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Step 2 A Flashcards

1
Q

Classic EKG finding in A-flutter

A

“Sawtooth” P waves

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2
Q

Definition of unstable angina

A

Angina that is new, worsening, or occurs at rest

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3
Q

Antihypertensive for a diabetic patient with proteinuria

A

ACE Inhibitor

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4
Q

Beck’s triad for cardiac tamponade

A

Hypotension
Distant heart sounds
JVD

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5
Q

Drugs that slow AV node transmission (3)

A

β-blockers, digoxin, CCB’s

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6
Q

Hypercholesterolemia treatment that causes flushing and pruritus

A

Niacin

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7
Q

Treatment for A-fib (3)

A

Anticoagulation
Rate control
Cardioversion

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8
Q

Treatment for V-fib

A

Immediate cardioversion

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9
Q

Autoimmune complication occurring 2-4 weeks post-MI

A

Dressler’s syndrome:

Fever, pericarditis, ↑ ESR

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10
Q

IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?

A

Treat existing heart failure and replace the tricuspid valve

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11
Q

Diagnostic test for hypertrophic cardiomyopathy

A

Echocardiogram (showing thickened LV wall and outflow obstruction)

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12
Q

Fall in systolic BP of >10mmHg with inspiration

A

Pulsus paradoxus (seen with cardiac tamponade)

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13
Q

Classic EKG findings in pericarditis

A

Low-voltage, diffuse ST-segment elevation

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14
Q

Definition of HTN

A

BP >140/90 on 3 separate occasions, 2 weeks apart

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15
Q

8 Surgically correctable causes of HTN

A 
Renal artery stenosis
Coarctation of the aorta
Pheochromocytoma 
Conn's syndrome 
Cushing's syndrome 
Unilateral renal parenchymal disease
Hyperthyroidism
Hyperparathyroidism
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16
Q

Eval of pulsatile abdominal mass and bruit

A

Abdominal US and CT

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17
Q

Indications for surgical repair of AAA (4)

A

> 5.5cm
Rapidly enlarging
Symptomatic
Ruptured

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18
Q

Treatment for acute coronary syndrome

A 
Morphine
O2
Sublingual nitrogen
ASA
IV β-blockers
Heparin
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19
Q

Characteristics of metabolic syndrome (6)

A 
Abdominal obesity
High triglycerides
Low HDL
HTN
Insulin resistance
Prothrombotic/proinflammatory state
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20
Q

Appropriate diagnostic test for:

50yoM with angina can exercise to 85% of max predicted heart rate

A

Exercise stress treadmill with EKG

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21
Q

Appropriate diagnostic test for:

65yoF with left bundle branch block and severe OA who has unstable angina

A

Pharmacological stress test (i.e. dobutamine echo)

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22
Q

Target LDL in patients with DM

A
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23
Q

Signs of active ischemia during stress testing

A

Angina, ST-segment changes on EKG, or ↓BP

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24
Q

EKG findings suggestive of MI (3)

