STEP 2 CK

Question 0

Anti-jo-1 ab

Answer 0

Dermatomyositis

Question 1

Anti-mi-2 ab

Answer 1

Dermatomyositis

Question 2

Complement-mediated diseases

Answer 2

PAM IS Crying
Post-infectious glomerulonephritis
Atheroembolic dx
MPGN
Infectious endocarditis
SLE
Cryoglobulinemia

Question 4

ACh receptor ab

Answer 4

Myesthenia gravis

Question 5

C-ANCA ab

Answer 5

Wegener’s granulomatosis (granulomatosis with polyangiitis)

Question 5

ACE level blood test

Answer 5

Sarcoidosis

Question 6

Anti-smooth muscle ab

Answer 6

Autoimmune hepatitis

Question 7

MELD Score

Answer 7

Prediction of 3 mo mortality - bili/INR/Cr
MELD=3.78[ln(serum bilirubin)]+11.2[ln(INR)]+[ln(serum creatinine)]+6.4
40+ = 70%
30-39 = 50%
20-29 = 20%

Question 8

Lupus criteria

Answer 8

SOAP BRAIN MD (4/11)
Serositis
Oral ulcers
Arthritis
Photosensitivity
Blood (any -penia, anemia)
Renal dx
ANA+
Immuno (+ anti-Smith/dsDNA/phospholipid)
Neuro
Malar rash
Discoid rash

Question 9

CA 15-3

Answer 9

Breast ca

Question 10

Light’s criteria

Answer 10

Transudate versus exudate
PFprotein:Sprotein > 0.5
PF LDH:S LDH > 0.6
PF LDH > 2/3 upper limit of nl for S LDH
T: inc hydrostatic or dec oncotic pressure
E: inc capillary permeability

Question 11

CREST syndrome

Answer 11

Calcinosis
Raynaud's phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasias

Question 12

CEA tumor

Answer 12

Colon cancer

General adenocarcinomas

Question 13

Anti-TPO ab

Answer 13

Hashimoto’s thyroiditis

Question 15

Cyclic citrallinated peptide (CCP) ab

Answer 15

Rheumatoid arthritis

Question 15

Enolase tumor

Answer 15

Small cell carcinoma

Question 16

AFP tumor

Answer 16

Hepatocellular carcinoma

Gonadal cancers

Question 17

Beta HCG tumor

Answer 17

Choriocarcinoma

Question 18

CA 19-9

Answer 18

Pancreatic cancer

Question 19

Anti-jo ab

Answer 19

Polymyositis

Question 20

CHA2DS2-VASc score

Answer 20

0 low, 1 moderate, 2+ high risk
CHF
HTN
Age (75+)                          2 pts
DM
Stroke/CVA/VTE               2 pts
Vascular dx
Age (65-74)
Sex (F)

Question 21

Cryptosporidium parvum

Answer 21

Diarrhea in HIV, watery, emerging cause of traveler’s diarrhea too when considering a trip to somewhere with poor sanitation and exposure to wilderness and bodies of water
Tx nitazoxanide

Question 22

Well’s criteria for DVT

Answer 22

Pretest probability of DVT (0-1 unlikely, 2+ likely [30%])
1 pt: active cancer, 3+ cm uneven calf swelling, swollen unilateral superficial veins, unilateral pitting edema, hx of DVT, swollen entire leg, tenderness along deep vein, immobilization, bedridden/post-op
-2 pts: other dx more likely

Question 23

HIV ADR: indinavir

Answer 23

Crystal-induced nephropathy

Question 24

Well's criteria for PE

Answer 24

Pretest probability of PE (0-1 15%, 2-5 30%, 6+ 60%) 3 pts: clinical signs of DVT, other dx less likely than PE 1.5 pts: tachycardia 100+

Question 25

Anti-centromere ab

Answer 25

Scleroderma

Question 26

HIV ADR: didanosine

Answer 26

Pancreatitis

Question 27

HIV ADR: abacavir

Answer 27

Hypersensitivity syndrome

Question 28

HIV ADR: NRTIs

Answer 28

Lactic acidosis

Question 29

HIV ADR: NNRTIs

Answer 29

Steven-johnson syndrome

Question 30

HIV ADR: nevirapine

Answer 30

Liver failure

Question 31

MI Classifications

Answer 31

1. Ischemia due to plaque rupture 2. Ischemia due to O2 demand mismatch 3. Sudden cardiac death 4. a/w angioplasty or stenting 5. a/w CABG

Question 32

Blastomycosis

Answer 32

Mississippi/Ohio river valley Broad-based budding yeast Wart-like skin lesions, ulcers, respiratory dx, osteomyelitis, prostate

Question 33

Nocardia

Answer 33

``` Weakly acid fast Gram + rods, aerobic Filamentous branching Pna (cavitations), brain, soft tissue HIV, immunocompromised Tx w bactrim ```

Question 34

CA-125

Answer 34

Ovarian cancer

Question 35

CRAB

Answer 35

``` Multiple myeloma HyperCalcemia Renal impairment Anemia/marrow full of malignant cells Bone issues Dx immune electrophoresis THEN BM bx ```

Question 36

Beta-2 microglobulin

Answer 36

Multiple myeloma

Question 37

Histoplasmosis

Answer 37

``` Mississippi/Ohio river valley Asymptomatic or mild pulmonary infx Papular crusting skin lesions, non-caseating granulomas Bird/bat droppings Septated hyphae Dx w urine or serum antigen (fastest) Tx w itraconazole ```

Question 38

Anti-topoisomerase-1 ab

Answer 38

Systemic sclerosis/scleroderma

Question 39

Coccidioidomycosis

Answer 39

Desert SW/central valley CA Spore inhalation Dimorphic fungus CNS dissemination

Question 40

Cosyntropin test

Answer 40

ACTH analogue testing for primary AI

Question 41

Aspergillosis

Answer 41

Mold, lung involvement, immunocompromised patient No skin lesions Mobile cavitary lung mass "Halo sign" or air crescent lesions on CT

Question 42

Actinomyces

Answer 42

``` Gram + rods, branching Anaerobic Head and neck abscesses Yellow sulfur granules Tx w penicillin ```

Question 43

Celiac dz tests

Answer 43

Anti-TTG Antiendomysial IgA antigliadin

Question 44

TSH immunoglobulin

Answer 44

Grave's dx

Question 45

Anti-mitochondrial ab

Answer 45

Primary biliary cirrhosis (PBC)

Question 46

Calcitonin tumor marker

Answer 46

Medullary thyroid cancer

Question 47

FAMES warfarin drug interactions

Answer 47

``` Fluconazole Amiodarone Metronidazole Erythromycin Sulfa drugs ``` Tylenol

Question 48

CA 27-29

Answer 48

Breast ca

Question 50

Serum osmolarity

Answer 50

Sosm = 2Na + (BUN/2.8) + (Glc/18) | Normal 275-295

Question 50

SIADH criteria

Answer 50

``` Euvolemic hyponatremia Decreased serum osmolarity Increased urine osmolarity Increased urine sodium concentration Failure to correct with NS IVF a/w small cell lung cancer ```

Question 51

3 major post-MI complications

Answer 51

LV free wall rupture to pericardial tamponade Papillary muscle rupture to MR Interventricular septum rupture

Question 52

Tumor lysis syndrome (K, PO4, Ca, uric acid)

Answer 52

Inc (intracellular) Inc (intracellular) Dec Inc PO4 binds Ca, K released, uric from protein degradation

Question 53

Hyperkalemia tx

Answer 53

1. Calcium gluconate if EKG changes 2. Drive into cells w insulin/glc, beta2 agonist, NaHCO3 3. Excrete with NS and loop diuretic, cation resin (kayexelate, sodium polystyrene sulfonate), hemodialysis

Question 54

Hydatid cyst

Answer 54

Echinococcus a/w dog exposure Eggshell calcifications Surgery + albendazole coverage

Question 55

HLA-B27

Answer 55

Ankylosing spondylitis Young female Stiff in AM gets better Anterior uveitis

Question 56

Nephrotic syndromes

Answer 56

FSGS- black/hispanic, obese, HIV, heroin, crescent formation Membranous nephropathy- adenocarcinoma, NSAIDs, HBV, SLE MPGN- HBV, HCV, subepithelial spikes and domes MCD- NSAIDs, lymphoma, podocyte effacement IgA nephropathy- URI

Question 57

Rotor syndrome

Answer 57

Benign hyperbilirubinemia, conjugated No hepatic pigmentation Hepatic storage defect

Question 58

Gilbert's syndrome

Answer 58

Unconjugated hyperbilirubinemia Defect in conjugation within hepatocytes No apparent liver dx

Question 59

Crigler-najjar syndrome

Answer 59

Type 1 severe w neuro dx, death, encephalopathy, bili 25-50 | Type 2 not as severe, bili

Question 60

Bullous pemphigoid

Answer 60

Benign, itchy, tense blisters (not flaccid) No oral IgG and C3 at dermal epidermal junction (subepi)

Question 61

Pemphigus vulgaris

Answer 61

``` Skin and mucous membranes Flaccid bullae, painful, erosive Positive Nikolsky's sign (sloughing) Anti-desmoglein abs form Intercellular IgG deposits in epidermis (intra epi) ```

Question 62

Anti-desmoglein ab

Answer 62

Pemphigus vulgaris

Question 63

Renal calculi diet recs

Answer 63

Increase fluids Increase dietary calcium Decrease protein and oxalate Decrease sodium

Question 64

CML

Answer 64

Philadelphia chr t(9:22) Gleevec Decreased leukocyte alk phos

Question 65

hyperGLUC

Answer 65

``` Glycemia Lipidemia Uricemia Calcemia (HypoNa/K) ```

Question 66

Rubella

Answer 66

Fever, tender LAD Blanching red maculopapular rash on face and spreads to trunk/ext within 24 hrs Arthralgias Congenital cataracts/glaucoma

Question 67

Class 1 antiarrhythmics

Answer 67

``` DQP LTM FP Na channel blocker Disopyramide, quinidine, procainamide Lidocaine, tocainamide, mexilitine Flecainide, propafenone ```

Question 68

Waldenstrom's macroglobulinemia

Answer 68

IgM spike Hyperviscosity of the blood, engorged blood vessels in eyes, mucosal bleeding HSM Visual disturbances

Question 69

Class 2 antiarrhythmics

Answer 69

Beta blockers

Question 70

Drug ADR: Cyclosporine

Answer 70

``` Nephrotoxic HyperK HTN Gum hypertrophy Hirsutism ```

Question 71

Drug ADR: Mycophenolate

Answer 71

Bone marrow suppression

Question 72

Drug ADR: Tacrolimus

Answer 72

Nephrotoxic HyperK HTN Very similar to cyclosporine, same MOA

Question 73

Drug ADR: Azathioprine

Answer 73

Diarrhea Leukopenia Hepatotoxicity

Question 74

Class 3 antiarrhythmics

Answer 74

K channel blocker Amiodarone Sotalol Dofetilide

Question 75

Duke's criteria for IE

Answer 75

Def: 2maj or 1maj+3min Poto: 1maj+1min or 3min Major: blood cx (s viridians, s aureus, enterococc), echo show vegetation Minor: ivdu, fever, embolic dx, immune dx, blood cx not major

Question 76

Class 4 antiarrhythmics

Answer 76

Ca channel blockers | Verapamil, diltiazem

Question 77

Osmolar gap

Answer 77

Observed osm - calculated osm Calculated serum osm = 2Na + glc/18 + BUN/2.8

Question 78

Otosclerosis

Answer 78

Low frequency conductive hearing loss

Question 79

Babesia

Answer 79

Transmitted by ixodes tick Northeastern US Hemolysis, jaundice, renal failure Giemsa-stain blood smear

Question 80

Presbycusis

Answer 80

High frequency sensorineural hearing loss

Question 81

Bacillary angiomatosis

Answer 81

``` Bartonella gram neg bacilli Constitutional symptoms Exophytic skin lesions resembling pyogenic granuloma/cherry angioma Risk of biopsy is hemorrhage HIV association Tx erythromycin ```

Question 82

Giardia

Answer 82

Bloating, diarrhea, fatty foul smelling, malabsorptive Ova and parasites in stool Areas with poor sanitation Tx with metronidazole

Question 83

Ehrlichiosis

Answer 83

Spotless RMSF Flu sx, leukopenia, thrombocytopenia Dx PCR or morulae in monocytes Tx doxycycline

Question 84

Whipple's disease

Answer 84

T whippelii Malabsorptive diarrhea, weight loss, athralgias, pigmentation, PAS positive staining in lamina propria, villous atrophy Tx ceftriaxone then bactrims

Question 85

Reversible causes of PEA

Answer 85

H: hypovolemia, hypoxia, hydrogen (acidosis), hypo/hyperK, hypothermia T: tension pneumo, tamponade, toxins, thrombosis, trauma

Question 86

Maddrey's hepatitis discriminant function index

Answer 86

Index = 4.6(PT-ctrlPT)+bilirubin | >32 Prednisolone tx (or pentoxifylline)

Question 87

CURB-65

Answer 87

Confusion Uremia RR > 30 BP

Question 88

CKD Staging

Answer 88

