IM mix UWQ - june 1st 2021 Flashcards

Question

lobar Pn breath sound?

Answer 1

dullness to percussion - > inc Breath sound!! - -> sound conducts rapidly thru solid --> inc tactile fremitus , egophony + , crackles ** pleural effusion (fluid) : dullness + dec/absent breath sound !!!

Answer 2

CT: White lesions @ internal capsule etio: -> HTN vasculopathy: small penetrating branches: Charcot- bouchard aneurysms 12-24 hr to be effective -> intravenous vitamin K rapid (minutes) and short-term (hours) reversal of warfarin - > Prothrombin complex concentrate (PCC) - -> vitamin K-dependent clotting factors (eg, II, VII, IX, X)

Answer 3

ischemia stroke by blood clots CT: Black lesions

Answer 4

presyncope POSTURAL decrease by > 20 SBP / 10 DBP normally: arterial BARORECEPTOR inc SNS -> vasoconstriction, inc HR etio: - > autonomic dysfunction: PD, DM - -> degenerative changes to autonomic ganglia / cns nuclei -> impair release NE / vasoconstriction

Answer 5

--> BRIEF (<1 min), episodic peripheral vertigo triggered by head position changes (eg, looking up, bending down) *** NOT cause HA!!!! rx: dix-hallpike maneuver

Answer 6

asso with: - > DM - > inc liver enz moa: inc intestinal IRON absorption , iron deposition sym: - > elev liver enz - > elev ferritin, transferrin saturation - > HFE genetic mutation XR: -> Joint space narrowing !!!! -> Chondrocalcinosis -> Hook-shaped osteophytes at metacarpal heads rx: - > NSAIDS, APAP - > prevent other complication: Phlebotomy

Answer 7

- > dec renin - > inc aldosterone ----> MORE common: UNILATERAL adrenal adenoma !!!! dx: early morning plasma ALDO concentration ( PAC) : plasma renin activity ( PRA) ratio !!! ratio > 20 & plasma aldo > 15 --> primary hyperaldo!!!! - > inc Na ( inc Na excretion aldo escape) - > dec K - > inc Hydrogen into urine ( dec H+) - > inc Hco3 ( METABOLIC ALKALOSIS) rx: unilat: surgery - > aldo antagonist ( spironolactone, eplerenone)

Answer 8

- > polyneuropathy - -> stocking-glove distribution with burning, painful hypersensitivity, distal weakness, and hyporeflexia. - > pancytopenia - > hepatitis: mild transaminase elevation - > SKIN lesions: - -> Hypo- and hyperpigmentation - -> hyperkeratosis and scaling of the soles and palms - -> Mees lines (horizontal striation of fingernails) rx: - > dimercaprol - > dimercaptosuccinic acid

Answer 9

sym: partial deficiency of porphobilinogen deaminase sym: 5P's - > port-wine urine - >severe abdominal pain - > psy: acute , intermittent neurovisceral attack - > polyneruopathy - > precipitate by drugs lab: elev porphyrin, ALA, PBG hypoNa ( SIADH) ** lead poisoning: fatigue, joint pain, anemia, NOT hypoNa

Answer 10

sensorimotor neuropathy in a stocking-glove distribution along with microcytic anemia - -> motor wkness ( wrist/ ankle drop) - > GI pain - > anemia - > psychosis lab: microcytic anemia basophilic stippling: impair purine met --> hyperuricemia ----> disrupt HEME SYNTHESIS -> skin changes NOT usually seen. rx: chelation: Ca Disodium EDTA

Answer 11

LVSD -> reduce EF -> pul edema ``` rx: loop diuretics ACEi beta blockers aldo antagonist ```

Answer 12

- > Endothelin receptor antagonists (eg, bosentan) - > phosphodiesterase-5 inhibitors (eg, sildenafil), - > prostanoids (eg, epoprostenol)

Answer 13

loc: - > central and midwestern states - --> bat cave dropping sym: - > Blastomyces acute or chronic pneumonia!!!! - > often with skin lesions, LAD - >longer incubation time (3-6 weeks) ** histoplasma urine Ag testing: -> NON-CASEATING GRANULOMA !!!!! narrow -based budding yeasts !!! ----> Mississippi !!! ----> bilateral hilar adenopathy - > rx: Amp B ( severe) - > itaconazole ( mild/ maintenance)

Answer 14

loc: -> desert southwest ( california, arizona) sym: lasting >1 wk - > community-acquired pneumonia (CAP) (fever, chest pain, productive cough, lobar infiltrate) - > arthralgias, erythema nodosum, or erythema multiforme rx: CAP: cefariaxone + azithromycin / doxycycline

Answer 15

sym: - > elev CSF pressure - > papilledema - > N6 palsy - ---> impaire absorption CSF arachnoid villi : risk BLINDNESS!!!! dx: LP : elev opening pressure rx: - > WL - > acetazolamide - > inhibits choroid plexus carbonic anhydrase -> dec CSF production and ICH

Answer 16

- > intubation!! - -> deteriorating respiratory status - -> diaphragmatic impairment + RESP FAILURE ( resp acidosis) - -> bulbar wkness , dysphagia !!!! -> Plasmapheresis or IVIG + corticosteroids risk: - > quinolones, macrolides, beta blockers - > infection (UTI) - > surgery, pregnancy

Answer 17

etio: 1. prosthetic valves/ Implant device: MC: s. aureus + staph epidermidis !!!!! rx: PNG 2. DENTAL procedure: Viridans strep (S. sanguinis, S. mitis, S. orilis, S. mutans, S. sobrinus, S. milleri) 3. Nasocominal UTI: Enterococci !!!! comp: - >perivalvular abscess : heart block !!! - -> AR : early diastolic murmur @ left sternal border B/C from 3 diff venipuncture sites prior Rx -> TEE ** *LYME dx: less affect valve : AR less likely

Answer 18

1. mild 32-35 -> active external rewarming tech 2. moderate 28-32 3. severe <28 - -> active internal rewarming (pleural / peritoneal irrigation) - ---> comp: hypotension, areflexia, coma, malign vent arrhythmia ( vent fib) , acidosis ( hypoventilation) eg. warm blankets, warm baths, warmed IV fluid: target 1-2 c/hr

Answer 19

1. asthma (often severe and presenting in adulthood) 2. bronchospasm or nasal congestion following the ingestion of aspirin or NSAIDs. 3. chronic rhinosinusitis with nasal polyposis.

Answer 20

etio - -> IDA - -> stressful event Hair follicles pass through 3 phases: 1. Growth phase (ANAGEN; 90% of follicles): proliferative hair follicles target this phase!! - ----> CMT 2. Transformative phase (catagen; <1%): regression + apoptosis 3. Rest/shedding phase (TELOGEN; 10%) -> induced by stressful event/ pregnancy!!!

Answer 21

1. flank pain, with/ without hematuria, flank mass 2. HTN 3. polyuria, nocturia 4. renal dysfunction -> CKD - -> CKD inc risk with CVD asso with: - > liver cysts - > cerebral aneurysms

Answer 22

- > Progressive proximal muscle weakness & atrophy without pain or tenderness - > Lower extremity muscles are more involved ESR normal CK normal

Answer 23

- > Muscle pain & stiffness in the shoulder & pelvic girdle - > Tenderness with decreased range of motion at shoulder, neck & hip - ------> inc RISK : GIANT cell arthritis ( GCA) : inc ESR - --> 10-20% AORTIC ANEURYSM + BLINDNESS!! - --> > 50 YR - --> Dx: temporal artery BIPOSY!! Rx -> rx not delay!! Responds rapidly to LOW dose glucocorticoid in days lab: ESR inc CK normal dx: ISOLATED Polymyalgia rheumatica , no GCA: dx with ESR + CRP: NO additional studies needed !!!

Answer 24

hyperplastic cells in toxic adenoma and toxic multinodular goiter -- > overproduce thyroid hormone autonomously without TSH stimulation --> older Pt - > inc T3, T4 - > dec TSH ``` dx: ----> MEASURE THYROGLOBULIN level: ddx -> elev : endogenous TH release -> dec : factitious/ exogenous ``` sym: - > systolic HTN + inc pulse pressure - > inc contractility + CO: AF/flutter - > premature atrial /vent complexes - > dec SVR - > inc myocardial O2 demand - > high output failure - > exacerbation of preexisting low output failure - --> coronary vasospasm Comp: - --> OSTEOPOROSIS: TH inc osteoclastic bone resorption!! - > hyperCa, hypercalciuria !!!! **** sensitive to catecholamine : inc expression beta-1 adrenergic receptor activity !!! NOT stimulate production !!! RAIU: INCREASE NODULAR pattern

Answer 25

moa: thyroid-stimulating autoantibody-induced T cell activation of TSH receptors on thyroid follicular cells + Thyrotropin receptor AB ( TRAB) on TSH receptor on retro - orbital fibroblasts + adipocytes RAIU: DIFFUSE!!!! rx: - > Beta blocker ( dec T4- T3 conversion): rx CV arrhythmiam HTN -> methimazole (agranulocytosis, teratogenic 1st trimester, cholestasis) -> PTU -------> se/ hepatic failure, ANCA vasculitis) !!! -> radioactive iodine ( worsening opthalomopathy: inc TRAB titer ------> glucocorticoids used to prevent -> thyroidectomy

Answer 26

Release of excess PRE-FORMED thyroid hormone: self limited hyperthyroid phase dx: thyroid nodules - -> serum TSH !!! - -> thyroid u/s - ---> thyroid peroxidase autoAB ( anti-TPO) RAIU: markedly REDUCED!!! comp: INC risk MISCARRIAGE!!! rx: Beta blockers : control palpitation -> sys glucocortioids

Answer 27

--> ascending infection asso with biliary OB ( choledocholithiasis, biliary stricture) charcots traid: -> fever, RUQ pain, Jaundice hx: dilation of intrhepatic and CBD lab: inc direct hyperbilirubinemia , inc ALP, GGT dx + rx: - > Ab, drainage - > ERCP with sphincterotomy

Answer 28

thickening GB WALL and pericholecystic fluid : cystic duct Ob lab: NO elevate bilirubin / ALP - -> AST, ALT <1000 dx: HIDA SCAN

Answer 29

wider CI * * tighter the CI = more precise the results - > inc sample size INC precision

Answer 30

sym: urinary retention dx: u/a urinary u/s rx: first line: 1. terazosin, tamsulosin ( a-adrenergic antagonist): relax SM bladder neck, prostate - ----> combine with PDE-5 inhibitor!!! se/ orthostatic hypotension!!!!! , dizziness 2. 5-a-reductase inhibitor ( finasteride, dutasteride): inhibit coversion testo -> DHEA se/ dec libido, erectile dysfunction, SLOWER ONSET 3. AntiMus (tolterodine) : overactive bladder ( Urinary freq, urgency, incontinence) se/ urinary retention, dry mouth

Answer 31

moa: simultaneous activation of the detrusor muscle and the urethral sphincter, resulting in BOO. -> neurologic disorders (eg, spinal cord injury, multiple sclerosis)

Answer 32

Result in stress incontinence with urinary leakage, -> NOT urinary retention.

Answer 33

tinea unguium: -> extensive thickening and discoloration of the toenails -> Trichophyton rubrum tinea Cruris: ---> jock itch!! tinea manum: - -> puritic, scaly patches on palms / annular plaques with raised border on dorsum - -> DOES NOT improve with emollients tinea capitis: -> sup dermatophyte inf , scaly, erythematous, patches hair loss, prominent itching + tender LAD dx: KOH need SKIN INSPECTION : autoinfection + reexposure rx: antifungal - topical: - > terbinafine - > MICONAZOLE - > griseofulvin

Answer 34

anti-NMDA receptor (anti-NMDAR) encephalitis dx: presence of CSF Ab to the GluN1 subunit of the NMDAR. sym: 1. psychiatric symptoms (eg, anxiety, psychosis, insomnia) 2. autonomic instability (eg, hyperthermia, hypertension, tachycardia) 3. cognitive impairment, rigidity, hyperreflexia, dystonia, and focal seizure

Answer 35

- > Autoimmune hemolytic anemia and thrombocytopenia, - > IgM cold agglutinin Ab cause complement-mediated destruction of RBC - > jaundice - > elev bilirubin, and inc RETICULOCYTES count

Answer 36

- > cyclic fever - > jaundice, - > hepatosplenomegaly, and anemia

Answer 37

- > sustained muscle contraction resulting in twisting, repetitive movements, or abnormal postures - > Torticollis can be congenital, idiopathic, secondary to trauma or local inflammation, or drug-induced.

Answer 38

- > A negative family history - > positive Coombs test suggest AIHA - > warm agglutinin IgG autoAb mediated

Answer 39

- > strong family history - > negative Coombs test. - > inc MCHC !!!! rx: inc osm fragility : acidified glycerol lysis test - > abnormal eosin-5 maleinide binding test

Answer 40

-> dorsal columns (tabes dorsalis) and causes sensory ataxia 2ndary : - -> episodes of severe pain that may affect the limbs, trunk/face, and cause pupillary abnormalities - -> maculopapular diffuse rash ( palm and soles) - -> oral lesion - -> condyloma latum: PAINLESS lesion with nonpurulent base, bilateral , painless LAD ( CHANCRE) --> inc risk Aortic aneurysm !!! rx: 10-14 days IV aqueous crystalline Penicillin G -> alternate: oral doxycycline 14 days + cefariaxone IV 14 days ( neisseria)

Answer 41

MRI: diffuse brain atrophy, ventricular enlargement, and increased white matter intensity Rf: age >50, and CD4 count <200/mm3. 1. Early impaired memory & attention/concentration 2. Personality & behavior changes 3. Motor symptoms (eg, ataxia, slowed movement)

Answer 42

MRI: atrophy in the frontal and anterior temporal cortices sym: 50-60 onset, EARLY personality change, compulsive beh - > rather than increased white matter intensity. *** vascualr dementia: cognitive impairment, focal neruo finding!!!

Answer 43

MRI: | well-delineated, asymmetric (rather than diffuse) PATCHY white matter lesion

Answer 44

sym: painful, red eye associated with photophobia, tearing, and diminished visual acuity - -> iritis, HYPOPYON (aqueous humor), pupillary constrict asso with: IBD, sarcoidosis - > uvea: tissue layer between cornea/sclera and the retina; - > anterior uvea: consist iris and ciliary body - > posterior uvea consists choroid

Answer 45

acute redness and tearing with injection of conjunctival and episcleral vessels.

Answer 46

- > Initial treatment: activity modification, counterforce bracing/strap - > Refractory symptoms: short-term NSAIDs, corticosteroid injection, surgery

Answer 47

!!! -> tenosynovitis - > asymmetric polyarthralgia - > skin rash few pustules dx: - > det Neisseria in urine ,cervial , urethral, anal - > proctitis: anal intercourse, prutitus, rectal pain - > Joint fluid: WBC >50,000, PMN ( GN diplococci), opaque rx: 3rd gen cephalosporin IV + VNC ( cover strep pn) + DOXYCYCLINE ( chylamydia)

Answer 48

- > 3-4 days of constitutional symptoms (eg, fever, myalgia, nausea, vomiting, headache) - > MACULOPAPULAR RASH develops on the wrists and ankles, inv palms/soles, and progresses centrally. - > noncardiogenic pulmonary edema (eg, bilateral rales) and shock lab: -> thrombocytopenia !!!! -> hyponatremia -> inc AST, ALT rx: DOXYCYCLINE !!!

Answer 49

herpes rash vesicular focal ACUTE neuro deficits seizure, fever, beh change ** herpetic whitlow: gp vesicles on erythematous base LP: lymphocytic pleocytosis, !!!! inc RBC in CSF MRI: UNILATERAL temporal lobe lesions!!! dx: PCR

Answer 50

nephrogenic DI @ renal CT --> blocks response to ADH!!! etio: lithium ( nephrogenic) lab: -> euvolemic hypernatremia !!! ---> Urine Osm LOW ( diluted ) !!!! ----> Serum osm HIGH ( losing water -> concentrated) ------> low urine specific gravity <1.006 !!!!! sym: severe polyuria, mild hypernatremia ** dehydration: hyopvolemia + hyperNa --> inc Urine Osm

Answer 51

etio: -> MENINGEAL ARTERY tears due to trauma head injury sym: with neuro deficits --> immediate surgery!!! -> inc ICP MRI: EYE shape biconvex

Answer 52

broad flat T wave, U wave, ST depression, premature ventricular beats etio: - > Diuretics K wasting :: - > beta-2 agonist - -> asthma exacerbation - -> DIGOXIN TOXICITY sym: High dose Beta agonist -> HYPOKALEMIA ( K shift into IC space + Na-K ATPase pump + NaKKCl cotransporter) ---> LOOP diuretics: met ALKALOSIS with inc HCO3, loss H+/K/Cl ---> HIGH urine Cl cuz of the diuretic loss!!!! - > dec DTR - > muscle wkness - > fatal arrythmia (VFib) - > tremor - > HA dx: FIRST : do ELECTROLYTES panel!!! r/o electrolytes + digoxin imbalance

Answer 53

UMN + corticospinal tract + corticobulbar tract: hyperreflexia, spasticity, fasciculation !!!! - -> denervation Ach receptor: longer receive input from NMJ -> hypersensitive to Ach and spontaneously discharge - -> widespread fibrillation + positive sharp waves LMN + : flaccid , wkness !!!!! Bulbar sym: coughing, choking when eating !!!! , WL - -> resp failure - --> Reduce TLC, FVC - --> FEV1/FVC normal - --> DLCO: NORMAL ( extrinsic muscle wkness, not affect intrinsic lung parenchyma) rx: non-invasive PPV - > riluzole ( glutamate inhibitor)

Answer 54

NO release: nitroprusside!!!! - > RF - > AMS, lactic acidosis, seizure, coma hypertensive ER rx: Na thiosulfate!!!!

Answer 55

- -> TIA: internal carotid artery dissection ( young pt) : s/p sports injury/ fall - -> EDS , OCP, smoking -->demyelinating plaques MS - > transiet <24hr - -> false lumen , aneurysm , intramural hematoma sym: - > partial HORNER syn: ptosis , miosis, anhidrosis - > tinnitus, carotid bruits dx: echocardio --> if suspect EMBOLI, prosthetic valve thrombosis!!! -> Ct / MR angiography rx: ASA ( give within 24 hrs) , statin , dec BP

Answer 56

--> Supplement IRON when serum ferritin ≤75 µg/L 1. Mild/intermittent symptoms: - > supportive measures (eg, leg massage, heating pads, exercise) -> Avoid aggravating factors (eg, sleep deprivation, medications) 2. Persistent/moderate to severe symptoms: !!!! rx: -> DOPAMINE agonists D2, D3 + (eg, pramipexole) -> α2δ calcium channel ligands (eg, gabapentin)

Answer 57

MRI: Subcortical white matter demyelination, periventricular sym: - > lhermitte sign + UMN * * not affect LMN ( peripheral NS) - > deficits takes days or weeks (not hours) to improve. - >optic neuritis !!!!!! transverse myelitis: ------> infiltration of inflammatory localizes to ≥1 contiguous SC --> rapidly progressive myelopathy --> motor weakness, autonomic dysfunction (eg, bowel/bladder dysfunction), and SENSORY deficits with a DISTINCT sensory level!!! dx: -> MRI: no compression lesion, T2 HYPERINTENSITY LP: inc WBC, inc IgG index rx: - > IV glucocorticodis - > IVIG - > Baclofen ( muscle spasity) ** LP NOT needed: -> when dx is clear!!! CSF: oligoclonal IgG bands

Answer 58

moa -> Sudden acceleration-deceleration or rotational forces during BLUNT MAJOR head trauma can cause shearing of the long, white matter tracts (ie, axons) of the brain. MRI: -> affects gray-white matter junction - > numerous minute punctate hemorrhages in the white matter (ie, axons) - > blurring of the gray-white interface (due to edema).

Answer 59

- > tonsillar herniation - > subfalcine herniation - > lateral shift in midline st

Answer 60

etio: rupture berry saccular aneurysms sym: - > thunderclap HA comp: -> rebleeding within first 24 hr -> vasospasm + infraction s/p 3 days ``` dx: -> urgent noncontrast CT scan !!! -> LP r/o : xanthochromia -> MRI: white, hyperdense regions in the brain parenchyma ( basal cisterns) ``` rx: -> CCB, endovascular therapy stenting

Answer 61

cadiogenic syncope - -> severe AS - ---> occur at REST without warning sym!!! - > pulsus parvus and tardus ( delay slow raising and weak carotid pulse) - > S3 heart sound - > mid-late peak systolic murmur dx: continous ECG monitoring : r/o Vent arrhythmia cardioecho!!! echo

Answer 62

- > hilar LAD, interstitial infiltrates ( restrictive pattern) - -> dec diffusion capacity of the lung - ---> INC A-a Gradient : hypoxemia > hypercapnia ( LATE finding) !!! - -> dec TLC, FRC, RV - > inc elastic recoil - > erythema nodosum : red nodules at shins - > facial nerve palsy: reactivation neurotrophic virus ( HSV) -> Bilateral parotid gland swelling --> hypercalcemia ( 1-a hydroxylase +): inc intestinal Ca, Po4 absorption, inc renal reab Ca, Po4 -> dec PTH ---> NONcaseating granulomatous inflammation !! -> hyperacusis dx: CXR - > bronchoscopy + biopsy rx: prednisone

Answer 63

painless intrparotid mass, cervial LN swelling -> slow growing, UNIlateral

Answer 64

serum albumin - fluid albumin >1.1 = water only, portal HTN -------> inc hydrostatic pressure <1.1 = absence portal HTN ------> inc capillary permeability

Answer 65

arthralgia , fingertips pain - > osler nodes - > active urine sediment

Answer 66

- -> referred visceral pain affecting back - -> relief by leaning foward!! 1. severe pancreatitis --> release local + pancreatic enz --> inc vascular permeability 2. voln retroperitoneum 3. systemic inflammation : sepsis , shock rx: IV fluid dx: --> AMYLASE/LIPASE >3 x upper limit NO NEED confirm CT!! --> CT scan D-xylose absorption test: NORMAL absorption!!! enz deficiency comp: pseudocysts -> 3-4 wks dev

Answer 67

asymmetric muscle wkness, flutuating UMN NOT present!!

Answer 68

STABLE patient: !!!! 1. RATE: digoxin , beta blockers, CCB (dilitazim) II, IV --> se/ CCB: arteriolar dilation: inc capillary hydrostatic pressure + fluid extravasation into interstitium --> peripheral edema 2. RHYTHM: used for unable to achieve adequate HR control / recurrent sym eposodes/ HF sym in LVSD - -> amiodarone, flecainide (I, III) UNSTABLE patient: ----> persistent tachyarrhythmia: hypotension, AMS, shock, ischemia shock, Acute HF **electrial + cardioversion + ibutilide --> restore sinus rhythm

Answer 69

AV node - > supraventricular tachy (PSVT) - -> sudden onset, regular, narrow -complex tachycardia - --> AVNRT : inverted P waves w.in QRS complexes moa: - -> INC PNS tone in heart !!!!! interrupt AV nodal reentry tachycardia pathway + terminate PSVT - -> slowing AV node conduction + inc AV node refractory period !! alternate rx: -> carotid sinus massage vagal maneuver COLD water IMMERSION / diving reflex !!!! Dx: vasodilator stress testing --> marked INC BF in normal artery , dilate LESS degree in BF in STENOTIC arteries

Answer 70

- --> abnormal electrical activity around ischemic scar tix / abnormal of vent conduction system - ---> AV dissociation rx: amiodarone/ lidocaine ( heme stable pt with wide QRS complex tachycardia) --> cannon A wave : intermittent, prominent A waves JVP: >- A wave ( Rt atrial contraction TV close) --> absent A wave AFib -> C wave ( rt vent contraction against TV) - > V wave ( rt atrial filling,) - -> prominent V wave in TR

Answer 71

lower GI bleeding in Adults - -> painless, large Voln bleeding : bright red BLOOD !! - > LH dx: coloscopy ** hemorrhoids: LESS blood compare to diverticulosis

Answer 72

anemia - progressive - > reticulocytosis ( inc RBC breakdown) - -> fatigue, jaudice, dark urine thrombocytopenia smear: schistocytes ( helmet cells) rx: TTE

Answer 73

ADAMTS-13: def plasma protease ( autoab formation) ``` Acute anemia (MAHA) !! !!!! pt < 10,000 ( schistocytes, normal PT, PTT, inc BT, inc reticulocytes) !!! AMS RF Fever ``` rx: Plasma exchange ( LIFE threatening!!) - > steroids - > rituximab

Answer 74

etio: chronic HCV, HIV, SLE IC deposits - > palpable purpura ( thrombocytopenia) * * inc pt destruction, dec pt production, splenic sequestration - > arthralgias - > renal dx: hematuria, pnuria, glomeronephritis Lab: - > low C4 complements: inc risk impaired CELLULAR Immunity ( HIV dx) - -> poxvirus - > viral hep rx: plasmophresis Immunosuppression

Answer 75

dx: BM biopsy serum pn -> electrophoesis -> neg RF -

Answer 76

s/p STEMI 5 days - several MONTHS !! - > thin dyskinetic myocardial wall - > @ LAD - > persistent ST elevation ECG dx: cardioecho

Answer 77

within 5 days- 2 wks ---> loc @ LAD - > pericardial effusion with cardiac tamponade traid: HYPOTENSION + muffled heart sound, JVD !!!!! - > shock, cardiac arrest rx: PERICARDIOCENTESIS!!! -becks traid: fluid acc -> restrict VR to RV -> dec RV compliance -> shifts IV septum towards LV -> dec LV filling ( dec preload) ** contractility and HR is increased -> SNS + to maintain CO -> @ LAD

Answer 78

s/p 3-5 days MI --> inv @ RCA -> severe MR ( hypotension, pul edema, cardiogenic shock) ---> MR : soft murmur + NO palpable thrill

Answer 79

inc BUN/Cr >20:1 Urinary Na < 20 Low FeNa !!!!! inc MET ACIDOSIS with AG--> Uremia AKI: INtrinsic -> drug induced: cocaine, statin, acyclovir ( direct renal tubule injury: intratubular Ob ) - > RHABDOMYOLSIS!!!! - > crush injury - > seizure lab: dark urine !!!!!! -> inc K, PO4, AST>ALT -> inc CK >1000!!!! -> dec Ca ( reduce PO4 clearance --> caPo4 salt formation) - > urine sediment NONE - --> HIGH URINE NA ( > 40 ) !!!!!! inc risk: - > acute compartment syn - > persist to ATN: BROWN MUDDY granular casts ( not always present) rx: IV hydration avoid NSAIDS : worsen vasoconstriction

Answer 80

Proximal : femoral , popliteal >90% etio: - > prolonged immobilization - > atrial fib - -> malignancy !!! sym: - > sudden onset dyspnea, tachycardia, hypoxia - > pleural effusion : exudate + !! pleural irritation pain dx: !!! pericardial effusion: electrical alternans : amplitudes QRS complex vary beat to beat ---> WEDGE SHAPE , pleural based opacification!!!! HAMPTON hump ``` !!! pul emboli: ECG: S1Q3T3 HIGH A-a V/Q mismatch --> gradient on arterial blood gas ----> PAO2 - PaO2 >15 mmHg -> PaO2 < 70mmHg ``` dx: CT pul angiography rx: EVALUATE FIRST for contra to anticoagulation!!! modified Wells criteria + GIVE prior dx !!! - > LMWH ( EnoXaparin), fondaparinuc ( Xa inhibitor), rivaroxaban - --> CANNOT be used in Renal failure + risk BLEEDING pt --> UNfractionated heparin + warfarin bridge it : need to monitor aPTT *** diffuse ST seg elevation on ecg: acute pericarditis !!!

