Medicine

Question 1

CD4+ count at which MMR/V vax contraindicated?

Answer 1

<200

Question 2

Patients with HIV need what vaccines due to elevated risk of infxn?

Answer 2

1. Hep B (unless immune);
2. S. pneumo (PCV13 followed by PPSV23 8 weeks later then again 5 yrs later and at 65yrs);
3. Varicella (if CD4+>200)
4. Influenza
5. Td q 10 yrs

Question 3

A commercial sex worker with Hx of IV drug use, fever, joint pains, and skin pustules on the extensors/chest, but not on palms/soles without abnormal heart tones likely has?

Answer 3

Disseminated gonorrhea:
1. purulent monoarthritis OR triad (tenosynovitis, dermatitis [papules/pustules], migratory polyarthralgias
2. Inflammatory effusion with PMNs in synovial fluid
Rx: ceftriaxone IV, then cefixime oral once improved; Azithromycin/doxy for chlamydia; can drain joint

Question 4

What pulse quality may help differentiate aortic regurgitation and aortic stenosis?

Answer 4

AR: bounding (water hammer effect due to high stroke volume)
AS: pulsus parvus et tardus (low amp, delayed)

Question 5

A young, obese female with a headache has normal imaging, papilledema, and elevated CSF pressure. What is the most likely complication?

Answer 5

Blindness is the most common complication of pseudotumor cerebri (idiopathic CSF pressure elevation). Weight reduction, acetazolamide, or if all else fails, optic nerve fenestration may prevent blindness. If SZ presents, think brain tumor, not CSF pressure.

Question 6

When might heterophile testing for Mono be falsely negative?

Answer 6

Early in illness - retest days later

Question 7

Why is routine dipstick testing of urine not effective during early nephropathy stages?

Answer 7

They detect only excessive urinary protein (albumin) excretion (>300mg/24hr - e.g. macroalbuminuria), which is above the threshold for a microalbuminuria that may be seen in DM. 24hr collection is best to detect microalbuminuria (30-300mg/24hr).

Question 8

What are the differences in appearance of leukoplakia and squamous cell cancer of the mouth?

Answer 8

Leuko: reactive precancerous lesion that demonstrates hyperplasia -white, granular lesions layered on top of oral mucosa
Ca: persistent nodular, erosive, ulcerative lesions with erythema/induration, maybe regional lymphadenopathy

Question 9

Define the following terms:
End diastolic volume
End systolic volume
Afterload
Preload

Answer 9

EDV: volume in the heart after diastolic filling (max volume) - increased by increasing preload
ESV: volume in heart after sytole/before diastole (min volume) - decreased by elevated stroke volume/increased afterload
A: force against which heart pumps to deliver blood from the heart - elevation leads to decreased ejection fxn/elevated ESV
P: fluid filling the vents - increased by longer diastolic filling time which increases EDV and ESV

Question 10

After subarachnoid hemmorrhage, what risks of complications occur within 24hrs? 3-10days? Any time?

Answer 10

24hrs: Rebleed
3-10days: Vasospasm (stroke-like Sx)- major cause morbidity/mortality
Others: elevated ICP, SZ, hyponatremia (SIADH)
Dx: CT>90% sensitive, LP reveals xanthochromia in CSF, angiography to ID source

Question 11

What is the feared side effect of propylthiouracil and methimazole? How does this present?

Answer 11

PTU and MMI cause agranulocytosis in 0.3% taking the drug. If a fever and sore throat occur, the drug should be DCed promptly and WBCs measured. If <1000, then permanent DC of drug should occur.

Question 12

How do erythrocyte sed rate and CK levels differentiate myopathies?

Answer 12

Glucocorticoids: normal ESR and CK
Polymyalgia rheumatica: elevated ESR, normal CK
***Important to diff. these two as temporal arteritis Rx with high dose steroids that are then tapered…
Others:
Inflammatory myopathy (polymyositis, dermatomyositis): CK and ESR elevated
Statins and hypothyroid myopathy: Normal ESR, elevated CK

Question 13

Symptomatic hypercalcemia (fatigue, constipation, kidney stones) suggests primary hyperparathyroidism. A man complaining of inflammatory arthritis and the suggested history likely will have what in the joint space on aspiration?

Answer 13

Pseudogout: Rhomboid-shaped crystals made of calcium pyrophosphate dihydrate - usually associated with hypeparathyroidism and chronic hypercalcemia as well as hypothyroid and hemochromatosis.

Question 14

What characteristics differentiate vitreous hemorrhage from retinal detachment?

Answer 14

VH: sudden loss of vision and onset of floaters/dark red glow in humor; hard to visualize fundus
RD: vision loss, photopsia (flashes of light) with showers of floaters

Question 15

How should acute pain management be induced in a person with a substance abuse Hx?

Answer 15

The same as anyone else. Meaning opioids should be included regardless.

Question 16

A patient with urethritis, conjunctivitis, or mouth ulcers as well as an asymmetric oligoarthritis (2-4 joints) including the back is suspicious for what?

Answer 16

Reactive arthritis. NSAIDs are the first line.

Question 17

How can amebic liver abscess and hydatid cyst due to Echinococcus granulosus be differentiated on CT?

Answer 17

Ameba: form abscess causing RUQ pain, fever, etc.
Echinococcus: form classic eggshell calcification on CT; transferred from contact with dogs

Question 18

The pathophysiology of Paget’s Disease involves disordered osteoclastic bone resorption. What is the treatment for this disease? Why?

Answer 18

Bisphosphonates (-dronates) - These drugs inhibit osteoclast fxn

Question 19

A man with abd. distention, and flatulence as well as foul smelling stools, generalized lymphadenopathy, skin hyperpigmentation, and a diastolic murmur in the aortic area has a biopsy of his intestinal wall and is found to have what pathologic changes there?

Answer 19

PAS-positive materials in the lamina propria secondary to Whipple’s disease. GI symptoms predominate with migratory polyarthropathy, cough, and cardiac symptoms (valvular) lead to CHF later. CNS manifestations can occur.

Question 20

What lung sound findings make CHF easily differentiated from COPD?

Answer 20

Crackles bilaterally at the lung bases. Wheezes may be present as cardiac asthma in CHF.

Question 21

Name three classes of abortive and three preventive migraine medications.

Answer 21

A: triptans, NSAIDs, antiemetics (metoclopramide), Ergots (dihydroergotamine)
P: Topiramate, divalproex, TCAs, Beta blockers

Question 22

40s female presents with pruritis has fatigue. PE reveals skin excoriations and mild hepatomegaly. She has xanthelasmas and a total bilirubin = 1.6. Antimitochondrial antibody is positive. What is she at risk for developing later?

Answer 22

Osteomalacia. This is classic example of Primary biliary cholangitis, an autoimmune disease that targets the intrahepatic bile ducts only (unlike sclerosing which attacks intra/extra and is assoc. w/ UC and colorectal cancer). Malabsorption in PBC leads to fat-soluble vitamin deficiencies and can cause hepatocellular carcinoma. Ursodeoxycholic acid delays progression. Liver Tx may be needed.

Question 23

Individuals with a previous Hx of malignancy from chemo or radiation are more likely to develop what later in life?

Answer 23

Secondary malignancy.

Question 24

What surgical procedure is the most effective cure for removing basal cell carcinoma?

Answer 24

Mohs procedure: a procedure involving taking layers of skin until the tumor is completely resected.
BCC presents as a persistent sore that oozes/crusts/bleeds and my be red or irritated and elevated. It may be pink, red, or white in color or be pale/scar-like.

Question 25

Women taking OCs are at risk of developing what liver anomaly?

Answer 25

Hepatic adenoma.

Question 26

What metabolic/electrolyte side effects may be expected in a Pt on chlorthalidone or another thiazide diuretic?

Answer 26

Hyponatremia, hypokalemia, hypomagnesemia, hypercalcemia, hyperuricemia, hyperglycemia, hypercholesterolemia

Question 27

How can lab values and S/S differentiate infectious mono from AML?

Answer 27

Mono: aside form obvious Sx, mono may present with leukopenia (viral suppression), +monospot (heterophile Ig), atypical lymphocytes on smear - autoimmune hemolytic anemia and thrombocytopenia may occur due to crossrxn w/ RBCs and platelets of Ig AML: generally present with pancytopenia, hepatosplenomegaly, and generalized lymphadenopathy, usually having leukocytosis rather than peukopenia as mono can

Question 28

What qualities differentiate Hashimoto, painless, and subacute thyroiditis from one another? How is Grave's differentiated from Painless thyroiditis?

Answer 28

H: hypothyroid with diffuse goiter, positive TPO antibidy, variable radioiodine uptake P: Brief hyperthyroid phase (2-5 months) followed by hypothyroidism and recovery, small nontender goiter; TPO Ig+, low radioiodine uptake (differentiates from Grave's during thyrotoxic phase) SA: Postviral inflammation causes high fever and hyperthyroid with painful/tender goiter, TPO Ig -, low radioiodine uptake

Question 29

What is the most probable form of glomerulopathy in an African/Hispanic individual with HIV?

Answer 29

Focal segmental glomerulosclerosis.

Question 30

Any Pt found to have an enlarged thyroid should be evaluated how first?

Answer 30

1. TSH, US of thyroid 2. If TSH low, do thyroid scintigraphy w/ Iodine123 3. Hot: low cancer risk-->Rx for hyperthyroid Cold: high cancer risk --> Fine needle aspiration

Question 31

A patient with chronic cough and mucopurulent discharge, but no smoking or CF Hx, dyspnea, hemoptysis, and recurrent infections may have what condition?

Answer 31

Bronchiectasis. Dx with CT initially. Recurrent inflammatory reaction due to CF (50% cases), or infxn (MCC if not CF), kartageners, autoimmune.

Question 32

Recall the mnemonics for IE and for RH disease.

Answer 32

IE: FROM JANE: Fever, Roth spots, Osler nodes ("Ouch" on fingertips), murmur, janeway lesions, anemia, nail hemorrhage, emboli RH: JONES Joints, O is heart shaped, Nodules, Erythema migrinatum, syndenham chorea

Question 33

What does DEXA stand for? What levels become concerning? Who gets one?

Answer 33

Dual-energy X-ray absorptiometry. Osteoporosis: ≥2.5 SDs below the mean for a young adult at peak bone density (T-score ≤-2.5) Osteopenia: T-score ≤-1 to -2.4 Women with RFs like smoking or age≥65.

Question 34

``` Define the following: Episcleritis Dacrocystitis Hordeolum Chalazion ```

Answer 34

E: Infxn of episcleral tissue b/t conjunctiva and sclera. Photophobia, watery discharge, PE shows bulbar conjunctival injxn D: (dacro=tears) infxn of lacrimal sac -pain in medial canthal region H: abscess over upper/lower eyelid (Usually S. aureus); sty C: granulomatous inflammation of meibomian gland - hard painless lid nodule

Question 35

What are the common associated neoplasms with each of the following: Lynch syndrome Familial adenomatous polyposis von Hippel-Lindau

Answer 35

L: colorectal, endometrial, ovarian FAP: colorectal, desmoids/osteomas, brain tumors VHL: Hemangioblastomas, clear cell renal carcinoma, pheochromocytoma

Question 36

``` What are the common associated neoplasms with each of the following: MEN1 MEN2a MEN2b (3) BRCA1 and 2 ```

Answer 36

MEN1 (3P's): Parathyroid, pituitary, pancreatic (ZES, insulinoma) adenomas MEN2a (Sipple syndrome - MPH): parathyroid hyperplasia (hyperparathyroidism), medullary thyroid cancer, pheochromocytoma MEN3 (MMMP): medullary thyroid carcinoma, mucosal neuromas, marfinoid habitus, pheochromocytoma,

Question 37

What indicates it is time for CT scan of the abdomen/pelvis in a patient with pyelonephritis?

Answer 37

No clinical improvement in 48-72hrs

Question 38

A confounder requires what two characteristics to be defined as such?

Answer 38

1. It must be related to the exposure (those who drink are more likely to smoke) 2. It must be related to the outcome of interest (smoking is associated with oral cancer as alcohol is)

Question 39

In HOCM, what valve is observed in the ECHO and what is the problem with it?

Answer 39

Anterior cusp of the mitral valve touches the septum during systole. This is worsened when preload is decreased, because the size of the chamber is smaller leaving a smaller gap to be bridged by the leaflet. This causes a midsystolic crescendo/decrescendo murmur at the LLSB. An MVP is a click with a mid-to-late systolic murmur of MR. It is also accentuated (earlier) by decreasing preload or afterload.

Question 40

``` What are the major side effects of the following DMARDs: Methotrexate Lefluonomide Hydroxychloroquine Sulfasalazine Anti-TNF agents (Infliximab) ```

Answer 40

M, L, S all cause hepatotox; M, L cause cytopenias (marrow suppression) S: Hemolytic anemia H: Retinopathy AntiTNF: TB reactivation, infxn

Question 41

What findings will help differentiate Blastomycoses from Histoplasmosis?

Answer 41

B: characteristic heaped-up verrucous/nodular lesions with violacious hue that can turn into microabscesses; skin involvement; can disseminate in immunocompetant as well as compromised H: rarely disseminates in immunocompetant; mild/asymptomatic pulm. infxn; immunocompromised may get disseminated disease with papular/crusting lesions on skin

Question 42

What are the qualities that differentiate delayed sleep phase syndrome from advanced sleep phase syndrome?

Answer 42

D: sleep-onset insomnia (can't fall asleep easily due to changes in schedule to earlier time frame that doesn't coincide with circadian rhythm), excessive sleepiness, often feel rested on weekends when they can sleep in to a time that coincides better w/ rhythm A: Inability to stay awake in evening --> fall asleep early --> early morning insomnia (wake up early often)

Question 43

What is the presentation of a ventricular aneurysm?

Answer 43

Scar tissue deposits after transmural MI leads to heart failure/angina months later. Arrythmia/embolization can occur due to hypokinesis of myocardial wall. ECG: persistent ST elevation/deep Q waves; Echo: thin/dyskinetic myocardial wall

Question 44

What is the first-line Rx for aborting cluster headaches?

Answer 44

100% O2.

Question 45

In a Pt. with suspected MS, what is the first test done to support Dx?

Answer 45

MRI of brain and spine (T2-weighted). An LP to check CSF for oligocloncal IgG bands may help also. MRI is 1st. Nerve conduction studies Dx peripheral nerve disorders.

Question 46

What qualities differentiate Waldenstrom macroglobulinemia, multiple myeloma, and monoclonal gammopathy of undetermined significance?

Answer 46

W: excessive monoclonal IgM, end-organ damage (hyperviscosity syndrome - diplopia, tinnitis, HA, fundoscopic changes), neuropathy, and infiltrative disease (anemia, hepatosplenomegaly) MM: IgG, IgA, or light chain spikes; osteolytic lesions/fractures (bone pain instead of hyperviscosity, neuropathy, infiltration) MG: IgM spike (but smaller, <3g/dL), no end organ damage or obvious systemic effects like the others

Question 47

Where is DHEAS produced and what is the significance of this in adrenal tumors vs virilizing ovarian tumors?

Answer 47

DHEAS is only made in the adrenals, whereas DHEA and testosterone are produced by both the adrenals and ovaries. Thus, DHEAS will only be elevated in a virilized female with an adrenal tumor and it will be normal in a virilized woman with an ovarian tumor.

Question 48

Thyrotoxicosis leads to what effects on myocardium and peripheral vasculature, respectively?

Answer 48

Myo: increased contractility and rate Vasc: oddly enough elevated thyroid leads to decreased systemic vascular resistance, the opposite is true of hypothyroidism (HTN)

Question 49

Common causes of anion gap metabolic acidosis?

Answer 49

``` MUDPILES: Methanol Uremia DKA Propylene glycol Isoniazid/Iron Lactic acidosis Ethylene glycol Salicylates ```

Question 50

Normal anion gap value?

Answer 50

6-12mEq/L

Question 51

Calculation for corrected calcium

Answer 51

corrected calcium = measured Ca++ + 0.8 x (4 - albumin)

Question 52

Best screens for multiple myeloma

Answer 52

serum protein electrophoresis (M-spike), urine protein electrophoresis, and free light chain analysis, confirm with bone marrow biopsy

Question 53

Ischemic vs hemorrhagic stroke progression

Answer 53

I: abrupt onset, may progress/fluctuate some; atherosclerotic RFs H: HTN/coagulopathy Hx; symptoms progress over minutes/hours; early neuro Sx with later ICP Sx (vomiting, HA, bradycardia)

Question 54

Management of acute bronchitis

Answer 54

Symptomatic Rx (NSAIDs, etc.)

