Step 2

Question 1

Treatment for Akathisia

Answer 1

Beta Blocker- Propranolol (1st line);

Benzodiazeopine - Lorazepam (2nd line)

Question 2

Treatment for Acute Dystonia

Answer 2

Diphenhydramine or Benztropine

Question 3

Treatment for Drug Induced Parkinsonism

Answer 3

Benztropine or Amantadine

Question 4

Treatment of Intrahepatic Cholestasis of Pregnancy

Answer 4

Ursodeoxycholic Acid (UDCA)

Question 5

Cause of Acute Bacterial Parotitis

Answer 5

Staph Aureus infection typically in post-operatively dehydrated patients (can be prevented by adequate hydration and oral hygiene)

Question 6

Silent Thyroiditis

Answer 6

Mild brief hyperthyroid phase, small non-tender goiter, positive TPO antibody, Low radioactive uptake (UNLIKE GRAVES)

Question 7

Subacute Thyroiditis (de Quervain)

Answer 7

Often post-viral, painful tender goiter with hyperthyroid symptoms, elevated ESR

Question 8

Graves Disease

Answer 8

Hyperthyroidism due to increased synthesis of thyroid hormone, radio-iodine uptake is diffusely increased

Question 9

Effect of Estrogen on Thyroid

Answer 9

Increased TBG concentration with estrogen/in pregnancy; If hypothyroid, will need to increase levothyroxine dose
Increase in total thyroid level (minimal increase in free)

Question 10

Most Common Thyroid Cancer

Answer 10

Papillary (70-90%, psamomma bodies, ground glass), followed by Follicular (Hurthle cells can be seen in both)

Question 11

Requirements of Brain Death

Answer 11

Coma, no brain or brainstem function (no gag reflex, pupil light reflex, corneal reflex, cough, posturing, caloric response), positive apnea test

Question 12

Drugs that Prevent Cardiac Remodeling/Decrease Mortality

Answer 12

ACE inhibitors, ARBs, B-blockers, Spironolactone

Hydralazine + Nitrates (in African Americans)

Question 13

Antibiotics for MRSA

Answer 13

Clindamycin, Trimethoprim-sulfamethoxazole, or Vancomycin

Question 14

Treatments for Mastitis

Answer 14

Dicloxacillin or Cephalexin

Question 15

Disorders Affecting Anterior Horn Cells

Answer 15

Spinal Muscular Atrophy, ALS, Poliomyelitis

Question 16

Guillain Barre Has Effects On

Answer 16

Peripheral Nerves, demyelination of motor nerves (acute ascending polyneuropathy)

Question 17

Treatment of Guillain Barre

Answer 17

Immunoglobulin or plasmapheresis

Question 18

Treatments of Acute Abnormal Uterine Bleedings

Answer 18

High dose IV or oral Estrogen, High dose combined OCP, High dose progestin pills, Tranexamic acid

Question 19

Sonohysterogram Used To Evaluate

Answer 19

Uterine cavity for fibroids or polyps

Question 20

Opioid Withdrawal Symptoms

Answer 20

Mydriasis (dilated pupils), N/V, diarrhea, diaphoresis, abdominal pain, rhinorrhea, lacrimation, hypertension

Question 21

Indications for NSTs

Answer 21

High risk pregnancy starting at 32-34 weeks (2x/week)

Perceived decrease in fetal movement

Question 22

NST

Answer 22

Reactive/Normal is at least 2 accelerations (15 for 15sec) in FHR within 20 minutes

• May be non-reactive during fetal sleep cycle
• Vibroacoustic stimulation used to awaken fetus

Question 23

Typical Causes of Hyperventilation

Answer 23

Pneumonia, High Altitude, Salicylate Poisoning, Pulmonary Embolism

Question 24

Causes of Metabolic Acidosis (Anion Gap)

Answer 24

MUDPILES (anion gap): Methanol, uremia, DKA, propylene glycol, INH, lactic acidosis, ethylene glycol, salicylates

Question 25

Causes of Metabolic Acidosis (Non-Anion Gap)

Answer 25

Diarrhea and Renal Tubular Acidosis

Question 26

Causes of Metabolic Alkalosis

Answer 26

Vomiting, Loop Diuretics, Hyperaldosteronism

Question 27

Anticonvulsants for Absence Seizures

Answer 27

Ethosuximide or Valproic Acid

Question 28

Causes for Liver Enzymes in the 1000s

Answer 28

Viral Hepatitis, Medications (e.g. acetaminophen), Autoimmune, Shock/Ischemic Liver

Question 29

Indications to Screen for HIV

Answer 29

Age 15-65, risk factors (IVDA, MSM, HIV+ partner), pregnancy, occupational exposure, hx of another STD, etc. - Preferred testing: HIV p24 antigen and HIV Antibodies - Positive test is confirmed with HIV-1/HIV-2 Antibody Immunoassay

Question 30

Treatment for Symptomatic HOCM

Answer 30

Negative inotropic agents: beta blockers (MC initial therapy, metoprolol or atenolol), verapamil, or disopyramide - Avoid vasodilators that will decrease preload

Question 31

Indications for Carotid Endarterectomy

Answer 31

Asymptomatic: if >60% in men or >70% in women Symptomatic: if >50% in men or >70% in women

Question 32

Friedreich Ataxia

Answer 32

MC type of spinocerebellar ataxia - Frequent falls, ataxia - Scoliosis and hammer toes - Hypertrophic Cardiomyopathy

Question 33

Pernicious Anemia

Answer 33

Signs and symptoms of B12 deficiency: macrocytic anemia, glossitis, and peripheral neuropathy - Risk of chronic atrophic gastritis and risk of gastric cancer - Anti-intrinsic factor antibodies decreases B12 absorption

Question 34

CD4 count

Answer 34

Pneumocystis jirovecci: trimethoprim-sulfamethoxazole

Question 35

CD4 count

Answer 35

Toxoplasma: trimethoprim-sulfamethoxazole

Question 36

CD4 count

Answer 36

MAC (mycobacterium avium): Azithromycin

Question 37

CD4 count

Answer 37

Histoplasma: Itraconazole

Question 38

Best diagnostic tool for Acute Diverticulitis

Answer 38

Abdominal CT with contrast

Question 39

Anticoagulation for DVT

Answer 39

Start on unfractionated Heparin, followed by Warfarin 6 hours later - Do not start warfarin alone, transient hypercoaguable state

Question 40

Refeeding Syndrome

Answer 40

Insulin secretion causes cellular uptake of Phosphorus, Potassium, and Magnesium - Risk of arrhythmias and cardiopulmonary failure

Question 41

Pregnant Mothers with Active Hep B

Answer 41

Infant should receive both Hep B vaccine and HBIG

Question 42

Dopamine Pathway: Mesolimbic

Answer 42

Antipsychotic efficacy

Question 43

Dopamine Pathway: Nigrostriatal

Answer 43

EPS: Acute dystonia, akathisia, parkinsonism

Question 44

Dopamine Pathway: Tuberoinfundibular

Answer 44

Hyperprolactinemia: amenorrhea, galactorrhea, gynecomastia, and sexual dysfunction

Question 45

Pertussis Treatment

Answer 45

Macrolides (azithro, clarithro, erythro)

Question 46

Pertussis vs Croup

Answer 46

Pertussis: bordetella, whooping cough 3 stages (catarrhal, paroxysmal, convalescent) Croup: Parainfluenza, barky cough, inspiratory stridor, steeple sign

Question 47

Acute and Chronic Psych Symptoms with SLE

Answer 47

Psychosis, depression, mania, and anxiety

Question 48

Biliary Colic vs Acute Cholecystitis

Answer 48

Biliary Colic due to gallstones: recurrent symptoms that resolve within 4-6 hours, no tenderness, fever or leukocytosis Acute Cholecystitis: >6 hrs, fever, leukocytosis, Murphys sign

Question 49

Posterior Urethral Injury

Answer 49

Aw/ Pelvic fractures | Blood at urethral meatus, high riding prostate, and scrotal hematoma

Question 50

GERD Symptoms

Answer 50

Sore throat, morning hoarseness, cough worse at night, chest pain/heartburn, dysphagia, regurgitation

Question 51

Upper Airway Cough Syndrome

Answer 51

Post nasal drip, dripping in throat feeling, chronic cough without rhinorrhea - Tx: diphenhydramine

Question 52

Aspirin Exacerbated Respiratory Disease (AERD)

Answer 52

In patients with asthma and chronic rhinosinusitis - symptoms of nasal congestion after ingestion of NSAIDs - worsening of asthma - nasal polyps

Question 53

Time Criteria to meed Generalized Anxiety Disorder

Answer 53

Symptoms lasting >6 months. Anxiety about multiple issues

Question 54

Germinal Matrix Bleed

Answer 54

Occurs in premature or low birth weight infants | - Bulging fontanel, focal neurologic signs, seizures, pallor

Question 55

Fetal Hydantoin Syndrome

Answer 55

Aw/ anticonvulsant medications, phenytoin and carbamazepine | - midfacial hypoplasia, microcephaly, cleft lip/palate, digital hypoplasia, hirsutism, developmental delate

Question 56

SIADH

Answer 56

Euvolemic Hyponatremia Urine osmolarity > serum osmolarity Urine Na > 20 Serum osmolarity

Question 57

Psychogenic Polydipsia

Answer 57

Euvolemic Hyponatremia | Decreased urine osmolality

Question 58

Hypovolemic Hyponatremia

Answer 58

Diuretic overuse, interstitial nephritis, or salt-wasting conditions - BUN and Cr would be elevated

Question 59

Side effects of Cyclosporine

Answer 59

Nephrotoxicity, HTN, Neurotoxicity, Glucose intolerance, Gingival hyperplasia, GI manifestations, Hirsutism, Malignancy

Question 60

Side effects of Tacrolimus

Answer 60

Neurotoxicity, diarrhea, and glucose intolerance | - higher incidence than with cyclsporine

Question 61

Side effects of Azathiprine

Answer 61

Dose related diarrhea, leukopenia, and Hepatotoxicity

Question 62

Side effects of Mycophenolate Mofetil

Answer 62

Bone marrow suppression

Question 63

First Degree Heart Block

Answer 63

Prolonged PR interval | - Observe

Question 64

Leukemoid Reaction vs Chronic Myeloid Leukemia (CML)

Answer 64

LR: severe infection and marked leukocyte counts (>50,000), Late neutrophil precursors, High LAP (alk phos) CML: Low LAP, early neutrophil precursors, absolute basophilia

Question 65

Positive Predictive Value

Answer 65

How likely a positive test is to be true, want more true positives than false positives - Decreasing the cutoff value, decreases the PPV because more false positives

Question 66

Renal Transplant Dysfunction

Answer 66

In the early post-op period: - Ureteral obstruction - Acute rejection (Lymphocyte infiltration, tx with IV steroids) - Cyclosporine toxicity - Vascular obstruction - ATN

Question 67

Cyanide Toxicity

Answer 67

If ingested: activated charcoal Antidote: hydroxycobalamin (1st) or sodium thiosulfate, if unavailable then nitrites Housefire/smoke exposure: hydrogen cyanide and CO Cyanide: binds cytochrome A3 in ETC chain, blocking oxidative phosphorylation --> lactic acidosis

Question 68

Diabetic Medications: Weight loss

Answer 68

Metformin (1st line), GLP-1 agonist (exenatide, liraglutide) | - everything else causes weight gain

Question 69

Side effects of Thiazolidinediones

Answer 69

Eg. Pioglitizone Can potentially induce CHF in patient with heart dz Risk of bladder cancer Weight gain

Question 70

Diabetes Medications: Hypoglycemia

Answer 70

Sulfonylurea, Insulin | Low risk with TZDs and DPP4 inhibitors (gliptins)

Question 71

Ventilator Associated Pneumonia

Answer 71

Empiric Abx to cover for Gm + and -, pseudomonas, and MRSA - nosocomial PNA develops at least 48 hours after intubation - MC: pseudomonas, e.coli, klebsiella, MRSA, strep

Question 72

Location of Ulcers from Venous Insufficiency

Answer 72

Medial aspect of leg, above medial malleolus

Question 73

Location of Ulcers from Neuropathy

Answer 73

Pressure/weight bearing points of feet, soles of feet, below head of first metatarsal

Question 74

Location of Ulcers from Arterial Insufficiency

Answer 74

Tips of digits (fingers or toes)

Question 75

Primary Adrenal Insufficiency

Answer 75

Hypotension, hyperpigmentation (Elevated ACTH, Low cortisol) Hyponatremia, Hyperkalemia (Low Aldosterone) Eosinophilia MC cause in developed countries: Autoimmune (80%) Hemorrhage (warfarin, meningococcemia, pseudomonas) less likely

Question 76

Rheumatic Heart Disease: Atrial Fibrillation

Answer 76

Mitral stenosis --> dilation of left atrium --> atrial fibrillation --> loss of atrial kick and worse flow --> increased lung congestion --> dyspnea

Question 77

Prevention of Pneumococcal Sepsis in Sickle Cell Anemia

Answer 77

PPSV23 vaccination (protection against encapsulated organism) and twice daily penicillin (till age 5)

Question 78

Galactose 1 phosphate uridyl transferase Deficiency

Answer 78

Galactosemia Vomiting, failure to thrive, bilateral cataracts, jaundice, and hypoglycemia, can lead to mental retardation if untreated - Increased risk of E. Coli sepsis

Question 79

Galactokinase Deficiency

Answer 79

Cataracts, otherwise asymptomatic

Question 80

Gonococcal Conjunctivitis

Answer 80

2-5 days after birth Copious exudates and eyelid swelling Tx: IV ceftriaxone or cefotaxime Ppx: erythromycin ophthalmic ointment (will not prevent chlamydia)

Question 81

Chlamydial Conjunctivitis

Answer 81

5-14 days after birth Presents with chemosis, moderate eye swelling Watery, mucoid discharge (less purulent) Tx: Oral erythromycin

Question 82

Infective Endocarditis (Duke Criteria)

Answer 82

Major Criteria: +blood cultures, echo showing vegetations Minor Criteria: IVDA, prior cardiac malformation, fever, embolic phenomenon (splinter hemorrhages, osler nodes, janeway lesions, roth spots, petechia), glomerulonephritis, heart murmur 2 major OR 1 major + 3 minor

Question 83

Cerebellar Lesion

Answer 83

Ipsilateral Ataxia, nystagmus, intention tremor, loss of coordination, dysmetria - Fall toward side of lesion

Question 84

Leriche Syndrome

Answer 84

Aortoiliac occlusion: triad of bilateral hip, thigh, and buttock claudication, impotence, and symmetric atrophy of bilateral lower extremities

Question 85

Contraindications to Trial of Labor

Answer 85

Classical (vertical) incision and Hx of abdominal myomectomy with uterine cavity entry

Question 86

Epithelial Ovarian Carcinoma

Answer 86

SOB, constipation, vomiting, abdominal bloating, early satiety, abdominal pain, increased CA125 - U/S: solid components, thick septations, ascites

Question 87

Endometriomas

Answer 87

Homogenous cysts with internal echoes (ground glass) Common cause of pelvic pain in premenopausal women Endometrial glandular tissue on ovary

Question 88

Mature Teratoma Adnexal Mass

Answer 88

Hyperechoic nodules and calcifications, may have solid components

Question 89

Cushings Reflex

Answer 89

HTN, bradycardia, respiratory depression | Due to increased ICP (possibly impending herniation, may see oculomotor nerve dysfunction)

Question 90

Uncal Herniation (transtentorial)

Answer 90

Ipsi hemiparesis Ipsi oculomotor paralysis (eye down and out) Contra homonymous hemianopsia

Question 91

Opening Snap w/ Low Pitched Diastolic Rumble

Answer 91

Mitral Stenosis | - likely due to RHD

Question 92

Multifocal Atrial Tachycardia

Answer 92

Frequent atrial premature beats often aw/ severe lung dysfunction (e.g. interstitial lung disease)

Question 93

Varicella Post-Exposure Prophylaxis

Answer 93

If immunized: observation If non-immune: Varicella vaccine If non-immune & immunocompromised: VZIG

