UWorld Flashcards
(221 cards)
1
Q
What things can trigger paroxysms of HTN in patients with a pheochromocytoma?
A
increases in intra-abdominal pressure, anesthesia medications, non-selective beta-blockers
2
Q
What are the two most common causes of esophageal rupture?
A
following EGD biopsy or Boerhave syndrome.
3
Q
What are potential patient presentations for a patient with esophageal rupture?
A
Chest pain, fever, pleural effusion, subcutaneous emphysema, hamman sign
4
Q
Esophageal rupture can be diagnosed via what imaging techniques?
A
CXR, CT scan, Water-soluble EGD
5
Q
What are some common characteristics of Parkinson’s Disease?
A
- Mask-like, immobile facies
- Bradykinesia
- Resting Tremor
- Rigidity
- Festinating/hypo-kinetic gate
6
Q
A young man presents with pulmonary hemoptasis. Upon further work-up, he also has 1.2 g of protein in his 24-hour urine collection and dysmorphic RBC casts in his urine. What are you suspecting? How could you diagnose?
A
Goodpasture disease due to antibodies to Type IV collagen. Diagnose via renal biopsy showing linear IgG deposits on the GBM.
7
Q
What is the most sensitive screening tool for diabetic nephropathy?
A
Random urine microalbumin: Cr
8
Q
A 40-year-old male with a harsh systolic murmur in the R. second ICS that radiates to the carotids likely has this heart defect?
A
Aortic stenosis due to bicuspid valve
9
Q
The most common cause of a aortic stenosis in a patient greater than 70-years-old?
A
Senile Califications
10
Q
What is the most important risk factor for stroke?
A
Hypertension
11
Q
What are symptoms of cushing’s Syndrome that would differentiate from PCOS?
A
Hyper-pigmentation (inflammatory acne or tinea versicolor), muscle wasting, easy bleeding, hypokalemic alkalosis
12
Q
How would you differentiate between primary and secondary Cushing’s Syndrome (hyper-cortisol)?
A
Primary, due to a pituitary tumor, will respond to a dexamethasone suppression test. Secondary (adrenal) or ectopic tumors producing cortisol will have low ACTH and will not respond to the suppression test.
13
Q
A patient with non-blanching violaceous petechiae should be checked for?
A
cutaneous small vessel vasculitis
14
Q
What drugs need to be held prior to a stress test?
A
Any drugs acting directly on the heart must be held for 48 hours prior to the stress test
15
Q
What blood levels would be elevated in each of the following testicular tumors?
- Leydig cell
- choriocarcinoma
- teratoma
- yolk sac
A
Leydig: increased aromotase, testosterone, estrogen; decreased FSH and LH.
Choriocarcinoma: increased serum Beta-hcg (this is also increased with a syncytiotrohphoblast seminoma)
teratoma: increased B-hcg and AFP
Yolk Sac: increased AFP
16
Q
Any patient with an unprovoked seizure must have what imaging?
A
CT without contrast or an MRI
17
Q
Increasing the cutoff point on a study does what to the sensitivity and specificity?
A
Increased specificity and decreased sensitivity
18
Q
What are some signs and symptoms of systemic amyloidosis?
A
Restrictive cardiomyopathy, asymptomatic proteinuria, waxy skin, anemia, hepatomegaly, early satiety, subcutaneous nodules, enlarged tongue, neuropathy.
19
Q
Cardiac effects of restrictive cardiomyopathy are?
A
LVH with a non-dilated LA; Right hear failure; preserved EF CHF
20
Q
Cardiac effects of hypertrophic cardiomyopathy are?
A
- Asymmetric septal hypertrophy
- anterior motion of mitral valve
- LV outflow tract obstruction
- Harsh Systolic ejection murmur at Left sternal border
21
Q
Beri-Beri from thiamine deficiency causes?
A
Dilated Cardiomyopathy
22
Q
Ischemic cardiomyopathy has what effect on CI, SVR, and LVEDV?
A
- Decreased CI
- Increased SVR
- Increased LVEDV
23
Q
A beta cell tumor would have what impact on C-peptide and proinsulin levels?
