Medicine Flashcards
(1315 cards)
1
Q
Cytochemical features of hairy cell leukemia?
A
Tartrate-resistant acid phosphotase (TRAP)
2
Q
When should you give an meningococcus vaccine?
A
Travels to Asia
3
Q
What type of cyst is found in echinococcus granulosus?
A
Hydatid cyst (eggshell calcifications
4
Q
When should you be tested for HIV is a low-risk population?
A
One time between 15-65 using p24 antigen and antibody testing
5
Q
What is imipramine?
A
Tricyclic antidepressent
6
Q
Exertional dyspnea, pounding heart sensation, widened pulse pressure?
A
Aortic regurgitation
7
Q
What cancer contains reed sternberg cells?
A
Hodgkin’s lymphoma
8
Q
What treatments help pass kidney stones?
A
Hydration, analgesics, alpha blockers
9
Q
How to evaluate uric acid stones?
A
Ct of the abdomen or intravenous pyelography
10
Q
How to you manage a patient who does not smoke ad had a small (less than 4mm) nodule on CT?
A
No follow-up imaging
11
Q
Patient with a sick contact, fever, cough, right lower lobe crackles, and absence of upper respiratory symptoms?
A
Community acquired pneumonia, diagnose with CXR
12
Q
Signs of non-glomerular hematuria?
A
Blood but no protein
13
Q
Dietary recommendations for patients with renal calculi are:
A
Increased fluid intake, decreased sodium intake, normal dietary calcium intake
14
Q
PE rule-out in a hemodynamically unstable individual who cannot undergo CT angio?
A
TTE
15
Q
empyema
A
collection of pus in a cavity, especially pleural
16
Q
Urine sodium > 20mEq/L with low serum osmolarity > 300 mOsm/kg
A
SIADH
17
Q
How does prevalence affect positive predictive value?
A
A population with a high prevalence means a positive test is more likely to be positive, increasing the positive predictive value
Greater the prevalence, the greater the PPB
18
Q
Order of likelihood for brain mets
A
Lung>breast > unknown primary > melanoma > colon
19
Q
In RA refractory to Methotrexate, what is next?
A
Add monoclonal antibody, etanercept
20
Q
Salvage therapy?
A
treatment for a disease when standard treatment fails
21
Q
Monoclonal gammopathy of unknown significance
A
Presence of serum monoclonal protein of less than3g/L without evidence of anemia, kidney failure, bone disease, or other myeloma-related and end-organ damage
22
Q
Treatments for uncomplicated cystitis?
A
Nitrofurantoin, trimethoprim/sulfamethoxazole, fosfomycin, fluoroquinolones, urine culture (only if initial treatment fails)
23
Q
Treatment for urinary urge incontinence?
A
Pelvic floor exercises -> antimuscarinic therapy if refractory (oxybutynin)
24
Q
How to manage a patient with a blood smear showing platelet clumping?
A
Repeat platelet count
25
First line treatment in COPD patient?
bronchodilators (ipratropium or tiotropium) that are anti-cholinergic
26
Effect of malabsorption on calcium levels
Inhibits absorption of Vit. D -\> low calcium, low phosphate
27
Treatment for Ulcerative Colitis?
Mesalamine (left-sided only), sulfasalazine, balsalazine, olsalazaine
28
When a patient presents with immediately-threatened limb ischemia, what should be the first step?
Heparinize the patient
29
ulnar nerve syndrome?
decreased sensation of 4th and 5th fingers, weak grip due to involvement of interosseous muscles
Most common site is the elbow (medial epicondylar)
30
dullnes to precussion with increased breath sounds?
Consolidated pneumonia
31
Lab findings in multiple myeloma?
Hypercalcemia and anemia, excessive production of a single monocloncal protein
32
painless, sudden vision loss (or haze)
centralretinal vein occlusion
33
Signs of thyroid storm?
Palpitations, weight loss, irregular menses, impaired glycemic control, confusion, agitation, n/v
34
Inheritance pattern of Hemophilia?
X-linked recessive
35
How do you treat cancer-related anorexia/cachexia syndrome?
Progesterone analogs \*megestrol acetate)
36
What is the most common complication of HIT?
Additional venous thrombosis
37
What is the most common trigger for bronchoconstriction in patients with asthma?
Aspirin
38
Risk factors for cholesterol emboli?
Comorbid conditions (HLD, HTN, DM type II) Cardiac catheterization
39
How do nitrates relieve chest pain in angina?
Systemic vasodilation and decreased in cardiac preload -\> reduction in left ventricular systolic wall stress -\> decrease in o2 demands
40
Side-effect of radioiodine ablation?
Worsening of opthalmopahty
41
Presentation of OA of the hand?
Squaring of the first carpometacarpal joint (base of thumb) and DIP and PIP
42
What can cause decreased serum potassium?
Increased beta-adrengergic activity -\> stimulates the sodium potassium ATPase pump and the sodium-potassium-2 chloride co-transporter
43
Signs of autoimmune hemolytic anemia?
Spherocytes and positive direct antiglobulin test
44
Why should metformin and NSAIDs be discontinued in treatment for volume depleted sepsis?
Nephrotoxins, worsen kidney function Metformin, specifically causes lactic acidosis in AKI and sepsis
45
What is an s4 heart sound associated with?
Long-standing hypertension, comes from a stiff left ventricle (diastolic heart failure)
46
Cardiac manifestations of TB
Pericarditis (fatigue, dyspnea, pericardial knock (early heart sounds after s2)), pericardial calcifications, sharp x, y decents
47
A person who is treated for Hodgkins lymphoma is at increased risk for?
Secondary malignancy
48
Parallel-group studies
One-treatrment to one group
Different treatment to a second
49
Severe symptoms of hyponatremia (seizures, inability to communicate and/or coma)
Bolus of hypertonic saline until symptoms improve, +/- vasopressin receptor antagonists (conivaptan)
50
Shingles infection (herpes zoster)
51
Yeast with papular, crusting lesion?
Histoplasmosis
52
Treatment for actinomyces?
Penicillin, surgery (if severe)
53
How to manage blood products in a patient who has experiences prior anaphylatic reactions?
Wash samples
54
How to treat an immunosuppressed patient with positive TB skin test?
9 months of isoniazid
55
How to diagnose cushing's disease?
24-hour urine cortisol measurments
56
"culture-negative" urethritis Diagnosis?
Chlamydia trachomatis NAAT on first-catch urine
57
When should CAD testing not be performed?
When they can exercise and have a normal ECG
58
What test is the most sensitive for diagnosing heart failure?
Elevated brain natruretic peptide levels
59
Prophylactic therapy for a patient with HIV?
Trimethoprim-sulfamethoxazole
60
How are methemoglobinemia formed?
Exposure to oxidation agents (Fe2+-\> 3+
Dapsone, nitrates, topical/local anesthetics
61
Signs of laxative abuse?
Hypokalemia with metabolic acidosis (decreased bucarb, which is lost in the GI tract
62
Treatment for RA?
Methotrexate
63
stevens-Johnson syndrome vs TENS?
SJS: \<10% of body surface area
TEN \>30% of total body surface area
64
Colloid solutions?
Albumin
65
Most common drugs assoicated with dyspepsia? Alternative tx?
NSAIDS, Initiate PPI is unable to stop NSAIDS
66
Management for epidural spinal cord compression?
Emergent MRI, Intravenous glucocorticoids, radiation-oncology and neurosurgy consultation
67
Confounding errors?
If the groups are stratified, there will not longer be any significant difference.
68
Features of glucogonoma?
Necrolytic migratory erythema- face, perineum, extremitiesDMGI- diarrhea, anorexiaWeight loss
69
What is the treatment for inadequately controlled asthma?
Long acting beta agonist
70
Hypertensive encephalopathy?
Severe hypertension with cerebral edema and non-locatizing neurologic symptoms and signs
71
Where is prophylaxis with with mefloquine, appropriate for malaria?
Sub-Saharan Africa, Amazon basic, Souther and Southeast Asia
72
Initial treatment for the management of severe hypercalcemia?
Normal saline infusion to restore intravascular volume immediately, bisphosphonates for long-term management
73
Bite cells with normal G6PD?
Glucose-6-phosphate dehydrogenase deficiency
74
oligomenorrhea, hirutism, elevated testosterone levels?Tx?
Polycystic ovarian syndromeTx: Weight loss and oral estrogen/progestin contraceptives
75
What is the next step after osteomyelitis is demonstrated?
Obtain blood cultures
76
If a person that HBsAB-positive need treatment after exposure to a hepatitis B patient?
No, they are immune
77
Most common trigger of COPD exacerbation?
Upper respiratory infection
78
Hearing loss with abnormal Rinne test?
Otosclerosis
79
Signs of allergic rhinitis?
nasal congestion, clear rhinorrhea, pale, edematous nasal mucosa, nasal creases, pharyngeal cobblestoning
80
What is the SPIKES protocol for family meetings?
Set up situation (privacy, etc)
Assess family perception ("What do you think is going on?")
Obtain family's invitation ("How much would you like to know?")
Give knowledge and information
Use empathic statements
Strategy and summary
81
Curb-65 croteroa?
Confusion, urea \>20mg/dL
Respiratory rate \>/= 30
Blood pressure (systolic \<90, diastolic \<60)
Age \>/= 65
82
Treatment for diabetic neuropathy in young patients?Older?
Young- amitriptylineOld: Pregabalin
83
What test should be used to evaluate the presence of a DVT in a low risk patient?
D-dimer (Wells criteria)
84
In patients with a likely PE, when should anticoagulants be given?
Unlikely?
Likely- anticoagulation prior to diagnostic testing
Unlikely- diagnostic testing before anticoagulation
85
Enlarged kidneys, hepatomegaly, and history of rheumatoid arthritis with nephrotic syndrome?
Amyloidosis -\> glomerular deposits visualized with specialized Congo red staining
86
What is the effect of high anti diuretic hormone levels?
increase dilute urine excretion and loss of sodium
87
Orthostatic proteinuria
Proteinuria is greater standing than lying down Most common in children or young adults Associated with the "nutcracker syndrome", compression of the left renal vein between the aorta and the SMA
88
What is the purpose of a negative predictive value?
Let's us know how often a negative result will mean the patient does not have the disease
89
What differentiated malignant hypertension?
Severe hypertension with retinal hemorrhages, exudates, or papilledema
90
Long-standing smoking, chronic productive cough, recent hemoptysis?
Chronic bronchitis
91
Factitious fever
Young woman with irregular fever patterns, track with fever diary
92
Auer Rods Cancer?
Acute Myeloid Leukemia
93
Signs of infective endocarditis?
low-grade fever, generalized weakness, holosystolic murmur, osler nodes
94
Treatment for restless leg syndrome?
1st line: Dopamine
Alternative: alpha-2-delta calcium channel ligands (gabapentin enacarbil)
95
Drop in platelets in 5-10 days puts a patient at risk for?
Arterial thrombosis
96
Leukomoid reaction
high fever, infectious diarrhea, with increased metamyelocytes (late neutrophil precursors and high leukocyte alkaline phosphatase
97
Common pathogens of brain abscesses?
Viridans, s. aureus, gram negative organisms
98
How to calculate expected compensation in metabolic acidosis?
1.5 times bicarb + 8 (+/-2)
99
Enveloped-shaped calcium oxalate crystals are classically observed in patients with
ethylene glycol poisoning, from antifreeze
100
What medications can cause hyperkalemia?
non-selective beta androgenic blockers, potassium=sparing diuretics (triamterene, amiloride), ACT-I, ARBs, NSAIDS
101
Clinical features of cholesterol emboli?
Renal injury, CNS stroke, ocular involvement, livedo reticularis, ulcers, gangrene, blue toe syndome
102
What is a significant side affect of dihydropyridine ca-channel antagonists like amlodipine?
Edema
103
Tubulointerstitial nephritis
Analgessic nephopathy, drug-induced chronic renal failure Presentation: polyuria and sterile pyuria, mild proteinuria Caused by Aspirin and naproxen, and other analgesics
104
Actinic Keratosis
105
What type of kidney disease in most common in hodgkin's lymphoma?
Minimal change disease
106
How to you calculate positive predictive value?
Across the row (TP)/(TP+FN)
107
Most common cause of abnormal hemostasis in patients with CRF?
Platelet dysfunction, treated with desmopressin
108
Facial plethora with normal oxygen saturations and low EPO?
Polycythemia Vera
109
How does long-standing hypertension affect the kidneys?
Intimal thickening, and intimal narrowing of renal arterioles with evidence of sclerosis
110
Direct contact with bone in a diabetic foot ulcer should require what management?
Bone biopsy
111
Signs of hypercalcemia?
Weakness, fastrointestinal distress, neuropsychiatric symptoms
112
When to suspect cardiac sarcoidosis?
Young patient (\<55) with unexaplained second- or third-degree heart block or when ECG changes occur in a patient with known or suspected systemic sarcoidosis
113
Treatment for hypertrophic cardiomyopathy?
Avoidance of volume depletion, BBs/CCB, surgery, if persistent symptoms
114
Signs of cerebellar degeneration?
Progressive gait dysfunction, truncal ataxia, nystagmus, intention tremor or dysmetria (limb-kinetic tremor when touching a target)
115
Myositis, fever, subungual splinter hemorrhages, periorbital edema, eosinophilia
Trichinellosis
116
How to do treat BPH?
5-alpha reductase inhibitor
117
What is the appropriate treatment for a needle stick on an HIV patietn?
Three drug regimen and serology (for baseline) 2 nucleotide/nucleoside RTI plus integrase strand transfer inhibitor
118
Biological role of vitamin B12?
Formation of thmidylate and purine molecules for DNA
119
funduscopy with dilated and tortous veins leading to scattered and diffuse hemorrhages
central vein embolus
120
What agents should be used to rapidly lower potassium?
Insulin with glucose, beta-2-adrengergic agonists, sodium bicarbonate
121
Vocal cord dysfunction
Commonly mistakes for asthma, however, negative methylcholine challenge Signs: difficulty breathing, wheezing, coughing Diagnosis: Laryngoscopy
122
Side effect of phenytoin?Treatment?
Mild megaloblastic anemia caused by reduction in folic acid levelsTx- folic acid supplementation
123
Neoadjuvant therapy?
Treatment given before the standard therapy
124
How do ACE inhibitors cause chronic nonproductive cough?
metabolism of kinins and substance P inhibition -\> kinin causes bronchial irritation
125
Mild to sever glomerular nephritis with low complement levels and nephritic urinary sediment?
Post infectious GN, lupud nephritis, MPGN, mixed cryoglobulinemia associated with hepatitis C
126
Signs of glucogonoma?
Hyperflycemia with elevated glucagon \> 500pg/mL
127
Signs of mixed essential cryoglobulinemia?
Palpable purpura, proteinuria, hematuria
128
If a patient is taking steroids and gets sick, what should happen?
Increase dose of hydrocortisone during the intercurrent illnesses to avoid adrenal crisis
129
Causes of macrocytic anemia?
Folate deficiencyB12 deficiencyMyelodysplastic syndromeAcute myeloid leukemiasDrug induced (chemotherapy agents)Liver DxAlcohol abuseHypothyroidism
130
What is the greatest predisposing factor for stent thrombosis after intracoronary drug-eluting stent placement?
Premature discontinuation of antiplatelet therapy
131
How to treat A fib with RVR?
Synchronized cardioversion
132
Where does selective survival occur?
Case-control studies
133
Babesiosis?
Diagnosis?
Tx?
Protozoal illness endemic to northeastern united states,
Often asymptomatic, but shows up in immunocompromised patients or splenectomy patients.
Signs: Anemia and intravascular hemolysisBlood smear (maltese cross)
Tx: atovaquone plus azithromycin or quinine plus clindamycin (severe)
134
Flank pain, poor urine output and intermittent episodes of high-volume output?
Urinary outflow obstruction
135
Meningitis - CSF findings
elevated WBC, protein levels, decrease glucose
136
Target for treatment o
137
Galactorrhea and signs of secondary amenorrhea, next step?
Obain prolactin levels
138
Laboratory signs of diabetes insipidus?
Severe polyuria and mild hypernatremia
139
Reversal agent for heparin?
Protamine sulfate
140
MS stenosis presentation
gradual and progressively worsening dyspnea and orthopnea, hoarseness, left atrial enlargement -\> elevation of left mainstem bronchus
141
Ebteroclysis
used to diagnose small bowel tumors and other pathology, which can cause intestinal obstruction
142
Clinical features of malaria?
Periodic febrile paroxysms, non specific malaise, headache, nausea, abdominal pain, diarrhea, myalgia, pallor, jaundice, petechiae, hepatosplenomegaly
143
In a young patient with suspected DM, what should be the first step in management?
Check for pancreatic autoantibodies to rule in/out DM type 1
144
Effects of hypopituitarism?
glucocorticoid deficiency, hypogonadism, hypothyroidism
145
Carcinoid tumors put you at risk for deficiency of what?
Niacin (diarrhea, dermatitis, dementia)
146
Physicial manifestations of Hemophilia A & B?
delayed/prolonged bleeding after mild traumaHemarthrosis, hemophilic arthropathyIntramuscular hematomasGastrointestinal or genitourinary tract bleeding
147
Role of large and small fibers in DM?
Large- numbness, proprioception, vibrationSmal- pain, paresthesias, allodynia
148
How does hypertensive intracerebral hemorrhage present?
Evolves over minutes to hours
Initially presents with focal neurological symptoms -\> vomiting, headache, bradycardia (increased intracranial pressure) -\>
149
Bacteria that can cause infective endocarditis?
Enterococci, Fungi, S. bovis, coagulase-negative Staph, Strep viridans, S. aureus
150
How does multiple myeloma cause infections? Most common types?
Impairs normal lymphocyte populations -\> ineffective antibody production and hypogammaglobulinemia Respiratory (streptococcal pneumonia) and UTI
151
In a younger patient presenting with osteoporosis, what should be the first step in workup?
Find an underlying cause.
152
Treatment for fibromyalgia with or without depression?
Serotonin-norepinephrine reuptake inhibtors (duloxetine, milnacipran
153
Without a clear provoking factors, what procedures should be conducted?
Age-appropriate cancer screening and CXR
154
Osmolarity formula?
2 x [Na] + glucose/18 + BUN/2.8
155
How does the body respond to decompensated heart failure?
