Family Medicine

Question 1

Normal maximum heart rate

Answer 1

220-patients age

Question 2

Key symptoms of MI/ angina(6)

Answer 2

Chest heaviness
Pressure
Pain
Radiating to left arm, shoulder, jaw
SOB
Diaphoresis is a key symptom

Question 3

Chest pain radiating to shoulder, neck or back, worse with deep breathing or cough

Relieved by sitting up and leaning forward

Answer 3

Pericarditis

Question 4

Severe chest pain radiating to back, associated with unequal pulses or blood pressure in arms

Answer 4

Aortic dissection

Question 5

Tachypnea

Tachycardia

Answer 5

Pulmonary embolism

Question 6

Sharp localized chest pain with reproducible tenderness

Exacerbated by exercise

Answer 6

Costochondritis

Question 7

Drugs to not take if taking stress test

Answer 7

Beta blockers

Digoxin

Question 8

Pharmacologic stress test

Answer 8

Dobutamine

Question 9

Stress test for CAD positive if patient develops (3)

Answer 9

ECG changes (ST elevation or depression)
Decrease blood pressure
Failure to exercise more than 2 minutes due to cardiac symptoms

Question 10

Echocardiography

Answer 10

Ultrasound of heart

Picture of heart

Can evaluate function

Valvular defects
Strength of heart muscle (ejection fraction)
Wall motion abnormality

Question 11

Left heart catheterization process

vs right heart catheterization

Answer 11

Wire is inserted through a vessel (radial or femoral) and threaded to coronary vessels

Right heart catheterization is through a vein

Question 12

Tx Stable angina

Answer 12

Beta blocker (reduces myocardial oxygen demand)
Aspirin
Nitroglycerin

Question 13

Chest pain certain hour in the morning
Chronic
- what is it
- imaging
- tx

Answer 13

Prinzmetal’s angina
- coronary vasospasm

No stenosis or plaque in coronary vessels

ECG may show transient ST elevations

Tx: Calcium channel blockers
Nitrates to reduce vasospasm

Question 14

Acute coronary syndromes

Answer 14

Unstable angina or actual MI

Imbalance of myocardial oxygen supply and demand

Question 15

Serum markers for MI

Answer 15

1 hr-4 : myoglobin elevated (peak 6)

3 hrs-12 : Troponin T or I
- very sensitive and specific
- elevated for a week
(peak 18-24)

4-8 hr: creatinine phosphokinase
(peak 18-24)
-nonspecific 
- but CK MB is specific
- elevated 3-4 days

Question 16

Patients with acute coronary syndrome should be given

Answer 16

MONA + beta blocker

Morphine
Oxygen
Nitate
Asprin (clopidogrel if allergy)

Morphine should be given last

Placed on cardiac monitor (at risk for arrhythmias)

Unfractioned heparin

Question 17

Closed fist over chest sign

Answer 17

Levine’s sign

Sign of acute coronary syndrome

Question 18

Thrombolytics

Answer 18

Streptokinase
Urokinase
Anistreplase
Alteplase
Reteplase

Contraindications are risk of bleeding

Question 19

ACS + ST elevation MI Tx

Answer 19

MONA + beta blocker

Thrombolytics and/or catheterization

Question 20

TIMI score (7)

Answer 20

scoring system for aptients with NSTEMI to determine if cath necessary

> 65
>= 3 CAD risk factors
Prior coronary stenosis
ST changes of ECG
>= 2 anginal episodes in 24 hrs
Use of aspirin in prior week
Positive serum markers

TIMI >4 get invasive management

Question 21

ECG changes in II, III, aVF

Answer 21

Inferior wall MI

Affects right ventricle

Major danger of dropping preload

Tx: maintain preload with aggressive fluids and avoid nitrates

Question 22

ST elevations in V1, v2, V3

Answer 22

Anteroseptal MI

Question 23

ST elevations in V5, V6, I, aVL

Answer 23

Lateral wall MI

Question 24

Tall ST elevation in II, III, AVF, tall R with ST depression in V1, V2, and ST elevation in V4R

Answer 24

Posterior wall MI

Question 25

Medications for discharge with ACS (5)

Answer 25

``` Aspirin Beta blocker ACE inhibitor Statin Clopidogrel (if stent placed) ```

Question 26

Patient with known history of CHF with a low EF. Most likely cause of death?

Answer 26

Arrhythmia

Question 27

Death 4-5 days after MI

Answer 27

``` Ruptures - free wall -intraventicular septum - papillary muscles (causes mitral regurg) ```

Question 28

Death 48 hours after MI

Answer 28

Arrhythmias - ventricular tachycardia when myocardium reprofuses - bradycardia

Question 29

Death 1-2 after MI Fever, chest pain, generalized malaise ECG shows diffuse ST-T changes Tx

Answer 29

Dressler syndrome Fever, pericarditis, pleural effusions Tx: NSAIDS and steroids

Question 30

Left heart failure vs Right

Answer 30

LHF - pulmonary venous congestion RHF - systemic venous congestion

Question 31

Right heart failure causes (5)

Answer 31

``` CAD (MI that damaged the right ventricle) 2nd degree to LHF Pulmonary HTN Endocarditis damaging tricuspid valve Ventricular septal defect ```

Question 32

Left Heart failure causes (5)

Answer 32

``` CAD (MI that has damaged the left ventricle) Hypertension Mitral and aortic valve disease Endocarditis Dilated cardiomyopathy ```

Question 33

Left heart failure signs (7) PE signs (4)