Question 94

Evaluation of Bilious Vomiting

Answer 94

NG decompression and IV fluids Abdominal X ray (first) If dilated bowel: contrast enema (Meconium ileus or Hirschsprung) If free air/unstable: surgery (Perforation) If gas-less abdomen: upper GI series (contrast) (Malrotation) If double-bubble: duodenal atresia

Question 95

Reye's Syndrome

Answer 95

Hepatoencephalopathy due to aspirin in children with viral infections

Question 96

Treatment of Tourette's

Answer 96

2nd Gen Antipsychotics (Risperidone) | Pimozide (not first line)

Question 97

Polymyositis vs Polymyalgia Rheumatica

Answer 97

Polymyositis: proximal muscle weakness, elevated liver/muscle enzymes, abnormal electromyography, aw/ malignancy Polymyalgia: aching and stiffness in shoulders, hips, torso, but no muscle tenderness, elevated ESR, resolves with low dose steroids, >50 yrs

Question 98

Treatment for Acute Mania

Answer 98

Antipsychotics, lithium, and anticonvulsant mood stabilizers (valproate, carbemazepine) - 1st or 2nd Gen antipsychotics to manage mania and acute behavioral agitation (other medications take several days before having effect)

Question 99

Envelope shaped Kidney Stones

Answer 99

Calcium Oxalate (MC type, 75-90%) & Calcium Phosphate Risks: Hypercalciuria, ethylene glycol, vit C abuse, Crohns (unabsorbed fatty acids bind calcium, so more oxalate free to be reabsorbed) Tx: citrate or thiazides, reduce sodium in diet

Question 100

Coffin Lid Kidney Stones

Answer 100

Struvite (Ammonium Mag Phosphate) UTI from Proteus, Staph, Klebsiella Alkaline urine

Question 101

Uric Acid Kidney Stones

Answer 101

Radiolucent (not seen on Xray) Aw/ gout or leukemia Tx: Alkalinize urine (potassium citrate)

Question 102

Hexagonal Kidney Stones

Answer 102

Cystine (secondary to cystinuria) +Sodium Nitroprusside Test Can form Staghorn Tx: Alkalinize urine

Question 103

CMV Colitis

Answer 103

Blood diarrhea in patients with CD4 counts

Question 104

CAH: 21 Hydroxylase Deficiency

Answer 104

Build up of 17 Hydroxyprogesterone Salt wasting hypotension Ambiguous genitalia in girls

Question 105

Spherocytes with +Coombs

Answer 105

Autoimmune Hemolytic Anemia (AIHA) | Due to autoantibodies to RBCs

Question 106

Erysipelas

Answer 106

Cellulitis caused by Group A Strep (S. Pyogenes)

Question 107

Innocent Murmurs

Answer 107

Decreased intensity with standing and valsalva Systolic Grade I-II Low pitches, musical, pure, or squeaky at LLSB High pitched at LUSB Asymptomatic, negative family Hx

Question 108

Benzodiazepines in Elderly

Answer 108

Risk of falls, confusion, and paradoxical agitation (typically within 1 hour)

Question 109

Hyperkalemia: cardiac stabilization

Answer 109

Calcium gluconate infusion

Question 110

Hyperkalemia: rapid treatment to decrease serum K

Answer 110

Insulin + Glucose Beta 2 agonists Sodium Bicarb (Diuretics, kayexelate, and Dialysis are slow acting)

Question 111

Rare Disease Assumption

Answer 111

OR is a close approximation of RR incase-control studies where the outcome is uncommon

Question 112

Obstructive Sleep Apnea: Acid Base

Answer 112

Hypoventilation causes chronic hypoxia and hypercapnia | - Compensate by metabolic alkalosis (bicarb retention)

Question 113

Congenital Heart Defect: Hypoxia failing to improve with supplemental O2

Answer 113

Give Prostaglandin E1 to keep a Patent Ductus Arteriosus | - Closure in a PDA dependent defect can shock & acidosis

Question 114

Arrest of Labor

Answer 114

Dilation of at least 6cm w/ ruptured membranes and 1 of the following: No cervical change for at least 4 hrs despite adequate ctx No cervical change for at least 6 hrs w/ inadequate ctx

Question 115

Adequate Contractions

Answer 115

Sum up to at least 200 montevideo units over 2 hours

Question 116

Shoulder Dislocation Due to Seizure

Answer 116

Posterior dislocation | - Shoulder is adducted and internally rotated

Question 117

Vaginal Cancer

Answer 117

MC is Squamous Cell; over age 60 Risks: HPV and smoking, Hx of cervical dysplasia - Upper 1/3 of the posterior vaginal wall - Malodorous vaginal discharge, bleeding, mass on vagina

Question 118

Vaginismus

Answer 118

Involuntary contraction of perineal musculature -Psychological cause Tx: relaxation, Kegel exercises to relax vaginal muscles, and insertion of dilators

Question 119

Treatment for a Human Bite

Answer 119

Ppx with Amoxicillin-clavulanate | - Also used for dog bites and cat bites

Question 120

MEN1

Answer 120

Parathyroid Pituitary Pancreatic

Question 121

MEN2A

Answer 121

Parathyroid Medullary Thyroid Pheochromocytoma

Question 122

MEN2B

Answer 122

Mucosal Neuroma/Marfanoid habitus Medullary Thyroid Pheochromocytoma

Question 123

Isolated Systolic Hypertension

Answer 123

HTN in elderly due to decreased elasticity of arterial wall - Wide pulse pressure - Tx: low dose thiazide, ACEi, or long acting CCB

Question 124

Drugs to Avoid in WPW

Answer 124

Adenosine, Beta Blockers, CCBs, and Digoxin (can increase conduction through accessory pathway) - Can use Procainamide or Quinidine, if unstable then cardioversion

Question 125

Treatment for PSVT (Paroxysmal SVT)

Answer 125

Vagal Stimulation: carotid sinus massage, valsalva, cold water immersion IV Adenosine

Question 126

Treatment for VTach (wide complex tachycardia)

Answer 126

If unstable: DC cardioversion | If stable: IV amiodarone preferred

Question 127

Blunt Abdominal Trauma Evaluation

Answer 127

After appropriate fluid resuscitation FAST scan to assess for intraperitoneal free fluid or hemorrhage If limited or equivocal, can do DPL (diagnostic peritoneal lavage) If either FAST or DPL is positive, ex laparotomy

Question 128

Nonseminomatous Germ Cell Tumor

Answer 128

AFP and B-hCG | In anterior mediastinum (usually primary)

Question 129

Seminoma

Answer 129

B-hCG (does not produce AFP)

Question 130

Rotor Syndrome

Answer 130

Defect in hepatic secretion of conjugated bilirubin | Positive urine bilirubin (has to be conjugated to be in urine)

Question 131

Drugs Aw/ Photosensitivity

Answer 131

Doxycyline (tetracyclines), Chlorpromazine, Prochlorperazine, Furosemide, HCTZ, Amiodarone, Promethazine

Question 132

Treatment for Urge Incontinence

Answer 132

Detrusor overactivity treated with Antimuscarinics - Oxybutynin If Pelvic floor exercises and bladder training fail

Question 133

Lipid Lowering Guidelines

Answer 133

Atherosclerotic Dz + under age 75: High intensity statin Atherosclerotic Dz + over age 75: Mod intensity statin Age 40-75 w/ DM with ASCVD risk >7.5%: High intensity Age 40-75 w/ DM with ASCVD risk 7.5%: Mod to High intensity statin

Question 134

Essential Tremor

Answer 134

Action tremor of hands, no other neurological signs - relieved with EtOH - Tx: propranolol, primidone, or topiramate

Question 135

Parkinson's Tremor

Answer 135

Resting tremor, decreases with voluntary movement

Question 136

Cerebellar Tremor

Answer 136

Aw/ ataxia, dysmetria, or gait disorder | Increases as hand reaches target

Question 137

Treatment for Cryptococcal Meningitis

Answer 137

Amphotericin B with Flucytosine intitially | - Maintenance with Fluconazole

Question 138

Vertebral Osteomyelitis MC Occurs in:

Answer 138

Sickle cell, IVDA, and immunosuppressed patients | - Tenderness to gentle percussion, ESR elevated

Question 139

MI Complications: Acute (within 24 hrs)

Answer 139

CHF, Cardiogenic Shock, RV failure, Arrythmia, Death

Question 140

MI Complications: 3-5 days

Answer 140

Papillary muscle rupture (acute Mitral Regurg) | Interventricular septum rupture

Question 141

MI Complications: 5-14 days

Answer 141

Free wall rupture | LV Pseudoaneurysm

Question 142

MI Complications: weeks to months

Answer 142

Dressler's Syndrome (immune pericarditis) | True ventricular aneurysm

Question 143

MI Complications: 1-3 days

Answer 143

Acute Pericarditis

Question 144

Graft vs Host Disease

Answer 144

Donor T cells attack the host - Rash - GI symptoms - Abnormal liver tests

Question 145

McCune Albright Syndrome

Answer 145

Precocious puberty Cafe au lait spots Multiple bone defects (Polyostotic FIbrous dysplasia)

Question 146

Rh(-) Anti -D Immune Globulin

Answer 146

``` Standard dose of 300ug at 28 weeks to prevent alloimmunization May need higher dose after delivery, procedures, or abruption Kleihauer Betke (KB) test used to determine dose ```

Question 147

Ethylene Glycol vs Methanol Ingestion

Answer 147

``` Metabolic Acidosis with anion gap Ethylene: (Tx with Fomepizole) - Envelope shaped Calcium-oxalate crystals - Acute renal failure, flank pain Methanol - Can cause blindness ```

Question 148

Electrical Alternans

Answer 148

Seen with Cardiac Tamponade

Question 149

Pulsus Paradoxus

Answer 149

Seen with Cardiac Tamponade

Question 150

Pulsus Parvus et Tardus

Answer 150

Seen with Aortic Stenosis

Question 151

Marjolin Ulcer

Answer 151

Squamous cell carcinoma that forms in area of a burn wound that undergoes extensive chronic healing/scar formation

Question 152

Fluphenazine Side Effect

Answer 152

Can cause hypothermia due to inhibition of body's shivering mechanism and/or inhibiting autonomic thermoregulation

Question 153

Digoxin Toxicity

Answer 153

``` N/V, vision changes (blurry, blue-green color) Fatal arrhythmias (Atrial Tachycardia with AV block) Worsened with Hypokalemia Worse with Amiodarone (need to lower Digoxin dose) ```

Question 154

CML

Answer 154

BCR-ABL (Chr 9:22 translocations) Leukocytosis, absolute basophilia, early neutrophil precursors (promyelocytes, myelocytes) Tyrosine kinase constitutively active Tx: Imatinib

Question 155

Malignant Otitis Externa (MOE)

Answer 155

Severe ear pain, purulent drainage, conductive hearing loss, edematous external canal with granulation tissue - may have facial droop if nerve damage Pseudomonas Aeruginosa MC in elderly, poorly controlled diabetics, and immunosuppressed Tx: IV Ciprofloxacin, or Piperacillin, or Ceftazadime

Question 156

Indication for Cystoscopy

Answer 156

Unexplained gross hematuria or with microscopic hematuria and other risk factors for bladder cancer (smoking, exposures, chronic cystitis, cyclphosphamide, radiation)

Question 157

Treatment for TCA overdose

Answer 157

Sodium Bicarbonate - Prevents cardiac problems (QRS widening or ventricular arrhythmias) Activated charcoal if

Question 158

Anterior Spinal Cord Syndrome

Answer 158

Loss of motor function, pain and temperature below level of injury - position/vibration/touch intact Due to spinal cord infarction Can be a complication of thoracic aortic aneurysm repair (reduced blood flow causing infarction) Ant 2/3 of cord

Question 159

Scaphoid Fracture Management

Answer 159

If initial Xray is negative, immobilize and xray again in 7-10 days If xray shows nondisplaced fracture, immobilize for 6-12 weeks If displaced/angulated fracture, surgical reduction needed

Question 160

Length of Treatment with Antidepressant

Answer 160

Single episode: continue for 4-9 months after improvement | Recurrent/chronic: 1-3 years or indefinitely

Question 161

Premature Ovarian Failure

Answer 161

``` Hypergonadotropic Hypogonadism Menopause before age 40 Elevated FSH (low estradiol) ```

Question 162

Amenorrhea Due to Hyperprolactinemia

Answer 162

Inhibits GnRH release

Question 163

Gestational Diabetes

Answer 163

Macrosomia, neonatal hypoglycemia, organomegaly, heart defects, polycythemia

Question 164

Treatment of a Breast Abscess

Answer 164

Needle aspiration and antibiotics (dicloxacillin, cephalexin) Continued breast feeding I and D if not responding to aspiration + abx, suspected necrosis, or >5cm pus collection

Question 165

Bronchiolitis

Answer 165

Age

Question 166

Beckwith Wiedemann Syndrome

Answer 166

Fetal macrosomia, umbilical hernia, macroglossia, hemihyperplasia Monitor for Hypoglycemia Risk of Wilms Tumor and hepatoblastoma - Abd U/S and AFP levels regularly

Question 167

Henoch Schonlein Purpura (HSP)

Answer 167

Abdominal pain, lower extremity purpura, arthritis | IgA nephropathy

Question 168

Acid Base of Chronic COPD

Answer 168

Respiratory Acidosis with compensatory Metabolic Alkalosis (kidney retention of bicarb)

Question 169

Omphalocele

Answer 169

Covering sac of peritoneum over the protruding bowel | - Over half occur with cardiac or neural tube defects, or trisomies

Question 170

Gastroschisis Occurrence

Answer 170

Isolated defect >90% of the time Elevated AFP Abdominal wall defect due to vascular insult Uncovered bowel herniation

Question 171

Toxic Shock Syndrome

Answer 171

Rapid onset rash (desquamating, hands and soles), fever, hypotension, diarrhea, thrombocytopenia - Staph Aureus, superantigen TSST-1 50% aw/ tampon use, the rest with surgical wound, sinusitis, nasal packing

Question 172

MC cause of Osteomyelitis

Answer 172

Staph Aureus (in both infants and children) Staph epidermis is a common cause in prosthetic devices Salmonella is common in Sickle cell patients

Question 173

Thalamic Hemorrhage

Answer 173

Contra hemiparesis and hemisensory loss | Upgaze palsy, eyes deviate toward hemiparesis

Question 174

Cerebral Hemorrhage

Answer 174

``` Contra hemiparesis (frontal) Contra hemisensory loss (parietal) Homonymous hemianopsia (occipital) Eyes deviate away from hemiparesis Seizure common ```

Question 175

Pontine Hemorrhage

Answer 175

Deep coma, total paralysis | Pinpoint reactive pupils

Question 176

MC cause of AR in young adults

Answer 176

Congenital bicuspid aortic valve in developed countries | Rheumatic Heart disease in developing countries

Question 177

Anion Gap =

Answer 177

Na - (HCO3 + Cl)

Question 178

Disseminated MAC

Answer 178

Fever, cough, diarrhea, night sweats, weight loss Splenomegaly Elevated Alk Phos CD4 count

Question 179

Paget Disease of Bone

Answer 179

Elevated Alk Phos, Normal Ca and P, Elevated Urine hydroxyproline Osteolytic and sclerotic bone lesions Disordered osteoclastic bone resorption Enlargement of skull, hearing loss, frontal bossing Tx: Bisphosphonates (inhibits osteoclasts, suppress bone turnover)

Question 180

Behcet Syndrome

Answer 180

Young adults, turkish, middle eastern or asian Recurrent oral aphthous ulcers Genital Ulcers Commonly have uveitis, skin lesions, or thrombosis Pathergy: exaggerated skin ulceration from minor taruma

Question 181

Condyloma Lata

Answer 181

Raised grey white mucosal lesions | Seen in syphilis

Question 182

Epitrochlear Lymphadenopathy

Answer 182

Pathognomonic for syphilis | - Sailor's handshake

Question 183

Central Cord Syndrome

Answer 183

Upper extremity weakness, loss of pain temp sensation in arms - Typically with Hyperextension injuries in elderly patients with pre-existing degenerative changes in cervical spine Selective damage to the central portion of the corticospinal tract and decussating fibers of lateral spinothalamic tract

Question 184

Brown Sequard Syndrome

Answer 184

Cord Hemisection Ipsi: weakness, spasticity, loss of vibration and proprioception Contra: pain and temp loss (lower do to lazy crossing)

Question 185

Cervical Actinomycosis

Answer 185

Dental caries, infected tooth, gingivitis, diabetes, etc Non-tender indurated abscess, draining sinus tract MC in the mandible Anaerobic Gm + filamentous branching, yellow granular pus Tx: Penicillin

Question 186

Nocardia

Answer 186

Aerobic Gm+ partially acid fast filamentous rod Affects brain, soft tissue/skin, and lungs of immunocompromised Fever and purulent crusting lesions/ulcers following traumatic inoculation Tx: Trimethoprim-sulfamethoxazole

Question 187

Vitamin D Deficiency

Answer 187

Low Calcium and Phosphorus High PTH May have bone pain, muscle weakness, cramps, gait abnormalities May be asymptomatic

Question 188

Acid Base: Post op Atelectasis

Answer 188

Hyperventilate to compensate Repiratory alkalosis Hypocapnia and Hypoxemia

Question 189

Becks Triad

Answer 189

Seen with Cardiac Tamponade | Distended neck veins, Distant Heart sounds, Hypotension

Question 190

Preterm Labor: 34 to 36 weeks

Answer 190

+/- Betamethasone; PCN if GBS + or unknown

Question 191

Preterm Labor: 32 to 33 weeks

Answer 191

Betamethasone, Tocolytics, PCN if GBS+ or unknown

Question 192

Preterm Labor:

Answer 192

Betamethason, Tocolytics, Mag Sulfate, PCN if GBS+ or unknown

Question 193

Vanishing Bile Duct Syndrome

Answer 193

Progressive destruction of intrahepatic bile ducts (ductopenia) PBC is MC cause in adults

Question 194

Amiodarone Side effects

Answer 194