Activates the Renin-angiotensin-aldosterone system -\> constriction of efferent renal arterioles -\> increased intraglomerular pressure to maintain GFR rate
156
High-output heart failure
Cardiac output is higher than normal -\> circulatory overload -\> pulmonay edema (secondary to elevated diastolic pressure in left ventricle
157
What is uremic pericarditis?
retrosternal chest pain that is relieved by leaning forward, pericardial friction rub and renal failure. BUN is normally greater than 60
158
When is a cystoscopy useful?
When hematuria is present in urinalysis
159
When should you given dental procedure prophylaxis antibiotics?
1. Prosthetic cardiac valves 2. History of prior infective endocarditis 3. Unrepaired congenital heart disease for 6 months following repair 4. Repaired congenital heart disease with residual defects or abnormalities 5. Cardiac transplantation recipients with cardiac valvulopathy
160
What defines a complicated pleural effusion?
1. pH less than 7.2 2. pleural effusion glucose less than 60 3. lactate dehydrogenase \> 1000 4. positive fluid gram stain
161
How to treat acute cholecystitis?
ERCP
162
Bird fancier's lung
hypersensitivity pneumonitis causes by repeated inhalation of antigen -\> leads to alveolar irritation Classic sign: haziness over the lower lung fields
163
Foul-smelling diarrhea, weight loss, fatigue
Steatorrhea and malabsorption
164
Calcium pyrophosphate dihydrate disease?
Presents like OA, but with atypical joints (hands)
165
How does trimethyprim cause hyperkalemia?
Blocks sodium channels in the epithelial sodium channel in the collecting tubule
166
How does primary polydipsia present osmolarity?
serum osmolarity less than 290, urine osmolarity less than 100
167
Malaria phases:
Cold- chills shivering, hot- fever, sweating
168
Which type of arrhythmia is most specific for digoxin toxicity?
Atrial tachycardia with AV block
169
How does pregnancy affect thyroid levels?
Causes a 30% increase in the first trimester
170
Normal DLCO and FEV1/FVC less than 70?
Chronic bronchitis, asthma
171
Signs of dominent frontal lobe ischemia?
Able to follow commands, but unable to veralize or write properly.
Affect brain pathways to mouth and larynx
172
Young adult who has a murmur that increases in intensity with the Valsalva?
Hypertrophic cardiomyopathy
173
What treatment should be used in severe chronic obstructive pulmonary disease?
Inhaled corticosteroids
174
How does heat stroke (105F+) cause rhabdomyolysis and organ system damage?
Body looses its ability to dissipate heat and leads to destruction of cells
175
most like cause of a respiratory alkalosis and metabolic acidosis?
Aspirin toxicity -\> stimulates respiratory center to cause tachypnea and respiratory alkalosis and causes metabolic acidosis by increasing the production of lactic acid
176
How do you treat hypercalcemia due to sarcoidosis?
Corticosteroids, which decreases vitamin D3 production
177
How do you treat antiphospholipid syndrome?
Indefinately continue warfarin
178
Signs of cyanide toxicity?
altered mental status, lactis acidosis, seizures, coma
179
Charcot Triad
Pain, fever, jaundice
180
What is leukocyte alkaline phosphatase?
An active enzyme found within mature blood cells
181
Microscopic colitis?
chonic watery diarrhea without bleeding
182
How should suspected BPH be managed?
Order kidney ultrasound to rule out obstruction
183
What drugs should not be used in cocaine abusers?
Beta-blockers
184
What factor contributes to Warfarin necrosis?
Protein C (primary) and S deficiency
185
Prerenal azotemia BUN/Cr
\>20:1
186
Sudden painless loss of vision?
Tx?
Central retinal artery occlusion d/t occlusion
Tx: Ocular massage and high flow O2
187
What actions are still present in a patient that is "brain dead"?
Deep tendon reflexes
188
Osteolytic lesions, fractures, hypercalcemia, anemia
Multiple myeloma
189
Aortic dissection that leads to pulmonary congestion?
Retrograde extension leads to aortic valve involvement and aortic regurgitation
190
thrombocytopenia and microangiopathic hemolyutic anemia
Thrombotic microangiopathy
191
What vaccinations should be taken prior to a trip to Ehypt?
Hepatitis A, B, typhoid vaccines, polio booster
192
Where do vagal maneuvers affect the heart?
AV node conduction
193
Selective survival bias
case-control studies when cases are selected from the entire disease population instead of just those who are newly diagnosed
194
How many days after last drink to alcohol withdrawal symptoms peak?
12-48 hours
195
What viruses can cause keratitis in an AIDs patient?
Varizella Zoster and herpes simplex
196
What is the most common cause of medical errors?
Communication failures between providers
197
MoA of HIT?
IgG autoantibody that coats the surface of platelets and forms complexes with platelet factor 4 (PF4)
198
JVD on expiration, wheezing, tachypnea, use of accessory muscles?
COPD
199
Acral lentiginous melanoma
Unevenly darkly pigmented patch mostly arises on the palmar, plantar, or subungual surfaces
200
What type of kidney stones are individuals with Chron's disease predisposed to developing?
Oxalate, due to lack of binding in the gut by calcium
201
How to treat narrow-QRS complex tachycardia? MoA?
Adenosine slows sinus rate, increased AV nodal conduction delay, or transient block in AV node conduction
202
What are exam findings in aortic stenosis?
1. Delayed rising and diminished carotid pulse (pulsus parvus and tardus) 2.Single and soft second heart sound 3. Mid- to late-peaking systolic murmur
203
Hawthorne effect?
Tendency of a study population to affect the outcome because theey are aware they are being studied
204
How does cardiogenic shock affect acid/base status?
Cells shift to anaerobic metabolism -\> accumulation of lactic acid -\> metabolic acidosis
205
Latency period
Delay between initial exposure and clinically apparent effects)
206
anasarca?
Extreme, whole body swelling
207
Human papillomarvirus infection
208
What predisposes an individual to the risk of developing minimal change disease?
NSAIDs, lymphoma
209
Best study for determining the incidence of a disease?
Cohort
210
Painless thyroiditis
acute thryotoxicosis with mild thyroid gland enlargement and suppressed TSH
211
How does renal hypoperfusion cause edema?
Activate renin-angiotensin system and causes retention of sodium and water, expanding intervascular volume
212
How do you manage hypobolemia hypernatremia?
Normal 0.9% saline, once resuscitated, switch to D5 (preferred) or 0.45% saline
213
What can happen is a penetrating injury to an eye?
Discovery of "hidden" antigens that the immune system can now recognize and attack, which leads to blindness
214
How do you treat a complicated pleural effusion?
Chest tube to drain
215
How do you treat single nodule colorectal mets?
Regional hepatectomy
216
How long can it take a person with inadequate dietary intake, intestinal malabsorption, or hepatocellular disease to become vitamin K deficient?
7-10 days
217
Hypotension, tachycardia, distended jugular veins, respiratory variation in systolic blood pressure?
Cardiac temponade
218
When is it appropriate to accept a gift from an external source?
Accepting nonmonetary gifts from parties only if the gifts directly benefit patient care and are or small monetary value
(educational materials, drug samples)
219
Where is blasto located?
Midwest, upper midwest, extending to southern Mississippi
220
How to diagnose idiopathic intracranial hypertension?
MRI +/- MRV, lumber puncture (CSF pressure \>250mm H20 with normal analysis)
221
When is enterococci likely to cause endocarditis?
nosocomial UTI
222
How often should a PAP smear be done in a woman who had a hysterectomy for non-malignant reasons?
Discontinue pap smears
223
When should an HIV infected person stop receiving line attenuated vaccines?
CD4+ counts less than 200
224
Expansile and eccentrically places lytic area in the epiphysis of the distal femur?
Giant cell tumor, "Soap bubble" appearance
225
How to treat chemotherapy-induced nausea and vomiting?
Serotonin receptor antagonist (5HT)
226
What affect does COPD have on vital capacity?
Decreases it
227
How to treat a patient with stage III colon cancer s/p hemicolectomy?
Adhyvant chemotherapy
228
How can you confirm proper randomization?
Analysis of the patient characteristics
229
Signs of acute HIV infection?
Fever, lymphadenopathy, sore throat, arthralgiaas, GI symptoms
Painful mucocutaneous ulcerations
230
What is a common exam finding with aortic regurgitation?
Bounding pulses
231
What vaccines should patients with chronic liver disease receive?
Tdap/Td: Tdap once, Td booster every 10 years
Influenza: Annually
Pneumococcal PPSV23 once and PVC13 and PPSC23 at age 65
Hep A: 2 doses 6 months apart (with initial seronegative)
Hep B: 3 doses at 0 months, 1 months, at least 4 months (with initial seronegative)
232
How to treat a patient with ventricular tachycardia?
Placement of an ICD
233
Three most common causes of chronic dry cough?
GERD, postnasal drip, asthma
234
transient vision loss "a curtain falling down"
Retinal embolus from ipsilateral carotid
235
What STD testing should be conducted on all sexually active woman?
HIV, gonorrhea, Chlamydia
236
Back pain in an individual with Chron's disease?
Enteropathic arthritis
237
Signs on glomerular hematuria?
Blood and protein
238
What is the first step in evaluating a patient for suspected BHP?
Urine analysis, check for PSA
239
Cardiac manifestations of Trypanosoma cruzi infection?
Cardiomegaly, causes systolic and diastolic heart failure
240
What is the role of heptoglobin?
Binds free hemoglobin and promotes its excretion by the reticuloendothelial system
241
Treatment for narrow complex tachycardia?
Supraventricular tachycardia -\> immediate synchronized direct cardioversion
242
What cancer has retinoic acid receptor present?
Acute promyelocytic leukemia, presents with pancytopenia
243
How to treat a patient with SLE and suspected lupus nephritis?
High-dose steroids
244
Long-term pharmacological management of atrial fib?
Metoprolol and warfarin
245
At what CD4+ count should HIV patients shop receiving inactivated vaccines?
They should always receive them
246
pain along the anteromedial proximal tibia distal to the joint like that worsens walking up stairs and at night
Pes anserine bursitis
247
Signs of lupus
Gradual symptom onset, malar or discoid rash, joint, renal, serosal, and neurological involvment Ex: photosensitive skin, thrombocytopenia, glomerulonephritis, RBC casts low c3/c4
248
How to treat an individual with an intermittent asthma?
short-acting bronchodilator
249
Cordlike thickening breast and bilateral prementstrual tenderness
Fibrocystic changes
250
Low DLCO and FEV1/FVC less than 70%?
Emphysema
251
Diabetic patient with elevated serum creatinine and proteinuria
Chronic kidney disease from diabetic hlomerulosclerosis
252
rapidly progressing bilateral necrotizing retinitis
HSV
253
How do you evaluate a patient with suspected vertebral osteomyelitis?
MRI
254
Hemodynamically stable person with high risk of suspected DVT, next step?
CT angiogram
255
papules with indented centers, infection? Where are they not found?
Molluscum contagiosum (pox virus),
Not found of palms and soles
256
How do you manage a patient with ventricular fibrillation arrest in the setting of acute myocardial infarction?
Continued medical management for MI. 1 year risk is no greater than normal is this acute setting
257
CHF development in a young person andpleural effusions, and third heart sound?
Coxsackie B virus
258
Calcium oxalate crystals in the kidney suggests?
Ethylene glycol poisoning
259
Dermatitis herpetiformis
260
Signs of adrenal insufficiency?
hyperkalemia, hypoglycemia, eosinophilia
261
How does aortic stenosis present?
Decreased exercise tolerance, exertional dyspnea, angina, or syncope
262
What is a factoral study design?
2 or more experimental interventions with 2 or more variables that are studies independently
263
Elderly male with agitation, tachycardia, and lower abdominal tenderness 2 days following surgery?
Acute urinary retention
264
How to identify drug-induced lung toxicity?
Chronic, high eosinophils, fatigue, low-grade fever, cough
265
Vaginal pessary use?
Symptomatic pelvic organ prolapse and stress incontinence when surgery fails/in not an option
266
Best empiric antibiotic treatment for a native valve in suspected endocarditis?
Vancomycin
267
Sudden onset excruciating left-sided chest pain, tachycardia, dilated pupils, with necrotic nasal mucosa?
Tx?
cocaine toxicity
Tx: intravenous diazepam
268
How should a tick be removed from the skin?
Remove the tick with tweezers
269
When is a CT contraindicated in PE workup?
With kidney failure (high creatinine), use ventilation/perfusion scan instead
270
What drugs have been shown to improve survival rate in patients with heart failure?
Beta-blockers, ACE/ARBs, hydralazine and nitrates and spirolactone, and eplerenone
271
Management of a patient with a new onset breast nodule that was negative on mammorgram?
Aspiration or Biospsy
272
How to treat pituitary apoplexy?
Neurosurgery consult and glucocorticosteroids
273
Blood transfusion reaction that occurs between 1 and 6 hours?How to prevent?
Febrile non-hemolytic transfusionLeukoreduction
274
Symptoms of histoplasmosis infection?
fever, chills, malaise, weight loss and cachexia, cough, dyspnea, papules, nodules, reticuloendothelial
275
Signs of polycythemia vera?
Increased hemoglobin, increase leukocytes, increased platelets
276
G6PD deficiency laboratory signs?
Low hemoglobin, increased indirect hemoglobin, increased indirect bilirubin, increased lactate dehydrogenase, decreased haptoglobin
277
278
Electrolyte abnormality with constipation, increased thirst, anorexia, and easy fallibility?
Hypercalcemia
279
Dyspnea, wheezing, cough with positive bronchodilation response
Asthma
280
cells iwth convoluted nuclei and highly vacuolated cytoplasm?
infectious Mononucleosis (EBV)
281
Lung cancer associated with hypercalcemia?
Squamous cell carcinoma, PTHrP secretion
282
Tracheal narrowing with ulceration
characteristic of Granulomatosis with polyangiitis
283
Best tests to diagnose obstructive ureterolithiasis?
US or spiral CT without contrast
284
Hyperkalemia with a normal ECG, next best step?
Check for pharmacological causes of hyperkalemia
285
What is the first step in managing iron deficiency?
Determining the cause (Fecal occult blood)
286
How to calculate anion gap acidosis?
Serum sodium - (serum chloride and bicarb) = 14
287
How do you treat an esophogeal rupture?
surgically repair it
288
Characteristic signs of systemic Blastomycosis infections?
ulcerated skin lesion and lytic bone lesions
289
What pharmacologic treatments should be given to prevent acute arterial occlusion?
Apixaban, dabigatran, rivaroxaban, edoxaban
290
Elderly patient with severe lumphocytosis (\>40000) lymphadenopathy, and bicytopenia suggests?
Chronic lymphocytic leukemia
291
When should you consider pulmonary rehabilitation?
COPD and remains symptomatic, or has decreased functional status
292
Waldenstrom macroglobulinemia
production of monoclonal IgM antibodieshymphadenopathy and hepatosplenomegaly may be present
293
Acute treatment for PE or DVT with subtheraputic INR on warfarin?
Rivaroxaban
294
Signs of cerebellar hemisphere infarct?
occipital headache, neck stiffness, ipsilateral hemiataxia
295
How to manage a patient with a PAP result of atypical squamous cells of undetermined significance?
Refer to colposcopy
296
How do you control for confounding errors in analysis?
Design state: Matching, restriction, randomization
Analysis stage: Stratified analysis, statistical modeling
297
What can improve survival in a severely septic patients at high risk of death?
Activated protein C
298
How are leukomoid reactions caused by severe infections?
Mobilization of mature and immature leukocytes from bone marrow
299
What is cryptogenic organizing pneumonia?
nonsmoker without any normal exposure history has acute to subacute development of nonspecific systemic and respiratory symptoms with a dominant alveolar process on CXR
300
Alternatives to mefloquine prophylaxis?
Atovaquone-proguanil and doxycycline
301
What medications can cause idiopathic intracranial hypertension?
tetracyclines, hypervitaminosis A,
Also associated with overweight woman of childbearing age
302
How to treat diffuse large B-cell NHL?
Abbreviated course of chemotherapy followed by radiation
303
Malaria: Lab findings, clinical diagnosis
Anemia, thrombocytopenia Diagnosis: blood smears
304
What types of vaccines are safe for people taking TNF-alpha inhibitors?
non-live attenuated
305
What does changing the cut off for a test change?
Sensitivity and specitivity
306
Effect modiciation?
external variable positively or negatively impacts the effect of a risk factor on the disease of interest
307
butterfly appearance with central necrosis on CT/MRI?
Glioblastoma multiforme
308
fatigue, weight gain, erectile dysfunction and hyponatremia suggest?
panhypopituitarism
309
Hard unilateral head and neck lymph nodes in an older patient with smoking history?
Squamous cell carcinoma
310
What DM medications are weight neutral?
DDP-4 inhibitors (sitagliptin)
311
What does a hazard ratio mean?
Less than 1 = treatment group had a significantly lower event rate
Greater than 1 = significant higher event rate
312
Solitary brain met in a patient with good performance status. Treatment?
Surgical excision
313
Signs of elevated pulmonary artery pressure?
1. Loud P2, fixed S2 2. Pulmonic flow murmur 3. tricuspid regurgitation
314
Patient with malignant throid mass, elevated serum calcitonin, and family hx of thyroid malignancy likely has an inherited form of?
MEN2a or 2bRet mutation
315
Monorrhagia is common in which bleeding disorder?
Willebrand disease
316
Subclinical hypothyroidism
Mildly elevated serum TSH and normal T3 and T4Do not have clinical signs
317
Renal findings in multiple myeloma?
Bland with granular casts; nephritic disease
318
Signs of post-streptococcal glomerulonephritis?
Periorbital swelling, hematuria, and oliguria, hypertensive, serum c3 complements are low
319
What DM medications cause weight loos?
GLP-1 agonists (exenatide)
320
What drug is used to treat hairy cell leukemia? Side effects?
Cladribine; neurological and kidney damage
321
How do you treat lung abscess following aspiration?
Ampicillin-sulbactram
322
Antibiotic of choice for Oitis media?
Amoxicillin, alternatives: Amoxicillin-clavulanate, cefuroxime, ceftriaxone
323
Most common cause of acute bronchitis?
Viral infection
324
dullness to percussion with decreased breath sounds?
Pleural effusion
325
Signs of drug-induced interstitial nephritis?