A
Both would be increased
24
Q
Chest pain triggered by emotional stress is common with?
A
Stable angina
25
Increased myocardial oxygen demand is the underlying mechanism of what CAD testing?
Exercise stress test
26
Why is the underlying mechanism of an adenosine induced stress test?
Increased BF to myocardium
27
Dobutamine stress ECHO should be done in this patient population with CAD?
Patients with reactive airway disease
28
Patients with peripheral arterial disease are at the highest risk for?
CV death
29
Diabetes neuropathy is a length dependent axonopathy with differing symptoms depending on fiber length. How would patients present with small fiber disease? Large fiber?
Small Fiber: pain, parasthesia, allodynia
| Large fiber: numbness, loss of DC, decreased DTR's in ankles
30
What cardiac and pulmonary sequlae can result from OSA?
systemic HTN, Pulmonary HTN, Right heart failure
31
Treatment of malignant otitis externa with pseudemonas should be treated with?
PO Ciprofloxacin
32
Osler Weber Rendu Syndrome has these three classical findings?
- Diffuse telangictasias
- recurrent epistaxis
- widespread AVM's
33
Acute Tubular Necrosis will prevent with these urine findings?
Uosm >300
Una>20
FeNa<2%
Muddy brown casts
34
Fatty casts are seen in?
Nephrotic syndrome
35
Broat casts and waxy casts are seen in?
Chronic renal disease
36
Patients with a Type A aortic dissection can develop this cardiac injury secondarily?
Aortic regurgitation
37
Patients with a porcelain gallbladder are at an increased risk for?
gallbladder adenocarcinoma
38
A rupture echinococcal cyst will present with?
anaphylaxis
39
Painless, transient vision loss in an elderly male with known atherosclerosis is?
amaurosis fugax due to atherosclerotic emboli from the carotid
40
Patients with back pain and any red flags should have?
X-rays and inflammatory markers
41
Cauda equina syndrome presents with?
Saddle anesthesia and urine retention
42
The lytic lesions of multiple myeloma are most easily seen on this imaging modality?
X-ray
43
The first line treatment for acne is?
topical retinoids
44
Patients with known BPH who present with an AKI need this test performed?
a renal Ultrasound
45
This dementia presents with chronic brain atrophy on imaging, progressively decreasing mental status and forgetfulness, and cholinergic neuron loss?
Alzheimer's Disease
46
What is the first line treatment for Alzheimer's Disease?
Cholinesterase inhibitors
47
What causes Ichthyosis Vulgaris?
It's hereditary
48
A patient with known type 2 Diabetes presents to the ED with increased urination and worsening mental status. With further testing, you find a glucose of 1,110 mmol/l and a serum osmolality of 330 mOsm/kg. What is the most likely diagnosis and what treatment should be initiated?
HHS
Start aggressive hydration with normal saline followed by IV insulin. Remember to replace potassium.
49
A PR interval of <0.2 with a sinus rhythm is?
a first degree AV block
50
What is the treatment protocol for a 1st degree AV Block?
If the QRS interval is normal, than the patient can just be observed. If the QRS interval is delayed the patient will need further testing, as these patients will likely develop further arrhythmia's.
51
How can a COPD exacerbation cause decreased consciousness and seizures?
Severe respiratory acidosis can cause decreased consciousness, while increased CO2 can cause reflex cerebral vasodilation leading to seizures.
52
Endocarditis following a dental procedure is likely due to this organism?
Strep. Viridans (Strep. Mutans)
53
A 25-year-old female presenting with UL conductive hearing loss and no signs of infection, likely has?
Otosclerosis
54
Otosclerosis typically shows up on a CT scan as?
Lucent focus in the temporal bone near the oval window
55
Vitiligo is caused by? How is it treated?
melanocyte destruction. Treat with steroids.
56
A patient presents with new onset, right sided sensory loss of 3 hours duration. She complains of a mild headache, but no other prior symptoms. She has known CAD and carotid stenosis. Neurological exam shows right sided loss of sensation, but no other neurological defects. What is the most likely cause of her symptoms?
