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1
Q

Cirrhotic liver

A

Shrunken and fibrotic

Not enlarged

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2
Q

Severe right leg pain after soccer match that resolved in 2 weeks.

Week later had recurrent pain and decreased ROM

Right thigh larger than left

Induration and tenderness to palpation over medial thigh

Pain with stretching, pulses normal

  • MOA
  • Name
  • PE
  • Lab
  • Xray shows
A

Heterotropic bone formation

Mositis ossificans

Formation of lamellar bone in extraskeletal tissues

Painful, firm mobile mass with local swelling

Elevated ESR

Egg shell calcification

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3
Q

Hard lump on palm of right hand. Doesnt affect function. Hard fibrous nodular band present on base of ring finger.

A

Fibrosis of palmar fascia

Dupuytren contracture

—> Decreased extension

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4
Q

Empiric antibiotics for calculus cholecystitis

A

cover aerobic and anaerobic bacteria in the enterobacteriaceae family

Piperacillin- tazobactam

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5
Q

KCN gene on chromosome 7

A

Jervell-Lange Nielsen syndrome

AR

Congenital deafness
Long QT syndrome

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6
Q

Fever, chills, general malaise

Presence of new murmur

Hx Rheumatic fever

A

Bacterial endocarditis

Get blood cultures

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7
Q

C5-C6 herniation

A

Compresses C6

Decreased sensation of thumb

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8
Q

Freyettes laws

A

First law
- Neutral mechanics
Rotation and SB are coupled in opposite directions

Second law

  • Non-neutral
  • Side bending and rotation same in non neural mechanics

Third law
- when motion is introduced into the spine in one direction, motion in the other directions is reduced

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9
Q

Pulls to stand

Crawls well

A

9 months

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10
Q

Standing momentarly without support

A

12 months

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11
Q

Low Cortisol
Low ACTh
Hypoglycemia

Tx

A

Secondary or tertiary adrenal insufficiency

Tx Glucocorticoids

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12
Q

Low Cortisol
Increased ACTH

Tx

A

Primary adrenal insufficiency

Prednisone and fludrocortisone

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13
Q

Abdominal pain in 70 y.o

Calcification of superior mesenteric artery with an occlusive thrombus

Initial treatment?

A

Heparin anticoagulation

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14
Q

When to get LEEP

A

> 24 with High grade squamous intraepithelial lesions

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15
Q

Tx Scaly hair lesion

A

Tinia capitis

Oral griseofulvin
Oral terbinafine

[Topical clotrimazole used for the other tinea infections]

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16
Q

Scoliosis

Apex on left

35 degrees

A

Levoscoliosis

< 20 mild
20-45 moderate
> 45 severe

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17
Q

Paroxysmal supraventricular tachycardia

A

AV nodal reentrant tachycardia

Narrow QRS tachycardia with P waves that overlap the T waves

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18
Q

Target lesion rash on hands and feet

Sudden onset

A

Erythema multiforme

Herpes simplex virus

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19
Q

Muscle weakness brought on by strong emotion

A

Cataplexy

Narcolepsy

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20
Q

Shortened QT interval and widened T waves

Hx Sarcoidoisis

A

Hypercalcemia

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21
Q

Loss of pain and temp in upper extremities

Bladder incontience

A

Central cord syndrome

Lateral spinothalamic fibers

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22
Q

Posterior segment of spinal cord

A

Posterior white column

Position and vibration sense of extremities

Descending motor neurons in lateral corticospinal tract

Descending autonomic tract (bladder function)

Flaccid weakness
Hyporeflexia

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23
Q

Anterior segment of spinal cord

A

Anterior horn grey matter

Lateral spinothalamic tract (pain and temperature inforamtion)

