Internal Medicine Flashcards Preview

Cardiology > Internal Medicine > Flashcards

Flashcards in Internal Medicine Deck (399):
1

Some SLE patients with dyspnea, persistent episodes of pleuritic chest pain, a progressive decrease in lung volume, and no evidence of interstitial fibrosis or significant pleural disease on chest CT have ... (dz).

Vanishing lung syndrome

1

Causes of primary HYPER-coagulable states

Antithrombin III deficiency, Protein C or S deficiency, Fibrinolytic abnormalities AND Homocystinuria AND Antiphospholipid Antibody Sdr.

1

Anticoagulation during pregnancy - 2 options

LMWH throughout the pregnancy AND AND LMWH until the 13th week, a change to warfarin until the middle of the third trimester, and then restart LMWH until delivery

1

ITP definition

isolated thrombocytopenia AND no peripheral smear abnormalities found AND no clinically apparent conditions causing thrombocytopenia

1

Acute rheumatic fever (ARF) major manifestations are: ...

Migratory arthritis predominantly involving the large joints / Carditis and valvulitis / Central nervous system involvement (eg, Sydenham chorea) / Rash

1

Anterior hip pains are ...

true hip pains.

1

Migratory polyarthritis is characteristic for ... and ...

gonococcal AND AND rheumatic fever

1

The peak incidence of West Nile virus infection arises at the end of ... and early... ( month).

August / September

1

Anti-ds DNA and anti-Smith antibodies are specific for...

SLE

1

Carpal tunel sdr in HD patients denotes

amyloidosis

1

Erythema migratum with migratory large joints arthritis occurs in...

acute rheumatic fever.

1

Worsening back pain with walking, but improving with back flexion or walking uphill

spinal stenosis

1

The definitive Tx for CML is...

BMT (hematopoietic cell transplantation)

1

... and ... are the two major clinical findings in primary aldosteronism.

Hypertension AND AND hypokalemia

1

Hypersegmented NFs are strongly sugestive of...

vitamin B12 or folate deficiency

1

Patients with the full Wiskott-Aldrich syndrome are cured by ...

bone marrow transplantation

1

Low ... is associated with increased risk for Alzheimer's dz in elderly.

diastolic BP

1

... vaccine is recommended for terminal complement or properdin def., asplenics and travelers to endemic areas.

Meningococcal

1

... is the best first test for excluding or confirming pheochromocytoma (sens 99, spec 89).

Plasma metanephrins

1

Screening with ... is done in women 40-69.

mammography

1

Endemic areas for ... infections are: sub-Saharan Africa extending from Guinea in the west to Ethiopia in the east and pilgrims who make the hajj to Mecca, Saudi Arabia.

Meningococcal

1

Neurologic symptoms after a benign respiratory or gastric infection: fine paresthesias followed by LEs weakness that may ascend is typical for...

Guillan-Barre sdr

1

...consists of: yellow nails, lymphedema, and pleural effusion.

Yellow nail syndrome

1

...has been commonly isolated in patients who suffered plantar puncture while wearing tennis shoes.

P. aeruginosa

1

When osteomyelitis arises following a puncture injury, ... is the most common pathogen in diabetic patients and ... in nondiabetics.

S. aureus AND AND P. aeruginosa

1

Three phase bone scan difference between ostemyelitis and cellulitis occurs in phase ... when only osteo results in increase uptake.

three

1

The initial Tx of spontaneous pneumothorax in a COPDer consists of…

tube placement followed by pleurodesis

1

The only useful Rx for gastroparesis is…

nutritional support

1

c-ANCA positive suggests...

Wegener granulomatosis

1

Anemia-pancytopenia, dementia, irritability, fatigue, weakness, constipation, dandruff, menstrual problems are all symptoms of …

Vitamin B12 deficiency

1

The most common cause of hemoptysis in HIV patients is…

bacterial infection

1

This sleep disorder occurs in the first third of the night and is rarely violent:

sleep walking

1

Inflammatory bowel dz, SLE, Behcet, and Reiters’ sdr. cause … in the oral cavity.

Ulcers (aftous stomatitis)

1

Erythema multiforme, …, and toxic epidermal necrolysis (TEN) are three disorders that have similar clinical features, including lesions of the skin and mucous membranes and induction by exposure to drugs or infections.

Stevens-Johnson syndrome (SJS),

1

Clinical criteria for… include fever, tonsillar exudates, tender anterior cervical lymphadenopathy, and absence of cough.

acute streptococcal pharyngitis

1

… represents 85% of brain infections in Mexico City.

Cysticercosis

1

In the perineal area, penetration of the gastrointestinal or urethral mucosa by enteric organisms can cause…, an aggressive infection

Fournier's gangrene

2

... is done in pts with unilateral tinnitus to rule out acoustic neuroma or a cerebellar-pontine angle tumor.

Gadolinium MRI

3

...therapy is given to most patients with COP (Cryptogenic organizing pneumonitis also called bronchiolitis obliterans organizing pneumonia - BOOP).

Corticosteroid

4

...is the antibiotic of choice, based upon its in vitro activity and the results of clinical trials in pertussis or "whooping cough".

Erythromycin

5

...is the second most common cause of disabling daytime sleepiness after sleep apnea.

Narcolepsy

6

The typical symptoms in... are excessive daytime sleepiness, hypnagogic, sleep paralysis, cataplexy and insomnia.

narcolepsy

7

Gamma hydroxybutyrate is especially useful in patients with severe cataplexy, but it can also improve daytime sleepiness in...

narcolepsy.

8

… arthropathy usually occurs in the 2nd and 3rd MCP joint.

Hemochromatosis

9

Abdominal pain or vaginal bleeding in a fertile woman raises concern for …

Ectopic pregnancy

10

Any new HA associated with seizure should prompt investigation with … and …

Neuroimaging / LP

11

To prevent endometrial carcinoma, women with these symptoms… should take PG with EG unless they had hysterectomy.

Hot flashes perimenopausal

12

…is a key predictor for poor outcome in patients with work-related back pain.

Low job satisfaction

13

… is very sensitive and specific for complete rotator cuff tears, less for partial.

MRI

14

… tears occur with twisting injuries (such as stopping short and turning).

Anterior cruciate ligament

15

Patients with … complain of recurrent episodes of vertigo lasting one minute or less provoked by specific types of head movements, such as looking up while standing or sitting, lying down or getting up from bed, and rolling over in bed.