``` Sinus bradycardia, heart block QT prolongation with risk of Torsades Chronic interstitial pneumonitis (MC) Elevated transaminases/hepatitis Thyroid problems, Optic neuropathy, blue gray skin color, peripheral neuropathy ```

Question 195

Adult Still's Disease

Answer 195

Recurrent high fever Rash (maculopapular, on trunk and extremities) Arthritis

Question 196

Acute Bacterial Rhinosinusitis

Answer 196

Persistent symptoms of at least 10 days without improvement Severe symptoms with fever, face pain, and purulent nasal discharge Worsening symptoms after 5 days of initially improving viral URI MC S pneumo, then haemophilus, then moraxella Tx: Amox-clav

Question 197

Tumor Lysis Syndrome

Answer 197

Hyperphosphatemia, Hyperkalemia, Hyperuricemia | Hypocalcemia (prolonged QT)

Question 198

External Cephalic Version

Answer 198

Can be offered for a singleton pregnancy is at least 37 weeks No contraindication to vaginal delivery (placenta previa, active herpes) No ruptured membranes, abnormal FHT, or oligohydramnios

Question 199

Schizoaffective

Answer 199

Delusion or hallucinations in the ABSENCE of major mood disorder (depressive or manic)

Question 200

Common Causes of Decrease Platelet Production

Answer 200

EBV, HIV, HepC Chemo, Myelodysplasia (>60yrs), Alcohol Fanconi Syndrome B12 or Folate deficiency

Question 201

Common Cause of Platelet Destruction or Sequestration

Answer 201

SLE, Heparin, ITP, DIC, TTP, HUS Sequestration by Spleen (May be false if clumping of platelets)

Question 202

Meniere Disease

Answer 202

Recurrent episodes of vertigo Hearing loss or tinnitus (Unilateral) Elevated endolymph pressure

Question 203

BPPV

Answer 203

Brief episodes of vertigo Triggered by head movement Nystagmus with Dix Hallpike Can correct with Epley maneuver

Question 204

Vestibular Neuritis

Answer 204

Acute, single episode (may last days) | Often following viral syndrome

Question 205

Giant Cell Tumor

Answer 205

Soap bubble appearance (lytic expansile area) in Epiphysis Benign, locally aggressive neoplasm in young adults MC in distal femus, proximal tibia Pain, swelling, decreased range of motion Pathologic fractures may occur

Question 206

Osteitis Fibrosa Cystica

Answer 206

MC due to hyperparathyroidism from parathyroid carcinoma Fibrous tissue (brown tumors), causes bone pain Subperiosteal bone resorption on radial aspect of the middle phalanges, salt pepper appearance

Question 207

Osteoid Osteoma

Answer 207

Sclerotic, cortical lesion with a central nidus lucency Worse at night Quickly relieved by NSAIDs

Question 208

Granulomatosis with Polyangiitis (Wegeners)

Answer 208

upper respiratory infections, lung nodules/cavitation Rapidly progressive glomerulonephritis C-ANCA (PR3) Small medium sized vessel vasculitis

Question 209

Imaging if Suspicious for Stroke

Answer 209

Non contrast head CT

Question 210

Cholesteatomas

Answer 210

In children, either congenital or acquired due to chronic middle ear disease New onset hearing loss or chronic ear drainage Granulation tissue and skin debris in ear canal Retraction pockets of tympanic membrane

Question 211

Hydrocele

Answer 211

Cystic scrotal mass that transilluminates Most disappear spontaneously by 1 yr of age Fluid within processus or tunica vaginalis

Question 212

Pneumonia in Cystic Fibrosis

Answer 212

Staph Aureus MC in children | Pseudomonas MC in adults

Question 213

Trichinellosis

Answer 213

Ingestion of undercooked meat (usually pork) - roundworm infection More in Mexico, China, Thailand, etc Encysted larvae become worms --> larvae encyst in striated muscle Intestinal stage: asymptomatic or abd pain, N/V, diarrhea Muscle stage: fever, splinter hemorrhages, conjunctival/retinal hemorrhages, periorbital edema, chemosis, Myositis (neck arm shoulder tenderness/weakness) Eosinophilia - Hallmark

Question 214

Ascariasis

Answer 214

Intestinal symptoms and eosinophila Lung phase with a nonproductive cough followed by an intestinal phase Worms may obstruct small bowel or bile ducts

Question 215

Dengue Fever

Answer 215

Fever, headache, retroorbital pain, rash Significant myalgia and arthralgia May be hemorrhagic (hemorrhage in skin or nose)

Question 216

Typhoid Fever

Answer 216

Over 3 weeks: Abdominal pain, salmon colored rash, then hepatospenomegaly and abdominal complications (bleeding)

Question 217

Necrotizing Surgical Site

Answer 217

Pain, edema, erythema, Fever, hypotension or tachycardia Paresthesia at edges of wound Purulent, cloudy gray discharge (dishwater drainage) Subcutaneous gas or crepitus Usually polymicrobial, MC in diabetics Tx: surgical debridements and antibiotics

Question 218

Treatment for Pneumocystis Jiroveci

Answer 218

Trimethoprim-Sulfamethoxazole | Adjunctive corticosteroids may decreased mortality in severe cases (steroid indicated if PaO2 35)

Question 219

Choanal Atresia

Answer 219

Cyanosis aggravated by feeding (can't breathe through mouth) Relieved (turn pink) with crying Isolated or may be part of CHARGE syndrome

Question 220

Pregnancy Visible on U/S

Answer 220

B-hCG of 1500-2000

Question 221

Treatment for Symptomatic Endometriosis

Answer 221

OCPs and NSAIDs, if this fails, laparoscopy

Question 222

Chronic Mesenteric Ischemia

Answer 222

Atherosclerosis of mesenteric arteries Crampy postprandial epigastric pain (POOP) Food aversion and weight loss CT angiography for diagnosis

Question 223

Treatment of Diabetes Insipidus

Answer 223

Desmopressin

Question 224

Treatment of SIADH

Answer 224

Remove cause if possible Fluid restriction If severely symptomatic hyponatremia, give hypertonic saline Demeclocycline decreases response to ADH, rarely used

Question 225

Mixed Cryoglobulinemia

Answer 225

Due to Chronic Hep C Palpable purpura - Vasculitis of skin, kidney, nerves, and joints Porphyria cutanea tarda (vesicles, lesions on back of hands) Glomerulonephritis, Arthralgia Low complement, elevated Rheumatoid factor and LFTs

Question 226

FSGS

Answer 226

Like minimal change, but in adults (foot process effacement) Segmental sclerosis and hyalinosis African americans and hispanics Aw/ HIV, Sickle cell, Heroin

Question 227

Membranous Nephropathy

Answer 227

Spike and dome MC in caucasian adults Aw/ SLE, Hep B and C, NSAIDs, solid tumors

Question 228

Minimal Change Disease

Answer 228

Effacement of foot processes MC in children Aw/ Hodgkins lymphoma

Question 229

Amyloidosis

Answer 229

apple green birefringence (congo red) | Aw/ MM, TB, RA

Question 230

MPGN

Answer 230

Subendothelial deposits, tram tract Aw/ Hep B and C Low C3

Question 231

Diabetic Glomerulonephropathy

Answer 231

Kimmelstiel WIlson nodules GBM thickening Mesangial espansion

Question 232

Post Strep GN

Answer 232

Weeks after Group A strep infection (skin or pharynx) | Dark urine, periorbital edema

Question 233

RPGN (Crescenteric)

Answer 233

Goodpasture, Wegeners (PR3, c-anca), Microscopic polyangiitis (MPO, p-anca)

Question 234

DPGN

Answer 234

Wire looping | Aw/ SLE (MC cause of death)

Question 235

IgA Nephropathy

Answer 235

Mesangial IgA deposits Few days after URI or acute gastroenteritis Seen with HSP

Question 236

Central Adrenal Insufficiency

Answer 236

Suppression of HPA axis due to chronic glucocorticoid use Suppresses ACTH and adrenal function, so when steroid stopped takes months to recover Will have low cortisol and low ACTH (adrenals have not woken up) Aldosterone levels will be normal (RAAS)

Question 237

Testing for Syphilis

Answer 237

VDRL (non-treponemal) may be negative in early disease FTA-ABS (treponemal) has higher sensitivity can can be used even if VDRL is negative Could also do darkfield microscopy to look at treponema pallidum

Question 238

Milk Protein Induced Enterocolitis

Answer 238

Fam Hx of allergies, eczema, or asthma Age 2-8 wks, regurgitation/vomiting, painless bloody stools, eczema Eliminate milk and soy from maternal diet (if breastfeeding) Hydrolyzed formula in formula fed infants Resolves by 1 yr of age

Question 239

Rotator Cuff Impingement or Tendinopathy

Answer 239

Pain with abduction, external rotation, positive impingement tests (Neer and Hawkins)

Question 240

Adhesive Capsulitis

Answer 240

Frozen shoulder Decreased passive and active ROM More stiffness than pain

Question 241

Biceps Tendinopathy or Rupture

Answer 241

Anterior shoulder pain, pain with lifting/carrying/overhead reaching

Question 242

HIV Screening in Pregnancy

Answer 242

All women should be screened in First Trimester Because of window period, should screen again in Third Trimester Infants diagnosed with PCR testing

Question 243

Basal Ganglia (Putamen) Hemorrhage

Answer 243

Conta hemiparesis (internal capsule) and hemisensory loss Homonymous hemianopsia Gaze palsy towards lesion

Question 244

Side effects of EPO therapy in ESRD

Answer 244

Worsening of HTN (1/3 of patients) Headaches Flu symptoms Red cell aplasia (rare)

Question 245

Congenital CMV

Answer 245

Blueberry muffin spots, periventricular calcifications

Question 246

Congenital Toxoplasmosis

Answer 246

Diffuse intracerebral calcifications | Chorioretinitis

Question 247

Congenital Syphilis

Answer 247

Rhinorrhea (snuffles), Abnormal long bone radiographs Desquamating or bullous rash Hutchinson teeth, saber shins, saddle nose

Question 248

Congenital Rubella

Answer 248

Cataracts PDA Deafness Blueberry muffin rash

Question 249

Cerebral Palsy

Answer 249

``` Increased risk with prematurity (before 32 wks especially) Nonprogressive motor dysfunction 3 types: spastic, dyskinetic, and ataxic Clasp knife spasticity 50% have intellectual disability ```

Question 250

Suspected Infection in Neonate

Answer 250

Poor feeding, decreased alertness, lethargy, fever or hypothermia Full evaluation: CBC, blood cultures, LP, urinalysis, urine culture Start empiric antibiotics

Question 251

Clavicular Fracture Evaluation

Answer 251

Careful neurovascular exam is important due to proximity to subclavian vein and brachial plexus - If bruit heard, do angiogram

Question 252

Femoral Nerve

Answer 252

IPSQuad muscles | Sensation to anterior thigh and medial leg

Question 253

Tick Borne Paralysis

Answer 253

Rapidly progressive ascending paralysis (may be asymmetrical) - No fever, sensory issues - Normal CSF

Question 254

Chlordiazepoxide

Answer 254

Benzo used for Alcohol withdrawal

Question 255

Dermatofibroma

Answer 255

Benign fibroblast proliferation Firm hyperpigmented nodule (usually on LE) When pinched, causes dimpling (buttonhole sign)

Question 256

Duchennes Muscular Dystrophy

Answer 256

Absent dystrophin gene | Dx: muscle biopsy, genetic testing is gold standard

Question 257

Becker's Muscular Dystrophy

Answer 257

Decreased (but not absent) dystrophin Muscle weakness later in childhood Milder version of Duchennes

Question 258

Myotonic Dystophy

Answer 258

AD; presents in teen years Muscle weakness, myotonia, cataracts, cardiac problems Delayed muscle relaxation Electromyography - myotonic pattern

Question 259

Risk for C Diff

Answer 259

Advanced age, recent abx use (clindamycin, penicillins, cephalosporins, FQs), hospitalization, prolong acid secretion by PPIs

Question 260

Treatment for Kawasakis

Answer 260

Aspirin + IVIG

Question 261

Asymmetric Fetal Growth Restriction

Answer 261

Maternal cause | HTN, Pre-E, DM, SLE, substance abuse

Question 262

Symmetric Fetal Growth Restriction

Answer 262

Fetal Factor Genetic disorder Congenital heart defect Intrauterine infection

Question 263

Peripheral Precocious Puberty (Gonadotropin Independent)

Answer 263

LH low at baseline, Does not increase with GnRH Advanced bone age, coarse axillary and pubic hair, cystic acne Late-onset (nonclassic) CAH

Question 264

Idiopathic Precocious Puberty

Answer 264

Premature HPG activation Almost exclusively in girls LH elevated at baseline, Increases with GnRH

Question 265

Leydig Cell Tumors

Answer 265

Gonadotropin independent precocious puberty | Unilateral testicular enlargement or mass

Question 266

Treatment for Restless Leg Syndrome

Answer 266

Dopamine Agonists Pramipexole or Ropinerole May need oral iron supplementation Can try using Gabapentin

Question 267

PCOS Cancer Risk

Answer 267

Unbalanced estrogen | Endometrial hyperplasia and risk of endometrial cancer

Question 268

pH of Exudate and Transudate

Answer 268

Transudate: 7.4-7.55 Exudate: 7.3-7.45 Normal Pleural Fluid: 7.6

Question 269

Pleural fluid glucose

Answer 269

Usually in complicated parapneumonic effusion, malignancy, TB, or RA

Question 270

Evaluation of Cushing's Syndrome

Answer 270

Initial: late night cortisol, 24 hr urine free cortisol, and/or low dose dexamethasone suppression If hypercortisolism: ACTH level measured (to see if dependent or independent) If ACTH suppressed/independent: CT scan adrenals If ACTH elevated/dependent: High dose dexamethasone (to determine if pituitary or ectopic) Ectopic: Dexa will not suppress cortisol Pit: Dexa suppresses cortisol

Question 271

Migratory Superficial Thrombophlebitis (Trousseau)

Answer 271

Usually aw/ occult malignancy (pancreatic cancer)

Question 272

Management of a Threatened Abortion

Answer 272

Symptoms resolve or progression to inevitable, incomplete, or missed abortion

Question 273

Incomplete, Inevitable, or Missed Abortion Management

Answer 273

If hemodynamically unstable (heavy bleeding): D&C surgical evacuation If hemodynamically stable (mild bleeding): Patient preference between --> Expectant management, Medical-prostaglandins, or Surgical evacuation

Question 274

Septic Abortion Management

Answer 274

Blood and endometrial cultures Broad spectrum abx Surgical evacuation

Question 275

Management of a Stable Ectopic Pregnancy

Answer 275

Methotrexate

Question 276

Neonatal Tetanus

Answer 276

Poor suckling, fatuge, then rigidity and spasms Fatal if untreated Infants born to unimmunized mothers Often have umbilical stump infection

Question 277

Central Precocious Puberty

Answer 277

Increased FSH and LH due to early activation of HPO axis Need brain imaging with CT or MR Tx: GnRH analog

Question 278

Osgood Schlatter Disease

Answer 278