Damage to anterior horn- weakness, muscle spastic

Hyperreflexia

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24
Q

Weakness of upper and lower extremities

Urinary incontinence

Decreased pain and temperature bilaterally

Normal position and vibration sense

A

Anterior spinal artery

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25
Dorsal cord syndrome
Posterior column of spinal cord Affect in MS, tabes dorsalis, fredreich ataxia Loss of prorioception and vibration Variable affects on bladder control Gait ataxia with weakness Hyporeflexia
26
Multiple hyperpigmented spots on lips and oral mucosa Hamartomatous polys
Peutz-Jeghers syndrome AD Increased risk of developing cancer Risk: intusssception and obstruction
27
Diagnostic of ankylosing spondylitis
Positive human leukocyte antigen B27
28
Dapsone
Dermatitis herpetiformis tx Celiac disease
29
Rash on elbows, blistering pruritic Abdominal bloating and diarrhea often Tx
Dermatitis herpetiformis Celiac disease Tx Dapsone
30
Blue white oral spots Fever Cough Rash What tx helps prevent death
Rubeola (measles) Vit A supplementation
31
Measles can return to school
5 days after onset of rash
32
Ribs 1-5 axis Ribs 6-10 axis Ribs 11 and 12 axis
1-5: Transverse axis 6-10: AP axis 11&12: vertical axis
33
Tenderpoint anterior ribs
Flexion STRT
34
Rib cage posterior tenderpoints
Elevated ribs
35
Superior transverse axis
Both respiraotry and inherent (craniosacral ) sacral mtoion occur about the superior transverse axis of the sacrum
36
Innomianate rotation occurs
Inferior transverse axis
37
Tx Guillain Barre
Plasmapheresis or IVIG
38
Snorted cocaine what medication to tx
Benzodiazepine Can cause MI if untreated
39
Tx hemochromatosis
Phlebotomy
40
Deferoxaine
Tx excess iron
41
Penicillamine
Promotes excretion of copper Wilson disease
42
Calf pain Abdominal pain brought on by eating Unintentional weight loss HTN Livedo reticularis in bilateral lower extremities Negative P-ANCA
Polyarteritis nodosa (PAN) Get Hep B serology Necrotizing arteritis of medium sized vessels Livedo reticularis Subcutaneous nodules Digital gangrene Ulcers
43
Seen with CREST ``` A. Asthma B. Autoimmune hepatitis C. Mononeuritis multiplex D. Pulmonary HTN E. Uveitis ```
Pulmonary HTN
44
Chapman points 1. Surgical neck of right humerus 2. First intercostal space 3. Second intercostal space 4. Third intercostal space
1. Surgical neck of right humerus= eyes 2. First intercostal space= tonsils 3. Second intercostal space= esophagus, bronchi, thyroid, and myocardium 4. Third intercostal space= upper lung and upper extremities
45
Cells with ringed blue dots
Sideroblastic anemia Tx Pyridoxine
46
Tx parkinson disease MOA
Anticholinergic drugs Benzotropine Trihexyphenidyl
47
Tx Neisseria meningitis
Vancomycin Ceftriaxone Steriods Rifampin for close contacts
48
Sickle cells Sick for a couple weeks Anemia Reticulocytopenia Pancytopenia ``` A.Papillomarvirus B. Paramyxovirus C. Parvovirus D. Picornavirus E. Poxvirus ```
C. Parvovirus Sickle cell + parvovirus B 19 results in aplastic crisis
49
Paramyxovirus Picornavirus
Paramyxovirus - Mumps - Parainfluenza virus Picornavirus - RNA viruses - Hep A virus
50
Osteopenia vs osteoporosis
Osteopenia DEXA T score -1 to -2.5 Osteoporosis Below -2.5
51
Infant Bilateral hearing loss Red reflex Cloudy cornea Purplish rash
Congenital rubella syndrome
52
Dilated tortuous submucosal vessels on colonoscopy
AV malformations Angiodysplasias Painless lower GI bleeding in people over 60
53
Chronic kidney disease Family hx cerebral aneurysm
Autosomal dominant adult polycystic kidney disease
54
