Misc

Question 1

1st choice antiHTN meds for pt on lithium:

Answer 1

CCB

2nd choice loops

Question 2

1st line antiHTN meds

Answer 2

ACE/ARB, CCB

2nd HCTZ, 3rd hydralazine, clonidine

Question 3

1st line Tx for nasal polyps?

Answer 3

Nasal GCS, if no improvement >surg

Question 4

27yo M, ASx, proteinuria on multiple UAs. NSIM?

Answer 4

16hr urine sample, day/night to r/o orthostatic proteinuria

Question 5

30yo M w/:

• pyrexia
• pharyngitis
• LAD
• arthralgia
• blanching red maculopapular rash
• mucocutaneous ulcer

Dx?

Answer 5

Acute HIV syndrome

1-3wks after infection in 50-70%

Question 6

3cm Breast CA w/o LN involvement. Tx?

Answer 6

lumpectomy w/ adjuvant chemo/rad

if 3+ LNs involved or tumor >1cm, give adjuvant tx

Question 7

45yo M w/ blisters, acantholysis on Tzank. Dx?

Answer 7

pemphigus vulgaris

Question 8

80yo CRC w/ mets. Na 114, K 4.5, gluc 80.

uric acid low, BUN 12. W/u & suspected Dx?

Answer 8

UNa (high) & UOsm (high)

SIADH

Question 9

____ is a precursor of thyroid hormones produced by mature thyroid cells & stored in follicles.

Answer 9

Thyroglobulin

Question 10

AChR Ab negative, but MG suspicion is high. NSIM?

Answer 10

EMG (repetative nerve stim & tensilon), + if demonstrated fatiguability.

Note: AChR Ab have sen 85%, spec 100%

Question 11

Acute gout at one site. Tx?

Answer 11

IL GCS

Question 12

Acute hirsutism 30-40yo F. NSIM?

Answer 12

US ovaries r/o tumor

if neg, CT adrenals

Question 13

Acute vs chronic demyelinating polyneuropathy/GBS.

Answer 13

Acute: S/p Campy, CMV. Auto-Abs.
Chronic: no pathogen link. Anti-GM1 gangliosde Abs

Question 14

ADAMTS13 mutation. Dx & Tx?

Answer 14

TTP, plasmapheresis

ADAMTS13= metalloproteinase that breaks down vWF

Question 15

Admin instructions for Ca+ acetate in HD patients w/ hyperPh

Answer 15

take with meals

not in AM or empty stomach

Question 16

ADPKD extrarenal complications (5)

Answer 16

1. MVP (26%)
2. diverticulosis
3. HTN
4. cerebral aneurysms
5. hepatic cysts

Question 17

ADPKD: assd abnormalities

1. cardiac
2. hepatic
3. GI

Answer 17

1. MVP
2. hepatic cysts
3. diverticulosis
   (also HTN, cerebral aneurysms)

Question 18

Adrenal adenoma > high aldoserone. Dx?

Answer 18

Conns

diastolic HTN, HA, m weakness, polyuria

Question 19

Adult Stills disease Sx? Tx?

Answer 19

Arthritis, rash, fevers, transaminitis, ~LAD, ~pericarditis, v high ferritin. May look like mono.

Tx: mild, LFTs <3x norm- NSAIDS
LFT >3x norm- GCS

Question 20

AE of exogenous GH (ie athletes)

Answer 20

HTN & fluid ret (edema/CTS)

Question 21

AE: priapism, orthostatic hypoTN, sedation. Which medication?

Answer 21

Trazodone

Question 22

AIDS pt from Mississippi w/ oral ulcers- which systemic fungal d?

Answer 22

Histoplasmosis (associated w/ bat droppings/caves, spelunking)

Question 23

AKI w/ RBC casts. NSIM?

Answer 23

Bx

Question 24

Alcohol w/o AG & + osmolar gap

Answer 24

isopropyl (both high w/ others)

Question 25

Anaplasia definition?

Answer 25

cells loose function and structural definition

Question 26

Anemia assd w/ radiation

Answer 26

aplastic

Question 27

Anemia, thrombocytopenia, AKI, GI sx, arthralgias, purpura. Tx?

Answer 27

HSP, supportive | If Dx is unclear, renal bx

Question 28

Anthrax: Tx?

Answer 28

Cipro or Doxy

Question 29

Anti-GM1 gangliosde Abs assn?

Answer 29

Chronic demyelinating polyneuropathy/GBS | not acute

Question 30

Anti-histone Abs+, dsDNA & complement wnl. Dx?

Answer 30

Drug induced lupus Meds: INH, hydralazine, procainamide, BB, phenothiazines

Question 31

Anti-malarial that can precipitate hemolytic anemia in G6PD.

Answer 31

Primaquine (others less so)

Question 32

Anti-mitochondrial Abs. Dx?

Answer 32

PBC (dx up to 15% in scleroderma)

Question 33

Anti-smooth m Abs. Dx?

Answer 33

AI hepatitis

Question 34

Anti-topoisomerase. Dx?

Answer 34

Scleroderma

Question 35

antiD Ig 2nd dose in preg: titration should be ____

Answer 35

increased based on bleed severity

Question 36

AntiJo+. Dx?

Answer 36

Polymyositis, dermatomyositis

Question 37

Antiphospholipid syndrome suspected. Best initial test after coags?

Answer 37

no correction of prolonged aPTT w/ mixing study | factor deficiencies correct on mixing

Question 38

Aortic dissection. Which meds to be given STAT before surgical repair?

Answer 38

BB, nitroprusside

Question 39

Arthralgia, eye pain & pathergy+. Dx?

Answer 39

Pathergy needed for Becet Dx | exaggerated skin injury sp minor trauma

Question 40

Assn ribosomal P ab in SLE?

Answer 40

SLE cerebritis - brain edema - psychosis/mania

Question 41

Associated condition: - Armadillo - Bats - Rats

Answer 41

Leprosy Rabies Plague

Question 42

Asthma exacerb: first line

Answer 42

albuterol & GCS | later: ipratropium

Question 43

Asthma: uncontrolled w/ standard Tx. IgE elevated. NSIM?

Answer 43

Omalizumab (anti IgE Ab)

Question 44

Asthmatic in disress w/ normal pCO2 after tx. NSIM?

Answer 44

Intubate

Question 45

Asx 74yo w/ hx carotid endardectomy, CABG 3y ago. Recommended pre-op screen?

Answer 45

Nothing

Question 46

Asx pt is NOT fom Lyme endemic area. Tick attached. Management?

Answer 46

Reassurance

Question 47

Asx pt w/ pre-exciting LBBB. Which pre-op eval do they require?

Answer 47

None. (unless new LBBB w/ CP)

Question 48

Bacillary angiomatosis: Etiology, significance

Answer 48

Bartonella henselae, AIDS-defining

Question 49

Bacterial prostatitis w/ urinary retention, Tx?

Answer 49

suprapubic cath/bladder decompression | Cipro or TMP-SMX

Question 50

Bartters synd looks like ____ overdose | Gitelmans synd looks like ____ overdose

Answer 50

Thiazine (works on DT) Loop (works on ascending limb) (both hypoK)

Question 51

BBs and which antiarrhythmic may induce bronchospasm?

Answer 51

Adenosine, hence caution in asthmatics

Question 52

BCx w/ capnocytophaga. How did the pt get infected?

Answer 52

Bitten by a doggo

Question 53

``` Beach Liver D EtOH Bullous skin lesion Food poisoning ``` Dx?

Answer 53

Vibrio vulnificus

Question 54

Behcet pulm complication

Answer 54

pulm artery aneurysm

Question 55

Behcets: orogenital ulcers, arthralgia, uveitis. Biggest concern: Dx test: Tx:

Answer 55

Concern: blindness Dx test: pathergy test Tx: colchicine for prevention, may give GCS for acute ulceration

Question 56

Best BP med for gout?

Answer 56

ARBs (increase uric acid excr)

Question 57

Best test Addisons dx?

Answer 57

Cosyntropin (ACTH) Stim test 0, 30, 60min if <18-20= adrenal insuff.

Question 58

Biggest lifestyle modification to lower BP?

Answer 58

weight loss/exercise

Question 59

Bites: cat/dog/human. NSIM?

Answer 59

``` Tdap (if dirty wound <5yrs, clean <10yrs) PLUS augmentin (amovi/clav) ```

Question 60

BK virus assn

Answer 60

renal transplant rejection

Question 61

Black widow bite. Tx?

Answer 61

``` Ca gluconate (venom plummets Ca) antivenin ```

Question 62

Bloody D, 2-4d sp undercooked chicken. Complic: GBS or post-inflamm arthritis. Tx?

Answer 62

Dx: Campylobacter Tx: Only use abx if high risk. Best: Azithromycin (previously cipro but resistence is rising)

Question 63

Blue pt sp nitrates or anesthetic. Dx & Tx?

Answer 63

Methemoglobinemia Methylene blue (Disease MOA oxidation: ferrous > Fe3)

Question 64

Bowel sounds in SBO

Answer 64

Initially high pitched tinkling >> absent

Question 65

BP arms > BP legs. Dx?

Answer 65

Coarctation | in adults: HTN & rib notching also

Question 66

Bronchiectasis w/u.

Answer 66

First CXR, then CT. | PFT: obstructive

Question 67

Bupropion inhibits reuptake of __ & __

Answer 67

NE & D | AE: HA, tachycardia, low sz threshold, insomnia

Question 68

Bx: periodic acid schiff & macrophages. Dx?

Answer 68

Whipples | Farmer w/ malabs/steatorrhea, D, arthritis, encephalopathy, LAD

Question 69

c-ANCA: p-ANCA: anti-GBM:

Answer 69

1. Wegeners (granulomatosis w/ polyangitis) 2. ChurgStrauss & microscopic polyangitis 3. Goodpastures

Question 70

Calcinosis cutis, reynauds, sclerodactyly. Dx?

Answer 70

CREST ``` Calcinosis Cutis Reynauds Esophageal dysmotility Sclerodactyly Telangiectasias ```

Question 71

Calcitonin is a tumomr marker for ___ CA

Answer 71

medullary thyroid

Question 72

Cardiac procedure > fever, livedo reticularis, petechiae, digital ischemia, AKI. Dx?

Answer 72

Cholesterol emboli

Question 73

Catamenial PTX. Path?

Answer 73

Pulm endometriosis > cyclic bleed > PTX

Question 74

Cell-free DNA testing performed at ___wk. | What do you do if it is +?

Answer 74

>10th wk. | Invasive testing: CVS or amniocentesis for direct genotype analysis

Question 75

CF w/ brown mucous plugs. Work up:

Answer 75

r/o ABPA (another assd condition is asthma)

Question 76

Chagas Tx

Answer 76

Benznidazole, nifurtimox

Question 77

Chagas vector

Answer 77

kissing bug bite

Question 78

Chronic interstitial nephritis & papillary necrosis is often caused by:

Answer 78

analgesics (analgesic nephropathy)

Question 79

Chronic regional pain syndrome: Dx (most accurate)?

Answer 79

bone scintigraphy- low metabolic activity > osteopenia

Question 80

Cluster HA. | Sx, freq, Tx?

Answer 80

- unilat tearing/rhinorrhea & stabbing pain behind eye. - 1+ HA daily for 1-2h x few weeks. - O2

Question 81

Colicky abd pain, high pitched tinking sounds, AXR w/o air in rectum. What are the MCC of this condition?

Answer 81

Bowel adhesions & incarcerated hernia | SBO

Question 82

Complication of gadolinium in renal failure?

Answer 82

nephrogenic systemic fibrosis | no Tx

Question 83

Complication of spontaneous abortion

Answer 83

``` hemorrhage retained products septic abortion uterine perf uterine adhesions ```

Question 84

Complications of cerebral venous sinus thrombosis:

Answer 84

seizures focal neuro deficits confusion RF: preg, OCP, inf, CA, trauma Dx: MRI w/ MRV Tx: LMWH

Question 85

Complications of Rh incompatability

Answer 85

- kernicterus 2/2 RBC lysis - fetal anemia > CHF - extramedullary hematopoesis (HSM, portal HTN, ascites, hydrops fetalis)

Question 86

Conns suspected. CT/MRI neg for adenoma. NSIM?

Answer 86

adrenal vein aldosterone sampling

Question 87

Constipation > D, pink rash, HSM, fatigue, fever, relative brady. Tx?

Answer 87

Cephalosporin or Cipro/FQ (S.typhi)

Question 88

Copper IUD is the best choice for:

Answer 88

young women with light menses

Question 89

Cough, hemoptysis, SOB, dark urine, CXR infiltrates UA 50-100 RBC, RBC cast, ANA- Bx Linear IgG on BM Dx?

Answer 89

Goodpastures (Anti-GBM d)

Question 90

CREST suspected. Best initial test? Best confirmatory test?

Answer 90

ANA, then anti-centromere

Question 91

Criteria for chest tube in empyema?

Answer 91

pH <7.19 | purulent material, WBC+++

Question 92

Croup Tx?

Answer 92

No stridor at rest: GCS + humidified air | Stridor at rest: GCS + racemic EPI

Question 93

Cryoglobulinemia assn?

Answer 93

HCV

Question 94

Cx: Cigar shaped yeast, rosette clusters, septate hyphae. What was the mode of infection?

Answer 94

Gardening (Sporothrix schenckii) | Tx: Itraconazole PO if cutaneous/lymph if systemic > ampho B

Question 95

DDx central vs nephrogenic DI

Answer 95

ADH/DDAVP will improve central but not nephrogenic type

Question 96

DDx Polycythemia vera vs 2o polycythemia

Answer 96

PV: low EPO 2o: high EPO

Question 97

DDx thalassemia vs IDA

Answer 97

RDW (thalassemia:wnl, IDA: elevated)

Question 98

Deficiency in NADPH oxidase. ↑ risk of catalase-positive infections (S. aureus, E. coli, Aspergillus, Candida, etc.) Dx?

Answer 98

Chronic granulomatous D (Dx w/ nitroblue tetrazolium) Granuloma formation as deficiency in NADPH oxiade > lack of ability to make ROS to for NADPH oxidative burst /lyse pathogen)

Question 99

Denosumab (Prolia, Xgeva). Use?

Answer 99

Injectable for osteoporosis SC Q6m | if cannot tolerate bisphosphonates or have poor renal function

Question 100

Devastating findings on head CT, labs wnl, not on sedatives, vitals wnl. Absent brain stem reflexes, apnea test+. What additional test to confirm brain death?

Answer 100

Nothing *IF not all above were present, ancillary test should be used: EEG, CTA/MRA

Question 101

DEXA T score -1 to -2.5 deviations from norm=

Answer 101

osteopenia

Question 102

Diarrhea that improves at night/fasting. Type?

Answer 102

``` Osmotic (high osmotic fecal gap >100) - celiac sprue - chronic pancreatitis - lactase deficiency -lactulose/laxative abuse - Whipple's disease ```

Question 103

Dicyclomine & hyoscyamine use?

Answer 103

Anti-spasmotics for crampy pain

Question 104

dimethyl fumarate use?

Answer 104

MS: decreases sx and progression but NOT disease modifying

Question 105

Disseminated histoplasmosis/systemic disease. Tx?

Answer 105

Amphotericin IV then itraconzaole PO

Question 106

DKA- in addition to hyperglyc work up, also order the following:

Answer 106

EKG, trop, (r/o ACS) UA (r/o UTI) CXR (r/o PNA)

Question 107

DKA: MCC/trigger

Answer 107

infection

Question 108

DM neuropathy: Tx?

Answer 108

Best: SNRI (duloxetine), Lyrica, TCA Also: gabapentin, lamotrigine, carbamaz Topical lido or capsaicin

Question 109

DOAC values: - PT - aPTT - INR

Answer 109

all increased (Xa inhibitor)

Question 110

DVT risk in CVA: __%

Answer 110

10% (esp w/ hemiparesis) | PPX w/ SC heparin IPC if already on thrombolytic, DAPT, AC 2/2 bleed risk

Question 111

Dx of choice: 1. achalasia 2. GERD 3. Barretts

Answer 111

1. manometry 2. 24pH monitor 3. EGD

Question 112

Dx test for gastroparesis? Tx?

Answer 112

Nuclear med scinigraphy Freq small meals, metoclopramide

Question 113

Dx test for hiatal hernia

Answer 113

CT

Question 114

Dx test of choice for PTX in urgent setting?

Answer 114

US: inability to detect lung sliding against pleura CXR/CT- too much time CXR must be AP otherwise sen <50%

Question 115

Dysphagia 10yrs sp heartburn onset. Dx?

Answer 115

Schatzki's ring- unknown mech

Question 116

Ehlers. MCCOD?

Answer 116

Spontaneous arterial rupture. | note also 50% colonic perf risk

Question 117

Elderly w/ afib, CHF, confusion, decreased appetite, constipation, prox m wasting. Lab w/u?

Answer 117

TSH- Apathetic thyrotoxicosis - tachcardia masked by BB - often no proptosis/lid lag, thyromegaly or tremor

Question 118

Empiric Tx osteomyelitis?

Answer 118

Vanc/ceftiaxone (need MRSA cover) * avoid vanc/zocyn per nephrotox * taper abx to C/S of bone bx

Question 119

Erythema nodosum: MCC (4)

Answer 119

Post-strep Sarcoidosis Coccidiodomycosis Crohns

Question 120

Esoph Bx w/ Dx: - Owl eyes: - Inclusion body:

Answer 120

CMV (large ulcers) | HSV (small crops)

Question 121

Esoph webs & anemia. Which CA is pt at risk for?

Answer 121

SCC

Question 122

Farmer w/ malabs/steatorrhea, D, arthritis, encephalopathy, LAD. Dx?

Answer 122

Whipples D (PAS+, macrophages)

Question 123

Febrile neutropenia in pt on chemo. NSIM?

Answer 123

START abx w/ pseudomonas cover (cefepime, meropenem, imipenem, zocyn) If still febrile x 3d, add vanc If still febrile after vanc, add caspofungin

Question 124

Fertile female w/ reticulonodular infiltrates/honeycombing. Spontaneous PTX w/ chylous pleural effusion. Dx?

Answer 124

Lymphangioleiomyomatosis 2/2 abn prolif immature smooth m cells involving alveolar septae/walls

Question 125

FHx premature CAD:

Answer 125

55 M, 65 F

Question 126

Foot paresthesias > loss of vibration sense/proprioception. Rhomberg+, LE spasticity/weakness. Decreased achilles reflex. NSIM?

Answer 126

B12 level, then MMP & homocysteine (both elevated- B12 def)

Question 127

Foot/wrist drop, asthma/allergic rhinitis, skin nodules, high IgE. Dx?

Answer 127

Churg Strauss (also eosinophilia, sinusitis)

Question 128

For BIPASS, how long do saphinous veins vs intramammary veins last?

Answer 128

saphinous: 5yrs intramammary: 10yrs

Question 129

Friable grey pseudomembrane in a teen. Dx work-up?

Answer 129

SCx Toxin assay (diptheria) Tx: erythro or penG

Question 130

Friable grey pseudomembrane in a teen. MC complications

Answer 130

myocarditis, neuritis, renal d

Question 131

GERD improvement in sp 3 months of PPI. NSIM?

Answer 131

GRADUAL TAPER (gastrin levels are very high, quitting cold turkey will spike gastrin levels wth rebound sx)

Question 132

GERD w/o response to PPI. NSIM?

Answer 132

24h pH

Question 133

Gold standard Dx of Trichomonas vaginalis

Answer 133

NAAT | However wet mount (pear shaped, motile) may suffice to make Dx.

Question 134

Graves has __% remission w/ meds in 1yr

Answer 134

50%, if persistent > c/w meds or ablate

Question 135

Greatest prognostic factor Br CA?

Answer 135

LN spread

Question 136

harsh holosystolic murmur over 3/4th ICS w/ thrill:

Answer 136

VSD (small- loud, big-quiet)

Question 137

HD indications

Answer 137

diuretic resistant pulmonary edema hyperkalemia (refractory to medical therapy) metabolic acidosis (refractory to medical therapy) uremic complications (pericarditis, encephalopathy, bleeding) dialyzable intoxications (eg, lithium, toxic alcohols, and salicylates).

Question 138

HD, pyrexia. NSIM?

Answer 138

BCx and give vanc/gentamycin

Question 139

Heavy smoker w/ high EPO. Which lab do you order to r/o CO toxicity?

Answer 139

carboxyhemoglobin

Question 140

Heinz Bodies or Bite cells- Dx?

Answer 140

G6PD def

Question 141

Hemotympanum noted after MVA/trauma. Dx?

Answer 141

basilar skull fracture | also CSF otorrhea/rhinorrhea, battle sign, racoon eyes

Question 142

high osmotic fecal gap >100. Etiologies?

Answer 142

- Celiac sprue - chronic pancreatitis - lactase deficiency - lactulose/laxative abuse - Whipple's disease

Question 143

High renin, high aldo, abd bruit, AKI. Dx?

Answer 143

RAS | note renal hypoperfusion increases RAAS

Question 144

HIT+. Tx?

Answer 144

STOP all heparins. Give Fonadaparinux. | note: high clotting AND bleed risk

Question 145

HIV w/ transaminitis. CT: mult cystic lesions Warthin–Starry silver w/ organisms DDx?

Answer 145

Bacillary angiomatosis | 2/2 Bartonella henselae

Question 146

House fire, pH < 7.2, Lactate ≥ 10 mmol/L. In addition to treating CO poisoning w/ 100% O2, you give ___ for possible concomittant ___ toxicity.

Answer 146

hydroxocobalamin (B12 precurs), cyanide

Question 147

How is ebola transmitted?

Answer 147

``` Bodily fluids (semen, sweat, urine) NOT airborne ```

Question 148

How long after initiating HAART does IRIS occur?

