COMQUEST material updated Flashcards
Initial test for diagnosing acromegaly
Insulin-like growth factor level (get an MRI)
Collection of blood beneath the periosteum of one of the calvarial bones; does not cross the suture lines
Cephalhematoma
Egg-on-a-string x-ray
Transposition of the great vessels
Benign tumors most commonly seen in women of reproductive age and are associated with contraceptive use, anabolic steroids, and glycogen storage disease
Hepatic adenomas (surgically remove if they are symptomatic, more than 5 cm, or do not regress after discontinuation of OCPs)
Mononeuritis multiplex and hepatitis B are associated with
Polyarteritis nodosa
Chest pain precipitated by hot or cold liquids without other obvious pathology is most likely the result of
diffuse esophageal spasm (use manometry to diagnose)
Classic triad of patent ductus arteriosus, deafness, and cataracts
Rubella (German measles)
Hypocellular marrow with loss of precursor cells, predominated by fat and stroma, is diagnostic of
aplastic anemia
Which labs should be checked prior to prescribing lithium?
BUN/Cr, thyroid function, and pregnancy
Most common causative agent of osteomyelitis
Staph aureus
Elevated methylmalonic acid and homocysteine
Vitamin B12 deficiency
Splitting of the basement membrane (tram-track appearance)
Membranoproliferative glomerulonephritis
Bead-like pattern on cholangiography; presents with pruritis and jaundice
Primary sclerosing cholangitis (associated with ulcerative colitis)
Boot-shaped heart
Tetralogy of Fallot
Low risk moms are advised to take how much folic acid before conception?
.4 mg (400 mcg)
Painful limp after a URI
transient synovitis
Cafe-au-lait spots, neurofibromas, freckling of the groin or the axilla, skeletal abnormalities, ad hamartomas of iris (Lisch nodules)
Neurofibromatosis type 1 (more common)
Always start lymphatic drainage techniques with
thoracic inlet release
Sacrum nutation and counternutation, while standing,occur about the
middle transverse axis
Defect in excretion of bilirubin and results in conjugated hyperbilirubinemia; liver has black pigmentation on biopsy
Dubin-Johnson syndrome
What is the most sensitive screening test for SLE?
ANA
Transient hyperthyroidism and thyroid tenderness followed by hypothyroidism
Subacute thyroiditis (de Quervain thyroiditis)
Positive blood culture for S. bovis along with features of infective endocarditis, you should suspect
colorectal cancer (order a scope)
Lateral and posterior margin of the IT band (Chapman’s point)
Prostate
Once the anterior fontanelle is closed, it is known as
bregma
Best test to assess iron deficiency
Ferritin
Once the posterior fontanelle is closed, it is known as
lambda
Hypogonadism plus impaired sense of smell equals
Kallmann syndrome
What leads to insulin resistance during pregnancy?
Human placental lactogen (chorionic somatomammotropin)
Hand, foot and mouth disease is most commonly caused by
Coxsackie A virus
Which type of stroke will result in contralateral motor and sensory deficit of the face, hand and arm?
Middle cerebral artery stroke
Gastric ulcers are more common in which blood type?
Type A
gAstric ulcers = type A
First-line vasopressor for sepsis
Norepinephrine
Decreased iron (Fe), decreased ferritin, increased TIBC
Iron deficiency anemia
The most common cause of SBO in adults in the US is
adhesions
The presence of a widened mediastinum on chest x-ray in patients who handle animal wool/hides/hair is a classic finding of
inhalational anthrax
Patients have a higher incidence of colon and multiple other cancers, especially endometrial cancer in women
Hereditary non-polyposis colorectal cancer (Lynch syndrome)..mutation of DNA mismatch repair genes. 3-2-1 rule: three affected family members, involving at least two generations, one or more cancer diagnosed before the age of 50
Hematochezia and narrow (pencil-thin) stool is usually indicative of
Left-sided colon cancer
Anytime a pt presents with a new onset murmur, what is the diagnostic modality of choice?