Rash which was one skin lesion several weeks ago Erupted into multiple enlarging lesions all over body Itchy not painful Circular and oval lesions, larger ones have central clearing What also would be expected
Multiple erythema migrans Disseminated Lyme disease Typically to have cardiac findings - AV heart block
55
Subungual hemorrhages
Infective endocarditis
56
Tx Tinea
Topical ketoconazole
57
Tx position for R/L sacral torsion
Lateral recumbent with axis side down Left lateral recumbent with face up
58
L/L sacral torsion position
Left lateral sims position
59
Hasnt taken medications in three days SOB Dyspnea Fatigue JVD ``` Rales bilaterally S3 gallop Edema LV hypertrophy Elevated creatinine level ``` Started on furosemide Also give?
Acute decompensated heart failure Give vasodilator, nitroglycerin
60
Dermatitis herpetiformis for rash MOA
Immune complex deposition
61
Tx insulinoma in nonsurgical patient
Diazoxide [Octreotide if only nothing else works]
62
Tx Salicylate toxicity
Gastric lavage Activated charcoal Alkalinization of urine Severe: dialysis
63
Lasegue test
Straight leg test + = sciatica
64
Thomas test
Patient supine and physican flexes hip until thigh approximates abdomen + test= hypertonic iliopsoas muscles
65
Patrick's test
FABERE test Flexion Abduction ER Extension Crossing supine patietns leg over the CL leg, such that ipslateral leg forms reversed L Stabilize CL ASIS and give downward force + hip pathology
66
Pleural effusion by TB finding
Lymphocytes > 80% Increased total protein Adenosine deaminase >40 Glucose 30-50 (will not be lower than 30)
67
Pleural effusion 1. 90% lymphocytes, adenosine deaminase 50 u/L 2. Bloody appearance 3. Extremely low pleural fluid glucose level ( <30) 4. Lactate dehydrogenase (LDH) level of 50, ratio of total pleural fluid protein to protein in serum of 0.45, ratio of LDH in pleural fluid to serum 0.40 5. White milky appearance
1. 90% lymphocytes, adenosine deaminase 50 u/L= TB 2. Bloody appearance= pulmonary embolism and malignancy 3. Extremely low pleural fluid glucose level ( <30) = Rheumatoid arthritis, empyema, malignancy 4. Lactate dehydrogenase (LDH) level of 50, ratio of total pleural fluid protein to protein in serum of 0.45, ratio of LDH in pleural fluid to serum 0.40= Transudative effusion (Congestive heart failure) 5. White milky appearance= chylothorax with triglyceride count above 110 - caused by lymphoma and trauma caused by thoracic surgery
68
9 y.o vomiting Has URI infection last week hepatomegaly Has seizure
Reye syndrome Aspirin in children Liver failure Increase PT Elevated ammonia Hypoglycemia Increased intracranial pressure
69
Medial forearm and arm numbness Limit wrist flexion
Cubital tunnel syndrome Ulnar nerve impingement
70
Loss of sensation in first three fingers Tinel sign at wrist is negative
Pronator teres compression syndrome
71
Painless ulcer on uvela that goes away Now severe headache, muscle aches and loss of appetite. Neck pain Fever Maculopapular rash on trunk, limbs, palms and soles What else is seen
neurosyphilis Personality changes [Sensory ataxia seen with tabes dorsalis, late form of neurosyphilis with 20 year latent on average]
72
Brief episodes of neurologic dysfunction Numbness in arm Loss of vision in one eye
Transient ischemic attack Carotid stenosis
73
Creutzfeldt jakob on biopsy
Neural cell loss and intraneuronal vacuolization
74
1. Eosinophilic spongiosis 2. Granular IgA 3. IgA at the dermal epidermal junction 4. Subepidermal blistering 5. Intraepidermal vesicles
1. Eosinophilic spongiosis= bullous pemphigoid 2. Granular IgA = dermatitis herpetiformmis 3. IgA at the dermal epidermal junction= IgA bullous dermatoses (rare autoimmune disease) 4. Subepidermal blistering= bullous pempihigoid 5. Intraepidermal vesicles= erytehma multiforme