Answer 81

MCC : sudden cardiac death!!!! --> LV systolic dysfunction EF < 30% rx: - > beta blockers, ACEI, diuretics - > persistent : ICD Stable: persistent, narrow (SVT) or wide QRS complex tacharrythmia: synchronized cardioversion unstable/ pulseless: Defibrillation ==> following with Epinephrine every 3-5/min

Answer 82

1. Bone pain & deformity - > Skull: headache, hearing loss - > Spine: spinal stenosis, radiculopathy - > Long bones: bowing, fracture, arthritis of adjacent joints - > Giant cell tumor, osteosarcoma hx: OSTEOCLAST dysfunction Increased bone turnover -> X-ray: osteolytic or mixed lytic/sclerotic lesions lab: - > Elevated ALP - > Elevated bone turnover markers (eg, PINP, urine hydroxyproline) - > Calcium & phosphorus are usually NORMAL rx: bisphosphonates: inhibits osteoclastic activity of bone, stabilize destructive bony tumor

Answer 83

dec ca, PO4 inc ALP, PTH hx: defective mineralization of osteroid matrix + epiphyseal growth plate

Answer 84

- > fever >40 - > confusion -> muscle lead-pipe RIGIDITY Generalized --> rhabdomyolysis with inc CK + leukocytosis - > autonomic instability - -----> Central DA receptor bockade ( hyperthermia, dysautonomia) ------> disruption nigrostriatal DA pathway ( rigidity) ** withOUT: hyperreflexia etio: DA antagonist --> haloperidol, olanzapine rx: - > supp care, BZD - > BROMOCRIPTINE (DA agonist)

Answer 85

- > tremor - > hyperreflexia - > myoclonus - > GI sym (vomiting, diarrhea) - > autonomic dys: diaphoresis, tachycardia, HTN, hyperthermia etio: sertaline, citalopram (SSRI), tramadol (analgesic with serotonergic) !!!! combine with MAOI --> Tranylcypromine, phenelzine, selegiline rx: - > supp care - > cyproheptadine (serotonin antagonist) - > BZD + ET if severe

Answer 86

* *social anxiety - > > 1 social situation for >6 months dx: -> CBT: exposure therapy: desensitization!!! first line rx PANIC DISORDER !!!!!! -> SSRI/ SNRI, * *performance only: - -> beta blockers CBT

Answer 87

----> present with: SOMATIC SYM!!!! buspirone (partial serotonin agonist) --> slower onset CBT SSRI SNRI: inhibits NE + serotonin reuptake eg. SNRI: Venlafaxine - -> se: dose dependent HTN , sexual dysfunction !!! --> DULOXETINE (SNRI) : rx: DM polyneuropathy * * BZD -> second line rx: risk of abuse , dependence, w/drawal - ----> psychosis , anxiety , early rebound effect, insomnia

Answer 88

Duration: >1 month!! -> nightmares emotional -> regulation struggles rx: - > CBT - > SSRI, SNRI - > Prazosin (alpha-1 adrenergic receptor antagonist) for nightmares: dec adrenergic hyperactivity

Answer 89

ApoE4 allele inc risk sym: dementia - > early memory sym - > late personality + beh change, apraxia - > Urinary incontinence MRI: medial temporal lobe atrophy lab: screen for B12, TSH, cbc

Answer 90

sym: bulky, foul-smelling, floating stools -> Vit D def ( osteomalacia, osteoporosis, rickets) : GRWOTH DELAY!! - > length dep axonal polyneuropathy: distal, symmetric , stocking glove distribution - > atropic glossitis, microcytic anemia ( IDA) - ---> INC risk with TYPE 1 DM!!! hx: villous atrophy lab: - > inc 2ndry PTH - > dec Ca, Po4 - > IgA anti-tix transglutaminase - > IgA anti-endomysial Ab dx: D-xylose absorption test: CANNOT absorb in intestine , urinary: D-xylose level is LOW!!! --> Biopsy confirmed celiac dx --> neg results on IgA Ab testing due to selective IgA deficiency !!!

Answer 91

focal ulceration + transmural imflammatory sign on biopsy -> aphthous ulcer + perianal skin tags + perianal fistulas ---> rectrovaginal fistula : cxn bowel + vagina rx: - > anti-TNF inhibitors - > steroids

Answer 92

diet related diarrhea impaired digestion and absorption of lactose : Postprandial GI dx dx: - > lactose hydrogen breath test - > high osm gap >125 - > ph acidic stool

Answer 93

- > HA - > HTN etio: tyramine inhibits MAOI--> inc SNS adrenergic effects --> severe HTN comp: IC bleeding, stroke, death

Answer 94

Chlamydia trachomatis + GI infection sym: - > peripheral oligarthritis - > enthesitis - > conjunctivitis - > urethritis - -> urethral discharge/ ASX - -> dx: NAAT, NO organism - > oral ulcers - > keratoderma blennorrhagicum rx: 1. Urethritis: partners need to be RX --> reinfection is common!!! 2. oligoarthritis: NSAIDS ( diclofenac)!!!!!

Answer 95

gradual wk-months - > mobilization of marginated neutrophil !!! - > + immature neutrophil circulating (bands) - > inhibit apoptosis - > proximal progressive painless muscle wkness: CATABOLIC effect - > cushing dx : HIRSUTISM -> osteoporosis : Osteoblast apoptosis!!! --> osteroporotic compression fracture: tenderness loc to vertebral bodies

Answer 96

oxidized form heme -> limit oxygen binding ability -> cyanosis --> cyanosis , dyspnea, tachycardia rx: Methylene blus

Answer 97

cherry lips, HA, confusion, nausea cerebral hypoxia -> HA, confusion - > lactic acidosis - > hypoxic brain injury @ Globus pallidus

Answer 98

!!! 1. CNS: AMS, seizure, resp depression 2. CVS: tachycardia, orthostatic hypotension, prolong PR/QRS/ST, arrythmia !! 3. antiAch: -> DRY mouth, DRY SKIN, blurred vision, dilated pupils, urinary retention, flushing, hyperthermia rx: -> activated charcoal within 2 hrs ingestion !!! -> NAHCO3 ( QRS widening/ vent arrhythmia) -> O2, ET, IV fluid

Answer 99

folate antimetabolite -> inhibits dihydrofolate reductase -> hepatoxicity : check HCV, HBV - > macrocytic anemia - > stomatitis - > cytopenias - > pul fibrosis ( restictive PFT)

Answer 100

!!! neurotoxicity: -> headache, seizures, tremor!!!! encephalopathy, and peripheral pain. ---> NEPHROtoxicity: hyperK, hyperUA, gout ---> se/ vasoconstrictive toxicity: AKI + HTN --> glc intolerance ( inc insulin req) : impairs pancreatic islet cells --> gingival hypertrophy , hirsutism , alopecia --> GI disturbance

Answer 101

retinal toxicity

Answer 102

- > risk for reactivation of latent tuberculosis. - > neutropenia - > CHF

Answer 103

viteous hemorrhage -> sudden loss of vision and onset of FLOATERS!!!! * * DM nephropathy: - -> persistent albuminuria + / dec GFR - -> proliferative diabetic RETINOPATHY (retinal neovasculization, hard exudates) - -> persistent hyperglycemia rx: ACEI dx; 10g MONOfilament test * *** GLYCEMIC control: - -> imp microvascular : retinal, nephro - -> does NOT reduce MACROvascular: stroke, MI * *** NECROBIOSIS LIPOIDICA : confluent annular lesions : yellowish - brown hue , dilated BV, epidermal atrophy - > pertibial skin

Answer 104

moa: -> separation of the inner layers of the retina. -> elevated retina with folds / tear !!!! ---> light flashes, FLOATERS, curtains across from visual field --> start peripheral asso with: - > metabolic disorders (e.g., diabetes mellitus), - >trauma (including ocular surgery) - > vascular disease, myopia, or degeneration

Answer 105

hx: HTN sym: -> PAINLESS loss vision !!!! "blood and thunder" -> disk swelling !!!!!! -> venous dilation and tortuosity, -> retinal hemorrhages !!! -> cotton wool spots, AV nicking, copper wiring

Answer 106

moa: inhibits PREsynaptic acetylcholine release at NM junction sym: ACUTE onset with 36 hrs!!!! -> Blurred vision, diplopia -> Facial weakness, dysarthria, dysphagia -> Symmetric descending muscle weakness -> Diaphragmatic weakness with respiratory failure (resp acidosis, ph < 7.35, PaCO2 >40) rx: botulinum antitoxin (equine serum heptavalent) ** MG: similar but papillary function spared!! more progressive onset

Answer 107

2ndry functional MR --> peripartum CMP!!! !!!! POOR heart contraction -> INC LVEDV/ preload --> reflect back to LA + acute pul edema, HF, JV distention ----> IMPAIRED myocardial RELAXATION/ inc LV STIFFNESS ( dec complicance)!!! - -> dec CO - -> compensate + RAAS (elev CVP) -> vasoconstriction afferent + efferent and Na retention to inc BV to maintain organ + tissue perfusion (ATII) !!!!!!!! --> S3 gallop: reverberation of the walls : dilated LV during during passive filling phase DIASTOLIC + diffuse hyokinesis !!!! -> dilation mitral valve annulus ----> Vent DILATION ( ECCENTRIC hypertrophy) -> lateral displacement papillary muscles -> taut stretching MV chordea tendineae dx: transthroacic echocardio!!! rx: diuretics , beta blockers ** does NOT cause sudden inc LA dilation / compliance --> chronic MR/ AR

Answer 108

moa: -> myxomatous degeneration of the mitral valve leaflets and chordae - > mid systolic click follow by MR murmur - > dec vent voln preload -> causes earlier click - > inc preload ( inc venous return) : later click

Answer 109

risk: - > Family history - > BRCA 1/2 - > Abnormal estrogen/androgen ratio: Klinefelter syndrome ( primary hypogonadism) - -> inc conversion testo -> estrogen/androgen ratio - > obesity, cirrhosis, marijuana use dx - > Mammography - > Biopsy: invasive ductal carcinoma (hormone receptor–positive) most common

Answer 110

sym: - -> EYE OPEN during episode - > postictal confusion awakening 1. Stabilize circulation, airway & breathing 2. Benzodiazepines (repeat administration until termination of seizure activity) 3. Begin antiepileptic drugs: FOSPHENYTOIN , PHENYTOIN, levetiracetam , valporic acid !!!!! 4. EEG monitoring for refractory status epilepticus or failure to regain consciousness risk: - -> postictal lactic acidosis : skeletal muscle hypoxia , impair LA uptake - -> self-limit 90 within mins dx: observe and repeat exam in 2 hrs !!! ** MRI perform after: inc risk cortical laminar necrosis ( HALLMARK)!!!

Answer 111

postpartum blue -> 2-3 days resolves within 14 days!!!! - > mild depression rx: reassurance postpartum depression -> 4-6 weeks (can be up to 1 year) - -> hallucination, suicide risk rx: - > Antidepressants, psychotherapy - -> SSRI ( sertaline)!!!!!

Answer 112

inc RAS -> inc Renin -> inc aldosterone -> inc Na reabsorption ( DEC URINE Na) !!! FeNa < 1 % --> dec K ( due to excretion) - > inc ADH -> dec serum Na: promotes water reabsorption --> causing dilutional hyponatremia - --> UREA reabsorption!!! indicates: HF!!! high ADH remains till hypovolemia corrected

Answer 113

hand-food-mouth dx - > oral lesion - > bilateral macular, maculopapular, vesicular rash

Answer 114

- > E.coli - > shigella - > campylobacter EHEC: shiga toxin - > bloody diarrhea without fever - > beef products rx: ciprofloxacin

Answer 115

wkness with active shoulder abd + ext rotation Passive ROM normal!!

Answer 116

glenohumeral joint capsule chronic inflammation, fibrosis, contracture -> reduction passive + active ROM inc risk with : DM, thyroid, chronic immobility

Answer 117

FAP > 1000 polys --> CRC develop prop: - > inc screening ** ASA has NOT shown reduction risk for CRC !!!

Answer 118

foul smelling stools, bloating -> rural area dx: stool antigen assay ( direct IF/ ELISA) - > stool microscopy for oocyts + trophozoites rx: metronidazole

Answer 119

trauma sym: - > pain, photophobia - > N5 lesion dx: fluorescenin staining ** N7 -> facial , taste 2/3 tongue, lacrimation , salivation, eyelid closure --> sensory fibers supplying sensation of ext ear + nasopharynx

Answer 120

Excessive intake of Ca & absorbable alkali - > Renal vasoconstriction & dec GFR -> AKI - > Renal loss of Na & H2O - > reabsorption of HCO3 etio: -> thiazide ( alone will mild inc Ca, but not extremely), ACEI, NSAIDS lab: - > met alkalosis ( INC HCO3) - > hypoPo4, hypoMg, hyperCa - > suppress PTH - ---> INC CREATININE

Answer 121

before age <12 --- need teacher evaluation also!!! 2 settings!!! rx: 1. methyphenidate - -> DA reuptake inhibitor and stimuation of DA release - > Beh therapy !!!!! 2. ATOMOXETINE: NE reuptake inhibitors ----> NON -addictive - > se: dec app, WL, insomnia - > age 4-5 yr: parent - child beh therapy

Answer 122

RV MI -> inc RV preload -> RV dilation + JVD - > dec LV preload - > inc SVR - > hypotension, dec CO!!!!!! rx: - > IV fluid - > avoid: nitrates, diuretics, opioids : dec RV preload, worsen hypotension - > beta blocker - > ASA + P2y12 receptor blocker - > anticoagulant - > statin: inhibits HMG-CoA reductase ( rate-limiting enz IC biosynthesis cholesterol converts HMG-CoA --> Mevalonate) - > PCI dx: transthoracic echocardiography!!! persist hypotension: -> Dopamine ** pacemaker rx: AV block 3rd degree

Answer 123

Dull headache associated with >1 of the following: 1. Nausea and vomiting (due to increased ICP) 2. Focal neurologic manifestations (due to tumor invasion or compression) 3. Symptoms worsening during the night or with positions that raise ICP (eg, bending, coughing) dx: exam: Papilledema (enlarged blind spot) inc ICP MRI

Answer 124

- > sudden stepwise decline!!! - > Early EXECUTIVE dysfunction: hemiparesis , pronator drift , romberg sign - > risk factors ( age, HTN) - > mild memory deficit MRI: Cerebral infarction &/or deep white matter changes on MRI

Answer 125

- > autoimmune CD8 T cell - > pink or purple plaques and papules, lasting months, relapsing over years - > associated with severe PRURITIC typically affects the volar surface of the wrists rather than the dorsum of the hands. - > genitalia LP - > oral LP - > "Kobner phenomenon" lacy marking wichkam striae - ---> EROSIVE ORAL LICHEN PLANUS -> Concurrent scalp lesions would be unusual. asso with: HCV rx: glucoorticoids ** aphthous stomatitis ( cranker sores): painful ulcer, last days

Answer 126

Atrial fibrillation (AF) occurs in 10%-30% of individuals with WPW ---> aberrant / accessory bypass conduction pathway btwn atria + ventricules ecg: - > short PR interval - > widening QRS interval - > delta wave rx: 1. Hemodynamically unstable: immediate electrical cardioversion !!!!! 2. stable patients, RHYTHM control with anti-arrhythmic drugs: intravenous ibutilide or procainamide ** AV node blockers such as BB, CCB, digoxin, and adenosine should be avoided -> increased conduction through the accessory pathway.

Answer 127

mental status changes, - > respiratory depression, and miosis ( not always present) - -> dec central Resp drive ( hypoventilation) ->Hypotension, bradycardia, hypothermia, and decreased bowel sounds lab: - > resp ACIDOSIS: PaCO2 > 40 mmHg, hypercarbia - > ph < 7.35 rx: naloxone ( acute) !!!!! -> buprenorphine ( long term rx) -> external rewarming after naloxone rx fails

Answer 128

etio: -> Immune-mediated demyelinating polyneuropathy !!!! -> Preceding GI (Campylobacter) or URI, HIV sym: days- weeks!! NOT hours. !!!! -> Paresthesia, neuropathic pain ( radicular pain: electric shock like sensation radiation from buttocks down the leg) : NOT DISTINCT UMN sensory level !!! LMN + -> Symmetric, ascending weakness ( flaccid) -> Decreased/absent DTR -> Autonomic dysfunction (eg, arrhythmia, ileus) Respiratory compromise dx: - > Cerebrospinal fluid: - > ↑ protein, - > NORMAL leukocytes, RBC, glc - > Abnormal EMG & nerve conduction - > MRI: NORMAL !!!! rx: IVIG or plasmapheresis

Answer 129

- > exaggerated fall in systemic blood pressure >10 mm Hg during inspiration. - -> increased sys VR to the right heart causes the interventricular septum to shift into the left ventricular cavity, reducing LVEDV - -> This leads to decreased SV, reduced SBP Asso with: asthma and chronic obstructive pulmonary disease (COPD). ** panic attack will not have pulsus paradoxus

Answer 130

UNcomplicated cystitis: 1. Nitrofurantoin for 5 days 2. TMP-SMX 3 days !!!!!! Narrower spectrum 3. fosfomycin single dose dx: NOT req routine CT!! reserve for 48-72 hrs not improved pt / gross hematuria / ob COmplicated cystitis: 1. fluroquinolones 5-14 days - --> urine culture prior RX Pyelonephritis: flank pain + tenderness + fever lab: Nitrite (e.coli) + esterase ( pyuria) OPD: quinolone Inpatient: IV Ab

Answer 131

1. Tetanus Every 10 years 2. Influenza Annually 3. Pneumococcal At diagnosis & at age 65 --> certain comorbid conditions that increase risk of pneumococcal disease (eg, chronic liver, lung, heart disease; diabetes mellitus; smoking). 4. Hepatitis A Initiate series if not immune 5. Hepatitis B Initiate series if not immune

Answer 132

1. ≥1 delusions for ≥1 months 2. Other psychotic symptoms absent or not prominent 3. Behavior not obviously odd/bizarre; ability to function apart from delusion's impact 4. Subtypes: erotomanic, grandiose, jealous, persecutory & somatic rx: CBT Antipsy * *schizotypal personality disorder: Related to schizophrenia - > eccentric behavior and odd beliefs or magical thinking eg. wear yellow suits - --> NO DELUSION/ HALLUNICATION!

Answer 133

schizophrenia are present for ≥1 month but <6 months. -> symptoms include ≥2 of the following: DELUSIONAL, HALLUNICATIONS, disorganized speech (eg, frequent derailment, incoherence), grossly disorganized or catatonic behavior, and negative symptoms (eg, flat affect, social withdrawal)

Answer 134

- > infection of the lacrimal sac. - > s. aureus, GAS ->occurs in infants / adults over the age of 40. sym: - > sudden onset of pain and redness in the medial canthal region. - > purulent discharge from punctum.

Answer 135

acute inf dx eyelash follicule / tear gland --> lid margin --> S. aureus rx: warm compresses - > persistent: incision + curettage comp: chalazion ( residual granulomatous nodule --> regress slowly over months)

Answer 136

- > chronic, granulomatous inflammation of the meibomian gland. - > hard, painless lid nodule.

Answer 137

total = 9 >2 : high risk stroke --> oral anticoagulants eg. LMWH: apixaban, rivaroxaban, dabigatran) ``` CHF HTN Age>75 *2 DM Stroke/ TIA/ thromboembolism *2 Vascular dx ( prior MI, PAD, aortic plaque) Age 65- 74 Sex (female) ``` * ** PAD inc risk CAD!!! - -> rx: EXERCISE !!! + cilostazol --> dx: Ankle brachial index ( ABI) ``` rx: !!!! DASH DIET!!! dec SBP: 11 mmHg -> smoking cessation -> exercise program -> Low dose ASA + STATIN : 2ndry prevent CVD ```

Answer 138

reserved for patients who have failed at least 2 antipsychotic trials due to the risk of agranulocytosis. se: WG, metabolic sym, SEIZURE - > neurotropenia/ agranulocytosis - > myocarditis

Answer 139

sec gen antipsy -> LOWER meta risk compare to Olanzapine se/ BLOCK DA -dep regulation prolactin secretion ---> TSH NOT affected !!!!

Answer 140

Reduced PiO2 at high altitude (>2,500 m -> AMS: HA, dec PaO2 -> inc CSF flow, hypoxic vasoconstriction , resp distress rx: O2, acetazolmaide DXM ( dec cerebral edema) descent to lower altitude ** diuretics furosemide-> rx edema from voln overload -> high altitude sickness : voln depletion-> shifted to IV space

Answer 141

greater risk of PSYCHOSIS : extreme antipsy hypersensitivity !!! rx: 1st: LOWER DOSE carbidopa-levodopa -> low potency Antipsy: -> DA-2 + serotonin 2A receptor blockade eg. quetiapine, clozapine, or pimavanserin

Answer 142

malingering: M for Money! external gain factitious: fake to be sick!!!

Answer 143

Varenicline: - > smoking cession - > a4-b2 nicotine ach receptor partial agonist - -> se: dose dep HTN , SEXUAL DYSfunction bupropion: -> NE-DA reuptake inhibitor rx: MDD + SMOKING cession + WL + NO sexual dysfunction --> se/ seizure from bulimia patients!!!

Answer 144

DM sym: - > necrotic spread to palate, orbit, brain dx: sinus endoscopy + biopsy + culture rx: surgical debridement - > amp B

Answer 145

HIV TST > 5 mm --> req CXR + sym to r/o active TB rx: latent TB - > 9 mo : ISN + PYN * * MC etio: - > endemic areas high risk sym: TB in older pt 1. anemia ( chronic dx) 2. monocytosis 3. hypergammaglobulinemia ( elev total pn) 4. hypoalbuminemia ( + inflammatory cytokines, Acute phase reactant) dx: TST neg CANNOT r/o active TB inf!!! CKD : inc risk of cell mediated immunity impaired: inc risk latent TB!!!!

