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1
Q

What presents with diarrhea, constricted visual fields, RF, tachycardia, HTN, and peripheral neuropathy

Treatment?

A

Mercury poisoning

Succimer, dimercaprol, penicillamine

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2
Q

What is chonrdromalacia?

A

Patellofemoral syndrome

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3
Q

Pt that is immunosuppressed has a negative PPD if what?

A

< 5mm

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4
Q

A pt brings a suit against a surgeon and the hospital bc of failure to remove a surgical sponge following surgery, this is called what?

A

Vicarious liability - employers are liable for negligence of their employees

Key word in vignette: AND HOSPITAL

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5
Q

Koilonychia means what?

Seen in what?

A

Spoon nails

Fe def anemia

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6
Q

What is Winter’s formula?

A

Expected CO2 = 1.5*HCO3 + 8 +/- 2

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7
Q

What test has the pt supinate the arm while the elbow is flexed at a 90 degree angle?

Tests what?

A

Yergason

Biceps tendinitis

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8
Q

Sinus tachycardia is rarely above what HR?

A

< 140

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9
Q

Origin of teres major?

Action?

A

Inf angle of scapula

ADDuction and IR of humerus

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10
Q

ABD Xray that shows a double loop sign means what?

Another name for this sign?

MC caused by what?

A

Sigmoid volvulus

Coffee bean

Chronic constipation

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11
Q

What is St John’s wort widely used to treat?

How does it effect enzymes?

A

Depression

CYP3A4 inducer

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12
Q

What are the 5 Major findings of LVH on EKG?

A 
Inc QRS voltage
Inc QRS duration 
LAD
ST-T changes
LA abnormality

R wave amplitude is INC in leads I, aVL and V4-V6

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14
Q

Pt that is aSx until adolescence and then present w/amenorrhea/oligomenorrhea, increased acne, or hirsutism is most likely what?

Obtain what lab?

Treat how?

A

No classical CAH

17-hydroxyprogesterone

Prednisone

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15
Q

What test is described by the pt flex the elbow to 20-30 degrees w/forearm in supination and examiner resist forward flexion of the arm?

Tests what?

A

Speed’s

Bicep tendonitis

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16
Q

What describes gastric mucosal disorder that is assoc w/little or NO inflammation?

Tender point where?

MC cause?

A

Gastropathy

Left 5th ICS - acid TP

NSAID use - look for pt w/OA

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17
Q

Pt that is having a blood transfusion and develops fever, HoTN, tachycardia w/NO lung findings or dec in Hg after 2 hours has what?

A

Transfusion transmitted bacterial infection

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18
Q

Pt w/SAH, how do you tell if the ACOM or the PCOM is involved?

A

ACOM - will have bitemporal hemianopsia

PCOM - will have 1-sided ptosis and mydriasis

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19
Q

HTN is risk factor for what in a pregnant pt?

Causes what?

A

Placenta abruption

Painful bleeding

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20
Q

Nummular means?

Seen in what?

A

Coin-like

Eczema —> round to oval erythematous plaques

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21
Q

What nerve supplies the aDDuctor muscles?

What spinal levels?

A

Obturator n. (L2-L4)

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22
Q

When is tPA contraindicated?

A

If systolic BP > 185 or diastolic > 110

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23
Q

Which SITS muscle ER the shoulder?

A

Infraspinatus

Teres minor

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24
Q

Membranous glomerulopathy is MC in whom?

What major complication?

A

Whites, solid tumors, HepB

Hypercoaguability

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27
Q

Ataxic or cluster breathing is known as what?

Caused by what?