Answer 33

``` SOB Orthopneu Paroxysmal nocturnal dyspnea (SOB when laying down) Dyspnea on exertion Cough Diaphoresis Nocturia ``` Rales S3 gallop Tachycardia Peripheral edema

Question 34

Right heart failure signs (4) PE signs (8)

Answer 34

RUQ pain (due to hepatic congestion) SOB Abdominal swelling (ascites) Weight gain ``` Hepatomegaly Hepatojugular reflex JVD Ascites Cirrhosis Abnormal LFTs Peripheral edema Cyanosis ```

Question 35

Young patient with sudden death - name - MOA - heart sound

Answer 35

Hypertrophic Cardiomyopathy (HCM) Hypertrophy of the interventricular septum narrows the LV outflow tract High velocity systolic flow draws the anterior leaflet of the mitral valve into the tract causing a dynamic LV outflow tract obstruction. Sudden death due to arrhythmia Paradoxical splitting of S2

Question 36

Hypotension Muffled heart sounds JVD Systolic bp drops by 10 mm hg with inspiration Narrow pulse pressure

Answer 36

Pericardial tamponade Beck's triad - Hypotension - muffled heart sounds - jvd Pulsus paradoxus: drop by 10

Question 37

Pericardial tamponade ECG

Answer 37

Low voltage or electrical alternans

Question 38

ECG low voltage, T wave flattening, inversion in V1 and V2, notched P waves Tx

Answer 38

Constrictive pericarditis - scarring from acute pericarditis Pericardiectomy

Question 39

Any disorder that causes dilation of the atria can cause

Answer 39

atrial fibrillation

Question 40

Loud S2/ tapping apex | Opening snap followed by mid-diastolic rumbling murmur

Answer 40

Mitral stenosis

Question 41

Holosystolic murmur best heard at the apex with radiation to the axilla

Answer 41

Mitral regurg

Question 42

Systolic ejection murmur Crescendo decrescendo Radiating to the carotids Low volume pulse Decreases with valsalva

Answer 42

Aortic stenosis

Question 43

Early diastolic decrescendo murmur best heard at left 3/4th intercostal space

Answer 43

Aortic regurg

Question 44

Holosystolic murmur left sternal border | Increased by inspiration

Answer 44

Tricuspid regurg Hepatomegaly

Question 45

mid-Diastolic rumbling murmur left sternal border with an opening snap and wide, splitting S1

Answer 45

Tricuspid stenosis Hepatomegaly Icterus, edema

Question 46

Midsystolic click Apex Wide split of S2

Answer 46

Mitral valve prolapse

Question 47

Sodium channel blockers

Answer 47

Lidocaine - Suppresses ventricular dysrhythmias - SE: drowsiness, confusion, psychosis, seizure, av block, respiratory depression ``` Quinidine - Suppresses ventricular dysrhythmiasa - Suppresses Atrail presmature beats - Suppresses A fib SE: Cinchonishm, tinnitus, eharing loss, visual changes, delirium, torsades de pointes ``` ``` Procainamide -Suppresses ventricular dysrhythmiasa - Suppresses A fib - A flutter - WPW SE: Myocardial depression, prolonged QT, torsades de points, V-fib ```

Question 48

Beta blockers - 4 examples - what they treat - SE of all beta blockerse

Answer 48

Class II Propranolol - SVT - Thyrotoxicosis - Acute MI - HTN Metoprolol - SVT - acute MI - HTN Esmolol - SVT - thyrotoxicosis Labetalol - HTN SE all beta blockers - bronchoconstriction

Question 49

Class III: prolongs action potentials

Answer 49

Amiodarone - VT, VF, Afib, WPW SE: bradycardia, av block, corneal deposits, skin discoloration, hepatotoxicity, iodine can cause hypo/hyperthyroidism Bretylium - ventricular dysrhythmias Sotalol - AV reentry, svt, WPW SE: bradycardia, CHF, perpherial edema

Question 50

Calcim channel blockers

Answer 50

Verapamil Diltiazem Amlodipine Nifedipine

Question 51

Adenosine

Answer 51

SVT SE flusing hypotension

Question 52

Digoxin

Answer 52

Rate control of Atrial tachydysrhythmia, increased inotrophy for CHf TOxicity, vomiting, confusion visual changes,

Question 53

Antihypertensive agents

Answer 53

Nitroprusside - malignant htn Minoxidil - severe htn Hydralazine - preeclampsia - direct vasodilator Clonidine - central acting agent Phentolamine - parenteral alpha blocker - htn due to pheochromocytoma Prazosin - PO alpha blocker ACE inhibitors Angiotensin receptor blockers

Question 54

Sulfonylureas

Answer 54

Glimepiride GLycuride Glipizide Stimulates insulin secretion from the pancreas

Question 55

Meglitinides

Answer 55

repaglinide Nateglinide Increase insulin production by the pancrease

Question 56

Biguanides

Answer 56

Metformin Decrease liver's glucose production and slightly increase muscle glucose uptake

Question 57

Thiazolidinediones

Answer 57

Troglitazone Rosiglitazone Pioglitazone Decreases insulin resistance at the muscle and liver

Question 58

Alpha glucosidase inhibitors

Answer 58

Acarbose Miglitol Slows the digestion of carbohydrates

Question 59

DDP-4 inhibitor

Answer 59

Sitagliptin Increases insulin production and decreases the liver's production of glucose

Question 60

GLP-1 analog

Answer 60

Exenatide Enhances insulin secretion, decreases liver glucose output and may suppress appeitite

Question 61

Pramlintide

Answer 61

Synthetic nalog of hte human homrone amylin that is cosecreted with insulin

Question 62

Tylenol

Answer 62

Acetaminophen Fever, aches

Question 63

A firm nodule palpable over the carpometacarpal joint of the thumb

Answer 63

Trigger thumb Stenosing flexor tenosynovitis Tendon sheath thickens creating palpable nodule

Question 64

Pain with palpation of the anatomic snuffbox

Answer 64

Scaphoid bone fractures

Question 65

Chronic venous insufficiency presents with

Answer 65

pain, pruritus, discoloration and thickening of the skin and edema

Question 66

Medication induced myopathy

Answer 66

Statin drugs

Question 67

Fetal demise | Closed cervix

Answer 67

Missed abortion

Question 68

Incomplete abortion

Answer 68

Incomplete evacuation of the products of conception from the uterus

Question 69

Inevitable abortion

Answer 69

Cervix is dilated but no products of conception have yet evacuated

Question 70

Pregnancy with vomiting and yeast infection ``` Dont give what? Acetaminophen Bismuth salicylate Clotrimazole Diphenhydramine Loperamide ```

Answer 70

Dont give bismuth salicylate (aspirin) Yeast infection prefered antifungal during pregnancy= clotrimazole Antihistamine during pregnancy for pruritis= diphenhydramine Safe opioid in pregnancy= Loperamide Opioid receptor agonist works on mu receptor of large intestine. Decrease activity of bowel movements

Question 71

NSAIDS

Answer 71

Ibuprofen | Naproxen

Question 72

Danazol

Answer 72

Synthetic androgen that decreases the secretion of estradiol in hopes to suppress menstrual cycle SE: hirsutism, acne, male pattern baldness

Question 73

Leuprolide

Answer 73

Gonadotropin-releasing hormone analogue that suppresses the menstrual cycle by down-regulating LH and FSH secretion SE: menopause symptoms

Question 74

Repeat labs if consume what

Answer 74

alcohol

Question 75

Tx Pelvic inflammatory disease (PID)

Answer 75

Cefriaxone and doxycycline Ceftriaxone covers neisseria gonorrheae Doxy covers chlamydia (or azithromycin)

Question 76

Patient with cirrhossi Painless rectal bleeding from what vein

Answer 76

Superior rectal vein Superior rectal vein drains into the inferior mesenteric vein which is part of portal system System is under HTN in chronic liver disease

Question 77

Esophageal varices is due to what vein

Answer 77

Engorgement of left gastric vein

Question 78

Caputmedusae due to what vein

Answer 78

Engorgement of the paraumbilical vein

Question 79

Smoker who had trauma to breast. Breast now inflamed and tender. Pus coming out nipple Tx

Answer 79

Periductal mastitis - inflammatory condition of the breast that occurs in smokers Smoking damages mamary ductal tissue causing inflammation of the subareolar ducts which can then become infected Unilateral breast tenderness Amoxicillin-clavulanate Clindamycin if penicillin allergy

Question 80

Anti-tissue transglutaminase

Answer 80

Celiac Allergy to gliadin

Question 81

Infant with sickle cell needs what vaccine

Answer 81

Reduction of the spleens ability to filter bacteria from the blood At risk for bacterial infections with encapsulated organisms - Streptococcus pneuoniae - Haemophilus influenzae - Neisseria meningitidis Pneumococcal polysaccharride vaccine

Question 82

Prophylaxis tx of animal bite

Answer 82

Amoxicillin-clavulanate Tx pasteurella

Question 83

First line tx for suspected staph infections like cellulitis

Answer 83

Dicloxacillin (beta-lactamase resistant penicillin)

Question 84

Recurrent pruritic vesicular rash on fingers palms and/or soles

Answer 84

Dyshidrotic eczema Triggered by allergic response (metals) Rash persists during times of vacation or when offending agent removed

Question 85

Yellow thickened nails in asymmetric distribution.

Answer 85

Dermatophytoses

Question 86

Herpes simplex on fingers

Answer 86

Pruritc fluid filled vesicles on fingers after periods of stress Lesions will have erythematous bae and progress to pustular and ulcerative lesions

Question 87

Hyperkeratotic plaques, pruritic papules and scales Linear burrows

Answer 87

Scabies

Question 88

Newborn rash not on palms or soles

Answer 88

Erythema toxicum neonatorum (ETN) Self limiting

Question 89

Acne neonatorum

Answer 89

Rash forehead, nose and cheeks. White heads Resolves in 4 months Due to androgen stimulation If persists suspect excessive androgen production

Question 90

Generalized rash on infant that involves trunk and extemities Diffuse mottling Improves when warmed

Answer 90

Cutis marmorata Due to infants vascular response to cold temps

Question 91

white/yellow papules on forehead, cheeks and nose. Sampling shows keratin within dermis

Answer 91

Milia resolves within 1 month w/o tx

Question 92

First line medication for prevention and tx of osteoporosis

Answer 92

T score below -2.5 Bisphosphonates - alendronate - risedronate - zoledronate - ibandronate MOA: bind to hydroxyapatite to decrease bone resorption and inhibit osteoclast from breaking down bone SE: erosive esophagitis Denosumab - monoclonal ab

Question 93

Calcitonin

Answer 93

Inhibits osteoclasts and decreases bone resorption Only indicated for tx osteoporosis not prevention

Question 94

Estrogen in osteoporosis

Answer 94

Prevention only

Question 95

Raloxifene

Answer 95

Prevention and tx osteoporosis Selective estrogen receptor modulator (SERM) and inhibits bone resorption Does not increase risk of endometrial or breast cancer Risk of DVt and PE Bisphosphonates are first line

Question 96

Teriparatide

Answer 96

Parathyroid hormone analogue and anabolic agent indicated in tx of osteoporosis and reduces both vertebral and nonvertebral fractures in postmenopausal women

Question 97

Elderly man take sildenafil and passes out what happened

Answer 97

Phosphodiesterase type 5 inhibitors - sildenafil - tadalafil - vardenafil Enhance nitric oxide within the body leading to increased vasodilation and penile erection Contraindicated in patient who are taking a nitrate medication (nitroglycerin, isosorbide mononitrate, isosorbide dinitrate) due to potentiation of nitric oxide, causing dangerous hypotension and syncope

Question 98

Alpha receptor antagonists

Answer 98

terazosin Tamsulosin Doxazosin

Question 99

Dont give beta blocker to

Answer 99

Metoprolol Labetalol Carvedilol Bradycardia Heart block Hemodynamic instability decompensated CHF (decreased ejection fraction leading to bilateral lower extremity edema and pulmonary effusion) are not hemodynamically stable

Question 100

CYP450 inhibitors

Answer 100

Erythromycin Cimetidine Ketoconazole Itraconazole Inhibition of P450 results in increase in PDE-5 inhibitor levels within serum --> increased nitric oxide and vasodilation

Question 101

Women with preeclampsia and in labor give what

Answer 101

IV magnesium sulfate

Question 102

Lung maturity glucocorticoids

Answer 102

Dexamethasone | Betamethasone

Question 103

Magnesium sulfate Toxicity

Answer 103

Seizure prophylaxis and tocolytic in pregnancy Check for toxicity by assessing for hyporeflexia of deep tendon reflexes, pulmonary edema, decreased urine output, cardiopulmonary arrest

Question 104

Gemfibrozil prevents

Answer 104

[Fibrates] Pancreatitis Hypertriglyceridemia is associated with increased risk of developing pancreatitis

Question 105

Dilated bronchi with adjacent companion arteries the are smaller in size with large cystic spaces and honey combing - patient profile - sign - disease process - imaging

Answer 105

Bronchiectasis Months to years of a daily cough and mucopurulent sputum, normal spirometry, unresponsive to antibiotics Signet ring sign Transmural inflammation and scarring , processses damage the surrounding lung parenchyma by destroying the muscular and elastic components of the bronchial walls. HRCT imaging

Question 106

Right Calf pain when walking, decrease in calf muscle size, lack of hair, thickened toe nails, left ankle/foot have stronger pulses -Test

Answer 106

Peripheral arterial occlusive disease (PAOD) Lack of palpable pulses, thinning or lack of hair, increase toe nails all signs of decreased arterial blood flow. 1st: Ankle-brachial index (ABI) (less than 0.9) Diagnosis: Angiography Smoking makes worse

Question 107

Firm or tense musculature, no atrophy, normal pulses, normal ABI. Pain with exertion relieved by rest. Trauma - test

Answer 107

Compartment syndrome Needle compartment pressure readings

Question 108

Asain infant with large blue spots since birth

Answer 108

Congenital dermal malanosis "Mongolian blue spots" Darker skinned ethnic groups Asymptomatic hyperpigmented macules and patches on back and buttocks Benign disappear by age 2

Question 109

Think iron-deficiency anemia check what lab

Answer 109

Serum ferritin Second check iron levels

Question 110

Patient with low hemoglobin but high MCV check what

Answer 110

macrocytic anemia check peripheral blood smear if shows megaloblastic features (hypersegmented neutrophils) , then take reticulocyte count. If less than 2% check B12 and folate

Question 111

Austin Flint murmur - is what - heard - symptoms(5)

Answer 111

Aortic regurgitation Diastolic rumbling murmur (doesnt have opening snap like mitral stenosis) Palpitations are uncomfortable in AR due to the widened pulse pressure. Head bobbing Nail bed pulsations Uvula pulsations "water hammer' pulse- rapid distention and collapse upon palpation of the pulse

Question 112

Harsh crescendo-decrescendo, mid-systolic ejection murmur with a palpable thrill

Answer 112

Pulmonary stenosis

Question 113

Early diastolic high pitched blowing, decrescendo murmur heard at left second intercostal space

Answer 113

Pulmonary regurgitation

Question 114

Tumor marker elevated in patients with colorectal cancer

Answer 114

Carcinoembryonic antigen (CEA)

Question 115

AFP elevated in what cancers

Answer 115

Liver cancer Germ cell cancers - teratomas

Question 116

CA15-3

Answer 116

transmembrane glycoprotein known as MUC1 expressed by MUC1 gene Tumor marker that is overexpressed in malignant breast glandular cells in patients with breast cancer Used to trended treatment or for recurrence Not diagnostic

Question 117

CA19-9

Answer 117

Tumor marker for multiple cancers involving GI tract (pancreatic, gall bladder/ biliary duct, and gastric cancers) Also elevated in endometrial cancer Trending for tx

Question 118

CA-125

Answer 118

elevated in ovarian cancer

Question 119

Kidney stone formation in patient with Crohn's due to what

Answer 119

malabsorption of fatty acids and bile salts.

Question 120

Decreased urinary citrate excretion as cause for kidney stones is see with

Answer 120

Chronic diarrhea and metabolic acidosis Which leads to low urinary pH

Question 121

Screening at 28 weeks pregnancy

Answer 121

gestational diabetes

Question 122

Screen for group B streptococcal infection at what week

Answer 122

36 weeks

Question 123

Most common bladder cancer

Answer 123

Transitional cell carcinoma

Question 124

Uterine cancer is probably what type

Answer 124

Leiomyosarcoma

Question 125

Squamous cell carcinoma in the bladder due to

Answer 125

Schistosoma haematobium

Question 126

Serum testing shows elevated serum alpha-fetoprotein levels, most likely cause

Answer 126

Inaccurate gestational age If age is accurate consider neural tube defects

Question 127

Abdominal pain improved with defecation. No blood or pus. Weight loss. Diffuse abdominal tenderness, discrete mass in RLQ Erythrocyte sedimetantion rate and C reactive protein are elevated Narrowed thickened ileum, string sign - Another sign

Answer 127

Crohn's disease Normocytic with iron deficiency and elevated ferritin.

Question 128

IBS imaging

Answer 128

Nothign seen on pathology or radiologic findings

Question 129

Lead pipe Bloody diarrhea Mucous discharge from rectum Distal rectum

Answer 129

Ulcerative colitis

Question 130

Infant excessive diaphoresis, poor feeding, and failure to thrive. Holosystolic murmur at lower left sternal border

Answer 130

Ventricular septal defect left to right shunt

Question 131

Wide fixed split S2 and a systolic ejection murmur at the left upper sternal border

Answer 131

Atrial septal defect

Question 132

Wide pulse pressure Continuous machinery murmur (present both systole and diastole) at he upper left sternal border Bounding peripheral pulses

Answer 132

Patent ductus arteriosus

Question 133

Menstrual migraines tx

Answer 133

NSAID first line Sumatriptan taken at he onset of symptoms Frovatriptan is prophylactic but don't use if trying to get pregnant

Question 134

75 y.o with painful skin rash on abdomen. Petechiae with scattered hemorrhagic bullae and black eschar ``` Aspirin Atorvastatin glargine lisinopril metoprolol warfarin ```

Answer 134

Warfarin skin necrosis - paresthesias - sensation of pressure - extreme pain Edematous, erythematous flush with developing petechiae that progress to hemorrhagic bullae with necrotic eschar

Question 135

Adverse effect aspirin

Answer 135

Samter's triad of asthma aspirin intolerance nasal polyps Aspirin intoxication - respiratory alkalosis from increased respiratory drive before culminating in an anion gap metabolic acidosis from salicylate toxicity

Question 136

Atorvastatin - MOA - AE

Answer 136

competitive inhibitor of HMG-CoA reductase Lower total cholesterol with predominant effect on decreasing low-density lipoprotein AE: diarrhea and myopathy

Question 137

Glargine - what is it - MOA - AE

Answer 137

Long-acting insulin analogue Stimulate peripheral glucose uptake by skeletal muscle and fat Inhibiting hepatic gluconeogenesis, lipolysis and proteolysis and enhancing protein synthesis AE: hypoglycemia, hypokalemia, local allergic rxn at injection site

Question 138

Lisinopril - what is it - MOA - AE

Answer 138

ACE inhibitor Coronary artery disease to lower afterload resistance DM to protect glomerulus from hyperfiltration injury by preventing constriction of the efferent arteriole AE: Cough

Question 139

Metoprolol - what is it - fxn - AE

Answer 139

selective beta-1 antagonist control heart rate in sinus tachycardia and atrial fibrillation AE: dizziness, headache, bradycardia and wheezing

Question 140

Beta 1 selective antagonists vs beta blockers

Answer 140

A-M beta 1 selective - atenolol - Esmolol N-Z non selective antagonists - nadolol - timolol outliers (carvedilol, labetalol) non selective

Question 141

Pemphigoid gestationis

Answer 141

pregnancy associated autoimmune disease Vesiclse and bullae C3 deposit on basement membrane SImilar to bullour pemphigoid and differentiated by "salt split techinique"

Question 142

Impetigo herpetiformis

Answer 142

type of pustular psoriasis that presents during the second half of pregnancy Group pustules and erythematous patches and plaques with overlying scale. Hyperpigmentation common Inguinal and axillary areas, also well as flexural surface arms and legs.

Question 143

Pruritic urticarial papules and plaques of pregnancy (PUPPS)

Answer 143

similarly to pemphigoid gestationis but lesions will not progress to tense bullae Third trimester Abdomen

Question 144

Absence seizures medication AE

Answer 144

Ethosuximide Dizziness is more common side effect does not require monitoring Serious adverse effect is pancytopenia Check CBC

Question 145

Group A streptococcus (GAS) pharyngitis tx

Answer 145

Penicillin V (if cant take oral penicillin G which is IM) [anaphylactic Penicillin allergy then azithromycin] [nonanaphylactic penicillin allergy then cephalosporin]

Question 146

Amoxicillin-clavulanate tx for

Answer 146

Respiratory tract infections Animal/human bites

Question 147

75 y.o nipple discharge past week. "creamy" discharge left breast. sometimes bloody. Mammogram last year normal, no lump. Inverted nipple, normal areola, no erythema, LN normal sized Ductoscopy reveals dialted ducts filled with secretions and fibrotic debris Tx

Answer 147

Duct ectasia Benign breast condition of increasing age [ductal Carcinoma involves areola] Tx complete duct excision

Question 148

Nipple inversion

Answer 148

Carcinoma Duct ectasia Periductal mastitis

Question 149

Straw colored or clear discharge from breast

Answer 149

Intraductal papilloma Benign neoplasm in lumen of breast

Question 150

Trauma or biopsy of breast. pain and small breast masses Debris-filled dilated duct

Answer 150

Mondor's disease Superficial thrombophlebitis of the breast develops when blood clots form in the superficial veins of the breast

Question 151

Inflammation in the subarolar ducts, no dilation. Younger woman or men. Associated with Tx

Answer 151

Periductal mastitis SMoking Tx: broad-spectrum antibiotics or drainage since frequently leads to infection

Question 152

STD with reactive arthritis

Answer 152

Chlamydia trachomatis Reiters syndrome

Question 153

keratoderma blennorrhagicum

Answer 153

hyperkeratotic lesions of palms of hands or soles of feet Reactive arthritis

Question 154

circinate balanitis

Answer 154

painless erythematous lesion of glans penis Chylamydia

Question 155

Hypotension JVD muffled heart sounds

Answer 155

Pericardial tamponade caused by myocardial rupture

Question 156

Pleural effusion caused by

Answer 156

Increased pulmonary capillary pressure, decreased capillary oncotic pressure, or increased membrane permeability

Question 157

SOB, anxiety and cough with pink frothy sputum

Answer 157

Pulmonary edema

Question 158

HIV positive individual give was vaccine

Answer 158

13 and 23 valent pneumococcal vaccine

Question 159

Give H. influenzae vaccine to who

Answer 159

asplenia

Question 160

Normal weight gain in pregnancy

Answer 160

25-35 lbs

Question 161

Pregnancy BMI over 30 weight gain

Answer 161

11-20 lbs

Question 162

Pregnancy BMI under 18.5 weight gain

Answer 162

35-45 lbs

Question 163

Meningococcal vaccine to

Answer 163

11-18 years old

Question 164

Leg swelling and fatigue. Has diabetes. Normal breathing sounds. Distended abdomen with positive lfuid wave. 3+ pitting edema. UA found urine protein/ creatinine ratio of 3.4 What do they have? Complication?

Answer 164

Nephrotic syndrome - proteinuria leading to hypoalbuminemia and diffuse edema DM common cause Complication is venous thrombosis

Question 165

Most common diagnosis in obese child with hip pain

Answer 165

Slipped capital femoral epiphysis (SCFE)

Question 166

Urine bright red and has clots indicated

Answer 166

Extraglomerular source of bleeding within the urinary tract non-glomerular cause - nephrolithiasis - tumor - cystic kidney disease UA first step Then ultrasound

Question 167

ASO

Answer 167

obtained when suspicion of post-streptococcus glomerulonephritis. History sore throat or skin infection preceding hematuria

Question 168

Hematuria cola colored or HTN then get

Answer 168

Complement C3 level Red blood cell casts or greater than 2+ protein on UA C3 levels low in post-infectious glomerulonephritis, lupus nephritis or membranoproliferativev glomerulonephritis

Question 169

Order in child with 2 or more febrile UTI infections

Answer 169

voiding cystourethrogram (VUR)

Question 170

11 y.o vaccine

Answer 170

TDaP Meningococcal HPV

Question 171

Fluoride supplemented water at what age for infant

Answer 171

6 months primary source needs 0.6 parts ppm

Question 172

Imaging to get with chest congestion and cough

Answer 172

plain chest radiograph rule out pneumonia, cardiomegaly, pleural effusions, aortic dissection

Question 173

Clumsiness (wide based ataxia), incomprehensible speech (explosive dysarthria), bilateral babinski sign, and bilateral loss of deep tendon reflexes - cardiac abnormality

Answer 173

Friedreich ataxia Hypertrophic obstructive cardiomyopathy Neurodengenerative disorder of axons within cerebellum and dorsal colums

Question 174

Japanese male, ataxia, loss of vibratory sense, hyperreflexia. Hyperpigmentation, behavior changes, decreased school performance, spasticity and paralysis

Answer 174

Adrenoleukodystrophy X linked recessive peroxisomal disorder ABCD1 gene Very long chain fatty acids into peroxisome

Question 175

Metachromatic leukodystrophy

Answer 175

autosomal recessive Deficiency of arylsulfatase A leads to accumulation of cerebroside sulfate. 2 years of age Loss of previous achieved milestones, tremors, truncal ataxia, hyperreflexia, hypotonia, nystagmus, and optic atrophy

Question 176

Coarse face, large tongue, electrical cardiac abnormalities, cherry red macular spot. 3-5 months olds. muscle weakness.

Answer 176

Tay-Sachs disease | - no hepatosplenomegaly

Question 177

Osteoarthritis medication

Answer 177

Patients with CHF should not get NSAIDs Give Duloxetine [Acetiaminophen used to be first line but studies show no efficacious]

Question 178

Diagnostic choice for hypertrophic obstructive cardiomyopathy

Answer 178

Echocardiogram

Question 179

tx hypertrophic obstructive cardiomyopathy

Answer 179

beta blocker

Question 180

Anemia of chronic disease lab values - MCV - iron - ferritin - total iron binding capacity

Answer 180

Low MCV Low iron High Ferritin Low total iron binding capacity Anemia of chronic disease (rheumatoid arthrits) iron is packed in the cells in excess so ferritin is high, serum iron low and TIBC low Different from iron deficiency anemia

Question 181

Low MCV Normal iron Normal ferritin normal TIBC

Answer 181

Thalassemia inadequate production of chains of hemoglobin Microcytic anemia

Question 182

Non-productive cough, wheezing, dyspnea. Flattening of the inspiratory loop and normal FVC and FEV1/FVC

Answer 182

Vocal cord dysfunction

Question 183

COPD values

Answer 183

Decrease FEV1/FVC ratio Normal inspiratory flow loop Irreversible with bronchodilator

Question 184

Asthma values

Answer 184

Decrease FEV1/FVC ratio Normal inspiratory flow loop reversible with bronchodilator

Question 185

Restrictive lung disease values

Answer 185

Reduced FVC Normal FEV/FVC

Question 186

Productive cough and SOB for 4 months. Started with fever and congestion. Decrease pulmonary fxn testing

Answer 186

Chronic bronchitis - obstructive airway disease Typically cyanotic PFT <70%

Question 187

Emphysema

Answer 187

Breathe rapidly Xray: bullae, flattened diaphragm, hyperinflated lung fields

Question 188

Bronchiectasis

Answer 188

Chronic cough with sputum production Purulent, foul smelling sputum for several years to months Dilated and thickened airways, mucus plugs

Question 189

Bronchiolitis obliterans

Answer 189

Rare cause of cough in adults Small airway obstruction caused by fibrosis or inflammation Present with non-productive cough and dyspnea with wheezing CT: expiratory air trapping within bronchioles, bronchial wall thickening, ground glass opacities

Question 190

Pregnant mother with upper respiratory tract infection then baby has hear loss what virus

Answer 190

CMV

Question 191

Tx CMV

Answer 191

ganciclovir

Question 192

CMV microscopy

Answer 192

Owl's eye

Question 193

Signs of rubella in infant

Answer 193

Cataracts Hearing loss Cardiac malformations Maculopapular rash

Question 194

Enlarged thick and pale placenta Hepatomegaly Persistent maculopapular rash Failure to move limb (pseudoparalysis due to pain)

Answer 194

Congenital syphilis | - sensiorneural hearing loss, interstitial keratitis, hutchinson teeth

Question 195

2 y.o child should be able to

Answer 195

Run Kick a ball Undress Two word sentences

Question 196

Stacking ability for years

Answer 196

1 year = 3 cubes | 2 year= 6 cubes

Question 197

3 y.o should be able to

Answer 197

draw circl (pi=3.14) ride tricycle three word sentences

Question 198

4 y.o should be able to

Answer 198

Draw cross or rectangle Hop on one foot Recognize colors/ numbers Cooperative play

Question 199

5 y.o should be able to

Answer 199