Answer 146

dose dep- QT prolongation

Answer 147

- > gastrointestinal (eg, nausea, vomiting) - > dermatologic (eg, rash, pruritus), - > neurologic (eg, drowsiness, blurred vision)

Answer 148

-> K>6.5: Urgent treatment (eg, CALCIUM gluconate, INSULIN plus glucose) - > oral cation exchange agent (eg, patiromer, zirconium cyclosilicate: - -> insoluble cpd bind K in colon exchange for Ca/ Na --> excreted in still and elimated K from body ecg: - > peaked T waves, widened QRS complex, conduction delay, arrythmia ( vent tachy)

Answer 149

- > narcolepsy | - > fatigue in ALS

Answer 150

Diabetic nephropathy - -> !! inc albuminuria: Cr ratio!!! MOST sensitive - ---> MICROANGIOPATHY - > inc glomerular hydrostatic pressure -> inc GFR Glomerular hyperfiltration in early DM ( Glomerular BM changes) : 1. inc afferent arteriole vasodilation (eg, natriuretic peptides, prostaglandins) 2. efferent arteriole vasoconstriction (eg, angiotensin II) 3. interstitial fibrosis , mesangial thickening, nodules ( Kimmelstil-Wilson lesion) rx: slow progression DM -> blocking AT II mediated renal EFFERENT arteriole vasoconstriction - -> reduce glomerular hydrostatic pressure !!!

Answer 151

a2-antagonist : inc release NE + 5-HT, potent 5-HT2, 5-HT3 receptor antagonist , H1-antagonist se: WG, inc APPETITE, sedation , dry mouth

Answer 152

- > hyperuricemia and precipitation of UA crystals in the joints, leading to episodic monoarticular arthritis - > especially in the first metatarsophalangeal joint and knee etio risk: - >PCV ( myeloproliferative dx): inc urate production - > inc red meat + seafood intake - > inc fructose - > inc Etho - ----> recurrent ATTACK max in 12-24 hr !!! --> rx PCV: phlebotomy, hydroxyurea ( if inc risk thrombosis) PPX: weight loss!! lifestyle modify

Answer 153

- > deposition of calcium and phosphorus in the skin - > whitish papules, plaques, nodules eg. ear

Answer 154

BZD sym: - > with 8-12 hrs after last drink - > acute onset, restless, elevate BP, pulse , diaphoresis, tremor - -> etho hallucination - > seizure s/p 12-48 hr - > delirium tremens s/p 48-96 hrs BZD: 1. short: Midazolam, triazolam !!! 2. INTERMITENT: Clonazepam Oxazepam, Alprazolam, Lorazepam, 3. !!!! long: Diazepam, chlordiazepoxide, flurazepam

Answer 155

1. cardiac: life threatening arrythmia - -> atrial tachycardia with AV block ( affect PR interval, NOT QRS complex) : inc automaticity of conduction atria + inc vagal tone - -> digoxin competes with K binding : hypoK inc digoxin binding --> worsen toxicity !!! 2. GI: anorexia, N/V, abd pain 3. neruo: fatigue, confusion , wkness, color VISION alteration * * drug interaction: - > amiodarone : inc digoxin toxicity dx: -> blood digoxin level rx: -> IV hydration, FAB frag digoxin spicecif- ab

Answer 156

-> early adulthood and in those age (15-35） >60 yr -> trigger by ETHO risk: SLE, IMS rx, EBV sym: - > painless lymphadenopathy in the cervical and/or supraclavicular chains ( mediastinal mass) - > B sym - > PURITUS XR: - > mediastinal mass - > Positron emission tomography (PET) scan with 18-fluorodeoxyglucose (FDG): high Glc uptake dx: - > inc LDH - > inc EOSINOPHIL - > LN biopsy : reed-sternberg cells inc risk: -> lung CA ** aspergillus : preexisting lung cavity : cavitary mass with air in periphery , not SOLID lung lesion

Answer 157

etio: -> carotid artery ATS with thrombosis / embolism sym: focal unilateral nero deficits "crossed sign": ipsilateral CN , contralateral hemiplegia - > acute onset - --> central vertigo !!!! NYSTAGMUS NOT fatigable , not inhibited by fixation of gaze!!! dx: head CT - > MRI !!!!!---> when change in conscious / neuro: REPEAT noncontrast CT scan of head !!!!

Answer 158

sym: -> rapid increase in intracranial pressure (ICP) -> diencephalon and midbrain become caudally displaced through the tentorium cerebelli. sym: - > unconsciousness - > midsized , fixed pupils - > abnormal limb posturing : disrupt descending tracts - -> decorticate flexor posturing above red nucleus - > change to decerebrate extensor posturing BS injury progresses

Answer 159

- > neuronal membrane hyperexcitability that leads to uncontrolled, repetitive firing of axons. - > fasciculations and jerking of the extremities rather than fixed, extensor posturing - > awake and local pain

Answer 160

- > blocks inhibitory (glycine) neurotransmission within the SC - > powerful, uncontrollable muscle contraction - > fully awake patient

Answer 161

!!!-> BLOCK inhibitory interneuron neurotransmission within the SC --> painful muscle contractions - > beginning in the head and neck (eg, trismus, lockjaw) and progressing to the rest of the body (eg, opisthotonus). - -> resp failure -> awake, and the pupils are not involved. rx: Ab ( PNC) tetanus IG

Answer 162

treatment for a disease when standard therapy fails -> recurrence Sx

Answer 163

treatment given in addition to standard therapy. -> radiation therapy given at the same time as the radical prostatectomy.

Answer 164

-> initial dose of treatment to rapidly kill tumor cells and send the patient into remission

Answer 165

etio: - > strep - > IBD - > sarcoidosis - > rx moa: delayed-type hypersensitivity reaction to various antigens. sym: - > Tender, indurated, erythematous nodules - > Most common on anterior legs

Answer 166

- > Cutaneous small-vessel vasculitis etio: trigger by AB sym: - > presents as painful, raised, nonblanching, petechial or purpuric lesions (ie, palpable purpura).

Answer 167

moa: - > immune reaction against blood products or antigens from a nonhuman species (eg, chimeric mouse antibodies [rituximab, infliximab]) - > Rx induced sym:5-`4 days s/p RX !!!! -> fever, joint pain, and an urticarial or vasculitis-like rash ---> pnuria + diffuse LAD

Answer 168

- > HYPONa, HypoK - > hyper GLUC - > dec insulin secretion + inc insulin resistance: syngertic for DM - > increased LDL cholesterol and plasma triglycerides, and hyperuricemia.

Answer 169

CBT SSRI: sertaline, lisdexamfetamine, topiramate

Answer 170

CBT | olanzapine

Answer 171

cognitive: CBT SSRI: fluoxetine rx: K + normal saline lab: met alkalosis , inc PH, inc HCO3 -> dec K, Na

Answer 172

- > MDD or manic episode + schizophrenia | - > history of delusions or hallucinations for ≥2 weeks in the ASBENCE of MDD/ manic episode

Answer 173

-----> time consuming >1 hr / day / causing sig distress !!! SSRI -> fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, escitalopram - > TCA clomipramine - > CBT dx: st abnormalities orbitofrontal cortex + BG

Answer 174

- > Neisseria gonorrhea (NAAT) : ceftriaxone - > chlamydia trachomatis (NAAT) : doxycycline - > syphilis (RPR) - ------> VDRL: cardiolipin - cholesterol- lecithin antigen: NOT specific ( higher false negative rate) - -------> FTA-ABS : AB to specific treponemal Ag ( highest dx sensitivity in early primary syphilis) -> HIV (4th gen ag/ ab) women only: -> !!! Trachomanas vaginalis ( wet mount) : metronidazole -> HSV if lesions

Answer 175

-> profuse, prolonged WATERY diarrhea - -> contamined water , swimming - --> HIV risk severe, chronic dx lab: - -> RARELY + leukocytes / blood - -> NEED microscopy with specialized stain dx rx: spontaneous resolution 10-14 days

Answer 176

Optic disc hyperemia | --> blurred vison, epigastric pain, vomiting

Answer 177

AKI- inc Cr damage tubule rx: FOMEPIZOLE ( competitive inhibitor alcohol dehydrogenase) - > prevents breakdown ethylene glycol into toxic met / integrals - -> Hemodialysis

Answer 178

moa: - > regulate glucose by slowing gastric emptying - > suppressing glucagon secretion - > increasing glucose-dependent insulin release sym: - > decrease app - > Weight loss se: -> nausea, bloating, abd pain

Answer 179

moa: - > increased renal excretion of sodium and glucose - > LOWER blood glucose+ WEIGHT LOSS!!! sym: -> Decrease BP and Decrease risk of HF and cardiovascular events!! se: -> Hypotension, UTI contra: - > type 1 DM - > DKA - > renal failure: GFR <30

Answer 180

moa: stimulating increased insulin secretion; like insulin se: - > weight gain - > risk of hypoglycemia. - ---> excess insulin: DOWN -regulation insulin receptor expression !!!

Answer 181

moa: - > decrease gluconeogenesis - > improve insulin sensitivity se: - > fluid retention, edema - > symptomatic heart failure - > WG

Answer 182

sym: -> recurrent episodes of awakening from sleep !!! -> RECALL of highly disturbing and frightening dream content. -> can usually be consoled. -> Nightmares occur during (REM) sleep more frequent in the second half of the night.

Answer 183

NON-REM arousal disorder -> incomplete awakening -> unresponsiveness to comfort !!! -> NO recall of dream content ->1/3 of the night -> marked autonomic arousal and amnesia rx: - > reassurance - > freq episode: low dose BZD

Answer 184

repeated episodes of complex MOTOR beh / vocalization during REM sleep --> related dementia with lewy body

Answer 185

1. revaccination tetanus w/in 5 yrs 2. tetanus IG dirty wounds who have not previously received at least 3 doses of tetanus vaccine or whose vaccine status is uncertain.

Answer 186

``` Confusion Urea>20 Resp >30/min BP SBP<90/ DBP<60 age >65 ``` Each 1 point: 1: low mortality: OPD --> CAP: doxycycline 1-2: intermediate mortality: InPatient rx 3-4: high mortality: urgent inpatient admission --> CAP: beta-lactam + macrolides/quinolone >4: ICU

Answer 187

``` inc risk: -> AS !!! ---> ENTHESITIS ( achilles tendon pain) -> psoriatic arthritis -> reactive arthritis --> limited spinal motility !!! ``` - > Vertebral fracture : osteopenia/ osteroporosis: inc osteoclast activity : TNFa, IL-6 + - > spinal rigidity - > hyerkyphosis Rx: first line prostaglandin E2 inhibit: NSAIDS, COX-2 alternate: - > TNFa inhibitor ( progressive despite nsaids) - > anti-IL-17 dx: confirm diagnosis !! XR sacroiliac joints lab: HLA-B27 (not specific)

Answer 188

etio: - > recent hospitalization and severe comorbid illness IBD - > adv age - > PPI: gastric acid suppression, inc difficile proliferation sym: -> watery stools (≥3 episodes in 24 hours) with no frank blood or melena lab: - > leukocytosis - > stool assay testing C. difficile toxins * * abd CT : severe CDI ( adb distension, hypovolemia), susp perforation rx: VNC/ fidaxomicin

Answer 189

CF: prior adulthood!!! related to: ---> CF : defect Cl + Na transport : impair mucociliary clearance sym: - > nonsmoking with chronic cough productive of large amounts of purulent sputum - > hemoptysis, dyspnea!!!!! - > exacerbation via bacteria - > bloody diarrhea - > pancreatic insuff ( malabsorption) moa: -> inf insult in comb with impaired bact clearance ( immunodef st airway defect) --> pseudomonas , upper lung lobe dx: cxr high resolution CT scan

Answer 190

NNH= 1/AR AR= rate rx- rate placebo NNT= 1/ ARR ARR = Risk control - Risk rx RIsk control = # / total pop control Risk rx= # / total pop rx

Answer 191

-> one time abd u/s risk: - -> smoking, male, age 65-75

Answer 192

-> antiretroviral therapy regardless of CD4 count to reduce HIV-related morbidity and death ---> VZV vaccine ( live attenuated virus): give to HIV pt CD4 >200 with low virulence infection after inoculation ------> NOT rxm CD4 <200 live vaccine: VZV, Zoster, MMP!!! - > primary prophylaxis against Toxoplasma TMP-SMX only CD4 counts <100/mm3. - > Primary prophylaxis against CMV not indicated regardless of CD4 count - > used in some organ transplantation recipients (CMV-seropositive recipients).

Answer 193

Progesterone analogues (megestrol acetate and medroxyprogesterone acetate) and corticosteroids -> inc app + WG

Answer 194

-> acute onset of psychosis (hallucinations) that is temporally ** delirium: wax and wane , poor attention + oriented dx: first URINE TOXICOLOGY screen !!!

Answer 195

r/o - > metabolic (eg, hypoglycemia, electrolyte disturbances) - > toxic (eg, amphetamine use, benzodiazepine/alcohol withdrawal) causes. -> ECG

Answer 196

---> > 1 unexplained sym; excessive thoughts, anxiety, heb response to sym highest asso with: -> sexual abuse, childhood neglect rx: provide GOOD news that seious illness is r.o!! rx: schedule regular visits -> SSRI -> CBT

Answer 197

-> mononucleosis-like syndrome consisting of fever, night sweats, lymphadenopathy, arthralgias, and diarrhea. !!!!!! ---> KOebner phenomenon : flares sudden onset of guttate psoriasis --> KAPOSI sarcoma : multiple violaceous papules : inc vascularity , LAD -> oral ulceration ---> TINEA CORPORIS: autoinculation -> GI sym

Answer 198

triggered by twisting, lifting, or physical exertion. sym: -> lumbar paravertebral muscles that does not radiate below the level of the knee. dx: Straight-leg raising testing is usually negative rx: NSAIDS