Echocardiogram
First-line tx to slow diabetic nephropathy
ACE inhibitors
Antimitochondrial antibodies are associated with
primary biliary cirrhosis
Pruritus associated with primary biliary cirrhosis (antimitochondrial antibodies) can be treated with
cholestyramine or colestipol
Tumor marker that is useful in the management of pancreatic cancer
CA 19-9
The inherent motion of the sacrum between the ilia as part of the primary respiratory mechanism happens on the
superior transverse axis (respiratory axis)
Tumors that arise at the confluence of the hepatic ducts
Klatskin tumors
Drugs of choice for absence seizures
Valproic acid or ethosuximide
Most common form of leukemia in children
Acute lymphoblastic leukemia (ALL) TdT+
Overdose associated with nystagmus
PCP
What is the most common infection leading to GBS?
Campylobacter jejuni
When the forearm pronates, the radial head moves
posterior
Patient’s limit for range of motion
Physiologic
Most specific test for myasthenia gravis
Acetylcholine receptor antibody test
Osteomyelitis in a patient with sickle cell disease is most likely due to
Salmonella
Most common cause of nephrotic syndrome in children
Minimal change disease (effacement of foot processes)
Seizures, mental retardation, ash-leaf spots (hypomelanotic macules), facial angiofibromas, and cutaneous nevi
Tuberous sclerosis
Treatment of choice for Shigella dysentery
Ciprofloxacin, azithromycin, or ceftriaxone
Essential tremor is best treated with
beta blockers
Smudge cells are a characteristic finding in
chronic lymphocytic leukemia
In a neutral group of segments, sidebending and rotation occur in
opposite directions
Leukocytosis after an infection with a lab finding of increased leukocyte alkaline phosphatase
Leukemoid reaction
Similar to Dubin-Johnson syndrome, resulting in conjugated hyperbilirubinemia, but the liver will not turn black
Rotor syndrome
Turner syndrome is treated with
human growth hormone and estrogen replacement therapy
Muscles involved with correction of a first rib dysfunction
Anterior and middle scalenes
Side effect associated with trazodone
Priapism
Most useful lab value to monitor heparin therapy
PTT
Best initial choice in workup of a breast mass in a woman < 30 years old or pregnant
Breast ultrasound
Most preferred test to diagnose renal cell carcinoma
CT with and without contrast
Patient presents with hundreds of thousands of adenomatous polyps in addition to osteomas, dental abnormalities, desmoid tumors, and cutaneous lesions
Gardner’s syndrome
Antidepressants associated with strong anticholinergic effects (dry mouth, drowsiness, nausea, constipation)
Tricyclic antidepressants
Multiple pigmented spots most often found on the lips, oral mucosas, and GI mucosa
Peutz-Jeghers syndrome
Most infantile hemangiomas require
observation
In dorsiflexion, the talus is
posterior
Zenker’s diverticulum is managed with
myotomy +/- diverticulectomy
First time PE should be treated with heparin followed by coumadin for
3-6 months
Causes ipsilateral hemiparesis, loss of proprioception and vibratory sense, as well as contralateral loss of pain and temp
Brown-Sequard syndrome
When endocarditis is suspected, the most important initial step is to
obtain three sets of blood cultures
Most common cause of meningitis from newborn to 3 months
GBS
Arousal by the clothing worn by the opposite sex
Transvestic fetishism
Most common inherited thrombophilia
Factor V Leiden
Injury of which nerve causes winging of the scapula?
Long thoracic nerve (serratus anterior)
Most common cardiac manifestation associated with Marfan’s syndrome
Mitral valve prolapse
Viscerosomatic reflex of the thyroid gland is between
T1-T4
Polycythemia vera leads to _______ erythropoeiten
decreased
Highest diagnostic sensitivity for the diagnosis of colorectal cancer
CEA (carcinoembryonic antigen)
Appropriate first-line tx for uterine relaxation for retained placenta
Nitroglycerin
The middle meningeal artery can be found just deep to
pterion
Most common type of testicular germ cell tumor
Seminomas (bhCG might be elevated)
First line tx for sideroblastic anemia with ringed sideroblasts
Pyridoxine (Vit B6)
Most common cause of meningitis from 3 months to 9 years
S. pneumoniae
Test of choice for suspected nephrolithiasis
Noncontrast CT
In plantarflexion, the talus is
anterior
Pruritic, purple, polygonal, papules/plaques
Lichen planus (look for Wickham striae)Most common: flexor surfaces of wrists/ankles
Which type of adenomas carry the highest risk of transformation to a malignant lesion?