``` Draw a square Skip Catch a ball Print own name Tie shoelaces ```

Question 200

Tumor of jaw

Answer 200

Burkitt lymphoma - starry sky - EBV related - non-hodgkin lymphoma - t(8;14)

Question 201

t(11;14)

Answer 201

mantle cell lymphoma Elderly Palpable lymphadenopathy

Question 202

t(14;18)

Answer 202

Follicular lymphoma Germinal centers BCL-2 over epxression

Question 203

Large cells with vesicular chromatin and prominent nucleoli

Answer 203

Diffuse Large B cell lymphoma (DLBCL) NHL

Question 204

Reed-Sternberg cells

Answer 204

Binucleated "owl eyed" giant cells in hodgkin lymphoma Prominent mediastinum

Question 205

Patient with asthma and recurrent exacerbations of fever, cough, and dyspnea Brown mucus plugs Has what? Test

Answer 205

Allergic bronchopulmonary aspergillous Also experience central bronchiectasis Diagnostic: total serum IgE test (elevated) and allergy skin prick test for IgE antibody to Aspergillus

Question 206

Who to screen for AAA

Answer 206

65-75 who ever smoked

Question 207

Dont give aspirin to those with history of

Answer 207

ulcers

Question 208

3 y.o with swelling all over body. Denies abodminal pain, hematuria or dysuria. Periorbital edema, abdominal distension with a fluid wave, 3+ pittign edema. 3+ proteinuria.

Answer 208

Minimal change disease - proteinuria - hypoalbumenia - edema - hyperlipidemia Younger than 10 Proteinuria > 3.5 grams

Question 209

Nephropathy associated iwth Hep B/ C infection

Answer 209

Membranous nephropathy

Question 210

POst-infectious glomerulonephritis characterized by

Answer 210

hematuria edema HTN decreased C3 complement elvels

Question 211

non-bloody, non-purulent chronic diarrhea Diffuse abdominal pain relieved by defecation Painful finger joints - what is it - labs - diagnostic

Answer 211

Crohns disease Elevated ESR and CRP Anemia of chronic infxn (normocytic w/ iron def and elevated ferritin) Diagnostic: colonoscopy with ileoscopy and biopsy SKip lesions Cobblestoning Noncaseating granulomas

Question 212

Anti-cyclic citrullinated peptide (antiCCP)

Answer 212

Rheumatoid arthritis

Question 213

Pain between the toes in the interdigital space, numbness and paresthesias radiating to the toes proximal to the pain Exacerbated by tight shoe wear

Answer 213

Morton's neuroma Mulder's sign: palpable painful click along with reproducible symptoms

Question 214

Sesamoid fracture

Answer 214

First toe pain Due to overuse (runners) Swelling and tenderness along the medial aspect on the plantar surface of the first metatarsophalangeal joint Pain worse with dorsiflexion

Question 215

Granuloma annulare

Answer 215

benign skin lesion that is asymptomatic and presents iwth 1-2 mm flesh colored and/or erythematous papules that coalesce to form 5 cm annular appearing plaque. Ankles, feet, hands, fingers and extensors of arms and legs Center of lesion can be hyperpigmented and scaling absent "Looks like like ring worm"

Question 216

Violacous, shiny, polygonal papules of varying sizes on flexural surfaces of limbs. Fine white reticular scales on papules

Answer 216

Lichen planus

Question 217

Mammogram screening

Answer 217

50-74 every 2 years

Question 218

Colorectal cancer screening

Answer 218

50-75 One of the options: Fecal occult blood testing annually Sigmoidoscopy every 5 years Colonoscopy every 10 years

Question 219

Screening for 75 y.o female

Answer 219

Alcohol misuse and counseling

Question 220

Hold up infant hand

Answer 220

4 months

Question 221

Sit or crawl at age

Answer 221

6 months

Question 222

Pertussis diagnosis tx

Answer 222

PCR Macrolides (azithromycin)

Question 223

Rheumatoid arthritis joints

Answer 223

PIP, MCP

Question 224

Recurrent Hematuria after upper respiratory infection. Negative for strep

Answer 224

IgA nephropathy Occurs are upper respiratory infection o ATHLETIC EXERTION Mild flank pain Low grade fever Associated with cirrhosis, celiac disease, and HIV Renal biopsy with immunofluorescence reveal the presence of IgA deposit

Question 225

Acute onset renal failure with UA revealing nephritic sediment (red blood cell casts, dysmorphic red blood cells, white blood cells), mild to moderate proteinuria Also have SOB, cough and hemoptysis

Answer 225

Good pasture syndrome

Question 226

Palpable purpura on skin, abdominal pain, arthralgias, and renal insufficiency with hematuria. No proteinuria Biopsy: granulocytes within the walls of the small arterioles and venules

Answer 226

Henoch-Schonlein purpura IgA vasculitis

Question 227

63 y.o alcoholic with nausea, vomiting and diffuse abdominal pain. Has had symptoms before. Metabolic acidosis, elevated serum beta-hydroxybutyrate and urine ketones. Glucose normal adminster what

Answer 227

Thiamine and dextrose Alcoholic ketoacidosis Possible Wernicke encephalopathy Acidosis will resolved self after thiamine, dextrose and saline Thiamine needed to bring pyruvate to TCA cycle (thiamine deficient leads to shift in pyruvate towards production of lactic acid instead of into TCA cycle)

Question 228

Pregnant female with pre-existing hypothyroidism

Answer 228

increase by 30%

Question 229

Urease breath test

Answer 229

H. pylori

Question 230

Antiparietal ab

Answer 230

autoimmune gastritis

Question 231

IgA nephropathy

Answer 231

painless gross hematuria that occurs simultaneously with infection

Question 232

``` Sore throat 2 weeks ago Hematuria Red blood cell casts Proteinuria Low complement C3 level ```

Answer 232

Post-infectious glomerulonephritis

Question 233

young patient with low back pain gradual progression. Space narrowing and sclerosis around sacroiliac joint Also develop Labs

Answer 233

Ankylosing spondylitis Calcaneal tendon enthesitis Plantar fasciitis ESR and CRP elevated HLA-B21 genotype

Question 234

Complication of Crohns disease

Answer 234

B12 deficiency Macrocytic anemia with a decrease in serum cobalamin (vit B12)

Question 235

Vaccination during pregnancy

Answer 235

Tdap 27-36 weeks [Dont give] - MMR - Zoster - Varicella - live flu

Question 236

Lytic lesions and cortical thickening of fibula and tibia

Answer 236

Pagets disease Elevated alkaline phosphatase

Question 237

Tx acute exacerbation of asthma

Answer 237

Oxygen Inhaled beta 2 agonist Oral corticosteriods

Question 238

Intermittent asthma

Answer 238

Symptoms less than or equal 2 days per week Nighttime awakenings less than 2 x per month Beta agonist 2 x per week

Question 239

Mild persistent asthma

Answer 239

symptoms greater than 2 days per week Nighttime awakening 3-4x per month inhaler > 2 x per week

Question 240

Moderate persistent asthma

Answer 240

Daily symptoms Nighttime awakenings > 1 per week Daily use of inhaler

Question 241

Severe persistent asthma

Answer 241

Symptoms throughout day Nightly awakenings Inhaler several times per day

Question 242

Diarrhea Dementia Dermatitis

Answer 242

Niacin deficiency

Question 243

CHARGE syndrome

Answer 243

CHD7 mutations Coloboma (defects in iris) Heart anomalies Choanal atresia (NG tube cant pass through nasal passage) Restricted growth Genital hypoplasia Ear anomalis (small low set) and deafness Polyhydramnios Difficulties feeding

Question 244

Pregnant uncontrolled DM complication in infant

Answer 244

horseshoe kidney

Question 245

Patient with hyperthyroid, improve symptoms most rapidly?

Answer 245

Propranolol

Question 246

Female Easy bruising Heavy bleeding Elevated thromboplastin time

Answer 246

Von Willebrand disease (vWD) AD Deficiency of factor VIII- related antigen Defect in clot formation and coagulation cascade

Question 247

Isolated defect in clot formation

Answer 247

Thrombocytopenia Increased bleeding time low platelet levels PT PTT normal

Question 248

Isolated defect in coagulation cascade

Answer 248

Hemophilia A / B A: deficiency of factor VIII B: def factor IX Prolonged PTT Bleeding time and PT normal

Question 249

Hypercalcemia medication

Answer 249

Thiazide diruetics (Hydrochlorothiazide) Lithium

Question 250

Loop diuretics and calcium

Answer 250

Dump calcium

Question 251

Elevated calcium Elevated PTH Tx

Answer 251

Primary hyperparathyroidism Surgicial removal of one or more parathyroid glands

Question 252

Fenofibrate AE

Answer 252

Hepatotoxicity Can enhance myalgias when combined with statin

Question 253

Hyperpigmented, thickened, scaly, edematous skin lesion

Answer 253

Lichen simplex chronicus

Question 254

Christmas tree rash | salmon colored on trunk w/ central clearing

Answer 254

Pityriasis rosea

Question 255

Sore throat with enlarged tonsils bacteria

Answer 255

Streptococcus pyogenes

Question 256

Biopsy technique for raised, superficial non-pigmented lesion

Answer 256

Shave biopsy For nonmelanoma skin cancer

Question 257

Curettage and electrodessication used when

Answer 257

Treatment not diagnostic method in low risk patients younger than 60 with known diagnosis of a primary babsal cell carcinoma located in an area that is without hair and doesnt require depth of removal

Question 258

Excisional biopsy use when

Answer 258

Including Mohs surgery First line tx for SCC and basal cell carcinoma

Question 259

Ingestion of clostridial spores

Answer 259

causes botulism syndrome in infants under the age of 8 months Honey to babies Adults and older children not effected

Question 260

Riluzole

Answer 260

medication for ALS

Question 261

Dantrolene

Answer 261

muscle relaxer Used in ALS to relieve spasticity Can cause weakness, dizziness and sedation

Question 262

Tx Temporal arteritis

Answer 262

First line prednisone IV methylprednisolone (if visual disturbances)

Question 263

Dihydroergotamine

Answer 263

ergot alkaloid medication used for abortive tx inpatients presenting to ER with a severe migraine not resonding to other migraine medication

Question 264

Patients with diabetes should get what screen

Answer 264

urinary spot microalbumin/creatinine ratio if >30 ug/mg then should be started on ACE (-pril) or angiotensin receptor blocker (-sartan) to prevent hyperfiltration injury

Question 265

Rapidly gowing, solitary, friable, bright red, papule that bleeds from little trauma Trauma precedes lesion

Answer 265

Pyogenic granuloma

Question 266

Painful, small blue-red, blanchable, vascular papules or nodules in deep dermis on distal extremities (palm, wrist, forearm, foot, under nails)

Answer 266

Glomus tumors

Question 267

Verruca vulgaris

Answer 267

non-genital warts caused by HPV

Question 268

Thyroid nodule Low TSH Test to get

Answer 268

technetium-99m or radioactive iodine

Question 269

3 y.o with bruising. Sick a month ago. Low platelet count. Normal hemoglobin. Normal blood times

Answer 269

Immune thrombocytopenia Ab to platelet membrane antigens results in increased platelet clearance by spleen and thrombocytopenia 2-5 y.o following viral infection or young women 20-40s Resolves 3-6 months

Question 270

