vs BPH

Answer 785

similar but Prostatitis --\> comes with back pain and pain with ejaculation BPH--\> only stream problem

Question 786

tender and immobile uterus and adhesive

Answer 786

Endometriosis

Question 787

Tardive dyskinesia after how many months and what drug?

Answer 787

6 months Valbenazine

Question 788

Hemorrhagic bladder and bladder cancer after starting a drug Which drug?

Answer 788

Cyclophosphamide

Question 789

Sudden epigastric pain--\> Intense Free Air under the diaphragm

Answer 789

Question 790

Hemodialysis Hypertensive crisis

Answer 790

Acute Hypertensive Crisis--\> Bilateral Retinal Hemorrhages, Headache and Severe Hypertension Anemia of CHronic Kidney diseases---\> patients are given Erythropoietin Erythropoietin increases RBc--\> HYpertension

Question 791

Compression of heart by Air inspired in Lung

Answer 791

systolic pressure drops --\> Pulsus paradoxus --\> equalized diastolic pressure in all four chambers Tamponade, Severe croup--\> Pulsus paradoxus

Question 792

Cardiogenic shock

Answer 792

Heart doesn't pump out blood Low urine cold extremities Hypotension

Question 793

Schizophrenic patient cannot sit and keeps wandering here and there

Answer 793

Akathisia--\> Restless Beta blocker Lorazepam Benztropine

Question 794

Amenorrhea test

Answer 794

Hx--\>PE--\> Pregnancy test--\>If negative --\> Prolactin TSH FSH

Question 795

Feltys

Answer 795

Advanced Rheumatid Arthritis W/ Splenomegaly Neutropenia

Question 796

Behcet

Answer 796

Recurring & painful oral and genital ulcers w/ Uveitis

Question 797

cruise trip hotel stay high fever crackles Interstitial Infiltrates

Answer 797

Legionella Low sodium on lab Macrolides or FLUOROQUINOLONES

Question 798

Atypical pneumonia

Answer 798

azithromycin fluoroquinolone

Question 799

Patient hx of immobilization cocaine use and lab is shown for creatine Phosphokinase (Kinase)

Answer 799

Rhabdomyolysis Intrinsic Renal Failure

Question 800

Cirrhosis and Portal htn management?

Answer 800

They frequently have Abdominal ascites due to low albumin---\> Transdutive effusion--\> leaks through small defects in right side ,less muscular side of Diaphragm --\>Hepatic Hydrothorax

Question 801

Tet spell

Answer 801

Agitation ,exertion--\> increases pulmonary resistance--\> RVOT exaggerated--\> RV drains into Aorta--\> cyanotic spell Pulmonary stenosis--\> blood makes noise at upper left sternal border Management--\> make aorta busy for rv blood--\> knee chest positioning

Question 802

Venous valve vs lymphatic obstruction

Answer 802

Lymphatic obstruction is severe than venous valve incompetence

Question 803

Enemies of patient with Cystic Fibrosis

Answer 803

age one to twenty = Staph Aureus beyond--strep straps you Staph comes and let streps come

Question 804

bubbles in urine

Answer 804

Check for colo-vesical fistula due to diverticulitis

Question 806

Depression after breakup gets angry--\> acts suicidal

Answer 806

BPD DIalect behavior therapy is best

Question 807

Outstreched hand

Answer 807

Scaphoid--\> snuff box resident--\> Avascular necrosis hook of hamate--\> Ulnar essential tremor--\> with movement Nigra--\> give movement--\> and tremor is gone--\>tremor when (Park)inson

Question 808

Sulfonylurea

Answer 808

class 1 and class2 class 1 -\> ChlorProp & TOLbut Class 2 --\> Glim Glyb Glip 1= Dislufiram 2= Hypoglycemia NOT at all a initiation therapy

Question 809

Mumps vs E coli

Answer 809

Mumps--\> prodrome viral--\> high fever--\> partitis --\> orchitis Ecoli--\> above 35--\> bladder obstruction--\>unilateral testicular pain--\>erythematous--\> Epididymitis Chlamydia & Gonorrhea--\> under 35--\> urthrtitis--\> discharge plus testes pain

Question 810

hyper-resonance to percussion

Answer 810

Hyperinflated lung or pneumothorax if fluid in the lung--\> pneumonia--\> sound travels better in liquid--\> increased breath sounds and increased tactile fremitus If fluid on the lung--\> malignacy or effusion from trauma--\> liquid will insulate the sound

Question 811

Disconjugate gaze absent ciliary reflex

Answer 811

Isopropyl alcohol ingestion

Question 812

Within 7 days of neonatal delivery--\> fuller anterior fontanelle

Answer 812

Meningitis Group **B**

Question 814

less the 3 months old infant What causes the meningitis

Answer 814

Strep Listeria Group B E coli Herpes

Question 815

Esophageal aperistalsis differential

Answer 815

**_Eosinophilic-_**-\> Gerd--\>hx of heart burn and exam-\>hypercontractility **_Increased LES_** pressure--\> Achalasia **_Decreased LES_** pressure--\>systemic sclerosis--\>Smooth muscle atrophies and fibrosed

