ABFM Questions Flashcards
1
Q
CXR findings of Bronchiectasis
A
Bronchial dilation and bronchial wall thickening
2
Q
CXR findings of Left Heart Failure
A
Pulmonary Edema
3
Q
CXR findings in Diffuse Panbronchiolitis
A
Diffuse small centrilobular nodule opacities along with hyperinflation
4
Q
CXR findings of interstitial lung disease
A
Reticular or increased Interstitial markings
5
Q
Pharmacologic treatment for BPH and lower UTI symptoms in male
A
alpha-adrenergic blocker, or 5-alpha-reductase inhibitor (if evidence of prostatic enlargement or PSA >1.5), PDE-5inhibitor or antimuscarinic therapy
6
Q
First test for male with hypogonadism (mild fatigue, decreased libido, erectile dysfunction)
A
FSH and LH levels (to distinguish between primary and secondary hypogonadism)
7
Q
Functional constipation (4 year old with hard stool)
A
Miralax (polyethylene glycol) is effective. Fiber not supported in treatment of functional constipation
8
Q
Patients treated with amiodarone (cordarone) should be monitored for:
A
Hyper vs. hypothyroidism (baseline TFTs with f/u every 6 months)
9
Q
First line treatment for primary dysmenorrhea
A
NSAIDs (started at the onset of menses and continued for the first 1-2 days of menstrual cycle)
10
Q
Tremors:
Abrupt onset, spontaneous remission, changing characteristics, extinction with distraction
A
Psychogenic tremor
11
Q
Tremors:
intention tremor with ipsilateral involvement on the side of the lesion
A
Cerebellar tremor (you will see past-pointing on finger-to-nose testing), CT/MRI diagnostic test of choice
12
Q
Tremors:
At rest, asymmetric, decreases with voluntary movement, sometimes bradykinesia, rigidity and postural instability are noted
A
Parkinsonian tremor (if atypical presentation, a single-photon emission CT or position emission tomography may help)
13
Q
Tremors:
symmetric, fine tremors that involve the hands, wrists, head, voice or lower extremities, improve with alcohol
A
Essential tremor
14
Q
How to treat essential tremor
A
Propranolol or Primidone
15
Q
Tremors:
Postural tremor of low amplitude exacerbated by medication (history of caffeine or anxiety)
A
Enhanced physiologic tremor
16
Q
Weakness with internal rotation of the shoulder
A
Tear of subcapularis tendon
17
Q
If you have hyponatremia and low serum osmolality, what confirms SIADH?
A
Elevated urine osmolality. Patient should be euvolemic and have not taken diuretics in the past 24-48 hours
18
Q
First line tx for HTN in African American pts
A
Thiazide diuretics and CCBs
19
Q
Liraglutide, Exenatide, Dulaglutide
A
GLP-1 agonists
20
Q
Liraglutide
A
Lowers risk of cardiovascular events and DM
21
Q
Empagliflozin
A
SGLT-2 inhibitor, secondary prevention of cardiovascular disease and DM
22
Q
Appropriate screening for 2-16 years old with SCD
A
Screen with transcranial Doppler ultrasonography because of increased risk of vascular disease
23
Q
Clinodactyly
A
Curvature of fifth digit of hand - FAS
24
Q
Camptodactyly
A
Flexion deformity of fingers - FAS
25
Camptydactyly + Clinodactyly + other flexion contractors + radioulnar synostosis, scoliosis, spinal malformations
Fetal Alcohol Syndrome
26
Tx for child with otitis media with effusion
No treatment and follow up in three months
27
Polyneuropathy, macrocytic anemia, history of chronic PPI use
Vitamin B12 deficiency
28
Causes of silicosis
Stone cutting, sand blasting, mining, quarrying exposure
29
Causes of chronic beryllium lung disease
Occupational exposure to beryllium (inorganic dust)
30
Causes of Farmer's Lung
Exposure to organic agricultural dusts (fungal spores, vegetable products, insect fragments, animal dander, animal feces, microorganisms, pollens)
31
How to confirm primary adrenal insufficiency
plasma ACTH level, should be greater than twice the upper limit of the reference range
32
Cause of the hyperpigmentation of Addison's disease
Caused by the MSH (melanocyte-stimulating hormone) effect of elevated plasma levels of ACTH
33
Initial tx for symptomatic HOCM
BB (Metoprolol), or CCB if BB is not tolerated
34
For dysfunctional uterine bleeding, progestin is effective in which menstrual phase?
Only effective when used on a 21 day cycle, but not if used only during the luteal phase
35
Low TSH level with normal free T4 and free T3 = ?
Subclinical hyperthyroidism
36
Causes of subclinical hyperthyroidism?
Grave's disease, autonomous functioning thyroid adenoma, multi nodular toxic goiter
37
What is the preferred antidepressant for older patients?
Escitalopram (Lexapro)
38
Which antidepressants should be avoided in the elderly?
Amitriptyline, imipramine, paroxetine (highly anticholinergic and sedating, cause orthostatic hypotension)
39
What is the first line treatment for social anxiety disorder?
Escitalopram (Lexapro) (SSRI)
40
Most common hip disorder in adolescents (ages 8-15)?
SCFE, slipped capital femoral epiphysis
41
Name the skin condition: Wood's Lamp turns coral pink florescence
Corynebacterium minutissimum (erythematous, well demarcated patches with some scale)
42
Name the skin condition:
| Wood's lamp turns yellow florescence
Tinea infections
43
Name the skin condition:
| Wood's lamp turns pale blue florescence
Pseudomonas infections
44
Name the skin condition: Wood's lamp turns white
Vitiligo
45
Pap test recs for women 21-29 years old
Every 3 years
46
Metatarsal stress fractures treatment
No weight bearing for a few days, possibly using a posterior splint, transitioning to a walking boot or short leg cast, and then a rigid-soled shoe in 4-6 weeks
47
How to rule out proteinuria in children?
Spot protein/creatinine ratio on the first morning urine
48
Treatment for traveler's diarrhea
Azithromycin
49
Pityriasis rosea is associated with what birth defect?
Spontaneous abortion in the first 15 weeks
50
Donepezil (Aricept) causes what side effect?
Increased risk of bradycardia, part of Beers Criteria. Avoid in patient's with syncope. Can cause prolonged PR interval.
51
Avoid which medication in patient with reduced EF?
CCB (verapamil or diltiazem) because they have a negative inotropic effect, and the heart already isn't beating well
52
Significant risk factors for esophageal adenocarcinoma
GERD and obesity
53
In a patient with AS and systolic murmur, what symptom would be most concerning?
Exertional dyspnea, first presentation of a downward spiral and the need for rapid valve replacement
54
treating acute aortic dissection
IV esmolol, loading dose of 500-1000 mcg/kg/min over 1 min and then infusion rate of 50/mcg/kg/min, max infusion rate is 200mcg/kg/min
55
Idiopathic thrombocytopenia purpura (ITP), first line treatment?
Corticosteroids is first line therapy. IVIG and rituximib
56
Idiopathic thrombocytopenia purpura (ITP), second line treatment?
thrombopoietin-receptor agonists and splenectomy. further evaluation is bone marrow biopsy to rule out MDS or lymphoproliferative disorders
57
Chronic rhinosinusitis defined as?
2/4 cardinal symptoms: nasal drainage, nasal obstruction, facial pain or pressure, hyposmia or anosmia, 6-8 days
58
Dx: overuse and causes pain at the insertion of the patellar ligament on the midline proximal tibia
Osgood-Schlatter disease
59
Dx: pain localized to medial joint line of knee rather than distal to the joint line, +McMurray
Medial meniscus tear
60
Dx: repetitive use, medial knee pain
Pes anserine bursitis
61
Dx: overuse, pain in the lateral knee
Iliotibial band syndrome
62
Dx: thin, clear discharge, associated with thin, friable vaginal mucosa
Atrophic vaginitis
63
Dx: burning and soreness with vulvar erythema, but no discharge
Irritant/allergic vaginitis
64
Dx: thin, homogenous discharge with fishy odor and no cervical or vaginal inflammation
Bacterial vaginosis
65
Dx: white, thick, cheesy or curdy discharge
Vulvovaginal candiasis
66
Dx: greenish-yellow, frothy discharge with a foul odor, inflammation of the vagina and cervix, sometimes punctate hemorrhages (strawberry cervix)
Trichomoniasis
67
Which medication for diabetes has an increased risk for candidiasis?
SGLT-2 inhibitors (causes yeast vaginitis, because the MOA is blocking the renal uptake of glucose, which results in an increase in glucosuria
68
Side effects of GLP-1 receptor agonists?
Nausea, early satiety, weight loss
69
Side effects of sulfonylureas?
Weight gain and hypoglycemia
70
Side effect of metformin?
GI upset
71
Vitamin D intake in 2 week year old that's primarily breastfed?
Daily intake of 400 IU of Vit D a day in infants, especially in primarily breastfed babies
72
Foot X-Ray Requirements
Ottawa:
- bone tenderness at fifth metatarsal
- bone tenderness at navicular
- inability to bear weight immediately in the ED for four steps
73
Ankle X-Ray Requirements
Ottawa:
- bone tenderness at posterior edge or tip of lateral malleolus
- bone tenderness at posterior edge or tip of medial malleolus
- inability to bear weight both immediately and in the ED for 4 steps
74
Best indicator of iron absorption and bone marrow response to oral iron therapy
Reticulocyte count (at 4 days)
75
Chronic urticaria (hives) treatment after 3 months of loratadine
Ranitidine, combine H1 and H2 together after H1 doesn't work, and then go to steroids
76
Cimetidine/Ranitidine
H2 receptor antagonist
77
TB induration 5 or above
- recent contact with infectious TB
- radiographic evidence for prior TB
- HIV infected persons
- immunosuppressed patients
78
TB induration 10 or above
increased risk of TB
79
TB induration 15 or above
no risks of TB
80
SGLT-2 inhibitor
Empagliflozin
81
GLP-1 agonists
liraglutide, exenatide, dulaglutide
82
sugar tong splint
for distal radial fractures
83
radial gutter splint
for uncomplicated fractures of second and third metacarpals
84
thumb spica splint
suspected scaphoid fracture
85
At which opioid dosage do you prescribe naloxone?
the risk of an opioid overdose increases at a threshold of 50 MME/day
86
chronic kidney disease with mildly low ionized calcium level will have which PTH and phosphorus levels?
elevated PTH and elevated phosphorus
this is because phosphate is not appropriately excreted and the subsequent hyperphosphatemia leads to secondary hyperparathyroidism
87
if you see a 1cm wide dimple on the sacrum, 1 cm superior to the anus, what is the next step?
ultrasound to rule out spinal dysraphism (tethered cord)
88
In an obese patient with peripheral neuropathy, erythema of the foot, but no fever, leukocytosis or inflammatory markers, what is the most likely diagnosis?