A

Biot’s

Head injury, CNS shit

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29
What is ginkgo biloba used to treat? MOA? What is the serious side effect?
Dementia, memory impairment, vascular disorders Inhibits binding of platelet activating factor Serious bleeding, esp in pts taking anticoagulation or post-op
30
What is a more virulent bacteria than salmonella typhimurium, lactose(-) rod that directly invades the colon and produces a protein-synthesis inhibiting toxin? MOA?
Shigella dysenteriae Propels itself through actin polymerization
31
Granular casts are found in what? Aka?
ATN Muddy brown
33
Pt that presents w/ pruritis, blurry vision, and erythromelalgia (burning in hands and feet then blue/red discoloration) has what? MC causes what? Treat how?
Polycythemia Vera Budd-Chiari syndrome Anti-coagulate w/Warfarin
35
What is characterized by continued pain, allodynia, or hyperalgesia in 1 of the extremities? Also presents w/what sx?
Complex regional pain syndrome Edema, vasomotor instability, skin changes, dec ROM
36
How do you calculate the corrected HCO3 in a metabolic acidosis pt to see if there is additional acid/base disturbance?
(Measured AG - Normal AG) + measured HCO3 This is the corrected value Then compare to 24 If > 24, then additional metabolic alkalosis If < 24 then additional metabolic acidosis
37
What complex pain syndrome does not migrate and is defined peripheral nerve injury w/hx of Trauma?
Type 2
38
Periosteum elevation in a bone indicates what?
Periosteum abscess from osteomyelitis
39
What are the MC features of nephrotic syndrome?
> 3.5 G protein/day Hypoalbuminemia Hyperlipidemia Edema
39
Where is the duodenal ulcer Ant Chapman point? Gastric ulcer?
Right 8th ICS Left 5th ICS
40
What drugs decrease the filtration fraction?
Loops Thiazides ACEi’s
41
Where is the Travell trigger point? It is associated with what?
Right pectoralis muscle 5th ICS, medial to nipple line SVT
43
What are the MC elevated enzymes in dermatomyositis?
CK and Aldolase
44
What is described by a constant, intense, dull discomfort in the RUQ, epigastric or substernal area that radiates to the right shoulder? Seen in what?
Biliary colic Cholelithiasis
45
What is echinacea goldenseal used for? MOA? SE’s? Contraindicated in whom?
Stimulate immunity, prevents URIs Inc synthesis of inflammatory cytokines N/V, dyspnea, rash, hepatotoxicity Autoimmune or CT disorders, or with hepatotoxic drugs
46
What is the only cure for PNH?
Alligeneic bone marrow transplant
47
What Chapman point is located at the Posterior left T3 intertransverse space?
Left Upper lobe of lung
48
What is the definitive management for foreign body extraction in pediatrics?
Rigid bronchoscopy
50
What Chapman reflex is located on the lateral thigh w/in the IT band from the greater trochanter to just above the knee?
Colon
51
What is an infection of the superficial layer of the skin by Corynebacterium minutissimum? Affects what areas?
Erythrasma Bw digits of foot, skin folds, and other moist areas
52
What are the 3 primary requirements of EMTALA?
Hospital must provide appropriate medical screening exam to anyone coming to ED and requires Dr participation Hospital must treat and stabilize the emergency medical condition Hospital must not transfer pt w/emergency medical condition that has NOT been stabilized unless specific criteria are met
53
Pt with vertigo of a few days and has accompanied or preceded URI most likely has what? Treat how?
Viral labyrinthitis Meclizine
54
Pt that has pain with single leg hop/pain radiating into the groin most likely has what?
Stress fracture
55
What age should a child stop using a belt positioning booster seat?
8 or older
56
What are the 5 diagnostic criteria for Kawasaki’s disease?
``` Changes in Extremities - edema/erythema Conjuctivitis - freq b/L Rash Cervical adenopathy, 1 node > 1.5 cm Change in oral cavity - lips, tongue ``` will have a FEVER > 5 days
58
What are the levels like of the following in vWF? Platelet count PT PTT Bleeding time
Normal Normal Prolonged Prolonged vWF carries factor 8, and without it factor 8 is degraded easily
60
When is fibrinolysis indicated in STEMIs? What evidence?
If cardiac intervention CANNOT be performed w/in 90 min ISIS-2 trial
61
What is an iodine containing glycoprotein produced by the follicular cells of the thyroid gland and stored as colloid?
Thyroglobulin aka colloid antigen
61
Psoriasis causes what condition in the nails?
Onycholysis
62
Pt with Fe def anemia, what is the level of transferrin?
Increased
64
What study design is useful in gathering info on the Prevalence?
Cross-sectional
65
What presents with proximal symmetric muscle weakness, hyperreflexia, and autonomic changes? What else about the muscle weakness?
Lambert-Eaton IMPROVES with use
66
Describe the following in Addison’s disease: Na K+ Ca 2+ Cortisol
Low High High Low
67
What is the most sensitive test for ACL diagnosis? What does this test entail?
Lachman better than ant drawer Pt supine, Flex leg to 30 degrees
68
Pts w/osteopenia should be started on Bisphosphonates when?
10-year probability of a hip fracture of 3%
69
How do NSAIDs effect kidney filtration?
Block PGs at afferent arteriole causing constriction and leading to DECREASED RPF and decreased GFR and therefore no change in FF
70
Secondary adrenal insufficiency occurs due to what?
Anything involving the pituitary and interferes w/ACTH secretion Dec in ACTH secretion leads to decrease in the activity of the adrenal glands to produce cortisol
72
What lab values does rickets present with?
Inc ALP Inc PTH Dec PO4
72
What is a common complication of untreated thyroid storm? What is 1st line treatment? Why? When should you give Iodine?
AFib PTU Methimazole CANNOT inhibit peripheral conversion of T4 to T3 1 hour after giving PTU
73
MC SE’s of Memantine? MOA?
HA, confusion, dizziness NMDA receptor antagonist
73
What causes anterior knee pain that presents with trouble going up and down stairs and gets better with physical activity? Due to what pathology?
Patellofemoral syndrome Weakness of Vastus medialis muscle
73
Pt that has RUQ pain, jaundice and palpable GB in the RUQ has what?
Choledocolithiasis
74
Tenderpoint medial to ASIS indicates what?
Psoas syndrome
76
What is the only muscle that opens the vocal cords?
Posterior cricoarytenoid muscle
77
LP in GBS shows what?
Increased protein, NORMAL cell count
78
What is Waddell sign indicate?
Malingering
81
Pt w/widespread skin rashes/discoloration that glows red fluorescent when exposed to UV light has what? Treat how? How else?
Erythrasma PO erythromycin Topical clindamycin if localized
82
What herbal supplement can render OCPs ineffective?
St John’s wort
83
What causes failure of bone resorption that leads to thickened, dense bones that are prone to fracture? Lab values of Ca? PO4? ALP? Xray shows what?
Osteopetrosis ALL normal Erlenmeyer flask deformity
83
What is acute Cholecystitis?
Inflammation of the GB that results from OBSTRUCTION of the cystic duct from gallstones
84
What is the formula for filtration fraction?
GFR / RPF
85
What is defined as the intentional act on the part of the caregiver to fail to respect a pt’s advance directive?
Battery
86
What is the MC outcome in a pt w/ADPKD?
Hemodialysis
87
Age group for Berger disease? When do symptoms present? PSGN? When do symptoms present?
10-30 y/o Within a day of an uri 3-14 y/o 2 weeks after infection
88
Which molar pregnancy has fetal tissue?
Partial
88
Patient with Addison’s disease, what are the levels of renin like? Aldosterone?
Inc Dec
89
What presents w/elevated IgM, anemia, and blurry vision with Raynaud phenomenon? How to treat?
Waldenstrom macroglobulinemia Plasmapharesis
89
Pt presents with 3rd trimester bleeding w/out contractions or fetal distress, what is the most likely Dx? D/t what?
Placenta previa Previous C section
89
Murphy’s sign tests for what?
Acute cholecystitis
90
What is a common occurrence in athletes who perform overhead activities repeatedly and have a + Neer’s and Hawkins test? D/t what?
Impingement syndrome Compression of supraspinatus and associated bursa in the subacromial space
91
Woman in her 30s that presents with ascites, jaundice, and abdominal pain and was recently pregnant likely has what?
Budd-Chiari
94
How do ACE-i’s effect FF, GFR, and RPF?
They dec AgII which leads to an increase in RPF, no change in GFR and therefore a DECREASE in FF
95
What is Beck’s syndrome? What symptoms?
Anterior spinal artery syndrome B/L loss of pain/temp and spastic paresis below the lesion w/b/L flaccid paralysis at level of lesion
96
How long should a child be in a rear facing car seat in a car?
< 2 years old
97
What is a KEY feature of central pontine myelinolysis? How do you prevent this condition?