A

ST-segment elevation (depression means ischemia)
flattened T waves
Q waves

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25
Young patient with angina at rest with ST segment elevation. Normal cardiac enzymes.
Prinzmetal's angina
26
Common symptoms associated with silent MI's
CHF, shock, AMS
27
Diagnostic test for PE
V/Q scan
28
Agent that reverses effects of heparin
Protamine
29
Coagulation parameter affected by warfarin
PT
30
Young patient with family history of sudden death collapses wand dies while exercising
Hypertrophic cardiomyopathy
31
Endocarditis prophylaxis regimens
Oral surgery: Amoxicillin | GI/GU procedures: Ampicillin/Gentamicin before and Amoxicillin after
32
The 6 P's of ischemia due to PVD
``` Pain Pallor Pulselessness Paralysis Paresthesia Poikilothermia ```
33
Virchow's triad
Stasis Hypercoagulability Endothelial damage
34
Most common cause of HTN in young women
OCP's
35
Most common cause of HTN in young men
Excessive EtOH
36
"Stuck on" appearance"
Seborrheic keratosis
37
Red plaques with silvery-white scales and sharp margins
Psoriasis
38
Most common type of skin cancer; lesion is a pearly-colored papule with a translucent surface and telaniectasias
Basal cell carcinoma
39
Honey crusted lesions
Impetigo
40
Febrile pt with hx of DM presents with red, swollen painful lower extremity
Cellulitis
41
+ Nikolsky's sign
Pemphigus vulgaris
42
Negative Nikolsky's sign
Bullous pemphigoid
43
55yo obsese pt presents with dirty, velvety patches on the back of the neck
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
44
Rash in a dermatomal distribution
Varicella zoster
45
Flat-topped papules
Lichen planus
46
Iris-like target lesions
Erythema multiforme
47
Lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry
Contact dermatitis
48
Presents with herald patch, Christmas-tree pattern
Pityriasis rosea
49
16yo with annular patch of alopecia with broken-off stubby hairs
Alopecia areata (AI process)
50
Pinkish, scaling, flat lesions on the chest and back. KOH prep has "spaghetti and meatballs" appearance
Pityriasis versicolor
51
4 characteristics of a nevus suggestive of melanoma
Asymmetry Border irregularity Color variation Large diameter
52
Premalignant lesion from sun exposure that can lead to squamous cell carcinoma
Actinic keratosis
53
"Dewdrop on a rose petal"
Lesions of primary varicella
54
Associated with Propionibacterium acnes and changes in androgen levels
Acne vulgaris
55
Associated with Propionibacterium acnes and changes in androgen levels
Acne vulgaris
56
Definition of unstable angina
Angina that is new, worsening, or occurs at rest
57
Antihypertensive for a diabetic patient with proteinuria
ACE Inhibitor
58
Beck's triad for cardiac tamponade
Hypotension Distant heart sounds JVD
59
Drugs that slow AV node transmission (3)
β-blockers, digoxin, CCB's
60
Hypercholesterolemia treatment that causes flushing and pruritus
Niacin
61
Treatment for A-fib (3)
Anticoagulation Rate control Cardioversion
62
Treatment for V-fib
Immediate cardioversion
63
Autoimmune complication occurring 2-4 weeks post-MI
Dressler's syndrome: | Fever, pericarditis, ↑ ESR
64
IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
Treat existing heart failure and replace the tricuspid valve
65
Diagnostic test for hypertrophic cardiomyopathy
Echocardiogram (showing thickened LV wall and outflow obstruction)
66
Fall in systolic BP of >10mmHg with inspiration
Pulsus paradoxus (seen with cardiac tamponade)
67
Classic EKG findings in pericarditis
Low-voltage, diffuse ST-segment elevation
68
Definition of HTN
BP >140/90 on 3 separate occasions, 2 weeks apart
69
8 Surgically correctable causes of HTN
``` Renal artery stenosis Coarctation of the aorta Pheochromocytoma Conn's syndrome Cushing's syndrome Unilateral renal parenchymal disease Hyperthyroidism Hyperparathyroidism ```
70
Eval of pulsatile abdominal mass and bruit
Abdominal US and CT
71
Indications for surgical repair of AAA (4)
>5.5cm Rapidly enlarging Symptomatic Ruptured
72
Treatment for acute coronary syndrome
``` Morphine O2 Sublingual nitrogen ASA IV β-blockers Heparin ```
73
Characteristics of metabolic syndrome (6)
``` Abdominal obesity High triglycerides Low HDL HTN Insulin resistance Prothrombotic/proinflammatory state ```
74
Why are β-blockers contraindicated in diabetics?
They can mask symptoms of hypoglycemia
75
Appropriate test for: | 65yoF with left bundle branch block and severe OA who has unstable angina
Pharmacological stress test (i.e. dobutamine echo)
76
Target LDL in patients with DM
Less than 70
77
Signs of active ischemia during stress testing
Angina, ST-segment changes on EKG, or ↓BP
78
EKG findings suggestive of MI (3)
ST-segment elevation (depression means ischemia) flattened T waves Q waves
79
Young patient with angina at rest with ST segment elevation. Normal cardiac enzymes.
Prinzmetal's angina
80
Common symptoms associated with silent MI's
CHF, shock, AMS
81
Diagnostic test for PE
V/Q scan
82
Agent that reverses effects of heparin
Protamine
83
Coagulation parameter affected by warfarin
PT
84
Young patient with family history of sudden death collapses wand dies while exercising
Hypertrophic cardiomyopathy
85
Endocarditis prophylaxis regimens
Oral surgery: Amoxicillin | GI/GU procedures: Ampicillin/Gentamicin before and Amoxicillin after
86
The 6 P's of ischemia due to PVD
``` Pain Pallor Pulselessness Paralysis Paresthesia Poikilothermia ```
87
Virchow's triad
Stasis Hypercoagulability Endothelial damage
88
Most common cause of HTN in young women
OCP's
89
Most common cause of HTN in young men
Excessive EtOH
90
"Stuck on" appearance"
Seborrheic keratosis
91
Red plaques with silvery-white scales and sharp margins
Psoriasis
92
Most common type of skin cancer; lesion is a pearly-colored papule with a translucent surface and telaniectasias
Basal cell carcinoma
93
Honey crusted lesions
Impetigo
94
Febrile pt with hx of DM presents with red, swollen painful lower extremity
Cellulitis
95
+ Nikolsky's sign
Pemphigus vulgaris
96
Negative Nikolsky's sign
Bullous pemphigoid
97
55yo obsese pt presents with dirty, velvety patches on the back of the neck
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
98
Rash in a dermatomal distribution
Varicella zoster
99
Flat-topped papules
Lichen planus
100
Iris-like target lesions
Erythema multiforme
101
Lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry
Contact dermatitis
102
Presents with herald patch, Christmas-tree pattern
Pityriasis rosea
103
16yo with annular patch of alopecia with broken-off stubby hairs
Alopecia areata (AI process)
104
Pinkish, scaling, flat lesions on the chest and back. KOH prep has "spaghetti and meatballs" appearance
Pityriasis versicolor
105
4 characteristics of a nevus suggestive of melanoma
Asymmetry Border irregularity Color variation Large diameter
106
Premalignant lesion from sun exposure that can lead to squamous cell carcinoma
Actinic keratosis
107
"Dewdrop on a rose petal"
Lesions of primary varicella
108
"Cradle cap"
Seborrheic dermatitis. Treat with antifungals
109
Associated with Propionibacterium acnes and changes in androgen levels
Acne vulgaris
110
Painful, recurrent vesicular eruption of mucocutaneous surfaces
Herpes simplex
111
Inflammation and epithelial thinning of anogenital area, predominantly in postmenopausal women
Lichen sclerosus
112
Exophytic nodules on the skin with varying degrees of scaling or ulceration; the 2nd most common type of skin cancer
Squamous cell carcinoma
113
Most common cause of hypothyroidism
Hashimoto's thyroditis
