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Flashcards in Master the Boards (Kaplan) Deck (40)

What is the sequence of steps involved in the evaluation of asymptomatic elevated transaminases (ALT, AST)?

1. through history (alcohol, travel, blood transfusions, sex, medications)
2. repeat liver function test 6 months later (chronic elevation)


What is the chronology of abdominal pain in acute appendicitis?

visceral followed by somatic
(shifting from periumbilical area to RLQ)


What type of restrictive cardiomyopathy due to infiltrative disease is reversible?

Hemochromatosis (phlebotomy removes iron from blood)


What is the best initial test for suspected PCP in an HIV patient?

sputum induction with hypertonic saline


What is the most accurate test for suspected PCP in an HIV patient?

bronchoscopy with bronchoalveolar lavage (BAL)


What is the preferred method of respiratory support in patients with acute exacerbation of COPD?

non-invasive positive-pressure ventilation
(used mechanical ventilation if fails)


What are causes of non-anion gap metabolic acidosis?

1. diarrhea
2. Renal tubular acidosis


A patient presenting with non-anion gap metabolic acidosis, hyperkalemia, and renal insufficiency most likely suffers from ...

type 4 renal tubular acidosis
(common in poorly controlled diabetics; due to aldosterone deficiency/ resistance)


A patient presenting with GI complaints one week followed by periorbital edema, myositis, and eosinophilia most likely suffers from ....

Trichinellosis (roundwarm parasite)


What is the triad associated with Trichinellosis infection?

1.periorbital edenam
2. myositis
3. eosinophilia


What is the initial best test for a patient with conjugated hyperbilirubinemia with elevated alkaline phosphatase and normal AST/ALT?

abdominal ultrasound (assess for obstruction)


What are the 4 causes of anterior mediastinal mass in a patient with sarcoidosis? (4 T's)

1. thymoma
2. teratoma (including mixed germ cell tumor)
3. thyroid cancer
4. terrible lymphoma


A patient presenting with a rash, fever, and arthalgias in the setting of acute kidney injury most likely suffers from ...

drug induced interstitial nephritis
(penicillins, cephalosporins, sulfas, NSAIDs, rifampin, phenytoin, allopurinol)


What tests are used to confirm Wilson's disease?

1. ceruloplasmin levels (low)
2. slit lamp exam of eyes (Kayser-Fleischer rings)
3. urinary copper (increased)


A patient presenting with elevated LFTs, neuro deficits (movement disorder), and eye problems most likely suffers from...

Wilson's disease (abnormal copper deposition in liver, basal ganglia, cornea)


What clinical features are strongly suggestive of melanoma?

1. Asymmetry
2. Border irregularities
3. Color variation
4. Diameter (>6 mm)
5. Evolving lesion


.... are cutaneous tumors that present with dome-shaped nodule and central keratinous plug



What is the best initial treatment for symptomatic LV failure?

IV diuretics (decrease excess fluid)


A low frequency diastolic sound heard just after S2 is most likely .....

S3 heart sound (LA blood flow hitting blood already in LV)


A patient with anemia in the setting of lymphadenopathy, hepatosplenomegaly and decreased appetite most likely has anemia due to...

lymphoproliferative disorder (lymphoma)


An HIV pt presenting with pulmonary symptoms and bilateral interstitial infiltrates when a CD4 count less than 200 most likely suffers from ...

PCP (pneumocystis pnemonia)


What is the best initial treatment for PCP in HIV patients?

Bactrim (trimethoprim-sulfamethoxazole)


When do you add steroids to PCP treatment in an HIV patient?

1. PaO2 35 mmHg


A patient present with hyperthyroid signs, low TSH, high fT4/fT3, no proptosis, decreased radio-active iodine uptake most likely suffers from ...

exogenous thyroid hormone (need to distinguish from thyroiditis/ iodine exposure/ extraglandular production via thyroglobulin level)
(low thyroglobulin level)


What is the initial step of evaluation of a solitary pulmonary nodule?

assess whether low, intermediate or high probability of malignancy


What is the best intial treatment for a patient with peripheral artery disease (PAD)?

1. factor modification (smoking, statin, bp med, diabetes)
2. low dose aspirin
3. statin for cholesterol
4. exercise program (to improve max distance)


What are pulmonary function test findings in restrictive lung disease?

1. FEV1 70%
3. FVC <80%


What are the pulmonary function test findings in obstructive lung disease?

1. FEV1 < 80%
2. FEV1/FVC < 70%
3. FVC normal or increased


A patient on anti-coagulant therapy develops pain followed bullae formation and skin necrosis most likely suffers from ...

warfarin-induced necrosis


A patient who develops digital clubbing and sudden onset joint in a chronic smoker suggests ...

hypertrophic (pulmonary) osteoarthropathy
(associated with lung cancer --> obtain CXR)


The true positive rate on a receiver operating characteristic curve correlates with ...

sensitivity (directly)


The false positive rate on a receiver operating characteristic curve correlates with ...

specificity (indirectly; 1-specificity)


A patient presenting with recent onset confusion, fever, muscle rigidity, autonomic instability, elevated creatine kinase after treatment with Dopamine antagonist most likely suffers from ...

Neuroleptic Malignant syndrome


What is the treatment for Neuroleptic Malignant Syndrome?

1. stop offending agent


What is the pathophysiologic cause of metabolic syndrome?

insulin resistance


A older pt develops burning localized pain followed by development of rash after severe physical stress (cancer tx, immunosuppression) most likely suffers from ...

Shingles (reactivation of varicella zoster from dorsal root ganglion)


A fat women presents with bloating, dyspepsia after eating fatty meals, RUQ pain most likely suffers from ..

Gallstone disease (cholelithiasis)


What is the best initial test for gallbladder disease?

abdominal ultrasound


A pt presenting with pneumonia, GI distress, high fever (>39), and a sputum gram stain with neutrophils but no organisms most likely suffers from ....

Legionella pneumophilia


What antibiotics are best for Legionella?

1. azithromycin (other macrolides)
2. levofloxacin (fluroquinolones)