Uworld Misc.

Question 1

Arrhythmia ️Assoc. With digitalis toxicity

Answer 1

A-tach with av block

Usually it is rare for both of these to occur at the same time so this is pretty diagnostic

Question 2

Initial Tx for Hypovolemic Hypernatremia and correction rate

Answer 2

Isotonic saline

Can use hypotonic saline once the patient is hemodynamically stable and euvolemic

Correction rate: .5meq/dl/hr without exceeding 12 in 24 hrs
This is done to prevent cerebral edema

Question 3

Hairy cell leukemia

Answer 3

B cell neoplasm associated with BRAF mutations

Clinical: Pancytopenia (infections, anemia, ️Bleeding)
Splenomegaly

Dx: BM biopsy

Tx: chemo

Question 4

Isolated increased ALK phos in a patient with an enlarging cap size

Answer 4

Paget’s disease

Question 5

Vasospastic angina

Answer 5

Hyperreactivity of ️coronary smooth muscle leading to transient myocardial ischemia

Presents in young patients (<50) who are smokers but lack other RFs for heart disease; have recurrent chest discomfort
️Occurs at rest and during sleep; resolves spontaneously

Diagnosis: ST elevations with exertion however, ️coronary angiography shows no CAD

Tx: CCB (preventative), nitroglycerin (acute)

Question 6

Earliest renal abnormality in diabetes patients

Answer 6

Glomerular hyper filtration

ACEIs help prevent this and therefore reduce chances of developing diabetic nephropathy

Question 7

Warm agglutinin AIHA

Answer 7

Caused by drugs (usually penicillins), viral infxns, AI disorders (lupus), and immunodeficiency or Lymphoproliferative states

Ss: Normocytic Anemia with hemolysis
DAT (+) with anti-IgG or anti-C3

Tx: corticosteroids, splenectomy if necessary

Question 8

Serum osmolality calculatio

Answer 8

[2 X (Na)] + [(glucose)/18] + [(BUN)/2.8]

Question 9

Hemodynamic measurements in hypovolemic shock

Answer 9

RA pressure (preload) (pulmonary capillary wedge) ⬇️

Cardiac index (output) ⬇️

SVR (Afterload) ⬆️

MvO2 ⬇️

Question 10

Cavernous sinus thrombosis

Answer 10

Can occur following infections of the facial skin, sinuses, and orbit ➡️ life-threatening CST and intracranial hypertension

Develop low grade fever, headache, and periorbital edema alongside CN II, IV, V, and VI pansies

Tx: Broad spectrum antibiotics and reversal of cerebral herniation if necessary

Question 11

IgA nephropath

Answer 11

Gross ️hematuria following a URI that happens within 5 days of the infxn

⭐️ Common in young adult men ages 20-30

Ss: Recurrent gross ️hematuria

Question 12

Extrarenal manifestations of ADKPD

Answer 12

Cerebral aneurysm

Hepatic or pancreatic cysts

Mitral valve prolapse

Aortic regurgitation

Colonic Diverticulation

Ventral or inguinal hernia

Dx: Abdominal US

Question 13

Cauda equina syndrome

Answer 13

Bilateral and severe radicular pain

Saddle anesthesia

Asymmetric motor weakness

Hyporeflexia

Late onset bowel and bladder dysfunction

Question 14

Conus medullaris syndrome

Answer 14

Sudden onset of severe back pain

Perianal anesthesia

Symmetric motor weakness

Hyperreflexia

Early onset bowel and bladder dysfnxn

Question 15

Tx for tachyarrhythmia with hemodynamic instability

Answer 15

Synchronized cardio aversion

Question 16

Disseminated histoplasmosis

Answer 16

Found in Midwestern US in soil contaminated by bird or bat droppings

S/s: Systemic (fevers, malaise, chills) 
       Weight loss/ cachexia 
       Cough, dyspnea 
       Mucocuatenous ulcers and papules 
       Lymphadenopathy, hepatosplenomegaly 

Dx: Pancytopenia, increased LDH and ferritin
***Urine/serum Histoplasma antigen

CXR: Reticulonodular opacities

Tx: Ampho B in hospital

After improvement, oral itraconazole is continued for 1 year for maintenance therapy

Question 17

Earliest finding in macular degeneration

Answer 17

Distortion of straight lines to where they start to appear wavy in the affected eye

Question 18

ADKPD extrarenal complications

Answer 18

Hepatic cysts (most common)

Valvular heart disease (mitral valve prolapse or aortic regurg.)

Colonic diverticula

Abdominal/inguinal hernia

***INTRACRANIAL BERRY ANEURYSM

Question 19

HIV patient with painful swallowing and substernal burning

Answer 19

HIV esophagitis

Occurs when CD4 <100

Etiologies: Candida, HSV, CMV

Tx: Empiric treatment with oral fluconazole; if they do not respond, THEN GET ENDOSCOPY

Question 20

Pseudotumor cerebri

Answer 20

Idiopathic Intracranial HTN

Patients present with a headache that is pulsatile and awakens the patient at night, transient vision loss, pulsatile tinnitus (whooshing sound in the ears) and diplopia

S/S: Papilledema, peripheral visual field defects, CN VI palsy

RFs: Overweight
Isotretinoin, tetracyclines, hypervitaminosis A

Tx: Stop medications
Weight loss
Acetazolamide for idiopathic cases

Question 21

Hidradenitis suppurativa

Answer 21

Also known as acne inversa

Occurs in intertrigous areas and is due to a chronic inflammatory occlusion of folliculopilosebaceous units preventing keratinocytes from shedding epithelium

RFs: DM, smoking, obesity, skin friction

S/s: Painful, solitary, and inflamed nodules that can progress to abscesses that open with purulent or serosanguineous drainage

Can lead to sinus tracts, comedones, and scarring with lymphedema

Question 22

Test for lactose intolerance

Answer 22

Lactose hydrogen breath test

-Increased breath hydrogen level after ingesting lactose =» POSITIVE

Question 23

Test to always include in Hep B testing

Answer 23

Anti-HepBc

This is the one that is positive during the window period

Question 24

Patient with sudden visual loss and S/s suspicious for GCA

Answer 24

Give High dose steroids

Wait for the temporal artery biopsy

Question 25

Toxic Shock Syndromew

Answer 25

Patient who has had a tampon in OR had a recent nasal packing Followed by: ``` Rash Fever Hypotension Diarrhea Thrombocytopenia Skin desquamation including palms and soles ``` ``` And 3 of the following systems: GI involvement (vomiting/diarrhea) Muscular (myalgia, elevated CK) Renal (Elevated BUN/Creatinine) Heme (Thrombocytopenia) Liver (Elevated transaminases) CNS (altered mentation without focal signs) ``` Tx: Fluids, broad-spectrum anti-Staphylococcal abs

Question 26

Trichinellosis

Answer 26

Patient eats undercooked meat (usually pork) and develops acute GI illness; corresponds to larvae invading SI and developing into worms 2-4 weeks later: Larvae encyst into muscle and cause myositis, subungual hemorrhages, periorbital edema, and eosinophilia Classic triad: Periorbital edema + myositis + eosinophilia

Question 27

Prevention of calcium kidney stones

Answer 27

Decreased sodium intake =>> Will enhance calcium excretion

Question 28

NMS tentrad

Answer 28

MSC Rigidity Fever Autonomic dysregulation (tachycardia, hypertension, tachypnea)

Question 29

Tx of uric acid stones

Answer 29

Hydration Alkalinization of the urine (Potassium citrate usually) Low-purine diet If absolutely necessary: Allopurinol (but only helps if there's hyperuricemia)

Question 30

Initial therapy for aortic dissection

Answer 30

IV BBs (labetalol, propanolol, esmolol) Decrease the HR, contractility, and SBP

Question 31

Wedge shaped infarct on chest CT scan

Answer 31

Think PE

Question 32

Periinfarction ventricular arrhythmias

Answer 32

Phase 1a - Acute ischemia causing heterogeneity of conduction with areas showing marked slowing and delayed activation Phase 1b - Occur 10-60 minutes following infarction and represent abnormal automaticity

Question 33

Primary polydipsia

Answer 33

Patients present with hyponatremia, decreased serum osmolality, and decreased urine osmolality and a normal BP Common in pts. with psychiatric conditions

Question 34

Giant cell tumor

Answer 34

Eccentric and lytic area of epiphyseal bone (soap bubble) Benigh and locally aggressive skeletal neoplasm seen in YOUNG ADULTS S/s: Pain, swelling, decreased ROM, pathologic fracture Tx: Surgery

Question 35

Arsenic poisoning

Answer 35

Binds to sulfhydryl groups and interferes with enzyme activity regulating cellular respiration RFs: Pesticides, contaminated well water, pressure-treated wood (antiquing) S/s: Stocking-glove neuropathy Hyporeflexia Distal weakness Hyperpigmentation of the skin Hyperkeratosis of the soles and palms Horizontal striation of the fingernails (DIAGNOSTIC) Pancytopenia Tx: Dimercaprol

Question 36

Patient with an increased T4 but normal TSH

Answer 36

Suggestive of a euthyroid state; look for possible causes of increased TBG such as estrogens, hepatic dysfnxn, or tamoxifen

Question 37

Isolated systolic hypertension

Answer 37

Systolic pressure >140 with a diastolic of <90 Path: Increased stiffness of the aorta and arterial walls in elderly patients reduces the abilities of the arteries to dampen systolic pressure Tx: Lifestyle modifications and same pharmacologic therapy

Question 38

Thyroid lymphoma

Answer 38

Presents as a rapidly enlarging, firm goiter assoc. with upper airway compressive symptoms; can have systemic B-sx. * **Arises w/ preexisting Hashimoto's thyroidits - Suspect if patient has a positve TPO-antibody test *When patients raise their arms, the mass will compress the subclavian and right internal jugular veins between the clavicle causing JVD Dx: Core biopsy

Question 39

Pemberton sign

Answer 39

Patient raises their arms up and get JVD due to compression of a lymphoma against the left subclavian and right internal jugular veins

Question 40

Shy-Drager Syndrome

Answer 40

"Multiple System Atrophy" 1. Parkinsonism 2. Autonomic dysfnxn (postural hypotension, abnormal sweating, loss of bowel and bladder control, impotence, decreased salivation) 3. Widespread neurologic signs (cerebellar, LMN) **Consider when a Parkinsonian patient has signs of autonomic dysfnxn Tx: Salt supplementation, fludrocortisone, a-agonists

Question 41

Painless thyroiditis

Answer 41

Patient has increased T4 and decreased TSH May have positive anti-TPO Tx: BB (just to control symptoms of hyperthyroid phase)

Question 42

Clubbing pathology

Answer 42

Megakaryocytes become entrapped in distal fingertips after bypassing the lungs (due to some pathology) and released PDGF and VEGF =>>CT hypertrophy and capillary growth

Question 43

Scleroderma renal crisis

Answer 43

Increased vascular permeability, activation of the coag cascade, and increased renin secretion =>> Malignant HTN, RF (increased labs), and microangiopathic hemolytic anemia/DIC Typically happens within 5 years of diagnosis

Question 44

Paroxysmal nocturnal hemoglobinuria

Answer 44

AI hemolytic disorder characterized by intravascular and extravascular hemolysis and hemoglobinuria Path: Lack of glycosylphophatidylinositol anchor that connects proteins CD55 and CD59 to RBC surface which normally inhibit complement activation Clinical: Hemolysis, cytopenias, hypercoagulability Dx: Flow cytometry to detect CD55 and CD59 *Sx. usually appear in pts. 40s

Question 45

Malignant (necrotizing) otitis externa

Answer 45

Severe infxn of the external auditory canal and base of the skull usually caused by Pseud. Most pts. are old, have poorly controlled DM, or immunosuppressed S/s: Unrelenting ear pain worse at night, purulent drainage, sense of fullness, conductive hearing loss, granulation tissue and edematous external canal on otoscopy Tx: IV ciprofloxacin

Question 46

Middle mediastinal mass

Answer 46

Suspect bronchogenic cysts

Question 47

Anterior mediastinal mass

Answer 47

Suspect thymoma

Question 48

Patient with pain, itching, red streaks on their left arm that are palpable

Answer 48

Suspect Trousseau's Syndrome Hypercoagulable disorder associated with occult malignancy (usually pancreatic; can also be lung, prostate, stomach, colon) Path: Tumor releases mucins that react with platelets to form microthrombi ***Patient's with this should get a CT to find malignancy

Question 49

Patient who received topical anesthetic and becomes hypoxic

Answer 49

Suspect methemoglobinemia; topic anesthetics cause the iron component of Hgb to be oxidized Patients will have O2 sats that appear normal BUT this is because the O2 sat only measures the PaO2 S/s: Headache, lethargy, AMS, seizure, respiratory depression Tx: Methylene blue

Question 50

RFs for acute urinary retention

Answer 50

Male >80 Hx of BPH Hx of neurologic disease Recent surgery Anticholinergics, opioids Tx: Foley cath, urinalysis

Question 51

Toxic megacolon

Answer 51

Caused by UC or C.diff infxn S/s: Fever, tachycardia, hypotension, BLOODY diarrhea, abdominal distension, Radio: Lead pipe Tx: Supportive, Steroids if UC, surgery if unresponsive

Question 52

Management of suspected esophageal perforation

Answer 52

Water soluble contrast esophogram Suspect if recent endoscopy, esophagitis, ulcer, or heavy retching

Question 53

Histoplasma capsulatum

Answer 53

Found in the Ohio and Mississippi river valleys in contaminated BAT DROPPINGS ***SUSPECT IN PTS WHO CAVE DIVE OR HAVE CHICKENS S/s: Fever, chills, myalgias, DRY COUGH, HILAR LYMPHADENOPATHY Dx: Histoplasma antigen urine testing; tissue diagnosis will reveal granulomas with budding yeasts

Question 54

Botulism

Answer 54

Can be obtained from canned foods OR aged seafood ("cured") S/s: Blurred vision, diplopia, facial weakness, dysarthria, dysphagia, progresses to =>>> Descending muscle weakness with possible diaphragmatic failure Dx: Toxin in blood Tx: Equine serum antitoxin (horse antitoxin)

Question 55

First-time seizure in an adult

Answer 55

Run: BMP, CBC, glucose, Ca2+, Mg2+, Renal and hepatic fnxn tests AND DRUG SCREEN -Possibly even consider an EKG

Question 56

Patient with history of treated Hodgkin's Lymphoma presenting with cough, hemoptysis, chest pain, and dyspnea

Answer 56

Likely a secondary malignancy developed after chemo or radiation therapy tx

Question 57

BB OD

Answer 57

Bradycardia, AV block, hypotension, diffuse wheezing*** Tx: Secure airway, IV fluid boluses, IV atropine, IV glucagon Consider IV calcium, EPI

Question 58

K+ sparing diuretics

Answer 58

Spironolactone, amiloride, triamterene

Question 59

Associated neoplasms with Lynch Syndrome

Answer 59

Colorectal cancer Endometrial cancer (prophylactic hysterectomy after childbearing is complete is recommendation) Ovarian cancer

Question 60

Associated cancers with FAP

Answer 60

Colorectal cancer Desmoids and osteomas Brain tumors

Question 61

Associated cancers with vHL Syndrome

Answer 61

Hemangioblastomas Clear cell renal carcinoma Pheochromocytoma

Question 62

Vertebral osteomyelitis

Answer 62

Usually chronic and insidious Will have tenderness to percussion over affected vertebrae ***Leukocytes can be normal as well as temp ***Usually will still have increased Platelets and ESR Tx: Long term IV abs

Question 63

Lead toxicity (3 manifestations)

Answer 63

1. GI- abdominal pain, constipation 2. Neuropsych- Forgetfulness, neuropathy, weakness in a stocking-glove distribution 3. Hematologic- Microcytic anemia with basophilic stipling * Also see HYPERURICEMIA

Question 64

Drugs to start on RA patients

Answer 64

NSAIDS and MTX (or sulfasalazine, hydroxychloroquine, azathioprine) ***PTS NEED MTX to prevent progression of diseae -Test them for Hep B, C, TB, and pregnancy

Question 65

Dermatofibroma

Answer 65

Firm, small, hyperpigmented nodules that have a "dimple" when pinched Typically follow a bug bite or minor trauma Tx not required

Question 66

MCC of pneumonia in IV drug abusers

Answer 66

Staph aureus

Question 67

Septic embolism

Answer 67

Occur in pts with tricuspid endocarditis (think IV drug abusers) Imaging may show pulmonary septic emboli seen as abscesses, infarction, or cavities typically in the lung periphery

Question 68

Extraglandular features of Sjogrens

Answer 68

Raynaud phenomenon Arthralgia Interstitial lung disease

Question 69

Idiopathic Intracranial HTN

Answer 69

Classic pt is an overweight woman of childbearing age possibly on OCPs, tetracyclines, or Vitamin A -Pts. may have an empty sella, although, this is not diagnostic Pts have an elevated opening pressure on spinal tap Tx: Stop offending meds; weight loss and acetazolamide for idiopathic cases