Charcot neuroarthropathy
89
Tx for Charcot neuroarthropathy
Immobilization with total contact casting, for 3-4 months but can be up to 12 months
90
goal fasting blood glucose level in patients with gestational diabetes?
<95 mg/dL
91
which NSAID is not associated with an increased risk of MI?
naproxen
92
which med used for anxiety also reduces the symptoms of IBS?
Celexa (Citalopram)
93
Causes of HTN in children
Renal parenchymal disease (glomerulonephritis, congenital abnormalities, and reflux nephropathy)
94
carbonic anhydrase inhibitor, which induces a
| metabolic acidosis that leads to hypercalciuria and the formation of calcium phosphate stones
Topiramate
95
TSH level in pregnancy
The TSH reference range is lower during pregnancy because of the cross-reactivity of the -subunit of
hCG. Levels of hCG peak during weeks 7–13 of pregnancy, and hCG has mild TSH-like activity, leading
to slightly high free T4 levels in early pregnancy.
96
transient or persistent thyroid dysfunction that occurs within 1 year
of childbirth, miscarriage, or medical abortion
Postpartum thyroiditis
97
How is postpartum thyroiditis confirmed?
Release of preformed thyroid hormone in the bloodstream initially results in hyperthyroidism. During the hyperthyroid phase, radioactive iodine uptake will be low, which can help to confirm the diagnosis. Pregnancy and breastfeeding are contraindications to radionuclide
imaging. T
98
Thyrotropin receptor antibody levels are positive in
Grave’s disease
99
Thyroid peroxidase antibody levels are elevated with
Hashimoto’s thyroiditis
100
Koilonychia, also known as spoon nail, is a finding that can be associated with multiple systemic conditions
Iron deficiency, SLE, hypothyroidism
101
Treatment of eosinophilia esophagitis
Application of corticosteroids to the esophagus is generally the treatment of choice,
either in the form of an oral suspension of budesonide or an inhaled corticosteroid sprayed into the mouth
and swallowed.
102
Characteristics that are more common with pulmonary malignant lesions are consistent with:
a nonsolid “ground glass” appearance, a size >6 mm, noncalcified lesions, a lesion size or volume doubling time between 1 month and 1 year, and irregular or spiculated borders.
103
6-month-old male is brought to the urgent care center with a 3-day history of rhinorrhea, cough, and increased respiratory effort. His temperature is 37.5°C (99.5°F), his heart rate is 120 beats/min, his respiratory rate is 42/min, and his oxygen saturation is 96% on room air. On examination the child appears well hydrated with clear secretions from his nasal passages, there is diffuse wheezing heard bilaterally, and there is no nasal flaring or retractions
Viral bronchiolitis, treat with supportive care and hydration
104
American Academy of Otolaryngology defines chronic rhinosinusitis as the presence of two of four cardinal symptoms, which include:
nasal drainage, nasal obstruction, facial pain or pressure, and hyposmia or anosmia, along with objective signs on examination or radiographic studies
105
__________ are known to cause an increased risk of yeast vaginitis because their mechanism of action involves blocking renal uptake of glucose, which results in an increase in glucosuria
SGLT2 inhibitors such as empagliflozin (Jardiance)
106
Glucose goals in gestational DM
Fasting <95
1 hr post-prandial: <145
2 hr post-prandial: <120
107
eczematous rash in semiprotected folds of skin such as the web spaces of fingers, the umbilicus, the axillae, or the genital region
Scabies
108
screening for elevated serum cholesterol levels in children
9-11 yo
109
Children, screened annually for depression beginning at?
11-21 yo
110
Universal screening for anemia (children)
12 months of age and again at 15–30 months of age if the patient is determined to be high risk
111
Which antidepressant lowers seizure threshold?
Bupropion
112
Hereditary hemochromatosis
Cardiomyopathy, cirrhosis and HCC
113
Cardiac murmur asso with marfan’s
Mitral valve prolapse, aortic root dilation, aortic insufficiency
114
Drugs for IBS
Neomycin first constipation predominant
| SSRIs or SNRIs for diarrhea predominant
115
GLP-1 agonists are contraindicated in patients with:
medullary thyroid cancer or multiple endocrine neoplasm syndrome, or with a family history of these conditions
116
Mild SLEtreatment
Hydroxychloroquine reduces arthritis pain in lupus patients and is the preferred initial treatment for lupus arthritis
117
Treatment for severe lupus or lupus nephritis
Cyclosporine and azathioprine
118
Treatment for refractory lupus or lupus nephritis
Mycophenolate
119
Treatment for severe refractory lupus
Rituximab
120
NT-proBNP level is affected by:
NT-proBNP is negatively correlated with kidney function as measured by the estimated glomerular filtration rate (GFR) and albumin levels. Patients with a low GFR or a low level of albumin have higher NT-proBNP levels.
A higher BMI is associated with a lower NT-proBNP. Thus, the utility of NT-proBNP to rule out heart failure in obese patients is decreased
121
physical examination reveals isolated tenderness with palpation at the medial and lateral aspects of the knee, and the grind test is also positive
Patellofemoral pain syndrome
122
Pain and tenderness over the tibial tubercle and the distal patellar tendon is the most common presentation
Osgood Schlatter disease
123
typically causes infrapatellar pain, and findings include extensor mechanism malalignment, weakness of ankle flexors, and tightness of the hamstring, heel cord, and/or quadriceps
Patellar tenidopathy
124
osteochondrosis at the insertion of the Achilles tendon on the calcaneal tuberosity. It occurs during periods of rapid growth, causes heel pain during and after activity, and is relieved with rest
Sever’s disease
125
How to diagnose nephrotic range proteinuria
protein-to-creatinine ratio from a single urine sample
126
Current criteria for the diagnosis of diabetes mellitus:
- hemoglobin A1c ≥6.5%
- a fasting plasma glucose level ≥126 mg/dL
- a 2-hour plasma glucose level ≥200 mg/dL OR in a symptomatic patient, a random blood glucose level ≥200 mg/dL.
127
26-year-old female presents with a 3-month history of abdominal pain, lightheadedness with standing, and some hyperpigmentation. Her CBC is normal, but a basic metabolic panel reveals a slightly low sodium level and a slightly high potassium level, what’s the diagnosis?
Primary adrenal insufficiency
128
What is used to screen for adrenal hyperplasia in hypertensive patients and also for establishing the existence of mineralocorticoid insufficiency in patients with Primary Adrenal Insufficiency?
Serum aldosterone paired with plasma renin activity
129
In patients ≥65 years of age treated with medication for type 2 diabetes mellitus, hemoglobin A1c values of _____ have shown the greatest reduction in mortality in multiple studies
7-8% to prevent hypoglycemia
130
high fever in a child with either mild upper respiratory symptoms or no other symptoms. After the fever subsides, a rash will appear
Roseola infantum, caused by HHV-6
131
single herald patch that is oval-shaped and scaly with central clearing, followed by a symmetric rash on the trunk in a typical distribution along the Langer lines
Pityriasis rosea
132
The child will typically have mild symptoms then an erythematous facial rash that has a “slapped cheek” appearance. This is sometimes followed by pink patches and macules in a reticular pattern. Once the rash appears the child is no longer contagious
Erythema infectiosum is caused by parvovirus B19 and is also known as fifth disease
133
scaly, erythematous plaques, commonly on the flexor surfaces of the extremities
Atopic dermatitis
134
Mild persistent asthma is defined as:
symptoms present >2 days per week but not daily, nighttime awakenings 3–4 times per month, and inhaler use >2 days per week but not daily and not more than once on any day. The FEV1 is >80% of predicted.
135
Severe asthma present as:
symptoms present throughout the day, nighttime awakenings up to 7 times per week, inhaler use several times per day, and an FEV1 <60% of predicted. Normal activities are extremely limited by severe asthma
136
Moderate persistent asthma presents as:
symptoms are present daily, nighttime awakenings occur >1 time per week but not nightly, and an inhaler is required daily
137
Intermittent asthma presents as:
symptoms are present ≤2 days per week, nighttime awakenings occur ≤2 times per month, an inhaler is required ≤2 days per week, and the FEV1 is >80% of predicted
138
unexplained proteinuria, peripheral neuropathy, enlargement of the tongue, cardiomegaly, intestinal malabsorption, bilateral carpal tunnel syndrome, and orthostatic hypotension
Primary amyloidosis
139
Common agents that cause viral pericarditis:
Enteroviruses, herpesviruses, adenovirus, and parvovirus B19
140
Organisms that cause infection of puncture wound of foot through shoe
Staphylococcus aureus is the most common, followed by other staphylococcal and streptococcal species. When the puncture wound is through the rubber sole of an athletic shoe, Pseudomonas is the most frequent pathogen (use Cipro)
141
Patients with a history of cryptorchidism are at high risk for the development of ______, especially if orchiopexy is performed after puberty
Testicular cancer
142
If mass is suspicious for testicular cancer, what should be performed?
If sonography shows a hypoechoic mass, a testicular biopsy is contraindicated, since it may contaminate the scrotum or alter the lymphatic drainage. Radical inguinal orchiectomy is both diagnostic and therapeutic
143
Causes of subclinical hyperthyroidism
Graves disease, autonomous functioning thyroid adenoma, and multinodular toxic goiter
144
Labs suggesting subclinical hypothyroidism
low TSH level with normal free T4 and free T3 levels
145
Even in the absence of overt hyperthyroidism patients with subclinical hypothyroidism are at higher risk for several health conditions, including:
atrial fibrillation, heart failure, and osteoporosis
146
Lactulose, also an osmotic laxative, should be avoided in patients with IBS because?
it is broken down by colonic flora and produces excessive gas
147
The only proven therapy for pulmonary hypertension related to COPD is?
Supplemental oxygen should be recommended when the PaO2 is <60 mm Hg, because it has been shown to improve mortality by lowering pulmonary arterial pressures
148
Which antihypertensive drug may reduce the severity of sleep apnea?
Potassium sparing diuretics
Resistant hypertension is common in patients with obstructive sleep apnea. Resistant hypertension is also associated with higher levels of aldosterone, which can lead to secondary pharyngeal edema, increasing upper airway obstruction
149
most sensitive test to diagnose primary hyperaldosteronism?
aldosterone/renin ratio
150
There are multiple tools for evaluation of pneumonia severity, including:
SMART-COP (predicts the likelihood of the need for invasive ventilation or vasopressor support), the Pneumonia Severity Index (predicts the risk of 30-day mortality and the need for admission to the intensive-care unit), and CURB-65 or CRB-65
151
hyperextension of the wrist leads to:
Triquetral fractures
152
Absolute contraindications for testosterone replacement therapy
Absolute contraindications include breast cancer, prostate cancer, a prostate-specific antigen (PSA) level >4 ng/dL, an abnormal rectal examination with nodules, and polycythemia with a hematocrit >54%
Testosterone stimulates erythropoiesis and increases the risk of thrombosis
153
Node-blocking medications such as
| diltiazem and metoprolol should not be used for the long-term treatment of WPW, due to
The increased risk of VFib
154
Chronic kidney disease–mineral and bone disorder (CKD-MBD)
In patients with CKD, phosphate is not appropriately excreted and the subsequent
hyperphosphatemia leads to secondary hyperparathyroidism and binding of calcium. Decreased production of calcitriol in patients with CKD also leads to hypocalcemic hyperparathyroidism. Patients with CKD stages 3a–5 should have phosphorus, calcium, parathyroid hormone, and 25-hydroxyvitamin D levels. checked regularly, and consultation with a nephrologist or endocrinologist should be obtained if CKD-MBD is suspected.