114
Lab findings in hashimoto's thyroiditis
↑ TSH ↓ T4 Antimicrosomal Ab
115
Exopthalmos, pretibial myxedema, and ↓TSH
Graves' disease
116
Most common cause of Cushing's syndrome
Iatrogenic steroid administration. 2nd most common cause is Cushing's disease
117
Pt presents with signs of hypocalcemia, high phosphorus, and low PTH
Hypoparathyroidism
118
"Stones, bones, groans, psychiatric overtones"
Signs and symptoms of hypercalcemia
119
Pt complains of HA, weakness, and polyuria; exam reveals HTN and tetany. Labs reveal hypernatremia, hypokalemia, and metabolic alkalosis
Primary hyperaldosteronism (dt Conn's syndrome or bilateral adrenal hyperplasia)
120
Pt presents with tachycardia, wild swings in BP, HA, diaphoresis, AMS, and sense of panic
Pheochromocytoma
121
Should α or β antagonists be used first in treating pheochromocytoma?
α- antagonists (phentolamine and phenoxybenzamine)
122
Pt with hx of Lithium use presents with copious amounts of dilute urine
Nephrogenic DI
123
Treatment of central DI
Administration of DDAVP: ↓ serum osmolality and free water restriction
124
Post-op patient w significant pain presents with hyponatremia and normal volume status
SIADH due to stress
125
Anti-diabetic agent associated with lactic acidosis
Metformin
126
Pt presents with weakness, nausea, vomiting, weight loss, new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
Primary adrenal insufficiency (Addison's disease). | Treat with replacement glucocorticoids, mineralocorticoids, and IVF
127
Goal HbA1C for pt with DM
128
Treatment of DKA
Fluids, insulin, and aggressive replacement of electrolytes (i.e. K+)
129
Why are β-blockers contraindicated in diabetics?
They can mask symptoms of hypoglycemia
130
Bias introduced into a study when a clinician is aware of the patient's treatment type
Observational bias
131
Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death
Lead-time bias
132
If you want to know if race affects infant mortality rate but most of the variation in infant mortality is predicted by socioeconomic status, then socioeconomic status is a _____________.
Confounding variable
133
Extraintestinal manifestations of IBD (6)
Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, primary sclerosing cholangitis
134
Sensitive tests have few false negatives and are used to rule ______ a disease
Out
135
PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a +PPD. Is this highly sensitive or specific?
Highly sensitive for TB
136
Chronic diseases such as SLE -- higher prevalence or incidence?
Higher prevalence
137
Epidemics such as influenza -- higher prevalence or incidence?
Higher incidence
138
Cross-sectional survey -- incidence or prevalence
Prevalence
139
Cohort study -- incidence or prevalence?
Incidence and prevalence
140
Case-control study -- incidence or prevalence?
Neither
141
Describe a test that consistency gives identical results, but the results are wrong. (_____ reliability, ______ validity)
High reliability, low validity
142
Difference between cohort and case control study
Cohort - can be used to calculate relative risk (RR), incidence, and/or odds ratio (OR) Case control - used to calculate an odds ratio
143
Attributable risk?
[Incidence rate (IR) of a disease in exposed] - [IR of disease in unexposed]
144
Relative risk?
[IR of a disease in a population exposed to a particular factor] + [IR of those not exposed]
145
Odds ratio?
Likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed.
146
Number needed to treat
1 + (rate in untreated group - rate in treated group)
147
In which patients do you initiate colorectal cancer screening early?
Pts with IBD; those with familial adenomatous polyposis (FAP)/hereditary nonpolyposis colorectal CA (HNPCC); and those who have 1st degree relatives with adenomatous polyps (
148
Most common CA in men and most common cause of death from CA in men
Prostate CA = most common | Lung CA = most deaths
149
Percentage of cases w/in 1 SD of the mean? 2 SD's? 3 SD's?
68% 95. 5% 99. 7%
150
Birth rate?
of live births per 1000 population
151
Fertility rate?
of live births per 1000 women 15-44yo
152
Mortality rate?
of deaths per 1000 population
153
Neonatal mortality?
of deaths from birth to 28 days per 1000 live births
154
Postnatal mortality?
of deaths from 28d-1y per 1000 live births
155
Infant mortality?
of deaths from birth-1y per 1000 live births (neonatal + postnatal)
156
Fetal mortality?
of deaths from 20w gestation-1mo life per 1000 total births
157
Maternal mortality?
of deaths during pregnancy to 90d postpartum per 100,000 live births
158
T or F: | Once a pt signs a statement giving consent, they must continue treatment
False Pts may change their minds at any time. Exceptions to the requirement of informed consent includes emergency situations and patients without decision-making capacity
159
15yoF requires hospitalization for preeclampsia. Should her parents be informed?
No. Parental consent is not necessary for the medical treatment of pregnant minors
160
Doctor refers pt for MRI at a facility he/she owns
Conflict of interest
161
Involuntary psychiatric hospitalization can be undertaken for which 3 reasons?
Pt is danger to self, danger to others, or gravely disabled (unable to provide for basic needs)
162
T or F: | Withdrawing life-sustaining care is ethically distinct from withholding sustaining care
False. | Withdrawing and withholding life are the same from an ethical standpoint
163
When can a physician refuse to continue treating a patient on the grounds of futility?
When there is no rationale for treatment, maximal intervention is failing, a given intervention has already failed, and treatment will not achieve the goals of care
164
An 8yo child is in a serious accident. She requires emergent transfusion but parents aren't present.
Treat immediately. Consent is implied in emergency situations.
165
Conditions in which confidentiality must be overridden
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
166
Involuntary commitment or isolation for medical treatment may be undertaken for what reason?
When treatment noncompliance represents a serious danger to public health (active TB)
167
10yo child presents in status epilepticus, but parents refuse treatment on religious grounds
Treat - disease represents an immediate threat to the child's life. Then seek a court order.
168
Son asks that his mother not be told about her recently discovered CA
Pt's family can't require that a doctor withhold information from the patient
169
Pt presents with sudden onset of severe, diffuse, abdominal pain. Exam reveals peritoneal signs and abdominal XR reveals free air under the diaphragm. Management?
Emergent laparotomy to repair perforated viscus, likely stomach
170
Most likely cause of acute lower GI bleed in patients >40yo
Diverticulosis
171
Diagnostic modality sued when US is equivocal for cholecystitis
HIDA scan
172
Sentinel loop on abdominal XR
Acute pancreatitis
173
Risk factors for cholelithiasis
Fat, female, fertile, forty, flatulent
174
Inspiratory arrest during palpation of the RUQ
Murphy's sign, seen with acute cholecystitis
175
Diarrhea - most common organism
Campylobacter
176
Diarrhea - recent abx use
Clostridium difficile
177
Diarrhea - camping
Giardia
178
Diarrhea - traveler's diarrhea
ETEC
179
Diarrhea - church picnic/mayonnaise
S. aureus
180
Diarrhea - uncooked hamburger
E. coli O157:H7
181
Diarrhea - fried rice
B. cereus
182
Diarrhea - poultry/eggs
Salmonella
183
Diarrhea - Raw seafood
Vibrio, HAV
184
Diarrhea - AIDS