``` Mucocutaneous bleeding Fever Fatigue Weight loss Bone pian Lymphadenopathy Hepatosplenomegaly ``` Anemia reduced or elevated white count, anemia

Answer 270

Acute lymphocytic leukemia

Question 271

Thrombocytopenia Hemolytic anemia Acute kidney injury Child < 5 with prodromal episode of abdominal pain and bloody diarrhea followed by pallor, fatigue, easy bruising and hematuria

Answer 271

Hemolytic uremic syndrome

Question 272

``` Thrombocytopenia Hemolytic anemia Renal disease Fever Neurologic changes ```

Answer 272

Thrombotic thrombocytopenic purpura

Question 273

Xray rules for angkel

Answer 273

Unable to bear weight for 4 steps Tenderness along distal 6 cm of the tibia or fibula Tenderness over the posterior medial or lateral malleolus Tenderness at he base of the 5th metatarsal Tenderness of navicular bone

Question 274

Streptococcal infection diagnosis

Answer 274

positive rapid antigen detection test for group A streptococcus Positive throat culture Elevated anti-streptolysin O (ASO) Ab titer

Question 275

Clostridium difficile tx

Answer 275

vancomycin | not metronidazole any more

Question 276

Tx traveler diarrhea

Answer 276

Ciprofloxacin

Question 277

Tx shigella fever bloody diarrhea

Answer 277

Azithromycin (marcolide)

Question 278

Tx recurrent C. difficile

Answer 278

Rifaximin

Question 279

reactive non stress test

Answer 279

presence of 2 accelerations within 20 minutes with or without fetal movement acceleration= increase by 15 bpm for a duration of 15-120 seconds

Question 280

Diagnose DM

Answer 280

1) Fasting blood glucose of greater than or equal to 126 on two separate occasions 2) A1C >= 6.5 on two separate occasions 3) 2 hr post oral glucose tolerance test >= 200 4) Random glucose >= 200 with DM symptoms

Question 281

Recurrent nose bleeds Telangiectasias Visceral lesions First degree releatiev

Answer 281

Hereditary hemorrhagic telangiectasia

Question 282

Thormbocytopenia

Answer 282

Associated iwth nose bleeds Platelet count will be low Peripheral smear will show giant platelets

Question 283

Low pitched systolic ejection murmur that is described as "vibratory" or "musical" and improves with valsalva and loud when supine

Answer 283

Still's murmur Innocent murmur of childhood

Question 284

``` Maternal fever Tachycardia Uterine tenderness Fetal tachycardia Abdominal pain Foul-smelling fluid in underwear No costovertebral angle tenderness 2 cm dilated, 10% effacement, microscopic analysis of fluid reveals delicate ferning pattern ``` A. Bacterial vaginosis B. Chorioamnionitis C. Placental abruption D. Pyelonephritis

Answer 284

Chorioamnionitis -Premature rupture of membranes is crucial risk factor

Question 285

Presence of amniotic fluid is confirmed on examination with

Answer 285

nitrazine testing pH of the amniotic fluid is alkaline between 7.0 to 7.3. when compared to vaginal fluid acidity of 3.8 to 4.2 and/or fern testing- presence of delicate ferning pattern on microscopic analysis

Question 286

Vaginal discharge "fishy" | clue cells

Answer 286

Bacterial vaginosis

Question 287

Brief, arrhythmic, involuntary, bilateral upper extremity myoclonic jerks without loss of consciousness - Triad - Age - EEG

Answer 287

Juvenile myolconic epilepsy Presents in adolescence Myoclonic jerks Generalized tonic-clonic seizures Absence seizures EEG: rapid, generalized, irregular spike and polyspike waves No fever, trauma, infection

Question 288

Febrile seizures

Answer 288

6 months - 5 years Generalized tonic-clonic activity Fever Postictal confusion Fatigue Preceding upper respiratory infection or recent immunization with DTP/ MMR 15 min non-recurrent TX: acetaminophen for fever

Question 289

Lennox-Gastaut syndrome

Answer 289

presents around age 2 Multiple types of seizures along with mental retardation, developmental regression and abnormal EEG EEG: paroxysms of fast activity and slow spike and wave discharges TX valproic acid/ clonazepam

Question 290

Panayiotopouos syndrome

Answer 290

benign occipital epilepsy Focal seizure disorder 3-6 y.o Occipital (visual) and autonomic disturbances (vomiting), unilateral head/eye deviation, loss of awareness, heiclonic seizures and migranous headahces 30 min Eyes closed EEG occipital andposterior temporal spikes Tx: carbamazepine

Question 291

Supplement for breastfed infants and for formula fed infants who do not consume at least 1 liter formula per day

Answer 291

Vit D

Question 292

Iron supplement in infant

Answer 292

exclusive breastfeeding pst 4-6 months

Question 293

Tx vulvovaginal candidiasis in nonpregnant female

Answer 293

oral fluconazole

Question 294

Thick, whitish discharge. No odor. pH 4. | microscopic with KOH= pseudohyphae or budding yeast

Answer 294

Vulvovaginal candidiasis

Question 295

pH > 4.5, clue cells Odor Tx

Answer 295

bacterial vaginosis Metronidzole

Question 296

pH ? 4.5, postcoital bleeding, dysuria, grene or yellow discharge, frothy, odor. Motile flagellated protozoa tx

Answer 296

Trichomoniasis Metronidazole

Question 297

Benign skin lesion that is flat pink or salmon colored, blanching skin patch between eyebrows or on nape of neck

Answer 297

Nevus simplex

Question 298

Port wine stain, asymmetric, unilateral, flat, dark red to purple patch on face.

Answer 298

Nevus flammeus Over concentration of capillaries located around the V1 branch of the trigeminal nerve. Can be associated iwth sturge weber syndrome (causes angiomas in brain) - port wine stain - glaucoma - seizures

Question 299

Symmetric mottling of the skin that involves the trunk and extremities

Answer 299

Cutis marmorata Reassurance no tx

Question 300

Small, erythematous papules and vesicles that occur on cover skin.

Answer 300

Miliaria rubra due to sweat gland obstruction

Question 301

Type 2 second degree av block due to

Answer 301

disturbance in conduction distal to AV node, most often in purkinje system

Question 302

Delayed conduction between SA and AV node

Answer 302

First degree AV block

Question 303

Accessory route of conduction around the AV node

Answer 303

Atrioventricular reentrant tachycardia Palpitations Regular narrow complex tachycardia on ECG with inverted P waves

Question 304

Complete block of conduction between SA and AV nodes

Answer 304

Third degree AV block Ventricles generating an escape rhythm via its own accessory pace maker

Question 305

Painful swelling joints. pulmonary embolism. DVT what abnormalitity

Answer 305

Factor V Leiden Defective form of Factor V taht is resistant to degradation by protein C Patients prone to clotting

Question 306

PT measures

Answer 306

extrinisc pathway Factor VII

Question 307

PTT measures

Answer 307

Intrinsic pathway | TENET XII, XI, IX, VIII, X

Question 308

Bleeding into joints, epistaxis, prolonged post-op bleeding

Answer 308

Def Factor VIII or Factor IX Hemophilia A/B X linked

Question 309

Hemoglobin A1C measures Falsely lower by (6) Elevated by (

Answer 309

measurement of glycoslyated hemoglobin Average blood glucose for past 3-4 months Lower - sickle cell - acute blood loss - hemolytic anemia - erythropoietin therapy - chronic renal failure - b12, iron, folate tx Elevate - anemia due to B12 def - chronic renal failure w/ elevated concentration urea - AA, hispanic, asain descent

Question 310

Third degree block EEG

Answer 310

Wide QRS Regular P-P interval no conducted P waves

Question 311

Narrow QRS irregularly irregular P-P interval | some conducted P waves

Answer 311

Atrial fibrillation

Question 312

Wide QRS Regular P-P interval no conducted P waves

Answer 312

Third degree AV block

Question 313

narrow QRS regular P-P interval SLowed conduction of P waves

Answer 313

First degree AV block

Question 314

Narrow QRS regular irregular P-P interval some conducted P waves

Answer 314

atrial flutter

Question 315

Wide qrs regular p-p interval some conducted P waves

Answer 315

Mobitz II second degree heart block

Question 316

Prediabetes diagnosis

Answer 316

fasting glucose 100-125 A1c 5.7-6.4%

Question 317

Tx acute bacterial rhinosinusitis

Answer 317

Amoxicillin-clavulanate Allergy: (children) cephalosporin Allergy (adult): doxy

Question 318

4 y.o AA fatigue and yellowing eye. Dysuria. UTI and antibiotic prior to.

Answer 318

G6PD deficiency Jaundice, pallor, dark urine and back pain 2-4 days after oxidative stress from certain medications (sulfas and anti-malarias) or infections Heinz bodies (oxidized hemoglobin) or bite cells on smear

Question 319

Hereditary spheocytosis

Answer 319

Splenomegaly | rigid RBC that are cleared by spleen

Question 320

Sore throat, fever, fatigue, bilateral posterior cervical lymphadenopathy, tonsillar enlargement, splenomegaly, palatal petechiae Tx w/ antibiotics got worse - What is it - Diagnosis

Answer 320

Infectious mononucleosis Heterophile antibody test [ if negative then CBC then EBV] [if positive, perform rapid strep test]

Question 321

Projectile vomiting Mobile mass 3 week old infant Imaging?

Answer 321

Pyloric stenosis ultrasound

Question 322

Double bubble on ultrasound

Answer 322

Annular pancreas Associated with down syndrome, tacheoesophageal fistula, imperforate anus and hirschsprung disease

Question 323

Bilious vomiting within hours of birth. Double bubble on ultrasound -also seen

Answer 323

Duodenal atesia Scaphoid abdomen (sunken anterior abodminal wall)

Question 324

Nonbilious vomiting that turns bilious Currant jelly stool Palpable sausage-shaped mass "Target sign""

Answer 324

Intussusception

Question 325

Infant distended abdomen, tenderness, and rigidity on palpation, currant jelly stool, lethargy, fever, tachycardia, hypotension. Birds beak

Answer 325

Malrotation

Question 326

Growth on knee, painless, increased insize over 3 months. Rough coalescing, flesh colored hyperkeratotic papules. No bleeding Scraping revelas several thrombosed capillaries

Answer 326

Warts (verruca vulgaris) HPV

Question 327

Flesh colored dome shpaed papules with central umbilication

Answer 327

Molluscumc ontagiosum

Question 328

Slapped cheek

Answer 328

Parvovirus B19

Question 329

Screening at initial visit for pregnancy (6)

Answer 329

Cervical cancer screening Pap smear Blood group Rh status Rubella status STI screening including HIV, syphilis, gonorrhea, and chlamydia, hep B

Question 330

DM testing in pregnancy when

Answer 330

24-28 weeks

Question 331

Group B strep screening in pregnancy when

Answer 331

36 weeks

Question 332

Elevated Creatinine and BUN= NSAID use

Answer 332

kidney injury via decreased synthesis of prostaglandins

Question 333

Tx herpes w/ pregnancy wanting to give vaginal birth

Answer 333

Treat any recurrent herpes episode with oral acyclovir and begin daily oral acyclovir therapy after 36 weeks gestation even if no episodes develop

Question 334

Blood transufion of anemia

Answer 334

Only if severe hemoglobin less than 8

Question 335

Tx acute onset of excruciating pain with external hemorrhoids within 72 hours

Answer 335

Surgical excision

Question 336

Rubber band ligation tx

Answer 336

appropriate non-surgical tx for internal hemorrhoids

Question 337

Hemorrhoids conservative tx

Answer 337

Fiber supplementation Stool softeners laxatives topical analgesics

Question 338

Bone pain Low hemoglobin Low hematocrit

Answer 338

Multiple myeloma ``` CRAB hyperCalcemia Renal failure (IgG light chains in urine) Anemia Bone lesions ```