75
Lab Finding with RCC (4)
Polycythemia Due to production of erythropoietin Cushing syndrome due to Cortisol production HTN due to renin production Hypercalcemia due to PTH like hormone secretion
76
Bone lesion child's leg 1. Large multinucleated cells among smaller mononuclear stromal cells 2. Pleomorphic malignant osteoblast cells surrounded by an osteoid matrix 3. Small round tumor cells with hyperchromatic nuclei and minimal cytoplasm 4. Thick sclerotic bone surrounding osteoblast cells and irregular bony trabeculae 5. Tumor cells with atypical nuclei and mitoses surrounded by a cartilage matrix
1. Large multinucleated cells among smaller mononuclear stromal cells= giant cell tumors 2. Pleomorphic malignant osteoblast cells surrounded by an osteoid matrix= osteosarcoma 3. Small round tumor cells with hyperchromatic nuclei and minimal cytoplasm= Ewing sarcoma 4. Thick sclerotic bone surrounding osteoblast cells and irregular bony trabeculae= osteoid osteomas 5. Tumor cells with atypical nuclei and mitoses surrounded by a cartilage matrix= chondrosarcomas
77
21 y.o with irregular periods Body hair LH/FSH 3.2: 1 Tx
PCOS Tx: Spironollactome - acts as testosterone antagonist [For fertility= clomiphene citrate]
78
Transmural inflammation of distal ileum Inital tx
Mild crohn's disease Budesonide (oral glucocorticoids) [Prednisone for crohns that involves distal colon or entire colon, not limited to ileum]
79
Chapman points 1. Umbilicus and pubic symphysis 2. Second intercostal space 3. Seventh intercostal space
1. Umbilicus and pubic symphysis= Bladder and urethra/ovaries 2. Second intercostal space= Esophagus, thyroid, Bronchi and heart 3. Seventh intercostal space= Spleen
80
Incremental response on nerve conduction
Lambert Eaton
81
Decremental response on repetitive nerve stimulation
Myasthenia gravis
82
Wiggling poop Tx
Tapeworm Taenia solium Tx Praziquantel
83
Ivermectin tx for
Strongyloidiasis and onchocerciasis
84
Mebendazole tx for
Effective against nematodes (round worms) Ascariasis Pinworm (enterobiasis) hook worm
85
1. Enlarged chorionic villi with trophoblastic hyperplasia 2. Pleomorphic glandular cells with mucin vacuoles 3. Sheets of atypical trophoblasts, necrosis and hemorrhage 4. Uniformly sized chorionic villi with scattered syncytiotrophoblasts 5. Variably sized chorionic villi with scalloping and trophoblastic inclusions
1. Enlarged chorionic villi with trophoblastic hyperplasia= Complete mole 2. Pleomorphic glandular cells with mucin vacuoles= Lung cancer, adenocarcinoma 3. Sheets of atypical trophoblasts, necrosis and hemorrhage= Choriocarcinoma 4. Uniformly sized chorionic villi with scattered syncytiotrophoblasts= Abortion (spontaneous) 5. Variably sized chorionic villi with scalloping and trophoblastic inclusions= Partial mole
86
Seen with cardiac tamponade ``` A. Bowel sounds in chest B. JVD C. Pericardial friction rub D. Tracheal deviation E. Widened mediastinum ```
B. JVD
87
ECG finding with acute pericarditis
Diffuse ST segment elevations
88
Boxer fracture
Metacarpal neck fracture
89
Seen with glucagonoma
Necrotizing migratory erythema
90
Bloody diarrhea Stool shows organisms with ingested erythrocytes
Entamoeba histolytica
91
A 50 y.o patient who was recently diagnosed with pneumonia is seen in clinic for shortness of breath, cough fever and chills. Hx reveals the patient has been home in bed for 2 days only getting up to use bathroom. CXR reveals pleural effusions and thoracentesis and studies of the fluid reveal pH of 7.0 and low pleural fluid glucose level. CT revelas loculation and thickening of the pleural membranes. ``` A. Chylothorax B. Pulmonary embolism C. Cirrhosis D. CHF E. Empyema ```