Benign paroxysmal positional vertigo (BPPV)

16

... is most commonly used to palliate pain from pancreatic cancer but has also been used for relieving pain in chronic pancreatitis.

Celiac plexus neurolysis (CPN)

17

Patients with celiac disease should omit ..., ... and ... from their diet.

wheat AND rye (orz) AND barley (secara)

18

When more than one household has pruritus, Rx for ... may be appropriate even when typical burrows are absent.

scabies

19

... is the Rx of choice in head lice, with lindane and benzyl benzoate also effective.

Permethrin

20

..., an emergency, is Rx with IV acetazolamide, osmotic diuresis, topical pilocarpine and laser peripheral iridotomy.

Acute angle closure glaucoma

21

... is usually unilateral and presents with halos around objects, worsening eye pain, HA, N&V, and red eye.

Acute angle closure glaucoma

22

Fosphenytoin with ECG monitoring is an important step in the treatment of... due to ease of administration (high rate IV or IM).

status epilepticus

23

High grade gliomas are removed surgically then treated with...

external beam radiation.

24

... (location) seizures are characterized by the sudden occurrence of visual phenomena (flashing lights, hallucinations, or loss of vision).

Occipital

25

The most common manifestation of neurocysticercosis are... due to parenchymal involvement.

seizures

26

To prevent aspiration in a weak patient when emesis occurs, patient has to be placed in... position.

lateral decubitus

27

A patient with... can only move the eyes vertically and blink.

locked-in syndrome

28

One single seizure does not prompt to institution of antiepileptic meds in the absence of...

risk factors.

29

Conservative Rx with … is effective in reducing the bleeding episodes in patients with internal hemorrhoids.

Fiber supplementation

30

Diarrhea within 12 hours of ingestion of preformed bacterial toxins occurs in … and …exposure.

S. aureus / enterotoxigenic E. coli

31

Antiperistaltic agents and intraluminal adsorbents can be safely used in diarrhea without…, with the exception of enterohemorrhagic Escherichia coli infection.

slowing the clearance of pathogens

32

In patients younger then 35 YO, … or … is adequate to assess hemorrhoids unless the patient has risk factors for CA.

Anoscopy / sigmoidoscopy

33

Perianal area application of … relieves the pain, reduces the anal canal pressure and improves the anodermal blood flow in patients with anal fissures.

NTG or nifedipine

34

The positive serologic markers in acute hepatitis C are: …

HCV IgM

35

The positive serologic markers in acute hepatitis A are: …

HAV IgM

36

Disabling painful condition that occurs after a minor/major injury and is associated with vasomotor changes, skin and muscle atrophy and osteopenia is…

Reflex sympathetic dystrophy

37

Patients have an inability to localize precisely the pain and have characteristic tender points in …

Fibromyalgia

38

Anal fissures that do not occur in ... (location) are more likely to be due to a secondary cause and need investigation.

the posterior midline

39

A person with low risk for cervical CA and in a monogamous relation with many normal Pap smears, it is appropriate to screen every... .

3 years

40

HIV infection and any immunosupression state increases the speed of human papillomavirus tumor growth, so women will have to be screened for ... more often.

cervical CA

41

A recent diagnosis of ... (group of dz) is a risk factor for cervical CA.

STD

42

All these disorders cause ... HA (timing): migraine, cluster, chronic paroxysmal, OSA (Sleep apnea syndrome) and increased intracranial pressure.

morning/nocturnal

43

... (drug) is the most helpful in both labyrinthitis and Menièr’s.

Meclizine

44

Recurrent episodes of tinea versicolor is Rx with ... (drug class).

oral antifungal agents

45

... can reduce the risk of hip fracture among patients who are at risk for falls and fractures.

Hip protectors

46

… has been shown to reduce the time to hematopoietic recovery in recipients of autologous and allogeneic bone marrow transplantation.

G-CSF

47

The majority of cases have been due to … microti, (first described in 1966) and occur predominantly on the NE US coast: Massachusetts, particularly Cape Cod, Nantucket and Martha's Vineyard, Long Island, and recently also New Jersey, Block Island, off of

Babesia

48

... is the most common cancer in man and the second most common cause of CA death.

Prostate CA

49

Patients with… (location) metastases of malignant melanoma can be treated with surgery, radiation therapy, and/or stereotactic radiosurgery.

Brain

50

All abnormal PSA screening lead to ... except in very elderly and infirm men.

US guided transrectal biopsy of the prostate

51

An enlarged supraclavicular node in a patient with testicular mass suggests...

metastasized testicular CA.

52

... is the most common CA in the young man, and 95% of cases can be cured.

Testicular CA

53

Patients with ... (electrolyte imbalance) should be Rx with volume repletion and a loop diuretic to maximize renal excretion.

hypercalcemia

54

Hypokalemia is difficult to correct in the presence of ... because the latter causes renal potassium wasting through an unknown mechanism.

hypomagnesemia

55

The signs and symptoms of ... (electrolyte imbalance) include lethargy, anorexia, neuromuscular disorders (Chvostek and Trousseau’s signs) and cardiac arrhythmias, even in the absence of hypocalcemia.

hypomagnesemia

56

Most cases of traveler’s diarrhea are caused by... .

enterotoxigenic E. coli

57

Most cases of traveler’s diarrhea are responsive to Rx with ... (ABx class).

fluoroquinolones

58

... (dz) is the most common primary immune defect.

Selective IgA deficiency

59

... (complement component range) and factor D and properdin deficiency lead to increased neisserial infections.

C5-C9

60

... is the ratio between the change in anion gap and the change in plasma HCO3 and should be 1-2; when is not, in a high anion gap metabolic acidosis, a concurrent non-anion gap metabolic acidosis exists.

Delta-Delta

61

Diuretic-induced metabolic alkalosis occurs through increased... delivery to the collecting tubules where its reabsorption increases H and K secretion.

Na

62

... is the most common cause of acute renal failure due to intrinsic renal disease in hospitalized patients.

ATN (acute tubular necrosis)

63

Rx with ... as doxazosin, prazosin or tamsulosin is the most effective in BPH.

alpha-1-antagonists

64

MAOI are effective in depression but are not used b/o risk for... .

hypertensive crisis

65

... is defined as extreme mood swings, with mania plummeting into a major depressive episode.