Horizontal gaze palsy Correct w/NS (NOT fluid restriction) at a rate no > than 10 mmol/L/24 hours or .5 mEq/L/hr
98
What does tertiary adrenal insufficiency result from?
20mg or more of prednisone per day for more than 3 weeks
99
Acceptable BPs in pts > 60 years old is what?
Less than 150/90
100
MOA of salmonella typhimurium?
Elicits a host immune response that upregulates intracellular cAMP
101
Hemophilia A is what? Describe the PT? PTT? Bleeding time? Plt count?
Factor 8 deficiency All normal except the PTT is increased
102
Loop diuretic use is associated w/what acid-base disturbance? How/why?
Metabolic alkalosis Loss of Na w/loss of HCO3, dec renal perfusion leading to elevated Angiotensin and Aldosterone levels
103
Child that develops tremors and renal insufficiency with mental status changes, muscle weakness in extremities has what?
Mercury poisoning
103
ITP lab values are what in the following: PT PTT Bleeding time Plt count
Normal Normal Inc Dec
103
How do NSAIDs effect filtration fraction?
No effect bc they decrease RPF and GFR
104
What presents in neonates as a bulging blue domed, translucent membrane at the level of the vaginal introitus and can lead to urinary obstruction? Best way to image?
Imperforate hymen US
105
When is Persantine and regadenoson testing indicated? When is it contraindicated? If contraindicated, use what instead?
Baseline ECK is uninterpretable - LBB or paced rhythm COPD Dobutamine
106
What Grade of a study means that it is harmful without benefits for pts?
D
106
When can children sit in the front seat?
Older than 13
106
Leg length discrepancies of what value may be treated with an in-sole shoe lift?
< 2 cm
107
What is panax ginseng (Asian ginseng root) used to treat? MC SE?
ED/sexual dysfunction, T2DM, fatigue Inability to sleep
108
A pt is scheduled to undergo an appendectomy, during the procedure a previously unknown ovarian mass is noted and removed, what is this called?
Battery
108
What is more common, lateral or medial meniscus tears?
Medial by 3x as much
109
What is the MC type of vulvar cancer? Presents in whom?
SCC Post-menopausal women
109
Pt w/FUO, what are the most likely causes?
Collagen vascular disease (22%) Chronic infection (16%) Malignancy (7%)
109
What is the MC cause of jaundice w/in the first 24 hours of delivery? What is the rule for total bilirubin levels?
ABO incompatibility 5 mg/dL per 24 hours
109
Saw palmetto is used to treat what? SE’s?
BPH Mild - HA, nausea, dizziness
109
What bacteria is a lactose-negative, hydrogen sulfide-producing g(-) bacteria? Which similar bacteria does NOT produce hydrogen sulfide?
Salmonella enterica typhimurium Shigella dysenteriae
111
Pt with preeclampsia before 20 weeks, uterine enlargement, disproportional fundal height indicate what? Treat how?
Molar pregnancy Dilation and evacuation
112
What is the indication for a carotid endarterectomy?
Carotid stenosis of 70-99% If 100% occluded, NO benefit
113
What is the CSF like in FUNGAL meningitis? ``` Cell count? Cell type? Pressure? Glucose? Protein? ```
``` 10-100s cell count Lymphocyte predom Inc pressure Dec glucose Inc protein ```
114
What will the ristocetin assay be in vWF pts? Bernard-Soulier?
Low Normal
115
How do you treat bacterial meningitis d/t Grp B strep in a 5 day old infant?
Ampicillin + gentamicin OR Ampicillin + cefotaxime
116
After a fracture of the scaphoid has been treated, what is the best imaging to verify osseous union?
CT
117
Multiple myeloma can cause what type of RTA? What specific features? What effect on bicarbonate?
Type II - proximal Hypokalemia and acidic urine (< 5.5) Dec reapportion by the prox tubule
118
What is the MC allergen in the summer? Fall/winter?
Grass (rose fever) or trees Ragweed (hay fever)
119
What causes restrictive cardiomyopathy that is a result of eosinophil degranulation leading to cardiac necrosis and fibrosis?
Loaf flyer endocarditis
120
In 5-alpha-reductase deficiency what is the testosterone to DHT level? Present how?
Elevated testosterone DHT is reduced Ambiguous genitalia at birth
121
What is the treatment for tension pneumothorax?
Immediate needle decompression followed by tube thoracostomy
122
Lactulose MOA?
Broken down by ABD flora into lactic acid and organic acids Lactic acid lowers fecal pH which promotes the diffusion of ammonium into ammonia (NH3) into the lumen Also reduce amount of bacteria in colon
123
How to control ascites in alcoholics?
Diuretics and Na restriction
124
Pt has a confirmed osteosarcoma, what imaging should take place next?
CT chest —> 80% go to lungs
125
What is the non-surgical conservative treatment for Achilles’ tendon rupture?
Long-leg cast w/20 degrees of plantarflexion for 2 weeks, followed by progressive weight bearing and therapy
126
Physicians acting as Good Samaritans have immunity to what?
Ordinary negligence
127
What stool osmotic gap indicates a secretory diarrhea?
< 50 Think: 5 looks like a S, therefore —> secretory
128
Pt that has hematuria, polyuria, and BPH may have what? Further testing how?
Urinary bladder diverticulitis VCUG
129
What causes a progressive, systemic CT disorder that affects striated muscle fibers and affects pts bw ages of 50-70 and is more common among females than males? Describe the labs
polymyositis Inc CK, Inc aldolase, + anti-Jo-1 Ab
130
How to treat hyperthyroidism in pregnant pt in 1st trimester? 2nd and 3rd?
PTU Methimazole
131
Pt that is bit by a cat has fatigue and generalized body aches, what bug is it? Describe it (g+, g-, shape, etc) What is the normal treatment?
Pateurella G(-) bacillus Augmentin
132
What is the MC cause of IE?
Staph aureus
133
What is complex regional pain syndrome? How many stages?
Disorder of extremities characterized by pain, swelling, limited ROM, vasomotor instability, skin changes, patchy bone demineralization 3
134
What test is described by passively flexing the pt’s shoulder to 90 degrees then IR the shoulder? Specific for what?
O’Brien’s test Superior labral anterior to posterior tear
135
What is subclinical hyperthyroidism? Associated w/what risks?
Low TSH Normal T4 Normal total/free T3 AFib, dec bone mineral density
136
Hyperthyroid symptoms with hoarseness indicates what? Why?
Graves Goiter irritates RLN
137
Pt with hyperthyroid symptoms d/t post-viral inflammatory process has what? What happens later?
Subacute [graulomatous] thyroiditis (de Quervain’s) Becomes hypothyroid
138
What thyroid problems may occur 2-6 months postpartum? What else can cause it?
Thyrotoxicosis Infection, malignancy, hyperythyroidism
139
What is Plummer’s disease known as? Prevalence biggest in whom? What is seen on thyroid scan?
Toxic multi nodular goiter Older people w/decreased iodine Patchy uptake
140
Chapman point at the TP of T2 indicates what?
Thyroid pathology
141
Chapman point at proximal right thigh indicates what?
Crohn’s
142
Pt is taking prednisone long term for some health problems. He wants to do an elective GB removal. What should be done prior to surgery? Why?
Increase prednisone dose Pts on long-term steroids are at risk for Adrenal Insufficiency during times of stress (surgery)
143
What level evidence is the strongest? What kind of study has this evidence? Weakest? What kind of study?
1, randomized, controlled, double-blind 3, case report and case series
144
What is another name for smudge cells? Seen in what?
Ruptured cells CLL
145
Auer rods are seen in what?
AML
146
What presents MC in men > 55 w/Asx leukocytosis w/WBC > 50,000, HSM, anemia?
CLL
147
What is the DeBakey type 1?
Ascending aorta, arch, and descending thoracic aorta
148
What is the DeBakey type 2?
Ascending aorta ONLY
149
What is the DeBakey type 3a?
Descending thoracic aorta distal to Left subclavian artery and proximal to celiac artery
150
What is the DeBakey type 3b?
Thoracic and ABD aorta distal to left subclavian artery
151
Hemodynamically stable pt w/sustained VTach gets what?
Amiodarone
152
Pt w/hemodynamically stable SVT, what is 1st line treatment? If unstable?
Vagal maneuver, then adenosine synchronized cardioversion
153
Generally speaking, what is the order of treatment when there are multiple SD’s?
Correct thoracic vertebral SD 1st bc it can improve other dysfx
154
Varying degrees of microcytosis with abnormally large central pallor?
Fe def anemia
155
Erythrocyte with a central color spot in the area of pallor is what? Seen in what condition
Target cell Alpha-thalassemia
156
What conditions can cause acquired sideroblastic anemia?
Lead Drugs - INH, EtOH, chloramphenicol collagen vascular disease Neoplasm
157
What rbcs have a regular outline and lack central pallor? Can be seen in what condition?
Spherocytes AIHA
158
Within the carotid sheath, where does the IJV lie anatomically?
Lateral to the common carotid | Anterior to the vagus n.
159
How does a child w/mild dehydration present? How much approx volume loss? Best 1st treatment?