Answer 199

``` -> young men frequently !! -> ATOPIC disorders ( asthma, ezcema, allergies) -> refractory -> stricture formation -> heartburn ``` -> intermittent solid food dysphagia and refractory heartburn. dx: endoscopy with esophageal biopsy ---> CIRUCLAR rings + esophageal furrows --> > 15 eosinophils rx: - > dietary mod - > 2 month PPI

Answer 200

- >recurrent pneumonia - > proximal airway - > young adults - > Nueorendocrine tumor bronchial kulchitsky cells dx: CT scan lung

Answer 201

DM + ETHO: 1. SMALL fiber injury - > Positive symptoms (eg, BURNING pain, paresthesia, allodynia) - -> axonal neuropathy 2. LARGE fiber -> negative symptoms (eg, numbness, loss of proprioception and vibration sense, diminished Ankle DTR). DM--> hammer toe deformity!!! rx: - > cessation etho - > anticonvulsants: !!!! GABAPENTIN: dec deoplariztion neurons in CNS -> TCA : refractory pain ( caution in age >65 yr: antiAch effects)

Answer 202

- > gait disturbances due to incoordination of the limbs. - > dysmetria (eg, abnormal finger-to-nose test, pednular knee reflex muscle hypotonia) - > dysarthric speech, and intention tremor ( postural)

Answer 203

nephrotic syn: - > hematuria - > flank pain - > hypercoagulability: loss antithrombin III - > pnuria >3.5 g/day (hypoalbuminemia ): low plasma oncotic pressure --> inc Hepatic lipoprotein synthesis !!! inc risk: DVT, pul embolism , RVT --> ATS dx (HTN, DM) ** JVP is reduce / normal

Answer 204

sym: -> elev ICP : vomiting, PAPILLEDEMA !!!!! CLOGS arachnoid villi -> indolet sym: progressive DAYS - WKS ABSENT: neck stiffness, photophobia, compress N6 ( lateral gaze palsy + diplopia) dx: - > cryptococcal Ab testing CSF LP: - > lymphocytosis - > mild elev WBC - > low glc - > mild elev pn START RX first: 1. induction therapy: - > liposomal AmpB + FLUCYTOSINE >2 wks till acute sym resolve 2. consolidation rx: high dose oral fluconazole >8 wks to prevent relapse 3. maintenance rx: low dose oral fluconazole indefinitely / CD4> 100 for 3 months on ART

Answer 205

Etho cessation !!! spironlactone with furosemide paracentesis TIPS

Answer 206

moa: - > facial/ophthalmic venous system is valveless, uncontrolled infection of the skin - > sinuses, and orbit can spread to the cavernous sinus. -> Inflammation subsequently results ICH sym: - > HA, papilledema, ICH - > N 3, 4, 51, 52, 6 - > binocular palsies, periorbital edema, hypoesthesia, or hyperesthesia in V1/V2 distribution

Answer 207

sym: - > mild infection of the eyelid anterior to the orbital septum - > fever and eyelid erythema/edema. -> NOT extend beyond orbital septum

Answer 208

-> autonomic neuropathy, dest enteric neurons, freq hypoglycemia rx: -> metoclopramide, erythromycin

Answer 209

sym: - > DENDRITIC corneal ulcer, - > pain, photophobia, and decreased vision ** NOT cause typical vesicular rash / sys sym

Answer 210

PCP + CMV dx: -> bronchoalveolar lavage. rx: - > TMP-SMX !!!! - -> Pentamidine ( alternate ) -> paO2 <70, !!!! A-a gradient > 35: STEROIDS concomittant!!! * * CT : cannot confirm dx * ** pimaquine: high se: hypotension, nephrotoxicity, arrythmia, hypoglycemia

Answer 211

PROGGRESSIVE SOB over several days or weeks (subacute) rather than with sudden-onset chest pain **inc risk from: Cancer!! 1. Uncomplicated: - -> INC flow of sterile exudate into pleural space : small / moderate free flowing, Ph, glc near serum, low Leukocyte + LDH level - --> Rx: AB 2. Complicated effusion: pleural membrane disruption + contiguous bact spread from pneumonia --> pleural space: * * NOT WEDGE shape: vascular distribution , less hemoptysis !! - -> large free flowing/ loculated, low Ph + glc , high leukocyte and LDH level - ---> Rx: chest tube drainage + AB

Answer 212

moa: Reabsorption of sodium and calcium is coupled calcium-sensing receptor in the thick ascending limb of the loop of Henle rx: restrict sodium intake. dx: abd U/S - --> noncontrast spiral CT ** excessive Ca intake / HCTZ reduce urinary ca excretion -> inc recurrent stones *** ca binds oxalate -> form inabsorbable Ca oxalate in GI tract Ca restriction inc free oxalate absorption -> hyperoxaluria + urinary ca oxalate stone formation *** inc Vit C intake promotes hyperoxaluria

Answer 213

risk: - > inc UA excretion: gout, Myeloproliferative dx, DM - > inc urine conc: hot , arid climates, dehydration - > low urine PH: chronic diarrhea ( loss Hco3 + acidification urine) lab: - > radiolucent stones - > UA crystal - > urine ph <5.5 rx: alkalination urine : K citrate --> allopurinol :Recurrent gout: dec UA production, inhibit XO --> Colchicine: acute gout: ** TZD : dec urinary Ca excretion -> dec UA excretion , lower urine Ph and inc risk UA stone !!!

Answer 214

kidney: converting 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D by the enzyme 1-alpha-hydroxylase impaired 1-a-hydroxylation !!! --> 2ndry paraPTH --> !!!! hyperPO4, hypoCa 3rd hyperPTH: - -> end stage CKD: done cyst + brown tumor - -> hyperCA ( CALCIPHYLAXIS) - --> sys arteriolar calcification in soft tix deposits + local ischemia + necrosis - > inc PTH unresponsive to plasma ca,

Answer 215

----> resistant HTN : uncontrolled despite 3 rx inc Cr > 30% from baseline - > recurrent flash pul edema - > diffuse ATS!!! - > asymmetric kidney size - > abd bruit !!!! SYSTOLIC - DIASTOLIC ABD BRUITS !!! lat to one side !!! - > intermittent claudication sym (PAD) rx: First line rx: ---> ACEI / ARB : nephroprotective effects , dec intraglomerular pressure

Answer 216

etio: woman age>60 immune-mediated colitis characterized by watery, nonbloody diarrhea: secretory diarrhea : nocturnal diarrhea dx: -> mononuclear inflammatory infiltrate within the lamina propria. Types: ->Collagenous colitis - thickened subepithelial collagen band -> Lymphocytic colitis - high levels of intraepithelial lymphocytes rx: NSAIDS, PPI, SSRI, smoking cessation -> diarrhea persists: budesonide, loperamide

Answer 217

crackles, wheezing hypoxia hypocapnia resp alkalosis *** ACUTE COPD exacerbation: resp acidosis with CO2 retention - -> Rx: non-invasive PPV + methylprednisolone + ANTIBIOTIC 3-7 days!!! : dec inflammation + imp lung function + hypoxemia - ----> dec in-hosp mortality ** inhale glucocorticoid therapy: long term rx ASTHMA

Answer 218

sym: > 1 week of hx - -> psy features : grandiose themes --> ANTIDEPRESSENT monotherapy / combine should be AVOIDED cuz risk of precipitating MANIA !!! rx: - > LITHIUM se: renal failure, nephrogenic DI, chronic ATN , hypothyroidism / hyperthyroidism, seizure, tremor, HYPERPARATHYROIDISM --> rx: Lithium toxicity > 2.5 : hemodialysis!! renal excreted !!!!! -> 2nd Gen ANTIPSY Rx: quetiapine, lurasidone, olanzapine IM ( rapid onset) !!!! --> se/ weight gain , hyperlipidemia , DM --> anticonvulsant rx: PO lamotrigine (SJS) , valproate * **valproate acid se: liver toxicity + thrombocytopenia, NTD ( pregnant women)

Answer 219

-> Pain in pelvis, perineum, genitalia >3 months without identiry cause - > Irritative voiding symptoms (eg, urgency, hesitancy) - > Hematospermia, pain with ejaculation dx: -> sterile urine culture DRE: swollen, tender prostate rx: - > tamsulosin - > TMP-SMX/ ciprofloxacin for 6 wks - > finasteride

Answer 220

moa: Hyperreactivity of coronary smooth muscle risk: smoking sym: -> occurs at rest/ sleep <15 mins dx: - > ecg: ST elev - > coronary angiography: no CAD rx: - > CCB ( preventive) - -> dilates coronary ARTERIES + prevent anginal episodes: eg. diltiazem - > sublingual NG ( abortive): inc venous CAPACITANCE ** ASA avoided in vasospastic angina: inhibits prostacyclin -> worsen coronary vasospasm *** anti-HTN: induce hyperPROLACTINEMIA ( reserpine, methydopa, verapamil)

Answer 221

- > Dyspnea on exertion, - > decreased exercise tolerance - > Angina pectoris : INC MYOCARDIAL O2 DEMAND!!!!! - > Syncope (LH) - > Heart failure exam: transthoracic echo: MODERATE: -> crescendo-decrescendo systolic murmur -!!! > PULSUS PARVUS et ARDUS: slow rising ( delayed) + wk carotid pulse SEVERE: - > SOFT delay AV closure A2 + delay point during inspiration with almost simultaneous P2 closure. - --> SOFT + SINGLE S2 during inspiration !!! rx: AV replacement ** exercise stress testing: severe, sym AS contraindicated -> inc risk of syncope + death

Answer 222

immunocompetency pt with pul dx (TB) sym: -> >3 MONTHS of symptoms - fever, weight loss, fatigue, cough, hemoptysis, and/or dyspnea -> Cavitary lesion(s) containing debris, fluid, or an aspergilloma (fungus ball)!!!! dx: -> Positive Aspergillus IgG serology rx: -azole, Caspofungin, surgery, bronchial artery embolization

Answer 223

moa: -> Progesterone-induced hyperventilation sym: -> Dyspnea of pregnancy ↑ PaO2, ↓ PaCO2 (respiratory alkalosis) -> Lung volumes ↑ Minute ventilation ( ↑ tidal volume) ↓ RV & RFC -> Normal vital capacity & FEV1 * ** obesity BMI > 30 related restrictive rent, prevent expansion of chest wall: VC + TV dec, min vent dec - ----> A-a gradient NORMAL, PaCO2 > 45mmHg, alveolar HYPOventilation

Answer 224

- > acute illness involving the skin/mucosa urticarial rash, pruritus, flushing, WHEALS!!!! - ---> rapid onset, >2 organs sys inc -> respiratory or cardiovascular compromise: vasodilation, hypotension, tix edema, tachycardia. Wheezing, stridor Risk: - > immune disorders such as asthma. - > Medications such as NSAIDs worsen anaphylaxis by nonimmunologinc mast cell activation!!!! rx: - > IM epinephrine ( a1 + b2 +: vasoconstriction + bronchodilation, dec mast cells + basophils) ``` Airway management & Adjunctive therapy (eg, ANTI-H1 blocker, glucocorticoids) --> IV in severe / refractory cases ( higher risk arrythmia) ```

Answer 225

-> slow-growing, ulcerated, pearly nodule with a rolled border on sun-exposed skin, rx: Mohs microsurgery

Answer 226

painful, rapidly expanding ULCER with purple/dusky margins. -> occurs on the trunk or a lower extremity asso with: RA, IBD

Answer 227

- > vascular tumor -> red, beefy, friable NODULE grow rapidly over weeks or months. - > can bleed with minor trauma but are not typically ulcerated.

Answer 228

--> > 2 wks sym!!! CSF: - > Low 5-HIAA serotonin - > inc cortisol ( inc HPA axis)!!! dx: -> cosyntropin stimulation testing: primary adrenal insufficiency : salt craving responsible for modulating mood and behavior. --> inc risk : Pancreatic Ca Rx: CONTINUE rx INDEFINITELY!!!! -->> high recurrent illness, chronic episodes >2 yrs, ongoing psy stressors, severe episodes ( suicide attempts) !!! ADMIT HOSP : involuntary if necessary !!! active suicidal thoughts, intent / plan ----> ECT electroconvulsive therapy * **PSEUDODEMENTIA - -> cognitive impairment + slowing - > reversible inc risk: inc # of depressive episodes

Answer 229

A diffuse 3-Hz spike and wave pattern

Answer 230

EEG: Generalized slowing with periodic sharp wave complexes CSF: - > increased CSF 14-3-3 protein - > positive RT-QuIC test MRI: -> widespread atrophy (cerebrum & cerebellum), cortical enhancement (ie, cortical ribboning), enhancement of putamen & caudate head (ie, hockey stick sign)

Answer 231

- > Inc natriuresis - > Dec serum AT-II concentration - > Dec aldosterone production. -> direct renin inhibitors

Answer 232

CD4 <200 --> Immunosuppressed ( prednisone use) dx: CT scan chest MC: STREP PN -> "rusty sputum" -> cxr: cavitary infiltrate * * s. aureus -> IE - -> more common risk in : adv age, poor dentition, injection drug user - -> inc in influenza s/p 2ndry bacterial pneumonia !!! LUNG cavity * ** influenza: self limited: <1 wk systemic + resp sym ( rhinorrhea, sore throat, nonproductive cough) , leukocytes <15,000 - --> Oseltamivir : w/in 48 HOURS!!! - -> no need dx testing !! - -> comp: PN

Answer 233

transuzumab rx: HER2 + breast ca -> se: cardiotoxicity dx: cardioecho tamoxifen : - -> Estrogen + breast ca se: venous thromboembolism , DVT ( factor V Leiden mut) ---> MC loc @ cerebral vein !!!

Answer 234

Septic shock !!! -> HYPOtension -> respiratory failure -> leukocytosis, fever lab: -> inc liver enz > 10,000 : diffuse liver injury due to hypotension ** acute viral hepatitis: large liver enz elev >1000 + hyperbilibinermia, nausea, vomiting

Answer 235

---> OLDER patient with vascular risk ( HTN, DM, Hyperlipidemia, smoking) etio: - > microatheroma formation and lipohyalinosis --> thrombotic small-vessel occlusion - ---> HTN !!!! - > Dm , advance age, inc LDL, smoking -> @ INTERNAL CAPSULE sym: -> pure MOTOR hemiparesis due to injury of the corticospinal (posterior limb) and corticobulbar (genu) tracts. - > weakness equally involving the contralateral face, arm, and leg. - > Sensory deficits, mental status changes, seizure, and cortical signs are typically ABSENT. * *** @ THALAMIC - -.> PURE SENSORY !!! - -> PCA branch - -> contralateral sensory loss - -> allodynia (paroxysmal burning pain)

Answer 236

---> HTN strongest asso !!! -> PROFOUND neurologic deficits (eg, contralateral homonymous hemianopsia, hemiparesis, hemisensory loss) due to ischemic infarction of the cerebral hemisphere

Answer 237

lab: -> dramatic leukocytosis, primarily with lymphocytes -> hairy projections , smudge cells sym: - > HSM, LAD - > bicytopenia (anemia, thrombocytopenia - > hypogammaglobulinemia + defects in cell signaling inc risk and severity of infections dx: flow cytometry ( mature B cells) + smudge cells + coombs test comp: - > inf - > autoimmune hemolytic anemia : WARM , IgG / C3 - > richter transformation

Answer 238

lab: - > calcium pyrophosphate dihydrate (CPPD) crystals !!!!!! - > chondrocalcinosis (calcification of articular cartilage) into the joint space * * NOT btwn muscle / tendons!! lab: - > synovial fluid: inflammatory effusion - > rhomboid shaped + birefringent crystals

Answer 239

transient perioperative bacteremia ---> common realted to : RA, OA, recurrent GOUT dx: synovial fluid analysis lab: -> leuocytosis >50,000 rx: IV AB + joint drainage

Answer 240

- > autoimmune inflammatory demyelinating disorder CNS - --> HLA-DRB1 INC risk: - > Uhthoff phenomenon: hot temp worsen the sym!!! - --> young WOMEN : early POSTPARTUM !!! - ----> VIT D DEFICIENCY!!! sym: - > NERUO deficits disseminated in space and time - > eg, sensory loss/paresthesias of the extremities, dizziness - > OPTIC NEURITIS in women age 15-50. - --> inc risk: DEPRESSION!! *** NOT affect proximal muscle + EOM!!!! dx: MRI: hypo/hyperintense lesion white matter @ periventricular , corpus callosum

Answer 241

adjustment dx: -> within 3 months -> identifiable stressor not last longer <6 months rx: psychotherapy!!! acute stress dx: - > > 3 days - < 1 month - > exposure actual trama - > dissociative syn " daze" - ---> monitor PTSD!!!! rx: CBT

Answer 242

!!!! concentric LV hypertrophy --> due to systemic HTN / severe AS/ ACUTE phase MI -> blood striking a stiff LV during atrial SYSTOLE, just before MV closure (S1) * ** inc risk: concentric myocardial hypertrophy: acromegaly!!! - > inc IGF-1

Answer 243

COHORT: RR -------> det INCIDENCE!!! exposure status - > exp vs nonexposed to a risk factor / rx - -> retrospective cohort : Ascertain risk factor EXPOSURE and then determine the outcome CASE CONTROL: Odd Ratio dx/ non-dx --> determine the SINGLE OUTCOME first then look for ASSO RISK FACTORS > 1 OR = 1.0 ( null value --> Ho) ---> Ho : NO asso ****RARE dx ASSUMPTION: outcome is uncommon (rare) in POP ( low dx prevalence): odd ratio is close approx of relative risk

Answer 244

Videofluoroscopic modified barium swallow study -> to evaluate swallowing mechanics, degree of dysfunction, and severity of aspiration *** esophageal motility studies + upper endoscopy: evaluate ESOPHAGEAL dysphagia: sensation food stuck in esophagus ( not THROAT)

Answer 245

1. low risk : no add dx testing 2. intermediate risk: able to exercise? - -> exercise yes: Normal ECG --> exercise ECG test --> coronary angiography --> exercise yes: Normal ECG: NOT able to exercise: exercise imagine test --> coronary angiography NOT able to exercise: pharm stress imaging test --> coronary angio 3. HIGH risk : start pharm rx CAD *** TTE : takotsubo stress CMP : OLDER woman after stress

Answer 246

lab: hypoNa !!!!!! serum osm LOW < 275 (diluted) !!!!! Urine osm HIGH >100 (highly concentrated) Urine Na >40 ( concentrated) rx: fluid restriction + high salt ** demeclocycline : only after fluid restriction and high salt intake FAILS

Answer 247

moa: replacement of terminal hairs by smaller vellus hairs (follicular miniaturization) sym: -> hair loss gradual thinning of the hair at the vertex and midline rx: - > topical minoxidil ( direct vasodilator inc BF to scalp) - > antiandrogenic agents ( spironolactone, finasteride): once minoxidil fails

Answer 248

etio: autoimmune attack on hair bulb cells -genetic asso : vitiligo, hypothyroidism sym: rounded patches of nonscarring, complete hair loss. rx: intralesional corticosteroids (triamcinolone) - >

Answer 249

sym: severe pyogenic bacterial infection -----> ENCAPSULATED organism risk: splenectomy pt!!!

Answer 250

- > urinary alkalization Ph >8 - > magnesium ammonium phosphate - > proteus mirabilis - > klebsiella pn ** E. coli mcc UTI : NOT produce urease !!!

Answer 251

-> Numbness or pain between the 3rd & 4th toes Mulder sign: -> Clicking sensation when palpating space between 3rd & 4th toes while squeezing the metatarsal joints

Answer 252

Plantar surface of the heel Worse when initiating running or first steps of the day

Answer 253

sym: - > adults - > painless peripheral LAD - > mediastinal, hilar mass - > B sym lab: - > Bcl-2 (18) - > t (14, 18) rx: rituximab ( monoclonal ab against CD 20)

Answer 254

moa: - > defect in a hepatocyte transporter protein --> unable bilirubin excretion into the biliary system - > Impaired hepatic excretion of conjugated bilirubin dx: liver biopsy -> grossly black liver and dark, granular pigment accumulation within hepatocytes lab: - > inc direct hyperbilirubinemia and bilirubinuria ** Rotor syn: liver biopsy NORMAL!!!

Answer 255

- > type 1 diabetes mellitus - > Calorie and carbohydrate restriction can cause ketosis !! - -> young age: GI infection + dehydration lab: - > total body K deficit from osm diuresis - > 2ndary hyperALDO: vol contraction: K excretion + reabsorption Na DCT --> hyperOSM: draws fluid and K passively out of cells into the extracellular space. --> insulin deficiency: impairs cellular entry of K by the cells, further increasing EC K concentration. dx: fingerstick glc, electrolytes ( K) rx: !!!! NORMAL 0.9% saline + IV REGULAR insulin + IV K ( when serum K <5.3) --> glc <200 : DEXTROSE fluid avoid hypoglycemia + insulin ** HYPERtonic saline: reserve for moderate - severe hypoNa

Answer 256

!!!!! 1. Naltrexone: mu-opioid receptor antagonist --> se: hepatotoxicity 2. Acamprosate: glutamate modulator (preferred in patients with liver disease or opioid use) - -> help risk relapse 3. Disulfiram is second-line 2nd line rx in HIGHLY motivated patients ** BZD (chlordiazepoxide) : moderate - severe etho withdrawal !!! not for AUD

Answer 257

association between 1 quantitative DEPENDENT variable (eg, outcome) and ≥1 INdependent variables (eg, exposures, risk factors)

Answer 258

1. primary achalasia (ie, loss of peristalsis in the distal esophagus with lack of lower esophageal sphincter relaxation) 2. pseudoachalasia -> esophageal cancer sym: 1. tabacco 2. sig WL, rapid sym onset < 6 months , age > 60 yr 3. tumor MTS ( mediastinal LN) local inv : widened mediastinum rx: endoscopic evaluation: --> achalasia, normal-appearing esophageal mucosa and a DILATION esophagus with possible residual material --> pseudoachalasia: not easy to pass!!!

Answer 259

-> S aureus is the most common etiology in adults. sym: - > conjunctival erythema and thick, purulent eye discharge - > reaccumulates within a few minutes after wiping.

Answer 260

adenovirus sym: - > watery, scant , stringy - > no reappearing after wiping - > asso with URI (eg, rhinorrhea, sore throat, cough) rx: warm / cold compresses - > antihistamine / decongestant drops

Answer 261

similar to GLP-1 agonist not cardioprotective weight neutral

Answer 262

>1 day < 1 month - > sudden onset - > acute dev paranoid delusion + bizarre behavior from stressor - > full return to function

Answer 263

sym: developing country - > 90% of patients asymptomatic - > Colitis (diarrhea, bloody stool with mucus, abdominal pain) - > amebic Liver abscess (RUQ pain, fever) - > Complications: rupture to pleura/peritoneum dx: - > Stool ova & parasites, stool antigen testing (colitis) - > E histolytica serology (liver abscess) Rx: Metronidazole & intraluminal antibiotic (eg, paromomycin)

Answer 264

sym: - > elevated intraocular pressure (IOP) - -> atrophy of the optic nerve head (eg, optic disc rim thinning, increased cup/disc ratio ["CUPPING"]). sym: - > gradual loss of PERIPHERAL vision!!!! rx: 1. topical prostaglandin (latanoprost) : inc drainage of aq humor thru uveoscleral pathway 2. topical beta blocker added - -> caution with asthma dx: ocular tonometry : measure IOP ** atropine : dilates pupil facilitate eye exam --> contra OAG

Answer 265

lab: - > elev conjugated direct hyperbilirubinemia - > elev ALP > 1.5 limit dx: abd U/S: biliary dilation : extrahepatic cholestasis absence dilation: intrahepatic cholestasis

Answer 266

PPV = decreases !!! dep on prevalence of the disease in the pop BEGING TESTED!!! PREVALANCE inc = inc PPV , dec NPV False negative = 1- NPV higher NPV = LOWER dx PREVALANCE ---> pt without dx is GREATER !!!

Answer 267

- > multiple ORAL and GENITAL ulcers that are recurrent and PAINFUL. - > Uveitis is common. dx: PATHERY test: 20G needle into skin check for >2mm papule

Answer 268

damage to multipotent hematopeietic stem cells -> alter to stem cell surface Ag -> cytotoxic T cell destruction etio: - > aplastic anemia - > inf, vit def, Rx sym: - > absence of splenomegaly - > pancytopenia peripheral smear lab: - > low reticulocyte count - > hypocellular marrow, no myeloid infiltration/ fibrosis , inc stroma /adipocytes **** NO BONE PAIN !!!

Answer 269

moa: collagen or reticulin deposition in BM --> diminished (or increased) peripheral blood counts. sym: - > HSM ( extramedullary hematopoiesis) - > peripheral blood smear: immature leukocytes + fragmented megakaryocytes risk: AML - --> t ( 15, 17) auer rods - --> inc risk of pancytopenia: hemorrhage + consumptive coagulopathy ( DIC) !!! - -> inc LDH rx: all trans retinoic acid

Answer 270

impaired DNA synthesis in precursor cells --> B12 def : terminal ileum -> MCV >100 etio: Chronic METFORMIN : -> neuropsy : myelinated fibers in brain -> sensory ataxia: dorsal columns -> + BANBSKI sign: lat corticospinal tract lab: - > methylmalonic acid - > homocysteine level

Answer 271

inital: - > NSAIDS, ketorolac severe pain: - > short-acting opioids - > morphine , hydromophone - -> dose adjustment + calculate - > transdermal fentanyl patches ** avoid long acting opioids prevent resp depression

Answer 272

SAME region: 1. external bronchial compression : LAD, CA 2. internal bronchial ob: foreign body, bronchiectasis, bronchial stenosis 3. recurrent aspiration: - > seizure - > dementia!!! - > etho - > gerd, dysphagia --> etio: foul smelling, poor dentation : oral !!!! ANaerobic rx: -> CLINDAMYCIN!! -> metronidazole + amoxicillin, amox-clavulanate/ carbapenem dx: -> ct scan chest ** bronchoscopy : to obtain lung tix biopsy when mass identified on CT scan!!!

Answer 273

CD4 < 50 lab: -> elev ALP sym: - > LAD, nonsp symptoms - > HSM rx: - > macrolides + ethambutol - ---> NOT given for PPX * * TMX-dapsone: rx: PCP * * TMX-SMX/ pyrimethamine: rx: toxoplasmosis

Answer 274

Vomiting: loss NaCl + H+ : GI losses!!!!! conseq: - -> met alkalosis , ph inc - > inc HCO3 - ----> DEC urine Cl- cuz body tried to reabsorb back into body!!! rx: IV fluid + K supp Diarrhea + RTA: loss HCO3 - -> met acidosis non-AG change , dec Ph - -> inc K

Answer 275

- > gradual-onset shoulder stiffness + reduction in both passive/ active ROM in multiple planes. - > Reflexes are unaffected.

Answer 276

Osteophyte formation in facet -> neural foramina narrowing !!!! -> compression of the nerve root due to HIVD ( acute symptom onset) --> pain in neck + upper ext + loss sensory/ motor deficits + dinimish reflexes -> progressive spinal spondylosis (evidenced by subacute or progressive symptom onset). MC in middle-aged men -> develop after repetitive exercise (eg, golf). dx: should abd relief test --> NO MRI needed rx: NSAIDS, PT

Answer 277

``` CML: BCR-ABL t (9,22) -> leukocytosis >100,000 + basophilia , left shifts ------> LAP LOW ----> Metamyelocytes < Myeocytes ( more) ``` rx: TK inhibitor : imatinib Leukemoid rxn: - -> > 50,000 - > severe Infection - -----> LAP HIGH - > more mature metamyelocytes > myelocytes - -> NO basophilia

Answer 278

estrogen up-regulate production of TBG in liver -> DEC free T4, T3 level lab: - > inc TBG - > inc TSH - > dec free T3, T4 rx: inc levothyroxine dose

Answer 279

``` dx: hemoglobin electrophoresis -> diff btwn thalassemia : target cell (AR), sickle cell Hg C/E ```

Answer 280

psy ED -> sudden onset sym: -> Persistence of nocturnal + early-morning penile erections organic ED: -> progressive, slowly , advance age

Answer 281

near daily HA -> preexisting HA dx ( migraine) > 3 months - > worsen upon awakening , quick rebound - > transition from episodic migraine to chronic migraine / dev new HA pattern ------> with AURA: avoid OCP pills : inc risk ischemic stroke !!! * ** Migraine w/o aura: - -> n/v, photophobia - -> pulsatile , throbbing, UNILATERAL

Answer 282

-> Behavioral therapy (habit reversal training) -> AntiDA: Tetrabenazine (VMAT2 inhibitor) - > Antipsychotics (receptor blockers): RISPERIDONE - > Alpha-2 adrenergic receptor agonists: guanfacine, clonidine

Answer 283

prolonged hypoxia - > acute : generalized , poor prognosis - > chronic : focal, weeks

Answer 284

AD disorder sym: - > diffuse telangiectasias (eg, ruby-colored papules that blanch with pressure) - > recurrent epistaxis, and widespread arteriovenous malformations (AVMs) - -> Pul AVM, digital clubbing -> reactive polycythemia

Answer 285

lateral ventricular enlargement - -> freq anxiety , acute psy episode - -> avoid BZD : risk of abuse + dependence !!!! ** OCD: Structural abnormalities in the orbitofrontal cortex and BG rx: antipsy FAMILY THERAPY!!!: reduce re-hospitalization

Answer 286

etio: - > Chronic alcoholism (MCC) - > Malnutrition (eg, anorexia nervosa, CD) - > Hyperemesis gravidarum sym: - > Confusion - > Ataxia - > Nystagmus rx: thiamine B1 + glc Korsakoff syn: retrograde + anterograde amnesia + confabulation

Answer 287

- > primarily vasodilators and dilate veins, arterioles ( dec afterload), and coronary arteries by relaxing vascular SM. - > Systemic VENOdilation lowers preload + dec LVEDV --> REDUCES myocardial O2 demand by REDUCING WALL STRESS!!!!!! !!!! ** NOT have direct effect on HR, ventricular compliance, CONTRACTILITY EF

Answer 288

AR mutation of ATP7B → hepatic copper accumulation → leak from damaged hepatocytes → deposits in tissues (eg, basal ganglia, cornea) sym: NHP - > hepatic LF, CIRRHOSIS - > NEURO: PARKINSONISM , gait, dysarthria - > PSY: depression, personality change, pyschosis rx: chelators, D-Penicillamine, trientine - > zinc interferes with copper absorption

Answer 289

- > parkinsonism - > chorea - > dementia, personality change - > delayed saccades - > motor impersistence - > Family Hx ** NO liver disease!!! occur MID-life

Answer 290

-> young women sym: -------> ANTI-SMOOTH MUSCLE AB!!! - > ASX - > large inc liver enz - > inc bilirubin - > hypergammaglobulinemia + gamma gap (total pn- albumin = > 4) --> with comorbid autoimmune dx ( vitiligo, auto thyroiditis) rx: steroids

Answer 291

etio: Plasma cell neoplasm produces monoclonal paraprotein (IG) ----> ELECTROLYTES disturbance !!! - ---> AL amyloidosis - > hyperCa : constipation - > Renal failure ( granular casts) - > Anemia - > Bone pain, !!! OSTEOLYTIC / osteopenia - > recurrent infection : strep pn, UTI - ---> waxy , TIGHT SKIN ( epidermal deposits) dx: - -> serum pn electrophoresis (SPEP) - > bone biopsy lab: - > hyperCA - > M-spike *** NOT elev ESR!! * ** waldernstrom macroglobinemia : - -> inc risk HYPERVISCOSITY syn: blurred vision, diplopia, confusion - > HSM, NEUROPATHY - -> rouleaux formation - --> "sausage link" : dilated, segmented, tortuous, RETINAL VEIN

Answer 292

similar to SLE, polymyositis lab: - > anti-U1 ribonucleoprotein - > ANA - > RF, anti-CCP - > elev CK - > anemia dx: muscle biopsy

Answer 293

-> elev liver enz > 1000 - > hepatic ENCEPHALOPATHY!!! - > hepatic necrosis : NAPQI toxic - -> coma, BS herniation, death - > synthetic liver dysfunction - > prolong PT, INR >1.5 rx: - -> hemodialysis - > liver transplantation

Answer 294

- > inc testosterone: hirsutism, severe acne, androgenic alopecia) - > inc estrogen - > LH/FSH imbalance dx: -> OCTT : type 2 DM common in PCOS rx: - > weight loss (1st) - > OCP MC regulation - > letrozole ( aromatase inhibitor) ovulation induction ** leuprolide: GNRH agonist: rx endometriosis -> plevic pain, dysmenorrhea ** spironolactone (androgen receptor antagonist) : rx hirsutism only

Answer 295

- > SSRI - > lidocaine - > psychotherapy, joint/ couple therapy

Answer 296

- > ring enhancing lesions @ gray -white matter junction + BG - > CD4 < 100 rx: TMP-SMX ** fluconazole : rx/ coccidioidomycosis *** TMP: blocking ENaC @ Collecting tubules : hyperkalemia + elev Cr!!! --> inc risk HYPERKALEMIA

Answer 297

rx: - > exercise - > TCA

Answer 298

etio: -> EMOTIONAL stress, prolonged standing sym: !!! RAPID recovery < 1-2 mins -> PRODROME: nausea, diaphoresis, pallor, LH --> follow LOC -> cardioinhibiotry response --> inc PNS !!!!! --> sinus BRADYCARDIA + asystole sinus arrest rx: counterpressure tech: leg crossing with tensing muscle, hand-griping, tensing arm muscle : inc VR + CO : abort syncope episode

Answer 299

acute toxicity: --> cerebellar dysfunction: HORIZONTAL NYSTAGMUS, ataxia, hyper-reflexia, AMS -> folic acid deficiency : impairs folic acids : def impairs DNA synthesis --> megaloblastic anemia !! -----> FETAL HYDANTOIN syndrome -> gingival overgrowth / hyperplasia absorption in jejunum rx: FOLIC acid supp - --> slow taper rx ** inhibits p450 system: TMP-SMX inc risk of toxicity!!!

Answer 300

methylxanthines: - > PDE inhibitors that cause bronchodilation. ipratropium: --> Anti-muscarinic agents!!! rx: -> chronic management of patients with uncontrolled asthma or severe COPD ** no benefits in acute exacerbation COPD * ** Beta blocker: cell surface receptor blocker - --> WORSEN sym

Answer 301

etio: TMP-SMX, nitrofurantoin , fave beans G6PD activity - > LOW sensitivity!!! lab: - > inc indirect bilirubin - > BITE cells + HEINZ bodies ( dark red erythrocyte inclusion) - > coombs negative - > low Hbg - > inc LDH - > dec HAPTOGLOBIN

Answer 302

AR - > dec ATP -> rigid RBC -> extravascular hemolysis - > inc 2,3 BPG sym: - > chronic hemolysis, -> hepatosplenomegaly, -> skin ulcers - > pigmented gallstones.

Answer 303

sickle cells, howell -jolly bodies!!!!!!!! - -> dec Hbg, dec haptoglobin, dec PT, - -> inc indirect bilirubin, inc LDH dx: electrophresis !!! rx: hydroxyurea

Answer 304

- > specific pint in time "snapshot" - > Can determine PREVALENCE of an outcome in a population --> PREVALENCE odds ratio

Answer 305

!!!! POPULATIONS rather than individual eg> national data

Answer 306

Reporting bias: subjects over- or under-report exposure history due to perceived social stigmatization. Nonreporting bias: -> high nonresponse rate

Answer 307

Berkson: disease studied using only HOSP -based pt -> not represent general pop Neyman ( PREVALENCE) -> exposure happen long before dx assessment, therefore can miss dx that DIE / recover ( prevalence bias)

Answer 308

risk : - > sepsis - > shock : splanchnic hypoperfusion, reflux bile, acc uremia toxins sym: - > GI bleeding, occult ( anemia , + occult blood testing) - > melena, hematemesis with shock ppx: -> PPI

Answer 309

- > hypoperfusion affect watershed areas - > crampy left side abd pain - > overt hematochezia short during/ after hypotension

Answer 310

asso: paraneoplastic syndromes: LES, MG, CA breast, lung, ovaries - > dermatomyositis (muscle fibers) ------> Inf myopathy mediated by CYTOTOXIC T-LYMPHOCYTES sym: -> DISTAL muscle wkness, symmetrical, proximal , ERYTHEMATOUS RASH dorsal fingers (GOTTRON sign) , upper eyelids ( HELIOTROPE eruption) dx: muscle bx **NO UMN sign!!!

Answer 311

inc risk: inc INR - > Ab; APAP - > azole - > amiodarone - > cimetidine - > grapefruit juice REDUCE warfarin: dec INR - > spinach, brussels sprouts - > phenytoin - > rifampin - > phenobarbital - > carbamazepine - > st. johns wort

Answer 312

B12 deficiency -> vitiligo , older pt - > intrinsic factor : ab-mediated destruction - > target gastric parietal cells : atrophy acid/pepsin producing part of stomach - -> macrocytic anemia - -> elev serum gastric level risk: - -> intestinal type metaplasia GASTRIC ca: GLOSSITIS - -> autoimmune metaplastic atrophic gastritis dx: EGD

Answer 313

- > Severe epigastric pain - > Elevated serum lipase >3 times the upper limit of normal - > CT scan: pancreatic inflammation etio: - > TZD, loops - > ACEI - > statin - > TMP_SMX, insoiazid moa: -> hypersensitivity to sulf molecules, pancreatic ischemia reduce BV -> inc viscosity + secretion lab: -> hyperTG>1000

Answer 314

``` -> Muscarinic: Diarrhea/diaphoresis Urination Miosis Bronchospasms, bronchorrhea, bradycardia Emesis Lacrimation Salivation ``` -> Nicotinic: muscle weakness, paralysis, fasciculations rx: - > Atropine reverses muscarinic symptoms -> Pralidoxime reverses nicotinic and muscarinic symptoms (administer after atropine) dx: RBC ACETYLCHOLINESTERASE activity !!!!!

