STEP 2 Flashcards

Question

Wiskott-Aldrich syndrome (WAS):- Etiology- Presentation- Labs

Answer 1

X-linked recessive. Defect in Wiskott-Aldrich syndrome protein (WASP). Presentation: young boy with eczema, thrombocytopenia, and recurrent infections with encapsulated organisms. At birth may have petechiae, bruises, bleeding from circumcision. or bloody stools. Low IgM, high IgA, and IgE levels. Poor response to polysaccharide antigens, and moderately reduced T-cells and platelets.

Answer 2

Characterized by decreased degranulation, chemotaxis, and granulopoiesis. Partial oculocutaneous albinism,neuropathy, hepatosplenomegaly, pancytopenia. Labs neutropenia, and giant lysosomes confirm diagnosis.

Answer 3

Defective tethering, adhesion, and targeting of myeloid leukocytes to sites of microbial invasion. Neutrophilia without PMNs in pus. Loss of baby and adult teeth.

Answer 4

Chronic pruritus dermatitis, recurrent staph infections, elevated IgE levels, eosinophilia and coarse facial features.

Answer 5

Treatment of choice: Tenofovir and then Entecavir.

Answer 6

Treatment: Pegylated interferon plus ribavirin

Answer 7

SLE can cause pancytopenia due to concurrent peripheral immune-mediated destruction of all 3 cell lines.

Answer 8

Second generation antipsychotics such as quetiapine, risperidone, olanzapine, aripiprazole, ziprasidone, andpaliperidone. Clozapine is a second generation antipsychotic that is considered the gold standard treatment for treatment resistantschizophrenia. Cause agranulocytosis.

Answer 9

If stable first line treatment is hormonal medication high dose estrogen (conjugated equine estrogen).

Answer 10

Fat malabsorption common leading to vitamin K deficiency. Leads to deficiency in coagulation factors II, VII, IX, andX. also C and S. 1972

Answer 11

Chronic inflammatory condition of the anogenital region that most commonly affects postmenopausal women andmanifests with vulvar pruritus and discomfort. Exam shows porcelain white atrophic. Must obtain biopsy to R/O vulvar SCC. Treatment is high potency topical corticosteroids.

Answer 12

Causes chest pain that classically described as sudden, tearing, and radiating to the back. Hypertension is the mostcommon predisposing factor.

Answer 13

Can be caused by acute pancreatitis with increase in serum phospholipase A2 from pancreas. This enzyme leaks intoalveoli and damages surfactant.

Answer 14

Characterized by triad of thrombocytopenia seen in over 90% of patients at diagnosis, eczema, and recurrentinfections.

Answer 15

Abdominal pain in a young female in the middle of her cycle with a benign history and clinical examination. The painis due to ovulation itself and tends to occur on the side that produces the mature ovum.

Answer 16

Epigastric pain relieved with eating as food causes alkali solution to released into the duodenum. Over 90 have H.pylori. Treatment omeprazole and antibiotics amoxicillin plus clarithromycin.

Answer 17

Pain is worse with eating

Answer 18

Normal upright person ventilation and perfusion greatest at the lung bases and least at apices. In a consolidated leftlobe. A patient will become hypoxic when lying on left side, but have normal O2 sats when lying on right because ofthis principle.

Answer 19

Presents with symmetric small joint inflammatory arthritis. Distinguished by that fact it tends to resolve within twomonths. Positive inflammatory markers such as ANA and rheumatoid factor may occur. Treatment NSAIDS.

Answer 20

Risk factors diabetic neuropathy is most important contributing factor and can be accessed using a 10g monofilament.Ankle-brachial index (ABI) primarily a measure of large vessel PAD.

Answer 21

Systolic-diastolic abdominal bruit in a patient with hypertension and atherosclerosis is strongly suggestive.

Answer 22

Due to defective mineralization of organic bone matrix. Can be caused by celiac sprue. Labs show elevated alkalinephosphatase, elevated PTH, hypophosphatemia and hypocalcemia.

Answer 23

Common form of acute cholecystitis in elderly diabetic males. It arises due to infection of gallbladder wall with gas-forming bacteria.

Answer 24

No prior history of skin disease who presents with eczematous rash near the nipple that does not improve with topicaltreatments. Most have underlying adenocarcinoma which show large cells surrounded by a halo-like area.

Answer 25

Presents with bradycardia, hypotension, wheezing, hypoglycemia, delirium, seizures, and cardiogenic shock.Intravenous fluids and atropine are first line treatment options. Intravenous glucagon should beadministered in patients with profound or refractory hypotension.

Answer 26

Autosomal dominant disorder. Characterized by diffuse telangiectasia, recurrent epistaxis, and widespread AVmalformations (AVM). AVM in lungs cause shunt of blood right to left side of heart, leading to chronic hypoxia andreactive polycythemia. Digital clubbing. Possible fatal hemoptysis with recurrent nose bleeds and oral lesions.

Answer 27

Low levels of leukocyte alkaline phosphatase (LAP) activity due to abnormal fusion gene t(9;22) (BCR/ABL1) causesdysregulation of tyrosine kinase activity. Leads to decreased apoptosis of myeloid cells and they accumulate highnumbers. They are functionally inactive, so low LAP activity.

Answer 28

Examination is normal and pain is during the first few days of menses. Pain pathophysiology release of prostaglandinsfrom endometrium causes uterine contractions. Treatment NSAIDS.

Answer 29

Chronic alcohol abuse and viral hepatitis ( think B and C infection) are the most common underlying cause of cirrhosis.

Answer 30

Most common cause Autoimmune. Cortisol = decreased; ACTH = increased; Aldosterone = decreased

Answer 31

Most common cause chronic glucocorticoid therapy. Cortisol = decreased; ACTH = decreased; Aldosterone = Normal

Answer 32

Oral amoxicillin is treatment of choice in pregnant and lactating women as well as children age

Answer 33

Seen patients with history of asthmatic or chronic rhinosinusitis with nasal polyposis. Non-IgE mediated reaction thatresults from aspirin induced prostaglandin/leukotriene misbalance. Treatment stop NSAIDS use leukotriene antagonistmontelukast.

Answer 34

Patient presents with hypotension (UNRESPONSIVE to IV FLUID bolus), tachycardia, and elevated jugular pressure after blunt thoracic trauma. Only takes 100-200mL of fluid, so chest X-ray can sometimes be normal.

Answer 35

Patients with HIV should receive vaccination for MMR if their CD4 cell count is >200/uL, they have no history ofAIDS-defining illness, and they have no evidence of immunity.Lack of current ART is not a contraindication.Otherwise all other live vaccines are contraindicated.

Answer 36

The most common predisposing factor for acute bacterial sinusitis is a viral respiratory infection.

Answer 37

Suspect primary CNS lymphoma in an HIV-infected patient with an altered mental status, ((EBV DNA in the CSF)), and asolitary, weakly ring-enhancing periventricular mass on MRI.

Answer 38

Self-limited condition associated with adenovirus and other URI. Treat symptomatic with COOL, MOIST COMPRESSES.

Answer 39

Can cause agranulocytosis: Patient will complain of fever and sore throat. STOP MEDICATIONS IMMEDIATELY. Recheck WBC count.

Answer 40

Most common adverse effect of inhaled corticosteroid therapy is oropharyngeal thrush.

Answer 41

Work up: Pelvic ultrasound is the prefered initial imaging modality for suspected gynecological tumors. It has a highsensitivity for diagnosing uterine fibroids and ovarian pathology.

Answer 42

Brain death refers to a total loss of brain function and is legally acceptable definition of death. Family permission is not legally required to discontinue mechanical ventilation in a patient with brain death.

Answer 43

Although it can decrease the risk of ventricular fibrillation, it may increase the risk of asystole.

Answer 44

Eye Opening; Verbal Response; Motor Response.

Answer 45

At increased risk of impaired fertility or infertility due to chronic inflammation and adhesion formation.

Answer 46

Laparoscopy with visualization and biopsy of implants is the only definitive way to diagnose endometriosis. It isindicated when NSAIDS and hormonal contraceptive therapy have failed.

Answer 47

Example: risperidone can cause extrapyramidal side effects and can be treated with anticholinergic medication likebenztropine.

Answer 48

Diagnose with rapid streptococcal antigen test (RAST) or throat culture which is gold standard. Antistreptolysin Oantibody is useless for acute infection because antibodies do not present for one month.

Answer 49

Women under age 40 with elevation in FSH for greater than or equal to 3 months of amenorrhea. FSH increased; LH increased; FSH/LH ratio >1.0; estrogen decreased.

Answer 50

Characterized by contralateral motor or sensory deficits, which are more pronounced in the lower limb than the upperlimb. Urinary incontinence can also be seen occassionaly.

Answer 51

With high bone turnover as seen in young people and Paget's disease can have increased osteoclast activity leadingto hypercalcemia. Hydration and bisphosphonates are effective treatments.

Answer 52

In the setting of knee pain: age >50; crepitus; bony enlargement, bony tenderness, and a lack of warmth/morning stiffness. If three criteria met specificity is 69%.

Answer 53

Primary prevention in patients age 40-75 with a 10-year risk of atherosclerotic disease ≥7.5%.

Answer 54

Classic findings are dry skin, dry mouth, constipation, urinary retention, flushing, vision change, and confusion. Often seen in the treatment of Parkinson disease due to treatment of EPS. Trihexyphenidyl and bromocriptine are common culprits.

Answer 55

High- dose dexamethasone does not suppress plasma cortisol levels in patients with ectopic ACTH syndrome.

Answer 56

ACTH-producing pituitary adenoma. Partially inhibited by high- dose dexamethasone.