Slight dry mucous membranes 3-5% PO rehydration
160
How does moderate dehydration present in children? Approx how much volume loss?
Tachycardia, deep respirations, reduced skin turgor, irritability, sunken fontanelle, dec urine output 6-9%
161
How does severe dehydration present in children? Approx how much volume loss?
HoTN, cap refill > 3s, cool skin, lethargy, tachypnea > 10%
162
What causes normal exercise tolerance with ST segment elevation w/out evidence of MI seen on echo? What is the pathophysiology?
Prinzmetal aka variant angina Coronary artery vasospasm
163
Transient, monocular loss of vision lasting a few minutes followed by complete recovery is called what? Most often d/t what?
Amaurosis fugax Retinal emboli dislodged from i/L carotid a.
164
Pt that has kidney stones, what is V. Important that they do as an outpt?
Filter urine to analyze the stone
165
How do you set up the pt for reciprocal inhibition ME treatment?
Put the pt into their DIRECT barrier
166
Fall backward onto hand results in what SD? Fall forwards?
Anterior radial head Posterior radial head It is REVERSED
167
What tendons are irritated in DeQuervain’s tenosynovitis?
APL | EPB
168
Pt that is presenting with a large bowel obstruction, what is the MC cause?
Neoplasm
169
What is the best initial step in w/u of normal pressure hydrocephalus?
Non-Con CT
170
Young girl that presents w/precocious puberty that has a negative LH response on leuprolide stimulation test indicates what? Therefore need to do what to w/u?
Peripheral cause US ovaries and adrenals
171
Lithium use during pregnancy can cause what?
Ebstein anomaly - tricuspid leaflets do not close properly, leads to enlarged heart Tricuspid atresia
172
Pt has subacromial bursitis, what is the preferred treatment? Why?
Subacromial steroid injection over intra-articular Less bursal inflammation
173
What may present with pain over the acromion, that is poorly localized, and can be exacerbated by overhead activities and has a positive Neer’s and Hawkin’s test?
Subacromial bursitis
174
MC causes of duodenal ulcer?
H. Pylori infection | NSAID use
175
What is the best test used to diagnose CTS?
Phalen’s
176
Hypospadias is associated with what else?
#1 - chordee: ventral curvature of the penis Also, cryptorchidism and inguinal hernias
177
What is 1st line treatment for stable angina? Adjunct treatment?
Beta blockers CCBs
178
What is a congenital abnormality in a newborn that is a mass and is edematous, dark in color, and is covered by a gelatinous matrix of greenish material? Where is it located?
Gastrochisis LATERAL to midline
179
What child condition causes exopthalamos, macroglossia, gigantism, hyperinsulinemia, and hypoglycemia? What is else is associated with it? What is seen in utero?
Beckwith-Weidmann Omphalocele Polyhydramnios
180
What causes diarrhea and inability to extend the wrist in an adult pt? Treat with what?
Pb poisoning EDTA or dimercaptosuccinic acid
181
Young female that comes to the ED for passing out after standing for 2 hours and felt lightheaded, sweaty, and anxious is caused by what?
Vasovagal
182
What is another name for the Patrick test? Used for what?
FABERE Sacroilitis or OA of the hip
183
What is a result of severe hypothyroidism leading to AMS, hypothermia, respiratory depression, bradycardia, HoTN, hyponatremia, and hypoglycemia? Need to check what else? Treat how?
Myxedema coma Serum cortisol to check for co-existing A.I. IV thyroxine (T4) and hydrocortisone
184
What is a sclerosing lesion of the breast that may mimic malignancy on mammography?
Radial scar
185
What is a hereditary form of glomerularnephritis that shows BM splitting on electron microscopy? Presents w/how much proteinuria a day?
Alport syndrome < 3.5 g/day as with ALL nephritic syndrome
186
Malignant hyperthermia is d/t what drug? What mechanism?
Succinylcholine Massive influx of intracellular Ca levels and a hypermetabolic state
187
What is the MC compulsion in OCD?
Repetitive washing (60%)
188
Pt that has SVT and is unconscious and unstable, treat how?
Synchronized cardioversion withOUT sedation
189
What type of Salter-Harris fracture is described through the growth plate (physis)? Also called what? What is spared?
Type 3 Tillaux fracture Metaphysis
190
What is the mneomnic for Salter-Harris fractures? Describe each 1
SALTR - slipped, above, lower, through, ruined 1 - slipped (growth plate) 2 - fracture extends ABOVE the physeal plate, involves the metaphysis 3 - through the growth plate and epiphysis, spares metaphysis 4 - through growth plate (physis), metaphysis, and epiphysis 5 - complete crush injury of all 3
191
What is the MC site of vaginal injury in a sexual assault victim?
Posterior fourchette
192
Pt in asystole is given epinephrine and is check 3 minutes later, what should be given this time?
1 mg of Epi every 3-5 minutes
193
What special fracture involves fractures of the maxilla, nasal bones, and medial aspects of the orbits?
Le Fort II
194
What special fracture involves only the maxilla at the level of the nasal fossa d/t direct blow or impact?
Le Fort I
195
What is a complete craniofacial disjunction that involves the maxilla, zygoma, nasal bones and bones fo the cranial base, midface will be “floating”?
Le Fort III
196
What is the most important criteria to monitor for determining replacement fluids in burn victims? What is the goal?
Urine output .5 mL/kg/hour
197
Pt that has Right-sided torticollis will present how? Why?
SB to right > SB to left Rotation Left > Rotation Right SCM SBs towards, Rotates AWAY Spasm of Right SCM will SB towards more and rotate away more
198
What is the parkland formula?
%BSA x weight (kg) x 4 = mL fluid over 24 hours
199
Hypotonia, decreased activity, macroglossia, and umbilical hernia indicate what? Can lead to what?
Hypothyroidism Mental retard
200
How does supination of the foot cause the fibular head to move?
Posteriorly
201
How do you treat an anterior fibular head with HVLA?
Thenar eminence placed over anterior aspect of proximal fibula, Thrust anterior to posterior
202
What is an osteochondral defect in the 2nd metatarsal head?
Frieberg’s infraction
203
What involves osteonecrosis of the tarsal navicular, presents in childhood?
Kohler’s disease
204
What involves osteochondrosis of the capitellum, common in little league baseballers?
Panner’s disease
205
What involves osteochondrosis at the insertion of the Achilles’ tendon on the calcaneal tuberosity, seen during rapid growth in the young?
Sever’s disease
206
What involves AVN and collapse of the lunate, common with repetitive compressive loading of wrist?
Kienbock’s disease
207
What can be taken to prevent uric acid stone formation? MOA?
Potassium citrate Alkalinzes the urine
208
What is the preferrred treatment for cutaneous larva migrans?
Thiabendazole
209
Young smoker w/“asthma attack” and family history of liver disease has what?
Alpha 1 anti-trypsin
210
What has broad staph, strep and enterococcus coverage?
Cephalexin
211
How do you set up a pt for Spuhrling’s maneuver?
SB and extend towards the affected side
212
30 year old woman that complains of pelvic pain, pain with intercourse, and pain during menses that radiates to her rectum has what?
Endometriosis
213
What is the treatment for chancroid?
``` 1 PD dose azithromycin 1 IM dose cetriaxone 1 week of erythromycin OR 3 days of Cipro ```
214
What is Chadwick’s sign? What is Goodell’s sign? Ladin’s sign?
Blue discoloration of cervix and vagina —> pregnancy Softening of vaginal portion of cervix Softening at junction of cervix and uterus
215
What is characterized by a rigid thoracic kyphosis, vertebral wedging, and degenerative end plates? Treat how?
Scheuermann disease PT and OMT
216
What does genu recurvatum mean?
Hyperextension of the knee PAST 0 degrees
217
Normal Q angle is what? Greater than normal indicates what?
14-17 degrees Genu Valgum
218
How much weight should a underweight pregnant pt gain? What BMI is underweight? Normal weight? What BMI? Overweight? What BMI Obese? What BMI?
28-40 lbs, < 18.5 25-35 lbs, 18.5 to 24.9 15-25 lbs, 25-29.9 11-20 lbs, > 30
219
What lab value is commonly elevated in pts with HIV and PCJ infection?
LDH
220
What nerves innervate the hamstring muscles?
Common fibular (short head of biceps femoris ONLY) and tibial branches of the sciatic nerve
221
Ankle plantarflexion effects the fibular head how?
Posterior fibular head | Occurs w/supination of foot
222
How are Anterior tenderpoints treated with counterstrain? Posterior?
Flexion, SB towards lesion Extension, SB away from lesion
223
What medicine can cause hypomagnesemia? What are KEY symptoms to make a diagnosis?
Mycophenolate Loops Thiazides PPIs Vomiting and diarrhea
224
How can you treat hypomagnesemia? Treatment based on what?
