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.level3 Flashcards

1
Q

first line mgmt of HTN in diabetic pt

A

ACE or ARB

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2
Q

constitutional symptoms, early satiety due to splenic enlargement, gum bleeding, excessive WBC count - dx?

A

CML

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3
Q

tx of CML

A

imatinib

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4
Q

next step for acute cholangitis in setting of biliary obstruction?

A

ERCP

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5
Q

pathophys of giant cell arteritis

A

inflammatory infiltrates, composed of macrophages and CD4+ lymphocytes in all artery layers

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6
Q

repeated use of benzocaine spray

A

methemoglobinemia risk in anemic pt

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7
Q

whooping cough tx

A

azithro or macrolide

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8
Q

nonpurulent cellulitis that is “edematous and well demarcated”

A

erysipelas - group A strep/ S. pyogenes

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9
Q

wilson’s disease labs

A

low ceruplasmin and increased Copper urinary secretion

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10
Q

late decel means

A

uteroplacental insufficiency

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11
Q

variable decels are indicative of

A

cord compression

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12
Q

early decels are likely due to

A

head compression

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13
Q

separation of the nail plate from the bed

A

onycholysis

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14
Q

koilonychia seen in

A

iron deficiency or plummer vinson

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15
Q

brittle nails split vertically

A

onychorrhexis

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16
Q

hormones in secondary ammenorrhea due to asherman syndrome

A

normal

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17
Q

elevated liver enzymes, multifocal stricture and dilation on cholangiography

A

primary sclerosing cholangitis

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18
Q

majority of patients with primary sclerosing cholangitis have underlying

A

ulcerative colitis

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19
Q

Magnesium is contraindicated in pre-eclamptic women with ______

A

myasthenia gravis

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20
Q

initial manifestation of mag toxicity

A

decrease in DTRs, followed by respiratory paralysis, cardiac conduction abnls, cardiac arrest

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21
Q

pt with acute pancreatitis, what is the greatest lab predictor of mortality?

A

change in BUN over the first 48 hours (with adequate fluid resus)

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22
Q

pt with acute pancreatitis with acute rise in what may indicate pancreatic necrosis?

A

hematocrit

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23
Q

kid with fever, cervical adenopathy, polymorphous rash, hand and foot edema, cracked lips and bilateral conjunctivitis.
dx and tx

A

kawasaki disease, aspirin and IVIG

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24
Q

pain and stiffness in proximal muscles, worse in AM or prolonged activity. also fever, wt loss, fatigue, depression

A

polymyalgia rheumatica

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25
Q

differentiate PMR with polymyositis types

A

PMR does not have muscle weakness

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26
Q

tx for PMR

A

corticosteroids

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27
Q

working with artisanal mining or smelting, or with fluorescent bulbs

A

mercury poisoning

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28
Q

change in personality, anxiety, irritability, excitability, fearfulness, pathologic shyness, insomnia etc. due to mercury poisoning

A

erethism mercurialis

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29
Q

treatment of mercury poisoning?

A

succimer, dimercaprol, or penicillamine

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30
Q

category A bioterrorism agents

A

anthrax, plague, botulism, and tularemia

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31
Q

tx of ITP

A

prednisone

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32
Q

dry v wet purpura

A

wet includes mucous membranes and more likely to hemorrhage, indicates urgent drug therapy for decreased plt.

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33
Q

croup aka

A

laryngotracheobronchitis

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34
Q

bioterrorism causing undulating fever, fatigue, diaphoresis, arthralgias, myalgia, anorexia, malaise, and HA

A

brucellosis

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35
Q

tx of brucellosis

A

doxy and rifampin

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36
Q

new onset pulmonary renal syndrome and ANCA negative

A

anti glomerular basement membrane disease (previously goodpastures)

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37
Q

tx of minor bleeding in pt with von willebrand disease?

A

desmopressin

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38
Q

disease that is highly prevalent for a consistent period of time.

A

hyperendemic

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39
Q

severely decreased or absent cranial rhythmic impulse (CRI)

A

compression

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40
Q

cranial tx to increase amplitude of CRI

A

compression of fourth ventricle or CV4

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41
Q

what is the main cause of fluid retention in cirrhosis?

A

activation of RAAS system due to a perceived low-flow state

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42
Q

colorectal cancers in lynch syndrome are predominantly where?

A

right sided in location

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43
Q

lab work up in pt with ascending cholangitis reveals what 4 things?

A

leukocytosis, increased GGT, increased bilirubin, and increased alk phos

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44
Q

isolated elevation in serum GGT or GGT elevated out of proportion to other enzymes may indicate

A

alcohol abuse or alcoholic liver disease

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45
Q

biliary disease associated with UC

A

primary sclerosing cholangitis

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46
Q

eye disease seen in Crohn’s patients or IBD

A

anterior uveitis, associated with erythema nodosum and arthralgias

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47
Q

fever, RUQ pain, confusion, jaundice

A

ascending cholangitis

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48
Q

Heberdens nodes are in

A

OA, located on the DIP

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49
Q

treatment of poison ivy

A

oral corticosteroids

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50
Q

labs in GCA/PMR

A

elevated ESR, CRP, and plt ct. normal CPK and aldolase

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51
Q

Graves pt with proptosis will also likely have…

A

pretibial myxedema, hyperpigmentation and thickening of the skin on the anterior legs

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52
Q

next step up for mild persistent asthma

A

add daily low dose inhaled glucocorticoid

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53
Q

criteria for moderate persistent asthma

A

daily symptoms, not everyday; night awakenings more than 1/wk, not nightly; mild limitation of activity

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54
Q

when is surgery indicated for carpal tunnel?

A

evidence of axonal loss or denervation on electrodiagnostic testing

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55
Q

30 yo male with HTN, hematuria, proteinuria, and flank pain

A

ADPKD

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56
Q

MC isolated etiologic pathogen of lung abscess in children, following viral infection

A

S. aureus

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57
Q

what are markers indicating increased risk of scoliotic curve progression?