Bipolar I disorder

66

... and … are the first line classes of drugs used for generalized anxiety disorder.

SSRIs / NRIs (norepinephrine reuptake inhibitors)

67

Symptoms of ... may include refractory hypotension, obtundation, circulatory collapse, and severe abdominal pain with nausea and vomiting.

adrenal insufficiency

68

... can be used in adrenal crisis because it does not interfere with cortisol measurements.

Dexamethasone

69

... (bacteria) meningitis is an important cause of infection in neonates, with a mortality rate of 7-27%.

Group B strep (Streptococcus agalactiae)

70

Adjunctive ... (drug) is recommended for infants/children with Hib meningitis and for children/adults with pneumococcal meningitis if initiated with or just prior to ABx.

dexamethasone

71

Infections with these 2 bugs, Clostridium septicum and Strep bovis are signaling the possible presence of a ... (dz).

GI malignancy

72

The typical rash of ... begins on the ankles and wrists and spreads both centrally and to the palms and soles. It often begins as a macular or maculopapular eruption and then usually becomes petechial.

Rocky Mountain spotted fever (RMSF)

73

Current Rx of an otherwise healthy, nonpregnant woman with uncomplicated UTI is Spectra or fluoroquinolones without a preceding ... (test).

urine Cx

74

Primary TB usually involves the ... lung zones and is associated with hilar adenopathy.

middle and lower

75

Reactivation TB commonly involves the ... and is associated with cavitation.

upper lobes

76

The clinical picture of ... (dz) is most commonly caused by Salmonella typhi, or Salmonella paratyphi A, B, or C, with some geographic variation.

typhoid fever

77

The incidence of coccidioidomycosis is increasing in older adults traveling to ... areas in the winter months.

desert

78

The causative agent in plague is... , a gram negative cocobacillus.

Yersinia pestis

79

All ... (dz group) are characterized by high fever, HA, arthralgias, myalgias, abdominal pain, conjunctivitis, pharyngitis, with petechia and purpura of mucosae.

viral hemorrhagic fevers

80

... (test) is indicated in acute or rapidly progressive glomerulonephritis and in elevated serum creatinine concentration in renal transplant recipients.

Kidney biopsy

81

These third-generation cephalosporins, cefoperazone and ceftazidime, have activity against... (bug).

P. aeruginosa

82

Multiplex polymerase chain reaction — M-PCR is a technique currently employed in research to detect the presence simultaneously of all three of the most common causes of ... in the United States.

genital ulcers

83

... remains the mainstay of therapy for genital HSV infections.

Acyclovir

84

Systemic ... has also been tried with some success for E. bieneusi infections

fumagillin

85

Any cranial nerve may be affected by Lyme disease, but ... neuropathy is most common; involvement can be bilateral, and may occur in association with meningitis or other cranial neuropathies.

facial - differentiated from patients with Bell's palsy by the presence of other clinical features of Lyme disease

86

Although ... (path finding) were exceedingly rare in syphilis the penicillin era before the onset of HIV disease, many case reports in HIV-infected persons have appeared in the last decade. Most of these have involved internal organs and seldom the skin.

gummas

87

Cardiovascular ... classically involves the ascending thoracic aorta resulting in a dilated aorta and aortic valve regurgitation. It may involve the coronary arteries, resulting in coronary thrombosis.

syphilis

88

Viral load influence the probability of developing an opportunistic infection in HIV, which, for unclear reasons, appears to be unusual with viral loads

5000

89

The ... syndrome is a form of progressive decrease renal perfusion in patients with advanced liver disease.

hepatorenal

90

Target daily protein intake should be ... to be safe (well tolerated and not leading to malnutrition) in CRF.

0.6-1 g/kg

91

... is a form of renal bone disease characterized by low bone turnover and increased osteoid levels secondary to aluminum deposition in the bone.

Osteomalacia

92

Cadaveric kidney transplant has shown to have a survival advantage over ... in patients matched for age and renal disease.

HD

93

Low dietary intake of ... is a risk factor for nephrolithiasis.

calcium

94

... (infection) in pregnancy should be treated b/o the risk for premature labor and delivery of infants who are small for gestational age.

Asymptomatic bacteriuria

95

... are needed after completion of ABx in pregnant women with asymptomatic bacteriuria.

Regular urine cultures

96

Noninfectious etiologies of ... (gyn path) include fixed drug reactions, Behcet's disease, neoplasms, and trauma.

genital ulcers

97

The ... should be suspected in any patient with hyponatremia, hypoosmolality, a urine osmolality above 100 mosmol/kg, a urine sodium concentration that is usually above 40 meq/L, normal acid-base and potassium balance, and frequently a low plasma uric aci

syndrome of inappropriate antidiuretic hormone secretion (SIADH)

98

Head and neck zoster of immunosuppressed patients should always be Rx with ...

IV acyclovir to prevent zoster ophtalmicus

99

SIADH results in ... (main electrolyte imbalance).

hyponatremia

100

High dietary intake of calcium is a protective factor for... (renal ds.).

nephrolithiasis

101

The... is a disorder in which water excretion is partially impaired because of the inability to shut off the secretion of ADH.

syndrome of inappropriate secretion of antidiuretic hormone (SIADH)

102

... contained in chewing tobacco cause HTN and hypokalemia by inactivating cortisol.

Licorice

103

... is a granulomatous dz of medium-sized to small arterioles and venules.

Wegener granulomatosis

104

AL amyloidosis is associated with increased secretion of a ... lymphoid product.

monoclonal

105

... (food) has been shown to slow the progression of renal failure in IgA nephropathy (Berger’s dz).

Fish oil

106

Circulating anti-glomerular basement membrane antibodies confirms ... (dz).

Goodpasture’s syndrome

107

Presenting symptoms in ... (disease) most often involve the URT and include rhinorrhea, sinusitis, ulcerations, cough, SOB and hemoptysis.

Wegener granulomatosis

108

An irregular contour of the kidneys on CT helps to confirm a clinical suspicion in ... (drug class) nephropathy.

analgesic

109

Very low levels of BUN and uric acid in an euvolemic patient suggest ... (syndrome).

SIADH

110

... should be suspected in hypokalemic patients because these intracellular ions are lost together.

Hypomagnesemia

111

A serum potassium level of 3 meq/L is equivalent to ... meq potassium deficit.