IV magnesium sulfate or PO magnesium oxide Severity of symptoms like tetany, seizure, cardiac abnormalities, hemodynamic instability
225
Pt with coffee ground emesis has an EGD that shows multiple duodenal ulcers, what must you rule out? If Gastric ulcers?
H pylori and NSAID use Cancer
226
Pt presents w/neutropenic fever and possible source of infection, what drugs to use? If it has been 3-5 days add what?
Vanc and Ceftazidime (or cefepime) Antifungals - fluconazole
227
What are the 2 MC sources of infection in neutropenic fever? What organisms?
G+ skin flora and G- enteric flora Staph epidermidis
228
Where is the high ilium tenderpoint? How to treat with counterstrain?
1.5 inches lateral to PSIS Pt prone, dr on side of dysfx, Hip extended and leg ER
229
What is a well-defined Hypoechoic mass on US in the scrotum of young male? What lab value?
Seminoma - germ cell tumor High hCG (in the 100’s)
230
What presents as a Non-homogeneous testicular mass w/calcifications, cystic areas, and insisting margins? What lab value?
Choriocarcinoma hCG in the 1000s
231
What Chapman point is located on the left proximal femur?
Sigmoid colon
232
Pt that has a posterior urethral injury that cannot void and has lower ABD pain should be managed how?
Placement of suprapubic catheter Fix the injury weeks to months after stabilization
233
What is the treatment for a black widow spider bite?
Anti venom Apparently calcium gluconate is no longer used?
234
Pt that has difficulty carrying out ADLs and path exam shows has brain clusters of round, dense cells w/eosinophilia core surrounded by a clear halo has what?
Lewy body dementia
235
Leukoaraiosis is another term for what? Seen in what disease?
White matter disease Vascular dementia
236
Well-defined solid mass of the breast in a woman 15-35 indicates what? Need to do what? Can appear during what?
Fibroadenoma Core needle biopsy Pregnancy
237
How to decrease intensity of HOCM?
Beta blocker
238
How do you treat anatomical short leg with heel lift in an old pt? How to increase, what is the goal? Young pt? What is the goal?
1.5mm (1/16’’) Increase q2 weeks by 1.5mm until full distance reached 3.2mm (1/8’’) Increase by 3.2mm until 1/2 to 3/4 distance reached
239
When is daytime incontinence achieved in children?
85% at 30 months | 98% at 36 months
240
What is vitamin B2? Symptoms of deficiency?
Riboflavin Corneal vascularization and cheilosis
241
B1 deficiency occurs MC in whom? Causes what sx?
Alcoholics and those malnourished (refugees) Wernicke-Korsakoff, dry beriberi (muscle wasting and neuritis), wet beriberi (dilated cardiomyopathy and edema)
242
What does wet beriberi cause? D/t what?
Dilated cardiomyopathy and edema B1 def
243
What does Dry beriberi cause? D/t what?
Muscle wasting and neuritis B1 def
244
Encephalopathy, ophthalmoplegia and ataxia indicate what? D/t what
Wernicke’s encephalopathy B1 - thiamine deficiency
245
Pt with pain in the shoulder after being kicked in the chest has referred pain from what?
Phrenic nerve
246
Infant born w/respiratory distress and CXR that shows b/L patchy opacities has what? What is a RF? Baby at risk for what?
Meconium aspiration syndrome Post term pregnancy Persistent pulmonary HTN
247
Maternal HTN carries what risks for baby?
Placental abruption | IUGR
248
6 week pregnant pt is exposed to lumbar xray, what is the risk to the fetus?
Low to No risk
249
What Cobb angle indicates scoliosis? What Cobb angle should OMT/PT be used?
> 10 degrees 10-20 degrees
250
When should spinal bracing be used for scoliosis pts? Surgery?
20-45 degrees > 45 degrees
251
Decreased pulmonary VC may develop in pts w/Cobb angle greater than what?
60 degrees
252
What are the MC etiologies of SAH?
Rupture of berry aneurysm | AV malformation
253
What are the MC cause of pyogenic liver abscesses?
Polymicrobial - mixed enteric facultative and anaerobic species
254
Pt that is anxious and on multiple meds that presents w/ataxia, vertigo, fatigue, HA, insomnia, irritability, nausea, tremor, vomiting has what?
Discontinuation syndrome from SSRI —> look for paroxetine
255
Pt with elevated LFTs appearing 8 weeks following exposure to HepB is in what stage? What are his HepB serology markers?
Active infection HBsAg + HBeAg + anti-HBc (IgM)
256
What is the HepB serology of a pt w/chronic infection and a high circulating viral load?
HBsAg + anti-HBc (IgG)
257
What is the HepB serology of a pt in the window period? How long is the window period?
Anti-HBc (IgM) ONLY 6 months
258
How do you diagnose DDH in baby?
Under 2 weeks wait until 2 weeks or older 2 weeks - 4 months: US of hip After 4-6 months - plan xray
259
Alpha angle < 60 degrees indicates what?
DDH in baby, find out in US
260
Inversion ankle sprain causes what kind of cuboid dysfunction? Treat with HVLA how?
IR (dropped) cuboid ER
261
How does handgrip effect the intensity of MR?
Increases
262
Shaken baby syndrome presents w/what eye symptoms?
Vitreous/retinal hemorrhages
263
What is the best study to order if you suspect child abuse?
Skeletal survey
264
Gout has what kind of aspirate (watery or purulent)? Birefringence? Shape? Wbc?
Watery Negatively, needle-shaped Wbc < 50,000
265
PseudoGout has what kind of aspirate (watery or purulent) Birefringence? Shape? Wbc?
Watery Positively, rhomboid-shaped < 50,000
266
Septic arthritis has what kind of aspirate (watery or purulent) Birefringence? Shape? Wbc?
Purulent No crystals > 50,000
267
Elderly male that presents w/symptoms of urinary outlet obstruction, PSA > 10 and/or abnormal prostate exam should have what?
TRUS - transrectal ultrasound guided biopsy
268
What is the treatment for Fe def anemia? Where will it be absorbed?
PO ferrous iron DMT-1 in the duodenum
269
Injecting a steroid into the subacromial space via what method?
Inferior to posterolateral edge of the acromion and direct it medially
270
How do you inject a steroid into the AC joint?
Insert needle superior to Anterolateral edge of the acromion, angled perpendicularly to junction of acromion and distal clavicle
271
Which vein in the LE has the highest potential for embolism to cause a PE?
Femoral Most proximal have highest probability
272
Pts w/neutropenic fever must be covered for what organism? If fever persists for several days to even week, what must be done?
Pseudomonas Add broad spectrum anti-fungal - amphotericin B
273
Rai staging used for what? What is stage 0? 1? 2?
CLL Lymphcytosis >15 x 10^9 Lymphocytosis + LAD Lymphocytosis + SM
274
Rai stage 3 means what? 4?
lymphocytosis + anemia Lymphocytosis + low platelets
275
Giant cells w/bilobular nuclei and eosinophilic nucleoli are what? Seen in what?
RS cells Hodgkin’s disease
276
Plasma cells w/fried egg appearance indicates what? PAS staining IgM deposits around nucleus of plasma cells means what?
Multiple myeloma Dutcher bodies - seen in Waldenstrom’s
277
What are the attachment sites of the dura?
Foramen magnum C2, C3 S2
278
Any medical device failure or malfunction needs to be reported to whom?
FDA
279
Hypoechoic findings on US mean what?
Dark area - suspicious for malignancy
280
What is the Apprehension test? Tests for what?
Shoulder goes into Extension, ABduction, External rotation Shoulder dislocation
281
Baby has trouble latching, what CN should treatment be directed at?
CN 12
282
PTT that is prolonged but corrects w/mixing study means what? Describe mixing study
Hemophilia A Add clotting factors to the blood and then it works
283
Ankylosing spondylitis will show what on xray? | What are they?
Syndesmophytes | Calcifications/heterotopic ossification in the interspinal ligaments or annulus fibrosis
284
What is described by an encapsulated, well circumscribed mass w/central necrosis and calcifications on CT in a pt w/RUQ pain? Assoc w/what?
Hepatic adenoma OCPs and anabolic steroids
285
What bones form the pterion?
``` TPSF Temporal Parietal Sphenoid Frontal ```
286
V-spread technique is OMT used to treat what?
Compression or misalignment of cranial suture
287
According to D.O.’s, what is the pathophyisology behind Migraines?
Trigeminovascular system No longer vasoconstriction
288
What meds can prophlyactically treat migraines?
``` Propanolol Verapamil Amitriptyline Valproic acid Venlafaxine Topiramate ```
289
What do you do if you think a pt would be a good organ donor candidate?
Contact the organ donor network regarding the situation
290
What is the MC organism responsible for necrotizing fasciitis?
Grp A Strep (strep pyogenes)
291
Lateral strain pattern occurs on what axis?
2 vertical axis
292
Torsional strain pattern occurs on what axis?
A-P
293
27 year old woman awoke 1 morning and found peripheral vision decreased, 2 days later she has blurry vision, fundoscopic exam shows pale optic discs bilaterally, diagnosis? Treatment?
Optic neuritis Admit and start IV methyl Prednisonolone
