Internal Medicine Flashcards
* be a master of clinical application of concepts (250 cards)
1
Q
what is an indication of a diagnosis of rhabdomyolysis in regards to creatine kinase (CK) level?
A
a creatine kinase (CK) level >x5 the upper limit of normal
2
Q
myoglobin is released as result of ………… ……….and is ………toxic
A
skeletal muscle damage
nephrotoxic
3
Q
what is the initial treatment of a crushed injury patient that presents with rhabdomyolysis?
A
IV fluids and sodium bicarbonate
4
Q
what is the purpose of the initial treatment of a crushed injury patient who presented with rhabdomyolysis?
A
diminish the impact of the myoglobin on the kidneys
5
Q
many cases of drug resistance in malignant cells are caused by …….
A
increased expression of drug efflux pumps
6
Q
what are some of the most commonly identified resistance mechanism demonstrated in vitro?
A
- Multidrug Resistance (MDR-1) protein
* Multidrug Resistance related protein (MRP)
7
Q
an elderly patient presents with microcytic anemia, what is your next two step in management?
A
fecal occult blood test and after which full colonscopy
8
Q
what is the treatment for iron deficiency anemia?
A
oral iron with stool softener
9
Q
symptoms of low or dysfunctional platelets includes:
A
easy bruising, nosebleeds, mucosal bleeding (e.g bleeding on tooth extraction), menorrhagia and occasionally GI bleeding
10
Q
a patient presents with easy bleeding and bruising with increased bleeding time and with normal response with ristocetin is highly suscipious of what
A
Glanzmann thrombasthenia
11
Q
deficiency of glycoprotein 11b/111a complex leads to …………….
A
defective platelet aggregation
12
Q
What is the dose-limiting side effect of zidovudine?
A
Hematotoxicity
13
Q
What is the most effective therapy for mitral stenosis in pregnancy
A
Percutaneous balloon valvuloplasty
14
Q
what is an important test for an elderly who presents with falls and what does the test demonstrate
A
“get up and go” test to demonstrate deficits in leg strength, balance, vestibular dysfunction and gait
15
Q
the empiric treatment for nosocomial infections not associated with ICU or ventilators includes:
A
levofloxacin, ceftriaxone, ciprofloxacin, ampicillin/sulbactam, piperacillin/tazobactam, ertapenem
16
Q
what is the first line of choice of treatment for Acinetobactam baumannii?
A
imipenem
17
Q
what is the second line of choice for A. baumanni?
A
polymyxin B
18
Q
hypokalemia, metabolic alkalosis with hypertension is suggestive of …………, ……………….., ………………, ………………….
A
aldosterone excess, cushing’s syndrome, liddle syndrome, licorie toxicity
19
Q
licorice metabolic effect is similar to ……………..
A
hyperaldosteronism
20
Q
hypokalemia in vomiting is from ……………………………
A
renal loss of K accompanying the loss of bicarbonate
21
Q
Chemical burn is treated initially with………
A
Massive irritation
22
Q
What is the most effective means of diagnosing colon cancer?
A
Colonoscopy
23
Q
In patients over 50 years presenting with obvious signs of chronic blood loss and positive guaiac stool the next step in management should be what and why?
A
Colonoscopy to rule out colon cancer
24
Q
Muscle weakness that improves with repetitive activities suggests a diagnosis of ………….
A
Lambert-Eaton syndrome
25
The syndrome suggestive of muscle weakness that improves with repetitive activities is high associated with .............
Small-cell lung cancer
26
An enlarged nerve located in the foot’s third interspace, between the third and fourth toes that is extremely painful on palpating the region is known as
Morton neuroma
27
What is the classic triad of pheochromocytoma?
Episodic headache, palpitations, diaphoresis
28
What is the first step in the diagnosis of pheochromocytoma?
24-hour urine fractionated metanephrines and catecholamines
29
How is herpes zoster treated
Acyclovir or famciclovir
30
What is used for treatment of postherpetic neuralgia?
TCA like desipramine, gabapentin, pregabalin
31
What is the most useful test for diagnosis of acute pericarditis?
Electrocardiogram
32
Dubin-Johnson syndrome is characterized by a defect in ............ ............. resulting in an increase in ............... bilirubin.