Question 816

parvus and tardus are seen in what heart condition

Answer 816

seen in aortic stenosis parvus--\>weak tardus--\> delayed

Question 817

Hot temperature migration eye disk swollen/blurry/hyperemic pain and light touch decreased mildly fatigue

Answer 817

MS

Question 818

Acute Abdominal Pain imaging

Answer 818

RUQ--\>Ultrasonography LLQ/RLQ--\> CT scan

Question 819

Non Exudated Ulcer on vulva indurated edges

Answer 819

Syphilis

Question 820

Blood at urethral meatus perineal injury high riding prostate

Answer 820

Posterir urethral Inury **_Do urethrogram_** and "aVoid Foley"

Question 821

Infant Intestinal perforation microcolon inissipated mucus in ileum

Answer 821

meconium ileus intestinal perforation --\>free air

Question 822

SLE Anemia

Answer 822

A) Immune-mediated destruction B) nephritis -- \> ineffective erythropoiesis

Question 824

Capillary refill time

Answer 824

Press the thumbnail--\> time it will take to re-fill the empty capillaries--\> normal is less than 2 seconds

Question 825

Hypertrophic Cardiomyopathy Treatment

Answer 825

BB--\> symptomatic relief--\> prevent syncope and load on heavy heart CCb partial excision or Alcohol Ablation of septum

Question 826

Increases with inspiration

Answer 826

TriCuspid Regurgitation lungs fill in with air--\> compresses the vessels--\> blood goes back to right ventricle

Question 827

young guy inspires and murmur is heard plus if they show you a arm with needle marks ( in a track)

Answer 827

IV Tricuspid Regurgitation

Question 828

septic emboli

Answer 828

MOSTLY middle carotid artery --\> stroke Give IV antibiotics no need of typical anticoagulants

Question 829

INR \>1.3

Answer 829

Synthetic Liver Dysfunction

Question 830

Answer 830

Palmar Erythema Due to excess estrogen Excess estrogen also causes Spider angiomas

Question 831

Turner like craniofacial defects like webbed neck but with very low Hemoglobin

Answer 831

Diamon becklowith Anemia also see triphalangeal thumb short strature cleft palate Defect --\> erythroid progenitor cells--\> leads to apoptosis of Red blood cells

Question 832

Young patient age less than 5 comes with tender and swollen single lymph node Patient is non-toxic appearing

Answer 832

Lymphadenitis Bacterial --\> non toxic appearing

Question 833

Accidental case xray is shown one lobe looks clouded and loss of diaphragmatic border--\> left side

Answer 833

look for 1) naso gastric tubes--\> if the tubes are in lungs--\> abdominal contents have hernited through diaphram tear--\> mostly left side 2) if patient is hypotensive if distended neck veins--\> globular arthitecture of heart--\> tamponade if not than just tension pneumothorax

Question 834

lack of muscle atonia in REM sleep Beta

Answer 834

Dream enactement Rem is dreaming phase penile clitoral Memory process

Question 835

SLeep phases

Answer 835

BATS DB Bats drink blook

Question 836

Central venous catheter places in either of subclavian vein jugular azygos

Answer 836

Keep checking now with portable chest radiograph because, most apporpirate place for the catheter is in lower superior vena cava all others are smaller veins--\> chances of perforation

Question 837

Fever + Thick and Multiloculated mass on adenexa

Answer 837

abscess =tubulo-Ovarian COmplication of PID polymicrobial infection--\> Inflammatory exudate--\>purulent fluid--\>Wall thickening

Question 838

bugs crawling withdrawal from what

Answer 838

alcohol

Question 839

Hyperechoic nodule + calcification + and found incidentally

Answer 839

cystic teratoma

Question 840

High B-hCG stimulates what?

Answer 840

Theca-Luetin cysts like in Molar pregnancy ( Present only during pregnancy)

Question 841

Patient has a history of some benign mass in adnexa Now comes with sudden pain and guarding to deep palpation

Answer 841

suspect ovarian torsion, no matter what to anyone with a mass until proven otherwise

Question 842

hyperkalemic patient with stroke and ecg shows bradycardia what to give

Answer 842

IV calcium gluconate or IV Insulin

Question 843

Lung squamous cell carcinoma small cell cancer

Answer 843

Sentrally located

Question 844

Scaphoid Fracture

Answer 844

Thumb Spica Splint repeat radiography in 2 weeks

Question 845

vericella vaccine at what ages? what if a kid has missed one vaccine and exposed to other kid going through vericella at age of 5

Answer 845

varicella at age of 1 and 4 give vaccine if exposed

Question 846

Pleuritic chest pain with pregnancy like mass

Answer 846

with fever & sepsis--\> ectopic due fitz-hugh without fever or sepsis like --\> Hyaditiform mole