294
USPSTF recommends all women ages 15-45 take what supplement no matter what?
Folic acid
295
+ anti-smooth muscle antibodies indicates what?
Autoimmune hepatitis
296
T10-T11 has VS reflexes?
Ovaries, testes | Right colon
297
What is the VS reflex levels for a pt w/endometriosis?
T10-11 Bc it is the ovaries
298
Pt that has trouble falling asleep, what drugs are 1st line? Pt that cannot stay asleep after falling asleep, what med to use?
Zolpidem Zaleplon Triazolam Benzo
299
What do the iron studies show in alpha thalassemia?
Normal to high ferritin | Normal to low TIBC
300
Premature ovarian failure has what values of: FSH? LH? FSH to LH ratio?
inc Inc FSH > LH
301
Where do carcinoid tumors arise from?
Neuroendocrine cells from the appendix and terminal ileum (small intestine)
302
What is the main difference between dermatomyositis and polymyositis?
Dermatomyositis has Grottron papules and Heliotrope rash It has SKIN manifestation Dermatomyositis involves the DERMIS
303
Unilateral Sacral flexion dysfunction, what will the sacral sulcus be on the involved side? ILA?
Deep Inferior
304
Unilateral Sacral extension dysfunction, what will the sacral sulcus be on the involved side? ILA?
Shallow Superior
305
Left u/L sacral flexion dysfunction, describe how you move What findings for the sacral sulci? ILA?
SB to the left Then look/flex to your RIGHT —> it is OPPOSITE Right sulci will be shallow Left ILA will be shallow
306
Right u/L sacral flexion dysfunction, describe how you move What findings for the sacral sulci? ILA?
SB Right, then Look/turn to the LEFT —> IT is OPPOSITE!!! Left sacral sulci will be shallow right ILA shallow
307
Premature ovarian failure, what are the levels of FSH and LH usually?
FSH > 40 | LH > 25
308
Dermatomyositis is associated w/what lab values? What other thing is it associated with?
Inc CPK, aldolase, LDH Anti-Jo1, anti-Mi2 15% inc in MALIGNANCY
309
Pt has AC joint pain. When pt shrugs his shoulders the proximal clavicle remains cephalad, this indicates what dysfunction?
ADDuction dysfunction Prox clavicle moves caudad when shrugging (ABducting) and moves cephalad when ADDucting
310
Pt w/bacterial meningitis gets treated with what if they over 50?
Ampicillin for Listeria Also steroids help in general
311
How do you treat fibromyalgia with OMT?
Counterstrain
312
What is the treatment for Sjogren syndrome?
Pilocarpine
313
Pt w/anteriomedial tibial knee pain and plays soccer has what?
Pes anserine bursitis
314
What is the preprandial glucose goal? Postprandial?
90-130 < 180
315
1 hour GTT greater than what needs 3 hour test? 3 hour test values of what indicate Gestational diabetes? 1st line therapy?
> 140 Any 2 of the following: Fasting > 95, 1 hour > 180, 2 hour > 155, 3 hour > 140 Diet and exercise
316
What presents with intracranial calcifications, hydrocephaly, chorioretinitis in a baby?
Toxo
317
What muscles insert at the anteromedial aspect of the tibia? Pain at this location is called what?
Gracilis, sartorius, semitendinosus Pes anserine bursitis
318
Pain on single-leg hop and when a tuning fork is placed over the leg in the distal 1/3 of the tibia indicates what?
Medial tibial stress syndrome - shin splints
319
What is the most effective treatment of post-rural puncture HAs?
Epidural blood patches - slows CSF leak
320
Pt that takes multiple medications for COPD and then develops Cushing’s like syndrome, what is the reason?
NOT smoking apparently Most likely iatrogenic - from prednisone use
321
How do you treat a posterior radial head with HVLA?
Arm in extension, supination, Anterior thrust
322
Anterior radial head dysfunction, what is the set up for HVLA?
Pronate arm, flex it and push anterior to POSTERIOR on radial head 24:55 on Elbow/wrist/hand tx OS2
323
Wermer syndrome is what?
MEN I
324
Pt that eats a normal balanced diet but vomits or skips meals when they feel fat has what?
Other specified feeding and eating disorder
325
Pt w/PMHx of a ventral hernia that is hemodynamically stable with several week history of possible bowel obstruction has what?
Chronically incarcerated ventral hernia NOT an EMERGENCY
326
Pt that has a supracervical hysterectomy needs what kind of Cervical cancer screening?
Women aged 30-65 Need: HPV + cytology q5 years Or Cytology alone q3 years
327
Symptomatic hemorrhoids are 1st treated with what? If it doesn’t work then what?
Rubber band ligation - nonsurgical Hemorrhoidectomy
328
CEA tumor marker elevated in what? CA-125?
Colon cancer Ovarian
329
What is the initial test for M.G.?
ACh-R antibody test
330
What is the only established risk factor for the development of Acne?
Family history
331
Acne with comedones that does not respond to benzoyl peroxide, what is the next step up in treatment? If that doesn’t work then what? Finally what?
Topical retinoids PO Abx PO isotretinoin
332
What is the translocation for Burkett Lymphoma?
8;14 c-myc
333
Tenderpoint for psoas syndrome located where? How to treat with counterstrain?
Medial to ASIS Hip flexed, External rotation
334
What qualifies as Severe pre-eclampsia?
BP > 160/110 | Proteinuria > 5 g
335
What qualifies as mild preeclampsia?
BP > 140/90 | Proteinuria > 300 mg
336
9 year old presents w/HA, fever, blanching rash and trace pedal edema after a summer camping trip has what?
RMSF
337
Which test is the most sensitive for diagnosis of DMD?
Serum CK
338
Distributive shock is a term used to describe which shock states?
Septic Anaphylactic Neurogenic
339
Pt that has bitter almond smelling breath has what poisoning? Treated how?
Cyanide Thiosulfate + amyl nitrate
340
What labs do you order in the initial evaluation of HTN?
``` EKG BMP CBC UA Lipid panel ```
341
What parts of the body drain to the right lymphatic duct? The right lymphatic duct then drains to where?
R side of H+N, R UE, heart, and portion of the lungs Junction of R IJV and R subclavian vein
342
Pt in DKA needs IV NS + KCl in what conditions?
K+ level is < 5.3
343
Renal biopsy that shows segmental solidification of the glomerular capillary tufts, particularly in the perihilar regions indicates what? Part of what renal syndrome? If present in a child, what are they at higher risk for? What should they get?
FSGS Nephrotic syndrome Encapsulated organism infection - S pneumo infections PPV23 vaccine
344
What is Burnett syndrome? Caused by what? What changes can it cause on EKG?
Milk-alkali syndrome Too much Calcium intake QT interval shortening, J wave
345
How do you treat Severe Milk-alkali Syndrome with Ca levels > 14?
Intranasal calcitonin | Bisphosphonates
346
Pt w/opioid dependence in pregnancy should be treated how?
Methadone
347
What measurements can be used by US to assess a gestational age?
Biparietal diameter ABD circumference Crown-rump length Femur length
348
In menopause, what is increased more, FSH or LH?
FSH
349
What is the most useful INITIAL method for detecting semen in a sexual assault victim?
Wood’s lamp
350
What kind of STEMI presents w/ST depression and R-waves in leads V1-V3?
Posterior
351
Posterior MI presents how?
ST Depression (reciprocal ST elevation) and R waves (reciprocal Q waves) in leads V1-V3
352
Infarction of what artery causes posterior MI? Comes off what?
Posterior descending coronary a. RCA
353
Occlusion of which artery causes an inferior MI?
RCA
354
Occlusion of the RCA will produce infarction where?
RV inferior wall Posterior wall
355
Lateral or posterior infarction is d/t occlusion of which artery? Is a branch off what?
Circumflex Left main coronary
356
What tender point is located inferior or inferolateral tip of C2 spinous process? Treatment position?
PC3 inion F SARA —> Maverickk point
357
What presents as a painless nodule near the MCP joint and can cause locking or catching of the digits?
Trigger finger
358
What gestational age can the uterine fundus be palpated at the level of the umbilicus? Halfway bw pubic symphysis and umbilicus?
20 weeks 16 weeks
359
What defines severe sepsis?
Sepsis + organ dysfunction (elevated BUN/Cr), hypoperfusion or HoTN
360
Elevated PO4 levels can lead to what? What can happen?
Decreased Ca levels bc PO4- binds to phosphate Fracture d/t inc PTH secretion which causes inc bone resorption by osteoclasts in an effort to increase Ca
361
What is the SALTR mnemonic?
Slipped growth plate Above - fracture above plate to involve Metaphysis Lower - fracture extends lower to involve epiphysis Through - through the metaphysis, physis, epiphysis Ruined - complete crush
362
Lateral epicondyltitis occurs d/t microscopic tearing of what muscle?
Extensor Carpi radialis brevis
363
JNC says pts 60 years and older is what?
< 150/90
364
Pt that has symptoms of heart failure with very little physical activity is what NYHA class?
3
365
what is the rule of 9s for kids?