Answer 57

triamterene and amiloride

Answer 58

``` 1. Sodium and water restriction. 2. Spironolactone. 3. Loop diuretics (not more than 1L/day of diuresis) 4. Frequent abdominal paracentesis (2-4 L/day, as long as the renal function is okay) ```

Answer 59

Clenched fist injury to hand from person fist hits opponents teeth. Treatment of choice for prophylaxis is amoxicillin-clavulanate since infection is usually polymicrobial. Also used for dog bites.

Answer 60

Beta blockers, calcium channel blockers, and nitrates are antianginal agents that are healed 48 before performing a cardiac stress test.

Answer 61

Hypertension in a pregnant female in the setting of massive proteinuria, malar rash, and a strongly positive ANA titer is most likely due to SLE. Glomerulonephritis in general will cause proteinuria, hematuria, and RBC casts. Not to be confused with what occurs in preeclampsia.

Answer 62

Characterized by hyperviscosity of blood owing to the excess production of IgM. Two important diagnostic clues: 1. An IgM spike on electrophoresis 2. hyperviscosity.

Answer 63

Immunoglobulins are usually IgG or IgA. No hyperviscosity.

Answer 64

chlorpromazine, nitrofurantoin, erythromycin, anabolic steroids

Answer 65

tetracycline, valproate, and antiretrovirals

Answer 66

halothane, phenytoin, isoniazid, and alpha-methyldopa

Answer 67

carbon tetrachloride and acetaminophen

Answer 68

allopurinol and phenylbutazone

Answer 69

Caused by Pox virus. Commonly seen in patient who have CELLULAR IMMUNODEFICIENCY such as HIV and patients on corticosteroids or chemotherapy.

Answer 70

MARFANOID BODY HABITUS that is autosomal recessive. INTELLECTUAL DISABILITY, FAIR complexion, CEREBROVASCULAR ACCIDENTS, megaloblastic anemia, and thrombosis.

Answer 71

Characterized by angiokeratomas, peripheral neuropathy, and asymptomatic corneal dystrophy. At risk for thromboembolic event.

Answer 72

Autosomal recessive lysosomal storage disorder caused by galactocerebrosidase deficiency. Clinical features intellectual disability, blindness, deafness, paralysis, neuropathy, and seizures.

Answer 73

Inborn error of metabolism that results from a deficiency of phenylalanine hydroxylase. Clinical features intellectual disability, fair complexion, eczema, and a musty body odor.

Answer 74

Autosomal recessive gangliosidosis caused by a deficiency of β-hexosaminidase A. Clinical features intellectual disability, weakness, seizures, and presence of a cherry- red macula on examination.

Answer 75

Screen weeks 24-28. Target blood glucose levels: Fasting ≤95 mg/dL; 1-hour postprandial ≤140 mg/dL; 2-hour postprandial ≤120 mg/dL. First line treatment: dietary modification; Second line treatment: Insulin, oral agents (metformin, glyburide)

Answer 76

Polycythemia (hct >65%), hyperviscosity, organomegaly, macrosomia, hypoglycemia

Answer 77

Comorbidities include MAJOR DEPRESSION, agoraphobia, bipolar disorder, and substance abuse. Higher rates of suicide attempts. Tx: SSRI

Answer 78

Noninflammatory and nonsclerotic condition primarily effectting renal arteries causing hypertension. Can affect carotid and vertebral with TIA like symptoms. Can hear carotid bruit.

Answer 79

Presents with acute pulmonary edema. Tx: Oxygen, assisted ventilation, aggressive intravenous diuresis (furosemide), and possible vasodilator therapy.

Answer 80

Acute, unilateral cervical adenitis in children is typically caused by streptococcal or staphylococcal infection. The treatment consists of clindamycin plus incision and drainage.

Answer 81

Polymorphic ventricular tachycardia that occurs in the setting of congenital or acquired prolonged QT interval. Tx: Immediate defibrillation is indicated in hemodynamically unstable patients with TdP, while intravenous magnesium is the first-line therapy for stable patients with recurrent episodes of TdP.

Answer 82

Must get a TEE, so you can rapidly diagnose and treat. Surgical emergency!

Answer 83

Tool to evaluate CAD and indicates inducible ischemia when a reversible defect is noted on stress and rest. Antiplatelet therapy, beta blockers, and life style modification.

Answer 84

Beta cell tumor: elevated levels of insulin, c-peptide, and proinsulin.

Answer 85

When the pH of the pleural fluid is less than 7.2, the probability is very high that this is an empyema and must be drained.

Answer 86

Should not drink alcohol because of disulfiram-like reaction.

Answer 87

Involve one or more somatic complaints (including pain) that are distressing or result in significant disruption of life, with excessive thoughts, feelings, or behaviors related to these symptoms and lasting ≥6 months.

Answer 88

Toxicity mainly due to hypercalcemia and includes constipation, abdominal pain, polyuria, and polydipsia.

Answer 89

Hypoxia in pneumonia causes areas of V/Q mismatch that manifests as increase in the alveolar-arterial oxygen gradient.

Answer 90

Increased risk of developing CLEAR CELL ADENOCARCINOMA of the vagina and cervix. Daughters and sons with in utero exposure also have structural anomalies of the reproductive tract (HOODED CERVIX, T-shaped uterus, small uterine cavity, vaginal septae, vaginal adenosis)

Answer 91

Depression of the deep tendon reflexes is the earliest sign of magnesium sulfate toxicity. STOP the MAGNESIUM SULPHATE infusion and administration of CALCIUM GLUCONATE.

Answer 92

Trimehoprim-sulfamethoxazole (TMP-SMX) is drug of choice. Corticosteroids decrease mortality in severe PCP infections and should be given if PaO2 ≤70 mmHG or A-a gradient ≥35 mmHg on room air.

Answer 93

Initial hematuria suggests urethral damage. Terminal hematuria indicates bladder or prostatic damage, and total hematuria reflects damage in the kidney or ureters. Clots are not usually seen with renal causes of hematuria.

Answer 94

Newborn with concave abdomen and barrel shaped chest with absent breath sounds on one side needs emergency intubation with cautious ventilations

Answer 95

Presents with fatigue and nonspecific symptoms. Patients transaminases wax and wane. Extrahepatic sequelae can include essential mixed cryoglobulinemia, porphyria cutanea tarda, and membranoproliferative glomerulonephritis.

Answer 96

In HIV patients, both HSV and VZV can cause severe,acute retinal necrosis associated with pain, keratitis, uveitis, and fundoscopic findings of peripheral pale lesions and central retinal necrosis. CMV retinitis is painless.

Answer 97

Patients typically have headache, neck stiffness, gait ataxia, and no hemiparesis

Answer 98

Most common cause is hypertension. Next to internal capsule, so leads to hemiparesis.

Answer 99

Coma due to disruption of reticular activating system, and quadriplegia that develops within a few minutes. Pinpoint pupils, but may react strongly to light with no horizontal movement. Decerebrate rigidity.

Answer 100

Patient who presents with clinical features of adrenal insufficiency and calcifications in the adrenal glands.

Answer 101

Presents with alterations in sensation, including loss of proprioception. When motor findings are present and patient has hyperactive reflexes and an upgoing plantar reflex (UMN) you need to get an MRI of spine for epidural abscess or cord compression.

Answer 102

Folic acid deficiency. Folic acid is heat sensitive and deficiency cause macrocytic anemia.

Answer 103

Caused by a stroke involving the VPL nucleus of the thalamus, which transmits sensory information from the contralateral side of the body. Classically presents with contralateral hemianesthesia that can be accompanied by transient hemiparesis, athetosis, or ballistic movements.

Answer 104

Classically involve the nuclei of the cranial nerves.

Answer 105

Characterized by a significant mood episode (depressive or manic) with concurrent psychotic symptoms in addition to a period of psychosis without mood symptoms of at least 2 weeks.

Answer 106

Common in Sub-Saharan Africa, the Amazon basin, and Southern and Southeast Asia. Tx chemoprophylaxis is mefloquine, atovaquone-proguanil.

Answer 107

Patients with multifetal gestation or molar pregnancy are at increased risk for hyperemesis gravidarum therefore an ultrasound should be performed in pregnant women with severe vomiting.

Answer 108

Clues to diagnosis: hypertension, palpable bilateral abdominal masses and microhematuria. Remember intracranial berry aneurysm is a common complication. No screening recommended.

Answer 109

Causes flank pain, low volume voids with or without occasional high volume voids, and if bilateral renal dysfunction.

Answer 110

Most frequently occurs as a drug reaction. Patient present with fever, rash, acute renal dysfunction, and eosinophiluria with white blood cell casts.

Answer 111

Presents with hematuria, red blood cell casts, acute renal failure, hypertension, and edema.

Answer 112

Primarily affects the heart (cardiomyopathy, RBBB) and gastrointestinal tract (megacolon, megaesophagus). First line treatment Benznidazole.

Answer 113

Presents with urticaria, abdominal pain, and respiratory problems (dry cough, dyspnea, wheezing). First line treatment ivermectin.

Answer 114

Causes ocular lesions and dermatitis. Treatment is ivermectin.

Answer 115

Most commonly occurs in the setting of untreated pneumonia due to bacterial seeding of a pleural effusion. Most common bacteria are Streptococcus pneumoniae, Staphylococcus Aureus, and Klebsiella pneumonia.

Answer 116

Depends on the severity of bleeding and the age of the pregnancy. Complete placenta previa requires delivery by cesarean section. If mother and baby are stable SCHEDULED cesarian section.

Answer 117

Weight should TRIPLE and height should INCREASE 50%. Walking independently, using a 2-finger pincer grasp, saying a few words other than “mama” and “dada” and imitating the actions of others.

Answer 118

Pulls to stand and cruises; 3-finger grasp and holds bottle or cup; Says “mama” and “dada”; Waves “bye” and plays pat-a-cake

Answer 119

Sits momentarily propped on hands (unsupported by 7 months); Transfers objects hand to hand and raking grasp; Responds to name and babbles; Stranger anxiety.

Answer 120

Sits with trunk support and begins to rolling; Hands mostly open and reaches midline; Laughs and turns to voice; Enjoys looking around

Answer 121

Lifts head/chest inprone position; Hands unfisted 50% of time, tracks pasat midline; Alerts to voice/sound and coos; Social smile and recognizes parents.

Answer 122

Developing osteopenia, osteoporosis, and bone fracture. Management adequate physical activity, optimization of calcium and vitamin D intake, minimization of corticosteroid therapy, and consideration for bisphosphonate treatment.

Answer 123

Most often due to acute viral hepatitis, ACETAMINOPHEN TOXICITY, and ischemic hepatopathy. Characteristic findings include the acute onset of markedly elevated transaminases ( often in the thousands), reduced hepatic synthetic function, and encephalopathy.

Answer 124

Newborn or young infant with failure to thrive, bilateral cataracts, jaundice, and hypoglycemia. GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE DEFICIENCY leads to ELEVATED BLOOD GALACTOSE.

Answer 125

Presents with cataracts only, otherwise asymptomatic.

Answer 126

Thought process deviate from original subject but eventually return to it.

Answer 127

Thought process in which there is abrupt, permanent deviation from the current subject. This new thought process is minimally relevant at best and never returns to the original subject.

Answer 128

Best described as the lack of a logical connection between the thoughts or ideas of an individual. It tends to be more severe form of tangentiality in which one statement follows another but there is no clear association between the sentences.

Answer 129

Repetition of words or ideas during a conversation.

Answer 130

Loosely associated thoughts that rapidly move from topic to topic.

Answer 131

Medical emergency: causes painful, red eye and opacification and ulceration of the cornea. Most case are due to Gram-negative organisms such as Pseudomonas and Serratia, but can be from gram-positive, fungi, and amoebas. Tx with topical broad spectrum antibiotics.

Answer 132

Radiograph reveals intraperitoneal air between the liver and diaphragm. This is surgical emergency.

Answer 133

Should be suspected in COPD patients presenting with catastrophic worsening of their respiratory symptoms and is usually due to dilated alveolar blebs that rupture air into the pleural space.

Answer 134

Calculate the anion gap: AG = Na - (HCO3 + Cl) KARMEL: K — Ketoacidosis; A — aspirin; R — Renal failure; M — Methanol; E — Ethylene glycol; L — Lactic acidosis

Answer 135

An elderly patient with bone pain, renal failure, and hypercalcemia. Renal insufficiency most likely due to obstruction of the distal and collecting tubules by large laminated casts containing PARAPROTEINS (mainly Bence Jones protein).

Answer 136

Can be attempted in women with breech pregnancies at ≥37 weeks gestational age if there are no contraindications to vaginal delivery, and fetal well-being has been established.

Answer 137

Reciprocal translocation of chromosome 9 and 33 can form the Philadelphia chromosome containing BCR/ABL fusion gene. Tyrosine kinase inhibitors are key treatments. Non-receptor tyrosine kinase.

Answer 138

Retinoic acid receptor is involved. Tx: All-retinoic acid.

Answer 139

Signifies bowel obstruction and requires immediate X-ray to evaluate the need for emergency surgery or further diagnostic study. Contrast studies (enema) should be performed in stable patients to determine the level of obstruction.

Answer 140

Phenotypically and genotypically female. They experience breast development and body hair growth at puberty but do not menstruate due to a congenitally absent or underdeveloped uterus, cervix, and upper vaginia.

Answer 141

Newborns with CONJUGATED hyperbilirubinemia and hepatosplenomegaly require immediate evaluation for biliary atresia. Evaluated with ultrasound.

Answer 142

Induced pancreatitis

Answer 143

related hypersensitivity syndrome.

Answer 144

associated liver failure.

Answer 145

lactic acidosis

Answer 146

Steven-Johnson syndrome.

Answer 147

Surgical resection is recommended in patients with good performance status and stable extracranial disease In patients with multiple metastases, whole brain radiation therapy is typically used.

Answer 148

Results from ingestion of exogenous thyroid hormone. Signs and symptoms of thyrotoxicosis without goiter or exophthalmos. TSH low; elevated T3/T4. Radioactive iodine uptake is low in these patients. Diagnosis is made by low serum thyroglobulin levels.

Answer 149

If a bruit is heard need an angiogram to rule out injury to the underlying vessel.

Answer 150

Diagnosed by the presence of rhomboid, positively birefringent crystals in synovial fluid analysis, and radiographic evidence of chondrocalcinosis.

Answer 151

Monosodium urate crystal deposition. Crystals are needle shaped and negatively birefringent on synovial fluid analysis.

Answer 152

Calcium oxalate

Answer 153

Magnesium ammonium phosphate may be found in the renal calculi of patients with UTI caused by urease-producing organisms (Klebsiella, Proteus).

Answer 154

Tx: Inpatients should be treated with methadone if they are being treated for another medical problem other than addiction.

Answer 155

During benzodiazepine intoxication, pupil size tends to be normal, with only mild respiratory depression.

Answer 156

Hemodynamically unstable electrical cardioversion. Hemodynamically stable give amiodarone.

Answer 157

Calcium, renal function, and thyroid function should be monitored.

Answer 158

Positive direct Coomb’s test.

Answer 159

Aminoglycosides are antibiotics used to treat serious gram-negative infections. They are potentially nephrotoxic and renal functions must be monitored closely. AMIKACIN.

Answer 160

The copper intrauterine device is the most effective precoital and postcoital contraceptive, with up to 99% efficacy. OCPs are less effective.

Answer 161

Catastrophic complication of acute aortic dissection. Suspected in patients with hypotension, tachycardia, distended neck veins, and pulsus paradoxus.

Answer 162

Intravenous adenosine is useful in the initial diagnosis and management. It slows the sinus rate, increases atrioventricular (AV) nodal conduction delay, or can cause a transient block in AV node conduction. Good for identifying P waves. Terminates PSVT sometimes.

Answer 163

mucormycosis (Rhizopus species).

Answer 164

Of hydrogen ions from albumin, allowing increased binding of calcium and a drop in unbound (ionised calcium. Ionized calcium is the physiologically active form, and decreased levels can result in clinical manifestations of hypoglycemia.

Answer 165

Involves one or more delusions and the absence of other psychotic symptoms in an otherwise high functioning individual.

Answer 166

Caused by parasite Babesia and is transmitted by Ixodes tick. Evidence of hemolysis in a patient who was splenectomised highly suspicious. Diagnosed Giemsa-stained thick and thin blood smear.

Answer 167

Weight lose is the most effective nonpharmacologic measure to decrease blood pressure in overweight individuals.

Answer 168

Urine studies reveal proteinuria, dysmorphic red blood cells (RBCs) or RBC cast.

Answer 169

More common. Gross hematuria with normal-appearing red blood cells (RBCs) but without significant proteinuria.

Answer 170

Not associated with hypoaldosteronism. Aldosterone is independent of ACTH secretion by pituitary gland.

Answer 171

Suggests tracheobronchial rupture. Findings include pneumomediastinum and subcutaneous emphysema.

Answer 172

Dilation of veins (capacitance vessels) which leads to decrease ventricular preload.

Answer 173

Low-grade fever, leukocytosis especially first 24 hours and vaginal discharge are normal findings. The vaginal discharge (lochia) is initially bloody, then serous and finally white to yellow in color days following delivery.

Answer 174

Start empiric antibiotics.

Answer 175

＜20mEq/L (saline responsive) | ＞20mEq/L (saline resistant)

Answer 176

Condition of painful, subcutaneous, pretibial nodules. Symptom of more serious diseases including sarcoidosis (get chest x ray especially in AAF), TB, histoplasmosis, recent streptococcal infection, and IBD.

Answer 177

Vaginal bleeding, a dilated cervical os, and partial expulsion of products of conception. Hemodynamically unstable: Surgical evacuation (D & C). Hemodynamically stable: Expectant management, prostaglandins (misoprostol), or surgical.

Answer 178

Vaginal bleeding, closed os, and fetal cardiac activity.

Answer 179

No vaginal bleeding, closed cervical os, no fetal cardiac activity or empty sac.

Answer 180

Vaginal bleeding, dilated os, products of conception may be seen or felt at or above cervical os.

Answer 181

Veginal bleeding or none, closed cervical os, and products of conception completely expelled.

Answer 182

Hypoparathyroidism caused by the removal of 3 ½ parathyroid glands causes low PTH with resultant hypocalcemia and elevated phosphorus levels.

Answer 183

Common cause of back pain in patients over 60 years of age. Characterized by back pain radiating to the buttocks and thighs that interferes with walking and lumbar extension.

Answer 184

Characterized by progressive limitation of back motion and most often occurs in young men. Back pain and stiffness are typically worst in the morning and improves as day progresses.

Answer 185

Classically presents with “5 Ps” (pain, pallor, pulselessness, paresthesia, and paralysis). Immediate anticoagulation and referral for vascular surgery.

Answer 186

Tears occur in the distal esophagus at the gastroesophageal junction after repeated bouts of retching and vomiting. Do not confuse with Acute erosive gastritis from severe hemorrhagic erosive lesions of the gastric mucosa.

Answer 187

Wounds can be infected with Pasteurella multocida, so prophylactic treatment with 5 day course of amoxicillin/clavulanate.

Answer 188

Autosomal recessive or X-linked disorder of chromosomal breaks usually diagnosed before age 16. Causes congenital marrow failure, with short stature, microcephaly, abnormal thumbs, and hypogonadism. Skin can be hypopigmentes or hyperpigmented, cafe au lait spots, and large freckles. Strabismus, low set ears, chronic, ear infections.

Answer 189

Causes pulmonary congestion which leads to symptoms such as exertional dyspnea, nocturnal cough, and hemoptysis. Atrial fibrillation occurs due to atrial dilation. Especially common in patients who had rheumatic fever.

Answer 190

Causes chest pain by coronary vasospasm. Treatment is calcium channel blocker. Nonselective β-blockers and aspirin should be avoided because they can promote vasoconstriction.

Answer 191

Occurs generally in a group O mother with a group A or B baby. Less severe than Rh(D) incompatibility.

Answer 192

Possible asthma must check PFTs.

Answer 193

Involve randomization to different interventions with additional study of 2 or more variables.

Answer 194

The proximal deep veins (iliac, femoral and politeal veins) are the source of ＞90% of acute PEs.

Answer 195

Both case the patient feels a popping sensation during an acute event, but the swelling that occurs with meniscal tear until 12 to 24 hours. Ligament tears swell almost immediately

Answer 196

Shows the strength and direction (positive, negative) of linear association between 2 variables. It does not imply causality. An r=-0.25 for HDL to carotid intima thickness would mean they are inversely proportional.

Answer 197

Should include transvaginal ultrasonography and a serum cancer antigen (CA)125 level which has good sensitivity and specificity for malignant adnexal mass. Needle aspiration for cytology is contraindicated due to possible cancer spread.

Answer 198

Teratogenic. Congenital rubella syndrome is characterized by the triad of cataracts, patent ductus arteriosus, and snesoneural hearing loss. Prevent by MATERNAL VACCINATION before conception. Must have IgM and IgG to know if current infection or previous immunity.

Answer 199

``` Arteriovenous fistulas (AVF) which can lead to high-output cardiac failure by shunting the blood from the arterial to venous side, thereby increasing cardiac preload. Hypoxia of tissues drives this. Doppler ultrasound to diagnose. ```

Answer 200

Heart rates between 160-220 beats per minute. Results from accessory conduction pathways through the AV node. Vagal maneuvers and medication (adenosine) that decrease conduction through the AV node often revolve the PSVT.

Answer 201

Appearance is a doll-like face (fat cheeks), thin extremities, short stature, and protuberant abdomen (due to enlarged liver and kidneys) in a 3-4 month old. Hypoglycemic seizures may occur.

Answer 202

Stands well, walks first steps independently throws ball; 2-finger pincer grasp; Says first words (other than “mama” & ”dada”); Separation anxiety, follows 1-step command with gestures

Answer 203

Runs, kicks ball; builds tower of 2-4 cubes, removes clothing; 10-25 word vocabulary, identifies ≥1 body part; Understands “mine”, begins pretend play.

Answer 204

Walks up/down stairs with both feet on each step, jumps; Builds 6-cube tower, copies a line, turns pages; 50+ word vocabulary, 2-word phrases; Follows 2-step command, parallel play, begins toilet training.

Answer 205

Walks up/down stairs with alternating feet, rides tricycle; copies a circle, uses utensils; 3-word sentences, speech 75% intelligible; Knows age/gender, imaginary play.

Answer 206

Balance & hops on 1 foot; Copies a square; Identifies colors, speech 100% intelligible; Cooperative play.

Answer 207

Skips, walks backward; Copies a triangle, ties shoelaces, independent dressing/bathing, prints letters; Counts to 10, 5-word sentences; Has friends, complete toilet-training.

Answer 208

Protein elevated (45-1000) albuminocytologic dissociation; WBC normal; RBC normal; Glucose normal.

Answer 209

Serotonin and TRH, and inhibited by dopamine. Hypothyroidism may result in amenorrhea and galactorrhea. Prolactin inhibits GnRH release thus decreasing FSH and LH.

Answer 210

Lymphoma of the thyroid. anti-thyroperoxidase (TPO) antibodies.

Answer 211

Follicular, papillary and anaplastic; C-cell origin is medullary.

Answer 212

Severe (calcium ＞14mg/dL) or symptomatic: Short term (immediate treatment) Normal saline hydration plus calcitonin. Long-term treatment bisphosphonates (zoledronic acid). Remember hypercalcemia induces urinary salt wasting, which results in significant volume depletion.

Answer 213

Patient with hypotension, jugular venous distension, and new-onset right bundle branch block (RBBB)

Answer 214

First line therapy Beta blocker: Metoprolol, decreases myocardial contractility & HR. Improves survival. Calcium channel blockers can be added if angina persists. Causes peripheral & coronary vasodilation. Nitrates, Aspirin, Statin, lifestyle.

Answer 215

Immediate synchronized DC cardioversion. Stable patients get vagal maneuvers (carotid sinus massage) and/or adenosine.

Answer 216

The pancreatic cells that produce vasoactive peptide (VIP). VIPoma syndrome (pancreatic cholera) with watery diarrhea, muscle weakness/cramps (due to hypokalemia), and hypo- or achlorhydria (due to decreased gastric acid secretion). Stool studies show secretory diarrhea, VIP levels are ＞75pg/mL confirms.

Answer 217

Radioactive iodine (RAI) due to thyroid cell death and release of excess thyroid hormone.

Answer 218

Ignoring the left side of a space, and involves the right (non-dominant) parietal lobe.

Answer 219

Rare condition characterized by precocious puberty, cafe au lait spots and multiple bone defects (polyostotic fibrous dysplasia). Can have other endocrine disorders.

Answer 220

Encapsulated organisms due to impaired antibody-mediated opsonization in phagocytosis. S. pneumoniae, N. meningitidis, and H. influenzae.

Answer 221

First line: Dopamine agonist (pramipexole, ropinirole) | Alternative: Alpha-2-delta calcium channel ligands (gabapentin)

Answer 222

It is important to give the drugs with at least a 4-hour interval to reduce the risk of hypotension.

Answer 223

Can present with CNS, cardiac, and anticholinergic findings. Sodium bicarbonate is used to treat cardaic toxicity (QRS＞100msec and ventricular arrhythmias). Sodium bicarbonate increases serum pH and extracellular sodium, therby alleviating the cardio-depressant action on sodium channels.

Answer 224

With normal QRS duration delay at AV node and require no further evaluation. Prolonged QRS duration likely have a conduction delay below the AV node and should have electrophysiology testing.

Answer 225

S. pneumoniae, H. influenzae.

Answer 226

A gallstone obstructing the cystic duct with subsequent inflammation and infection.

Answer 227

In the basal ganglia, thalamus, pons, and cerebellum. Evolves over minutes to hours with focal neurologic symptoms compared to subarachnoid hemorrhages complain of severe HA do not have focal deficits.