Fever, rash, arthralgia, peripheral eosinophilia, hematuria, sterile pyuria and eosinophilurea and WBC casts
326
Acute radiation proctitis-cause, diagnostic method
Patient who receive pelvic radiation exposure and develop diarrhea.Diagnosis is done via flexible sigmoidoscopyLook for mucosal telangiectasia and submucosal fibrosis and arteriole endarteritis
327
Early diastolic murmur?
Aortic regurgitation
328
Signs of renal cell carcinoma?
Flank pain, hematuria, palpable abdominal mass scrotal varicoceles paraneoplastic syndrome
329
Most common cause of death in dialysis patients?
Cardiovascular disease
330
Concern when a patient with endocarditis develops a new conduction abnormality?
Perivalvular abscess
331
1-day history of swlling aliong the margen of the upper eyelid?
Stye, external hordeolum
Staphococcal infection of the eyelid, responds to the application of warm compresses
332
Gastric Bezoar
foreign body resulting from the accumulation of injested material,
333
How to diagnose CLL?
Flow cytometry of peripheral blood
334
Hemoptysis-definition
expectoration of blood originating from the lower respiratory tract
335
Syndrome with high proteinuria and evidence of edema
Nephrotic
336
Greater than 10 mm Hg drop in systolic blood pressure with inspiration?
Cardiac temponade
337
What type of acinar pattern exists with alpha-1-antitripsin?
Panacinar?
338
Uveitis
blurred vision, moderate pain, conjunctival injection and constricted pupils
339
Symptoms of Anklyosing spondylitis?
Low back pain (\<40)
Hip and buttocks pain
limited chest expansion and spinal mobility
Enthesitis (inflammation at site of tendon insertion to bone)
systemic symptoms (fever, chills,)
acute anterior uveitis (unilateral pain, photophobia, blurry vision)
340
What is persistent asthma?
Asthma occurring 2 or more times per week or 2 or two or more times a month
341
Severe headaches at night for weeks/months over time? Treatment
Cluster headaches, treat with 100% oxygen
342
Friable papules and subcutaneous plaques?
Bartonella angiomatosis
343
Cardiac manfestations of sarcoidosis?
complete AC block, restrictive cardiomyopathy (early) and dilated cardiomyopathy (late)
Sings: Uveitis
344
Mediastinal widening, pericardial effusion, neck pain, syncope, HTN history, chest pain
Acute aortic dissection
345
Decrescendo early diastolic murmur when patient is sitting up, leaning forward, and holding the breath at maximum expiration
Aortic regurgitation
346
Common types of selection biases?
Ascertainment (sampling): study population differs rom target population
Nonresponse vias: High non-response to surveys/questionnaires
Berkson bias: Disease studies using onl hospital-based patients
Prevalence bias (neyman): exposure that happens long before disease assesment may cause study to miss diseased patients
Attrition bias: significant loss of study participants lost of follow-up
347
Side effects of thiazide siuretics?
Glucose intolerance by impairing insulin release from the pancreas and glucose utilization in the peripheral tissues
348
How do you calculate the number needed to treat?
1/absolute risk reduction
349
Acute hypophosphatemia signs?
Confusion, rhabomyolysis, hemolytic anemia, severe muscle weakness, most commonly seen in alcoholics after glucose administration, which causes uptake of phosphate into cells
350
Pain, itching, red streaks on an arm that presented in a different location preciously?Next step?
Migratory superficial thrombophlebitis (Trousseau's syndrome)CT of the abdomen due to association with pancreatic cancer
351
Episodes of extraocular changes, dysarthria, dysphagia, any symmetrical proximal weakness involving the neck
Myasthenia gravis, cause by acetylcholine receptor antibodies at the motor end plate
352
Signs of TCA oversode?
drowsiness, delirium, seizures, prolonged QRS, dry mouth
353
Where is histoplasmosis found?
Mississippi and Ohio river valleys
354
Ruby-colored papules on lips that blanch partially with pressure?
Arteriovenous shunting (Osler-Weber-Syndrome)
355
Treatment of choice for serious gram-negative, multidrug resistant infections?
Aminoglycosides
356
signs of major depression? Treatment?
anhedonia, poor appetite, insomnia, fatigue, difficulties with focus accompanies by memory impairment
Tx: SSRI
357
What is the most important prognostic factor in breast cancer?
TNM staging, followed by ER/PR status, then Her-2/neu oncogene expression
358
Signs of theophylline toxiity?
central nervous system stimulation (headache, insomnia, seizures), GI disturbances (nausea, vomiting), cardiac toxicity (arrhythmia)
359
Sudden onset of shortness of breast, suspect?
Upper airway obstruction, laryngeal edema
360
hepatic cysts with daughter cysts within?
Echinococcosis (dogs and sheep)
361
Chronic cough that worsens overnight and does not improve with antihistamines?
Asthma
362
Obstructive lung disease FEV1, FVC, FEV1/FVC
Fev1-
363
How do you treat Pneumocystis jirovecii pneumonia?
Trimethoprim-sulfamethoxazole plus corticosteroids
364
postoperative endophthalmitis?
Within six weeks of surgery Presents with pain and decreased visual acuity, with swollen eyelids, conjunctiva, hypoyon, corneal edema, infection Mostly affects the vitreous
365
Dengue fever: signs
4-7 days post exposure muscle and joint pain, retroorbital pain, rash, leukopenia
366
What should all patients diagnosed with ITP be tested for?
HIV
367
What type of valve defect in seen with hypertrophic cardiomyopathy?
Systolic anterior motion of the mitral valve
368
Why is the general population not screening for Syphilis?
High rate of false-positives
369
When is the best time to initiate evaluation of thrombophilia?
2-4 weeks following completion of wargarin therapyStops false positives and false negatives
370
Cholesterol emboli, laboratory findings?
Eosinophilia, eosinophilerua, hypocomplementemia
371
Suspected autoimmune disorder, but treatment with corticosteroids causes rapid deterioration?
Think underlying infection
372
signs on meningococcemia
petechial rash that progresses to ecchymosis, bullae, vesicles, and gangrenous necrosis
373
Pain exacerbated by bladder filling and relieved by voiding
Interstitial cystitis
374
What is the first renal abnormality in diabetes?
Glomerular hyper-filtration
375
Signs of porphyria cutanea tarda?
Blisters, bullae, scarring, hypopigmentation/hyperpigmentation in sun-exposed skin
376
Signs of hypercortisolism?
Weight gain, psychiatric symptoms, HTN, hyperglycemia
377
How are p-values and confidence intervals related?
p-value of 0.05 is equal to a confidence interval of 95%
378
hypernatremia with hypokalemia with htn? Diagnostic test?
Hyperaldosteronism, aldosterone to plasma renin
379
After confirming a normal TSH, what is the next step in working up suspected Cushings?
24 hour free urine cortisol, salicary cortisol, or low-dose decamethasone suppression 2 must be abnormal
380
What drugs can increase bleeding risk for a patient on Warfarin?
Acetaminophen, NSAIDS, antibiotics, amiodarone,
381
What vitamin deficiency is associated with pernicious anemia?
B12, megaloblastic anemia
382
How do you reverse warfarin?
Vitamine K (slow) and prothrombin complex concentrate (rapid)
383
Needle-shaped urinary crystals
Uric acid
384
Transfusion-related acute lung injury
Fever, dyspnea, diffuse pulmonary infiltrates and hypocia
385
Swlliung on the eyelid which has appeared off an on for the past several years
Initially starts as a painful lesion, which regresses with hot compressions, but eventually reappears
Treatment?
Chalazion
Tx- Histopathological examination
386
Physical sign of acute cholecystitis?
Pain in the right upper abdominal area, positive Murphey's sign
387
Signs of vitamin D toxicity?
vomiting, confusion, polyuria, polydipsia
388
Laboratory findings for lead poisoning
microcytic anemia,, basophilic stippling, high lead levels
389
Where can aspiration pneumonia form when supine?
posterior segments of upper lobes and superior segments of lower loabs
390
Restrictive lung disease FEV1, FVC, Fev1/FVC
FEV1- 70% FVC
391
EKG signs for supraventricular tachycardia?
No regular P waves. buried within the QRS complex
392
When do you see Auer rods? How does it present?
Acute myeloid leukemiaPresents with pancytopenia (bleeding or infection) and myeloblasts would be expected
393
Multiple miscarraiges and DVTs with SLE?
Antiphospholipid syndrome
394
Treatment for post nasal drip?
Chlorpheniramine (1st generation antihistamine)
395
Intermittent fever, fatigue, new holosystolic murmur and positive blood cultures?
Infective endocarditis
396
Complication of infectious mononucleosis?
Autoimmune hemolytic anemia and thrombocytopenia
397
How are ACEI/ARBS renal protective in diabetic patients?
reduces intraglomerular hypertension
398
Recent URI, dyspnea, elevated JVP, clear lung fields, increased cardiac silhouette on CXR?
Cardiac tamponade due to large pericardial effusion
399
Most common cause of mitral regurgitation in the developed world?
Mitral valve prolapse
400
Chronic myeloid leukemia laboratory findings?
leukocyte alkaline phosphotase = lowhigh number of myelocytes to melamyelocytesPresence of absolute basophilia
401
How do you treat severe, community acquired pneumonia?
cefotaxime, levofloxacin, and vancomycin
402
How do you treat diabetic neuropathy?
ACE inhibitors and ARBs, however, do not combine an ACE and an ARB
403
Treatment of a patient that has been exposed to smoke inhalation?
100% oxygen with facemask
404
What does an ANOVA test compare?
Means of three of more variables
405
Electrical alternans with sinus tachycardia is suggestive of? Treatment?
Pericardial effusion Pericardiocentesis
406
How to you treat prostate cancer?
Androgen deprivation therapy
407
Mutations that causes primary polycythemia vera?
Jak2 mutation
408
Cough-variant asthma
cough and chest-tightness
409
How to prevent malaria?
Chemoprophylaxis
410
Thrombocytopenia with thrombus progression 3 days into heparin therapy?
Type 2 herarin-induced thrombocytopenia
411
Chalazion
412
How does cyanide affect tissues?
reduces oxygen utilization by tissues by inhibiting cytochrome oxygase a3 in the electron transport chain
413
edematous external auditory canal with purulent discharge and granulation tissue on the floor? Tx?
Maligname (necrotizing) otitis externa (Pneudomonas aeruginosa) treat with intravenous ciprofloxacin
414
Does aspergillosis affect immunocompetent individuals?
Not likely
415
skin fradility, echymosis, normal laboratory studies
Senile purpura - Cause n pericascular connective tissue atrophy
416
Facial Rash and symmetric oligoarthritis are highly suggestive of?
Systemic Lupus Erythematosus
417
When should you receive your meningococcal vaccinations?
Age 11-12, 19-21 (if not previously vaccinated
418
Asporin exacerbated respiratory disease?
Asthma, chronic rhinosinusitis with nasal polyposis and broncospasm or nasal congestion following ingestion of aspirin or NSAID
419
What happens to incidence and prevalence when survival time increases?
Incidence remains the same, prevalence increases (more people living with the disease
420
Lentigo Maligna?
Slow growing melanoma seen on the sun-exposed areas of the face
421
Infection control protocol for N. meningitides?
Droplet precautions (face-mask)
422
Definition of diabetic neuropathy?
Hypertension, proteinuria, decline in GFR
423
IBS - Symptoms and Treatment
Recurrent abdominal pain or discomfort; marked change in bowel habit for at least 6 months, with syumptoms experience at least 3 days a month for 3 months.Must have 2 of the following:1. Pain relived by a bowel movement2. Onset of pain in related to a change in frequency of stool3. Onser ot pain is related to a change in the appearance of stool Tx- reassurance and high-fiber diet
424
Milk-alkali syndrome
Overconsumption of calcium and absorbable alkali -\> hypercalcemia -\> renal vasoconstriction and decreased GFR
425
When should you consider electric cardioversion?
Any patient who is unstable with an arrhythmia, other than sinus tachycardia
426
When do sideroblasts form?
When iron is available, but is unable to be incorporated into hemoglobin
427
When is cystoscopy recommended?
Unexplained gross hematuria or with microscopic hematuria with no evidence of glomerular disease or infection
428
What paraneoplastic syndrome is caused by small cell lung cancer?
SIADH, decreased sodium
429
chest pain, dyspnea, asymmetric leg edema, elevated central venous pressure, tachypnea, tachycardia, suspect?
Pulmonary Embolism, diagnose with CT angiography
430
SIADH osmolarity
Less than 290 serum, greater than 25mEq/L sodium with greater than 100 mOsm/kg urine
431
In a low risk patient, what is the size of a "positive" TB test?
For healthcare workers?
Immunocompromised patients?
15mm,
10mm,
5mm
432
How to you manage an adrenal incidentoma?
Overnight dexamethasone suppression test, 24-hour urine collection for metanephrines, measurement of plasma renin activity and serum aldosterone levels
433
How do you pharmacologically treat a patient with heart failure?
Beta-blocker and ACE inhibitor
434
Characteristic microscopic finding for membranoproliferative glomerulonephritis type 2?
dense intramembranous deposits that stain for C3
435
Anasarca, pulmonary and facial edema, hypertension, abnormal urinalysis with proteinuria?
acute nephritic syndrome
436
Side effects of rifampin?
Red-orange discoloration of body fluids
437
Leukoreduction
reducing the number of transgused leukocytes through filtering or other methods (washing). Reduces changes of HLA allommunization and transmission of CMV
438
What can be used for DVT prophylaxis?
unfractionated heparin, low molecular weight heparin, fondaparinux
439
Side effects of HCTZ?
hypercalcemia, photosensitivity, orthostatic hypotension
440
Scaly papules or plaques of fair skinned individuals that have high sun exposure?
Actinic keratosis
441
First step in the evaluation of a thyroid nodule \> 1cm?
TSH levels and U/S
442
Cause of abnormal hemostasis in CRF?
Uremic coagulopathy`
443
How do you treat polycythemia vera?
Aspirin and phlebotomy
444
Alternative treatment for syphilis?
Doxycycline X 14 days (primary and secondary) Doxycycline x 28 days (latent) Ceftriaxone x 14 days (tertiary)
445
What infections should patients positive for gonorrhoeae also be tested for?
HIV, syphilis, Chlamydia, hep B
446
What is the treatment for toxoplasmosis?
zTrimethoprim-sulfamethoxazole, especially when cd count is less than 100,
447
low-grade fever and periorbital edema, several days after headache with vomiting and papilledema?
Cavernous sinus thrombosis
448
Still disease
daily (quotidian fever) evanescent salmon-colored rash, arthritis, multisystem involvement, markedly elevated ferritin
449
Absolute indications for dialysis?
Uncontrollable hyperkalemia, uncontrollable hypervolemia, altered mental status, increased somnolence, pericarditis, bleeding due to uremia platelet dysfunction
450
What does a Chi-square test measure?
proportions of categorized outcome. High/Low 2x2 table
451
Intermittent asthma definition?
daytime symptoms less than 2 times per week, nighttime less than/equal to 2 times per month, baseline FEV1 and FEV1/FVC are normal
452
How to treat complete heart block?
Cardiac pacing (pacemaker)
453
Causes of crystal-induced acute kidney injury?
Acyclovir, sulfonamides, methotrexae, ethylene glycol, protease inhibitors
454
What is required to discontinue life support for a patient that has legally been declared brain dead?
Nothing,
455
You suspect a patient is being abuse after noticing bruising, what is the first step?
Ask about the bruises
456
Treatment for TCA overdose with QRS \> 100ms?
Sodium bicarbonate therapy
Allows the sodium load to alleviate depressant action on myrcardial sodium channels
457
How to treat infective endocarditis?
IV antibiotics for 4 weeks
458
First step in screening for thalassemia anemia?
Complete blood count
459
How to manage HIT?
Stop heparin and start non-heparin anticoagulation (fondaparinux or argatroban)
460
Henoch-schonlein purpura
purpuric rash predominately affecting distal lower extremities, artritis, abdominal pain, hematuriaskin biopsies reveal leukocytoclastic vasculitis
461
Nonsmoker with recent URI and persistent cough productive of yellow, blood-tinged sputum?
Acute bronchitis
462
Large amount of blood in the urine, but only 0-1 RBCs? Think?
Rhabdomyolysis
463
Thrombolytic therapy drug name?
Alteplase (tissue plasminogen activator
464
Signs of a first degree heart block?
PR interval greater than 0.2
465
Moderate symptoms of hyponatremia (confusion, lethargy) treatment?
Hypertonic saline first 3-4 hours
466
Brownish skin pigment? Disease?
Bronze diabetes, hereditary hemochromatosis
467
What are the exposures associated with smoke inhalation?
Carbon monoxide and hydrogen cyanide
468
Crystalloids
saline solutions
469
Young person with sudden onset of fever, stiff neck, headache, nausea, and myalgias
bacterial meningitis, can develop within several hours of the initial meningitis
470
Bleeding episodes and severe isolated thrombocytopenia with normal hematocrit and leukocyte count with normal fibrinogen and PT?
Immune thrombocytopenia (idiopathic thrombocytopenic purpura
471
Signs of lead poisoning?
Abdominal pain, constipation, fatique, irritability insomnia, neuropathies, neuropsychiatric disturbances and nephropathy, HTN
472
Isolated thrombocytopenia without anemia or leukopenia?
Idiopathic thrombocytopenia purpura
473
How do you treat chronic stable angina with worsening symptoms?
Increase dosage of beta-blocker
474
How do you prevent ventilatory associated pneumonia?
Keep the bed in a semi-erect position
475
What is the treatment for norcardia?
trimethoprim-suldamethoxazole (add carbapenems when the brain in affected for better control
476
BRBPR and pain with defectation?
Anal Fissure
477
Type of edema caused by hypoalbuminemia?
Peripheral
478
Displaced apical impulse, holosystolic murmur, third heard sound?
Mitral regurgitation
479
How to manage pain in terminal cancer patients?
1. Try non-narcotics first (short-acting morphine is first)2. Do not be afraid to give narcotics3. Prescribe adequate amounts of medication
480
Crescendo-decrescendo systolic murmur without radiation to the carotids?
Interventricular septal hypertrophy
481
Prerenal Azotemia
autoregulation of kidney flow can no longer maintain GFR Look for nausea, vomiting, anorexia accompanied by relatively low pressure int eh absence of edema
482
What causes urinary retention in first generation antihistamines?