``` Stage eGFR Cockgroft-Gault (age, wt, Cr) 1 90+ 2 60-89 3a 45-59 3b 30-44 4 15-29 5 ```

Question 89

Rome criteria

Answer 89

>= 3 days/mo for 3 mos + >= 2 of following: 1. Change in frequency 2. Change in form of stool 3. Sx improve with BMs

Question 90

Child-pugh score

Answer 90

1pt 2pts 3pts T bili 3 Serum alb >3.5 2.8-3.5 2.30 Ascites None Mild Mod-Severe Hep Enceph None Ctrl w meds Refractory to meds A: 5-6, 100% 1yr, 85% 2yr B: 7-9, 81%, 57% C: 10-15, 45%, 35%

Question 91

Indications for hemodialysis

Answer 91

Refractory hyperkalemia Hypervolemic/pulm edema non-responsive to diuretics Refractory metabolic acidosis

Question 92

RIPE Therapy

Answer 92

Rifampin Isoniazid Pyrazinamide Ethambutol RIPE 2 mos, RI 4 mos. Positive PPD - 9 mos isoniazid

Question 93

Felty syndrome

Answer 93

RA Splenomegaly Neutropenia

Question 94

Caplan syndrome

Answer 94

RA Pneumoconiosis Lung nodules

Question 95

Drug ADR: Anti-TNFi

Answer 95

Reactivation of latent TB | PPD screening required

Question 96

Drug ADR: Hydroxychloroquine

Answer 96

Retinal toxicity

Question 97

Drug ADR: Methotrexate

Answer 97

Lung and liver toxicity | Bone marrow suppression

Question 98

Anti-phospholipid syndrome

Answer 98

Clotting Normal PT time Prolonged aPTT time Mixing studies do not resolve

Question 99

Behcet syndrome

Answer 99

Painful oral/genital ulcers - sterile skin pustules Erythema nodosum Uveitis/blindness MS-like symptoms, neurologic dysfn, nonspecific Arthritis

Question 100

Cryoglobulinemia

Answer 100

Associated with Hep C C4 mediated Purpura, neuropathy, glomerulonephritis, arthralgias Rheumatoid factor increased

Question 101

Cold agglutinin associations

Answer 101

EBV Mycoplasma Lymphoma

Question 102

Dengue fever

Answer 102

``` Similar to malaria but 4-7 days from mosquito bite Retro orbital pain Fever HA Rash Muscle/joint pains ```

Question 103

Human african trypanosomiasis

Answer 103

``` "Sleeping sickness" Tsetse fly Acute fever Trypanosomal chancre Myocarditis Neurological sx ```

Question 104

Malaria

Answer 104

Mosquito-borne Cyclical fevers ~2 weeks from insect bite GI sx, anemia, thrombocytopenia

Question 105

Meningococcal vaccine

Answer 105

First 11-12 yo | Booster before college-age assuming first dose before age 16

Question 106

Chalazion vs Hordeolum vs BCC

Answer 106

C: rubbery nodule, r/o cancer, steroid inj H: frequent hot compresses, drain BCC: confirm biopsy, remove

Question 108

UA Casts

Answer 108

Muddy brown ATN RBC Glomerulonephritis WBC Insterstitial nephritis or pyelonephritis Fatty Nephrotic syndrome Broad/waxy Chronic renal failure Hyaline nl protein Tamm-Horsfall a/w dehydration

Question 109

Carbon monoxide poisoning

Answer 109

Smoke inhalation- automobile, wood/furnace, charcoal Seizure, AMS, wheeze, HA, bright red lips, abd pain Skin pink/red hue Dx carboxyhemoglobin levels Tx 100% O2, pulse ox cannot differentiate from normal SpO2

Question 110

IV adenosine

Answer 110

narrow-complex supraventricular tachy slows sinus rate conduction inc AV nodal conduction delay

Question 110

ABI

Answer 110

1. 3-1.0 normal | 0. 9-0.4 PAD

Question 111

IV amiodarone

Answer 111

wide-complex ventricular tachy | can also push lidocaine as alternative

Question 112

Conn syndrome

Answer 112

``` Elevated aldosterone, low renin HypoK manifests as muscle cramping and weakness Metabolic alkalosis HAs, thirsty Tx with spironolactone ```

Question 113

Renal osteodystrophy

Answer 113

Chronic renal failure, retain phosphate, abnl processing of vit D Low calcium, high phosphate, parathyroid hyperplasia

Question 114

Overflow incontinence

Answer 114

High postvoid volume Catheterizations Cholinergic agonist, bethanecol

Question 115

Stress incontinence

Answer 115

Increased intraabdominal pressure, cough, sneeze | Pelvic floor kegel exercises

Question 116

Urge incontinence

Answer 116

Detrusor instability | Anti-cholinergic or TCA

Question 117

ADR: Trastuzumab

Answer 117

Tx HER2 positive breast cancer Combined with chemo tx leads to cardiotoxicity Screening echo req'd prior to start

Question 118

Familial hypocalciuric hypercalcemia

Answer 118

Hypercalcemia and UrineCa/Cr clearance ratio | Benign, asymptomatic

Question 119

Bell's palsy

Answer 119

Central: above facial nucleus, forehead sparing Peripheral: below facial nucleus, non-sparing

Question 120

Cat scratch disease

Answer 120

Bartonella henselae Azithromycin Positive warthin-starry stain

Question 121

Amebic liver abscess

Answer 121

``` Entamoeba histolytica Endemic mexico Hx bloody diarrhea Low grade fevers presently w vague abd pain Single thin wall cyst Tx w flagyl ```

Question 122

Hep B birth weight vaccine req

Answer 122

2 kg

Question 123

Exertional vs nonexertional heat stroke

Answer 123

E: strenuous exercise, ice water immersion N: no stress, cool water evaporating only

Question 124

Decreasing contrast-induced nephropathy

Answer 124

Non-ionic contrast IV hydration w NS or isotonic bicarb NAC

Question 125

Meds during cardiac stress test

Answer 125

Hold: BB, CCB, nitrates Ctn: ACEi, ARB, digoxin, statins, diuretics Pharm vasodilator stress: hold dipyridamole 48hrs, caffeine 12hrs

Question 126

Diffuse axonal injury

Answer 126

Traumatic brain injury Deceleration Vegetatuve patient CT minute punctuate hemorrhages and blurry grey-white interface

Question 127

TTP-HUS

Answer 127

``` Adult patient Unexplained hemolytic anemia Renal injury Uremic sx ADAMS-13 deficiency Tx w plasmaphoresis TTP, HUS self-limited ```

Question 128

Pneumococcal vaccine

Answer 128

PCV13 adults >65 followed by PPSV23 in 6-12 mos

Question 129

ARDS

Answer 129

Respiratory distress and worsening Bilateral lung opacities looking like pulmonary edema No signs cardiac failure or fluid overload PaO2/FiO2

Question 131

Management of hypercalcemia

Answer 131

>14: NS, calcitonin, then bisphosphonate long term, NO loop diuretics 12-14: NS, observe if asymptomatic

Question 132

Melanosis coli

Answer 132

Biopsy finds dark brown discoloration of colon with lymph follicles shining through as pale patches. Result of laxative abuse with bisacodyl (anthraquinone-containing).

Question 132

HIV esophagitis

Answer 132

Candida: oral thrush, oral fluconazole. Herpes: small round/ovoid ulcers and intranuclear inclusions, acyclovir. CMV: large linear ulcers and intranuclear/intracytoplasmic inclusions, ganciclovir.

Question 133

MEN Syndromes

Answer 133

1: primary hyperparathyroid, enteropancreatic tumors, pituitary tumors 2A: MTC, pheo, parathyroid hyperplasia 2B: MTC, pheo, mucosal/intestinal neuromas, marfanoid habitus

Question 134

McCune-Albright syndrome

Answer 134

Triad: cafe au lait spots, polyostotic fibrous dysplasia, endocrine hyperfunction (precocious puberty)

Question 135

Aromatase deficiency

Answer 135

Cannot convert testosterone to estrogen Masculinization, normal internal genitalia, ambiguous external Gestational mother resolves after delivery, virilized XX child

Question 136

Human rabies exposure

Answer 136

Rabies vaccine and immune globulin following exposure to high-risk animal

Question 137

Amyloidosis dx and tx

Answer 137

Biopsy abdominal fat pad | Colchicine as ppx and acute tx

Question 139

Fetal hydantoin syndrome

Answer 139

Phenytoin in utero | Hypoplastic fingers/nails/distal phalanges, cleft lip/palate

Question 140

Congenital CMV

Answer 140

Periventricular calcifications, microcephaly, chorioretinitis, retarded, blind, deaf, jaundice, HSM, petechiae Tx ganciclovir

Question 140

SIRS criteria

Answer 140

T >38.5 or 90 RR>20 WBC >12,000 or 10% bands

Question 141

Saline-responsive and unresponsive metabolic alkalosis

Answer 141

SR: urine chloride 20, tx underlying dz

Question 142

Congenital rubella

Answer 142

PDA, deaf, cataracts, microcephaly, blueberry muffin purpura rash, HSM, thrombocytopenia, retarded

Question 143

Neurocysticercosis

Answer 143

Parasitic infx of brain, multiple cysts Pigs tx albendazole

Question 144

Cauda equina vs conus medullaris syndrome

Answer 144

CE: severe LBP unilateral radiculopathy, saddle anesthesia, hyporeflexia (LMN), asymmetric weakness, late B/B dysfn CM: lesser degree of radiculopathy, symmetric, perianal anesthesia, hyperreflexia (UMN), lesser weakness early B/B dysfn Both tx emergent steroids, MRI, surgery

Question 145

Methanol intoxication

Answer 145

OCULAR HA, nausea, emesis, epigastric pain Coma, optic disc hyperemia, vision blurred/loss Tx fomepizole

Question 146

Paroxysmal nocturnal hemoglobinuria

Answer 146

``` CD55/59 deficiency Overactive complement system Dark urine first of the day Pancytopenia and iron deficiency Death by thrombosis Tx prednisone ```

Question 147

AML/APML

Answer 147

Auer rods

Question 148

CLL

Answer 148

Smudge cells LAD, fatigue, HSM, infections Warm autoimmune antibodies Tx fludarabine

Question 149

CML

Answer 149

Fever, night sweats, splenomegaly, pruritus BCR-ABL Tx imatinib/gleevec

Question 150

Myelodysplastic syndrome

Answer 150

Pre-leukemia Pelger-huet cells, bilobed Ringed sideroblasts

Question 151

CHOP therapy

Answer 151

Cyclophosphamide Adriamycin Vincristine Prednisone For NHL

Question 152

Non hodgkin lymphoma

Answer 152

Prolif of lymphocytes in lymph nodes and spleen Painless LAD, no warmth or erythema B cell symptoms fever, sweats, weight loss Cannot aspirate nodes, must excise bx CHOP therapy

Question 153

ABVD therapy

Answer 153

For HL Adriamycin Bleomycin Vinblastine Dacarbazine

Question 154

ADR: doxorubicin

Answer 154

Cardiomyopathy

Question 155

Hodgkin lymphoma

Answer 155

Reed sternberg cells, painless LAD, B cell sx. Localized around cervical area. Minimal change disease association ABVD therapy

Question 156

ADR: vincristine

Answer 156

Neuropathy

Question 157

ADR: bleomycin

Answer 157

Pulmonary fibrosis

Question 158

ADR: cyclophosphamide

Answer 158

Hemorrhagic cystitis

Question 159

ADR: cisplatin

Answer 159

Renal/ototoxicity

Question 160

Hairy cell leukemia

Answer 160

Tartrate resistant acid phosphatase stain Dry tap for bone marrow aspiration Tx cladribine