Excretion of bilirubin
| Conjugated bilirubin
33
Black pigmentation in hepatocytes on liver biopsy is characteristic of what syndrome?
Dublin-Johnson syndrome
34
Papillary muscle rupture occurs ...-...... days after myocardial infarction
2-7days
35
Symptoms of papillary muscle rupture includes
Acute mitral regurgitation and subsequently acute left heart failure
36
What is the management of papillary muscle rupture
Surgical repair through valve replacement
37
Recurrent episodes of severe stabbing or lancinating pain (usually unilateral) in the distribution of one or more branches of the trigeminal nerve not due to a structural lesion is characteristic of .......... .......
Trigeminal neuralgia
38
What is the drug of choice for trigeminal neuralgia
Carbamazepine
39
When medical therapy fails in a patient with trigeminal neuralgia, what is the next step in management?
Surgical decompression or stereotactic ablation
40
Symmetric descending flaccid paralysis, prominent bulbar palsies, normal sensory examination in the absence of fever is a classic presentation of .........
Botulism
41
After diagnosis of Barrett esophagus, what is the recommendation for these patients and why
Endoscopic surveillance every 2-3 years for esophageal adenocarcinoma
42
What are the risk factors included for reactivating VZV
Advancing age
Recent trauma to affected site
Immunosuppression
43
Zollinger-Ellison syndrome (gastrinoma) is characterized by
Watery diarrhea and refractory ulcers in distal duodenum
44
What is the first step in diagnosis of ZES
Gastrin level after abstaining from antisecretory therapy for 1 week
45
What is the most common clinical manifestation of multiple myeloma?
Bone pain (from lytic bone lesions)
46
the management of barrett esophagus without dysplasia is endoscopy .......(time interval)
every 3-5 years
47
the management of barrett esophagus with low grade dysplasia is endoscopy ........ (time interval)
within 6-12 months
48
management of barrett esophagus with high grade dysplasia is ................. or ....................
endoscopic ablation or endoscopy in 3 months.
49
..........., ............. and .......... have been associated with Bell palsy
Herpes simplex virus
Epstein-Barr virus
Lyme disease
50
How and why do you treat a new onset hyperthyroidism ?
Non selective beta blocker
| Decrease risk of arrhythmia and death.
51
Macrocytosis (MCV >110fl), diarrhea and neurologic symptoms strong suggest .....…
Vitamin B12 deficiency
52
What lung cancer is most sensitive to chemotherapy?
Small-cell carcinoma
53
What is the most sensitive test for the diagnosis of pheochromocytoma?
Plasma free fractionated metanephrines
54
Platypnea refers to ..............
Dyspnea with an upright posture and relief while lying down
55
Orthodeoxia refers to .....….…
Worsening hypoxia in the upright position
56
Platypnea and orthodeoxia in the setting of cirrhosis argues for .……… syndrome
Hepatopulmonary syndrome
57
........... ....…… are ugly-appearing vascular, friable papules that form at the site of prior trauma
Pyogenic granulomas
58
What is the treatment of pyogenic granulomas?
- Surgical excision
- Curettage
- Electrodesiccation
59
What are the treatments that prolongs survival (decrease morbidity and mortality) in COPD patients?
- Smoking cessation
| - Oxygen therapy
60
What are the criteria for home oxygen therapy?
- Resting PaO2 <55mmHg
- O2 Sat < 88%
- PaO2 <60mmHg with evidence of cor pulmonale or polycythemia
61
Zollinger-Ellison syndrome is associated with ................ syndrome
MEN-1
62
Achlorhydria and vitamin B12 deficiency is typical for ...........
Autoimmune gastritis
63
How is autoimmune gastritis diagnosed?
Positive anti-parietal cell and anti-intrinsic factor antibodies
64
............. .................. is associated with anti-intrinsic factor antibodies
Hashimoto thyroiditis
65
Anemia plus altered position and vibration sense. Suspect?
Vitamin B12 deficiency
66
Presence of a solitary esophageal ulcer and signs of retinitis and colitis in a patient who has advanced HIV infection suggests .....................
Disseminated CMV infection
67
What is the treatment for disseminated CMV infection
Ganciclovir with or without foscarnet
68
What is used for the treatment of opportunistic Herpes Simplex Virus infection?