Failure of detrusor muscle contraction, and to a lesser extent impaired bladder sphincter relaxation
483
What is doxazosin?
alpha blocker
484
Gilbert Syndrome
Indirect hyperbilirubinemia, with normal hemoglobin and otherwise normal liver tests in an asymptomatic patient
485
Signs of an epidural spinal cord compression?
lower extremity motor weakness, hyperreflexia, and bladder dysfunction
486
Workup for hypocalcemia?
Recheck-\> drug-\> PTH-\> 25-hydrocy vitamin D levels
487
Yeast with low grade fever and violaceous skin lesion?
Blastomycosis
488
Treatment for alcohol withdrawals?
Benzodiazepines (Chlordiazepoxide)
489
What anticoagulant can lead to low levels of Protein C and S?
Warfarin
490
Hemophilia laboratory findings?
Prolonged aPPT, decreased or absent Factor VIII or IX activity
491
How to distinguish neuromuscular restrictive disorder from obstructive disorders?
FEV1/TLC is larger, low maximal respiratory pressure
492
Facial plethora and high hemoglobin?Tx?
Polycythemia VeraPhlebotomy, may add hydroxyuria in cases with high risk of thrombosis
493
Late complications of STEMI?
Cardiogenic shock, ventricular septal defect, mitral regurgitation, free wall rupture, left ventricular thrombus
494
Signs of generalized resistance to thyroid hormones?
Normal TSH and high T3 and T4 with signs of hypothyroidism
495
Nephrotic syndrome complex
Proteinuria, hypoalbuminemia, edema, hyperlipidemia, lipiduria
496
What is the appropriate duration of heparin when using a bridge
Minimum 5 days with two IRN measurements \>/= 2, 24 hours apart
497
What should you screen for in patients with hepatitis B?
Hepatocellular carcinoma
498
Heredity hemochromoctoma- risk factors?
Hepatocellular carcinoma
499
What drugs can cause ototoxicity?
Aminoglycosides, chemotherapy agents, aspirine, loop diuretics
500
Associated conditions with Porphyria Cutanea Tarda?
Hep C, HIV, EtOH abuse, estrogen use, smoking
501
a-thalassemia trait characteristics
mild anemia, microcytosis, hypochromia, target cells, and normal hemoglobin electrophoresis in adults
502
Acute radiation proctitis-cause, diagnostic method
Patient who receive pelvic radiation exposure and develop diarrhea.
Diagnosis is done via flexible sigmoidoscopy
Look for mucosal telangiectasia and submucosal fibrosis and arteriole endarteritis
503
IBS - Symptoms and Treatment
Recurrent abdominal pain or discomfort; marked change in bowel habit for at least 6 months, with syumptoms experience at least 3 days a month for 3 months.
Must have 2 of the following:
1. Pain relived by a bowel movement
2. Onset of pain in related to a change in frequency of stool
3. Onser ot pain is related to a change in the appearance of stool
Tx- reassurance and high-fiber diet
504
Gilbert Syndrome
Indirect hyperbilirubinemia, with normal hemoglobin and otherwise normal liver tests in an asymptomatic patient
505
Physical sign of acute cholecystitis?
Pain in the right upper abdominal area, positive Murphey's sign
506
Charcot Triad
Pain, fever, jaundice
507
How to treat acute cholecystitis?
ERCP
508
Most common drugs assoicated with dyspepsia? Alternative tx?
NSAIDS, Initiate PPI is unable to stop NSAIDS
509
BRBPR and pain with defectation?
Anal Fissure
510
What should you screen for in patients with hepatitis B?
Hepatocellular carcinoma
511
Treatment for Ulcerative Colitis?
Mesalamine (left-sided only), sulfasalazine, balsalazine, olsalazaine
512
Microscopic colitis?
chonic watery diarrhea without bleeding
513
Signs of an epidural spinal cord compression?
lower extremity motor weakness, hyperreflexia, and bladder dysfunction
514
Management for epidural spinal cord compression?
Emergent MRI, Intravenous glucocorticoids, radiation-oncology and neurosurgy consultation
515
Facial plethora and high hemoglobin?
Tx?
Polycythemia Vera
Phlebotomy, may add hydroxyuria in cases with high risk of thrombosis
516
Facial plethora with normal oxygen saturations and low EPO?
Polycythemia Vera
517
Mutations that causes primary polycythemia vera?
Jak2 mutation
518
How do you treat cancer-related anorexia/cachexia syndrome?
Progesterone analogs \*megestrol acetate)
519
Lab findings in multiple myeloma?
Hypercalcemia and anemia, excessive production of a single monocloncal protein
520
Renal findings in multiple myeloma?
Bland with granular casts; nephritic disease
521
Signs of vitamin D toxicity?
vomiting, confusion, polyuria, polydipsia
522
Leukomoid reaction
high fever, infectious diarrhea, with increased metamyelocytes (late neutrophil precursors and high leukocyte alkaline phosphatase
523
How are leukomoid reactions caused by severe infections?
Mobilization of mature and immature leukocytes from bone marrow
524
Chronic myeloid leukemia laboratory findings?
leukocyte alkaline phosphotase = low
high number of myelocytes to melamyelocytes
Presence of absolute basophilia
525
What is leukocyte alkaline phosphatase?
An active enzyme found within mature blood cells
526
Without a clear provoking factors, what procedures should be conducted?
Age-appropriate cancer screening and CXR
527
When do you see Auer rods? How does it present?
Acute myeloid leukemia
Presents with pancytopenia (bleeding or infection) and myeloblasts would be expected
528
cells iwth convoluted nuclei and highly vacuolated cytoplasm?
infectious Mononucleosis (EBV)
529
Signs of lead poisoning?
Abdominal pain, constipation, fatique, irritability insomnia, neuropathies, neuropsychiatric disturbances and nephropathy, HTN
530
Laboratory findings for lead poisoning
microcytic anemia,, basophilic stippling, high lead levels
531
Physicial manifestations of Hemophilia A & B?
delayed/prolonged bleeding after mild trauma
Hemarthrosis, hemophilic arthropathy
Intramuscular hematomas
Gastrointestinal or genitourinary tract bleeding
532
Monorrhagia is common in which bleeding disorder?
Willebrand disease
533
Inheritance pattern of Hemophilia?
X-linked recessive
534
Hemophilia laboratory findings?
Prolonged aPPT, decreased or absent Factor VIII or IX activity
535
How long can it take a person with inadequate dietary intake, intestinal malabsorption, or hepatocellular disease to become vitamin K deficient?
7-10 days
536
What is the role of heptoglobin?
Binds free hemoglobin and promotes its excretion by the reticuloendothelial system
537
What is the first step in managing iron deficiency?
Determining the cause (Fecal occult blood)
538
What drug is used to treat hairy cell leukemia? Side effects?
Cladribine; neurological and kidney damage
539
Cytochemical features of hairy cell leukemia?
Tartrate-resistant acid phosphotase (TRAP)
540
Facial Rash and symmetric oligoarthritis are highly suggestive of?
Systemic Lupus Erythematosus
541
Multiple miscarraiges and DVTs with SLE?
Antiphospholipid syndrome
542
Brownish skin pigment? Disease?
Bronze diabetes, hereditary hemochromatosis
543
Heredity hemochromoctoma- risk factors?
Hepatocellular carcinoma
544
Elderly patient with severe lumphocytosis (\>40000) lymphadenopathy, and bicytopenia suggests?
Chronic lymphocytic leukemia
545
How to diagnose CLL?
Flow cytometry of peripheral blood
546
What vitamin deficiency is associated with pernicious anemia?
B12, megaloblastic anemia
547
Osteolytic lesions, fractures, hypercalcemia, anemia
Multiple myeloma
548
How does multiple myeloma cause infections? Most common types?
Impairs normal lymphocyte populations -\> ineffective antibody production and hypogammaglobulinemia
Respiratory (streptococcal pneumonia) and UTI
549
Isolated thrombocytopenia without anemia or leukopenia?
Idiopathic thrombocytopenia purpura
550
What should all patients diagnosed with ITP be tested for?
HIV
551
Bleeding episodes and severe isolated thrombocytopenia with normal hematocrit and leukocyte count with normal fibrinogen and PT?
Immune thrombocytopenia (idiopathic thrombocytopenic purpura
552
thrombocytopenia and microangiopathic hemolyutic anemia
Thrombotic microangiopathy
553
How to treat chemotherapy-induced nausea and vomiting?
Serotonin receptor antagonist (5HT)
554
Pain, itching, red streaks on an arm that presented in a different location preciously?
Next step?
Migratory superficial thrombophlebitis (Trousseau's syndrome)
CT of the abdomen due to association with pancreatic cancer
555
Blood transfusion reaction that occurs between 1 and 6 hours?
How to prevent?
Febrile non-hemolytic transfusion
Leukoreduction
556
Leukoreduction
reducing the number of transgused leukocytes through filtering or other methods (washing). Reduces changes of HLA allommunization and transmission of CMV
557
Side effect of phenytoin?
Treatment?
Mild megaloblastic anemia caused by reduction in folic acid levels
Tx- folic acid supplementation
558
Salvage therapy?
treatment for a disease when standard treatment fails
559
Neoadjuvant therapy?
Treatment given before the standard therapy
560
Bite cells with normal G6PD?
Glucose-6-phosphate dehydrogenase deficiency
561
G6PD deficiency laboratory signs?
Low hemoglobin, increased indirect hemoglobin, increased indirect bilirubin, increased lactate dehydrogenase, decreased haptoglobin
562
Ruby-colored papules on lips that blanch partially with pressure?
Arteriovenous shunting (Osler-Weber-Syndrome)
563
How to manage pain in terminal cancer patients?
1. Try non-narcotics first (short-acting morphine is first)
2. Do not be afraid to give narcotics
3. Prescribe adequate amounts of medication
564
First step in screening for thalassemia anemia?
Complete blood count
565
What anticoagulant can lead to low levels of Protein C and S?
Warfarin
566
How to manage HIT?
Stop heparin and start non-heparin anticoagulation (fondaparinux or argatroban)
567
Drop in platelets in 5-10 days puts a patient at risk for?
Arterial thrombosis
568
Thrombocytopenia with thrombus progression 3 days into heparin therapy?
Type 2 herarin-induced thrombocytopenia
569
MoA of HIT?
IgG autoantibody that coats the surface of platelets and forms complexes with platelet factor 4 (PF4)
570
Biological role of vitamin B12?
Formation of thmidylate and purine molecules for DNA
571
Expansile and eccentrically places lytic area in the epiphysis of the distal femur?
Giant cell tumor, "Soap bubble" appearance
572
Target for treatment o
573
What cancer has retinoic acid receptor present?
Acute promyelocytic leukemia, presents with pancytopenia
574
What factor contributes to Warfarin necrosis?
Protein C (primary) and S deficiency
575
Acute treatment for PE or DVT with subtheraputic INR on warfarin?
Rivaroxaban
576
Causes of macrocytic anemia?
Folate deficiency
B12 deficiency
Myelodysplastic syndrome
Acute myeloid leukemias
Drug induced (chemotherapy agents)
Liver Dx
Alcohol abuse
Hypothyroidism
577
Hard unilateral head and neck lymph nodes in an older patient with smoking history?
Squamous cell carcinoma
578
When is the best time to initiate evaluation of thrombophilia?
2-4 weeks following completion of wargarin therapy
Stops false positives and false negatives
579
How often should a PAP smear be done in a woman who had a hysterectomy for non-malignant reasons?
Discontinue pap smears
580
Waldenstrom macroglobulinemia
production of monoclonal IgM antibodies
hymphadenopathy and hepatosplenomegaly may be present
581
Monoclonal gammopathy of unknown significance
Presence of serum monoclonal protein of less than3g/L without evidence of anemia, kidney failure, bone disease, or other myeloma-related and end-organ damage
582
a-thalassemia trait characteristics
mild anemia, microcytosis, hypochromia, target cells, and normal hemoglobin electrophoresis in adults
583
When do sideroblasts form?
When iron is available, but is unable to be incorporated into hemoglobin
584
How do you treat single nodule colorectal mets?
Regional hepatectomy
585
How to treat a patient with stage III colon cancer s/p hemicolectomy?
Adhyvant chemotherapy
586
What is the most common complication of HIT?
Additional venous thrombosis
587
How to manage a patient with a PAP result of atypical squamous cells of undetermined significance?
Refer to colposcopy
588
Management of a patient with a new onset breast nodule that was negative on mammorgram?
Aspiration or Biospsy
589
How to you manage a patient who does not smoke ad had a small (less than 4mm) nodule on CT?
No follow-up imaging
590
How to you treat prostate cancer?
Androgen deprivation therapy
591
How to do treat BPH?
5-alpha reductase inhibitor
592
How do you treat polycythemia vera?
Aspirin and phlebotomy
593
Signs of polycythemia vera?
Increased hemoglobin, increase leukocytes, increased platelets
594
What cancer contains reed sternberg cells?
Hodgkin's lymphoma
595
How to manage a patient with a blood smear showing platelet clumping?
Repeat platelet count
596
Auer Rods Cancer?
Acute Myeloid Leukemia
597
Transfusion-related acute lung injury
Fever, dyspnea, diffuse pulmonary infiltrates and hypocia
598
How to manage blood products in a patient who has experiences prior anaphylatic reactions?
Wash samples
599
Acral lentiginous melanoma
Unevenly darkly pigmented patch mostly arises on the palmar, plantar, or subungual surfaces
600
How to treat diffuse large B-cell NHL?
Abbreviated course of chemotherapy followed by radiation
601
Signs of autoimmune hemolytic anemia?
Spherocytes and positive direct antiglobulin test
602
How do you treat antiphospholipid syndrome?
Indefinately continue warfarin
603
Lentigo Maligna?
Slow growing melanoma seen on the sun-exposed areas of the face
604
605
Foul-smelling diarrhea, weight loss, fatigue
Steatorrhea and malabsorption
606
Effect of malabsorption on calcium levels
Inhibits absorption of Vit. D -\> low calcium, low phosphate
607
First step in the evaluation of a thyroid nodule \> 1cm?
TSH levels and U/S
608
Effects of hypopituitarism?
glucocorticoid deficiency, hypogonadism, hypothyroidism
609
Features of glucogonoma?
Necrolytic migratory erythema- face, perineum, extremities
DM
GI- diarrhea, anorexia
Weight loss
610
Signs of glucogonoma?
Hyperflycemia with elevated glucagon \> 500pg/mL
611
Painless thyroiditis
acute thryotoxicosis with mild thyroid gland enlargement and suppressed TSH
612
What DM medications cause weight loos?
GLP-1 agonists (exenatide)
613
What DM medications are weight neutral?
DDP-4 inhibitors (sitagliptin)
614
Treatment for diabetic neuropathy in young patients?
Older?
Young- amitriptyline
Old: Pregabalin
615
Signs of thyroid storm?
Palpitations, weight loss, irregular menses, impaired glycemic control, confusion, agitation, n/v
616
After confirming a normal TSH, what is the next step in working up suspected Cushings?
24 hour free urine cortisol, salicary cortisol, or low-dose decamethasone suppression
2 must be abnormal
617
Carcinoid tumors put you at risk for deficiency of what?
Niacin (diarrhea, dermatitis, dementia)
618
Patient with malignant throid mass, elevated serum calcitonin, and family hx of thyroid malignancy likely has an inherited form of?
MEN2a or 2b
Ret mutation
619
Milk-alkali syndrome
Overconsumption of calcium and absorbable alkali -\> hypercalcemia -\> renal vasoconstriction and decreased GFR
620
Workup for hypocalcemia?
Recheck-\> drug-\> PTH-\> 25-hydrocy vitamin D levels
621
Signs of generalized resistance to thyroid hormones?
Normal TSH and high T3 and T4 with signs of hypothyroidism
622
Subclinical hypothyroidism
Mildly elevated serum TSH and normal T3 and T4
Do not have clinical signs
623
Signs of hypercortisolism?
Weight gain, psychiatric symptoms, HTN, hyperglycemia
624
oligomenorrhea, hirutism, elevated testosterone levels?
Tx?
Polycystic ovarian syndrome
Tx: Weight loss and oral estrogen/progestin contraceptives
625
Side-effect of radioiodine ablation?
Worsening of opthalmopahty
626
Role of large and small fibers in DM?
Large- numbness, proprioception, vibration
Smal- pain, paresthesias, allodynia
627
How does pregnancy affect thyroid levels?
Causes a 30% increase in the first trimester
628
How to you manage an adrenal incidentoma?
Overnight dexamethasone suppression test, 24-hour urine collection for metanephrines, measurement of plasma renin activity and serum aldosterone levels
629
Galactorrhea and signs of secondary amenorrhea, next step?
Obain prolactin levels
630
In a young patient with suspected DM, what should be the first step in management?
Check for pancreatic autoantibodies to rule in/out DM type 1
631
In a younger patient presenting with osteoporosis, what should be the first step in workup?
Find an underlying cause.
632
fatigue, weight gain, erectile dysfunction and hyponatremia suggest?
panhypopituitarism
633
How to treat pituitary apoplexy?
Neurosurgery consult and glucocorticosteroids
634
hypernatremia with hypokalemia with htn? Diagnostic test?
Hyperaldosteronism, aldosterone to plasma renin
635
How to diagnose cushing's disease?
24-hour urine cortisol measurments
636
If a patient is taking steroids and gets sick, what should happen?
Increase dose of hydrocortisone during the intercurrent illnesses to avoid adrenal crisis
637
Calcium pyrophosphate dihydrate disease?
Presents like OA, but with atypical joints (hands)
638
Treatment for fibromyalgia with or without depression?
Serotonin-norepinephrine reuptake inhibtors (duloxetine, milnacipran
639
Presentation of OA of the hand?
Squaring of the first carpometacarpal joint (base of thumb) and DIP and PIP
640
How to treat a patient with SLE and suspected lupus nephritis?
High-dose steroids
641
Back pain in an individual with Chron's disease?
Enteropathic arthritis
642
Henoch-schonlein purpura
purpuric rash predominately affecting distal lower extremities, artritis, abdominal pain, hematuria
skin biopsies reveal leukocytoclastic vasculitis
643
pain along the anteromedial proximal tibia distal to the joint like that worsens walking up stairs and at night
Pes anserine bursitis
644
Still disease
daily (quotidian fever) evanescent salmon-colored rash, arthritis, multisystem involvement, markedly elevated ferritin
645
Treatment for RA?