Answer 148

weeks symptomatic Tx +/- short course GCS

Question 149

How long is a stress test valid for pre-op eval?

Answer 149

2 years

Question 150

HSP Tx

Answer 150

supportive

Question 151

HTN emergency: avoid dropping BP >__% in 24h.

Answer 151

20% Tx: labetalol, nitrates, esmolol, nifedipine

Question 152

HTN, periorbital edema, 1wk sp skin infection. Dx?

Answer 152

PSGN | cross reactivity of anti-strep ab w/ GBM

Question 153

Hx anorexia/insomnia. Pt presents for MDD, does not want sexual adverse effects. Best choice of antidepressant?

Answer 153

Mirtazepine (effects of weight gain and sedation)

Question 154

Hx working w/ electronics, alloys or dental ceramics. Chronic interstitial pneumonitis in upper lobes. Granulomatosis. Dx?

Answer 154

Berylliosis

Question 155

HyperK & chronic illness= RTA #__

Answer 155

4

Question 156

Hypertrophic Osteoarthropathy. | Etiologies: 1o vs 2o

Answer 156

``` 1o = rare, M>F, PLT fragmenting 2o = 2/2 bronchiectasis, CF, IBD, infective endocarditis, cyanotic heart d ```

Question 157

HypoCa, hyperPh, hyperPTH. Dx & path?

Answer 157

PseudohypoPTH | 2/2 PTH organ resistence

Question 158

HypoK, hyperNa, met alk, low renin. M.weakness, HA, polyuria. Dx?

Answer 158

Conns. Also elevated diastolic HTN.

Question 159

HypoNa w/u steps

Answer 159

1. SeOsm (most: hypoOsm, unless pseudoHyopoNa) 2. Hyper, Eu or Hypovolemic? 3. UrOsm & UrNa

Question 160

ICU Na 114, gluc 1750. Tx?

Answer 160

Insulin & NS | disregard Na as it is pseudohypoNa

Question 161

If breast CA sentinel node+, perform:

Answer 161

axillary LN dissection | if negative, dont perform

Question 162

IgA vs PSGN: 1. complement levels 2. timing after URTI

Answer 162

IgA: complement wnl, soon after/during URTI PSGN: low complement, 2w post URTI

Question 163

Indication for carotid endardectomy

Answer 163

78-99% stenosis

Question 164

Indications for cell-free DNA testing & what does it test?

Answer 164

- maternal age >35 - abn maternal serum test - US w/ fetal aneuploidy signs - hx preg w/ fetal aneuploidy - parental balanced Robertsonian transl. Tests for T21, T18, T13 & sex chromosome aneuploidies

Question 165

Indications for modified radical mastectomy

Answer 165

- >7cm or smaller in small breasts where clear margins cannot be obtained - 2+ primary breast tumors (otherwise lumpectomy w/ RAD)

Question 166

Indications for oseltamivir after 48h Sx

Answer 166

Increased risk: - 65+ - preg > 2wks postpartum - chronic d (pulm, renal, cardiac) - immunosupp - BMI >40 - natives - NH or chronic care facility

Question 167

Inreaperitoneal organs

Answer 167

stomach, ileum/jej, transverse c, sigmoid, liver, gallb, panc, spleen

Question 168

Ischemic CVA Sx x 4h, NSIM?

Answer 168

tPA if no contraindications (<4.5h window)

Question 169

Isolated 2cm pulm nodule, no prior imaging. NSIM?

Answer 169

CT

Question 170

ITP. Fastest improvement w/ following Tx:

Answer 170

IVIg

Question 171

Kartageners Dx?

Answer 171

Sperm mobility test

Question 172

Known AE of flumazenil

Answer 172

seizures

Question 173

Labs in ABPA

Answer 173

- skin: A. fumigatus + - eosinophilia >500 - IgE >417 - IgG/IgE exaggerated response to A.fumig CXR fleeting infiltrates CT central bronchiectasis

Question 174

Largest source of potassium in diet?

Answer 174

meat

Question 175

Least AE: A) mupirocin B) bactrim C) neomycin

Answer 175

A (use: impetigo!!)

Question 176

Leptospirosis is transmitted via:

Answer 176

contam water/food w/ animal urine

Question 177

Leucovorin use?

Answer 177

(folinic acid) First line for folate supplementation

Question 178

Levels in Conns: - K - Na - met alk or acidosis? - renin

Answer 178

hypoK hyperNa met alk low renin (high aldo > feedback inhibition)

Question 179

Levels in Cushing: - renin - aldo

Answer 179

- low | - low

Question 180

Linear deposits IgG & C3 in epidermal BM. Dx?

Answer 180

Bullous pemphigoid (note: no correlation w/ Ab amount and disease severity!) (note: pemphigus vulgaris is intradermal)

Question 181

long aPTT and normal PT. Dx?

Answer 181

antiphospholipid syndrome - Beta2 GLP1 ab - anticardiolpin - lupus anticoagulant (best initial test no correction w/ mixing study)

Question 182

Low cortisol, low aldosterone, hyperK, hypoNa. Fatigue, hyperpigmentation. Tx?

Answer 182

lifelong GCS (ie pred 5mg QD) Dx: Addisons

Question 183

Low UOsm & UNa. How can you DDx psychogenic polydipsia vs nephrogenic DI?

Answer 183

nocturia occurs w/ DI but not psychogenic as pt is not drinking at night

Question 184

Low/normal vaginal pH w/ vaginitis. Dx?

Answer 184

Trichomonas (Candida & BV: high pH)

Question 185

Lubiprostone use

Answer 185

IBS-C or opioid-induced constipation

Question 186

Lung CA w/ ectopic PTH-rp.

Answer 186

SCC

Question 187

Lung mass w/ gynecomastia/galactorrhea. Which Lung CA?

Answer 187

Large cell lung CA (ectopic bhCG)

Question 188

Lyme Tx age <8 vs >8

Answer 188

<8 amox | >8 doxy

Question 189

Lymphogranuloma venerum. Pathogen?

Answer 189

Chlamydia (**painless ulcer)

Question 190

Malaria PPX

Answer 190

Mefloquine or atovaquone (NOT doxy d/t phototoxicity) **Mefloquine is contraindicated for psych hx or arrhythmi

Question 191

Male w/ dysuria, urinary urgency/frequency. Dx test?

Answer 191

Urinary NAAT | Tx: Doxy & Azithro

Question 192

MALT lymphoma. Cause & Tx?

Answer 192

Hpylo, Tx PPI/amox/clarithro If no improvement chemo/rad

Question 193

Maltese cross, ixodes tick bite. Tx?

Answer 193

Babesia. Azithromycin & atovaquone.

Question 194

Massive trauma inury- IV unsuccessful x 10 mins. NSIM?

Answer 194

IO access

Question 195

MC polyneuropathy in Churg Strauss?

Answer 195

foot/wrist drop

Question 196

MC RF GERD

Answer 196

obesity

Question 197

MC sexual dysfunction in men?

Answer 197

premature ejaculation

Question 198

MC statin AE

Answer 198

liver dysfunction

Question 199

MC thyroid CA?

Answer 199

Papillary | 2nd MCC: Follicular

Question 200

MCC Cx negative endocarditis?

Answer 200

Bartonella & coxiella

Question 201

MCC erythema multiforme

Answer 201

HSV

Question 202

MCC lung CA in female & non-smokers?

Answer 202

Adenocarcinoma

Question 203

MCC organ damage in severe congenital anemias?

Answer 203

hypertransfusion regimen > iron overload

Question 204

MCC painful swallowing in HIV

Answer 204

Esophageal candidiasis (often w/ oral inf)

Question 205

MCC sexual dysfunction in men w/ SSRI?

Answer 205

retrograde ejaculation

Question 206

MCCOD Scleroderma?

Answer 206

Pulm HTN | then renal

Question 207

Medication for PAD?

Answer 207

Cilostazol - improves claudication - increases walking distance

Question 208

Medication to improve cardiac contractility via inhibiting cAMP defred, used in advanced CHF pt w/ shock to be bridged to heart transplant?

Answer 208

Milrinone (AE: hypotension, tachycardia, vent arrhythmias, GI upset)

Question 209

Medication which can mask hypoglycemia in DM?

Answer 209

BB

Question 210

Meds causing Tubulointerstitial nephritis.

Answer 210

- NSAIDs - PCN - sulpha drugs - rifampin - HCTZ - furosemide - phenytoin - cimetidine - allopurinol

Question 211

Meds for PAD? (4)

Answer 211

Cilostazol, DAPT, statin, metoprolol if CAD Good glycemic/BP control Quit smoking dummie

Question 212

Meds that increase risk of Cdiff: (4)

Answer 212

Clindamycin Cipro FQs Cephalosporins PPI

Question 213

Meds that interfere w/ folate metabolism? (3)

Answer 213

MTX, phenytoin, trimethoprim

Question 214

Mefloquine: contraindications

Answer 214

psych hx or arrhythmias

Question 215

Megaloblastic anemia, D, cheilosis, glossitis. Dx?

Answer 215

folate def

Question 216

MELD parameters

Answer 216

Bili INR Cr +/- Na

Question 217

Meningitis PEP indicated for following:

Answer 217

- household members, immediate contacts - involved in CPR/intubation, kissing - seated next to >8h (ie flight) (best agent: rifampin BID x 2 days, ~also cipro or ceft x 1 dose)

Question 218

Metanephric blastema differentiate into _____

Answer 218

kidneys

Question 219

Mid systolic ejection murmur (due to increased PV flow) & mid diastolic rumble:

Answer 219

ASD (also wide fixed splitting of 2nd heart sound)

Question 220

Mid to late systolic murmur of MR. Softer after admin of amyl nitrate inhalation/Valsalva. Delayed w/ squatting. Dx?

Answer 220

MVP

Question 221

Milrinone use?

Answer 221

Medication to improve cardiac contractility via inhibiting cAMP defred, used in shock pt to be bridged to heart transplant

Question 222

MOA cholelithiasis in setting of spherocytosis

Answer 222

Spherocytosis > HA > RBC breakdown > cholelithiasis (& splenomegaly)

Question 223

MOA diarrhea in scleroderma?

Answer 223

progressive colonic fibrosis >inability to absorb free water

Question 224

MOA EPI

Answer 224

Stimulates cAMP

Question 225

MOA IDA in nephrotic syndrome?

Answer 225

loss of carrier proteins

Question 226

MOA PTX in advanced COPD?

Answer 226

bleb rupture

Question 227

MOA renal failure > hypoCa+

Answer 227

decreased vitD production decreased phos excretion >> Ca deposits in tissues hence risk of: - osteomalacia/osteoporosis - osteitis fibrosa cystica (2/2 high PTH)

Question 228

monoclonal ab against HER2

Answer 228

traztuzumab

Question 229

Mosquito bite, fever, flu-like, severe arthralgias. Dx?

Answer 229

Chikungunya

Question 230

``` Most effective Tx GERD: A) H2 blocker B) Diet modification C) Weight loss D) PPI ```

Answer 230

D

Question 231

Most sensitive response for nephrogenic DI?

Answer 231

no response to ADH Tx: supplement Mg, Ph, Ca HCTZ low protein/Na diet

Question 232

MS suspicion occurs when:

Answer 232

2 attacks of neuro deficits w/ some resolution OR 2 brain lesions separated by time

Question 233

MS: - initial dx test? - most accurate dx test?

Answer 233

MRI brain/neck (LP for oligoclonal bands only if MRI is equivocal)

Question 234

MUDPILES

Answer 234

``` Methanol Uremia (RF) DKA (EtOH acidosis, ketoacidosis) Paraldehyde Isoniazid, iron Lactic acodosis EtOH Salicylates/ASA ```

Question 235

Murmur assd w/ pulm HTN

Answer 235

TR

Question 236

Na 112 UOsm 50 UO high POsm 230 Dx?

Answer 236

Psychogenic (serum & urine are wet)

Question 237

Nephrotic syndrome MOA HLD

Answer 237

Increased cholesterol production to make up for loss of oncotic protein

Question 238

Neuro complication of mycoplasma PNA?

Answer 238

GBS (also Campylobacter gastroenteritis)

Question 239

Neurosyphilis: CSF FTA vs CSF VDRL

Answer 239

FTA: v sen, lower spec. (good test to r/o) VDRL: v spec, ~ sen (good dx test)

Question 240

New onset HTN & proteinuria or end organ damage. Dx?

Answer 240

Preeclampsia | Dx after 20w gest

Question 241

Normochromic anemia w/ basophillic stippling. Dx & assd neuro deficit?

Answer 241

Lead tox. Sx: abd pain, HA, irrit, fatigue, wrist/foot drop

Question 242

NSAIDs cause constriction of afferent or efferent?

Answer 242

efferent | they also cause direct toxicity

Question 243

Nuclear catastrophe occurs. What do you give to protect the thyroid?

Answer 243

K+ iodine (competes w/ radioactive isotopes)

Question 244

Numerous K supplements w/o improvement. Which lab do you order?

Answer 244

Mg (hypoMg affects K absorp)

Question 245

OGTT performed at ___ wks gest

Answer 245

26

Question 246

Oligomenorrhea, acne, hirsutism, clitomegaly. Dx?

Answer 246

Non-classical CAH

Question 247

Opthalmoplegia & ataxia in pregnant woman with hyperemesis. Tx?

Answer 247

High dose thiamine (Wernickies from thiamine deficiency)

Question 248

p wave increased in lead II suggests:

Answer 248

RV hypertrophy & ?chronic hypoxia

Question 249

Palpable purpura, arthralgia, GN, low C4 in pt w/ HCV. Dx?

Answer 249

Cryoglobulinemia

Question 250

PAN suspected. Which Dx test do you order first?

Answer 250

Abd CT: reveals microaneurysms of blood vessels in the renal, hepatic, or mesenteric circulations. If non-Dx, Bx affected region

Question 251

Pancytopenia w/ blasts++. Dx?

Answer 251

Acute leukemia

Question 252

Pancytopenia, low retic. BMB: hypocellular w/ fat cells. Dx & Tx?

Answer 252

Dx: Aplastic anemia, Tx: BMT. Etiologies: MCC: unknown, benzene, arsenic, chloramphenicol, carbonic anhydrase inhib, CMV, EBV, parvovirus

Question 253

Pancytopenia. | BMB: hypercellularity w/ dysplasia of marrow & precursor cells. Dx?

Answer 253

Myelodysplastic syndrome

Question 254

PAP indication in HIV

Answer 254

Q6months- Q1year. If 3x wnl, then Q3years?

Question 255

Papillary necrosis suspected. Dx test?

Answer 255

CT: translucent spots on renal parenchyma Path: vasoconstriction 2/2 SCD, DM, NSAIDs, ASA

Question 256

Parameters used in Child-Pugh?

Answer 256

``` Bili PT Alb Ascites Encephalopathy ```

Question 257

PCOS: - LH: FSH = __:__ - TSH (low, wnl, high) - DHEA (low, wnl, high)

Answer 257

- LH: FSH = 2-3:1 - TSH slight elevation - DHEA wnl

Question 258

Peak age for primary pulm HTN

Answer 258

20-30

Question 259

Peaked Ts on EKG. NSIM?

Answer 259

Ca gluconate

Question 260

PEP for meningitis. Agents?

Answer 260

Best: rifampin BID x 2 days ~or - cipro x 1 dose - ceft x 1 dose

Question 261

PEP HBV vs HBC

Answer 261

HBV: Ig & vax (transm risk 10-30%) HBC: no ppx (transm risk 3-6%)

Question 262

Periph lungs, digital clubbing, SIADH. Which lung CA?

Answer 262

AdenoCA | MCC lung CA in female & non-smokers

Question 263

``` Peripheral neuropathy w/u: A1C >DM B12 > deficiency ESR > ____ electrophoresis > ____ ```

Answer 263

ESR> nerve related vasculitis | Serum immunoelectrophoresis & quant Ig > paraproteinemia

Question 264

Pioglitazone effect on bones?

Answer 264

decreased bone density

Question 265

Polycythemia. EPO high. Dx?

Answer 265

chronic hypoxia or RCC | if EPO was low= true PV

Question 266

Polycythemia. EPO low. Dx?

Answer 266

PV

Question 267

Post prandial emesis. Cerulide toxin present. Pathogen?

Answer 267

B.cereus

Question 268

PPI AEs:

Answer 268

- increased risk Cdiff, PNA, osteoporosis | - Mg, iron, B12 deficiencies

Question 269

Pralidoxime is an antidote for:

Answer 269

Cholinergic toxicity

Question 270

Pre-eclampsia PPx for high risk pts?

Answer 270

ASA 12wks gest High risk: - hx pre-eclampsia - CKD - chronic HTN - DM - mult gest - AI Also: ~nulliparity, maternal age, obesity

Question 271

Preg w/ HBV needle stick. Had vacccine but HBs Ab not detected. NSIM?

Answer 271

Ig & HBV vaccine

Question 272

Preg w/ hx SCD has hyperemesis gravidum. What is she at risk of developing?

Answer 272

Sickle crisis (hepatic vaso-occlusive crisis 2/2 hypovol) RUQ pain, anemia, jaundice

Question 273

Preg woman w/ HA worse w/ coughing/sneesing. ICP is high. Undergoes sz in ER. Dx?

Answer 273

r/o cerebral venous thrombosis w/ MRI & MRV. RF: preg, OCP, CA, inf, trauma Tx: LMWH

Question 274

Primary Tx Br CA

Answer 274

Breast-conserving lumpectomy w/ subsequent RAD (same results as radical mastectomy). Modified radical mastectomy if: - >7cm or smaller in small breasts where clear margins cannot be obtained - 2+ primary breast tumors

Question 275

Prolactinemia <150. Etiologies

Answer 275

- Chlorpromazine, Promethazine (low D) - Metoclopramide (low D) - SSRI / MAO /TCA If >150, r/o prolactinoma

Question 276

Pseudoappendicitis sp spoiled meat. Dx?

Answer 276

Yersinia entercolitis

Question 277

Pseudoparkinsonism develops days>wks after starting which meds?

Answer 277

``` (2/2 D block) 1st gen antypsych lithium valproate metoclopramide ```

Question 278

Psych pt w/ involuntary movements of tongue/mouth worsened by anticholinergics. Tx?

Answer 278

benzos, botox (tardative dyskinesia) MOA: D block (1st gen 25%, 2nd gen 5%)

Question 279

Psych, urinary incont, leg weakness. Which artery is affected?

Answer 279

anterior cerebral a

Question 280

Pt diagnosed w/ seizure disorder, Tx started. 1-3wks later: pyrexia, leukocytosis, diffuse purpuric eruprion, LAD, hepatitis. Dx?

Answer 280

Dx: Phenytoin hypersensitivity syndrome Tx: switch phenytoin to valproate, give GCS.

Question 281

Pt from central america w/ ventricular apical aneurysm. Dx?

Answer 281

Chagas Also: - biventricular HF R>L w/ cardiomegaly - mural thrombus w/ embolic complications - fibrosis > conduction abn

Question 282

Pt has anti-histone abs. Which drugs do you ask if she is taking?

Answer 282

Hydralazine, procainamide, isoniazid

Question 283

Pt in burning building. CarboxyHb 32%. You give 100% O2 via NRB. NSIM?

Answer 283

ABG, EKG, trop (r/o isch from lack of perfusion) Carbon monoxide poisoning. Dont give bicarb as it is metabolized to more CO2.

Question 284

Pt on antidepressant c/o insomnia. Which medication do you prescribe?

Answer 284

Trazodone (great adjunct to MDD tx if insomnia 2/2 MDD) AE: priapism, orthostatic hypoTN, sedation

Question 285

Pt on HD w/ pruritus & increased bleeds. Possible mech?

Answer 285

Uremia prevents PLT degran > increased bleed

Question 286

Pt on PCP w/ agression. Tx?

Answer 286

Benzo 2nd line: antipsychotic

Question 287

Pt sp splenectomy gets bitten by a dog and develops hypotension. Pathogen?

Answer 287

Capnocytophaga

Question 288

Pt w/ DM or PCOS is taking metformin. Becomes pregnant. What do you advise in terms of medication?

Answer 288

Continue metformin- improves outcomes

Question 289

Pulm arterial HTN= Pulm a pressure > ___

Answer 289

25mmHg

Question 290

Pulm HTN path

Answer 290

1. injury to vasc endothelium 2. medial hypertrophy & intraluminal prolif >> narrowed lumen 3. local procoag state w/in endothelium >> thrombosis 4. decreased pulm arterial flow 5. R heart hypertrophy & TR

Question 291

Pulm lesion: - popcorn appearance. Dx? - onion skinning. Dx?