Isospora, Cryptosporidium, Mycobacterium avium complex (MAC)
185
Diarrhea - Pseudoappendicitis
Yersinia
186
25yo Jewish male presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibias
Chron's disease
187
Inflammatory dz of the colon with ↑ risk of colon CA
Ulcerative colitis
188
Extraintestinal manifestations of IBD (6)
Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, primary sclerosing cholangitis
189
Medical treatment for IBD
5-aminosalicylic acid agents and steroids during acute exacerbations
190
Difference between mallory-weiss and boerhaave tears
Mallory weiss: superficial tear in the esophageal mucosa | Boerhaave: full thickness esophageal rupture
191
Charcot's triad
RUQ pain, jaundice, fever/chills in the setting of ascending cholangitis
192
Reynold's pentad
Charcots triad (RUQ pain, jaundice, fever/chills in the setting of ascending cholangitis) PLUS shock and AMS with suppurative ascending cholangitis
193
Medical treatment for hepatic encephalopathy (3)
Decreased protein intake Lactulose Neomycin
194
1st step in management of patient with acute GI bled
ABC's
195
4yo child with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
Hemolytic-uremic syndrome (HUS) due to E. Coli O157:H7
196
Post-HBV exposure treatment
HBV immunoglobulin
197
Classic causes of drug-induced hepatitis (3)
Tb meds (INH, rifampin, pyrazinamide) Acetaminophen Tetracycline
198
40yo obese F with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine, and clay-colored stools
Biliary tract obstruction
199
Hernia with highest risk of incarceration - indirect, direct, or femoral?
Femoral hernia
200
50yoM with hx of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?
Confirm diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IVF, O2, analgesia, and "tincture of time"
201
4 causes of microcytic anemia
``` TICS: Thalassemia Iron deficiency anemia of Chronic disease Sideroblastic anemia ```
202
Elderly male with hypochromic, microcytic anemia is asymptomatic, Diagnostic tests?
Fecal occult blood test and sigmoidoscopy; suspect colorectal CA
203
Precipitants of hemolytic crisis in patients with G6PD deficiency (3)
Sulfonamides, antimalarial drugs, favabeans
204
Most common inherited cause of hypercoagulability
Factor V Leiden mutation
205
Most common inherited hemolytic anemia
Hereditary spherocytosis
206
Diagnostic test for hereditary spherocytosis
Osmotic fragility test
207
Pure RBC aplasia
Diamond-Blackfan anemia
208
Anemia associated with absent radii and thumbs, diffuse hyperpigmentation, cafe-au-lait spots, microcephaly and pancytopenia
Fanconi's anemia
209
Medications and viruses that cause aplastic anemia
Chloramphenicol, sulfonamides, radiation, HIV, chemotherapeutic agents, hepatitis, parvovirus B19, EBV
210
How to distinguish polycythemia vera from secondary polycythemia
Both have ↑ HCT and RBC mass Polycythemia vera should have normal O2 saturation and ↓ EPO
211
Thrombotic thrombocytopenic purpura (TTP) Pentad
``` FAT RN: Fever Anemia Thrombocytopenia Renal dysfunction Neurologic abnormalities ```
212
HUS triad?
Anemia Thrombocytopenia Acute renal failure
213
Treatment for TTP
Emergent large-volume plasmapheresis, corticosteroids, antiplatelet drugs
214
Treatment for idiopathic thrombocytopenic purpura (ITP) in children
Usually resolves spontaneously; may require IVIG and/or corticosteroids
215
``` Which of the following are increased in DIC? Fibrin split products D-dimer Fibrinogen Platelets HCT ```
Fibrin split products and D-dimer are elevated | Platelets, fibrinogen, and hematocrit are decreased
216
An 8yoM presents with hemarthrosis and increased PTT with normal PT and bleeding time. Diagnosis? Treatment?
``` Hemophilia A or B Consider desmopressin (for hemophilia A) or factor VIII or IX supplements ```
217
14yoF presents with prolonged bleeding after dental surgery and with menses, normal PT, normal or increased PTT, and increased bleeding time. Diagnosis? Treatment?
Von Willebrand's disease; treat with desmopression, FFP, or cryoprecipitate
218
60yo African American male presents with bone pain. Workup for multiple myeloma might reveal?
Monoclonal gammopathy, Bence Jones proteinuria, "punched out" lesions on XR of the skull and long bones
219
Reed-sternberg cells
Hodgkin's lymphoma
220
10yoM with fever, weight loss, and night sweats. Exam shows anterior mediastinal mass. Suspected diagnosis?
Non-hodgkin's lymphoma
221
Microcytic anemia with ↓ serum iron, ↓ total iron-binding capacity (TIBC), and normal or ↑ ferritin
Anemia of chronic disease
222
Microcytic anemia with ↓ serum iron, ↓ ferritin, and ↑TIBC
Iron deficiency anemia
223
80yoM with fatigue, LAD, splenomegaly, and isolated lymphocytosis. Suspected diagnosis?
Chronic lymphocytic leukemia (CLL)
224
Late, life-threatening complication of chronic myelogenous leukemia (CML)
Blast crisis (fever, bone pain, splenomegaly, pancytopenia)
225
Auer rods on blood smear
Acute myelogenous leukemia (AML)
226
AML subtype associated with DIC
M3
227
Electrolyte changes in tumor lysis syndrome
↓Ca ↑ K ↑Phosphate ↑ Uric acid
228
Treatment for AML M3
Retinoic acid
229
50yoM with early satiety, splenomegaly, bleeding. Cytogenetics show t(9,22). Diagnosis?
CML
230
Heinz bodies?
Intracellular inclusions seen in thalassemia, G6PD deficiency, and post-splenectomy
231
AR disorder with defect in the GPIIbIIIa platelet receptor and ↓ platelet aggregation
Glanzmann's thrombasthenia
232
Virus associated with aplastic anemia in patients with sickle cell anemia
Parvovirus B19
233
25yo African American male with sickle cell anemia has sudden onset of bone pain. Management of pain crisis? (4)
O2 Analgesia Hydration If severe, transfusion
234
Significant cause of morbidity in thalassemia patients. Treatment?
Iron overload | Use deferoxamine
235
3 most common causes of fever of unknown origin (FUO)
Infection Cancer Autoimmune disease
236
4 signs and symptoms of streptococcal pharyngitis
Fever Pharyngeal erythema Tonsillar exudate Lack of cough
237
Non-suppurative complication of streptococcal infection that is not altered by treatment of primary infection
Postinfectious glomerulonephritis
238
Asplenic patients are particularly susceptible to these organisms
Encapsulated organisms: Pneumococcus, Meningococcus, Haemophilus influenzae, Klebsiella
239
of bacteria on a clean-catch specimen to diagnosie a UTI
100,000 bacteria/mL
240
Which healthy population is susceptible to UTI's
Pregnant women -- treat this group aggressively because of potential complications
241
A patient from CA or AZ presents with fever, malaise, cough, and night sweats. Diagnosis? Treatment?
Coccidioidomycosis | Amphotericin B
242
Nonpainful chancre
Primary syphilis
243
"Blueberry muffin" rash is characteristic of what congenital infection?
Rubella
244
Meningitis in neonates. Causes? Treatment?
GBS, E. coli, Listeria | Treat with gentamicin and ampicillin
245
Meningitis in infants. Causes? Treatment?
Pneumococcus, meningococcus, H. influenzae. | Treat with cefotaxime and vancomycin
246
What should always be done prior to LP?
Check for ↑ ICP, look for papilledema
247
CSF findings: 1. ↓ glucose, PMN predominance 2. Normal glucose, lymphocytic predominance 3. Numerous RBCs in serial CSF samples 4. ↑ gamma globulins
1. Bacterial meningitis 2. Aseptic (viral) meningitis 3. Subarachnoid hemorrhage (SAH) 4. MS
248
Initially presents with a pruritic papule with regional LAD and evolves into a black eschar after 7-10d. Treatment?
Cutaneous anthrax | Treat with Penicillin G or ciprofloxacin
249
Findings in tertiary syphilis (6)