Answer 315

types: type 1 HIT: nonimmune direct effect on heparin on pt aggregation --> first 2 days of exposure !!!!! type 2 HIT: more serious, immune mediated dx: Ab to pt factor 4 (PF4) - -> risk of thrombocytopenia - --> THROMBOSIS (arterial or venous):!!!! --> >50% drop in the pt count from baseline 5-10 days after the initiation of rx. Etio caused by: UnFRACTIONAED HEPARIN rx: discontinue all anticoagulants - > LMWH - > enoxaparin, dalteparin - > fondaparinux

Answer 316

- > venous HTN - > leg discomfort, pain, or swelling worse in the evening or following prolonged standing - > pitting edema - > lipodermatosclerosis , skin ulceration (medical aspect) rx: - > improves after walking or leg elevation. - > compression stocking dx: -> DUPLEX U/S: venous reflux!!!!!

Answer 317

pericardial friction rub ecg: diffuse ST segment elevation + PR seg depression rx: NSAIDS + COLCHICINE !! *** NSAIDS + prednisone combination avoided: Renal failure !!!! **DRESSLER syn: WKS s/p pericarditis MI ( Ab to myocardial Ag) * ** Peri-infarction pericarditis ( PIP): 2-4 days s/p MI - --> PPX/ early CORONARY REPERFUSION!!!

Answer 318

1. age < 40 w/o red flags - > ANOSCOPY 2. age 40-49 with RED flags - > sigomoidscopy / colonoscopy 3. age >50 with RED flags - > colonoscopy

Answer 319

Allowing recently seen or memorable (high-stakes) cases to sway diagnosis

Answer 320

Emphasizing evidence that supports PRESUMED diagnosis & overlooking information that supports other diagnoses -> Related to anchoring bias

Answer 321

Fixating on INITIAL impressions to make a diagnosis -> Related to confirmation bias

Answer 322

Allowing diagnostic approach to be influenced by context & presentation of information eg. abd pain dx as Opioid w/drawal drug seeking actual dx: bowel obstruction

Answer 323

AST> ALT > 2 times ratio ( <300IU/L) - > elev GGT - > elev ferritin ( acute phase reactant)

Answer 324

+ 1 point: - > hemoptysis - > cancer +1.5: - > previous PE/ DVT - > HR >100 - > recent sx/ immbolization +3: - > clinical sign DVT - > alternate dx less likely than PE > 4 PE likely <4 unlikely PE Rx: ACUTE DVT/ PE : rapid ONSET, NO req INR monitoring + NO req OVERLAP rx ---> pt diff with dietary restriction / freq monitoring --> oral direct Xa inhibitors ( Rivaroxaban, apixaban) *** VC filter: when failure to control with INR / recurrent emboli / active bleeding

Answer 325

odds od exposure in cases eg. OR= 1 when (given OR = 3.5) ( 3.5 -1 ) /1 = 2.5 =250% 1 = 100% ADJUSTED OR - account for the effect of potential cofounders : better estimates of asso *** Unadjusted OR : DOES NOT account !!

Answer 326

MC adverse transfusion rxn -> benign cause by CYTOKINE !!!! release from leukocytes within donar blood product - > release cytokines : transient fever, chills, malaise w/in 1-6 hrs rx: cessation + APAP PPX: LEUKOREDUCED blood products -> mini cyokine production + reduce HLA alloimmunization CMV transmission ** ppx with antihistamine : NOT reduce FNHTR

Answer 327

-> Mismatched donor and recipient blood.: ABO incompatibility!!!! Sym: - > chills, flank pain - > gross HEMATURIA within 1 hour transfusion.!!! - -> Acute RF ( ATN) - -> DIC - > + direct antiglobulin (Coombs) test, - > increased plasma-free hemoglobin, and hemoglobinuria.

Answer 328

painless , rapid, transient (<10 mins), monocular vision loss - > CURTAIN descending over visual field etio: retinal ischemia : ATS emboli ( ipsilateral internal carotid artery) dx: duplex U/S neck

Answer 329

- > IRON overload - -> elev liver enz - > DM - >cirrhosis - > hypogonadism - > arthritis (chondrocalcinosis): CPPD pseudogout - > HF - -> bronze DM : acanthosis @ sun exposed area: FACE!!!

Answer 330

ASX -> HM with elev liver enz - > fatty infiltration liver - > obesity , DM, hyperTG

Answer 331

moa: - > inherited disorders by epithelial fragility (eg, bullae, erosions, ulcers) triggered by minor trauma - -> friction blisters at PALMS + SOLES - > thickening skin of feet - > oral blisters with BOTTLE -feeding -->mutation pn iv in intraepidermal + dermoepidermal adhesion complexes BM zone types: 1. simplex 2. junctional 3. dystrophic 4. kindler syn

Answer 332

---> LOW AMP , relative FAST 10-12 Hz sym: fine, fast, symmetric action tremor INC with SNS ACTIVITY --> IMPROVE with REST!! --> NON-progressive , dec over time etio: - > dose dep drug enhanced eg. SSRI, beta +, lithium ( iron acc in substantia nigra) - > stress, anxiety, caffeine - > med condition: hypoglycemia, etho, thyrotoxicosis, liver dx

Answer 333

eye: - > VZV @ N1 - > elderly - > fever malaise and a burning, itching sensation in the periorbital region. - > vesicular rash in the distribution of the cutaneous branch of the V1 Ears: VZV @ N7 , 8 --> vesicular rash auditory canal / auricle -> ipsilateral facial paralysis

Answer 334

antihistamine H1 ( more effective) -> not effective 2-3 wks : further dx

Answer 335

- > women age 15-50. - > noninflammatory + nonatherosclerotic sym: - > HTN, non sp --> 2ndry hyperaldosteronism - > brain ischemia ( TIA, stroke, amaurosis fugax) - > carotid bruit - > inv artery ( renal, carotid, vertebral) dx: -> CT abd/ duplex u/s

Answer 336

WORSEN with ACTION -> anxiety , outstretch arms More pronounced @ "END GOAL directed movement" -> improves with etho , REST rx: beta blocker: propranolol - > anticonvulsants: PRIMIDONE **** Clonidine: central acting A2-adrenergic agonist: adjunctive severe HTN

Answer 337

noncomplence to rx highest risk !!! -> DAPT : ASA + P2Y12 receptor blocker ( clopidogrel, prasugrel, ticagrelor) -> STEMI / non- STEMI/ unstable angina *** severe AS : concentric LVH : AV stenosis <1 cm

Answer 338

-> acute MI sym: -> dec myocardial contractility -> LOW CI -> hypotension + reflexive tachycardia -> failure foward blood flow !!!! --- > back up to LUNG --> PUL EDEMA ( dyspnea, tachypnea, hypoxemia) --> inc PCWP!!!! LA inc -> SVR inc : vasoconstriction, cool extremities

Answer 339

Right side tension pnthorax --> pinching VC --> dec venous return to RA - > CVP inv ( right side preload) - > inc SVR - > dec PCWP + CI ( dec blood delivery to LA)

Answer 340

-> chronic ANTERIOR knee pain in YOUNG women dx: - > negotating stairs, prolonged sitting - > atrophy / wkness QUARDICEPS / hip adbuctors , varus/ valgus malalignment -> reproducible with isometric quadriceps contraction (eg, squatting). rx: - > MUSCLE EXERCISE: strengthening the quadriceps and hip abductors. - > NSAIDS *** rigid knee immboilizers : short term rx patella fracture / rupture of quadriceps/ patellar ligament --> not rx here : can cause MUSCLE ATROPHY!!

Answer 341

anterior laxity tibia

Answer 342

loss knee extension -> swelling + deformity

Answer 343

repetitve tenderness at tibila tubercle - > preadolescent / adolescent during rapid growth spurts * uncommon in adults

Answer 344

chronic inflammations suppression of RBC production by inflammatory cytokines -> etio: RA , SLE, Ca dx: -> cbc, iron studies lab: - -> normochromic normocytic RBC - > transferrin: sat mildly dec - > MCV: normal/ dec - > iron dec - > TIBC dec - > Ferritin: N/ inc - > TIBC N/ dec - > retiuclocyte count: LOW ( impair RBC production) -> Hepcidin : bind + destroy iron channel on RBC --> dec iron absorption + release . --> IRON trapping within macrophages , dec serum iron concentration , poor iron available for Hbg synthesis rx: rx underline dx

Answer 345

PPA: strictly adhered and completed protocol - > excluding dropouts , true effect , assuming perfect scenario - > OVERESTIMATES the actual practical clinical setting ITT: keeping all dropouts , conservative estimate of the effect , REALISTIC clinical setting

Answer 346

antiphospholipid ab mixing study FAILS to correct prolong aPTT -> risk of fetal loss + thromboembolism -> DVT lab: - > anticardiolipin ab - > anti-beta2-glycoprotein 1 ab * * VWF def : ASX - -> easy brusing + mucocutaneous bleeding, prolong aPTT : will CORRECT with mix study (F8)

Answer 347

etio: inv ascending aorta (between the aortic valve and the brachiocephalic artery) etio: 1. degenerative changes : disruption aortic wall medial layer : loss elasticity + AD 2. HTN 3. cxn tix dx sym: -> AXS CXR: -> widened mediastinum, enlarged aortic knob, and tracheal deviation * * hiatal hernia : round retrocardiac mediastinal density with air-fluid level - > GERD

Answer 348

!!!! -> renal: nephrotic syn: PNURIA >3.5 !!!!! - > skin ecchymoses, waxy skin - > RESTRICITIVE CMP: CHF, LVH, nondilated LV cavity - > HM, !!!! dysmotility - > neruo: peripheral neuro, dementia, stroke lab: - > ESR - > normocytic anemia tix biopsy: -> amyloid congo red , amorphous hyaline material * * Proliferative GN --> cellular proliferation and glomerular immune deposits : HTN, hematuria, and RBC casts - ---> dec GFR !!!

Answer 349

first line: CBT | than: SSRI

Answer 350

-> elderly person in dry environment - > eczematous plaques - > improve with moisture

Answer 351

- > idopathic inflammatory dx - > MC in middle -age older pt - > "COIN" like !!! rx: -> topical glucocorticoids

Answer 352

- > asymmetric septal hypertrophy and abnormal systolic anterior motion of the mitral valve - > LV outflow tract (LVOT) obstruction. - -> harsh cresendo - decrescendo murmur @ left sternal borders - -> INCREASE with dec LV vol ( valsalva) - --> DECREASE with inc LV vol ( squatting) rx: Beta blocker, CCB, disopyramide - > neg inotropic agents ( prolong diastole + dec myocardial contractility)

Answer 353

- > distortion of STRAIGHT lines such that they appear wavy. - >macula inv first "drusen deposits" etio - > age - > smoking

Answer 354

- > detrusor overactivity - > >40 yo with prior pelvic surgery rx: - > bladder training kegel training - > anti-muscarinic (oxybutynin): dec Ach activity : dec detrusor contraction , dec sense urgency se: dry mouth, constipation, blurry vision * * Pessary: rx stress urinary incontinence - -> pelvic organ prolapse (ant vag wall bulge)

Answer 355

disruption throacic duct - > malignancy, trauma - > exudative effusion: high TG , milky white appearance

Answer 356

1. dec intrapleural ( atelectasis) : red perivascular pressure pulls fluid across vascular mem into pleural space 2. dec plasma oncotic pressure (nephrotic syn) 3. elev hydrostatic pressure (CHF)

Answer 357

trigger: cold, dry air - > beta agonist, mast cell stabilizers eg. albuterol 10-20 min prior exercise - > Antileukotrines agent 15-20 min prior exercise if unable to tolerate beta + - > combination in high performance athletes

Answer 358

``` ICH : HTN -----> etio: 1. cerebral AMYLOID ANGIOPATHY 2. s/p HTN ``` ``` mc loc@ !!! 1. BG (putamen) 2. cerebellar nuclei 3. thalamus 4. pons 5. cerebral cortex ``` ``` sym: !!!! -> gradual onset min- hrs -> contralateral hemiparesis -> contralateral sensory loss -> conjugate gaze dev TOWARDS side of lesions ``` dx: non-contrast CT scan rx: ER decompression if hemorrhage >3 cm

Answer 359

hemiplegia: - > cortical, subcortical, upper BS - -> injury descending corticospinal tract hemisensory: - > @ ascending somatosensory pathway ( dorsal column-medial lemniscal + anterolateral pathway)

Answer 360

loc @ TEMPORAL LOBE ATROPHY!! ---> hippocampi + medical temporal lobes - > memory loss for recent event - > later psy features ( delusion, hallucination) rx: - -> cholinesterase inhibitor : Donepezil, galantamine, RIVASTIGMINE - > NMDA receptor antagonist : Memantine

Answer 361

- > COPD - > elev JVP - > enlarged liver (congestive hepatopathy) --> impaired RV: pul HTN , OSA, idopathic Pul HTN!!!! sym: - > loud P2 - > right vent 3rd heart sounds - > TR murmur - > elev JVP with hepatojugular reflex, HM with pulsatile liver , ascites / pleural effusion - -----> NOT cause BIBASILAR CRACKLES!!! dx: CLX - > echo: RVH, TR with RA enlargement - -> enlarge central pul arteries - -> Rt axis dev -> CATHETERIZATION (GS): elev Put artery systolic pressure > 25 without Lt heart dx

Answer 362

- > ecchomyoses, epistaxis - > major BLEEDING : advent of dialysis lab: - > PLATELET DYSFUNCTION - > pt count NORMAL: Chronic RF!!!! - > Pt , aPTT ,normal - > BT prolong rx: - > desmopressin: inc vwf - > crypoprecipitate - > conjugated estrogen

Answer 363

sym: -> over WEEKS !!!! -> n/v, nuchal rigidity, HA, CN PALSY , stroke dx: -> BASILAR meningeal enhancement & hydrocephalus - > CSF: WBC count 100-500 (LEUKOCYTOSIS) - > mildly ↑ protein - > ↓ glucose, - > ↑ adenosine deaminase NAAT or AFB CSF smear

Answer 364

1. avoid exposure sun 2. topical brimonidine /laser 3. papulopustular rosacea: - > first line: topical METRONIDAZOLE, azelaic acid, ivermectin - > 2nd line: oral tetracyclines ** topical corticosteroids : not rxm -> rebound worsening sym

Answer 365

-> injury to the upper aerodigestive tract a sym: - > SEVERE pain, dysphagia, and oropharyngeal erythema and ULCERATION. - > NOT AMS dx: -> Full-thickness necrosis of the esophagus can lead to perforation, resulting in either mediastinitis or peritonitis. --> Esophageal STRICTURES are MC complication s/p weeks to months !!! --> esophageal SCC YEARS after rx: 1. secure ABC 2. decontamination: remove clothing 3. CXR 4. ENDOSCOPY within 24 hrs ** Steroids: NOT shown to reduce risk of strictures!!

Answer 366

- > GI bleeding, rectal bleeding - > nocturnal diarrhea , WL, ANemia - > age > 50 yr dx; - > inc fecal calprotectin - > fecal leukocytes - -> Colonoscopy: normal mucosa rx: FIber supplement

Answer 367

STATIN: --> red risk of MI and ischemic stroke in ATS CVD risk >7.5 -10% - > proximal , symmetric muscle, pain/ wkness - > elev CK ** UMN sign NOT expected rx: switch MODERATE stain ** FIBRATE : when TG > 400/ low HDL <40

Answer 368

- > young women !! - > asx - >elev CK - > normal/ mild elev ESR, CRP dx: TSH, fT4 -> ANA, anti-Jo-1 Ab muscle biopsy

Answer 369

delirium, seizures -> EUPHORIA, INTIMACY NOT combative agitation -> hyperthermia --> HYPONATREMIA!!

Answer 370

amphetamine analogs. -> increase the release, or inhibit the reuptake, of NE, DA, and serotonin. sym: - > severe agitation, combativeness, psychosis, delirium, myoclonus, and, rarely, seizures. - > inc SNS : inc BP + HR. !!!!! -> intoxication is the prolonged duration of effect

Answer 371

- > s/p radiation therapy - > RHF - -> PRIOR Cardiac surgery!!! -> ethio: scarring and subseq loss of normal elasticity of the pericardial sac. - ------> DEC RV contractiltiy!!! - ---> DEC CO , HYPOTENSION!! -> inelastic pericardium prevents VR to the right heart during inspiration and leads --> RHF sym: - > peripheral edema, ascites, - > hepatic congestion with hepatomegaly, -> cirrhosis (cardiac cirrhosis). - -------> CLEAR LUNGS!!! not affected echo: - > elev JVP with prominent x and y descents - > hepatojugular reflux - > Kussmaul's sign (lack of dec or inc in JVP on inspiration), or pericardial knock (mid-diastolic sound).

Answer 372

- > inc JVP - > hypotension - > BRADYCARDIA rx: Atropine pacemaker

Answer 373

confounding bias: -> fail to ADJUST comorbidities can lead to FALSE conclusion -->> link to BOTH exposure + OUTCOME interest!!! -> extraneous variable try to eliminate: --> matching, restriction , randomization !!!! EFFECT modificaiton: - > STRATIFICATION can make the effects of the modifier more apparent. - --> extraneous variable changes the direction / strength asso btwn risk factor and dx

Answer 374

Dementia!!! LEWY bodies / multiple system atrophy ( Shy -Drager syndrome) !!! -> male > 50 yr -> muscle atonia -> alpha-synuclein neurodegeneration (eosinophilic intracytoplasic inclusion ) ---> fluctuating cognition -> visual hallucination _> REM sleep beh !!!!!! -> Parkinsonism ----> Latter 1/2 of the night: UNABLE to inhibit muscle ATONIA !!! !!!!! etio: Severe sensitivity to antipsy rx ( DA antagonist) --> first gen : Haloperiodl

Answer 375

wax & wane condition etio: 1. rx 2. infection 3. electrolyte derangement 4. sys illness: CHF, HF, Ca 5. CNS : seizure, stroke, head injury, subdural hematoma dx: UA + electrolytes rx: - > antipsy: haloperidol - > BZD - > nonopioids **** CBC + iron studies: dx: chronic anemia

Answer 376

H. pylori (asia) -> urease producing organism sym: - > dyspepsia "BURNING" sensation - > postprandial fullness - > nausea - > GI bleeding, worsening pain during fasting, nocturnal pain --> duodenal ulcer formation !!! - > microcytic anemia ( IDA) dx: >60 yr: upper endo ----> elev BUN/CR RATIO!!! HYPOVOLEMIA !! <60 yr: h. pylori testing, upper endo with high risk pt : GI bleeding, WL, >1 alarm sym * * endo bx: gastric antrum - -> urea breath testing - > stool Ag studies rx: - > Ab ( amx + clarithromycin) + PPI ``` Alarm symptoms: 1. Progressive dysphagia 2. Iron deficiency anemia 3. Odynophagia 4. Palpable mass or lymphadenopathy 5. Persistent vomiting 6. Family history of GI malignancy ```

Answer 377

moa: OSTEONECROSIS of femoral head etio: - > SLW - > steroids use sym: - > Groin pain on weight bearing - > Pain on hip abduction & int rotation: red ROM - > No erythema, swelling, or point tenderness lab: - > NormalWBC - > Normal ESR & CRP ``` XR: normal!! Crescent sign (subchondral lucency) in advanced stage ``` -> MRI: boundary btwn normal and ischemic bone, as well as the zone of hypervascularity. ** osteonecrosis: subchondral fracture will be seen on XR

Answer 378

Alveolar min vent inc enough to decrease the PaCO2: induce RESP ALKALOSIS - ------> kidney compensation : retain H+ and excrete HCO3 to normalize the Ph!!! - --> urine alkaline (high urine ph) !!!! - -> tachypnea (ie, inc RR) - --> GOAL: PaO2 55-80mmHg - -> O2 sat: > 88-95% - -> inc TV - --> inc FiO2 + PEEP ``` sym: -> parathesia, HA, LH, carpopedal spasm -> cerebral vasoconstriction / alkalosis -ind hypoca + hypophosphatemia ``` rx: reassurance + deep breathing training (abd diaphragmatic breathing) - -> BZD (lorazepam) ** paper bag ventilation : NOT recommend -: induce hypoxia !!!

Answer 379

pseudomonas ``` sym: -> granulation tix -> think , purulent discharge Ext auditory canal -> elev ESR -> severe , unremitting ear pain -> N7, 10, 11 deficits : facial drooping ``` comp: -> bact abscess, MNG, death , TMJ dx rx: IV ciprofloxacin -> surgical debridment ** DM rhizopus : blask eschar

Answer 380

- > reintro of carb in pt with chronic malnourishment. - -> inc INSULIN - > inc glycogen syn - > inc pn syn - > inc IC UPTAKE PO4, K, Mg, thiamine - -----> DEC serum PO4, K, Mg - ------> dec serum thiamine - -----> inc Na, water lab: - > hypophosphatemia -> muscle weakness - > hyporeflexia, compl: - > arrhythmias, seizure ( hypoK) - > congestive heart failure, pul edema, edema ( inc na, water intake) - > wernicke encephopathy ( dec thiamine)

Answer 381

-> childhood trauma ( phy , sexual abuse neglect) rx: BEST dialectial beh therapy - > antipsy (second gen) - > antidep

Answer 382

- > spastic contraction anal sphincter - -> pudenal nerve compression RF: - > female - > other dx: IBD - > psy stress, anxiety sym: - > Recurrent rectal pain UNRELATED to defecation - > Episodes lasting sec- mins (≤30 min) - > No pain between episodes rx: NG biotherapy

Answer 383

MC women - > obesity - > trauma injury -> pain exacerbated by sitting + DRE

Answer 384

amyloidoses misfolded precursor pn (beta2 microglobulin) ---> deposit IC tix, causing organ dysfunction. sym: affinity OA : 1. scapulohumeral periarthritis: inc shoulder pain, inc rotator cuff thickness, hyperechogenic deposits 2. CTS: median neuropathy, thenar eminence atrophy 3. bone cysts: fracture

Answer 385

MC postmenopausal women -> Rapidly progressive hirsutism with virilization (clitromegaly) lab: - > Very high serum androgens - > high DHEA +Testosterone by ovaries + adrenal glands - > low LH ( neg feedback) * * ovarian tumor: - -> inc Testosterone - -> normal DHEA - > low LH * * PCOS: high LH, testo - -> low / normal DHEA

Answer 386

ARP = (risk in exposed - risk in unexposed) / risk in exposed. ARP = (RR - 1)/RR.

Answer 387

selenium sulfide

Answer 388

PERSISTENT pattern - > Center of attention, frequently use physical appearance to attract attention, -> behave in a sexually seductive or provocative manner - > drama communication, exaggerate facial expression + hand gestures, cross arms dramatically - > rapid shifting emotions, impressionistic speech

Answer 389

intermittent verbal / physical aggressive beh disproportionate to objective triggering offense --> feeling REMORSE after!!!!!

Answer 390

dx impaired NEUTROPHIL MIGRATION --> defect LFA-1 intergin CD18 - > recurrent skin inf, mucosal bact - > ABSENT PUS - > impaired wound healing - > DELAY Umbilical cord seperation lab: inc Neutrophils, absent at infection site ( no migration)

Answer 391

-> autoimmune hemolytic disorder Intravascular and extravascular hemolysis + hemoglobinuria - > Aq genetic defect --> lack of the glycosylphosphatidylinositol anchor, cxn pn, including CD55 and CD59, to the cell surface. - -> pn normally inhibits activation of COMPLEMENT on RBC: absence pn : hemolysis sym: -> hemolysis -> hemoglobinuria -> cytopenia : fatigue, dyspnea !!! -> hyper-coagulable ( PV THROMOSIS)!! -> abd pain lab: - > low Haptoglobin ( hemolysis causing RBC bind to pn transport) - > elev bilirubin + LDH ( inc RBC breakdown) - ---> RETICULOCYTES dx: -> flow cytometry test : absence CD55, 59 pn

Answer 392

congenital heart dx --> bicuspid aortic valve (BAV) - > AD - > freq asso with AS!! - -> with aortic root dilation :: right UPPER sternal border sym: !!!! -> decrescendo, EARLY DIASTOLIC murmur @ left sternal border , leaning forward , EXPIRATION !! !!!! -----> WIDE PULSE PRESSURE : WATER HAMMER pulse - -> inc Voln OVERLOAD in LV - -> LV stretch (inc PRELOAD) allowing inc SV to help maintain CO - -----> ECCENTRIC HYPERTROPHY : myocardial fiber in series - ----> inc LV COMPLIANCE -> initial Asx , eventually LV wall stress -> contractile dysfunction -> decompensated HF

Answer 393

to avoid: | patients are RANDOM assigned to treatments to minimize potential CONFOUNDING variables

Answer 394

etio: -> NOT asso with abnormal cortical activity during the episode. sym: - > longer DURATION > 5 mins !!!!! - > forced eye closure, side-to-side head or body movements - > memory recall of the event - > lack of postictal confusion. dx: Video-EEG monitoring is gold standard

Answer 395

--> INC PO4, K, UA: hyperuricemia ( lysed tumor cells met by XO --> UA) --> Dec Ca - > AKI: ca- po4 stone obstruction - > cardiac arrhythmia : HYPERKalemia rx: -> IV fluid ppx: reduce UA level - > allopurinol - > rasburicase - > febuxostat

Answer 396

type 4 HSR - > acute: pruritic red, indurated plaques with vesicles/ bullae!!!! chronic: lichenificaiton, fissuring 1. sensitization phase: naive T cells after initial exposure 2. re-exposure (elicitation phase) : memory T cells proliferation + release inf cytokines promote CD8 rx: topical / sys corticosteroids ---> TRIAMINCLONE * ** s. aureus : bullous impetigo - > enlarging vesicles + bullae rupture exudates + crusts - > pruritis , NO/little ERYTHEMA - ----> Rx: Mupirocin!!!

Answer 397

sym: - > Insufficient care (eg, neglect, abuse, inconsistent caregiving) - > Does NOT SEEK or respond to comfort rx: - > early intervention promoting safe environment - > psy services *** disinhibited socail engagement dx: over-friendly

Answer 398

sym: ASX lab: - > normal Hbg, reticulocytes count, RBC indices - > Hbg electrophoresis : mut traits : HbA > HbS comp: !!!!! -> hematuria/ RENAL PAPILLARY NECROSIS !!!! -> splenic infarction ( HIGHER ALTITUDES, dehydration, ETHO consumption ) -> venous thromboembolism , priapism -> exertional rhabdomyolysis ***rhabdomyolysis: myoglobinuria , + u/a for blood, not RBC, muscle pain + wkness

Answer 399

progressive dx: inflammation, fibrosis, stricturing intrahepatic + extrahepatic bile duct - > asso with UC - > fatigue, pruritus lab: elev ALP, bilirubin -> inc ESR, IgM, + p-ANCA ---------> antiMITOCHONDRIAL AB assay!!! dx: MRCP!!!! noninvasive alternative: ERCP if MRCP not able to perform -> liver biopsy : onion skin fibrosis rx: URSODEOXYCHOLIC ACID!! ASAP - > hydrophilic bile acid -> dec biliary injury + inc biliary secretion + anti-inf - -> alternate: liver transplant * *** anti-SM AB: autoimmune hepatitis * *** HIDA scan: acute cholecystitis * ** CEA: WL, HM

Answer 400

UMN: pyramidal / corticospinal tract dx --->" CLASP knife" : velocity dep reisitance to passive movement to limbs - -> outstretch arm with palms up eye closed - -> drift arm DOWNWARDS * ** ROMBERG test: loss balance - > Proprioception impaired : Vit B12, tabes dorsalis

Answer 401

--> 1 day - 1 month sym: - > disorganized , biazzare beh - > disorganized speech - > hallucination - > trigger by stressful event

Answer 402

after >18 yr - > violation right of others - > phsy aggressive + impulsive , repeat fights - > illegal activities ( drugs, theft) - > lack of remorse - > failure to accept responsibility - > lying *** CONDUCT dx: <15 yr rx: CBT , family therapy - > parent management training

Answer 403

- > exaggerated sense of self importance - > lack empathy - --> LESS impulsive , NOT engage violent / illegal activities

Answer 404

bright light trigger muscle eyelid bil, symmetric contraction --> sensory trick --> asso with lower face, tongue, jaw : MEIGE syndrome!! etio: -> PD, antipsy , idiopathic trigger rx: -> B. toxin

Answer 405

sym: AIN: - -> fever, rash, WBC - -> sloughing renal papilla - ----> papillary ischemia + vasoconstriction medullary BV ( vasa recta) **NO RBC, RASH, esoinophil, Cast!!! etio : naproxen ( NSAIDS)!!!! aminglycosides: amikacin -> rx: pyelonephritis with multi-drug resistance se/ Nephrotoxicity, neruotoxicity Ototoxicity Teratogenic

Answer 406

-> small, skin colored papules with indented centers rx: - > 1st line: :Liquid nitrogen ( cryotherapy) - > curettage - > topic cantharidin *** localized dermatitis: topic corticosteroids ( Triamciolone)

Answer 407

sleep onset insomnia , excessive daytime sleepiness "night owl"

Answer 408

-> few DAYS after URI!!!!!! - > gross hematuria, flank pain , low grade fever - > mucosal inf - > IgA -based IC deposits in glomerular mesangium lab: - > U/A : Pn RBC, RBC cast - > normal C3, C4 - > inc CR

Answer 409

AFib without palpable pulse --> CPR + vasopressor epinephrine -> dx: Id 5H, 5P * **NOT SHOCKABLE ryhthm!!!! NO DEFIBRILLATIOn / SYNCHORONIZED Cardioversion !!!!! - -> Vent Tach

Answer 410

- > vertebral artery dissection!! - -> vertigo sym: 1. Loss of pain and temp ipsilateral face (spinal trigeminal tract) and contralateral trunk/limbs (spinothalamic tract) 2. Ataxia (inferior cerebellar peduncle) and nystagmus (vestibular nucleus) 3. Dysphagia and dysphonia due to bulbar muscle weakness (nucleus ambiguus) 4. Ipsilateral Horner syndrome (Sym tract)

Answer 411

- > benign , ASX - > resolve with 24-48 hrs etio: simple trauma, rubbing eyes dx: -> observe

Answer 412

- > aminoglycosides - > cisplatin - > salicylates - > furosemide : co-exit with RF

Answer 413

etio: - > Staphylococcus aureus - > Viridans streptococci - > Anaerobes patho: - > direct spread : otitis media, mastoiditis, sinusitis - > hema spread ( IE) sym: - > focal deficits, seizure, fever, - --> NOCTURAL HA, morning vomiting!!! dx: - > MRI: RING -enhancing lesion with central NECROSIS biopsy: obtain tix + gram stain + culture rx: -> metronidazole * ** Herpes encephalitis: - -> HYPODENSE lesion TEMPORAL lobe , ring enhancement NOT common !!

Answer 414

brachial artery cannulation -> IN catheters delivery vasopressor sym: ->median nerve lies DIRECTLY medial to brachial artery --> lacerated / compressed by post-procedural hematoma / local swelling -> spontaneous resolution in days to wks ***VASOPRESSOR extravasation : local vasoconstriction effect: venous blanching , pallow surrounding tix --> NOT explain MEDIAN nerve deficits

Answer 415

etio: Multiple sclerosis : autoimmune demyelinating, vascular loop, neoplastic growth ---> COMPRESSION of CN V2, V3 ROOT @ PONS !!! -> BILATERAL neuralgia sym: -> last 2 wks and resolve spontaneously rx: - > carbamazepine / oxcarbazepine - > surgery ( decompression ) severe refractory cases ** herpes zoster viral reactivation : UNILATERAL : V1 branch- blindness

Answer 416