``` Traction Apophysitis (soft tissue swelling, irrgular/fragmented tubercle) In adolescents playing sports Tenderness over tibial tubercle Tx: activity restriction, stretching, NSAIDs ```

Question 279

Patellar Tendonitis

Answer 279

``` Overuse injury (jumping or kicking) Anterior knee pain (no point tenderness) ```

Question 280

HIV and Live Vaccines

Answer 280

Most contraindicated EXCEPT MMR and Varicella zoster | - can be given if CD4 count >200 and no hx of AIDs defining illness

Question 281

Shy Drager Syndrome

Answer 281

Multiple system atrophy - Parkinsonism - Autonomic Dysfunction - Widespread neurological signs (cerebellar, pyramidal, LMN)

Question 282

Antiphospholipid Syndrome

Answer 282

Higher frequency in SLE VTE or recurrent early miscarriage Pro-thrombotic immunoglobulin (in vivo) --> causes prolonged PTT in vitro

Question 283

Diabetes Screening

Answer 283

All patients 45 or older, and those at any age who have additional risk factors -Fasting plasma glucose HA1C or OGTT

Question 284

Hyper IgM

Answer 284

Elevated IgM, low IgA and IgG X linked defect in CD40 ligand Recurrent infections Tx: Abx ppx and interval IVIG

Question 285

Metoclopramide Induced Dystonic Reaction

Answer 285

DA antagonist used to treat N/V and gastroparesis EPS can occur Tx: discontinue medication, benztropine or duphenhydramine

Question 286

Prosthetic Joint Infection

Answer 286

Within 3 months: staph aureus | After 3 months: staph epidermis

Question 287

Serotonin Syndrome

Answer 287

Hyperreflexia and myoclonus present (unlike in NMS)

Question 288

Infectious Mono

Answer 288

EBV, fever, fatigue, exudative pharyngitis, and cervical lymphadenopathy Polymorphous maculopapular rash develops with administration of amoxicillin

Question 289

Klumpke's Palsy

Answer 289

Claw hand (extended wrist, hyperextended MCP, flexed interphalangeal joints) Due to shoulder dystocia Damage to C8 and T1 Abnormal grasp, Normal moro

Question 290

Erb Duchenne Palse

Answer 290

MC type of brachial plexus injurt 5th and 6th cervical nerves Waiter tip Normal grasp, Abnormal Moro

Question 291

Young healthy patient with CHF

Answer 291

Myocarditis is likely, due to a Viral infection | - With a coxsackie B virus is MC cause

Question 292

Anemia, Osteolytic lesions, Hypercalcemia

Answer 292

Multiple Myeloma Excessive production of monoclonal proteins Ineffective antibody production Screen with SPEP, Confirm dx with bone marrow biopsy

Question 293

Radioactive Iodine Uptake

Answer 293

Increased RAIU suggests de novo thyroid hormone synthesis Decrease suggests preformed hormone release or exogenous hormone intake - If exogenous, then thyroglobulin low - If thyroiditis (preformed release), high thyroglobuline

Question 294

Torus Palatinus

Answer 294

Fleshy immobile mass on the midline hard palate Congenital No medical or surgical therapy unless symptomatic or interfering with speech/eating

Question 295

Acid Base: Chronic COPD

Answer 295

Normal pH, elevated HCO3 | If acute CO2 retention, then HCO3 near normal levels and decreased pH

Question 296

Treatment for Bipolar Disorder

Answer 296

First Line: lithium or valproate with a 2nd gen antipsych Approved: Lithium, valproate, quetiapine, and lamotrigine Avoid antidepressants Do not use lithium if impaired renal function

Question 297

Dumping Syndrome

Answer 297

Common postgastretomy complication Abd pain, diarrhea, nausea, hypotension 15-30 min after meals due to rapid emptying of hypertonic gastric contents Tx: small frequent meals, complex carbs, high fiber and protein

Question 298

Complete Mole

Answer 298

2 sperm fertilize an ovum without genetic material No fetal tissue Hyperemesis gravidarum , enlarged uterus, theca lutein ovarian cyts

Question 299

Incomplete Mole

Answer 299

2 sperm fertilize a haploid ovum | Fetal tissue, triploid karyotype

Question 300

Resuscitative vs Maintenance Fluids

Answer 300

Resuscitative: D5 never used, only NS or LR (isotonic crystalloids); DO not use 1/2or 1/4 NS (hypotonic) Maintenance: D5 can be added

Question 301

Treatment of Hip Dysplasia in Infants

Answer 301

Tx: pavlik hip harness if

Question 302

Serous Otitis Media

Answer 302

Non infectious effusion, MC middle early pathology in AIDs patients Due to lymphadenopathy or obstructing lymphomas - Conductive hearing loss is MC symptom - Dull TM that is hypomobile

Question 303

Lead Poisoning in Adults

Answer 303

``` Occupational exposure (lead paint, batteries, construction) Abd pain, constipation, anorexia, cognitive deficits, peripheral neuropathy, Anemia ```

Question 304

Microangiopathic Hemolytic Anemia

Answer 304

HUS following diarrheal syndrome from E coli 0157H7 Purpura, HTN, renal failure, oliguria, thrombocytopenia, fever Schistocytes on peripheral smear Elevated LDH and indirect bili

Question 305

SCID

Answer 305

Failed T cell development and dysfunctional B cells as a results of absent T cells X linked recessive or AR Recurrent infection, FTT, chronic diarrhea

Question 306

Chronic Granulomatous Disease (CGD)

Answer 306

NADPH oxidase defect, impaired killing of catalase+ organisms (eg. staph aureus) Phagocytes filled with bacteria Recurrent skin and soft tissue infections Normal lymphocytes and immunoglobulins Dx: DHR or NBT tests to test neutrophil function

Question 307

CVID

Answer 307

Recurrent sinopulmonary or GI bacterial infections Hypoglobulinemia Unlike Bruton agammaglobulinemia, it is less severe, presents later, and has normal B cell counts

Question 308

Bruton (X-Linked) Agammaglobulinemia

Answer 308

Absern B cells, low serum immunoglobulins Normal T cell concentration Recurrent infection Absent lymphoid tissue

Question 309

Burr Cells

Answer 309

Spiculated RBCs (serrated edges) seen in liver disease and ESRD

Question 310

Howell Jolly Bodies

Answer 310

Splenectomy patients or patients with functional asplenia (sickle cell)

Question 311

Treatment of Sinus Bradycardia

Answer 311

IV Atropine | If inadequate response, IV epi or dopamine, or trancutaneous pacing

Question 312

Chronic CO Poisoning

Answer 312

Intermittent headaches, dizziness, nausea, polycythemia due to hypoxemia Carboxyhemoglobinemia - Exposure to automobile exhaust

Question 313

Vit D Deficiency (Rickets)

Answer 313

- Rachitic rosary: Enlarged protruding costochondral joins - Delayed fontanel closure, craniotabes - Genu varum, bowing, metaphyseal cupping - Hyperpigmentation - Usually due to exclusive breastfeeding/homemade food Normal to low Ca and P, Elevated Alk Phos and PTH

Question 314

Meniscal Tear

Answer 314

Passive knee flexion (McMurray) and extension while in itnernal adn external rotation Pain, clicking, or catching, sensation of instability Usually from twisting force with foot fixed

Question 315

Pendular Knee Swing Reflex

Answer 315

Indicates muscular hypotonia | May be seen with cerebellar dysfunction (other signs include gait instability, ataxia, intention tremor)

Question 316

Acetaminophen Ingestion

Answer 316

If less than 4 hrs, give charcoal and check level (nomogram) | - Give N acetylcysteine and monitor for liver injury

Question 317

Transfusion Reactions: Febrile Non-Hemolytic

Answer 317

MC, 1-6 hrs, fever chills, from cytokines (prevent with leukoreduction)

Question 318

Neonatal Thyrotoxicosis

Answer 318

Transplacental anti-TSH receptor antibodies - bind infants TSH receptors causing excessive hormone release - Watm, tachycardia, irritable, low weight Self resolves in 3 months, or methimazole + B-blocker

Question 319

MCL Tear

Answer 319

Laxity with valgus stress Blow to lateral kneww or twist injury If uncomplicated: RICE and analgesics Complicated need surgery

Question 320

Common bacterial trigger of SJS

Answer 320

Mycoplasma pneumonia

Question 321

Baseline Studies Needed Before Starting Lithium

Answer 321

Creatinin/BUN and Thyroid function tests | Calcium, U/A, and maybe ECG

Question 322

Diamond Blackfan Syndrome

Answer 322

Congenital Macrocytic anemia | Congenital anomalies: short stature, webbed neck, cleft lip, shield chest, triphalangeal thumbs

Question 323

CMV Retinitis

Answer 323

Painless, not aw/ keratitis or conjunctivitis MC ocular complication in HIV patients Fluffy or granular lesions around retinal vessels

Question 324

HSV and VZV Keratitis

Answer 324

Pain and may show peripheral pale lesions and central retinal necrosis Rapidly progressing bilateral necrotising retinitis

Question 325

Electrolyte Disturbances: Vtach

Answer 325

Hypokalemia or Hypomagnesemia | May be due to diuretic use

Question 326

Amebic Liver Abscess

Answer 326

Fever, pain, leukocytosis, Emigated from Mexico Hx of dysentery, likely Entamoeba Hystolytica Tx: Metronidazole (oral), may also need a luminal agent (parrmomycin)

Question 327

Hydatid Cyst

Answer 327

Echinococcus, pyogenic bacterial abscess Frequently asymptomatic Requires animal contact (dogs,sheep)

Question 328

Unexplained elevation of CK and Myopathy

Answer 328

Suspect Hypothyroidism

Question 329

Risk of Sepsis post-splenectomy

Answer 329

Risk present for up to 30 years Should get anti-pneumococcal, haemophilus, and miningococcal vaccines several weeks before operation Daily oral PCN ppx for 3-5 years following splenectomy

Question 330

Malaria PPx: | Sub-saharan Africa and Southeast Asia

Answer 330

If Chloroquine resistant P falciparum: Atovaquone-proguanil, Doxy, or Mefloquine (use in pregnancy) If sensitive: above or chloroquine, hydroxychloroquine

Question 331

Malaria PPx: Areas without P Falciparum | South America, Mexico, Korean Peninsula

Answer 331

Primaquine

Question 332

Treatment for Social Anxiety Disorder

Answer 332

SSRIs or SNRIs (first line) and CBT | Beta blockers for performance only social anxiety

Question 333

Bicuspid Aortic Valve Murmur

Answer 333

Systolic click followed by a fain midsystolic murmur

Question 334

Adult - Late Presentation of Coarctation

Answer 334

Upper extremity HTN, may have chest pain, headache, claudication Diminished femoral pulses with brachial femoral delay Continuous cardiac murmur Rib notching

Question 335

Supratentorial Tumors

Answer 335

Elevated ICP and seizures

Question 336

Posterior Fossa Tumors

Answer 336

Elevated ICP, ataxia, clumsiness

Question 337

Pilocytic Astrocytoma

Answer 337

MC brain tumor in children

Question 338

Medulloblastoma

Answer 338

2nd MC tumor of posterior fossa in children

Question 339

PPSV23 and PCV13 Recommended for:

Answer 339

PPSV alone: Adults under 65 w/ chronic condition (heart or lung disease, diabetes, smoking, or liver disease) PCV then PPSV: Adults under 65, w/ high risk condition (CSF leak, Sickle cell, Asplenia, renal fail, immunocomp) PCV then PPSV after 6-12 mo: ALL adults over 65

Question 340

Acute Rheumatic Fever

Answer 340

Migratory arthritis, carditis, subcut nodules, erythema marginatum, syndenhams chorea fever, arthralgia, ESR,CRP, prolonged PR

Question 341

Treatment for Uremic Encephalopathy

Answer 341

Urgent Dialysis

Question 342

Organophosphate Poisoning

Answer 342

Acetylcholinesterase inhibited --> Cholinergic excess Bradycardia, miosis, salivation, lacrimation, diarrhea, urination Tx: Atropine will counteract effects

Question 343

PCOS

Answer 343

Elevated LH--> excess androgens Anovulation, male pattern hair growth, acne, ovarian cysts Aw/ obesity, insulin resistance

Question 344

Pediatric Viral Myocarditis

Answer 344

``` Coxsackie B or Adenovirus Viral prodrome followed by heart failure Cardiomegaly and pulmonary edema High mortality in newborns Dx: biopsy ```

Question 345

Class IC Antiarrhythmics

Answer 345

Sodium channel blockers (eg flecainide) - can be used to treat a fib Use dependence Less time to dissociate with fast HR, can lead to QRS widening

Question 346

Case Control

Answer 346

Observation study Retrospectively associates outcomes with specific risks Determine the outcome and look for associated risk factors

Question 347

Cross Sectional Studies

Answer 347

Observational study Assess both exposure and outcome at a single point in time Can show association, not causation

Question 348

Prospective Cohort Study

Answer 348

Observational study | Exposed and Unexposed groups followed for development of a disease

Question 349

Retrospective Cohort Study

Answer 349

Risk factor exposure and outcome of interest occur in past, and assessed through review of records

Question 350

Randomized control trial

Answer 350

Experimental study to study efficacy of a treatment or procedure

Question 351

Evaluation of Adrenal Insufficiency

Answer 351

ACTH Cosyntropin stimulation test with cortisol and ACTH level If basal cortisol low, and ACTH high, with minimal response --> Primary adrenal insuff If basal cortisol low and ACTH low, and inadequate response --> Secondary adrenal insuff

Question 352

Interstitial Cystitis

Answer 352

Painful bladder syndrome Idiopathic (aw/anxiety and fibtromyalgia), chronic Worse with filling, relieved by voiding Dyspareunia, urinary frequency/urgency

Question 353

Hysterosalpingogram

Answer 353

To assess if there is tubal obstruction or patency | Especially in patients with hx of PID and current infertility

Question 354

Number Needed to Treat (NNT)

Answer 354

1/ARR

Question 355

Prinzmetal Angina

Answer 355

Chest pain due to coronary vasospasm Young females, smoking is a risk factory Episodes usually at night, transient ST elevations Tx: CCBs, nitrates, stop smoking

Question 356

Pseudoachalasia

Answer 356

Achalasia due to esophageal cancer Older age, weight loss, hx of smoking Will need to do Endoscopy to exclude malignancy CT after for staging

Question 357

Bupropion

Answer 357

NE DA reuptake inhibitor | No weight gain or sexual size effects

Question 358

Intraductal Papilloma

Answer 358

Unilateral bloody nipple discharge No mass or lymphadenopathy Benign

Question 359

Infiltrating Ductal Carcinoma

Answer 359

Pathologic nipple discharge Corresponding breast mass and lymphadenopathy Microcalcifications

Question 360

Amyloidosis and RA

Answer 360

AA amyloidosis Abnormally dolder proteins, Beta 2 microglobulin Nephrotic syndome: edema, proteinuria Enlarged kidneys and Hepatomegaly

Question 361

MC cause of AL amyloidosis

Answer 361

Multiple Myeloma

Question 362

MC cause of AA amyloidosis

Answer 362

RA

Question 363

Managing Stroke in Sickle Cell Patient

Answer 363

Stroke secondary to sludging and occlusion Exchange transfusion recommended acutely Prevents second infarct Fibrinolytic, Heparin, or Warfarin are not helpful since there is not a true thrombus

Question 364

Nocardia

Answer 364

Filamentous, aerobic, Gm+ Partially acid fast Pulmonary or disseminated disease to brain Tx: TMP-SMX

Question 365

Papillary Necrosis

Answer 365

Renal complication from Sickle cell trait Massive hematuria, mild episodes that resolve spontaneously U/A: normal appearing RBCs

Question 366

Managing Blunt Trauma to Spleen

Answer 366

If hemodynamically unstable and unresponsive to fluids: emergent ex laparotomy If responsive to fluids: Abd CT to see if operative intervention is needed - Effort to repair in children and avoid removal - If removed, need vaccines against encapsulated bacteria

Question 367

Allergic Interstitial Nephritis

Answer 367

Acute renal failure Recent use of sulfonamide/NSAIDs/PCNs Fever, rash WBC casts and eosinophiluria

Question 368

Rivaroxaban

Answer 368

Direct factor Xa inhibitor Efficacy similar to heparin and LMWH in treating acute DVT or PE Does not need frequent lab monitoring or daily injections No reversal antidote

Question 369

Recurrent pneumonia in same anatomic region

Answer 369

Suggests bronchial obstruction due to an underlying abnormality Chest CT indicated to visualize parenchyma

Question 370

Elevated Inhibin A

Answer 370

Trisomy 21

Question 371

Decreased Estriol

Answer 371

Trisomy 18 and 21

Question 372

Increased B-hCG

Answer 372

Trisomy 21

Question 373

Decreased AFP

Answer 373

Trisomy 18 and 21

Question 374

Trachoma

Answer 374

By Chlamydia serotype A-C Major cause of blindness worldwise Follicular conjunctivitis and pannus (neovascularization) formation of the corner Concurrent infection in nasopharynx (nasal discharge) Tx: topical tetracycline or oral azithro

Question 375

DHEA

Answer 375

Elevated in patients with androgen producing adrenal tumors

Question 376

Contact Dermatitis

Answer 376

Type IV hypersensitivity - T cell lymphocyte mediated

Question 377

Side Effect of Idinavir (Protease Inhibitor), Acyclovir, Ethylene glycol, Methotrexate

Answer 377

Crystal induced nephropathy | - Renal Tubular Obstruction

Question 378

Smudge Cells

Answer 378

Seen with CLL with small mature lymphocytes

Question 379

Treatment for Chemo-induced nausea

Answer 379

Serotonin (5HT) Receptor Antagonists (first line) | - Ondansetron

Question 380

Intermittent Asthma

Answer 380

Daytime

Question 381

Mild Persistent Asthma

Answer 381

Daytime >2x week, Nighttime >2x month | -Low dose steroid, SABA

Question 382

Moderate Persistent Asthma

Answer 382

Daytime daily, Nightitme weekly - High dose steroid, SABA - Low dose steroid, LABA, SABA

Question 383

Severe Persistent Asthma

Answer 383

Symptoms throughout day and frequently at night - High dose steroid, LABA, SABA - May need oral steroid if worsening

Question 384

FHR: Sinusoidal Fetal Heart Tones

Answer 384

Smooth undulating waveform with no variability | Aw/ fetal anemia

Question 385

FHR: Early Decels

Answer 385

Occurs with contractions, fetal head compression

Question 386

FHR: Late Decels

Answer 386

Uteroplacental Insufficiency

Question 387

FHR: Variables

Answer 387

Compressed cord or Prolapsing cord

Question 388

Lowering a Screening Tests Cuttoff Point

Answer 388