Front of head is 9%, back is 9% for total of 18% (normal for adults is the TOTAL head = 9%) Each leg is 7% in front and back vs normal 9% for adults
366
Tetany, hyperreflexia, and cardiac dysrhythmias indicate what electrolyte abnormality?
Hypomagnesemia
367
What are the mechanics of the AO joint?
SB and rotation are always OPPOSITE
368
Dull aching scrotal pain w/dec fertility, a sensation of scrotal fullness,and palpable testicular mass that does not trans illuminate indicates what?
Varicocele
369
What presents w/normal TSH, elevated total T4, normal free T3?
Euthyroid hyperthyroxinemia
370
What presents w/low TSH, normal free T4 and normal T3?
Subclinical hyperthyroidism
371
What is the 1st step in management when you cannot visualize the string of an IUD? What is next?
US Flat plate ABD xray
372
What is a fracture at the base of the thumb or 1st metacarpal extending into the intra-articulate space called?
Bennet’s fracture
373
What is the Pap smear guidelines for women 21-29? 30-65?
Q3 years Q3 years w/cytology or q5 years w/cytology and HPV
374
Adverse reaction to a vaccine would occur when? If there is one, where do you report it?
Within 7 days from vaccination Vaccine Adverse event reporting system
375
Which kidney has a longer renal vein?
Left
376
What lab values correlate with disease severity in SLE?
Decrease in complement
377
How should a thoracic aortic aneurysm be followed if it is 4-5cm?
Q6 months w/contrast CT
378
What entity holds information about physician malpractice, licensure and negative actions against drs?
National Practioner Data Bank
379
What is the MC neurologic deficit of untreated bacterial meningitis?
Hearing loss
380
What is the best initial treatment of Legg-Calve-Perthes disease?
Bracing w/partial weight-bearing If that fails then surgery
381
Pt has received 1.5 L over 3 hours in the ER and the Pt is 60kg and has 45% of his body burned, how much total fluid should he receive in 24 hours? How much of that volume should be given in the 1st 8 hours? How much in the next 16? How much in the next 16 hours?
10,800 mL 5,400: but he already got 1,500 so he needs 3,900 more over 5 hours which is 780!! 5,400 mL / 16 = 337 mL/hr
382
Pt w/sickle cell and suspected acute chest syndrome, what is the 1st step in workup? What normally causes ACS?
CXR Fat or bone marrow embolus
383
What is the most accurate test to diagnose cholecystitis?
HIDA scan
384
What is the best initial treatment for symptomatic hypocalcemia?
IV calcium gluconate
385
1st line prophylaxis for traveler’s diarrhea is what?
Ciprofloxacin
386
VS level of adrenals? Uterus? Prostate?
T8-10 T12-L2 T12-L2
387
Pt that has decreased mentation, delirium, HA, weakness and slurred speech w/hypothermia, dilated pupils, and reduced RR has what?
Benzo overdose
388
At what level does Hyponatremia causes seizures? Symptomatic when?
< 115 < 125
389
What is a benign, self-limited derm condition that presents as an itchy papular rash over the trunk, often triggered by sun exposure, MC seen in middle aged men?
Grover disease aka transient acantholytic dermatosis
390
What is an AD disease that presents w/vesicular lesions and crusting erythematous plaques over intertriginous areas like the genitals, inguinal area, neck, axilla, etc?
Familial benign pemphigus (Hailey-Hailey disease)
391
PCT is d/t def of what enzyme?
Uroporphyrinogen decarboxylase
392
What congenital brain malformation presents w/absent or dysplastic cerebellar vermis and cystic dilation of the 4th ventricle?
Dandy Walker
393
Sjogren’s has what Abs?
Anti-Ro/SSA | Anti-La/SSB
394
Describe an inevitable abortion
Dilated os NO expelled products NO rupture of membranes
395
What is the most accurate test for ZE syndrome?
Secretin stim test
396
How do you diagnose DM with a 2 hour GTT?
> 200 with or without symptoms
397
Severe c diff should be treated how? What indicates severe?
PO Vanc Age > 60, temp > 38.3, albumin < 2.5 ICU admin, pseudomembranous colitis
398
Pt is having inferior wall MI as evidenced by EKG, what is the next best step?
Put EKG leads on right side...LOL
399
HIV pt w/odynophagia and multiple linear, shallow to deep ulcers has what?
CMV
400
How is status epilepticus treated initially? If this fails then what? 3rd line treatment? If after 30 minutes still nothing?
Benzo 2nd round of Benzo Fosphenytoin Propofol or midazolam and incubate Finally phenobarbital
401
How do you treat tenderpoints w/counterstrain if they are all EQUALLY tender?
Treat the 1 in the middle 1st and work proximally to distally
402
Pts w/ADHD are increased risk of developing what as an adult?
Antisocial personality disorder
403
What kind of HIV esophagitis presents w/round and ovoid ulcers w/vesicles?
HSV
404
In DKA management, when do you switch to subQ insulin?
AG closed, 2 hours before insulin drip is stopped
405
Episodic tachycaria, HA, diaphoresis and HTN is what?
Pheochromocytoma
406
What presents w/ABD pain, irritability, wrist/ankle drop and dense metaphyseal lines on joints?
Lead poisoning
407
What lab should be ordered in suspected lead poisoning?
Free erythrocytes protoporhyrin level or serum blood level
408
What EKG findings for print metal angina?
Transient ST elevation - d/t vasospasm
409
Posterior costal tender points are associated w/what kind of somatic dysfunction?
Inhalation (elevated ribs)
410
What presents in a 40 y/o male w/sudden death and EKG shows ST elevation in V1-V3 w/RBBB, and terminal S waves in the lateral leads? Look for what in the history?
Brugada syndrome ASIAN man
411
Pt w/unprovoked VTE w/unknown secondary cause should be on anticoagulation for how long? If d/t surgery or trauma or immobility?
INDEFINITELY 3-6 months
412
What presents as an allergy to a drug w/asthma, chronic rhinosinusitus, congestion, b/L nasal polyps?
ASA allergy
413
Herniation bw L4 and L5 what nerve root is compressed?
L5
414
Herniation bw L5 and S1 what nerve root is compressed?
S1
415
Herniation bw L3 and L4 what nerve root is compressed?
L4
416
Ribs 1-5 exhalation Dysfunction presents how?
Narrowing of the intercostal space below the dysfunction ANTERIORLY
417
Innominate rotation occurs which sacral axis?
Inferior transverse
418
What muscle group is used in the treatment of anterior inominate rotation?
Hamstrings
419
What muscle group is used in the treatment of posterior inominate rotation?
Quads
420
Pt has a 1st degree relative that got colon cancer at age 46, when should he get a colonoscopy? How often after that?
Age 36 Q5 years
421
ICU pt that is having RUQ pain and US shows bile sludge, pericholecystic fluid and thickened gallbladder walls has what?
Acalculous cholecystitis
422
Bishop score of what level or higher indicates a favorable delivery? Highest score possible?
9 13
423
Bishop score of 5-9 indicates what? Should do what?
10% chance of failure Augment w/oxytocin
424
How does viral conjuctivitis present?
Preauricular LAD w/red watery eyes
425
When is a bronchodilator challenge diagnostic? If it is not, next step?
FEV1 increases by 200 mL or 12% Methacholine challenge
426
Age 2 months what should a baby do?
Lift their head when prone, coo, track sounds, smile
427
Baby comes in for a visit, it can roll front to back, grasp a rattle and orient to voice and laugh, how old?
4 months
428
What does a DEEP posterior transverse process on the left mean?
Pt is rotated RIGHT Bc there is a hard end feel on the right
429
Make sure to look at what the question is asking —> “where the patient is CONTRACTING towards”
That’s it
430
What is classified as elevated BP?
120-129 / 80-89
431
What viruses MC cause onset of T1DM DKA?
``` #1 Coxsackie B But also rotavirus, mumps, CMV ```
432
What is a collection of blood in the anterior chamber of the eye? Occurs MC in what?
Hyphema Blunt trauma to the eye
433
What occurs d/t rupture of a small ocular vessel in the eye? Resolves when?
Subconjuctival hemorrhage 7-10 days w/no treatment
434
GFR lower than what level is an ABSOLUTE contraindication to using metformin for T2DM pts?
< 30
435
Pt that has cocaine-induced chest pain, what is 1st line treatment? What is CONTRAINDICATED?
Benzos BBlockers
436
Brochiolitis occurs in what age group?
Under 2 years old RSV —> NO stridor
437
What will you see on xray in a pt w/croup?
Steeple sign aka SUBglottic narrowing
438
1st line choice for priapism?
Intracavernosal phenylephrine
439
Large giant cells w/a multinucleated or bilobed nucleus are what?
Reed Sternberg cells
440
ARDS mainly has what clinical feature?
Pulmonary edema
441
Washed out appearance to bone and cortical thinning mean what? Seen in what?
Dec bone mineral density Osteopenia/osteoporosis
442
Chondromalacia is seen in what?
Overuse, degeneration of articular cartilage in the knee joint
443
What is Cushing Triad? Physiologic response to what? Can imply what?
Systolic HTN, bradycardia, Irregular respirations Increased ICP Impending brain herniation