Question 70

Ichthyosis vulgaris

Answer 70

Chronic, inherited skin disorder characterized by diffuse dermal scaling caused by mutations in the filaggrin gene Skin appears as "plated" much like reptile scales *Symptoms often worse in the winter Tx: Lotion, coal tar, topical retinoids

Question 71

Work up for suspected Zenker's

Answer 71

Contrast esophagram

Question 72

Chronic prostatitis

Answer 72

Often a diagnosis of exclusion; presents as pain the perineum, pelvis, or genitalia with irritative voiding symptoms -Urine is sterile; may have increased WBCs Tx: Tamsulosin (a-blocker), antibiotics, finasteride

Question 73

Tx for cutaneous larva migrans

Answer 73

Ivermectin (antihelminthic)

Question 74

Patient who is vomiting up blood and you think is a risk for aspiration

Answer 74

INTUBATE; this will block off her airway and not allow her to aspirate while you get an upper endoscopy

Question 75

Ludwig angina

Answer 75

Cellulitis of the submandibular space arising from a dental infxn; infxn is usually polymicrobial and spreads deep into the teeth roots S/s: Fever, chills, malaise, local compressive symptoms such as drooling, mouth pain, muffled voice, and potential airway compromise Tx: IV abxx (Bactrim, clindamycin); possible removal of tooth

Question 76

Panendoscopy

Answer 76

Esophagoscopy + bronchoscopy + laryngoscopy Also called a triple endoscopy

Question 77

Amiodarone ADRs

Answer 77

Cardiac: Bradycardia, heart block, QT PROLONGATION Pulm: Interstitial pneumonitis (infiltrates on CXR) GI: Elevated transaminases Ocular: Corneal microdeposits that are blue-gray; optic neuropathy Derm: Blue-gray skin discoloration Neuro: Peripheral neuropathy

Question 78

Pt with signs of inferior MI and symptoms get worse with sublingual nitrogylcerin

Answer 78

Suspect RV MI Give pt. IV bolus and avoid venodilation; otherwise, treat like normal MI

Question 79

Patients who cannot produce sputum for a sample should undergo what

Answer 79

BAL

Question 80

Patient who is presenting with signs of heart failure after placement of a pacemaker

Answer 80

Suspect tricuspid regurg. (or some other right heart problem) -Pacemakers pass thru the SVC into the RA

Question 81

Pneumococcal vaccines and their differences

Answer 81

PPSV23: capsular materials from 23 serotypes that induces a T-cell INDEPENDENT B-cell response -Recommended to adults >65 and people <65 with predisposing conditions (IC, lung disease, cirrhosis, DM) PCV13: Capsular polysaccharides that induces a T-cell dependent B-cell response -Recommended for infants and children

Question 82

EEG in cVJD

Answer 82

Sharp, triphasic, and synchronous discharges Pts. present with myoclonus and rapidly progressive dementia

Question 83

Carcinoid syndrome

Answer 83

Neuroendocrine tumors found in the distal SI, colon, and lung with metastasis to the liver; only become symptomatic with metastasis because histamine, serotonin, and VIP are inactivated by the liver S/s: Flushing, cyanosis Diarrhea, cramping RIGHT SIDED HEART LESIONS (insufficient tricuspid) Bronchospasm Niacin deficiency (dermatitis, diarrhea, dementia) Dx: Elevated 24 hour urine 5-HIAA; CT: echo Tx: Octreotide and then surgery

Question 84

Baker's Cyst

Answer 84

Occurs due to extrusion of synovial fluid from the knee into the gastrocnemius or semimembranosus bursa thru a communication typically from chronic inflammation (osteoarthritis) ***CAN RUPTURE; following strenuous exercise, pt. will present with tenderness and swelling of the calf resembling a DVT and will show ecchymosis distal to the medial malleolus US will r/o DVT

Question 85

Psoriatic arthritis

Answer 85

Presents as morning stiffness and swelling of the DIP joints; may also have dactylitis (SAUSAGE DIGITS) and nail involvement Nails may be pitting showing onycholysis (Separation of the nail bed)

Question 86

Low risk cardiac chest pain patients

Answer 86

Men <40 Women <50 with atypical chest pain and no RFs If patient is low-risk and has a normal EKG, do not do further work up on chest pain

Question 87

Hypokalemia

Answer 87

S/s: Weakness, fatigue, muscle cramps, flaccid paralysis, hyporeflexia, rhabdomyolysis, arrhthmias EKG =>> Broad T-waves, U waves, ST depression, and PVCs

Question 88

Putamen hemorrhage

Answer 88

Sudden contralateral hemiparesis and hemianesthesia with conjugate gaze deviation towards the side of the lesion *Internal capsule containing the corticospinal and somatosensory fibers in the PLIC is damaged

Question 89

Noninvasive Positive Pressure Ventilation

Answer 89

Ventilator support delivered via facemask allowing for CPAP or BiPAP Decreases the work of breathing, improves alveolar ventilation Indications: COPD exacerbation not responding to normal tx., cardiogenic pulmonary edema, Acute respiratory failure CIs: ARDS, severe acidosis, cardiac arrest, encephalopathy, GI bleed, agitated, high aspiration risk

Question 90

MC missed lesion on colonoscopy

Answer 90

Angiodysplasia Think this if a patient has painless GI bleed with a recent negative colonoscopy

Question 91

Lambert-Eaton Syndrome

Answer 91

S/s: Proximal muscle weakness, autonomic dysfnxn (Dry mouth), CN involvement (ptosis), diminished DTRs

Question 92

PE Management

Answer 92

Step 1: Supportive care with O2 and fluids Step 2: Assess CIs for anticoagulation (bleeding, hemorrhagic stroke) Step 3: Wells Criteria

Question 93

Wells Criteria for PE

Answer 93

+3 = Signs of DVT, alternate diagnosis less likely than PE +1.5 = Previous PE or DVT, HR >100, Recent surgery or immobilization +1 = Hemoptysis, cancer >4= PE likely; Heparin BEFORE further testing

Question 94

Causes of constrictive pericarditis

Answer 94

Tuberculosis (in endemic areas) Cardiac surgery Radiation therapy Viral Idiopathic

Question 95

Constrictive pericarditis

Answer 95

``` S/s: Fatigue Dyspnea Peripheral edema, ascites Increased JVP Pulsus paradoxus, Kussmaul's sign ``` Dx: EKG shows low-voltage QRS Imaging shows pericardial thickening with possible calcification JVP tracing shows prominent x and y descents

Question 96

Sensorimotor polyneuropathy and differences in symptoms

Answer 96

Small fiber injury =>> Pain, paresthesias, allodynia ("Positive sx.") Large fiber injury =>> Numbness, loss of proprioception and vibration sense, decreased DTRs ("Negative sx.)

Question 97

Tx for testicular tumor

Answer 97

Radical orchiectomy FOLLOWED by platinum based chemo if necessary

Question 98

Mitral stenosis

Answer 98

Presents as dyspnea, orthopnea, and hemoptysis May see afib, thromboembolisms, and voice hoarseness from recurrent laryngeal nerve compression after LAE PE: Mitral facies (pink-purple patches on cheeks), LOUD S1, opening snap, mid-diastolic rumble Dx: CXR shows pulmonary blood flow redistribution to upper lobes EKG shos "p mitrale" (notched p wabes), RVH Echo shows MV thickening with possible calcification, decreased mobility

Question 99

Patient presenting with acute limb ischemia following an MI

Answer 99

Perform an echo; need to identify if there is a thrombus along with immediate anticoagulation

Question 100

Pts. with candida esophagitis will also have what

Answer 100

Oral thrush

Question 101

Criteria for LTOT

Answer 101

Pulse ox <88% on RA Resting PaO2 <55 PaO2 <59 or SaO2<89% in patients with cor pulmonale, RHF, or Hcrt >55% -O2 will greatly enhance these patients' survival

Question 102

Cerebellar degeneration

Answer 102

Gait probs Truncal ataxia Nystagmus Intention tremor Dysmetria Dysdiadochokinesia

Question 103

First tx of PACs

Answer 103

Stop smoking, caffeine, alcohol, and stress

Question 104

Acute interstitial nephritis

Answer 104

Maculopapular rash, fever, arthralgia following an acute drug exposure Labs: AKI, pyuria, hematuria, eosinophilia, urinary eosinophils Tx: Discontinue drug, steroids if unstable

Question 105

Diseases leading to secondary pseudogout

Answer 105

Hyperparathyroidism Hemochromatosis Hypothyroidism

Question 106

Renal tubular acidosis

Answer 106

Patients present with non-anion gap metabolic acidosis in t he presence of preserved kidney fnxn; patients may be hyperkalemic if the problem is in the collecting tubule Seen in patients with poorly controlled diabetes due to hyporeninemic hypoaldosteronism from longterm damage to the juxtaglomerular apparatus

Question 107

Causes of normal anion gap metabolic acidosis

Answer 107

Diarrhea Fistulas Carbonic anhydrase inhibitors RTA Iatrogenic

Question 108

Patient's with a likely PE

Answer 108

GET A CTA; FUCK THE DDIMER

Question 109

Bronchogenic carcinoma

Answer 109

Common with asbestos exposure; may see pleural plaques alongside other typical lung cancer signs

Question 110

Intracranial HTN

Answer 110

Patients present with a headache worse at night, N/V, and AMS changes Can also have focal neurologic symptoms such as vision change, unsteady gait, and seizure Symptoms worsen with maneuvers that increase intracranial pressure such as leaning forward, Valsalva

Question 111

Myasthenic crisis

Answer 111

Patient presents as a 30-40 year old woman with generalized and oropharyngeal weakness alongside respiratory insufficiency Can be brought on by infxn, surgery, pregnancy, childbirth, aminoglycosides, FQNs, BBs Monitor in ICU; intubate if necessary

Question 112

Bath salts intoxication

Answer 112

Amphetamines S/s: Severe agitation, combativeness, psychosis, delirium, myoclonus, increased BP and HR ***HAS A VERY LONG DURATION; can last from days to weeks

Question 113

Pt who presents as an MI with a new onset of a holosystolic murmur at the apex

Answer 113

MI with papillary muscle displacement =>> acute mitral regurg.

Question 114

Pramiprexole

Answer 114

Dopamine agonist used for Restless Leg Syndrome If patients have comorbid insomnia, chronic pain, or anxiety, can try Gabapentin insetead (Ca2+ channel ligand)

Question 115

Interstitial cystitis

Answer 115

"Painful bladder syndrome" Patients present with bladder pain when it is full and relief with voiding; patient's have increased urinary frequency and urgency along with dyspareunia and pain on pelvic exam Dx: Normal urinalysis, pelvic pain with other causes ruled out Tx: Avoiding triggers, amitriptyline, NSAIDs

Question 116

Differentiating ALF from acute hepatitis

Answer 116

Presence of hepatic encephalopathy

Question 117

Uncommon complication of mono

Answer 117

AI hemolytic anemia along with thrombocytopenia

Question 118

Hydroxychloroquine ADRs

Answer 118

Retinopathy Pts. should have annual eye exam while on this drug

Question 119

Prerenal AKI

Answer 119

Causes: Volume depletion, displace intravascular fluid (sepsis, pancreatitis), renal artery stenosis, afferent arteriole vasoconstriction (NSAIDs), S/s: Increased serum creatinine, decreased UOP, BUN >20:1, FeNa <1 Tx: Fluid replacement

Question 120

Tx of afib in stable pts.

Answer 120

BBs, diltiazem, digoxin to control rate

Question 121

Acute erosive gastropathy

Answer 121

Development of severe hemorrhagic lesions after the exposure of the gastric mucosa to agents that reduce blood flow; decreased blood flow and mucosal injury allow acids and proteases to injure the stomach and vasculature ***Think this if a patient develops hematemesis and epigastric pain after ingesting Aspirin and Cocaine

Question 122

Acetaminophen intoxication protocol

Answer 122

<4 hours since administration? =>> Administer activated charcoal while obtaining acetaminophen levels N-acetylcysteine administered based on the nomogram

Question 123

Hyperthyroidism

Answer 123

S/s: Anxiety, insomnia, palpitations, heat intolerance, increased perspiration, weight loss, goiter PE: HTN, tremors, hyperreflexia, PROXIMAL MUSCLE WEAKNESS, lid lag, A-fib Chronic findings can include muscle atrophy

Question 124

Patient with bone lesion and recurrent infxn

Answer 124

MM

Question 125

Alcoholic hepatitis

Answer 125

``` S/s: Jaundice, anorexia, fever RUQ pain Abdominal distension Proximal muscle weakness (due to muscle wasting) Possible hepatic encephalopathy ``` ``` Labs: AST:ALT >2 Increased GGT, Br, and INR Leukocytosis Fatty liver Increased ferritin ```

Question 126

Ferritin as an APR

Answer 126

Increased

Question 127

Membranoproliferative glomerulonephritis, Type 2

Answer 127

Caused by IgG abs against C3 convertase causing persistent complement activation and kidney damage Antibodies are called "C3 convertase" EM: Dense deposits with the glomerular basement membrane

Question 128

Mixed cryoglobulinemia

Answer 128

Presents as palpable purpura, proteinuria, and hematuria Other nonspecific symptoms: Arthralgia, hepatosplenomegaly, hypocomplementemia Confirm with test for circulating cryoglobulins ***F/U: Test for HCV as these two usually COEXIST

Question 129

Wallenburg Syndrome

Answer 129

Lateral medullary infarction possibly due to intracranial vertebral artery occlusion Vestibulocerebellar: Vertigo, falling to side of lesion, diplopia, nystagmus, ipsilateral limb ataxia Sensory: Loss of pain and temp. in ipsilateral face and contralateral body Autonomic: Ipsilateral Horner's, hiccups, lack of autonomic respiration Ipsilateral bulbar muscle weakness (dysphagia, hoarseness, aspiration)

Question 130

First step in managing liver cirrhosis

Answer 130

Screening endoscopy to identify varices and determine risk

Question 131

Management of cirrhosis

Answer 131

Variceal hemorrhage: BB or ligation (ligation preferred if varices are large) Ascites: Na restriction, diuretics, abstinence Encephalopathy: ID underlying cause, lactulose

Question 132

Deficiency associated with carcinoid syndrome

Answer 132

Niacin Increased tryptophan =>> serotonin conversion; less niacin and tryptophan

Question 133

Disseminated MAC

Answer 133

Presents with fever, cough, abdominal pain, diarrhea, night sweats, weight loss, and SPLENOMEGALY AND ELEVATED AP -indicates hepatosplenic involvement) Tx: Azithromycin

Question 134

TTP

Answer 134

ADAMTS13 deficiency leads to formation of small vessel thrombi due to long chains of vWF accumulating on the endothelial wall Dx: Hemolytic anemia, thrombocytopenia, possible renal failure, neurologic change, and fever Tx: Plasma exchange

Question 135

Sporotrichosis

Answer 135

Infections occur in gardeners via direct inoculation; a papuler forms at the site that ulcerates and drains an odorless and nonpurulent fluid =>>Later, several proximal lesions develop along the line of lymphatic drainage Tx: Oral itraconazole

Question 136

Management of stones <1cm

Answer 136

Hydration Analgesics a-blockers (Tamsulosin)

Question 137

MCCo acute epididymitis in pts. >35 years

Answer 137

E. coli

Question 138

ADRs of cyclosporine

Answer 138

Nephrotoxicity- azotemia, hyperuricemia, hyperkalemia HTN- can tx w/ CCBs Neurotoxicity- Headache, tremors, visual probs Glucose intolerance Infxn Malignancy- SCC *****Gingival hypertrophy *****Hirsutism GI probs

Question 139

Autoimmune adrenalitis

Answer 139

Presents with symptoms of primary adrenal insufficiency (hyperpigmentation, hyponatremia, hyperkalemia, fatigue, weakness, GI probs) Can occur as an isolated disorder or in association with other AI syndromes

Question 140

S3 sound

Answer 140

ken-tuc-KY Typically a sign of Left Ventricular failure

Question 141

Senile purpura

Answer 141

Ecchymosis, skin fragility, and consistent bruising due to loss of elastic fibers in the perivascular CT Minor abrasions can rupture superficial vessels and lead to large ecchymoses -Labs normally appear normal

Question 142

Best test to diagnose brain tumors

Answer 142

MRI with gadolinium

Question 143

Double duct sign

Answer 143

CT finding with a carcinoma of the head of the pancreas in which we see compression of the pancreatic and common bile duct =>>Intra and extrahepatic biliary duct dilatation with a nontender, distended gallbladder

Question 144

Complications of primary biliary cholangitis

Answer 144

Xanthelasmas (due to hyperlipidemia) Malabsorption (fat-soluble deficiencies) Hepatocellular carcinoma Osteoporosis, osteomalacia (not due to deficiencies; Ca and Vit D can be normal so pathophysiology is unknown)

Question 145

Tx of bacterial endocoarditis w/ acute stroke

Answer 145

Just IV fluids and antibiotics; do not anticoagulate

Question 146

Leukomoid Reaction

Answer 146

Reactive process to acute infxn LAP score: High (>20) PMN precursors: Late phases Basophilia: Not present