``` Increases Sensitivity (disease+ will test + --> less false negatives) Decreases Specificity (disease- will test - -->more false positives) ```

Question 389

Treatment for Torsades

Answer 389

If stable, IV mag | If unstable, immediate defibrillation

Question 390

Gilbert's Syndrome

Answer 390

Unconjugated hyprbilirubinemia Decreased UDP glucoronyl transferase enzyme Usually asymptomatic Fasting, crash diets, fever, physical exertion, stress, and fatigue are triggers

Question 391

Crigler Najjar Syndrome

Answer 391

Unconjugated hyperbilirumbinemia Severe jaundice and neurologic impairment due to kernicteris Type 2 is a milder form

Question 392

Rotor Syndrome

Answer 392

``` Conjugated hyperbilirubinemia (in urine) - Benign condition Defect in hepatic storage of conjugate bilirubin --> leakage into plasma ```

Question 393

Giardiasis

Answer 393

International travel, diarrhea, cramping, foul smelling stools, bloating Benign abd exam

Question 394

IVDA - Infective Endocarditis

Answer 394

MC due to staph aureus Tricuspid valve, holosystolic murmur Tx: Vancomycin (cover for MSSA, MRSA, strep, and enterococci)

Question 395

Acute Limb Ischemia Post-MI

Answer 395

Suggests possible arterial embolis from LV thrombus Get transthoracic Echo to look for thrombus in LV Immediate anticoagulation, vascular surgery

Question 396

Abx Prophylaxis for Rheumatic Fever

Answer 396

Penicillin for Whichever is longer 5 yrs or until age 21: RF without carditis 10 years or until age 21: RF with carditis no valve disease 10 years or until age 40: RF, carditis, and valve disease

Question 397

G6PD activity

Answer 397

Normal during an acute episode becuase the G6PD deficient RBCs have been hemolysed early, reticulocytes have normal enzyme levels

Question 398

Infective Endocarditis - Valve

Answer 398

MC affects Mitral valve (MVP with mitral regurg, RHD mitral stenosis) Aortic vave is 2nd MC involved (bicuspid, with aortic stenosis)

Question 399

Studies looking at Disease Incidence

Answer 399

Cohort

Question 400

Studies looking at Disease Prevalence

Answer 400

Cross Sectional

Question 401

Studies looking at Risk Factor Frequency

Answer 401

Case Control

Question 402

Paroxysmal Nocturnal Hemoglobinuria

Answer 402

Hemolysis, cytopenias, venous thrombosis (portal vein thrombosis) Absence of CD55 and 59 - Flow cytometry Tx: Eculizumab (inhibits complement activation), Iron and folate

Question 403

Sudden Cardiac Arrest in setting of acute MI

Answer 403

MC cause if Vfib (occurs in the first hour) | - Reentrant ventricular arrhythmia is the mechanism

Question 404

Cholesterol Embolism

Answer 404

After a vascular procedure (cardiac cath) Livedo reticularis, Blue toe Mesenteric ischemia, acute pancreatitis

Question 405

Abnormal Fingerstick Lead values

Answer 405

Confirm with a venous blood draw

Question 406

Specialized RBC treatments

Answer 406

Irradiate: for BMT patients, immunodeficient patients Leukoreduction: CMV seronegative at risk patients, potential transplant pts, previous febrile nonhemolytic reaction Washed: IgA deficiency, allergy, complement dependent AIHA

Question 407

Antiphospholipid Syndrome

Answer 407

Commonly false positive VDRL Thrombocytopenia and prolonged PTT Start on LMWH during pregnancy

Question 408

Salicylate Poisoning

Answer 408

Tinnitis, fever, tachypnea Respiratory Alkalosis followed by metabolic acidosis Anion gap

Question 409

Uric Acid Crystals in Diaper

Answer 409

Brick dust streaks - sign of mild dehydration Excretion seen during first week as mothers milk is coming in, or later as morning void when infant starts sleeping through night

Question 410

Leydig cell tumor

Answer 410

Elevated testosterone as well as estrogen | HbCG and AFP negative

Question 411

Primary Ovarian Failure

Answer 411

LH and FSH elevated, FSH:LH ratio >1

Question 412

Air in biliary tree

Answer 412

Emphysematous infection or Gallstone ileus (due to fistula)

Question 413

Treatment of Postpartum Endometritis

Answer 413

Polymicrobial infection | IV clindamycin + gentamicin

Question 414

Steroid Acne

Answer 414

Monomorphous pink papules and absence ofcomedones

Question 415

Bath Salt Intoxication

Answer 415

Amphetamine analog Severe agitation, combativeness, psychosis, delirium, myoclonus Prolonged duration of effect

Question 416

Phototherapy for Jaundice

Answer 416

If total bili >20

Question 417

Prevention of Post-SAH Cerebral Vasospasm

Answer 417

Nimodipine

Question 418

Managing Congenital Prolonged QT

Answer 418

Risk of syncope, arrhythmia and sudden death Avoid electrolyte derangement, medications blocking potassium, and excess exertion - Beta blockers and pacemaker placement

Question 419

Internuclear Ophthalmoplegia

Answer 419

Disorder of conjugate horizontal gaze, affected eye (ipsi to lesion) cannot adduct, and the contra eye abducts with nystagmus Normal convergence and pupil reflex Damage to MLF Bilateral lesions classically seen in MS

Question 420

Fat Necrosis of the Breast

Answer 420

Fat globules and foamy histiocytes Immobile, may have retraction of overlying skin Appearance of Calcifications on mammography

Question 421

Amiloride

Answer 421

Potassium Sparing Diuretic

Question 422

Full Thickness Burns causing vascular compromise

Answer 422

Escharotomy, if no relief, Fasciotomy

Question 423

Tennis Elbow

Answer 423

Lateral Epicondylitis

Question 424

Golfer Elbow

Answer 424

Medial Epicondylitis

Question 425

Treatment of Lichen Sclerosis

Answer 425

After confirmed with Punch Biopsy | High potency vaginal steroid

Question 426

MC Malignancy of the Lip

Answer 426

Squamous Cell Carcinoma (SCC) | 95% on lower lip

Question 427

Glucose 6 Phosphatase Deficiency

Answer 427

(NOT G6PD) 3-4 month old with hypoglycemia (may have seizures), hyperuricemia, hyperlipidemia Lactic acidosis, doss like face (fat cheeks), thin extremities, short stature Enlarged liver and kidneys

Question 428

CMV Infection

Answer 428

Resembled EBV mono Fever, malaise, fatigue, mild or absent pharyngitis Lymphocytosis with >10% atypical lymphocytes - Negative heterophile antibody Self limited

Question 429

PPV and Prevalence

Answer 429

PPV increases with prevalence | NPV decreases

Question 430

Septic Shock

Answer 430

Decreased Pulm Wedge pressure Decreased SVR Increased cardiac index Increased Mixed Venous Sat

Question 431

Hypovolemic Shock

Answer 431

Decreased Pulm Wedge pressure Decreased Cardiac index Increased SVR

Question 432

Cardiogenic Shock

Answer 432

Increased Pulm Wedge Pressure Decreased Cardiac index Increased SVR

Question 433

Rhabdomyolysis

Answer 433

Standard U/A shows Large Blood Microscopy shows very few RBCs - Myoglobin not visible Can cause Acute Renal Failure

Question 434

Transient Tachypnea vs Respiratory Distress Syndrome: CXR

Answer 434

TTN: Bilateral perihilar linear streaking RDS: Diffuse reticulogranular (ground glass), air bronchograms, low lung volumes

Question 435

Home O2 Treatment

Answer 435

SaO2

Question 436

Lacunar Infarcts

Answer 436

Pure motor hemiparesis | Commonly occurs in internal capsule

Question 437

Amaurosis Fugax

Answer 437

Painless loss of vision due to emboli Warning sign for impending stroke Most emboli from carotid bifurcation Duplex U/S should be performed

Question 438

Meningococcal Vaccine

Answer 438

All adolescents age 11-12 Should get boost between ages 16-21 Important for: Military recruits, college students, and travelers to sub Saharan Africa or Mecca

Question 439

Risk factors for Respiratory Distress Syndrome

Answer 439

Prematurity and Maternal Diabetes Mellitus

Question 440

Immunization D T P Contraindications

Answer 440

Diphtheria/tetanus: anaphylaxis Precaution with Guillain barre, Arthus reaction Pertussis: anaphylaxis, neurologic disorder (epilepsy, spasms), encephalopathy Precaution with seizure, fever, hypotonia

Question 441

Beta Blocker Overdose

Answer 441

Bradycardia (AV Block), hypotension, wheezing, hypoglycemia, delirium, seizures, and cardiogenic shock Tx: Administer IV Glucagon

Question 442

Positive Bronchodilator Response

Answer 442

>12% increase in FEV1 | Asthma - reversible

Question 443

Complicated Diverticulitis with Abscess

Answer 443

3 cm: CT guided percutaneous drainage

Question 444

Vasa Previa

Answer 444

Fetal vessels traverse the amniotic membranes over the internal os, vulnerable to tearing - Tachycardia followed by bradycardia, eventual sinusoidal. Risk of fetal exsanguination Risk factors: 2nd trimester u/s showing a placenta previa resolving by 3rd trimester

Question 445

Fibromuscular Dysplasia

Answer 445

MC cause of secondary HTN in children Also in young women; low aldosterone renin ratio Also seen in premenopausal women (renin high) Bruit at costovertebral angle, carotid Angiography shows string of beads

Question 446

Systemic Blastomycosis

Answer 446

-Great lakes, Upper Midwest, Mississippi, Ohio River - Ulcerated skin lesion (wartlike, violaceous) and lytic bone lesions - Pulmonary manifestations - Broad based budding yeast Tx: itraconazole or amphotericin B

Question 447

Medications causing Hyperkalemia

Answer 447

B-blockers, Potassium sparing diuretics (amiloride), ACEis, ARBs, and NSAIDs

Question 448

Central Retinal Vein Occlusion

Answer 448

Painless loss of vision, acute, unilateral Venous dilation and tortuosity Scattered hemorrhages and cotton wool spots "blood and thunder" appearance

Question 449

Palpable Breast Mass: >30

Answer 449

Mammogram +/- U/S | If suspicious do Core Biopsy

Question 450

Palpable Breast Mass:

Answer 450

U/S +/- Mammogram If simple cyst: needle aspiration If complex cyst or mass: Core biopsy

Question 451

Magnesium Sulfate Toxicity Risk Factor

Answer 451

Renal insuffiencieny (Mag excreted by kidneys) Decreased DTR, somnolence, respiratory depression

Question 452

Reactive Arthritis

Answer 452

Seronegative spondyloarthropathy Triad: Nongonnococcal urethritis, Asymmetric oligoarthritis, and conjunctivitis Tx: NSAIDS

Question 453

Lactation Suppression

Answer 453

NSAIDs, ice packs, supportive bra, and avoid nipple stimulation

Question 454

Abrupt Cessation of Short Acting Benzos

Answer 454

eg. Alprazolam Aw/ significant withdrawal - Generalized seizure - Confusion

Question 455

Serum Sickness Like Reaction

Answer 455

Type III Hypersensitivity 1-2 weeks after Beta lactam or TMP-SMX - Fever, urticaria, polyarthrlagia

Question 456

Zinc Deficiency

Answer 456

Chronic TPM or malabsorption Alopecia, skin lesions, abnormal taste Impaired wound healing

Question 457

Any Penetrating Wound in Thorax Below Nipples

Answer 457

Potential to be abdominal | Requires an Ex Lap

Question 458

Side Effect of Hydroxychloroquine

Answer 458

Retinopathy

Question 459

Rash commonly seen with Mycoplasma pneumonia

Answer 459

Erythema Multiforme | Dusky red target shaped lesions

Question 460

Medications that Cause Idiopathic Intracranial Hypertension

Answer 460

Growth hormone Tetracyclines Excess Vit A, Isoretinoin, ATRA

Question 461

Morton Neuroma

Answer 461

Usually between 3rd and 4th toes | Clicking sensation with palpation and squeezing

Question 462

Optic Neuritis

Answer 462

Suspect in patient with central scotoma, afferent pupillary defect, change in color perception, and decreased visual acuity - Aw/ Multiple sclerosis

Question 463

Testing for Acute Hep B infection

Answer 463

HBsAg and anti-HBc Both elevated during initial infection anti-HBc will be elevated during window period

Question 464

Risk of Brain Abscess with:

Answer 464

Recurrent Sinusitis Fever, severe headaches (morning or nocturnal) Focal neurologic changes Seizures in 25%

Question 465

Treatment of UTIs

Answer 465

Uncomplicated: nitrofurantoin or TMP-SMX right away, don't need urine cx Complicated of Pyelo: need urine cx first, will probably need to use FQs

Question 466

Normal Anion Gap Acidosis and FTT

Answer 466

Renal or GI etiology If no diarrhea, then likely RTA (alkaline urine) Low serum bicarb, high chloride Type 2 RTA (Fanconi) cant reabsorb bicarb Type 1 RTA cant excrete hydrogen

Question 467

Dominant Lobe

Answer 467

Opposite side of Handedness

Question 468

Prolonged infusion of Sodium Nitroprusside

Answer 468

Cyanide toxicity Especially in patients with CKD Headache, confusion, flushing, arrhythmias, and respiratory depression Tx: Sodium Thiosulfate

Question 469

Ecthema Gangrenosum

Answer 469

Pseudomonas aeruginosa infection Rapidly progressive skin lesions that develops into nontender nodules with central necrosis (ruptured bulla leaving nontender ulcer with black center) - Seen in immunocompromised

Question 470

Sore throat, dry cough, chest pain radiating to shoulder followed by weakness,dizziness, syncope, and pulsus paradoxus

Answer 470

Viral Myocarditis followed by Cardiac Tamponade

Question 471

Large Decrease in Systolic BP with Inspiration

Answer 471

Pulsus Paradoxus | - may have loss of radial pulse during inspiration

Question 472

Herpes Simplex Encephalitis: CSF

Answer 472

Lymphocytosis, increased protein and RBCs, normal glucose | May have seizures or bizarre psychotic behavior

Question 473

Restrictive Pulmonary Disease

Answer 473

Decreased FEV1, FVC, and TLC Normal or Increased FEV1/FVC (since proportional decrease) Bibasilar fine, dry crackles May be due to Pulmonary fibrosis

Question 474

Transfusion Reaction: Anaphylaxis

Question 475

Transfusion Reaction: TRALI

Answer 475

Respiratory distress and hemolyis

Question 476

Transfusion Reaction: Acute Hemolytic

Answer 476

ABO incompatibility

Question 477

Lumbar Spinal Stenosis

Answer 477

Neurogenic claudication MC cause is degenerative osteoarthritis of spine Relief with flexion of spine (leaning forward, walking uphill) MRI to diagnose

Question 478

Reducing Risk of Thromboembolism in Patients with Afib

Answer 478

Warfarin or oral anticoagulants (Rivaroxaban, dabigatran, apixaban)

Question 479

Tuberculous Pulmonary Effusions

Answer 479

Very high protein levels, lymphocytosis, low glucose

Question 480

Treatment of SVC Syndrome

Answer 480