Answer 228

``` Of acid (caustic substance) causes pyloric strictures to form. This presents as early satiety, nausea, nonbilious, vomiting and weight lose. ```

Answer 229

Common viral infection of the hand by HSV 1 or 2 and is self limiting. Healthcare workers especially dentist are at risk for it. Remember multinucleated giant cells in the Tzanck smear confirms diagnosis.

Answer 230

Reentrant ventricular arrhythmias (ventricular fibrillation).

Answer 231

Causes weakness, fatigue, and muscle cramps. ECG may show U wave, flat and broad T waves, and premature ventricular beats.

Answer 232

Intravenous glucocorticoids (decreases vasogenic edema) and MRI.

Answer 233

Characterized by visual loss that is transient and usually monocular. “Curtain falling down.” Most common cause RETINAL EMBOLI from the CAROTID ARTERY.

Answer 234

Non-polio enteroviruses, such as echoviruses and coxsackie viruses.

Answer 235

Triad of fever, tinnitus, and tachypnea (stimulates respiratory center in the medulla). Adults with aspirin toxicity develop a mixed respiratory alkalosis and anion gap metabolic acidosis. pH 7.39; PaCO2 20; HCO3 12.

Answer 236

A mixed respiratory and metabolic acid-base disorder.

Answer 237

Increases the risk of cardiac malformations including septal defects and possibly Ebstein’s anomaly

Answer 238

May cause goiter and transient neuromuscular dysfunction.

Answer 239

2 years starting at age 50 in women till age 74 at average risk for breast cancer. Not recommended after 75.

Answer 240

Proximal muscle weakness with or without muscle atrophy can occur in 60-80% of patients with untreated hyperthyroidism and correlates to the duration of the hyperthyroid state.

Answer 241

Fatigable muscle weakness that primarily involves the extraocular and bulbar musculature is the most consistent with MG. Approximately 15% have a Thymoma, so screening with a chest CT recommended.

Answer 242

Idiopathic inflammatory myopathy with immune mediated muscle injury that can be due to paraneoplastic syndrome in malignancy. Patient typically have symmetrical proximal muscle weakness and erythematous rash over the dorsum of the fingers (Gottron’s sign) and/or upper eyelids (heliotrope eruption).

Answer 243

DIMINISHED or ABSENT DEEP TENDON REFLEXES. Proximal muscle weakness, autonomic dysfunction (dry mouth).

Answer 244

Angiotensin converting enzyme (ACE) levels.

Answer 245

Low plasma osmolarity especially Na (hyponatremia) with an inappropriately elevated urine osmolality and urine sodium concentration.

Answer 246

May be treated with observation and supportive care initially, followed by laparoscopic cholecystectomy within 72 hours during same hospitalization.

Answer 247

Impairment of daily functioning is seen in dementia.

Answer 248

Amenorrhea, hypoestrogenism, and elevated gonadotropins (increased serum FSH & LH). Patients lack oocytes. Infertility is treated with in vitro fertilization with donor oocytes for women who desire pregnancy.

Answer 249

Frequent, watery, nocturnal diarrhea. Diagnoses can be confirmed with characteristic biopsy of dark brown discoloration of the colon with lymph follicles shining though pale patches (melanosis coli).

Answer 250

Intravenous broad spectrum antibiotics (ampicillin, gentamicin, clindamycin). Oxytocin to accelerate labor. This is not a reason for cesarean delivery.

Answer 251

Fetal distress, breech presentation, multiple prior cesarean deliveries.

Answer 252

Type 2 diabetics are prone to the development of a hyperosmolar hyperglycemic state without ketoacidosis. Decreased consciousness is the most common symptom, and other neurologic abnormalities such as blurred vision.

Answer 253

Of apnea that are precipitated by frustration, anger, or pain. Age 6 months-2 years. Patients should be evaluated for iron deficiency anemia. CBC

Answer 254

Ganciclovir or foscarnet

Answer 255

ARP =(RR-1)/RR | RR = Relative Risk

Answer 256

Leads to ectopy and increased vagal tone. Atrial tachycardia with AV block occurs from combination of these two digitalis effects and is relatively specific for digitalis.

Answer 257

An acneiform eruption characterized by monomorphous, erythematous follicular papules distributed on the face, trunk and extremities. Comedones are characteristically absent.

Answer 258

A hazard ratio ＜1 indicates that an event is more likely to occur in the control group A hazard ration ＞1 signifies that an event is more likely to occur in the treatment group. A ratio close to 1 implies little difference between the 2 groups.

Answer 259

Mobitz Type I: Atrioventricular block has PROGRESSIVE PROLONGATION of PR interval leading to a NON-CONDUCTED P WAVE and a dropped QRS complex. Problem is conduction in the AV node. Mobitz Type II: PR interval is always CONSTANT with no progressive prolongation and ((QRS complex drops suddenly)). Due to a block in the His-Purkinje system below AV node. Can lead to third degree block.

Answer 260

Parvovirus can cause an acute symmetric arthritis of the hands (MCP, PIP, and wrist), knees, and ankle joints. Onset is 10 days unlike RA symptoms 6 weeks. Morning stiffness 1 hour RA, and only 10-15 minutes Parvo .

Answer 261

Rate control should be attempted initially with beta blockers or calcium channel blockers. Immediate synchronised electrical cardioversion is indicated in hemodynamically unstable patients.

Answer 262

An abdominal aortic aneurysm (AAA). Abdominal ultrasound is the study of choice for diagnosis.

Answer 263

Immunized against A and B if they are not immune. Including pregnant women. Vaccines are inactivated (killed). Safe.

Answer 264

Initial evaluation is with ECG. Acute therapy is given for patients with ((ECG changes, potassium ≥7.0 mEq/L without characteristic ECG changes, or rapidly rising POTASSIUM due to tissue breakdown)).

Answer 265

They stain with the periodic acid-Schiff (PAS) reaction and resist digestion to diastase.

Answer 266

Nonspecific symptoms and require a high index of suspicion to make the diagnosis. Patients presenting with mild diabetes mellitus or hyperglycemia with NECROTIC MIGRATORY ERYTHEMA, diarrhea, anemia, and weight lose. Glucagon >500 pg/mL. Get abdominal imaging.

Answer 267

The loss of small amounts of urine with increased intra-abdominal pressure, as occurs with laughing, coughing, and sneezing. Urine leakage occurs from ineffective closure of urethral sphincter. Inserting cotton swab demonstrating angle >30° upon increase abdominal pressure. Kegel exercises and urethropexy.

Answer 268

Results from detrusor hyperactivity and is characterized by a sudden urge to urinate that may come at any time, not just increased intraabdominal pressure. Oxybutynin.

Answer 269

Progesterone analogs (megestrol acetate and medroxyprogesterone acetate), and corticosteroids have been shown to increase appetite and weight gain in patients. Cannabinoids show no effect.

Answer 270

Autosomal recessive condition characterized by an excessive number of trinucleotide repeat sequences, resulting in a tocpherol transfer protein.

Answer 271

A spuriously (not genuine) prolonged partial thromboplastin time in vitro.

Answer 272

Recognized by their widened QRS (>120 msec), bizarre morphology, and compensatory pause. Worse prognosis but no treatment unless symptomatic then Beta blocker.

Answer 273

Be investigated using transthoracic doppler echocardiography. Midsystolic soft murmurs in asymptomatic young patient require no further work up.

Answer 274

Impaired function of the right ventricle due to pulmonary hypertension that usually occurs due to chronic lung disease. Signs: Elevated JVP, right ventricle heart sound, tricuspid regurgitation murmur, pulsatile liver, LEE, ascites. Right heart catheterisation shows elevated pulmonary artery systolic pressure (>25 mmHg).

Answer 275

With an unexplained elevation in serum creatine kinase concentration and myopathy. Presents with fatigue, myalgias, proximal muscle weakness, sluggish ankle reflexes. Check TSH and free T4.

Answer 276

Squamous cell carcinoma: Biopsy shows invasive cords of squamous cells with keratin pearls.

Answer 277

A “steppage” gait, exaggerated hip and knee flexion while walking. Common causes include L5 radiculopathy and compression peroneal neuropathy. L5 radiculopathy may also have weak foot inversion and plantar flexion.

Answer 278

Usually caused by fetal anomalies, abnormal fetal karyotype, and early MATERNAL VIRAL INFECTION. CMV most common and most women have no apparent symptoms.

Answer 279

Generally appears later in the pregnancy and is caused by maternal vascular disease, including hypertension, diabetes, and smoking.

Answer 280

Unexplained hemolytic anemia and thrombocytopenia in a patient with renal failure and neurologic symptoms. Presence of fragmented cells in the peripheral smear suggest microangiopathic hemolytic anemia (MAHA). Plasmapheresis. (ADAMTS-13)

Answer 281

Hypothyroidism is most common duh. Increased ophthalmopathy is second at 10%. corticosteroids before and after help.

Answer 282

Central hyperthyroidism with elevated TSH (or inappropriately normal), T3, and T4. Patients have goiter due to TSH effects on tissue growth. VISUAL DISTURBANCES and HA from tumor growth.

Answer 283

Iron-deficiency anemia in an adult male or a postmenopausal woman. Test for occult blood in the stool.

Answer 284

Acetaminophen because of proven efficacy and a favorable side effect profile.

Answer 285

Typical features of gastrointestinal malignancy, like colon cancer, metastatic to the liver. Liver metastases manifests as right upper quadrant pain, mildly elevated liver enzymes, and firm hepatomegaly. Diagnose with CT abdomen.

Answer 286

Amyloidosis. you see renal involvement with nephrotic syndrome. Stain with Congo red and demonstrates apple-green birefringence under polarised light.

Answer 287

Adenocarcinoma of the esophagus.

Answer 288

Dysregulation of imprinted gene expression in chromosome 11p15. Characterized by macrosomia, umbilical hernia/omphalocele, hemihyperplasia (asymmetric larger arm/leg), and hypoglycemia. Children must closely monitored for development of Wilms tumor or hepatoblastoma. GET ABDOMINAL ULTRASOUND.

Answer 289

Focal segmental glomerulosclerosis (FSGS).

Answer 290

Focal segmental glomerulosclerosis (FSGS) and membranous nephropathy.

Answer 291

Nonstress test (NST), followed by a contraction stress test (CST) or biophysical profile if the NST is nonreactive. A CST can be performed if there is no contraindications to labor.

Answer 292

Evaluation of umbilical artery flow in fetal intrauterine growth restriction only.

Answer 293

Amniotic fluid level; Fetal breathing movement; Fetal movement; Fetal tone; Fetal heart rate. You get 2 points for each for total of 10. Abnormal 0, 2, and 4. Equivocal: 6 points.

Answer 294

Fetal compromise is unlikely. The chance of fetal death within 1 week of a normal test is rare, so antepartum testing may be repeated 1 week later.

Answer 295

Labor should be allowed to proceed in patients where the fetus has been diagnosed with severe congenital anomaly incompatible with life.

Answer 296

An accessory pathway conducts depolarization directly from the atria to the ventricles with traversing the AV node. Hemodynamically unstable require immediate electrocardioversion: Hemodynamically stable patients PROCAINAMIDE (preferred) or ibutilide.

Answer 297

Adenosine, beta blockers, calcium channel blockers and digoxin. These agents may promote conduction across the accessory pathway and lead to degeneration of AF to VF.

Answer 298

ABG CHF: hypoxia, HYPOCAPNIA, and respiratory alkalosis; example pH 7.46, pO2 73 mmHG, ((pCO2 31 mmHg)). ABG COPD: hypoxia, HYPERCAPNIA, and respiratory acidosis: example pH 7.39, pO2 80 mmHg ((pCO2 50 mmHg)).

Answer 299

CHF: Bibasilar crackles. COPD: Widespread bilateral wheezes.

Answer 300

B-type natriuretic peptide (BNP) or pulmonary capillary wedge pressure.

Answer 301

Pseudomonas aeruginosa. Most common cause pneumonia in adolescent and adults.

Answer 302

Nontypeable Haemophilus influenzae

Answer 303

Streptococcus pneumoniae. Most common cause of pneumonia in all patients.

Answer 304

Staphylococcus aureus. Most common cause in infants and young children with CF

Answer 305

Petechial rash. Almost 75% have a petechial rash that is prominent on the axilla, wrists, flanks, and ankles.

Answer 306

DOES NOT HAVE A RASH.

Answer 307

Surgery can be delayed up to 72 hours. Elderly patient with syncopal episode should get ECG, cardiac markers and chest- x-ray. If pulmonary edema and pleural effusion you need Echo.

Answer 308

Primary hyperaldosteronism Conn’s disease). Low renin and elevated aldosterone and serum bicarbonate. Causes hypertension, mild hypernatremia, hypokalemia, and metabolic alkalosis.

Answer 309

Portable chest x-ray to confirm proper placement of the catheter tip and absence of complications beofre administering drugs or other agents through the catheter.

Answer 310

Epigastric pain, especially in the setting of symptoms that worsened with exertion. An exercise stress test without imaging if the baseline ECG is normal. Stress test positive then Coronary angiography (gold standard for Dx CAD).

Answer 311

Valsalva (straining phase), Abrupt standing (from sitting or supine position), Nitroglycerin. Physiologic effect: Decrease in preload.

Answer 312

1. Sustained hand grip 2. Squatting (from standing position) 3. Passive leg raise Physiologic effect: 1. Increase Afterload 2. Increase Afterload & Preload 3. Increase Preload

Answer 313

Severe, unbearable pain in face that is knife like, comes in paroxysms, and occurs 10-20 times a day and last a few seconds. Carbamazepine (Prolonged use causes aplastic anemia, get routine CBCs).

Answer 314

MRI of brain. TEE of heart. Blood cultures and intravenous antibiotic therapy. Then watch. No need for antiplatelet therapy (aspirin) that you normally give in acute ischemic stroke due to atherosclerotic thrombosis or embolism. Medullary thyroid cancer (MTC): Presentation: Hard nodule, elevated calcitonin, malignant cells.

Answer 315

Primary hyper((parathyroid)) Entero((pancreatic)) tumors: ((Pituitary)) tumors:

Answer 316

Medullary ((thyroid)) cancer (MTC) ((Pheochromocytoma)): ((Parathyroid)) hyperplasia:

Answer 317

Medullary ((thyroid)) cancer (MTC) ((Pheochromocytoma)): Other: mucosal & interstitial neuromas, ((marfanoid habitus)) Kyphoscoliosis and lordosis.

Answer 318

Autosomal dominant mutations involving RET proto-oncogene located on chromosome 10.

Answer 319

Pseudomonas aeruginosa

Answer 320

Psychomotor agitation, dilated pupils, atrophic nasal mucosa, hypertension, ECG changes. Treatment supplemental oxygen and intravenous benzodiazepines.

Answer 321

Treatment is conservatively with nasogastric suction and parenteral nutrition. Most hematomas spontaneously resolve in 1-2 weeks. Pain is from gastric secretions being blocked.

Answer 322

Albuterol: bronchodilator

Answer 323

ipratropium and tiotropium: bronchodilator:

Answer 324

Idiopathic avascular necrosis of the femoral capital epiphysis (Legg-Calve-Perthes disease)

Answer 325

Congenital cyanotic heart disease in the neonatal period. Presents in the first few hours of life with cyanosis and a single loud second heart sound, and a narrow mediastinum “egg on a string” x-ray. Treat prostaglandins keep PDA open.

Answer 326

Nodule size (cm) ≥2.0; Age(yr) >60; Smoking status Current; Smoking cessation (yr)

Answer 327

A chronic protozoal disease caused by Trypanosoma cruzi. Latin America. Pedal edema, JVD, S3, and cardiomegaly. Because infection causes megaesophagus, megacolon, and/or cardiac dysfunction. Tx: Benznidazole

Answer 328

Do not give beta blockers without alpha blockers. A beta blocker alone may cause increases in blood pressure due to unopposed alpha- receptors. Remember alpha-1 causes vasoconstriction of peripheral vessels.

Answer 329

Ischemia of the distal fingers and toes secondary to vasospasm. Diagnosis is suggested by symmetric duskiness and coolness of all the finger tips. Norepinephrine has alpha-1 agonist properties which cause vasoconstriction. This phenomenon can occur in intestines and kidneys.

Answer 330

The plateau pressure is the measured during an inspiratory hold maneuver Formula: Plateau pressure = elastic pressure + PEEP

Answer 331

Useful in mechanically ventilated patients. Peak airway pressure (the maximum pressure measured as the tidal volume is being delivered) equals the sum of the resistance pressure (flow x resistance) and the plateau pressure. Formula: Peak airway pressure = resistive pressure + plateau pressure

Answer 332

end-expiratory hold maneuver

Answer 333

Decrease the FiO2 to relatively non-toxic values

Answer 334

(3Ds): Diarrhea, Dermatitis, and Dementia, and if untreated Death. Due to niacin deficiency seen in corn based diets in Asia, Africa, and China.

Answer 335

Signs of low arterial perfusion (hypotension, syncope), and acute dyspnea, pleuritic chest pain, and tachycardia. Thrombus increases pulmonary vascular resistance and right ventricular pressure, causing ventricular hypokinesis and dilation, decreased preload, and hypotension.

Answer 336

Increased dyspnea, cough, and sputum production. If patient has 2 of these give antibiotics. Moderate to severe COPD exacerbation or those requiring ventilation also receive antibiotics.

Answer 337

Villous adenoma, sessile adenoma, and size >2.5 cm.

Answer 338

An abnormal fourth heart sound (atrial gallop) due to left ventricular stiffening and dysfunction induced by myocardial ischemia.

Answer 339

Diffusing capacity of the lung (DLCO( is decreased in emphysema and normal in bronchitis.

Answer 340

interstitial lung disease. Sarcoidosis, Asbestosis.

Answer 341

Because the facial/ophthalmic venous system is valveless, uncontrolled infection of the skin sinuses, and orbit can spread to the cavernous sinus. Red flag symptoms include severe headache; bilateral periorbital edema; and cranial nerve II, IV, V, and VI deficits. May see papilledema with ICH.

Answer 342

Infants and children age

Answer 343

Presentation: Acute onset of severe unilateral pelvic pain immediately after strenuous activity or sexual intercourse. Pelvic ultrasound can confirm the diagnosis by showing free fluid in the pelvis. Uncomplicated analgesics, Complicated surgery.

Answer 344

Microvascular complications (retinopathy, nephropathy), but increases risk of hypoglycemia. No change in all cause mortality.

Answer 345

Low estrogen levels and inability to mestate. The poor ovarian function because FSH levels to be high due to lack of negative feedback. LH is also elevated for the same reason.

Answer 346

Iron utilization that most commonly occurs in the setting of chronic inflammation. Normocytic anemia with decreased serum iron, decreased total-iron binding capacity: decreased iron saturation, and normal/elevated ferritin.

Answer 347

That is caused by persistent activation of the alternative complement pathway. Leaves dense intramembranous deposits that stain for C3.

Answer 348

Cephalosporins, penicillins, sulfonamides, NSAIDs, rifampin, phenytoin, and allopurinol. Patient present with arthralgias, rash, renal failure, and the urinalysis will show eosinophiluria.

Answer 349

Dehydroepiandrosterone-sulphate

Answer 350

An angiofibroma until proven otherwise.

Answer 351

Unexplained congestive heart failure (predominantly diastolic dysfunction), echocardiography findings of increased ventricular wall thickness with normal ventricular cavity dimensions (especially in the absence of hypertension, and low voltage on ECG.

Answer 352

pH >7.45 and serum bicarbonate level > 24 mEq/L

Answer 353

Vomiting/ nasogastric aspiration; Prior diuretic use; Current diuretic use.

Answer 354

Excess mineralocorticoids activity ( Primary aldosteronism, cushing's disease, ectopic ACTH production); Barter & Gitleman syndrome.

Answer 355

Contrast enema; If microcolon then diagnosis Meconium ileus; If rectosigmoid transition zone, then Hirschsprung disease.

Answer 356

Upper GI series; If ligament of treitz on right side of abdomen, then malrotation. (Volvulus)

Answer 357

Duodenal atresia

Answer 358

Estrogen antagonist on breast tissue, agonist on endometrium, and decreases risk of osteoporosis. Treatment and prevention of breast cancer. Increases the risk of endometrial cancer. Overall mortality benefit.

Answer 359

Typically cause a contralateral lower facial weakness that spares the forehead.

Answer 360

Intracranial lesion and would warrant brain imaging to evaluate ischemia or tumors.

Answer 361

Immunocompromised patients, who may present with fever, cough, dyspnea, or hemoptysis. Chest x-ray may show a cavitary lesion, and CT scan shows pulmonary nodules with a halo sign or lesions with an air crescent.

Answer 362

Associated with medications that block dopamine transmission such as high potency, typical antipsychotics like haloperidol. Clinical features fever, rigidity, mental status changes, and autonomic instability. Treatment stop drug, control hyperthermia, and maintenance of electrolyte balance. Dantrolene for skeletal muscle relaxation.

Answer 363

Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine.

Answer 364

A middle age or older male, who loses his consciousness immediately after urination, or a man who loses his consciousness during coughing fits. Mechanism includes autonomic dysregulation.

Answer 365

Defined as > 600mL of expectorated blood over 24-hour period or a bleeding rate >100 mL/hour. Greatest danger is aspyxiation due to airway flooding. Patient placed with bleeding lung in the dependent position (lateral position). Bronchoscopy.

Answer 366

Prevention of osteoporosis, and it decreases breast cancer risk. It increase the risk of thromboembolism. Generally women should not get pregnant after rubella vaccination: How long: Recommended waiting time is 28 days, but if women inadvertently get pregnant shortly after vaccination for rubella, they can be reassured that here is little risk to the fetus and they can proceed with ((routine prenatal care)).

Answer 367

Nausea, vomiting, diarrhea, vision changes, and arrhythmias. Get a drug level.

Answer 368

PTH levels are usually much higher in secondary than primary. In addition, serum calcium levels are low to normal in secondary hyperparathyroidism. Serum phosphorous may be low or normal in PHPT were it tends to be high in kidney disease.

Answer 369

CMV pneumonitis after BMT is about 45 days, also manifests as upper and lower gastrointestinal ulcers. Diagnosis with bronchoalveolar lavage.

Answer 370

Should be induced without delay. Especially with low platelets. Remember fibrinogen levels are high in pregnancy therefore anything in the low normal can be an early sign of disseminated intravascular coagulation (DIC).

Answer 371

Maintenance of the corpus luteum.

Answer 372

Preparing the endometrium for implantation of a fertilized ovum.

Answer 373

Progesterone

Answer 374

Syncytiotrophoblast

Answer 375

PAS positive material in the lamina propria of the small intestines. Arthralgias, ((weight loss)), fever, ((diarrhea)), and abdominal pain. Tropheryma whippeli.

Answer 376

Autosomal dominant expansion CTG chromosome 19q 13.3. Onset 12-30. Patient with facial weakness, handgrip myotonia, dysphagia. ((Arrhythmias, cataracts, balding, and testicular atrophy/infertility)). Remember Duchenne and Becker have earlier age of onset without underlined.

Answer 377

((Miosis)), depressed mental status, decreased respiratory rate, decreased bowel sounds, ((hypotension)), and ((bradycardia)).

Answer 378

Administering systemic antibiotics ampicillin plus gentamicin.

Answer 379

GBS and E. coli. Term infants more likely GBS. Preterm is E. coli.

Answer 380

Infant borne: Ingestion of C. botulinum ((spores)) from environmental. Tx: ((Human)) derived botulinum immune ((globulin.)) Foodborne botulism: Ingestion of ((preformed)) C. botulinum ((toxin)). Tx: ((Equine))-derived botulinum ((antitoxin)).

Answer 381

Presentation most consistent with ((ischemic hepatic injury)), or ((shock liver)). Hallmark of ischemic hepatopathy is a rapid and massive increase in the transaminases with modest accompanying elevation in total bilirubin and alkaline phosphatase. If patient survives liver enzymes return to normal in a few weeks.

Answer 382

Sick sinus syndrome, ((bradyarrhythmias)), atrioventricular block; Can be ((intermittent)).

Answer 383

Prolonged QRS duration.

Answer 384

Polymorphic ventricular tachycardia in the setting of prolonged QT interval. Long QTc interval

Answer 385

Get plasma free metanephrine or 24-hour urine metanephrines.

Answer 386

Most common thyroid cancer. Characterized by a slow infiltrative local spread affecting other parts of thyroid gland and regional lymph nodes. Prognosis good. nonencapsulated

Answer 387

Demonstration of invasion of the capsule and blood vessels is required to differentiate follicular cancers from follicular adenomas. Early hematogenous spread to the lungs, brain, and bone.

Answer 388

Calcitonin

Answer 389

Can be seen in both follicular and papillary cancers. Hurthle cell carcinoma is a variant of follicular cell carcinoma.

Answer 390

Vitiligo is an autoimmune condition characterized by areas of depigmentation lacking melanocytes. Vitiligo is sometimes associated with other autoimmune conditions such as pernicious anemia, autoimmune thyroid disease, type I diabetes mellitus, primary adrenal insufficiency, hypopituitarism, and alopecia areata.

Answer 391

The odds ration (OR) is a close approximation of the relative risk (RR) (“rare disease assumption”).

Answer 392

Contralateral hemiparesis and sensory loss. Typically associated with nonreactive miotic pupils and eyes that deviate TOWARD the side of hemiparesis.

Answer 393

Contralateral hemiparesis and sensory loss. Homonymous hemianopsia, and Gaze palsy.

Answer 394

Deep coma & total paralysis within minutes, PINPOINT reactive pupils.

Answer 395

Calcium oxalate crystals (rectangular, envelope-shaped crystals) are seen in urine. Common in antifreeze.

Answer 396

Can cause visual changes (“snowfield vision”) and pancreatitis.

Answer 397

``` Gastrointestinal complaints (abdominal pain, nausea, vomiting) followed by the characteristic triad of periorbital edema, myositis, and eosinophilia (hallmark of the disease). Other clinical findings include fever, subungual splinter hemorrhages or retinal hemorrhages. ```

Answer 398

Severe neutropenia seen in chemo patients should get blood cultures followed by monotherapy with an antipseudomonal beta-lactam agent (cefepime, meropenem, piperacillin-tazobactam) provides both gram-negative & gram-positive coverage.