Question 847

echinococcus vs ameobic cyst drugs

Answer 847

**_Echinococcus_**--\> Eggshell calcification --\>**_Albendazole_** **_Entamoeba histolytica-_**-\>Pasty exudate abscess on liver--\>plus bloody diarrhea and flask ulcers--\> **_Metronidazole_** plus paromomycin to clear up the intestine

Question 848

MEN 2**_A_**

Answer 848

Medullary thyroid Pheochromocytom**_A_** Parathyroid Hyperplasi**_A_**

Question 849

Anti Smooth muscle antibody OR Anti Nuclear Antibody

Answer 849

Autoimmune Hepatitis

Question 850

gritty sandy irritation in eye plus proptosis

Answer 850

propotisis = scary protuding eyes ptosis= eye lid drops gritty/ sandy kind of irritation= Graves proptosis MG==\> Ptosis== not PROPTOSIS LEMS==\> less frequently ocular

Question 851

Idiopathic Juvenile Arthritis

Answer 851

not migratory

Question 852

No mucoid discharge no purulent discharge no morning mattering of eye lids but blood shot eyes and diarrhe with apthous ulcer in mouth

Answer 852

Anterior Uveitis No mucoid--\> not viral no purulent --\> not bacterial DIarrhea and ulcers--\> associated with IBS--\> Uveitis

Question 853

more than 25% lymphoblasts

Answer 853

ALL

Question 854

BAck pain Focal exquisite tenderness on palpation paraspinal muscle spasm leg raise test is negative febrile

Answer 854

vertebral osteomyelitis

Question 855

bone pain cytopenia

Answer 855

G.Cbro--\> GAU-CH-ERrrrr

Question 856

Von Gierke

Answer 856

Type VON 1 Glycogen stays in one form only and does not gets broken down to glucose kids with chubby cheeks--\> doll like face

Question 857

Chronic Fluctuating mood disorders ( when cant dignose depression or bipolar)

Answer 857

Cyclothymic

Question 858

Inspiration and venous return

Answer 858

Venous return increases and gets into right heart ----\>\> pushes the interventricular septum into the left heart ---\> decreases LEDV

Question 859

Progesterone vs hCG

Answer 859

progesterone maintains implantation hCG maintains corpus luteum

Question 860

Lyme Babesiosis Ehrilichiosis RMSF

Answer 860

Lyme--\>early--\>see migrans Babesios----\>splenectomy--\>anemia, reticulocytosis, Leukocytosis Ehrilichiosis--\>\>lichi and amb --\>amblyoma--\>leukopenia & thrombocytopenia RMSF--\>wrist and ankles to--\> rash on hand and rash on soles

Question 861

mesenteric Ischemia

Answer 861

fresh bllod through anus--\> Hematochezia Plus out of poportion kind of pain on Periumbilical area

Question 862

Rebound Tenderness

Answer 862

anything that irritates Peritoneum Appendicitis Peptic Ulcer Disease Small bowel Obstruction

Question 863

vaginal bacterial color code

Answer 863

Greybound--\> Grey bacterieal GTA--\>\> trichomonas is green

Question 864

Coliform bacteria

Answer 864

Floss after cowliflower Ecoli--\> levofloxacin

Question 865

smooth tapering of distal esophagus with dilated proximal esophagus

Answer 865

Achalasia or pseduoachalsis aperistalsis vs malignancy Achalasia--\>sphincter wont relax Esophageal cancer--\> changes the tissue or compresses it Endoscopic evaluation

Question 866

pseudotumor cerebri treatment kya hai bhai

Answer 866

acetazolamide weight loss stop offending drugs

Question 867

cyst here

Answer 867

bakers popliteal cyst see a crescent shaped ecchymosis

Question 868

Crescent

Answer 868

shaped hematoma--\> sub-dura bleed Kidneys--\>Light microscopy--\>crescent shapes--\>antibodies --\>RPGN Crescent shaped Ecchymosis on gastronemius area--\> bakers cyst--\> can rupture and spill below and cause swelling of calf

Question 869

viral video paramixed Group of dogs barking and striding in flames and larynxing the turkey

Answer 869

Croup inflammation of turkey and larynx paramyxovirus dexamethasone--\>worse case give Nebulized racemic Epinephrine

Question 870

collison trauma case do first what

Answer 870

FAST focussed-assesment-sonograph for Trauma

Question 871

Chronic HCV

Answer 871

treatment revolves around prevent further liver damage --\> vaccinate patient give antioxidants and give some anti virals

Question 872

Acromegaly

Answer 872

COarse face enlargement of fingers and carpal tunnel--\> shooting pain upon tapping

Question 873

BArtholin cyst vs gartner

Answer 873

Bartholin--\> bahar than gartner gartner is deeper than bartholin

Question 874

previa = vaginal or cesarean

Answer 874

cesarean vagina if placent is less than 2 cm on os

Question 875

dementia & parkinson

Answer 875

if muscular/tremors are present before the hallucinations begin--\> parkinson disease dementia if hallucinations or dementia is present and then later on you get rigid gait--\> lewy body dementia