Question 161

5 Ts cyanotic congenital heart defects

Answer 161

``` Transposition of great vessels Tetralogy of fallot Tricuspid atresia Truncus arteriosus Total anomalous pulm venous return ```

Question 162

Complete mole vs partial mole

Answer 162

C: 2 sperm, lacks genetic material, no fetal tissue, theca lutein cysts, snowstorm/grapes on US P: triploid, +fetal tissue on US Tx evacuation and suction curettage, serial B-hCG levels

Question 163

Retinal detachment

Answer 163

"Curtain down over eyes" | Tears, gray-appearing retina, floaters, light flashes

Question 164

Proteus mirabilis

Answer 164

UTI with alkaline urine Secretes urease Struvite stones (staghorn calculi)- coffin shaped Associated with indwelling catheters

Question 165

Perivalvular abscess

Answer 165

IV drug abuse Diastolic murmur, aortic (Tricuspid would be systolic) AV conduction abnormality

Question 166

Central retinal artery occlusion

Answer 166

``` Sudden painless loss of vision Pallor of optic disc Cherry red fovea Segmentation of blood in vessels Tx ocular massage and high flow O2 ```

Question 167

Cavernous sinus thrombosis

Answer 167

Valveless system so uncontrolled skin/sinus/orbit infection can cause Severe HA, bilateral periorbital edema, CN3/4/5/6 deficits Increased intracranial pressure

Question 168

Schizoaffective disorder

Answer 168

Mood episode (depression or mania) w psychotic sx and pd of psychosis without mood sx for at least 2 weeks

Question 169

Diagnosing hepatitis B

Answer 169

Acute: HbsAg and IgM anti-HBc Chronic: HBV DNA

Question 170

Cluster headache

Answer 170

``` Awakening w severe retroorbital pain Unilateral Ipsilateral horner's Red eye, tearing, rhinorrhea Tx 100% O2 ```

Question 171

Progressive multifocal leukoencephalopathy

Answer 171

JC virus, immunocompromised patient Focal neuro sx, hemiparesis, dysarthria, visual abnl, gait abnl Multiple demyelinating non-enhancing lesions No mass effect

Question 172

Decrease mortality COPD

Answer 172

Home O2 | Smoking cessation

Question 173

Hypertensive complications

Answer 173

Severe htn: >180/120 Malignant htn: severe w end-organ or life threatening complications HTN encephalopathy: severe w cerebral edema/focal neuro deficits

Question 174

Herpes simplex keratitis vs herpes zoster ophthalmicus

Answer 174

HSK: pain, photophobia, dec vision, dendritic ulcer, clear vesicles on cornea HZO: vesicular rash in trigeminal distribution, dendriform corneal ulcer, conunctivitis

Question 175

OBGYN HIV

Answer 175

Mom: triple antiretroviral tx Baby: zidovudine 6 wks w serial HIV PCR

Question 176

Zinc deficiency

Answer 176

Result of chronic TPN | Alopecia, skin lesions surrounding orifices, abnl taste, impaired wound healing

Question 177

Selenium deficiency

Answer 177

Result of chronic TPN Most impt complication is cardiomyopathy Malabsorption, malnutrition

Question 178

Pulsus paradoxus

Answer 178

Drop >10 in blood pressure on inspiration | Pericardial effusion or severe asthma/COPD bc inc lung volume

Question 179

Cyanide poisoning

Answer 179

Smoke inhalation- plastic, rubber, paint, house fire blocks ATP production, leads to anaerobic and lactic acidosis Neurologic and cardiorespiratory stimulation acutely followed by depression and arrest Anoxic brain injury Bitter almond breath Tx hydroxocobalamin or sodium thiosulfate

Question 180

Friedreich ataxia

Answer 180

Most common spinocerebellar ataxia Neuro: ataxia, dysarthria, posterior column degeneratiom Skeletal: scoliosis, foot deformity, hammer toes Cardiac: CMO Respiratory compromise

Question 181

Uric acid kidney stone

Answer 181

Low urine pH, hyperuricosuria, needle-shaped crystals on UA Dx w ultrasound or CT (preferred) Tx hydration, alkalinize urine, low-purine diet, potassium citrate

Question 182

Waldenstrom macroglobulinemia

Answer 182

IgM overproduction Hyperviscosity- lethargy, blurry vision, retinal vessels engorged, mucosal bleeding Tx plasmapheresis

Question 183

Ristocetin cofactor assay

Answer 183

Von willebrand dx, tx DDAVP

Question 184

Russel viper venom test

Answer 184

Lupus anticoagulant

Question 185

Pain worse w food

Answer 185

Gastric ulcer

Question 186

Pain better w food

Answer 186

Duodenal ulcer

Question 187

H. pylori

Answer 187

Assoc'd w duodenal ulcer 90% Assoc'd w gastric ulcer 60% Tx PPI + clarithromycin + amoxicillin Can add bismuth/flagyl/doxycycline

Question 188

Somatostatin receptor scintigraphy

Answer 188

Most accurate for gastrinoma bc somatostatin receptors so upregulated against gastrin

Question 189

Dopamine pathways

Answer 189

Mesolimbic: anti-psychotic efficacy Nigrostriatal: extra-pyramidals, dystonia/parkinsonism/akathisia Tuberoinfundibular: prolactin

Question 190

Diamond-blackfan anemia

Answer 190

Macrocytic anemia, low retics, congenital anomalies | Pure red cell aplasia

Question 191

Most common complications anorexia nervosa

Answer 191

Osteoporosis | Pregnancy: SGA baby, infertility not as common

Question 192

Wiskott-aldrich syndrome

Answer 192

Eczema, thrombocytopenia (small platelets, production dysfn), hypogammaglobulinemia (infections)

Question 193

Sturge-weber syndrome

Answer 193

Unilateral cavernous hemangioma along trigeminal distribution Radiographic intracranial calcifications, "tramline" Tx skin w argon laser Tx seizures and decrease intraocular pressure

Question 194

Unilateral cervical lymphadenitis

Answer 194

Most commonly staph or strep | Tx clindamycin - lymph node penetration and adequate coverage

Question 195

Winter's formula

Answer 195

(Bicarb x 1.5) + 8 +/-2

Question 196

Alcoholic cerebellar degeneration

Answer 196

Gait dysfn, truncal ataxia, dysmetria, intention tremor, dysdiadochokinesia. Negative babinski.

Question 197

CMV pneumonitis

Answer 197

Post-bone marrow transplant | Pneumonitis and colitis

Question 198

5-a reductase deficiency

Answer 198

46 xy M internal genitalia, F or undermasculinized ext genitalia Masculinize at puberty due to testosterone No breast tissue, diffs from andr insens

Question 199

Androgen insensitivity

Answer 199

46 xy Resists androgens, M int genitalia +breast tissue separates from 5-a reductase deficiency

Question 200

Premature ovarian failure

Answer 200

Estrogen deficient LH and FSH inc FSH moreso due to slower clearance FSH:LH>1.0

Question 201

Location of broca's, wernicke's, and arcuate fasciculus

Answer 201

B: left frontal W: left temporal A: left temporal

Question 202

Leukocyte adhesion defect type 1

Answer 202

Delayed separation of umbilical cord Recurrent bacterial skin/mucosal infx Leukocytosis w absence of leukocytes in inflamed/infected tissue

Question 203

Acute angle-closure glaucoma

Answer 203

Sudden onset eye pain, HA, nausea, conjunctival erythema, photophobia, non-reactive pupil Associated with decongestant use Dx tonometry, GS=gonioscopy Tx acetazolamide, mannitol, timolol, pilocarpine NEVER use atropine, dilating agents

Question 204

Chagas disease

Answer 204

Trypanosoma cruzi Latin america Megacolon, megaesophagus, myocarditis

Question 205

Trousseau syndrome

Answer 205

Migratory thrombophlebitis assoc'd w cancer (pancreas MC) | CT looking for neoplastic dz

Question 206

Thyroid in pregnancy

Answer 206

Total T4: inc x1.5 Free T4: inc TSH: dec TH production inc, TBG inc and binds T4, so- much inc'd TT4, some inc'd FT4, suppresses TSH

Question 207

Distinction btwn anorexia and bulimia

Answer 207

A: maintain weight below minimal acceptable level

Question 208

MC Down syndrome cardiac defects

Answer 208

1. Endocardial cushion, complete AV septal defect: loud S2 2/2 pulm HTN, systolic ejection murmur, holosystolic VSD murmur 2. VSD: harsh holosystolic murmur LLSB 3. ASD: fixed split S2, systolic ejection murmur

Question 209

Mucormycosis

Answer 209

Rhizopus species DM immunocompromised Nose, maxillary sinus Low fever, bloody nasal dc, congestion, eye involvement, necrotic turbinates

Question 210

Cataract

Answer 210

Thickening of the lens Due to oxidative damage Opacification of lens, blurry vision, difficult night vision

Question 211

Open angle glaucoma

Answer 211

Insidious loss peripheral vision Increased intraocular pressure Cupping of optic disc

Question 212

Cancer-related anorexia/cachexia

Answer 212

Tx progesterone analogue, then steroids | Cannibus has insufficient evidence

Question 213

ASC-US management

Answer 213

HPV DNA test Pos: colpo Neg: pap and HPV in 3 yrs

Question 214

CMV retinitis

Answer 214

MC ocular complication of HIV Painless, fluffy/granular retinal lesions, hemorrhages Tx ganciclovir, foscarnet vs HSV/VZV which cause painful conjunctivitis/keratitis and vision loss

Question 215

Cocaine-induced chest pain

Answer 215

IV benzos Also aspirin, nitro, CCBs BBs contraindicated, unopposed alpha

Question 216

Psych neuroimaging

Answer 216

``` Autism: inc brain vol OCD: orbitofrontal cortex and striatum Panic do: amygdala PTSD: hippocampus Schizo: enlarged ventricles ```

Question 217

Brain mets

Answer 217

Lung>breast>unk primary>melanoma>colon

Question 218

Purulent vs non-purulent cellulitis

Answer 218

Staph vs strep

Question 219

Differentiate folic acid from B12 deficiency

Answer 219

Both inc homocysteine | B12 inc methylmalonic acid

Question 220

FAP and HNPCC colorectal cancer screening

Answer 220

FAP: sigmoidoscopy every yr begin 12yo HNPCC: colonoscopy every yr begin 25yo

Question 221

Buerger's disease (thromboangiitis obliterans)

Answer 221

Small vessel vasculitis Smoking Black gangrenous fingers Digit autoamputation

Question 222

Takayasu arteritis

Answer 222

Large vessel vasculitis | Pseudo coarctation symptoms from aortic arch vasculitis

Question 223

Gardner syndrome

Answer 223

Colon ca | Bone ca

Question 224

Turcot syndrome

Answer 224

Colon ca | CNS ca

Question 225

JONES criteria

Answer 225

rheumatic fever | joints, heart/carditis, nodules, erythema marginatum, syndenham chorea

Question 226

Universal pregnancy screening

Answer 226

HIV, syphilis, Hep B

Question 227

Congenital toxoplasmosis

Answer 227

Chorioretinitis, hydrocephalus, intracranial calcifications, multiple ring-enhancing lesions Tx pyrimethamine and sulfadiazine

Question 228

Cirrhosis surveillance

Answer 228

ultrasound liver for HCC q6mo AFP q6mo EGD for varices q6mo

Question 229

Sulfonylureas

Answer 229

hypoglycemia, weight gain add to metformin ex: glipizide

Question 230

GLP-1 receptor agonist

Answer 230

used w desired weight loss add to metformin ex: exenatide

Question 231

ADR: TZDs (pioglitazone)

Answer 231

worsening cardiac fn in CHF pt with DM

Question 232

DPP-4 inhibitors

Answer 232

inc endogenous incretins, stimulate natural release of body's insulin

Question 233

hyperactive DTRs, cramping, convulsions following multi-transfusion surgery

Answer 233

hypocalcemia | citrate in transfused blood binds free calcium and magnesium

Question 234

ADR: isoniazid

Answer 234

peripheral neuropathy, tx vit B6 | hepatitis

Question 235

Sodium thiosulfate

Answer 235

cyanide poisoning antidote

Question 236

SAAG

Answer 236

>1.1 indicates portal HTN, inc hydrostatic pressure

Question 237

Flumazenil

Answer 237

benzo OD antidote

Question 238

Fomepizole

Answer 238

alcohol dehydrogenase inhibitor | ethylene glycol poisoning antidote, also methanol antidote

Question 239

Wernicke's encephalopathy

Answer 239

encephalopathy, ataxia, oculomotor dysfn (nystagmus, gaze palsy) add irreversible amnesia, confabulation = korsakoff

Question 240

ADR: risperidone

Answer 240

hyperprolactinemia, gonadal dysfn

Question 241

Rheumatic fever PCN ppx

Answer 241

no carditis: 5 yrs pcn carditis but resolved: 10 yrs or 21yo carditis and persistent: 10 yrs or 40yo