200-400

112

The key features of the ... syndrome are: absence of fever, symmetric neurologic deficits, patient remains responsive with normal or slow heart rate and normal blood pressure and no sensory deficits with the exception of blurred vision.

botulism

113

A positive nitroblue tetrazolium test establishes the diagnosis of...

chronic granulomatous disease

114

Ciprofloxacin is still the most potent fluoroquinolone for... (infectious agent).

P. aeruginosa.

115

Valacyclovir is a pro-drug that gets converted to ... in the intestinal wall and liver.

acyclovir

116

Rx of sensitive Strep. viridans endocarditis on native valves is done with penicillin or ceftriaxone for... weeks.

4

117

IgA deficiency is usually ... with multiple bacterial infections.

not associated

118

Drusen deposits are localized deposits of extracellular material concentrated in the macula, some of the earlier signs in patients with...

age-related macular degeneration (ARMD).

119

Parenteral therapy in severe hypoglycemia for patients who cannot take oral glucose is...

IV D50 and IM glucagon.

120

Decreasing dietary protein to less than... improves creatinine clearance and proteinuria.

0.8g/kg weight/day

121

... BMT is used in the treatment of certain patients with leukemias, lymphomas, multiple myeloma.

Autologous

122

The only known effect of prolactin deficiency is the inability...

to lactate after pregnancy.

123

The first step in evaluating... is measurement of target gland or tissue secretion or function.

pituitary function

124

Normal levels of target gland or tissue secretion or function of hormones rules out...

abnormal pituitary function.

125

... test is the gold standard test for normal pituitary growth hormone secretion.

The insulin tolerance (hypoglycemia is a potent GH stimulant)

126

Levels of FSH and LH should be chronically elevated in...

postmenopausal women.

127

The presence of normal menstrual cycles rules out...

abnormal FSH and LH secretion.

128

A spontaneous AM level of >18micrograms/dL of cortisol signifies...

adequate ACTH secretion.

129

..., a defect in the diaphragm sella is thought to allow CSF pressure to enlarge the sella that is not entirely filled with pituitary tissue and occurs in obese women with HTN and benign increased intracranial pressure.

Primary empty sella

130

Cortisol axis depressed patients should receive... during major physical stress (Sx, infections, hTN, N&V not allowing PO steroids).

full stress doses of hydrocortisone (300mg/d IV)

131

... is hypotonic polyuria as a result of inadequate AVP (vasopressin) secretion or response to AVP.

Diabetes insipidus

132

Increase in urine osmolality... after AVP administration indicates nephrogenic diabetes insipidus.

<10%

133

HIV patients receiving antiretroviral Rx and erythropoietin level less then 500mU/mL benefit from ... administration.

erythropoietin

134

Autologous blood donation before elective surgery is helped by administering ...

erythropoietin

135

... (ABx) is preferred in bartonellosis because it also is effective against often associated Salmonella infections.

Chloramphenicol

136

Argyll Robertson pupils are small fixed pupils that do not react to strong light but do react to convergence-accomodation, typical of ...

tabes dorsalis

137

... is a disease of the posterior columns of the spinal cord and of the dorsal roots, which occurs 18 to 25 years after initial untreated infection. Typical manifestations include paresthesias, abnormal gait, and lightning (sudden severe) pains of the ext

Tabes dorsalis

138

Starting oral acyclovir in chickenpox in the first ... after the onset of rash shortens the fever duration with one day and decreases the number of lesions in children, adolescents and adults.

24 hours

139

The number of doses of doxycycline 200mg for Lyme dz suspected infection (endemic area, tick exposure duration) is...

one

140

N. meningitidis post-exposure prophylaxis is done only if the subject had contact with the patient’s ...

respiratory secretions

141

The development of reactivation tuberculosis often follows closely after... (test).

tuberculin skin test conversion.

142

Worsening of other infectious dz with antiretroviral Rx is caused by...

partial immune reconstruction

143

... after the lesion was noted is too late for any Rx in herpes labialis.

One day

144

All patients with VRE have ... with it and there is no way to eradicate it now.

intestinal colonization

145

All patients receiving linezolid (Zyvox®, VRE infections) should have a complete blood count each week b/o possible...

thrombocytopenia

146

... in addition to ABx in PCP with hypoxemia have been shown to improve the outcome.

Corticosteroids

147

... is the presence of thyroid tissue as a major cellular component in an ovarian tumor, nearly always a teratoma.

Struma ovarii

148

TSH secreting tumors should be treated by...

surgery.

149

TSH is checked after... on a stable dose of levothyroxine.

5-6 weeks

150

Persistently elevated or increasing TSH levels and hyperlipidemia are indications for... therapy.

levothyroxine

151

... can be described as abnormal findings on thyroid function tests that occur in the setting of a nonthyroidal illness (NTI) without preexisting hypothalamic-pituitary and thyroid gland dysfunction. After recovery from an NTI, these thyroid function test

Euthyroid sick syndrome

152

Most women with hypothyroidism will require an... in their levothyroxine dose during the 2nd and 3rd trimesters and a subsequent… after delivery.

increase / reduction

153

Fine needle aspiration positive for thyroid CA in a pregnant woman leads to... only when extensive local disease or rapid growth occur.

emergent surgery

154

The lab findings in... are volume contraction with hyponatremia, hyperkalemia, hypoglycemia, azotemia, non-anion-gap acidosis, anemia and eosinophilia.

adrenal insufficiency

155

Bilateral internuclear ophthalmoplegia is the classical presentation for...

MS.

156

The standard treatment for a significant acute MS exacerbation is...

high dose methylprednisolone (500-1000/d 3-5 days).

157

The genes DQA and DQB predispose to...

type Ia diabetes.

158

The two mechanisms in type 2 DM are...

decrease insulin secretion in response to glucose and peripheral resistance to insulin.

159

... is a subset of type 2 DM with early age of onset and a strong family history.

Maturity-onset type 2 DM (MODY)

160

... is defined as any degree of glucose intolerance with onset or first recognition during pregnancy.

Gestational diabetes

161

Women with gestational diabetes should undergo a 6-week postpartum...

oral glucose tolerance test.

162

Daily insulin production in healthy persons is usually... U that are secreted in the portal circulation.