E. Empyema Parapneumonic effusion are pleural effusion that arise from pneumonia Empyema: ph < 7.30, very high LDH and low glucose < 60
92
Cell with two eyes
Owl eye= Reed Sternberg Hodgkin lymphoma Painless rubbery lymph nodes
93
Seen with borderline personality disorder
Transient stress related dissociative symptoms
94
``` Bradycardia Hypotension M shaped wave Nausea Emesis Headache ``` Also see
Digoxin toxicity Altered color perception
95
Bronchospasm caused by
Beta blocker
96
Dry mouth caused by what heart drug
Clonidine toxicity Centrally acting alpha agonist
97
Hyperglycemia seen with what heart drug
CCB toxicity
98
Turner most common heart finding
Bicuspid aortic valve [ Coarctation is second]
99
If strep left untreated develop what
Rheumatic fever Mitral stenosis
100
Solid testicular mass Elevated beta HCG Fried egg appearance ``` A. Seminoma B. Embryonal carcinoma C. Yolk sac (endodermal sinus) tumor) D. Choriocarcinoma E. Teratoma ```
A. Seminoma [Yolk elevated AFP]
101
Most common spot of anal fissure
Posterior midline of anal canal
102
Only dysentery you treat Seen on culture Tx
Shigella Negative for motility, H2S production and lactose fermentation [Only one negative for all three] Ciprofloxacin, azithromycin, ceftraixone
103
Worsening fatigue Three bacterial infections in six months Neutropenia Hypochromic anemia Deficiency of??
Copper Neutropenia (recurrent infections) Thrombocytopenia (bruising petechiae) Microcytic hypochromic anemia
104
Who to get a Low dose CT scan on check
Individuals 55-80 who have smoked for 30 years Who are currently smoking or have quit in last 15 years
105
Heavy sensation in chest New murmur Elevated troponin No ST segment elevations Initial test? A. CT of chest with IV contrast B. Exercise electrocardiograph stress test C. Percutaneous coronary angiography D. Radionuclide stress myocardial perfusion imaging E. Transthoracic echocardiogram
C. Percutaneous coronary angiography Followed by intervention if discrete narrowing or blockage is found
106
Dark velvety patch of skin in both armpits and skin folds of groin Elevated ALT HTN
Non-alcoholic steatohepatitis (NASH) Inflammation of the liver due to excess fat deposition that causes damage to hepatocytes Tx Weight loss
107
Tx Ventricular fibrillation Emergent
Defibrillation Unsynchronized delivery of electricity
108
Direct current energy cardioversion
Tx new onset atrial fibrillation or atrial flutter If unstable patient or chemical means not working
109
1 y.o Rash for two months Ill defined patches of red thickened skin and multiple excoriation marks through out both arms Multiple vesicles with areas of crusting and presence of clear exudate
Atopic dermatitis
110
Beckwith Wiedemann syndrome Features
Anterior linear earlobe creases Pediatric disease Macrosomia Macroglossia (tongue) Omphalocele Wilms tumor Neuroblastoma
111
Took amoxicillin for H pylori infection ten days ago Develops fever, joint pain, and rash Maculopapular rash Elevated serum creatinine Seen w/ staining
Acute interstitial nephritis (AIN) Eosinophils with Wright staining of the urine elevated IgE Eosinophiluria
112
Chapman for pancreas
Between the transverse process of T7 and T8 on right
113
Myasthenia gravis ab target
Nicotinic post synaptic acetylcholine receptors
114
Broca artery
Middle cerebral artery
115
Tx Chorea in huntington
Tetrabenazine Inhibits VMAT which release dopamine [Not Benztropine]
116
Prophylaxis tx for cluster headaches