Lacunar stroke of the thalamogeniculate arteries
57
A patient receiving follow-up after her stroke 2 months ago complains of episodes of burning pain on her right side. She states that these episodes come and go, but they are accompanied by severe burning pain that is worsened when the area is touched. She suffered a pure sensory lacunar stroke 2 months ago. What is likely causing her current symptoms?
Dejerine-Roussey Syndrome
58
A lacunar stroke of the internal capsule would present as?
CL motor loss
59
A lateral medullary stroke would present with these symptoms?
- IL facial loss of pain and temperature
- CL body loss of pain and temperature
- Nystagmus
- IL Horner Syndrome
60
A patient with known uncontrolled HTN presents with stroke like symptoms. They are found to have an inter parenchymal, hemorrhagic stroke of the putamen. What symptoms did they likely present with?
- CL hemiparesis
- CL Sensory loss
- Conjugate Gaze palsy
61
A patient with HIV presents with red, friable, exophytic nodules on his forehead. They are easily bleeding. What is the likely causative agent?
Bacillary angiomatosis from a bartonella infection. Treat with PO erythromycin
62
What are the qualifications for an HIV patient to receive live vaccines?
CD4 Count >200
63
What changes in blood counts will occur as a result of chronic exposure to carbon monoxide?
secondary polycythemia and carboxyhemoglobin on an ABG
64
In a patient with sudden cardiac arrest who is found to have suffered an MI, what is the most common cause of his arrest?
Re-entrant ventricular tachycardia
65
A patient presents to the ED with an NSTEMI and is found to have ventricular tachycardia 30 minutes later. What is the most likely cause of his V-tach?
Abnormal automaticity
66
A patient with ST elevation in leads II, III, and AVF as well as a second degree AV block likely has? What while resolve this?
Inferior wall MI
| Reperfusion
67
A patient with known DJD who presents with worsening pain and sensory loss when standing or walking down-hill should be evaluated for? What imaging modality should be used?
Lumbar stenosis
| MRI
68
A patient with C. difficile colitis will likely present with this abnormality of the RAAS system? What treatment should this patient receive?
increased RAAS system
| Metronidazole
69
Why would a patient develop hypocalcemia following a blood transfusion?
Blood products are packaged with citrate which is a chelating agent
70
What triggers esophageal spasm? What test is used for diagnosis? What is found on that test?
- temperature changes in food, emotional stress, etc.
- esophageal manometry
- non-peristaltic, high amplitude contractions
71
Factor V leiden causes thrombosis by?
An activated Protein C Resistance
72
in a patient with anti-phospholipid syndrome, this blood abnormality will be present?
increased PTT that is not corrected by a mixing study
73
Patients with a TCA overdose will present with these symptoms?
- Increased HR, hypotension, drowsiness
- prolonged PR, QRS, and QT intervals
- Anti-cholinergic effects.
74
In a patient suffering from a TCA overdose with EKG changes, what is the first line treatment?
IV sodium bicarbonate
75
What drugs are known to induce BL sensorineural hearing loss?
Aminoglycosides, chemo agents, high dose aspirin, loop diuretics
76
What is the gold standard diagnostic tool for diagnosing Boorehave syndrome?
CT with gastrografin contrast
77
What Chest x-ray and pleural fluid findings are consistent with esophageal perforation?
- pseudomediastinum on chest x-ray
| - pleural fluid with high amylase concentrations
78
What is the only FDA approved treatment for the symptoms of ALS?
Riluzole
79
Patients with an Upper GI bleed and melena will likely have this lab abnormality on their BMP?
increased BUN: Cr
80
In a patient who suffered a tonic-clonic seizure who now has an AKI, what would indicated rhabdomyolsis?
Large amount of blood on the UA, but no RBC's on the urine studies. This indicates that myoglobin is present in the urine.
81
What two studies could be completed on a living patient with suspected CJD?
EEG to look for periodic sharp wave complexes
| Lumbar puncture with CSF assay to look for 14-3-3 protein
82
What is the biggest risk factor for an enlarging AAA or a rupture?