Question 147

Exam for suspected chronic pancreatitis

Answer 147

Abdominal CT

Question 148

Raynaud's Phenomenon workup

Answer 148

CBC Metabolic panel Urinalysis ANA, RF -If positive for ANA, get antitopoisomerase-1 abs for systemic sclerosis ESR and C3, C4 levels

Question 149

Zinc deficiency

Answer 149

Alopecia Pustular skin rash (perioral region and extremities) Hypogonadism Impaired wound healing Impaired taste Immune dysfnxn Causes: Malabsorption, bowel resection, poor intake, paraenteral nutrition

Question 150

Patient who has just gotten out of ophthalmic surgery and presents with a fever, swollen eyelid, edematous conjunctiva, and exudates in the anterior chamber

Answer 150

Postoperative endophthalmitis Occurs within six weeks of surgery and is due to an infection of the eye; viterous humor can be sent for gram stain and culture Tx: Intravitreal antibiotics

Question 151

MCC of gross painless lower intestinal bleeding in adults

Answer 151

Diverticulosis

Question 152

Hyponatremic patients who are presenting with severe neurologic manifestations

Answer 152

Treat with hypertonic saline; still correct at <8meq/L for first 24 hours to prevent osmotic demyelination syndrome

Question 153

Hallmark of prolonged and recurrent seizures

Answer 153

Cortical laminar necrosis; MRI shows cortical hyperintensity suggestive of infarction

Question 154

Tumor lysis Syndrome

Answer 154

Patients present with N/V, diarrhea, muscle cramps, seizures, tetany, CARDIAC ARRHYTHMIA, and AKI HAllmarks: Hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia Tx: IV fluids (flush kidneys), allopurinol

Question 155

Mechanism of ACEI dry cough

Answer 155

Inhibits the metabolism of kinins and substance P =>> Kinins irritate bronchi with increased prostaglandin production Also, inhibition of ACE activates the arachidonic acid pathway =>>Increased thromboxane =>> Bronchoconstriction

Question 156

Clinical features of multiple sclerosis

Answer 156

Optic neuritis Internuclear opthalmoplegia Fatigue Heat sensitivity Numbness, parasthesia Paraparesis, spasticity Bowel, bladder dysfnxn MRI: Lesions disseminated in space and time (usually found in periventricular, juxtacortical, intratentorial, or spinal cord areas) CSF: Oligoclonal IgG bands

Question 157

CSF in MS pts

Answer 157

Oligoclonal bands

Question 158

S4 Sound

Answer 158

TEN-nes-see Indicates a stiff, left ventricle which occurs in the standing of longstanding hypertension or restrictive cardiomyopathy Sound is made by blood striking a stiffened left ventricle

Question 159

Mechanical Complication of acute MI timeline

Answer 159

Acute: RV failure (Kussmaul's sign) 3-5 days: Papillary muscle rupture (severe pulmonary edema, new holosystolic murmur) 3-5 days: Interventricular septum rupture (shock, chest pain, new holosystolic murmur, biventricular failure) 5 days-2 weeks: Free wall rupture (shock, chest pain, JVD, distant heart sounds)

Question 160

Disseminated gonoccocal infxn

Answer 160

Presents as a purulent monoarthritis OR Triad: Tenosynovitis, dermatitis (erythematous papules/pustules), and asymmetric MIGRATORY POLYARTHRALGIAS Dx: Blood cultures can be negative, synovial fluids show PMNs Tx: IV ceftriaxone, empiric azithromycin/doxy, joint drainage for purulent arthritis

Question 161

Reactive arthritis

Answer 161

Cant' see, can't pee, can't climb a tree Look for STD history Tx: NSAIDs

Question 162

Patient who has arthritis of the hands, wrists, and knees with joint effusion BUT also has kids

Answer 162

THINK ABOUT PARVOVIRUS B19

Question 163

MCC of primary adrenal insufficiency

Answer 163

Autoimmune adrenalitis

Question 164

Pulmonary empyema

Answer 164

Patients have frank pus or bacteria in a cavitary space; usually an IC pt. Pleural fluid: ph<7.2, decreased glucose, WBC >50,000 Tx: Abs and drainage

Question 165

Anserine burisitis

Answer 165

"Pes anserinus" Localized pain and tenderness over the anteromedial tibia distal to the joint line Patients are usually fat and obese diabetic females Tx: NSAIDs, symptoms usually go away in a few weeks

Question 166

Amyloidosis

Answer 166

Can be primary or secondary to chronic inflammation (RA, TB, osteomyelitis, IBD, malignancy, vasculitis) S/s: Proteinuria, nephrotic syndrome Restrictive cardiomyopathy (heart is concentrically thickened) Hepatomegaly Peripheral neuropathy/Autonomic neuropathy Organ enlargement (macroglossia) Waxy, thickened skin that easily bruises**

Question 167

Extrahepatic manifestations of chronic HCV

Answer 167

Mixed cryoglobulinemia syndrome Membranoproliferative glomerulonephritis Porphyria Cutanea Tarda (photosensitive vesicles and bullae erupt on skin with sun exposure, lesions scar forming hyperpigmented areas) ****Always order HCV testing if a pt. has this Lichen planus

Question 168

Highest RF for stroke

Answer 168

HTN

Question 169

Patients with steatorrhea may present with what deficiencies

Answer 169

Fat soluble vitamin deficiencies Vit D= Low Ca2+, Low PO4, and increased PTH

Question 170

Best tests for Cushing Syndrome

Answer 170

Low-dose dexamethasone suppression test

Question 171

RBC transfusion thresholds

Answer 171

<7 = always <8= Cardiac sx., oncology patients in treatment, heart failure 8-10= Symptomatic anemia, ongoing bleeding, ACS, noncardiac surgery

Question 172

Complication of aortic dissection

Answer 172

Cardiac tamponade

Question 173

Acromegaly effects

Answer 173

Local tumor effect: Visual field defects, headache, cranial nerve defects MSK: Gigantism, protruding jaw, arthralgia, myopathy, skin tags, carpal tunnel syndrome Cardiac: Concentric hypertrophy, HTN, mitral/aortic regurg, Pulm/GI: OSA, colon polyps, diverticulosis Enlarge organs = Tongue, salivary glands, liver, spleen Endocrine: Galactorrhea, decreased libido, DM, hyperparathyroidism, hypertriglyceridemia **Effects are due to increased IGF-1

Question 174

Patient with periodic headaches and HTN who presents with severe HTN after anesthetic admin.

Answer 174

Suspect pheochromocytoma BBs can also cause these exacerbations

Question 175

Epidermal Inclusion Cyst

Answer 175

Dome-shaped, firm, freely movable cyst or nodule with a central punctum (pore-like opening) Represents epidermis lodging in the dermis; can intermittently produce discharge; only needs tx. if signs of infxn develop

Question 176

Characteristics of uncomplicated parapneumonic effusion

Answer 176

Caused by movement of fluid from pneumonia into visceral pleura ``` Fluid analysis: ph>7.2 Decreased-normal glucose WBC <50,000 Gram stain (-) EXUDATIVE ``` -Differs from empyema because no bacteria are present

Question 177

Tx for acute sciatica

Answer 177

1. Trial of NSAIDs 2. Muscle relaxant/short-term opioid * Don't need MRI unless patient has progressive deficits, cauda equina, or signs of epidural abscess (IV drug use, fever)

Question 178

Aspirin allergy

Answer 178

ALSO GOES FOR NSAIDs

Question 179

Globus sensation

Answer 179

Sensation of foreign body in the throat; occurs when swallowing saliva and is assoc. w/ anxiety Patients do not have pain, dysphagia, or dysphonia; just the sensation of something in their throat

Question 180

Crescendo-decrescendo murmur along the left sternal border with no radiation

Answer 180

HCOM; indicates the presence of interventricular septal hypertrophy S/s: Syncope, dyspnea, chest pain

Question 181

Spinal cord compression management

Answer 181

Immediate IV glucocorticoids (decreased vasogenic edema caused by an obstructed epidural venous plexus) Emergency MRI Neurosx. consult

Question 182

Patients with steatorrhea may present with what deficiencies

Answer 182

Fat soluble vitamin deficiencies Vit D= Low Ca2+, Low PO4, and increased PTH

Question 183

Best tests for Cushing Syndrome

Answer 183

Low-dose dexamethasone suppression test

Question 184

RBC transfusion thresholds

Answer 184

<7 = always <8= Cardiac sx., oncology patients in treatment, heart failure 8-10= Symptomatic anemia, ongoing bleeding, ACS, noncardiac surgery

Question 185

Complication of aortic dissection

Answer 185

Cardiac tamponade

Question 186

Acromegaly effects

Answer 186

Local tumor effect: Visual field defects, headache, cranial nerve defects MSK: Gigantism, protruding jaw, arthralgia, myopathy, skin tags, carpal tunnel syndrome Cardiac: Concentric hypertrophy, HTN, mitral/aortic regurg, Pulm/GI: OSA, colon polyps, diverticulosis Enlarge organs = Tongue, salivary glands, liver, spleen Endocrine: Galactorrhea, decreased libido, DM, hyperparathyroidism, hypertriglyceridemia **Effects are due to increased IGF-1

Question 187

Patient with periodic headaches and HTN who presents with severe HTN after anesthetic admin.

Answer 187

Suspect pheochromocytoma BBs can also cause these exacerbations

Question 188

Epidermal Inclusion Cyst

Answer 188

Dome-shaped, firm, freely movable cyst or nodule with a central punctum (pore-like opening) Represents epidermis lodging in the dermis; can intermittently produce discharge; only needs tx. if signs of infxn develop

Question 189

Characteristics of uncomplicated parapneumonic effusion

Answer 189

Caused by movement of fluid from pneumonia into visceral pleura ``` Fluid analysis: ph>7.2 Decreased-normal glucose WBC <50,000 Gram stain (-) EXUDATIVE ``` -Differs from empyema because no bacteria are present

Question 190

Tx for acute sciatica

Answer 190

1. Trial of NSAIDs 2. Muscle relaxant/short-term opioid * Don't need MRI unless patient has progressive deficits, cauda equina, or signs of epidural abscess (IV drug use, fever)

Question 191

Aspirin allergy

Answer 191

ALSO GOES FOR NSAIDs

Question 192

Globus sensation

Answer 192

Sensation of foreign body in the throat; occurs when swallowing saliva and is assoc. w/ anxiety Patients do not have pain, dysphagia, or dysphonia; just the sensation of something in their throat

Question 193

Crescendo-decrescendo murmur along the left sternal border with no radiation

Answer 193

HCOM; indicates the presence of interventricular septal hypertrophy S/s: Syncope, dyspnea, chest pain

Question 194

Spinal cord compression management

Answer 194

Immediate IV glucocorticoids (decreased vasogenic edema caused by an obstructed epidural venous plexus) Emergency MRI Neurosx. consult

Question 195

Patients with steatorrhea may present with what deficiencies

Answer 195

Fat soluble vitamin deficiencies Vit D= Low Ca2+, Low PO4, and increased PTH

Question 196

Best tests for Cushing Syndrome

Answer 196

Low-dose dexamethasone suppression test

Question 197

RBC transfusion thresholds

Answer 197

<7 = always <8= Cardiac sx., oncology patients in treatment, heart failure 8-10= Symptomatic anemia, ongoing bleeding, ACS, noncardiac surgery

Question 198

Complication of aortic dissection

Answer 198

Cardiac tamponade

Question 199

Acromegaly effects

Answer 199

Local tumor effect: Visual field defects, headache, cranial nerve defects MSK: Gigantism, protruding jaw, arthralgia, myopathy, skin tags, carpal tunnel syndrome Cardiac: Concentric hypertrophy, HTN, mitral/aortic regurg, Pulm/GI: OSA, colon polyps, diverticulosis Enlarge organs = Tongue, salivary glands, liver, spleen Endocrine: Galactorrhea, decreased libido, DM, hyperparathyroidism, hypertriglyceridemia **Effects are due to increased IGF-1

Question 200

Patient with periodic headaches and HTN who presents with severe HTN after anesthetic admin.

Answer 200

Suspect pheochromocytoma BBs can also cause these exacerbations

Question 201

Epidermal Inclusion Cyst

Answer 201

Dome-shaped, firm, freely movable cyst or nodule with a central punctum (pore-like opening) Represents epidermis lodging in the dermis; can intermittently produce discharge; only needs tx. if signs of infxn develop

Question 202

Characteristics of uncomplicated parapneumonic effusion

Answer 202

Caused by movement of fluid from pneumonia into visceral pleura ``` Fluid analysis: ph>7.2 Decreased-normal glucose WBC <50,000 Gram stain (-) EXUDATIVE ``` -Differs from empyema because no bacteria are present

Question 203

Tx for acute sciatica

Answer 203

1. Trial of NSAIDs 2. Muscle relaxant/short-term opioid * Don't need MRI unless patient has progressive deficits, cauda equina, or signs of epidural abscess (IV drug use, fever)

Question 204

Aspirin allergy

Answer 204

ALSO GOES FOR NSAIDs

Question 205

Globus sensation

Answer 205

Sensation of foreign body in the throat; occurs when swallowing saliva and is assoc. w/ anxiety Patients do not have pain, dysphagia, or dysphonia; just the sensation of something in their throat

Question 206

Crescendo-decrescendo murmur along the left sternal border with no radiation

Answer 206

HCOM; indicates the presence of interventricular septal hypertrophy S/s: Syncope, dyspnea, chest pain

Question 207

Spinal cord compression management

Answer 207

Immediate IV glucocorticoids (decreased vasogenic edema caused by an obstructed epidural venous plexus) Emergency MRI Neurosx. consult

Question 208

Effect modification

Answer 208

External variable positively or negatively impacts the effect of a risk factor on a disease of interest *However, if you remove the variable, there is still risk in the group with one factor

Question 209

Confounding

Answer 209

Exposure-disease relationship is obscured by an extraneous factor associated with exposure and disease *If you remove the RF, there is no difference between two groups

Question 210

Lacunar stroke

Answer 210

Occlusion of the deep penetrating arteries of the brain; particularly susceptible to HTN, DM, hyperlipidemia, and smoking Path: Microatheroma formation and lipohyalinosis leading to small vessel occlusion

Question 211

Erlichiosis

Answer 211

S/s: Flu-like illness, neurologic symptoms (confusion) "RMSF without the spots" Labs: Leukopenia, thrombocytopenia, elevated LFTs, elevated LDH Dx: Intracytoplasmic morulae in monocytes Tx: Doxycycline

Question 212

First line tx. of chemotherapy-induced nausea

Answer 212

SSRI

Question 213

Caustic ingestion

Answer 213

S/s: Hoarseness, stridor (laryngeal), dysphagia, odynophagia (esophageal), epigastric pain, bleeding (gastric) Tx: Secure airway, remove contaminated clothing, CXR if respiratory probs, EGD

Question 214

Systolic anterior motion of the mitral valve

Answer 214

Associated with HCOM; contacts the thickened interventricular septum causing LVOT obstruction

Question 215

Patient who recently had a drug eluting stent placed and has an MRI

Answer 215

Think medication noncompliance

Question 216

Cardiac myxoma

Answer 216

S/s: Constitutional (fever, weight loss, Raynaud's),Heart failue, arrhythmia, embolization Dx: Echo Tx: Surgery soon (decrease risk of embolus)

Question 217

Tubulointerstitial nephritis

Answer 217

Usually due to analgesic use Patients may have poluria and steril pyuria

Question 218

Glucocorticoid-induced myopathy

Answer 218

Patients have proximal muscle weakness and atrophy but no pain due to inflammation caused by catabolic breakdown Will also see signs of glucocorticoid excess

Question 219

Felty Syndrome

Answer 219

Advance RA with splenomegaly and neutropenia

Question 220

Pleural effusion exam findings

Answer 220

Decreased breath sounds Decreased tactile fremitus Dullness to percussion May be a mediastinal shift away from effusion

Question 221

Pt with an acute STEMI and pulmonary edema

Answer 221

Make sure to give Lasix

Question 222

Tophaceous gout

Answer 222

Tumors in the soft tissues that can ulcerate and drain a chalky material Patients don't even need microscopic examination for gout crystals; this is pathagnomic

Question 223

Most common glomerulopathy with HIV

Answer 223

Focal segmental glomerulosclerosis

Question 224

Bilateral trigeminal neuralgia

Answer 224

Think MS as this is usually a unilateral condition

Question 225

Bethanechol

Answer 225

Cholinergic agonist used to treat urinary retention

Question 226

Hyposthenuria

Answer 226

Found in patients with SCD OR Sickle Cell Trait; presents as a patient who cannot concentrate urine or reabsorb water; usually will be young in the question stem -RBCs get caught in the vasa recta impairing countercurrent exchange

Question 227

Tx for syphilis patients who have SEVERE penicillin allergies

Answer 227

Doxycycline

Question 228

Supravalvular aortic stenosis

Answer 228

Congenital LVOT obstruction causing a systolic murmur; usually heard in the first intercostal space **Patients have differential blood pressures in the two arms

Question 229

Hypertensive nephropathy

Answer 229

2nd leading cause of ESRD Decrease in renal blood flow and GFR =>> hypertrophy and intimal medial fibrosis of the renal arterioles Can see microscopic hematuria and proteinuria

Question 230

Patient with renal issues who suddenly develops severe retroperitoneal pain, fever, and gross hematuria

Answer 230

Think RVT due to antithrombin III loss

Question 231

HIV screening indications

Answer 231

Once between the ages 15-65 Treatment for TB Treatment for another STD Annual: IVDU, MSM, prostitutes, partners of HIV positive, homeless, prison Additional: Pregnancy, exposure

Question 232

Solitary brain mass in HIV patient

Answer 232

CNS lymphoma; is usually ring-enhancing

Question 233

Multiple ring enhancing lesions in HIV pt.