Answer 399

Seen in children from ages 2-10. Varying degrees of anemia, neutropenia, and thrombocytopenia. Blast cells have condensed nuclear chromatin, small nucleoli and scant agranular cytoplasm. Histochemical staining strongly positive periodic acid Schiff (PAS). Deoxynucleotidyltransferase (TdT) is positive 95% time. 25% lymphoblasts bone marrow diagnostic.

Answer 400

A form of compartment syndrome (CS). Post-ischemic CS is due to interstitial edema and possibly intracellular swelling following tissue ischemia and subsequent reperfusion such as after and embolectomy. Compartment pressure > 300 mmHg.

Answer 401

Aspirin, Clopidogrel, Nitrates (sublingual), beta blocker (unless hypotension, bradycardia, CHF, heart block), High dose statin, anticoagulation (depends on planned revascularization).

Answer 402

Intravenous nitroglycerin (not if hypotension, right ventricular infarct, or severe aortic stenosis occurs)

Answer 403

Intravenous morphine

Answer 404

Intravenous atropine Initial stabilization of acute ST-elevation MI: Drug given pulmonary edema: Intravenous furosemide (not if patient is hypotensive or hypovolemic)

Answer 405

Spiculated “sunburst” pattern and periosteal elevation known as the Codman triangle. Most common primary bone tume affecting children and young adults.

Answer 406

An osteolytic lesion with a periosteal reaction that produces layers of reactive bone, giving the classic “onion skin” appearance. Second most common primary bone tumor.

Answer 407

Sclerotic, cortical lesion on imaging with a central nidus of lucency. It typically causes pain that is worse at night and unrealted to activity. Pain is quickly relieved by NSAIDs.

Answer 408

Erythematous papules, vesicles, and bullae that occur bilaterally, symmetrically, and in grouped “herpetiform” arrangement on the extensor surfaces elbows, knees, upper back, and buttocks. Associated with gluten-sensitive entropathy (celiac disease). Tx: Dapsone

Answer 409

Increased beta-hCG

Answer 410

Elevations in serum concentration AFP or beta-HCG can appear, due to coexistence of other germ cell tumor components.

Answer 411

Serum tumor markers are usually normal, although beta-hCG maybe somewhat elevated if they contain synctiotrophoblastic giant cells.

Answer 412

Germ cell tumor accompanied by an increase in serum AFP.

Answer 413

Inconclusive: diagnostic peritoneal lavage (DPL). Positive: Laparotomy.

Answer 414

Check prolactin, TSH, FSH

Answer 415

Diagnosis hypothyroidism

Answer 416

Premature ovarian failure

Answer 417

Absence of menses for ≥3 cycles or ≥6 months in women who menstruated previously.

Answer 418

Periannular extension of endocarditis.

Answer 419

Caused by β-lactams, and sulfa drugs. Symptoms arise 1-2 weeks after exposure and include fever, urticarial rash, polyarthralgia, and lymphadenopathy. Remove offending agent.

Answer 420

Decreased cardiac output/index, increased systemic vascular resistance (SVR), and an increase in left ventricular end-diastolic volume (LVEDV).

Answer 421

Skin: flushing, telangiectasia, cyanosis; GI: diarrhea, cramping; Cardiac: valvular lesions (right>left); Pulmonary: bronchospasms; Niacin deficiency (dermatitis, diarrhea, dementia). Diagnosis 24-hour urine 5-hydroxyindoleacetic acid. CT/MRI to localize tumor. OctreoScan to detect metastasis.

Answer 422

fetal aneuploidy and can be ordered at ≥10 weeks gestation.

Answer 423

Chorionic villus sampling at 10-12 weeks or amniocentesis at 15-20 weeks.

Answer 424

Pregnancy- associated plasma protein, β-hCG, nuchal translucency.

Answer 425

Maternal serum ɑ-fetoprotein, estriol, β-hCG, inhibin A.

Answer 426

most common in cancers that have spread to bone from the lung, thyroid, kidney, and colon.

Answer 427

It is more frequently seen in spread of prostate, bladder, and stomach cancer.

Answer 428

To localize ischemia or assess viability to recommend exercise

Answer 429

CT scan of abdomen

Answer 430

Prior PTB is the strongest risk factor for future PTB, and recurrences often occur at the same gestational age

Answer 431

ACTH stimulation test

Answer 432

Dexamethasone suppression test.

Answer 433

1. The Flu Vaccine 2. Pneumococcal vaccine 3. Diphtheria, tetanus, and pertussis vaccines 4. HPV vaccine 5. Hep B vaccine

Answer 434

* Live in a city that has had a meningitis outbreak (such as New York City) * Travel to a city that has had a meningitis outbreak * Have or will have close contact with other men who have sex with men from a city that has had a meningitis outbreak

Answer 435

When the ultrasound is inconclusive, because it deals with the gall bladder, no need in patient who already has cholecystectomy.

Answer 436

* People who use intravenous (IV) drugs * Men who have sex with men * People who already have other forms of liver disease * People with a bleeding disorder called hemophilia * People who travel to certain parts of the world

Answer 437

Varicella and Zoster vaccines

Answer 438

at the elbow, followed by the wrist

Answer 439

heparin therapy

Answer 440

Cubital tunnel syndrome is used to describe ulnar nerve impingement along the cubital tunnel at the medial edge of the elbow. It is the most common location of nerve impingement in the elbow area

Answer 441

Guyon's canal syndrome, or ulnar tunnel syndrome, refers to nerve compression affecting the ulnar nerve as it passes through an anatomical space in the wrist called Guyon's canal

Answer 442

Rh(+) factors from newborn leaks into mothers bloodstream, causes anti IgG Rh antibodies.

Answer 443

Intermittent urinary incontinence, overflow incontinence by an acontractyle bladder (think detrusor muscle - lack of innervation)

Answer 444

Essential hypertension, from renal vascular lesions, most commonly in the renal vasculature.

Answer 445

Adrenoleukodystrophy (ALD)

Answer 446

Adrenoleukodystrophy (ALD) is an X-linked disorder

Answer 447

Mutations may prevent normal transport of very long chain fatty acids (VLCFAs) into peroxisomes, thereby preventing beta-oxidation and breakdown of VLCFAs. Accumulation of abnormal VLCFAs in CNS, Leydig cells of the testes, and the adrenal cortex

Answer 448

blood pressure greater than the 95th percentile for age, height, weight.

Answer 449

Aortic stenosis

Answer 450

Pulmonic stenosis, flow murmur, ASD (atrial septal defect)

Answer 451

Pulmonic stenosis

Answer 452

Hypertrophic cardiomyopathy

Answer 453

Aortic regurgitation, pulmonic regurgitation

Answer 454

mitral regurgitation

Answer 455

mitral valve prolapse

Answer 456

mitral stenosis

Answer 457

tricuspid regurgitation, ventral septal defect

Answer 458

tricuspid stenosis, ASD (atrial septal defect)

Answer 459

ASD murmurs caused by increased blood flow across pulmonic valve and tricuspid valve

Answer 460

Embolic stroke, brain abscess or cerebritis, meningitis, acute encephalopathy, meningoencephalitis.

Answer 461

Adults with a body mass index (BMI) ≥40 kg/m2 without comorbid illness or a BMI 35.0 to 39.9 kg/m2 with at least one serious comorbidity, such as type 2 diabetes or hypertension, are candidates for a bariatric surgical procedure. Adults with BMI between 30.0 to 34.9 kg/m2 and either difficult to control type 2 diabetes mellitus or metabolic syndrome should be considered as candidates

Answer 462

Wrist drop, loss of thumb abduction

Answer 463

Tapping over the median nerve at the wrist elicits tingling in the median nerve distribution.

Answer 464

Pain, pallor paresthesias, poikilothermic, paralysis, pulselessness

Answer 465

- Entrapment of the median nerve at the wrist. - Presents w/ aching over the thenar area of the hand and proximal forearm (maybe shoulder). - parasthesia/numbness in median nerve distribution - Symptoms worsen at night - Phalen's maneuver and Tinel's sign are (+)

Answer 466

1st and 2nd lumbrical muscles and the muscles of the thenar eminence.

Answer 467

The median nerve innervates the skin of the palmar side of the thumb, the index and middle finger and half the ring finger.

Answer 468

Loss of pronation of forearm, weakness in flexion of the hand at the wrist, loss of flexion of radial half of digits and thumb, loss of abduction and opposition of thumb. Presence of an ape hand deformity when the hand is at rest, due to an hyperextension of index finger and thumb, and an adducted thumb. Presence of benediction sign when attempting to form a fist, due to loss of flexion of radial half of digits. Sensory deficit: Loss of sensation in lateral 3 1⁄2 digits including their nail beds, and the thenar area.

Answer 469

Cubital tunnel syndrome, fracture of the medial epicondyle

Answer 470

Ulnar lesions at the elbow typically present with numbness and tingling in the fourth and fifth digits, medial elbow pain, nocturnal numbness and paresthesia, and worsening of symptoms with elbow and/or repeated wrist flexion

Answer 471

Sensory deficit: Loss of sensation or paresthesiae in ulnar half of the palm and dorsum of hand, and the medial 1½ digits on both palmar and dorsal aspects of the hand

Answer 472

Loss of sensation or paresthesia in ulnar half of the palm, and the medial 1½ digits on the palmar aspect of the hand. The dorsal aspect of the hand is unaffected.

Answer 473

Loss of flexion of ulnar half of digits, or the 4th and 5th digits, loss of ability to cross the digits of the hand. Presence of a claw hand deformity when the hand is at rest.

Answer 474

penetrating wound or Guyon canal cyst

Answer 475

Dilated - impaired contractility Hypertrophic - impaired relaxation Restrictive - impaired elasticity

Answer 476

For dilated cardiomyopathy: - ↑↑ Left ventricular cavity size (end diastole) - ↑↑ Left ventricular cavity size (end systole) - ↓↓ Ejection fraction (EF) - ↓, variable Wall thickness

Answer 477

For hypertrophic cardiomyopathy: - ↓ Left ventricular cavity size (end diastole) - ↓↓ Left ventricular cavity size (end systole) - ↑ or ↔ Ejection fraction (EF) - ↑↑ Wall thickness

Answer 478

For dilated cardiomyopathy: - ↑ Left ventricular cavity size (end diastole) - ↑ Left ventricular cavity size (end systole) - ↓ or ↔ Ejection fraction (EF) - ↑, variable Wall thickness

Answer 479

An S3 gallop signifies the end of rapid ventricular filling in the setting of fluid overload and is associated with dilated cardiomyopathy.

Answer 480

Echocardiography

Answer 481

■ CXR shows an enlarged, balloon-like heart and pulmonary congestion.

Answer 482

■ Address the underlying etiology (e.g., stop all alcohol use, treat endocrine disorders). ■ Treat symptoms of CHF with diuretics, and prevent disease progression with ACEIs, β-blockers, and aldosterone antagonists. Consider anticoagulation to ↓ thrombus risk only if AF or an intraventricular thrombus is present. Digoxin is a second-line agent; avoid CCBs in CHF. ■ Consider an ICD if EF

Answer 483

LVH results in impaired left ventricular relaxation and filling (diastolic dysfunction). Hypertrophy frequently involves the interventricular septum, leading to left ventricular outflow tract obstruction and impaired ejection of blood.

Answer 484

The congenital form of hypertrophic cardiomyopathy, hypertrophic obstructive cardiomyopathy (HOCM).

Answer 485

It is inherited as an autosomal-dominant trait in 50% of HOCM patients.

Answer 486

A stiff, noncompliant ventricle

Answer 487

hypertrophic cardiomyopathy.

Answer 488

eosin-5 maleimide test (flow cytometry) with acid glycerol lysis test

Answer 489

Wind (lungs): Pulmonary embolism; Pneumonia; Aspiration; Wound: Surgical site infection Water: Urinary tract infection (UTI) Walk: Deep venous thrombosis Wonder drugs/products: Drug fever; Blood products; Intravenous lines.

Answer 490

(most common reaction): Fever and chills; Within 1-6 hours of transfusion; Caused by cytokine accumulation during blood storage.

Answer 491

Fever, flank pain, hemoglobinuria, renal failure and DIC; Within 1 hour of transfusion. Positive direct Coombs test, pink plasma; Caused by ABO incompatibility.

Answer 492

Mild fever and hemolytic anemia; Within 2-10 days after transfusion; Positive direct Coombs test, positive antibody screen; Caused by anamnestic antibody response.

Answer 493

Rapid onset of shock, angioedema/urticaria and respiratory distress; Within a few seconds to minutes of transfusion; Caused by recipient anti-IgA antibodies

Answer 494

Urticaria, flushing, angioedema and pruritus; Within 2-3 hours of transfusion; Caused by recipient IgE antibodies and mast cell activation.

Answer 495

Respiratory distress and signs of noncardiogenic pulmonary edema; Within 6 hours of transfusion; Caused by donor anti-leukocyte antibodies.

Answer 496

Mathematical average

Answer 497

splits an ordered dataset in half.

Answer 498

The most frequently observed value.

Answer 499

Nontreponemal serological tests (VDRL, RPR) are used for screening test, and treponemal serologic tests (FTA-ABS) are used to confirm. Darkfield microscopy is also an effective method for diagnosing, but requires equipment. Darkfield is used because serologic testing has a high false negative rate.

Answer 500

Symmetrical proximal muscle weakness; Increasing difficulty climbing stairs, getting up from a chair, carrying heavy groceries; Less prominent hip/shoulder involvement; Labs: Elevated muscle enzymes (creatine kinase, aldolase, lactate dehydrogenase, aspartate aminotransferase), possible autoantibodies, EMG abnormal.

Answer 501

Age usually >50. Aching and morning stiffness>pain in shoulders, hips, neck, torso. Synovitis, bursitis, decreased range of motion. No significant tenderness. Possible systemic symptoms; Clinical diagnosis. Significantly elevated ESR. Symptoms improve with corticosteroids.

Answer 502

Can cause autoimmune hemolytic anemia and thrombocytopenia, which is due to cross reactivity of the EBV-induced antibodyeas against RBCs and platelets. These antibodies are IgM cold agglutinin antibodies lead to compliment mediated RBC destruction (Coombs +). Onset 2-3 weeks.

Answer 503

Prinzmetal’s (variant) angina

Answer 504

Prinzmetal’s (variant) angina mimics angina pectoris but is caused by vasospasm of coronary vessels. It classically affects young women at rest in the early morning and is associated with ST-segment elevation in the absence of cardiac enzyme elevation.

Answer 505

substernal chest pain that is provoked by exertion and relieved by rest or nitrates.

Answer 506

Only ASA and β-blockers

Answer 507

Women, diabetics, the elderly, and post–heart transplant patients

Answer 508

ASA, O2 and/or IV nitroglycerin, and IV mor- phine, and consider IV β-blockers.

Answer 509

nitrates, ASA, and β-blockers; CCBs are second-line agents for symptomatic control only

Answer 510

A spectrum of clinical syndromes caused by plaque disruption or vasospasm that leads to acute myocardial ischemia.

Answer 511

chest pain that is new onset, is accelerating (i.e., occurs with less exertion, lasts longer, or is less responsive to medications), or occurs at rest; it is distinguished from stable angina by patient history.

Answer 512

impending infarction

Answer 513

NSTEMI indicates myocardial necrosis marked by elevations in troponin I, troponin T, or CK-MB

Answer 514

unstable angina

Answer 515

Clopidogrel, unfractionated heparin or enoxaparin, and glycoprotein IIb/IIIa inhibitors (e.g., eptifibatide, tirofiban, abciximab) should also be considered.

Answer 516

Give Heparin and scheduled for angiography and possible revascularization (percutaneous coronary intervention [PCI] or CABG).

Answer 517

1. Age ≥ 65 years = 1 2. ≥ 3 CAD risk factors (family history, DM, tobacco, hypertension, ↑ cholesterol) = 1 3. Known CAD (stenosis > 50%) = 1 4. ASA use in past seven days = 1 5. Severe angina (≥ 2 episodes within 24 hours) = 1 6. ST deviation ≥ 0.5 mm 7. + cardiac marker

Answer 518

Enoxaparin (vs. unfractionated heparin), glycoprotein IIb/IIIa inhibitors, and early angiography.

Answer 519

ST-segment elevations and cardiac enzyme release 2° to prolonged cardiac ischemia and necrosis.

Answer 520

■ Presents with acute-onset substernal chest pain, commonly described as a pressure or tightness that can radiate to the left arm, neck, or jaw. ■ Associated symptoms may include diaphoresis, shortness of breath, light- headedness, anxiety, nausea/vomiting, and syncope. ■ Physical exam may reveal arrhythmias, new mitral regurgitation (ruptured papillary muscle), hypotension (cardiogenic shock), and evidence of new CHF (rales, peripheral edema, S3 gallop).

Answer 521

ECG: Look for ST-segment elevations or new LBBB. ST-segment depressions in leads V1–V2 can also be reciprocal change indicating infarction in the posterior wall.

Answer 522

ST-segment elevation in leads II, III, and aVF is consistent with an inferior MI involving the RCA/PDA and LCA.

