Amboss

Question 1

Intussusception

Answer 1

Acute, cyclical colicky pain

Sudden screaming and crying spells

Vomiting = initially non-bilious

Palpable sausage-shaped mass in the abdomen

Question 2

Direct Excision of Lung Nodule =

Answer 2

> 2cm

> 60 year old

The shape is Corona Radiata / Spiculated

Question 3

Morbilliform rash

Answer 3

a rash that looks like measles

macular lesions that are red and usually 2–10 mm in diameter but may be confluent in places

Question 4

Maculopapular rash

Answer 4

The rash is caused by the infection itself in about 5% of cases
But, is most commonly associated with the administration of aminopenicillin (e.g., ampicillin, amoxicillin
The rate of aminopenicillin-related exanthem is very high (roughly around 50%)

Question 5

Scabies and Lice treatment

Answer 5

Permethrin
topical Sulfur
Crotamiton
>6 year old = Oral Ivermectin and Lindane

Question 6

2. Pneumonia = Curb-65 =

Answer 6

Confusion

Urea (blood) > 7 mmol/L (20 mg/dL)

Respiratory rate ≥ 30/min

Blood pressure (systolic) ≤ 90 mm Hg or diastolic BP ≤ 60 mm Hg

≥ 65 years (of age)

Question 7

Curb >2 ( Combination therapy )

Answer 7

CURB-65 score is ≥ 2, hospitalization is indicated

1. Anti-pneumococcal Beta-Lactam IV= Amoxicillin -Clav, Cefuroxime, Cefpodoxime
2. Macrolide = Azithromycin IV, Clarithromycin PO
3. Doxycycline PO

Question 8

1. PCP treatment

Answer 8

First line = > TMP-SMX Aka Cotrimexazole ( Sulfa )
add steroids if PaO2 is less than 70%

Sulfa Allergic  IV Clindamycin & Primaquine

Question 9

Beefy red strawberry tongue + non-pruritic diffuse rash

Answer 9

Scarlet fever

Question 10

Beefy red strawberry tongue + cervical adenopathy + edema of extremities

Answer 10

Kawasaki

Question 11

Infant
Botulinism
tetany

Answer 11

Botulism = Hypotony

Tetany = muscle stiffness

Question 12

The lower esophageal sphincter fails to relax + weight loss

Answer 12

check for malignancy –> endoscopy

Question 13

1. the most common cause of adult gastroenteritis –> watery diarrhea

Answer 13

Norovirus

Question 14

Watery diarrhea after 12 hours

Answer 14

Norovirus

Question 15

Watery diarrhea 6–15 hours after ingestion

Answer 15

Bacillus Cereus

Question 16

Skin infection MRSA treatment

Answer 16

Daptomycin IV

Question 17

Daptomycin MOA and side effects

Answer 17

Creates transmembrane pathway –> disrupts the cell membrane

Myopathy & Rhabdomyolysis

Question 18

What anti staph drug cannot be used for Pneumonia

Answer 18

Daptomycin: it binds to surfactant readily and gets deactivated

Question 19

Small non-tender hemorrhagic macules on hands and soles + Murmur

Answer 19

endocarditis

Question 20

Endocarditis prophylactic drugs

Answer 20

Amoxi and Ampi

Clarithro and Azithro

Question 21

Twirling an eraser over the trunk results in a blister

Answer 21

+ Ve nikolski sign

Question 22

Nikolsky’s sign

Answer 22

pemphigus vulgaris 
 toxic epidermal necrolysis,
 staphylococcal scalded skin syndrome, 
scalding, bullous impetigo, 
and Stevens-Johnson syndrome

Not present in bullous pemphigoid
Slight mechanical pressure (by rubbing) is exerted on the skin → upper epidermal layer slips away from lower layer

Question 23

tense blisters without involvement of oral involvement

Answer 23

Bullous pemphigoid

Question 24

Exclusively oral mucosa involvement of blisters + Flaccid

Answer 24

Vulgaris

Question 25

Bullous pemphigoid

Answer 25

Bullous pemphigoid is a relatively benign pruritic disease characterized by tense blisters in flexural areas, usually remitting in 5 or 6 years, with a course characterized by exacerbations and remissions. Most affected persons are over the age of 60 and men are affected twice as frequently as women.