Answer 233

Toxoplasma

Question 234

Patient who becomes alkalotic after being treated for fluid overload

Answer 234

Think loop diuretics The increased Na+ delivery to the DCT causes K+ and H+ to be secreted

Question 235

Pt with AKI due to postrenal causes

Answer 235

Catheterization Do bladder scan first to see but if it's inconclusive, jump to this

Question 236

Medications associated with SIADH

Answer 236

Carbamazepine SSRIs NSAIDs

Question 237

Pt. with COPD exacerbation and has a seizure

Answer 237

Due to acute cerebral vasodilation Use O2 with a goal of 90-93%

Question 238

NaHCO3 mechanism in TCA OD

Answer 238

Na+ increases the serum pH and extracellular sodium =>> decreased avidity of TCA for cardiac sodium channels -This helps to prevent QRS widening

Question 239

Charcot joint

Answer 239

"Neurogenic arthropathy" Presents as patients with large, deformed joints that lack sensation and have lost neurologic input; patients can have DJD and loose bodies on joint imaging -Patients only have mild pain tho due to the loss of neurologic input Causes: Diabetes, syringomyelia, spinal cord injury, B12 deficiency, tabes dorsalis =>>Patients damage feet unknowingly Tx: Manage underlying conditions; weight bearing assistance

Question 240

Secondary amyloidosis

Answer 240

Seen with chronic inflammation, chronic infections, IBD, malignancy, and vasculitis S/s: Proteinuria w/ nephrotic syndrome possible Cardiomyopathy Hepatomegaly Peripheral neuropathy Macroglossia Waxy thickening and easy bruising of skin

Question 241

Management of frostbite

Answer 241

Rapid rewarming in 37-39 degree water Analgesia and wound care Thrombolysis in severe, limb-threatening cases

Question 242

"Water hammer pulse"

Answer 242

Aortic regurgitation

Question 243

Vasovagal syncope

Answer 243

"Neurocardiogenic syncope" Triggered by emotional or painful stimuli and is associated with prodromal sx. (dizziness, nausea, pallor, diaphoresis); pts. rapidly regain consciousness Tx: Reassurance, avoidance of triggers, ***Counterpressure maneuvers (leg crossing, tensing arm muscles) that involve raising the SVR

Question 244

CT imaging on pyelonephritis

Answer 244

Persistent clinical symptoms after 48-72 hours of therapy, history of kidneys tones, or unusual findings (gross hematuria, obstruction)

Question 245

Pressure ulcers

Answer 245

Suspect over any bony prominences (sacrum, ischia tuberosities, malleoli, heels, 1st or 5th metatarsal heads)

Question 246

Serous otitis media

Answer 246

Conductive hearing loss that presents with a dull tympanic membrane that is hypomobile

Question 247

Aspirin Toxicity

Answer 247

RESPIRATORY ALKALOSIS THEN ANION GAP METABOLIC ACIDOSIS pH is relatively normal, however, the pCO2 and HCO3 will both be decreased

Question 248

Vessel that supplys the inferior wall of the heart

Answer 248

RCA

Question 249

Protein C resistance

Answer 249

Factor V Leiden

Question 250

Splenic abscess

Answer 250

Patients present with fever, leukocytosis, and LUQ pain; possibly can have left-sided pleuritic chest pain with a left sided effusion RFs: Infxn, hemoglobinopathy, IC, IV drug use, trauma Tx: Abs and splenectomy ****HIGHLY ASSOC. W/ LEFT-SIDED ENDOCARDITIS

Question 251

Meniere Disease

Answer 251

Increased volume and pressure of endolymph in the inner ear due to defective resorption Triad: Low frequency tinnitus w/ a feeling of fullness Episodic vertigo (may have N/V, lightheadedness) Sensorineural hearing loss (usually worsens with time) Tx: Restrict Na+, caffeine, nicotine, alcohol Benzos or antiemetics for acute sx. Diuretics for long term management

Question 252

Management of hypercalcemia

Answer 252

1. Normal saline 2. Calcitonin 3. (Long term) bisphosphonates

Question 253

Hepatic hydrothorax

Answer 253

Pleural effusion due to small defects in the diaphragm that occurs when PERITONEAL FLUID passes thru ***MORE COMMON ON THE RIGHT S/s: Dyspnea, cough, pleuritic chest pain, hypoxemia Tx: Na+ restriction, diuretics

Question 254

Prevalence studies are what kind of study?

Answer 254

Cross-sectional

Question 255

Pneumonia breath sounds

Answer 255

Represents consolidation of a lung Increased crackles Increased tactile fremitus Dullness to percussion No mediastinal shift

Question 256

Cyanide toxicity

Answer 256

Causes: Combustion of carbon and nitrogen material (wool, silk), industrial exposure (mining metals), or sodium nitroprusside ``` S/s: Skin- Flushing, cyanosis CNS- Headache, AMS, seizure, coma CV- Arrhythmia Respiratory- Tachypnea followed by respiratory depression, pulmonary edema GI- Pain, N/V Renal- Metabolic acidosis (LA), RF ```

Question 257

Type of cardiomyopathy assoc. w/ amyloidosis

Answer 257

Restrictive cardiomyopathy

Question 258

Antiparkinsonian drug that is dangerous in pts. w/ glaucoma

Answer 258

Anticholinergics (trihexyphenidyl) These can ppt. ACG

Question 259

Granulomatosis with polyangiitis Diagnostic findings

Answer 259

anti-PR3, anti-MPO Biopsy: Skin-leukocytoclastic vasculitis Kidney- Pauci-immune GN Lung- granulomatous vasculitis Tx: Corticosteroids and immune modulators (MTX, cyclophosphamide)

Question 260

Pancoast tumor

Answer 260

S/s: Shoulder pain Horner cyndrome C8-T2 neurologic involvement (weakness of intrinsic hand muscles) Weight loss Enlarged supraclavicular lymph nodes SVC syndrome

Question 261

MS

Answer 261

S/s: Fatigue Episodes of numbness, paresthesia, bowel/bladder dysfnxn, heat sensitivity, optic neuritis Symptoms may worsen when a patient moves to a hotter area

Question 262

Uhthoff phenomenon

Answer 262

MS patients experiencing increased frequency of episodes after they move to a hotter region

Question 263

Adhesive capsulitis

Answer 263

"Frozen shoulder" Patients have decreased passive and active ROM in the shoulder joint with a gradual increase in severity but NOT a lot of pain -Can be due to chronic inflammation, fibrosis, or contracture of the capsule

Question 264

Felty Syndrome | triad

Answer 264

RA -including vasculitis with necrotizing skin lesions Neutropenia Splenomegaly *Also have anti-CCP, elevated ESR

Question 265

Mechanism of cyanide poisoning

Answer 265

Inhibits cytochrome oxidase a3 in the mitochondrial electron transport chain blocking the production of ATP =>>Increase in anaerobic metabolism and metabolic acidosis

Question 266

Follow-up of a CXR with a new mass

Answer 266

Chest CT

Question 267

Hypertrophic Osteoarthropathy

Answer 267

Digital clubbing accompanied by sudden-onset arthropathy affecting the wrist and hand joints -Can be due to underlying lung disease (cancer, TB, bronchiectasis, COPD) Initial study: CXR (rule out cancer)

Question 268

Things to rule out in patients presenting with pseudogout

Answer 268

1. Hyperparathyroidism 2. Hypothyroidism 3. Hemochromatosis (get iron studies)

Question 269

Progressive Multifocal Leukoencephalopathy

Answer 269

JC virus reactivation typically in an IC host S/s: Slowly progressive confusion, paresis, ataxia, and seizure Dx: MRI of brain shows multiple white matter lesions with NO enhancement or edema -Virus lies dormant in kidneys and lymphoid but reactivated w/ CD4 <200; moves to CNS and lyses oligodendrocytes

Question 270

Medications to hold prior to cardiac stress test

Answer 270

48 hrs: BBs, CCBs, Nitrates -If vasodilator, dipyramidole as well 12 hrs: Caffeine

Question 271

Chikungunya fever

Answer 271

Patient who is from Central or South America (or recently traveled) and presents with high fever, SEVERE ARTHRALGIA, lymphopenia, thrombocytopenia, and increased LFTs Other S/s: Headache, myaglia, conjunctivits, maculopapular rash Tx: Supportive

Question 272

Anemia that develops with antiepileptics

Answer 272

Folic acid; due to impaired absorption

Question 273

Tx for hepatic encephalopathy

Answer 273

Lactulose

Question 274

Tx for Lyme Disease in kids and pregnant women

Answer 274

Amoxicillin

Question 275

Treatment of cachexia

Answer 275

Progesterone analogues (megestrol acetate) Corticosteroids - These increase appetite, cause weight gain, and improve well being - Megestrol acetate preferred due to decreased side effects

Question 276

Takayasu Arteritis

Answer 276

Asian female who presents with constitutional signs of fever and weight loss as well as with arterio-occlusive sx. (Claudication, ulcers in the upper extremities) PE: Blood pressure discrepancies Pulse deficits Arterial Bruits, especially in the upper extremities Dx: elevated ESR, CRP CXR: widened mediastinum, aortic dilatation Ct/MRI: thickening of aortic walls and narrowing of vessel lumen Tx: Glucocorticoids

Question 277

Invasive aspergillosis

Answer 277

Triad of fever, chest pain, and hemoptysis in an IC pt. ⭐️CXR: Pulmonary nodules with halo sign Can also have cell wall bio marks (Galactomannan, beta-D-glucan) Tx: Voriconazole plus caspofungin

Question 278

Post-streptococcal AGN

Answer 278

Preiorbital edema, hematuria, and oliguria Patient will have ️Decreased c3

Question 279

Systemic sclerosis subtypes

Answer 279

Limited cutaneous: Scleroderma on the head and distal upper esophagus Vascular manifestation (Raynauds, cutaneous Telangiectasia, pulmonary hypertension) CReSt Anti-centromere abs DIFFUSE CUTANEOUS: More internal organ involvement as well as the skin (renal crisis, myocardial ischemia and ️fibrosis, interstitial lung disease) Anti-Scl-70 (anti-topoisomerase-1) and anti-RNA polymerase III

Question 280

Tx for variceal hemorrhages

Answer 280

Volume resuscitation IV octreotide Antibiotics Urgent endoscopy to evaluate for balloon tamponade

Question 281

First thing to do with hyperkalemia

Answer 281

STABILIZE THE MYOCARDIUM Give calcium gluconate

Question 282

Patient who has had a gastrectomy years ago and is now presenting with signs of anemia

Answer 282

IF deficiency; suspect Vitamin b12 deficiency

Question 283

Most common vaccination to give to people traveling abroad

Answer 283

Hepatitis A vaccine

Question 284

Patient who still has a tick attached and it just happened recently

Answer 284

Remove tick; follow-up closely

Question 285

Evaluation of hyperthyroidism

Answer 285

1. Measure TSH, T3, and T4 2. If primary, evaluate for signs of Graves (goiter, ophthalmopathy) 3. If none, do a radioactive iodine uptake scan 4. If it is low, evaluate serum TBG High? =>> Thyroiditis, iodide exposure Low? =>> Exogenous

Question 286

Cervicofacial actinomyces

Answer 286

Patient with dental infxn or facial trauma who is IC, DM, or malnourished S/s: Nonpainful, indurate mass; sinus tracts with SULFUR-LIKE GRANULES -typically affects the mandible Dx: FNA; culture shows GPR that are slightly branching Tx: Penicillin; surgery if invasive

Question 287

Management of cancer pain

Answer 287

Mild= NSAIDs Moderate= Weak opioids and NSAIDs -Codeine, hydrocodone, tramadol Severe = Strong, short-acting opioids - morphine, hydromorphone - consider adding long acting if this does not provide relief

Question 288

pH effects on Ca2+

Answer 288

Increased= dissociation of H+ from albumin =>> increased calcium binding to albumin =>> decreased serum level Decreased ph= association of h+ to albumin =>> decreased calcium binding to albumin =>> increased serum level

Question 289

Ice pack test

Answer 289

Ice pack applied over eyelid that is droopy =>> relief in ptosis CONFIRMS MG *Cold temperature inhibits the breakdown of Ach in the NMJ

Question 290

Ventilation goals with ARDS

Answer 290

Low-tidal volume ventilation to decrease the likelihood of overdistending the alveoli -decreases the work on the lungs Provide oxygenation by increasing the FiO2 and PEEP -prevent SpO2 <88%

Question 291

Patient who presents with widespread molluscum contagiosum

Answer 291

Test for HIV or other immunodeficiency

Question 292

Tx for variceal hemorrhages

Answer 292

Volume resuscitation IV octreotide Antibiotics Urgent endoscopy to evaluate for balloon tamponade

Question 293

First thing to do with hyperkalemia

Answer 293

STABILIZE THE MYOCARDIUM Give calcium gluconate

Question 294

Patient who has had a gastrectomy years ago and is now presenting with signs of anemia

Answer 294

IF deficiency; suspect Vitamin b12 deficiency

Question 295

Most common vaccination to give to people traveling abroad

Answer 295

Hepatitis A vaccine

Question 296

Patient who still has a tick attached and it just happened recently

Answer 296

Remove tick; follow-up closely

Question 297

Evaluation of hyperthyroidism

Answer 297

1. Measure TSH, T3, and T4 2. If primary, evaluate for signs of Graves (goiter, ophthalmopathy) 3. If none, do a radioactive iodine uptake scan 4. If it is low, evaluate serum TBG High? =>> Thyroiditis, iodide exposure Low? =>> Exogenous

Question 298

Cervicofacial actinomyces

Answer 298

Patient with dental infxn or facial trauma who is IC, DM, or malnourished S/s: Nonpainful, indurate mass; sinus tracts with SULFUR-LIKE GRANULES -typically affects the mandible Dx: FNA; culture shows GPR that are slightly branching Tx: Penicillin; surgery if invasive

Question 299

Management of cancer pain

Answer 299

Mild= NSAIDs Moderate= Weak opioids and NSAIDs -Codeine, hydrocodone, tramadol Severe = Strong, short-acting opioids - morphine, hydromorphone - consider adding long acting if this does not provide relief

Question 300

pH effects on Ca2+

Answer 300

Increased= dissociation of H+ from albumin =>> increased calcium binding to albumin =>> decreased serum level Decreased ph= association of h+ to albumin =>> decreased calcium binding to albumin =>> increased serum level

Question 301

Ice pack test

Answer 301

Ice pack applied over eyelid that is droopy =>> relief in ptosis CONFIRMS MG *Cold temperature inhibits the breakdown of Ach in the NMJ

Question 302

Ventilation goals with ARDS

Answer 302

Low-tidal volume ventilation to decrease the likelihood of overdistending the alveoli -decreases the work on the lungs Provide oxygenation by increasing the FiO2 and PEEP -prevent SpO2 <88%

Question 303

Patient who presents with widespread molluscum contagiosum

Answer 303

Test for HIV or other immunodeficiency

Question 304

Renovascular HTN S/s

Answer 304

Severe HTN after the age of 55 Recurrent flash pulmonary edema or resistant HF Unexplained rise in serum Cr Abdominal bruits (can be periumbilical)

Question 305

ADRs of EPO therapy

Answer 305

Worsening of HTN Headaches Flu like syndrome Red cell aplasia (rare)

Question 306

CYP 450 inhibitors

Answer 306

ACETAMINOPHEN, NSAIDs Metronidazole, antifungals Amiodarone Cimetidine Cranberry juice, Ginkgo bilboa, Vitamin E Omeprazole SSRIs