Methotrexate
646
In RA refractory to Methotrexate, what is next?
Add monoclonal antibody, etanercept
647
Inelastic pericardium - AKA? Signs? Risk?
AKA- restrictive pericarditis
Signs-increased JVP, peripheral edema, ascites, hepatic congestion with hepatomegaly
Risk- late complication of radiation therapy
648
dyspnea, third heart sound, bibasilar crackles, low ejection fraction?
decompensated congestive heart failure due to LV systolic dysfunction
649
Alcoholic cardiomyopathy
Dilated cardiomyopathy in an alcoholic, when everything else has been rules out
650
Reversible risk factors for premature atrial contracitons?
Alcohol and tobacco, caffeine, stress
651
Premature atrial contractions-treatment?
Cessation of alcohol, tobacco, caffeine, stress, initiation of beta-blockers (if symptomatic)
652
Ludwig angina
Rapidly progresive cellulitis of the submandibular and sublingual spaces
653
Ceftriaxome with azithromycin- treatment?
Community acquired pneumonia
654
vanomycin with piperacillin-tazobactam-treatment?
Hospital-acquired pneumonia
655
Low-pitched, early diastolic heart sound, think?
Heart failure (third heart sound)
656
dypnea, hypoxemia, diffuse pulmonary crackles with third heart sound?
decompensated heart failure
657
Treatment for severe heart failure associated with severe left ventricular systolic dysfunction and cardiogenic shock? MoA?
Dobutamine, beta-1 receptor
MoA- increased myocardial contractilit -\> greater colume of forward blood efection -\> decreased left ventricular end-systolic volume
658
holosystolic murmur that increases with inspiration?
Tricuspid involvement
659
Systemic murmur that increases when the patient stands up?
hypertrophic cardiomyopathy
660
Mechanical complications post MI?
RC failure- acute
Papillary muscle rupture- Acute, 3-5 days
Interventricular septum rupture/defect- Acute, 3-5 days
Free wall rupture- 5 days to 2 weeks
661
How to calculate attributed risk percent?
ARP= (RR-1)/RR
662
Signs of cardiogenic shock?
Hypotension, reduced urine outpout, cool extremities
Classic finding: Beck triad-hypotension, elevated jugular venous pressure, distant heart sounds
663
hypoxia vasoconstriction in the lung
vessels shrink and divert blood to maintain V and Q matching
664
Intrapulmonary shunting
shunting of blood away from blocked alveolar consolidation and shunts it to other areas -\> can cause V and Q mismatch
665
Continuous murmur throughout thorax with high blood pressure and headaches? Imaging?
Coarctation of the aorta
X-ray findings- inferior notching of the third to eighth rib, "3" sign due to aortic indentation
ECG: Left ventricular hypertrophy
Echo: diagnostic confirmation
666
Upturning of the cardiac apex- AKA, cause?
boot-shaped heart, caused by Tetralogy of Fallot, d/t pulmonic stenosis
667
Commonly associated SLE rashes
Malar rash, discoid plaques, ulcers
668
What causes drug induced acne? What do they look like? Management?
Glucocorticoids, androgens, azathioprine, EGFR inhibitors, anticonvulsants, antituberculosis
Description, monomorphic papules or pustules, no comedones, cysts, nodules
Management: D/C offending medication, standard acne therapy unlikely to be effective
669
What populations have a 5mm PPD/TST induration limit?
HIV-positive, recent contacts of known TB, nodular fibrotic changes of CXR consistent with previously healed tb, organ transplant recipients, and other immunosuppressed patients
670
Treatment for latent tb?
Isoniaxid and pyriodoxine
671
Drug-resistent HTN, and a midabdominal bruit?
Rebal artery stenosis
672
Highly specific finding in renal artery stenosis?
syustolic-diastolic abdominal bruit
673
What drugs can lithium interact with to cause toxicity?
ibuprofen, NSAIDS, thiazide diuretics, ACE-I, tetracyclines, metronidazole -\> decrease renal clearance of lithium
674
Back pain with increased ESR/CRP, but normal X-rays, next step?
MRI, bone scanning using gallium (if MRI contraindicated)
675
MoA of beta blockers?
reducing cardiac oxygen deman through a decrease in heart rate and myocardial contractility
676
Treatment regimine for stable angina?
Beta blockers, aspirin, sublingual nitroglycerine
677
Signs of Alcoholic cerebellar degeneration?
Trucal coordination impairment (tandem gait), wide-based gait, postural instability, with intact limb coordination (finger-nose test)
678
Signs of hypokalemia?
Muscle weakness, arrhythmias, EKG changes
679
Chikungunya fever? Vector?
High fevers, polyarthralgias, maculopapular rash, lymphop[enia, thrombocytopenia
Vector: Ades mosquito
680
Cyclosporine side effects:
Nephrotoxicity- hyperkalemia, hypophosphatemia, hypomagnesemia
HTN: renal vasoconstriction and sodium retension
Neurotoxicity: headache, visual disturbances, seizures
Glucose intolerace
681
Dermatofibroma
benign fibroblast proliferation
firm, hyperpgmented nodule, most often on lower extremties
682
epidermal inclusion cyst? Diagnosis?
Discrete benign nodule lined with dquamous epithelium, that containes semisolid core of keratin and lipid.
Diagnosis: clinical with a firm, freely movable, dome-shaped cyst iwth central punctum
683
Cor pulmonale? X-ray findings? Diagnosis?
exertion symptoms over time, loud P2, tricuspid regurgitation, elevated JVP, hepatomegaly
X-Ray- enlarged central pulmonary arteries, right ventricular hypertrophy, right atrial enlargement
Diagnosis- fold standard is right heart catheterization
684
Priapism
persistent, painful ereation that develops without sexual stimulation and has a long duration
685
Post-void residual volume in UTI?
Low, due to frequent urination
686
b-HCG and AFP producing tumors in young males?
Nonseminomatous germ cell tumors
687
Seminoma vs nonseminomatous germ cell tumors
Nonseminomatous germ cell tumors - product AFP and b-HCG
Seminoma produce b-HCG
688
Site of nonseminomatous germ cell tumors in young males
mediastinal mass, testicular
689
pityriasis rosea?
numerous oval, scaly plaques that follow the cleavage lines fo the trunk, often presents with an inital, larger lesion, a herald patch
690
TInea corporis
pruritic rahs with scaly, erythematous border and central clearing
691
Ichthyosis vularis? Treatment
Chronic inherited skin disorder with diffuse dermal scaling, caused by mutation in filaggrin gene
Treatment -emollients, severe cases male require keratolytics (coal tar, salicylic acid, and topical retinoids
692
How to calculate sensitivity? Specificity?
Sensitivity- TP/(TP+FN)
Specificity = TN/(TN+TP)
693
Untreated AIDS, progressive neurological symptoms, nonenhancing white matter lesions suggest? Diagnosis?
Progressive multifocal leukoencephalopathy, caused by JC virus
Diagnosis: LP with PCR for JC
694
HIV-associated dementia?
deep gray matter structures affected, causing subacute connitive, behavioral, and motor deficits
695
Subacute sclerosing panencephalitis
progressive, fetal disease caused years after measles infections
696
Signs of peripheral nerve compression
Transient, unilateral foot drop, impaired anbkle dorsiflecion, preseved plantar flexion
697
How to rule out primary psychiatric disorders in physical manifestations?
Symptoms are explained by distribution along a single nerve
698
Arteriovenous fistula signs?
widenedd pulse presure, brish carotid upstroke, systolic flow murmur, tachycardia, flushed extremities, left ventricular hypertrophy
699
Hypertrophic cardiomyopathy vs AVF murmur
HCM- crescendo-decrescendo, increasing with valsava
AVF- systolic murmur, no increase with valsava
700
Treatment for torsades de pointes?
IV magnesium sulfate
701
What drugs should be withheld 48 hours prior to cardiac stress tests?
Beta-blockers, calcium channel blockers, nitrates
702
Signs of secondary syphillis?
Diffuse rash (begins on the trunk, extends to the extremities, involsing palms and soles), widespread lymphadenopathy, grey mucosal patches, raised grey genital lesions (condylomata lata), epitrochlear lymphadenopathy (pathognomonic)
703
Disseminated gonococcus signs
tenosynovitis, polyarthralgia, skin rash consting of a few pustules
704
What causes cardiac tamponade?
Decreased left ventricular preload
705
Signs of restrictive pericarditis?
Progressive peripheral edema, ascities, elevated JVP, pericaridal knowck, pericardial calcifications
706
How often are mammograms performed?
Every 2 years.
707
Disseminated mycobacterium avium complex infection signs?
fever, cough, diarrhea, splenomegaly, elevated alkaline phosphatase
708
Most common cause of community acquired vacterial meningitis?
Strep pneumoniae
709
Drugs that can cause angioedema?
Ace inhibitors -\> increased bradykinin
710
Organs affected in Goodpasteur's syndrome?
Renal and pulmonary
711
How to improve quality of care when transitioning between facilities?
Pharmacist-directed interventions
712
Drugs with photosensitivity reactions
Tetracyclines, chlorpromazine, prochlorperazine, hurosemide, hydrochlorothiazide, amiodarone, promethazine, piroxicam
713
Side effects of Erythromycin?
GI upset, cholestatic jaundice (estolate base)
714
Cause of ARDS in pancreatitis?
Phosphilipase A2 crosses pulmonary capillaries and increases inflammatory response
715
What is the negative predictive value?
Probability of being free of disease, if the test is negative
716
Positive predictive value, meaning?
Likelihood that a positive test means you have the disease.
717
Tinea versicolor causal organism? Trreatment?
Malassezia species
Tx: selenium sulfide, ketoconazole
718
Signs of atrial fibrillation?
palpitations, weakness, dizziness, presyncope, dyspnea, and/or chest pain
719
Conditions associated with atrial fibrillation?
CHF, Hypertrophic cardiomyothy, hypertensive heart disease (most common), obstructive sleep apnea, obesity, endocrine
720
Valvular involvement in infective endocarditis?
Mitral-damaged heart valces
Tricuspid- intravenous drug abuse
721
Signs of CMV in an AIDS patient? CD4+ count? Diagnostic test? Treatment?
Frequent, small volume diarrhea; hematochezia' abdominal pain
CD4+ \< 50
Diagnostic test: colonoscopy with biopsy (eosinophilic intranuclear and basophilic intracytoplasmic inclusion
Treatment: ganciclovir
722
Epinephrine vs antihistamines
Antihistamines treat uticaria, pruritus in anaphalaxis, however, they do not relieve upper airway edema or hypotension
723
Streptococcus gallolyticus
Streptococcus bovis (biotype 1) highest risk of colon cancer
724
Vibrio vulnificus? Treatment? Manifestations?
Gram-negative, free-living in marine environments
Increased risk in those with liver disease
Manifestations: rapidly progressive, septicemia, cellulitis (hemorrhagic bullae, necrotizing fascitis)
Treatment: IV ceftriaxone, doxycycline
725
What does A sengstaken-Blakemore tube do?
Balloon tamponade of variceal bleeding if endoscopy is unavailable
726
In patients with variceal bleeding, what should be the main goal?
Fluid resuscitation
727
In a patient with weakness and decreased pain in both legs, what type of injury is suspected? Action?
Lower spinal cord injury, insert urinary catheter to assess for urinary retention and prevent bladder injury
728
Signs of cardiac temponade?
hypotension (unresponsive to IV fluids), tachycardia, and elevated jugular venous pressure after blunt thoracic trauma
729
How is duodenal hematoma treated?
NG suction and parenteral nutrition
730
What is the first step in management of damage to the urethral meatus?
retrograde urethrogram
731
Use of NSAIDS with episodic postprandial epigastric pain?
Perforated peptic ulcer
732
How to treat perforated peptic ulcers?
NG suction, bowel rest, intravenous fluids, broad-spectrum antibiotics, IV PPI
733
Signs of acute adrenal insufficiency?
Severe and often refractory hypotension, vomiting, abdominal pain and fever
734
Signs of primary adrenal insufficiency?
hyponatremia and hyperkalemia
735
Best management of acute appendicitis?
Laparoscopic appendectomy
736
Epigastric pain/tenderness, weight loss in the setting of nonspecific systemic symptoms and significant smoking history?
Cancer of the upper GI or associated organs...think gallbladder, liver, pancreas
737
Classic description of pain in pancreatic cancer?
Abdominal pain that is insidious, gnawing, and worse at night
738
Varicocele-signs? Diagnostic method?
soft mass that worsens with standing and Valsalva maneuvers, but decreases when supine, does not transilluminated Diagnostic- US
739
Varicocele treatment?
NSAIDS or surgical correction
740
How do you manage small pneumothorax? Large?
Small- supplemental O2 Large- Needle thoracostomy/chest tube
741
Young male (20s) without trauma has pneumothorax?
Primary spontaneous pneumothorax
742
Differential for anterior mediastinal mass?
1. Thymoma 2. teratoma 3. thyroid neoplasm 4. Lymphoma
743
Mediastinal mass with elevated AFP and b-HCG?
mixed cell germ tumor
744
Elevated serum b-HCG with normal AFP?
seminoma
745
Mediastinal mass with nomral b-HCG and AFP?
Thymomas
746
Initial management of non-displaced scaphoid bone fracture?
Wrist immobilization for 6-10weeks, with x-rays in7-10 days
747
Signs of elevated intracranial pressure?
HTN, bradycardia, respiratory depression (Cushing's reflex)
748
Effects of uncal herniation?
1. Ipsilateral hemiparesis 2. parasympathetic loss (mydriasis (early) ptosis, 3. Contralateral homonymous hemianopdia 4. altered level of consciousness
749
Patient response to atelectasis?
Hyperventilation -\> respo. alkalosis, decreased pCO2
750
Leriche syndrome
bilateral hip, thigh, buttock claudication impotence symmetric atrophy of the bilateral extremities due to ischemia
751
Syndrome associated with arterial occlusion at the bifurcation of the aorta?
Leriche Syndrome
752
How do you counteract a decrease in blood pressure after administration of propofol?
Administer dopamine
753
How does pneumonia that is developing into septic shock present? Treatment?
acidosis, low urine output, hypotension, tachypnea, fever Tx- IV normal saline
754
Tetanus prophylaxis in a clean or minor wound?
Tetanus toxoid-containing vaccine only if
755
Tetanus prophylaxis in a dirty or severe wound?
Tetanus toxoid-containing vaccine only if booster \> 5 years ago If unsure, tetanus toxoid-containing vaccine plus tetanus immune globulin
756
When do you give tetanus immune globulin?
severe or dirty wound with unsure vaccination history
757
How does venous insufficiency present?
worsens throughout the day and resolves overnight when the patient is recumbent
758
What are the signs of arterial occlusion?
Pain, pallor, paresthesias, pulselessness, and coolness to the touch
759
How do you store an amputated limb?
Place in saline moistened gauze and then in a plastic bag on ice...bring it wherever the patient goes.
760
Signs of retroperitoneal abscesses?
fever, child, and deep abdominal pain may initially be missed by a CT scan
761
How to treat a pancreatic abscess
Immediate placement of a percutaneous drainage catheter, culture of the drained fluid and surgical debridement
762
Hemoptysis with upper lung lobe involvment? Initial step?
TB, Isolation
763
Initial management of coughing with large amounts of blood (\>600mL or 100mL/hour)?
Secure airway
764
When should you suspect diaphragmatic rupture?
History of blunt trauma/MVA, abnormal CXR, left lower lung opacity, elevated hemidiaphragm, and mediastinal deviation
765
How do patients with duodenal hematomas present? Etiology?
epigastric pain and vomiting d/t blood collection between the submucosal and muscular layers of the duodenum
766
Signs of urethral injury?
blood at the urethral meatus, inability to void, high-riding prostate on DRE
767
How to diagnose bladder trauam?
Retrograde cystogram with post-void films
768
NSAID use with several-day history of epigastric pain followed by acute-onset sevfere constant pain?
perforated peptic ulcer
769
Initial management for perforated peptic ulcer
NG suction, bowel rest, intravenous fluids, broad spectrum Abx ad intravenous PPI
770
periumbilical pain out of proportion to examination and hematochezia?
acute mesenteric ischemia Gold standard diagnosis is mesenteric angiography
771
Signs of adrenal insufficiency?
hypoension/shock weakness nausea, vomiting, abdominal pain, fever
772
Etiology of adrenal insufficiency?
adrenal hemorrhage/infarction acute illness/injury/surgery in patient with chronic adrenal insufficiency or long-term glucocorticoid use
773
migratory RLQ pain, nausea, vomiting, fever, leukocytosis
acute appendicitis
774
When are US and CT used in acute appendicitis?
when classic presentation/signs are not present
775
epigastroc pain/tenderness and weight loss with nonspecific systemic symptoms with significant smoking history
pancreatic adenocarcinoma
776
type of pain experiences with pancreatic cancer?
epigastric abdominal pain that is insidious. gnawing, and worse at night
777
Classic association with pancreatic cancer? Name?
migratory thrombophlebitis Trousseau sign
778
soft mass that worsens with standing and Valsalva maneuvers, but decreases when supine; does not transilluminate
varicocele
779
cardiac catheterization, anticoagulation, sudden hypotension, tachycardia, flat neck veins, back pain
retroperitoneal hematoma
780
Complications from cardiac catheterization
pseudoaneurysm, arteriovenous fistular formation, arterial dissection, acute thrombosis
781
pneumomediastinum and pleural effusions-cause?
esophageal rupture
782
pneumothorax despite chest tube, pneumomediastinum subcutaneous emphysema
tracheobronchial perforation (right bronchus is most common
783
Gallbladder distension and wall thickening, presence of pericholecystic fluid, without gallstones
acalculous cholecystitis
784
How to treat acalculous cholecystitis acutely? Definitively?
Acutely- percutaneous cholecystostomy and antibiotics Definitively- cholecystectomy with drainage of associated abscessess
785
How does mesenteric ischemia present?
sudden periumbilical abdominal pain out of proportion to examination findings
786
Signs of compartment syndrome?
1. Pain out of proportion to injury 2. Pain increasing on passive stretch 3. rapidly increasing & tense swelling 4. paresthesia (early)
787
Signs of deep vein thrombosis?
alf tenderness with pain worsened by passive stretching of the calf.