24-36

163

Metformin (Glucophage) works mainly by... (action).

inhibiting hepatic gluconeogenesis

164

This oral hypoglycemic drug is contraindicated in creatinine>1.5, ETOH abuse, CHF:...

Metformin (Glucophage)

201

... (oral hypoglycemic) should be stopped 24-48 hours before contrast procedures.

Metformin (Glucophage)

202

... is indicated in patients in whom HbA1c<7 can not be maintained while on 2 oral hypoglycemic drugs combined with lifestyle modifications.

Insulin therapy

203

... is long-acting insulin with much reduced risk for hypoglycemia.

Glargine (Lantus®)

204

Acute bicarbonate replacement is usually mandatory when the pH is...

<7.0

205

Signs of complication of... (electrolyte imbalance) occur rarely: hemolysis, unexplained CHF, and rhabdomyolysis.

hypophosphatemia

206

Headache and unexplained diminished in consciousness several hours after therapy for DKA was initiated, signal...

cerebral edema.

207

Chronic hypoglycemia can lead to...

hypoglycemia unawareness.

208

A supraclavicular node of >2cm associated with systemic symptoms in a young smoker should be followed...

with CXR.

209

Surgery is not indicated in... lung carcinoma due to its systemic nature.

small-cell

210

... is a PULMONARY disease caused by the interaction between anti-granulocyte antibodies (usually of donor origin) and granulocytes (usually of recipient origin) after transfusion of blood products leading to fever, tachycardia, hypotension, and hypoxemia

The transfusion-related acute lung injury (TRALI)

211

When a patient needs platelets and has HLA alloimmunization and thus..., the platelets have to be single-donor and matched.

immune refractoriness

212

... has to be ruled out in any cancer patient with new onset back pain, and… is the test of choice.

Spinal cord compression / MRI

213

Non-small cell lung CA with one brain met should be Rx with...

excision and radiation.

214

The first priority in hypercalcemia is...

vigorous rehydration.

215

The brains of individuals with... are characterized by extracellular deposition of amyloid-beta protein, intracellular neurofibrillary tangles, and loss of neurons.

Alzheimer's disease

216

Statins Rx of hypercholesterolemia (and no other Rx) decreases the incidence of this neurological condition...

Alzheimer's disease.

217

In MDS,... (2 types cells) have abnormal function, so normal counts of either do not confer enough protection.

granulocytes and platelets

218

Rx with... is commonly used to normalize blood counts in CML

hydroxyurea or alpha-INF

219

Acquired neutropenia is most commonly caused by ...

infections and drugs.

220

Elevated red mass without secondary causes of erythrocytosis and the presence of splenomegaly or abnormal BM karyotype other then t(9;22) chromosome establish the diagnosis of...

polycythemia vera.

221

The target hematocrit in polycythemia vera is...

45%.

222

... , as opposed to essential thrombocythemia (ET), is not associated with increased incidence of thrombosis or hemorrhage, splenomegaly, or abnormal cytogenetic findings.

Secondary thrombocytosis

223

... is the most common acute leukemia in the immediate perinatal period.

AML

224

... migraine is characterized by attacks in which neurologic symptoms last for the entire headache, for several days or weeks, or in some cases leave a permanent neurological deficit.

Complicated

225

Basilar artery migraine, ophthalmoplegic migraine and hemiplegic migraine are all...

complicated migraines.

226

First line treatment of essential tremor consists of...

primidone or a nonselective beta blocker.

227

The diagnostic triad in... is: monoclonal gammopathy, lytic bone lesions, and >10% plasma cells in the BM. (manifests with bone pains, anemia, renal insufficiency, and recurrent infections)

multiple myeloma

228

The presence of Heinz bodies and characteristic bite cells make the diagnosis of... very likely.

G6PD deficiency

229

... is characterized by the following: presence of a serum monoclonal protein (

Monoclonal gammopathy of undetermined significance (MGUS)

230

Patients with febrile neutropenia should receive...

empirical ABx Rx.

231

Patients with afebrile neutropenia but signs or symptoms of infection should receive...

empirical ABx Rx.

232

Radiation for any type of CA has two major side effects...

premature CAD and secondary cancers.

233

In some patients with severe ETOH cirrhosis, RBCs accumulate large quantities of cholesterol and became small, spheroidal, and with short, spiny projections, causing a severe hemolytic anemia called...

spur cell anemia.

234

... (test) is the only blood test differentiating between iron-deficiency anemia and anemia of chronic disease.

Serum ferritin level (the gold standard is BM biopsy)

235

An extensive search for an occult malignancy in otherwise healthy patients is...

not cost-effective, due to lack of success in finding a treatable disease.

236

... is the burning pain of the hands or feet associated with erythema and warmth.

Erythromelalgia

237

Plasma exchange with... as replacement solution is the procedure of choice in TTP.

fresh frozen plasma

238

Polyneuropathy can be investigated by... when vasculitis, amyloidosis, leprosy, sarcoidosis, or tumor infiltration are suspected.

nerve biopsy

239

Glatiramer acetate works in MS by decreasing... by a mechanism called bystander suppression.

CNS inflammation

240

... usually manifests as a sudden sensorineural hearing loss and is the most common infection of the inner ear in adults.

Viral cochleitis

241

Adult dermatomyositis w/u should include... in women, and… in men.

breast and pelvic exam / prostate exam

242

If the meningioma is small and asymptomatic,... are usually appropriate.

radiological and clinical observation

243

... is recommended for symptomatic meningioma.

Surgical management

244

Teardrop cells (poikilocytes) and nucleated RBCs signal the presence of a...

myelophtisic process in the BM.

245

... which leads to excretion of iron in the urine is the drug of choice for iron overload in anemia.

Parenteral desferioxamine B

246

The most sensitive test of iron storage is the determination of the... level.

serum ferritin

247

The initial Rx for autoimmune hemolytic anemia is...

prednisone.

248

Before splenectomy, vaccination with... (3) are necessary.

pneumococcal, Hib, and meningococcal

249

Sickle cell disease is characterized by thrombosis due to enhanced sickle erythrocyte...

adhesion to the vascular endothelium.