Radiation, primarily palliative treatment | Usually malignancy is a lung cancer or lymphoma

Question 481

Aspiration Pneumonia Location

Answer 481

Supine: posterior upper lobes, and superior lower lobes Upright: right middle lobe, bases of lower lobes - Risk of anaerobic infection: clindamycin, amoxicillin (w/ or w/o clav), or metronidazole

Question 482

Pruritic Prodrome followed by Subepidermal Blisters

Answer 482

Bullous Pemphigoid - tense bullae | Tx: high potency topical steroid (clobetasol)

Question 483

Intraepidermal Blisters

Answer 483

Pemphigus Vulgaris - fragile | - Usually oral mucosa involved as well

Question 484

Management of a Tension Pneumothorax

Answer 484

Needle decompression --> will increase venous return

Question 485

Amyotrophic Lateral Sclerosis (ALS)

Answer 485

Upper and lower motor neuron signs Atrophied muscles and fasciculations --> LMN Babinski and hyperactive reflexes --> UMN

Question 486

Partial Complex Seizures

Answer 486

Stare blankly then may have automatisms (chewing, lip smacking) Post ictal confusion or Todd's paralysis TemporalLobe Epilepsy is a common cause

Question 487

Potential Complication of Esophageal Dilation

Answer 487

Esophageal rupture causiing mediastinitis

Question 488

ABI

Answer 488

1-1.3 normal

Question 489

Primary Hyperaldosteronism

Answer 489

Resistant HTN, Hypokalemia, Metabolic alkalosis MC due to Bilateral adrenal hyperplasia or Aldosterone producing adrenal adenoma Adrenalectomy for adenoma Aldosterone antagonist (Spironolactone) for bilateral hyperplasia

Question 490

Gastric Bypass Surgery: Managing increased risk of Gallstones

Answer 490

- Prophylactic treatment with ursodeoxycholic acid can decrease the risk

Question 491

Secondary Hyperparathyroidism

Answer 491

Hypocalcemia Hyperphosphatemia - kidney cannot adequately excrete Chronic Kidney Disease - Over time results in parathyroid hyperplasia - Renal osteodystrophy

Question 492

Neurogenic Bladder- Management

Answer 492

Suprapubic pressure, timed voids, double voiding | Cholinergic agents

Question 493

Altered Mental Status, Cirrhosis, Abdominal Pain or Fever

Answer 493

SBP | Neutrophil count >250 - ascitic fluid

Question 494

Young patient with recent viral illness, now with heart failure

Answer 494

Dilated cardiomyopathy secondary to viral myocarditis

Question 495

Painless Jaundice

Answer 495

Secondary to pancreatic cancer, until proven otherwise

Question 496

Iron Toxicity in a Child

Answer 496

Accidental poisoning Abdominal pain, vomiting/hematemesis, explosive diarrhea Later: hepatotoxicity and severe lactic acidosis Tx: Defuroxamine

Question 497

Fever, night sweats + Cavitary lesion in Lung Apex and Pain in Lower Spine

Answer 497

Disseminated TB (hematogenously)

Question 498

Afib with Unintentional Weight Loss

Answer 498

Test for hyperthyroidism

Question 499

Prognosis of Astrocytomas Determined by:

Answer 499

Tumor grade: degree of anaplasia

Question 500

Chronic Lymphocytic Leukemia (CLL)

Answer 500

Severe lymphocytosis, smudge cells Flow cytometry to diagnose: monoclonal B cell lymphocytes Tx: Rituximab (anti- CD20 monoclonal antibody)

Question 501

Brain Abscess as Complication of IE

Answer 501

IVDA at risk Hematogenous seeding of bacteria or systemic embolization Focal neuro deficits, elevated ICP, vomiting, fever

Question 502

Hypovolemic Hyponatremia

Answer 502

Na

Question 503

Sickle Cell Infections

Answer 503

Pneumonia, Sepsis, Meningitis: S. pneumo | Osteomyelitis: S. Aureus, Salmonella

Question 504

Antibiotic Prophylaxis before Dental Procedures

Answer 504

Only for: Prothetic valves, prior IE, or unrepaired congenital heard disease Not for MVP, MR, bicuspid aortic valve, or acquired aortic valve disease

Question 505

Sensitivity

Answer 505

Identify diseased patients as diseased (+test for +disease)

Question 506

Specificity

Answer 506

Identify healthy patients as healthy (-test for -disease)

Question 507

Urinary frequency or urgency, pain, bloating, abdominal distension, and early satiety in postmenopausal woman

Answer 507

Ovarian cancer, MC is epithelial ovarian carcinoma | Pleural effusion and rectovaginal nodularity are signs of metastatic spread

Question 508

Midshaft Fracture of Humerus

Answer 508

Risk of injury to Radial Nerve and Deep brachial artery

Question 509

Management of Jaundice and Pruritus due to Advanced Pancreatic Cancer

Answer 509

Palliative endoscopic CBD stent placement to relieve obstruction

Question 510

MC causes of malignant pleural effusions

Answer 510

Breast and Lung cancer

Question 511

Rate control in Afib

Answer 511

Beta blocker or CCB

Question 512

Wide Fixed Split S2

Answer 512

Delayed closure of Pulmonic valve | - Due to ASD (L to R shunt)

Question 513

Diarrhea, abdominal pain, bloating, Eosinophilia

Answer 513

Parasitic infection most likely

Question 514

Fever + Monoarticular joint Symptoms

Answer 514

Consider Septic arthritis - Even in presence of a pre-existing joint disease like RA - Abnormal join has increased risk of infection

Question 515

Malignancy: DIC

Answer 515

Anemia in patients with DIC due to microangiopathic hemolysis Low platelets, elevated LDH and bilirubin, elevated retic count

Question 516

Lipid Screening

Answer 516

Between ages 40-75 | If Risk

Question 517

Non blanching erythema on heels

Answer 517

Early stage of a pressure ulcer

Question 518

Cisplatin: Side effect

Answer 518

Nephrotoxicity, tinnitis, hearing loss, electrolyte abnormalities, N/V, and neurotoxicity

Question 519

Juvenile Myoclonic Epilepsy

Answer 519

Progression from absence seizures (around age 10) to myclonic seizures (around age 15) Worse with sleep deprivation

Question 520

Lennox Gastaut

Answer 520

Children under age 7, wide array of seizure types | Mental retardation

Question 521

Most important factor in reducing chest pain

Answer 521

Venous dilation | Decreases preload and as a result decreases oxygen demand

Question 522

Treating Bacterial Meningitis

Answer 522

Ceftriaxone (3rd gen cephalosporin) + Ampicillin | S. pneumo, N. meningitis, H influenza and Listeria

Question 523

Epidural Abscess

Answer 523

Diabetics, IVDA, and patients with recent hx of spinal trauma Staph aureus is MC etiology Tx: Vancomycin (cover for MRSA)

Question 524

Distributive Shock

Answer 524

Increased cardiac output Decreased PVR and PCWP - Includes sepsis and anaphylaxis

Question 525

Granulomatosis with Polyangiitis

Answer 525

Necrotizing vasculitis Typically affects lower respiratory tract and Kidneys Cutaneous manifestations common - local ischemia and impaired wound healing

Question 526

Myelodysplastic Syndrome

Answer 526

Macrocytic anemia (without hypersegmented neutrophils), leukopenia, and thrombocytopenia Ovalo-macrocytes on peripheral smear Dx: Bone marrow biopsy

Question 527

MC postinfectious complication of Impetigo

Answer 527

Glomerulonephritis | if Group A Strep infection

Question 528

Infection in Neutropenic Patient

Answer 528

Can't mount same response May not have a fever and may have more subtle signs of infection Tx: empiric Abx

Question 529

DKA Biochem

Answer 529

Lack of insulin causes breakdown of fatty acids to ketones inthe liver Increased lipolysis of peripheral fat stores secondary to high catecholamine levels

Question 530

Treatment of DKA

Answer 530

Gradual fluid resuscitation with 10ml/kg NS bolus over 1 hr Followed by IV regular insulin drip with potassium Transition to subcutaneous when patient is eating, gap resolved

Question 531

High Pretest Probability of PE with Low probability VQ scan

Answer 531

Get CT angiogram of chest - cannot rule out PE without more testing - PE excluded if low pretest and low VQ probabilities

Question 532

Efavirenz: Side Effect

Answer 532

NNRTI that causes neuropsych side effects: insomnia, vivid dreams, depression, and anxiety

Question 533

Management of Urge Incontinence

Answer 533

First line: bladder training | Oxybutynin (antimuscarinic) agent that relax detrusor

Question 534

Leukocytoclastic Vasculitis

Answer 534

Henoch Schonlein Purpura Palpable, nonblanching lesions, IgA deposits Abdominal pain and renal failure following a URI

Question 535

Joint pain that worsens throughout the day

Answer 535

Osteoarthritis

Question 536

Suspicion of Placenta Previa

Answer 536

Transabdominal U/S first, then if still suspicious, Transvaginal U/S (gold standard(

Question 537

Avoid Coadministration of Triptan and Ergotamine

Answer 537

May result in prolonged vasospasm due to overactivation of 5HT receptors --> hypertension --> MI or stroke - Should be 24 hours between

Question 538

Strawberry tongue, Conjunctivitis (limbal sparing), polymorphous rash, and high fevers

Answer 538

Kawasaki | Scarlet fever would have tonsillar exudates or posterior pharyngeal inflammation

Question 539

Splenectomy: Effect on Platelets

Answer 539

Thrombocytosis because spleen is not there to remove old platelets from circulation

Question 540

Heart Failure: Medications that improve survival

Answer 540

ACEi, ARBs, Beta blockers (metoprolol, carvedilol, bisoprolol), Aldosterone antagonists, and Hydralazine+nitrates (in African Americans)

Question 541

First Line Tocolytic if

Answer 541

Indomethacin: COX inhibition

Question 542

First Line Tocolytic if 32-34 Weeks

Answer 542

Nifedipine: CCB | Can cause flushing, headache, hypotension, and tachycardia

Question 543

Central Cyanosis

Answer 543

Due to low arterial O2 saturation | -Blue in lips, tongue, and nail beds

Question 544

Peripheral Cyanosis

Answer 544

Increased oxygen extraction secondary to sluggish blood flow | - Blue in distal extremities

Question 545

Treating Hypertriglyceridemia

Answer 545

Fibric Acid Derivatives: Fenofibrate

Question 546

When to give Mag Sulfate for Neuroprotection

Answer 546

Less than 32 weeks

Question 547

When to give Tocolytics

Answer 547

Less than 34 weeks

Question 548

Antenatal corticosteroids (betamethasone)

Answer 548

If

Question 549

MC Location of Ulnar Nerve Compression

Answer 549

Elbow - paresthesias in 4th and 5th digits, and medial forearm - weakness of intrinsic hand muscles

Question 550

Roseola Infantum

Answer 550

MC caused by HHV-6 Blanching maculopapular rash after 3-5 days of very high fever Age

Question 551

Treatment of Raynaud's

Answer 551

CCB like Nifedipine

Question 552

Sudden Onset Syncope without Prodrome

Answer 552

Most consistent with arrhythmia | (ventricular arrhythmia)

Question 553

Initial treatment for Torsades in patients who are Hemodynamically Stable

Answer 553

Mag Sulfate (even if mag level is normal)

Question 554

Prolonged QT

Answer 554

Due to certain medications, hypokalemia, or hypomagnesemia | Risk of developing Torsades

Question 555

Supracondylar Humerus Fracture: Complication

Answer 555

Small risk of Compartment syndrome | MC complication: Risk of injury to brachial artery, frequently check radial pulse

Question 556

Chondrocalcinosis

Answer 556

Meniscal Calcification | Seen with Pseudogout (calcium pyrophophate crystals -rhomboid)

Question 557

Levodopa/Carbidopa: Side effects

Answer 557

Somnolence, confusion, Hallucinations | Dyskinesia/Involuntary movements (after 5-10 years of therapy)

Question 558

Cryptorchidism

Answer 558

Orchiopexy in infancy prevents testicular torsion, improves fertility, and decreases risk of testicular malignancy

Question 559

Thyroid Hormones in Pregnancy

Answer 559

Increased Total T4 and T3 Increased TBG Net results of: Decreased TSH, slightly elevated Free T4 and T3

Question 560

Felty Syndrome

Answer 560

RA + Neutropenia + Splenomegaly Vasculitis (necrotizing skin lesions) may also have anemia, thrombocytopenia, and lymphadenopathy High RF titers, occurs late in disease

Question 561

Treatment for Simple and Complex Partial Seizures

Answer 561

Phenytoin and Carbemazepine | - Ethosuximide and Valproic acid for Absence seizures

Question 562

Radiographic changes seen with RA

Answer 562

Bony erosions and periarticular decalcifications | Narrowing of joint space (thinned cartilage)

Question 563

Adult onset Still's Disease

Answer 563

High spiking fevers, joint pain, salmon colored bumpy rash | Enlarged spleen and liver, lymphadenopathy

Question 564

Methotrexate: Must supplement ____

Answer 564

Folate

Question 565

Radiographic Findings in OA

Answer 565

Subchondral sclerosis Subchondral cysts Joint narrowing

Question 566

Probenecid

Answer 566

Prevents acute gout attacks Uricosuric agent: increases excretion of uric acid Only use if decreased excretion

Question 567

Allopurinol

Answer 567

Prevents acute gout attacks, never use in acute attack Xanthine oxidase inhibitor Decreases production of uric acid - Risk of SJS

Question 568

Treatment for Acute Gouty Attack

Answer 568

NSAIDs (first line); Bed rest (early ambulation may cause attack) Colchicine (2nd) Steroids (3rd)

Question 569

Leading Cause of Death with Acromegaly

Answer 569

Cardiac cause (increased incidence of coronary heart disease, cardiomyopathy, LVH, diastolic dysfunction, and arrhythmias)

Question 570

Indications for ECT for Depression

Answer 570

Treatment resistance Psychotic features present Pregnant, refusal to eat or drink, imminent risk of suicide

Question 571

Most Common Complication of Sickle Cell Trait

Answer 571

Painless microscopic or gross hematuria

Question 572

Heart Defect in Edwards (Trisomy 18)

Answer 572

VSD - Holosystolic murmur at LLSB

Question 573

Immune Thrombocytopenia: Peripheral Smear Findings

Answer 573

Few large platelets (megakaryocytes)

Question 574

Retropharyngeal Abscess

Answer 574

Neck pain, odynophagia, fever following trauma to posterior pharynx Infection can drain into superior mediastinum Extension through alar fascia (danger space) can transmit infection into posterior mediastinum --> acute necrotizing mediastinitis

Question 575

Conn's Syndrome

Answer 575

Primary Hyperaldosteronism - adenoma or b/l hyperplasia HTN, Hypokalemia Metabolic alkalosis Low renin, High Aldosterone, High bicarb

Question 576

Osteomalacia (Vit D deficiency MC cause)

Answer 576