Question 55

Acute bronchitis Dx

Answer 55

Clinical Dx: (no CXR) | Cough>5days - 3 wks +/- purulent sputum; absent systemic findings (fever/chills); wheeing/rhonchi

Question 56

What nephrotic syndrome is Hodgkins lymphoma associated with?

Answer 56

Minimal change disease

Question 57

First-line Rx in rheumatoid arthritis?

Answer 57

DMARDS (e.g. methotrexate - 1st line, hydroxychloroquine, sulfasalazine, leflunomide, azathioprine, and the anti-INF agents: infliximab, etc.)

Question 58

3 most common etiologies of acute pancreatitis?

Answer 58

Chronic EtOH Gallstones HyperTG

Question 59

Dx criteria for pancreatitis?

Answer 59

2+ of following: 1. Acute epigastric pain rad to back 2. Elevated amylase or lipase >3x Normal limit 3. Abnormalities on imaging Note: ALT>150 suggests biliary pancreatitis

Question 60

Meds that must be held prior to cardiac stress testing?

Answer 60

Hold 48hrs prior: Beta blockers, calcium channel blockers, nitrates Continue others: ACEI, digoxin, statins, diuretics

Question 61

Features that differentiate R. sided CHF from ascites due to cirrhosis

Answer 61

Ascites due to liver failure will have shifting dullness and fluid waves. R. sided CHF will not have this, but will have JVD and hepatojugular reflex.

Question 62

Isolated systolic HTN definition and path?

Answer 62

ISH: >140/<90 (elevated sys, normal dias) | In elderly, usually due to aortic stiffness/decreased elasticity of the arterial wall

Question 63

Warfarin-induced skin necrosis path?

Answer 63

Reduced Vit K-dependent clotting factors II, VII, IX, X, Protein C and S results in Protein C deficiency within first day while others decline more slowly, resulting in a transient hypercoagulable state.

Question 64

Presence of erythema nodosum requires what imaging?

Answer 64

CXR for sarcoidosis (sarcoid may be present in almost 30% of EN cases)

Question 65

Two most commonly isolated organisms in single brain abscess

Answer 65

S. aureus, Strep viridans both due to direct extension from adjacent infxn (sinuses, otitis media, etc.)

Question 66

Most common Rx for essential tremor

Answer 66

Propanolol (ß-blocker)

Question 67

Most common thalassemia in Mediterraneans

Answer 67

ß-thalassemia (anemia, microcytosis, target cells on smear, normal RDW)

Question 68

Most common thalassemia in Southeast Asians

Answer 68

alpha-thalassemia (anemia, microcytosis, target cells on smear, normal RDW)

Question 69

Light criteria for pleural effusion (transudate has absence of all of these values)

Answer 69

1. Protein-p/Protein-s>0.5 2. LDH-p/LDH-s >0.6 3. LDH-p >2/3 upper limit of normal for serum LDH (45-90 normally) * s = serum * p = pleural fluid * *Transudative pleural fluid pH is 7.4-7.55

Question 70

3 main causes of unconjugated hyperbilirubinemia

Answer 70

- Overprodxn (e.g. hemolysis) - Reduced liver uptake - Conjugation defect (e.g. Gilbert's)

Question 71

Evaluating liver enzyme pattern in conjugated hyperbilirubinemia (3 possibilities) - UWQ 2975

Answer 71

- Elevated AST and ALT (viral, autoimmune, toxin, ischmemic, alcohol hepatitis or hemochromatosis) - Normal AST, ALT, alk phos (Dubin-Johnson, Rotors) - Predominantly elevated alk phos (Malignancy (pancreas, ampulla), cholangiocarcinoma, PBC, PSC, choledocolithiasis) --> do US/CT or Antimitochondrial antibody

Question 72

Elevated alkaline phosphatase levels indicate

Answer 72

Cholestasis

Question 73

EBV DNA positive CSF in HIV Pt with solitary weakly ring-enhancing lesion in brain

Answer 73

Primary CNS lymphoma

Question 74

Brain damage in heavy alcohol use

Answer 74

Cerebellar vermis - truncal coordination (wide gait, postural issues, falls, etc.)

Question 75

Presentation: Alzhemier's

Answer 75

Early, insidious short-term memory loss

Question 76

Presentation: Vascular dementia

Answer 76

Stepwise decline in executive fxn, forgetful, neuro deficits (hemiparesis, etc.)

Question 77

Presentation Frontotemporal dementia

Answer 77

Early personality changes (apathy, disinhibition, compulsive)

Question 78

Presentation Lewy body dementia

Answer 78

Visual hallucinations, parkinsonianism

Question 79

Presentation normal-pressure hydrocephalus

Answer 79

Ataxia early, urinary incontinence, dementia, dilated vents on imaging (wet, wobbly, wacky)

Question 80

Presentation Prion disease

Answer 80

Rapid behavioral changes w/ myoclonus/seizures

Question 81

Classic allergic conjunctivitis presentation

Answer 81

red, watery, ITCHY, granular conjunctiva

Question 82

Acute kidney transplant rejection first-line

Answer 82

IV steroids

Question 83

Treatment for trigeminal neuralgia

Answer 83

Carbamazepine

Question 84

Imaging for suspected stroke

Answer 84

CT scan without contrast (hemorrhage appears as white hyperdense regions in parenchyma; ischemic strokes are hypodense until >24 hrs after event)

Question 85

Rx for anorexia in cancer; HIV?

Answer 85

C: progesterone (megestrol, medroxyprogesterone), corticosteroids H: cannabinoid

Question 86

Low haptoglobin indicates?

Answer 86

Hemolysis

Question 87

Elevated LDH indicates?

Answer 87

Hemolysis

Question 88

Low haptoglobin with elevated bilirubin and LDH indicate?

Answer 88

Intravascular hemolysis

Question 89

If hemolytic anemia, cytopenias, and hypercoagulable state (presence of thrombus) suspicious of?

Answer 89

Paroxysmal nocturnal hemoglobinuria

Question 90

Zinc deficiency Sx?

Answer 90

- Alopecia - pustular skin rash (perioral) - impaired wound healing - impaired taste - immune dysfxn

Question 91

Anion gap metabolic acidosis after Sz Rx?

Answer 91

Repeat tests after 2 hrs in post-ictal lactic acidosis - usually resolves in 90 mins.

Question 92

High stepping (steppage gait) due to right foot drop secondary to?

Answer 92

L5 radiculopathy or common peroneal nerve neuropathy

Question 93

Porcelein gallbladder (calcium rim on CT) at risk for?

Answer 93

Gallbladder adenocarcinoma

Question 94

1st line for MS attacks?

Answer 94

Glucocorticoids

Question 95

Refractory MS attack Rx to steroids?

Answer 95

Plasmapheresis

Question 96

Allergic/irritant contact dermatitis Sx?

Answer 96

Erythema Papules/vesicles Lichenification Fissures

Question 97

Initial screening in suspected thalassemia?

Answer 97

CBC, if abnormal and MCV is low (iron, TIBC, and ferritin normal in thalassemia vs iron def.), then Hgb electrophoresis.

Question 98

Mitral regurgitation sound?

Answer 98

Holosystolic @apex w/ radiation to axilla

Question 99

Isoniazid leads to neuropathy due to what deficiency?

Answer 99

Pyridoxine (B6)

Question 100

Hazard ratio definition? (as in a study outcome)

Answer 100

Ratio of an event rate occurring in Rx arm versus non-treatment arm. Ratio>1 indicate Rx arm has higher rate of events, <1 ratio means lower rate.

Question 101

Adrenal adenoma or bilateral adrenal hyperplasia Rx?

Answer 101

Aldosterone antagonist (spirinolactone/eplerenone) or surgery for adenoma (unless poor candidate)

Question 102

Pernicious anemia is the most common cause of what?

Answer 102

B12 deficiency

Question 103

Pernicious anemia is associated with what cancer?

Answer 103

Double risk of gastric cancer

Question 104

Hypovolemic hypernatremia Rx?

Answer 104

IV 0.9% saline

Question 105

Desmopressin admin for what?

Answer 105

Differentiate Central DI (No ADH) from Nephrogenic DI (No response)

Question 106

Most common causes of hyperkalemia are?

Answer 106

Acute/chronic kidney disease, meds (ß-blockers, K+-sparing drugs, ACEI/ATII blocker, NSAIDs, trimethoprim), disorders of RAA

Question 107

Tricuspid regurgitation and right sided HF are caused by what syndrome?

Answer 107

Carcinoid syndrome - plaque-like fibrous deposits on endocardium in R>L heart

Question 108

24-hour test for what in carcinoid syndrome?

Answer 108

5-hydroxyindoleacetic acid (5-HIAA)

Question 109

Dx: Decreased FEV1/FVC ratio, decreased FEV1, normal FVC, normal DLCO

Answer 109

Chronic bronchitis

Question 110

Dx: Decreased FEV1/FVC ratio, decreased FEV1, normal FVC, decreased DLCO

Answer 110

Emphysema (low DLCO from destroyed alveoli)

Question 111

Dx: Decreased FEV1/FVC ratio, decreased FEV1, normal FVC, elevated DLCO

Answer 111

Asthma

Question 112

Obstructive pattern PFTs

Answer 112

- Decreased FEV1/FVC - Decreased FEV1 - Normal FVC

Question 113

Restrictive pattern PFTs

Answer 113

- Normal/elevated FEV1/FVC - Normal/somewhat low FEV1 - Low FVC - DLCO is either normal or low (unless morbidly obese then high)

Question 114

Precision measures?

Answer 114

Random error in a study (The smaller the confidence interval is, the more precise.)

Question 115

Carcinoid syndrome causes what vitamin deficiency?

Answer 115

Niacin (Niacin and serotonin made from tryptophan. Serotonin overprodxn = deficient niacin = pellagra).

Question 116

In HIV, PPD resulting in induration ≥5mm requires?

Answer 116

Isoniazid and pyridoxine Rx for latent TB

Question 117

What size PPD requires treatment in nonimmunocompromised person?

Answer 117

≥15mm

Question 118

Attributable risk measures?

Answer 118

Measure of impact attributed to a risk factor (i.e. impact of diet on colon cancer risk)

Question 119

Calculate attributable risk

Answer 119

Calculation: (RR - 1)/RR Words: (risk in exposed - risk in unexposed)/risk in exposed

Question 120

BSA in Stephen Johnson vs Toxic-epidermal necrosis

Answer 120

``` 10% = SJS 10-30% = SJS/TEN overlap 30+ = TEN ```

Question 121

Classic SJS/TEN Sx

Answer 121

Skin and mucosal (oral) macules, vesicles, bullae (mucocutaneous)

Question 122

Nonosmotic stimuli (i.e. hypovolemia) results in ADH secretion leading to what?

Answer 122

Hypovolemic hyponatremia (more H2O uptake than Na+ reuptake) - once hypovolemia corrected (euvolemia), ADH shuts off, and body corrects hyponatremia via RAAS

Question 123

Most common porphyria?

Answer 123

Porphyria cutanea tarda (uroporphyrinogen decarboxylase deficiency) - blisters w/ skin fragility are classic - commonly an extrahepatic manifestation of HepC

Question 124

Most common cause AR in young adults in developed world?

Answer 124

Congenital bicuspid aortic valve

Question 125

Scleroderma renal crisis typical presentation?

Answer 125

Acute renal failure with no previous renal disease and malignant HTN (HA, blurry vision, nausea)

Question 126

First step in hypercalcemia management?

Answer 126

Normal saline and calcitonin

Question 127

High levels of estrogen (e.g. pregnancy, OCs, HRT) can lead to what changes in total vs free T4?

Answer 127

Total T4 elevated due thyroid binding globulin via reduced catabolism/increased synth in the liver. Free T4 (unbound by TBG/albumin) is normal (euthyroid).

Question 128

Treatment for hyperthyroidism/storm?

Answer 128

ß-blocker, PTU

Question 129

AR murmur sound?

Answer 129

Blowing diastolic/decrescendo after A2

Question 130

AR murmur best heard?

Answer 130

LLSB w/ Pt sitting up and leaning forward with full expiration

Question 131

Labs/Hx in nonalcoholic fatty liver disease?

Answer 131

Labs: Steatohepatitis (AST/ALT ratio<1) Hx: No alcohol Hx *NAFLD resembles alcohol induced liver disease, but without EtOH Hx

Question 132

Path of nonalcoholic fatty liver disease?

Answer 132

Insulin resistance (elevated FFA Tx from adipose to liver due to peripheral lipolysis/TG synth/hepatic FFA uptake)

Question 133

Mycoplasma pneumonia onset vs S. pneumoniae?

Answer 133

Indolent (vague) vs abrupt in S. pneumoniae

Question 134

Mycoplasma pneumonia CXR vs S. pneumoniae?

Answer 134

Interstitial infiltrate vs lobar in S. pneumoniae

Question 135

Mycoplasma pneumonia skin signs vs S. pneumoniae?

Answer 135

Myco: Maculovesicular rash SP: Rash very rare

Question 136

Common medications causing priapism?

Answer 136

Trazadone, prazosin

Question 137

Common diseases causing priapism?

Answer 137

Sickle cell, leukemia

Question 138

Isoniazid therapy can cause what vitamin deficiencies?

Answer 138

Most commonly B6 (pyridoxine), but also B3 (niacin)

Question 139

2 groups at risk for subdural hematoma?

Answer 139

Elderly and alcoholics (both have cerebral atrophy and increased fall risk)

Question 140

Common causes of ill esophagitis?

Answer 140

``` PAINT-B: Tetracyclines NSAIDs ASA Bisphosphonates Potassium chloride Iron ```

Question 141

2 common locations for stenosis in fibromuscular dysplasia?

Answer 141

Internal carotid artery stenosis = HA | Renal artery stenosis = HTN

Question 142

Most common organism causing IE after UTI?

Answer 142

Enterococci

Question 143

Most common organism causing IE after dentist visit or respiratory tract incision?

Answer 143

Viridans stretococci

Question 144

Most common organism causing IE after pacemaker/prosthesis/catheter placement?

Answer 144

S. aureus (also IV drug use) | S. epidermidis

Question 145

Most common organism causing IE in colon carcinoma or IBD?

Answer 145

Streptococcus gallolyticus (S. bovis)

Question 146

Hypokalemia, alkalosis and normotension may indicate what causes?

Answer 146

Surreptitious vomiting Diuretic abuse Bartter syndrome Gitelman's syndrome

Question 147

Urine Ca++ and serum Mg++ in Bartter vs Gitelman's syndrome?

Answer 147

B: UCa++ excretion high, normal serum Mg++ G: UCa++ excretion low, low serum Mg++

Question 148

Most appropriate tests for acute Hep B infxn?

Answer 148

HBsAg | anti-HBc IgM

Question 149

Liver enzymes in acute Hep B infxn?

Answer 149

ALT>AST spike around 3 months or after 4-8wks (about same time IgM anti-HBc appears)

Question 150

MCC of polyuria in nonhospitalized Pts?

Answer 150

DM. primary polydipsia, DI

Question 151

Polyuria, increased water intake with dilute urine (<1/2 plasma Osm), and hyponatremia classic for?

Answer 151

Primary polydipsia

Question 152

Polyuria, increased water intake with dilute urine (<1/2 plasma Osm), and Na+>145 indicates?

Answer 152

DI - Central: impaired thirst mechanism leads to severe hypernatremia (>150) - Neph: Intact thirst mech, adequate water intake, maybe normal Na+

Question 153

Absence of polyuria, concentrated urine (Uosm>100), hypotonic serum osmolality (<275), hyponatremia, low Serum uric acid level indicates?

Answer 153

SIADH

Question 154

Postvoid residual bladder volume over what value is diagnostic for urinary retention?

Answer 154

>50mL

Question 155

Appearance of pyoderma gangrenosum?

Answer 155

Inflamed pustule that expands to ulcer with purulent base/violaceous borders

Question 156

Pyoderma gangrenosum assoc. with what disease?

Answer 156

Systemic inflamm. disease: IBD, RA, hematologic issues (AML)

Question 157

Initial imaging modality for gastric adenocarcinoma?

Answer 157

CT scan - determine stage (usually detected late; stage 3-4)

Question 158

Management of Pt w/ claudication due to PAD?