Question 307

2 most common orgs that can cause direct extension to the brain from sinusitis

Answer 307

Strep viridans and Staph aureus

Question 308

Organisms associated with contact lens keratitis

Answer 308

Psuedomonas and Serratia

Question 309

MC source of pulmonary embolus

Answer 309

Femoral vein

Question 310

Empiric tx for meningitis

Answer 310

``` Cefepime/Ceftazidine + Vancomycin + Ampicillin (covers Listeria monocytogenes) ``` -Pts. should also receive dexamethasone to prevent complications of S. pneumoniae meningitis (deafness, focal probs) until it is ruled out

Question 311

Small intestinal bacteria overgrowth

Answer 311

Causes: Anatomic abnormalities (surgery, strictures) Motility disorders (DM, scleroderma) ESRD, AIDS, cirrhosis S/s: Abdominal pain, diarrhea, bloating, malabsorption, weight loss, anemia, nutritional deficiencies Dx: Endoscopy (shows >10^5 organisms), glucose breath hydrogen testing (shows rapid increase in lactulose) Common orgs: Strep, bacteroides, E. coli, lactobacillus Tx: 7-10 day course of rifaximin or Augmentin, avoid antimotility agents, high fat diet, metoclopramide (promotes motility) Normal protection comes from gastric acidity, peristalsis, intact ileocecal valve preventing retrograde travel of bacteria from the colon

Question 312

Tx for vitiligo

Answer 312

Topical or systemic corticosteroids Can try topical calcineurin inhibitors but the answer is probably steroids

Question 313

Characteristics of benign renal cysts

Answer 313

Thin, smooth, regular wall Unilocular No septae Homogenous content Absence of contrast enhancement on CT/MRI Asymptomatic *Do not need follow-up unless there are changes

Question 314

Tetanus prophylaxis

Answer 314

ALWAYS JUST GIVE TDaP UNLESS THEY ARE IC =>>THEN ALSO GIVE TIG

Question 315

Patient with TB who is presenting with fatigue, weakness, borderline hypotension, and electrolyte abnormalities

Answer 315

Suspect chronic primary adrenal insufficiency due to TB

Question 316

FAP screening guidelines

Answer 316

Annual sigmoidoscopies starting at age 10-12 Annual colonoscopies once colorectal adenomas are detect or at the age of 50 Proctocolectomy if the patient presents with carcinoma or adenomas with high-grade dysplasia

Question 317

Less known RFs for Toxic Shock Syndrome

Answer 317

Recent surgery Sinusitis Nasal surgery Skin lesions/burns

Question 318

Primidone

Answer 318

Used as a treatment for essential tremor alongside BB *BB is still first line

Question 319

TX FOR PARKINSON'S

Answer 319

Trihexiphenidyl (anticholinergic)

Question 320

Enthesitis

Answer 320

Pain at sites where tendons and ligaments attach Common in AS, psoriatic arthritis, and reactive arthritis

Question 321

Patient with meningococcal meningitis

Answer 321

ISOLATE THEM; even if it's against their wishes

Question 322

Riluzole

Answer 322

Glutamate inhibitor used in patients with ALS Prolongs survival time and the time towards necessary tracheostomy

Question 323

Alveolar infiltrates with several thin-walled cavities

Answer 323

Can be a finding in normal, uncomplicated pnemonia

Question 324

Patient who presents with skeletal deformities, bone and joint pain, and fractures -May possibly also have headache or hearing loss

Answer 324

Paget's Disease

Question 325

First order test for suspected SLE

Answer 325

ANA

Question 326

Babesiosis

Answer 326

S/s: Flu-like sx., Severe (CHF, DIC, splenic rupture) Dx: Anemia, thrombocytopenia, increased bilirubin, LDH, and LFTs -Findings due to intravascular hemolysis ****Intraerythrocytic rings on peripheral smear Tx: Atovaquone + Azithromycine Quinine + clindamycin (if severe)

Question 327

Occupational HIV postexposure prophylaxis

Answer 327

Tenofovir + emtricitabine (two NRTIs) + Raltegravir (integrase inhibitor), protease inhibitor, or NNRTI

Question 328

Cocaine toxicity tx

Answer 328

IV Benzos and O2 -Also consider CCBs, nitrates, and aspirin if their is CA vasoconstriction

Question 329

Rotor's Syndrome

Answer 329

Defect in the hepatic secretion of bilirubin; consider this when the patient has normal LFTs and AP but has hyperbilirubinemia

Question 330

Patient who has a negative IgA anti-tissue transglutaminase deficiency but the biopsy still shows villi blunting

Answer 330

This is still Celiac's! Many patients have selective IgA deficiency; if your assay is negative, measure total IgA

Question 331

Juvenile Idiopathic Arthritis

Answer 331

Symmetric arthritis for at least six weeks Lab findings: Increased ESR, CRP Hyperferritinemia Hypergammaglobulinemia Thrombocytosis Anemia

Question 332

Patients who have been longtime vegans and are alcoholics

Answer 332

Likely BOTH folic acid and B12 deficiencies On administration of folic acid, megaloblastosis will resolve, however, the pt. will still have neurologic sx.

Question 333

Vertebral compression fracture

Answer 333

Clinical: Chronic: Progress kyphosis and loss of statue; can even be painless Acute: Low back pain with decreased spinal mobility, pain increasing with standing, walking, and lying on the back; tenderness at the affected level ****Patients CAN have neuro sx. BUT if they have shooting pains down their spine, THEN you should think maybe a herniation -Pts are at increased risk for future fractures and development of hyperkyphosis =>> protuberant abdomen, early satiety, weight loss, and decreased respiratory capacity

Question 334

Cryoglobuinemia Type 1 (not mixed)

Answer 334

Pts. may have hyperviscosity (blurry vision), thrombosis, livedo reticularis, purpura -Pts. have normal complement levels (unlike in mixeD) Assoc. w/ lymphoproliferative conditions or hematologic probs

Question 335

Suppurative thyroiditis

Answer 335

High grade fever and pain at the thyroid due to infxn; can be enlarged due to abscess formation *Pts. are EUTHYROID

Question 336

de Quervain thyroiditis

Answer 336

"Subacute thyroiditis" Pts. present with prominent fever and hyperthyroid sx. as well as a painful, tender goiter ***Likely a postviral etiology Dx: Elevated ESR and CRP, low radioiodine uptake

Question 337

"Ostetitis deformans"

Answer 337

Paget's

Question 338

Symptomatic sarcoidosis tx

Answer 338

Glucorticoids

Question 339

Milk-alkali syndrome

Answer 339

Pts. have excessive intake of calcium and absorbable alkali (usually calcium carbonate in pts. w/ osteoporosis) =>>Renal vasoconstriction and decreased glomerular blood flow =>>Renal loss of Na+ and H2O, increased resorption of HCO3- -due to inhibition of the Na-K-2Cl transporter and impaired ADH Sx: N/V, constipation, polyuria, polydipsia, neuropsychiatric sx. -"Hypercalcemia + extra pee -Increased risk w/ ACEIs, Thiazides, and NSAIDs Lab: Hypercalcemia, hypophosphatemia, hypomagnesemia Metabolic alkalosis AKI Decreased PTH Tx: Discontinue causative agents, IV saline + furosemide

Question 340

SCD pt. with decreased internal rotation and abduction of the hip with normal x-rays and inflammatory markers

Answer 340

Think aseptic necrosis; occlusion of end artery by sickle cell

Question 341

Warfarin skin necrosis

Answer 341

Warfarin administration causes immediate DECREASE in Protein C and S =>>Transient hypercoagulable state Tx: Protein C concentrate and cessation of warfarin

Question 342

TSH in prolactinoma

Answer 342

To assess whether you think it might be low or normal, look at the patient's sx. cause it could be either

Question 343

Lab findings in VIPoma

Answer 343

Hypokalemia (increased intestinal secretion) Hypercalcemia (increased bone resorption) Hyperglycemia (increased glycogenolysis) Stool osmolality studies show decreased gap and increased Na

Question 344

Methods to control confounding

Answer 344

Design: Matching, restriction, and RANDOMIZATION Analysis: Stratified; statistical monitoring

Question 345

Saline-resistant and saline-responsive Metabolic alkalosis

Answer 345

Saline-responsive: Due to vomiting, diuretics, laxative, decreased oral fluids Saline-resistant: Primary hyperaldosteronism, Cushing's, severe hypokalemia Urine chloride can differentiate if the history does not (it is <20 in saline-responsive)

Question 346

Nocardia

Answer 346

Partially acid-fast branching, GPR Presents in IC pts. with systemic symptoms, possible lung nodules, and possible lung abscesses Tx: Bactrim

Question 347

Phosphorus levels in tertiary hyperparathyroidism

Answer 347

High; kidney is not able to excrete it

Question 348

Factorial design

Answer 348

Study that is designed to have 2 or more interventions with 2 or more variable endpoints -Like studying BP endpoints on different antihypertensives

Question 349

Morton neuroma

Answer 349

Numbness or pain between the 3rd and 4th toes **Clicking sensation when palpating space between 3rd and 4th toes while squeezing the metatarsals **Common in runners Path: Mechanically induced neuropathic degeneration of the interdigital nerves Sx. can be worse when walking in high heeled shoes Tx: Metatarsal support with inserts

Question 350

Leprosy

Answer 350

S/s: Anesthetic, macular skin lesions with raised borders -Nerves nearby can be painful or also have a loss of sensory -Patients present as immigrants or long travel history Dx: Full-thickness biopsy of the skin lesion Tx: Dapsone; rifampin; possible clofazimine if there are extensive lesions

Question 351

MC nephrotic syndrome in pts. with Hodgkins

Answer 351

Minimal change disease -Resolves with successful treatment of the lymphoma

Question 352

Type of reaction that aspirin-exacerbated respiratory disease is

Answer 352

Pseudoallergic rxn Production of leukotrienes via lipooxygenase and decreased anti-inflammatory prostaglandins due to COX inhibition Tx: Leukotriene inhibitors (zileuton) or antagonists (montelukast) for acute sx.

Question 353

Patient presenting with chest pain not related to exertion and has a chronic history

Answer 353

This shit dont sound like cardiac CP

Question 354

Reason alcohol is bad for acetaminophen related liver failure

Answer 354

Depletes glutathione levels preventing the liver from glucuronidating NAPQI, the toxic metabolite of acetaminophen

Question 355

Patient who has a syncopal episode and starts jerking

Answer 355

Do not rule out other causes; any case of cerebral hypoxia can cause jerks

Question 356

Asymptomatic range of carotid artery blockage that indicates surgery

Answer 356

>60% Symptomatic? >50%

Question 357

Total body K+ in DKA or HHS

Answer 357

Decreased; elevated plasma levels but osmotic diuresis causes excessive loss

Question 358

NF1

Answer 358

CFs: Cafe-au-lait spots Neurofibromas Lisch nodules Optic gliomas (lead to decreased visual acuity, optic nerve atrophy, and proptosis) -Defect in NF1 TSG neurofibromin on Cr. 17

Question 359

D-xylose test

Answer 359

D-xylose is absorbed in the proximal SI; patients will absorb this after administration and increased levels are detected in the urine ABNORMAL TEST: No increase in D-xylose in the urine =>>SUSPECT CELIAC False positives can be seen with impaired glomerular filtration or delayed gastric emptying

Question 360

Thalamic pain syndrome

Answer 360

Weeks after suffering a stroke of the penetrating branches of the PCA (supplies the ventral posterolateral and ventral posteromedial nuclei of the brain); patients will have paroxysmal burning over the affected areas of their body and allodynia (pain with light touch) -These nuclei transmit sensory info from the contralateral side of the body in all modalities

Question 361

Pulmonary physiology with pneumonia

Answer 361

Inflammation =>> impaired alveolar ventilation =>> RIGHT-TO-LEFT SHUNT -Also described as a V/Q mismatch (decreased)

Question 362

Hepatorenal syndrome

Answer 362

Significant decrease in renal fnxn in the absence of any causes of renal dysfnxn ***As cirrhosis progresses, patients get splanchnic vasodilation and renal vasoconstriction Precipitating factors: GI bleed, vomiting, sepsis, spontaneous bacterial perotonitis, NSAID use Dx: Renal hypoperfusion FeNa <1% Absence of signs of tubular injury No casts in the urine No improvement in renal fnxn with fluids Tx: Stabilize; give splachnic vasoconstrictors (octreotide, midodrine, norepinephrine); transplant

Question 363

Significant complication of pseudotumor cerebri (idiopathic intracranial HTN)

Answer 363

Blindness IF necessary, can perform shunting or optic nerve sheath fenestration to prevent

Question 364

Young Patient with chronic low back pain that improves with activity and has an elevated ESR

Answer 364

AS Pain may also be worse at night; sacroiliitis on radiographs

Question 365

Tx for acute pericarditis

Answer 365

NSAIDs

Question 366

Sick sinus syndrome

Answer 366

Symptomatic bradycardia without signs of heartblock

Question 367

Tx of torsades du pointes

Answer 367

MgSo4 if hemodynamically stable If not =>> Defibrillation

Question 368

Postpartum endometritis tx

Answer 368

Clindamycin + gentamicin

Question 369

Odds ratio

Answer 369

Measures the odds of exposure among individuals with the disease to the odds of exposure among individuals without the disease

Question 370

Rare disease assumption

Answer 370

A rare disease that has a low incidence and allows for the OR to be approximately equal to the RR

Question 371

Atropine

Answer 371

Dilates the eye; avoid in AACG

Question 372

Pilocarpine

Answer 372

Topical agent that rapidly reduces intraocular pressure by opening the canals of Schlemm and drain aqueous humor

Question 373

Lymphocytes with vacuolated cytoplasm

Answer 373

Atypical lymphs; probably Mono

Question 374

Heterophile antibody test

Answer 374

Negative during first week of mono; may want to repeat after a while TL:DR = NEGATIVE TEST DOES NOT RULE OUT MONO

Question 375

Pts who have a CN III palsy but preserved pupillary dilation (control of the iris and ciliary muscles)

Answer 375

Acute ischemia of the fiber (outer fibers control pupillary dilation; inner fibers control EOMs) -IF they have both, it is likely a lacunar stroke

Question 376

CMV-related HIV

Answer 376

Frequent, small volume diarrhea Hematochezia Abdominal pain Low-grade fever Weight loss Dx: Colonoscopy with biopsy; shows eosiniophilic intranuclear and basophilic intracytoplasmic inclusions Tx: Ganciclovir; eye exam to rule out retinitis

Question 377

Central retinal artery occlusion

Answer 377

Painless monocular vision loss that persists for serveral hours Fundoscopy reveals a whitened retinal and a cherry red macula Patients may have a defect in the afferent pupillary reflex Tx: Attempt at revascularization; follow-up with carotid imaging and atherosclerosis tx

Question 378

Gonococcal pharyngitis

Answer 378

Inoculation of the pharynx with pharyngeal erythema and NONTENDER cervical lymphadenopathy

Question 379

Treatment with radioactive iodine for Grave's disease

Answer 379

Give glucocorticoids with treatment; otherwise pt. can get worsening of ophthalmopathy This is because titers of anti-TSH antibodies typically increase after therapy

Question 380

Bicuspid valve

Answer 380

Actually causes aortic regurgitation in young patients

Question 381

Pt with bright red blood on the toilet paper and is under the age of 40

Answer 381

Get an anoscopy; colonoscopy if they are older than age 50 or have risks for colorectal cancer

Question 382

ACTH levels in pts. with secondary adrenal insufficiency

Answer 382

Decreased; the HPA is what gets suppressed with chronic steroid use

Question 383

Delayed sleep phase syndrome

Answer 383

Circadian rhythm sleep-wake disorder characterized by sleep-onset insomnia and excessive morning sleepiness Occurs when internal clock is misaligned with a persons desired sleep time - Pts. describe themselves as "night owls" - Sleep normally when allowed to set their own schedule

Question 384

Treatment for febrile neutropenia

Answer 384

Monotherapy Pip-tazo, cefepime, meropenem Just make sure there is Pseudomonas coverage

Question 385

Cryptosporidium

Answer 385

Possible in healthy adults, however, it should resolve in 10-14 days

Question 386

Coccidiodes

Answer 386

PT DOES NOT HAVE THIS IF THEY DO NOT LIVE IN THE SOUTHWESTERN US

Question 387

Thiazide diuretic effect on glucose

Answer 387

Increases blood levels -Impairs insulin release and glucose utilization in the peripheral tissues

Question 388

Pt with heat stroke and red urine

Answer 388

Rhabdomyolysis can occur when body temp is >105

Question 389

Trimethoprim effects on kidney

Answer 389

Increases serum K+ by blocking the epithelial sodium channels in the CT (like amiloride) Increases creatinine by competitively inhibiting its secretion (although GFR is unchanged)

Question 390

Patient who has a high fever, VS instability, agitation/delirium, lid lag, tremor, warm skin

Answer 390

Thyroid storm Give propanolol, PTU, and glucocorticoids (decreases peripheral T4=>T3) -This can be triggered by surgery, trauma, infxn

Question 391

Testing to do on all ITP pts

Answer 391

HIV, Hep C Bone marrow bx. if you still dont have an answer

Question 392

Metabolic syndrome triad

Answer 392

HTN Dyslipidemia Impaired glucose tolerance

Question 393

Metabolic syndrome diagnostic criteria

Answer 393

Abdominal obesity (Men: >40; Women: >35) Fasting glucose >100-110 BP >130/80 TGL >150 HDL (Men: <40; Women: <50) Must have 3/5 of these

Question 394

Hemodynamic measures in septic shock

Answer 394

RA pressure (preload): Normal or decreased PCWP (preload): Normal or decreased CI (pump fnxn): Increased SVR (afterload): Decreased MvO2: Increased

Question 395

Differentiating HG from normal N/V during pregnancy

Answer 395

Urinary ketones are (+) in HG

Question 396

FiO2 in ARDS

Answer 396

Start off high; however, it should be decreased to <60% to keep PaO2 in the 50-80 range

Question 397

Flow-volume loop in fixed upper airway obstruction

Answer 397

Looks pretty egg shaped

Question 398

Recurrent pneumonia in the same location of the lung

Answer 398

Can be due to localized airway obstruction =>>impaired bacterial clearance ``` Causes: External bronchial compression (neoplasm, lymphadenopathy, vascular irregularity) Intrinsic obstruction (bronchiectasis, foreign body) ``` -Get a CT to eval

Question 399

Complication of GCA

Answer 399

Aortic aneurysm

Question 400

treatment for refractory c dif

Answer 400

Fidaxonycin If all else fails, fecal transplant

Question 401

Toxins that can cause ATN

Answer 401

IV contrast Myoglobin It's also caused by ischemia

Question 402

Tx of prerenal AKI

Answer 402

IVF Or Diuretics if they are in a volume overload state

Question 403

Indications for hemodialysis

Answer 403

Acidosis Electrolytes ( particularly potassium and calcium) Intoxication Overload Uremia

Question 404

Common confections with gonorrhea

Answer 404

Chlamydia, hiv, hep b, and syphilis Test for all of these

Question 405

Rivaroxaban

Answer 405

Direct Xa inhibitor used for DVT prevention and has no increased risk for ️Bleeding Can additionally be used for acute DVT as long as the patient is hemodynamically stable

Question 406

Ekg finding in PE

Answer 406

New onset bundle branch block

Question 407

Hypercalcemia of immobilization

Answer 407

Increased osteoclastic resorption after increased periods of time being nonambulatory Worse with renal insufficiency

Question 408

Polymyositis

Answer 408

Patients have symmetrical proximal muscle weakness with possible Mild muscle tenderness Dx: AAs (anti-Jo-1) Elevated CK Muscle biopsy shows endomysial mononuclear infiltrate Can be associated with Cancer, myocarditis, and lung disease Tx: Systemic glucocorticoids

Question 409

What should you do at stage IV CKD?

Answer 409

Place an av fistula in to prep for dialysis need GFR= 15-29

Question 410

Treatment of severe hypernatremia

Answer 410

D5W

Question 411

Hyponatremia workup

Answer 411

1. Serum osmols 2xNa+gluc/18+BUN/2.8= approx. 280 Normal? =>> isotonic (pseudohyponatremia) Abnml =>> Hypertonic hyponatremia -Hyperglycemia (For every 100g starting at 200= +1.6) ``` Hypotonic hyponatremia -Diuresis -SIADH (euvolemic) Renal tubular acidosis Addison's Thyroid Disease ```

Question 412

First thing to check on a sample with hyperkalemia

Answer 412

Evidence of hemolysis in the tube

Question 413

Barrter's disease

Answer 413

Looks like Loop diuretics hypoglycemia, hypocalcemia

Question 414

Gittelman's Syndrome

Answer 414

Looks like thiazide diuretics hyperglycemia, hypercalcemia

Question 415

IV K+ replacement

Answer 415

IV replacement can not go faster than 10meQ/hr 10meQ =>> Change of 0.1

Question 416

Initial eval of adrenocortical insufficiency

Answer 416

8AM serum cortisol and ACTH stimulation test

Question 417

Crystal-induced AKI

Answer 417