Acyclovir
69
What is used for cryptococcal infection which presents as .......... in immunocompromised patients?
- Meningitis
| - Amphotericin B
70
..................syncope is associated with diaphoresis, lightheadedness, nausea, sweating, visual alterations and pallor
Vasovagal or neurocardiogenic syncope
71
What usually triggers vasovagal syncope
Emotional situation
72
Apnea, bradycardia, hypotension is characteristic of .......... ............
Jarisch-Bezold reflex
73
Jarisch-Bezold reflex is associated with ............(3 things)
```
- nicotine
Snake venom
Halogenated anesthesia
Serotonin
Antihistamines
Biguanides
```
74
What is the classic triad for normal pressure hydrocephalus?
- dementia
- gait disturbances
- urinary incontinence
75
............. is the most effective treatment in near drowning episodes to improve both hypoxia and acidosis
Continuous Positive Airway Pressure
76
A late complication of near drowning episode is .........
Adult respiratory distress syndrome (ARDS)
77
```
Mild intermittent asthma :
Day time symptom-
Nighttime symptom-
PFTs-
Treatment-
```
- <2/week
- <2/month
- FEV1 >80%
- Short acting beta agonist(SABA)
78
```
Mild persistent asthma:
Day time symptom-
Nighttime symptom-
PFTs-
Treatment-
```
- >2/week
- >2/month
FEV1 -80%
SABA+Inhaled corticosteroid or cromolyn (children)
79
```
Moderate asthma:
Day time symptom-
Nighttime symptom-
PFTs-
Treatment-
```
- daily
- >1/week
- FEV1: 60-80%
- SABA+ ICS+ long acting beta agonist
80
```
Severe asthma:
Day time symptom-
Nighttime symptom-
PFTs-
Treatment-
```
- Continuous and daily
- Frequent
- <60%
- increase dose of ICS, leukotriene modifiers and of nothing else works- add oral corticosteroids
81
Opiate intoxication may present with ............., ............., .............. and ................
Severe respiratory depression, nausea, vomiting and pinpoint pupils
82
What is the most rapid way of reversing the anticoagulant effect of warfarin is by .............
Transfusing fresh frozen plasma
83
When organic causes of low libido are suspected, a ..................... is useful in making the correct diagnosis
A morning total serum testosterone level
84
What is a vector?
Am invertebrate animal capable of transmitting a pathogen to other host
85
Describe a pathogen
Microorganism that causes a disease
86
What is the most common vector responsible for Lyme disease
Ixodes scapularis
87
What is the pathogen responsible for Lyme disease
Borrelia burgdorferi
88
What is the effect of hypothyroidism on blood pressure and lipid profile
Hypertension and hypercholesterolemia
89
What is the first-line antibiotic choice for acute uncomplicated sinusitis?
Amoxicillin/clavulanate (augmentin)
90
Atopic dermatitis is best treated with .................... and ..................
Moisturizing emollient and steroid ointment
91
Avoid soaps since they can predispose to worsening of symptoms of atopic dermatitis. True or false
True
92
What is the clinical triad highly specific for a right ventricular infarction?
- Hypotension,
- Jugular venous distention with a clear lung examination and
- chest pain
93
How is RV infarct treated?
Treat immediately with aggressive IV fluid administration
94
Patients who have hyperkalemia and ECG changes require treatment with ........…… to stabilize cardiac membranes
Calcium gluconate
95
...........…….... presents with spasms of pain, usually unilateral, often radiating to the groin
Renal colic
96
What is the beat initial treatment of renal colic?
Pain control with NSAIDs and IV hydration
97
CMV colitis causers ........, ........., ..........., ..........
Tenesmus, urgency, bloody diarrhea and LLQ pain
98
Brown pigment stones are due to ........
Infection
99
Management of esophageal variceal bleeding should start with ......…………
Aggressive blood resuscitation
100
Pharmacologic therapies for esophageal variceal bleeding include
Vasopressin
Octreotide
Somatostatin
101
Patients who are severely hypothyroid do very poorly when they have surgery. True/ False
True
102
A patient who faced a stressor such as surgery in the presence of hypothyroidism need to be treated urgently with ..............