Villous adenomas
RhoGAM is administered to all Rh-negative women at
28 weeks gestation
First line treatment for whooping cough
Macrolides (Azithromycin, erythromycin, clarithromycin)
Glucagonomas arise from pancreatic
alpha cells
MEN IIA
Medullary thyroid carcinoma, pheochromocytoma, parathyroid tumors/hyperplasia
Low calcium, low phosphate, elevated PTH
Secondary hyperparathyroidism due to Vitamin D deficiency
Occurs when the supratentorial brain herniates downward and compresses cranial nerve 3, resulting in an ipsilateral dilated pupil that cannot constrict to light
Uncal herniation
Preferred method of biopsy for a suspected melanoma
Excisional biopsy
Diagnostic test of choice for lactose intolerance
hydrogen breath test
Treatment of choice for acromegaly
Transsphenoidal surgical resection
Painless blistering of the dorsal surface of the hands with increased facial hair and hyperpigmentation
Porphyria cutanea tarda (does not present with abdominal pain)
Primary treatment for hydatidiform mole
D&C
Test of choice for patients with uncomplicated diverticulosis
Colonoscopy
ANA and anti-smooth muscle antibodies are positive; associated with SLE
Autoimmune hepatitis
Albinism is associated with loss of pigmentation secondary to
tyrosinase deficiency
CD4 count below 100, which prophylaxis should be started
Toxoplasma gondii (TMP-SMX)
Bilateral tremor (6-10 Hz) that improves with alcohol use
Essential tremor
What has been shown to reduce the morbidity and mortality of measles (rubeola)?
Vitamin A
What should be given with isoniazid to prevent deficiency?
Vitamin B6 (pyridoxine)
Muscle involved in a rib 2 dysfunction
Posterior scalene
Anticoagulation of choice in pregnancy
Subcutaneous heparin
Irregularly prolonged or heavy menstrual period that maintains a normal menstrual cycle
Menorrhagia
Most common cause of renal stenosis in young adults, especially women
Fibromuscular dysplasia
BLT with Mayo and a Kosher Pickle
Breast, Lung, Thyroid, Multiple myeloma, Kidney and Prostate (cancers with bone mets)
Treatment of choice for dermatitis herpetiformis
Dapsone
Most common organism associated with spontaneous bacterial peritonitis
E. coli
An inflammatory vasculitis characterized by claudication from vaso-occlusion; known as thromboangiitis obliterans; smoking is strongest risk factor
Buerger disease
Characterized by menorrhagia and dysmenorrhea; physical exam will reveal and enlarged and soft uterus
Adenomyosis (ectopic endometrial glands)
Patients at risk for tumor lysis syndrome should receive prophylaxis with
allopurinol or rasburicase
Defect in the pars interarticularis; radiography may reveal a scotty dog “collar”
Spondylolysis
Word substitutions, meaningless words, meaningless phrases (poor comprehension, “word salad”).
Wernicke’s aphasia (receptive)
First trimester hyperthyroidism is treat with
propylthiouracil
CD4 count below 50, which prophylaxis should be started?
Mycobacterium avium complex (azithromycin)
What is often the first manifestation of asbestosis?
Decreased DLCO (carbon monoxide diffusing capacity)
Doxorubicin is associated with
dilated cariomyopathy
Muscle involved in rib 12 dysfunction
Quadratus lumborum
NNT formula
1/absolute risk reduction
Most sensitive test for pancreatic cancer
CT scan
Numbness and tingling at the fifth finger and ulnar half of the fourth finger is associated with
Cubital tunnel syndrome
Trigeminal neuralgia can be treated with
carbamazepine or oxcarbazepine
The most specific test for CREST syndrome is
anti-centromere antibody
The most common cardiac abnormality associated with Turner syndrome is
bicuspid aortic valve
Granular casts (muddy brown casts) and renal tubular casts
Acute tubular necrosis
Most common location for compartment syndrome
Anterior compartment
Patients with family history of familial adenomatous polyposis should undergo annual flexible sigmoidoscopy or colonoscopy starting at
puberty
Treatment of choice for endometriosis
NSAIDs and OCPs
Major risk factor for placenta accreta
Previous c-section
Isoniazid can deplete vitamin ____ so supplementation is necessary
B6
Nephritic syndrome, low C3 levels; biopsy reveals IgG and C3 in a granular pattern
Postinfectious glomerulonephritis
Most common cause of nephrotic syndrome in patients with HIV, IV drug abuse and sickle cell
Focal segmental glomerulosclerosis
Trinucleotide repeat (CGG) on FMR1 gene
Fragile X syndrome
Treatment of choice for von Willebrand disease
Desmopressin (DDAVP)
What class of anti-hypertensives can be used for osteoporosis or kidney stones?