Smoking
83
In a patient who presents with low urine: serum osmolality, how who you determine if the patient is suffering from Primary polydipsia, Central DI, or nephrogenic DI?
1. water restriction for 2 hours. If their urine osmolality jumps to >600, that primary polydipsia is the likely diagnosis.
2. Administer DDAVP: if their urine osmolality increased by >50%, that the patient is suffering from Central DI. If no change is seen, than the patient is suffering from nephrogenic DI.
84
A known IV drug users presents with a few months of progressively worsening back pain. He states that the pain is worsened if anything touches the area. You order blood work and find a normal WBC, elevated platelets, and an elevated ESR. What's the likely diagnosis? How could you confirm your diagnosis?
Vertebral osteomyelitis
| MRI
85
What are the the three components of MEN Syndrome?
1. Parathyroid Adenoma
2. Pancreas/ GI tumors
3. Pituitary adenoma
86
What is the easiest way to distinguish between botulism and gullian-barre syndrome?
Botulism is descending weakness, GB syndrome is ascending weakness
87
What is the likely diagnosis for a liver cyst with a calcified cover? What's the treatment? What happens if it ruptures?
Echinococcus granulosus
surgery and albendazole
anaphylaxis
88
What is dacryocystitis?
lacrimal duct infection, most likely from S. aureus
89
How could you determine if a patient is suffering from a thyroid storm vs. malignant hypertension?
Patients in a thyroid storm generally have a goiter and lid lag. Patients with malignant hypertension will have muscle rigidity and increased CPK.
90
In patients with pyelonephritis, when would imaging be necessary?
If patient are septic or they show no clinical improvement after 48-72 hours of antibiotic therapy
91
A patient who presents with vomiting three hours after eating reheated chinese food likely has?
Food poisoning from ingesting the preformed toxin of bacillus cereus
92
What imaging modalities are necessary to visualize uric acid kidney stones?
CT or pyelography
93
What is the triad of RCC presentation?
- palpable abdominal mass
- left sided variocele
- paraneoplastic symptoms
94
A patient suffering from aspiration pneumonia likely has this bacteria type? What is the first line treatment?
Anaerobes
| Clindamycin
95
A patient who has respiratory distress within an hour of aspirating during a surgery, but does not have a fever, likely has?
pneumonitis from gastric acid
96
What two body parts are impacted in patients with alpha-1-antitrypsin deficiency? What are the underlying abnormalities in those body parts?
Lung: pan-acinar emphysema impacting the lower lobes
Liver: neonatal hepatitis, cirrhosis, or HCC
97
A patient presenting with ventricular tachycardia and in stable condition, should be treated with? What if the patient becomes unstable?
IV amiodarone
| Cardioversion
98
A young female patient presenting with fatigue, proximal muscle weakness, constipation, decreased DTR's, and increased CPK likely has?
Hypothyroid myopathy
99
Adhesive capsulitis will likely present as?
decreased passive and action ROM and stiffness
100
In a patient on warfarin who presents with stroke like symptoms and a dramatically increased INR, what was the most likely inciting factor?
The patient took OTC cold medicine. The tylenol contributed to the increased INR, while the phenylephrine increased BP.
101
In a patient with a cerebral hemorrhage, increased INR, and is currently on warfarin therapy, what is the first like treatment?
Vitamin K and PCC (which contains vitamin K and other factors)
102
The three D's of Pellagra or Niacin deficiency is?
1. Dermatitis (rough, hyper-pigmented areas)
2. Dementia
3. Diarrhea
103
This patient population commonly has a false positive VDRL and a history of thrombus or pregnancy loss?
anti-phospholipid syndrome
104
Cardiac tamponade presents with a tetrad of these symptoms?
1. Hypotension
2. tachycardia
3. JVD
4. Pulsus Paradoxus
105
The deficits of brown sequard syndrome are?
- IL hemiparesis
- IL loss of propioception and vibration
- CL loss of pain and temperature
106
Why might a patient with chronic alcoholism have hypokalemia that is not repaired after administration of potassium chloride?