Steroids
103
Prostate cancer typically metastasizes to the .............., .......... and ...........
- lymph nodes
- lungs
- bone
104
_______________ is the most common form of primary intracranial neoplasm
Astrocytoma
105
___________ is the most common malignant tumor of the brain
Lung cancer
106
Symptoms of brain metastases include _________, _______________ and __________
Weight loss
| Headaches worse with recumbency and nausea
107
_____________ may develop in patients with gastric ulcers of the greater curvature that lead to adjacent transverse colonic inflammation
Gastrocolic fistulas
108
______________ on oral examination is key to the diagnosis of gastrocolic fistula
Feculent smell
109
_____________ presents with papules after a lengthy incubation period that can last from 2 to 6 months
Donovanosis
110
Describe the ulcers seen in donovanosis
The ulcers have sharply defined borders and a significant amount to velvety granulation tissue.
111
Diagnosis of donovanosis is confirmed by ____________
Donovan bodies on microscopy
112
The organism that causes donovanosis is _________
Klebsiella granulomatis
113
What is the preferred agent for treatment of donovanosis? And how long should it be given for?
Azithromycin
At least 3weeks
114
Adult-onset asthma, particularly in a patient with no history of stops or previous pulmonary problems, demands a search for _________ cause
An occupational cause
115
All patients who have COPD should receive _____________ and ______________ to prevent _______, ________, __________ and ___________
- an annual influenza vaccine and pneumococcal vaccine
| - influenza, pneumonia, meningitis and bacteremia
116
Risk factors for squamous cell carcinoid the head and neck mucosa include _________ and _______ use.
Excessive alcohol and nicotine use
117
_______ and _______ are the most common sites for SCC of the oral mucosa
The palate and tongue
118
Erythroplakia and leukoplakia are common precursors of ____
Squamous Cell Carcinoma
119
What is a Pterygium
A pterygium is a benign growth of vascularized conjunctiva that extends onto the cornea
120
How is a pterygium managed?
Topical lubricants including drops, gels and ointment.
121
Thickened rugal folds and smooth ulceration in the antrum of the stomach are characteristic of either ____ or _______
NSAID or H.pylori-induced gastritis
122
_________ usually presents with altered mental status and fever with CSF findings showing a lymphocytic pleocytosis.
HSV encephalitis
123
Differentials of presentation with history of chronic sinusitis, unilateral proptosis and cranial nerve palsies include:(4)
- cavernous sinus thrombosis
- bacterial meningitis
- epidural or subdural hematoma
- cerebral abscesses
124
How is cavernous sinus thrombosis diagnosed?
Contrast CT scan or MRI
125
What is the treatment of cavernous sinus thrombosis?
Parenteral antibiotics are the mainstay of treatment.
126
The first line treatment of animal bites particularly dogs is
Amoxicillin-clavulanate
127
__________ is characterized by dilation of veins, micro aneurysm, retinal edema and retinal hemorrhages.
Nonproliferative Diabetic retinopathy
128
Three types of drugs have been shown to reduce mortality in patients who have CHF:
- ACE inhibitors/ ARBs
- Spironolactone
- Beta blockers
129
Epinephrine can reverse both the hypotension and the bronchospasm seen in anaphylactic shock. True/False
True
130
Both bleeding time and PTT are elevated =________
Von Willebrand factor deficiency
131
Patients with Cushing syndrome are prone to develop deep venous thrombosis. True/False
True
132
The findings of petechiae, alteration in mental status and refractory hypoxemia in a patient with multiple bone trauma suggest the diagnosis of ________________
Fat embolism
133
What is the diagnosis of acromegaly confirmed?
100-gram oral glucose tolerance test (OGTT)
134
What is used for chronic management of urate stones in patients with hyperuricemia, and who fail to respond to the initial stone treatment with hydration, low purine diet, and alkalinization of urine?
Allopurinol
135
Hemophilia A is due to deficiency of _________
Factor VIII
136
Hemophilia B is due to deficiency of _________
Factor IX
137
Wernicke encephalopathy presents with a triad of ________, _________ and _________
Confusion
Ataxia
Ophthalmoplegia
138
What is the treatment of Wernicke encephalopathy?