788
Postoperative cholestasis-signs?
hypotension, blood loss into tissues, massive blood load (transfusion), decrease liver functionalty, decreased renal bilirubin excretion with normal ALT/AST
789
Preferred anticoagulant in end-stage renal failure patients?
Warfarin
790
What is required when starting Warfarin?
Heparin bridge- warfarin activates proteins C and S causing a transient prothrombotic state
791
When do patients show signs of pulmonary contusions?
Approx. 4 hours post-injury when hypoxia, respiratory distress, pulmonary edema set in
792
Physical signs of pulmonary contusions?
tachycardia, hypoxia, tachypenea
793
Pulmonary contusion-CXR results
patchy irregular alveolar infiltrate
794
Physical signs of a meniscal tear?
joint line tenderness, pain or catching in the provocative tests (Thessaly, McMurray
795
how to diagnose meniscal tears?
MRI
796
When should conservative management be used for menscal tear? Examples?
Short-term pain, elderly Example: rest, NSAIDs
797
Hoe do you treat anal fissures?
topical anesthetics, vasodilators (nifedipine) Sitz baths stool softeners high-fiber diet & adequate fluid intake
798
When should you considerd surgical interventions for anal fissures?
When medical management has failed
799
acute abdominal pain followed by lower GI bleeding after an episode of hypotension?
Ischemic colitis
800
Sites for ischemic colitis? Imaging signs? How to confirm?
Splenic flexure, rectosigmoid junction CT scan may show thickened bowel wall Confirm with colonoscopy
801
What is the postoperative cause of fever 0-2 hours after surgery?
Prior trauma/infection, blood products, malignant hyperthermia
802
What is the postoperative cause of fever 1-7 days after surgery?
Nosocomial infections, Group A streptcoccus, or C. perfringens
803
What is the postoperative cause of fever 1-4 weeks post surgery?
Other organisms (nor GAS, C. perfringens), C difficile, drug fever, PE/DVT
804
What is the cause of postoperative fever more than 1 months post-surgery
Viral infections, indolent organisms
805
Signs of fat embolism?
severe respiratory distress, petechial rash, subconjuctival hemorrhage, tachycardia, tachypnea, and fever
806
Organism most likely responsible for infection from intravascular devices?
Coagulase negative s. epi
807
How does an anterior should dislocation occur?
forceful abduction and external rotation a the glenohumeral joint; risks damage to the axillary nerve
808
Torus palatinus? Tx?
benign, bony growth located on the mid-line suture of the hard palate No treatment necessary unless systemic effects develop or it interferes with speech
809
Signs of rotator cuff impingement
pain with abduction, external rotation subacromial tenderness normal range of motion with positive impingement tests (Neer, Hawkins)
810
How does cervical impingement present?
pain and paresthesias of the neck and arm along with upper extremity weakness
811
Clinical signs of acute mesenteric ischemia?
Rapid onset of periumbilical pain Pain out of proportion to examination findings hematochezia
812
Risk factors for acute mesenteric ischemia?
Atherosclerosis Embolic source hypercoagulable disorders
813
What is the drop arm test?
Detects a tear in the supraspinatus; arm is abducted passively above head and they are instructed to lower it slowly
814
Signs of abdominal aortic aneurysm rupture?
severe back pain, syncope, profound hypotension
815
Signs of SBO strangulation?
peritoneal signs (rigidity, rebound) signs of shock (fever, tachycardia, leukocytosis)
816
Trochanteric bursitis- definition? Signs?
definition- inglammation of the curse surrounding the insertion of the gluteus medius onto the femur's trochanter signs- hip pain when pressure is applied and with external or resisted abduction
817
Femoral nerve innervation
hip joint and skin of the anterior and medial thigh and leg
818
Complications associated with supracondylar fracture of the humerus
Brachial artery injury Median nerve injury Cubitus varus deformity Compartment syndrome/Volkman ischemic contracture
819
Signs of sepsis
worsening hyperglycemia, leukocytosis, thrombocytopenia, milk hypothermia, tachypnea, tachycardia
820
Signs of gallstone ileus
stuttering episodes of nausea and vomiting, pneumobilia, hyperactive bowel sounds, dilated loops of bowels
821
Important steps in the preoperative management of a patient taking Warfarin?
Check INR, reverse with fresh, frozen plasma
822
blunt abdominal trauma, hypotension, right chest/abdominal wall injury, and free intraperitoneal fluid
Hepatic laceration
823
Signs of meniscal tears?
pain, clicking, or catching
824
post-operative thoracic surgery, fever, tachycardia, chest pain, leukocytosis, and sternal wound drainage or purulent discharge?
Acute mediastinitis, TX- surgical debridement and antibiotic therapy
825
Signs of septal perforation?
whistling noise during respiration, caused by post-operative septal hematoma
826
blunt thoracic trauma, respiratory distress despite bilateral chest tubes
Flail chest, demonstrate tachypnea, shallow breaths
827
Symptoms in arterial embolism?
sudden and severe, with diminished pulses in the affected limb, but normal in the unaffected
828
Signs of arterial thrombosis
Slow, progressive narrowing of the vascular lumen Pulses are diminished bilaterally (normally)
829
Signs of pyloric strictures
postprandial pain, vomiting with early satiety, succussion splash on the epigastrium
830
Signs of esophageal stricture?
Dysphagia, no abdominal succussion splash
831
Signs of diaphragmatic hernia?
blunt abdominal trauma with mild respiratory distress and abnormal xray \*\*smaller hernias present with nausea/vomiting and are delayed
832
Cause of infertility from varicocele?
Increased scrotal temperature
833
Cause of pretibial edema?I
Increased pulmonary vascular resistance
834
Holosystolic murmur heart of the left sternal border?
Pulmonary regurgitation
835
5 days after pancreatoduodenectomy , what type of feeding should be used?
Enteral tube feedings
836
What is erythema nodosum?
Acute, nodular, erythematous eruption on the extensor aspects of the lower legs. Associated with hypersensitivity reactions
837
What someone falls from a height, what X-rays should be ordered?
C-spine
838
What should be the first step in the treatment of a woman with breast cancer?
Resect the mass, then treat with chemo/rad
839
How can heart failure develop from an aneurysm?
Lead to the development of a fistula
840
What can cause narrowing of the biliary ducts?
cancer (specifically pancreatic), strictures (trauma)
841
Most common organism causing lymphangitis?
Strep pyo (group A)
842
How can you minimize the risk of infection from a PICC?
Remove it as soon as treatment/use is complete
843
Osgood-Schkatter disease
Painful lump below the kneecap in children during puberty, can cause a limp
844
Legg-Calve-Perthes disease
Blood flow is interrupted to the femoral head in children, can cause necrosis
845
How do you manage sigmoid volvulus?
Sigmoidoscopy-guided placement of a rectal tube
846
What should be the first step in management of an unknown mass on an HIV patient?
Biopsy
847
What is a pneumatocele?
cavity in the lung parenchyma filled with air that may result from pulmonary trauma during mechanical ventilation
848
Written description of C- Diff infection?
Patchy, white mucosa on colonoscopy
849
Diffusely enlarged thyroid gland with neck swelling and no symptoms of decreased thyroid?
Chronic lymphocytic thyroiditis (Hashimoto disease)
850
Long-term growth (\> 6 months) on glans penis with negative VDRL test?
Penis cancer
851
How do you counteract the effects of propofol?
Dopamine
852
borborygmi
a rumbling or gurgling noise made by the movement of fluid and gas in the intestines
853
What is a major complication risk from AAA repair?
MI
854
diaphoretic
Sweating heavily
855
C8 radiculopathy
causes pain from the neck to the hand. Patients may experience weakness in hand grip, and pain and numbness can radiate along the inner side of the arm, ring, and little fingers.
856
C7 radiculopathy
(the most common) causes pain and/or weakness from the neck to the hand and can include the triceps (the muscles on the back of the upper arms) and the middle finge
857
C6 radiculopathy
(one of the most common), causes pain and/or weakness along the length of the arm, including the biceps (the muscles in front of the upper arms), wrists, and the thumb and index finger.
858
C5 radiculopathy
can cause pain and/or weakness in the shoulders and upper arms. Especially may cause discomfort around the shoulder blades. It rarely causes numbness or tingling.
859
Child with current-jelly stools?
Intussusception
860
How to treat intussusception?
Control enema
861
Cause of subcutaneous emphysema?
Tension pneumothorax
862
When giving large amounts of packed RBC's, what must be added?
Platelets
863
Should volume support or patient transport during traumas come first?
Urban areas with close trauma center - transport All other areas- resuscitate
864
How to treat rib fractures in the elderly?
Local nerve block and epidural catheter
865
What should be done with all gunshot wounds to the abdomen?
Exploratory Laparotomy
866
What treatments should be provided for a through-and-through extremity gunshot wound?
Tetanus prophylaxis
867
When can early excision and grafting be used?
Small (
868
What degree of angulation is unacceptable in children (compared to adults)
Larger amounts
869
How are intertrochaneric fractures treated?
ORIF with anticoagulation
870
"tip of the finger remains flexed when the rest of the fingers are extended
Malley
871
Common cause of coma in a cirrhotic patient with bleeding varices?
Ammonium toxicities
872
Liters of drainage from an upper GI wound?
fluid replacement, nutritional support, protection of the abdominal wall
873
Old man with blood on the outside of his stool?
Hemorrhoids
874
Sources of inflammation in the left lower quadrant of women?
Diverticulitis, tube, ovary Diagnose with CT
875
Acute edematous pancreatitis
Alcoholics of gallstones Pain after large meal or EtOH \_\> constant, radiates to back-\> nausea, vomiting, retching
876
Vascular rings
stridor, "crowing", baby assumes hyperextended neck Bronchoscopy shows segmental compression of the trachea Tx- surgical division
877
What type of catheter is used for embolectomy of an atrial clot from a. fib?
Fogarty
878
Small, raised, waxy lesion
Basal cell carcinoma
879
non-healing ulcer?
Basal cell carcinoma
880
Where are squamous cell carcinoma found?
Lower lip and below on face
881
Where do you biopsy a basal cell carcinoma?
Edge of the lesion
882
Amblyopia
vision impairment resulting from interference with the processing of images by the brain during the firs t6-7 years of life
883
How to treat trigeminal neuralgia?
Anti-convulsants (carbamazapine)
884
Sudden testicular pain, pyuria, fever
acute epididymitis
885
acute epididymitis- treatment
Abx and sonogram to rule out torsion
886
Uropelvic junction obstruction signs
Intense pain when large diuresis occurs (beer drinking)
887
How do you treat testicular cancer?
platinum-based therapies
888
Treatment for impotence-first line?
Sildenafil, tadalafil, vardenafil
889
What is mandatory for all abdominal bullet wounds?
Ex Lap
890
Abdominal mass that moves up and down in a baby
Malignant tumor of the liver ie-hepatoblastoma or hepatocellular carcinoma
891
Child class factors to deny surgery
albumin below 2, INR 2 x normal, ascites
892
bilateral pulmonary infiltrates with low PO2
ARDS, PEEP
893
How do you obtain samples from a breast?
US guided imaging
894
Back pain in woman who recently has breast cancer?
Metastatic spread, diagnose with MRI
895
Signs of Zollinger-Ellison disease
Refractory to other treatments, multiple ulcers
896
Double bubble with normal gas
Malrotation
897
Square root sign
Chronic constrictive pericarditis
898
Workup for squamous cell carcinoma of the mucosa?
Panendoscopy
899
1 week post- otitis media infection: projectile vomiting, seizures, blurred vision, severe headache
Brain abscess
900
Why a newborn does not urinate during the first day after birth?
posterior urethral valves
901
Intervention for UPJ stones larger than 7mm
extraperitoneal shock-wave lithotripsy
902
Standard bolus for burns
1000mL/hr 30-120mL/hr
903
How do you test an animal for rabies?
Kill the animal and scan its brain
904
Chubby 13 year old boy limping, complaining of knee pain, sole of affected foot points towards the other one
slipped capital femoral epiphysis
905
arm held close to the body
Posterior shoulder dislocation, axillary/scapula xrays needed for diagnosis
906
In an ejection, what should always be imaged?
C-spine (CT scan)
907
How to treat lumbar disk herniation?
MRI of L4-S1, pain control with nerve blocks
908
Morton neuroma
inflammation of the common digital nerve in the third space
909
Signs of PE?
pleuritic (sudden onset), sob, diaphoretic, tachycardic, distended veins in neck and face
910
Cause of blood in rectum from child?
Merkel's diverticulum, workup with technetium scan
911
First step in the workup for pancreatic cancer?
CT of the abdomen
912
First step in workup for a palpable breast mass?
US guided core biopsy
913
What are burns near the eyes covered with?
Triple abx ointment
914
Trashing around with sudden pain?
Stone stuck in ureter
915
If a patient is stable, which test is most sensitive for blood?
CT
916
How to treat acute rejection?
Tacrolimus or Mycophenolate mofetil with/without steroids
917
Patient passing stone suddenly spikes a fever
ER immediately, nephrostomy tube placement
918
How to workup claudication?
Doppler studies
919
Knee to chest position in children?
Ependymoma
920
Stumbling around and truncal ataxia in children?
Medulloblastoma
921
Contraindication to organ donation?
Positive HIV status
922
What does A sengstaken-Blakemore tube do?
Balloon tamponade of variceal bleeding if endoscopy is unavailable
923
In patients with variceal bleeding, what should be the main goal?
Fluid resuscitation
924
What does A sengstaken-Blakemore tube do?
Balloon tamponade of variceal bleeding if endoscopy is unavailable
925
In patients with variceal bleeding, what should be the main goal?
Fluid resuscitation
926
In a patient with weakness and decreased pain in both legs, what type of injury is suspected? Action?
Lower spinal cord injury, insert urinary catheter to assess for urinary retention and prevent bladder injury
927
Signs of cardiac temponade?
hypotension (unresponsive to IV fluids), tachycardia, and elevated jugular venous pressure after blunt thoracic trauma
928
How is duodenal hematoma treated?
NG suction and parenteral nutrition
929
What is the first step in management of damage to the urethral meatus?
retrograde urethrogram
930
Use of NSAIDS with episodic postprandial epigastric pain?
Perforated peptic ulcer
931
How to treat perforated peptic ulcers?
NG suction, bowel rest, intravenous fluids, broad-spectrum antibiotics, IV PPI
932
Signs of acute adrenal insufficiency?
Severe and often refractory hypotension, vomiting, abdominal pain and fever
933
Signs of primary adrenal insufficiency?
hyponatremia and hyperkalemia
934
Best management of acute appendicitis?
Laparoscopic appendectomy
935
Epigastric pain/tenderness, weight loss in the setting of nonspecific systemic symptoms and significant smoking history?
Cancer of the upper GI or associated organs...think gallbladder, liver, pancreas
936
Classic description of pain in pancreatic cancer?
Abdominal pain that is insidious, gnawing, and worse at night
937
Varicocele-signs? Diagnostic method?
soft mass that worsens with standing and Valsalva maneuvers, but decreases when supine, does not transilluminated Diagnostic- US
938
Varicocele treatment?
NSAIDS or surgical correction
939
How do you manage small pneumothorax? Large?
Small- supplemental O2 Large- Needle thoracostomy/chest tube
940
Young male (20s) without trauma has pneumothorax?
Primary spontaneous pneumothorax
941
Differential for anterior mediastinal mass?
1. Thymoma 2. teratoma 3. thyroid neoplasm 4. Lymphoma
942
Mediastinal mass with elevated AFP and b-HCG?
mixed cell germ tumor
943
Elevated serum b-HCG with normal AFP?
seminoma
944
Mediastinal mass with nomral b-HCG and AFP?
Thymomas
945
Initial management of non-displaced scaphoid bone fracture?
Wrist immobilization for 6-10weeks, with x-rays in7-10 days
946
Signs of elevated intracranial pressure?
HTN, bradycardia, respiratory depression (Cushing's reflex)
947
Effects of uncal herniation?
1. Ipsilateral hemiparesis 2. parasympathetic loss (mydriasis (early) ptosis, 3. Contralateral homonymous hemianopdia 4. altered level of consciousness
948
Patient response to atelectasis?
Hyperventilation -\> respo. alkalosis, decreased pCO2
949
Leriche syndrome
bilateral hip, thigh, buttock claudication impotence symmetric atrophy of the bilateral extremities due to ischemia
950
Syndrome associated with arterial occlusion at the bifurcation of the aorta?
Leriche Syndrome
951
How do you counteract a decrease in blood pressure after administration of propofol?
Administer dopamine
952
How does pneumonia that is developing into septic shock present? Treatment?
acidosis, low urine output, hypotension, tachypnea, fever Tx- IV normal saline
953
Tetanus prophylaxis in a clean or minor wound?
Tetanus toxoid-containing vaccine only if
954
Tetanus prophylaxis in a dirty or severe wound?
Tetanus toxoid-containing vaccine only if booster \> 5 years ago If unsure, tetanus toxoid-containing vaccine plus tetanus immune globulin
955
When do you give tetanus immune globulin?
severe or dirty wound with unsure vaccination history
956
How does venous insufficiency present?
worsens throughout the day and resolves overnight when the patient is recumbent
957
What are the signs of arterial occlusion?
Pain, pallor, paresthesias, pulselessness, and coolness to the touch
958
How do you store an amputated limb?
Place in saline moistened gauze and then in a plastic bag on ice...bring it wherever the patient goes.
959
Signs of retroperitoneal abscesses?
fever, child, and deep abdominal pain may initially be missed by a CT scan
960
How to treat a pancreatic abscess
Immediate placement of a percutaneous drainage catheter, culture of the drained fluid and surgical debridement
961
Hemoptysis with upper lung lobe involvment? Initial step?
TB, Isolation
962
Initial management of coughing with large amounts of blood (\>600mL or 100mL/hour)?
Secure airway
963
When should you suspect diaphragmatic rupture?
History of blunt trauma/MVA, abnormal CXR, left lower lung opacity, elevated hemidiaphragm, and mediastinal deviation
964
How do patients with duodenal hematomas present? Etiology?
epigastric pain and vomiting d/t blood collection between the submucosal and muscular layers of the duodenum
965
Signs of urethral injury?
blood at the urethral meatus, inability to void, high-riding prostate on DRE
966
How to diagnose bladder trauam?