Answer 158

1. Smoking cessation 2. ASA, statins 3. Exercise program (most useful for Sx reduction) 4. Surgery/stenting reserved only for failure to improve w/ exercise

Question 159

Red-flag symptoms for cavernous sinus thrombosis?

Answer 159

Severe HA Bilat. periorbital edema CN 3, 4, 5, 6 deficits

Question 160

Lead poisoning Sx?

Answer 160

Stocking glove neuropathy | Microcytic anemia

Question 161

Arsenic poisoning Sx?

Answer 161

- Stocking glove neuropathy w/ burning/pain, weakness, hyporeflexia - Skin hypo/hyperpigmentation and hyperkeratosis - Pancytopenia - Hepatitis

Question 162

Arsenic OD Rx?

Answer 162

Dimercaprol, Succimer (dimercaptosuccinic acid)

Question 163

Primary sclerosing cholangitis labs/imaging?

Answer 163

Labs: Elevated alk phos; usualy ATs <300 I: ERCP confirms Dx showing "beads on a string" intra/extrahepatic duct dilation

Question 164

Priary sclerosing cholangitis comorbid disease?

Answer 164

Ulcerative colitis (unlike PBC)

Question 165

Primary biliary cholangitis (or cirrhosis) antibody?

Answer 165

Antimitochondrial antibody

Question 166

Primary biliary cholangitis (or cirrhosis) affected duct?

Answer 166

Intrahepatic only

Question 167

Trimethoprim lab abnormalities?

Answer 167

Blocks Na+ channel in CT like amiloride diuretic - Hyperkalemia (must do serial check in AIDS on high doses) - Creatinine elevation

Question 168

Pulsus paradoxus occurs with what conditions?

Answer 168

- Cardiac tamponade | - Severe asthma/COPD (high pressure elevation intrathorax during inspiration = blood pooling = low left vent. preload)

Question 169

Imaging for uric acid stones?

Answer 169

CT as they are radiolucent, US or IV pylogram

Question 170

Findings on PE coarctation?

Answer 170

Brachial-femoral delayed pulse, upper/lower BP differential, continuous murmur

Question 171

Sx in coarctation?

Answer 171

Epistaxis, HA, claudication

Question 172

Oliguria definition?

Answer 172

≤250mL urine output in 12 hours

Question 173

Atypical pneumonia after travel w/ high fever, GI Sx, confusion, and hyponatremia are signs of?

Answer 173

Legionnaires' disease (gram neg. rod, intracellular = poor staining - often shows up as PMNs w/o organism)

Question 174

Legionnaires' disease Rx?

Answer 174

Macrolides, flouroquinolones

Question 175

Postcholecystectomy syndrome presentation?

Answer 175

Persistent abd pain/dyspepsia occurring months/years after cholecystectomy

Question 176

Best Rx for primary hyperparathyroidism?

Answer 176

Parathyroidectomy or bisphosphonates in those who decline surgery and have osteopenia/osteoporosis

Question 177

Primary hyperparathyroidism labs?

Answer 177

Asymptomatic hypercalcemia, hypophosphatemia, and elevated PTH

Question 178

Familial hypocalciuric hypercalcemia labs?

Answer 178

Hypercalcemia, elevated PTH, but low urinary calcium excretion (<100mg/24hrs)

Question 179

Median definition?

Answer 179

To the right or left of the mode (peak) of curve if data skewed positively/negatively. Value in the middle of a dataset (divides right from left - e.g. 18, 20, 21, 22, 22 - median is 21; If there are even number of values, add middle two and divide by 2).

Question 180

Mode definition?

Answer 180

The peak of the curve. Most frequent dataset - e.g. 9, 10, 9, 15, 12 - then 9 is mode; can have more than one mode in a dataset if the several values have the same frequency.

Question 181

Mean definition?

Answer 181

Always the most right or left on a curve if the curve is skewed positively or negatively. Sum of all observations divided by the number of observations; the average

Question 182

Rx in exercise induced asthma?

Answer 182

Antileukotrienes (mast cell stabilization) and albuterol taken 10-20 minutes prior to exercise

Question 183

Bright red, firm, friable, exophytic nodules on skin of HIV+?

Answer 183

Bacillary angiomatosis (Bartonella)

Question 184

Rx for bacillary angiomatosis (Bartonella)?

Answer 184

Oral erythromycin

Question 185

Papular lesions (trunk/face/extremities) that become plaques/nodules starting as light brown to pink to dark violet in HIV+?

Answer 185

Kaposi Sarcoma (HSV 8)

Question 186

Broca's area location?

Answer 186

Dominant (left hemisphere in right hander and most left handers) frontal lobe

Question 187

Wernicke's area location?

Answer 187

Dominant (left hemisphere in right hander and most left handers) posterior temporal lobe

Question 188

Classic psoriatic arthritis pattern?

Answer 188

DIP joints effected Morning stiffness Dactylitis (sausage fingers) Nail involvement (pitting, onycholysis - separation of nail bed)

Question 189

Age range for HPV vax?

Answer 189

Women recommended 11-12yrs (9-26 at latest) | Men up to 21yrs

Question 190

Tdap vax recommendation?

Answer 190

Single dose at 11yrs and Td q 10 yrs after

Question 191

Pap smear recommendations?

Answer 191

21-29 q 3 yrs | 30-65 q 5 yrs

Question 192

Duodenal ulcer pain improved by?

Answer 192

Eating

Question 193

Gastric ulcer pain worsened by?

Answer 193

Eating

Question 194

Suppurative (infective) thyroiditis labs/Sx?

Answer 194

Euthyroid High fever Pain at thyroid gland Palpable enlargement of thyroid

Question 195

Subacute (de Quervain) thyroiditis Labs/Sx?

Answer 195

``` Elevated free T4/low TSH (early) Hypothyroidism (late) followed by recovery Recent infxn Fever Tender goiter ESR elevated ```

Question 196

Chronic lymphocytic (Hashimoto) thyroiditis labs/Sx?

Answer 196

Hypothyroidism (low free T4/high TSH) Nontender goiter Absence of fever

Question 197

Non-anion gap metabolic acidosis and hyperkalemia out of proportion to renal dysfxn indicate?

Answer 197

Renal tubular disorder

Question 198

Renal tubular acidosis is a group of disorders characterized by?

Answer 198

Non-anion gap metabolic acidosis in the presence of preserved kidney fxn

Question 199

Path/labs in Type 1 RTA?

Answer 199

Type 1 "Classic" distal RTA: Defective H+ secretion in distal tubule--> defective pH gradient --> hyperchloremia and poor bicarb. reuptake Hypokalemia Metabolic acidosis High urine pH (>6) Nephrolithiasis common (up to 70% have stones)

Question 200

Path/labs Type II Proximal RTA?

Answer 200

Type II proximal RTA: Similar to type 1 in that: Defective bicarbonate reuptake in proximal tubule causes metabolic acidosis --> hyperchloremia and hypokalemia, but may be due to Fanconi syndrome w/ loss of glucose, AAs, PO4, Ca++, K+ or multiple myeloma; no nephrolithiasis as in Type 1 RTA

Question 201

Path/labs Type IV RTA?

Answer 201

Type IV RTA: Aldosterone deficiency or antagonism causes reduced hyperchloremia, hyperkalemia, non-anion gap metabolic acidosis, salt wasting

Question 202

Hemiparesis w/ motor aphasia location lesion?

Answer 202

Frontal cortex of dominant lobe

Question 203

Hemiparesis without motor aphasia location lesion?

Answer 203

Frontal cortex of nondominant lobe

Question 204

Receptive aphasia location lesion?

Answer 204

Left temporal lobe

Question 205

Visual disturbances brain lesion location?

Answer 205

Occipital lobe

Question 206

Hemi-neglect syndrome lesion location?

Answer 206

Ignoring entire side (e.g. shaving only one side of face); involves right (non-dominant) parietal lobe (even in most left handers ~70%).

Question 207

Bleeding in diverticulosis is commonly what color?

Answer 207

Arterial bleeding, thus, frank red bloody stool

Question 208

Pathology of angiodysplasia of colon?

Answer 208

Tortuous, dilated veins in submucosa in colon wall; common cause of painless GI bleeding frequently missed on colonoscopy; usually low volume bleeding

Question 209

Suspect what with recurrent, painless, maroon colored GI bleeding without definitive Dx after colonoscopy?

Answer 209

Angiodysplasia of the colon (Diverticulosis would be frank red blood and larger-volume hemorrhage)

Question 210

Rare, AR disease characterized by abnormal copper deposition in liver, basal ganglia, and cornea?

Answer 210

Wilson's disease

Question 211

Test for Wilson's disease?

Answer 211

Low serum ceruloplasmin w/ elevated urinary copper and Kayser-Fleischer rings

Question 212

Steatorrhea w/ an Hx of longstanding alcohol abuse suspicious for?

Answer 212

Pancreatic insufficiency/cancer

Question 213

Acute reversal of warfarin-associated bleeding?

Answer 213

Prothrombin complex concentrate (PCC; contains clotting factors; onset minutes) or fresh frozen plasma (if PCC not available) and vitamin K admin (12-24hr onset)

Question 214

Long-term reversal of warfarin-associated bleeding?

Answer 214

IV Vitamin K (12-24 hours onset)

Question 215

Protamine sulfate indication?

Answer 215

Heparin reversal, not warfarin

Question 216

Prothrombin complex concentrate indication?

Answer 216

Acute warfarin reversal; contains clotting factors

Question 217

Relative risk <1 interpretation?

Answer 217

Exposed are less likely to have condition than unexposed (e.g. pericarditis trials: those w/ colchicine less likely to get recurrent pericarditis than those on placebo)

Question 218

Relative risk >1 interpretation?

Answer 218

Exposed have higher incidence of disease than unexposed (e.g. smoking and lung cancer incidence)

Question 219

Nephritic syndrome casts?

Answer 219

RBC or mixed

Question 220

Localized nonpitting thickening and induration of the skin over the lower legs/pretibial area/dorsum of feet Dx?

Answer 220

Graves disease

Question 221

Severe abd. pain after meal that presents with w/ vomiting and elevated lipase Dx?

Answer 221

Acute gallstone pancreatitis

Question 222

Dx of IE criteria?

Answer 222

Modified Duke criteria: 2 major, 1 major + 3 minor Major criteria - 1. Blood culture + (S. viridians, S. auereus, Enterococcus) 2. Echo shows valvular vegetation Minor: IV drug use, fever >100.4, embolic signs, etc.

Question 223

Reduced vital capacity and total lung capacity but normal FEV1/FVC in a young male with back pain/high ESR suspect?

Answer 223

Ankylosing spondylitis

Question 224

Caustic ingestion managment?

Answer 224

Endoscopy w/in 12-24hrs to assess for severity. Charcoal or acid neutralization are not recommended.

Question 225

Amaurosis fugax presentation?

Answer 225

Rapid, painless, transient (<10 minutes) monocular vision loss

Question 226

Amaurosis fugax imaging?

Answer 226

Duplex US of neck

Question 227

Most common cause of spontaneous lobar (e.g. parietal, occipital) hemorrhage in the elderly?

Answer 227

Cerebral amyloid angiopathy

Question 228

Cerebral amyloid angiopathy associated disease?

Answer 228

Alzheimer's disease (ß-amyloid deposition in walls of small-medium vessels.

Question 229

Osler-Weber-Rendu syndrome is associated with hemoptysis and shunting in the lungs due to?

Answer 229

Pulmonary AVM | It's also called hereditary telangiectasia.

Question 230

Ingested enterotoxin bugs?

Answer 230

S. aureus Bacillus cereus (Quick onset - hours; Vomiting)

Question 231

Enterotoxin made in intestine bugs?

Answer 231

C. perfringens ETEC Vibrio cholerae (Delayed onset >1day; watery/bloody diarrhea)

Question 232

Bacterial epithelial invasion bugs?

Answer 232

Campylobacter jejuni Nontyphoidal salmonella Listeria (Watery/bloody diarrhea; fever)

Question 233

Acute angle closure glaucoma Sx?

Answer 233

Severe eye pain Blurred vision Nausea/vomiting

Question 234

Open angle glaucoma Sx?

Answer 234

Insidious onset w/ gradual vision loss peripherally due to cupping of optic disk

Question 235

Management of mild hypercalcemia (<12) of malignancy to bone?

Answer 235

Bisphosphonates

Question 236

Ankylosing spondylitis PE presentation?

Answer 236

``` UDARE: Uveitis Dactylitis (sausage finger) Arthritis (sacroiliitis) Reduced chest expansion/spinal mobility Enthesitis (tenderness at tendon insertion) ```

Question 237

Ankylosing spondylitis relieved by?

Answer 237

Exercise, worsened by rest

Question 238

Common complications of ankylosing spondylitis?

Answer 238

Osteoporosis/Fx Aortic regurg Cauda equina

Question 239

Solitary, hard, nontender lymph nodes in the head and neck are characteristic of?

Answer 239

Squamous cell carcinoma

Question 240

A/a ratio oxygen gradient def?

Answer 240

The A/a ratio indicates the percentage of alveolar PO2 located in the arteriolar PO2.

Question 241

When V/Q elevated (as in PE), what happens to A/a oxygen gradient?

Answer 241

A/a increases on ABG (alveolar PO2 increases vs arteriolar)

Question 242

Rx for viral/idiopathic pericarditis?

Answer 242

NSAIDs and colchicine

Question 243

Young man (<40) with insidious onset arthritic pain with pain at the insertion sites of tendons Dx?

Answer 243

Ankylosing spondylitis (Enthesis - pain at tendon insertion sites)

Question 244

Sudden onset pulm edema with a new holosystolic murmur w/in 3-5 days of an MI Dx?

Answer 244

Papillary muscle rupture (severe mitral regurg)

Question 245

Sudden onset CP, pulm edema w/ new holosystolic murmur, biventricular failure and shock after 3-5 days of an MI Dx?

Answer 245

Interventricular septum rupture

Question 246

Free wall rupture time period?

Answer 246

5 days - 2 wks

Question 247

Free wall rupture presentation?

Answer 247

Cardiac tamponade

Question 248

Blastomycosis may resemble histoplasmosis and tuberculosis, but what differentiates it from the others?

Answer 248

Skin lesions and lytic bone lesions

Question 249

Acute asthma exacerbation PaCO2?

Answer 249

Resp alkalosis (low PaCO2, high pH) 2° to hyperventilation

Question 250

Normal or elevated PaCO2/normal pH in acute asthma exacerbation suggests?

Answer 250

Impending respiratory failure (due to severe muscle fatigue or severe air trapping)

Question 251

Corneal vesicles an dendritic ulcers on eye Dx?

Answer 251

Herpes simplex keratitis

Question 252

Path of Factor V Leiden?

Answer 252

Hypercoagulable state caused by protein C resistance

Question 253

Lupus anticoagulant Path?

Answer 253

Antiphospholipid antibody prolongs the PTT in diagnostic testing, but results in hypercoagulability and venous clots

Question 254

von Willebrand disease path?

Answer 254

MCC bleeding time and PTT increase. PT is normal.

Question 255

Vit K labs?

Answer 255

Acquired bleeding disorder causing prolonged PTT and PT.

Question 256

DIC path?

Answer 256

Depletion of clotting factors and secondary fibrinolysis results in bleeding.

Question 257

DIC labs?