Thiamine IV BEFORE glucose
139
Abdominal angina, arthritis, skin changes and ulcerations on a background of constitutional symptoms strongly suggests ___________
Polyarteritis nodosa (PAN)
140
The history of normal skin at birth with gradual progression to dry scaly skin is typical of __________
Ichthyosis
141
Dry and rough skin with horny plates over the extensor surfaces of the limbs is a hallmark of ________
Ichthyosis
142
Any patient with more than 2-3 attacks of gout a year should be given ___________
Allopurinol
143
A patient who has a DVT or pulmonary embolism who experiences a complication from anticoagulation therapy requires ___________ to prevent further embolism
IVC fliter
144
Ibuprofen may cause _______, _________ or ___________
Acute kidney Injury
Interstitial nephritis
Secondary minimal change disease with proteinuria
145
When patients who have hep C develop cirrhosis, _____________ for __________ is indicated
Yearly screening with ultrasound for hepatocellular carcinoma is indicated
146
What is the most common infectious cause of Stevens-Johnson syndrome?
Mycoplasma pneumoniae
147
HIV associated nephropathy is due to ___________
Focal segmental glomerulosclerosis
148
What is the treatment of HIV associated nephropathy
HAART drugs and ACE inhibitors
149
______________ should be provided when CD4 counts decrease below 50
Prophylaxis for MAI
150
What is the regimen of choice for prophylaxis for MAI?
Azithromycin weekly or clarithromycin twice daily
151
Hypocellular marrow with loss of precursor cells, predominated by fat and stroma is diagnostic of __________
Aplastic anemia
152
The diagnosis of the pheochromocytoma can best be confirmed by ______________________
MRI scan of the adrenals
153
Melanoma is associated with _______ mutation
CDKN2A
154
An A1C of 5.7-6.2 is considered _________
Prediabetes
155
_____________ is indicated to prevent progression to type 2 diabetes mellitus in patients with impaired glucose tolerance
Metformin
156
_____________ is the best initial treatment for a characteristic acute symptomatology of painful and red eyes, headache, blurred vision and halos around lights which is worse at night
Acetazolamide
157
What are the first line treatments for Bartter syndrome?
NSAIDs and spironolactone
158
___________ is characterized by severe hypocalcemia and hypophosphatemia following partial parathyroidectomy
Hungry bone syndrome
159
____________ followed by _______ is the best treatment strategy for an advanced inflammatory carcinoma of the breast.
Neoadjuvant chemotherapy followed by modified radical mastectomy
160
_______ and ________ are useful agents for breast cancer chemoprevention in women who are at an increased risk for the disease.
Tamoxifen and raloxifene
161
The treatment of choice for tinea capitis is _______________
Oral griseofulvin for 6 to 12 weeks
162
_____________ is the most common cause of hypertension in children
Reno vascular disease
163
Patients at risk for tumor lysis syndrome should receive prophylaxis with _________ or ______
Allopurinol of rasburicase
164
The classic CSF findings in GBS is _________
albuminocytologic association
165
The most common visceral malignancy to cause migratory thrombophlebitis is _____________
Pancreatic adenocarcinoma
166
Chronic diarrhea, malabsorption and weight loss is highly suggestive of ______________
Celiac disease
167
The recommended dosage of bupropion for smoking cessation is ________
300mg/day
168
Live vaccine include: ________, __________, __________ and ____________
MMR, varicella, zoster and live attenuated intranasal influenza
169
Live vaccine include: ________, __________, __________ and ____________
MMR, varicella, zoster and live attenuated intranasal influenza
170
What is the difference between diffuse esophageal spasm and nutcracker esophagus on manometry?