A

female, thoracic spine, larger initial curve

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58
Q

young woman with chronic joint pain, synovitis, mucositis/ulceration, photosensitive rash

A

lupus

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59
Q

drug treatment for lupus

A

oral hydroxychloroquine

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60
Q

most catastrophic pulmonary complication of lupus

A

diffuse alveolar hemorrhage

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61
Q

pt with SLE, development of thrombi, should be thinking underlying

A

antiphospholipid syndrome

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62
Q

antiphospholipid syndrome is associated with

A

an elevation in PTT

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63
Q

tx for pt with antiphospholipid syndrome

A

oral warfarin

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64
Q

apophysitis

A

inflammation of the apophysis or insertion site for tendons, normal in growing athlete

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65
Q

tx of spondylolysis

A

refrain from strenuous activity, given analgesia, and PT

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66
Q

MC overall cause of endocarditis

A

S. aureus

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67
Q

MC cause of transient monocular vision loss

A

embolism from diseased ipsilateral carotid artery

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68
Q

can’t look up after orbital trauma, what muscle is entrapped?

A

inferior rectus, cant relax/elongate when superior rectus contracts

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69
Q

overuse injury associated with RA, presenting with pain and tenderness at the radial styloid

A

de quervain tenosynovitis

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70
Q

MOA sulfonylureas

A

increase secretion of insulin from pancreatic islet cells

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71
Q

Side effect of sulfonylureas

A

weight gain, hypoglycemia without DKA, pancreatitis

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72
Q

high ACTH and high cortisol, next step?

A

dexamethasone suppression test

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73
Q

results of dexamethasone test… urine cortisol low

A

pituitary adenoma

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74
Q

results of dexamethasone test… results urine cortisol high

A

ectopic production of ACTH, small cell carcinoma, other tumor

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75
Q

chronically lethargic and hyperpigmented, hypotensive after acute GI illness

A

Addison disease/ primary adrenal insufficiency

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76
Q

electrolyte changes with Addison disease

A

hyponatremia and hyperkalemia

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77
Q

lab values to get in patient with myxedema coma

A

thyrotropin/TSH, free T4, and random serum cortisol

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78
Q

myxedema coma initial mgmt in stabilized pt

A

IV levothyroxine

IV hydrocortisone

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79
Q

infection with roundworms spread by black flies or misquitoes

A

filariasis

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80
Q

tx of filariasis

A

diethylcarbamazine (DEC)

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81
Q

malabsorption, chronic joint pain, weight loss, confusion/neuro ssx

A

whipple disease

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82
Q

what do you do after diverticulitis flare?

A

6-8 weeks later c scope

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83
Q

what risk increases in those with celiac disease?

A

fracture risk

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84
Q

long term tx of HTG induced pancreatitis

A

statin and a fibrate

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85
Q

virus causing hand foot mouth

A

enterovirus - coxsackievirus A16 and enterovirus A71

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86
Q

dog bite to hand

A

augmentin ppx for risky or large wounds

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87
Q

chapmans reflex point posteriorly

A

transverse process of T11 on the right

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88
Q

initial work up of acanthosis nigricans

A

HgbA1c, random glucose, lipids, total testosterone

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89
Q

tx of moderate to severe crohns

A

adalimumab

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90
Q

sympathetic viscerosomatic location of stomach

A

T5-9 on the left

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91
Q

high level of concern for acute HIV infection - what tests

A

HIV RNA levels

HIV antigen/antibody testing

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92
Q

pt suspected of having PCP, should get what tests

A

ABG, LDH, 1-3-beta-D-glucan, CXR, high res CT

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93
Q

what med to start s/p angioedema with lisinopril?

A

switch to ARB, angioedema can still recur for up to 6 weeks after stopping med

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94
Q

Most specific marker to confirm rhabdo

A

serum CK

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95
Q

chocolate brown blood

A

methemoglobinemia (metHb)

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96
Q

rigid thoracic kyphosis of more than 45 degrees, anterior wedging of 5 or more in at least 3 adjacent vertebral bodies, schmorl nodes, and degenerative endplates

A

Scheuermann disease

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97
Q

tx of scheuermann disease

A

conservative, PT and OMT for less than 60 degrees; ortho bracing would have to be done before skeletal maturity

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98
Q

tx of scheuermann disease

A

conservative, PT and OMT for less than 60 degrees; ortho bracing would have to be done before skeletal maturity

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99
Q

hypercalcemia, hypophosphatemia, metabolic alkalosis, with depressed PTH

A

milk alkali syndrome

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100
Q

milk alkali syndrome is due to

A

excess calcium intake in the setting of progressive renal dysfunction

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101
Q

tx milk alkali syndrome

A

isotonic saline for expanding volume and removing the offending agent

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102
Q

Framingham (major) criteria for CHF

A 
acute pulm edema
cardiomegaly
hepatojugular reflux
neck vein distention
nocturnal dyspnea or orthopnea
rales
S3
wt loss >4.5 kg in five days in response to tx
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103
Q

meds that improve mortality in CHF

A 
ACEI/ARBs
aldosterone antagonists
beta blockers
hydralazine/nitrates
sacubitril/valsartan
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104
Q

in lateral strain, rotation occurs around

A

2 vertical axes

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105
Q

galbreath technique is also known as

A

mandibular drainage

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106
Q

removal of the contents of the globe while leaving the sclera and extraocular muscles intact

A

evisceration

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107
Q

what is enucleation?

A

removal of the eye from the orbit while preserving all other orbital structures

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108
Q

removal of the eye and adnexa, along with part of the bony orbit

A

exenteration

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109
Q

tennis elbow affects what?

A

extensor carpi radialis brevis tendon

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110
Q

unilateral RLN injury with vocal fold stuck in paramedian or lateral position is associated with …

A

increased risk of aspiration

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111
Q

risk factors for cervical cancer

A 
early age at coitus
early child bearing
multiple partners
smoking
immunodeficiency
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112
Q

young male, no family hx of bleeding disorders, but pt with prolonged PTT…

A

hemophilia A

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113
Q

hemophilia A is a deficiency in the level or function of

A

factor VIII, causing increased PTT, normal PT and bleeding time

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114
Q

newborn with continued bleeding from umbilical stump - ddx?