Answer 257

``` Hemodynamic compromise (hypotension/tachycardia) assoc. with: Thrombocytopenia Prolonged PT/PTT Decreased fibrinogen Schistocytes on smear ```

Question 258

Bulbar symptoms area damage?

Answer 258

Dysphagia, dysarthria, etc. caused by brainstem (bulbar) damage and cranial nerve problems

Question 259

Classic symptoms of glucagonoma?

Answer 259

Mild DM/hyperglycemia (easily controlled by meds) Necrotic migratory erythema (pustular rash) Diarrhea Anemia Weight loss

Question 260

Glucagonoma lab Dx?

Answer 260

Glucagon>500pg/mL

Question 261

Smoked with vital capacity that is 65% of predicted likely Dx?

Answer 261

COPD (decreased FVC and increased total lung capacity): FEV1 disproportionately decreased vs FVC, thus, FEV1/FVC is low.

Question 262

Define adjuvant therapy

Answer 262

Rx given in addition to standard Rx

Question 263

Consolidation therapy definition

Answer 263

Given after induction Rx with multidrug regimens to further reduce tumor burden

Question 264

Induction therapy define

Answer 264

Initial dose of Rx to rapidly kill tumor cells and send Pt into remission (<5% tumor burden)

Question 265

Define maintenance therapy

Answer 265

Given after induction and consolidation therapies (or initial standard Rx) to kill residual tumor and keep Pt in remission

Question 266

Define neoadjuvant therapy

Answer 266

Treatment given before the standard therapy for a disease (e.g. radiation given prior to radical prostatectomy)

Question 267

Salvage therapy definition

Answer 267

Treatment for a disease when standard therapy fails (e.g. radiation for PSA recurrence after radical prostatectomy)

Question 268

Screening test assessing risk for future diabetic foot ulcers?

Answer 268

Monofilament test

Question 269

Most common underlying cause of diabetic foot ulcers?

Answer 269

Diabetic neuropathy (reduces pain/pressure perception leading to microcirculation/skin integrity impairment)

Question 270

Rx for bullous pemphigoid?

Answer 270

Topical clobetasol

Question 271

Path of lacunar strokes?

Answer 271

Microatheroma (plaque) formation and lipohyalinosis (vessel wall thickening in brain) lead to thrombotic small-vessel occlusion

Question 272

Lacunar stroke Sx?

Answer 272

Often internal capsule infarction leads to pure motor hemiparesis on contralateral side. Absence of "cortical" signs (aphasia, agnosia, neglect, apraxia, hemianopia), Sz, and AMS supports Dx. Basal ganglia and pons also possible.

Question 273

Carotid artery dissxn Sx?

Answer 273

Head or neck pain followed by partial ipsilateral Horner (ptosis/miosis w/o anhidrosis) due to postganglionic sympathetic fiber damage often after trauma

Question 274

Cerebral vasospasm cause/Sx?

Answer 274

Often w/ amphetamine/cocaine leading to stroke

Question 275

Cerebral sinus thrombosis cause/Sx?

Answer 275

Often in hypercoag. state (contraceptives/malig) leads to HA, AMS, SZ, focal deficits

Question 276

Path of Zollinger Ellison syndrome?

Answer 276

Gastrinoma leads to hyperplasia of parietal cells and acid overprodxn. Deactivation of pancreatic enzymes can lead to injury of the mucosa and ulcers in the duodenum/jejunum.

Question 277

Management of asymptomatic gallstones?

Answer 277

No treatment

Question 278

Erythema multiforme presentation?

Answer 278

Target lesion with red iris shaped macules that may contain vesicles. Painful/pruritic on extensors.

Question 279

Mutation responsible for polycythemia vera?

Answer 279

JAK2 mutation in myeloid precursor

Question 280

Mainfestations of polycythemia vera?

Answer 280

HTN, erythromelalgia (burning cyanosis in hands/feet), Aquagenic pruritis, transient visual changes, thrombosis, facial plethora

Question 281

Polycythemia vera labs?

Answer 281

Elevated Hgb/Hct Leukocytosis/thrombocytosis Low EPO

Question 282

Acute Rx in AAA?

Answer 282

Beta blocker

Question 283

Polycythemia vera Rx?

Answer 283

Serial phlebotomy

Question 284

Radioiodine ablation of thyroid in Graves can lead to?

Answer 284

``` Hypothyroid Worsened ophthalmopathy (proptosis, periorbital puffiness) ```

Question 285

PaO2/FiO2 ratio Dx for ARDS?

Answer 285

≤300mmHg

Question 286

Management of frostbitten skin?

Answer 286

Rapid rewarming of affected area in warm bath (37-39°C). Debridement if needed afterwards and after assessment.

Question 287

Common condition leading to dead space ventilation?

Answer 287

PE. Pneumonia does not cause significant alterations in dead space ventilation.

Question 288

SpO2 in a patient with pneumonia changes depending on which side they are laying on due to what?

Answer 288

Right-to-left intrapulmonary shunting and V/Q mismatch. Alveolar consolidation results in impaired ventilation. If a L. sided PNA, then laying on L. side results in elevated blood flow to that area, poor V/Q and then hypoxemia.

Question 289

Panacinar (panlobular) emphysema cause/location?

Answer 289

Alpha-1 antitrypsin deficiency; bases (bilateral basilar lucency)

Question 290

Cantriacinar (Centrilobular) emphysema cause/location?

Answer 290

Smoking; apex

Question 291

Consider what Dx if Hx of unexplained liver disease in young patient?

Answer 291

Alpha-1 antitrypsin deficiency

Question 292

Alpha-1 antitrypsin (AAT) deficiency Rx?

Answer 292

IV supplementation of pooled human AAT

Question 293

Exertional dyspnea and S4 likely indicates what?

Answer 293

Diastolic heart failure

Question 294

S4 path?

Answer 294

S4 corresponds w/ atrial contraction and is believed to result from blood striking stiff L. vent

Question 295

Best tool to address medical errors by physician communication failure?

Answer 295

Signout checklists reduce medical errors secondary to communication failures

Question 296

Pain with reduced internal rotation and abduction at hip joint, and normal initial Xray and normal ESR findings suspect what?

Answer 296

Osteonecrosis

Question 297

Peripheral edema is a common SE in what HTN medicine class?

Answer 297

Calcium channel blockers (25% after 6 months)

Question 298

Inspiration Fx on heart size?

Answer 298

RV increases volume, LV shrinks (low preload), split S2

Question 299

Early systolic murmurs?

Answer 299

MR TR VSD

Question 300

Midsystolic ejection murmurs?

Answer 300

``` Innocent murmur Flow murmur (e.g. pregnancy) Aortic sclerosis Aortic stenosis Aortic outflow obstruction (valvular, HCM) Pulmonic stenosis ```

Question 301

Holosystolic murmurs?

Answer 301

MR TR VSD

Question 302

Late systolic murmur?

Answer 302

MVP (MCC)

Question 303

Early diastolic murmurs?

Answer 303

AR PR LAD artery stenosis (Dock's murmur - due to stenosis in the artery)

Question 304

Mid-diastolic or late diastolic murmurs?

Answer 304

Mitral stenosis Tricuspid stenosis Prosthetic mitral valve Atrial myxoma

Question 305

Continuous murmur?

Answer 305

PDA | Coarctation

Question 306

Abd. pain, microcytic anemia, positive fecal occult blood, and hepatomegaly is typical of?

Answer 306

GI malignancy. Mets to the liver is the most common colon cancer malignancy site.

Question 307

PE differentiation of hypovolemic, euvolemic, and hypervolemic hyponatremia?

Answer 307

Hypo: volume depletion (dry membranes) Eu: Moist membranes, no edema Hyper: Edema, JVD

Question 308

Hyponatremia level?

Answer 308

<135mEq/L

Question 309

Secondary syphilis systemic symptoms?

Answer 309

Fever, malaise Widespread lymphadenopathy (esp. epitrochlear - inner arm) Diffuse maculopapular rash (starts on trunk then to ex.) Grey mucosal patches

Question 310

Rash in gonoccocal infxn?

Answer 310

Pustular with rash

Question 311

Sx in Rocky mountain SF?

Answer 311

High fever, HA, maculopapular rash spreading centripetally toward trunk (hands and soles) that later develops into petechiae

Question 312

EKG in hypokalemia?

Answer 312

Broad flat T waves, U waves, ST depression, and PVCs

Question 313

Modified Wells criteria?

Answer 313

``` 3 points: - Clinical DVT signs - Alt. Dx less likely than PE 1.5 points: - Previous PE/DVT - Tachycardia (>100) - Recent surgery or immobilization 1 point: - Hemoptysis - Cancer ```

Question 314

Modified Wells of <4, next step?

Answer 314

D-dimer testing: helpful to establish need for more testing. Does not rule in PE, specifically.

Question 315

Modified Wells 4+, next step?

Answer 315

CTA, then anticoagulation for PE if positive.

Question 316

What quality differentiates vitiligo from Tinea versicolor?

Answer 316

Vitiligo is completely dipigmented (white skin) vs tinea versicolor which causes salmon, hyper, or hypopigmentation macules (may appear hypopigmented after sun exposure due to tanning of surrounding skin). Dx via scrapings and KOH stain.

Question 317

Organism in tinea versicolor?

Answer 317

Malassezia species

Question 318

Iron deficiency anemia levels: iron, ferritin, TIBC, transferrin, RDW?

Answer 318

``` Iron: Low Fe: low TIBC: high Tr: low RDW: high ```

Question 319

Anemia of chronic disease levels: iron, ferritin, TIBC, transferrin, RDW?

Answer 319

``` Iron: Low F: high TIBC: low Tr: low RDW: normal ```

Question 320

Iron deficiency in men likely due to?

Answer 320

Chronic GI bleed

Question 321

Thallassemia disease levels: iron, ferritin, TIBC, transferrin, RDW?

Answer 321

Normal to high in all categories, and TIBC normal.

Question 322

Hormones testing in MEN2A or 2B?

Answer 322

Calcitonin (Medullary thyroid cancer) Plasma fractionated metanephrine assay (pheo) PTH (2A only)

Question 323

JVD in association with pleuritic chest pain may indicate?

Answer 323

PE and right atrial pressure elevation

Question 324

Slight miosis of pupils with normal pupillary constriction/accommodation but no rxn to light?

Answer 324

Argyll Robertson pupils (tabes dorsalis)

Question 325

Tabes dorsalis CNS Sx?

Answer 325

Sensory ataxia, lancinating pains, reduced/absent DTRs, Argyll Robertson pupils

Question 326

GERD predisposes to formation of what conditions?

Answer 326

Barret's esophagus Erosive esophagitis Esophageal (peptic) stricture

Question 327

Esophageal adenocarcinoma Sx?

Answer 327

Subtle retrosternal pain, mild dysphagia of solids, burning sensation, weight loss

Question 328

Esophageal adenocarcinoma imaging?

Answer 328

Barium swallow = asymmetric narrowing of esophagus

Question 329

Esophageal stricture Sx?

Answer 329

Dysphagia of solids, but no weight loss; resolution of GERD Sx after formation

Question 330

Esophageal stricture imaging?

Answer 330

Barium swallow = symmetric/circumferential narrowing of esophagus

Question 331

Fever, pharyngitis, and cervical lymphadenopathy present in?

Answer 331

Mononucleosis and Strep. Rarely found in gonococcal pharyngitis.

Question 332

MCC of gross lower GI bleed?

Answer 332

Diverticulosis (painless, frank red bleeding - often severe leading to lightheadedness and hemodynamic instability)

Question 333

Preferred Rx syphilis?

Answer 333

Benzathine PCN G for any stage

Question 334

Rx non-tertiary syphilis w/ severe allergy PCN?

Answer 334

Doxycycline (PCN desensitization actually not preferred due to cost)

Question 335

Rx tertiary syphilis w/ severe allergy PCN?

Answer 335

Ceftriaxone (CNS penetrating)

Question 336

MCC of vitamin B12 deficiency?

Answer 336

Pernicious anemia

Question 337

Suspect B12 deficiency with what Sx?

Answer 337

``` Megaloblastic anemia Atrophic glossitis (shiny tongue) Vitiligo Thyroid disease CNS Sx ```

Question 338

MC SE of isoniazid?

Answer 338

Peripheral neuropathy | Hepatotoxicity

Question 339

What occurs first, deficient B12 or folate?

Answer 339

Folate (months of deficient diet) | B12 (4-5 yrs diet deficiency)

Question 340

RFs for toxic megacolon?

Answer 340

C. diff infxn | IBD (may be initial presentation of IBD)

Question 341

Sx of Toxic Megacolon?

Answer 341

Systemic toxicity (fever, tachy, hypotension, leukocytosis, ESR up) Bloody diarrhea Abd. distention/peritonitis Colonic distention on imaging (Abd. Xray)

Question 342

Imaging for UC vs toxic megacolon?

Answer 342

UC: Barium enema TM: Abd Xray (barium enema contra'd due to perforation risk)

Question 343

Management of hyperkalemia w/ EKG changes?

Answer 343

Calcium gluconate

Question 344

Fat embolism presentation?

Answer 344

Resp distress Petechiae AMS

Question 345

Pulmonary contusion presentation?

Answer 345

``` Dyspnea Tachypnea Tachycardia Hypoxia Patchy/irregular infiltrates on CXR ```

Question 346

Amyloidosis clinical features?