Tabes dorsalis, general paresis, gummas, argyll robertson pupil, aortitis, aortic root aneurysms
250
Characteristics of secondary lyme disease (4)
Arthralgias Migratory polyarthropathies Bell's palsy Myocarditis
251
Cold agglutinins
Mycoplasma
252
24yoM presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Candidal thrush Workup should include HIV test Treat with nystatin oral suspension
253
Risk factors for pyelonephritis (5)
``` Pregnancy Vesicoureteral reflux Anatomic anomalies Indwelling catheters Kidney stones ```
254
Neutropenic nadir postchemotherapy
7-10d
255
Erythema migrans
Lesion of primary Lyme disease
256
Classic physical findings for endocarditis
Fever, heart murmur, Osler's nodes, splinter hemorrhages, Janeway lesions, Roth's spots
257
Aplastic crisis in sickle cell disease
Parvovirus B19
258
Ring-enhancing brain lesion on CT with seizures
Taenia solium (cysticercosis)
259
Name the organism: | Branching rods in oral infection
Actinomyces israleii
260
Name the organism: | Painful chancroid
Haemophilus ducreyi
261
Name the organism: | Dog/cat bite
Pasteurella multocida
262
Name the organism: | Gardener
Sporothrix schenckii
263
Name the organism: | Pregnant woman with pets
Toxoplasma gondii
264
Name the organism: | Meningitis in adults
Neisseria meningitidis
265
Name the organism: | Meningitis in elderly
Streptococcus pneumoniae
266
Name the organism: | Alcoholic with pneumonia
Klebsiella
267
Name the organism: | "Currant jelly" sputum
Klebsiella
268
Name the organism: | Infection in burn victims
Pseudomonas
269
Name the organism: | Osteomyelitis from foot wound puncture
Pseudomonas
270
Name the organism: | Osteomyelitis in sickle cell patient
Salmonella
271
55yoM smoker and heavy drinker presents with a new cough and flu-like symptoms. Gram stain shows no organisms. Silver stain of sputum shows GNR. What is the diagnosis?
Legionella pneumonia.
272
Middle aged man with acute-onset monoarticular joint pain and bilateral Bell's palsy. What is the likely diagnosis, how did he get it, and treatment?
Lyme disease Ixodes tick Doxycycline
273
Patient develops endocarditis 3 weeks after receiving a prosthetic heart valve. What organism is suspected? (2)
S. aureus or S. epidermidis
274
Patient presents with pain on passive movement, pallor, poikilothermia, paresthesias, paralysis, and pulselessness. Treatment?
All-compartment fasciotomy for suspected compartment syndrome
275
Back pain exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.
Spinal stenosis
276
Joints in the had affected in Rheumatoid arthritis
MCP and PIP joints | DIP joints are spared.
277
Joint pain and stiffness that worsens over the course of the day and is relieved by rest
Osteoarthritis
278
Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Osteogenesis Imperfecta
279
Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Suspect ankylosing spondylitis. | Check HLA-B27
280
Arthritis, conjunctivitis, and urethritis in young men. Associated organisms?
Reactive (Reiter's) arthritis. Associated with Campylobacter, Shigella, Salmonella, Chlamydia, and Ureaplasma.
281
55yoM has sudden, excruciating 1st mTP joint pain after a night of drinking red wine. Diagnosis? Workup? Chronic treatment?
Gout Needle-shaped, negatively birefringent crystals are seen on joint fluid aspirate Chronic treatment with allopurinol or probenecid
282
Rhomboid-shaped, positively birefringent crystals on joint fluid aspirate
Pseudogout
283
An elderly female presents with pain and stiffness of the shoulders and hips; she can't lift her arms above her head. Labs show anemia and ↑ESR
Polymyalgia rheumatica
284
Active 13yoM with anterior knee pain. | Diagnosis?
Osgood-Schlatter disease
285
Bone is fractured in fall on outstretched hand.
Distal radius (Colles' fracture)
286
Complication of scaphoid fracture
Avascular necrosis
287
Signs suggesting radial nerve damage with humeral fracture
Wrist drop | Loss of thumb abduction
288
Young child presents with proximal muscle weakness, waddling gait, and pronounced calf muscles
Duchenne muscular dystrophy
289
1st born female born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
Developmental dysplasia of the hip. | If severe, consider a Pavlik harness to maintain abduction.
290
11yo obese African-American boy presents with sudden onset of limp. Diagnosis? Workup?
Slipped capital femoral epiphyses. | AP and frog-leg lateral view
291
Most common primary malignant tumor of bone
Multiple myeloma
292
Unilateral, severe, periorbital HA with tearing and conjunctival erythema
Cluster HA
293
Prophylactic treatment for migraine
β-blockers Calcium channel blockers TCAs
294
Most common pituitary tumor. | Treatment?
Prolactinoma | Tx: Dopamine agonists (i.e. bromocriptine)
295
55yo patient with acute "broken speech". What type of aphasia? What lobe and vascular distribution?
Broca's aphasia. Frontal lobe. L MCA distribution.
296
2 most common causes of SAH
1. Trauma | 2. Berry aneurysm
297
Crescent-shaped hyperdensity on CT that doesn't cross midline
Subdural hematoma - bridging veins torn
298
Hx significant for initial altered mental status with intervening lucid interval. Diagnosis? Most likely etiology? Treatment?
Epidural hematoma. Middle meningeal artery. Neurosurgical evaluation.
299
CSF findings with SAH
↑ICP RBC's Xanthochromia
300
Albuminocytologic dissociation
Guillain-Barre (↑ protein in CSF with only modest ↑ in cell count)
301
Cold water is flushed into a patient's ear, and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Normal
302
Most common primary sources of mets to the brain (5)
``` Lung Breast Skin (melanoma) Kidney GI tract ```
303
May be seen in children who are accused of inattention in class and confused with ADHD
Absence seizures
304
Most frequent presentation of intracranial neoplasm
Headache
305
Most common cause of seizures in children 2-10yo (4)
Infection Febrile seizures Trauma Idiopathic
306
Most common cause of seizures in young adults 18-35yo (3)
Trauma Alcohol withdrawal Brain tumor
307
1st line medication for status epilepticus
IV Benzodiazepine
308
Confusion, confabulation, opthalmoplegia, ataxia
Wernicke's encephalopathy due to deficiency of thiamine
309
What % lesion is an indication for carotid endarterectomy?
70% if the stenosis is symptomatic
310
Most common causes of dementia (2)
1. Alzheimer's | 2. Multi-infarct
311
Combined UMN and LMN disorder
ALS
312
Rigidity and stiffness with resting tremor and masked facies
Parkinson's disease
313
Mainstay of Parkinson's therapy
Levodopa/carbidopa
314
Tx for Guillain-Barre syndrome
IVIG or plasmapheresis
315
Rigidity and stiffness that progress to choreiform movements, accompanied by moodiness and altered behavior
Huntington's disease
316
6yoF presents with port-wine stain in the V2 distribution as well as with mental retardation, seizures, and leptomeningeal angioma
Sturge-weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe.
317
Cafe-au-lait spots on skin
Neurofibromatosis 1
318
Hyperphagia, hypersexuality, hyperorality and hyperdocility
Kluver-Bucy syndrome (amygdala)
319
Administer to a symptomatic patient to diagnose myasthenia gravis
Edrophonium
320
Primary causes of 3rd trimester bleeding
Placental abruption and placenta previa
321
Classic US and gross appearance of complete hydatidiform mole
Snowstorm on US | "Cluster of grapes" appearance on gross examination
322
Chromosomal pattern of complete mole
46XX
323
Molar pregnancy containing fetal tissue
Partial mole
324
Symptoms of placental abruption