Answer 291

popcorn- hamartoma | onion- granuloma

Question 292

Pyrexia, abd cramps, bloody/mucous D w/ tenesmus. Assd w/ ~reactive arthritis. Dx?

Answer 292

Shigella sonnei

Question 293

Radionuclear iodine uptake DDx: Low/high? - Thyroiditis - Graves - Toxic/multinodular goiter - Factitious hyperthyroidism

Answer 293

low high high low

Question 294

RAS: Dx of choice?

Answer 294

CT angio

Question 295

Recommend ____ in patients w/ FHx to prevent Alzhemers.

Answer 295

Vit E 400 units/day | exercise DOES NOT prevent Alz

Question 296

Recurrent asthma exac. Fever/lethargy Productive cough w/ brown mucous plugs Fleeting infiltrates on CXR Dx?

Answer 296

ABPA Also - skin: A. fumigatus + - eosinophilia >500 - IgE >417 - IgG/IgE exaggerated response to A.fumig

Question 297

Renal Bx: IgG along GBM Pulm: hemosiderin laden macrophages Dx?

Answer 297

Goodpastures (antiGBM d)

Question 298

Renal failure mechanism of hyperPTH

Answer 298

decreased vitD production >decreased GI Ca/Ph absorp >> increased PTH to improve Ca level

Question 299

Renal injury 2/2 aminoglycosides/amox?

Answer 299

AIN Intrinsic renal damage UA: high UNa, RBC, prot, Eos

Question 300

Retroperitoneal Organs

Answer 300

``` Supraadrenals Aorta/IVC Duodenum (2nd/3rd part) Pancreas (except tail) Ureters Colon (asc/desc) Kidneys Esoph Rectum ```

Question 301

Reversal meds: - prothrombin complex concentration - protamine sulfate - idarusizimab - andexanet

Answer 301

- warfarin - heprain - dabigatran - DOAC

Question 302

RF for hyperemesis gravidum

Answer 302

multigestation hx motion sickness hx migraines

Question 303

RF for spontaneous abortion

Answer 303

- advanced maternal age - hx spontaneous abortion - PSA - BMI extremes

Question 304

Rh incompatability > HSM, portal HTN, ascites, hydrops fetalis. MOA?

Answer 304

extramedullary hematopoesis (2/2 RBC lysis)

Question 305

Rh incompatability: Mother __, infant ___

Answer 305

- , + | mothers abs > fetal RBC lysis >kernicterus

Question 306

Rheum Fever: Major criteria?

Answer 306

``` Joint pain (polyarth) O Carditis Nodules (SC) Erythema marginatum Syndactam chorea ``` Minor: Hx RF, arthralgia, fever, ^ESR, ^WBC, prolonged PR **Dx requires 2 major OR 2 minor w/ 1 major

Question 307

Risk of supplementing SSRI w/ StJohns Wort?

Answer 307

5HT Synd

Question 308

Risks of St.Johns Wort

Answer 308

- inconsistent studies ?mild efficacy in MDD - 5HT Synd w/ concurrent SSRI - DRUG INTERACTIONS - OCP - HAART - immunosupp - nacotics - antifungals - anticoag

Question 309

Rose gardener lesion > lymph spread. Tx?

Answer 309

``` Itraconazole PO (?or K-iodide) Ampho B IV if disseminated ``` Cx: Cigar shaped yeast, rosette clusters, septate hyphae

Question 310

RPR & FTA positive. HA & blurry vision. NSIM?

Answer 310

LP, r/o neurosyphilis | dont just admin Tx for syphilis as it differes from that of neurosyphilis

Question 311

RTA assd w/ amphotericin?

Answer 311

Distal RTA 1 (hypokalemic)

Question 312

Rusty nail puncture. NSIM if: 1. Tetanus booster >5yrs ago 2. Tetanus booster <5yrs ago

Answer 312

1. tetanus booster | 2. no management

Question 313

Salicylate tox. Medical management?

Answer 313

IV bicarb (urinary alkalosis), +/- HD

Question 314

Salmonella typhi gastroenteritis. Tx?

Answer 314

Supportive Assd w/ reptiles, birds, eggs. N/V/D (non-bloody, profuse)

Question 315

SBO or paralytic ileus? A) diffuse continuous abd pain B) BS always absent C) AXR no air in rectum

Answer 315

A) paralytic ileus B) paralytic ileus C) SBO

Question 316

SCD passing necrotic material in urine. Renal path?

Answer 316

papillary necrosis CT: translucent spots on renal parenchyma

Question 317

Schizophrenic w/ limb rigidity, shuffling gait, bradykinesia, postular instability, unhabituated glabellar reflex. Dx?

Answer 317

Pseudoparkinsonism (2/2 D block)

Question 318

Screening recs AAA?

Answer 318

65-75yo w/ any smoking hx

Question 319

Several hours after uncooked meat > D/V/cramps, resolves in 24h. Dx?

Answer 319

Clostridium perfringens intoxication | C. perfringens infection: gas gangrene

Question 320

SIADH: high or low? - SOsm - SNa - UOsm - UNa

Answer 320

low low high high

Question 321

SIADH: MOA

Answer 321

increased ADH > increased H2O absorp in collecting ducts >> diluted serum & concentrated urine

Question 322

Signs of basilar skull fracture

Answer 322

Racoon eyes Battle sign CSF rhinorrhea/otorrhea hemotympanum

Question 323

Silicosis requires periodic screen of ___

Answer 323

TB 2/2 increased risk

Question 324

Sjogrens: assd CA?

Answer 324

lymphoma

Question 325

Sjogrens: high suspicion but labs (ANA, ro, la) not convincing. How do you confirm the dx?

Answer 325

salivary gland bx

Question 326

SLE: Which is more specific antiSmith or dsDNA?

Answer 326

antiSmith

Question 327

SNRI for MDD & GAD?

Answer 327

Venlafaxine

Question 328

SOB 30 years after sandblasting, glasswork, quartz mining. Dx?

Answer 328

Silicosis

Question 329

Sodium thiosulfate is used for which complication of ERSD?

Answer 329

Calciphylaxis | disease mech: increased Ph drives Ca to be deposited in tissues

Question 330

Spina bifida complications

Answer 330

- motor/sensory dysfunction - neurogenic bladder/bowel - hydrocephalus - scoliosis

Question 331

Spinal cord compression suspected. NSIM?

Answer 331

Emergent high dose GCS | do not wait for MRI!

Question 332

Spontaneous abortion: preg loss

Answer 332

<20wks | chromosomal abn

Question 333

SSRI given > manic sx. NSIM?

Answer 333

STOP SSRI. Can start lithium or valproate (if still no improvement > add antipsychotic)

Question 334

Steps on rusty rake, never vax. Tx?

Answer 334

Ig & vax

Question 335

Stool wnl, gluc breath test +. Dx? (3)

Answer 335

Dysmotility (IBS, DM, SBOv)

Question 336

Strict glycemic control: effect on neuropathy?

Answer 336

slows progress (does not reverse it)

Question 337

Strongest BB for BP? | Strongest antiHTN med for BP?

Answer 337

labetalol | minixodil (4th line, v strong)

Question 338

TBW low UOsm low SOsm high SNa high Dx?

Answer 338

DI | DDx: if ADH/DDAVP given it will improve all parameters above in central but not in nephrogenic

Question 339

Testicular pain, testes in transverse position. Dx?

Answer 339

torsion

Question 340

``` Th1 cells > IFNy relese >> activate microphages >>> TNFa >>>> maintain macrophages >>>>> _____ formation ```

Answer 340

granuloma

Question 341

``` Thiazide effect on: A) calcium B) magnesium C) potassium D) uric acid E) glycemia F) lipids ```

Answer 341

BC decreased, rest increased

Question 342

Three things to give in stupurous pt:

Answer 342

naloxone, dextrose, thiamine

Question 343

Thrombolytic indication for PE?

Answer 343

Impending RV failure or CV instability

Question 344

Thrombolytics used for acute CVA. When to start ASA?

Answer 344

24h after tPA admin

Question 345

Thyroid nodule. NSIM?

Answer 345

TSH - if low, Tx - if high, FNA (r/o CA d/t cold nodule) - also if nodule >1.5cm, Bx

Question 346

TIA. Which anti-PLT regimen & for how long?

Answer 346

DAPT x 3 weeks

Question 347

Toe discoloration sp angiography. Dx & Tx?

Answer 347

Dx atheroemboli Tx IVF (Bx lipids in capillaries)

Question 348

Topical for impetigo?

Answer 348

Mupirocin

Question 349

Traztuzumab: - cardiotox in __% - reverisble or irreversible? - cumulative tox w/ dose or not?

Answer 349

5% (doxrubicin 25%) reversible (doxrub is not reversible) non-cumilative (doxrub is cumulative)

Question 350

Triad. Dx? - Ipsilateral facial paralysis - Ear pain - Vesicles in auditory canal/auricle, hard palate, ant 2/3 of tongue.

Answer 350

Ramsay Hunt Synd ?VZV complication, more severe than Bells. Tx: antivirals/GCS

Question 351

Trigeminal neuralgia: dx imaging & recs for imgaing

Answer 351

MRI to to r/o neurovascular compression for trigeminal nerve root or brain lesions MS (note: Hx ask whether VZV infection or rad/other possible trigem injury w/in 6m)

Question 352

Trigeminal neuralgia: Tx?

Answer 352

Carbamazepine | 2nd line: lamotrigine, lyrica

Question 353

Trousseus sign+, Chvostek sign+, perioral paresthesias. Dx?

Answer 353

hypoCa (also irrit, cramps, MDD, sz)

Question 354

Tumor in zona fasciculata: | Tumor in zona glomerulosa:

Answer 354

Conns Cushings Adrenal Cortex: (salt sugar sex GFR) Medulla: Stress hormones

Question 355

``` Tumor lysis: Following are high or low? K Ph Ca urate ```

Answer 355

high high low high

Question 356

Tx & duration antiphospholipid sx

Answer 356

Warfarin INR 2-3, lifelong | May add ASA 81 if additional CVS RF

Question 357

Tx ABPA

Answer 357

itraconazole & GCS

Question 358

Tx ABPA Pulmonary aspergilloma Invasive aspergillosis

Answer 358

ABPA: Oral prednisone if severe Itraconazole if recurrent Pulmonary aspergilloma: lobectomy

Question 359

Tx absence sz

Answer 359

ethosuximibe

Question 360

Tx Bacillary angiomatosis

Answer 360

Doxycycline | 2/2 bartonella henselae

Question 361

Tx central DI

Answer 361

vasopressin/ADH (DDAVP)

Question 362

Tx cerebral venous thrombosis

Answer 362

LMWH (does not increase risk of IC hemorrhage, however prevents clot propagation)

Question 363

Tx CMV

Answer 363

Ganciclovir

Question 364

Tx Conns based on path

Answer 364

if 2/2 adenoma: surgical | if 2/2 hyperplasia: spironolactone

Question 365

Tx diptheria

Answer 365

erythromycin or pen G | diptheria antitoxin if severe

Question 366

Tx Dressler Syndrome

Answer 366

NSAIDs (ie increase ASA) Complications - constrictive pericarditis - pericardial effusion > tamponade

Question 367

Tx dystonic rxn

Answer 367

Benadryl or benztropine

Question 368

Tx for mild vs severe malaria:

Answer 368

mild: atovaquone, mefloquine severe: ART drugs (artemether, artesunate)

Question 369

Tx functional hypothalamic amenorrhea

Answer 369

(athlete triad) | Ca/vitD, caloric supplement, estrogen

Question 370

Tx glaucoma

Answer 370

1. Topical BB (decrease humor production) | 2. Topical prostaglandin

Question 371

Tx HIV nephropathy

Answer 371

HAART

Question 372

Tx immune reconstitution syndrome

Answer 372

Usually supportive- NSAIDs, +/- short course GCS

Question 373

Tx insomnia in elderly

Answer 373

1st line- aways CBT Then lowest dose of z drugs etc

Question 374

Tx Jarisch Herxheimer rxn

Answer 374

Nothing, resolves in 48h

Question 375

Tx juvenile myoclonic epilepsy

Answer 375

Valproate

Question 376

Tx Kaposi sarcoma

Answer 376

interferon-a | also used to HBV, HCV

Question 377

Tx lupus nephritis

Answer 377

cyclophosphamide, GCS

Question 378

Tx MS crisis

Answer 378

GCS (if ineffective > plasmaphoresis)

Question 379

Tx myxedema coma?

Answer 379

GCS & T4 | 80% mortality

Question 380

Tx NMS

Answer 380

dantrolene

Question 381

Tx of papillary/follicular thyroid CA? tumor marker?

Answer 381

surg >rad | thyroglobin

Question 382

Tx postpartum thyroiditis

Answer 382

propanolol

Question 383

Tx Scleroderma renal disease?

Answer 383

ACEi

Question 384

Tx SIADH

Answer 384

Mainstay: fluid restriction <800mL/day For severe Sx/hypoNa: - tolvaptan - 3% NaCl - Loops

Question 385

Tx SLE pulm fibrosis?

Answer 385

cyclophosphamide, mycophenoate, MTX

Question 386

Tx spina bifida

Answer 386

surgical closure +/-: - intermittent cath - lax/enemas - bracing/correct deformities

Question 387

Tx spontaneous abortion

Answer 387

- expectant - misoprostol induction - D&C if hemodyn instab - Rho D Ig PRN

Question 388

Tx Syphilis: - 1o, 2o - latent - neuro - congenital

Answer 388

- 1o, 2o: ben penG x 1 - latent: ben penG IM weekly x 3 weeks - neuro: acq penG IV Q4h x 10-14d - congen: acq penG IV Q8-12h x 10d

Question 389

Tx TCA OD

Answer 389

bicarb

Question 390

Tx Wegeners/Goodpastures

Answer 390

GCS, cyclophosphamide or mycophenoate

Question 391

UA: microscopic hematuria, ~proteiuria, eosinophilia. Dx?

Answer 391

Tubulointerstitial nephritis - NSAIDs - PCN - sulpha drugs - rifampin - HCTZ - furosemide - phenytoin - cimetidine - allopurinol

Question 392

Unilat tearing/rhinorrhea & stabbing pain behind eye. Tx?

Answer 392

O2

Question 393

Unknown immunity to tetanus. Rusty nail puncture. NSIM?

Answer 393

IVIg & tetanus booster w/ series | 2nd dose after 4-8w, 3rd 6-12 months later

Question 394

Uremia, CP, pyrexia, pericardial friction rub. NSIM?

Answer 394

HD

Question 395

Use of Gleason score

Answer 395

Prognostic for prostate CA - if low and elderly: no surg - if high & young: surg

Question 396

V high PSA. US neg. NSIM?

Answer 396

Bx 12 sites of prostate

Question 397

Valproic acid causes toxicity to which 2 organs?

Answer 397

liver/panc | also NTD in preg

Question 398

VZV most accurate test?

Answer 398

PCR

Question 399

Walking milestone should be achieved by:

Answer 399

16 months

Question 400

Watery D, abd cramping, flatus, ADEK malabsorp. Dx & Tx?

Answer 400

Dx: Giardia Tx: Metro

Question 401

What are the RFs which modify LDL goals? (5)

Answer 401

1. Smoking 2. HTN (or on Tx) 3. low HDL 4. FHx premature CAD (<55 M, <65 F) 5. Age (>45 M, >55 F)

Question 402

What is the only indication for warfarin tx for afib?

Answer 402

Mitral stenosis

Question 403

What kind of acidosis do RTAs cause?

Answer 403

NAGMA

Question 404

When do you stop DOAC before surgery?

Answer 404

1-2 days

Question 405

When do you use heparin for acute CVA?

Answer 405

never

Question 406

When to use ticlopidine or prasugrel in acute CVA?

Answer 406

AVOID ticlopidine: TTP & thrombocytopenia | AVOID prasugrel: higher risk of brain hemorr

Question 407

Which 2 Dx can present w/ | LOW UOsm & UNa?

Answer 407

psychogenic polydipsia nephrogenic DI (DDx nocturia occurs w/ DI but not psychogenic as pt is not drinking at night)

Question 408

Which Ab do you test in *pregnant* SLE pt to screen for neonatal lupus?

Answer 408

Anti-Ro

Question 409

Which agent is used for chemical decortication? (breaking up fibrous tissue around lung)

Answer 409

alteplase

Question 410

Which does NOT work via V-gated Na channels? A) carbamaz B) phenytoin C) valproate

Answer 410

C (valproate)

Question 411

``` Which drug DECREASES lithium? A) ACE/ARB B) osm diuretic C) thiazides D) NSAID E) metronidazole F) tetracyclines ```

Answer 411

B (ie mannitol) | all others INCREASE lithium

Question 412

Which goes first w/ presbyaccusis- high or low pitch?

Answer 412

high

Question 413

Which hormone is elevated in female w/ adrenal tumor and virilizing sx?

Answer 413

DHEA

Question 414

``` Which is NOT a cause of paralytic ileus? A: bowel adhesions B: recent surg C: atherosclerosis D: abd inf E: opioids F: anti-cholinergics G: anti-parkinsons meds ```

Answer 414

A: bowel adhesions (cause SBO!)

Question 415

``` Which is not first line for DM neuropathty? A) duloxetine B) Lyrica C) TCA D) valproate E) gabapentin F) lamotrigine G carbamaz ```

Answer 415

D (note: duloxetine & lyrica are best)

Question 416

Which Lung CA is assd w/ both ectopic ADH & ACTH?

Answer 416

Small cell (> Cushings & SIADH)

Question 417

Which murmur is: - improved w/ increased venous return - non-ejection click, systolic

Answer 417

MVP

Question 418

Which parameters do you use to monitor SLE flare?

Answer 418

high dsDNA & low complement

Question 419

Which tumors are associated w/ increased proagulant release?

Answer 419

mucin-producing tumors (CRC/panc)

Question 420

Why does RPR suck for syphilis Dx?

Answer 420

takes many months to be +. | 1/4 of syphiis pts are RPR neg

Question 421

Why is bicarb relatively contraindicated CO poisoning despite ongoing acidosis?

Answer 421

it is metabolized to more CO2 (CO and CO2 compete for clearance, therefore elimination of both is slowed).

Question 422

Why is G6PD def more prevelent in men?

Answer 422

XL rec

Question 423

Why PPI is taken in AM, pre-prandial?

Answer 423

GH increases proton pumps, highest levels in AM

Question 424

Why should you avoid D5W in hypokalemia?

Answer 424

D5W increases insulin which further decreases K

Question 425

Wide fixed splitting of 2nd heart sound:

Answer 425

ASD

Question 426

WPW on EKG. NSIM?

Answer 426

Electrophysiology study for possible ablation

Question 427

You need to r/o OM. First test?

Answer 427

XR if +: bone bx if -: MRI, if + perform bone Bx (if you cant perform MRI > bone scan)

Question 428

You suspect low testosterone. Which labs do you order?

Answer 428

Free T in AM | the PRL, LH/TSH

Question 429

Young man wakes up w/ back pain. No trauma. Dx?

Answer 429

r/o ankylosing spondylitis

Question 430

Young woman w/ heavy menses and easy bruising. PLT wnl. Dx?

Answer 430

r/o vWF def w/ risocetin assay (checks VWF function)

Question 431

Partial SBO suspected. (SBO w/ air in distal colon). Tx?

Answer 431

Observation 12-24h. If no improvement, surg consult.

Question 432

MCC septic arthritis peds: <3 months: >3 months:

Answer 432

<3 months- S.aureus, GBS, GN bacteria | >3 months- S.aureus, GAS

Question 433

Child w/ hip pain, refusal to bear weight, pyrexia, leukocytosis. MRI/US shows effusion. NSIM?

Answer 433

drainage/debridement | IV Abx

Question 434

Neonate- irritable, febrile, poor feeding, refusal to be held. Hip flexed, abducted, externally rotated. NSIM?

Answer 434

US hip to r/o septic arthritis, if effusion: debride/IV abx

Question 435

RF hip dysplasia

Answer 435

Breech | Female

Question 436

Precipitating factors hepatic encephalopathy

Answer 436

``` Drugs (sedatives, narcotics) Hypovol (D > excess urea, nitrogen. Excessive diuresis) HypoK High nitrogen (GIB) Inf (PNA, UTI, SBP) TIPS ```

Question 437

Tx Hepatic encephalopathy

Answer 437

Vol/electrolyte repletion. | Lactulose/rifampin to decrease ammonia

Question 438

Septic arthritis suspected. Labs?

Answer 438

WBC, ESR, CRP BCx Arthrocentesis (WBC >50,000) MRI/US effusion

Question 439

Breastfeeding benefits: maternal

Answer 439

- decrease post-partum bleed - faster return to pre-partum weight - natural contraceptive (child spacing) - DECREASE br & ov CA risk

Question 440

Breastfeeding benefits: infant

Answer 440

- improved GI function (low risk necr enterocolitis) - decrease infections: (OM, gastroenteritis, resp) - decreased risk of pediatric CA

Question 441

Which maternal CA does breastfeeding lower?