``` Causes: Acyclovir (especially if IV) Sulfonamides Methotrexate Ethylene glycol Protease inhibitors ``` S/s: Elevated Creatinine, possible hematuria, pyuria, crystals Tx: Discontinue drug; IV fluids ****IF YOU GIVE PLENTY OF FLUIDS WITH ADMINISTRATION OF DRUG; YOU CAN PREVENT IT FROM EVER HAPPENING

Question 418

Patient who has a popping sensation in their kneww and has a rapid onset of hemarthrosis

Answer 418

Probably ACL tear

Question 419

Pt. with thrush and signs of pneumonia

Answer 419

Probably still PCP

Question 420

Pt. who has decreased proprioception and a pupil that does not constrict with light

Answer 420

Probably tabes dorsalis Tx: IV penicillin

Question 421

Complications with SAH

Answer 421

Rebleeding (think this if in 24 hrs) Vasospasm (think this if in 3 days) Hydrocephalus/Increased ICP Seizure Hyponatremia due to SIADH

Question 422

Familial hypocalciuric hypercalcemia

Answer 422

Mutation of the Calcium-sensing receptor that leads to increased reabsorption of calcium in the tubules

Question 423

Causes of Wernicke's encephalopathy

Answer 423

Chronic alcoholism Malnutrition (anorexia) Hyperemesis gravidarum

Question 424

Pneumonia vaccine everyone should get

Answer 424

PPSV23

Question 425

MCC of resistant HTN

Answer 425

Renal artery stenosis These pts. will be on 3 or more antihypertensives with consistently high readings PE: Can hear abdominal bruits, asymmetric renal size, rise in serum Cr after starting ACEIs

Question 426

Patient with a nonpalpable point of maximal impulse and dyspnea

Answer 426

Consider pericardial tamponade

Question 427

Reason pts. with Crohn's get kidney stones

Answer 427

Hyperoxaluria

Question 428

Bacillary angiomatosis

Answer 428

Arises w/ CD4 <100 S/s: Vascular cutaneous lesions resembling Kaposi's sarcoma -Papular, nodular, peduncular B-sx. Dx: Lesional biopsy Tx: Doxycycline or erythromycin

Question 429

Pts. with malabsorption issues and now have bone pain

Answer 429

Osteomalacia May also see muscle cramps or a waddling gait Dx: Increased AP, increased PTH, decreased Ca2+ and PO43-, decreased urinary Ca2+ X-ray shows thinning of the cortex and reduced BMD Bilateral and symmetric pseudofractures can be found

Question 430

Intraocular inflammation in HIV patients

Answer 430

Actually caused by HSV or VZV; called bilateral necrotizing retinitis -keratitis, conjunctivitis, eye pain, rapid vision loss *CMV retinitis is painless and has hemorrhages and retinal lesions

Question 431

MRI of metastatic brain lesions

Answer 431

Multiple-well circumscribed lesions with vasogenic edema at the gray and white matter jnxn Lung cancer and melanoma most commonly have multiple brain mets

Question 432

Tx for Eikenella corrodens

Answer 432

Augmentin

Question 433

Pt treated with antiarrhythmic and later develops pulmonary sx.

Answer 433

Probably amiodarone toxicity; develops months after treatment

Question 434

Pt. with abdominal pain right after eating that is not localized

Answer 434

Suspect chronic mesenteric ischemia

Question 435

Most effective way of improving communication of relevant patient transfers

Answer 435

Implementing a signout checklist

Question 436

Volume responsive metabolic alkalosis

Answer 436

Diuretics, dehydration, enuresis Pts will have a urinary Cl of less than 10

Question 437

RTA urine anion gap

Answer 437

Increased

Question 438

CT in acute pancreatitis

Answer 438

Swelling with peripancreatic fluid and fat stranding Fluid does NOT appear enhanced

Question 439

Tx of acute MS exacerbation

Answer 439

Corticosteroids If no improvement =>> Plasmapheresis

Question 440

Tx of bony mets in prostate cancer

Answer 440

Radiation

Question 441

Salvage therapy

Answer 441

Therapy when standard treatment for a disease fails Ex: Radical prostatectomy performed but months later the pts. PSA begins to rise again

Question 442

Adjuvant therapy

Answer 442

Tx given in addition to standard therapy

Question 443

Consolidation therapy

Answer 443

Given after induction therapy with multidrug regimens to further reduce tumor burder

Question 444

Induction therapy

Answer 444

Initial dose of tx. to rapidly kill tumor cells and send a patient into remission

Question 445

Maintenance therapy

Answer 445

Given after induction and consolidation therapies to kill any residual tumor cells and keep the pt. in remission

Question 446

Neoadjuvant therapy

Answer 446

Tx give before the standard therapy for a particular disease usually used to decreased the size of a tumor before a resection or some shit like that

Question 447

G6PD activity test during an acute hemolytic episode

Answer 447

Useless

Question 448

Signs of severe aortic stenosis

Answer 448

Diminished and delayed carotid pulse "pulsus parvus and tardus" Mid-to-late peaking systolic murmur Present of a single and SOFT S2

Question 449

Tx for Central Retinal Artery Occlusion

Answer 449

Hyperbaric O2 and ocular massage

Question 450

Tx of elevated homocysteine levels and hypercoagulability

Answer 450

Pyridoxine -This will help to active cystathionine B-synthase to eventually convert homocysteine to cysteine

Question 451

Initial work-up of HTN

Answer 451

BMP, CBC, urinalysis, lipid profile, and EKG -These are done to evaluate for any high risk comorbidities made worse by HTN

Question 452

Tx for HIT

Answer 452

Stop heparin; start argatroban (diretct thrombin inhibitor) or fondaparinux

Question 453

Assist control mode of respirator

Answer 453

Delivers a preset tidal volume that the patient can initiate with a breath but if they fail to breathe, then the respirator maintains a minimum breathing rate If the respirator is on this setting, consider adjusting the respirator rate with undesirable CO2 and O2 levels

Question 454

Most frequent location of ectopic foci that cause a-fib

Answer 454

Pulmonary veins

Question 455

PPD treatment protocols

Answer 455

>5: HIV, recent TB contact, nodules or fibrotic changes on CXR, organ transplant, immunosuppresion >10: Recent immigrant, injection drug users, high risk settings (homeless, prison, hospital), prolonged corticosteroids, diabetes, ESRD, children 15: Everybody

Question 456

HHV-8

Answer 456

Kaposi's Sarcoma

Question 457

Charcot-Bouchard aneurysms

Answer 457

HTN causing small ruptures and bleeds into the deep brain structures Locations: Basal ganglia (putamen), cerebellar nuclei, thalamus, pons

Question 458

MCCo lobar or cortical hemorrhage

Answer 458

Cerebral amyloid angiopathy

Question 459

MCCo nephrotic syndrome in adults

Answer 459

FSGS -Assoc. w/ being black, using heroin, having HIV, and being fat

Question 460

Patient who presents with signs of B12 deficiency but doesn't have classic RFs for nutritional deficiencies

Answer 460

Pernicious anemia ***Monitor these pts. for gastric cancer because they typically have atrophic gastritis from the anti-IF abs

Question 461

HIV pt with diarrhea

Answer 461

Non-bloody? =>> Stool exam for ova/parasites, C. dif ag, and acid-fast stain for Cryptosporidium Nloody? =>> CMV colitis or other typical infectious cause

Question 462

Hyperextensive injury in pt. with degenerative changes in the cervical spine

Answer 462

High RF for central cord syndrome S/s: Weakness in upper extremities w/ possible loss of pain and temp up here too

Question 463

Primary intervention to control GFR decline once azotemia is present

Answer 463

Intensive BP control Target= 130/80

Question 464

Patient with an autoimmune condition and it asks what other disease they might have

Answer 464

PICK THE AUTOIMMUNE CONDITION

Question 465

Lab findings in Paget's

Answer 465

Calcium- Normal PO43- Normal AP- Increased Urine hydroxyproline- Increased Urine Calcium- Increased

Question 466

Ulnar nerve syndrome

Answer 466

Entrapment of the ulnar nerve in the medial epicondylar groove Commonly caused by prolonged, inadvertant compression of the nerve by leaning elbows on a desk or table S/s: Numbness in 4th and 5th digits; weakened grip

Question 467

MTX ADRs

Answer 467

Hepatotoxicity Stomatitis Cytopenias -Try to prevent by giving the pt. folic acid supplementation

Question 468

Sulfasalazine ADRs

Answer 468

TNF and IL-1 suppressor ADRs are hepatotoxicity, stomatitis, and hemolytic anemia

Question 469

Pt who receives blood and shows signs of tetany and carpopedal spasm

Answer 469

Hypocalcemia

Question 470

Prevention of recurrent nephrolithiasis

Answer 470

Increase fluids Reduce sodium and protein Thiazide diuretics

Question 471

Test used to compare two means

Answer 471

Two sample t-test

Question 472

Test used to compare 3 or more means

Answer 472

ANOVA

Question 473

Best survival chance for renal failure pts.

Answer 473

Renal transplantation from a living related donor

Question 474

Hawthorne effect

Answer 474

Subjects are aware they are being studied and then they alter their behavior

Question 475

Isoniazid toxicity

Answer 475

Peripheral neuropathy and hepatotoxicity

Question 476

Post-ictal pt. who is acidotic

Answer 476

Just wait; this is temporary lactic acidosis caused by skeletal muscle hypoxia

Question 477

Lupus nephritis abs

Answer 477

anti-dsDNA

Question 478

Drug induced lupus abs

Answer 478

anti-histone ab

Question 479

PBC antibodies

Answer 479

anti-mitochondrial abs

Question 480

Pseudogout flare tx

Answer 480

Colcichine, NSAIDs Steroids if absolutely necessary Colcichine can cause diarrhea so be careful

Question 481

Causes of gout

Answer 481

Increased production: Tumor lysis syndrome Chemotherapy for leukemia Renal Failure Decreased excretion: Probenecid CKD EtOH HCTZ

Question 482

"Periarticular osteopenia"