Diffuse esophageal spasm: normal resting lower esophageal pressure
Nutcracker esophagus: increased resting lower esophageal pressure
171
__________ is characterized by fever, microangiopathic hemolytic anemia, thrombocytopenia, renal failure, neurologic symptoms
thrombotic thrombocytopenia purpura
172
one major difference between TTP and DIC is that _______
PT and PTT is normal in TTP but prolonged in DIC
173
________ is indicated in all nontraumatic neck pain in patients older than the age 50 years
X-ray films of cervical spine
174
________ decrease mortality in patients who have history of MI
beta blockers
175
the most common cause of cancer among men in the US is __________
prostate cancer
176
the most common cause of cancer among women in the US is ___________
breast cancer
177
the most common cause of cancer deaths among both men and women in the US is ___________
lung cancer
178
__________ causes decreased cardiac output, pulmonary congestion, hypotension and hypoperfusion
cardiogenic shock
179
catheterization in cardiogenic shock caused by left ventricular dysfunction shows ________, _______ and ______
increased pulmonary capillary wedge pressure
normal right atrial pressure
decreased cardiac output
180
_______ is a complication of erythropoietin therapy for treating anemia related to chronic renal failure
hypertension
181
if a lower GI bleeding is >2mL/min _____ is indicated
angiogram
182
if a lower GI bleed <0.5mL/min what is the next action of management?
wait till bleeding stops and then do colonoscopy
183
lower GI bleed 0.5-2.0mL/min ________ is indicated
tagged red blood cell study
184
anal cancer metastasizes to the __________
inguinal lymph node basin
185
adenocarcinoma of the rectum metastasizes to the _____
mesorectal ingunal nodes
186
mitral valve area less than 1.5cmsquare indicates need for
valvotomy
187
for patients who have systolic dysfunction and who have received optimal initial management but are still symptomatic should be given ___________ to ______
dobutamine
| enhance cardiac contractility
188
_________ is the treatment of choice in a patient with pleuritic chest pain that improves with sitting up / leaning forward.
NSAIDs
189
Treatments of essential tremor include: ___________, _________ and ___________
Propranolol
Alcohol
Primidone
190
________ is an invasive infection of the external auditory canal, which typically affects elderly with diabetes mellitus and AIDS patients
Malignant external canal
191
_______ is the most common organism involved in malignant otitis externa
Pseudomonas aeruginosa
192
Best time to treat thrombosed external hemorrhoids =
First 3 days of symptoms
193
Rubber band ligation is only usss in the treatment of ____________
Internal hemorrhoids
194
Pneumonia is characterized by _________, ____________, _________ and ___________
Fever, productive cough, SOB and chest pain
195
Antiglutamic acid decarboxlase antibodies is mostly associated with ___________
Type 1 diabetes mellitus
196
What is the most appropriate long-term therapy for patients with anti phospholipid syndrome?
Lifelong anticoagulation with warfarin to a target INR 2.0-3.0
197
What is the treatment of keloids?
Intralesional steriod injection
198
What is the most specific marker for diagnosis of acute hepatitis B?
IgM anti-HBc
199
Patients with HIV are prone to developing adrenal insufficiency. T/F
True
200
when is steroid indicated in a HIV patient with pneumocystic pneumonia
PaO2 <70mmHg or AA gradient >35mmHg
201
Zenker's diverticulum is best seen on ______ view of _____________
a lateral view of a pharyngeal barium swallow
202
ACE inhibitors are used in management of hypertensiob in patient with the following comorbities: _______, _______, __________ or ____________
diabetes, post-MI, heart failure with systolic dysfunction or chronic kidney disease
203
first line treatment for animal bites is ___________
amoxicilllin/clavulanic acid
204
2nd line treatment for animal bites is
clindamycin and doxycyline/fluoroquinolone
205
The drug of choice for WPW in hemodynamically stable patients is ________
Procainamide
206
____________ is a strong indicator for the development of diabetic nephropathy
The presence of microalbuminemia (30-300mg/dL)
207
What are the recommended drugs for malaria prophylaxis for those traveling to chloroquine-sensitive areas?
Chloroquine
208
Chloroquine-sensitive endemic malaria areas include:
```
Countries of Central America
Paraguay
Argentina
The Caribbean
Mexico
```
209
___________ is recommended for prophylaxis against chloroquine-resistance malaria
Mefloquine
Atovaquone/proguanil
Doxycycline
210
________________ is the standard of care for diagnosing Cushing syndrome
24-hour urinary-free cortisol
211
________ is considered the first-line drug for acute hepatic encephalopathy.
Lactulose
212
_________ seen on radiograph is characteristic of rheumatoid arthritis
bone erosion
213
fever, "hot- potato" voice, deviation of uvula to the contralateral side and cervical adenopathy is characteristic of __________
peritonsillar abscess
214
the first step in any patient who presents with suspected acute coronary syndrome is to ___________
give 325mg chewable aspirin
215
an acute exacerbation of chronic bronchitis in a patient who has COPD that results from Strep pneumonia and M. catarhhalis should be treated with ________
amoxicillin/clavulanate
216
_________ is the most accurate test to confirm CSF leakage
beta-2-transferrin
217
The treatment of choice for prostatitis is _____________
Fluoroquinolones for 4-6 wks
218
Aortic dissection that extend all the way to the aortic root may present with a _____________ which is a classic finding of aortic insufficiency
Diastolic murmur
219
Treatment of syphilis in a pregnant woman who is allergic to penicillin?