A

hemophilia A/B, vit K deficiency, platelet function disorders

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115
Q

newborn with continued bleeding work up

A

PT, PTT, CBC, consider peripheral smear

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116
Q

peds pt, presenting with acute onset, severe, joint pain, associated with fever or constitutional symptoms, inability to bear weight

A

septic arthritis

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117
Q

mono or polyarticular arthritis, enthesitis, dactylitis, or low back pain, multiple weeks after infection

A

reactive arthritis

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118
Q

autoimmune, noninfective, inflammatory joint disease of more than 6 weeks in duration in children less than 16 yo

A

juvenile rheumatoid arthritis

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119
Q

pleural effusion as complication of pancreatitis demonstrate

A

elevated LDH and protein
exudative
contain very high levels of amylase

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120
Q

2 high intensity statins and best in CKD

A

atorvastatin

rosuvastatin

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121
Q

when should simvastatin be used in low doses

A

with amlodipine, verapamil, diltiazem, and amio due to increase in simvastatin levels and increased risk for myopathy (increased P450 system)

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122
Q

systemic symptoms and lymphadenopathy in a 20 some year old. says alcohol causes severe pain

A

Hodgkins lymphoma

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123
Q

how to confirm dx of suspected lymphoma

A

excisional lymph node biopsy

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124
Q

when do you screen kids for Fe deficiency anemia?

A

for high risk pt, start at 4 months and go through 2 years

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125
Q

confirm dx of sickle cell anemia with

A

hgb electrophoresis

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126
Q

hypercalcemia will change EKG by

A

shortening of the QT

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127
Q

blowing systolic murmur best heard at the fifth intercostal space in the midclavicular line with radiation to the axilla

A

mitral regurg

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128
Q

MCC of significant U waves is

A

severe hypokalemia

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129
Q

how to assess adequate fluid resuscitation in a burn patient?

A

central venous pressure
urine output
cardiac output

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130
Q

how to evaluate for suspected closed spinal disraphism?

A

MRI whole spine

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131
Q

five high yield risk factors for PE

A 
CHF
IBD
ortho surgery
malignancy
nephrotic syndrome
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132
Q

treatment of PE

A

tPA for unstable

LMWH for anticoagulation, but does not reverse clot

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133
Q

empiric antibiotic therapy for meningitis in elderly

A

vancomycin, ceftriaxone, and ampicillin

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134
Q

high arched palate and increased carrying angle of the arm

A

turner syndrome

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135
Q

XR of nursemaids reveal

A

normal study

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136
Q

treatment of preeclampsia

A

hydralazine (or labetalol) to lower BP and mag sulfate to prevent progression to eclampsia

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137
Q

HTN and proteinuria in pregnancy

A

preeclampsia

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138
Q

work up for incidental first degree AV block

A

cardiac and med hx
basic labs
TSH and BMP
consider lyme carditis

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139
Q

isolated antibodies to the core antigen - anti-HBc

A

window period

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140
Q

dx of acute liver failure requires 3 components

A

elevated aminotransferases
INR >1.5
hepatic encephalopathy

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141
Q

indications for ppx abx with dental procedure

A

prior infective endocarditis
prosthetic heart valve
unrepaired cyanotic congenital heart disease
cardiac transplant with valvulopathy

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142
Q

OA in knee, started having pain at night, medial aspect

A

pes anserine bursitis

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143
Q

enlarged liver, S4, S3, peripheral edema
worsening arthritis, polydipsiam and polyphagia
erectile dyfuction and shrunken testicles

A

hemochromatosis

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144
Q

lab test for dx of hemochromatosis

A

increased Fe, increased percentage of saturation of Fe, increased ferritin, and decreased serum-transferrin level

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145
Q

most sensitive diagnostic test for hemochromatosis

A

transferrin saturation level/test

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146
Q

tachypneic, normal glucose, low bicarb

A

alcoholic ketoacidosis

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147
Q

MCC of exogenous endophthalmitis

A

staph epidermidis

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148
Q

euvolemic state with increased urine osmolality and urine sodium concentration

A

SIADH

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149
Q

new neuro symptoms with hx of monoclonal gammopathy of undetermined significance

A

hyperviscosity syndrome

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150
Q

syringomyelia symptoms that come on gradually in 3rd or 4th decade?

A

arnold chiari malformation

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151
Q

IV meds to treat hypertensive emergencies

A

IV nitroprusside, nicardipine, clevidipine, labetalol, and fenoldopam

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152
Q

contraindications to oral bisphosphonates

A

bariatric surgery, esophageal disorders, or GI distress

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153
Q

drug of choice to treat tularemia

A

streptomycin

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154
Q

bugs in younger and older CF patients

A

pseudomonas after 25-35 years, s. aureus younger

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155
Q

HTN in OCP using young female

A

stop OCP

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156
Q

vagina - progressive pruritus, dyspareunia, dysuria, or genital bleeding

A

lichen sclerosus

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157
Q

IV formulation of bisphosphonate

A

zoledronate, zoledronic acid

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158
Q

how do you name nerves exiting spine

A

L4 nerve is above L4

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159
Q

MCC of septic arthritis

A

S. aureus

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160
Q

quad screen result for down syndrome

A

increased serum beta hcg and inhibin A, decreased estriol

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161
Q

markedly elevated alpha fetoprotein on quad screen

A

neural tube defects

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162
Q

decreases in a-fetoprotein, estriol, and b-hcg are associated with

A

trisomy 18

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163
Q

when to do amniocentesis v chorionic villous sampling

A

CVS should be done prior to 12 weeks gestation, amniocentesis after 12 weeks

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164
Q

new endometrial carcinoma diagnosed on bx… next step?

A

hysterectomy, BSO, lymphadenectomy - surgically staged malignancy

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165
Q

“complete claw hand” nerve injury

A

ulnar and median nerve

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166
Q

nonspecific bone pain, esp in legs and pelvis, and associated with insufficiency fx

A

osteomalacia

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167
Q

MCC of osteomalacia

A

vitamin D deficiency

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168
Q

vit D deficiency labs

A

mild decrease Ca, P, and an elevated PTH

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169
Q

contraindications to bracing for scoliosis

A

little growth remaining (Risser grade of 3)/skeletal maturity, cobb angle of 50 or more, and cobb angle less than 20

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170
Q

blood supply to extracapsular arterial network that feeds the femoral neck and head of the femur

A

medial and lateral circumflex arteries

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171
Q

dry cough, SOB, hypercalcemia, and CXR showing bilateral hilar fullness

A

sarcoidosis

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172
Q

weird complication of sarcoidosis

A

blindness

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173
Q

hypercalcemia, combined with recurrent duodenal ulcers and family hx of pituitary tumor

A

consider gastrinoma

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174
Q

BPH and renal insufficiency, next step

A

renal US

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175
Q

counterstrain positioning for posterior ribs 2-6

A

flexion, sidebent away, rotate away with dr thigh under patients axilla, ipsilateral

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176
Q

atypical glandular cells on cervical cytology, next step

A

colposcopy with endocervical curettage, if older than 35 also endometrial bx

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177
Q

endocervical curettage is abnormal, next step?