Low magnesium
107
The peripheral smear of a patient with CLL would contain?
Sever lymphocytosis and smudge cells
108
Hairy Cell Leukemia would present as?
Pancytopenia and splenomegaly
109
What are the adverse effects of treatment with EPO?
worsening HTN, headaches, flu-like symptoms, red cell aplasia
110
A patient on isoniazid therapy needs this vitamin to prevent anemia?
pyridoxine
111
Sideroblastic anemia would have these peripheral smear and iron findings?
- microcytic, hypochromic anemia
- elevated iron
- Low TIBC
112
Hollenhorst plaques are commonly seen in?
cholesterol emboli to the eye
113
Patients with Pancoast Tumors often present with these symptoms?
1. shoulder pain
2. Horner Syndrome
3. Weight Loss
4. C8-T2 neurologic deficits
5. Supraclavicular lymph nodes
114
What conditions are associated with porphyria cutanea tarda?
- Hep C
- HIV
- Chronic alcohol use
- Estrogen use
- Smoking
115
The cutaneous manifestations of porphyria cutanea tarda are?
blisters, bullae, changing skin pigmentation, and scarring on sun-exposed skin
116
How can one differentiate between secretory and osmotic diarrhea?
Secretory diarrhea has a decreased SOG, while osmotic diarrhea has an increased SOG
117
Widespread Molluscum Contagisum in an adult patient could mean?
The patient has underlying HIV
118
A mid-systolic click followed by a short systolic murmur at the cardiac apex, that has a decreased duration with squatting indicates?
MVP
119
Which heart murmurs are made louder by decreased preload?
MVP and HCM
120
Which heart murmurs are made louder by increased after load?
AR, MR, VSD
121
What drug/drug classes are known to cause photosensitivity?
Tetracyclines, Chlorpromazine, furosemide, HCTZ, amiodarone
122
A young female athlete presents complaining of anterior knee pain. She claims the pain is worse when walking up stairs and running for long periods of time. What is the most likely diagnosis? What physical exam finding would help you confirm this diagnosis?
Patellofemoral syndrome
| (+) patellofemoral compression test
123
A patient crashes in the ED following an MI, what should be done?
Check telemetry! Likely Ventricular fibrillation, and patient needs immediate cardioversion
124
In a patient with endocarditis, what would a new AV block indicate?
perivalvular abscess
125
Diffuse ST elevation in a patient who is leaning forward on the exam table with diaphoresis?
Acute pericarditis
126
What is the underlying cause of lympadenopathy in a patient with Turner Syndrome?
dysgenesis of lymphatic system
127
Patients with PKU typically have these symptoms?
- Mental retardation
- Musty Urine
- Seizures
- Hypopigmentation
128
An infant presenting to the ED with seizures and encephalopathy whose Mom fed him fruit yesterday?
Fructose intolerance due to aldolase B deficiency
129
Infants with galactosemia present as?
Jaundice, hepatomegaly, and failure to thrive following initiation of formula feeding.
130
Granulosa cell tumors of the ovary cause a change in this hormone?
increased estrogen
131
An 8-year-old child who presents with abdominal pain, jaundice, and a palpable liver mass?
Biliary Cyst
132
Skin necrosis following warfarin induction reveals this underlying abnormality?
Protein C resistance
133
What two antibiotics can be used to treat syphilis?
PCN G or Doxycycline
134
Hashimoto's Thyroiditis increases your risk of acquiring this cancer?
Thyroid Lymphoma
135
What are the signs and symptoms of Whipple's Disease?
Chronic diarrhea, migratory arthritis, lympadenopathy, fever, weight loss
136
This feature in the gut lining is common with T. whipelli infection?
PAS (+) macrophages
137
Sjogren Syndrome commonly has these signs and symptoms?
keratoconjunctivitis sicca, dry mouth, skin xerosis, Raynauds, Arthritis, and interstitial lung disease
138
What antibodies are commonly present in a patient with Sjogren syndrome?