Answer 441

breast and ovarian CA

Question 442

__% weight loss in 1st week of life.

Answer 442

10%, then breast milk production meets demand & birth weight is surpassed in 2nd week

Question 443

How often do new mothers breast feed?

Answer 443

Q1-3h

Question 444

Breast milk contains all essential nutrients *except:

Answer 444

vitD

Question 445

Infection complications of atopic derm

Answer 445

Molluscum contagiosum Impetigo Tinea corpis Eczema herpeticum HSV1

Question 446

Complications of eczema herpeticum

Answer 446

hepatitis encephalitis keratitis Tx acyclovir

Question 447

Why is CAGE no longer recommended for EtOH screen?

Answer 447

Would not catch moderate/heavy use

Question 448

Best single question to screen for EtOH overuse

Answer 448

How many times in the last year have you had 6+ drinks men (4+ women) drinks at one time?

Question 449

AUDIT-C

Answer 449

How often How many in one sitting How often >4F, >6M

Question 450

Indications to Tx ASx bacteruria

Answer 450

- preg - urologic process - w/in 3 months renal transplant

Question 451

SAH suspected. CT head inconclusive. NSIM?

Answer 451

LP

Question 452

CVA Sx at 12h. CT w/ ischemic CVA. NSIM?

Answer 452

CTA head/neck - large vessel occlusion +: mech thrombectomy - large vessel occlusion -: ASA, statin

Question 453

CVA on CT, 12h sp Sx onset. CTA head/neck showing large vessel occlusion. NSIM?

Answer 453

mech thrombectomy (if it were negative, ASA/statin) **no mech thrombectomy >24h

Question 454

After __ CVA Sx, pts are never eligible for thrombectomy.

Answer 454

24h

Question 455

Amiodarone toxicity

Answer 455

``` Chronic interstitial pneumonitis, PNA, ARDS Photosensitivity Skin discoloration Bone marrow toxicity Thyroid dysfunction Abn LFTs ``` *cumulative dose Tx: d/c amio, GCS if life-threatening

Question 456

Non-caseating granulomas in the colon. Dx?

Answer 456

Crohns. Also: - transmural inflammation - fissures - apthous ulcers

Question 457

GN rod, lactose-fermenting, bacillus w/ thick polysaccharide capsule. Tx?

Answer 457

Tx: FQ or 3rd gen ceph Klebsiella or Ecoli.

Question 458

Eosin methylene blue agar changes color. What does this mean?

Answer 458

Lactose fermenter

Question 459

Why should GCS never be used in burns?

Answer 459

Delay healing

Question 460

Third degree burn. Tx?

Answer 460

Excision of necrotic tissue & splint thickness splint graft

Question 461

MC location of venous ulcers?

Answer 461

above medial ankle

Question 462

Warfarin induced skin necrosis When: Why:

Answer 462

3-5d after starting warfarin | Pro-coag state decreased protein C+S drug induced microvascular occulusion

Question 463

Pyoderma gangrenosum assd w/:

Answer 463

UC. Neutrophillic dermatosis sp small papule after minor trauma (pathergy) >> large necrotic wound

Question 464

Neutrophillic dermatosis sp small papule after minor trauma (pathergy) >> large necrotic wound. Assd w/ UC?

Answer 464

Pyoderma gangrenosum

Question 465

MC location of arterial ulcers

Answer 465

Lateral ankle and digit tips. | also pallor, decreased pulse, atrophy, claudication

Question 466

Atropine may precipitate which acute eye condition?

Answer 466

Acute angle closure glaucoma

Question 467

Pathologic inclusions in UMN & LMN. Dx?

Answer 467

ALS

Question 468

Demyelination of brain/spinal cord axons. Dx?

Answer 468

MS

Question 469

Preg, PLT 70-150 in 2nd/3rd trimester, no bleeds/bruising. No fetal thrombocytopenia. Dx: Path: Tx:

Answer 469

Dx: Gestational thrombocytopenia Path: hemodil & accelerated PLT destruction Tx: Resolves sp pregnancy . Fetal/materanal bleed risk is NOT elevated. Monitor w/ CBC, obtain post-partum CBC to ensure resolution

Question 470

Neuraxial analgesia (epidural) contraindications (2)

Answer 470

PLT <70 rapidly worsening thrombocytopenia (risk of epidural hematoma)

Question 471

High risk Sx sp minor head trauma

Answer 471

``` retrograde amnesia >30 min vom 2+ seizures severe HA Basilar fracture signs GCS <14 AMS or LOC neuro deficit ```

Question 472

High risk patients sp minor head trauma.

Answer 472

>65 coagulopathy drug/EtOH intox high risk inj mech (ie ejected from vehicle)

Question 473

Tx anal abscess

Answer 473

I&D abx (if DM, immunosupp, extensive cellulitis, valvular cardiac d) *larger abscess may need surgery MC complication: fistula

Question 474

MC complication anal abscess

Answer 474

fistula

Question 475

Labs at 24-28w gestation

Answer 475

Hgb/HCT Ab screen if RhD neg 50g 1h GTT

Question 476

Lab at 36-38w gestation

Answer 476

GBS

Question 477

Initial visit pre-natal labs

Answer 477

``` RhD, Ab screen Hgb/HCT, MCV HIV, VDRL/RPR, HBs Ag Rubella/Varicella ab PAP Chlamydia PCR UrCx UrPr ```

Question 478

``` Initial previsit prenatal labs, all EXCEPT RhD, Ab screen Hgb/HCT, MCV 50g 1hr GTT HIV, VDRL/RPR, HBs Ag Rubella/Varicella ab PAP Chlamydia PCR UrCx UrPr ```

Answer 478

50g 1hr GTT

Question 479

50g 1hr GTT is positive. NSIM?

Answer 479

Confirm w/ 1hr GTT

Question 480

human placental lactogen: role in pregnancy?

Answer 480

Induces maternal insulin resistance to increase fetal glucose supply

Question 481

hypocretin 1 deficiency- Dx?

Answer 481

narcolepsy

Question 482

REM sleep latency <15 min may suggest:

Answer 482

narcolepsy if also recurrent lapses into sleep or multiple naps daily

Question 483

Narcolepsy criteria for Dx

Answer 483

- fragmented sleep - REM <15 min of falling asleep - hypocretin 1 def - hypnagogic hallucinations - cataplexy 70% - sleeping at inappropriate times

Question 484

1st line Tx narcolepsy

Answer 484

modafenil | + schedule naps during the day w/ good sleep hygiene

Question 485

Tx cataplexy

Answer 485

SNRI or SSRI or TCA Sodium oxybate (Na-GHB) effective but rarely used abuse potential and restrictive regulations

Question 486

Tx absence sz

Answer 486

Valproic acid

Question 487

Difficult to control asthma, nasal polyps, chronic sinusitis, rhinitis, palpable purpura. Dx?

Answer 487

Churg Strauss (AI vasculitis)

Question 488

Shoulder pain/weakness, ipsilateral ptosis, miosis, anhidrosis, supraclav LAD. Dx?

Answer 488

Sup pulm sulcus tumor (Pancoast) w/ Horners Syndrome Often NON-SmCLC Horners signifies poor prognosis

Question 489

Sup pulm sulcus tumor (Pancoast) w/ Horners Syndrome. Which type of CA?

Answer 489

Non-SmCLC | Horners signifies poor prognosis

Question 490

Shoulder pain/weakness, ipsilateral ptosis, miosis, anhidrosis, supraclav LAD, weight loss. Treatment?

Answer 490

GCS, surg, rad | Pancoast tumor likely NON- SmCLC

Question 491

Acute cervicitis etiologies

Answer 491

Inf: Chlamydia/Gonorrh | Non-inf: IUD, latex, douching

Question 492

Mucopurulent discharge, post-coital/intermenstrual bleed, friable cervix. Which Dx tests do you order?

Answer 492

NAAT Wet Mount **Tx empirically: Doxy/Ceftriaxone (if preg: doxy/azi). Tx sexual partners. Dont wait for results to Tx

Question 493

Mucopurulent discharge, post-coital/intermenstrual bleed, friable cervix. NSIM?

Answer 493

Obtain NAAT, wet mount & Tx empirically: Doxy/Ceftriaxone (if preg: doxy/azi) Also Tx sexual partners

Question 494

Tx Chlamydia/Gonorrhea in preg vs non-preg

Answer 494

non-preg: Doxy/Ceft | preg: Doxy/Azi

Question 495

Chlam/gonorr suspected. After initiating Tx, how long should they abstain from sex?

Answer 495

1 week

Question 496

Tx amiodarone toxicity?

Answer 496

GCS if life threatening | Discontinue amio

Question 497

DKA Tx: When to add D5W to NS?

Answer 497

When gluc <200.

Question 498

Formula to calculate AG?

Answer 498

Na- (Cl + HCO3)

Question 499

Tuberculin skin test +. | No Sx, CXR wnl. Tx?

Answer 499

``` Latent TB is - non infectious - activates in 5-10% - 6-9m INZ should be offered (**highly recommended for immunosuppressed, inmates, HCP) ```

Question 500

Who should Tx latent TB?

Answer 500

immunosuppressed inmates HCP Tx: INZ x 6-9 months

Question 501

Tx Bacterial prostatitis

Answer 501

Abx: cipro, TMP, SMX | bladder decompression PRN (ie supbladder cath)

Question 502

Dx test of PTX in emergent setting?

Answer 502

US (inability to detect lungs sliding against one another) Other studies take too much time. Also CXR sen only 50% if supine

Question 503

CKD pt w/ prolonged bleeding time, otherwise coags wnl (APTT, PT, PLT). Which tx should pt receive prior to surgical procedure?

Answer 503

desmopressin (for PLT dysfunction) MOA: increases release of vWF release from endothelium

Question 504

``` Renal dysfunction assd increased bleeding risk. What do you expect in labs: low/wnl/high A) aPTT B) PT C) bleeding time D) PLT ```

Answer 504

normal normal prolonged normal MCC: PLT dysfunction Tx: desmopressin (MOA: increases release of vWF release from endothelium)

Question 505

Infant w/ refractory candidal diaper dermatitis and failure to thrive. Which labs do you order?

Answer 505

HIV DNA or RNA PCR (nucleic acid test) (other signs, LAD, HSM, chronic D, poor w gain) DDX zinc deficiency: also has perioral derm and D

Question 506

Diagnostic test for HIV in infants <18 months

Answer 506

HIV DNA or RNA PCR (nucleic acid test) **serology is unreliable as it may reflect maternally transmitted abs

Question 507

Infant w/ persistent diaper rash, perioral derm and diarrhea. Tx?

Answer 507

zinc! (severe deficiency)

Question 508

Strep throat can be diagnosed w/ rapid strep Ag test OR:

Answer 508

throat Cx **rapid strep test is highly spec but not very sensitive hence if negative, always obtain Cx

Question 509

* *Strep throat Tx 1) standard 2) PNC allergic

Answer 509

1) PNC or amoxicillin 2) mild: cephalosporin anaphylaxis: azi or clinda

Question 510

Strep pharyngitis complications? (4)

Answer 510

- peritonsilar abscess - anterior cervical LAD - post strep GN - RF

Question 511

7yo M w/ sore throat, fever, abd pain, HA, no cough/rhinorrhea. Tonsillar erythema/exudates, cervical LAD. Rapid strep test is neg. NSIM?

Answer 511

Obtain throat Cx! **rapid strep test is highly spec but not very sensitive hence if negative, always obtain Cx

Question 512

``` Rapid strep test is: A) v sen, not spec B) not sen, v spec C) not sen or spec D) v sen, v spec ```

Answer 512

B) not sen, v spec has high positive predictive value. If neg, obtain Cx

Question 513

Tx acute diverticulitis

Answer 513

bowel rest | Abx: ie cipro, metro

Question 514

Elderly w/ LLQ pain, fever, N/V, ileus. tachy, WBC+. Which dx test do you order?

Answer 514

CT abd (PO & IV contract)

Question 515

No improvement w/ 2-3 days abx for diverticulitis. NSIM?

Answer 515

repeat abd CT w/ PO/IV contrast | r/o abscess, fistula, perf

Question 516

MC complication of diverticulitis?

Answer 516

colonic abscess (15-55%) "acute diverticulitis that does not improve w/ 2-3 days of abx" Tx: percutaneous drainage & IV abx +/- partial colectomy

Question 517

Tx colonic abscess sp diverticulitis

Answer 517

percutaneous drainage & IV abx | +/- partial colectomy

Question 518

____ should be performed in most pt 6-8wks sp complete resolution of diverticulitis

Answer 518

colonoscopy to r/o CA **NOT earlier as it is contraindicated in acute diverticulitis

Question 519

``` Hyperthyroid sx 2 months after delivery, non-tender goiter & labs: - low TSH - high T4 - TPO Ab++ - high thyroglobulin I123 uptake is LOW. Dx? ```

Answer 519

postpartum thyroiditis | variant of chronic lymphocytic/Hashimoto thyroiditis

Question 520

Postpartum thyroiditis: high/low? 1) TSH 2) T4 3) TPO 4) thyroglobulin 5) I123 uptake

Answer 520

``` low high high high low ``` DDx Graves (has HIGH I123 uptake)

Question 521

Why is thyroglobulin elevated in Graves and postpartum thyroiditis?

Answer 521

Graves: increased follicle activity PT: destruction of follicles

Question 522

Preg & thyroid - what causes ^TBG - what causes ^thyroxine

Answer 522

- increased E > ^TBG - bCG > ^ thyroxine release (hCG looks like TSH) Elevated total T4 but euthyroid during preg

Question 523

HbA & HbS in 60:40 ratio. Dx?

Answer 523

SCD carrier | ASx, no anemia

Question 524

Why are button batteries dangerous when ingested?

Answer 524

They conduct electricity > ulceration, liquefication necrosis, perforation. ALWAYS remove if in esoph. Close monitoring if beyond esoph > endoascopic/surg removal if not progressing.

Question 525

DM 2/2 chronic pancreatitis, Tx?

Answer 525

metformin if mild insulin if severe ** avoid DPP4 inhibitors (sitagliptin) or GLP1 receptor agonists (liraglutide etc) per risk of pancreatitis

Question 526

Pancreatogenic DM (ie chronic panc): Why are patients more prone to HYPOGLYCEMIA & why is DKA RARE?

Answer 526

Loss of glucagon-producing alpha cells and insulin producing beta cells.

Question 527

HIV, RLL infiltrate. Thoracentesis: lymphocyte predom, no organisms. Elevated adenosine deaminase. How do you confirm the Dx?

Answer 527

Pleural Bx (TB effusion) **note: those w/ HIV cannot mount sufficient mediated defence to create upper lobe cavitations hence > lobar, pleural, disseminated infection

Question 528

What is seen on thoracentesis in an HIV pt w/ TB?

Answer 528

- no organisms, lymphocyte-predominant, exudative effusion (similar to CA, hence check adenosine deaminase for DDx) NSIM pleural bx

Question 529

HIV pt dx w/ TB. When do you start HAART?

Answer 529

1-2wks after starting tx for TB (to avoid IRIS)

Question 530

6yo M w/ RUE HTN, LE claudication & murmur. Dx?

Answer 530

Coarctation (Most commonly sporadic in males, less common: Turners) Note: milder narrowing in childhood, in neonates: HF ? shock after PDA closure

Question 531

Aortic coarctation murmur?

Answer 531

Continuous systolic murmur at LUSB Also on Exam: - brachiofemoral pulse delay - UE HTN CXR: rib notching & figure 3 sign (aortic narrowing)

Question 532

CXR: rib notching & figure 3 sign. Dx?

Answer 532

Aortic coarctation TTE confirms Dx

Question 533

Parasternal heave assd w/:

Answer 533

RVH

Question 534

Decline in BP >10mmHg during inspiration. Dx?

Answer 534

pulsus paradoxus, cardiac tamponade

Question 535

Resected medullary thyroid CA. At time of surgery calcitonin was 240, now 120. NSIM?

Answer 535

CT neck/chest to r/o mes. If still neg: CT abd, bone scan. ~~I111 octreotide or PET.

Question 536

Why is iodine not useful in detecting mets sp medullary thyroid CA resection?

Answer 536

medullary CA involves parafollicular C cells that do not secrete iodine

Question 537

SLE suspected, which is more likely to be positive? - dsDNA - antiSmith

Answer 537

dsDNA (sen 66-95%) | antiSmith sen only 25%

Question 538

Which lab value correlates w/ disease activity or development of lupus nephritis?

Answer 538

dsDNA

Question 539

Tx SLE

Answer 539

low dose prednisone hydroxychloroquine (cyclophosphamide or MTX w/ GCS for more serious sx- lupus nephritis, CNS sx, vasculitis)

Question 540

Immigrant 30yo F dyspnea+++ x 2wks, diastolic murmur on exam. TTE w/ MV 1.5cm. NSIM?

Answer 540

pregnancy test (Dx: severe MS) Note normally *gradual* worsening of Sx (SOB > cough, hemoptysis, RHF ie HSM, periph edema) BUT pregnancy may cause RAPID worsening of sx

Question 541

K 7 w/ arrhythmia. Tx?

Answer 541

Calcium gluconate

Question 542

Prolonged PR interval, prolonged QRS, disappearance of P waves, Dx?

Answer 542

hyperK

Question 543

HyperK w/ EKG showing Prolonged PR interval, prolonged QRS, disappearance of P waves. Tx?

Answer 543

First CaGluconate Then - beta agonists - glucose & insulin

Question 544

Abnormal sigmoidoscopy. NSIM?

Answer 544

Colonoscopy w/ any abnormal finding on sigmoidoscopy

Question 545

Lab work up for suspected lead poisoning?

Answer 545

venous lead CBC iron/ferritin retic

Question 546

DDx premature thelarche/adrenarche VS precocious puberty?

Answer 546

bone age! normal bone age: premature thelarche/ adrenarche advanced bone age: precocious puberty

Question 547

Precocious puberty in girls

Answer 547

F <8 | M <9

Question 548

Which nerve injury? 1. inability to extent knee 2. problem w/ leg adduction 3. quad weakness 4. foot drop

Answer 548

1. femoral 2. obturator 3. femoral 4. peroneal

Question 549

Clinical criteria+ & abn neuro findings. What is needed to fulfil brain death criteria?

Answer 549

apnea test (no breathing 8-10min after taking off vent & pH <7.28) Avoid apnea test in hypercapnea

Question 550

Which toxicity? | Tachypnea, tachycardia, hyperthermia, dizziness, GI Sx (N/V)

Answer 550

ASA - stimulates resp center in the medulla > resp alk - chemoreceptor trigger zone > N/V - Cochlear neurotoxicity > tinnitus (early) - AMS (cerebral tissue injury/ neuroglycopenia > cerebral edema) - lacticemia & hyperthermia *via inhibition of cellular metabolism - severe: pulm edema, arrhythmia, death

Question 551

Effects of ASA toxicity (+++)

Answer 551

- stimulates resp center in the medulla > resp alk - chemoreceptor trigger zone > N/V - Cochlear neurotoxicity > tinnitus (early) - AMS (cerebral tissue injury/ neuroglycopenia > cerebral edema) - lacticemia & hyperthermia *via inhibition of cellular metabolism - severe: pulm edema, arrhythmia, death

Question 552

Which toxicity? | fever, dry mucous membranes, tachycardia, nonreactive mydriasis, erythema, anhydrosis, AMS. Dx?

Answer 552

Anticholinergic (also urinary ret) Tx: physostigmine

Question 553

Tx ASA intox

Answer 553

- IV bicarb (alkalization) - D5W (to avoid neurohypoglycemia) - activated charcoal if <2h ingestion - HD if pulm edema or fluid overload (limiting bicarb infusion), AMS, RF, cerebral edema, severe acidosis,, v high ASA

Question 554

Indication for HD in Tx of ASA toxicity

Answer 554

- pulm edema or fluid overload (limiting bicarb infusion) - AMS - RF - cerebral edema - severe acidosis - v high ASA

Question 555

Cholinergic toxicity Tx?

Answer 555

atropine

Question 556

Pathogen cat scratch disease?

Answer 556

Bartonella hensele Tx - self limiting - azithromycin

Question 557

Complications of which disease? 1. coronary a aneurysm 2. LN suppuration

Answer 557

1. Kawasaki | 2. Cat scratch d

Question 558

10yo F w/ fever x 2wks, unilateral LAD, unilateral conjunctivitis. Papule on arm. Dx & Tx?

Answer 558

Cat scratch disease Tx - self limiting - azithromycin Note: LAD regional to bite/scratch. MC: unilat axillary or inguinal hwr if scratch is in the face > cervical LAD w/ possible conjunctivitis (Parinaud syndrome0

Question 559

Acute mania Tx?

Answer 559

antipsychotic IM (lithium & valproate are NOT appropriate for acute mania: - PO admin - require titration - days-wks for effect

Question 560

Avoid lithium in ___ disease and valproate in __ disease

Answer 560

Lithium- renal | Valproate- hepatic

Question 561

Range for impaired fasting blood glucose?

Answer 561

100-126

Question 562

What is impaired glucose a risk factor for?

Answer 562

CAD & DM gluc 100-126

Question 563

Pt has hx latent TB. How do you screen them?

Answer 563

CXR (they have a positive tubberculin skin test and quantiferon for life)

Question 564

Initial Tx cough predom GERD

Answer 564

PPI x wks & lifestyle modification

Question 565

Cough, inflamm of nasal mucosa, oropharyngeal cobblestoning. Tx?

Answer 565

Tx: Intranasal GCS Dx: Upper Airway Cough Syndrome

Question 566

Constipation, pelvic pressure, LBP, fecal incont & pelvic mass increasing w/ Valsalva. Tx?

Answer 566

Kegals & surgery or pessary

Question 567

Steps in primary amenorrhea w/u

Answer 567

1. pelvic exam/US 2. Uterus + > FSH - high FSH > karyotype - low FSH > brain MRI 3. Uterus - > karyotype & serum T - 46 XX & normal female T > abnormal Mullerian development - 46 XY & normal male T > AIS

Question 568

Absent uterus, 46 XX & normal female testosterone. Dx?

Answer 568

abnormal Mullerian development

Question 569

Breasts+, primary amernorrhea, no pubic/axillary hair. Dx?

Answer 569

- Androgen insensitivity syndrome | - (Cryptorchid testes+, vagina ends in blind pouch, breasts develop 2/2 excess T aromatized to E)

Question 570

Amenorrhea >__ of age is considered abnormal.

Answer 570

15+

Question 571

House fire. Dx tests to r/o CO poisoning?

Answer 571

- ABG w/ carboxyhemoglobin level, lactate++ - Also order EKG w/ cardiac enzymes to r/o MI - **note: pulse oximetry is often normal

Question 572

Tx CO poisoning.

Answer 572

- high flow 100% O2 | - intubation/hyperbaric oxygen if severe

Question 573

Pulse ox levels w/ CO poisoning.

Answer 573

- wnl (pulse ox cannot differentiate oxyHgb vs carboxyHgb)

Question 574

Which populations should be tested for HCV?

Answer 574

- RF (IVDU, RBC before 1992, unreg tattoo w/ transaminitis | - high prevalence groups: HIV, HD, incarcerated, born 1945-1965

Question 575

HIV screening indicated for ages: ___-___

Answer 575

13-65

Question 576

Associated conditions? - Duodenal atresia - Pyloric stenosis - Meconium ileus - Hirschprungs

Answer 576

Duodenal atresia: - Downs Pyloric stenosis: - maternal macrolide use in preg Meconium ileus: - CF (pathomnemonic) Hirschprungs: - Downs

Question 577

Dx tests for CF?

Answer 577

- CFTR mutation (genetic testing) - elevated sweat Cl - abn nasal potential difference

Question 578

Congenital cataracts, vomiting, poor feeding, lethargy, jaundice, hepatomegaly. Dx?

Answer 578

- galactosemia

Question 579

Sandpaper rash, circumoral pallor, strawberry tongue. Abx choice?

Answer 579

Amoxicillin (Dx Scarket Fever)

Question 580

Dx criteria for Kawasaki Disease? Fever >5d AND 4 of the following:

Answer 580

- 1. conjunctivitis - 2. mucous memb changes - 3. rash - 4. cervical LAD - 5. extremity edema/eryth (If not all are present, order CRP/ESR & re-examine the following day.)

Question 581

Kawasaki Tx

Answer 581

IVIg & ASA (complic: coronary a aneurysms & vent dysfunction) TTE at Dx, then 2w and 6w sp Tx

Question 582

Kawasaki Labs:

Answer 582

- high: WBC, PLT, ESR, CRP, LFTs | - low: Hgb

Question 583

Kawasaki etiology

Answer 583

- febrile vasculitis of unknown etiology, ??viral assn

Question 584

Intervals for TTE w/ Kawasaki

Answer 584

at Dx, then 2w and 6w sp Tx

Question 585

IVIg recently given. Pt is due for a scheduled vaccine. NSIM?

Answer 585

- postpone vaccine by 11 months sp completion IVIg Tx

Question 586

Tx primary vs secondary (central) adrenal insufficiency

Answer 586

- Primary: GCS & mineralocorticoids - Secondary (central) GCS (note mineralocorticoids regulated by RAAS)

Question 587

Primary adrenal insufficiency etiolgies?

Answer 587

- MCC: AI | - Also infection (TB) or metastatic infiltration

Question 588

34yo F w/ fatigue, weight loss, N/V/abd pain, orthostatic hypotension, hyperpigmentation. What lab values do you expect? - Na - K - eosinophils - AM cortisol - ACTH

Answer 588