155
affected skin appears as erythematous patches with white to yellow greasy scales
Seborrheic dermatitis, treat with topical antifungals
156
Tdap is recommended for all women with each pregnancy, preferably between:
27-36 weeks gestation
157
Leser-Trélat sign may be defined as:
the abrupt onset of multiple seborrheic keratoses, which is an unusual finding that often indicates an underlying malignancy, most commonly an adenocarcinoma of the stomach
well circumscribed brown, oval, rough papules with a “stuck-on” appearance on his trunk and proximal extremities
158
considered a second-line choice for patients who are intolerant of metformin?
SGLT2 (Empagliflozin)
159
Both sitagliptin, a DPP-4 inhibitor, and liraglutide, a GLP-1 receptor agonist, should be avoided or used with caution in patients with a history of?
Pancreatitis
160
In the newborn period the two most common causes of neonatal sepsis are
Group B STREP & E. coli
161
Both 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23) are recommended for patients with
Chronic renal failure
162
How to CONFIRM diagnose Cushing’s syndrome
24 hr urinary free cortisol
Dexamethasone test is only for screening
163
Current criteria for obesity hypoventilation syndrome (OHS) include:
hypoventilation leading to carbon dioxide retention (PaCO2 >45 mm Hg) in an individual with a BMI > 30 kg/m2 when other causes of chronic alveolar hypoventilation have been ruled out
These patients retain bicarbonate to compensate for respiratory acidosis
164
A 42-year-old female presents with shortness of breath that has slowly worsened over the past 6 months. She can now walk only 10 feet without becoming short of breath. She does not have a cough or chest pain. Her history is significant only for obesity. She smoked one pack of cigarettes per day for 20 years and quit smoking 6 years ago. Her blood pressure is 138/88 mm Hg, pulse rate 92 beats/min, respiratory rate 18/min, and oxygen saturation 92% on room air. Her BMI is 42 kg/m2.
Her heart has a regular rate and rhythm with no murmurs and her lungs are clear to auscultation. Her lower extremities have bilateral 1+ edema. A chest radiograph is normal. Spirometry reveals a decreased FVC with a normal FEV1/FVC ratio. A CBC, a TSH level, and a basic metabolic panel are all normal except for a serum bicarbonate level of 35 mEq/L (N 22–29).
These findings are most consistent with:
Obesity hypoventilation syndrome
165
Management of systolic heart failure without exacerbation whose EF is 35% and they cannot tolerate ace/arb due to angioedema in African American patient
a combination of direct-acting vasodilators such as isorbide and hydralazine is preferred
166
A young man with weight loss, oral thrush, lymphadenopathy, and ulcerative esophagitis is likely to have:
HIV infection (IV drug use)
167
The most common pathogens causing esophageal ulceration in HIV-positive patients include:
Candida, herpes simplex virus, and cytomegalovirus
168
The majority of cases of viral conjunctivitis are caused by
Adenovirus
(which cause pharyngeal conjunctival fever and epidemic keratoconjunctivitis. Pharyngeal conjunctival fever is characterized by high fever, pharyngitis, and bilateral eye inflammation. Keratoconjunctivitis occurs in epidemics, and is associated with a watery discharge, hyperemia, and ipsilateral lymphadenopathy in >50% of cases)
Viral, no treatment
169
47-year-old female presents to your office with a complaint of hair loss. On examination she has a localized 2-cm round area of complete hair loss on the top of her scalp
Alopecia areata (thought to be caused by a localized autoimmune reaction to hair follicles)
170
The initial treatment of choice for patients older than 10 years of age, in cases where alopecia areata affects less than 50% of the scalp, is:
Intralesional corticosteroid injections
171
_____ is an alternative for children younger than 10 years of age or for patients in whom alopecia areata affects more than 50% of the scalp.
Minoxidil
172
In a patient with CAP and history of AAA, what antibiotic should be avoided?
Fluoroquinolones because they cause increased risk of aortic dissection in patients who already have aortic aneurysm or increased risk of aortic aneurysm
173
In a young adult with community-acquired pneumonia who is not sick enough to be hospitalized, the current recommendation is to empirically treat with
macrolide antibiotic such as azithromycin. This covers the atypical organism Mycoplasma pneumoniae, which is one of the most common causes of community-acquired pneumonia. Certain fluoroquinolones such as levofloxacin also cover atypical causes, but ciprofloxacin does not
174
Nonprolactin-secreting adenomas, especially those >10 mm in size (macroadenomas), require
Neurosurgical evaluation
175
Microadenomas <10 mm in size that are secreting prolactin are treated with
Dopaminertic agent such as bromocriptine
176
Indications for an adult patient with acute bronchitis to have a chest radiograph include:
bloody sputum, rusty-colored sputum, or dyspnea; a pulse rate >100 beats/min; a respiratory rate >24/min; or a temperature >37.8°C (100.0°F). A chest radiograph is also indicated if there are abnormal findings on a chest examination such as fremitus, egophony, or focal consolidation.
177
Risk factors for septic arthritis include
underlying joint disease such as rheumatoid arthritis or osteoarthritis, and immunosuppressive states such as HIV infection, diabetes mellitus, and taking immunosuppressive medications
178
Leser-Trelat sign
Sudden onset of seborrheic keratosis means adenocarcinoma of stomach
179
What causes falsely elevated A1c
Vitamin B12 def bc of decreased erythropoiesis
Iron def anemia bc of decreased erythropoiesis
CKD may increased RBC glycation through liquid peroxidaxe and extends erythrocytes lifespan due to do erythropoietin levels
180
What falsely lowers A1c
Hemolytic anemia bc if decreased RBC lifespan
181
Most common cause of neonatal sepsis
E. Coli, GBS
182
Lichen nitidus
Benign but uncommon.
Discreet pinhead sized hypopigmented papules that are asymptomatic
183
Lichen sclerosis
Common, appear as hypoigmented lesions with texture of cellophane, on glans or prepuce
Atrophy, erosions and bullae are common
Patients present with itching, pain , bleeding, possibly phimosis or obstructed voiding
184
Angiokeratomas
Asymptomatic, circumscribed, red or blueish papules
185
Brown sputum plug in asthma patients with multiple exacerbation
Aspergillosis
186
the most common cause of polyhydramnios
Anencephaly due to transudation from the exposed meninges
187
Treatment of cocaine-associated chest pain is similar to that of acute coronary syndrome, unstable angina, or acute myocardial infarction, but there are exceptions. The hypertension, tachycardia, and chest pain will often respond to
IV Benzos
BB contraindicated in cocaine induced ischemia bc they can exacerbate coronary artery spasm
188
herpes zoster ophthalmicus (four vesicles on upper eyelid)
In addition to treatment with a systemic antiviral agent, it is important that the patient see an ophthalmologist to be evaluated for corneal disease and iritis, as vision can be lost. This is a viral infection, so corticosteroids could worsen the infection.
189
Hepatotoxicity resulting from timed-release formulations of _____ have been reported in the elderly
Niacin
190
postpartum urinary retention risk factors
more likely to occur in patients who are primiparous, have a prolonged first or second stage of labor, have instrumented vaginal deliveries, or require a cesarean section for failure to progress
191
Postpartum urinary retention
defined as a post-void bladder residual of at least 150 cc that is present 6 hours or more after delivery
192
Nausea in pregnancy
methylprednisolone is also effective
but should be avoided in the first trimester as it is associated with
with an increased risk of cleft palate if used before 10 weeks of gestation
193
Scopolamine is effective for nausea and vomiting of pregnancy but should be avoided in the first trimester
due to
possibility of causing trunk and limb deformities
194
First line therapy for nausea in pregnancy
Vitamin B6
195
All causes of polyhydraminos
Anencephaly, esophageal atresia, heart failure, and maternal α-thalassemia
196
Intrauterine heart failure, whether due to dysrhythmias, structural defects, or severe anemia, often leads to
Fetal hydrops which is associated with polyhydraminos
197
α-Thalassemia, relatively common in Asians, can also cause
Fetal hydrops and polyhydraminos
198
Most commonly associated with oligonydraminos
Posterior urethral valves
199
In many normally developing infants there may be imperfect coordination of eye movements and alignment during the early days and weeks of life, but proper coordination should be achieved by
Age 4-6 months
Less than 3 month olds is normal, otherwise kid is at risk of developing amblyopia
200
Primary ovarian failure is defined as:
This is defined as menopause before the age of 40 due to ovarian follicular depletion. Laboratory findings will usually reveal a low serum estradiol and elevated FSH and LH levels.
201
Intrauterine synechiae
Patients present with abnormal uterine bleeding, recurrent pregnancy loss, dysmenorrhea, and infertility. FSH and LH levels are usually normal
Characterized by scarring in the uterus
202
Risk factors for intrauterine syncheciae
Risk factors include intrauterine procedures, pregnancy, inflammation, and infection
(Scar tissue inside the uterus)
203
The most common cause of hypercalcemia is
Hyperparathyroidism
204
An infant appears nontoxic and is afebrile, but is tachypneic with a prominent cough. Physical examination reveals diffuse rales with few wheezes. Conjunctivitis is present in about 50% of cases
The chest film shows hyperinflation and diffuse interstitial or patchy infiltrates.
Chlamydial pneumonia
205
Focal wheezing in a pediatric pt with no asthma
Mycoplasma pneumonia
206
Has a sudden onset, and infant appears very ill and has a fever. At the time of onset there may be an expiratory wheeze simulating bronchiolitis. Signs of abdominal distress, tachypnea, dyspnea, and localized or diffuse bronchopneumonia or lobar disease may be present. The WBC count shows a prominent leukocytosis.
Staphylococcal pneumonia
207
start with rhinorrhea and pharyngitis, followed in 1–3 days by cough and wheezing. Auscultation reveals diffuse rhonchi, fine rales, and wheezes. The chest film is often normal, but if the illness progresses, cough and wheezing increase, air hunger and intercostal retractions develop, and evidence of hyperexpansion of the chest is seen
Respiratory syncytial virus
208
presents with typical cold symptoms. Eight percent of infections affect the upper respiratory tract. In children hospitalized for severe respiratory illness, this virus account for about 50% of the cases of laryngotracheitis and about 15% each of the cases of bronchitis, bronchiolitis, and pneumonia.