Anti-Ro and Anti-La
139
A patient with hypercalcemia, high PTH, but who has low urinary excretion of calcium has?
familial hypocalcuric hypercalcemia
140
A 23-year-old Asian female presents to the ED complaining of chest pain. She has also been having muscle pain in her legs. Upon exam she is found to have no detectable pulses in her UE's. What other vital abnormality would she likely have? what is she suffering from?
Differing blood pressures in her UE's compared to her LE's
| Takayasu Arteritis
141
What are the signs and symptoms present in a child with Kawasaki Disease?
- recent viral infection
- Fever
- myositis
- conjunctivitis
- cervical adenopathy
- rash
- edema
142
How would I differentiate between a pemphigus vulgaris and a bullous pemphigus when looking at a stain?
pemphigus vulgaris has epidermal-dermal separation with net-like IgG
Bullous Pemphigus has sub epidermal separation with linear IgG
143
Long term cardiac and pulmonary effects in a patient with untreated mitral stenosis are?
- pulmonary congestion
- LA enlargement
- L. recurrent laryngeal n. enlargement
- Elevated L. mainstem bronchus
144
A young patient presenting with palpitations relieved by immersing her face in cold water or holding pressure on her eye like has?
AVNRT
145
What prophylactic medication should be added for a CD4 <200? What if it drops below 150? 50? What infections are you attempting to prevent?
<200: Bactrim to prevent PCP and toxoplasmosis
<150: Itraconazole to prevent Histoplasmosis
<50: Azithromycin to prevent MAC
146
What are the qualifications for needing home oxygen therapy in patients with COPD?
If resting PaO2 < 55 mm Hg or SaO2 <88%
147
Vaginal SCC due to HPV is usually found?
in the upper 1/3 of the vaginal wall
148
What are the indications for urgent hemodialysis?
- metabolic acidosis with a pH <7.1
- symptomatic hyperkalemia (cardiac)
- Toxic alcohol ingestion
- Salicylate, lithium, or anti-epileptic drugs overdose
- Uremic encephalopathy
149
Patients with flushing, diarrhea, bronchospasm, and right sided valvular lesions should be evaluated for?
Carcinoid syndrome
150
What treatment could be initiated in patients with carcinoid syndrome prior to surgery?
octreotide
151
What is the treatment for an acute MS flare?
GC's or plasmapheresis
152
What is the treatment for patients with hyperkalemia who present with EKG changes?
Calcium gluconate
153
The major motor characteristics of Parkinson's Disease are?
- 4 to 6 hz resting tremor
- bradykinesia
- postural instability
- rigidity
154
Findings from a tissue biopsy of the small intestine in a patient with crohn's disease would show?
noncaseating granulomas
155
A 55-year-old female presents to the ED following a TIA. The patients husband tells you that she has been experiencing headaches and ringing in her ears for weeks, but she thought this was normal due to her uncontrolled HTN. On exam you find a subaricular bruit. What disease are you concerned about?
Fibromuscular dysplasia
156
In a patient with hypopituitarism due to a pituitary adenoma, what hormone levels would be impacted?
Low LH, testosterone, TSH
| High Prolactin
157
How does pernicious anemia result in macrocytic, megaloblastic anemia?
Antibodies to IF prevent the absorption of vitamin B12
158
What is the treatment for a patient with a-fib with RVR who is in stable condition? What if the patient becomes unstable?
- IV beta blocker, diltiazem, or digoxin
| - Cardioversion
159
The treatment for paroxysmal SVT is?
adenosine and carotid massage
160
A person who is traveling to India for 2 months will need this malaria prophylaxis?
Doxycyline or Mefloquine for 2 weeks prior to departure and 4 weeks following the trip
161
Wilson's Disease presenting with neuropsychiatric symptoms generally presents with symptoms characteristic of damage to this brain structure?
Basal Ganglia
162
First line treatment for lumbar radiculopathy?
NSAID's and PT Trial
163
A patient presents to the ED with a recent travel history to rural areas of China. He is complaining of fever and muscle pain for the last few days of which tylenol has provided no relief. On exam you find subungal splinter hemorrhages and periorbital edema. What lab test could help confirm your diagnosis? What is your diagnosis?