Answer 346

``` Enlargement of any organ (Kidneys, etc.) Proteinuria or nephrotic syndrome Cardiomegaly and CHF Hepatomegaly Neuropathy Bleeding disorders Waxy/thick skin ```

Question 347

Dx of amyloidosis?

Answer 347

Abd. fat pad aspiration biopsy

Question 348

Rx of amyloidosis?

Answer 348

Colchicine for prevention and Rx

Question 349

Absent motor fxn and decreased pain/temp sensation bilaterally w/ proprioception, light touch, and vibratory sensation intact below the injury?

Answer 349

Anterior cord syndrome (spares dorsal columns for light touch/proprioception

Question 350

Left leg motor loss w/ diminished DTRs, proprioception, and vibration; loss of pain/temp sensation 1-2 levels below the lesion on the right side?

Answer 350

Brown-Sequard syndrome (hemisection of spinal cord; e.g. right T10 lesion = left T12 loss of pain/temp on)

Question 351

Dorsal columns carry?

Answer 351

Light touch/proprioception from lower segments

Question 352

Spinothalamic tract carry?

Answer 352

Ipsilateral pain/temp sense from lower segments

Question 353

Lateral corticospinal tracts carry?

Answer 353

Ipsilateral upper motor neurons (crosses at medulla/spinal cord)

Question 354

Anterior horn cells carry?

Answer 354

Ipsilateral lower motor neurons

Question 355

Common anemia in CKD?

Answer 355

Hypofroliferative (normochromic, normocytic) anemia due to low EPO

Question 356

Common SE from erythropoiesis-stimulating agents (ESAs) in CKD?

Answer 356

Iron deficiency, often presenting as microcytic, hypochromic anemia.

Question 357

Rx Toxoplasma encephalitis?

Answer 357

Sulfadiazine and pyrimethamine (plus leucovorin, a folinic acid supplement )

Question 358

Leucovorin coadmin with what drugs?

Answer 358

5-FU Methotrexate Pyrimethamine - Folinic acid supplement used to combat toxic Fx

Question 359

Ipsilateral hemiataxia lesion?

Answer 359

***Recall that corticopontocerebellar fibers decussate twice. Cerebellar Vermis = trunk Cerebellar hemisphere = limbs

Question 360

B12 and folate deficiency present with elevated levels of?

Answer 360

Methylmalonic acid (byproduct when B12 or folate cannot methylate)

Question 361

Most sensitive test for Myasthenia gravis?

Answer 361

ACh receptor antibodies. Edrophonium may be used to support Dx, but is not as specific.

Question 362

Associated imaging in myasthenia gravis?

Answer 362

Chest CT or MRI for thymoma (requires thmectomy)

Question 363

Winter's formula use?

Answer 363

Determine expected change in PaCO2 (ABG) in pH derangement (metabolic acidosis/alkalosis) and determines whether compensation is appropriate or not. If the measured PaCO2 is within the expected value calculated by Winter's formula, then considered compensated despite pH being normal or not.

Question 364

What is Winter's formula?

Answer 364

PaCO2=1.5*(HCO3-) + 8 (+/- 2)

Question 365

Treatment in alcoholic cardiomyopathy?

Answer 365

Alcohol cessation often leads to normalization of LV fxn

Question 366

Classic angina has what 3 qualities?

Answer 366

1. Substernal CP w/ usual quality and duration 2. Provoked by activity 3. Relieved by rest/nitro

Question 367

Atypical angina and nonanginal angina have how many classic signs?

Answer 367

Classic: 3/3 Atypical: 2/3 Nonanginal: <2/3

Question 368

Initial stress test in suspected stable ischemic heart disease?

Answer 368

Exercise ECG (Exercise stress test)

Question 369

Coronary angiography (cath) performed in patients with?

Answer 369

High-risk findings on initial stress testing and patients with high pretest probability

Question 370

Any hypertensive patient with hypokalemia suspect for?

Answer 370

Primary hyperaldosteronism. Na+ may be slightly high and metabolic alkalosis may occur.

Question 371

Best screening test when suspecting primary hyperaldosteronism?

Answer 371

Early-morning plasma aldosterone concentration to plasma renin activity ratio. PAC/PRA ratio >20 w/ plasma aldosterone >15ng/dL suggests primary aldosteronism. Next step is adrenal suppression testing.

Question 372

Sensitivity?

Answer 372

TP/(TP+FN)

Question 373

Specificity?

Answer 373

TN/(TN+FP)

Question 374

Brain tumor on MRI/Sx?

Answer 374

Tumor: HA, SZ, etc. with multiple, well-circumscribed (not irregular) lesions with vasogenic edema at the gray and white matter jxn

Question 375

Toxoplasmosis on brain MRI?

Answer 375

Toxo: HIV+ with fever and ring-enhancing lesions

Question 376

Infarxn on brain MRI/Sx?

Answer 376

Hemiparesis, sensory/motor stroke, without HA/SZ and deep brain lesions not at the gray/white matter jxn

Question 377

MS on MRI?

Answer 377

Well-circumscribed (not irregular) white matter lesions

Question 378

Do HIV+ patients have MS flares?

Answer 378

Rarely do advanced AIDS cases have MS flares.

Question 379

Primary CNS lymphoma on MRI?

Answer 379

Well-defined, enhancing focal lesion

Question 380

Virus assoc. with Progressive multifocal leukoencephalopathy?

Answer 380

JC virus. Reactivation in advanced HIV (CD4+<200).

Question 381

Progressive multifocal leukoencephalopathy on MRI/Sx?

Answer 381

Subacute neurologic changes and multiple, asymmetric nonenhancing brain lesions without mass effect (edema).

Question 382

Subacute sclerosing panencephalitis on imaging?

Answer 382

Post untreated measles sequelae. Scarring and atrophy of brain.

Question 383

Tick bite, febrile w/ systemic symptoms, leukopenia and thrombocytopenia, w/ elevated liver enzymes and LDH Dx?

Answer 383

Ehrlichiosis. Similar in presentation of Rocky Mountain Spotted Fever, but no rash.

Question 384

Rx Ehrlichiosis?

Answer 384

Doxycycline

Question 385

Rx Lyme disease?

Answer 385

Early localized infxn: Oral Doxycycline (if local erythema migrans, fatigue, HA, myalgia/arthralgia) Disseminated: IV Ceftriaxone (if multiple rash, facial palsy, meningitis, AV block, migratory arthralgias, or worse symptoms indicating further dissemination).

Question 386

Tick type in ehrlichiosis?

Answer 386

Lone star (SE, south central US)

Question 387

MC disease assoc. with popliteal cyst?

Answer 387

Arthritis

Question 388

Popliteal cyst pathology?

Answer 388

Synovial fluid from knee joint extrudes into gastrocnemius and semimembranosus bursa.

Question 389

Popliteal cyst Sx?

Answer 389

Painless bulge in popliteal space. Rupture can cause acute pain in calf like DVT with ecchymosis in the medial malleolus (crescent sign: crescent shape under malleus).

Question 390

Dermatitis herpetiformis is assoc. with?

Answer 390

Celiac's disease (diarrhea, weight loss, etc.)

Question 391

Dermatitis herpetiformis presentation?

Answer 391

Clusters of pruritic papules and vesicles on the elbows, knees, back, and butt.

Question 392

Rx of dermatitis herpetiformis?

Answer 392

Dapsone and gluten-free diet (if assoc. with celiac's)

Question 393

Substernal pain, radiation to arm, worse with exertion, relieved by rest and nitro. CP culprit?

Answer 393

Classic CAD CP

Question 394

Sharp/stabbing pain, worse with inspiration and when lying flat. CP culprit?

Answer 394

Pericarditis. PE or pneumothorax if resp. distress, hypoxia.

Question 395

Sudden, severe "tearing" pain radiating to back in elderly man w/ HTN and atherosclerosis risks. CP culprit?

Answer 395

Aortic dissxn

Question 396

Nonexertional CP w/ upper abd. pain and substernal location assoc. with regurg, nausea, dysphagia and pain worse at night. CP culprit?

Answer 396

GI/esophageal pain

Question 397

Persistent/prolonged CP that worsens with movement/changes in position often following repetitive movements. CP culprit?

Answer 397

Chest wall/MSK CP

Question 398

In a dehydrated patient with sugar of 900 and a measured sodium of 127 likely has what corrected sodium?

Answer 398

8 x 1.6 + 127 = 141.4; remember to correct Na+ in DKA or HHNK.

Question 399

In a dehydrated patient with sugar of 900 and a measured sodium of 127 likely has AMS due to?

Answer 399

High serum osmolality (hyperosmolarity). Though measured sodium is low, corrected sodium is 141.4 and normal.

Question 400

Dilated ventricles and diffuse hypokinesia with signs of CHF in a young person with recent URI Dx?

Answer 400

Viral myocarditis (Coxsackievirus B) that caused dilated cardiomyopathy.

Question 401

Dome-shaped, firm, freely movable cyst of nodule with a small central punctum that produces cheesy white discharge Dx?

Answer 401

Epidermal inclusion cyst. Typically regress over time without Rx.

Question 402

Benign, painless, SubQ rubbery and irregularly shaped mass with normal overlying epidermis Dx?

Answer 402

Lipoma. Do not regress spontaneously.

Question 403

What is the equivalent to mmol/L?

Answer 403

mEq/L | They simply depict the number of particles dissolved in a volume.

Question 404

Treatment for uncomplicated acute cystitis and pyelonephritis in nonpregnant female?

Answer 404

Nitrofurantoin (cystitis only) TMP/SMX (avoid if resistance locally >20%) Fosfomycin Fluoroquinolones (only if above not ok)

Question 405

Rx complicated cystitis and pyelo?

Answer 405

``` Oral Fluoroquinolones (outpatient) IV antibiotics (inpatient) ```

Question 406

Rx cystitis in pregnancy?

Answer 406

Fluoroquinolones contraindicated. Consider: Cefpodoxime or Cephalexin Amox-clav Fosfomycin

Question 407

Management of Hep C antibody + patient?

Answer 407

1. HepC virus RNA PCR to Dx current acute infxn | 2. Rx (Ledipasvir-sofosbuvir)

Question 408

Hallmark MRI signs of prolonged (>5mins; i.e. status) seizure?

Answer 408

Cortical laminar necrosis (cortical hyperintensity on diffuse-weighted imaging suggests infarction)

Question 409

Most common cells in nonfunctioning (mainly alpha-subunit secreting) pituitary adenoma?

Answer 409

Gonadotropin-secreting cells

Question 410

Classic nonfxning (gonadotroph) adenoma hormone levels?

Answer 410

Mild to moderate prolactin increase, low LH/FSH/testosterone/TSH/T4 (Symptomatic hypogonadism/hypothyroid can occur also, but usually mass effect occurs first - HA, vision changes, pituitary dysfxn.)

Question 411

Classic prolactin-secreting adenoma (prolactinoma) hormone levels?

Answer 411

Prolactin>200ng/mL (really high), low LH/FSH/testosterone (hypogonadism/ED, etc.)

Question 412

Classic Guillain-Barre syndrome Sx?

Answer 412

``` Ascending paralysis Weak/absent DTRs Weak resp. muscles Autonomic dysfxn Post-GI/URI infxn ```

Question 413

Myasthenic crisis Sx?

Answer 413

Increased general/bulbar muscle weakness (bulbar affected before respiratory muscles fail) Severe resp. muscle weakness leading to failure

Question 414

Precipitating factor of myasthenic cirsis?

Answer 414

Infection, surgery, medications (esp. antibiotics)

Question 415

Cytotoxic chemotherapy brings the risk of electrolyte disturbances via what syndrome?

Answer 415

Tumor lysis syndrome

Question 416

Manifestations tumor lysis syndrome?

Answer 416

Electrolytes: Elevated PO4-, K+, Uric acid (nucleic acid breakdown) Decreased Ca++ (binds with liberated PO4-, reducing levels) AKI, arrhythmias

Question 417

Prophylaxis of tumor lysis syndrome?

Answer 417

IV fluids | Allopurinol or rasburicase

Question 418

Management of a prolactinoma?

Answer 418

``` Dopamine agonist (cabergoline, bromocroptine) Resxn if >3cm ```

Question 419

Cryoglobinemia classic Sx?

Answer 419

Palpable purpura, proteinuria, hematuria, other systemic manifestations. Usually have underlying HepC (test for Hep C antibodies)

Question 420

Epidural hematoma appearance on CT?

Answer 420

Biconvex hematoma on CT

Question 421

Subarachnoid hemorrhage on CT?

Answer 421

Blood b/t subarachnoid and pia mater

Question 422

Diffuse axonal injury on CT?

Answer 422

Diffuse small bleeding at grey-white matter jxn

Question 423

Subdural hematoma on CT?

Answer 423

Crescent shaped hyperdensity that crosses suture lines

Question 424

Glucose, bicarb, anion gap, ketones, serum osmolality, K+ in DKA?

Answer 424

``` Glucose: 250-500 Bicarb: <18 Elevated anion gap Positive ketones OsmS: <320mOsm/kg K+: Depleted (diruesis) ```

Question 425

Glucose, bicarb, anion gap, keontes, serum osmolality, K+ in HHNK?

Answer 425

``` Glucose: >600 Bicarb: >18 Normal anion gap Negative or little ketones OsmS: >320mOsm/kg K+: Depleted (diuresis) ```

Question 426

Patients at average risk of colon cancer begin screening when?

Answer 426

Age 50 w/ high-sensitivity fecal occult blood testing annually, flexible sigmoidoscopy q 5 yrs, or colonoscopy q 10 yrs.

Question 427

A man who's father died of colon cancer at 55 should begin screening for colon cancer when?

Answer 427

40 years or 10 years prior to the first degree relative's diagnosis

Question 428

Biggest risk factor for stroke?

Answer 428

HTN increases risk of stroke more than any other RF (hypercholesterolemia, DM, smoking, etc.)

Question 429

Lab studies in central adrenal insufficiency?

Answer 429

Suppression (MCC glucocorticoids) of the HPA axis leads to central adrenal insufficiency that causes low ACTH and low cortisol. Aldosterone level is normal.

Question 430

Primary adrenal insufficiency lab studies?

Answer 430

``` Usually due to autoimmune (Addison's): Elevated ACTH Low aldosterone (hyponatremia, hyperkalemia) ```

Question 431

Path of neurogenic arthropathy (Charcot joint)?

Answer 431

Often due to diabetes. Decreased proprioception, pain, temp perception leads to trauma to weight-bearing joints and degenerative joint disease (loss of cartilage, osteophyte development, loose bodies in joint space).

Question 432

Triad of ASA intoxication?

Answer 432

Fever (uncoupling of ox-phos in mitochondria) Tinnitus Tachypnea (stimulus )

Question 433

Labs in ASA intoxication?

Answer 433

Mixed respiratory alkalosis and anion gap metabolic acidosis with near-normal pH

Question 434

Angioedema from ACE inhibitors occur most commonly when in Rx?

Answer 434

Can occur anytime, even after years of Rx, not just at the start of Rx.

Question 435

Classic changes in kidney in HTN?

Answer 435

Arteriosclerosis of afferent/efferent arterioles and glomerular capillary tufts

Question 436

Classic changes in kidney in DM?

Answer 436

Increased ECM, basement membrane thickening, mesangial expansoin, fibrosis

Question 437

Proper management of lumbosacral radiculopathy?

Answer 437

NSAIDs. Sciatica due to nerve root compression is usually due to herniated disc or lumbar spndylosis. This usually resolves spontaneously, thus, initial management is NSAIDs. MRI is done if sensory/motor deficits or cauda equina syndrome occur.

Question 438

Appropriate management of elevated homocysteine level?

Answer 438

Pyridoxine (B6)

Question 439

Glomerulopathy resulting in C3 depletion?

Answer 439

Membranoproliferative glomerulonephritis (type 2). C3 depletion due to persistent activation of alternative complement pathway.

Question 440

Rx of Guillain-Barre syndrome?

Answer 440

IVIG or plasmapheresis

Question 441

Rx of Myasthenia Gravis?

Answer 441

Cyclosporine and pyridostigmine

Question 442

Fx of glucocorticoids leukocyte numbers?

Answer 442

Mobilize neutrophils (leukocytosis) Stim. release of immature neutrophils from marrow (bands increased) Inhibit neutrophil apoptosis

Question 443

Severe aortic stenosis signs on PE?

Answer 443

Delayed/dim. carotid pulse Soft second S2 Mid-to-late systolic murmur at right 2nd IS

Question 444

Oxalate stone formation is commonly associated with what disease?

Answer 444

Crohn's disease. Elevated oxalate absorption due to poor bile salt absorption and subsequent fat malabsorption results in Ca++ binding to fats and not oxalate, resulting in their absorption.

Question 445

Classic flow loop appearance in COPD/Asthma?

Answer 445

Obstructive pattern: decreased airflow in exhalation phase --> "scooped out" pattern w/ normal inspiratory pattern

Question 446

Classic flow loop appearance in restrictive airway disease?

Answer 446

Restrictive: Peaked appearance of, but still normal flow in inspiratory and expiratory phases. Volume, however, is decreased resulting in narrower peaks.

Question 447

Classic flow loop appearance in fixed airway obstrxn (e.g. foreign object or laryngeal edema)?

Answer 447

Flattened inspiratory and expiratory waves - no clear peaks, more symmetrical plateaus

Question 448

Likely cause of spontaneous deep intracerebral hemorrhage?

Answer 448

Hypertensive vasculopathy of penetrating branches into basal ganglia (putaminal hemorrhage), cerebellar nuclei, thalamus, and pons.

Question 449

Sx of putaminal hemorrhage?

Answer 449

Damage to the putamen of the basal ganglia leads to contralateral hemiapresis and hemianesthesia

Question 450

Positive leukocyte esterase indicated by dipstick?

Answer 450

Pyuria (pus in urine as in acute pyelonephritis)

Question 451

Positive nitrates in urine indicate by dipstick?

Answer 451

Enterobacteriaceae (e.g. E. coli)

Question 452

Fever, chills, and pleuritic chest pain w/ SOB in an IV drug user w/ cavitary lesions on CT suggest what condition?

Answer 452

Septic embolism secondary to infective endocarditis

Question 453

Secondary illness that increases risk of IE in IV drug abusers?

Answer 453

HIV

Question 454

Health care worker exposed to HepB blood should receive?

Answer 454

Post-exposure prophylaxis (the complete HepB Vax series)

Question 455

Unvaccinated individuals exposed to HepB should receive?

Answer 455

HepB Vax and HepB Ig

Question 456

Immunocompromised patient with triad of fever, pleuritic chest pain, and hemoptysis, with pulmonary nodules with surrounding ground glass opacities ("halo sign") Dx?

Answer 456

Invasive aspergillosis

Question 457

Rx for invasive aspergillosis

Answer 457

Voriconazole and caspofungin (an echinocandin)

Question 458

Tubulointerstitial nephritis (acute interstitial nephritis) casts?

Answer 458

WBC casts

Question 459

RBC casts and RBCs assoc. with?

Answer 459

Glomerular disease (nephritis)

Question 460

Muddy brown casts or renal tubular cells/casts?

Answer 460

Acute tubular necrosis

Question 461

WBC casts assoc. with?

Answer 461

Pyelonephritis | Acute interstitial nephritis

Question 462

Acute HIV infxn presentation?

Answer 462

2-4 wk onset after infxn of mono-like syndrome (fever, night sweats, arthralgias, lymphadenopathy), mucocutaneous ulcerations, skin rash, diarrhea

Question 463

Best Dx method for Histoplasma?

Answer 463

Serum or urine Histoplasma antigen immunoassay

Question 464

Typical histoplasmoda Sx?

Answer 464

Febrile, wasting disorder with prominent pulmonary, mucocutaneous (papules/nodules), and reticuloendothelial (lymphadenopathy, hepatosplenomegaly) Sx in immunocompromised. Pancytopenia and elevated ATs/LDH levels common.

Question 465

Best Rx for histoplasmosis?

Answer 465

Systemic: Amphoteracin B | Milder/maintenance: itraconazole

Question 466

After what insult might an MRI be used to evaluate the knee?

Answer 466

Suspected trauma. MRI is best for soft-tissue structures in the knee (e.g. meniscus, ligaments).

Question 467

What time frame after infxn is Lyme arthritis usually suspected after initial infxn?

Answer 467

Months after initial infxn.

Question 468

Fever and acute monoarticular arthritis (swelling, redness, pain) requires what Dx tool urgently?

Answer 468

Synovial fluid analysis. Risk of septic arthritis.

Question 469

CURB-65 criteria?

Answer 469

``` Confusion Blood Urea >7mmol/L (>19mg/dL) RR>30 BP <90sys or <60dias >65 years of age ***All are worth 1 point. Score of 1 = outpatient; 2 = careful outpatient or admit; 3+ = admit/consider ICU ```

Question 470

Empiric Rx for CAP (OutPt and InPt)?