``` Delirium Inf ( UTI) Atrophic urethritis/ vaginitis Pharm ( a-blockers, diuretic) Psy (depression) Exessive UO ( DM, CHF) Restricted mobility ( s/p surgery) Stool impact ``` dx: U/A + culture

Answer 417

Fracture of a bone (eg, pelvis, femur) Sym: 1. Microvascular occlusion in the pul capillaries --> ARDS 2. Microvascular occlusion in the sys circulation (eg, brain, dermal capillaries), - -> neuro dysfunction + petechial rash 3. Degradation of embolized fat into proinflammatory intermediaries - -> sys inflammatory response (eg, tachycardia, leukocytosis) dx: clx rx: supportive O2

Answer 418

-> PROSPECTIVE, systematic, team-based approach --> identifying steps in a process and finding solutions to any problems that may arise -> goal ensuring safe outcomes *** ROOT cause analysis / control charts: once problem is IDENTIFIED

Answer 419

1. primary: DESTRUCTION BILATERAL ADRENAL CORTEX - -> autoimmune adrenalitis (90%), inf, Ca lab: - > DEC cortisol: - > DEC aldo: hypoNa, HyperK, hyperCl, HypoVolemia --> MET ALKALOSIS - ---> SALT craving !! - !!!!!! > inc ACTH : HYPERpigmentation - > Eosinophilia + hyperplasia lym tix ( tonsil) dx: cosyntropin stimulation testing rx: steroids + hydrocortisone ( synthetic mineralocorticoid)

Answer 420

- > hookwarm larvae - > bare foot walk on sand, soil sym: - > lower ext - > intensely pruritic, reddish brown tracts dx: eosiniphils rx: IVERMECTIN * * SPIDER bites: UPPER arm, inner thigh, thorax - > central clearing, red plaques/ papule - > necrotic eschar, less pruritic lesion

Answer 421

-> carboxyhemoglobin : impairs O2 delivery to tix --> shifting Hb-Oxygen dissociation curve to LEFT --> inc EPO - > HA, AMS, seizure, dizziness, come, syncope, HF, arrythymia - > cherry red lips rx: 100% facemask O2 *** BZD if continuous seizure

Answer 422

sym: | -> wheezing + RARELY < 1 % have diffuse , bil reticular infiltrates

Answer 423

moa: !!!! B-1 + receptor: stimulate inc myocardial contractility --> inc cAMP cardiac myocytes --> enhance Ca-mediated binding actin-myosin complex to Toponin C --> + inotropic effect: inprove EF, reduce LVESV ----> dec LVEDV : dec preload) --> inc HR ( shorter diastolic filling time --> CO improve weak: B2 + : smaller dec (SVR) afterload weak A-1 : SNS improvement *** Beta blocker: dec HR, contractility ( neg inotropic effect) , myocardial O1 demand red

Answer 424

- > RECURRENT episodes lasting 20 mins to several hrs ( not PERSISTENT)!!!! - > sensorineural hearing loss - > tinnitus / fullness in ear -----> inc voln / pressure ENDOLYMPH ( ENDOLYMPHATIC HYDROPS) !!!!

Answer 425

self limited dx: !!!!! SINGLE episodes last DAYS - > N8 dx - >s/p viral URI !!!! - -> UNILATERAL hearing loss ( labyrinithitis) - -> head thrust test abnormal rx: meclizine , steroids,

Answer 426

etio: complication of head injury or barotrauma that -> leakage of fluid from the semicircular canal. sym: -> A perilymphatic fistula causes vertigo, nystagmus, hearing loss, and tinnitus that is triggered by sneezing, straining, or sudden loud noises (Tullio phenomenon).

Answer 427

nocardia: ----> sys sym, lung nodules disseminated, brain abscess ( seizure) ---> G+, partical acid-fast, filamentous branching rods rx: --> TMP-SMX ``` Actinomyces: ----> ANAEROBIC , not acid-fast ----> sulfur granules, direct extension rx: PNC-G ```

Answer 428

- > homeless shelter, drug users - > men sex with men lab: - > inc ALT, AST > 1000 - > RUQ pain, bilirubinuria, pale stool ( lack bilirubin pigment) - > fever, anorexia, N/V - > jaundice, pruritus - -> anti-HAV IgM - > inc ALP

Answer 429

Pituitary adenoma Primary hyperPTH Pancreatic/ GI Neuroendocrine tumor : - --> Gastrinoma : recurrent PEPTIC ULCER - -> VIPoma - -> Glucagonoma : hyperglycemia, necrolytic migratory erythema - --> Insulinoma : hypoglycemia **** toxic thyroid adenoma : inc bone turnover --> hypercalcemia :WL, tachycardia

Answer 430

chronic systemic HTN!!! MC - > cocaine - > age >60 yr sym: - > AR!!!! - > widening mediastinum - > nonsp ST eev + T wave change dx: - > ECG - > CXR - > CT angio / TEE rx: -> pain morphine !!! -> IV beta blocker ( esmolol): dec LV contractility: dec aortic wall stress, dec SBP , dec HR -> Na nitroprusside -> ER surgery repair ( TYPE A) *** AVOID : tPA / Heparin : risk BLEEDING !!!! hemopericardium

Answer 431

MC @ children 2-5 , adolescent Immune thrombocytopenia - > autoimmune dx: IgG autoAB against pt membrane glycopn - > inc pt dest + inhibit pt production sym: - > MUCOSAL BLEEDING ( epistaxis, heavy menses, ecchymoses) - > NORMAL liver span - > nonpalpable spleen lab: - -> ISOLATED THROMBOCYTOPENIA <100, 000 - -> normal Pt, Ptt, fibrinogen rx: IVIG, anti-D, steroids

Answer 432

block Thromboxane A2 --> impair Pt function

Answer 433

AD -> heavy MC bleeding !!! ---> impaired pt-endothelial binding + pt aggregation ---> F8 def lab: Pt FUNCTION affected : pt plug formation abnormal --> Pt count NORMAL

Answer 434

asso: - > lung CA, cystic fibrosis, and R-to-L cardiac shunts. moa: -> megakaryocytes skip normal route of fragmentation within pul circulation --> enter sys circulation (disruption from tumors, chronic lung inflammation) - > Megakaryocytes entrapped in the distal fingertips: large size and release PDGF + VEGF. - > PDGF and VEGF have growth-promoting properties that inc cxn tix hypertrophy and capillary permeability and vascularity --> clubbing

Answer 435

- > inconsistent tremor - > ABRUPT onset and cessation - > present @ rest - > involuntary movements not related to neuro causes - -> DEC with DISTRACTION - > FINGERS are spared!! - -> changeable features

Answer 436

lab - -> WBC <2000 - > PMN 25% - > brief stiffness < 30 mins -----> affects LARGE weight bearing joints Lower ext ( Hip, knee) -> XR: narrowed lumber facent joint space, osteophytes, subchondral SCLEROSIS/ cysts, crepitus + pain !!! -----> LUMBAR SPINAL STENOSIS -> synovial effusions : popliteal baker cysts modifiable: -> lifestyle, obesity, DM, occupational joint loading ``` non-MODifiable: !!! -> Prior trauma -> fx hx -> female sex -> advance age -> abnormal joint alignment ``` dx: CLINICAL --> imagine less sensitive , not necessary!!!

Answer 437

recurrent , spontaneous anxiety attack -> avoidance beh etio: -> PANIC attack rx: -> CBT *** social anxiety dx: avoid public places, fear social humiliation / criticism

Answer 438

Low grade B cell lymphoma - mucosa asso lymphoid tix --> H. pylori -> B + T cell gastric lamina rx: - > eradication therapy ( quadruple / triple therapy) - > complete remission with AB - > advance dx: radiation therapy, immunotherpay ( rituximab) , single agent CMT * *** Gastric Ca: - > risk: smoking, salt , Nitroso cpd food, pernicious anemia

Answer 439

- > Immobility or excessive purposeless activity - > Mutism, stupor - > Negativism (resistance to instructions & movement) - > Posturing (assuming positions against gravity) - > Waxy flexibility (initial resistance, then maintenance of new posture) - > Echolalia, echopraxia rx: - > BXD - > ECT

Answer 440

-> air trapping and ob - > dec VC , inc FRV - > inc compliance: hyperinflation - > dec elasticity - > inc airway resistance : inc Min vent ---> inc WORK of BREATHING

Answer 441

- > inf effusion: WBC 2000 - 100,000 - > PMN > 50% - > translucent/ opaque appearance sym: - > morning stiffness >30 mins - > synovitis - > sys sym: fever, fatigue, anemia * ** extrasym: - ----> osteopenia/ osteoporosis lab: ---------> Anti-CCP ab RF + TNF, IL-1 + : promote inflammatory cytokines rx: minimize steroids exercise, vit D, Ca -> bisphosphonate

Answer 442

class IC antiarrythmic : Na channel inhibiting : depol phase (phase 0) --> control rhythm control Afib se: prolong QRS duration / QT interval : pt with RAPID HR --> drug less time to dissociate from Na channel --> higher # blocked channel : WIDENING QRS complex!!! --> use DEPENDENCE

Answer 443

sym: - > delusion - > TACTILE HALLUNICATION - > aggressive beh severe insomnia - > poor dentition , bruxism - > skin sore -> excoriation , skin picking rx: CBT pstipsy rx * *** Etho withdrawal: - -> MARKDED TREMULOUSNESS , hallunication , elev Vital

Answer 444

topical 5-FU

Answer 445

mech vent improve O2 by inc FiO2 + PEEP prolong high FiO2 --> O2 free radical Goal : FiO2 <60% more SAFE !!! LOW TIDAL VOLN VENTILATION : 4- 6 ml/g/kg body weight. : went w/o causing further injury + provide adeq oxygenation + vent ------> LTVV prevents OVERDISTENSION alveoli !!! Improves MORTALITY! ***** PaCO2: pul min vent = TV x RR no need to adjust !!

Answer 446

-> pervasive DISTRUST + Suspiciousness * ** delusional dx , persecutory type: believe being conspired against , sym > 1 mth - -> no ODD dressing

Answer 447

-> neisseria MNG MC young adults sym: -> initial: nonsp fever, HA, V, myalgias, sore throat !!!!!!! -> RAPID ONSET w/in 12-24 hr : PETECHIAE/ PURPURA ( MOTTLEE skin/ pallor) -> meningeal sign, AMS rx: ceftriaxone comp: shock - > DIC - > adrenal hemorrhage

Answer 448

-> throat culture - > sore throat, fever - > gray, adherent , posterior pharyngeal pseudomembrane

Answer 449

CREST --> anticerntromere ab DIffuse: - --> anti-topoisomerease i ( anti-sScl 70) + anti-RNA polymerase III - > ANA +

Answer 450

DM type 2 --> elev HbA1c despict normal fasting glc rx: comb regimen : LA BASAL insulin ( control fasting glc) + rapid BOLUS acting mealtime insulin ( control postprandial glc)

Answer 451

very high insulin dose req | --> Fasting + non-fasting hyperglycemia

Answer 452

early morning hyperglycemia surge : diurnal inc GH + cortisol secretion --> elev FASTING hyperglycemia

Answer 453

X-linked recessive sym: -> delayed / prolong bleeding after trauma !!!! -> recurrent HEMARTHOSIS, IM hematomas -> GI bleeding -> IC hemorrhage -> hemophilic arthopathy!!!! : hemosiderin deposition in joints + trigger synovial inflammation + fibrosis + destruction !!! lab: - > inc APTT - > normal PC, PT - > absent / dec F8 / F9 rx: - > factor replacement - : desmopressin

Answer 454

N3 palsy --> ISCHEMIC NEUROPATHY --> inner somatic fiber: 4 EOM "down and out gaze) --> sup PNS fiber: sphincter iris + ciliary muscle ( controlling pupil constriction) *** nerve COMPRESSION: aneurysm, tumor : !!!! PNS fiber + pupillary response ( MYDRIASIS) *** Nerve inflammation ( vasculitis, autoimmune ) :

Answer 455

2 steps process: 1. -> + serology testing : anti-HCV IgG Ab 2. -> confirm test: molecular testing HCV RNA rx: once confirm : ---> direct acting antiviral agents ( Ledipasvir- sofosbuvir)

Answer 456

mean = median = mode!!!

Answer 457

- > bilateral , nonfocal, chest pain - ---> glandular tix proliferation : diffusely nodular breasts -> Cyclic premenstrual tendernes rx: relief with NSAIDS, OCP **** cyclic mastalgia: NO asso BREAST NODULARITY / MASSES!

Answer 458

estrogen sensitive - > vary in size, tenderness on MC cycle - -> solitary , unilateral, well circumscribed, mobile mass

Answer 459

large artery vasculitis - -> young asian women - -> fever, arthralgias, WL, BP discrepancies ( UPPER ext) - > pulse deficits, arterial bruits LOWER -> arterio-occlusiove sym ( claudication, ulcers) dx: -> ESR, CRP -> CXR: Aortic dilation , widen mediastinum _> MRI/CT: wall thickening, narrowing lumen rx: steroids

Answer 460

-> pulse deficits + BP discrepancies ---> Narrowing descending aorta ( distal to origin to Left subclavian artery) Upper : - -> HTN : EPISTAXIS, HA - -> More affect LOWER ext!!! : claudication , underdev - -> left interscapular sys / continuous murmur !!!!!! ecg: - -> LVH : high voltage QRS complex, lateral ST seg depression , lat T wave inversion dx: ECHOcardio - -> neonates, young childrens - > not asso with constitutional sym / ESR

Answer 461

- -> Cancer ind - -> confusion, coma, stupor, rapid Ca raise - ----> LOW PTH - -----> MARKED Ca, PTHrP 1. severe: Ca >14 !!!! / sym: - -> short term/ immediate: NS + calcitonin !!!!!!! - -> avoid LOOPS !!!!!!! - -> long : bisphosphonate 2. moderate : ca 12-14: no immediate rx 3. ASX: ca <12 - -> no immediate rx - > avoid TZD, Li, dehydration , prolong bed rest

Answer 462

--> Cochlear hair cell loss + cochlear neuron degeneration --> age- related brain atrophy, exposure to loud noises --> high freq affect first

Answer 463

- --> younger pt - -> conductive hearing loss - -> paradoxially improve speech with noise abnormal BONE deposition --> stiffening ossicular chain

Answer 464

1. evaluate Ca 2. --> corrected ca = [measure ca] + 0.8 x (4.0 - serum alb)] 3. --> measure ALBUMIN level !!!!!! 4. measure PTH: - -----> LOW/ normal PTH: - -> r/o hypocalcemia : blood transfusion, citrate bind to ion ca - > hypoMg: resistance to PTH - -----> high PTH: - > Ca, inflammatory, Tumor lysis syn, PTH resistance 5. serum 25-hydroxyvitamins D : r/o vit D def - -> poor sun exposure, malabsorption * **FGF23 : lowers PO4 --> dec interstitial absorption: inc Urinary excretion PO4 - -> CKD ( 2ndry hyerpPTH) ** ALP : poor sensitivity

Answer 465

stress, BILATERAL, DULL, non-throbbing w/o asso sym (n/v) - -> non-changing from prior HA - -> last 30 mins - i week . - > muscle tenderness Head + neck --> rx: ibuprofen TCA

Answer 466

1. central adrenal insuff: LOW CORTISOL + ACTH - --> mild hypoNa + mild hypotension : 2ndry : aldo not affected NORMAL 2. Hypogonadotropic hypogonadism : Low FSH, LH, testo - -> measure : PROLACTIN!!!!! 3. central hypothyroidism : LOW free T4, normal / low TSH

Answer 467

-> INH hepatotoxicity ALT, AST <100 IU/L w/in few weeks of rx --> self limited , miaintain rx and f/u closely ** severe toxicity >10 x times upper limit of normal!!! * ** Drug -ind liver injury: - -> rash, fever, leukocytosis, eosinophilia ** Idiosyncratic rxn: not dose dep: Isoniazid , chlorpromazine, antiretroviral rx

Answer 468

- > HBV/HCV - > transmural fibrinoid necrosis arterial wall -> luminal narrowing + thrombosis -> tix ischemia - > int/ ext elastic lamina damage -> microaneurysm formation -> rupture + bleeding sym: - > mononeuritis multiplex > 2 noncontiguous peripheral nerves - -> vasculitis (PAN) - > skin: livedo reticularis - > renal failure - > GI: mesenteric arteries ischemia lab: inc ESR anemia chronic dx -> tix biopsy

Answer 469

!!! 1. PaO2 <55 mmHg ->SaO2 <88% room air 2. PaO2 <59 - > SaO2 <89% cor pulmonale (RHF) - > Hct >55% !!! RX: SMOKING cessation + O2 therapy!! *** vaccine against influenza + pncoccus : no studies demo dec mortality!