``` hypoNa hyperK high eos low AM cortisol high ACTH ```

Question 589

40yo w/ newly diagnosed HTN & flank fullness. NSIM?

Answer 589

renal US (r/o ADPKD)

Question 590

Tx ADPKD

Answer 590

- aggressive RF control (CVD, CKD) - ACEi for HTN, statins - HD, transplant if ESRD

Question 591

ADPKD Extrarenal features

Answer 591

- ventral/inguinal hernias - MVP, AR - hepatic & pancreatic cysts - colonic diverticulosis - cerebral aneurysms

Question 592

ADPKD: true/false - Genetic testing required to confirm Dx - MRI brain required to screen for aneurysms - Interval renal US to monitor progression/RCC - CT abd to check for panc/hepatic cysts

Answer 592

All false Genetic test only if imaging unclear MRI brain only for high risk pt (FHx, Hx bleed) Renal US sensitivity is too low to monitor cyst growth. No RCC risk CT abd not necessary

Question 593

18yo finds out his parent has ADPKD. NSIM?

Answer 593

- US renal screen w/ counselling beforehand | - If single parent is affected, 50% change of disease in child

Question 594

1st line Tx Torsades

Answer 594

- Mg Sulfate | - (if no improvement, temporary transvenous pacing)

Question 595

Pt w/ torsades. No improvement w/ MgSO4, NSIM?

Answer 595

- temporary transvenous pacing

Question 596

Most important predictor of survival in COPD?

Answer 596

- age & FEV1 (<40 is severe obstruction) | - LESS SO: cigarette smoking, low BMO, airway bact load, decreased exercise capacity, HIV

Question 597

Dose/duration of oral GCS for asthma exacerbation?

Answer 597

- 40-60mg daily x 5-7 days

Question 598

``` Sarcoidosis effect on following systems: Skin Eyes Joints Nervous S. Reticuloendothelial system ```

Answer 598

Skin: papular, nodular or plaque-like lesions Eyes: uveitis & keratoconjunctivitis sicca Joints: acute polyarthritis Nervous S: Facial N palsy, central DI, hyperCa Reticuloendothelial system: hepatomegaly 20%, periph LAD 40% *extrapulm sarcoidosis is almost always accompanied by significant fatigue

Question 599

Facial N palsy: Red flag sx?

Answer 599

- sparing of the upper face - assd hearing loss - assd facial twitching - worsens sp 3wks - does not improve in 4m

Question 600

40yo w/ polyarthritis, facial nerve palsy, LAD, hepatomegaly. NSIM?

Answer 600

- CXR for Dx Sarcoidosis

Question 601

CXR w/ hilar LAD. What is necessary to confirm Dx?

Answer 601

- r/o TB | - ***Bx: excisional LN w/ noncaseating granuloma (may be from accessible periph LAD), if unclear, transbronchial bx

Question 602

Tx urethritis

Answer 602

- Gonococcal: ceftriaxone - Non-gonococcal: azithromycin (or doxy) (Aseptic: Chlamydia, Ureaplasma, Mycoplasma, Trichomonas)

Question 603

Pt treated for non-gonococcal urethritis continues to have sx. NSIM?

Answer 603

- repeat urine NAAT (likely re-infection, resistance or infection not susceptible to azithro)

Question 604

Target TSH w/ Synthroid for differentiated thyroid CA (papillary & follicular) 1. Small, low risk 2. Intermediate risk 3. Large, aggressive/mets

Answer 604

Small, low risk— TSH 0.1-0.5 x 6-12 months, then normal Intermediate risk— TSH 0.1-0.5 Large, aggressive/mets— TSH <0.1

Question 605

Abx for bacteremia 2/2 HD catheter

Answer 605

- vanc and cefepime (or genta)

Question 606

Indications for long-term HD catheter removal

Answer 606

- severe sepsis - hemodynamic instability - evidence of metastatic infection (endocarditis) - pus at cath site - sx sp 72h abx - BCx growing S.aureus, Pseudomonas, fungi

Question 607

Indications for adding caspofungin for Tx catheter-related bloodstream infection

Answer 607

- TPN - prolonged use broad spectrum abx - blood CA - solid organ transplant - femoral cath - Candida colonization at multiple sites

Question 608

Spinal infection (OM, epidural abscess).

Answer 608

- WBC: - Fever: - BCx: All above may be wnl. BCx+ in 50% Dx of choice MRI, then CT w/ bx

Question 609

Spinal infection (OM, epidural abscess). Diagnostic tests to confirm?

Answer 609

- spinal MRI, then CT-guided bx

Question 610

40% S.aureus bacteremia develop metastatic infection. Which structures are most commonly affected?

Answer 610

- heart valves - lungs - osteoarticular structures

Question 611

Preschool age child w/ PNA. MCC (pathogen) & Tx?

Answer 611

- S.pneumo | - Tx: high dose amoxicillin

Question 612

Child w/ PNA, focal lung findings. MCC?

Answer 612

- S.pneumo - Tx: high dose amox (if findings were diffuse, likely M.pneuom, Tx azithro)

Question 613

Older child w/ PNA, bilateral lung findings. Pathogen and Tx?

Answer 613

- Likely M.pneumo | - Tx: azithro

Question 614

Why is cipro never given for PNA?

Answer 614

- poor lung penetration (unlike FQs moxi and levo)

Question 615

Polymyalgia rheumatica Tx?

Answer 615

- low dose GCS 10-20mg QD (if no response, question Dx)

Question 616

50+, bilateral pain/AM stiffness of shoulders/hips >1h, fever, malaise Decreased active ROM. ESR/CRP++. Dx and Tx?

Answer 616

- Polymyalgia rheumatica, low dose GCS | * *often assd w/ GCA (temporal arteritis), requires high dose GCS)

Question 617

GCA (temporal arteritis): 1. Dx test? 2. Tx? 3. Which myopathy is it associated with?

Answer 617

- polymyalgia rheumatica - temporal artery bx - high dose GCS (40-60mg QD)

Question 618

SBO or ileus? - presence of gas in the colon/rectum - bowel w/ air-fluid levels

Answer 618

ileus | SBO

Question 619

``` Testicular CA Age: RF: Dx w/u: Staging: Tx: Cure rate: ```

Answer 619

- 15-35 - FHx, cryptorchidism, ~HIV - scrotal US, bhCG, AFP - CT, CXR - radical oorchiectomy, chemo - 95%

Question 620

Tx infectious epididymo-orchitis

Answer 620

- ceftriaxone IM x1 & doxy PO x 10

Question 621

Antipsychotic use in dementia.

Answer 621

- worsens mortality 2/2 ?increased cardiac events, CVA, falls, asp PNA. - used when benefits outweight risk > use minimal dose/duration w/ constant re-eval

Question 622

Rectal prolapse: indications for surgery?

Answer 622

- full thickness prolapse, signs of ischemia/strangulation - debilitating sx (incont, constip, mass sensation) (otherwise medical tx: kegals, hydration/fiber)

Question 623

Splenic rupture: 1st step: Dx w/u? Tx?

Answer 623

- IVF - CT w/ contrast to eval extent of bleed - non-operative preferred (observation, serial CBC, embolization) - if persistent hemorrhage despite above, laparotomy/splenectomy

Question 624

``` Statin use for which one of these is primary prevention? A) >40yo w/ DM B) ACS C) Stable angina D) hx CABG/stents E) CVA/TIA F) PAD ```

Answer 624

A (rest are secondary ppx)

Question 625

Indication for mod vs high-intensity statin for secondary prevention of ASCVD? (ie. ACS, stable angina, hx CABG/stents, CVA, TIA, PAD)

Answer 625

- age <75: high intensity - age >75: mod intensity (note atorvastatin 40-80mg & rosuvastatin 20-40mg are high intensity)

Question 626

Primary vs secondary ppx?

Answer 626

- primary: pure prevention in at risk pt (ie DM >give statin to prevent ASCVD) - secondary: Pt has hx ASCVD and you would like to prevent a second occurrence

Question 627

When its PTU recommended over MMZ for hyperthyroidism?

Answer 627

- first trimester of pregnancy only

Question 628

MOA hyperthyroidism & osteoporosis

Answer 628

- elevated thyroid hormones stimulate Ca & Ph release from bone

Question 629

Anti-TPO Abs+++. Dx?

Answer 629

- hashimotos | thyroid stimulating Ig is high in Graves

Question 630

Induced sputum sensitivity for PCP?

Answer 630

- 60-90%, therefore if suspicion is high, Tx or obtain BAL (sen 90-100%)

Question 631

Indication for GCS *in addition* to TMP-SMX for PCP?

Answer 631

- ABG: A-a gradient >35 and/or PaO2 <70 RA | - (some research suggests pulse ox <92% alone can be indication)

Question 632

Organophosphate poisoning Tx?

Answer 632

- pralidoxime *and* atropine - emergent resuscitation: O2, IVF, intub - activated charcoal if w/in 1hr

Question 633

Schizoaffective disorder vs MDD or BPD w/ psych features

Answer 633

- Schizoaffective: 2+ weeks of psych features w/o mood/manic sx

Question 634

MCC septic abortion

Answer 634

- sp elective abortion - Tx: BCx/EndoCx, genta/clinda, suction curettage, +/- hysterectomy - Risks: sepsis, ARDS, DIC

Question 635

Tx septic abortion

Answer 635

- Tx: BCx/EndoCx, genta/clinda, suction curettage, +/- hysterectomy

Question 636

Malnourished alcoholic. CMP/Mg/Ph wnl. You give D5W, thiamine, folate. Pt develops profound generalized weakness the next day. Mechanism?

Answer 636

- Refeeding syndrome > hypoPh (ATP shifts Ph into cell) > rhabdo - NSIM: check CK, phos. Supplement phos

Question 637

Family/friends ask for prescription. Response?

Answer 637

- “I would like to help you but I am uncomfortable prescribing for someone I am not treating” (prescribing for friends/family should be restricted to emergent situations when no other physician is available)

Question 638

Congenital vs pediatric rubella Sx

Answer 638

- Congen: SNHL, cataracts, PDA, (blueberry muffin rash in minority) - Ped: fever, cephalocaudal spread of maculopapular rash (teens/adults w/ addition of arthralgia/arthritis)

Question 639

Neonate w/ SNHL, cataracts, PDA. Dx?

Answer 639

- rubella (German measles)

Question 640

Dx? Neonate, HSM, SNHL, periventricular calcifications Neonate, HSM, SNHL, intracerebral calcifications

Answer 640

- CMV | - Toxoplasmosis

Question 641

Causes of non-resolving PNA/infiltrates?

Answer 641

- Bronchoalveolar cell carcinoma - carcinoid endobronchial obstruction (young, non-smoker) - lymphoma - eosinophilic PNA - bronchiolitis obliterans organizing PNA (BOOP) - systemic vasculitis - pulm alv proteinosis - drugs (amiodarone)

Question 642

CXRs w/ recurrent PNA in same lobe. Extensive smoking Hx. NSIM? Test to confirm Dx?

Answer 642

- endobronchial obstruction likely CA - NSIM CT scan - Ultimate Dx test: flex bronch

Question 643

BAL showing hemosiderin laden macrophages. Dx?

Answer 643

- vasculitis: granulomatosis w/ polyangitis, anti-GBM disease, etc

Question 644

Lateral shoulder pain or pain with arm abduction or external rotation suggests:

Answer 644

- rotator cuff path: tendonitis/tear or impingement

Question 645

Competitive inhibitor of ACh? Cholinesterase reactivating agent? Uses?

Answer 645

- Atropine - Pralidoxime - Organophospate poisoning

Question 646

Garlic like odor from clothes? | Garlic odor from breath?

Answer 646

- clothes: organophosphate tox | - breath: arsenic tox

Question 647

Pancreatitis is 1% drug induced via sensitivity to sulfonamides, ischemia 2/2 hypovol, increased viscosity of panc secretions. Examples of meds? ``` CVS: AI: Pain: Antiepileptics: HIV: ```

Answer 647

``` CVS: ACE/ARB, diuretics AI: azathioprine, mesalamine, GCS Pain: Tylenol, NSAIDs, opiates Antiepileptics: valproic acid, carbamazepine HIV: lamivudine, didanosine, TMP-SM ```

Question 648

Sudden HA, nausea, nuchal rigidity, ptosis, aniscoria. CVA location?

Answer 648

- posterior communicating artery aneurysm (per CN III dysfunction)

Question 649

Enlarged LNs, mobile/rubbery x 4 wks. NSIM?

Answer 649

- Bx if persist >4wks.

Question 650

DDx viral vs bacterial conjunctivitis?

Answer 650

- both are uni or bilateral, lasting 1-2wks - viral: assd w/ prodrome, watery discharge - bacterial: more purulent discharge

Question 651

How long is viral conjunctivitis contagious for?

Answer 651

- until eye discharge resolves (morning crusting or conjunctival injection may persist)

Question 652

JONES Criteria?

Answer 652

``` Joint pain O carditis (3w sp infection) Nodules (subcutaneous) Erythema marginatum Sydenham chorea (1-8 monts sp infection) (Minor criteria: fever, arthralgia, ESR/CRP, prolonged PR) ```

Question 653

Onset of carditis vs sydenaham chorea sp GAS pharyngitis?

Answer 653

- carditis ~3 wks (note MR/MS >>yrs or decades) | - sydenham chorea 1-8 months

Question 654

Tx for rheumatic fever and indication for GCS?

Answer 654

- PNC, | - GCS only for severe cases

Question 655

Tx syndenham chorea sp RF.

Answer 655

- PNC IM until adulthood as secondary prevention | - if severe sx & pt is at risk of self injury, haloperidol

Question 656

Which medication is avoided in peds 2/2 Reye Syndrome?

Answer 656

- ASA (except Kawasaki)

Question 657

Lyme Sx ** 1. Early (<1 month) 2. Early disseminated (wks>months) 3. Late (m>yrs)

Answer 657

- 1) erythema migrans, fatigue, HA, myalgia, arthralgia - 2) multiple erythema migrans, uni/bilat CN palsy, meningitis, carditis (AV block), migratory arthralgias - 3) arthritis, encephalitis, periph neuropathy

Question 658

MC late complication of Lyme

Answer 658

- arthritis 60%, months/years later - Dx w/ ELISA/Western Blot. (Synovial WBC 20-60k) - Arthrocentesis is often performed to r/o concomitant septic arth

Question 659

Tx lyme arthritis

Answer 659

- doxy or amox x 28 days (Doxy has better nerve penetration) - Prog: most resolve but may recur

Question 660

1st line abx for late lyme in peds <8?

Answer 660

A) amoxicillin B) ceftriaxone C) doxycycline - Doxy x 21 days (better nerve penetration) - (ceftriaxone is used for Lyme carditis/encephalopathy)

Question 661

When is pyridoxine added to the TB regimen and why?

Answer 661

to prevent neuropathies in pts on isoniazid who have PMH of: - DM - uremia - EtOH - malnutrition - HIV - preg - epilepsy

Question 662

HCP who have latent TB are generally treated w/ which regimen?

Answer 662

isoniazid x 9 months

Question 663

quantiferon+, no sx, CXR neg. NSIM?

Answer 663

Tx latent TB | note quantiferon is >99% specific

Question 664

When is exercise during pregnancy AVOIDED?

Answer 664

Risk of preterm delivery - cervical insufficiency - PPROM Risk of antepartum bleed - placenta previa - persistent 2nd/3rd trim bleed Underlying condition that could be exacerbated by disease - severe anemia - preeclampsia - restrictive lung d - severe heart disease

Question 665

``` Which is NOT a contraindication to exercise during pregnancy? A) cervical insufficiency B) PPROM C) in vitro D) placenta previa E) persistent 2nd/3rd trim bleed F) severe anemia G) preeclampsia H) restrictive lung d I) severe heart disease ```

Answer 665

C) in vitro

Question 666

Glucagonoma 1. origin 2. malign or benign 3. how to confirm dx 4. Tx

Answer 666

1. pancreas 2. malignant, often mets to liver 3. high glucagon levels (assd w/ necrolytic migratory erythema) 4. surgery

Question 667

Glucagonoma tumors often secrete:

Answer 667

Other peptides: - VIP - calcitonin - GLP1

Question 668

Dermatitis, dementia, diarrhea, stomatitis, cheilosis. Tx?

Answer 668

- Pellagra (niacin deficiency)

Question 669

Generalized urticarial rash in child, rubbing the edge produces Darier sign. HSM present in 50%. Dx?

Answer 669

- systemic mastocytosis

Question 670

Tx cough variant asthma?

Answer 670

- GCS & bronchodilators | - if refractory, some efficacy w/ montelukast (leukotriene inhibitor)

Question 671

Rhinorrhea, chronic cough & oropharyngeal cobblestoning. Dx?

Answer 671

- Upper airway cough syndrome

Question 672

Extensive smoking hx & hoarseness. Mechanism?