Retrograde cystogram with post-void films
967
NSAID use with several-day history of epigastric pain followed by acute-onset sevfere constant pain?
perforated peptic ulcer
968
Initial management for perforated peptic ulcer
NG suction, bowel rest, intravenous fluids, broad spectrum Abx ad intravenous PPI
969
periumbilical pain out of proportion to examination and hematochezia?
acute mesenteric ischemia Gold standard diagnosis is mesenteric angiography
970
Signs of adrenal insufficiency?
hypoension/shock weakness nausea, vomiting, abdominal pain, fever
971
Etiology of adrenal insufficiency?
adrenal hemorrhage/infarction acute illness/injury/surgery in patient with chronic adrenal insufficiency or long-term glucocorticoid use
972
migratory RLQ pain, nausea, vomiting, fever, leukocytosis
acute appendicitis
973
When are US and CT used in acute appendicitis?
when classic presentation/signs are not present
974
epigastroc pain/tenderness and weight loss with nonspecific systemic symptoms with significant smoking history
pancreatic adenocarcinoma
975
type of pain experiences with pancreatic cancer?
epigastric abdominal pain that is insidious. gnawing, and worse at night
976
Classic association with pancreatic cancer? Name?
migratory thrombophlebitis Trousseau sign
977
soft mass that worsens with standing and Valsalva maneuvers, but decreases when supine; does not transilluminate
varicocele
978
cardiac catheterization, anticoagulation, sudden hypotension, tachycardia, flat neck veins, back pain
retroperitoneal hematoma
979
Complications from cardiac catheterization
pseudoaneurysm, arteriovenous fistular formation, arterial dissection, acute thrombosis
980
pneumomediastinum and pleural effusions-cause?
esophageal rupture
981
pneumothorax despite chest tube, pneumomediastinum subcutaneous emphysema
tracheobronchial perforation (right bronchus is most common
982
Gallbladder distension and wall thickening, presence of pericholecystic fluid, without gallstones
acalculous cholecystitis
983
How to treat acalculous cholecystitis acutely? Definitively?
Acutely- percutaneous cholecystostomy and antibiotics Definitively- cholecystectomy with drainage of associated abscessess
984
How does mesenteric ischemia present?
sudden periumbilical abdominal pain out of proportion to examination findings
985
Signs of compartment syndrome?
1. Pain out of proportion to injury 2. Pain increasing on passive stretch 3. rapidly increasing & tense swelling 4. paresthesia (early)
986
Signs of deep vein thrombosis?
alf tenderness with pain worsened by passive stretching of the calf.
987
Postoperative cholestasis-signs?
hypotension, blood loss into tissues, massive blood load (transfusion), decrease liver functionalty, decreased renal bilirubin excretion with normal ALT/AST
988
Preferred anticoagulant in end-stage renal failure patients?
Warfarin
989
What is required when starting Warfarin?
Heparin bridge- warfarin activates proteins C and S causing a transient prothrombotic state
990
When do patients show signs of pulmonary contusions?
Approx. 4 hours post-injury when hypoxia, respiratory distress, pulmonary edema set in
991
Physical signs of pulmonary contusions?
tachycardia, hypoxia, tachypenea
992
Pulmonary contusion-CXR results
patchy irregular alveolar infiltrate
993
Physical signs of a meniscal tear?
joint line tenderness, pain or catching in the provocative tests (Thessaly, McMurray
994
how to diagnose meniscal tears?
MRI
995
When should conservative management be used for menscal tear? Examples?
Short-term pain, elderly Example: rest, NSAIDs
996
Hoe do you treat anal fissures?
topical anesthetics, vasodilators (nifedipine) Sitz baths stool softeners high-fiber diet & adequate fluid intake
997
When should you considerd surgical interventions for anal fissures?
When medical management has failed
998
acute abdominal pain followed by lower GI bleeding after an episode of hypotension?
Ischemic colitis
999
Sites for ischemic colitis? Imaging signs? How to confirm?
Splenic flexure, rectosigmoid junction CT scan may show thickened bowel wall Confirm with colonoscopy
1000
What is the postoperative cause of fever 0-2 hours after surgery?
Prior trauma/infection, blood products, malignant hyperthermia
1001
What is the postoperative cause of fever 1-7 days after surgery?
Nosocomial infections, Group A streptcoccus, or C. perfringens
1002
What is the postoperative cause of fever 1-4 weeks post surgery?
Other organisms (nor GAS, C. perfringens), C difficile, drug fever, PE/DVT
1003
What is the cause of postoperative fever more than 1 months post-surgery
Viral infections, indolent organisms
1004
Signs of fat embolism?
severe respiratory distress, petechial rash, subconjuctival hemorrhage, tachycardia, tachypnea, and fever
1005
Organism most likely responsible for infection from intravascular devices?
Coagulase negative s. epi
1006
How does an anterior should dislocation occur?
forceful abduction and external rotation a the glenohumeral joint; risks damage to the axillary nerve
1007
Torus palatinus? Tx?
benign, bony growth located on the mid-line suture of the hard palate No treatment necessary unless systemic effects develop or it interferes with speech
1008
Signs of rotator cuff impingement
pain with abduction, external rotation subacromial tenderness normal range of motion with positive impingement tests (Neer, Hawkins)
1009
How does cervical impingement present?
pain and paresthesias of the neck and arm along with upper extremity weakness
1010
Clinical signs of acute mesenteric ischemia?
Rapid onset of periumbilical pain Pain out of proportion to examination findings hematochezia
1011
Risk factors for acute mesenteric ischemia?
Atherosclerosis Embolic source hypercoagulable disorders
1012
What is the drop arm test?
Detects a tear in the supraspinatus; arm is abducted passively above head and they are instructed to lower it slowly
1013
Signs of abdominal aortic aneurysm rupture?
severe back pain, syncope, profound hypotension
1014
Signs of SBO strangulation?
peritoneal signs (rigidity, rebound) signs of shock (fever, tachycardia, leukocytosis)
1015
Trochanteric bursitis- definition? Signs?
definition- inglammation of the curse surrounding the insertion of the gluteus medius onto the femur's trochanter signs- hip pain when pressure is applied and with external or resisted abduction
1016
Femoral nerve innervation
hip joint and skin of the anterior and medial thigh and leg
1017
Complications associated with supracondylar fracture of the humerus
Brachial artery injury Median nerve injury Cubitus varus deformity Compartment syndrome/Volkman ischemic contracture
1018
Signs of sepsis
worsening hyperglycemia, leukocytosis, thrombocytopenia, milk hypothermia, tachypnea, tachycardia
1019
Signs of gallstone ileus
stuttering episodes of nausea and vomiting, pneumobilia, hyperactive bowel sounds, dilated loops of bowels
1020
Important steps in the preoperative management of a patient taking Warfarin?
Check INR, reverse with fresh, frozen plasma
1021
blunt abdominal trauma, hypotension, right chest/abdominal wall injury, and free intraperitoneal fluid
Hepatic laceration
1022
Signs of meniscal tears?
pain, clicking, or catching
1023
post-operative thoracic surgery, fever, tachycardia, chest pain, leukocytosis, and sternal wound drainage or purulent discharge?
Acute mediastinitis, TX- surgical debridement and antibiotic therapy
1024
Signs of septal perforation?
whistling noise during respiration, caused by post-operative septal hematoma
1025
blunt thoracic trauma, respiratory distress despite bilateral chest tubes
Flail chest, demonstrate tachypnea, shallow breaths
1026
Symptoms in arterial embolism?
sudden and severe, with diminished pulses in the affected limb, but normal in the unaffected
1027
Signs of arterial thrombosis
Slow, progressive narrowing of the vascular lumen Pulses are diminished bilaterally (normally)
1028
Signs of pyloric strictures
postprandial pain, vomiting with early satiety, succussion splash on the epigastrium
1029
Signs of esophageal stricture?
Dysphagia, no abdominal succussion splash
1030
Signs of diaphragmatic hernia?
blunt abdominal trauma with mild respiratory distress and abnormal xray \*\*smaller hernias present with nausea/vomiting and are delayed
1031
Cause of infertility from varicocele?
Increased scrotal temperature
1032
Cause of pretibial edema?I
Increased pulmonary vascular resistance
1033
Holosystolic murmur heart of the left sternal border?
Pulmonary regurgitation
1034
5 days after pancreatoduodenectomy , what type of feeding should be used?
Enteral tube feedings
1035
What is erythema nodosum?
Acute, nodular, erythematous eruption on the extensor aspects of the lower legs. Associated with hypersensitivity reactions
1036
What someone falls from a height, what X-rays should be ordered?
C-spine
1037
What should be the first step in the treatment of a woman with breast cancer?
Resect the mass, then treat with chemo/rad
1038
How can heart failure develop from an aneurysm?
Lead to the development of a fistula
1039
What can cause narrowing of the biliary ducts?
cancer (specifically pancreatic), strictures (trauma)
1040
Most common organism causing lymphangitis?
Strep pyo (group A)
1041
How can you minimize the risk of infection from a PICC?
Remove it as soon as treatment/use is complete
1042
Osgood-Schkatter disease
Painful lump below the kneecap in children during puberty, can cause a limp
1043
Legg-Calve-Perthes disease
Blood flow is interrupted to the femoral head in children, can cause necrosis
1044
How do you manage sigmoid volvulus?
Sigmoidoscopy-guided placement of a rectal tube
1045
What should be the first step in management of an unknown mass on an HIV patient?
Biopsy
1046
What is a pneumatocele?
cavity in the lung parenchyma filled with air that may result from pulmonary trauma during mechanical ventilation
1047
Written description of C- Diff infection?
Patchy, white mucosa on colonoscopy
1048
Diffusely enlarged thyroid gland with neck swelling and no symptoms of decreased thyroid?
Chronic lymphocytic thyroiditis (Hashimoto disease)
1049
Long-term growth (\> 6 months) on glans penis with negative VDRL test?
Penis cancer
1050
How do you counteract the effects of propofol?
Dopamine
1051
borborygmi
a rumbling or gurgling noise made by the movement of fluid and gas in the intestines
1052
What is a major complication risk from AAA repair?
MI
1053
diaphoretic
Sweating heavily
1054
C8 radiculopathy
causes pain from the neck to the hand. Patients may experience weakness in hand grip, and pain and numbness can radiate along the inner side of the arm, ring, and little fingers.
1055
C7 radiculopathy
(the most common) causes pain and/or weakness from the neck to the hand and can include the triceps (the muscles on the back of the upper arms) and the middle finge
1056
C6 radiculopathy
(one of the most common), causes pain and/or weakness along the length of the arm, including the biceps (the muscles in front of the upper arms), wrists, and the thumb and index finger.
1057
C5 radiculopathy
can cause pain and/or weakness in the shoulders and upper arms. Especially may cause discomfort around the shoulder blades. It rarely causes numbness or tingling.
1058
Child with current-jelly stools?
Intussusception
1059
How to treat intussusception?
Control enema
1060
Cause of subcutaneous emphysema?
Tension pneumothorax
1061
When giving large amounts of packed RBC's, what must be added?
Platelets
1062
Should volume support or patient transport during traumas come first?
Urban areas with close trauma center - transport All other areas- resuscitate
1063
How to treat rib fractures in the elderly?
Local nerve block and epidural catheter
1064
What should be done with all gunshot wounds to the abdomen?
Exploratory Laparotomy
1065
What treatments should be provided for a through-and-through extremity gunshot wound?
Tetanus prophylaxis
1066
When can early excision and grafting be used?
Small (
1067
What degree of angulation is unacceptable in children (compared to adults)
Larger amounts
1068
How are intertrochaneric fractures treated?
ORIF with anticoagulation
1069
"tip of the finger remains flexed when the rest of the fingers are extended
Malley
1070
Common cause of coma in a cirrhotic patient with bleeding varices?
Ammonium toxicities
1071
Liters of drainage from an upper GI wound?
fluid replacement, nutritional support, protection of the abdominal wall
1072
Old man with blood on the outside of his stool?
Hemorrhoids
1073
Sources of inflammation in the left lower quadrant of women?
Diverticulitis, tube, ovary Diagnose with CT
1074
Acute edematous pancreatitis
Alcoholics of gallstones Pain after large meal or EtOH \_\> constant, radiates to back-\> nausea, vomiting, retching
1075
Vascular rings
stridor, "crowing", baby assumes hyperextended neck Bronchoscopy shows segmental compression of the trachea Tx- surgical division
1076
What type of catheter is used for embolectomy of an atrial clot from a. fib?
Fogarty
1077
Small, raised, waxy lesion
Basal cell carcinoma
1078
non-healing ulcer?
Basal cell carcinoma
1079
Where are squamous cell carcinoma found?
Lower lip and below on face
1080
Where do you biopsy a basal cell carcinoma?
Edge of the lesion
1081
Amblyopia
vision impairment resulting from interference with the processing of images by the brain during the firs t6-7 years of life
1082
How to treat trigeminal neuralgia?
Anti-convulsants (carbamazapine)
1083
Sudden testicular pain, pyuria, fever
acute epididymitis
1084
acute epididymitis- treatment
Abx and sonogram to rule out torsion
1085
Uropelvic junction obstruction signs
Intense pain when large diuresis occurs (beer drinking)
1086
How do you treat testicular cancer?
platinum-based therapies
1087
Treatment for impotence-first line?
Sildenafil, tadalafil, vardenafil
1088
What is mandatory for all abdominal bullet wounds?
Ex Lap
1089
Abdominal mass that moves up and down in a baby
Malignant tumor of the liver ie-hepatoblastoma or hepatocellular carcinoma
1090
Child class factors to deny surgery
albumin below 2, INR 2 x normal, ascites
1091
bilateral pulmonary infiltrates with low PO2
ARDS, PEEP
1092
How do you obtain samples from a breast?
US guided imaging
1093
Back pain in woman who recently has breast cancer?
Metastatic spread, diagnose with MRI
1094
Signs of Zollinger-Ellison disease
Refractory to other treatments, multiple ulcers
1095
Double bubble with normal gas
Malrotation
1096
Square root sign
Chronic constrictive pericarditis
1097
Workup for squamous cell carcinoma of the mucosa?
Panendoscopy
1098
1 week post- otitis media infection: projectile vomiting, seizures, blurred vision, severe headache
Brain abscess
1099
Why a newborn does not urinate during the first day after birth?
posterior urethral valves
1100
Intervention for UPJ stones larger than 7mm
extraperitoneal shock-wave lithotripsy
1101
Standard bolus for burns
1000mL/hr 30-120mL/hr
1102
How do you test an animal for rabies?
Kill the animal and scan its brain
1103
Chubby 13 year old boy limping, complaining of knee pain, sole of affected foot points towards the other one
slipped capital femoral epiphysis
1104
arm held close to the body
Posterior shoulder dislocation, axillary/scapula xrays needed for diagnosis
1105
In an ejection, what should always be imaged?
C-spine (CT scan)
1106
How to treat lumbar disk herniation?
MRI of L4-S1, pain control with nerve blocks
1107
Morton neuroma
inflammation of the common digital nerve in the third space
1108
Signs of PE?
pleuritic (sudden onset), sob, diaphoretic, tachycardic, distended veins in neck and face
1109
Cause of blood in rectum from child?
Merkel's diverticulum, workup with technetium scan
1110
First step in the workup for pancreatic cancer?
CT of the abdomen
1111
First step in workup for a palpable breast mass?
US guided core biopsy
1112
What are burns near the eyes covered with?
Triple abx ointment
1113
Trashing around with sudden pain?
Stone stuck in ureter
1114
If a patient is stable, which test is most sensitive for blood?
CT
1115
How to treat acute rejection?
Tacrolimus or Mycophenolate mofetil with/without steroids
1116
Patient passing stone suddenly spikes a fever
ER immediately, nephrostomy tube placement
1117
How to workup claudication?
Doppler studies
1118
Knee to chest position in children?
Ependymoma
1119
Stumbling around and truncal ataxia in children?
Medulloblastoma
1120
Contraindication to organ donation?
Positive HIV status
1121
In a patient with weakness and decreased pain in both legs, what type of injury is suspected? Action?
Lower spinal cord injury, insert urinary catheter to assess for urinary retention and prevent bladder injury
1122
Signs of cardiac temponade?
hypotension (unresponsive to IV fluids), tachycardia, and elevated jugular venous pressure after blunt thoracic trauma
1123
How is duodenal hematoma treated?
NG suction and parenteral nutrition
1124
What is the first step in management of damage to the urethral meatus?
retrograde urethrogram
1125
Use of NSAIDS with episodic postprandial epigastric pain?
Perforated peptic ulcer
1126
How to treat perforated peptic ulcers?
NG suction, bowel rest, intravenous fluids, broad-spectrum antibiotics, IV PPI
1127
Signs of acute adrenal insufficiency?
Severe and often refractory hypotension, vomiting, abdominal pain and fever
1128
Signs of primary adrenal insufficiency?
hyponatremia and hyperkalemia
1129
Best management of acute appendicitis?
Laparoscopic appendectomy
1130
Epigastric pain/tenderness, weight loss in the setting of nonspecific systemic symptoms and significant smoking history?
Cancer of the upper GI or associated organs...think gallbladder, liver, pancreas
1131
Classic description of pain in pancreatic cancer?
Abdominal pain that is insidious, gnawing, and worse at night
1132
Varicocele-signs? Diagnostic method?
soft mass that worsens with standing and Valsalva maneuvers, but decreases when supine, does not transilluminated Diagnostic- US
1133
Varicocele treatment?
NSAIDS or surgical correction
1134
How do you manage small pneumothorax? Large?
Small- supplemental O2 Large- Needle thoracostomy/chest tube
1135
Young male (20s) without trauma has pneumothorax?
Primary spontaneous pneumothorax
1136
Differential for anterior mediastinal mass?
1. Thymoma 2. teratoma 3. thyroid neoplasm 4. Lymphoma
1137
Mediastinal mass with elevated AFP and b-HCG?
mixed cell germ tumor
1138
Femoral nerve innervation
hip joint and skin of the anterior and medial thigh and leg
1139
Child with current-jelly stools?
Intussusception
1140
What is mandatory for all abdominal bullet wounds?
Ex Lap
1141
Contraindication to organ donation?
Positive HIV status
1142
Stumbling around and truncal ataxia in children?
Medulloblastoma
1143
Knee to chest position in children?
Ependymoma
1144
How to workup claudication?
Doppler studies
1145
Patient passing stone suddenly spikes a fever
ER immediately, nephrostomy tube placement
1146
How to treat acute rejection?