Question 242

VACTERL

Answer 242

vertebral, anal, cardiac, tracheoesophageal, esophageal, renal, limb

Question 243

Oral succimer

Answer 243

mild lead poisoining antidote

Question 244

``` NF 1 (von Recklinghausen dz) NF 2 ```

Answer 244

1: cafe au lait, axillary freckling, lisch nodules (eyes), optic glioma 2: bl acoustic neuromas (vestibular schwannomas)

Question 245

IV calcium EDTA

Answer 245

severe lead poisoning antidote

Question 247

Anti-phospholipid syndrome

Answer 247

high aPTT, thrombocytopenia, arterial/venous thromboses | false positive VDRL

Question 248

Paraneoplastic small cell lung cancer

Answer 248

SIADH ACTH LEMS

Question 249

Paraneoplastic squamous cell lung cancer

Answer 249

PTHrP

Question 250

Coxiella burnetii

Answer 250

Q fever, inhaled, a/w livestock or unpasteurized milk. | Hepatitis, pneumonia.

Question 251

Von-gierke's dz

Answer 251

glucose 6-phosphatase deficiency "doll-face", thin extremities, short, distended abd w enlarged liver/kidneys hypoglycemia, seizures, lactic acidosis

Question 252

Pompes' dz

Answer 252

acid maltase deficiency | "floppy baby", cardiomyopathy/failure, hepatomegaly

Question 253

Diabetic retinopathy

Answer 253

microaneurysms, hemorrhages, edema, exudates +/- cotton wool spots +/- neovascularization

Question 254

Management acetaminophen overdose

Answer 254

charcoal, serum acetaminophen levels | can be asymptomatic 24 hours, use levels to guide NAC

Question 255

Carcinoid syndrome

Answer 255

episodic flushing, chronic diarrhea (secretory), valvular heart disease (tricuspid), weight loss, "pounding sensation" a/w niacin deficiency dx 5-HIAA levels 24hr urine tx octreotide, resection

Question 256

Toxoplasmosis

Answer 256

HIV-associated mass brain lesion ring-enhancing ppx w bactrim, tx w sulfadiazine/pyrimethamine

Question 257

Hyperthyroid-induced afib w RVR management

Answer 257

BBs, propranolol

Question 258

Schizoid personality disorder

Answer 258

social detachment, rather be alone than with others restricted affect no magical thinking

Question 259

Schizotypal personality disorder

Answer 259

eccentric behavior, difficulty w normal relationships | magical thinking, bizzare

Question 260

Schizophreniform disorder

Answer 260

"diet schizophrenia" | same sx, just not long enough i.e.

Question 261

bHCG level seen on US

Answer 261

2000 | if lower, wait 48-72hrs and re-US

Question 262

Brutons agammaglobulinemia vs CVID

Answer 262

BA: dec Ig's, B cells and lymph tissue absent, tx IVIG CVID: dec Ig's, B cells and lymph tissue present but don't work, inc risk lymphoma, tx IVIG

Question 263

Cushing reflex

Answer 263

HTN, bradycardia, resp depression | suggests brainstem compression

Question 264

Sickle cell stroke management

Answer 264

exchange transfusion, keep hydroxyurea on board | fibrinolytics have no role

Question 265

Acute HIV vs EBV mono

Answer 265

HIV: rash, diarrhea EBV: tonsillar exudates otherwise very similar

Question 266

MESNA

Answer 266

used to prevent hemorrhagic cystitis etc with cyclophosphamide use

Question 267

Optic neuritis

Answer 267

MS association | painful eye movements, central scotoma, decreased visual acuity, change in color perceptions, afferent pupillary defect

Question 268

ADR: theophylline

Answer 268

CNS: HA, insomnia, seizures GI: nausea, vomit Cardiac: arrhythmia, multifocal atrial tachy, PVCs, palps

Question 269

ADR: aminoglycosides (aGNATS)

Answer 269

nephrotoxicity, follow UA | typically used for serious gram negative infx, commonly UTI/pyelo

Question 270

Toco strip: early, late, variables

Answer 270

E: head compression L: uteroplacental insufficiency V: cord compression

Question 271

NMS

Answer 271

Tx dantrolene fever, muscle rigidity, AMS differ from SS bc no diarrhea

Question 272

Granulomatosis with polyangiitis (Wegener's)

Answer 272

C-ANCA positive upper and lower respiratory: epistaxis, hemoptysis, rhinorrhea/purulence, saddle nose bridging, destruction of nasal cartilage skin lesions: palpable purpura, painful subq nodules, pyoderma gangrenosum-like lesions glomerulonephritis Tx cyclophosphamide and prednisone

Question 273

Chronic HTN vs Gestational HTN vs PES

Answer 273

C: onset before 20 wks G: onset after 20 wks PES: HTN + proteinuria after 20 wks, if HTN before and new onset protein, then PES superimposed

Question 274

PES severe features criteria

Answer 274

HTN 160/110 Cr 1.1 or double baseline pulm edema, elevated LFTs, CNS sx

Question 275

Leukoplakia

Answer 275

larger white patches or plaques in oral mucosa unable to scratch off must biopsy to r/o SCC a/w smoking and alcohol

Question 276

Aphthous stomatitis

Answer 276

looks like normal ulcer in mouth

Question 277

Gingivostomatitis

Answer 277

grime cold sore on the lip like MM

Question 278

Thiamine (B1) and dextrose for alcoholism

Answer 278

B1 and then glucose always

Question 279

Methemoglobinemia

Answer 279

similar to CO poisoning skin and mucous membrane blue/purple hue sets it apart Tx methylene blue

Question 280

Tuberous sclerosis

Answer 280

retarded, seizures, red facial nodules, ash leaf spots, retinal hamartomas

Question 281

Restless leg syndrome

Answer 281

Tx pramipexole or ropinorole first line DA agonists, not what Dr. Lowden did with neurontin

Question 282

Ethylene glycol poisoning

Answer 282

RENAL AKI from oxalate precipitating with calcium, renal failure Ca levels are then low Tx fomepizole

Question 283

ADR: loop diuretics

Answer 283

ototoxicity

Question 284

Goodpasture syndrome

Answer 284

``` Lung and kidney involvement, hemoptysis No upper resp tract involvement No skin, joint, GI, eye, neuro involvement Dx linear deposits, anti-GBM ab Tx plasmapheresis, steroids ```

Question 285

IgA nephropathy (Berger dz)

Answer 285

1-2 days following URI Gross hematuria Tx ACEi and steroids

Question 286

PSGN

Answer 286

Cola-colored urine, periorbital edema, HTN, oliguria | Best test anti-streptolysin titers and anti-DNAse ab

Question 287

Alport's syndrome

Answer 287

``` Collagen type IV defect Sensorineural hearing loss Visual disturbance No tx Electron microscopy shows thickening and thinning of capillary loops with splitting of the basement membrane ```

Question 288

Acute dystonia

Answer 288

a/w anti-psychotic tx | Tx anticholinergics or antihistamines (benztropine or diphenhydramine)

Question 289

Galactokinase deficiency

Answer 289

Bilateral cataracts congenital | otherwise asymptomatic

Question 290

Galactose-1-phosphate uridyl transferase deficiency

Answer 290

``` Galactosemia FTT, bl cataracts, mental retardation, jaundice, hypoglycemia, hepatomegaly Inc levels galactose +/- aminoaciduria Inc risk neonatal sepsis from e. coli ```

Question 291

Spinal cord compression management

Answer 291

Initial: need MRI, but add steroids first | Dec vasogenic edema and relieves pressure

Question 292

Aspirin-exacerbated resp dz (AERD)

Answer 292

Prostaglandin/leukotriene imbalance from NSAID use, results in bronchospasm and nasal congestion a/w nasal polyps Tx by avoiding aspirin, using montelukast if asthmatic

Question 293

Best HTN benefits

Answer 293

weight loss > DASH > exercise

Question 294

Testing prior to lithium

Answer 294

a/w DI, hypothyroid, ebstein anomaly check UA (Cr) and TSH/T4 (thyroid) prior to starting check pregnancy test in fertile women

Question 295

Carotid endarterectomy

Answer 295

Never below 50% Symptomatic anything above 50% Asymptomatic anything above 70%

Question 296

Antiarrhythmic use dependence

Answer 296

Class 1 and 4 Na- flecainide/propafenone Ca- verapamil/diltiazem

Question 297

Monosodium urate crystal

Answer 297

gout

Question 298

Hydroxyapatite

Answer 298

complexed calcium in bones and teeth

Question 299

Calcium pyrophosphate crystal

Answer 299

pseudogout (which is a/w hemochromatosis)

Question 300

Torsades management

Answer 300

HD stable: mag | HD unstable: defibrillate

Question 301

Single and multiple brain mets management

Answer 301

Single, good performance: resect Single, poor performance: whole brain radiotherapy Multiple: whole brain radiotherapy Screwed: palliative and seizure ppx

Question 302

Renal tubular acidoses

Answer 302

1 (distal): high urine pH >5.5, no H+ secretion, CaOx stones, dx administer acid, tx HCO3 2 (proximal): fanconi syndrome, no HCO3 reabsorption, dx administed bicarb, tx thiazides 4: low urine pH, high K, distal tubule dysfn, hypoaldosterone, dx urine salt loss, tx fludrocortisone

Question 303

Amaurosis fugax

Answer 303

transient monocular vision loss retinal vessel emboli ipsilateral carotid MC source, duplex carotids

Question 304

HBV exposure

Answer 304

vaccinated: no tx | unsure or nonvaccinated: HBV vaccine and HBIg

Question 305

Tx hypertrophic cardiomyopathy

Answer 305

BB or cardio selective CCB | prolong filling time, decrease obstruction

Question 306

Umbilical artery flow velocimetry

Answer 306

used in IUGR below 10th %ile Nl: high velocity flow in diastole Abnl: decreased, absent, reverse end diastolic flow

Question 307

Non-reactive NST

Answer 307

Either CST or biophysical profile | Nl CST: no variable or late decels = reassuring

Question 308

A-thalassemia minor vs B-thalassemia minor

Answer 308

B has HbA2 levels inc

Question 309

Dermatofibroma vs lipoma vs epidermal inclusion cyst

Answer 309

D: pigmented nodule, central dimple L: nonpigmented, nonregressing EIC: regresses and returns

Question 310

Fanconi anemia

Answer 310

MC congenital aplastic anemia multiple DNA repair gene mutations implicated macrocytic anemia, congenital malformations, poor growth

Question 311

Syringomyelia

Answer 311

cape-like areflexic weakness and sensory loss bl UEs spares posterior columns bc hits anterior first spinothalamics first fluid-filled central area of cord

Question 312

Number needed to treat

Answer 312

1/ARR | absolute risk reduction

Question 313

ADR: ceftriaxone in infant

Answer 313

inc risk kernicterus in infant with hyperbili

Question 314

Neonatal conjunctivitis

Answer 314

24 hrs: chemical, tx lubricant 2-5 d: gonococcal, eyelid swelling, cornea ulcers/edema, purulent dc, tx IV/IM ceftriaxone 5-14 d: chlamydial, eyelid swelling, bloody/purulent dc, tx oral erythromycin

Question 315

ADR: erythromycin in infant

Answer 315

inc risk pyloric stenosis

Question 316

Flail chest management

Answer 316

PPV, helps with symmetrical chest rise

Question 317

Exclusion criteria tPA

Answer 317

BP 185/110 INR 1.7, long PT or aPTT Recent stroke/bleed

Question 318

Lennox-Gastaut syndrome

Answer 318

children, mental retardation, multiple types of seizures

Question 319

ADR: propylthiouracil

Answer 319

agranulocytosis | any sx of infx or illness, stop drug, obtain CBC

Question 320

Panic disorder management

Answer 320

Acute: benzo (lorazepam) Chronic: SSRI and CBT

Question 321

Type I, II, III metatarsus adductus

Answer 321

I: overcorrect passively/actively into ABduction, observe II: correct p/a to neutral, tx orthosis III: rigid feet don't correct, serial casting or surgery if refractory

Question 322

Primary CNS lymphoma

Answer 322

EBV DNA in CSF | solitary weakly enhancing periventricular lesion

Question 323

Contact-lens keratitis

Answer 323

pseudomonas, serratia | Tx remove contacts, possible topical abx

Question 324

Granulosa vs Leydig cell tumors

Answer 324

G: estrogen L: testosterone

Question 325

WPW in atrial fibrillation

Answer 325

HD stable: procainamide | HD unstable: electrical cardioversion

Question 326

ADR: metoclopramide

Answer 326

dopamine antagonist, used for nausea, vomiting, gastroparesis prokinetic a/w extra-pyramidal side effects