Continuous, painful vaginal bleeding
325
When should a vaginal exam be performed with suspected placenta previa?
Never
326
Antibiotics with teratogenic effects
Tetracycline, fluoroquinolones, aminoglycosides, sulfonamides
327
Shortest AP diameter of the pelvis
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
328
Medication given to accelerate fetal lung maturity
Betamethasone or dexamethasone x48h
329
Most common cause of postpartum hemorrhage
Uterine atony
330
Tx for postpartum hemorrhage
Uterine massage | If that fails, give oxytocin
331
Typical abx for GBS prophylaxis
IV PCN or Ampicillin
332
Pt fails to lactate after emergency C-section with marked blood loss
Sheehan's syndrome (postpartum pituitary necrosis)
333
What type of abortion? | Uterine bleeding at 18w gestation, no products expelled; membranes ruptured, cervical os open
Inevitable abortion
334
What type of abortion? | Uterine bleeding at 18w gestation, no products expelled, cervical os closed
Threatened abortion
335
1st test to perform when a woman presents with amenorrhea
β-hCG - most common cause of amenorrhea is pregnancy
336
Term for heavy bleeding during and between menstrual peroids
Menometrorrhagia
337
Cause of amenorrhea with normal prolactin, no response to estrogen-progesterone challenge, and hx of D&C
Asherman's syndrome
338
Therapy for polycystic ovarian syndrome
Weight loss and OCP's
339
Medication used to induce ovulation
Clomiphene citrate
340
Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding
Endometrial biopsy
341
Indications for medical treatment of ectopic pregnancy
Stable, unruptured ectopic pregnancy of
342
Medical options for endometriosis (3)
OCPs, danazol, GnRH agonists
343
Most common location for an ectopic pregnancy
Ampulla of the oviduct
344
Laparoscopic findings in endometriosis
"Chocolate cysts", powder burns
345
How to diagnose and follow a leiomyoma
Ultrasound
346
Natural history of a leiomyoma
Regresses after menopause
347
Patient has ↑ vaginal discharge and petechial patches in the upper vagina and cervix
Trichomonas vaginitis
348
Treatment for bacterial vaginosis
Oral/topical metronidazole
349
Most common cause of bloody nipple discharge
Intraductal papilloma
350
Contraceptive methods that protect against PID
OCP and barrier contraception
351
Unopposed estrogen is contraindicated in which cancers?
Endometrial or ER+ breast CA
352
Patient presents with PID and RUQ pain
Consider Fitz-Hugh-Curtis syndrome
353
Breast malignancy presenting as itching, burning, and erosion of the nipple
Paget's disease
354
Annual screening for women with a strong family hx of ovarian CA
CA-125 and transvaginal US
355
50yoF leaks urine when laughing or coughing. Nonsurgical options? (3)
Kegel exercises, estrogen, pessaries for stress incontinence
356
30yoF has unpredictable urine loss. Exam is normal. Medical options? (2)
Anticholinergics (oxybutynin) or β-adrenergics (metaproterenol) for urge incontinence
357
Lab values suggestive of menopause
↑ serum FSH
358
Most common cause of female infertility
Endometriosis
359
2 consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow up evaluation?
Colposcopy and endocervical curettage
360
Breast cancer type that ↑ the future risk of invasive CA in both breasts
Lobular carcinoma in situ
361
Nontender abdominal mass associated with ↑ VMA and HVA
Neuroblastoma
362
Most common type of trachoesophageal fistula (TEF). | Diagnosis?
Esophageal atresia with distal TEF (85). | Unable to pass NG tube
363
Not contraindications to vaccinations (3)
Mild illness/low-grade fever Current abx therapy Prematurity
364
Tests to rule out shaken baby syndrome (3)
Opthalmologic exam CT MRI
365
A neonate has meconium ileus
CF or Hirschsprung's disease
366
Bilious emesis w/in hours after the first feeding
Duodenal atresia
367
2 month old presents with non-bilious projectile emesis. What are the appropriate steps in management?
Correct metabolic abnormalities. Then, correct pyloric stenosis with pyloromyotomy.
368
Most common primary immunodeficiency
Selective IgA deficiency
369
An infant has a high fever and onset of rash as fever breaks. What is he at risk for?
Febrile seizures (roseola infantum)
370
What is the immunodeficiency? | Boy has chronic respiratory infections. Nitroblue tetrazolium test is positive
Chronic granulomatous disease
371
What is the immunodeficiency? | Child has eczema, thrombocytopenia, and ↑ IgA levels
Wiskott-Aldrich syndrome
372
What is the immunodeficiency? | 4moM has life-threatening Pseudomonas infection
Bruton's X-linked agammaglobulinemia
373
Acute-phase treatment for Kawasaki disease
High-dose ASA for inflammation and fever | IVIG to prevent coronary artery aneurysms
374
Treatment for mild and severe unconjugated hyperbilirubinemia
Phototherapy (mild) or exchange transfusion (severe)
375
Sudden onset of mental status changes, emesis, and liver dysfunction after taking ASA
Reye's syndrome
376
Child has loss of red light reflex. Diagnosis?
Suspect retinoblastoma
377
Vaccinations at 6mo well-child visit
HBV, DTaP, Hib, IPV, PCV
378
Tanner stage 3 in a 6yoF
Precocious puberty
379
Infection of small airways with epidemics in winter and spring
RSV Bronchiolitis
380
Cause of neonatal RDS
Surfactant deficiency
381
Red "currant-jelly" stools
Intussusception
382
Congenital heart disease that causes secondary HTN
Coarctation of the aorta
383
1st line tx for otitis media
Amoxicillin x10d
384
Most common pathogen causing croup
Parainfluenza virus type 1
385
Homeless child is small for his age and has peeling skin and swollen belly
Kwashiorkor (protein malnutrition)
386
Defect in X-linked syndrome with mental retardation, gout, self-mutilation, and choreoathetosis
Lesch-Nyhan syndrome (purine salvage problem with HGPRTase deficiency)
387
Newborn female has continuous "machinery" murmur
Patent ductus arteriosus (PDA)
388
1st line pharmacotherapy for depression
SSRIs
389
Antidepressants associated with hypertensive crisis
MAOIs
390
Galactorrhea, impotence, menstrual dysfunction, and ↓ libido
Patient on dopamine antagonist
391
17yoF with L arm paralysis after her boyfriend dies in a car crash. No medical cause found.
Conversion disorder
392
Name the defense mechanism: | Mom who is angry at her husband yells at her child
Displacement
393
Name the defense mechanism: | Pedophile enters a monastery
Reaction formation
394
Name the defense mechanism: | Woman calmly describes a grisly murder
Isolation
395
Name the defense mechanism: | Hospitalized 10yo begins to wet his bed
Regression
396
Life-threatening muscle rigidity, fever, and rhabdomyolysis
Neuroleptic malignant syndrome
397
Amenorrhea, bradycardia and abnormal body image in a young female
Anorexia
398
35yoM has recurrent episodes of palpitations, diaphoresis, and fear of going crazy
Panic disorder
399
Most serious side effect of clozapine
Agranulocytosis
400
21yoM had 3mo of social withdrawal, worsening grades, flattened affect, concrete thinking
Schizophreniform disorder (dx of schizophrenia requires >6mo of sx)
401
Key side effects of atypical antipsychotics (3)
Weight gain Type 2 DM QT prolongation
402
A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?
``` Acute dystonia (oculogyric crisis) Treat with benztropine or diphenhydramine ```
403
Medication to avoid in patients with hx of alcohol withdrawal seizures
Neuroleptics
404
13yoM with hx of theft, vandalism, and violence toward family pets
Conduct disorder
405
5moF has ↓ head growth, truncal dyscoordination, and ↓ social interaction
Rett's disorder
406