Tacrolimus or Mycophenolate mofetil with/without steroids
1147
If a patient is stable, which test is most sensitive for blood?
CT
1148
Trashing around with sudden pain?
Stone stuck in ureter
1149
What are burns near the eyes covered with?
Triple abx ointment
1150
First step in workup for a palpable breast mass?
US guided core biopsy
1151
First step in the workup for pancreatic cancer?
CT of the abdomen
1152
Cause of blood in rectum from child?
Merkel's diverticulum, workup with technetium scan
1153
Signs of PE?
pleuritic (sudden onset), sob, diaphoretic, tachycardic, distended veins in neck and face
1154
Morton neuroma
inflammation of the common digital nerve in the third space
1155
How to treat lumbar disk herniation?
MRI of L4-S1, pain control with nerve blocks
1156
In an ejection, what should always be imaged?
C-spine (CT scan)
1157
arm held close to the body
Posterior shoulder dislocation, axillary/scapula xrays needed for diagnosis
1158
Chubby 13 year old boy limping, complaining of knee pain, sole of affected foot points towards the other one
slipped capital femoral epiphysis
1159
How do you test an animal for rabies?
Kill the animal and scan its brain
1160
Standard bolus for burns
1000mL/hr 30-120mL/hr
1161
Intervention for UPJ stones larger than 7mm
extraperitoneal shock-wave lithotripsy
1162
Why a newborn does not urinate during the first day after birth?
posterior urethral valves
1163
1 week post- otitis media infection: projectile vomiting, seizures, blurred vision, severe headache
Brain abscess
1164
Workup for squamous cell carcinoma of the mucosa?
Panendoscopy
1165
Square root sign
Chronic constrictive pericarditis
1166
Double bubble with normal gas
Malrotation
1167
Signs of Zollinger-Ellison disease
Refractory to other treatments, multiple ulcers
1168
Back pain in woman who recently has breast cancer?
Metastatic spread, diagnose with MRI
1169
How do you obtain samples from a breast?
US guided imaging
1170
bilateral pulmonary infiltrates with low PO2
ARDS, PEEP
1171
Child class factors to deny surgery
albumin below 2, INR 2 x normal, ascites
1172
Abdominal mass that moves up and down in a baby
Malignant tumor of the liver ie-hepatoblastoma or hepatocellular carcinoma
1173
Treatment for impotence-first line?
Sildenafil, tadalafil, vardenafil
1174
How do you treat testicular cancer?
platinum-based therapies
1175
Uropelvic junction obstruction signs
Intense pain when large diuresis occurs (beer drinking)
1176
acute epididymitis- treatment
Abx and sonogram to rule out torsion
1177
Sudden testicular pain, pyuria, fever
acute epididymitis
1178
How to treat trigeminal neuralgia?
Anti-convulsants (carbamazapine)
1179
Amblyopia
vision impairment resulting from interference with the processing of images by the brain during the firs t6-7 years of life
1180
Where do you biopsy a basal cell carcinoma?
Edge of the lesion
1181
Where are squamous cell carcinoma found?
Lower lip and below on face
1182
non-healing ulcer?
Basal cell carcinoma
1183
Small, raised, waxy lesion
Basal cell carcinoma
1184
What type of catheter is used for embolectomy of an atrial clot from a. fib?
Fogarty
1185
Vascular rings
stridor, "crowing", baby assumes hyperextended neck Bronchoscopy shows segmental compression of the trachea Tx- surgical division
1186
Acute edematous pancreatitis
Alcoholics of gallstones Pain after large meal or EtOH \_\> constant, radiates to back-\> nausea, vomiting, retching
1187
Sources of inflammation in the left lower quadrant of women?
Diverticulitis, tube, ovary Diagnose with CT
1188
Old man with blood on the outside of his stool?
Hemorrhoids
1189
Liters of drainage from an upper GI wound?
fluid replacement, nutritional support, protection of the abdominal wall
1190
Common cause of coma in a cirrhotic patient with bleeding varices?
Ammonium toxicities
1191
"tip of the finger remains flexed when the rest of the fingers are extended
Malley
1192
How are intertrochaneric fractures treated?
ORIF with anticoagulation
1193
What degree of angulation is unacceptable in children (compared to adults)
Larger amounts
1194
When can early excision and grafting be used?
Small (
1195
What treatments should be provided for a through-and-through extremity gunshot wound?
Tetanus prophylaxis
1196
What should be done with all gunshot wounds to the abdomen?
Exploratory Laparotomy
1197
How to treat rib fractures in the elderly?
Local nerve block and epidural catheter
1198
Should volume support or patient transport during traumas come first?
Urban areas with close trauma center - transport All other areas- resuscitate
1199
When giving large amounts of packed RBC's, what must be added?
Platelets
1200
Cause of subcutaneous emphysema?
Tension pneumothorax
1201
How to treat intussusception?
Control enema
1202
C5 radiculopathy
can cause pain and/or weakness in the shoulders and upper arms. Especially may cause discomfort around the shoulder blades. It rarely causes numbness or tingling.
1203
C6 radiculopathy
(one of the most common), causes pain and/or weakness along the length of the arm, including the biceps (the muscles in front of the upper arms), wrists, and the thumb and index finger.
1204
C7 radiculopathy
(the most common) causes pain and/or weakness from the neck to the hand and can include the triceps (the muscles on the back of the upper arms) and the middle finge
1205
C8 radiculopathy
causes pain from the neck to the hand. Patients may experience weakness in hand grip, and pain and numbness can radiate along the inner side of the arm, ring, and little fingers.
1206
diaphoretic
Sweating heavily
1207
What is a major complication risk from AAA repair?
MI
1208
borborygmi
a rumbling or gurgling noise made by the movement of fluid and gas in the intestines
1209
How do you counteract the effects of propofol?
Dopamine
1210
Long-term growth (\> 6 months) on glans penis with negative VDRL test?
Penis cancer
1211
Diffusely enlarged thyroid gland with neck swelling and no symptoms of decreased thyroid?
Chronic lymphocytic thyroiditis (Hashimoto disease)
1212
Written description of C- Diff infection?
Patchy, white mucosa on colonoscopy
1213
What is a pneumatocele?
cavity in the lung parenchyma filled with air that may result from pulmonary trauma during mechanical ventilation
1214
What should be the first step in management of an unknown mass on an HIV patient?
Biopsy
1215
How do you manage sigmoid volvulus?
Sigmoidoscopy-guided placement of a rectal tube
1216
Legg-Calve-Perthes disease
Blood flow is interrupted to the femoral head in children, can cause necrosis
1217
Osgood-Schkatter disease
Painful lump below the kneecap in children during puberty, can cause a limp
1218
How can you minimize the risk of infection from a PICC?
Remove it as soon as treatment/use is complete
1219
Most common organism causing lymphangitis?
Strep pyo (group A)
1220
What can cause narrowing of the biliary ducts?
cancer (specifically pancreatic), strictures (trauma)
1221
How can heart failure develop from an aneurysm?
Lead to the development of a fistula
1222
What should be the first step in the treatment of a woman with breast cancer?
Resect the mass, then treat with chemo/rad
1223
What someone falls from a height, what X-rays should be ordered?
C-spine
1224
What is erythema nodosum?
Acute, nodular, erythematous eruption on the extensor aspects of the lower legs. Associated with hypersensitivity reactions
1225
5 days after pancreatoduodenectomy , what type of feeding should be used?
Enteral tube feedings
1226
Holosystolic murmur heart of the left sternal border?
Pulmonary regurgitation
1227
Cause of pretibial edema?I
Increased pulmonary vascular resistance
1228
Cause of infertility from varicocele?
Increased scrotal temperature
1229
Signs of diaphragmatic hernia?
blunt abdominal trauma with mild respiratory distress and abnormal xray \*\*smaller hernias present with nausea/vomiting and are delayed
1230
Signs of esophageal stricture?
Dysphagia, no abdominal succussion splash
1231
Signs of pyloric strictures
postprandial pain, vomiting with early satiety, succussion splash on the epigastrium
1232
Signs of arterial thrombosis
Slow, progressive narrowing of the vascular lumen Pulses are diminished bilaterally (normally)
1233
Symptoms in arterial embolism?
sudden and severe, with diminished pulses in the affected limb, but normal in the unaffected
1234
blunt thoracic trauma, respiratory distress despite bilateral chest tubes
Flail chest, demonstrate tachypnea, shallow breaths
1235
Signs of septal perforation?
whistling noise during respiration, caused by post-operative septal hematoma
1236
post-operative thoracic surgery, fever, tachycardia, chest pain, leukocytosis, and sternal wound drainage or purulent discharge?
Acute mediastinitis, TX- surgical debridement and antibiotic therapy
1237
Signs of meniscal tears?
pain, clicking, or catching
1238
blunt abdominal trauma, hypotension, right chest/abdominal wall injury, and free intraperitoneal fluid
Hepatic laceration
1239
Important steps in the preoperative management of a patient taking Warfarin?
Check INR, reverse with fresh, frozen plasma
1240
Signs of gallstone ileus
stuttering episodes of nausea and vomiting, pneumobilia, hyperactive bowel sounds, dilated loops of bowels
1241
Signs of sepsis
worsening hyperglycemia, leukocytosis, thrombocytopenia, milk hypothermia, tachypnea, tachycardia
1242
Complications associated with supracondylar fracture of the humerus
Brachial artery injury Median nerve injury Cubitus varus deformity Compartment syndrome/Volkman ischemic contracture
1243
Trochanteric bursitis- definition? Signs?
definition- inglammation of the curse surrounding the insertion of the gluteus medius onto the femur's trochanter signs- hip pain when pressure is applied and with external or resisted abduction
1244
Signs of SBO strangulation?
peritoneal signs (rigidity, rebound) signs of shock (fever, tachycardia, leukocytosis)
1245
Signs of abdominal aortic aneurysm rupture?
severe back pain, syncope, profound hypotension
1246
What is the drop arm test?
Detects a tear in the supraspinatus; arm is abducted passively above head and they are instructed to lower it slowly
1247
Risk factors for acute mesenteric ischemia?
Atherosclerosis Embolic source hypercoagulable disorders
1248
Clinical signs of acute mesenteric ischemia?
Rapid onset of periumbilical pain Pain out of proportion to examination findings hematochezia
1249
How does cervical impingement present?
pain and paresthesias of the neck and arm along with upper extremity weakness
1250
Signs of rotator cuff impingement
pain with abduction, external rotation subacromial tenderness normal range of motion with positive impingement tests (Neer, Hawkins)
1251
Torus palatinus? Tx?
benign, bony growth located on the mid-line suture of the hard palate No treatment necessary unless systemic effects develop or it interferes with speech
1252
How does an anterior should dislocation occur?
forceful abduction and external rotation a the glenohumeral joint; risks damage to the axillary nerve
1253
Organism most likely responsible for infection from intravascular devices?
Coagulase negative s. epi
1254
Signs of fat embolism?
severe respiratory distress, petechial rash, subconjuctival hemorrhage, tachycardia, tachypnea, and fever
1255
What is the cause of postoperative fever more than 1 months post-surgery
Viral infections, indolent organisms
1256
What is the postoperative cause of fever 1-4 weeks post surgery?
Other organisms (nor GAS, C. perfringens), C difficile, drug fever, PE/DVT
1257
What is the postoperative cause of fever 1-7 days after surgery?
Nosocomial infections, Group A streptcoccus, or C. perfringens
1258
What is the postoperative cause of fever 0-2 hours after surgery?
Prior trauma/infection, blood products, malignant hyperthermia
1259
Sites for ischemic colitis? Imaging signs? How to confirm?
Splenic flexure, rectosigmoid junction CT scan may show thickened bowel wall Confirm with colonoscopy
1260
acute abdominal pain followed by lower GI bleeding after an episode of hypotension?
Ischemic colitis
1261
When should you considerd surgical interventions for anal fissures?
When medical management has failed
1262
Hoe do you treat anal fissures?
topical anesthetics, vasodilators (nifedipine) Sitz baths stool softeners high-fiber diet & adequate fluid intake
1263
When should conservative management be used for menscal tear? Examples?
Short-term pain, elderly Example: rest, NSAIDs
1264
how to diagnose meniscal tears?
MRI
1265
Physical signs of a meniscal tear?
joint line tenderness, pain or catching in the provocative tests (Thessaly, McMurray
1266
Pulmonary contusion-CXR results
patchy irregular alveolar infiltrate
1267
Physical signs of pulmonary contusions?
tachycardia, hypoxia, tachypenea
1268
When do patients show signs of pulmonary contusions?
Approx. 4 hours post-injury when hypoxia, respiratory distress, pulmonary edema set in
1269
What is required when starting Warfarin?
Heparin bridge- warfarin activates proteins C and S causing a transient prothrombotic state
1270
Preferred anticoagulant in end-stage renal failure patients?
Warfarin
1271
Postoperative cholestasis-signs?
hypotension, blood loss into tissues, massive blood load (transfusion), decrease liver functionalty, decreased renal bilirubin excretion with normal ALT/AST
1272
Signs of deep vein thrombosis?
alf tenderness with pain worsened by passive stretching of the calf.
1273
Signs of compartment syndrome?
1. Pain out of proportion to injury 2. Pain increasing on passive stretch 3. rapidly increasing & tense swelling 4. paresthesia (early)
1274
How does mesenteric ischemia present?
sudden periumbilical abdominal pain out of proportion to examination findings
1275
How to treat acalculous cholecystitis acutely? Definitively?
Acutely- percutaneous cholecystostomy and antibiotics Definitively- cholecystectomy with drainage of associated abscessess
1276
Gallbladder distension and wall thickening, presence of pericholecystic fluid, without gallstones
acalculous cholecystitis
1277
pneumothorax despite chest tube, pneumomediastinum subcutaneous emphysema
tracheobronchial perforation (right bronchus is most common
1278
pneumomediastinum and pleural effusions-cause?
esophageal rupture
1279
Complications from cardiac catheterization
pseudoaneurysm, arteriovenous fistular formation, arterial dissection, acute thrombosis
1280
cardiac catheterization, anticoagulation, sudden hypotension, tachycardia, flat neck veins, back pain
retroperitoneal hematoma
1281
soft mass that worsens with standing and Valsalva maneuvers, but decreases when supine; does not transilluminate
varicocele
1282
Classic association with pancreatic cancer? Name?
migratory thrombophlebitis Trousseau sign
1283
type of pain experiences with pancreatic cancer?
epigastric abdominal pain that is insidious. gnawing, and worse at night
1284
epigastroc pain/tenderness and weight loss with nonspecific systemic symptoms with significant smoking history
pancreatic adenocarcinoma
1285
When are US and CT used in acute appendicitis?
when classic presentation/signs are not present
1286
migratory RLQ pain, nausea, vomiting, fever, leukocytosis
acute appendicitis
1287
Etiology of adrenal insufficiency?
adrenal hemorrhage/infarction acute illness/injury/surgery in patient with chronic adrenal insufficiency or long-term glucocorticoid use
1288
Signs of adrenal insufficiency?
hypoension/shock weakness nausea, vomiting, abdominal pain, fever
1289
periumbilical pain out of proportion to examination and hematochezia?
acute mesenteric ischemia Gold standard diagnosis is mesenteric angiography
1290
Initial management for perforated peptic ulcer
NG suction, bowel rest, intravenous fluids, broad spectrum Abx ad intravenous PPI
1291
NSAID use with several-day history of epigastric pain followed by acute-onset sevfere constant pain?
perforated peptic ulcer
1292
How to diagnose bladder trauam?
Retrograde cystogram with post-void films
1293
Signs of urethral injury?
blood at the urethral meatus, inability to void, high-riding prostate on DRE
1294
How do patients with duodenal hematomas present? Etiology?
epigastric pain and vomiting d/t blood collection between the submucosal and muscular layers of the duodenum
1295
When should you suspect diaphragmatic rupture?
History of blunt trauma/MVA, abnormal CXR, left lower lung opacity, elevated hemidiaphragm, and mediastinal deviation
1296
Initial management of coughing with large amounts of blood (\>600mL or 100mL/hour)?
Secure airway
1297
Hemoptysis with upper lung lobe involvment? Initial step?
TB, Isolation
1298
How to treat a pancreatic abscess
Immediate placement of a percutaneous drainage catheter, culture of the drained fluid and surgical debridement
1299
Signs of retroperitoneal abscesses?
fever, child, and deep abdominal pain may initially be missed by a CT scan
1300
How do you store an amputated limb?
Place in saline moistened gauze and then in a plastic bag on ice...bring it wherever the patient goes.
1301
What are the signs of arterial occlusion?
Pain, pallor, paresthesias, pulselessness, and coolness to the touch
1302
How does venous insufficiency present?
worsens throughout the day and resolves overnight when the patient is recumbent
1303
When do you give tetanus immune globulin?
severe or dirty wound with unsure vaccination history
1304
Tetanus prophylaxis in a dirty or severe wound?
Tetanus toxoid-containing vaccine only if booster \> 5 years ago If unsure, tetanus toxoid-containing vaccine plus tetanus immune globulin
1305
Tetanus prophylaxis in a clean or minor wound?
Tetanus toxoid-containing vaccine only if
1306
How does pneumonia that is developing into septic shock present? Treatment?
acidosis, low urine output, hypotension, tachypnea, fever Tx- IV normal saline
1307
How do you counteract a decrease in blood pressure after administration of propofol?
Administer dopamine
1308
Syndrome associated with arterial occlusion at the bifurcation of the aorta?
Leriche Syndrome
1309
Leriche syndrome
bilateral hip, thigh, buttock claudication impotence symmetric atrophy of the bilateral extremities due to ischemia
1310
Patient response to atelectasis?
Hyperventilation -\> respo. alkalosis, decreased pCO2
1311
Effects of uncal herniation?
1. Ipsilateral hemiparesis 2. parasympathetic loss (mydriasis (early) ptosis, 3. Contralateral homonymous hemianopdia 4. altered level of consciousness
1312
Signs of elevated intracranial pressure?
HTN, bradycardia, respiratory depression (Cushing's reflex)
1313
Initial management of non-displaced scaphoid bone fracture?
Wrist immobilization for 6-10weeks, with x-rays in7-10 days
1314
Mediastinal mass with nomral b-HCG and AFP?
Thymomas
1315
Elevated serum b-HCG with normal AFP?
seminoma