Parainfluenza virus
209
Bone age would be expected to be at least ___ standard deviations below the mean for agematched peers of the same chronologic age
2.5
210
According to the American Heart Association’s 2007 guidelines, prophylaxis to prevent bacterial endocarditis associated with dental, gastrointestinal, or genitourinary procedures is now indicated only for
high-risk patients with prosthetic valves, a previous history of endocarditis, unrepaired cyanotic congenital heart disease (CHD), or CHD repaired with prosthetic material, and for cardiac transplant recipients who develop valvular disease.
211
Hyperthyroidism can be caused by
Amiodarone
212
preferred initial test for a patient with painless postmenopausal bleeding
Transvaginal ultrasound
213
Polymyalgia rheumatica is usually associated with an elevated
ESR
214
drug-induced myopathy caused by the simvastatin, which is associated with elevated
Creatine kinase
215
Low urine 24-hour calcium levels or a low urine calcium to urine creatinine ratio is not characteristic of hyperparathyroidism. This finding should suggest
familial hypocalciuric hypercalcemia
216
Akathisia
a syndrome marked by motor restlessness. Affected patients commonly complain of being inexplicably anxious, of being unable to sit still or concentrate, and of feeling comfortable only when moving
Side effect of antipsychotics
217
a result of pelvic relaxation and is manifested as involuntary loss of urine with increases in abdominal pressure such as that which occurs with laughing, sneezing, or coughing
Urinary stress incontinence
218
when the urge to urinate is quickly followed by loss of urine, usually a large volume
Detrusor instability and overactive bladder
219
marked by constant leakage of small amounts of urine
Neurogenic bladder
220
pulmonary hemorrhage, glomerulonephritis, and antiglomerular basement membrane antibodies
Goodpasture's syndrome
221
Neurogenic bladder
can be caused by diabetes mellitus, multiple sclerosis, or spinal cord injury, and is usually initially treated with a strict voluntary urination schedule, which may be coupled with Crede's maneuver. It can be treated further by adding bethanechol to the regimen. Many patients have to be taught intermittent self-catheterization of the bladder. Ultimately, the patient may require resection of the internal sphincter of the bladder neck.
222
herpes zoster ophthalmicus (four vesicles on eyelid)
In addition to treatment with a systemic antiviral agent, it is important that the patient see an ophthalmologist to be evaluated for corneal disease and iritis, as vision can be lost. This is a viral infection, so corticosteroids could worsen the infection
223
Hepatotoxicity resulting from timed-release formulations of ___ has been reported in elderly individuals.
Niacin
224
What imaging procedure for hematuria?
CT urography or intravenous pyelography
225
What lab to check for duchenne muscular dystrophy?
Creatinine kinase (will be elevated)
226
Postpartum urinary retention
defined as a post-void bladder residual of at least 150 cc that is present 6 hours or more after delivery
227
Risk factors for postpartum urinary retention
primiparous, have a prolonged first or second stage of labor, have instrumented vaginal deliveries, or require a cesarean section for failure to progress
228
The most common pathogen for nonpurulent cellulitis
Group B strep
229
How to treat nausea in pregnancy
Vitamin B6
230
Avoid what med for nausea in pregnancy bc if first trimester defects?
Scopolamine is effective for nausea and vomiting of pregnancy but should be avoided in the first trimester due to the possibility of causing trunk and limb deformities. Likewise, methylprednisolone is also effective
but should be avoided in the first trimester as it is associated with an increased risk of cleft palate if used
before 10 weeks of gestation.
231
It presents as palpable purpura of the lower extremities without thrombocytopenia or coagulopathy. It is often associated with arthralgias and arthritis, abdominal pain, and renal dysfunction. It is self-limited and treatment is supportive only
Henoch-Schönlein purpura is an IgA vasculitis
232
erythematous rash on the cheeks and a lacy reticular rash on the extremities
Fifths disease (Erythema infectiosum)
233
sudden papular or papulovesicular eruption on the extensor surfaces of the arms, legs, buttocks, and face, and it is not purpuric, usually after illness
Gianotti-Crosti syndrome
234
classic triad of hemolytic anemia, thrombocytopenia, and kidney injury
Hemolytic uremia syndrome
235
most useful predictors of the severity of pancreatitis, reflecting the degree of intravascular volume depletion
Hematocrit, BUN, creatinine
236
Causes of AIN
various antibiotics (particularly cephalosporins, penicillins, sulfonamides, aminoglycosides, and rifampin), diuretics, and miscellaneous medications such as allopurinol, NSAIDs
237
Effective treatments for chronic orthostatic hypotension include
fludrocortisone, midodrine, and physostigmine
238
Risk factors for progression from latent to active tuberculosis include
lung cancer, diabetes mellitus,
alcoholism, recent contact with a person who has an active tuberculosis infection, any condition treated with immunosuppressive therapy, and lung parenchymal diseases such as COPD, silicosis, or lung cancer
239
In patients with renal failure, the risk for death and serious cardiovascular events is increased with higher hemoglobin levels (≥13.5 g/dL), and it is therefore recommended that levels be maintained at
10-12
240
severe pruritus in the third trimester of pregnancy
Intrahepatic cholestasis of pregnancy
241
Characteristic findings of intrahepatic cholestasis of pregnancy
absence of primary skin lesions and elevation of serum levels of total bile acids
242
ipsilateral ptosis, miosis, and decreased facial sweating-suggests?
Horner’s syndrome
decreased sympathetic innervation due to involvement of the stellate ganglion, a complication of Pancoast’s superior sulcus tumors of the lung
243
responsible for more than 50% of hearing impairments in children?
Genetic disorders (e.g., Waardenburg syndrome, Usher’s syndrome, Alport syndrome, and Turner’s syndrome)
244
What is associated with testosterone supplementation in men with hypogonadism
Testosterone increases hematocrit and can cause polycythemia. In patients receiving testosterone supplementation, hematocrit should be monitored every 6 months for the first 18 months, then annually. Testosterone should be discontinued if there is more than a 50% rise in hematocrit
245
Oral iron is absorbed better with
with an acidic gastric environment, which can be accomplished with the concomitant administration of vitamin C. Agents that raise gastric pH, such as antacids, proton pump inhibitors, and H2 blockers, should be avoided if possible. Oral iron absorption is improved if the iron is taken on an empty stomach, but this may not be well tolerated because gastric irritation is a frequent side effect
246
Anemia of chronic disease is characterized by the underproduction of red cells, due to low serum iron caused by
the uptake of iron by the reticuloendothelial system
Total-body iron stores are increased but the iron in storage is not available for red cell production
247
normochromic and normocytic, and is associated with a reduction in iron, transferrin, and transferrin saturation, and increased total iron stores, ferritin is normal or increased
Anemia of chronic disease
248
total-body iron levels are low, leading to hypochromia and microcytosis, low iron levels, increased transferrin levels, and reduced ferritin levels
Iron def anemia
249
The ophthalmopathy of Grave’s disease may initially flare and worsen when treated with
Radioactive iodine
250
Streptococcus bovis bacteremia or endocarditis is associated with a high incidence of
occult colorectal malignancies. It may also occur with upper gastrointestinal cancers
251
Calcium chloride or gluconate has no effect on the plasma potassium level, but it should be given first in Hypercalcemia bc
rapidly stabilizes the membranes of cardiac myocytes, reducing the risk of cardiac dysrhythmias
252
Patients who have had preeclampsia have a fourfold increased risk of
HTN
253
Risk factors for age associated macular degeneration
Smoking and HTN
254
evanescent salmon-pink rash
Systemic juvenile-onset rheumatoid arthritis
255
pink maculopapules, progresses to petechiae or purpura, which are clinically palpable, and changes in color from red to dusty brown before fading. Arthritis, usually involving the knees and ankles, is present in two-thirds of cases, and gastrointestinal tract involvement results in heme-positive stools in 50% of cases
Henoch-Schonlein purpura typically follows an upper respiratory tract infection, and presents with low-grade fever, fatigue, arthralgia, and colicky abdominal pain
256
While prednisone is used to treat other forms of vasculitis, it is considered unsafe in Kawasaki disease, as a previous study showed
Coronary artery aneurysm with it’s use
257
child, between 4 and 24 months of age with impaired growth, diarrhea, and abdominal distention. An iron deficiency anemia can occur with impairment of iron absorption from the small intestine.
Celiac sprue
258
This illness is due to an uncontrolled proliferation of lymphocytes and plasma cells, which produce IgM proteins with kappa light chains
Weakness, fatigue, weight loss, bleeding, and recurrent infections
Waldenström’s macroglobulinemia
259
persistent groin pain, and limited hip flexion and internal rotation
Stress fractures of the femoral neck are most commonly seen in military recruits and runners
260
Thalamotomy and pallidotomy, contralateral to the side of the body that is most affected, are most effective for the treatment of
disabling unilateral tremor and dyskinesia from Parkinson’s disease
261
Hypertrophic pyloric stenosis, if allowed to be left untreated, can lead to:
malnutrition, constipation, oliguria, and profound hypochloremic metabolic alkalosis
262
What medication is contraindicated in older patients who take statins?
clarithromycin or erythromycin
263
HELLP
hemolysis, elevated liver enzymes, and low platelets
Severe preeclampsia
264
The most common cause of pneumonia in children age 4 months to 4 years
RSV
265
accounts for up to 60% of all cases of asymptomatic proteinuria reported in children, with an even higher incidence in adolescents
Orthostatic proteinuria
266
When to treat acute rhinosinusitis
After 7 days
267
PPIs adverse effects
C diff infection, Vit B12 def, iron def anemia, AIN, fractures
268
Cross legged posturing, neck stiffness, hyper reflexia
Cerebral palsy, central cause of motor delay
269
Classic early finding of muscular dystrophy
Head lag during neck muscle weakness
270
Myelodysplastic anemia has which lab finding
High serum ferritin
271
Hemolysis would reticulocyte count be low or high
High
272
SCFE
obesity and limited internal rotation of hip
273
Nightmares and PTSD, use which med?
Prazosin
274
Donepezil causes what side effect
Prolonged PR interval bc of cholingeric vasovagal response, bradycardia
275
provides pain relief within a few days in many patients with osteoporotic vertebral compression fractures
Calcitonin
276
Overt hyperthyroidism during pregnancy is associated with adverse effects to the mother and fetus, so treatment is required. In first trimester treat with?
Since methimazole is associated with birth defects when used in the first trimester, propylthiouracil is preferred
277
Overt hyperthyroidism during pregnancy is associated with adverse effects to the mother and fetus, so treatment is required. What therapy after the first trimester?