A patient hasn't slept for days, lost $20,000 gambling, is agitated, and has pressured speech. Diagnosis? Treatment?
Acute mania | Tx with mood stabilizer (i.e. Lithium)
407
After a minor fender bender, a man wears a neck brace and requests permanent disability
Malingering
408
A nurse presents with severe hypoglycemia; blood analysis reveals no ↑ in C-peptide
Factitious disorder (Munchausen syndrome)
409
A patient continues to use cocaine after being in jail, losing his job, and not paying child support
Substance abuse
410
A violent patient has vertical and horizontal nystagmus
Phencyclidine HCl (PCP) intoxication
411
A woman who was abused as a child frequently feels outside or detached from her body
Depersonalization disorder
412
A man has repeated, intense urges to rub his body against unsuspecting passengers on a bus
Frotteurism (a paraphilia)
413
A schizophrenic patient takes haloperidol for 1y and develops uncontrollable tongue movements. Diagnosis? Treatment?
Tardive dyskinesia ↓ or d/c haloperidol Consider other antipsychotic (i.e. Risperidone, Clozapine)
414
A man unexpectedly flies across the country, takes a new name, and has no memory of his prior life
Dissociative fugue
415
Risk factors for DVT (Vircho's triad)
Stasis Endothelial injury Hypercoaguability
416
Criteria for exudative effusion
Pleural/serum protein >0.5 | Pleural/serum LDH >0.6
417
Causes of exudative effusion
Leaky capillaries: | Malignancy, TB, bacterial/viral infection, PE with infarct, and pancreatitis
418
Causes of transudative effusion
Intact capillaries: | CHF, liver/kidney disease, and protein-losing enteropathy
419
Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Fatigue and impending respiratory failure
420
Dyspnea, lateral hilar LAD on CXR, noncaseating granulomas, ↑ACE and hypercalcemia
Sarcoidosis
421
PFT showing ↓FEV1/FVC
Obstructive pulmonary disease
422
PFT showing ↑FEV1/FVC
Restrictive pulmonary disease
423
Honeycomb pattern on CXR Diagnosis? Treatment
Diffuse interstitial pulmonary fibrosis. Supportive care Steroids may help
424
Treatment for SVC syndrome
Radiation
425
Treatment for mild, persistent asthma
Inhaled β-agonists and inhaled corticosteroids
426
Acid-base disorder in PE
Hypoxia and hypocarbia (respiratory alkalosis)
427
Non-small cell lung CA (NSCLC) associated with hypercalcemia
Squamous cell carcinoma
428
Lung CA associated with SIADH
Small cell lung CA (SCLC)
429
Lung CA highly related to cigarette exposure
Small cell lung CA (SCLC)
430
A tall white male presents with acute SOB. Diagnosis? Treatment?
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful
431
Treatment of tension pneumothorax
Immediate needle thoracostomy
432
Characteristics favoring carcinoma in an isolated pulmonary nodule (5)
Age >45-50yo Lesions new or larger in comparison to old films Absence of calcification or irregular calcification Size >2cm Irregular margins
433
Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure
ARDS
434
↑ risk of what infection with silicosis?
Mycobacterium tuberculosis
435
Causes of hypoxemia (5)
``` Right to left shunt Hypoventiliation Low inspired O2 tension Diffusion defect V/Q mismatch ```
436
Classic CXR findings for pulmonary edema (5)
``` Cardiomegaly Prominent pulmonary vessels Kerley B lines "Bat's-wing" appearance of hilar shadows Perivascular/peribronchial cuffing ```
437
Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis
Type I (distal) RTA
438
Renal tubular acidosis (RTA) associated with abnormal HCO3- and rickets
Type II (proximal) RTA
439
Renal tubular acidosis (RTA) associated with aldosterone defect
Type IV (distal) RTA
440
"Doughy skin"
Hypernatremia
441
Differential of hypervolemic hyponatremia (3)
Cirrhosis CHF Nephritic syndrome
442
Chvostek's and Trousseau's signs
Hypocalcemia
443
Most common causes of hypercalcemia (2)
Malignancy | Hyperparathyroidism
444
T-wave flattening and U waves
Hypokalemia
445
Peaked T waves and widened QRS
Hyperkalemia
446
1st line tx for moderate hypercalcemia
IV hydration and loop diuretics (furosemide)
447
Type of ARF in pt with FeNa
Prerenal
448
49yoM with acute-onset flank pain and hematuria
Nephrolithiasis
449
Most common composition of nephrolithiasis
Calcium oxalate
450
20yoM with palpable flank mass and hematuria. US shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
Cerebral berry aneurysms (autosomal dominant PCKD)
451
Hematuria, hypertension and oliguria
Nephritic syndrome
452
Proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, edema
Nephrotic syndrome
453
Most common form of nephritic syndrome
Membranous glomerulonephritis
454
Most common form of glomerulonephritis
IgA nephropathy (Berger's disease)
455
Glomerulonephritis with deafness
Alport's syndrome
456
Glomerulonephritis with hemoptysis (2)
Wegner's granulomatosis and Goodpature's syndrome
457
Presence of red cell casts in urine sediment
Glomerulonephritis/nephritic syndrome
458
Eosinophils in urine sediment
Allergic interstitial nephritis
459
Waxy casts in urine sediment and Maltese crosses (seen with lipiduria)
Nephrotic syndrome
460
Drowsiness, asterixis, nausea, and a pericardial friction rub
Uremic syndrome seen in patients with renal failure
461
55yoM diagnosed with prostate CA. Treatment options?
Wait Surgical resection Radiation and/or androgen suppression
462
Low urine specific gravity in the presence of high serum osmolality
DI
463
Treatment of SIADH?
Fluid restriction | Demeclocycline
464
Hematuria, flank pain, and palpable flank mass
Renal cell carcinoma (RCC)
465
Testicular CA associated with β-hCG, AFP
Choriocarcinoma
466
Most common type of testicular CA
Seminoma - a type of germ cell tumor
467
Most common histology of bladder CA
Transitional cell carcinoma
468
Complication of overly rapid correction of hyponatremia
Central pontine myelinolysis
469
Salicylate ingestion causes what type of acid-base disorder?
Anion gap acidosis and primary respiratory alkalosis due to central respiratory stimulation
470
Acid-base disturbance commonly seen in pregnant women
Respiratory alkalosis
471
3 systemic diseases that cause nephrotic syndrome
DM SLE Amylodosis
472
↑ EPO level, ↑ HCT, and normal O2 saturation suggests?
Renal cell carcinoma or other EPO-producing tumor. | Evaluate with CT scan
473
55yoM with irritative and obstructive urinary symptoms. | Treatment options? (4)
``` Likely BPH: No treatment Terazosin Finasteride Surgical intervention (TURP) ```
474
Class of drugs that may cause syndrome of muscle rigidity, hyperthermia, autonomic instability, and extrapyramidal symptoms
Antipsychotics (neuroleptic malignant syndrome)
475
Side effects of corticosteroids
Acute mania, immunosuppression, thin skin, osteoporosis, easy bruising, myopathies
476
Treatment for delirium tremens
Benzodiazepines
477
Treatment for APAP overdose
N-acetylcysteine
478
Treatment for opioid overdose
Naloxone
479
Treatment for benzodiazepine overdose
Flumazenil
480
Treatment for neuroleptic malignant syndrome
Dantrolene or bromocriptine
481
Treatment for malignant HTN
Nitroprusside
482
Treatment of A-fib
Rate control, rhythm conversion, and anticoagulation
483
Treatment of supraventricular tachycardia
If stable, rate control with carotid massage or other vagal stimulation. If unsuccessful, consider adenosine
484
Causes of drug-induced SLE (7)
``` INH Penicillamine Hydralazine Procainamide Chlorpromazine Methyldopa Quinidine ```
485
Macrocytic, megaloblastic anemia with neurologic symptoms
B12 deficiency
486
Macrocytic, megaloblastic anemia without neurologic symptoms
Folate deficiency
487