A

cervical cold knife cone

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178
Q

what is indicated following cervical intraepithelial neoplasia when endocervical curettage is negative?

A

loop electrosurgical excision

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179
Q

MC type of hodgkin lymphoma

A

nodular sclerosing, mixed inflammatory background with Reed Sternberg cells

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180
Q

lymphocyte depleted type of hodgkin lymphoma associated with

A

EBV positivity

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181
Q

amenorrhea in turner syndrome is caused by

A

ovarian failure, elevated FSH

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182
Q

breath holding spells in baby, evaluate for

A

iron deficiency anemia

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183
Q

another name for vasovagal syncope

A

reflex syncope

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184
Q

tx of DMD

A

glucocorticoids

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185
Q

bad labs with hypertensive pregnancy

A

pre-e with severe features

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186
Q

34-37 weeks, single gestation, no prior steroids, not diabetic - preterm delivery anticipated… then give

A

late preterm steroids

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187
Q

pregnant with IUD in place, how do you remove?

A

gentle traction on stringts, prior to 12 weeks

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188
Q

what is fetal fibronectin used as?

A

marker to assess likelihood of preterm labor between 22-34 weeks of pregnancy

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189
Q

CT chest shows airway dilatation, mucus plugging and bronchial wall thickening

A

bronchiectasis

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190
Q

bronchiectasis is caused by what bug and needs what abx?

A

pseudomonas, tx with cefepime

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191
Q

anti-pseudomonal abx

A 
cefepime
pip tazo
fluoroquinolones
aztreonam
meropenem
gentamicin
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192
Q

new S3 and low voltage, think

A

infiltrative cardiomyopathy

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193
Q

visual or neurologic changes, B symptoms, bleeding, lymphadenopathy, hepatosplenomegaly, infiltrative disease

A

waldenstroms macroglobulinemia

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194
Q

new dx of dermatomyositis, all patients should get

A

age appropriate cancer screening

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195
Q

UTI in pregnancy, tx with

A

cefpodoxime

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196
Q

mets to spine from prostate cancer - how?

A

hematogenous spread through Batson venous plexus

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197
Q

additional calorie consumption in pregnancy

A

340cal in second tri, then 450 cal in third tri

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198
Q

tx of mastitis

A

dicloxacillin

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199
Q

hypopigmentation, prolonged bleeding/bruising, recurring infections,

A

chediak-higashi

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200
Q

bacterial and fungal infections early in life, granulomas on skin/GI tract

A

chronic granulomatous disease

201
Q

silver hair, neuro ssx/seizures, MR, bronze skin

A

elejalde syndrome

202
Q

neonate with low serum calcium and possible seizures

A

digeorge syndrome

203
Q

bulging vaginal introitus

A

imperforate hymen

204
Q

dx tool for imperforate hymen

A

pelvic US

205
Q

chronic progressive loss of the nerve fiber layer in the retina

A

primary open angle glaucoma

206
Q

elevated IOP, visual field loss, changes in optic disc morphology

A

primary open angle gluacoma

207
Q

carpal tunnel syndrome may be caused by severe untreated

A

hypothyroidism

208
Q

amyloid precursor protein

A

alzheimers, specifically trisomy 21 associated

209
Q

lithium should be avoided in severe

A

cardiovascular disease and renal disease

210
Q

mineral/nutrient deficiency has been associated with glucose intolerance

A

chromium deficiency

211
Q

direct tx of the sacrum, pressure during inhalation or exhalation

A

inhalation phase

212
Q

renal artery stenosis may cause what electrolyte disturbances

A

hypokalemia and hypernatremia

213
Q

indication for asx AAA repair

A

diameter greater than 5.5, rapid expansion, or a AAA associated with symptomatic PAD requiring revascularization

214
Q

ground level fall, breaks hip

A

start alendronate

215
Q

what will improve murmur of HOCM

A

beta blockers

216
Q

endocarditis, going to dental cleaning

A

2g amoxicillin 30-60 minutes prior to procedure

217
Q

Most specific lab test result for iron deficiency anemia

A

low transferrin saturation

218
Q

antihypertensive causing hyper k

A

ACE I like lisinopril

219
Q

3 vessel disease and severe LV systolic dysfunction

A

revascularize - CABG

220
Q

OA mechanics

A

side bend and rotate in opposite

221
Q

glomerular basement membrane splitting

A

alport syndrome

222
Q

apple green birefringence

A

renal amyloidosis

223
Q

linear anti-GBM

A

good pasture syndrome

224
Q

spike and dome appearance

A

granular deposits of IgG and C3 at the basement membrane - membranous nephropathy

225
Q

nephrotic syndrome associated with Hep B, syphilis, malaria, and exposure to gold salts

A

membranous nephropathy

226
Q

tram track appearance basement membrane

A

subendothelial mesangial deposits, membranoproliferative nephropathy

227
Q

flattened femoral head

A

legg calves perthes, AVN hip, male 4-12

228
Q

ulnar nerve innervates

A 
palmaris brevis
dorsal interosseous
palmer interosseous
adductor pollicis
third and fourth lumbricals
229
Q

AA male with hx of HIV or uncontrolled HTN, what renal issue

A

focal segmental glomerulosclerosis

230
Q

type III HSN rxn to intradermal injection of antigen

A

arthus reaction

231
Q

dx and tx exercise induced laryngeal obstruction

A

continuous laryngoscopy during exercise, speech behavioral therapy

232
Q

axis is always …… the side of the seated flexion test

A

opposite

233
Q

common associated conditions with ankylosing spondylosis

A

enthesitis, synovitis, dactylitis, uveitis, psoriasis, IBD

234
Q

transferrin saturation will be increased in

A

hereditary hemochromatosis

235
Q

inhalational anthrax treatment

A

cipro plus clinda plus anthrax immunoglobulin

236
Q

significant developmental delay, no trunk control, smile, or find own hands

A

Menkes disease, inborn error of copper metabolism

237
Q

difference in radical mastectomy and modified

A

modified will spare musculature

238
Q

HIV exposure, but intact skin

A

reassurance

239
Q

NPV equation

A

TN/ (TN +FN)

240
Q

when do you screen for AAA?