Answer 672

- laryngeal nodules w/ chronic vocal cord irritation

Question 673

Common causes of papilledema?

Answer 673

- mass lesions - increased CSF production - decreased CSF outflow (venous sinus thrombosis) - idiopathic intracranial HTN (pseudotumor cerebri

Question 674

HA. Papilledema on exam. NSIM?

Answer 674

CT head WITH contrast (unless SAH suspected, then without) **do not perform LP first as a mass lesion must be excluded beforehand per risk of herniation

Question 675

Oligoarthritis, arthrocentesis: >2000 WBC (75% PMN). Sterile. DDx?

Answer 675

``` RA viral/Lyme SLE sarcoidosis spondyloarthritis ```

Question 676

Reactive arthritis etiologies.

Answer 676

GU - Chlamydia GI - Salmonella - Shigella - Yersinia - Campylobacter

Question 677

Sacroiliitis, asymmetric oligoarthritis, dactylitis, enthesitis, uveitis. What do you expect from hx?

Answer 677

Reactive arthritis 2/2 GU - Chlamydia GI - Salmonella - Shigella - Yersinia - Campylobacter

Question 678

``` Which is NOT part of reactive arthritis? A) uveitis B) sacroiliitis C) symmetric arth D) circinate balanitis E) dactylitis F) enthesitis G) urethritis ```

Answer 678

D) symmetric arth *its asymmetric oligoarthritis

Question 679

RF for developing reactive arthritis excluding GI/GU infection?

Answer 679

HLAB27+ (normal pop risk: 8% HLAB27: 20%)

Question 680

When to give PNC GBS PPx if GBS status is unknown?

Answer 680

- preterm <37w gest - PPROM >18h - intrapartum fever (ie intraamniotic infection ) (also GBS rectovag Cx/UTI in preg, prior infact w/ early oneset neonatal GBS infection)

Question 681

Dx? 1. AutoAbs against AChR 2. inhibited release of Ach into synaptic cleft (ie no action potential)

Answer 681

1. MG | 2. Botulism

Question 682

``` Which are NOT seen in MG? A) autonomic dysfunct B) ptosis C) diplopia D) dysarthria E) dysphagia F) diminished reflexes G) fluctuating weakness ```

Answer 682

A) autonomic dysfunct F) diminished reflexes Both hwr seen in botulism

Question 683

How does calcium exist in the blood?

Answer 683

40% ionized (active) 45% albumin bound 15% bound to organic/inorganic anions

Question 684

Tx adenomyosis?

Answer 684

If childbearing not completed: progestin IUD or depot implant Otherwise hysterectomy

Question 685

Heavy regular menses, chronic pelvic pain, diffuse uterine enlargement. Dx?

Answer 685

adenomyosis DDx endometriosis: - fixed uterus - rectovaginal nodularity - adnexal mass

Question 686

MCC fecal incontinence in elderly?

Answer 686

fecal impaction (liquid overflow)

Question 687

Tx of fecal impaction?

Answer 687

manual disempaction then enema aggressive PO bowel regimen to prevent recurrence

Question 688

``` Elderly, no BM x 4 days. Exam: hard stool in colon, decreased anal tone. AXR: no air fluid levels. Tx? A) fiber B) lactulose C) stool softner D) disempaction E) rectal tube ```

Answer 688

D) disempaction (manual) then enema for fecal impaction - fiber may worsen obstruction

Question 689

Indication for rectal tube?

Answer 689

acute pseudoobstruction of colon & dilated colon and acute distension

Question 690

Acitve Lyme in preg woman. Prognosis/fetal outcome?

Answer 690

Good if mother receives adequate Tx - amoxicillin 2-3wks OR - cefuroxime

Question 691

Lyme in pregnancy may be treated w/ amoxicillin OR

Answer 691

- cefuroxime | in non-preg pts, doxy is preferred

Question 692

Sandy sensation in eyes and oral thrush. Dx?

Answer 692

r/o Sjogrens "do you wake up at night thirsty or need to drink water to help swallow food"

Question 693

Tx West Nile

Answer 693

Supportive

Question 694

Dx West Nile

Answer 694

IgM in CSF

Question 695

Peds: MCC viral CNS infections?

Answer 695

1. enterovirus (coxackie) 2. HSV 3. West Nile (arbovirus)

Question 696

CNS suspected: which Sx are consistent w/ encephalitis?

Answer 696

seizures confusion disorientation (meningitis & encephalitis = likely viral)

Question 697

LEad Tx moderate VS severe?

Answer 697

Mod 45-69: DMSA- succimer Severe 70+: hospitalization Dimercaprol AND EDTA

Question 698

Oral D penicillamine is used for?

Answer 698

Wilsons

Question 699

Viral conjunctivitis cn be Tx w/ warm/cold compress AND

Answer 699

+/- antihistamine/ | decongestant drops

Question 700

Bacterial conjunctivitis Tx: 1. first line 2. preferred in contact lens wearers

Answer 700

1. erythromycin ointment or polymyxin-TMP drops ~azithromycin drops 2. FQ drops (per higher incidence of Pseudomonas)

Question 701

``` Which is the BEST tx of bacterial conjunctivitis in contact lens wearers? A) polymyxin-TMP drops B) FQ drops C) azithromycin drops D) erythromycin ointment ```

Answer 701

2. FQ drops (per higher incidence of Pseudomonas)

Question 702

Which is NOT a first line Tx for bacterial conjunctivitis? ``` A) polymyxin-TMP drops B) GCS drops C) azithromycin drops D) erythromycin ointment E) FQ drops ```

Answer 702

B) GCS drops

Question 703

Contact lens wearers w/ bacterial conjunctivitis are at risk of developing:

Answer 703

keratitis (corneal inflammation) pathogens - pseudomonas - HSV, VZV - acathomoeba

Question 704

Contact wearer, acute bacterial conjunctivitis. After few days of abx > photophobia, impaired vision, foreign body sensation, nSIM?

Answer 704

STAT optho Slit lamp to confirm keratitis Tx: broaden abx Risk of scarring/ blindness

Question 705

Cirrhosis w/ ascites, hypoTN, no LE edema. Cr 2.8, BUN 60. SBP ruled out. Confused. NSIM?

Answer 705

Volume challenge, if he fails to respond > HEPATORENAL SYNDROME (otherwise presentation likely intravascular depletion) Tx: - octreotide & midodrine OR -NE and albumin x 2-3 days

Question 706

BUN:Cr of 20:1 indicates-

Answer 706

prerenal cause

Question 707

Indications for *tapering* steroids (as opposed to abrupt cessation)

Answer 707

>3wks use (per HPA axis suppression) OR Cushingoid appearance

Question 708

Which is NOT a feature of NF1? ``` A) acoustic neuroma B) neurofibroma C) optic glioma D) astrocytoma E) neural crest cell derived tumors F) chromosome 17 mutation ```

Answer 708

A) acoustic neuroma *feature of NF2 which also has schwannomas, epenyomas, meningiomas

Question 709

``` Which is NOT a feature of NF2? A) schwannomas B) acoustic neuroma C) neural crest derived tumors D) epenyomas, meningiomas ```

Answer 709

C) neural crest derived tumors ``` (feature of NF1 which also has: A) ch17 mutation B) neurofibroma** C) optic glioma D) astrocytoma E) neural crest cell derived tumors F) presents in childhood G) Lisch nodules H) axillary freckling ```

Question 710

``` Which is NOT a feature of NF2? A) schwannomas B) acoustic neuroma C) Dx in 3rd decade D) epenyomas, meningiomas E) axillary freckling ```

Answer 710

E) axillary freckling ``` Thats NF1! which also has A) ch17 mutation B) neurofibroma** C) optic glioma D) astrocytoma E) neural crest cell derived tumors F) presents in childhood G) Lisch nodules ```

Question 711

NF1 or NF2 1. axillary freckling 2. neurofibromas++ 3. ch17 mutation 4. auditory issues 5. cranial neuropathies 6. optic path gliomas 7. cafe au lait spots 8. Dx in 3rd decade

Answer 711

1. NF1 2. NF1 3. NF1 4. NF2 5. NF2 6. NF1 7. NF1 8. NF2 Note: neurofibroms are rare in NF2

Question 712

72yo started on prozac which is effective but now has jitteriness & insomnia NSIM?

Answer 712

switch to SSRI w/ less AE ie Lexapro

Question 713

Feminization of male fetus is caused by which medication?

Answer 713

spironolactone

Question 714

AE of PO tetracyclines in Tx of acne?

Answer 714

- teratogenicity - increased risk of vaginal trush - abx resistance

Question 715

Inflamm acne w/ mild improvement w/ clindamycin gel, BP wash & tretinoin, worse on lower face/neck before menses. NSIM?

Answer 715

Try OCP Likely to respond given hormonal acne sx May also try: ~Spironoclactone ~PO doxy

Question 716

Risk of syphilis during pregnancy?

Answer 716

intrauterine demise & preterm labor

Question 717

RPR or VDRL is positive. NSIM?

Answer 717

FTA-abs (treponemal test) The others are nontreponemal tests, require confirmation

Question 718

Indications or syphilis screening in preg?

Answer 718

all: first prenatal visit | high risk: 3rd trimester & delivery

Question 719

Pregnant F w/ confirmed syphilis. Hx PNC allergy: skin rash & SOB. Tx?

Answer 719

penicillin desensitization then IM penicillin benz G (PEN G is the ONLY Tx for syphilis in pregnancy) (4x decrease in serologic titers indicates success)

Question 720

``` Which is NOT use to Tx syphilis: A) pen G IM B) azithromycin C) doxycycline D) ceftriaxone E) erythromycin ```

Answer 720

all of them are used | - pen G is first line and the rest are 2nd

Question 721

Fetal effects of syphilis?

Answer 721

- HSM, jaundice - hemolytic anemia, thrombocytopenia - long bone abnorm - failure to thrive

Question 722

Pediatric sepsis: MCC in <28d VS >28d

Answer 722

<28d: Ecoli, GBS (Tx: ampi/gent OR ampi/cefotaxime) >28d: S.pneumo, Neisseria (Tx: ceftriaxone or cefotaxime)

Question 723

Pediatric sepsis: Tx age <28d VS >28d

Answer 723

<28d: Ecoli, GBS (Tx: ampi/gent OR ampi/cefoTAXime) >28d: S.pneumo, Neisseria (Tx: ceftriaxone or cefotaxime)

Question 724

Febrile neonate, NSIM?

Answer 724

``` CBC Bx UA UCx CSF cell count CSF Cx ```

Question 725

Why should ceftriaxone be avoided in neonates?

Answer 725

RF of hyperbilirubinemia (use cefoTAXime instead)

Question 726

Why is bactrim avoided in neonates?

Answer 726

RF methemoglobulinemia

Question 727

Hepatic hydrothorax: - Path? - Tx?

Answer 727

Path: passage of peritoneal ascites through the diaphragm Tx: Na restriction, diuretics (furosemide, spironolactone) Liver transplant

Question 728

R-sided transudative pleural effusion in patients w/ decompensated HF & ascites. Dx?

Answer 728

Hepatic hydrothorax Tx: Na restriction, diuretics (furosemide, spironolactone) Liver transplant ~~ thoracic repair of diaphragmatic defects (highly invasive ~~TIPS- relieves portal HTN but risk of encephalopathy & decompensation

Question 729

Which condition is NOT assd w/ bullous pemphigoid? ``` A) MM B) dementia C) Parkinsons D) MDD E) BPD ```

Answer 729

A) MM

Question 730

Bullous pemphigoid suspected. NSIM?

Answer 730

obtian bx to confirm before Tx (GCS)

Question 731

Skin Bx: IgG/C3 deposition along the BM. AutoAbs to hemidesmosopmes. Tx & Dx?

Answer 731

Bullous pemphigoid Tx: topical high potency GCS (clobetasol) & PO GCS or doxy

Question 732

Tx bullous pemphigoid

Answer 732

topical high potency GCS (clobetasol) | & PO GCS or doxy

Question 733

Urethral hypermobility indicates which urinary incontinence?

Answer 733

stress | and decreased urethral sphincter tone

Question 734

Decreased urethral sphincter tone: which urinary incontinence?

Answer 734

stress | and urethral hypermobility

Question 735

Urinary incontinence and urethral hypermobility. Tx?

Answer 735

- limit water to 2L/d - limit coffee - kegals - last resort: mid urethral sling procedure

Question 736

Risks of kidney donation?

Answer 736

Immediate post-op: DVT, hosp acquired infection Risk of gestational complications: fetal loss, preeclampsia, gestational DM or HTN Otherwise: - NO increased risk of ESRD (GFR drops immediately post-op but remaining kidney gradually compensates) - LOW mortality procedure

Question 737

Blepharospasm: - prevalence in which population? - triggers - Tx?

Answer 737

- older women (maybe 2/2 dry eyes) - dry eyes, irritants, bright light - Tx: BOTOX (v effective in tx of this focal dystonia, INCLUDING cervical dystonia)

Question 738

Tx for generalized dystonia?

Answer 738

- carbi-levodopa - trihexyphenidyl - diazepam/clonazepam - baclofen - *deep brain stimulation (for focal dystonia: botox)

Question 739

Labs & work up for Sjogrens?

Answer 739

Schrimer test (slit lamp exam to assess tear break up time) Labs: ro/la, ANA, RF Gold standard: labial salivary gland bx (rarely necessary) US & MRI may be used to assess structure/function of salivary glands

Question 740

How long does an ixodes tick have to be attached to transmit Lyme?

Answer 740

36-48h hence if attached <36h, REASSURE

Question 741

How long does it take for erythema migrans to appear?

Answer 741

>3d

Question 742

IVDU w/ AKI, palpable purpura, arthralgias, high RF, low complement, transaminitis. Dx?

Answer 742

r/o mixed cryoglobulinemia in setting of HCV

Question 743

Palpable purpura, arthralgias, weakness, high RF, low complement. Dx & Tx?

Answer 743

r/o mixed cryoglobulinemia Tx: 1. initial (2-3month) immunosuppressive Tx - stabilize end organ damage ie GN RITUXIMAB & GCS 2. Tx underlying d (**HCV, HBV, HIV, malig, rheum d)

Question 744

PSGN: high/norm/low A) C3 B) C4

Answer 744

low C3, normal C4

Question 745

AOM sp Tx. Peristent serous otitis media. NSIM?

Answer 745

observe if under 3 months (serous OM is normal for up to 3 months)

Question 746

When is amoxiclav indicated for AOM?

Answer 746

``` resistant cases (normally just tx w/ amox) ```

Question 747

Pediatric epistasix, not resolving sp 10 min nose pinch. NSIM?

Answer 747

1. topical vasoconstrictor ie oxymetazoline (NOT silver nitrate which is a form of chemical cauterization that can be used as second line Tx or electrocautery) If above fail > nasal packing (bacitracin covered sponge) n

Question 748

Wrestler w/ auricular hematoma. NSIM?

Answer 748

STAT I&D & pressure dressing Otherwise, complications: - abscess - avasc necrosis - fibrocartilage overgrowth - cauliflower ear **daily f/u x 3-5d to assess healing, eval for signs of infection

Question 749

Wrestler w/ auricular hematoma. Complications?

Answer 749

- abscess - avasc necrosis - fibrocartilage overgrowth - cauliflower ear **daily f/u x 3-5d to assess healing, eval for signs of infection Tx: STAT I&D & pressure dressing Avoid NSAIDs to avoid rebleeding

Question 750

Why are OCPs contraindicated in migraine w/ auras?

Answer 750

migraines pose slight risk of ischemic stroke

Question 751

ABSOLUTE contraindications to OCPs (12)

Answer 751

- hx DVT - hx CVA - heart disease - cirrhosis/ liver CA - breast CA - DM w/ end organ d - >35yo smoking >15/d - antiphospholipid s - migraines - BP >160/100 - major surgery w/ prolonged immobilization - <3wks postpartum

Question 752

OCPs increase risk of: A) breast CA B) uterine CA C) ovarian CA

Answer 752

A) breast CA (ABSOLUTE contraindication) *decreases risk of ovarian/uterine CA

Question 753

``` Which is NOT an ABSOLUTE contraindication to OCP use: A) hx DVT B) hx CVA C) heart disease D) cirrhosis/ liver CA E) ovarian CA F) DM w/ end organ d G) >35yo smoking >15/d H) antiphospholipid s I) migraines J) BP >160/100 K) major surgery w/ prolonged immobil L) <3wks postpartum ```

Answer 753

E) ovarian CA *OCPs are protective in ovarian/uterine CA but contraindicated w/ breast CA

Question 754

``` How often do you monitor TSH in pregnancy? Every: A) 4 weeks B) 6 weeks C) 8 weeks D) 12 weeks (each trimester) ```

Answer 754

A) every 4 weeks

Question 755

``` What happens with the following in pregnancy? A) TSH receptor stimulation B) feedback suppression of TSH C) circulating TBG D) Total T3 & T4 E) Free T3 & T4 ```

Answer 755

``` A) increased via bCG B) increased C) increased D) increased E) normal or minimal increase ```

Question 756

``` Which is NOT an early sign of compartment syndrome? A) taught area B) muscle weakness C) paresthesias D) pain w/ passive stretch ```

Answer 756

C) paresthesias

Question 757

Compartment syndrome w/ pressures > ___ require fasciotomy

Answer 757

20-30

Question 758

Which is more accurate in detecting H.pylori eradication: urea breath test or stool Ag?

Answer 758

urea breath test | but fecal Ag is more available

Question 759

PUD on endoscopy. When is repeat EGD indicated for surveillance?

Answer 759

To confirm healing in those with *gastric* ulcers & HIGH malignancy risk. (duodenal ulcers have a v.low malignancy risk)

Question 760

Which conditions warrant confirming Hpylori eradication?

Answer 760

- PUD - MALT - persistent sx - resection of early gastric CA

Question 761

Colonoscopy: hyperplastic polyp >1cm. Next screening?

Answer 761

3-5yrs

Question 762

Colonoscopy: Indication for next screening? A) 1-2 tubular adenomas <1cm B) 3-4 tubular adenomas <1cm C) 5-10 tubular adenomas <1cm

Answer 762

A) 7-10yrs B) 3-5yrs C) 3yrs

Question 763

Colonoscopy: Indication for next screening? A) hyperplastic adenoma <1cm B) hyperplastic polyp >1cm

Answer 763

A) 10y | B) 3-5y

Question 764

Colonoscopy: Indication for next screening? A) >10 adenomas B) large adenoma <2cm removed by piecemeal excision

Answer 764

A) 1yr | B) 6 months

Question 765

Which warrants a repeat colonoscopy in 6 months? ``` A) 1-2 tubular adenomas <1cm B) 3-4 tubular adenomas <1cm C) 5-10 tubular adenomas <1cm D) >10 adenomas E) adenoma <2cm removed by piecemeal excision F) hyperplastic adenoma <1cm G) hyperplastic polyp >1cm ```

Answer 765

E) adenoma <2cm removed by piecemeal excision

Question 766

Diabetic w/ - postprandial bloating, N/V - weight loss - postural dizziness - abnormal sweating - labile glyc control - frequent hypoglyc NSIM?

Answer 766

FIRST r/o mechanical obstruction w/ EGD or barium THEN: If no obstruction, confirm gastroparesis (DM autonomic dysfunction) w/ nuclear gastric emptying study

Question 767

Tx gastroparesis

Answer 767

- smaller, frequent meals - decrease fiber & fat - erythromycin or metoclopramide (refractory cases: liquid diet/PEG/gastric electric stimulation)

Question 768

Elderly pt w/ hip fracture sp mechanical fall. What is necessary upon discharge?

Answer 768

Home assessment by a nurse

Question 769

Metformin decreases fasting glucose by ~__%

Answer 769

20% | note: also useful in hyperTG & hepatic steatosis

Question 770

Temporal HA, transient vision loss & unilateral: miosis, ptosis, anhidrosis. Dx?

Answer 770

Horner syndrome- CAROTID ARTERY DISSECTION RF: CT d, HTN, smoking, recent infection Freq complications: TIA/CVA

Question 771

Temporal HA, transient vision loss & unilateral: miosis, ptosis, anhidrosis. Dx test & Tx?

Answer 771

Horner syndrome- CAROTID ARTERY DISSECTION Dx: CTA or MRA (if neg but high suspicion >cath angio) Tx: thrombolysis if <4.5h If not: aspirin +/- AC

Question 772

Temporal HA, transient vision loss & unilateral: miosis, ptosis, anhidrosis. Initial Dx test VS Gold standard for Dx

Answer 772

Initial: CTA or MRA Gold: cath angio

Question 773

Carotid dissection: RF & complications

Answer 773

RF: CT d, HTN, smoking, recent infection Freq complications: TIA/CVA

Question 774

Jaw claudication, fever, anemia, high ESR. Dx?

Answer 774

Temporal a bx

Question 775

Longstanding Hashimotos w/ sudden /rapid enlarging thyroid. NSIM?

Answer 775

Bx to r/o thyroid lymphoma | Pembertons test: facial plethora after raising hands overhead x20s thyroid is likely cause of obstructive sx

Question 776

Pembertons test: facial plethora after raising hands overhead x20s. Significance?

Answer 776

thyroid is likely cause of obstructive sx | inability to palpate inferior thyroid is also suggestive

Question 777

Longstanding Hashimotos is a RF for which CA?

Answer 777

thyroid lymphoma d/t chronic lymphocytic infiltration signs: rapidly elarging thyroid or obstructive sx

Question 778

antiTPO abs & rapidly enlarging thyroid is a sign of which thyroid CA?

Answer 778

thyroid lymphoma d/t chronic lymphocytic infiltration w/ Hashimotos

Question 779

Tx contact dermatitis

Answer 779

- avoid allergen | - <4wks high dose GCS (betamethasone, fluocinonide or if on face: tacrolimus)

Question 780

Tx contact derm on face

Answer 780

- avoid allergen - tacrolimus (if not on face, can use high potency GCS ir betamethasone or fluocinonide)

Question 781

Lichen simplex chronicus- etiology?

Answer 781

"neurodermatitis" | - chronic scratching and rubbing (assd w/ anxiety)

Question 782

Which condition is associated w/ Lichen simplex chronicus?

Answer 782

anxiety "neurodermatitis" - chronic scratching and rubbing

Question 783

``` LEAST COMMON trigger of acute cholangitis? A) gallstone B) bile duct stenosis C) incompetence of sphincter of Oddi D) hematogenous spread E) hx sphincterotomy (oddi) ```

Answer 783

D) hematogenous spread

Question 784

Fever, jaundice, RUQ pain, hypoTN, AMS. Dx & Tx?