Question 876

Heart Rupturing after M.I

Answer 876

(Right Coronary--\> Papillary) Left Anterior Descending--\> Interventricular septum Papillary muscle & Interventricular septum= Within 5 days----\> _New Holosystolic Murmur_ After 5th day---\> LAD--\>Wall rupture--\> **_Shock_** Aneurysm Formation--\> Months Weeks--\>months==remodelling= thin walls of the heart and dilated chamber--\> CHF = prevent with ACEi

Question 877

no central pallor rbc round and small

Answer 877

membrane tights it up and constrains the rbc membrane defect--\> tight rbc round as round abdomen of lifeless married man to a boring wife chittrocytosis spherocytosis

Question 878

PVR cystica

Answer 878

parathyroid related von recklinghausen increased osteoclastic activity and replacement of bone with brown tumors

Question 879

excess T3 or constant thyroid upregulation

Answer 879

osteoclastic

Question 880

Actinic Keratosis vs Melanoma

Answer 880

white flaky like a deas skin --\>AK squamous brown irregular margin --\> Basal

Question 881

Fever dry cough CD4 less then 200

Answer 881

PCP Punjab control police--\> Rs 200cd4 tmp-smx with glucocorticoids

Question 882

(Stroke kind of presentation) Neurologic deficits lasted less than 24 hrs Non contrast CT shows no abnormalities

Answer 882

Transient Ischemic Stroke Aspirin and statin

Question 883

Catatonia vs akathisia vs NMS and malignant hyperthermia

Answer 883

Catatonia--\> is a part of syndrome versus others are side effect of drugs EIther patient would stay immobile and wont move or make purposeless movements

Question 884

rash face to trunk and neck to trunk Head/neck with buccal mucosa

Answer 884

face to trunk -3 day german toga rubella neck to trunk scarlet head/neck with buccle--\> ola -\> cough coryza conjuctiva

Question 885

how to diagnose SLE

Answer 885

start with Anti nuclear antibody if present then confirm with Anti double strand dna anti smith

Question 886

septated mass on ovary vs ectodermal calcified mass

Answer 886

sepateted mass--\>with fluid--\>epithelial of ovary/fallopian tube carcinoma calcified mass--\>without fluid--\>with nodule--\>dermoid ectodermal cystic teratoma

Question 887

Tuning fork web

Answer 887

Normally there is a background noise all the time if you hear the the tuning fork **_better_** on one side--\> conductive hearing loss on that side--\> tuning fork not masked by backgroud noise if its not heard **_at all_** by left ear--\> and heard only by the right ear = sensoryneuronal loss of left ear. RInne--\> bone vs air--\> air needs to work

Question 888

Factitious vs Malingering

Answer 888

Factitious= false facts and no gains Malingering==Money, motivation for multitude gains Conversion= Emotional Con, no gains

Question 889

Hx =prostate cancer now has hyperreflexia urinary incontinence

Answer 889

Spinal nerves are compressed Epidural Spinal Cord Compression Intavenous Glucocorticoids--\>Decrease vasogenic Edema--\> then MRI to see the theca compression

Question 890

Delerium management

Answer 890

establish sleep-wake cycle frequently reorient the patient avoid multiple drugs or physocal restraints

Question 891

Pulmonary capillary

Answer 891

measures Left Atrial Pressure

Question 892

take two arms blood pressure

Answer 892

Takayasu

Question 893

Norepinephrine and Dopamine increaser

Answer 893

BuProPion

Question 894

diverticulosis vs angiodysplasia

Answer 894

Diverticulosis--\>arterial bleeding--\> bright red blood angiodysplasia--\> anywhere in colon--\> m/c in Vwf acquired coz of misbehaving valvcongenitalntial disease--\> maroon colored stool

Question 895

bulky & tender uterus globular shape

Answer 895

Adinosaurus adenomyosis

Question 896

endometrosis

Answer 896

Metro pain--peaks--\> before menses oasis out of endometrium--\>adhesions--\>non mobile uterus

Question 897

Cat Bite

Answer 897

mostly anaerobic & multocida--\> amoxicillin/clavulanate rare--\>bartonella hanslae--\>azithromycin

Question 898

Holter

Answer 898

to monitor intermittent arrhytmia but Hx needs to have episodes of syncope,, or Palpitations

Question 899

HACEK organisms dental or colon

Answer 899

Dental

Question 900

pyelonephritis in pregnancy what drug?