A

abdominal US for men 65-75 who have ever smoked

241
Q

metabolic syndrome 3 of 5 - list all 5

A

1) abd obesity >40in M, >35in F
2) triglycerides >150 or tx
3) HDL <40 M, <50 F, or tx
4) BP >130/80, or tx
5) glucose >100 or tx

242
Q

risk factor for endometrial cancer

A

tamoxifen use

243
Q

yellow white appearing lesion on conjunctiva, hx of bowel resection

A

bitot spot, vit A deficiency

244
Q

decreased sensation on the lateral aspect of the lower leg and dorsum of the foot, specifically the web space between first and second digits

A

L5 nerve root compression

245
Q

most important prognostic factor on bx of melanoma

A

tumor thickness, depth >0.8 is an indication for sentinel LN bx

246
Q

palpable sausage like mass in kiddo

A

intussusception

247
Q

nontender, small, hemorrhagic, macular or nodular lesions on palms or soles, for IE

A

Janeway lesions

248
Q

tender violaceous nodules classically on pads of fingers and toes, in IE

A

osler nodes

249
Q

bulimia nervosa, volume depletion 2/2 vomiting/laxative abuse can cause

A

secondary hyperaldosteronism, renal K loss - hypoK

250
Q

first line tx for plantar fasciitis

A

better shoes

251
Q

positive LR equation

A

sensitivity/ (1-specificity)

252
Q

breast screening recommendations

A

USPSTF says 50

Am.Ca society says 40

253
Q

tx of tinea versicolor

A

topical ketoconazole

254
Q

tx of lichen sclerosus

A

topical corticosteroids

255
Q

action of anterior interosseous nerve

A

flexion of thumb at interphalangeal joint

256
Q

action of posterior interosseous nerve

A

extension of thumb at interphalangeal joint

257
Q

essential tremor treatment

A

propanolol, second line is clonazepam

258
Q

what produces surfactant

A

type II pneumocytes

259
Q

tx hyperthyroidism in pregnancy

A

PTU in first trimester, methimazole after

260
Q

new pt, suspicious for gout, first step

A

joint aspiration to r/o other

261
Q

dysfunctional uterine bleeding is likely due to

A

unopposed production of estradiol

262
Q

tx of paget disease

A

IV zolendronic acid, PO alendronate and risedronate

263
Q

probability that a pt with a positive test has a disease

A

PPV

264
Q

bioterrorism with shortest incubation period

A

pneumonic plague

265
Q

schizophreniform time frame

A

lasts 1-6 months

266
Q

kid with neuro symptoms, microcytic anemia, and vomiting

A

lead poisoning

267
Q

tx for pseudotumor cerebri

A

acetozolamide

268
Q

flask lesions

A

entamoeba histolytica

269
Q

skip lesions

A

crohns disease

270
Q

increased friability of the colonic mucosa, exudates, pseudopolyps, petechia, and frank hemorrhage

A

UC

271
Q

anticoagulation for patient with renal insufficiency

A

warfarin

272
Q

MC bug causing cholangitis

A

E coli

273
Q

res ipsa loquitur

A

negligence

274
Q

bulging mass from the umbilicus that can ulcerate and ooze

A

Sister Mary Joseph nodule - mets from gastrointestinal cancers

275
Q

MCC of postmenopausal bleeding

A

endometrial atrophy

276
Q

secondary amenorrhea work up after negative pregnancy test

A

TSH, FSH, prolactin levels

277
Q

wide splitting second heart sound with respiratory variation may be associated with

A

pulmonic stenosis or a RBBB

278
Q

pt adopts the opposite attitude of personally unacceptable emotions in order to avoid them

A

reaction formation

279
Q

drugs that may increase risk of osteoporosis

A

antiepileptic drugs

280
Q

nonbullous impetigo tx

A

dicloxacillin and cephalexin

281
Q

young female with bilateral conductive hearing loss and family hx

A

otosclerosis, loss of stapedial reflex

282
Q

inappropriate growth in baby

A

failure to thrive

283
Q

initial work up for failure to thrive in a baby

A

CBC, BMP, UA

284
Q

cystine renal stones are caused by

A

a genetic defect in amino acid transport and are associated with acidic urine

285
Q

mobitz type II occurs due to fibrotic disease of

A

his purkinje

286
Q

boards response to status epilepticus

A

lorazepam, phenytoin, phenobarbital, propofol

287
Q

most specific antibody to test for with lupus

A

anti-dsDNA antibody

288
Q

thyroglossal duct cyst attaches to the

A

foramen cecum

289
Q

possible preterm labor in pt 22-35 weeks gestation get

A

get fetal fibronectin test

290
Q

cuada equina syndrome needs surgery within

A

48 hours

291
Q

decrease risk of infection in pt with neurogenic bladder by

A

intermittent cath

292
Q

baby with odd shaped head and poor suckling

A

OA compression, decreased cranial rhythmic impulse

293
Q

septic shock - what happens to extremities

A

warm 2/2 vasodilation

294
Q

unstable patient with tension pneumo

A

needle thoracostomy first

295
Q

dilated intrahepatic ducts in

A

ascending cholangitis

296
Q

precocious puberty, fibrous skeletal dysplasia, cafe au lait spots

A

mccune albright syndrome

297
Q

MC site of vaginal injury in a sexual assault

A

posterior fourchette

298
Q

first line test for osmotic demyelination syndrome

A

MRI

299
Q

patient on ventilator now showing probable brain death

A

needs 2 physicians to confirm

300
Q

labs in Fe deficiency anemia

A

low serum iron
high TIBC
low ferritin

301
Q

haptoglobin is low in setting of

A

hemolytic anemia

302
Q

TIA and negative cerebral and neck work up, next step?