Question 339

Metastatic cancer spread to bone

Answer 339

Late stages of prostate cancer Characterized by elevated alkaline phosphatase

Question 340

Solitary painless well circumscribed, rubbery, mobile breast mass

Answer 340

Fibroadenomas

Question 341

Painless breast lump found below the areola with bloody nipple discharge Breast pain Retraction Enlargement Itchy nipple

Answer 341

Infiltrating ductal carcinoma

Question 342

Drug that causes increase in baseline fetal heart rate and incidence of fetal tachycardia

Answer 342

Terbutaline (beta-adrenergic agonist)

Question 343

Betamethasone on fetal heart rate

Answer 343

Decrease in fetal heart variability and abolishment of diurnal fetal rhythms

Question 344

Opioids/ morphine on fetus

Answer 344

Decrease variability | Decrease frequency of accelerations

Question 345

When should a baby start solid baby food

Answer 345

after 4-6 months of age

Question 346

Child should begin whole cows milk when

Answer 346

after 1 year of age

Question 347

Pregnant patients with preeclampsia without severe features should deliver when

Answer 347

37 weeks

Question 348

Preeclampsia with severe features

Answer 348

Blood pressure greater than 160/110 Proteinuria higher than 5 g End organ damage Persistent frontal headache, visual disturbances, acute mental status changes, RUQ pain, peripheral edema, and oliguria

Question 349

Elevated unconjugated hyperbilirubinemia without underlying cause

Answer 349

Gilbert Show at times of stress

Question 350

Crigler-Najjar syndrome

Answer 350

unconjugated hyperbilirubinemia Complete absence of bilirubin UGT enzymatic activity First days of life

Question 351

``` elevated conjugated bilirubin Fatigue pururitus RUQ pain middle aged female hepatosplenomegaly hyperpigmentation xanthelasma (yellow deposition of fat near eyelid) ``` antimitochondrial ab

Answer 351

Primary biliary cirrhosis autoimmune destruction of the hepatic biliary system

Question 352

Wilson disease

Answer 352

cirrhosis common initial presenation Ascites, jaundice, spider nevi, palmar erytehma, digital clubbing, prominent abdominal veins, caput medusae, hematemesis mental status changes, seizures Decreased serum ceruloplasmin, increased urinary copper

Question 353

Positive whiff-amine test

Answer 353

bacterial vaginosis fishy odor when KOH added

Question 354

Rare epithelial cells covered in bacteria seen on microscopy

Answer 354

Clue cells bacterial vaginosis

Question 355

Medication that interact w/ phosphodiesterase type 5 inhibitors (sildenafil, tadalafil, vardenafil)

Answer 355

antiretroviral medications increase the levels of PDE-5 inhibitors

Question 356

Thyroid mass that grows rapid in a year. Hard painless No cervical adenopathy Diagnosis?

Answer 356

Reiter thyroiditis Surgical biopsy [Other thyroid nodules can do FNA]

Question 357

``` Neutropenia Dyspnea Fever Cough Halo sign on xray Macronodule surrounded by ground-glass opacity ```

Answer 357

Aspergillosis

Question 358

Sarcoidosis what is seen

Answer 358

cough, dyspnea, hemoptysis, night sweats, WL Hypercalcemia African americans Bilateral hilar adenopathy Non-caseating granulomatous infiltration

Question 359

Most common genetic abnormality that is aborted

Answer 359

autosomal trisomy

Question 360

Child with repeat proteinuria positive

Answer 360

Orthostatic proteinuria Characterized by proteinuria while in the upright position which resolves when supine Diagnose with morning urine protein-to-creatinine ratio

Question 361

Serum antinuclear antibody

Answer 361

Lupus

Question 362

GBS positive in first baby

Answer 362

Should not be test again with next babies just get GBS prophylaxis

Question 363

Pneumonia can be prevented by

Answer 363

Getting flu vaccine Succumb to bacterial infection when weakened by flu virus

Question 364

Most common cause of secondary htn (htn that is no reduced by 3 different medications) -diagnosis

Answer 364

renal artery stenosis renal arteriogram

Question 365

Secondary htn with hypokalemia and hypernatremia

Answer 365

Primary aldosteronism

Question 366

Noncaseating granulomas Clacified nodular opacities with hilar and mediastinal lymphadenitis Upper lobes

Answer 366

Beryllium

Question 367

Honey combing

Answer 367

Asbestosis

Question 368

Infant with jaundice and hyperbilirubinemia diagnosis?

Answer 368

Hemolytic disease of newborn Due to IgG ab from mother Direct Coombs test

Question 369

Constellation of benign and malignant tumors

Answer 369

Von Hippel Lindau disease AD Mutations inthe VHL gene

Question 370

Hematuria Flank pain palpable abdominal or flank mass

Answer 370

Renal cell carcinoma VHL

Question 371

p53 mutation

Answer 371

AD Li-fraumeni syndrome Several malignancies throughout life time Sarcomas Breast cancer Brain tumors Adrenocortical carcinomas

Question 372

Neurofibromatosis type 1

Answer 372

cafe au lait sots neurofibromas RAS protein

Question 373

Osteomyelitis starts with

Answer 373

infection of surround soft tissues Staphylococcus aureus

Question 374

PCOS causes what

Answer 374

dysregulated intrinsic ovarian androgen production

Question 375

steps in asthma

Answer 375

1. SABA as needed 2. low-dose inhaled glucocorticoids 3. medium-dose inhaled glucocorticoids low dose inhaled glucocorticoids plus LABA 4. medium dose inhaled glucocorticoids plus LABA 5. High dose Consider omalizumab

Question 376

``` Alcoholic Low hemoglobin Low heamtocrit Siderocytes Basophilic stipping positive for iron ``` -cause?

Answer 376

Abnormality in heme synthesis Excessive alcohol is most common cause of sideroblastic anemia Heme synthesis is disrupted causing iron to accumulate in mitochondria causes the bone marrow to produce ringed sideroblasts

Question 377

Defect in hemoglobin structure - on blood smear

Answer 377

Thalassemia poikilocytosis (irregular shaped) target cells (bull's eye) Schistocytes

Question 378

watery/ Bloody diarrhea Ate chicken Motile, spiral, gram-negative rods

Answer 378

Campylobacter jejuni Poulty and unpasteurized milk

Question 379

Anaerobic gram negative bacillus

Answer 379

EHEC E. coli bloody diarrhea beef

Question 380

Gram negative motile bacilli watery stool septic arthritis

Answer 380

salmonella

Question 381

non-motile, glucose fermenting | gram negative rod

Answer 381

Shigella bloody diarrhea

Question 382

``` gram negative bacillus bloody diarrhea pork, milk, water, tofu erythema nodosum appendicitis ```

Answer 382

yersinia enterocolitica

Question 383

Infant not passing meconium cystic fibrosis

Answer 383

Meconium ileus

Question 384

Hirschsprung disease

Answer 384

functional obstruction due to developmental abnormality of enteric nervous system Absence of ganglion cells in distal colon Not passing meconium Negative for stool in rectal vault

Question 385

``` Preterm 2-3 weeks old formula fed abdominal distention bloody stool penumatosis intestinalis (gas/air in bowel wall) ```

Answer 385

Necrotizing enterocolitis

Question 386

Bilateral proximal muscle aches (shoulders and hips) Morning stiffness over an hour Giant cell arteritis in past

Answer 386

Polymyalgia rheumatica (PMR) elevated IL-5, CRP, ESR

Question 387

Anti-Mi-2 or anti-jo-1 ab

Answer 387

dermatomyosistis

Question 388

Progressive symmetrical proximal muscle weakness (not pain)

Answer 388

Polymyositis Anti-Mi-2 or anti-jo-1 ab

Question 389

Sand paper spot on skin, redder,

Answer 389

AK cryotherapy

Question 390

Lower triglycerides

Answer 390

Fibrates (fenofibrate gemfibrozil)

Question 391

Cause of anemia in renal failure patients

Answer 391

Suppression of erythropoietin

Question 392

Blood loss anemia

Answer 392

Microcytic MCV <80

Question 393

Hemolysis causes increase in

Answer 393

serum bilirubin due to degradation of heme as RBC are destroyed Haptoglobin levels would also be expected to be low Haptoglobin binds to hemoglobin and levels decrease as hemoglobin is released form destroyed RBC

Question 394

Iron deficiency anemia

Answer 394

Microcytic MCV <80

Question 395

Inhaled chlorine causes what - predominant cell type

Answer 395

Reactive airway dysfunction syndrome (RADS) or irritant-induced asthma Last more than 3 months Caused by chlorine, aerosol and smoke Positive methacholine challenge Improved with bronchodilatory therapy Airway inflammation from RADS (not atopy) Presence of neutrophils

Question 396

Predominant cell type in asthma

Answer 396

eosinophil

Question 397

Predominant cell type in allergic rxn

Answer 397

basophil

Question 398

Complication of bronchodilator therapy

Answer 398

Transient arterial oxygen desaturation Increase in ventilation-perfusion (V/Q) mismatch Characterized by dyspnea, wheezing, hypoxia, tachycardia, and tachypnea

Question 399

``` Dark urine Tired Jaundice with scleral icterus Low hemoglobin Low hematocrit Normal MCV High reticulocyte High Lactate dehydrogenase High total bilirubin ``` Bite cells Heinz bodies

Answer 399

G6PD deficiency Symptoms to hemolytic anemia (jaundice, scleral icterus, anemia) Common precipitating factor is ingestion of fava beans, acute infection, oxidant drugs (dapsone, sulfonamides, primaquine, nitrofurantoin)

Question 400

Avoid high altitudes

Answer 400

recommended to prevent sickle cell crisis

Question 401

Ascites, fever, chills, jaundice and abdominal pain, tenderness and fluid wave on examination Fluid analysis reveals a neutrophil count > 250, lactate > 25 and pH less than 7.35, total protein less than 1 gram/dL Tx

Answer 401

Spontaneous bacterial peritonitis (SBP) Bacterial infection of peritoneal cavity Empiric antibiotics with third generation cephalosporin (cefotaxime) or aminoglycoside (gentamicin) with ampicillin Cefotaxime preferred due to risk of nephrotoxicity with aminoglycoside

Question 402

Total protein less than 2.5

Answer 402

Transudate

Question 403

Total protein > 2.5

Answer 403

Exudate

Question 404

What should be given with large volume paraecentesis

Answer 404

Albumin

Question 405

Biliary atresia

Answer 405

More common cause of cholestasis in newborn 1 wk to 8 wks ``` Jaundice Pale colored stool Dark urine Hyperbilirubinemia Elevated direct bilirubin ```

Question 406

1 wk to 8 wks ``` Jaundice Pale colored stool Dark urine Hyperbilirubinemia Elevated direct bilirubin ``` No mass

Answer 406

Biliary atresia

Question 407

Pale colored stool Direct hyperbilirubinemia Hepatomegaly Palpable mass in RUQ

Answer 407

Choledochal cyst Bilirubin conjugated and excreted but unable to get into bowel

Question 408

Positive coombs test

Answer 408

Hemolytic disease of the newborn

Question 409

Breast milk jaundice

Answer 409

Beta glucouronidase in breast milk removed glucuronic group that was added during conjugation Leading to further accumulation and indirect hyperbilirubinemia

Question 410

Cold, constipated, lethargic, yellow baby with a large tongue and poor feeding.

Answer 410

Congenital hypothyroidism Elevated TSH

Question 411

26 with history of chronic htn goes in to labor. Boggy uterus and bleeding. What intervention is contraindicated ``` Carboprost Methylergonovine Misoprostol Oxytocin Uterine fundal massage ```

Answer 411

Methylergonovine Contraindicated in patient with htn Acts directly on the smooth muscle of the uterus and increases the tone, rate and amplitude of rhythmic contractions

Question 412

Carboprost should be avoided in

Answer 412

prostaglandin analogue Uterotonic agent Dont use in patient with asthma

Question 413

Misoprostol

Answer 413

synthetic prostaglandin binds myometrial cells causing contraction Uterotonic agent Use in post partum hemorrhage

Question 414

Oxytocin

Answer 414

Use in post partum hemorrhage Naturally made by pituitary gland

Question 415

Ulcer with H. pylori tx

Answer 415

Omeprazole (or lansoproazole) or an antidiarrheal (bismuth subsalicylate) Plus 2 antibiotics Amoxicillin Clarithromycin

Question 416

Helix shaped, gram negative bacterium test

Answer 416

H. pylori Fecal antigen test Carbon 13 urea breath test

Question 417

Infant test positive on Barlow and Ortolani tests

Answer 417

Developmental dysplasia of the hip or congenital dislocation of the hip Orthopedic referral

Question 418

Infant hip flexed at 90 degrees and adduction of the leg with posterior pressure directed at the knee

Answer 418

Barlow test Positive if there is a clunking sensation or a sensation of movement is felt as the femoral head exits the acetabulum posteriorly

Question 419

Gripping the infant's femur, flexing the leg at the hip at 90 degrees and applying anterior pressure on the thigh towards the acetabulum

Answer 419

Ortolani test Positive if a clunking sensation is felt

Question 420

Positive barlow maneuver and negative ortolani what next

Answer 420

Observation and repeat exam

Question 421

What confirms the diagnosis of celiac disease

Answer 421

Gastroduodenoscopy with biopsy Upper endoscopy and duodenal biopsy demonstrating enterocyte villous atrophy is diagnostic