CCB
117
Burn percentage Anterior head Posterior left UE Anterior abdomen Anterior left LE
27% Anterior head 4.5% Posterior left UE 4.5% Anterior abdomen 9% Anterior left LE 9%
118
Patient first diagnosed with HTN 148/95
Stage 2 HTN > 140 ``` Exercise and low salt diet Combination pharmacotherapy (CCB, ACE, Thiazide) ``` Stage 1 130-139
119
Spontaneous bacterial peritionitis bacteria
Ecoli
120
Epidural hematoma artery
Middle meningeal artery | `Branch of maxillary artery branch
121
Test for aortic dissection
Chest radiography
122
Heart chapman point
2nd ICS
123
organisms on prosthetic heart
Staphylococcus epidermidis and staph aureus [Native valve endocarditis= streptococcal viridnas]
124
Positively skewed
Right skew Mean is greater than median, both greater than mode
125
Lab elevated in POlymyalgia rheumatica
ESR
126
67 y.o sudden onset of weakness fell to ground Cranial nerves intact, but unable to move any of his limbs. Sensory exam he unable to perceive pain, but able to discrimiante between two sharp pinpricks. When a cold vibrating tuning fork is placed over his extremities, he is able to perceive the vibrations, but not the coldness of the fork. Diagnosis? ``` A. Anterior cord B. Central cord C. Guillain Barre D. Hypokalemic periodic paralysis E. Vertebrobasilar infarction ```
A. Anterior cord syndrome Anterior spinal artery Corticospinal tracts (voluntary movement) Spinothalamic tracts (temp and pain)
127
5 y.o female with enlarged clitoris. Clitoromegaly, found at puberty stage 4. Hyponatremia and hyperkalemia. Appropriate test to order? ``` A. serum 21-hydroxylase B. Serum 17 hydroxyprogesterone level C. Serum 11-hydroxyprogesterone level D. Serum aldosterone level E. Serum ACTH ```
B. Serum 17 hydroxyprogesterone level CAH 21-hydroxylase deficiency
128
Bilateral sacral extension somatic dysfunction inhibits sacral (blank)
Nutation
129
Straw color discharge from right nipple ``` A. Ductal carcinoma in situ B. Lobular carcinoma in situ C. Invasive ductal carcinoma D. Intraductal papilloma E. Fibrocytist disease ```
D. Intraductal papilloma
130
Sphenobasilar flexion you also see
Flexion of midline bones ER of paired bones Decrease in AP diameter Extension of sacrum
131
Seen with viral conjunctivitis A. Darkening and edema of the infraorbital skin B. Follicular appearance of the tarsal conjunctiva C. Linear stain after application of fluorescein D. Pain with eye movement E. Photophobia
B. Follicular appearance of the tarsal conjunctiva Papillae which are inflamed follicles are seen on the inside of the eyelids causing bumpy appearance
132
Viscerosomatic levels
``` S 5-9 L 6-9 P 5-11 S 9-11 K 10-11 B 11-2 L 11-2 ``` ``` Stomach/Spleen Liver Pancreas Small bowel (jejunum and ileum) Kidney Bladder Lower extremities (and penis) ```
133
Asterion Pterion Lambda Nasion Bregma
Asterion: point where occipital, temporal and parietal bones meet Pterion: greater wing of sphenoid, temporal, parietal bone and front bone meet. Behind zygomatic arch Lambda: Remnant of posterior fontanelle, sagittal suture ends to lambdoidal suture Nasion: superior aspect of nose, two nasal bone articulate with frontal bone Bregma: anterior fontanelle, sagittal, frontal and coronal sutures meet
134
To move radial head anteriorly physician must
Engage in arm supination Patient must resist supination by pronating arm
135
SBO what first exam to get
Xray
136
ESRD missed dialysis see what on Lab EKG
Hyperkalemia Peaked T waves
137
Profuse watery diarrhea after antibiotic treatment Structural finding? ``` A. Diverticuli B. Pseudomembranes C. Thickened mucosal folds D. Transmural inflammation of the colon E. Villous adenoma ```