250

Standard Rx for sickle cell disease includes consideration of..., an inducer of fetal gamma-globulin.

hydroxyurea

251

BM displays a... process when the normal elements are replaced by fibrosis, granulomatous inflammation, or neoplasm.

myelophtisic

252

Microangiopathic hemolytic anemia and thrombocytopenia with predominant renal insufficiency occurs in...

postpartum acute renal failure due to (TTP-HUS) or severe preeclampsia

253

The hallmark of acute hemolytic anemia is...

red plasma and urine.

254

The blood from close relatives has to be... (preparation) because of increased risk of GVH dz, even in immunocompetent individuals.

irradiated

255

The hallmark of transfusion-related lung injury is...

hypoxemia.

256

... is the most common malignant neoplasm of the urinary tract in children (87 percent of renal tumors) and is responsible for 8 percent of all solid tumors in this age group.

Wilms' tumor (nephroblastoma)

257

... lung CA is associated with SIADH, ectopic adrenocorticotropic hormone and Eaton-Lambert syndrome.

Small-cell

258

The most powerful prognostic factor in breast CA is the...

presence or absence of invasive dz in the biopsy specimen.

259

Squamous cell and small-cell lung CA tend to be located...

centrally.

260

All patients evaluated for dementia should have... (imaging).

brain CT or MRI

261

... (lifestyle intervention) plays a very important role in idiopathic intracranial hypertension.

Weight loss

262

Initial Rx in essential tremor consists of a...

non-selective ß-blocker (propranolol or nadolol) or with the anticonvulsant primidone.

263

... is indicated for tumors>6cm, hormone-producing tumors that are clinically apparent, and pheochromocytomas.

Adrenal surgery

264

If an adrenal mass is stable in size by CT after..., the management is stopping radiological surveillance due to very low risk for malignant transformation.

6-12 months

265

The ratio of morning aldosterone concentration to plasma renin activity test cannot be performed in patients on... (drug)

spironolactone.

266

Primary hyperaldosteronism has been recognized in as many as... % of HTN patients.

14

267

... patients have no secondary sexual characteristics, have low-set hair line, growth retardation, webbed neck and skeletal abnormalities.

Turner syndrome

268

Patients with hyperdynamic septic shock (hypotension, low SVR, and high CI) tend to have warm extremities ("warm sepsis") due to inappropriate hyperperfusion of the skin and soft tissues and should be treated with...

norepinephrine.

269

Patients receiving... are extremely sensitive to vasopressors, and require much lower doses.

monoamine oxidase inhibitors

270

... may be preferable in patients with hypodynamic sepsis (hypotension, low SVR, and low CI) which manifest hypoperfusion of the extremities ("cold sepsis").

Dopamine

271

Nonrandomized, open label case series have suggested that... may be useful in the treatment of refractory septic shock, particularly as a second pressor agent.

Vasopressin

272

The addition of... (infused at a fixed rate of 0.04 U/min) to norepinephrine was more effective in reversing late vasodilatory shock than norepinephrine alone and similar results were noted in severe septic shock.

vasopressin

273

An unprovoked and persistent hypokalemia, metabolic alkalosis in a patient with a recent diagnosis of HTN is a common lab finding in...

mineralocorticoid excess (Conn sdr).

274

In a man with lower extremity lymphedema,... should be suspected.

prostate cancer

275

A multinucleated giant cell surrounded by macrophages and T lymphocytes is called... and is characteristic of rheumatic fever.

Aschoff nodule

276

The hallmark of traditional diabetes dyslipidemia is... (2 changes).

elevated triglycerides and low HDL.

277

Obesity is defined as BMI>27 or an abdominal girth of over... (cm).

107

278

... is confirmed by an elevated lactate dehydrogenase level, reticulocytosis, and schistocytes on the peripheral blood smear.

Microangiopathic hemolytic anemia

279

... is the treatment of choice for patients with autoimmune thrombocytopenia.

Prednisone

280

In otherwise healthy young women with dysuria and pyuria without high fever or signs of pyelonephritis, a 3-day regimen of trimethoprim-sulfamethoxazole, trimethoprim alone, or a fluoroquinolone or a... regimen of nitrofurantoin may be initiated without u

7-day

281

Parenteral antibiotics (i.e. IV ceftriaxone) are recommended for treating neurologic disease, more severe cardiac disease (high grade AVB with PR>0.3sec), and complicated Lyme arthritis. Duration of therapy is usually...

4 weeks.

282

... is the single most important infection control measure.

Hand washing

283

... are an important cause of bacterial diarrhea and the most common cause of infective hemorrhagic colitis in the United States.

Enterohemorrhagic Escherichia coli

284

The most significant sequelae of enterohemorrhagic Escherichia coli infection are...

hemolytic-uremic syndrome and thrombotic thrombocytopenic purpura.

285

The sensitivity and specificity of the urea breath test for H. pylori are greater than...

90%.

286

... , is the most common cause of acute pancreatitis.

Gallstones, including microliths (microlithiasis)

287

Smoking, diabetes mellitus, chronic pancreatitis, and exposure to industrial toxins are predisposing factors for...

pancreatic cancer.

288

For the patient with MR who is contemplating pregnancy, but is not considered a candidate for surgical mitral valve repair or replacement on the basis of usual clinical indications, prophylactic surgery should ...

not be done, because pregnancy after valve replacement may be less desirable.

289

If labor begins in a patient with PHV receiving warfarin, delivery should be ...

a cesarean section.

290

The possibility of... should be considered in any patient older than 40 years of age with unexplained anemia, renal failure, bone lesion, or recurrent infections.

myeloma

291

Cigarette smoking, postnasal drip, asthma, and gastroesophageal reflux are the most common causes of...

chronic cough.

292

... (imaging) may help to establish a diagnosis of bronchiolitis obliterans.

Expiratory high-resolution CT scan

293

A young woman with a pneumothorax and any patient with abnormal lung parenchyma on a postdrainage radiograph should undergo... to look for underlying lung disease.

high-resolution CT of the chest

294

... is a skin condition induced by heat, activity and emotional stress frequently associated with dermographism.

Cholinergic urticaria

295

Both 6-mercaptopurine and metronidazole prolonged remission and are helpful in treating fistulizing disease in patients with...

Crohn’s disease.

296

Risk factors for stress ulcers are... If these factors are absent, prophylaxis is not indicated.

mechanical ventilation and coagulopathy

297

... is a chronic inflammatory disorder of young adults presenting with interstitial keratitis (IK), vestibuloauditory dysfunction (vertigo) with sensorineural hearing loss and possibly aortitis.