Question 327

A1AT deficiency

Answer 327

panacinar emphysema liver cirrhosis PAS positive stain, diastase resistant

Question 328

Subclinical hypothyroid

Answer 328

mild elevated TSH | normal T3 and T4

Question 329

Symptomatic sinus bradycardia

Answer 329

IV atropine (anticholinergic/antimuscarinic). 2nd line is transcutaneous pacing OR IV dopamine OR IV epi

Question 330

BCC vs SCC

Answer 330

BCC: below mouth, most common SCC: above, sun exposed, crustier

Question 331

Botulism (infantile vs foodborne)

Answer 331

I: ingest spores, tx human botulism immune globulin F: ingest preformed toxin, tx equine botulism antitoxin

Question 332

Pheochromocytoma blood pressure management

Answer 332

alpha blocker prior to beta blocker | avoid unopposed alpha

Question 333

Dermatitis herpetiformis

Answer 333

a/w celiac dz | Tx dapsone, NOT ACYCLOVIR

Question 334

SAH vasospasm

Answer 334

tx nimodipine (CCB)

Question 335

Trichinellosis (trichinosis)

Answer 335

triad periorbital edema, myositis, eosinophilia ingested uncooked meat gi sx, subungual hemorrhages, ocular hemorrhages

Question 336

Fibromuscular dysplasia

Answer 336

Tx angioplasty and stent placement, surgery if stent fails

Question 337

Giant cell arteritis

Answer 337

steroids, then temporal artery biopsy | serial CXR surveying for aortic aneurysm (common complication)

Question 338

ADR: digoxin (cardiac)

Answer 338

atrial tachy with AV block | rare combo, fairly specific for dig tox

Question 339

Mycobacterium leprae

Answer 339

insensate hypopigmented skin plaques periph nerve dmg causes muscle atrophy, crippling deformities suspect in Asian patient Dx skin biopsy, demonstrate acid fast bacilli

Question 340

Homocystinuria

Answer 340

cystathionine synthase deficiency cerebrovascular accident, dev delay, fair complexion many overlapping features with marfan Dx inc methionine and homocysteine levels Tx B6, folate, B12 to dec homocystiene levels Also tx w antiplatelet/AC

Question 341

Fabry dz

Answer 341

a-galactosidase deficiency angiokeratomas, periph neuropathy, corneal dystrophy renal/heart failure thromboembolic events

Question 342

Krabbe dz

Answer 342

galactocerebrosidase deficiency | retarded, blind, deaf, paralyzed, neuropathy, seizures

Question 343

Tay-Sachs dz

Answer 343

B-hexosaminidase deficiency | retarded, weakness, seizures, cherry-red macula

Question 344

Chronic liver dz vaccines

Answer 344

HAV, HBV, PPSV23 before 65 then PCV13 followed by PPSV23 again, influenza yearly, Td every 10 yrs

Question 345

ADR: epidural anesthesia

Answer 345

vasodilation and venous pooling from sympathetic blockade

Question 346

Aspirin/BBs in asthma

Answer 346

may induce cough from bronchoconstriction

Question 347

Effects of O2 and CO2 on blood flow

Answer 347

CO2 affects vascular tone more than O2 high CO2: vasodilate to inc blood flow low CO2: vasoconstrict

Question 348

Refeeding syndrome

Answer 348

insulin surge drives K, PO4, Mg into cells, causing arrhythmias and cardiopulmonary failure

Question 349

Afib vs Aflutter anatomic etiology

Answer 349

afib: ectopic pulm vein foci aflutter: tricuspid annulus re-entrant circuit

Question 350

Arrest of labor

Answer 350

>4hrs with good ctx or >6hrs with poor ctx

Question 351

Cataplexy

Answer 351

sudden loss muscle tone w strong emotion

Question 352

Narcolepsy

Answer 352

daytime sleepiness, cataplexy, sleep attacks, hyponogogic/hypnopompic hallucinations, sleep paralysis. feel refreshed from naps Tx sleep hygiene, modafinil/stimulants if needed

Question 353

DVT iso inc homocysteine levels

Answer 353

inc homocysteine inc risk of thromboembolic events Tx B6, folate and add B12 only if documented deficiency DVT tx heparin, warfarin, and normalize homocysteine

Question 354

Neonatal tetanus

Answer 354

umbilical stump infx poor suckling, fatigue, rigidity, spasms look for lack of maternal vaccines or home birth with dirty tools or untrained deliverer

Question 355

Hepatic adenoma

Answer 355

a/w OCP use | complications of hemorrhage or malignant transformation

Question 356

Cholesteatoma

Answer 356

chronic ear dysfn, continued drainage, granulation tissue with skin debris, retraction pocket in TM

Question 357

CMV colitis

Answer 357

low CD4, chronic bloody diarrhea | internuclear and intracytoplasmic inclusions (owl's eye)

Question 358

Luteoma vs theca luteum cyst

Answer 358

bl solid vs cystic mass, luteoma a/w virilization, both regress spont after pregnancy

Question 359

Acute AC in pt with renal insufficiency

Answer 359

unfractionated heparin better than LMWH and factor Xa inhibitors, all of which are renally metabolized, but unfrac heparin easy to monitor with aPTT and then can switch to warfarin after 5 days

Question 360

Gallstones management

Answer 360

asymptomatic: observe symptomatic, poor surg candidate: ursodeoxycholic symp, good surg cand: cholecystectomy

Question 361

Anterior mediastinal masses

Answer 361

thymoma teratoma thyroid terrible lymphoma

Question 362

ADR: succinylcholine

Answer 362

disaster a/w hyperkalemia | use vecuronium when inc K

Question 363

Presbyopia

Answer 363

dec lens elasticity, classic presentation needing to hold things further from eyes to see

Question 364

Plummer vinson syndrome

Answer 364

esophageal web, a/w iron deficiency | dysphagia, stomatits

Question 365

Klumpke palsy

Answer 365

C8 T1, claw hand, extended wrist, ext MCPs, flexed IPs | +/- horner's

Question 366

Erb-duchenne palsy

Answer 366

C5 C6, waiter's tip, extended elbow, pronate forearm, flex wrist and fingers

Question 367

Hand-foot-mouth dz

Answer 367

posterior oropharynx vesicles, hand and feet | NOT perioral

Question 368

Tdap vs Td

Answer 368

first ADULT vaccination is Tdap then Td every 10years | women get repeat Tdap for each pregnancy

Question 369

Howell-jolly bodies

Answer 369

sickle cell anemia. nuclear remnants.

Question 370

Bite cells and heinz bodies

Answer 370

G6PD deficiency or thalassemia. hemoglobin ppts.

Question 371

Synchronized cardioversion vs defibrillation

Answer 371

SC: symptomatic or sustained VT or unstable afib w RVR D: vfib or pulseless VT Neither has a role in PEA - start compressions

Question 372

PMR vs FM

Answer 372

PMR has elevated ESR, CPK and aldolase normal, give steroids. FM has entirely normal labs, can treat with TCAs or gabapentin, do not give steroids.

Question 373

Congenital syphilis

Answer 373

palms and soles rash (ulcerative), HSM, jaundice, anemia, rhinorrhea late hutchinson teeth

Question 374

Strabismus

Answer 374

misalignment of eyes, abnormal after 4 months, patch the normal eye or "penalize/blur" it

Question 375

HTN hemorrhagic strokes

Answer 375

putamen, thalamus, pons, cerebellum, cortex | in that order

Question 376

HIV post-exposure ppx

Answer 376

3-drug tx immediately for 4 weeks draw serologies in the mean time if negative, end tx after 4 weeks

Question 377

Post-partum contraception

Answer 377

high prolactin levels suppress GnRH anyways, but use progestin-only OCPs. mixed OCPs haven't been studied yet