B. Pseudomembranes C. Diff [Transmural inflammation= Crohns]
138
Test for C diff ``` A. blood culture B. Sigmoidoscopy C. Stool culture D. Stool toxin E. Urea breath test ```
D. Stool toxin
139
Craniosacral extension see what
Nutation of the sacral base SBS moves inferiorly Pair temporal and parietal bones rotate internally AP diameter is increased Tension of sacral base is release and moves anteriorly (nutation)
140
Scaly lesion on scalp and ears that flakes
Seborrheic dermatitis "dandruff"
141
Graves antibody against
Thyrotropin (thyroid stimulating hormone) receptor
142
Hashimoto antibody
Thyroid peroxidase TPO
143
Number risk factor for osteoporosis
Smoking
144
Tx PAD
Statin
145
Cafe au lait
Hyperpigmented spots Neurofibromatosis (intellectual disability, iris hamartomas, optic gliomas, pheochromocytomas, seizures) Fanconi anemia (absent radii and thumbs, microcephaly, pancytopenia) McCune Albright (unilateral, precocious puberty)
146
Downs syndrome why to not do HVLA
Weakness of alar and transverse ligaments
147
HVLA contraindicated (5)
``` Osteomyelitis Osteoporosis Metastatic carcinoma Down's syndrome Local fractures ```
148
35 y.o with progessive cough and greem sputum. Multiple lung infections as child. Non smoker. Hyperinflation and ill defined pulmonary nodules - Name - Dx
Bronchiectasis CT chest
149
Acne ``` A. Aerobic gram neg bacillus B. Aerobic gram neg coccobacillus C. Aerobic gram pos coccus D. Anaerobic gram pos bacillus E. Anaerobic gram pos coccus ```
Anaerobic gram positive bacillus Acne vulgaris Propionibacterium acnes
150
New born screening tests
Phenylketonuria | Hypothyroidism
151
``` 5 y.o Hyperpigmented spot Short New pubic hair growth, breast buds Three bone fractures Thyroid nodules ```
McCune Albright syndrome
152
Sponylosis
Osteoarthritis of spine
153
DM uncontrolled on Metformin Add what medication
Sulfonylurea | - Glyburide
154
When to add insulin
A1C > 8.5%
155
Suspect Rhabdomyolysis - See what in labs - Diagnostic test
Hyperkalemia Get Serum creatine kinase [Not urine microscopy]
156
1 month old Poor feeding Floppiness (Progressive) Normal ocular movement Hypotonia Lack of head control
Werdnig Hoffman disease (Spinal muscular atrophy type 1) AR Diagnosed by molecular genetic testing of the SMN1 gene Apoptosis cannot be stopped. [Botulism has decreased eye movement]
157
Uterine tumor Smooth muscle with areas on hemorrhage and necrosis ``` A. Leiomyosarcoma B. Endometrial carcinoma C. Leiomyoma D. Teratoma E. Choriocarcinoma ```
A. Leiomyosarcoma
158
Reoccuring painful ulcers on genitals for 5-6 years Ulceration on mucosa Uveitis
Behcet disease Rare autoimmune disease Can also experience mild monoarticular arthritis or arthralgias (ankle or knee)
159
Tremor Shuffling gait Micrographia Give what drug
Carbidopa-levodopa Parkinson
160
Antibodies for sclerosis
Anti-topoisomerase
161
Anti-centromere
CREST
162
Anti-topoisomerase
Sclerosis
163
Rhomboid crystals
Calcium pyrophosphate deposition disease | pseudogout
164
Large red lesion on childs face Seizures Also see?
Sturge-Weber Syndrome Nevus flammeus= port wine stain Intellectual disability Hemiparesis Angiomas in parietal or occipital lobes —> homonymous hemianopsia (loss of either left or right visual fields)
165
How to CONFIRM cholecystitis
HIDA scan
166
Diabetes 219 y.o Give what medication
DM type 1 Young Skinny Insulin
167
Hard lump in neck Moves up and down when swallows Firm non tender, non mobile mass left of midline Solitary nodule with multiple regions of echogenicity Calcitonin 5 (< 8.8 normal)