Answer 523

ST-segment elevation in leads V1–V4 usually indicates an anterior MI involving the LAD and diagonal branches

Answer 524

ST-segment elevation in leads I, aVL, and V5–V6 points to a lateral MI involving the LCA.

Answer 525

ST-segment depression in leads V1–V2 can be “reciprocal change” indicative of an acute infarct in the posterior wall.

Answer 526

ASA, β-blockers, clopidogrel, morphine, nitrates, and O2.

Answer 527

Do not give β-blockers; instead, give ACEIs, provided that the patient is not hypotensive.

Answer 528

Emergent angiography and PCI should be performed

Answer 529

Acute pericarditis, LVH, LBBB, and a normal variant (e.g., “early repolarization”).

Answer 530

Inferior wall MI.

Answer 531

Anterior wall MI.

Answer 532

Thrombolysis with tPA, reteplase, or streptokinase should be performed instead of PCI.

Answer 533

PCI should be attempted immediately for the lesion thought to be responsible for STEMI; the patient is a candidate for CABG afterward.

Answer 534

Long-term treatment includes ASA, ACEIs, β-blockers, high-dose statins, and clopidogrel (if PCI was performed). Modify risk factors with dietary changes, exercise, and tobacco cessation.

Answer 535

Arrhythmia

Answer 536

Dressler’s syndrome, an autoimmune process occurring 2–10 weeks post- MI, presents with fever, pericarditis, pleural effusion, leukocytosis, and ↑ ESR.

Answer 537

Reinfarction, left ventricular wall rupture, VSD, pericarditis, papillary muscle rupture (with mitral regurgitation), left ventricular aneurysm or pseudoaneurysm, and mural thrombi.

Answer 538

A timeline of common post-MI complications: ■ First day: Heart failure (treat with nitroglycerin and diuretics). ■ 2–4 days: Arrhythmia, pericarditis (diffuse ST elevation with PR depression). ■ 5–10 days: Left ventricular wall rupture (acute pericardial tamponade causing electrical alternans, pulseless electrical activity), papillary muscle rupture (severe mitral regurgitation). ■ Weeks to months: Ventricular aneurysm (CHF, arrhythmia, persistent ST elevation, mitral regurgitation, thrombus formation).

Answer 539

Etiologies include obesity, DM, alcoholism, hypothyroidism, nephrotic syndrome, hepatic disease, Cushing’s disease, OCP use, high-dose diuretic use, and familial hypercholesterolemia.

Answer 540

■ Most patients have no specific signs or symptoms. ■ Patients with extremely high triglyceride or LDL levels may have xanthomas (eruptive nodules in the skin over the tendons), xanthelasmas (yellow fatty deposits in the skin around the eyes), and lipemia retinalis (creamy appearance of retinal vessels).

Answer 541

■ Conduct a fasting lipid profile for patients > 20 years of age and repeat ev- ery five years or sooner if elevated. ■ Total serum cholesterol > 200 mg/dL on two different occasions is diagnos- tic of hypercholesterolemia.

Answer 542

Dyslipidemia: ■ LDL > 130 mg/dL or ■ HDL

Answer 543

- CAD or CAD risk equivalents:

Answer 544

- CAD or CAD risk equivalents: > 100 mg/dL - 2+ risk factors: > 130 mg/dL - 0-1 risk factor: > 160 mg/dL

Answer 545

- CAD or CAD risk equivalents: > 130 mg/dL - 2+ risk factors: > 160 mg/dL - 0-1 risk factor: > 190 mg/dL

Answer 546

symptomatic carotid artery disease, peripheral arterial disease, abdominal aortic aneurysm, diabetes.

Answer 547

Cigarette smoking, hypertension, low HDL ( 45 years; women > 55 years). An HDL > 60 mg/dL counts as a “negative” risk factor and removes one risk factor from the total score.

Answer 548

LDL > 130 mg/dL or HDL

Answer 549

LDL > 130 mg/dL or HDL

Answer 550

The first intervention should be a 12-week trial of diet and exercise in a patient with no known atherosclerotic vascular disease.

Answer 551

Defined as a systolic BP > 140 mmHg and/or a diastolic BP > 90 based on three measurements separated in time

Answer 552

Can cause autoimmune hemolytic anemia and thrombocytopenia, which is due to cross reactivity of the EBV-induced antibodies against RBCs and platelets. These antibodies are IgM cold agglutinin antibodies lead to compliment mediated RBC destruction (Coombs +). Onset 2-3 weeks.

Answer 553

1 Complete atrioventricular canal 2 Ventricular septal defect 3 Atrial septal defect

Answer 554

Gram-positive rod (beaded or branching), partially acid-fast, aerobic. Found in soil. Most common in immune compromised or elderly patients.Inhalation of aerosolized saprophytes or traumatic inoculation skin. Pneumonia like TB, Neural tropism (brain abscess), cutaneous involvement. Tx: TMP-SMX.

Answer 555

In the case of isolated rotator cuff tendonitis, any pain and limitation of motion is resolved by injection. Does do this for the other two.

Answer 556

Lynch syndrome II is distinctly associated with a high risk of extracolonic tumors, the most common of which is endometrial carcinoma.

Answer 557

Radicular pain, asymmetric motor weakness, hyporeflexia/areflexia. Late bladder/bowel dysfunction. A sensory level at the umbilicus excludes this.

Answer 558

Sudden onset severe back pain, symmetrical motor weakness, hyperreflexia. Early onset bladder/bowel dysfunction.

Answer 559

Initial endoscopy/biopsy positive for adenocarcinoma; Ct abdomen and pelvis; Limited stage = surgical resection. Advanced stage = Chemotherapy, palliative.

Answer 560

CURB-65 (1 point each): 2 or more inpatient Tx. score ≥ 4 ICU. Confusion Uremia (BUN > 20 mg/dL) Tachpnea (Respirations > 30/min) Hypotension 65 Community-acquired pneumonia (CAP): Treatment: Outpatient, Inpatient, ICU Outpatient Healthy: Macrolide or Doxycycline Outpatient Comorbid: Fluoroquinolones or beta-lactam + macrolide Inpatient: Fluoroquinolones (levofloxacin, moxifloxacin) or beta-lactam + macrolide ICU: Beta-lactam + macrolide (IV) or Fluoroquinolones + beta-lactam

Answer 561

Pulmonary veins

Answer 562

The tricuspid annulus

Answer 563

Delta waves are characteristic of WPW syndrome.

Answer 564

Calcium decreased; Phosphate increased; Potassium increased; Uric acid increased; Tx: Allopurinol: Most common tumors lymphomas (Burkitt’s) and leukemias (ALL).

Answer 565

Elderly patients with poorly controlled diabetes. Pseudomonas aeruginosa.

Answer 566

Aspergillus.

Answer 567

Multisystemic inflammatory condition seen commonly in Turkish, Asian, and Middle Eastern populations. Characterised by recurrent oral and genital ulcers, skin lesions (erythema nodosum), eye lesions including anterior/posterior uveitis.

Answer 568

Ultrasound dating with fetal crown-rump measurement in the first trimester. 2nd and third not as accurate.

Answer 569

They are in labor

Answer 570

Sudden behavioral problems, families with unstable economic backgrounds, or parents with a history of drug/alcohol abuse.

Answer 571

With repeat urine dipsticks on two separate occasions to R/O persistent proteinuria, which requires more work up.

Answer 572

Excessive collagen deposition in extracellular matrix around alveoli; Leads to decreased lung volume (low total lung capacity, functional residual capacity, and residual volume) with preserved or increased forced expiratory volume in 1 second/forced vital capacity. Impaired gas exchange resulting in reduced diffusion capacity of carbon monoxide and increased alveolar-arterial gradient.

Answer 573

``` Multiple myeloma (MM), amyloidosis, Waldenstrom's macroglobulinemia, and monoclonal gammopathy of undetermined significance (MGUS). ```

Answer 574

MGUS patients usually have

Answer 575

Metastatic skeletal bone survey

Answer 576

``` Stage 0 = Lymphocytosis only = Good Stage I = Lymphocytosis + adenopathy = Fair Stage II = Splenomegaly = Fair Stage III = Anemia = Intermediate Stage IV = Thrombocytopenia = Poor ```

Answer 577

“smudge cells” = leukocytes that have undergone partial breakdown during preparation of a stained smear or tissue section, because of their greater fragility.

Answer 578

Serum anion gap and beta-hydroxybutyrate levels.

Answer 579

Hypertension with no identifiable cause. Represents 95% of cases of hyperten- sion. Risk factors include a family history of hypertension or heart disease, a high-sodium diet, smoking, obesity, race (blacks > whites), and advanced age.

Answer 580

■ Hypertension is asymptomatic until complications develop. ■ Patients should be evaluated for end-organ damage to the brain (stroke, dementia), eye (cotton-wool exudates, hemorrhage), heart (LVH), and kid- ney (proteinuria, chronic kidney disease). Renal bruits may signify renal artery stenosis as the cause of hypertension.

Answer 581

■ Conduct cardiovascular, neurologic, ophthalmologic, and abdominal ex- ams. ■ Obtain a UA, BUN/creatinine, CBC, and electrolytes to assess the extent of end-organ damage.

Answer 582

Normal = none Prehypertension = none Stage 1 hypertension = Thiazide diuretics for most patients; ACEIs, ARBs, β-blockers, CCBs, or a combination may be considered. Stage 2 hypertension = Two-drug combination for most patients (usually a thiazide diuretic plus an ACEI, an ARB, a β-blocker, or a CCB).

Answer 583

■ Rule out 2° causes of hypertension, particularly in younger patients. ■ Begin with lifestyle modifications (e.g., weight loss, smoking cessation, salt reduction). Weight loss is the single most effective lifestyle modification. The BP goal in otherwise healthy patients is

Answer 584

Hypertension 2° to an identifiable organic cause

Answer 585

``` Cushing's syndrome Hyperaldosteronism (Conn's syndrome) Aortic coarctation Pheochromocytoma Stenosis of renal arteries ```

Answer 586

A spectrum of clinical presentations in which elevated BPs lead to end-organ damage.

Answer 587

Presents with end-organ damage revealed by chest pain (ischemia or MI), back pain (aortic dissection), or changes in mental status (hypertensive en- cephalopathy).

Answer 588

Hypertensive crises are diagnosed on the basis of the extent of end-organ damage, not BP measurement.

Answer 589

■ Hypertensive urgency: Diagnosed on the basis of an elevated BP with only mild to moderate symptoms (headache, chest pain, syncope) and without end-organ damage. ■ Hypertensive emergency: Diagnosed by a significantly elevated BP with signs or symptoms of impending end-organ damage such as ARF, intracranial hemorrhage, papilledema, or ECG changes suggestive of ischemia or pulmonary edema.

Answer 590

Diagnosed on the basis of progressive renal fail- | ure and/or encephalopathy with papilledema.

Answer 591

Hypertensive crises are diagnosed on the basis of the extent of end-organ damage, not BP measurement.

Answer 592

Thiazide diuretics, β-blockers, ACEIs, ARBs, aldosterone antagonists.

Answer 593

β-blockers, ACEIs, aldosterone antagonists.

Answer 594

Thiazide diuretics, β-blockers, ACEIs, CCBs.

Answer 595

Thiazide diuretics, β-blockers, ACEIs, ARBs, CCBs.

Answer 596

ACEIs, ARBs

Answer 597

Thiazide diuretics, ACEIs

Answer 598

- 1° renal disease - Renal artery stenosis - OCP use - Pheochromocytoma - Conn’s syndrome (hyperaldosteronism) - Cushing’s syndrome - Coarctation of the aorta

Answer 599

- 1° renal disease - Often unilateral renal parenchymal disease. - Treat with ACEIs - Renal artery stenosis - Especially common in patients 50 years of age with recent-onset hypertension. - Diagnose with MRA or renal artery Doppler ultrasound. May be treated with angioplasty or stenting. Consider ACEIs if unilateral, not if bilateral. - OCP use - Common in women > 35 years of age, obese women, and those with long-standing use. - Discontinue OCPs

Answer 600

May be treated with angioplasty or stenting. Consider ACEIs as adjunctive or temporary therapy in unilateral disease. (In bilateral disease, ACEIs can accelerate kidney failure by preferential vasodilation of the efferent arteriole.) Open surgery is a second option if angioplasty is not effective or feasible.

Answer 601

- Pheochromocytoma - An adrenal gland tumor that secretes epinephrine and norepinephrine, leading to episodic headache, sweating, and tachycardia - Diagnose with urinary metanephrines and catecholamine levels or plasma metanephrine. Surgical removal of tumor after treatment with both α-blockers and β-blockers. - Conn's syndrome (hyperaldosteronism) - Most often 2° to an aldosterone-producing adrenal adenoma. Causes the triad of hypertension, unexplained hypokalemia, and metabolic alkalosis - Remove tumor

Answer 602

- Cushing's syndrome - Due to an ACTH-producing pituitary tumor, an ectopic ACTH-secreting tumor, or cortisol secretion by an adrenal adenoma or carcinoma. - Remove tumor

Answer 603

Hypertensive urgencies: Can be treated with oral antihypertensives (e.g., β-blockers, clonidine, ACEIs) with the goal of gradually lowering BP over 24–48 hours

Answer 604

Treat with IV medications (labetalol, nitro- prusside, nicardipine) with the goal of lowering mean arterial pressure by no more than 25% over the first two hours to prevent cerebral hypoperfusion or coronary insufficiency.

Answer 605

Results from acute or chronic pericardial insults; may lead to pericardial effusion.

Answer 606

ACEIs or ARBs.

Answer 607

β-blockers, ACEIs or ARBs, diuretics (including spironolactone).

Answer 608

Diuretics are preferred; long-acting dihydropyridines.

Answer 609

β-blockers without intrinsic sympathomimetic activity; ACEIs.

Answer 610

Thiazide diuretics.

Answer 611

α1-adrenergic blockers.

Answer 612

Results from acute or chronic pericardial insults; may lead to pericardial effusion.

Answer 613

Tamponade or constrictive pericarditis

Answer 614

Idiopathic

Answer 615

Viral infection, TB, SLE, uremia, drugs, radiation, injury, acute renal failure and neoplasms. May also occur after MI (either within days after MI or as a delayed phenomenon, i.e., Dressler’s syndrome) or open heart surgery.

Answer 616

■ May present with pleuritic chest pain, dyspnea, cough, and fever. ■ Chest pain tends to worsen in the supine position and with inspiration.

Answer 617

■ Exam may reveal a pericardial friction rub, elevated JVP, and pulsus paradoxus (a ↓ in systolic BP > 10 mmHg on inspiration).

Answer 618

CXR, ECG, and echocardiogram to rule out MI and pneumonia.

Answer 619

ECG changes include diffuse ST-segment elevation and PR-segment depressions followed by T-wave inversions

Answer 620

Pericardial thickening or effusion may be evident on echocardiography.

Answer 621

Growth hormone, tetracyclines (minocycline, doxycycline), and excessive vitamin A (isotretinoin, all-trans-retinoic acid)

Answer 622

Abrupt and often dramatic, URI symptoms are mild, but systemic symptoms are prominent with possible high fever, myalgias, headache.

Answer 623

Slow, stepwise, migratory, or evolving. URI symptoms, rhinorrhea, coryza, sneezing, mild pharyngitis, while systemic symptoms usually mild.

Answer 624

Within 48 hours of symptoms onset. Neuraminidase inhibitors (oseltamivir, zanamivir).

Answer 625

Tumor burden which is based on TMN staging.

Answer 626

Can cause blindness.

Answer 627

CT scan is best.

Answer 628

The incidence of hepatocellular carcinoma.

Answer 629

Rate and rhythm control.

Answer 630

Glomerulonephritis in adults:

Answer 631

Effect: Antipsychotic efficacy.

Answer 632

Effect: Extrapyramidal symptoms: Acute dystonia, akathisia, parkinsonism.

Answer 633

Effect: Hyperprolactinemia.

Answer 634

Needle thoracostomy.

Answer 635

Surreptitious vomiting, diuretic abuse, Bartter syndrome, Gitelman syndrome.

Answer 636

Stretching, manipulation, followed by serial casting. This is clubfoot (talipes equinovarus)

Answer 637

Streptococcus pyogenes; Fiery red, tender, painful plaque with sharply demarcated edges.

Answer 638

Staphylococcus Aureus; Folliculitis, Furuncle, Carbuncle.

Answer 639

Streptococci; Flat lesion with less demarcation than in erysipelas.

Answer 640

Pleural fluid protein/serum protein ratio >0.5 Pleural fluid lactate dehydrogenase (LDH)/serum LDH ratio >0.6 Pleural fluid LDH>⅔ of the upper limit of normal serum LDH

Answer 641

pH 7.60 normal pH 7.4-7.55 transudate pH 7.30-7.45 exudate pH

Answer 642

Glucose ratio

Answer 643

Bright, red, firm, friable, exophytic nodules in an HIV infected patient. Bacillary angiomatosis is caused by Bartonella, a gram-negative bacillus. Tx: Oral erythromycin.

Answer 644

Group A streptococcus (GAS)/ Streptococcus pyogenes: Causes pharyngitis. Tx: Penicillin.

Answer 645

Suspected in a child with sore throat, fever, pericarditis, erythema marginatum, arthritis, chorea, and subcutaneous nodules.

Answer 646

Often arises in Hispanics and Southwestern Native American females with history of gallstones. Typically diagnosed after cholecystectomy. Highly fatal, but if confined to gallbladder 73-100% cure rate.

Answer 647

Focal substernal burning pain and odynophagia. Large linear ulcerations generally shallow in lower esophagus. Presence of intranuclear and intracytoplasmic inclusions on biopsy. Tx: IV ganciclovir. Acyclovir does not work because CMV does not have thymidine kinase enzyme to activate.

Answer 648

Usually multiple, small, and well circumscribed with a round/ovoid “volcano-like” appearance. Cells show ballooning degeneration and eosinophilic intranuclear inclusions. Tx: Acyclovir.

Answer 649

Rapid bone loss resulting from increased osteoclastic activity in bone cells. Also at risk for cardiac tachyarrhythmias AF.

Answer 650

Pharmacist directed interventions.

Answer 651

Occurs days 5-14 days. Oral erythromycin. Erythromycin can cause infantile hypertrophic pyloric stenosis.

Answer 652

Flecainide and propafenone. They work by blocking sodium channels. In patients with fast heart rates, the drug has less time to dissociate, leading to more channels blocked, which leads to progressive decrease in impulse conduction and widened QRS.

Answer 653

Intravascular volume depletion and poor renal perfusion (renal arteriolar vasoconstriction).

Answer 654

Spontaneous speech: Sparse and nonfluent. Comprehension: Relatively preserved. Repetition: Impaired. Associated: Right hemiparesis. Located in dominant right frontal lobe.

Answer 655

Spontaneous speech: Fluent and voluminous, but lacks meaning Comprehension: Greatly diminished. Repetition: Impaired. Associated: Right superior visual field defect.

Answer 656

Spontaneous speech: Fluent with pneumonic errors. Comprehension:Relatively preserved. Repetition: Very poor. Associated: None.

Answer 657

beta blocker such as propranolol

Answer 658

Next is HPV testing. If positive get colposcopy. If negative repeat pap smear and HPV test in 3 years.

Answer 659

Repeat pap smear at 12 months. If ASC-H or AGC or HSIL get a colposcopy. If negative or ASC-US or LSIL then repeat pap smear at 12 months Must have a negative pap smear X2 to return to normal screening.

Answer 660

Regular contractions causing cervical dilation and/or effacement at

Answer 661

A tocolytic agent (calcium channel blocker), magnesium sulfate for neuroprotection, and corticosteroids for acceleration of fetal lung maturity.

Answer 662

syphilis, HIV, and hepatitis B.

Answer 663

A sudden vasomotor collapse and skin rash (large purpuric lesions on the flanks) due to hemorrhage. This is due to adrenal hemorrhage.

Answer 664

IgE and mast cells/basophils.

Answer 665

With antihistamines and discontinuation of the offending drug. As long as no signs of shock then epinephrine.

Answer 666

Most commonly caused by the Epstein-Barr virus. Transmitted person to person through saliva typically infecting 15-24 years old. Presentation triad of exudative tonsillitis/pharyngitis, posterior or diffuse cervical lymphadenopathy, and fever. There can be a rash with IM in some patient given ampicillin or amoxicillin.

Answer 667

Presents before age 1 year. Persistent stridor that improves with neck extension. Associated with cardiac abnormalities. Vascular rings, which can encircle both the trachea and esophagus, are caused by abnormal development of the aortic arch.

Answer 668

Stridor most severe at age 4-8 months. Persistent stridor that worsens in supine position and improves in prone position.

Answer 669

Most common from age 6 months to 6 years. Associated with “barky” cough, fever, rhinorrhea and congestion.

Answer 670

Paget’s disease of bone (osteitis deformans). Usually diagnosed on routine laboratory testing.

Answer 671

Staphylococcus aureus

Answer 672

Age >50, bilateral pain and morning stiffness > 1 month, involvement of 2 of the following: neck, shoulders or proximal arms, proximal thigh or hip, constitutional (fever, malaise, weight lose). Physical exam shows decreased active ROM in shoulders, neck and hips. Labs: ESR >40, sometimes >100, elevated CRP, normocytic anemia. Tx: Glucocorticoids (low-dose prednisone).

Answer 673

Likely clostridium difficile colitis. Can be confirmed with a stool assay for toxins A and B. Gastric suppression with PPI and H2 blockers increase risk.

Answer 674

Uncertain cases need upright tilt table testing.

Answer 675

Empiric Vancomycin to cover staphylococcus, streptococcus, and enterococcus after getting BC. Then tailor to specific bug.

Answer 676

Intravenous aqueous penicillin G or intravenous ceftriaxone for 4 weeks.

Answer 677

Calculated by subtracting the peritoneal fluid albumin concentration from the serum albumin concentration and is useful to differentiate between portal and non-portal hypertension etiologies. SAAG ≥1.1 g/dL indicates portal hypertension (increased capillary hydrostatic pressure) while a SAAG

Answer 678

Delivery: Vaginal if possible. Cesarian for (maternal hemodynamic instability, nonreassuring fetal status, breech presentation).

Answer 679

Von Hippel-Lindau disease.

Answer 680

Pregnancy, oral contraceptive use, and cirrhosis-related hyperestrogenemia, because spider angiomas are estrogen dependent.

Answer 681

Sphingomyelinase deficiency; Autosomal recessive inheritance, Ashkenazi Jewish heritage; Onset age 2-6 months; Loss of motor milestones, hypotonia, feeding difficulties, “Cherry-red” macula, [HEPATOSPLENOMEGALY], [AREFLEXIA].

Answer 682

β-hexosaminidase A deficiency;Autosomal recessive inheritance, Ashkenazi Jewish heritage; Onset age 2-6 months; Loss of motor milestones, hypotonia, feeding difficulties, “Cherry-red” macula, [HYPERREFLEXIA].

Answer 683

Glucocerebrosidase deficiency; Classic features include anemia, thrombocytopenia, and hepatosplenomegaly, and no loss of developmental milestones.

Answer 684

Galactocerebrosidase deficiency; Rare autosomal recessive lysosomal storage disorder; Presents early in infancy; with developmental regression, hypotonia, and areflexia.

Answer 685

(One of the mucopolysaccharidoses) is a lysosomal storage disease due to lysosomal hydrolase deficiency. It presents at age 6 months-2 years with coarse facial features, inguinal or umbilical hernias, corneal clouding, and hepatosplenomegaly.

Answer 686

Bicarbonate in the urine. This results in an alkalinized urine (increased urine pH).

Answer 687