Cogan's syndrome (CS)

298

... is the development of sterile pustules at the site of needle entry.

Pathergy

299

The classic triad of organ involvement in... is respiratory tract, the lungs and the kidneys.

Wegener’s granulomatosis

300

A red, warm, swollen joint presentation is... until proven otherwise.

infectious arthritis

301

Treatment with... reduces cryoglobulin levels and clinical symptoms of cryoglobulinemia.

INF-alpha

302

The number of unexplained consecutive spontaneous abortions before the 10th week of gestation to qualify for antiphospholipid antibody syndrome is at least...

three.

303

There is a possible increase in congenital CNS and limb abnormalities in fetuses with exposure to... (cholesterol drug class) during the first trimester.

lipophilic statins

304

In addition to octreotide, a new agent pegvisomat has become available for...

acromegaly (a growth hormone receptor antagonist)

305

In a symptomatic popliteal cyst that can simulate DVT, this therapy is contraindicated...

anticoagulation.

306

Serum alkaline phosphatase concentrations are physiologically significantly higher (up to two to four times normal) in the... trimester of pregnancy.

third

307

The preferred therapy for recurrent pregnancy losses in antiphospholipid antibody syndrome is...

heparin and aspirin.

308

The indications for total knee replacement in patients with OA are...

pain and limitation of function that decreases the quality of life.

309

The nasal septum ulceration causing the collapse of the nasal bridge and the characteristic saddle nose occurs in...

Wegener’s granulomatosis.

310

Phentolamine is an alpha-adrenergic blocker, the use of which is limited to the treatment of severe hypertension due to increased catecholamine activity: pheochromocytoma and tyramine ingestion in a patient being treated with...

MAOI

311

Patients with hepatitis C should receive vaccination with... unless already immune.

hepatitis A and B

312

A military recruit returning from boot camp with symptoms of URI has...

Mycoplasma.

313

The therapy for Mycoplasma is...

erythromycin.

314

Exposure to goats, cattle or swine leads to...

Q fever - widespread zoonotic infection caused by the pathogen Coxiella burnetii which has both acute and chronic manifestations

315

The CDC guidelines recommend the combination of... for the treatment of acute epididymitis most likely caused by gonococcal or chlamydial infection.

ceftriaxone (250 mg IM as a single dose) plus doxycycline (100 mg PO BID for 10 days)

316

The clinical finding of acanthosis nigricans suggests... (Metabolic derangement)

insulin resistance.

317

IM glucagon given for hypoglycemia has to be followed shortly by...

carbohydrate ingestion, due to its very low effective – minutes – half-life.

318

The diseases from this class (including Graves’ disease) remit during pregnancy...

autoimmune.

319

... is a disease characterized by vomiting leading to weight loss associated with hyperthyroidism due to elevated HCG levels.

Hyperemesis gravidarum

320

New onset hypoglycemia can occur due to... in a DM patient, especially black.

renal failure

321

The therapy for prolactin-secreting macroadenomas in patients intolerant to drugs consists of...

transsphenoidal surgery or radiation.

322

... has revolutionized the treatment options for men with impaired sperm production.

In vitro fertilization

323

“Normal” FSH and LH levels in postmenopausal women signify...

pituitary dysfunction.

324

The total body vitamin D stores are represented by the plasma concentration of...

25-hydroxyvitamin D3.

325

Androstenedione is a weak androgenic steroid hormone, the product of natural gonadal and adrenal synthesis and a precursor to...

testosterone

326

The initial therapy in a patient with DM 2 presenting with acute symptoms, pregnancy or hyperglycemic emergencies is...

insulin.

327

The prognosis of gastric carcinoma is primary related to...

the depth of local penetration through the gastric wall.

328

Symptoms of GERD more than a year duration prompt this test...

endoscopy.

329

A... is the most appropriate therapy for a patient with GERD.

PPI

330

High grade dysplasia in Barrett’s esophagus is treated with...

esophagectomy.

331

... has a typical appearance on barium esophagogram of bird’s beak.

Achalasia

332

... is a group of heterogeneous upper GI symptoms: epigastric fullness, postprandial pain and discomfort, belching, bloating, nausea and food intolerance.

Dyspepsia

333

Gastric H. pylori infection can lead to this type of lymphoma:

MALT – mucosa-associated lymphoid tissue.

334

... (drug class) should not be taken at least 2 weeks prior to a urea breath test or urea blood test for assessment of H. pylori status.

PPIs

335

... is the drug of choice for acute onset gastroparesis.

IV erythromycin

336

The severity of pancreatitis is... to the level of serum amylase or lipase.

not related

337

Symptoms of acute diarrhea that occurred after eating poorly cooked beef suggests...

enterohemorrhagic E. coli O157:H7, which can be associated with HUS.

338

Lung CA is considered an absolute contraindication to lung transplantation for at least... after curative resection.

5 years

339

As many as 30% of patients with subacute bacterial endocarditis have arthritis, particularly in the...

knees.

340

…therapy has to be instituted before anxiety treatment in hospitalized patients.

The pain control

341

The presence of cataplexy is pathognomonic for...

narcolepsy.

342

... is characterized by sudden attacks of focal or generalized muscle weakness in response to strong emotion, such as anger or laughter.

Cataplexy

343

The therapy for bronchiolitis obliterans is a...

steroid.

344

Methotrexate treated patients have to receive... as supplement.

folic acid

345

For preventing fetal loss in antiphospholipid antibody syndrome... has been advocated based on retrospective studies.

low-dose ASA

346

PET scanning in DM patients is affected by...

uncontrolled glucose levels (elevated levels cause false negative tests).

347

The empiric therapy for CAP in a non-ICU patient is...

cephalosporin plus macrolide.

348

The empiric therapy for CAP in an ICU patient is...

cephalosporin plus fluoroquinolone.

349

Risk factors for... (bug) include bronchiectasis, daily steroid therapy, recent ABx use, and malnutrition.

P. aeruginosa

350

PET scanning cannot differentiate lesions smaller than...

1 cm.

351

The test of choice in Pancoast tumor is...

MRI (local vascular and neurological structures involvement).

352

The... is reticulocytes (percent) x HCT / 90 and is normal 1, but has to increase to more than 2 to represent a normal bone marrow response to anemia.

reticulocyte production index

353

... are characterized on intestinal biopsy by villous atrophy and plasma cell infiltrate.