Answer 470

- > contralateral motor / sensory deficits - > LOWER ext >> upper - > Urinary incontinence

Answer 471

acute w/in 3-5 days - > acute cardiogenic shock - > @ LAD / RCA !!!! -> New holosystolic murmur : L->R vent shunt -> inc O2 level from RA to RV - > biventricular failure - > shock - > chest pain

Answer 472

- > IV steroids (ACUTE) - > plamspheresis ( refractory to steroids) - > interferon beta/ glatiramer acetate : chronic maintenance rx , relapsing - remitting / 2ndry progressive form MS

Answer 473

- > MAMMOGRAM q2 year : 50-74 yr - --> over > 75 yr : not routinely rxm *** CXR/ CT scan : rxm smoking hx ***Colonoscopy: q10 yr: start age 45 yr ** ECG: @ 65 yr ** lipid : @ 40 yr / q3- 5 yr

Answer 474

- > Topirmate - > divalproex na - > TCA - > beta blocker

Answer 475

1. lifestyle changes 2. A1c <7 % 3. screen CVD : HTN <130/80 4. urine alb/ cr ratio < 30 mg/g 5. foot neuropathy + retinopathy *** mod inc albuminuria 30-300 mg/g + HTN : ACCEI / ARB 2ndry PPX

Answer 476

- -> embolized plaques ( AFib) - > ipsilateral carotid artery -> sig permanent visual deficits, PAINLESS MONOCULAR vision loss !!!! ``` fundoscopy: !!! --> whitened retina ( edema) --> macula, central fovea is red !!!! -> cherry red spot -> defect afferent pupil reflex ``` rx: -> ER!!! -> asa, statin warfarin dx: noninvasive imaging cartoids evulate stenosis

Answer 477

- > ASX - > HA, N3 palsy, facial pain - > pupillary DILATION *** wkness + neck pain : NOT expected!!

Answer 478

Erythema migrans : slow expanding erythematous macule / patch with central clearing -> doxycyline --> pregnant women: oral AMOXICILLIN!!!9 *** Azithromycin: less EFFECTIVE ! unless allergic rc

Answer 479

1. TG: 150-500 - -> WL - > ETHO moderate intake - > inc exercise - > STATIN!!!!!!! most beneficial!!! 2. TG >1000: - > fibrates!!!!! - > fish oil - > Etho cessation !!

Answer 480

-> direct effect on esophageal mucosa etio: - > tetracycline (Ab) - > KCl, iron - > bisphosphonate - > NSAIDS, ASA sym: - > sudden onset odynophagia, retrosternal pain - > mid esophagus by compression aortic arch / enlarge LA dx: endoscopy *** Esophageal Ca: unintentional WL, progressive solid food dysphagia risk factors -> smoking, etho, barrett, GERD, obesity

Answer 481

- > small cell lung ca - > autoab directed against voltage gated calcium channel in presynaptic motor nerve terminal - -> symmetric proximal muscles wkness + depress DTR - > autonominc dys ( dry mouth , erectile dysfunction) rx: - > guanidine - > 3,4 diaminopyridine : inc presyn Ach level - > steroids

Answer 482

-> inc risk arrythmia - -> mix AG met acidosis with high AG + resp alkalosis!!!! - -> hyperventilation - -> lactic acidosis , hyperthermia - > confusion - > epigastric pain

Answer 483

- > S. pneumonia | - >TM perforation

Answer 484

- > keratin producing sq cell tapped in the middle ear space - > erode surrounding st -> edematous swollen canal , pain

Answer 485

-> inc vagal tone + bronchial reactivity --> rx: SABA, inhaled ipratropium, sys steroids --> resp failure: intubation!!! ---> risk factor: prior intubation + recent poor asthma control !!!

Answer 486

-> seizure + mri @ gray + white matter junction 1. single MTS: - -> good status: surgical resection !!! 2. multiple brain MTS: whole brain radiation therapy (WBRT)!!! - > rx: glucocorticoids reduce swelling + palliate sym * *** Brain MTS : small cell lung ca, lymphoma, choriocarcinoma: - -> CMT!!! - -> NOT effective in NSCLC *** brachytherapy: conjunction with surgery / after recurrence follow WBRT/ surgery!

Answer 487

Secondary: distupt HPA - > CHRONIC steroids rx, infiltrative dx ( SHEEHAN syn) - ---> destruction PITUITARY / hypothalamus dx: cosyntropin stimulation testing lab: - > dec cortisol : SIADH inc ( cortisol acts to INHIBIT ADH) - ---> HYPONa - -> Dec Lh, FSH, TSH - > NORMAL ALDO: euvolemia, mini electro imbalance , less severe sym - -> normal K !!! !!!! -> dec ACTH: NO hyperpigmentation

Answer 488

MC inherited hypercoagulable dx - -> AD pt mutation in gene factor V : unable to respond to activated Pn C - -> continue thrombin formation + slowed degradation of F8 - > caucasian pop - > inc risk DVT, PE - > normal Pt, PTT

Answer 489

- > abrupt inc athletic activity - > quinolones sym: -> ankle pain, swelling, tender 2-6cm proximal insertion tendon rx: - > cold compression, ice - > NSAIDS - > chronic sym: rehab ECCENTRIC resistance exercise rxm

Answer 490

- > diffuse abd pain + dilated loops of small bowel | - > high pitched initially

Answer 491

-> CIRRHOSIS pt - > low grade fever, abd discomfort - > subtle AMS - > hypotension, hypothermia, paralytic ileus with severe inf dx: Diagnositic LAPAROSCOPY!!! -----> e. coli, klebsiella - > PMN >250 - > + culture, GNB ( e. coli, klebsiella) - > pn <1 g/dl - > SAAG >1.1 g/dl ( cirrhosis) --> Reitan trail test: time connect the # test: detect subtle AMS change in SBP rx: - > empiric : 3rd gen cepha!! - > quinolone PPX

Answer 492

- > poor nutritional intake - > etho- ind renal losses, diarrhea lab: - > diarrhea: hypoMg - > REFRACTORY hypoK - ---> IC Mg inhibits K secretion by renal outer medullary K channels ( ROMK) @ CT kidney. - --> low Mg => excessive K loss ---> dec PTH secretion : resistance persist rx: correct Mg level

Answer 493

- > babesia microti - > ixodes scapularis tick bite - > NE USA - ---> inc RISK in splenectomy!!! sym: - > fever , fatigue, myalgias, HA - > ARDS, DIC, CHF, splenic rupture - > anemia, thrombocytopenia , inc bilirubin/ LDH/LFT - -> Leukocytosis!!! dx: thin blood smear " INTRAERYTHROCYTIC RING" maltese cross rx: atovaquone + azithromycin - > quinine + clindamycin ( severe)

Answer 494

- > tick borne - > non-sp sym -> leukopenia !! thrombocytopenia

Answer 495

2 mths of MDD sym: atypical mood: - -> WG, hypersomnia - > leaden paralysis ( heavy feeling in limbs) - > hypersensitivity to rejection - > enjoy family reunion

Answer 496

persistent depressive dx > 2 years !!!

Answer 497

- > trauma (MCC) - > vascular damage - > coagulopathy ( hemophilia)

Answer 498

1. <1 month : RAPID ONSET -> high fever, hypotension, RUQ pain, tachycardia, leukocytosis, SEPSIS !!! - --> BACTERIA from operative comp: hepatic abscess, biliary leak , wound inf - --> hosp IUC, ext drain 2. month 1-6 : opp path : !!!!CMV, Aspergillus, mycobact TB in ICP !!!! ----> tix invasive CMV dx ( pneumonitis, gastroenteritis, hepatitis) 3. > 6 mo: ICP : CAP

Answer 499

<90 days s/p transplant | --> fever, RUQ pain, elev LFT

Answer 500

-> extend from subclavian to iliac vessels >> ANTERIOR SPINAL CORD ISCHEMIA !!! risk: ANT SC ischemia T10-12 !!! sym: - > urinary retention ( bladder paresis) - > motor paresis Lower ext - > loss crude touch/ pain sens ( ant/ lat spinothalamic tracts) - > diminish reflexes ( days -wks ) *** DORASL column SC ( vib , sens, proprioception) preserved!!! + UPP ext INTACT !!

Answer 501

VERTEBRAL ARTERY!!! - > ischemic stroke, HA, neck pain - -> sig HTN - > decrescendo diastolic murmur: AR - > POSTERIOR SC ischemia - > loss proprioception/ vib sensation below lesion + mild wkness dx: 1. CXR / ECG 2. norma; Cr + no contrast allergy ? 3. TEE !!! sens + specific / CHEST CT 4. MRI

Answer 502

-> LATERAL knee overuse injury

Answer 503

Apophysis of TIBIAL tubercle -> progressive knee pain over se young adults --> pain stops once growth stops

Answer 504

- > nasal congestion, rhinorrhea, sneezing, postnasal drainage - > LATER ONSET >20 yr - > NO obvious allergic triggers - > WORSEN with season change rx: -> INTRANASAL anti-histamine/ steroids!!!!

Answer 505

- > CVD!! - > dec LDL turnover - > dec expression activity LDL receptor : inc total cholesterol + LDL - -> dec lipoprotein lipase : hyperTG!!!

Answer 506

SBP > 140 DBP <90 ---> inc CV morbidity + mortility - --> elderly pt - -> INC STIFFNESS / dec COMPLIANCE aortic + arterial walls ***Inc plasma renin -> renovascular HTN ( RAS) : 3ndry HTN : inc BOTH SBP + DBP !!!!

Answer 507

BENIGN: - > Insuline resistance - > GI CA - > Obesity - > PCOS !!! --> inc insulin + insulin like -GF --> + epidermal + dermal proliferation -> skin tags ( acrochordons) MALIGNANT: - > Ca : GI/ GU - -> WL

Answer 508

--> long standing DM : blunt autonomic response : hypoglycemia with reduce awareness

Answer 509

Spirometry before + after SABA !!! - > asthma: complete reversal - > copd: wk / partial reversibility ; airway ob is fixed!!

Answer 510

- > Arachnodactyly - > pectus deformity, scoliosis, kyphosis - > joint hypermobility -> ectopic lentis - >AD, AR, AD (type A): - -------> AORTIC ROOT DILATION: chronic AR--: EARLY decrescendo diastolic murmur!!!! @ Rt upper sternal border!!! -> MVP

Answer 511

``` First degree: ---> ASX --> PR interval prolongation ( delay conduation w/in AV block) rx: OBSERVATION ``` Second degree: type 1: AV node : PROGRESSIVE prolongation --> follow by a dropped QRS complex rx: observation type 2: below AV node ( his bundle) - --> CONSTANT PR interval with RANDOM drop QRS complexes rx: pacemaker

Answer 512

Strep A pyogenes - > superificial UPPER dermis + lym - > raised , sharply demarcated edges - > RAPIDLY spread, onset - > fever early in course eg. ext ear - ---> comorbility with DM rx: IV Ab : cetriaxone, cefazolin - > w/o SYSTEMIC sym: oral amoxicillin

Answer 513

S pyogenes MSSA - > DEEP dermis, subcutaneous fat - > flat edges with POOR demarcation - > indolent ( days) - > localized ( systemic fever later)

Answer 514

MSSA ( s. aureus) MRSA PURULENT drainage -> folliculitis : infected hair follicle - > furuncles: folliculitis -> dermis -> abscess - > SystemicL fever, leukocytosis, inc ESR -> carbuncle: multiple furuncles

Answer 515

Recurrent, pruritic , vesicular rash --> affects palms, soles, SIDES of digits dx: CLX biopsy: intraepidermal spongiosis, lym infiltrate -> rx: high potency topical steroids

Answer 516

etio: DM, chronic opiate use, altered small bowel motility , s/p surgery, scleroderma - > delay gastric emptying - > impaired GFR - > small int BACT overgrowth (SIBO)!!! dx: - -> JEJUNAL aspiration : high bact conc - -> Carb breath test: early peak ----> alter small int flora : bact ferm of D-xylose before it can be absorbed rx: RIFAXIMIN, neomycin ( AB )

Answer 517

-> mycobacterium leprae --> THICKEN, HYPOPIGMENTATION, macular, anesthetic SKIN lesion with raised borders> 1 areas - > nodular , painful peripheral NERVE nearby, loss of SENSORY / motor function dx: FULL THICKNESS BIOPSY of skin lesion ( active edge) rx: DAPSONE + RIFAMPIN - > + CLOFAZIMINE severe

Answer 518

atrial remodeling ---> abnomral automaticity disorganized atrial electrical activity : originating PUL VEIN OSTIA - -> IRREGULAR IRREGULAR RR interval , narrow QRS complex - --> absence P wave - --> paroxysmal AF - --> inc Atrial enlargement !!! etio: inc with AGE!!! dx: CHECK TSH : evaluate HYPERTHYROIDISM !!!

Answer 519

- -> Asx - -> low back pain - > dec spinal mobility after sudden bending, cough , lifting ---> loc tenderness AT AFFECTED LEVEL!!! etio: - > osteoporosis - > chronic steroids

Answer 520

sciatica | + SLT

Answer 521

sepsis | --> cause lactic acidosis in AKI

Answer 522

MET alkalosis - -> loss NAKKCl - -> inc HCO3 in serum com: -> melanosis coli : dark brown discoloration colon with pale patches lymph follicules hist: pigment macrophages lamina propria dx: positive stool screen

Answer 523

protozoal dx - -> megacolon - > CHF ( myocarditis )

Answer 524

- > thyroid dysfunction : - > AIT -1 : hyperthyroidism - AIT -2 : hypo-thyroidism ( large IONINE load suppress synthesis TH : WOLFF Chaikoff effect) -> inc LFT : hepatocellular injury - > cardiac conduction abnormal - > skin - > peripheral neuropath

Answer 525

- > constipation - > impaired cardiac conduction + contractility - > worsening bradyarrhythmias - > CHF

Answer 526

microadenoma -> galactorrhea + low estrogen prolactinoma - > elev prolactin > 200!!!!! - --> suppress GNRH , LH, estradiol - -> TSH: normal / low --> HA, visual field defects rx: sym tumor: DA agonist ( cabergoline , bromocriptine) --> fail rx: large tumor > 3 cm : transsphenoidal resection !!!

Answer 527

!!! excessive inc water intake - --> serum osm LOW - -> serum Na LOW - -> urine DILUTED

Answer 528

- > bradycardia - > hypotension - > hypoglycemia - > bronchospasm !!!!! - > AMS - > seizure -----> competitive ANTAGONIST catecholamine receptors : prevent hep glucose production + prevent glycogen breakdown : HYPOGLYCEMIA antidote: IV fluid atropine glucagon !!!!

Answer 529

EBV: heterophile ab monospot test - ---> atypical lymphocytosis - > transient hepatitis ``` !!! prolonged course > 1 month -> fever -> exudative pharyngitis/ tonsilitis + exudates -> tender LAD - > HSM -> fatigue RASH after amoxicillin !!! ``` CMV: less common

Answer 530

acute: shingles - -> steroids, valacyclovir chronic: !!!! ---> gabapentin / pregabalin --> TCA ( amitriptyline) -> opioids ( oxycodone) : not as effective

Answer 531

-> axial skeleton ( vertebral bodies, rib) - > focal , sclerotic bone lesions - > progressive BACK PAIN - > motor wkness, incontience ->> PURE OSTEOBLASTIC lab: low/ normal Ca -> inc ALP

Answer 532

low serum testosterone -> low / normal LH sym: - > fatigue, dec libido, testicular atrophy - > hot flashes, osteoporosis, depression etio: !!!! -> OPIOIDS : SUPPRESS GNRH + LH secretion ---> LH + testosterone synthesis , dec spermatogenesis , testicular atrophy 2. steroids, exogenous androgen ( w/drawal) 3. chronic/ severe illness 4. hemochromatosis 5. eating dx ( severe WL) 6. pituitary tumor, hyperprolactinemia

Answer 533

- -> less severe compare to conduct dx | - > NOT inc stealing/ aggressive beh, violation of right of others

Answer 534

EPS: - > orofacial dyskinesia - > trunk dyskinesia -> prolong 1st gen antipsy rx rx: - > reduce antipsy dose - > switch to VMAT2 (valbenazine / deutetrabenazine) - > switch cross tapering with lower tendency : CLOZAPINE / quetiapine

Answer 535

Parkinson dx: dx by clinical !!! 2/3 needed --> resting tremor, rigidity, bradykinesia ------> HYPOKINETIC GAIT!!!! ( slowing all motor activity) *risk in: haloperidol , risperidone ( easier to cause EPS at high dosage: 1. acute dystonia - -> add benztropine: AntiAch - > DIPHENHYDRAMINE: antiHistamine - > amantdine: drug induced Parkinsonims not dystonic rxn!!! 2. Akathisia: Add: beta blocker + lower antipsy rx --> EPS: ADAPT: No tachycardia !!!

Answer 536

---> MEDIAN nerve nerve conduction studies - > Phalen test - > tinel test

Answer 537

"UGLY ducking " sign -> ABCDE criteria

Answer 538

intraepidermal melanocytes hyperplasia | -> older pt

Answer 539

localized pain + tenderness MEDIAL TIBIAL condyle - -> overuse - > obesity, DM - > OA - > angular deformity of knee dx: XR knee rx: strengthening exercies + NSAIDS

Answer 540

LATERAL femoral epicondyle tenderness

Answer 541

relationship btwn dep variable vs independent variable -> how the study was designed , conducted , analyzed

Answer 542

generalization to other population

Answer 543

pulmonary local infiltrates + mediastinal NODULAR adenopathy ICP!!! -> prolonged neutropenia --> ABPA ( allergic bronchopulmonary aspergillosis) : promotes Th2- based allergic response , production IgE + eosinophilia

Answer 544

1. candida albican : oral thrust MC - ---> pseudohyphae - --> Rx: azole 1st - ----> if no improve: endoscopy! 2. HSV: orolabial round /ovoid lesion "volcano like" - --> multinucleated giant cells 3. CMV: large , linear ulcer distal esophagus - ---> intranuclear / intracytoplasmic inclusion ``` viral esophagitis: sym: -> SEVERE ODYNOPHAGIA -> no dysphagia -> no thrush ``` dx: endoscopy

Answer 545

sym: - > Cushingoid body habitus - > Proximal muscle weakness - > Hyperglycemia etio: - > exogenous steroids intake - > ectopic ACTH production ( small cell lung ca) - > ACTH-producing pituitary adenoma ( cushing dx) lab: - > Urine free cortisol - > low dose DXM suppression test - > ACTH level : dep/ independent - ---> HYPERK

Answer 546

--> prolonged exercise + ingestion large amt HYPOTONIC fluid ( water , sports drinks) sym: serum OSM > 285 !!!! -----> lossing WATER: higher serum OSM ( Na+ in body) --> SEVERE sym ( seizure, profound confusion)

Answer 547

--> AGE related degeneration with fibrosis of sinus node -----> - -> ischemia - > sarcoidosis, amyloidosis sym: - -> bradycardia, fatigue, dyspnea, LH, confusion, syncope, pre-syncope fibrosis: paroxysmal A. arrythmias ecg: - > sinus pauses ( delayed P waves) - > SA nodal exit block ( dropped P wave) - > chronotropic incompetence rx: - > Pacemaker - > rate -control rx: beta blockers

Answer 548

etio: - > smoking inhalation - > defective heating sys - > gas motor operating poor vent lab: - > reduce O2 carrying capacity - > dec O2 unloading in tix ( Hbg dissociation curve LEFT shift) - > impairs O2 utilization ( disrupted mito oxidative phosphorylation) - -> confusion, LA, met acidosis with AG - > myocardial ischemia - > NO hyperthermia !!! rx: 100% O2

Answer 549

---> Encapsulate org: S. pn, H, influenza, N. meningitidis ---> Humoral immune response with Ab-mediated phagocytosis ( opsonization ) + Ab-mediated Complement activation --> splenic macrophages rx: VACCINE !!

Answer 550

impaired oxidative burst -> recurrent bac / fungal inf - -> CATALASE -producing org eg. Aspergillus nidulans, S. aureus

Answer 551

- > occipital HA - > neck stiffness (extension blood into 4th ventricle) - > N/V , nystagmus - > IPSILATERAL HEMIATAXIA (cerebellar vermis) , limbs ---> hemiparesis + sensory loss absent unless extension to BS (ipsilateral facial palsy

Answer 552

: blisters at sun exposure areas, -----> NO oral mucosa inv

Answer 553

- -> flaccid bullae inv ORAL mucose + skin painful erosion, - -> NOT palm / soles -> age 40-60 yr dx: skin biopsy - -> ab against desmosome comp ( desmogleins 1 + 3) rx: sys steroids, rituximab

Answer 554

hix: SUBEPIDERMAL cleavage IF: linear IgG/ C2 deposition along BM serology: autoAb to bullous pemphigoid Ag ( Hemidesmosomes) sym: - > pruritic , TENSE bullae - > RARE mucosal inv!!!!! rx: -> topical: high potency steroids -> sys: steroids, DOXYCYCLINE

Answer 555

TP/TN/ TP + FP + TN + FN

Answer 556

- > immune med dest lacrimal + salivary glands - > asso SLE, RA - > dry eyes, mouth, skin - > + RRA ( anti-Ro) , + SSB ( anti-La) comp: NKL - > CORNEAL DAMAGE, dental caries

Answer 557

etio: s/p surgery/ trauma 4-6 wks ----> inf CYTOKINES + - > severe pain, regional ( NOT dermatonal) burning/ stinging Out of proportion inciting event - > ALLODYNIA (worsen by movement / light contact) - > edema - > erythmea , alter skin temp dx: XR: patchy DEMINERALIZATION - > bone scintigraphy: INC uptake affected limb dx: - > exercise, PT - > NSAIDS, pregabalin, TCA , alendronate

Answer 558

TCA ( TRIHEXPHENIDYL ) : anticholinergic --> rx: PD sym: - > inc ICP : impaired drainage aq humor thru pupil into ant chamber

Answer 559

initiate empiric therapy while awaiting test results : ISN + rifampin + PYZ + ethambutol 2 months --> 2 rx: ISN + Rifampin 4 months *** 2 rx : inc risk resistance!!!

Answer 560

--> speech -> brocas area ( posterior inferior FRONTAL gyrus) Wernike : temporal lobe lesions: receptive aphasia , repetition ---> INTACT expressive speech , motor , sensory

Answer 561

- > aplastic crisis with severe , acute anemia - --> MALAR surface rash - > reticulocyte count LOW - > DEC EPO

Answer 562

-> rxn > 24hr - 1 month s/p transfusion causing hemolytic anemia --> inc risk with SCD !!! sym: fatigue, jaundice, low fever, AXS lab: hemolytic anemia -> inc indirect bilirubin, LDH, ret count -> dec HBG , Haptoglobin -> + coombs test

Answer 563

HEMORRHAGIC mucosal lesions erosion after exposure - > ASA : dec protective Prostaglandin production - > COCAINE: vasoconstriction !!! red gastric BF - > ETHO: direct mucosal injury

Answer 564

- > RA + neutropenia ( ANC <2000) - > Splenomegaly - > HLA-DR4 + dx: - > anti-CCP + RF - > elev ESR > 85

Answer 565

reentrant circuits around TRICUSPID ANNULUS , slowing impulse thru cavotricuspid isthmus

Answer 566

- > proximal muscle wkness ( myopathy) : diff combing hair , wkness getting out/ in chair - > anxiety , WL , tachycardia acute thyrotoxic myopathy : severe distal / proximal muscle wkness -> w/o bulbar / resp muscle inv Chronic ---> MUSCLE ATROPHY

Answer 567

- > IV BZD + O2 - -> reduce sym outflow, dec anxiety + agitation , lower BP + HR, CV sym - > ASA : slow thrombus - > Nitrate + CCB : vasodilates **** BETA blocker selective ( A-M) : NOT used to rx till cocaine el from body ---> UNOPPOSED alpha -adrenergic + , worsening coronary vasoconstriction

Answer 568

--> TOPIC retinoids -> inhibits comedogenesis : normalizing keratinization ,dec epithelial cohesiveness, inc epi turnover

Answer 569

1. topic retinoids : inhibits comedogenesis + benzoyl peroxide 2. topical ab ( clindamycin) - > estrogen -OCP

Answer 570

etio: SUN exposed area - > >60 yr , fair skin asso: - -> actinic keratosis!!!!! hyperpigmentation , telangiectasis - -> HPV : perianal skin, genitalia - > scaly plaques/ nodules - > +/- ulceration -> SCC in situ: well demarcated patched / plaques dx: BIOPSY - > dysplastic / anaplastic keratinocytes rx: 1. Invasive SCC : excision 4-6mm margin - > Mohs micrographic surgery 2. SCC in situ : excision 4-6 mm margins - > C& E - > cyrotherapy - > topical 5-FU , imiquimod

Answer 571

triad: episodic HA, sweating, palp, tachycardia - --> RESISTANT HTN/ HTN with unexplain inc GLC - --> Paroxysmal HTN ( variable BP reading) -> FX MEN2, NF1, VHL dx: urine / plasm a metanephrine - > confirm abd imagine for inc metanephrines rx: - > Preop Alpha blocker PRIOR to BETA blockers - > LP / surgery

Answer 572

wider CI = SMALLER sample size ---> DEC power of study narrower CI = INC sample size , INC POWER

Answer 573

Erythema multiforme - -> erythematous papules evolve into target lesion - -> dasky central area - > red inf zone

Answer 574

``` sym: -> AXS till 30-40 yr -> flank pain ,hematuria -HTN !!! -> BIL palpable mass -> CKD ``` comp: - --> cerebral aneurysm - > hep + pancreatic cysts - > MVP , AR - > colonic diverticulosis - > ventral + inguinal hernia dx: U/S renal rx: - > ACEI - > hemodialysis , renal transplant

Answer 575

- > rapid progressive sensory loss in distal symmetric, stocking - glove dist - > distal numbness, tingling, pins, BURNING needles sensation -> length -dep axonal polyneuropathy etio: - > TOXIN (ETHO, metal exp) - > RX: metronidazole, fluroquinolones - > uremia - > long standing HIV - > DM neuropathy - > CMT

Answer 576

Parkinson disease!!!! - >> low amp / low freq 4-6 Hz - > typically start one hand - > worsen with MENTAL task moa: progressive loss DA neurons BG

Answer 577

rupture BRIDGING VEINS ---> crescent shaped hyper-density , cross suture lines

Answer 578

SUDDEN cardiac arrest in acute MI -> occur w/in 1st hour of sym onset ---> reentrant vent arrhythmia "immediately" : phase 1a : w.in 10 mins coronary occlusion --> "delayed " phase 1b: 10-60 mins : abnormal automaticity

Answer 579

- > high dose SSRI | - > CBT

Answer 580

- > fibroblast proliferation : isolated / multiple lesions - -> MC lower ext - > firm, discrete hyperpigmentation nodules <1 cm - > "BUTTONHOLE/ DIMPLE" sign dx: clx rx: cyosurgery

Answer 581

- > GN organism - > QUINOLONES !!!!! vs/ clindamycin : rx: ANAEROBIC!!!!