Question 422

``` Chest pain Tachycardia Dyspnea Hemoptysis and recent travel ```

Answer 422

Pulmonary embolism

Question 423

Pulmonary embolism on EKG

Answer 423

Sinus tachycardia Sinus rhythm with ventricular rate of 132 beats per minute

Question 424

ECG with diffuse ST segment elevations and PR interval depresion without T wave inversions

Answer 424

Pericarditis

Question 425

Greater tahn 1 mm ST elevations in leads II, III, aVF

Answer 425

Inferior wall MI

Question 426

S-waves in lead I, Q waves in lead III, and inverted T waves in lead III

Answer 426

S1Q3T3 Pulmonary embolism [Sinus tachycardia: Sinus rhythm with ventricular rate of 132 beats per minute more common for PE]

Question 427

Testicular torsion caused by

Answer 427

congenital malformation of the processus vaginalis leading to inadequate fixation of the testicle to the tunica vaginalis

Question 428

Ascending bacterial infection from the prostatic urethra

Answer 428

Epididymitis

Question 429

Dilation of the pampiniform venous plexus

Answer 429

Varicoceles Mass and heaviness within the left side of the scrotum that is associated with a dull, achy pain. " bag of warms"

Question 430

Male with low grade fever, headaches and malaise followed by parotitis then gens pain and swelling and edema of scrotum

Answer 430

Mumps --> systemic viral infection --> epididymoorchitis Inflammation of the testicle and epididymis

Question 431

Chemotherapy to treat HER2/neu positive breast cancer

Answer 431

Trastuzumab

Question 432

Clomiphene

Answer 432

selective estrogen receptor modulator that acts to inhibit hypothalamic estrogen receptor which blocks estrogen negative feedback on GnRH GnRH persist and instigate the release of FSH and LH Use with infertile female with PCOS

Question 433

Raloxifene

Answer 433

selective estrogen receptor modulator taht acts to regulate osteoclast and osteoblast activity Tx osteoporosis Only use if failed first line therapy bisphosphonates (-dronate) Can also be used to tx estrogen receptor and progesterone receptor positive breast cancer Less likely to potentiate endometrial cancer

Question 434

Rituximab

Answer 434

monoclonalab against CD20 found on B cells. Tx autoimmune disorders (rheumatoid arthritis, polyangiitis with granulomatosis) and B cell lymphomas

Question 435

Tamoxifen

Answer 435

selective estrogen receptor modulator used in tx estrogen receptor and progesterone receptor positive breast cancer CI in patients with endometrial cancer

Question 436

History of abdominal trauma in pregnany is most classically associated with what complication

Answer 436

Placental abruption

Question 437

Gestational diabetes in pregnancy is most associated with what complication

Answer 437

Shoulder dystocia

Question 438

Placental hypoperfusion is most classically associated with what complication

Answer 438

Preeclampsia

Question 439

Vaginal coloinization w/ group B streptococcus is most classically associated with what complication

Answer 439

Chorioamnionitis ``` Maternal fever 100.4 Maternal tachycardia (>100) Fetal tachycardia (>160) Uterine tenderness Foul smelling amniotic fluid ```

Question 440

``` 13 y.o recent cold yellow eyes dark urine fatigue low hemoglobin High reticulocyte count ``` Spherocytes Coombs test positive

Answer 440

Autoimmune hemolytic anemia Autoantibodies to erythrocytes leading to premature destruction RBC production increased in bone marrow to compensate= increased reticulocytes Can occur secondary to infection, malignancy, lupus

Question 441

Anemia Elevated reticulocyte count Spherocytes Negative coombs

Answer 441

Hereditary spherocytosis

Question 442

Bell's palsy type of nerve palsy

Answer 442

Peripehral facial nerve palsy Lower motor neuron of cranial nerve VII Unilateral complete hemi-facial paralysis (includes forehead)

Question 443

Central facial nerve palsy

Answer 443

Dysfunction of the upper motor neuron of cranial nerve VII Paralysis of the lower face with forehead sparing

Question 444

Annual lung cancer screening

Answer 444

patients 55-80 who have 30 pack year Low dose CT

Question 445

Sickle cell disease at risk for

Answer 445

encapsulated organisms Streptococcus pneumoniae Haemophilus influenzae Neisseria meningitidis Need pneumococcal vaccination SHiNE SKiS ``` Strep pneumoniae Haemophilus influ B Neisseria meningitidis Ecoli Salmonella Klebsiella Streptococcus agalactiae ```

Question 446

Chronic management of sickle cell disease

Answer 446

Annual screening for retinopathy and folic acid supplementation Pneumococcal vaccination

Question 447

Itchy rash Began as single round itchy red lesion on patients chest. Within 5 days a large number of smaller red oval lesions appeared. Follow natural skin lines Oval well demarcated salmon colored patch with central clearing and scaling at edges

Answer 447

Pityriasis rosea self limiting linked to upper respiratory infection and in immunosuppresed patients including pregnancy

Question 448

Chordee

Answer 448

abnormal ventral curvature of the penis accompanyed by hypospadias

Question 449

Aspiration pneumonia likely to occur when in the lung

Answer 449

Right inferior lobe

Question 450

Finding on complete blood out with chronic myelogenous leukemia (CML)

Answer 450

Basophilia

Question 451

child with acute onset fever, sore throat, difficulty swallowing, and muffled speech. Child leaning forward and hyperextended neck Drooling from mouth

Answer 451

Epiglottitis Thumb sign Haemophilus influenzae type B 3rd gen cephalosporin and MRSA coverage - ceftriaxone - vancomycin

Question 452

Edema Hypoalbuminemia Proteinuria > 3 g Diabetic

Answer 452

Diabetic glomerulonephropathy

Question 453

Diabetic glomerulonephropathy can be prevent by what medication

Answer 453

Angiotension converting enzyme (-pril) Decreases glomerular capillary pressure by inhibiting constriction of the efferent renal arteriole

Question 454

Bumetanide

Answer 454

loop diuretic

Question 455

Screenings for 65 y.o smoker

Answer 455

Abdominal US Colonoscopy Fasting lipid panel [Not PSA]

Question 456

Elevated AFP in pregnancy with non-consistent prenatal care with no ultrasound assume elevated AFP is due to

Answer 456

Multiple gestations Incorrect dating is the most common reason for elevated AFP

Question 457

10 day old iwth bilateral eye swelling, redness, crusting and watery discharge STI during first trimester

Answer 457

Chlamydia trachomatis Oral erythromycin

Question 458

Vaccine for 15 y.o

Answer 458

HPV

Question 459

MMR given when

Answer 459

12-15 months 4-6 years Booster in teens

Question 460

Facial twitching what

Answer 460

hypocalcemia

Question 461

Tx for patients on warfarin who develop lift-threatening bleeding or require surgery

Answer 461

Vitamin K and Fresh frozen plasma

Question 462

when to do lipid screening

Answer 462

men 35 or older men 20-35 or woemn 20 and older if increased risk of coronary heart disease (smoking, DM, strong family history, HTN, BMI>30)

Question 463

Diabetic patient Abdominal discomfort after meals that takes hours to dissipate N/V after meals Slowed gastric transit w/o evidence of obstruction

Answer 463

Autonomic neuropathy

Question 464

Zollinger-Ellison syndrome diagnosis

Answer 464

Gastrinoma Presents as painful duodenal ulcers, gastroesophageal reflux and diarrhea Elevated gastrin resulting in increased stomach acid production Diagnosis made by an elevated fasting serum gastrin concentration

Question 465

ECG on pericarditis

Answer 465

Diffuse ST elevations for diagnosis

Question 466

Tx pericarditis

Answer 466

Addressing underlying etiology Exercise restriction NSAIDS

Question 467

Pain in chest with activity of deep inspiration Pain with palpation of the chest

Answer 467

Costochondritis

Question 468

Fever New onset cardiac murmur Purple tender nodules on finger tips, splinter hemorrhages and non-tender nodules on palms and soles

Answer 468

Endocarditis Staphylococcus aureus Streptococcus viridans if previous damaged valves

Question 469

Aplastic crisis

Answer 469

a cell anemia Characterized by an acute reduction in bone marrow erythropoiesis followed by acute drop in hemoglobin and reticulocyte count

Question 470

Anemia of chronic ifnlammation labs

Answer 470

normocytic (early) or microcytic anemia Low reticulocyte count Low iron Elevated ferritin Low TIBC

Question 471

Wheezing and SOB. SOB not when running around. Itchy eyes and runny nose. Taken aspirin for several weeks due to sprained ankle. Fever. Lacrimation and inject conjunctiva , nasal polyps - test

Answer 471

Aspirin-exacerbated respiratory disease (AERD) Samter's triad - aspirin intolerance - nasal polyps - asthma Oral aspirin challenge

Question 472

Measurement of DLCO

Answer 472

Test of the diffusing capacity of the lungs for carbon monoxide Can help differentiate obstructive and restrictive lung disease Only inpatient Normal or high= asthma Low= emphysema, interstitial lung disease

Question 473

Acute otitis media tx

Answer 473

Oral ibuprofen < 6months: amoxicillin 6 mn -2 y.o= rapid onset, middle ear effusion or severe illness w/ fever Allergy to penicillin give azithromycin

Question 474

Chronic purulent otitis media tx

Answer 474

Topical antibiotics like aminoglycosides (neomycin), polymyxins, and fluoroquinoles (ciprofloxacin) dont give ofloxacin to children younger than 12

Question 475

Struma ovarii

Answer 475

ovarian tumor comprised of mature and functional thyroid tissue teratoma of the ovary Elevated free thyroxine CA 125 not always elevated

Question 476

Elevated alpha fetoprotein in adult female

Answer 476

tumor marker elevated in yolk sac tumors and hepatocellular carcinoma

Question 477

Elevated estradiol in female with pelvic mass

Answer 477

Granulosa cell tumors Precocious puberty

Question 478

Elevated hCG w/o pregnancy

Answer 478

Molar pregnancy --> choriocarcinoma

Question 479

History of thyroid disease, rapidly growing neck mass, cough, dysphagia, dyspnea, and neck pain

Answer 479

Anaplastic thyroid carcinoma Surgical biopsy

Question 480

``` Bilious vomiting, abdominal distention and abdominal pain Hemodynamic instability Hematochezia Difficulties feeding Decrease in bowel movements ``` Bowel sounds hyperactive No masses Test to be done

Answer 480

Intestinal malrotation Upper gastrointestinal barium contrast series Proximal duodenal dilation followed by a "bird-beak" obstruction and then a spiral or corkscrew duodenal configuration Xray will give double bubble not specific (gastric and duodenal dilation)

Question 481

Tx vulvovaginitis

Answer 481

Inflammation of vulva or vagina Avoid tight cloting and irritants including bubble baths and perfumed soaps

Question 482

Nystatin

Answer 482

tx for candidal vulvovaginitis

Question 483

PCOS at risk for

Answer 483

Endometrial cancer Lack of ovulation leads to endometrial hyperplasia

Question 484

Mutation for increased risk of ovarian cancer

Answer 484

BRCA 1/2 mutation

Question 485

Tx for acute PE

Answer 485

anticoagulation

Question 486

``` Sore throat Fever Muffled voice Trismus (inability to completely open the mouth) Deviated uvula ``` Tonsil medially displaced and swollen

Answer 486

Peritonsillar abscess Abscess occurs between the palatine tonsil and its capsule

Question 487

Exudative tonsillitis

Answer 487

Precedes peritonsillar abscess Tonsil will be swollen with exudates Tonsil will not be deviated though

Question 488

Sore throat Fever Tonsillar exudates Tender anterior cervical lymphadenopathy No cough

Answer 488

Acute pharyngitis

Question 489

Child with stiff neck and not tonsillar involvement Discrete mass and generalized swelling within th emidline

Answer 489

Retropharyngeal abscess

Question 490

12 y.o for persistent nose bleeds. Has URI three weeks ago. Petechiae Low platelet count Elevated bleeding time Normal PT Normal PTT Complete blood count normal Decreased platelets and occasional megathrombocytes

Answer 490

Immune thrombocytopenic purpura Megathrombocytes (young platelets that are larger in size) PT and PTT normal since coagualtion factors in affected

Question 491

Prolonged bleeding time | Platelet count normal

Answer 491

Glanzmann's thromboasthenia Disorder of platelet aggregation due to decrease in glycoproteins GPIIb and IIIa.

Question 492

``` Fever Anemia Thrombocytopenia Renal failure Neurologic symptoms ```

Answer 492

Thrombotic thrombocytopenic purpura

Question 493

Bleeding time increased Platelet count normal PTT prolonged (can be normal) PT normal Easy bruising Heavy bleeding Elevated thromboplastin time

Answer 493

Von Willebrand disease

Question 494

Heart problems after death of loved one Imaging

Answer 494

Takotsubo cardiomyopathy Two step echocardiogram Transient left ventricular dyskinesia and mimics ACS Returns to normal 1-4 weeks

Question 495

18 y.o multiple shoulder dislocation. Runs in the family. Visable widened scar superior to umbilicus from piercing. Mutation

Answer 495

Ehlers- Danlos Type V collagen COL5A1/ COL5A2 Skin hyperextensibility Joint laxity Tissue fragility Wide atrophic scars

Question 496

COL5A1/COL5A2

Answer 496

Ehlers danlos

Question 497

FBN1

Answer 497

Fibrillin Marfan syndrome Tall Aortic root dilation Ectopia lentis

Question 498

``` Tall Atrophic scars Translucent skin Prominent cranio-facial deformities (wide spaced eyes) cleft palate BIfid uvula ``` mutation

Answer 498

TGFBR1/TGFBR2 Loeys Dietz syndrome

Question 499

TGFBR1/TGFBR2

Answer 499

Loeys Dietz syndrome ``` Tall Atrophic scars Translucent skin Prominent cranio-facial deformities (wide spaced eyes) cleft palate BIfid uvula ```

Question 500

COL1A1/ COL1A2

Answer 500

Osteogenesis imperfecta Type I collagen

Question 501

LAR1

Answer 501

Larsen syndrome similar to EDS with frequent joint dislocations Also have abnormal craniofacial features (flattened face, depressed nasal bridge, and cleft palate)

Question 502

4 y.o ingested medication Lethargic, mildly responsive, fever, HR 160. Skin warm and dry no rash, pupils dilated, twitching of arms and legs ``` Acetaminophen Amlodipine Digoxin Imipramine propranolol ``` Involved mechanism of action Tx

Answer 502

Cholinergic inhibition TCA- imipramine ``` Mydriasis Tachycardia Hyperthermia Sedation Coma Twitching Seizure Hypotension Arrthymia Dry skin and mucous membranes ``` Ingestion recent (within 60 min) = activated charcoal Sodium bicarbonate is indicated if hypotensive, arrhythmia or QRS prolongation

Question 503

Ingestion of beta adrenergic blockade

Answer 503

-lol severe bradycardia and hypotension

Question 504

Ingestion of calcium channel inhibition

Answer 504

amlodipine diltiazem Verapamil Hypotension Severe bradycardia AV block

Question 505

Acetaminophen overdose

Answer 505

Hepatic failure Nausea/vomiting jaundice Abdominal pain Elevated liver function tests Tx Charcoal N-acetylcysteine

Question 506

Digoxin overdose tx

Answer 506

av block bradycardia Ventricular tachycardia atrial tachycardia severe hyperkalemia anti-digitalis ab

Question 507

children with multiple episodes of sudden, rapid, symmetric tonic contraction of the neck, trunk and extremities Typically occur before sleep or upon awakening Regression of psychomotor development