- eosinophilia would be present
| - Trichinellosis following uncooked pork consumption
164
In patients with Typhoid fever, their symptoms generally unfurl slowly with days to weeks between each presentation. What would this progression in symptoms look like?
A patient with a week of fever or gets a salmon colored rash. A week later he could be found to have hepatosplenomegaly.
165
Parvovirus B19 can take on many symptoms depending on the age and immune state of the patient. Describe the most likely presentation in each patient population below:
- Children
- Daycare teacher
- Sickle Cell patient
- children generally present with a flu-like illness and a "slapped cheek" rash. This is known as 5th disease.
- Patients with sick child contacts usually present with a BL rheumatoid like arthritis
- Sickle cell patients can develop red cell aplasia if infected
166
A 55-year-old female patient with shoulder and hip pain and an elevated ESR?
Polymyalgia rheumatica
167
What are the biggest ADR's associated with PDE-5 inhibitors?
hypotension, blue vision discoloration, anterior optic neuropathy, priapism.
168
What are beta blockers contraindicated in patients with known cocaine use?
unopposed alpha agonism leading to cardiac vasoconstriction and ischemia
169
An 80-year old female presenting with chest pain and dyspnea after the death of her husband would like have this defect on her ECHO?
Ballooning of the apical portion of her LV with hyperkinesis of the basal segments
170
What urinary findings would be present in a patient with cystrinuria?
Hexagonal crystals
| (+) urinary cyanide nitroprusside test
171
In early cases of syphilis, the best diagnostic test is?
FTA antibodies
172
In a right ventricular MI, what EKG leads would be abnormal?
There would be ST elevation in II, III, and AVF, but also in pericardial leads V4R-V6R
173
In patients with an IBD diagnosis, when do they need their first follow-up colonoscopy?
8 years post diagnosis
174
Patients with FAP should begin have colonscopies at this age?
10-12 years old
175
What four systems are impacted in Granulomatosis with polyangiitis?
URT: sinusitis, otitis, saddle nose deformity
LRT: lung nodules (granulomas)
Renal: RPGN
Skin: livedo reticularis and leukocytoclastic ulcers
176
The treatment for a severe asthma exacerbation?
SABA, ipatropium, and systemic GC's
177
the aldosterone: Renin ratio in primary aldosteronism would be?
>20:1
178
What Barium study finding is classic for Achlasia?
"Bird's beak" narrowing at the GE junction
179
What diuretic class can be used to treat recurrent kidney stones?
Thiazide diuretics
180
The tetrad of symptoms common in patients with AERD is?
1. Asthma
2. Chronic rhinosinusitis
3. nasal polyps
4. bronchospasm with NSAIDs
181
Chronic epistaxis in a pregnant patient would be concerning for?
pyogenic granuloma
182
In a patient with a confirmed gonorrhea infection, what antibiotics should be used for treatment?
3rd generation cephalosporin for coverage of N. gonorrhea; Azithromycin or Doxycycline for potential Chlymidia infection.
183
Patients with reactive arthritis generally present with?
- Urethritis
- peripheral arthritis
- conjunctivitis
184
Reactive arthritis generally occurs follow what types of infection?
Chylmydia or recent GI infection
185
Post-strep glomerulonephritis presents as?
Peri-orbital swelling, hematuria, and oliguria following a recent strep infection.
186
What serum lab finding is significant in a patient with post-strep GN?
low serum C3
187
What is the most common cause of mitral valve prolapse?
myxomatous degeneration of the mitral leaflets and chordae
188
In a pleural exudate, the LDH of the pleural fluid will be how high compared to serum LDH?
>2/3* normal serum LDH
189
A deep puncture wound infection is most likely to grow what two bacteria?
S. aureus or Pseudemonas
190
What patient population is at the highest risk for severe infection caused by Vibrio Vulnificus? Why?
Patients with hereditary hemochromatosis
| Iron is a catalyst for bacterial growth
191
Where are patients most likely to encounter Vibrio Vulnificus?
A cut in a marine environment leading to a rapidly progressing cellulitis.