Answer 582

nondisjunctional sex chrm 47 XXY ---> testicular fibrosis with SEMINIFEROUS TUBLE DYSGENESIS - > primary hypogonadism - > inc long bone length - > gynecomastia lab: - > dec testo - > inc LH + FSH - > inc Estradiol

Answer 583

impair testicular function -> dec gonadal size + dec sperm count --> inc LIBIDO , NOT sparse facial / body hair

Answer 584

- > advance HIV - > sub Saharan african descent - > APOL1 gene variant sym: - > HEAVY PNURIA - > rapid progressive RF - > collapsing focal segmental glomerulosclerosis rx: ART ACEI poor prognosis

Answer 585

- -> hypotension - > tachycardia - > dec SVR - > capillary leak : loss IV voln into surrounding tix - --> low PCWP - > inc CI + SV - > INC PULSE PRESSURE : BOUNDING PERIPHERAL PULSE!!!

Answer 586

Unilateral: renal calculi (MC) - > flank pain : renal capsular distension - > low void voln: mech ob urine outflow - > w/ or w/o HIGH voln VOIDS (post-ob diuresis) - > K wasting + dehydration : wkness!!

Answer 587

asso with: MS!!!! - > MONOOCULAR vision loss - > pain with eye movement - > WASHOUT color vision - > AFFERENT pupillary defect + - > CENTRAL SCOTOMA !!! dx: fundoscopy: Normal !

Answer 588

- -> congenital anomaly aortic arch - > dysphagia, vomiting, food impaction - -> NO abd pain dx: INDENTATION at sie of ring

Answer 589

moa: early + adrenal androgens ADRENARCHE - > early 2ndry sexual dev - > NORMAL bone age - > ISOLATED PUBIC HAIR dev THELARCHE -> isolated BREAST dev !!!

Answer 590

neonate transmitted vertically: --> multifocal micronodules / ventricular enhancement MRI --> !!!! PERIventricular Calcification - -> Sensorineural hearing loss - > IUGR - > HSM - > Jaundice - > Thrombocytopenia dx: PCR CMV urine / saliva

Answer 591

- > transmitted undercook meat - > hydrocephalus - > diffuse PARENCHYMAL calcification

Answer 592

- > microcephaly | - > INTRACEREBRAL calcification

Answer 593

- > genetic mut loss photoreceptors - > progressive retinal degeneration - > age 10 - adult sym: night blindness - > progressive Visual field loss ( MIDPERIPHERAL) - > dec VA ( late ) - ----> BLINDNESS by 40 yr dx: fundoscopy: - > retinal vessel attenuation - > optic disc pallor - > abnormal retinal pigmentation

Answer 594

- > xerophthalmia | - > excessive dryness cornea + conjunctivae + night blindness

Answer 595

--> long standing sym wk-months concurrent urogenital infection adults sym: painless ulcer, very small and disappears within few days--> less common in USA) neonate: 5-14 days -> mild eyelid WATERY / MUCOPURULENT discharge -> chemosis ( conjunctival edema) dx: Gram stain - -> PCR testing confirm dx rx: oral ERYTHROMYCIN --> monitor pyloric stenosis

Answer 596

nasolacrimal ducts ob -> UNIlateral tearing + mini conjunctival injection

Answer 597

- > fever, sore throat, diff swallowing - > TRISMUS - > HOT potato voice - > pooling saliva - ----> ULVAR deviation !!! - -> bact inf region btwn tonsil + pharyngeal muscle - --> persistent tonsilitis / pharyngitis ---> cellulitis / phlegmon rx: -> need asp / incision drainage + AB

Answer 598

coxsackie A virus - > fever , sore throat , odynophagia - > vesicles on tonsils + soft palate

Answer 599

--> collapse supraglottic tix on inspiration - > inspiratory stridor when supine - > peak @ 4-8 month dx: LARYNGOSCOPY rx: - > reassurance close f/u - > supraglottoplasty severe sym

Answer 600

--> anomalous branch of the aortic arch or pulmonary artery encircles the trachea and esophagus. sym: -> biphasic or exp stridor --> tracheal compression and feeding diff dx: barium swallow - > confirmed CT scan or MR angiography.

Answer 601

- > toddlers - > fever, dysphagia, neck pain , stridor dx: !!!! -> XR: thickening pre-vertebral space -> ct scan

Answer 602

2 dose: age 1, 4 yr --> IF not complete 2 dose: Immunocompetent : VZV vaccine !!! --> ICP : VZ IG

Answer 603

-> H. influenza type b ( Hib) ``` sym: tripod position, sniffing, stridor -> distress -> dysphagia , dysphonia, drooling -> high fever ``` dx: XR: thumb sign rx: - > endotracheal intubation - > ab: CEFTRIAXONE + VNC PPx: immunization against Hib *** AMP + gentamicin : Gp B strep + e. coli

Answer 604

- > S. pn - > N. meningitidis sym: - > fever - > age <1 : bulding fontanelle, irritability, poor feeding - > age > 2: inc ICP, MNG sign ( nuchal rigidity) dx: CSF LP!!!! rx: ceftriaxone + VNC +/- DXM comp: intellectual / beh disaility - > hearing loss - > cerebral palsy - > epilepsy

Answer 605

high risk age <2 yr: - -> AMS - > LOC - > severe injury fall >0.9 m high - > nonfrontal scalp hematoma - > palpable skull fracture : raccoon eye, battle sign dx: head CT w/o contrast observe 4-6 hrs ER ----> EEG after CT : with seizure!!!! * ** AGE 2-18 yr: - -> fall >1.5 m high !!!! rx: reassurance + discharge

Answer 606

etio: - > penetrating trauma - > fall with object in mouth - > neck manipulation ----> injury post pharynx : cervical ICA : directly lateral + posterior to tonsillar pillars sym: - > gradual onset hemiplegia - > aphasia - > neck pain - > thunderclap HA dx: CT/ MR angiography

Answer 607

- > transient hemiplegia s/p focal onset seizure - -> may become 2ndry generalized sym: - > flaccid wkness / paralysis 1/both ext SAME side - > LOC - > postictal confusion dx: clx rx; self limiting

Answer 608

- > hemiparesis - > facial droop - > aphasia - --> antithrombin III def : hypercoagulable state - > inc spontaneous venous trromboembolism : femoral + mesenteric veins

Answer 609

age 2-5 yr MC child!!! - > nonsp sym - > leukemic cell overcrowd BM: pallor/ fatigue : anemia - > petechiae _ thrombocytopenia : !!!!! Impaired Pt production - > BONE pain !!! !!! Extramedullary spread: - > LAD - > HSM - > testicular enlargement !!! MEDIASTINAL MASS ( T cell ineage) : airway compression + SVC syn -> leptomng spread: CN deficits dx: CBC - > BM bx: >20 blast - > LP

Answer 610

etio: - --> MC: viral URI!!!! - > nontypeable h. influenzae - > s. pn - > moraxella catarrhalis - > cough, nasal discharge - > fever - > face pain/ HA - ---> allergic rhinits !!! dx criteria (1/3) : 1. persistent sym > 10 days w/o imp 2. severe onset fever >39c + drainage > 3 days 3. worsening syn f/u initial imp rx: AMX + clavuanate @@@@!!! *** smoking , chemical : wheezing !!!

Answer 611

- > skin breakdown from exp stool/ urine - > MC diaper rash sym: erythematous papules , plaques - > SPARES skinfolds + satellite lesions rx: - > topical barrier ( petrolatum , zinc oxide) - > refractory: low potency steroids

Answer 612

-> INC SKINFOLDS + stelliate lesion --> moist + macerated rx: topical antifungal

Answer 613

etio: FOODBORNE ILLNESS !!!! -> undercook poultry / eggs -> inadeq fridge prepared food sym: - > w/in 3 days - > fever, V, D - > abd pain - > bloody stool ( child) dx: stool culture rx: supp care alone : slef limited - > AB rarely needed

Answer 614

-> MC dev countries + poor sanitation sym: - > fever + bacteremia - > abd pain + rose spots - > late: HSM, int perforation dx: blood culture rx: fetal - > ab (ceftriaxone) - > drug resistance

Answer 615

- > dec wet diaper : UA crystals !!!!! pink stains / brisk dust - > absence tears - > dry mucosal - > dec skin tugor - > dec cap refill ----> NORMALLY lose up to 4% weight s/p birth !!! rx: WL <7%; up to first 5 days -> continue freq breastfeeding -> f/u 10-14 days check WL >7%: oromotor dysfunction - > assess for lactation failure - > daily weights - > formula supp

Answer 616

patho: congenital erythroid aplasia ( pure RBC ) !!!! sym: -> craniofacial abnormalities !!!!! -> TRIPHALANGEAL thumb -> inc CA lab: - > macrocytic anemia - > reticulocytopenia - > NORMAL Pt, WBC rx: steroids RBC transfusion

Answer 617

PANCYTOPENIC BM failure

Answer 618

recurrent UTI -> retrograde urine from bladder to ureter + renal pelvis - > dysuria - > fever - > suprapubic pain ( cystitis) + flank pain ( pyleonephritis) lab: pyuria + bacteriuria U/C dx: -> renal u/s: fever >39c with bacterial !!!! -> voiding cystourethrogram ( VCUG) --> > 2 febrile UTI rx: Ab ppx

Answer 619

MC : S. aureus -> hematogenous spread loc@ vertebral sym: fever, localize bony inf ( localized focal tenderness!!!) comp: epidural abscess : inf extends posteriorly into epidural space : severe back pain !! motor and sensory abnormal --> paralysis dx: cbc + ESR + CRP XR MRI CT guide needle asp / biopsy rx: VNC

Answer 620

1. postnatal: - > dec PVR, inc SVR - > L-> R shunting VSD ( HOLOSYSTOLIC MURMUR) !!!!! 2. infancy: -> RV voln overload / dilation -> pul over-circulation !!!! -> inc LA preload + LV overload,/ dilation -----> CXR: enlarge left heart contour!!! late childhood: - > inc PVR : pul A vascular thickening - > R-L shunting thru VSD ( eisenmenger syn)

Answer 621

ET: cxn middle ear -> nasopharynx - > equalize middle ear pressure - > drain middle ear fluid - > prevent Nasopharyngeal secretions into middle ear --> infection , allergies, envrio : tube OB --> inc risk in child: SHORTER , NARROW, floppy tube : inc risk acute otitis media (AOM) !!! sym: - > ear fullness/ discomfort - > tinnitus - > conductive hearing loss - > POPPING sensation dx: otoscopic : RETRACTED TM : neg pressure -> dilated BV rx: underline rx : Ab

Answer 622

--> hearing loss + tinnitus -> ACUTE days

Answer 623

``` Appearance Pulse Grimace / rxn Activity / muscle tone Resp effort ``` max: 10 pts dx: -> routine NB care : CHD, pre/ post ductal pulse oximetry !!!! echocardio hyperoxia test ( 100% O2) : distinguish btwn pul dx ( improve with O2) vs CHD ( persistent cyanosis )

Answer 624

SINGLE rx: continue rx additional 6 months!! -> dose maintained at same level , not be reduced >2 episodes rx: 1-3 years

Answer 625

PERMETHRIN

Answer 626

excessive COWs milk - > dec Hbg - > low MCV - > inc RDW --> rx: IRON rx for 2-3 months once hbg normalizes

Answer 627

- > resp droplets - > close quaters/ military , school - > fall/ winter sym: - > INDOLENT HA, fever , persistent DRY COUGH : gradual , less severe : 2-3 wks !!! - > Pharyngitis ( non-exudative) - > MACUALR/ VESICULAR rash dx: - > CBC - > RX: BILATERAL INTERSTITIAL INFILTRATES ( pleural effusion ) !!!! rx: empiric - > macrolides/ quinolones

Answer 628

- > MC , mildest type - > ASX in childhood - --> asso with SYRINGOMYELIA : syrinx loc at cervical region , progressive neuro dysfunction - > sym @ aldoescence : - -> dizziness, worsening pain with VALSAVA / phy activity straining -> Inferior displacement cerebellum thru FORAMEN MAGNUM!!! --> ONLY cerebellar tonsils displaces !!!

Answer 629

Asso with : ---> Myelomeningocele --> inc herniation cerebellar tonsils + VERMIS + inf displacement medullar !!! --> OB hydrocephalus : CSF thru 4th ventricule

Answer 630

--> HAMARTOMAS ``` Hamartomas CNS + skin Angiofibromas MR Ash-left spots Rhabdomyoma cardia TS dOminant Mental retardation Angiomyolipomas renal Seizures Shagreen patches ``` - -> inc risk: Subependymal giant cell astrocytomas - > ungual fibromas

Answer 631

- > painful eyelid swelling + erythema - > ANT to orbital septum : break in periorbital skin -> s. aureus, s. pyogenes enter preseptal space !!! NOT inv: - > intraobrital st -----> orbital fat: protyosis - ----> EOM: ophthalmoplegia ( eye muscle wkness / paralysis ), painful eye movement , visual change rx: oral Ab ( clindamycin )

Answer 632

- > sym preseptal cellulitis + PLUS - > Pain EOM , proptyosis / opthalmoplegia with diplopia ----> space POSTERIOR to orbital septum : contiguous spread from inf ( sinusitis , dental abscess, preseptal cellulitis) rx: IV ab + surgery

Answer 633

- > limp in one / both hips - > age 3-8 yo - -> FOLLOWING mild VIRAL illness - > sym resolve w/in wks lab: normal WBC, ESR, CRP rx: conservative rx: NSAIDS

Answer 634

- > VENTRALLY displaced urethral opening - > def failure urethral folds to fuse during early fetal dev - > incomplete ventral foreskin closure --> dorsal hood appearance ( extra dorsal foreskin with def ventral foreskin) - > penile curvature dx: CLX rx: UROLOGY evaluation : surgical correction - > circumcision deferred till evaluation

Answer 635

Wilms tumor Aniridia GU malformation Retardation mental dx: renal u/s

Answer 636

- > chronic joint pain + flam - > rash , fever - > inc ESR

Answer 637

- > BTK gene mut --> def BTK - > impaired B cell maturation + Ig production sym: recurrent sinopul + GI inf @ 2-6 month -> chronic enteroviral inf => small / absent LN ( tonsil/ adenoids) lab: dec all IG + AB response to vaccine -> flow cytometry : CD19 B cell dec normal T cell!!!

Answer 638

-> R --> L shunt across PDA physio: elev PVR normally dec O2 + vent of lungs - -> persistent fetal circulation : PVR remains elev : deO2 blood cross pul artery --> aorta + mixes O2 blood from LV - -------> lower POSTDUCTAL sat% compare to PREDUCTAL sat% - ----> normal distal pulses !!! risk: - >lung hypoplasia ( congenital diaphragmatic hernia , potter seq) - > inf ( pn) - > meconium asp rx: NO ( pul vasodilator) : prostaglandin E1 - > O2

Answer 639

prolonged > 4 wks concussion sym after mild traumatic brain injury sym: - > HA, dizziness, sleep dist, mood changes, cognitive impair - > no st IC injury rx: sym care

Answer 640

-> common URI VIRAL - > inf nasal passage + paranasal sinuses - > purulent discharge + facial pressure /pain exacerabte by leaning foward - > mild sym imp by 5-`0 days rx: supp care

Answer 641

-> failed NC migration during fetal dev enteric NS - > poor feeding , abd distension - > failure PASS meconium - > bilious emesis - > rectal tone INC + expulsion gas / stool !!!! dx: XR: complete bowel ob ( dilated bowel loops, absent rectal air ) w/o perforation ( free air under diaphragm) - > contrast enema : transition zone btwn narrowed aganglionic seg + normal diameter colon ( megacolon) - -> rectal suction BIPOSY !!!

Answer 642

-> asso : CF - > delay meconium passage - > abnormal Cl transport : thick , inspissated meconium, impacted ileum - > microcolon

Answer 643

Selenium sulfide - > terbinafine - > topical ketaconazole

Answer 644

Barky cough - > 6 mo - 3 yrs - > hoarseness, stridor, fever

Answer 645

def: Ca, Vit D, B12 , IDA soy: contains essential AA

Answer 646

Young age 1-3 yr !!! sym: sudden onset cough , dyspnea, cyanosis - > hx choking episode - > not relief by O2 exam: wheezing + stridor - > focal area diminished BS xr: hyperinflation affected side _> mediastinal shift towards unaffected side _ atelectasis ob if complete ---> 30% RX normal !!! rx: RIDGIT bronchoscopy!!!

Answer 647

Pelvic u/s : --> uterus absent : Karyotype :: 46 XY / 46 XX -> uterus + : check FSH !!! * ** central cause: 1. -----> Low FSH: TSH, prolactin: hypothyroidism , Prolactinoma, FHA 2. -----> Normal FSH: imperforated hymen *** peripheral causes: 3. ----> high FSH: Karyotype: : 46XX : primary ovarian insufficiency 45XO : TS

Answer 648

- > inc risk pnthroax : insuff surfactant - > meconium aspiration syn : airways traps distal gas rx: mech ventilation : nCPAP !!! ----> tension pnthroax: high Intrapleural pressure --> dec VR + CO --> hypotension + hypoxemia XR: hemithroax transillumination rx: ER NEEDLE thoracostomy !!

Answer 649

sym: enlarge 3-6 cm cervical node , marked tender , warm , erythematous - > S. aureus, S. pyogenes - > anaerobes asso periodontal dx rx: Empirical Ab : clindamycin ( MRSA) - -> amx + clavulanate - > incusion + drainage abscess

Answer 650

-> excessive prostaglandin production sym: - > pain 1st 2-3 days menses - > N, V, D - > normal pelvic exam rx: NSAIDS - > OCP

Answer 651

- > >40 yr - > endometrial glands + stroma w/in uterine myometrium -> tender, SYMmetrically enlarged globular uterus

Answer 652

- > adolescent with dysmenorrhea - > pain prior MC and THROUGHOUT MC - > uterosacral ligament tenderness, cul-de-sac nodularity, adnexal enlargement

Answer 653

-> Joint swelling O: carditis: MS (MC)!!!! --> inc LA pressure - --> elev pul vascular congestion , hemoptysis , RHF - --> risk : AFIB (LA dilation) , thrombus formation !!!!! Nodules Erythema mirginatum rash Sdyheam cholera

Answer 654

- > fever , rash " diffuse sunburn like" palms + soles - > rapid onset hypotension !!! - > multi-organ failure

Answer 655

-> abd pain, diarrhea, hematemesis ( GI errosive to gastric mucose)!!! - > hypovolemia shock w/in few HOURS : GI loss - > met acidosis with high AG rx: radiopaque tablets!!!

Answer 656

-> inc CSF production !!! enlarge head circumference -> inc ICP : poor feeding, buldging frontanellle, irritability, vomiting dx: MRI

Answer 657

-> chronic cough children > 4 wks/ > 8 wks adults - > hilar LAD( ghon complex) - > consolidation / pleural effusion ( 2ndry reactivation) - > Upper lung inv -> prolong fever, WL, fatigue dx: PPD / INF-g assy - > CXR - > _ AFB smear + culture

Answer 658

<15 yr : 2 dose >15 yr: 3 doses

Answer 659

etio: - > B6 (pyridoxine) def: TB rx -> ISONIAZID rx --> def heme synthesis ( mito) + ring sideroblasts (nucleated erythroblasts with mito iron granules surrounding nucleus) lab: - > inc lron conc - > dec TIBC

Answer 660

- > minor: reassurance | - > major: deferoxamine : Iron overload

Answer 661

etio: transudative pleural effusion ---> small defects in diaphragm : permits peritoneal fluid pass into pleural space --> MC right side : less muscular hemidiaphragm

Answer 662

intrapulmonary vascular dilation --> chronic liver dx -> platypnea ( inc dyspnea upright) / orthodeoxia ( O2 desat upright)

Answer 663

- > strenuous activity during hot weather - > dehydration - > rx: SSRI, TCA, sym: temp > 40C with CNS dysfunction - > organ / tix damage : renal/ hepatic failure , DIC , ARDS rx: rapid cooling : ice water immersion - > fluid

Answer 664

NON- glomerular hematuria | ``` SAND Sickle cell dx Analgesic abuse Inf ( pyelonephritis) NSAIDS DM ```

Answer 665

- > reduce renal perfusion :: SPLANCHNIC ARTERIAL DILATION : dec vascular resistance ---> + renal vasoconstriction , + RAAS, + dec GFR - > GI bleeding, sepsis, excessive diuretics use , SBP - > NSAIDS use ( constrict afferent ) rx: hypovolemia, anemia, inf -> splanchnic vasoconstriction ( midodrine, octreotide, NE) -> liver transplant rx: -> hypo

Answer 666

sym: TONGUE BITING @!!!! | high specificity!

Answer 667

pediatric mood disorder : persistent > 1 yr + freq outburst -- > prior 10 yr

Answer 668

-> NMJ dx: autoab against Ach receptor in MOTOR END PLATE - > fluctuating EOM + bulbar muscle wkness - > symmetric proximal wkness inv NECK + UPPER ext

Answer 669

-> familial dysautonomia (AR) jewish -> present at BIRTH > feeding problem w/ low muscle tone -> GROSS autonomic NS + severe orthostatic hypotension

Answer 670

hypomanic + mild depression dx > 2 year !

Answer 671

4-8 wks after infection: - > HBV ag + - > anti- HBc IgM + window period: -> IgM anti-HBc +

Answer 672

- > diffuse reticulonodular pattern ( millet seed) - > hema spread EPD : LN, liver, bones, CNS etio: incarceration + sub abuse

Answer 673

- > chronic exertional dyspnea : RHF --> PUL HTN - > IV hemolysis : chronic inf + endothelial dysfunction : hyperplasia + hypertrophy small pul vessels ( vascular remodeling ) + inc PVR !!!! PVR: dec RV output - > exertional dyspnea + fatigue - > HM + edema - > loud S2 lab: dec DLCO Normal TLC, FEV1/FVC

Answer 674

- --> phy disruption lym drainage !! - > Lymphadenectomy , radiation!!!! - > Ca Obstruction - > parasite - > congenital ( TS) - > obesity sym: deposit subcutaneous collagen + adipose tix : FIRM , thickened skin + nonpitting edema + stemmer sign rx: WL, limb elev, compression bandage, physiotherapy

Answer 675

drug- induced acne : steroid ind folliculitis / steroid acne etio: steroids , azathiroprine , cyclosporine anticonvulstants, antiTB

Answer 676

-> flushing + gen pruritus : peripheral vasodilation --> release histamine + prostaglandins rx: ASA

Answer 677

- > MC cutaneous HPV inf - > plantar, palmar, genital - > Young adults, ICP, organ transplant - > dev wks- months later hx: hyperkeratotic papules on sole foot

Answer 678

- > insp VELCRO ( DRY , FINE) CRACKLES !!! risk: HF : early ILD dx: high resolution CT - --> subtle reticulation / honeycombing - -> PFT

Answer 679

-> CKD : hypoproliferative anemia rx: + Erythropoiesis stimulating agents: recombinant EPO + darbepoetin: + RBC se/ HTN 2-8 wk s/p rx --> severe EOF

Answer 680

- -> PAINLESS GI bleeding - > dilated submucosal veins + AVM - > inc incidence > 60 yr - -> MC@ Right colon asso with : advance Renal dx + VWF dx -> AS dx: endoscopy GI , colonoscopy rx: Cautery

Answer 681

-> inhibits purine synthesis : rx/ chronic transplant IMS se/ BM suppression hepatotoxicity

Answer 682

lab: -> chronic hypoxia + hypercapnia inc PCO2 --> compensate with kidney inc HCO3 retention : dec Cl reabsorption ( HCO3-Cl exchanges in intercalated cells in DCT) --> compensate met alkalosis

Answer 683

abnormal cxn btwn aortoiliac vessels + GI tract : abd pain. GI bleeding, hypotension

IM mix UWQ - june 1st 2021 Flashcards

(709 cards)