Question 378

MC cause of death acromegaly

Answer 378

cardiac

Question 379

Intussusception associations

Answer 379

rotavirus vaccine, HSP

Question 380

CHARGE

Answer 380

``` C: coloboma of eye H: heart defects A: atresia of choanae R: retarded growth/development G: genitourinary E: ear/deaf ```

Question 381

Currant jelly blood

Answer 381

Klebsiella pna | intussusception

Question 382

CAH

Answer 382

21-hydroxylase deficiency, inc 17-hydroxyprogesterone Hypotensive child, electrolytes abnl hypoNa, hypoCl, hypoglycemia, hyperK Girls ambiguous genitals, inappropriate facial hair, virilization Boys nl initially, then delayed sexual devel

Question 383

Scarlet fever

Answer 383

strep pyogenes fever, pharyngitis, sandpaper rash, strawberry tongue, cervical LAD Dx inc anti-streptolysin O titer Tx penicillin, azithromycin, cephalosporin

Question 384

Contacts of pt with epiglottitis

Answer 384

Rifampin for close contacts, ceftriaxone for pt

Question 385

Contacts of pt w whooping cough

Answer 385

macrolide for pt and all close contacts, isolate pt

Question 386

Diptheria

Answer 386

Corynebacterium diptheriae gray pseudomembranous plaques on pharyngeal wall do not scrape plaques Tx w antitoxin, abx won't help

Question 387

Glc load vs glc tolerance test

Answer 387

24-28 wks gestation load is 50g and test at 1 hr tolerance is 100g and test at 1, 2, 3hrs

Question 388

Medical management ectopic pregnancy

Answer 388

Methotrexate, but first obtain LFTs for risk of hepatotoxicity. Follow bHCG until hits zero, should dec 15% every few weeks. If fails, then surgery. Cannot medically manage if 3.5+cm

Question 389

Placenta accreta/increta/percreta

Answer 389

A: attached to superficial uterine wall I: attached to myometrium P: invades through to serosa/bladder/rectum

Question 390

Diabetes screening pregnancy

Answer 390

24-28wks, 2 step method 50g glc load test: if >140 pos, follow 100g glc tolerance 100g glc tol test: >95 fast, 180, 155, 140

Question 391

Abortion vs Stillbirth

Answer 391

20 weeks threshold

Question 392

Tetanus ppx

Answer 392

Immunized: clean- Td toxoid if last was >10yrs, dirty- Td toxoid if last was >5yrs. NO immune globulin Unk/Nonimm: clean- Td toxoid, dirty- Td toxoid and immune globulin

Question 393

Varicella post-exposure ppx

Answer 393

Immunized: nothing | Unk/Nonimm: immunocompetent- varicella vaccine, immunocompromised- varicella zoster IG

Question 394

Central vs peripheral precocious puberty

Answer 394

high FSH, LH vs low FSH, LH

Question 395

Management of pseudotumor cerebri

Answer 395

Acetazolamide and furosemide initially, then serial lumbar punctures if not working. LPs are not long term answer. Long term tx refractory indicates surgery for peritoneal shunt.

Question 396

Management chronic HBV

Answer 396

Chronic HBV, acute liver failure, cirrhosis issues, or high HBV DNA levels Tx entecavir or tenofovir

Question 397

Ludwig's angina

Answer 397

infx of submandibular and sublingual glands. MC source infx tooth. MC cause of death is asphyxiation. drooling, fever, soft tissue crepitus. Tx abx and tooth extraction

Question 398

Aromatase in adipose tissue

Answer 398

Peripheral conversion of adrenal androgens into estrogen by aromatase, which is present in adipose tissue. There is not a frank increase in production. Leads to milder menopause

Question 399

Pna sepsis in CF

Answer 399

Young children MC cause is staph aureus. Assume MRSA, cover IV vancomycin. As get into adolescence etc, switches to pseudomonas most common. Co-existing influenza infx inc chances of staph aureus.

Question 400

PCOS

Answer 400

Weight loss, OCPs, clomid for ovulation induction, metformin. LH:FSH ratio 3:1.

Question 401

Lead screening

Answer 401

Venous sample. Arterial has too high false positive rates. 5-44: repeat test 45-69: DMSA succimer 70+: calcium EDTA

Question 402

Internuclear ophthalmoplegia

Answer 402

Lesion of medial longitudinal fasciculus. A/w MS

Question 403

VIPoma

Answer 403

Rare pancreatic cell tumor, watery diarrhea, hypoK, hyperCa, hyperglycemia, flushing, cramps, weak. Very similar presentation to carcinoid. Dx VIP > 75, mass MC in pancreatic tail w liver mets Tx fluids, resection, octreotide

Question 404

Management of FAP

Answer 404

Elective proctocolectomy for all

Question 405

Indication for bronchoalveolar lavage

Answer 405

Suspicion for malignancy or opportunistic infx

Question 406

MC premalignant colonic lesion

Answer 406

sessile, villous, adenoma, 2.5cm+

Question 407

Physiologic neonatal jaundice

Answer 407

High Hb turnover and inc bilirubin production, dec bilirubin conjugation/clearance (immature until 2 wks), inc enterohepatic recycling. Tx phototherapy unless 20-25 then exchange transfusion. Goal to prevent kernicterus.

Question 408

ADR: MAOi and tyramine food

Answer 408

HTN crisis

Question 409

Milk/Soy protein induced protocolitis

Answer 409

Switch to hydrolyzed feeds. Eliminate soy and dairy. Baby will tolerate by age 1 yr.

Question 410

Digoxin toxicity

Answer 410

Nausea, emesis, dec appetite, confusion, vision changes, weakness, arrhythmias. Visual scotomata, blurry vision, color perception changes, blindness. HypoK inc risk of toxicity.

Question 411

Osler-weber-rendu syndrome

Answer 411

Hereditary AVMs syndrome. Involve respiratory, GI, mucous membranes. Results in bleeding and chronic hypoxia from weird pulmonary blood flow. Telangiectasias seen on skin and MMs. Recurrent nose bleeds.

Question 412

When minors don't require parental consent

Answer 412

emergency care, STDs, substance abuse, pregnancy

Question 413

Stable and unstable afib with RVR

Answer 413

Stable: CCBs or BBs. Rate control Unstable: synchronized cardioversion

Question 414

HIT 1 vs 2

Answer 414

1: Non-immune mediated. Ctn heparin. Plts stay >100k. 1-4 days following administration. 2: Immune mediated. Stop heparin. Plts get very low. 5-7 days out. Anti-platelet factor 4 abs. Risk of thrombosis.

Question 415

Coronary steal

Answer 415

Give dipyridamole or adenosine. Coronary vasodilators, inc blood flow 5x. Diseased vessels distal to obstruction cannot increase their myocardial perfusion capacity. Thus, redistribution of extra flow goes to non-diseased areas and the diseased flow diminishes.

Question 416

Chikungunya fever

Answer 416

Carribean. Mosquito-borne. Flulike illness, polyarthlragies, maculopapular rash, edema, cervical LAD. Low WBC and mild thrombocytopenia.

Question 417

Platelet dysfn management

Answer 417

DDAVP, stimulates vWF multimers from endothelium.

Question 418

Quantitative pilocarpine iontophoresis

Answer 418

Sweat chloride test

Question 419

Rosacea

Answer 419

Adult patients, telangiectasias on cheeks/nose/chin. Flushing periodically. Tx topical metronidazole

Question 420

Biophysical profile

Answer 420

8+ normal, 6 equivocal, less is abnl

Question 421

Stages of labor

Answer 421

1 latent: onset to 4cm dilated 1 active: 4cm to 10cm dilated 2: full dilation to delivery (engage, descent, flexion, int rot, extension, ext rot, anterior shoulder, post shoulder) 3: delivery to placental delivery

Question 422

McRobert's maneuver

Answer 422

macrosomic vaginal delivery, mom flex hips and knees into abdomen and apply suprapubic pressure to straighten the canal

Question 423

HRT contraindications for menopause

Answer 423

Hx DVT or breast/endometrial ca

Question 424

Dysfunctional uterine bleeding

Answer 424

a/w anovulation. Unopposed estrogen never experiences w/d bleeding from corpus luteum formation and progesterone. Bleeding occurs when endometrium outgrows the blood supply. Anyone over 35 yo gets endometrial biopsy to r/o cancer

Question 425

Erysipelas

Answer 425

Strep skin infx. Bacteremia, enlarged lymph nodes, fevers, red streaking of skin, well demarcated tender area of erythema and edema. Leukocytosis.

Question 426

Homunculus

Answer 426

Face and arms more lateral in MCA area. Legs medial in ACA area.

Question 427

Central and peripheral lung cancers

Answer 427

Central: squamous cell, small cell Peripheral: adenocarcinoma, large cell

Question 428

Epididymitis MC organisms

Answer 428

Adult: chlamydia if sexually active | Prepubescent boy: e coli

Question 429

ADHD management

Answer 429

Methylphenidate or dextroamphetamine first line. Side effects include insomnia, appetite suppression, GI disturbance. Atomoxetine, norepi reuptake inhibitor, second line, but often used first bc low side effect profile.

Question 430

Tourrette management

Answer 430

antipsychotics

Question 431

Depression and sleep disorder tx

Answer 431

Mirtazapine

Question 432

Bipolar mania and aggressive

Answer 432

lithium and atypical antipsychotic | if lithium doesn't work, use valproic acid

Question 433

Bipolar depression

Answer 433

lithium or quetiapine

Question 434

MAOIs

Answer 434

Used to tx atypical depression. | phenelzine, isocarboxazid, tranylcypromine

Question 435

Valproic acid toxicity

Answer 435

hypoNa, coma, death

Question 436

Depression and need to gain weight with cancer

Answer 436

Mirtazapine

Question 437

Serotonin syndrome

Answer 437

hyperthermia, myoclonus, diarrhea, flushing, tachy | Tx cyproheptadine

Question 438

ADR: olanzapine

Answer 438

inc risk metabolic sydrome compared to other atypical antipsychotics. avoid in DM and obese patients

Question 439

ADR: ziprasidone

Answer 439

inc risk prolonged QT. avoid in pts w heart disease

Question 440

ADR: clozapine

Answer 440

agranulocytosis

Question 441

Lurasidone

Answer 441

only preg class B antipsychotic

Question 442

Antipsychotics least a/w metabolic syndrome

Answer 442

aripirazole and ziprasidone

Question 443

Manage panic attack vs disorder

Answer 443

Attack: acute, right now, benzos Disorder: overarching, chronic, SSRIs

Question 444

Only TCA indicated for OCD

Answer 444

clomipramine

Question 445

Benzos to be given in pts with liver injury

Answer 445

oxazepam, lorazepam. neither is metabolized by liver

Question 446

Sexual identity

Answer 446

literally their sex, penis or vagina

Question 447

Gender identity

Answer 447

internal feeling of being a man or woman

Question 448

Gender role

Answer 448

external patterns of behavior, reflective of identity

Question 449

Sexual orientation

Answer 449

gay, lesbian, bisexual, asexual

Question 450

Contraindications to bupropion

Answer 450

Epilepsy/seizure disorder, anorexia, bulemia. These cause electrolyte abnl and predispose to seizures.

Question 451

Toxic megacolon

Answer 451

Inflammatory bowel disease, acutely worsened, concerning physical exam with acute belly distended/tender/hypoactive. Elevated fever, WBC >10k, tachy, anemia, elevated ESR. Dx with AXR because management is medical before resorting to surgery. Bowel rest, NGT, steroids, +/- abx. If surgery, then colectomy w ileostomy.

Question 452

Endometrial biopsy for AUB

Answer 452

45yo+, younger than 45 w persistent sx, unopposed estrogen (PCOS, obese), prolonged amenorrhea