The diagnosis is made by biopsy with direct immunofluorescence examination and serum antibody testing.
Light microscopy shows a subepidermal blister. With
direct immunofluorescence, IgG and C3 are found at the
dermal-epidermal junction.

Question 26

Hypomaniac

Answer 26

> 4 days of excited and pressured symptoms= consecutive

Not hospitalized like in a mania

Question 27

Cyclothymic

Answer 27

Two distinct periods

one distinct period = Depressed
second distinc period = Hypomanic for >2years

Question 28

Attributable risk

Answer 28

The difference in risk between
exposed and unexposed groups
A\a+b - C\c+d

Question 29

analysis of vaccine or intervention

Answer 29

Absolute risk reduction

Question 30

Absolute risk reduction

Answer 30

C/c+d - a/a+b

Question 31

risk of getting disease between exposed and unexposed

Answer 31

Attributable risk

Question 32

Pygmalion effect

Answer 32

( experimenter’s/investigator )

The experimenter’s/investigator expectation influences the outcome of the study

Question 33

Hawthorne

Answer 33

( participants )

information disclosed to the participants in the study

Question 34

Ascertainment bias

Answer 34

( certain individuals )

certain individuals are more likely to be selected for a study group

Question 35

Procedure bias

Answer 35

different study groups receive different treatment

Question 36

Effect modification

Answer 36

exposure has a different effect on different subgroups because of an additional factor internal to the respective subgroups

Question 37

cah ( dhea-s )

Answer 37

Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders characterized by impaired cortisol synthesis.[1][2] It results from the deficiency of one of the five enzymes required for the synthesis of cortisol in the adrenal cortex.[3]
Most of these disorders involve excessive or deficient production of hormones such as glucocorticoids, mineralocorticoids, or sex steroids,[4][2] and can alter development of primary or secondary sex characteristics in some affected infants, children, or adults.[5] It is one of the most common autosomal recessive disorders in humans.

Question 38

CAH

Answer 38

1. 17 oh is usually high
2. the symptoms of nonclassic CAH progress insidiously; the rapid onset and progression of virilization over 2 months suggest a different diagnosis.

Question 39

Serum testosterone and dehydroepiandrosterone sulfate (DHEA-S) concentrations are significantly elevated.

Answer 39

DHEA-S = Adrenal Tumor

Question 40

Capitation

Answer 40

regardless of the actual amount of health care utilized by the patient.

Capitation incentivizes health care providers to promote efficient use of health care resources (e.g., cost-effective preventive health care to avoid larger downstream costs) but also carries the risk that patients will be undertreated

Question 41

Fee-for-service

Answer 41

health care providers are compensated for each individual service provided

individual laboratory tests, imaging studies, procedures.

They are not paid a fixed amount, for each patient enrolled over a specific period of time, regardless of the amount of care provided

Question 42

Per diem payment

Answer 42

In a per diem payment model,
a health care organization is compensated
a fixed amount
per patient
per day for a specific care service provided

Question 43

levofloxacin in pregnancy

fluoroquinolones

Answer 43

contraindicated

teratogenic

Question 44

Pregnant + Ureaplasma

Answer 44

Macrolides
Azithromycin, non-estotate erythromycin

They are effective against bacteria without a cell wall such as Ureaplasma spp. (e.g., U. urealyticum) and Mycoplasma spp. and against bacteria with cell walls that are not primarily composed of peptidoglycans

Question 45

inhibit bacterial topoisomerase II and IV

Answer 45

Levofloxacin

Fluoroquinolones

Question 46

Antibiotic treatment of uncomplicated lower UTIs

Answer 46

First-line treatment
Nitrofurantoin for 5 days
Trimethoprim/sulfamethoxazole (TMP-SMX) for 3 days
Fosfomycin (single dose)

Second-line treatment: beta-lactam antibiotics for 5–7 days
Aminopenicillins plus beta-lactamase inhibitors, e.g., amoxicillin/clavulanic acid
Oral cephalosporins, e.g., cefpodoxime, cefdinir, or cefaclor

Alternatives: Consider fluoroquinolones, e.g., ciprofloxacin for 3 days for patients with previous infections with bacteria resistant to other drug classes.

Fluoroquinolones have been shown to be highly effective
but should be reserved for uses
other than uncomplicated cystitis whenever possible.

They carry a high risk of adverse effects and promote the proliferation of drug-resistant organisms.