Answer 900

Cefrtriaxone

Question 901

0.45% given IV (Hypotonic fluid )

Answer 901

check for iatrogenic hyponatremic confusion reverese by giving 3%

Question 902

Photosensitivity causing drugs

Answer 902

tetracyclines furosemide, thiazide Amiodarone Promethazine Piroxicam

Question 903

tremor at movement or when anxious

Answer 903

essential to keep moving when at movement--\> tremor--\> essential tremor Propranolol

Question 904

Squamous cell carcinoma of head/neck

Answer 904

PANendoscopy ( esophagus,laryngeal,broncho) --\>establish histology --\>decide on treatment

Question 905

Akathisia

Answer 905

restless propranolol benzodiazepine benztropine

Question 906

Hx of chronic rhinusitis + Hemoptysis + Tracheal pathology ( some kind on imaging) + lung nodules

Answer 906

GPA- Pr-Anca Poly---Ang--iitis

Question 907

Copious watery diarrhea

Answer 907

cryptosporidium cyclospora Giardia

Question 908

watery diarrhea

Answer 908

Giardia Etec Cryptospor Noro, rota & adenovirus Clostridiums (difficile and perfringens)

Question 909

GAs producing bugs in gall bladder

Answer 909

Emphysematous --\> cholecystitis wall of gall bladder is infected

Question 910

accident --\> bleeding into stomach

Answer 910

hypovolemic shock

Question 911

what pressures are increased in cardiogenic shock

Answer 911

Cardiogenic--\>\> CArdiojammed--\> Right atrial & PCWp blood is seeping into the heart via vena cava--\> but wont move forward

Question 912

pseudogout

Answer 912

Rhomboid (remember--\>there are no needles on the image & there are no two colors)

Question 913

distal esophagus chocked

Answer 913

solid and liquid problem--\> achalasia mass effect/ chagas/ loss of auerBach Myenteric plexus--\> Achalasia Chronic Gastritis--\>

Question 914

hepatic troubled patient Hx of hepatis c vericeal bleed management?

Answer 914

SaO\_E Saline-\>Vol Antibiotic--\>Ceftriaxone Octreotide --\> Endoscopy and check the status of bleeding

Question 915

atrophied hand muscle atrophied testes

Answer 915

balding cataracts progressive muscle weakness Myotonic domination

Question 916

XLR-muscle car

Answer 916

duchenne and beckers Lesch Nyhan VLCFA buildup defective collagen (menkes) WISKOTT--\> Fucked up cytoskeleton of leukocytes and platelets G6PD

Question 917

Delusions vs Interpersonal Problems

Answer 917

Delusions of food being poisoned--\> Delusion Interpersonal pervasive pattern---\> Paranoid

Question 918

young patient Hx of Otitis Media now Headaches wake him up and vomits in the morning

Answer 918

do CT or Mri to rule out Brain abscess Otitis--Mastoiditis--\> Temporal Abscess--\> pressure--\>supine---\> Stimulates Medullary centre vomiting & Area postrema Contrast--\>shows hypointense CT---\> Bone

Question 919

obesessive personality disorder vs Obsessive compulsive

Answer 919

obsessive personality--\> perfection compulsive--\> ritualistic and ego dystonic

Question 920

Copper IUD side effect

Answer 920

Heavy bleeding Not for women with Hx of heavy periods

Question 921

long-term Contraception

Answer 921

MedroxyProgsterone injection every 3 months

Question 922

COPD and liver

Answer 922

Copd can impact liver by increasing backflow copd--\>pulmonary htn--\> cor pulmonale--\> RV backed up--\> backs up to liver

Question 923

Diverticulosis Diagnosis

Answer 923

Abdominal CT scan with Contrast Contradicted--\>\> Sigmoidoscopy or colonoscopy Dont put anything in the ass of elderly with constipation issues

Question 924

nail through shoe what bug and why

Answer 924

pseudomonas because--\> humid and warmer in shoe

Question 925

Malignant Hyperthermia vs Neuroleptic Malignant Syndrome

Answer 925

Malignant--\> Sucks to be under anesthesia rapid onset vs NMS

Question 926

Intrauterine fetal demise \<20weeks

Answer 926

Missed abortion

Question 927

Fluctuant anterior Cervical Mass + Neck Swelling

Answer 927

Auerus Adenitis Clindamycin

Question 928

Bilateral Lymph Adenitis

Answer 928

EBV and Adenovirus Well, mostly Viral

Question 929

Pneumothorax

Answer 929

spontaneous or gradual primary or secondary primary gets tracheal deviation visceral pleural line is seen

Question 930

Spasm neonatal stiff neck jaw and stridor

Answer 930

tetanus spasm--\> of diaphragm--\> respiratory failure

Question 931

conduct disorder

Answer 931

Society property Aggression rights

Question 932

Holosystolic

Answer 932

lower left sternum--\>T.V tricuspid regurg & VSD left apex--\> Mitral Regurgitation

Question 933

urinary urgency plus hematospermia pain with ejaculation pernineal pain

Answer 933

inflamed prostate Prostatitis

Question 934

D Dimer nirmal less than 500

Answer 934

rule out PE if more than 500---\> pulmonary angiography

Question 935

Alkaline phosphatase Conjugate Hyperbilurubinemia

Answer 935

Conjugated--\> Internal Liver excretion or Extrahepatic block--\> Do ultrasound Alkaline--\> Ducts

Question 936

Liver With good AAA Credit Rating

Answer 936

Dj ROTOR

Question 937

easily treated diabetic condition plaques on skin

Answer 937

Glucagonoma can have ataxia, diarrhea and dementia venous thrombosis

Question 938

Exudative mechanism

Answer 938

infection or inflammation--\> cytokines--\>increase permability--\>fluids moves into pericapillary space--\> aids in transportation of immune response but also causes exudative effusion see elevated LDH