Answer 784

*acute cholangitis* RUQ US (r/o ductal dil) Aggressive IVF BCx > empiric Tx - zocyn or cipto/metro ERCP w/in 24-48h for biliary drainage or gallstone removal

Question 785

Fever, jaundice, RUQ pain, hypoTN, AMS. Abx?

Answer 785

*acute cholangitis* zocyn or metro/cipro

Question 786

Bloody urine after marathon. UA: RBC+++, blood+++, no casts. NSIM?

Answer 786

repeat in a week - 25% of marathon runners have hematuria (2/2 bladder bouncing up and down). Hematuria in contact sports is secondary from direct trauma. - No casts means GN is unlikely. RBC presence means bloody urine is not soley from rhabdo (CK can be checked)

Question 787

Initial improvement w/ vent x few days and then worsening resp parameters. NSIM?

Answer 787

1. r/o VAT: obtain BAL or tracheobronchial aspiration | 2. START empiric abx MCC asp of Ecoli or Strep BUT if RF for resistance, ensure MRSA & Pseudomonal cover

Question 788

When are GCS indicated in ARDS?

Answer 788

controversial

Question 789

Pt sp stem cell/organ transplant, chronic GCS use, chronic neutropenia develops cough, pleuritic CP & hempotysis. CXR: nodules w/ ground glass opacity. Dx?

Answer 789

r/o pulm aspergillosis CT Chest: also halo sign or cavitations w/ air/fluid levels Labs: Galactomannan & beta-D-glucan elevation fungal stain/Cx+ Tx: voriconazole, reduce immunosuppressive Tx +/- surgery

Question 790

IMMUNOSUPPRESSED PT pt w/ cough, pleuritic CP & hempotysis. Labs w/ galactomannan. Dx & Tx?

Answer 790

Invasive pulm aspergillosis CT chest: - nodules w/ ground glass opacity - air/fluid level, HALO Tx: - Voriconazole - reduce immunosuppression - +/- surg

Question 791

Tx: Invasive pulm aspergillosis

Answer 791

- Voriconazole - reduce immunosuppression - +/- surg

Question 792

Tx Aspergillosis A) Fluconazole B) Amphotericin B C) Voroconazole

Answer 792

C) Voroconazole

Question 793

Asx F incidentally found to have 1cm gallstone. Tx?

Answer 793

Reassurance & no intervention - preg > increased risk of gallstones per hormonal changes (they resolve after preg)

Question 794

Childs arm is yanked > arm held extended/ pronated. No swelling, deformity or focal tenderness. NSIM?

Answer 794

*Radial head subluxation in child (nursemaids elbow)* Tx: hyperpronation or arm or supination of forearm & flexion of elbow XR IS NOT NECESSARY FOR DX

Question 795

Radial head subluxation in child (nursemaids elbow). Dx work up & Tx?

Answer 795

Dx: clinical Tx: Reduction o hyperpronation or arm or supination of forearm & flexion of elbow

Question 796

ID a LBBB

Answer 796

look it up dummi

Question 797

ST elevation in >2 leads. NSIM?

Answer 797

CATH LAB | no cardiac enzymes or trops needed

Question 798

Troponemia w/ ST depressions in a few leads. Tx?

Answer 798

Dx: NTSEMI ``` DAPT NTG BB statin AC ```

Question 799

Review arrhythmias & how to terminate them

Answer 799

:)

Question 800

Tx to achieve rapid warfarin reversal?

Answer 800

Prothrombin complex concentrate (normalizes INR w/in 10 mins) Also add IV vitK (hwr takes 12-24h to take effect) IF PTCC is unavailable, may use FFP (hwr less desirable d/t large vol & delay for blood compatibility testing)

Question 801

Rapid warfarin reversal desired. In which situation would you give FFP?

Answer 801

If prothrombin complex was unavailable FFP is less desirable d/t large vol & delay for blood compatibility testing

Question 802

Elderly w/ femoral neck fracture. When is non operative management recommended?

Answer 802

- advanced dementia - unstable medical - non-ambulatory

Question 803

Elderly w/ femoral neck fracture. What is crucial to reduce mortality & risk of pressure ulcers/PNA?

Answer 803

performing surgery w/in 48h

Question 804

SCD not in crisis. What do you see on peripheral smear or Hgb electrophoresis?

Answer 804

smear: sickled RBC Hgb electrophoresis: (GOLD Standard) HIGH HbS, NO HbA

Question 805

SCD: PNC is given until age of __

Answer 805

5

Question 806

Maintenance management of SCD: (4)

Answer 806

Pneumovax PNC until 5yo folic a hydroxyurea

Question 807

HIGH HbS, NO HbA. Dx?

Answer 807

SCD

Question 808

Dactylitis in SCD: mechanism?

Answer 808

sequestration in small bones of the hands/feet > bone infarct > vaso-occlusion

Question 809

WHy do SCD patients have chronic anemia?

Answer 809

chronic intravascular hemolysis

Question 810

Knock knee appearance age 2-5yo. NSIM?

Answer 810

Reassurance: this is physiologic genu varum - no pain ambulating - normal height - no medial thrust - no fracture, infection, tumor, swelling/warmth, signs of metabolic disease

Question 811

35yo w/ chronic back pain develops CVS tenderness. Labs showing AKI, hematuria, proteinuria, pyuria, nitrite neg, LE neg, no bact. No stone on imaging. Dx & Tx?

Answer 811

Chronic tubular injury > tubulointerstitial nephritis. **ischemic damage to papilla > sloughing >hematuria/pain d/t chronic use of ASA, acetaminophen, NSAIDs Tx: discontinue analgesics > stabilize renal funct or w/ some improvement.

Question 812

Necrosis and calcification of the renal papilla. Etiology?

Answer 812

Dx: renal papillary necrosis - analgesic nephropathy - anything causing ischemia (SCD etc) - DM - pyelo - vasculitis - pyelo

Question 813

Other than sun/UV light, what are some RFs of skin SCC?

Answer 813

- chronic scars, wounds, burns - immunosuppression - ionizing radiation exposure

Question 814

Tx invasive SCC

Answer 814

- excise 4-6mm margins - Mohs (IF SCC in situ: may also tx w/ curettage & dessication, cryo, 5FU, imiquimod)

Question 815

What are high risk features of SCC?

Answer 815

- on face, ears, neck, hands, feet, genitals (esp >1cm) | - 2+cm anywhere

Question 816

Which has a higher cure rate: Mohs or excision?

Answer 816

Mohs

Question 817

After quitting, mortality risk will fall below current smokers after __yrs

Answer 817

5yrs Also - reduced cardiac events - lower osteoporosis risk -

Question 818

Sudden SNHL. NSIM?

Answer 818

STAT ENT - audiogram - MRI tx - GCS tx *high dose w/in 24h (risk of permanent HL)

Question 819

SNHL 1) AC>BC 2) BC>AC 3) lateralizes to affected ear 4) lateralizes to unaffected ear

Answer 819

1) AC>BC | 4) lateralizes to unaffected ear

Question 820

Can employers request genetic info?

Answer 820

NO. GINA prohibits discrimination by health insurers and employers based on genetic info

Question 821

Mechanisms in which GCS lead to bone loss

Answer 821

- decrease GI absorp - renal Ca wasting - direct anti-anabolic effect on bones - suppress release of GnRH > central hypogonadism

Question 822

Cancer pt develops akathisia, dystonia 0or Parkinson like sx. Mechanism?

Answer 822

Possibly 2/2 entiemetic (ie metoclopramide, dopamine antagonist) Note: MC agents for chemo-assd nausea: - 5HT3 antagonists ie ondansetron and aprepitant

Question 823

chemo-assd nausea: Tx?

Answer 823

5HT3 antagonists: - ondansetron - aprepitant Less commonly dopaminergic antagonists (metoclopramide)

Question 824

Indications for injection sclerotherapy?

Answer 824

small, symptomatic varicose veins having FAILED 3-6 months of conservative Tx - leg elevation - compression stockings - leg elevation - weight loss

Question 825

When is surgical ligation/stripping indicated in the management of varicose veins?

Answer 825

Large, symptomatic varicose veins w/ - ulcers - bleeding - recurrent thrombophlebitis of veins

Question 826

Bilateral hilar LAD, hyperCa, hyperAlkP, transaminitis. Dx?

Answer 826

hepatic sarcoidosis (50-60%) CT/MRI to view hepatic infiltration w/ non-caseating granulomas Bx required for defDx

Question 827

MCC legal blindness in the US?

Answer 827

DM 1. prolif DM retinopathy 2. vitreous bleed 3. retinal detachment

Question 828

Newly dx DM1 w/ sugars 300s. Pt c/o blurry vision. What is the likely mechanism? 1. prolif DM retinopathy 2. vitreous bleed 3. retinal detachment 4. optic lens swelling

Answer 828

4. optic lens swelling 2/2 osmotic changes

Question 829

Chronic granulomatous disease: recurrent infections w/ ____ & ____

Answer 829

- catalase positive bacteria - fungi hence ppx: bactrim, itraconazole

Question 830

Chronic granulomatous disease: Dx test?

Answer 830

BEST: dihydrorhodamine ~also nitroblue tetrazolium Tx: - ppx: bactrim, itraconazole - inf: Cx based abx (prolonged course) - hematopoietic cell transplant is curative

Question 831

Chronic granulomatous disease: Tx?

Answer 831

- ppx: bactrim, itraconazole - inf: Cx based abx - INFy if severe - hematopoietic cell transplant is curative

Question 832

``` Which is NOT catalase positive? A) Pseudomonas B) S.aureus C) Burkholderia cepacia D) Serratia E) Nocardia F) Aspergillus ```

Answer 832

A) Pseudomonas MC infections in CGD: - skin: abscess - LN: adenitis - lungs: PNA - liver * difficult to tx, requires prolonged course abx

Question 833

2yo w/ hx recurrent infectionsm 4 episodes of cervical LAD p/w PNA w/ Burkholderia cepacia. Is there a CURE for this condition?

Answer 833

YES Dx: CGD hematopoietic cell transplant is curative

Question 834

Indications for azithromycin/palivizumab PPx?

Answer 834

Occasionally used in CF

Question 835

REcurrent sinopulmonary infections by encapsulated bacteria. Dx?

Answer 835

XL agammaglobulinemia (def opsonizing IgG & mucosal IgA)

Question 836

Adequate hydration helps prevent skin damage from sun exposure. T/F?

Answer 836

True

Question 837

Tx for cardioprotection in the setting of TCA OD?

Answer 837

Sodium Bicarb If refractory > Mg or lido

Question 838

NaHCO3 is recommended if pH

Answer 838

ph <7.1 | HCO3 <6

Question 839

TCA OD: Sx?

Answer 839

CNS: confusion, drowsiness, seizures, resp depression CVS: sinus tach, prolonged PR/QRS/QT, arrhythmia (VT, VF) AntiACh: dry mouth, blurred vision, dilated pupils, urinary ret, flushing, hypothermia

Question 840

Which OD includes the following? CNS: confusion, drowsiness, seizures, resp depression CVS: sinus tach, prolonged PR/QRS/QT, arrhythmia (VT, VF) AntiACh: dry mouth, blurred vision, dilated pupils, urinary ret, flushing, hypothermia

Answer 840

TCA Tx - IV Sodium Bicarb (for QRS widening or vent arrhythmia) - If refractory > Mg or lido - O2, intub, IVF - charcoal if <2h ingestion

Question 841

Pubertal M w/ small <4cm, firm, unilateral, disc shapedsubareaolar mass. No nipple discharge, axillary LAD, illness. Dx & Tx?

Answer 841

Physiologic gynecomastia 2/2 excess E production. (may be bilateral) Tx: Reassurance & observation DDx pseudogynecomastia (fat deposit in overweight boys)

Question 842

What is pseudogynecomastia?

Answer 842

fat deposit in breast tissue overweight boys

Question 843

8yo M w/ gynecomastia. NSIM?

Answer 843

r/o pathologic hormone imbalance - serum PRL if galactorrhea - ref: endocrinologist (r/o hyperthyroidism, hCG secreting tumor)

Question 844

Constitutional delay in puberty is considered in girls >__yo w/ short stature and NO breast development.

Answer 844

>12yo

Question 845

F w/ secondary sexual characteristics & no menses at 15yo+. NSIM?

Answer 845

Pelvic US & FSH | or if NO secondary sexual characteristics & NO menses at 13yo+.

Question 846

F w/ NO secondary sexual characteristics & NO menses at 13yo+. NSIM?

Answer 846

Pelvic US & FSH | or if secondary sexual characteristics & no menses at 15yo+

Question 847

14yo F w/ breasts and pubic hair but no menarche. NSIM?

Answer 847

Reassure | if secondary sexual characteristics & no menses at 15yo+ > pelvic US & FSH

Question 848

SIADH: 1. hypovolemic 2. euvolemic 3. hypervolemic

Answer 848

2. euvolemic

Question 849

SIADH: 1. SOsm ___ 3. UNa >__

Answer 849

<275 (hypotonic) >100 >40

Question 850

Tx SIADH

Answer 850

- fluid restriction - +/- Na tabs - hypertonic saline for severe hypoNa

Question 851

DDx Psychogenic polydipsia VS SIADH

Answer 851

UOsm PP: <100 SIADH: >100

Question 852

Apart from meds, what is a common trigger for SIADH?

Answer 852

PNA

Question 853

First deg relative w/ CRC. Which intervals do you screen with a normal study?

Answer 853

CRC Dx relative <60: Q5yrs relative >60: Q10yrs

Question 854

Joint injury > local burning pain, edema, vasomotor skin changes and decreased ROM. Dx & Tx?

Answer 854

Complex regional pain syndrome Dx increased resting sweat testing (autonomic dysfunction) OR MRI/XR w/ bone demineralization, muscle wasting Tx Nerve block or IV regional anesthesia

Question 855

Stages of Complex regional pain syndrome

Answer 855

Joint injury >>> 1. edema, vasomotor skin changes, burning pain 2. worsening edema, skin thickening, muscle wasting 3. limited ROM & bone demineralization on XR

Question 856

Mechanism of Complex regional pain syndrome

Answer 856

1. Injury causing decreased sensitivity to sympathetic nerves 2. Abnormal response to pain 3. Increased neuropeptide release >allodynia ***90% cases dont have an identifiable nerve injury

Question 857

Hypomanic pt reports upcoming wedding to a guy she just met. NSIM?

Answer 857

Explore reasons for the marriage (DONT offer congrats and schedule close f/u for monitoring)

Question 858

30yo dude w/ oral thrush refusing HIV testing. NSIM?

Answer 858

Explore reservations

Question 859

40yo M receives Dx of being HIV+. Refusing to tell wife per fear of rejection. SIM?

Answer 859

Support pt and strongly encourage them to tell sexual partners. Note: Some states have duty-to-warn. Others criminalize withholding dx. Others have anonymous partner notification systems.

Question 860

T/F All new HIV cases are to be reported to Department of Health

Answer 860

TRUE

Question 861

Drug user comes in w/ mydriasis, irritability, N/V, abdominal cramping, lacrimation, myalgia/arthralgia. Dx?

Answer 861

Opioid withdrawal

Question 862

31yo M w/ epigastric fullness & occasional nausea x few months. NO heartburn, early satiety or weight loss. NSIM?

Answer 862

Hpylori testing | also EGD if high risk; GIB, w.lossm >1 alarm sx

Question 863

61yo M w/ epigastric fullness & occasional nausea x few months. NO heartburn, early satiety or weight loss. NSIM?

Answer 863

EGD (if the same scenario was for a pt <60, first step is Hpylori unless alarm sx) Alarm Sx: - progressive dysphagia - IDA - odynophagia - palpable mass/LAD - persistent vom - FHx GI malig

Question 864

Dyspepsia causes?

Answer 864

MCC: idiopathic Hpylo NSAIDs PUD

Question 865

Indications for EGD in eval of dyspepsia?

Answer 865

<60 WITH alarm sx | >60

Question 866

MOA ovarian hyperstimulation syndrome

Answer 866

high hCG > increased VEGF in ovaries > increased vasc permeability > 3rd spacing (ascites, resp distress, hemoconcentration, hypercoag, e imbalance, AKI, DIC)

Question 867

In Vitro complication w/ ascites, resp distress, hemoconcentration, hypercoag, e imbalance, AKI, DIC. Dx?

Answer 867

ovarian hyperstimulation syndrome Eval: - trend CBC, electr - serum hCG - pelvic US - CXR - TTE

Question 868

Features of ovarian hyperstimulation syndrome?

Answer 868

high hCG > increased VEGF in ovaries > increased vasc permeability > 3rd spacing - ascites - resp distress - hemoconcentration - hypercoag - e imbalance - AKI - DIC

Question 869

In Vitro complication w/ ascites, resp distress, hemoconcentration, hypercoag, e imbalance, AKI, DIC. Tx?

Answer 869

Correct electrolytes Para/thoracentesis - VTE ppx

Question 870

Ovarian Hyperstimulation Syndrome 1- how soon after ovulation induction does it occur? 2- findings on pelvic US? 3- lab findings?

Answer 870

1. 1-2 wks 2. bilaterally enlarged ovaries w/ multiple follicles 3. Labs: - hemoconcentration - hypercoag - e imbalance - AKI - DIC - high bhCG

Question 871

In Vitro: 1-2wks later > rapid weight gain, dyspnea, oliguria. Which tests do you order?

Answer 871

Suspected Ovarian Hyperstimulation Syndrome. - trend CBC, electrolytes - monior renal function (high risk AKI) - hCG - pelvic US (enlarged ovaries, mult follicles) - CXR (ARDS, congestion, pleural effusion) - TTE (r/o pericardial effusion)

Question 872

Severe AS, now symptomatic. Prognosis if pt does not undergo valve replacement?

Answer 872

death w/in 2-3yrs

Question 873

Qualifications for severe AS: 1. aortic jet velocity >__ 2. mean transvalvular gradient >__ 3. AV area

Answer 873

1. >4 2. >40 3. <1cm

Question 874

Aortic stenosis w. aortic jet velocity >4 & Sx (angina, syncope, DOE). NSIM?

Answer 874

VALVE REPLACEMENT | this pt has severe AS with sx, if untreated- death w/in 2-3yrs

Question 875

Pt has severe AS> In addition to sx onset, what are the other indications for valve replacement?

Answer 875

- LVEF <50% - Undergoing other cardiac procedure ie CABG (Qualifications for severe AS: 1. aortic jet velocity >4 2. mean transvalvular gradient >40 3. AV area <1

Question 876

Mother smoked during pregnancy: Neonatal complications?

Answer 876

- DM - Asthma - Obesity - SIDS (obstetric complications: - spontaneous abortion - congen abn - PPROM - preeclampsia - abruptio placentae - low birth weight - fetal demise)

Question 877

RF for continued smoking during pregnancy?

Answer 877

- heavy use > 1/2 PPD | - other smokers at home

Question 878

Dyspnea, persistent cough, facial fullness/erythema, neck pain, dilated veins of the arms/neck. NSIM?

Answer 878

CT neck/chest w/ contrast r/o bronchogenic CA Dx: superior vena cava syndrome

Question 879

MCC superior vena cava syndrome

Answer 879

Bronchogenic CA

Question 880

Initially: Dyspnea, persistent cough, facial fullness/erythema, neck pain >>> cyanosis, collateral veins in thorax, ocular proptosis, lingual edema.) NSIM and Dx?

Answer 880

CT neck/chest w/ contrast r/o bronchogenic CA (which is causing superior vena cava syndrome)

Question 881

13yo F: short stature, no breasts, amenorrhea. Dx?

Answer 881

r/o Turners w/ karyotyping

Question 882

What kind of valvular abnormality is prevalent in Turners?

Answer 882

bicuspid aortic valve 30%

Question 883

Bicuspid aortic valve: 1. Affects __% pop 2. More freq in M/F? 3. AD, AR or XL 4. Screening TTE q__y

Answer 883

1. 1% 2. M>F 3. AD 4. Q1-2y Also: screening TTE for first degree relatives Tx: balloon valvuloplasty or surgery (valve & ascending aorta replacement)

Question 884

Bicuspid aortic valve: Tx?

Answer 884

Tx: balloon valvuloplasty or surgery (valve & ascending aorta replacement)

Question 885

Bicuspid aortic valve: Complications?

Answer 885

- infective endocarditis - severe AR or AS - aortic root or ascending aortic dilation - dissection

Question 886

ASx 20yo M is diagnosed w/ bicuspid aortic valve on TTE. NSIM?

Answer 886

screen all first degree relatives w/ TTE

Question 887

When is ballon valvuloplasty indicated for bicuspid aortic valve?

Answer 887

Young adults who plan on becoming pregnant or participating in competative sports IF - AS w/o calcification or regurg w/ peak gradient >40

Question 888

``` Which is NOT required for balloon valvuloplasty for bicuspid aortic valve? A) must be sx B) aortic stenosis C) no AV calcification D) no AR E) peak gradient >50 ```

Answer 888

A) must be sx | may be symptomatic or asymptomatic

Question 889

``` Which is NOT more prevalent in women who have sex w/ women? A) cervical CA B) breast CA C) ovarian CA D) MDD/anx E) intimate partner violence F) syphilis G) BV H) CVD I) obesity J) DM ```

Answer 889

F) syphilis

Question 890

Why is cervical CA prevalent in women who have sex w/ women?

Answer 890

- less HPV vax - less screening - higher rates obesity & smoking

Question 891

Why is ovarian/breast CA prevalent in women who have sex w/ women?

Answer 891

- higher rates smoking/obesity - less freq screening - lower parity - less OCP use

Question 892

``` Which is NOT a reason for higher incidence of ovarian/breast CA in women who have sex w/ women? A) higher rates smoking B) higher rates of obesity C) less freq screening D) higher parity E) loss OCP use ```

Answer 892

D) higher parity

Question 893

TBI > dizziness, disorientation, mild amnesia. When do you need imaging?