Methimazole should be considered after the first trimester because the risk of congenital anomalies is less than the risk of liver failure associated with propylthiouracil
278
Which one of the following agents used for tocolysis has the unique adverse effect of respiratory depression?
Magnesium sulfate
Magnesium sulfate infusions must be carefully monitored because respiratory depression is a potential lethal side effect. Reflexes are usually lost first.
279
Which one of the following agents used for tocolysis has the unique adverse effect of pulmonary edema?
Terbutaline and ritodrine have the potential to cause respiratory distress in the form of pulmonary edema. They do not cause respiratory depression.
280
numerous manifestations, including night sweats, fatigue, weight loss, myalgia, and arthritis. Later findings may include hypertension, skin lesions, and cardiac disorders.
Takayasu arteritis
281
conjunctival injection, mucosal erythema, rash, and lymphadenopathy
Kawasaki
282
constitutional symptoms also, including weight loss and fatigue, with later findings including respiratory problems, ophthalmologic lesions, neuropathies, glomerulonephritis, and skin lesions
Wegenar granulomatosis
283
constitutional symptoms such as fatigue, fever, and myalgias. It also causes skin lesions, gastrointestinal symptoms such as postprandial abdominal pain, and cardiac lesions.
Polyatyeritis nodosa
284
IgA-mediated small-vessel vasculitis that classically presents with the triad of nonthrombocytopenic palpable purpura, colicky abdominal pain, and arthritis.
Henoch-Schonlein purpura
285
Causes of SIADH
CNS tumors, various infections such as meningitis, and pneumonia. Several drugs can cause this condition, including amiodarone, carbamazepine, SSRIs, and chlorpromazine
286
Both ectopic pregnancy and spontaneous or therapeutic abortion pose a significant risk for fetomaternal hemorrhage. Thus, administration of RHO immune globulin (RhoGAM) is recommended in any Rh-negative patient who is unsensitized (D antibody screen–negative prior to administration of RhoGAM). If the estimated gestational age is 12 weeks or less,
50 mcg of RhoGAM is recommended
287
Both ectopic pregnancy and spontaneous or therapeutic abortion pose a significant risk for fetomaternal hemorrhage. Thus, administration of RHO immune globulin (RhoGAM) is recommended in any Rh-negative patient who is unsensitized (D antibody screen–negative prior to administration of RhoGAM). If the estimated gestational age is greater than 12 weeks
If the estimated gestational age is greater than 12 weeks, 300 µg of RhoGAM is recommended.
288
Contraindications to treatment with electrosurgery include
the use of a pacemaker and the treatment of melanoma
289
Contraindications to zoledronic acid (bisphosphonate) include
hypocalcemia and a creatinine clearance <35 mL/min or other evidence of acute renal impairment
290
In patients with stage 4 chronic kidney disease, current guidelines recommend monitoring of
serum calcium and phosphate levels every 3–6 months and bone-specific alkaline phosphatase activity every 6–12 months with the goal of normalizing these values
291
Which one of the following cardiac rhythm abnormalities is most common in patients with anorexia nervosa?
Sinus Brady
Sinus tachy may occur with refeeding of anorexia pts
292
by large ears, an elongated face, macrocephaly, or frontal bossing
Fragile X syndrome
293
microbrachycephaly, maxillary hypoplasia, a large mouth, and prognathism
Angelman syndrome
294
narrow distance between the temples, almond-shaped eyes, and a thin upper lip.
Prader-Willi syndrome
295
When draining a felon (acute hand infection), which one of the following incisions is recommended?
a volar longitudinal incision or a high lateral incision is recommended. Incisions that are not recommended are the “fish-mouth” incision, the “hockey stick” (or “J”) incision, and the transverse palmar incision.
296
erythroderma accompanied by fever, lymphadenopathy, elevation of liver enzymes, and eosinophilia
DRESS syndrome
Drug Reaction with Eosinophilia and Systemic Symptoms
297
What meds cause DRESS syndrome?
Seizure medications such as carbamazepine, phenytoin, lamotrigine, and phenobarbital are responsible for approximately one-third of cases. Allopurinol-associated DRESS syndrome has the highest mortality rate.
298
vesiculobullous rash with mucocutaneous involvement, and erysipelas is a painful localized rash with well-demarcated borders
Stevens-Johnson syndrome
299
Red man syndrome
Vancomycin
300
Which one of the following agents can be used as part of a test for diagnosing renovascular hypertension, but would also increase the risk for azotemia if used for treatment
Captopril
301
should be performed prior to initiating TFN-inhibitor therapy
PPD
potential for developing primary tuberculosis or reactivating latent tuberculosis. These drugs are
also associated with an increased risk for invasive fungal infections and opportunistic bacterial and viral
diseases. The FDA also warns of reports of lymphomas and other malignancies in children and adolescents
taking these drugs.
302
dry, scaling, dark red rash in the groin, with an active border and central clearing
Times cruris
303
diffuse eruption with clear vesicles surrounded by reddish macules
Varicella
304
MOA of Metformin
inhibition of gluconeogenesis in the liver
305
Reduced FEV1 and a decreased FEV1/FVC ratio
Asthma
306
An abandoned infant is brought to the hospital for evaluation. Based on the presence of a dried umbilical cord remnant and her overall appearance, you believe her to be no more than 5 days of age. A thorough examination is normal except for a finding of bilateral conjunctival erythema and exudate. A Gram stain of the exudate is remarkable for numerous WBCs, very few of which are noted to contain gram-negative diplococci.
Infantile gonococcal infection is usually the result of exposure to infected cervical exudate during delivery and manifests 2–5 days after birth. Ophthalmia neonatorum and sepsis are the most severe gonococcal infections in newborns and immediate treatment is warranted based on the presumptive diagnosis
Tx with single dose of 25–50 mg/kg of ceftriaxone administered intravenously or intramuscularly
307
Sevelamer MOA
Blocking intestinal absorption of phosphate, which lowers parathyroid hormone secretion
308
tight Achilles tendon then pulls on its insertion site at the posterior calcaneus with repetitive running or jumping activities, causing microtrauma to the area. There may be swelling and tenderness in this area and passive dorsiflexion may increase the pain
Calcaneal apophysitis
309
Endometriosis is caused by
menstrual tissue in the pelvic peritoneal cavity. Infertility, dysmenorrhea, and
dyspareunia with postcoital bleeding are common.
310
complication of Graves disease, whether it presents as hypo-or hyperthyroidism. It is a dermopathy that most often occurs in the lower legs and results from increased deposition of mucin due to the endocrine abnormality
Pretibial myxedema
311
What causes necrobiosis lipoidica, a lesion on the lower extremities
DM
312
Laryngoscopy should be performed to visualize the larynx and evaluate for vocal cord pathology in a patient whose hoarseness does not resolve within
3 months
313
Emphysema and chronic bronchitis, forms of COPD, also cause a decreased FEV1/FVC ratio, but the sputum is generally
mucoid and luminal dilation of bronchi is not characteristically present
314
illness of the bronchi and bronchioles involving obstructive and infectious processes that injure airways and cause luminal dilation. In addition to daily viscid, often purulent sputum production with occasional hemoptysis, wheezing and dyspnea occur in 75% of patients
Bronchiectasis
315
During the treatment of severe preeclampsia with intravenous magnesium, the occurrence of apnea and areflexia is most consistent with magnesium toxicity. In addition to hemodynamic support, what else do you do?
calcium infusion is recommended as an antidote. Calcium chloride can be used if a central line has been established. Calcium gluconate would be safer with a peripheral intravenous site.
316
When epiglottitis is suspected based on findings such as hoarseness, dysphagia, stridor, drooling, fever, chills, and respiratory distress, what treatment should be instituted immediately?
intravenous antibiotic treatment should be instituted immediately, ideally with a $-lactam drug that exhibits activity against methicillin-resistant Staphylococcus aureus.
317
fever over 100.4°F, tonsillar exudates, anterior cervical lymphadenopathy, and absence of cough
Streptococcal pharyngitis
318
Although patients with chronic mild liver disease may take NSAIDs, they should be avoided in all patients with cirrhosis, due to the risk of
Precipitating hepatorenal syndrome
319
Coral-red fluorescence on Wood’s light examination is typical of infection with
Corynebacterium
320
The inhalation of asbestos fibers may lead to a number of respiratory diseases, including
ung cancer, asbestosis, pleural plaques, benign pleural effusion, and malignant mesothelioma
321
individuals who worked in construction trades or as boilermakers, shipyard workers, or railroad workers, as well as U.S. Navy veterans are at risk for?
Asbestos
322
cardiovascular changes that is a recognized age-related effect
decreased maximal heart rate with exercise
Myocardial collagen and mass both increase with age. The increase in collagen may play a role in decreasing left ventricular compliance. The resting heart rate, like the maximal exercising heart rate, decreases with normal aging. Tachycardia at rest may suggest a pathologic state.
323
medication that reduces all-cause mortality and improves ejection fractions in systolic HF
Spironolactone
324
Verapamil, due to its negative inotropic effect, is associated with
worsening heart failure and increased risk of adverse CV events
325
pseudogynecomastia
increases in subareolar fat secondary to obesity
clinical findings of symmetric adipose tissue in the breast region bilaterally and a lack of firm, palpable glandular tissue in the nipple and areolar region
326
palpable, firm glandular tissue in a concentric mass around the nipple-areola complex.
gynecomastia
327
Hard, immobile masses, masses associated with skin changes, nipple retraction, nipple discharge, or enlarged lymph nodes would suggest
possible malignancy
328
Fat necrosis of breast
would involve a history of breast region trauma and would generally be asymmetric
329
caused by reactivation of the varicella-zoster virus (VZV) in the geniculate ganglion of the facial nerve
Ramsey-Hunt syndrome (herpes zoster oticus)
330
e painful vesicles on one side of the palate and the ipsilateral ear. When the reactivation involves other branches of the facial nerve it can result in a unilateral facial herpetiform rash that may also involve the anterior two-thirds of the tongue, taste disturbance, and reduced lacrimation
Ramsey-Hunt syndrome (herpes zoster oticus)
331
oral vesicles and ulcers, but the distribution of vesicles in the ear and the mouth is not typical of this virus
HSV
332
leukoplakia of the mouth but not vesicles and is typically associated with systemic signs of illness
EBV
333
throat pain and fever, not vesicles
Group A Strep
334
oral vesicles and ulcers but is usually associated with fever and does not typically involve the ear
Coxsackie virus
335
The drug most often recommended as first-line therapy for hypertension in pregnancy is
Labetalol
336
Metoprolol is contraindicated in pregnancy because?
Reports of an association of metoprolol with fetal growth restriction have given rise to the recommendation to avoid its use in pregnancy.