Question 939

vaginal wall tender afebrile voiding frequently

Answer 939

interstitial cystitis--\> painful bladder syndrome pain on intercourse dhakka to bladder remember what the propalsing bladder is knows as--\> Cystocele--\> pink seal like face peeking through vagina

Question 940

Amphetamine Analog

Answer 940

**_Bath salts_**--\> Agitation **_Ecstasy_ (** Molly)--\>serotonin syndrome Amphetamine toxicity--\> Serotonin Syndrome, SiADH hyponatremia

Question 941

Posterior acousitc Enhancement of mass

Answer 941

means it had fluid in it

Question 942

Breast Cancer mass

Answer 942

below 30--\> needle aspiration or image guided core biopys if it is complex cyst or mass

Question 943

Preecclampsia protein measurements

Answer 943

300 mg of protein in a day Protein / creatinine = More than 0.3 Dipstick = \>0.1+ or signs of End organ Damage

Question 944

Shy drager

Answer 944

parkinson symptoms + Autonomic Dysfunction ( Abnormal sweating, postural Hypotension, Impotence, Abnormal Salivation or Lacrimation) Serious-\> Bulbar dysfunction & Laryngeal stridor Wear Constrictive clothes

Question 945

**_Stridor_** **_without Infectious Symptoms_** stridor begain in neonatal period

Answer 945

Laryngomalacia

Question 946

Stridor with ILL appearing & drooling

Answer 946

Epiglotittis

Question 947

muffled voice

Answer 947

Epiglottitis Retropharyngeal Abscess

Question 948

Family history of migrains what other can also be in the family

Answer 948

Cyclical Vomiting

Question 949

Hair on a patch

Answer 949

congenital melanocytic nevus

Question 950

bluish skin coloration ( greyish)

Answer 950

Congenital Dermal Melanocytosis

Question 951

flat patches but hyperpigmented

Answer 951

Neurofibromatosis Mccune-Albright

Question 952

arterial emboli vs venous emboli

Answer 952

arterial--\> mottled leg--ST Elevated MI--\> LV sends out emboli Venous--\> warmth, tenderness, swelling (HIT) Thrombotic patient post MI--\> Arterial thrombus--\> Do Transthoracic echo--\> to rule out bigger LV Thrombus

Question 953

bursitis pains whats at the medial side of the tibia?

Answer 953

Pes Anserine S P I Pes

Question 954

Aplasitc Anemia like or Bone MArrow failure when looking at WBC & platelets is it bone marrow or anything else?

Answer 954

Monocytic Ehrilichiosis Doxycycline

Question 955

ricketsial diseases

Answer 955

Doxycycline cefur

Question 956

Post infection post toxin what kind of cardiomyopathy that happens in sudden and quick time

Answer 956

Dilated cardiomyopathy--\> CHF

Question 957

First Prenatal Visit

Answer 957

Syphilis HIV Influenza Rubella Chlamydia Protein and RH(D)

Question 958

Inflammatory Ligamentous LBP--\>chronic

Answer 958

ligamentous insertion site pain--\> Inflammatory--\> chronic--\> Ankylosing Spondyloarthropathy---\> worst at rest and gets better with movement Ligament sprain --\> worst with Movement and better with rest, furthermore --\> some incident could have led it to that kind of pain--\> incident means acute setting

Question 959

A fertile age woman comes to your office and asks you what endocrine problems can cause miscarriage

Answer 959

Polycystic Ovary Diabetes Thyroid diseases and prolactin

Question 960

how does preeclampsia causes pulmonary edema

Answer 960

preeclampsia--\> systemtic ,generalized artery spasm --\>afterload--\> backflow to heart and increased pressure B) protenuria--\> albumin lost--\> less oncotic pressure in capillary

Question 961

tennis ball like aorta on image

Answer 961

Dissection Never give thrombolytics or Anticoagulants

Question 962

Asthma amanagement

Answer 962

1--2---3-----4 1 = SABA--\> 2 = LD ICS----\> 3 = LABA +LD ICS or MD ICS--\> Till 2== SABA to LD corticosteroid --\>saba has been used about 2 times in week and now Wakes up 3-4 times per month in night Step 3= if saba has been used everyday--\>now woke up too --\>now go eithere long actine LABA along with LD or MD on steroid 4 = MD ICS+LABA Severe= Steps 5 & 6 Step 5 = HD ICS + LABA & omalizumab for allergy Step 6

Question 963

Dystonia

Answer 963

Disrespecting posture sustained contraction (torticollis) myoclonus vs chorea myoclnus --\>rhymtic jerking

Question 964

Fragile X

Answer 964

Mentally fragile but CGG-jaw continous growth of gonads and jaw

Question 965

cancer pain managment

Answer 965

NSAIDS--\> weak opioid--\>Short Acting Opioid--\>Long Acting opioid Weak= Tramadol, Codeine Short= Morphine