Question 453

ADR: primidone

Answer 453

precipitates acute intermittent porphyria. manifests as abd pain and neuropsychiatric sx. Dx check urine porphobilinogen

Question 454

Edrophonium test

Answer 454

Anticholinesterase test. Rapidly improves sx of MG. Not tx. Tx w pyridostigmine, longer acting.

Question 455

Cystinuria

Answer 455

Impaired amino acid transport by renal tubular cells. Forms radioopaque hexagonal renal stones on UA. Urinary cyanide nitroprusside test shows elevated cystine levels. Familial, recurrent stones.

Question 456

Painless hematuria, sickle cell trait

Answer 456

Renal papillary necrosis. SST benign, normal peripheral smear. Look for black kid with no issues and transient episode hematuria. Labs all normal. Hb electrophoresis shows elevated HbAS.

Question 457

Methacholine challenege test

Answer 457

Causes bronchoconstriction. Used to dx asthma

Question 458

Ca-Alb correction factor

Answer 458

For every dec in alb by 1, Ca dec by 0.8. This is total calcium. Ionized calcium stays regulated but is often not measured in labs directly.

Question 459

Endometritis tx

Answer 459

gentamicin and clindamycin

Question 460

Complication of correcting B12 deficiency with B9

Answer 460

Corrects megaloblastic anemia, but ppts the neurological dysfn much more rapidly a/w B12 deficiency.

Question 461

Adult parvovirus B19 infx

Answer 461

Polyarticular, symmetric, self-limiting, a/w frequent contact with children. Arthritis involving MCP, PIP, wrist. Morning stiffness 15 minutes, less than RA. Dx by parvovirus IgM

Question 462

Methods of controlling confounding

Answer 462

matching, restriction, randomization

Question 463

Post-MI ventricular aneurysm

Answer 463

Late complication. Prolonged ST-elevation along same leads with deep Q waves. Enlargement of LV can lead to mitral regurge and CHF.

Question 464

Thyroid cancers

Answer 464

Papillary: MC Follicular: bx to tell from follicular adenoma Medullary: calcitonin, parafollicular C-cells, RET oncogene Anaplastic: rare but worst prognosis

Question 465

HIV ppx

Answer 465

200 bactrim 150 itraconazole 50 azithromycin

Question 466

MC cause ascending aortic aneurysm

Answer 466

cystic medial necrosis or connective tissue disorder

Question 467

MC cause descending aortic aneurysm

Answer 467

atherosclerosis

Question 468

Anemia in scleroderma

Answer 468

Hemolytic anemia from scleroderma renal crisis. Schistocytes present from microangiopathic hemolysis or DIC.

Question 469

SBP

Answer 469

Paracentesis- 250+ PMNs, SAAG >1.1, gram neg e. coli most common, glc >50, protein

Question 470

Morton neuroma

Answer 470

numbness/pain btwn 3rd and 4th toe. clicking sensation when squeezing metatarsal joints

Question 471

Respiratory Quotient

Answer 471

Rate of CO2 produced to rate of O2 uptake. Using protein only 0.8 Using glucose only 1.0 Using fatty acid only 0.7 Normal is around 0.8 because combination of all 3

Question 472

MC complication sickle cell trait

Answer 472

hematuria

Question 473

Hypersensitivity Types

Answer 473

1: IgE- anaphylaxis, immediate, urticaria, mast cell 2: Ab-mediated- IgM/IgG to cell-bound antigens, ex. Rh hemolytic newborn disease 3: Immune-complex- already formed, circulating, ex. serum sickness 4: Cell-mediated- delayed, ex. contact dermatitis

Question 474

Management of EPS with antipsychotics

Answer 474

Aside from stopping drug, can give anticholinergics. | Tx benztropine

Question 475

Sick euthyroid vs sublicinical hypothyroid

Answer 475

SE: dec total T3, dec free T3, normal T4 and TSH, caused by general thyroid abnl a/w any sickness. ST: nl T3 and T4, inc TSH

Question 476

Ventilator tidal volume

Answer 476

6mL/kg, going higher inc risk of barotrauma

Question 477

PEEP

Answer 477

Main modality of management for supplemental O2 in ARDS. 5-15 is the range to work with. Higher inc risk of barotrauma.

Question 478

Anti-SSA(Ro) or Anti-SSB(La)

Answer 478

Sjogren syndrome - infiltration of salivary glands

Question 479

MC cause viral meningitis

Answer 479

echovirus, coxsackievirus

Question 480

Renal vein thrombosis

Answer 480

Nephrotic syndrome patient, sudden onset severe flank pain, fever, gross hematuria. Common a/w membranous glomerulopathy

Question 481

Pediatric constipation and UTI association

Answer 481

Hard impacted stool distends colon/rectum compressing outlet of bladder. Leads to urinary stasis and recurrent UTIs. Look for child with constipation and anal fissures who has dysuria but can only pee little amounts.

Question 482

Pediatric incidental proteinuria management

Answer 482

follow-up with dipstick at subsequent visit. must evaluate for persistence of proteinuria, at which point more work up would be necessary

Question 483

CMV-mononucleosis

Answer 483

Presents as EBV mono without pharyngitis or posterior cervical LAD. Smear shows atypial lymphocytes w basophilic vacuolated appearance. Monospot negative. Splenomegaly present.

Question 484

PKU

Answer 484

Phenylalanine hydroxylase deficiency. Retarded, fair skin and eyes, eczema, mousy/musty body odor. Tx special diet

Question 485

Hereditary fructose intolerance

Answer 485

Aldolase B deficiency. Accumulation of F1P w intro of fruits to diet. Vomiting, FTT, lethargy. Seizures and encephalopathy if diet not changed.

Question 486

Isolated systolic hypertension

Answer 486

Common in elderly. Due to decreased elasticity of arterial wall. Tx w HCTZ, ACEi, CCB

Question 487

Oxybutinin

Answer 487

Anticholinergic, urge incontinence

Question 488

Urethral hypermobility

Answer 488

Angle >30, a/w stress incontinence

Question 489

Giant cell tumor of bone

Answer 489

Local bone tumor, epiphysis long bones, pain, swelling, decreased ROM at joint. Appears as osteolytic lesions or soap bubbles. Contains both cystic and hemorrhagic portions.

Question 490

Osteoid osteoma

Answer 490

Sclerotic cortical bone lesion with central lucency. Pain worse at night, not a/w activity. Tx NSAIDs

Question 491

IgA deficiency transfusion anaphylaxis

Answer 491

Transfuse pRBCs, must wash cells to remove plasma prior to infusion to avoid anaphylactic reaction.

Question 492

Febrile nonhemolytic transfusion reaction

Answer 492

No hemolysis, but malaise, fever 1-6 hrs following transfusion. Tx by leukoreduction of cells prior to transfusion.

Question 493

ADR: RAI therapy for Graves

Answer 493

worsening of ophthalmopathy

Question 494

ADR: Methimazole and PTU

Answer 494

agranulocytosis. look for signs of infx

Question 495

Chediak Higashi

Answer 495

Dysfn of degranulation, chemotaxis, granulopoiesis. Albino, recurrent bacterial infx, pancytopenia. Tx bactrim ppx and ascorbic acid ppx

Question 496

Somatic symptom vs illness anxiety disorder

Answer 496

SS: persistent complaint of >1 sx, concern for it being something terrible despite extensive negative workup and no explanation IA: persistent worry about something terrible with minimal, if any, sx at all. continually neg workups

Question 497

Waterhouse-Friderichsen

Answer 497

Meningococcemia (meningitis with purpura rash), acute decompensation and hypotension, death. Caused by adrenal failure and hemorrhage, complete vasomotor collapse.

Question 498

Blood tests for secondary amenorrhea

Answer 498

bHCG, prolactin, TSH, FSH

Question 499

Syphilis management in PCN allergic pt

Answer 499

nonpregnant: doxycycline pregnant: desensitize and give PCN

Question 500

Acute hemolytic transfusion reaction

Answer 500

Within 1 hr of transfusion, fever, flank pain, hemoglobinuria, renal failure, DIC (bleeding from IV sites). Positive Coombs. Due to ABO incompatibility.

Question 501

Panacinar vs centriacenar emphysema

Answer 501

A1AT deficiency vs smoking COPD

Question 502

Ondansetron/Zofran

Answer 502

Serotonin/5HT3 antagonist, anti-emetic, good for chemo-induced nausea

Question 503

Metoclopramide

Answer 503

Dopamine antagonist, anti-emetic, not as good as zofran

Question 504

Scopolamine

Answer 504

anticholinergic, anti-emetic good for motion sickness, comes in patch form

Question 505

Serum sickness

Answer 505

MC caused by abx. 1-2 weeks post-exposure, fever, urticaria, arthralgias. Possible HA, LAD, edema, splenomegaly. Tx remove offending drug, add steroids if severe

Question 506

Inferior MI

Answer 506

2, 3, aVF | RCA occlusion

Question 507

Anterior MI

Answer 507

V1-V6 any | LAD occlusion

Question 508

Multiple sclerosis exacerbation and maintenance

Answer 508

E: steroids M: glatiramir acetate and beta-interferon

Question 509

C difficile

Answer 509

Risk factors: abx, PPIs, H2 blockers | Tx oral flagyl, oral vanc

Question 510

Beck's Triad

Answer 510

HypoTN, muffled heart sounds, JVD. Cardiac tamponade. Dec left ventricular filling from shift of ventricular septum towards left, decreasing available filling space. Dec stroke volume and cardiac output

Question 511

Sympathetic ophthalmia

Answer 511

Penetrating eye trauma. Anterior uveitis, papilledema, blindness develops, uncovering of "hidden antigens" Immunologic dmg to eye

Question 512

Lactational mastitis

Answer 512

Results from missed feedings and inadequate milk drainage from breast. Continue breast feeding. MC pathogen is staph aureus. Tx dicloxacillin or cephalexin. If more severe, aim at MRSA

Question 513

SIADH management

Answer 513

Goal is to fix Na levels. Fluid restrict first. If need, add hypertonic saline. If very resistant, can give demeclocycline.

Question 514

Demeclocycline

Answer 514

ADH receptor antagonist. Used for refractory SIADH.

Question 515

Condyloma accuminata vs lata

Answer 515

CA: HPV, raised CL: syphilis, flat

Question 516

Acne management

Answer 516

Cleansers, benzoyl peroxide, topical retinoids, topical abx, oral abx, oral retinoids

Question 517

Dissociative identity disorder

Answer 517

Multiple personalities, forget important personal information, and only certain personalities know certain things.

Question 518

Dissociative amnesia

Answer 518

Inability to recall important personal information on multiple occasions. Too much to be considered normal.

Question 519

Dissociative fugue

Answer 519

Confusion about personal identity, a/w travel and patient not knowing where they are or why.

Question 520

Depersonalization disorder

Answer 520

Feeling out of body, significantly impairs daily living, feel detached from themselves.

Question 521

Pleural fluid pH

Answer 521

Nl: 6.0 Transudate: 7.4-7.55 Exudate: 7.3-7.45

Question 522

Angiofibroma (juvenile)

Answer 522

Epistaxis, localized mass, bony erosion in back of nose. Dangerous due to rich blood supply, requires surgery from specialist, unencapsulated and deeply invasive. Recurrence is common.

Question 523

Pralidoxime

Answer 523

antidote for organophosphates, reactivates acetylcholinesterase

Question 524

Mercury poisoning

Answer 524

pulmonary toxicity (fibrosis), neurological sx (jittery, twitching, nervous)

Question 525

BSA for burns

Answer 525