Papillary thyroid carcinoma Solitary non-tender, non mobile neck mass with multiple ares of echogenicity Cold nodule Associated Family adenomatous polyposis APC gene
168
Tx Acute diverticulitis
Oral amoxicillin clavulanate
169
Rubella virus family Measles virus family
Rubella: Togavirus family Measles: Paramyxovirus
170
Most specific antibody for SLE
Anti- smith
171
HUS lab finding (4)
Elevated LDH Decreased haptoglobin Anemia Schistocytes
172
Cobb angles
Mild 5-15 Moderate 20-45 Respiratory compromised seen when angle is over 50 Cardiovascular compromise when angle > 75
173
75 y.o Dry cough and exertional dyspnea Worked in glass factor for 30 years Increased FEV1/FVC - Name - CXR
Silicosis Nodular opacities in the upper lobes
174
85 y.o cough and exertional dyspnea. Never smoked. Worked as metal worker in machine shop. Weight loss 20 lbs Fever Bilateral inspiratory crackles - Name - CXR
Berylliosis Metal workers Jewelry makers Electronics Bilateral hilar adenopathy
175
85 y.o cough and exertional dyspnea. Never smoked. Worked as metal worker in machine shop. Weight loss 20 lbs Fever Bilateral inspiratory crackles - Name - CXR
Berylliosis Metal workers Jewelry makers Electronics Bilateral hilar adenopathy
176
Asbestosis CXR
Bilateral opacities with pleural plaques
177
Imaging for acromegaly
MRI of pituitary
178
Increase voltage (large peak QRS) due to
LV hypertrophy | HTN
179
Visited Wisconsin presents with cough, fever, chest pain and severe arthralgia. Physical exam is remarkable for non-pruritic verrucous skin lesions on trunk. ``` A. Blastomycosis B. Coccidioidomycosis C. Histoplamosis D. Cutaneous candidiasis E. Cryptococcosis ```
A. Blastomycosis dimorphic Well demarcated verrucous or ulcerated skin lesions, bone lesions, CNS disease
180
Seen with Acute tubular necrosis
Muddy brown granular casts
181
Untreated syphilis at risk for
Nephrotic syndrome Membranous glomerulonephritis
182
16 y.o fever, sore throat myalgias. Yesterday developed a painful rash on face that spread to extremities and developing blisters. Crusting of lips and eye redness. HIV hx. Took course of TMP-SMX recently. Skin of trunk, extremities, and face is diffusely erythematous with confluent vesicles and bullae, several rupture. + Nikolsky. Erosion covering her lips and oral mucosa. Conjunctiva are injected bilateraly with purulent discharge ``` A. Erysipelas B. Erythema multiforme C. Necrotizing fasciitis D. Staphylococcal scaled skin syndrome E. Toxic epidermal necrolysis ```
E. Toxic epidermal necrolysis > 30% body * Involves mouth, eyes and genitalia Triggered by medication [SJS is counterpart 10% body]
183
Best to give to patient with HTN after MI
Beta blocker + ACE-I
184
6 y.o with pheochromocytomas and clear renal cell carcinoma. Heritable disorder ``` A. NF1 B. NF2 C. Tuberous sclerosis D. Von Hippel LIndau E. Sturge-Weber syndrome ```
D. Von Hippel lindau Multisystem cancer syndrome Clear renal cell carcinomas PHeochromocytomas Hemangioblastoms
185
Neurogenic shock CO PCWP SVR
CO: Low PCWP: Low SVR: Low
186
In septic shock kidneys are damaged due to
Hypoperfusion
187
Posterior appendix chapman
TP of T 11
188
Inital tx aortic dissection
Labetalol Lowering BP
189
Allergic contact dermatitis MOA
Protein haptenation Delayed inflammatory reaction 1st step development of binding of haptens to protein carriers in skin
190
Moles all over back
Seborrheic keratosis
191
Vit B12 deficency symptoms
Glossitis * Paresthesias of LE Mental sluggishness Fatigue
192
Non surgical tx of carcinoid syndrome ``` A. Octreotide B. Propanolol C. Prazosin D. Doxycycline E. Open laparotomy ```
A. Octreotide

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