Answer 507

Infantile spasms Triad - spasms - hyperarrhythmia (chaotic brain waves) - mental retardation

Question 508

Petit mal epilepsy

Answer 508

Present with absence seizures

Question 509

Family history of kidney cysts | Bloody urine after running into table

Answer 509

Autosomal dominant polycystic kidney disease Renal US

Question 510

11 should be screen for

Answer 510

Obesity

Question 511

Corneal abrasions tx

Answer 511

Appear green in color Pseudomonas aeruginosa and other gram negative organisms discontinuation of contact lens use, disposal of previous lesnses, avoidance of eye patching, use of anti-pseudomonal ophthalmic antibiotic (fluroquinolone or aminoglycoside) ciprofloxacin if not contact lens wearer then polymyxin B/ trimethoprim solution

Question 512

Single most effective public health measure shown to decrease the prevalence of dental caries

Answer 512

Fluoride in public water

Question 513

Child new onset of unilateral conductive hearing loss with white mass behind intact tympanic membrane

Answer 513

Cholesteatoma

Question 514

Graudal unilateral hearing loss and tinnitus. Facial nerve weakness Normal tympanic membrane Unilateral sensorineural hearing loss

Answer 514

Acoustic neuroma

Question 515

Pulsatile tinnitus and gradual painless hearing loss Middle age female Pulsating, reddish blue mass behind intact tympanic membrane

Answer 515

glomus tumor Neuroendocrine

Question 516

Sensorineural hearing loss taht is sudden, fluctuating and unilateral hearing loss that begins with low frequencies and progresses to higher frequencies

Answer 516

Meniere disease

Question 517

Weber: sound heard best in right ear Rinne: bone conduction > air conduction in right ear

Answer 517

conductive hearing loss R ear

Question 518

Weber: sound heard best in right ear Rinne: Air conduction > bone conduction

Answer 518

Sensorineural hearing loss left ear

Question 519

Labor of first c-section odd

Answer 519

Risk of maternal death is decreased with trial of labor compared to repeat c-section

Question 520

If previous c-section risk of uterine rupture is

Answer 520

1%

Question 521

What is contraindicated with trial of labor after cesarean delivery

Answer 521

Misoprostol

Question 522

Anti-HBc

Answer 522

only have if previous infection not immunization

Question 523

Positive McMurry Knee flexed and externally rotated with valgus stress

Answer 523

Medial menicus tear

Question 524

2 week old with foot deformity Left foot abrupt medial deviation of metatarsals with prominent fifth metatarsal styloid process and a deep skin cleft at the medial midfoot

Answer 524

Talipes equinovarus

Question 525

Extreme hyperextension of the foot due to external rotation of the calcaneus, overstretched achilles tendon and tight anterior musculature

Answer 525

Calcaneovalgus " up and out"

Question 526

Rocker bottom feet Reversed arch, convex plantar surface and deep crease on the lateral dorsal side of the foot

Answer 526

Congenital vertical talus

Question 527

Painful non-healing tongue ulcer for 3 months Smoker Tender solid 2 cm nodule on left lateral tongue. Lesion is whitish in color with marked ulceration and accompanied by surrounding erythema. Two anterior cervical lymph nodes are palpable

Answer 527

Squamous cell carcinoma Most common cancer in oral cavity Especially if smoke Ovar cavity lesion not healed in 6 weeks w/ LAD

Question 528

Leukoplakia does not

Answer 528

ulcerate

Question 529

First step for vulvar lesion

Answer 529

Punch biopsy of raised lesion

Question 530

Acetic acid in vaginal exam

Answer 530

Only for use w/ colposcopy

Question 531

Imiquimod cream

Answer 531

Used for vulvar intraepithelial neoplasia (VIN)

Question 532

2 wk old with rash. Bumps on back of infants scalp. Progress ot whole scalp and neck. Tx

Answer 532

Seborrheic dermatitis (cradle cap) Self limiting Greasy scales on scalp

Question 533

Atopic dermatitis

Answer 533

presents after 3 MONTHS pruritis and recurrent Topical and systemic steroids

Question 534

Diabetic first line medication

Answer 534

Metformin (biguanide) Decreases hepatic gluconeogensis

Question 535

People who should get Hep A vaccine

Answer 535

People traveling to countries iwth high hepatitis A incidence Working in Hep A lab Homelessness If have Hep B/C Risk of chronic liver disease

Question 536

Neurotoxin secreted from bacteria

Answer 536

Botulinum toxin by clostridium botulinum. Prevents release of acetylcholine Descending paralysis starting at trunk to extremities

Question 537

Metabolic and vascular effects on peripheral nerves

Answer 537

Diabetic neuropathy Accumulation of sorbitol can cause microvascular damage

Question 538

Tx febrile seizures

Answer 538

Acetaminophen and reassurance

Question 539

Antibiotic contraindicated in 7 y.o

Answer 539

doxycycline (tetracycline) risk of tooth enamel staining

Question 540

Acne tx

Answer 540

Topical benzoyl peroxide Tetracycline, macrolides, erythromycin

Question 541

Diabetic retinopathy work up

Answer 541

Fluorescein angiography Stain will elucidate microaneurysm formation and neovascularization

Question 542

Falling curtain Floaters in eyes

Answer 542

Diabetic retinopathy falling curtain : Signifying vitreous bleeding Floaters: resolution of bleed

Question 543

Fluorescein staining

Answer 543

diagnose corneal abrasions, ulcers and infections

Question 544

Duodenal ulcer perforates and damages

Answer 544

gastroduodenal artery

Question 545

Perforated gastric ulcer

Answer 545

Left gastric artery

Question 546

``` RUQ pain Hepatomegaly Jaundice Ascites Variceal bleeding ```

Answer 546

Hepatic vein disease Budd chiari syndrome Diagnosis by dopple US

Question 547

tumor marker of testicular choriocarcinoma

Answer 547

beta-hCG

Question 548

Painless testicular mass Bilateral increased breast tissue confusion/ headaches Solid intratesticular mass with necrotic center

Answer 548

Testicular choriocarcinoma non-seminomatous tumor Most aggressive of germ cell tumors Hematogenous spread= brain metastases

Question 549

Frontotemporl dementia vs alzheimers

Answer 549

FTD is commonly before 65 years of age

Question 550

w/o spleen need what vaccines

Answer 550

H. influenzae type B vaccination Monovalent meningococcal serogroup B (MenB) First dose of quadrivalent meningococcal conjugate ACWY ( Men ACWY) 13-valent pneumococcal conjugate vaccine PCV13

Question 551

PPSV23

Answer 551

less effective in immunocompromised Use in those w/ chronic illlnesses non immunocompromised >65 y.o

Question 552

Craniosynostosis

Answer 552

premature, abnormal fusion of cranial suture lines

Question 553

Obese child that is learning how to walk who appears to have both his feet facing outward at 90 degree angles when standing Legs have 90 degrees of ER and limited internal rotation

Answer 553

Femoral retroversion

Question 554

Genu varum

Answer 554

Bowlegs

Question 555

Genu valgum

Answer 555

Knock-knees

Question 556

Metatarsus adductus

Answer 556

Pigeon toe Lateral foot border appears C shaped

Question 557

Stiffness in neck, radiates to arm. Numbness is upper extremity and lower extremity hyperreflexia Imaging

Answer 557

MRI of cervical spine Cervical stenosis

Question 558

Elevated Serum alkaline phosphatase

Answer 558

Paget disease of the bone

Question 559

``` Pain Hearing loss Bowing of the long bones Lytic lesion Cortical thickening on imaging ```

Answer 559

Paget disease

Question 560

Initial Tx carpal tunnel

Answer 560

Neutral wrist splinting

Question 561

Most effective first step for insomnia

Answer 561

CBT

Question 562

scaphoid bone located where

Answer 562

anatomical snuff box

Question 563

Hand bones

Answer 563

Some Lovers TRI Positions That They Cant Handle Radial to ulnar

Question 564

Tenderness to palpation on the ulnar aspect of wrist in the proximal hypothenar area 1 cm distal to the flexion crease of the wrist

Answer 564

Hook of hamate fracture

Question 565

What to do with tooth if knocked out

Answer 565

transport in cold milk or childs saliva

Question 566

Mono is due to what virus

Answer 566

EBV

Question 567

Cherry red spot GM2 ganglioside Deficiency of

Answer 567

Tay-Sachs Disease Hexosaminidase A No hepatosplenomegaly

Question 568

Fabry deficiency of

Answer 568

Alpha-galactosidase A Accumulate of glycosphingolipids Cardiomegaly Punctate, nonblanching dark red to blue black clusters of ectatic blood vessels directly under skin Renal failure

Question 569

GM1 gangliosidosis

Answer 569

AR Deficiency of beta-galactosidase A ``` Hepatosplenomegaly Cherry red spots Defective ossification Facial coarsening Rapid neurological decline ```

Question 570

Gaucher disease

Answer 570

AR Deficiency of beta-glucosidase Glucocerebroside accumulates Crumbled tissue paper appearance Ashkenazi jewish ``` Painless splenomegaly Anemia Thrombocytopenia Fatigue bruising neurological impairment bone pain ``` Erlenmeyer flask deformity of femur

Question 571

Niemann pick

Answer 571

AR Deficiency sphingomyelinase Accumualtes sphingomyelin Ashkenazi jew Lung disease Hepatosplenomegaly Short stature pancytopenia Cherry red spot Neurologic impairment

Question 572

Patietn w/o pulse and no electrical activity what medication

Answer 572

Epinephrine for asystole

Question 573

Amiodarone SE

Answer 573

Second medication utilized in VF and pulseless VT if inital vasopressor medication used (epinephrine or vasopressin) Hepatotoxicity pulmonary effects (interstitial pneumonitis, pulmonary fibrosi) Hypotension Hypothyroidism CNS disturbances (ataxia, memory disturbances, movement/ coordination issues) Photosensitivity Optic neuritis/ neuropathy

Question 574

Atropine

Answer 574

Used in patients with symptomatic bradycardia Avoid w/ AV lbock

Question 575

Digoxin

Answer 575

Dont use in WPW Tx CHF

Question 576

Digoxin effect on ECG

Answer 576

Downward scooping of ST segment and inverted T waves

Question 577

B12 deficiency left untreated leads to

Answer 577

ataxia Develop irreversible neurologic deficiency Demyelination of posterior colums leads to loss of position and vibratory sensation and ataxia

Question 578

Bromocriptine MOA

Answer 578

Dopamine receptor agonist

Question 579

Dopamine receptor antagonists tx

Answer 579

Psychosis

Question 580

Muscarinic receptor antagonists

Answer 580

Tx cholinergic toxicity | Cholinergic toxicity diarrhea, urination, bradycardia, bronchospasm, lacrimation, lethargy, salivation seizures

Question 581

AA 1 y.o mother with anemia. Height weight and head circumferance in 25% for age Low hemoglobin Normal paltelet Low MCV Normal red blood cell distribution Target cells Tear drop cells Normal iron ferritin TIBC

Answer 581

Beta-thalassemia minor Microcytic anemia Normal red blood cell distribution Target or tear drop shpaed cells Diagnosis confirmed with Elevated hemoglobin A2 level on hemoglobin electrophoresis

Question 582

Pure red cell aplasia

Answer 582

normocytic anemia ineffective erythropoiesis of RBC line caused b infection w parvovirus B19

Question 583

Tall peaked T waves Shorted QT interval Muscle weakness Heart palpitations

Answer 583

Hyperkalemia

Question 584

``` Painful neck thyromegaly Fever No nodules Muscle weakness ``` lab value

Answer 584

Subacute thyroiditis First phase: elevated free T4 Third phase: Elevated TSH

Question 585

Thyroid peroxidase antibody

Answer 585

Hashimoto thyroiditis

Question 586

Thyroid stimulating immunoglobulin

Answer 586

Grave's disease

Question 587

Ezetimibe

Answer 587

inhibits dietary cholesterol absorption in the intestine by binding to Niemann-pick C1 like 1 protein

Question 588

Cholestyramine | Colesevelam

Answer 588

Bile acid sequestrants bind to bile acids in gut and prevent reabsorption of bile acids. SE flatulence and loose lbowel movements Adjuvant medication to statins to help further decrease LDL

Question 589

Pruritus due to hyperbilirubinemia in liver failure patient what medication

Answer 589

Bile acid sequestrants Cholestyramine Colesevelam

Question 590

Used to help lower triglycerides

Answer 590

Fibrates - fenofibrate - gemfibrozil Work by inducing lipoprotein lipase Which decreases hepatic production of apolipoprotein CIII via peroxisome proliferator- activated receptors (PPARs) alpha activity Triglyceride level > 1000

Question 591

Inhibiting HMB-CoA reductase

Answer 591

Statins Also increase cholesterol metabolism Decreasess both LDL and triglycerides Muscle cramping Assess hepatotoxic and liver function

Question 592

Nicotinic acid moa

Answer 592

Niacin Inhibits peripheral mobilization of fatty acids Decreases the quantity of substrates needed for hepatic synthesis of triglycerides and VLDLs Helps to increase HDL levels SE: flushing

Question 593

4 y.o flu 10 days ago. Swelling in legs and face. Albumin of 4+. serum albumin concentration elevated. Urine protein - diagnosis - tests

Answer 593

Minimal change disease Renal biopsy and electron microscopy Showing retracted of the epithelial foot process Nothing on light microscopy or imaging

Question 594

Increased mesangial matrix and increased mesangial hypercellularity in diffuse mesangial porliferation

Answer 594

DMP

Question 595

Discrete segments of glomerular tuft reveal sclerosis

Answer 595

Segmental

Question 596

Some glomeruli involved and some spared

Answer 596

focal segmental glomerulosclerosis (FSGS)

Question 597

Lobulated glomeruli and mesangial proliferation

Answer 597

membranoproliferative glomerulonephritis (MPGN)

Question 598

Low serum complement C3, C4 levels found in

Answer 598

Post-infectious nephritis MPGN Lupus nephritis

Question 599

Multiple tender erythematous nodules located on the lower extremities (extensor portion) recent illness or pregnancy

Answer 599

Erythema nodosum Also inflammatory bowel, oral contraceptive use, and sarcoidosis can cause

Question 600

Hypopigmented patches (ash leaf spots) Mental retardation Epilepsy Firm papules over the face and growths around the nails Also grow

Answer 600

Tuberous sclerosis AD Adenoma sebaceum: Firm papules over the face periungual fibromas: growths around the nails Shagreen patches: yellow plaques with a pigskin consistency located on back and buttocks Cafe au lait spots Phakomas: yellow retinal plaques

Question 601

Stages of kidney disease

Answer 601

GFR Stage 1: > 90 mL asymptomatic Stage 2: 60-89 asymptomatic Stage 3a: 45-59 anemia, hyperparathyroidism, htn, fluid retention, electorlyte abnromalities Stage 3b: 30-44 worsening complications Stage 4: 15-29 Stage 5: < 15 require hemodialysis

Question 602

Joint locking up, popping and catching sensation Walk with externally rotated leg Joint crepitus and effusions on palpation Gradual onset of pain

Answer 602

Osteochondritis dissecans Occurs when cracks form in the cartilage and underlying bone Leads to avascular necrosis of portions of the bone and fragmentation of tissue into the joint space.

Question 603

Pes anserine bursitis

Answer 603

Repetitive stress to area Pain when rising from seated position, ascending stairs, localizes to interior knee (proximal, medial aspect of tibia)

Question 604