``` Absolute risk reduction (ARR) NNT = 1/ARR Example 16.3% incidence clopidogrel + aspirin compared to 12.3% with efrenzia + aspirin ARR = 0.163 - 0.123 = 0.04 NNT = 1/0.04 = 25 ```

Answer 688

PaO2≤55, SaO2≤88%, hematocrit>55%, or evidence of cor pulmonale.

Answer 689

Esophageal cancer. Diagnose by barium swallow followed by endoscopy.

Answer 690

Squamous cell carcinoma: associated with smoking and alcohol consumption. Adenocarcinoma: Barrett's esophagus, a complication of GERD is the main risk factor.

Answer 691

Leukemia; Aplastic anemia; Infection; Medication side effect.

Answer 692

Hemorrhage; Hemolysis: Intrinsic inherited defects of hemoglobin, RBC membrane, or enzymes. Hemolysis extrinsic: Autoimmune, Paroxysmal nocturnal hemoglobinuria.

Answer 693

Iron deficiency; Lead intoxication; Thalassemia; Sideroblastic anemia.

Answer 694

B12 deficiency; Folate deficiency. Preventing pneumonia in transplant patients: What drug given prophylaxis: trimethoprim-sulfamethoxazole (TMP-SMX) for Pneumocystis pneumonia (PCP).

Answer 695

Influenza, pneumococcal, and hepatitis B.

Answer 696

Ganciclovir or valganciclovir.

Answer 697

Hyponatremia from mineralocorticoid deficit. You also get hyperkalemia but to a laesser extent.

Answer 698

Abdominal ultrasound is the initial imaging performed on patients with jaundice. Great at detecting mass lesions or metastisis.

Answer 699

CA 19-9 level.

Answer 700

Colonoscopy.

Answer 701

Bloody diarrhea with abdominal pain. Colonoscopy shows multiple ulcers and mucosal erosions.

Answer 702

Large cells containing eosinophilic intranuclear and basophilic intracytoplasmic inclusions.

Answer 703

The diarrhea is non-bloody and generally involves the small intestines.

Answer 704

Gastroesophageal reflux disease (GERD) or esophageal motility disorder are common causes of noncardiac chest pain.

Answer 705

Consistent with tetralogy of fallot (TOF):

Answer 706

Ventricular septal defect; an overriding aorta over the right and left ventricles; right ventricular outflow obstruction, and right ventricular hypertrophy.

Answer 707

Squatting increases the peripheral systemic vascular resistance (afterload), and decreases the degree of the right to left shunting across the VSD.

Answer 708

Relatively T-cell independent B-cell response because polysaccharides cannot be presented to T-cells. Moderate levels of intermittent affinity antibodies. Less effective in young and elderly.

Answer 709

Increased number of covered strains. Decrease incidence of replacement strains due to lack of mucosal immunity.

Answer 710

Polysaccharide-protein conjugate induces T-cell-dependent B-cell response, resulting in improved immunogenicity due to the formation of higher-affinity antibodies and memory cells.

Answer 711

Increase efficacy in elderly and children

Answer 712

Vasa previa: Painless vaginal bleeding that occurs on ROM, fetal deterioration (sinusoidal tracing or bradycardia). Diagnose with antenatal abdominal and transvaginal doppler ultrasound. Offer cesarean delivery.

Answer 713

Most common organism causing this is Viridans streptococcus (Streptococcus intermedius, S. mitis, S. oralis, S. mutans). Spreads from sinusitis.

Answer 714

Hyponatremia. It is caused by increased levels of renin, norepinephrine and antidiuretic hormone. Lead to free water retention.

Answer 715

Toxic adenoma

Answer 716

Heterogeneous pattern.

Answer 717

Diffusely increased radioactive iodine uptake.

Answer 718

Hypotension caused by blood redistribution to the lower extremities and venous pooling from sympathetic blockade. Vasodilation and venous pooling.

Answer 719

Persistent untreated hypotension can lead to decreased placental perfusion and fetal acidosis. Treatment volume expansion with fluids, and place patient on left side to improve venous return.

Answer 720

Sulfadiazine and pyrimethamine. TMP-SMX is used for prophylaxis.

Answer 721

Aliskiren: direct renin inhibitor.

Answer 722

Open neural tube defects (anencephaly, open spina bifida); Ventral wall defects (omphalocele, gastroschisis; Multiple gestations. When elevated need careful ultrasound.

Answer 723

Aneuploidies: Trisomy 18 and 21.

Answer 724

VC 50% and FRC 30% decrease. Moving from supine to sitting can increase the FRC by 20% to 35%. Increasing the FRC can help prevent postoperative atelectasis.

Answer 725

Howell Jolly bodies.

Answer 726

G6PD and Thalassemia.

Answer 727

Seen in traumatic hemolysis such as DIC, HUS, and ITP.

Answer 728

Nocardia. TMX-SMX.

Answer 729

Increase water intake Antipsychotics, anxious, middle age women, central hypothalamic lesion Polyuria and low urine osmolality, Serum Na

Answer 730

Decrease ADH release from pituitary Idiopathic, trauma, pituitary surgery, ischemic encephalopathy. Polyuria and low urine osmolality, Serum Na may be >150 mEq/L due to significant thirst impairment.

Answer 731

ADH resistance in kidney Chronic lithium use, hypercalcemia, heredity (AVPR2 mutation). Polyuria and low urine osmolality, Serum Na 152-150 mEq/L due to intact thirst mechanism

Answer 732

Brief (lasting a few minutes) episodes of impaired consciousness, failure to respond to various stimuli during the episodes, staring spell, and automatisms (lip smacking, swallowing, picking movements of the hand), and post ictal confusion.

Answer 733

Brief (lasting a few minutes) episodes of impaired consciousness. Patient may also present with automatisms, but there is no post ictal state. Hyperventilation during EEG causes 3Hz pike.

Answer 734

Doxycycline X 14 days. In pregnant patient they should undergo desensitization before penicillin.

Answer 735

Most likely left ventricular failure, treat with intravenous diuretics. This is decompensated heart failure.

Answer 736

schistocytes: fragmented red blood cells.

Answer 737

Coxsackie A virus; Age 3-10 years; Summer/early fall: Clinical features: fever, pharyngitis, gray vesicles/ulcers on the posterior oropharynx: Treatment: Supportive management.

Answer 738

Herpes simplex virus type 1; Age 6 months-5 years; None; Clinical features: fever, pharyngitis, erythematous gingiva, clusters of small vesicles on anterior oropharynx/lips; Treatment: acyclovir.

Answer 739

Venous dilation and tortuosity due to venous occlusion; Scattered and diffuse hemorrhages due to backup of blood and increased resistance, leading to ischemic damage; “Blood and thunder: appearance due to diffuse hemorrhages; Cotton wool spots, disk swelling. Painless loss of vision.

Answer 740

Occurs due to occlusion of the posterior inferior cerebellar or vertebral artery. Patient develops loss of pain and temperature over the ipsilateral face and contralateral body, ipsilateral bulbar muscle weakness, vestibulocerebellar impairment (vertigo, nystagmus), and Horner’s syndrome. Motor function face and body spared.

Answer 741

Test may come back as normal, because the most sensitive cells are the first to lys.

Answer 742

Gait disturbances, dementia, and urinary incontinence. CT or MRI will show dilated ventricles.

Answer 743

The putamen. The internal capsule that lies adjacent to the putamen is almost always involved, leading to contralateral hemiparesis.

Answer 744

Beta-blocker or a cardiac acting calcium channel blockers such as diltiazem since they promote diastolic relaxation.

Answer 745

Apnea, respiratory failure.

Answer 746

Classic presentation: migratory pain, nausea, vomiting, fever, leukocytosis, McBurney's point tenderness, and Rovsing sign. Should have immediate appendectomy. Only need Ct or ultrasound on atypical presentations.

Answer 747

Supportive care, lowering the serum ammonia. Nonabsorbable disaccharides (lactulose, lactitol). Rifaximin can decrease the number of ammonia producing bacteria in the colon.

Answer 748

Pineal gland masses and presents as limitation of upward gaze, bilateral ptosis, and bilateral retraction. HA, vomiting and obstructive hydrocephalus.

Answer 749

Suprasellar masses that can compress the optic chiasm, resulting in visual field deficits.

Answer 750

Early diastolic murmur and can be associated with several physical signs caused by a hyperdynamic pulse, including bounding or “water hammer” peripheral pulses.

Answer 751

Hypercalcemia

Answer 752

Vertebral fracture due to rigidity and decreased bone mineralization.

Answer 753

Primidone: anticonvulsant that converts into phenylethylmalonamide and phenobarbital. Primidone can cause acute intermittant porphyria, which manifests as abdominal pain, neurologic, and psychiatric abnormalities.

Answer 754

The ulcer has not degenerated into a squamous cell carcinoma. When SCC arise within a burn wound, these ulcers are known as Marjolin's ulcers.

Answer 755

Mass pathology, such as renal cell carcinoma: Get Ct abdomen.

Answer 756

Flank pain, hematuria, and a palpable abdominal mass.

Answer 757

CT by the presence of dilated bronchi with thickened walls.

Answer 758

Hemoptysis

Answer 759

The peripheral nerves and skin, and is caused by Mycobacterium leprae. Diagnosis is made by the demonstration of acid-fast bacilli on skin biopsy.

Answer 760

Distinguished from other murmurs by augmentation of the intensity of the holosystolic murmur with inspiration.

Answer 761

Pericardial scarring and thickening that results in diastolic dysfunction; USA: Viruses, cardiac surgery, chest radiation, and idiopathic; Developing countries such as Africa, India, and China: Tuberculosis.

Answer 762

Erb-Duchenne palsy: C5, C6, C7; Weakness deltoid and infraspinatus (C5), biceps (C6), and wrist/finger extensors (C7). Fortunately, most infants recover arm function spontaneously within a few months.

Answer 763

In the mandibular region as a slow growing, nontender mass with characteristic yellow granular pus (“sulfur granules”). Diagnosis is confirmed by Gram stain (Gram-positive branching bacilli) and culture. Tx: Penicillin.

Answer 764

Normal serum calcium and phosphate levels and increased alkaline phosphatase, and urinary hydroxyproline levels.

Answer 765

No underlying cause; Usually women age

Answer 766

Connective tissue diseases, occlusive vascular conditions, sympathetic drugs, vibrating tools, hyperviscosity syndromes, nicotine; Usually men >40, asymmetric attack, symptoms of underlying disease, tissue injury or digital ulcers, abnormal nailfold capillary examination; Management: CCB for persistent symptoms, aspirin for patients at risk for digital ulceration.

Answer 767

Complete blood count and metabolic panel Urinalysis Antinuclear antibody (ANA) and rheumatoid factor Erythrocyte sedimentation rate and complement levels (C3 and C4).

Answer 768

Pulmonary hypertension: x ray would show enlargement of the pulmonary arteries with rapid tapering of the distal vessels (pruning) and enlargement of the right ventricle.

Answer 769

Mitral stenosis; Mitral prolapse; Left ventricular failure. With all three of these you see signs of pulmonary venous congestion.

Answer 770

Fasting blood glucose of 100-125 mg/dL 2-hour OGTT level of 140-199 mg/dL HbA1C 0f 5.7%-6.4%

Answer 771

Fasting blood glucose ≥126 mg/dL HbA1C ≥6.5% 2-hour OGTT level ≥200 mg/dL Random plasma glucose ≥ 200 mg/dL plus symptoms

Answer 772

1. bicuspid aortic valve 2. coarctation of the aorta 3 aortic root dilation

Answer 773

In asymptomatic patient this is bete-thalassemia minor. No specific therapy is required. Reassurance.

Answer 774

Asymptomatic, with mild anemia, microcytosis out of proportion to the degree of anemia, hemoglobin >10g/dL

Answer 775

Cryptococcal meningitis: Diagnosis is established by detection of the cryptococcal antigen or isolation of the organism in cerebrospinal fluid.

Answer 776

Opportunistic infection seen in HIV patients caused by the JC virus. It can be detected by polymerase chain reaction testing of CSF. Neuroimaging shows patchy areas of white matter consistent with demyelination.

Answer 777

Upper motor neuron lesion. Pronator drift is a relatively sensitive and specific physical exam finding for UMNL. Some stroke patients will demonstrate pronator drift in the absence of other findings.

Answer 778

Dysmetria and rapidly alternating movements. Can Be affected by motor weakness. Cerebellar lesions can produce an upward drift on pronator drift test.

Answer 779

Skin induration of greater than 5mm in HIV patient. Requires prophylaxis with isoniazid (and pyridoxine) for 9 months. Need chest x-ray too.

Answer 780

Brain abscesses. Bacteria can spread hematogenously from right to left shunt. They do not get filtered out in the lung capillary bed.

Answer 781

brain abscesses.

Answer 782

Dome of the bladder. You can get peritonitis with referred pain to shoulder.

Answer 783

Dome of the bladder.

Answer 784

Infection due to both a total decrease in functional antibodies and leukopenia that develop as bonemarrow fill with malignant plasma cells.

Answer 785

C-Calcium (hypercalcemia) R-Renal impairment (From IgG antibodies or paraproteins) A-Anemia (from bone marrow being replaced with plasma cells) B-Bone pain (bone pain, lytic lesions fractures)

Answer 786

Microatheroma and lipohyalinosis in small penetrating arteries of the brain. They often affect the internal capsule and result in pure motor dysfunction. Risk factors Hypertension, hyperlipidemia, smoking and diabetes.

Answer 787

Type 4 renal tubular acidosis (hyperkalemic renal tubular acidosis) is characterized by non-gap metabolic acidosis, persistent hyperkalemia, and mild-to moderate renal insufficiency.