Both sprues (celiac and tropical sprue)

354

Before instituting this measure..., a small bowel biopsy is needed to confirm celiac sprue.

gluten-free diet

355

If an adenomatous or hyperplastic polyp is found on sigmoidoscopy, this test follows...

full colonoscopy.

356

Elevated alkaline phosphatase with normal liver imaging should be followed by the measurement of...

antimitocondrial antibodies to r/o primary biliary cirrhosis (PBC).

357

All patients with variceal bleeding due to cirrhosis should receive one week of antibiotic prophylaxis with... (class).

a fluoroquinolone

358

Acute acalculous cholecystitis is treated with...

urgent cholecystectomy.

359

The therapy of choice in patients with acetaminophen-induced fulminant hepatic failure is prompt administration of...

N-acetylcysteine.

360

... refers to common hepatic duct obstruction caused by an extrinsic compression from an impacted stone in the cystic duct.

The Mirizzi syndrome

361

... is a dilated aberrant submucosal vessel which erodes the overlying epithelium in the absence of a primary ulcer.

A Dieulafoy's lesion

362

A patient older than... with dyspepsia should undergo endoscopic evaluation.

50 years

363

Splenic vein thrombosis is a complication of both acute and chronic pancreatitis and is treated with...

splenectomy.

364

Determination of... is done to rule out carcinoid syndrome.

5-HIAA

365

Patients with porcelain gallbladder need...

removal due to the possible (20%) risk of cancer.

366

... was used as a digestive tonic and as a stimulant for milk flow in nursing mothers. It appears to supply important compounds for hepatic detoxification reactions (including drug metabolism) and to block the hepatotoxic effects of some compounds.

Milk thistle (silymarin – active ingredient)

367

Choledochal cysts are associated with increased risk of...

cancer so they need surgical excision.

368

Pulse oximetry can be falsely... if the patient being tested has an excessively high carbon monoxide concentration, because it can not distinguish between carboxyhemoglobin and oxyhemoglobin due to the same wave-length light absorption.

elevated

369

... (class drugs) are a good choice for patients with mild persistent asthma, patients taking high doses of inhaled glucocorticoids, and especially patients with aspirin-sensitive asthma.

Leukotriene receptor antagonists (Zileuton (Zyflo) is an inhibitor of 5-lipoxygenase, zafirlukast (Accolate) and montelukast (Singulair) are inhibitors of the action of LTD4 at its receptor)

370

Obstructive lung disease is present if the FEV1/FVC ratio is less than...

70%.

371

The side effects of these asthma drugs... are dose dependent and include tremor, tachycardia, SV arrhythmias and hypokalemia.

beta-agonists AND short acting = isoproterenol AND intermediate acting = albuterol, metaproterenol, levalbuterol AND long acting = salmeterol, formoterol

372

... is the only Rx that has been shown to prolong life in hypoxemic patients with emphysema.

Oxygen

373

... is the current “gold standard” test for bronchiectasis.

HRCT

374

Fluid boluses in patients with septic shock should continue until BP improves or signs of early high LV filling pressure occur...

lung crackles or drop in the pulse oximetry.

375

... is the treatment for bronchorrhea in a cholinergic crisis.

Atropine

376

The pleural fluid in... has high TG and normal protein and LDL.

chylothorax

377

... is the most effective therapy for most patients with dystonia.

Botulinum toxin

378

... refers to the repetitive, voluntary or involuntary, passage of stool in inappropriate places by children four years of age and older, at which time a child may be reasonably expected to have completed toilet training and to exercise bowel control.

Encopresis

379

... is a chronic, blistering autoimmune disease of unknown cause that most commonly affects persons 60 years of age or older. It is twice as common as pemphigus vulgaris, being the most common blistering autoimmune disease.

Bullous pemphigoid

380

The hair and nails dermatophytosis has to be treated with...

systemic antifungals.

381

Noninfectious epidermal inflammatory conditions can be treated with...

topical glucocorticoids.

382

The KOH prep showing budding yeast forms or short (pseudo-) hyphae are diagnostic of...

candidiasis.

383

... is characterized by the Ph chromosome and progression from a chronic phase to acute leukemia (blast crisis).

Chronic myelogenous leukemia (CML)

384

Approximately 50% of patients with... (disorder) have a history of pica—an unusual compulsive craving for chewy or crunchy substances, such as ice (pagophagia), clay, starch, potato chips, and even burnt match heads.

iron deficiency

385

Fulminant autoimmune hemolytic anemia after viral infections is a feature of...

paroxysmal cold hemoglobinuria.

386

Primary hypoadrenalism may include... (skin change) and features of mineralocorticoid deficiency, none of which is seen in central hypoadrenalism.

hyperpigmentation

387

Recommendations to prevent... cancer include increased dietary fiber, fruits, and vegetables, moderate alcohol consumption, and avoidance of tobacco products.

colorectal

388

The incidence of and mortality from... cancer may be decreased by long-term aspirin or NSAID use, folic acid, and calcium.

colorectal

389

Isolated liver metastases from colorectal cancer should...

be resected.

390

In patients with cirrhosis, prophylaxis with... reduces the risk of first variceal hemorrhage.

beta-blockade

391

Although primary (end-organ) gland failure is more common than secondary (central),... should be considered in any patient with symptoms of hypoadrenalism, hypothyroidism, or hypogonadism.

hypopituitarism

392

... (imaging) should be performed in all patients with central hypothyroidism, central hypoadrenalism, or central diabetes insipidus, and in most patients with central hypogonadism.

MRI of the head

393

If malignancy is the cause of hypercalcemia,... is suppressed and the tumor is usually apparent.

PTH

394

... (CV disease) can present as a musculoskeletal syndrome, with excruciating back pain, or a peripheral nonseptic arthritis.

Subacute bacterial endocarditis

395

BRCA1 abnormalities are associated with a high risk of... (2 types) cancers.

breast and ovarian

396

In immunosuppressed patients, simple exposure to a household or workplace person infected with TB leads to therapy with...

INH for 9 months.

397

... is the test of choice to confirm eradication of H. pylori infection.

Urea breath testing

398

The most specific finding in ITP is... in the BM examination without any other abnormalities.

megakaryocytosis

399

Hyperaldosteronism is also called... syndrome.

Conn’s