Answer 470

OutPt: Macrolide or doxycycline (if healthy); Fluoroquinolone or ß-lactam + macrolide (comorbidities) InPt: Fluoroquinolones (non-ICU), ß-lacram + Macrolide (ICU or non-ICU), or ß-lactam + fluoroquinolones (ICU)

Question 471

Define reliability?

Answer 471

A reliable test gives similar results on repeated measurements (good grouping, despite where on the target). It is maximal when random error is minimal.

Question 472

Define accuracy (validity)?

Answer 472

Validity is defined as the tests ability to properly measure what it is supposed to measure (better when closer to bullseye, or on target).

Question 473

Path. in nephrotic syndrome leading to hyperlipidemia and edema?

Answer 473

Glomerular injury --> glomerular permeability -->hypoproteinemia -->elevated liver synth of protein/lipids --> high lipids; Hypoproteinemia leads to decreased oncotic pressure resulting in 3rd spacing; the body senses hypovolemia also, RAAS activates (Na+/H2O retention) and contributes to edema.

Question 474

Path of 2° hyperPTH in CKD?

Answer 474

Low vit D output by kidney = low Ca++ reabsorption Low kidney output = high phosphate Low Ca++ then = high PTH output

Question 475

Brain death definition?

Answer 475

Irreversible loss of fxn of the whole brain including brainstem

Question 476

In brain death, can the ventilator be removed without permission from the kin?

Answer 476

Technically, family permission is not legally required if a patient has brain death.

Question 477

Risks associated with erythropoietin Rx?

Answer 477

HTN due to Hgb concentration

Question 478

3 main categories of diabetic retinopathy?

Answer 478

Background (aka simple) Pre-proliferative Proliferative (aka malignant)

Question 479

Background DM retinopathy signs?

Answer 479

microaneurysms or hemorrhage

Question 480

Pre-proliferative DM retinopathy signs?

Answer 480

Cotton wool spots

Question 481

Proliferative DM retinoapthy signs?

Answer 481

Neovascularization

Question 482

Initial Rx for diabetic neuropathy?

Answer 482

TCAs, SNRIs (duloxetine), gabapentin or pregabalin

Question 483

Any elderly patient on NSAIDs is at risk for what type of anemia?

Answer 483

Iron deficiency, but if no NSAIDs are being taken, think B12 deficiency.

Question 484

Dermatomyositis is commonly associated with what disease process?

Answer 484

Malignancy

Question 485

PSA screening for prostate cancer should be utilized only with?

Answer 485

Discussion with the patient - screening timeframe has not been determined and the risks associated with it may not outweigh the benefits.

Question 486

Labs in germ cell tumor and choriocarcinoma?

Answer 486

Elevated ß-HCG

Question 487

Labs in Leydig cell tumor?

Answer 487

Elevated testosterone, estrogen may lead to precocious puberty in children or gynecomastia in males. Subsequent inhibition of LH and FSH occurs.

Question 488

Labs in teratomas?

Answer 488

Elevated AFP or ß-HCG

Question 489

Labs in seminomas?

Answer 489

ßHCG maybe somewhat elevated, but usually normal

Question 490

Winter's formula?

Answer 490

Used in metabolic acidosis to calculate the appropriate compensated arterial pCO2... pCO2 = 1.5 [HCO3-] +8 +/- 2

Question 491

Appropriate compensation in PaCO2 in metabolic alkalosis?

Answer 491

0.7mmHg for every 1mEq/L rise in serum HCO3-

Question 492

Management of cryptococcal neoformans infxn?

Answer 492

Amphoteracin B and flucytosine, followed by fluconazole for maintenance

Question 493

CD4 count when cryptococcal infxn is at risk?

Answer 493

<100/uL

Question 494

Natural HBV immunity vs vaccinated antibodies?

Answer 494

Anti-HBs in both | IgG Anti-HBc in naturally immune only

Question 495

Early phase and window phase antibodies?

Answer 495

IgM anti-HBc

Question 496

Major organism to cause chronic diarrhea in HIV Pts w/ CD4<180?

Answer 496

Cryptosporidium parvum (non-bloody stool) - drinking water/animal contact spread

Question 497

CMV leads to what GI manifestations in HIV Pts?

Answer 497

colitis (bloody stool), esophagitis, retinitis

Question 498

HSV and VZV lead to what eye manifestations in HIV Pts?

Answer 498

``` Retinal necrosis (acute) Pain Keratitis Uveitis Pale peripheral lesions Central retinal necrosis ```

Question 499

CMV retinitis in HIV manifestation?

Answer 499

Painless No keratitis or conjunctivitis Hemorrhages in retina

Question 500

Common antibiotics for anaerobic induced pneumonia?

Answer 500

Clindamycin Metronidazole w/ amoxacillin Amox/clav Carbapenem

Question 501

Dx of follicular thyroid cancer requires?

Answer 501

Finding of invasion of tumor capsule and/or blood vessels after excision

Question 502

Parafollicular (aka medullary) thyroid cancer lab anomaly?

Answer 502

Calcitonin elevation

Question 503

MCC of comm-acquired bacterial meningitis?

Answer 503

Strep pneumoniae ~70% of CA meningitis (pneumococcal pneumonia may or may not be present) N. meningitidis ~ 12% H. influenzae and L. monocytogenes are less prevalent

Question 504

Low sodium w/ symptoms of CHF indicate?

Answer 504

Poor prognosis as hyponatremia parallels severity due to renin, NE, and ADH release secondary to reduced CO.

Question 505

Antibiotics for aspiration pneumonia?

Answer 505

Clindamycin or ß-lactam and ß-lactamase inhibitor

Question 506

Effect of estrogens on vascular wall?

Answer 506

Dilation

Question 507

Pathophys of spider angioma and palmar erythema in presence of chronic alcoholism?

Answer 507

Impaired hepatic metabolism of estrogens due to cirrhosis. Gynecomastia, testicular atrophy, and decreased body hair also indicate hyperestrinism.

Question 508

Typical T3, T4, TSH in TSH-secreting adenoma (secondary hyperthyroidism)?

Answer 508

All elevated

Question 509

Primary hyperthyroidism (Graves, toxic adenoma, thyroiditis, exogenous hormone) T3, T4, TSH labs?

Answer 509

TSH low | Free T3, T4 high

Question 510

TSH low, free T3, T4 high. High, nodular radioactive iodine uptake scan in?

Answer 510

Toxic adenoma | Multinodular goiter

Question 511

TSH low, free T3, T4 high. High, diffuse radioactive iodine uptake scan in?

Answer 511

Graves

Question 512

TSH low, free T3, T4 high. Low radioactive iodine uptake w/ high serum thyroglobulin in?

Answer 512

Thyroiditis | Iodide exposure

Question 513

TSH low, free T3, T4 high. Low radioactive iodine uptake w/ low serum thyroglobulin in?

Answer 513

Exogenous hormone intake

Question 514

Cough, dyspnea, fever, and malaise occurring 4 hours after work with birds or agricultural work?

Answer 514

Hypersensitivity pneumonitis (Bird fancier's lung or farmer's lung)

Question 515

Most effective agent at lowering TGs?

Answer 515

Fibrates (though statins provide CV benefit and are recommended first line even in mild-moderate (150-500) TG elevation).

Question 516

Management of foodborne botulism?

Answer 516

Equine serum heptavalent botulinum antitoxin (Equine antitoxin Rx)

Question 517

First line for tinea corporis?

Answer 517

Topical antifungals (clotrimazole, terbinafine)

Question 518

Second line (refractory) for tinea corporis?

Answer 518

Oral antifungals (terbinafine, griseofulvin)

Question 519

Bias causing a distortion of the measure of association by misclassifying exposed/unexposed or diseased/nondiseased subjects?

Answer 519

Observer's bias

Question 520

Common causes of acute hypocalcemia

Answer 520

``` Parathyroidectomy Pancreatitis Sepsis Tumor lysis syndrome Blood transfusion (citrate binds Ca++) Foscarnet ```

Question 521

What factors determines pretest probability in CAD?

Answer 521

Age, gender, cardiac RFs, chest pain qualities (classic, atypical, nonanginal). Low risk men are <40 and women <50 w/ atypical CP and no significant cardiac RFs.

Question 522

A 35y/o female w/ no RFs and atypical CP requires what workup?

Answer 522

None. Low pretest probability = no workup, unlikely cardiac origin

Question 523

Ascending aortic aneurysm MCC path?

Answer 523

Cystic medial necrosis (often due to aging) or CT disorder (Marfans, Ehlers-Danlos)

Question 524

Descending aoprtic aneurysm path?

Answer 524

Atherosclerosis (HTN, hypercholesterolemia, smoking Hx)

Question 525

Acute back pain with unilateral radiation down one leg to the foot. Worse with lumbar flexion. Dx?

Answer 525

Lumbar disk herniation.

Question 526

Back pain radiating to the thighs worsened by extension and persisting with standing. Does not resolve with rest. Improves with flexion. Dx?

Answer 526

Lumbar spinal stenosis - narrowing of foramina results from degenerative arthritis and osteophyte formation affecting the facet joints (spondylosis) compressing the nerve root. Hypertrophy of the ligamentum flavum, bulging of the disc, or other factors can worsen it.

Question 527

Pt with constipation, back pain, anemia, renal insufficiency, and hypercalcemia likely has what Dx?

Answer 527

Multiple myeloma. Bone marrow infiltration result in fractures, bone pain, and hypercalcemia. Monoclonal protein elevation in serum result in renal insufficiency. Constipation is often a result of asymptomatic hypercalcemia (<12, but >10).

Question 528

Common triggers of gout?

Answer 528

Heavy alcohol intake, urate rich foods (meat), trauma/surgery, dehydration, medications (diuretics, cyclosporin)

Question 529

Young female with flulike symptoms and symmetric metacarpophalyngeal pain as well as some wrist and knee swelling and fevers, that lasts for several weeks and resolves without any sequelae? Dx?

Answer 529

Viral arthritis. Parvovirus B19 infxn causes a similar presentation as RA with symmetric polyarticular arthritis for a brief course. Children present with slapped cheek rash and maybe a morbilliform exanthem. HIV, mumps, rubella, etc. may cause a similar arthritis that resolves quickly.

Question 530

Parvovirus B19 infxn in sickly cell disease or other blood diseases can lead to what blood complications?

Answer 530

Pure red cell aplasia (an aplastic crisis)

Question 531

Pheochromocytoma can lead to HTN crisis more commonly when?

Answer 531

Surgery, anesthetic administration, beta blocker administration (unopposed alpha)

Question 532

Fever, myalgias after Rx of syphilis?

Answer 532

Jarisch-Herxheimer rxn. 6-48hrs post Rx. Give IV fluids, acetaminophen, NSAIDs.

Question 533

Methanol poisoning lead to what changes to the optic disk on PE and pH?

Answer 533

Hyperemia of optic disk and anion gap metabolic acidosis.

Question 534

Classic Sx of methanol poisoning?

Answer 534

Blurred vision, epigastric pain, vomiting, hyperemic optic disk.

Question 535

Classic Sx of ethylene glycol poisoning?

Answer 535

Similar to methanol (vomiting, intoxication, etc.), but kidney damage due to crystal formation

Question 536

How does SLE arthritis differ from RA?

Answer 536

Joint involvement tends to be symmetric, migratory, with morning stiffness like RA, but nonerosive on Xray and morning stiffness that is much more brief than RA.

Question 537

Lab findings in SLE?

Answer 537

``` Hemolytic anemia Thrombocytopenia Leukopenia Hypocomplementemia (C3/4) ANA (sensitive) Anti-dsDNA&Anti-Sm (specific) Renal involvement (proteinuria and elevated creatinine) ```

Question 538

Classic fibromyalgia Sx?

Answer 538

Middle-aged female. Chronic widespread pain (esp. after exercise), fatigue, impaired cognition, trigger point tenderness (mid-trap, chostocondral jxn, lateral epicondyles of elbow). Labs are normal.

Question 539

Classic polymyalgia rheumatica Sx?

Answer 539

Age>50, stiffness > pain in shoulders, hip girdle, neck, and ESR, CRP elevated. Improves with steroid admin rapidly.

Question 540

In an IV drug abuser, tender percussion over the spinous process of the involved vertebra with pain is a sign of?

Answer 540

Spinal osteomyelitis. Fever and leukocytosis are unrealiable for Dx, but platelet count may be elevated as a marker of stress/inflammation. ESR often >100mm/hr. MRI is best study.

Question 541

A patient with an acute, severe illness with low total and free T3 levels, but normal T4 and TSH may have?

Answer 541

Euthyroid sick syndrome (aka low T3 syndrome). Due to decreased peripheral 5'-deiodination of T4 due to cortisol levels and inflammation, etc.

Question 542

Overt primary hypothyroidism is characterized by what labs?

Answer 542

Decreased free T4 levels with elevated TSH. T3 generally remains normal until late stages.

Question 543

Subclincial hypothyroidism is characterized by what labs?

Answer 543

Elevated TSH and normal T4 levels. T3 generally remains normal until late hypothyroid stages.

Question 544

A hard goiter with overt hypothyroidism may indicate?

Answer 544

Riedel's (fibrous) thyroiditis. Inflammation of the thyroid resulting in fibrosclerosis and a "hard goiter".

Question 545

Pts with Zenker's diverticulum are at risk for?

Answer 545

Aspiration pneumonia

Question 546

Best test for Zenker's Diverticulum?

Answer 546

Contrast esophagram

Question 547

Best Rx for bite wounds from cats, dogs, humans?

Answer 547

Amox-clav, give tetanus vax if not up to date

Question 548

Confirmative testing for carpal tunnel?

Answer 548

Nerve conduction study

Question 549

Pt was vomiting and now has severe retrosternal pain, dyspnea, and sub Q air. Dx?

Answer 549

Boerhaave syndrome. Spontaneous perforation of esophagus.

Question 550

Protracted vomiting with hematemasis and pain in the chest/abdomen. Dx?

Answer 550

Mallory-Weiss tear. Incomplete mucosal tear at gastroesophageal jxn. Self- limited without pneumomediastinum.

Question 551

Niacin flushing path?

Answer 551

Prostaglandin-induced peripheral vasodilation.

Question 552

Growth hormone, tetracyclines, and excessive vitamin A intake (and its derivatives - i.e. isotretinoin, all-trans,retinoic acid) can lead to?

Answer 552

Idiopathic intracranial HTN. Headache, vision changes, papilledema, CN palsies with elevated opening pressures.

Question 553

Management of polymyositis?

Answer 553

Glucocorticoid and mathotrexate

Question 554

Definitive Rx for normal pressure hydrocephalus?

Answer 554

Ventriculo-peritoneal shunts

Question 555

Incidence definition?

Answer 555

New cases of a disease at a specific time

Question 556

Prevalence definition?

Answer 556

Number of cases at a specific time

Question 557

Well-defined superomedial tibial pain not aggravated by valgus stress test. Dx?

Answer 557

Pes anserinus pain syndrome (aka anserine bursitis). Not always due to bursa inflammation. Gracilis, sartorius, and semitendinosus insertion point. Anserine bursa sits underneath the three tendons and the medial patella retinaculum. No pain with valgus indicates no medial collateral ligament involvement.

Question 558

What are pH, glucose, and WBCs usually in pleural effusion secondary to pneumonia?

Answer 558

pH <7.2 G <60 WBC>50,000 Gram stain - usually falsely negative due to low bacterial count (positive in empyema)

Question 559

Rx for pleural effusion secondary to pneumonia and empyema?

Answer 559

Antibiotics and drainage

Question 560

Polyp size, growth, shape, and type that are worrisome and require excision in colonoscopy?

Answer 560

``` Polyp ≥1cm High grade dysplasia Sessile polyps (nonpedunculated or flat - often advanced neoplasia) Villous features (long glands on histo) High number (≥3 concurrent adenomas) ```

Question 561

Hyponatremia with a serum osmolality > 290mOsm/kg likely (2 conditions)?

Answer 561

Hyperglycemia (marked) or advanced renal failure.