Desensitize patient and then administer penicillin
220
Milk- alkali syndrome consist of the triad of __________, ___________ and __________ in the setting of large amount of calcium and absorbable alkali
Hypercalcemia
Metabolic alkalosis
Renal insufficiency
221
_________ is the best drug for ALL anaerobic infections above the diaphragm
Clindamycin
222
__________ compresses the oculomotor nerve causing an ipsilateral dilated pupil.
Lateral (uncal) herniation
223
Lamivudine and peginterferon is used in the treatment of ____________
Chronic hepatitis B
224
Ledipasvir and sofosbuvir is the treatment for ______________
Chronic Hepatitis C
225
____________ is characterized by palatal ulcers, hepatosplenomegaly and pancytopenia
Disseminated histoplasmosis
226
Angiodysplasia is most often located in the _________ or _________
Cecum or ascending colon
227
what is the induction therapy for cryptococcal meningitis ?
amphotericin B and high dose flucytosine for 10-14 days
228
what is the maintenance therapy for cryptococcal meningitis?
fluconazole 400mg od for first 2-3 months then 200mg od until CD4>100 continuously for one year
229
_____________ is an autosomal dominant defect in profilaggrin characterized clinically as a white scale in a linear distribution on the palms and soles.
Ichthyosis vulgaris
230
What regions are spared in ichthyosis vulgaris?
The flexural and intertriginous areas
231
USPSTF recommends lupus profile screening starting at age _______ in men and age _______ in women
Age 35 years in men
| Age 45 years in women
232
Diabetes screening begins at age __________
45 years
233
________ is required to diagnose spontaneous bacterial peritonitis
Paracentesis
234
An ascitic fluid of PMN leukocyte count of >269 cells/mm3 is diagnostic of ______
Spontaneous Bacterial Peritonitis
235
the treatment of choice for angiodysplasia is ______
endoscopic ablation
236
_______ and _______ antibodies are positive in autoimmune hepatitis
ANA and anti-smooth muscle antibodies
237
Treatment for autoimmune hepatitis _________
corticosteriods and/or Azathioprine
238
suspect _________ in IV drug users of black-tar heroin preparation
clostridium
239
what metabolic abnormalities are not corrected by dialysis?
hyperphosphatemia and hypocalcemia
240
In patients presenting with hypertensive emergency and coexisting signs of ischemic heart disease________ is the treatment of choice
IV nitroglycerin
241
Felty syndrome is the triad of ________, ________ and ____________
Rheumatoid Arthritis
Splenomegaly
Neutropenia
242
What is the drug of choice in Felty syndrome?
Gold or methotrexate
243
Alcoholism leads to _________ because of its direct myotoxic effect on muscle
Rhabdomyolysis
244
The first symptom of _______ is the appearance of a painless, ulcerated nodule or a flat ulcer at the tip of the penis that does not heal but enlarges progressively.
Penile cancer
245
What is the treatment of organophosphates poisoning?
Atropine and pralidoxime
246
____________ should be considered in a patient who presents with muscle weakness and who is receiving statins, preventive gout medications and corticosteroids.
Drug-induced myopathy
247
Symptoms of Charcot joint ( neuropathic arthropathy) include:
_______, _______ _________ _______
Leg swelling
Erythema
Warmth
Joint effusion
248
What are the classic underlying diseases of Charcot joint
Diabetes
Syphilis
Syringomyelia
249
What is the drug of choice in treating CML?
Imatinib mesylate
250
What is the gold standard in diagnosing CML
Detection of the bcr-abl gene in the peripheral blood by FISH
Cytogenetic studies for the Philadelphia chromosome