Thiazide diuretics (reduced calcium excretion in the urine)
Low risk patients with a solitary lung nodule should be followed with
serial chest CTs for two years
Pancreatic cancer is most often located in the
pancreatic head
Deletion of paternal 15q11-12
Prader-Willi syndrome
(diminished fetal activity, obesity, hypotonia, mental retardation, short stature, hypogonadotropic hypogonadism, strabismus, and small hands and feet)
Akathisia is treated with
beta blockers, benzodiazepines, and benztropine
A 6-year-old child is diagnosed with pheochromocytoma and clear cell renal cell carcinoma. Testing reveals a heritable disorder
von Hippel-Lindau syndrome
Antibodies directed against presynaptic calcium channels; better with activity
Lambert-Eaton syndrome
Initial treatment for ulcerative colitis
5-ASA/mesalamine or sulfasalazine
Cornerstone of preventing contrast induced nephropathy
Vigorous hydration
What is the most common cause of gastric and duodenal ulcers?
H. pylori
For an acute cluster headache, what is the first line tx?
100% oxygen
Muscle involved in ribs 6-9 dysfunction
Serratus anterior
Occurs when patients are overtreated with NPH and 3am glucose measurement reveals hypoglycemia; patients will be hyperglycemic in the morning
Somogyi effect
Increased level of insulin and decreased C-peptide and proinsulin levels
Factitious hypoglycemia
Smudge cells and the CD5 protein
Chronic lymphocytic leukemia
Neurologic deficits and upper arm claudication with exercise of the upper extremity
Subclavian steal syndrome
Erythema multiforme minor is most commonly associated with
herpes simplex virus (target-like lesions)
Sarcoidosis causes what type of pattern on spirometry?
Restrictive (FEV1/FVC normal or elevated). Look for hypercalcemia and an elevated ACE level
Microcytic anemia, pica, koilonuchia (spoon shaped nails) and esophageal webs
Plummer-Vinson syndrome
Respiratory and craniosacral motion
Superior transverse axis
Contralateral motor and sensory deficit in the leg is associated with which artery?
Anterior cerebral artery
Roseola infantum (sixth disease) is caused by
HHV-6 (fever for 2-5 days followed by a maculopapular rash)
Response to treatment of osteomyelitis is monitored with
ESR and CRP
Presents with hematuria following a viral illness and biopsy will show IgA and C3 deposits
IgA nephropathy (Berger’s disease)
Low dose CT of the chest is recommended for lung cancer screening for
55 to 80 years old; 30 pack year hx who are still smoking or whom have quit in the past 15 years
Bilat weakness; loss of pain and temp in a cape-like distribution
Syringomyelia
CD4 count below 200, which prophylaxis should be started?
Pneumocystis jiroveci (TMP-SMX)
Maculopapular rash that starts on the face and spreads caudally; arthralgias; suboccipital and postauricular lymphadenopathy
Rubella (Togavirus)
Postural motion
Middle transverse axis
Epidural hematomas are caused by rupture of the
middle meningeal artery
Possible findings on a chest x-ray in a patient with PE
Westermark sign or a Hampton hump
Treatment for toxoplasmosis
Pyrimethamine and sulfadiazine
Lupus immunoglobulins
anti-dsDNA, anti-Smith
Reflux in a baby is very commonly due to vagal irritation secondary to congestion from
occipital condylar compression
Most common infection causing aplastic crisis in patients with sickle cell disease
Parvovirus B19 (tx aplastic crisis with blood transfusion)
During craniofacialsacral flexion, the sacrum
counternutates (extends)
Duodenal ulcers are more common in which blood type?