Question 966

pregnant and lactating and lyme

Answer 966

Lime in front of pregnant ox Amoxicillin CefurOXamine

Question 967

Mccune albright

Answer 967

cafe spots polyostotic fibrous displasia endocrine hyperfunction

Question 968

morton hears a who on feet

Answer 968

clicking noise, when two meta tarsals are squeezed together

Question 969

newborn with Rhinorrhea & Desquamating rash

Answer 969

Secondary Syphilis

Question 970

Relationship between Increased insulin in mother and Neonatal lungs

Answer 970

Maternal Diabetes--\> increased insulin--\> INSULIN ANTAGONIZES CORTISON/CORTISOL CORTISOL( SPHINGOMYELIN)

Question 971

cesarean contradiction

Answer 971

any incision that entered the Uterine cavity veritical cesarean myomectomy through the uterine cavity

Question 972

What do you think of when you see A Patient with a Clasp Knife Rigidity of hand

Answer 972

UMN lesion ISsue--\> Increased tonicity

Question 973

DHEAS Androgen is produced where

Answer 973

Adrenal Gland

Question 974

when to give IV HCO3

Answer 974

when pH is Below 7.1

Question 975

Post viral patient comes confused and high fever imaging shows multiple thin walled cavities and he had blood tinged sputum

Answer 975

MRSA post viral causes Necrotizing pneumonia

Question 976

Herniated Disk

Answer 976

Unilateral Radiation

Question 977

A child comes and tells he woke up with a hip pain has a soccer history and also a URI history lab is normal fever is normal

Answer 977

Transient Synovitis

Question 978

The newborn is cyanotic when feeding gets better when he cries

Answer 978

ChoAnal Atresia Failure of the posterior Nasal septum to canalaize ( Charge Syndrome )

Question 979

Charge Syndrome

Answer 979

Neonatal with Choanal Atresia--\> Cyanosis gets better with crying Coloboma--\> hole in the eye--\> dripping pupil Heart defect Genito-Urinary Defect Ear abormality--\>deafness

Question 980

Ovarian cystic masses

Answer 980

Homogeneous --\> Endrometrioma Hyperechoic--\>calcified--\>dermoid mature teratoma

Question 981

Breast tenderness bleeding

Answer 981

estrogen secreting tumors Granulosa thecoma

Question 982

AV node bypassed

Answer 982

Wolff atria to ventricle==\> Quick contraction gets AF= in 30% Treatement= Procainamide or ibutilide Don't give Nodal Blockers-\> wolff will bypass more ( Beta blockers, calcium blocker, Adenosine,Digoxin)

Question 983

Congenital Dysmorphic features

Answer 983

Smooth philtrum and thin upper lip, limb dislocation--\> Alochol Short distal finger phalanges & hirsutism along with microcephaly--\> Phenytoin fetal hydantoin syndrome corneal scarring/interstitial keratitis ,Saber shins & Hutchison teeth= syphilis

Question 984

Hypodense lesions

Answer 984

if on liver--\> fluid in it--\> contrast not taken up--\> Abscess Hyper dense--\>

Question 985

severe stenosis vs mild

Answer 985

@right sternum early peaking--\> Mild late peaking & leaflets calcified and stenotic--\> reduced mobility--\> soft S2

Question 986

Penetration through Alar fascia--\> posterior neck

Answer 986

retropharyngeal Abscess --\>deep space infection of the neck through Alar Fascia--\> infection can spread to Superior Mediastinum--\> Anterior Mediastinitis

Question 987

what happens to cardiac Index in Septic shock

Answer 987

It increases because of Decrease in SVR and as Vasodilation happens --\> CI increases

Question 988

RAAS on arterioles

Answer 988

constricts two arterioles #Afferent & Efferent --\> increased Resistance--\> Decreases RBF #But to maintain Adequate GFR--\> constricts the efferent arteriole more

Question 989

crescent formation by a hematoma

Answer 989

Subdural

Question 990

Central facial nerve palsy vs Peripheral Facial Nerve

Answer 990

Question 991

holosystolic murmur

Answer 991

VSD

Question 992

Absent or diminished R wave peaked P wave lack of pulmonary vasculature image on xray

Answer 992

Diminished R wave= RV hypoplastic Peaked P = Right atrium enarged lack of pulmonary vasculature visualization = due to less blood supply to RV and pulmonic outflow tract--\> underdeveloped pulmonic valve **_Tricuspid Valve Atresia_**

Question 993

palpable mass on back bone of a young child

Answer 993

Spondylolisthesis

Question 994

HBV vaccine vs natural immunity

Answer 994

Anti HBcAb vaccine doesnt have Core

Question 995

Infective endocarditis predisposition

Answer 995

Previous Valve defect= Mitral regurgitation IV abuse--\> Tricuspid regurgitation

Question 996

Epitrochlear Lymphadenopathy

Answer 996

With diffuse rash On palms and soles

Question 997

secondary syphilis

Answer 997

Flu like--\> sore throat and fever grey mucus patches wide spread lymphadenopathy raised grey genital papules EPITROCHLEAR is pathognomic