A

echo, eval for PFO, sometimes presents with RBBB

303
Q

rash, facial flushing, episodic nature,

dx and tx

A

rosacea, tx with topical metronidazole

304
Q

ppx for traveler’s diarrhea

A

rifaximin

305
Q

tx of subungual hematoma

A

trephination (nail drilling) to relieve the pressure - not necessary if not painful

306
Q

Acute OM bugs in kids

A

s. pneumo, h influ, mor cat

307
Q

kiddo with maculopapular rash, low grade fever, LAD

A

rubella

308
Q

mimicker of squamous cell carcinoma on the skin

A

keratocathoma

309
Q

macrosomia, hypoglycemia at birth and organomegaly

A

beckwith wiedemann syndrome

310
Q

associated with beckwith wiedemann syndrome

A

macroglossia, nephroblastoma

311
Q

MCC of fever on post-op day 4

A

UTI

312
Q

blowing diastolic murmur at the left sternal border with or without a mid-diastolic rumble

A

aortic regurg

313
Q

lab to confirm salicylate toxicity

A

ABG - mixed respiratory alkalosis and positive gap metabolic acidosis

314
Q

what does giardia do to cause diarrhea?

A

decrease fat absorption

315
Q

anterior chapmans point for myocardium

A

2nd intercostal space near the sternum

316
Q

bacteremia and now effusion of joint in kid, bone looks jacked up

A

acute hematogenous osteomyelitis

317
Q

what do you use to follow tx response in osteomyelitis

A

CRP

318
Q

why does febrile non-hemolytic transfusion reaction occur

A

recipient antibodies against donor leukocytes

319
Q

tx for anal squamous cell carcinoma

A

combo of chemo and radiation (Nigro protocol)

320
Q

newborn conjunctivitis followed by pneumonia - what bug

A

chlamydia trachomatis

321
Q

lateralization/Weber test shows louder vibration on the side indicating

A

conductive hearing loss

322
Q

in conductive hearing loss, the sound will be detected longer in

A

the bone on the affected side

322
Q

in conductive hearing loss, the sound will be detected longer in

A

the bone on the affected side

323
Q

contraindicated meds in WPW

A

digoxin, Beta blockers, CCB

324
Q

MC elevated enzymes in dermatomyositis

A

CK and aldolase

325
Q

lymphogranuloma venereum is caused by

A

chlamydia trachomatis

326
Q

what abx require oxygen for uptake into bacterial cells?

A

aminoglycosides

gentamycin, neomycin, amikacin, tobramycin, and streptomycin

327
Q

what abx can cause renal damage and CN VIII damage in both a mom and fetus?

A

aminoglycosides

328
Q

when do you start ophtho exams for diabetics?

A

3-5 years after initial diagnosis

329
Q

MCC of endocarditis in pt with prosthetic valve

A

s. epidermidis

330
Q

emphysematous pyelonephritis bug

A

e coli

331
Q

gold standard for confirming reflux

A

24 hr esophageal ph monitoring

332
Q

infant initial tx of GERD

A

formula thickening with SMALL amount of baby cereal and upright positioning following meals

333
Q

lofgren’s syndrome is a form of

A

acute sarcoidosis

334
Q

carcinoid tumor will have mets to where first?

A

liver

335
Q

an estimate of the additional cost to society to increase population health by 1 year of perfect health

A

cost-effectiveness ratio

336
Q

newborn with hct >65%

A

polycythemia

337
Q

polycythemia of the newborn occurs in who most often

A

diabetic moms,

338
Q

receiving blood transfusion, hypotension, wheezing, diaphoresis, rash

A

anaphylaxis, IgA deficiency

339
Q

asymptomatic first degree block in athlete

A

no further work up

340
Q

elevated megakaryocytes

A

ITP

341
Q

giant platelets are associated with

A

bernard-soulier syndrome, abnl ristocetin assay with thrombocytopenia

342
Q

lyme disease patient that doesn’t get better with standard therapy

A

consider coinfection - A. phagocytophilum and babesia microti

343
Q

kid with daily fevers for 2 weeks, arthralgias for 6 weeks, and rash

A

systemic juvenile idiopathic arthritis

344
Q

lithium side effect of polyuria and polydipsia

A

nephrogenic diabetes insipidus

345
Q

tx of lithium induced nephrogenic diabetes insipidis

A

amiloride, thiazides, low salt and low protein diet, NSAIDS

346
Q

when should kids start an adult diet?

A

2 years old

347
Q

odd lab in systemic juvenile idiopathic arthritis

A

hyperferritinemia

348
Q

pt with hx of gastric bypass and now has ascedning cholangitis - next step

A

biliary decompression by percutaneous transhepatic cholangiography (PTC), ERCP less successful

349
Q

MCC of epistaxis in peds

A

trauma

350
Q

hypothyroidism in pregnancy

A

follow TSH, increased TBG that binds T4, give higher dose of levothyroxine

351
Q

first line tx for panic disorder

A

SSRIs

352
Q

up to 1/3 of panic disorder cases are associated with

A

depression

353
Q

recommendations for new hypertension pt

A

stop smoking
DASH diet
increase exercise
weight loss

354
Q

eczematous plaque behind ears

A

nickel dermatitis

355
Q

posterior radial head is often caused by

A

falling on outstretched hand

356
Q

4 yo well child vaccines if already up to date

A

MMR
varicella
IPV/polio
Dtap

357
Q

when do you give Tdap

A

11-12 yo, or 7 yo if not fully immunized with Dtap

358
Q

muscle rigidity, hyperthermia, AMS, tachycardia, htn

A

neuroleptic malignant syndrome - from psych drug use

359
Q

shivering, hyperreflexia, myoclonus, and ataxia

A

serotonin syndrome

360
Q

fenofibrate is used most often for

A

the control of hypertriglyceridemia

361
Q

false positive or rejecting the null hypothesis error

A

type I error

362
Q

acutely decompensated aortic regurg - tx

A

surgery, but nitroprusside to vasodilate and decrease afterload with dobutamine for inotrope support

363
Q

occupational risk for bladder cancer

A

textiles, painters, electrical workers, miners, transport operators, excavating machine operators

364
Q

best way to monitor for impending uterine rupture

A

internal fetal monitoring

365
Q

adult with chickenpox complication

A

varicella pneumonia

366
Q

retinal and CNS hemangioblastomas, pheos, multiple cysts in pancreas and kidneys, increased risk for malignant transformation of renal cysts

A

von hippel lindau

367
Q

neuro and derm findings

A

tuberous sclerosis complex

368
Q

best case scenario with pancreatic cancer?