``` Vit D deficiency: decreased intestinal Ca and P absorption Decreased bone density, pseudofractures Hypocalcemia and Hypophosphatemia Elevated PTH (worsens low phos) ```

Question 577

Enthesitis

Answer 577

Inflammation and pain at sites where tendons and ligaments attach to bone - Aw/ Ankylosing spondylitis

Question 578

Nail Puncture Wound through Shoe

Answer 578

Osteomyelitis dye to Pseudomonas Aeruginosa

Question 579

Smooth round big cyst filled with small cysts in Liver

Answer 579

Echinococcus (dog or sheep) | Hydatid cyst

Question 580

Increased TRH

Answer 580

Stimulates Prolactin production | - May lead to hypothyroidism

Question 581

Clubfoot

Answer 581

Equinus and varus of the calcaneum and talus, varus mdfoot, adduction of forefoot Tx: Stretching and manipulation of foot followed by serial plantar casts - Surgery if needed, between 3-6 months of age

Question 582

Spondylolisthesis

Answer 582

Forward slip of vertebrae in Preadolescent Children - Palpable Step Off at the lumbosacral area - Back pain, neurologic dysfunction (urinary incontinence)

Question 583

Carotid Artery Dissection

Answer 583

Potential complication of seemingly minor penetrating trauma to oropharynx or neck strain/manipulation Hemiparesis, facial droop, and aphasia

Question 584

Mediastinal Mass: 4 T's

Answer 584

Thymoma, Teratoma, Thyroid, and Terrible Lymphoma

Question 585

Tabes Dorsalis

Answer 585

Neurosyphilis Sensory ataxia, Posterior/dorsal columns, reduced/absent DTRs Lancinating pains Argyll Robertson Pupils

Question 586

Hyperkalemia: EKG Changes

Answer 586

Tall peaked T waves PR prolongation QRS Widening

Question 587

Spared Eye Injury (Sympathetic Ophthalmia)

Answer 587

Damage of one eye after a penetrating injury to the other eye Immune mechanism involving recognition of "hidden" antigents

Question 588

Acquired Torticollis

Answer 588

Common condition in children Caused by: URI, minor trauma, cervical lymphadenitis, and retropharyngeal abscess Need cervical spine xrays to r/o fracture or dislocation

Question 589

Strong clinical suspicion of Syphilis but Negative Serology

Answer 589

Empirically treat with penicillin | - biopsy is not useful, cannot culture t. pallidum

Question 590

Osteoid Osteoma

Answer 590

Benign bone forming tumor - Adolescent and early adult males Proximal femur, pain worse at night, relieved by NSAIDS Small, round lucency with sclerotic mmargins

Question 591

Hazard Ratio

Answer 591

More than 1 = event more likely in Treatment Group | Less than 1 = event less likely in Treatment Group

Question 592

Rapidly Developing Hyperandrogenism

Answer 592

``` Androgen secreting neoplasm In ovary (elevated Testosterone) or adrenal glands (elevated DHEAS) ```

Question 593

Febrile Neutropenia

Answer 593

Usually do to chemotherapy Initial management: Empiric monotherapy with an Anti-Pseudomonal agent (pip-tazo, meropenem, or cefepime)

Question 594

Cerebral Amyloid Angiopathy

Answer 594

MC cause of spontaneous lobar hemorrhage in elderly Due to B-amyloid deposition in cerebral arteries Aw/ Alzheimers

Question 595

Symptoms of Polycythemia in Neonates

Answer 595

Respiratory distress, hypoglycemia, and neurologic manifestations

Question 596

Renal stones: Imaging

Answer 596

Ultrasound or Non-contrast spiral CT of abdomen and pelvis | - U/S in pregnancy

Question 597

Cervical Discharge During Ovulation

Answer 597

Clear, profuse and thin cervical musuc | Stretch to 6 cm, ferning on microscopy

Question 598

Lichen Planus

Answer 598

Purple planar, polygonal, pruritic, plaques | Flexure surfaces of extremities

Question 599

Succinylcholine Contraindication

Answer 599

Hyperkalemia or risk of hyperkalemia (burn or crush injuries, demyelinating syndromes, tumor lysis syndrome)

Question 600

MC cause of Nonpurulent Cellulitis

Answer 600

Group A strep

Question 601

Hypotension, JVD, and new onset RBBB

Answer 601

Massive PE

Question 602

Euthyroid Sick Syndrome

Answer 602

Patient with acute, severe illness Low T3 syndrome T4 and TSH are normal

Question 603

Defective Mineralization of Organic Bone Matrix

Answer 603

Osteomalacia | - Severe vit D deficiency

Question 604

Herpetic Whitlow

Answer 604

Common viral infection of the hand (HSV 1 or 2) Self limiting Health care workers in direct contact with infected orotracheal secretions are at increased risk

Question 605

Atlantoaxial Instability

Answer 605

Suspect in patient with Down's Syndrome with UMN findings Due to excessive laxity of posterior transverse ligament Leg spasticity, hyperreflexia, +babinski, clonus

Question 606

Bacillary Angiomatosis

Answer 606

Bartonella henslae affects immunosuppressed (HIV) Constitutional symptoms + Cutaneous and Visceral angioma like blood vessel growths large pedunculated exophytic papule with collarette of scale Antibiotics cause lesion regression

Question 607

Risk factors for Carpal Tunnel

Answer 607

Obesity, Diabetes, Pregnancy, and Hypothyroidism

Question 608

Clinical Features of Secondary Amyloidosis

Answer 608

Inflammatory arthritis, chronic infections (bronchiectasis), IBD, malignancy, vasculitis - Proteinuria - Cardiomyopathy - Hepatomegaly

Question 609

Foodborne Botulism

Answer 609

Improperly canned food or cured fish Bilateral cranial neuropathies Symmetric descending muscle weakness Tx: equine anti-toxin

Question 610

23PPSV Immune Response

Answer 610

T cell Independent - B cell response

Question 611

13PCV Immune Response

Answer 611

Robust T cell dependent B cell response

Question 612

Transient Synovitis

Answer 612

Followed a viral infection usually Pain, decreased ROM, limping but CAN bear weight Rarely fever or lab abnormalities (unlike septic arthritis which has fever, high WBC, and high ESR, unable to bear weight) - Do not need arthrocentesis unless concerned for septic

Question 613

Erythema Chronicum Migrans

Answer 613

Pathognomonic for early localized Lyme | Tx: Amoxicillin if

Question 614

Aromatase Deficiency

Answer 614

Total absence of poor functioning enzyme to convert androgens to estrogens Masculinization in mother (resolves postpartum) Virilized XX child Later in life: very low estrogen, high FSH and LH

Question 615

Managing Opioid Withdrawal

Answer 615

Oral or IM methadone

Question 616

Management of TTP

Answer 616

Plasma exchange to removed autoantibodies (ADAMST13) Microangiopathic hemolytic anemia and thrombocytopenia are life threatening

Question 617

Osler Weber Rendu

Answer 617

AD disorder, hereditary telengectasia | Diffuse telengectasias, recurrent epistaxis, widespread AVMs

Question 618

Management of Afib due to Hyperthyroidism

Answer 618

Beta blockers (propranolol)

Question 619

TPN: Gallstones

Answer 619

Due to gallbladder stasis | Since no CCK stimulating contraction

Question 620

High Steppage Gait

Answer 620

Due to foot drop | L5 radiculopathy or Neuropathy of common peroneal nerve

Question 621

Negative Predictive Value

Answer 621

Probability of being Disease-free if Test result is negative | NPV varies with pretest probability (and prevalence)

Question 622

Mimics Sarcoidosis

Answer 622

Histoplasmosis | Non-caseating granulomas in lungs

Question 623

Wiskott Aldrich Syndrome

Answer 623

Thrombocytopenia, Eczema, and Immune Dysfunction | WASp gene - impaired cytoskeleton

Question 624

Hyperventilation To Reduce ICP

Answer 624

Cerebral vasoconstriction due to decreased paCO2

Question 625

Prolactinoma Hormone Levels

Answer 625

Prolactin usual >200 LH low TSH normal

Question 626

Wernickes' Encephalopathy

Answer 626

Encephalopathy, ocular dysfunction, gait ataxia | Tx: thiamine then glucose

Question 627

AAA Screening

Answer 627

Age 65-75, former or current smokers

Question 628

CMV Diarrhea in HIV Patients

Answer 628

Frequent small volume diarrhea Hematochezia Abdominal pain, weight loss, low grade fever

Question 629

MAC Diarrhea in HIV Patients

Answer 629

Watery Diarrhea High fever >102 Weight loss

Question 630

Medication Induced Psychosis

Answer 630

Delusions or hallucinations associated with medication | High dose glucocorticoids are often implicated

Question 631

Niemann Pick vs Tay Sachs

Answer 631

Both have cherry red spot, regression of milestones, hypotonia Niemann Pick: Sphingomyelinase - hepatosplenomegaly Tay Sachs: B hexosaminidase - hyperreflexia

Question 632

Krabbe Disrease

Answer 632

Galactocerebrocidase - lysosomal storage disorder | Developmental regression, hypotonia, areflexia

Question 633

Gaucher Disease

Answer 633

Glucocerebrosidase | Anemia, thrombocytopenia, hepatosplenomegaly

Question 634

Chaga's Disease

Answer 634

Protozoal Disease by T cruzi Megacolon/esophagus Cardiac disease - Myocarditis --> dilated cardiomyopathy

Question 635

Contraindications to Breastfeeding

Answer 635

Galactosemia in infant Active TB, HIV infection, Herpetic breast lesions, Very recent varicella infection, Certain medications, Chemo/radiation, Active drug or EtOH use

Question 636

Breastfeeding: Reduced Cancer Risk

Answer 636

Breast and Ovarian

Question 637

Electrolytes in Cushings Syndrome

Answer 637

Hypokalemia | Hypernatremia, Hyperglycemia

Question 638

Renal Effects of CHF

Answer 638

RAAS Activation due to Decreased Renal Perfusion | - Vasoconstriction of Efferent arterioles to maintain GFR

Question 639

Pregnant Women with Hx of Anorexia

Answer 639

Risk of IUGR, miscarriage, hyperemesis gravidarum, premature birth, postpartum depression

Question 640

Biliary Atresia

Answer 640

Initially well, over 1-8 weeks develop: Jaundice, Pale stool, Dark urine, Hepatomegaly Conjugated Hyperbilirubinemia Tx: Kasai procedure or Liver transplant

Question 641

Empyema or Parapneumonic Effusion: Pleural Fluid

Answer 641

Low glucose (

Question 642

Wallenberg Syndrome

Answer 642

Lateral medulla Vertigo, nystagmus, hoarseness, Horners Loss of pain and temp in ipsi face and contra body

Question 643

Wilm's Tumor

Answer 643

Does not cross midline (unlike neuroblastoma) MC renal neoplasm of childhood Asymptomatic abdominal mass, age 2-5 Hematuria

Question 644

Pertussis: Household Contacts

Answer 644

Prophylaxis with a macrolide is recommended for all close contacts Despite vaccination status If not vaccinated, should also receive vaccine with macrolide

Question 645

Premature adrenarche

Answer 645

Early activation of adrenal androgen release Obese, black or hispanic Pubic hair, axillary hair, acne, body odor NO breast development

Question 646

Tactile Fremitis

Answer 646

Consolidation: Increased (increased breath sounds) | Effusion/Pneumothorax/Atelectasis: Decreased

Question 647

Homocysteine: Hypercoagulable

Answer 647

Vit B6, B12 and folate involved in metabolism | can help lower levels

Question 648

Inpatient Tx for CAP

Answer 648

Fluoroquinolone (Levofloxacin or Moxifloxacin) OR Beta-Lactam plus Macrolide

Question 649

Anemia of Prematurity

Answer 649

Impaired EPO production Usually asymptomatic Low hemoglobin and Low retic count Normocytic and normochromic

Question 650

Management of Acute Cocaine Toxicity

Answer 650

Supplemental O2 and IV benzo

Question 651

Tx for Pinworm (Enterobius)

Answer 651

Albendazole or Pyrantel Pamoate

Question 652

Cutaneous Larva Migrans

Answer 652

Serpiginous raised Lesions, pruritic Skin contact with feces contaminated soil/sand - Hookworm (cat or dog)

Question 653

Blunt Trauma: Pancreatic Contusion or Laceration

Answer 653

May not be visible on initial CT Later will present with fever, chills, deep abdominal pain suggests retroperitoneal abscess

Question 654

Nonfunctioning Pituitary Adenoma

Answer 654

Hypopituitarism with mildly elevated prolactin (unlike a functional adenoma, >200 suggests prolactinoma) Hypogonadism, hypothyroidism

Question 655

Hypocalcemia in Alcoholics

Answer 655

Consider Hypomagnesemia | - Low Mg decreases PTH release

Question 656

Werdnig Hoffman Syndrome

Answer 656

AR, degeneration of anterior horn cells SMA (spinal muscular atrophy) - proximal and more lower extremity, does not affect pupiles Floppy baby syndrome

Question 657

Congenital Hypothyroidism

Answer 657

Normal at birth MC cause: thyroid dysgenesis Develop apathy, weakness, hypotonia, large tongue, abdominal bloating, umbilical hernia, sluggish movement

Question 658

Diabetic Retinopathy Findings

Answer 658

Microaneurysms, hemorrhages, exudates, retinal edema, cotton wool spots, neovascularization

Question 659

Calcium During Respiratory Alkalosis

Answer 659

Increased binding of Ca to Albumin | Decreased in ionized calcium (unbound)

Question 660

Antibiotics for UTI in Pregnancy

Answer 660

Nitrofurantoin (5-7 days) Amox or Amox+Clav (3-7 days) Fosfomycin (1 dose)

Question 661

Acute Cervical Lymphadenitis

Answer 661

Bilateral: adeno or EBV Unilateral: Staph aureus or S. pyogenes (red tender), Anaerobic bacteria (if poor dental hygiene), Bartonella (cat), Mycobacterium avium (gradual, non-tender)

Question 662

Posterior Fossa Tumors

Answer 662

In children Cerebellar Astrocytoma (MC) Medulloblastoma (2nd MC) - Truncal or gait instability, increased ICP

Question 663

Study to confirm Carpal Tunnel

Answer 663

Nerve conduction study -shows slowing of median nerve

Question 664

Tx of Tinea Corporis (Ringworm)

Answer 664

Topical antifungal (clotrimazole or terbinafine)

Question 665

Age at which Bedwetting is Normal

Answer 665

5 yrs or under

Question 666

Eczema Herpeticum

Answer 666

Eczema with superimposed HSV1 Painful vesicles that become punched out erosions with hemorrhagic crusting Tx: systemic acyclovir

Question 667

Confidence Interval

Answer 667

If 95% CI p .05 if null value is inside interval (RR = 1 means no association --> null value)

Question 668

Erythema Toxicum Neonatorum

Answer 668

Benign evanescent rash Changes appearance and occurs on any part of the body During the first 2 weeks of life

Question 669

Suspected Mono, negative heterophile antibody

Answer 669

Sometimes test is negative early in disease, may be helpful to recheck

Question 670

MC cause of Bacterial Meningitis in Children and Young Adults

Answer 670

Neisseria Meningiditis

Question 671

Rapidly Correct Hyponatremia

Answer 671

CPM (Osmotic demyelination)

Question 672

Rapidly Correct Hypernatremia

Answer 672

Cerebral Edema

Question 673

Causes of Clubbing

Answer 673

Lung Malignancy, cystic fibrosis, and R to L cardiac shunts | COPD does not cause clubbing

Question 674

Benzodiazepine Overdose

Answer 674

Slurred speech, unsteady gait, drowsiness | Normal pupil size (unlike opioids)

Question 675

Langerhans Histiocytosis

Answer 675

Solitary painful lytic bone lesion with overlying swelling | Hypercalcemia

Question 676

Acute unilateral Motor deficit (no sensory deficit)

Answer 676