A burn patient presents with cherry-red flushed skin and coma. SaO2 is normal, but carboxyhemoglobin is elevated. Treatment?
Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant.
488
Blood in the urethral meatus or high-riding prostate
Bladder rupture or urethral injury
489
Test to rule out urethral injury
Retrograde cytourethrogram
490
Radiographic evidence of aortic disruption or dissection (5)
Widened mediastinum (>8cm), loss of aortic knob, pleural cap, tracheal deviation to the right, depression of L main stem bronchus
491
Radiographic indications for surgery in patients with acute abdomen (5)
Free air under the diaphragm, extravasation of contrast, severe bowel distention, space-occupying lesion (CT), mesenteric occlusion (angiography)
492
Most common organism in burn-related infections
Pseudomonas
493
Method of calculating fluid repletion in burn patients
Parkland formula
494
Acceptable urine output in a trauma patient
50cc/h
495
Acceptable urine output in a stable patient
30cc/h
496
Cannon "a" waves
3rd degree heart block
497
Signs of neurogenic shock (2)
Hypotension and bradycardia
498
Signs of ↑ ICP (Cushing's triad)
HTN Bradycardia Abnormal respirations
499
↓CO ↓ pulmonary capillary wedge pressure (PCWP) ↑ peripheral vascular resistance (PVR)
Hypovolemic shock
500
↓ CO ↑ pulmonary capillary wedge pressure (PCWP) ↑ peripheral vascular resistance (PVR)
Cardiogenic shock
501
↑CO ↓pulmonary capillary wedge pressure (PCWP) ↓ peripheral vascular resistance (PVR)
Septic/anaphylactic shock
502
Treatment of septic shock
Fluids and abx
503
Treatment of cardiogenic shock
Identify cause | Pressors (i.e. Dopamine)
504
Treatment of hypovolemic shock
Identify cause | Fluid and blood repletion
505
Treatment of anaphylactic shock
Diphenhydramine or epinephrine 1:1000
506
Supportive treatment for ARDS
Continuous positive airway pressure
507
Signs of air embolism
A patient with chest trauma who was previously stable suddenly dies
508
Trauma series (3)
AP chest AP/lateral C-spine AP pelvis
509
Why are β-blockers contraindicated in patients with cocaine-induced angina or cocaine-induced HTN?
Cocaine blocks NE reuptake ↑ NE → vasoconstriction of coronary arteries (ischemia) and of peripheral arteries (HTN) by acting on α and β receptors β blockade → unopposed α → worsening coronary vasoconstriction → ischemia and MI
510
Lab findings with acute DIC (8)
Thrombocytopenia (
511
Causes of DIC (6)
``` Sepsis (GN and GP) Trauma OB Complications Acute Pancreatitis Malignancy Transfusion Reaction ```
512
HTN + Hypokalemia
``` Primary hyperaldosteronism (Conn Syndrome) ↑ Aldosterone acting on DCT and medullary system → ↑ Na reabsorption (HTN) and ↑ K secretion ```
513
Hyponatremia + Hyperkalemia + Hyperpigmentation
Primary adrenal insufficiency (Addison's syndrome) ↓ glucocorticoids and mineralocorticoids (aldosterone) ↓ Aldosterone → ↓BP, ↓Na, ↑K
514
Hypocalcemia + Hyperphosphatemia + low PTH
Hypoparathyroidism Remember: PTH can also stand for "phosphate trashing hormone"
515
Features of nephrotic syndrome (5)
``` ↑ proteinuria (>3.5g/24h) Hypoalbuminemia Edema Hyperlipidemia Hypercoagulability ```
516
Common causes of osteomyelitis 1. Normal population 2. Sickle cell patients 3. IVDU
1. Normal - S. aureus 2. Sickle cell - S. aureus, Salmonella 3. IVDU - S. aureus, Pseudomonas
517
Diagnostic criteria for systemic lupus erythematosus (SLE) (11)
4+/11 required: 1. Malar rash 2. Discoid rash 3. Photosensitivity 4. Oral ulcers 5. Arthritis 6. Serositis 7. + ANA 8. Renal disease 9. Neurological disorders - seizures, psychosis 10. Hematological disorders - hemolytic anemia, leukopenia, thrombocytopenia 11. Immune disorder - anti-dsDNA, anti-smith, anti-phospholipid
518
Lab findings with DKA (5)
``` ↑ serum glucose (>250) ↑ plasma osmolality ↑ anion gap metabolic acidosis + Ketones in serum and urine Normal/↑ serum K, with low total body K ```
519
Diagnostic criteria for diabetes mellitus? (4)
1. Fasting glucose > 126 mg/dL 2. Plasma glucose > 200 mg/dL 2h after 75g glucose load (oral glucose tolerance test) 3. Random plasma glucose >200 mg/dL + symptoms of hyperglycemia (i.e. polydipsia, polyuria) 4. HgbA1c > 6.5%
520
In which patients are ACE inhibitors considered 1st line treatments for essential HTN? (5)
1. CHF + LV dysfunction (↓ mortality) 2. STEMI (↓ mortality) 3. NSTEMI - anterior MI, DM, systolic dysfunction 4. Proteinuric CKD 5. DM - prevents nephropathy
521
In which patients are ACE inhibitors contraindicated? (3)
1. pregnancy 2. renal artery stenosis 3. H/o ACE inhibitor angioedema
522
Pathophysiology of G6PD Deficiency? Characteristic cells seen?
G6PD generates NADPH needed to reduce glutathione Glutathione is needed to neutralize reactive oxygen species and hydrogen peroxide Without G6PD, RBC's are susceptible to oxidation Characteristic cells: Heinz bodies, bite cells
523
Drugs that provoke G6PD deficiency anemia? (7)
Spleen Purges Nasty Inclusions From Damaged Cells ``` Sulfonamides Primaquine Nitrofurantoin INH Fava beans Dapsone Chloroquine ```
524
What seronegative spondyloarthropathy? Asymmetric arthritis preceded by GI/GU infection
``` Reactive arthritis (Reiter syndrome) - Uveitis, urethritis, asymmetric arthritis ``` HLA B27
525
Exudative pleural effusion: Specific gravity? Protein content? Cellularity? Causes? (4)
High specific gravity High protein High Cellularity Causes: infection, malignancy, inflammation, lymphatic obstruction
526
Transudative pleural effusion: Specific gravity? Protein content? Cellularity? Causes? (3)
Low specific gravity Low protein content Low cellularity Causes: Na retention, ↑ hydrostatic pressure, ↓ oncotic pressure
527
What organisms are associated with struvite renal stones??
Proteus mirabilis (most common Klebsiella Enterobacter Pseudomonas ** All urease producing; splits urea → 2 ammonia *** Struvite stones: Magnesium, ammonium, phosphate
528
What is achalasia and how is it diagnosed?
Failure of LES to relax + impaired peristalsis → dysphagia of solids/liquids, regurgitation of undigested food Diagnosis: Esophageal manometry, barium swallow
529
Anti-dsDNA
SLE - especially active lupus nephritis
530
Anti-histone
Drug-induced lupus
531
Anti-La/SSB
Sjogren's syndrome
532
Anti-smith
SLE
533
Anti-topoisomerase 1
aka Anti-Scl70 Diffuse cutaneous systemic sclerosis (scleroderma)
534
Anti-centromere
Limited cutaneous systemic sclerosis (CREST scleroderma)
535
Characteristics of CREST scleroderma
``` Calcinosis cutis Raynaud phenomenon Esophageal dysmotility Sclerodactyly Telangiectasias ```
536
Antihypertensives safe in pregnancy (4)
Methyldopa Labetolol Hydralazine Nifedipine
537
Second degree, Mobitz I vs Mobitz II heart block
Mobitz I (Wenckebach) - Longer, longer, longer drop Mobitz II - PR constant, with intermittent dropped beats. 2:1 or 3:1 conduction, ect. *** may progress to 3rd degree block.
538
Lab findings suggesting anemia due to hemolysis (8)
``` ↓ hgb ↓ hct ↑ reticulocytes Normal MCV ↑ RDW ↑ indirect bili ↑ LDH ↓ haptoglobin ```
539
Risk factors for PUD (6)
``` H. pylori infection Chronic NSAID use Tobacco Alcohol Corticosteroids Male gender ```
540
S&S of hypothyroidism (10)
``` Weight gain Cold intolerance Dry skin Fatigue Hair loss Depression Constipation Menorrhagia Bradycardia Delayed relaxation of DTRs ```
541
Causes of metabolic acidosis with elevated anion gap? (8)
``` MUDPILES Methanol Uremia (renal failure) DKA Propylene glycol Iron tabs, INH Lactic acidosis Ethylene glycol Salicylates ```

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