A

involvement of gastroduodenal artery because it can be resected without significant morbidity

369
Q

TCA toxicity will cause what in ekg

A

QRS prolongation due to blockade of fast sodium channels

370
Q

goodpasture syndrome is now known as

A

anti-glomerular basement membrane disease

371
Q

treatment of anti-GBM disease

A

plasma exchange and immunosuppression with corticosteroids and cyclophosphamide

372
Q

notable labs in anti-GBM disease

A

ANA positive
C3 and C4 low
anti-dsDNA elevated

373
Q

upper airway, eye, and ear disease along with rapidly progressive glomerulonephritis

A

granulomatosis with polyangiitis

374
Q

positive C-ANCA and anti-PR3

A

granulomatosis with polyangiitis

375
Q

systemic vasculitis with positive p-ANCA

A

microscopic polyangiitis

376
Q

degree of calcification of the pelvis as it relates to skeletal maturity as noted on pelvic XR

A

Risser sign - 1 to 5

377
Q

noncardiogenic pulmonary edema, GI hemorrhage, skin vesicles, generalized widespread multi organ system failure from bioterrorism - happens very quickly

A

ricin poisoning

378
Q

from the seeds of castor oil plant

A

ricin toxin

379
Q

what is ricin’s MOA?

A

preventing protein synthesis leading to very quick cell death

380
Q

pneumonia birth to 4 weeks of life?

A

GBS

381
Q

pneumonia 4 weeks to 12 weeks?

A

Chlamydia trachomatis

382
Q

young female, headaches, pulsatile tinnitus, neck pain, or flank pain

A

fibromuscular dysplasia

383
Q

best imaging to diagnose FMD?

A

CT angio

384
Q

normal epithelium of esophagus?

A

stratified squamous

385
Q

epithelium of barrets esophagus?

A

metaplastic simple columnar

386
Q

new hemolytic anemia concern, best next test for work up?

A

direct antiglobulin test

387
Q

autoimmune hemolytic anemia can be idiopathic, but is often associated with

A

lymphoproliferative disorders like CLL or nonhodgkins lymphoma

388
Q

unexplained thrombocytopenia and anemia in CLL requires

A

bone marrow biopsy

389
Q

CLL transforming to a more aggressive and deadly lymphoma is called

A

Richter transformation

390
Q

tennis elbow affects what muscle?

A

extensor carpi radialis brevis tendon

391
Q

what symptoms of schizophrenia respond well to treatment?

A

positive symptoms (delusions, hallucinations, disordered patterns of thought)

392
Q

initial management of trigger finger?

A

stretching and splinting then steroids then surgical release

393
Q

pan systolic blowing murmur

A

mitral regurg

394
Q

metronidazole side effect

A

disulfram like reaction

395
Q

posterior dislocation of knee, now reduced and has normal pulses, next step?

A

ABI

396
Q

new late decels noted, what do you do?

A

stop oxytocin, reposition patient, add IV fluids, place patient on oxygen

397
Q

MC elevated enzymes in dermatomyositis?

A

CK and aldolase

398
Q

carbon monoxide poisoning lab

A

metabolic acidosis

399
Q

tx acute, uncomplicated diverticulitis?

A

abx - ceftriaxone and metronidazole

400
Q

what is the only recommended pneumonia vaccine now?

A

PPSV23

401
Q

how to diagnose imperforate hymen?

A

pelvic US

402
Q

antibiotics that require oxygen to be taken up into bacterial cells

A

aminoglycosides

403
Q

hydronephrois equals

A

obstructive uropathy

404
Q

tendons in de quervain’s tenosynovitis?

A

abductor pollicis longus and extensor pollicis brevis

405
Q

provides information concerning malpractice payments, adverse licensure, withdrawal of clinical privileges and other negative actions taken against individual health care practitioners

A

National practitioner Data Bank

406
Q

pt with shock, polydipsia, GI symptoms, excessive weight loss, dehydration and hyperpigmentation in palmar creases

A

Addisonian crisis

407
Q

scabies tx

A

permethrin and close contacts

408
Q

greatest lab predictor of mortality in acute pancreatitis

A

change in BUN over the first 48 hours

409
Q

where do you use PT for lateral epicondylitis?

A

rest and PT focusing on eccentric strengthening exercises and wrist mobility

410
Q

tx of alcoholic ketoacidosis

A

reverse the low insulin to glucagon ratio with dextrose and to replenish fluids

411
Q

mgmt of suspected closed (occult) spinal dysraphism (CSD)

A

MRI of the whole spine

412
Q

contraindications to bracing for scoliosis?

A

little growth remaining (Riser of 3)
skeletal maturity
Cobb angle 50 or more or less than 20

413
Q

Cobb angle less than 20, treatment?

A

follow up every 6-12 months

414
Q

anterior thoracic counterstrain tenderpoint for T5 (AT5) is located where

A

midline on the sternum at the attachment of rib 5, which is approximately 1 inch superior to the xiphisternal junction

415
Q

inhalation dysfunction - which rib are you treating when using muscle energy?

A

key rib is bottom rib

416
Q

inhalation dysfunction is also known as

A

an exhalation restriction

417
Q

what drug for a heart patient can cause hyperkalemia?

A

ACE inhibitor

418
Q

1-6 months of psychotic symptoms

A

schizophreniform

419
Q

only antihypertensives known to be safe in pregnancy?

A

labetalol, methyldopa, and hydralazine

420
Q

bizarre complication of sarcoid that actually happens about 50% of the time?

A

blindness

421
Q

sudden, rapid, irregular, and aimless involuntary movments of the arms, legs, and trunk, and facial muscles

A

sydenham chorea (antibody mediated neuronal damage)

422
Q

migratory arthritis and sydenham chorea?

A

rheumatic fever

423
Q

what kidney stones are hereditary?

A

cystine - AR defect in the reabsorptive transport of cystine and the dibasic amino acids ornithine, arginine, and lysine

424
Q

MCC of epiglottitis in adults?

A

S. pneumo

425
Q

MC bug of endocarditis?

A

S. aureus

426
Q

eye infection on baby 2-5 days of life?

A

gonococcal infection

427
Q

iron deficiency anemia labs

A

serum iron low
TIBC high
ferritin low

428
Q

porcelain white plaques on labia and peri-anal region, dx? punch biopsy does not have evidence of atypia or carcinoma

A

lichen sclerosis

429
Q

minimal tx for prostate cancer?

A

radiation beam therapy

430
Q

benztropine MOA?