337
ACE/ARB are contraindicated in pregnancy because?
risk of birth defects and fetal or neonatal renal failure
338
The appropriate management of a thrombosed hemorrhoid presenting within 72 hours of the onset of symptoms is
elliptical excision of the hemorrhoid and overlying skin under local anesthesia, such as 0.5% bupivacaine hydrochloride in 1:200,000 epinephrine, infiltrated slowly with a 27-gauge needle
339
constipation predominant IBS?
neomycin
340
diarrhea predominant IBS?
celexa (citalopram)
341
cute, transient, febrile reaction that occurs within the first few hours after treatment for syphilis. The condition peaks at 6–8 hours and disappears within 12–24 hours after therapy. The temperature elevation is usually low grade, and there is often associated myalgia, headache, and malaise.
Jarisch-Herxheimer reaction
342
According to the American Diabetes Association, screening for diabetes mellitus in the asymptomatic patient with no risk factors should begin at which age?
45
343
Which one of the following is more likely to occur with an aromatase inhibitor such as letrozole (Femara) than with tamoxifen (Soltamox)
Myalgias
Myalgias and noninflammatory arthralgias are more likely with aromatase inhibitors.
344
Myelodysplastic syndrome is a hematologic malignancy with a predisposition to leukemic transformation. It can present with findings of
nemia, thrombocytopenia, neutropenia, or any combination of these. Anemia occurs in 80%–85% of patients and is typically macrocytic.
345
asthma type:
Symptoms less than or equal to twice weekly, nighttime awakenings ≤2 times/month, short-acting β-agonist usage ≤2 days/week, no interference with daily activities, and normal FEV1 and FEV1/FVC ratio at baseline
intermittent asthma
346
asthma type:
symptoms >2 days/week but not daily, nighttime awakenings 3–4 times/month, short-acting β-agonist usage >2 days/week but not more than once daily, minor limitation to daily activities, FEV1 ≥80% predicted, and normal FEV1/FVC ratio
mild persistent asthma
347
asthma type:
Daily symptoms, nighttime awakenings greater than once weekly but not nightly, daily use of a short-acting β-agonist, some limitation to daily activity, FEV1 >60% but <80% of predicted, and FEV1/FVC ratio reduced by 5%
moderate persistent asthma
348
asthma type:
Symptoms throughout the day, nighttime awakenings nightly, short-acting β-agonist usage several times daily, extremely limited daily activities, FEV1 <60% of predicted, and FEV1/FVC ratio reduced by >5%
severe persistent asthma
349
asthma type:
medical emergency and requires emergent treatment in a hospital setting
Status asthmaticus
350
the one SSRI that is thought to carry an increased risk of congenital malformations with first-trimester exposure and should be avoided
Paroxetine
351
Tricyclic antidepressants are class __ in pregnancy.
D
352
Are MAOi's contraindicated in pregnancy?
yes
353
However, the rotavirus series should not be started at what age?
past 15 weeks of age, or continued past 8 months of age
354
When compared with an occiput anterior fetal position, a persistent occiput posterior fetal position is LESS likely to result in?
Spontaneous vaginal delivery
A persistent occiput posterior position is associated with a higher risk of cesarean delivery and assisted vaginal delivery, and a lower chance of spontaneous vaginal delivery.
355
increased pain with overhead shoulder activity, popping or grinding, loss of strength, and trouble locating a specific point of pain.
Tear of the labrum
356
enerally occurs with a fall on an outstretched arm or direct blow to the lateral side of the arm. Generally there is pain or bruising over the fracture site. Movement will be restricted by pain, but there should not be any weakness.
fracture of the humeral head
357
not generally caused by acute trauma, but by irritation and microtrauma due to repetitive elevation or abduction of the shoulder, causing an inflammatory reaction in the synovial sheath. Patients generally present with a complaint of pain in the anterior shoulder that radiates into the upper arm. It is more painful with activity and is worse at night. Abduction and external rotation of the arm exacerbates the pain. On examination there should be point tenderness in the bicipital groove. Active range of motion will be limited by pain but passive range of motion will be intact. There should not be any weakness.
Bicipital tendinitis
358
usually caused by a fall or a direct blow to the point of the shoulder with the shoulder abducted. The pain associated with this injury is over the acromioclavicular joint margin and there may be swelling. Depending on the severity of the injury there may be full range of motion but it may be restricted due to pain. There should not be any weakness associated with this injury.
acromioclavicular separation
359
The most appropriate treatment of a mallet fracture is to
splint the DIP joint in extension for 8 weeks
360
There is good evidence that psychostimulants reduce symptoms of depression within?
days
Methylphenidate (Ritalin)
good for depression in end of life patients who only have 2-3 weeks to live
361
Clindamycin has broader coverage against both pulmonary anaerobes and facultative aerobes such as
Staphylococcus aureus and Klebsiella, which are often seen with lung abscesses
362
A 42-year-old male sees you for help to quit smoking. His sister had excellent results with bupropion (Zyban) and he asks if he could try using it. When you review his medical history, which one of the following would be a contraindication to bupropion?
Seizure disorder; bupropion lowers the seizure threshold and should not be used in patient's with seizure disorder or alcoholism
363
MOA of renal side effect of ACE inhibitors
Impaired autoregulation of glomerular blood flow
Blood flow to the kidney is autoregulated so as to sustain pressure within the glomerulus. This is influenced by angiotensin II–related vasoconstriction. ACE inhibitors can impair the kidney’s autoregulatory function, resulting in a decreased glomerular filtration rate and possibly acute renal injury. This is usually reversible if it is recognized and the offending agent stopped.
364
MOA of renal side effects of statins, haloperidol, and drugs of abuse (cocaine, heroin)
can cause rhabdomyolysis with the release of myoglobin, which causes acute renal injury.
365
MOA of renal side effects of clopidogrel, quinine, or certain chemotherapeutic agents
Thrombotic microangiopathy is a rare mechanism of injury to the kidney
366
treatment of choice for menorrhagia due to endometrial hyperplasia without atypia
progestational drugs
Progestins convert the proliferative endometrium to a secretory one, causing withdrawal bleeding and the regression of hyperplasia. The most commonly used form is cyclic oral medroxyprogesterone, given 14 days per month, but implanted intrauterine levonorgestrel is the most effective (SOR A) and also provides contraception.
367
Maternal varicella infection is particularly problematic during weeks 13–20 of pregnancy (resulting in a...)
2% risk of congenital varicella in the newborn
| neonatal varicella infection
368
Maternal varicella infection is particularly problematic during
during weeks 13–20 of pregnancy (resulting in a 2% risk of congenital varicella in the newborn) and when the onset of maternal symptoms occurs from 5 days before until 2 days after delivery
369
The ACIP also recommends that term infants born within the 7-day window described above (maternal symptoms 5 days before until 2 days after delivery), as well as all preterm infants, receive
receive varicella immune globulin, and that those who develop any signs of varicella infection also be given intravenous acyclovir
370
Term infants delivered more than 5 days after the onset of maternal varicella...
are thought to have adequate passive immunity for protection and the expected benign course generally requires only observation
371
pain in the medial knee distal to the joint space, at the conjoined tendon of the sartorius, gracilis, and semitendinosus
Pes anserine bursitis
372
tenderness of the tibial tubercle at the distal insertion of the patellar ligament
Osgood-Schlatter disease
373
most common between 8 months and 4 years of age and the child is most likely to have a history of the sudden onset of wheezing associated with choking
Foreign body aspiration
374
American Academy of Pediatrics now recommends screening for ___ between 8 and 11 yrs old
Dyslipidemia
375
American Academy of Pediatrics now recommends screening for ___ between 11 and 21
Depression
376
Peds:
Universal screening for iron deficiency anemia is recommended at
recommended at 12 months of age and
| again at 15–30 months of age if the patient is determined to be high risk
377
Community-acquired pneumonia in children over the age of 5 is most commonly due to
Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Streptococcus pneumoniae
(Treat with Azithromycin)
378
Primary hyperaldosteronism is the most common cause of secondary hypertension in the middle-aged population, and can be diagnosed from
renin/aldosterone ratio
379
vertigo lasting for 20–120 minutes, accompanied by a fluctuating hearing loss, tinnitus, and a sense of aural fullness
Meniere disease
380
In young children with bilious emesis, anorexia, and lack of fever, the most likely diagnosis is
Intestinal malrotation with volvulus
381
intestinal malrotation with volvulus, how to diagnose
Upper GI series
382
pneumococcal vaccine is recommended once at age 65, or as soon afterward as possible. Persons that should be immunized before age 65 include patients with
chronic lung disease, cardiovascular disease, diabetes mellitus, chronic liver disease, cerebrospinal fluid leaks, cochlear implants, immunocompromising conditions, or asplenia, and residents of nursing homes and long-term care facilities
383
Early recognition and prompt treatment with intubation and mechanical ventilation is necessary to improve chances for survival in patients with ARDS.
What ventilator settings?
Patients with ARDS should be started at lower tidal volumes (6 mL/kg) instead of the traditional volumes (10–15 mL/kg). These patients also often require higher positive end-expiratory pressure settings (SOR B).
384
hypotonia, a flat face, upward and slanted palpebral fissures and epicanthic folds, and speckled irises (Brushfield spots); varying degrees of mental and growth retardation; dysplasia of the pelvis; cardiac malformations; a simian crease; short, broad hands; hypoplasia of the middle phalanx of the 5th finger; and a high, arched palate.
Down syndrome
385
widely separated eyes with epicanthic folds, low-set ears, a broad and flat nose, a receding chin, and limb anomalies, bilateral renal agenesis
Potter syndrome
386
Children with diabetes mellitus are at increased risk for
Retinopathy, nephropathy and hypertension
387
Children with DM1 are likely to have more immune mediated disorders such as?
celiac disease and hypothyroidism
388
For several years, a hypertensive 65-year-old female has been treated with hydrochlorothiazide, 25 mg/day; atenolol (Tenormin), 100 mg/day; and hydralazine, 50 mg 4 times/day. Her blood pressure has been well controlled on this regimen. Over the past 2 months she has experienced malaise, along with diffuse joint pains that involve symmetric sites in the fingers, hands, elbows, and knees. A pleural friction rub is noted on examination. Laboratory testing shows that the patient has mild anemia and leukopenia, with a negative rheumatoid factor and a positive antinuclear antibody (ANA) titer of 1:640
What med to stop?
Hydralazine
Drug induced SLE, procainamide and hydralazine
389
Patients with disorders in this group exhibit odd or eccentric personalities, and the group
includes paranoid, schizoid, and schizotypal personality disorders
Cluster A personalities
390
characterized by dramatic, emotional, or erratic personalities, and include
antisocial, borderline, histrionic, and narcissistic personality disorders
Cluster B personality disorders
391
include avoidant, obsessive-compulsive, and dependent personality disorders. Patients with disorders in this group exhibit mainly anxious or fearful behaviors.
Cluster C personality disorders
392
The etiologic agent that causes erysipelas is?