Answer 788

``` Diarrhea Fistulas (pancreatic, ileocutaneous); Carbonic anhydrase inhibitors Renal tubular acidosis Ureteral diversion (ileal loop) Iatrogenic ```

Answer 789

Squamous cell carcinoma of the lung: These tumors can produce parathyroid hormone-related protein (PTHrP). Remember sCa++mous

Answer 790

Small cell lung carcinoma usually causes paraneoplastic syndromes such as ACTH production and SIDH.

Answer 791

Presents with fever, chest pain, leukocytosis, and mediastinal widening on chest x-ray. Tx: Requires drainage, surgical debridement, and prolonged antibiotic therapy.

Answer 792

To infection of a pilonidal cyst. Pilonidal cysts are most prevalent in young males especially with larger amounts of body hair.

Answer 793

blood glucose ≥250 mg/dL, pH

Answer 794

Preterm premature rupture of membrane (PPROM) before 32 weeks to reduce RDS, necrotizing enterocolitis, neonatal intraventricular hemorrhage, and neonatal death.

Answer 795

Delivery at

Answer 796

Increased systemic vascular resistance.

Answer 797

Stress fracture. They are not always seen on x-ray. Tibia is the most common bone to occur. Tx: Rest and healing.

Answer 798

Amiodarone can cause pulmonary toxicity.

Answer 799

Pseudomonas aeruginosa, Treatment ciprofloxacin.

Answer 800

Choanal atresia a congenital nasal malformation is caused by failure of the posterior nasal passage to canalize completely leaving either a bone 90% or membrane 10% obstruction. Failure to move a catheter through nose is suggestive. CT scan.

Answer 801

Significant headaches, very low testosterone levels (

Answer 802

Consistent with esophageal rupture. Diagnostic study of choice is Gastrografin-contrast esophagography, or CT esophagography.

Answer 803

Confirm the hypercalcemia with second reading if still elevated gt PTH level.

Answer 804

Due to papillary muscle displacement in patients with acute MI. Leads to excessive volume overload, causing elevated left atrial and ventricular filling pressures and acute pulmonary edema.

Answer 805

Submandibular and sublingual glands: Source most commonly an infected tooth 2nd or 3rd molar. Asphyxiation is most common cause death. Olanzapine and clozapine should have what done when taking these medications: BMI measured monthly and a fasting plasma glucose and lipids, BP and waist circumference should be assessed at baseline, 3 months, and then annually. Metabolic syndrome.

Answer 806

Renovascular hypertension. Presence of continuous abdominal bruit.

Answer 807

Aortic dissection

Answer 808

Get serum creatine incase you have to get chest ct with contrast otherwise you want a TEE.

Answer 809

Microvesicular fatty infiltrates.

Answer 810

Hallmark ECG findings of persistent ST- segment elevation after a recent MI and deep Q waves in the same leads

Answer 811

Measure serum electrolytes. Loop diuretics can cause hypokalemia and hypomagnesemia which can cause ventricualar tachycardia, also potentiate digoxin.

Answer 812

Of time that passes before coronary blood flow is restored (via PTCA or fibrinolysis).

Answer 813

1. Parkinsonism 2. Autonomic dysfunction (postural hypotension, abnormal sweating, disturbance of bowel or bladder control, abnormal salivation or lacrimation, impotence, gastroparesis) 3. Widespread neurological signs (cerebellar, pyramidal or lower motor neuron). The accompanying bulbar dysfunction and laryngeal stridor may be fatal.

Answer 814

Ventricular fibrillation and pulseless VT.

Answer 815

Symptomatic or sustained monomorphic VT (unresponsive to antiarrhythmic) and hemodynamically unstable atrial fibrilation with rapid ventricular response.

Answer 816

Uninterrupted CPR along with vasopressor therapy to maintain cerebral and coronary perfusion.

Answer 817

Endoscopy to exclude varices, indicate the risk for variceal hemorrhage, and determine strategies (nonselective betablocker) for primary prevention. This is a major cause of morbidity and mortality up to 50% of patients.

Answer 818

Nephrotoxicity, hyperkalemia, hypertension, gum hypertrophy, hirsutism, and tremor.

Answer 819

Nephrotoxicity, hyperkalemia, hypertension, and tremor

Answer 820

Dose related diarrhea, leukopenia, and hepatotoxicity.

Answer 821

Bone marrow suppression.

Answer 822

Emergency treated with an ocular massage and high flow oxygen administration.

Answer 823

Occurs when a patient demonstrates significant improvement (with or without remission), generally defined as 50% reduction in baseline of severity.

Answer 824

Recovery signifies that the episode is over and presents the option of the patient either discontinuing treatment or continuing maintenance.

Answer 825

Multisystem involvement with acute or subacute renal failure, typical skin manifestations (livedo reticularis, blue toe syndrome), cerebral or intestinal ischemia, and Hollenhorst plaques after a recent arteriography or cardiac catheterization.

Answer 826

Echinococcosis is a parasitic tapeworm common people who raise sheep. Form hydatid cyst anywhere in the body, but most common liver next is lungs. Most people asymptomatic.

Answer 827

Trousseau’s syndrome is a hypercoagulable disorder. It is usually associated with an occult visceral malignancy such as pancreatic (most common), stomach, lung, or prostate carcinoma. Get CT scan of the abdomen.

Answer 828

cystic fibrosis

Answer 829

Surgical pinning of the slipped epiphysis where it lies (in situ) in order to lessen the risk of avascular necrosis of the femoral head and chondrolysis.

Answer 830

Diaphragmatic rupture that does show initially can take months even years. After chest x-ray get ct scan.

Answer 831

Weight loss in obese patient. Next is DASH diet. Exercise, Dietary sodium decrease. Alcohol intake.

Answer 832

Administering oxygen and changing maternal position. Uterotonic drugs must be discontinued.

Answer 833

Internal malignancies, up to >15% develope these (Most common is ovarian, lung, pancreatic, stomach, or colorectal cancers, or non-hodgkin's lymphoma).

Answer 834

Cladribine

Answer 835

Give corticosteroids.

Answer 836

Can cause atrophy and fibrosis of the smooth muscle.

Answer 837

BUN >60 mg/dL. Does Not have the normal ECG changes. Dialysis.

Answer 838

Glucagon-like peptide-1 (GLP-1) agonist (Exenatide, liraglutide).

Answer 839

Systolic ejection murmur that radiates to the apex and carotid arteries.

Answer 840

Epstein-Barr virus (EBV)

Answer 841

Carpal tunnel syndrome of median nerve.

Answer 842

Thyroiditis, Graves has increased radioactive iodine uptake

Answer 843

Most common early are hallucinations, dizziness, headache, and agitation. After several years involuntary movements.

Answer 844

Traveler’s diarrhea and should be considered in patients with persistent, watery diarrhea for > 2 weeks.

Answer 845

PSA should be discussed on a case by case with patient.

Answer 846

Chest x-ray is frequently abnormal, but need a CT scan for definitive diagnosis.

Answer 847

35-37 weeks gestation.

Answer 848

Lung carcinoma, breast carcinoma, and lymphoma.

Answer 849

Receive post-exposure prophylaxis within 3-5 days exposure. Nearly 70-100% effective in preventing infection when given in 3-5 day.

Answer 850

Receive varicella zoster immune globulin. The vaccine is a live attenuated virus and is contraindicated in immunocompromised.

Answer 851

Both ALT and HBeAg every 3-6 months until they achieve viral clearance.

Answer 852

A-Appearance: 0 completely blue/pale; 1 body pink, extremities blue; 2 completely pink P-Pulse: 0 absent; 1 100/min G-Grimace: 0 absent; 1 Grimace/whimper; 2 Cough/sneeze/cry A-Activity/muscle tone: 0 limp; 1 Some flexion; 2 Active/spontaneous R-Respiratory: 0 Absent; 1 Slow, weak cry; 2 Regular, good cry

Answer 853

Further evaluation and resuscitation.

Answer 854

Secondary malignancy especially those treated before age 30.

Answer 855

Lung field radiation and develop dyspnea, nonproductive cough, and chest pain 4-24 months after therapy.

Answer 856

First line Propranolol; Second line primidone and topiramate

Answer 857

Non Progressive motor dysfunction: The three primary subtypes are spastic, dyskinetic, and ataxic. Biggest risk factor is prematurity.

Answer 858

Defibrillation: Time to defibrillation is strongly correlated with survival.

Answer 859

VTE and atrial fibrillation: 2.0-3.0 prosthetic heart valve: 2.5-3.5 3 months for reversible risk factor. 6-12 months idiopathic DVT.

Answer 860

Serum osmolality 100 mOsm/kg (inappropriately elevated) Urine sodium > 40 mEq/L Normal serum creatinine, potassium, and acid-base balance Normal adrenal and thyroid function

Answer 861

Fluid restriction (2 times serum osmolality

Answer 862

Hypertonic saline in first 3-4 hours to increase sodium > 120 mEq/L Later treatment same as mild hyponatremia

Answer 863

Bolus of hypertonic saline until symptoms resolution | +/- Vasopressin receptor antagonists (conivaptan)

Answer 864

Fibrinolytic therapy especially if given in 3-4.5 hours of onset.

Answer 865

Tick-borne paralysis is characterized by rapidly progressive ascending paralysis (which may be asymmetric). Need to perform a meticulous search for tick because they must feed for 4-7 days and remove it. Most patient spontaneously recover.

Answer 866

Bronchial obstruction due to an underlying abnormality. You need to get a CT scan to visualize the underlying parenchymal abnormalities. Biopsy via bronchoscopy is next.

Answer 867

NSAIDS and lymphoma (Most common form of nephrotic syndrome in patients with Hodgkin lymphoma).

Answer 868

Hepatitis B and C infections and lipodystrophy.

Answer 869

Adenocarcinoma (breast, lung), NSAIDS, Hepatitis B, SLE.

Answer 870

Age ≥45, obesity, diabetes, unopposed estrogen exposure, PCOS, early menarche/late menopause.

Answer 871

Exclude pregnancy with serum beta-hCG. Workup for abnormal uterine bleeding after pregnancy test: First line tests include blood counts, coagulation studies, and TSH. May also include prolactin, FSH, +/- LH, and serum androgens.

Answer 872

Endometrial biopsy

Answer 873

Pregnancy and severe ophthalmopathy.

Answer 874

Decreased lens elasticity leads to difficulty with near vision.

Answer 875

Hyperpigmentation (bronze diabetes), arthralgia, arthropathy, chondrocalcinosis, elevated hepatic enzymes hepatomegaly (early), cirrhosis (later), and increased risk for HCC, diabetes mellitus, secondary hypogonadism and hypothyroidism, restrictive or dilated cardiomyopathy and conduction abnormalities, increased susceptibility to listeria, vibrio vulnificus, yersinia enterocolitica.

Answer 876

Urgent surgical exploration

Answer 877

Extrapyramidal effects that can resemble Parkinsonism. Think about drug induced parkinsonism from risperidone causing bradykinesia, rigidity, and tremor.

Answer 878

``` Rare autosomal recessive; Characterized by abnormal copper deposition in the tissues such as liver, basal ganglia, and cornea. Children tend to present with liver disease while young adults tend to have neuropsychiatric disease. Low ceruloplasmin ( ```

Answer 879

Prerenal failure, gastrointestinal bleeding (secondary to reabsorption of blood from the gastrointestinal tract), and steroid administration.

Answer 880

Screening for bladder cancer is not recommended.

Answer 881

May look normal on labs but total body potassium is in deficit due to urinary loss caused by glucosuria-induced osmotic diuresis.

Answer 882

Spinocerebellar ataxias. Remember the combination of neurologic (ataxia, dysarthria), skeletal (scoliosis, feet deformities), and cardiac (concentric hypertrophic cardiomyopathy) manifestations of the disease. The most common cause of death are cardiomyopathy and respiratory complications.

Answer 883

Membranous nephropathy.

Answer 884

Alpha-1 receptor blockers such as tamsulosin act on the distal ureter, lowering muscle tone and reducing reflux uteral spasm secondary to stone impaction.

Answer 885

Urethritis, conjunctivitis, mucocutaneous lesions, enthesitis (site were tendons insert bone), and asymmetric oligoarthritis. Treatment: NSAIDS.

Answer 886

Immediate thoracostomy.

Answer 887

The sudden onset of pain and redness in the medial canthus region. Dacryocystitis is an infection of the lacrimal sac common in infants and adults over 40. Staphylococcus aureus and beta hemolytic streptococcus.

Answer 888

Abscess located over the upper or lower eyelid.

Answer 889

Granulomatous inflammation of the meibomian gland. It appears as a hard painless lid nodule.

Answer 890

Dantrolene, bromocriptine, amantadine

Answer 891

Antirheumatic drug; TNF and IL-1 suppressor; Hepatotoxicity, stomatitis, hemolytic anemia.

Answer 892

Antirheumatic drug; TNF and IL-1 suppressor; Retinopathy

Answer 893

Antirheumatic drug; Purine antimetabolite; Hepatotoxicity; Stomatitis, Cytopenia.

Answer 894

Antirheumatic drug; Pyrimidine synthesis inhibitor; Hepatotoxicity, cytopenia.

Answer 895

There is respiratory acidosis, so there is a compensatory effort to maintain normal pH, the kidney increase bicarbonate retention and decreases chloride reabsorption.

Answer 896

Paraplegia, bladder, and fecal incontinence, and absent sensation from the nipple downwards.

Answer 897

Absent sensation from the umbilicus downwards.

Answer 898

Polymicrobial infection composed of gram positive and gram negative organisms, aerobic and anaerobic organisms and occasionally other organisms.

Answer 899

Clindamycin and gentamicin

Answer 900

Negative predictive value: Will vary with the pretest probability of a disease. High probability = low NPV. Low probability = high NPV.

Answer 901

``` Type 1 (distal): Poor hydrogen ion secretion into urine; ≥5.5 pH urine; Potassium low-normal; Causes genetics disorders, medication toxicity, autoimmune (Sjogren's syndrome, rheumatoid arthritis). ```

Answer 902

Type 2 (proximal): Poor bicarbonate resorption;

Answer 903

Type 4: Aldosterone resistance;

Answer 904

You can get endocarditis from it when you have dental procedure.

Answer 905

Because it does not adequately penetrate renal tissue.

Answer 906

Persist or worsen after 2-3 days.

Answer 907

Thyroid or non thyroid surgery, infection, iodine contrast, or childbirth. Characterized by tachycardia, hypertension, cardaic arrhythmias, high fever, tremor, altered mentation, and lid lag.

Answer 908

Active external and internal rewarming, which includes use of heated humidified oxygen and warmed intravenous fluids.

Answer 909

Does not require treatment unless it persist with rewarming or if associated with hypotension. Pacemaker cells are refractory to atropine.

Answer 910

Fungal ball: Pulmonary aspergillosis. Think this when patient from endemic TB area.

Answer 911

Lateral epicondylitis (tennis elbow)

Answer 912

Hereditary angioedema is a deficiency or dysfunction in C1 inhibitor, which results in elevated levels of the edema producing factors C2b and bradykinin.

Answer 913

Abnormal gait, incontinence, and dementia. Due to decreased CSF absorption.

Answer 914

Weakness that is more pronounced in the upper extremities than the lower and accompanied by localized deficits in pain and temperature sensation.

Answer 915

Bilateral spastic motor paresis distal to the lesion. Usually due to occlusion of anterior spinal artery.

Answer 916

Due to 5p deletion and presents as microcephaly, hypotonia, short stature, and a cat-like cry.

Answer 917

Posterior urethral injury is associated with pelvic fractures

Answer 918

Asked to return after her menstrual period for reexamination (which may reveal regression of the mass). If decrease in size probably benign. Otherwise proceed with ultrasonography, fine needle aspiration biopsy, and/or excisional biopsy.

Answer 919

Because the density of breast tissue is high in young women.

Answer 920

Sleepwalking is another non-REM parasomnia. Occurs later in childhood and adolescence.

Answer 921

The pupil is constricted with poor light response, in acute angle glaucoma, the pupil is dilated and is nonreactive to light.

Answer 922

Cupping of the optic disk, persistently elevated intraocular pressure.

Answer 923

Cyanosis and dyspnea secondary to right to left shunting.

Answer 924

Large ventral septal defects

Answer 925

Pernicious anemia an autoimmune disease with autoantibodies against gastric intrinsic factor. Results in B12 deficiency.

Answer 926

Disseminated gonococcal infection: Neisseria gonorrhoeae is the most common sexually transmitted disease causing arthitis. Due to the fastidious growth requirements blood cultures are often negative. Must get nucleic acid amplification testing.

Answer 927

Hypercalcemia with elevated or inappropriately normal PTH. 24-hour urinary calcium >250 mg. Urine calcium/creatinine >0,02 differentiate from familial hypocalciuric hypercalcemia: Bone mineral density scan for osteopenia/osteoporosis. Sestamibi scan plus ultrasound to locate hyperactive parathyroid tissue prior to surgery.

Answer 928

Score +3 points: Clinical signs of DVT; Alternative diagnosis less likely than PE. Score +1.5 points: Previous PE or DT; Heart rate >100; Recent surgery or immobilization. Score +1 points: Hemoptysis; Cancer. Total score for clinical probability ≤4 = PE unlikely Get CT angiogram of chest patient's normal renal function; V/Q scan otherwise >4 = PE likely Start anticoagulation therapy

Answer 929

Renal vein thrombosis (RVT) and other thromboembolism are important complications of nephrotic syndrome because of loss of antithrombin III in the urine.

Answer 930

Provide patient with ursodeoxycholic acid and advice to avoid fatty foods.

Answer 931

``` Diabetic gastroparesis (delayed gastric emptying): Treatment Prokinetics metoclopramide, erythromycin, cisapride. Diabetic autonomic neuropathy occurs >50%. ```

Answer 932

Hyperglycemia, increased LDL cholesterol, and plasma triglycerides. hyponatremia, hypokalemia, and hypercalcemia.

Answer 933

Due intravascular volume loss secondary to local and systemic vascular endothelial damage causing vasodilation, increased vascular permeability, and plasma leak into retroperitoneum.

Answer 934

Presents with nonspecific systemic symptoms, bone pain, lymphadenopathy, hepatomegaly, pallor (from anemia), petechia (from thrombocytopenia). Diagnosed with bone marrow biopsy >25% lymphoblasts.

Answer 935

Fever, altered mental status with confusion and agitation, risk of seizures and coma. Get CSF: Elevated WBC with lymphocytic predominance, normal glucose, and elevated protein. Diagnosed by viral DNA by PCR. Empiric treatment acyclovir.

Answer 936

Echocardiogram: Exercise stress test are contraindicated in symptomatic severe AS.

Answer 937

Theophylline toxicity can manifest as central nervous system stimulation (headache, insomnia, seizure), gastrointestinal disturbance (nausea, vomiting), and cardiac toxicity (arrhythmia). Narrow therapeutic window check levels.

Answer 938

Uterine leiomyoma

Answer 939

Both can cause extravascular hemolytic anemia. A negative family history and + Coombs test suggest AIHA. A positive family history and negative Coombs test suggest HS. The peripheral blood smear for both may show sperocytes with central pallor.

Answer 940

Genetic testing for dystrophin gene on Xp21.

Answer 941

One-time abdominal ultrasound to evaluate for an abdominal aortic aneurysm.

Answer 942

Streptococcus pneumoniae and nontypable Haemophilus influenzae.

Answer 943

Gynecomastia, testicular atrophy, decreased body hair, spider angiomas, and palmar erythema.

Answer 944

Abdominal ultrasound to assess hepatic parenchyma and biliary ducts.

Answer 945

Deficiency in uroporphyrinogen decarboxylase, an enzyme in heme synthesis.Presents with painless blisters, increased fragility on the dorsal surfaces of the hands, facial hypertrichosis and hyperpigmentation. Hepatitis C.

Answer 946

Neonatal thyrotoxicosis caused by transplacental TSH-receptor antibody. Self resolves by 3 months treat with methimazole and beta-blocker.

Answer 947

Aromatase deficiency

Answer 948

Benign and neither require workup or treatment.

Answer 949

Massive Hematuria, but episodes are usually mild and resolve spontaneously. Can occur in sickle cell trait.

Answer 950

A fixed upper airway obstruction will decrease the airflow rate during inspiration and expiration. Laryngeal edema.

Answer 951

Of herpes zoster (shingles): Treatment: acyclovir, valacyclovir, famciclovir

Answer 952

Diffuse cortical and subcortical atrophy which is disproportionately greater in the temporal and parietal lobes.

Answer 953

Isolated thrombocytopenia

Answer 954

Hemorrhage

Answer 955

Glucose-6 dehydrogenase deficiency

Answer 956

It causes platelet dysfunction. Dialysis usually keeps this from happening, but patients can be treated with desmopressin that exposes factor 8. PT, PTT and TT normal. Only bleeding time prolonged.

Answer 957

Malabsorption of fat due to pancreatic enzymes inactivated by acid. Can even have jejunal ulcers.