Answer 482

RA

Question 483

DMARDS for RA

Answer 483

MTX Leflunoamide Sulfasalazine Hydroxychloroquine

Question 484

CREST syndrome

Answer 484

``` Calcinosis Raynauds (tx. w/ CCB) Esophageal dysmotility (tx. w/ PPI) Sclerodactyl (tight and no wrinkles) (tx. w/ penicillamine) Telangectasia ```

Question 485

Tx for renal failure in sclerotic crisis

Answer 485

ACEI Usually you give steroids w/ ARF but not in this case

Question 486

Lymphoplasmacytic infiltration of the exocrine glands

Answer 486

Sjogren's Syndrome

Question 487

Stasis dermatitis

Answer 487

Patients have peripheral edema that leads to chronic stretching presenting as erythematous and dark skin Tx: Diuretics; compression stalkings; leg elevation Can progress to ulcers on the medial malleolus (stasis ulcer)

Question 488

Hand dermatitis

Answer 488

Chronic hand-washing =>> dermatitis Found in health care workers and food preparers Tx: Conservative

Question 489

Tinea versicolor | Malasezzia sp.

Answer 489

Fungal infxn presenting as scaly macules of varying color ****There are areas of the body that DO NOT TAN Dx: KOH prep =>> Spaghetti and meatballs Tx: Selenium shampoo; ketoconazole

Question 490

Diagnosing and treating vitiligo

Answer 490

Dx: Wood's lamp; biopsy shows lack of melanocytes Tx: High potency topical steroids; extensive UV light

Question 491

Tyrosinase deficiency

Answer 491

Albinism

Question 492

Ash Leaf spot

Answer 492

Found in TS ***LOOK FOR SHARGREN PATCHES (elevated patches of fleshy blood vessels) F/u: CT scan to ID brain lesions

Question 493

"eggshell calcification"

Answer 493

Hyatid cyst

Question 494

Ototoxic drugs

Answer 494

AGCs, chemo, LOOP DIURETICS, and aspirin in high doses

Question 495

Things you can still see after brain death

Answer 495

Spinal reflexes (anything that doesn't require input to the brain)

Question 496

MCCo elevated AP in an asymptomatic elderly pt.

Answer 496

Ostetitis deformans

Question 497

Tx for renovascular HTN

Answer 497

ACEIs

Question 498

Renal stenting indications

Answer 498

Pts who cant tolerate medical therapy, develop recurrent flash pulmonary edema and/or refractory CHF, and pts. who fail to reach adequate BP control after a long time of medical therapy

Question 499

Best preventative measure for pressure ulcers

Answer 499

Pressure redistribution

Question 500

Tx for SVT

Answer 500

Adenosine; lowers automaticity of the SA node ADRs: Headache, flushing, SOB, chest pressure, nausea

Question 501

Prevention of SVT

Answer 501

Digoxin BB or Verapamil are 2nd line

Question 502

WPW drug tx

Answer 502

Type 1A or 1c antiarrhythmics Although definitive tx is radioablation

Question 503

Torsades de pointes tx

Answer 503

IV magnesium

Question 504

Tx of Vtach

Answer 504

Stable =>> IV amiodarone or sotalol Unstable =>> Cardioversion followed by amiodarone

Question 505

Patient who has sharp chest pain and it is the worst of their life with a widened mediastinum

Answer 505

Aortic dissection Probably caused by systemic HTN

Question 506

Tx of hyperthyroidism

Answer 506

Mild =>> Antithyroid med alone Moderate to severe =>> Antithyroid med, BBs, radioactive iodine

Question 507

Tinea corporis

Answer 507

Scaly, erythematous, pruritic patch with centrifugal spread and central clearing with a raised, annular border Skin scraping w/ KOH would show segmented hyphae and arthrospores Tx: Topical clotrimazole or terbinafine Second line: Oral griseofulvin or terbinafine

Question 508

Cyclophosphamide ADRs

Answer 508

Acute hemorrhagic cystitis, bladder cancer, sterility, and myelosuppression Prevent by drinking plenty of fluids or taking MESNA******

Question 509

Follow-up of positive stress test

Answer 509

Coronary angiography on pts. with high risk findings OR Have a high pre-test probability (typical angina in men >40 or women >60)

Question 510

Bronchiectasis

Answer 510

Pts have repeated pulmonary infxn plus defective bacterial clearance; could also be caused by airway obstruction (cancers) immunodeficiencies, CR, a1-antitrypins deficiency PE: Crackles, wheezing, fever, dyspnea, increased sputum Dx: CT scan of the chest (shows bronchial dilation and wall thickening) -May also consider IG quantification, CF testing, and PFTs

Question 511

Tx of diabetic gastroparesis

Answer 511

Increased fiber, small and frequent meals Metoclopromide Erythromycin is second line

Question 512

Anemia that pyridoxine deficiency produces

Answer 512

Acquired sideroblastic anemia Increased serum iron and decreased TIBC

Question 513

Euthyroid sick syndrome

Answer 513

Normal TSH And T4 but decreased T3 caused by decreased deiodination to T4 Typically occurs in pts. w/ exacerbation of illnesses and thyroid hormone supplementation is NOT recommended

Question 514

Severely ill pts. who on CXR have pneumonia

Answer 514

Still get a sputum culture before empiric antibiotics because the antibiotics can produce a false negative

Question 515

Extramuscular findings of dermatomyositis

Answer 515

Interstitial lung disease Dysphagia Myocarditis MALIGNANCY (must screen pts.)

Question 516

Follicular thyroid cancer

Answer 516

Biopsy shows follicular cells clustered together and INVADE THE TUMOR CAPSULE and possibly a blood vessel ***Spreads hematogenously

Question 517

Drug that acts on B1-receptors

Answer 517

Dobutamine Used for severe left ventricular systolic dysfnxn and cardiogenic shock =>>Decreased LVESV

Question 518

First thing to do in someone SUSPICIOUS for pneumonia

Answer 518

CXR YOU DUMB FUCK

Question 519

Postviral thyroiditis

Answer 519

Likely subacute thyroiditis; hyperthyroid sx. and fever alongside elevated ESR and CRP

Question 520

RA leads to an increased risk of what bone conditions?

Answer 520

Osteoporosis and bone fractures

Question 521

Extension of the knee while compressing the patella

Answer 521

Patellofemoral compression test

Question 522

Dermatitis herpetiformis

Answer 522

Intensely pruritic papules, vesicles, and bullae that occure symmetrically in clusters on the elbows, knees, back, and butt AI rxn to gluten; ASSOC. W/ CELIAC Skin biopsy: Microabscesses at the tips of the dermal papilla and anti-epidermal transglutamase IgA Tx: Dapsone; long-term is gluten free diet

Question 523

Recurrent cataracts

Answer 523

NOT A THING

Question 524

Pt recovering from a viral uri who is having episodic dizziness and hearing loss

Answer 524

Vestibular neuritis Tx: Steroids

Question 525

MAO-b inhibitor

Answer 525

Selegline

Question 526

COMT inhibitor

Answer 526

Entacapone

Question 527

Major interactions of levothyroxine

Answer 527

Decreased absorption: Bile acid binders, iron, calcium, AlOH, PPIs, sucralfate Increased TBG conc: Estrogen, tamoxifen, raloxifene, heroin, methadone Decreased TBG conc: Androgens, glucocorticoids, anabolic steroids Increased thyroid hormone metabolism: Rifampin, phenytoin, carbamazepin (CYP-inducers)

Question 528

Drug-induced acne

Answer 528

Monomorphic papules without comedones Lesions are found in the same stage of development; does not respon to typical tx. Causes: Steroids, androgens, azathioprine, anticonvulsant, antipsychotics, isoniazid

Question 529

pH disorder with adrenal insufficiency

Answer 529

Normal anion gap metabolic acidosis Due to decreased aldosterone

Question 530

Tx for cervicofacial Actinomyces

Answer 530

Penicillin

Question 531

DOC for primary biliary cholangitis

Answer 531

Ursodeoxycholic acid

Question 532

Measurement bias

Answer 532

Results from poor data collection with inaccurate results

Question 533

STI that cannot be seen on gram stain

Answer 533

Chlamydia

Question 534

Imaging for obstructive urolithiasis

Answer 534

Abdominal US or noncontrast spiral CT

Question 535

IE from streptococcus sp.

Answer 535

IV penicillin or ceftriaxone

Question 536

Biopsy in Histoplasmosis

Answer 536

Granulomas with narrow-based budding yesasts

Question 537

Confirming a diagnosis of primary sclerosing cholangitis

Answer 537

Can be done with an ERCP Bx would show intrahepatic ductular obliteration with lymphocytic infiltration and periductular "onion-skin" fibrosis

Question 538

CHADS-VASc score

Answer 538

``` Congestive heart failure HTN Age >75 (+2) DM Stroke/TIA/Thromboembolism hx. (+2) Age 65-74 Sex category (female) ```

Question 539

Naloxone OD in homeless person

Answer 539

AMS, hypothermia, bradypnea, and hypoxia

Question 540

Tx for hypertensive emergency

Answer 540

IV nitrates, CCBs, and BBs Drop the BP by 25% in 2-6 hrs; get it to normal in 24

Question 541

Tx for hypertensive emergency

Answer 541

IV nitrates, CCBs, and BBs Drop the BP by 25% in 2-6 hrs; get it to normal in 24

Question 542

Acute, monocular vision loss, "washed-out" colors, afferent pupillary defect, and pain with eye movement in a woman

Answer 542

Optic neuritis Immune-mediated inflammatory demyelination of the optic nerbve

Question 543

Chronic cirrhosis effects on thyroid hormone

Answer 543

Lowers total T3 and T4 Free T3 and T4 are normal as well as TSH

Question 544

Blastomycosis

Answer 544

Found in the Mississippi and Ohio River valleys as well as the Great Lakes region S/s: Pneumonia, wartlike lesions, skin ulcers, violaceous skin lesions, possible osteomyelitis and prostatits

Question 545

Amitriptyline in old people

Answer 545

Dont do this, you'll trigger urinary retention and then have to cath them

Question 546

Patient who receives nitroprusside for a long time

Answer 546

Look for signs of cyanide toxicity

Question 547

Signs of secondary syphilis

Answer 547

Diffuse rash Lymphadenopathy *epitrochlear* Condyloma lata Grey mucous patches Hepatitis

Question 548

Repaglinide, nateglinide

Answer 548

Glinides Weight gain; mostly targets postprandial glucose Binds to sulfonylurea receptor and stimulates insulin release

Question 549

Pioglitazone, rosiglitazone

Answer 549

Thiazolidinediones PPARy activators that increase peripheral tissue sensitivity to insulin ADRs: HF, weight gain, minor infarction risk

Question 550

Exenatide, liraglutide

Answer 550

Incretins Activates GLP-1 receptors increasing glucose-dependent insulin secretion and decreasing glucagon secretion ****ALSO DELAYS GASTRIC EMPTYING AND INCREASES EARLY SATIETY ADRs: N/V; rare pancreatitis

Question 551

Sitagliptin, saxagliptin

Answer 551

DDP-4 inhibitors Inhibit degradation of GLP-1 ADRs: Urticaria

Question 552

Dapagliflozin, canagliflozin

Answer 552

SGLT2 inhibitors in the proximal renal tubules to reduce renal reabsorption of filtered glucose ADRs: Genital yeast infxns and UTIs

Question 553

Elderly pt. with history of chronic falls and progressive dementia

Answer 553

Think chronic subdural hematoma before vascular dementia

Question 554

RVMI leads

Answer 554

V4r-V6r

Question 555

Pneumomediastinum

Answer 555

Esophageal perforation related to Boerhaave syndrome, instrumentation, esophagitis, or ulcer rupture

Question 556

CRVO tx

Answer 556

No macular edema? =>> Conservative Macular edema? =>> Intravitreal injxn of anti-VEGF

Question 557

Indications to treat subclinical hypothyroidism

Answer 557

Symptomatic Pregnancy TSH >10 Anti-TPO abs

Question 558

Acute cystitis tx options

Answer 558

Nitrofurantoin for 5 days (avoid in suspected pyelonephritis or CKD) Bactrim for 3 days Single fosfomycin dose FQNs if primary tx. fails; also get a urine culture

Question 559

Pt. who is on a ventilator and develops signs of pneumonia

Answer 559

VAP; typically caused by Psed. E. coli, or K. pneumoniae (gram negs) or gram pos bacteria Management: 1. Get CXR 2. Sputum culture 3. Abs

Question 560

Pts. who are on EPO but remain anemia

Answer 560

Give iron supplementation due to rapid depletion

Question 561

First thing to do in suspected stroke

Answer 561

Non-contrast CT

Question 562

Coverage for HCAP

Answer 562

Vance and zosyn

Question 563

F/u on pulmonary cavitary lesion on CXR

Answer 563

CT

Question 564

Improvers of mortality in copd

Answer 564

O2 Smoking cessation

Question 565

Treatment of hypernatremia

Answer 565

Dextrose in water

Question 566

Confounding factors

Answer 566

Things that partially explain an association I.e. - People who smoke are also more likely to drink

Question 567

Tx for severe hypovolemic hypernatremia

Answer 567

Normal saline

Question 568

Patients with mild hypovolemic hypernatremia

Answer 568

Dextrose in saline

Question 569

Patients with hypervolemic hypernatremia

Answer 569

Dextrose in 1/2NS

Question 570

Patient who has a viral illness but then a cough productive of sputum that sticks around for a while

Answer 570

Acute bronchitis

Question 571

Initial step in confirming hypercortisolism

Answer 571

EITHER A 24 HOUR URINE FREE CORTISOL MEASUREMENT AND/OR OVERNIGHT LOW-DOSE DEXAMETHASONE SUPPRESSION TEST YA DUMB FUCK

Question 572

Comps of acute pancreatitis

Answer 572

ARDS ARF GI bleed Necrotizing pancreatitis Peripancreatic fluid collection Pseudocyst Pathophys: Release of inflammatory mediators cause widespread vasodilation, capillary leak, shock, and end organ damage

Question 573

Miliary TB x ray

Answer 573

Diffuse reticulonodular patter (millet seed) Make sure to be on the look out for predisposing factors

Question 574

Tx for single brain mets

Answer 574

SURGERY

Question 575

Tx for multiple brain mets

Answer 575

Whole Brain Radiation or supportive care

Question 576

Wernicke Encephalopathy features

Answer 576

Encephalopathy (confusion) Oculomotor dysfnxn (horizontal nystagmus, bilateral abducens palsy) Postural and gait ataxia

Question 577

Pt with aortic stenosis and under the age of 70

Answer 577

Bicuspid valve

Question 578

S4 associated conditions

Answer 578

Young adults/children Ventricular hypertrophy MYOCARDIAL INFARCTION (EARLY)

Question 579

Acute GVHD

Answer 579

Donor T-lymphocytes react with host minor HLA-antigens and produce a cell-mediated response =>>Maculopapular, pruritic rash, bloody diarrhea, and abnormal LFTs with jaundice are common manifestations

Question 580

HIT antibodies

Answer 580

Heparin produces a change in platelet surface protein 4 causing the formation of AAs =>>Platelet aggregation, thrombocytopenia, skin necrosis at abdominal injection site

Question 581

Papillary muscle displacement but not rupture of the mitral valve

Answer 581

Increased left ventricular pressure due to the regurgitation

Question 582

Patients to screen for fibromuscular dysplasia

Answer 582

Women <50 with one of the following: Severe or resistant HTN Onset of HTN before 35 Increase in Cr after starting an ACEI or ARB Epigastric bruit Screen with CT scan or US

Question 583

EKG showing LVH

Answer 583

High voltage QRS complexes, lateral lead ST segment depression, lateral lead T wave inversion

Question 584

Renal vascular lesions with chronic HTN

Answer 584

Arteriosclerosis of the afferent and efferent arterioles and glomerular capillary tufts Eventually hypertrophy and intimal fibrosis of the arterioles

Question 585

Pronator drift

Answer 585

Patient whose hand drifts downward when they hold their arms straight out with their palms up and eyes close ****SIGN OF PYRAMIDAL OR CORTICOSPINAL TRACT LESION -UMNs cause more weakness in supinator muscles

Question 586

Patient with a stone 5mm or less

Answer 586

DRINK LOTS OF FLUIDS YOU DUMB FUCK

Question 587

Flank pain, RCC, palpable renal mass

Answer 587

RCC triad; pt. needs a CT scan ***Scrotal varicies can be seen on the the left side due to tumor obstruction of the gonadal vein entering the renal vein

Question 588

Pt with bone mets from prostate cancer

Answer 588

TX WITH RADIATION YA DUMB FUCK

Question 589

Chronic pancreatitis

Answer 589

Can occur with prolonged consumption of socially acceptable amounts of alcohol; pain can radiate to the back and be relieved by sitting up or leaning forward Pts typically also have steatorrhea, weight loss, glucose intolerance

Question 590

Does prostate cancer go to the liver?

Answer 590

No, colon cancer does ya dingus

Question 591

New onset of urinary incontinence in an elderly patient

Answer 591

UTI= MCC Could also include meds, CHF, DM, alcohol, stool impaction

Question 592

Initial workup of any blood disorder q

Answer 592

CBC ya dingus

Question 593

What should be done after a diagnosis of cancer?

Answer 593

CT scan Stage disease and look for mets

Question 594

New lung mass found on CXR, what do you do next?

Answer 594

CT scan

Question 595

Patient with back pain that improves with movement who is >50

Answer 595

Probably spinal stenosis AS presents in pts. from 15-30

Question 596

Confirmatory test for spinal stenosis

Answer 596

MRI

Question 597

Young patient presenting with restrictive lung disease signs but also improves with exertion

Answer 597

Probably AS Restrictive signs are due to chest wall motion restriction

Question 598

PT with acutely elevated serum creatinine

Answer 598

Get a renal US Want to rule out hydronephrosis

Question 599

Causes of increased peak pressure on a ventilator

Answer 599

Normal plateau pressure: Bronchospasm, mucus plug, biting ET tub Increased plateau pressure: PTX, edema, pneumonia, atelectasis

Question 600

Seborrheic keratosis locations

Answer 600

Face, trunk, upper extremities

Question 601

Initial test for a positive cervical lymph node for cancer

Answer 601

Panendoscopy

Question 602

Contact dermatitis

Answer 602

Encompasses both allergic and irritant (acids, soaps)

Question 603

Tx of uric acid stones

Answer 603

Hydration, alkalinization, and low-purine diet Prevention: Potassium citrate (citrate reduces crystallization) Allopurinol if this fail

Question 604

Follow up test for a positive Hep C antibody

Answer 604

HCV viral load (confirmatory)

Question 605

Pt who is started on a BB and develops SOB a couple days later and wheezing

Answer 605

Guess what happened? Pt probably has a history of rhinitis and eczema meaning undiagnosed asthma

Question 606

Pt with amoxicillin and develops anemia later

Answer 606

Warm AIHA

Question 607

Positive urine urobilinogen

Answer 607

Sign of INTRAVASCULAR hemolysis Unconjugated hemoglobin is converted to this and excreted in the urine and feces

Question 608

Megacolon in someone who is from SA

Answer 608

Still consider chagas

Question 609

Pt with alcohol abuse who develops mouth swelling from the floor of the mouth

Answer 609

Ludwigs angina

Question 610

TTP

Answer 610

Hemolytic anemia with possible renal failure, neurologic manifestations, and fever Tx: Plasma exchange

Question 611

Most effective nonpharmacologic measure to decrease BP in overweight individuals

Answer 611

Weight loss

Question 612

Asking about hypertensive emergency criteria

Answer 612

Pick end organ damage over BP

Question 613

Cauda equina syndrome is primarily an issue with what?