``` Lacunar stroke (internal capsule) Aw/ chronic HTN ```

Question 677

Aminoglycoside Side effect

Answer 677

Ototoxicity | Vestibulopathy with some (gentamycin)

Question 678

Pellagra

Answer 678

Niacin Deficiency - diets primarily consisting of corn Diarrhea (nausea, abdominal pain) Dermatitis (sunburn-like, thick, hyperpigment) Dementia (irritable, aggressive) Prolonged isoniazid therapy can eventually cause it

Question 679

TB RIPE Drugs: Hepatooxic

Answer 679

Only replace if patient is symptomatic, has history of liver disease, or drinks alcohol Mild LFT elevations are normal, and self limited

Question 680

Ehrlichiosis

Answer 680

Tick, southeast and south central US Confusion, flu-like illness, No rash Thrombocytopenia and Leukopenia, Elevated LFTs Tx: Doxycycline

Question 681

Stridor

Answer 681

Croup/laryngotreacheobronchitis - barky cough, runny nose Laryngomalacia: worse in supine Foreign body: acute onset Vascular ring: persistent stridor, improves with neck extension, aw/ cardiac abnormalities

Question 682

Tx of Panic Attacks

Answer 682

Immediate distress: benzo | Long term: SSRI/SNRI and/or CBT

Question 683

Hypertension and Hypokalemia

Answer 683

Check plasma aldosterone/renin ratio

Question 684

Primary Amenorrhea

Answer 684

No secondary development (hair or breast) FSH measurement: if low, pituitary MRI, If high, karyotype

Question 685

Hypopituitarism

Answer 685

Low glucocorticoid Hypogonadism Hypothyroidism Normal aldosterone (because ACTH independent)

Question 686

Babesiosis

Answer 686

Tick, ixodes, northeast US Hemolysis, jaundice Illness more significant in patients >40, asplenic or immunocompromised patients

Question 687

Bacterial Meningitis Management

Answer 687

Age 2-50: Vanc + 3rd gen cephalosporin Age >50: Vanc + 3rd gen ceph + amp If immunocompromised: Vanc + amp + cefepime (for Gm-rods)

Question 688

Older children with Intussusception

Answer 688

Suspect a pathological lead point | MC is Meckels Diverticulum

Question 689

MC Infection aw/ FSGS

Answer 689

HIV

Question 690

MC infection aw/ Membranous Nephropathy

Answer 690

Active Hep B

Question 691

Unilateral varicocele that fails to empty

Answer 691

Suspicious for a mass obstruction like RCC

Question 692

Tx for Hairy Cell leukemia

Answer 692

Cladribine

Question 693

Bite Cells and Heinz Bodies

Answer 693

G6PD

Question 694

Hemi-neglect Syndrome

Answer 694

Ignoring Left side of space | Nondominant (Right) parietal lobe is affected

Question 695

Cyclical VOmiting

Answer 695

Recurrent self-limited episodes of vomiting or nausea Normal workup, no symptoms between Family hx of migraines

Question 696

Ramsay Hunt Syndrome

Answer 696

Herpes zoster infection in the ear Facial nerve palsy Vesicles in the auditory canal and auricle

Question 697

Rectovaginal Fistula

Answer 697

After obstetric trauma Malodorous brown/tan discharge Red velvety rectal mucosa seen on posterior vaginal wall

Question 698

Electrolytes in Primary Adrenal Insufficiency (Cortisol/Mineralocorticoid deficiency)

Answer 698

Hyponatremia | Hyperkalemia

Question 699

PML (progressive multifocal leukoencephalopathy)

Answer 699

HIV patient with focal neurological signs Multiple brain lesions on CT (no mass effect) Non-enhancing

Question 700

Management of Mucormycosis

Answer 700

Aggressive surgical debridement + early IV amphotericin B

Question 701

CMV Retinitis

Answer 701

Blurred vision, floaters, sensation of flashing lights Seen in HIV patients - can cause blindness Yellow-white fluffy hemorrhagic lesions along vasculature Tx: valgancyclovir

Question 702

Leprosy

Answer 702

Insensate, hypopigmented patch of skin | Dx: skin biopsy --> acid fast bacilli

Question 703

Ice Pack Test: Improvementof Ptosis

Answer 703

Supports diagnosis of Myasthenia Gravis | Cold temp inhibits Ach breakdown

Question 704

Pulseless Electrical Activity (PEA)

Answer 704

Rhythm without pulses | Manage with Chest Compressions and vasopressors to maintain perfusion

Question 705

Pineaoloma

Answer 705

Parinaud Syndrome Limited upward gaze, headache, vomiting, hydrocephalus Upper eyelid retraction Pupils non-reactive to light, but will accomodate

Question 706

Whipple Disease

Answer 706

T. Whippelii Chronic malabsorptive diarrhea, weight loss Non-deforming Arthritis Lymphadenopathy and Low grade Fever

Question 707

Norepinephrine Induced Vaspospasm

Answer 707

Pressors like NE can cause distal fingers and toes become dusky blue and cool due to vasconstriction in periphery

Question 708

Interstitial Pneumonitis Due to Amiodarone

Answer 708

Progressive dyspnea, nonproductive cough | Reticular or ground glass opacities on CXR

Question 709

Hemolytic Uremic Syndrome (HUS)

Answer 709

Bloody Diarrhea (e coli o157h7 or shigella) Petechiae or bruising Hemolytic Anemia, Thrombocytopenia Increased Creatinine

Question 710

Henoch Schonlein Purpura (HSP)

Answer 710

Purpura on buttocks and legs Abdominal and Joint pain Acute renal failure NORMAL platelets

Question 711

Cholesterol Emboli

Answer 711

Renal failure, skin manifestations, and GI symptoms after a recent vascular procedure Livedo Reticularis or Blue toe syndrome Eosinophilia, Low complement

Question 712

TB Test: PPD

Answer 712

Treat if: >5 with HIV, recent TB contact, CXR, or transplant pt >10 if recent immigrant, IVDA, high risk setting (prison, homeless, hospital), children >15 for healthy

Question 713

Ecstacy (MDMA)

Answer 713

Amphetamine that increases NE, dopamine, and serotonin HTN, tachycardia, hyperthermia Serotonin Syndrome Hyponatremia

Question 714

Untreated Hyperthyroidism

Answer 714

Rapid bone loss due to increased osteoclastic activity Tachyarrhythmias (including Afib) Fetal Hyperthyroidism (if Graves, not toxic adenoma)

Question 715

Bleeding >8 weeks Postpartum

Answer 715

Concern for Choriocarcinoma (GTD) Irregular bleeding, large uterus, pelvic pain Pulmonary symptoms (multiple pulmonary nodules/mets) Elevated beta hCG to diagnose

Question 716

Pseudocyesis

Answer 716

Women with signs and symptoms of pregnancy Normal endometrial stripe Reported positive pregnancy test but negative in office Form of conversion disorder

Question 717

Vitamine Deficiency in Carcinoid Syndrome

Answer 717

Niacin

Question 718

Initial Management of Massive Hemoptysis

Answer 718

Secure airway then bronchoscopy to identify and stop bleeding source Bleeding lung dependent position (lateral)

Question 719

Brain abscess from Sinusitis

Answer 719

MC pathogens are Viridans streptococci and head and neck anearobes

Question 720

Chikungunya Fever

Answer 720

Central and South america, mosquito High fever, Polyarthralgias Maculopapular rash on limbs and trunk Thrombocytopenia, lymphopenia, LFTs

Question 721

RA: Effect on Spine

Answer 721

Cervical spine MC affected | Can cause spinal cord compression due to subluxation

Question 722

Waldenstrom Macroglobulinemia

Answer 722

Hyperviscosity Hepatosplenomegaly Neuropathy IgM monoclonal spike (M spike)

Question 723

Thalamic Pain Syndrome

Answer 723

Weeks to months after a stroke Patient may have severe paroxysmal burning over affected area Exacerbated with light touch

Question 724

Alcohol Hallucinosis

Answer 724

Withdrawal symptom within 12-24 hours Resolved in 24-48 hours Vital signs stable Alert with visual hallucinations

Question 725

Hypertensive Emergency in Pregnancy

Answer 725

Labetalol If risk of bradycardia, Hydralazine Methyldopa is for chronic BP control

Question 726

Trastuzumab: Side Effect

Answer 726

Risk of developing cardiotoxicity especially in patients with low ejection fractions - Get baseline Echo prior to starting

Question 727

Rapid Reversal of Warfarin

Answer 727

Prothrombin Complex Concentrate If not FFP IV Vit K takes too long

Question 728

Treatment of Disseminated Histoplasmosis

Answer 728

``` IV Amphotericin B (1-2 weeks) Followed by maintenance therapy: Oral Itraconazole (1 year) ```

Question 729

Cancer Related Cachexia

Answer 729

Progesterone analogs increased appetite and weight gain | - Megestrol acetate or medroxyprogesterone acetate

Question 730

HIT: Classic Skin Sign

Answer 730

Skin necrosis at site of abdominal injection of subcutaneous heparin

Question 731

Afib: MC location of Ectopic Foci

Answer 731

Pulmonary veins

Question 732

Legg Calve Perthes

Answer 732

Idiopathic osteonecrosis (avascular necrosis) of femoral head Boys age 4-10 Insidious hip pain, antalgic gait, pain for >1 month

Question 733

Dubin Johnson

Answer 733

``` Black LIver Conjugated hyperbilirubinemia (not hemolysis) ```

Question 734

Rotor Syndrome

Answer 734

Defect in hepatic storage of conjugated bilirubin Conjugate hyperbilirubinemia Liver is not Black

Question 735

Drug to Facilitate Renal Stone Passage

Answer 735

Alpha 1 blockers | - Tamsulosin

Question 736

Hyposthenuria

Answer 736

Impairment in kidney's ability to concentrate urine - Nocturia - Aw/ sickle cell, less severe in sickle cell trait

Question 737

Holosystolic Murmur that Increases in Intensity with Inspiration

Answer 737

Tricuspid Regurgitation

Question 738

ASCUS

Answer 738

If age 21-24 repeat pap in 1 year | If 25+: HPV (if positive, colp; if negative repeat pap and hpv in 3 years)

Question 739

Primidone: Side effect

Answer 739

May precipitates acute intermittent porphyria - abdominal pain - neuro psych abnormalities

Question 740

Pancreatic Cancer: Effect on Gallbladder

Answer 740

``` Distended gallbladder (courvoisier sign) Dilated intra and extrahepatic ducts ```

Question 741

Management of Peritonsillar Abscess

Answer 741

Needle aspiration followed by IV antibiotics

Question 742

Harsh Holosystolic Murmur at LLSB

Answer 742

VSD | Get an Echo to evaluate size and location, rule out other defects

Question 743

Myotonic Dystrophy

Answer 743

AD, CTG trinucleotide repeat expansion Facial weakness, hand grip (delayed muscle relaxation), dysphagia, cardiac arrhythmias Cataracts, Balding, Testicular atrophy

Question 744

Penile Fracture

Answer 744

Emergent urethrogram to assess for urethral injury and emergent surgery to evacuate hematoma

Question 745

Drugs for Stable Angina

Answer 745

Beta blockers (1st line) - Controls sx and improves exercise tolerance CCBs Nitrates

Question 746

Fanconi Anemia

Answer 746

``` Aplastic anemia and progressive bone marrow failure Chromosomal breaks - Short stature, microcephaly - Abnormal thumbs - Hypo/hyperpigmented areas - Low set ears, middle ear abnormalities ```

Question 747

Heat Exhaustion vs Heat Stroke

Answer 747

Exhaustion: Inadequate fluids and sodium, Temp 104, AMS

Question 748

Management of CRAO

Answer 748

Emergent: Ocular massage and high flow O2

Question 749

Factor V Leiden

Answer 749

MC in caucasian Activated Protein C resistance Hypercoagulability - PE or DVT in young patient

Question 750

Familial Hypocalciuric Hypercalcemia

Answer 750

CaSR mutation - cannot sense calcium High/normal PTH, High Ca Low Urine calcium/creatinine ratio

Question 751

Acute liver failure

Answer 751

Elevated enzymes Hepatic encephalopathy Impaired synthetic function (High INR)

Question 752

Hyperthyroidism: Myopathy

Answer 752

Proximal muscle weakness, possible muscle atrophy, high frequency low amp tremor, normal or increased DTR - Hip flexors and quads predominantly affected

Question 753

Fatty Casts

Answer 753

Nephrotic Syndrome

Question 754

Broad Waxy Casts

Answer 754

Chronic Renal Failure

Question 755

WBC Casts

Answer 755

Pyelonephritis OR Interstitial Nephritis

Question 756

Shock Due to Massive PE

Answer 756

Elevated Pulm Artery Pressure and RA pressure --> pulmonary HTN Normal PCWP, Hypotension, Decreased Cardiac output

Question 757

Linear Ulcers in Esophagus

Answer 757

CMV esophagitis

Question 758

Punched Out Ulcers in Esophagus

Answer 758

HSV Esophagitis

Question 759

Candida Esophagitis

Answer 759

Pain with swallowing and white plaques in mouth

Question 760

Treatment of Catatonia

Answer 760

Benzodiazepine (Lorazepam challenge) and/or ECT

Question 761

Thyroid Lymphoma

Answer 761

Risk is 60x more in patients with Hashimoto's Thyroiditis

Question 762

Metatarsus Adductur

Answer 762

Medial deviation of forefoot | Tx: none, reassurance, usually corrects self

Question 763

Drugs that may cause Folate Deficiency

Answer 763

Phenytoin, methotrexate, and trimethoprim

Question 764

De Quervain Tenosynovitis

Answer 764

``` Classically affects new mothers Thumb pain (pain on palpation to radial side) ```

Question 765

PBC: Hyperlipidemia

Answer 765

Hyperlipidemia with xanthelasmas can be a common complication of Primary Biliary Sclerosis

Question 766

Nephrotic Syndrome: Hyperlipidemia

Answer 766

Accelerates atherosclerosis | Especially with hypercoagulability

Question 767

Pulmonary Nodules surrounded by Ground glass Opacities

Answer 767

Halo Sign | Invasive Aspergillosus

Question 768

Meningitis with Purpura

Answer 768

Gononcoccal Meningitides | Meningococcal meningitis

Question 769

14-3-3 CSF assay or Periodic sharp wave complexes on EEG

Answer 769

Creutzfeldt Jakob disease | Rapidly progressing dementia and myoclonus

Question 770

Coccidiomycosis

Answer 770

Arizona/California, south west US Fever, fatigue, dry cough, weight loss Pleuritic chest pain Erythema nodosum and multiforme

Question 771

MC Source of PE

Answer 771

``` Proximal Thigh (Ilial, femoral, or popliteal) deep veins >90% of acute PEs ```

Question 772

Meds to Hold Prior to Cardiac Stress Test

Answer 772

B-blockers, CCBs, and nitrates | hold 48 hours

Question 773

Low volume Hemoptysis after URI, no weight loss

Answer 773

Assumed Bronchitis

Question 774

Herpangina

Answer 774

Coxsackie A Summer/early fall Gray vesicles/ulcers on Posterior Pharynx Tonsillar pillars

Question 775

HSV1

Answer 775

Erythematous gingiva | Clusters of small vesicles on Anterior oropharynx and Lips

Question 776

Hypercalcemia due to Immobilization

Answer 776

Due to increased osteoclastic activity | Use bisphosphonates to reduce Ca and prevent bone loss

Question 777

Management of Narrow Complex SVT

Answer 777

Synchronized cardioversion if Unstable

Question 778

Otosclerosis

Answer 778

Conductive hearing loss (abnormal rinne) | Adults, usually female, age 20s-30s

Question 779

Evaluation of Febrile UTI in child

Answer 779

Renal and bladder ultrasound

Question 780

UC Bimodal Occurrence

Answer 780

Age 20s-30s and also in 60s