Question 998

Community Acquired Pneumonia Treatment

Answer 998

Beta lactam plus Macrolide Ceftriaxone plus Azithromycin Or a FLuoroquinolone Moxifloxacin

Question 999

post partum continous febrile even with broad spectrum antibiotics

Answer 999

Septic Pelvic Thrombophlebitis

Question 1000

Muffled voice and uvula deviated

Answer 1000

do drainage its peritonsillar abscess Complication of tonsillitis

Question 1001

What does 10% of Renal Cell Cancer patients get

Answer 1001

Scrotal Varicocele ( Tumor obstruction of the Gonadal Vein )

Question 1002

Smoking Cessation

Answer 1002

if bulimic or seizures--\> dont give bupropion if moods problem--\> dont give ach partial agonist verencycline

Question 1003

Fibroids vs Endometrioasis

Answer 1003

Fibroids--\>\> Irregular and enlarged --\>UTERUS Endometriosis--\> Nodularity in extra uteral places--\> like posterior cul de sac

Question 1004

Erythromycin can also cause

Answer 1004

pyloric stenosis

Question 1005

how to confirm HCV chronic status

Answer 1005

positive serologic test confirmatory molecular test--\> looking for circulating HCV RNA

Question 1006

CF neonate hasn't passed the meconeum yet

Answer 1006

do xray to rule out pneumoperitneum--\>perforation then do water based contrast to get more insight into bowel

Question 1007

smaller vsd vs bigger vsd

Answer 1007

smaller vsd is harsher sounding--\> may self resolve

Question 1008

TIA vs Demyelinating plaque effect of MS

Answer 1008

TIA can resolve the same day but demyelinated plaque effects lasts atleast a week MS patient with stroke issue

Question 1009

Trachea vs Epiglottis

Answer 1009

Narrowed trachea--\> barking cough-\> epinephephrine or corticosteroid True tripodal emergency of ABC--\>Epiglottis swollen--\>impeded airflow--\> H.I.--\> ABC--\>Airway needs to be secured

Question 1010

fragmented RBC

Answer 1010

JIZZTOCYTE

Question 1011

CM vs Horse

Answer 1011

**_C**_onus _**M_**edullaris--\> _**H**yper_ reacts and numb ass and _**E**arly_ fuck of ass and bladder Cauda equina---\>\> slower reflexes and later ass and bladder dysfunction but severe pain though--\> bilaterally

Question 1012

if 1 gm of albumin decreases

Answer 1012

.8 mg of calcium decreases too

Question 1013

a patient comes with a thyroid nodule what to do now

Answer 1013

measure TSh and ultrasound

Question 1014

leas 2 and 3 and avf raised up and chest pain

Answer 1014

Avoid Nitroglycerin ---\> causes Profound Hypotension

Question 1015

Blastomyces coccoidiodes incubation period

Answer 1015

Blast 3-6 weeks Cocco--\> within 2 weeks

Question 1016

Live Attenuated vaccines

Answer 1016

Adenovirus, Rotavirus,MMR, Yellow,Influenza nasal,Vericella chickenpox,polio sabin Live show of vaccine warriors PYAR-V-MMR--\>dangerous to weak immuned

Question 1017

Vaccines for ages of 4 - 18

Answer 1017

Pneumococcal Hib

Question 1018

Approach to Hyponatremia

Answer 1018

check moistness ( if dry --\>hypovolemic) check edema ( of present--\> hypervolemic) if moist and ( no edema ) --\> euvolemic--\> SiADH

Question 1019

tympanocentesis & culture tympanostomy

Answer 1019

multiple episodes of AOM--\> more than _THREE_ episodes in 6 months more than _FOUR_ episodes in 12 months

Question 1020

Elderly woman tests

Answer 1020

BCC Breast every 2 years cervical every 3 years colon every 10 years

Question 1021

tamoxifen's anti estrogenic properties are on?

Answer 1021

Breast and CNS (reason for hot flashes)

Question 1022

Lvedp aka ? lvedp increased in what?

Answer 1022

LVEDP aka LV filling pressure LVEDP is increased in MR or AR

Question 1023

patient comes with tender spots

Answer 1023

Erythema nodosum first of all rule out sarcoidosis and tb by doing x ray pharyngitis step test cbc liver test renal test

Question 1024

Ventricular fibrillation

Answer 1024

difibrilation if failed give amiodarone

Question 1025

patient comes and tells he has electrical pain sensation going up and down the body from back to the lower limbs

Answer 1025

Lhemette sign of MS

Question 1026

14-3-3 protein on lab work

Answer 1026

Creutzfelt jakob --\> startling myoclonus rapid and **_Profound_** deterioration

Question 1027

Active labor cervical changes

Answer 1027

If slower change --\> Give Oxytocin If no change --\> Do Cesarean

Question 1028

Glasgow scale

Question 1029

Acute Pancreatitis vs Chronic

Answer 1029

Chronic==\> Burnt out pancreas--\> no lipase increase like in acute