Answer 613

Spinal nerve roots Causes: Disc herniation, spinal mets, spinal stenosis, infxn, hemorrhage ***Spinal cord ends at L1-L2 and cauda equina begins below this ***Only causes LMN signs as opposed to conus medullaris

Question 614

Classic clinical criteria for ARDS

Answer 614

Hypoxemia refractory to O2 therapy Bilateral diffuse pulmonary infiltrates on CXR No evidence of CHF

Question 615

Tx of ARDS

Answer 615

Mechanical ventilation w/ PEEP; increases lung volume by opening collapsed alveoli Avoid volume overload

Question 616

Synchronous intermittent mandatory ventilation

Answer 616

Like assist control BUT the tidal volume is not precontrolled by the ventilator ***AC is much more commonly used -This mode is good for weaning patients off the ventilator tho BUT I WOULD STILL USE CPAP

Question 617

Ventilator to adjust to achieve baseline PaCO@

Answer 617

Minute ventilation

Question 618

I:E ration on a vent

Answer 618

Usually uses 1:2 If you increase one, the other goes down

Question 619

ADRs of high levels of PEEP

Answer 619

Barotrauma with possible PTX Low CO due to decreased VR

Question 620

Comps on ventilators

Answer 620

Sedation with benzos as anxiety and agitation are common Suction trachea Nosocomial pneumonia if >72 hrs Accidental extubation Barotrauma Tracheomalacia (you know who) -If she would have gotten a tracheostomy after 2 weeks on the vent; none of that would have happened

Question 621

Tx for primary pulmonary HTN

Answer 621

Prostacyclin; CCBs (pulmonary vasodilators) Anticoagulation Lung transplantation if possible after evaluation

Question 622

Peaked p waves

Answer 622

P pulmonale

Question 623

Manifestations of Grave's Disease

Answer 623

Gen: Heat intolerance, weight loss, sweating Eyes: Lid lag, proptosis, DIPLOPIA, DECREASED CONVERGENCE Skin: Hair loss, infiltrate dermopathy CV: Tachycardia, HTN, a-fib Nails- Onycholysis, clubbing Endo: Hyperglycemia, hypercalcemia, bone loss, menstrual irregularities GI: Diarrhea Neuro: Tremors, hyporreflexia, proximal muscle weakness

Question 624

Ventricular aneurysm

Answer 624

Commonly occurs 5 days-2 weeks after an MI EKG: persistent ST-segment elevation after a recent MI and deep Q waves in the same leads -HF, refractory angina, arrhythmia, mural thrombus with possible embolization, mitral annular dilatation with regurgitation Dx: Echo shows dyskinetic LV portion in same area of previous MI

Question 625

Indications for testing for someone for an inheritable hypercoagulopathy

Answer 625

Age <45 Recurrent DVT Multiple or unusual sites of thrombosis FH of VTE

Question 626

Where is Broca's area located?

Answer 626

Frontal lobe

Question 627

Where is Wernicke's area located

Answer 627

Temporal lobe

Question 628

Thyrotoxicosis with normal or decreased iodine uptake

Answer 628

Painless (Silent) thyroiditis; assoc. w/ anti-TPO and is a variant of chronic lymphocytic (Hashimoto's) thyroiditis Subacute thyroiditis Amiodarone-induced thyroiditis Excessive intake Struma ovarii Iodine-induced Cancer met s

Question 629

Study of choice for Aortic Dissection of unstable pt.

Answer 629

Transthoracic echocardiography CT if stable (Don't do with kidney disease)

Question 630

Tx for acute back pain

Answer 630

NSAIDs; moderate activity NOT PT YOU IDIOT

Question 631

Therapy for chronic back pain

Answer 631

PT

Question 632

Pts loss to follow-up in a prospective study is what type of bias?

Answer 632

Selection bias | -Study winds up with inaccurate estimate of disease exposures and relevance

Question 633

Pt who is given amoxicillin for sore throat and develops a rash 24 HOURS after administration

Answer 633

Probably has mono ***If the rash immediately develops, it is hypersensitivity

Question 634

Riley-Day Syndrome

Answer 634

"Familial dysautonomia" Jewish kid with gross dysfnxn of the autonomic nervous system with severe orthostatic hypotension

Question 635

Attributable risk percent

Answer 635

Represents the excess risk in a population due to exposure to an RF ARD= (risk in exposed-risk in unexposed)/risk in exposed

Question 636

Factors found in Cushing Syndrome but not in PCOS

Answer 636

Skin atrophy Muscle weakness Bruisability

Question 637

Patient who develops an infxn after being treated for hyperthyroidism

Answer 637

THINK ABOUT AGRANULOCYTOSIS STOP PTU

Question 638

Chronic bronchitis

Answer 638

Can progress to hemoptysis Don't automatically think of cancer or bronchiectasis

Question 639

Polymositis vs/ hyperthyroidism

Answer 639

Does not present with any other sx. than muscle weakness IF patients have tachcardia, weight loss; think hyperthyroidism

Question 640

Patient who is on an antipsychotic and has elevated prolactin

Answer 640

Check other pituitary hormones; they should not be suppressed If they are =>> suspect adenoma

Question 641

Hypothyroid myopathy

Answer 641

Muscle weakness; elevated CK; fatigued woman with decreased DTRs

Question 642

Pt in the hospital for 2 days with hallucinations, HTN, hyperthermia, tremors, and diaphoresis

Answer 642

Delirium tremens Give benzos because they act as GABA agonists like alcohol

Question 643

Differences between strokes caused by amyloidopathy and HTN

Answer 643

Amyloidopathy =>> Lobar and CORTICAL HTN=>> Charcot-Bouchard aneurysms and deep structures

Question 644

Lab findings in anemia of chronic disease

Answer 644

Iron: Decreased TIBC: Decreased Ferritin: Normal-increased Transferrin saturation: Decreased-normal MCV: Decreased-normal

Question 645

Patient with signs of RA and splenomegaly

Answer 645

Felty Syndrome

Question 646

Bullous pemphigoid tx

Answer 646

Topical clobetasol

Question 647

"Carboxyhemoglobinemia"

Answer 647

Refers to CO poisoning NOT CO2 you dipshit

Question 648

Other sign of a STEMI

Answer 648

New onset of LBBB

Question 649

Psoriasis treatment

Answer 649

Calcipotriol Steroids Combo is best

Question 650

Where is the fluid in Angioedema?

Answer 650

The subcutaneous layer, unlike with urticaria Can also be found in the hands, feet and genitalia

Question 651

Pleural effusion lung sounds

Answer 651

Percussion: Dull Tactile fremitus: Decreased Breath sounds: Decreased

Question 652

Lung consolidation sounds

Answer 652

Percussion: Dull Tactile fremitus: Increased Breath sounds: Decreased

Question 653

Mechanical obstruction abdominal x-ray appearance

Answer 653

Air through the entire GI tract with dilated and scattered loops stacked on top of each other "Bag of sausages"

Question 654

Ileus abdominal x-ray appearance

Answer 654

Dilated loops that are scattered and lack organization "Bag of popcorn"

Question 655

Patient who has a central line placed and then has sudden onset of dyspnea

Answer 655

Consder PTX or venous air embolism

Question 656

Patient who was given an antibiotic for let's say endocarditis and develops a diffuse, red rash

Answer 656

Probably vancomycin "Red Man Syndrome" S/s: Fever, nephrotoxicity, ototoxicity Tx: Slow the infusion; give antihistamines

Question 657

Drug you should always give with imipinem

Answer 657

Cilastatin; prevents renal toxicity

Question 658

Drug used for GNR sepsis

Answer 658

CArbapenem

Question 659

Tx of chlamydia in a pregnant woman

Answer 659

Erythromycin

Question 660

Only FQN with anaerobic coverage

Answer 660

Moxifloxacin

Question 661

TB therapy

Answer 661

4 drug therapy for two months Rifampin and INH for 4 months

Question 662

Prophylactic for pts. with contact for menigococcal meningitis

Answer 662

Rifampin

Question 663

Pt treated for vaginal discharge and has vomiting after going out one night

Answer 663

Disulfarim rxn due to metronidazole

Question 664

Pt who is in a car accident and has weakness that is more pronounced in the upper extremities than the lower

Answer 664

Central cord syndrome - This is because the motor fibers serving the arms are closer to the central part of the corticospinal tract - Pt. does not necessarily have to have loss of pain and temp

Question 665

Patient who has signs of a heart attack and then has a syncopal episode shortly after to the ER

Answer 665

PRobably due to a reentrant arrhythmia If it happens 10-60 minutes later, it is due to abnormal automaticity

Question 666

Pt who has a chronically progressive cough and comes to the ER with upper lobe consolidation with possible cavitation

Answer 666

Mycobacteria Remember, aspiration pneumonia typically affects the lower lobes

Question 667

PT. who has malaria-like sx. but lives in New York

Answer 667

Babesiosis

Question 668

Hypovolemic shock hemodynamic parameters

Answer 668

RA pressure: Decreased PCWP: Decreased CI: Decreased SVR: Increased MvO2: Decreased

Question 669

Study in which population is randomly selected and then determined if they have the disease and marker or not

Answer 669

Probably a cross-sectional study ****ANY STUDY THAT LOOKS AT PREVALENCE, GUESS THIS*****

Question 670

Tx for patients with symptomatic hypercalcemia

Answer 670

Parathyroidectomy

Question 671

Causes of 1st time seizure

Answer 671

``` Vitamins Infxn Trauma Autoimmune Metabolic Ingestion/Withdrawal (benzos and alcohol) Neoplasm pSych ```

Question 672

Tx for myoclonic seizures

Answer 672

Valproic acid No loss of tone

Question 673

Tx for atonic seizure

Answer 673

Valproic Acid Loss of tone

Question 674

Paradoxical splitting of S2

Answer 674

Narrowing of normal S2 split Occurs due to LBBB, aortic stenosis, and HTN

Question 675

Rales

Answer 675

Same thing as crackles! Due to excessive fluid in the lungs

Question 676

Positive babinski

Answer 676

EXTENSION

Question 677

Observational studies

Answer 677

Case-control studies

Question 678

Study that observes subjects at a specific point in time

Answer 678

Cross-sectional "Snapshot of a population"

Question 679

Patients are selected because they have a certain outcome and their history is reviewed for any exposures

Answer 679

Case-control ALWAYS RETROSPECTIVE *Good for rare diseases and diseases with long latent periods

Question 680

Studies are selected according to exposure and are followed over time to determine the development of disease

Answer 680

Cohort study

Question 681

Type I error | alpha error

Answer 681

Same thing as a p-value Null hypothesis is rejected even though it's true

Question 682

Type II error

Answer 682

Null hypothesis is accepted even though it is not true *Determines the statistical power of a study Usually, 20% is accepted Factors that affect it: Sample size, p-value, variability of data, effect size chosen by researcher

Question 683

PErformance bias

Answer 683

Subjects in comparison groups are given different care other than the intervention being studied Example: One group receives interventional counseling in addition to the treatments that both groups get

Question 684

Attrition bias

Answer 684

Drop-outs from a study

Question 685

Intent-to-treat analysis

Answer 685

Analyzes drop outs from a study in groups to which they were initially assigned Helps prevent attrition bias

Question 686

Studies that suffer from bias lack what type of validity?

Answer 686

Internal

Question 687

Studies that cannot be generalized to a larger and more complex population lack?

Answer 687

External validity

Question 688

Pt presenting with upper abdominal pain with nausea and vomiting and a history of diabetes

Answer 688

Still get EKG first; need to rule out ACS

Question 689

Pt who has HIV and CXR suggestive of pneumoniae but CD4>200

Answer 689

NOT PCP; PROBABLY ONE OF THE NORMAL BUGS

Question 690

COPD respiratory findings

Answer 690

Bilateral wheezing ABG shows respiratory acidosis and hypoxia

Question 691

Pt who has either liver disease or nephropathy and presents with hypocalcemia

Answer 691

Consider hypoalbuminemia as the cause

Question 692

Should you give someone bitten by a pet rabies prophylaxis

Answer 692

Nah just observe the pet for 10 days

Question 693

Tx for cocaine OD even if it is presenting with coronary vasospasm

Answer 693

IV benzodiazepines

Question 694

Does thyroid hormone increase production of catecholamines?

Answer 694

No; it increases sensitivity to them

Question 695

Best medication reconciliation to reduce adverse drug events in patients

Answer 695

Pharmacist-directed interventions

Question 696

Ventilation-perfusion scans that show perfusion defects

Answer 696

SUSPECT SOME SORT OF EMBOLI - Could be recurrent if the pt is not currently symptomatic - Pt will probably have evidence of venous disease

Question 697

Bone scan showing multiple dark areas that are well circumscribed and not diffuse

Answer 697

Think mets

Question 698

Fluffy bilateral interstitial and alveolar infiltrates

Answer 698

Think pulmonary edema =>>Pts. will have alveolar-arteriolar mismatch

Question 699

Severe umremitting chest pain radiating to the arm and back

Answer 699

Aortic dissection Pt can have small left pleural effusion

Question 700

Type I diabetic who collapses while exercising. What is your immediate treatment?

Answer 700

Dextrose Probably a hypoglycemic episode

Question 701

Pt with epigastric tenderness, itching, increased bilirubin, and a history of having her gallbladder removed

Answer 701

CT to r/o pancreatic cancer You know it cant be gallstones

Question 702

Healthcare proxy who insists that you do something that is medically contraindicated for a patient

Answer 702

Nah don't do it what does he know

Question 703

Cause of dehydration in HNNC

Answer 703

Osmotic diuresis

Question 704

Most effective therapy to prevent an asthma exacerbation following an illness

Answer 704

Oral corticosteroids

Question 705

Indications for a court order

Answer 705

Patient has no capacity to make a decision, there is no living will or proxy, and the family cannot decide

Question 706

Drug to use when statins can't be used

Answer 706

Fibrates Can cause same ADRs tho

Question 707

Ezetemibe ADR

Answer 707

Diarrhea; consider this if pt. just started

Question 708

Drug to give w/ niacin

Answer 708

Aspirin Will prevent the flushing

Question 709

Vasovagal syncope causes

Answer 709

Visceral organ stimulation (excessive coughing, urination) Carotid bodies (increased sensitivity to pressure =>>vagal response) Test: Tilt-table if you want but DX IS USUALLY DETERMINED BY HISTORY ****USUALY A PRODROME Tx: BB

Question 710

Dx of orthostatic hypotension

Answer 710

Systolic change of 20 Diastolic change of 10 HR change of 15 Tx: Give fluids or treat any loss of fluids or neuropathic disease

Question 711

Test done for pain sensation

Answer 711

Pinprick yah dingus Remember that the nerves come from 1-2 levels higher

Question 712

Causes of pulsus paradoxus

Answer 712

Cardiac tamponade Severe asthma COPD definition: drop in systolic bp >10 on inspiration

Question 713

Indications for splenectomy

Answer 713

Hereditary spheroctosis Warm AIHA if severe Massive splenomegaly w/ B-thalassemia major or Hgb H disease

Question 714

ANYTIME IT TELLS YOU ABOUT A PACEMAKER AND HEART FAILURE OR MURMUR

Answer 714

DO NOT RULE OUT RIGHT SIDED CAUSES

Question 715

Pt who has a nighttime dry cough with a history of seasonal allergy; what is probably causing it?

Answer 715

Post-nasal drip yah dingus

Question 716

Pt who has aortic stenosis at age 70 or greater

Answer 716

Age-related change

Question 717

Pt with IV drug abuse and they also have TB but have rapid signs of decompensation

Answer 717

I would look more towards a problem with the IV drug use

Question 718

INITIAL TREATMENT FOR FEBRILE NEUTROPENIA

Answer 718

Pip-tazo -This is going to cover gram negs (including pseud) and many gram positives as well

Question 719

Pt with hypernatremia with neurologic manifestations

Answer 719

Normal saline then switch to D5W later

Question 720

Initial treatment for Chronic Venous Insufficiency

Answer 720

Leg Elevation Followed by compression stockings

Question 721

Hyperkalemia EKG

Answer 721

Tall peaked T-waves PR prolongated QRS widened Disappearance of p wave Conduction blocks, sine wave pattern

Question 722

Meningococcal meningitis

Answer 722

Sudden onset of fever, headache, myalgia, and vomiting alongside nuchal rigidity, AMS, and petechial rash Differentiate this from RMSF because RMSF has CSF findings similar to VIRAL MENINGITIS

Question 723

Old patient on NSAIDs and/or aspirin who is anemic

Answer 723

IDE most likely cause

Question 724

Can osteoarthritis cause anemia of chronic disease?

Answer 724

No; but lupus and RA can

Question 725

Treatment for CML

Answer 725

Imatinib; A TK INHIBITOR

Question 726

RApid reversal of warfarin bleed

Answer 726

Prothrombin complex concentrate or FPP along with Vitamin K

Question 727

Degenerative changes in Alzheimer's

Answer 727

Diffuse cortical and subcortical atrophy mostly in the temporal and parietal lobes

Question 728

Persistent Vegetative State

Answer 728

Similar to coma but there is NO ACTIVITY ON EEG Both still have brainstem activity; therefore there is reflexes, they may swallow, have that cold water eye reflex, corneal reflex, and other shit ya feel

Question 729

Virchow's triad

Answer 729

1. Venous stasis 2. Endothelial injury 3. Hypercoagulable state

Question 730

Likely ABG on PE

Answer 730

Decreased pO2 -Due to decreased perfusion and it is DIFFUSION limited Decreased pCO2 -Due to increased CO secondary to hypoxemia Overall will show respiratory alkalosis

Question 731

Test to get in pt with possible PE but history of CKD

Answer 731

V/Q scan

Question 732

Massive PE tx

Answer 732

tPA Do this if the pt. has PE with pulmonary hTN and overall hypotension