Question 562

Hyponatremia, serum Osm <290, and Urine Osm <100mOsm/kg likely (2 conditions)?

Answer 562

Primary polydipsia or beer drinkers potomania. Diluting the shit out of urine with normal ADH response (thus, serum Osm is not high) - i.e. peeing a lot off.

Question 563

Hypoatremia, serum Osm<290, Urine Osm>100, and UrineNa >25 likely (3 conditions)?

Answer 563

SIADH (water retention with poor Na+ retention- no RAAS in euvolemia). Adrenal insufficiency (poor water and sodium retention). Hypothyroidism.

Question 564

Hyponatremia, serum Osm<290, Urine Osm>100, and UrineNa <25 likely (3 conditions)?

Answer 564

Volume depletion, CHF, or cirrhosis.

Question 565

HIV patient with upper lobe cavitary pneumonia must suspect what bug?

Answer 565

Mycoplasma tuberculosis. TB is aerobic and prefers the high O2 tension in the upper lobes. Sx may be subacute or chronic (fever, sweats, etc.).

Question 566

Definition Hawthrone effect bias?

Answer 566

Study population changes behavior as they know they're being watched

Question 567

Sample distortion bias def?

Answer 567

Estimate of exposure/outcome association biased due to study sample being poor representation of target population

Question 568

Information bias def?

Answer 568

Imperfect assessment of association b/t exposure and outcome as a result of errors in exposure/outcome measurement

Question 569

Sodium of 120-130 Sx? Rx?

Answer 569

Asymptomatic to mild symptoms (lethargy, forgetful). Rx: fluid restriction (<800mL/day).

Question 570

Serum Na+ < 120 Sx?

Answer 570

Severe symptoms (confusion, Sz, coma) signaling cerebral edema and brainstem herniation. Rx: hypertonic (3%) saline w/ ≤ 8mEq/L in first 24 hrs.

Question 571

Infusion of Normal Saline 0.9% or half normal saline 0.45% have 300 and 150 mOsm/kg H2O respectively and would do what to total free body water and sodium content?

Answer 571

Increase total body free water and reduce serum sodium content. e.g. do NOT give to hyponatremic patients.

Question 572

Classic appearance of simple renal cysts on CT? Rx?

Answer 572

Thin, smooth, regular walls. Unilocular without septae and homogenous content. May be found incidentally on CT. Rx: If no Sx, then reassurance.

Question 573

Classic appearance of malignant cystic renal mass on CT? Rx?

Answer 573

Thick, irregular walls with multiloculated septae. Calcifications and heterogenous content throughout. Contrast enhancement on CT/MRI occurs also. Pain, HTN, or hematuria may occur. Rx: Follow-up imaging and eval for malignancy.

Question 574

Typical ratio of AST to ALT in alcoholic hepatitis?

Answer 574

2:1 AST>ALT

Question 575

Mallory-Weiss tear location?

Answer 575

Gastroesophogeal jxn

Question 576

Symptoms of SLE with hypercoagulability (PE, stroke, DVT) despite a prolonged PTT. Dx?

Answer 576

Antiphospholipid antibody syndrome. Classic signs include repeated fetal losses or premature birth of a normal neonate. Positive for lupus anticoagulant, anticardiolipin antibody, or anti-beta-2 glycoprotein 1 antibody lab titers.

Question 577

Does supplemental oxygen administration correct right to left shunting due to pneumonia, pulmonary edema, atelectasis, tetrology of Fallot, or Eisenmenger syndrome?

Answer 577

In extreme cases, no. The right to left shunting results in a V/Q mismatch where ventilation or perfusion reach zero in certain areas and no oxygen administration can counter the shunt and correct the hypoxemia.

Question 578

If ventilation > 0 as in emphysema, interstitial lung disease, or pulmonary embolism, can an increase in FiO2 via supplemental O2 correct hypoxemia?

Answer 578

Yes.

Question 579

What test is used to discover macular degeneration?

Answer 579

The grid test. One of the earliest findings in MD is distortion of straight lines to appear wavy on this test. Age and smoking are the RFs. It is the most common cause of blindness in industrialized nations.

Question 580

What sign on opthalmologic exam may help confirm macular degeneration?

Answer 580

Drusen (fatty lipid) deposits in the macula (shotgun appearing yellow spots around macula).

Question 581

What comorbidity is commonly present in celiac disease that results in negative IgA anti-tissue transglutaminase and IgA anti-endomysial antibodies?

Answer 581

Selective IgA deficiency. Commonly found associated with celiac's, if IgA serology is negative, but suspicion for celiac's is high (foul, bulky stools with malabsorption issues), total IgA must be measured or IgG-based serology must be done.

Question 582

What is the typical histological feature in ciliac's disease?

Answer 582

Villous atrophy on small bowel biopsy.

Question 583

Gold standard Dx for aortic aneurysm?

Answer 583

CT angiography

Question 584

Buttonhole sign (dimpling) occurs in a lesion < 1cm with slight pigmentation and firm on palpation. Dx?

Answer 584

Dermatofibroma. BCC is most common, may be pigmented, and does not dimple. SCC is scaley, and does not dimple.

Question 585

Conus medullaris path/Sx?

Answer 585

Lesion in conus (end of cord) causes upper (hyperreflexia) and lower motor neuron signs. Severe back pain, perianal anesthesia, symmetric motor weakness, early onset bowel/bladder dysfxn.

Question 586

Cauda equina syndrome path/Sx?

Answer 586

Lesion in nerve roots leaving conus cause radicular pain, saddle anesthesia, asymmetric motor weakness, hypOreflexia/areflexia, late onset bowel/bladder dysfxn.

Question 587

How to tell CNIII nerve compression from ischemia?

Answer 587

Comp: Parasympathetic fibers are affected in nerve compression leading to midriasis. Isch: Somatic nerves are usually impaired in ischemia only, while the parasympathetic fibers on the outside of the nerve spared leading to a normal pupillary response. Side note: In diabetics, the central portion of the nerve (the most peripherally going portion of the nerve) will be effected first.

Question 588

Equation for sensitivity?

Answer 588

TP/(TP+FN)

Question 589

Equation for specificity?

Answer 589

TN/(TN+FP)

Question 590

Neuroimaging of Alzheimer's shows?

Answer 590

Global atrophy particularly in temporal and parietal lobes.

Question 591

Neuroimaging of frontotemporal dementia?

Answer 591

Marked atrophy of frontal and temporal lobes.

Question 592

Mini Mental State Exam scoring?

Answer 592

MMSE score ≤ 24/30 points suggests dementia

Question 593

Onset of Alzheimer's?

Answer 593

Almost exclusively >60 years old

Question 594

Onset of frontotemporal dementia?

Answer 594

40-60 years

Question 595

Acute urinary retention is common in elderly men with BPH when?

Answer 595

During the postoperative period

Question 596

A patient taking new oral estrogens with levothyroxine may require what? Why?

Answer 596

Higher levothyroxine dose. Oral estrogen increases thyroxine-binding globulin, and require more to saturate the TBG binding sites.

Question 597

ASD murmur sound?

Answer 597

Mid-systolic ejection murmur with FIXED SPLIT S2 (no variation with respiration)

Question 598

Pulmonic stenosis murmur sound?

Answer 598

- Ejection click - Left upper sternal border - - Crescendo-decrescendo systolic murmur - WIDENING SPLIT of S2 with respiration (compared to ASD)

Question 599

Female with swelling/joint disease in hands and knees, neutropenia and splenomegaly. Labs reveal anti-CCP and RF positive with elevated ESR. Dx?

Answer 599

Felty syndrome. Triad of inflammatory arthritis, splenomegaly and neutropenia. Often found in long term RA. Marrow biopsy often done to rule out other neutropenia causes.

Question 600

Most common bugs and empirical Rx for bacterial meningitis in 2-50y/o?

Answer 600

S. pneumoniae: Vancomycin | N. meningitidis: 3rd gen ceph (ceftriaxone, ceftaxime)

Question 601

Most common bugs and empirical Rx for bacterial meningitis in 50+ y/o?

Answer 601

S. pneumoniae: Vancomycin N. meningitidis: 3rd gen ceph (ceftriaxone, cefotaxime) Listeria: ampicillin

Question 602

MC bugs and empirical Rx for bacterial meningitis in immunocompromised?

Answer 602

S. pneumoniae: Vanco N. meningitidis: Cefepime Listeria: Ampicillin Gram negative rods: Cefepime?

Question 603

MC bugs and empirical Rx for bacterial meningitis after neurosurgery/penetrating skull trauma?

Answer 603

Gram negative rods, MRSA, Coag negative staph; vanco and cefepime

Question 604

Acute post-streptococcal glomerulonephritis occurs how long after strep throat/impetigo?

Answer 604

10-20 days

Question 605

Acute post-streptococcal glomerulonephritis classic Sx?

Answer 605

Hematuria, HTN, RBC casts, mild proteinuria

Question 606

MCC of malignant disease in male 15-35?

Answer 606

Germ cell tumor of testes.

Question 607

CHA2DS2-VASc Score? Significance?

Answer 607

``` Utilized to reduce thromboembolic event. Each worth 1 pt (or 2 if A2 or S2). 1+ pts indicates ASA or oral anticoagulant Rx (oral anticoag preferred>ASA). 2+ pts indicates oral anticoag only. CHF HTN A2: Age≥75 (A2 = 2 pts) DM S2: Stroke/TIA/Thromboembolism (S2 = 2 pts) Vascular disease Age 65-74 Sex (male or female) ```

Question 608

Which type of aortic dissxn may extend into the pericardial space causing hemopericardium and tamponade w/ shock?

Answer 608

Ascending type A aortic dissxn. MCC is HTN. CT angiography is Dx of choice.

Question 609

Which part of the nerve becomes ischemic first in diabetic neuropathy?

Answer 609

The central aspect, or the more distally reaching aspect of the nerve, hence the progression of the disease.

Question 610

HOCM murmur sound?

Answer 610

Crescendo-decrescendo systolic murmur at LLSB without carotid radiation (as in AS).

Question 611

Murmurs that get louder with valsalva?

Answer 611

HCM | MVP

Question 612

Murmurs that get softer with valsalva?

Answer 612

All, except HOCM and MVP

Question 613

Murmurs that get louder with standing?

Answer 613

HCM | MVP

Question 614

Murmurs that get softer with standing?

Answer 614

All, except HCM and MVP

Question 615

Murmurs that get louder with squatting?

Answer 615

AR MR VSD

Question 616

Murmurs that get softer with squatting?

Answer 616

``` HCM MVP (delayed prolapse/shorter murmur due to higher preload/enlarged vent size) ```

Question 617

Murmurs that get louder with handgrip?

Answer 617

AR MR VSD

Question 618

Murmurs that get softer with handgrip?

Answer 618

HCM | AS

Question 619

Valsalva effects on body?

Answer 619

Decrease venous return during strain. Increase return during relaxation.

Question 620

Standing effects on body?

Answer 620

Decrease venous return

Question 621

Squatting Fx on body?

Answer 621

Increase venous return Increase afterload Increase regurgitant fraction

Question 622

Handgrip Fx on body?

Answer 622

Increase afterload Increase BP Increase regurgitant fraction

Question 623

Murmur of MVP?

Answer 623

Mid to late systolic click followed by systolic murmur due to MR

Question 624

Sx of erysipelas and causes?

Answer 624

Superficial dermis/lymphatics infxn with raised and well demarcated edges and early systemic signs (fever, etc.). Strep pyogenes (GAS) cause it.

Question 625

Sx of cellulitis and causes?

Answer 625

Deep dermis and sub Q fat infxn. Edges of infxn are flat and poorly demarcated. Systemic symptoms occur later. GAS and MSSA cause it. If purulent, then possible MRSA or MSSA.

Question 626

Urinary leakage with valsalva. Dx?

Answer 626

Stress.

Question 627

Urinary leakage 2° to sudden urge?

Answer 627

Urgency.

Question 628

Urinary leakage 2° to valsalva and episodes of urgency?

Answer 628

Mixed.

Question 629

Urinary leakage from constant dribbling/incomplete emptying?

Answer 629

Overflow. Retention of urine leads to slow leaking. Often neurogenic bladder requiring Bethenachol (ACh agonist) or catheterization. PVR ≥150 women and ≥50mL in men are likely retaining.

Question 630

Stress incontinence Rx?

Answer 630

Kegels/pessary/surgery

Question 631

Urgency incontinence Rx?

Answer 631

Bladder training/antimuscarinic drugs (oxybutynin)

Question 632

A young female with stabbing facial pain bilaterally with brushing teeth or a light breeze on the face may have what associated condition?

Answer 632

Multiple sclerosis. Trigeminal neuralgia may be caused by demyelination of the nucleus of the trigeminal nerve. Trigeminal neuralgia is rarely bilateral, unless associated with MS.

Question 633

Classic PCO signs/Sx?

Answer 633

Androgenic alopecia, irregular menses, obesity. Elevated risk of DM2 and should be screened with oral glucose tolerance test.

Question 634

Leukemoid rxn cause, LAD score, leukocyte count, neutrophil precursors, and absolute basophilia?