``` 2 y.o Fever 104 Rash- flat blotchy erythematous rash on chest, abdomen and back without pustules or desquamation Red eyes and mouth Unilateral Enlarged cervical LN Hands/ feet swollen Erythema palms and soles Conjunctivitis Dry cracked lips ``` Tx

Answer 604

Kawasaki disease Acute vasculitis in children < 5 y.o Intravenous immunoglobulin to help prevent coronary artery aneurysms High fever Unilateral cervical lymphadenopathy swelling and erythema palms and soles, bright red oral mucosa IVIG Antipruritics Analgesics (acetaminophen, high dose aspirin)

Question 605

Bright red oral mucosa Strawberry tongue Desquamation of hands and feet Rash

Answer 605

Scarlet fever (strep pyogenes) Antibiotics penicillin [Doesnt have dry cracked lips, or conjunctivits]

Question 606

Fever, anorexia, weight loss, joint pain, and photophobia tx

Answer 606

malaria Hydroxychloroquine

Question 607

Plasma exchange

Answer 607

performed in cases of polyarteritis nodosa in patients positive with Hep B or C in attempt to clear virus

Question 608

Most significant modifiable risk factor for stroke

Answer 608

HTN

Question 609

Childhood disintegrative disorder

Answer 609

Devlopmental disorder characterized by normal development until at least 2 years of age followed by regression of language, socail and motor skins Differentiate from Rett, mets milestones for 2 like climbing stairs, stacking six blocks and two word phrases and following two step commands

Question 610

Child who does not bable by 1 year and not use any words by 15 months no intelligible speech at 2

Answer 610

Expressive language disorder

Question 611

Long narrow face, prominent chin, large ears and large testicles Pale blue irises, high arched palate, joint hyperlaxity Developmetnal delay

Answer 611

Fragile X X linked dominant Mutation FMR1 Causes CGG trinucleotide expansion and symptoms will be worse the longer the expansion

Question 612

``` Female Developmental regression Microcephaly Mental retardation Seizures Hand wringing ```

Answer 612

Rett syndrome Develop milestones all the way up to 18 months (runs, kicks ball, can stack 4 blocks, begins to toilet train, can name objects)

Question 613

Vaccine to not give immunocompromised

Answer 613

Varicella MMR Live flu vaccine

Question 614

Vaccine to give HIV patient

Answer 614

``` Hep B HPV Inactived influenza Pneumococcal TdaP ```

Question 615

Avascular necrosis risk factors

Answer 615

corticosteroid use | heavy alcohol consumption

Question 616

What medications cause low potassium

Answer 616

Albuterol Beta agonists, inhaled or systemic increase potassiumuptake by cells ``` Insulin Loop diuretics (furosemide, bumetanide) Sodium polystyrene sulfonate Alkalinizing agents (sodium bicarbonate) ```

Question 617

Losartan causes

Answer 617

hyperaklemia decrease in aldosterone, decrease in activation of Na/K pumps

Question 618

What is elevated in sickle cell disease

Answer 618

Reticulocyte percentage

Question 619

Common complication of sickle cell disease

Answer 619

avascular necrosis of the femoral head

Question 620

Encapsulated bacteria

Answer 620

SHiNE SKiS ``` Strep pneumoniae Haemophilus influ B Neisseria meningitidis Ecoli Salmonella Klebsiella Streptococcus agalactiae ```

Question 621

Erythrocyte sedimentation rate

Answer 621

rate at which RBC settle in 1 hr Elevated in inflammatory states due to an increased concentration of fibrinogen that causes RBC to stick together in rouleaux formation Erythrocytes sedimentation rate is decreased in sickle cell disease, CHF, spherocytosis, polycythemia

Question 622

Diagnosis of multiple myeloma needs what

Answer 622

Serum and urine electrophoresis

Question 623

Pneumothorax vs hemothorax

Answer 623

Pneumothorax - dyspnea - chest pain - decreased or absent breath sounds - HYPERRESONANCE to percussion Hemothorax - Dullness to percussion

Question 624

Metoclopramide

Answer 624

dopaminergic antagonist used as adjunct to abortive migraine therapy in those who n/v is predominant symptom SE: acute dystonic rxn (spasmodic or sustained muscle contractions)

Question 625

Metoprolol

Answer 625

beta blocker used in migraine prophylaxis in patients with frequent migraines

Question 626

Sumatriptan

Answer 626

serotonin receptor agonist primary abortive therapy in migraine headaches Contraindicated in those w/ HTN, CAD or peripheral vascular disease

Question 627

Topiramate

Answer 627

antiepileptic used in migraine prophylaxis or those whom abortive therapies are ineffective or contraindicated

Question 628

Protein C deficiency

Answer 628

inherited thrombophilia that typically presents with venous thromboembolism hypercoagulable

Question 629

Ototoxicity

Answer 629

Aminoglycosides - gentamicin - tobramycin - amikacin - neomycin - streptomycin Vancomycin Aspirin Cisplatin

Question 630

Lithium SE

Answer 630

Nephrogenic diabetes insipidus Direct nephrotoxicity Thyroid disturbances Ebstein anomaly in fetus

Question 631

B12 deficiency bug/ worm

Answer 631

Diphyllobothrium latum pallor fatigue weakness bilateral burning/ numbness/ in feet

Question 632

Ascaris lumbricoides

Answer 632

Intestinal obstruction and lungs round worm nonproductive cough with fevers, crackles, wheezing and oval infiltrates on xray. Human feces as fertilzer

Question 633

Giardia lamblia

Answer 633

contaminated water Malaise Diarrhea foul smelling flatulence

Question 634

Taenia saginata

Answer 634

Undercooked beef WL Abdominal pain nausea Passing tape worm segments in stool

Question 635

Taenia solium

Answer 635

Two routes: eating raw meat or fecal oral transmission Fecal oral --> brain Abdominal pain cramping N/v loss appetite Appendicitis

Question 636

Preeclampsia severe features

Answer 636

Visual changes Headache Pulmonary edema N/V, RUQ pain Anemia Thrombocytopenia Proteinuria >= 5 g in 24 hr 3+ on two dip sticks 4 hrs apart

Question 637

Urinary obstruction in male infant Grunting when peeing Needed to confirm diagnosis?

Answer 637

Posterior urethral valves Membranous folds within the posterior urethra that cause urinary obstruction in male infants Grunting and straining when urinating Failure to thrive Urosepsis Voiding cystourethrogram

Question 638

Bladder US shows

Answer 638

urinary obstruction or dilated bladder

Question 639

Cystoscopy

Answer 639

therapeutic procedure for posterior urethral valves after diagnosis is made Obliterating the posterior valves

Question 640

``` abdominal pain bloody diarrhea WL night sweats elevated ESR and CRP pANCA ```

Answer 640

Ulcerative colitis

Question 641

string sign

Answer 641

Crohns disease

Question 642

ASCA positive

Answer 642

anti-saccharomyces cerevisiae ab Crohns disease

Question 643

Fistula formation | Skip lesion

Answer 643

Crohns disease

Question 644

Screening for DM

Answer 644

Over age 45 every 3 years Fasting blood glucose > 125

Question 645

Tx premature ejaculation

Answer 645

SSRI

Question 646

Drug that blocks alpha adrenergic receptors for penis

Answer 646

Yohimbine Psychogenic erectile dysfunction

Question 647

Scotch tape test

Answer 647

Enterobius vermicularis

Question 648

Profuse watery mucoid diarrhea with abdominal cramping Cough, wheezing, pleuritic chest pain Hemoptysis Pruritic linear urticarial rash of 1 or more bands Stepping on soil

Answer 648

Strongyloides stercoralis

Question 649

82 y.o chronic cough, sporadic crackles over right lung fields, puts petroleum jelly on chest Chest xray several poorlyd efined opacities in right lower lobe with bilateral reticulonodular pattern Foamy macrophages with large cytoplasmic vacuoles and extracellular hdrophobic droplets

Answer 649

Lipoid pneumonia Aspiration pneumonia caused by inhalation or aspiration of exogenous lipoid oils

Question 650

Anti-glomerular basement membrane antibodies Pulmonary and renal ``` Hemoptysis Cough Fever hematuria proteinuria RBC casts ```

Answer 650

Good pasture syndrome

Question 651

``` Sinusitis otitis medica cough renal failure c-ANCA ```

Answer 651

Granulomatosis w/ polyangiitis Small vessel vasculitis

Question 652

Ectopia cordia

Answer 652

failure of sternum to form leaving the heart and upper abdominal cavity covered by only a thin layer of skin Heart expossed

Question 653

Adolescent athlete with knee pain and point tenderness at tibial tuberosity

Answer 653

Osgood- Schlatter disease Osteochondritis of tibial tubercle Inflammation of patellar ligament where it attaches to the tibial tuberosity

Question 654

Patellar tendinopathy

Answer 654

jumpers knee anterior knee pain that increases over time, worsens with use, may cuase limp Tenderness more prominent in and localized to the patellar tendon (not tibial tuberosity like osgood schlatter disease)

Question 655

Asymptomatic children with diffusely enlarged, firm non-tender thyroid test?

Answer 655

Autoimmune thyroiditis (hashimoto's) TSH, free T4 (thyroxine) and anti- thyroid ab

Question 656

``` Headaches dizziness erythromelalgia (burning pain) visual impairment pruritus ``` Labs Mutation

Answer 656

Polycythemia vera Myeloproliferative disorder hyperviscosity of the blood ``` Splenomegaly engorded retinal veins elevated - hemoglobin - wbc - platelets - hematocrit ``` JAK2 mutation

Question 657

8 day cough temp 100 tenderness over maxillary region

Answer 657

Rhinovirus Unilateral facial pain/tenderness over cheek Painin teeth, tymple, vertex or occiput Erythema nose, cheeks, or eyelids Postnasal drip or nasal congestion Cough

Question 658

Bacterial infection (5)

Answer 658

``` Symptoms > 10 days Symptoms improve then intensify within 10 days Fever >102 Purulent nasal discharge Severe facial pain ```

Question 659

AAA 4-5.4 cm

Answer 659

Repeat US 6-12 months

Question 660

AAA screening

Answer 660

65-75 if smoked

Question 661

Surgical repair for AAA

Answer 661

elective surgical repair reserved for AAA > 5.5 cm

Question 662

Camper Diarrhea Watery malodorous, greasy

Answer 662

Giardia lamblia

Question 663

Drinking or swimming water Mild watery diarrhea in adult IC: biliary tract involvement

Answer 663

Cryptosporidium

Question 664

Immigrant or travelers Bloody diarrhea Liver abscess

Answer 664

Entamoeba histolytica

Question 665

Abdominal pain vomiting Diarrhea 15 hr after ingestion of seafood

Answer 665

Vibrio vulnificus

Question 666

Take alpha-1 adrenergic (terazosin) for when

Answer 666

At bedtime enlarged prostate Postural hypotension Lightheadedness

Question 667

Fell on back of right hand Supination Tenderness of lateral distal aspect on right forearm

Answer 667

Distal radius w/ associated ventral displacement Smith or reverse colles fracture falls on flexed wrist

Question 668

Falling on outstretched hand

Answer 668

Colles fracture fracture of the distal radius with associated dorsal displacement

Question 669

Fractures of ulna

Answer 669

unlikely to occur in isolation

Question 670

Barking cough Nasal flaring Intercostal retractions Stridor Steeple sign

Answer 670

Croup parainfluenza virus

Question 671

Most common pharyngitis

Answer 671

Fever No cough Anterior cervical lymphadenopathy or tonsillar erytehma Streptococcus pyogenes

Question 672

Virus that can cause pancreatitis

Answer 672

Mumps

Question 673

Pancreatitis stool

Answer 673

Tan and floats less dense due to malabsorption of fat from exocrine pancreas insufficiency

Question 674

Sore throat and a coalescing gray pseudomembrane in the oropharynx that bleeds when removed

Answer 674

Corynebacterium diphtheria Risk for cardiotoxicity and neurotoxicity

Question 675

Rash on face spreads to trunk and limbs

Answer 675

Rubella adult

Question 676

Infant with cataracts Deafness Patent ductus arteriosus (machine like murmur)

Answer 676

Rubella

Question 677

Rubeola

Answer 677

measles High fever before cough, coryza and conjunctivitis

Question 678

Ulcers that pop up in mouth when stressed tx

Answer 678

Aphthous ulcers Triamcinolone (oral rinse)

Question 679

``` Cough muscle pains headaches Traveled to Ohio for hiking Fever Bilateral focal infiltration with hilar lymphadenopathy ```

Answer 679

Histoplasmosis

Question 680

``` Southwestern of US Fever Dyspnea Cough Fatigue Arthralgias ``` Unilateral infiltrate with ipsilateral hilar adenopathy

Answer 680

Coccidioidomycosis

Question 681

Tuberculosis location in lungs

Answer 681

Ghon complex hilar adenopathy Caseous lesion in lower lung field

Question 682

Tachycardia narrow QRS complexes w/o P waves Tx

Answer 682

SVT Adenosine

Question 683

A1C goal of elderly with life expectance less than 10 years

Answer 683

8.0%

Question 684

A1C goal for normal DM

Answer 684

<7%

Question 685

A1C at risk for DM

Answer 685

5.7-6.4

Question 686

Clonidine

Answer 686

Not appropriate first step for tobacco cessation or alcohol Can be used for opiate cessation alpha 2 noradrenergic agonist Decreases autonomic arousal and symptoms