Answer 958

Interstitial fibrosis

Answer 959

``` Asthma = inhaled corticosteroid COPD = long acting anticholinergic ```

Answer 960

Calcium pyrophosphate crystals that are released from chondrocalcinosis (calcification of articular cartilage) into the joint space. Rhomboid shaped, positively birefringent crystals is diagnostic.

Answer 961

Cryoglobulinemia is an immune complex disorder (IgM against anti-hepatitis C virus IgG) most commonly due to chronic hepatitis C.

Answer 962

p-ANCA positive

Answer 963

BP ≥160 mmHG systolic or ≥110 mmHG diastolic on 2 occasions ≥4 hours apart during bedrest Thrombocytopenia 1.1 mg/dL or doubling of serum creatinine Elevated transaminases Pulmonary edema New-onset visual or cerebral symptoms Note: Elevated BP in a previously normotensive patient makes diagnosis jump to severe, but not for patients who had high BP before.

Answer 964

Leads to pellagra, which is characterized by diarrhea, dermatitis (sunburn like rash in sun exposed areas, becomes hyperpigmented), dementia, and if severe, death. Red beefy tongue (glossitis).

Answer 965

Can lead to cheilosis, glossitis, seborrheic dermatitis (often affecting the genital areas), pharyngitis, and edema and/or erythema of the mouth.

Answer 966

Causes irritability, depression, dermatitis, and stomatitis (inflammation of mucosa mouth). Can cause elevated homocysteine concentration which increases risk for venous thromboembolism.

Answer 967

Risk factors: Prior placenta previa, prior cesarean or other uterine surgery, multiparity, advanced age. Clinical features: Painless third trimester bleeding, bleeding with uterine contraction. Diagnosis: Transabdominal followed by transvaginal sonography. NO DIGITAL vaginal examination before US!

Answer 968

Premature placental separation initiated by hemorrhage in the decidua basilis. Vaginal bleeding and abdominal pain are frequent presenting complaints.

Answer 969

Sudden onset of intense abdominal pain and vaginal bleeding associated with hyperventilation, agitation, and tachycardia. Although it may occur prior to onset of labor, it is commonly associated with labor, especially in women with a prior cesarean delivery.

Answer 970

Fetal blood vessels cross the fetal membranes in the lower segment of the uterus between the fetus and the internal cervical os. Presents with painless antepartum hemorrhage, but is associated with rapid deterioration of the fetal heart tracing as the hemorrhage is of fetal origin.

Answer 971

First trimester propylthiouracil (PTU), methimazole is a teratogen, but can be used the 2nd, and 3rd trimester. Both cause agranulocytosis.

Answer 972

Hyperkalemia, by blocking eNac same mechanism as amiloride. Also blocks creatinine secretion, so may have artificial elevation with no actual kidney damage. Serial monitoring of potassium levels.

Answer 973

Anabolic steroids can also cause erythrocytosis, so don’t be fooled by high RBCs. EPO does not cause gynecomastia, and anabolic steroids do cause gynecomastia.

Answer 974

Only left sided murmurs increase on expiration.

Answer 975

The forceful atrial contraction against the thick non-compliant ventricle.

Answer 976

Syncope, Angina, and Dyspnea. The indications for aortic valve replacement are: 1. All symptomatic patients with AS 2. Patients with severe AS undergoing CABG or other valvular surgery 3. Asymptomatic patients with severe AS and either poor LV systolic function, LV hypertrophy >15 mm, valve area

Answer 977

Estrogen (oral increases TBG), tamoxifen, raloxifene, rifampin, phenytoin, carbamazepine, heroin, methadone.

Answer 978

Androgens, glucocorticoids, anabolic steroids, slow release nicotinic acid.

Answer 979

Afebrile and have irritative voiding. UA normal. Expressed prostatic secretions show normal number of leukocytes and culture of the secretions is negative for bacteria.

Answer 980

Afebrile and irritative voiding symptoms including frequency, urgency and suprapubic or perineal discomfort. UA normal. Expressed prostatic secretions show leukocyte count greater than 10 WBC/HPF and cultures grow causative pathogens.

Answer 981

Afebrile and irritative voiding symptoms including frequency, urgency and suprapubic or perineal discomfort. UA normal. Expressed prostatic secretions show leukocyte count greater than 10 WBC/HPF and cultures are negative.

Answer 982

ANA = sensitive Anti-dsDNA and anti-SM (smooth muscle) = specific Hypocomplementemia (C3 and C4) common

Answer 983

S3 which is a soft diastolic sound produced by the tensing of the papillary chordal apparatus when there is rapid influx of blood into the ventricle in early diastole. BNP and S3 are both signs of increased cardiac filling pressure.

Answer 984

CT scan of abdomen without contrast.

Answer 985

5-10%, if both parents than 60% chance, if dizygotic twin than 70% chance. General population is only 1%.

Answer 986

Include pneumatosis intestinalis (intramural air) or air in the bowel wall and portal vein.

Answer 987

Oral azithromycin

Answer 988

A nonseminomatous germ cell tumor. Seminomatous only have β-hCG.

Answer 989

``` Adrenal insufficiency (Addison's disease) in endemic areas. Cause aldosterone deficiency and presents with non-anion gap and hyperkalemic and hyponatremic metabolic acidosis. ```

Answer 990

Avoid contact sports for ≥3 weeks due to the risk of splenic rupture.

Answer 991

Pseudocyesis: Seen in women with a strong desire to conceive and is a form of conversion disorder.

Answer 992

Simple: Thin smooth regular wall, unilocular no septate homogenous content and absence of contrast on CT/MRI Malignant cystic mass: Thick, irregular wall, multilocular, multiple septate, occasional calcification, heterogenous content, and presence of contrast on CT/MRI. Simple just give reassurance.

Answer 993

Autosomal disorder due to germline mutation in RET proto-oncogene in >95%.

Answer 994

Glucocorticoid induced myopathy with progressive proximal muscle weakness and atrophy without pain or tenderness. Normal ESR and CK. Most common drug induced myopathy occurs weeks to months.

Answer 995

Diabetic microangiopathy, nephropathy, and glomerulosclerosis.

Answer 996

Presents with combination of vertigo, ear fullness, tinnitus, and hearing loss. First line therapy consists low salt diet.

Answer 997

Can resemble breast cancer, including skin or nipple retraction and calcifications on mammography. Biopsy of the mass will reveal fat globules and foamy macrophages (histiocytes). No treatment is indicated for this self-limited condition.

Answer 998

Unfractionated heparin, all others increase bleeding risk due to Xa activity.

Answer 999

Condition that often develops after a major surgery characterized by hypotension, extensive blood loss into tissues, and massive blood replacement. Alkaline phosphatase is elevated, but ALT and AST are normal to mild elevated. Benign condition.

Answer 1000

Enlargement of the cerebral ventricles.

Answer 1001

Increased total brain volume.

Answer 1002

Abnormalities in Orbitofrontal cortex and striatum

Answer 1003

Decreased volume of amygdala.

Answer 1004

Decreased hippocampal volume.

Answer 1005

Secure ABC. Decontamination: Remove clothing and visible chemical. X Ray if respiratory symptoms Endoscopy within 24 hours.

Answer 1006

Close to 1.0 carbohydrates. Protein 0.8. Lipids 0.7.

Answer 1007

IgA anti-endosomal and anti tissue transglutaminase antibody. Biopsy shows villous atrophy.

Answer 1008

Tdap should be substituted for Td once then Td every 10 years as adult.

Answer 1009

Administered ≥14 days before or >14 days after splenectomy.

Answer 1010

Postgastrectomy, need to modify diet.

Answer 1011

US with graded compression technique. Non Compression and dilation are diagnostic.

Answer 1012

most common cause of hyperestrogenism in pregnancy Luteoma solid on US. No maternal treatment can cause virilization female fetus.

Answer 1013

Acyclovir, sulfonamides, methotrexate, ethylene glycol, protease inhibitors. Cause renal tubular obstruction.

Answer 1014

hypercoagulable: loss of antithrombin III in urine.

Answer 1015

Profuse, clear and thin. It will stretch to approximately 6 cm and exhibits ferning on a microscopic slide. pH is 6.5 or greater the most basic of any phase.

Answer 1016

Hemolysis leads to fatigue, Cytopenias (impaired hematopoiesis), venous thrombosis (intra abdominal, cerebral veins). Labs show elevated LDH and low haptoglobin (due to hemolysis). Absence of CD55 and CD59. Tx: iron and folate and Eculizumab.

Answer 1017

Foods high in tyramine(aged meats and cheese), as the combination can cause hypertensive crisis.

Answer 1018

due to citrate in stored blood products binds up the ionized calcium.

Answer 1019

Require 24 hour indwelling catheter to decompress the bladder and regain detrusor muscle function. These patients have urinary retention and overflow incontinence.

Answer 1020

Deposition of mucopolysaccharides protein complex within the perineurium and endoneurium (accumulation of matrix substance.

Answer 1021

Start rivaroxaban (direct factor Xa inhibitor) similar efficacy no labs

Answer 1022

Beta-interferon and glatiramer acetate

Answer 1023

High concentrations of amylase from oral secretions.

Answer 1024

Aortic dissection

Answer 1025

Physical exam showing tremor, rigidity, postural instability, and bradykinesia.

Answer 1026

Compare outcome of interest

Answer 1027

Compare disease incidence.

Answer 1028

Compare disease incidence by reviewing past records.

Answer 1029

Compare risk factor frequency.

Answer 1030

Compare disease prevalence.

Answer 1031

Dopamine agonist (bromocriptine, cabergoline).

Answer 1032

Tubulointerstitial nephritis

Answer 1033

Hysterosalpingogram

Answer 1034

β-hCG stimulate thyroid hormone (T4) and both increase during first trimester, so TSH go down. There is also an increase in thyroid binding globulin.

Answer 1035

Progestin therapy. Hyperplasia with atypia and no plans for pregnancy/fails medical management should have hystersctomy.

Answer 1036

Kid with pubarche has adrenal androgen production (premature adrenarche). Obesity is a risk factor for this. If patient has breast bud (thelarche) then HPG axis.

Answer 1037

Aortic aneurysm, get serial chest x-ray.

Answer 1038

Saline hydration with furosemide

Answer 1039

Undetectable.

Answer 1040

Orthostatic hypotension

Answer 1041

In children produce estrogen cause precocious puberty.

Answer 1042

In disease with autonomic or dysmotility. Leads to malabsorption can happen with systemic sclerosis.

Answer 1043

Hyperkalemia

Answer 1044

Zenker (pharyngoesophageal)diverticulum. Has motor disfunction. Barium esophagram Patient with delayed onset prosthetic joint infection >3 months and 3 months Staphylococcus epidermidis

Answer 1045

Diastolic dysfunction

Answer 1046

Autoimmune destruction of the intrahepatic bile ducts and cholestasis. Has elevated IgM and anti-mitochondrial antibodies in the serum. Treatment is ursodeoxycholic slow progression and lengthens transplant free survival time.

Answer 1047

28-32 weeks gestation and again after delivery if the baby is Rh positive.

Answer 1048

Mitral valve prolapse. Squatting increase venous return.

Answer 1049

Endometrial carcinoma

Answer 1050

The elbow where the ulnar nerve lies at the medial epicondylar groove

Answer 1051

Poor absorption in the small intestine = Celiac sprue.

Answer 1052

Haloperidol. Use lorazepam for young people.

Answer 1053

Need a renal biopsy for baseline.

Answer 1054

Elevated homocysteine.

Answer 1055

Elevated homocysteine and methylmalonic acid

Answer 1056

Acute tubular necrosis

Answer 1057

Glomerulonephritis

Answer 1058

Interstitial nephritis or pyelonephritis

Answer 1059

Nephrotic syndrome

Answer 1060

Chronic renal failure

Answer 1061

Management reassurance and another US one week later

Answer 1062

Angiodysplasia (arteriovenous malformation) of the gastrointestinal tract seen in patients >60. The bad valve causes disruption of von Willebrand factor leading to more bleeding.

Answer 1063

Zidovudine and tenofovir. One should be part of mothers

Answer 1064

ACEI to decrease cardiac remodeling post MI.

Answer 1065

Placement of a retrievable inferior vena cava filter

Answer 1066

An expansible and eccentric osteolytic lesion resembling a soap bubble; Surgery

Answer 1067

Ascending due to cystic medial necrosis or connective tissue disorder. Descending due to atherosclerosis.

Answer 1068

Statin therapy regardless of baseline lipid levels.

Answer 1069

Distortion of straight lines that appear wavy.

Answer 1070

Proteus mirabilis = secrete urease. Can have struvite stones

Answer 1071

Vitreous hemorrhage, most common cause is diabetic retinopathy

Answer 1072

PTHrP production, breast cancer can produce this and release systemically or through metastasis to bone.

Answer 1073

Anterior uveitis

Answer 1074

Most likely diagnosis is cystinuria, which is due to amino acid transport abnormality. Stones are radiopaque. Look for positive family history of stones.

Answer 1075

Highly thrombogenic for both venous and arterial clots.

Answer 1076

Behavioral therapy (exposure, systematic desensitization)

Answer 1077

Posterior shoulder dislocation.

Answer 1078

Hepatitis B vaccine, must be ≥2kg (4lb 6oz).

Answer 1079

The initial management orchiectomy.

Answer 1080

Tricuspid regurgitation

Answer 1081

Get barium esophagogram followed by possible manometry. Patient initially problem with liquids then solids, most likely obstruction. Patient with both from start most likely motility disorder.

Answer 1082

Paracentesis to determine cause.

Answer 1083

Nasal packings from nosebleed, not just tampons.

Answer 1084

UA Chemistry panel Lipid profile Baseline ECG

Answer 1085

``` 250ug cosyntropin (ACTH) stimulation test with cortisol and ACTH levels (GREATER THAN 20 INCREASE IN SERUM CORTISOL IN 30-60 MINUTES RULES OUT ADRENAL INSUFFICIENCY). ```

Answer 1086

Diverticulosis: Patient will have painless bleeding. Diverticulitis: Patient will have abdominal pain and infectious symptoms secondary to obstruction of the diverticula. It is uncommon to see bleeding with diverticulitis.

Answer 1087

Massive lower GI bleeding and will usually be detected on rectal exam.

Answer 1088

You need chylomicrons to absorb vitamin D. Low vitamin D causes decreases in both calcium and phosphorous absorption in the intestines. Hypocalcemia, hypophosphatemia, and high PTH.

Answer 1089

CBC and electrolytes; BC; LP and CSF analysis and cultures. Always give antibiotics before lumbar puncture, but after blood cultures. LP takes long to set up. Ceftriaxone and vancomycin IV. Imaging done before LP in children with coma, focal neurologic findings, and history of neurosurgery.

Answer 1090

Ceftriaxone displaces bilirubin from albumin and increases the risk of kernicterus.

Answer 1091

CT scan of the chest with intravenous contrast.

Answer 1092

1. Decreased dietary protein and oxalate. 2. Decreased sodium intake. 3. Increased fluid intake. 4. Increased dietary calcium

Answer 1093

Still’s murmur: Benin, no work up done. Reassurance.

Answer 1094

Innocent murmurs.

Answer 1095

Neutrophilic cryptitis seen in both Crohn's and ulcerative colitis.

Answer 1096

Weight loss. Don’t let this fool you and lead you to think cancer.

Answer 1097

Of the variation in of the range of variation of red blood cell (RBC) volume.

Answer 1098

Severe hypertension with retinal hemorrhages, exudates, or papilledema.

Answer 1099

Severe hypertension with cerebral edema and non-localizing neurologic symptoms and signs.

Answer 1100

Histopathological examination. Patient has a recurrent chalazion, but could be an underlying sebaceous carcinoma.

Answer 1101

Pregnancy to protect the infant. This applies to all women including HIV positive.

Answer 1102

CT of abdomen this is most likely a psoas abscess from resulting hematogenous spread of bacteria from furuncles.

Answer 1103

Ovulatory reserve: takes place during a woman’s fourth decade so that on in 5 women age 35-39 is no longer fertile.

Answer 1104

Ancylostoma braziliense; The dog and cat hookworm; Present tropical and subtropical regions USA; Kids sandbox/beaches; Characterized by pruritic, elevated, serpiginous lesions on the skin.

Answer 1105

Up to age 20 staphylococcus aureus treat with vancomycin first. After 20 pseudomonas is most common treat amikacin, ceftazidime, and ciprofloxacin.

Answer 1106

Follicular conjunctivitis and pannus (neovascularization) formation in the cornea. Treatment topical tetracycline and oral azithromycin.

Answer 1107

Patient presents with blunt head trauma with signs/symptoms of ipsilateral hemiparesis, ipsilateral mydriasis, and strabismus, contralateral hemianopia, and altered mentation. Many times it compresses oculomotor nerve.

Answer 1108

Diagnosis of exclusion: Intrahepatic cholestasis of pregnancy (ICP):

Answer 1109

Dilation is ≥6 cm with ROM and 1 of the following: No cervical change for ≥4 hours despite adequate contractions or No cervical change for ≥6 hours with inadequate contractions. Tx: cesarean

Answer 1110

Bronchogenic carcinoma number one has pleural plaques. Remember pleural mesothelioma is usually unilateral pleural abnormalities with large effusion.

Answer 1111

CK-MB because it returns to baseline in 1-2 days. Troponin T takes 10 days to go down.

Answer 1112

Smudge cells. Other diagnostic features are marked leukocytosis with predominant lymphocytosis.

Answer 1113

Lung malignancies and cystic fibrosis

Answer 1114

Serotonin release assay.

Answer 1115

Stop heparin and start direct thrombin inhibitor (argatroban, bivalirudin)

Answer 1116

Acetaminophen is CYP450 inhibitor, so increases warfarin effect and causes excessive bleeding. Other drugs that do this NSAIDS, metronidazole, amiodarone, cimetidine, cranberry juice, omeprazole, thyroid hormone, SSRI, ginko bilbo, vitamin E.

Answer 1117

Carbamazepine, ginseng, green vegetables, oral contraceptives, phenobarbital, rifampin, st. john's wort.

Answer 1118

Nonclassical congenital adrenal hyperplasia

Answer 1119

>10 mmHG and pulmonary artery pressure > 40 mmHg.

Answer 1120

Weight lose and OTC. Metformin for existing DM2

Answer 1121

vancomycin, plus ampicillin, and plus cefepime or ceftazidime. Steroids given same time. Stopped if culture grows anything besides streptococcus pneumoniae.

Answer 1122

Large aneurysm diameter, rapid rate expansion, and current cigarette smoking.

Answer 1123

Increase work of breathing.

Answer 1124

They have hypomagnesemia give magnesium.

Answer 1125

Get MRI possible spinal cord compression from epidural abscess.

Answer 1126

Plasmapheresis

Answer 1127

Combination cyclophosphamide and steroids

Answer 1128

Bicuspid valve.

Answer 1129

Positive hydrogen breath test, positive stool test for reducing substances, low stool pH and increased stool osmotic gap. No steatorrhea.

Answer 1130

Meckel's diverticulum should be suspected as a lead point.

Answer 1131

Viral esophagitis, HSV or CMV.

Answer 1132

Trihexyphenidyl (anticholinergic)

Answer 1133

Combination of increased dead space perfusion causing V/Q mismatch, decreased affinity of hemoglobin of CO2, and reduced alveolar ventilation.

Answer 1134

Compression of spinal nerve roots.

Answer 1135

Get venous sample, the finger stick has high false positive results.

Answer 1136

CT of abdomen.

Answer 1137

Hypothermia, this can be seen in other antipsychotics

Answer 1138

Second generation antipsychotic first (risperidone). Then titrate the mood stabilizer.

Answer 1139

Restrictive disease due to diminished chest wall and spinal mobility.

Answer 1140

Carcinoids are slow growing tumors found in GI tract that secrete histamine, serotonin, and VIP. Liver usually filters these so no symptoms till it metastasis to liver. Presets with episodic flushing, secretory diarrhea, bronchospasm, and cardiac valvular abnormalities.

Answer 1141

Hyperlipidemia, hyponatremia, elevated creatinine kinase

Answer 1142

Entamoeba histolytica: Oral metronidazole

Answer 1143

Mosquito borne viral illness, especially common in Caribbean. Presents with polyarthralgias, lymphopenia, thrombocyopenia and rash.

Answer 1144

Bronchogenic cyst

Answer 1145

Neurogenic tumors

Answer 1146

calcium oxalate stone

Answer 1147

HBsAg and anti- HBc

Answer 1148

Worsening of hypertension