192
Uncontrolled diabetics are most likely to have ischemic to this cranial nerve and present with this neurological defect as a result?
CN III
IL ptosis and a "down and out" eye
193
Dermatomyositis presents with?
proximal muscle weakness and Grotton's Sign (rash on hand and upper eye-lids)
194
Lamber-Eaton Syndrome is caused by?
Antibodies to presynaptic VGCC
195
A 30-year-old female presenting with Chronic headaches is found to have papilledema. Her BMI is 42. What is the most likely diagnosis? How could you confirm this diagnosis/
Idiopathic intracranial HTN
| Get a CSF opening pressure. It should be >250 mm Hg
196
Exopthalamos in Grave's Disease is due to?
T-cell activation leads to fibroblast activation leading to tissue expansion around the eyes.
197
A patient presenting with signs and symptoms of diabetes with bronze looking skin should be checked for? What cancer are these patients at an increased risk of acquiring?
Hereditary hemochromatosis
| HCC
198
The best genetic test to determine if a patient is a carrier for thalassemia traits is?
HgB electrophoresis
199
What antibodies are found in patients with systemic sclerosis?
Anti-topoisomerase 1 (anti-scle-70)
| Anticentromere
200
Systemic sclerosis symptoms are due to what underlying pathology?
smooth muscle atrophy and fibrosis
201
The three characteristics of MEN2A syndrome are?
- Medullary Thyroid Cancer
- Pheochromocytoma
- Parathyroid adenoma
202
The three characteristic findings in MEN2B are?
- Medullary thyroid cancer
- Marfinoid habitus/mucosal neuromas
- Pheochromocytoma
203
Patients with Trigeminal neuralgia have pain alone what nerve pathways?
V2 and V3 (not V1)
204
What cardiac exam findings are consistent with aortic stenosis?
Mid systolic murmur with carotid radiation; soft S2; delayed and diminished carotid upstrokes
205
Carcinoid syndrome causes this vitamin deficiency?
Niacin (pellagra)
206
How does the immunologic action of the pneumococcal vaccine differ from preener 13?
The pneumococcal vaccine is a polysaccharide vaccine, so it only provides T-cell dependent B-cell response. The Prevnar 13 vaccine will actually produce a B-cell memory response.
207
Medical management of stable angina from CAD should include what three agents?
- aspirin
- a beta blocker
- prn nitroglycerin
208
The easiest way to differentiate between an ACA stroke and a MCA stroke is?
ACA stroke produces more LE weakness
| MCA stroke produces more UE weakness
209
Female patients on combination analgesic therapy are highly likely to develop what renal complication?
Either papillary necrosis or interstitial nephritis
210
A Giant cell tumor will present with this characteristic x-ray finding?
a "soap bubble" lytic lesion on the epiphysis of long bones
211
A sclerotic bone lesion with a lucent center. Patient complains of pain that is worse at night and mostly relieved by NSAIDs?
Osteoid osteoma
212
B12 deficiency causes an increase in this chemical?
MMA
213
What drug class is useful in facilitating passage of renal stones <1 cm?
alpha blockers
214
The CSF of a patient with gullian barre syndrome will show?
increased protein only
215
What impact does amiodarone have on digoxin?
increases digoxin concentration
216
Patients with common variable immunodeficiency are at an increased risk for?
Recurrent respiratory and GI infections, autoimmune disease, bronchiectasis, GI disorders
217
Phenytoin toxicity presents as?
horizontal nystagmus, cerebellar ataxia, and confusion
218
Systemic Blastomycosis presents with what findings?
Pneumonia, wart like lesions, cutaneous nodules, osteomyelitis, prostatis, meningitis
219
First line treatment for nocardia pneumonia? What about facial abscess with actinomyces?
- Bactrim
| - PCN
220
How can one determine if a patient is suffering from Bell's Palsy or a stroke?
Bell's Palsy will impact the whole facial nerve, so the patients upper face will be impaired. In a stroke, the patients movement to their eye will be spared.
221
The gold standard test for diagnosis HIT is?
serotonin release assay