Strep pyogenes (group A strep)
393
Which one of the following is an appropriate treatment for tinea capitis?
Oral griseofulvin
It has the fewest drug interactions, a good safety record, and anti-inflammatory properties. Terbinafine has equal effectiveness and requires a significantly shorter duration of therapy, but it is only available in tablet form. Since tinea capitis most commonly occurs in children, tablets would have to be cut and/or crushed prior to administration. Oral itraconazole, fluconazole, and ketoconazole have significant side effects. Topical antifungals such as ketoconazole and miconazole are ineffective against tinea capitis. Topical acyclovir is used in the treatment of herpesvirus infections, and oral cephalosporins are used in the treatment of bacterial skin infections.
394
Which one of the following organisms is the most common cause of cutaneous infections associated with intertrigo?
Candida
It is facilitated by moisture trapped in deep skinfolds where air circulation is limited. When intertrigo does not respond to usual conservative measures, including keeping the skin clean and dry, evaluation for infection is recommended. A Wood’s light examination, KOH preparation, and exudate culture can assist in identifying causative organisms.
395
Intertrigo in interdigital spaces is most often caused by
dermatophytes (e.g., Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum) are more common
396
Drugs that dilate the internal sphincter, including ___, ____, ____ have proven to be beneficial in healing acute fissures
diltiazem, nifedipine, and nitroglycerin ointment
397
characterized by tremor, anxiety, nausea, vomiting, and/or insomnia 6–24 hours after the patient’s last drink
Minor alcohol withdrawal
398
occurs 10–72 hours after the last drink and can include the signs and symptoms of minor withdrawal, as well as visual and auditory hallucinations, diaphoresis, tachycardia, and elevated blood pressure
Major alcohol withdrawal
399
generally occurs within 2 days of the last drink and may be the only sign of withdrawal, although approximately one-third of these patients will progress to delirium tremens
Alcoholic seizure
400
can occur anytime within 3–10 days following the last drink. The defining clinical finding is delirium, but the findings seen in milder forms of alcohol withdrawal can also be present, and may be more severe. Fever is most often seen with this
Delirium tremens
401
A heroin overdose is most likely to cause acute?
Pulmonary edema
Overdose is manifested by CNS depression and hypoventilation. Clinical clues include pupillary miosis and a decreasing respiratory rate in the presence of a semi-wakeful state. In addition to hypoventilation, a multifactorial acute lung injury occurs within 2–4 hours of the overdose and is associated with hypoxemia and a hypersensitivity reaction, resulting in noncardiogenic pulmonary edema
402
The only FDA-approved oral treatment for acne rosacea is
Doxycycline
403
diabetes insipidus, which is caused by
a deficiency in the secretion or renal action of arginine vasopressin (AVP). AVP, also known as antidiuretic hormone, is produced in the posterior pituitary gland and the route of secretion is generally regulated by the osmolality of body fluid stores, including intravascular volume. Its chief action is the concentration of urine in the distal tubules of the kidney. Both low secretion of AVP from the pituitary and reduced antidiuretic action on the kidney can be primary or secondary, and the causes are numerous.
404
A reduction of the pain caused by abdominal palpation when the abdominal muscles are tightened is known as
Carnett’s sign
If the cause of the pain is visceral, the taut abdominal muscles may protect the locus of pain. In contrast, intensification of pain with this maneuver points to a source of pain within the abdominal wall itself.
405
Centor criteria
tonsillar exudates, tender anterior cervical lymphadenopathy, absence of cough, and history of fever
Strep throat
406
Patients with repeated EKGs showing a QTc interval >480 ms with a syncopal episode, or >500 ms in the absence of symptoms, are diagnosed with long QT syndrome if no secondary cause such as medication use is present. This syndrome occurs in 1 in 2000 people and consists of cardiac repolarization defects. It is associated with
polymorphic ventricular tachycardia, including torsades de pointes, and sudden cardiac death. It may be treated with p-blockers and implanted cardioverter defibrillators.
407
effective treatments for mild psoriasis
Topical corticosteroids, vitamin D analogs, and tazarotene
408
Bacterial conjunctivitis is associated with
Mattering and adherence to the eyelid
409
The majority of cases of viral conjunctivitis are caused
Adenovirus, which cause pharyngeal conjunctival fever and epidemic keratoconjunctivitis
Pharyngeal conjunctival fever is characterized by high fever, pharyngitis, and bilateral eye inflammation. Keratoconjunctivitis occurs in epidemics, and is associated with a watery discharge, hyperemia, and ipsilateral lymphadenopathy in >50% of cases.
410
Pharyngeal conjunctival fever is characterized by
high fever, pharyngitis, and bilateral eye inflammation
Adenovirus
411
Keratoconjunctivitis occurs in epidemics, and is associated with
watery discharge, hyperemia, and ipsilateral lymphadenopathy in >50% of cases.
412
Common features of acute adrenal insufficiency include
fatigue and lack of energy, weight loss, hypotension, loss of appetite, nausea, and vomiting. Other features such as dry skin, hyperpigmentation, and abdominal pain are seen to varying degrees. Common laboratory findings include electrolyte disturbances, hyponatremia, hyperkalemia, hypercalcemia, azotemia, anemia, and eosinophilia. Patients can also have unexplained hypoglycemia. Patients with advanced-stage cancer (especially of the lung or breast) may develop acute adrenal insufficiency from metastatic infiltration of the adrenal glands
413
treatment of choice in the management of adrenal crisis
IV hydrocortisone
414
A 25-year-old gravida 1 para 1 presents for insertion of a levonorgestrel-releasing intrauterine device (Mirena). She is on the last day of her menses, which began 5 days ago. A urine pregnancy test in the office is negative. You insert the device without complications and she asks how long she needs to use backup contraception.
Backup contraception not necessary if inserted within 7 days after menstrual bleeding started.
If IUD inserted more than 7 days after menses started, then contraceptive protection for 7 days.
415
Reduced FVC and increased FEV1/FVC ratio
Restrictive lung disease (intrinsic lung disease, chest wall deformities, neuromuscular disorders)
416
Reduced FVC1 and decreased FEV1/FVC ratio
Obstructive lung disease (asthma, COPD)
417
Reduced DLCO (diffuse capacity of the lung for carbon monoxide)
- interstitial fibrosis is extensive
- when capillary surface is compromised by vascular obstruction or non perfusion
- emphysema (destroyed)
418
typical circumscribed, raised, erythematous lesion with central pallor.
chronic uticaria
419
small, erythematous papules that are frequently excoriated
scabies
420
lichenified plaques and excoriations that result from excessive scratching
lichen simplex chronicus
421
strong 3A4 inhibitor that can slow the metabolism of calcium channel blockers metabolized by this enzyme, thus increasing their levels
Clarithomycin
Amlodipine and CCB metabolized by cytochrome P450 3A4 enzyme; do not use together
422
In pt with CAD, what antibiotic should you avoid and why?
Azithromycin, causes fatal arrhythmias and prolonged QT
423
treatment of allergic rhinitis
topical intranasal glucocorticoids
424
numbness involving the digital nerve in the area, and usually is caused by the nerve being pinched between metatarsal heads in the center of the foot
Morton's neuroma
425
an extremely tender right testis with some tenderness extending to the epididymis. A preliminary report from a stat ultrasound examination shows an enlarged, heterogeneous right testis with increased color flow
acute epididymitis, give anbx
426
Crohn’s disease is associated with many extragastrointestinal conditions such as
rythema nodosum (as with this patient), anemia, inflammatory arthropathies, uveitis, and venous thromboembolism
427
A decrease in which one of the following could be expected from long-term use of postmenopausal estrogen plus progesterone?
hip fracture
428
Bisphosphonates should not be used in patients with
creatinine clearance <35
429
if cannot use bisphosphonate in pt with creatinine clearance <35, what can you use instead?
denosumab bc it is not cleared by the kidneys
430
most common causes of serious bacterial infection in children 3-36 months of age are?
PNA and UTI
431
side effects with long term chronic use of opioids?
hypogonadism, constipation, hyperalgesia and allodynia
432
esotropia
red reflex will be over the lateral portion of the iris in the affected eye
433
exotropia
the light reflex will be over the medial iris
434
hypertropia
the light reflex will be over the inferior iris
435
hypotropia
the light reflex will be over the superior iris
436
hypertropia is associated with?
congenital palsy involving the superior oblique muscle, which is innervated by CN 4
437
syncope related to changes in position, such as bending, lying down from a seated position, or turning over in bed
atrial myxoma
438
syncope from changing from a sitting or lying position to an upright position
orthostatic hypotension
439
syncope from unpleasant stimuli or physiologic conditions, including sights, sounds, smells, sudden pain, sustained upright posture, heat, hunger, and acute blood loss
vasovagal syncope
440
What support a diagnosis of subacute granulomatous thyroiditis?
Low radioactive iodine uptake
441
Multiple nodules on thyroid US suggest?
multi nodular goiter
442
RAIU in Grave's?
High uptake
443
A 53-year-old white female with chronic hepatitis C is concerned about ulcers in her mouth. She is not currently receiving therapy. Your examination reveals several ulcers involving the buccal mucosa. The patient also points out a number of pruritic, reddish-purple plaques on her wrists, ankles, and back. Laboratory studies are within normal limits except for mildly elevated transaminases.
Lichen planus
444
The use of bisphosphonates is associated with a small increase in the risk of
atypical femoral shaft fractures, osteonecrosis of jaw, esophagitis, esophageal ulceration, hypocalcemia
445
Developmental dysplasia of the hip is associated with
firstborns, females, breech presentation, oligohydraminos, pts with FH of developmental dysplasia
446
codeine, hydrocodone and morphine should be avoided in patients with?