Type O
duOdenal ulcers = type O
Polyarteritis nodose related to hep B should be treated with
interferon alpha-2b
Most common hereditary cause of colon cancer
Lynch syndrome
Most specific test for pancreatic cancer
ERCP
Defects in type III collagen are associated with
Ehlers-Danlos syndrome (joint hypermobility and cutaneous fragility and hyperelasticity)
Used to slow the progression of disease in ALS
Riluzole
Number needed to harm equation
1/attributable risk
Lyme disease is caused by
Borrelia burgdorferi (Ixodes tick)
Necrolytic migratory erythema is associated with
glucagonoma
Autoantibodies directed against the postsynaptic acetylcholine receptors; worsens with activity
Myasthenia gravis
First-line tx of diabetic gastroparesis
metoclopramide or erythromycin
Most common cause of acute pancreatitis
Gallstones
Most common risk factor for dementia
Age
Patients develop significant anxiety about development of a serious physical illness in response to minor or no symptoms
Illness anxiety disorder
Measles (rubeola) is caused by
Paramyxovirus (conjunctivitis, cough and coryza; Koplik spots)
Anti-glomerular basement membrane (anti-GBM) antibodies and ANCA are indicative of
Goodpasture syndrome
Caused by tertiary syphilis; decreased reflexes, unsteady gait, formication, and impaired proprioception
Tabes dorsalis
Skin condition associated with celiac disease
Dermatitis herpetiformis (IgA and gliadin protein combine)
Treatment of choice for diffuse esophageal spasm
Calcium channel blockers (e.g., diltiazem)
Reveal blasts from myeloid lineage and be positive for reactions with myeloperoxidase and sudan black
Acute myelogenous leukemia
Target organ resistance to PTH
Pseudohypoparathyroidism (low Ca, elevated phosphate, elevated PTH)
Primary adrenal insufficiency requires replacement of
both mineralocorticoid and glucocorticoid (hydrocortisone)
Innominate rotation
Inferior transverse axis
Caused by growth hormone secretion in the morning; 2 am glucose measurement will reveal hyperglycemia
Dawn phenomenon
Decreased iron (Fe), increased ferritin, decreased TIBC
Anemia of chronic (inflammatory) disease
Primary hyperparathyroidism is most commonly caused by
adenoma (look for serum PTH and calcium levels to be elevated; phosphorous will be decreased)
Best diagnostic test for C. difficile colitis
Detecting toxin A or B in the stool
MEN I
Pituitary tumor, Pancreatic tumor, Parathyroid tumors
Familial adenomatous polyposis and CNS malignancy
Turcot’s syndrome
Muscle involved in ribs 10&11 dysfunction
Latissimus dorsi
Haptoglobin is ________ in hemolysis
decreased
Used to monitor the response of ovarian cancer to treatment
CA-125
Most common type of breech presentation
Frank breech
Vertigo, tinnitus and hearing loss
Meniere’s disease
High risk moms are advised to take how much folic acid before conception?
4 mg
Associated with newborns whom are delivered via C-section
Transient tachypnea of the newborn
Decreased FEV1, decreased FEV1/FVC, decreased vital capacity, decreased peak expiratory flow rate, increased residual volume, and increased total lung capacity
Obstructive pulmonary disease
Personality disorders are classified into three clustersL
Cluster A (weird), Cluster B (wild), Cluster C (worried)
Most common sequelae of meningitis is
hearing loss
Most common type of cutaneous T-cell lymphoma
Mycosis fungoides
Which type of colon cancer typically presents with melena and occult blood in the stool leading to iron deficiency anemia?
Right-sided tumors
Adenomatous polyps plus osteomas, lipomas, fibromas, cysts and dental abnormalities
Gardner’s syndrome
Gold standard for the diagnosis of endometriosis
Laparoscopy
Few words, difficulty producing words (non-fluent); good comprehension; loss of oral coordination
Broca (expressive)
Allergic rhinitis, asthma, blood eosinophilia and positive p-ANCA
Churg-Strauss Syndrome
Confirm intussusception with
ultrasound (bulls-eye sign)
Most of the edema is located over the occipital bones and crosses over the suture lines to involve portions of the parietal bones bilaterally
Caput succedaneum
If the dipstick shows blood but no RBC’s, than _______is most likely
hemolysis
Findings in infective endocarditis can be remembered by FROM JANE
- Fever
- Roth spots
- Osler nodes
- Murmur
- Janeway lesions
- Anemia
- Nail hemorrhages
- Emboli
Most common causes of acute interstitial nephritis (AIN)
Penicillins and NSAIDs
While rheumatic heart disease can involve any heart valve, what is the most common outcome?
Mitral stenosis
Caused by decreased activity of hepatic UGT; unconjugated hyperbilirubinemia is typically the only finding
Gilbert’s syndrome