``` Head 9% Arms 9% each Legs 18% each Chest 18% Back 18% ```

Question 526

Volume replacement for burn victim

Answer 526

%BSA burnt x 4 x weight in kg

Question 527

Hypothermia EKG finding

Answer 527

elevated J point

Question 528

Asystole management

Answer 528

Epinephrine or vasopressin. Vasoconstricts to shunt blood to heart and brain.

Question 529

VFib management

Answer 529

Defibrillate. Then epinephrine/vasopressin. Then amiodarone or lidocaine (amio better). Then magnesium.

Question 530

Vtach management

Answer 530

Pulseless: defibrillate HD stable: amio, then lidocaine, then procainamide. HD unstable: synchronized cardioversion, then amio, then lido, then procainamide

Question 531

PEA defn and management

Answer 531

Nl EKG with no pulses. Start compressions, then worry about getting IVs for fluids and epi running.

Question 532

HD unstable afib management

Answer 532

synchronized cardioversion to prevent vfib

Question 533

SVT management

Answer 533

``` Patient w palpitations. Narrow complex tachy. AV nodal reentry conduction. Vagal maneuvers (carotid massage, Valsalva, ice immersion). Then adenosine. Then BBs, CCBs ```

Question 534

WPW

Answer 534

Find conduction pathway abnormality with EP studies. Tx acute sx with procainamide or amiodarone. Chronic management with catheter ablation. CCBs and digoxin not to be used, they block the normal conduction pathway

Question 535

Multifocal atrial tachycardia

Answer 535

a/w COPD | look for EKG with at least 3 different P wave morphologies

Question 536

Sinus bradycardia

Answer 536

Asymp: observe Symp: atropine and pacemaker

Question 537

Second degree AV block

Answer 537

Type 1 Wenckebach: progressive lengthening PR interval until drops beat. observe Type 2: drops a beat without progressive lengthening, deteriorates to 3rd degree. pacemaker

Question 538

Complications of uncontrolled maternal hyperglycemia

Answer 538

macrosomia, neonatal hypoglycemia, polycythemia/hyperviscosity, congenital malformations

Question 539

Post-splenectomy vaccines/ppx

Answer 539

pneumococcal, Hib, meningococcal, PCN ppx 3-5 yrs

Question 540

Impotence following pelvic fracture vs penile fracture

Answer 540

Pelvic: neurogenic, injury to parasympathetics Penile: venogenic, AVMs form

Question 541

MC ADR from RAI therapy

Answer 541

1. hypothyroid | 2. worsening of ophthalmopathy

Question 542

Struma ovarii

Answer 542

ovarian tumor that produces thyroid hormone, results in thyrotoxicosis

Question 543

Brainstem CNs

Answer 543

Midbrain: 3, 4 Pons: 5, 6, 7 Medulla: 8, 9, 10, 11, 12

Question 544

CJD

Answer 544

Prion dz, rapid dementia, myoclonus, EEG periodic sharp waves, elevated 14-3-3 proteins in CSF

Question 545

Diagnosis of lactose intolerance

Answer 545

Clinical suspicion, pos hydrogen breath test, pos stool test for reducing substances, low stool pH, inc stool osmotic gap

Question 546

Digital clubbing associations

Answer 546

malignancy, CF, right to left shunts

Question 547

MOE management

Answer 547

pseudomonas | Tx ciprofloxacin

Question 548

Quadruple screen abnormalities

Answer 548

Trisomy 21: inc bHCG/inhibin A, dec AFP/estriol Trisomy 18: dec AFP/bHCG/estriol, nl inhibin A NTD/AWD: inc AFP, nl otherwise

Question 549

Polycythemia vera

Answer 549

JAK2 mutation, O2 levels normal, EPO levels low, pruritus from inc histamine from basophils. Tx aspirin, phlebotomy to keep Hct under 45%, hydroxyurea, allopurinol/rasburicase. Antihistamines for itching.

Question 550

ADR: niacin

Answer 550

cutaneous flushing and pruritus, managed with aspirin, due to prostaglandin peripheral vasodilation

Question 551

Adult Still Dz or JRA

Answer 551

recurrent high fevers, salmon colored rash trunk and extremities, not itchy, flares during febrile episodes, trunk and extremities, arthritis. splenomegaly, pericardial effusion

Question 552

Distinguish sideroblastic anemia from iron deficient anemia from thalassemia

Answer 552

SA has inc total iron but decreased TIBC, which is opposite iron deficient anemia. Thal has normal iron studies

Question 553

Labs to follow for immune clearance of HBV

Answer 553

HBeAg and ALT remain abnl until cleared

Question 554

ADR: bactrim

Answer 554

hyperkalemia due to blockage of ENaC at collecting tubule

Question 555

ADR: macrolides

Answer 555

prolonged QT and cholestasis

Question 556

CF infertility

Answer 556

congenital absence of vas deferens

Question 557

Hereditary spherocytosis vs autoimmune hemolytic anemia

Answer 557

HS: pos family hx, neg coomb's AIHA: neg family hx, pos coomb's Peripheral smear same for both

Question 558

Biggest risk factor aortic dissection

Answer 558

HTN

Question 559

Biggest risk factor aortic aneurysm

Answer 559

smoking

Question 560

Order of decision making

Answer 560

Patient w capacity, healthcare proxy with agent, living will, family (spouse, adult children, parents, siblings)

Question 561

When do we perform bacterial antigen tests?

Answer 561

Abx started before LP

Question 562

Neisseria meningitis management

Answer 562

IV ceftriaxone. ppx for close contacts with rifampin, cipro, or ceftriaxone. Pt in droplet isolation.

Question 563

Complication of untreated bacterial meningitis

Answer 563

MC 8th cranial nerve deficit, deafness

Question 564

Influenza management

Answer 564

Within 48 hours: oseltamivir | Later: supportive

Question 565

HBV first abnl lab in acute infx

Answer 565

surface antigen

Question 566

Indication of HBV infx resolved

Answer 566

lack of surface antigen

Question 567

HCV management

Answer 567

Interferon is secondary now to sofosbuvir and ribavirin combo. Other combo is sofosbuvir and ledipasvir

Question 568

Jarisch-Herxheimer reaction

Answer 568

fever and worsening sx after tx syphilis. give aspirin and fever reducers. observe

Question 569

Clostridium septicum

Answer 569

order colonoscopy

Question 570

MC culture negative organisms for IE

Answer 570

coxiella and bartonella

Question 571

Hereditary angioedema

Answer 571

C1 esterase deficiency. Tx ecallantide. Dec levels C2 and C4 on labs.

Question 572

Supracondylar fracture

Answer 572

median nerve | brachial artery

Question 573

Midshaft humerus fracture

Answer 573

radial nerve

Question 574

Take-tsubo cardiomyopathy

Answer 574

Stressful event, catecholamine discharge, acute mycardial damage.

Question 575

Order of test abnormalities for MI

Answer 575

EKG, myoglobin, CKMB, trops

Question 576

Rheumatic fever valvular disease

Answer 576

mitral stenosis MC

Question 577

Effects on HCM and MVP

Answer 577

opposite what you think for others | i.e. less volume, more murmur. more volume, less murmur.

Question 578

PAD management

Answer 578

Always start diet/exercise/smoking etc. Then add antiplatelet aspirin, and can use cilostazol as most effective medical management. surgery is medical management fails in severely limiting and debilitating disease. most effective med is cilostazol.

Question 579

Relation of thyroid hormone, GH, and prolactin

Answer 579

TRH stimulates prolactin. Prolactin cosecreted with GH. Hypothyroid results in elevated prolactin

Question 580

DLCO in emphysema vs chronic bronchitis

Answer 580

E: dec CB: unchanged

Question 581

MC bacterial pna w COPD

Answer 581

Hib

Question 582

ADR: pyrazinamide

Answer 582

hyperuricemia | part of ripe therapy

Question 583

EKG findings in PE

Answer 583

MC sinus tachy. MC abnl EKG is nonspecific ST-T wave changes. Alternative S1Q3T3

Question 584

Obesity hypoventilation syndrome

Answer 584

presents as obstructive sleep apnea, but with elevated bicarb

Question 585

Cinacalcet

Answer 585

Tx for hyperparathyroid when surgery cannot be done

Question 586

Diabetic gastroparesis management

Answer 586

erythromycin or metoclopramide. mechanism of dysfn is inability of stretch receptors to sense filling from food

Question 587

ADR: colchicine

Answer 587

diarrhea and BM suppression (neutropenia)

Question 588

Acute gout attack management

Answer 588

NSAIDs (better than colchicine), then steroids, then colchicine if contraindicated for the other two

Question 589

Best BP meds in gout

Answer 589

Losartan (ARB), lowers uric acid

Question 590

Sciatica/disk herniation management

Answer 590

NSAIDs and continued ADLs. Do not do bed rest. Persistence indicates steroid injection.

Question 591

Dupuytren contracture

Answer 591

Hyperplasia of palmar fascia, contraction of 4th and 5th digit. Tx steroids, lidocaine, collagenase injections. Refractory management with surgical release.

Question 592

RA vs OA xray findings

Answer 592

RA: erosion of joints, osteopenia OA: joint space narrowing, osteophytes

Question 593

Pilocarpine

Answer 593

increases acetylcholine

Question 594

Worst complication of Sjogren

Answer 594

lymphoma

Question 595

Churg-strauss

Answer 595

asthma, eosinophilia, renal

Question 596

ADR: bisphosphonates

Answer 596

pill esophagitis (remain upright 30 mins), osteonecrosis of jaw

Question 597

Prostethic joint infection

Answer 597

MC staph epi. Remove joint, 6-8 wks abx, replace joint.

Question 598

Gonococcal arthritis

Answer 598

Polyarticular, not symmetric, tenosynovitis, petechial rash. Culture, but often negative in joint, so culture multiple spots. Tx cephalosporin.

Question 599

Osteomyelitis management

Answer 599

MC staph aureus. Sickle cell salmonella. Dx biopsy, not culture. Children: hematogenous Adult: contiguous

Question 600

Bilirubin gallstones

Answer 600

a/w chronic hemolysis

Question 601

Rasburicase

Answer 601

Protects against tumor lysis syndrome related rise in uric acid

Question 602

Lupus anticoagulant and anticardiolipin antibodies

Answer 602

Anticardiolipin a/w multiple miscarriages, both thrombophilia w high aPTT. Best study is mixing studies

Question 603

Drugs causing pill esophagitis

Answer 603

bisphosphonates, potassium chloride, doxycycline

Question 604

Secretin stimulation test

Answer 604

Test of pancreatitis, normal result would show massive inc in bicarb

Question 605

Celiac and tropical sprue management

Answer 605

C: avoid gluten TS: bactrim, doxycycline

Question 606

IBS management

Answer 606

fiber, dicyclomine (antispasmodic), TCAs, loperamide for diarrhea, lubiprostone for constipation

Question 607

Abs in crohn and UC

Answer 607

CD: ASCA positive UC: ANCA positive

Question 608

PBC and PSC management

Answer 608

ursodeoxycholic acid

Question 609

Wilson dz management

Answer 609

penicillamine (copper chelation) | zinc and trientine alternatives

Question 610

EHEC

Answer 610

Watery to bloody diarrhea, do not give abx, will ppt HUS

Question 611

C perfringens food poisoning

Answer 611

unrefrigerated, nonbloody diarrhea

Question 612

Milk-alkali syndrome

Answer 612

hypercalcemia, met alkalosis, renal failure. was common when ppl used antacids for PUD, less common now.

Question 613

New HCV patient initial management

Answer 613

Offer liver bx, determine progression before initiating therapy.

Question 614

Vitreous hemorrhage

Answer 614

Sudden loss of vision and onset of floaters. Red glow signifies bleeding. Obscured fundus. a/w diabetes

Question 615

Peds volvulus management

Answer 615

Hx of bilious emesis, no distal gas in bowel. Dx upper GI series promptly before ischemia. Tx surgically

Question 616

Beckwith-Wiedman

Answer 616

Macroglossia, rapid growth, hemihyperplasia, omphalocele/umbilical hernia

Question 617

Angelman Syndrome

Answer 617

Smiling, laughing, hand-flapping, ataxia, seizures. Retard, short stature

Question 618

Prader-Willi

Answer 618

Hypotonia, poor suck/feeding, hyperphagia, obesity. Risk for DM, OSA, gastric rupture.

Question 619

Rett Disorder

Answer 619

Retard, ataxia, stereotyped hand-wringing, developmental delay.

Question 620

Asherman Syndrome

Answer 620

Amenorrhea and lack of withdrawal bleeding when tested in woman following D&C. Result of adhesion and scarring of endometrium.

Question 621

PDA murmur

Answer 621

"Machine murmur" or "to-and-fro murmur 2nd left intercostal space, loud S2, bounding peripheral pulses, widened pulse pressure in infant. A/w recurrent URIs since birth and poor feeding

Question 622

Adrenoleukodystrophy

Answer 622

Very long chain fatty acid metabolism defect, builds up in CNS, adrenals, testes. Long term coma/death.

Question 623

Rabies management

Answer 623

First clean wound. Unimmunized: active (rabies vaccine) and passive (rabies Ig). Immunized: rabies vaccine only. High risk animal- Tested: PEP if positive. Untestable: PEP without testing. If domestic, quarantine and look for warning signs.

Question 624

Wallenberg syndrome

Answer 624

Lateral medullary infarct. Horners, loss pain/temp sensory ipsilateral face and contralateral body, ipsilateral bulbar muscle weakness, vertigo/nystagmus/ataxia

Question 625

ADR: nitroprusside

Answer 625

cyanide toxicity, result of metabolite, monitor levels of cyanide. Tx sodium thiosulfate or nitrites

Question 626

Hydralazine/labetalol vs nitroprusside vs nitroglycerine

Answer 626

H/L: HTN emergency in pregnancy. Fast-acting, arterial vasodilator. DO not use hydralazine in aortic dissection as will increase shearing forces and make worse. Labetalol is first line for dissection. NP: Small vessel (arteriolar/venule) vasodilator, dec peripheral vascular resistance. Use in HTN emergency/malignant/enceph NON-PREG. Risk of cyanide toxicity as byproduct. NG: antianginal, no role in HTN management

Question 627

ADR: hydralazine

Answer 627

reflex tachycardia

Question 628

BV (gardnerella vaginallis) Trichomoniasis (trichomonas vaginalis) Candida (candida albicans)

Answer 628

BV: thin, off-white/grey, non-inflam, fish odor, clue cells, pos whiff test, pH > 4.5, tx metronidazole Trich: thin, yellow/green, frothy, inflam, malodorous, motile trichomonads, pH > 4.5, tx metronidazole pt and partner Candida: thick, cottage cheese, inflam, pseudohyphae, normal pH

Question 629

Acute aortic dissection management

Answer 629

IV BBs, labetalol

Question 630

Peds UTI work-up

Answer 630

Renal US: 1st febrile UTI under 2 yo. Recurrent UTIs | VCUG: abnl renal US, UTI under 1 mo, recurrent UTIs under 2 yo, UTI from organism other than e. coli

Question 631

Indicators of response to tx in DKA

Answer 631

Follow serum anion gap and/or beta-hydroxybutyrate levels (MC serum ketone in DKA). Urine ketones are not helpful

Question 632

Midazolam

Answer 632

Benzo used for conscious sedation for medical procedures. Often an answer choice as a distractor with a second benzo.

Question 633

Hypoventilation

Answer 633

Normal A-a gradient but in respiratory acidosis. Also suggested by high PaCO2 and low PaO2. PaCO2 btwn 50-80 is very suggestive.

Question 634

Normal A-a gradient

Answer 634

Less than 15, but changes with age, so greater than 30 is universally accepted as large/abnl

Question 635

Langerhans cell histiocytosis

Answer 635

Solitary painful lytic long bone lesion, swelling, hypercalcemia. Rule out hyperparathyroid. Treat conservatively, spontaneously resolves.

Question 636

Magnesium sulfate toxicity

Answer 636

Depressed DTRs is first sign. Tx calcium gluconate

Question 637

Ewing sarcoma

Answer 637

MC in femur, very malignant, easy confused with osteomyelitis, mets to lungs. Characteristic onion-skin periosteal rxns on xray. Described as lytic, central, endosteal scalloping. "Moth-eaten" or mottled w extension to soft tissues.

Question 638

Salicylate toxicity

Answer 638

Combined resp alkalosis and met acidosis. RA from salicylate stimulation of resp centers in brainstem. Thus, looking for near normal pH because of the mixed picture.

Question 639

Meniere's dz

Answer 639

Vertigo, nystagmus, tinnitus, ear fullness, hearing loss. Tx dietary modifications i.e. low sodium diet. 2nd line is diuretics and anticholinergics.

Question 640

Home O2 criteria

Answer 640

sat 88% or below, or arterial O2 below 55

Question 641

Virus a/w nasopharyngeal cancer

Answer 641

EBV

Question 642

Attributable risk percent (what percent of X can be attributed to Y)

Answer 642

(RR-1)/RRca

Question 643

Increase warfarin effect

Answer 643

Acetaminophen, amiodarone, abx, NSAIDs, omeprazole, SSRIs, cranberry juice

Question 644

Decrease warfarin effect

Answer 644

carbamazepine, rifampin, green veggies, OCPs

Question 645

Third degree heart block

Answer 645

Regular P-P intervals, regular R-R intervals, they are unassociated

Question 646

Indications for urgent dialysis

Answer 646

pH less than 7.1, hyperK cannot be managed by medicine, volume overload unmanaged by diuresis, symptomatic uremia

Question 647

Malaria ppx

Answer 647

Africa/SE Asia: mefloquine, atovaquone-proguanil | South America/Mexico: primaquine

Question 648

Post-menopausal asymptomatic pelvic mass

Answer 648

transvaginal US and CA-125. do not FNA for fear of seeding. suspicion = surgery, none = observe.

Question 649

Bernard Soulier syndrome

Answer 649

absent platelet glycoprotein, mild low plts, circulating giant platelets, severe platelet dysfn, bleeding

Question 650

Lidocaine in ACS situations

Answer 650

dec risk vfib, inc risk asystole

Question 651

Addison's disease acid base status

Answer 651

hyponatremic, hyperkalemic NON anion gap met acidosis

Question 652

Sheehan syndrome

Answer 652

pituitary infarction, a/w postpartum hemorrhage, mom can't lactate and menstrual cycles messed up. loss of anterior pituitary hormones (gh, acth, fsh, lh, tsh, prolactin). ADH and oxytocin unchanged

Question 653

Bacterial meningitis infant management

Answer 653

Must start empiric abx (ceftriaxone and vanc) prior to LP. cannot delay abx tx. image w CT only with focal neurological findings, coma, or hx of neurosurgery

Question 654

Intrauterine fetal testing

Answer 654

Cell-free DNA test: 35+yo chick, 10 wks, looking for abnl, if pos then do chorionic villus sampling CVS: 10-13 wks, karyotype of baby, looks for down's Amniocentesis: 15-20 wks, karyotype

Question 655

Type 1 and 2 error

Answer 655

1: false positive, reject null hypoth but its true 2: false neg, accept null hypoth but its false

Question 656

Trachoma

Answer 656

Chlamydia trachomatis Follicular conjunctivitis, neovascularization Tx topical doxy or oral zpac

Question 657

Infective endocarditis

Answer 657

``` Bacteremia (staph, strep, HACEK) New regurge murmur Vegetations Risks (IVDU, bad valve) Fever Rheum (roth spots eyes, splinter hem, janeway lesions, osler nodes fingers painful) Vascular (emboli, RF+) ```

Question 658

Cat scratch vs bite

Answer 658

S: macrolide or doxy B: augmentin