ESRD
447
fentanyl is absorbed through the?
liver
448
why should paroxetine be avoided in the elderly?
it has a long half life
449
low DLCO and obstructive pattern on PFTs
Emphysema
450
Low DLCO and restrictive pattern on PFTs
Interstitial lung disease and hypersensitivity pneumonitis
451
High DLCO with obstructive PFTs with reversibility after bronchodilator administration
asthma
452
Low DLCO with normal PFTs
chronic pulmonary embolism
453
Medical conditions that decrease responsiveness to warfarin and reduce the INR include
hypothyroidism, visceral carcinoma, increased vitamin K intake, diabetes mellitus, and hyperlipidemia
454
Conditions that increase responsiveness to warfarin, the INR, and the risk of bleeding include
vitamin K deficiency caused by decreased dietary intake, malabsorption, scurvy, malnutrition, cachexia, small body size, hepatic dysfunction, moderate to severe renal impairment, hypermetabolic states, fever, hyperthyroidism, infectious disease, heart failure, and biliary obstruction
455
The differential diagnosis of multiple small scaling plaques includes
drug eruptions, secondary syphilis, guttate psoriasis, and erythema migrans. If the diagnosis cannot be made conclusively by clinical examination, a test for syphilis should be ordered. The rash of secondary syphilis may be indistinguishable from pityriasis rosea on initial examination, particularly when no herald patch is noted
456
Due to the increasing incidence of pertussis, the Centers for Disease Control and Prevention recommends that all pregnant women receive Tdap vaccine during every pregnancy regardless of when their last dose was. It is ideally administered between
27 and 36 weeks gestation to maximize the maternal antibody response and passive antibody transfer to the infant
457
The most common bacterial organisms in this age group (less than 29 days) are
group B Streptococcus and Escherichia coli
458
Uveitis is inflammation of the uveal tract and can affect any or all of its components, including the iris. It is the most common extra-articular manifestation of
Ankylosis spondylitis
459
painful red eye with conjunctival injection, photophobia, and a sluggishly reacting pupil
Iritis
460
Reduced anterior spine flexion (a positive modified Schober test) results from the skeletal manifestations of
Ankylosis spondylitis
461
rhinorrhea is clear and often has a sweet or salty taste. The drainage can be continuous or intermittent, and is often associated with a gush when changing from a recumbent to an upright position
Cerebrospinal fluid (CSF) rhinorrhea is not that rare, and has both surgical and nonsurgical causes. It results from a direct communication between the subarachnoid space and the paranasal sinuses. Accidental trauma causes 70%–80% of CSF rhinorrhea cases, with 2%–4% of acute head injuries resulting in CSF rhinorrhea. Nontraumatic CSF rhinorrhea includes high-pressure and normopressure leaks from causes including tumors, processes including boney erosion, empty sella syndrome, and congenital defects including meningoceles.
462
An 18-month-old previously healthy infant is admitted to the hospital with bronchiolitis. Pulse
oximetry on admission is 92% on room air.
What should be included in the management of this patient?
Nasal suction to clear the upper airway
463
Somatic complaints are seen in up to two-thirds of primary care patients with depression, and are more likely in certain groups, including
pregnant women, children, the elderly, and low-income groups
464
Which one of the following EKG abnormalities would dictate the use of a pharmacologic stress test as opposed to an exercise stress test?
Left bundle branch block
Left bundle branch block makes the EKG uninterpretable during an exercise stress test, and can also interfere with nuclear imaging performed during the test. It is associated with transient positive defects in the anteroseptal and septal regions in the absence of a lesion within the left anterior descending coronary artery. This leads to a high rate of false-positive tests and low specificity. Pharmacologic stress tests using vasodilators such as adenosine with nuclear imaging have a much higher specificity and positive predictive value for LAD lesions, and the same is true for dobutamine stress echocardiography, which is why these are the preferred methods for evaluating patients with left bundle branch block.
465
clinical presentation in patients without HIV/AIDS is typically an acute onset of hypoxia and respiratory failure, associated with a dry cough and fever. Characteristic radiographic findings include diffuse bilateral interstitial infiltrates.
Pneumocystis pneumonia. Initially named Pneumocystis carinii, the causative organism has been reclassified and renamed Pneumocystis jiroveci. It causes disease in immunocompromised patients. In non–HIV-infected patients, the most significant risk factors are defects in cell-mediated immunity, glucocorticoid therapy, use of immunosuppressive agents (especially when dosages are being lowered), hematopoietic stem cell or solid organ transplant, cancer, primary immunodeficiencies, and severe malnutrition.
466
fever, chills, cough, and pleuritic chest pain. A sudden onset of severe hypoxia is less common. Radiologic findings typically include lobar infiltrates or bronchopneumonia (with a segmental pattern of infiltrate), whereas diffuse bilateral infiltrates are much less common
Pneumococcal PNA
467
radiologic findings of focal, multiple infiltrates or cavitary lesions.
Staphylococcal PNA
468
presents most commonly with pleuritic or retrosternal chest pain. Fever is present in about 25% of patients. Cough is actually less common, and a sudden onset of acute hypoxia would be a very rare presentation. Radiographs typically reveal hilar adenopathy and pleural effusion
Pulmonary tuberculosis
469
Patients with a CD4+ count <200 cells/mm3 should receive
trimethoprim/sulfamethoxazole for prevention of Pneumocystis pneumonia, and prophylaxis against Toxoplasma gondii should also be given if the CD4+ level is <100 cells/mm3.
470
Azithromycin is used to prevent infection with Mycobacterium avium-intracellulare complex when CD4+ counts are
<50
471
Legg-Calvé-Perthes disease results from
interruption of the blood supply to the still-growing femoral head
472
In the hospital setting, the use of atypical antipsychotics is most appropriate for which one of the following conditions?
ICU associated delirium
473
This class of drugs has been found to reduce all-cause mortality and cardiac death when initiated after a myocardial infarction in patients with a low left ventricular ejection fraction (LVEF) and signs of heart failure
Spironolactone
474
Guidelines from the American College of Cardiology and the American Heart Association recommend the use of aldosterone blockers in patients who have
heart failure or diabetes mellitus, have an LVEF :40%, are receiving ACE inhibitors and p-blockers, and have a serum potassium level <5.0 mEq/L (5.0 mmol/L) and a creatinine level >2.5 mg/dL in men or >2.0 mg/dL in women
475
A 24-year-old gravida 4 para 2 with mild chronic hypertension and an uncomplicated pregnancy has just delivered a vigorous male by spontaneous vaginal delivery. She is noted to have heavy vaginal bleeding and a bimanual examination reveals a soft, poorly contracted uterus. Her temperature is 37.1°C (98.8°F), blood pressure 158/92 mm Hg, pulse rate 105 beats/min, and oxygen saturation 95% on room air.
Which one of the following uterotonic agents is CONTRAINDICATED in the management of this patient’s postpartum hemorrhage?
Methylergonovine
Uterotonics are the first-line treatment for postpartum hemorrhage in patients with decreased uterine tone. While all of the uterotonic agents listed are options for the management of postpartum hemorrhage, methylergonovine should be avoided if the patient is hypertensive.
476
It is an ergot alkaloid that causes generalized smooth muscle contraction and can raise blood pressure and shouldn’t be given in post partum hemorrhage in a patient with HTN
Methylergonovine
477
Used for post partum hemorrhage, but should be avoided in asthmatic patients and is relatively contraindicated if the patient has hepatic, renal, or cardiac disease
Carboprost tromethamine
478
Medications for post partum hemorrhage
Oxytocin (Pitocin), Methylergonovine, Carboprost tromethamine (Hemabate), Misoprostol (Cytotec)
479
Tramadol (Ultram) should be avoided in patients with a history of
Seizures (lowers the seizure threshold)
480
For patients on lithium monotherapy for bipolar disease, monitoring should include periodic blood levels of
Lithium, creatinine and TSH
481
Tortuous retinal veins on funduscopic examination
retinal vein occlusion
482
When to avoid stimulants for ADHD
Avoid in the following, psychosis, tics, or hypertension
483
___ is the greatest risk factor for group B streptococcal infection
prematurity
484
Positive anti-GAD antibodies and low C-peptide at the time of the initial diagnosis are also consistent with type...
type 1 diabetes
485
Which one of the following does the American College of Obstetricians and Gynecologists recommend as first-line treatment for nausea and vomiting in pregnancy?
Doxylamine (Unisom) and pyridoxine (vitamin B6)
486
A 56-year-old female with a history of poorly controlled type 2 diabetes mellitus presents with a complaint of progressive loss of sensation and weakness in both legs over the past 2 days and low back pain that is nonradiating. She also reports that she is unable to feel bowel movements or urination. She says she has not had any fever or chills.
On examination she has a low-grade fever with a blood pressure of 142/84 mm Hg. She has no sensation to pinprick or vibration from the T9 level down, bilaterally. She is unable to move her legs voluntarily or resist gravity, and no reflexes are elicited in the lower extremities. Her WBC count is 12,700/mm3 (N 4000–10,000) and her erythrocyte sedimentation rate is 127 mm/hr (N 1–25).
What test is most appropriate?
MRI thoracic spine
487
With rapidly progressing symptoms of paraparesis and sensory abnormalities in a diabetic patient, you should suspect
Spinal cord lesion with epidural abscess
488
Treatments to reduce awareness of tinnitus and tinnitus-related distress
cognitive-behavioral therapy, acoustic stimulation, and educational counseling
489
indicated for dyspareunia related to vulvar and vaginal atrophy due to menopause
Ospemifene
490
a safe alternative for treating menopausal vasomotor symptoms, but not for treating sexual arousal dysfunction in women who are premenopausal
Black cohosh
491
A 62-year-old female with stage 3 chronic kidney disease and an estimated glomerular filtration rate of 37 mL/min/1.73 m2 is found to have a mildly low ionized calcium level. Which one of the following would you expect to see if her hypocalcemia is secondary to her chronic kidney disease?
In patients with CKD, phosphate is not appropriately excreted and the subsequent hyperphosphatemia leads to secondary hyperparathyroidism and binding of calcium. Decreased production of calcitriol in patients with CKD also leads to hypocalcemic hyperparathyroidism
492
transient or persistent thyroid dysfunction that occurs within 1 year of childbirth, miscarriage, or medical abortion
Postpartum thyroiditis
493
How to confirm diagnosis of postpartum thyroiditis
Release of preformed thyroid hormone in the bloodstream initially results in hyperthyroidism. During the hyperthyroid phase, radio iodine uptake will be low which confirms the diagnosis
Pregnancy and breastfeeding are contraindications to radionuclide imaging
494
Koilonychia, also known as spoon nail, is a finding that can be associated with multiple systemic conditions
iron deficiency, hypothyroidism, and SLE
495
Meds also with osteoporosis and increased fracture risk
antiepileptic drugs, long-term heparin, cyclosporine, tacrolimus, aromatase inhibitors, glucocorticoids, gonadotropin-releasing hormone agonists, thiazolidinediones, excessive doses of levothyroxine, proton pump inhibitors, SSRIs, parenteral nutrients, medroxyprogesterone contraceptives, methotrexate, and aluminum antacids.
496
associated with higher risks of endometrial cancer, celiac disease, and structural heart defects
Turner syndrome
497
Pt has hypercalcemia with a normal albumin level
Stop HCTZ
498
You are administering a mental status examination to a 92-year-old male with suspected dementia. You give the patient a pencil and ask him to show how it is used. He gives you a bewildered look and eventually puts the pencil in his mouth and demonstrates using it as a toothbrush.
This task assesses
Praxis
499
the ability to carry out intentional motor acts and is commonly assessed by giving the patient a common object such as a hairbrush or pencil and asking the patient to show how it is used
Praxis
500
Meds that most commonly cause hyponatremia
SSRIs and thiazide diuretics
501
Present in the Midwest, symptoms are mild
Histoplasmosis
502
Present in the Midwest but symptoms include sudden onset of fever chills pleuritic chest pain arthralgias and myalgias
Blastomycosis