Answer 634

``` Severe infxn. >50,000 leukocytes Metamyelocytes>myelocytes (more mature) No basophilia Leukocyte alkaline phosphate score is high (infection rxn) ```

Question 635

CML cause, LAD score, leukocyte count, neutrophil precursors, and basophilia?

Answer 635

BCR-ABL fusion. Often > 100,000. Metamyelocytes

Question 636

Syncope with prolonged standing/emotional distress/pain and nausea, warmth, diaphoresis?

Answer 636

Vasovagal

Question 637

Syncope with cough, micturation, defacation?

Answer 637

Situational.

Question 638

Syncope with postural changes?

Answer 638

Orthostatics

Question 639

Syncope with exertion or exercise?

Answer 639

AS, HCM, anomalous coronary arteries

Question 640

Syncope cause with prior CAD, MI, cardiomyopathy, or reduced EF?

Answer 640

Ventricular arrythmias

Question 641

Syncope cause with sinus pauses, increased PR, and/or QRS duration?

Answer 641

SSS, bradyarrythmia, AV block

Question 642

Syncope with hypokalemia, hypomagnesemia, medications causing increased QT interval?

Answer 642

Torsades (acquired long QT syndrome)

Question 643

Syncope with family Hx of sudden death, increased QT interval, syncope ith triggers (exercise, startle, sleep, etc.)?

Answer 643

Congenital long QT syndrome

Question 644

Influenza-like prodrome with necrosis and sloughing of epidermis that includes mucosal involvement is classic for?

Answer 644

SJS and toxic epidermal necrolysis. BSA<10% only SJS 10-30% mixed BSA>30% only TEN

Question 645

Bone pain, HA, unilateral hearing loss, and femoral bowing with elevated alkaline phosphatase in a person >40 is classic for?

Answer 645

Paget disease of bone. Increase in bone turnover due to osteoclast dysfxn. Rx: bisphosphonates

Question 646

What test is used to compare proportions of a categorized (e.g. high, normal, or low, yes or no, etc.) outcome.

Answer 646

Chi-squared.

Question 647

What test is used to compare the means of two outcomes?

Answer 647

Two sample Z-test or two sample t-test.

Question 648

What test is used to compare the means of three or more variables?

Answer 648

Analysis of variance (ANOVA)

Question 649

Classic signs of a fat embolism?

Answer 649

Dyspnea, neurological changes (confusion, Sz, focal deficits), and petechial rash 12 -24 hrs after injury.

Question 650

Sx of Graves ophthalmopathy?

Answer 650

Proptosis or "pop"-tosis of the eyes and impaired extraocular motion (decreased convergence and diplopia). Irritation, redness, photophobia, pain, and tearing can also occur.

Question 651

In rhabdomyolysis, why does urinalysis come back with high blood content, but urine sediment microscopy shows scant RBCs?

Answer 651

A large amount of myoglobin is present in the urine in rhabdo, which is indistinguishable from hemoglobin in a standard urinalysis. Myoglobin can lead to tubular injury and AKF.

Question 652

MCC of PTH-independent hypercalcemia?

Answer 652

Humoral hypercalcemia of malignancy. Very high, symptomatic Ca++ levels are common.

Question 653

Symptomatic patients of TIA or stroke within 6 months of onset with high-grade carotid stenosis (70-99%) should be managed how?

Answer 653

Carotid endarterectomy. Patient should be given ASA concominantly.

Question 654

Chronic hypoxia and hypercapnia in morbid obesity can result in what changes to labs/pH?

Answer 654

Decreasing pH due to CO2 retention (hypoventilation) causes bicarbonate retention and decreased chloride reabsorption (2° to bicarb/Cl- exchangers in intercalated cells) resulting in metabolic acidosis. Chronic hypoxia leads to elevated EPO secretion and erythrocytosis.

Question 655

Define positive predictive value.

Answer 655

Probability that a patient has a disease given a positive test result.

Question 656

Is the PPV of a test higher in an area of low or high prevalence of a disease?

Answer 656

PPV is higher as disease prevalence goes up in a population. This is checking for probability that a person will truly have the disease if the test is positive. The converse is true also. Lower prevalence = low PPV.

Question 657

ParvoB19 Sx in adults/children?

Answer 657

Children: erythema infectiosum (slapped cheek) Adults: Joint sx (RA-like) more likely Both may get transient pure red cell aplasia; aplastic crisis if Hx of hematologic disease

Question 658

Drugs that classically increase digoxin levels?

Answer 658

Amiodarone, verapamil, quinide, propafenone

Question 659

Digoxin toxicity Sx?

Answer 659

Acute: GI symptoms (anorexia, vomiting, abd. pain) Chronic: Less severe GI sx, but more so CNS/visual changes

Question 660

Define cardiac index and its relationship to hypovolemic, cardiogenic and septic shock.

Answer 660

CI = CO / BSA; Cardiac index equals cardiac output to body surface area. It is a way of measuring pump function. Normal is 2.8-4.2. In cardiogenic shock and hypovolemic shock it is low due to poor CO, but in septic shock it is elevated.

Question 661

High anion gap metabolic acidosis with known drug ingestion. MCC?

Answer 661

Salicilates (early resp acidosis) Iron Isoniazid

Question 662

High anion gap metabolic acidosis with hypoperfusion and elevated lactic acid. Most likely cause?

Answer 662

Lactic acidosis 2° to sepsis.

Question 663

High anion gap metabolic acidosis with renal failure and high BUN. MCC?

Answer 663

Uremia

Question 664

High anion gap metabolic acidosis with hyperglycemia and ketones in urine/serum. MCC?

Answer 664

DKA

Question 665

High anion gap metabolic acidosis with osmolal gap. MCC?

Answer 665

Ethylene glycol (envelope shaped calcium oxalate crystals in urine) Methanol (blindness) Propylene glycol

Question 666

Virus that causes Kaposi sarcoma? Dx method?

Answer 666

HSV 8 | Biopsy

Question 667

How do gonorrhoeae and chlamydia differ in gram staining quality in urethritis?

Answer 667

Chlamydia rarely show up on gram stain. Gonorrhoeae show gram-negative cocci in 95% of cases.

Question 668

Comorbidity that increases predisposition tothoracic and abdominal aortic aneurysms?

Answer 668

Systemic HTN, not atherosclerosis (though it is often present in association with them).

Question 669

TMP/SMX is given to prevent what diseases in immunocomp due to HIV?

Answer 669

Toxo gondii | Pneumocystis pneumonia

Question 670

Akathisia def?

Answer 670

Sensation of restlessness resulting in frequent patient movements

Question 671

Athetosis def?

Answer 671

Slow, writhing movements (often in Huntington's - occur alongside chorea)

Question 672

AD polycystic kidney disease comes with the potential for what extrarenal manifestations?

Answer 672

HTN Hepatic cysts Berry aneurysms (5-10% cases ADPKD)

Question 673

A woman with sudden blindness and a pale, swollen disc with blurred margins on fundoscopy with an Hx of frequent headache and jaw claudication suffers from what?

Answer 673

Anterior ischemic optic neuropathy (2° to Giant cell arteritis). High dose steroids are Rx.

Question 674

If TSH is low and there are no signs of Graves disease on PE, what test is required to give a good differential? (4588)

Answer 674

Radioactive iodine uptake scan (RAIU). RAIU High/diffuse = Graves RAIU High/Nodular = Adenoma(s) RAIU Low/thyroglobulin low = exogenous hormone RAIU Low/thyroglobulin high = thyroiditis

Question 675

4 hormones with alpha-subunit in common?

Answer 675

TSH, FSH, LH, hCG

Question 676

If alpha subunit elevated in hyperthyroid disease what is suspicion?

Answer 676

TSH-secreting adenoma

Question 677

Acute glaucoma is treated with?

Answer 677

Mannitol, acetazolamide, timolol, or pilocarpine. Atropine or its variants will dilate the pupil and worsen glaucoma.

Question 678

The patient with chronic nonbloody diarrhea and weight loss after multipe abdominal surgeries likely has?

Answer 678

Secretory diarrhea. This is characterized by larger daily stool volumes (>1L/day) and diarrhea that occurs during fasting and sleep.

Question 679

What are the classic TB-like diseases?

Answer 679

Histoplasmosis (more commonly assoc. with hilar adenopathy) Blastomycosis Sarcoidosis

Question 680

Appropriate Rx for puncture wound (e.g. rusty nail)?

Answer 680

If no Tdap Vax w/in 5 years, then Tdap given. Also tetanus immune globulin if the pt has not completed 3 doses of tetanus vax before.

Question 681

Definition of chronic bronchitis?

Answer 681

Chronic productive cough for ≥3months in 2 successive years, usually with smoking Hx.

Question 682

A patient with HIV and an EBV-like presentation that lacks or only has mild pharyngitis, lymphadenopathy, and/or splenomegaly likely has?

Answer 682

CMV mononucleosis

Question 683

Pain and parasthesias in DM polyneuropathy are due to what nerve fiber involvement?

Answer 683

Small

Question 684

Numbness, loss of proprioception, and vibration sense, as well as diminished ankle reflexes in DM polyneuropathy are due to what nerve fiber involvement?

Answer 684

Large

Question 685

Cord syndrome characterized by bilateral spastic motor paresis distal to the lesion?

Answer 685

Anterior (ventral) cord syndrome. Often 2° to occlusion of ant. spina artery.

Question 686

Cord syndrome characterized by bilateral loss of vibratory and proprioceptive sensation, often with weakness, paresthesias, and urinary incontinence/retention?

Answer 686

Posterior (dorsal) cord syndrome. Often 2° to MS or vascular disruption.

Question 687

Cord syndrome characterized by weakness more pronounced in the upper extremities than the lower with local deficit in pain/temp?

Answer 687

Central cord syndrome. Often 2° to hyperextension injury.

Question 688

Cord syndrome characterized by ipsilateral weakness, spasticity, and loss of vibration sense/proprioception with contralateral loss of pain/temp?

Answer 688

Hemisection of cord aka Brown-Sequard.

Question 689

A patient under 50 with recurrent chest discomfort especially during sleep/rest that resolves in 15 or so minutes and has an Hx of smoking likely has? Rx?

Answer 689

Vasospastic angina. CCB is preventive. Nitro is abortive. Classic MI-like Sx accompany the angina and ST-changes on EKG that are transient may occur during an episode.

Question 690

Hypotension, pulsus paradoxus, elevated JVP, and cardiogenic shock with clear lung fields are common signs of?

Answer 690

Cardiac tamponade. Notice the clear lung fields - does not cause pulmonary edema necessarily. In aortic dissxn, aortic regurgitation may cause pulmonary edema rather than tamponade.

Question 691

Nephrotic syndrome (proteinuria, HTN, hyperlipidemia, etc.) in the presence of cardiomyopathy is likely due to?

Answer 691

Amyloidosis. Dx via abd. fat pad biopsy.

Question 692

Study selects a group, determines their exposure status, and follows them over time for development of disease of interest. Study type?

Answer 692

Cohort. Can be prospective or retrospective.

Question 693

Study selects patients with a particular disease and those without that disease, then determines their previous exposure status. Study type?

Answer 693

Case-control study.

Question 694

Study selects patients randomly and measures an exposure and outcome simultaneously at that point in time. Study type?

Answer 694

Cross-sectional study aka prevalence study.

Question 695

PPV equation? NPV equation?

Answer 695

TP/ (TP + FP) = PPV | TN/ (FN + TN) = NPV

Question 696

What concerning SE can occur after multiple blood transfusions resulting in tingling and a positive Chvostek's sign?

Answer 696

Citrate chelates/binds Ca++ resulting in hypocalcemia. This is only a risk after multiple transfusions.

Question 697

Antibodies in recovery phase vs resolution of infxn by HepB?

Answer 697

IgG anti HBc (both) AntiHBs (both) Anti HBe (recovery phase only)

Question 698

Pseudoallergic rxns to NSAIDs and ASA occur in pts with comorbid asthma, chronic rhinosinusitis with nasal polyposis as a result of?

Answer 698

COX-1 and 2 inhibition results in shunting towards 5-LOX pathway resulting in leukotriene overprodxn causing asthmatic flare ups and nasal/ocular sx with flushing after NSAID ingestion. ID4065

Question 699

Name 4 endocrine related causes of recurrent pregnancy loss.

Answer 699

Hypothyroidism (Hashimoto) PCOS DM Hyperprolactinemia

Question 700

How commonly do women at average risk ages 50-75 get mammograms?

Answer 700

q 2 yrs

Question 701

How frequently do 35+ y/o men with average risk of hyperlipidemia get screened?

Answer 701

q 5 yrs

Question 702

A man with weeks of HA, NV, and AMS presents with papilledema and some focal CNS deficits. Later he decompensates with HTN, bradycardia, and respiratory depression in the hospital. His decompensation is due to?

Answer 702

Cushing reflex 2° to brainstem compression.

Question 703

Both acute cellular rejection and bacterial infxn after liver transplant present with fever, abd. pain and elevations in LFTs. What qualities differentiate them?

Answer 703

Significant leukocytosis and hemodynamic instability are more commonly found in bacterial infxn vs rejection. Bacterial infxn usually<1month of Tx. Acute rejection <90days commonly.

Question 704

Timeframe/cause of hyperacute rejection of organ Tx?

Answer 704

Usually under 1 week after Tx and due to antibody/compliment-mediated response (ABO mismatch).

Question 705

Brain scans of choice in emergency and nonemergency/elective first-time seizures?

Answer 705

Emergency: CT wiuthout contrast Nonemergency: MRI (more sensitive than CT)

Question 706

A skin lesion without any of the ABCDE criteria, but appearing differently than the others is still suspicious due to what sign?

Answer 706

The ugly duckling sign. It has a sensitivity of up to 90% for melanoma. Breslow depth corresponding to palpable nodularity due to verticalgrowth also plays the most important role prognosis in melanoma.

Question 707

Skin condition associated with Hep C?

Answer 707

Prophyria cutanea tarda. Fragile, photosensitive skin that develops vesicles and bullae with trauma/sun exposure esp on dorsa of hand. Scarring leaves hypo/hyperpigmented areas.

Question 708

Tricyclics (amitriptyline) have NE and serotonin reuptake inhibition effects as well as what other effects?

Answer 708

Anticholinergic Antihistamine Antialpha adrenergic

Question 709

The development of clubbing and sudden-onset joint arthropathy in a chronic smoker suggets?

Answer 709

Hypertrophic osteoarthropathy. This condition is often associated with lung cancer and a longterm smoker complaining of clubbing and joint problems requires an X-ray.

Question 710

Time frame for anaphylaxis onset during transfusion?

Answer 710

Seconds to minutes

Question 711

Time frame for acute hemolysis onset during transfusion?

Answer 711

Minutes to an hour

Question 712

Time frame for febrile nonhemolytic event or TRALI (transfusion related acute lung injury) onset in blood transfusion?

Answer 712

1-6 hours

Question 713

Time frame for delayed hemolytic event onset after transfusion?

Answer 713

2-10days post infusion

Question 714

When are RBCs required to be irradiated before transfusion?

Answer 714

Bone marrow transplant, immunodeficiency, blood donated from 1st or 2nd relatives

Question 715

When are RBCs required to be leukoreduced before blood Tx?

Answer 715

Chronic transfusions, CMV seronegative Pts at risk (arrive in WBCs), previous febrile nonhemolytic rxn

Question 716

When are RBCs required to be washed before blood Tx?

Answer 716

IgA deficiency, autoimmune hemolytic anemia (complement dependent), allergic rxns despite histamine Rx

Question 717

Classic EEG reading in Ceutzfeldt-Jakob disease?

Answer 717

Sharp, triphasic, synchronous discharges

Question 718

What valvular dysfxn is most commonly associated with IE?

Answer 718

MVP with mitral regurgitation. About 75% of patients with IE have previously damaged heart valves, with mitral valvular disease being the most common.

Question 719

6 classic causes of gout?

Answer 719

``` Primary gout (idiopathic) Myelo/lymphoproliferative disorders (e.g. polycythemia, etc) Tumor lysis syndrome HGPRT deficiency CKD Thiazides/loop diuretics ```

Question 720

Procedures can be performed on a newly deceased patient for training only after what?

Answer 720

Permission was obtained from the family

Question 721

Form of acne vulgaris that requires oral isotretinoin Rx?

Answer 721

Refractory nodular (cystic) acne. Large nodules appear cystic under skin.

Question 722

3 forms of acne vulgaris?

Answer 722

Comedonal Inflammatory (papules <5mm with pustules) Nodular (large >5mm nodules that appear cystic)

Question 723

Form of acne vulgaris requiring topical antibiotics before moving to oral antibiotics?

Answer 723

Inflammatory. Use erythromycin or clindamycin in topical form before orals are used.

Question 724

Differentiate Bell's palsy from UMN lesion on PE?

Answer 724

Forehead muscle sparing is suggestive of intracranial lesion warranting brain imaging for lesion upstream of pons. Eyebrow paralysis is found in Bell's as the lesion is below (downstream from) the pons.

Question 725

Panendoscopy def?

Answer 725

Esophagoscopy, bronchoscopy, laryngoscopy or triple endoscopy

Question 726

DM nephropathy is characterized by what?

Answer 726

Proteinuria and a progressive decline in GFR. Nodular glomerulosclerosis with Kimmelstiel-Wilson nodules is pathognomonic, but diffuse glomerulosclerosis is more common.

Question 727

Hypotension, JVD, and new-onset RBBB are signs of ?

Answer 727

Right sided strain. If post-surgical maybe massive PE.

Question 728

Inherited skin disorder characterized by diffuse dermal scaling. Skin is rough with horny "plates" that look like scales. Dx?

Answer 728

Ichthyosis vulgaris. Rx: emollients, keratolytics, topical retinoids.

Question 729

What neurohormonal adaptations (3) are occurring during acute CHF exacerbation?

Answer 729

Decreased CO leads to increased sympathetic tone, RAAS activation, and increased secretion of ADH. ID4594

Question 730

Best test for AAA suspected?

Answer 730

Abd. US.

Question 731

Minimal bright red blood per rectum is a sign that should evaluated with colonoscopy when?

Answer 731

At age 50+ OR any age with red flags (change in bowel habits, abd. pain, weight loss, iron def. anemia, Fam Hx of colon cancer).

Question 732

A wide-complex tachycardia with fusion beats or AV dissociation are classic for?

Answer 732

Sustained monomorphic V-tach.

Question 733

Rabies postexposure prophylaxis (rabies vaccine and rabies Ig) are indicated when?

Answer 733

The animal is either unavailable or symptomatic. An available, asymptomatic animal can be observed (for 10 days) or tested (wild animals).

Question 734

Rapidly developing hyperandrogenism suggests what about the source of the androgens?

Answer 734

Neoplasm of the ovary or adrenals. If DHEAS is normal, then likely ovarian, if DHEAS is elevated, then likely adrenal.

Question 735

In a young man with undiagnosed CF, bronchiectasis in what area of the lung might spur investigation for CF?

Answer 735

Upper lung lobe bronchiectasis is characteristic of CF, whereas, bronchiectasis occurs in the lower lungs 2° to other causes.

Question 736

Patients with Familial adenomatous polyposis require what screening?

Answer 736

Colonoscopic screening starts in childhood and elective proctocolectomy are standard of care.

Question 737

An elevated or even normal PaCO2 in an asthmatic refractory to typical Rx and steroids likely indicates what?

Answer 737

Impending respiratory collapse requiring intubation.

Question 738

A patient with parkinsonian Sx experiences autonomic dysfxn (orthostatic hypotension, impotence, incontinence, etc.). Dx?

Answer 738

Multiple System atrophy (aka Shy-Drager syndrome)