Answer 893

Only if HIGH RISK features are present: - AMS - LOC - severe HA/V - severe mech of injury - signs of basillar skull fracture

Question 894

Concussion diagnosed clinically after football head injury. When can pt resume activity?

Answer 894

24-48h rest after injury, then gradual return to activity. 1. light aerobics 2. moderate non-contact activity 3. competitive play *as tolerated Note: if sx develop upon resuming activity go back to the previous step

Question 895

Concussion diagnosed clinically after football head injury. Pt rests 24h then resumes light activity upon which she gets dizzy. NSIM?

Answer 895

24h rest then resume light aerobics 1. 24h rest then 2. light aerobics 3. moderate non-contact activity 4. competitive play **if sx develop with any of the steps, go back to the previous step

Question 896

Do you need imaging to r/o IC injury upon head trauma?

Answer 896

NO, only if HIGH RISK features are present: - AMS - LOC - severe HA/V - severe mech of injury - signs of basillar skull fracture - worsening sx

Question 897

``` Which is NOT an indication for ICD placement in HCM? A) FHx sudden cardiac death B) LVH >1.5cm C) syncope (recurrent or assd w/ exertion) D) non-sustained VT on Holter E) hypoTN w/ exercise F) hx cardiac arrest G) sustained spontaneous VT/VF ```

Answer 897

B) LVH >1.5cm **Extreme LVH >3cm is an indication for ICD

Question 898

Why are ACEi BAD for HCM?

Answer 898

They (along with vasodilators) reduce systemic vascular resistance > worsening LVOT

Question 899

List some indications for ICD placement in HCM?

Answer 899

``` A) FHx sudden cardiac death B) extreme LVH, >3cm IV septum C) syncope (recurrent or assd w/ exertion) D) non-sustained VT on Holter E) hypoTN w/ exercise F) hx cardiac arrest G) sustained spontaneous VT/VF ```

Question 900

Two good meds for EtOH cessation?

Answer 900

- Naltrexone (mu opioid receptor antagonist) ~ Acamprosate (glutamate modulator) * *contraindications to naltrexone - pts on opioids - acute hepatitis - liver failure

Question 901

Contraindications to naltrexone?

Answer 901

- pts on opioids - acute hepatitis - liver failure

Question 902

PCOS: first line Tx for infertility?

Answer 902

1. Weight loss 2. If unable/no response, try LETROZOLE (aromatase inhibitor) 3. If above are ineffective, try Gonadotropins (LH, FSH) or IVF

Question 903

Why does weight loss improve fertility in PCOS?

Answer 903

decreased adipose > decreased peripheral E conversion to T via aromatase. If unable to lose weight, try LETROZOLE (aromatase inhibitor) If above are ineffective, try Gonadotropins (LH, FSH) or IVF

Question 904

PCOS & infertility despite unsuccessful weight loss attempts and letrozole. NSIM?

Answer 904

Gonadotropins (LH, FSH)

Question 905

Tx to prevent endometrial hyperplasia/CA in PCOS?

Answer 905

OCPs

Question 906

PCOS: high or low? A) T B) E

Answer 906

both high | ovaries producing tons of E >> high conversion of E >T via aromatase

Question 907

VZV in elderly. When do you Tx w/ valacyclovir?

Answer 907

if lesions <72h Valacyclovir - reduces transmission - reduces new lesions - reduces post herpetic neuralgia

Question 908

``` Which is false about valacyclovir tx for VZV in elderly? Valacyclovir A) does not reduce transmission B) reduces new lesions C) reduces post herpetic neuralgia D) administered if lesions <72h ```

Answer 908

A) does not reduce transmission it does!

Question 909

Pt w/ shingles in R flank develops rash in L flank and upper back. NSIM?

Answer 909

Admit for disseminated VZV requiring IV acyclovir * increase risk of complications ie post-herpetic neuralgia, Ramsay Hunt * *contact/airbourne precautions

Question 910

Pt has trigeminal VZV. Later develops facial paralysis & HL on the same side. Dx & Tx?

Answer 910

Ramsay Hunt | Tx: antiviral rx

Question 911

Which kind of precautions are necessary in disseminated vs local shingles?

Answer 911

local: rash cover, handwashing dissem: contact/airbourne (admit to hospital for IV acyclovir)

Question 912

Poor surgical candidate w/ vaginal prolapse. Tx?

Answer 912

pessary (placed intravaginally) If good surgical candidate: hysterectomy w/ prolapse repair

Question 913

70yo undergoes thyroidectomy. 3h later: Slurred speech, R sided weakness. NSIM?

Answer 913

CT head w/o contrast to r/o hemorrhagic CVA. Once excluded- reperfusion )IV thrombolysis or mechanical thrombectomy initiated for PERIOPERATIVE ISCHEMIC STROKE

Question 914

Average age to star walking?

Answer 914

12-15m

Question 915

Genu varum in infant- indication for XR?

Answer 915

- progressive bowing - unilateral - persistent >3yo (normally until 2yo) - assd w/ short stature (metabolic d)

Question 916

42yo w/ increasing heartburn & regurg daily. No alarm Sx. NSIM?

Answer 916

LIFESTYLE AND PPI trial x 8wks If fails: incease PPT to high dose BID If fails: esophageal pH monitor or EGD *Note: if Sx are mild, every few days, use famotidine PRN

Question 917

30yo M w/ fatigue, DOE, systolic murmur that increases w/ Valsalva & systolic anterior motion of mitral leaflets. Which meds should you avoid?

Answer 917

*HCM* Vasodilators: amlodipine, nifedipine, ACE/ARBS, nitrates (worsening of LVOT)

Question 918

23yo M w/ fatigue, DOE, systolic murmur that increases w/ Valsalva & systolic anterior motion of mitral leaflets. BB initiated w/o much sx improvement. NSIM?

Answer 918

ADD verapamil or disopyromide (more negative inortopes to "weaken force of the contraction"

Question 919

Tx: NON-functioning pituitary adenoma (gonadotrophs) VS PRL-secreting adenomas

Answer 919

NON-functioning pituitary adenoma (gonadotrophs): TRANSSPHENOIDAL SURGERY PRL-secreting adenomas- DOPAMINERGIC MEDS

Question 920

T/F The first line Tx of a non-functioning pituitary adenoma is surgery

Answer 920

T NON-functioning pituitary adenoma (gonadotrophs): TRANSSPHENOIDAL SURGERY

Question 921

Medical contraindications to pregnancy?

Answer 921

- EF <40 - NYHA III-IV HF - Hx peripartum myopathy - severe obstructive cardiac lesions - severe pulm HTN (Eisenmenger) - Unstable aortic dil >40

Question 922

Woman had peripartum myopathy during last pregnancy and asks about the risk of her next pregnancy. Answer?

Answer 922

Prior peripartum cardiomyopathy is a CONTRAINDICATION to pregnancy

Question 923

30yo F w/ large VSD >> EIsenmengers presents asking about how she should prepare for pregnancy. Answer?

Answer 923

Eisenmengers is a CONTRAINDICATION to pregnancy. - decreased SVR would exacerbate R>L shunting and worsen cyanosis & HF. Maternal mortality 50%. Recommend abortion & hysteroscopic sterilization or subdermal progestin implant

Question 924

Tx Eisenmengers

Answer 924

Surg: - heart-lung transplant - lung transplant plus cardiac defect repair

Question 925

Obese teen M w/ dull hip pain referred to knee, altered gait, limited internal rotation. XR: posterior * inferior displacement of femoral head. Dx & Tx?

Answer 925

Dx: Slipped capital femoral epiphysis. Tx: avoid weight bearing **STAT surgical pinning Complications: avascular necrosis, OA

Question 926

Slipped capital femoral epiphysis. 1. demographic 2. Tx 3. complications 4. ulinateral/bilat?

Answer 926

1. teen M 2. avoid weight bearing & STAT surgical pinning 3. Complications: avascular neccrosis, OA 4. 20-40% have involvement of the other hip by 18m

Question 927

S/p gastrectomy > dizziness, sweating, dyspnea, N/V/D, abd pain after meals. Tx?

Answer 927

Dx: dumping syndrome Tx: HIGH PROTEIN diet - small, freq meals - low carbs

Question 928

Negative stress test: meaning/significance?

Answer 928

<1% CVS events within the next year | test is negative if exertion >85% w/o ST depressions/elevations >1mm

Question 929

**Which meds should be HELD prior to stress test and when? ``` A) statin B) BB C) CCB D) ASA E) ACEi F) nitrates ```

Answer 929

B) BB C) CCB F) nitrates 48h prior

Question 930

Upcoming stress test: Which meds should be held?

Answer 930

BB CCB nitrates (NOT statin, ASA, ACEi)

Question 931

Exercise stress test: EKG variables w/ poor prog: - STE - ST depressions >1mm - Vent arrhythmia What are the clinical variables w/ poor prognosis?

Answer 931

- poor exercise capacity - low workload > angina - Fall in SBP - chronotropic incompetence

Question 932

Angina: which three traits must it have to be considered classic?

Answer 932

- typical location, quality, duration - provoked by exercise or emotional stress - relieved by NTG If 2/3: atypical If 1/3: non-anginal

Question 933

Centor criteria for Dx strep? (4) Note: low probability if <3

Answer 933

- tonsillar exudate - tender anterior cervical LAD - fever - NO cough Tx PO pen V or amox x 10 days

Question 934

``` Which is NOT a part of Centor criteria to r/o GAS pharyngitis? A) tonsillar exudate B) cough C) tender anterior cervical LAD D) fever ```

Answer 934

B) cough *absence of cough

Question 935

Familial hypercalciuric hypercalemia. What do you expect for the following: 1. Serum Ca 2. Urine Ca 3. PTH 4. bone density 5. hyperCa Sx 6. path?

Answer 935

1. mildly high 2. low 3. wnl/high 4. normal 5. none 6. mutation in CaSR (sensing receptor) > increased Ca resporp in tubules)

Question 936

- High serum Ca - norm/high PTH - ~hyperCa Sx - low bone density - high urinary Ca excretion What are the complications of this condition?

Answer 936

hyperPTH Complications: CKD, nephrolithiasis, osteoporosis

Question 937

DDx urinary Ca excretion in FHH VS hyperPTH?

Answer 937

FHH: low <100 hyperPTH: high >100 (d/t accelerated bone turnover)

Question 938

Complications of FHH VS hyperPTH?

Answer 938

FHH: none hyperPTH: osteoporosis, nephrolithiasis, CKD

Question 939

High PTHrP What do you expect for the following: Ca+ PTH

Answer 939

high >14 low (seen w/ malignancy)

Question 940

urine Ca/CrCl ratio is used to DDX which two conditions? | UCa/SCa)/(UCr/SCr

Answer 940

FHH: <0.01 hyperPTH: >0.02

Question 941

Protective factors for epithelial ovarian CA EXCEPT: A) early menarche B) OCP C) multiparity D) breastfeeding

Answer 941

A) early menarche RFs: - early menarche - late menopause - infertility - endometriosis - HRT - >50yo - BRCA1/2 - FHx

Question 942

``` All are RFs for epithelial ovarial CA EXCEPT (2): A) breast feeding B) early menarche C) late menopause D) infertility E) endometriosis F) multiparity G) HRT H) >50yo I) BRCA1/2 J) FHx ```

Answer 942

A) breast feeding F) multiparity (both protective, along w/ OCPs)

Question 943

Complex ovarian mass discovered in F 10th wk gestation. NSIM? 1. US Bx 2. Chemo 3. Rad 4. Surgery now 5. Surgery in 1 month

Answer 943

5. Surgery in 1 month **SURGERY in early 2nd trimester Otherwise risks of torsion, rupture, labor obstruction. If CA is Dx, chemo in 2nd or 3rd trimester. Note Bx may cause SEEDING

Question 944

Indications for excision of pelvic mass during pregnancy?

Answer 944

- complex features - >10cm - persistent surgery best during early 2nd trimester

Question 945

Tunnel vision, diaphoresis, nausea pallor > syncope. Dx?

Answer 945

vasovagal

Question 946

What is COBRA?

Answer 946

"Consolidated Omnibus Budget Reconciliation Act": legal framework in which pt who have left their employer may continue to have health benefits for a limited duration of time (ie job transition, death, divorce)

Question 947

``` What do the following cover: A) Medicare A: B) Medicare B: C) Medicare C: D) Medicare D: ```

Answer 947

A) inpatient services B) outpatient services C) enrolment in private insurance plans ie Advantage D) meds

Question 948

``` What do the following cover: A) Medicare A: B) Medicare B: C) Medicare C: D) Medicare D: ```

Answer 948

A) inpatient services B) outpatient services C) enrolment in private insurance plans ie Advantage D) meds

Question 949

``` Which covers hospice care? A) Medicare A B) Medicare B C) Medicare C D) Medicare D ```

Answer 949

A) Medicare A A) inpatient services B) outpatient services C) enrolment in private insurance plans ie Advantage D) meds

Question 950

Which covers outpatient surgery? A) Medicare A B) Medicare B C) Medicare C D) Medicare D

Answer 950

B) Medicare B A) inpatient services B) outpatient services C) enrolment in private insurance plans ie Advantage D) meds

Question 951

Rise in Cr >30% after staring ACEi. Dx?

Answer 951

r/o renovascular disease

Question 952

Exam findings suggesting renovascular disease? (2)

Answer 952

abd bruit asymmetric renal size >1.5cm Also: imaging w/ atrophic kidney and rise in Cr >30% after staring ACEi.

Question 953

Prevalence of RAS in the following: 1. mild HTN 2. severe HTN 3. PAD

Answer 953

1. 1% 2. 45% 3. 30% Confirm w/ US doppler (or CTA/MRA)

Question 954

Recurrent flash pulmonary edema w/ severe HTN. What do you suspect?

Answer 954

r/o renovascular disease | Confirm w/ US doppler or CTA/MRA

Question 955

Which HTN scenarios raise suspicion for renovascular disease?

Answer 955

- resistant HTN - malig HTN - severe HTN sp 55yo >180/120 - severe HTN w/ CAD/PAD - recurrent flash pulmonary edema w/ severe HTN.

Question 956

BEST dx test for renovascular disease?

Answer 956

US doppler Other: MRA- risk of nephrogenic systemic fibrosis w/ gadolinium CTA- risk of contrast-induced nephropathy

Question 957

HTN w/ unexplained hypoK. Dx?

Answer 957

``` primary hyperaldosteronism (Conns). ``` Dx: aldo/renin ratio

Question 958

20yo w/ white scrapable oral plaques. In addition to HIV, which test do you order?

Answer 958

KOH or gram stain of mucosal scraping to confirm Candida

Question 959

ROUTINE testing for dementia?

Answer 959

CBC, CMP< vitB12, TSH CT/MRI If at risk: - RPR/VDRL (promiscuous) - folate (EtOH) - vitD (CKD)

Question 960

MMSE

Answer 960

<24 | <26

Question 961

``` Which artery supplies LATERAL WALL of the LV? A) L circumflex B) LAD C) L main D) RCA ```

Answer 961

A) L circumflex

Question 962

``` Which artery supplies INF-POST WALL of the LV? A) L circumflex B) LAD C) L main D) RCA ```

Answer 962

D) RCA

Question 963

``` Which artery supplies ANT & ANT-LAT WALL of the LV? A) L circumflex B) LAD C) L main D) RCA ```

Answer 963

B) LAD

Question 964

Hx BPH ? urinary obstruction relieved w/ FC. PSA found to be 6.5 NSIM?

Answer 964

Recheck in 6-8wks | likely high 2/2 acute manipulation, BPH & urinary retention w/ possible acute infection

Question 965

Causes of high PSA?

Answer 965

TRANSIENT - urinary retention - acute/mild prostate infection/inflam - urologic procedure (ie cystoscopy) - recent ejaculation - DRE PERSISTENT - BPH - severe/chronic prostatitis - prostate CA

Question 966

``` Which is NOT a RF for gout? A) diuretics B) ASA 81mg C) cyclosporine D) trauma E) CKD F) high carb diet G) high fat diet H) hypovol ```

Answer 966

F) high carb diet *high fat and high protein diets cause gout flares

Question 967

Arthrocentesis to r/o gout. | WBC ~ ___-___

Answer 967

2,000-100,000, PMN predom negatively birefringent, needle-shaped monosodium urate crystals **do NOT use uric acid levels as an indicator of gout flare

Question 968

Gout: Which is FALSE? A) uric acid for flare Dx B) trauma is a trigger C) surgery is a trigger D) arthrocentesis 2,000-100,000, PMN predom E) arthrocentesis: negatively birefringent urate crystals

Answer 968

A) uric acid for flare Dx **do NOT use uric acid levels as an indicator of gout flare, levels can often be wnl

Question 969

Pt w/ CKD has gout flare in big toe confirmed w/ arthrocentesis. Tx?

Answer 969

intraarticular injection or ?colchicine! (cannot use first line indomethacin per CKD) *if multiple joints > PO GCS

Question 970

Pakinsons > dysphagia, w.loss, frequent PNA. How do you confirm Dx?

Answer 970

videofluoroscopic swallowing study *asp PNA: leading COD in Parkinsons! Tx: multidisciplinary rehab program (nutrition, SLP, nursing)

Question 971

Recurrent aspiration in Parkinsons confirmed w/ fluoro. Tx?

Answer 971

Tx: multidisciplinary rehab program (nutrition, SLP, nursing) *asp PNA: leading COD in Parkinsons!

Question 972

Recurrent PNA w/ : - S.pneumo - H.influenzae - Pneumocystis - Atypicals ``` A) aspiration B) COPD C) Immunodef: HIV, heme CA, hypogamma D) Post-obstructive E) TB ```

Answer 972

C) Immunodef: HIV, heme CA, hypogamma

Question 973

Recurrent PNA w/ : - Anaerobes - Polymicrobial Underlying disease? ``` A) epilepsy B) Chronic bronchitis C) HIV D) Post-obstructive E) TB ```

Answer 973

A) epilepsy Also dysphagia & EtOH Dx: chronic aspiration

Question 974

Recurrent PNA w/ : - S.pneumo - H.influenzae - Moraxella catarrhalis - Pseudomonas - Viral Underlying disease? ``` A) epilepsy B) bronchiectasis C) HIV D) bronchogenic CA E) TB ```

Answer 974

B) bronchiectasis | and COPD, CB/emphysema, asthma

Question 975

MC location of asp PNA?

Answer 975

RML or RLL

Question 976

**MCC high output HF?

Answer 976

``` MCC: morbid obesity AVF (congenital or acquired) hyperthyroidism severe anemia advanced cirrhosis Pagets thiamine deficiency ```

Question 977

``` Which is NOT a common cause of high output HF? A) morbid obesity B) thiamine deficiency C) AVF (congenital or acquired) D) hypothyroidism E) severe anemia F) advanced cirrhosis G) Pagets ```

Answer 977

D) hypothyroidism *hypERthyroidism is a cause