444
Pt w/multiple myeloma can develop what heart problem? Manifests how physiologically?
Cardiac amyloidosis Restrictive cardiomyopathy causing constrictive HF —> dec SV
445
What test is the best to assess fetal limb development and cardiac function?
Level II US
446
Pt has psoas syndrome, how will the upper lumbar SDs appear? What muscle does it commonly cause SD to on the opposite side?
Flexed, SB, rotated to side of hypertonic psoas Piriformis muscle
447
Pt that has a stroke of the ACA will have what symptoms?
c/L LE weakness, incontinence and personality changes
448
ADHD is commonly associated with what other disorders?
Conduct Tourette’s Oppositional defiant disorder
449
Rash that starts on the face and moves downwards w/cold symptoms = ? What can decrease mortality?
Rubeola aka measles Vit A
450
Describe roseola
Fever for 4 days, then a rash that SPARES the face in kids 6mo - 2 years
451
Pt that has scoliosis on the right, what does the T-spine do to compensate?
Rotation to the right and SB to the left
452
How long of a washout period do you need to go from MAOI to SSRI?
14 days
453
Pt w/ESRD that is having parenthesis, muscle cramps and weakness but no EKG changes still needs what treatment?
Calcium gluconate
454
What is the empiric treatment of CAP in the outpt setting in a healthy person?
Macrolide or Doxycycline
455
Pt is 17 w/no period, US shows a uterus, FSH is high, what is next step? If FSH is low?
Karyotype TSH, prolactin
456
How to tell the difference bw EBV pharyngitis and gonococcal?
EBV has TENDER cervical LAD
457
What is the rule of 3s for SP?
``` T1-3 SP at level of corr vert T4-6 1/2 below T7-9 1 level below T10 1 level below T11 1/2 T12 at level ```
458
What is Homan’s sign?
Pain w/Dorsiflexion of the foot
459
What must be done to terminate a relationship with a pt?
Certified letter in the mail, has to have reason and effective date (30 days), list interim care providers and closest ER
460
Apley scratch test used to evaluate what?
Rotator cuff muscles
461
What nerve root is the biceps? What sensation aka dermatome structure?
C5 Deltoid
462
What nerve root is the bracioradialis reflex? What dermatome?
C6 Lateral forearm, 1st 2 digits
463
Pt w/FUO for over a week, HA and visual disturbances w/failure to make a Dx has what?
Temporal arteritis
464
What nerve supplies supraspinatus muscle?
Suprascapular
465
HIV pt w/fever, watery diarrhea, RUQ pain, fatigue, weight loss and clear lungs has what?
Disseminated MAC
466
What is Preh’s sign? + sign indicates what?
Pain relief when lifting the affected testicle Epididymitis
467
Tightness of the calf muscle results in what SD?
Dorsiflexion restriction at the ankle
468
How do you treat pubic lice?
Permethrin
469
Pt is 10 weeks pregnant and stable and has an IUD in place, what is the best next step?
Pull out it in the office If over 12 weeks leave it in
470
DLCO in pts w/COPD is what? Asthma?
Decreased Normal/increased
471
Central cyanosis and respiratory distress in a 3 month old baby w/Down syndrome is d/t what?
VSD causing Eisenmenger’s syndrome R —> L shunting of blood
472
Preterm labor risk can be assessed w/what test when a woman is 22-34 weeks gestation?
Fetal fibronectin
473
What is 1st line treatment for tinea versicolor?
Ketoconazole 2% cream
474
Mammography that presents w/a smooth, large, polylobulated mass is what? Treat how?
Phyllodes tumor Wide local excision
475
Fryette’s principle states that concavity of the curve is what?
On the side of Side-bending
476
How do you treat hot flashes (vasomotor sx)?
HRT - estrogen and progesterone
477
MC SE of SERMs?
Hot flashes
478
What is ethacrynic acid? Used for what?
Loop BP control in pt w/sulfa allergy
479
Pt w/vWD will have what abnormal lab value? Why?
Inc PTT vWF protects Factor 8 from degradation
480
Pt has posterior inominate rotation, what muscle is isometrically contracted to treat this?
Rectus femoris Just think about it. If you have tight hamstrings they will pull the inominate back into a posterior rotation. To treat this, activate the front muscles (quads)
481
Classic symptoms of polymyalgia rheumatica? Lab values?
Pain and stiffness in shoulder and pelvic girdle Inc ESR
482
What does cryoprecipitate contain? Used for what?
Factor 8, 13, vWF, fibrinogen Needs FFP but volume overloaded or fibrinogen < 1
483
PAS staining IgM deposits around the nucleus of plasma cells are consistent w/what?
Waldenstrom’s
484
Pt w/diaper rash has what? Treat how?
Candidal dermatitis Nyastatin ointment
485
What is minoxidil? What is an adverse SE?
Anti-hypertensive that causes vasodilation Excessive hair growth (hypertrichosis)
486
LP that shows IgG antibodies to NMDA-R and pt presents w/a seizure, w/CT that is normal, what does the pt have? High assoc w/what?
NMDAR encephalitis Ovarian teratoma - get ABD/Pelvis CT
487
What med SE causes blue halos? Green halos?
Sildenafil Amiodarone
488
Dirty wound and don’t know how many tetanus shots they got, what do you treat with?
TIG and Tdap
489
When do you transfuse platelets?
Under 50,000 and bleeding Or Under 10,000
490
What is the test to diagnose exercise induced bronchoconstriction?
Bronchial provocation testing aka methacholine challenge
491
Pt has a left MCA stroke w/right-sided paralysis. Visual field testing will reveal what?
Right homonymous hemianopsia Both the weakness and visual defects occur OPPOSITE side of stroke
492
What is a fear of public places an can result in a panic attack and then you are afraid of having another one so you avoid situations?
Agoraphobia
493
Child that is sweating and turning blue during feeding has what?
ToF
494
What is a dermatosis characterized by scaly, erythematous rash patches on photosensitive areas w/+ Anti-Ro/SSA ab?
Subacute cutaneous lupus erythematous
495
Where is the Chapman point for the pancreas?
7th Right ICS
496
How do you do Adson’s test? Tests for what?
Monitor pulse, extend arm, extend shoulder, ER and slightly ABduct, pt turns head TOWARDS effected shoulder Thoracic outlet syndrome
497
How to treat lichen sclerosis if topical corticosteroids do not work?
Topical calcineurin inhibitors like tacrolimus
498
MC causes of death in kids 1-4 is what?
Drowning > MVA > homicide > burn/fire > suffocation
499
Ulnar nerve entrapment w/NO problems flexing the digit means entrapment where?
At the wrist —> Guyon’s canal If entrapped at the cubital tunnel, then you cannot flex the 4th and 5th DIPs
500
When do you cardiovert in AFib? What else may you need to do?
Pt must be SYMPTOMATIC despite adequate rate control AFib present for < 48 hours TEE 1st if longer than 48 hours to assess for thrombus OR anticoagulation for 3 weeks prior to cardioversion
501
Young female w/b/L conductive hearing loss w/+ FHx of hearing loss has what? Inheritance?
Otosclerosis - loss of stapedial reflux AD
502
What VS level is lower ureter?
L1-L2
503
Pt that has diabetic foot ulcer and then leg pain may have developed what?
Osteomyelitis via direct spread
504
Erysipelas vs cellulitis, how do you tell them apart?
Erysipelas develops RAPIDLY and is more serious, involves only the dermis Will see the buzz word “streaking” Caused MC be GrpA strep
505
What is the ME treatment position for Ant. Inominate rotation?
Pt supine, pt flex knee up to chest and activate downwards
506
What is the ME treatment position for Post. Inominate rotation?
Pt supine, leg drops off table, pt activates up against dr pushing leg down to the ground
507
Negative Romberg test could indicate a lesion where? | Also will be an anterior Chapman point on the coracoid process
Cerebellum
508
What is saw palmetto used to treat? Common SE?
BPH Bleeding when taken w/Warfarin
509
What is an anatomical cause of recurrent heavy epistaxis?
AVM
510
Cob angle > what should warrant investigation of pulmonary function?
60
511
Pt w/asbestos lung biopsy will show what?
+ for Prussian blue
512
Lung biopsy showing diffuse alveolar damage d/t what?
RDS
513
How to treat anterior TPs T1-T6 w/counterstrain?
Flexion and arms Internally rotated
514
AT 7-9 c/s treatment position?
F, STRA
515
How does cerebral palsy present? MC d/t what? RF?
Developmental delay and hypertonic Perinatal neurologic insult Prematurity
516
What medicine that people take can qualify your PPD + if it is > 5mm?
Glucorticoids use
517
MOA of Riluzole?
Glutamate antagonist
518
PO Isotretinoin can cause what SE?
Suicidal ideation
519
Pt has L1-5 Rotated right, what will the sacrum do?
Sacrum will be Left on Left Sacrum is always rotated OPPOSITE the lumbar rotation L1-5 means Neutral and that means the sacrum will be FORWARD
520
L5 is flexed or extended, what is the sacrum doing?
Sacrum will be backward
521
Rib hump on the right T5 means what SD?
PTP on right T5 N RRSL

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