A

anticholinergic

431
Q

hemochromatosis pt, increase risk of developing

A

hepatocellular carcinoma

432
Q

fluorescent bulbs - tox? dx and tx?

A

mercury poisoning, treat with succimer

433
Q

drug of choice in ovulation induction for PCOS pt

A

letrazole, aromatase inhibitor

434
Q

Down syndrome with AD - protein responsible?

A

amyloid precursor protein

435
Q

thyroid cancer nodules are usually

A

cold and solid

436
Q

MC type of thyroid cancer

A

papillary thyroid cancer

437
Q

spherical concentrically laminated masses of calcium

A

psammomma bodies. - papillary thyroid carcinoma

438
Q

emergent anti-hypertensive push or drip?

A

drip

439
Q

high risk procedures for patient recently treated for infective endocarditis?

A

drainage of cutaneous, pulmonary, or dental abscess

440
Q

valsalva causing worsening of murmur in

A

HCM

441
Q

cause of acromegaly

A

usually benign pituitary adenoma

442
Q

nonresolving conjunctivitis in 3rd world country

A

trachoma - chlymidia, tx with 1 g azithro

443
Q

battery ingestion - when to remove and when to observe

A

remove in esophagus and observe in small intestine

444
Q

what are the two high intensity statins

A

atorvastatin and rosuvastatin

445
Q

HIV pt with yellow infiltrates on fundoscopic exam

A

CMV retinitis - CD4 <50

446
Q

MCC of hypercalcemia?

A

hyperparathyroidism from adenoma

447
Q

most sensitive and specific test for MG?

A

single fiber EMG

448
Q

abx worsening MG

A

macrolides, fluoroquinolones, penicillin

449
Q

severely resistant hypertension, next drug?

A

minoxidil

450
Q

acid base disorder in PE

A

mixed metabolic acidosis and respiratory alkalosis

451
Q

two significant risk factors for GI cancers?

A

smoking and alcohol

452
Q

when do you measure serum cortisol levels?

A

7 am

453
Q

C3 level decreased in this nephropathy

A

post streptococcal glomerulonephritis

454
Q

most specific tests for identifying rupture of membranes

A

vaginal pooling, nitrazine, and fern

455
Q

hypercalcemia with recurrent duodenal ulcers and family history of MEN1

A

gastrinoma

456
Q

middle aged man, multiple enlarged lymph nodes, next step?

A

excisional lymph node biopsy

457
Q

tx postherpetic neuralgia

A

TCAs

458
Q

abdominal pain and recurrent cholangitis

A

choledochal cyst

459
Q

MC transmitted disease acquired during blood transfusiond

A

hep B

460
Q

sciatica may cause what neuro presentation?

A

decreased DTRs

461
Q

lactose fermenting gram negative rod, B hemolytic

A

E coli

462
Q

gram positive, coag negative, nonhemolytic

A

saprophyticus

463
Q

gram negative encapsulated aerobic rod

A

pseudomonas

464
Q

baby with microcephaly, short palpebral fissures, and a smooth nasal philtrum

A

fetal alcohol syndrome

465
Q

psychotic symptoms accompanied by a mood disorder

A

schizoaffective

466
Q

human fusion protein of TNF-a type 2 receptor that binds and inactivates soluble tumor necrosis factor

A

etanercept

467
Q

MC bugs of AOM

A

S. pnuemoniae and H. influenza nontyable (not vaccinated against)

468
Q

chronic diarrhea electrolyte change and ph

A

hypokalemia and acidosis

469
Q

Phase IV drug trials, the drug is

A

already FDA approved

470
Q

forward flexion of shoulder while scapula is stabilized

A

Neers test - positive > subacromial bursitis

471
Q

the number of new cases of a disease diagnosed during a one year time period

A

incidence

472
Q

the total number of cases of a disease, divided by the total population in the area

A

prevalence

473
Q

gold standard for diagnosing tracheomalacia?

A

bronchoscopy

474
Q

pregnant lady with controlled diabetes - still will have progression of

A

diabetic retinopathy

475
Q

rib and muscle association for muscle energy tx

A 
rib 1 - anterior and middle scalenes
rib 2 - posterioer scalene
rib 3-5 - pec minor
rib 6-9 - serratus anterior
rib 10-11 - lat
rib 12 - QL
476
Q

abx used to treat GBS in pregnancy?

A

IV pen G or IV ampicillin at least 4 hours prior to delivery

477
Q

meningitis in elderly tx

A

ceftriaxone, vanc, ampicillin

478
Q

macrosomia and hypoglycemia at birth and organomegaly

A

Beckwith Wiedemann syndrome - nephroblastoma

479
Q

MC malignancy of childhood

A

nephroblastoma/Wilms tumor

480
Q

first line test for detecting osmotic demyelination syndrome

A

MRI

481
Q

preferred anticoagulant for patient with severe renal insufficiency?

A

warfarin

482
Q

recurent and persistent thoughts, urges, or images

A

Obsessions part of OCD

483
Q

harsh pansystolic murmur best auscultated at the left lower sternal border

A

VSD

484
Q

increased body temp, HTN, increased RR, tachy, tremulous, increased reflexes, seizures, disorientation, aroused level of consciousness or frank delirium and psychosis

A

benzo withdrawal

485
Q

infant GERD tx first line

A

thicken formula with small amount of baby cereal

486
Q

s/p lap chole and now has perihepatic and peritoneal fluid collections, next step?

A

HIDA scan

487
Q

labs in VWD?

A

nl plt
nl PT
nl or slight prolonged PTT
prolonged BT

488
Q

how long to stop MAO inhibitors before starting SSRI?

A

14 days

489
Q

what will soften the murmur of HCM?

A

beta blockers

490
Q

house fire patient with metabolic acidosis - dx and tx?

A

cyanide toxicity tx with hydroxycobalamin

491
Q

drug for adult depression, seasonal affective disorder, and smoking cessation

A

buproprion

492
Q

cefazolin will cover for

A

gram positive

493
Q

common cause of elevated a-fetoprotein?

A

inaccurate dating - get an US

also twin gestation and placental abnormalities

494
Q

anti-centromere antibody

A

crest syndrome

495
Q

contraindication to metformin

A

severe renal disease

496
Q

osteosarcoma most commonly sends mets to

A

lung

497
Q

tx malignant otitis externa?

A

IV cipro

.level 3 (1 decks)

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